Upload
others
View
20
Download
0
Embed Size (px)
Citation preview
1
Formulary
(04/01/2019)
INTRODUCTION We are pleased to provide the 2019 UM Health Partners (UMHP) Formulary as a useful reference and informational tool. This document can assist medical providers in selecting clinically-appropriate and cost-effective products for their patients.
The document is reflective of current medical practice as of the date on which UMHP completed its standard review.
The information contained in this document and its appendices is provided solely for the convenience of medical providers. We do not warrant or assure accuracy of such information nor is it intended to be comprehensive in nature. This document is not intended to be a substitute for the knowledge, expertise, skill and judgment of the medical provider in his or her choice of prescription drugs. All the information in the document is provided as a reference for drug therapy selection. Specific drug selection for an individual patient rests solely with the prescriber.
The document is subject to state-specific regulations and rules, including, but not limited to, those regarding generic substitution, controlled substance schedules, preference for brands and mandatory generics whenever applicable.
We assume no responsibility for the actions or omissions of any medical provider based upon reliance, in whole or in part, on the information contained herein. The medical provider should consult the drug manufacturer's product literature or standard references for more detailed information.
PREFACE The document is organized by sections. Each section is divided by therapeutic drug class primarily defined by mechanism of action. Drugs represented in this document may have varying cost to the plan member based on the plan's benefit structure. Generic medications typically are available at the lower cost, brand-name medications on the document will generally cost more than generics. Generics should be considered the first line of prescribing subject to applicable rules.
PHARMACY AND THERAPEUTICS (P&T) COMMITTEE The services of an independent National Pharmacy and Therapeutics Committee ("P&T Committee") are utilized to determine the safety and clinical effectiveness of drug therapies. The P&T Committee is an external advisory body of clinical professionals from across the United States. Voting members of the P&T Committee must disclose any financial relationship or conflicts of interest with any pharmaceutical manufacturers.
GENERIC SUBSTITUTION Generic substitution is a pharmacy action whereby a generic version is dispensed rather than a prescribed brand-name product. Lower case type indicates generic availability. In most instances, a brand-name drug for which a generic product becomes available will become non-formulary, with the generic product covered in its place, upon release of the generic product to the market. However, the document is subject to state specific regulations and rules regarding generic substitution and mandatory generic rules apply where appropriate.
Generic drugs are usually priced lower than their brand-name equivalents. Prescription generic drugs are:
• Approved by the U.S. Food and Drug Administration for safety and effectiveness, and are manufactured under the same strict standards that apply to brand-name drugs.
• Tested in humans to assure the generic is absorbed into the bloodstream in a similar rate and extent compared to the brand-name drug (bioequivalence). Generics may be different from the brand in size, color and inactive ingredients, but this does not alter their effectiveness or ability to be absorbed just like the brand-name drug.
2
• Manufactured in the same strength and dosage form as the brand-name drugs.
When a generic drug is substituted for a brand-name drug, you can expect the generic to produce the same clinical effect and safety profile as the brand-name drug (therapeutic equivalence).
SPECIALTY PLAN DESIGN Specialty Guideline Management (SGM)
SGM is our utilization management program that helps ensure appropriate utilization for specialty medication based on currently accepted evidence-based medicine guidelines. The utilization management program is available for all therapeutic areas dispensed by our specialty pharmacies. SGM is designed to help ensure safety and efficacy while preventing off-guideline utilization. Medications which may be included in the SGM program are identified in the document as “SP” for your reference.
PLAN DESIGN The document represents a closed formulary plan design. The medications listed on the document are covered by the plan as represented. Certain medications on the list are covered if utilization management criteria are met (i.e., Step Therapy, Prior Authorization, Quantity Limits, etc.); requests for use of such medications outside of their listed criteria will be reviewed for medical necessity. If a medication is not listed on the document, a formulary exception may be requested for coverage. Medical necessity or formulary exception requests will be reviewed based on drug-specific prior authorization criteria or standard non- formulary prescription request criteria. Log in to www.umhealthpartners.com to check coverage.
AUTHORIZATIONS Authorization requests for both FORMULARY and NON-FORMULARY products requiring either a PA (Prior Authorization), QL (Quantity Limit), ST (Step Therapy) or medical necessity review - contact CVS Caremark® at: 1-877-418-4133.
Authorization requests for specific MENTAL HEALTH/HIV products - contact MDH - Maryland Department of Health at: 1-800- 932-3918 (Anti-Psychotic Peer Review Line for children 0-9 years old: 1-855-283-0876).
OPIOIDS The quantity of opioid products prescribed (including those that are combined with acetaminophen, aspirin or ibuprofen) will be limited to up to 90 morphine milligram equivalents (MME) per day based on a 30-day supply. Prescriptions that exceed 90 MME daily limits will be subject to UM criteria, such as prior authorization. Members who are opioid-naïve may be subject to additional step therapy requirements (use of an immediate-release (IR) formulation will be required before moving to an extended-release (ER) formulation) and quantity limit restrictions (first fill will be limited to seven days).
NOTICE The information contained in this document is proprietary. The information may not be copied in whole or in part without written permission. ©2019. All rights reserved. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers. Plan member privacy is important to us. Our employees are trained regarding the appropriate way to handle members' private health information.
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 3 AGE - Age Limit GNDR - Gender Edit
Drug Name Requirements/Limits PENICILLINS
NATURAL PENICILLINS BICILLIN L-A INJ 600000 BICILLIN L-A INJ 1200000 BICILLIN L-A INJ 2400000 penicillin v potassium tab 250 mg penicillin v potassium tab 500 mg penicillin v potassium for soln 125 mg/5ml penicillin v potassium for soln 250 mg/5ml
AMINOPENICILLINS amoxicillin (trihydrate) cap 250 mg amoxicillin (trihydrate) cap 500 mg amoxicillin (trihydrate) tab 500 mg amoxicillin (trihydrate) tab 875 mg amoxicillin (trihydrate) chew tab 125 mg amoxicillin (trihydrate) chew tab 250 mg amoxicillin (trihydrate) for susp 125 mg/5ml amoxicillin (trihydrate) for susp 200 mg/5ml amoxicillin (trihydrate) for susp 250 mg/5ml amoxicillin (trihydrate) for susp 400 mg/5ml AMOXICILLIN POW TRIHYDRA ampicillin cap 500 mg
PENICILLINASE-RESISTANT PENICILLINS dicloxacillin sodium cap 250 mg dicloxacillin sodium cap 500 mg
PENICILLIN COMBINATIONS amoxicillin & k clavulanate tab 250-125 mg amoxicillin & k clavulanate tab 500-125 mg amoxicillin & k clavulanate tab 875-125 mg amoxicillin & k clavulanate chew tab 200-28.5 mg amoxicillin & k clavulanate chew tab 400-57 mg AUGMENTIN SUS 125/5ML amoxicillin & k clavulanate for susp 200-28.5
mg/5ml amoxicillin & k clavulanate for susp 250-62.5
mg/5ml amoxicillin & k clavulanate for susp 400-57
mg/5ml amoxicillin & k clavulanate for susp 600-42.9
mg/5ml
CEPHALOSPORINS CEPHALOSPORINS - 1ST GENERATION
cefadroxil cap 500 mg cefadroxil tab 1 gm
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 4 AGE - Age Limit GNDR - Gender Edit
Drug Name Requirements/Limits cefadroxil for susp 250 mg/5ml
cefadroxil for susp 500 mg/5ml cephalexin cap 250 mg cephalexin cap 500 mg cephalexin cap 750 mg cephalexin tab 250 mg cephalexin tab 500 mg cephalexin for susp 125 mg/5ml cephalexin for susp 250 mg/5ml
CEPHALOSPORINS - 2ND GENERATION cefprozil tab 250 mg cefprozil tab 500 mg cefprozil for susp 125 mg/5ml
cefprozil for susp 250 mg/5ml cefuroxime axetil tab 250 mg cefuroxime axetil tab 500 mg
CEPHALOSPORINS - 3RD GENERATION cefdinir cap 300 mg cefdinir for susp 125 mg/5ml
cefdinir for susp 250 mg/5ml ceftriaxone sodium for inj 250 mg ceftriaxone sodium for inj 500 mg ceftriaxone sodium for inj 1 gm ceftriaxone sodium for inj 2 gm
CEPHALOSPORIN COMBINATIONS ZERBAXA INJ 1.5GM PA
MACROLIDES ERYTHROMYCINS
erythromycin tab 250 mg erythromycin tab 500 mg ERYTHROMYCIN POW erythromycin w/ delayed release particles cap 250 mg erythrocin tab 250mg
e.e.s. 400 tab 400mg
erythromycin ethylsuccinate tab 400 mg
erythromycin ethylsuccinate for susp 200 mg/5ml ERYTHROMYCIN POW ETHYLSUC
AZITHROMYCIN azithromycin tab 250 mg azithromycin tab 500 mg azithromycin tab 600 mg azithromycin for susp 100 mg/5ml
azithromycin for susp 200 mg/5ml
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 5 AGE - Age Limit GNDR - Gender Edit
azithromycin powd pack for susp 1 gm
CLARITHROMYCIN clarithromycin tab 250 mg clarithromycin tab 500 mg clarithromycin for susp 125 mg/5ml clarithromycin for susp 250 mg/5ml clarithromycin tab er 24hr 500 mg
TETRACYCLINES TETRACYCLINES
doxycycline monohydrate for susp 25 mg/5ml doxycycline hyclate cap 50 mg morgidox cap 1x50mg doxycycline hyclate cap 100 mg morgidox cap 1x100mg morgidox cap 2x100mg doxycycline hyclate tab 20 mg doxycycline hyclate tab 100 mg DOXYCYCLINE POW HYCLATE minocycline hcl cap 50 mg
minocycline hcl cap 75 mg minocycline hcl cap 100 mg MINOCYCLINE POW OXYTETRACYC POW HCL tetracycline hcl cap 250 mg
tetracycline hcl cap 500 mg
FLUOROQUINOLONES FLUOROQUINOLONES
ciprofloxacin-ciprofloxacin hcl tab er 24hr 500 mg (base eq) ciprofloxacin-ciprofloxacin hcl tab er 24hr 1000
mg(base eq) ciprofloxacin hcl tab 100 mg (base equiv)
ciprofloxacin hcl tab 250 mg (base equiv) ciprofloxacin hcl tab 500 mg (base equiv) ciprofloxacin hcl tab 750 mg (base equiv) levofloxacin tab 250 mg levofloxacin tab 500 mg
levofloxacin tab 750 mg levofloxacin oral soln 25 mg/ml
AMINOGLYCOSIDES AMINOGLYCOSIDES
AMIKACIN POW SULFATE neomycin sulfate tab 500 mg
STREPTOMYCIN POW SULFATE
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 6 AGE - Age Limit GNDR - Gender Edit
tobramycin nebu soln 300 mg/5ml SP, QL (10 each / 1 day),
PA tobramycin nebu soln 300 mg/5ml SP, QL (10 mL / 1 day), PA
BETHKIS NEB 300/4ML SP, QL (8 each / 1 day), PA
TOBRAMYCIN POW SULFATE
SULFONAMIDES SULFONAMIDES
SULFADIAZINE TAB 500MG SULFADIAZINE POW SULFADIAZINE POW SODIUM SULFAMETHOX POW SULFAMETHOX POW MICRO SULFAPYRIDIN POW SULFISOXIZOL CRY SULFATHIAZOL POW
ANTIMYCOBACTERIAL AGENTS ANTIMYCOBACTERIAL AGENTS
AMINOSAL ACD POW -4 ethambutol hcl tab 100 mg
ethambutol hcl tab 400 mg ETHAMBUTOL POW HCL isoniazid tab 100 mg
isoniazid tab 300 mg isoniazid syrup 50 mg/5ml ISONIAZID POW pyrazinamide tab 500 mg
rifabutin cap 150 mg rifampin cap 150 mg rifampin cap 300 mg
ANTIFUNGALS ANTIFUNGALS
griseofulvin microsize susp 125 mg/5ml griseofulvin ultramicrosize tab 125 mg griseofulvin ultramicrosize tab 250 mg nystatin tab 500000 unit bio-statin pow
terbinafine hcl tab 250 mg QL (90 tabs / year)
IMIDAZOLE-RELATED ANTIFUNGALS MICONAZOLE POW fluconazole tab 50 mg
fluconazole tab 100 mg fluconazole tab 150 mg fluconazole tab 200 mg fluconazole for susp 10 mg/ml
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 7 AGE - Age Limit GNDR - Gender Edit
fluconazole for susp 40 mg/ml
itraconazole cap 100 mg QL (4 caps / 1 day), PA
voriconazole tab 50 mg PA
voriconazole tab 200 mg PA
voriconazole for susp 40 mg/ml PA
ANTIVIRALS CMV AGENTS
valganciclovir hcl tab 450 mg (base equivalent) valganciclovir hcl for soln 50 mg/ml (base equiv)
HEPATITIS AGENTS adefovir dipivoxil tab 10 mg entecavir tab 0.5 mg entecavir tab 1 mg BARACLUDE SOL .05MG/ML lamivudine tab 100 mg (hbv)
EPIVIR HBV SOL 5MG/ML VEMLIDY TAB 25MG PEGASYS INJ 180MCG/M SP, PA PEGASYS INJ SP, PA
PEGASYS INJ PROCLICK SP, PA
ribasphere cap 200mg SP, PA
ribavirin cap 200 mg SP, PA
moderiba tab 200mg SP, PA
ribasphere tab 200mg SP, PA
ribavirin tab 200 mg SP, PA
ribasphere tab 600mg SP, PA
REBETOL SOL 40MG/ML SP, PA
SOVALDI TAB 400MG SP, QL (1 tab / 1 day), PA
ZEPATIER TAB 50-100MG SP, QL (1 tab / 1 day), PA
HARVONI TAB 90-400MG SP, QL (1 tab / 1 day), PA
ledip-sofosb tab 90-400mg SP, QL (1 tab / 1 day), PA
VIEKIRA PAK TAB SP, QL (4 tabs / 1 day), PA
HERPES AGENTS acyclovir cap 200 mg acyclovir tab 400 mg acyclovir tab 800 mg acyclovir susp 200 mg/5ml valacyclovir hcl tab 500 mg valacyclovir hcl tab 1 gm famciclovir tab 125 mg famciclovir tab 250 mg famciclovir tab 500 mg
INFLUENZA AGENTS
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 8 AGE - Age Limit GNDR - Gender Edit
oseltamivir phosphate cap 30 mg (base equiv) QL (28 caps / 180 days)
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 8 AGE - Age Limit GNDR - Gender Edit
oseltamivir phosphate cap 45 mg (base equiv) QL (14 caps / 180 days)
oseltamivir phosphate cap 75 mg (base equiv) QL (14 caps / 180 days)
oseltamivir phosphate for susp 6 mg/ml (base QL (180 mL / 180 days) equiv)
ANTIMALARIALS ANTIMALARIALS
chloroquine phosphate tab 250 mg QL (8 tabs / 180 days) chloroquine phosphate tab 500 mg QL (8 tabs / 180 days)
CHLOROQUINE POW PHOSPHAT hydroxychloroquine sulfate tab 200 mg mefloquine hcl tab 250 mg QL (8 each / 180 days)
mefloquine hcl tab 250 mg QL (8 tabs / 180 days)
QUININE POW SULFATE QUININE SULF POW DIHYDRAT
ANTIMALARIAL COMBINATIONS atovaquone-proguanil hcl tab 62.5-25 mg QL (23 tabs / 180 days) atovaquone-proguanil hcl tab 250-100 mg QL (23 tabs / 180 days)
ANTHELMINTICS ANTHELMINTICS
ivermectin tab 3 mg EMVERM CHW 100MG QL (12 tabs / year)
MEBENDAZOLE POW PIPERAZINE POW PINWORM TAB MEDICINE OTC
cvs pinworm sus 50mg/ml OTC
pinworm med sus 144mg/ml OTC
REESES MED SUS PINWORM OTC
THIABENDAZOL POW ANTI-INFECTIVE AGENTS - MISC.
ANTI-INFECTIVE AGENTS - MISC. metronidazole cap 375 mg metronidazole tab 250 mg metronidazole tab 500 mg XIFAXAN TAB 550MG ST trimethoprim tab 100 mg
TRIMETHOPRIM POW
POLYMYXINS POLYMYXIN B POW SULFATE
LINCOSAMIDES clindamycin hcl cap 150 mg clindamycin hcl cap 300 mg clindamycin palmitate hcl for soln 75 mg/5ml
(base equiv)
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 9 AGE - Age Limit GNDR - Gender Edit
OXAZOLIDINONES linezolid tab 600 mg PA linezolid for susp 100 mg/5ml PA
ZYVOX SOL 2MG/ML PA
linezolid iv soln 600 mg/300ml (2 mg/ml) PA
linezolid in sodium chloride iv soln 600 PA
mg/300ml-0.9%
GLYCOPEPTIDES vancomycin hcl cap 125 mg (base equivalent) ST vancomycin hcl cap 250 mg (base equivalent) ST FIRST-VANC SOL 25MG/ML FIRST-VANC SOL 50MG/ML
LEPROSTATICS dapsone tab 25 mg dapsone tab 100 mg
ANTIPROTOZOAL AGENTS
atovaquone susp 750 mg/5ml
ANTI-INFECTIVE MISC. - COMBINATIONS sulfamethoxazole-trimethoprim tab 400-80 mg sulfamethoxazole-trimethoprim tab 800-160 mg sulfamethoxazole-trimethoprim susp 200-40 mg/5ml sulfatrim pd sus 200-40/5
TOXOIDS TOXOID COMBINATIONS
BOOSTRIX INJ
PASSIVE IMMUNIZING AND TREATMENT AGENTS MONOCLONAL ANTIBODIES
SYNAGIS INJ 50MG SP, PA SYNAGIS INJ 100MG/ML SP, PA
ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES ALKYLATING AGENTS
MYLERAN TAB 2MG LEUKERAN TAB 2MG cyclophosphamide cap 25 mg
cyclophosphamide cap 50 mg melphalan tab 2 mg GLEOSTINE CAP 10MG GLEOSTINE CAP 40MG GLEOSTINE CAP 100MG temozolomide cap 5 mg SP, PA
temozolomide cap 20 mg SP, PA
temozolomide cap 100 mg SP, PA
temozolomide cap 140 mg SP, PA
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 10 AGE - Age Limit GNDR - Gender Edit
temozolomide cap 180 mg SP, PA
temozolomide cap 250 mg SP, PA
ANTIMETABOLITES capecitabine tab 150 mg SP, QL (4 tabs / 1 day), PA capecitabine tab 500 mg SP, QL (10 each / 1 day),
PA capecitabine tab 500 mg SP, QL (10 tabs / 1 day), PA
mercaptopurine tab 50 mg
methotrexate sodium tab 2.5 mg (base equiv)
TREXALL TAB 5MG
TREXALL TAB 7.5MG TREXALL TAB 10MG TREXALL TAB 15MG
ANTINEOPLASTIC - HEDGEHOG PATHWAY INHIBITORS
ERIVEDGE CAP 150MG SP, QL (1 cap / 1 day), PA ANTINEOPLASTIC - HORMONAL AND RELATED AGENTS
LYSODREN TAB 500MG bicalutamide tab 50 mg
flutamide cap 125 mg tamoxifen citrate tab 10 mg (base equivalent) tamoxifen citrate tab 20 mg (base equivalent) toremifene citrate tab 60 mg (base equivalent) anastrozole tab 1 mg exemestane tab 25 mg letrozole tab 2.5 mg FASLODEX INJ 250/5ML megestrol acetate tab 20 mg megestrol acetate tab 40 mg megestrol acetate susp 40 mg/ml leuprolide acetate inj kit 5 mg/ml SP, PA ELIGARD INJ 7.5MG SP, PA
ELIGARD INJ 22.5MG SP, PA
ELIGARD INJ 30MG SP, PA
ELIGARD INJ 45MG SP, PA
abiraterone acetate tab 250 mg SP, QL (4 tabs / 1 day), PA
ZYTIGA TAB 500MG SP, QL (2 tabs / 1 day), PA
ANTINEOPLASTIC - BCL-2 INHIBITORS VENCLEXTA TAB 10MG SP, PA VENCLEXTA TAB 50MG SP, PA
VENCLEXTA TAB 100MG SP, PA
VENCLEXTA TAB START PK SP, PA
MITOTIC INHIBITORS etoposide cap 50 mg
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 11 AGE - Age Limit GNDR - Gender Edit
ANTINEOPLASTIC ENZYME INHIBITORS IBRANCE CAP 75MG SP, QL (1 cap / 1 day), PA IBRANCE CAP 100MG SP, QL (1 cap / 1 day), PA
IBRANCE CAP 125MG SP, QL (1 cap / 1 day), PA
FARYDAK CAP 10MG SP, PA
FARYDAK CAP 15MG SP, PA
FARYDAK CAP 20MG SP, PA
ISTODAX OVR INJ 10MG SP, PA
ROMIDEPSIN INJ 10MG SP, PA
ZOLINZA CAP 100MG SP, QL (4 caps / 1 day), PA
TAFINLAR CAP 50MG SP, QL (4 caps / 1 day), PA
TAFINLAR CAP 75MG SP, QL (4 caps / 1 day), PA
ZELBORAF TAB 240MG SP, QL (8 tabs / 1 day), PA
AFINITOR TAB 2.5MG SP, QL (1 tab / 1 day), PA
AFINITOR TAB 5MG SP, QL (1 tab / 1 day), PA
AFINITOR TAB 7.5MG SP, QL (1 tab / 1 day), PA
AFINITOR TAB 10MG SP, QL (1 tab / 1 day), PA
RYDAPT CAP 25MG SP, QL (8 caps / 1 day), PA
STIVARGA TAB 40MG SP, QL (3 tabs / 1 day), PA
NEXAVAR TAB 200MG SP, QL (4 tabs / 1 day), PA
SUTENT CAP 12.5MG SP, QL (1 cap / 1 day), PA
SUTENT CAP 25MG SP, QL (1 cap / 1 day), PA
SUTENT CAP 37.5MG SP, QL (1 cap / 1 day), PA
SUTENT CAP 50MG SP, QL (1 cap / 1 day), PA
MEKINIST TAB 0.5MG SP, QL (3 tabs / 1 day), PA
MEKINIST TAB 2MG SP, QL (1 tab / 1 day), PA
GILOTRIF TAB 20MG SP, QL (1 tab / 1 day), PA
GILOTRIF TAB 30MG SP, QL (1 tab / 1 day), PA
GILOTRIF TAB 40MG SP, QL (1 tab / 1 day), PA
INLYTA TAB 1MG SP, QL (6 tabs / 1 day), PA
INLYTA TAB 5MG SP, QL (4 tabs / 1 day), PA
CABOMETYX TAB 20MG SP, QL (30 tabs / 25 days),
PA CABOMETYX TAB 40MG SP, QL (30 tabs / 25 days),
PA CABOMETYX TAB 60MG SP, QL (30 tabs / 25 days),
PA COMETRIQ KIT 60MG SP, QL (3 caps / 1 day), PA
COMETRIQ KIT 100MG SP, QL (2 caps / 1 day), PA
COMETRIQ KIT 140MG SP, QL (4 caps / 1 day), PA
ZYKADIA CAP 150MG SP, QL (3 caps / 1 day), PA
TARCEVA TAB 25MG SP, QL (2 tabs / 1 day), PA
TARCEVA TAB 100MG SP, QL (1 tab / 1 day), PA
TARCEVA TAB 150MG SP, QL (1 tab / 1 day), PA
IMBRUVICA CAP 140MG SP, QL (3 caps / 1 day), PA
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 12 AGE - Age Limit GNDR - Gender Edit
imatinib mesylate tab 100 mg (base equivalent) SP, QL (3 each / 1 day), PA
imatinib mesylate tab 100 mg (base equivalent) SP, QL (3 tabs / 1 day), PA imatinib mesylate tab 400 mg (base equivalent) SP, QL (2 each / 1 day), PA imatinib mesylate tab 400 mg (base equivalent) SP, QL (2 tabs / 1 day), PA TYKERB TAB 250MG SP, QL (6 tabs / 1 day), PA LENVIMA CAP 4MG SP, QL (1 cap / 1 day), PA
LENVIMA CAP 4MG SP, QL (1 ea / 1 day), PA
LENVIMA CAP 8 MG SP, QL (2 caps / 1 day), PA
LENVIMA CAP 8 MG SP, QL (2 ea / 1 day), PA
LENVIMA CAP 10 MG SP, QL (1 cap / 1 day), PA
LENVIMA CAP 10 MG SP, QL (1 ea / 1 day), PA
LENVIMA CAP 12MG SP, QL (3 caps / 1 day), PA
LENVIMA CAP 12MG SP, QL (3 ea / 1 day), PA
LENVIMA CAP 20 MG SP, QL (2 caps / 1 day), PA
LENVIMA CAP 20 MG SP, QL (2 ea / 1 day), PA
LENVIMA CAP 14 MG SP, QL (2 caps / 1 day), PA
LENVIMA CAP 14 MG SP, QL (2 ea / 1 day), PA
LENVIMA CAP 18 MG SP, QL (3 caps / 1 day), PA
LENVIMA CAP 18 MG SP, QL (3 ea / 1 day), PA
LENVIMA CAP 24 MG SP, QL (3 caps / 1 day), PA
LENVIMA CAP 24 MG SP, QL (3 ea / 1 day), PA
VOTRIENT TAB 200MG SP, QL (4 tabs / 1 day), PA
CAPRELSA TAB 100MG SP, QL (2 tabs / 1 day), PA
CAPRELSA TAB 300MG SP, QL (1 tab / 1 day), PA
ZEJULA CAP 100MG SP, QL (3 caps / 1 day), PA
RUBRACA TAB 200MG SP, QL (4 tabs / 1 day), PA
RUBRACA TAB 250MG SP, QL (4 tabs / 1 day), PA
RUBRACA TAB 300MG SP, QL (4 tabs / 1 day), PA
JAKAFI TAB 5MG SP, QL (2 tabs / 1 day), PA
JAKAFI TAB 10MG SP, QL (2 tabs / 1 day), PA
JAKAFI TAB 15MG SP, QL (2 tabs / 1 day), PA
JAKAFI TAB 20MG SP, QL (2 tabs / 1 day), PA
JAKAFI TAB 25MG SP, QL (2 tabs / 1 day), PA
ZYDELIG TAB 100MG SP, QL (2 tabs / 1 day), PA
ZYDELIG TAB 150MG SP, QL (2 tabs / 1 day), PA
ANTINEOPLASTICS MISC. hydroxyurea cap 500 mg MATULANE CAP 50MG
INTRON A INJ 18MU SP, PA
INTRON A INJ 25MU SP, PA
INTRON A INJ 10MU SP, PA
INTRON A INJ 18MU SP, PA
INTRON A INJ 50MU SP, PA
tretinoin cap 10 mg
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 13 AGE - Age Limit GNDR - Gender Edit
bexarotene cap 75 mg SP, PA
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 14 AGE - Age Limit GNDR - Gender Edit
CHEMOTHERAPY RESCUE/ANTIDOTE AGENTS leucovorin calcium tab 5 mg leucovorin calcium tab 10 mg leucovorin calcium tab 15 mg leucovorin calcium tab 25 mg
CORTICOSTEROIDS GLUCOCORTICOSTEROIDS
budesonide delayed release particles cap 3 mg decadron tab 0.5mg dexamethasone tab 0.5 mg decadron tab 0.75mg dexamethasone tab 0.75 mg dexamethasone tab 1 mg dexamethasone tab 1.5 mg dexamethasone tab 2 mg decadron tab 4mg dexamethasone tab 4 mg decadron tab 6mg dexamethasone tab 6 mg decadron elx 0.5/5ml dexamethasone elixir 0.5 mg/5ml dexamethasone soln 0.5 mg/5ml hydrocortisone tab 5 mg hydrocortisone tab 10 mg hydrocortisone tab 20 mg MEDROL TAB 2MG
methylprednisolone tab 4 mg methylprednisolone tab 8 mg methylprednisolone tab 16 mg methylprednisolone tab 32 mg methylprednisolone tab therapy pack 4 mg (21) prednisolone syrup 15 mg/5ml (usp solution equivalent) prednisolone sod phosphate oral soln 15 mg/5ml (base equiv)
prednisolone sodium phosphate oral soln 25 mg/5ml (base eq)
prednisolone sod phosph oral soln 6.7 mg/5ml (5 mg/5ml base)
prednisolone sod phos orally disintegr tab 10 mg (base eq)
prednisolone sod phos orally disintegr tab 15 mg (base eq)
prednisolone sod phos orally disintegr tab 30 mg (base eq)
prednisone tab 1 mg
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 14 AGE - Age Limit GNDR - Gender Edit
prednisone tab 2.5 mg prednisone tab 5 mg prednisone tab 10 mg deltasone tab 20mg prednisone tab 20 mg prednisone tab 50 mg prednisone oral soln 5 mg/5ml
prednisone tab therapy pack 5 mg (21) prednisone tab therapy pack 5 mg (48) prednisone tab therapy pack 10 mg (21) prednisone tab therapy pack 10 mg (48)
MINERALOCORTICOIDS fludrocortisone acetate tab 0.1 mg
ANDROGENS-ANABOLIC ANDROGENS
danazol cap 50 mg danazol cap 100 mg danazol cap 200 mg
testosterone td gel 25 mg/2.5gm (1%) PA
testosterone td gel 10mg/act (2%) PA testosterone cypionate im inj in oil 100 mg/ml PA testosterone cypionate im inj in oil 200 mg/ml PA testosterone enanthate im inj in oil 200 mg/ml PA
ESTROGENS ESTROGENS
estradiol tab 0.5 mg estradiol tab 1 mg estradiol tab 2 mg estradiol td patch weekly 0.025 mg/24hr estradiol td patch weekly 0.0375 mg/24hr (37.5 mcg/24hr) estradiol td patch weekly 0.05 mg/24hr estradiol td patch weekly 0.06 mg/24hr estradiol td patch weekly 0.075 mg/24hr estradiol td patch weekly 0.1 mg/24hr
ESTROGEN COMBINATIONS amabelz tab 0.5-0.1
estradiol & norethindrone acetate tab 0.5-0.1 mg lopreeza tab 0.5-0.1 mimvey lo tab 0.5-0.1 amabelz tab 1-0.5mg estradiol & norethindrone acetate tab 1-0.5 mg lopreeza tab 1-0.5mg mimvey tab 1-0.5mg
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 15 AGE - Age Limit GNDR - Gender Edit
COMBIPATCH DIS .05/.14
COMBIPATCH DIS .05/.25 fyavolv tab 0.5-2.5 norethindrone acetate-ethinyl estradiol tab 0.5
mg-2.5 mcg fyavolv tab 1-5
jinteli tab 1mg-5mcg norethindrone acetate-ethinyl estradiol tab 1 mg-5
mcg
CONTRACEPTIVES COPPER CONTRACEPTIVES - IUD
PARAGARD IUD T380A QL (1 IUD in lifetime)
PROGESTIN CONTRACEPTIVES - ORAL camila tab 0.35mg QL (1 tab / 1 day) deblitane tab 0.35mg QL (1 tab / 1 day)
errin tab 0.35mg QL (1 tab / 1 day)
heather tab 0.35mg QL (1 tab / 1 day)
incassia tab 0.35mg QL (1 tab / 1 day)
jencycla tab 0.35mg QL (1 tab / 1 day)
jolivette tab 0.35mg QL (1 tab / 1 day)
lyza tab 0.35mg QL (1 tab / 1 day)
nora-be tab 0.35mg QL (1 tab / 1 day)
norethindrone tab 0.35 mg QL (1 tab / 1 day)
norlyda tab 0.35mg QL (1 tab / 1 day)
norlyroc tab 0.35mg QL (1 tab / 1 day)
sharobel tab 0.35mg QL (1 tab / 1 day)
tulana tab 0.35mg QL (1 tab / 1 day)
PROGESTIN CONTRACEPTIVES - INJECTABLE medroxyprogesterone acetate im susp 150 mg/ml QL (5 injections / 364 days) medroxyprogesterone acetate im susp prefilled syr QL (5 injections / 364 days) 150 mg/ml
PROGESTIN CONTRACEPTIVES - IUD SKYLA IUD 13.5MG SP, QL (1 IUD in lifetime) KYLEENA IUD 19.5MG SP, QL (1 IUD in lifetime)
LILETTA IUD 52MG SP, QL (1 IUD in lifetime)
MIRENA IUD SYSTEM SP, QL (1 IUD in lifetime)
PROGESTIN CONTRACEPTIVES - IMPLANTS NEXPLANON IMP 68MG SP, QL (1 implant in
lifetime)
EMERGENCY CONTRACEPTIVES aftera tab 1.5mg OTC, QL (1 tab / 30 days) econtra ez tab 1.5mg OTC, QL (1 tab / 30 days)
econtra os tab 1.5mg OTC, QL (1 tab / 30 days)
levonorgestrel tab 1.5 mg OTC, QL (1 tab / 30 days)
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 16 AGE - Age Limit GNDR - Gender Edit
my choice tab 1.5mg OTC, QL (1 tab / 30 days)
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 17 AGE - Age Limit GNDR - Gender Edit
my way tab 1.5mg OTC, QL (1 tab / 30 days)
new day tab 1.5mg OTC, QL (1 tab / 30 days)
opcicon tab 1.5mg OTC, QL (1 tab / 30 days)
option 2 tab 1.5mg OTC, QL (1 tab / 30 days)
preventeza tab 1.5mg OTC, QL (1 tab / 30 days)
react tab 1.5mg OTC, QL (1 tab / 30 days)
take action tab 1.5mg OTC, QL (1 tab / 30 days)
ELLA TAB 30MG QL (2 tabs / year)
COMBINATION CONTRACEPTIVES - TRANSDERMAL xulane dis 150-35 QL (39 patches / 364 days)
COMBINATION CONTRACEPTIVES - VAGINAL NUVARING MIS QL (13 rings / 364 days)
COMBINATION CONTRACEPTIVES - ORAL apri tab QL (1 tab / 1 day) cyred eq tab QL (1 tab / 1 day)
cyred tab QL (1 tab / 1 day)
desogestrel & ethinyl estradiol tab 0.15 mg-30 QL (1 tab / 1 day) mcg emoquette tab QL (1 tab / 1 day)
enskyce tab QL (1 tab / 1 day)
isibloom tab QL (1 tab / 1 day)
juleber tab QL (1 tab / 1 day)
reclipsen tab QL (1 tab / 1 day)
drospirenone-ethinyl estradiol tab 3-0.02 mg QL (1 tab / 1 day)
gianvi tab 3-0.02mg QL (1 tab / 1 day)
loryna tab 3-0.02mg QL (1 tab / 1 day)
nikki tab 3-0.02mg QL (1 tab / 1 day)
drospirenone-ethinyl estradiol tab 3-0.03 mg QL (1 tab / 1 day) ocella tab 3-0.03mg QL (1 tab / 1 day) syeda tab 3-0.03mg QL (1 tab / 1 day)
zarah tab 3-0.03mg QL (1 tab / 1 day)
ethynodiol diacetate & ethinyl estradiol tab 1 QL (1 tab / 1 day) mg-35 mcg kelnor tab 1/35 QL (1 tab / 1 day)
zovia 1/35e tab QL (1 tab / 1 day)
ethynodiol diacetate & ethinyl estradiol tab 1 QL (1 tab / 1 day) mg-50 mcg kelnor 1/50 tab QL (1 tab / 1 day)
aubra eq tab 0.1-0.02 QL (1 tab / 1 day)
aubra tab 0.1-0.02 QL (1 tab / 1 day)
aviane tab QL (1 tab / 1 day)
delyla tab 0.1-0.02 QL (1 tab / 1 day)
falmina tab QL (1 tab / 1 day)
larissia tab QL (1 tab / 1 day)
lessina tab QL (1 tab / 1 day)
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 17 AGE - Age Limit GNDR - Gender Edit
levonorgestrel & ethinyl estradiol tab 0.1 mg-20 QL (1 tab / 1 day) mcg lutera tab QL (1 tab / 1 day)
orsythia tab QL (1 tab / 1 day)
sronyx tab QL (1 tab / 1 day)
vienva tab 0.1-20 QL (1 tab / 1 day)
altavera tab QL (1 tab / 1 day)
chateal eq tab 0.15/30 QL (1 tab / 1 day)
chateal tab 0.15/30 QL (1 tab / 1 day)
kurvelo tab 0.15/30 QL (1 tab / 1 day)
levonorgestrel & ethinyl estradiol tab 0.15 mg-30 QL (1 tab / 1 day) mcg levora-28 tab 0.15/30 QL (1 tab / 1 day)
lillow tab 0.15/30 QL (1 tab / 1 day)
marlissa tab 0.15/30 QL (1 tab / 1 day)
portia-28 tab QL (1 tab / 1 day)
balziva tab QL (1 tab / 1 day)
briellyn tab QL (1 tab / 1 day)
philith tab 0.4-35 QL (1 tab / 1 day)
vyfemla tab 0.4-35 QL (1 tab / 1 day)
necon tab 0.5/35 QL (1 tab / 1 day)
nortrel tab 0.5/35 QL (1 tab / 1 day)
wera tab 0.5/35 QL (1 tab / 1 day)
alyacen tab 1/35 QL (1 tab / 1 day)
cyclafem tab 1/35 QL (1 tab / 1 day)
dasetta tab 1/35 QL (1 tab / 1 day)
nortrel tab 1/35 QL (1 tab / 1 day)
pirmella tab 1/35 QL (1 tab / 1 day)
junel 1/20 tab QL (1 tab / 1 day)
larin tab 1/20 QL (1 tab / 1 day)
microgestin tab 1/20 QL (1 tab / 1 day)
norethindrone ace & ethinyl estradiol tab 1 mg-20 QL (1 tab / 1 day) mcg junel 1.5/30 tab QL (1 tab / 1 day)
larin tab 1.5/30 QL (1 tab / 1 day)
microgestin tab 1.5/30 QL (1 tab / 1 day)
cryselle-28 tab 28 tabs QL (1 tab / 1 day)
elinest tab QL (1 tab / 1 day)
low-ogestrel tab QL (1 tab / 1 day)
ogestrel tab QL (1 tab / 1 day)
estarylla tab 0.25-35 QL (1 tab / 1 day)
femynor tab 0.25-35 QL (1 tab / 1 day)
mili tab 0.25/35 QL (1 tab / 1 day)
mono-linyah tab 0.25-35 QL (1 tab / 1 day)
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 18 AGE - Age Limit GNDR - Gender Edit
mononessa tab QL (1 tab / 1 day)
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 19 AGE - Age Limit GNDR - Gender Edit
norgestimate & ethinyl estradiol tab 0.25 mg-35 QL (1 tab / 1 day) mcg previfem tab QL (1 tab / 1 day)
sprintec 28 tab 28 day QL (1 tab / 1 day)
vylibra tab 0.25-35 QL (1 tab / 1 day)
blisovi fe tab 1/20 QL (1 tab / 1 day)
junel fe tab 1/20 QL (1 tab / 1 day)
larin fe tab 1/20 QL (1 tab / 1 day)
microgestin tab fe 1/20 QL (1 tab / 1 day)
norethindrone ace & ethinyl estradiol-fe tab 1 QL (1 tab / 1 day) mg-20 mcg tarina fe tab 1/20 QL (1 tab / 1 day)
tarina fe tab 1/20 eq QL (1 tab / 1 day)
blisovi fe tab 1.5/30 QL (1 tab / 1 day)
junel fe tab 1.5/30 QL (1 tab / 1 day)
larin fe tab 1.5/30 QL (1 tab / 1 day)
microgestin tab fe1.5/30 QL (1 tab / 1 day)
azurette tab 28 day QL (1 tab / 1 day)
bekyree tab QL (1 tab / 1 day)
desogest-eth estrad & eth estrad tab QL (1 tab / 1 day) 0.15-0.02/0.01 mg(21/5) kariva tab 28 day QL (1 tab / 1 day)
pimtrea tab QL (1 tab / 1 day)
viorele tab QL (1 tab / 1 day)
caziant pak QL (1 tab / 1 day)
velivet pak QL (1 tab / 1 day)
enpresse-28 tab QL (1 tab / 1 day)
levonest tab QL (1 tab / 1 day)
levonorgestrel-eth estra tab QL (1 tab / 1 day) 0.05-30/0.075-40/0.125-30mg-mcg myzilra tab QL (1 tab / 1 day)
trivora-28 tab QL (1 tab / 1 day)
alyacen tab 7/7/7 QL (1 tab / 1 day)
cyclafem tab 7/7/7 QL (1 tab / 1 day)
dasetta tab 7/7/7 QL (1 tab / 1 day)
nortrel tab 7/7/7 QL (1 tab / 1 day)
pirmella tab 7/7/7 QL (1 tab / 1 day)
aranelle tab QL (1 tab / 1 day)
leena tab QL (1 tab / 1 day)
norgestimate-eth estrad tab QL (1 tab / 1 day) 0.18-25/0.215-25/0.25-25 mg-mcg tri-lo tab estaryll QL (1 tab / 1 day)
tri-lo- tab marzia QL (1 tab / 1 day)
tri-lo- tab sprintec QL (1 tab / 1 day)
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 20 AGE - Age Limit GNDR - Gender Edit
tri-vylibra tab lo QL (1 tab / 1 day)
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 21 AGE - Age Limit GNDR - Gender Edit
norgestimate-eth estrad tab QL (1 tab / 1 day) 0.18-35/0.215-35/0.25-35 mg-mcg tri femynor tab QL (1 tab / 1 day)
tri-estaryll tab QL (1 tab / 1 day)
tri-linyah tab QL (1 tab / 1 day)
tri-mili tab QL (1 tab / 1 day)
tri-previfem tab QL (1 tab / 1 day)
tri-sprintec tab QL (1 tab / 1 day)
tri-vylibra tab QL (1 tab / 1 day)
amethia tab QL (1 tab / 1 day)
ashlyna tab QL (1 tab / 1 day)
camrese tab QL (1 tab / 1 day)
daysee tab QL (1 tab / 1 day)
levonorg-eth est tab 0.15-0.03mg(84) & eth est QL (1 tab / 1 day) tab 0.01mg(7)
PROGESTINS PROGESTINS
MAKENA INJ 275MG SP, PA medroxyprogesterone acetate tab 2.5 mg
medroxyprogesterone acetate tab 5 mg medroxyprogesterone acetate tab 10 mg norethindrone acetate tab 5 mg progesterone micronized cap 100 mg progesterone micronized cap 200 mg
ANTIDIABETICS INSULIN
BASAGLAR INJ 100UNIT ADMELOG INJ 100U/ML ADMELOG SOLO INJ 100U/ML TRESIBA FLEX INJ 100UNIT TRESIBA FLEX INJ 200UNIT HUMULIN R INJ U-100 OTC
NOVOLIN R INJ RELION OTC
NOVOLIN R INJ U-100 OTC
HUMULIN R INJ U-500
HUMULIN R INJ U-500 HUMULIN N INJ U-100 OTC NOVOLIN N INJ RELION OTC
NOVOLIN N INJ U-100 OTC
HUMULIN N INJ U-100KWP OTC
NOVOLOG MIX INJ 70/30 NOVOLOG MIX INJ FLEXPEN HUMALOG MIX SUS 75/25 HUMALOG MIX INJ 50/50
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 22 AGE - Age Limit GNDR - Gender Edit
HUMALOG MIX INJ 75/25KWP
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 20 AGE - Age Limit GNDR - Gender Edit
HUMALOG MIX INJ 50/50KWP
HUMULIN INJ 70/30 OTC
NOVOLIN70/30 INJ RELION OTC
NOVOLIN INJ 70/30 OTC
HUMULIN INJ 70/30KWP OTC
NOVOLIN INJ FLEXPEN OTC
INCRETIN MIMETIC AGENTS (GLP-1 RECEPTOR AGONISTS) TRULICITY INJ 0.75/0.5 ST TRULICITY INJ 1.5/0.5 ST
VICTOZA INJ 18MG/3ML ST
OZEMPIC INJ 2/1.5ML ST
OZEMPIC INJ 2/1.5ML ST
SULFONYLUREAS glimepiride tab 1 mg glimepiride tab 2 mg glimepiride tab 4 mg glipizide tab 5 mg glipizide tab 10 mg glipizide tab er 24hr 2.5 mg
glipizide xl tab 2.5mg glipizide tab er 24hr 5 mg glipizide xl tab 5mg glipizide tab er 24hr 10 mg glipizide xl tab 10mg glyburide tab 1.25 mg glyburide tab 2.5 mg glyburide tab 5 mg glyburide micronized tab 1.5 mg
glyburide micronized tab 3 mg glyburide micronized tab 6 mg
BIGUANIDES
metformin hcl tab 500 mg metformin hcl tab 850 mg metformin hcl tab 1000 mg metformin hcl tab er 24hr 500 mg metformin hcl tab er 24hr 750 mg
MEGLITINIDE ANALOGUES nateglinide tab 60 mg nateglinide tab 120 mg repaglinide tab 0.5 mg repaglinide tab 1 mg repaglinide tab 2 mg
DIABETIC OTHER GLUCAGON KIT 1MG QL (2 kits / 30 days)
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 21 AGE - Age Limit GNDR - Gender Edit
GLUCAGEN INJ HYPOKIT
ALPHA-GLUCOSIDASE INHIBITORS acarbose tab 25 mg acarbose tab 50 mg acarbose tab 100 mg
DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITORS JANUVIA TAB 25MG ST JANUVIA TAB 50MG ST
JANUVIA TAB 100MG ST
INSULIN SENSITIZING AGENTS pioglitazone hcl tab 15 mg (base equiv) pioglitazone hcl tab 30 mg (base equiv) pioglitazone hcl tab 45 mg (base equiv)
SODIUM-GLUCOSE CO-TRANSPORTER 2 (SGLT2) INHIBITORS JARDIANCE TAB 10MG PA JARDIANCE TAB 25MG PA
STEGLATRO TAB 5MG ST
STEGLATRO TAB 15MG ST
ANTIDIABETIC COMBINATIONS JANUMET TAB 50-500MG ST JANUMET TAB 50-1000 ST
JANUMET XR TAB 50-500MG ST
JANUMET XR TAB 50-1000 ST
JANUMET XR TAB 100-1000 ST
SEGLUROMET TAB 2.5-500 ST
SEGLUROMET TAB 2.5-1000 ST
SEGLUROMET TAB 7.5-500 ST
SEGLUROMET TAB 7.5-1000 ST
glipizide-metformin hcl tab 2.5-250 mg
glipizide-metformin hcl tab 2.5-500 mg glipizide-metformin hcl tab 5-500 mg glyburide-metformin tab 1.25-250 mg glyburide-metformin tab 2.5-500 mg glyburide-metformin tab 5-500 mg pioglitazone hcl-glimepiride tab 30-2 mg pioglitazone hcl-glimepiride tab 30-4 mg pioglitazone hcl-metformin hcl tab 15-500 mg pioglitazone hcl-metformin hcl tab 15-850 mg
THYROID AGENTS THYROID HORMONES
euthyrox tab 25mcg levo-t tab 25mcg levothyroxine sodium tab 25 mcg
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 22 AGE - Age Limit GNDR - Gender Edit
levoxyl tab 25mcg
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 23 AGE - Age Limit GNDR - Gender Edit
unith direct tab 25mcg unithroid tab 25mcg euthyrox tab 50mcg levo-t tab 50mcg levothyroxine sodium tab 50 mcg levoxyl tab 50mcg unith direct tab 50mcg unithroid tab 50mcg euthyrox tab 75mcg levo-t tab 75mcg levothyroxine sodium tab 75 mcg levoxyl tab 75mcg unith direct tab 75mcg unithroid tab 75mcg euthyrox tab 88mcg levo-t tab 88mcg levothyroxine sodium tab 88 mcg levoxyl tab 88mcg unith direct tab 88mcg unithroid tab 88mcg euthyrox tab 100mcg levo-t tab 100mcg levothyroxine sodium tab 100 mcg levoxyl tab 100mcg unith direct tab 100mcg unithroid tab 100mcg euthyrox tab 112mcg levo-t tab 112mcg levothyroxine sodium tab 112 mcg levoxyl tab 112mcg unith direct tab 112mcg unithroid tab 112mcg euthyrox tab 125mcg levo-t tab 125mcg levothyroxine sodium tab 125 mcg levoxyl tab 125mcg unith direct tab 125mcg unithroid tab 125mcg euthyrox tab 137mcg levo-t tab 137mcg levothyroxine sodium tab 137 mcg levoxyl tab 137mcg unithroid tab 137mcg euthyrox tab 150mcg levo-t tab 150mcg
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 23 AGE - Age Limit GNDR - Gender Edit
levothyroxine sodium tab 150 mcg
levoxyl tab 150mcg unith direct tab 150mcg unithroid tab 150mcg euthyrox tab 175mcg levo-t tab 175mcg levothyroxine sodium tab 175 mcg levoxyl tab 175mcg unith direct tab 175mcg unithroid tab 175mcg euthyrox tab 200mcg levo-t tab 200 mcg levothyroxine sodium tab 200 mcg levoxyl tab 200mcg unith direct tab 200mcg unithroid tab 200mcg levo-t tab 300 mcg levothyroxine sodium tab 300 mcg unith direct tab 300mcg unithroid tab 300mcg liothyronine sodium tab 5 mcg liothyronine sodium tab 25 mcg liothyronine sodium tab 50 mcg
ANTITHYROID AGENTS methimazole tab 5 mg methimazole tab 10 mg propylthiouracil tab 50 mg
ENDOCRINE AND METABOLIC AGENTS - MISC. BONE DENSITY REGULATORS
alendronate sodium tab 5 mg alendronate sodium tab 10 mg alendronate sodium tab 35 mg alendronate sodium tab 40 mg alendronate sodium tab 70 mg calcitonin (salmon) nasal soln 200 unit/act
TYMLOS INJ SP, QL (1.154 pens / 30
days), PA PROLIA SOL 60MG/ML SP, QL (.3 injections / 30
days), PA
HORMONE RECEPTOR MODULATORS OSPHENA TAB 60MG PA raloxifene hcl tab 60 mg
LHRH/GNRH AGONIST ANALOG PITUITARY SUPPRESSANTS SYNAREL SOL 2MG/ML
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 24 AGE - Age Limit GNDR - Gender Edit
GROWTH HORMONES NORDITROPIN INJ 5/1.5ML SP, ST NORDITROPIN INJ 10/1.5ML SP, ST
NORDITROPIN INJ 15/1.5ML SP, ST
NORDITROPIN INJ 30/3ML SP, ST
SEROSTIM INJ 4MG SP, PA
SEROSTIM INJ 5MG SP, PA
SEROSTIM INJ 6MG SP, PA
ZORBTIVE INJ 8.8MG SP, PA
SOMATOSTATIC AGENTS SOMATULINE INJ 60/0.2ML SP, QL (1.5 syringes / 30
days), PA SOMATULINE INJ 90/0.3ML SP, QL (1.1 syringes / 30
days), PA SOMATULINE INJ 120/.5ML SP, QL (1.2 syringes / 30
days), PA octreotide acetate inj 50 mcg/ml (0.05 mg/ml) SP, QL (3 mL / 1 day), PA
octreotide acetate inj 50 mcg/ml (0.05 mg/ml) SP, QL (3 vials / 1 day), PA octreotide acetate inj 100 mcg/ml (0.1 mg/ml) SP, QL (3 mL / 1 day), PA octreotide acetate inj 100 mcg/ml (0.1 mg/ml) SP, QL (3 vials / 1 day), PA octreotide acetate inj 200 mcg/ml (0.2 mg/ml) SP, QL (45 vials / 30 days),
PA octreotide acetate inj 500 mcg/ml (0.5 mg/ml) SP, QL (3 mL / 1 day), PA
octreotide acetate inj 500 mcg/ml (0.5 mg/ml) SP, QL (3 vials / 1 day), PA octreotide acetate inj 1000 mcg/ml (1 mg/ml) SP, QL (9 vials / 30 days),
PA
POSTERIOR PITUITARY HORMONES desmopressin acetate tab 0.1 mg PA desmopressin acetate tab 0.2 mg PA
desmopressin acetate nasal spray soln 0.01% PA
(refrigerated) desmopressin acetate nasal spray soln 0.01% PA
CORTICOTROPIN H.P. ACTHAR INJ 80UNIT SP, QL (50.1 mL / 30 days)
PROLACTIN INHIBITORS cabergoline tab 0.5 mg
VASOPRESSIN RECEPTOR ANTAGONISTS SAMSCA TAB 15MG SP, PA SAMSCA TAB 30MG SP, PA
METABOLIC MODIFIERS calcitriol cap 0.25 mcg calcitriol cap 0.5 mcg calcitriol inj 1 mcg/ml calcitriol oral soln 1 mcg/ml
doxercalciferol cap 0.5 mcg
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 25 AGE - Age Limit GNDR - Gender Edit
doxercalciferol cap 1 mcg
doxercalciferol cap 2.5 mcg paricalcitol cap 1 mcg paricalcitol cap 2 mcg paricalcitol cap 4 mcg KUVAN POW 100MG SP, PA
KUVAN TAB 100MG SP, PA
CARDIOTONICS CARDIAC GLYCOSIDES
LANOXIN TAB 0.0625MG digitek tab 0.125mg
digox tab 0.125mg digoxin tab 125 mcg (0.125 mg)
LANOXIN TAB 0.1875MG
digitek tab 0.25mg
digox tab 0.25mg digoxin tab 250 mcg (0.25 mg)
digoxin oral soln 0.05 mg/ml
ANTIANGINAL AGENTS NITRATES
isosorbide dinitrate tab 5 mg isosorbide dinitrate tab 10 mg isosorbide dinitrate tab 20 mg isosorbide dinitrate tab 30 mg ISORDIL TAB 40MG isosorbide dinitrate tab er 40 mg
isosorbide mononitrate tab 10 mg isosorbide mononitrate tab 20 mg isosorbide mononitrate tab er 24hr 30 mg isosorbide mononitrate tab er 24hr 60 mg isosorbide mononitrate tab er 24hr 120 mg nitro-time cap 2.5mg cr nitroglycerin cap er 2.5 mg
nitro-time cap 6.5mg cr nitroglycerin cap er 6.5 mg nitro-time cap 9mg cr nitroglycerin cap er 9 mg nitroglycerin sl tab 0.3 mg nitroglycerin sl tab 0.4 mg nitroglycerin sl tab 0.6 mg NITRO-BID OIN 2% minitran dis 0.1mg/hr
nitroglycerin td patch 24hr 0.1 mg/hr
minitran dis 0.2mg/hr
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 25 AGE - Age Limit GNDR - Gender Edit
nitroglycerin td patch 24hr 0.2 mg/hr
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 26 AGE - Age Limit GNDR - Gender Edit
NITRO-DUR DIS 0.3MG/HR
minitran dis 0.4mg/hr
nitroglycerin td patch 24hr 0.4 mg/hr
minitran dis 0.6mg/hr nitroglycerin td patch 24hr 0.6 mg/hr NITRO-DUR DIS 0.8MG/HR
BETA BLOCKERS BETA BLOCKERS NON-SELECTIVE
nadolol tab 20 mg nadolol tab 40 mg nadolol tab 80 mg pindolol tab 5 mg pindolol tab 10 mg propranolol hcl tab 10 mg propranolol hcl tab 20 mg propranolol hcl tab 40 mg propranolol hcl tab 60 mg propranolol hcl tab 80 mg propranolol hcl oral soln 20 mg/5ml
propranolol hcl oral soln 40 mg/5ml propranolol hcl cap er 24hr 60 mg propranolol hcl cap er 24hr 80 mg propranolol hcl cap er 24hr 120 mg propranolol hcl cap er 24hr 160 mg sorine tab 80mg sotalol hcl tab 80 mg
sorine tab 120mg sotalol hcl tab 120 mg sorine tab 160mg sotalol hcl tab 160 mg sorine tab 240mg sotalol hcl tab 240 mg sotalol hcl (afib/afl) tab 80 mg
sotalol hcl (afib/afl) tab 120 mg sotalol hcl (afib/afl) tab 160 mg timolol maleate tab 5 mg timolol maleate tab 10 mg timolol maleate tab 20 mg
BETA BLOCKERS CARDIO-SELECTIVE atenolol tab 25 mg atenolol tab 50 mg atenolol tab 100 mg bisoprolol fumarate tab 5 mg
bisoprolol fumarate tab 10 mg
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 27 AGE - Age Limit GNDR - Gender Edit
metoprolol succinate tab er 24hr 25 mg (tartrate equiv)
metoprolol succinate tab er 24hr 50 mg (tartrate equiv)
metoprolol succinate tab er 24hr 100 mg (tartrate equiv)
metoprolol succinate tab er 24hr 200 mg (tartrate equiv)
metoprolol tartrate tab 25 mg metoprolol tartrate tab 50 mg metoprolol tartrate tab 100 mg
ALPHA-BETA BLOCKERS carvedilol tab 3.125 mg carvedilol tab 6.25 mg carvedilol tab 12.5 mg carvedilol tab 25 mg labetalol hcl tab 100 mg labetalol hcl tab 200 mg labetalol hcl tab 300 mg
CALCIUM CHANNEL BLOCKERS CALCIUM CHANNEL BLOCKERS
amlodipine besylate tab 2.5 mg (base equivalent) amlodipine besylate tab 5 mg (base equivalent) amlodipine besylate tab 10 mg (base equivalent) diltiazem hcl tab 30 mg diltiazem hcl tab 60 mg diltiazem hcl tab 90 mg diltiazem hcl tab 120 mg diltiazem hcl cap er 12hr 60 mg diltiazem hcl cap er 12hr 90 mg diltiazem hcl cap er 12hr 120 mg dilt-xr cap 120mg diltiazem hcl cap er 24hr 120 mg dilt-xr cap 180mg diltiazem hcl cap er 24hr 180 mg dilt-xr cap 240mg diltiazem hcl cap er 24hr 240 mg
diltiazem hcl extended release beads cap er 24hr 120 mg
taztia xt cap 120mg/24
diltiazem hcl extended release beads cap er 24hr 180 mg
taztia xt cap 180mg/24
diltiazem hcl extended release beads cap er 24hr 240 mg
taztia xt cap 240mg/24
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 28 AGE - Age Limit GNDR - Gender Edit
diltiazem hcl extended release beads cap er 24hr 300 mg
taztia xt cap 300mg/24
diltiazem hcl extended release beads cap er 24hr 360 mg
taztia xt cap 360mg/24
diltiazem hcl extended release beads cap er 24hr 420 mg
cartia xt cap 120/24hr
diltiazem hcl coated beads cap er 24hr 120 mg cartia xt cap 180/24hr
diltiazem hcl coated beads cap er 24hr 180 mg cartia xt cap 240/24hr diltiazem hcl coated beads cap er 24hr 240 mg cartia xt cap 300/24hr diltiazem hcl coated beads cap er 24hr 300 mg diltiazem hcl coated beads cap er 24hr 360 mg diltiazem hcl coated beads tab er 24hr 180 mg matzim la tab 180mg/24
diltiazem hcl coated beads tab er 24hr 240 mg matzim la tab 240mg/24 diltiazem hcl coated beads tab er 24hr 300 mg matzim la tab 300mg/24 diltiazem hcl coated beads tab er 24hr 360 mg matzim la tab 360mg/24 diltiazem hcl coated beads tab er 24hr 420 mg matzim la tab 420mg/24 felodipine tab er 24hr 2.5 mg felodipine tab er 24hr 5 mg felodipine tab er 24hr 10 mg nifedipine tab er 24hr 30 mg nifedipine tab er 24hr 60 mg nifedipine tab er 24hr 90 mg nifedipine tab er 24hr osmotic release 30 mg nifedipine tab er 24hr osmotic release 60 mg nifedipine tab er 24hr osmotic release 90 mg verapamil hcl tab er 120 mg verapamil hcl tab er 180 mg verapamil hcl tab er 240 mg verapamil hcl cap er 24hr 100 mg verapamil hcl cap er 24hr 200 mg verapamil hcl cap er 24hr 300 mg
ANTIARRHYTHMICS ANTIARRHYTHMICS TYPE I-A
disopyramide phosphate cap 100 mg
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 29 AGE - Age Limit GNDR - Gender Edit
disopyramide phosphate cap 150 mg
NORPACE CAP 100MG CR
NORPACE CAP 150MG CR
ANTIARRHYTHMICS TYPE I-C flecainide acetate tab 50 mg flecainide acetate tab 100 mg flecainide acetate tab 150 mg propafenone hcl tab 150 mg propafenone hcl tab 225 mg propafenone hcl tab 300 mg propafenone hcl cap er 12hr 225 mg propafenone hcl cap er 12hr 325 mg propafenone hcl cap er 12hr 425 mg
ANTIARRHYTHMICS TYPE III amiodarone hcl tab 200 mg pacerone tab 200mg dofetilide cap 125 mcg (0.125 mg) SP, PA
dofetilide cap 250 mcg (0.25 mg) SP, PA
dofetilide cap 500 mcg (0.5 mg) SP, PA
ANTIHYPERTENSIVES ACE INHIBITORS
benazepril hcl tab 5 mg benazepril hcl tab 10 mg benazepril hcl tab 20 mg benazepril hcl tab 40 mg captopril tab 12.5 mg captopril tab 25 mg captopril tab 50 mg captopril tab 100 mg enalapril maleate tab 2.5 mg
enalapril maleate tab 5 mg enalapril maleate tab 10 mg enalapril maleate tab 20 mg fosinopril sodium tab 10 mg fosinopril sodium tab 20 mg fosinopril sodium tab 40 mg lisinopril tab 2.5 mg lisinopril tab 5 mg lisinopril tab 10 mg
lisinopril tab 20 mg lisinopril tab 30 mg lisinopril tab 40 mg quinapril hcl tab 5 mg quinapril hcl tab 10 mg
quinapril hcl tab 20 mg
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 30 AGE - Age Limit GNDR - Gender Edit
quinapril hcl tab 40 mg ramipril cap 1.25 mg ramipril cap 2.5 mg ramipril cap 5 mg ramipril cap 10 mg trandolapril tab 1 mg trandolapril tab 2 mg trandolapril tab 4 mg
ANGIOTENSIN II RECEPTOR ANTAGONISTS irbesartan tab 75 mg irbesartan tab 150 mg irbesartan tab 300 mg losartan potassium tab 25 mg losartan potassium tab 50 mg
losartan potassium tab 100 mg valsartan tab 40 mg
valsartan tab 80 mg valsartan tab 160 mg valsartan tab 320 mg
ANTIADRENERGIC ANTIHYPERTENSIVES clonidine td patch weekly 0.1 mg/24hr clonidine td patch weekly 0.2 mg/24hr clonidine td patch weekly 0.3 mg/24hr clonidine hcl tab 0.1 mg
clonidine hcl tab 0.2 mg clonidine hcl tab 0.3 mg guanfacine hcl tab 1 mg guanfacine hcl tab 2 mg methyldopa tab 250 mg methyldopa tab 500 mg doxazosin mesylate tab 1 mg doxazosin mesylate tab 2 mg doxazosin mesylate tab 4 mg doxazosin mesylate tab 8 mg prazosin hcl cap 1 mg prazosin hcl cap 2 mg prazosin hcl cap 5 mg
terazosin hcl cap 1 mg (base equivalent) terazosin hcl cap 2 mg (base equivalent) terazosin hcl cap 5 mg (base equivalent) terazosin hcl cap 10 mg (base equivalent)
SELECTIVE ALDOSTERONE RECEPTOR ANTAGONISTS (SARAS) eplerenone tab 25 mg eplerenone tab 50 mg
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 31 AGE - Age Limit GNDR - Gender Edit
VASODILATORS hydralazine hcl tab 10 mg hydralazine hcl tab 25 mg hydralazine hcl tab 50 mg hydralazine hcl tab 100 mg
ANTIHYPERTENSIVE COMBINATIONS amlodipine besylate-benazepril hcl cap 2.5-10 mg amlodipine besylate-benazepril hcl cap 5-10 mg amlodipine besylate-benazepril hcl cap 5-20 mg amlodipine besylate-benazepril hcl cap 5-40 mg amlodipine besylate-benazepril hcl cap 10-20 mg amlodipine besylate-benazepril hcl cap 10-40 mg benazepril & hydrochlorothiazide tab 5-6.25 mg benazepril & hydrochlorothiazide tab 10-12.5 mg benazepril & hydrochlorothiazide tab 20-12.5 mg benazepril & hydrochlorothiazide tab 20-25 mg captopril & hydrochlorothiazide tab 25-15 mg captopril & hydrochlorothiazide tab 25-25 mg captopril & hydrochlorothiazide tab 50-15 mg captopril & hydrochlorothiazide tab 50-25 mg enalapril maleate & hydrochlorothiazide tab 5-12.5 mg enalapril maleate & hydrochlorothiazide tab 10-25 mg
fosinopril sodium & hydrochlorothiazide tab 10-12.5 mg
fosinopril sodium & hydrochlorothiazide tab 20-12.5 mg
lisinopril & hydrochlorothiazide tab 10-12.5 mg lisinopril & hydrochlorothiazide tab 20-12.5 mg lisinopril & hydrochlorothiazide tab 20-25 mg quinapril-hydrochlorothiazide tab 10-12.5 mg quinapril-hydrochlorothiazide tab 20-12.5 mg quinapril-hydrochlorothiazide tab 20-25 mg atenolol & chlorthalidone tab 50-25 mg atenolol & chlorthalidone tab 100-25 mg
bisoprolol & hydrochlorothiazide tab 2.5-6.25 mg bisoprolol & hydrochlorothiazide tab 5-6.25 mg bisoprolol & hydrochlorothiazide tab 10-6.25 mg metoprolol & hydrochlorothiazide tab 50-25 mg metoprolol & hydrochlorothiazide tab 100-25 mg metoprolol & hydrochlorothiazide tab 100-50 mg irbesartan-hydrochlorothiazide tab 150-12.5 mg
irbesartan-hydrochlorothiazide tab 300-12.5 mg
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 32 AGE - Age Limit GNDR - Gender Edit
losartan potassium & hydrochlorothiazide tab 50-12.5 mg
losartan potassium & hydrochlorothiazide tab 100-12.5 mg
losartan potassium & hydrochlorothiazide tab 100-25 mg
valsartan-hydrochlorothiazide tab 80-12.5 mg valsartan-hydrochlorothiazide tab 160-12.5 mg valsartan-hydrochlorothiazide tab 160-25 mg valsartan-hydrochlorothiazide tab 320-12.5 mg valsartan-hydrochlorothiazide tab 320-25 mg
DIURETICS CARBONIC ANHYDRASE INHIBITORS
acetazolamide tab 125 mg acetazolamide tab 250 mg acetazolamide cap er 12hr 500 mg methazolamide tab 25 mg methazolamide tab 50 mg
LOOP DIURETICS bumetanide tab 0.5 mg bumetanide tab 1 mg bumetanide tab 2 mg furosemide tab 20 mg furosemide tab 40 mg furosemide tab 80 mg furosemide oral soln 8 mg/ml furosemide oral soln 10 mg/ml torsemide tab 5 mg
torsemide tab 10 mg torsemide tab 20 mg torsemide tab 100 mg
POTASSIUM SPARING DIURETICS amiloride hcl tab 5 mg spironolactone tab 25 mg spironolactone tab 50 mg spironolactone tab 100 mg
THIAZIDES AND THIAZIDE-LIKE DIURETICS chlorthalidone tab 25 mg chlorthalidone tab 50 mg hydrochlorothiazide cap 12.5 mg hydrochlorothiazide tab 12.5 mg hydrochlorothiazide tab 25 mg hydrochlorothiazide tab 50 mg indapamide tab 1.25 mg
indapamide tab 2.5 mg
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 33 AGE - Age Limit GNDR - Gender Edit
metolazone tab 2.5 mg
metolazone tab 5 mg metolazone tab 10 mg
DIURETIC COMBINATIONS amiloride & hydrochlorothiazide tab 5-50 mg spironolactone & hydrochlorothiazide tab 25-25 mg ALDACTAZIDE TAB 50/50 triamterene & hydrochlorothiazide cap 37.5-25 mg triamterene & hydrochlorothiazide tab 37.5-25 mg triamterene & hydrochlorothiazide tab 75-50 mg
VASOPRESSORS VASOPRESSORS
midodrine hcl tab 2.5 mg midodrine hcl tab 5 mg midodrine hcl tab 10 mg
ANAPHYLAXIS THERAPY AGENTS EPIPEN-JR INJ 0.15MG QL (8 pens / year) epinephrine solution auto-injector 0.15 mg/0.15ml QL (4 pens / year)
(1:1000) epinephrine solution auto-injector 0.3 mg/0.3ml QL (8 pens / year)
(1:1000) ANTIHYPERLIPIDEMICS
BILE ACID SEQUESTRANTS cholestyramine powder 4 gm/dose cholestyramine powder packets 4 gm cholestyramine light powder 4 gm/dose prevalite pow 4gm cholestyramine light powder packets 4 gm
prevalite pow 4gm pk colestipol hcl tab 1 gm
colestipol hcl granules 5 gm colestipol hcl granule packets 5 gm
FIBRIC ACID DERIVATIVES fenofibrate tab 48 mg fenofibrate tab 54 mg fenofibrate tab 145 mg fenofibrate tab 160 mg fenofibrate micronized cap 67 mg fenofibrate micronized cap 134 mg fenofibrate micronized cap 200 mg gemfibrozil tab 600 mg
INTESTINAL CHOLESTEROL ABSORPTION INHIBITORS ezetimibe tab 10 mg
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 34 AGE - Age Limit GNDR - Gender Edit
PROPROTEIN CONVERTASE SUBTILISIN/KEXIN TYPE 9 INHIBITORS PRALUENT INJ 75MG/ML QL (2.16 injections / 30
days), PA PRALUENT INJ 75MG/ML SP, QL (2.16 injections / 30
days), PA PRALUENT INJ 150MG/ML QL (2.16 injections / 30
days), PA PRALUENT INJ 150MG/ML SP, QL (2.16 injections / 30
days), PA
HMG COA REDUCTASE INHIBITORS atorvastatin calcium tab 10 mg (base equivalent) atorvastatin calcium tab 20 mg (base equivalent) atorvastatin calcium tab 40 mg (base equivalent) atorvastatin calcium tab 80 mg (base equivalent) lovastatin tab 10 mg lovastatin tab 20 mg
lovastatin tab 40 mg pravastatin sodium tab 10 mg pravastatin sodium tab 20 mg pravastatin sodium tab 40 mg pravastatin sodium tab 80 mg simvastatin tab 5 mg simvastatin tab 10 mg simvastatin tab 20 mg simvastatin tab 40 mg simvastatin tab 80 mg
NICOTINIC ACID DERIVATIVES niacin tab er 500 mg (antihyperlipidemic) niacin tab er 750 mg (antihyperlipidemic) niacin tab er 1000 mg (antihyperlipidemic)
CARDIOVASCULAR AGENTS - MISC.
PULMONARY HYPERTENSION - PROSTACYCLIN RECEPTOR AGONIST UPTRAVI TAB 200MCG SP, PA UPTRAVI TAB 400MCG SP, PA
UPTRAVI TAB 600MCG SP, PA
UPTRAVI TAB 800MCG SP, PA
UPTRAVI TAB 1000MCG SP, PA
UPTRAVI TAB 1200MCG SP, PA
UPTRAVI TAB 1400MCG SP, PA
UPTRAVI TAB 1600MCG SP, PA
UPTRAVI TAB 200/800 SP, PA
PULMONARY HYPERTENSION - PHOSPHODIESTERASE INHIBITORS sildenafil citrate tab 20 mg QL (3 tabs / 1 day), PA sildenafil citrate tab 20 mg SP, QL (3 tabs / 1 day), PA
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 35 AGE - Age Limit GNDR - Gender Edit
REVATIO SUS 10MG/ML SP, QL (225 mL / 30 days),
PA
PULMONARY HYPERTENSION - ENDOTHELIN RECEPTOR ANTAGONISTS
LETAIRIS TAB 5MG SP, QL (1 tab / 1 day), PA LETAIRIS TAB 10MG SP, QL (1 tab / 1 day), PA
TRACLEER TAB 62.5MG SP, QL (2 tabs / 1 day), PA
TRACLEER TAB 125MG SP, QL (2 tabs / 1 day), PA
OPSUMIT TAB 10MG SP, QL (1 tab / 1 day), PA
PROSTAGLANDIN VASODILATORS epoprostenol sodium for inj 0.5 mg SP, PA VELETRI INJ 0.5MG SP, PA
epoprostenol sodium for inj 1.5 mg SP, PA
VELETRI INJ 1.5MG SP, PA
TYVASO REFIL SOL 0.6MG/ML SP, QL (87 mL / 30 days),
PA TYVASO SOL 0.6MG/ML SP, QL (87 mL / 30 days),
PA TYVASO START SOL 0.6MG/ML SP, QL (87 mL / 30 days),
PA ORENITRAM TAB 0.125MG SP, PA
ORENITRAM TAB 0.25MG SP, PA
ORENITRAM TAB 1MG SP, PA
ORENITRAM TAB 2.5MG SP, PA
ORENITRAM TAB 5MG SP, PA
REMODULIN INJ 1MG/ML SP, PA
REMODULIN INJ 2.5MG/ML SP, PA
REMODULIN INJ 5MG/ML SP, PA
REMODULIN INJ 10MG/ML SP, PA
SINUS NODE INHIBITORS CORLANOR TAB 5MG CORLANOR TAB 7.5MG
CARDIOVASCULAR AGENTS MISC. - COMBINATIONS ENTRESTO TAB 24-26MG ENTRESTO TAB 49-51MG ENTRESTO TAB 97-103MG
ANTIHISTAMINES ANTIHISTAMINES - ALKYLAMINES
aller-chlor tab 4mg OTC allergy relf tab 4mg OTC
allergy tab 4mg OTC
allergy-time tab 4mg OTC
chlor-phenir tab 4mg OTC
chlorhist tab 4mg OTC
chlorpheniramine maleate tab 4 mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 36 AGE - Age Limit GNDR - Gender Edit
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 36 AGE - Age Limit GNDR - Gender Edit
cvs allergy tab 4mg OTC
eq chlortabs tab 4mg OTC
eql allergy tab 4mg OTC
gnp allergy tab 4mg OTC
hm allergy tab 4mg OTC
pharbechlor tab 4mg OTC
ra allergy tab 4mg OTC
ra chlorphen tab 4mg OTC
sm allergy tab 4mg OTC
wal-finate tab 4mg OTC
allergy relf tab 12mg cr OTC
allergy tab 12mg cr OTC
chlorphen sr tab 12mg OTC
chlorpheniramine maleate tab er 12 mg OTC
diabet tuss syp allergy OTC
ed chlorped syp jr OTC
ANTIHISTAMINES - ETHANOLAMINES allergy relf tab 1.34mg OTC
dayhist alrg tab 12 hour OTC
eq dayhist tab 1.34mg OTC
gnp dayhist tab 1.34mg OTC
px dayhist tab 1.34mg OTC
clemastine fumarate tab 2.68 mg
aler-cap cap 25mg OTC
allergy cap 25mg OTC
allergy med cap 25mg OTC
allergy rel cap 25mg OTC
allergy relf cap 25mg OTC
antihistamin cap 25mg OTC
banophen cap 25mg OTC
comp allergy cap 25mg OTC
cvs allergy cap 25mg OTC
diphenhist cap 25mg OTC
diphenhydramine hcl cap 25 mg OTC
eq allergy cap 25mg OTC
genahist cap 25mg OTC
geri-dryl cap 25mg OTC
gnp allergy cap 25mg OTC
hm allergy cap 25mg OTC
medi-phedryl cap 25mg OTC
pharbedryl cap 25mg OTC
px allergy cap 25mg OTC
sm allergy cap relief OTC
wal-dryl cap 25mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 37 AGE - Age Limit GNDR - Gender Edit
banophen cap 50mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 38 AGE - Age Limit GNDR - Gender Edit
diphenhydramine hcl cap 50 mg OTC
ormir cap 50mg OTC
pharbedryl cap 50mg
pharbedryl cap 50mg OTC
a-s pls alrg tab 25mg OTC
alertab tab 25mg OTC
allergy med tab 25mg OTC
allergy rel tab 25mg OTC
allergy relf tab 25mg OTC
allergy tab 25mg OTC
anti-hist tab 25mg OTC
banophen tab 25mg OTC
comp allergy tab 25mg OTC
comp allergy tab 25mg med OTC
cvs allergy tab 25mg OTC
diphen tab 25mg OTC
diphenhist tab 25mg OTC
diphenhydramine hcl tab 25 mg OTC
eql allergy tab 25mg OTC
geri-dryl tab 25mg OTC
gnp allergy tab 25mg OTC
hm allergy tab 25mg OTC
kls allergy tab 25mg OTC
px allergy tab 25mg OTC
ra allergy tab 25mg OTC
sb allergy tab 25mg med OTC
sm allergy tab 25mg OTC
sm allergy tab 25mg rlf OTC
total allerg tab 25mg OTC
wal-dryl tab 25mg OTC
ALER-DRYL TAB 50MG OTC
gnp allergy chw 12.5mg OTC
allergy chld liq 12.5/5ml OTC
allergy liq 12.5/5ml OTC
allergy med liq 12.5/5ml OTC
allergy relf liq 12.5/5ml OTC
allergy relf liq 50/20ml OTC
banophen liq 12.5/5ml OTC
chld allergy liq 12.5/5ml OTC
cvs allergy liq 25/10ml OTC
diphedryl liq 12.5/5ml OTC
diphenhist liq 12.5/5ml OTC
diphenhydramine hcl liquid 12.5 mg/5ml OTC
geri-dryl liq 12.5/5ml OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 39 AGE - Age Limit GNDR - Gender Edit
naramin liq OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 38 AGE - Age Limit GNDR - Gender Edit
pediacare al liq 12.5/5ml OTC
siladryl alr liq 12.5/5ml OTC
total allerg liq 12.5/5ml OTC
wal-dryl liq 12.5/5ml OTC
allergy rel elx 12.5/5ml OTC
diphenhydramine hcl elixir 12.5 mg/5ml
allrgy melts tab 12.5mg OTC
allrgy relf tab 12.5mg OTC
cvs allergy chw 12.5mg OTC
cvs allergy tab chldrn OTC
eql allergy tab chldrn OTC
wal-dryl alr tab 12.5mg OTC
ANTIHISTAMINES - PHENOTHIAZINES promethazine hcl tab 12.5 mg promethazine hcl tab 25 mg promethazine hcl tab 50 mg promethazine hcl syrup 6.25 mg/5ml phenadoz sup 12.5mg
promethazine hcl suppos 12.5 mg promethegan sup 12.5mg phenadoz sup 25mg promethazine hcl suppos 25 mg promethegan sup 25mg promethazine hcl suppos 50 mg promethegan sup 50mg
ANTIHISTAMINES - PIPERIDINES cyproheptadine hcl tab 4 mg cyproheptadine hcl syrup 2 mg/5ml
ANTIHISTAMINES - NON-SEDATING all day allg cap 10mg OTC
allergy relf cap 10mg OTC
wal-zyr cap 10mg OTC
cetirizine tab 5mg OTC
all day allg tab 10mg OTC
aller-tec tab 10mg OTC
allergy 24hr tab 10mg OTC
allergy rel tab 10mg OTC
allergy relf tab 10mg OTC
allergy rlf tab 10mg OTC
cetirizine hcl tab 10 mg OTC
cvs allergy tab 10mg OTC
eql all day tab allergy OTC
gnp all day tab allergy OTC
qc allergy tab 10mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 39 AGE - Age Limit GNDR - Gender Edit
ra cetirizin tab 10mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 39 AGE - Age Limit GNDR - Gender Edit
sb allergy tab 10mg OTC
sm all day tab 10mg OTC
sm all day tab allergy OTC
wal-zyr tab 10mg OTC
cetirizine chw 5mg OTC
wal-zyr chw 5mg OTC
allergy relf chw 10mg OTC
cetirizine chw 10mg OTC
wal-zyr chw 10mg OTC
all day allg sol 1mg/ml OTC
all day allg sol 5mg/5ml OTC
all-day allg sol 5mg/5ml OTC
aller-tec sol 1mg/ml OTC
allergy chld sol 1mg/ml OTC
allergy rel sol 1mg/ml OTC
allergy relf sol 5mg/5ml OTC
cetirizine hcl oral soln 1 mg/ml (5 mg/5ml)
cetirizine sol 1mg/ml OTC
cetirizine sol 5mg/5ml OTC
child allrgy sol 5mg/5ml OTC
wal-zyr chld sol 5mg/5ml OTC
wal-zyr sol 1mg/ml OTC
wal-zyr sol 5mg/5ml OTC
ZYRTEC ALLGY TAB 10MG OTC
ZYRTEC CHILD TAB 10MG OTC
aller-ease tab 60mg OTC
allergy relf tab 60mg OTC
fexofenadine hcl tab 60 mg OTC
fexofenadine tab 60mg OTC
wal-fex alrg tab 60mg 12h OTC
aller-ease tab 180mg OTC
aller-fex tab 180mg OTC
allergy relf tab 180mg OTC
allergy tab 180mg OTC
cvs allergy tab 180mg OTC
fexofenadine hcl tab 180 mg OTC
fexofenadine tab 180mg OTC
gnp allergy tab 180mg OTC
24hr allergy tab 180mg OTC
mucinex allr tab 180mg OTC
wal-fex allr tab 180mg OTC
wal-fex tab 180mg OTC
allergy rlf sus 30/5ml OTC
ALLEGRA ALRG TAB 30MG OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 40 AGE - Age Limit GNDR - Gender Edit
loratadine cap 10 mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 41 AGE - Age Limit GNDR - Gender Edit
allerclear tab 10mg OTC
allergy relf tab 10mg OTC
allergy rlf tab 10mg OTC
allergy tab 10mg OTC
kp loratadin tab 10mg OTC
loradamed tab 10mg OTC
loratadine tab 10 mg OTC
sm loratadin tab 10mg OTC
wal-itin tab 10mg OTC
ALLERGY RLF CHW 5MG OTC
loratadine chw 5mg OTC
allergy chld syp 5mg/5ml OTC
allergy relf syp 5mg/5ml OTC
claritin sol 5mg/5ml OTC
loratadine sol 5mg/5ml OTC
loratadine sol 10/10ml OTC
loratadine syp 5mg/5ml OTC
wal-itin chl sol 5mg/5ml OTC
wal-itin syp 5mg/5ml OTC
CLARITIN RDT TAB 5MG OTC
alavert tab 10mg OTC
allergy relf tab 10mg OTC
loratadine tab 10mg OTC
triaminic tab 10mg OTC
wal-itin tab 10mg OTC
wal-vert tab 10mg OTC
NASAL AGENTS - SYSTEMIC AND TOPICAL SYMPATHOMIMETIC DECONGESTANTS
decongestant tab 30mg OTC eq suphedrin tab 30mg OTC
genaphed tab 30mg OTC
gnp deconge tab 30mg OTC
nasal decong tab 30mg OTC
pseudoephedr tab 30mg OTC
ra suphedrin tab 30mg OTC
sm nasal dec tab 30mg OTC
sudogest tab 30mg OTC
suphedrine tab 30mg OTC
wal-phed tab 30mg OTC
pseudoephedr tab 60mg OTC
sudogest tab 60mg OTC
child silfed liq 15mg/5ml OTC
gnp suphedrn liq 15mg/5ml OTC
NASAL DECONG LIQ 30MG/5ML OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 42 AGE - Age Limit GNDR - Gender Edit
NASAL DECON SYP 30MG/5ML OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 41 AGE - Age Limit GNDR - Gender Edit
decongestant tab 120mg er OTC, QL (60 tabs / 30 days)
12hr deconge tab 120mg cr OTC, QL (60 tabs / 30 days)
nasal decong tab 120mg er OTC, QL (60 tabs / 30 days)
pseudoephedr tab 120mg er OTC, QL (60 tabs / 30 days)
qc suphedrin tab 120mg sr OTC, QL (60 tabs / 30 days)
ra suphedrin tab 120mg cr OTC, QL (60 tabs / 30 days)
sudafed 12hr tab 120mg cr OTC, QL (60 tabs / 30 days)
sudogest tab 120mg er OTC, QL (60 tabs / 30 days)
tgt sinus tab 120mg OTC, QL (60 tabs / 30 days)
wal-phed d tab 120mg OTC, QL (60 tabs / 30 days)
wal-phed tab 120mg er OTC, QL (60 tabs / 30 days)
SUDAFED 24HR TAB 240MG OTC, QL (30 tabs / 30 days)
NASAL STEROIDS budesonide nasal susp 32 mcg/act OTC, QL (1 bottle / 30 days) budesonide sus 32mcg OTC, QL (1 bottle / 30 days)
budesonide sus nasal OTC, QL (1 bottle / 30 days)
rhinocort sus allergy OTC, QL (1 bottle / 30 days)
rhinocort sus allergy OTC, QL (1.686 bottles / 30
days) flunisolide nasal soln 25 mcg/act (0.025%) QL (2 bottles / 25 days)
aller-flo spr 50mcg OTC, QL (1.013 bottles / 25
days) allergy nasa spr 50mcg OTC, QL (1.013 bottles / 25
days) allergy nasa spr 50mcg OTC, QL (1.616 bottles / 25
days) allergy relf spr 50mcg OTC, QL (1.013 bottles / 25
days) allergy relf spr 50mcg OTC, QL (1.616 bottles / 25
days) clarispray spr 50mcg OTC, QL (1.013 bottles / 25
days) clarispray spr 50mcg OTC, QL (1.616 bottles / 25
days) fluticasone propionate nasal susp 50 mcg/act QL (1 bottle / 25 days)
fluticasone propionate nasal susp 50 mcg/act OTC, QL (1.013 bottles / 25
days) fluticasone spr 50mcg OTC, QL (1.013 bottles / 25
days) fluticasone spr 50mcg OTC, QL (1.616 bottles / 25
days) allergy nasa spr 24hr OTC, QL (1.006 bottles / 25
days) 24 hr nasal spr allergy OTC, QL (1.006 bottles / 25
days) nasal allerg spr 55mcg OTC, QL (1.006 bottles / 25
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 41 AGE - Age Limit GNDR - Gender Edit
days)
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 42 AGE - Age Limit GNDR - Gender Edit
nasal allgy spr 55mcg/ac OTC, QL (1.006 bottles / 25
days) nasal allrgy spr 55mcg/ac OTC, QL (1.006 bottles / 25
days) ra nasal spr allergy OTC, QL (1.006 bottles / 25
days) triamcinolone acetonide nasal aerosol suspension OTC, QL (1.006 bottles / 25
55 mcg/act days)
NASAL ANTICHOLINERGICS ipratropium bromide nasal soln 0.03% (21 mcg/spray) ipratropium bromide nasal soln 0.06% (42
mcg/spray)
NASAL ANTIALLERGY azelastine hcl nasal spray 0.1% (137 mcg/spray) QL (2 bottles / 25 days) cromolyn sodium nasal aerosol soln 5.2 mg/act OTC (4%)
NASAL AGENTS - MISC. RHINARIS SPR 0.2% OTC afrin saline spr 0.65% OTC
altamist spr 0.65% OTC
ayr spr 0.65% OTC
baby ayr spr 0.65% OTC
deep sea spr 0.65% OTC
hm saline spr 0.65% OTC
little noses dro stuf nos OTC
little noses spr 0.65% OTC
nasal moist spr 0.65% OTC
nasal saline spr 0.65% OTC
ocean kids spr 0.65% OTC
saline mist spr 0.65% OTC
saline nasal spray 0.65% OTC
saline nose spr 0.65% OTC
sb saline spr 0.65% OTC
tgt nasal spr 0.65% OTC
AYR NASAL DRO 0.65% OTC
CVS NASAL SPR MIST OTC
RA STERILE SOL NASAL OTC
SIMPLY SALIN AER 0.9% OTC
COUGH/COLD/ALLERGY ANTITUSSIVES
hydrocodone w/ homatropine tab 5-1.5 mg hydrocodone w/ homatropine syrup 5-1.5 mg/5ml hydromet syp 5-1.5/5
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 42 AGE - Age Limit GNDR - Gender Edit
benzonatate cap 100 mg
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 43 AGE - Age Limit GNDR - Gender Edit
benzonatate cap 200 mg
EXPECTORANTS coughtab tab 200mg OTC
guaifenesin tab 200 mg OTC
mucus relief tab 200mg OTC
refenesen tab 200mg OTC
sb coughtab tab 200mg OTC
bidex tab 400mg OTC
chest conges tab 400mg OTC
fenesin ir tab 400mg OTC
g-fen ex tab 400mg OTC
guaifenesin tab 400 mg OTC
liquibid tab 400mg OTC
medifin 400 tab 400mg OTC
mucosa tab 400mg OTC
pharbinex tab 400mg OTC
refenesen tab 400mg OTC
tab tussin tab 400mg OTC
xpect tab 400mg OTC
buckleys liq chest OTC
chest conges liq 100/5ml OTC
chest conges liq childrns OTC
diabetic tus liq 100/5ml OTC
guaifenesin liquid 100 mg/5ml OTC
mucinex chld liq 100/5ml OTC
mucus relief liq 100/5ml OTC
mucus relief liq 400/20ml OTC
mucus+chst liq 100/5ml OTC
mucus+chst liq 200/10ml OTC
px tussin sol 100/5ml OTC
qc medifin liq mucus rl OTC
ra tussin liq 100/5ml OTC
robafen liq 200/10ml OTC
scot-tussin liq expct sf OTC
siltuss das liq 100/5ml OTC
tussin adult liq 100/5ml OTC
tussin mucus liq 100/5ml OTC
tussin mucus liq 200/10ml OTC
wal-tussin liq 100/5ml OTC
altarussin syp 100/5ml OTC
cough syp OTC
cough syp 100/5ml OTC
diabtc tussn syp 100/5ml OTC
geri-tussin syp 100/5ml OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 44 AGE - Age Limit GNDR - Gender Edit
ra tussin syp 100/5ml OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 45 AGE - Age Limit GNDR - Gender Edit
robafen syp 100/5ml OTC
sb cgh contr syp 100/5ml OTC
siltussin sa syp 100/5ml OTC
tussin chest syp 100/5ml OTC
tussin syp 100/5ml OTC
wal-tussin syp 100/5ml OTC
MUCINEX/KIDS GRA 100MG OTC
cvs mucus er tab 600mg OTC
eq mucus er tab 600mg OTC
gnp mucus er tab 600mg OTC
mucus relief tab 600mg OTC
mucus relief tab 600mg er OTC
pa mucus rel tab 600mg OTC
sm mucus rel tab 600mg er OTC
cvs mucus tab 1200 er OTC
eql mucus-er tab 1200mg OTC
gnp mucus er tab 1200mg OTC
guaifenesin tab er 12hr 1200 mg OTC
hm mucus er tab 1200mg OTC
mucus er tab 1200mg OTC
mucus relief tab 1200 er OTC
mucus relief tab 1200mg OTC
sm mucus rel tab 1200 er OTC
SSKI SOL 1GM/ML
MISC. RESPIRATORY INHALANTS sodium chloride soln nebu 0.9% nebusal neb 3% sodium chloride soln nebu 3%
pulmosal neb 7% sodium chloride soln nebu 7%
sodium chloride soln nebu 10% simply salin aer baby OTC
sodium chloride aero soln 0.9% OTC
COUGH/COLD/ALLERGY COMBINATIONS cold/allergy elx children OTC rynex pse liq OTC
wal-tap elx cld/alle OTC
all day alrg tab 5-120mg OTC
aller-tec d tab 5-120mg OTC
allergy d tab 5-120mg OTC
allergy relf tab 5-120mg OTC
allergy+ con tab 5-120mg OTC
allergy-d tab 5-120mg OTC
allgy comp-d tab 5-120mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 46 AGE - Age Limit GNDR - Gender Edit
allrgy relf tab 5-120mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 45 AGE - Age Limit GNDR - Gender Edit
allrgy rlf-d tab 5-120mg OTC
cetirizine-pseudoephedrine tab er 12hr 5-120 mg OTC ra cetiri-d tab 5-120mg OTC wal-zyr d tab 5-120mg OTC
alavert alrg tab /sinus OTC
allerclear d tab 5-120mg OTC
allergy relf tab 5-120mg OTC
allergy relf tab d12 OTC
allergy/cong tab 5-120mg OTC
allrgy rlf-d tab 5-120mg OTC
loratadine d tab 5-120mg OTC
loratadine-d tab 5-120mg OTC
wal-itin d tab 5-120mg OTC
aller/conges tab 10-240mg OTC
allerclear d tab 10-240mg OTC
allergy rel/ tab deconges OTC
allergy relf tab /nsl dec OTC
allergy relf tab d OTC
allergy relf tab d 24 hr OTC
allergy relf tab d-24 OTC
allergy relf tab deconges OTC
allrgy rel d tab 10-240mg OTC
allrgy rlf-d tab 10-240mg OTC
eql allergy tab 10-240mg OTC
lorata-dine tab d 24hr OTC
loratadine-d tab 10-240mg OTC
ra lorata-d tab 24 hour OTC
tgt allergy/ tab congest OTC
wal-itin d tab 10-240mg OTC
wal-itin d tab 24 hour OTC
allergy d tab 60-120mg OTC
allergy+cong tab relief-d OTC
allergy-d tab 12 hour OTC
allergy-d tab 60-120mg OTC
fexofenadine-pseudoephedrine tab er 12hr 60-120
mg fexofenadine-pseudoephedrine tab er 12hr 60-120 OTC
mg wal-fex d tab 12 hour OTC
fexofenadine-pseudoephedrine tab er 24hr OTC 180-240 mg wal-fex d tab 24 hour OTC
promethazine & phenylephrine syrup 6.25-5
mg/5ml ENTRE-HIST LIQ 0.938-10 OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 45 AGE - Age Limit GNDR - Gender Edit
promethazine w/ codeine syrup 6.25-10 mg/5ml
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 46 AGE - Age Limit GNDR - Gender Edit
promethazine-phenylephrine-codeine syrup
6.25-5-10 mg/5ml promethazine-dm syrup 6.25-15 mg/5ml
BROTAPP DM LIQ 15-1-5/5 OTC
bromfed dm syp
pseudoephed-bromphen-dm syrup 30-2-10
mg/5ml altarussin syp -pe OTC
cvs mucus d tab 60-600mg OTC
gnp mucus d tab 12hr OTC
mucus d tab 60-600mg OTC
mucus relf d tab 60-600mg OTC
mucus relief tab 60-600mg OTC
mucus rlf d tab 60-600mg OTC
mucus-d tab 60-600mg OTC
pseudoephedrine-guaifenesin tab er 12hr 60-600 OTC mg mucus d tab 120/1200 OTC
mucus rlf d tab 120-1200 OTC
CODITUSSIN LIQ AC OTC
m-clear wc liq 100-6.3 OTC
cheratussin syp ac OTC
g tussin ac liq 100-10/5 OTC
guaiatussin syp 100-10/5 OTC
guaifenesin syp 100-10/5 OTC
guaifenesin-codeine soln 100-10 mg/5ml OTC robafen ac sol 100-10/5 OTC virtussin ac sol 100-10/5 OTC vcks dayquil liq mucus dm OTC
cgh cong dm liq 5-100/5 OTC
childrens liq 5-100mg OTC
cong/cough liq 5-100/5 OTC
cough child liq 5-100/5 OTC
cough/chest liq 20-400 OTC
cough/chest liq dm child OTC
delsym cough liq congs dm OTC
dm max adult liq 20-400 OTC
gnp mucus liq rlf dm OTC
muc/cgh relf liq 5-100mg OTC
mucinex cgh liq 5-100mg OTC
mucinex dm liq 20-400 OTC
mucus rel dm liq 5-100/5 OTC
mucus relief liq 5-100mg OTC
mucus rlf dm liq 5-100/5 OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 47 AGE - Age Limit GNDR - Gender Edit
recofen "d" liq 5-100mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 48 AGE - Age Limit GNDR - Gender Edit
robitussin liq OTC
robitussin liq 20-400 OTC
sm tussin dm liq 5-100/5 OTC
tussin dm liq 20-400mg OTC
biocotron liq 100-10/5 OTC
diabetic tus liq children OTC
diabetic tus liq dm OTC
giltuss cgh liq & chest OTC
gnp tussin liq dm OTC
gnp tussin liq dm cough OTC
guaiasorb dm liq 100-10/5 OTC
hm tussin liq adlt dm OTC
ped formula liq 100-10/5 OTC
px tussin dm liq 100-10/5 OTC
ra tussin dm liq 100-10/5 OTC
robafen dm liq 10-100/5 OTC
robafen dm liq 10-100mg OTC
robafen dm liq cough OTC
robitussin liq cgh/cong OTC
robitussin liq to go dm OTC
safe tussin liq 10-100/5 OTC
sb cgh contr liq dm OTC
siltussin dm liq das OTC
siltussin-dm liq diabetic OTC
sorbugen nr liq OTC
tgt cough liq form dm OTC
tusnel diabt liq 10-100/5 OTC
tussin adult liq cgh/cong OTC
tussin cough liq 10-100/5 OTC
tussin dm liq OTC
tussin dm liq 10-100/5 OTC
tussin dm liq 10-100mg OTC
tussin dm liq 100-10/5 OTC
wal-tussin liq 10-100/5 OTC
wal-tussin liq dm OTC
cough cont liq dm max OTC
diabetic tus liq max st OTC
eq tussin dm liq max OTC
eql tussin liq 10-200 OTC
gnp tussin liq dm max OTC
hm tussin liq dm max OTC
ra tussin liq dm max OTC
siltussin-dm liq max st OTC
sm tussin dm liq max OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 49 AGE - Age Limit GNDR - Gender Edit
tussin dm liq 10-200mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 48 AGE - Age Limit GNDR - Gender Edit
tussin dm liq max OTC
tussin dm mx liq 10-200/5 OTC
wal-tussin liq dm max OTC
intense coug liq reliever OTC
intense coug liq reliever OTC
medi-tuss dm liq dbl str OTC
neotuss liq OTC
altarussn dm syp 100-10/5 OTC
cough/chest syp dm OTC
dextromethorphan-guaifenesin syrup 10-100 OTC mg/5ml eq tussin dm syp cgh/chst OTC
eql tussin syp dm OTC
extra action syp 10-100/5 OTC
geri-tussin syp dm OTC
guaicon dms syp 100-10/5 OTC
medi-tussin syp dm OTC
robafen dm syp 100-10/5 OTC
siltussin-dm syp alc free OTC
sm tussin dm syp 100-10/5 OTC
sm tussin syp dm OTC
tussin dm syp 100-10/5 OTC
wal-tussin syp dm OTC
MUCINEX CGH GRA 5-100MG OTC
eql mucus-dm tab 30-600cr OTC
mucus relief tab 30-600er OTC
mucus rlf dm tab 30-600er OTC
mucus-dm tab 30-600mg OTC
eql mucus-dm tab 60-1200 OTC
mucus relief tab 60-1200 OTC
mucus-dm max tab 60-1200 OTC
TUSNEL C SYP OTC
virtussin sol dac OTC
sm tussin cf liq OTC
wal-tussin liq cf OTC
ANTIASTHMATIC AND BRONCHODILATOR AGENTS BRONCHODILATORS - ANTICHOLINERGICS
ipratropium bromide inhal soln 0.02% QL (375.6 vials / 75 days) ipratropium bromide inhal soln 0.02% QL (939 mL / 75 days) INCRUSE ELPT INH 62.5MCG
ANTI-INFLAMMATORY AGENTS cromolyn sodium soln nebu 20 mg/2ml
SYMPATHOMIMETICS albuterol sulfate tab 2 mg
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 49 AGE - Age Limit GNDR - Gender Edit
albuterol sulfate tab 4 mg
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 50 AGE - Age Limit GNDR - Gender Edit
albuterol sulfate syrup 2 mg/5ml
albuterol sulfate soln nebu 0.083% (2.5 mg/3ml) QL (1125 each / 75 days)
albuterol sulfate soln nebu 0.5% (5 mg/ml) QL (180 each / 75 days)
albuterol sulfate soln nebu 0.5% (5 mg/ml) QL (180 mL / 75 days)
albuterol sulfate soln nebu 0.63 mg/3ml (base QL (1125 each / 75 days) equiv) albuterol sulfate soln nebu 1.25 mg/3ml (base QL (1125 each / 75 days) equiv) albuterol sulfate inhal aero 108 mcg/act (90mcg base equiv) VENTOLIN HFA AER QL (6 inhalers / 75 days)
albuterol sulfate tab er 12hr 4 mg
albuterol sulfate tab er 12hr 8 mg STRIVERDI AER 2.5MCG QL (1 inhaler / 25 days) terbutaline sulfate tab 2.5 mg
terbutaline sulfate tab 5 mg ipratropium-albuterol nebu soln 0.5-2.5(3) mg/3mlQL (1620 mL / 75 days) COMBIVENT AER 20-100 QL (2 inhalers / 25 days) SYMBICORT AER 80-4.5 ST SYMBICORT AER 160-4.5 ST
fluticasone-salmeterol aer powder ba 113-14 QL (1.2 inhalers / 30 days) mcg/act fluticasone-salmeterol aer powder ba 100-50 QL (60 inhalations / 25 mcg/dose days), ST wixela inhub aer 100/50 QL (60 inhalations / 25
days), ST fluticasone-salmeterol aer powder ba 232-14 QL (1.2 inhalers / 30 days)
mcg/act DULERA AER 100-5MCG QL (1 inhaler / 25 days), ST
DULERA AER 100-5MCG QL (1.477 inhalers / 25
days), ST DULERA AER 200-5MCG QL (1 inhaler / 25 days), ST
DULERA AER 200-5MCG QL (1.477 inhalers / 25
days), ST ANORO ELLIPT AER 62.5-25 QL (60 blisters / 25 days)
XANTHINES ELIXOPHYLLIN ELX 80/15ML theophylline soln 80 mg/15ml
THEO-24 CAP 100MG CR THEO-24 CAP 200MG CR THEO-24 CAP 300MG CR THEO-24 CAP 400MG ER theochron tab 100mg cr
theophylline tab er 12hr 100 mg theochron tab 200mg cr theophylline tab er 12hr 200 mg
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 51 AGE - Age Limit GNDR - Gender Edit
theochron tab 300mg cr
theophylline tab er 12hr 300 mg theophylline tab er 12hr 450 mg theophylline tab er 24hr 400 mg theophylline tab er 24hr 600 mg
STEROID INHALANTS QVAR REDIHAL AER 40MCG QL (10.599 gm / 30 days) QVAR REDIHA AER 80MCG QL (10.599 gm / 30 days)
budesonide inhalation susp 0.25 mg/2ml QL (120 mL / 25 days)
budesonide inhalation susp 0.5 mg/2ml QL (120 mL / 25 days) budesonide inhalation susp 1 mg/2ml QL (60 mL / 25 days) ARNUITY ELPT INH 100MCG QL (1 blister / 1 day) ARNUITY ELPT INH 200MCG QL (1 blister / 1 day)
FLOVENT DISK AER 50MCG QL (2 inhalations / 1 day)
FLOVENT DISK AER 100MCG QL (2 inhalations / 1 day)
FLOVENT DISK AER 250MCG QL (2 inhalations / 1 day)
FLOVENT HFA AER 44MCG QL (1 inhaler / 30 days)
FLOVENT HFA AER 110MCG QL (1 inhaler / 30 days)
FLOVENT HFA AER 220MCG QL (1 inhaler / 30 days)
LEUKOTRIENE MODULATORS montelukast sodium tab 10 mg (base equiv) montelukast sodium chew tab 4 mg (base equiv) montelukast sodium chew tab 5 mg (base equiv) montelukast sodium oral granules packet 4 mg (base equiv)
ANTIASTHMATIC - MONOCLONAL ANTIBODIES XOLAIR SOL 150MG SP, QL (6.6 vials / 30 days),
PA
RESPIRATORY AGENTS - MISC. ALPHA-PROTEINASE INHIBITOR (HUMAN)
PROLASTIN-C INJ 1000MG SP, PA GLASSIA INJ SP, PA
PROLASTIN-C INJ 1000MG SP, PA
CYSTIC FIBROSIS AGENTS KALYDECO TAB 150MG SP, QL (2 tabs / 1 day), PA KALYDECO PAK 50MG SP, QL (2 packets / 1 day),
PA KALYDECO PAK 75MG SP, QL (2 packets / 1 day),
PA PULMOZYME SOL 1MG/ML SP, QL (5 mL / 1 day), PA
ORKAMBI TAB 100-125 SP, QL (4 tabs / 1 day), PA
ORKAMBI TAB 200-125 SP, QL (4 tabs / 1 day), PA
ORKAMBI GRA 100-125 SP, QL (2 packets / 1 day),
PA
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 51 AGE - Age Limit GNDR - Gender Edit
ORKAMBI GRA 150-188 SP, QL (2 packets / 1 day), PA
PULMONARY FIBROSIS AGENTS OFEV CAP 100MG SP, QL (2 caps / 1 day), PA
OFEV CAP 150MG SP, QL (2 caps / 1 day), PA
LAXATIVES STIMULANT LAXATIVES
alophen tab 5mg ec OTC
bisacodyl tab 5mg ec OTC
correct tab 5mg ec OTC
correctol tab 5mg ec OTC
cvs c-lax tab 5mg OTC
ducodyl tab 5mg ec OTC
eql gentle tab laxative OTC
eql laxative tab 5mg ec OTC
ex-lax ultra tab 5mg ec OTC
feenamint tab 5mg ec OTC
gentle laxat tab 5mg ec OTC
gnp bisa-lax tab 5mg ec OTC
gnp laxative tab 5mg ec OTC
hm laxative tab 5mg OTC
hm laxative tab 5mg ec OTC
kp bisacodyl tab 5mg ec OTC
laxative tab 5mg ec OTC
qc laxative tab 5mg ec OTC
ra laxative tab 5mg ec OTC
sb bisacodyl tab 5mg ec OTC
sm gentle tab laxative OTC
sm laxative tab 5mg ec OTC
stim laxat tab 5mg ec OTC
vercolate tab 5mg ec OTC
womans laxat tab 5mg ec OTC
womens laxat tab 5mg ec OTC
bisac-evac sup 10mg OTC
bisacodyl sup 10mg OTC
biscolax sup 10mg OTC
fast relief sup 10mg OTC
gentle laxat sup 10mg OTC
gnp laxative sup 10mg OTC
hm laxative sup 10mg OTC
laxative sup 10mg OTC
magic bullet sup 10mg OTC
qc laxative sup 10mg OTC
ra laxative sup 10mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 52 AGE - Age Limit GNDR - Gender Edit
sb laxative sup 10mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 53 AGE - Age Limit GNDR - Gender Edit
sm laxative sup 10mg OTC
SENNA SYP OTC
CORRECTOL MIS HERBAL OTC
SENNA LEAVES MIS OTC
ra senna cap 8.6mg OTC
sennosides cap 8.6 mg OTC
cvs senna tab 8.6mg OTC
dr edwards tab 8.6mg OTC
eq laxative tab 8.6mg OTC
evac-u-gen tab 8.6mg OTC
geri-kot tab 8.6mg OTC
gnp senna tab 8.6mg OTC
hm senna tab 8.6mg OTC
kp senna tab 8.6mg OTC
medi-natural tab 8.6mg OTC
nat veg lax tab 8.6mg OTC
natural lax tab 8.6mg OTC
px laxative tab 8.6mg OTC
qc senna tab 8.6mg OTC
ra senna tab 8.6mg OTC
sb senna-lax tab 8.6mg OTC
senna lax tab 8.6mg OTC
senna laxati tab 8.6mg OTC
senna-lax tab 8.6mg OTC
senna-tabs tab 8.6mg OTC
senna-time tab 8.6mg OTC
senno tab 8.6mg OTC
sennosides tab 8.6 mg OTC
sm senna lax tab 8.6mg OTC
tgt senna tab 8.6mg OTC
laxative tab 15mg OTC
medi-lax tab 15mg OTC
senna smooth tab 15mg OTC
ra laxative tab ex st OTC
senna-extra tab 17.2mg OTC
senokot extr tab 17.2mg OTC
cvs laxative tab 25mg OTC
eq laxative tab 25mg OTC
eql laxative tab 25mg OTC
gnp laxative tab 25mg OTC
laxative tab 25mg OTC
laxative tab max-str OTC
laxative tab w/senna OTC
ra laxative tab 25mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 54 AGE - Age Limit GNDR - Gender Edit
sm laxative tab 25mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 55 AGE - Age Limit GNDR - Gender Edit
sm senna lax tab max str OTC
tgt natural tab laxative OTC
BLK DRAUGHT CHW 10MG OTC
EVAC-U-GEN CHW 10MG OTC
choc laxativ chw 15mg OTC
cvs laxative chw 15mg OTC
eq laxative chw 15mg OTC
eql laxative chw 15mg OTC
laxative chw 15mg OTC
ra laxative chw 15mg OTC
AGORAL LIQ MAX ST OTC
LITTLE TUMMY DRO LAXATIVE OTC
senna-grx syp 8.8mg/5 OTC
sennazon syp 8.8mg/5 OTC
sennosides syrup 8.8 mg/5ml OTC
SURFACTANT LAXATIVES docusate calcium cap 240 mg OTC kao-tin cap 240mg OTC
stool softnr cap 240mg OTC
surfak cap 240mg OTC
ra col-rite cap 50mg OTC
stool softnr cap 50mg OTC
correctol cap 100mg OTC
docu soft cap 100mg OTC
docusate sodium cap 100 mg OTC
docusil cap 100mg OTC
dok cap 100mg OTC
dulcolax pnk cap 100mg OTC
dulcolax ss cap 100mg OTC
easy-lax cap 100mg OTC
eq stool cap softener OTC
hm stool sof cap 100mg OTC
laxa basic cap 100mg OTC
phillips cap 100mg OTC
ra col-rite cap 100mg OTC
stool soften cap 100mg OTC
stool softnr cap 100mg OTC
docusate sodium cap 250 mg OTC
dok cap 250mg OTC
ra col-rite cap 250mg OTC
stool soften cap 250mg OTC
stool softnr cap 250mg OTC
docusate sodium tab 100 mg OTC
dok tab 100mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 56 AGE - Age Limit GNDR - Gender Edit
move along tab 100mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 57 AGE - Age Limit GNDR - Gender Edit
promolaxin tab 100mg OTC
stool softnr tab 100mg OTC
PEDIA-LAX LIQ 50MG OTC
diocto liq 50mg/5ml OTC
docu liq 50mg/5ml OTC
docusate sod liq 50mg/5ml OTC
docusate sodium liquid 150 mg/15ml OTC
silace liq 10mg/ml OTC
diocto syp 60/15ml OTC
docusate sodium syrup 60 mg/15ml OTC
silace syp 60/15ml OTC
stool softnr syp 60/15ml OTC
LAXATIVES - MISCELLANEOUS constulose sol 10gm/15 lactulose solution 10 gm/15ml clearlax pow OTC cvs purelax pow OTC
cvs purelax pow 3350 OTC
eq clearlax pow OTC
eql clearlax pow OTC
gavilax pow OTC
gentlelax pow OTC
glycolax pow 3350 nf OTC
gnp clearlax pow OTC
hm clearlax pow OTC
laxaclear pow OTC
natura-lax pow 3350 nf OTC
polyeth glyc pow 3350 nf OTC
polyethylene glycol 3350 oral powder OTC
powderlax pow OTC
ra laxative pow OTC
sm clearlax pow OTC
smooth lax pow OTC
smooth lax pow 3350 OTC
cvs purelax pak OTC
gnp clearlax pak 3350 nf OTC
polyethylene glycol 3350 oral packet OTC
ra laxative pow OTC
smooth lax pow 3350 nf OTC
LAXATIVE COMBINATIONS colace 2in1 tab 8.6-50mg OTC cvs senna pl tab 8.6-50mg OTC
docuzen tab 8.6-50mg OTC
dok plus tab 8.6-50mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 58 AGE - Age Limit GNDR - Gender Edit
dok plus tab 50-8.6mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 59 AGE - Age Limit GNDR - Gender Edit
easy-lax pls tab 8.6-50mg OTC
eq senna-s tab 8.6-50mg OTC
eql stool tab softener OTC
hm senna-s tab 8.6-50mg OTC
hm stool sof tab 8.6-50mg OTC
lax/stl soft tab 8.6-50mg OTC
laxacin tab 8.6-50mg OTC
laxative pls tab 8.6-50mg OTC
medi-natural tab 8.6-50mg OTC
ra p col-rit tab 8.6-50mg OTC
sb docusate tab 8.6-50mg OTC
senexon-s tab 8.6-50mg OTC
senna plus tab 8.6-50mg OTC
senna s tab 8.6-50mg OTC
senna tab 8.6-50mg OTC
senna-s tab 8.6-50mg OTC
senna-time s tab 8.6-50mg OTC
sennosides-docusate sodium tab 8.6-50 mg OTC sm senna-s tab 8.6-50mg OTC sm stool tab softener OTC stool softnr tab 8.6-50mg OTC
SUPREP BOWEL SOL PREP KIT gavilyte-n sol flav pk
peg 3350-kcl-sod bicarb-nacl for soln 420 gm
trilyte sol gavilyte-g sol peg 3350-kcl-na bicarb-nacl-na sulfate for soln
236 gm gavilyte-c sol
peg 3350-kcl-na bicarb-nacl-na sulfate for soln
240 gm GOLYTELY SOL
ANTIDIARRHEAL/PROBIOTIC AGENTS ANTIPERISTALTIC AGENTS
diphenoxylate w/ atropine tab 2.5-0.025 mg diphenoxylate w/ atropine liq 2.5-0.025 mg/5ml anti-diarrhe cap 2mg OTC loperamide cap 2mg OTC
loperamide hcl cap 2 mg
qc anti-diar cap 2mg OTC
anti-diarrhe tab 2mg OTC
diamode tab 2mg OTC
kls anti-dia tab 2mg OTC
loperamide tab 2mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 60 AGE - Age Limit GNDR - Gender Edit
sm anti-diar tab 2mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 61 AGE - Age Limit GNDR - Gender Edit
anti-diarrhe liq 1mg/5ml OTC
ANTIDIARRHEAL/PROBIOTIC AGENTS - MISC. cvs bismuth tab 262mg OTC
kaopectate tab 262mg OTC
pink bismuth tab 262mg OTC
ra pink bism tab 262mg OTC
sb bismuth tab 262mg OTC
soothe tab 262mg OTC
stom relief tab 262mg OTC
stomach relf tab 262mg OTC
stomach rlf tab 262mg OTC
bismatrol chw 262mg OTC
bismuth subsalicylate chew tab 262 mg OTC
cvs bismuth chw 262mg OTC
eq stomach chw 262mg OTC
eql stomach chw 262mg OTC
medi-bismuth chw 262mg OTC
peptic relf chw 262mg OTC
pink bismuth chw 262mg OTC
px stomach chw 262mg OTC
ra pink bism chw 262mg OTC
soothe chw 262mg OTC
stomach relf chw 262mg OTC
anti-diarrhl sus 262/15ml OTC
bismatrol sus 262/15ml OTC
diarrhea rel sus 262/15ml OTC
diarrhea sus 262/15ml OTC
geri-pectate sus 262/15ml OTC
gnp k-pec sus 262/15ml OTC
hm stomach sus 262/15ml OTC
kao-tin sus 262/15ml OTC
kaopectate sus 262/15ml OTC
pink bismuth sus 262/15ml OTC
px stomach sus 262/15ml OTC
ra k-pec sus 262/15ml OTC
sm stomach sus 262/15ml OTC
sm stomach sus 525/30ml OTC
soothe sus 262/15ml OTC
stomach relf sus 262/15ml OTC
stomach relf sus 524/30ml OTC
stomach relf sus 525/30ml OTC
stomach relf sus 527/30ml OTC
bismatrol sus 525/15ml OTC
cvs bismuth sus max str OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 62 AGE - Age Limit GNDR - Gender Edit
kaopectate sus ex st OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 63 AGE - Age Limit GNDR - Gender Edit
pink bismuth sus max str OTC
px stomach sus 525/15ml OTC
soothe sus 525/15ml OTC
stomach relf sus OTC
stomach relf sus 525/15ml OTC
stomach relf sus plus OTC
abatinex cap 680mg OTC
acidophilus cap 10mg OTC
acidophilus cap 100mg OTC
acidophilus cap ex st OTC
biotinex cap OTC
digestive cap health OTC
digestive cap probioti OTC
dofus cap OTC
FLORAJEN CAP ACIDOPHI OTC
intestinex cap OTC
lacto-key- cap 100 OTC
lacto-key- cap 600 OTC
lactobacillu cap OTC
lactobacillus cap OTC
primadophilu cap OTC
probiotic cap OTC
PROBIOTIC CAP OTC
probiotic cap acidophi OTC
probiotic cap formula OTC
probiotic cap gold OTC
PROBIOTIC CAP GOLD OTC
ra acidophil cap 300mg OTC
REPHRESH CAP PRO-B OTC
acidoph/prob tab formula OTC
ACIDOPH/PROB TAB FORMULA OTC
acidophilus tab probiotc OTC
floranex tab OTC
lactobacillus tab OTC
probiata tab OTC
lactinex chw OTC
probiotic chw children OTC
MORE-DOPHILU POW ACIDOPHI OTC
flora assist pak OTC
floranex gra OTC
lactobacillus - packet OTC
probiotic pak children OTC
acidophilus waf OTC
ACIDOPHILUS/ WAF BIFIDUS OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 64 AGE - Age Limit GNDR - Gender Edit
LACTO-BIFIDU CAP -600 OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 58 AGE - Age Limit GNDR - Gender Edit
BIOGAIA CHW 100M CEL OTC
BIOGAIA CHW GASTRUS OTC
PEDIA-LAX CHW YUMS OTC
BIOGAIA DRO PROBIOTI OTC
BIOGAIA PROT DRO BABY OTC
GERBR SOOTHE DRO COLIC OTC
BIOGAIA MIS PROBIOTI OTC
hm probiotic cap OTC
probiotic cap OTC
CULTURELLE CHW KIDS OTC
PROBIOTIC DRO COLIC OTC
PROBIOTIC LIQ 15 DAY OTC
PROBIOTIC LIQ NEWBORN OTC
CULTURELLE PAK KIDS OTC
MOMMYS BLISS POW PROBIOTI OTC
ANTIDIARRHEAL/PROBIOTIC COMBINATIONS IMODIUM MS TAB RELIEF OTC
ANTACIDS ANTACIDS - CALCIUM SALTS
calcium carb tab 648mg OTC child soothe chw 400mg OTC
childrens chw pepto OTC
childrens chw soothe OTC
maalox child chw OTC
stomach rlf chw 400mg OTC
titralac chw 420mg OTC
antacid chw 500mg OTC
cal-gest chw 500mg OTC
calc antacid chw 500mg OTC
calcium anta chw 500mg OTC
calcium carbonate (antacid) chew tab 500 mg OTC eql antacid chw fruit OTC eql antacid chw pepprmnt OTC qc antacid chw 500mg OTC
ra antacid chw 500mg OTC
tame flame chw 500mg OTC
MAALOX CHW 600MG OTC
antacid chw 750mg OTC
antacid extr chw 750mg OTC
antacid flav chw 750mg OTC
antacid kids chw 750mg OTC
cal antacid chw 750mg OTC
calc antacid chw 750mg OTC
calcium anta chw 750mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 59 AGE - Age Limit GNDR - Gender Edit
calcium carbonate (antacid) chew tab 750 mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 59 AGE - Age Limit GNDR - Gender Edit
eq antacid chw 750mg OTC
eql antacid chw 750mg OTC
flavor chews chw 750mg OTC
smooth antac chw 750mg OTC
tums smoothi chw 750mg OTC
antacid chw 1000mg OTC
antacid max chw 1000mg OTC
cal antacid chw 1000mg OTC
calc antacid chw 1000mg OTC
eq antacid chw 1000mg OTC
eql antacid chw 1000mg OTC
gnp antacid chw 1000mg OTC
px antacid chw 1000mg OTC
ra antacid chw 1000mg OTC
tgt antacid chw 1000mg OTC
ANTACID CHW 1177MG OTC
ANTACID SOFT CHW 1177MG OTC
TUMS CHW DEL CHW 1177MG OTC
calcium carbonate (antacid) susp 1250 mg/5ml OTC
ANTACID COMBINATIONS MAG-AL LIQ OTC acid gone chw OTC
eq antacid chw 160-105 OTC
gnp antacid chw 160-105 OTC
heartbrn ant chw 160-105 OTC
heartbrn rlf chw 160-105 OTC
heartburn chw ex st OTC
acid gone sus OTC
foam antacid sus OTC
gavis-care sus OTC
heartburn sus relief OTC
GAVISCON CHW OTC
foam antacid chw 80-20mg OTC
antacid chw 550-110 OTC
gnp antacid chw 550-110 OTC
rolaids chw 550-110 OTC
MI-ACID CHW OTC
cvs antacid sus supreme OTC
geri-lanta sus supreme OTC
mintox plus chw OTC
DI-GEL SUS OTC
almacone sus OTC
alum & mag hydroxide-simethicone susp OTC 200-200-20 mg/5ml
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 60 AGE - Age Limit GNDR - Gender Edit
antacid fast sus acting OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 61 AGE - Age Limit GNDR - Gender Edit
antacid fast sus relief OTC
antacid i sus OTC
antacid liq sus OTC
antacid m sus OTC
antacid plus sus gas rel OTC
antacid sus OTC
antacid sus anti-gas OTC
antacid sus mint crm OTC
antacid sus reg OTC
antacid sus reg st OTC
comfort gel sus OTC
comfort gel sus anti-gas OTC
cvs antacid sus anti-gas OTC
cvs antacid/ sus anti-gas OTC
eq antacid sus OTC
eq antacid sus anti-gas OTC
eql antacid sus anti-gas OTC
geri-lanta sus OTC
geri-mox sus OTC
gnp antacid sus anti-gas OTC
gnp antacid sus coolmint OTC
gnp antacid sus reg st OTC
gnp masanti sus reg st OTC
hm antacid sus OTC
hm antacid sus anti-gas OTC
mag-al plus liq OTC
mi-acid sus OTC
milantex sus original OTC
mintox sus OTC
px antacid sus reg st OTC
qc antacid sus OTC
qc antacid sus anti-gas OTC
ra antacid sus anti-gas OTC
ra liquid sus antacid OTC
rulox sus OTC
sb antacid sus anti-gas OTC
sm antacid sus advanced OTC
sm antacid sus anti-gas OTC
sm antacid/ sus antigas OTC
tgt antacid sus anti-gas OTC
advanced sus antacid OTC
almacone dbl sus strength OTC
antacid adv sus max st OTC
antacid iii sus OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 62 AGE - Age Limit GNDR - Gender Edit
antacid max sus anti-gas OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 61 AGE - Age Limit GNDR - Gender Edit
antacid plus sus anti-gas OTC
antacid plus sus gas rel OTC
antacid sus OTC
antacid sus advanced OTC
antacid sus anti-gas OTC
antacid sus ex st OTC
antacid sus max st OTC
antacid/gas sus rel max OTC
antacid/sime sus ds OTC
comfort gel sus antacid OTC
comfort gel sus anti-gas OTC
cvs antacid sus antigas OTC
cvs antacid/ sus anti-gas OTC
eq antacid sus max st OTC
gnp antacid sus cherry OTC
gnp antacid sus original OTC
gnp masanti sus max st OTC
hm antacid sus anti-gas OTC
maalox max sus cherry OTC
maalox max sus lemon OTC
maalox max sus wild bry OTC
maalox multi sus symp max OTC
mag-al plus liq xs OTC
meijer sus antacid OTC
mi-acid sus max st OTC
milantex sus ex st OTC
mintox sus max st OTC
mylanta sus max st OTC
px antacid sus max st OTC
qc antacid sus anti-gas OTC
ra antacid sus antigas OTC
sm antacid sus advanced OTC
sm antacid sus max st OTC
LCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS ANTISPASMODICS
hyoscyamine sulfate tab 0.125 mg oscimin tab 0.125mg SYMAX DUOTAB TAB
hyoscyamine sulfate sl tab 0.125 mg
oscimin sub 0.125mg hyoscyamine sulfate elixir 0.125 mg/5ml hyoscyamine sulfate soln 0.125 mg/ml ed-spaz tab 0.125mg hyoscyamine sulfate tab disint 0.125 mg
U
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 62 AGE - Age Limit GNDR - Gender Edit
nulev tab 0.125mg
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 63 AGE - Age Limit GNDR - Gender Edit
oscimin tab 0.125mg
hyoscyamine sulfate tab er 12hr 0.375 mg oscimin sr tab 0.375mg
symax-sr tab 0.375mg glycopyrrolate tab 1 mg glycopyrrolate tab 2 mg CUVPOSA SOL 1MG/5ML
dicyclomine hcl cap 10 mg dicyclomine hcl tab 20 mg dicyclomine hcl oral soln 10 mg/5ml chlordiazepoxide hcl-clidinium bromide cap 5-2.5 mg
H-2 ANTAGONISTS acid reducer tab 200mg OTC
cimetidine tab 200 mg
cimetidine tab 200 mg OTC
cimetidine tab 200mg OTC
eq cimetidin tab 200mg OTC
eq heartburn tab relief OTC
heartbrn rel tab 200mg OTC
heartburn tab 200mg OTC
heartburn tab relief OTC
sm acid redu tab 200mg OTC
cimetidine tab 300 mg cimetidine tab 400 mg cimetidine tab 800 mg cimetidine hcl soln 300 mg/5ml ranitidine hcl cap 150 mg ranitidine hcl cap 300 mg
acid reducer tab 75mg OTC
ranitidine tab 75mg OTC
wal-zan 75 tab OTC
wal-zan tab 75mg OTC
acid control tab 150mg OTC
acid reducer tab 150mg OTC
eql heartbur tab 150mg OTC
heartburn tab 150mg OTC
ranitidine hcl tab 150 mg
ranitidine hcl tab 150 mg OTC
wal-zan tab 150mg OTC
ranitidine hcl tab 300 mg
ranitidine hcl syrup 15 mg/ml (75 mg/5ml)
acid control tab 10mg OTC
acid reducer tab 10mg OTC
eql heartbrn tab 10mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 64 AGE - Age Limit GNDR - Gender Edit
famotidine tab 10 mg OTC
heartburn tab relief OTC
acid control tab 20mg OTC
acid reducer tab 20mg OTC
famotidine tab 20 mg
famotidine tab 20mg OTC
heartburn tab 20mg OTC
famotidine tab 40 mg
famotidine for susp 40 mg/5ml nizatidine cap 150 mg nizatidine cap 300 mg nizatidine oral soln 15 mg/ml
ULCER DRUGS - PROSTAGLANDINS misoprostol tab 100 mcg misoprostol tab 200 mcg
PROTON PUMP INHIBITORS
NEXIUM 24HR TAB 20MG OTC, QL (90 tabs / year) NEXIUM GRA 2.5MG DR QL (90 packets / year)
NEXIUM GRA 5MG DR QL (90 packets / year)
NEXIUM GRA 10MG DR QL (90 packets / year)
esomepra mag cap 20mg dr OTC, QL (30 caps / 25 days)
heartburn tr cap 24h 20mg OTC, QL (30 caps / 25 days)
heartburn tr cap 15mg OTC
lansoprazole cap 15mg dr OTC
lansoprazole cap delayed release 15 mg
lansoprazole cap delayed release 15 mg OTC
OMEPRAZOLE TAB 20MG OTC
OMEPRAZOLE TAB 20MG DR OTC
omeprazole cap delayed release 10 mg QL (90 caps / year)
omeprazole cap delayed release 20 mg QL (90 caps / year) omeprazole cap delayed release 20 mg QL (90 each / year) omeprazole cap delayed release 20 mg OTC, QL (90 caps / year) omeprazole cap delayed release 40 mg QL (90 caps / year) PRILOSEC OTC TAB 20MG OTC
acid reducer cap 20.6mgdr OTC
omeprazole cap 20.6mgdr OTC
OMEPRAZOLE CAP 20.6MGDR OTC
omeprazole magnesium cap dr 20.6 mg (20 mg OTC base equiv) pantoprazole sodium ec tab 20 mg (base equiv) QL (90 tabs / year)
pantoprazole sodium ec tab 40 mg (base equiv) QL (90 each / year) pantoprazole sodium ec tab 40 mg (base equiv) QL (90 tabs / year)
MISC. ANTI-ULCER sucralfate tab 1 gm
CARAFATE SUS 1GM/10ML
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 65 AGE - Age Limit GNDR - Gender Edit
ULCER THERAPY COMBINATIONS omeprazole-sodium bicarbonate cap 20-1100 mg OTC, QL (90 caps / year)
ANTIEMETICS ANTIEMETICS - ANTICHOLINERGIC
meclizine hcl tab 12.5 mg meclizine hcl tab 12.5 mg OTC
dramamine tab 25mg OTC
eql motion tab sickness OTC
meclizine hcl tab 25 mg
meclizine hcl tab 25 mg OTC
motion relf tab 25mg OTC
motion sick tab 25mg OTC
travel-ease tab 25mg OTC
wal-dram ii tab 25mg OTC
bonine chw 25mg OTC
meclizine hcl chew tab 25 mg OTC
motion sick chw 25mg OTC
motion-time chw 25mg OTC
travel sick chw 25mg OTC
trimethobenzamide hcl cap 300 mg
5-HT3 RECEPTOR ANTAGONISTS granisetron hcl tab 1 mg QL (6 tabs / 15 days) ondansetron orally disintegrating tab 4 mg QL (12 each / 15 days) ondansetron orally disintegrating tab 4 mg QL (12 tabs / 15 days) ondansetron orally disintegrating tab 8 mg QL (12 each / 15 days) ondansetron orally disintegrating tab 8 mg QL (12 tabs / 15 days) ondansetron hcl tab 4 mg QL (12 each / 15 days) ondansetron hcl tab 4 mg QL (12 tabs / 15 days)
ondansetron hcl tab 8 mg QL (12 each / 15 days)
ondansetron hcl tab 8 mg QL (12 tabs / 15 days)
ondansetron hcl tab 24 mg QL (1 tab / 15 days)
ondansetron hcl oral soln 4 mg/5ml QL (100 mL / 15 days)
SUBSTANCE P/NEUROKININ 1 (NK1) RECEPTOR ANTAGONISTS aprepitant capsule 40 mg PA aprepitant capsule 80 mg PA
aprepitant capsule 125 mg PA
EMEND SUS 125MG PA
aprepitant capsule therapy pack 80 & 125 mg PA
ANTIEMETICS - MISCELLANEOUS dronabinol cap 2.5 mg QL (60 caps / 25 days) dronabinol cap 5 mg QL (60 caps / 25 days)
dronabinol cap 10 mg QL (60 caps / 25 days)
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 66 AGE - Age Limit GNDR - Gender Edit
DIGESTIVE AIDS DIGESTIVE ENZYMES
VIOKACE TAB 10440 VIOKACE TAB 20880
CREON CAP 3000UNIT ZENPEP CAP 3000UNIT ZENPEP CAP 5000UNIT CREON CAP 6000UNIT CREON CAP 12000UNT ZENPEP CAP 15000UNT ZENPEP CAP 20000UNT CREON CAP 24000UNT ZENPEP CAP 25000 CREON CAP 36000UNT ZENPEP CAP 40000
GASTROINTESTINAL AGENTS - MISC. GALLSTONE SOLUBILIZING AGENTS
ursodiol cap 300 mg ursodiol tab 250 mg ursodiol tab 500 mg
ANTIFLATULENTS gas relief cap 125mg OTC gas-x cap 125mg OTC
simethicone cap 125 mg OTC
anti-gas cap 180mg OTC
eql gas rlf cap 180mg OTC
gas relief cap 180mg OTC
gas-x cap 180mg OTC
simethicone cap 180 mg OTC
cvs gas relf chw 80mg OTC
gas relief chw 80mg OTC
gnp gas relf chw 80mg OTC
hm gas relf chw 80mg OTC
mi-acid gas chw 80mg OTC
qc gas relf chw 80mg OTC
ra gas relf chw 80mg OTC
simethicone chew tab 80 mg OTC
sm gas relf chw 80mg OTC
sm gas relie chw 80mg OTC
cvs gas relf chw 125mg OTC
eql gas gone chw 125mg OTC
gas relief chw 125mg OTC
gnp gas relf chw 125mg OTC
hm gas relf chw 125mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 67 AGE - Age Limit GNDR - Gender Edit
phazyme chw 125mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 68 AGE - Age Limit GNDR - Gender Edit
qc gas relf chw 125mg OTC
ra gas relf chw 125mg OTC
sb gas relf chw 125mg OTC
simethicone chew tab 125 mg OTC
sm gas rel chw 125mg OTC
SIMETHICONE LIQ
SIMETHICONE LIQ OTC
cvs gas relf dro ex st OTC
gas relief dro infants OTC
gas relief liq infants OTC
gas-x infant dro OTC
gas relief dro 20/0.3ml OTC
gas relief dro 40/0.6ml OTC
little remed sus 20/.03ml OTC
little tummy dro 20/0.3ml OTC
simeped dro 40/0.6ml OTC
simethicone dro 20/0.3ml OTC
simethicone susp 40 mg/0.6ml OTC
GAS-X CHILD MIS 40MG OTC
GAS-X EX-STR MIS 62.5MG OTC
GASTROINTESTINAL STIMULANTS metoclopramide hcl tab 5 mg (base equivalent) metoclopramide hcl tab 10 mg (base equivalent) metoclopramide hcl soln 5 mg/5ml (10 mg/10ml) (base equiv)
INTESTINAL ACIDIFIERS
enulose sol 10gm/15 generlac sol 10gm/15 lactulose (encephalopathy) solution 10 gm/15ml
INFLAMMATORY BOWEL AGENTS balsalazide disodium cap 750 mg PENTASA CAP 250MG CR PA
PENTASA CAP 500MG CR PA
mesalamine enema 4 gm
APRISO CAP 0.375GM
mesalamine rectal enema 4 gm & cleanser wipe kit
sulfasalazine tab 500 mg sulfasalazine tab delayed release 500 mg
AGENTS FOR CHRONIC IDIOPATHIC CONSTIPATION (CIC) TRULANCE TAB 3MG
IRRITABLE BOWEL SYNDROME (IBS) AGENTS LINZESS CAP 72MCG LINZESS CAP 145MCG
LINZESS CAP 290MCG
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 69 AGE - Age Limit GNDR - Gender Edit
PERIPHERAL OPIOID RECEPTOR ANTAGONISTS MOVANTIK TAB 12.5MG MOVANTIK TAB 25MG
PHOSPHATE BINDER AGENTS calcium acetate (phosphate binder) cap 667 mg (169 mg ca) sevelamer carbonate tab 800 mg ST
sevelamer carbonate packet 0.8 gm ST
sevelamer carbonate packet 2.4 gm ST
URINARY ANTI-INFECTIVES URINARY ANTI-INFECTIVES
NALIDIXIC POW ACID nitrofurantoin susp 25 mg/5ml
nitrofurantoin macrocrystalline cap 25 mg nitrofurantoin macrocrystalline cap 50 mg nitrofurantoin macrocrystalline cap 100 mg NITROFURAN POW ANHYDROU nitrofurantoin monohydrate macrocrystalline cap
100 mg
URINARY ANTISPASMODICS URINARY ANTISPASMODIC - ANTIMUSCARINICS (ANTICHOLINERGIC)
OXYTROL/WOMN DIS 3.9MG/24 OTC, GNDR oxybutynin chloride tab 5 mg
oxybutynin chloride syrup 5 mg/5ml oxybutynin chloride tab er 24hr 5 mg oxybutynin chloride tab er 24hr 10 mg oxybutynin chloride tab er 24hr 15 mg trospium chloride tab 20 mg
URINARY ANTISPASMODICS - CHOLINERGIC AGONISTS bethanechol chloride tab 5 mg bethanechol chloride tab 10 mg bethanechol chloride tab 25 mg bethanechol chloride tab 50 mg
VAGINAL PRODUCTS VAGINAL ANTI-INFECTIVES
clindamycin phosphate vaginal cream 2% metronidazole vaginal gel 0.75% vandazole gel 0.75% clotrimazole cre 1% vag OTC
clotrimazole vaginal cream 1% OTC
clotrimazole cre 2% OTC
clotrimazole cre 3 day OTC
cvs 3-day cre OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 70 AGE - Age Limit GNDR - Gender Edit
3 day vaginl cre 2% OTC
ra clotrimaz cre 3 OTC
cvs miconazo cre 7 OTC
miconazole 7 cre OTC
miconazole 7 cre 2% OTC
miconazole 7 cre tube/kit OTC
miconazole nitrate vaginal cream 2% OTC
3 day vagnal cre 4% OTC
miconazole 3 cre 4% OTC
miconazole 7 sup 100mg OTC
miconazole nitrate vaginal suppos 100 mg OTC sm micon 7 sup 100mg OTC miconazole 3 sup 200mg
miconazole 3 kit combo pk OTC
vagistat-3 kit combo pk OTC
miconazole 1 kit OTC
miconazole 1 kit 1200-2% OTC
miconazole 1 kit 1200mg2% OTC
MONISTAT 7 KIT COMBO PK OTC
miconazole 3 kit combinat OTC
miconazole 3 kit combo OTC
MONISTAT 7 KIT COMPLETE OTC
MONISTAT 3 KIT COMBO PK OTC
MICONAZOLE 1 KIT COMBO OTC
terconazole vaginal cream 0.4%
terconazole vaginal cream 0.8% terconazole vaginal suppos 80 mg
SPERMICIDES VCF VAGINAL AER CONTRACP OTC SHUR-SEAL GEL 2% OTC
GYNOL II GEL 3% OTC
vcf vaginal gel contrace OTC
ENCARE SUP 100MG OTC
VCF VAGINAL MIS CONTRACP OTC
VAGINAL ESTROGENS estradiol vaginal tab 10 mcg yuvafem tab 10mcg
MISCELLANEOUS VAGINAL PRODUCTS acetic acid vaginal solution OTC ex cleansing sol OTC
feminine car sol douche OTC
massengill sol vin&watr OTC
summers eve sol ex clean OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 71 AGE - Age Limit GNDR - Gender Edit
GENITOURINARY AGENTS - MISCELLANEOUS ALKALINIZERS
potassium citrate tab er 5 meq (540 mg) potassium citrate tab er 10 meq (1080 mg) potassium citrate tab er 15 meq (1620 mg)
URINARY ANALGESICS phenazopyridine hcl tab 100 mg phenazo tab 200mg phenazopyridine hcl tab 200 mg
PROSTATIC HYPERTROPHY AGENTS finasteride tab 5 mg
alfuzosin hcl tab er 24hr 10 mg tamsulosin hcl cap 0.4 mg
ANTIPSYCHOTICS/ANTIMANIC AGENTS PHENOTHIAZINES
compro sup 25mg prochlorperazine suppos 25 mg
prochlorperazine maleate tab 5 mg (base equivalent)
prochlorperazine maleate tab 10 mg (base equivalent)
HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS BARBITURATE HYPNOTICS
phenobarbital tab 15 mg phenobarbital tab 16.2 mg phenobarbital tab 30 mg phenobarbital tab 32.4 mg phenobarbital tab 60 mg phenobarbital tab 64.8 mg phenobarbital tab 97.2 mg phenobarbital tab 100 mg phenobarbital elixir 20 mg/5ml
ANTIHISTAMINE HYPNOTICS eql sleep tab aid OTC
hm sleep aid tab 25mg OTC
ra sleep aid tab 25mg OTC
sleep aid tab 25mg OTC
sleep-aid tab 25mg OTC
ultra sleep tab 25mg OTC
wal-som tab 25mg OTC
compoz cap 50mg OTC
eq sleep aid cap 50mg OTC
qc sleep aid cap 50mg OTC
ra nighttime cap 50mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 72 AGE - Age Limit GNDR - Gender Edit
ra sleep aid cap 50mg OTC
sleep aid cap 50mg OTC
sm sleep aid cap 50mg OTC
wal-som cap 50mg OTC
hm nighttime tab 25mg OTC
night time tab 25mg OTC
nighttime tab 25mg OTC
nytol tab 25mg OTC
ra nighttime tab 25mg OTC
ra sleep aid tab 25mg OTC
rest simply tab 25mg OTC
sb sleep tab 25mg OTC
simply sleep tab 25mg OTC
sleep aid tab 25mg OTC
sleep ii tab 25mg OTC
sleep tab 25mg OTC
sleep-aid tab 25mg OTC
sleep-tabs tab 25mg OTC
sm nighttime tab 25mg OTC
sm sleep aid tab 25mg OTC
compoz tab 50mg OTC
diphenhydramine hcl (sleep) tab 50 mg OTC
sleep aid tab 50mg OTC
PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. ANTIDEMENTIA AGENTS
donepezil hydrochloride tab 5 mg donepezil hydrochloride tab 10 mg donepezil hydrochloride tab 23 mg donepezil hydrochloride orally disintegrating tab 5 mg
donepezil hydrochloride orally disintegrating tab 10 mg
galantamine hydrobromide tab 4 mg galantamine hydrobromide tab 8 mg galantamine hydrobromide tab 12 mg galantamine hydrobromide oral soln 4 mg/ml galantamine hydrobromide cap er 24hr 8 mg galantamine hydrobromide cap er 24hr 16 mg galantamine hydrobromide cap er 24hr 24 mg
rivastigmine td patch 24hr 4.6 mg/24hr PA
rivastigmine td patch 24hr 9.5 mg/24hr PA rivastigmine td patch 24hr 13.3 mg/24hr PA rivastigmine tartrate cap 1.5 mg (base equivalent) PA rivastigmine tartrate cap 3 mg (base equivalent) PA
rivastigmine tartrate cap 4.5 mg (base equivalent) PA
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 71 AGE - Age Limit GNDR - Gender Edit
rivastigmine tartrate cap 6 mg (base equivalent) PA
memantine hcl tab 5 mg
memantine hcl tab 10 mg memantine hcl tab 5 mg (28) & 10 mg (21)
titration pak memantine hcl oral solution 2 mg/ml
MULTIPLE SCLEROSIS AGENTS glatiramer acetate soln prefilled syringe 20 mg/ml SP, QL (1 injection / 1 day),
PA glatopa inj 20mg/ml SP, QL (1 injection / 1 day),
PA glatiramer acetate soln prefilled syringe 40 mg/ml SP, QL (12.9 injections / 30
days), PA glatopa inj 40mg/ml SP, QL (12.9 injections / 30
days), PA AVONEX KIT 30MCG SP, QL (4.5 injections / 30
days), PA AVONEX PEN KIT 30MCG SP, QL (1.2 injections / 30
days), PA AVONEX PREFL KIT 30MCG SP, QL (1.2 injections / 30
days), PA AUBAGIO TAB 7MG SP, QL (1 tab / 1 day), PA
AUBAGIO TAB 14MG SP, QL (1 tab / 1 day), PA
OCREVUS INJ 300/10ML SP, QL (0.36 vials / 30
days), PA TECFIDERA MIS STARTER SP, QL (0.033 kits / 1 day),
PA TECFIDERA CAP 120MG SP, QL (2 caps / 1 day), PA
TECFIDERA CAP 240MG SP, QL (2 caps / 1 day), PA
GILENYA CAP 0.5MG SP, QL (1 cap / 1 day), PA
ANTI-CATAPLECTIC AGENTS XYREM SOL 500MG/ML SP, PA
FIBROMYALGIA AGENTS SAVELLA TAB 12.5MG PA SAVELLA TAB 25MG PA
SAVELLA TAB 50MG PA
SAVELLA TAB 100MG PA
SAVELLA MIS TITR PAK PA
PSEUDOBULBAR AFFECT (PBA) AGENTS NUEDEXTA CAP 20-10MG PA
ANALGESICS - NONNARCOTIC SALICYLATES
aspirin tab 325 mg OTC bayer adv tab 325mg OTC
bayer asa tab 325mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 72 AGE - Age Limit GNDR - Gender Edit
cvs aspirin tab 325mg OTC
eq aspirin tab 325mg OTC
eql aspirin tab 325mg OTC
gnp aspirin tab 325mg OTC
hm aspirin tab 325mg OTC
medique asa tab 325mg OTC
mm aspirin tab 325mg OTC
norwich asa tab 325mg OTC
px aspirin tab 325mg OTC
qc aspirin tab 325mg OTC
ra aspirin tab 325mg OTC
sb aspirin tab 325mg OTC
sm aspirin tab 325mg OTC
tgt aspirin tab 325mg OTC
aspirtab m/s tab 500mg OTC
bayer adv tab 500mg OTC
bayer asa tab 500mg OTC
ra aspirin tab 500mg OTC
aspirin chld chw 81mg OTC
aspirin chw 81mg OTC
aspirin low chw 81mg OTC
aspirin-81 chw 81mg OTC
bayer low chw 81mg OTC
child asa chw 81mg OTC
child asa ls chw 81mg OTC
eq child asa chw 81mg OTC
eql aspirin chw 81mg OTC
gnp aspirin chw 81mg OTC
hm aspirin chw 81mg OTC
px aspirin chw 81mg OTC
qc child asa chw 81mg OTC
ra aspirin chw 81mg OTC
ra child asa chw 81mg OTC
sb child asa chw 81mg OTC
sm aspirin chw 81mg OTC
sm child asa chw 81mg OTC
st joseph chw low 81mg OTC
tgt aspirin chw 81mg OTC
tgt aspirin chw child OTC
aspir-81 tab 81mg ec OTC
aspir-low tab 81mg ec OTC
aspirin adlt tab 81mg OTC
aspirin low tab 81mg ec OTC
aspirin tab 81mg ec OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 73 AGE - Age Limit GNDR - Gender Edit
aspirin tab delayed release 81 mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 74 AGE - Age Limit GNDR - Gender Edit
bayer low tab 81mg ec OTC
cvs aspirin tab 81mg ec OTC
ecotrin low tab 81mg ec OTC
gnp aspirin tab 81mg ec OTC
kls aspirin tab 81mg ec OTC
kp aspirin tab 81mg ec OTC
low dose asa tab 81mg OTC
miniprin low tab 81mg ec OTC
px aspirin tab 81mg ec OTC
ra aspirin tab 81mg ec OTC
sm aspirin tab 81mg ec OTC
tgt aspirin tab 81mg OTC
tgt aspirin tab 81mg ec OTC
aspirin tab 325mg ec OTC
aspirin tab delayed release 325 mg OTC
aspirtab tab 324mg ec OTC
bayer asa tab 325mg OTC
cvs aspirin tab 325mg ec OTC
ecotrin tab 325mg OTC
ecpirin tab 325mg ec OTC
enteric asa tab 325mg OTC
eq aspirin tab 325mg ec OTC
eql aspirin tab 325mg ec OTC
gnp aspirin tab 325mg ec OTC
kls aspirin tab 325mg ec OTC
px aspirin tab 325mg ec OTC
qc aspirin tab 325mg ec OTC
ra aspirin tab 325mg ec OTC
sb aspirin tab 325mg ec OTC
sm aspirin tab 325mg ec OTC
eq aspirin tab 500mg ec OTC
aspirin sup 300mg OTC
aspirin sup 600mg OTC
diflunisal tab 500 mg
ANALGESICS OTHER gnp acetamin cap 500mg OTC
mapap cap 500mg OTC
sm pain rel cap 500mg OTC
acetaminophen tab 325 mg OTC
acetaminophn tab 325mg OTC
aminofen tab 325mg OTC
aspirin free tab 325mg OTC
eql acetamin tab 325mg OTC
gnp acetamin tab 325mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 75 AGE - Age Limit GNDR - Gender Edit
mapap tab 325mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 76 AGE - Age Limit GNDR - Gender Edit
non-aspirin tab 325mg OTC
pain & fever tab 325mg OTC
pain relief tab 325mg OTC
pain relieve tab 325mg OTC
pain relievr tab 325mg OTC
pharbetol tab 325mg OTC
ra acetamin tab 325mg OTC
tactinal tab 325mg OTC
acetamin tab 500mg OTC
acetaminophen tab 500 mg OTC
acetaminophn tab 500mg OTC
aminofen tab 500mg OTC
eq acetamin tab 500mg OTC
eql acetamin tab 500mg OTC
mapap tab 500mg OTC
medi-tabs tab 500mg OTC
non-aspirin tab 500mg OTC
non-aspirin tab 500mg/rr OTC
pain & fever tab 500mg OTC
pain relief tab 500mg OTC
pain relief tab 500mg/rr OTC
pain relieve tab 500mg OTC
pain relieve tab 500mg/rr OTC
pain relievr tab 500mg OTC
pharbetol tab 500mg OTC
shake ache tab 500mg OTC
tactinal tab 500mg OTC
tgt acetamin tab 500mg OTC
acetaminophen tab er 650 mg OTC
arthrts pain tab 650mg OTC
eql arthrts tab 650mg OTC
hm arthrts tab 650mg OTC
hm pain rlf tab 650mg OTC
8 hour pain tab 650mg OTC
8hr pain er tab 650mg OTC
midol tab 650mg OTC
non-aspirin tab 650mg OTC
pain relief tab 650mg OTC
qc apap 8 hr tab 650mg OTC
sm pain rlvr tab 650mg OTC
childrens chw apap OTC
chld meditab chw 80mg OTC
chld non-asa chw 80mg grp OTC
cvs childs chw 80mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 77 AGE - Age Limit GNDR - Gender Edit
non-aspirin chw 80mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 78 AGE - Age Limit GNDR - Gender Edit
pain relievr chw 80mg OTC
sb non-asa chw 80mg frt OTC
sb non-asa chw 80mg grp OTC
tactinal chw children OTC
acetaminophe chw 160mg OTC
acetaminophen chew tab 160 mg OTC
asa free chw 160mg jr OTC
mapap chw 160mg OTC
medi-tabs jr chw 160mg OTC
non-aspirin chw 160mg jr OTC
pain & fever chw 160mg OTC
pain relief chw 160mg OTC
pain relieve chw 160mg jr OTC
sb non-asa chw 160mg OTC
acetaminophen liquid 160 mg/5ml OTC
chld silapap liq 160/5ml OTC
ed-apap liq 80mg/2.5 OTC
little remed liq 160/5ml OTC
mapap liq 160/5ml OTC
pain relief liq 160/5ml OTC
acetamin liq 500/15ml OTC
chloraseptic liq sore thr OTC
mapap apap liq 500/15ml OTC
pain relief liq 500/15ml OTC
pain relievr liq 500/15ml OTC
acetaminophen elixir 160 mg/5ml OTC
apra elx 160/5ml OTC
chld asafree elx 80/2.5ml OTC
medi-tabs elx 80/2.5ml OTC
nortemp sus infants OTC
acetaminophn sus 160/5ml OTC
betatemp sus 160/5ml OTC
fever/pain sus 160/5ml OTC
non-aspirin sus 160/5ml OTC
nortemp sus 160/5ml OTC
pain & fever sus 160/5ml OTC
pain relief sus 160/5ml OTC
pain relieve sus 160/5ml OTC
pain/fever sus 160/5ml OTC
pediacare sus 160/5ml OTC
acetaminophen soln 160 mg/5ml OTC
pain & fever sol 160/5ml OTC
FEVERALL INF SUP 80MG OTC
acephen sup 120mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 79 AGE - Age Limit GNDR - Gender Edit
acetaminophen suppos 120 mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 76 AGE - Age Limit GNDR - Gender Edit
fever reduce sup 120mg OTC
feverall sup 120mg OTC
fevr reducng sup 120mg OTC
pain/fever sup 120mg OTC
acephen sup 325mg OTC
feverall sup 325mg OTC
acephen sup 650mg OTC
acetaminophen suppos 650 mg OTC
feverall sup 650mg OTC
apap melt tab 80mg OTC
apap rapid tab tab 80mg OTC
child apap tab 80mg OTC
chld non-asa tab 80mg qm OTC
chld pain rl tab 80mg OTC
easy-melts tab 80mg OTC
eq acetamin tab 80mg OTC
mapap child tab 80mg rt OTC
acetaminophe tab 160mg OTC
apap melts tab 160mg OTC
eql acetamin tab 160mg OTC
non-asa jr tab 160mg OTC
non-asa jr tab 160mg qm OTC
pain relievr tab 160mg OTC
sm rpd melt tab 160mg OTC
ANALGESIC COMBINATIONS butalbital-acetaminophen-caffeine cap 50-325-40 QL (60 caps / 25 days) mg esgic cap QL (60 caps / 25 days)
zebutal cap QL (60 caps / 25 days)
butalbital-acetaminophen-caffeine tab 50-325-40 QL (60 tabs / 25 days) mg butalbital-aspirin-caffeine cap 50-325-40 mg QL (60 caps / 25 days)
BUT/ASA/CAF TAB QL (60 tabs / 25 days)
ANALGESICS - OPIOID OPIOID AGONISTS
fentanyl td patch 72hr 12 mcg/hr QL (10 patches / 25 days), PA
fentanyl td patch 72hr 25 mcg/hr QL (10 patches / 25 days),
PA fentanyl td patch 72hr 50 mcg/hr QL (10 patches / 25 days),
PA fentanyl td patch 72hr 75 mcg/hr QL (10 patches / 25 days),
PA fentanyl td patch 72hr 100 mcg/hr QL (10 patches / 25 days),
PA
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 77 AGE - Age Limit GNDR - Gender Edit
hydromorphone hcl tab 2 mg QL (180 tabs / 25 days), PA
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 77 AGE - Age Limit GNDR - Gender Edit
hydromorphone hcl tab 4 mg QL (180 tabs / 25 days), PA
hydromorphone hcl tab 8 mg QL (180 tabs / 25 days), PA
methadone hcl tab 5 mg QL (120 each / 25 days), PA
methadone hcl tab 5 mg QL (120 tabs / 25 days), PA
methadone hcl tab 10 mg QL (120 each / 25 days), PA
methadone hcl tab 10 mg QL (120 tabs / 25 days), PA
morphine sulfate tab 15 mg QL (180 tabs / 25 days), PA
morphine sulfate tab 30 mg QL (180 tabs / 25 days), PA
morphine sulfate tab er 15 mg QL (90 ea / 25 days), PA
morphine sulfate tab er 15 mg QL (90 tabs / 25 days), PA
morphine sulfate tab er 30 mg QL (90 ea / 25 days), PA
morphine sulfate tab er 30 mg QL (90 tabs / 25 days), PA
morphine sulfate tab er 60 mg QL (90 ea / 25 days), PA
morphine sulfate tab er 60 mg QL (90 tabs / 25 days), PA
morphine sulfate tab er 100 mg QL (90 ea / 25 days), PA
morphine sulfate tab er 100 mg QL (90 tabs / 25 days), PA
morphine sulfate tab er 200 mg QL (60 tabs / 25 days), PA morphine sulfate oral soln 10 mg/5ml QL (900 mL / 25 days), PA morphine sulfate oral soln 20 mg/5ml QL (900 mL / 25 days), PA morphine sulfate oral soln 100 mg/5ml (20 mg/ml)QL (180 mL / 25 days), PA morphine sulfate suppos 5 mg QL (180 supp / 25 days), PA
morphine sulfate suppos 10 mg QL (180 supp / 25 days), PA
morphine sulfate suppos 20 mg QL (180 supp / 25 days), PA
oxycodone hcl cap 5 mg QL (180 caps / 25 days), PA
oxycodone hcl tab 5 mg QL (180 each / 25 days), PA
oxycodone hcl tab 5 mg QL (180 tabs / 25 days), PA
oxycodone hcl tab 10 mg QL (180 tabs / 25 days), PA
oxycodone hcl tab 15 mg QL (180 each / 25 days), PA
oxycodone hcl tab 15 mg QL (180 tabs / 25 days), PA
oxycodone hcl tab 20 mg QL (180 tabs / 25 days), PA
oxycodone hcl tab 30 mg QL (180 each / 25 days), PA
oxycodone hcl tab 30 mg QL (180 tabs / 25 days), PA oxycodone hcl conc 100 mg/5ml (20 mg/ml) QL (180 mL / 25 days), PA oxycodone hcl soln 5 mg/5ml QL (180 mL / 25 days), PA tramadol hcl tab 50 mg QL (240 each / 25 days), PA
tramadol hcl tab 50 mg QL (240 tabs / 25 days), PA
tramadol hcl tab er 24hr 100 mg QL (30 tabs / 25 days), PA
tramadol hcl tab er 24hr 200 mg QL (30 tabs / 25 days), PA
tramadol hcl tab er 24hr 300 mg QL (30 tabs / 25 days), PA
OPIOID COMBINATIONS endocet tab 2.5-325 QL (375 tabs / 25 days), PA oxycodone w/ acetaminophen tab 2.5-325 mg QL (375 tabs / 25 days), PA endocet tab 5-325mg QL (375 tabs / 25 days), PA oxycodone w/ acetaminophen tab 5-325 mg QL (375 each / 25 days), PA
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 78 AGE - Age Limit GNDR - Gender Edit
oxycodone w/ acetaminophen tab 5-325 mg QL (375 tabs / 25 days), PA
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 79 AGE - Age Limit GNDR - Gender Edit
endocet tab 7.5-325 QL (375 tabs / 25 days), PA
oxycodone w/ acetaminophen tab 7.5-325 mg QL (375 each / 25 days), PA oxycodone w/ acetaminophen tab 7.5-325 mg QL (375 tabs / 25 days), PA endocet tab 10-325mg QL (375 tabs / 25 days), PA oxycodone w/ acetaminophen tab 10-325 mg QL (375 each / 25 days), PA oxycodone w/ acetaminophen tab 10-325 mg QL (375 tabs / 25 days), PA oxycodone-aspirin tab 4.8355-325 mg QL (308 tabs / 25 days), PA acetaminophen w/ codeine tab 300-15 mg QL (300 tabs / 25 days), PA acetaminophen w/ codeine tab 300-30 mg QL (300 each / 25 days), PA acetaminophen w/ codeine tab 300-30 mg QL (300 tabs / 25 days), PA acetaminophen w/ codeine tab 300-60 mg QL (300 tabs / 25 days), PA acetaminophen w/ codeine soln 120-12 mg/5ml QL (5000 mL / 25 days), PA hydrocodone-acetaminophen tab 10-325 mg QL (375 each / 25 days), PA hydrocodone-acetaminophen tab 10-325 mg QL (375 tabs / 25 days), PA lorcet hd tab 10-325mg QL (375 tabs / 25 days), PA hydrocodone-acetaminophen tab 5-325 mg QL (375 each / 25 days), PA hydrocodone-acetaminophen tab 5-325 mg QL (375 tabs / 25 days), PA lorcet tab 5-325mg QL (375 tabs / 25 days), PA hydrocodone-acetaminophen tab 7.5-325 mg QL (375 each / 25 days), PA hydrocodone-acetaminophen tab 7.5-325 mg QL (375 tabs / 25 days), PA lorcet plus tab 7.5-325 QL (375 tabs / 25 days), PA hydrocodone-acetaminophen soln 7.5-325 QL (2700 mL / 25 days), PA mg/15ml tramadol-acetaminophen tab 37.5-325 mg QL (40 tabs / 25 days), PA
ANALGESICS - ANTI-INFLAMMATORY NONSTEROIDAL ANTI-INFLAMMATORY AGENTS (NSAIDS)
diclofenac potassium tab 50 mg diclofenac sodium tab delayed release 25 mg
diclofenac sodium tab delayed release 50 mg diclofenac sodium tab delayed release 75 mg diclofenac sodium tab er 24hr 100 mg etodolac cap 200 mg etodolac cap 300 mg
etodolac tab 400 mg etodolac tab 500 mg etodolac tab er 24hr 400 mg etodolac tab er 24hr 500 mg etodolac tab er 24hr 600 mg flurbiprofen tab 50 mg flurbiprofen tab 100 mg ibuprfn liqd cap 200mg OTC
ibuprofen cap 200mg OTC
ks ibuprofen cap 200mg OTC
medi-profen cap 200mg OTC
ra ibuprofen cap 200mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 80 AGE - Age Limit GNDR - Gender Edit
sm ibuprofen cap 200mg OTC
wal-profen cap 200mg OTC
advil jr st tab 100mg OTC
sm ibuprofen tab 100mg jr OTC
addaprin tab 200mg OTC
dyspel tab 200mg OTC
eq ibuprofen tab 200mg OTC
eql ibuprofn tab 200mg OTC
genpril tab 200mg OTC
hm ibuprofen tab 200mg OTC
ibu-200 tab 200mg OTC
ibuprofen tab 200 mg OTC
kls ibuprofn tab 200mg OTC
medi-profen tab 200mg OTC
motrin ib tab 200mg OTC
pain relief tab 200mg OTC
provil tab 200mg OTC
px ibuprofen tab 200mg OTC
qc ibuprofen tab 200mg OTC
ra ibuprofen tab 200mg OTC
sb ibuprofen tab 200mg OTC
sm ibuprofen tab 200mg OTC
wal-profen tab 200mg OTC
ibu tab 400mg ibuprofen tab 400 mg ibu tab 600mg ibuprofen tab 600 mg ibu tab 800mg ibuprofen tab 800 mg
advil jr str chw 100mg OTC
hm ibuprofen chw 100mg OTC
ibuprofen ib chw 100mg OTC
ibuprofen jr chw 100mg OTC
ibuprofen js chw 100mg OTC
ibuprofn 100 chw jr 100mg OTC
chld ibuprfn dro 40mg/ml OTC
cvs ibuprof dro 50/1.25 OTC
ibu-drops dro 50/1.25 OTC
ibuprofen dro 50/1.25 OTC
medi-profen sus 40mg/ml OTC
px profen ib dro 50/1.25 OTC
cvs ibuprofe sus 100/5ml OTC
hyvee ibupro sus 100mg/5m OTC
ibuprofen ch sus 100/5ml OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 81 AGE - Age Limit GNDR - Gender Edit
ibuprofen sus 100/5ml OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 80 AGE - Age Limit GNDR - Gender Edit
ibuprofen susp 100 mg/5ml ibuprofen susp 100 mg/5ml OTC
medi-profen sus 100/5ml OTC
px profen ib sus 100/5ml OTC
ketorolac tromethamine tab 10 mg QL (20 tabs / 25 days)
meloxicam tab 7.5 mg
meloxicam tab 15 mg nabumetone tab 500 mg nabumetone tab 750 mg naproxen tab 250 mg naproxen tab 375 mg naproxen tab 500 mg naproxen dr tab 375mg naproxen dr tab 500mg eql naproxen cap 220mg OTC
naproxen sodium cap 220 mg OTC
all day pain tab 220mg OTC
all day relf tab 220mg OTC
cvs naproxen tab 220mg OTC
flanax pain tab 220mg OTC
kls naproxen tab 220mg OTC
mediproxen tab 220mg OTC
naproxen sod tab 220mg OTC
pamprin tab 220mg OTC
naproxen sodium tab 275 mg
naproxen sodium tab 550 mg oxaprozin tab 600 mg sulindac tab 150 mg sulindac tab 200 mg
celecoxib cap 50 mg PA
celecoxib cap 100 mg PA
celecoxib cap 200 mg PA
celecoxib cap 400 mg PA
NTIRHEUMATIC ANTIMETABOLITES RASUVO INJ 7.5MG SP, QL (30 pens / 30 days),
PA RASUVO INJ 10MG SP, QL (22.5 pens / 30
days), PA RASUVO INJ 12.5MG SP, QL (18 pens / 30 days),
PA RASUVO INJ 15MG SP, QL (15 pens / 30 days),
PA RASUVO INJ 17.5MG SP, QL (12.857 pens / 30
days), PA RASUVO INJ 20MG SP, QL (11.25 pens / 30
A
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 81 AGE - Age Limit GNDR - Gender Edit
days), PA
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 82 AGE - Age Limit GNDR - Gender Edit
RASUVO INJ 22.5MG SP, QL (10 pens / 30 days),
PA RASUVO INJ 25MG SP, QL (9 pens / 30 days),
PA RASUVO INJ 30MG SP, QL (7.5 pens / 30 days),
PA
ANTI-TNF-ALPHA - MONOCLONAL ANTIBODIES HUMIRA PEN INJ 40MG/0.8 SP, QL (4.5 pens / 30 days),
PA HUMIRA PEN INJ CD/UC/HS SP, QL (6.6 pens / 30 days),
PA HUMIRA PEN INJ PS/UV SP, QL (4.5 pens / 30 days),
PA HUMIRA PEN KIT CD/UC/HS SP, QL (3.3 pens / 30 days),
PA HUMIRA PEN KIT PS/UV SP, QL (3.3 pens / 30 days),
PA HUMIRA INJ 10MG/0.2 SP, QL (2.4 injections / 30
days), PA HUMIRA KIT 20MG/0.4 SP, QL (2.4 injections / 30
days), PA HUMIRA KIT 40MG/0.8 SP, QL (4.5 injections / 30
days), PA HUMIRA PEDIA INJ CROHNS SP, QL (6.6 injections / 30
days), PA
PYRIMIDINE SYNTHESIS INHIBITORS leflunomide tab 10 mg leflunomide tab 20 mg
SOLUBLE TUMOR NECROSIS FACTOR RECEPTOR AGENTS ENBREL INJ 25MG SP, QL (8.7 syringes / 30
days), PA ENBREL SRCLK INJ 50MG/ML SP, QL (8.7 syringes / 30
days), PA ENBREL MINI INJ 50MG/ML SP, QL (8.878 injections /
30 days), PA ENBREL INJ 25/0.5ML SP, QL (17.059 syringes /
30 days), PA ENBREL INJ 50MG/ML SP, QL (8.878 syringes / 30
days), PA
INTERLEUKIN-6 RECEPTOR INHIBITORS KEVZARA INJ 150/1.14 SP, QL (2.368 syringes / 30
days), PA KEVZARA INJ 200/1.14 SP, QL (2.368 syringes / 30
days), PA
ANTIRHEUMATIC - ENZYME INHIBITORS XELJANZ TAB 5MG SP, QL (2 tabs / 1 day), ST
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 83 AGE - Age Limit GNDR - Gender Edit
XELJANZ TAB 10MG SP, QL (2 tabs / 1 day), ST
XELJANZ XR TAB 11MG SP, QL (1 tab / 1 day), ST
MIGRAINE PRODUCTS SEROTONIN AGONISTS
naratriptan hcl tab 1 mg (base equiv) QL (8 tabs / 25 days), ST naratriptan hcl tab 2.5 mg (base equiv) QL (8 each / 25 days), ST naratriptan hcl tab 2.5 mg (base equiv) QL (8 tabs / 25 days), ST rizatriptan benzoate tab 5 mg (base equivalent) QL (12 tabs / 25 days), ST rizatriptan benzoate tab 10 mg (base equivalent) QL (12 tabs / 25 days), ST rizatriptan benzoate oral disintegrating tab 5 mg QL (12 tabs / 25 days), ST
(base eq) rizatriptan benzoate oral disintegrating tab 10 mg QL (12 tabs / 25 days), ST (base eq) sumatriptan nasal spray 5 mg/act QL (8 inhalers / 25 days) sumatriptan nasal spray 20 mg/act QL (8 inhalers / 25 days)
sumatriptan succinate tab 25 mg QL (8 tabs / 25 days)
sumatriptan succinate tab 50 mg QL (8 tabs / 25 days)
sumatriptan succinate tab 100 mg QL (8 tabs / 25 days)
sumatriptan succinate inj 6 mg/0.5ml QL (8 injections / 25 days)
sumatriptan succinate solution auto-injector 4 QL (8 injections / 25 days) mg/0.5ml sumatriptan succinate solution auto-injector 6 QL (8 injections / 25 days) mg/0.5ml sumatriptan succinate solution cartridge 4 QL (8 injections / 25 days) mg/0.5ml sumatriptan succinate solution cartridge 6 QL (8 injections / 25 days) mg/0.5ml sumatriptan succinate solution prefilled syringe 6 QL (8 injections / 25 days) mg/0.5ml zolmitriptan tab 2.5 mg QL (8 tabs / 25 days), ST
zolmitriptan tab 5 mg QL (8 tabs / 25 days), ST
zolmitriptan orally disintegrating tab 2.5 mg QL (8 each / 25 days), ST zolmitriptan orally disintegrating tab 2.5 mg QL (8 tabs / 25 days), ST zolmitriptan orally disintegrating tab 5 mg QL (8 each / 25 days), ST zolmitriptan orally disintegrating tab 5 mg QL (8 tabs / 25 days), ST
MIGRAINE COMBINATIONS ergotamine w/ caffeine tab 1-100 mg
GOUT AGENTS GOUT AGENTS
allopurinol tab 100 mg allopurinol tab 300 mg colchicine tab 0.6 mg QL (30 tabs / 25 days)
URICOSURICS probenecid tab 500 mg
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 84 AGE - Age Limit GNDR - Gender Edit
ANTICONVULSANTS HYDANTOINS
phenytoin chew tab 50 mg phenytoin susp 125 mg/5ml DILANTIN CAP 30MG
phenytoin sodium extended cap 100 mg phenytoin sodium extended cap 200 mg phenytoin sodium extended cap 300 mg
SUCCINIMIDES ethosuximide cap 250 mg ethosuximide soln 250 mg/5ml
ANTICONVULSANTS - MISC. primidone tab 50 mg primidone tab 250 mg
ANTIPARKINSON AND RELATED THERAPY AGENTS ANTIPARKINSON COMT INHIBITORS
entacapone tab 200 mg
ANTIPARKINSON DOPAMINERGICS amantadine hcl cap 100 mg amantadine hcl tab 100 mg amantadine hcl syrup 50 mg/5ml bromocriptine mesylate cap 5 mg (base equivalent)
bromocriptine mesylate tab 2.5 mg (base equivalent)
pramipexole dihydrochloride tab 0.125 mg pramipexole dihydrochloride tab 0.25 mg pramipexole dihydrochloride tab 0.5 mg pramipexole dihydrochloride tab 0.75 mg pramipexole dihydrochloride tab 1 mg pramipexole dihydrochloride tab 1.5 mg ropinirole hydrochloride tab 0.25 mg ropinirole hydrochloride tab 0.5 mg ropinirole hydrochloride tab 1 mg ropinirole hydrochloride tab 2 mg ropinirole hydrochloride tab 3 mg ropinirole hydrochloride tab 4 mg ropinirole hydrochloride tab 5 mg carbidopa & levodopa tab 10-100 mg carbidopa & levodopa tab 25-100 mg carbidopa & levodopa tab 25-250 mg carbidopa & levodopa tab er 25-100 mg carbidopa & levodopa tab er 50-200 mg
carbidopa & levodopa orally disintegrating tab 10-100 mg
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 85 AGE - Age Limit GNDR - Gender Edit
carbidopa & levodopa orally disintegrating tab
25-100 mg carbidopa & levodopa orally disintegrating tab
25-250 mg carbidopa-levodopa-entacapone tabs 12.5-50-200
mg carbidopa-levodopa-entacapone tabs
18.75-75-200 mg carbidopa-levodopa-entacapone tabs 25-100-200
mg carbidopa-levodopa-entacapone tabs
31.25-125-200 mg carbidopa-levodopa-entacapone tabs
37.5-150-200 mg carbidopa-levodopa-entacapone tabs 50-200-200
mg
ANTIPARKINSON MONOAMINE OXIDASE INHIBITORS selegiline hcl cap 5 mg selegiline hcl tab 5 mg
NEUROMUSCULAR AGENTS ALS AGENTS
riluzole tab 50 mg
MUSCULOSKELETAL THERAPY AGENTS CENTRAL MUSCLE RELAXANTS
baclofen tab 10 mg baclofen tab 20 mg carisoprodol tab 250 mg QL (120 tabs / 25 days)
carisoprodol tab 350 mg QL (120 tabs / 25 days)
chlorzoxazone tab 250 mg
chlorzoxazone tab 500 mg cyclobenzaprine hcl tab 5 mg cyclobenzaprine hcl tab 10 mg methocarbamol tab 500 mg methocarbamol tab 750 mg orphenadrine citrate tab er 12hr 100 mg tizanidine hcl tab 2 mg (base equivalent) tizanidine hcl tab 4 mg (base equivalent)
DIRECT MUSCLE RELAXANTS dantrolene sodium cap 25 mg dantrolene sodium cap 50 mg dantrolene sodium cap 100 mg
VISCOSUPPLEMENTS
GEL-ONE INJ 30MG/3ML SP, PA SYNVISC INJ 8MG/ML SP, PA
SYNVISC ONE INJ 8MG/ML SP, PA
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 86 AGE - Age Limit GNDR - Gender Edit
VISCO-3 INJ 25/2.5ML SP, PA
ANTIMYASTHENIC/CHOLINERGIC AGENTS ANTIMYASTHENIC/CHOLINERGIC AGENTS
pyridostigmine bromide tab 60 mg pyridostigmine bromide tab er 180 mg MESTINON SYP 60MG/5ML
VITAMINS
WATER SOLUBLE VITAMINS thiamine hcl tab 50 mg OTC b-1 hi potcy tab 100mg OTC
cvs b1 tab 100mg OTC
cvs b-1 tab 100mg OTC
thiamine hcl tab 100 mg OTC
pyridoxine hcl tab 25 mg OTC
neuro-k-50 tab OTC
pyridoxine hcl tab 50 mg OTC
ra vit b-6 tab 50mg OTC
c-500 tab non-acid OTC
calcium ascorbate tab 500 mg OTC
OIL SOLUBLE VITAMINS VITAMIN D CAP 2000UNIT OTC ergocalciferol cap 50000 unit
VITAMIN D2 TAB 400UNIT OTC
VITAMIN D2 TAB 2000UNIT OTC
calcidol dro 8000/ml OTC
calciferol dro 8000/ml OTC
ergocalciferol soln 8000 unit/ml OTC
cholecalciferol cap 1000 unit OTC
cvs d3 cap 1000unit OTC
d3 cap 1000unit OTC
d3-1000 cap 1000unit OTC
d 1000 cap 1000unit OTC
gnp d cap 1000unit OTC
vitamin d3 cap 1000unit OTC
vitamin d cap 1000unit OTC
cholecalciferol cap 2000 unit OTC
cvs d3 cap 2000unit OTC
d3 cap 2000unit OTC
d3 super str cap 2000unit OTC
hm vit d3 cap 2000unit OTC
pa vitamin cap 2000unit OTC
ra vitamin cap 2000unit OTC
vitamin d3 cap 2000unit OTC
vitamin d-3 cap 2000unit OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 86 AGE - Age Limit GNDR - Gender Edit
cholecalciferol cap 5000 unit OTC
cvs d3 cap 5000unit OTC
d3 maximum cap 5000unit OTC
dialyvite d cap 5000unit OTC
eql vitamin cap d3 OTC
cholecalciferol cap 10000 unit OTC
decara cap 10000unt OTC
vitamin d3 cap 10000unt OTC
cholecalciferol cap 50000 unit OTC
d3-50 cap 50000unt OTC
decara cap 50000unt OTC
optimal-d cap 50000unt OTC
cholecalciferol tab 400 unit OTC
d3 tab 400unit OTC
d 400 tab 400unit OTC
delta d3 tab 400unit OTC
sm vitamin d tab 400unit OTC
cholecalciferol tab 1000 unit OTC
gnp vit d3 tab 1000unit OTC
gnp vit d tab 1000unit OTC
hm vitamin d tab 1000unit OTC
sm vitamind3 tab 1000unit OTC
vitamin d tab 1000unit OTC
vitamin d-3 tab 1000unit OTC
cholecalciferol tab 2000 unit OTC
thera-d tab 2000unit OTC
cholecalciferol tab 5000 unit OTC
gnp vit d tab 5000unit OTC
vitamin d tab 5000iu OTC
vitamin d-3 tab 5000unit OTC
cholecalciferol chew tab 400 unit OTC
d3 kids chw 400unit OTC
d 400 chw 400unit OTC
d-3 gummy chw 400unit OTC
vitamin d chw 400unit OTC
cvd d3 chw 1000unit OTC
cvs d3 chw 1000 unt OTC
d3 adult chw 1000unit OTC
gnp d chw 2000unit OTC
kids vit d3 chw 1000unit OTC
vit d3 gumm chw 1000unit OTC
vit d child chw 1000unit OTC
vitajoy daly chw d 1000iu OTC
vitamin d3 chw 1000unit OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 87 AGE - Age Limit GNDR - Gender Edit
vitamin d chw 1000unit OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 88 AGE - Age Limit GNDR - Gender Edit
cholecalciferol oral liquid 400 unit/ml OTC
d3 vitamin liq 400unit OTC
just d liq 400unit OTC
pedia d-vite dro 400unit OTC
BABY DDROPS LIQ 400UNIT OTC
baby super dro daily d3 OTC
baby vit d dro 400/.028 OTC
vit d3 drops liq 400unit OTC
DDROPS LIQ 2000UNIT OTC
phytonadione tab 5 mg
MULTIVITAMINS VITAMIN MIXTURES
e-400 cap selenium OTC VITAMIN E CAP COMPLETE OTC
vitamin mixture cap OTC
ecee plus tab OTC
VITA-MAG TAB OTC
VITAMIN C LIQ OTC
d 400 cap OTC
d-natural-5 cap OTC
ra cod liver cap OTC
vitamin a&d cap OTC
vitamins a & d cap OTC
yl vitamin cap a & d OTC
vitamins a & d tab OTC
cod liver cap norwegia OTC
cod liver cap oil OTC
cod liver cap oil/a&d OTC
cod liver oil cap OTC
COD LIVER OIL OTC
COD LIVER OIL FOR KIDS OTC
COD LIVER OIL NORWEGIA OTC
COD LIVER OIL OIL OTC
COD LIVER OIL USP/NF OTC
RA COD LIVER OIL OTC
cod liver chw /vit d OTC
cod liver chw w/vit OTC
SUPER D3 CAP COMPLEX OTC
AZEC CAP OTC
c & e cap 500-400 OTC
cranberry cap urin com OTC
vitamins c & e cap OTC
niacin cap 400-100 OTC
niacin cap 400mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 89 AGE - Age Limit GNDR - Gender Edit
D3/VITAMIN C TAB /ZINC OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 90 AGE - Age Limit GNDR - Gender Edit
D3 + K2 DOTS TAB OTC
DOSOQUIN TAB OTC
K2 PLUS D3 TAB OTC
B-COMPLEX VITAMINS b-complex vitamin cap OTC b-complex 50 tab OTC
b-complex vitamin tab OTC
pa b-complex tab w/b-12 OTC
ra b-complex tab OTC
ra b-complex tab w/b-12 OTC
b-complex tab OTC
b-complex tab 50 tr OTC
cvs balanced tab b100 OTC
b-complex vitamin sublingual liquid OTC
APETEX ELX OTC
APETIGEN ELX OTC
brewers yeast tab OTC
BREWERS YEAS POW OTC
B-COMPLEX W/ C b-complex w/ c cap OTC super b w/c cap OTC
vt b complex cap OTC
allbee plus tab vit c OTC
b complex tab plus c OTC
b-complex w/ c tab OTC
better b tab complex OTC
cvs super b tab complx/c OTC
sm b complex tab with c OTC
super b comp tab vit c OTC
superplex-t tab OTC
total b/c tab OTC
balanced b tab complex OTC
ra b-complex tab vit c tr OTC
PRONUTRIENTS TAB SUPER B OTC
bec/zinc tab OTC
cvs stress tab form/zn OTC
stress b com tab vit c/zn OTC
stress b/ tab zinc OTC
stress form tab /zinc OTC
stress form/ tab zinc OTC
stress formu tab /zinc OTC
stress plus tab zinc OTC
zinc-vites tab OTC
b-complex tab /vit c OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 91 AGE - Age Limit GNDR - Gender Edit
b-complex w/ c & calcium tab OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 92 AGE - Age Limit GNDR - Gender Edit
B-COMPLEX W/ FOLIC ACID b-complex w/ folic acid cap OTC benfotiamine cap multi-b OTC
b complex tab form 1 OTC
b complex tab plus OTC
b-complex w/ folic acid tab OTC
big 100 tab OTC
kobee tab OTC
sm balanced tab b-50 OTC
sm balanced tab b-100 OTC
super b comp tab maxi OTC
b-50 tr tab OTC
balance b-50 tab tr OTC
gnp b-100 tab OTC
m2 b125 tab tr OTC
B-COMPLEX CAP OTC
MULTI-B CAP COMPLEX OTC
SUPER B-50 CAP B-COMP OTC
SUPER B-50 CAP COMPLEX OTC
SUPER B- CAP COMPLEX OTC
EXTRESS-30 CAP OTC
b complete tab OTC
b-100 tab b-100 OTC
b-compleet- tab 50 OTC
b-compleet- tab 100 OTC
b-complex w/biotin & folic acid tab OTC
balance b-50 tab OTC
balanced b tab complex OTC
balanced tab b-50 OTC
balanced tab b-100 OTC
big 100 tab OTC
eql b complx tab 50 OTC
extress tab OTC
extress- tab super OTC
gnp b-50 tab balanced OTC
quin b stron tab b-25 OTC
ra balanced tab b-50 OTC
ra balanced tab b-100 OTC
sm b100 tab complex OTC
sm b-complex tab OTC
super b-50 tab OTC
super b-100 tab OTC
super b- tab complex OTC
super dec tab b-100 OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 93 AGE - Age Limit GNDR - Gender Edit
super quints tab OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 94 AGE - Age Limit GNDR - Gender Edit
super-b tab complex OTC
vitamin b50 tab complex OTC
vitamin b100 tab complex OTC
yl balanced tab b-100 OTC
b50 complex tab tr OTC
b-50 complex tab OTC
b-100 complx tab OTC
b-100 tab complex OTC
b-100 tr tab OTC
b-complex tab 100 tr OTC
balanc b-100 tab tr OTC
balanced tab b-100 tr OTC
complex b-50 tab OTC
endur-b tab OTC
eql b-100 tab complex OTC
gnp b-50 tab complex OTC
gnp b-100 tab complex OTC
poten b-150 tab tr OTC
ra balanced tab b-50 tr OTC
ra balnaced tab b-100 tr OTC
vitamin b50 tab complex OTC
mynephrocaps cap
mynephron cap renal cap reno cap
reno cap OTC
triphrocaps cap
virt-caps cap b complex tab vit c OTC
b-complex tab balanced OTC
b-complex w/ c & folic acid tab OTC
hm b complex tab with c OTC
kp b complex tab /c OTC
sm b super tab vita com OTC
SM B-COMPLEX TAB /VIT C OTC
stress form tab OTC
super b comp tab /vit c OTC
super b comp tab vit c OTC
super b-comp tab /fa/vitc OTC
super b-comp tab vit c/fa OTC
vit b complx tab /vit c OTC
vita-bee/c tab OTC
BIOTIN FORTE TAB OTC
dialyvite tab 800 OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 95 AGE - Age Limit GNDR - Gender Edit
FULL SPECT TAB B/ VIT C OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 91 AGE - Age Limit GNDR - Gender Edit
nephro tab vitamins OTC
rena-vite tab OTC
renal tab multivit OTC
renal vitamn tab OTC
renal-vite tab OTC
rena-vite rx tab OTC
B COMPLEX +C TAB TR OTC
b-complex/fa tab /vit c OTC
DIALYVITE TAB 800/IRON OTC
BIOTIN FORTE TAB /ZINC OTC
DIALYVIT 800 TAB ZINC 15 OTC
DIALYVITE TAB 800/ZINC OTC
BIOTALAN LIQ CLEAR OTC
B-COMPLEX TAB C/FA/BIO OTC
B-COMPLEX W/ IRON b-complex w/ iron tab OTC super b-comp tab iron/c OTC
APETIGEN-PLS SOL OTC
SUPLEVIT LIQ OTC
B-COMPLEX W/ MINERALS APETIGEN TAB PLUS OTC GLYCO-TECH TAB OTC
geriaton liq OTC
rabano liq yodado OTC
senior tonic liq OTC
GERIATRIC LIQ VITAMIN OTC
VITONIC LIQ OTC
BIOFLAVONOID PRODUCTS ACTITROM CAP OTC ACTITROM-D CAP OTC
c 1000/biofl cap /r hips OTC
C 1000/BIOFL CAP /R HIPS OTC
C-PLEX CAP OTC
grape seed cap 50mg OTC
TROMBONEX CAP OTC
trombonex-d cap OTC
VASOFLEX CAP OTC
vasoflex cap forte OTC
M2 C CAP OTC
ADVANCED C TAB PLUS OTC
anti-allergy tab OTC
bioflavonoid products tab OTC
bioflex tab OTC
CEMILL PLUS TAB OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 92 AGE - Age Limit GNDR - Gender Edit
cemill/biofl tab OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 93 AGE - Age Limit GNDR - Gender Edit
easy-c tab 500mg OTC
ester-c tab OTC
ester-c tab 500mg OTC
ester-c tab 1000mg OTC
flexgen tab OTC
hi c-500 tab OTC
pan-c 500 tab bioflavo OTC
span c tab OTC
super c-500 tab OTC
super c-1000 tab OTC
tri super tab flavons OTC
vasoflex hd tab OTC
vasoflex tab OTC
vita c/biofl tab rose hip OTC
vitamin c tab plus OTC
ASCOCID-500 TAB OTC
ASCOCID-1000 TAB OTC
bioflavonoid products tab er OTC
c1000 tr/rh tab bioflav OTC
c1500 tr/rh tab bioflav OTC
c1500/rh tab bioflav OTC
c complex tab 500mg OTC
c complex tab 1000mg OTC
DAFLONEX-XL TAB OTC
ester-c tab 500mg OTC
ra vitamin c tab 1000mg OTC
SUPER C-500 TAB COMPLEX OTC
FRUIT C CHW 200MG OTC
VITAMIN C CHW 500MG OTC
LIQUID C LIQ OTC
BIOFLAVONOID POW CITRUS OTC
MULTIVITAMINS antioxidant cap formula OTC chlorocaps cap OTC
DEKAS CAP ESSENTIA OTC
multiple vitamin cap OTC
multivitamin cap OTC
mv-one cap OTC
anti-oxidant tab OTC
daily multi tab vitamins OTC
daily tab vitamin OTC
daily value tab multivit OTC
daily vit tab OTC
daily vite tab OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 94 AGE - Age Limit GNDR - Gender Edit
daily-vitamn tab OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 95 AGE - Age Limit GNDR - Gender Edit
daily-vite tab OTC
essentl one tab daily OTC
ESTROFACTORS TAB OTC
healthy hair tab skn/nail OTC
mult vitamin tab daily OTC
mult vitamin tab essent OTC
mult vitamin tab mens OTC
multi vitami tab OTC
multi vitami tab d-3 OTC
multi-day tab OTC
multi-vitamn tab OTC
multiple vitamin tab OTC
multivitamin tab daily OTC
multivitamin tab iron-fre OTC
NEOMULTIVITE TAB OTC
OMNICAP TAB OTC
once daily tab OTC
one daily tab OTC
one daily tab essentl OTC
one daily tab multivit OTC
one-daily tab mult vit OTC
qc essential tab OTC
QUINTABS TAB OTC
ra one daily tab essentia OTC
ra one daily tab multivit OTC
renal/zinc tab multivit OTC
sigtab tab OTC
sm multiple tab vitamins OTC
stress form tab OTC
stress formu tab OTC
stresstabs tab OTC
stresstabs tab energy OTC
tab-a-vite tab OTC
tab-a-vite tab beta car OTC
thera tab OTC
THERA TAB OTC
thera-mill tab OTC
thera-tabs tab OTC
therapeutic tab OTC
therems tab OTC
vitalee tab OTC
CHEW-12 CHW OTC
ONE-A-DAY CHW VITACRAV OTC
DEKAS LIQ ESSENTIA OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 96 AGE - Age Limit GNDR - Gender Edit
MULTIVITAMIN DRO ORGANIC OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 97 AGE - Age Limit GNDR - Gender Edit
MULTIVITAMIN LIQ OTC
MIL-A-MULSIO EMU OTC
MULTIPLE VITAMINS W/ IRON CHLORELLA CAP OTC daily multi tab vit/iron OTC
daily vit tab +iron OTC
daily vit tab iron OTC
daily vite tab iron OTC
daily-vitamn tab OTC
daily-vite/ tab iron OTC
hm one daily tab /iron OTC
multi vitami tab w/iron OTC
multi-day tab /iron OTC
multi-vit/fe tab OTC
multiple vitamins w/ iron tab OTC
nat-rul dail tab vit/iron OTC
once daily tab iron OTC
one daily mv tab /iron OTC
one daily tab pls iron OTC
one-daily tab /iron OTC
ra one daily tab +iron OTC
sm multiple tab vit/iron OTC
stress b com tab w/iron OTC
stress form tab /iron OTC
stress formu tab w/iron OTC
tab-a-vite tab /iron OTC
MULTIPLE VITAMINS W/ MINERALS ABDEK CAP OTC actical cap OTC
ACTIVNUTRIEN CAP OTC
ADULT 50+ CAP OCUVITE OTC
50+ adult cap eye hlth OTC
advanced eye cap health OTC
amoryn mood cap booster OTC
anti-oxidant cap formula OTC
antiox form/ cap minerals OTC
antioxidant cap OTC
antioxin cap 4000 OTC
BARIATRIC CAP MULTIVIT OTC
bdy/hair/skn cap nails OTC
BIO-35 GLUTE CAP FREE OTC
BIO-35 IRON CAP FREE OTC
BIOCAL CAP OTC
BIOTECT PLUS CAP OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 98 AGE - Age Limit GNDR - Gender Edit
CELEBRATE CAP 18 OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 99 AGE - Age Limit GNDR - Gender Edit
CELEBRATE CAP 36 OTC
CELEBRATE CAP 45 OTC
CELEBRATE CAP 60 OTC
CELLULAR CAP SECURITY OTC
CHOICEFUL CAP MULTIVIT OTC
coral calciu cap plus OTC
daily vitamn cap plus OTC
DECUBI-VITE CAP OTC
DEKAS PLUS CAP OTC
dry eye cap formula OTC
EYE HEALTH CAP OTC
eye vitamins cap OTC
glucoten cap OTC
hair/skin cap nails OTC
hair/skin/ cap nails OTC
healthy eyes cap supervis OTC
icaps areds cap 2 OTC
icaps cap OTC
icaps lutein cap /omega-3 OTC
K-PAX CAP DOUBLE OTC
K-PAX CAP SINGLE OTC
macular hlth cap formula OTC
MENS 50+ CAP ADVANCED OTC
mens daily cap lycopene OTC
multi 50+ cap for her OTC
multi cap complete OTC
multi cap for her OTC
multi cap for him OTC
multivitamin cap daily OTC
MVW COMPLETE CAP D3000 OTC
MVW COMPLETE CAP D5000 OTC
MVW COMPLETE CAP FORMULAT OTC
MVW COMPLETE CAP MINIS OTC
my-vitalife cap OTC
NUTRIENTS CAP ANTIOXID OTC
OCUVITE CAP ADULT OTC
ocuvite eye cap health OTC
OCUVITE LUTE CAP OTC
pms support cap complex OTC
PORENAL+D CAP OMEGA 3 OTC
PRESERVISION CAP AREDS OTC
PRESERVISION CAP AREDS 2 OTC
PRESERVISION CAP LUTEIN OTC
prevent cap OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 100 AGE - Age Limit GNDR - Gender Edit
PRORENAL+D CAP OMEGA-3 OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 101 AGE - Age Limit GNDR - Gender Edit
prosight cap w/lutein OTC
PROTECT CAP CARDIO OTC
PROTECT CAP PLUS SO OTC
PROTEGRA CAP OTC
REPLACE CAP OTC
SAVISION CAP OTC
SUPER ANTIOX CAP OTC
super antiox cap protect OTC
super multip cap OTC
theramill cap plus OTC
THERANATAL CAP LACTATIO OTC
ultra multi cap /iron OTC
vision form cap eye hlth OTC
vision formu cap 50+ OTC
vision plus cap OTC
vita-min cap OTC
VITABEX CAP OTC
VITABEX PLUS CAP OTC
viteyes ared cap advanced OTC
viteyes ared cap formula OTC
viteyes cap /lutein OTC
viteyes cap complete OTC
viteyes smkr cap advanced OTC
viteyes smkr cap w/lutein OTC
womens 50+ cap advanced OTC
womens cap multi OTC
a thru z adv tab adult OTC
a thru z sel tab 50+ adva OTC
a thru z sel tab 50+ mens OTC
a thru z sel tab advanced OTC
a thru z tab advanced OTC
a thru z tab high pot OTC
a thru z tab select OTC
a thru z tab ultimate OTC
a thru z ult tab mens OTC
abc plus tab OTC
abc plus tab senior OTC
ADV DIABETIC TAB MULTIVIT OTC
advanced tab formula OTC
ALIVE 50+ TAB ENERGY OTC
ALIVE 50+ TAB WOMENS OTC
ALIVE DAILY TAB WOMENS OTC
ALIVE ENERGY TAB MENS OTC
ALIVE ENERGY TAB WOMENS OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 102 AGE - Age Limit GNDR - Gender Edit
antioxidant tab OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 103 AGE - Age Limit GNDR - Gender Edit
ANTIOXIDANT TAB FORTE OTC
antioxidant tab protecti OTC
antioxidant tab vitamins OTC
b-r edi/rd hr tab ts/rd ro OTC
BASIC AM TAB OTC
BASIC PM TAB OTC
biotin plus/ tab cal/vitd OTC
CAL-DAY 1000 TAB OTC
carravite tab OTC
CENT MATURE TAB ADLT 50+ OTC
cent mature tab womn 50+ OTC
centavite az tab minerals OTC
CENTRAL-VITE TAB OTC
central-vite tab mens mat OTC
CENTRAL-VITE TAB UNDER 50 OTC
central-vite tab wmns mat OTC
centravites tab OTC
centravites tab 50 plus OTC
CENTRAVITES TAB 50 PLUS OTC
CENTRAVITES TAB ADULTS OTC
CENTRUM SPEC TAB HEART OTC
CENTRUM SPEC TAB IMMUNE OTC
CENTRUM SPEC TAB VISION OTC
CENTRUM TAB CARDIO OTC
CENTRUM TAB MEN OTC
CENTRUM TAB SILVER OTC
CENTRUM TAB ULTRA OTC
century tab OTC
century tab mature OTC
cerovite tab advanced OTC
cerovite tab senior OTC
certa plus tab OTC
certagen tab OTC
CERTAVITE TAB SENIOR OTC
certavite/ tab antioxid OTC
comp daily tab w/lutein OTC
comp energy tab OTC
companion tab OTC
compete tab OTC
comple multi tab adlt 50+ OTC
complere tab OTC
COMPLETE 50+ TAB MENS OTC
COMPLETE 50+ TAB WOMENS OTC
complete tab OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 104 AGE - Age Limit GNDR - Gender Edit
complete tab senior OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 105 AGE - Age Limit GNDR - Gender Edit
complete tab womens OTC daily betic tab OTC
daily combo tab OTC
daily diet tab support OTC
daily mens tab health OTC
daily multi tab OTC
daily multi tab 50+ OTC
daily multi tab men OTC
daily multi tab minerals OTC
daily multi tab vit/mens OTC
daily multi tab vit/min OTC
daily multi tab women OTC
daily multi tab womn 50+ OTC
daily vit tab +mineral OTC
daily womens tab health OTC
daily-vitamn tab maximum OTC
DERMAVITE TAB OTC
diabetic sup tab formula OTC
diabets hlth tab formula OTC
dialyvite tab 800/d OTC
drs choice tab men OTC
enviro-stres tab OTC
EQ COMPLETE TAB ADULT OTC
EQ ONE DAILY TAB MENS OTC
eq one daily tab womens OTC
EQ ONE DAILY TAB WOMENS OTC
eql century tab OTC
eql century tab mature OTC
EQL CENTURY TAB MENS OTC
EQL CENTURY TAB WOMENS OTC
eql vision tab formula OTC
essentia tab OTC
essential tab balance OTC
eye health & tab lutein OTC
eye-vites tab OTC
eyeprotect tab OTC
FITNESS TABS TAB MEN OTC
FITNESS TABS TAB WOMEN OTC
FREEDAVITE TAB OTC
GERI-FREEDA TAB SENIOR OTC
gerivite tab complete OTC
gnp century tab OTC
gnp century tab adult OTC
gnp century tab cardio OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 106 AGE - Age Limit GNDR - Gender Edit
gnp century tab mature OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 107 AGE - Age Limit GNDR - Gender Edit
gnp century tab senior OTC
gnp century tab ultimate OTC
gnp healthy tab eyes OTC
gnp one dail tab maximum OTC
gnp opti-vit tab OTC
hair formula tab ex stren OTC
hair formula tab ultr man OTC
HAIR SKIN & TAB NAILS AD OTC
hair skin tab nails OTC
hair vitamin tab OTC
hair/skin/ tab nails OTC
healthy eyes tab OTC
healthy eyes tab lutein OTC
hi-kovite tab 2-part OTC
hi-potency tab multivit OTC
hm complete tab OTC
HM COMPLETE TAB OTC
hm complete tab 50+ OTC
hm complete tab women OTC
HM HAIR/SKIN TAB /NAILS OTC
HM ONE DAILY TAB MENS OTC
HYALEX TAB OTC
i-vite prote tab OTC
i-vite tab OTC
ICAPS AREDS TAB FORMULA OTC
icaps mv tab OTC
ICAPS PLUS TAB OTC
K-PAX TAB PROF ST OTC
kp adult 50+ tab daily OTC
kp adults tab daily OTC
kp mens 50+ tab daily OTC
kp mens tab daily OTC
kp vision tab for/ltn OTC
kp vision tab formula OTC
kp women 50+ tab daily OTC
kp womens tab daily OTC
life pack tab mens OTC
life pack tab womens OTC
MACULAR VIT TAB BENEFIT OTC
macuvite tab OTC
macuvite tab eye care OTC
macuvite tab lutein OTC
max daily tab green OTC
maximum tab blue lab OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 108 AGE - Age Limit GNDR - Gender Edit
maximum tab green lb OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 100 AGE - Age Limit GNDR - Gender Edit
maximum tab red labl OTC
mediplex tab plus OTC
mega multi tab men OTC
MEGA MULTI TAB MEN OTC
mega multi tab women OTC
MEGA MULTI TAB WOMEN OTC
MEGA MULTIVI TAB MEN OTC
MEGA MULTIVI TAB WOMEN OTC
mega vm-80 tab OTC
MEGAVITE TAB FRT/VEG OTC
MEGAVITE TAB GOLD 55+ OTC
mens 50+ adv tab one daly OTC
mens daily tab formula OTC
MENS MULTI TAB VIT/MIN OTC
milltrium sr tab OTC
milltrium tab advanced OTC
milltrium tab cardio OTC
mult vitamin tab no iron OTC
mult vitamin tab womens OTC
multi 50+ tab for her OTC
multi 50+ tab for him OTC
multi complt tab /iron OTC
multi tab for her OTC
multi tab for him OTC
MULTI VITAMN TAB MINERALS OTC
MULTI-BETIC TAB DIABETES OTC
multi-day tab minerals OTC
multi-day tab wght trm OTC
multi-lean tab OTC
multi-vit/ tab minerals OTC
multi-vitami tab menopaus OTC
MULTI-VITAMI TAB MONOCAPS OTC
multi-vite tab OTC
multi-vite tab 50&over OTC
multilex tab OTC
multilex-t&m tab OTC
multimineral tab plus OTC
multiple vitamins w/ minerals tab OTC
multiv women tab 50+ OTC
multivitamin tab adlt 50+ OTC
multivitamin tab adt 50+ OTC
MULTIVITAMIN TAB ADULT OTC
multivitamin tab adults OTC
MULTIVITAMIN TAB ADULTS OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 101 AGE - Age Limit GNDR - Gender Edit
MULTIVITAMIN TAB MEN OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 102 AGE - Age Limit GNDR - Gender Edit
multivitamin tab men 50+ OTC
multivitamin tab mens OTC
multivitamin tab mineral OTC
multivitamin tab women OTC
multivitamin tab womens OTC
myamulti tab OTC
NAT-RUL THER TAB M OTC
NATRUL-VITES TAB OTC
NUTRIENT 45+ TAB WOMEN OTC
NUTRIENT 50+ TAB MEN OTC
NUTRIENTS TAB MEN OTC
NUTRIENTS TAB TEENS OTC
NUTRIENTS TAB WOMEN OTC
OCULAR TAB VITAMINS OTC
ocutabs tab OTC
ocutabs tab lutein OTC
ocuvite eye tab + multi OTC
ocuvite tab lutein OTC
ocuvite xtra tab OTC
ONCOVITE TAB OTC
ONE DAILY MN TAB W/O IRON OTC
one daily tab 50 plus OTC
one daily tab 50+ OTC
one daily tab 50+ adv OTC
one daily tab /mineral OTC
one daily tab complete OTC
one daily tab essentl OTC
one daily tab fe/ca OTC
one daily tab healthy OTC
one daily tab iron-fre OTC
one daily tab maximum OTC
one daily tab men OTC
one daily tab men 50+ OTC
one daily tab mens OTC
ONE DAILY TAB MENS OTC
one daily tab mens 50+ OTC
ONE DAILY TAB MENS 50+ OTC
one daily tab multivit OTC
one daily tab plus iro OTC
ONE DAILY TAB WMNS 50+ OTC
one daily tab wom 50+ OTC
ONE DAILY TAB WOMANS OTC
one daily tab women OTC
one daily tab women 50 OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 103 AGE - Age Limit GNDR - Gender Edit
one daily tab womens OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 104 AGE - Age Limit GNDR - Gender Edit
ONE DAILY TAB WOMENS OTC
one daily wm tab pro-actv OTC
one daily/ tab minerals OTC
one dly hlth tab wght adv OTC
ONE-A-DAY TAB 50+ ADV OTC
ONE-A-DAY TAB 65+ OTC
ONE-A-DAY TAB ENERGY OTC
ONE-A-DAY TAB MENOPAUS OTC
ONE-A-DAY TAB MENS OTC
ONE-A-DAY TAB PROEDGE OTC
one-a-day tab teen/her OTC
ONE-A-DAY TAB TEEN/HIM OTC
optic-vites tab OTC
optic-vites tab lutein OTC
optimum pms tab OTC
OPURITY TAB OTC
OSTEOPRIME TAB PLUS OTC
osteoprime tab ultra OTC
PARVLEX TAB OTC
PHYTOMULTI TAB OTC
PRESERVISION TAB AREDS OTC
PRO-CAL TAB OTC
PROCERV HP TAB OTC
PRORENAL +D TAB OTC
PRORENAL+D TAB OTC
prosight tab OTC
PROVIT TAB OTC
px advanced tab multivit OTC
px complete tab senior OTC
px mens mult tab vitamins OTC
qc therin-m tab OTC
QUENCH TAB OTC
QUIN B TAB STRONG OTC
quintabs-m tab OTC
QUINTABS-M TAB OTC
ra central tab -vite OTC
ra central tab energy OTC
ra central tab vite sel OTC
ra central tab vite sen OTC
ra hair/skin tab /nails OTC
ra mature wm tab diet sup OTC
ra one daily pak mens 50+ OTC
ra one daily tab energy OTC
ra one daily tab maximum OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 105 AGE - Age Limit GNDR - Gender Edit
ra one daily tab mens OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 106 AGE - Age Limit GNDR - Gender Edit
ra one daily tab mens 50+ OTC
ra one daily tab mens/d3 OTC
ra one daily tab womens OTC
ra therapeut tab m/beta OTC
ra vision tab vite/zn OTC
renaplex tab OTC
RENAPLEX-D TAB OTC
savision tab OTC
sclerex tab OTC
senior tabs tab OTC
sentry adult tab under 50 OTC
SENTRY SENIO TAB LUTEIN OTC
sentry tab OTC
SENTRY TAB OTC
sentry tab senior OTC
SENTRY TAB SENIOR OTC
sm complete tab OTC
sm complete tab 50+ OTC
sm complete tab 50+ mens OTC
sm complete tab 50+ wmn OTC
sm complete tab adv form OTC
sm complete tab senior OTC
sm hair/skin tab /nails OTC
SM ONE DAILY TAB MENS OTC
SM ONE DAILY TAB WOMENS OTC
sm opti-vita tab OTC
SOLO TAB OTC
spectr women tab hlth sen OTC
spectra ultr tab hlth men OTC
SPECTRAVITE TAB OTC
SPECTRAVITE TAB ADLT 50+ OTC
spectravite tab advanced OTC
SPECTRAVITE TAB MEN 50+ OTC
spectravite tab senior OTC
SPECTRAVITE TAB SENIOR OTC
SPECTRAVITE TAB ULT MEN OTC
SPECTRAVITE TAB ULT WMN OTC
stress b-com tab /c/zinc OTC
stress form tab /iron OTC
stress form/ tab zinc OTC
stress formu tab advanced OTC
stress formu tab energy OTC
stress tab formula OTC
stresstabs tab advanced OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 107 AGE - Age Limit GNDR - Gender Edit
sunvite actv tab adult OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 108 AGE - Age Limit GNDR - Gender Edit
sunvite tab advanced OTC
super 28 tab formula OTC
super antiox tab a/c/e/se OTC
super multip tab OTC
super tab nu-thera OTC
super thera tab vite m OTC
super vikaps tab OTC
supr aytinal tab OTC
supr aytinal tab 50 plus OTC
supr vitamin tab OTC
T-VITES TAB OTC
thera form/ tab hematin OTC
THERA M PLUS TAB OTC
thera tab vital-m OTC
thera vital tab m OTC
thera-m tab OTC
THERA-M TAB OTC
thera-mill m tab OTC
THERA-TABS M TAB OTC
therabasic-m tab OTC
THERABETIC TAB MULTIVIT OTC
theradex m tab OTC
theradex m/ tab beta car OTC
THERAGRAN-M TAB OTC
THERAGRAN-M TAB 50 PLUS OTC
THERAGRAN-M TAB ADVANCED OTC
THERAGRAN-M TAB PREMIER OTC
therapeutic tab OTC
therapeutic tab -m OTC
therapeutic- tab m OTC
therapeutic- tab m/lutein OTC
theratrum co tab 50 plus OTC
theratrum tab complete OTC
theravim -m tab OTC
THEREMS-H TAB OTC
THEREMS-M TAB OTC
thrive for tab women OTC
total formul tab OTC
total formul tab 2 OTC
total formul tab 3 OTC
trueplus tab diabetic OTC
ultra antiox tab formula OTC
ultra freeda tab OTC
ultra freeda tab /iron OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 109 AGE - Age Limit GNDR - Gender Edit
ultra vita-t tab OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 110 AGE - Age Limit GNDR - Gender Edit
ultrachoice tab advanced OTC
UNICOMPLEX-M TAB OTC
vision form tab 2 OTC
vision form/ tab lutein OTC
vision tab vitamins OTC
visivites tab OTC
visivites tab /lutein OTC
vita hair tab OTC
vitabasic tab complete OTC
vitabasic tab senior OTC
VITALINE TAB FORMULA2 OTC
VITALINE TAB FORMULA3 OTC
VITAMIN D3 TAB COMPLETE OTC
VITASANA TAB OTC
VITATRUM TAB OTC
vitatrum tab complete OTC
viteyes tab lycopene OTC
vitrum tab senior OTC
VITRUM TAB SENIOR OTC
WHOLE FOOD TAB MULTIVIT OTC
whole source tab dietary OTC
whole source tab for men OTC
whole source tab mature OTC
whole source tab women OTC
womens 50+ tab advanced OTC
WOMENS BIO- TAB MULTIPLE OTC
womens daily tab fa/ca/fe OTC
womens daily tab formula OTC
womens mult tab OTC
WOMENS MULTI TAB VIT/MIN OTC
womens one tab daily OTC
womns active tab daily OTC
YELETS TEEN TAB FORMULA OTC
your life tab mens 50+ OTC
your life tab wmns 50+ OTC
ENDUR-VM TAB OTC
ENDUR-VM TAB IRON OTC
M2 B-60 TAB TR OTC
magnum-75 tab OTC
mega-maratho tab 100 tr OTC
natrul-100 tab super OTC
superior 35 tab OTC
totalday mul tab tr OTC
ULTRA MEGA G TAB 75MG CR OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 111 AGE - Age Limit GNDR - Gender Edit
ULTRA MEGA G TAB 100MG OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 112 AGE - Age Limit GNDR - Gender Edit
ULTRA MEGA TAB 75MG CR OTC
ULTRA MEGA TAB TWO OTC
ultra-mega tab cr OTC
a thru z chw select OTC
adlt multivi chw gummies OTC
ADLT ONE DLY CHW GUMMIES OTC
adult gummy chw OTC
advanced chw multi ea OTC
airborne chw OTC
airborne chw gummies OTC
airborne chw immune OTC
AIRSHIELD CHW IMMUNITY OTC
ALIVE WOMENS CHW GUMMY OTC
AQUADEKS CHW OTC
BARIATRIC CHW FUSION OTC
CELEBRATE CHW 18 OTC
CELEBRATE CHW 36 OTC
CELEBRATE CHW 45 OTC
CELEBRATE CHW 60 OTC
CENTRUM CHW OTC
CENTRUM CHW FLAV BST OTC
CENTRUM CHW MEN OTC
CENTRUM CHW MULTI OTC
CENTRUM CHW SILVER OTC
CENTRUM CHW VITAMINT OTC
CENTRUM CHW WOMEN OTC
CENTRUM KIDS CHW FLAV BST OTC
CHOICEFUL CHW MULTIVIT OTC
cvs daily chw gummies OTC
DEKAS CHW BARIATRI OTC
DEKAS PLUS CHW OTC
EMERGEN-C CHW IMMUNE/D OTC
EMERGEN-C CHW VITA C OTC
hm multivit chw gummy OTC
ICAPS CHW AREDS 2 OTC
IMMUNE CHW SUPPORT OTC
mens daily chw gummies OTC
MULTI ADULT CHW EXTRA C OTC
multi adult chw gummies OTC
multi gummie chw mens OTC
multi gummie chw womens OTC
multi+omega3 chw adult OTC
multi-vitami chw gummies OTC
multivi adlt chw gummies OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 113 AGE - Age Limit GNDR - Gender Edit
MULTIVITAMIN CHW ADLT GUM OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 114 AGE - Age Limit GNDR - Gender Edit
MULTIVITAMIN CHW ADULT OTC
multivitamin chw vita d3 OTC
MVW COMPLETE CHW GRAPE OTC
ocuvite eye chw heatlh OTC
ONE DAILY CHW ADLT GUM OTC
one daily chw gummy OTC
ONE-A-DAY CHW IMMUNITY OTC
ONE-A-DAY CHW VITACRAV OTC
OPTIMUM CHW AIRVITES OTC
OPTISOURCE CHW BARIATRC OTC
OPURITY CHW BYPASS OTC
PRESERVISION CHW AREDS 2 OTC
SPECTRAVITE CHW ADLT 50+ OTC
VITACRAVES CHW IMMUNITY OTC
VITACRAVES CHW MENS OTC
VITACRAVES CHW SOUR GUM OTC
VITACRAVES CHW WOMENS OTC
vitatrum chw OTC
WAL-BORN CHW VIT C OTC
womens daily chw gummies OTC
YOUR LIFE CHW GUMMIES OTC
YOUR LIFE CHW MULTIVIT OTC
ACTIVE 55 LIQ PLUS OTC
BIOSUPP LIQ OTC
BIOTECT PLUS LIQ OTC
bprotected liq multi-vi OTC
centamin liq OTC
centavite liq OTC
comp multivi liq mineral OTC
FORTAVIT LIQ OTC
lysiplex liq plus OTC
multivitamin liq OTC
multivitamin liq mineral OTC
PROTECT PLUS LIQ NF OTC
super liq nu-thera OTC
tropical liq nutritio OTC
VITAMIN LIQ MINERAL OTC
ELDERTONIC ELX OTC
BIOVOL SYP OTC
C-BUFF POW OTC
DAILY ENERGY POW ENFUSION OTC
MEGA MULTIVI POW OTC
PHLEXY-VITS POW OTC
SUPER POW NU-THERA OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 115 AGE - Age Limit GNDR - Gender Edit
ACTIVESSENT PAK OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 116 AGE - Age Limit GNDR - Gender Edit
CENTRUM POW DRINK OTC
EMERGEN-C PAK BLUE OTC
EMERGEN-C PAK FIVE OTC
EMERGEN-C PAK HEART OTC
EMERGEN-C PAK IMMUNE OTC
EMERGEN-C PAK JOINT OTC
EMERGEN-C PAK KIDZ OTC
EMERGEN-C PAK MSM LITE OTC
EMERGEN-C PAK PINK OTC
EMERGEN-C PAK SUPER FR OTC
EMERGEN-C PAK VIT D/CA OTC
EMERGEN-C PAK VITA C OTC
ENERGY POW BOOSTER OTC
EVOLUTION60 POW OTC
IMMUNE SUPP POW VIT C OTC
MAXIMIN PAK OTC
MULTI FOR POW HER OTC
MULTI FOR POW HIM OTC
ONE-DAILY PAK VIT/MIN OTC
PROXEED PLUS PAK OTC
RA ESSENCE-C POW LMN-LIME OTC
RA ESSENCE-C POW ORANGE OTC
RA ESSENCE-C POW RASPBRY OTC
RA ESSENCE-C POW TNGERINE OTC
SKIN BEAUTY/ PAK WELLNESS OTC
VITAMENT PAK OTC
VITAMIN C PAK BLEND OTC
VITAMIN C POW ELECTROL OTC
AIRBORNE LOZ OTC
ZINC LOZ OTC
CONCEPTIONXR MIS MOTILITY OTC
DAILY HEART PAK SUPPORT OTC
DAILY PAK MIS MULTIVIT OTC
DIABET HLTH PAK SUPPORT OTC
DIABETES PAK HEALTH OTC
DIABETES PAK SUPPORT OTC
KP MENS MIS DAILY PK OTC
KP WOMENS PAK DAILY OTC
LIFE PACK MIS MENS OTC
LIFE PACK MIS WOMENS OTC
MENS PAK OTC
MH MACULAR MIS HEALTH OTC
PA MENS 50 PAK VITAPAK OTC
PA MENS PAK VITAPAK OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 117 AGE - Age Limit GNDR - Gender Edit
PA WOMENS 50 PAK VITAPAK OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 109 AGE - Age Limit GNDR - Gender Edit
PA WOMENS PAK VITAPAK OTC
PREMIUM MIS PACKETS OTC
PRESCRIPTIVE PAK FORM MEN OTC
PRESCRIPTIVE PAK FORM WMN OTC
THERANATAL MIS LACTATIO OTC
ULTRA MENS MIS PACK OTC
ULTRA WOMENS MIS PACK OTC
VITAMINS TO MIS GO MAX OTC
VITAMINS TO MIS GO MEN OTC
VITAMINS TO MIS GO WOMEN OTC
WOMENS PAK OTC
ACTIVITE EC TAB OTC
MULTIPLE VITAMINS W/ CALCIUM daily multiv tab womens OTC essent one tab daily OTC
hm one daily tab essentia OTC
HM ONE DAILY TAB ESSENTIA OTC
hm vita-mini tab multi OTC
multi-day tab /ca/iron OTC
one daily tab womens OTC
signacal tab OTC
SM ONE DAILY TAB ESSENTIA OTC
PEDIATRIC VITAMINS HONEY BEARS CHW OTC MULTIVITAMIN CHW CHILD OTC
PEDIATRIC MULTIPLE VITAMINS multi-delyn liq OTC pediavit liq OTC
poly-vite dro OTC
animal chews chw OTC
animal shape chw OTC
bite-a-mins chw OTC
bounty bears chw /c OTC
chewabl vite chw childrns OTC
child chew chw vitamins OTC
children vit chw OTC
childrens chw multivit OTC
childrens chw vitamin OTC
childrens chw vitamins OTC
dino-life chw OTC
flintstones chw my first OTC
flintstones chw omega-3 OTC
flintstones chw pls calc OTC
fruity chews chw OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 110 AGE - Age Limit GNDR - Gender Edit
gnp animal chw shapes OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 110 AGE - Age Limit GNDR - Gender Edit
gnp little chw ones OTC
little chw animals OTC
multivitamin chw children OTC
poly vitamin chw OTC
sm animal chw shapes OTC
zoo friends chw gummies OTC
child chew/ chw extra c OTC
dino-life chw extra c OTC
flintstones chw extra c OTC
gnp animal chw plus c OTC
land bfr tim chw vit/c OTC
qc childrens chw extra c OTC
zoo friends chw extra c OTC
zoo friends chw plus c OTC
PED MULTIPLE VITAMINS W/ MINERALS DEKAS PLUS LIQ OTC UPSPRINGBABY DRO MV/IRON OTC
NANOVM POW 1-3 YRS OTC
NANOVM POW 4-8YEARS OTC
NANOVM POW 9-18 YRS OTC
NANOVM T/F POW OTC
abdek chw OTC
alive gummie chw children OTC
chewable chw children OTC
childrens chw gummies OTC
complete chw multi-vi OTC
disney cars chw gummies OTC
eq multivita chw gummies OTC
gnp zoochews chw gummies OTC
gummi bear chw multivit OTC
gummies chw OTC
gummy dinos chw OTC
gummy dinos chw chldrn OTC
gummy multiv chw kids OTC
gummy vit/ chw minerals OTC
healthy kids chw overall OTC
multivitamin chw child OTC
multivitamin chw children OTC
mvw complete chw bubblgum OTC
mvw complete chw d3000 OTC
mvw complete chw d5000 OTC
mvw complete chw orange OTC
princess chw gummies OTC
smarty pants chw kids OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 111 AGE - Age Limit GNDR - Gender Edit
spider-man chw OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 112 AGE - Age Limit GNDR - Gender Edit
ultra choice chw kids OTC
vitachew chw OTC
zoo friends chw extra d OTC
zoo friends chw gummies OTC
CHILDRENS CHW COMPLETE OTC
HEALTHY KIDS CHW GUMMIES OTC
NF FORMULAS CHW CHILDREN OTC
ZOO FRIENDS CHW COMPLETE OTC
FLINTSTONES CHW TODDLER OTC
VITALETS CHW OTC
VITALETS CHW CHILD OTC
alive multi chw childrns OTC
animal shape chw complete OTC
centrum kids chw complete OTC
cerovite jr chw OTC
child vitami chw OTC
childrens chw complete OTC
chld mltivit chw /mineral OTC
compl multiv chw childrns OTC
cvs children chw complete OTC
flintstones chw bone bld OTC
flintstones chw complete OTC
hm animal chw shapes OTC
polyvitamin chw /iron OTC
qc childrens chw complete OTC
sea buddies chw dly mult OTC
sm animal sh chw complete OTC
VITAMAX CHW OTC
zoo friends chw OTC
abdek pediat dro OTC
aquadeks dro OTC
PED MV W/ IRON DINO-LIFE CHW IRON-ZIN OTC HONEY BEARS CHW IRON-ZIN OTC
SCOOBY-DOO CHW OTC
animal shape chw /iron OTC
bite-a-mins chw /iron OTC
child chew chw iron OTC
child multiv chw iron OTC
childrens chw /iron OTC
chld vitamin chw iron OTC
flnston plus chw iron OTC
fruity chews chw /iron OTC
land bfr tim chw vit/iron OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 113 AGE - Age Limit GNDR - Gender Edit
little anima chw plus fe OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 114 AGE - Age Limit GNDR - Gender Edit
qc childrens chw iron OTC
ra child vit chw /iron OTC
vite/iron chw children OTC
zoo friends chw pls iron OTC
animal shape chw iron OTC
ANIMAL SHAPE CHW IRON OTC
MULTIVITAMIN CHW IRON OTC
MULTI-DELYN LIQ /IRON OTC
poly-vite sol /iron OTC
PED MV W/ FLUORIDE tri-vit/fluo dro 0.25mg vit a/c/d/fl dro 0.25mg pediatric vitamins acd w/ fluoride soln 0.5 mg/ml
tri-vit/fluo dro 0.5mg multi vit/fl chw 0.25mg
multivit/fl chw 0.25mg mvc-fluoride chw 0.25mg QUFLORA PED CHW 0.25MG multivit/fl chw 0.5mg
mvc-fluoride chw 0.5mg QUFLORA PED CHW 0.5MG
multivit/fl chw 1mg
mvc-fluoride chw 1mg QUFLORA PED CHW 1MG FLORIVA DRO PLUS multivit/fl dro 0.25mg QUFLORA PED DRO 0.25MG
multi vit/fl dro 0.5mg/ml
multi-vit/fl dro 0.5mg/ml multivit/fl sol 0.5mg/ml QUFLORA PED DRO 0.5MG/ML
PED MULTI VITAMINS W/FL & FE ESCAVITE CHW TL-FLUORIVIT CHW
multi-vit/fe dro /fl 0.25
multi-vit/fl dro /fe 0.25 multivit/fl/ dro fe 0.25
SPECIALTY VITAMINS PRODUCTS ADRENOID CAP OTC BILBERRY CAP PLUS OTC
CAL-CO3Y CAP OTC
CARDIOPRESS CAP OTC
CAROZYME CAP OTC
CHOLASE CAP CONTROL OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 115 AGE - Age Limit GNDR - Gender Edit
COLLAGEN CAP ULTRA OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 113 AGE - Age Limit GNDR - Gender Edit
GLUCO COR CAP OTC
GLYCOTROL CAP OTC
GLYCOTROL CAP COMPLETE OTC
HEART SAVIOR CAP OTC
immunicare cap OTC
INULOSE BLD CAP SUGAR OTC
LIPOTRIAD CAP VIS PLUS OTC
LIPOTRIAD CAP VISION OTC
LIPOTRIAD CAP VISIONAR OTC
LONGEVITY CAP OTC
LONGEVITY CAP PLUS OTC
MM BIOTIN CAP KERATIN OTC
MPS CAP OTC
RETAINE CAP VISION OTC
SYNERTROPIN CAP OTC
vigor cap OTC
a thru z tab advantag OTC
ADRENAL TAB CALM OTC
ADV COLLAGEN TAB OTC
ALLERWELL TAB ALLERGY OTC
BIOTIN PLUS TAB KERATIN OTC
BRAIN MIGHT TAB OTC
BRAIN TAB 355MG OTC
CA-PLUS TAB 280MG OTC
CARDIO TONE TAB OTC
central-vite tab cardio OTC
central-vite tab performa OTC
CENTRUM SPEC TAB ENERGY OTC
CENTRUM TAB PERFORMA OTC
CU-PLUS TAB 2MG OTC
CVS HAIR/SKN TAB NAILS OTC
ELON MATRIX TAB 5000 OTC
ELON MATRIX TAB 5000 COM OTC
ELON MATRIX TAB COMPLETE OTC
ELON MATRIX TAB PLUS OTC
ELON R3 TAB OTC
GNP CENTURY TAB ENERGY OTC
GREEN SOURCE TAB OTC
HAIR FARE TAB OTC
HAIR NOURISH TAB SUPPLEMN OTC
hair/skin/ tab nails OTC
HEALTHY TAB HEART OTC
HEART TAB 140MG OTC
HM ESTROPLUS TAB OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 114 AGE - Age Limit GNDR - Gender Edit
KIDNEY TAB 280MG OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 115 AGE - Age Limit GNDR - Gender Edit
LIPIDSHIELD TAB PLUS OTC
LUNG TAB 180MG OTC
LYMPH TAB 150MG OTC
M2 CALCIUM TAB 280MG OTC
M2 CHROMIUM TAB 500MCG OTC
MAMMARY TAB 150MG OTC
menopause tab support OTC
MG-PLUS TAB PROTEIN OTC
MIL ADREGEN TAB OTC
MILADRE FORT TAB 160MG OTC
milltrium tab stamina OTC
MILPAN TAB 325 MG OTC
MULTI-GLAN TAB 455 MG OTC
NEW LIFE TAB HAIR OTC
ORCHIC TAB 150MG OTC
OVARY TAB 125 MG OTC
PARATHYROID TAB 10MG OTC
PITUITARY TAB 35 MG OTC
PROSTATE TAB 130MG OTC
RA EAR CARE TAB OTC
ra menopause tab support OTC
SPLEEN TAB 250MG OTC
STOMACH TAB 300MG OTC
THERABETIC TAB EYE HLTH OTC
THYMUS TAB 140MG OTC
ultimate fat tab burner OTC
UTERUS TAB 150MG OTC
varisan tab vitality OTC
vit for hair tab OTC
VITAMINS FOR TAB THE HAIR OTC
weight loss tab multi OTC
ZN-PLUS TAB 15MG OTC
ULTRA MAN TAB OTC
ULTRA WOMAN TAB OTC
GERM DEFENSE TAB LEM-LIME OTC
GERM DEFENSE TAB ORANGE OTC
GERM DEFENSE TAB PM OTC
RA EFFERVESC TAB FORMULA OTC
WAL-BORN TAB OTC
MENOPAUSE MIS AM/PM OTC
WOMENS MENOP MIS VITA PAK OTC
WOMENS VITA MIS PAK OTC
PRENATAL VITAMINS prenatabs rx tab
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 116 AGE - Age Limit GNDR - Gender Edit
elite-ob tab
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 115 AGE - Age Limit GNDR - Gender Edit
trinate tab
prenatal 19 chw tab
pnv-select tab CITRANATAL TAB RX inatal gt tab prenatal 19 tab CITRANATAL MIS B-CALM CITRANATAL TAB BLOOM pnv-dha cap CITRANATAL PAK DHA
CITRANATAL PAK ASSURE CITRANATAL MIS CITRANATAL MIS 90 DHA CITRANATAL CAP HARMONY
VITAMINS W/ LIPOTROPICS b-s tress cap OTC balance b-50 cap complex OTC
methacholine cap /liver OTC
multi-vit hp cap /mineral OTC
ACTIFLOVIT TAB EAR HEAL OTC
b-50 tab OTC
b-100 complx tab OTC
b-100 tab OTC
b-complex tab form 1 OTC
balance b100 tab OTC
balance b-50 tab complex OTC
cvs balanced tab b50 OTC
cvs inner tab ear plus OTC
ear health tab formula OTC
ear health tab plus OTC
lipo-key tab OTC
lipocomplex tab OTC
lipoflavon tab OTC
lipoflavovit tab OTC
mega multi tab w/che mi OTC
nat-rul tab b-50 OTC
px b-50 tab OTC
risanoid tab plus OTC
ultra b-100 tab complex OTC
vitamins w/ lipotropics tab OTC
b-100 comp tab tr OTC
b-100 tab td OTC
b-100 tab tr OTC
balanc b-100 tab tr OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 116 AGE - Age Limit GNDR - Gender Edit
super stress tab b-complx OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 117 AGE - Age Limit GNDR - Gender Edit
GERAVINE ELX OTC
IRON W/ VITAMINS s.s.s. tonic tab OTC s.s.s. tonic liq OTC
MINERALS & ELECTROLYTES CALCIUM
ra calcium tab 500mg OTC ra calcium tab hi-cal OTC
calcium tab 600 mg OTC
cvs calcium tab 600mg OTC
ra calcium tab 600mg OTC
ra calcium tab high pot OTC
calcium 600 tab OTC
calcium carbonate tab 600 mg OTC
calcium tab 600mg OTC
super calciu tab 600mg OTC
calcium carb tab 1250mg OTC
calcium carbonate tab 1250 mg (500 mg OTC elemental ca) calcium 600 tab OTC
calcium carbonate tab 1500 mg (600 mg OTC elemental ca) caltrate 600 tab OTC
CALCI-CHEW CHW 1250MG OTC
calcitrate tab 950mg OTC
calcium citrate tab 950 mg (200 mg elemental ca) OTC
oysco 500 tab 500mg OTC
oyster shell calcium tab 500 mg OTC
oystercal tab 500mg OTC
ra hi-cal tab 500mg OTC
CA HI-CAL/D TAB 500MG OTC
CALCIUM TAB 600MG OTC
cal-mag aspa tab 333-167 OTC
super cal/ tab mag OTC
cal-mag tab 500-250 OTC
calcium w/ magnesium tab 500-250 mg OTC
calcium w/ magnesium tab 250-125 mg OTC
CA HI-CAL/D TAB 500MG OTC
CA HI-CAL/D TAB 250MG OTC
PARVA-CAL TAB 500MG OTC
calcium carbonate-vitamin d cap 600 mg-200 unit OTC
liq ca/vit d cap 600mg OTC
calcium carbonate-vitamin d tab 250 mg-125 unit OTC
oyst cal/d tab 250mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 118 AGE - Age Limit GNDR - Gender Edit
oyst shell/d tab 250mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 119 AGE - Age Limit GNDR - Gender Edit
calcium 500 tab +d OTC
calcium 500 tab /vit d OTC
calcium carbonate-vitamin d tab 500 mg-125 unit OTC
oys shell ca tab 500 + d OTC
oyst cal/d tab 500mg OTC
calcium carbonate-vitamin d tab 500 mg-200 unit OTC
calcium tab 500+d OTC
calcium tab 500/d OTC
gnp calcium tab 500/d OTC
oscal 500/ tab 200 d-3 OTC
pa oyster sh tab 500mg OTC
ra hi cal tab 500-200 OTC
ra hi-cal/d tab 500mg OTC
calcium 500 tab +d OTC
calcium carbonate-vitamin d tab 500 mg-400 unit OTC
os calcium tab /vit d OTC
oys shell ca tab /d3 OTC
sm calcium tab /vit d3 OTC
calcium carbonate-vitamin d tab 600 mg-125 unit OTC
calcium 600 tab +d OTC
calcium + d tab 600-200 OTC calcium carbonate-vitamin d tab 600 mg-200 unit OTC calcium tab vit d OTC calcium/d tab 600-200 OTC
ra calcium+d tab 600mg OTC
calcium 600 tab + d OTC
calcium 600 tab +d OTC
calcium carbonate-vitamin d tab 600 mg-400 unit OTC
calcium+d3 tab 600-400 OTC
calcium+d tab 600-400 OTC
gnp calcium tab 600/d OTC
px calcium&d tab 600-400 OTC
ra calcium tab vit d OTC
sm calcium/d tab 600-400 OTC
super ca 600 tab + d3 OTC
super ca 600 tab + d3 400 OTC
super ca 600 tab + d 400 OTC
calcium 600 chw w/vit d OTC
creamies chw 600-400 OTC
tgt calcium chw suppleme OTC
calc 600+d3 cap 600-500 OTC
calcium plus cap d3 OTC
calcium/d3 cap 600-500 OTC
calcium/vitd cap 600-500 OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 120 AGE - Age Limit GNDR - Gender Edit
kp calcium cap 600+d OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 121 AGE - Age Limit GNDR - Gender Edit
calcium carbonate-cholecalciferol tab 250 mg-125 unit
OTC
oys shell+d tab 250-125 OTC calcium carbonate-cholecalciferol tab 500 mg-125 unit
OTC
nat-rul cal tab /d 500mg OTC
oyst shell/d tab 500-125 OTC
oyst shell/d tab 500mg OTC calcium carbonate-cholecalciferol tab 500 mg-200 unit
OTC
calcium tab 500+d OTC
calcium/d tab 500-200 OTC
calcium/d tab 500/200 OTC
calcium/d tab 500mg OTC
os-cal + d3 tab 500-200 OTC
oysco 500+d tab OTC
oyst ca/d3 tab 500-200 OTC
oyst shell/d tab 500-200 OTC
sm calcium/d tab 500-200 OTC
calcium 500 tab +d OTC calcium carbonate-cholecalciferol tab 500 mg-400 unit
OTC
calcium/d tab 500-400 OTC
oyst shell/d tab 500-400 OTC
oyst shell/d tab 500mg OTC
oystercal-d tab 500mg OTC
calcium/d3 tab OTC
calcium/d3 tab 500-600 OTC
os-cal extra tab d3 OTC
calcium 600 tab +d3 OTC
calcium + d tab 600mg OTC calcium carbonate-cholecalciferol tab 600 mg-200 unit
OTC
calcium 600 tab -d OTC
calcium 600/ tab vit d OTC calcium carbonate-cholecalciferol tab 600 mg-400 unit
OTC
calcium+d3 tab 600-400 OTC
calcium+d tab 600-400 OTC
eql calcium tab w/vit d OTC
hm ca/vit d3 tab 600-400 OTC
kp calcium tab 600+d OTC
pa calcium tab vit d OTC
ra ca/vit d3 tab 600-400 OTC
sm ca/vit d3 tab 600-400 OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 122 AGE - Age Limit GNDR - Gender Edit
calc 600+d tab 600-800 OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 119 AGE - Age Limit GNDR - Gender Edit
calc 600/d3 tab 600-800 OTC
calcium+d3 tab 600-800 OTC
calcium+d tab 600-800 OTC
calcium/d3 tab OTC
calcium/d3 tab 600-800 OTC
calcium/d tab 600-800 OTC
calcium/vita tab d3 OTC
hm ca/vit d3 tab 600-800 OTC
kp calcium tab +d OTC
calcium/d chw 500-400 OTC
oys shell+d chw 500-400 OTC
os-cal chw OTC
os-cal chw 500-600 OTC
oysco 500+d chw OTC
RA OYS SHL/D TAB 250MG OTC
RA OYS SHL/D TAB 500MG OTC
calc cit+d3 tab 200-250 OTC
calc citr+d3 tab 200-250 OTC
calc citr/d3 tab 200-250 OTC
calcium citrate-vitamin d tab 200 mg-250 unit OTC (elemental ca) calcium/d3 tab 200-250 OTC
calc cit+d3 tab 250-200 OTC
calc citrate tab +d OTC
ca citrate + tab OTC
ca citrate tab + d OTC
ca citrate tab plus d OTC
calcitrate tab plus d OTC
calcium + d tab OTC
calcium citrate-vitamin d tab 315 mg-200 unit OTC (elemental ca) cal cit+d3 tab maximum OTC
calc citr+d3 tab 315-250 OTC
calc citr+d tab 315-250 OTC
calc citra+d tab 315-250 OTC
calcitrate tab OTC
calcium +d3 tab maximum OTC
calcium +d tab maximum OTC
calcium citr tab +d OTC
calcium citr tab plus d-3 OTC
calcium citr tab w/vit d3 OTC
calcium citrate-vitamin d tab 315 mg-250 unit OTC (elemental ca) calcium+d3 tab 315-250 OTC
cit calc/d tab 315-250 OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 120 AGE - Age Limit GNDR - Gender Edit
eq calcium tab citr+d OTC
eql calcium tab citr/d3 OTC
gnp calcium tab cit +d3 OTC
hm calcium tab citr+d OTC
CAL CIT MAL/ TAB VITAMIND OTC
calcium-magnesium-zinc tab 333-133-5 mg OTC
calcium/magn tab /zinc OTC
cvs ca/mg/zn tab OTC
gnp ca/mg/zn tab OTC
kp ca/mg/zn tab OTC
ra ca/mg/zn tab OTC
sm ca/mg/zn tab OTC
calcium-magnesium-zinc tab 333-133-8.3 mg OTC
sm ca/mg/zn tab OTC
RISACAL-D TAB OTC
calcium for chw women OTC
calcium soft chw mlk choc OTC
cal soft chw chw mlk choc OTC
chew calcium chw OTC
ra calcium chw caramel OTC
ra calcium chw mlk choc OTC
sm calcium chw OTC
calcium soft chw caramel OTC
calcium soft chw chocolat OTC
coral calciu cap plus OTC
FLUORIDE sodium fluoride tab 0.5 mg f (from 1.1 mg naf) sodium fluoride tab 1 mg f (from 2.2 mg naf) fluoritab chw 0.25mg f ludent chw 0.25mg f
sodium fluoride chew tab 0.25 mg f (from 0.55 mg
naf) fluoritab chw 0.5mg f
ludent chw 0.5mg f sodium fluoride chew tab 0.5 mg f (from 1.1 mg naf) fluoritab chw 1mg f
fluoritab chw 2.2mg ludent chw 1mg f nafrinse chw 1mg f sodium fluoride chew tab 1 mg f (from 2.2 mg naf) fluoritab dro 0.125mg nafrinse dro 0.125mg
flura-drops dro 0.25mg f
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 121 AGE - Age Limit GNDR - Gender Edit
sodium fluoride soln 0.5 mg/ml f (from 1.1 mg/ml
naf)
PHOSPHATE K-PHOS TAB
POTASSIUM effer-k tab 25meq ef k-prime tab 25meq ef klor-con/ef tab 25meq fr potassium bicarbonate effer tab 25 meq
klor-con spr cap 8meq potassium chloride cap er 8 meq
klor-con spr cap 10meq potassium chloride cap er 10 meq klor-con 8 tab 8meq er potassium chloride tab er 8 meq (600 mg)
klor-con 10 tab 10meq er potassium chloride tab er 10 meq
potassium chloride tab er 20 meq (1500 mg)
potassium chloride oral soln 10% (20 meq/15ml) potassium chloride oral soln 20% (40 meq/15ml) klor-con m10 tab 10meq er potassium chloride microencapsulated crys er tab 10 meq klor-con m20 tab 20meq er
potassium chloride microencapsulated crys er tab
20 meq
ELECTROLYTE MIXTURES ceralyte 70 sol OTC cvs electrol sol OTC
gnp pediatri sol electrol OTC
oral electro sol cherry OTC
oral electro sol freezer OTC
oral electro sol h-e-b OTC
oral electrolyte solution OTC
oralyte sol OTC
oralyte sol freeze OTC
ped elctrlyt sol OTC
ped elctrlyt sol /zinc OTC
ped elctrlyt sol apple OTC
ped elctrlyt sol freeze OTC
ped elctrlyt sol freezer OTC
ped elctrlyt sol freezpop OTC
ped elctrlyt sol grape OTC
ped elctrlyt sol pineappl OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 122 AGE - Age Limit GNDR - Gender Edit
ped elctrlyt sol unflavor OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 123 AGE - Age Limit GNDR - Gender Edit
pedia vance sol apple OTC
pedia vance sol grape OTC
ra pediatric sol electrol OTC
rehydralyte sol OTC
NUTRIENTS PROTEINS
levocarnitine cap 250 mg OTC L-CARNITINE CAP 500MG OTC
L-CARNITINE TAB 250MG OTC
LEVOCARNITIN TAB 330MG OTC
levocarnitine tab 500 mg OTC
g-levocarnit sol 1gm/10ml OTC
levocarnitine (dietary) oral soln 1 gm/10ml OTC
MISC. NUTRITIONAL SUBSTANCES eskimo-3 cap 500mg OTC fish oil cap 500mg OTC
omega 3 500 cap 500mg OTC
omega-3 fatty acids cap 500 mg OTC
ovega-3 cap 500mg OTC
sam-e.p.a. cap 500mg OTC
super omega cap 500mg OTC
sv fish oil cap 500mg OTC
fish oil cap 300mg OTC
fish oil con cap 300mg OTC
omega-3 fatty acids cap 300 mg OTC
fish oil cap 435mg OTC
gnp fish oil cap OTC
omega-3 fatty acids cap 435 mg OTC
FISH OIL CAP 1000MG OTC
FISH OIL CAP 1400MG OTC
OMEGA-3 CAP 1400MG OTC
ULTRA OMEGA3 CAP 1400MG OTC
cvs fish oil cap 1000mg OTC
eql fish oil cap 1000mg OTC
fish oil con cap 1000mg OTC
gnp fish oil cap 1000mg OTC
hm fish oil cap 1000mg OTC
maxepa cap 1000mg OTC
maximum epa cap 1000mg OTC
omega 3 cap 1000mg OTC
omega iii cap epa+dha OTC
omega-3 cf cap 1000mg OTC
omega-3 fatty acids cap 1000 mg OTC
omega-3 fish cap 1000 mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 124 AGE - Age Limit GNDR - Gender Edit
omega-3 plus cap 1000mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 123 AGE - Age Limit GNDR - Gender Edit
omera cap 1000mg OTC
pa fish oil cap 1000mg OTC
purefa cap 1000mg OTC
px fish oil cap 1000mg OTC
ra fish oil cap 1000mg OTC
salmon oil cap 1000mg OTC
sea-omega 50 cap 1000mg OTC
sm fish oil cap 1000mg OTC
super dha cap gems OTC
super omega cap -3 OTC
supr omega 3 cap epa/dha OTC
theromega cap 1000mg OTC
cvs fish oil cap 1200mg OTC
eql fish oil cap 1200mg OTC
fish oil cap 1200mg OTC
hm fish oil cap 1200mg OTC
kp fish oil cap 1200mg OTC
omega-3 fatty acids cap 1200 mg OTC
omega-3 fish cap 1200mg OTC
sea-omega 30 cap 1200mg OTC
sm fish oil cap 1200mg OTC
FISH OIL CAP 1360MG OTC
fish oil chw gummies OTC
healthy kids chw gummies OTC
omega-3 fish chw 113.5mg OTC
emulsified liq omega-3 OTC
eskimo-3 liq OTC
finest fish liq oil OTC
finest fish liq oil/kids OTC
omega essent liq basic OTC
very finest liq fish oil OTC
DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS DIETARY MANAGEMENT PRODUCTS
av-vite fb tab 2.5-25-2 folbic tab niva-fol tab
HEMATOPOIETIC AGENTS COBALAMINS
cyanocobalamin inj 1000 mcg/ml
FOLIC ACID/FOLATES folic acid tab 400 mcg OTC sm folic acd tab 400mcg OTC
yl folic aci tab 400mcg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 124 AGE - Age Limit GNDR - Gender Edit
fa-8 tab 0.8mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 125 AGE - Age Limit GNDR - Gender Edit
folic acid tab 800mcg OTC
folic acid tab 1 mg
folic acid tab 1000mcg OTC
IRON ferrous sulfate tab 27 mg (elemental fe) OTC high potency tab fe 27mg OTC
px iron tab 27mg OTC
ra iron tab 27mg OTC
cvs iron tab 325mg OTC
ferosul tab 325mg OTC
ferrous sulf tab 325mg OTC
ferrous sulfate tab 325 mg (65 mg elemental fe) OTC
ferrousul tab 325mg OTC
gnp iron tab 325mg OTC
iron supplem tab 325mg OTC
iron supplem tab therapy OTC
nat-rul iron tab 325mg OTC
ra iron tab 65mg OTC
ra iron tab 325mg OTC
sm iron tab 325mg OTC
ferrous sulfate tab er 142 mg (45 mg fe OTC equivalent) gnp iron tab 45mg OTC
hm iron tab 45mg OTC
slow fe tab 45mg OTC
sm iron tab 45mg OTC
slow release tab 47.5mg OTC
FERROUS SULF TAB 324MG EC OTC
fe tabs tab 325mg ec OTC
ferrous sulfate tab ec 325 mg (65 mg fe OTC equivalent) ferosul elx 220/5ml OTC
ferrous sulfate elixir 220 mg/5ml (44 mg/5ml OTC elemental fe) iron suppmnt elx 220/5ml OTC
ferrous sulfate soln 75 mg/ml (15 mg/ml OTC elemental fe) iron supplmt dro 15mg/ml OTC
pedia iron dro 15mg/ml OTC
ferrous sulf tab 65mg OTC
gnp iron tab 65mg OTC
hm iron tab 65mg OTC
px iron tab 200mg OTC
iron slow tab 45mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 126 AGE - Age Limit GNDR - Gender Edit
slow release tab 45mg OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 125 AGE - Age Limit GNDR - Gender Edit
slow release tab iron 45 OTC
slow-release tab fe 45mg OTC
slow iron tab 160mg cr OTC
slow rel fe tab 160mg cr OTC
sm iron slow tab 160mg cr OTC
cvs iron tab 27mg OTC
ferate tab 27mg OTC
fergon tab 27mg OTC
ferrotabs tab OTC
ferrous gluconate tab 240 mg (27 mg elemental OTC fe) ferrous gluc tab 324mg OTC
ferrous gluconate tab 324 mg (37.5 mg elemental OTC iron) FERRETTS TAB 325MG OTC
ferrocite tab 324mg OTC
ferrous fumarate tab 324 mg (106 mg elemental OTC fe)
HEMATOPOIETIC GROWTH FACTORS ARANESP INJ 25MCG SP, PA ARANESP INJ 40MCG SP, PA
ARANESP INJ 60MCG SP, PA
ARANESP INJ 100MCG SP, PA
ARANESP INJ 200MCG SP, PA
ARANESP INJ 300MCG SP, PA
ARANESP INJ 25MCG SP, PA
ARANESP INJ 40MCG SP, PA
ARANESP INJ 60MCG SP, PA
ARANESP INJ 100MCG SP, PA
ARANESP INJ 150MCG SP, PA
ARANESP INJ 200MCG SP, PA
ARANESP INJ 300MCG SP, PA
ARANESP INJ 500MCG SP, PA
ZARXIO INJ 300/0.5 SP, PA
ZARXIO INJ 480/0.8 SP, PA
PROMACTA TAB 12.5MG SP, QL (1 tab / 1 day), PA
PROMACTA TAB 25MG SP, QL (1 tab / 1 day), PA
PROMACTA TAB 50MG SP, QL (2 tabs / 1 day), PA
PROMACTA TAB 75MG SP, QL (2 tabs / 1 day), PA
AGENTS FOR GAUCHER DISEASE CERDELGA CAP 84MG SP, QL (2 caps / 1 day), PA CEREZYME INJ 400UNIT SP, QL (32.16 vials / 30
days), PA
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 126 AGE - Age Limit GNDR - Gender Edit
HEMATOPOIETIC MIXTURES folic acid-vitamin b6-vitamin b12 tab 2.2-25-0.5 mg
folplex 2.2 tab
fabb tab 2.2-25-1 tl gard rx tab virt-gard tab 2.2-25-1 airavite tab folbee tab nufol tab
ANTICOAGULANTS HEPARINS AND HEPARINOID-LIKE AGENTS
enoxaparin sodium inj 30 mg/0.3ml enoxaparin sodium inj 40 mg/0.4ml enoxaparin sodium inj 60 mg/0.6ml enoxaparin sodium inj 80 mg/0.8ml enoxaparin sodium inj 100 mg/ml enoxaparin sodium inj 120 mg/0.8ml enoxaparin sodium inj 150 mg/ml enoxaparin sodium inj 300 mg/3ml fondaparinux sodium subcutaneous inj 2.5 mg/0.5ml
fondaparinux sodium subcutaneous inj 5 mg/0.4ml fondaparinux sodium subcutaneous inj 7.5 mg/0.6ml
fondaparinux sodium subcutaneous inj 10 mg/0.8ml
COUMARIN ANTICOAGULANTS jantoven tab 1mg warfarin sodium tab 1 mg jantoven tab 2mg warfarin sodium tab 2 mg jantoven tab 2.5mg
warfarin sodium tab 2.5 mg jantoven tab 3mg
warfarin sodium tab 3 mg jantoven tab 4mg warfarin sodium tab 4 mg jantoven tab 5mg warfarin sodium tab 5 mg jantoven tab 6mg warfarin sodium tab 6 mg jantoven tab 7.5mg
warfarin sodium tab 7.5 mg
jantoven tab 10mg
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 127 AGE - Age Limit GNDR - Gender Edit
warfarin sodium tab 10 mg
DIRECT FACTOR XA INHIBITORS ELIQUIS TAB 2.5MG ELIQUIS ST P TAB 5MG ELIQUIS TAB 5MG XARELTO TAB 10MG XARELTO TAB 15MG XARELTO TAB 20MG XARELTO STAR TAB 15/20MG
HEMATOLOGICAL AGENTS - MISC. ANTIHEMOPHILIC PRODUCTS
JIVI INJ 500 UNIT SP, PA JIVI INJ 1000UNIT SP, PA
JIVI INJ 2000UNIT SP, PA
JIVI INJ 3000UNIT SP, PA
PLATELET AGGREGATION INHIBITORS dipyridamole tab 25 mg dipyridamole tab 50 mg dipyridamole tab 75 mg cilostazol tab 50 mg cilostazol tab 100 mg ZONTIVITY TAB 2.08MG anagrelide hcl cap 0.5 mg
anagrelide hcl cap 1 mg clopidogrel bisulfate tab 75 mg (base equiv) clopidogrel bisulfate tab 300 mg (base equiv) prasugrel hcl tab 5 mg (base equiv) prasugrel hcl tab 10 mg (base equiv) BRILINTA TAB 60MG BRILINTA TAB 90MG
COMPLEMENT INHIBITORS SOLIRIS INJ 10MG/ML SP, PA RUCONEST INJ 2100UNIT SP, PA
OPHTHALMIC AGENTS OPHTHALMIC ANTI-INFECTIVES
bacitracin ophth oint 500 unit/gm ciprofloxacin hcl ophth soln 0.3% erythromycin ophth oint 5 mg/gm gentamicin sulfate ophth soln 0.3% gentak oin 0.3% op levofloxacin ophth soln 0.5%
ofloxacin ophth soln 0.3% tobramycin ophth soln 0.3%
sulfacetamide sodium ophth soln 10%
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 128 AGE - Age Limit GNDR - Gender Edit
trifluridine ophth soln 1%
NATACYN SUS 5% OP
ak-poly-bac oin op
bacitracin-polymyxin b ophth oint
polycin oin op polymyxin b-trimethoprim ophth soln 10000
unit/ml-0.1% neo-polycin oin op
neomycin-bacitrac zn-polymyx
5(3.5)mg-400unt-10000unt op oin neomycin-polymy-gramicid op sol 1.75-10000-0.025mg-unt-mg/ml
ARTIFICIAL TEARS AND LUBRICANTS eye drops dro 0.25% OTC THERATEARS SOL OP OTC
cvs lubricnt dro 0.5% op OTC
gnp eye drop sol 0.5% op OTC
lubricnt eye dro 0.5% op OTC
restore tear dro 0.5% op OTC
ultra fresh dro 0.5% op OTC
biolle tears dro 0.5% op OTC
cvs lubricnt dro 0.5% op OTC
eq revive pl dro 0.5% op OTC
lubricating dro 0.5% OTC
lubricnt eye dro 0.5% op OTC
restore plus dro 0.5% op OTC
retaine cmc sol 0.5% op OTC
lubricnt gel dro 1% OTC
biolle gel 1% OTC
refresh cell gel 1% op OTC
GENTEAL MILD DRO 0.2% OTC
RETAINE HPMC SOL 0.3% OTC
eq gentle dro 0.3% OTC
pure & gentl dro 0.3% OTC
artificial sol tears op OTC
GENTEAL GEL 0.3% OTC
SYSTANE GEL 0.3% OTC
artifi tears sol 1.4% op OTC
liquitears sol OTC
polyvinyl alcohol ophth soln 1.4% OTC
lubricant dro eye 0.6% OTC
lubricnt eye dro 0.6% OTC
genteal tear sol moderate OTC
just tears sol eye drop OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 129 AGE - Age Limit GNDR - Gender Edit
sm artificia sol tears OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 130 AGE - Age Limit GNDR - Gender Edit
soothe dro hydratio OTC
soothe xp dro OTC
soothe xp dro 1%-4.5% OTC
systane dro contacts OTC
tears again sol adv eye OTC
tears again sol op OTC
akwa tears oin op OTC
altalube oin OTC
eq restore oin pm OTC
eye lubrican oin op OTC
hypotears oin op OTC
lubricant oin eye OTC
refresh lacr oin op OTC
refresh p.m. oin op OTC
tears again oin op OTC
ultra fresh oin pm OTC
eye drops dro 0.5-0.9% OTC
lubr/dry eye dro 0.5-0.9% OTC
lubricat/eye dro 0.5-0.9% OTC
REFRESH OPTI DRO 0.5-0.9% OTC
lubricnt gel dro 0.25-0.3 OTC
artificial sol tears OTC
genteal tear sol mild OTC
natural bal sol tears OTC
natures sol tears OTC
tears pure sol OTC
artificial sol tears OTC
cvs natural sol tears OTC
lubricnt eye dro OTC
HYPOTEARS SOL 1-1% OTC
eq lubricant dro eye drop OTC
gnp eye drop dro 0.4-0.3% OTC
lubric tears sol 0.4-0.3% OTC
lubricant dro 0.4-0.3% OTC
lubricant dro eye OTC
lubricating sol 0.4-0.3% OTC
lubricnt eye dro 0.4-0.3% OTC
ra lubricant dro 0.4-0.3% OTC
sm lubricant dro 0.4-0.3% OTC
lubricnt eye dro 0.4-0.3% OTC
artificial sol tears OTC
clear eyes dro 0.5-0.6% OTC
murine tears dro dry eyes OTC
REFRESH DRO OP OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 131 AGE - Age Limit GNDR - Gender Edit
artifi tears dro 1-0.3% OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 130 AGE - Age Limit GNDR - Gender Edit
artificial dro tears OTC
artificial sol tears OTC
lubricnt eye dro OTC
tgt lubricnt dro eye OTC
artifi tears oin op OTC
cvs lubricat oin OTC
dry eye relf oin night OTC
eye lubrican oin op OTC
for sty reli oin OTC
genteal tear oin nt-time OTC
lubricnt eye oin fast act OTC
lubricnt eye oin nighttim OTC
puralube oin OTC
retaine pm oin OTC
soothe night oin op OTC
stye oin OTC
systane oin OTC
tgt lubricnt oin eye nite OTC
REFRESH SOL OPTIVE OTC
REFRESH OPT SOL MEGA-3 OTC
REFRESH SOL OPTIVE OTC
artificial dro tears OTC
cvs dry eye dro relief OTC
hm dry eye sol relief OTC
sm dry eye sol relief OTC
BETA-BLOCKERS - OPHTHALMIC betaxolol hcl ophth soln 0.5% levobunolol hcl ophth soln 0.5% timolol maleate ophth soln 0.25% timolol maleate ophth soln 0.5% timolol maleate ophth gel forming soln 0.25% timolol maleate ophth gel forming soln 0.5% dorzolamide hcl-timolol maleate ophth soln 22.3-6.8 mg/ml
OPHTHALMIC STEROIDS dexamethasone sodium phosphate ophth soln 0.1% fluorometholone ophth susp 0.1%
prednisolone acetate ophth susp 1% PREDNISOLONE SUS 1% PRED SOD PHO SOL 1% OP sulfacetamide sodium-prednisolone ophth soln
10-0.23(0.25)% tobramycin-dexamethasone ophth susp 0.3-0.1%
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 131 AGE - Age Limit GNDR - Gender Edit
neomycin-polymyxin-dexamethasone ophth susp
0.1% neomycin-polymyxin-dexamethasone ophth oint
0.1% neomycin-polymyxin-hc ophth susp
bacitracin-polymyxin-neomycin-hc ophth oint 1%
neo-polycin oin hc 1%op
PROSTAGLANDINS - OPHTHALMIC latanoprost ophth soln 0.005%
OPHTHALMIC ADRENERGIC AGENTS brimonidine tartrate ophth soln 0.15% brimonidine tartrate ophth soln 0.2%
OPHTHALMIC INTEGRIN ANTAGONISTS XIIDRA DRO 5% PA
OPHTHALMICS - MISC. azelastine hcl ophth soln 0.05% cromolyn sodium ophth soln 4% alaway child dro 0.025%op OTC
alaway dro 0.025%op OTC
allergy eye dro 0.025%op OTC
antihistamin dro 0.025%op OTC
claritin eye dro 0.025%op OTC
cvs allergy dro 0.025%op OTC
eye itch rel dro 0.025% OTC
eye itch rel dro 0.025%op OTC
eye itch sol relief OTC
itchy eye dro 0.025%op OTC
itchy eye sol 0.025% OTC
ketotif fum dro 0.025%op OTC
dorzolamide hcl ophth soln 2%
DORZOLAMIDE SOL 2%
diclofenac sodium ophth soln 0.1%
ketorolac tromethamine ophth soln 0.4% ketorolac tromethamine ophth soln 0.5%
OTIC AGENTS OTIC ANTI-INFECTIVES
ofloxacin otic soln 0.3%
OTIC AGENTS - MISCELLANEOUS acetic acid otic soln 2% auraphene-b sol 6.5% ot OTC
ear drops dro 6.5% OTC
ear drops sol 6.5% ot OTC
ear wax kit sol 6.5% ot OTC
ear wax remv dro 6.5% ot OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 132 AGE - Age Limit GNDR - Gender Edit
ear wax remv sol 6.5% ot OTC
ear wax sol 6.5% OTC
earwax remov dro kit OTC
earwax remov dro system OTC
earwax remov sol 6.5% OTC
earwax remv sol 6.5% ot OTC
earwax sol removal OTC
eq ear wax sol removal OTC
gnp ear dro 6.5% ot OTC
gnp ear drop sol 6.5% ot OTC
gnp ear sys sol 6.5% ot OTC
murine ear dro 6.5% ot OTC
murine ear sol 6.5% ot OTC
otix sol 6.5% ot OTC
ra ear dro 6.5% ot OTC
sm ear dro 6.5% ot OTC
OTIC COMBINATIONS CIPRODEX SUS 0.3-0.1% neomycin-polymyxin-hc otic susp 3.5
mg/ml-10000 unit/ml-1% neomycin-polymyxin-hc otic soln 1%
MOUTH/THROAT/DENTAL AGENTS ANTI-INFECTIVES - THROAT
AMPHOTERICIN POW B nystatin susp 100000 unit/ml
clotrimazole troche 10 mg
ANTISEPTICS - MOUTH/THROAT chlorhexidine gluconate soln 0.12% paroex sol 0.12%
STEROIDS - MOUTH/THROAT oralone dent pst 0.1% triamcinolone acetonide dental paste 0.1%
ANESTHETICS TOPICAL ORAL lidocaine hcl viscous soln 2%
DENTAL PRODUCTS sod fluoride sol 0.2% denta 5000 cre plus denta 5000 cre plus 2pk sf 5000 plus cre 1.1% cavarest gel 1.1%
dentagel gel 1.1%
sf gel 1.1%
clinpro 5000 pst 1.1%
fluoridex pst 1.1%
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 133 AGE - Age Limit GNDR - Gender Edit
THROAT PRODUCTS - MISC. pilocarpine hcl tab 5 mg pilocarpine hcl tab 7.5 mg
ANORECTAL AGENTS RECTAL STEROIDS
hydrocortisone rectal cream 1% procto-pak cre 1% hydrocortisone rectal cream 2.5% procto-med cre hc 2.5% proctosol hc cre 2.5% proctozone cre -hc 2.5%
INTRARECTAL STEROIDS colocort ene 100mg hydrocortisone enema 100 mg/60ml
DERMATOLOGICALS ACNE PRODUCTS
bp wash liq 2.5% creamy face liq wash 4% OTC
panoxyl wash liq 4% OTC
benzoyl per liq 5% wash OTC
bp wash liq 5% OTC
3-in-1 clean liq 5% OTC
benzepro liq creamy
bp wash liq 7% pr benzoyl liq 7% wash acne foaming liq wash 10% OTC
benzoyl per liq 10% wash OTC
bp wash liq 10% OTC
foaming face liq wsh 10% OTC
panoxyl wash liq 10% OTC
benziq wash liq 5.25%
acne control cre clns 10% OTC
acne max str cre 10% OTC
acne treat cre 10% OTC
acne treatme cre 10% OTC
clean&clear cre 10% OTC
clearasil cre acne OTC
clearskin cre 10% OTC
cvs acne cre 10% OTC
ra acne cre 10% OTC
BENZOYL PER GEL 2.5% OTC
acne medicat gel 5% OTC
benzoyl peroxide gel 5% OTC
bp gel gel 5% OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 134 AGE - Age Limit GNDR - Gender Edit
acne medicat gel 10% OTC
acne treatmn gel 10% OTC
acne-clear gel 10% OTC
benzoyl peroxide gel 10% OTC
bp gel gel 10% OTC
persa-gel gel 10% OTC
ra renewal gel 10% OTC
amnesteem cap 10mg PA
claravis cap 10mg PA
isotretinoin cap 10 mg PA
myorisan cap 10mg PA
zenatane cap 10mg PA
amnesteem cap 20mg PA
claravis cap 20mg PA
isotretinoin cap 20 mg PA
myorisan cap 20mg PA
zenatane cap 20mg PA
claravis cap 30mg PA
isotretinoin cap 30 mg PA
myorisan cap 30mg PA
zenatane cap 30mg PA
amnesteem cap 40mg PA
claravis cap 40mg PA
isotretinoin cap 40 mg PA
myorisan cap 40mg PA
zenatane cap 40mg PA
avita cre 0.025% PA
tretinoin cream 0.025% PA
tretinoin cream 0.05% PA
tretinoin cream 0.1% PA
tretinoin gel 0.01% PA
avita gel 0.025% PA
tretinoin gel 0.025% PA
clindamycin phosphate soln 1% clindamycin phosphate gel 1% clindamycin phosphate lotion 1% erythromycin soln 2%
erythromycin gel 2%
sulfacetamide sodium lotion 10% (acne)
ROSACEA AGENTS metronidazole cream 0.75%
rosadan cre 0.75%
metronidazole gel 0.75%
rosadan gel 0.75%
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 135 AGE - Age Limit GNDR - Gender Edit
metronidazole gel 1% ST
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 136 AGE - Age Limit GNDR - Gender Edit
metronidazole lotion 0.75%
ANTIBIOTICS - TOPICAL BACITRACIN POW bacitracin oin 500/gm OTC
bacitracin oint 500 unit/gm OTC
bacitraycin oin 500/gm OTC
BACITRACIN POW ZINC USP
GENTAMICIN POW SULFATE gentamicin sulfate cream 0.1% gentamicin sulfate oint 0.1% NEOMYCIN POW SULFATE CENTANY OIN 2% mupirocin oint 2% mupirocin calcium cream 2%
TETRACYCLINE POW
double antib oin OTC
double oin antibiot OTC
poly bacitra oin OTC
wal-sporin oin OTC
antibiotic oin OTC
curad triple oin antibiot OTC
cvs triple oin antibiot OTC
eq triple oin antibiot OTC
eql firstaid oin antibiot OTC
first aid oin antibiot OTC
gnp triple oin antibiot OTC
hm triple oin antibiot OTC
lanabiotic oin OTC
px triple oin OTC
ra triple oin antibiot OTC
sb triple oin antibiot OTC
sm triple oin antibiot OTC
triple antib oin OTC
triple antib oin frst aid OTC
ANTIFUNGALS - TOPICAL ciclopirox gel 0.77% ciclopirox shampoo 1%
ciclopirox olamine susp 0.77% (base equiv)
CICLOPIROX POW OLAMINE
ciclopirox olamine cream 0.77% (base equiv)
CLIOQUINOL POW
CLIOQUINOL POW OTC
GENTIAN VIOL POW
nyamyc pow 100000
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 137 AGE - Age Limit GNDR - Gender Edit
nystatin topical powder 100000 unit/gm
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 136 AGE - Age Limit GNDR - Gender Edit
nystop pow 100000
nystatin cream 100000 unit/gm
nystatin oint 100000 unit/gm anti-fungal sol 1% OTC
blis-to-sol liq 1% OTC
dr gs clear sol nail 1% OTC
formula 3 sol OTC
mycocide ns sol 1% OTC
tinaspore sol 1% OTC
af spry powd aer 1% OTC
antifung pow aer 1% OTC
athlete foot aer 1% OTC
athletes ft aer 1% pow OTC
foot&sneaker aer 1% OTC
jck itch pow aer 1% OTC
jock itch aer 1% OTC
lamisil af aer 1% OTC
odor control aer powd 1% OTC
odor eaters aer 1% OTC
tolnaftate aerosol pow 1% OTC
anti-fungal cre 1% OTC
antifungal cre 1% OTC
antifungal cre foot OTC
athlete foot cre 1% OTC
fungi-guard cre 1% OTC
fungoid-d cre 1% OTC
sm antifungl cre 1% OTC
tgt antifung cre 1% OTC
tolnaftate cre 1% OTC
clotrimazole soln 1%
clotrimazole soln 1% OTC
fungicure spr intens OTC
CLOTRIMAZOLE POW
antifungal cre 1% OTC
athlete foot cre 1% OTC
clotrimazole cre 1% OTC
clotrimazole cre grx 1% OTC
clotrimazole cream 1%
clotrimazole cream 1% OTC
cvs itch rel cre 1% OTC
desenex cre 1% OTC
jock itch cre 1% OTC
pro-ex antif cre 1% OTC
ringworm cre 1% OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 137 AGE - Age Limit GNDR - Gender Edit
CLOTRIMAZOLE CRY
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 138 AGE - Age Limit GNDR - Gender Edit
ketoconazole cream 2%
ketoconazole shampoo 2%
MICONAZOLE POW NITRATE
anti-fungal pow 2% OTC
antifungal pow 2% OTC
athlete foot pow 2% OTC
desenex pow 2% OTC
lotrimin af pow 2% OTC
miconazorb pow af 2% OTC
remedy pow antifung OTC
zeasorb-af pow 2% OTC
antifungal cre 2% OTC
cavilon cre 2% OTC
micaderm cre 2% OTC
miconazole cre 2% OTC
podactin cre 2% OTC
remedy cre antifung OTC
sm antifungl cre 2% OTC
soothe&cool cre inzo 2% OTC
tineacide cre OTC
dermafungal oin 2% OTC
remedy oin af 2% OTC
tetterine oin 2% OTC
triple paste oin af 2% OTC
ANTI-INFLAMMATORY AGENTS - TOPICAL diclofenac sodium gel 1% QL (500 gm / 25 days)
ANTIPSORIATICS calcipotriene soln 0.005% (50 mcg/ml) calcipotriene oint 0.005%
calcitrene oin 0.005%
SILIQ INJ 210/1.5 SP, QL (2.2 syringes / 30
days), PA COSENTYX PEN INJ 150MG/ML SP, QL (1.2 pens / 30 days),
ST COSENTYX PEN INJ 300DOSE SP, QL (2.4 pens / 30 days),
ST COSENTYX INJ 150MG/ML SP, QL (1.2 syringes / 30
days), ST COSENTYX INJ 300DOSE SP, QL (2.4 syringes / 30
days), ST
ANTISEBORRHEIC PRODUCTS anti-dandruf sha 1% OTC dandruff sha 1% OTC
ra dandruff sha 1% OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 139 AGE - Age Limit GNDR - Gender Edit
selenium sulfide lotion 2.5%
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 140 AGE - Age Limit GNDR - Gender Edit
ANTIVIRALS - TOPICAL ABREVA CRE 10% OTC
ANTINEOPLASTIC OR PREMALIGNANT LESION AGENTS - TOPICAL fluorouracil cream 5%
BURN PRODUCTS silver sulfadiazine cream 1% ssd cre 1%
CORTICOSTEROIDS - TOPICAL alclometasone dipropionate cream 0.05% QL (120 gm / 25 days) alclometasone dipropionate oint 0.05% QL (120 gm / 25 days) betamethasone dipropionate cream 0.05% QL (120 gm / 25 days) betamethasone dipropionate lotion 0.05% QL (120 mL / 25 days) betamethasone dipropionate oint 0.05% QL (120 gm / 25 days) betamethasone dipropionate augmented cream QL (120 gm / 25 days)
0.05% betamethasone dipropionate augmented gel QL (120 gm / 25 days) 0.05% betamethasone dipropionate augmented lotion QL (120 mL / 25 days) 0.05% betamethasone dipropionate augmented oint QL (120 gm / 25 days) 0.05% betamethasone valerate cream 0.1% (base QL (120 gm / 25 days) equivalent) betamethasone valerate lotion 0.1% (base QL (120 mL / 25 days) equivalent) betamethasone valerate oint 0.1% (base QL (120 gm / 25 days) equivalent) desonide cream 0.05% QL (120 gm / 25 days)
desonide lotion 0.05% QL (120 mL / 25 days)
desonide oint 0.05% QL (120 gm / 25 days)
desoximetasone cream 0.05% QL (120 gm / 25 days)
desoximetasone cream 0.25% QL (120 gm / 25 days)
desoximetasone gel 0.05% QL (120 gm / 25 days)
desoximetasone oint 0.25% QL (120 gm / 25 days)
diflorasone diacetate cream 0.05% QL (120 gm / 25 days)
PSORCON CRE 0.05% QL (120 gm / 25 days)
diflorasone diacetate oint 0.05% QL (120 gm / 25 days)
fluocinolone acetonide soln 0.01%
fluocinolone acetonide cream 0.025% QL (120 gm / 25 days)
fluocinolone acetonide oint 0.025% QL (120 gm / 25 days) fluocinonide soln 0.05% fluocinonide cream 0.05% QL (120 gm / 25 days) fluocinonide gel 0.05% QL (120 gm / 25 days)
fluocinonide oint 0.05% QL (120 gm / 25 days)
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 141 AGE - Age Limit GNDR - Gender Edit
fluticasone propionate cream 0.05% QL (120 gm / 25 days)
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 142 AGE - Age Limit GNDR - Gender Edit
fluticasone propionate oint 0.005% QL (120 gm / 25 days) halobetasol propionate cream 0.05% QL (120 gm / 25 days) halobetasol propionate oint 0.05% QL (120 gm / 25 days)
noble formul spr 1% OTC
ra anti-itch spr 1% OTC
scalp relief sol 1% OTC
scalpicin sol 1% OTC
hydrocortisone cream 0.5% OTC
instacort 5 cre 0.5% OTC
ala-cort cre 1%
anti-itch cre 1% OTC
anti-itch cre 1%pls 10 OTC
anti-itch cre /aloe/e OTC
anti-itch cre /oatmeal OTC
aveeno cre 1% OTC
cort intense cre heal 1% OTC
cortaid cre 1% OTC
cortisone cre 1% OTC
curad hydro cre 1% OTC
eq 1% hydroc cre OTC
eq hydrocort cre 1% OTC
gnp hydrocor cre 1% plus OTC
hydrocort cre 1% OTC
hydrocort cre 1% plus OTC
hydrocort cre plus 1% OTC
hydrocortisone cream 1%
hydrocortisone cream 1% OTC
hydrocream cre 1% OTC
kericort 10 cre 1% OTC
noble formul cre hc 1% OTC
prep h hc cre 1% OTC
ra anti-itch cre 1% OTC
ra hydrocort cre 1% OTC
ra hydrocort cre 1%pls 12 OTC
recort plus cre 1% OTC
sb hydrocort cre 1% OTC
sm hydrocort cre 1% OTC
ala-cort cre 2.5%
hydrocortisone cream 2.5%
cortisone gel 1% OTC
cortizone-10 gel 1% OTC
mg217 gel 1% OTC
anti-itch lot 1% OTC
aquanil hc lot 1% OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 143 AGE - Age Limit GNDR - Gender Edit
beta hc lot 1% OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 140 AGE - Age Limit GNDR - Gender Edit
cortisone lot 1% OTC
cortizone-10 lot diab/1% OTC
cortizone-10 lot eczema OTC
cortizone-10 lot hydraten OTC
dermarest lot 1% OTC
hydrocortisone lotion 1% OTC
sarnol-hc lot 1% OTC
hydrocortisone lotion 2.5%
hydrocortisone oint 0.5% OTC
anti-itch oin 1% OTC
cortisone oin 1% OTC
cortizone-10 oin 1% OTC
hydrocort oin 1% OTC
hydrocortiso oin absorbas hydrocortisone oint 1%
hydrocortisone oint 1% OTC
ra anti-itch oin 1% OTC
sb hydrocort oin 1% OTC
sm hydrocort oin 1% OTC
hydrocortisone oint 2.5%
gynecort 10 cre 1% OTC
lanacort 10 cre 1% OTC
vagisil cre 1% OTC
hydrocortisone valerate cream 0.2% QL (120 gm / 25 days)
hydrocortisone valerate oint 0.2% QL (120 gm / 25 days)
hydrocortisone butyrate soln 0.1%
hydrocortisone butyrate cream 0.1% QL (120 gm / 25 days) hydrocortisone butyrate oint 0.1% QL (120 gm / 25 days) mometasone furoate solution 0.1% (lotion)
mometasone furoate cream 0.1% QL (120 gm / 25 days)
mometasone furoate oint 0.1% QL (120 gm / 25 days)
triamcinolone acetonide cream 0.025% triamcinolone acetonide cream 0.1% triderm cre 0.1% triamcinolone acetonide cream 0.5% triderm cre 0.5% triamcinolone acetonide lotion 0.025% triamcinolone acetonide lotion 0.1% triamcinolone acetonide oint 0.025% triamcinolone acetonide oint 0.1% triamcinolone acetonide oint 0.5% cortizone-10 cre /aloe 1% OTC
cortizone-10 cre healing OTC
cortizone-10 cre plus OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 141 AGE - Age Limit GNDR - Gender Edit
hm hydrocort cre 1% plus OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 142 AGE - Age Limit GNDR - Gender Edit
hydrocort/ cre aloe 1% OTC
hydrocortisone-aloe vera cream 1% OTC
kls hydrocrt cre pls 1% OTC
ra hydrocort cre 1% OTC
sm hydrocort cre 1% plus OTC
DIAPER RASH PRODUCTS A+D DIAPER CRE RASH OTC BENSONS CRE BOTTOM OTC
HINEY HEALER CRE OTC
a+d prevent oin OTC
medi-paste oin OTC
paladin oin OTC
pediatric oin OTC
pinxav oin OTC
skin protect oin all-purp OTC
EMOLLIENTS geri-hydrola cre 12% OTC lactic acid (ammonium lactate) cream 12%
lactic acid (ammonium lactate) cream 12% OTC
al12 lot 12% OTC
amlactin lot 12% OTC
geri-hydrola lot 12% OTC
lactic acid (ammonium lactate) lotion 12%
lactic acid (ammonium lactate) lotion 12% OTC
skin trtment lot 12% OTC
EMOLLIENT/KERATOLYTIC AGENTS gordons urea cre 40% OTC urea cream 40%
uremez-40 cre 40%
ENZYMES - TOPICAL SANTYL OIN 250/GM PA
KERATOLYTIC/ANTIMITOTIC AGENTS podofilox soln 0.5%
IMMUNOMODULATING AGENTS - TOPICAL imiquimod cream 5%
LOCAL ANESTHETICS - TOPICAL lidocaine patch 5% PA lidocaine hcl soln 4%
lidocaine-prilocaine cream 2.5-2.5% QL (1 gm / 1 day)
SCABICIDES & PEDICULICIDES malathion lotion 0.5% ST lice trtmnt liq 1% OTC
bedding spra aer 0.5% OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 143 AGE - Age Limit GNDR - Gender Edit
lice bedding aer OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 144 AGE - Age Limit GNDR - Gender Edit
lice bedding aer 0.5% OTC
licide aer 0.5% OTC
sm bedding aer lice OTC
stop lice 3 spr 0.5% OTC
stop lice spr 0.5% OTC
permethrin cream 5%
lice treatmt lot 1% OTC
ra lice lot 1% OTC
spinosad susp 0.9% ST
lice killing sha OTC
lice killing sha 0.33-4% OTC
lice treatmt sha 0.33-4% OTC
licide sha 0.33-4% OTC
rid lice kil sha 0.33-4% OTC
stop lice ms sha 0.33-4% OTC
MISC. TOPICAL CALAMINE LOT OTC SM CALAMINE LOT OTC
ANTISEPTICS & DISINFECTANTS CHLORINE ANTISEPTICS
CHLOR GLUC LIQ 2% OTC betasept liq 4% OTC
chlorhexidine gluconate liquid 4% OTC
dyna-hex 2 sol 2% OTC
hand wash sol 2% OTC
antiseptic sol clnsr 4% OTC
antiseptic sol skin cln OTC
dyna-hex 4 sol 4% OTC
skin cleansr sol 4% OTC
CHLORHEX GLU PAD 2% OTC
BIOPATCH MIS 1"/4MM OTC
BIOPATCH MIS 1"/7MM OTC
BIOPATCH MIS 3/4"/1.5 OTC
BIOPATCH PRO MIS DISK/CHG OTC
TEGADERM CHG MIS DRESSING OTC
IODINE ANTISEPTICS povidone-iod sol 7.5% OTC ap povid-iod sol 10% OTC
first aid sol 10% OTC
hm povid-iod sol 10% OTC
povidone-iod sol 10% OTC
povidone-iodine soln 10% OTC
povidone/iod sol 10% OTC
pvp prep sol 10% OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 145 AGE - Age Limit GNDR - Gender Edit
ra antisepti sol 10% OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 143 AGE - Age Limit GNDR - Gender Edit
sm povid-iod sol 10% OTC
povidone iod oin 10% OTC
povidone-iodine oint 10% OTC
ANTISEPTIC COMBINATIONS IV PREP WIPE PAD OTC MICROCLENS PAD WIPES OTC
UNI-SOLVE PAD WIPES OTC
ANTIDOTES AND SPECIFIC ANTAGONISTS ANTIDOTES AND SPECIFIC ANTAGONISTS
VISTOGARD PAK 10GM SP
DIAGNOSTIC PRODUCTS DIAGNOSTIC TESTS
ONETOUCH TES ULTRA BL OTC, QL (200 strips / 25 days)
ONETOUCH TES VERIO OTC, QL (200 strips / 25
days) CHEMSTRIP 2 TES GP OTC
CHEMSTRIP 5 TES OB OTC
CHEMSTRIP 7 TES OTC
CHEMSTRIP 9 TES STRIPS OTC
CHEMSTRIP 10 TES MD OTC
CHEMSTRIP TES -10 SG OTC
CHEMSTRIP TES UGK OTC
CVS KETONE TES CARE OTC
KETO-DIASTIX TES OTC
ALTERNATIVE MEDICINES ALTERNATIVE MEDICINE - M'S
cvs quality cap sleep OTC melatonin cap 10mg OTC
MELATONIN TAB 200MCG OTC
melatonin tab 300 mcg OTC
melatonin tab 1 mg OTC
kp melatonin tab 3mg OTC
melatonin tab 3mg OTC
ra melatonin tab 3mg OTC
sm melatonin tab 3mg OTC
melatonin tab 5mg OTC
melatonin tab max st OTC
pa melatonin tab 5mg OTC
ra melatonin tab 5mg OTC
sv melatonin tab 5mg OTC
melatonin tab 10 mg OTC
ra melatonin tab 10mg OTC
MELADOX TAB 3MG CR OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 144 AGE - Age Limit GNDR - Gender Edit
MELATONIN TAB 3MG CR OTC
melatonin tab 10mg cr OTC
mm melatonin tab 10mg tr OTC
melatonin chew tab 2.5 mg OTC
vitajoy gumm chw 2.5mg OTC
RA MELATONIN SUB 1MG OTC
melatonin sub 5mg OTC
melatonin sl tab 10 mg OTC
melatonin sub quik dis OTC
MELATONIN LIQ 1MG/4ML OTC
MELATONIN LIQ 2.5MG OTC
melatonin liq 5mg/15ml OTC
melatonin liquid 1 mg/ml OTC
SLEEP SOUNDL LIQ 3.5/2ML OTC
MELATONIN LOZ 5MG OTC
MELATONIN TAB 500MCG OTC
melatonin tablet disintegrating 3 mg OTC
sv melatonin tab 3mg OTC
melatonin tablet disintegrating 5 mg OTC
sm melatonin tab 5mg OTC
melatonin chw 10mg OTC
melatonin chw quik dis OTC
melatonin tablet disintegrating 10 mg OTC
CHEMICALS LIQUIDS
ALMOND OIL ALMOND OIL SWEET ALMOND OIL SWEET OTC BASE G ALMON OIL SWEET
OIL-ALMOND OIL SWEET OTC
CASTOR OIL CASTOR OIL OTC HM CASTOR OIL OTC
QC CASTOR OIL OTC
LINSEED OIL RAW
OLIVE OIL OLIVE OIL OTC QC SWEET OIL OTC
SM SWEET OIL OTC
SWEET OIL OTC
MEDICAL DEVICES AND SUPPLIES PARENTERAL THERAPY SUPPLIES
INSULIN SYRG MIS 0.3/30G OTC INSULIN SYRG MIS 0.5/31G OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 145 AGE - Age Limit GNDR - Gender Edit
INSULIN SYRG MIS 0.5/30G OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 145 AGE - Age Limit GNDR - Gender Edit
INSULIN SYRG MIS 0.3/31G
INSULIN SYRG MIS 0.3/31G OTC
INSULIN SYRG MIS 1ML/30G OTC
INSULIN SYRG MIS 1ML/31G OTC
INSULIN SYRG MIS 0.3/31G OTC
INSULIN SYRG MIS 0.5/31G OTC
INSULIN SYRG MIS 1ML/31G OTC BD U-500 MIS 31GX6MM BD PEN NEEDL MIS 29GX12.7 OTC
LITETOUCH MIS 29GX12.7 OTC
PEN NEEDLE MIS 29GX1/2" OTC PEN NEEDLES MIS 29GX12.7 PEN NEEDLES MIS 29GX12.7 OTC
SURE COMFORT MIS 29GX1/2" OTC
SURE-FINE MIS 29GX1/2" OTC
ULTILET PEN MIS 29GX12.7 OTC
ASSURE ID MIS 31GX3/16 OTC
BD PEN NEEDL MIS 31GX5MM OTC
CARETOUCH MIS 31GX5MM OTC
COMFORT EZ MIS 31GX5MM OTC
EASY COMFORT MIS 31GX3/16 OTC
EASY TOUCH MIS 31GX3/16 OTC
FIFTY50 MIS 31GX3/16 OTC
FIFTY50 MIS 31GX5MM OTC
IN CONTROL MIS 31GX5MM OTC
INSUPEN MIS 31GX5MM OTC MM PENTIPS MIS 31GX5MM PEN NEEDLES MIS 31GX3/16 OTC PEN NEEDLES MIS 31GX5MM PEN NEEDLES MIS 31GX5MM OTC PENTIPS MIS 31GX5MM PENTIPS MIS 31GX5MM OTC
RA PEN NEEDL MIS 31GX3/16 OTC
SURE COMFORT MIS 31GX3/16 OTC
SURE-FINE MIS 31GX3/16 OTC
1ST TIER UNI MIS 31GX5MM OTC
ULTICARE PEN MIS 31GX5MM OTC
ULTILET PEN MIS 31GX5MM OTC
UNIFINE PNTP MIS 31GX3/16 OTC
UNIFINE PNTP MIS 31GX5MM OTC
BD PEN NEEDL MIS 31GX8MM OTC
CAREFINE MIS 31GX8MM OTC
CARETOUCH MIS 31GX8MM OTC
CLICKFINE MIS 31GX5/16 OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 146 AGE - Age Limit GNDR - Gender Edit
CLICKFINE MIS 31GX8MM OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 147 AGE - Age Limit GNDR - Gender Edit
COMFORT EZ MIS 31GX8MM OTC
EASY COMFORT MIS 31GX5/16 OTC
EASY TOUCH MIS 31GX5/16 OTC
FIFTY50 MIS 31GX5/16 OTC
FIFTY50 PEN MIS 31GX8MM OTC
HM ULTICARE MIS 31GX8MM OTC
IN CONTROL MIS 31GX8MM OTC
INSULIN PEN MIS 31GX8MM OTC
INSUPEN MIS 31GX8MM OTC
INSUPEN ULTR MIS 31GX8MM OTC
LITETOUCH MIS 31GX8MM OTC MM PENTIPS MIS 31GX8MM PEN NEEDLES MIS 31GX5/16 OTC PEN NEEDLES MIS 31GX8MM PEN NEEDLES MIS 31GX8MM OTC PENTIPS MIS 31GX8MM PENTIPS MIS 31GX8MM OTC PRO COMFORT MIS 31GX8MM RELION PEN MIS 31GX8MM OTC
SURE COMFORT MIS 31GX5/16 OTC
SURE-FINE MIS 31GX5/16 OTC
1ST TIER UNI MIS 31GX8MM OTC
TIER UNI PLS MIS 31GX8MM OTC
ULTICARE PEN MIS 31GX8MM OTC
ULTILET PEN MIS 31GX8MM OTC
UNIFINE PNTP MIS 31GX5/16 OTC
UNIFINE PNTP MIS 31GX8MM OTC BD PEN NEEDL MIS 32GX4MM
BD PEN NEEDL MIS 32GX4MM OTC
CAREFINE MIS 32GX4MM OTC
CARETOUCH MIS 32GX4MM OTC
CLICKFINE MIS 32GX5/32 OTC
COMFORT EZ MIS 32GX4MM OTC
EASY COMFORT MIS 32GX5/32 OTC
EASY TOUCH MIS 32GX5/32 OTC
FIFTY50 PEN MIS 32GX4MM OTC
INSUPEN MIS 32GX4MM OTC MM PENTIPS MIS 32GX4MM NOVOFINE PLS MIS 32GX4MM OTC
PEN NEEDLE MIS 32GX4MM OTC PEN NEEDLES MIS 32GX4MM PEN NEEDLES MIS 32GX4MM OTC
PEN NEEDLES MIS 32GX5/32 OTC PENTIPS MIS 32GX4MM
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 148 AGE - Age Limit GNDR - Gender Edit
PENTIPS MIS 32GX4MM OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 147 AGE - Age Limit GNDR - Gender Edit
PRO COMFORT MIS 32GX4MM
RELION PEN MIS 32GX4MM OTC
SURE COMFORT MIS 32GX5/32 OTC
1ST TIER UNI MIS 32GX4MM OTC
ULTICARE MIC MIS 32GX4MM OTC
ULTILET PEN MIS 32GX4MM OTC
UNFINE PNTP MIS 32GX4MM OTC
UNIFINE PNTP MIS 32GX4MM OTC
UNIFINE PNTP MIS 32GX5/32 OTC
BD PEN NEEDL MIS 32GX6MM OTC
CAREFINE MIS 32GX6MM OTC
COMFORT EZ MIS 32GX6MM OTC
EASY TOUCH MIS 32GX1/4" OTC
EASY TOUCH MIS 32GX6MM OTC
FIFTY50 PEN MIS 32GX6MM OTC
INSUPEN SENS MIS 32GX6MM OTC
NOVOFINE MIS 32GX6MM OTC
PEN NEEDLES MIS 32GX1/4 OTC
PEN NEEDLES MIS 32GX1/4" OTC
PEN NEEDLES MIS 32GX6MM OTC
PRO COMFORT MIS 32GX6MM OTC
SURE COMFORT MIS 32GX6MM OTC
UNIFINE PNTP MIS 32GX6MM OTC
RESPIRATORY THERAPY SUPPLIES ACE AERO CLD MIS ENHANCER ACTIVITY PCH MIS ADULT MASK MIS ADULT MASK MIS LARGE AEROSOL MASK MIS ADULT
AEROSOL MASK MIS ADULT OTC AEROTRC PLUS MIS
AIR TUBE MIS /PLUGS
AIRS PEDIATR MIS MASK OTC ALTERA NEB MIS HANDSET BUBBLES PEDI MIS MASK OTC CO MONITOR MIS T PIECES CONVERSION MIS BABY SZ1 CONVERSION MIS BABY SZ2 CONVERSION MIS BABY SZ3 EBASE CONTRO MIS KIT EFLOW SCF MIS AEROSOL ELITE DC AUT MIS ADAPTER ERAPID NEB MIS HANDSET FILTER AIR MIS PP
FULL KIT NEB MIS SET
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 148 AGE - Age Limit GNDR - Gender Edit
LITETOUCH MIS MASK LG LITETOUCH MIS MASK MD LITETOUCH MIS MASK SM
MICROELITE MIS BATTERY OTC
MICROELITE MIS FILTERS OTC MINIELITE MIS BATTERY MINIELITE MIS FILTERS OTC
NOSE CLIP MIS OTC
PARI EXPIRAT MIS FILTER PARI MASK MIS SIZE 3 PARI PLASTIC MIS MASK
PARI PLASTIC MIS MASK PED PEDIATRIC MIS MASK PEDIATRIC MIS MOUTHPIE OTC PFLEX MIS PFT FILTER MIS 1000 PILLOW MASK MIS ADULT PILLOW MASK MIS CHILD PILLOW MASK MIS PEDIATRI REPLACEMENT MIS FILTER
REPLACEMENT MIS FILTERS OTC SIDESTREAM MIS MASK
SIDESTREAM MIS MASK OTC SIDESTREAM MIS PED MASK
SIDESTREAM MIS PED MASK OTC
SIDESTRM PLS MIS FACE MSK OTC SILICONE MSK MIS ADULT SILICONE MSK MIS INFANT SILICONE MSK MIS PED SOOTHENEB MIS MED CUP OTC
SOOTHENEB MIS MESH CAP OTC
SOOTHENEB MIS NBL 100 OTC THRESHOLD MIS IMT WINDMILL MIS TRAINER
WING TIP MIS TUBING OTC
AERCHMBR PLS MIS FLOW-VU AERCHMBR PLS MIS LRG MASK AERCHMBR PLS MIS MED MASK AERCHMBR PLS MIS SM MASK AERCHMBR Z- MIS STAT PLS AEROCHAMBER MIS CHAMBER AEROCHAMBER MIS FLOSIGNA AEROCHAMBER MIS MV AEROCHAMBER MIS PLUS
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 149 AGE - Age Limit GNDR - Gender Edit
AEROVENT MIS PLUS
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 150 AGE - Age Limit GNDR - Gender Edit
ARIAL MIS CHAMBER OTC
BREATHE EASE MIS LG MASK BREATHE EASE MIS MED MASK BREATHE EASE MIS SM MASK BREATHERITE MIS BREATHERITE MIS LG MASK BREATHERITE MIS MED MASK BREATHERITE MIS SM MASK BREATHERITE MIS SPACER BREATHERITE MIS W/MASK COMPACT SPAC MIS CHAMBER COMPACT SPAC MIS LG MASK COMPACT SPAC MIS MD MASK COMPACT SPAC MIS SM MASK EASIVENT MIS
EASIVENT MIS MASK LG EASIVENT MIS MASK MED EASIVENT MIS MASK SM FLEXICHAMBER MIS
HOLD CHAMBER MIS ADLT LG HOLD CHAMBER MIS MEDIUM HOLD CHAMBER MIS SMALL INSPIRACHAMB MIS LARGE INSPIRACHAMB MIS MEDIUM INSPIRACHAMB MIS MOUTHPCE INSPIRACHAMB MIS SMALL INSPIREASE MIS DD SYST LITEAIRE MIS
MICROCHAMBER MIS MICROSPACER MIS OPTICHAMBER MIS ADV LRG OPTICHAMBER MIS ADV MED OPTICHAMBER MIS ADV SM OPTICHAMBER MIS DIA LG OPTICHAMBER MIS DIA MD OPTICHAMBER MIS DIA SM OPTICHAMBER MIS DIAMOND
OPTICHAMBER MIS FACE MAS OTC OPTIHALER MIS
POCKET CHAMB MIS POCKET SPACE MIS RITEFLO MIS SPACER CHAMB MIS ADULT OTC
SPACER CHAMB MIS CHILD OTC VALVD HOLDNG MIS CHAMBER
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 150 AGE - Age Limit GNDR - Gender Edit
VORTEX VALVE MIS CHAMBER WATCHHALER MIS FLEXICHAMBER MIS MASK LRG QL (2 boxes / year)
FLEXICHAMBER MIS MASK SM QL (2 boxes / year)
MASK VORTEX/ MIS BABY DUC OTC, QL (2 each / year)
MASK VORTEX/ MIS DUCK OTC, QL (2 each / year)
MASK VORTEX/ MIS FROG OTC, QL (2 each / year)
MASK VORTEX/ MIS LADY BUG OTC, QL (2 each / year)
PANDA MASK MIS LARGE OTC, QL (0.2 packs / year)
PANDA MASK MIS LARGE OTC, QL (2 packs / year)
PANDA MASK MIS MEDIUM OTC, QL (0.2 packs / year)
PANDA MASK MIS MEDIUM OTC, QL (2 packs / year)
PANDA MASK MIS PEDIATRI OTC, QL (0.2 packs / year)
PANDA MASK MIS PEDIATRI OTC, QL (2 packs / year)
PANDA MASK MIS SMALL OTC, QL (0.2 packs / year)
PANDA MASK MIS SMALL OTC, QL (2 packs / year) AEROECLIPSE MIS II NEB AERONEB GO MIS
AERONEB GO MIS COMPLETE AERONEB GO MIS HAND/CBL AERONEB GO MIS HANDSET AIRIAL COMP MIS COMPRESS AIRIAL MIS COMPACT
AIRIAL MIS VOYAGER AIRIAL PEDIA MIS BUILDING AIRIAL PEDIA MIS DUCK AIRIAL PEDIA MIS FIRE ENG AIRIAL PEDIA MIS PANDA AIRIAL PEDIA MIS PENGUIN
AIRS DISPOSA MIS NEBULIZR OTC
ALL-IN-ONE MIS NEBULIZR OTC ALTERA MIS NEBULIZE CLEVER CHOIC MIS NEBULIZR COMP AIR MIS COMP/NEB COMP AIR MIS ELITE
COMPMIST MIS NEBULIZE OTC COMPRESSOR MIS NEBULIZE COMPRESSOR MIS NEBULIZR OTC
EASY AIR COM MIS NEBULIZE OTC
EASY NEB MIS OTC
EFLOW SCF MIS NEBULIZR
ELITE COMPRS MIS NEBULIZR OTC ELITE SYSTEM MIS NEBULIZR ERAPID MIS NEBULIZE
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 151 AGE - Age Limit GNDR - Gender Edit
FLYP NEBULZR MIS
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 152 AGE - Age Limit GNDR - Gender Edit
HOMENEB MIS SIDESTRE OTC INNOSPIRE EL MIS NEBULIZE INNOSPIRE ES MIS NEBULIZE
INNOSPIRE MIS DEL NEBU OTC INNOSPIRE MIS MINI NEB
INNOSPIRE MIS PORTABLE OTC INSPIRATION MIS ELITE
INSPIRATION MIS NEBULIZR LUMINEB II MIS NEBULIZR
MABIS COMPXP MIS COMP/NEB OTC MABIS COSMO MIS NEBULIZR
MARGO MOO MIS NEBULIZE OTC MICRO AIR MIS NEBULIZR MICRO PLUS MIS NEBULIZR MICROELITE MIS COMP/NEB MICROELITE MIS COMP/NEB OTC MINI COMPRES MIS NEBULIZR MINI PLUS MIS NEBULIZR
MINI-MIST MIS PORTABLE OTC
MINIBREEZE MIS NEBULIZE OTC MINIELITE MIS COMP/NEB MISTERNEB MIS NEBULIZE MY MDI PORTA MIS NEBULISE NEBULIZER MIS OTC
NEBULIZER MIS CMPRESSR NEBULIZER MIS ULTRASON NEBULIZER SY KIT ALLINONE OPTIONHOME MIS NEBULIZR PARI BABY MIS SIZE 0
PARI BABY MIS SIZE 1 PARI BABY MIS SIZE 2 PARI LC D MIS NEBULIZR PARI LC MIS SPRINT PARI LC PLUS MIS
PARI LC PLUS MIS NEBULIZR PARI LC PLUS MIS VIOS PRO PARI LC STAR MIS PARI LC STAR MIS NEBULIZR PARI PRONEB MIS ULTRA II PARI SINUS MIS AERO SYS PARI TREK S MIS
PORT COMPRES MIS NEBULIZR OTC
PROCARE COMP MIS NEBULIZE OTC PRONEB ULTRA MIS II/LCD
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 153 AGE - Age Limit GNDR - Gender Edit
PRONEB ULTRA MIS II/PED
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 154 AGE - Age Limit GNDR - Gender Edit
PRONEB ULTRA MIS LC PLUS PRONEB ULTRA MIS LC SPRNT PRONEB ULTRA MIS LC STAR SIDESTREAM MIS NEBULIZR SIDESTREAM MIS PLUS SOOTHE NEB MIS NEBULIZE SOOTHENEB MIS COMP NEB VIOS LC MIS SPRINT
VIOS LC PLUS MIS
VIOS LC PLUS MIS DELUXE VIOS LC PLUS MIS PEDIATRC VIOS MIS SYSTEM
VIOS PRO LC MIS SPRINT VIOS PRO LC+ MIS SYSTEM WHISPER AIRE MIS PED NEBU
WILLIS THE MIS WHALE OTC
KAZ VAPORIZR MIS 1 GALLON OTC
KAZ VAPORIZR MIS 1.5 GAL OTC
KAZ VAPORIZR MIS 2.2 GAL OTC
SUNBEAM VAP MIS 1 GAL OTC
SUNBEAM VAP MIS 1.5 GAL OTC
SUNBEAM VAP MIS 2 GAL OTC
VAPORIZER MIS 1 GALLON OTC
VAPORIZER MIS 1.2 GAL OTC
VAPORIZER MIS 1.5 GAL OTC
VAPORIZER MIS 1.7 GAL OTC
VAPORIZER MIS 1.9 GAL OTC
VAPORIZER MIS 2 GALLON OTC
VAPORIZER MIS 2.5 GAL OTC
VAPORIZER MIS 3 GALLON OTC
VAPORIZER MIS PORTABLE OTC
VAPORIZER MIS WATERLES OTC
RESPIRATORY AIDS ALL PURPOSE MIS MASK OTC
EAR-LOOP MIS MASK SM OTC
EARLOOP MIS MASK OTC
FACE MASK MIS EARLOOP
FACE MASK MIS EARLOOP OTC FACE MASK MIS N-100
FACE MASK MIS R95 PART
J&J GERM FIL MIS MASK OTC
LIGHT SHIELD MIS OTC
LIGHT SHIELD MIS SLP MASK OTC
MASK PEDIATR MIS SIZE 1" OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 155 AGE - Age Limit GNDR - Gender Edit
MASK PEDIATR MIS SIZE 3" OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 156 AGE - Age Limit GNDR - Gender Edit
MAXI-MASK MIS OTC
MICROSHIELD MIS CPR OTC
PEDIATRIC MD MIS MASK OTC
PEDIATRIC SM MIS MASK OTC
PROCEDURAL MIS MASK OTC
RA EAR-LOOP MIS MASK OTC
SHIELD-SECUR MIS OTC
SIESTA MASK MIS OTC
SIESTA MASK MIS ONE SIZE OTC
DIABETIC SUPPLIES ONETOUCH KIT ULT MINI OTC
ONETOUCH KIT ULTRA 2 OTC
ONETOUCH KIT VERIO OTC
ONETOUCH KIT VERIO FL OTC
ONETOUCH KIT VERIO IQ OTC
ONETOUCH VER KIT SYNC OTC
ACCU-CHEK MIS MLTICLIX OTC
ACTI-LANCE MIS 28G OTC
ACTI-LANCE MIS LITE 28G OTC
ACTI-LANCE MIS SPEC 17G OTC
ACTI-LANCE MIS UNIV 23G OTC
ADV TRAVEL MIS LANC 28G OTC
ADVCATE SAFE MIS LANC 26G OTC
ADVOCATE MIS LANC 30G OTC
ADVOCATE MIS LANCETS OTC
AGAMATRIX MIS 33G OTC
AQUALANCE MIS 30G OTC
ASSURE CMFRT MIS 28G OTC
ASSURE LANCE MIS 21G OTC
ASSURE LANCE MIS LOW FLOW OTC
ASSURE LANCE MIS MICRO OTC
ASSURE LANCE MIS SAFE 25G OTC
ASSURE LANCE MIS SAFE 30G OTC
ASSURE MIS LANCETS OTC
ASSURE PLUS MIS HIGH 18G OTC
ASSURE PLUS MIS LOW 25G OTC
ASSURE PLUS MIS MCRO 28G OTC
ASSURE PLUS MIS NORM 21G OTC
ASSURE PLUS MIS PEDIATRI OTC
AURORA LANCE MIS 30G OTC
AURORA LANCE MIS THIN 23G OTC
AUTO LANCET MIS OTC
BAYER MICRLT MIS LANCETS OTC
BD LANCET UF MIS 30G OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 157 AGE - Age Limit GNDR - Gender Edit
BD LANCET UF MIS 33G OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 158 AGE - Age Limit GNDR - Gender Edit
BD MICROTAIN MIS LANCETS OTC
BULLSEYE MIS LANCETS OTC
BULLSEYE MIS MINI LNC OTC
CAREONE LANC MIS 28G OTC
CAREONE LANC MIS THIN 23G OTC
CARETOUCH MIS TWIST 28 OTC
CARETOUCH MIS TWIST 30 OTC
CARETOUCH MIS TWIST 33 OTC
CLEANLET 28G MIS LANCETS OTC
CLEVER CHECK MIS OTC
CLEVER CHECK MIS 30G OTC
COAGUCHEK MIS LANCETS OTC
COMFORT ASSU MIS LANC 28G OTC
COMFORT ASSU MIS LANC 33G OTC
COMFORT EZ MIS 21G OTC
COMFORT EZ MIS 23G OTC
COMFORT EZ MIS 28G OTC
COMFORT MIS LANCETS OTC
COMFORTOUCH MIS LANCET OTC
CVS LANCETS MIS 21G OTC
CVS LANCETS MIS 30G OTC
CVS LANCETS MIS 33G OTC
CVS LANCETS MIS ORIGINAL OTC
CVS LANCETS MIS THIN 26G OTC
CVS LANCETS MIS THIN 30G OTC
CVS LANCETS MIS THIN 33G OTC
DROPLET LANC MIS 30G OTC
E-Z JECT MIS 21G OTC
E-Z JECT MIS 21G COLR OTC
E-Z JECT MIS 30G OTC
E-Z JECT MIS 32G COLR OTC
E-Z JECT MIS LANC 21G OTC
E-Z JECT MIS THIN 26G OTC
E-ZJECT LANC MIS 33G OTC
EASY COMFORT MIS 30G OTC
EASY COMFORT MIS LANC/30G OTC
EASY COMFORT MIS TWIST OTC
EASY TOUCH MIS LANC/21G OTC
EASY TOUCH MIS LANC/23G OTC
EASY TOUCH MIS LANC/26G OTC
EASY TOUCH MIS LANC/28G OTC
EASY TOUCH MIS LANC/30G OTC
EASY TOUCH MIS LANC/32G OTC
EASY TOUCH MIS LANC/33G OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 159 AGE - Age Limit GNDR - Gender Edit
EMBRACE LANC MIS THIN 30G OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 160 AGE - Age Limit GNDR - Gender Edit
EQL LANCETS MIS 21G COLR OTC
EQL LANCETS MIS 33G COLR OTC
EQL LANCETS MIS THIN 26G OTC
EQL LANCETS MIS THIN 30G OTC
EZ SMART MIS LANCETS OTC
EZ-LETS 21G MIS LANCETS OTC
EZ-LETS 23G MIS LANCETS OTC
EZ-LETS 26G MIS LANCETS OTC
EZ-LETS 28G MIS LANCETS OTC
EZ-LETS 30G MIS LANCETS OTC
FASTCLIX MIS LANCETS OTC
FIFTY50 SAFE MIS LANCETS OTC
FINE 30 MIS OTC
FINGERSTIX MIS LANCETS OTC
FORA LANCETS MIS 30G OTC
FORA MIS LANCETS OTC
FREESTYLE MIS LANCETS OTC
FREESTYLE MIS UNISTICK OTC
GENTEEL MIS LANCETS OTC
GENTLE-LET MIS 26G OTC
GENTLE-LET MIS 28G OTC
GENTLE-LET MIS LANCETS OTC
GLOBAL 28G MIS LANCETS OTC
GLOBAL 30G MIS LANCETS OTC
GLUCOCOM MIS 28G OTC
GLUCOCOM MIS 30G OTC
GLUCOCOM MIS 33G OTC
GNP LANCETS MIS OTC
GNP LANCETS MIS 21G OTC
GNP LANCETS MIS MICRO OTC
GNP LANCETS MIS SUP THIN OTC
GNP LANCETS MIS THIN OTC
GNP LANCETS MIS THIN 26G OTC
GOODSENSE MIS LANC 26G OTC
GOODSENSE MIS LANC 30G OTC
GOODSENSE MIS LANC 33G OTC
HAEMOLANCE MIS HIGH FLO OTC
HAEMOLANCE MIS LOW FLOW OTC
HAEMOLANCE MIS PLUS OTC
HAEMOLANCE MIS PLUS LOW OTC
HAEMOLANCE MIS PLUS MAX OTC
HAEMOLANCE MIS PLUS PED OTC
HAEMOLANCE MIS RETRACT OTC
HLTHY ACCNTS MIS LANC 30G OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 161 AGE - Age Limit GNDR - Gender Edit
IN TOUCH LAN MIS 30G OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 162 AGE - Age Limit GNDR - Gender Edit
INCONTROL MIS LANC 28G OTC
INCONTROL MIS LANC 30G OTC
INCONTROL MIS LANC 33G OTC
KINNEY MIS LANCETS OTC
KINNEY THIN MIS LANCETS OTC
KROGER LANCE MIS OTC
KROGER LANCE MIS THIN OTC
KROGER LANCE MIS THIN 30G OTC
LANCET MICRO MIS THIN 33G OTC
LANCET STAND MIS 21G OTC
LANCET SUPER MIS THIN 30G OTC
LANCET ULTRA MIS 28G OTC
LANCET ULTRA MIS FINE OTC
LANCET ULTRA MIS THIN 30G OTC
LANCETS MICR MIS THIN 33G OTC
LANCETS MIS OTC
LANCETS MIS 21G OTC
LANCETS MIS 21G COLR OTC
LANCETS MIS 26G OTC
LANCETS MIS 28G OTC
LANCETS MIS 30G OTC
LANCETS MIS 31G OTC
LANCETS MIS 33G OTC
LANCETS MIS ORANGE OTC
LANCETS MIS ORIGINAL OTC
LANCETS MIS THIN OTC
LANCETS MIS THIN 26G OTC
LANCETS MIS THIN 30G OTC
LANCETS SUPR MIS THIN 28G OTC
LANCETS THIN MIS OTC
LANCETS THIN MIS 26G OTC
LANCETS ULTR MIS THIN OTC
LB LANCET MIS 28G OTC
LIFESCAN MIS UNISTIK2 OTC
LITE TOUCH MIS LANCETS OTC
LITETOUCH MIS LANCETS OTC
LONGS LANCET MIS STANDARD OTC
LONGS LANCET MIS THIN OTC
LONGS LANCET MIS ULTRA TH OTC
MEDICHOICE MIS LANCET OTC
MEDLANCE MIS 30G PLUS OTC
MEDLANCE MIS EXTR 21G OTC
MEDLANCE MIS LITE 25G OTC
MEDLANCE MIS PLUS OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 163 AGE - Age Limit GNDR - Gender Edit
MEDLANCE MIS PLUS 30G OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 164 AGE - Age Limit GNDR - Gender Edit
MEDLANCE MIS UNV 21G OTC
MEDLANCE PLS MIS 0.8MM OTC
MEDLANCE PLS MIS EXTR 21G OTC
MEDLANCE PLS MIS LITE 25G OTC
MEDLANCE PLS MIS UNIV 21G OTC
MEIJER LANCE MIS COLOR OTC
MEIJER LANCE MIS UNIV 21G OTC
MEIJER LANCE MIS UNIV 30G OTC
MEIJER LANCE MIS UNIVERSA OTC
MEIJER MIS LANCETS OTC
MICRO THIN MIS LANC 33G OTC
MICROLET MIS LANCETS OTC
MICROTAINER MIS LANCET OTC
MM TWIST MIS LANCETS OTC
MOBILE LANCE MIS 30G OTC
MONOLET MIS LANCETS OTC
MONOLET OPD MIS LANCETS OTC
MONOLETTOR MIS LANCETS OTC
MPD SFTY LAN MIS 21G OTC
MPD SFTY LAN MIS 23G OTC
MPD SFTY LAN MIS 28G OTC
MPD SFTY LAN MIS 30G OTC
MYGLUCOHEALT MIS LANC 30G OTC
NOVA SAFETY MIS LANC 23G OTC
NOVA SAFETY MIS LANC 28G OTC
NOVA SURE MIS LANCETS OTC
ON CALL MIS LANCETS OTC
ON CALL PLUS MIS LANCETS OTC
ON-THE-GO MIS LANC 30G OTC
ONETOUCH FP MIS LANCETS OTC
ONETOUCH MIS 30G OTC
ONETOUCH MIS COMBO OTC
ONETOUCH MIS LANCETS OTC
ONETOUCH US MIS LANCETS OTC
PC LANCETS MIS 30G OTC
PERFECT 28G MIS LANCETS OTC
PERFECT 30G MIS LANCETS OTC
PHARMACY COU MIS LANCETS OTC
PRESSURE ACT MIS LANCET OTC
PRESSURE ACT MIS LANCETS OTC
PRO COMFORT MIS 31G OTC
PRO COMFORT MIS LANCETS OTC
PRODIGY MIS 26G OTC
PRODIGY MIS 28G OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 165 AGE - Age Limit GNDR - Gender Edit
PSS SAFE LAN MIS OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 166 AGE - Age Limit GNDR - Gender Edit
PSS SEL LANC MIS OTC
PX LANCETS MIS 28G OTC
PX LANCETS MIS ULT THIN OTC
QC LANCETS MIS 28G OTC
QC LANCETS MIS 30G OTC
RA E-ZJECT MIS 28G OTC
RA E-ZJECT MIS 33G OTC
RA E-ZJECT MIS THIN 26G OTC
RA E-ZJECT MIS THIN 28G OTC
RA E-ZJECT MIS ULT THIN OTC
READYLANCE MIS 21G OTC
READYLANCE MIS 23G OTC
READYLANCE MIS 26G OTC
READYLANCE MIS 28G OTC
READYLANCE MIS 30G OTC
REALITY MIS LANCETS OTC
REALITY TRIG MIS LANCETS OTC
RELION LANCE MIS STND 21G OTC
RELION LANCE MIS THIN 26G OTC
RELION LANCE MIS THIN 30G OTC
RELION MICRO MIS THIN 33G OTC
RELION ULTRA MIS THIN 32G OTC
RELION ULTRA MIS THIN PLS OTC
RIGHTEST MIS GL300 OTC
SAFE-T-LANCE MIS 21G OTC
SAFE-T-LANCE MIS 25G OTC
SAFE-T-LANCE MIS HI FLOW OTC
SAFE-T-LANCE MIS LOW FLOW OTC
SAFE-T-LANCE MIS NOR FLOW OTC
SAFE-T-PRO MIS LANCETS OTC
SAFE-T-PRO MIS PLUS OTC
SAFETY 21G MIS LANCETS OTC
SAFETY 28G MIS LANCETS OTC
SAFETY LET MIS LANCETS OTC
SAFETY MIS LANCETS OTC
SAFETY SEAL MIS 28G OTC
SAFETY SEAL MIS 30G OTC
SAPS HEALTH MIS TWIST OTC
SAPSCARE MIS TWIST OTC
SB LANCETS MIS THIN OTC
SB LANCETS MIS ULTR THN OTC
SIDE BUTTON MIS SAFETY OTC
SINGLE-LET MIS 23G OTC
SM LANCETS MIS 33G OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 167 AGE - Age Limit GNDR - Gender Edit
SMART SENSE MIS LANC 21G OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 168 AGE - Age Limit GNDR - Gender Edit
SMART SENSE MIS LANC 26G OTC
SMART SENSE MIS LANC 30G OTC
SMART SENSE MIS LANC 33G OTC
SMARTEST MIS LANCETS OTC
SOFT TOUCH MIS LANCETS OTC
SOFTCLIX MIS LANCETS OTC
SOLUS V2 MIS LANC 28G OTC
SOLUS V2 MIS LANC 30G OTC
STERILANCE MIS TL 28G OTC
STERILANCE MIS TL 30G OTC
STERILANCE MIS TL 32G OTC
SUPER THIN MIS LANC 28G OTC
SUPER THIN MIS LANCETS OTC
SURE COMFORT MIS LANC 18G OTC
SURE COMFORT MIS LANC 21G OTC
SURE COMFORT MIS LANC 23G OTC
SURE COMFORT MIS LANC 30G OTC
SURE COMFORT MIS LANCETS OTC
SURE-LANCE MIS 26G OTC
SURE-LANCE MIS LANCETS OTC
SURE-TOUCH MIS UNV LANC OTC
SUREFLEX MIS LANCETS OTC
SURELITE MIS LANCETS OTC
TECHLITE AST MIS LANCETS OTC
TECHLITE MIS LANC 30G OTC
TECHLITE MIS LANCETS OTC
TGT LANCET MIS 26G OTC
TGT LANCET MIS 30G OTC
TGT LANCET MIS 33G OTC
THIN LANCETS MIS OTC
THIN LANCETS MIS 26G OTC
THIN LANCETS MIS 30G OTC
THINLETS GP MIS 26G OTC
TOPCARE MIS LANC 33G OTC
TRAVEL LANCE MIS 30G OTC
TRAVEL LANCE MIS ADV 28G OTC
TRUE COMFORT MIS LANC 30G OTC
TRUPLUS LANC MIS 26G OTC
TRUPLUS LANC MIS 28G OTC
TRUPLUS LANC MIS 30G OTC
TRUPLUS LANC MIS 33G OTC
ULTILET MIS 26G OTC
ULTILET MIS 28G OTC
ULTILET MIS 30G OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 169 AGE - Age Limit GNDR - Gender Edit
ULTILET MIS 33G OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 160 AGE - Age Limit GNDR - Gender Edit
ULTILET MIS LANCETS OTC
ULTILET MIS SAFETY OTC
ULTILET SAFE MIS 21G OTC
ULTRA THIN MIS 28G OTC
ULTRA THIN MIS 30G OTC
ULTRA THIN MIS 31G OTC
ULTRA THIN MIS 33G OTC
ULTRA THIN MIS LAN 31G OTC
ULTRA THIN MIS LANC 26G OTC
ULTRA THIN MIS LANC 28G OTC
ULTRA THIN MIS LANC 30G OTC
ULTRA THIN MIS LANCETS OTC
UNILET CMFR MIS TCH 28G OTC
UNILET CMFR MIS TCH 30G OTC
UNILET EX II MIS 28G OTC
UNILET EXCEL MIS 23G OTC
UNILET G.P MIS SUPR 23G OTC
UNILET G.P. MIS 21G OTC
UNILET GP 28 MIS ULT THIN OTC
UNILET LANC MIS 33G OTC
UNILET LANCE MIS 21G OTC
UNILET LANCE MIS 28G OTC
UNILET LANCE MIS 33G OTC
UNILET LANCT MIS 28G OTC
UNILET LANCT MIS 30G OTC
UNILET LANCT MIS 33G OTC
UNILET MICRO MIS 33G OTC
UNILET MIS 21G OTC
UNILET SUPER MIS 23G OTC
UNILET SUPER MIS G.P. 23G OTC
UNISTIK 3 MIS GENT 30G OTC
UNISTIK II MIS LANCETS OTC
UNISTIK PRO MIS LANC 21G OTC
UNISTIK PRO MIS LANC 28G OTC
UNISTIK SAFE MIS LANC 28G OTC
UNISTIK SAFE MIS LANC 30G OTC
UNISTIK TOUC MIS LANC 21G OTC
UNISTIK TOUC MIS LANC 23G OTC
UNISTIK TOUC MIS LANC 28G OTC
UNISTIK TOUC MIS LANC 30G OTC
UNITSTIK PRO MIS LANC 25G OTC
UNIVERSAL 1 MIS 33G OTC
UNIVERSAL 1 MIS LANC 26G OTC
UNIVERSAL 1 MIS LANC 30G OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 161 AGE - Age Limit GNDR - Gender Edit
VITALET PRO MIS OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 162 AGE - Age Limit GNDR - Gender Edit
VITALET PRO MIS PLUS OTC
BANDAGES-DRESSINGS-TAPE ACT BRIGHTS MIS BANDAGES OTC
ACT SPORT FM MIS 1-1/8"X3 OTC
ACT SPORT FM MIS ASSORTED OTC
ACT SPORT FM MIS KNEE/ELB OTC
ADH BANDAGE MIS ANTIBACT OTC
ADH BANDAGE MIS CLEAR OTC
ADH BANDAGE MIS FLEXIBLE OTC
ADH BANDAGE MIS FOAM OTC
ADH BANDAGE MIS FOAM TOE OTC
ADH BANDAGE MIS HEALTH OTC
ADH BANDAGE MIS HYPO-ALL OTC
ADH BANDAGE MIS PLASTIC OTC
ADH BANDAGE MIS RETENTIO OTC
ADH BANDAGE MIS SHEER OTC
ADH BANDAGE MIS STRONG OTC
ADH BANDAGE MIS WTR SHLD OTC
ADHESIVE KNT MIS 3"X5" OTC
ADHESIVE PAD MIS LARGE OTC
ADHESIVE PAD MIS MEDIUM OTC
ADV HEALING MIS BANDAGES OTC
ADVANC CURAD MIS AQUA-PRO OTC
ADVANC CURAD MIS BLISTER OTC
ADVANC CURAD MIS COOL-WRP OTC
ADVANC CURAD MIS SOF-GEL OTC
ANIMAL PRINT MIS STRIPS OTC
ANTI-BACTRIA MIS CHILD OTC
ANTIBAC BNDG MIS 7/8" OTC
ANTIBAC FABR MIS STRIPS OTC
ANTIBACTERAI MIS BANDAGES OTC
ANTIBACTERIA MIS BANDAGES OTC
ANTIBACTERIA MIS CLEAR OTC
BAND AID MED MIS BUTTRFLY OTC
BAND AID MIS 1" OTC
BAND AID MIS MICKEY OTC
BAND-AID CLR MIS 7/8"SPOT OTC
BAND-AID CLR MIS STRIPS OTC
BAND-AID FLX MIS OTC
BAND-AID FLX MIS 1" X 3" OTC
BAND-AID FLX MIS 1"X3" OTC
BAND-AID FLX MIS 3/4"X3" OTC
BAND-AID FLX MIS ASSORTED OTC
BAND-AID FLX MIS EXTRA LG OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 163 AGE - Age Limit GNDR - Gender Edit
BAND-AID FLX MIS FABRIC OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 164 AGE - Age Limit GNDR - Gender Edit
BAND-AID FLX MIS FINGRTIP OTC
BAND-AID FLX MIS KNUCKLE OTC
BAND-AID HYD MIS ALL-PURP OTC
BAND-AID HYD MIS BLS CUSH OTC
BAND-AID HYD MIS FINGERS OTC
BAND-AID HYD MIS LARGE OTC
BAND-AID HYD MIS X-LARGE OTC
BAND-AID LG MIS BUTTRFLY OTC
BAND-AID MIS OTC
BAND-AID MIS 3/4"X3" OTC
BAND-AID MIS FROZEN OTC
BAND-AID MIS GLOW-DRK OTC
BAND-AID MIS HL KITTY OTC
BAND-AID MIS HOT COLR OTC
BAND-AID MIS INCRED 2 OTC
BAND-AID MIS JUS LEAG OTC
BAND-AID MIS MEDICATE OTC
BAND-AID MIS POKEMON OTC
BAND-AID MIS PRINCESS OTC
BAND-AID MIS SHEER OTC
BAND-AID MIS SHEER CF OTC
BAND-AID MIS SPORT EX OTC
BAND-AID MIS STAR WAR OTC
BAND-AID MIS TOUGH OTC
BAND-AID MIS TOUGH WP OTC
BAND-AID MIS TOUGH XL OTC
BAND-AID MIS TOUGH-ST OTC
BAND-AID MIS VARIETY OTC
BAND-AID MIS WON WOM OTC
BAND-AID MIS WTER BLK OTC
BAND-AID MIS X-LG OTC
BAND-AID PAW MIS PATROL OTC
BANDAGE FABR MIS EX-LONG OTC
BANDAGE FABR MIS KNUC/FIN OTC
BANDAGES CLR MIS ASSORTED OTC
BANDAGES FAB MIS 3/4" OTC
BANDAGES FAB MIS ASSORTED OTC
BLISTER REL MIS BANDAGE OTC
BUTTERFLY MIS CLOSURES OTC
CARPALAID MIS EMPLOYEE OTC
CARPALAID MIS LARGE OTC
CARPALAID MIS PRA LG OTC
CARPALAID MIS PRAC SM OTC
CARPALAID MIS SMALL OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 165 AGE - Age Limit GNDR - Gender Edit
CLEAR BANDAG MIS 3/4" OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 166 AGE - Age Limit GNDR - Gender Edit
CLEAR SPOT MIS 7/8" OTC
CLEAR STRIPS MIS 3/4" OTC
COMFORT FAB MIS 3/4"X3" OTC
COMFORT FAB MIS ASSORTED OTC
COMFORT FAB MIS KNEE/ELB OTC
COVERLET MIS STRIPS OTC
CRAYON STRIP MIS BANDAGE OTC
CURAD 7/8" MIS ACTIFLEX OTC
CURAD ASSORT MIS ACTIFLEX OTC
CURAD COMFOR MIS .75X3" OTC
CURAD FAMILY MIS FLX ASST OTC
CURAD FLEX MIS ASSORTED OTC
CURAD KID SZ MIS DINOSAUR OTC
CURAD MIS GODZILLA OTC
CURAD MIS JURASSIC OTC
CURAD SENSIT MIS 3/4" OTC
CURAD SENSIT MIS ASSORTED OTC
CURAD SENSIT MIS EX LARGE OTC
CURAD SENSIT MIS SPOTS OTC
CURAD WILD MIS DESIGNIT OTC
CURAD WILD MIS TATTOO-U OTC
CURITY CURAD MIS 3/4 FABR OTC
CURITY CURAD MIS 3/4 PLAS OTC
CURITY CURAD MIS 3/4 SHEE OTC
CURITY CURAD MIS ASST FAB OTC
CURITY CURAD MIS PLASTIC OTC
CURITY CURAD MIS SHEER OTC
CVS ANTI-BAC MIS OTC
CVS ANTI-BAC MIS BANDAGE OTC
CVS FLEX FAB MIS BANDAG OTC
CVS PLASTIC MIS BANDAGE OTC
CVS SPOT BAN MIS SHEER OTC
EQ STRONG MIS STRIPS OTC
EQL BUTTERFL MIS CLOSURE OTC
EQL FIRST MIS AID BAND OTC
EQL FLEXIBLE MIS FABRIC OTC
EQL FLEXIBLE MIS FOAM OTC
EQL GENTLE MIS STRIPS OTC
EQL HVY DUTY MIS STRIPS OTC
EQL PLASTIC MIS STRIPS OTC
EQL SHEER MIS SPOTS OTC
EQL SHEER MIS STRIPS OTC
EQL STRIPS MIS OTC
FABRIC BANDG MIS ASSORTED OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 167 AGE - Age Limit GNDR - Gender Edit
FABRIC BANDG MIS FLEXIBLE OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 168 AGE - Age Limit GNDR - Gender Edit
FIRST AID MIS ANTIBACT OTC
FIRST AID MIS FLEX FAB OTC
FIRST AID MIS SHEER OTC
FLEX BANDAGE MIS OTC
GNP PLASTIC MIS 3/4" OTC
GNP SHEER MIS STRIPS OTC
GNP SHEER ST MIS ASSORTED OTC
GNP SUPER MIS STRIP OTC
GNTL ADHESVE MIS BNDG XL OTC
HEAVY DUTY MIS BANDAGES OTC
HEAVY DUTY MIS CLR&TGH OTC
HEAVY DUTY MIS FAB BAND OTC
HM BUTTERFLY MIS CLOSURES OTC
HYPO-ALLERG MIS BANDAGE OTC
LEUKOSTRIP MIS 1/2"X4" OTC
LEUKOSTRIP MIS 1/4"X3" OTC
LEUKOSTRIP MIS 1/4"X4" OTC
LEUKOSTRIP MIS 1/8X1.5" OTC
NEON STRIPS MIS 3/4 ASST OTC
NEXCARE TATT MIS BANDAGES OTC
NEXCARE WATR MIS PRF BAND OTC
PEANUTS MIS BANDAGES OTC
PLASTC BANDG MIS 3/4" OTC
PLASTIC MIS BANDAGES OTC
PROXI-STRIP MIS 1/4"X4" OTC
PROXI-STRIPS MIS 1/2"X4" OTC
QUIKSTIK ADH MIS BANDAGES OTC
RA ADH BANDG MIS EX-LARGE OTC
RA ADH PADS MIS 3"X4" OTC
RA ADHESIVE MIS 2-1/4X3" OTC
RA ADHESIVE MIS BANDAGES OTC
RA BANDAGES MIS 1"X3" OTC
ra bandages mis 3/4" OTC
RA BANDAGES MIS 3/4"X3" OTC
RA BANDAGES MIS ASSORTED OTC
RA BANDAGES MIS CLEAR OTC
RA BANDAGES MIS EX-LRG OTC
RA BUTTERFLY MIS BANDAGES OTC
SHEER ADHESI MIS 3/4"X3" OTC
SHEER BANDGE MIS OTC
SHEER BANDGE MIS 1" OTC
SHEER BANDGE MIS ASSORTED OTC
sheer bandge mis ex-large OTC
SHR BANDAGES MIS OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 169 AGE - Age Limit GNDR - Gender Edit
SHR BANDAGES MIS 3/4" OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 170 AGE - Age Limit GNDR - Gender Edit
SHR BANDAGES MIS ASSORTED OTC
SHR BANDAGES MIS EX-LARGE OTC
2ND SKIN CUT MIS CLOSURE OTC
2ND SKIN PAD MIS BLISTER OTC
SM BANDAGES MIS ANTIBACT OTC
SM BANDAGES MIS CLEAR OTC
SM BANDAGES MIS CLR SPOT OTC
SM BANDAGES MIS FAB 3/4" OTC
SM BANDAGES MIS FAB XL OTC
SM BANDAGES MIS FLEXIBLE OTC
SM BANDAGES MIS FOAM OTC
SM BANDAGES MIS FOAM XL OTC
SM BANDAGES MIS PLASTIC OTC
SM BANDAGES MIS SHEER OTC
SM BANDAGES MIS SHEER XL OTC
SM BANDAGES MIS STRNG ST OTC
SM BANDAGES MIS WTRSHELD OTC
SM KNUCKLE/ MIS FINGERTP OTC
SM STRONG MIS STRIPS OTC
SM STURDY MIS STRIP OTC
SOFT 'N FLEX MIS OTC
SORESPOT MIS BANDAGES OTC
STERI-STRIP MIS OTC
STERI-STRIP MIS 1" X 5" OTC
STERI-STRIP MIS 1/2"X2" OTC
STERI-STRIP MIS 1/2"X4" OTC
STERI-STRIP MIS 1/4"X1.5 OTC
STERI-STRIP MIS 1/4"X3" OTC
STERI-STRIP MIS 1/4"X4" OTC
STERI-STRIP MIS 1/8"X3" OTC
STRONG STRIP MIS BANDAGES OTC
STRONG STRIP MIS WATERPRF OTC
SUPER STRIP MIS 1"X3" OTC
SUPERSTRIP MIS 1" X 3" OTC
SURESEAL MIS EX LARGE OTC
SURESEAL MIS K OTC
SURESEAL MIS LARGE OTC
VARIETY PACK MIS BANDAGES OTC
WATERPROOF MIS BANDAGES OTC
WATERSHIELD MIS BANDAGES OTC
ADHESIVE PAD 2"X3" OTC
ADHESIVE PAD 3"X4" OTC
ADHESIVE PAD 4"X4" OTC
ADHESIVE PAD 6"X6" OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 171 AGE - Age Limit GNDR - Gender Edit
ADHESIVE PAD PAD 2.25"X3" OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 172 AGE - Age Limit GNDR - Gender Edit
ADHESIVE PAD PAD ANTIBACT OTC
BAND-AID PAD 2"X3" OTC
BAND-AID PAD 3"X4" OTC
BAND-AID PAD ADHESIVE OTC
BAND-AID PAD LARGE OTC
CURAD PAD 3"X4" OTC
EASY RELEASE PAD NONSTICK OTC
FIRST AID NO PAD STICK OTC
GNP ADHESIVE PAD 3" X 4" OTC
J & J ADHES PAD LARGE OTC
MOLESKIN PAD FOAM OTC
RA SHEER ADH PAD LARGE OTC
SM ADHESIVE PAD 2"X3" OTC
SM ADHESIVE PAD 3"X4" OTC
SOF-SET ADH PAD PATCH OTC
WATERPROOF PAD 3"X4" OTC
CONTRACEPTIVES CONDOMS MIS OTC, QL (12 boxes / 1 day)
LIFESTYLES MIS COLORS OTC, QL (12 boxes / 1 day)
LIFESTYLES MIS EXT STR OTC, QL (12 boxes / 1 day)
LIFESTYLES MIS FORM FIT OTC, QL (12 boxes / 1 day)
LIFESTYLES MIS LUBRICAT OTC, QL (12 boxes / 1 day)
LIFESTYLES MIS RIBBED OTC, QL (12 boxes / 1 day)
LIFESTYLES MIS SKYN OTC, QL (12 boxes / 1 day)
LIFESTYLES MIS SPERM/LU OTC, QL (12 boxes / 1 day)
LIFESTYLES MIS STUDDED OTC, QL (12 boxes / 1 day)
LIFESTYLES MIS ULT/SENS OTC, QL (12 boxes / 1 day)
LIFESTYLES MIS VIBRA-RI OTC, QL (12 boxes / 1 day)
LIFESTYLES MIS XPLEASUR OTC, QL (12 boxes / 1 day)
AIMSCO MIS LUBRICAT OTC, QL (12 boxes / 1 day)
COLOR CONDOM MIS + LUBE OTC, QL (12 boxes / 1 day)
CONDOMS MIS LUBRICAT OTC, QL (12 boxes / 1 day)
DUREX EXTRA MIS SENSITIV OTC, QL (12 each / 1 day)
FANTASY LUBR MIS OTC, QL (12 boxes / 1 day)
FANTASY LUBR MIS COLORS OTC, QL (12 boxes / 1 day)
FANTASY LUBR MIS SPERMICI OTC, QL (12 boxes / 1 day)
FANTASY MIS LUBRICAT OTC, QL (12 boxes / 1 day)
KAMELEON LUB MIS COLORS OTC, QL (12 boxes / 1 day)
KAMELEON MIS TRI-COLR OTC, QL (12 boxes / 1 day)
KIMONO COLOR MIS OTC, QL (12 each / 1 day)
KIMONO MICRO MIS THIN + OTC, QL (12 boxes / 1 day)
KIMONO MICRO MIS THIN PLS OTC, QL (12 each / 1 day)
KIMONO MIS LUBRICAT OTC, QL (12 boxes / 1 day)
KIMONO MIS LUBRICAT OTC, QL (12 each / 1 day)
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 173 AGE - Age Limit GNDR - Gender Edit
KIMONO MIS SENSATIO OTC, QL (12 boxes / 1 day)
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 174 AGE - Age Limit GNDR - Gender Edit
KIMONO MIS SENSATIO OTC, QL (12 each / 1 day)
KIMONO PLUS MIS LUBRICAT OTC, QL (12 boxes / 1 day)
KIMONO PLUS MIS LUBRICAT OTC, QL (12 each / 1 day)
KIMONO PLUS MIS SPERMICI OTC, QL (12 boxes / 1 day)
KIMONO PS MIS LUBRICAT OTC, QL (12 each / 1 day)
KIMONO PS MIS PLUS OTC, QL (12 each / 1 day)
KIMONO SENSA MIS PLUS OTC, QL (12 boxes / 1 day)
KIMONO SENSA MIS PLUS OTC, QL (12 each / 1 day)
KIMONO SPEC MIS OTC, QL (12 each / 1 day)
MAXX MIS LUBRICAT OTC, QL (12 boxes / 1 day)
MAXX MIS LUBRICAT OTC, QL (12 each / 1 day)
MAXX PLUS MIS SPERMICI OTC, QL (12 boxes / 1 day)
MAXX PLUS MIS SPERMICI OTC, QL (12 each / 1 day)
NATURAL COND MIS + LUBE OTC, QL (12 boxes / 1 day)
REALITY MIS LUBRICAT OTC, QL (12 boxes / 1 day)
REALITY ULTR MIS TEXTURED OTC, QL (12 each / 1 day)
REALITY ULTR MIS THIN OTC, QL (12 each / 1 day)
TRUSTEX LUBR MIS ASSORTED OTC, QL (12 boxes / 1 day)
TRUSTEX LUBR MIS BANANA OTC, QL (12 boxes / 1 day)
TRUSTEX LUBR MIS CHOC OTC, QL (12 boxes / 1 day)
TRUSTEX LUBR MIS COLA OTC, QL (12 boxes / 1 day)
TRUSTEX LUBR MIS COLORS OTC, QL (12 boxes / 1 day)
TRUSTEX LUBR MIS EX LARGE OTC, QL (12 boxes / 1 day)
TRUSTEX LUBR MIS EX STR OTC, QL (12 boxes / 1 day)
TRUSTEX LUBR MIS GRAPE OTC, QL (12 boxes / 1 day)
TRUSTEX LUBR MIS MINT OTC, QL (12 boxes / 1 day)
TRUSTEX LUBR MIS RIB/STUD OTC, QL (12 boxes / 1 day)
TRUSTEX LUBR MIS SPERMICI OTC, QL (12 boxes / 1 day)
TRUSTEX LUBR MIS STRWBRY OTC, QL (12 boxes / 1 day)
TRUSTEX LUBR MIS VANILLA OTC, QL (12 boxes / 1 day)
TRUSTEX/RIA MIS LUBRICAT OTC, QL (12 boxes / 1 day)
TRUSTEX/RIA MIS SPERMICI OTC, QL (12 boxes / 1 day)
TRUSTX NON-9 MIS RIB/STUD OTC, QL (12 boxes / 1 day)
KIMONO MICRO MIS THIN OTC, QL (12 boxes / 1 day)
KIMONO MICRO MIS THIN OTC, QL (12 each / 1 day)
TRUSTEX MIS BANANA OTC, QL (12 boxes / 1 day)
TRUSTEX MIS CHOCOLAT OTC, QL (12 boxes / 1 day)
TRUSTEX MIS FLAVORS OTC, QL (12 boxes / 1 day)
TRUSTEX MIS MINT OTC, QL (12 boxes / 1 day)
TRUSTEX MIS STRWBRY OTC, QL (12 boxes / 1 day)
TRUSTEX MIS VANILLA OTC, QL (12 boxes / 1 day)
TRUSTEX/RIA MIS NON-LUB OTC, QL (12 boxes / 1 day)
DUREX MIS REALFEEL OTC, QL (12 each / 1 day)
FC2 FEMALE MIS CONDOM OTC, QL (12 boxes / 1 day)
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 175 AGE - Age Limit GNDR - Gender Edit
FC FEMALE MIS CONDOM OTC, QL (12 boxes / 1 day)
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 168 AGE - Age Limit GNDR - Gender Edit
OMNIFLEX DPR QL (1 each / year)
MISC. DEVICES ALCOH-GLOVE PAD CONTOURE
ALCOHOL PAD OTC
ALCOHOL PAD 70% OTC
ALCOHOL PAD PREP OTC
ALCOHOL PAD SWABSTIC OTC
ALCOHOL PREP PAD OTC
ALCOHOL PREP PAD 70% OTC
ALCOHOL PREP PAD MED 70% OTC
ALCOHOL PREP PAD PADS 70% OTC
ALCOHOL SWAB PAD OTC
ALCOHOL SWAB PAD 70% OTC
ALCOHOL SWAB PAD EX-THICK OTC
ALCOHOL WIPE PAD OTC
APLICARE ALC PAD SWABSTIC OTC
BD SWAB BFLY PAD SNGL USE OTC
BD SWAB REG PAD SNGL USE OTC
CARETOUCH PAD ALCOHOL OTC
CURITY PREP PAD ALCOHOL OTC
CURITY SWABS PAD ALCOHOL OTC
FIFTY50 PREP PAD PADS OTC
GLOBAL PREP PAD PADS OTC
GNP ALCOHOL PAD SWABS OTC
HM STERILE PAD ALCHOL OTC
INCONTROL PAD ALCOHOL OTC
PREP PADS PAD OTC
PRO COMFORT PAD ALCOHOL OTC
QC ALCOHOL PAD SWABS OTC
RA ALCOHOL PAD SWABS OTC
REALITY SWAB PAD OTC
SAPS CARE PAD ALCOHOL OTC
SAPS HEALTH PAD ALCOHOL OTC
SB ALCOHOL PAD PREP OTC
SM ALCOHOL PAD PREP OTC
ULTICARE PAD ALCOHOL OTC
ULTILET PAD ALCOHOL OTC
WEBCOL PREP PAD LARGE OTC
WEBCOL PREP PAD MEDIUM OTC ALCOH-WIPE MIS 12"X12"
PHARMACEUTICAL ADJUVANTS ANTIMICROBIAL AGENTS
BENZYL ALC LIQ
BENZYL ALC LIQ OTC
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 169 AGE - Age Limit GNDR - Gender Edit
LIQUID VEHICLES glycine diluent for injection water for injection water for iv injection
water for inject, bacteriostatic benzyl alcohol
BACTER WATER INJ PARABENS
saline injection bacteriostatic
NACL/BACT INJ 0.9%BENZ SALINE/PHENO SOL
MISCELLANEOUS THERAPEUTIC CLASSES IMMUNOMODULATORS
REVLIMID CAP 2.5MG SP, QL (1 cap / 1 day), PA REVLIMID CAP 5MG SP, QL (1 cap / 1 day), PA
REVLIMID CAP 10MG SP, QL (1 cap / 1 day), PA
REVLIMID CAP 15MG SP, QL (1 cap / 1 day), PA
REVLIMID CAP 20MG SP, QL (1 cap / 1 day), PA
REVLIMID CAP 25MG SP, QL (1 cap / 1 day), PA
IMMUNOSUPPRESSIVE AGENTS cyclosporine cap 25 mg cyclosporine cap 100 mg SANDIMMUNE SOL 100MG/ML cyclosporine modified cap 25 mg
gengraf cap 25mg cyclosporine modified cap 50 mg
cyclosporine modified cap 100 mg gengraf cap 100mg cyclosporine modified oral soln 100 mg/ml gengraf sol 100mg/ml mycophenolate mofetil cap 250 mg mycophenolate mofetil tab 500 mg mycophenolate mofetil for oral susp 200 mg/ml sirolimus tab 0.5 mg sirolimus tab 1 mg sirolimus tab 2 mg sirolimus oral soln 1 mg/ml tacrolimus cap 0.5 mg tacrolimus cap 1 mg tacrolimus cap 5 mg azathioprine tab 50 mg AZASAN TAB 75 MG AZASAN TAB 100MG
POTASSIUM REMOVING AGENTS kionex sus 15gm/60 sodium polystyrene sulfonate oral susp 15
gm/60ml
Drug Name Requirements/Limits
PA - Prior Authorization OTC - Over the counter
QL - Quantity Limits ST - Step Therapy SP - Specialty 170 AGE - Age Limit GNDR - Gender Edit
sps sus 15gm/60
sodium polystyrene sulfonate rectal susp 30 gm/120ml
171
Index 1 12hr deconge tab 120mg cr ............... 41 1ST TIER UNI MIS 31GX5MM ........... 145 1ST TIER UNI MIS 31GX8MM ........... 146 1ST TIER UNI MIS 32GX4MM ........... 147 2 24 hr nasal spr allergy ...................... 41 24hr allergy tab 180mg ..................... 39 2ND SKIN CUT MIS CLOSURE .......... 165 2ND SKIN PAD MIS BLISTER ............ 165 3 3 day vaginl cre 2% .......................... 68 3 day vagnal cre 4% ......................... 68 3-in-1 clean liq 5% ......................... 133 5 50+ adult cap eye hlth ...................... 94 8 8 hour pain tab 650mg ...................... 74 8hr pain er tab 650mg ...................... 74 A a thru z adv tab adult ....................... 96 a thru z chw select ......................... 106 a thru z sel tab 50+ adva .................. 96 a thru z sel tab 50+ mens ................. 96 a thru z sel tab advanced .................. 96 a thru z tab advanced ....................... 96 a thru z tab advantag...................... 113 a thru z tab high pot ......................... 96 a thru z tab select ............................ 96 a thru z tab ultimate ......................... 96 a thru z ult tab mens ........................ 96 A+D DIAPER CRE RASH................... 141 a+d prevent oin ............................. 141 abatinex cap 680mg ......................... 57 abc plus tab ..................................... 96 abc plus tab senior ........................... 96 ABDEK CAP ...................................... 94 abdek chw ..................................... 110 abdek pediat dro ............................ 111 abiraterone acetate tab 250 mg ......... 10 ABREVA CRE 10% .......................... 138 acarbose tab 100 mg ........................ 21 acarbose tab 25 mg .......................... 21 acarbose tab 50 mg .......................... 21 ACCU-CHEK MIS MLTICLIX .............. 153 ACE AERO CLD MIS ENHANCER ........ 147
acephen sup 120mg ......................... 75 acephen sup 325mg ......................... 76 acephen sup 650mg ......................... 76 acetamin liq 500/15ml ...................... 75 acetamin tab 500mg ......................... 74 acetaminophe chw 160mg ................. 75 acetaminophe tab 160mg .................. 76 acetaminophen chew tab 160 mg ....... 75 acetaminophen elixir 160 mg/5ml ...... 75 acetaminophen liquid 160 mg/5ml ...... 75 acetaminophen soln 160 mg/5ml........ 75 acetaminophen suppos 120 mg .......... 75 acetaminophen suppos 650 mg .......... 76 acetaminophen tab 325 mg ............... 73 acetaminophen tab 500 mg ............... 74 acetaminophen tab er 650 mg ........... 74 acetaminophen w/ codeine soln 120-12 mg/5ml........................................... 78 acetaminophen w/ codeine tab 300-15 mg ................................................. 78 acetaminophen w/ codeine tab 300-30 mg ................................................. 78 acetaminophen w/ codeine tab 300-60 mg ................................................. 78 acetaminophn sus 160/5ml................ 75 acetaminophn tab 325mg .................. 73 acetaminophn tab 500mg .................. 74 acetazolamide cap er 12hr 500 mg ..... 32 acetazolamide tab 125 mg................. 32 acetazolamide tab 250 mg ................. 32 acetic acid otic soln 2% ................... 131 acetic acid vaginal solution ................ 68 acid control tab 10mg ....................... 62 acid control tab 150mg ..................... 62 acid control tab 20mg ....................... 63 acid gone chw .................................. 59 acid gone sus................................... 59 acid reducer cap 20.6mgdr ................ 63 acid reducer tab 10mg ...................... 62 acid reducer tab 150mg .................... 62 acid reducer tab 200mg .................... 62 acid reducer tab 20mg ...................... 63 acid reducer tab 75mg ...................... 62 acidoph/prob tab formula .................. 57 ACIDOPH/PROB TAB FORMULA........... 57 acidophilus cap 100mg...................... 57
172
acidophilus cap 10mg ....................... 57 acidophilus cap ex st ......................... 57 acidophilus tab probiotc .................... 57 acidophilus waf ................................ 57 ACIDOPHILUS/ WAF BIFIDUS ............. 57 acne control cre clns 10%................ 133 acne foaming liq wash 10% ............. 133 acne max str cre 10% ..................... 133 acne medicat gel 10% ..................... 134 acne medicat gel 5% ...................... 133 acne treat cre 10% ......................... 133 acne treatme cre 10% .................... 133 acne treatmn gel 10% .................... 134 acne-clear gel 10% ......................... 134 ACT BRIGHTS MIS BANDAGES ......... 161 ACT SPORT FM MIS 1-1/8 ................ 161 ACT SPORT FM MIS ASSORTED ........ 161 ACT SPORT FM MIS KNEE/ELB .......... 161 actical cap ....................................... 94 ACTIFLOVIT TAB EAR HEAL .............. 115 ACTI-LANCE MIS 28G ..................... 153 ACTI-LANCE MIS LITE 28G .............. 153 ACTI-LANCE MIS SPEC 17G ............. 153 ACTI-LANCE MIS UNIV 23G ............. 153 ACTITROM CAP ................................ 91 ACTITROM-D CAP ............................. 91 ACTIVE 55 LIQ PLUS ....................... 107 ACTIVESSENT PAK.......................... 107 ACTIVITE EC TAB ........................... 109 ACTIVITY PCH MIS ......................... 147 ACTIVNUTRIEN CAP .......................... 94 acyclovir cap 200 mg ......................... 7 acyclovir susp 200 mg/5ml ................. 7 acyclovir tab 400 mg ......................... 7 acyclovir tab 800 mg ......................... 7 addaprin tab 200mg ......................... 79 adefovir dipivoxil tab 10 mg ................ 7 ADH BANDAGE MIS ANTIBACT ......... 161 ADH BANDAGE MIS CLEAR .............. 161 ADH BANDAGE MIS FLEXIBLE .......... 161 ADH BANDAGE MIS FOAM ............... 161 ADH BANDAGE MIS FOAM TOE ......... 161 ADH BANDAGE MIS HEALTH ............ 161 ADH BANDAGE MIS HYPO-ALL.......... 161 ADH BANDAGE MIS PLASTIC ............ 161 ADH BANDAGE MIS RETENTIO ......... 161 ADH BANDAGE MIS SHEER .............. 161
ADH BANDAGE MIS STRONG ........... 161 ADH BANDAGE MIS WTR SHLD ........ 161 ADHESIVE KNT MIS 3 ..................... 161 ADHESIVE PAD 2 ........................... 165 ADHESIVE PAD 3 ........................... 165 ADHESIVE PAD 4 ........................... 165 ADHESIVE PAD 6 ........................... 165 ADHESIVE PAD MIS LARGE .............. 161 ADHESIVE PAD MIS MEDIUM ........... 161 ADHESIVE PAD PAD 2.25 ................ 165 ADHESIVE PAD PAD ANTIBACT ........ 166 adlt multivi chw gummies ................ 106 ADLT ONE DLY CHW GUMMIES ......... 106 ADMELOG INJ 100U/ML ..................... 19 ADMELOG SOLO INJ 100U/ML ............ 19 ADRENAL TAB CALM ....................... 113 ADRENOID CAP .............................. 112 ADULT 50+ CAP OCUVITE ................. 94 adult gummy chw ........................... 106 ADULT MASK MIS ........................... 147 ADULT MASK MIS LARGE ................ 147 ADV COLLAGEN TAB ....................... 113 ADV DIABETIC TAB MULTIVIT ............ 96 ADV HEALING MIS BANDAGES ......... 161 ADV TRAVEL MIS LANC 28G............. 153 ADVANC CURAD MIS AQUA-PRO ...... 161 ADVANC CURAD MIS BLISTER ......... 161 ADVANC CURAD MIS COOL-WRP ...... 161 ADVANC CURAD MIS SOF-GEL ......... 161 ADVANCED C TAB PLUS .................... 91 advanced chw multi ea.................... 106 advanced eye cap health ................... 94 advanced sus antacid ....................... 60 advanced tab formula ....................... 96 ADVCATE SAFE MIS LANC 26G ......... 153 advil jr st tab 100mg ........................ 79 advil jr str chw 100mg ...................... 79 ADVOCATE MIS LANC 30G............... 153 ADVOCATE MIS LANCETS ................ 153 AERCHMBR PLS MIS FLOW-VU ......... 148 AERCHMBR PLS MIS LRG MASK ........ 148 AERCHMBR PLS MIS MED MASK ....... 148 AERCHMBR PLS MIS SM MASK ......... 148 AERCHMBR Z- MIS STAT PLS ........... 148 AEROCHAMBER MIS CHAMBER......... 148 AEROCHAMBER MIS FLOSIGNA ........ 148 AEROCHAMBER MIS MV .................. 148
173
AEROCHAMBER MIS PLUS................ 148 AEROECLIPSE MIS II NEB ................ 150 AERONEB GO MIS........................... 150 AERONEB GO MIS COMPLETE ........... 150 AERONEB GO MIS HAND/CBL ........... 150 AERONEB GO MIS HANDSET ............ 150 AEROSOL MASK MIS ADULT ............. 147 AEROTRC PLUS MIS ........................ 147 AEROVENT MIS PLUS ...................... 148 af spry powd aer 1% ....................... 136 AFINITOR TAB 10MG ......................... 11 AFINITOR TAB 2.5MG ........................ 11 AFINITOR TAB 5MG .......................... 11 AFINITOR TAB 7.5MG ....................... 11 afrin saline spr 0.65% ....................... 42 aftera tab 1.5mg .............................. 15 AGAMATRIX MIS 33G ...................... 153 AGORAL LIQ MAX ST ......................... 53 AIMSCO MIS LUBRICAT ................... 166 AIR TUBE MIS /PLUGS ..................... 147 airavite tab .................................... 126 airborne chw .................................. 106 airborne chw gummies .................... 106 airborne chw immune ..................... 106 AIRBORNE LOZ .............................. 108 AIRIAL COMP MIS COMPRESS .......... 150 AIRIAL MIS COMPACT ..................... 150 AIRIAL MIS VOYAGER ..................... 150 AIRIAL PEDIA MIS BUILDING ........... 150 AIRIAL PEDIA MIS DUCK ................. 150 AIRIAL PEDIA MIS FIRE ENG ............ 150 AIRIAL PEDIA MIS PANDA ............... 150 AIRIAL PEDIA MIS PENGUIN ............ 150 AIRS DISPOSA MIS NEBULIZR ......... 150 AIRS PEDIATR MIS MASK ................ 147 AIRSHIELD CHW IMMUNITY ............. 106 ak-poly-bac oin op .......................... 128 akwa tears oin op ........................... 129 al12 lot 12% .................................. 141 ala-cort cre 1% .............................. 139 ala-cort cre 2.5% ........................... 139 alavert alrg tab /sinus ....................... 45 alavert tab 10mg .............................. 40 alaway child dro 0.025%op .............. 131 alaway dro 0.025%op ..................... 131 albuterol sulfate inhal aero 108 mcg/act (90mcg base equiv) .......................... 49
albuterol sulfate soln nebu 0.083% (2.5 mg/3ml) ......................................... 49 albuterol sulfate soln nebu 0.5% (5 mg/ml) ........................................... 49 albuterol sulfate soln nebu 0.63 mg/3ml (base equiv) .................................... 49 albuterol sulfate soln nebu 1.25 mg/3ml (base equiv) .................................... 49 albuterol sulfate syrup 2 mg/5ml ........ 49 albuterol sulfate tab 2 mg ................. 48 albuterol sulfate tab 4 mg ................. 48 albuterol sulfate tab er 12hr 4 mg ...... 49 albuterol sulfate tab er 12hr 8 mg ...... 49 alclometasone dipropionate cream 0.05% .................................................... 138 alclometasone dipropionate oint 0.05% .................................................... 138 ALCOH-GLOVE PAD CONTOURE ........ 168 ALCOHOL PAD ............................... 168 ALCOHOL PAD 70% ........................ 168 ALCOHOL PAD PREP ....................... 168 ALCOHOL PAD SWABSTIC ............... 168 ALCOHOL PREP PAD........................ 168 ALCOHOL PREP PAD 70% ................ 168 ALCOHOL PREP PAD MED 70% ......... 168 ALCOHOL PREP PAD PADS 70%........ 168 ALCOHOL SWAB PAD ...................... 168 ALCOHOL SWAB PAD 70% ............... 168 ALCOHOL SWAB PAD EX-THICK ....... 168 ALCOHOL WIPE PAD ....................... 168 ALCOH-WIPE MIS 12 ...................... 168 ALDACTAZIDE TAB 50/50 .................. 33 alendronate sodium tab 10 mg ........... 23 alendronate sodium tab 35 mg ........... 23 alendronate sodium tab 40 mg ........... 23 alendronate sodium tab 5 mg ............ 23 alendronate sodium tab 70 mg ........... 23 aler-cap cap 25mg ........................... 36 ALER-DRYL TAB 50MG ...................... 37 alertab tab 25mg ............................. 37 alfuzosin hcl tab er 24hr 10 mg .......... 69 ALIVE 50+ TAB ENERGY .................... 96 ALIVE 50+ TAB WOMENS .................. 96 ALIVE DAILY TAB WOMENS................ 96 ALIVE ENERGY TAB MENS.................. 96 ALIVE ENERGY TAB WOMENS............. 96 alive gummie chw children .............. 110
174
alive multi chw childrns ................... 111 ALIVE WOMENS CHW GUMMY .......... 106 all day allg cap 10mg ........................ 38 all day allg sol 1mg/ml ...................... 39 all day allg sol 5mg/5ml .................... 39 all day allg tab 10mg ........................ 38 all day alrg tab 5-120mg ................... 44 all day pain tab 220mg...................... 80 all day relf tab 220mg ....................... 80 ALL PURPOSE MIS MASK ................. 152 allbee plus tab vit c ........................... 88 all-day allg sol 5mg/5ml .................... 39 ALLEGRA ALRG TAB 30MG ................. 39 aller/conges tab 10-240mg ................ 45 aller-chlor tab 4mg ........................... 35 allerclear d tab 10-240mg ................. 45 allerclear d tab 5-120mg ................... 45 allerclear tab 10mg ........................... 40 aller-ease tab 180mg ........................ 39 aller-ease tab 60mg .......................... 39 aller-fex tab 180mg .......................... 39 aller-flo spr 50mcg ........................... 41 allergy 24hr tab 10mg....................... 38 allergy cap 25mg .............................. 36 allergy chld liq 12.5/5ml .................... 37 allergy chld sol 1mg/ml ..................... 39 allergy chld syp 5mg/5ml .................. 40 allergy d tab 5-120mg ...................... 44 allergy d tab 60-120mg ..................... 45 allergy eye dro 0.025%op ............... 131 allergy liq 12.5/5ml .......................... 37 allergy med cap 25mg....................... 36 allergy med liq 12.5/5ml ................... 37 allergy med tab 25mg ....................... 37 allergy nasa spr 24hr ........................ 41 allergy nasa spr 50mcg ..................... 41 allergy rel cap 25mg ......................... 36 allergy rel elx 12.5/5ml ..................... 38 allergy rel sol 1mg/ml ....................... 39 allergy rel tab 10mg ......................... 38 allergy rel tab 25mg ......................... 37 allergy rel/ tab deconges ................... 45 allergy relf cap 10mg ........................ 38 allergy relf cap 25mg ........................ 36 allergy relf chw 10mg ....................... 39 allergy relf liq 12.5/5ml ..................... 37 allergy relf liq 50/20ml ...................... 37
allergy relf sol 5mg/5ml .................... 39 allergy relf spr 50mcg ....................... 41 allergy relf syp 5mg/5ml ................... 40 allergy relf tab /nsl dec ..................... 45 allergy relf tab 1.34mg...................... 36 allergy relf tab 10mg ...................38, 40 allergy relf tab 12mg cr ..................... 36 allergy relf tab 180mg ....................... 39 allergy relf tab 25mg ........................ 37 allergy relf tab 4mg .......................... 35 allergy relf tab 5-120mg ..............44, 45 allergy relf tab 60mg ........................ 39 allergy relf tab d............................... 45 allergy relf tab d 24 hr ...................... 45 allergy relf tab d12 ........................... 45 allergy relf tab d-24 .......................... 45 allergy relf tab deconges ................... 45 ALLERGY RLF CHW 5MG .................... 40 allergy rlf sus 30/5ml ........................ 39 allergy rlf tab 10mg .....................38, 40 allergy tab 10mg .............................. 40 allergy tab 12mg cr .......................... 36 allergy tab 180mg ............................ 39 allergy tab 25mg .............................. 37 allergy tab 4mg ................................ 35 allergy/cong tab 5-120mg ................. 45 allergy+ con tab 5-120mg ................. 44 allergy+cong tab relief-d ................... 45 allergy-d tab 12 hour ........................ 45 allergy-d tab 5-120mg ...................... 44 allergy-d tab 60-120mg .................... 45 allergy-time tab 4mg ........................ 35 aller-tec d tab 5-120mg .................... 44 aller-tec sol 1mg/ml ......................... 39 aller-tec tab 10mg ............................ 38 ALLERWELL TAB ALLERGY ............... 113 allgy comp-d tab 5-120mg ................ 44 ALL-IN-ONE MIS NEBULIZR ............. 150 allopurinol tab 100 mg ...................... 82 allopurinol tab 300 mg ...................... 82 allrgy melts tab 12.5mg .................... 38 allrgy rel d tab 10-240mg .................. 45 allrgy relf tab 12.5mg ....................... 38 allrgy relf tab 5-120mg ..................... 44 allrgy rlf-d tab 10-240mg .................. 45 allrgy rlf-d tab 5-120mg .................... 45 almacone dbl sus strength ................. 60
175
almacone sus ................................... 59 ALMOND OIL .................................. 144 ALMOND OIL SWEET ....................... 144 alophen tab 5mg ec .......................... 51 altalube oin .................................... 129 altamist spr 0.65% ........................... 42 altarussin syp 100/5ml ...................... 43 altarussin syp -pe ............................. 46 altarussn dm syp 100-10/5 ................ 48 altavera tab ..................................... 17 ALTERA MIS NEBULIZE .................... 150 ALTERA NEB MIS HANDSET .............. 147 alum & mag hydroxide-simethicone susp 200-200-20 mg/5ml ......................... 59 alyacen tab 1/35 .............................. 17 alyacen tab 7/7/7 ............................. 18 amabelz tab 0.5-0.1.......................... 14 amabelz tab 1-0.5mg ........................ 14 amantadine hcl cap 100 mg ............... 83 amantadine hcl syrup 50 mg/5ml........ 83 amantadine hcl tab 100 mg................ 83 amethia tab ..................................... 19 AMIKACIN POW SULFATE ................... 5 amiloride & hydrochlorothiazide tab 5-50 mg ................................................. 33 amiloride hcl tab 5 mg ....................... 32 aminofen tab 325mg ......................... 73 aminofen tab 500mg ......................... 74 AMINOSAL ACD POW -4 ..................... 6 amiodarone hcl tab 200 mg ............... 29 amlactin lot 12% ............................ 141 amlodipine besylate tab 10 mg (base equivalent) ...................................... 27 amlodipine besylate tab 2.5 mg (base equivalent) ...................................... 27 amlodipine besylate tab 5 mg (base equivalent) ...................................... 27 amlodipine besylate-benazepril hcl cap 10-20 mg ........................................ 31 amlodipine besylate-benazepril hcl cap 10-40 mg ........................................ 31 amlodipine besylate-benazepril hcl cap 2.5-10 mg ....................................... 31 amlodipine besylate-benazepril hcl cap 5-10 mg .......................................... 31 amlodipine besylate-benazepril hcl cap 5-20 mg .......................................... 31
amlodipine besylate-benazepril hcl cap 5-40 mg .......................................... 31 amnesteem cap 10mg..................... 134 amnesteem cap 20mg..................... 134 amnesteem cap 40mg..................... 134 amoryn mood cap booster ................. 94 amoxicillin & k clavulanate chew tab 200-28.5 mg ..................................... 3 amoxicillin & k clavulanate chew tab 400-57 mg ........................................ 3 amoxicillin & k clavulanate for susp 200-28.5 mg/5ml ............................... 3 amoxicillin & k clavulanate for susp 250-62.5 mg/5ml ............................... 3 amoxicillin & k clavulanate for susp 400-57 mg/5ml.................................. 3 amoxicillin & k clavulanate for susp 600-42.9 mg/5ml ............................... 3 amoxicillin & k clavulanate tab 250-125 mg ................................................... 3 amoxicillin & k clavulanate tab 500-125 mg ................................................... 3 amoxicillin & k clavulanate tab 875-125 mg ................................................... 3 amoxicillin (trihydrate) cap 250 mg ...... 3 amoxicillin (trihydrate) cap 500 mg ...... 3 amoxicillin (trihydrate) chew tab 125 mg ........................................................ 3 amoxicillin (trihydrate) chew tab 250 mg ........................................................ 3 amoxicillin (trihydrate) for susp 125 mg/5ml............................................. 3 amoxicillin (trihydrate) for susp 200 mg/5ml............................................. 3 amoxicillin (trihydrate) for susp 250 mg/5ml............................................. 3 amoxicillin (trihydrate) for susp 400 mg/5ml............................................. 3 amoxicillin (trihydrate) tab 500 mg ....... 3 amoxicillin (trihydrate) tab 875 mg ....... 3 AMOXICILLIN POW TRIHYDRA.............. 3 AMPHOTERICIN POW B ................... 132 ampicillin cap 500 mg ......................... 3 anagrelide hcl cap 0.5 mg ............... 127 anagrelide hcl cap 1 mg .................. 127 anastrozole tab 1 mg ........................ 10 animal chews chw .......................... 109
176
ANIMAL PRINT MIS STRIPS .............. 161 animal shape chw ........................... 109 animal shape chw /iron ................... 111 animal shape chw complete ............. 111 animal shape chw iron .................... 112 ANIMAL SHAPE CHW IRON .............. 112 ANORO ELLIPT AER 62.5-25 .............. 49 antacid adv sus max st ..................... 60 antacid chw 1000mg ......................... 59 ANTACID CHW 1177MG ..................... 59 antacid chw 500mg .......................... 58 antacid chw 550-110 ........................ 59 antacid chw 750mg .......................... 58 antacid extr chw 750mg .................... 58 antacid fast sus acting ...................... 59 antacid fast sus relief ........................ 60 antacid flav chw 750mg .................... 58 antacid i sus .................................... 60 antacid iii sus ................................... 60 antacid kids chw 750mg .................... 58 antacid liq sus .................................. 60 antacid m sus .................................. 60 antacid max chw 1000mg .................. 59 antacid max sus anti-gas ................... 60 antacid plus sus anti-gas ................... 61 antacid plus sus gas rel ............... 60, 61 ANTACID SOFT CHW 1177MG ............ 59 antacid sus ................................ 60, 61 antacid sus advanced ........................ 61 antacid sus anti-gas .................... 60, 61 antacid sus ex st .............................. 61 antacid sus max st ........................... 61 antacid sus mint crm ........................ 60 antacid sus reg ................................ 60 antacid sus reg st ............................. 60 antacid/gas sus rel max .................... 61 antacid/sime sus ds .......................... 61 anti-allergy tab ................................ 91 ANTIBAC BNDG MIS 7/8 .................. 161 ANTIBAC FABR MIS STRIPS ............. 161 ANTIBACTERAI MIS BANDAGES ........ 161 ANTIBACTERIA MIS BANDAGES ........ 161 ANTIBACTERIA MIS CLEAR .............. 161 ANTI-BACTRIA MIS CHILD ............... 161 antibiotic oin .................................. 135 anti-dandruf sha 1% ....................... 137 anti-diarrhe cap 2mg ........................ 55
anti-diarrhe liq 1mg/5ml ................... 56 anti-diarrhe tab 2mg ........................ 55 anti-diarrhl sus 262/15ml .................. 56 antifung pow aer 1% ...................... 136 antifungal cre 1%........................... 136 anti-fungal cre 1% ......................... 136 antifungal cre 2%........................... 137 antifungal cre foot .......................... 136 antifungal pow 2% ......................... 137 anti-fungal pow 2% ........................ 137 anti-fungal sol 1% .......................... 136 anti-gas cap 180mg .......................... 65 anti-hist tab 25mg ............................ 37 antihistamin cap 25mg ..................... 36 antihistamin dro 0.025%op ............. 131 anti-itch cre /aloe/e ........................ 139 anti-itch cre /oatmeal ..................... 139 anti-itch cre 1% ............................. 139 anti-itch cre 1%pls 10 .................... 139 anti-itch lot 1% .............................. 139 anti-itch oin 1% ............................. 140 antiox form/ cap minerals.................. 94 antioxidant cap ................................ 94 antioxidant cap formula .................... 92 anti-oxidant cap formula ................... 94 antioxidant tab ................................ 96 anti-oxidant tab ............................... 92 ANTIOXIDANT TAB FORTE ................. 97 antioxidant tab protecti ..................... 97 antioxidant tab vitamins.................... 97 antioxin cap 4000 ............................. 94 antiseptic sol clnsr 4% .................... 142 antiseptic sol skin cln ...................... 142 ap povid-iod sol 10% ...................... 142 apap melt tab 80mg ......................... 76 apap melts tab 160mg ...................... 76 apap rapid tab tab 80mg ................... 76 APETEX ELX ..................................... 88 APETIGEN ELX ................................. 88 APETIGEN TAB PLUS ......................... 91 APETIGEN-PLS SOL .......................... 91 APLICARE ALC PAD SWABSTIC ........ 168 apra elx 160/5ml .............................. 75 aprepitant capsule 125 mg ................ 64 aprepitant capsule 40 mg .................. 64 aprepitant capsule 80 mg .................. 64 aprepitant capsule therapy pack 80 &
177
125 mg ........................................... 64 apri tab ........................................... 16 APRISO CAP 0.375GM ....................... 66 AQUADEKS CHW ............................ 106 aquadeks dro ................................. 111 AQUALANCE MIS 30G ..................... 153 aquanil hc lot 1% ........................... 139 aranelle tab ..................................... 18 ARANESP INJ 100MCG ..................... 125 ARANESP INJ 150MCG .................... 125 ARANESP INJ 200MCG .................... 125 ARANESP INJ 25MCG ...................... 125 ARANESP INJ 300MCG .................... 125 ARANESP INJ 40MCG ...................... 125 ARANESP INJ 500MCG .................... 125 ARANESP INJ 60MCG ...................... 125 ARIAL MIS CHAMBER ...................... 149 ARNUITY ELPT INH 100MCG ............... 50 ARNUITY ELPT INH 200MCG ............... 50 arthrts pain tab 650mg...................... 74 artifi tears dro 1-0.3% .................... 129 artifi tears oin op ............................ 130 artifi tears sol 1.4% op .................... 128 artificial dro tears ........................... 130 artificial sol tears .................... 129, 130 artificial sol tears op ........................ 128 a-s pls alrg tab 25mg ........................ 37 asa free chw 160mg jr ...................... 75 ASCOCID-1000 TAB .......................... 92 ASCOCID-500 TAB............................ 92 ashlyna tab ...................................... 19 aspir-81 tab 81mg ec ........................ 72 aspirin adlt tab 81mg ........................ 72 aspirin chld chw 81mg ...................... 72 aspirin chw 81mg ............................. 72 aspirin free tab 325mg ...................... 73 aspirin low chw 81mg ........................ 72 aspirin low tab 81mg ec..................... 72 aspirin sup 300mg ............................ 73 aspirin sup 600mg ............................ 73 aspirin tab 325 mg ........................... 71 aspirin tab 325mg ec ........................ 73 aspirin tab 81mg ec .......................... 72 aspirin tab delayed release 325 mg ..... 73 aspirin tab delayed release 81 mg ....... 72 aspirin-81 chw 81mg ........................ 72 aspir-low tab 81mg ec ....................... 72
aspirtab m/s tab 500mg.................... 72 aspirtab tab 324mg ec ...................... 73 ASSURE CMFRT MIS 28G ................ 153 ASSURE ID MIS 31GX3/16 .............. 145 ASSURE LANCE MIS 21G ................. 153 ASSURE LANCE MIS LOW FLOW ....... 153 ASSURE LANCE MIS MICRO ............. 153 ASSURE LANCE MIS SAFE 25G ......... 153 ASSURE LANCE MIS SAFE 30G ......... 153 ASSURE MIS LANCETS .................... 153 ASSURE PLUS MIS HIGH 18G .......... 153 ASSURE PLUS MIS LOW 25G ........... 153 ASSURE PLUS MIS MCRO 28G.......... 153 ASSURE PLUS MIS NORM 21G ......... 153 ASSURE PLUS MIS PEDIATRI ........... 153 atenolol & chlorthalidone tab 100-25 mg ...................................................... 31 atenolol & chlorthalidone tab 50-25 mg ...................................................... 31 atenolol tab 100 mg ......................... 26 atenolol tab 25 mg ........................... 26 atenolol tab 50 mg ........................... 26 athlete foot aer 1% ........................ 136 athlete foot cre 1% ........................ 136 athlete foot pow 2% ....................... 137 athletes ft aer 1% pow .................... 136 atorvastatin calcium tab 10 mg (base equivalent) ...................................... 34 atorvastatin calcium tab 20 mg (base equivalent) ...................................... 34 atorvastatin calcium tab 40 mg (base equivalent) ...................................... 34 atorvastatin calcium tab 80 mg (base equivalent) ...................................... 34 atovaquone susp 750 mg/5ml .............. 9 atovaquone-proguanil hcl tab 250-100 mg ................................................... 8 atovaquone-proguanil hcl tab 62.5-25 mg ................................................... 8 AUBAGIO TAB 14MG ......................... 71 AUBAGIO TAB 7MG ........................... 71 aubra eq tab 0.1-0.02 ....................... 16 aubra tab 0.1-0.02 ........................... 16 AUGMENTIN SUS 125/5ML .................. 3 auraphene-b sol 6.5% ot ................ 131 AURORA LANCE MIS 30G ................ 153 AURORA LANCE MIS THIN 23G ........ 153
178
AUTO LANCET MIS .......................... 153 aveeno cre 1% ............................... 139 aviane tab ....................................... 16 avita cre 0.025% ............................ 134 avita gel 0.025% ............................ 134 AVONEX KIT 30MCG ......................... 71 AVONEX PEN KIT 30MCG ................... 71 AVONEX PREFL KIT 30MCG ................ 71 av-vite fb tab 2.5-25-2.................... 123 AYR NASAL DRO 0.65% ..................... 42 ayr spr 0.65% .................................. 42 AZASAN TAB 100MG ....................... 169 AZASAN TAB 75 MG ........................ 169 azathioprine tab 50 mg ................... 169 AZEC CAP ........................................ 87 azelastine hcl nasal spray 0.1% (137 mcg/spray) ...................................... 42 azelastine hcl ophth soln 0.05% ....... 131 azithromycin for susp 100 mg/5ml ....... 4 azithromycin for susp 200 mg/5ml ....... 4 azithromycin powd pack for susp 1 gm . 5 azithromycin tab 250 mg .................... 4 azithromycin tab 500 mg .................... 4 azithromycin tab 600 mg .................... 4 azurette tab 28 day .......................... 18 B b complete tab ................................. 89 B COMPLEX +C TAB TR...................... 91 b complex tab form 1 ........................ 89 b complex tab plus............................ 89 b complex tab plus c ......................... 88 b complex tab vit c ........................... 90 b-1 hi potcy tab 100mg ..................... 85 b-100 comp tab tr .......................... 115 b-100 complx tab ..................... 90, 115 b-100 tab ...................................... 115 b-100 tab b-100 ............................... 89 b-100 tab complex ............................ 90 b-100 tab td .................................. 115 b-100 tab tr ................................... 115 b-100 tr tab ..................................... 90 b-50 complex tab ............................. 90 b50 complex tab tr ........................... 90 b-50 tab ........................................ 115 b-50 tr tab ....................................... 89 baby ayr spr 0.65% .......................... 42 BABY DDROPS LIQ 400UNIT .............. 87
baby super dro daily d3 ..................... 87 baby vit d dro 400/.028 .................... 87 bacitracin oin 500/gm ..................... 135 bacitracin oint 500 unit/gm .............. 135 bacitracin ophth oint 500 unit/gm ..... 127 BACITRACIN POW .......................... 135 BACITRACIN POW ZINC USP ............ 135 bacitracin-polymyxin b ophth oint ..... 128 bacitracin-polymyxin-neomycin-hc ophth oint 1% ........................................ 131 bacitraycin oin 500/gm ................... 135 baclofen tab 10 mg ........................... 84 baclofen tab 20 mg........................... 84 BACTER WATER INJ PARABENS ........ 169 balanc b-100 tab tr ................... 90, 115 balance b100 tab ........................... 115 balance b-50 cap complex ............... 115 balance b-50 tab .............................. 89 balance b-50 tab complex ............... 115 balance b-50 tab tr ........................... 89 balanced b tab complex ...............88, 89 balanced tab b-100 .......................... 89 balanced tab b-100 tr ....................... 90 balanced tab b-50 ............................ 89 balsalazide disodium cap 750 mg ....... 66 balziva tab ...................................... 17 BAND AID MED MIS BUTTRFLY ......... 161 BAND AID MIS 1 ............................ 161 BAND AID MIS MICKEY ................... 161 BANDAGE FABR MIS EX-LONG ......... 162 BANDAGE FABR MIS KNUC/FIN ........ 162 BANDAGES CLR MIS ASSORTED ....... 162 BANDAGES FAB MIS 3/4 ................. 162 BANDAGES FAB MIS ASSORTED ....... 162 BAND-AID CLR MIS 7/8 ................... 161 BAND-AID CLR MIS STRIPS ............. 161 BAND-AID FLX MIS ......................... 161 BAND-AID FLX MIS 1 ...................... 161 BAND-AID FLX MIS 3/4 ................... 161 BAND-AID FLX MIS ASSORTED ........ 161 BAND-AID FLX MIS EXTRA LG .......... 161 BAND-AID FLX MIS FABRIC ............. 161 BAND-AID FLX MIS FINGRTIP .......... 162 BAND-AID FLX MIS KNUCKLE........... 162 BAND-AID HYD MIS ALL-PURP ......... 162 BAND-AID HYD MIS BLS CUSH ......... 162 BAND-AID HYD MIS FINGERS .......... 162
179
BAND-AID HYD MIS LARGE .............. 162 BAND-AID HYD MIS X-LARGE ........... 162 BAND-AID LG MIS BUTTRFLY ........... 162 BAND-AID MIS ............................... 162 BAND-AID MIS 3/4 ......................... 162 BAND-AID MIS FROZEN .................. 162 BAND-AID MIS GLOW-DRK .............. 162 BAND-AID MIS HL KITTY ................. 162 BAND-AID MIS HOT COLR ............... 162 BAND-AID MIS INCRED 2 ................ 162 BAND-AID MIS JUS LEAG ................ 162 BAND-AID MIS MEDICATE ............... 162 BAND-AID MIS POKEMON ................ 162 BAND-AID MIS PRINCESS................ 162 BAND-AID MIS SHEER .................... 162 BAND-AID MIS SHEER CF ................ 162 BAND-AID MIS SPORT EX ................ 162 BAND-AID MIS STAR WAR ............... 162 BAND-AID MIS TOUGH .................... 162 BAND-AID MIS TOUGH WP .............. 162 BAND-AID MIS TOUGH XL ............... 162 BAND-AID MIS TOUGH-ST ............... 162 BAND-AID MIS VARIETY .................. 162 BAND-AID MIS WON WOM ............... 162 BAND-AID MIS WTER BLK ............... 162 BAND-AID MIS X-LG ....................... 162 BAND-AID PAD 2 ............................ 166 BAND-AID PAD 3 ............................ 166 BAND-AID PAD ADHESIVE ............... 166 BAND-AID PAD LARGE .................... 166 BAND-AID PAW MIS PATROL ............ 162 banophen cap 25mg ......................... 36 banophen cap 50mg ......................... 36 banophen liq 12.5/5ml ...................... 37 banophen tab 25mg .......................... 37 BARACLUDE SOL .05MG/ML ................ 7 BARIATRIC CAP MULTIVIT ................. 94 BARIATRIC CHW FUSION ................ 106 BASAGLAR INJ 100UNIT .................... 19 BASE G ALMON OIL SWEET ............. 144 BASIC AM TAB ................................. 97 BASIC PM TAB .................................. 97 bayer adv tab 325mg ........................ 71 bayer adv tab 500mg ........................ 72 bayer asa tab 325mg .................. 71, 73 bayer asa tab 500mg ........................ 72 bayer low chw 81mg ......................... 72
bayer low tab 81mg ec ..................... 73 BAYER MICRLT MIS LANCETS .......... 153 b-compleet- tab 100 ......................... 89 b-compleet- tab 50 ........................... 89 b-complex 50 tab ............................. 88 B-COMPLEX CAP .............................. 89 b-complex tab ................................. 88 b-complex tab /vit c ......................... 88 b-complex tab 100 tr ........................ 90 b-complex tab 50 tr .......................... 88 b-complex tab balanced .................... 90 B-COMPLEX TAB C/FA/BIO ................ 91 b-complex tab form 1 ..................... 115 b-complex vitamin cap ...................... 88 b-complex vitamin sublingual liquid .... 88 b-complex vitamin tab ...................... 88 b-complex w/ c & calcium tab ............ 88 b-complex w/ c & folic acid tab .......... 90 b-complex w/ c cap .......................... 88 b-complex w/ c tab ........................... 88 b-complex w/ folic acid cap ................ 89 b-complex w/ folic acid tab ................ 89 b-complex w/ iron tab ...................... 91 b-complex w/biotin & folic acid tab ..... 89 b-complex/fa tab /vit c ..................... 91 BD LANCET UF MIS 30G .................. 153 BD LANCET UF MIS 33G .................. 153 BD MICROTAIN MIS LANCETS .......... 154 BD PEN NEEDL MIS 29GX12.7 .......... 145 BD PEN NEEDL MIS 31GX5MM.......... 145 BD PEN NEEDL MIS 31GX8MM.......... 145 BD PEN NEEDL MIS 32GX4MM ......... 146 BD PEN NEEDL MIS 32GX6MM ......... 147 BD SWAB BFLY PAD SNGL USE ........ 168 BD SWAB REG PAD SNGL USE ......... 168 BD U-500 MIS 31GX6MM ................. 145 bdy/hair/skn cap nails ....................... 94 bec/zinc tab ..................................... 88 bedding spra aer 0.5% ................... 141 bekyree tab ..................................... 18 benazepril & hydrochlorothiazide tab 10-12.5 mg ..................................... 31 benazepril & hydrochlorothiazide tab 20-12.5 mg ..................................... 31 benazepril & hydrochlorothiazide tab 20-25 mg ........................................ 31 benazepril & hydrochlorothiazide tab
180
5-6.25 mg ....................................... 31 benazepril hcl tab 10 mg ................... 29 benazepril hcl tab 20 mg ................... 29 benazepril hcl tab 40 mg ................... 29 benazepril hcl tab 5 mg ..................... 29 benfotiamine cap multi-b ................... 89 BENSONS CRE BOTTOM .................. 141 benzepro liq creamy ........................ 133 benziq wash liq 5.25% .................... 133 benzonatate cap 100 mg ................... 42 benzonatate cap 200 mg ................... 43 BENZOYL PER GEL 2.5% .................. 133 benzoyl per liq 10% wash ................ 133 benzoyl per liq 5% wash .................. 133 benzoyl peroxide gel 10% ................ 134 benzoyl peroxide gel 5% ................. 133 BENZYL ALC LIQ ............................. 168 beta hc lot 1% ............................... 139 betamethasone dipropionate augmented cream 0.05% ................................. 138 betamethasone dipropionate augmented gel 0.05% ..................................... 138 betamethasone dipropionate augmented lotion 0.05% .................................. 138 betamethasone dipropionate augmented oint 0.05% .................................... 138 betamethasone dipropionate cream 0.05%........................................... 138 betamethasone dipropionate lotion 0.05%........................................... 138 betamethasone dipropionate oint 0.05% .................................................... 138 betamethasone valerate cream 0.1% (base equivalent) ........................... 138 betamethasone valerate lotion 0.1% (base equivalent) ........................... 138 betamethasone valerate oint 0.1% (base equivalent) .................................... 138 betasept liq 4% .............................. 142 betatemp sus 160/5ml ...................... 75 betaxolol hcl ophth soln 0.5% .......... 130 bethanechol chloride tab 10 mg .......... 67 bethanechol chloride tab 25 mg .......... 67 bethanechol chloride tab 5 mg............ 67 bethanechol chloride tab 50 mg .......... 67 BETHKIS NEB 300/4ML ....................... 6 better b tab complex ......................... 88
bexarotene cap 75 mg ...................... 12 bicalutamide tab 50 mg ..................... 10 BICILLIN L-A INJ 1200000 ................... 3 BICILLIN L-A INJ 2400000 ................... 3 BICILLIN L-A INJ 600000 .................... 3 bidex tab 400mg .............................. 43 big 100 tab ...................................... 89 BILBERRY CAP PLUS ....................... 112 BIO-35 GLUTE CAP FREE ................... 94 BIO-35 IRON CAP FREE ..................... 94 BIOCAL CAP .................................... 94 biocotron liq 100-10/5 ...................... 47 BIOFLAVONOID POW CITRUS ............ 92 bioflavonoid products tab .................. 91 bioflavonoid products tab er............... 92 bioflex tab ....................................... 91 BIOGAIA CHW 100M CEL ................... 58 BIOGAIA CHW GASTRUS ................... 58 BIOGAIA DRO PROBIOTI ................... 58 BIOGAIA MIS PROBIOTI .................... 58 BIOGAIA PROT DRO BABY ................. 58 biolle gel 1% ................................. 128 biolle tears dro 0.5% op .................. 128 BIOPATCH MIS 1 ............................ 142 BIOPATCH MIS 3/4 ......................... 142 BIOPATCH PRO MIS DISK/CHG ........ 142 bio-statin pow .................................... 6 BIOSUPP LIQ ................................. 107 BIOTALAN LIQ CLEAR ....................... 91 BIOTECT PLUS CAP ........................... 94 BIOTECT PLUS LIQ ......................... 107 BIOTIN FORTE TAB ........................... 90 BIOTIN FORTE TAB /ZINC ................. 91 BIOTIN PLUS TAB KERATIN ............. 113 biotin plus/ tab cal/vitd ..................... 97 biotinex cap ..................................... 57 BIOVOL SYP .................................. 107 bisac-evac sup 10mg ........................ 51 bisacodyl sup 10mg .......................... 51 bisacodyl tab 5mg ec ........................ 51 biscolax sup 10mg ............................ 51 bismatrol chw 262mg ....................... 56 bismatrol sus 262/15ml .................... 56 bismatrol sus 525/15ml .................... 56 bismuth subsalicylate chew tab 262 mg ...................................................... 56 bisoprolol & hydrochlorothiazide tab
181
10-6.25 mg ..................................... 31 bisoprolol & hydrochlorothiazide tab 2.5-6.25 mg .................................... 31 bisoprolol & hydrochlorothiazide tab 5-6.25 mg ....................................... 31 bisoprolol fumarate tab 10 mg ........... 26 bisoprolol fumarate tab 5 mg ............. 26 bite-a-mins chw ............................. 109 bite-a-mins chw /iron...................... 111 blisovi fe tab 1.5/30 .......................... 18 blisovi fe tab 1/20 ............................ 18 BLISTER REL MIS BANDAGE ............ 162 blis-to-sol liq 1% ............................ 136 BLK DRAUGHT CHW 10MG ................. 53 bonine chw 25mg ............................. 64 BOOSTRIX INJ .................................. 9 bounty bears chw /c ....................... 109 bp gel gel 10% ............................... 134 bp gel gel 5% ................................ 133 bp wash liq 10% ............................ 133 bp wash liq 2.5% ........................... 133 bp wash liq 5% .............................. 133 bp wash liq 7% .............................. 133 bprotected liq multi-vi ..................... 107 BRAIN MIGHT TAB .......................... 113 BRAIN TAB 355MG ......................... 113 BREATHE EASE MIS LG MASK .......... 149 BREATHE EASE MIS MED MASK ........ 149 BREATHE EASE MIS SM MASK .......... 149 BREATHERITE MIS .......................... 149 BREATHERITE MIS LG MASK ............ 149 BREATHERITE MIS MED MASK .......... 149 BREATHERITE MIS SM MASK............ 149 BREATHERITE MIS SPACER .............. 149 BREATHERITE MIS W/MASK ............. 149 b-r edi/rd hr tab ts/rd ro .................... 97 BREWERS YEAS POW ........................ 88 brewers yeast tab ............................. 88 briellyn tab ...................................... 17 BRILINTA TAB 60MG ....................... 127 BRILINTA TAB 90MG ....................... 127 brimonidine tartrate ophth soln 0.15% .................................................... 131 brimonidine tartrate ophth soln 0.2% 131 bromfed dm syp ............................... 46 bromocriptine mesylate cap 5 mg (base equivalent) ...................................... 83
bromocriptine mesylate tab 2.5 mg (base equivalent) ...................................... 83 BROTAPP DM LIQ 15-1-5/5 ................ 46 b-s tress cap .................................. 115 BUBBLES PEDI MIS MASK ................ 147 buckleys liq chest ............................. 43 budesonide delayed release particles cap 3 mg .............................................. 13 budesonide inhalation susp 0.25 mg/2ml ...................................................... 50 budesonide inhalation susp 0.5 mg/2ml ...................................................... 50 budesonide inhalation susp 1 mg/2ml . 50 budesonide nasal susp 32 mcg/act ..... 41 budesonide sus 32mcg ..................... 41 budesonide sus nasal ........................ 41 BULLSEYE MIS LANCETS ................. 154 BULLSEYE MIS MINI LNC ................. 154 bumetanide tab 0.5 mg ..................... 32 bumetanide tab 1 mg ....................... 32 bumetanide tab 2 mg ....................... 32 BUT/ASA/CAF TAB ............................ 76 butalbital-acetaminophen-caffeine cap 50-325-40 mg ................................. 76 butalbital-acetaminophen-caffeine tab 50-325-40 mg ................................. 76 butalbital-aspirin-caffeine cap 50-325-40 mg ................................................. 76 BUTTERFLY MIS CLOSURES ............. 162 C c & e cap 500-400 ............................ 87 c 1000/biofl cap /r hips ..................... 91 C 1000/BIOFL CAP /R HIPS ............... 91 c complex tab 1000mg ..................... 92 c complex tab 500mg ....................... 92 c1000 tr/rh tab bioflav ...................... 92 c1500 tr/rh tab bioflav ...................... 92 c1500/rh tab bioflav ......................... 92 c-500 tab non-acid ........................... 85 ca citrate + tab .............................. 119 ca citrate tab + d ........................... 119 ca citrate tab plus d ........................ 119 CA HI-CAL/D TAB 250MG ................ 116 CA HI-CAL/D TAB 500MG ................ 116 cabergoline tab 0.5 mg ..................... 24 CABOMETYX TAB 20MG ..................... 11 CABOMETYX TAB 40MG ..................... 11
182
CABOMETYX TAB 60MG ..................... 11 cal antacid chw 1000mg .................... 59 cal antacid chw 750mg ...................... 58 CAL CIT MAL/ TAB VITAMIND ........... 120 cal cit+d3 tab maximum .................. 119 cal soft chw chw mlk choc ............... 120 CALAMINE LOT ............................... 142 calc 600/d3 tab 600-800 ................. 119 calc 600+d tab 600-800 .................. 118 calc 600+d3 cap 600-500 ................ 117 calc antacid chw 1000mg .................. 59 calc antacid chw 500mg .................... 58 calc antacid chw 750mg .................... 58 calc cit+d3 tab 200-250 .................. 119 calc cit+d3 tab 250-200 .................. 119 calc citr/d3 tab 200-250 .................. 119 calc citr+d tab 315-250 ................... 119 calc citr+d3 tab 200-250 ................. 119 calc citr+d3 tab 315-250 ................. 119 calc citra+d tab 315-250 ................. 119 calc citrate tab +d .......................... 119 CALCI-CHEW CHW 1250MG ............. 116 calcidol dro 8000/ml ......................... 85 calciferol dro 8000/ml ....................... 85 calcipotriene oint 0.005% ................ 137 calcipotriene soln 0.005% (50 mcg/ml) .................................................... 137 calcitonin (salmon) nasal soln 200 unit/act ........................................... 23 calcitrate tab .................................. 119 calcitrate tab 950mg ....................... 116 calcitrate tab plus d ........................ 119 calcitrene oin 0.005% ..................... 137 calcitriol cap 0.25 mcg ...................... 24 calcitriol cap 0.5 mcg ........................ 24 calcitriol inj 1 mcg/ml ........................ 24 calcitriol oral soln 1 mcg/ml ............... 24 calcium + d tab .............................. 119 calcium + d tab 600-200 ................. 117 calcium + d tab 600mg ................... 118 calcium +d tab maximum ................ 119 calcium +d3 tab maximum .............. 119 calcium 500 tab /vit d ..................... 117 calcium 500 tab +d ................. 117, 118 calcium 600 chw w/vit d .................. 117 calcium 600 tab .............................. 116 calcium 600 tab + d ........................ 117
calcium 600 tab +d ........................ 117 calcium 600 tab +d3....................... 118 calcium 600 tab -d ......................... 118 calcium 600/ tab vit d ..................... 118 calcium acetate (phosphate binder) cap 667 mg (169 mg ca) ......................... 67 calcium anta chw 500mg ................... 58 calcium anta chw 750mg ................... 58 calcium ascorbate tab 500 mg ........... 85 calcium carb tab 1250mg ................ 116 calcium carb tab 648mg .................... 58 calcium carbonate (antacid) chew tab 500 mg ........................................... 58 calcium carbonate (antacid) chew tab 750 mg ........................................... 58 calcium carbonate (antacid) susp 1250 mg/5ml........................................... 59 calcium carbonate tab 1250 mg (500 mg elemental ca) ................................ 116 calcium carbonate tab 1500 mg (600 mg elemental ca) ................................ 116 calcium carbonate tab 600 mg ......... 116 calcium carbonate-cholecalciferol tab 250 mg-125 unit .................................. 118 calcium carbonate-cholecalciferol tab 500 mg-125 unit .................................. 118 calcium carbonate-cholecalciferol tab 500 mg-200 unit .................................. 118 calcium carbonate-cholecalciferol tab 500 mg-400 unit .................................. 118 calcium carbonate-cholecalciferol tab 600 mg-200 unit .................................. 118 calcium carbonate-cholecalciferol tab 600 mg-400 unit .................................. 118 calcium carbonate-vitamin d cap 600 mg-200 unit .................................. 116 calcium carbonate-vitamin d tab 250 mg-125 unit .................................. 116 calcium carbonate-vitamin d tab 500 mg-125 unit .................................. 117 calcium carbonate-vitamin d tab 500 mg-200 unit .................................. 117 calcium carbonate-vitamin d tab 500 mg-400 unit .................................. 117 calcium carbonate-vitamin d tab 600 mg-125 unit .................................. 117 calcium carbonate-vitamin d tab 600
183
mg-200 unit .................................. 117 calcium carbonate-vitamin d tab 600 mg-400 unit .................................. 117 calcium citr tab +d ......................... 119 calcium citr tab plus d-3 .................. 119 calcium citr tab w/vit d3 .................. 119 calcium citrate tab 950 mg (200 mg elemental ca) ................................. 116 calcium citrate-vitamin d tab 200 mg-250 unit (elemental ca) ............. 119 calcium citrate-vitamin d tab 315 mg-200 unit (elemental ca) ............. 119 calcium citrate-vitamin d tab 315 mg-250 unit (elemental ca) ............. 119 calcium for chw women ................... 120 calcium plus cap d3 ........................ 117 calcium soft chw caramel ................ 120 calcium soft chw chocolat ................ 120 calcium soft chw mlk choc ............... 120 calcium tab 500/d ........................... 117 calcium tab 500+d .................. 117, 118 calcium tab 600 mg ........................ 116 calcium tab 600mg ......................... 116 CALCIUM TAB 600MG ...................... 116 calcium tab vit d ............................. 117 calcium w/ magnesium tab 250-125 mg .................................................... 116 calcium w/ magnesium tab 500-250 mg .................................................... 116 calcium/d chw 500-400 ................... 119 calcium/d tab 500/200 .................... 118 calcium/d tab 500-200 .................... 118 calcium/d tab 500-400 .................... 118 calcium/d tab 500mg ...................... 118 calcium/d tab 600-200 .................... 117 calcium/d tab 600-800 .................... 119 calcium/d3 cap 600-500 .................. 117 calcium/d3 tab ....................... 118, 119 calcium/d3 tab 200-250 .................. 119 calcium/d3 tab 500-600 .................. 118 calcium/d3 tab 600-800 .................. 119 calcium/magn tab /zinc ................... 120 calcium/vita tab d3 ......................... 119 calcium/vitd cap 600-500 ................ 117 calcium+d tab 600-400 ........... 117, 118 calcium+d tab 600-800 ................... 119 calcium+d3 tab 315-250 ................. 119
calcium+d3 tab 600-400 .......... 117, 118 calcium+d3 tab 600-800 ................. 119 calcium-magnesium-zinc tab 333-133-5 mg ............................................... 120 calcium-magnesium-zinc tab 333-133-8.3 mg ............................ 120 CAL-CO3Y CAP ............................... 112 CAL-DAY 1000 TAB ........................... 97 cal-gest chw 500mg ......................... 58 cal-mag aspa tab 333-167 ............... 116 cal-mag tab 500-250 ...................... 116 caltrate 600 tab ............................. 116 camila tab 0.35mg ........................... 15 camrese tab .................................... 19 capecitabine tab 150 mg ................... 10 capecitabine tab 500 mg ................... 10 CA-PLUS TAB 280MG ...................... 113 CAPRELSA TAB 100MG ...................... 12 CAPRELSA TAB 300MG ...................... 12 captopril & hydrochlorothiazide tab 25-15 mg ................................................. 31 captopril & hydrochlorothiazide tab 25-25 mg ................................................. 31 captopril & hydrochlorothiazide tab 50-15 mg ................................................. 31 captopril & hydrochlorothiazide tab 50-25 mg ................................................. 31 captopril tab 100 mg ........................ 29 captopril tab 12.5 mg ....................... 29 captopril tab 25 mg .......................... 29 captopril tab 50 mg .......................... 29 CARAFATE SUS 1GM/10ML ................ 63 carbidopa & levodopa orally disintegrating tab 10-100 mg ............. 83 carbidopa & levodopa orally disintegrating tab 25-100 mg ............. 84 carbidopa & levodopa orally disintegrating tab 25-250 mg ............. 84 carbidopa & levodopa tab 10-100 mg . 83 carbidopa & levodopa tab 25-100 mg . 83 carbidopa & levodopa tab 25-250 mg . 83 carbidopa & levodopa tab er 25-100 mg ...................................................... 83 carbidopa & levodopa tab er 50-200 mg ...................................................... 83 carbidopa-levodopa-entacapone tabs 12.5-50-200 mg .............................. 84
184
carbidopa-levodopa-entacapone tabs 18.75-75-200 mg ............................. 84 carbidopa-levodopa-entacapone tabs 25-100-200 mg ................................ 84 carbidopa-levodopa-entacapone tabs 31.25-125-200 mg ........................... 84 carbidopa-levodopa-entacapone tabs 37.5-150-200 mg ............................. 84 carbidopa-levodopa-entacapone tabs 50-200-200 mg ................................ 84 CARDIO TONE TAB ......................... 113 CARDIOPRESS CAP ......................... 112 CAREFINE MIS 31GX8MM ................ 145 CAREFINE MIS 32GX4MM ................ 146 CAREFINE MIS 32GX6MM ................ 147 CAREONE LANC MIS 28G ................. 154 CAREONE LANC MIS THIN 23G ......... 154 CARETOUCH MIS 31GX5MM ............. 145 CARETOUCH MIS 31GX8MM ............. 145 CARETOUCH MIS 32GX4MM ............. 146 CARETOUCH MIS TWIST 28 ............. 154 CARETOUCH MIS TWIST 30 ............. 154 CARETOUCH MIS TWIST 33 ............. 154 CARETOUCH PAD ALCOHOL ............. 168 carisoprodol tab 250 mg .................... 84 carisoprodol tab 350 mg .................... 84 CAROZYME CAP .............................. 112 CARPALAID MIS EMPLOYEE .............. 162 CARPALAID MIS LARGE ................... 162 CARPALAID MIS PRA LG .................. 162 CARPALAID MIS PRAC SM ................ 162 CARPALAID MIS SMALL ................... 162 carravite tab .................................... 97 cartia xt cap 120/24hr ....................... 28 cartia xt cap 180/24hr ....................... 28 cartia xt cap 240/24hr ....................... 28 cartia xt cap 300/24hr ....................... 28 carvedilol tab 12.5 mg....................... 27 carvedilol tab 25 mg ......................... 27 carvedilol tab 3.125 mg ..................... 27 carvedilol tab 6.25 mg....................... 27 CASTOR OIL .................................. 144 cavarest gel 1.1%........................... 132 cavilon cre 2% ............................... 137 caziant pak ...................................... 18 C-BUFF POW .................................. 107 cefadroxil cap 500 mg ........................ 3
cefadroxil for susp 250 mg/5ml............ 4 cefadroxil for susp 500 mg/5ml............ 4 cefadroxil tab 1 gm............................. 3 cefdinir cap 300 mg ............................ 4 cefdinir for susp 125 mg/5ml ............... 4 cefdinir for susp 250 mg/5ml ............... 4 cefprozil for susp 125 mg/5ml ............. 4 cefprozil for susp 250 mg/5ml ............. 4 cefprozil tab 250 mg ........................... 4 cefprozil tab 500 mg ........................... 4 ceftriaxone sodium for inj 1 gm ........... 4 ceftriaxone sodium for inj 2 gm ........... 4 ceftriaxone sodium for inj 250 mg ........ 4 ceftriaxone sodium for inj 500 mg ........ 4 cefuroxime axetil tab 250 mg .............. 4 cefuroxime axetil tab 500 mg .............. 4 CELEBRATE CAP 18 .......................... 94 CELEBRATE CAP 36 .......................... 95 CELEBRATE CAP 45 .......................... 95 CELEBRATE CAP 60 .......................... 95 CELEBRATE CHW 18 ....................... 106 CELEBRATE CHW 36 ....................... 106 CELEBRATE CHW 45 ....................... 106 CELEBRATE CHW 60 ....................... 106 celecoxib cap 100 mg ....................... 80 celecoxib cap 200 mg ....................... 80 celecoxib cap 400 mg ....................... 80 celecoxib cap 50 mg ......................... 80 CELLULAR CAP SECURITY .................. 95 CEMILL PLUS TAB ............................. 91 cemill/biofl tab ................................. 91 CENT MATURE TAB ADLT 50+ ............ 97 cent mature tab womn 50+ ............... 97 centamin liq .................................. 107 CENTANY OIN 2% .......................... 135 centavite az tab minerals .................. 97 centavite liq................................... 107 CENTRAL-VITE TAB .......................... 97 central-vite tab cardio .................... 113 central-vite tab mens mat ................. 97 central-vite tab performa ................ 113 CENTRAL-VITE TAB UNDER 50 ........... 97 central-vite tab wmns mat ................. 97 centravites tab ................................. 97 centravites tab 50 plus ..................... 97 CENTRAVITES TAB 50 PLUS............... 97 CENTRAVITES TAB ADULTS ............... 97
185
CENTRUM CHW .............................. 106 CENTRUM CHW FLAV BST ................ 106 CENTRUM CHW MEN ....................... 106 CENTRUM CHW MULTI .................... 106 CENTRUM CHW SILVER ................... 106 CENTRUM CHW VITAMINT ............... 106 CENTRUM CHW WOMEN .................. 106 centrum kids chw complete ............. 111 CENTRUM KIDS CHW FLAV BST ........ 106 CENTRUM POW DRINK .................... 108 CENTRUM SPEC TAB ENERGY ........... 113 CENTRUM SPEC TAB HEART ............... 97 CENTRUM SPEC TAB IMMUNE ............. 97 CENTRUM SPEC TAB VISION .............. 97 CENTRUM TAB CARDIO ..................... 97 CENTRUM TAB MEN .......................... 97 CENTRUM TAB PERFORMA ............... 113 CENTRUM TAB SILVER ...................... 97 CENTRUM TAB ULTRA........................ 97 century tab ...................................... 97 century tab mature ........................... 97 cephalexin cap 250 mg ....................... 4 cephalexin cap 500 mg ....................... 4 cephalexin cap 750 mg ....................... 4 cephalexin for susp 125 mg/5ml.......... 4 cephalexin for susp 250 mg/5ml.......... 4 cephalexin tab 250 mg ....................... 4 cephalexin tab 500 mg ....................... 4 ceralyte 70 sol ............................... 121 CERDELGA CAP 84MG ..................... 125 CEREZYME INJ 400UNIT .................. 125 cerovite jr chw ............................... 111 cerovite tab advanced ....................... 97 cerovite tab senior ............................ 97 certa plus tab ................................... 97 certagen tab .................................... 97 CERTAVITE TAB SENIOR ................... 97 certavite/ tab antioxid ....................... 97 cetirizine chw 10mg .......................... 39 cetirizine chw 5mg ............................ 39 cetirizine hcl oral soln 1 mg/ml (5 mg/5ml) .......................................... 39 cetirizine hcl tab 10 mg ..................... 38 cetirizine sol 1mg/ml ......................... 39 cetirizine sol 5mg/5ml ....................... 39 cetirizine tab 5mg ............................. 38 cetirizine-pseudoephedrine tab er 12hr
5-120 mg ........................................ 45 cgh cong dm liq 5-100/5 ................... 46 chateal eq tab 0.15/30 ...................... 17 chateal tab 0.15/30 .......................... 17 CHEMSTRIP 10 TES MD ................... 143 CHEMSTRIP 2 TES GP ..................... 143 CHEMSTRIP 5 TES OB ..................... 143 CHEMSTRIP 7 TES .......................... 143 CHEMSTRIP 9 TES STRIPS ............... 143 CHEMSTRIP TES -10 SG .................. 143 CHEMSTRIP TES UGK ..................... 143 cheratussin syp ac ............................ 46 chest conges liq 100/5ml ................... 43 chest conges liq childrns.................... 43 chest conges tab 400mg ................... 43 chew calcium chw .......................... 120 CHEW-12 CHW ................................ 93 chewabl vite chw childrns ................ 109 chewable chw children .................... 110 child allrgy sol 5mg/5ml .................... 39 child apap tab 80mg ......................... 76 child asa chw 81mg .......................... 72 child asa ls chw 81mg ....................... 72 child chew chw iron ........................ 111 child chew chw vitamins .................. 109 child chew/ chw extra c ................... 110 child multiv chw iron ...................... 111 child silfed liq 15mg/5ml ................... 40 child soothe chw 400mg .................... 58 child vitami chw ............................. 111 children vit chw .............................. 109 childrens chw /iron ......................... 111 childrens chw apap ........................... 74 childrens chw complete ................... 111 CHILDRENS CHW COMPLETE ........... 111 childrens chw gummies ................... 110 childrens chw multivit ..................... 109 childrens chw pepto .......................... 58 childrens chw soothe ........................ 58 childrens chw vitamin ..................... 109 childrens chw vitamins .................... 109 childrens liq 5-100mg ....................... 46 chld allergy liq 12.5/5ml .................... 37 chld asafree elx 80/2.5ml .................. 75 chld ibuprfn dro 40mg/ml .................. 79 chld meditab chw 80mg .................... 74 chld mltivit chw /mineral ................. 111
186
chld non-asa chw 80mg grp ............... 74 chld non-asa tab 80mg qm ................ 76 chld pain rl tab 80mg ........................ 76 chld silapap liq 160/5ml..................... 75 chld vitamin chw iron ...................... 111 CHLOR GLUC LIQ 2% ...................... 142 chloraseptic liq sore thr ..................... 75 chlordiazepoxide hcl-clidinium bromide cap 5-2.5 mg ................................... 62 CHLORELLA CAP ............................... 94 CHLORHEX GLU PAD 2% ................. 142 chlorhexidine gluconate liquid 4% ..... 142 chlorhexidine gluconate soln 0.12% .. 132 chlorhist tab 4mg ............................. 35 chlorocaps cap ................................. 92 chloroquine phosphate tab 250 mg ...... 8 chloroquine phosphate tab 500 mg ...... 8 CHLOROQUINE POW PHOSPHAT .......... 8 chlorphen sr tab 12mg ...................... 36 chlor-phenir tab 4mg ........................ 35 chlorpheniramine maleate tab 4 mg .... 35 chlorpheniramine maleate tab er 12 mg ......................................................36 chlorthalidone tab 25 mg ................... 32 chlorthalidone tab 50 mg ................... 32 chlorzoxazone tab 250 mg ................. 84 chlorzoxazone tab 500 mg ................. 84 choc laxativ chw 15mg ...................... 53 CHOICEFUL CAP MULTIVIT ................. 95 CHOICEFUL CHW MULTIVIT ............. 106 CHOLASE CAP CONTROL .................. 112 cholecalciferol cap 1000 unit .............. 85 cholecalciferol cap 10000 unit ............ 86 cholecalciferol cap 2000 unit .............. 85 cholecalciferol cap 5000 unit .............. 86 cholecalciferol cap 50000 unit ............ 86 cholecalciferol chew tab 400 unit ........ 86 cholecalciferol oral liquid 400 unit/ml .. 87 cholecalciferol tab 1000 unit .............. 86 cholecalciferol tab 2000 unit .............. 86 cholecalciferol tab 400 unit ................ 86 cholecalciferol tab 5000 unit .............. 86 cholestyramine light powder 4 gm/dose ......................................................33 cholestyramine light powder packets 4 gm ................................................. 33 cholestyramine powder 4 gm/dose ...... 33
cholestyramine powder packets 4 gm . 33 ciclopirox gel 0.77% ....................... 135 ciclopirox olamine cream 0.77% (base equiv) ........................................... 135 ciclopirox olamine susp 0.77% (base equiv) ........................................... 135 CICLOPIROX POW OLAMINE ............ 135 ciclopirox shampoo 1% ................... 135 cilostazol tab 100 mg ...................... 127 cilostazol tab 50 mg........................ 127 cimetidine hcl soln 300 mg/5ml .......... 62 cimetidine tab 200 mg ...................... 62 cimetidine tab 200mg ....................... 62 cimetidine tab 300 mg ...................... 62 cimetidine tab 400 mg ...................... 62 cimetidine tab 800 mg ...................... 62 CIPRODEX SUS 0.3-0.1% ................ 132 ciprofloxacin hcl ophth soln 0.3% ..... 127 ciprofloxacin hcl tab 100 mg (base equiv) ........................................................ 5 ciprofloxacin hcl tab 250 mg (base equiv) ........................................................ 5 ciprofloxacin hcl tab 500 mg (base equiv) ........................................................ 5 ciprofloxacin hcl tab 750 mg (base equiv) ........................................................ 5 ciprofloxacin-ciprofloxacin hcl tab er 24hr 1000 mg(base eq) .............................. 5 ciprofloxacin-ciprofloxacin hcl tab er 24hr 500 mg (base eq) ............................... 5 cit calc/d tab 315-250 ..................... 119 CITRANATAL CAP HARMONY ............ 115 CITRANATAL MIS ........................... 115 CITRANATAL MIS 90 DHA ................ 115 CITRANATAL MIS B-CALM ................ 115 CITRANATAL PAK ASSURE ............... 115 CITRANATAL PAK DHA .................... 115 CITRANATAL TAB BLOOM ................ 115 CITRANATAL TAB RX....................... 115 claravis cap 10mg .......................... 134 claravis cap 20mg .......................... 134 claravis cap 30mg .......................... 134 claravis cap 40mg .......................... 134 clarispray spr 50mcg ........................ 41 clarithromycin for susp 125 mg/5ml...... 5 clarithromycin for susp 250 mg/5ml...... 5 clarithromycin tab 250 mg ................... 5
187
clarithromycin tab 500 mg .................. 5 clarithromycin tab er 24hr 500 mg ....... 5 claritin eye dro 0.025%op ............... 131 CLARITIN RDT TAB 5MG .................... 40 claritin sol 5mg/5ml .......................... 40 clean&clear cre 10% ....................... 133 CLEANLET 28G MIS LANCETS ........... 154 CLEAR BANDAG MIS 3/4 ................. 162 clear eyes dro 0.5-0.6% .................. 129 CLEAR SPOT MIS 7/8 ...................... 163 CLEAR STRIPS MIS 3/4 ................... 163 clearasil cre acne ............................ 133 clearlax pow .................................... 54 clearskin cre 10% ........................... 133 clemastine fumarate tab 2.68 mg ....... 36 CLEVER CHECK MIS ........................ 154 CLEVER CHECK MIS 30G ................. 154 CLEVER CHOIC MIS NEBULIZR ......... 150 CLICKFINE MIS 31GX5/16 ............... 145 CLICKFINE MIS 31GX8MM ............... 145 CLICKFINE MIS 32GX5/32 ............... 146 clindamycin hcl cap 150 mg ................ 8 clindamycin hcl cap 300 mg ................ 8 clindamycin palmitate hcl for soln 75 mg/5ml (base equiv).......................... 8 clindamycin phosphate gel 1% ......... 134 clindamycin phosphate lotion 1% ...... 134 clindamycin phosphate soln 1% ........ 134 clindamycin phosphate vaginal cream 2% ......................................................67 clinpro 5000 pst 1.1% ..................... 132 CLIOQUINOL POW .......................... 135 clonidine hcl tab 0.1 mg .................... 30 clonidine hcl tab 0.2 mg .................... 30 clonidine hcl tab 0.3 mg .................... 30 clonidine td patch weekly 0.1 mg/24hr 30 clonidine td patch weekly 0.2 mg/24hr 30 clonidine td patch weekly 0.3 mg/24hr 30 clopidogrel bisulfate tab 300 mg (base equiv) ........................................... 127 clopidogrel bisulfate tab 75 mg (base equiv) ........................................... 127 clotrimazole cre 1% ........................ 136 clotrimazole cre 1% vag .................... 67 clotrimazole cre 2% .......................... 67 clotrimazole cre 3 day ....................... 67 clotrimazole cre grx 1% .................. 136
clotrimazole cream 1% ................... 136 CLOTRIMAZOLE CRY ....................... 136 CLOTRIMAZOLE POW ...................... 136 clotrimazole soln 1% ...................... 136 clotrimazole troche 10 mg ............... 132 clotrimazole vaginal cream 1%........... 67 CO MONITOR MIS T PIECES ............ 147 COAGUCHEK MIS LANCETS ............. 154 cod liver cap norwegia ...................... 87 cod liver cap oil ................................ 87 cod liver cap oil/a&d ......................... 87 cod liver chw /vit d ........................... 87 cod liver chw w/vit ........................... 87 COD LIVER OIL ................................ 87 cod liver oil cap ................................ 87 COD LIVER OIL FOR KIDS ................. 87 COD LIVER OIL NORWEGIA ............... 87 COD LIVER OIL OIL .......................... 87 COD LIVER OIL USP/NF .................... 87 CODITUSSIN LIQ AC ......................... 46 colace 2in1 tab 8.6-50mg .................. 54 colchicine tab 0.6 mg ........................ 82 cold/allergy elx children .................... 44 colestipol hcl granule packets 5 gm ..... 33 colestipol hcl granules 5 gm ............... 33 colestipol hcl tab 1 gm ...................... 33 COLLAGEN CAP ULTRA .................... 112 colocort ene 100mg ........................ 133 COLOR CONDOM MIS + LUBE .......... 166 COMBIPATCH DIS .05/.14 ................. 15 COMBIPATCH DIS .05/.25 ................. 15 COMBIVENT AER 20-100 ................... 49 COMETRIQ KIT 100MG ...................... 11 COMETRIQ KIT 140MG ...................... 11 COMETRIQ KIT 60MG ....................... 11 COMFORT ASSU MIS LANC 28G ....... 154 COMFORT ASSU MIS LANC 33G ....... 154 COMFORT EZ MIS 21G .................... 154 COMFORT EZ MIS 23G .................... 154 COMFORT EZ MIS 28G .................... 154 COMFORT EZ MIS 31GX5MM ............ 145 COMFORT EZ MIS 31GX8MM ............ 146 COMFORT EZ MIS 32GX4MM ............ 146 COMFORT EZ MIS 32GX6MM ........... 147 COMFORT FAB MIS 3/4 ................... 163 COMFORT FAB MIS ASSORTED ........ 163 COMFORT FAB MIS KNEE/ELB .......... 163
188
comfort gel sus ................................ 60 comfort gel sus antacid ..................... 61 comfort gel sus anti-gas .............. 60, 61 COMFORT MIS LANCETS .................. 154 COMFORTOUCH MIS LANCET ........... 154 COMP AIR MIS COMP/NEB ............... 150 COMP AIR MIS ELITE....................... 150 comp allergy cap 25mg ..................... 36 comp allergy tab 25mg ...................... 37 comp allergy tab 25mg med ............... 37 comp daily tab w/lutein ..................... 97 comp energy tab .............................. 97 comp multivi liq mineral .................. 107 COMPACT SPAC MIS CHAMBER ......... 149 COMPACT SPAC MIS LG MASK .......... 149 COMPACT SPAC MIS MD MASK ......... 149 COMPACT SPAC MIS SM MASK ......... 149 companion tab ................................. 97 compete tab .................................... 97 compl multiv chw childrns ................ 111 comple multi tab adlt 50+ .................. 97 complere tab .................................... 97 COMPLETE 50+ TAB MENS ................. 97 COMPLETE 50+ TAB WOMENS ............ 97 complete chw multi-vi ..................... 110 complete tab .................................... 97 complete tab senior .......................... 97 complete tab womens ....................... 98 complex b-50 tab ............................. 90 COMPMIST MIS NEBULIZE ............... 150 compoz cap 50mg ............................ 69 compoz tab 50mg ............................. 70 COMPRESSOR MIS NEBULIZE ........... 150 COMPRESSOR MIS NEBULIZR .......... 150 compro sup 25mg ............................. 69 CONCEPTIONXR MIS MOTILITY ........ 108 CONDOMS MIS ............................... 166 CONDOMS MIS LUBRICAT ................ 166 cong/cough liq 5-100/5 ..................... 46 constulose sol 10gm/15 ..................... 54 CONVERSION MIS BABY SZ1............ 147 CONVERSION MIS BABY SZ2............ 147 CONVERSION MIS BABY SZ3............ 147 coral calciu cap plus .................. 95, 120 CORLANOR TAB 5MG ........................ 35 CORLANOR TAB 7.5MG ...................... 35 correct tab 5mg ec............................ 51
correctol cap 100mg ......................... 53 CORRECTOL MIS HERBAL .................. 52 correctol tab 5mg ec ......................... 51 cort intense cre heal 1% ................. 139 cortaid cre 1% ............................... 139 cortisone cre 1% ............................ 139 cortisone gel 1% ............................ 139 cortisone lot 1% ............................ 140 cortisone oin 1% ............................ 140 cortizone-10 cre /aloe 1% ............... 140 cortizone-10 cre healing.................. 140 cortizone-10 cre plus ...................... 140 cortizone-10 gel 1% ....................... 139 cortizone-10 lot diab/1% ................ 140 cortizone-10 lot eczema .................. 140 cortizone-10 lot hydraten ................ 140 cortizone-10 oin 1% ....................... 140 COSENTYX INJ 150MG/ML ............... 137 COSENTYX INJ 300DOSE ................ 137 COSENTYX PEN INJ 150MG/ML ........ 137 COSENTYX PEN INJ 300DOSE .......... 137 cough child liq 5-100/5 ..................... 46 cough cont liq dm max ..................... 47 cough syp ....................................... 43 cough syp 100/5ml........................... 43 cough/chest liq 20-400 ..................... 46 cough/chest liq dm child ................... 46 cough/chest syp dm ......................... 48 coughtab tab 200mg ........................ 43 COVERLET MIS STRIPS ................... 163 C-PLEX CAP ..................................... 91 cranberry cap urin com ..................... 87 CRAYON STRIP MIS BANDAGE ......... 163 creamies chw 600-400 .................... 117 creamy face liq wash 4% ................ 133 CREON CAP 12000UNT ..................... 65 CREON CAP 24000UNT ..................... 65 CREON CAP 3000UNIT ...................... 65 CREON CAP 36000UNT ..................... 65 CREON CAP 6000UNIT ...................... 65 cromolyn sodium nasal aerosol soln 5.2 mg/act (4%) ................................... 42 cromolyn sodium ophth soln 4% ...... 131 cromolyn sodium soln nebu 20 mg/2ml ...................................................... 48 cryselle-28 tab 28 tabs ..................... 17 CULTURELLE CHW KIDS .................... 58
189
CULTURELLE PAK KIDS ..................... 58 CU-PLUS TAB 2MG .......................... 113 CURAD 7/8 .................................... 163 CURAD ASSORT MIS ACTIFLEX ........ 163 CURAD COMFOR MIS .75X3 ............. 163 CURAD FAMILY MIS FLX ASST .......... 163 CURAD FLEX MIS ASSORTED ........... 163 curad hydro cre 1% ........................ 139 CURAD KID SZ MIS DINOSAUR ........ 163 CURAD MIS GODZILLA .................... 163 CURAD MIS JURASSIC .................... 163 CURAD PAD 3 ................................ 166 CURAD SENSIT MIS 3/4 .................. 163 CURAD SENSIT MIS ASSORTED ........ 163 CURAD SENSIT MIS EX LARGE ......... 163 CURAD SENSIT MIS SPOTS.............. 163 curad triple oin antibiot ................... 135 CURAD WILD MIS DESIGNIT ............ 163 CURAD WILD MIS TATTOO-U ........... 163 CURITY CURAD MIS 3/4 FABR .......... 163 CURITY CURAD MIS 3/4 PLAS .......... 163 CURITY CURAD MIS 3/4 SHEE .......... 163 CURITY CURAD MIS ASST FAB ......... 163 CURITY CURAD MIS PLASTIC ........... 163 CURITY CURAD MIS SHEER .............. 163 CURITY PREP PAD ALCOHOL ............ 168 CURITY SWABS PAD ALCOHOL ......... 168 CUVPOSA SOL 1MG/5ML .................... 62 cvd d3 chw 1000unit ......................... 86 cvs 3-day cre ................................... 67 cvs acne cre 10% ........................... 133 cvs allergy cap 25mg ........................ 36 cvs allergy chw 12.5mg ..................... 38 cvs allergy dro 0.025%op ................ 131 cvs allergy liq 25/10ml ...................... 37 cvs allergy tab 10mg ........................ 38 cvs allergy tab 180mg ....................... 39 cvs allergy tab 25mg ......................... 37 cvs allergy tab 4mg .......................... 36 cvs allergy tab chldrn ........................ 38 cvs antacid sus antigas ...................... 61 cvs antacid sus anti-gas .................... 60 cvs antacid sus supreme .................... 59 cvs antacid/ sus anti-gas ............. 60, 61 CVS ANTI-BAC MIS ......................... 163 CVS ANTI-BAC MIS BANDAGE .......... 163 cvs aspirin tab 325mg ....................... 72
cvs aspirin tab 325mg ec ................... 73 cvs aspirin tab 81mg ec .................... 73 cvs b1 tab 100mg ............................ 85 cvs b-1 tab 100mg ........................... 85 cvs balanced tab b100 ...................... 88 cvs balanced tab b50 ...................... 115 cvs bismuth chw 262mg .................... 56 cvs bismuth sus max str .................... 56 cvs bismuth tab 262mg ..................... 56 cvs ca/mg/zn tab ........................... 120 cvs calcium tab 600mg ................... 116 cvs children chw complete ............... 111 cvs childs chw 80mg ......................... 74 cvs c-lax tab 5mg ............................. 51 cvs d3 cap 1000unit ......................... 85 cvs d3 cap 2000unit ......................... 85 cvs d3 cap 5000unit ......................... 86 cvs d3 chw 1000 unt......................... 86 cvs daily chw gummies ................... 106 cvs dry eye dro relief ...................... 130 cvs electrol sol ............................... 121 cvs fish oil cap 1000mg ................... 122 cvs fish oil cap 1200mg ................... 123 CVS FLEX FAB MIS BANDAG ............ 163 cvs gas relf chw 125mg ..................... 65 cvs gas relf chw 80mg ...................... 65 cvs gas relf dro ex st ........................ 66 CVS HAIR/SKN TAB NAILS ............... 113 cvs ibuprof dro 50/1.25 ..................... 79 cvs ibuprofe sus 100/5ml .................. 79 cvs inner tab ear plus ..................... 115 cvs iron tab 27mg .......................... 125 cvs iron tab 325mg......................... 124 cvs itch rel cre 1%.......................... 136 CVS KETONE TES CARE ................... 143 CVS LANCETS MIS 21G ................... 154 CVS LANCETS MIS 30G ................... 154 CVS LANCETS MIS 33G ................... 154 CVS LANCETS MIS ORIGINAL ........... 154 CVS LANCETS MIS THIN 26G ........... 154 CVS LANCETS MIS THIN 30G ........... 154 CVS LANCETS MIS THIN 33G ........... 154 cvs laxative chw 15mg ...................... 53 cvs laxative tab 25mg ....................... 52 cvs lubricat oin .............................. 130 cvs lubricnt dro 0.5% op ................. 128 cvs miconazo cre 7 ........................... 68
190
cvs mucus d tab 60-600mg ................ 46 cvs mucus er tab 600mg ................... 44 cvs mucus tab 1200 er ...................... 44 cvs naproxen tab 220mg ................... 80 CVS NASAL SPR MIST ....................... 42 cvs natural sol tears ........................ 129 cvs pinworm sus 50mg/ml .................. 8 CVS PLASTIC MIS BANDAGE ............ 163 cvs purelax pak ................................ 54 cvs purelax pow ............................... 54 cvs purelax pow 3350 ....................... 54 cvs quality cap sleep ....................... 143 cvs senna pl tab 8.6-50mg ................. 54 cvs senna tab 8.6mg ......................... 52 CVS SPOT BAN MIS SHEER .............. 163 cvs stress tab form/zn ....................... 88 cvs super b tab complx/c ................... 88 cvs triple oin antibiot ....................... 135 cyanocobalamin inj 1000 mcg/ml ...... 123 cyclafem tab 1/35 ............................. 17 cyclafem tab 7/7/7 ........................... 18 cyclobenzaprine hcl tab 10 mg ........... 84 cyclobenzaprine hcl tab 5 mg ............. 84 cyclophosphamide cap 25 mg .............. 9 cyclophosphamide cap 50 mg .............. 9 cyclosporine cap 100 mg ................. 169 cyclosporine cap 25 mg ................... 169 cyclosporine modified cap 100 mg .... 169 cyclosporine modified cap 25 mg ...... 169 cyclosporine modified cap 50 mg ...... 169 cyclosporine modified oral soln 100 mg/ml ........................................... 169 cyproheptadine hcl syrup 2 mg/5ml .... 38 cyproheptadine hcl tab 4 mg .............. 38 cyred eq tab .................................... 16 cyred tab ......................................... 16 D d 1000 cap 1000unit ......................... 85 d 400 cap ........................................ 87 d 400 chw 400unit ............................ 86 d 400 tab 400unit ............................. 86 D3 + K2 DOTS TAB ........................... 88 d3 adult chw 1000unit ....................... 86 d3 cap 1000unit ............................... 85 d3 cap 2000unit ............................... 85 d-3 gummy chw 400unit .................... 86 d3 kids chw 400unit .......................... 86
d3 maximum cap 5000unit ................ 86 d3 super str cap 2000unit.................. 85 d3 tab 400unit ................................. 86 d3 vitamin liq 400unit ....................... 87 D3/VITAMIN C TAB /ZINC ................. 87 d3-1000 cap 1000unit....................... 85 d3-50 cap 50000unt ......................... 86 DAFLONEX-XL TAB ........................... 92 daily betic tab .................................. 98 daily combo tab ............................... 98 daily diet tab support ........................ 98 DAILY ENERGY POW ENFUSION ....... 107 DAILY HEART PAK SUPPORT ............ 108 daily mens tab health ....................... 98 daily multi tab.................................. 98 daily multi tab 50+ ........................... 98 daily multi tab men .......................... 98 daily multi tab minerals .................... 98 daily multi tab vit/iron ...................... 94 daily multi tab vit/mens .................... 98 daily multi tab vit/min ...................... 98 daily multi tab vitamins ..................... 92 daily multi tab women ...................... 98 daily multi tab womn 50+ ................. 98 daily multiv tab womens ................. 109 DAILY PAK MIS MULTIVIT ................ 108 daily tab vitamin .............................. 92 daily value tab multivit ...................... 92 daily vit tab ..................................... 92 daily vit tab +iron ............................ 94 daily vit tab +mineral ....................... 98 daily vit tab iron ............................... 94 daily vitamn cap plus ........................ 95 daily vite tab ................................... 92 daily vite tab iron ............................. 94 daily womens tab health ................... 98 daily-vitamn tab..........................92, 94 daily-vitamn tab maximum................ 98 daily-vite tab ................................... 93 daily-vite/ tab iron ............................ 94 danazol cap 100 mg ......................... 14 danazol cap 200 mg ......................... 14 danazol cap 50 mg ........................... 14 dandruff sha 1% ............................ 137 dantrolene sodium cap 100 mg .......... 84 dantrolene sodium cap 25 mg ............ 84 dantrolene sodium cap 50 mg ............ 84
191
dapsone tab 100 mg .......................... 9 dapsone tab 25 mg ............................ 9 dasetta tab 1/35 ............................... 17 dasetta tab 7/7/7 ............................. 18 dayhist alrg tab 12 hour .................... 36 daysee tab ....................................... 19 DDROPS LIQ 2000UNIT ..................... 87 deblitane tab 0.35mg ........................ 15 decadron elx 0.5/5ml ........................ 13 decadron tab 0.5mg .......................... 13 decadron tab 0.75mg ........................ 13 decadron tab 4mg ............................ 13 decadron tab 6mg ............................ 13 decara cap 10000unt ........................ 86 decara cap 50000unt ........................ 86 decongestant tab 120mg er ............... 41 decongestant tab 30mg ..................... 40 DECUBI-VITE CAP ............................. 95 deep sea spr 0.65% .......................... 42 DEKAS CAP ESSENTIA ....................... 92 DEKAS CHW BARIATRI .................... 106 DEKAS LIQ ESSENTIA ....................... 93 DEKAS PLUS CAP .............................. 95 DEKAS PLUS CHW .......................... 106 DEKAS PLUS LIQ ............................ 110 delsym cough liq congs dm ................ 46 delta d3 tab 400unit.......................... 86 deltasone tab 20mg .......................... 14 delyla tab 0.1-0.02 ........................... 16 denta 5000 cre plus ........................ 132 denta 5000 cre plus 2pk .................. 132 dentagel gel 1.1% .......................... 132 dermafungal oin 2% ....................... 137 dermarest lot 1% ........................... 140 DERMAVITE TAB ............................... 98 desenex cre 1% ............................. 136 desenex pow 2% ............................ 137 desmopressin acetate nasal spray soln 0.01%............................................. 24 desmopressin acetate nasal spray soln 0.01% (refrigerated) ......................... 24 desmopressin acetate tab 0.1 mg ....... 24 desmopressin acetate tab 0.2 mg ....... 24 desogest-eth estrad & eth estrad tab 0.15-0.02/0.01 mg(21/5) .................. 18 desogestrel & ethinyl estradiol tab 0.15 mg-30 mcg ...................................... 16
desonide cream 0.05% ................... 138 desonide lotion 0.05% .................... 138 desonide oint 0.05% ....................... 138 desoximetasone cream 0.05% ......... 138 desoximetasone cream 0.25% ......... 138 desoximetasone gel 0.05% .............. 138 desoximetasone oint 0.25% ............ 138 dexamethasone elixir 0.5 mg/5ml ...... 13 dexamethasone sodium phosphate ophth soln 0.1% ..................................... 130 dexamethasone soln 0.5 mg/5ml........ 13 dexamethasone tab 0.5 mg ............... 13 dexamethasone tab 0.75 mg ............. 13 dexamethasone tab 1 mg .................. 13 dexamethasone tab 1.5 mg ............... 13 dexamethasone tab 2 mg .................. 13 dexamethasone tab 4 mg .................. 13 dexamethasone tab 6 mg .................. 13 dextromethorphan-guaifenesin syrup 10-100 mg/5ml................................ 48 DIABET HLTH PAK SUPPORT ............ 108 diabet tuss syp allergy ...................... 36 DIABETES PAK HEALTH ................... 108 DIABETES PAK SUPPORT ................. 108 diabetic sup tab formula .................... 98 diabetic tus liq 100/5ml ..................... 43 diabetic tus liq children ..................... 47 diabetic tus liq dm ............................ 47 diabetic tus liq max st ....................... 47 diabets hlth tab formula .................... 98 diabtc tussn syp 100/5ml .................. 43 DIALYVIT 800 TAB ZINC 15 ............... 91 dialyvite d cap 5000unit .................... 86 dialyvite tab 800 .............................. 90 dialyvite tab 800/d ........................... 98 DIALYVITE TAB 800/IRON ................. 91 DIALYVITE TAB 800/ZINC ................. 91 diamode tab 2mg ............................. 55 diarrhea rel sus 262/15ml ................. 56 diarrhea sus 262/15ml ...................... 56 diclofenac potassium tab 50 mg ......... 78 diclofenac sodium gel 1% ................ 137 diclofenac sodium ophth soln 0.1% ... 131 diclofenac sodium tab delayed release 25 mg ................................................. 78 diclofenac sodium tab delayed release 50 mg ................................................. 78
192
diclofenac sodium tab delayed release 75 mg ................................................. 78 diclofenac sodium tab er 24hr 100 mg .78 dicloxacillin sodium cap 250 mg ........... 3 dicloxacillin sodium cap 500 mg ........... 3 dicyclomine hcl cap 10 mg ................. 62 dicyclomine hcl oral soln 10 mg/5ml.... 62 dicyclomine hcl tab 20 mg ................. 62 diflorasone diacetate cream 0.05% ... 138 diflorasone diacetate oint 0.05% ...... 138 diflunisal tab 500 mg ........................ 73 DI-GEL SUS ..................................... 59 digestive cap health .......................... 57 digestive cap probioti ........................ 57 digitek tab 0.125mg .......................... 25 digitek tab 0.25mg ........................... 25 digox tab 0.125mg ........................... 25 digox tab 0.25mg ............................. 25 digoxin oral soln 0.05 mg/ml ............. 25 digoxin tab 125 mcg (0.125 mg) ........ 25 digoxin tab 250 mcg (0.25 mg) .......... 25 DILANTIN CAP 30MG ........................ 83 diltiazem hcl cap er 12hr 120 mg ........ 27 diltiazem hcl cap er 12hr 60 mg .......... 27 diltiazem hcl cap er 12hr 90 mg .......... 27 diltiazem hcl cap er 24hr 120 mg ........ 27 diltiazem hcl cap er 24hr 180 mg ........ 27 diltiazem hcl cap er 24hr 240 mg ........ 27 diltiazem hcl coated beads cap er 24hr 120 mg ........................................... 28 diltiazem hcl coated beads cap er 24hr 180 mg ........................................... 28 diltiazem hcl coated beads cap er 24hr 240 mg ........................................... 28 diltiazem hcl coated beads cap er 24hr 300 mg ........................................... 28 diltiazem hcl coated beads cap er 24hr 360 mg ........................................... 28 diltiazem hcl coated beads tab er 24hr 180 mg ........................................... 28 diltiazem hcl coated beads tab er 24hr 240 mg ........................................... 28 diltiazem hcl coated beads tab er 24hr 300 mg ........................................... 28 diltiazem hcl coated beads tab er 24hr 360 mg ........................................... 28 diltiazem hcl coated beads tab er 24hr
420 mg ........................................... 28 diltiazem hcl extended release beads cap er 24hr 120 mg ................................ 27 diltiazem hcl extended release beads cap er 24hr 180 mg ................................ 27 diltiazem hcl extended release beads cap er 24hr 240 mg ................................ 27 diltiazem hcl extended release beads cap er 24hr 300 mg................................ 28 diltiazem hcl extended release beads cap er 24hr 360 mg................................ 28 diltiazem hcl extended release beads cap er 24hr 420 mg................................ 28 diltiazem hcl tab 120 mg ................... 27 diltiazem hcl tab 30 mg ..................... 27 diltiazem hcl tab 60 mg ..................... 27 diltiazem hcl tab 90 mg ..................... 27 dilt-xr cap 120mg ............................ 27 dilt-xr cap 180mg ............................ 27 dilt-xr cap 240mg ............................ 27 dino-life chw .................................. 109 dino-life chw extra c ....................... 110 DINO-LIFE CHW IRON-ZIN .............. 111 diocto liq 50mg/5ml.......................... 54 diocto syp 60/15ml ........................... 54 diphedryl liq 12.5/5ml ....................... 37 diphen tab 25mg .............................. 37 diphenhist cap 25mg ........................ 36 diphenhist liq 12.5/5ml ..................... 37 diphenhist tab 25mg......................... 37 diphenhydramine hcl (sleep) tab 50 mg ...................................................... 70 diphenhydramine hcl cap 25 mg ......... 36 diphenhydramine hcl cap 50 mg ......... 37 diphenhydramine hcl elixir 12.5 mg/5ml ...................................................... 38 diphenhydramine hcl liquid 12.5 mg/5ml ...................................................... 37 diphenhydramine hcl tab 25 mg ......... 37 diphenoxylate w/ atropine liq 2.5-0.025 mg/5ml........................................... 55 diphenoxylate w/ atropine tab 2.5-0.025 mg ................................................. 55 dipyridamole tab 25 mg .................. 127 dipyridamole tab 50 mg .................. 127 dipyridamole tab 75 mg .................. 127 disney cars chw gummies ................ 110
193
disopyramide phosphate cap 100 mg ..28 disopyramide phosphate cap 150 mg ..29 dm max adult liq 20-400 ................... 46 d-natural-5 cap ................................ 87 docu liq 50mg/5ml ............................ 54 docu soft cap 100mg ......................... 53 docusate calcium cap 240 mg............. 53 docusate sod liq 50mg/5ml ................ 54 docusate sodium cap 100 mg ............. 53 docusate sodium cap 250 mg ............. 53 docusate sodium liquid 150 mg/15ml .. 54 docusate sodium syrup 60 mg/15ml .... 54 docusate sodium tab 100 mg ............. 53 docusil cap 100mg ............................ 53 docuzen tab 8.6-50mg ...................... 54 dofetilide cap 125 mcg (0.125 mg) ..... 29 dofetilide cap 250 mcg (0.25 mg) ....... 29 dofetilide cap 500 mcg (0.5 mg) ......... 29 dofus cap ........................................ 57 dok cap 100mg ................................ 53 dok cap 250mg ................................ 53 dok plus tab 50-8.6mg ...................... 54 dok plus tab 8.6-50mg ...................... 54 dok tab 100mg ................................. 53 donepezil hydrochloride orally disintegrating tab 10 mg ................... 70 donepezil hydrochloride orally disintegrating tab 5 mg ..................... 70 donepezil hydrochloride tab 10 mg ...... 70 donepezil hydrochloride tab 23 mg ...... 70 donepezil hydrochloride tab 5 mg ....... 70 dorzolamide hcl ophth soln 2% ......... 131 dorzolamide hcl-timolol maleate ophth soln 22.3-6.8 mg/ml ....................... 130 DORZOLAMIDE SOL 2% .................. 131 DOSOQUIN TAB ............................... 88 double antib oin ............................. 135 double oin antibiot .......................... 135 doxazosin mesylate tab 1 mg ............. 30 doxazosin mesylate tab 2 mg ............. 30 doxazosin mesylate tab 4 mg ............. 30 doxazosin mesylate tab 8 mg ............. 30 doxercalciferol cap 0.5 mcg................ 24 doxercalciferol cap 1 mcg .................. 25 doxercalciferol cap 2.5 mcg................ 25 doxycycline hyclate cap 100 mg .......... 5 doxycycline hyclate cap 50 mg ............ 5
doxycycline hyclate tab 100 mg ........... 5 doxycycline hyclate tab 20 mg ............. 5 doxycycline monohydrate for susp 25 mg/5ml............................................. 5 DOXYCYCLINE POW HYCLATE .............. 5 dr edwards tab 8.6mg ....................... 52 dr gs clear sol nail 1% .................... 136 dramamine tab 25mg ....................... 64 dronabinol cap 10 mg ....................... 64 dronabinol cap 2.5 mg ...................... 64 dronabinol cap 5 mg ......................... 64 DROPLET LANC MIS 30G ................. 154 drospirenone-ethinyl estradiol tab 3-0.02 mg ................................................. 16 drospirenone-ethinyl estradiol tab 3-0.03 mg ................................................. 16 drs choice tab men ........................... 98 dry eye cap formula .......................... 95 dry eye relf oin night ...................... 130 ducodyl tab 5mg ec .......................... 51 dulcolax pnk cap 100mg .................... 53 dulcolax ss cap 100mg ...................... 53 DULERA AER 100-5MCG .................... 49 DULERA AER 200-5MCG .................... 49 DUREX EXTRA MIS SENSITIV ........... 166 DUREX MIS REALFEEL ..................... 167 dyna-hex 2 sol 2% ......................... 142 dyna-hex 4 sol 4% ......................... 142 dyspel tab 200mg ............................ 79 E e.e.s. 400 tab 400mg ......................... 4 e-400 cap selenium .......................... 87 ear drops dro 6.5% ........................ 131 ear drops sol 6.5% ot ..................... 131 ear health tab formula .................... 115 ear health tab plus ......................... 115 ear wax kit sol 6.5% ot ................... 131 ear wax remv dro 6.5% ot ............... 131 ear wax remv sol 6.5% ot ............... 132 ear wax sol 6.5% ........................... 132 EARLOOP MIS MASK ....................... 152 EAR-LOOP MIS MASK SM................. 152 earwax remov dro kit ...................... 132 earwax remov dro system ............... 132 earwax remov sol 6.5% .................. 132 earwax remv sol 6.5% ot ................ 132 earwax sol removal ........................ 132
194
EASIVENT MIS ............................... 149 EASIVENT MIS MASK LG ................. 149 EASIVENT MIS MASK MED ............... 149 EASIVENT MIS MASK SM ................. 149 EASY AIR COM MIS NEBULIZE .......... 150 EASY COMFORT MIS 30G ................. 154 EASY COMFORT MIS 31GX3/16 ........ 145 EASY COMFORT MIS 31GX5/16 ........ 146 EASY COMFORT MIS 32GX5/32 ........ 146 EASY COMFORT MIS LANC/30G ........ 154 EASY COMFORT MIS TWIST ............. 154 EASY NEB MIS................................ 150 EASY RELEASE PAD NONSTICK ........ 166 EASY TOUCH MIS 31GX3/16 ............ 145 EASY TOUCH MIS 31GX5/16 ............ 146 EASY TOUCH MIS 32GX1/4 .............. 147 EASY TOUCH MIS 32GX5/32 ............ 146 EASY TOUCH MIS 32GX6MM ............ 147 EASY TOUCH MIS LANC/21G ............ 154 EASY TOUCH MIS LANC/23G ............ 154 EASY TOUCH MIS LANC/26G ............ 154 EASY TOUCH MIS LANC/28G ............ 154 EASY TOUCH MIS LANC/30G ............ 154 EASY TOUCH MIS LANC/32G ............ 154 EASY TOUCH MIS LANC/33G ............ 154 easy-c tab 500mg ............................. 92 easy-lax cap 100mg .......................... 53 easy-lax pls tab 8.6-50mg ................. 55 easy-melts tab 80mg ........................ 76 EBASE CONTRO MIS KIT ................. 147 ecee plus tab ................................... 87 econtra ez tab 1.5mg ........................ 15 econtra os tab 1.5mg ........................ 15 ecotrin low tab 81mg ec .................... 73 ecotrin tab 325mg ............................ 73 ecpirin tab 325mg ec ........................ 73 ed chlorped syp jr ............................. 36 ed-apap liq 80mg/2.5 ....................... 75 ed-spaz tab 0.125mg ........................ 61 effer-k tab 25meq ef ....................... 121 EFLOW SCF MIS AEROSOL ............... 147 EFLOW SCF MIS NEBULIZR .............. 150 ELDERTONIC ELX ........................... 107 ELIGARD INJ 22.5MG ........................ 10 ELIGARD INJ 30MG ........................... 10 ELIGARD INJ 45MG ........................... 10 ELIGARD INJ 7.5MG .......................... 10
elinest tab ....................................... 17 ELIQUIS ST P TAB 5MG ................... 127 ELIQUIS TAB 2.5MG ....................... 127 ELIQUIS TAB 5MG .......................... 127 ELITE COMPRS MIS NEBULIZR ......... 150 ELITE DC AUT MIS ADAPTER ............ 147 ELITE SYSTEM MIS NEBULIZR.......... 150 elite-ob tab ................................... 114 ELIXOPHYLLIN ELX 80/15ML .............. 49 ELLA TAB 30MG ............................... 16 ELON MATRIX TAB 5000 ................. 113 ELON MATRIX TAB 5000 COM .......... 113 ELON MATRIX TAB COMPLETE .......... 113 ELON MATRIX TAB PLUS ................. 113 ELON R3 TAB ................................. 113 EMBRACE LANC MIS THIN 30G ........ 154 EMEND SUS 125MG .......................... 64 EMERGEN-C CHW IMMUNE/D ........... 106 EMERGEN-C CHW VITA C ................ 106 EMERGEN-C PAK BLUE .................... 108 EMERGEN-C PAK FIVE..................... 108 EMERGEN-C PAK HEART .................. 108 EMERGEN-C PAK IMMUNE ............... 108 EMERGEN-C PAK JOINT................... 108 EMERGEN-C PAK KIDZ .................... 108 EMERGEN-C PAK MSM LITE ............. 108 EMERGEN-C PAK PINK .................... 108 EMERGEN-C PAK SUPER FR ............. 108 EMERGEN-C PAK VIT D/CA .............. 108 EMERGEN-C PAK VITA C ................. 108 emoquette tab ................................. 16 emulsified liq omega-3.................... 123 EMVERM CHW 100MG ......................... 8 enalapril maleate & hydrochlorothiazide tab 10-25 mg .................................. 31 enalapril maleate & hydrochlorothiazide tab 5-12.5 mg ................................. 31 enalapril maleate tab 10 mg .............. 29 enalapril maleate tab 2.5 mg ............. 29 enalapril maleate tab 20 mg .............. 29 enalapril maleate tab 5 mg ................ 29 ENBREL INJ 25/0.5ML ....................... 81 ENBREL INJ 25MG ............................ 81 ENBREL INJ 50MG/ML ....................... 81 ENBREL MINI INJ 50MG/ML ............... 81 ENBREL SRCLK INJ 50MG/ML ............. 81 ENCARE SUP 100MG ......................... 68
195
endocet tab 10-325mg ...................... 78 endocet tab 2.5-325 ......................... 77 endocet tab 5-325mg ........................ 77 endocet tab 7.5-325 ......................... 78 endur-b tab ..................................... 90 ENDUR-VM TAB .............................. 105 ENDUR-VM TAB IRON ...................... 105 ENERGY POW BOOSTER .................. 108 enoxaparin sodium inj 100 mg/ml ..... 126 enoxaparin sodium inj 120 mg/0.8ml 126 enoxaparin sodium inj 150 mg/ml ..... 126 enoxaparin sodium inj 30 mg/0.3ml .. 126 enoxaparin sodium inj 300 mg/3ml ... 126 enoxaparin sodium inj 40 mg/0.4ml .. 126 enoxaparin sodium inj 60 mg/0.6ml .. 126 enoxaparin sodium inj 80 mg/0.8ml .. 126 enpresse-28 tab ............................... 18 enskyce tab ..................................... 16 entacapone tab 200 mg ..................... 83 entecavir tab 0.5 mg .......................... 7 entecavir tab 1 mg ............................ 7 enteric asa tab 325mg ...................... 73 ENTRE-HIST LIQ 0.938-10 ................. 45 ENTRESTO TAB 24-26MG ................... 35 ENTRESTO TAB 49-51MG ................... 35 ENTRESTO TAB 97-103MG ................. 35 enulose sol 10gm/15 ......................... 66 enviro-stres tab ................................ 98 epinephrine solution auto-injector 0.15 mg/0.15ml (1:1000) ......................... 33 epinephrine solution auto-injector 0.3 mg/0.3ml (1:1000) ........................... 33 EPIPEN-JR INJ 0.15MG ...................... 33 EPIVIR HBV SOL 5MG/ML.................... 7 eplerenone tab 25 mg ....................... 30 eplerenone tab 50 mg ....................... 30 epoprostenol sodium for inj 0.5 mg ..... 35 epoprostenol sodium for inj 1.5 mg ..... 35 eq 1% hydroc cre ........................... 139 eq acetamin tab 500mg ..................... 74 eq acetamin tab 80mg ...................... 76 eq allergy cap 25mg ......................... 36 eq antacid chw 1000mg..................... 59 eq antacid chw 160-105 .................... 59 eq antacid chw 750mg ...................... 59 eq antacid sus .................................. 60 eq antacid sus anti-gas ..................... 60
eq antacid sus max st ....................... 61 eq aspirin tab 325mg ........................ 72 eq aspirin tab 325mg ec.................... 73 eq aspirin tab 500mg ec.................... 73 eq calcium tab citr+d ...................... 120 eq child asa chw 81mg ..................... 72 eq chlortabs tab 4mg ........................ 36 eq cimetidin tab 200mg .................... 62 eq clearlax pow ................................ 54 EQ COMPLETE TAB ADULT ................. 98 eq dayhist tab 1.34mg ...................... 36 eq ear wax sol removal ................... 132 eq gentle dro 0.3% ........................ 128 eq heartburn tab relief ...................... 62 eq hydrocort cre 1% ....................... 139 eq ibuprofen tab 200mg .................... 79 eq laxative chw 15mg ....................... 53 eq laxative tab 25mg ........................ 52 eq laxative tab 8.6mg ....................... 52 eq lubricant dro eye drop ................ 129 eq mucus er tab 600mg .................... 44 eq multivita chw gummies ............... 110 EQ ONE DAILY TAB MENS ................. 98 eq one daily tab womens .................. 98 EQ ONE DAILY TAB WOMENS ............. 98 eq restore oin pm ........................... 129 eq revive pl dro 0.5% op ................. 128 eq senna-s tab 8.6-50mg .................. 55 eq sleep aid cap 50mg ...................... 69 eq stomach chw 262mg .................... 56 eq stool cap softener ........................ 53 EQ STRONG MIS STRIPS ................. 163 eq suphedrin tab 30mg ..................... 40 eq triple oin antibiot ....................... 135 eq tussin dm liq max ........................ 47 eq tussin dm syp cgh/chst ................. 48 eql acetamin tab 160mg ................... 76 eql acetamin tab 325mg ................... 73 eql acetamin tab 500mg ................... 74 eql all day tab allergy ....................... 38 eql allergy tab 10-240mg .................. 45 eql allergy tab 25mg ........................ 37 eql allergy tab 4mg .......................... 36 eql allergy tab chldrn ........................ 38 eql antacid chw 1000mg ................... 59 eql antacid chw 750mg ..................... 59 eql antacid chw fruit ......................... 58
196
eql antacid chw pepprmnt ................. 58 eql antacid sus anti-gas..................... 60 eql arthrts tab 650mg ....................... 74 eql aspirin chw 81mg ........................ 72 eql aspirin tab 325mg ....................... 72 eql aspirin tab 325mg ec ................... 73 eql b complx tab 50 .......................... 89 eql b-100 tab complex ...................... 90 EQL BUTTERFL MIS CLOSURE .......... 163 eql calcium tab citr/d3 ..................... 120 eql calcium tab w/vit d .................... 118 eql century tab ................................. 98 eql century tab mature ...................... 98 EQL CENTURY TAB MENS ................... 98 EQL CENTURY TAB WOMENS .............. 98 eql clearlax pow ............................... 54 EQL FIRST MIS AID BAND ............... 163 eql firstaid oin antibiot..................... 135 eql fish oil cap 1000mg ................... 122 eql fish oil cap 1200mg ................... 123 EQL FLEXIBLE MIS FABRIC .............. 163 EQL FLEXIBLE MIS FOAM ................. 163 eql gas gone chw 125mg ................... 65 eql gas rlf cap 180mg ........................ 65 EQL GENTLE MIS STRIPS ................. 163 eql gentle tab laxative ....................... 51 eql heartbrn tab 10mg ...................... 62 eql heartbur tab 150mg ..................... 62 EQL HVY DUTY MIS STRIPS ............. 163 eql ibuprofn tab 200mg ..................... 79 EQL LANCETS MIS 21G COLR ........... 155 EQL LANCETS MIS 33G COLR ........... 155 EQL LANCETS MIS THIN 26G ........... 155 EQL LANCETS MIS THIN 30G ........... 155 eql laxative chw 15mg ....................... 53 eql laxative tab 25mg........................ 52 eql laxative tab 5mg ec ..................... 51 eql motion tab sickness ..................... 64 eql mucus-dm tab 30-600cr ............... 48 eql mucus-dm tab 60-1200 ................ 48 eql mucus-er tab 1200mg .................. 44 eql naproxen cap 220mg ................... 80 EQL PLASTIC MIS STRIPS ................ 163 EQL SHEER MIS SPOTS ................... 163 EQL SHEER MIS STRIPS .................. 163 eql sleep tab aid ............................... 69 eql stomach chw 262mg .................... 56
eql stool tab softener ........................ 55 EQL STRIPS MIS ............................ 163 eql tussin liq 10-200 ......................... 47 eql tussin syp dm ............................. 48 eql vision tab formula ....................... 98 eql vitamin cap d3 ............................ 86 ERAPID MIS NEBULIZE ................... 150 ERAPID NEB MIS HANDSET ............. 147 ergocalciferol cap 50000 unit ............. 85 ergocalciferol soln 8000 unit/ml ......... 85 ergotamine w/ caffeine tab 1-100 mg . 82 ERIVEDGE CAP 150MG ...................... 10 errin tab 0.35mg .............................. 15 erythrocin tab 250mg ......................... 4 erythromycin ethylsuccinate for susp 200 mg/5ml............................................. 4 erythromycin ethylsuccinate tab 400 mg ........................................................ 4 erythromycin gel 2% ...................... 134 erythromycin ophth oint 5 mg/gm .... 127 ERYTHROMYCIN POW ......................... 4 ERYTHROMYCIN POW ETHYLSUC .......... 4 erythromycin soln 2%..................... 134 erythromycin tab 250 mg .................... 4 erythromycin tab 500 mg .................... 4 erythromycin w/ delayed release particles cap 250 mg .......................... 4 ESCAVITE CHW .............................. 112 esgic cap ......................................... 76 eskimo-3 cap 500mg ...................... 122 eskimo-3 liq .................................. 123 esomepra mag cap 20mg dr .............. 63 essent one tab daily........................ 109 essentia tab ..................................... 98 essential tab balance ........................ 98 essentl one tab daily ......................... 93 estarylla tab 0.25-35 ........................ 17 ester-c tab ...................................... 92 ester-c tab 1000mg .......................... 92 ester-c tab 500mg............................ 92 estradiol & norethindrone acetate tab 0.5-0.1 mg ...................................... 14 estradiol & norethindrone acetate tab 1-0.5 mg......................................... 14 estradiol tab 0.5 mg ......................... 14 estradiol tab 1 mg ............................ 14 estradiol tab 2 mg ............................ 14
197
estradiol td patch weekly 0.025 mg/24hr ......................................................14 estradiol td patch weekly 0.0375 mg/24hr (37.5 mcg/24hr) ................. 14 estradiol td patch weekly 0.05 mg/24hr ......................................................14 estradiol td patch weekly 0.06 mg/24hr ......................................................14 estradiol td patch weekly 0.075 mg/24hr ......................................................14 estradiol td patch weekly 0.1 mg/24hr 14 estradiol vaginal tab 10 mcg .............. 68 ESTROFACTORS TAB ......................... 93 ethambutol hcl tab 100 mg ................. 6 ethambutol hcl tab 400 mg ................. 6 ETHAMBUTOL POW HCL ...................... 6 ethosuximide cap 250 mg .................. 83 ethosuximide soln 250 mg/5ml........... 83 ethynodiol diacetate & ethinyl estradiol tab 1 mg-35 mcg .............................. 16 ethynodiol diacetate & ethinyl estradiol tab 1 mg-50 mcg .............................. 16 etodolac cap 200 mg ......................... 78 etodolac cap 300 mg ......................... 78 etodolac tab 400 mg ......................... 78 etodolac tab 500 mg ......................... 78 etodolac tab er 24hr 400 mg .............. 78 etodolac tab er 24hr 500 mg .............. 78 etodolac tab er 24hr 600 mg .............. 78 etoposide cap 50 mg ......................... 10 euthyrox tab 100mcg ........................ 22 euthyrox tab 112mcg ........................ 22 euthyrox tab 125mcg ........................ 22 euthyrox tab 137mcg ........................ 22 euthyrox tab 150mcg ........................ 22 euthyrox tab 175mcg ........................ 23 euthyrox tab 200mcg ........................ 23 euthyrox tab 25mcg .......................... 21 euthyrox tab 50mcg .......................... 22 euthyrox tab 75mcg .......................... 22 euthyrox tab 88mcg .......................... 22 EVAC-U-GEN CHW 10MG ................... 53 evac-u-gen tab 8.6mg ....................... 52 EVOLUTION60 POW ........................ 108 ex cleansing sol ................................ 68 exemestane tab 25 mg ...................... 10 ex-lax ultra tab 5mg ec ..................... 51
extra action syp 10-100/5 ................. 48 extress tab ...................................... 89 extress- tab super ............................ 89 EXTRESS-30 CAP ............................. 89 eye drops dro 0.25% ...................... 128 eye drops dro 0.5-0.9% .................. 129 eye health & tab lutein ...................... 98 EYE HEALTH CAP .............................. 95 eye itch rel dro 0.025% .................. 131 eye itch rel dro 0.025%op ............... 131 eye itch sol relief ............................ 131 eye lubrican oin op .................. 129, 130 eye vitamins cap .............................. 95 eyeprotect tab ................................. 98 eye-vites tab ................................... 98 E-Z JECT MIS 21G .......................... 154 E-Z JECT MIS 21G COLR ................. 154 E-Z JECT MIS 30G .......................... 154 E-Z JECT MIS 32G COLR ................. 154 E-Z JECT MIS LANC 21G ................. 154 E-Z JECT MIS THIN 26G .................. 154 EZ SMART MIS LANCETS ................. 155 ezetimibe tab 10 mg ......................... 33 E-ZJECT LANC MIS 33G ................... 154 EZ-LETS 21G MIS LANCETS ............. 155 EZ-LETS 23G MIS LANCETS ............. 155 EZ-LETS 26G MIS LANCETS ............. 155 EZ-LETS 28G MIS LANCETS ............. 155 EZ-LETS 30G MIS LANCETS ............. 155 F fa-8 tab 0.8mg............................... 123 fabb tab 2.2-25-1 ........................... 126 FABRIC BANDG MIS ASSORTED ....... 163 FABRIC BANDG MIS FLEXIBLE ......... 163 FACE MASK MIS EARLOOP ............... 152 FACE MASK MIS N-100 ................... 152 FACE MASK MIS R95 PART .............. 152 falmina tab ...................................... 16 famciclovir tab 125 mg ....................... 7 famciclovir tab 250 mg ....................... 7 famciclovir tab 500 mg ....................... 7 famotidine for susp 40 mg/5ml .......... 63 famotidine tab 10 mg ....................... 63 famotidine tab 20 mg ....................... 63 famotidine tab 20mg ........................ 63 famotidine tab 40 mg ....................... 63 FANTASY LUBR MIS ........................ 166
198
FANTASY LUBR MIS COLORS ........... 166 FANTASY LUBR MIS SPERMICI ......... 166 FANTASY MIS LUBRICAT ................. 166 FARYDAK CAP 10MG ......................... 11 FARYDAK CAP 15MG ......................... 11 FARYDAK CAP 20MG ......................... 11 FASLODEX INJ 250/5ML .................... 10 fast relief sup 10mg .......................... 51 FASTCLIX MIS LANCETS .................. 155 FC FEMALE MIS CONDOM ................ 167 FC2 FEMALE MIS CONDOM .............. 167 fe tabs tab 325mg ec ...................... 124 feenamint tab 5mg ec ....................... 51 felodipine tab er 24hr 10 mg .............. 28 felodipine tab er 24hr 2.5 mg ............. 28 felodipine tab er 24hr 5 mg ............... 28 feminine car sol douche ..................... 68 femynor tab 0.25-35 ......................... 17 fenesin ir tab 400mg ......................... 43 fenofibrate micronized cap 134 mg ..... 33 fenofibrate micronized cap 200 mg ..... 33 fenofibrate micronized cap 67 mg ....... 33 fenofibrate tab 145 mg ...................... 33 fenofibrate tab 160 mg ...................... 33 fenofibrate tab 48 mg ....................... 33 fenofibrate tab 54 mg ....................... 33 fentanyl td patch 72hr 100 mcg/hr ..... 76 fentanyl td patch 72hr 12 mcg/hr ....... 76 fentanyl td patch 72hr 25 mcg/hr ....... 76 fentanyl td patch 72hr 50 mcg/hr ....... 76 fentanyl td patch 72hr 75 mcg/hr ....... 76 ferate tab 27mg ............................. 125 fergon tab 27mg............................. 125 ferosul elx 220/5ml ......................... 124 ferosul tab 325mg .......................... 124 FERRETTS TAB 325MG .................... 125 ferrocite tab 324mg ........................ 125 ferrotabs tab .................................. 125 ferrous fumarate tab 324 mg (106 mg elemental fe) ................................. 125 ferrous gluc tab 324mg ................... 125 ferrous gluconate tab 240 mg (27 mg elemental fe) ................................. 125 ferrous gluconate tab 324 mg (37.5 mg elemental iron)............................... 125 FERROUS SULF TAB 324MG EC ......... 124 ferrous sulf tab 325mg .................... 124
ferrous sulf tab 65mg ..................... 124 ferrous sulfate elixir 220 mg/5ml (44 mg/5ml elemental fe) ..................... 124 ferrous sulfate soln 75 mg/ml (15 mg/ml elemental fe) ................................. 124 ferrous sulfate tab 27 mg (elemental fe) .................................................... 124 ferrous sulfate tab 325 mg (65 mg elemental fe) ................................. 124 ferrous sulfate tab ec 325 mg (65 mg fe equivalent) .................................... 124 ferrous sulfate tab er 142 mg (45 mg fe equivalent) .................................... 124 ferrousul tab 325mg ....................... 124 fever reduce sup 120mg ................... 76 fever/pain sus 160/5ml ..................... 75 FEVERALL INF SUP 80MG .................. 75 feverall sup 120mg ........................... 76 feverall sup 325mg ........................... 76 feverall sup 650mg ........................... 76 fevr reducng sup 120mg ................... 76 fexofenadine hcl tab 180 mg .............. 39 fexofenadine hcl tab 60 mg ............... 39 fexofenadine tab 180mg ................... 39 fexofenadine tab 60mg ..................... 39 fexofenadine-pseudoephedrine tab er 12hr 60-120 mg ............................... 45 fexofenadine-pseudoephedrine tab er 24hr 180-240 mg ............................. 45 FIFTY50 MIS 31GX3/16 ................... 145 FIFTY50 MIS 31GX5/16 ................... 146 FIFTY50 MIS 31GX5MM ................... 145 FIFTY50 PEN MIS 31GX8MM ............ 146 FIFTY50 PEN MIS 32GX4MM ............ 146 FIFTY50 PEN MIS 32GX6MM ............ 147 FIFTY50 PREP PAD PADS ................. 168 FIFTY50 SAFE MIS LANCETS ............ 155 FILTER AIR MIS PP ......................... 147 finasteride tab 5 mg ......................... 69 FINE 30 MIS .................................. 155 finest fish liq oil .............................. 123 finest fish liq oil/kids ....................... 123 FINGERSTIX MIS LANCETS .............. 155 FIRST AID MIS ANTIBACT ............... 164 FIRST AID MIS FLEX FAB ................. 164 FIRST AID MIS SHEER .................... 164 FIRST AID NO PAD STICK ................ 166
199
first aid oin antibiot ........................ 135 first aid sol 10% ............................. 142 FIRST-VANC SOL 25MG/ML................. 9 FIRST-VANC SOL 50MG/ML................. 9 FISH OIL CAP 1000MG .................... 122 fish oil cap 1200mg ........................ 123 FISH OIL CAP 1360MG .................... 123 FISH OIL CAP 1400MG .................... 122 fish oil cap 300mg .......................... 122 fish oil cap 435mg .......................... 122 fish oil cap 500mg .......................... 122 fish oil chw gummies ...................... 123 fish oil con cap 1000mg................... 122 fish oil con cap 300mg .................... 122 FITNESS TABS TAB MEN .................... 98 FITNESS TABS TAB WOMEN ............... 98 flanax pain tab 220mg ...................... 80 flavor chews chw 750mg ................... 59 flecainide acetate tab 100 mg ............ 29 flecainide acetate tab 150 mg ............ 29 flecainide acetate tab 50 mg .............. 29 FLEX BANDAGE MIS ........................ 164 flexgen tab ...................................... 92 FLEXICHAMBER MIS........................ 149 FLEXICHAMBER MIS MASK LRG ........ 150 FLEXICHAMBER MIS MASK SM ......... 150 flintstones chw bone bld .................. 111 flintstones chw complete ................. 111 flintstones chw extra c .................... 110 flintstones chw my first ................... 109 flintstones chw omega-3 ................. 109 flintstones chw pls calc .................... 109 FLINTSTONES CHW TODDLER .......... 111 flnston plus chw iron ....................... 111 flora assist pak ................................. 57 FLORAJEN CAP ACIDOPHI .................. 57 floranex gra ..................................... 57 floranex tab ..................................... 57 FLORIVA DRO PLUS ........................ 112 FLOVENT DISK AER 100MCG .............. 50 FLOVENT DISK AER 250MCG .............. 50 FLOVENT DISK AER 50MCG ............... 50 FLOVENT HFA AER 110MCG ............... 50 FLOVENT HFA AER 220MCG ............... 50 FLOVENT HFA AER 44MCG ................. 50 fluconazole for susp 10 mg/ml ............ 6 fluconazole for susp 40 mg/ml ............ 7
fluconazole tab 100 mg ....................... 6 fluconazole tab 150 mg ....................... 6 fluconazole tab 200 mg ....................... 6 fluconazole tab 50 mg ......................... 6 fludrocortisone acetate tab 0.1 mg ..... 14 flunisolide nasal soln 25 mcg/act (0.025%) ........................................ 41 fluocinolone acetonide cream 0.025%138 fluocinolone acetonide oint 0.025% .. 138 fluocinolone acetonide soln 0.01% .... 138 fluocinonide cream 0.05% ............... 138 fluocinonide gel 0.05% ................... 138 fluocinonide oint 0.05% .................. 138 fluocinonide soln 0.05% .................. 138 fluoridex pst 1.1% .......................... 132 fluoritab chw 0.25mg f .................... 120 fluoritab chw 0.5mg f ...................... 120 fluoritab chw 1mg f ........................ 120 fluoritab chw 2.2mg........................ 120 fluoritab dro 0.125mg ..................... 120 fluorometholone ophth susp 0.1% .... 130 fluorouracil cream 5%..................... 138 flura-drops dro 0.25mg f ................. 120 flurbiprofen tab 100 mg .................... 78 flurbiprofen tab 50 mg ...................... 78 flutamide cap 125 mg ....................... 10 fluticasone propionate cream 0.05%. 138 fluticasone propionate nasal susp 50 mcg/act .......................................... 41 fluticasone propionate oint 0.005% .. 139 fluticasone spr 50mcg ....................... 41 fluticasone-salmeterol aer powder ba 100-50 mcg/dose ............................. 49 fluticasone-salmeterol aer powder ba 113-14 mcg/act ............................... 49 fluticasone-salmeterol aer powder ba 232-14 mcg/act ............................... 49 FLYP NEBULZR MIS......................... 150 foam antacid chw 80-20mg ............... 59 foam antacid sus .............................. 59 foaming face liq wsh 10% ............... 133 folbee tab ...................................... 126 folbic tab ....................................... 123 folic acid tab 1 mg .......................... 124 folic acid tab 1000mcg .................... 124 folic acid tab 400 mcg ..................... 123 folic acid tab 800mcg ...................... 124
200
folic acid-vitamin b6-vitamin b12 tab 2.2-25-0.5 mg ............................... 126 folplex 2.2 tab ................................ 126 fondaparinux sodium subcutaneous inj 10 mg/0.8ml .................................. 126 fondaparinux sodium subcutaneous inj 2.5 mg/0.5ml ................................. 126 fondaparinux sodium subcutaneous inj 5 mg/0.4ml ...................................... 126 fondaparinux sodium subcutaneous inj 7.5 mg/0.6ml ................................. 126 foot&sneaker aer 1% ...................... 136 for sty reli oin ................................ 130 FORA LANCETS MIS 30G.................. 155 FORA MIS LANCETS ........................ 155 formula 3 sol.................................. 136 FORTAVIT LIQ ................................ 107 fosinopril sodium & hydrochlorothiazide tab 10-12.5 mg ................................ 31 fosinopril sodium & hydrochlorothiazide tab 20-12.5 mg ................................ 31 fosinopril sodium tab 10 mg ............... 29 fosinopril sodium tab 20 mg ............... 29 fosinopril sodium tab 40 mg ............... 29 FREEDAVITE TAB .............................. 98 FREESTYLE MIS LANCETS ................ 155 FREESTYLE MIS UNISTICK ............... 155 FRUIT C CHW 200MG ........................ 92 fruity chews chw............................. 109 fruity chews chw /iron ..................... 111 FULL KIT NEB MIS SET .................... 147 FULL SPECT TAB B/ VIT C .................. 90 fungicure spr intens ........................ 136 fungi-guard cre 1% ......................... 136 fungoid-d cre 1%............................ 136 furosemide oral soln 10 mg/ml ........... 32 furosemide oral soln 8 mg/ml ............. 32 furosemide tab 20 mg ....................... 32 furosemide tab 40 mg ....................... 32 furosemide tab 80 mg ....................... 32 fyavolv tab 0.5-2.5 ........................... 15 fyavolv tab 1-5 ................................. 15 G g tussin ac liq 100-10/5 ..................... 46 galantamine hydrobromide cap er 24hr 16 mg ............................................. 70 galantamine hydrobromide cap er 24hr
24 mg ............................................. 70 galantamine hydrobromide cap er 24hr 8 mg ................................................. 70 galantamine hydrobromide oral soln 4 mg/ml ............................................ 70 galantamine hydrobromide tab 12 mg 70 galantamine hydrobromide tab 4 mg .. 70 galantamine hydrobromide tab 8 mg .. 70 gas relief cap 125mg ........................ 65 gas relief cap 180mg ........................ 65 gas relief chw 125mg ........................ 65 gas relief chw 80mg ......................... 65 gas relief dro 20/0.3ml ..................... 66 gas relief dro 40/0.6ml ..................... 66 gas relief dro infants ......................... 66 gas relief liq infants .......................... 66 gas-x cap 125mg ............................. 65 gas-x cap 180mg ............................. 65 GAS-X CHILD MIS 40MG ................... 66 GAS-X EX-STR MIS 62.5MG ............... 66 gas-x infant dro ............................... 66 gavilax pow ..................................... 54 gavilyte-c sol ................................... 55 gavilyte-g sol ................................... 55 gavilyte-n sol flav pk ........................ 55 gavis-care sus ................................. 59 GAVISCON CHW .............................. 59 GEL-ONE INJ 30MG/3ML ................... 84 gemfibrozil tab 600 mg ..................... 33 genahist cap 25mg ........................... 36 genaphed tab 30mg ......................... 40 generlac sol 10gm/15 ....................... 66 gengraf cap 100mg ........................ 169 gengraf cap 25mg .......................... 169 gengraf sol 100mg/ml .................... 169 genpril tab 200mg ............................ 79 gentak oin 0.3% op ........................ 127 GENTAMICIN POW SULFATE ............ 135 gentamicin sulfate cream 0.1% ........ 135 gentamicin sulfate oint 0.1% ........... 135 gentamicin sulfate ophth soln 0.3% .. 127 GENTEAL GEL 0.3% ........................ 128 GENTEAL MILD DRO 0.2% ............... 128 genteal tear oin nt-time .................. 130 genteal tear sol mild ....................... 129 genteal tear sol moderate................ 128 GENTEEL MIS LANCETS .................. 155
201
GENTIAN VIOL POW ........................ 135 gentle laxat sup 10mg ....................... 51 gentle laxat tab 5mg ec ..................... 51 gentlelax pow................................... 54 GENTLE-LET MIS 26G ...................... 155 GENTLE-LET MIS 28G ...................... 155 GENTLE-LET MIS LANCETS .............. 155 GERAVINE ELX ............................... 116 GERBR SOOTHE DRO COLIC............... 58 geriaton liq ...................................... 91 GERIATRIC LIQ VITAMIN ................... 91 geri-dryl cap 25mg ........................... 36 geri-dryl liq 12.5/5ml ........................ 37 geri-dryl tab 25mg ............................ 37 GERI-FREEDA TAB SENIOR ................ 98 geri-hydrola cre 12% ...................... 141 geri-hydrola lot 12% ....................... 141 geri-kot tab 8.6mg............................ 52 geri-lanta sus ................................... 60 geri-lanta sus supreme ...................... 59 geri-mox sus .................................... 60 geri-pectate sus 262/15ml ................. 56 geri-tussin syp 100/5ml..................... 43 geri-tussin syp dm ............................ 48 gerivite tab complete ........................ 98 GERM DEFENSE TAB LEM-LIME ......... 114 GERM DEFENSE TAB ORANGE .......... 114 GERM DEFENSE TAB PM .................. 114 g-fen ex tab 400mg .......................... 43 gianvi tab 3-0.02mg ......................... 16 GILENYA CAP 0.5MG ......................... 71 GILOTRIF TAB 20MG ......................... 11 GILOTRIF TAB 30MG ......................... 11 GILOTRIF TAB 40MG ......................... 11 giltuss cgh liq & chest........................ 47 GLASSIA INJ .................................... 50 glatiramer acetate soln prefilled syringe 20 mg/ml ........................................ 71 glatiramer acetate soln prefilled syringe 40 mg/ml ........................................ 71 glatopa inj 20mg/ml.......................... 71 glatopa inj 40mg/ml.......................... 71 GLEOSTINE CAP 100MG ..................... 9 GLEOSTINE CAP 10MG ....................... 9 GLEOSTINE CAP 40MG ....................... 9 g-levocarnit sol 1gm/10ml ............... 122 glimepiride tab 1 mg ......................... 20
glimepiride tab 2 mg ........................ 20 glimepiride tab 4 mg ........................ 20 glipizide tab 10 mg ........................... 20 glipizide tab 5 mg............................. 20 glipizide tab er 24hr 10 mg ............... 20 glipizide tab er 24hr 2.5 mg............... 20 glipizide tab er 24hr 5 mg ................. 20 glipizide xl tab 10mg ........................ 20 glipizide xl tab 2.5mg ....................... 20 glipizide xl tab 5mg .......................... 20 glipizide-metformin hcl tab 2.5-250 mg ...................................................... 21 glipizide-metformin hcl tab 2.5-500 mg ...................................................... 21 glipizide-metformin hcl tab 5-500 mg . 21 GLOBAL 28G MIS LANCETS .............. 155 GLOBAL 30G MIS LANCETS .............. 155 GLOBAL PREP PAD PADS ................. 168 GLUCAGEN INJ HYPOKIT ................... 21 GLUCAGON KIT 1MG......................... 20 GLUCO COR CAP ............................ 113 GLUCOCOM MIS 28G ...................... 155 GLUCOCOM MIS 30G ...................... 155 GLUCOCOM MIS 33G ...................... 155 glucoten cap .................................... 95 glyburide micronized tab 1.5 mg ........ 20 glyburide micronized tab 3 mg ........... 20 glyburide micronized tab 6 mg ........... 20 glyburide tab 1.25 mg ....................... 20 glyburide tab 2.5 mg ........................ 20 glyburide tab 5 mg ........................... 20 glyburide-metformin tab 1.25-250 mg 21 glyburide-metformin tab 2.5-500 mg .. 21 glyburide-metformin tab 5-500 mg ..... 21 glycine diluent for injection .............. 169 glycolax pow 3350 nf ........................ 54 glycopyrrolate tab 1 mg .................... 62 glycopyrrolate tab 2 mg .................... 62 GLYCO-TECH TAB ............................. 91 GLYCOTROL CAP ............................ 113 GLYCOTROL CAP COMPLETE ............ 113 gnp acetamin cap 500mg .................. 73 gnp acetamin tab 325mg................... 73 GNP ADHESIVE PAD 3 ..................... 166 GNP ALCOHOL PAD SWABS ............. 168 gnp all day tab allergy ...................... 38 gnp allergy cap 25mg ....................... 36
202
gnp allergy chw 12.5mg .................... 37 gnp allergy tab 180mg ...................... 39 gnp allergy tab 25mg ........................ 37 gnp allergy tab 4mg .......................... 36 gnp animal chw plus c ..................... 110 gnp animal chw shapes ................... 109 gnp antacid chw 1000mg ................... 59 gnp antacid chw 160-105 .................. 59 gnp antacid chw 550-110 .................. 59 gnp antacid sus anti-gas ................... 60 gnp antacid sus cherry ...................... 61 gnp antacid sus coolmint ................... 60 gnp antacid sus original..................... 61 gnp antacid sus reg st ....................... 60 gnp aspirin chw 81mg ....................... 72 gnp aspirin tab 325mg ...................... 72 gnp aspirin tab 325mg ec .................. 73 gnp aspirin tab 81mg ec .................... 73 gnp b-100 tab .................................. 89 gnp b-100 tab complex ..................... 90 gnp b-50 tab balanced ...................... 89 gnp b-50 tab complex ....................... 90 gnp bisa-lax tab 5mg ec .................... 51 gnp ca/mg/zn tab ........................... 120 gnp calcium tab 500/d..................... 117 gnp calcium tab 600/d..................... 117 gnp calcium tab cit +d3 ................... 120 gnp century tab ................................ 98 gnp century tab adult ........................ 98 gnp century tab cardio ...................... 98 GNP CENTURY TAB ENERGY ............. 113 gnp century tab mature ..................... 98 gnp century tab senior ...................... 99 gnp century tab ultimate ................... 99 gnp clearlax pak 3350 nf ................... 54 gnp clearlax pow .............................. 54 gnp d cap 1000unit ........................... 85 gnp d chw 2000unit .......................... 86 gnp dayhist tab 1.34mg..................... 36 gnp deconge tab 30mg ...................... 40 gnp ear dro 6.5% ot ....................... 132 gnp ear drop sol 6.5% ot ................. 132 gnp ear sys sol 6.5% ot .................. 132 gnp eye drop dro 0.4-0.3% .............. 129 gnp eye drop sol 0.5% op ................ 128 gnp fish oil cap ............................... 122 gnp fish oil cap 1000mg .................. 122
gnp gas relf chw 125mg .................... 65 gnp gas relf chw 80mg ...................... 65 gnp healthy tab eyes ........................ 99 gnp hydrocor cre 1% plus................ 139 gnp iron tab 325mg ........................ 124 gnp iron tab 45mg .......................... 124 gnp iron tab 65mg .......................... 124 gnp k-pec sus 262/15ml .................... 56 GNP LANCETS MIS.......................... 155 GNP LANCETS MIS 21G ................... 155 GNP LANCETS MIS MICRO ............... 155 GNP LANCETS MIS SUP THIN ........... 155 GNP LANCETS MIS THIN.................. 155 GNP LANCETS MIS THIN 26G ........... 155 gnp laxative sup 10mg ...................... 51 gnp laxative tab 25mg ...................... 52 gnp laxative tab 5mg ec .................... 51 gnp little chw ones ......................... 110 gnp masanti sus max st .................... 61 gnp masanti sus reg st ...................... 60 gnp mucus d tab 12hr ....................... 46 gnp mucus er tab 1200mg ................. 44 gnp mucus er tab 600mg .................. 44 gnp mucus liq rlf dm ......................... 46 gnp one dail tab maximum ................ 99 gnp opti-vit tab ................................ 99 gnp pediatri sol electrol ................... 121 GNP PLASTIC MIS 3/4 ..................... 164 gnp senna tab 8.6mg ........................ 52 GNP SHEER MIS STRIPS .................. 164 GNP SHEER ST MIS ASSORTED ........ 164 GNP SUPER MIS STRIP .................... 164 gnp suphedrn liq 15mg/5ml ............... 40 gnp triple oin antibiot ...................... 135 gnp tussin liq dm.............................. 47 gnp tussin liq dm cough .................... 47 gnp tussin liq dm max ....................... 47 gnp vit d tab 1000unit ...................... 86 gnp vit d tab 5000unit ...................... 86 gnp vit d3 tab 1000unit ..................... 86 gnp zoochews chw gummies ............ 110 GNTL ADHESVE MIS BNDG XL .......... 164 GOLYTELY SOL ................................. 55 GOODSENSE MIS LANC 26G ............ 155 GOODSENSE MIS LANC 30G ............ 155 GOODSENSE MIS LANC 33G ............ 155 gordons urea cre 40% .................... 141
203
granisetron hcl tab 1 mg ................... 64 grape seed cap 50mg ........................ 91 GREEN SOURCE TAB ....................... 113 griseofulvin microsize susp 125 mg/5ml 6 griseofulvin ultramicrosize tab 125 mg . 6 griseofulvin ultramicrosize tab 250 mg . 6 guaiasorb dm liq 100-10/5 ................ 47 guaiatussin syp 100-10/5 .................. 46 guaicon dms syp 100-10/5 ................ 48 guaifenesin liquid 100 mg/5ml ........... 43 guaifenesin syp 100-10/5 .................. 46 guaifenesin tab 200 mg ..................... 43 guaifenesin tab 400 mg ..................... 43 guaifenesin tab er 12hr 1200 mg ........ 44 guaifenesin-codeine soln 100-10 mg/5ml ......................................................46 guanfacine hcl tab 1 mg .................... 30 guanfacine hcl tab 2 mg .................... 30 gummi bear chw multivit ................. 110 gummies chw ................................. 110 gummy dinos chw .......................... 110 gummy dinos chw chldrn ................. 110 gummy multiv chw kids .................. 110 gummy vit/ chw minerals ................ 110 gynecort 10 cre 1% ........................ 140 GYNOL II GEL 3% ............................. 68 H H.P. ACTHAR INJ 80UNIT................... 24 HAEMOLANCE MIS HIGH FLO ........... 155 HAEMOLANCE MIS LOW FLOW ......... 155 HAEMOLANCE MIS PLUS .................. 155 HAEMOLANCE MIS PLUS LOW .......... 155 HAEMOLANCE MIS PLUS MAX ........... 155 HAEMOLANCE MIS PLUS PED ........... 155 HAEMOLANCE MIS RETRACT ............ 155 HAIR FARE TAB .............................. 113 hair formula tab ex stren ................... 99 hair formula tab ultr man .................. 99 HAIR NOURISH TAB SUPPLEMN ........ 113 HAIR SKIN & TAB NAILS AD ............... 99 hair skin tab nails ............................. 99 hair vitamin tab................................ 99 hair/skin cap nails ............................ 95 hair/skin/ cap nails ........................... 95 hair/skin/ tab nails .................... 99, 113 halobetasol propionate cream 0.05% 139 halobetasol propionate oint 0.05% ... 139
hand wash sol 2% .......................... 142 HARVONI TAB 90-400MG .................... 7 healthy eyes cap supervis.................. 95 healthy eyes tab .............................. 99 healthy eyes tab lutein...................... 99 healthy hair tab skn/nail.................... 93 healthy kids chw gummies .............. 123 HEALTHY KIDS CHW GUMMIES ........ 111 healthy kids chw overall .................. 110 HEALTHY TAB HEART ...................... 113 HEART SAVIOR CAP........................ 113 HEART TAB 140MG ......................... 113 heartbrn ant chw 160-105 ................. 59 heartbrn rel tab 200mg ..................... 62 heartbrn rlf chw 160-105 .................. 59 heartburn chw ex st ......................... 59 heartburn sus relief .......................... 59 heartburn tab 150mg ....................... 62 heartburn tab 200mg ....................... 62 heartburn tab 20mg ......................... 63 heartburn tab relief .....................62, 63 heartburn tr cap 15mg ...................... 63 heartburn tr cap 24h 20mg ............... 63 heather tab 0.35mg .......................... 15 HEAVY DUTY MIS BANDAGES .......... 164 HEAVY DUTY MIS CLR&TGH ............. 164 HEAVY DUTY MIS FAB BAND ............ 164 hi c-500 tab ..................................... 92 high potency tab fe 27mg ................ 124 hi-kovite tab 2-part .......................... 99 HINEY HEALER CRE ........................ 141 hi-potency tab multivit ...................... 99 HLTHY ACCNTS MIS LANC 30G ........ 155 hm allergy cap 25mg ........................ 36 hm allergy tab 25mg ........................ 37 hm allergy tab 4mg .......................... 36 hm animal chw shapes.................... 111 hm antacid sus ................................ 60 hm antacid sus anti-gas ...............60, 61 hm arthrts tab 650mg ....................... 74 hm aspirin chw 81mg........................ 72 hm aspirin tab 325mg ....................... 72 hm b complex tab with c ................... 90 HM BUTTERFLY MIS CLOSURES ........ 164 hm ca/vit d3 tab 600-400 ................ 118 hm ca/vit d3 tab 600-800 ................ 119 hm calcium tab citr+d ..................... 120
204
HM CASTOR OIL ............................. 144 hm clearlax pow ............................... 54 hm complete tab .............................. 99 HM COMPLETE TAB ........................... 99 hm complete tab 50+ ....................... 99 hm complete tab women ................... 99 hm dry eye sol relief ....................... 130 HM ESTROPLUS TAB ....................... 113 hm fish oil cap 1000mg ................... 122 hm fish oil cap 1200mg ................... 123 hm gas relf chw 125mg ..................... 65 hm gas relf chw 80mg ....................... 65 HM HAIR/SKIN TAB /NAILS................ 99 hm hydrocort cre 1% plus ............... 140 hm ibuprofen chw 100mg .................. 79 hm ibuprofen tab 200mg ................... 79 hm iron tab 45mg........................... 124 hm iron tab 65mg........................... 124 hm laxative sup 10mg ....................... 51 hm laxative tab 5mg ......................... 51 hm laxative tab 5mg ec ..................... 51 hm mucus er tab 1200mg.................. 44 hm multivit chw gummy .................. 106 hm nighttime tab 25mg ..................... 70 hm one daily tab /iron ....................... 94 hm one daily tab essentia ................ 109 HM ONE DAILY TAB ESSENTIA ......... 109 HM ONE DAILY TAB MENS ................. 99 hm pain rlf tab 650mg ...................... 74 hm povid-iod sol 10% ..................... 142 hm probiotic cap .............................. 58 hm saline spr 0.65% ......................... 42 hm senna tab 8.6mg ......................... 52 hm senna-s tab 8.6-50mg ................. 55 hm sleep aid tab 25mg ...................... 69 HM STERILE PAD ALCHOL ................ 168 hm stomach sus 262/15ml ................ 56 hm stool sof cap 100mg .................... 53 hm stool sof tab 8.6-50mg ................ 55 hm triple oin antibiot ...................... 135 hm tussin liq adlt dm ........................ 47 hm tussin liq dm max ....................... 47 HM ULTICARE MIS 31GX8MM ........... 146 hm vit d3 cap 2000unit ..................... 85 hm vitamin d tab 1000unit ................ 86 hm vita-mini tab multi .................... 109 HOLD CHAMBER MIS ADLT LG .......... 149
HOLD CHAMBER MIS MEDIUM ......... 149 HOLD CHAMBER MIS SMALL ............ 149 HOMENEB MIS SIDESTRE ................ 151 HONEY BEARS CHW ........................ 109 HONEY BEARS CHW IRON-ZIN ......... 111 HUMALOG MIX INJ 50/50 .................. 19 HUMALOG MIX INJ 50/50KWP ............ 20 HUMALOG MIX INJ 75/25KWP ............ 19 HUMALOG MIX SUS 75/25 ................. 19 HUMIRA INJ 10MG/0.2 ...................... 81 HUMIRA KIT 20MG/0.4 ..................... 81 HUMIRA KIT 40MG/0.8 ..................... 81 HUMIRA PEDIA INJ CROHNS .............. 81 HUMIRA PEN INJ 40MG/0.8 ............... 81 HUMIRA PEN INJ CD/UC/HS .............. 81 HUMIRA PEN INJ PS/UV .................... 81 HUMIRA PEN KIT CD/UC/HS .............. 81 HUMIRA PEN KIT PS/UV .................... 81 HUMULIN INJ 70/30.......................... 20 HUMULIN INJ 70/30KWP ................... 20 HUMULIN N INJ U-100 ...................... 19 HUMULIN N INJ U-100KWP ................ 19 HUMULIN R INJ U-100 ...................... 19 HUMULIN R INJ U-500 ...................... 19 HYALEX TAB .................................... 99 hydralazine hcl tab 10 mg ................. 31 hydralazine hcl tab 100 mg................ 31 hydralazine hcl tab 25 mg ................. 31 hydralazine hcl tab 50 mg ................. 31 hydrochlorothiazide cap 12.5 mg ........ 32 hydrochlorothiazide tab 12.5 mg ........ 32 hydrochlorothiazide tab 25 mg ........... 32 hydrochlorothiazide tab 50 mg ........... 32 hydrocodone w/ homatropine syrup 5-1.5 mg/5ml .................................. 42 hydrocodone w/ homatropine tab 5-1.5 mg ................................................. 42 hydrocodone-acetaminophen soln 7.5-325 mg/15ml ............................. 78 hydrocodone-acetaminophen tab 10-325 mg ................................................. 78 hydrocodone-acetaminophen tab 5-325 mg ................................................. 78 hydrocodone-acetaminophen tab 7.5-325 mg ................................................. 78 hydrocort cre 1% ........................... 139 hydrocort cre 1% plus ..................... 139
205
hydrocort cre plus 1% ..................... 139 hydrocort oin 1% ........................... 140 hydrocort/ cre aloe 1% ................... 141 hydrocortiso oin absorbas ................ 140 hydrocortisone butyrate cream 0.1%.140 hydrocortisone butyrate oint 0.1% .... 140 hydrocortisone butyrate soln 0.1% ... 140 hydrocortisone cream 0.5% ............. 139 hydrocortisone cream 1% ................ 139 hydrocortisone cream 2.5% ............. 139 hydrocortisone enema 100 mg/60ml .133 hydrocortisone lotion 1% ................. 140 hydrocortisone lotion 2.5% .............. 140 hydrocortisone oint 0.5% ................ 140 hydrocortisone oint 1% ................... 140 hydrocortisone oint 2.5% ................ 140 hydrocortisone rectal cream 1% ....... 133 hydrocortisone rectal cream 2.5% .... 133 hydrocortisone tab 10 mg .................. 13 hydrocortisone tab 20 mg .................. 13 hydrocortisone tab 5 mg ................... 13 hydrocortisone valerate cream 0.2% .140 hydrocortisone valerate oint 0.2% .... 140 hydrocortisone-aloe vera cream 1% .. 141 hydrocream cre 1% ........................ 139 hydromet syp 5-1.5/5 ....................... 42 hydromorphone hcl tab 2 mg ............. 76 hydromorphone hcl tab 4 mg ............. 77 hydromorphone hcl tab 8 mg ............. 77 hydroxychloroquine sulfate tab 200 mg 8 hydroxyurea cap 500 mg ................... 12 hyoscyamine sulfate elixir 0.125 mg/5ml ......................................................61 hyoscyamine sulfate sl tab 0.125 mg... 61 hyoscyamine sulfate soln 0.125 mg/ml 61 hyoscyamine sulfate tab 0.125 mg ...... 61 hyoscyamine sulfate tab disint 0.125 mg ......................................................61 hyoscyamine sulfate tab er 12hr 0.375 mg ................................................. 62 HYPO-ALLERG MIS BANDAGE ........... 164 hypotears oin op ............................ 129 HYPOTEARS SOL 1-1% .................... 129 hyvee ibupro sus 100mg/5m .............. 79 I IBRANCE CAP 100MG ........................ 11 IBRANCE CAP 125MG ........................ 11
IBRANCE CAP 75MG ......................... 11 ibu tab 400mg ................................. 79 ibu tab 600mg ................................. 79 ibu tab 800mg ................................. 79 ibu-200 tab 200mg ........................... 79 ibu-drops dro 50/1.25 ....................... 79 ibuprfn liqd cap 200mg ..................... 78 ibuprofen cap 200mg ........................ 78 ibuprofen ch sus 100/5ml .................. 79 ibuprofen dro 50/1.25 ....................... 79 ibuprofen ib chw 100mg .................... 79 ibuprofen jr chw 100mg .................... 79 ibuprofen js chw 100mg .................... 79 ibuprofen sus 100/5ml ...................... 79 ibuprofen susp 100 mg/5ml ............... 80 ibuprofen tab 200 mg ....................... 79 ibuprofen tab 400 mg ....................... 79 ibuprofen tab 600 mg ....................... 79 ibuprofen tab 800 mg ....................... 79 ibuprofn 100 chw jr 100mg................ 79 icaps areds cap 2 ............................. 95 ICAPS AREDS TAB FORMULA ............. 99 icaps cap ......................................... 95 ICAPS CHW AREDS 2 ...................... 106 icaps lutein cap /omega-3 ................. 95 icaps mv tab .................................... 99 ICAPS PLUS TAB .............................. 99 imatinib mesylate tab 100 mg (base equivalent) ...................................... 12 imatinib mesylate tab 400 mg (base equivalent) ...................................... 12 IMBRUVICA CAP 140MG .................... 11 imiquimod cream 5% ...................... 141 IMMUNE CHW SUPPORT .................. 106 IMMUNE SUPP POW VIT C ............... 108 immunicare cap ............................. 113 IMODIUM MS TAB RELIEF .................. 58 IN CONTROL MIS 31GX5MM ............ 145 IN CONTROL MIS 31GX8MM ............ 146 IN TOUCH LAN MIS 30G .................. 155 inatal gt tab ................................... 115 incassia tab 0.35mg ......................... 15 INCONTROL MIS LANC 28G ............. 156 INCONTROL MIS LANC 30G ............. 156 INCONTROL MIS LANC 33G ............. 156 INCONTROL PAD ALCOHOL .............. 168 INCRUSE ELPT INH 62.5MCG ............. 48
206
indapamide tab 1.25 mg .................... 32 indapamide tab 2.5 mg ..................... 32 INLYTA TAB 1MG .............................. 11 INLYTA TAB 5MG .............................. 11 INNOSPIRE EL MIS NEBULIZE .......... 151 INNOSPIRE ES MIS NEBULIZE .......... 151 INNOSPIRE MIS DEL NEBU............... 151 INNOSPIRE MIS MINI NEB ............... 151 INNOSPIRE MIS PORTABLE .............. 151 INSPIRACHAMB MIS LARGE ............. 149 INSPIRACHAMB MIS MEDIUM ........... 149 INSPIRACHAMB MIS MOUTHPCE ....... 149 INSPIRACHAMB MIS SMALL ............. 149 INSPIRATION MIS ELITE .................. 151 INSPIRATION MIS NEBULIZR ........... 151 INSPIREASE MIS DD SYST ............... 149 instacort 5 cre 0.5% ....................... 139 INSULIN PEN MIS 31GX8MM ............ 146 INSULIN SYRG MIS 0.3/30G ............ 144 INSULIN SYRG MIS 0.3/31G ............ 145 INSULIN SYRG MIS 0.5/30G ............ 144 INSULIN SYRG MIS 0.5/31G..... 144, 145 INSULIN SYRG MIS 1ML/30G ........... 145 INSULIN SYRG MIS 1ML/31G ........... 145 INSUPEN MIS 31GX5MM .................. 145 INSUPEN MIS 31GX8MM .................. 146 INSUPEN MIS 32GX4MM .................. 146 INSUPEN SENS MIS 32GX6MM ......... 147 INSUPEN ULTR MIS 31GX8MM .......... 146 intense coug liq reliever..................... 48 intestinex cap .................................. 57 INTRON A INJ 10MU.......................... 12 INTRON A INJ 18MU.......................... 12 INTRON A INJ 25MU.......................... 12 INTRON A INJ 50MU.......................... 12 INULOSE BLD CAP SUGAR ............... 113 ipratropium bromide inhal soln 0.02% .48 ipratropium bromide nasal soln 0.03% (21 mcg/spray) ................................ 42 ipratropium bromide nasal soln 0.06% (42 mcg/spray) ................................ 42 ipratropium-albuterol nebu soln 0.5-2.5(3) mg/3ml ........................... 49 irbesartan tab 150 mg ....................... 30 irbesartan tab 300 mg ....................... 30 irbesartan tab 75 mg ........................ 30 irbesartan-hydrochlorothiazide tab
150-12.5 mg ................................... 31 irbesartan-hydrochlorothiazide tab 300-12.5 mg ................................... 31 iron slow tab 45mg ......................... 124 iron supplem tab 325mg ................. 124 iron supplem tab therapy ................ 124 iron supplmt dro 15mg/ml ............... 124 iron suppmnt elx 220/5ml ............... 124 isibloom tab..................................... 16 ISONIAZID POW ................................ 6 isoniazid syrup 50 mg/5ml................... 6 isoniazid tab 100 mg .......................... 6 isoniazid tab 300 mg .......................... 6 ISORDIL TAB 40MG .......................... 25 isosorbide dinitrate tab 10 mg ............ 25 isosorbide dinitrate tab 20 mg ............ 25 isosorbide dinitrate tab 30 mg ............ 25 isosorbide dinitrate tab 5 mg ............. 25 isosorbide dinitrate tab er 40 mg ........ 25 isosorbide mononitrate tab 10 mg ...... 25 isosorbide mononitrate tab 20 mg ...... 25 isosorbide mononitrate tab er 24hr 120 mg ................................................. 25 isosorbide mononitrate tab er 24hr 30 mg ................................................. 25 isosorbide mononitrate tab er 24hr 60 mg ................................................. 25 isotretinoin cap 10 mg .................... 134 isotretinoin cap 20 mg .................... 134 isotretinoin cap 30 mg .................... 134 isotretinoin cap 40 mg .................... 134 ISTODAX OVR INJ 10MG ................... 11 itchy eye dro 0.025%op .................. 131 itchy eye sol 0.025% ...................... 131 itraconazole cap 100 mg ..................... 7 IV PREP WIPE PAD.......................... 143 ivermectin tab 3 mg ........................... 8 i-vite prote tab ................................. 99 i-vite tab ......................................... 99 J J & J ADHES PAD LARGE ................. 166 J&J GERM FIL MIS MASK ................. 152 JAKAFI TAB 10MG ............................ 12 JAKAFI TAB 15MG ............................ 12 JAKAFI TAB 20MG ............................ 12 JAKAFI TAB 25MG ............................ 12 JAKAFI TAB 5MG .............................. 12
207
jantoven tab 10mg ......................... 126 jantoven tab 1mg ........................... 126 jantoven tab 2.5mg ........................ 126 jantoven tab 2mg ........................... 126 jantoven tab 3mg ........................... 126 jantoven tab 4mg ........................... 126 jantoven tab 5mg ........................... 126 jantoven tab 6mg ........................... 126 jantoven tab 7.5mg ........................ 126 JANUMET TAB 50-1000...................... 21 JANUMET TAB 50-500MG ................... 21 JANUMET XR TAB 100-1000 ............... 21 JANUMET XR TAB 50-1000 ................. 21 JANUMET XR TAB 50-500MG .............. 21 JANUVIA TAB 100MG ........................ 21 JANUVIA TAB 25MG .......................... 21 JANUVIA TAB 50MG .......................... 21 JARDIANCE TAB 10MG ...................... 21 JARDIANCE TAB 25MG ...................... 21 jck itch pow aer 1% ........................ 136 jencycla tab 0.35mg ......................... 15 jinteli tab 1mg-5mcg ......................... 15 JIVI INJ 1000UNIT .......................... 127 JIVI INJ 2000UNIT .......................... 127 JIVI INJ 3000UNIT .......................... 127 JIVI INJ 500 UNIT ........................... 127 jock itch aer 1% ............................. 136 jock itch cre 1% ............................. 136 jolivette tab 0.35mg ......................... 15 juleber tab ....................................... 16 junel 1.5/30 tab ............................... 17 junel 1/20 tab .................................. 17 junel fe tab 1.5/30 ........................... 18 junel fe tab 1/20 .............................. 18 just d liq 400unit .............................. 87 just tears sol eye drop .................... 128 K K2 PLUS D3 TAB ............................... 88 KALYDECO PAK 50MG ....................... 50 KALYDECO PAK 75MG ....................... 50 KALYDECO TAB 150MG ..................... 50 KAMELEON LUB MIS COLORS ........... 166 KAMELEON MIS TRI-COLR ............... 166 kaopectate sus 262/15ml .................. 56 kaopectate sus ex st ......................... 56 kaopectate tab 262mg ...................... 56 kao-tin cap 240mg ........................... 53
kao-tin sus 262/15ml ....................... 56 kariva tab 28 day ............................. 18 KAZ VAPORIZR MIS 1 GALLON ......... 152 KAZ VAPORIZR MIS 1.5 GAL ............ 152 KAZ VAPORIZR MIS 2.2 GAL ............ 152 kelnor 1/50 tab ................................ 16 kelnor tab 1/35 ................................ 16 kericort 10 cre 1% ......................... 139 ketoconazole cream 2% .................. 137 ketoconazole shampoo 2% .............. 137 KETO-DIASTIX TES ........................ 143 ketorolac tromethamine ophth soln 0.4% .................................................... 131 ketorolac tromethamine ophth soln 0.5% .................................................... 131 ketorolac tromethamine tab 10 mg ..... 80 ketotif fum dro 0.025%op ............... 131 KEVZARA INJ 150/1.14 ..................... 81 KEVZARA INJ 200/1.14 ..................... 81 KIDNEY TAB 280MG........................ 113 kids vit d3 chw 1000unit ................... 86 KIMONO COLOR MIS ...................... 166 KIMONO MICRO MIS THIN ............... 167 KIMONO MICRO MIS THIN + ............ 166 KIMONO MICRO MIS THIN PLS ......... 166 KIMONO MIS LUBRICAT .................. 166 KIMONO MIS SENSATIO........... 166, 167 KIMONO PLUS MIS LUBRICAT .......... 167 KIMONO PLUS MIS SPERMICI .......... 167 KIMONO PS MIS LUBRICAT .............. 167 KIMONO PS MIS PLUS ..................... 167 KIMONO SENSA MIS PLUS ............... 167 KIMONO SPEC MIS ......................... 167 KINNEY MIS LANCETS ..................... 156 KINNEY THIN MIS LANCETS ............. 156 kionex sus 15gm/60 ....................... 169 klor-con 10 tab 10meq er ................ 121 klor-con 8 tab 8meq er ................... 121 klor-con m10 tab 10meq er ............. 121 klor-con m20 tab 20meq er ............. 121 klor-con spr cap 10meq .................. 121 klor-con spr cap 8meq .................... 121 klor-con/ef tab 25meq fr ................. 121 kls allergy tab 25mg ......................... 37 kls anti-dia tab 2mg ......................... 55 kls aspirin tab 325mg ec ................... 73 kls aspirin tab 81mg ec ..................... 73
208
kls hydrocrt cre pls 1% ................... 141 kls ibuprofn tab 200mg ..................... 79 kls naproxen tab 220mg .................... 80 kobee tab ........................................ 89 kp adult 50+ tab daily ....................... 99 kp adults tab daily ............................ 99 kp aspirin tab 81mg ec ...................... 73 kp b complex tab /c .......................... 90 kp bisacodyl tab 5mg ec .................... 51 kp ca/mg/zn tab ............................. 120 kp calcium cap 600+d ..................... 117 kp calcium tab +d ........................... 119 kp calcium tab 600+d ..................... 118 kp fish oil cap 1200mg .................... 123 kp loratadin tab 10mg ....................... 40 kp melatonin tab 3mg ..................... 143 kp mens 50+ tab daily ...................... 99 KP MENS MIS DAILY PK ................... 108 kp mens tab daily ............................. 99 kp senna tab 8.6mg .......................... 52 kp vision tab for/ltn .......................... 99 kp vision tab formula ........................ 99 kp women 50+ tab daily .................... 99 KP WOMENS PAK DAILY .................. 108 kp womens tab daily ......................... 99 K-PAX CAP DOUBLE .......................... 95 K-PAX CAP SINGLE ........................... 95 K-PAX TAB PROF ST .......................... 99 K-PHOS TAB .................................. 121 k-prime tab 25meq ef ..................... 121 KROGER LANCE MIS ....................... 156 KROGER LANCE MIS THIN ............... 156 KROGER LANCE MIS THIN 30G ......... 156 ks ibuprofen cap 200mg .................... 78 kurvelo tab 0.15/30 .......................... 17 KUVAN POW 100MG .......................... 25 KUVAN TAB 100MG ........................... 25 KYLEENA IUD 19.5MG ....................... 15 L labetalol hcl tab 100 mg .................... 27 labetalol hcl tab 200 mg .................... 27 labetalol hcl tab 300 mg .................... 27 lactic acid (ammonium lactate) cream 12% ............................................. 141 lactic acid (ammonium lactate) lotion 12% ............................................. 141 lactinex chw ..................................... 57
lactobacillu cap ................................ 57 lactobacillus - packet ........................ 57 lactobacillus cap ............................... 57 lactobacillus tab ............................... 57 LACTO-BIFIDU CAP -600 ................... 57 lacto-key- cap 100 ........................... 57 lacto-key- cap 600 ........................... 57 lactulose (encephalopathy) solution 10 gm/15ml ......................................... 66 lactulose solution 10 gm/15ml ........... 54 lamisil af aer 1% ............................ 136 lamivudine tab 100 mg (hbv) ............... 7 lanabiotic oin ................................. 135 lanacort 10 cre 1% ......................... 140 LANCET MICRO MIS THIN 33G ......... 156 LANCET STAND MIS 21G ................. 156 LANCET SUPER MIS THIN 30G ......... 156 LANCET ULTRA MIS 28G.................. 156 LANCET ULTRA MIS FINE ................. 156 LANCET ULTRA MIS THIN 30G .......... 156 LANCETS MICR MIS THIN 33G ......... 156 LANCETS MIS ................................ 156 LANCETS MIS 21G .......................... 156 LANCETS MIS 21G COLR ................. 156 LANCETS MIS 26G .......................... 156 LANCETS MIS 28G .......................... 156 LANCETS MIS 30G .......................... 156 LANCETS MIS 31G .......................... 156 LANCETS MIS 33G .......................... 156 LANCETS MIS ORANGE ................... 156 LANCETS MIS ORIGINAL ................. 156 LANCETS MIS THIN ........................ 156 LANCETS MIS THIN 26G .................. 156 LANCETS MIS THIN 30G .................. 156 LANCETS SUPR MIS THIN 28G ......... 156 LANCETS THIN MIS ........................ 156 LANCETS THIN MIS 26G .................. 156 LANCETS ULTR MIS THIN ................ 156 land bfr tim chw vit/c ...................... 110 land bfr tim chw vit/iron .................. 111 LANOXIN TAB 0.0625MG ................... 25 LANOXIN TAB 0.1875MG ................... 25 lansoprazole cap 15mg dr .................. 63 lansoprazole cap delayed release 15 mg ...................................................... 63 larin fe tab 1.5/30 ............................ 18 larin fe tab 1/20 ............................... 18
209
larin tab 1.5/30 ................................ 17 larin tab 1/20 ................................... 17 larissia tab ....................................... 16 latanoprost ophth soln 0.005% ........ 131 lax/stl soft tab 8.6-50mg ................... 55 laxa basic cap 100mg ....................... 53 laxacin tab 8.6-50mg ........................ 55 laxaclear pow ................................... 54 laxative chw 15mg ........................... 53 laxative pls tab 8.6-50mg .................. 55 laxative sup 10mg ............................ 51 laxative tab 15mg ............................ 52 laxative tab 25mg ............................ 52 laxative tab 5mg ec .......................... 51 laxative tab max-str ......................... 52 laxative tab w/senna ......................... 52 LB LANCET MIS 28G ....................... 156 L-CARNITINE CAP 500MG ................ 122 L-CARNITINE TAB 250MG ................ 122 ledip-sofosb tab 90-400mg ................. 7 leena tab ......................................... 18 leflunomide tab 10 mg ...................... 81 leflunomide tab 20 mg ...................... 81 LENVIMA CAP 10 MG ......................... 12 LENVIMA CAP 12MG .......................... 12 LENVIMA CAP 14 MG ......................... 12 LENVIMA CAP 18 MG ......................... 12 LENVIMA CAP 20 MG ......................... 12 LENVIMA CAP 24 MG ......................... 12 LENVIMA CAP 4MG ........................... 12 LENVIMA CAP 8 MG .......................... 12 lessina tab ....................................... 16 LETAIRIS TAB 10MG ......................... 35 LETAIRIS TAB 5MG ........................... 35 letrozole tab 2.5 mg ......................... 10 leucovorin calcium tab 10 mg............. 13 leucovorin calcium tab 15 mg............. 13 leucovorin calcium tab 25 mg............. 13 leucovorin calcium tab 5 mg .............. 13 LEUKERAN TAB 2MG .......................... 9 LEUKOSTRIP MIS 1/2 ...................... 164 LEUKOSTRIP MIS 1/4 ...................... 164 LEUKOSTRIP MIS 1/8X1.5 ............... 164 leuprolide acetate inj kit 5 mg/ml ....... 10 levobunolol hcl ophth soln 0.5% ....... 130 LEVOCARNITIN TAB 330MG ............. 122 levocarnitine (dietary) oral soln 1
gm/10ml ....................................... 122 levocarnitine cap 250 mg ................ 122 levocarnitine tab 500 mg ................ 122 levofloxacin ophth soln 0.5% ........... 127 levofloxacin oral soln 25 mg/ml ............ 5 levofloxacin tab 250 mg ...................... 5 levofloxacin tab 500 mg ...................... 5 levofloxacin tab 750 mg ...................... 5 levonest tab .................................... 18 levonorgestrel & ethinyl estradiol tab 0.1 mg-20 mcg ..................................... 17 levonorgestrel & ethinyl estradiol tab 0.15 mg-30 mcg .............................. 17 levonorgestrel tab 1.5 mg ................. 15 levonorgestrel-eth estra tab 0.05-30/0.075-40/0.125-30mg-mcg .. 18 levonorg-eth est tab 0.15-0.03mg(84) & eth est tab 0.01mg(7) ...................... 19 levora-28 tab 0.15/30 ....................... 17 levo-t tab 100mcg ............................ 22 levo-t tab 112mcg ............................ 22 levo-t tab 125mcg ............................ 22 levo-t tab 137mcg ............................ 22 levo-t tab 150mcg ............................ 22 levo-t tab 175mcg ............................ 23 levo-t tab 200 mcg ........................... 23 levo-t tab 25mcg .............................. 21 levo-t tab 300 mcg ........................... 23 levo-t tab 50mcg .............................. 22 levo-t tab 75mcg .............................. 22 levo-t tab 88mcg .............................. 22 levothyroxine sodium tab 100 mcg ..... 22 levothyroxine sodium tab 112 mcg ..... 22 levothyroxine sodium tab 125 mcg ..... 22 levothyroxine sodium tab 137 mcg ..... 22 levothyroxine sodium tab 150 mcg ..... 23 levothyroxine sodium tab 175 mcg ..... 23 levothyroxine sodium tab 200 mcg ..... 23 levothyroxine sodium tab 25 mcg ....... 21 levothyroxine sodium tab 300 mcg ..... 23 levothyroxine sodium tab 50 mcg ....... 22 levothyroxine sodium tab 75 mcg ....... 22 levothyroxine sodium tab 88 mcg ....... 22 levoxyl tab 100mcg .......................... 22 levoxyl tab 112mcg .......................... 22 levoxyl tab 125mcg .......................... 22 levoxyl tab 137mcg .......................... 22
210
levoxyl tab 150mcg .......................... 23 levoxyl tab 175mcg .......................... 23 levoxyl tab 200mcg .......................... 23 levoxyl tab 25mcg ............................ 21 levoxyl tab 50mcg ............................ 22 levoxyl tab 75mcg ............................ 22 levoxyl tab 88mcg ............................ 22 lice bedding aer .............................. 141 lice bedding aer 0.5% ..................... 142 lice killing sha ................................ 142 lice killing sha 0.33-4% ................... 142 lice treatmt lot 1% ......................... 142 lice treatmt sha 0.33-4%................. 142 lice trtmnt liq 1%............................ 141 licide aer 0.5% ............................... 142 licide sha 0.33-4%.......................... 142 lidocaine hcl soln 4% ...................... 141 lidocaine hcl viscous soln 2% ........... 132 lidocaine patch 5% ......................... 141 lidocaine-prilocaine cream 2.5-2.5% .141 LIFE PACK MIS MENS ...................... 108 LIFE PACK MIS WOMENS ................. 108 life pack tab mens ............................ 99 life pack tab womens ........................ 99 LIFESCAN MIS UNISTIK2 ................. 156 LIFESTYLES MIS COLORS ................ 166 LIFESTYLES MIS EXT STR ................ 166 LIFESTYLES MIS FORM FIT............... 166 LIFESTYLES MIS LUBRICAT .............. 166 LIFESTYLES MIS RIBBED ................. 166 LIFESTYLES MIS SKYN .................... 166 LIFESTYLES MIS SPERM/LU .............. 166 LIFESTYLES MIS STUDDED .............. 166 LIFESTYLES MIS ULT/SENS .............. 166 LIFESTYLES MIS VIBRA-RI ............... 166 LIFESTYLES MIS XPLEASUR ............. 166 LIGHT SHIELD MIS ......................... 152 LIGHT SHIELD MIS SLP MASK .......... 152 LILETTA IUD 52MG ........................... 15 lillow tab 0.15/30 ............................. 17 linezolid for susp 100 mg/5ml ............. 9 linezolid in sodium chloride iv soln 600 mg/300ml-0.9% ............................... 9 linezolid iv soln 600 mg/300ml (2 mg/ml) ............................................ 9 linezolid tab 600 mg........................... 9 LINSEED OIL RAW .......................... 144
LINZESS CAP 145MCG ...................... 66 LINZESS CAP 290MCG ...................... 66 LINZESS CAP 72MCG ........................ 66 liothyronine sodium tab 25 mcg ......... 23 liothyronine sodium tab 5 mcg ........... 23 liothyronine sodium tab 50 mcg ......... 23 LIPIDSHIELD TAB PLUS ................... 114 lipocomplex tab.............................. 115 lipoflavon tab ................................. 115 lipoflavovit tab ............................... 115 lipo-key tab ................................... 115 LIPOTRIAD CAP VIS PLUS ................ 113 LIPOTRIAD CAP VISION .................. 113 LIPOTRIAD CAP VISIONAR .............. 113 liq ca/vit d cap 600mg .................... 116 liquibid tab 400mg ........................... 43 LIQUID C LIQ................................... 92 liquitears sol .................................. 128 lisinopril & hydrochlorothiazide tab 10-12.5 mg ..................................... 31 lisinopril & hydrochlorothiazide tab 20-12.5 mg ..................................... 31 lisinopril & hydrochlorothiazide tab 20-25 mg ................................................. 31 lisinopril tab 10 mg ........................... 29 lisinopril tab 2.5 mg .......................... 29 lisinopril tab 20 mg ........................... 29 lisinopril tab 30 mg ........................... 29 lisinopril tab 40 mg ........................... 29 lisinopril tab 5 mg ............................ 29 LITE TOUCH MIS LANCETS .............. 156 LITEAIRE MIS ................................ 149 LITETOUCH MIS 29GX12.7 .............. 145 LITETOUCH MIS 31GX8MM .............. 146 LITETOUCH MIS LANCETS ............... 156 LITETOUCH MIS MASK LG ............... 148 LITETOUCH MIS MASK MD ............... 148 LITETOUCH MIS MASK SM ............... 148 little anima chw plus fe ................... 111 little chw animals ........................... 110 little noses dro stuf nos ..................... 42 little noses spr 0.65% ....................... 42 little remed liq 160/5ml ..................... 75 little remed sus 20/.03ml .................. 66 little tummy dro 20/0.3ml ................. 66 LITTLE TUMMY DRO LAXATIVE ........... 53 LONGEVITY CAP ............................. 113
211
LONGEVITY CAP PLUS ..................... 113 LONGS LANCET MIS STANDARD ....... 156 LONGS LANCET MIS THIN ................ 156 LONGS LANCET MIS ULTRA TH ......... 156 loperamide cap 2mg ......................... 55 loperamide hcl cap 2 mg .................... 55 loperamide tab 2mg .......................... 55 lopreeza tab 0.5-0.1 ......................... 14 lopreeza tab 1-0.5mg ........................ 14 loradamed tab 10mg ......................... 40 loratadine cap 10 mg ........................ 39 loratadine chw 5mg .......................... 40 loratadine d tab 5-120mg .................. 45 loratadine sol 10/10ml ...................... 40 loratadine sol 5mg/5ml ..................... 40 loratadine syp 5mg/5ml..................... 40 loratadine tab 10 mg ......................... 40 loratadine tab 10mg .......................... 40 lorata-dine tab d 24hr ....................... 45 loratadine-d tab 10-240mg ................ 45 loratadine-d tab 5-120mg .................. 45 lorcet hd tab 10-325mg ..................... 78 lorcet plus tab 7.5-325 ...................... 78 lorcet tab 5-325mg ........................... 78 loryna tab 3-0.02mg ......................... 16 losartan potassium & hydrochlorothiazide tab 100-12.5 mg .............................. 32 losartan potassium & hydrochlorothiazide tab 100-25 mg ................................. 32 losartan potassium & hydrochlorothiazide tab 50-12.5 mg ................................ 32 losartan potassium tab 100 mg .......... 30 losartan potassium tab 25 mg ............ 30 losartan potassium tab 50 mg ............ 30 lotrimin af pow 2% ......................... 137 lovastatin tab 10 mg ......................... 34 lovastatin tab 20 mg ......................... 34 lovastatin tab 40 mg ......................... 34 low dose asa tab 81mg ...................... 73 low-ogestrel tab ............................... 17 lubr/dry eye dro 0.5-0.9% ............... 129 lubric tears sol 0.4-0.3% ................. 129 lubricant dro 0.4-0.3% .................... 129 lubricant dro eye ............................ 129 lubricant dro eye 0.6% .................... 128 lubricant oin eye ............................. 129 lubricat/eye dro 0.5-0.9% ............... 129
lubricating dro 0.5% ....................... 128 lubricating sol 0.4-0.3% .................. 129 lubricnt eye dro....................... 129, 130 lubricnt eye dro 0.4-0.3% ............... 129 lubricnt eye dro 0.5% op ................. 128 lubricnt eye dro 0.6% ..................... 128 lubricnt eye oin fast act .................. 130 lubricnt eye oin nighttim ................. 130 lubricnt gel dro 0.25-0.3 ................. 129 lubricnt gel dro 1% ......................... 128 ludent chw 0.25mg f ....................... 120 ludent chw 0.5mg f ........................ 120 ludent chw 1mg f ........................... 120 LUMINEB II MIS NEBULIZR .............. 151 LUNG TAB 180MG .......................... 114 lutera tab ........................................ 17 LYMPH TAB 150MG ......................... 114 lysiplex liq plus .............................. 107 LYSODREN TAB 500MG ..................... 10 lyza tab 0.35mg ............................... 15 M m2 b125 tab tr ................................ 89 M2 B-60 TAB TR............................. 105 M2 C CAP ........................................ 91 M2 CALCIUM TAB 280MG ................ 114 M2 CHROMIUM TAB 500MCG ........... 114 maalox child chw .............................. 58 MAALOX CHW 600MG ....................... 58 maalox max sus cherry ..................... 61 maalox max sus lemon ..................... 61 maalox max sus wild bry ................... 61 maalox multi sus symp max .............. 61 MABIS COMPXP MIS COMP/NEB ....... 151 MABIS COSMO MIS NEBULIZR ......... 151 macular hlth cap formula ................... 95 MACULAR VIT TAB BENEFIT ............... 99 macuvite tab ................................... 99 macuvite tab eye care ...................... 99 macuvite tab lutein .......................... 99 MAG-AL LIQ..................................... 59 mag-al plus liq ................................. 60 mag-al plus liq xs ............................. 61 magic bullet sup 10mg ...................... 51 magnum-75 tab ............................. 105 MAKENA INJ 275MG ......................... 19 malathion lotion 0.5% .................... 141 MAMMARY TAB 150MG .................... 114
212
mapap apap liq 500/15ml .................. 75 mapap cap 500mg ............................ 73 mapap child tab 80mg rt ................... 76 mapap chw 160mg ........................... 75 mapap liq 160/5ml ........................... 75 mapap tab 325mg ............................ 73 mapap tab 500mg ............................ 74 MARGO MOO MIS NEBULIZE ............ 151 marlissa tab 0.15/30 ......................... 17 MASK PEDIATR MIS SIZE 1 .............. 152 MASK PEDIATR MIS SIZE 3 .............. 152 MASK VORTEX/ MIS BABY DUC ........ 150 MASK VORTEX/ MIS DUCK ............... 150 MASK VORTEX/ MIS FROG ............... 150 MASK VORTEX/ MIS LADY BUG ......... 150 massengill sol vin&watr ..................... 68 MATULANE CAP 50MG ....................... 12 matzim la tab 180mg/24 ................... 28 matzim la tab 240mg/24 ................... 28 matzim la tab 300mg/24 ................... 28 matzim la tab 360mg/24 ................... 28 matzim la tab 420mg/24 ................... 28 max daily tab green .......................... 99 maxepa cap 1000mg....................... 122 MAXI-MASK MIS ............................. 153 MAXIMIN PAK ................................ 108 maximum epa cap 1000mg .............. 122 maximum tab blue lab ....................... 99 maximum tab green lb ...................... 99 maximum tab red labl ..................... 100 MAXX MIS LUBRICAT ...................... 167 MAXX PLUS MIS SPERMICI............... 167 m-clear wc liq 100-6.3 ...................... 46 MEBENDAZOLE POW .......................... 8 meclizine hcl chew tab 25 mg ............. 64 meclizine hcl tab 12.5 mg .................. 64 meclizine hcl tab 25 mg ..................... 64 medi-bismuth chw 262mg ................. 56 MEDICHOICE MIS LANCET ............... 156 medifin 400 tab 400mg ..................... 43 medi-lax tab 15mg ........................... 52 medi-natural tab 8.6-50mg ................ 55 medi-natural tab 8.6mg .................... 52 medi-paste oin ............................... 141 medi-phedryl cap 25mg ..................... 36 mediplex tab plus ........................... 100 medi-profen cap 200mg .................... 78
medi-profen sus 100/5ml .................. 80 medi-profen sus 40mg/ml ................. 79 medi-profen tab 200mg .................... 79 mediproxen tab 220mg ..................... 80 medique asa tab 325mg .................... 72 medi-tabs elx 80/2.5ml ..................... 75 medi-tabs jr chw 160mg ................... 75 medi-tabs tab 500mg ....................... 74 medi-tuss dm liq dbl str .................... 48 medi-tussin syp dm .......................... 48 MEDLANCE MIS 30G PLUS ............... 156 MEDLANCE MIS EXTR 21G ............... 156 MEDLANCE MIS LITE 25G ................ 156 MEDLANCE MIS PLUS ...................... 156 MEDLANCE MIS PLUS 30G ............... 156 MEDLANCE MIS UNV 21G ................ 157 MEDLANCE PLS MIS 0.8MM.............. 157 MEDLANCE PLS MIS EXTR 21G ......... 157 MEDLANCE PLS MIS LITE 25G .......... 157 MEDLANCE PLS MIS UNIV 21G ......... 157 MEDROL TAB 2MG ............................ 13 medroxyprogesterone acetate im susp 150 mg/ml ...................................... 15 medroxyprogesterone acetate im susp prefilled syr 150 mg/ml ..................... 15 medroxyprogesterone acetate tab 10 mg ...................................................... 19 medroxyprogesterone acetate tab 2.5 mg ................................................. 19 medroxyprogesterone acetate tab 5 mg ...................................................... 19 mefloquine hcl tab 250 mg .................. 8 mega multi tab men ....................... 100 MEGA MULTI TAB MEN .................... 100 mega multi tab w/che mi ................. 115 mega multi tab women ................... 100 MEGA MULTI TAB WOMEN ............... 100 MEGA MULTIVI POW ....................... 107 MEGA MULTIVI TAB MEN ................. 100 MEGA MULTIVI TAB WOMEN ............ 100 mega vm-80 tab ............................ 100 mega-maratho tab 100 tr ................ 105 MEGAVITE TAB FRT/VEG ................. 100 MEGAVITE TAB GOLD 55+ ............... 100 megestrol acetate susp 40 mg/ml....... 10 megestrol acetate tab 20 mg ............. 10 megestrol acetate tab 40 mg ............. 10
213
MEIJER LANCE MIS COLOR .............. 157 MEIJER LANCE MIS UNIV 21G .......... 157 MEIJER LANCE MIS UNIV 30G .......... 157 MEIJER LANCE MIS UNIVERSA ......... 157 MEIJER MIS LANCETS ..................... 157 meijer sus antacid ............................ 61 MEKINIST TAB 0.5MG ....................... 11 MEKINIST TAB 2MG .......................... 11 MELADOX TAB 3MG CR ................... 143 melatonin cap 10mg ....................... 143 melatonin chew tab 2.5 mg ............. 144 melatonin chw 10mg....................... 144 melatonin chw quik dis .................... 144 MELATONIN LIQ 1MG/4ML ............... 144 MELATONIN LIQ 2.5MG ................... 144 melatonin liq 5mg/15ml .................. 144 melatonin liquid 1 mg/ml ................. 144 MELATONIN LOZ 5MG ..................... 144 melatonin sl tab 10 mg ................... 144 melatonin sub 5mg ......................... 144 melatonin sub quik dis .................... 144 melatonin tab 1 mg......................... 143 melatonin tab 10 mg ....................... 143 melatonin tab 10mg cr .................... 144 MELATONIN TAB 200MCG ................ 143 melatonin tab 300 mcg.................... 143 melatonin tab 3mg ......................... 143 MELATONIN TAB 3MG CR ................ 144 MELATONIN TAB 500MCG ................ 144 melatonin tab 5mg ......................... 143 melatonin tab max st ...................... 143 melatonin tablet disintegrating 10 mg144 melatonin tablet disintegrating 3 mg .144 melatonin tablet disintegrating 5 mg .144 meloxicam tab 15 mg ....................... 80 meloxicam tab 7.5 mg ...................... 80 melphalan tab 2 mg ........................... 9 memantine hcl oral solution 2 mg/ml .. 71 memantine hcl tab 10 mg .................. 71 memantine hcl tab 5 mg ................... 71 memantine hcl tab 5 mg (28) & 10 mg (21) titration pak .............................. 71 MENOPAUSE MIS AM/PM ................. 114 menopause tab support ................... 114 mens 50+ adv tab one daly ............. 100 MENS 50+ CAP ADVANCED ................ 95 mens daily cap lycopene .................... 95
mens daily chw gummies ................ 106 mens daily tab formula ................... 100 MENS MULTI TAB VIT/MIN ............... 100 MENS PAK ..................................... 108 mercaptopurine tab 50 mg ................ 10 mesalamine enema 4 gm .................. 66 mesalamine rectal enema 4 gm & cleanser wipe kit .............................. 66 MESTINON SYP 60MG/5ML ................ 85 metformin hcl tab 1000 mg ............... 20 metformin hcl tab 500 mg ................. 20 metformin hcl tab 850 mg ................. 20 metformin hcl tab er 24hr 500 mg ...... 20 metformin hcl tab er 24hr 750 mg ...... 20 methacholine cap /liver ................... 115 methadone hcl tab 10 mg .................. 77 methadone hcl tab 5 mg ................... 77 methazolamide tab 25 mg ................. 32 methazolamide tab 50 mg ................. 32 methimazole tab 10 mg .................... 23 methimazole tab 5 mg ...................... 23 methocarbamol tab 500 mg ............... 84 methocarbamol tab 750 mg ............... 84 methotrexate sodium tab 2.5 mg (base equiv) ............................................. 10 methyldopa tab 250 mg .................... 30 methyldopa tab 500 mg .................... 30 methylprednisolone tab 16 mg ........... 13 methylprednisolone tab 32 mg ........... 13 methylprednisolone tab 4 mg ............. 13 methylprednisolone tab 8 mg ............. 13 methylprednisolone tab therapy pack 4 mg (21) .......................................... 13 metoclopramide hcl soln 5 mg/5ml (10 mg/10ml) (base equiv) ..................... 66 metoclopramide hcl tab 10 mg (base equivalent) ...................................... 66 metoclopramide hcl tab 5 mg (base equivalent) ...................................... 66 metolazone tab 10 mg ...................... 33 metolazone tab 2.5 mg ..................... 33 metolazone tab 5 mg ........................ 33 metoprolol & hydrochlorothiazide tab 100-25 mg ...................................... 31 metoprolol & hydrochlorothiazide tab 100-50 mg ...................................... 31 metoprolol & hydrochlorothiazide tab
214
50-25 mg ........................................ 31 metoprolol succinate tab er 24hr 100 mg (tartrate equiv) ................................ 27 metoprolol succinate tab er 24hr 200 mg (tartrate equiv) ................................ 27 metoprolol succinate tab er 24hr 25 mg (tartrate equiv) ................................ 27 metoprolol succinate tab er 24hr 50 mg (tartrate equiv) ................................ 27 metoprolol tartrate tab 100 mg .......... 27 metoprolol tartrate tab 25 mg ............ 27 metoprolol tartrate tab 50 mg ............ 27 metronidazole cap 375 mg .................. 8 metronidazole cream 0.75% ............ 134 metronidazole gel 0.75% ................. 134 metronidazole gel 1% ..................... 134 metronidazole lotion 0.75% ............. 135 metronidazole tab 250 mg .................. 8 metronidazole tab 500 mg .................. 8 metronidazole vaginal gel 0.75% ........ 67 mg217 gel 1% ............................... 139 MG-PLUS TAB PROTEIN ................... 114 MH MACULAR MIS HEALTH............... 108 MI-ACID CHW .................................. 59 mi-acid gas chw 80mg ...................... 65 mi-acid sus ...................................... 60 mi-acid sus max st............................ 61 micaderm cre 2% ........................... 137 miconazole 1 kit ............................... 68 miconazole 1 kit 1200-2% ................. 68 miconazole 1 kit 1200mg2% .............. 68 MICONAZOLE 1 KIT COMBO ............... 68 miconazole 3 cre 4% ......................... 68 miconazole 3 kit combinat ................. 68 miconazole 3 kit combo ..................... 68 miconazole 3 kit combo pk ................. 68 miconazole 3 sup 200mg ................... 68 miconazole 7 cre .............................. 68 miconazole 7 cre 2% ......................... 68 miconazole 7 cre tube/kit .................. 68 miconazole 7 sup 100mg ................... 68 miconazole cre 2% ......................... 137 miconazole nitrate vaginal cream 2% .. 68 miconazole nitrate vaginal suppos 100 mg ................................................. 68 MICONAZOLE POW ............................ 6 MICONAZOLE POW NITRATE ............ 137
miconazorb pow af 2% ................... 137 MICRO AIR MIS NEBULIZR .............. 151 MICRO PLUS MIS NEBULIZR ............ 151 MICRO THIN MIS LANC 33G ............ 157 MICROCHAMBER MIS ...................... 149 MICROCLENS PAD WIPES ................ 143 MICROELITE MIS BATTERY .............. 148 MICROELITE MIS COMP/NEB ........... 151 MICROELITE MIS FILTERS ............... 148 microgestin tab 1.5/30 ...................... 17 microgestin tab 1/20 ........................ 17 microgestin tab fe 1/20..................... 18 microgestin tab fe1.5/30 ................... 18 MICROLET MIS LANCETS ................. 157 MICROSHIELD MIS CPR................... 153 MICROSPACER MIS ........................ 149 MICROTAINER MIS LANCET ............. 157 midodrine hcl tab 10 mg ................... 33 midodrine hcl tab 2.5 mg .................. 33 midodrine hcl tab 5 mg ..................... 33 midol tab 650mg .............................. 74 MIL ADREGEN TAB ......................... 114 MILADRE FORT TAB 160MG ............. 114 MIL-A-MULSIO EMU .......................... 94 milantex sus ex st ............................ 61 milantex sus original ......................... 60 mili tab 0.25/35 ............................... 17 milltrium sr tab .............................. 100 milltrium tab advanced ................... 100 milltrium tab cardio ........................ 100 milltrium tab stamina ..................... 114 MILPAN TAB 325 MG ...................... 114 mimvey lo tab 0.5-0.1 ...................... 14 mimvey tab 1-0.5mg ........................ 14 MINI COMPRES MIS NEBULIZR ........ 151 MINI PLUS MIS NEBULIZR ............... 151 MINIBREEZE MIS NEBULIZE ............ 151 MINIELITE MIS BATTERY ................. 148 MINIELITE MIS COMP/NEB .............. 151 MINIELITE MIS FILTERS .................. 148 MINI-MIST MIS PORTABLE .............. 151 miniprin low tab 81mg ec .................. 73 minitran dis 0.1mg/hr ....................... 25 minitran dis 0.2mg/hr ....................... 25 minitran dis 0.4mg/hr ....................... 26 minitran dis 0.6mg/hr ....................... 26 minocycline hcl cap 100 mg ................. 5
215
minocycline hcl cap 50 mg .................. 5 minocycline hcl cap 75 mg .................. 5 MINOCYCLINE POW ........................... 5 mintox plus chw ............................... 59 mintox sus ....................................... 60 mintox sus max st ............................ 61 MIRENA IUD SYSTEM ........................ 15 misoprostol tab 100 mcg ................... 63 misoprostol tab 200 mcg ................... 63 MISTERNEB MIS NEBULIZE .............. 151 mm aspirin tab 325mg ...................... 72 MM BIOTIN CAP KERATIN ................ 113 mm melatonin tab 10mg tr .............. 144 MM PENTIPS MIS 31GX5MM ............. 145 MM PENTIPS MIS 31GX8MM ............. 146 MM PENTIPS MIS 32GX4MM ............. 146 MM TWIST MIS LANCETS ................. 157 MOBILE LANCE MIS 30G .................. 157 moderiba tab 200mg .......................... 7 MOLESKIN PAD FOAM ..................... 166 mometasone furoate cream 0.1% ..... 140 mometasone furoate oint 0.1% ........ 140 mometasone furoate solution 0.1% (lotion).......................................... 140 MOMMYS BLISS POW PROBIOTI ......... 58 MONISTAT 3 KIT COMBO PK .............. 68 MONISTAT 7 KIT COMBO PK .............. 68 MONISTAT 7 KIT COMPLETE ............... 68 MONOLET MIS LANCETS .................. 157 MONOLET OPD MIS LANCETS ........... 157 MONOLETTOR MIS LANCETS ............ 157 mono-linyah tab 0.25-35 ................... 17 mononessa tab ................................. 17 montelukast sodium chew tab 4 mg (base equiv) .................................... 50 montelukast sodium chew tab 5 mg (base equiv) .................................... 50 montelukast sodium oral granules packet 4 mg (base equiv) ............................ 50 montelukast sodium tab 10 mg (base equiv) ............................................. 50 MORE-DOPHILU POW ACIDOPHI ......... 57 morgidox cap 1x100mg ...................... 5 morgidox cap 1x50mg ........................ 5 morgidox cap 2x100mg ...................... 5 morphine sulfate oral soln 10 mg/5ml .77 morphine sulfate oral soln 100 mg/5ml
(20 mg/ml) ..................................... 77 morphine sulfate oral soln 20 mg/5ml. 77 morphine sulfate suppos 10 mg ......... 77 morphine sulfate suppos 20 mg ......... 77 morphine sulfate suppos 5 mg ........... 77 morphine sulfate tab 15 mg............... 77 morphine sulfate tab 30 mg............... 77 morphine sulfate tab er 100 mg ......... 77 morphine sulfate tab er 15 mg ........... 77 morphine sulfate tab er 200 mg ......... 77 morphine sulfate tab er 30 mg ........... 77 morphine sulfate tab er 60 mg ........... 77 motion relf tab 25mg ........................ 64 motion sick chw 25mg ...................... 64 motion sick tab 25mg ....................... 64 motion-time chw 25mg ..................... 64 motrin ib tab 200mg ......................... 79 MOVANTIK TAB 12.5MG .................... 67 MOVANTIK TAB 25MG ....................... 67 move along tab 100mg ..................... 53 MPD SFTY LAN MIS 21G .................. 157 MPD SFTY LAN MIS 23G .................. 157 MPD SFTY LAN MIS 28G .................. 157 MPD SFTY LAN MIS 30G .................. 157 MPS CAP ....................................... 113 muc/cgh relf liq 5-100mg .................. 46 mucinex allr tab 180mg .................... 39 MUCINEX CGH GRA 5-100MG ............ 48 mucinex cgh liq 5-100mg .................. 46 mucinex chld liq 100/5ml .................. 43 mucinex dm liq 20-400 ..................... 46 MUCINEX/KIDS GRA 100MG .............. 44 mucosa tab 400mg........................... 43 mucus d tab 120/1200...................... 46 mucus d tab 60-600mg ..................... 46 mucus er tab 1200mg ....................... 44 mucus rel dm liq 5-100/5 .................. 46 mucus relf d tab 60-600mg ............... 46 mucus relief liq 100/5ml ................... 43 mucus relief liq 400/20ml .................. 43 mucus relief liq 5-100mg .................. 46 mucus relief tab 1200 er ................... 44 mucus relief tab 1200mg .................. 44 mucus relief tab 200mg .................... 43 mucus relief tab 30-600er ................. 48 mucus relief tab 600mg .................... 44 mucus relief tab 600mg er ................ 44
216
mucus relief tab 60-1200 .................. 48 mucus relief tab 60-600mg ................ 46 mucus rlf d tab 120-1200 .................. 46 mucus rlf d tab 60-600mg ................. 46 mucus rlf dm liq 5-100/5 ................... 46 mucus rlf dm tab 30-600er ................ 48 mucus+chst liq 100/5ml .................... 43 mucus+chst liq 200/10ml .................. 43 mucus-d tab 60-600mg ..................... 46 mucus-dm max tab 60-1200 .............. 48 mucus-dm tab 30-600mg .................. 48 mult vitamin tab daily ....................... 93 mult vitamin tab essent ..................... 93 mult vitamin tab mens ...................... 93 mult vitamin tab no iron .................. 100 mult vitamin tab womens ................ 100 multi 50+ cap for her ........................ 95 multi 50+ tab for her ...................... 100 multi 50+ tab for him ..................... 100 MULTI ADULT CHW EXTRA C ............ 106 multi adult chw gummies ................ 106 multi cap complete ........................... 95 multi cap for her ............................... 95 multi cap for him .............................. 95 multi complt tab /iron ..................... 100 MULTI FOR POW HER ...................... 108 MULTI FOR POW HIM ...................... 108 multi gummie chw mens .................. 106 multi gummie chw womens .............. 106 multi tab for her ............................. 100 multi tab for him ............................ 100 multi vit/fl chw 0.25mg ................... 112 multi vit/fl dro 0.5mg/ml ................. 112 multi vitami tab ................................ 93 multi vitami tab d-3 .......................... 93 multi vitami tab w/iron ...................... 94 MULTI VITAMN TAB MINERALS ......... 100 multi+omega3 chw adult ................. 106 MULTI-B CAP COMPLEX ..................... 89 MULTI-BETIC TAB DIABETES ............ 100 multi-day tab ................................... 93 multi-day tab /ca/iron ..................... 109 multi-day tab /iron ........................... 94 multi-day tab minerals .................... 100 multi-day tab wght trm ................... 100 multi-delyn liq ................................ 109 MULTI-DELYN LIQ /IRON ................. 112
MULTI-GLAN TAB 455 MG ............... 114 multi-lean tab ................................ 100 multilex tab ................................... 100 multilex-t&m tab ............................ 100 multimineral tab plus ...................... 100 multiple vitamin cap ......................... 92 multiple vitamin tab.......................... 93 multiple vitamins w/ iron tab ............. 94 multiple vitamins w/ minerals tab ..... 100 multiv women tab 50+ ................... 100 multivi adlt chw gummies................ 106 multi-vit hp cap /mineral ................. 115 multi-vit/ tab minerals .................... 100 multi-vit/fe dro /fl 0.25 ................... 112 multi-vit/fe tab ................................ 94 multivit/fl chw 0.25mg .................... 112 multivit/fl chw 0.5mg ..................... 112 multivit/fl chw 1mg ........................ 112 multi-vit/fl dro /fe 0.25 ................... 112 multivit/fl dro 0.25mg ..................... 112 multi-vit/fl dro 0.5mg/ml ................ 112 multivit/fl sol 0.5mg/ml .................. 112 multivit/fl/ dro fe 0.25 .................... 112 multi-vitami chw gummies .............. 106 multi-vitami tab menopaus .............. 100 MULTI-VITAMI TAB MONOCAPS ........ 100 multivitamin cap .............................. 92 multivitamin cap daily ....................... 95 MULTIVITAMIN CHW ADLT GUM ....... 106 MULTIVITAMIN CHW ADULT ............ 107 multivitamin chw child .................... 110 MULTIVITAMIN CHW CHILD ............. 109 multivitamin chw children ............... 110 MULTIVITAMIN CHW IRON .............. 112 multivitamin chw vita d3 ................. 107 MULTIVITAMIN DRO ORGANIC ........... 93 multivitamin liq .............................. 107 MULTIVITAMIN LIQ .......................... 94 multivitamin liq mineral .................. 107 multivitamin tab adlt 50+ ................ 100 multivitamin tab adt 50+ ................ 100 MULTIVITAMIN TAB ADULT .............. 100 multivitamin tab adults ................... 100 MULTIVITAMIN TAB ADULTS ............ 100 multivitamin tab daily ....................... 93 multivitamin tab iron-fre ................... 93 MULTIVITAMIN TAB MEN ................. 100
217
multivitamin tab men 50+ ............... 101 multivitamin tab mens .................... 101 multivitamin tab mineral ................. 101 multivitamin tab women .................. 101 multivitamin tab womens ................ 101 multi-vitamn tab .............................. 93 multi-vite tab ................................. 100 multi-vite tab 50&over .................... 100 mupirocin calcium cream 2% ........... 135 mupirocin oint 2% .......................... 135 murine ear dro 6.5% ot ................... 132 murine ear sol 6.5% ot.................... 132 murine tears dro dry eyes ................ 129 mvc-fluoride chw 0.25mg ................ 112 mvc-fluoride chw 0.5mg .................. 112 mvc-fluoride chw 1mg..................... 112 mv-one cap ..................................... 92 MVW COMPLETE CAP D3000 .............. 95 MVW COMPLETE CAP D5000 .............. 95 MVW COMPLETE CAP FORMULAT ........ 95 MVW COMPLETE CAP MINIS ............... 95 mvw complete chw bubblgum .......... 110 mvw complete chw d3000 ............... 110 mvw complete chw d5000 ............... 110 MVW COMPLETE CHW GRAPE ........... 107 mvw complete chw orange .............. 110 my choice tab 1.5mg ........................ 15 MY MDI PORTA MIS NEBULISE ......... 151 my way tab 1.5mg ............................ 16 myamulti tab ................................. 101 mycocide ns sol 1% ........................ 136 mycophenolate mofetil cap 250 mg ... 169 mycophenolate mofetil for oral susp 200 mg/ml ........................................... 169 mycophenolate mofetil tab 500 mg ... 169 MYGLUCOHEALT MIS LANC 30G ........ 157 mylanta sus max st........................... 61 MYLERAN TAB 2MG ............................ 9 mynephrocaps cap............................ 90 mynephron cap ................................ 90 myorisan cap 10mg ........................ 134 myorisan cap 20mg ........................ 134 myorisan cap 30mg ........................ 134 myorisan cap 40mg ........................ 134 my-vitalife cap ................................. 95 myzilra tab ...................................... 18
N nabumetone tab 500 mg ................... 80 nabumetone tab 750 mg ................... 80 NACL/BACT INJ 0.9%BENZ .............. 169 nadolol tab 20 mg ............................ 26 nadolol tab 40 mg ............................ 26 nadolol tab 80 mg ............................ 26 nafrinse chw 1mg f ......................... 120 nafrinse dro 0.125mg ..................... 120 NALIDIXIC POW ACID ....................... 67 NANOVM POW 1-3 YRS ................... 110 NANOVM POW 4-8YEARS................. 110 NANOVM POW 9-18 YRS ................. 110 NANOVM T/F POW .......................... 110 naproxen dr tab 375mg .................... 80 naproxen dr tab 500mg .................... 80 naproxen sod tab 220mg ................... 80 naproxen sodium cap 220 mg ............ 80 naproxen sodium tab 275 mg ............ 80 naproxen sodium tab 550 mg ............ 80 naproxen tab 250 mg ....................... 80 naproxen tab 375 mg ....................... 80 naproxen tab 500 mg ....................... 80 naramin liq ...................................... 37 naratriptan hcl tab 1 mg (base equiv) . 82 naratriptan hcl tab 2.5 mg (base equiv) ...................................................... 82 nasal allerg spr 55mcg ...................... 41 nasal allgy spr 55mcg/ac ................... 42 nasal allrgy spr 55mcg/ac.................. 42 NASAL DECON SYP 30MG/5ML ........... 40 NASAL DECONG LIQ 30MG/5ML ......... 40 nasal decong tab 120mg er ............... 41 nasal decong tab 30mg ..................... 40 nasal moist spr 0.65% ...................... 42 nasal saline spr 0.65% ...................... 42 nat veg lax tab 8.6mg ....................... 52 NATACYN SUS 5% OP ..................... 128 nateglinide tab 120 mg ..................... 20 nateglinide tab 60 mg ....................... 20 nat-rul cal tab /d 500mg ................. 118 nat-rul dail tab vit/iron ...................... 94 nat-rul iron tab 325mg .................... 124 nat-rul tab b-50 ............................. 115 NAT-RUL THER TAB M ..................... 101 natrul-100 tab super ....................... 105 NATRUL-VITES TAB ........................ 101
218
natural bal sol tears ........................ 129 NATURAL COND MIS + LUBE ............ 167 natural lax tab 8.6mg ........................ 52 natura-lax pow 3350 nf ..................... 54 natures sol tears ............................ 129 NEBULIZER MIS ............................. 151 NEBULIZER MIS CMPRESSR ............. 151 NEBULIZER MIS ULTRASON ............. 151 NEBULIZER SY KIT ALLINONE .......... 151 nebusal neb 3% ............................... 44 necon tab 0.5/35 .............................. 17 NEOMULTIVITE TAB .......................... 93 NEOMYCIN POW SULFATE ................ 135 neomycin sulfate tab 500 mg .............. 5 neomycin-bacitrac zn-polymyx 5(3.5)mg-400unt-10000unt op oin ... 128 neomycin-polymy-gramicid op sol 1.75-10000-0.025mg-unt-mg/ml ..... 128 neomycin-polymyxin-dexamethasone ophth oint 0.1% ............................. 131 neomycin-polymyxin-dexamethasone ophth susp 0.1% ............................ 131 neomycin-polymyxin-hc ophth susp .. 131 neomycin-polymyxin-hc otic soln 1% 132 neomycin-polymyxin-hc otic susp 3.5 mg/ml-10000 unit/ml-1% ............... 132 NEON STRIPS MIS 3/4 ASST ............ 164 neo-polycin oin hc 1%op ................. 131 neo-polycin oin op .......................... 128 neotuss liq ....................................... 48 nephro tab vitamins .......................... 91 neuro-k-50 tab ................................. 85 new day tab 1.5mg ........................... 16 NEW LIFE TAB HAIR ........................ 114 NEXAVAR TAB 200MG ....................... 11 NEXCARE TATT MIS BANDAGES ........ 164 NEXCARE WATR MIS PRF BAND ........ 164 NEXIUM 24HR TAB 20MG ................... 63 NEXIUM GRA 10MG DR ...................... 63 NEXIUM GRA 2.5MG DR ..................... 63 NEXIUM GRA 5MG DR ....................... 63 NEXPLANON IMP 68MG ...................... 15 NF FORMULAS CHW CHILDREN......... 111 niacin cap 400-100 ........................... 87 niacin cap 400mg ............................. 87 niacin tab er 1000 mg (antihyperlipidemic) .......................... 34
niacin tab er 500 mg (antihyperlipidemic) ...................................................... 34 niacin tab er 750 mg (antihyperlipidemic) ...................................................... 34 nifedipine tab er 24hr 30 mg.............. 28 nifedipine tab er 24hr 60 mg.............. 28 nifedipine tab er 24hr 90 mg.............. 28 nifedipine tab er 24hr osmotic release 30 mg ................................................. 28 nifedipine tab er 24hr osmotic release 60 mg ................................................. 28 nifedipine tab er 24hr osmotic release 90 mg ................................................. 28 night time tab 25mg ......................... 70 nighttime tab 25mg .......................... 70 nikki tab 3-0.02mg ........................... 16 NITRO-BID OIN 2% .......................... 25 NITRO-DUR DIS 0.3MG/HR ................ 26 NITRO-DUR DIS 0.8MG/HR ................ 26 NITROFURAN POW ANHYDROU .......... 67 nitrofurantoin macrocrystalline cap 100 mg ................................................. 67 nitrofurantoin macrocrystalline cap 25 mg ................................................. 67 nitrofurantoin macrocrystalline cap 50 mg ................................................. 67 nitrofurantoin monohydrate macrocrystalline cap 100 mg ............. 67 nitrofurantoin susp 25 mg/5ml ........... 67 nitroglycerin cap er 2.5 mg ................ 25 nitroglycerin cap er 6.5 mg ................ 25 nitroglycerin cap er 9 mg .................. 25 nitroglycerin sl tab 0.3 mg ................. 25 nitroglycerin sl tab 0.4 mg ................. 25 nitroglycerin sl tab 0.6 mg ................. 25 nitroglycerin td patch 24hr 0.1 mg/hr . 25 nitroglycerin td patch 24hr 0.2 mg/hr . 25 nitroglycerin td patch 24hr 0.4 mg/hr . 26 nitroglycerin td patch 24hr 0.6 mg/hr . 26 nitro-time cap 2.5mg cr .................... 25 nitro-time cap 6.5mg cr .................... 25 nitro-time cap 9mg cr ....................... 25 niva-fol tab .................................... 123 nizatidine cap 150 mg ....................... 63 nizatidine cap 300 mg ....................... 63 nizatidine oral soln 15 mg/ml ............. 63 noble formul cre hc 1% ................... 139
219
noble formul spr 1% ....................... 139 non-asa jr tab 160mg ....................... 76 non-asa jr tab 160mg qm .................. 76 non-aspirin chw 160mg jr .................. 75 non-aspirin chw 80mg ....................... 74 non-aspirin sus 160/5ml .................... 75 non-aspirin tab 325mg ...................... 74 non-aspirin tab 500mg ...................... 74 non-aspirin tab 500mg/rr .................. 74 non-aspirin tab 650mg ...................... 74 nora-be tab 0.35mg .......................... 15 NORDITROPIN INJ 10/1.5ML .............. 24 NORDITROPIN INJ 15/1.5ML .............. 24 NORDITROPIN INJ 30/3ML ................. 24 NORDITROPIN INJ 5/1.5ML ................ 24 norethindrone ace & ethinyl estradiol tab 1 mg-20 mcg ................................... 17 norethindrone ace & ethinyl estradiol-fe tab 1 mg-20 mcg .............................. 18 norethindrone acetate tab 5 mg.......... 19 norethindrone acetate-ethinyl estradiol tab 0.5 mg-2.5 mcg .......................... 15 norethindrone acetate-ethinyl estradiol tab 1 mg-5 mcg ............................... 15 norethindrone tab 0.35 mg ................ 15 norgestimate & ethinyl estradiol tab 0.25 mg-35 mcg ...................................... 18 norgestimate-eth estrad tab 0.18-25/0.215-25/0.25-25 mg-mcg .... 18 norgestimate-eth estrad tab 0.18-35/0.215-35/0.25-35 mg-mcg .... 19 norlyda tab 0.35mg .......................... 15 norlyroc tab 0.35mg ......................... 15 NORPACE CAP 100MG CR .................. 29 NORPACE CAP 150MG CR .................. 29 nortemp sus 160/5ml ........................ 75 nortemp sus infants .......................... 75 nortrel tab 0.5/35 ............................. 17 nortrel tab 1/35 ................................ 17 nortrel tab 7/7/7 .............................. 18 norwich asa tab 325mg ..................... 72 NOSE CLIP MIS .............................. 148 NOVA SAFETY MIS LANC 23G ........... 157 NOVA SAFETY MIS LANC 28G ........... 157 NOVA SURE MIS LANCETS ............... 157 NOVOFINE MIS 32GX6MM ................ 147 NOVOFINE PLS MIS 32GX4MM.......... 146
NOVOLIN INJ 70/30 .......................... 20 NOVOLIN INJ FLEXPEN ...................... 20 NOVOLIN N INJ RELION .................... 19 NOVOLIN N INJ U-100 ...................... 19 NOVOLIN R INJ RELION .................... 19 NOVOLIN R INJ U-100 ...................... 19 NOVOLIN70/30 INJ RELION ............... 20 NOVOLOG MIX INJ 70/30 .................. 19 NOVOLOG MIX INJ FLEXPEN .............. 19 NUEDEXTA CAP 20-10MG .................. 71 nufol tab ....................................... 126 nulev tab 0.125mg ........................... 61 NUTRIENT 45+ TAB WOMEN ............ 101 NUTRIENT 50+ TAB MEN ................. 101 NUTRIENTS CAP ANTIOXID................ 95 NUTRIENTS TAB MEN ...................... 101 NUTRIENTS TAB TEENS ................... 101 NUTRIENTS TAB WOMEN ................. 101 NUVARING MIS ................................ 16 nyamyc pow 100000 ...................... 135 nystatin cream 100000 unit/gm ....... 136 nystatin oint 100000 unit/gm ........... 136 nystatin susp 100000 unit/ml .......... 132 nystatin tab 500000 unit ..................... 6 nystatin topical powder 100000 unit/gm .................................................... 135 nystop pow 100000 ........................ 136 nytol tab 25mg ................................ 70 O ocean kids spr 0.65% ....................... 42 ocella tab 3-0.03mg ......................... 16 OCREVUS INJ 300/10ML.................... 71 octreotide acetate inj 100 mcg/ml (0.1 mg/ml) ........................................... 24 octreotide acetate inj 1000 mcg/ml (1 mg/ml) ........................................... 24 octreotide acetate inj 200 mcg/ml (0.2 mg/ml) ........................................... 24 octreotide acetate inj 50 mcg/ml (0.05 mg/ml) ........................................... 24 octreotide acetate inj 500 mcg/ml (0.5 mg/ml) ........................................... 24 OCULAR TAB VITAMINS .................. 101 ocutabs tab ................................... 101 ocutabs tab lutein........................... 101 OCUVITE CAP ADULT ........................ 95 ocuvite eye cap health ...................... 95
220
ocuvite eye chw heatlh .................... 107 ocuvite eye tab + multi ................... 101 OCUVITE LUTE CAP ........................... 95 ocuvite tab lutein ............................ 101 ocuvite xtra tab .............................. 101 odor control aer powd 1%................ 136 odor eaters aer 1% ......................... 136 OFEV CAP 100MG ............................. 51 OFEV CAP 150MG ............................. 51 ofloxacin ophth soln 0.3% ............... 127 ofloxacin otic soln 0.3% .................. 131 ogestrel tab ..................................... 17 OIL-ALMOND OIL SWEET ................. 144 OLIVE OIL ..................................... 144 omega 3 500 cap 500mg ................. 122 omega 3 cap 1000mg ..................... 122 omega essent liq basic .................... 123 omega iii cap epa+dha .................... 122 OMEGA-3 CAP 1400MG .................... 122 omega-3 cf cap 1000mg .................. 122 omega-3 fatty acids cap 1000 mg ..... 122 omega-3 fatty acids cap 1200 mg ..... 123 omega-3 fatty acids cap 300 mg ....... 122 omega-3 fatty acids cap 435 mg ....... 122 omega-3 fatty acids cap 500 mg ....... 122 omega-3 fish cap 1000 mg .............. 122 omega-3 fish cap 1200mg ............... 123 omega-3 fish chw 113.5mg .............. 123 omega-3 plus cap 1000mg............... 122 omeprazole cap 20.6mgdr ................. 63 OMEPRAZOLE CAP 20.6MGDR ............ 63 omeprazole cap delayed release 10 mg63 omeprazole cap delayed release 20 mg63 omeprazole cap delayed release 40 mg63 omeprazole magnesium cap dr 20.6 mg (20 mg base equiv)........................... 63 OMEPRAZOLE TAB 20MG ................... 63 OMEPRAZOLE TAB 20MG DR .............. 63 omeprazole-sodium bicarbonate cap 20-1100 mg ..................................... 64 omera cap 1000mg ......................... 123 OMNICAP TAB .................................. 93 OMNIFLEX DPR ............................... 168 ON CALL MIS LANCETS .................... 157 ON CALL PLUS MIS LANCETS............ 157 once daily tab .................................. 93 once daily tab iron ............................ 94
ONCOVITE TAB .............................. 101 ondansetron hcl oral soln 4 mg/5ml .... 64 ondansetron hcl tab 24 mg ................ 64 ondansetron hcl tab 4 mg .................. 64 ondansetron hcl tab 8 mg .................. 64 ondansetron orally disintegrating tab 4 mg ................................................. 64 ondansetron orally disintegrating tab 8 mg ................................................. 64 ONE DAILY CHW ADLT GUM ............. 107 one daily chw gummy ..................... 107 ONE DAILY MN TAB W/O IRON ......... 101 one daily mv tab /iron ....................... 94 one daily tab ................................... 93 one daily tab /mineral ..................... 101 one daily tab 50 plus ...................... 101 one daily tab 50+ ........................... 101 one daily tab 50+ adv ..................... 101 one daily tab complete .................... 101 one daily tab essentl.................. 93, 101 one daily tab fe/ca ......................... 101 one daily tab healthy ...................... 101 one daily tab iron-fre ...................... 101 one daily tab maximum .................. 101 one daily tab men .......................... 101 one daily tab men 50+ ................... 101 one daily tab mens ......................... 101 ONE DAILY TAB MENS .................... 101 one daily tab mens 50+ .................. 101 ONE DAILY TAB MENS 50+ .............. 101 one daily tab multivit ................. 93, 101 one daily tab pls iron ........................ 94 one daily tab plus iro ...................... 101 ONE DAILY TAB WMNS 50+ ............. 101 one daily tab wom 50+ ................... 101 ONE DAILY TAB WOMANS ............... 101 one daily tab women ...................... 101 one daily tab women 50 .................. 101 one daily tab womens .............. 101, 109 ONE DAILY TAB WOMENS ............... 102 one daily wm tab pro-actv ............... 102 one daily/ tab minerals ................... 102 one dly hlth tab wght adv ................ 102 ONE-A-DAY CHW IMMUNITY ............ 107 ONE-A-DAY CHW VITACRAV ....... 93, 107 ONE-A-DAY TAB 50+ ADV ............... 102 ONE-A-DAY TAB 65+ ...................... 102
221
ONE-A-DAY TAB ENERGY ................. 102 ONE-A-DAY TAB MENOPAUS ............ 102 ONE-A-DAY TAB MENS .................... 102 ONE-A-DAY TAB PROEDGE .............. 102 one-a-day tab teen/her ................... 102 ONE-A-DAY TAB TEEN/HIM .............. 102 ONE-DAILY PAK VIT/MIN ................. 108 one-daily tab /iron ............................ 94 one-daily tab mult vit ........................ 93 ONETOUCH FP MIS LANCETS ........... 157 ONETOUCH KIT ULT MINI ................ 153 ONETOUCH KIT ULTRA 2 ................. 153 ONETOUCH KIT VERIO .................... 153 ONETOUCH KIT VERIO FL ................ 153 ONETOUCH KIT VERIO IQ ................ 153 ONETOUCH MIS 30G ....................... 157 ONETOUCH MIS COMBO .................. 157 ONETOUCH MIS LANCETS................ 157 ONETOUCH TES ULTRA BL ............... 143 ONETOUCH TES VERIO.................... 143 ONETOUCH US MIS LANCETS ........... 157 ONETOUCH VER KIT SYNC ............... 153 ON-THE-GO MIS LANC 30G .............. 157 opcicon tab 1.5mg ............................ 16 OPSUMIT TAB 10MG ......................... 35 OPTICHAMBER MIS ADV LRG ........... 149 OPTICHAMBER MIS ADV MED ........... 149 OPTICHAMBER MIS ADV SM ............. 149 OPTICHAMBER MIS DIA LG .............. 149 OPTICHAMBER MIS DIA MD ............. 149 OPTICHAMBER MIS DIA SM ............. 149 OPTICHAMBER MIS DIAMOND .......... 149 OPTICHAMBER MIS FACE MAS ......... 149 optic-vites tab ................................ 102 optic-vites tab lutein ....................... 102 OPTIHALER MIS ............................. 149 optimal-d cap 50000unt .................... 86 OPTIMUM CHW AIRVITES ................ 107 optimum pms tab ........................... 102 option 2 tab 1.5mg ........................... 16 OPTIONHOME MIS NEBULIZR ........... 151 OPTISOURCE CHW BARIATRC .......... 107 OPURITY CHW BYPASS .................... 107 OPURITY TAB ................................. 102 oral electro sol cherry ..................... 121 oral electro sol freezer .................... 121 oral electro sol h-e-b ...................... 121
oral electrolyte solution................... 121 oralone dent pst 0.1% .................... 132 oralyte sol ..................................... 121 oralyte sol freeze ........................... 121 ORCHIC TAB 150MG ....................... 114 ORENITRAM TAB 0.125MG ................ 35 ORENITRAM TAB 0.25MG .................. 35 ORENITRAM TAB 1MG ....................... 35 ORENITRAM TAB 2.5MG .................... 35 ORENITRAM TAB 5MG ....................... 35 ORKAMBI GRA 100-125 .................... 50 ORKAMBI GRA 150-188 .................... 51 ORKAMBI TAB 100-125 ..................... 50 ORKAMBI TAB 200-125 ..................... 50 ormir cap 50mg ............................... 37 orphenadrine citrate tab er 12hr 100 mg ...................................................... 84 orsythia tab ..................................... 17 os calcium tab /vit d ....................... 117 os-cal + d3 tab 500-200 ................. 118 oscal 500/ tab 200 d-3 .................... 117 os-cal chw ..................................... 119 os-cal chw 500-600 ........................ 119 os-cal extra tab d3 ......................... 118 oscimin sr tab 0.375mg .................... 62 oscimin sub 0.125mg ........................ 61 oscimin tab 0.125mg ...................61, 62 oseltamivir phosphate cap 30 mg (base equiv) ............................................... 7 oseltamivir phosphate cap 45 mg (base equiv) ............................................... 8 oseltamivir phosphate cap 75 mg (base equiv) ............................................... 8 oseltamivir phosphate for susp 6 mg/ml (base equiv) ...................................... 8 OSPHENA TAB 60MG......................... 23 OSTEOPRIME TAB PLUS .................. 102 osteoprime tab ultra ....................... 102 otix sol 6.5% ot ............................. 132 OVARY TAB 125 MG ........................ 114 ovega-3 cap 500mg ........................ 122 oxaprozin tab 600 mg ....................... 80 oxybutynin chloride syrup 5 mg/5ml ... 67 oxybutynin chloride tab 5 mg ............ 67 oxybutynin chloride tab er 24hr 10 mg 67 oxybutynin chloride tab er 24hr 15 mg 67 oxybutynin chloride tab er 24hr 5 mg . 67
222
oxycodone hcl cap 5 mg .................... 77 oxycodone hcl conc 100 mg/5ml (20 mg/ml) ........................................... 77 oxycodone hcl soln 5 mg/5ml ............. 77 oxycodone hcl tab 10 mg ................... 77 oxycodone hcl tab 15 mg ................... 77 oxycodone hcl tab 20 mg ................... 77 oxycodone hcl tab 30 mg ................... 77 oxycodone hcl tab 5 mg..................... 77 oxycodone w/ acetaminophen tab 10-325 mg ................................................. 78 oxycodone w/ acetaminophen tab 2.5-325 mg ..................................... 77 oxycodone w/ acetaminophen tab 5-325 mg ................................................. 77 oxycodone w/ acetaminophen tab 7.5-325 mg ..................................... 78 oxycodone-aspirin tab 4.8355-325 mg 78 OXYTETRACYC POW HCL .................... 5 OXYTROL/WOMN DIS 3.9MG/24 ......... 67 oys shell ca tab /d3 ......................... 117 oys shell ca tab 500 + d .................. 117 oys shell+d chw 500-400................. 119 oys shell+d tab 250-125.................. 118 oysco 500 tab 500mg ...................... 116 oysco 500+d chw ........................... 119 oysco 500+d tab ............................ 118 oyst ca/d3 tab 500-200 ................... 118 oyst cal/d tab 250mg ...................... 116 oyst cal/d tab 500mg ...................... 117 oyst shell/d tab 250mg .................... 116 oyst shell/d tab 500-125 ................. 118 oyst shell/d tab 500-200 ................. 118 oyst shell/d tab 500-400 ................. 118 oyst shell/d tab 500mg ................... 118 oyster shell calcium tab 500 mg ....... 116 oystercal tab 500mg ....................... 116 oystercal-d tab 500mg .................... 118 OZEMPIC INJ 2/1.5ML ....................... 20 P pa b-complex tab w/b-12................... 88 pa calcium tab vit d ........................ 118 pa fish oil cap 1000mg .................... 123 pa melatonin tab 5mg ..................... 143 PA MENS 50 PAK VITAPAK ............... 108 PA MENS PAK VITAPAK .................... 108 pa mucus rel tab 600mg .................... 44
pa oyster sh tab 500mg .................. 117 pa vitamin cap 2000unit .................... 85 PA WOMENS 50 PAK VITAPAK .......... 108 PA WOMENS PAK VITAPAK .............. 109 pacerone tab 200mg ......................... 29 pain & fever chw 160mg ................... 75 pain & fever sol 160/5ml ................... 75 pain & fever sus 160/5ml .................. 75 pain & fever tab 325mg .................... 74 pain & fever tab 500mg .................... 74 pain relief chw 160mg ....................... 75 pain relief liq 160/5ml ....................... 75 pain relief liq 500/15ml ..................... 75 pain relief sus 160/5ml ..................... 75 pain relief tab 200mg ........................ 79 pain relief tab 325mg ........................ 74 pain relief tab 500mg ........................ 74 pain relief tab 500mg/rr .................... 74 pain relief tab 650mg ........................ 74 pain relieve chw 160mg jr ................. 75 pain relieve sus 160/5ml ................... 75 pain relieve tab 325mg ..................... 74 pain relieve tab 500mg ..................... 74 pain relieve tab 500mg/rr .................. 74 pain relievr chw 80mg....................... 75 pain relievr liq 500/15ml ................... 75 pain relievr tab 160mg ...................... 76 pain relievr tab 325mg ...................... 74 pain relievr tab 500mg ...................... 74 pain/fever sup 120mg ....................... 76 pain/fever sus 160/5ml ..................... 75 paladin oin .................................... 141 pamprin tab 220mg .......................... 80 pan-c 500 tab bioflavo ...................... 92 PANDA MASK MIS LARGE ................ 150 PANDA MASK MIS MEDIUM .............. 150 PANDA MASK MIS PEDIATRI ............ 150 PANDA MASK MIS SMALL ................ 150 panoxyl wash liq 10% ..................... 133 panoxyl wash liq 4% ....................... 133 pantoprazole sodium ec tab 20 mg (base equiv) ............................................. 63 pantoprazole sodium ec tab 40 mg (base equiv) ............................................. 63 PARAGARD IUD T380A ...................... 15 PARATHYROID TAB 10MG ................ 114 PARI BABY MIS SIZE 0 .................... 151
223
PARI BABY MIS SIZE 1 .................... 151 PARI BABY MIS SIZE 2 .................... 151 PARI EXPIRAT MIS FILTER ............... 148 PARI LC D MIS NEBULIZR ................ 151 PARI LC MIS SPRINT ....................... 151 PARI LC PLUS MIS .......................... 151 PARI LC PLUS MIS NEBULIZR ........... 151 PARI LC PLUS MIS VIOS PRO ........... 151 PARI LC STAR MIS .......................... 151 PARI LC STAR MIS NEBULIZR ........... 151 PARI MASK MIS SIZE 3 ................... 148 PARI PLASTIC MIS MASK ................. 148 PARI PLASTIC MIS MASK PED........... 148 PARI PRONEB MIS ULTRA II ............. 151 PARI SINUS MIS AERO SYS ............. 151 PARI TREK S MIS ............................ 151 paricalcitol cap 1 mcg ........................ 25 paricalcitol cap 2 mcg ........................ 25 paricalcitol cap 4 mcg ........................ 25 paroex sol 0.12% ........................... 132 PARVA-CAL TAB 500MG ................... 116 PARVLEX TAB ................................. 102 PC LANCETS MIS 30G ..................... 157 PEANUTS MIS BANDAGES ................ 164 ped elctrlyt sol ............................... 121 ped elctrlyt sol /zinc ........................ 121 ped elctrlyt sol apple ....................... 121 ped elctrlyt sol freeze ...................... 121 ped elctrlyt sol freezer .................... 121 ped elctrlyt sol freezpop .................. 121 ped elctrlyt sol grape ...................... 121 ped elctrlyt sol pineappl .................. 121 ped elctrlyt sol unflavor ................... 121 ped formula liq 100-10/5 ................... 47 pedia d-vite dro 400unit .................... 87 pedia iron dro 15mg/ml ................... 124 pedia vance sol apple ...................... 122 pedia vance sol grape ..................... 122 pediacare al liq 12.5/5ml ................... 38 pediacare sus 160/5ml ...................... 75 PEDIA-LAX CHW YUMS ...................... 58 PEDIA-LAX LIQ 50MG ........................ 54 PEDIATRIC MD MIS MASK ............... 153 PEDIATRIC MIS MASK ..................... 148 PEDIATRIC MIS MOUTHPIE .............. 148 pediatric oin ................................... 141 PEDIATRIC SM MIS MASK ................ 153
pediatric vitamins acd w/ fluoride soln 0.5 mg/ml ..................................... 112 pediavit liq .................................... 109 peg 3350-kcl-na bicarb-nacl-na sulfate for soln 236 gm ............................... 55 peg 3350-kcl-na bicarb-nacl-na sulfate for soln 240 gm ............................... 55 peg 3350-kcl-sod bicarb-nacl for soln 420 gm ........................................... 55 PEGASYS INJ ..................................... 7 PEGASYS INJ 180MCG/M ..................... 7 PEGASYS INJ PROCLICK ...................... 7 PEN NEEDLE MIS 29GX1/2 .............. 145 PEN NEEDLE MIS 32GX4MM ............. 146 PEN NEEDLES MIS 29GX12.7 ........... 145 PEN NEEDLES MIS 31GX3/16 ........... 145 PEN NEEDLES MIS 31GX5/16 ........... 146 PEN NEEDLES MIS 31GX5MM ........... 145 PEN NEEDLES MIS 31GX8MM ........... 146 PEN NEEDLES MIS 32GX1/4 ............ 147 PEN NEEDLES MIS 32GX4MM ........... 146 PEN NEEDLES MIS 32GX5/32 ........... 146 PEN NEEDLES MIS 32GX6MM ........... 147 penicillin v potassium for soln 125 mg/5ml............................................. 3 penicillin v potassium for soln 250 mg/5ml............................................. 3 penicillin v potassium tab 250 mg ......... 3 penicillin v potassium tab 500 mg ......... 3 PENTASA CAP 250MG CR ................... 66 PENTASA CAP 500MG CR ................... 66 PENTIPS MIS 31GX5MM .................. 145 PENTIPS MIS 31GX8MM .................. 146 PENTIPS MIS 32GX4MM .................. 146 peptic relf chw 262mg....................... 56 PERFECT 28G MIS LANCETS ............ 157 PERFECT 30G MIS LANCETS ............ 157 permethrin cream 5% ..................... 142 persa-gel gel 10% .......................... 134 PFLEX MIS ..................................... 148 PFT FILTER MIS 1000...................... 148 pharbechlor tab 4mg ........................ 36 pharbedryl cap 25mg ........................ 36 pharbedryl cap 50mg ........................ 37 pharbetol tab 325mg ........................ 74 pharbetol tab 500mg ........................ 74 pharbinex tab 400mg........................ 43
224
PHARMACY COU MIS LANCETS ......... 157 phazyme chw 125mg ........................ 65 phenadoz sup 12.5mg ....................... 38 phenadoz sup 25mg ......................... 38 phenazo tab 200mg .......................... 69 phenazopyridine hcl tab 100 mg ......... 69 phenazopyridine hcl tab 200 mg ......... 69 phenobarbital elixir 20 mg/5ml .......... 69 phenobarbital tab 100 mg ................. 69 phenobarbital tab 15 mg ................... 69 phenobarbital tab 16.2 mg ................ 69 phenobarbital tab 30 mg ................... 69 phenobarbital tab 32.4 mg ................ 69 phenobarbital tab 60 mg ................... 69 phenobarbital tab 64.8 mg ................ 69 phenobarbital tab 97.2 mg ................ 69 phenytoin chew tab 50 mg ................ 83 phenytoin sodium extended cap 100 mg ......................................................83 phenytoin sodium extended cap 200 mg ......................................................83 phenytoin sodium extended cap 300 mg ......................................................83 phenytoin susp 125 mg/5ml .............. 83 philith tab 0.4-35 ............................. 17 phillips cap 100mg ........................... 53 PHLEXY-VITS POW .......................... 107 PHYTOMULTI TAB ........................... 102 phytonadione tab 5 mg ..................... 87 PILLOW MASK MIS ADULT ............... 148 PILLOW MASK MIS CHILD ................ 148 PILLOW MASK MIS PEDIATRI ........... 148 pilocarpine hcl tab 5 mg .................. 133 pilocarpine hcl tab 7.5 mg ............... 133 pimtrea tab...................................... 18 pindolol tab 10 mg............................ 26 pindolol tab 5 mg ............................. 26 pink bismuth chw 262mg................... 56 pink bismuth sus 262/15ml................ 56 pink bismuth sus max str .................. 57 pink bismuth tab 262mg.................... 56 pinworm med sus 144mg/ml............... 8 PINWORM TAB MEDICINE ................... 8 pinxav oin ..................................... 141 pioglitazone hcl tab 15 mg (base equiv) ......................................................21 pioglitazone hcl tab 30 mg (base equiv)
...................................................... 21 pioglitazone hcl tab 45 mg (base equiv) ...................................................... 21 pioglitazone hcl-glimepiride tab 30-2 mg ...................................................... 21 pioglitazone hcl-glimepiride tab 30-4 mg ...................................................... 21 pioglitazone hcl-metformin hcl tab 15-500 mg ...................................... 21 pioglitazone hcl-metformin hcl tab 15-850 mg ...................................... 21 PIPERAZINE POW ............................... 8 pirmella tab 1/35 ............................. 17 pirmella tab 7/7/7 ............................ 18 PITUITARY TAB 35 MG .................... 114 PLASTC BANDG MIS 3/4 .................. 164 PLASTIC MIS BANDAGES ................. 164 pms support cap complex .................. 95 pnv-dha cap .................................. 115 pnv-select tab ................................ 115 POCKET CHAMB MIS ....................... 149 POCKET SPACE MIS ........................ 149 podactin cre 2% ............................. 137 podofilox soln 0.5% ........................ 141 poly bacitra oin .............................. 135 poly vitamin chw ............................ 110 polycin oin op ................................ 128 polyeth glyc pow 3350 nf .................. 54 polyethylene glycol 3350 oral packet .. 54 polyethylene glycol 3350 oral powder . 54 POLYMYXIN B POW SULFATE ............... 8 polymyxin b-trimethoprim ophth soln 10000 unit/ml-0.1% ....................... 128 polyvinyl alcohol ophth soln 1.4% ..... 128 polyvitamin chw /iron ..................... 111 poly-vite dro .................................. 109 poly-vite sol /iron ........................... 112 PORENAL+D CAP OMEGA 3 ................ 95 PORT COMPRES MIS NEBULIZR ........ 151 portia-28 tab ................................... 17 potassium bicarbonate effer tab 25 meq .................................................... 121 potassium chloride cap er 10 meq .... 121 potassium chloride cap er 8 meq ...... 121 potassium chloride microencapsulated crys er tab 10 meq ......................... 121 potassium chloride microencapsulated
225
crys er tab 20 meq ......................... 121 potassium chloride oral soln 10% (20 meq/15ml) .................................... 121 potassium chloride oral soln 20% (40 meq/15ml) .................................... 121 potassium chloride tab er 10 meq ..... 121 potassium chloride tab er 20 meq (1500 mg) .............................................. 121 potassium chloride tab er 8 meq (600 mg) .............................................. 121 potassium citrate tab er 10 meq (1080 mg) ................................................ 69 potassium citrate tab er 15 meq (1620 mg) ................................................ 69 potassium citrate tab er 5 meq (540 mg) ......................................................69 poten b-150 tab tr ............................ 90 povidone iod oin 10%...................... 143 povidone/iod sol 10% ..................... 142 povidone-iod sol 10% ..................... 142 povidone-iod sol 7.5% .................... 142 povidone-iodine oint 10% ................ 143 povidone-iodine soln 10%................ 142 powderlax pow ................................. 54 pr benzoyl liq 7% wash ................... 133 PRALUENT INJ 150MG/ML .................. 34 PRALUENT INJ 75MG/ML .................... 34 pramipexole dihydrochloride tab 0.125 mg ................................................. 83 pramipexole dihydrochloride tab 0.25 mg ......................................................83 pramipexole dihydrochloride tab 0.5 mg ......................................................83 pramipexole dihydrochloride tab 0.75 mg ......................................................83 pramipexole dihydrochloride tab 1 mg .83 pramipexole dihydrochloride tab 1.5 mg ......................................................83 prasugrel hcl tab 10 mg (base equiv) 127 prasugrel hcl tab 5 mg (base equiv) .. 127 pravastatin sodium tab 10 mg ............ 34 pravastatin sodium tab 20 mg ............ 34 pravastatin sodium tab 40 mg ............ 34 pravastatin sodium tab 80 mg ............ 34 prazosin hcl cap 1 mg ....................... 30 prazosin hcl cap 2 mg ....................... 30 prazosin hcl cap 5 mg ....................... 30
PRED SOD PHO SOL 1% OP ............. 130 prednisolone acetate ophth susp 1% 130 prednisolone sod phos orally disintegr tab 10 mg (base eq) ......................... 13 prednisolone sod phos orally disintegr tab 15 mg (base eq) ......................... 13 prednisolone sod phos orally disintegr tab 30 mg (base eq) ......................... 13 prednisolone sod phosph oral soln 6.7 mg/5ml (5 mg/5ml base) .................. 13 prednisolone sod phosphate oral soln 15 mg/5ml (base equiv) ........................ 13 prednisolone sodium phosphate oral soln 25 mg/5ml (base eq) ........................ 13 PREDNISOLONE SUS 1% ................. 130 prednisolone syrup 15 mg/5ml (usp solution equivalent) .......................... 13 prednisone oral soln 5 mg/5ml ........... 14 prednisone tab 1 mg ......................... 13 prednisone tab 10 mg ....................... 14 prednisone tab 2.5 mg ...................... 14 prednisone tab 20 mg ....................... 14 prednisone tab 5 mg ......................... 14 prednisone tab 50 mg ....................... 14 prednisone tab therapy pack 10 mg (21) ...................................................... 14 prednisone tab therapy pack 10 mg (48) ...................................................... 14 prednisone tab therapy pack 5 mg (21) ...................................................... 14 prednisone tab therapy pack 5 mg (48) ...................................................... 14 PREMIUM MIS PACKETS .................. 109 prenatabs rx tab ............................ 114 prenatal 19 chw tab ....................... 115 prenatal 19 tab .............................. 115 prep h hc cre 1% ........................... 139 PREP PADS PAD ............................. 168 PRESCRIPTIVE PAK FORM MEN ........ 109 PRESCRIPTIVE PAK FORM WMN ....... 109 PRESERVISION CAP AREDS ............... 95 PRESERVISION CAP AREDS 2 ............ 95 PRESERVISION CAP LUTEIN .............. 95 PRESERVISION CHW AREDS 2 ......... 107 PRESERVISION TAB AREDS ............. 102 PRESSURE ACT MIS LANCET ............ 157 PRESSURE ACT MIS LANCETS .......... 157
226
prevalite pow 4gm ............................ 33 prevalite pow 4gm pk ........................ 33 prevent cap ..................................... 95 preventeza tab 1.5mg ....................... 16 previfem tab .................................... 18 PRILOSEC OTC TAB 20MG .................. 63 primadophilu cap .............................. 57 primidone tab 250 mg ....................... 83 primidone tab 50 mg ......................... 83 princess chw gummies .................... 110 PRO COMFORT MIS 31G .................. 157 PRO COMFORT MIS 31GX8MM .......... 146 PRO COMFORT MIS 32GX4MM .......... 147 PRO COMFORT MIS 32GX6MM .......... 147 PRO COMFORT MIS LANCETS ........... 157 PRO COMFORT PAD ALCOHOL .......... 168 probenecid tab 500 mg ..................... 82 probiata tab ..................................... 57 probiotic cap .............................. 57, 58 PROBIOTIC CAP ............................... 57 probiotic cap acidophi ........................ 57 probiotic cap formula ........................ 57 probiotic cap gold ............................. 57 PROBIOTIC CAP GOLD ....................... 57 probiotic chw children ....................... 57 PROBIOTIC DRO COLIC ..................... 58 PROBIOTIC LIQ 15 DAY ..................... 58 PROBIOTIC LIQ NEWBORN................. 58 probiotic pak children ........................ 57 PRO-CAL TAB ................................. 102 PROCARE COMP MIS NEBULIZE ........ 151 PROCEDURAL MIS MASK ................. 153 PROCERV HP TAB ........................... 102 prochlorperazine maleate tab 10 mg (base equivalent) ............................. 69 prochlorperazine maleate tab 5 mg (base equivalent) ...................................... 69 prochlorperazine suppos 25 mg .......... 69 procto-med cre hc 2.5% .................. 133 procto-pak cre 1% .......................... 133 proctosol hc cre 2.5% ..................... 133 proctozone cre -hc 2.5% ................. 133 PRODIGY MIS 26G .......................... 157 PRODIGY MIS 28G .......................... 157 pro-ex antif cre 1%......................... 136 progesterone micronized cap 100 mg .. 19 progesterone micronized cap 200 mg .. 19
PROLASTIN-C INJ 1000MG ................ 50 PROLIA SOL 60MG/ML ...................... 23 PROMACTA TAB 12.5MG .................. 125 PROMACTA TAB 25MG .................... 125 PROMACTA TAB 50MG .................... 125 PROMACTA TAB 75MG .................... 125 promethazine & phenylephrine syrup 6.25-5 mg/5ml ................................ 45 promethazine hcl suppos 12.5 mg ...... 38 promethazine hcl suppos 25 mg ......... 38 promethazine hcl suppos 50 mg ......... 38 promethazine hcl syrup 6.25 mg/5ml .. 38 promethazine hcl tab 12.5 mg............ 38 promethazine hcl tab 25 mg .............. 38 promethazine hcl tab 50 mg .............. 38 promethazine w/ codeine syrup 6.25-10 mg/5ml........................................... 45 promethazine-dm syrup 6.25-15 mg/5ml ...................................................... 46 promethazine-phenylephrine-codeine syrup 6.25-5-10 mg/5ml ................... 46 promethegan sup 12.5mg ................. 38 promethegan sup 25mg .................... 38 promethegan sup 50mg .................... 38 promolaxin tab 100mg ...................... 54 PRONEB ULTRA MIS II/LCD ............. 151 PRONEB ULTRA MIS II/PED ............. 151 PRONEB ULTRA MIS LC PLUS ........... 152 PRONEB ULTRA MIS LC SPRNT ......... 152 PRONEB ULTRA MIS LC STAR ........... 152 PRONUTRIENTS TAB SUPER B ............ 88 propafenone hcl cap er 12hr 225 mg... 29 propafenone hcl cap er 12hr 325 mg... 29 propafenone hcl cap er 12hr 425 mg... 29 propafenone hcl tab 150 mg .............. 29 propafenone hcl tab 225 mg .............. 29 propafenone hcl tab 300 mg .............. 29 propranolol hcl cap er 24hr 120 mg .... 26 propranolol hcl cap er 24hr 160 mg .... 26 propranolol hcl cap er 24hr 60 mg ...... 26 propranolol hcl cap er 24hr 80 mg ...... 26 propranolol hcl oral soln 20 mg/5ml .... 26 propranolol hcl oral soln 40 mg/5ml .... 26 propranolol hcl tab 10 mg.................. 26 propranolol hcl tab 20 mg.................. 26 propranolol hcl tab 40 mg.................. 26 propranolol hcl tab 60 mg.................. 26
227
propranolol hcl tab 80 mg .................. 26 propylthiouracil tab 50 mg ................. 23 PRORENAL +D TAB ......................... 102 PRORENAL+D CAP OMEGA-3 .............. 95 PRORENAL+D TAB .......................... 102 prosight cap w/lutein ........................ 96 prosight tab ................................... 102 PROSTATE TAB 130MG .................... 114 PROTECT CAP CARDIO ...................... 96 PROTECT CAP PLUS SO ..................... 96 PROTECT PLUS LIQ NF .................... 107 PROTEGRA CAP ................................ 96 provil tab 200mg .............................. 79 PROVIT TAB ................................... 102 PROXEED PLUS PAK ........................ 108 PROXI-STRIP MIS 1/4 ..................... 164 PROXI-STRIPS MIS 1/2 ................... 164 pseudoephed-bromphen-dm syrup 30-2-10 mg/5ml ............................... 46 pseudoephedr tab 120mg er .............. 41 pseudoephedr tab 30mg .................... 40 pseudoephedr tab 60mg .................... 40 pseudoephedrine-guaifenesin tab er 12hr 60-600 mg ...................................... 46 PSORCON CRE 0.05% ..................... 138 PSS SAFE LAN MIS ......................... 157 PSS SEL LANC MIS ......................... 158 pulmosal neb 7%.............................. 44 PULMOZYME SOL 1MG/ML ................. 50 puralube oin .................................. 130 pure & gentl dro 0.3% .................... 128 purefa cap 1000mg ......................... 123 pvp prep sol 10% ........................... 142 px advanced tab multivit ................. 102 px allergy cap 25mg.......................... 36 px allergy tab 25mg .......................... 37 px antacid chw 1000mg .................... 59 px antacid sus max st ....................... 61 px antacid sus reg st ......................... 60 px aspirin chw 81mg ......................... 72 px aspirin tab 325mg ........................ 72 px aspirin tab 325mg ec .................... 73 px aspirin tab 81mg ec ...................... 73 px b-50 tab ................................... 115 px calcium&d tab 600-400 ............... 117 px complete tab senior .................... 102 px dayhist tab 1.34mg ...................... 36
px fish oil cap 1000mg .................... 123 px ibuprofen tab 200mg .................... 79 px iron tab 200mg.......................... 124 px iron tab 27mg ........................... 124 PX LANCETS MIS 28G ..................... 158 PX LANCETS MIS ULT THIN ............. 158 px laxative tab 8.6mg ....................... 52 px mens mult tab vitamins .............. 102 px profen ib dro 50/1.25 ................... 79 px profen ib sus 100/5ml .................. 80 px stomach chw 262mg .................... 56 px stomach sus 262/15ml ................. 56 px stomach sus 525/15ml ................. 57 px triple oin ................................... 135 px tussin dm liq 100-10/5 ................. 47 px tussin sol 100/5ml ....................... 43 pyrazinamide tab 500 mg .................... 6 pyridostigmine bromide tab 60 mg ..... 85 pyridostigmine bromide tab er 180 mg 85 pyridoxine hcl tab 25 mg .................. 85 pyridoxine hcl tab 50 mg .................. 85 Q QC ALCOHOL PAD SWABS ............... 168 qc allergy tab 10mg .......................... 38 qc antacid chw 500mg ...................... 58 qc antacid sus .................................. 60 qc antacid sus anti-gas ................60, 61 qc anti-diar cap 2mg ........................ 55 qc apap 8 hr tab 650mg .................... 74 qc aspirin tab 325mg ........................ 72 qc aspirin tab 325mg ec .................... 73 QC CASTOR OIL ............................. 144 qc child asa chw 81mg ...................... 72 qc childrens chw complete ............... 111 qc childrens chw extra c .................. 110 qc childrens chw iron ...................... 112 qc essential tab ................................ 93 qc gas relf chw 125mg ...................... 66 qc gas relf chw 80mg ........................ 65 qc ibuprofen tab 200mg .................... 79 QC LANCETS MIS 28G .................... 158 QC LANCETS MIS 30G .................... 158 qc laxative sup 10mg ........................ 51 qc laxative tab 5mg ec ...................... 51 qc medifin liq mucus rl ...................... 43 qc senna tab 8.6mg .......................... 52 qc sleep aid cap 50mg ...................... 69
228
qc suphedrin tab 120mg sr ................ 41 QC SWEET OIL ............................... 144 qc therin-m tab .............................. 102 QUENCH TAB ................................. 102 QUFLORA PED CHW 0.25MG ............. 112 QUFLORA PED CHW 0.5MG .............. 112 QUFLORA PED CHW 1MG ................. 112 QUFLORA PED DRO 0.25MG ............. 112 QUFLORA PED DRO 0.5MG/ML ......... 112 QUIKSTIK ADH MIS BANDAGES........ 164 quin b stron tab b-25 ........................ 89 QUIN B TAB STRONG ...................... 102 quinapril hcl tab 10 mg ...................... 29 quinapril hcl tab 20 mg ...................... 29 quinapril hcl tab 40 mg ...................... 30 quinapril hcl tab 5 mg ....................... 29 quinapril-hydrochlorothiazide tab 10-12.5 mg ................................................. 31 quinapril-hydrochlorothiazide tab 20-12.5 mg ................................................. 31 quinapril-hydrochlorothiazide tab 20-25 mg ................................................. 31 QUININE POW SULFATE ..................... 8 QUININE SULF POW DIHYDRAT ........... 8 QUINTABS TAB ................................ 93 quintabs-m tab .............................. 102 QUINTABS-M TAB ........................... 102 QVAR REDIHA AER 80MCG ................. 50 QVAR REDIHAL AER 40MCG ............... 50 R ra acetamin tab 325mg ..................... 74 ra acidophil cap 300mg ..................... 57 ra acne cre 10% ............................. 133 RA ADH BANDG MIS EX-LARGE ........ 164 RA ADH PADS MIS 3 ....................... 164 RA ADHESIVE MIS 2-1/4X3 ............. 164 RA ADHESIVE MIS BANDAGES ......... 164 RA ALCOHOL PAD SWABS................ 168 ra allergy tab 25mg .......................... 37 ra allergy tab 4mg ............................ 36 ra antacid chw 1000mg ..................... 59 ra antacid chw 500mg ....................... 58 ra antacid sus antigas ....................... 61 ra antacid sus anti-gas ...................... 60 ra anti-itch cre 1% ......................... 139 ra anti-itch oin 1% ......................... 140 ra anti-itch spr 1% ......................... 139
ra antisepti sol 10% ....................... 142 ra aspirin chw 81mg ......................... 72 ra aspirin tab 325mg ........................ 72 ra aspirin tab 325mg ec .................... 73 ra aspirin tab 500mg ........................ 72 ra aspirin tab 81mg ec ...................... 73 ra balanced tab b-100 ...................... 89 ra balanced tab b-50 ........................ 89 ra balanced tab b-50 tr ..................... 90 ra balnaced tab b-100 tr ................... 90 RA BANDAGES MIS 1 ...................... 164 ra bandages mis 3/4 ....................... 164 RA BANDAGES MIS 3/4 ................... 164 RA BANDAGES MIS ASSORTED ........ 164 RA BANDAGES MIS CLEAR .............. 164 RA BANDAGES MIS EX-LRG ............. 164 ra b-complex tab .............................. 88 ra b-complex tab vit c tr .................... 88 ra b-complex tab w/b-12 ................... 88 RA BUTTERFLY MIS BANDAGES ........ 164 ra ca/mg/zn tab ............................. 120 ra ca/vit d3 tab 600-400 ................. 118 ra calcium chw caramel ................... 120 ra calcium chw mlk choc ................. 120 ra calcium tab 500mg ..................... 116 ra calcium tab 600mg ..................... 116 ra calcium tab hi-cal ....................... 116 ra calcium tab high pot ................... 116 ra calcium tab vit d ........................ 117 ra calcium+d tab 600mg ................. 117 ra central tab energy ...................... 102 ra central tab -vite ......................... 102 ra central tab vite sel ...................... 102 ra central tab vite sen ..................... 102 ra cetiri-d tab 5-120mg ..................... 45 ra cetirizin tab 10mg......................... 38 ra child asa chw 81mg ...................... 72 ra child vit chw /iron ....................... 112 ra chlorphen tab 4mg ....................... 36 ra clotrimaz cre 3 ............................. 68 ra cod liver cap ................................ 87 RA COD LIVER OIL ........................... 87 ra col-rite cap 100mg ....................... 53 ra col-rite cap 250mg ....................... 53 ra col-rite cap 50mg ......................... 53 ra dandruff sha 1% ........................ 137 RA EAR CARE TAB .......................... 114
229
ra ear dro 6.5% ot .......................... 132 RA EAR-LOOP MIS MASK ................. 153 RA EFFERVESC TAB FORMULA .......... 114 RA ESSENCE-C POW LMN-LIME ........ 108 RA ESSENCE-C POW ORANGE .......... 108 RA ESSENCE-C POW RASPBRY ......... 108 RA ESSENCE-C POW TNGERINE ....... 108 RA E-ZJECT MIS 28G ...................... 158 RA E-ZJECT MIS 33G ...................... 158 RA E-ZJECT MIS THIN 26G .............. 158 RA E-ZJECT MIS THIN 28G .............. 158 RA E-ZJECT MIS ULT THIN ............... 158 ra fish oil cap 1000mg ..................... 123 ra gas relf chw 125mg ....................... 66 ra gas relf chw 80mg ........................ 65 ra hair/skin tab /nails ...................... 102 ra hi cal tab 500-200 ...................... 117 ra hi-cal tab 500mg ........................ 116 ra hi-cal/d tab 500mg ..................... 117 ra hydrocort cre 1% ................ 139, 141 ra hydrocort cre 1%pls 12 ............... 139 ra ibuprofen cap 200mg .................... 78 ra ibuprofen tab 200mg ..................... 79 ra iron tab 27mg ............................ 124 ra iron tab 325mg .......................... 124 ra iron tab 65mg ............................ 124 ra k-pec sus 262/15ml ...................... 56 ra laxative chw 15mg ........................ 53 ra laxative pow................................. 54 ra laxative sup 10mg ........................ 51 ra laxative tab 25mg ......................... 52 ra laxative tab 5mg ec....................... 51 ra laxative tab ex st .......................... 52 ra lice lot 1% ................................. 142 ra liquid sus antacid .......................... 60 ra lorata-d tab 24 hour ...................... 45 ra lubricant dro 0.4-0.3% ................ 129 ra mature wm tab diet sup .............. 102 RA MELATONIN SUB 1MG ................ 144 ra melatonin tab 10mg .................... 143 ra melatonin tab 3mg ...................... 143 ra melatonin tab 5mg ...................... 143 ra menopause tab support ............... 114 ra nasal spr allergy ........................... 42 ra nighttime cap 50mg ...................... 69 ra nighttime tab 25mg ...................... 70 ra one daily pak mens 50+ .............. 102
ra one daily tab +iron ....................... 94 ra one daily tab energy ................... 102 ra one daily tab essentia ................... 93 ra one daily tab maximum ............... 102 ra one daily tab mens ..................... 102 ra one daily tab mens 50+ .............. 103 ra one daily tab mens/d3 ................ 103 ra one daily tab multivit .................... 93 ra one daily tab womens ................. 103 RA OYS SHL/D TAB 250MG .............. 119 RA OYS SHL/D TAB 500MG .............. 119 ra p col-rit tab 8.6-50mg ................... 55 ra pediatric sol electrol.................... 122 RA PEN NEEDL MIS 31GX3/16 ......... 145 ra pink bism chw 262mg ................... 56 ra pink bism tab 262mg .................... 56 ra renewal gel 10% ........................ 134 ra senna cap 8.6mg.......................... 52 ra senna tab 8.6mg .......................... 52 RA SHEER ADH PAD LARGE ............. 166 ra sleep aid cap 50mg ....................... 70 ra sleep aid tab 25mg ..................69, 70 RA STERILE SOL NASAL .................... 42 ra suphedrin tab 120mg cr ................ 41 ra suphedrin tab 30mg ...................... 40 ra therapeut tab m/beta .................. 103 ra triple oin antibiot ........................ 135 ra tussin dm liq 100-10/5 .................. 47 ra tussin liq 100/5ml ......................... 43 ra tussin liq dm max ......................... 47 ra tussin syp 100/5ml ....................... 43 ra vision tab vite/zn ........................ 103 ra vit b-6 tab 50mg .......................... 85 ra vitamin c tab 1000mg ................... 92 ra vitamin cap 2000unit .................... 85 rabano liq yodado............................. 91 raloxifene hcl tab 60 mg.................... 23 ramipril cap 1.25 mg ........................ 30 ramipril cap 10 mg ........................... 30 ramipril cap 2.5 mg .......................... 30 ramipril cap 5 mg ............................. 30 ranitidine hcl cap 150 mg .................. 62 ranitidine hcl cap 300 mg .................. 62 ranitidine hcl syrup 15 mg/ml (75 mg/5ml) ......................................... 62 ranitidine hcl tab 150 mg .................. 62 ranitidine hcl tab 300 mg .................. 62
230
ranitidine tab 75mg .......................... 62 RASUVO INJ 10MG ........................... 80 RASUVO INJ 12.5MG ......................... 80 RASUVO INJ 15MG ........................... 80 RASUVO INJ 17.5MG ......................... 80 RASUVO INJ 20MG ........................... 80 RASUVO INJ 22.5MG ......................... 81 RASUVO INJ 25MG ........................... 81 RASUVO INJ 30MG ........................... 81 RASUVO INJ 7.5MG .......................... 80 react tab 1.5mg ............................... 16 READYLANCE MIS 21G .................... 158 READYLANCE MIS 23G .................... 158 READYLANCE MIS 26G .................... 158 READYLANCE MIS 28G .................... 158 READYLANCE MIS 30G .................... 158 REALITY MIS LANCETS .................... 158 REALITY MIS LUBRICAT ................... 167 REALITY SWAB PAD ........................ 168 REALITY TRIG MIS LANCETS ............ 158 REALITY ULTR MIS TEXTURED.......... 167 REALITY ULTR MIS THIN ................. 167 REBETOL SOL 40MG/ML ..................... 7 reclipsen tab .................................... 16 recofen ........................................... 46 recort plus cre 1% .......................... 139 REESES MED SUS PINWORM ............... 8 refenesen tab 200mg ........................ 43 refenesen tab 400mg ........................ 43 refresh cell gel 1% op ..................... 128 REFRESH DRO OP ........................... 129 refresh lacr oin op .......................... 129 REFRESH OPT SOL MEGA-3.............. 130 REFRESH OPTI DRO 0.5-0.9%.......... 129 refresh p.m. oin op ......................... 129 REFRESH SOL OPTIVE ..................... 130 rehydralyte sol ............................... 122 RELION LANCE MIS STND 21G ......... 158 RELION LANCE MIS THIN 26G .......... 158 RELION LANCE MIS THIN 30G .......... 158 RELION MICRO MIS THIN 33G.......... 158 RELION PEN MIS 31GX8MM ............. 146 RELION PEN MIS 32GX4MM ............. 147 RELION ULTRA MIS THIN 32G .......... 158 RELION ULTRA MIS THIN PLS........... 158 remedy cre antifung ....................... 137 remedy oin af 2% ........................... 137
remedy pow antifung ...................... 137 REMODULIN INJ 10MG/ML ................. 35 REMODULIN INJ 1MG/ML................... 35 REMODULIN INJ 2.5MG/ML ................ 35 REMODULIN INJ 5MG/ML .................. 35 renal cap ......................................... 90 renal tab multivit ............................. 91 renal vitamn tab .............................. 91 renal/zinc tab multivit ....................... 93 renal-vite tab ................................... 91 renaplex tab .................................. 103 RENAPLEX-D TAB ........................... 103 rena-vite rx tab ................................ 91 rena-vite tab ................................... 91 reno cap ......................................... 90 repaglinide tab 0.5 mg ...................... 20 repaglinide tab 1 mg ........................ 20 repaglinide tab 2 mg ........................ 20 REPHRESH CAP PRO-B ...................... 57 REPLACE CAP .................................. 96 REPLACEMENT MIS FILTER .............. 148 REPLACEMENT MIS FILTERS ............ 148 rest simply tab 25mg ........................ 70 restore plus dro 0.5% op ................. 128 restore tear dro 0.5% op ................. 128 RETAINE CAP VISION ..................... 113 retaine cmc sol 0.5% op ................. 128 RETAINE HPMC SOL 0.3% ............... 128 retaine pm oin ............................... 130 REVATIO SUS 10MG/ML .................... 35 REVLIMID CAP 10MG ...................... 169 REVLIMID CAP 15MG ...................... 169 REVLIMID CAP 2.5MG ..................... 169 REVLIMID CAP 20MG ...................... 169 REVLIMID CAP 25MG ...................... 169 REVLIMID CAP 5MG ........................ 169 RHINARIS SPR 0.2% ........................ 42 rhinocort sus allergy ......................... 41 ribasphere cap 200mg ........................ 7 ribasphere tab 200mg ........................ 7 ribasphere tab 600mg ........................ 7 ribavirin cap 200 mg .......................... 7 ribavirin tab 200 mg ........................... 7 rid lice kil sha 0.33-4% ................... 142 rifabutin cap 150 mg .......................... 6 rifampin cap 150 mg ........................... 6 rifampin cap 300 mg ........................... 6
231
RIGHTEST MIS GL300 ..................... 158 riluzole tab 50 mg ............................. 84 ringworm cre 1% ............................ 136 RISACAL-D TAB .............................. 120 risanoid tab plus ............................. 115 RITEFLO MIS.................................. 149 rivastigmine tartrate cap 1.5 mg (base equivalent) ...................................... 70 rivastigmine tartrate cap 3 mg (base equivalent) ...................................... 70 rivastigmine tartrate cap 4.5 mg (base equivalent) ...................................... 70 rivastigmine tartrate cap 6 mg (base equivalent) ...................................... 71 rivastigmine td patch 24hr 13.3 mg/24hr ......................................................70 rivastigmine td patch 24hr 4.6 mg/24hr ......................................................70 rivastigmine td patch 24hr 9.5 mg/24hr ......................................................70 rizatriptan benzoate oral disintegrating tab 10 mg (base eq) ......................... 82 rizatriptan benzoate oral disintegrating tab 5 mg (base eq) ........................... 82 rizatriptan benzoate tab 10 mg (base equivalent) ...................................... 82 rizatriptan benzoate tab 5 mg (base equivalent) ...................................... 82 robafen ac sol 100-10/5 .................... 46 robafen dm liq 10-100/5 .................... 47 robafen dm liq 10-100mg .................. 47 robafen dm liq cough ........................ 47 robafen dm syp 100-10/5 .................. 48 robafen liq 200/10ml......................... 43 robafen syp 100/5ml ......................... 44 robitussin liq .................................... 47 robitussin liq 20-400 ......................... 47 robitussin liq cgh/cong ...................... 47 robitussin liq to go dm ...................... 47 rolaids chw 550-110 ......................... 59 ROMIDEPSIN INJ 10MG ..................... 11 ropinirole hydrochloride tab 0.25 mg ... 83 ropinirole hydrochloride tab 0.5 mg .... 83 ropinirole hydrochloride tab 1 mg ....... 83 ropinirole hydrochloride tab 2 mg ....... 83 ropinirole hydrochloride tab 3 mg ....... 83 ropinirole hydrochloride tab 4 mg ....... 83
ropinirole hydrochloride tab 5 mg ....... 83 rosadan cre 0.75% ......................... 134 rosadan gel 0.75% ......................... 134 RUBRACA TAB 200MG ....................... 12 RUBRACA TAB 250MG ....................... 12 RUBRACA TAB 300MG ....................... 12 RUCONEST INJ 2100UNIT ............... 127 rulox sus ......................................... 60 RYDAPT CAP 25MG ........................... 11 rynex pse liq .................................... 44 S s.s.s. tonic liq ................................ 116 s.s.s. tonic tab ............................... 116 safe tussin liq 10-100/5 .................... 47 SAFE-T-LANCE MIS 21G .................. 158 SAFE-T-LANCE MIS 25G .................. 158 SAFE-T-LANCE MIS HI FLOW ........... 158 SAFE-T-LANCE MIS LOW FLOW ........ 158 SAFE-T-LANCE MIS NOR FLOW ........ 158 SAFE-T-PRO MIS LANCETS .............. 158 SAFE-T-PRO MIS PLUS .................... 158 SAFETY 21G MIS LANCETS .............. 158 SAFETY 28G MIS LANCETS .............. 158 SAFETY LET MIS LANCETS ............... 158 SAFETY MIS LANCETS ..................... 158 SAFETY SEAL MIS 28G .................... 158 SAFETY SEAL MIS 30G .................... 158 saline injection bacteriostatic ........... 169 saline mist spr 0.65% ....................... 42 saline nasal spray 0.65% .................. 42 saline nose spr 0.65% ...................... 42 SALINE/PHENO SOL ....................... 169 salmon oil cap 1000mg ................... 123 sam-e.p.a. cap 500mg .................... 122 SAMSCA TAB 15MG .......................... 24 SAMSCA TAB 30MG .......................... 24 SANDIMMUNE SOL 100MG/ML ......... 169 SANTYL OIN 250/GM ...................... 141 SAPS CARE PAD ALCOHOL ............... 168 SAPS HEALTH MIS TWIST ................ 158 SAPS HEALTH PAD ALCOHOL ........... 168 SAPSCARE MIS TWIST .................... 158 sarnol-hc lot 1% ............................ 140 SAVELLA MIS TITR PAK ..................... 71 SAVELLA TAB 100MG ........................ 71 SAVELLA TAB 12.5MG ....................... 71 SAVELLA TAB 25MG.......................... 71
232
SAVELLA TAB 50MG .......................... 71 SAVISION CAP ................................. 96 savision tab ................................... 103 SB ALCOHOL PAD PREP ................... 168 sb allergy tab 10mg .......................... 39 sb allergy tab 25mg med ................... 37 sb antacid sus anti-gas ...................... 60 sb aspirin tab 325mg ........................ 72 sb aspirin tab 325mg ec .................... 73 sb bisacodyl tab 5mg ec .................... 51 sb bismuth tab 262mg ...................... 56 sb cgh contr liq dm ........................... 47 sb cgh contr syp 100/5ml .................. 44 sb child asa chw 81mg ...................... 72 sb coughtab tab 200mg ..................... 43 sb docusate tab 8.6-50mg ................. 55 sb gas relf chw 125mg ...................... 66 sb hydrocort cre 1% ....................... 139 sb hydrocort oin 1% ....................... 140 sb ibuprofen tab 200mg .................... 79 SB LANCETS MIS THIN .................... 158 SB LANCETS MIS ULTR THN ............. 158 sb laxative sup 10mg ........................ 51 sb non-asa chw 160mg ..................... 75 sb non-asa chw 80mg frt ................... 75 sb non-asa chw 80mg grp ................. 75 sb saline spr 0.65% .......................... 42 sb senna-lax tab 8.6mg ..................... 52 sb sleep tab 25mg ............................ 70 sb triple oin antibiot ........................ 135 scalp relief sol 1% .......................... 139 scalpicin sol 1% ............................. 139 sclerex tab ..................................... 103 SCOOBY-DOO CHW......................... 111 scot-tussin liq expct sf ....................... 43 sea buddies chw dly mult ................ 111 sea-omega 30 cap 1200mg ............. 123 sea-omega 50 cap 1000mg ............. 123 SEGLUROMET TAB 2.5-1000 .............. 21 SEGLUROMET TAB 2.5-500 ................ 21 SEGLUROMET TAB 7.5-1000 .............. 21 SEGLUROMET TAB 7.5-500 ................ 21 selegiline hcl cap 5 mg ...................... 84 selegiline hcl tab 5 mg ...................... 84 selenium sulfide lotion 2.5% ............ 137 senexon-s tab 8.6-50mg ................... 55 senior tabs tab ............................... 103
senior tonic liq ................................. 91 senna lax tab 8.6mg ......................... 52 senna laxati tab 8.6mg ..................... 52 SENNA LEAVES MIS .......................... 52 senna plus tab 8.6-50mg .................. 55 senna s tab 8.6-50mg ....................... 55 senna smooth tab 15mg .................... 52 SENNA SYP ...................................... 52 senna tab 8.6-50mg ......................... 55 senna-extra tab 17.2mg .................... 52 senna-grx syp 8.8mg/5 ..................... 53 senna-lax tab 8.6mg......................... 52 senna-s tab 8.6-50mg ...................... 55 senna-tabs tab 8.6mg ....................... 52 senna-time s tab 8.6-50mg ............... 55 senna-time tab 8.6mg ...................... 52 sennazon syp 8.8mg/5 ...................... 53 senno tab 8.6mg .............................. 52 sennosides cap 8.6 mg...................... 52 sennosides syrup 8.8 mg/5ml ............ 53 sennosides tab 8.6 mg ...................... 52 sennosides-docusate sodium tab 8.6-50 mg ................................................. 55 senokot extr tab 17.2mg ................... 52 sentry adult tab under 50 ................ 103 SENTRY SENIO TAB LUTEIN ............. 103 sentry tab ..................................... 103 SENTRY TAB .................................. 103 sentry tab senior ............................ 103 SENTRY TAB SENIOR ...................... 103 SEROSTIM INJ 4MG .......................... 24 SEROSTIM INJ 5MG .......................... 24 SEROSTIM INJ 6MG .......................... 24 sevelamer carbonate packet 0.8 gm ... 67 sevelamer carbonate packet 2.4 gm ... 67 sevelamer carbonate tab 800 mg ....... 67 sf 5000 plus cre 1.1% ..................... 132 sf gel 1.1%.................................... 132 shake ache tab 500mg ...................... 74 sharobel tab 0.35mg......................... 15 SHEER ADHESI MIS 3/4 .................. 164 SHEER BANDGE MIS ....................... 164 SHEER BANDGE MIS 1 .................... 164 SHEER BANDGE MIS ASSORTED....... 164 sheer bandge mis ex-large .............. 164 SHIELD-SECUR MIS ........................ 153 SHR BANDAGES MIS ....................... 164
233
SHR BANDAGES MIS 3/4 ................. 164 SHR BANDAGES MIS ASSORTED ...... 165 SHR BANDAGES MIS EX-LARGE ........ 165 SHUR-SEAL GEL 2% ......................... 68 SIDE BUTTON MIS SAFETY .............. 158 SIDESTREAM MIS MASK .................. 148 SIDESTREAM MIS NEBULIZR ............ 152 SIDESTREAM MIS PED MASK ........... 148 SIDESTREAM MIS PLUS ................... 152 SIDESTRM PLS MIS FACE MSK ......... 148 SIESTA MASK MIS .......................... 153 SIESTA MASK MIS ONE SIZE ........... 153 signacal tab ................................... 109 sigtab tab ........................................ 93 silace liq 10mg/ml ............................ 54 silace syp 60/15ml ........................... 54 siladryl alr liq 12.5/5ml ..................... 38 sildenafil citrate tab 20 mg ................ 34 SILICONE MSK MIS ADULT .............. 148 SILICONE MSK MIS INFANT ............. 148 SILICONE MSK MIS PED .................. 148 SILIQ INJ 210/1.5 .......................... 137 siltuss das liq 100/5ml ...................... 43 siltussin dm liq das ........................... 47 siltussin sa syp 100/5ml .................... 44 siltussin-dm liq diabetic ..................... 47 siltussin-dm liq max st ...................... 47 siltussin-dm syp alc free .................... 48 silver sulfadiazine cream 1%............ 138 simeped dro 40/0.6ml ....................... 66 simethicone cap 125 mg.................... 65 simethicone cap 180 mg.................... 65 simethicone chew tab 125 mg ............ 66 simethicone chew tab 80 mg .............. 65 simethicone dro 20/0.3ml .................. 66 SIMETHICONE LIQ ............................ 66 simethicone susp 40 mg/0.6ml........... 66 SIMPLY SALIN AER 0.9% ................... 42 simply salin aer baby ........................ 44 simply sleep tab 25mg ...................... 70 simvastatin tab 10 mg ...................... 34 simvastatin tab 20 mg ...................... 34 simvastatin tab 40 mg ...................... 34 simvastatin tab 5 mg ........................ 34 simvastatin tab 80 mg ...................... 34 SINGLE-LET MIS 23G ...................... 158 sirolimus oral soln 1 mg/ml.............. 169
sirolimus tab 0.5 mg ....................... 169 sirolimus tab 1 mg ......................... 169 sirolimus tab 2 mg ......................... 169 SKIN BEAUTY/ PAK WELLNESS ......... 108 skin cleansr sol 4%......................... 142 skin protect oin all-purp .................. 141 skin trtment lot 12% ...................... 141 SKYLA IUD 13.5MG........................... 15 sleep aid cap 50mg .......................... 70 sleep aid tab 25mg ......................69, 70 sleep aid tab 50mg ........................... 70 sleep ii tab 25mg ............................. 70 SLEEP SOUNDL LIQ 3.5/2ML ............ 144 sleep tab 25mg ................................ 70 sleep-aid tab 25mg .....................69, 70 sleep-tabs tab 25mg ......................... 70 slow fe tab 45mg ........................... 124 slow iron tab 160mg cr ................... 125 slow rel fe tab 160mg cr .................. 125 slow release tab 45mg .................... 124 slow release tab 47.5mg ................. 124 slow release tab iron 45 .................. 125 slow-release tab fe 45mg ................ 125 sm acid redu tab 200mg ................... 62 SM ADHESIVE PAD 2 ...................... 166 SM ADHESIVE PAD 3 ...................... 166 SM ALCOHOL PAD PREP .................. 168 sm all day tab 10mg ......................... 39 sm all day tab allergy........................ 39 sm allergy cap relief ......................... 36 sm allergy tab 25mg ......................... 37 sm allergy tab 25mg rlf ..................... 37 sm allergy tab 4mg........................... 36 sm animal chw shapes .................... 110 sm animal sh chw complete ............. 111 sm antacid sus advanced .............60, 61 sm antacid sus anti-gas .................... 60 sm antacid sus max st ...................... 61 sm antacid/ sus antigas .................... 60 sm anti-diar tab 2mg ........................ 55 sm antifungl cre 1% ....................... 136 sm antifungl cre 2% ....................... 137 sm artificia sol tears ....................... 128 sm aspirin chw 81mg ........................ 72 sm aspirin tab 325mg ....................... 72 sm aspirin tab 325mg ec ................... 73 sm aspirin tab 81mg ec ..................... 73
234
sm b complex tab with c .................... 88 sm b super tab vita com .................... 90 sm b100 tab complex ........................ 89 sm balanced tab b-100...................... 89 sm balanced tab b-50 ....................... 89 SM BANDAGES MIS ANTIBACT ......... 165 SM BANDAGES MIS CLEAR .............. 165 SM BANDAGES MIS CLR SPOT .......... 165 SM BANDAGES MIS FAB 3/4 ............ 165 SM BANDAGES MIS FAB XL .............. 165 SM BANDAGES MIS FLEXIBLE .......... 165 SM BANDAGES MIS FOAM ............... 165 SM BANDAGES MIS FOAM XL ........... 165 SM BANDAGES MIS PLASTIC ............ 165 SM BANDAGES MIS SHEER .............. 165 SM BANDAGES MIS SHEER XL .......... 165 SM BANDAGES MIS STRNG ST ......... 165 SM BANDAGES MIS WTRSHELD ........ 165 sm b-complex tab ............................. 89 SM B-COMPLEX TAB /VIT C ................ 90 sm bedding aer lice......................... 142 sm ca/mg/zn tab ............................ 120 sm ca/vit d3 tab 600-400 ................ 118 SM CALAMINE LOT ......................... 142 sm calcium chw .............................. 120 sm calcium tab /vit d3 .................... 117 sm calcium/d tab 500-200 ............... 118 sm calcium/d tab 600-400 ............... 117 sm child asa chw 81mg ..................... 72 sm clearlax pow ............................... 54 sm complete tab ............................ 103 sm complete tab 50+ ...................... 103 sm complete tab 50+ mens ............. 103 sm complete tab 50+ wmn .............. 103 sm complete tab adv form ............... 103 sm complete tab senior ................... 103 sm dry eye sol relief ....................... 130 sm ear dro 6.5% ot ........................ 132 sm fish oil cap 1000mg ................... 123 sm fish oil cap 1200mg ................... 123 sm folic acd tab 400mcg .................. 123 sm gas rel chw 125mg ...................... 66 sm gas relf chw 80mg ....................... 65 sm gas relie chw 80mg ..................... 65 sm gentle tab laxative ....................... 51 sm hair/skin tab /nails .................... 103 sm hydrocort cre 1% ...................... 139
sm hydrocort cre 1% plus ............... 141 sm hydrocort oin 1% ...................... 140 sm ibuprofen cap 200mg ................... 79 sm ibuprofen tab 100mg jr ................ 79 sm ibuprofen tab 200mg ................... 79 sm iron slow tab 160mg cr .............. 125 sm iron tab 325mg ......................... 124 sm iron tab 45mg ........................... 124 SM KNUCKLE/ MIS FINGERTP .......... 165 SM LANCETS MIS 33G..................... 158 sm laxative sup 10mg ....................... 52 sm laxative tab 25mg ....................... 52 sm laxative tab 5mg ec ..................... 51 sm loratadin tab 10mg ...................... 40 sm lubricant dro 0.4-0.3% .............. 129 sm melatonin tab 3mg .................... 143 sm melatonin tab 5mg .................... 144 sm micon 7 sup 100mg ..................... 68 sm mucus rel tab 1200 er .................. 44 sm mucus rel tab 600mg er ............... 44 sm multiple tab vit/iron .................... 94 sm multiple tab vitamins ................... 93 sm nasal dec tab 30mg ..................... 40 sm nighttime tab 25mg ..................... 70 SM ONE DAILY TAB ESSENTIA ......... 109 SM ONE DAILY TAB MENS ............... 103 SM ONE DAILY TAB WOMENS ........... 103 sm opti-vita tab ............................. 103 sm pain rel cap 500mg ..................... 73 sm pain rlvr tab 650mg .................... 74 sm povid-iod sol 10% ..................... 143 sm rpd melt tab 160mg..................... 76 sm senna lax tab 8.6mg .................... 52 sm senna lax tab max str .................. 53 sm senna-s tab 8.6-50mg ................. 55 sm sleep aid cap 50mg ..................... 70 sm sleep aid tab 25mg ...................... 70 sm stomach sus 262/15ml................. 56 sm stomach sus 525/30ml................. 56 sm stool tab softener ........................ 55 SM STRONG MIS STRIPS ................. 165 SM STURDY MIS STRIP ................... 165 SM SWEET OIL ............................... 144 sm triple oin antibiot ....................... 135 sm tussin cf liq ................................. 48 sm tussin dm liq 5-100/5 .................. 47 sm tussin dm liq max ....................... 47
235
sm tussin dm syp 100-10/5 ............... 48 sm tussin syp dm ............................. 48 sm vitamin d tab 400unit .................. 86 sm vitamind3 tab 1000unit ................ 86 SMART SENSE MIS LANC 21G .......... 158 SMART SENSE MIS LANC 26G .......... 159 SMART SENSE MIS LANC 30G .......... 159 SMART SENSE MIS LANC 33G .......... 159 SMARTEST MIS LANCETS ................ 159 smarty pants chw kids ..................... 110 smooth antac chw 750mg .................. 59 smooth lax pow ................................ 54 smooth lax pow 3350 ........................ 54 smooth lax pow 3350 nf .................... 54 sod fluoride sol 0.2% ...................... 132 sodium chloride aero soln 0.9% .......... 44 sodium chloride soln nebu 0.9% ......... 44 sodium chloride soln nebu 10% .......... 44 sodium chloride soln nebu 3% ............ 44 sodium chloride soln nebu 7% ............ 44 sodium fluoride chew tab 0.25 mg f (from 0.55 mg naf) ......................... 120 sodium fluoride chew tab 0.5 mg f (from 1.1 mg naf) ................................... 120 sodium fluoride chew tab 1 mg f (from 2.2 mg naf) ................................... 120 sodium fluoride soln 0.5 mg/ml f (from 1.1 mg/ml naf) ............................... 121 sodium fluoride tab 0.5 mg f (from 1.1 mg naf) ......................................... 120 sodium fluoride tab 1 mg f (from 2.2 mg naf) .............................................. 120 sodium polystyrene sulfonate oral susp 15 gm/60ml ................................... 169 sodium polystyrene sulfonate rectal susp 30 gm/120ml ................................. 170 SOF-SET ADH PAD PATCH ................ 166 SOFT 'N FLEX MIS ........................... 165 SOFT TOUCH MIS LANCETS ............. 159 SOFTCLIX MIS LANCETS .................. 159 SOLIRIS INJ 10MG/ML..................... 127 SOLO TAB...................................... 103 SOLUS V2 MIS LANC 28G ................ 159 SOLUS V2 MIS LANC 30G ................ 159 SOMATULINE INJ 120/.5ML ................ 24 SOMATULINE INJ 60/0.2ML ................ 24 SOMATULINE INJ 90/0.3ML ................ 24
soothe chw 262mg ........................... 56 soothe dro hydratio ........................ 129 SOOTHE NEB MIS NEBULIZE ............ 152 soothe night oin op ......................... 130 soothe sus 262/15ml ........................ 56 soothe sus 525/15ml ........................ 57 soothe tab 262mg ............................ 56 soothe xp dro ................................ 129 soothe xp dro 1%-4.5% .................. 129 soothe&cool cre inzo 2% ................. 137 SOOTHENEB MIS COMP NEB ............ 152 SOOTHENEB MIS MED CUP .............. 148 SOOTHENEB MIS MESH CAP ............ 148 SOOTHENEB MIS NBL 100 ............... 148 sorbugen nr liq ................................ 47 SORESPOT MIS BANDAGES ............. 165 sorine tab 120mg ............................. 26 sorine tab 160mg ............................. 26 sorine tab 240mg ............................. 26 sorine tab 80mg ............................... 26 sotalol hcl (afib/afl) tab 120 mg ......... 26 sotalol hcl (afib/afl) tab 160 mg ......... 26 sotalol hcl (afib/afl) tab 80 mg ........... 26 sotalol hcl tab 120 mg....................... 26 sotalol hcl tab 160 mg....................... 26 sotalol hcl tab 240 mg....................... 26 sotalol hcl tab 80 mg ........................ 26 SOVALDI TAB 400MG .......................... 7 SPACER CHAMB MIS ADULT ............. 149 SPACER CHAMB MIS CHILD ............. 149 span c tab ....................................... 92 spectr women tab hlth sen............... 103 spectra ultr tab hlth men ................. 103 SPECTRAVITE CHW ADLT 50+ ......... 107 SPECTRAVITE TAB .......................... 103 SPECTRAVITE TAB ADLT 50+ ........... 103 spectravite tab advanced................. 103 SPECTRAVITE TAB MEN 50+ ............ 103 spectravite tab senior ..................... 103 SPECTRAVITE TAB SENIOR .............. 103 SPECTRAVITE TAB ULT MEN ............ 103 SPECTRAVITE TAB ULT WMN ........... 103 spider-man chw ............................. 110 spinosad susp 0.9%........................ 142 spironolactone & hydrochlorothiazide tab 25-25 mg ........................................ 33 spironolactone tab 100 mg ................ 32
236
spironolactone tab 25 mg .................. 32 spironolactone tab 50 mg .................. 32 SPLEEN TAB 250MG ........................ 114 sprintec 28 tab 28 day ...................... 18 sps sus 15gm/60 ............................ 170 sronyx tab ....................................... 17 ssd cre 1% .................................... 138 SSKI SOL 1GM/ML ............................ 44 st joseph chw low 81mg .................... 72 STEGLATRO TAB 15MG ..................... 21 STEGLATRO TAB 5MG ....................... 21 STERILANCE MIS TL 28G ................. 159 STERILANCE MIS TL 30G ................. 159 STERILANCE MIS TL 32G ................. 159 STERI-STRIP MIS ........................... 165 STERI-STRIP MIS 1......................... 165 STERI-STRIP MIS 1/2 ..................... 165 STERI-STRIP MIS 1/4 ..................... 165 STERI-STRIP MIS 1/8 ..................... 165 stim laxat tab 5mg ec ....................... 51 STIVARGA TAB 40MG ........................ 11 stom relief tab 262mg ....................... 56 stomach relf chw 262mg ................... 56 stomach relf sus ............................... 57 stomach relf sus 262/15ml ................ 56 stomach relf sus 524/30ml ................ 56 stomach relf sus 525/15ml ................ 57 stomach relf sus 525/30ml ................ 56 stomach relf sus 527/30ml ................ 56 stomach relf sus plus ........................ 57 stomach relf tab 262mg .................... 56 stomach rlf chw 400mg ..................... 58 stomach rlf tab 262mg ...................... 56 STOMACH TAB 300MG .................... 114 stool soften cap 100mg ..................... 53 stool soften cap 250mg ..................... 53 stool softnr cap 100mg ..................... 53 stool softnr cap 240mg ..................... 53 stool softnr cap 250mg ..................... 53 stool softnr cap 50mg ....................... 53 stool softnr syp 60/15ml ................... 54 stool softnr tab 100mg ...................... 54 stool softnr tab 8.6-50mg .................. 55 stop lice 3 spr 0.5% ........................ 142 stop lice ms sha 0.33-4% ................ 142 stop lice spr 0.5% .......................... 142 STREPTOMYCIN POW SULFATE ............ 5
stress b com tab vit c/zn ................... 88 stress b com tab w/iron .................... 94 stress b/ tab zinc .............................. 88 stress b-com tab /c/zinc.................. 103 stress form tab ...........................90, 93 stress form tab /iron.................. 94, 103 stress form tab /zinc ......................... 88 stress form/ tab zinc.................. 88, 103 stress formu tab ............................... 93 stress formu tab /zinc ....................... 88 stress formu tab advanced .............. 103 stress formu tab energy .................. 103 stress formu tab w/iron ..................... 94 stress plus tab zinc ........................... 88 stress tab formula .......................... 103 stresstabs tab .................................. 93 stresstabs tab advanced .................. 103 stresstabs tab energy ....................... 93 STRIVERDI AER 2.5MCG.................... 49 STRONG STRIP MIS BANDAGES ....... 165 STRONG STRIP MIS WATERPRF ........ 165 stye oin......................................... 130 sucralfate tab 1 gm .......................... 63 sudafed 12hr tab 120mg cr ............... 41 SUDAFED 24HR TAB 240MG .............. 41 sudogest tab 120mg er ..................... 41 sudogest tab 30mg ........................... 40 sudogest tab 60mg ........................... 40 sulfacetamide sodium lotion 10% (acne) .................................................... 134 sulfacetamide sodium ophth soln 10% .................................................... 127 sulfacetamide sodium-prednisolone ophth soln 10-0.23(0.25)% ............. 130 SULFADIAZINE POW ........................... 6 SULFADIAZINE POW SODIUM .............. 6 SULFADIAZINE TAB 500MG ................. 6 SULFAMETHOX POW ........................... 6 SULFAMETHOX POW MICRO ................ 6 sulfamethoxazole-trimethoprim susp 200-40 mg/5ml.................................. 9 sulfamethoxazole-trimethoprim tab 400-80 mg ........................................ 9 sulfamethoxazole-trimethoprim tab 800-160 mg ...................................... 9 SULFAPYRIDIN POW ........................... 6 sulfasalazine tab 500 mg ................... 66
237
sulfasalazine tab delayed release 500 mg ......................................................66 SULFATHIAZOL POW .......................... 6 sulfatrim pd sus 200-40/5 .................. 9 SULFISOXIZOL CRY ........................... 6 sulindac tab 150 mg.......................... 80 sulindac tab 200 mg.......................... 80 sumatriptan nasal spray 20 mg/act ..... 82 sumatriptan nasal spray 5 mg/act ....... 82 sumatriptan succinate inj 6 mg/0.5ml .82 sumatriptan succinate solution auto-injector 4 mg/0.5ml................... 82 sumatriptan succinate solution auto-injector 6 mg/0.5ml................... 82 sumatriptan succinate solution cartridge 4 mg/0.5ml ..................................... 82 sumatriptan succinate solution cartridge 6 mg/0.5ml ..................................... 82 sumatriptan succinate solution prefilled syringe 6 mg/0.5ml .......................... 82 sumatriptan succinate tab 100 mg ...... 82 sumatriptan succinate tab 25 mg ........ 82 sumatriptan succinate tab 50 mg ........ 82 summers eve sol ex clean .................. 68 SUNBEAM VAP MIS 1 GAL ................ 152 SUNBEAM VAP MIS 1.5 GAL ............. 152 SUNBEAM VAP MIS 2 GAL ................ 152 sunvite actv tab adult ...................... 103 sunvite tab advanced ...................... 104 super 28 tab formula ...................... 104 SUPER ANTIOX CAP .......................... 96 super antiox cap protect .................... 96 super antiox tab a/c/e/se................. 104 SUPER B- CAP COMPLEX .................... 89 super b comp tab /vit c ..................... 90 super b comp tab maxi ...................... 89 super b comp tab vit c ................. 88, 90 super b- tab complex ........................ 89 super b w/c cap ................................ 88 super b-100 tab ............................... 89 SUPER B-50 CAP B-COMP .................. 89 SUPER B-50 CAP COMPLEX ................ 89 super b-50 tab ................................. 89 super b-comp tab /fa/vitc .................. 90 super b-comp tab iron/c .................... 91 super b-comp tab vit c/fa .................. 90 super c-1000 tab .............................. 92
super c-500 tab ............................... 92 SUPER C-500 TAB COMPLEX .............. 92 super ca 600 tab + d 400 ................ 117 super ca 600 tab + d3 .................... 117 super ca 600 tab + d3 400 .............. 117 super cal/ tab mag ......................... 116 super calciu tab 600mg ................... 116 SUPER D3 CAP COMPLEX ................... 87 super dec tab b-100 ......................... 89 super dha cap gems ....................... 123 super liq nu-thera .......................... 107 super multip cap .............................. 96 super multip tab ............................. 104 super omega cap -3 ....................... 123 super omega cap 500mg ................. 122 SUPER POW NU-THERA ................... 107 super quints tab ............................... 89 super stress tab b-complx ............... 115 SUPER STRIP MIS 1 ........................ 165 super tab nu-thera ......................... 104 super thera tab vite m .................... 104 SUPER THIN MIS LANC 28G ............. 159 SUPER THIN MIS LANCETS .............. 159 super vikaps tab ............................ 104 super-b tab complex ......................... 90 superior 35 tab .............................. 105 superplex-t tab ................................ 88 SUPERSTRIP MIS 1 ......................... 165 suphedrine tab 30mg ........................ 40 SUPLEVIT LIQ .................................. 91 supr aytinal tab .............................. 104 supr aytinal tab 50 plus .................. 104 supr omega 3 cap epa/dha .............. 123 supr vitamin tab ............................. 104 SUPREP BOWEL SOL PREP KIT ........... 55 SURE COMFORT MIS 29GX1/2 ......... 145 SURE COMFORT MIS 31GX3/16 ....... 145 SURE COMFORT MIS 31GX5/16 ....... 146 SURE COMFORT MIS 32GX5/32 ....... 147 SURE COMFORT MIS 32GX6MM ........ 147 SURE COMFORT MIS LANC 18G ....... 159 SURE COMFORT MIS LANC 21G ....... 159 SURE COMFORT MIS LANC 23G ....... 159 SURE COMFORT MIS LANC 30G ....... 159 SURE COMFORT MIS LANCETS ......... 159 SURE-FINE MIS 29GX1/2 ................ 145 SURE-FINE MIS 31GX3/16 ............... 145
238
SURE-FINE MIS 31GX5/16 ............... 146 SUREFLEX MIS LANCETS ................. 159 SURE-LANCE MIS 26G ..................... 159 SURE-LANCE MIS LANCETS ............. 159 SURELITE MIS LANCETS .................. 159 SURESEAL MIS EX LARGE ................ 165 SURESEAL MIS K ............................ 165 SURESEAL MIS LARGE .................... 165 SURE-TOUCH MIS UNV LANC ........... 159 surfak cap 240mg ............................. 53 SUTENT CAP 12.5MG ........................ 11 SUTENT CAP 25MG ........................... 11 SUTENT CAP 37.5MG ........................ 11 SUTENT CAP 50MG ........................... 11 sv fish oil cap 500mg ...................... 122 sv melatonin tab 3mg ..................... 144 sv melatonin tab 5mg ..................... 143 SWEET OIL .................................... 144 syeda tab 3-0.03mg .......................... 16 SYMAX DUOTAB TAB ......................... 61 symax-sr tab 0.375mg ...................... 62 SYMBICORT AER 160-4.5 .................. 49 SYMBICORT AER 80-4.5 .................... 49 SYNAGIS INJ 100MG/ML ..................... 9 SYNAGIS INJ 50MG ............................ 9 SYNAREL SOL 2MG/ML ...................... 23 SYNERTROPIN CAP ......................... 113 SYNVISC INJ 8MG/ML ....................... 84 SYNVISC ONE INJ 8MG/ML ................. 84 systane dro contacts ....................... 129 SYSTANE GEL 0.3% ........................ 128 systane oin .................................... 130 T tab tussin tab 400mg ........................ 43 tab-a-vite tab ................................... 93 tab-a-vite tab /iron ........................... 94 tab-a-vite tab beta car ...................... 93 tacrolimus cap 0.5 mg..................... 169 tacrolimus cap 1 mg ....................... 169 tacrolimus cap 5 mg ....................... 169 tactinal chw children ......................... 75 tactinal tab 325mg............................ 74 tactinal tab 500mg............................ 74 TAFINLAR CAP 50MG ........................ 11 TAFINLAR CAP 75MG ........................ 11 take action tab 1.5mg ....................... 16 tame flame chw 500mg ..................... 58
tamoxifen citrate tab 10 mg (base equivalent) ...................................... 10 tamoxifen citrate tab 20 mg (base equivalent) ...................................... 10 tamsulosin hcl cap 0.4 mg ................. 69 TARCEVA TAB 100MG ....................... 11 TARCEVA TAB 150MG ....................... 11 TARCEVA TAB 25MG ......................... 11 tarina fe tab 1/20 ............................. 18 tarina fe tab 1/20 eq ........................ 18 taztia xt cap 120mg/24 ..................... 27 taztia xt cap 180mg/24 ..................... 27 taztia xt cap 240mg/24 ..................... 27 taztia xt cap 300mg/24 ..................... 28 taztia xt cap 360mg/24 ..................... 28 tears again oin op .......................... 129 tears again sol adv eye ................... 129 tears again sol op ........................... 129 tears pure sol ................................ 129 TECFIDERA CAP 120MG .................... 71 TECFIDERA CAP 240MG .................... 71 TECFIDERA MIS STARTER.................. 71 TECHLITE AST MIS LANCETS ........... 159 TECHLITE MIS LANC 30G ................ 159 TECHLITE MIS LANCETS.................. 159 TEGADERM CHG MIS DRESSING ...... 142 temozolomide cap 100 mg................... 9 temozolomide cap 140 mg................... 9 temozolomide cap 180 mg ................ 10 temozolomide cap 20 mg .................... 9 temozolomide cap 250 mg ................ 10 temozolomide cap 5 mg ...................... 9 terazosin hcl cap 1 mg (base equivalent) ...................................................... 30 terazosin hcl cap 10 mg (base equivalent) ...................................... 30 terazosin hcl cap 2 mg (base equivalent) ...................................................... 30 terazosin hcl cap 5 mg (base equivalent) ...................................................... 30 terbinafine hcl tab 250 mg................... 6 terbutaline sulfate tab 2.5 mg ............ 49 terbutaline sulfate tab 5 mg ............... 49 terconazole vaginal cream 0.4% ........ 68 terconazole vaginal cream 0.8% ........ 68 terconazole vaginal suppos 80 mg ...... 68 testosterone cypionate im inj in oil 100
239
mg/ml ............................................. 14 testosterone cypionate im inj in oil 200 mg/ml ............................................. 14 testosterone enanthate im inj in oil 200 mg/ml ............................................. 14 testosterone td gel 10mg/act (2%) ..... 14 testosterone td gel 25 mg/2.5gm (1%)14 tetracycline hcl cap 250 mg ................ 5 tetracycline hcl cap 500 mg ................ 5 TETRACYCLINE POW ....................... 135 tetterine oin 2% ............................. 137 tgt acetamin tab 500mg .................... 74 tgt allergy/ tab congest ..................... 45 tgt antacid chw 1000mg .................... 59 tgt antacid sus anti-gas ..................... 60 tgt antifung cre 1%......................... 136 tgt aspirin chw 81mg ........................ 72 tgt aspirin chw child .......................... 72 tgt aspirin tab 325mg ........................ 72 tgt aspirin tab 81mg ......................... 73 tgt aspirin tab 81mg ec ..................... 73 tgt calcium chw suppleme ................ 117 tgt cough liq form dm ........................ 47 TGT LANCET MIS 26G ..................... 159 TGT LANCET MIS 30G ..................... 159 TGT LANCET MIS 33G ..................... 159 tgt lubricnt dro eye ......................... 130 tgt lubricnt oin eye nite ................... 130 tgt nasal spr 0.65% .......................... 42 tgt natural tab laxative ...................... 53 tgt senna tab 8.6mg ......................... 52 tgt sinus tab 120mg .......................... 41 THEO-24 CAP 100MG CR ................... 49 THEO-24 CAP 200MG CR ................... 49 THEO-24 CAP 300MG CR ................... 49 THEO-24 CAP 400MG ER.................... 49 theochron tab 100mg cr .................... 49 theochron tab 200mg cr .................... 49 theochron tab 300mg cr .................... 50 theophylline soln 80 mg/15ml ............ 49 theophylline tab er 12hr 100 mg ......... 49 theophylline tab er 12hr 200 mg ......... 49 theophylline tab er 12hr 300 mg ......... 50 theophylline tab er 12hr 450 mg ......... 50 theophylline tab er 24hr 400 mg ......... 50 theophylline tab er 24hr 600 mg ......... 50 thera form/ tab hematin .................. 104
THERA M PLUS TAB ........................ 104 thera tab ......................................... 93 THERA TAB ...................................... 93 thera tab vital-m ............................ 104 thera vital tab m ............................ 104 therabasic-m tab ............................ 104 THERABETIC TAB EYE HLTH ............ 114 THERABETIC TAB MULTIVIT ............. 104 thera-d tab 2000unit ........................ 86 theradex m tab .............................. 104 theradex m/ tab beta car ................ 104 THERAGRAN-M TAB ........................ 104 THERAGRAN-M TAB 50 PLUS ........... 104 THERAGRAN-M TAB ADVANCED ....... 104 THERAGRAN-M TAB PREMIER .......... 104 thera-m tab ................................... 104 THERA-M TAB ................................ 104 theramill cap plus ............................. 96 thera-mill m tab ............................. 104 thera-mill tab .................................. 93 THERANATAL CAP LACTATIO .............. 96 THERANATAL MIS LACTATIO ........... 109 therapeutic tab ......................... 93, 104 therapeutic tab -m ......................... 104 therapeutic- tab m ......................... 104 therapeutic- tab m/lutein ................ 104 THERA-TABS M TAB ........................ 104 thera-tabs tab.................................. 93 THERATEARS SOL OP ..................... 128 theratrum co tab 50 plus ................. 104 theratrum tab complete .................. 104 theravim -m tab ............................. 104 therems tab..................................... 93 THEREMS-H TAB ............................ 104 THEREMS-M TAB ............................ 104 theromega cap 1000mg .................. 123 THIABENDAZOL POW .......................... 8 thiamine hcl tab 100 mg ................... 85 thiamine hcl tab 50 mg ..................... 85 THIN LANCETS MIS ........................ 159 THIN LANCETS MIS 26G.................. 159 THIN LANCETS MIS 30G.................. 159 THINLETS GP MIS 26G .................... 159 THRESHOLD MIS IMT ...................... 148 thrive for tab women ...................... 104 THYMUS TAB 140MG....................... 114 TIER UNI PLS MIS 31GX8MM ........... 146
240
timolol maleate ophth gel forming soln 0.25%........................................... 130 timolol maleate ophth gel forming soln 0.5% ............................................ 130 timolol maleate ophth soln 0.25% .... 130 timolol maleate ophth soln 0.5% ...... 130 timolol maleate tab 10 mg ................. 26 timolol maleate tab 20 mg ................. 26 timolol maleate tab 5 mg ................... 26 tinaspore sol 1% ............................ 136 tineacide cre .................................. 137 titralac chw 420mg ........................... 58 tizanidine hcl tab 2 mg (base equivalent) ......................................................84 tizanidine hcl tab 4 mg (base equivalent) ......................................................84 tl gard rx tab.................................. 126 TL-FLUORIVIT CHW ........................ 112 tobramycin nebu soln 300 mg/5ml ....... 6 tobramycin ophth soln 0.3% ............ 127 TOBRAMYCIN POW SULFATE ............... 6 tobramycin-dexamethasone ophth susp 0.3-0.1% ...................................... 130 tolnaftate aerosol pow 1% ............... 136 tolnaftate cre 1% ........................... 136 TOPCARE MIS LANC 33G ................. 159 toremifene citrate tab 60 mg (base equivalent) ...................................... 10 torsemide tab 10 mg ......................... 32 torsemide tab 100 mg ....................... 32 torsemide tab 20 mg ......................... 32 torsemide tab 5 mg .......................... 32 total allerg liq 12.5/5ml ..................... 38 total allerg tab 25mg ......................... 37 total b/c tab ..................................... 88 total formul tab .............................. 104 total formul tab 2 ........................... 104 total formul tab 3 ........................... 104 totalday mul tab tr .......................... 105 TRACLEER TAB 125MG ...................... 35 TRACLEER TAB 62.5MG ..................... 35 tramadol hcl tab 50 mg ..................... 77 tramadol hcl tab er 24hr 100 mg ........ 77 tramadol hcl tab er 24hr 200 mg ........ 77 tramadol hcl tab er 24hr 300 mg ........ 77 tramadol-acetaminophen tab 37.5-325 mg ................................................. 78
trandolapril tab 1 mg ........................ 30 trandolapril tab 2 mg ........................ 30 trandolapril tab 4 mg ........................ 30 TRAVEL LANCE MIS 30G ................. 159 TRAVEL LANCE MIS ADV 28G........... 159 travel sick chw 25mg ........................ 64 travel-ease tab 25mg ....................... 64 TRESIBA FLEX INJ 100UNIT ............... 19 TRESIBA FLEX INJ 200UNIT ............... 19 tretinoin cap 10 mg .......................... 12 tretinoin cream 0.025% .................. 134 tretinoin cream 0.05% .................... 134 tretinoin cream 0.1%...................... 134 tretinoin gel 0.01% ........................ 134 tretinoin gel 0.025%....................... 134 TREXALL TAB 10MG .......................... 10 TREXALL TAB 15MG .......................... 10 TREXALL TAB 5MG ........................... 10 TREXALL TAB 7.5MG ......................... 10 tri femynor tab ................................ 19 tri super tab flavons ......................... 92 triamcinolone acetonide cream 0.025% .................................................... 140 triamcinolone acetonide cream 0.1% 140 triamcinolone acetonide cream 0.5% 140 triamcinolone acetonide dental paste 0.1% ............................................ 132 triamcinolone acetonide lotion 0.025% .................................................... 140 triamcinolone acetonide lotion 0.1% . 140 triamcinolone acetonide nasal aerosol suspension 55 mcg/act ..................... 42 triamcinolone acetonide oint 0.025% 140 triamcinolone acetonide oint 0.1% .... 140 triamcinolone acetonide oint 0.5% .... 140 triaminic tab 10mg ........................... 40 triamterene & hydrochlorothiazide cap 37.5-25 mg ..................................... 33 triamterene & hydrochlorothiazide tab 37.5-25 mg ..................................... 33 triamterene & hydrochlorothiazide tab 75-50 mg ........................................ 33 triderm cre 0.1% ........................... 140 triderm cre 0.5% ........................... 140 tri-estaryll tab.................................. 19 trifluridine ophth soln 1% ................ 128 tri-linyah tab ................................... 19
241
tri-lo tab estaryll .............................. 18 tri-lo- tab marzia .............................. 18 tri-lo- tab sprintec ............................ 18 trilyte sol ......................................... 55 trimethobenzamide hcl cap 300 mg .... 64 TRIMETHOPRIM POW ......................... 8 trimethoprim tab 100 mg ................... 8 tri-mili tab ....................................... 19 trinate tab ..................................... 115 triphrocaps cap ................................ 90 triple antib oin ............................... 135 triple antib oin frst aid ..................... 135 triple paste oin af 2% ..................... 137 tri-previfem tab ................................ 19 tri-sprintec tab ................................. 19 tri-vit/fluo dro 0.25mg .................... 112 tri-vit/fluo dro 0.5mg ...................... 112 trivora-28 tab .................................. 18 tri-vylibra tab ................................... 19 tri-vylibra tab lo ............................... 18 TROMBONEX CAP ............................. 91 trombonex-d cap .............................. 91 tropical liq nutritio .......................... 107 trospium chloride tab 20 mg .............. 67 TRUE COMFORT MIS LANC 30G ........ 159 trueplus tab diabetic ....................... 104 TRULANCE TAB 3MG ......................... 66 TRULICITY INJ 0.75/0.5 .................... 20 TRULICITY INJ 1.5/0.5 ...................... 20 TRUPLUS LANC MIS 26G ................. 159 TRUPLUS LANC MIS 28G ................. 159 TRUPLUS LANC MIS 30G ................. 159 TRUPLUS LANC MIS 33G ................. 159 TRUSTEX LUBR MIS ASSORTED ........ 167 TRUSTEX LUBR MIS BANANA ........... 167 TRUSTEX LUBR MIS CHOC ............... 167 TRUSTEX LUBR MIS COLA ............... 167 TRUSTEX LUBR MIS COLORS ........... 167 TRUSTEX LUBR MIS EX LARGE ......... 167 TRUSTEX LUBR MIS EX STR ............. 167 TRUSTEX LUBR MIS GRAPE .............. 167 TRUSTEX LUBR MIS MINT ................ 167 TRUSTEX LUBR MIS RIB/STUD ......... 167 TRUSTEX LUBR MIS SPERMICI ......... 167 TRUSTEX LUBR MIS STRWBRY ......... 167 TRUSTEX LUBR MIS VANILLA ........... 167 TRUSTEX MIS BANANA .................... 167
TRUSTEX MIS CHOCOLAT ................ 167 TRUSTEX MIS FLAVORS .................. 167 TRUSTEX MIS MINT ........................ 167 TRUSTEX MIS STRWBRY ................. 167 TRUSTEX MIS VANILLA ................... 167 TRUSTEX/RIA MIS LUBRICAT ........... 167 TRUSTEX/RIA MIS NON-LUB ............ 167 TRUSTEX/RIA MIS SPERMICI ........... 167 TRUSTX NON-9 MIS RIB/STUD......... 167 tulana tab 0.35mg ............................ 15 TUMS CHW DEL CHW 1177MG ........... 59 tums smoothi chw 750mg ................. 59 TUSNEL C SYP ................................. 48 tusnel diabt liq 10-100/5 ................... 47 tussin adult liq 100/5ml .................... 43 tussin adult liq cgh/cong ................... 47 tussin chest syp 100/5ml .................. 44 tussin cough liq 10-100/5 ................. 47 tussin dm liq .................................... 47 tussin dm liq 100-10/5 ..................... 47 tussin dm liq 10-100/5 ..................... 47 tussin dm liq 10-100mg .................... 47 tussin dm liq 10-200mg .................... 47 tussin dm liq 20-400mg .................... 47 tussin dm liq max ............................. 48 tussin dm mx liq 10-200/5 ................ 48 tussin dm syp 100-10/5 .................... 48 tussin mucus liq 100/5ml .................. 43 tussin mucus liq 200/10ml................. 43 tussin syp 100/5ml ........................... 44 T-VITES TAB .................................. 104 TYKERB TAB 250MG ......................... 12 TYMLOS INJ ..................................... 23 TYVASO REFIL SOL 0.6MG/ML ............ 35 TYVASO SOL 0.6MG/ML .................... 35 TYVASO START SOL 0.6MG/ML .......... 35 U ULTICARE MIC MIS 32GX4MM .......... 147 ULTICARE PAD ALCOHOL ................ 168 ULTICARE PEN MIS 31GX5MM .......... 145 ULTICARE PEN MIS 31GX8MM .......... 146 ULTILET MIS 26G ........................... 159 ULTILET MIS 28G ........................... 159 ULTILET MIS 30G ........................... 159 ULTILET MIS 33G ........................... 159 ULTILET MIS LANCETS .................... 160 ULTILET MIS SAFETY ...................... 160
242
ULTILET PAD ALCOHOL ................... 168 ULTILET PEN MIS 29GX12.7 ............. 145 ULTILET PEN MIS 31GX5MM ............. 145 ULTILET PEN MIS 31GX8MM ............. 146 ULTILET PEN MIS 32GX4MM ............ 147 ULTILET SAFE MIS 21G ................... 160 ultimate fat tab burner .................... 114 ultra antiox tab formula ................... 104 ultra b-100 tab complex .................. 115 ultra choice chw kids....................... 111 ultra freeda tab .............................. 104 ultra freeda tab /iron....................... 104 ultra fresh dro 0.5% op ................... 128 ultra fresh oin pm ........................... 129 ULTRA MAN TAB ............................. 114 ULTRA MEGA G TAB 100MG ............. 105 ULTRA MEGA G TAB 75MG CR .......... 105 ULTRA MEGA TAB 75MG CR ............. 106 ULTRA MEGA TAB TWO ................... 106 ULTRA MENS MIS PACK ................... 109 ultra multi cap /iron .......................... 96 ULTRA OMEGA3 CAP 1400MG ........... 122 ultra sleep tab 25mg ......................... 69 ULTRA THIN MIS 28G ...................... 160 ULTRA THIN MIS 30G ...................... 160 ULTRA THIN MIS 31G ...................... 160 ULTRA THIN MIS 33G ...................... 160 ULTRA THIN MIS LAN 31G ............... 160 ULTRA THIN MIS LANC 26G ............. 160 ULTRA THIN MIS LANC 28G ............. 160 ULTRA THIN MIS LANC 30G ............. 160 ULTRA THIN MIS LANCETS .............. 160 ultra vita-t tab................................ 104 ULTRA WOMAN TAB ........................ 114 ULTRA WOMENS MIS PACK .............. 109 ultrachoice tab advanced ................. 105 ultra-mega tab cr ........................... 106 UNFINE PNTP MIS 32GX4MM ............ 147 UNICOMPLEX-M TAB ....................... 105 UNIFINE PNTP MIS 31GX3/16........... 145 UNIFINE PNTP MIS 31GX5/16........... 146 UNIFINE PNTP MIS 31GX5MM .......... 145 UNIFINE PNTP MIS 31GX8MM .......... 146 UNIFINE PNTP MIS 32GX4MM .......... 147 UNIFINE PNTP MIS 32GX5/32 .......... 147 UNIFINE PNTP MIS 32GX6MM .......... 147 UNILET CMFR MIS TCH 28G ............. 160
UNILET CMFR MIS TCH 30G ............. 160 UNILET EX II MIS 28G .................... 160 UNILET EXCEL MIS 23G .................. 160 UNILET G.P MIS SUPR 23G .............. 160 UNILET G.P. MIS 21G ..................... 160 UNILET GP 28 MIS ULT THIN ........... 160 UNILET LANC MIS 33G .................... 160 UNILET LANCE MIS 21G .................. 160 UNILET LANCE MIS 28G .................. 160 UNILET LANCE MIS 33G .................. 160 UNILET LANCT MIS 28G .................. 160 UNILET LANCT MIS 30G .................. 160 UNILET LANCT MIS 33G .................. 160 UNILET MICRO MIS 33G ................. 160 UNILET MIS 21G ............................ 160 UNILET SUPER MIS 23G .................. 160 UNILET SUPER MIS G.P. 23G ........... 160 UNI-SOLVE PAD WIPES ................... 143 UNISTIK 3 MIS GENT 30G ............... 160 UNISTIK II MIS LANCETS ................ 160 UNISTIK PRO MIS LANC 21G ........... 160 UNISTIK PRO MIS LANC 28G ........... 160 UNISTIK SAFE MIS LANC 28G .......... 160 UNISTIK SAFE MIS LANC 30G .......... 160 UNISTIK TOUC MIS LANC 21G ......... 160 UNISTIK TOUC MIS LANC 23G ......... 160 UNISTIK TOUC MIS LANC 28G ......... 160 UNISTIK TOUC MIS LANC 30G ......... 160 unith direct tab 100mcg .................... 22 unith direct tab 112mcg .................... 22 unith direct tab 125mcg .................... 22 unith direct tab 150mcg .................... 23 unith direct tab 175mcg .................... 23 unith direct tab 200mcg .................... 23 unith direct tab 25mcg ...................... 22 unith direct tab 300mcg .................... 23 unith direct tab 50mcg ...................... 22 unith direct tab 75mcg ...................... 22 unith direct tab 88mcg ...................... 22 unithroid tab 100mcg ....................... 22 unithroid tab 112mcg ....................... 22 unithroid tab 125mcg ....................... 22 unithroid tab 137mcg ....................... 22 unithroid tab 150mcg ....................... 23 unithroid tab 175mcg ....................... 23 unithroid tab 200mcg ....................... 23 unithroid tab 25mcg ......................... 22
243
unithroid tab 300mcg ........................ 23 unithroid tab 50mcg .......................... 22 unithroid tab 75mcg .......................... 22 unithroid tab 88mcg .......................... 22 UNITSTIK PRO MIS LANC 25G .......... 160 UNIVERSAL 1 MIS 33G .................... 160 UNIVERSAL 1 MIS LANC 26G ........... 160 UNIVERSAL 1 MIS LANC 30G ........... 160 UPSPRINGBABY DRO MV/IRON ......... 110 UPTRAVI TAB 1000MCG ..................... 34 UPTRAVI TAB 1200MCG ..................... 34 UPTRAVI TAB 1400MCG .................... 34 UPTRAVI TAB 1600MCG .................... 34 UPTRAVI TAB 200/800 ...................... 34 UPTRAVI TAB 200MCG ...................... 34 UPTRAVI TAB 400MCG ...................... 34 UPTRAVI TAB 600MCG ...................... 34 UPTRAVI TAB 800MCG ...................... 34 urea cream 40% ............................ 141 uremez-40 cre 40% ........................ 141 ursodiol cap 300 mg ......................... 65 ursodiol tab 250 mg .......................... 65 ursodiol tab 500 mg .......................... 65 UTERUS TAB 150MG ....................... 114 V vagisil cre 1% ................................ 140 vagistat-3 kit combo pk ..................... 68 valacyclovir hcl tab 1 gm .................... 7 valacyclovir hcl tab 500 mg ................. 7 valganciclovir hcl for soln 50 mg/ml (base equiv) ..................................... 7 valganciclovir hcl tab 450 mg (base equivalent) ....................................... 7 valsartan tab 160 mg ........................ 30 valsartan tab 320 mg ........................ 30 valsartan tab 40 mg .......................... 30 valsartan tab 80 mg .......................... 30 valsartan-hydrochlorothiazide tab 160-12.5 mg .................................... 32 valsartan-hydrochlorothiazide tab 160-25 mg ................................................. 32 valsartan-hydrochlorothiazide tab 320-12.5 mg .................................... 32 valsartan-hydrochlorothiazide tab 320-25 mg ................................................. 32 valsartan-hydrochlorothiazide tab 80-12.5 mg ..................................... 32
VALVD HOLDNG MIS CHAMBER ........ 149 vancomycin hcl cap 125 mg (base equivalent) ........................................ 9 vancomycin hcl cap 250 mg (base equivalent) ........................................ 9 vandazole gel 0.75% ........................ 67 VAPORIZER MIS 1 GALLON .............. 152 VAPORIZER MIS 1.2 GAL ................. 152 VAPORIZER MIS 1.5 GAL ................. 152 VAPORIZER MIS 1.7 GAL ................. 152 VAPORIZER MIS 1.9 GAL ................. 152 VAPORIZER MIS 2 GALLON .............. 152 VAPORIZER MIS 2.5 GAL ................. 152 VAPORIZER MIS 3 GALLON .............. 152 VAPORIZER MIS PORTABLE ............. 152 VAPORIZER MIS WATERLES ............. 152 VARIETY PACK MIS BANDAGES ........ 165 varisan tab vitality .......................... 114 VASOFLEX CAP ................................ 91 vasoflex cap forte ............................. 91 vasoflex hd tab ................................ 92 vasoflex tab..................................... 92 VCF VAGINAL AER CONTRACP ............ 68 vcf vaginal gel contrace..................... 68 VCF VAGINAL MIS CONTRACP ............ 68 vcks dayquil liq mucus dm................. 46 VELETRI INJ 0.5MG .......................... 35 VELETRI INJ 1.5MG .......................... 35 velivet pak ...................................... 18 VEMLIDY TAB 25MG ........................... 7 VENCLEXTA TAB 100MG .................... 10 VENCLEXTA TAB 10MG ..................... 10 VENCLEXTA TAB 50MG ..................... 10 VENCLEXTA TAB START PK ................ 10 VENTOLIN HFA AER .......................... 49 verapamil hcl cap er 24hr 100 mg ...... 28 verapamil hcl cap er 24hr 200 mg ...... 28 verapamil hcl cap er 24hr 300 mg ...... 28 verapamil hcl tab er 120 mg .............. 28 verapamil hcl tab er 180 mg .............. 28 verapamil hcl tab er 240 mg .............. 28 vercolate tab 5mg ec ........................ 51 very finest liq fish oil ...................... 123 VICTOZA INJ 18MG/3ML.................... 20 VIEKIRA PAK TAB ............................... 7 vienva tab 0.1-20 ............................. 17 vigor cap ....................................... 113
244
VIOKACE TAB 10440 ......................... 65 VIOKACE TAB 20880 ......................... 65 viorele tab ....................................... 18 VIOS LC MIS SPRINT....................... 152 VIOS LC PLUS MIS .......................... 152 VIOS LC PLUS MIS DELUXE .............. 152 VIOS LC PLUS MIS PEDIATRC ........... 152 VIOS MIS SYSTEM .......................... 152 VIOS PRO LC MIS SPRINT ................ 152 VIOS PRO LC+ MIS SYSTEM ............. 152 virt-caps cap .................................... 90 virt-gard tab 2.2-25-1 ..................... 126 virtussin ac sol 100-10/5 ................... 46 virtussin sol dac ............................... 48 VISCO-3 INJ 25/2.5ML ...................... 85 vision form cap eye hlth .................... 96 vision form tab 2 ............................ 105 vision form/ tab lutein ..................... 105 vision formu cap 50+ ........................ 96 vision plus cap ................................. 96 vision tab vitamins .......................... 105 visivites tab ................................... 105 visivites tab /lutein ......................... 105 VISTOGARD PAK 10GM ................... 143 vit a/c/d/fl dro 0.25mg .................... 112 vit b complx tab /vit c ....................... 90 vit d child chw 1000unit..................... 86 vit d3 drops liq 400unit ..................... 87 vit d3 gumm chw 1000unit ................ 86 vit for hair tab ................................ 114 vita c/biofl tab rose hip ...................... 92 vita hair tab ................................... 105 vitabasic tab complete ..................... 105 vitabasic tab senior ......................... 105 vita-bee/c tab .................................. 90 VITABEX CAP ................................... 96 VITABEX PLUS CAP ........................... 96 vitachew chw ................................. 111 VITACRAVES CHW IMMUNITY ........... 107 VITACRAVES CHW MENS ................. 107 VITACRAVES CHW SOUR GUM .......... 107 VITACRAVES CHW WOMENS ............ 107 vitajoy daly chw d 1000iu .................. 86 vitajoy gumm chw 2.5mg ................ 144 vitalee tab ....................................... 93 VITALET PRO MIS ........................... 160 VITALET PRO MIS PLUS ................... 161
VITALETS CHW .............................. 111 VITALETS CHW CHILD .................... 111 VITALINE TAB FORMULA2 ............... 105 VITALINE TAB FORMULA3 ............... 105 VITA-MAG TAB ................................. 87 VITAMAX CHW ............................... 111 VITAMENT PAK .............................. 108 vitamin a&d cap ............................... 87 vitamin b100 tab complex ................. 90 vitamin b50 tab complex ................... 90 VITAMIN C CHW 500MG .................... 92 VITAMIN C LIQ ................................ 87 VITAMIN C PAK BLEND ................... 108 VITAMIN C POW ELECTROL ............. 108 vitamin c tab plus ............................ 92 vita-min cap .................................... 96 vitamin d cap 1000unit ..................... 85 VITAMIN D CAP 2000UNIT................. 85 vitamin d chw 1000unit .................... 86 vitamin d chw 400unit ...................... 86 vitamin d tab 1000unit ..................... 86 vitamin d tab 5000iu ........................ 86 VITAMIN D2 TAB 2000UNIT ............... 85 VITAMIN D2 TAB 400UNIT................. 85 vitamin d3 cap 10000unt .................. 86 vitamin d3 cap 1000unit ................... 85 vitamin d3 cap 2000unit ................... 85 vitamin d-3 cap 2000unit .................. 85 vitamin d3 chw 1000unit ................... 86 vitamin d-3 tab 1000unit .................. 86 vitamin d-3 tab 5000unit .................. 86 VITAMIN D3 TAB COMPLETE ............ 105 VITAMIN E CAP COMPLETE ................ 87 VITAMIN LIQ MINERAL .................... 107 vitamin mixture cap ......................... 87 vitamins a & d cap ........................... 87 vitamins a & d tab ............................ 87 vitamins c & e cap ............................ 87 VITAMINS FOR TAB THE HAIR ......... 114 VITAMINS TO MIS GO MAX .............. 109 VITAMINS TO MIS GO MEN.............. 109 VITAMINS TO MIS GO WOMEN ......... 109 vitamins w/ lipotropics tab .............. 115 VITASANA TAB .............................. 105 vitatrum chw ................................. 107 VITATRUM TAB .............................. 105 vitatrum tab complete .................... 105
245
vite/iron chw children ..................... 112 viteyes ared cap advanced ................. 96 viteyes ared cap formula ................... 96 viteyes cap /lutein ............................ 96 viteyes cap complete ........................ 96 viteyes smkr cap advanced ................ 96 viteyes smkr cap w/lutein .................. 96 viteyes tab lycopene ....................... 105 VITONIC LIQ .................................... 91 vitrum tab senior ............................ 105 VITRUM TAB SENIOR ...................... 105 voriconazole for susp 40 mg/ml ........... 7 voriconazole tab 200 mg .................... 7 voriconazole tab 50 mg ...................... 7 VORTEX VALVE MIS CHAMBER ......... 150 VOTRIENT TAB 200MG ...................... 12 vt b complex cap .............................. 88 vyfemla tab 0.4-35 ........................... 17 vylibra tab 0.25-35 ........................... 18 W WAL-BORN CHW VIT C .................... 107 WAL-BORN TAB .............................. 114 wal-dram ii tab 25mg ........................ 64 wal-dryl alr tab 12.5mg ..................... 38 wal-dryl cap 25mg ............................ 36 wal-dryl liq 12.5/5ml ........................ 38 wal-dryl tab 25mg ............................ 37 wal-fex allr tab 180mg ...................... 39 wal-fex alrg tab 60mg 12h................. 39 wal-fex d tab 12 hour........................ 45 wal-fex d tab 24 hour........................ 45 wal-fex tab 180mg............................ 39 wal-finate tab 4mg ........................... 36 wal-itin chl sol 5mg/5ml .................... 40 wal-itin d tab 10-240mg .................... 45 wal-itin d tab 24 hour ....................... 45 wal-itin d tab 5-120mg...................... 45 wal-itin syp 5mg/5ml ........................ 40 wal-itin tab 10mg ............................. 40 wal-phed d tab 120mg ...................... 41 wal-phed tab 120mg er ..................... 41 wal-phed tab 30mg ........................... 40 wal-profen cap 200mg ...................... 79 wal-profen tab 200mg ....................... 79 wal-som cap 50mg ........................... 70 wal-som tab 25mg ............................ 69 wal-sporin oin ................................ 135
wal-tap elx cld/alle ........................... 44 wal-tussin liq 100/5ml ...................... 43 wal-tussin liq 10-100/5 ..................... 47 wal-tussin liq cf ................................ 48 wal-tussin liq dm .............................. 47 wal-tussin liq dm max ....................... 48 wal-tussin syp 100/5ml ..................... 44 wal-tussin syp dm ............................ 48 wal-vert tab 10mg ............................ 40 wal-zan 75 tab ................................. 62 wal-zan tab 150mg ........................... 62 wal-zan tab 75mg ............................ 62 wal-zyr cap 10mg ............................. 38 wal-zyr chld sol 5mg/5ml .................. 39 wal-zyr chw 10mg ............................ 39 wal-zyr chw 5mg .............................. 39 wal-zyr d tab 5-120mg...................... 45 wal-zyr sol 1mg/ml ........................... 39 wal-zyr sol 5mg/5ml ......................... 39 wal-zyr tab 10mg ............................. 39 warfarin sodium tab 1 mg ................ 126 warfarin sodium tab 10 mg .............. 127 warfarin sodium tab 2 mg ................ 126 warfarin sodium tab 2.5 mg ............. 126 warfarin sodium tab 3 mg ................ 126 warfarin sodium tab 4 mg ................ 126 warfarin sodium tab 5 mg ................ 126 warfarin sodium tab 6 mg ................ 126 warfarin sodium tab 7.5 mg ............. 126 WATCHHALER MIS.......................... 150 water for inject, bacteriostatic benzyl alcohol .......................................... 169 water for injection .......................... 169 water for iv injection ....................... 169 WATERPROOF MIS BANDAGES ......... 165 WATERPROOF PAD 3....................... 166 WATERSHIELD MIS BANDAGES ........ 165 WEBCOL PREP PAD LARGE ............... 168 WEBCOL PREP PAD MEDIUM ............ 168 weight loss tab multi....................... 114 wera tab 0.5/35 ............................... 17 WHISPER AIRE MIS PED NEBU ......... 152 WHOLE FOOD TAB MULTIVIT ........... 105 whole source tab dietary ................. 105 whole source tab for men ................ 105 whole source tab mature ................. 105 whole source tab women ................. 105
246
WILLIS THE MIS WHALE .................. 152 WINDMILL MIS TRAINER ................. 148 WING TIP MIS TUBING .................... 148 wixela inhub aer 100/50 .................... 49 womans laxat tab 5mg ec .................. 51 womens 50+ cap advanced ............... 96 womens 50+ tab advanced .............. 105 WOMENS BIO- TAB MULTIPLE .......... 105 womens cap multi ............................ 96 womens daily chw gummies............. 107 womens daily tab fa/ca/fe ............... 105 womens daily tab formula................ 105 womens laxat tab 5mg ec .................. 51 WOMENS MENOP MIS VITA PAK ....... 114 womens mult tab ........................... 105 WOMENS MULTI TAB VIT/MIN .......... 105 womens one tab daily ..................... 105 WOMENS PAK ................................ 109 WOMENS VITA MIS PAK .................. 114 womns active tab daily .................... 105 X XARELTO STAR TAB 15/20MG .......... 127 XARELTO TAB 10MG ....................... 127 XARELTO TAB 15MG ....................... 127 XARELTO TAB 20MG ....................... 127 XELJANZ TAB 10MG .......................... 82 XELJANZ TAB 5MG ............................ 81 XELJANZ XR TAB 11MG ..................... 82 XIFAXAN TAB 550MG ......................... 8 XIIDRA DRO 5% ............................. 131 XOLAIR SOL 150MG .......................... 50 xpect tab 400mg .............................. 43 xulane dis 150-35............................. 16 XYREM SOL 500MG/ML...................... 71 Y YELETS TEEN TAB FORMULA ............ 105 yl balanced tab b-100 ....................... 90 yl folic aci tab 400mcg .................... 123 yl vitamin cap a & d .......................... 87 YOUR LIFE CHW GUMMIES .............. 107 YOUR LIFE CHW MULTIVIT............... 107 your life tab mens 50+ .................... 105 your life tab wmns 50+ ................... 105 yuvafem tab 10mcg .......................... 68 Z zarah tab 3-0.03mg .......................... 16
ZARXIO INJ 300/0.5 ....................... 125 ZARXIO INJ 480/0.8 ....................... 125 zeasorb-af pow 2% ........................ 137 zebutal cap ...................................... 76 ZEJULA CAP 100MG .......................... 12 ZELBORAF TAB 240MG ...................... 11 zenatane cap 10mg ........................ 134 zenatane cap 20mg ........................ 134 zenatane cap 30mg ........................ 134 zenatane cap 40mg ........................ 134 ZENPEP CAP 15000UNT ..................... 65 ZENPEP CAP 20000UNT ..................... 65 ZENPEP CAP 25000 .......................... 65 ZENPEP CAP 3000UNIT ..................... 65 ZENPEP CAP 40000 .......................... 65 ZENPEP CAP 5000UNIT ..................... 65 ZEPATIER TAB 50-100MG .................... 7 ZERBAXA INJ 1.5GM ........................... 4 ZINC LOZ ...................................... 108 zinc-vites tab ................................... 88 ZN-PLUS TAB 15MG........................ 114 ZOLINZA CAP 100MG ........................ 11 zolmitriptan orally disintegrating tab 2.5 mg ................................................. 82 zolmitriptan orally disintegrating tab 5 mg ................................................. 82 zolmitriptan tab 2.5 mg ..................... 82 zolmitriptan tab 5 mg ....................... 82 ZONTIVITY TAB 2.08MG .................. 127 zoo friends chw .............................. 111 ZOO FRIENDS CHW COMPLETE ........ 111 zoo friends chw extra c ................... 110 zoo friends chw extra d ................... 111 zoo friends chw gummies ......... 110, 111 zoo friends chw pls iron .................. 112 zoo friends chw plus c ..................... 110 ZORBTIVE INJ 8.8MG ........................ 24 zovia 1/35e tab ................................ 16 ZYDELIG TAB 100MG ........................ 12 ZYDELIG TAB 150MG ........................ 12 ZYKADIA CAP 150MG ........................ 11 ZYRTEC ALLGY TAB 10MG ................. 39 ZYRTEC CHILD TAB 10MG ................. 39 ZYTIGA TAB 500MG .......................... 10 ZYVOX SOL 2MG/ML ........................... 9