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UMHP Formulary Print April 2019 - Final · 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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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