VIRGINIA PREMIER HEALTH PLAN MEDICAID FORMULARY · 2019-09-27 · 7-keto dhea powder: Formulary. A & D ZINC OXIDE EXTERNAL CREAM. Formulary. OTC: a thru z advanced oral tablet. Formulary:

VIRGINIA PREMIER HEALTH PLAN

MEDICAID FORMULARY

PLEASE NOTE: Check your benefit materials for the specific drugs covered and the

copayments for your prescription drug program. For specific questions about your

coverage, please call the phone number printed on your ID card. The list may not be all-

inclusive. THIS LIST IS SUBJECT TO CHANGE.

For the member: Generic medications contain the same active ingredients as their

corresponding brand-name medications, although they may look different in color or shape.

They have been FDA-approved under strict standards.

For the physician: Please prescribe preferred products and allow generic substitutions when

medically appropriate. Thank you.

CURRENT AS OF 3/1/2019

lowercase italics = Generic Formulary drugsUPPERCASE = Brand name Formulary drugs

Formulary StatusFormulary = Covered

Requirements/LimitsAGE = Age limit requirementCustom = Drug has unique restrictionsOTC = Over the CounterPA = Prior Authorization requiredQL = Quantity Level LimitSP = Specialty Drug. Preferred Specialty Pharmacy will be listed if applicableST = Step Therapy may apply to some or all strengths of the drug

Drug Name Formulary Status Requirements/Limits1st relief spray external liquid 4-1 % Formulary OTC

1st tier unifine pentips 29g x 12mm , 31g x 5 mm , 31g x 6 mm , 31g x 8 mm , 32g x 4 mm

Formulary OTC; QL (200 EA per 30 days)

1st tier unilet comfortouch Formulary OTC; QL (150 EA per 30 days)

2-deoxy-d-glucose powder Formulary

50+ adult eye health oral capsule Formulary OTC

7-keto dhea powder Formulary

A & D ZINC OXIDE EXTERNAL CREAM Formulary OTC

a thru z advanced oral tablet Formulary OTC

a thru z advantage oral tablet Formulary OTC

a thru z select oral tablet chewable Formulary OTC

A+D CRACKED SKIN RELIEF EXTERNAL CREAM 2-0.13 %

Formulary OTC

a1c test at-home in vitro kit Formulary OTC

a-25 oral capsule 25000 unit Formulary OTC

abacavir sulfate oral solution 20 mg/ml Formulary

abacavir sulfate oral tablet 300 mg Formulary

abacavir sulfate-lamivudine oral tablet 600-300 mg Formulary

abacavir-lamivudine-zidovudine oral tablet 300-150-300 mg

Formulary

ABANATUSS PED ORAL LIQUID 15-0.5-6.25 MG/ML, 60-2-25 MG/5ML

Formulary OTC

ABATRACE ORAL CAPSULE Formulary OTC

ABATREX ORAL TABLET 8-200-4-100-600 MG Formulary OTC

ABATRON AF ORAL TABLET 150-1 MG Formulary OTC

ABATRON ORAL LIQUID Formulary OTC

ABATUSS DMX ORAL LIQUID 30-1-15 MG/5ML Formulary OTC

ABILIFY MAINTENA INTRAMUSCULAR PREFILLED SYRINGE 300 MG, 400 MG

Formulary AGE (Min 18 Years)

ABILIFY MAINTENA INTRAMUSCULAR SUSPENSION RECONSTITUTED ER 300 MG, 400 MG


abiraterone acetate oral tablet 250 mg Formulary

ABRAXANE INTRAVENOUS SUSPENSION RECONSTITUTED 100 MG

Formulary

ABREVA EXTERNAL CREAM 10 % Formulary OTC

acacia powder Formulary

1

Drug Name Formulary Status Requirements/Limitsacamprosate calcium oral tablet delayed release 333 mg Formulary

acarbose oral tablet 100 mg, 25 mg, 50 mg Formulary

ACCU-CHEK FASTCLIX LANCET KIT Formulary OTC

ACCU-CHEK SOFT TOUCH LANCETS Formulary OTC; QL (150 EA per 30 days)

ACCU-CHEK SOFTCLIX LANCETS Formulary OTC; QL (150 EA per 30 days)

ACCUTREND CHOLESTEROL CONTROL IN VITRO SOLUTION

Formulary OTC

ACCUTREND CHOLESTEROL IN VITRO STRIP Formulary OTC

ACCUTREND PLUS DEVICE Formulary OTC

ACE AEROSOL CLOUD ENHANCER Formulary QL (2 EA per 365 days)

ACE KNEE BRACE W/STABILIZERS Formulary OTC

acebutolol hcl oral capsule 200 mg, 400 mg Formulary

ACEROLA C 500 ORAL WAFER 500 MG Formulary OTC

acesulfame potassium powder Formulary

ACETA-GESIC ORAL TABLET 12.5-325 MG Formulary OTC

acetaminophen oral liquid 160 mg/5ml Formulary OTC

acetaminophen oral solution 160 mg/5ml Formulary OTC

acetaminophen oral tablet 325 mg Formulary OTC

acetaminophen powder Formulary

acetaminophen-codeine #2 oral tablet 300-15 mg Formulary PA; QL (280 EA per 7 days)



acetaminophen-codeine oral solution 120-12 mg/5ml Formulary PA; QL (1750 ML per 7 days)

ACETASOL HC OTIC SOLUTION 2-1 % Formulary

acetazolamide crystals Formulary OTC

acetazolamide er oral capsule extended release 12 hour 500 mg

Formulary

acetazolamide oral tablet 250 mg Formulary

acetic acid glacial solution 99 % Formulary

acetic acid irrigation solution 0.25 % Formulary

acetic acid otic solution 2 % Formulary

acetic acid solution 3 % Formulary OTC

acetone solution Formulary

acetylcysteine inhalation solution 10 %, 20 % Formulary

acetyl-l-carnitine hcl powder Formulary

ACID GONE ORAL SUSPENSION 95-358 MG/15ML Formulary OTC

acid reducer maximum strength oral tablet 20 mg Formulary OTC

acidophilus oral capsule Formulary OTC

acidophilus probiotic oral tablet 10 mg Formulary OTC

acidophilus/bifidus oral tablet chewable Formulary OTC

acidophilus/citrus pectin oral tablet Formulary OTC

acidophilus/pectin oral capsule Formulary OTC

acitretin oral capsule 10 mg, 17.5 mg, 25 mg Formulary PA; QL (68 EA per 34 days)

acne medication 10 external gel 10 % Formulary OTC; AGE (Max 18 Years)

2

Drug Name Formulary Status Requirements/Limitsacne medication 10 external lotion 10 % Formulary OTC; AGE (Max 18 Years)

acne medication 5 external gel 5 % Formulary AGE (Max 18 Years)

acne medication 5 external lotion 5 % Formulary OTC; AGE (Max 18 Years)

ACNEFREE ACNE CLEARING SYSTEM EXTERNAL KIT 2.5 & 3.7 %

Formulary OTC

ACNEFREE SEVERE CLEARING SYST EXTERNAL KIT 2.5 & 10 %

Formulary OTC

ACT TOTAL CARE MOUTH/THROAT SOLUTION 0.05 %

Formulary OTC

ACTHIB INTRAMUSCULAR SOLUTION RECONSTITUTED


ACTICARNITINE SF ORAL SOLUTION 1 GM/10ML Formulary OTC

ACTICON ORAL SOLUTION 1-30 MG/5ML Formulary OTC

ACTICON ORAL TABLET 2-60 MG Formulary OTC

actidom dmx oral liquid 10-30-200 mg/5ml Formulary OTC

actidose/sorbitol oral liquid 50 gm/240ml Formulary OTC

actidose-aqua oral liquid 15 gm/72ml Formulary OTC

ACTIFLOVIT EAR HEALTH ORAL TABLET Formulary OTC

ACTIFOAM COLLAGEN SPONGE EXTERNAL Formulary

acti-lance lite lancets 28g Formulary OTC; QL (150 EA per 30 days)

acti-lance special lancets 17g Formulary OTC; QL (150 EA per 30 days)

acti-lance universal 23g Formulary OTC; QL (150 EA per 30 days)

ACTIMMUNE SUBCUTANEOUS SOLUTION 2000000 UNIT/0.5ML

Formulary

ACTINEL ORAL LIQUID 30-15-200 MG/5ML Formulary OTC

ACTISEP MOUTH/THROAT SOLUTION 2-0.5-0.1 % Formulary OTC

ACTITROM ORAL CAPSULE Formulary OTC

ACTIVE Q MAXIMUM STRENGTH ORAL CAPSULE 300 MG

Formulary OTC

ACTIVE Q ORAL SYRUP 100 MG/5ML Formulary OTC

ACTIVE-Q EXTRA STRENGTH ORAL CAPSULE 200 MG

Formulary OTC

ACTIVE-Q ORAL CAPSULE 200-30 MG Formulary OTC

ACTIVITE EC ORAL TABLET 1 MG Formulary OTC

ACTIVON ARTHRITIS ULTRA ST EXTERNAL STICK 0.028-4.574 %

Formulary OTC

acyclovir external ointment 5 % Formulary

acyclovir oral capsule 200 mg Formulary

acyclovir oral suspension 200 mg/5ml Formulary

acyclovir oral tablet 400 mg, 800 mg Formulary

ADACEL INTRAMUSCULAR SUSPENSION 5-2-15.5 LF-MCG/0.5

Formulary

ADAGEN INTRAMUSCULAR SOLUTION 250 UNIT/ML

Formulary PA

adapalene external cream 0.1 % Formulary AGE (Max 18 Years)

adapalene external gel 0.1 %, 0.3 % Formulary AGE (Max 18 Years)

3

Drug Name Formulary Status Requirements/LimitsADCIRCA ORAL TABLET 20 MG Formulary PA

ADDERALL XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR 10 MG, 15 MG, 5 MG

FormularyST; QL (30 EA per 30 days); AGE (Min 4 Years and Max 17 Years)

ADDERALL XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR 20 MG, 25 MG, 30 MG

FormularyST; QL (60 EA per 30 days); AGE (Min 4 Years and Max 17 Years)

adefovir dipivoxil oral tablet 10 mg Formulary

adenosylcobalamin powder Formulary OTC

adhesive bandages sheer Formulary OTC

adjustable lancing device Formulary OTC; QL (1 EA per 365 days)

ADRENAL C FORMULA ORAL TABLET Formulary

ADRENALIN INJECTION SOLUTION 1 MG/ML, 30 MG/30ML

Formulary

ADRUCIL INTRAVENOUS SOLUTION 2.5 GM/50ML, 5 GM/100ML, 500 MG/10ML

Formulary

adult gummy oral tablet chewable Formulary OTC

adult mask device Formulary QL (2 EA per 365 days)

adult wash cloths with aloe external 3 % Formulary OTC

adult-lock weekly pill remind Formulary OTC

ADVAIR DISKUS INHALATION AEROSOL POWDER BREATH ACTIVATED 100-50 MCG/DOSE


ADVAIR DISKUS INHALATION AEROSOL POWDER BREATH ACTIVATED 250-50 MCG/DOSE, 500-50 MCG/DOSE


advanced acne wash external liquid extended release 4.4 % Formulary OTC

ADVANCED CALCIUM/D/MAGNESIUM ORAL TABLET

Formulary OTC

advanced hand sanitizer external liquid 70 % Formulary OTC

ADVIL ALLERGY & CONGESTION ORAL TABLET 4-10-200 MG

Formulary OTC

ADVIL ALLERGY SINUS ORAL TABLET 2-30-200 MG Formulary OTC

ADVIL COLD & SINUS LIQUI-GELS ORAL CAPSULE 30-200 MG

Formulary OTC

ADVIL COLD/SINUS ORAL TABLET 30-200 MG Formulary OTC

ADVIL ORAL CAPSULE 200 MG Formulary OTC

ADVIL ORAL TABLET 200 MG Formulary OTC

ADVIL PM ORAL CAPSULE 200-25 MG Formulary OTC

ADVIL PM ORAL TABLET 200-38 MG Formulary OTC

ADVIL SINUS CONGESTION & PAIN ORAL TABLET 10-200 MG

Formulary OTC

ADVOCATE INSULIN SYRINGE 29G X 1/2" 0.5 ML 29G X 1/2" 0.5 ML

Formulary OTC

ADVOCATE INSULIN SYRINGE 30G X 5/16" 0.3 ML 30G X 5/16" 0.3 ML

Formulary OTC

ADVOCATE INSULIN SYRINGE 30G X 5/16" 1 ML 30G X 5/16" 1 ML

Formulary OTC

ADVOCATE INSULIN SYRINGE 31G X 5/16" 1 ML 31G X 5/16" 1 ML

Formulary OTC

AEROCHAMBER PLUS FLO-VU Formulary QL (2 EA per 365 days)

4

Drug Name Formulary Status Requirements/LimitsAEROCHAMBER PLUS FLO-VU LARGE Formulary QL (2 EA per 365 days)

AEROCHAMBER PLUS FLO-VU SMALL Formulary QL (2 EA per 365 days)

AEROCHAMBER PLUS FLO-VU W/MASK Formulary QL (2 EA per 365 days)

AFEDITAB CR ORAL TABLET EXTENDED RELEASE 24 HOUR 30 MG, 60 MG

Formulary

AFLURIA INTRAMUSCULAR SUSPENSION Formulary AGE (Min 19 Years)

AFLURIA PRESERVATIVE FREE INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.5 ML


AFREZZA INHALATION POWDER 12 UNIT, 8 UNIT Formulary

AFRIN CHILDRENS NASAL SOLUTION 0.25 % Formulary OTC

AFRIN MENTHOL SPRAY NASAL SOLUTION 0.05 % Formulary OTC

AFTERA ORAL TABLET 1.5 MG Formulary OTC; QL (2 EA per 34 days)

AGAMATRIX ULTRA-THIN LANCETS Formulary OTC; QL (150 EA per 30 days)

AHIST ORAL TABLET 25 MG Formulary OTC

aimsco lubricated Formulary OTC

AIRAVITE ORAL TABLET 2.5-25-1 MG Formulary

AIRBORNE ORAL LOZENGE Formulary OTC

AIRS DISPOSABLE NEBULIZER Formulary OTC; QL (2 EA per 365 days)

AIRS DISPOSABLE NEBULIZER KIT Formulary QL (2 EA per 365 days)

AIRZONE PEAK FLOW METER DEVICE Formulary OTC; QL (2 EA per 365 days)

ak-poly-bac ophthalmic ointment 500-10000 unit/gm Formulary

AL12 EXTERNAL LOTION 12 % Formulary OTC

ALA SEB EXTERNAL SHAMPOO 2-2 % Formulary OTC

ALA SEB T EXTERNAL SHAMPOO 1-2-2 % Formulary OTC

ALAHIST DM ORAL LIQUID 7.5-2-15 MG/5ML Formulary OTC

ALA-HIST IR ORAL TABLET 2 MG Formulary OTC

ALA-HIST PE ORAL TABLET 2-10 MG Formulary OTC

alanine 1000 oral packet 1000 mg Formulary OTC

alba-lybe nr oral liquid 325-10-50 mg/5ml Formulary OTC

albendazole oral tablet 200 mg Formulary

ALBOLENE EXTERNAL CREAM Formulary OTC; QL (454 GM per 34 days)

ALBUKED 25 INTRAVENOUS SOLUTION 25 % Formulary

ALBUKED 5 INTRAVENOUS SOLUTION 5 % Formulary

albuterol sulfate er oral tablet extended release 12 hour 4 mg, 8 mg

Formulary

albuterol sulfate inhalation nebulization solution (2.5 mg/3ml) 0.083%, (5 mg/ml) 0.5%, 0.63 mg/3ml, 1.25 mg/3ml

Formulary

albuterol sulfate oral syrup 2 mg/5ml Formulary

albuterol sulfate oral tablet 2 mg, 4 mg Formulary

alclometasone dipropionate external cream 0.05 % Formulary

alclometasone dipropionate external ointment 0.05 % Formulary

alcohol (rubbing) solution 70 % Formulary OTC

alcohol anhydrous liquid Formulary OTC

alcohol prep pad 70 % Formulary OTC

5

Drug Name Formulary Status Requirements/Limitsalcohol prep pad 70 % 70 % Formulary OTC

alcohol swabs pad Formulary OTC

alcohol swabs pad 70 % 70 % Formulary OTC

alcohol wipes pad 70 % 70 % Formulary OTC

alcohol, usp solution 95 % Formulary

alendronate sodium oral tablet 10 mg, 35 mg, 40 mg, 5 mg, 70 mg

Formulary

aler-cap oral capsule 25 mg Formulary OTC

aler-dryl oral tablet 50 mg Formulary OTC

alertness aid oral tablet 200 mg Formulary OTC

alevazol external ointment 1 % Formulary OTC

ALEVE ORAL CAPSULE 220 MG Formulary OTC

ALEVE ORAL TABLET 220 MG Formulary OTC

ALFERON N INJECTION SOLUTION 5000000 UNIT/ML

Formulary PA

alfuzosin hcl er oral tablet extended release 24 hour 10 mg Formulary

alga oral capsule 0.225-2000 mg-unit Formulary OTC

ALGAL-900 DHA ORAL CAPSULE 300 MG Formulary OTC

ALIMTA INTRAVENOUS SOLUTION RECONSTITUTED 100 MG, 500 MG

Formulary

ALIVE MULTI-VITAMIN CHILDRENS ORAL TABLET CHEWABLE 60 MG

Formulary OTC

ALIVIO EXTERNAL PATCH 0.03-5 % Formulary OTC

alka-aid oral tablet 180-360 mg Formulary OTC

ALKA-SELTZER HEARTBURN + GAS ORAL TABLET CHEWABLE 750-80 MG

Formulary OTC

ALKA-SELTZER ORAL TABLET EFFERVESCENT 325-1000-1916 MG

Formulary OTC

all day allergy childrens oral solution 5 mg/5ml Formulary OTC

all day pain relief oral tablet 220 mg Formulary OTC

allantoin powder Formulary

ALL-DRY SIZE 3 Formulary OTC

ALLEGRA ALLERGY CHILDRENS ORAL SUSPENSION 30 MG/5ML

Formulary OTC

ALLEGRA ALLERGY CHILDRENS ORAL TABLET DISPERSIBLE 30 MG

Formulary OTC

ALLEGRA ALLERGY ORAL TABLET 180 MG, 60 MG Formulary OTC

ALLEGRA-D ALLERGY & CONGESTION ORAL TABLET EXTENDED RELEASE 12 HOUR 60-120 MG

Formulary OTC

ALLEGRA-D ALLERGY & CONGESTION ORAL TABLET EXTENDED RELEASE 24 HOUR 180-240 MG

Formulary OTC

aller-ease oral tablet 60 mg Formulary OTC; QL (68 EA per 34 days)

allergy childrens oral liquid 12.5 mg/5ml Formulary OTC

allergy eye ophthalmic solution 0.025-0.3 % Formulary OTC

allergy multi-symptom day/nght oral Formulary OTC

allergy spray 24 hour aerosol 55 mcg/act nasal 55 mcg/act Formulary OTC

6

Drug Name Formulary Status Requirements/LimitsALLEVYN PLUS CAVITY PAD 6"X8" Formulary OTC

ALLI ORAL CAPSULE 60 MG Formulary OTC

allopurinol oral tablet 100 mg, 300 mg Formulary

ALMACONE ORAL TABLET CHEWABLE 200-200-25 MG

Formulary OTC

almond oil bitter flavor liquid Formulary

ALOCANE PLUS EXTERNAL GEL 4-0.13 % Formulary OTC

ALOE GRANDE EXTERNAL CREAM 100000-1500 UNIT/GM

Formulary OTC

ALOE GRANDE EXTERNAL LOTION 10000-1500 UNIT/30ML

Formulary OTC

aloe vera external cream 72 % Formulary OTC

aloe vera external gel 99.5 % Formulary OTC

aloe vera freeze dried powder Formulary

aloe vera moisturizing external gel 99.5 % Formulary OTC

ALOE VESTA 2-N-1 PROTECTIVE EXTERNAL OINTMENT

Formulary OTC

ALOE VESTA CLEAR ANTIFUNGAL EXTERNAL OINTMENT 2 %

Formulary OTC

ALOE VESTA MULTI PURPOSE EXTERNAL FOAM Formulary OTC

ALOE VESTA PROTECTIVE EXTERNAL OINTMENT Formulary OTC

ALOE VESTA SKIN PROTECTANT EXTERNAL AEROSOL 36 %

Formulary OTC

aloe/lidocaine pain reliever external gel 0.5 % Formulary OTC

alosetron hcl oral tablet 0.5 mg, 1 mg Formulary PA

alp high3 oral capsule delayed release 600 mg Formulary OTC

ALPAWASH EXTERNAL OINTMENT Formulary

ALPHAGAN P OPHTHALMIC SOLUTION 0.1 %, 0.15 %

Formulary

alpha-lipoic acid oral capsule 100 mg Formulary OTC

alpha-lipoic acid oral tablet 200 mg Formulary OTC

alpha-lipoic acid powder Formulary

ALPHANATE/VWF COMPLEX/HUMAN INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT, 1500 UNIT, 250 UNIT, 500 UNIT

Formulary

ALPHANINE SD INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT, 500 UNIT

Formulary

alph-e oral capsule 400 unit Formulary OTC

alph-e-mixed 1000 oral capsule 1000 unit Formulary OTC

alph-e-mixed oral capsule 200 unit Formulary OTC

alprazolam er oral tablet extended release 24 hour 0.5 mg, 1 mg, 2 mg

Formulary QL (170 EA per 30 days)

alprazolam er oral tablet extended release 24 hour 3 mg Formulary QL (170 EA per 34 days)

ALPRAZOLAM INTENSOL ORAL CONCENTRATE 1 MG/ML

Formulary QL (170 ML per 34 days)

alprazolam oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg Formulary QL (170 EA per 34 days)

7

Drug Name Formulary Status Requirements/Limitsalprazolam oral tablet dispersible 0.25 mg, 0.5 mg, 1 mg, 2 mg


ALTACAINE OPHTHALMIC SOLUTION 0.5 % Formulary

ALTAFLUOR OPHTHALMIC SOLUTION 0.25-0.4 % Formulary

ALTAVERA ORAL TABLET 0.15-30 MG-MCG Formulary QL (28 EA per 28 days)

alum ammonium powder Formulary OTC

aluminum acetate external solution Formulary OTC

aluminum bottle seal Formulary OTC

aluminum chloride hexahydrate crystals Formulary

aluminum chloride hexahydrate powder Formulary

aluminum chlorohydrate powder Formulary

aluminum hydroxide dried gel powder Formulary

aluminum hydroxide gel oral suspension 320 mg/5ml Formulary OTC

ALVESCO INHALATION AEROSOL SOLUTION 160 MCG/ACT, 80 MCG/ACT

Formulary

ALWAYS MAXI MAXIMUM PROTECTION PAD Formulary OTC

alyacen 1/35 oral tablet 1-35 mg-mcg Formulary QL (28 EA per 28 days)

alyacen 7/7/7 oral tablet 0.5/0.75/1-35 mg-mcg Formulary QL (28 EA per 28 days)

amantadine hcl oral capsule 100 mg Formulary

amantadine hcl oral syrup 50 mg/5ml Formulary

amantadine hcl oral tablet 100 mg Formulary

ambi 12.5cpd/100gfn/30pse oral liquid 30-12.5-100 mg/5ml Formulary OTC

ambi 12.5cpd/1dcpm/30pse oral liquid 30-1-12.5 mg/5ml Formulary OTC

ambi 40pse/400gfn oral tablet 40-400 mg Formulary OTC

ambi 60pse/400gfn oral tablet 60-400 mg Formulary OTC

ambi 60pse/4cpm oral tablet 60-4 mg Formulary OTC

AMBI FADE EXTERNAL CREAM 2 % Formulary OTC

amcinonide external cream 0.1 % Formulary

AMERICERIN EXTERNAL CREAM Formulary OTC

AMERIWASH EXTERNAL LOTION Formulary OTC

AMETHIA LO ORAL TABLET 0.1-0.02 & 0.01 MG Formulary QL (91 EA per 91 days)

AMETHIA ORAL TABLET 0.15-0.03 &0.01 MG Formulary QL (91 EA per 91 days)

AMETHYST ORAL TABLET 90-20 MCG Formulary QL (28 EA per 28 days)

AMICAR ORAL SOLUTION 0.25 GM/ML Formulary

amiloride hcl oral tablet 5 mg Formulary

amiloride-hydrochlorothiazide oral tablet 5-50 mg Formulary

aminoacetic acid irrigation solution 1.5 % Formulary

AMINOPMRMS ORAL CAPSULE Formulary

AMINORELIEF RMS ORAL CAPSULE Formulary

aminosalicylic acid-5 powder Formulary

amiodarone hcl oral tablet 100 mg, 200 mg, 400 mg Formulary

AMITIZA ORAL CAPSULE 24 MCG, 8 MCG Formulary PA; AGE (Min 18 Years)

amitriptyline hcl oral tablet 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg

Formulary

8

Drug Name Formulary Status Requirements/Limitsamlodipine besy-benazepril hcl oral capsule 10-20 mg, 10-40 mg, 2.5-10 mg, 5-10 mg, 5-20 mg, 5-40 mg

Formulary

amlodipine besylate oral tablet 10 mg, 2.5 mg, 5 mg Formulary

amlodipine besylate-valsartan oral tablet 10-160 mg, 10-320 mg, 5-160 mg, 5-320 mg

Formulary

amlodipine-atorvastatin oral tablet 10-10 mg, 10-20 mg, 10-40 mg, 5-10 mg, 5-20 mg, 5-40 mg

Formulary

amlodipine-valsartan-hctz oral tablet 10-160-12.5 mg, 10-160-25 mg, 10-320-25 mg, 5-160-12.5 mg, 5-160-25 mg

Formulary ST

ammonia aromatic inhalation inhaler Formulary OTC

ammonia aromatic inhalation spirit Formulary OTC

ammonium carbonate powder Formulary OTC

ammonium chloride granules Formulary

ammonium hydroxide solution Formulary

ammonium lactate external cream 12 % Formulary

amoxicillin oral capsule 250 mg, 500 mg Formulary

amoxicillin oral suspension reconstituted 125 mg/5ml, 200 mg/5ml, 250 mg/5ml, 400 mg/5ml

Formulary

amoxicillin oral tablet 500 mg, 875 mg Formulary

amoxicillin oral tablet chewable 125 mg, 250 mg Formulary

amoxicillin-pot clavulanate oral suspension reconstituted200-28.5 mg/5ml, 250-62.5 mg/5ml, 400-57 mg/5ml, 600-42.9 mg/5ml

Formulary

amoxicillin-pot clavulanate oral tablet 250-125 mg, 500-125 mg, 875-125 mg

Formulary

amoxicillin-pot clavulanate oral tablet chewable 200-28.5 mg, 400-57 mg

Formulary

amphetamine-dextroamphetamine oral tablet 10 mg, 12.5 mg, 15 mg, 20 mg, 30 mg, 5 mg, 7.5 mg

Formulary AGE (Min 4 Years and Max 17 Years)

ampicillin oral capsule 500 mg Formulary

ANA-LEX RECTAL KIT 2-2 % Formulary

ANASEPT ANTIMICROBIAL EXTERNAL GEL 0.057 % Formulary OTC

ANASEPT EXTERNAL LIQUID 0.057 % Formulary

anastrozole oral tablet 1 mg Formulary

ANBESOL MAXIMUM STRENGTH MOUTH/THROAT LIQUID 20 %

Formulary OTC

ANBESOL MOUTH/THROAT GEL 10 % Formulary OTC

ANBESOL MOUTH/THROAT LIQUID 10 % Formulary OTC

ANDROGEL PUMP TRANSDERMAL GEL 20.25 MG/ACT (1.62%)

Formulary PA

ANDROGEL TRANSDERMAL GEL 20.25 MG/1.25GM (1.62%), 25 MG/2.5GM (1%), 40.5 MG/2.5GM (1.62%), 50 MG/5GM (1%)

Formulary PA

ANECREAM EXTERNAL CREAM 4 % Formulary OTC

animal chews oral tablet chewable Formulary OTC

anise oil Formulary OTC

ANORO ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED 62.5-25 MCG/INH


9

Drug Name Formulary Status Requirements/Limitsantacid anti-gas max strength oral suspension 400-400-40 mg/5ml

Formulary OTC

antacid anti-gas oral suspension 200-200-20 mg/5ml Formulary OTC

antacid extra strength oral tablet chewable 675-135 mg Formulary OTC

antacid multi-symptom oral tablet chewable 675-135-60 mg Formulary OTC

antacid oral tablet chewable 500 mg Formulary OTC

antacid soft chews oral tablet chewable 1177 mg Formulary OTC

ANTARA ORAL CAPSULE 30 MG, 90 MG Formulary

anthelios 50 mineral external liquid Formulary OTC

anti-allergy oral tablet 100-100-50 mg Formulary OTC

antibacterial liquid soap external liquid 0.15 % Formulary OTC

anti-diarrheal oral liquid 1 mg/5ml Formulary OTC

anti-diarrheal oral tablet 2 mg Formulary OTC

antifungal external aerosol 1 % Formulary OTC

antifungal external cream 2 % Formulary OTC

anti-itch external cream 1-0.1 % Formulary OTC

anti-itch external lotion 0.5-0.5 % Formulary OTC

ANTI-ITCH INTENSIVE HEALING EXTERNAL LOTION 1 %

Formulary OTC

antioxidant formula sg oral capsule extended release Formulary OTC

anti-oxidant oral tablet Formulary OTC

antiseptic external aerosol 4.5-0.05-40.5 % Formulary OTC

ANTISEPTIC HAND RINSE EXTERNAL GEL 62 % Formulary OTC

antiseptic skin cleanser external solution 4 % Formulary OTC

ANUSOL-HC RECTAL CREAM 2.5 % Formulary

AO-SEPT CONTACT LENS HOLDER Formulary OTC

APETIGEN ORAL ELIXIR Formulary OTC

APETIGEN-PLUS ORAL SOLUTION Formulary OTC

APETIGEN-PLUS ORAL TABLET Formulary OTC

ap-hist dm oral liquid 7.5-4-15 mg/5ml Formulary OTC

APLIGRAF EXTERNAL DISK Formulary

apothesar external cream Formulary

apraclonidine hcl ophthalmic solution 0.5 % Formulary

aprepitant oral capsule 125 mg, 40 mg, 80 & 125 mg Formulary QL (1 EA per 34 days)

aprepitant oral capsule 80 mg Formulary QL (2 EA per 34 days)

APRI ORAL TABLET 0.15-30 MG-MCG Formulary QL (28 EA per 28 days)

APRISO ORAL CAPSULE EXTENDED RELEASE 24 HOUR 0.375 GM

Formulary

APTIVUS ORAL CAPSULE 250 MG Formulary

APTIVUS ORAL SOLUTION 100 MG/ML Formulary

AQUA CARE EXTERNAL LOTION 10 % Formulary OTC

aquabase external ointment Formulary OTC

AQUADEKS ORAL LIQUID Formulary OTC

AQUAFRESH DR SEUSS EXTRA SOFT Formulary OTC

10

Drug Name Formulary Status Requirements/Limitsaquanaz oral tablet 10-15-400 mg Formulary OTC

AQUAPHILIC EXTERNAL OINTMENT Formulary OTC

AQUAPHILIC/CARBAMIDE EXTERNAL OINTMENT 10 %, 20 %

Formulary OTC

AQUASONIC 100 EXTERNAL GEL Formulary OTC

AQUEOUS SELENIUM ORAL LIQUID 95 MCG/DROP Formulary OTC

aqueous vitamin e oral solution 15 unit/0.3ml Formulary OTC

AQUORAL MOUTH/THROAT SOLUTION Formulary

ARANELLE ORAL TABLET 0.5/1/0.5-35 MG-MCG Formulary QL (28 EA per 28 days)

ARANESP (ALBUMIN FREE) SOLUTION 100 MCG/ML INJECTION 100 MCG/ML

Formulary


Formulary


Formulary


Formulary


Formulary


Formulary

ARANESP (ALBUMIN FREE) SOLUTION PREFILLED SYRINGE 10 MCG/0.4ML INJECTION 10 MCG/0.4ML

Formulary


Formulary


Formulary


Formulary


Formulary


Formulary


Formulary

ARANESP (ALBUMIN FREE) SOLUTION PREFILLED SYRINGE 500 MCG/ML INJECTION 500 MCG/ML

Formulary


Formulary

ARCALYST SUBCUTANEOUS SOLUTION RECONSTITUTED 220 MG

Formulary PA

ARCAPTA NEOHALER INHALATION CAPSULE 75 MCG

Formulary

arctic relief pain relieving external gel 0.2-3.5 % Formulary OTC

ARGIMENT AT ORAL PACKET Formulary OTC

11

Drug Name Formulary Status Requirements/Limitsarginine oral packet 500 mg Formulary OTC

arginine2000 oral packet 2000 mg Formulary OTC

ARGYLE STERILE SALINE IRRIGATION SOLUTION 0.9 %

Formulary

ARGYLE STERILE WATER IRRIGATION SOLUTION Formulary

aripiprazole oral tablet 10 mg, 15 mg, 2 mg, 20 mg, 30 mg, 5 mg


ARISTADA INITIO INTRAMUSCULAR PREFILLED SYRINGE 675 MG/2.4ML


ARISTADA INTRAMUSCULAR PREFILLED SYRINGE 1064 MG/3.9ML, 441 MG/1.6ML, 662 MG/2.4ML, 882 MG/3.2ML


arkaliox oral capsule 200 mg Formulary OTC

ARLASILK PHOSPHOLIPID PLN LIQUID Formulary OTC

ARMOUR THYROID ORAL TABLET 120 MG, 15 MG, 180 MG, 240 MG, 30 MG, 300 MG, 60 MG, 90 MG

Formulary

arnica external tincture 20 % Formulary OTC

arnicare arthritis oral tablet dispersible Formulary OTC

ARRANON INTRAVENOUS SOLUTION 5 MG/ML Formulary

arthritis pain relieving external cream 0.075 % Formulary OTC

artificial tears ophthalmic solution 1-0.3 %, 1.4 % Formulary OTC

ARZERRA INTRAVENOUS CONCENTRATE 100 MG/5ML, 1000 MG/50ML

Formulary

ARZOL SILVER NIT APPLICATORS EXTERNAL 75-25 %

Formulary

asafetida tincture Formulary OTC

ascocid-iso-ph oral powder effervescent Formulary OTC

ASCOMP-CODEINE ORAL CAPSULE 50-325-40-30 MG Formulary PA

ascorbic acid granules Formulary

ascorbic acid oral granules Formulary OTC

ascorbic acid oral tablet 1000 mg, 500 mg Formulary OTC

ascorbic acid oral tablet chewable 250 mg Formulary OTC

ascorbic acid powder Formulary

ascorbyl palmitate powder Formulary

ASCRIPTIN ORAL TABLET 325 MG Formulary OTC

asepto oral thermometer kit Formulary OTC

ASILNASAL RMS ORAL CAPSULE Formulary

ASMANEX 120 METERED DOSES INHALATION AEROSOL POWDER BREATH ACTIVATED 220 MCG/INH

Formulary

ASMANEX 30 METERED DOSES INHALATION AEROSOL POWDER BREATH ACTIVATED 110 MCG/INH

Formulary

aspartame powder Formulary

aspartate mg & k oral capsule 90-90 mg Formulary OTC

ASPERCREME W/LIDOCAINE EXTERNAL CREAM 4 %

Formulary OTC

12

Drug Name Formulary Status Requirements/Limitsaspir-81 oral tablet delayed release 81 mg Formulary OTC

aspirin oral tablet 325 mg Formulary OTC

aspirin oral tablet chewable 81 mg Formulary OTC

aspirin oral tablet delayed release 325 mg Formulary OTC

aspirin powder Formulary

aspirin rectal suppository 300 mg, 600 mg Formulary OTC

aspirin-dipyridamole er oral capsule extended release 12 hour 25-200 mg

Formulary

aspirtab maximum strength oral tablet 500 mg Formulary OTC

ASSURE ID INSULIN SAFETY SYR 29G X 1/2" 0.5 ML (OTC) 29G X 1/2" 0.5 ML

Formulary

ASSURE ID INSULIN SAFETY SYR 29G X 1/2" 1 ML 29G X 1/2" 1 ML

Formulary

ASSURE LANCETS Formulary OTC; QL (150 EA per 30 days)

ASTHMAPACK FOR CHILDREN KIT Formulary OTC; QL (2 EA per 365 days)

atazanavir sulfate oral capsule 150 mg, 200 mg, 300 mg Formulary

atenolol oral tablet 100 mg, 25 mg, 50 mg Formulary

atenolol-chlorthalidone oral tablet 100-25 mg, 50-25 mg Formulary

athletes foot maximum strength external ointment Formulary OTC

atomoxetine hcl oral capsule 10 mg Formulary AGE (Min 4 Years and Max 17 Years)

atomoxetine hcl oral capsule 100 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg

FormularyQL (30 EA per 30 days); AGE (Min 4 Years and Max 17 Years)

ATOPICLAIR EXTERNAL CREAM Formulary

atorvastatin calcium oral tablet 10 mg, 20 mg, 40 mg, 80 mg

Formulary

atovaquone oral suspension 750 mg/5ml Formulary

atovaquone-proguanil hcl oral tablet 250-100 mg, 62.5-25 mg

Formulary

ATRAC-TAIN EXTERNAL CREAM 10 % Formulary OTC

ATRAC-TAIN EXTERNAL LOTION 5 % Formulary OTC

ATRIPLA ORAL TABLET 600-200-300 MG Formulary

ATROVENT HFA INHALATION AEROSOL SOLUTION 17 MCG/ACT

Formulary

atuss da oral liquid 30-2-12.5 mg/5ml Formulary OTC

AUBRA ORAL TABLET 0.1-20 MG-MCG Formulary QL (28 EA per 28 days)

auraphene-b otic solution 6.5 % Formulary OTC

aurora lancet super thin 30g Formulary OTC; QL (150 EA per 30 days)

aurora lancet thin 23g Formulary OTC; QL (150 EA per 30 days)

AUTOJECT 2 Formulary OTC; QL (1 EA per 365 days)

AUTOLET PLATFORMS Formulary OTC

autopen device Formulary OTC; QL (1 EA per 365 days)

avalin external patch 4-1 % Formulary OTC

AVAR CLEANSER EXTERNAL EMULSION 10-5 % Formulary

AVAR-E EMOLLIENT EXTERNAL CREAM 10-5 % Formulary

AVASTIN INTRAVENOUS SOLUTION 100 MG/4ML, 400 MG/16ML

Formulary PA

13

Drug Name Formulary Status Requirements/LimitsAVEENO BABY GENTLE CONDITION EXTERNAL SHAMPOO

Formulary OTC

AVEENO BABY SOOTHING WASH EXTERNAL LIQUID

Formulary OTC

AVEENO INTENSE RELIEF EXTERNAL CREAM 1.3 % Formulary OTC

AVEENO POSITIVELY RADIANT WASH EXTERNAL LIQUID

Formulary OTC

AVENOVA/NEUTROX EXTERNAL SOLUTION 0.01 % Formulary

AVERTEAX MOUTH/THROAT OINTMENT 1 % Formulary OTC

AVITENE EXTERNAL PAD Formulary

AVITENE FLOUR EXTERNAL POWDER Formulary

AVO CREAM EXTERNAL EMULSION Formulary

AVONEX INTRAMUSCULAR KIT 30 MCG Formulary

AVONEX PEN INTRAMUSCULAR AUTO-INJECTOR KIT 30 MCG/0.5ML

Formulary

AVONEX PREFILLED INTRAMUSCULAR PREFILLED SYRINGE KIT 30 MCG/0.5ML

Formulary

av-phos 250 neutral oral tablet 155-852-130 mg Formulary

axillary block needle 22g x 1" , 25g x 1" Formulary OTC

AXSAIN EXTERNAL CREAM 0.25 % Formulary OTC

AYR SALINE NASAL DROPS NASAL SOLUTION 0.65 %

Formulary OTC

AYR SALINE NASAL GEL NASAL SWAB Formulary OTC

AYR SALINE NASAL NASAL GEL Formulary OTC

AYR SALINE NASAL NO-DRIP NASAL GEL Formulary OTC

AYR SALINE NASAL RINSE NASAL PACKET 1.57 GM

Formulary OTC

azacitidine injection suspension reconstituted 100 mg Formulary

AZASAN ORAL TABLET 100 MG, 75 MG Formulary

azathioprine oral tablet 50 mg Formulary

azec oral capsule Formulary OTC

azelaic acid flakes Formulary

azelaic acid powder Formulary OTC

azelastine hcl nasal solution 0.1 %, 0.15 % Formulary

azithromycin oral packet 1 gm Formulary

azithromycin oral suspension reconstituted 100 mg/5ml, 200 mg/5ml

Formulary

azithromycin oral tablet 250 mg, 500 mg, 600 mg Formulary

AZOPT OPHTHALMIC SUSPENSION 1 % Formulary

AZURETTE ORAL TABLET 0.15-0.02/0.01 MG (21/5) Formulary QL (28 EA per 28 days)

b complete oral tablet Formulary OTC

b complex formula 1 oral tablet Formulary OTC

b complex oral capsule Formulary OTC

b complex oral tablet Formulary OTC

b complex-folic acid oral tablet 500-5-200 mcg-mg-mcg Formulary OTC

b-1 oral tablet 100 mg, 250 mg Formulary OTC

14

Drug Name Formulary Status Requirements/Limitsb-100 cr oral tablet extended release Formulary OTC

b-12 oral tablet 2000 mcg, 250 mcg Formulary OTC

b-12 sublingual tablet sublingual 1000 mcg, 2500 mcg, 5000 mcg

Formulary OTC

b-12 tr oral tablet extended release 2000 mcg Formulary OTC

b-2 oral tablet 100 mg Formulary OTC

B-2-400 ORAL CAPSULE 400 MG Formulary OTC

b-6 oral tablet 250 mg, 50 mg, 500 mg Formulary OTC

BABY ANBESOL MOUTH/THROAT GEL 7.5 % Formulary OTC

baby lotion external lotion Formulary OTC

baby super daily d3 oral liquid 400 ut/0.028ml Formulary OTC

baby teething pain medicine mouth/throat gel 7.5 % Formulary OTC

baby thermometer Formulary OTC

baciim intramuscular solution reconstituted 50000 unit Formulary

bacitracin ophthalmic ointment 500 unit/gm Formulary

bacitracin zinc external ointment 500 unit/gm Formulary OTC

bacitra-neomycin-polymyxin-hc ophthalmic ointment 1 % Formulary

back pain-off oral tablet 250-50-290 mg Formulary OTC

baclofen oral tablet 10 mg, 20 mg Formulary

BACTROBAN NASAL NASAL OINTMENT 2 % Formulary

balamine dm oral syrup 5-2-10 mg/5ml Formulary OTC

balanced b-50 complex oral capsule Formulary OTC

balanced b-50 oral tablet extended release Formulary OTC

BAL-CARE DHA ORAL 27-1 & 430 MG Formulary

BALNEOL EXTERNAL LOTION Formulary OTC

balsalazide disodium oral capsule 750 mg Formulary

BALZIVA ORAL TABLET 0.4-35 MG-MCG Formulary QL (28 EA per 28 days)

BAND-AID SURGIPAD SURGICAL PAD 5"X9" Formulary OTC

BANOPHEN ORAL CAPSULE 50 MG Formulary OTC

BANZEL ORAL SUSPENSION 40 MG/ML Formulary PA

BANZEL ORAL TABLET 200 MG, 400 MG Formulary PA

BARACLUDE ORAL SOLUTION 0.05 MG/ML Formulary

BASAGLAR KWIKPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNIT/ML


base g almond oil (sweet) oil Formulary

basic fuchsin hcl powder Formulary

BAYER BACK & BODY ORAL TABLET 500-32.5 MG Formulary OTC

BAYER BREEZE 2 CONTROL LIQUID HIGH IN VITRO HIGH


BAYER BREEZE 2 CONTROL LIQUID LOW IN VITRO LOW


BAYER BREEZE 2 CONTROL LIQUID NORMAL IN VITRO NORMAL


BAYER BREEZE 2 SYSTEM KIT W/DEVICE W/DEVICE


15

Drug Name Formulary Status Requirements/LimitsBAYER BREEZE 2 TEST DISK IN VITRO Formulary OTC; QL (150 EA per 30 days)

BAYER CONTOUR LINK MONITOR KIT W/DEVICE W/DEVICE


BAYER CONTOUR LIQUID HIGH IN VITRO HIGH Formulary OTC; QL (100 EA per 30 days)

BAYER CONTOUR LIQUID LOW IN VITRO LOW Formulary OTC; QL (100 EA per 30 days)

BAYER CONTOUR LIQUID NORMAL IN VITRO NORMAL


BAYER CONTOUR MONITOR DEVICE Formulary OTC; QL (1 EA per 365 days)

BAYER CONTOUR MONITOR KIT W/DEVICE W/DEVICE


BAYER CONTOUR MONITOR KIT W/DEVICE W/DEVICE


BAYER CONTOUR TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days)

BAYER MICROLET LANCETS Formulary OTC; QL (150 EA per 30 days)

BAYER WOMENS ORAL TABLET 81-777 MG Formulary OTC

BAZA CLEANSE & PROTECT EXTERNAL LOTION 2 %

Formulary OTC

BC FAST PAIN RELIEF ARTHRITIS ORAL PACKET 742-222-38 MG

Formulary OTC

BC FAST PAIN RELIEF ORAL PACKET 650-195-33.3 MG

Formulary OTC

b-caro-t oral capsule 15 mg Formulary OTC

b-complex high potency oral tablet extended release Formulary OTC

BD ALLERGY SYRINGE 28G X 1/2" 1 ML Formulary OTC

BD AUTOSHIELD 29G X 5MM , 29G X 8MM Formulary OTC

BD AUTOSHIELD DUO 30G X 5 MM Formulary OTC

BD BLUNT FILTER NEEDLE 18G X 1-1/2" Formulary OTC

BD DISP NEEDLE 22G X 3/4" , 23G X 1-1/4" , 27G X 1-1/4" , 30G X 1"

Formulary OTC

BD DISP NEEDLE TW 18G X 1" Formulary OTC

BD DISP NEEDLES 16G X 1-1/2" , 19G X 1" , 20G X 1" , 21G X 1-1/2" , 25G X 7/8" , 27G X 1/2" , 30G X 1/2"

Formulary OTC

BD ECLIPSE NEEDLE 22G X 1-1/2" , 23G X 1" , 25G X 1-1/2" , 25G X 5/8"

Formulary OTC

BD ECLIPSE SYRINGE 25G X 5/8" 1 ML, 30G X 1/2" 1 ML

Formulary OTC

BD HYPODERMIC NEEDLE 23G X 1-1/2" , 26G X 5/8" Formulary OTC

BD INSULIN SYR ULTRAFINE II 31G X 5/16" 0.3 ML 31G X 5/16" 0.3 ML

Formulary OTC

BD INSULIN SYR ULTRAFINE II 31G X 5/16" 0.5 ML 31G X 5/16" 0.5 ML

Formulary OTC

BD INSULIN SYR ULTRAFINE II 31G X 5/16" 1 ML 31G X 5/16" 1 ML

Formulary OTC

BD INSULIN SYRINGE 25G X 1" 1 ML 25G X 1" 1 ML Formulary OTC

BD INSULIN SYRINGE 25G X 5/8" 1 ML 25G X 5/8" 1 ML

Formulary OTC


Formulary OTC

16

Drug Name Formulary Status Requirements/LimitsBD INSULIN SYRINGE 27.5G X 5/8" 2 ML 27.5G X 5/8" 2 ML

Formulary OTC


Formulary OTC


Formulary OTC

BD INSULIN SYRINGE HALF-UNIT 31G X 5/16" 0.3 ML 31G X 5/16" 0.3 ML

Formulary OTC

BD INSULIN SYRINGE MICROFINE 27G X 5/8" 1 ML 27G X 5/8" 1 ML

Formulary OTC

BD INSULIN SYRINGE MICROFINE 28G X 1/2" 0.5 ML 28G X 1/2" 0.5 ML

Formulary OTC

BD INSULIN SYRINGE MICROFINE 28G X 1/2" 1 ML 28G X 1/2" 1 ML

Formulary OTC

BD INSULIN SYRINGE U/F 1/2UNIT 31G X 5/16" 0.3 ML 31G X 5/16" 0.3 ML

Formulary OTC

BD INSULIN SYRINGE U/F 30G X 1/2" 0.3 ML 30G X 1/2" 0.3 ML

Formulary OTC


Formulary OTC

BD INSULIN SYRINGE U/F 30G X 1/2" 1 ML 30G X 1/2" 1 ML

Formulary OTC


Formulary OTC


Formulary OTC

BD INSULIN SYRINGE U/F 31G X 5/16" 1 ML 31G X 5/16" 1 ML

Formulary OTC

BD INSULIN SYRINGE U-100 1 ML U-100 1 ML Formulary OTC

BD INSULIN SYRINGE U-500 31G X 6MM 0.5 ML 31G X 6MM 0.5 ML

Formulary

BD INSULIN SYRINGE ULTRAFINE 29G X 1/2" 0.3 ML 29G X 1/2" 0.3 ML

Formulary OTC


Formulary OTC

BD INSULIN SYRINGE ULTRAFINE 29G X 1/2" 1 ML 29G X 1/2" 1 ML

Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC

BD LANCET ULTRAFINE 30G Formulary OTC; QL (150 EA per 30 days)

BD LANCET ULTRAFINE 33G Formulary OTC; QL (150 EA per 30 days)

17

Drug Name Formulary Status Requirements/LimitsBD LUER-LOK SYRINGE 18G X 1-1/2" 3 ML, 20G X 1" 1 ML, 20G X 1" 10 ML, 20G X 1" 3 ML, 20G X 1" 5 ML, 20G X 1-1/2" 10 ML, 20G X 1-1/2" 3 ML, 20G X 1-1/2" 5 ML, 21G X 1" 10 ML, 21G X 1" 3 ML, 21G X 1" 5 ML, 21G X 1-1/2" 3 ML, 22G X 1" 10 ML, 22G X 1" 3 ML, 22G X 1" 5 ML, 22G X 1-1/2" 5 ML, 23G X 1" 3 ML, 23G X 1-1/2" 3 ML, 23G X 1-1/4" 10 ML, 25G X 1" 3 ML, 25G X 1-1/2" 3 ML, 25G X 5/8" 3 ML

Formulary OTC

BD PEN NEEDLE ORIGINAL U/F 29G X 12.7MM Formulary OTC

BD SAFETYGLIDE INSULIN SYRINGE 29G X 1/2" 0.3 ML 29G X 1/2" 0.3 ML

Formulary OTC


Formulary OTC


Formulary OTC


Formulary


Formulary OTC

BD SAFETYGLIDE NEEDLE 27G X 5/8" Formulary OTC

BD SAFETYGLIDE SYRINGE/NEEDLE 27G X 5/8" 1 ML

Formulary OTC

BD SAFETY-LOK INSULIN SYRINGE 29G X 1/2" 1 ML 29G X 1/2" 1 ML

Formulary OTC

BD SHARPS COLLECTOR Formulary OTC

BD SWAB SINGLE USE REGULAR PAD Formulary OTC

BD SWABS SINGLE USE BUTTERFLY PAD Formulary OTC

BD SYRINGE/NEEDLE SLIP TIP 26G X 5/8" 1 ML Formulary OTC

BD TB SYRINGE 21G X 1" 1 ML, 27G X 1/2" 0.5 ML Formulary OTC

BD VEO INSULIN SYRINGE U/F 31G X 15/64" 0.3 ML 31G X 15/64" 0.3 ML

Formulary OTC

BD VEO INSULIN SYRINGE U/F 31G X 15/64" 0.5 ML 31G X 15/64" 0.5 ML

Formulary OTC

BD VEO INSULIN SYRINGE U/F 31G X 15/64" 1 ML 31G X 15/64" 1 ML

Formulary OTC

BEBULIN INTRAVENOUS SOLUTION RECONSTITUTED 200-1200 UNIT

Formulary

bec/zinc oral tablet Formulary OTC

bee pollen oral capsule 580 mg Formulary OTC

bee pollen oral tablet chewable 500 mg Formulary OTC

BEELITH ORAL TABLET 362-20 MG Formulary OTC

BELBUCA BUCCAL FILM 150 MCG, 300 MCG, 450 MCG, 600 MCG, 75 MCG, 750 MCG, 900 MCG

Formulary PA; QL (68 EA per 34 days)

belladonna alkaloids-opium rectal suppository 16.2-60 mg Formulary

belladonna-opium rectal suppository 16.2-30 mg Formulary

BENADRYL ALLERGY CHILDRENS ORAL LIQUID 12.5 MG/5ML

Formulary OTC

BENADRYL ALLERGY CHILDRENS ORAL TABLET CHEWABLE 12.5 MG

Formulary OTC

BENADRYL ALLERGY ORAL TABLET 25 MG Formulary OTC

18

Drug Name Formulary Status Requirements/LimitsBENADRYL ITCH RELIEF EXTERNAL STICK 2-0.1 % Formulary OTC

BENADRYL ITCH STOPPING EXTERNAL CREAM 1-0.1 %

Formulary OTC

BENADRYL-D ALLERGY/SINUS CHILD ORAL SOLUTION 12.5-5 MG/5ML

Formulary OTC

benazepril hcl oral tablet 10 mg, 20 mg, 40 mg, 5 mg Formulary

benazepril-hydrochlorothiazide oral tablet 10-12.5 mg, 20-12.5 mg, 20-25 mg, 5-6.25 mg

Formulary

BENEFIBER FOR CHILDREN ORAL POWDER Formulary OTC

BENEFIBER ON THE GO ORAL PACKET Formulary OTC

BENEFIBER ORAL POWDER Formulary OTC

BENEFIBER PLUS B VITS & FA ORAL TABLET Formulary OTC

BENEFIBER PLUS CALCIUM ORAL POWDER Formulary OTC

BENEFIBER PLUS CALCIUM ORAL TABLET CHEWABLE

Formulary OTC

BENEFIBER PLUS HEART HEALTH ORAL POWDER Formulary OTC

benfotiamine multi-b oral capsule Formulary OTC

bentonite powder Formulary

benzaldehyde oral elixir Formulary OTC

benzalkonium chloride external concentrate 50 % Formulary OTC

benzalkonium chloride external solution 50 % Formulary

BENZEDREX NASAL INHALER Formulary OTC

BENZEPRO CREAMY WASH EXTERNAL LIQUID 7 % Formulary

BENZEPRO EXTERNAL FOAM 5.3 % Formulary

BENZEPRO SHORT CONTACT EXTERNAL FOAM 9.8 %

Formulary

benzocaine powder Formulary

BENZODENT MOUTH/THROAT CREAM 20 % Formulary OTC

benzoic acid crystals Formulary

benzoin external tincture Formulary

benzonatate oral capsule 100 mg, 150 mg, 200 mg Formulary AGE (Min 6 Years)

BENZ-O-STHETIC MOUTH/THROAT SWAB 20 % Formulary OTC

benzoyl peroxide cleanser external lotion 6 % Formulary

benzoyl peroxide external gel 2.5 % Formulary OTC; AGE (Max 18 Years)

benzoyl peroxide wash external liquid 10 % Formulary AGE (Max 18 Years)

benzoyl peroxide wash external liquid 5 % Formulary OTC; AGE (Max 18 Years)

benzoyl peroxide-erythromycin external gel 5-3 % Formulary

benzphetamine hcl oral tablet 50 mg Formulary PA

benztropine mesylate oral tablet 0.5 mg, 1 mg, 2 mg Formulary

benzyl alcohol liquid Formulary

benzyl benzoate liquid Formulary

bergamot oil oil Formulary OTC

BERINERT INTRAVENOUS KIT 500 UNIT Formulary PA; QL (8 EA per 30 days)

BERRI-FREEZ PAIN RELIEVING EXTERNAL GEL 4.5 %

Formulary OTC

19

Drug Name Formulary Status Requirements/LimitsBERRI-FREEZ PAIN RELIEVING EXTERNAL LIQUID 10 %

Formulary OTC

BERRI-FREEZ PLUS EXTERNAL GEL 0.2-4-8 % Formulary OTC

beta carotene provitamin a oral capsule 25000 unit Formulary OTC

BETADINE EXTERNAL SOLUTION 10 %, 5 % Formulary OTC

BETADINE SURGICAL SCRUB EXTERNAL SOLUTION 7.5 %

Formulary OTC

BETADINE SWABSTICKS EXTERNAL SWAB 10 % Formulary OTC

betaine anhydrous powder Formulary

betaine hcl oral tablet 300 mg Formulary OTC

betamethasone dipropionate aug external cream 0.05 % Formulary

betamethasone dipropionate aug external lotion 0.05 % Formulary

betamethasone dipropionate aug external ointment 0.05 % Formulary

betamethasone dipropionate external cream 0.05 % Formulary

betamethasone dipropionate external lotion 0.05 % Formulary

betamethasone dipropionate external ointment 0.05 % Formulary

betamethasone valerate external cream 0.1 % Formulary

betamethasone valerate external lotion 0.1 % Formulary

betamethasone valerate external ointment 0.1 % Formulary

BETAQUIK ORAL EMULSION Formulary OTC

BETASERON SUBCUTANEOUS KIT 0.3 MG Formulary

betaxolol hcl ophthalmic solution 0.5 % Formulary

betaxolol hcl oral tablet 10 mg, 20 mg Formulary

bethanechol chloride oral tablet 10 mg, 25 mg, 5 mg, 50 mg Formulary

BETHKIS INHALATION NEBULIZATION SOLUTION 300 MG/4ML

FormularyQL (280 ML per 28 days); AGE (Min 6 Years)

BEVESPI AEROSPHERE INHALATION AEROSOL 9-4.8 MCG/ACT


bexarotene oral capsule 75 mg Formulary PA

BIATAIN HEEL ADH FOAM DRESSING PAD 19CMX20CM

Formulary OTC

BIATAIN SACRAL FOAM DRESSING PAD 9"X9" Formulary OTC

bicalutamide oral tablet 50 mg Formulary

BICARSIM FORTE ORAL TABLET 125 MG Formulary OTC

BICARSIM ORAL TABLET 80 MG Formulary OTC

BICNU INTRAVENOUS SOLUTION RECONSTITUTED 100 MG

Formulary

BIKTARVY ORAL TABLET 50-200-25 MG Formulary QL (30 EA per 30 days)

biobron sf oral syrup 10-15-350 mg/5ml Formulary OTC

biocotron oral liquid 10-100 mg/5ml Formulary OTC

biodesp dm oral syrup 5-15-100 mg/5ml Formulary OTC

bioflavonoid citrus powder Formulary OTC

BIO-FLAX ORAL CAPSULE 1000 MG Formulary OTC

BIOFLONEX ORAL TABLET 250-650 MG Formulary OTC

BIOFREEZE EXTERNAL AEROSOL 10.5 % Formulary OTC

20

Drug Name Formulary Status Requirements/LimitsBIOFREEZE ROLL-ON COLORLESS EXTERNAL GEL 4 %

Formulary OTC

BIOGAIA GASTRUS ORAL TABLET CHEWABLE Formulary OTC

biogtuss oral liquid 10-28-388 mg/5ml Formulary OTC

BIOGUARD NON-ADHERENT DRESSING PAD 3"X8" Formulary

BIOLLE GEL TEARS OPHTHALMIC GEL 1 % Formulary OTC

bionatuss dxp oral liquid 10-2-20 mg/5ml Formulary OTC

BIOPATCH PROTECTIVE DISK/CHG EXTERNAL (DRESSING)

Formulary OTC

BIORX SPONIX ANTI-FUNGAL EXTERNAL SOLUTION 22 %

Formulary OTC

BIORX SPONIX ARTHR & MUSC EXTERNAL SOLUTION 4-10-0.035 %

Formulary OTC

biospec dmx oral liquid 15-25 mg/5ml Formulary OTC

biotalan clear oral liquid Formulary OTC

BIO-THERM PAIN RELIEVING EXTERNAL LOTION 0.002-10-20 %

Formulary OTC

biotin forte oral tablet 3 mg Formulary OTC

biotin oral capsule 10 mg, 2500 mcg Formulary OTC

biotin oral tablet 1000 mcg, 10000 mcg, 300 mcg, 800 mcg Formulary OTC

biotin plus keratin oral tablet 10000-100 mcg-mg Formulary OTC

biotin-d powder Formulary OTC

biotuss oral liquid 10-15-300 mg/5ml Formulary

biovol oral syrup Formulary OTC

bisacodyl ec oral tablet delayed release 5 mg Formulary OTC

bismatrol maximum strength oral suspension 525 mg/15ml Formulary OTC

bismatrol oral tablet chewable 262 mg Formulary OTC

bismuth citrate powder Formulary

bismuth subcarbonate powder Formulary

bismuth subgallate powder Formulary

bismuth subnitrate powder Formulary

bismuth subsalicylate powder Formulary

bisoprolol fumarate oral tablet 10 mg, 5 mg Formulary

bisoprolol-hydrochlorothiazide oral tablet 10-6.25 mg, 2.5-6.25 mg, 5-6.25 mg

Formulary

bite/itch external lotion 1-2 % Formulary OTC

BI-ZETS/BENZOTROCHES MOUTH/THROAT LOZENGE 15 MG

Formulary OTC

bladder 2.2 oral tablet Formulary OTC

bleomycin sulfate injection solution reconstituted 15 unit, 30 unit

Formulary

BLINK TEARS OPHTHALMIC GEL 0.25 % Formulary OTC

BLINK TEARS OPHTHALMIC SOLUTION 0.25 % Formulary OTC

BLISOVI 24 FE ORAL TABLET 1-20 MG-MCG(24) Formulary

BLISOVI FE 1.5/30 ORAL TABLET 1.5-30 MG-MCG Formulary

BLISOVI FE 1/20 ORAL TABLET 1-20 MG-MCG Formulary

21

Drug Name Formulary Status Requirements/Limitsblood pressure monitor/wrist kit Formulary OTC

BOIL EASE MAXIMUM STRENGTH EXTERNAL OINTMENT 20 %

Formulary OTC

BONE DENSITY ORAL TABLET 300-200 MG-UNIT Formulary OTC

BOOST PUDDING ORAL PUDDING Formulary OTC

BOOSTRIX INTRAMUSCULAR SUSPENSION 5-2.5-18.5

Formulary

borage oral capsule 1000-240-378 mg Formulary OTC

borax granules Formulary OTC

boric acid external granules Formulary

boric acid powder Formulary

boron oral capsule 3 mg Formulary OTC

boron oral tablet 6 mg Formulary OTC

BOTOX INJECTION SOLUTION RECONSTITUTED 100 UNIT, 200 UNIT

Formulary PA

BOUDREAUXS BABY KISSES EXTERNAL OINTMENT

Formulary OTC

BOUDREAUXS BUTT PASTE EXTERNAL OINTMENT 16 %, 40 %

Formulary OTC

BOUDREAUXS RASH PREVENTOR EXTERNAL LIQUID 10 %

Formulary OTC

bp 10-1 external emulsion 10-1 % Formulary QL (170.1 GM per 30 days)

bp cleansing wash external emulsion 10-4 % Formulary

bp wash external liquid 2.5 % Formulary

BPROTECTED MULTI-VITE ORAL LIQUID Formulary OTC

BPROTECTED PEDIA IRON ORAL SOLUTION 75 (15 FE) MG/ML

Formulary OTC

BPROTECTED PEDIA POLY-VITE ORAL SOLUTION 35 MG/ML

Formulary OTC

BRAINSTRONG PRENATAL ORAL 33-0.8 & 350 MG Formulary OTC

BRASIVOL EXTERNAL PASTE Formulary OTC

BRAUN NO TOUCH + FOREHEAD Formulary OTC

BREVIBLOC IN NACL INTRAVENOUS SOLUTION 2000 MG/100ML, 2500 MG/250ML

Formulary

brewers yeast oral tablet Formulary OTC

BRIJ 30 LIQUID Formulary OTC

BRILINTA ORAL TABLET 60 MG, 90 MG Formulary

brilliant green powder Formulary

brimonidine tartrate ophthalmic solution 0.15 %, 0.2 % Formulary

BRIVIACT INTRAVENOUS SOLUTION 50 MG/5ML Formulary

brohist d oral tablet 4-10 mg Formulary OTC

bromelain powder Formulary

bromi-lotion external lotion Formulary OTC

bromocriptine mesylate oral capsule 5 mg Formulary

bromocriptine mesylate oral tablet 2.5 mg Formulary

bronchial asthma relief oral tablet 12.5-200 mg Formulary OTC

22

Drug Name Formulary Status Requirements/LimitsBRONKAID ORAL TABLET 25-400 MG Formulary OTC

bronkids oral liquid 1.5-0.6-2.75 mg/ml, 10-4-10 mg/5ml Formulary OTC

brontuss dx oral liquid 10-20-200 mg/5ml Formulary OTC

brotapp dm oral liquid 15-1-5 mg/5ml Formulary OTC

BROVANA INHALATION NEBULIZATION SOLUTION 15 MCG/2ML


btrex oral tablet extended release 8-200-4-100-600 mg Formulary OTC

BUCKLEYS CHEST CONGESTION ORAL LIQUID 100 MG/5ML

Formulary OTC

BUCKLEYS COUGH ORAL LIQUID 12.5 MG/5ML Formulary OTC

budesonide oral capsule delayed release particles 3 mg Formulary

budesonide suspension 32 mcg/act nasal (otc) 32 mcg/act Formulary

BUFFERIN EXTRA STRENGTH ORAL TABLET 500 MG

Formulary OTC

BUFFERIN LOW DOSE ORAL TABLET 81 MG Formulary OTC

BUFFERIN ORAL TABLET 325 MG Formulary OTC

BULL FROG WATER ARMOR SPORT EXTERNAL GEL

Formulary OTC

bumetanide oral tablet 0.5 mg, 1 mg, 2 mg Formulary

BUPHENYL ORAL TABLET 500 MG Formulary

buprenorphine hcl injection solution 0.3 mg/ml Formulary PA

buprenorphine hcl sublingual tablet sublingual 2 mg FormularyPA; QL (360 EA per 30 days); AGE (Min 16 Years)

buprenorphine hcl sublingual tablet sublingual 8 mg FormularyPA; QL (90 EA per 30 days); AGE (Min 16 Years)

buprenorphine transdermal patch weekly 10 mcg/hr, 15 mcg/hr, 20 mcg/hr, 5 mcg/hr, 7.5 mcg/hr


bupropion hcl er (smoking det) oral tablet extended release 12 hour 150 mg

Formulary

bupropion hcl er (sr) oral tablet extended release 12 hour100 mg, 150 mg, 200 mg

Formulary

bupropion hcl er (xl) oral tablet extended release 24 hour150 mg, 300 mg

Formulary

bupropion hcl oral tablet 100 mg, 75 mg Formulary

burn relief/lidocaine/aloe external gel 0.5 % Formulary OTC

buspirone hcl oral tablet 10 mg, 15 mg, 30 mg, 5 mg, 7.5 mg

Formulary

busulfan intravenous solution 6 mg/ml Formulary

butalbital-acetaminophen oral tablet 50-325 mg Formulary

butalbital-apap-caff-cod oral capsule 50-300-40-30 mg, 50-325-40-30 mg


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

butalbital-aspirin-caffeine oral capsule 50-325-40 mg Formulary

butorphanol tartrate injection solution 1 mg/ml, 2 mg/ml Formulary

butorphanol tartrate nasal solution 10 mg/ml Formulary PA; QL (5 ML per 34 days)

BUTRANS TRANSDERMAL PATCH WEEKLY 10 MCG/HR, 15 MCG/HR, 20 MCG/HR, 5 MCG/HR, 7.5 MCG/HR


23

Drug Name Formulary Status Requirements/Limitsbutylated hydroxytoluene crystals Formulary OTC

butylparaben powder Formulary OTC

BYDUREON SUBCUTANEOUS PEN-INJECTOR 2 MG Formulary

BYDUREON SUBCUTANEOUS SUSPENSION RECONSTITUTED ER 2 MG

Formulary

BYETTA 10 MCG PEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 10 MCG/0.04ML

Formulary

BYETTA 5 MCG PEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 5 MCG/0.02ML

Formulary

c-1500/rose hips sr oral tablet extended release 1500 mg Formulary OTC

c1500/rose hips/bioflavonoid oral tablet extended release Formulary OTC

ca phosphate dibasic dihyd powder Formulary OTC

cabergoline oral tablet 0.5 mg Formulary QL (10 EA per 34 days)

cadeau dha oral capsule 29-0.4-0.8-375 mg Formulary OTC

caffeine anhydrous powder Formulary

caffeine citrate oral solution 20 mg/ml Formulary

cal/mag oral tablet 200-100 mg Formulary OTC

CALADRYL CLEAR EXTERNAL LOTION 1-0.1 % Formulary OTC

CALADRYL EXTERNAL LOTION 1-8 % Formulary OTC

CALAGEL MAXIMUM STRENGTH EXTERNAL GEL Formulary OTC

CALAGESIC EXTERNAL LOTION 1-8 % Formulary OTC

calahist clear external lotion 1-0.1 % Formulary OTC

calamine external lotion , 8-8 % Formulary OTC

calamine phenolated external lotion Formulary OTC

calamine powder Formulary

calamine-zinc oxide external suspension 8-8 % Formulary OTC

CAL-CARB FORTE ORAL TABLET 1250 (500 CA) MG Formulary OTC

CALCET PETITES ORAL TABLET 200-250 MG-UNIT Formulary OTC

CALCI-CHEW ORAL TABLET CHEWABLE 1250 (500 CA) MG

Formulary OTC

calci-max oral capsule Formulary OTC

calcipotriene external cream 0.005 % Formulary

calcipotriene external ointment 0.005 % Formulary

calcipotriene external solution 0.005 % Formulary

calcitonin (salmon) nasal solution 200 unit/act Formulary

cal-citrate oral capsule 150 mg Formulary OTC

CALCITRATE ORAL TABLET 950 MG Formulary OTC

calcitriol oral capsule 0.25 mcg, 0.5 mcg Formulary

calcitriol oral solution 1 mcg/ml Formulary

calcium + d3 oral tablet 600-800 mg-unit Formulary OTC

calcium 1200 oral tablet chewable 1200-1000 mg-unit Formulary OTC

calcium 500 + d3 oral tablet 500-600 mg-unit Formulary OTC

calcium 600 + d oral tablet 600-200 mg-unit Formulary OTC

calcium 600 oral tablet 1500 (600 ca) mg Formulary OTC

calcium 600+d3 oral tablet 600-400 mg-unit Formulary OTC

24

Drug Name Formulary Status Requirements/Limitscalcium 600+d3 plus minerals oral tablet 600-800 mg-unit Formulary OTC

calcium acetate (phos binder) oral capsule 667 mg Formulary

calcium acetate (phos binder) oral tablet 667 mg Formulary

calcium acetate oral tablet 668 (169 ca) mg Formulary OTC

calcium ascorbate oral tablet 500 mg Formulary OTC

calcium ascorbate powder Formulary

calcium aspartate oral tablet 75 mg Formulary OTC

calcium carbonate antacid oral tablet 648 mg Formulary OTC

calcium carbonate oral powder 800 mg/2gm Formulary OTC

calcium carbonate oral tablet 600 mg Formulary OTC

calcium carbonate powder Formulary

calcium carbonate-vitamin d oral capsule 600-200 mg-unit Formulary OTC

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

calcium citrate + d3 oral tablet 250-200 mg-unit Formulary OTC

calcium citrate malate-vit d oral tablet 250-100 mg-unit Formulary OTC

calcium citrate oral tablet 1040 mg, 200 mg, 250 mg Formulary OTC

calcium citrate plus oral tablet Formulary OTC

calcium citrate tetrahydrate powder Formulary

calcium citrate-vitamin d oral tablet 200-125 mg-unit Formulary OTC

calcium citrate-vitamin d3 oral liquid 1000-400 Formulary OTC

calcium citrate-vitamin d3 oral tablet 315-250 mg-unit Formulary OTC

calcium gluconate oral tablet 500 mg Formulary OTC

calcium gluconate powder Formulary

calcium gummies oral tablet chewable 250-100-500 mg-unit

Formulary OTC

calcium high potency/vitamin d oral tablet 600-200 mg-unit Formulary OTC

calcium hydroxide powder Formulary

calcium lactate oral tablet 100 mg, 648 mg Formulary OTC

calcium oral tablet 500-125 mg-unit Formulary OTC

calcium oral tablet chewable 500-100 mg-unit, 600-400 mg-unit

Formulary OTC

calcium oyster shell oral tablet 500 mg Formulary OTC

calcium pantothenate oral tablet 100 mg, 200 mg, 500 mg Formulary OTC

calcium pantothenate powder Formulary

calcium phosphate tribasic powder Formulary

calcium plus vitamin d3 oral capsule 600-500 mg-unit Formulary OTC

calcium saccharate powder Formulary OTC

calcium soft chews oral tablet chewable 500-1000-40 mg-unt-mcg, 500-500-40 mg-unt-mcg

Formulary OTC

calcium sulfate powder 90 % Formulary OTC

calcium-magnesium-zinc oral tablet 333-133-5 mg Formulary OTC

calcium-vitamin d oral tablet 600-200 mg-unit Formulary OTC

calcium-vitamin d3 oral tablet 600-125 mg-unit Formulary OTC

calcium-vitamin d-minerals oral tablet chewable 600-400 mg-unit, 600-800 mg-unit

Formulary OTC

25

Drug Name Formulary Status Requirements/Limitscalendula external lotion Formulary OTC

calendula external ointment Formulary OTC

cal-glu oral capsule 500 mg Formulary OTC

cal-lac oral capsule 500 mg Formulary OTC

calmag thins oral tablet 200-50 mg Formulary OTC

cal-mint oral tablet chewable 260 mg Formulary OTC

CALMOL-4 RECTAL SUPPOSITORY 76-10 % Formulary OTC

calna oral tablet Formulary OTC

CALTRATE 600+D ORAL TABLET 600-800 MG-UNIT Formulary OTC

CALTRATE 600+D PLUS MINERALS ORAL TABLET 600-800 MG-UNIT

Formulary OTC

CALTRATE 600+D PLUS MINERALS ORAL TABLET CHEWABLE 600-800 MG-UNIT

Formulary OTC

CALTRATE 600+D3 SOFT ORAL TABLET CHEWABLE 600-800 MG-UNIT

Formulary OTC

CALTRATE GUMMY BITES ORAL TABLET CHEWABLE 250-400 MG-UNIT

Formulary OTC

CALTRATE MINIS PLUS MINERALS ORAL TABLET 300-800 MG-UNIT

Formulary OTC

CAMILA ORAL TABLET 0.35 MG Formulary QL (28 EA per 28 days)

CAMPHO-PHENIQUE EXTERNAL GEL 10.8-4.7 % Formulary OTC

CAMPHO-PHENIQUE EXTERNAL LIQUID 10.8-4.7 % Formulary OTC

camphor blocks gum Formulary OTC

camphor crystals Formulary

camphor granules Formulary

camphor spirit spirit Formulary OTC

CAMPHOTREX EXTERNAL GEL 10-4 % Formulary OTC

CAMPTOSAR INTRAVENOUS SOLUTION 300 MG/15ML

Formulary

CANASA RECTAL SUPPOSITORY 1000 MG Formulary

candesartan cilexetil oral tablet 16 mg, 32 mg, 4 mg, 8 mg Formulary

candesartan cilexetil-hctz oral tablet 16-12.5 mg, 32-12.5 mg

Formulary

CANKAID MOUTH/THROAT SOLUTION 10 % Formulary OTC

capcof oral syrup 5-2-10 mg/5ml Formulary OTC

capecitabine oral tablet 150 mg, 500 mg Formulary PA

capmist dm oral tablet 60-15-400 mg Formulary OTC

capron dm oral liquid 7.5-7.5 mg/5ml Formulary OTC

capron dmt oral tablet 30-30 mg Formulary OTC

capsaicin external cream 0.025 %, 0.1 % Formulary OTC

capsaicin hot patch external pad 0.025 % Formulary OTC

capsaicin powder Formulary

CAPSIDERM EXTERNAL PATCH 0.0375-5 % Formulary OTC

capsule 1 clear veggie capsule Formulary OTC

captopril oral tablet 100 mg, 12.5 mg, 25 mg, 50 mg Formulary

CAPZASIN-HP EXTERNAL CREAM 0.1 % Formulary OTC

26

Drug Name Formulary Status Requirements/LimitsCARAFATE ORAL SUSPENSION 1 GM/10ML Formulary

caraway oil oil Formulary OTC

CARBAGLU ORAL TABLET 200 MG Formulary

carbamazepine er oral capsule extended release 12 hour100 mg, 200 mg, 300 mg

Formulary

carbamazepine er oral tablet extended release 12 hour 100 mg, 200 mg, 400 mg

Formulary

carbamazepine oral suspension 100 mg/5ml Formulary

carbamazepine oral tablet 200 mg Formulary

carbamazepine oral tablet chewable 100 mg Formulary

CARBAPHEN CH ORAL SUSPENSION 10-4-24 MG/5ML

Formulary OTC

CARBAPHEN PED CH ORAL SUSPENSION 2.5-1.25-8 MG/ML

Formulary OTC

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

Formulary

carbidopa-levodopa oral tablet 10-100 mg, 25-100 mg, 25-250 mg

Formulary

carbidopa-levodopa oral tablet dispersible 10-100 mg, 25-100 mg, 25-250 mg

Formulary

carbidopa-levodopa-entacapone oral tablet 12.5-50-200 mg Formulary

CARBOHOL 940 GEL Formulary

carbopol 940 nf powder Formulary

carboxymethylcellulose sodium granules Formulary

carboxymethylcellulose sodium powder Formulary

CARBZERO ORAL EMULSION Formulary OTC

cardamom oil Formulary OTC

CARDENZ ORAL TABLET Formulary OTC

CAREFINE PEN NEEDLES 32G X 5 MM , 32G X 6 MM Formulary OTC

careone insulin syringe 30g x 1/2" 0.3 ml 30g x 1/2" 0.3 ml Formulary OTC

careone insulin syringe 30g x 1/2" 0.5 ml 30g x 1/2" 0.5 ml Formulary OTC

careone insulin syringe 30g x 1/2" 1 ml 30g x 1/2" 1 ml Formulary OTC

careone insulin syringe 31g x 5/16" 0.3 ml 31g x 5/16" 0.3 ml

Formulary OTC

careone insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 ml

Formulary OTC

careone insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 1 ml Formulary OTC

careone lancet thin 23g Formulary OTC; QL (150 EA per 30 days)

careone lancet ultra thin 28g Formulary OTC; QL (150 EA per 30 days)

CA-REZZ EXTERNAL LIQUID 0.25 % Formulary OTC

ca-rezz gentle external liquid 0.2 % Formulary OTC

ca-rezz norisc external cream 0.2 % Formulary OTC

CARNI Q-GEL FORTE ORAL CAPSULE 30-250 MG Formulary OTC

CARRACOLLOID 4"X4" EXTERNAL PAD Formulary OTC

CARRASMART EXTERNAL GEL Formulary OTC

CARRASORB H EXTERNAL Formulary OTC

27

Drug Name Formulary Status Requirements/LimitsCARRASYN V WOUND DRESSING EXTERNAL GEL Formulary OTC

CARRINGTON DERMAL WOUND EXTERNAL GEL Formulary OTC

carteolol hcl ophthalmic solution 1 % Formulary

CARTIA XT ORAL CAPSULE EXTENDED RELEASE 24 HOUR 120 MG, 180 MG, 240 MG, 300 MG

Formulary

carvedilol oral tablet 12.5 mg, 25 mg, 3.125 mg, 6.25 mg Formulary

cascara sagrada oral capsule 450 mg Formulary OTC

castellani paint modified external liquid 1.5 % Formulary OTC

CASTIVA COOLING EXTERNAL LOTION 5-14 % Formulary OTC

CASTIVA WARMING EXTERNAL LOTION 0.035 % Formulary OTC

castor oil oil Formulary

castor oil stimulant laxative oral oil 100 % Formulary OTC

castor oil sulfated oil Formulary OTC

CATAPRES-TTS-1 TRANSDERMAL PATCH WEEKLY 0.1 MG/24HR

Formulary


Formulary


Formulary

CAVAREST DENTAL GEL 1.1 % Formulary

CAVILON EMOLLIENT EXTERNAL CREAM Formulary OTC

CAVILON FOOT & DRY SKIN EXTERNAL CREAM Formulary OTC

CAVILON NO STING BARRIER FILM EXTERNAL LIQUID

Formulary OTC

CAVILON ONE-STEP SKIN CARE EXTERNAL LOTION

Formulary OTC

CAVILON SKIN CLEANSER EXTERNAL LIQUID Formulary OTC

CAZIANT ORAL TABLET 0.1/0.125/0.15 -0.025 MG Formulary QL (28 EA per 28 days)

cefaclor oral capsule 250 mg, 500 mg Formulary

cefaclor oral suspension reconstituted 125 mg/5ml Formulary

cefadroxil oral capsule 500 mg Formulary

cefadroxil oral suspension reconstituted 250 mg/5ml, 500 mg/5ml

Formulary

cefadroxil oral tablet 1 gm Formulary

cefdinir oral capsule 300 mg Formulary

cefdinir oral suspension reconstituted 125 mg/5ml, 250 mg/5ml

Formulary

cefixime oral suspension reconstituted 100 mg/5ml, 200 mg/5ml

Formulary

cefpodoxime proxetil oral suspension reconstituted 100 mg/5ml, 50 mg/5ml


cefpodoxime proxetil oral tablet 100 mg, 200 mg Formulary QL (28 EA per 34 days)

cefprozil oral suspension reconstituted 125 mg/5ml, 250 mg/5ml

Formulary

cefprozil oral tablet 250 mg, 500 mg Formulary

ceftriaxone sodium in dextrose intravenous solution 20 mg/ml, 40 mg/ml

Formulary

28

Drug Name Formulary Status Requirements/Limitsceftriaxone sodium injection solution reconstituted 1 gm, 2 gm, 250 mg, 500 mg

Formulary

ceftriaxone sodium intravenous solution reconstituted 10 gm, 2 gm

Formulary

ceftriaxone sodium-dextrose intravenous solution reconstituted 1-3.74 gm-%, 2-2.22 gm-%

Formulary

cefuroxime axetil oral tablet 250 mg, 500 mg Formulary

CELACYN EXTERNAL GEL Formulary

celecoxib oral capsule 100 mg, 200 mg, 400 mg, 50 mg Formulary ST

celery seed oil Formulary OTC

cellulase powder Formulary OTC

cellulose crystals Formulary

cellulose powder Formulary

CELONTIN ORAL CAPSULE 300 MG Formulary

CENTRATEX ORAL CAPSULE 106-1 MG Formulary

centravites adults oral tablet Formulary OTC

CENTRUM FLAVOR BURST DRINK ORAL PACKET Formulary OTC

CENTRUM ORAL LIQUID Formulary OTC

CENTRUM SPECIALIST PRENATAL ORAL 27-0.8 & 200 MG

Formulary OTC

CEO-TWO RECTAL SUPPOSITORY Formulary OTC

CEPACOL EXTRA STRENGTH MOUTH/THROAT LOZENGE 15-2.6 MG

Formulary OTC

CEPACOL SORE THROAT & COUGH MOUTH/THROAT LOZENGE 5-7.5 MG

Formulary OTC

CEPACOL SORE THROAT EX ST MOUTH/THROAT LOZENGE 15-3.6 MG

Formulary OTC

CEPACOL SORE THROAT MOUTH/THROAT LOZENGE 15-2.6 MG

Formulary OTC

CEPASTAT MOUTH/THROAT LOZENGE 5-6-10 MG Formulary OTC

cephalexin oral capsule 250 mg, 500 mg Formulary

cephalexin oral suspension reconstituted 125 mg/5ml, 250 mg/5ml

Formulary

CERACADE EMULSION EXTERNAL Formulary

CERALYTE 70 ORAL PACKET Formulary OTC

CERAVE BABY EXTERNAL LOTION 1 % Formulary OTC

CERAVE ITCH RELIEF EXTERNAL CREAM 1 % Formulary OTC

CERAVE SUNSCREEN SPF50 EXTERNAL LOTION Formulary OTC

CEROVEL EXTERNAL LOTION 40 % Formulary

CESIUM 1000 ORAL CAPSULE 1000 MG Formulary OTC

cesium 500 oral capsule 500 mg Formulary OTC

cesium oral tablet 100 mg Formulary OTC

CETAPHIL GENTLE CLEANSING EXTERNAL BAR Formulary OTC

cetirizine hcl oral tablet 5 mg Formulary OTC

CETRAXAL OTIC SOLUTION 0.2 % Formulary

cetyl alcohol flakes Formulary

29

Drug Name Formulary Status Requirements/LimitsCHANTIX CONTINUING MONTH PAK ORAL TABLET 1 MG

Formulary

CHANTIX ORAL TABLET 0.5 MG Formulary

CHANTIX STARTING MONTH PAK ORAL TABLET 0.5 MG X 11 & 1 MG X 42

Formulary

CHAP-EX TROPICALS EXTERNAL STICK Formulary OTC

charcoal activated powder Formulary

CHAR-FLO WITH SORBITOL ORAL SUSPENSION 25-48 GM/120ML

Formulary OTC

chelated calcium oral tablet 200 mg Formulary OTC

chelated magnesium oral tablet 100 mg Formulary OTC

chelated zinc oral tablet 50 mg Formulary OTC

CHEMSTRIP CALIBRATION IN VITRO STRIP Formulary OTC

CHEMSTRIP UGK IN VITRO STRIP Formulary OTC

CHENODAL ORAL TABLET 250 MG Formulary PA

CHERACOL-D COUGH ORAL LIQUID 10-100 MG/5ML Formulary OTC

cherry concentrate oral concentrate Formulary OTC

cherry oral syrup Formulary

chest rub external ointment 4.8-1.2-2.6 % Formulary OTC

CHEW Q ORAL TABLET CHEWABLE 100 MG, 30 MG, 600 MG

Formulary OTC

chewable iron oral tablet chewable 30-10-25 mg Formulary OTC

CHIGG AWAY EXTERNAL LOTION 5-10 % Formulary OTC

childrens aspirin free oral elixir 80 mg/2.5ml Formulary OTC

CHILDRENS MOTRIN ORAL SUSPENSION 100 MG/5ML

Formulary OTC

childrens pain reliever oral tablet chewable 80 mg Formulary OTC

childrens plus multi-sympt cld oral suspension 2.5-1-5-160 mg/5ml

Formulary OTC

childrens silfedrine oral liquid 15 mg/5ml Formulary OTC

CHILDRENS SOOTHE ORAL TABLET CHEWABLE 400 MG

Formulary OTC

chlo hist oral solution 12.5-1 mg/5ml Formulary OTC

CHLO TUSS ORAL LIQUID 30-1-12.5 MG/5ML Formulary OTC

chlophed oral liquid 5-12.5-100 mg/5ml Formulary OTC

chloral hydrate crystals Formulary

CHLORASEPTIC MOUTH/THROAT LOZENGE 6-10 MG

Formulary OTC

chlordiazepoxide hcl oral capsule 10 mg, 5 mg Formulary QL (170 EA per 34 days)

chlordiazepoxide hcl oral capsule 25 mg Formulary QL (170 EA per 30 days)

chlorella oral capsule Formulary OTC

chlorhexidine gluconate cloth external pad 2 % Formulary OTC

chlorhexidine gluconate external liquid 2 %, 4 % Formulary OTC

chlorhexidine gluconate mouth/throat solution 0.12 % Formulary

chloroform solution Formulary

chlorophyll oral tablet 3-0.6 mg Formulary OTC

30

Drug Name Formulary Status Requirements/Limitschloroquine phosphate oral tablet 250 mg, 500 mg Formulary

chlorothiazide oral tablet 250 mg, 500 mg Formulary

CHLORPHEN SR ORAL TABLET EXTENDED RELEASE 12 MG

Formulary OTC

chlorpromazine hcl injection solution 25 mg/ml, 50 mg/2ml Formulary AGE (Min 18 Years)

chlorpromazine hcl oral tablet 10 mg, 100 mg, 200 mg, 25 mg, 50 mg


chlorpromazine hcl powder Formulary

chlorthalidone oral tablet 25 mg, 50 mg Formulary

CHLOR-TRIMETON ALLERGY ORAL TABLET EXTENDED RELEASE 12 MG

Formulary OTC

CHLOR-TRIMETON ORAL SYRUP 2 MG/5ML Formulary OTC

CHLOR-TRIMETON ORAL TABLET 4 MG Formulary OTC

chlorzoxazone oral tablet 500 mg Formulary

chocolated laxative oral tablet chewable 15 mg Formulary OTC

cholecalciferol powder Formulary

cholesterol acetate powder Formulary OTC

cholesterol powder Formulary

cholestyramine light oral packet 4 gm Formulary

cholestyramine light oral powder 4 gm/dose Formulary

cholestyramine oral packet 4 gm Formulary

cholestyramine oral powder 4 gm/dose Formulary

choline citrate oral tablet 650 mg Formulary OTC

choline oral capsule 648 mg Formulary OTC

choline sr oral tablet extended release 300 mg Formulary OTC

choline-mag trisalicylate oral liquid 500 mg/5ml Formulary

CHONDROITIN SULFATE COMPLEX ORAL CAPSULE 400-60-2.5 MG

Formulary OTC

CHROMACAPS ORAL CAPSULE 1 MG Formulary OTC

chromium aspartate oral tablet 1000 mcg Formulary OTC

chromium gtf oral tablet 200 mcg Formulary OTC

chromium oral tablet 1000 mcg, 400 mcg Formulary OTC

chromium picolate oral tablet 1000 mcg Formulary OTC

chromium picolinate oral capsule 200 mcg Formulary OTC

chromium picolinate oral tablet 200 mcg, 400 mcg Formulary OTC

chromium picolinate powder Formulary

chrysin powder Formulary

CICLODAN EXTERNAL CREAM 0.77 % Formulary

ciclopirox external gel 0.77 % Formulary

ciclopirox external shampoo 1 % Formulary

ciclopirox external solution 8 % Formulary

ciclopirox olamine external suspension 0.77 % Formulary

ciclopirox treatment external kit 8 % Formulary

cilostazol oral tablet 100 mg, 50 mg Formulary

cimetidine oral tablet 300 mg, 400 mg, 800 mg Formulary

31

Drug Name Formulary Status Requirements/Limitscinnamon oil oil Formulary OTC

cinnamon oral capsule 500 mg Formulary OTC

CINRYZE INTRAVENOUS SOLUTION RECONSTITUTED 500 UNIT


CIPRODEX OTIC SUSPENSION 0.3-0.1 % Formulary

ciprofloxacin hcl ophthalmic solution 0.3 % Formulary

ciprofloxacin hcl oral tablet 100 mg, 250 mg, 500 mg, 750 mg

Formulary

ciprofloxacin hcl otic solution 0.2 % Formulary

ciprofloxacin oral suspension reconstituted 500 mg/5ml (10%)

Formulary

cisplatin intravenous solution 50 mg/50ml Formulary

citalopram hydrobromide oral solution 10 mg/5ml Formulary

citalopram hydrobromide oral tablet 10 mg, 20 mg, 40 mg Formulary

CITRA PH ORAL SOLUTION 2.7 GM/30ML Formulary OTC

CITRANATAL 90 DHA ORAL 90-1 & 300 MG Formulary

CITRANATAL ASSURE ORAL 35-1 & 300 MG Formulary

CITRANATAL B-CALM ORAL 20-1 & 25 (2) MG Formulary

CITRANATAL DHA ORAL 27-1 & 250 MG Formulary

CITRANATAL HARMONY ORAL CAPSULE 27-1-260 MG

Formulary

CITRANATAL RX ORAL TABLET 27-1 MG Formulary

citric acid anhydrous granules Formulary

citric acid anhydrous powder Formulary

citric acid monohydrate granules Formulary

citronella oil oil Formulary

CITRUCEL ORAL POWDER Formulary OTC

CITRUCEL ORAL TABLET 500 MG Formulary OTC

CITRULLINE 1000 ORAL PACKET 1 GM Formulary OTC

CITRULLINE200 ORAL PACKET 200 MG Formulary OTC

cladribine intravenous solution 10 mg/10ml Formulary

clarithromycin er oral tablet extended release 24 hour 500 mg

Formulary

clarithromycin oral suspension reconstituted 125 mg/5ml, 250 mg/5ml

Formulary

clarithromycin oral tablet 250 mg, 500 mg Formulary

CLARITIN CHILDRENS ORAL TABLET CHEWABLE 5 MG

Formulary OTC

CLARITIN ORAL CAPSULE 10 MG Formulary OTC

CLARITIN ORAL SYRUP 5 MG/5ML Formulary OTC

CLARITIN ORAL TABLET 10 MG Formulary OTC

CLARITIN REDITABS ORAL TABLET DISPERSIBLE 10 MG, 5 MG

Formulary OTC

CLARITIN-D 12 HOUR ORAL TABLET EXTENDED RELEASE 12 HOUR 5-120 MG

Formulary OTC

32

Drug Name Formulary Status Requirements/LimitsCLARITIN-D 24 HOUR ORAL TABLET EXTENDED RELEASE 24 HOUR 10-240 MG

Formulary OTC

classic prenatal oral tablet 28-0.8 mg Formulary OTC

CLEAN & CLEAR ACNE CLEANSER EXTERNAL FOAM 2 %

Formulary OTC

CLEAN & CLEAR ACNE CLEANSER EXTERNAL LIQUID 2 %

Formulary OTC

CLEAN & CLEAR ADVANTAGE MARK EXTERNAL GEL 2 %

Formulary OTC

CLEAN SIGHTS SOLUTION Formulary OTC

CLEAN ZING MOUTH/THROAT LIQUID 0.06 % Formulary OTC

CLEANLET LANCETS 28G Formulary OTC; QL (150 EA per 30 days)

CLEAR EYES REDNESS RELIEF OPHTHALMIC SOLUTION 0.012-0.2 %

Formulary OTC

clear zinc spf 50 external lotion Formulary OTC

CLEARASIL DAILY CLEAR ACNE EXTERNAL CREAM 10 %

Formulary OTC

CLEARCANAL EAR WAX REMOVAL OTIC KIT 6.5 % Formulary OTC

CLEARLAX ORAL POWDER Formulary OTC

CLEARLIFE ALLERGY RELIEF NASAL LIQUID Formulary OTC

clemastine fumarate oral tablet 2.68 mg Formulary

CLEOCIN VAGINAL SUPPOSITORY 100 MG Formulary

CLERZ PLUS SOLUTION Formulary OTC

CLEVER CHOICE BP MONITOR/WRIST DEVICE Formulary OTC

CLINDACIN ETZ EXTERNAL SWAB 1 % Formulary

clindamycin hcl oral capsule 150 mg, 300 mg, 75 mg Formulary

clindamycin palmitate hcl oral solution reconstituted 75 mg/5ml

Formulary

clindamycin phos-benzoyl perox external gel 1.2-5 % Formulary

clindamycin phos-benzoyl perox external gel 1-5 % Formulary AGE (Max 18 Years)

clindamycin phosphate external foam 1 % Formulary AGE (Max 18 Years)

clindamycin phosphate external lotion 1 % Formulary AGE (Max 18 Years)

clindamycin phosphate external solution 1 % Formulary AGE (Max 18 Years)

clindamycin phosphate external swab 1 % Formulary AGE (Max 18 Years)

clindamycin phosphate vaginal cream 2 % Formulary

CLINDESSE VAGINAL CREAM 2 % Formulary

clioquinol powder Formulary

clobetasol propionate e external cream 0.05 % Formulary

clobetasol propionate emulsion external foam 0.05 % Formulary

clobetasol propionate external cream 0.05 % Formulary

clobetasol propionate external foam 0.05 % Formulary

clobetasol propionate external gel 0.05 % Formulary

clobetasol propionate external ointment 0.05 % Formulary

clobetasol propionate external solution 0.05 % Formulary

clofarabine intravenous solution 1 mg/ml Formulary

clomipramine hcl oral capsule 25 mg, 50 mg, 75 mg Formulary

33

Drug Name Formulary Status Requirements/Limitsclonazepam oral tablet 0.5 mg, 1 mg, 2 mg Formulary

clonazepam oral tablet dispersible 0.125 mg, 0.25 mg, 0.5 mg, 1 mg, 2 mg


clonidine hcl (analgesia) epidural solution 100 mcg/ml Formulary

clonidine hcl oral tablet 0.1 mg, 0.2 mg, 0.3 mg Formulary

clopidogrel bisulfate oral tablet 300 mg, 75 mg Formulary

clorazepate dipotassium oral tablet 15 mg, 3.75 mg, 7.5 mg Formulary QL (170 EA per 30 days)

CLORPACTIN POWDER 2 GM Formulary OTC

clotrimazole 3 vaginal cream 2 % Formulary OTC

clotrimazole anti-fungal external cream 1 % Formulary

clotrimazole external cream 1 % Formulary

clotrimazole mouth/throat lozenge 10 mg Formulary

clotrimazole solution 1 % external (otc) 1 % Formulary

clotrimazole vaginal cream 1 % Formulary OTC

clotrimazole-betamethasone external cream 1-0.05 % Formulary

clotrimazole-betamethasone external lotion 1-0.05 % Formulary

clove oil oil Formulary

clozapine oral tablet 100 mg, 200 mg, 25 mg, 50 mg Formulary AGE (Min 18 Years)

clozapine oral tablet dispersible 100 mg, 12.5 mg, 150 mg, 200 mg, 25 mg


co q-10 oral capsule 150 mg, 200 mg Formulary OTC

COAGUCHEK XS PLUS SYSTEM KIT Formulary OTC

COAGUCHEK XS PT TEST IN VITRO STRIP Formulary OTC

coal tar liquid Formulary OTC

coal tar solution Formulary

coal tar tar Formulary

COARTEM ORAL TABLET 20-120 MG Formulary

COATS ALOE EXTERNAL CREAM 0.5 % Formulary OTC

COATS ALOE EXTERNAL GEL 0.5 % Formulary OTC

COATS ALOE EXTERNAL LOTION 0.5 % Formulary OTC

COATS ALOE JUICE DRINK ORAL LIQUID Formulary OTC

COATS ALOE LINIMENT EXTERNAL LOTION 10 % Formulary OTC

cocoa butter Formulary

cocoa butter skin external cream Formulary OTC

cod liver oil oral capsule Formulary OTC

cod liver oil oral oil Formulary

codeine sulfate oral tablet 15 mg, 30 mg, 60 mg Formulary PA; QL (180 EA per 7 days)

coditussin ac oral liquid 200-10 mg/5ml Formulary OTC

coditussin dac oral liquid 30-10-200 mg/5ml Formulary OTC

coenzyme q10 oral capsule 100 mg Formulary OTC

coenzyme q-10 oral capsule 60 mg Formulary OTC

coenzyme q10 oral liquid 30 mg/5ml Formulary OTC

coenzyme q10 oral tablet 100 mg, 25 mg Formulary OTC

coenzyme q10 oral tablet chewable 60 mg Formulary OTC

34

Drug Name Formulary Status Requirements/Limitsco-enzyme q10-vitamin e oral wafer 200-400 mg-unit Formulary OTC

cola syrup oral syrup Formulary OTC

COLACE ORAL CAPSULE 100 MG Formulary OTC

colchicine oral capsule 0.6 mg Formulary

colchicine oral tablet 0.6 mg Formulary

colchicine-probenecid oral tablet 0.5-500 mg Formulary

cold & cough childrens oral liquid 2.5-1-5 mg/5ml Formulary OTC

cold & cough day/night child oral 2.5-5 &2.5-6.25 mg/5ml Formulary OTC

cold remedy oral tablet dispersible Formulary OTC

cold sore treatment external gel 10.8-4.7 % Formulary OTC

cold sore treatment external liquid Formulary OTC

cold therapy pain relief external gel 3.1 % Formulary OTC

COLD-EEZE MOUTH/THROAT LOZENGE 13.3 MG Formulary OTC

colestipol hcl oral packet 5 gm Formulary

colestipol hcl oral tablet 1 gm Formulary

COLLASIL OSA POWDER Formulary

collodion flexible external liquid Formulary

collodion liquid Formulary

COLOCORT RECTAL ENEMA 100 MG/60ML Formulary

COMBIGAN OPHTHALMIC SOLUTION 0.2-0.5 % Formulary

COMBIVENT RESPIMAT INHALATION AEROSOL SOLUTION 20-100 MCG/ACT

Formulary

COMFORT ASSIST INSULIN SYRINGE 29G X 1/2" 0.3 ML 29G X 1/2" 0.3 ML

Formulary OTC


Formulary OTC

COMFORT ASSIST INSULIN SYRINGE 29G X 1/2" 1 ML 29G X 1/2" 1 ML

Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC

comfort assured lancets 28g Formulary OTC; QL (150 EA per 30 days)

comfort assured lancets 33g Formulary OTC; QL (150 EA per 30 days)

COMFORT CLEAN/COMFORT SHIELD EXTERNAL 3 %

Formulary OTC

COMFORT EZ PEN NEEDLES 32G X 8 MM Formulary OTC

COMPAT STAY-PUT NJ DOUBLE LUME Formulary OTC

COMPLERA ORAL TABLET 200-25-300 MG Formulary

35

Drug Name Formulary Status Requirements/Limitscomplete lice treatment combination kit 0.33-4-0.5 % Formulary OTC

complete natal dha oral 29-1-200 & 250 mg Formulary

completenate oral tablet chewable 29-1 mg Formulary

COMPOUND W MAXIMUM STRENGTH EXTERNAL GEL 17 %

Formulary OTC

COMPOUND W ONE STEP INVISIBLE EXTERNAL STRIP 40 %

Formulary OTC

compoz oral capsule 50 mg Formulary OTC

COMTREX COLD & COUGH MAX ST ORAL TABLET 10-5-325 MG

Formulary OTC

COMTREX COLD/COUGH DAY/NITE MS ORAL 5-2-10-325 MG

Formulary OTC

COMTREX DEEP CHEST COLD ORAL TABLET 325-200 MG

Formulary OTC

CO-NATAL FA ORAL TABLET Formulary

CONCEPT DHA ORAL CAPSULE 53.5-38-1 MG Formulary

CONCEPT OB ORAL CAPSULE 130-92.4-1 MG Formulary

CONCEPTIONXR MOTILITY SUPPORT ORAL Formulary OTC

CONCERTA ORAL TABLET EXTENDED RELEASE 18 MG, 27 MG, 36 MG, 54 MG


condoms Formulary OTC

constulose oral solution 10 gm/15ml Formulary

CONTAC COLD+FLU MAX ST ORAL TABLET 5-500 MG

Formulary OTC

CONTOUR NEXT CONTROL SOLUTION LOW IN VITRO LOW


CONTOUR NEXT CONTROL SOLUTION NORMAL IN VITRO NORMAL


CONTOUR NEXT EZ KIT W/DEVICE W/DEVICE Formulary OTC; QL (1 EA per 365 days)

CONTOUR NEXT LINK KIT W/DEVICE W/DEVICE Formulary OTC; QL (1 EA per 365 days)

CONTOUR NEXT MONITOR KIT W/DEVICE W/DEVICE


CONTOUR NEXT ONE KIT Formulary OTC; QL (1 EA per 365 days)

CONTOUR NEXT TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days)

control denture adhesive cream Formulary OTC

control syringe disposable 10 ml Formulary OTC

convex eye protector Formulary OTC

cool n heat ex st external patch 5 % Formulary OTC

cool n heat maximum strength external liquid 16 % Formulary OTC

COPAXONE SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 20 MG/ML

Formulary

copper sulfate crystals Formulary OTC

COPPERMIN ORAL TABLET 5 MG Formulary OTC

co-q 10 omega-3 fish oil oral capsule Formulary OTC

coq10 oral capsule 30 mg Formulary OTC

coq-10 oral capsule 50 mg Formulary OTC

coq10 oral powder 50 gm Formulary OTC

36

Drug Name Formulary Status Requirements/Limitscoral calcium oral capsule 185-50-100 mg-mg-unit, 200-100-100 mg-unit

Formulary OTC

CORICIDIN HBP COLD/FLU ORAL TABLET 2-325 MG Formulary OTC

CORICIDIN HBP COUGH/COLD ORAL TABLET 4-30 MG

Formulary OTC

CORICIDIN HBP DAY/NIGHT COLD ORAL 10-20 &15-200-2 MG

Formulary OTC

CORICIDIN HBP NIGHTTIME COLD ORAL LIQUID 15-6.25-500 MG/15ML

Formulary OTC

CORIFACT INTRAVENOUS KIT 1000-1600 UNIT Formulary

corn oil oil Formulary

corn oil oral oil Formulary OTC

CORN REMOVER WATERPROOF EXTERNAL PAD 40 %

Formulary OTC

corn starch powder Formulary

corn/callus remover external solution 12.6 % Formulary OTC

CORRECTOL EXTRA GENTLE ORAL CAPSULE 100 MG

Formulary OTC

CORTIFOAM RECTAL FOAM 10 % Formulary

cortisone acetate oral tablet 25 mg Formulary

CORTIZONE-10/ALOE EXTERNAL CREAM 1 % Formulary OTC

CORVITA 150 ORAL TABLET 150-1.25 MG Formulary

COSAMIN ASU FOR JOINT HEALTH ORAL CAPSULE Formulary OTC

COSAMIN VERDE FOR JOINT HEALTH ORAL TABLET

Formulary OTC

cottonseed oil oil Formulary

COTTONTAILS DIAPER RASH CREAMY EXTERNAL OINTMENT 10 %

Formulary OTC

cough & chest congestion dm oral liquid 5-100 mg/5ml Formulary OTC

cough & cold oral tablet 4-30 mg Formulary OTC

cough drops mouth/throat lozenge 10 mg, 3.1 mg, 5 mg, 5.4 mg, 6.5 mg, 7.5 mg, 7.6 mg, 8 mg, 9.1 mg

Formulary OTC

cough relief oral liquid 15 mg/5ml Formulary OTC

coughtab oral tablet 200 mg Formulary OTC

cramp tabs oral tablet 325-25 mg Formulary OTC

cranberry oral capsule 250 mg Formulary OTC

cream base with liposome external cream Formulary

creatine monohydrate powder Formulary

creatine oral powder Formulary OTC

creatine5000 oral packet 5000 mg Formulary OTC

CREON ORAL CAPSULE DELAYED RELEASE PARTICLES 12000 UNIT, 24000-76000 UNIT, 3000-9500 UNIT, 36000 UNIT, 6000 UNIT

Formulary PA

CR-GTF ORAL CAPSULE 200 MCG Formulary OTC

CRITIC-AID CLEAR AF EXTERNAL OINTMENT 2 % Formulary OTC

CRIXIVAN ORAL CAPSULE 200 MG, 400 MG Formulary

37

Drug Name Formulary Status Requirements/Limitscromolyn sodium inhalation nebulization solution 20 mg/2ml

Formulary

cromolyn sodium nasal aerosol solution 5.2 mg/act Formulary OTC

cromolyn sodium ophthalmic solution 4 % Formulary

cromolyn sodium oral concentrate 100 mg/5ml Formulary

CROTAN EXTERNAL LOTION 10 % Formulary ST

croton oil oil Formulary

CR-PLUS ORAL TABLET 500 MCG Formulary OTC

CRYOSERV SOLUTION Formulary

CRYSELLE-28 ORAL TABLET 0.3-30 MG-MCG Formulary QL (28 EA per 28 days)

cu-25 oral capsule 25 mg Formulary OTC

cu-5 oral capsule 5 mg Formulary OTC

CULTURELLE GENTLE-GO KIDS ORAL PACKET Formulary OTC

CULTURELLE KIDS ORAL PACKET Formulary OTC

cupric sulfate powder Formulary

CURAD GERM SHIELD EXTERNAL GEL Formulary OTC

CURAFIL WOUND DRESSING EXTERNAL GEL Formulary OTC

CURASOL WOUND DRESSING EXTERNAL GEL Formulary OTC

CURITY ALCOHOL PREPS PAD 70 % 70 % Formulary OTC

CURITY ALCOHOL SWABS PAD Formulary OTC

CURITY GAUZE SPONGE PAD 2"X2" Formulary OTC

CURITY MESH GAUZE BNDG 4"X30' Formulary OTC

CURITY NURSING PAD Formulary OTC

CURX ANTIMICROBIAL EXTERNAL GEL 0.13 % Formulary OTC

CUTINOVA HYDRO 2"X2-3/8" EXTERNAL Formulary OTC

cvs adhesive gauze pad 2-3/8"x4" Formulary OTC

cvs aftersun aloe/lidocaine external gel 0.5 % Formulary OTC

CVS AIRSHIELD ORAL TABLET EFFERVESCENT Formulary OTC

cvs alcohol prep pads pad 70 % 70 % Formulary OTC

cvs allergy relief childrens oral tablet dispersible 12.5 mg Formulary OTC

cvs allergy relief d oral tablet extended release 12 hour 60-120 mg


cvs all-purpose skin protect external ointment Formulary OTC

cvs antacid childrens oral liquid 400 mg/5ml Formulary OTC

cvs anti-diarrheal oral capsule 2 mg Formulary OTC

cvs anti-diarrheal oral suspension 262 mg/15ml Formulary OTC

cvs anti-itch sensitive external lotion 1 % Formulary OTC

cvs astringent solution external packet Formulary OTC

cvs b complex plus c oral tablet Formulary OTC

cvs baby safety swabs swab Formulary OTC

cvs backache relief oral tablet 500 mg Formulary OTC

cvs calcium 600 plus oral tablet chewable Formulary OTC

cvs calcium oral tablet chewable 250-400 mg-unit Formulary OTC

cvs cherry menthol drops mouth/throat lozenge Formulary OTC

38

Drug Name Formulary Status Requirements/Limitscvs chest rub medicated external ointment 4.7-1.2-2.6 % Formulary OTC

cvs cleansing eyelid wipes external pad Formulary OTC

cvs cleansing skin external cream Formulary OTC

cvs cold remedy oral tablet dispersible Formulary OTC

cvs corn/callus remover external kit 17 % Formulary OTC

cvs creamy acne face wash external liquid 4 % Formulary OTC; AGE (Max 18 Years)

cvs d3 oral capsule 1000 unit Formulary OTC

cvs dairy relief ex st oral tablet 4500 unit Formulary OTC

cvs daytime/nighttime cold/flu oral (liquid) Formulary OTC

cvs daytime/nighttime cough oral liquid therapy pack 6.25-15 & 15 mg/15ml

Formulary OTC

cvs diabetes health support oral Formulary OTC

cvs digestive probiotic oral capsule Formulary OTC

cvs diuretic maximum strength oral capsule 50 mg Formulary OTC

cvs e oil oral oil 100 unt/0.25ml Formulary OTC

cvs early result pregnancy in vitro diagnostic test Formulary OTC

cvs easy fiber/calcium oral tablet chewable Formulary OTC

cvs enema disposable rectal enema 19-7 gm/118ml Formulary OTC

cvs epsom salt granules Formulary OTC

cvs ethyl alcohol solution 70 % Formulary OTC

cvs eye pad Formulary OTC

cvs fiber gummies oral tablet chewable 2 gm Formulary OTC

cvs gas relief extra strength oral tablet chewable 125 mg Formulary OTC

cvs gas relief oral tablet chewable 80 mg Formulary OTC

cvs gauze sterile pad 4"x4" Formulary OTC

cvs gluco-chondroit plus uc-ii oral tablet 125-100-10 mg Formulary OTC

cvs glucosamine-chondroitin oral tablet chewable 750-600 mg

Formulary OTC

cvs glucosamine-chondroit-msm oral tablet 375-300-250 mg

Formulary OTC

cvs glucose bits oral tablet chewable 1 gm Formulary OTC

cvs glucose shot oral liquid Formulary OTC

cvs glycerin adult rectal suppository 2.1 gm Formulary OTC

cvs hair regrowth for women external foam 5 % Formulary OTC

cvs hand wash advanced antibac external solution 2 % Formulary OTC

cvs heartburn relief ex st oral suspension 254-237.5 mg/5ml Formulary OTC

cvs heatwraps/back/hip Formulary OTC

cvs hemorrhoidal rectal suppository 0.25-88.44 % Formulary OTC

cvs hot steam inhalation liquid 6.2 % Formulary OTC

cvs hydrocolloid pads pad Formulary OTC

cvs inner ear plus oral tablet Formulary OTC

cvs instant food thickener oral powder Formulary OTC

cvs iron oral tablet 325 (65 fe) mg Formulary OTC

cvs isopropyl alcohol wipes external 70 % Formulary OTC

39

Drug Name Formulary Status Requirements/Limitscvs itch relief external gel 2 % Formulary OTC

cvs lancets 21g Formulary OTC; QL (150 EA per 30 days)

cvs lancets micro thin 33g Formulary OTC; QL (150 EA per 30 days)

cvs lancets original Formulary OTC; QL (150 EA per 30 days)

cvs lancets thin 26g Formulary OTC; QL (150 EA per 30 days)

cvs lancets ultra thin 30g Formulary OTC; QL (150 EA per 30 days)

cvs lancets ultra-thin 30g Formulary OTC; QL (150 EA per 30 days)

cvs laxative dietary supplemnt oral tablet 500 mg Formulary OTC

cvs l-lysine oral tablet 500 mg Formulary OTC

cvs lubricant drops ophthalmic gel 0.25-0.3 % Formulary OTC

cvs magnesium citrate oral capsule 125 mg Formulary OTC

cvs manuka honey wound external gel Formulary OTC

cvs melatonin extra strength oral liquid 5 mg/15ml Formulary OTC

cvs melatonin oral tablet chewable 5 mg Formulary OTC

cvs melatonin sublingual tablet sublingual 5 mg Formulary OTC

cvs miconazole 1 combo pack vaginal kit 1200 & 2 mg & % Formulary OTC

cvs miconazole 3 combo pack vaginal kit 200 & 2 mg-% (9gm)

Formulary OTC

cvs mineral oil enema rectal enema Formulary OTC

cvs mineral oil oral oil Formulary OTC

cvs mini enema kids rectal enema 100 mg/5ml Formulary OTC

cvs multi-purpose external ointment 15.5-53.4 % Formulary OTC

cvs nasal allergy spray aerosol 55 mcg/act nasal 55 mcg/act

Formulary OTC

cvs nasal decongestant inhalation inhaler 50 mg Formulary OTC

cvs nasal decongestant oral capsule 30 mg Formulary OTC

cvs nasal mist nasal aerosol solution 3 % Formulary OTC

cvs natural fiber supplement oral packet 58.6 % Formulary OTC

cvs natural fish oil oral capsule 1000 mg Formulary OTC

cvs nerve pain relief external ointment Formulary OTC

cvs non-drying sinus pe oral tablet 5-200 mg Formulary OTC

cvs omeprazole oral tablet delayed release 20 mg Formulary OTC

cvs oral pain reliever mouth/throat cream 20 % Formulary OTC

cvs pain relief external cream 4 % Formulary OTC

cvs pain relief regular st oral capsule 325 mg Formulary OTC

cvs phosphate saline laxative oral solution 2.7-7.2 gm/15ml Formulary OTC

cvs potassium gluconate oral tablet 2 meq Formulary OTC

cvs prenatal gummy oral tablet chewable 0.4-113.5 mg Formulary OTC

cvs prenatal oral tablet 28-0.8 mg Formulary OTC

cvs prep pad 70 % 70 % Formulary OTC

cvs protective external powder 81-15 % Formulary OTC

cvs saline wound wash external solution 0.9 % Formulary OTC

cvs selenium oral tablet 200 mcg Formulary OTC

cvs silver external gel Formulary OTC

40

Drug Name Formulary Status Requirements/Limitscvs sinus relief day/night oral Formulary OTC

cvs skin relief external lotion 1.3 % Formulary OTC

cvs sore muscle rub external gel 2.5 % Formulary OTC

cvs sore throat max strength mouth/throat lozenge 15-2.6 mg

Formulary OTC

cvs sore throat relief pops mouth/throat lozenge on a handle20 mg

Formulary OTC

cvs steam inhaler Formulary OTC

cvs stool softener oral capsule 50 mg Formulary OTC

cvs stuffy nose & cold child oral liquid 2.5-100 mg/5ml Formulary OTC

cvs super cranberry urinary oral capsule 140-100 mg Formulary OTC

cvs tension headache oral capsule 500-65 mg Formulary OTC

cvs therapeutic external shampoo 0.5 % Formulary OTC

cvs triacting cough/runny nose oral liquid 1-5 mg/5ml Formulary OTC

cvs triple magnesium complex oral capsule 400 mg Formulary OTC

cvs ultra thin lancets Formulary OTC; QL (150 EA per 30 days)

cvs vaporizer warm steam Formulary OTC

cvs wound wash advanced external liquid Formulary OTC

cvs yogurt+calcium gummies oral tablet chewable 250-100 mg-unit

Formulary OTC

cvs zinc oxide diaper external cream 1-10 % Formulary OTC

cyanocobalamin crystals Formulary

cyanocobalamin injection solution 1000 mcg/ml Formulary

cyclobenzaprine hcl oral tablet 10 mg, 5 mg, 7.5 mg Formulary

CYCLOMYDRIL OPHTHALMIC SOLUTION 0.2-1 % Formulary

cyclopentolate hcl ophthalmic solution 1 % Formulary

cyclophosphamide injection solution reconstituted 1 gm, 2 gm, 500 mg

Formulary

cyclophosphamide oral capsule 25 mg, 50 mg Formulary

cyclosporine modified oral capsule 100 mg, 25 mg, 50 mg Formulary

cyclosporine modified oral solution 100 mg/ml Formulary

cyclosporine oral capsule 100 mg, 25 mg Formulary

cyproheptadine hcl oral syrup 2 mg/5ml Formulary

cyproheptadine hcl oral tablet 4 mg Formulary

CYSTADANE ORAL POWDER Formulary PA

CYSTAGON ORAL CAPSULE 150 MG, 50 MG Formulary

CYSTECH ORAL CAPSULE 500 MG Formulary OTC

cystine oral packet 500 mg Formulary OTC

cytarabine (pf) injection solution 100 mg/ml, 20 mg/ml Formulary

CYTO-Q MAX ORAL LIQUID 100 MG/ML Formulary OTC

d 1000 oral tablet 1000 unit Formulary OTC

d 2000 oral tablet 2000 unit Formulary OTC

dacarbazine intravenous solution reconstituted 100 mg, 200 mg

Formulary

daily care skin protectant external ointment 30 % Formulary OTC

41

Drug Name Formulary Status Requirements/Limitsdaily ovulation predictor in vitro strip Formulary OTC

daily vite multivitamin/iron oral tablet Formulary OTC

dairy relief oral tablet 3000 unit Formulary OTC

dakins (1/2 strength) external solution 0.25 % Formulary OTC

dakins (1/4 strength) external solution 0.125 % Formulary OTC

dakins external solution 0.4-0.5 % Formulary OTC

DAKRINA OPHTHALMIC SOLUTION 2.7-2 % Formulary OTC

danazol oral capsule 100 mg, 200 mg, 50 mg Formulary

dandruff shampoo external lotion 1 % Formulary OTC

dantrolene sodium oral capsule 100 mg, 25 mg, 50 mg Formulary

dapsone oral tablet 100 mg, 25 mg Formulary

DARAPRIM ORAL TABLET 25 MG Formulary PA

daunorubicin hcl intravenous injectable 5 mg/ml Formulary

day time multi-sympt cold/flu oral capsule 10-5-325 mg Formulary OTC

DAYTIME COLD MEDICINE ORAL LIQUID 325-15 MG/15ML

Formulary OTC

daytime cough oral liquid 15 mg/15ml Formulary OTC

daytime severe cold & flu oral liquid 5-10-200-325 mg/15ml

Formulary OTC

DAYTRANA TRANSDERMAL PATCH 10 MG/9HR, 15 MG/9HR, 20 MG/9HR, 30 MG/9HR


DDROPS ORAL LIQUID 2000 UT/0.028ML Formulary OTC

DEBACTEROL MOUTH/THROAT SOLUTION 30-50 % Formulary

DECARA ORAL CAPSULE 25000 UNIT Formulary OTC

decitabine intravenous solution reconstituted 50 mg Formulary

DECONEX DMX ORAL TABLET 10-17.5-385 MG Formulary OTC

DECONEX IR ORAL TABLET 10-385 MG Formulary OTC

dehydroepiandrosterone powder Formulary

del clens external gel Formulary OTC

DELBASE COMPOUNDING EXTERNAL OINTMENT Formulary OTC

DELSYM COUGH CHILDRENS ORAL SUSPENSION EXTENDED RELEASE 30 MG/5ML

Formulary OTC

DELTUSS DP ORAL LIQUID 1-30 MG/5ML Formulary OTC

DELZICOL ORAL CAPSULE DELAYED RELEASE 400 MG

Formulary

demeclocycline hcl oral tablet 150 mg, 300 mg Formulary

DEMEROL INJECTION SOLUTION 100 MG/2ML, 100 MG/ML, 25 MG/0.5ML, 25 MG/ML, 50 MG/ML, 75 MG/1.5ML, 75 MG/ML

Formulary

DEMSER ORAL CAPSULE 250 MG Formulary

DENDRACIN NEURODENDRAXCIN EXTERNAL LOTION 0.0375-10-30 %

Formulary OTC

DENTAPAINE MOUTH/THROAT GEL 20 % Formulary OTC

DEPACON INTRAVENOUS SOLUTION 100 MG/ML Formulary

DEPEN TITRATABS ORAL TABLET 250 MG Formulary PA

42

Drug Name Formulary Status Requirements/LimitsDEPO-PROVERA INTRAMUSCULAR SUSPENSION 400 MG/ML

Formulary

DEQUASINE ORAL TABLET Formulary OTC

DERMA CIDOL 2000 EXTERNAL LIQUID 0.5 % Formulary OTC

dermacloud external cream Formulary OTC

DERMAGESIC EXTERNAL CREAM 1-0.4-0.4 % Formulary OTC

DERMAGESIC EXTERNAL LIQUID 1-0.4-0.4 % Formulary OTC

DERMAGRAN EXTERNAL GEL Formulary OTC

DERMAL THERAPY FINGER CARE EXTERNAL LOTION 20 %

Formulary OTC

DERMAL WOUND CLEANSER EXTERNAL LIQUID 0.13 %

Formulary OTC

DERMAMED EXTERNAL OINTMENT Formulary OTC

DERMAPLEX EXTERNAL GEL Formulary OTC

DERMAREST PSORIASIS EXTERNAL GEL 3 % Formulary OTC

DERMASTAT EXTERNAL FOAM 65 % Formulary OTC

DERMASYN EXTERNAL GEL Formulary OTC

DERMAZENE EXTERNAL CREAM 1-1 % Formulary

DERMOPLAST EXTERNAL AEROSOL 20-0.5 % Formulary OTC

DESCOVY ORAL TABLET 200-25 MG Formulary

DESENEX FOOT/SNEAKER SPRAY EXTERNAL AEROSOL

Formulary OTC

DESGEN DM ORAL SYRUP 5-15-100 MG/5ML Formulary OTC

DESGEN DM ORAL TABLET 30-10-200 MG Formulary OTC

desipramine hcl oral tablet 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg

Formulary

DESITIN MAXIMUM STRENGTH EXTERNAL PASTE 40 %

Formulary OTC

desmopressin ace spray refrig nasal solution 0.01 % Formulary

desmopressin acetate oral tablet 0.1 mg, 0.2 mg Formulary

desmopressin acetate spray nasal solution 0.01 % Formulary

desonide external cream 0.05 % Formulary

desonide external lotion 0.05 % Formulary

desonide external ointment 0.05 % Formulary

despec dm-g oral syrup 5-10-100 mg/5ml Formulary OTC

desvenlafaxine succinate er oral tablet extended release 24 hour 100 mg, 25 mg, 50 mg

Formulary ST

DEVROM ORAL TABLET CHEWABLE 200 MG Formulary OTC

DEWEES CARMINATIVE ORAL LIQUID 6-250 Formulary OTC

DEXAMETHASONE INTENSOL ORAL CONCENTRATE 1 MG/ML

Formulary

dexamethasone oral elixir 0.5 mg/5ml Formulary

dexamethasone oral solution 0.5 mg/5ml Formulary

dexamethasone oral tablet 0.5 mg, 0.75 mg, 1 mg, 1.5 mg, 2 mg, 4 mg, 6 mg

Formulary

43

Drug Name Formulary Status Requirements/Limitsdexamethasone sodium phosphate ophthalmic solution 0.1 %

Formulary

dexrazoxane intravenous solution reconstituted 250 mg, 500 mg

Formulary

dextroamphetamine sulfate oral tablet 10 mg, 5 mg Formulary AGE (Min 4 Years and Max 17 Years)

dextrose anhydrous granules Formulary OTC

dextrose powder Formulary

dhea oral capsule 50 mg Formulary OTC

dhea oral tablet 25 mg Formulary OTC

DHS ZINC EXTERNAL SHAMPOO 2 % Formulary OTC

DIAB DAILY CARE EXTERNAL GEL Formulary OTC

DIABETIC BASICS HEALTHY FOOT EXTERNAL LOTION 0.13 %

Formulary OTC

DIABETIC TUSSIN ALLERGY ORAL SYRUP 2 MG/5ML

Formulary OTC

DIABETIC TUSSIN COLD/FLU ORAL CAPSULE 325-4-15 MG

Formulary OTC

DIABETIC TUSSIN NIGHT COLD/FLU ORAL LIQUID 10-12.5-325 MG/5ML

Formulary OTC

DIABETISWEET ORAL POWDER Formulary OTC

diabet-x daily prevention external cream 0.3 % Formulary OTC

DIADERM FOOT REJUVENATING EXTERNAL CREAM

Formulary OTC

DIALYVITE 800 ORAL WAFER 0.8 MG Formulary OTC

DIALYVITE 800 PLUS D ORAL WAFER 800 MCG Formulary OTC

DIALYVITE 800/IRON ORAL TABLET 29-0.8 MG Formulary OTC

DIALYVITE ORAL TABLET Formulary

DIALYVITE/ZINC ORAL TABLET Formulary

diaper rash external cream 10 % Formulary OTC

diaper rash external paste 40 % Formulary OTC

DIASTIX IN VITRO STRIP Formulary OTC

DIAZEPAM INTENSOL ORAL CONCENTRATE 5 MG/ML


diazepam oral solution 1 mg/ml Formulary QL (136 EA per 34 days)

diazepam oral tablet 10 mg Formulary QL (136 EA per 34 days)

diazepam oral tablet 2 mg, 5 mg Formulary QL (136 EA per 30 days)

diazepam rectal gel 10 mg, 2.5 mg, 20 mg Formulary

dibucaine external ointment 1 % Formulary OTC

diclofenac potassium oral tablet 50 mg Formulary

diclofenac sodium er oral tablet extended release 24 hour100 mg

Formulary

diclofenac sodium ophthalmic solution 0.1 % Formulary

diclofenac sodium oral tablet delayed release 25 mg, 50 mg, 75 mg

Formulary

diclofenac sodium powder Formulary

diclofenac sodium transdermal gel 1 % Formulary QL (200 GM per 30 days)

44

Drug Name Formulary Status Requirements/Limitsdicloxacillin sodium oral capsule 250 mg, 500 mg Formulary

dicyclomine hcl oral capsule 10 mg Formulary

dicyclomine hcl oral solution 10 mg/5ml Formulary

dicyclomine hcl oral tablet 20 mg Formulary

DI-DAK-SOL EXTERNAL SOLUTION 0.0125 % Formulary OTC

didanosine oral capsule delayed release 200 mg, 250 mg, 400 mg

Formulary

dieters super tea oral Formulary OTC

dietex forte oral capsule Formulary OTC

diethylpropion hcl er oral tablet extended release 24 hour75 mg

Formulary PA

diethylpropion hcl oral tablet 25 mg Formulary PA

DIFFERIN GEL 0.1 % EXTERNAL (OTC) 0.1 % Formulary AGE (Max 18 Years)

diflunisal oral tablet 500 mg Formulary

digestive enzyme ultra oral capsule Formulary OTC

DIGITEK ORAL TABLET 125 MCG, 250 MCG Formulary

digoxin oral solution 0.05 mg/ml Formulary

DILANTIN ORAL CAPSULE 100 MG, 30 MG Formulary

DILAUDID INJECTION SOLUTION 1 MG/ML, 2 MG/ML, 4 MG/ML

Formulary

diltiazem cd oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg, 300 mg

Formulary

diltiazem hcl er beads oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg, 300 mg, 360 mg, 420 mg

Formulary

diltiazem hcl er coated beads oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg, 300 mg, 360 mg

Formulary

diltiazem hcl er coated beads oral tablet extended release 24 hour 180 mg, 240 mg, 300 mg, 360 mg, 420 mg

Formulary

diltiazem hcl er oral capsule extended release 12 hour 120 mg, 60 mg, 90 mg

Formulary

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

Formulary

diltiazem hcl intravenous solution 125 mg/25ml, 25 mg/5ml, 50 mg/10ml

Formulary

diltiazem hcl intravenous solution reconstituted 100 mg Formulary

diltiazem hcl oral tablet 120 mg, 30 mg, 60 mg, 90 mg Formulary

dilt-xr oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg

Formulary

dimenhydrinate oral tablet 50 mg Formulary

DIMETAPP COLD/ALLERGY ORAL ELIXIR 1-2.5 MG/5ML

Formulary OTC

DIMETAPP DM COLD/COUGH ORAL LIQUID 2.5-1-5 MG/5ML

Formulary OTC

DIMETAPP LONG ACT COUGH/COLD ORAL SYRUP 1-7.5 MG/5ML

Formulary OTC

diphenhydramine hcl (sleep) oral tablet 50 mg Formulary OTC

diphenhydramine hcl oral tablet 25 mg Formulary OTC

diphenoxylate-atropine oral tablet 2.5-0.025 mg Formulary

45

Drug Name Formulary Status Requirements/Limitsdiphtheria-tetanus toxoids dt intramuscular suspension 25-5 lfu/0.5ml


dipyridamole oral tablet 25 mg, 50 mg, 75 mg Formulary

disulfiram oral tablet 250 mg, 500 mg Formulary

divalproex sodium er oral tablet extended release 24 hour250 mg, 500 mg

Formulary

divalproex sodium oral capsule delayed release sprinkle125 mg

Formulary

divalproex sodium oral tablet delayed release 125 mg, 250 mg, 500 mg

Formulary

dl-leucine powder Formulary

dl-pa-500 oral capsule 500 mg Formulary OTC

DML EXTERNAL LOTION Formulary OTC

DOANS PILLS ORAL TABLET 325 MG Formulary OTC

DOANS PM EXTRA STRENGTH ORAL TABLET 580-25 MG

Formulary OTC

DOC OMEGA ORAL PACKET 200 MG Formulary OTC

docetaxel intravenous concentrate 160 mg/8ml, 20 mg/0.5ml, 20 mg/ml, 80 mg/2ml, 80 mg/4ml

Formulary

docetaxel intravenous solution 160 mg/16ml, 20 mg/2ml, 80 mg/8ml

Formulary

docusate sodium oral liquid 50 mg/5ml Formulary OTC

docusate sodium oral tablet 100 mg Formulary OTC

DOCUSOL KIDS RECTAL ENEMA 100 MG/5ML Formulary OTC

DOCUSOL PLUS MINI-ENEMA RECTAL ENEMA 20-283 MG

Formulary OTC

dofetilide oral capsule 125 mcg, 250 mcg, 500 mcg Formulary

DOLOGEN ORAL TABLET 1-325 MG Formulary OTC

dologesic-df oral tablet 1-500 mg Formulary OTC

dolorex oral tablet 25-325 mg Formulary OTC

DOMEBORO EXTERNAL PACKET Formulary OTC

dometuss-da/children oral liquid 1-2.5 mg/5ml Formulary OTC

donepezil hcl oral tablet 10 mg, 5 mg Formulary

donepezil hcl oral tablet 23 mg Formulary QL (30 EA per 30 days)

donepezil hcl oral tablet dispersible 10 mg, 5 mg Formulary

dorzolamide hcl ophthalmic solution 2 % Formulary

dorzolamide hcl-timolol mal ophthalmic solution 22.3-6.8 mg/ml

Formulary

DOUBLE-TUSSIN DM ORAL LIQUID 20-300 MG/5ML Formulary OTC

DOVER IRRIGATION TRAY KIT Formulary OTC

doxazosin mesylate oral tablet 1 mg, 2 mg, 4 mg Formulary QL (34 EA per 34 days)

doxazosin mesylate oral tablet 8 mg Formulary QL (68 EA per 34 days)

doxepin hcl oral capsule 10 mg, 100 mg, 150 mg, 25 mg, 50 mg

Formulary

doxepin hcl oral concentrate 10 mg/ml Formulary

doxorubicin hcl intravenous solution 2 mg/ml Formulary

46

Drug Name Formulary Status Requirements/Limitsdoxorubicin hcl intravenous solution reconstituted 10 mg, 50 mg

Formulary

doxycycline hyclate oral capsule 100 mg, 50 mg Formulary

doxycycline hyclate oral tablet 100 mg, 20 mg Formulary

doxycycline monohydrate oral capsule 100 mg, 50 mg Formulary

doxycycline monohydrate oral suspension reconstituted 25 mg/5ml

Formulary

doxycycline monohydrate oral tablet 150 mg, 50 mg, 75 mg Formulary

doxylamine succinate powder Formulary

DR BOLDTS HINEY HEALER EXTERNAL CREAM Formulary OTC

DR SMITHS DIAPER EXTERNAL OINTMENT 10 % Formulary OTC

DR SMITHS DIAPER RASH EXTERNAL AEROSOL 10 %

Formulary OTC

DR SMITHS RASH + SKIN EXTERNAL OINTMENT 16-57 %

Formulary OTC

DRAMAMINE ORAL TABLET 50 MG Formulary OTC

DRAMAMINE ORAL TABLET CHEWABLE 50 MG Formulary OTC

DRITHO-CREME HP EXTERNAL CREAM 1 % Formulary

DRIXORAL COLD/ALLERGY ORAL TABLET EXTENDED RELEASE 12 HOUR 6-120 MG

Formulary OTC

DRIXORAL COUGH/SORE THROAT ORAL CAPSULE 325-15 MG

Formulary OTC

dronabinol oral capsule 10 mg, 2.5 mg, 5 mg Formulary PA

DROPLET LANCETS ULTRA THIN 30G Formulary OTC; QL (150 EA per 30 days)

drospirenone-ethinyl estradiol oral tablet 3-0.02 mg, 3-0.03 mg


DROXIA ORAL CAPSULE 200 MG, 300 MG, 400 MG Formulary

drug mart lancets thin 26g Formulary OTC; QL (150 EA per 30 days)

DRUG MART UNILET LANCETS 28G Formulary OTC; QL (150 EA per 30 days)

DRUG MART UNILET LANCETS 30G Formulary OTC; QL (150 EA per 30 days)

dry skin treatment adv therapy external ointment Formulary OTC

drymax extra pad 8"x8" Formulary OTC

DRYSOL EXTERNAL SOLUTION 20 % Formulary

DULCOLAX MILK OF MAGNESIA ORAL SUSPENSION 400 MG/5ML

Formulary OTC

DULCOLAX ORAL TABLET DELAYED RELEASE 5 MG

Formulary OTC

DULCOLAX RECTAL SUPPOSITORY 10 MG Formulary OTC

DULERA INHALATION AEROSOL 100-5 MCG/ACT, 200-5 MCG/ACT


duloxetine hcl oral capsule delayed release particles 20 mg, 30 mg, 60 mg

Formulary

DURAFLEX COMFORT EXTERNAL GEL Formulary OTC

DURAFLU ORAL TABLET 60-20-200-325 MG Formulary OTC

DURAPROXIN ES TRANSDERMAL PATCH 3-1.25-10 %

Formulary OTC

DURAPROXIN TRANSDERMAL PATCH 1.25-3 % Formulary OTC

47

Drug Name Formulary Status Requirements/LimitsDURASAFE SPINAL/EPIDURAL KIT Formulary

DURATION SPRAY NASAL SOLUTION 0.05 % Formulary OTC

DURAVENT DM ORAL TABLET 10-15-395 MG Formulary OTC

DURAVENT PE ORAL TABLET 10-395 MG Formulary OTC

DUREZOL OPHTHALMIC EMULSION 0.05 % Formulary

dutasteride oral capsule 0.5 mg Formulary

dutasteride-tamsulosin hcl oral capsule 0.5-0.4 mg Formulary

D-VI-SOL ORAL LIQUID 400 UNIT/ML Formulary OTC

d-xylose powder Formulary

DY-O-DERM VITILIGO STAIN EXTERNAL SOLUTION 6.55 %

Formulary OTC

E.E.S. GRANULES ORAL SUSPENSION RECONSTITUTED 200 MG/5ML

Formulary

ear wax cleansing otic kit 6.5 % Formulary OTC

EASIVENT Formulary QL (2 EA per 365 days)

EASIVENT MASK LARGE Formulary QL (2 EA per 365 days)

EASIVENT MASK MEDIUM Formulary QL (2 EA per 365 days)

EASIVENT MASK SMALL Formulary QL (2 EA per 365 days)

easy fiber oral powder Formulary OTC

EASY TOUCH ALCOHOL PREP MEDIUM PAD 70 % 70 %

Formulary OTC

EASY TOUCH ALLERGY SYRINGE 26G X 3/8" 1 ML, 27G X 1/2" 1 ML

Formulary OTC

EASY TOUCH FLIPLOCK INSULIN SY 29G X 1/2" 1 ML 29G X 1/2" 1 ML

Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC

EASY TOUCH FLURINGE 25G X 1" 1 ML Formulary OTC

EASY TOUCH INSULIN SAFETY SYR 29G X 1/2" 0.5 ML 29G X 1/2" 0.5 ML

Formulary OTC

EASY TOUCH INSULIN SAFETY SYR 29G X 1/2" 1 ML 29G X 1/2" 1 ML

Formulary OTC

EASY TOUCH INSULIN SAFETY SYR 30G X 1/2" 1 ML 30G X 1/2" 1 ML

Formulary OTC

EASY TOUCH INSULIN SAFETY SYR 30G X 5/16" 0.5 ML 30G X 5/16" 0.5 ML

Formulary OTC

EASY TOUCH INSULIN SYRINGE 27G X 1/2" 0.5 ML 27G X 1/2" 0.5 ML

Formulary OTC

EASY TOUCH INSULIN SYRINGE 27G X 1/2" 1 ML 27G X 1/2" 1 ML

Formulary OTC


Formulary OTC


Formulary OTC

48

Drug Name Formulary Status Requirements/LimitsEASY TOUCH INSULIN SYRINGE 29G X 1/2" 0.5 ML 29G X 1/2" 0.5 ML

Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC

EASY TOUCH LANCETS 26G Formulary OTC; QL (150 EA per 30 days)

EASY TOUCH LANCETS 26G/TWIST Formulary OTC; QL (150 EA per 30 days)








EASY TOUCH SHEATHLOCK SYRINGE 29G X 1/2" 1 ML 29G X 1/2" 1 ML

Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC

EASY TWIST & CAP LANCETS Formulary OTC; QL (150 EA per 30 days)

EASYGEL DENTAL GEL 0.4 % Formulary

ecee plus oral tablet Formulary OTC

econazole nitrate external cream 1 % Formulary

ECOTRIN MAXIMUM STRENGTH ORAL TABLET DELAYED RELEASE 500 MG

Formulary OTC

ECOTRIN ORAL TABLET DELAYED RELEASE 325 MG

Formulary OTC

e-cream complex external cream Formulary OTC

49

Drug Name Formulary Status Requirements/Limitsed a-hist dm oral tablet 10-4-10 mg Formulary OTC

ED A-HIST ORAL LIQUID 4-10 MG/5ML Formulary OTC

ed bron gp oral liquid 5-100 mg/5ml Formulary OTC

ED CHLORPED D ORAL LIQUID 2-5 MG/ML Formulary OTC

ED CHLORPED ORAL LIQUID 2 MG/ML Formulary OTC

edetate disodium powder Formulary

ed-spaz oral tablet dispersible 0.125 mg Formulary

EDURANT ORAL TABLET 25 MG Formulary

efavirenz oral capsule 200 mg, 50 mg Formulary

efavirenz oral tablet 600 mg Formulary

EFFER-K ORAL TABLET EFFERVESCENT 25 MEQ Formulary

effervescent pain relief oral tablet effervescent 325 mg Formulary OTC

effervescent pot chloride oral tablet effervescent 25 meq Formulary

EGRIFTA SUBCUTANEOUS SOLUTION RECONSTITUTED 1 MG

Formulary PA

ELDERTONIC ORAL ELIXIR Formulary OTC

ELIDEL EXTERNAL CREAM 1 % Formulary PA; AGE (Min 2 Years)

ELIGARD SUBCUTANEOUS KIT 22.5 MG, 30 MG, 45 MG, 7.5 MG


ELIQUIS ORAL TABLET 2.5 MG, 5 MG Formulary

elite ca/mg oral tablet 100-50 mg Formulary OTC

elite calcium oral tablet 150 mg Formulary OTC

ELITE ZINC ORAL CAPSULE 15 MG Formulary OTC

ELITEK INTRAVENOUS SOLUTION RECONSTITUTED 1.5 MG, 7.5 MG

Formulary

ELITE-OB ORAL TABLET 50-1.25 MG Formulary

elite-thin insulin syringe 28g x 1/2" 0.5 ml 28g x 1/2" 0.5 ml Formulary OTC

elite-thin insulin syringe 28g x 1/2" 1 ml 28g x 1/2" 1 ml Formulary OTC

elite-thin insulin syringe 28g x 5/16" 0.5 ml 28g x 5/16" 0.5 ml

Formulary OTC


elite-thin insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC



Formulary OTC



Formulary OTC



Formulary OTC


Formulary OTC


ELIXOPHYLLIN ORAL ELIXIR 80 MG/15ML Formulary

ELIXSURE COUGH ORAL GEL 7.5 MG/5ML Formulary OTC

50

Drug Name Formulary Status Requirements/LimitsELIXSURE FEVER/PAIN ORAL GEL 160 MG/5ML Formulary OTC

ELLA ORAL TABLET 30 MG Formulary

ELLURA ORAL CAPSULE 200 MG Formulary OTC

ELMIRON ORAL CAPSULE 100 MG Formulary

ELTA DERMAL EXTERNAL GEL Formulary OTC

EMCYT ORAL CAPSULE 140 MG Formulary

EMETROL ORAL SOLUTION 1.87-1.87-21.5 Formulary OTC

EMJOI TENS DEVICE Formulary

empty capsule size 1 clear capsule Formulary

EMTRIVA ORAL CAPSULE 200 MG Formulary

EMTRIVA ORAL SOLUTION 10 MG/ML Formulary

EMULSION SB EMULSION EXTERNAL Formulary

enalapril maleate oral tablet 10 mg, 2.5 mg, 20 mg, 5 mg Formulary

enalapril-hydrochlorothiazide oral tablet 10-25 mg, 5-12.5 mg

Formulary

ENBREL SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 25 MG/0.5ML, 50 MG/ML


ENBREL SUBCUTANEOUS SOLUTION RECONSTITUTED 25 MG


ENBREL SURECLICK SUBCUTANEOUS SOLUTION AUTO-INJECTOR 50 MG/ML


ENDOXCIN EXTERNAL PATCH 4-1 % Formulary OTC

ENDUR-ACIN ORAL TABLET EXTENDED RELEASE 500 MG

Formulary OTC

ENEMEEZ MINI RECTAL ENEMA 283 MG Formulary OTC

ENFAMIL ENFALYTE ORAL SOLUTION Formulary OTC

ENFAMIL EXPECTA ORAL 28-0.8 & 200 MG Formulary OTC

ENGERIX-B INJECTION SUSPENSION 10 MCG/0.5ML, 20 MCG/ML


ENLITE GLUCOSE SENSOR Formulary

enoxaparin sodium injection solution 300 mg/3ml Formulary

enoxaparin sodium subcutaneous solution 100 mg/ml, 120 mg/0.8ml, 150 mg/ml, 30 mg/0.3ml, 40 mg/0.4ml, 60 mg/0.6ml, 80 mg/0.8ml

Formulary

ENPRESSE-28 ORAL TABLET Formulary QL (28 EA per 28 days)

entecavir oral tablet 0.5 mg, 1 mg Formulary

ENTEX T ORAL TABLET 60-375 MG Formulary OTC

ENTRESTO ORAL TABLET 24-26 MG, 49-51 MG, 97-103 MG

FormularyPA; QL (68 EA per 34 days); AGE (Min 18 Years)

ENTSOL NASAL NASAL SOLUTION 3 % Formulary OTC

enulose oral solution 10 gm/15ml Formulary

e-oil external oil 30000 unit Formulary OTC

epa/gla oral capsule Formulary OTC

ephedrine hcl oral tablet 25 mg Formulary OTC

epidural needle 18g x 2" , 18g x 4" Formulary OTC

epinastine hcl ophthalmic solution 0.05 % Formulary

51

Drug Name Formulary Status Requirements/Limitsepinephrine injection solution 30 mg/30ml Formulary

epinephrine injection solution auto-injector 0.15 mg/0.3ml, 0.3 mg/0.3ml

Formulary

epinephrine pf injection solution 1 mg/ml Formulary

epinephrine pf injection solution prefilled syringe 1 mg/10ml

Formulary

epinephrine solution auto-injector 0.15 mg/0.15ml injection0.15 mg/0.15ml

Formulary

epinephrine solution auto-injector 0.3 mg/0.3ml injection0.3 mg/0.3ml

Formulary

EPIPEN 2-PAK SOLUTION AUTO-INJECTOR 0.3 MG/0.3ML INJECTION 0.3 MG/0.3ML

Formulary

EPIPEN JR 2-PAK SOLUTION AUTO-INJECTOR 0.15 MG/0.3ML INJECTION 0.15 MG/0.3ML

Formulary

epirubicin hcl intravenous solution 200 mg/100ml, 50 mg/25ml

Formulary

EPISORB TRANSDERMAL Formulary OTC

EPITOL ORAL TABLET 200 MG Formulary

EPIVIR HBV ORAL SOLUTION 5 MG/ML Formulary

eplerenone oral tablet 25 mg, 50 mg Formulary

eprosartan mesylate oral tablet 600 mg Formulary ST

epsom salt oral granules Formulary OTC

epsom salt powder Formulary OTC

eq allergy relief childrens oral elixir 12.5 mg/5ml Formulary OTC

eq allergy relief oral tablet 10 mg Formulary OTC

eq allergy/sinus headache oral tablet 12.5-30-500 mg Formulary OTC

eq aspirin oral tablet delayed release 500 mg Formulary OTC

EQ BABY CHEST RUB EXTERNAL CREAM Formulary OTC

eq calcium citrate+d3 petites oral tablet 200-250 mg-unit Formulary OTC

eq cough sugar free mouth/throat lozenge 5.8 mg Formulary OTC

eq cryogenic wart removal sys external aerosol Formulary OTC

eq daily fiber oral capsule 400 mg Formulary OTC

eq dairy digestive fast acting oral tablet 9000 unit Formulary OTC

eq dairy digestive fast acting oral tablet chewable 9000 unit Formulary OTC

eq feminine wash sensitive vaginal liquid Formulary OTC

eq ibuprofen pm oral tablet 200-38 mg Formulary OTC

EQ MUCUS ER ORAL TABLET EXTENDED RELEASE 12 HOUR 600 MG

Formulary OTC

eq multi-symptom cold children oral liquid 2.5-5-100 mg/ml Formulary OTC

eq omeprazole oral tablet delayed release 20 mg Formulary OTC

eq pain relief/rapid burst oral liquid 500 mg/15ml Formulary OTC

eq sinus relief max st oral tablet 30-500 mg Formulary OTC

eq tioconazole 1 vaginal ointment 6.5 % Formulary OTC

eql 2 in 1 probiotic oral tablet Formulary OTC

eql advanced relief ophthalmic solution 0.05-0.1-1-1 % Formulary OTC

eql alcohol swabs pad 70 % 70 % Formulary OTC

52

Drug Name Formulary Status Requirements/Limitseql aller-ease oral tablet 180 mg Formulary OTC; QL (34 EA per 34 days)

eql allergy oral tablet 4 mg Formulary OTC

eql aloe vera after sun external gel Formulary OTC

eql antacid ultra strength oral tablet chewable 1000 mg Formulary OTC

eql antibacterial hand soap external liquid 0.13 % Formulary OTC

eql anti-nausea oral solution 1.87-1.87-21.5 Formulary OTC

eql biotin oral capsule 5000 mcg Formulary OTC

eql color lancets 21g Formulary OTC; QL (150 EA per 30 days)

eql color lancets micro 33g Formulary OTC; QL (150 EA per 30 days)

eql congestion relief oral tablet 10-200 mg Formulary OTC

eql denture brush/pick Formulary OTC

eql denture cleanser tablet effervescent Formulary OTC

eql digestive enzymes oral tablet Formulary OTC

eql ear drops otic solution Formulary OTC

eql effervescent cold relief oral tablet effervescent 2-7.8-325 mg

Formulary OTC

eql ethyl alcohol (rubbing) solution 70 % Formulary OTC

eql everyday clean external shampoo 1 % Formulary OTC

eql eye drops ac ophthalmic solution 0.05-0.25 % Formulary OTC

eql fiber therapy oral powder 48.57 % Formulary OTC

eql gas prevention oral capsule Formulary OTC

eql gentle skin cleanser external liquid Formulary OTC

eql insulin syringe 29g x 1/2" 0.3 ml 29g x 1/2" 0.3 ml Formulary OTC


eql insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC







eql lutein oral capsule 20 mg Formulary OTC

eql mouthwash/gargle mouth/throat liquid Formulary OTC

eql mucus-dm oral tablet extended release 12 hour 30-600 mg

Formulary OTC

eql multi-purpose solution Formulary OTC

eql omega 3 fish oil oral capsule delayed release 1200 mg Formulary OTC

eql omeprazole oral tablet delayed release 20 mg Formulary OTC

eql one daily womens oral tablet Formulary OTC

eql redness relief ophthalmic solution 0.012-0.2 % Formulary OTC

eql scalp relief max strength external liquid 3 % Formulary OTC

eql super thin lancets 30g Formulary OTC; QL (150 EA per 30 days)

eql thin lancets 26g Formulary OTC; QL (150 EA per 30 days)

eql ultra protection spf50 external aerosol Formulary OTC

53

Drug Name Formulary Status Requirements/Limitseql vitamin d3 oral capsule 400 unit Formulary OTC

eql wet cleansing towelettes external Formulary OTC

EQUALACTIN ORAL TABLET CHEWABLE 625 MG Formulary OTC

ERBITUX INTRAVENOUS SOLUTION 100 MG/50ML, 200 MG/100ML

Formulary PA

ergocalciferol oral capsule 50000 unit Formulary

ergocalciferol oral solution 8000 unit/ml Formulary OTC

ergoloid mesylates oral tablet 1 mg Formulary

ery external pad 2 % Formulary

ERYPED 200 ORAL SUSPENSION RECONSTITUTED 200 MG/5ML

Formulary

ERY-TAB ORAL TABLET DELAYED RELEASE 250 MG

Formulary

ERYTHROCIN LACTOBIONATE INTRAVENOUS SOLUTION RECONSTITUTED 500 MG

Formulary

ERYTHROCIN STEARATE ORAL TABLET 250 MG Formulary

erythromycin base oral capsule delayed release particles250 mg

Formulary

erythromycin ethylsuccinate oral suspension reconstituted200 mg/5ml

Formulary

erythromycin ethylsuccinate oral tablet 400 mg Formulary

erythromycin external gel 2 % Formulary

erythromycin external solution 2 % Formulary AGE (Max 18 Years)

erythromycin ophthalmic ointment 5 mg/gm Formulary

escavite lq oral liquid 0.25-6 mg/ml Formulary

escitalopram oxalate oral tablet 10 mg, 20 mg, 5 mg Formulary

esmolol hcl intravenous solution 100 mg/10ml Formulary

esomeprazole magnesium oral capsule delayed release 20 mg, 40 mg


ESOTERICA FADE NIGHTTIME EXTERNAL CREAM 2 %

Formulary OTC

ESOTERICA SENSITIVE SKIN EXTERNAL CREAM 1.5 %

Formulary OTC

ESTARYLLA ORAL TABLET 0.25-35 MG-MCG Formulary QL (28 EA per 28 days)

estazolam oral tablet 1 mg, 2 mg Formulary

estradiol oral tablet 0.5 mg, 1 mg, 2 mg Formulary

estradiol transdermal patch twice weekly 0.025 mg/24hr, 0.0375 mg/24hr, 0.05 mg/24hr, 0.075 mg/24hr


estradiol transdermal patch twice weekly 0.1 mg/24hr Formulary QL (8 EA per 28 days)

estradiol transdermal patch weekly 0.025 mg/24hr, 0.0375 mg/24hr, 0.05 mg/24hr, 0.06 mg/24hr, 0.075 mg/24hr, 0.1 mg/24hr


estradiol valerate intramuscular oil 20 mg/ml, 40 mg/ml Formulary

estradiol-norethindrone acet oral tablet 0.5-0.1 mg, 1-0.5 mg

Formulary

estro support es oral tablet Formulary OTC

estropipate oral tablet 0.75 mg Formulary

54

Drug Name Formulary Status Requirements/Limitseszopiclone oral tablet 1 mg, 2 mg, 3 mg Formulary QL (30 EA per 30 days)

ethambutol hcl oral tablet 100 mg, 400 mg Formulary

ethosuximide oral capsule 250 mg Formulary

ethosuximide oral solution 250 mg/5ml Formulary

ethoxy diglycol liquid Formulary

ethyl alcohol (rubbing) solution 70 % Formulary OTC

ethyl alcohol external solution 95 % Formulary OTC

ethyl alcohol solution 100 % Formulary

ethyl chloride external aerosol Formulary

ethyl oleate liquid Formulary

etidronate disodium oral tablet 200 mg, 400 mg Formulary

etodolac er oral tablet extended release 24 hour 400 mg, 500 mg, 600 mg

Formulary

etodolac oral capsule 200 mg, 300 mg Formulary

etodolac oral tablet 400 mg, 500 mg Formulary

ETOPOPHOS INTRAVENOUS SOLUTION RECONSTITUTED 100 MG

Formulary

etoposide intravenous solution 1 gm/50ml, 100 mg/5ml Formulary

etoposide oral capsule 50 mg Formulary

eucalyptol liquid Formulary

eucalyptus oil external oil Formulary OTC

eucalyptus oil oil Formulary

EUCERIN ECZEMA RELIEF EXTERNAL CREAM 1 % Formulary OTC

EUCERIN EXTERNAL CREAM Formulary OTC

EUCERIN ORIGINAL HEALING EXTERNAL LOTION Formulary OTC

EUFLEXXA INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE 20 MG/2ML

Formulary PA

eugenol solution Formulary

EURAX EXTERNAL CREAM 10 % Formulary ST

EVAC-U-GEN ORAL TABLET 8.6 MG Formulary OTC

evening primrose oil oral capsule 1000 mg, 500 mg Formulary OTC

EXACTECH R-S-G TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days)

EXACTECH TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days)

EXACTUSS TR ORAL TABLET 10-28-388 MG Formulary OTC

EXAPHEN CH ORAL TABLET 10-3.5-24 MG Formulary OTC

EXAPHEN ORAL TABLET 3.5-10 MG Formulary OTC

EXAPHEX TR ORAL TABLET 10-388 MG Formulary OTC

EXCEDRIN PM ORAL TABLET 500-38 MG Formulary OTC

EXCEDRIN TENSION HEADACHE ORAL TABLET 500-65 MG

Formulary OTC

EXCEL AP EXTERNAL SWAB 7.5-72 % Formulary OTC

EXCEL-GEL EXTERNAL GEL Formulary OTC

EXEL COMFORT POINT INSULIN SYR 28G X 1/2" 0.5 ML 28G X 1/2" 0.5 ML

Formulary OTC

55

Drug Name Formulary Status Requirements/LimitsEXEL COMFORT POINT INSULIN SYR 28G X 1/2" 1 ML 28G X 1/2" 1 ML

Formulary OTC


Formulary OTC


Formulary OTC

EXEL COMFORT POINT INSULIN SYR 29G X 1/2" 1 ML 29G X 1/2" 1 ML

Formulary OTC


Formulary OTC


Formulary OTC

EXEL COMFORT POINT INSULIN SYR 30G X 5/16" 1 ML 30G X 5/16" 1 ML

Formulary OTC

EXELON TRANSDERMAL PATCH 24 HOUR 13.3 MG/24HR, 4.6 MG/24HR, 9.5 MG/24HR

Formulary

exemestane oral tablet 25 mg Formulary

EXFOLIX EXFOLIATING FOOT SOAP EXTERNAL BAR

Formulary OTC

EXJADE ORAL TABLET SOLUBLE 125 MG, 250 MG, 500 MG

Formulary PA

EX-LAX MAXIMUM STRENGTH ORAL TABLET 25 MG

Formulary OTC

EX-LAX ORAL TABLET 15 MG Formulary OTC

EX-LAX ORAL TABLET CHEWABLE 15 MG Formulary OTC

exoten-c pain relief external lotion 0.001-10-20 %, 0.025-10-20 %

Formulary OTC

exotic-hc otic solution 10-10-1 mg/ml Formulary

EXTRESS-30 ORAL CAPSULE EXTENDED RELEASE Formulary OTC

eye allergy relief ophthalmic solution 0.027-0.315 % Formulary OTC

eye drops ophthalmic solution 0.012-0.2 % Formulary OTC

eye itch relief ophthalmic solution 0.025 % Formulary OTC

EYE STREAM OPHTHALMIC SOLUTION Formulary OTC

E-Z JECT LANCET MICRO-THIN 33G Formulary OTC; QL (150 EA per 30 days)

E-Z JECT LANCET SUPER THIN 30G Formulary OTC; QL (150 EA per 30 days)

E-Z JECT LANCETS Formulary OTC; QL (150 EA per 30 days)

E-Z JECT LANCETS 21G Formulary OTC; QL (150 EA per 30 days)

E-Z JECT LANCETS THIN 26G Formulary OTC; QL (150 EA per 30 days)

EZ SMART BLOOD GLUCOSE LANCETS Formulary OTC; QL (150 EA per 30 days)

ezetimibe oral tablet 10 mg Formulary

ezetimibe-simvastatin oral tablet 10-10 mg, 10-20 mg, 10-40 mg, 10-80 mg

Formulary ST

EZFE 200 ORAL CAPSULE 434.8 (200 FE) MG Formulary OTC

E-Z-GAS II ORAL PACKET 2.21-1.53-0.04 GM Formulary OTC

EZ-LETS LANCETS 21G Formulary OTC; QL (150 EA per 30 days)



56

Drug Name Formulary Status Requirements/Limitsfabb oral tablet 2.2-25-1 mg Formulary

face mask respirator r-95 part Formulary

FAGRON VERSIFIX TRANSDERMAL LIQUID Formulary OTC

famciclovir oral tablet 125 mg, 250 mg, 500 mg Formulary

famotidine oral suspension reconstituted 40 mg/5ml Formulary

famotidine oral tablet 10 mg Formulary OTC

famotidine oral tablet 40 mg Formulary

FARESTON ORAL TABLET 60 MG Formulary

FARXIGA ORAL TABLET 10 MG, 5 MG Formulary AGE (Min 18 Years)

FASLODEX INTRAMUSCULAR SOLUTION 250 MG/5ML

Formulary

FAST FREEZE PRO STYLE THERAPY EXTERNAL GEL 3.5 %

Formulary OTC

FAST FREEZE PRO STYLE THERAPY EXTERNAL LIQUID 3.5 %

Formulary OTC

fast-heat heating pad pad Formulary OTC

father johns medicine oral syrup 10 mg/5ml Formulary OTC

FATTYBLEND Formulary OTC

fa-vitamin b-6-vitamin b-12 oral tablet 2.2-25-0.5 mg Formulary

FAYOSIM ORAL TABLET 42-21-21-7 DAYS Formulary QL (91 EA per 91 days)

FC FEMALE CONDOM Formulary OTC

fd&c blue #2 powder Formulary OTC

fd&c red #40 aluminum lake powder Formulary OTC

fd&c yellow #5 powder Formulary

fdc blue 1 powder Formulary

fdc green #3 powder Formulary

fdc red #3 powder Formulary

fdc yellow 6 powder Formulary

FEIBA INTRAVENOUS SOLUTION RECONSTITUTED Formulary

felbamate oral suspension 600 mg/5ml Formulary

felbamate oral tablet 400 mg, 600 mg Formulary

felodipine er oral tablet extended release 24 hour 10 mg, 2.5 mg, 5 mg

Formulary

FEM PH VAGINAL GEL 0.9-0.025 % Formulary

FEMINEASE VAGINAL CREAM Formulary OTC

fenofibrate micronized oral capsule 134 mg, 200 mg, 67 mg Formulary

fenofibrate oral tablet 145 mg, 160 mg, 48 mg, 54 mg Formulary

fenofibric acid oral capsule delayed release 135 mg, 45 mg Formulary

fenofibric acid tablet 105 mg oral 105 mg Formulary

fenofibric acid tablet 35 mg oral 35 mg Formulary

fenoprofen calcium capsule 200 mg oral 200 mg Formulary

fentanyl citrate (pf) injection solution cartridge 100 mcg/2ml

Formulary

fentanyl citrate buccal lozenge on a handle 1200 mcg, 1600 mcg, 200 mcg, 400 mcg, 600 mcg, 800 mcg


57

Drug Name Formulary Status Requirements/Limitsfentanyl transdermal patch 72 hour 100 mcg/hr, 12 mcg/hr, 25 mcg/hr, 50 mcg/hr, 75 mcg/hr


FER-IN-SOL ORAL SOLUTION 75 (15 FE) MG/ML Formulary OTC

ferocon oral capsule Formulary

ferraplus 90 oral tablet 90-1 mg Formulary

ferretts chewable iron oral tablet chewable 18 mg Formulary OTC

ferretts ips oral solution 40 mg/15ml Formulary OTC

ferretts oral tablet 325 (106 fe) mg Formulary OTC

FERREX 150 FORTE PLUS ORAL CAPSULE 50-100 MG

Formulary OTC

ferrex 150 oral capsule 150 mg Formulary OTC

FERREX 28 ORAL Formulary OTC

ferric subsulfate powder Formulary OTC

ferric subsulfate solution Formulary

FERRIMIN 150 ORAL TABLET 150 MG Formulary OTC

FERROCITE ORAL TABLET 324 MG Formulary OTC

FERROCITE PLUS ORAL TABLET 106-1 MG Formulary

ferrous gluconate oral tablet 324 (37.5 fe) mg, 324 (38 fe) mg

Formulary OTC

ferrous sulfate er oral tablet extended release 140 (45 fe) mg

Formulary OTC

ferrous sulfate granules Formulary

ferrous sulfate oral elixir 220 (44 fe) mg/5ml Formulary OTC

ferrous sulfate oral liquid 220 (44 fe) mg/5ml Formulary OTC

ferrous sulfate oral syrup 300 (60 fe) mg/5ml Formulary OTC

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

Formulary OTC

ferrous sulfate powder Formulary

FEVERALL INFANTS RECTAL SUPPOSITORY 80 MG Formulary OTC

FEVERALL JUNIOR STRENGTH RECTAL SUPPOSITORY 325 MG

Formulary OTC

fexofenadine hcl childrens oral suspension 30 mg/5ml Formulary OTC

fiber laxative oral tablet 625 mg Formulary OTC

fiber oral powder Formulary OTC

FIBERCON ORAL TABLET 625 MG Formulary OTC

FIBEREX F15 ORAL LIQUID 15 GM/30ML Formulary OTC

FIFTY50 ALCOHOL PREP PAD 70 % 70 % Formulary OTC

FIFTY50 SUPERIOR COMFORT SYR 31G X 5/16" 0.3 ML 31G X 5/16" 0.3 ML

Formulary OTC

FIFTY50 SUPERIOR COMFORT SYR 31G X 5/16" 0.5 ML 31G X 5/16" 0.5 ML

Formulary OTC

FIFTY50 SUPERIOR COMFORT SYR 31G X 5/16" 1 ML 31G X 5/16" 1 ML

Formulary OTC

filter needle 18g x 1-1/2" Formulary

finasteride oral tablet 5 mg Formulary

FINE 30 Formulary OTC; QL (150 EA per 30 days)

58

Drug Name Formulary Status Requirements/LimitsFIRAZYR SUBCUTANEOUS SOLUTION 30 MG/3ML Formulary PA; QL (24 ML per 14 days)

first aid antibiotic external ointment 4 % Formulary OTC

first aid antiseptic spray external aerosol 20-0.13 % Formulary OTC

fish oil + d3 oral capsule 1000-1000 mg-unit Formulary OTC

fish oil adult gummies oral tablet chewable 113.5 mg Formulary OTC

fish oil oral capsule 1200 mg, 500 mg, 600 mg Formulary OTC

fish oil oral capsule delayed release 1000 mg Formulary OTC

fish oil-flax oil-borage oil oral capsule Formulary OTC

flavor packets oral packet Formulary OTC

flavoxate hcl oral tablet 100 mg Formulary

flecainide acetate oral tablet 100 mg, 150 mg, 50 mg Formulary

FLEET BISACODYL RECTAL ENEMA 10 MG/30ML Formulary OTC

FLEET LIQUID GLYCERIN SUPP RECTAL ENEMA 5.4 GM/DOSE

Formulary OTC

FLEET NATURALS CLEANSING ENEMA RECTAL ENEMA

Formulary OTC

FLEET OIL RECTAL ENEMA Formulary OTC

FLEET PEDIATRIC RECTAL ENEMA 3.5-9.5 GM/59ML Formulary OTC

FLEXICHAMBER CHILD MASK/LARGE Formulary

FLEXICHAMBER DEVICE Formulary QL (2 EA per 365 days)

FLINTSTONES TODDLER ORAL TABLET CHEWABLE 40 MG

Formulary OTC

FLOGEN ORAL TABLET 250-650 MG Formulary OTC

FLONASE ALLERGY RELIEF SUSPENSION 50 MCG/ACT NASAL 50 MCG/ACT

Formulary OTC

FLONASE SENSIMIST NASAL SUSPENSION 27.5 MCG/SPRAY

Formulary OTC

FLORA ASSIST ORAL PACKET Formulary OTC

FLORANEX ORAL PACKET Formulary OTC

FLORASTOR KIDS ORAL PACKET 250 MG Formulary OTC

FLORASTOR ORAL CAPSULE 250 MG Formulary OTC

FLORICAL ORAL CAPSULE 8.3-364 MG Formulary OTC

FLORICAL ORAL TABLET 8.3-364 MG Formulary OTC

FLOVENT DISKUS INHALATION AEROSOL POWDER BREATH ACTIVATED 100 MCG/BLIST, 250 MCG/BLIST, 50 MCG/BLIST

Formulary

FLOVENT HFA INHALATION AEROSOL 110 MCG/ACT, 220 MCG/ACT, 44 MCG/ACT

Formulary

flow-eze vented needle Formulary OTC

floxuridine injection solution reconstituted 0.5 gm Formulary

flu hbp oral tablet 15-500-2 mg Formulary OTC

FLUCAINE OPHTHALMIC SOLUTION 0.25-0.5 % Formulary

FLUCELVAX QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.5 ML

Formulary

fluconazole oral suspension reconstituted 10 mg/ml, 40 mg/ml

Formulary

59

Drug Name Formulary Status Requirements/Limitsfluconazole oral tablet 100 mg, 150 mg, 200 mg, 50 mg Formulary

fludarabine phosphate intravenous solution 50 mg/2ml Formulary

fludarabine phosphate intravenous solution reconstituted 50 mg

Formulary

fludrocortisone acetate oral tablet 0.1 mg Formulary

flunisolide nasal solution 25 mcg/act (0.025%) Formulary QL (3 ML per 34 days)

fluocinolone acetonide body external oil 0.01 % Formulary

fluocinolone acetonide external cream 0.01 %, 0.025 % Formulary

fluocinolone acetonide external ointment 0.025 % Formulary

fluocinolone acetonide external solution 0.01 % Formulary

fluocinolone acetonide otic oil 0.01 % Formulary

fluocinolone acetonide scalp external oil 0.01 % Formulary

fluocinonide external cream 0.05 %, 0.1 % Formulary

fluocinonide external gel 0.05 % Formulary

fluocinonide external ointment 0.05 % Formulary

fluocinonide external solution 0.05 % Formulary

fluoride mouth rinse mouth/throat solution 0.0221 (0.01 f) %

Formulary OTC

fluorometholone ophthalmic suspension 0.1 % Formulary

fluorouracil external cream 5 % Formulary

fluorouracil external solution 2 %, 5 % Formulary

fluorouracil intravenous solution 1 gm/20ml Formulary

fluoxetine hcl (pmdd) oral capsule 10 mg, 20 mg Formulary

fluoxetine hcl oral capsule 10 mg, 20 mg, 40 mg Formulary

fluoxetine hcl oral solution 20 mg/5ml Formulary

fluoxetine hcl oral tablet 10 mg Formulary QL (34 EA per 34 days)

fluphenazine decanoate injection solution 25 mg/ml Formulary AGE (Min 18 Years)

fluphenazine hcl injection solution 2.5 mg/ml Formulary AGE (Min 18 Years)

fluphenazine hcl oral concentrate 5 mg/ml Formulary AGE (Min 18 Years)

fluphenazine hcl oral elixir 2.5 mg/5ml Formulary AGE (Min 18 Years)

fluphenazine hcl oral tablet 1 mg, 10 mg, 2.5 mg, 5 mg Formulary AGE (Min 18 Years)

flurazepam hcl oral capsule 15 mg, 30 mg Formulary QL (68 EA per 34 days)

flurbiprofen oral tablet 100 mg, 50 mg Formulary

flurbiprofen sodium ophthalmic solution 0.03 % Formulary

flutamide oral capsule 125 mg Formulary

fluticasone propionate external cream 0.05 % Formulary

fluticasone propionate external ointment 0.005 % Formulary

fluticasone propionate nasal suspension 50 mcg/act Formulary

fluticasone-salmeterol inhalation aerosol powder breath activated 113-14 mcg/act, 232-14 mcg/act, 55-14 mcg/act


FLUVIRIN INTRAMUSCULAR SUSPENSION Formulary AGE (Min 19 Years)

fluvoxamine maleate oral tablet 100 mg, 25 mg, 50 mg Formulary

FLUZONE HIGH-DOSE INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.5 ML


60

Drug Name Formulary Status Requirements/LimitsFLUZONE QUADRIVALENT INTRAMUSCULAR SUSPENSION 0.5 ML


FLUZONE QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.25 ML, 0.5 ML


FOCALIN ORAL TABLET 10 MG, 2.5 MG, 5 MG Formulary AGE (Min 4 Years and Max 17 Years)

FOCALIN XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR 10 MG, 15 MG, 20 MG, 25 MG, 30 MG, 35 MG, 40 MG, 5 MG


FOILLE EXTERNAL OINTMENT 5-0.1 % Formulary OTC

FOLET DHA ORAL THERAPY PACK 38-1 & 350 MG Formulary

FOLGARD ORAL TABLET Formulary OTC

FOLGARD OS ORAL TABLET 500-1.1 MG Formulary

FOLIC + B12 ORAL TABLET 800-1000 MCG Formulary OTC

folic acid oral capsule 0.8 mg, 20 mg, 5 mg Formulary OTC

folic acid oral tablet 1 mg Formulary

folic acid oral tablet 400 mcg, 800 mcg Formulary OTC

folic acid powder Formulary

folinic-plus oral tablet 4-50-2 mg Formulary OTC

FOLITAB 500 ORAL TABLET EXTENDED RELEASE 105-500-0.8 MG

Formulary OTC

FOLIVANE-F ORAL CAPSULE 125-1 MG Formulary

FOLIVANE-PLUS ORAL CAPSULE Formulary

FOLOTYN INTRAVENOUS SOLUTION 20 MG/ML Formulary

food color black powder Formulary

food color blue powder Formulary

food color blue royal powder Formulary OTC

food color brown powder Formulary

food color flesh powder Formulary OTC

food color green powder Formulary

food color lime green powder Formulary

food color orange powder Formulary

food color red powder Formulary

food color yellow powder Formulary

FORA D40 GLUCOSE/PRESSURE DEVICE Formulary OTC

FORA LANCETS Formulary OTC; QL (150 EA per 30 days)

FORMADON EXTERNAL SOLUTION 10 % Formulary

formaldehyde external solution 37 % Formulary

FORMA-RAY EXTERNAL SOLUTION 20 % Formulary

FORTEO SUBCUTANEOUS SOLUTION 600 MCG/2.4ML

Formulary PA; QL (2.4 ML per 90 days)

fosamprenavir calcium oral tablet 700 mg Formulary

fosinopril sodium oral tablet 10 mg, 20 mg, 40 mg Formulary

fosinopril sodium-hctz oral tablet 10-12.5 mg, 20-12.5 mg Formulary

fosphenytoin sodium injection solution 100 mg pe/2ml, 500 mg pe/10ml

Formulary

freds pharmacy unilet lanc 28g Formulary OTC; QL (150 EA per 30 days)

61

Drug Name Formulary Status Requirements/LimitsFREE & CLEAR EXTERNAL LIQUID Formulary OTC

FREE & CLEAR EXTERNAL SHAMPOO Formulary OTC

freedom cepapro gel Formulary

FREEDOM ODT BASE POWDER Formulary

FREESTYLE CONTROL SOLUTION LIQUID IN VITRO Formulary OTC; QL (100 EA per 30 days)

FREESTYLE FLASH SYSTEM KIT Formulary OTC; QL (1 EA per 365 days)

FREESTYLE FREEDOM KIT Formulary OTC; QL (1 EA per 365 days)

FREESTYLE FREEDOM LITE KIT W/DEVICE W/DEVICE


FREESTYLE INSULINX SYSTEM KIT W/DEVICE W/DEVICE


FREESTYLE INSULINX TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days)

FREESTYLE LANCETS Formulary OTC; QL (150 EA per 30 days)

FREESTYLE LIBRE 14 DAY READER DEVICE Formulary

FREESTYLE LIBRE 14 DAY SENSOR Formulary

FREESTYLE LIBRE READER DEVICE Formulary QL (1 EA per 365 days)

FREESTYLE LIBRE SENSOR SYSTEM Formulary QL (3 EA per 30 days)

FREESTYLE LITE TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days)

FREESTYLE PRECISION INS SYR 30G X 5/16" 0.5 ML 30G X 5/16" 0.5 ML

Formulary OTC

FREESTYLE PRECISION INS SYR 30G X 5/16" 1 ML 30G X 5/16" 1 ML

Formulary OTC

FREESTYLE PRECISION INS SYR 31G X 5/16" 0.5 ML 31G X 5/16" 0.5 ML

Formulary OTC

FREESTYLE PRECISION INS SYR 31G X 5/16" 1 ML 31G X 5/16" 1 ML

Formulary OTC

FREESTYLE PRECISION NEO SYSTEM KIT W/DEVICE


FREESTYLE SIDEKICK II KIT Formulary OTC; QL (1 EA per 365 days)

FREESTYLE SYSTEM KIT Formulary OTC; QL (1 EA per 365 days)

FREESTYLE TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days)

fructose granules Formulary

fruit c oral tablet chewable 100 mg Formulary OTC

fullers earth powder Formulary

FUNGI-NAIL EXTERNAL SOLUTION 25 % Formulary OTC

FUNGI-NAIL TOE & FOOT EXTERNAL OINTMENT 5-20 %

Formulary OTC

FUNGOID TINCTURE EXTERNAL KIT 2 % Formulary OTC

FUNGOID TINCTURE EXTERNAL SOLUTION 2 % Formulary OTC

FUNGOID-D EXTERNAL CREAM 1 % Formulary OTC

furosemide oral solution 10 mg/ml Formulary

furosemide oral tablet 20 mg, 40 mg, 80 mg Formulary

FUSION ORAL CAPSULE 65-65-25-30 MG Formulary OTC

FUZEON SUBCUTANEOUS SOLUTION RECONSTITUTED 90 MG

Formulary PA

FYAVOLV ORAL TABLET 1-5 MG-MCG Formulary

62

Drug Name Formulary Status Requirements/Limitsgabapentin oral capsule 100 mg, 300 mg, 400 mg Formulary

gabapentin oral solution 250 mg/5ml Formulary

gabapentin oral tablet 600 mg, 800 mg Formulary

GABITRIL ORAL TABLET 12 MG, 16 MG, 2 MG, 4 MG Formulary

galantamine hydrobromide er oral capsule extended release 24 hour 16 mg, 24 mg, 8 mg

Formulary

galantamine hydrobromide oral solution 4 mg/ml Formulary

galantamine hydrobromide oral tablet 12 mg, 4 mg, 8 mg Formulary

garlic/epa oral capsule 60-90-250 mg Formulary OTC

garlic-lecithin oral capsule 192-650 mg Formulary OTC

garlic-parsley oral tablet 100-175 mg Formulary OTC

gas relief oral liquid 40 mg/0.6ml Formulary OTC

GASTROCROM ORAL CONCENTRATE 100 MG/5ML Formulary

GAS-X CHILDRENS ORAL STRIP 40 MG Formulary OTC

GAS-X EXTRA STRENGTH ORAL STRIP 62.5 MG Formulary OTC

GAS-X EXTRA STRENGTH ORAL TABLET CHEWABLE 125 MG

Formulary OTC

GAS-X ORAL TABLET CHEWABLE 80 MG Formulary OTC

GAS-X PREVENTION ORAL CAPSULE Formulary OTC

GAS-X WITH MAALOX EX ST ORAL TABLET CHEWABLE 500-125 MG

Formulary OTC

GAVILYTE-C ORAL SOLUTION RECONSTITUTED 240 GM

Formulary

GAVILYTE-G ORAL SOLUTION RECONSTITUTED 236 GM

Formulary

GAVILYTE-N WITH FLAVOR PACK ORAL SOLUTION RECONSTITUTED 420 GM

Formulary

GAVISCON EXTRA STRENGTH ORAL SUSPENSION 254-237.5 MG/5ML

Formulary OTC

GAVISCON EXTRA STRENGTH ORAL TABLET CHEWABLE 160-105 MG

Formulary OTC

GAVISCON ORAL SUSPENSION 95-358 MG/15ML Formulary OTC

GAVISCON ORAL TABLET CHEWABLE 80-14.2 MG Formulary OTC

G-BUCAL-C MOUTH/THROAT SOLUTION 0.15-0.1 % Formulary OTC

G-DOLOGEN ORAL TABLET 2-650 MG Formulary OTC

ge-150 oral capsule 150 mg Formulary OTC

GEBAUERS INSTANT ICE EXTERNAL AEROSOL Formulary OTC

gelatin oral capsule 650 mg Formulary OTC

GELFOAM SPONGE EXTERNAL 12-7 MM Formulary

GELFOAM SPONGE SIZE 100 EXTERNAL Formulary

GEL-KAM DENTAL GEL 0.4 % Formulary OTC

GELONASAL NASAL SOLUTION Formulary OTC

GELUSIL ORAL TABLET CHEWABLE 200-200-25 MG Formulary OTC

gemcitabine hcl intravenous solution 1 gm/26.3ml, 2 gm/52.6ml, 200 mg/5.26ml

Formulary

63

Drug Name Formulary Status Requirements/Limitsgemcitabine hcl intravenous solution reconstituted 1 gm, 2 gm, 200 mg

Formulary

gemfibrozil oral tablet 600 mg Formulary

GENCONTUSS ORAL LIQUID 5-2-10 MG/5ML Formulary OTC

GENOTROPIN MINIQUICK SOLUTION RECONSTITUTED 0.2 MG SUBCUTANEOUS 0.2 MG

Formulary PA; AGE (Max 18 Years)







GENOTROPIN MINIQUICK SOLUTION RECONSTITUTED 1 MG SUBCUTANEOUS 1 MG










GENOTROPIN MINIQUICK SOLUTION RECONSTITUTED 2 MG SUBCUTANEOUS 2 MG


GENOTROPIN SOLUTION RECONSTITUTED 12 MG SUBCUTANEOUS 12 MG


GENOTROPIN SOLUTION RECONSTITUTED 5 MG SUBCUTANEOUS 5 MG


gentamicin sulfate external cream 0.1 % Formulary

gentamicin sulfate external ointment 0.1 % Formulary

gentamicin sulfate ophthalmic solution 0.3 % Formulary

GENTEAL MILD OPHTHALMIC SOLUTION 0.2 % Formulary OTC

GENTEAL MILD TO MODERATE OPHTHALMIC SOLUTION 0.3 %

Formulary OTC

GENTEAL OPHTHALMIC GEL 0.25-0.3 % Formulary OTC

GENTEAL TEARS PF OPHTHALMIC SOLUTION 0.1-0.3 %

Formulary OTC

gentian violet external solution 1 %, 2 % Formulary OTC

gentle laxative rectal suppository 10 mg Formulary OTC

GENTLE RAIN EXTERNAL LIQUID 0.3 % Formulary OTC

gentle skin cleanser external lotion Formulary OTC

GENTLE-LET GP LANCETS Formulary OTC; QL (150 EA per 30 days)

GENTLE-LET LANCETS Formulary OTC; QL (150 EA per 30 days)

GENVOYA ORAL TABLET 150-150-200-10 MG Formulary

geravine oral elixir Formulary OTC

geriatric vitamin oral liquid 100-1-10 Formulary OTC

gerisilk bath oil external oil Formulary OTC

GERMBLOC HEALTH EXTERNAL FOAM 0.1 % Formulary OTC

64

Drug Name Formulary Status Requirements/LimitsGILENYA ORAL CAPSULE 0.5 MG Formulary ST

GILTUSS COUGH & COLD ORAL LIQUID 10-29-390 MG/5ML

Formulary OTC

ginger root oral capsule 500 mg Formulary OTC

ginseng oral capsule 250 mg, 50 mg Formulary OTC

gla-45 oral capsule 45 mg Formulary OTC

glass syringe 3 ml kit Formulary

glatiramer acetate subcutaneous solution prefilled syringe20 mg/ml, 40 mg/ml

Formulary

glen pe oral liquid 16-5 mg/5ml Formulary OTC

glenmax peb dm forte oral liquid 10-4-20 mg/5ml Formulary OTC

glenmax peb dm oral liquid 5-2-10 mg/5ml Formulary OTC; AGE (Min 2 Years)

glenmax peb oral liquid 4-10 mg/5ml Formulary OTC

glentuss oral liquid 30-6.25-15 mg/5ml Formulary OTC

g-levocarnitine s/f oral solution 1 gm/10ml Formulary OTC

glimepiride oral tablet 1 mg, 2 mg, 4 mg Formulary

glipizide er oral tablet extended release 24 hour 10 mg, 2.5 mg, 5 mg

Formulary

glipizide oral tablet 10 mg, 5 mg Formulary

glipizide xl oral tablet extended release 24 hour 10 mg, 2.5 mg, 5 mg

Formulary

glipizide-metformin hcl oral tablet 2.5-250 mg, 2.5-500 mg, 5-500 mg

Formulary

global inject ease insulin syr 29g x 1/2" 1 ml 29g x 1/2" 1 ml

Formulary OTC

global inject ease insulin syr 30g x 1/2" 1 ml 30g x 1/2" 1 ml

Formulary OTC

global insulin syringes 30g x 5/16" 0.3 ml 30g x 5/16" 0.3 ml

Formulary OTC

GLUCAGEN HYPOKIT INJECTION SOLUTION RECONSTITUTED 1 MG


GLUCAGON EMERGENCY INJECTION KIT 1 MG Formulary QL (2 EA per 34 days)

GLUCOCOM AUTOLINK TELEMONITOR Formulary OTC

GLUCOCOM LANCETS 28G Formulary OTC; QL (150 EA per 30 days)



GLUCOPRO INSULIN SYRINGE 30G X 1/2" 0.3 ML 30G X 1/2" 0.3 ML

Formulary OTC


Formulary OTC

GLUCOPRO INSULIN SYRINGE 30G X 1/2" 1 ML 30G X 1/2" 1 ML

Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC

65

Drug Name Formulary Status Requirements/LimitsGLUCOPRO INSULIN SYRINGE 31G X 5/16" 0.3 ML 31G X 5/16" 0.3 ML

Formulary OTC


Formulary OTC


Formulary OTC

glucosamine chond complex/msm oral tablet Formulary OTC

glucosamine chondroitin complx oral capsule 500-250 mg Formulary OTC

glucosamine complex/vitamin d3 oral tablet Formulary OTC

glucosamine hcl oral tablet 1500 mg Formulary OTC

glucosamine hcl powder Formulary

glucosamine sulfate oral capsule 1000 mg, 500 mg Formulary OTC

glucosamine sulfate oral tablet 1000 mg Formulary OTC

glucosamine sulfate powder Formulary

glucosamine-chondroitin oral capsule 250-200 mg, 500-400 mg

Formulary OTC

glucosamine-chondroitin oral liquid 1500-1200 mg/30ml Formulary OTC

glucosamine-chondroitin oral tablet 500-400 mg, 750-600 mg

Formulary OTC

glucosamine-chondroitin-msm oral tablet 400-333.3-200 mg, 500-400-167 mg

Formulary OTC

glucosamine-chondroitin-vit d3 oral packet 1500-1200-800 mg-mg-unit

Formulary OTC

glucosamine-msm oral liquid 1500-500 mg/30ml Formulary OTC

GLUCOSE NURSETTE ORAL SOLUTION 5 % Formulary OTC

glucose oral gel 40 % Formulary OTC

glucose oral liquid 15 gm/59ml Formulary OTC

glucose oral tablet chewable 4 gm, 4-6 gm-mg Formulary OTC

glutamine oral capsule 500 mg Formulary OTC

glutamine powder Formulary

glutathione oral tablet 50 mg Formulary OTC

glutol oral liquid Formulary OTC

glyburide micronized oral tablet 1.5 mg, 3 mg, 6 mg Formulary

glyburide oral tablet 1.25 mg, 2.5 mg, 5 mg Formulary

glyburide-metformin oral tablet 1.25-250 mg, 2.5-500 mg, 5-500 mg

Formulary

glycerin (adult) rectal suppository 2 gm Formulary OTC

glycerin (infants & children) rectal suppository 1 gm, 1.2 gm

Formulary OTC

glycerin external liquid Formulary OTC

glycerin liquid Formulary

glycerin solution Formulary

glyceryl monostearate flakes Formulary

glycine powder Formulary

glycine500 oral packet 500 mg Formulary OTC

glycolic acid crystals Formulary

66

Drug Name Formulary Status Requirements/Limitsglycolic acid solution 70 % Formulary

glycopyrrolate oral tablet 1 mg, 2 mg Formulary

GLYDO EXTERNAL GEL 2 % Formulary

GLYXAMBI ORAL TABLET 10-5 MG, 25-5 MG Formulary PA

g-myco nail external solution Formulary OTC

gnp 24 hour nasal allergy aerosol 55 mcg/act nasal 55 mcg/act

Formulary OTC

gnp 4x probiotic oral tablet Formulary OTC

gnp advanced eye health oral capsule 250-2.5-0.5 mg Formulary OTC

gnp alcohol denatured solution Formulary OTC

gnp alcohol swabs pad 70 % 70 % Formulary OTC

gnp animal shapes plus iron oral tablet chewable 15 mg Formulary OTC

gnp b-50 complex oral tablet extended release Formulary OTC

gnp b-complex plus vitamin c oral tablet Formulary OTC

gnp calamine external lotion 8-8 % Formulary OTC

gnp calcium 600 plus d/mineral oral tablet 600-400 mg-unit Formulary OTC

gnp calcium plus 600 +d oral tablet 600-200 mg-unit Formulary OTC

gnp capsaicin external liquid 0.15 % Formulary OTC

gnp childrens chewables/ex c oral tablet chewable Formulary OTC

gnp coq-10 & fish oil oral capsule 120-180-50-30 Formulary OTC

gnp ethyl alcohol solution 70 % Formulary OTC

gnp fish oil oral capsule 435 mg Formulary OTC

gnp gentian violet external solution 1 % Formulary OTC

gnp glycerin/rose water external solution 10 % Formulary OTC

gnp headache relief extra str oral tablet 250-250-65 mg Formulary OTC

gnp insulin syringe 28g x 1/2" 0.5 ml 28g x 1/2" 0.5 ml Formulary OTC

gnp insulin syringe 28g x 1/2" 1 ml 28g x 1/2" 1 ml Formulary OTC










gnp iodides external tincture Formulary OTC

gnp iodine external tincture Formulary OTC

gnp isopropyl alcohol wipes 70 % external 70 % Formulary OTC

gnp lancets Formulary OTC; QL (150 EA per 30 days)

gnp lancets 21g Formulary OTC; QL (150 EA per 30 days)

gnp lancets micro thin 33g Formulary OTC; QL (150 EA per 30 days)

gnp lancets super thin 30g Formulary OTC; QL (150 EA per 30 days)

gnp lancets thin 26g Formulary OTC; QL (150 EA per 30 days)

67

Drug Name Formulary Status Requirements/Limitsgnp lice egg remover external gel Formulary OTC

gnp liquid bandage external liquid 0.75-0.2 % Formulary OTC

gnp l-lysine oral tablet 600 mg Formulary OTC

gnp micro thin lancets 33g Formulary OTC; QL (150 EA per 30 days)

gnp niacin oral tablet 250 mg Formulary OTC

gnp omeprazole oral tablet delayed release 20 mg Formulary OTC

gnp pain relief/benzocaine external pad 6-70 % Formulary OTC

gnp peppermint spirit spirit Formulary OTC

gnp potassium oral tablet 99 mg Formulary OTC

gnp shampoo & body wash external liquid Formulary OTC

gnp sinus wash refill nasal packet 2300-700 mg Formulary OTC

gnp sodium silicate solution Formulary OTC

gnp super thin lancets 30g Formulary OTC; QL (150 EA per 30 days)

gnp terbinafine hydrochloride external cream 1 % Formulary OTC

gnp ultra com insulin syringe 28g x 1/2" 0.5 ml 28g x 1/2" 0.5 ml

Formulary OTC

gnp ultra com insulin syringe 28g x 1/2" 1 ml 28g x 1/2" 1 ml

Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC

gnp urinary pain relief oral tablet 97.5 mg Formulary OTC

gnp vitamin d super strength oral tablet 5000 unit Formulary OTC

gnp vitamin d-400 oral tablet 90-400 mg-unit Formulary OTC

GOLD BOND MULTI-SYMPTOM EXTERNAL CREAM 4 %

Formulary OTC

GOLD BOND RAPID RELIEF EXTERNAL CREAM 1-1 %

Formulary OTC

GOLD BOND ULTIMATE EXTERNAL LOTION Formulary OTC

GONIOSOL OPHTHALMIC SOLUTION 2.5 % Formulary OTC

GONIOTAIRE OPHTHALMIC SOLUTION 2.5 % Formulary OTC

GONIOVISC OPHTHALMIC SOLUTION 2 % Formulary OTC

68

Drug Name Formulary Status Requirements/LimitsGOOD START 5% GLUCOSE WATER ORAL SOLUTION 5 %

Formulary OTC

goodsense all day allergy oral tablet 10 mg Formulary OTC

goodsense cough dm oral suspension extended release 30 mg/5ml

Formulary OTC

goodsense eye drops ophthalmic solution 0.05 % Formulary OTC

goodsense flu/cold/cough/night oral packet 25-10-650 mg Formulary OTC

goodsense flu/cold/daytime oral packet 20-10-500 mg Formulary OTC

goodsense ibuprofen childrens oral suspension 100 mg/5ml Formulary OTC

goodsense ibuprofen infants oral suspension 50 mg/1.25ml Formulary OTC

goodsense ibuprofen oral tablet 200 mg Formulary OTC

goodsense lancets 30g Formulary OTC; QL (150 EA per 30 days)

goodsense lancets 33g Formulary OTC; QL (150 EA per 30 days)

goodsense lubricant eye drops ophthalmic solution 0.4-0.3 %

Formulary OTC

goodsense miconazole 1 vaginal kit 1200 & 2 mg & % Formulary OTC

goodsense nicotine mouth/throat gum 4 mg Formulary OTC

goodsense nighttime cold & flu oral liquid 5-6.25-10-325 mg/15ml

Formulary OTC

goodsense petroleum jelly gel Formulary OTC

goodsense redness relief plus ophthalmic solution 0.5-0.03 %

Formulary OTC

goodsense sinus congest/pain oral 2-5-325 & 5-325 mg Formulary OTC

goodsense sleeptime oral liquid 50 mg/30ml Formulary OTC

goodsense sore throat spray mouth/throat liquid 1.4 % Formulary OTC

gordomatic external crystals Formulary OTC

GORDONS NO 5 EXTERNAL AEROSOL POWDER Formulary OTC

gordons urea external ointment 22 % Formulary OTC

GORDONS-VITE A EXTERNAL CREAM 100000 UNIT/GM

Formulary OTC

GORDONS-VITE A EXTERNAL LOTION 100000 UNIT Formulary OTC

GORDO-POOL CONCENTRATE Formulary OTC

GRANDPAS OATMEAL SOAP EXTERNAL BAR Formulary OTC

GRANDPAS THYLOX SOAP EXTERNAL BAR 3 % Formulary OTC

GRANIX SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 300 MCG/0.5ML, 480 MCG/0.8ML

Formulary PA

grape seed oil Formulary

green soap external tincture Formulary OTC

green tea extract liquid 90 % Formulary OTC

griseofulvin microsize oral suspension 125 mg/5ml Formulary

griseofulvin microsize oral tablet 500 mg Formulary

grx wound external gel Formulary OTC

G-TRON PED ORAL LIQUID 10-15-350 MG/5ML Formulary OTC

G-TUSICOF ORAL LIQUID 10-20-400 MG/5ML Formulary OTC

guaifenesin oral tablet 400 mg Formulary OTC

guaifenesin-codeine oral solution 100-10 mg/5ml Formulary OTC; AGE (Min 6 Years)

69

Drug Name Formulary Status Requirements/Limitsguanfacine hcl er oral tablet extended release 24 hour 1 mg, 2 mg, 3 mg, 4 mg


guanfacine hcl oral tablet 1 mg, 2 mg Formulary

guanidine hcl oral tablet 125 mg Formulary

gumsol mouth/throat liquid 5-0.1 % Formulary OTC

GYNE-LOTRIMIN 3 VAGINAL CREAM 2 % Formulary OTC

GYNE-LOTRIMIN VAGINAL CREAM 1 % Formulary OTC

H2Q ORAL POWDER 200 MG/GM Formulary OTC

halobetasol propionate external cream 0.05 % Formulary

halobetasol propionate external ointment 0.05 % Formulary

haloperidol decanoate intramuscular solution 100 mg/ml, 50 mg/ml


haloperidol lactate injection solution 5 mg/ml Formulary

haloperidol lactate oral concentrate 2 mg/ml Formulary AGE (Min 18 Years)

haloperidol oral tablet 0.5 mg, 1 mg, 10 mg, 2 mg, 20 mg, 5 mg


haloperidol powder Formulary

hand wipes external 0.13 % Formulary OTC

HARD NAILS ORAL CAPSULE 2.5 MG Formulary OTC

HAVRIX INTRAMUSCULAR SUSPENSION 1440 EL U/ML, 720 EL U/0.5ML


HC DERMAPAX EXTERNAL LIQUID 0.5-0.5 % Formulary OTC

H-CHLOR 12 EXTERNAL SOLUTION 0.125 % Formulary OTC

H-CHLOR 6 EXTERNAL SOLUTION 0.062 % Formulary OTC

headache relief pm oral tablet 500-38 mg Formulary OTC

healthy accents unilet lancets Formulary OTC; QL (150 EA per 30 days)

hearing aid batteries Formulary OTC

heartburn antacid ex st oral tablet chewable 160-105 mg Formulary OTC

heartburn treatment 24 hour oral capsule delayed release15 mg


h-e-b incontrol alcohol pad Formulary OTC

h-e-b incontrol lancets 28g Formulary OTC; QL (150 EA per 30 days)



HEET TRIPLE ACTION EXTERNAL LIQUID Formulary OTC

hematinic/folic acid oral tablet 324-1 mg Formulary

HEMATOGEN FA ORAL CAPSULE 200-250-0.01-1 MG Formulary

HEMATOGEN ORAL CAPSULE Formulary

HEMOCYTE ORAL TABLET 324 (106 FE) MG Formulary OTC

hemorrhoidal cooling rectal gel 0.25-50 % Formulary OTC

hemorrhoidal max st/aloe rectal cream 1-0.25-14.4-15 % Formulary OTC

hemorrhoidal rectal suppository 0.25-3-85.5 %, 0.25-85.39 %, 0.25-88.44 %

Formulary OTC

heparin (porcine) in nacl injection solution 100-0.45 unit/ml-%, 2-0.9 unit/ml-%, 50-0.45 unit/ml-%

Formulary

70

Drug Name Formulary Status Requirements/Limitsheparin sodium (porcine) injection solution 1000 unit/ml, 10000 unit/ml, 20000 unit/ml, 5000 unit/ml

Formulary

heparin sodium (porcine) pf injection solution 5000 unit/0.5ml

Formulary

HERCEPTIN INTRAVENOUS SOLUTION RECONSTITUTED 440 MG

Formulary

hetastarch-nacl intravenous solution 6-0.9 % Formulary

HEXALEN ORAL CAPSULE 50 MG Formulary

HIBICLENS EXTERNAL LIQUID 4 % Formulary OTC

high potency iron oral tablet 27 mg Formulary OTC

histaflex oral tablet 325-25 mg Formulary OTC

HISTEX ORAL SYRUP 2.5 MG/5ML Formulary OTC

HISTEX ORAL TABLET CHEWABLE 1.25 MG Formulary OTC

HISTEX PD ORAL LIQUID 0.938 MG/ML Formulary OTC

HISTEX PDX ORAL LIQUID 1.25 MG/ML Formulary OTC

HISTEX-AC ORAL SYRUP 10-2.5-10 MG/5ML Formulary OTC

HISTEX-DM ORAL SYRUP 10-2.5-20 MG/5ML Formulary OTC

HISTEX-PE ORAL SYRUP 2.5-10 MG/5ML Formulary OTC

hm calamine external lotion 8-8 % Formulary OTC

hm castor oil oil Formulary OTC

hm clear fiber oral powder Formulary OTC

hm ethyl rubbing alcohol solution 70 % Formulary OTC

hm iodides external tincture Formulary OTC

hm iodine external tincture Formulary OTC

hm iron oral tablet 200 (65 fe) mg Formulary OTC

hm melatonin quick dissolve oral tablet dispersible 10 mg Formulary OTC

hm nighttime sleep aid oral tablet 25 mg Formulary OTC

hm omeprazole oral tablet delayed release 20 mg Formulary OTC

hm probiotic digestive health oral capsule Formulary OTC

hm rolled gauze bandage Formulary OTC

HM SALONPAS PAIN RELIEF EXTERNAL PATCH 1.2-5.7-6.3 %

Formulary OTC

hm severe cold/cough/flu oral packet 20-10-650 mg Formulary OTC

hm super vitamin b12 oral tablet chewable 2500 mcg Formulary OTC

hm vitamin b12 oral tablet extended release 1000 mcg Formulary OTC

hm z-sleep oral capsule 25 mg Formulary OTC

HOLD MOUTH/THROAT LOZENGE 5 MG Formulary OTC

HOMATROPAIRE OPHTHALMIC SOLUTION 5 % Formulary

HONEY BEARS W/IRON-ZINC ORAL TABLET CHEWABLE 30-200-3

Formulary OTC

HPR PLUS HYDROGEL EXTERNAL KIT Formulary

hrt essential cream Formulary

huber needle 19g x 1-1/4" , 19g x 3/4" , 20g x 1-1/4" , 20g x 3/4" , 22g x 1-1/4"

Formulary OTC

HUGGIES NATURAL CARE WIPES Formulary OTC

71

Drug Name Formulary Status Requirements/LimitsHUMALOG MIX 50/50 SUBCUTANEOUS SUSPENSION (50-50) 100 UNIT/ML

Formulary

HUMALOG MIX 75/25 SUBCUTANEOUS SUSPENSION (75-25) 100 UNIT/ML

Formulary

HUMALOG SUBCUTANEOUS SOLUTION 100 UNIT/ML

Formulary

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

Formulary

humidifier Formulary OTC; QL (2 EA per 365 days)

HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS PREFILLED SYRINGE KIT 40 MG/0.8ML


HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS PREFILLED SYRINGE KIT 80 MG/0.8ML

Formulary SP; AGE (Min 2 Years)

HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS PREFILLED SYRINGE KIT 80 MG/0.8ML & 40MG/0.4ML

Formulary SP

HUMIRA PEN SUBCUTANEOUS PEN-INJECTOR KIT 40 MG/0.4ML


HUMIRA PEN SUBCUTANEOUS PEN-INJECTOR KIT 40 MG/0.8ML


HUMIRA PEN-CD/UC/HS STARTER SUBCUTANEOUS PEN-INJECTOR KIT 40 MG/0.8ML


HUMIRA PEN-CD/UC/HS STARTER SUBCUTANEOUS PEN-INJECTOR KIT 80 MG/0.8ML


HUMIRA PEN-PS/UV/ADOL HS START SUBCUTANEOUS PEN-INJECTOR KIT 40 MG/0.8ML


HUMIRA PEN-PS/UV/ADOL HS START SUBCUTANEOUS PEN-INJECTOR KIT 80 MG/0.8ML & 40MG/0.4ML


HUMIRA SUBCUTANEOUS PREFILLED SYRINGE KIT 10 MG/0.1ML, 20 MG/0.2ML, 40 MG/0.4ML


HUMIRA SUBCUTANEOUS PREFILLED SYRINGE KIT 10 MG/0.2ML, 20 MG/0.4ML, 40 MG/0.8ML


HUMULIN 70/30 KWIKPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR (70-30) 100 UNIT/ML

Formulary OTC

HUMULIN 70/30 SUBCUTANEOUS SUSPENSION (70-30) 100 UNIT/ML

Formulary OTC

HUMULIN N KWIKPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR 100 UNIT/ML

Formulary OTC

HUMULIN N SUBCUTANEOUS SUSPENSION 100 UNIT/ML

Formulary OTC

HUMULIN R INJECTION SOLUTION 100 UNIT/ML Formulary OTC

HUMULIN R U-500 (CONCENTRATED) SUBCUTANEOUS SOLUTION 500 UNIT/ML

Formulary

HUMULIN R U-500 KWIKPEN SOLUTION PEN-INJECTOR 500 UNIT/ML SUBCUTANEOUS 500 UNIT/ML

Formulary

HURRICAINE MOUTH/THROAT AEROSOL 20 % Formulary OTC

72

Drug Name Formulary Status Requirements/LimitsHURRICAINE MOUTH/THROAT SOLUTION 20 % Formulary OTC

HURRICAINE MOUTH/THROAT SWAB 20 % Formulary OTC

HURRICAINE ONE MOUTH/THROAT SOLUTION 20 %

Formulary OTC

HURRIVIEW DENTAL SWAB 1.5 % Formulary OTC

HURRIVIEW II DENTAL SWAB Formulary OTC

HYALGAN INTRA-ARTICULAR SOLUTION 20 MG/2ML

Formulary PA

HYCAMTIN ORAL CAPSULE 0.25 MG, 1 MG Formulary

hydralazine hcl oral tablet 10 mg, 100 mg, 25 mg, 50 mg Formulary

HYDROCELL ADHESIVE DRESSING PAD 6"X6" Formulary OTC

hydrocerin external cream Formulary OTC

hydrocerin external lotion Formulary OTC

hydrochloric acid liquid 37 % Formulary

hydrochlorothiazide oral capsule 12.5 mg Formulary

hydrochlorothiazide oral tablet 12.5 mg, 25 mg, 50 mg Formulary

hydrocod polst-cpm polst er oral suspension extended release 10-8 mg/5ml


hydrocodone-acetaminophen oral solution 7.5-325 mg/15ml Formulary PA; QL (1260 ML per 7 days)

hydrocodone-acetaminophen oral tablet 10-300 mg, 10-325 mg


hydrocodone-acetaminophen oral tablet 2.5-325 mg Formulary PA; QL (252 EA per 7 days)

hydrocodone-acetaminophen oral tablet 5-300 mg, 5-325 mg


hydrocodone-acetaminophen oral tablet 7.5-300 mg, 7.5-325 mg


hydrocodone-homatropine oral syrup 5-1.5 mg/5ml Formulary AGE (Min 6 Years)

hydrocodone-homatropine oral tablet 5-1.5 mg Formulary

hydrocodone-ibuprofen oral tablet 10-200 mg Formulary PA; QL (63 EA per 7 days)

hydrocodone-ibuprofen oral tablet 5-200 mg Formulary PA; QL (126 EA per 7 days)

hydrocodone-ibuprofen oral tablet 7.5-200 mg Formulary PA; QL (84 EA per 7 days)

hydrocortisone ace-pramoxine rectal cream 1-1 %, 2.5-1 % Formulary

hydrocortisone butyrate external cream 0.1 % Formulary

hydrocortisone butyrate external ointment 0.1 % Formulary

hydrocortisone butyrate external solution 0.1 % Formulary

hydrocortisone external cream 0.5 % Formulary OTC

hydrocortisone external cream 1 %, 2.5 % Formulary

hydrocortisone external lotion 2.5 % Formulary

hydrocortisone external ointment 0.5 % Formulary OTC

hydrocortisone external ointment 1 %, 2.5 % Formulary

hydrocortisone oral tablet 10 mg, 20 mg, 5 mg Formulary

hydrocortisone rectal cream 1 % Formulary

hydrocortisone valerate external cream 0.2 % Formulary

hydrocortisone valerate external ointment 0.2 % Formulary

HYDROGEL EXTERNAL GEL Formulary OTC

73

Drug Name Formulary Status Requirements/Limitshydromet oral syrup 5-1.5 mg/5ml Formulary AGE (Min 6 Years)

hydromorphone hcl injection solution 1 mg/ml, 2 mg/ml, 4 mg/ml

Formulary

hydromorphone hcl oral tablet 2 mg Formulary PA; QL (79 EA per 7 days)



hydromorphone hcl pf injection solution 10 mg/ml Formulary

hydrophilic external ointment Formulary OTC

hydrophilic petrolatum external ointment Formulary OTC

hydroxychloroquine sulfate oral tablet 200 mg Formulary

hydroxyprogesterone caproate intramuscular oil 250 mg/ml Formulary

hydroxyprogesterone caproate intramuscular solution 1.25 gm/5ml

Formulary

hydroxypropyl cellulose powder Formulary

hydroxyurea oral capsule 500 mg Formulary

hydroxyzine hcl intramuscular solution 50 mg/ml Formulary

hydroxyzine hcl oral tablet 10 mg, 25 mg, 50 mg Formulary

hydroxyzine pamoate oral capsule 25 mg, 50 mg Formulary

HYLATOPIC PLUS EXTERNAL LOTION Formulary

HYOPHEN ORAL TABLET 81.6 MG Formulary

hyoscyamine sulfate er oral tablet extended release 12 hour0.375 mg

Formulary

hyoscyamine sulfate oral elixir 0.125 mg/5ml Formulary

hyoscyamine sulfate oral solution 0.125 mg/ml Formulary

hyoscyamine sulfate oral tablet 0.125 mg Formulary

hyoscyamine sulfate sl sublingual tablet sublingual 0.125 mg

Formulary

HYPERCARE EXTERNAL SOLUTION 15 % Formulary OTC

HYPERRHO S/D INTRAMUSCULAR SOLUTION PREFILLED SYRINGE 1500 UNIT, 250 UNIT

Formulary

hypodermic needle 21g x 1-1/4" , 25g x 3/4" , 26g x 3/8" Formulary OTC

HYPOTEARS OPHTHALMIC SOLUTION 1-1 % Formulary OTC

hypromellose powder Formulary

HYSEPT EXTERNAL SOLUTION 0.25 %, 0.5 % Formulary OTC

HYVEE ADVANCED ANTACID ORAL SUSPENSION 400-400-40 MG/5ML

Formulary OTC

HY-VEE LANCETS Formulary OTC; QL (150 EA per 30 days)

hy-vee thin lancets Formulary OTC; QL (150 EA per 30 days)

ibandronate sodium intravenous solution 3 mg/3ml Formulary PA; QL (1 ML per 90 days)

ibuprofen 100 junior strength oral tablet chewable 100 mg Formulary OTC

ibuprofen oral capsule 200 mg Formulary OTC

ibuprofen oral tablet 400 mg, 600 mg, 800 mg Formulary

ibuprofen pm oral capsule 200-25 mg Formulary OTC

ICAR ORAL SUSPENSION 15 MG/1.25ML Formulary OTC

ICAR-C ORAL TABLET 100-250 MG Formulary OTC

74

Drug Name Formulary Status Requirements/Limitsice blue external gel 2 % Formulary OTC

ICY HOT EXTERNAL STICK 10-30 % Formulary OTC

ICY HOT LIDOCAINE PLUS MENTHOL EXTERNAL CREAM 4-1 %

Formulary OTC

ICY HOT LIDOCAINE PLUS MENTHOL EXTERNAL PATCH 4-1 %

Formulary OTC

idarubicin hcl intravenous solution 10 mg/10ml, 20 mg/20ml, 5 mg/5ml

Formulary

IFEX INTRAVENOUS SOLUTION RECONSTITUTED 3 GM

Formulary

ifosfamide intravenous solution 1 gm/20ml, 3 gm/60ml Formulary

ifosfamide intravenous solution reconstituted 1 gm Formulary

imatinib mesylate oral tablet 100 mg, 400 mg Formulary PA

imipramine hcl oral tablet 10 mg, 25 mg, 50 mg Formulary

imipramine pamoate oral capsule 100 mg, 125 mg, 150 mg, 75 mg

Formulary

imiquimod external cream 5 % Formulary QL (2 EA per 34 days)

immune support oral tablet chewable Formulary OTC

IMODIUM A-D ORAL CAPSULE 2 MG Formulary OTC

IMODIUM A-D ORAL LIQUID 1 MG/7.5ML Formulary OTC

IMODIUM A-D ORAL TABLET 2 MG Formulary OTC

IMODIUM MULTI-SYMPTOM RELIEF ORAL TABLET 2-125 MG

Formulary OTC

IMOVAX RABIES INTRAMUSCULAR INJECTABLE 2.5 UNIT/ML


IMPROVUE OPHTHALMIC SOLUTION PREFILLED SYRINGE 1.7 %

Formulary OTC

indapamide oral tablet 1.25 mg, 2.5 mg Formulary

indole-3-carbinol powder Formulary

indomethacin er oral capsule extended release 75 mg Formulary

indomethacin oral capsule 25 mg, 50 mg Formulary

INFANRIX INTRAMUSCULAR SUSPENSION 25-58-10 Formulary

infants gas relief oral suspension 40 mg/0.6ml Formulary OTC

INFED INJECTION SOLUTION 50 MG/ML Formulary

INFUMORPH 200 INJECTION SOLUTION 200 MG/20ML (10 MG/ML)

Formulary

INFUMORPH 500 INJECTION SOLUTION 500 MG/20ML (25 MG/ML)

Formulary

inositol hexanicotinate powder Formulary

inositol oral tablet 500 mg, 650 mg Formulary OTC

INOSITOL-5 ORAL TABLET 324 MG Formulary OTC

INSPIRACHAMBER/LARGE DEVICE Formulary QL (2 EA per 365 days)

INSPIRACHAMBER/MEDIUM DEVICE Formulary QL (2 EA per 365 days)

INSPIRACHAMBER/MOUTHPIECE DEVICE Formulary QL (2 EA per 365 days)

INSPIRACHAMBER/SMALL DEVICE Formulary QL (2 EA per 365 days)

INSPIREASE Formulary QL (2 EA per 365 days)

75

Drug Name Formulary Status Requirements/LimitsINSTACLEAN EXTERNAL LIQUID Formulary OTC

INSTA-GLUCOSE ORAL GEL 77.4 % Formulary OTC

instant ear-dry otic liquid 95-5 % Formulary OTC

instant hand sanitizer external liquid 62 % Formulary OTC

INSTAT EXTERNAL PAD Formulary

INSUFLON 25G X 0.71" Formulary

insulin syringe 27g x 1/2" 0.5 ml 27g x 1/2" 0.5 ml Formulary OTC

insulin syringe 27g x 1/2" 1 ml 27g x 1/2" 1 ml Formulary OTC













insulin syringe/needle 27g x 1/2" 0.5 ml 27g x 1/2" 0.5 ml Formulary OTC

insulin syringe/needle 28g x 1/2" 0.5 ml 28g x 1/2" 0.5 ml Formulary OTC

insulin syringe/needle 28g x 1/2" 1 ml 28g x 1/2" 1 ml Formulary OTC

INSUPEN ULTRAFIN 30G X 8 MM Formulary OTC

INTEGRA ORAL CAPSULE 62.5-62.5-40-3 MG Formulary OTC

INTELENCE ORAL TABLET 100 MG, 200 MG Formulary

intense cough reliever ex st oral liquid 20-300 mg/5ml Formulary OTC

INTERDRY AG TEXTILE 10"X144" EXTERNAL SHEET

Formulary OTC

INTRASITE GEL APPLIPAK EXTERNAL GEL Formulary OTC

INTRON A INJECTION SOLUTION 10000000 UNIT/ML, 6000000 UNIT/ML

Formulary PA

INTRON A INJECTION SOLUTION RECONSTITUTED 10000000 UNIT, 18000000 UNIT, 50000000 UNIT

Formulary PA

INTROVALE ORAL TABLET 0.15-0.03 MG Formulary QL (91 EA per 91 days)

INVEGA SUSTENNA INTRAMUSCULAR SUSPENSION 117 MG/0.75ML, 156 MG/ML, 234 MG/1.5ML, 39 MG/0.25ML, 78 MG/0.5ML


INVEGA TRINZA INTRAMUSCULAR SUSPENSION 273 MG/0.875ML, 410 MG/1.315ML, 546 MG/1.75ML, 819 MG/2.625ML


INVIRASE ORAL CAPSULE 200 MG Formulary

INVIRASE ORAL TABLET 500 MG Formulary

INVOKANA ORAL TABLET 100 MG, 300 MG Formulary AGE (Min 18 Years)

iodides tincture external tincture Formulary OTC

iodine crystals Formulary OTC

76

Drug Name Formulary Status Requirements/Limitsiodine external tincture , 2 % Formulary OTC

iodine strong (lugol's) solution Formulary

iodine strong external tincture 6.9-5 % Formulary OTC

iodine strong oral solution 5 % Formulary

iodine tincture external tincture Formulary OTC

iodine tincture external tincture 2 % Formulary

iodoform powder Formulary

IONIL EXTERNAL SHAMPOO 2-0.2 % Formulary OTC

IONIL-T EXTERNAL SHAMPOO 1 % Formulary OTC

IONSYS TRANSDERMAL PATCH 40 MCG/ACT Formulary PA

IPOL INJECTION INJECTABLE Formulary AGE (Min 19 Years)

ipratropium bromide inhalation solution 0.02 % Formulary

ipratropium bromide nasal solution 0.03 % Formulary QL (60 ML per 34 days)

ipratropium bromide nasal solution 0.06 % Formulary QL (30 ML per 34 days)

ipratropium-albuterol inhalation solution 0.5-2.5 (3) mg/3ml

Formulary

irinotecan hcl intravenous solution 100 mg/5ml, 40 mg/2ml, 500 mg/25ml

Formulary

IROFOL ORAL LIQUID 100-1000-15 MG-MCG/5ML Formulary OTC

IROFOL ORAL TABLET 150-0.025-1 MG Formulary OTC

iron (ferrous sulfate) oral tablet extended release 142 (45 fe) mg

Formulary OTC

iron 100 plus oral tablet 100-250-0.025-1 mg Formulary OTC

iron 100/c oral tablet 100-250 mg Formulary OTC

iron 21/7 oral Formulary OTC

iron 27 oral tablet 240 (27 fe) mg Formulary OTC

iron chews pediatric oral tablet chewable 15 mg Formulary OTC

iron slow release oral tablet extended release 143 (45 fe) mg

Formulary OTC

irrigating eyewash ophthalmic solution Formulary OTC

ISENTRESS HD ORAL TABLET 600 MG Formulary

ISENTRESS ORAL TABLET 400 MG Formulary

ISOLEUCINE 1000 ORAL PACKET 1 GM Formulary OTC

isoleucine oral packet 50 mg Formulary OTC

isomalt lollipop base powder Formulary

isoniazid oral syrup 50 mg/5ml Formulary

isoniazid oral tablet 100 mg, 300 mg Formulary

isopropyl alcohol (rubbing) solution 70 % Formulary OTC

isopropyl alcohol solution , 70 %, 99 % Formulary

isopropyl alcohol solution 50 %, 91 % Formulary OTC

isopropyl alcohol wipes 70 % external 70 % Formulary OTC

isopropyl myristate solution Formulary

isopropyl palmitate liquid Formulary

ISOPTO TEARS OPHTHALMIC SOLUTION 0.5 % Formulary OTC

isosorbide dinitrate er oral tablet extended release 40 mg Formulary

77

Drug Name Formulary Status Requirements/Limitsisosorbide dinitrate oral tablet 10 mg, 20 mg, 30 mg, 5 mg Formulary

isosorbide mononitrate er oral tablet extended release 24 hour 120 mg, 30 mg, 60 mg

Formulary

isosorbide mononitrate oral tablet 10 mg, 20 mg Formulary

isradipine oral capsule 2.5 mg, 5 mg Formulary

itch relief external cream 2 % Formulary OTC

ITCH-X EXTERNAL GEL 1-10 % Formulary OTC

ITCH-X EXTERNAL SOLUTION 1-10 % Formulary OTC

itraconazole oral capsule 100 mg Formulary QL (34 EA per 34 days)

itraconazole oral solution 10 mg/ml Formulary

IVAREST MEDICATED POISON IVY EXTERNAL LIQUID 1 %

Formulary OTC

IVAREST POISON IVY ITCH EXTERNAL CREAM 2-14-10.5 %

Formulary OTC

ivermectin oral tablet 3 mg Formulary

ivy wash poison ivy cleanser external lotion 1 % Formulary OTC

IXEMPRA KIT INTRAVENOUS SOLUTION RECONSTITUTED 15 MG, 45 MG

Formulary

IXIARO INTRAMUSCULAR SUSPENSION Formulary AGE (Min 19 Years)

J & J ALL-PURPOSE FIRST AID COMBINATION KIT Formulary OTC

J & J DENTAL FLOSS FOR KIDS Formulary OTC

JANTOVEN ORAL TABLET 1 MG, 10 MG, 2 MG, 2.5 MG, 3 MG, 4 MG, 5 MG, 6 MG, 7.5 MG

Formulary

JANUMET ORAL TABLET 50-1000 MG, 50-500 MG Formulary ST

JANUMET XR ORAL TABLET EXTENDED RELEASE 24 HOUR 100-1000 MG, 50-1000 MG, 50-500 MG

Formulary ST

JANUVIA ORAL TABLET 100 MG, 25 MG, 50 MG Formulary ST

JARDIANCE ORAL TABLET 10 MG, 25 MG Formulary AGE (Min 18 Years)

JENTADUETO ORAL TABLET 2.5-1000 MG, 2.5-500 MG, 2.5-850 MG

Formulary ST

jessners external solution Formulary OTC

jock itch spray external aerosol powder 1 % Formulary OTC

JOHNSONS BABY CORNSTARCH EXTERNAL POWDER

Formulary OTC

JOHNSONS BABY OIL GEL EXTERNAL GEL Formulary OTC

JOHNSONS BABY POWDER EXTERNAL POWDER Formulary OTC

JUNEL 1/20 ORAL TABLET 1-20 MG-MCG Formulary

JUVEN ORAL PACKET Formulary OTC

k 100 oral tablet 100 mcg Formulary OTC

k-99 oral capsule 595 mg Formulary OTC

KAITLIB FE ORAL TABLET CHEWABLE 0.8-25 MG-MCG

Formulary

KALBITOR SUBCUTANEOUS SOLUTION 10 MG/ML Formulary PA; QL (6 ML per 34 days)

KALETRA ORAL TABLET 100-25 MG, 200-50 MG Formulary

KANGAROO ENTRIFLUSH PUMP SET Formulary

KANGAROO JOEY PUMP SET Formulary

78

Drug Name Formulary Status Requirements/LimitsKANK-A MOUTH PAIN MOUTH/THROAT SOLUTION 20 %

Formulary OTC

KANK-A SOFTBRUSH MOUTH/THROAT GEL 20-0.1 %

Formulary OTC

kaolin powder Formulary

KAOPECTATE ORAL TABLET 262 MG Formulary OTC

KAPVAY ORAL TABLET EXTENDED RELEASE 12 HOUR 0.1 MG

FormularyST; AGE (Min 4 Years and Max 17 Years)

karaya gum gum Formulary

KARBOZYME ORAL TABLET DELAYED RELEASE 167-173-346 MG

Formulary OTC

K-BICARB ORAL CAPSULE 99 MG Formulary OTC

KELNOR 1/35 ORAL TABLET 1-35 MG-MCG Formulary QL (28 EA per 28 days)

kelp oral tablet 150 mcg Formulary OTC

kelp-b6-lecithin-vinegar oral capsule 5-0.75-200-50 mg Formulary OTC

KENALOG INJECTION SUSPENSION 10 MG/ML Formulary

KENDALL ALGINATE DRESS 8"X8" EXTERNAL PAD Formulary OTC

KENDALL ANTIMICROBIAL BANDAGE EXTERNAL Formulary OTC

KENDALL CA ALGINATE 6"X10" EXTERNAL Formulary OTC

KENDALL HYDROPHILIC FOAM DRESS PAD 4"X8" , 5"X5"

Formulary OTC

KENDALL TRANSPARENT FILM DRESS Formulary OTC

KEPIVANCE INTRAVENOUS SOLUTION RECONSTITUTED 6.25 MG

Formulary

KERAMATRIX REPLICINE 10CMX10CM EXTERNAL SHEET

Formulary

KERR TRIPLE DYE SWABS EXTERNAL SWAB Formulary OTC

ketoconazole external cream 2 % Formulary

ketoconazole external foam 2 % Formulary

ketoconazole external shampoo 2 % Formulary

ketoconazole oral tablet 200 mg Formulary

ketorolac tromethamine injection solution 15 mg/ml, 30 mg/ml

Formulary

ketorolac tromethamine intramuscular solution 60 mg/2ml Formulary

ketorolac tromethamine ophthalmic solution 0.4 %, 0.5 % Formulary

ketorolac tromethamine oral tablet 10 mg Formulary QL (20 EA per 34 days)

KETOSTIX IN VITRO STRIP Formulary OTC

kettle neti pot sinus wash nasal kit 2300-700 mg Formulary OTC

KEY OMEGA ORAL PACKET 200-100 MG Formulary OTC

k-iii oral solution reconstituted 33.3-33.3-33.3 % Formulary OTC

KINERASE EXTERNAL CREAM 0.1 %, 0.125 % Formulary OTC

KINERASE EXTERNAL LOTION 0.1 % Formulary OTC

kinney lancets Formulary OTC; QL (150 EA per 30 days)

kinney thin lancets Formulary OTC

kinray insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC

kinray insulin syringe 31g x 5/16" 0.3 ml 31g x 5/16" 0.3 ml Formulary OTC

79

Drug Name Formulary Status Requirements/Limitskinray insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 ml Formulary OTC

kinray insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 1 ml Formulary OTC

KINRIX INTRAMUSCULAR SUSPENSION Formulary

KIONEX ORAL SUSPENSION 15 GM/60ML Formulary AGE (Min 19 Years)

KITABIS PAK NEBULIZATION SOLUTION 300 MG/5ML INHALATION 300 MG/5ML

FormularyQL (280 ML per 28 days); AGE (Min 6 Years)

KLOR-CON 10 ORAL TABLET EXTENDED RELEASE 10 MEQ

Formulary

KLOR-CON M10 ORAL TABLET EXTENDED RELEASE 10 MEQ

Formulary


Formulary


Formulary

KLOR-CON ORAL TABLET EXTENDED RELEASE 8 MEQ

Formulary

KLOR-CON SPRINKLE ORAL CAPSULE EXTENDED RELEASE 10 MEQ, 8 MEQ

Formulary

kls cold & flu ms day/night oral tablet therapy pack Formulary OTC

kls esomeprazole magnesium oral capsule delayed release20 mg

Formulary OTC

kls omeprazole oral tablet delayed release 20 mg Formulary OTC

K-MAG ASPARTATE ORAL TABLET 250-250 MG Formulary OTC

K-MAG ORAL CAPSULE 40-40 MG Formulary OTC

K-MAG-70 ORAL CAPSULE 70-70 MG Formulary OTC

kmart valu insulin syringe 29g u-100 0.5 ml u-100 0.5 ml Formulary OTC

kmart valu insulin syringe 29g u-100 1 ml u-100 1 ml Formulary OTC



kmart valu insulin syringe 30g u-100 1 ml u-100 1 ml Formulary OTC

kojic acid powder Formulary

konsyl daily fiber oral packet 100 % Formulary OTC

konsyl daily fiber oral powder 100 % Formulary OTC

KONSYL ORAL PACKET 28.3 %, 60.3 % Formulary OTC

KONSYL ORAL POWDER 60.3 %, 71.67 % Formulary OTC

KONSYL-D ORAL POWDER 52.3 % Formulary OTC

korean ginseng oral capsule 350 mg Formulary OTC

kp hydrocortisone-aloe external cream 0.5 % Formulary OTC

kp mag-oxide magnesium oral tablet 200 mg Formulary OTC

kp silicone scar therapy gel strip Formulary OTC

K-PHOS NO 2 ORAL TABLET 305-700 MG Formulary

K-PHOS ORAL TABLET 500 MG Formulary

kpn prenatal oral tablet 0.1 mg Formulary OTC

kroger insulin syringe 29g x 1/2" 0.3 ml 29g x 1/2" 0.3 ml Formulary OTC


kroger insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC

80

Drug Name Formulary Status Requirements/Limitskroger insulin syringe 30g x 5/16" 0.3 ml 30g x 5/16" 0.3 ml Formulary OTC






kroger lancets Formulary OTC; QL (150 EA per 30 days)

kroger lancets 21g Formulary OTC; QL (150 EA per 30 days)

kroger lancets micro thin 33g Formulary OTC; QL (150 EA per 30 days)

kroger lancets super thin Formulary OTC; QL (150 EA per 30 days)

kroger lancets thin Formulary OTC; QL (150 EA per 30 days)

kroger lancets thin 26g Formulary OTC; QL (150 EA per 30 days)

kroger lancets ultrathin 30g Formulary OTC; QL (150 EA per 30 days)

KT TAPE PRO TAPE Formulary OTC

K-TAN PLUS ORAL CAPSULE 162-115.2-1 MG Formulary

KUVAN ORAL TABLET SOLUBLE 100 MG Formulary PA

KWAN LOONG PAIN RELIEVING EXTERNAL OIL Formulary OTC

KYLEENA INTRAUTERINE INTRAUTERINE DEVICE 19.5 MG

Formulary

labetalol hcl intravenous solution 5 mg/ml Formulary

labetalol hcl oral tablet 100 mg, 200 mg, 300 mg Formulary

LAC-HYDRIN FIVE EXTERNAL LOTION 5 % Formulary OTC

LAC-HYDRIN TWELVE EXTERNAL LOTION 12 % Formulary OTC

lactated ringers irrigation solution Formulary

lactic acid e external cream 10-3500 %-unt/30gm Formulary

lactic acid external lotion 10 % Formulary

lactic acid solution 85 % Formulary OTC

lacto-bifidus-600 oral capsule Formulary OTC

lactose monohydrate powder Formulary

lactose powder Formulary

l-alanine powder Formulary

LAMISIL ADVANCED EXTERNAL GEL 1 % Formulary OTC

LAMISIL AT EXTERNAL CREAM 1 % Formulary OTC

LAMISIL AT EXTERNAL POWDER Formulary OTC

LAMISIL AT SPRAY EXTERNAL SOLUTION 1 % Formulary OTC

LAMISILK PROTECT EXTERNAL LIQUID Formulary OTC

lamivudine oral solution 10 mg/ml Formulary

lamivudine oral tablet 100 mg, 150 mg, 300 mg Formulary

lamivudine-zidovudine oral tablet 150-300 mg Formulary

lamotrigine er oral tablet extended release 24 hour 100 mg, 200 mg, 25 mg, 250 mg, 300 mg, 50 mg

Formulary

lamotrigine oral tablet 100 mg, 150 mg, 200 mg, 25 mg Formulary

lamotrigine oral tablet chewable 25 mg, 5 mg Formulary

81

Drug Name Formulary Status Requirements/LimitsLANACANE ANTI-BACTERIAL EXTERNAL AEROSOL 20-0.2 %

Formulary OTC

LANACANE MAXIMUM STRENGTH EXTERNAL CREAM 20-0.2 %

Formulary OTC

lancets Formulary OTC; QL (150 EA per 30 days)

lancets 28g Formulary OTC; QL (150 EA per 30 days)

lancets 30g Formulary OTC; QL (150 EA per 30 days)

lancets micro thin 33g Formulary OTC; QL (150 EA per 30 days)

lancets super thin 28g Formulary OTC; QL (150 EA per 30 days)

lancets thin Formulary OTC; QL (150 EA per 30 days)

LANCETS ULTRA THIN Formulary OTC; QL (150 EA per 30 days)

lancets ultra thin 30g Formulary OTC; QL (150 EA per 30 days)

lanolin anhydrous external ointment Formulary

lanolin external ointment Formulary

lanolin hydrous-grx external ointment 72 % Formulary OTC

lansoprazole oral capsule delayed release 15 mg Formulary

lansoprazole oral capsule delayed release 30 mg Formulary QL (34 EA per 34 days)

lansoprazole oral tablet dispersible 15 mg, 30 mg Formulary PA

LANTUS SOLOSTAR SOLUTION PEN-INJECTOR 100 UNIT/ML SUBCUTANEOUS 100 UNIT/ML

Formulary

LANTUS SUBCUTANEOUS SOLUTION 100 UNIT/ML Formulary

l-arginine hcl powder Formulary

l-arginine oral capsule 500 mg Formulary OTC

l-arginine oral tablet 1000 mg Formulary OTC

l-arginine powder Formulary

LARIN 1/20 ORAL TABLET 1-20 MG-MCG Formulary

l-aspartic acid powder Formulary

latanoprost ophthalmic solution 0.005 % Formulary

LATUDA ORAL TABLET 120 MG, 20 MG, 40 MG, 60 MG, 80 MG


lavender oil oil Formulary

laxative oral tablet 25 mg Formulary OTC

laxative pills oral tablet 15 mg Formulary OTC

LAZANDA NASAL SOLUTION 100 MCG/ACT, 400 MCG/ACT


l-carnitine hcl powder Formulary OTC

l-carnitine oral capsule 250 mg, 500 mg Formulary OTC

l-carnitine oral tablet 250 mg, 500 mg Formulary OTC

l-carnitine powder Formulary

l-citrulline powder Formulary

l-cysteine hcl powder Formulary

l-cysteine powder Formulary

l-cystine powder Formulary

leader insulin syringe 28g x 1/2" 0.5 ml 28g x 1/2" 0.5 ml Formulary OTC

leader insulin syringe 28g x 1/2" 1 ml 28g x 1/2" 1 ml Formulary OTC

82

Drug Name Formulary Status Requirements/Limitsleader insulin syringe 29g x 1/2" 0.3 ml 29g x 1/2" 0.3 ml Formulary OTC








lecithin granules Formulary

lecithin-kelp-b6-cider vinegar oral capsule 200-0.075-5-50 mg

Formulary OTC

leflunomide oral tablet 10 mg, 20 mg Formulary

lemon bioflavanoid powder Formulary OTC

lemon oil oil Formulary OTC

lemon-glycerin mouth/throat swab Formulary OTC

LENZAPATCH EXTERNAL PATCH 4-1 % Formulary

LETAIRIS ORAL TABLET 10 MG, 5 MG Formulary PA; AGE (Min 18 Years)

letrozole oral tablet 2.5 mg Formulary

leucine oral packet 100 mg Formulary OTC

leucovorin calcium injection solution reconstituted 100 mg, 200 mg, 350 mg, 50 mg, 500 mg

Formulary

leucovorin calcium oral tablet 10 mg, 15 mg, 25 mg, 5 mg Formulary

LEUKERAN ORAL TABLET 2 MG Formulary

leuprolide acetate injection kit 1 mg/0.2ml Formulary PA

levalbuterol hcl inhalation nebulization solution 0.31 mg/3ml, 0.63 mg/3ml, 1.25 mg/0.5ml, 1.25 mg/3ml

Formulary PA

levalbuterol tartrate inhalation aerosol 45 mcg/act Formulary

LEVEMIR FLEXTOUCH SOLUTION PEN-INJECTOR 100 UNIT/ML SUBCUTANEOUS 100 UNIT/ML

Formulary

LEVEMIR SUBCUTANEOUS SOLUTION 100 UNIT/ML Formulary

levetiracetam er oral tablet extended release 24 hour 500 mg, 750 mg

Formulary

levetiracetam in nacl intravenous solution 1000 mg/100ml, 1500 mg/100ml, 500 mg/100ml

Formulary

levetiracetam intravenous solution 500 mg/5ml Formulary

levetiracetam oral solution 100 mg/ml Formulary

levetiracetam oral tablet 1000 mg, 250 mg, 500 mg, 750 mg Formulary

levobunolol hcl ophthalmic solution 0.5 % Formulary

levocarnitine (dietary) oral tablet 330 mg Formulary OTC

levocarnitine oral solution 1 gm/10ml Formulary

levocarnitine oral tablet 330 mg Formulary

levocarnitine-b5-taurine oral liquid 1000-10-150 mg/15ml Formulary OTC

levocetirizine dihydrochloride oral solution 2.5 mg/5ml Formulary

levocetirizine dihydrochloride oral tablet 5 mg Formulary

levofloxacin intravenous solution 25 mg/ml Formulary

83

Drug Name Formulary Status Requirements/Limitslevofloxacin ophthalmic solution 0.5 % Formulary

levofloxacin oral solution 25 mg/ml Formulary

levofloxacin oral tablet 250 mg, 500 mg, 750 mg Formulary

levoleucovorin calcium intravenous solution reconstituted50 mg

Formulary

LEVO-T ORAL TABLET 100 MCG, 112 MCG, 125 MCG, 137 MCG, 150 MCG, 175 MCG, 200 MCG, 25 MCG, 300 MCG, 50 MCG, 75 MCG, 88 MCG

Formulary

LEXIVA ORAL SUSPENSION 50 MG/ML Formulary

l-glutamic acid powder Formulary

l-glutamine oral capsule 500 mg Formulary OTC

l-glutamine oral tablet 500 mg Formulary OTC

l-glutathione crystals Formulary OTC

l-histidine powder Formulary

LIALDA ORAL TABLET DELAYED RELEASE 1.2 GM Formulary

LICE B GONE CAP SATURATED EXTERNAL KIT Formulary OTC

LICE B GONE EXTERNAL SHAMPOO Formulary OTC

lice cure external solution Formulary OTC

lice killing maximum strength external shampoo 0.33-4 % Formulary OTC

LICEFREEE EXTERNAL SOLUTION Formulary OTC

LICEMD COMPLETE EXTERNAL KIT 0.33-4 % Formulary OTC

LICIDE TREATMENT COMBINATION KIT Formulary OTC

lidocaine external cream 5 % Formulary OTC; QL (60 GM per 30 days)

lidocaine external ointment 5 % Formulary ST; QL (30 GM per 34 days)

lidocaine external patch 5 % Formulary QL (90 EA per 30 days)

lidocaine hcl external solution 4 % Formulary

lidocaine hcl mouth/throat solution 4 % Formulary

lidocaine viscous mouth/throat solution 2 % Formulary

lidocaine-hydrocortisone ace rectal kit 3-1 %, 3-2.5 % Formulary

lidocaine-prilocaine external cream 2.5-2.5 % Formulary

lidocaine-transparent dressing external kit 4 % Formulary OTC

LIDOPATCH PAIN RELIEF EXTERNAL PATCH 3.99-1.25 %

Formulary OTC

LIDOPRO TRANSDERMAL PATCH 4-4-5 % Formulary OTC

LIDOZENGEL EXTERNAL GEL 4-1 % Formulary OTC

LILETTA (52 MG) INTRAUTERINE INTRAUTERINE DEVICE 18.6 MCG/DAY

Formulary

lime oil oil Formulary

limencin external patch 4-4 % Formulary OTC

lindane external shampoo 1 % Formulary ST; QL (60 ML per 30 days)

linezolid oral suspension reconstituted 100 mg/5ml Formulary PA

linezolid oral tablet 600 mg Formulary PA

LINZESS ORAL CAPSULE 145 MCG, 290 MCG, 72 MCG

Formulary PA; AGE (Min 18 Years)

liothyronine sodium oral tablet 25 mcg, 5 mcg, 50 mcg Formulary

84

Drug Name Formulary Status Requirements/Limitslip balm base natural ointment Formulary OTC

lip balm external ointment Formulary OTC

lip balm external stick Formulary OTC

LIP MEDEX EXTERNAL OINTMENT Formulary OTC

lipochol nr oral capsule Formulary OTC

lipochol plus oral tablet Formulary OTC

LIPO-GEL ORAL CAPSULE 100-30 MG-UNIT Formulary OTC

lipoic acid oral capsule 150 mg Formulary OTC

LIPOIL OIL Formulary OTC

LIPOTRIAD ORAL TABLET Formulary OTC

LIPOTRIAD VISIONARY ORAL CAPSULE Formulary OTC

lipovan base external cream Formulary OTC

LIQ-10 ORAL SYRUP 100-1 MG-UNT/5ML, 50-15 Formulary OTC

LIQSORB ORAL LIQUID 100 MG/ML Formulary OTC

LIQUACEL ORAL LIQUID Formulary OTC

LIQUIMAT EXTERNAL LOTION 5 % Formulary OTC

lisinopril oral tablet 10 mg, 2.5 mg, 20 mg, 30 mg, 40 mg, 5 mg

Formulary

lisinopril-hydrochlorothiazide oral tablet 10-12.5 mg, 20-12.5 mg, 20-25 mg

Formulary

l-isoleucine powder Formulary

LISTERINE NATURALS ANTISEPTIC MOUTH/THROAT LIQUID

Formulary OTC

lite touch lancets Formulary OTC; QL (150 EA per 30 days)

LITETOUCH INSULIN SYRINGE 28G X 1/2" 0.5 ML 28G X 1/2" 0.5 ML

Formulary OTC

LITETOUCH INSULIN SYRINGE 28G X 1/2" 1 ML 28G X 1/2" 1 ML

Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC

LITETOUCH LANCETS Formulary OTC; QL (150 EA per 30 days)

85

Drug Name Formulary Status Requirements/Limitslithium carbonate er oral tablet extended release 300 mg, 450 mg

Formulary

lithium carbonate oral capsule 150 mg, 300 mg, 600 mg Formulary

lithium carbonate oral tablet 300 mg Formulary

lithium oral solution 8 meq/5ml Formulary

LITTLE COLDS COUGH FORMULA ORAL LIQUID 7.5 MG/ML

Formulary OTC

LITTLE COLDS DECONGESTANT ORAL LIQUID 2.5 MG/ML

Formulary OTC

LITTLE REMEDIES POISON TREAT ORAL SUSPENSION RECONSTITUTED 15 GM/120ML

Formulary OTC

LITTLE TUMMYS LAXATIVE ORAL LIQUID 8.8 MG/ML

Formulary OTC

LIVALO ORAL TABLET 1 MG, 2 MG, 4 MG Formulary ST

live better lancet super thin Formulary OTC; QL (150 EA per 30 days)

live better lancet ultra thin Formulary OTC; QL (150 EA per 30 days)

liver extract oral tablet 455 mg Formulary OTC

liver oral capsule 500 mg Formulary OTC

l-lysine hcl oral capsule 500 mg Formulary OTC

l-lysine hcl oral tablet 1000 mg Formulary OTC

l-lysine hcl powder Formulary

l-lysine oral capsule 500 mg Formulary OTC

l-lysine oral tablet 1000 mg, 500 mg Formulary OTC

l-methionine powder Formulary

LMX 4 EXTERNAL CREAM 4 % Formulary OTC

LMX 4 PLUS EXTERNAL KIT 4 % Formulary OTC

LO LOESTRIN FE ORAL TABLET 1 MG-10 MCG / 10 MCG


local anesthesia needle 20g x 4" , 22 x 4" , 22g x 3" Formulary OTC

LODRANE D ORAL CAPSULE 4-60 MG Formulary OTC

LOHIST-D ORAL LIQUID 2-30 MG/5ML Formulary OTC

lohist-dm oral syrup 5-2-10 mg/5ml Formulary OTC; AGE (Min 2 Years)

longs insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 ml Formulary OTC

longs lancets thin Formulary OTC; QL (150 EA per 30 days)

loperamide hcl oral suspension 1 mg/7.5ml Formulary OTC

lopinavir-ritonavir oral solution 400-100 mg/5ml Formulary

loratadine childrens oral solution 5 mg/5ml Formulary OTC

loratadine oral capsule 10 mg Formulary OTC

LORAZEPAM INTENSOL ORAL CONCENTRATE 2 MG/ML


lorazepam oral tablet 0.5 mg, 1 mg, 2 mg Formulary QL (170 EA per 30 days)

l-ornithine hydrochloride powder Formulary

l-ornithine powder Formulary OTC

LORTUSS DM ORAL LIQUID 30-6.25-15 MG/5ML Formulary OTC

LORTUSS EX ORAL LIQUID 30-10-100 MG/5ML Formulary OTC

LORTUSS LQ ORAL LIQUID 6.25-30 MG/5ML Formulary OTC

86

Drug Name Formulary Status Requirements/Limitslosartan potassium oral tablet 100 mg, 25 mg, 50 mg Formulary

losartan potassium-hctz oral tablet 100-12.5 mg, 100-25 mg, 50-12.5 mg

Formulary

LOTRIMIN AF EXTERNAL AEROSOL 2 % Formulary OTC

LOTRIMIN AF EXTERNAL CREAM 1 % Formulary OTC

LOTRIMIN ULTRA EXTERNAL CREAM 1 % Formulary OTC

lovastatin oral tablet 10 mg, 20 mg, 40 mg Formulary

loxapine succinate oral capsule 10 mg, 25 mg, 5 mg, 50 mg Formulary AGE (Min 18 Years)

LOZIBASE S Formulary

l-phenylalanine oral tablet 500 mg Formulary OTC

l-phenylalanine powder Formulary

l-proline powder Formulary

l-serine powder Formulary

l-tyrosine oral capsule 500 mg Formulary OTC

l-tyrosine oral tablet 500 mg Formulary OTC

l-tyrosine powder Formulary

lubricant drops/dual-action ophthalmic solution 0.5-0.9 % Formulary OTC

lubricant eye drops ophthalmic solution 0.4-0.3 % Formulary OTC

LUBRISKIN EXTERNAL LOTION Formulary OTC

LUCENTIS INTRAVITREAL SOLUTION 0.5 MG/0.05ML

Formulary PA; QL (0.05 ML per 28 days)

LUDENS COUGH DROPS MOUTH/THROAT LOZENGE 3-60 MG

Formulary OTC

LUDENS THROAT DROPS MOUTH/THROAT LOZENGE 1 MG, 1.6 MG, 1.7 MG, 2.4 MG, 2.5 MG, 2.8 MG, 4 MG

Formulary OTC

LUPRON DEPOT (1-MONTH) INTRAMUSCULAR KIT 3.75 MG, 7.5 MG


LUPRON DEPOT (3-MONTH) INTRAMUSCULAR KIT 11.25 MG, 22.5 MG


LUPRON DEPOT (4-MONTH) INTRAMUSCULAR KIT 30 MG


LUPRON DEPOT (6-MONTH) INTRAMUSCULAR KIT 45 MG


LUPRON DEPOT-PED (1-MONTH) INTRAMUSCULAR KIT 11.25 MG, 15 MG, 7.5 MG


LUPRON DEPOT-PED (3-MONTH) INTRAMUSCULAR KIT 11.25 MG (PED), 30 MG (PED)


lutein oral capsule 15-0.7 mg, 40 mg, 6 mg Formulary OTC

lutein oral tablet 10 mg, 20 mg, 6 mg Formulary OTC

LUVENA FEMININE WIPES EXTERNAL 1 % Formulary OTC

LYCELLE EXTERNAL GEL Formulary

LYRICA ORAL CAPSULE 100 MG, 150 MG, 200 MG, 225 MG, 25 MG, 300 MG, 50 MG, 75 MG

Formulary ST

lysine4000 oral packet 4000 mg Formulary OTC

LYSODREN ORAL TABLET 500 MG Formulary

M2 C ORAL CAPSULE EXTENDED RELEASE 500 MG Formulary OTC

87

Drug Name Formulary Status Requirements/LimitsMAALOX ADVANCED MAX ST ORAL TABLET CHEWABLE 1000-60 MG

Formulary OTC

MAALOX JUNIOR PLUS ANTIGAS ORAL TABLET CHEWABLE 400-24 MG

Formulary OTC

MAALOX ORAL TABLET CHEWABLE 600 MG Formulary OTC

MACUGEN INTRAOCULAR SOLUTION 0.3 MG Formulary

mafenide hcl powder Formulary OTC

MAG-200 ORAL TABLET 200 MG Formulary OTC

mag-al oral liquid 200-200 mg/5ml Formulary OTC

magdelay oral tablet delayed release 70 mg Formulary OTC

MAGELLAN INSULIN SAFETY SYR 29G X 1/2" 0.3 ML 29G X 1/2" 0.3 ML

Formulary


Formulary

MAGELLAN INSULIN SAFETY SYR 29G X 1/2" 1 ML 29G X 1/2" 1 ML

Formulary


Formulary


Formulary

MAGELLAN INSULIN SAFETY SYR 30G X 5/16" 1 ML 30G X 5/16" 1 ML

Formulary

MAGIC3 INTERMITTENT CATHETER Formulary OTC

MAGIMIN ORAL TABLET 80 MG Formulary OTC

magnacaps oral capsule 100 mg Formulary OTC

MAGNEBIND 200 ORAL TABLET 450-200 MG Formulary OTC

MAGNEBIND 300 ORAL TABLET 250-300 MG Formulary OTC

magnesium aspartate oral tablet 65 mg Formulary OTC

magnesium carbonate granules Formulary OTC

magnesium carbonate heavy powder Formulary

magnesium carbonate oral powder 250 mg/gm Formulary OTC

magnesium chloride powder Formulary

magnesium chloride-calcium oral tablet 64-112 mg Formulary OTC

magnesium citrate oral solution 1.745 gm/30ml Formulary OTC

magnesium citrate powder Formulary

magnesium fizz-plus oral powder effervescent 300-500 mg/6.1gm

Formulary OTC

magnesium gluconate oral tablet 27.5 mg Formulary OTC

magnesium oral capsule 300 mg Formulary OTC

magnesium oral tablet 200 mg, 250 mg, 30 mg Formulary OTC

magnesium oxide oral capsule 500 mg Formulary OTC

magnesium oxide oral powder Formulary OTC

magnesium oxide oral tablet 400 (240 mg) mg, 400 (241.3 mg) mg, 400 mg, 420 mg, 500 mg

Formulary OTC

magnesium oxide powder Formulary

magnesium stearate powder Formulary

88

Drug Name Formulary Status Requirements/Limitsmagnesium sulfate oral capsule 70 mg Formulary OTC

magnesium sulfate powder Formulary

magnum-75 oral tablet extended release Formulary OTC

MAGONATE ORAL TABLET 500 (27 MG) MG Formulary OTC

mag-sr plus calcium oral tablet delayed release 64-106 mg Formulary OTC

MAG-TAB SR ORAL TABLET EXTENDED RELEASE 84 MG (7MEQ)

Formulary OTC

MAKENA OIL 250 MG/ML INTRAMUSCULAR 250 MG/ML

Formulary

MAKENA SUBCUTANEOUS SOLUTION AUTO-INJECTOR 275 MG/1.1ML

Formulary

malathion external lotion 0.5 % Formulary ST

malic acid powder Formulary

manganese aspartate oral tablet 93 mg Formulary OTC

manganese gluconate oral tablet 50 mg Formulary OTC

manganese oral tablet 15 mg Formulary OTC

MANGIMIN ORAL TABLET 10 MG Formulary OTC

mannitol powder Formulary

MAOX ORAL TABLET 420 MG Formulary OTC

MAPAP HEADACHE PLUS ORAL TABLET 500-250 MG

Formulary OTC

MAR-COF BP ORAL LIQUID 30-2-7.5 MG/5ML Formulary OTC

MAR-COF CG EXPECTORANT ORAL LIQUID 225-7.5 MG/5ML

Formulary OTC

marshmallow artificial flavor concentrate Formulary OTC

MASTISOL ADHESIVE EXTERNAL LIQUID Formulary OTC

MATULANE ORAL CAPSULE 50 MG Formulary

MAVYRET ORAL TABLET 100-40 MG Formulary PA

MAXI-COMFORT INSULIN SYRINGE 28G X 1/2" 0.5 ML 28G X 1/2" 0.5 ML

Formulary OTC

MAXI-COMFORT INSULIN SYRINGE 28G X 1/2" 1 ML 28G X 1/2" 1 ML

Formulary OTC

MAXIMUM D3 ORAL CAPSULE 10000 UNIT Formulary OTC

ME-500 ORAL CAPSULE 500 MG Formulary OTC

mecholyl external ointment 0.25 % Formulary OTC

meclizine hcl oral tablet 12.5 mg, 25 mg Formulary

MEDADYNE ORAL PAIN RELIEF MOUTH/THROAT LIQUID 10-0.13-70 %

Formulary OTC

MEDERMA AG FACIAL CLEANSER EXTERNAL LIQUID

Formulary OTC

MEDERMA EXTERNAL GEL Formulary OTC

MEDERMA PM EXTERNAL CREAM 2 % Formulary OTC

medic insulin syringe 30g x 5/16" 0.3 ml 30g x 5/16" 0.3 ml Formulary OTC

medic insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml Formulary OTC

medicated body external powder Formulary OTC

medicated douche vaginal solution 0.3 % Formulary OTC

89

Drug Name Formulary Status Requirements/Limitsmedicated wipes external pad 50 % Formulary OTC

MEDICONE RECTAL SUPPOSITORY 0.25 % Formulary OTC

MEDI-DERM/L-RX EXTERNAL CREAM 2-0.035-5-20 %

Formulary

MEDI-DERM-RX EXTERNAL CREAM 0.035-5-20 % Formulary

MEDI-FIRST ANTISEPTIC CLEANER EXTERNAL GEL 66.5 %

Formulary OTC

MEDI-FIRST/LIDOCAINE EXTERNAL CREAM 0.5-0.13 %

Formulary OTC

MEDIHONEY WOUND/BURN DRESSING EXTERNAL GEL

Formulary OTC

MEDIHONEY WOUND/BURN DRESSING EXTERNAL PASTE

Formulary OTC

medi-laxx oral capsule 8.6-50 mg Formulary OTC

MEDI-LYTE ORAL TABLET 18-9-40 MG Formulary OTC

medi-patch-lidocaine external patch 0.5-0.035-5-20 % Formulary OTC

MEDIPLAST EXTERNAL 40 % Formulary OTC

MEDIPORE + PAD ADHESIVE DRESS PAD 2"X2-3/4" , 3-1/2"X10" , 3-1/2"X13-3/4"

Formulary OTC

MEDISENSE GLUCOSE KETONE CONTR LIQUID IN VITRO


MEDISENSE HI/MID/LOW CONTROL LIQUID IN VITRO


MEDISENSE HIGH/LOW CONTROL LIQUID IN VITRO Formulary OTC; QL (100 EA per 30 days)

MEDISENSE MID CONTROL LIQUID IN VITRO Formulary OTC; QL (100 EA per 30 days)

MEDISENSE THIN LANCETS Formulary OTC; QL (150 EA per 30 days)

medi-tussin dm double strength oral liquid 30-200 mg/5ml Formulary OTC

MEDROX EXTERNAL OINTMENT 0.0375-5-20 % Formulary OTC

MEDROX EXTERNAL PATCH 0.0375-5-20 % Formulary OTC

medroxyprogesterone acetate intramuscular suspension 150 mg/ml


medroxyprogesterone acetate intramuscular suspension prefilled syringe 150 mg/ml

Formulary

medroxyprogesterone acetate oral tablet 10 mg, 2.5 mg, 5 mg

Formulary

mefenamic acid oral capsule 250 mg Formulary

mefloquine hcl oral tablet 250 mg Formulary

mega coq10 oral capsule 400 mg Formulary OTC

MEGA MULTIVITAMIN ORAL POWDER Formulary OTC

megestrol acetate oral suspension 40 mg/ml Formulary

megestrol acetate oral tablet 20 mg, 40 mg Formulary

meijer alcohol swabs pad 70 % 70 % Formulary OTC

MEIJER LANCETS Formulary OTC; QL (150 EA per 30 days)

MEIJER LANCETS THIN Formulary OTC; QL (150 EA per 30 days)

MEIJER LANCETS UNIVERSAL 21G Formulary OTC; QL (150 EA per 30 days)

MEIJER LANCETS UNIVERSAL 33G Formulary OTC; QL (150 EA per 30 days)

MEIJER SUPER THIN LANCETS Formulary OTC; QL (150 EA per 30 days)

90

Drug Name Formulary Status Requirements/Limitsmelatonin er oral tablet extended release 3 mg Formulary OTC

melatonin oral capsule 1 mg, 10 mg, 3 mg, 5 mg Formulary OTC

melatonin oral tablet 1 mg, 10 mg, 3 mg, 300 mcg, 5 mg Formulary OTC

melatonin oral tablet dispersible 5 mg Formulary OTC

melatonin powder Formulary

melatonin sublingual tablet sublingual 10 mg Formulary OTC

melatonin tr oral tablet extended release 1 mg Formulary OTC

MELLOW-TONE ORAL STRIP Formulary OTC

meloxicam oral tablet 15 mg, 7.5 mg Formulary

melphalan hcl intravenous solution reconstituted 50 mg Formulary

melphalan oral tablet 2 mg Formulary

memantine hcl er oral capsule extended release 24 hour 14 mg, 21 mg, 28 mg, 7 mg

Formulary

memantine hcl oral solution 2 mg/ml Formulary

memantine hcl oral tablet 10 mg, 5 (28)-10 (21) mg, 5 mg Formulary

MENACTRA INTRAMUSCULAR INJECTABLE Formulary AGE (Min 19 Years)

mencaps external patch 0.0225-4.5 % Formulary OTC

m-end dmx oral liquid 20-0.667-10 mg/5ml Formulary OTC

M-END PE ORAL LIQUID 3.33-1.33-6.33 MG/5ML Formulary OTC

MENEST ORAL TABLET 0.3 MG, 0.625 MG, 1.25 MG Formulary

menstrual pain relief oral tablet 500-25-15 mg Formulary OTC

menstrual relief max strength oral tablet 500-60-15 mg Formulary OTC

menthol crystals Formulary

MENVEO INTRAMUSCULAR SOLUTION RECONSTITUTED


meperidine hcl injection solution 10 mg/ml, 100 mg/ml, 25 mg/ml, 50 mg/ml

Formulary

mercaptopurine oral tablet 50 mg Formulary

mesalamine oral tablet delayed release 1.2 gm Formulary

mesalamine rectal enema 4 gm Formulary

mesalamine rectal suppository 1000 mg Formulary

mesalamine-cleanser rectal kit 4 gm Formulary

mesna intravenous solution 100 mg/ml Formulary

MESNEX ORAL TABLET 400 MG Formulary

MESTINON ORAL SYRUP 60 MG/5ML Formulary

METAMUCIL MULTIHEALTH FIBER ORAL PACKET 58.12 %

Formulary OTC

METAMUCIL MULTIHEALTH FIBER ORAL POWDER 63 %

Formulary OTC

METAMUCIL ORAL CAPSULE 0.52 GM Formulary OTC

METAMUCIL ORAL POWDER 48.57 % Formulary OTC

METAMUCIL SMOOTH TEXTURE ORAL PACKET 28 %

Formulary OTC

metaproterenol sulfate oral syrup 10 mg/5ml Formulary

METAXALL ORAL TABLET 800 MG Formulary ST

91

Drug Name Formulary Status Requirements/Limitsmetformin hcl er oral tablet extended release 24 hour 500 mg, 750 mg

Formulary

metformin hcl oral solution 500 mg/5ml Formulary ST

metformin hcl oral tablet 1000 mg, 500 mg, 850 mg Formulary

METHADONE HCL INTENSOL ORAL CONCENTRATE 10 MG/ML

Formulary PA; QL (90 ML per 30 days)

methadone hcl oral solution 10 mg/5ml Formulary PA; QL (450 ML per 30 days)

methadone hcl oral solution 5 mg/5ml Formulary PA; QL (900 ML per 30 days)

methadone hcl oral tablet 10 mg Formulary PA; QL (90 EA per 30 days)

methadone hcl oral tablet 5 mg Formulary PA; QL (180 EA per 30 days)

methadone hcl oral tablet soluble 40 mg Formulary PA; QL (22.5 EA per 30 days)

methazolamide oral tablet 25 mg, 50 mg Formulary

methenamine hippurate oral tablet 1 gm Formulary

methenamine mandelate oral tablet 1 gm Formulary

methimazole oral tablet 10 mg, 5 mg Formulary

methionine oral packet 100 mg Formulary OTC

methionine oral tablet 500 mg Formulary OTC

methitest oral tablet 10 mg Formulary

methocarbamol injection solution 1000 mg/10ml Formulary

methocarbamol oral tablet 500 mg, 750 mg Formulary

methotrexate oral tablet 2.5 mg Formulary

methotrexate sodium (pf) injection solution 1 gm/40ml, 250 mg/10ml, 50 mg/2ml

Formulary

methotrexate sodium injection solution 250 mg/10ml, 50 mg/2ml

Formulary

methotrexate sodium injection solution reconstituted 1 gm Formulary

methyl alcohol solution Formulary OTC

methyl salicylate external liquid Formulary

methyl salicylate external oil Formulary OTC

methyl sulfone crystals Formulary

methylcellulose gel 1 % Formulary

methylcellulose gel 2 %, 3 % Formulary OTC

methylcellulose powder Formulary

methylcobalamin powder Formulary

methyldopa oral tablet 250 mg, 500 mg Formulary

methylparaben powder Formulary

methylphenidate hcl er oral tablet extended release 10 mg Formulary AGE (Min 6 Years)

methylphenidate hcl er oral tablet extended release 24 hour18 mg, 27 mg, 36 mg, 54 mg


methylphenidate hcl oral tablet 10 mg, 20 mg, 5 mg Formulary AGE (Min 4 Years and Max 17 Years)

methylprednisolone acetate injection suspension 40 mg/ml, 80 mg/ml

Formulary

methylprednisolone oral tablet 16 mg, 32 mg, 4 mg, 8 mg Formulary

methylprednisolone oral tablet therapy pack 4 mg Formulary

methylprednisolone sodium succ injection solution reconstituted 1000 mg, 125 mg, 40 mg

Formulary

92

Drug Name Formulary Status Requirements/Limitsmetipranolol ophthalmic solution 0.3 % Formulary

metoclopramide hcl oral solution 5 mg/5ml Formulary

metoclopramide hcl oral tablet 10 mg, 5 mg Formulary

metolazone oral tablet 10 mg, 2.5 mg, 5 mg Formulary

metoprolol succinate er oral tablet extended release 24 hour 100 mg, 200 mg, 25 mg, 50 mg

Formulary

metoprolol tartrate intravenous solution 5 mg/5ml Formulary

metoprolol tartrate intravenous solution cartridge 5 mg/5ml Formulary

metoprolol tartrate oral tablet 100 mg, 25 mg, 37.5 mg, 50 mg, 75 mg

Formulary

metoprolol-hydrochlorothiazide oral tablet 100-25 mg, 100-50 mg, 50-25 mg

Formulary

METRO INTRAVENOUS SOLUTION 500-0.74 MG/100ML-%

Formulary

METROCREAM EXTERNAL CREAM 0.75 % Formulary

METROGEL EXTERNAL GEL 1 % Formulary

METROLOTION EXTERNAL LOTION 0.75 % Formulary

metronidazole external cream 0.75 % Formulary

metronidazole external gel 0.75 % Formulary

metronidazole external lotion 0.75 % Formulary

metronidazole in nacl intravenous solution 500-0.79 mg/100ml-%

Formulary

metronidazole oral capsule 375 mg Formulary

metronidazole oral tablet 250 mg, 500 mg Formulary

metronidazole vaginal gel 0.75 % Formulary

mexiletine hcl oral capsule 150 mg, 200 mg, 250 mg Formulary

MEXSANA EXTERNAL POWDER 10.8 % Formulary OTC

MG/TAURINE FORTE ORAL CAPSULE Formulary OTC

MI PASTE PLUS DENTAL PASTE Formulary

MIBELAS 24 FE ORAL TABLET CHEWABLE 1-20 MG-MCG(24)


MICATIN EXTERNAL CREAM 2 % Formulary OTC

miconazole 3 vaginal cream 4 % Formulary OTC

miconazole 7 vaginal suppository 100 mg Formulary OTC

miconazole nitrate vaginal cream 2 % Formulary OTC; QL (45 GM per 34 days)

microfiber cleaning cloths Formulary OTC

MICROGESTIN 1/20 ORAL TABLET 1-20 MG-MCG Formulary

MICROKLENZ EXTERNAL LIQUID 0.1 % Formulary OTC

MICROLET LANCETS Formulary OTC; QL (150 EA per 30 days)

midazolam hcl oral syrup 2 mg/ml Formulary

midodrine hcl oral tablet 10 mg, 2.5 mg, 5 mg Formulary

MIDOL CAFFEINE FREE ORAL TABLET 500-25 MG Formulary OTC

MIDOL COMPLETE ORAL TABLET 500-60-15 MG Formulary OTC

MIGERGOT RECTAL SUPPOSITORY 2-100 MG Formulary

miglitol oral tablet 100 mg, 50 mg Formulary

93

Drug Name Formulary Status Requirements/Limitsmiglustat oral capsule 100 mg Formulary

MIL-A-MULSION ORAL EMULSION 10-15000 UNIT/DROP

Formulary OTC

MILCO-ZYME ORAL TABLET Formulary OTC

milk of magnesia concentrate oral suspension 2400 mg/10ml

Formulary OTC

MILLGUARD ORAL TABLET 800-10-115 MCG-MG-MCG

Formulary OTC

MILTAB #1 ORAL TABLET Formulary OTC

mineral oil light external oil 100 % Formulary OTC

mineral oil oil Formulary

mineral oil-hydrophil petrolat external ointment Formulary OTC

MINIMED GUARDIAN LINK 3 Formulary

MINIMED PRO-SET INFUSION 42" Formulary

MINITRAN TRANSDERMAL PATCH 24 HOUR 0.1 MG/HR, 0.2 MG/HR, 0.4 MG/HR, 0.6 MG/HR

Formulary

minocycline hcl oral capsule 100 mg, 50 mg, 75 mg Formulary

minocycline hcl oral tablet 100 mg, 50 mg, 75 mg Formulary

minoxidil for women external solution 2 % Formulary OTC

minoxidil oral tablet 10 mg, 2.5 mg Formulary

MIRALAX ORAL PACKET Formulary OTC

MIRALAX ORAL POWDER Formulary OTC

MIRCERA INJECTION SOLUTION PREFILLED SYRINGE 150 MCG/0.3ML, 200 MCG/0.3ML, 30 MCG/0.3ML

Formulary

MIRENA (52 MG) INTRAUTERINE INTRAUTERINE DEVICE 20 MCG/24HR


mirtazapine oral tablet 15 mg, 30 mg, 45 mg, 7.5 mg Formulary

mirtazapine oral tablet dispersible 15 mg, 30 mg, 45 mg Formulary

misoprostol oral tablet 100 mcg, 200 mcg Formulary

mitomycin intravenous solution reconstituted 20 mg, 40 mg, 5 mg

Formulary

mitoxantrone hcl intravenous concentrate 20 mg/10ml, 25 mg/12.5ml, 30 mg/15ml

Formulary

M-M-R II SUBCUTANEOUS INJECTABLE Formulary AGE (Min 19 Years)

mn-50 oral capsule 16.67 mg Formulary OTC

moexipril hcl oral tablet 15 mg, 7.5 mg Formulary

moexipril-hydrochlorothiazide oral tablet 15-12.5 mg, 15-25 mg, 7.5-12.5 mg

Formulary

moisture barrier external ointment , 0.44-20.6 % Formulary OTC

MOISTURE GUARD EXTERNAL CREAM 5 % Formulary OTC

MOISTUREL EXTERNAL LOTION 3 % Formulary OTC

moisturizing skin protectant external cream 8 % Formulary OTC

molybdenum oral capsule 30 mcg Formulary OTC

mometasone furoate external cream 0.1 % Formulary

mometasone furoate external ointment 0.1 % Formulary

94

Drug Name Formulary Status Requirements/Limitsmometasone furoate external solution 0.1 % Formulary

mometasone furoate nasal suspension 50 mcg/act Formulary QL (17 GM per 30 days)

MONOCAL ORAL TABLET 625-22.75 MG Formulary OTC

MONOJECT ALLERGIST TRAY KIT 28G X 1/2" 1 ML Formulary

MONOJECT BLUNTIP CANNULA 21G X 1" Formulary

MONOJECT HYPODERMIC NEEDLE 14G X 1-1/2" , 14G X 2" , 16G X 3/4" , 16G X 5/8" , 21G X 2" , 25G X 1-1/4" , 25G X 2" , 26G X 1-1/2" , 26G X 1/2" , 27G X 1-1/2" , 30G X 3/4"

Formulary

MONOJECT INSULIN SYRINGE 25G X 5/8" 1 ML 25G X 5/8" 1 ML

Formulary OTC

MONOJECT INSULIN SYRINGE 27G X 1/2" 1 ML (OTC) 27G X 1/2" 1 ML

Formulary

MONOJECT INSULIN SYRINGE 27G X 1/2" 1 ML (RX) 27G X 1/2" 1 ML

Formulary

MONOJECT INSULIN SYRINGE 28G X 1/2" 0.5 ML (OTC) 28G X 1/2" 0.5 ML

Formulary

MONOJECT INSULIN SYRINGE 28G X 1/2" 0.5 ML (RX) 28G X 1/2" 0.5 ML

Formulary


Formulary


Formulary

MONOJECT INSULIN SYRINGE 29G X 1/2" 0.3 ML 29G X 1/2" 0.3 ML

Formulary


Formulary


Formulary


Formulary

MONOJECT INSULIN SYRINGE 30G X 5/16" 0.5 ML (RX) 30G X 5/16" 0.5 ML

Formulary


Formulary


Formulary

MONOJECT INSULIN SYRINGE 31G X 5/16" 1 ML 31G X 5/16" 1 ML

Formulary OTC

MONOJECT INSULIN SYRINGE U-100 1 ML U-100 1 ML

Formulary

MONOJECT LIFESHIELD SYRINGE 18G X 1" 3 ML Formulary

MONOJECT MAGELLAN SAFETY NDL 21G X 5/8" , 23G X 5/8"

Formulary

MONOJECT MAGELLAN SYRINGE 20G X 1-1/2" 12 ML, 21G X 1" 12 ML, 21G X 1-1/2" 12 ML

Formulary

MONOJECT SYRINGE 18G X 1" 12 ML, 20G X 3/4" 3 ML, 21G X 1-1/2" 6 ML

Formulary

MONOJECT ULTRA COMFORT SYRINGE 28G X 1/2" 0.5 ML (OTC) 28G X 1/2" 0.5 ML

Formulary

95

Drug Name Formulary Status Requirements/LimitsMONOJECT ULTRA COMFORT SYRINGE 28G X 1/2" 0.5 ML (RX) 28G X 1/2" 0.5 ML

Formulary

MONOJECT ULTRA COMFORT SYRINGE 28G X 1/2" 1 ML (OTC) 28G X 1/2" 1 ML

Formulary

MONOJECT ULTRA COMFORT SYRINGE 28G X 1/2" 1 ML (RX) 28G X 1/2" 1 ML

Formulary

MONOJECT ULTRA COMFORT SYRINGE 29G X 1/2" 0.3 ML 29G X 1/2" 0.3 ML

Formulary OTC


Formulary OTC

MONOJECT ULTRA COMFORT SYRINGE 29G X 1/2" 1 ML 29G X 1/2" 1 ML

Formulary OTC


Formulary

MONOJECT ULTRA COMFORT SYRINGE 30G X 5/16" 0.3 ML (RX) 30G X 5/16" 0.3 ML

Formulary


Formulary

MONOJECT ULTRA COMFORT SYRINGE 30G X 5/16" 0.5 ML (RX) 30G X 5/16" 0.5 ML

Formulary


Formulary OTC


Formulary OTC

MONOLET LANCETS Formulary OTC; QL (150 EA per 30 days)

MONOLET OPD LANCETS Formulary OTC; QL (150 EA per 30 days)

MONOVISC INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE 88 MG/4ML

Formulary PA

montelukast sodium oral packet 4 mg Formulary

montelukast sodium oral tablet 10 mg Formulary

montelukast sodium oral tablet chewable 4 mg, 5 mg Formulary

MONUROL ORAL PACKET 3 GM Formulary QL (3 EA per 30 days)

MORPHABOND ER ORAL TABLET ER 12 HOUR ABUSE-DETERRENT 60 MG

Formulary PA

morphine sulfate (concentrate) oral solution 100 mg/5ml Formulary PA; QL (32 ML per 7 days)

morphine sulfate (pf) injection solution 0.5 mg/ml, 1 mg/ml Formulary

morphine sulfate (pf) intravenous solution 10 mg/ml, 2 mg/ml, 4 mg/ml, 8 mg/ml

Formulary

morphine sulfate er beads oral capsule extended release 24 hour 120 mg, 30 mg, 45 mg, 60 mg, 75 mg, 90 mg

Formulary PA

morphine sulfate er oral tablet extended release 100 mg Formulary PA; QL (34 EA per 34 days)


morphine sulfate er oral tablet extended release 200 mg Formulary PA; QL (15.3 EA per 34 days)



morphine sulfate injection solution 10 mg/ml, 2 mg/ml, 4 mg/ml, 5 mg/ml, 8 mg/ml

Formulary

morphine sulfate intravenous solution 1 mg/ml, 150 mg/30ml, 25 mg/ml, 50 mg/ml

Formulary

96

Drug Name Formulary Status Requirements/Limitsmorphine sulfate oral solution 10 mg/5ml Formulary PA; QL (315 ML per 7 days)

morphine sulfate oral solution 20 mg/5ml Formulary PA; QL (158 ML per 7 days)

morphine sulfate oral tablet 15 mg Formulary PA; QL (42 EA per 7 days)

morphine sulfate oral tablet 30 mg Formulary PA; QL (21 EA per 7 days)

morphine sulfate rectal suppository 30 mg Formulary

MOTRIN INFANTS DROPS ORAL SUSPENSION 50 MG/1.25ML

Formulary OTC

mouth rinse mouth/throat liquid 0.07 % Formulary OTC

MOVANTIK ORAL TABLET 12.5 MG, 25 MG Formulary PA; AGE (Min 18 Years)

MOXEZA OPHTHALMIC SOLUTION 0.5 % Formulary

moxifloxacin hcl ophthalmic solution 0.5 % Formulary

moxifloxacin hcl oral tablet 400 mg Formulary

MOZOBIL SUBCUTANEOUS SOLUTION 24 MG/1.2ML Formulary

ms insulin syringe 31g x 5/16" 0.3 ml 31g x 5/16" 0.3 ml Formulary OTC

ms insulin syringe 31g x 5/16" 0.5 ml 31g x 5/16" 0.5 ml Formulary OTC

ms insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 1 ml Formulary OTC

MUCINEX COUGH CHILDRENS ORAL LIQUID 5-100 MG/5ML

Formulary OTC

MUCINEX COUGH FOR KIDS ORAL PACKET 5-100 MG

Formulary OTC

MUCINEX D MAX STRENGTH ORAL TABLET EXTENDED RELEASE 12 HOUR 120-1200 MG

Formulary OTC

MUCINEX D ORAL TABLET EXTENDED RELEASE 12 HOUR 60-600 MG

Formulary

MUCINEX DM MAXIMUM STRENGTH ORAL TABLET EXTENDED RELEASE 12 HOUR 60-1200 MG

Formulary OTC

MUCINEX DM ORAL TABLET EXTENDED RELEASE 12 HOUR 30-600 MG

Formulary

MUCINEX FAST-MAX COLD & SINUS ORAL LIQUID 10-650-400 MG/20ML

Formulary OTC

MUCINEX FAST-MAX COLD & SINUS ORAL TABLET 5-325-200 MG

Formulary OTC

MUCINEX FAST-MAX COLD FLU ORAL LIQUID 5-10-200-325 MG/10ML

Formulary OTC

MUCINEX FAST-MAX CONGEST COUGH ORAL LIQUID 2.5-5-100 MG/5ML

Formulary OTC

MUCINEX FAST-MAX CONGEST COUGH ORAL TABLET 5-10-200 MG

Formulary OTC

MUCINEX FAST-MAX DAY/NIGHT M/S ORAL (TABLET)

Formulary OTC

MUCINEX FAST-MAX DAY/NIGHT ORAL Formulary OTC

MUCINEX FAST-MAX DAY/NIGHT ORAL CAPSULE THERAPY PACK

Formulary OTC

MUCINEX FAST-MAX DAY/NIGHT TAB ORAL Formulary OTC

MUCINEX FAST-MAX ORAL CAPSULE 5-10-200-325 MG

Formulary OTC

MUCINEX FOR KIDS ORAL PACKET 100 MG Formulary OTC

97

Drug Name Formulary Status Requirements/LimitsMUCINEX MAXIMUM STRENGTH ORAL TABLET EXTENDED RELEASE 12 HOUR 1200 MG

Formulary OTC

MUCINEX ORAL TABLET EXTENDED RELEASE 12 HOUR 600 MG

Formulary OTC

MUCINEX SINUS-MAX CONGESTION ORAL TABLET 5-325-200 MG

Formulary OTC

MUCINEX SINUS-MAX DAY/NIGHT ORAL LIQUID Formulary OTC

MUCINEX SINUS-MAX PRESS & PAIN ORAL TABLET 5-325-200 MG

Formulary OTC

MUCINEX STUFFY NOSE/COLD CHILD ORAL LIQUID 2.5-100 MG/5ML

Formulary OTC

mucus relief cold/sinus max st oral liquid 10-650-400 mg/20ml

Formulary OTC

mucus relief d oral tablet extended release 12 hour 60-600 mg

Formulary OTC

mucus relief er oral tablet extended release 12 hour 1200 mg

Formulary OTC

mucus relief pe oral tablet 10-400 mg Formulary OTC

mucus-dm max oral tablet extended release 12 hour 60-1200 mg

Formulary OTC

multi-delyn/iron oral liquid Formulary OTC

multi-draw needle 20g x 1" , 21g x 1" , 22g x 1" Formulary

MULTIGEN FOLIC ORAL TABLET 70-150-2-1 MG Formulary

MULTIGEN ORAL TABLET 70 MG Formulary

MULTIGEN PLUS ORAL TABLET 50-101-1 MG Formulary

multi-minerals oral tablet Formulary OTC

multi-purpose cold compress Formulary OTC

multi-symptom cold plus child oral liquid 2.5-5-100 mg/5ml Formulary OTC

multi-vit/fluoride oral solution 0.25 mg/ml Formulary

multivitamin gummies childrens oral tablet chewable Formulary OTC

multivitamins/fluoride oral tablet chewable 0.5 mg Formulary

mupirocin external ointment 2 % Formulary

mupirocin powder Formulary

MURI-LUBE OIL Formulary

MURO 128 OPHTHALMIC OINTMENT 5 % Formulary OTC

MURO 128 OPHTHALMIC SOLUTION 2 %, 5 % Formulary OTC

muscle rub ultra strength external cream 4-10-30 % Formulary OTC

mustard oil oil Formulary OTC

MUSTARGEN INJECTION SOLUTION RECONSTITUTED 10 MG

Formulary

M-VIT ORAL TABLET Formulary QL (34 EA per 34 days)

MYCOCIDE CX CALLUS EXFOLIATOR EXTERNAL CREAM 12-0.1 %

Formulary OTC

mycophenolate mofetil oral capsule 250 mg Formulary

mycophenolate mofetil oral suspension reconstituted 200 mg/ml

Formulary

mycophenolate mofetil oral tablet 500 mg Formulary

98

Drug Name Formulary Status Requirements/Limitsmycophenolate sodium oral tablet delayed release 180 mg, 360 mg

Formulary

MYGLUCOHEALTH LANCETS 30G Formulary OTC; QL (150 EA per 30 days)

MYLANTA ORAL SUSPENSION 200-200-20 MG/5ML Formulary OTC

MYLERAN ORAL TABLET 2 MG Formulary

MYNATAL ORAL CAPSULE Formulary

mynate 90 plus oral tablet extended release Formulary

mynephrocaps oral capsule 1 mg Formulary

MYOBLOC INTRAMUSCULAR SOLUTION 10000 UNIT/2ML, 2500 UNIT/0.5ML, 5000 UNIT/ML

Formulary PA

MYORISAN ORAL CAPSULE 10 MG, 20 MG, 30 MG, 40 MG

Formulary

nabumetone oral tablet 500 mg, 750 mg Formulary

nac oral capsule 600 mg Formulary OTC

nadolol oral tablet 20 mg, 40 mg, 80 mg Formulary

nadolol-bendroflumethiazide oral tablet 40-5 mg, 80-5 mg Formulary

NAIL SCRUB EXTERNAL LIQUID Formulary OTC

NAIL-EX ORAL TABLET 2.5 MG Formulary OTC

nalbuphine hcl injection solution 10 mg/ml, 20 mg/ml Formulary

naloxone hcl injection solution 0.4 mg/ml, 4 mg/10ml Formulary

naloxone hcl injection solution cartridge 0.4 mg/ml Formulary

naloxone hcl injection solution prefilled syringe 2 mg/2ml Formulary

naltrexone hcl oral tablet 50 mg Formulary

NAMENDA XR TITRATION PACK ORAL CAPSULE EXTENDED RELEASE 24 HOUR 7 & 14 & 21

Formulary

NAMZARIC ORAL CAPSULE EXTENDED RELEASE 24 HOUR 14-10 MG

Formulary

NAPHCON-A OPHTHALMIC SOLUTION 0.025-0.3 % Formulary OTC

naproxen dr oral tablet delayed release 375 mg, 500 mg Formulary

naproxen oral suspension 125 mg/5ml Formulary

naproxen oral tablet 250 mg, 375 mg, 500 mg Formulary

naproxen sodium oral capsule 220 mg Formulary OTC

naratriptan hcl oral tablet 1 mg, 2.5 mg Formulary

NARCAN NASAL LIQUID 4 MG/0.1ML Formulary

NASACORT ALLERGY 24HR AEROSOL 55 MCG/ACT NASAL 55 MCG/ACT

Formulary OTC

NASACORT ALLERGY 24HR CHILDREN AEROSOL 55 MCG/ACT NASAL 55 MCG/ACT

Formulary OTC

nasal allergy 24 hour aerosol 55 mcg/act nasal 55 mcg/act Formulary OTC

nasal aspirator Formulary OTC

nasal decongestant oral liquid 30 mg/5ml Formulary OTC

nasal decongestant oral syrup 30 mg/5ml Formulary OTC

nasal decongestant spray nasal solution 0.05 % Formulary OTC

NASAL EASE ALLERGY RELIEVER NASAL POWDER Formulary OTC

NASALCROM NASAL AEROSOL SOLUTION 5.2 MG/ACT

Formulary OTC

99

Drug Name Formulary Status Requirements/LimitsNASOGEL NASAL GEL Formulary OTC

NASONEB NEBULIZER STARTER Formulary OTC; QL (2 EA per 365 days)

NASOPEN PE ORAL LIQUID 50-10 MG/15ML Formulary OTC

NATACYN OPHTHALMIC SUSPENSION 5 % Formulary

natapres liquid Formulary

nateglinide oral tablet 120 mg, 60 mg Formulary

NATROBA EXTERNAL SUSPENSION 0.9 % Formulary

natural bitterness powder Formulary OTC

natural fiber laxative oral powder 28.3 % Formulary OTC

natural vitamin e moisturizing external gel Formulary OTC

NATURAL WHEY ORAL POWDER Formulary OTC

NATURE-THROID ORAL TABLET 130 MG, 16.25 MG, 162.5 MG, 195 MG, 260 MG, 32.5 MG, 325 MG, 48.75 MG, 65 MG, 97.5 MG

Formulary

NEBUPENT INHALATION SOLUTION RECONSTITUTED 300 MG

Formulary

NECON 0.5/35 (28) ORAL TABLET 0.5-35 MG-MCG Formulary QL (28 EA per 28 days)

neomycin sulfate oral tablet 500 mg Formulary

neomycin-bacitracin zn-polymyx ophthalmic ointment 5-400-10000

Formulary

neomycin-polymyxin b gu irrigation solution 40-200000 Formulary

neomycin-polymyxin-dexameth ophthalmic ointment 3.5-10000-0.1

Formulary

neomycin-polymyxin-dexameth ophthalmic suspension 3.5-10000-0.1

Formulary

neomycin-polymyxin-gramicidin ophthalmic solution 1.75-10000-.025

Formulary

neomycin-polymyxin-hc otic solution 3.5-10000-1 Formulary

neomycin-polymyxin-hc otic suspension 3.5-10000-1 Formulary

NEOSPORIN + PAIN RELIEF MAX ST EXTERNAL OINTMENT 1 %

Formulary OTC

NEOSPORIN ORIGINAL EXTERNAL OINTMENT 3.5-400-5000

Formulary OTC

NEOSPORIN PLUS MAX ST EXTERNAL OINTMENT 4 %

Formulary OTC

NEOSPORIN PLUS PAIN RELIEF MS EXTERNAL CREAM 3.5-10000-10

Formulary OTC

NEOSTRATA FACIAL CLEANSER EXTERNAL LIQUID 0.3 %

Formulary OTC

NEOTUSS-D ORAL LIQUID 7.5-30-200 MG/5ML Formulary OTC

NEPHRONEX ORAL LIQUID 0.9 MG/5ML Formulary OTC

NEPHRO-VITE ORAL TABLET 0.8 MG Formulary OTC

NEULASTA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 6 MG/0.6ML

Formulary PA; QL (2 ML per 34 days)

NEUPOGEN INJECTION SOLUTION 300 MCG/ML, 480 MCG/1.6ML

Formulary PA

NEUPOGEN INJECTION SOLUTION PREFILLED SYRINGE 300 MCG/0.5ML, 480 MCG/0.8ML

Formulary PA

100

Drug Name Formulary Status Requirements/LimitsNEURO-K-250 T.D. ORAL CAPSULE 250 MG Formulary OTC

neuromax external gel 20 % Formulary OTC

NEUROPEN KIT Formulary OTC

NEUROTIPS Formulary OTC

NEUTROGENA BODY EXTERNAL OIL Formulary OTC

NEUTROGENA CLEAR PORE EXTERNAL LIQUID 3.5 %

Formulary OTC

NEUTROGENA T/GEL STUBBORN ITCH EXTERNAL SHAMPOO 0.5 %

Formulary OTC

nevirapine er oral tablet extended release 24 hour 100 mg, 400 mg

Formulary

nevirapine oral suspension 50 mg/5ml Formulary

nevirapine oral tablet 200 mg Formulary

NEW DIGNITY ODOR ELIMINATOR EXTERNAL SOLUTION

Formulary OTC

NEW IMAGE SKIN BARRIER/FLANGE WAFER Formulary OTC

NEW IMAGE SKIN/FLANGE/TAPE Formulary OTC

new terocin external lotion 0.025-10-25 % Formulary OTC

NEXAFED ORAL TABLET ABUSE-DETERRENT 30 MG

Formulary OTC

NEXAFED SINUS PRESSURE + PAIN ORAL TABLET 30-325 MG

Formulary OTC

NEXAVAR ORAL TABLET 200 MG Formulary PA

NEXCARE PREMIUM ADHESIVE GAUZE PAD 3-1/2"X6" , 3-1/2"X8"

Formulary OTC

NEXIUM 24HR CAPSULE DELAYED RELEASE 20 MG ORAL 20 MG


NEXIUM 24HR TABLET DELAYED RELEASE 20 MG ORAL 20 MG


NEXPLANON SUBCUTANEOUS IMPLANT 68 MG Formulary

niacin er (antihyperlipidemic) oral tablet extended release1000 mg, 500 mg, 750 mg

Formulary

niacin er oral capsule extended release 250 mg, 500 mg Formulary OTC

niacin er oral tablet extended release 1000 mg, 250 mg, 750 mg

Formulary OTC

niacin flush free oral capsule 400-100 mg, 500 mg Formulary OTC

niacin oral tablet 100 mg, 50 mg, 500 mg Formulary OTC

niacin powder Formulary

niacinamide oral tablet 100 mg, 500 mg Formulary OTC

niacinamide powder Formulary

nicardipine hcl intravenous solution 2.5 mg/ml Formulary

nicardipine hcl oral capsule 20 mg, 30 mg Formulary

NICODERM CQ TRANSDERMAL PATCH 24 HOUR 14 MG/24HR, 21 MG/24HR, 7 MG/24HR

Formulary OTC

NICORETTE MOUTH/THROAT GUM 2 MG, 4 MG Formulary OTC

NICORETTE MOUTH/THROAT LOZENGE 2 MG, 4 MG Formulary OTC

nicotinamide adenine dinucleo powder Formulary

101

Drug Name Formulary Status Requirements/Limitsnicotine polacrilex mouth/throat gum 2 mg Formulary OTC

nicotine polacrilex mouth/throat lozenge 2 mg, 4 mg Formulary OTC

nicotine step 1 transdermal patch 24 hour 21 mg/24hr Formulary OTC



nicotine transdermal kit 21-14-7 mg/24hr Formulary OTC

NICOTROL INHALATION INHALER 10 MG Formulary

NIFEDICAL XL ORAL TABLET EXTENDED RELEASE 24 HOUR 60 MG

Formulary

nifedipine er oral tablet extended release 24 hour 30 mg, 60 mg, 90 mg

Formulary

nifedipine er osmotic release oral tablet extended release 24 hour 30 mg, 90 mg

Formulary

nifedipine oral capsule 10 mg, 20 mg Formulary

nilutamide oral tablet 150 mg Formulary

nimodipine oral capsule 30 mg Formulary

NINJACOF ORAL LIQUID 12.5-12.5 MG/5ML Formulary OTC

NINJACOF-A ORAL LIQUID 12.5-12.5-160 MG/5ML Formulary OTC

NINJACOF-XG ORAL LIQUID 200-8 MG/5ML Formulary OTC

NIPENT INTRAVENOUS SOLUTION RECONSTITUTED 10 MG

Formulary

NISEKO SUNSCREEN SPF 25 EXTERNAL CREAM Formulary OTC

nisoldipine er oral tablet extended release 24 hour 17 mg, 25.5 mg, 34 mg, 8.5 mg

Formulary

NITEBITE ORAL BAR Formulary OTC

nite-time cold/flu relief oral liquid 5-6.25-15-500 mg/15ml Formulary OTC

NITRO-BID TRANSDERMAL OINTMENT 2 % Formulary

nitrofurantoin macrocrystal oral capsule 100 mg, 50 mg Formulary

nitrofurantoin monohyd macro oral capsule 100 mg Formulary

nitrofurantoin oral suspension 25 mg/5ml Formulary

nitroglycerin er oral capsule extended release 2.5 mg, 6.5 mg, 9 mg

Formulary

nitroglycerin sublingual tablet sublingual 0.3 mg, 0.4 mg, 0.6 mg

Formulary

NIVANEX DMX ORAL TABLET 10-15-380 MG Formulary OTC

NIX CREME RINSE EXTERNAL LIQUID 1 % Formulary OTC

nizatidine oral capsule 150 mg, 300 mg Formulary

nizatidine oral solution 15 mg/ml Formulary

NIZORAL A-D EXTERNAL SHAMPOO 1 % Formulary OTC

NOBLE FORMULA EXTERNAL SHAMPOO 2 % Formulary OTC

NOBLE FORMULA HC EXTERNAL SOLUTION 1 % Formulary OTC

nohist-lq oral liquid 4-10 mg/5ml Formulary OTC

NOKOR ADMIX NEEDLE 18G X 1-1/2" Formulary OTC

non-stick pad 2"x3" Formulary OTC

NOREL AD ORAL TABLET 4-10-325 MG Formulary OTC

NOREL CS ORAL LIQUID 10-4-12.5 MG/5ML Formulary OTC

102

Drug Name Formulary Status Requirements/Limitsnorethindrone acetate oral tablet 5 mg Formulary

norethindrone acet-ethinyl est oral tablet 1-20 mg-mcg Formulary

norgestim-eth estrad triphasic oral tablet 0.18/0.215/0.25 mg-35 mcg


NORMLSHIELD EXTERNAL CREAM 4.5 % Formulary OTC

nortriptyline hcl oral capsule 10 mg, 25 mg, 50 mg, 75 mg Formulary

NORVIR ORAL CAPSULE 100 MG Formulary

NORVIR ORAL SOLUTION 80 MG/ML Formulary

NO-STING SKIN-PREP EXTERNAL Formulary OTC

NOVA SUREFLEX LANCETS Formulary OTC; QL (150 EA per 30 days)

NOVAFERRUM 125 ORAL LIQUID 125-100 MG-UNT/5ML

Formulary OTC

NOVAFERRUM 50 ORAL CAPSULE 50 MG Formulary OTC

NOVAFERRUM PEDIATRIC DROPS ORAL LIQUID 15 MG/ML

Formulary OTC

NOVOLOG FLEXPEN SOLUTION PEN-INJECTOR 100 UNIT/ML SUBCUTANEOUS 100 UNIT/ML

Formulary

NOVOLOG MIX 70/30 FLEXPEN SUSPENSION PEN-INJECTOR (70-30) 100 UNIT/ML SUBCUTANEOUS (70-30) 100 UNIT/ML

Formulary

NOVOLOG MIX 70/30 SUBCUTANEOUS SUSPENSION (70-30) 100 UNIT/ML

Formulary

NOVOLOG PENFILL SOLUTION CARTRIDGE 100 UNIT/ML SUBCUTANEOUS 100 UNIT/ML

Formulary

NOVOLOG SUBCUTANEOUS SOLUTION 100 UNIT/ML

Formulary

NOXICARE EXTERNAL CREAM Formulary OTC

np thyroid oral tablet 30 mg, 60 mg, 90 mg Formulary

NPLATE SUBCUTANEOUS SOLUTION RECONSTITUTED 250 MCG, 500 MCG

Formulary PA

NUEDEXTA ORAL CAPSULE 20-10 MG Formulary PA

NUFERA ORAL TABLET Formulary

NU-GEL EXTERNAL GEL Formulary OTC

NU-MAG ORAL TABLET DELAYED RELEASE 71.5-119 MG

Formulary OTC

NUPERCAINAL RECTAL OINTMENT 1 % Formulary OTC

NUTRA BALANCE PROTEIN COOKIE ORAL Formulary OTC

NUTRA SHAKE ORAL LIQUID (FROZEN) Formulary OTC

NUTRA/PRO CHOCOLATE ORAL PACKET Formulary OTC

NUTRATEAR OPHTHALMIC SOLUTION 0.6 % Formulary OTC

NUTR-E-SOL ORAL LIQUID 400 UNIT/15ML Formulary OTC

nutritional shake high protein oral liquid Formulary OTC

NUTROPIN AQ NUSPIN 10 SOLUTION 10 MG/2ML SUBCUTANEOUS 10 MG/2ML






103

Drug Name Formulary Status Requirements/LimitsNUVARING VAGINAL RING 0.12-0.015 MG/24HR Formulary QL (1 EA per 28 days)

NYAMYC EXTERNAL POWDER 100000 UNIT/GM Formulary

NYMALIZE ORAL SOLUTION 30 MG/10ML, 60 MG/20ML

Formulary

nystatin external cream 100000 unit/gm Formulary

nystatin external ointment 100000 unit/gm Formulary

nystatin external powder 100000 unit/gm Formulary

nystatin mouth/throat suspension 100000 unit/ml Formulary

nystatin oral tablet 500000 unit Formulary

nystatin-triamcinolone external cream 100000-0.1 unit/gm-%

Formulary

nystatin-triamcinolone external ointment 100000-0.1 unit/gm-%

Formulary

NYSTOP EXTERNAL POWDER 100000 UNIT/GM Formulary

NYTOL MAXIMUM STRENGTH ORAL TABLET 50 MG

Formulary OTC

OASIS MOISTURIZING MOUTHWASH MOUTH/THROAT LIQUID

Formulary OTC

OBSTETRIX DHA ORAL 29-1 & 387 MG Formulary

OBSTETRIX EC ORAL TABLET 29-1 MG Formulary

OC8 EXTERNAL GEL 7 % Formulary OTC

OCEAN BLUE MINICAPS D/OMEGA3 ORAL CAPSULE 350-1000 MG-UNIT

Formulary OTC

OCEAN BLUE MINICAPS OMEGA-3 ORAL CAPSULE 350 MG

Formulary OTC

OCEAN BLUE OPTIMAL HEALTH ORAL CAPSULE 250 MG

Formulary OTC

OCEAN COMPLETE SINUS RINSE NASAL AEROSOL SOLUTION

Formulary OTC

OCEAN NASAL SPRAY NASAL SOLUTION 0.65 % Formulary OTC

oceanic selenium oral tablet 50 mcg Formulary OTC

OCUSOFT LID SCRUB COMPLIANCE KIT Formulary OTC

ODEFSEY ORAL TABLET 200-25-25 MG Formulary

ODOR EATERS ANTIFUNGAL EXTERNAL POWDER 1 %

Formulary OTC

odor spray liquid Formulary OTC

OFF ACTIVE EXTERNAL AEROSOL 15 % Formulary OTC

OFF FAMILYCARE CLEAN FEEL EXTERNAL LIQUID 5 %

Formulary OTC

ofloxacin ophthalmic solution 0.3 % Formulary

ofloxacin oral tablet 400 mg Formulary QL (68 EA per 34 days)

ofloxacin otic solution 0.3 % Formulary

OGESTREL ORAL TABLET 0.5-50 MG-MCG Formulary

olanzapine intramuscular solution reconstituted 10 mg Formulary AGE (Min 18 Years)

olanzapine oral tablet 10 mg, 15 mg, 2.5 mg, 20 mg, 5 mg, 7.5 mg


104

Drug Name Formulary Status Requirements/Limitsolanzapine oral tablet dispersible 10 mg, 15 mg, 20 mg, 5 mg


olive oil oil Formulary

olmesartan medoxomil oral tablet 20 mg, 40 mg, 5 mg Formulary QL (34 EA per 34 days)

olmesartan medoxomil-hctz oral tablet 20-12.5 mg, 40-12.5 mg, 40-25 mg


olopatadine hcl nasal solution 0.6 % Formulary

olopatadine hcl ophthalmic solution 0.1 % Formulary

omega dha oral tablet chewable Formulary OTC

OMEGA POWER ORAL CAPSULE 1050 MG Formulary OTC

omega-3 fish oil ex st oral capsule 880 mg Formulary OTC

omega-3 fish oil oral capsule 300 mg Formulary OTC

omega-3 fish oil-vitamin d3 oral capsule 1200-1000 mg-unit

Formulary OTC

OMEGA-3 IQ ORAL TABLET CHEWABLE 240 MG Formulary OTC

omega-3 oral capsule 1400 mg Formulary OTC

omega-3-acid ethyl esters oral capsule 1 gm Formulary

omeprazole magnesium oral capsule delayed release 20.6 (20 base) mg

Formulary OTC

omeprazole oral capsule delayed release 10 mg, 20 mg, 40 mg

Formulary

omeprazole oral tablet delayed release 20 mg Formulary OTC

omeprazole-sodium bicarbonate capsule 20-1100 mg oral (otc) 20-1100 mg


OMNIFLEX DIAPHRAGM VAGINAL DIAPHRAGM Formulary

ONCASPAR INJECTION SOLUTION 750 UNIT/ML Formulary

ondansetron hcl oral solution 4 mg/5ml Formulary QL (150 ML per 30 days)

ondansetron hcl oral tablet 24 mg Formulary QL (1 EA per 30 days)

ondansetron hcl oral tablet 4 mg, 8 mg Formulary QL (15 EA per 34 days)

ondansetron oral tablet dispersible 4 mg, 8 mg Formulary QL (15 EA per 34 days)

one step pregnancy in vitro diagnostic test Formulary OTC

ONE-A-DAY ADULT VITACRAVES+DHA ORAL TABLET CHEWABLE

Formulary OTC

ONE-A-DAY WOMENS 50+ ADVANTAGE ORAL TABLET

Formulary OTC

ONETOUCH DELICA LANCETS 33G Formulary OTC; QL (150 EA per 30 days)

ONETOUCH DELICA LANCETS FINE Formulary OTC; QL (150 EA per 30 days)

ONETOUCH FINEPOINT LANCETS Formulary OTC; QL (150 EA per 30 days)

ONETOUCH PING METER REMOTE SUPPLIES Formulary OTC

ONETOUCH ULTRASOFT LANCETS Formulary OTC; QL (150 EA per 30 days)

ONEXTON EXTERNAL GEL 1.2-3.75 % Formulary AGE (Max 19 Years)

ONFI ORAL SUSPENSION 2.5 MG/ML Formulary

ONFI ORAL TABLET 10 MG, 20 MG Formulary

opium oral tincture 10 mg/ml (1%) Formulary

OPTICLEANSE GHI ORAL POWDER Formulary OTC

OPTIONS CONCEPTROL VAGINAL GEL 4 % Formulary OTC

105

Drug Name Formulary Status Requirements/LimitsOPTIONS GYNOL II CONTRACEPTIVE VAGINAL GEL 3 %

Formulary OTC

OPTIUM BLOOD GLUCOSE MONITOR KIT W/DEVICE W/DEVICE


OPTIUM GLUCOSE MONITOR SYSTEM DEVICE Formulary OTC; QL (150 EA per 30 days)

OPTIUM TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days)

OPTIUMEZ TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days)

ORA-FILM MOUTH/THROAT STRIP 6 % Formulary OTC

ORA-HESIVE BASE PASTE Formulary OTC

oral analgesic max st mouth/throat gel 20 % Formulary OTC

oral anesthetic mouth/throat paste 20 % Formulary OTC

oral electrolytes oral solution Formulary OTC

ORAL SWAB PETITE MOUTH/THROAT SWAB Formulary OTC

oral syringe bottle adapter Formulary OTC

ORALONE MOUTH/THROAT PASTE 0.1 % Formulary

ORAMAGIC PLUS MOUTH/THROAT SUSPENSION RECONSTITUTED 10 %

Formulary OTC

orange oil oil Formulary OTC

ORAZINC ORAL CAPSULE 220 (50 ZN) MG Formulary OTC

ORAZINC ORAL TABLET 110 MG Formulary OTC

ORFADIN ORAL CAPSULE 10 MG, 2 MG, 5 MG Formulary

organic coconut oil oil Formulary OTC

ornithine oral capsule 500 mg Formulary OTC

orphenadrine citrate er oral tablet extended release 12 hour100 mg

Formulary

orphenadrine citrate injection solution 30 mg/ml Formulary

ORTHOVISC INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE 30 MG/2ML

Formulary PA

OS-CAL EXTRA D3 ORAL TABLET 500-600 MG-UNIT Formulary OTC

OS-CAL ORAL TABLET CHEWABLE 500-600 MG-UNIT

Formulary OTC

OS-CAL ULTRA ORAL TABLET 600 MG Formulary OTC

oseltamivir phosphate oral capsule 30 mg, 45 mg, 75 mg Formulary QL (20 EA per 180 days)

oseltamivir phosphate oral suspension reconstituted 6 mg/ml

Formulary

OSTEO-PORETICAL ORAL TABLET 600-1000 MG-UNIT

Formulary OTC

ostomy protective powder Formulary OTC

ovulation predictor in vitro kit Formulary OTC

oxalic acid crystals Formulary OTC

oxaliplatin intravenous solution 100 mg/20ml, 50 mg/10ml Formulary

oxaliplatin intravenous solution reconstituted 100 mg Formulary

oxandrolone oral tablet 10 mg, 2.5 mg Formulary

oxaprozin oral tablet 600 mg Formulary

oxazepam oral capsule 10 mg, 15 mg, 30 mg Formulary QL (136 EA per 34 days)

oxcarbazepine oral suspension 300 mg/5ml Formulary

106

Drug Name Formulary Status Requirements/Limitsoxcarbazepine oral tablet 150 mg, 300 mg, 600 mg Formulary

oxybutynin chloride er oral tablet extended release 24 hour10 mg, 15 mg

Formulary

oxybutynin chloride er oral tablet extended release 24 hour5 mg


oxybutynin chloride oral syrup 5 mg/5ml Formulary

oxybutynin chloride oral tablet 5 mg Formulary

oxycodone hcl er oral tablet er 12 hour abuse-deterrent 10 mg, 20 mg, 40 mg


oxycodone hcl er oral tablet er 12 hour abuse-deterrent 80 mg


oxycodone hcl oral capsule 5 mg Formulary PA; QL (84 EA per 7 days)

oxycodone hcl oral concentrate 10 mg/0.5ml, 100 mg/5ml Formulary PA

oxycodone hcl oral solution 5 mg/5ml Formulary PA; QL (420 ML per 7 days)

oxycodone hcl oral tablet 10 mg Formulary PA; QL (42 EA per 7 days)





oxycodone-acetaminophen oral tablet 10-325 mg Formulary PA; QL (42 EA per 7 days)

oxycodone-acetaminophen oral tablet 2.5-325 mg Formulary PA; QL (168 EA per 7 days)

oxycodone-acetaminophen oral tablet 5-325 mg Formulary PA; QL (84 EA per 7 days)

oxycodone-acetaminophen oral tablet 7.5-325 mg Formulary PA; QL (56 EA per 7 days)

oxycodone-ibuprofen oral tablet 5-400 mg Formulary PA

OXYCONTIN ORAL TABLET ER 12 HOUR ABUSE-DETERRENT 15 MG, 30 MG, 60 MG


oxymorphone hcl er oral tablet extended release 12 hour 10 mg, 15 mg, 20 mg, 5 mg, 7.5 mg


oxymorphone hcl er oral tablet extended release 12 hour 30 mg


oxymorphone hcl er oral tablet extended release 12 hour 40 mg


oxymorphone hcl oral tablet 10 mg Formulary PA; QL (90 EA per 30 days)

oxymorphone hcl oral tablet 5 mg Formulary PA; QL (180 EA per 30 days)

OXYTROL FOR WOMEN TRANSDERMAL PATCH TWICE WEEKLY 3.9 MG/24HR

Formulary OTC

OXYZAL WET DRESSING EXTERNAL SOLUTION 1:2000

Formulary OTC

oyster calcium + d oral tablet 250-125 mg-unit Formulary OTC

oyster calcium/d3 oral tablet 500-200 mg-unit Formulary OTC

oyster shell calcium 250+d oral tablet 250-125 mg-unit Formulary OTC

oyster shell calcium 500+d oral tablet chewable 500-400 mg-unit

Formulary OTC

oyster shell calcium oral tablet 500-400 mg-unit Formulary OTC

oyster shell calcium plus d oral tablet 500-125 mg-unit Formulary OTC

oyster shell calcium/d oral tablet 250-250 mg-unit, 500-200 mg-unit

Formulary OTC

107

Drug Name Formulary Status Requirements/Limitsoyster shell calcium/d3 oral tablet 500-400 mg-unit Formulary OTC

P & S EXTERNAL LIQUID Formulary OTC

P & S EXTERNAL SHAMPOO 2 % Formulary OTC

p-1000 oral capsule 500 mg Formulary OTC

PA CLA ORAL CAPSULE 1000 MG Formulary OTC

pa fish oil/vit d3 triple st oral capsule delayed release 900-1000 mg-unit

Formulary OTC

pa glucosamine-chondroitin oral capsule 166.7-133.3 mg Formulary OTC

pa prenatal formula oral tablet 9-0.5 mg Formulary OTC

pa probiotic complex oral tablet Formulary OTC

paclitaxel intravenous concentrate 100 mg/16.7ml, 150 mg/25ml, 30 mg/5ml, 300 mg/50ml

Formulary

pain & fever childrens oral tablet chewable 160 mg Formulary OTC

pain relief day & night ex st oral 25-500 & 500 mg Formulary OTC

pain relief oral tablet Formulary OTC

pain relief roll-on external liquid 4 % Formulary OTC

pain reliever extra strength oral tablet 500 mg Formulary OTC

pain reliever pm ex st oral tablet 25-500 mg Formulary OTC

pain reliever pm oral tablet 25-500 mg Formulary OTC

pain reliever/fever reducer rectal suppository 120 mg Formulary OTC

pain relieving external gel 3.5 % Formulary OTC

PALADIN EXTERNAL OINTMENT Formulary OTC

pamidronate disodium intravenous solution 30 mg/10ml, 6 mg/ml, 90 mg/10ml

Formulary PA

pamidronate disodium intravenous solution reconstituted 30 mg, 90 mg

Formulary PA

pancreatin oral tablet 325 mg Formulary OTC

PANCREAZE ORAL CAPSULE DELAYED RELEASE PARTICLES 4200 UNIT

Formulary

PANOXYL EXTERNAL LIQUID 2.5 % Formulary OTC

PANOXYL WASH EXTERNAL LIQUID 10 % Formulary OTC; AGE (Max 18 Years)

PANOXYL-4 CREAMY WASH EXTERNAL LIQUID 4 %

Formulary OTC; AGE (Max 18 Years)

panto-250 oral capsule 250 mg Formulary OTC

pantoprazole sodium oral tablet delayed release 20 mg, 40 mg

Formulary

pantothenic acid oral tablet 500 mg Formulary OTC

papaya enzyme oral tablet chewable Formulary OTC

paraffin wax beads wax Formulary OTC

PARAGARD INTRAUTERINE COPPER INTRAUTERINE INTRAUTERINE DEVICE

Formulary

paricalcitol intravenous solution 2 mcg/ml, 5 mcg/ml Formulary PA

paricalcitol oral capsule 1 mcg, 2 mcg, 4 mcg Formulary PA

PARODONTAX MOUTH/THROAT PASTE 0.454 % Formulary OTC

paromomycin sulfate oral capsule 250 mg Formulary

108

Drug Name Formulary Status Requirements/Limitsparoxetine hcl er oral tablet extended release 24 hour 12.5 mg, 25 mg, 37.5 mg


paroxetine hcl oral tablet 10 mg, 20 mg, 30 mg, 40 mg Formulary

parvenzyme digestive enzyme oral tablet Formulary OTC

PAZEO OPHTHALMIC SOLUTION 0.7 % Formulary

pc lancets super thin 30g Formulary OTC; QL (150 EA per 30 days)

PCCA MBK (FATTY ACID) BASE Formulary OTC

peanut oil oil Formulary

pearberry fragrance liquid Formulary OTC

PECGEN DMX ORAL LIQUID 10-187 MG/5ML, 15-125 MG/5ML

Formulary OTC

pectin powder Formulary

PEDIACARE CHILDRENS LONG-ACT ORAL LIQUID 7.5 MG/5ML

Formulary OTC

PEDIACARE CHILDRENS MULTI-SYMP ORAL LIQUID 2.5-5 MG/5ML

Formulary OTC

PEDIACARE MULTI-SYMPTOM ORAL LIQUID 2.5-1-5-160 MG/5ML

Formulary OTC

PEDIA-LAX FIBER GUMMIES ORAL TABLET CHEWABLE

Formulary OTC

PEDIA-LAX ORAL LIQUID 50 MG/15ML Formulary OTC

PEDIA-LAX ORAL TABLET CHEWABLE 400 MG Formulary OTC

PEDIA-LAX RECTAL SUPPOSITORY 1 GM, 2.8 GM Formulary OTC

PEDIALYTE ADVANCED CARE ORAL SOLUTION Formulary OTC

PEDIARIX INTRAMUSCULAR SUSPENSION Formulary

PEDIAVENT ORAL SYRUP 2 MG/5ML Formulary OTC

PEDIAVENT ORAL TABLET CHEWABLE 1 MG Formulary OTC

PEDIAVIT ORAL LIQUID Formulary OTC

PEDVAX HIB INTRAMUSCULAR SUSPENSION 7.5 MCG/0.5ML


peg 300 liquid Formulary

PEGANONE ORAL TABLET 250 MG Formulary

PEGASYS PROCLICK SUBCUTANEOUS SOLUTION 135 MCG/0.5ML, 180 MCG/0.5ML

Formulary PA

PEGASYS SUBCUTANEOUS SOLUTION 180 MCG/ML Formulary PA; QL (1 ML per 34 days)

PEGINTRON SUBCUTANEOUS KIT 50 MCG/0.5ML Formulary

penicillin g potassium injection solution reconstituted20000000 unit, 5000000 unit

Formulary

penicillin v potassium oral solution reconstituted 125 mg/5ml, 250 mg/5ml

Formulary

penicillin v potassium oral tablet 250 mg, 500 mg Formulary

PENTACEL INTRAMUSCULAR SUSPENSION RECONSTITUTED

Formulary

PENTASA ORAL CAPSULE EXTENDED RELEASE 250 MG, 500 MG

Formulary

pentoxifylline er oral tablet extended release 400 mg Formulary

PENTRAX GOLD EXTERNAL SHAMPOO 4 % Formulary OTC

109

Drug Name Formulary Status Requirements/Limitspeppermint oil oil Formulary

peppermint spirit spirit Formulary OTC

PEPTO-BISMOL MAX STRENGTH ORAL SUSPENSION 525 MG/15ML

Formulary OTC

PEPTO-BISMOL ORAL SUSPENSION 262 MG/15ML Formulary OTC

PEPTO-BISMOL ORAL TABLET 262 MG Formulary OTC

PEPTO-BISMOL TO-GO ORAL TABLET CHEWABLE 262 MG

Formulary OTC

PERFORM ATOMIC HEAT EXTERNAL CREAM 0.034-10 %

Formulary OTC

PERFORM ATOMIC HEAT EXTERNAL LIQUID 0.034-10 %

Formulary OTC

PERFORM PAIN RELIEVING EXTERNAL LIQUID 10.4 %

Formulary OTC

PERFORM PAIN RELIEVING ROLL-ON EXTERNAL LIQUID 3.1 %

Formulary OTC

PERFOROMIST INHALATION NEBULIZATION SOLUTION 20 MCG/2ML


PERIDIN-C ORAL TABLET 200-50-150 MG Formulary OTC

perindopril erbumine oral tablet 2 mg, 4 mg, 8 mg Formulary

PERIOMED MOUTH/THROAT CONCENTRATE 0.63 % Formulary OTC

permethrin external cream 5 % Formulary

PERNOX EXTERNAL LOTION 1.5-2 % Formulary OTC

PEROXYL EXTERNAL SOLUTION 1.5-6 % Formulary OTC

PEROXYL MOUTH/THROAT SOLUTION 1.5 % Formulary OTC

PEROXYL SPOT TREATMENT MOUTH/THROAT GEL 1.5 %

Formulary OTC

perphenazine oral tablet 16 mg, 2 mg, 4 mg, 8 mg Formulary AGE (Min 18 Years)

perphenazine-amitriptyline oral tablet 2-10 mg, 2-25 mg, 4-10 mg, 4-25 mg, 4-50 mg


PERRY PRENATAL ORAL CAPSULE 13.5-0.4 MG Formulary OTC

peruvian balsam liquid Formulary OTC

petroleum jelly external aerosol Formulary OTC

petroleum jelly external ointment Formulary OTC

PHARMABASE BARRIER EXTERNAL OINTMENT 9.38 %

Formulary OTC

PHARMACY COUNTER LANCETS Formulary OTC; QL (150 EA per 30 days)

PHAZYME MAXIMUM STRENGTH ORAL CAPSULE 250 MG

Formulary OTC

PHAZYME ULTRA STRENGTH ORAL CAPSULE 180 MG

Formulary OTC

PHENADOZ RECTAL SUPPOSITORY 12.5 MG, 25 MG Formulary AGE (Min 2 Years)

PHENAZO ORAL TABLET 200 MG Formulary

phenazopyridine hcl oral tablet 100 mg Formulary

phenelzine sulfate oral tablet 15 mg Formulary

phenobarbital oral elixir 20 mg/5ml Formulary

phenobarbital oral solution 20 mg/5ml Formulary

110

Drug Name Formulary Status Requirements/Limitsphenobarbital oral tablet 100 mg, 15 mg, 16.2 mg, 30 mg, 32.4 mg, 60 mg, 64.8 mg, 97.2 mg

Formulary

phenol external liquid Formulary OTC

PHENOL EZ SWABS EXTERNAL SWAB 89 % Formulary OTC

phenoxybenzamine hcl oral capsule 10 mg Formulary

phentermine hcl oral capsule 15 mg, 30 mg, 37.5 mg Formulary PA

phentermine hcl oral tablet 37.5 mg Formulary PA

phenylalanine oral packet 50 mg Formulary OTC

PHENYTOIN INFATABS ORAL TABLET CHEWABLE 50 MG

Formulary

phenytoin oral suspension 125 mg/5ml Formulary

phenytoin oral tablet chewable 50 mg Formulary

phenytoin sodium extended oral capsule 100 mg, 200 mg, 300 mg

Formulary

phenytoin sodium injection solution 50 mg/ml Formulary

PHLEXY-10 ORAL TABLET Formulary OTC

PHOS-FLUR ORTHO DEFENSE MOUTH/THROAT SOLUTION 0.044 %

Formulary OTC

phos-nak oral packet 280-160-250 mg Formulary OTC

PHOSPHASAL ORAL TABLET 81.6 MG Formulary

phosphatidyl choline oral tablet 65 mg Formulary OTC

phosphatidylcholine powder Formulary

phosphatidylserine powder Formulary OTC

PHOSPHOLINE IODIDE OPHTHALMIC SOLUTION RECONSTITUTED 0.125 %

Formulary

PHOTOFRIN INTRAVENOUS SOLUTION RECONSTITUTED 75 MG

Formulary

phytonadione liquid Formulary

phytonadione oral tablet 5 mg Formulary

PHYTOPLEX Z-GUARD EXTERNAL PASTE 57-17 % Formulary OTC

PIFELTRO ORAL TABLET 100 MG Formulary QL (30 EA per 30 days)

pilocarpine hcl oral tablet 5 mg, 7.5 mg Formulary

pimecrolimus external cream 1 % Formulary PA; AGE (Min 2 Years)

pindolol oral tablet 10 mg, 5 mg Formulary

pioglitazone hcl oral tablet 15 mg, 30 mg, 45 mg Formulary

pioglitazone hcl-glimepiride oral tablet 30-2 mg, 30-4 mg Formulary ST; QL (34 EA per 34 days)

pioglitazone hcl-metformin hcl oral tablet 15-500 mg, 15-850 mg

Formulary

piroxicam oral capsule 10 mg, 20 mg Formulary

PLAN B ONE-STEP ORAL TABLET 1.5 MG Formulary OTC; QL (2 EA per 34 days)

plasticized base ointment Formulary

PLIAGEL GEL 0.5-0.5-0.25 % Formulary OTC

PLO ULTRAMAX EXTERNAL GEL Formulary OTC

PLURONIC GEL 20 %, 30 % Formulary

pmx-1184 silicone liquid Formulary

111

Drug Name Formulary Status Requirements/LimitsPNEUMOVAX 23 INJECTION INJECTABLE 25 MCG/0.5ML


pnv-dha oral capsule 27-0.6-0.4-300 mg Formulary

pnv-omega oral capsule 28-0.6-0.4-340 mg Formulary

pnv-select oral tablet 27-0.6-0.4 mg Formulary

podofilox external solution 0.5 % Formulary

podophyllum resin powder Formulary

poison ivy wash fast acting external Formulary OTC

POLAR FREEZE EXTERNAL GEL 3.5-0.8 % Formulary OTC

poloxamer 188 powder Formulary

poly bacitracin external ointment 500-10000 unit/gm Formulary OTC

POLY HIST FORTE ORAL TABLET 7.5-10 MG Formulary OTC

polyethylene glycol 1000 liquid Formulary OTC

polyethylene glycol 1450 liquid Formulary

polyethylene glycol 3350 powder Formulary

polyethylene glycol 400 liquid Formulary

polyethylene glycol 8000 powder Formulary

poly-hist dm oral liquid 5-25-10 mg/5ml Formulary OTC

poly-hist pd oral liquid 6.25-6.25 mg/ml Formulary OTC

polymyxin b sulfate powder Formulary

polymyxin b-trimethoprim ophthalmic solution 10000-0.1 unit/ml-%

Formulary

polyoxyl 40 stearate powder Formulary

polysorbate 20 solution Formulary

polysorbate 80 oral liquid Formulary

POLYSPORIN EXTERNAL OINTMENT 500-10000 UNIT/GM

Formulary OTC

poly-tussin ac oral liquid 10-4-10 mg/5ml Formulary OTC

POLY-VENT DM ORAL TABLET 60-20-380 MG Formulary OTC

POLY-VENT IR ORAL TABLET 60-380 MG Formulary OTC

POLY-VI-SOL ORAL SOLUTION Formulary OTC

POLY-VI-SOL/IRON ORAL SOLUTION Formulary OTC

potassimin oral tablet 75 mg Formulary OTC

potassium bitartrate powder Formulary

potassium bromide crystals Formulary

potassium chloride crystals Formulary OTC

potassium chloride granules Formulary

potassium citrate er oral tablet extended release 10 meq (1080 mg), 5 meq (540 mg)

Formulary

potassium citrate granules Formulary OTC

potassium citrate-citric acid oral solution 1100-334 mg/5ml Formulary

potassium gluconate anhydrous powder Formulary

potassium gluconate oral tablet 2.5 meq, 595 (99 k) mg Formulary OTC

potassium hydroxide pellet Formulary

potassium hydroxide solution 10 %, 20 % Formulary OTC

112

Drug Name Formulary Status Requirements/Limitspotassium iodide (antidote) oral solution 65 mg/ml Formulary OTC

potassium iodide crystals Formulary

potassium nitrate granules Formulary OTC

potassium permanganate granules Formulary

potassium sodium tartrate powder Formulary OTC

potassium sorbate crystals Formulary OTC

povidone-iodine external ointment 10 % Formulary OTC

povidone-iodine external solution 10 % Formulary OTC

povidone-iodine external swab 7.5 % Formulary OTC

povidone-iodine paint sponge external swab 10 % Formulary OTC

povidone-iodine prep external pad 10 % Formulary OTC

povidone-iodine scrub sponge external 10 % Formulary OTC

power oral care system mouth/throat kit Formulary OTC

PR NATAL 400 EC ORAL 29-1-200 & 400 MG (DR) Formulary

PR NATAL 400 ORAL 29-1-200 & 400 MG Formulary

PR NATAL 430 EC ORAL 29-1-200 & 430 MG (DR) Formulary

PR NATAL 430 ORAL 29-1-200 & 430 MG Formulary

PRADAXA ORAL CAPSULE 110 MG, 150 MG, 75 MG Formulary

PRALUENT SUBCUTANEOUS SOLUTION PEN-INJECTOR 150 MG/ML, 75 MG/ML

Formulary PA

PRAMEGEL EXTERNAL GEL 1 % Formulary OTC

pramipexole dihydrochloride oral tablet 0.125 mg, 0.25 mg, 0.5 mg, 0.75 mg, 1 mg, 1.5 mg

Formulary

pramoxine hcl rectal foam 1 % Formulary OTC

prasugrel hcl oral tablet 10 mg, 5 mg Formulary

pravastatin sodium oral tablet 10 mg, 20 mg, 40 mg, 80 mg Formulary

prazosin hcl oral capsule 1 mg, 2 mg, 5 mg Formulary

PRECISION GLUCOSE CONTROL LIQUID IN VITRO Formulary OTC; QL (100 EA per 30 days)

PRECISION GLUCOSE CONTROL SOLN SOLUTION IN VITRO


PRECISION GLUCOSE KETONE CONTR LIQUID IN VITRO


PRECISION GLUCOSE/KETONE CONTR LIQUID IN VITRO


PRECISION LINK KIT Formulary OTC; QL (1 EA per 365 days)

PRECISION PCX PLUS TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days)

PRECISION PCX STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days)

PRECISION POINT OF CARE TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days)

PRECISION QID MONITOR DEVICE Formulary OTC; QL (1 EA per 365 days)

PRECISION QID MONITOR DEVICE Formulary OTC; QL (150 EA per 30 days)

PRECISION QID TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days)

PRECISION SOF-TACT MONITOR DEVICE Formulary OTC; QL (1 EA per 365 days)

PRECISION SOF-TACT TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days)

PRECISION SUREDOSE PLUS SYR 29G X 1/2" 0.3 ML 29G X 1/2" 0.3 ML

Formulary OTC

113

Drug Name Formulary Status Requirements/LimitsPRECISION SUREDOSE PLUS SYR 29G X 1/2" 1 ML 29G X 1/2" 1 ML

Formulary OTC

PRECISION SURE-DOSE SYRINGE 28G X 1/2" 0.5 ML 28G X 1/2" 0.5 ML

Formulary OTC

PRECISION SURE-DOSE SYRINGE 28G X 1/2" 1 ML 28G X 1/2" 1 ML

Formulary OTC


Formulary OTC


Formulary OTC

PRECISION THINS GP LANCETS Formulary OTC; QL (150 EA per 30 days)

PRECISION XTRA BLOOD GLUCOSE STRIP IN VITRO


PRECISION XTRA DEVICE Formulary OTC; QL (1 EA per 365 days)

PRECISION XTRA DEVICE Formulary OTC; QL (150 EA per 30 days)

PRECISION XTRA KETONE STRIP IN VITRO Formulary OTC; QL (100 EA per 30 days)

PRECISION XTRA KIT Formulary OTC; QL (1 EA per 365 days)

PRECISION XTRA MONITOR DEVICE Formulary OTC; QL (1 EA per 365 days)

PRED MILD OPHTHALMIC SUSPENSION 0.12 % Formulary

prednicarbate external cream 0.1 % Formulary

prednicarbate external ointment 0.1 % Formulary

prednisolone acetate ophthalmic suspension 1 % Formulary

prednisolone oral solution 15 mg/5ml Formulary

prednisolone sodium phosphate oral solution 15 mg/5ml, 20 mg/5ml, 25 mg/5ml, 6.7 (5 base) mg/5ml

Formulary

PREDNISONE INTENSOL ORAL CONCENTRATE 5 MG/ML

Formulary

prednisone oral solution 5 mg/5ml Formulary

prednisone oral tablet 1 mg, 10 mg, 2.5 mg, 20 mg, 5 mg, 50 mg

Formulary

prednisone oral tablet therapy pack 10 mg (21), 10 mg (48), 5 mg (21), 5 mg (48)

Formulary

preferred plus insulin syringe 28g x 1/2" 0.5 ml 28g x 1/2" 0.5 ml

Formulary OTC

preferred plus insulin syringe 28g x 1/2" 1 ml 28g x 1/2" 1 ml

Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC

preferred plus lancets colored Formulary OTC; QL (150 EA per 30 days)

114

Drug Name Formulary Status Requirements/Limitspreferred plus lancets thin Formulary OTC; QL (150 EA per 30 days)

PREGNITUDE ORAL PACKET 2000-200 MG-MCG Formulary OTC

PREMARIN VAGINAL CREAM 0.625 MG/GM Formulary

PREMIER UROSTOMY POUCH Formulary OTC

PREMPHASE ORAL TABLET 0.625-5 MG Formulary

PREMPRO ORAL TABLET 0.3-1.5 MG, 0.45-1.5 MG, 0.625-2.5 MG, 0.625-5 MG

Formulary

prenatal formula a-free oral tablet 9-0.267 mg Formulary OTC

prenatal formula oral capsule 28-0.8-235 mg Formulary OTC

prenatal low iron oral tablet 27-0.8 mg Formulary OTC

prenatal multi +dha oral capsule 27-0.8-200 mg Formulary OTC

prenatal multivitamin plus dha oral capsule 27-0.8-250 mg Formulary OTC

prenatal oral tablet 27-0.8 mg Formulary

prenatal oral tablet 28-0.8 mg, 6.75-0.2 mg Formulary OTC

PRENATE ORAL TABLET CHEWABLE 0.6-0.4 MG Formulary

PRENATE PIXIE ORAL CAPSULE 10-0.6-0.4-200 MG Formulary

prep protective skin barrier external pad 0.5 % Formulary OTC

PREPARATION H RECTAL CREAM 1-0.25-14.4-15 %, 5-14.4 %

Formulary OTC

PREPARATION H RECTAL GEL 0.25-50 % Formulary OTC

PREPARATION H RECTAL OINTMENT 0.25-14-74.9 % Formulary OTC

PREPARATION H TOTABLES RECTAL CREAM 1-0.25-14.4-15 %

Formulary OTC

pres gen pediatric oral liquid 2.5-5-75 mg/5ml Formulary OTC

PRESGEN B ORAL LIQUID 10-4-20 MG/5ML Formulary OTC

PRETZ NASAL SOLUTION Formulary OTC

PRETZ SOLUTION 10 % Formulary OTC

PREVACARE ANTIMICROBIAL EXTERNAL GEL 60 %

Formulary OTC

PREVACARE EXTRA PROTECTIVE EXTERNAL OINTMENT

Formulary OTC

PREVACARE PERSONAL PROTECT EXTERNAL CREAM

Formulary OTC

PREVACARE TOTAL SKIN CARE EXTERNAL SOLUTION

Formulary OTC

PREVACID 24HR ORAL CAPSULE DELAYED RELEASE 15 MG

Formulary OTC

PREVALITE ORAL PACKET 4 GM Formulary

PREVALITE ORAL POWDER 4 GM/DOSE Formulary

PREVNAR 13 INTRAMUSCULAR SUSPENSION Formulary AGE (Min 19 Years)

PREZCOBIX ORAL TABLET 800-150 MG Formulary

PREZISTA ORAL TABLET 150 MG, 600 MG, 75 MG, 800 MG

Formulary

PRIFTIN ORAL TABLET 150 MG Formulary

PRILOSEC OTC ORAL TABLET DELAYED RELEASE 20 MG

Formulary OTC

115

Drug Name Formulary Status Requirements/LimitsPRIMATENE ASTHMA ORAL TABLET 12.5-200 MG Formulary OTC

primidone oral tablet 250 mg, 50 mg Formulary

PRO NUTRIENTS OMEGA 3 ORAL CAPSULE DELAYED RELEASE 332.5 MG

Formulary OTC

PROAIR HFA INHALATION AEROSOL SOLUTION 108 (90 BASE) MCG/ACT

Formulary

probenecid oral tablet 500 mg Formulary

PROBIOMAX PLUS DF ORAL PACKET Formulary OTC

probiotic digestive support oral capsule Formulary OTC

probiotic oral capsule 250 mg Formulary OTC

probiotic oral tablet delayed release Formulary OTC

probiotic-prebiotic oral capsule 1-250 billion-mg Formulary OTC

PROCARE PLUS UNDERWEAR MEDIUM Formulary OTC

PRO-CEPTION VAGINAL KIT Formulary OTC

prochlorperazine maleate oral tablet 10 mg, 5 mg Formulary

prochlorperazine rectal suppository 25 mg Formulary

PROCOMYCIN EXTERNAL CREAM 4 % Formulary OTC

PROCRIT SOLUTION 10000 UNIT/ML INJECTION 10000 UNIT/ML

Formulary


Formulary


Formulary


Formulary


Formulary


Formulary

PROCTOCORT RECTAL CREAM 1 % Formulary

PROCTOFOAM RECTAL FOAM 1 % Formulary OTC

PROCTOSOL HC RECTAL CREAM 2.5 % Formulary

PRODIGY INSULIN SYRINGE 28G X 1/2" 1 ML 28G X 1/2" 1 ML

Formulary OTC

PRODIGY INSULIN SYRINGE 31G X 5/16" 0.3 ML 31G X 5/16" 0.3 ML

Formulary OTC

PRODIGY INSULIN SYRINGE 31G X 5/16" 0.5 ML 31G X 5/16" 0.5 ML

Formulary OTC

PRODIGY NO CODING BLOOD GLUC STRIP IN VITRO

Formulary PA; OTC; QL (150 EA per 30 days)

PRODIGY TWIST TOP LANCETS 28G Formulary OTC; QL (150 EA per 30 days)

PROFE ORAL CAPSULE 391.3 (180 FE) MG Formulary OTC

PROFERRIN ES ORAL TABLET 12 MG Formulary OTC

PROFERRIN-FORTE ORAL TABLET 12-1 MG Formulary OTC

PROFILNINE SD INTRAVENOUS SOLUTION RECONSTITUTED 500 UNIT

Formulary

progesterone intramuscular oil 50 mg/ml Formulary

116

Drug Name Formulary Status Requirements/Limitsprogesterone micronized oral capsule 100 mg, 200 mg Formulary

progesterone micronized powder Formulary

PROGLYCEM ORAL SUSPENSION 50 MG/ML Formulary

PROLENSA OPHTHALMIC SOLUTION 0.07 % Formulary

PROLIA SUBCUTANEOUS SOLUTION 60 MG/ML Formulary PA

PROLIDA EXTERNAL PATCH 4-1 % Formulary OTC

PROMACTA ORAL TABLET 12.5 MG Formulary PA; QL (240 EA per 30 days)

PROMACTA ORAL TABLET 25 MG Formulary PA; QL (120 EA per 30 days)



promethazine hcl oral syrup 6.25 mg/5ml Formulary AGE (Min 2 Years)

promethazine hcl oral tablet 12.5 mg, 25 mg, 50 mg Formulary AGE (Min 2 Years)

promethazine hcl rectal suppository 12.5 mg, 50 mg Formulary AGE (Min 2 Years)

promethazine hcl rectal suppository 25 mg Formulary

promethazine vc/codeine oral syrup 6.25-5-10 mg/5ml Formulary AGE (Min 6 Years)

promethazine-codeine oral syrup 6.25-10 mg/5ml Formulary AGE (Min 6 Years)

promethazine-dm oral syrup 6.25-15 mg/5ml Formulary AGE (Min 6 Years)

PROMETHEGAN RECTAL SUPPOSITORY 25 MG Formulary

PROMOLAXIN ORAL TABLET 100 MG Formulary OTC

PRONUTRIENTS CALCIUM+D3 ORAL TABLET 600-800 MG-UNIT

Formulary OTC

PRONUTRIENTS SUPER B COMPLEX ORAL TABLET Formulary OTC

propafenone hcl er oral capsule extended release 12 hour225 mg, 325 mg, 425 mg

Formulary

propafenone hcl oral tablet 150 mg, 225 mg, 300 mg Formulary

propranolol hcl er oral capsule extended release 24 hour120 mg, 160 mg, 60 mg, 80 mg

Formulary

propranolol hcl intravenous solution 1 mg/ml Formulary

propranolol hcl oral solution 20 mg/5ml, 40 mg/5ml Formulary

propranolol hcl oral tablet 10 mg, 20 mg, 40 mg, 60 mg, 80 mg

Formulary

propranolol-hctz oral tablet 40-25 mg, 80-25 mg Formulary

propylene glycol external solution Formulary

propylene glycol liquid Formulary

propylparaben powder Formulary

propylthiouracil oral tablet 50 mg Formulary

PRO-RED AC ORAL SYRUP 5-1-9 MG/5ML Formulary OTC

PROSHIELD SKIN CARE EXTERNAL KIT Formulary OTC

protein oral powder 80 % Formulary OTC

protein oral tablet 975 mg Formulary OTC

PROTEINEX ORAL LIQUID Formulary OTC

PROTEINEX P100 ORAL LIQUID Formulary OTC

protriptyline hcl oral tablet 10 mg, 5 mg Formulary

PROVENT SLEEP APNEA THERAPY Formulary

117

Drug Name Formulary Status Requirements/LimitsPROVENTIL HFA INHALATION AEROSOL SOLUTION 108 (90 BASE) MCG/ACT

Formulary

PROVIDA DHA ORAL CAPSULE 16-16-1.25-110 MG Formulary

PROVIEW KIT Formulary OTC

pseudoeph-bromphen-dm oral syrup 30-2-10 mg/5ml Formulary

pseudoephedrine hcl er oral tablet extended release 12 hour120 mg

Formulary OTC

pseudoephedrine hcl oral syrup 30 mg/5ml Formulary OTC

pseudoephedrine hcl oral tablet 30 mg Formulary OTC

pseudoephedrine hcl oral tablet 60 mg Formulary

psorcon external cream 0.05 % Formulary

PSS SELECT GP LANCETS Formulary OTC; QL (150 EA per 30 days)

PSS SELECT SAFETY LANCETS Formulary OTC; QL (150 EA per 30 days)

psyllium husk powder Formulary

PULMICORT FLEXHALER INHALATION AEROSOL POWDER BREATH ACTIVATED 180 MCG/ACT, 90 MCG/ACT

Formulary

PULMICORT INHALATION SUSPENSION 0.25 MG/2ML, 0.5 MG/2ML, 1 MG/2ML

Formulary

PULMOZYME INHALATION SOLUTION 1 MG/ML Formulary

PURACYN PLUS DUO-CARE EXTERNAL LIQUID Formulary OTC

pure l-citrulline oral capsule 600 mg Formulary OTC

pure l-citrulline oral powder Formulary OTC

purefe ob plus oral capsule 162-115.2-1 mg Formulary

purified water oral liquid Formulary

PURILON EXTERNAL GEL Formulary OTC

px allergy relief d oral tablet extended release 12 hour 5-120 mg

Formulary OTC

px allergy sinus pe oral tablet 2-5-325 mg Formulary OTC

px antacid extra strength oral tablet chewable 750 mg Formulary OTC

px artificial tears ophthalmic solution 5-6 mg/ml Formulary OTC

px daytime cold oral tablet 10-5-325 mg Formulary OTC

px daytime multi-symptom oral capsule 30-325-15 mg Formulary OTC

px gas relief extra strength oral capsule 125 mg Formulary OTC

px ibuprofen cold & sinus oral tablet 30-200 mg Formulary OTC

px insulin syringe 30g x 1/2" 0.5 ml 30g x 1/2" 0.5 ml Formulary OTC

px lancets ultra thin Formulary OTC; QL (150 EA per 30 days)

px minoxidil for men external solution 5 % Formulary OTC

px nasal four nasal solution 1 % Formulary OTC

px nitetime multi-symptom oral capsule 30-6.25-15-325 mg Formulary OTC

px omeprazole oral tablet delayed release 20 mg Formulary OTC

PYLERA ORAL CAPSULE 140-125-125 MG Formulary

pyrazinamide oral tablet 500 mg Formulary

pyridostigmine bromide er oral tablet extended release 180 mg

Formulary

pyridostigmine bromide oral tablet 60 mg Formulary

118

Drug Name Formulary Status Requirements/Limitspyridoxal-5 phosphate powder Formulary

pyridoxine hcl oral tablet 25 mg Formulary OTC

pyridoxine hcl powder Formulary

PYRIDOXINE/MINERALS ORAL CAPSULE 100-99-200 MG

Formulary OTC

pyrilamine-phenylephrine oral tablet 25-10 mg Formulary OTC

pyruvic acid liquid Formulary

qc alcohol swabs pad 70 % 70 % Formulary OTC

qc arthritis external cream 10 % Formulary OTC

qc calamine external lotion Formulary OTC

qc castor oil oil Formulary OTC

qc iodides external tincture Formulary OTC

qc iodine tincture external tincture Formulary OTC

qc lancets super thin 30g Formulary OTC; QL (150 EA per 30 days)

qc lancets ultra thin Formulary OTC; QL (150 EA per 30 days)

QC MEDIFIN PE ORAL TABLET 10-400 MG Formulary OTC

qc natural vegetable oral powder 95 % Formulary OTC

qc non-adherent pad 3"x4" Formulary OTC

qc unilet lancets 28g Formulary OTC; QL (150 EA per 30 days)

qc unilet lancets micro thin Formulary OTC; QL (150 EA per 30 days)

Q-GEL ORAL CAPSULE 15 MG Formulary OTC

quercetin oral tablet 250 mg, 50 mg Formulary OTC

quetiapine fumarate er oral tablet extended release 24 hour150 mg, 200 mg

FormularyQL (30 EA per 30 days); AGE (Min 18 Years)

quetiapine fumarate er oral tablet extended release 24 hour300 mg, 400 mg, 50 mg


quetiapine fumarate oral tablet 100 mg, 200 mg, 25 mg, 300 mg, 400 mg, 50 mg


QUILLICHEW ER ORAL TABLET CHEWABLE EXTENDED RELEASE 20 MG, 30 MG, 40 MG


QUILLIVANT XR ORAL SUSPENSION RECONSTITUTED 25 MG/5ML


quinapril hcl oral tablet 10 mg, 20 mg, 40 mg, 5 mg Formulary

quinapril-hydrochlorothiazide oral tablet 10-12.5 mg, 20-12.5 mg, 20-25 mg

Formulary

quinidine gluconate er oral tablet extended release 324 mg Formulary

quinidine sulfate oral tablet 200 mg, 300 mg Formulary

quinine sulfate oral capsule 324 mg Formulary

ra 8 hour pain relief oral tablet extended release 650 mg Formulary OTC

ra acetaminophen flu cold oral tablet 30-500-15 mg Formulary OTC

ra acid reducer plus antacid oral tablet chewable 10-800-165 mg

Formulary OTC

ra acne maximum external pad 2 % Formulary OTC

ra advanced eye health oral capsule 250-2.5-0.5 mg, 500-5-1 mg

Formulary OTC

ra alcohol swabs pad 70 % 70 % Formulary OTC

119

Drug Name Formulary Status Requirements/Limitsra anorectal external cream 5 % Formulary OTC

ra antifungal pen external liquid 25 % Formulary OTC

ra b-12 mouth/throat lozenge 1000-400 mcg Formulary OTC

ra back & body pain relief oral tablet 500-32.5 mg Formulary OTC

ra b-complex/vitamin c cr oral tablet extended release Formulary OTC

ra ca/mg/zn/cu oral tablet Formulary OTC

ra calamine external lotion 6.971-6.971 % Formulary OTC

ra calamine external suspension 8-8 % Formulary OTC

ra calcium hi-cal oral tablet 500 mg Formulary OTC

ra calcium hi-cal/vitamin d oral tablet 250-125 mg-unit, 500-125 mg-unit, 500-200 mg-unit

Formulary OTC

ra calcium high potency oral tablet 600 mg Formulary OTC

ra calcium-boron oral tablet 500-1.5 mg Formulary OTC

ra cold remedy multi-symptom oral tablet dispersible Formulary OTC

ra cold/sinus max oral tablet 5-325-200 mg Formulary OTC

ra corn cushions small pad Formulary OTC

ra corn removers ultra thin external pad 40 % Formulary OTC

ra dark tanning external oil Formulary OTC

ra day/night/cold/flu relief oral Formulary OTC

ra daytime cold/flu relief oral liquid 10-5-325 mg/15ml Formulary OTC

ra ear wax cleansing system otic kit 6.5 % Formulary OTC

ra ethyl alcohol solution 70 % Formulary OTC

ra exfoliating moisturizer external ointment 5-10 % Formulary OTC

RA E-ZJECT COLOR LANCETS 33G Formulary OTC; QL (150 EA per 30 days)

RA E-ZJECT LANCETS 28G Formulary OTC; QL (150 EA per 30 days)

RA E-ZJECT LANCETS THIN 26G Formulary OTC; QL (150 EA per 30 days)

RA E-ZJECT LANCETS THIN 28G Formulary OTC; QL (150 EA per 30 days)

RA E-ZJECT LANCETS ULTRA THIN Formulary OTC; QL (150 EA per 30 days)

ra feminine care douche vaginal solution Formulary OTC

ra fever reducer/pain reliever oral suspension 160 mg/5ml Formulary OTC

ra fiber weight management oral tablet chewable Formulary OTC

ra first aid iodine external tincture Formulary OTC

ra first aid non-stick pad Formulary OTC

ra first aid saline wound wash external liquid 0.13 % Formulary OTC

RA FISH OIL EXTRA STRENGTH ORAL CAPSULE 870 MG

Formulary OTC

ra fish oil oral capsule 900 mg Formulary OTC

ra fish oil oral capsule delayed release 1400 mg Formulary OTC

ra foaming hand soap refill external liquid 0.6 % Formulary OTC

ra gel toe separator Formulary OTC

ra glucosamine-chondroitin oral capsule 166.7-133.3 mg Formulary OTC

ra glucosamine-chondroitin-d3 oral tablet 750-600-500 mg-mg-unit

Formulary OTC

ra glucosamine-chondroit-msm oral tablet , 500-400-300 mg

Formulary OTC

120

Drug Name Formulary Status Requirements/Limitsra hot/cold gel sleeve Formulary OTC

ra hydrogen peroxide external solution 3 % Formulary OTC

ra insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC

ra insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC

ra insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml Formulary OTC

ra insulin syringe 30g x 5/16" 1 ml 30g x 5/16" 1 ml Formulary OTC

ra intimacy gels/him/her external gel Formulary OTC

ra isopropyl alcohol wipes external 70 % Formulary OTC

ra lice solution combination kit 0.5-0.33-4 % Formulary OTC

RA LOTION EXTERNAL LOTION Formulary OTC

ra lubricant eye drops ophthalmic solution 0.6 % Formulary OTC

ra lutein oral capsule 20-1 mg Formulary OTC

RA LYCOPENE ORAL CAPSULE 15 MG Formulary OTC

ra melatonin sublingual tablet sublingual 1 mg Formulary OTC

ra miconazole 3 combo pack vaginal kit 200 & 2 mg-% (9gm)

Formulary OTC

ra mouth pain anesthetic mouth/throat liquid 20 % Formulary OTC

ra mucus relief d max strength oral tablet extended release 12 hour 120-1200 mg

Formulary OTC

ra multihealth fiber oral powder 58.6 % Formulary OTC

ra nasal strip/drug free/large strip Formulary OTC

ra nighttime cold/flu relief oral liquid 30-12.5-650 mg/30ml Formulary OTC

ra oatmeal moisturizing external lotion 1.6 % Formulary OTC

ra omega 3-6-9 oral capsule Formulary OTC

ra omeprazole oral tablet delayed release 20 mg Formulary OTC

ra omeprazole-sodium bicarb capsule 20-1100 mg oral 20-1100 mg


ra oyster shell calcium/d oral tablet 250-125 mg-unit, 500-200 mg-unit

Formulary OTC

ra pain relief external cream 4 % Formulary OTC

ra personal lubricant external liquid Formulary OTC

ra prenatal oral tablet 28-0.8 mg Formulary OTC

ra probiotic complex oral tablet Formulary OTC

ra probiotic digestive care oral tablet Formulary OTC

ra probiotic gummies oral tablet chewable Formulary OTC

RA RENEWAL ACNE TREATMENT EXTERNAL GEL 10 %

Formulary OTC

RA RENEWAL SHOWER & BATH EXTERNAL OIL Formulary OTC

ra saccharin oral tablet 15 mg Formulary OTC

ra saline nasal spray nasal solution 0.65 % Formulary OTC

ra saline wound wash external solution 0.9 % Formulary OTC

ra sensitive anti-itch external lotion 1 % Formulary OTC

ra severe cold/night cold&flu oral Formulary OTC

ra severe congestion/cold max oral tablet 5-10-200-325 mg Formulary OTC

ra shower & bath body external powder Formulary OTC

121

Drug Name Formulary Status Requirements/Limitsra silky lubricant moisturizer vaginal gel Formulary OTC

ra sinus wash nasal relief nasal packet 1685-515 mg Formulary OTC

ra sinus wash neti pot nasal packet 1685-515 mg Formulary OTC

ra slow release iron oral tablet extended release 45 mg Formulary OTC

ra stay awake oral tablet 100 mg Formulary OTC

ra sterile saline nasal mist nasal solution 0.9 % Formulary OTC

ra therapeutic external shampoo 2.5 % Formulary OTC

ra triple antibiotic external aerosol 3.5-400-5000 Formulary OTC

RA TUGABOOS BABY EXTERNAL OIL Formulary OTC

ra vaginal infection screening in vitro kit Formulary OTC

ra vitamin b-12 oral liquid 1000 mcg/ml Formulary OTC

ra vitamin c oral tablet chewable 300 mg Formulary OTC

ra wart remover external solution 17 % Formulary OTC

ra yeast relief plus oral tablet Formulary OTC

rabano yodado oral liquid Formulary OTC

RABAVERT INTRAMUSCULAR SUSPENSION RECONSTITUTED


rabeprazole sodium oral tablet delayed release 20 mg Formulary

racepinephrine hcl powder Formulary

RADIACARE POST HEALING EXTERNAL CREAM Formulary OTC

raloxifene hcl oral tablet 60 mg Formulary

ramipril oral capsule 1.25 mg, 10 mg, 2.5 mg, 5 mg Formulary

ranitidine hcl oral syrup 75 mg/5ml Formulary

ranitidine hcl oral tablet 150 mg, 300 mg Formulary

ranitidine hcl oral tablet 75 mg Formulary OTC

RAPAMUNE ORAL SOLUTION 1 MG/ML Formulary

RASH AWAY EXTERNAL AEROSOL 33 % Formulary OTC

RASH RELIEF EXTERNAL LIQUID 20-25 % Formulary OTC

raspberry flavor powder Formulary

raspberry syrup oral syrup Formulary

reality insulin syringe 28g x 1/2" 0.5 ml 28g x 1/2" 0.5 ml Formulary OTC

reality insulin syringe 28g x 1/2" 1 ml 28g x 1/2" 1 ml Formulary OTC

reality insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC

reality insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC

reality lancets Formulary OTC; QL (150 EA per 30 days)

reality swabs pad Formulary OTC

reality trigger lancets Formulary OTC; QL (150 EA per 30 days)

REA-LO EXTERNAL CREAM 30 % Formulary OTC

REBETOL ORAL CAPSULE 200 MG Formulary PA

REBETOL ORAL SOLUTION 40 MG/ML Formulary PA

REBIF REBIDOSE SUBCUTANEOUS SOLUTION AUTO-INJECTOR 22 MCG/0.5ML, 44 MCG/0.5ML

Formulary

REBIF REBIDOSE TITRATION PACK SUBCUTANEOUS SOLUTION AUTO-INJECTOR 6X8.8 & 6X22 MCG

Formulary

122

Drug Name Formulary Status Requirements/LimitsREBIF SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 22 MCG/0.5ML, 44 MCG/0.5ML

Formulary

REBIF TITRATION PACK SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 6X8.8 & 6X22 MCG

Formulary

RECOMBIVAX HB INJECTION SUSPENSION 10 MCG/ML, 40 MCG/ML, 5 MCG/0.5ML


RECTICARE EXTERNAL CREAM 5 % Formulary OTC

red cross cotton sterile Formulary OTC

red yeast rice extract powder Formulary OTC

REDNESS RELIEF OPHTHALMIC SOLUTION 0.012-0.25 %

Formulary OTC

reeses pinworm medicine oral tablet 180 mg Formulary OTC

REFENESEN CHEST CONG/PAIN RLF ORAL TABLET 650-400 MG

Formulary OTC

REFENESEN CHST CONG/PAIN PE ORAL TABLET 10-650-400 MG

Formulary OTC

REFRESH LACRI-LUBE OPHTHALMIC OINTMENT Formulary OTC

REFRESH LIQUIGEL OPHTHALMIC SOLUTION 1 % Formulary OTC

REFRESH OPHTHALMIC SOLUTION 1.4-0.6 % Formulary OTC

REFRESH OPTIVE MEGA-3 OPHTHALMIC SOLUTION 0.5-1-0.5 %

Formulary OTC

REFRESH OPTIVE OPHTHALMIC GEL 1-0.9 % Formulary OTC

REFRESH OPTIVE OPHTHALMIC SOLUTION 0.5-0.9 %

Formulary OTC

REFRESH OPTIVE SENSITIVE OPHTHALMIC SOLUTION 0.5-0.9 %

Formulary OTC

REFRESH P.M. OPHTHALMIC OINTMENT Formulary OTC

REFRESH TEARS OPHTHALMIC SOLUTION 0.5 % Formulary OTC

REGENECARE HA EXTERNAL LIQUID 2 % Formulary OTC

REGRANEX EXTERNAL GEL 0.01 % Formulary PA; QL (15 GM per 34 days)

relagesic oral tablet 29-500 mg Formulary OTC

relcof c oral solution 100-6.3 mg/5ml Formulary OTC; AGE (Min 6 Years)

RELENZA DISKHALER INHALATION AEROSOL POWDER BREATH ACTIVATED 5 MG/BLISTER

Formulary

RELIADERM EXTERNAL CREAM 0.035-10-25 % Formulary OTC

RELIEF PAIN RELIEVING EXTERNAL CREAM 3 % Formulary OTC

RELION ALCOHOL SWABS PAD Formulary OTC

RELION ALCOHOL SWABS PAD 70 % 70 % Formulary OTC

RELION ALL-IN-ONE DEVICE Formulary OTC

RELION BLOOD GLUCOSE TEST STRIP IN VITRO Formulary OTC; QL (150 EA per 30 days)

RELION GLUCOSE SHOT ORAL LIQUID Formulary OTC

RELI-ON INSULIN SYRINGE 29G 0.3 ML 29G 0.3 ML Formulary OTC


RELION INSULIN SYRINGE 29G X 1/2" 0.3 ML 29G X 1/2" 0.3 ML

Formulary OTC


Formulary OTC

123

Drug Name Formulary Status Requirements/LimitsRELION INSULIN SYRINGE 29G X 1/2" 1 ML 29G X 1/2" 1 ML

Formulary OTC

RELI-ON INSULIN SYRINGE 29G X 1/2" 1 ML 29G X 1/2" 1 ML

Formulary OTC



RELI-ON INSULIN SYRINGE 30G 1 ML 30G 1 ML Formulary OTC


Formulary OTC


Formulary OTC

RELION INSULIN SYRINGE 30G X 5/16" 1 ML 30G X 5/16" 1 ML

Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC

RELION LANCETS MICRO-THIN 33G Formulary OTC; QL (150 EA per 30 days)

RELION LANCETS STANDARD 21G Formulary OTC; QL (150 EA per 30 days)

RELION LANCETS THIN 26G Formulary OTC; QL (150 EA per 30 days)

RELION LANCETS ULTRA-THIN 30G Formulary OTC; QL (150 EA per 30 days)

RELION ULTRA THIN LANCETS 30G Formulary OTC; QL (150 EA per 30 days)

RELION ULTRA THIN PLUS LANCETS Formulary OTC; QL (150 EA per 30 days)

RELISTOR ORAL TABLET 150 MG Formulary PA; QL (90 EA per 30 days)

RELISTOR SUBCUTANEOUS SOLUTION 12 MG/0.6ML

Formulary PA

RELPAX ORAL TABLET 20 MG, 40 MG Formulary QL (6 EA per 34 days)

REMEDY ANTIMICROBIAL CLEANSER EXTERNAL LIQUID 0.12 %

Formulary OTC

REMEDY CALAZIME EXTERNAL PASTE 0.4-20.5 % Formulary OTC

REMEDY CLEANSING BODY EXTERNAL LOTION 1.5 %

Formulary OTC

REMEDY PHYTOPLEX ANTIFUNGAL EXTERNAL POWDER 2 %

Formulary OTC

REMEDY SKIN REPAIR EXTERNAL CREAM 1.5 % Formulary OTC

REMODULIN INJECTION SOLUTION 1 MG/ML, 10 MG/ML, 2.5 MG/ML, 5 MG/ML

Formulary PA

REMOVE ADHESIVE REMOVER WIPES EXTERNAL Formulary OTC

RENACIDIN IRRIGATION SOLUTION Formulary

RENAGEL ORAL TABLET 800 MG Formulary

124

Drug Name Formulary Status Requirements/Limitsrenal vitamin oral tablet 0.8 mg Formulary OTC

renuu nl external patch 2-30 % Formulary

repaglinide oral tablet 0.5 mg, 1 mg, 2 mg Formulary

REPATHA SOLUTION PREFILLED SYRINGE 140 MG/ML SUBCUTANEOUS 140 MG/ML

Formulary PA

REPATHA SURECLICK SOLUTION AUTO-INJECTOR 140 MG/ML SUBCUTANEOUS 140 MG/ML

Formulary PA

REPLACE SR ORAL TABLET EXTENDED RELEASE Formulary OTC

RESCON ORAL TABLET 2-60 MG Formulary OTC

RESCRIPTOR ORAL TABLET 100 MG, 200 MG Formulary

reserpine oral tablet 0.1 mg, 0.25 mg Formulary

resorcinol crystals Formulary

resorcinol powder Formulary

RESOURCE THICKENUP WATER ORAL LIQUID Formulary OTC

RESPAIRE-30 ORAL CAPSULE 30-150 MG Formulary OTC

RESTASIS OPHTHALMIC EMULSION 0.05 % Formulary PA; QL (60 EA per 30 days)

RESTORE CLEANSER & MOISTURIZER EXTERNAL LIQUID 2 %

Formulary OTC

RETAINE PM OPHTHALMIC OINTMENT Formulary OTC

RETIN-A EXTERNAL CREAM 0.025 %, 0.05 %, 0.1 % Formulary AGE (Max 18 Years)

RETIN-A EXTERNAL GEL 0.01 %, 0.025 % Formulary AGE (Max 18 Years)

REVEAL COLON DISEASE IN VITRO DIAGNOSTIC TEST

Formulary OTC

REVEAL DNA PATERNITY TEST IN VITRO KIT Formulary OTC

REVEAL GET PREGNANT QUICK IN VITRO KIT Formulary OTC

REVEAL MULTI-DRUG TESTING CUP IN VITRO Formulary OTC

REVEAL URINARY TRACT IN VITRO STRIP Formulary OTC

REVITADERM WOUND CARE EXTERNAL GEL Formulary OTC

REVLIMID ORAL CAPSULE 10 MG, 15 MG, 2.5 MG, 20 MG, 25 MG, 5 MG

Formulary PA

REVONTO INTRAVENOUS SOLUTION RECONSTITUTED 20 MG

Formulary

REXALL LANCETS ULTRA THIN 30G Formulary OTC; QL (150 EA per 30 days)

REZAMID EXTERNAL LOTION 2-5 % Formulary OTC

RHINARIS NASAL SOLUTION 0.2 % Formulary OTC

RHINASE NASAL GEL Formulary OTC

RHINASE NASAL SOLUTION Formulary OTC

RIASTAP INTRAVENOUS SOLUTION RECONSTITUTED

Formulary

RIAX EXTERNAL FOAM 5.5 %, 9.5 % Formulary AGE (Max 19 Years)

RIBASPHERE ORAL TABLET 400 MG, 600 MG Formulary PA

riboflavin oral capsule 50 mg Formulary OTC

riboflavin powder Formulary

riboflavin-5-phosphate sodium powder Formulary

RICOLA CHERRY HONEY HERB MOUTH/THROAT LOZENGE 2 MG

Formulary OTC

125

Drug Name Formulary Status Requirements/LimitsRICOLA HERB MOUTH/THROAT LOZENGE 1.1 MG, 2.6 MG

Formulary OTC

RICOLA LEMON MINT MOUTH/THROAT LOZENGE 1.5 MG

Formulary OTC

RICOLA W/ECHINACEA MOUTH/THROAT LOZENGE 3.5 MG

Formulary OTC

RIDAURA ORAL CAPSULE 3 MG Formulary

rifabutin oral capsule 150 mg Formulary

rifampin oral capsule 150 mg, 300 mg Formulary

RIGHTEST GL300 LANCETS Formulary OTC; QL (150 EA per 30 days)

riluzole oral tablet 50 mg Formulary

rimantadine hcl oral tablet 100 mg Formulary

ringers irrigation irrigation solution Formulary

RISAMINE EXTERNAL OINTMENT 0.44-20.625 % Formulary OTC

RISPERDAL CONSTA INTRAMUSCULAR SUSPENSION RECONSTITUTED 12.5 MG, 25 MG, 37.5 MG, 50 MG


risperidone oral solution 1 mg/ml Formulary AGE (Min 18 Years)

risperidone oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg


risperidone oral tablet dispersible 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg


ritonavir oral tablet 100 mg Formulary

RITUXAN INTRAVENOUS SOLUTION 100 MG/10ML, 500 MG/50ML

Formulary PA

rivastigmine tartrate oral capsule 1.5 mg, 3 mg, 4.5 mg, 6 mg

Formulary

rivastigmine transdermal patch 24 hour 13.3 mg/24hr, 4.6 mg/24hr, 9.5 mg/24hr

Formulary

rixubis intravenous solution reconstituted 3000 unit Formulary

rizatriptan benzoate oral tablet 10 mg, 5 mg Formulary QL (12 EA per 34 days)

rizatriptan benzoate oral tablet dispersible 10 mg, 5 mg Formulary QL (12 EA per 34 days)

ROBATHOL EXTERNAL OIL Formulary OTC

ROBITUSSIN CHILD COUGH/COLD CF ORAL LIQUID 2.5-5-50 MG/5ML

Formulary OTC

ROBITUSSIN COUGH+CHEST CONG DM ORAL CAPSULE 10-200 MG

Formulary OTC

ROBITUSSIN DAY/NIGHT VALUE PAK ORAL Formulary OTC

ROBITUSSIN LINGERING COUGHGELS ORAL CAPSULE 15 MG

Formulary OTC

ROBITUSSIN MULTI-SYMPTOM MAX ORAL LIQUID 5-10-200 MG/5ML

Formulary OTC

ROBITUSSIN NIGHTTIME COUGH DM ORAL LIQUID 12.5-30 MG/10ML

Formulary OTC

ROBITUSSIN NIGHTTIME COUGH ORAL LIQUID 1-7.5 MG/5ML

Formulary OTC

ROBITUSSIN PK COLD DAY/NGHT DM ORAL Formulary OTC

ROBITUSSIN PK COLD DAY/NGHT MS ORAL Formulary OTC

126

Drug Name Formulary Status Requirements/LimitsROBITUSSIN SEVERE NIGHTTIME ORAL LIQUID 12.5-5-325 MG/10ML

Formulary OTC

ROBITUSSIN TO GO COUGH/COLD CF ORAL LIQUID 5-10-100 MG/5ML

Formulary OTC

ROLAIDS ORAL TABLET CHEWABLE 550-110 MG Formulary OTC

ropinirole hcl oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg, 5 mg

Formulary

rose oil oil Formulary

rose water external liquid Formulary OTC

rosin powder Formulary OTC

rosuvastatin calcium oral tablet 10 mg, 20 mg, 40 mg, 5 mg Formulary

ROTARIX ORAL SUSPENSION RECONSTITUTED Formulary AGE (Min 19 Years)

ROTATEQ ORAL SOLUTION Formulary AGE (Min 19 Years)

rotex external cream 0.038-4-35 % Formulary OTC

ROZEREM ORAL TABLET 8 MG Formulary ST; QL (34 EA per 34 days)

ru-hist d oral tablet 4-10 mg Formulary OTC

rutin oral tablet 50 mg Formulary OTC

rydex g oral tablet 38.5-398 mg Formulary OTC

rymed oral tablet 2-10 mg Formulary OTC

rynex pse oral liquid 1-15 mg/5ml Formulary OTC

SABRIL ORAL TABLET 500 MG Formulary PA

saccharin powder Formulary

SAFE TUSSIN PM ORAL LIQUID 3.125-7.5 MG/5ML Formulary OTC

SAFELET IV CATHETER Formulary OTC

safety insulin syringes 27g x 1/2" 1 ml 27g x 1/2" 1 ml Formulary OTC

safety insulin syringes 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC



safety insulin syringes 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml Formulary OTC

SAFETY SEAL LANCETS Formulary OTC; QL (150 EA per 30 days)

SAFETY-GARD NEEDLE 18G Formulary OTC

SAFETY-LOK SYRINGE 21G X 1-1/2" 10 ML, 21G X 1-1/2" 5 ML

Formulary OTC

safflower oil oil Formulary

SAF-GEL EXTERNAL GEL Formulary OTC

SALEM SUMP TUBE 12FR Formulary

salicylic acid external foam 6 % Formulary

salicylic acid external gel 6 % Formulary

salicylic acid powder Formulary

salicylic acid wart remover external liquid 27.5 % Formulary

salicylic acid-cleanser external kit 6 % (lotion) Formulary

saline nasal gel Formulary OTC

saline solution Formulary OTC

SALMON ORAL CAPSULE 200 MG Formulary OTC

127

Drug Name Formulary Status Requirements/LimitsSAM-E COMPLETE ORAL TABLET DELAYED RELEASE 200 MG

Formulary OTC

sam-e oral tablet delayed release 400 mg Formulary OTC

sam-g.l.a. oral capsule 100-150-40 mg Formulary OTC

SAMSCA ORAL TABLET 15 MG Formulary PA; QL (34 EA per 34 days)

SAMSCA ORAL TABLET 30 MG Formulary PA; QL (68 EA per 34 days)

SANTYL EXTERNAL OINTMENT 250 UNIT/GM Formulary QL (60 GM per 34 days)

SARNA EXTERNAL LOTION 0.5-0.5 % Formulary OTC

SASTID SOAP EXTERNAL BAR 3-5 % Formulary OTC

SAVELLA ORAL TABLET 100 MG, 12.5 MG, 25 MG, 50 MG


SAVELLA TITRATION PACK ORAL 12.5 & 25 & 50 MG


sb alcohol prep pad 70 % 70 % Formulary OTC

sb bacitracin external ointment 500 unit/gm Formulary OTC

sb cold & flu hbp oral tablet 2-325 mg Formulary OTC

sb fib lax orange oral powder 30 % Formulary OTC

sb insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml Formulary OTC

sb insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC

sb insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml Formulary OTC



sb lancets thin Formulary OTC; QL (150 EA per 30 days)

sb lancets ultra thin Formulary OTC; QL (150 EA per 30 days)

sb lice treatment external liquid 0.3-3 %, 1 % Formulary OTC

sb omeprazole oral tablet delayed release 20 mg Formulary OTC

sb stool softener oral capsule 240 mg Formulary OTC

scarcin external cream Formulary OTC

SCYTERA EXTERNAL FOAM 2 % Formulary OTC

se-100 oral capsule 100 mcg Formulary OTC

SEBUDERM EXTERNAL GEL Formulary

SEBULEX EXTERNAL SHAMPOO 2-2 % Formulary OTC

SECONAL ORAL CAPSULE 100 MG Formulary

SECURA EPC SKIN CARE STARTER EXTERNAL KIT 0.13 & 30.6 %

Formulary OTC

SECURA EXTRA PROTECTIVE EXTERNAL CREAM 30.6 %

Formulary OTC

SECURA MOISTURIZING CLEANSER EXTERNAL LIQUID 0.13 %

Formulary OTC

SECURA PERSONAL CLEANSER EXTERNAL LIQUID 0.13 %

Formulary OTC

SECURA TOTAL BODY CLEANSER EXTERNAL FOAM 0.13 %

Formulary OTC

SECURA TWO-STEP EXTERNAL KIT 0.13 & 10 % Formulary OTC

SELECT-OB ORAL TABLET CHEWABLE 29-1 MG Formulary

selegiline hcl oral capsule 5 mg Formulary

128

Drug Name Formulary Status Requirements/Limitsselegiline hcl oral tablet 5 mg Formulary

selenicaps-200 oral capsule 200 mcg Formulary OTC

selenimin oral tablet 125 mcg Formulary OTC

selenium er oral tablet extended release 200 mcg Formulary OTC

selenium sulfide external lotion 2.5 % Formulary

SELSUN BLUE DEEP CLEANSING EXTERNAL SHAMPOO 3 %

Formulary OTC

SELZENTRY ORAL TABLET 150 MG, 300 MG Formulary

senna leaves oral leaves Formulary OTC

senna oral capsule 8.6 mg Formulary OTC

senna oral syrup 176 mg/5ml, 8.8 mg/5ml Formulary OTC

senna oral tablet 8.6 mg Formulary OTC

SENNA PROMPT ORAL CAPSULE 9-500 MG Formulary OTC

senna s oral tablet 8.6-50 mg Formulary OTC

SENOKOT EXTRA STRENGTH ORAL TABLET 17.2 MG

Formulary OTC

SENOKOT S ORAL TABLET 8.6-50 MG Formulary OTC

SENSI-CARE BODY EXTERNAL CREAM 1-30 % Formulary OTC

SENSI-CARE PERINEAL/SKIN EXTERNAL LIQUID Formulary OTC

SENSI-CARE PROTECTIVE BARRIER EXTERNAL OINTMENT 49-15 %

Formulary OTC

SENSIPAR ORAL TABLET 30 MG, 60 MG, 90 MG Formulary PA

SENSITIVE EYES ENZYME CLEANER TABLET EFFERVESCENT

Formulary OTC

SENSODYNE MAXIMUM STRENGTH DENTAL GEL Formulary OTC

SE-PLUS PROTEIN ORAL TABLET 200 MCG Formulary OTC

SEREVENT DISKUS INHALATION AEROSOL POWDER BREATH ACTIVATED 50 MCG/DOSE


sertraline hcl oral concentrate 20 mg/ml Formulary

sertraline hcl oral tablet 100 mg, 25 mg, 50 mg Formulary

sesame oil oil Formulary

sevelamer carbonate oral packet 0.8 gm, 2.4 gm Formulary

severe cold & flu day/night oral liquid therapy pack Formulary OTC

shampoo & body wash rinse-free external foam Formulary OTC

SHAMROCK LATEX EXAM GLOVES Formulary OTC

shea butter Formulary

SHINGRIX INTRAMUSCULAR SUSPENSION RECONSTITUTED 50 MCG

Formulary

SHOPKO ALCOHOL SWABS PAD 70 % 70 % Formulary OTC

SHOPKO UNILET LANCETS 30G Formulary OTC; QL (150 EA per 30 days)

SHUR-SEAL CONTRACEPTIVE VAGINAL GEL 2 % Formulary OTC

silace oral syrup 60 mg/15ml Formulary OTC

sildenafil citrate oral tablet 20 mg Formulary PA; AGE (Min 18 Years)

silica gel Formulary

silodosin oral capsule 4 mg, 8 mg Formulary

129

Drug Name Formulary Status Requirements/Limitssilver nitrate crystals Formulary

silver nitrate external ointment 10 % Formulary

silver nitrate external solution 0.5 %, 10 %, 25 %, 50 % Formulary

silver sulfadiazine external cream 1 % Formulary

SIMBRINZA OPHTHALMIC SUSPENSION 1-0.2 % Formulary

simethicone liquid Formulary

SIMILAC GO & GROW TODDLER ORAL PACKET Formulary OTC

SIMILAC GO & GROW TODDLER ORAL POWDER Formulary OTC

SIMILAC HUMAN MILK FORTIFIER ORAL CONCENTRATE

Formulary OTC

SIMILAC PRO-SENSITIVE OPTIGRO ORAL LIQUID Formulary OTC

SIMILAC STERILIZED WATER ORAL LIQUID Formulary OTC

simple syrup oral syrup Formulary

simvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg, 80 mg Formulary

SINADRIN PE COMPLETE SINUS REL ORAL TABLET 2-10-650 MG

Formulary OTC

sinus & cold-d oral tablet extended release 12 hour 120-220 mg

Formulary OTC

sinus & congestion day/night oral Formulary OTC

sinus congestion/pain daytime oral tablet 5-325 mg Formulary OTC

sinus relief sublingual tablet sublingual Formulary OTC

sirolimus oral tablet 0.5 mg, 1 mg, 2 mg Formulary

siterol external patch 3.99-1 % Formulary OTC

skin protectant external cream 12 % Formulary OTC

skin tag remover external liquid Formulary OTC

SKINTEGRITY HYDROGEL EXTERNAL GEL Formulary OTC

SKYLA INTRAUTERINE INTRAUTERINE DEVICE 13.5 MG

Formulary

sleep aid oral tablet 25 mg Formulary OTC

SLEEP-N-HEEL EXTERNAL KIT 20 % Formulary OTC

SLO-NIACIN ORAL TABLET EXTENDED RELEASE 500 MG, 750 MG

Formulary OTC

SLOW FE ORAL TABLET EXTENDED RELEASE 142 (45 FE) MG

Formulary OTC

slow iron oral tablet extended release 160 (50 fe) mg Formulary OTC

slow magnesium/calcium oral tablet delayed release 70-117 mg

Formulary OTC

slow release iron oral tablet extended release 47.5 mg Formulary OTC

sm alcohol prep pad Formulary OTC

sm alcohol prep pad 70 % 70 % Formulary OTC

sm allergy relief oral tablet 1.34 mg Formulary OTC

sm b super vitamin complex oral tablet Formulary OTC

sm biotin oral tablet 5000 mcg Formulary OTC

sm calamine external lotion Formulary OTC

sm chest congestion relief dm oral tablet 20-400 mg Formulary OTC

130

Drug Name Formulary Status Requirements/LimitsSM CORAL CALCIUM ORAL TABLET 1000 (390 CA) MG

Formulary OTC

sm cosmetic puffs jumbo Formulary OTC

sm cough drops mouth/throat lozenge 7 mg Formulary OTC

sm daytime cold & cough child oral solution 2.5-5 mg/5ml Formulary OTC

sm dental rinse anti-plaque mouth/throat liquid Formulary OTC

sm ethyl alcohol (rubbing) solution 70 % Formulary OTC

sm foaming antacid oral tablet chewable 80-20 mg Formulary OTC

sm fruit coolers mouth/throat lozenge 7 mg Formulary OTC

sm glucosamine hcl-msm oral tablet 750-750 mg Formulary OTC

SM GLUCOSAMINE/CALCIUM + D ORAL TABLET 500-333-250 MG-MG-UNIT

Formulary OTC

sm hemorrhoidal rectal ointment 0.25-14-74.9 % Formulary OTC

sm ibuprofen jr oral tablet 100 mg Formulary OTC

sm iodides external tincture Formulary OTC

sm iodine tincture external tincture Formulary OTC

sm lancets 33g Formulary OTC; QL (150 EA per 30 days)

sm melatonin oral tablet dispersible 5 mg Formulary OTC

sm natural herb cough drops mouth/throat lozenge 4.8 mg Formulary OTC

sm omega-3-6-9 fatty acids oral capsule Formulary OTC

sm omeprazole oral tablet delayed release 20 mg Formulary OTC

sm one daily prenatal oral 28-0.8 & 440 mg Formulary OTC

sm pain relief/menthol external gel Formulary OTC

sm prenatal vitamins oral tablet 28-0.8 mg Formulary OTC

sm slow release iron oral tablet extended release 143 (45 fe) mg

Formulary OTC

sm vitamin b1 oral tablet 100 mg Formulary OTC

SMART SENSE COLOR LANCETS 33G Formulary OTC; QL (150 EA per 30 days)

SMART SENSE STANDARD LANCETS Formulary OTC; QL (150 EA per 30 days)

SMART SENSE SUPER THIN LANCETS Formulary OTC; QL (150 EA per 30 days)

SMART SENSE THIN LANCETS 26G Formulary OTC; QL (150 EA per 30 days)

smoothfit cuff Formulary OTC

sod citrate-citric acid oral solution 500-334 mg/5ml Formulary

sodium acetate powder Formulary

sodium ascorbate powder Formulary

sodium benzoate powder Formulary

sodium bicarbonate oral powder Formulary

sodium bicarbonate oral tablet 325 mg, 650 mg Formulary OTC

sodium bicarbonate powder Formulary

sodium bisulfite granules Formulary

sodium borate powder Formulary OTC

sodium bromide granules Formulary

sodium butyrate powder Formulary

sodium chloride (hypertonic) ophthalmic ointment 5 % Formulary OTC

131

Drug Name Formulary Status Requirements/Limitssodium chloride (hypertonic) ophthalmic solution 5 % Formulary OTC

sodium chloride granules Formulary

sodium chloride inhalation nebulization solution 0.9 %, 3 %, 7 %

Formulary

sodium chloride oral solution 4 meq/ml Formulary OTC

sodium chloride oral tablet 1 gm Formulary OTC

sodium citrate dihydrate granules Formulary OTC

sodium citrate granules Formulary OTC

sodium fluoride oral solution 1.1 (0.5 f) mg/ml Formulary

sodium fluoride oral tablet chewable 0.55 (0.25 f) mg, 1.1 (0.5 f) mg, 2.2 (1 f) mg

Formulary

sodium hydroxide pellet Formulary

sodium metabisulfite granules Formulary

sodium nitrate granules Formulary OTC

sodium nitrite granules Formulary

sodium perborate crystals Formulary OTC

sodium perborate granules Formulary OTC

sodium perborate powder Formulary

sodium phosphate dibasic granules Formulary

sodium phosphate monobasic powder Formulary

sodium polystyrene sulfonate oral suspension 15 gm/60ml Formulary

sodium polystyrene sulfonate rectal suspension 30 gm/120ml

Formulary

sodium propionate powder Formulary

sodium saccharin granules Formulary

sodium saccharin powder Formulary

sodium silicate solution 40 % Formulary OTC

sodium starch glycolate powder Formulary OTC

sodium sulfite powder Formulary

SOLIRIS INTRAVENOUS SOLUTION 300 MG/30ML Formulary PA

SOLOSITE WOUND GEL EXTERNAL GEL Formulary OTC

solvatech plus oral suspension Formulary

SOMBRA COOL THERAPY EXTERNAL GEL 6 % Formulary OTC

SOMBRA WARM THERAPY EXTERNAL GEL 3-3 % Formulary OTC

SOOTHE & COOL INZO BARRIER EXTERNAL CREAM 5-5 %

Formulary OTC

SOOTHE XP XTRA PROTECTION OPHTHALMIC SOLUTION

Formulary OTC

sorbic acid powder Formulary

sorbitol oral solution 70 % Formulary OTC

sorbitol rectal solution 70 % Formulary OTC

sorbitol solution Formulary

sorbutuss nr oral liquid 15-150-127.5 mg/7.5ml Formulary OTC

sore throat lozenges mouth/throat lozenge 6-10 mg Formulary OTC

sore throat mouth/throat lozenge 15-3.6 mg Formulary OTC

132

Drug Name Formulary Status Requirements/LimitsSORINE ORAL TABLET 120 MG, 160 MG, 240 MG, 80 MG

Formulary

sotalol hcl (af) oral tablet 120 mg, 160 mg, 80 mg Formulary

sotalol hcl oral tablet 120 mg, 160 mg, 240 mg, 80 mg Formulary

soya lecithin oral capsule 1200 mg Formulary OTC

soybean oil oil Formulary

spearmint oil oil Formulary

spinosad external suspension 0.9 % Formulary

SPIRIVA HANDIHALER INHALATION CAPSULE 18 MCG

Formulary

spironolactone oral tablet 100 mg, 25 mg, 50 mg Formulary

spironolactone-hctz oral tablet 25-25 mg Formulary

sportbalm external lotion Formulary OTC

SPORTSCREME EXTERNAL CREAM 10 % Formulary OTC

spot acne treatment external cream 2.5 % Formulary OTC

SPRAYZOIN EXTERNAL LIQUID Formulary OTC

squaric acid di-n-butyl ester powder Formulary OTC

squaric acid in butanol liquid Formulary OTC

stahist ad oral liquid 25-60 mg/5ml Formulary OTC

stahist ad oral tablet 25-60 mg Formulary OTC

STALEVO 100 ORAL TABLET 25-100-200 MG Formulary

STALEVO 125 ORAL TABLET 31.25-125-200 MG Formulary


STALEVO 200 ORAL TABLET 50-200-200 MG Formulary


STANBACK HEADACHE POWDERS ORAL PACKET 650-200-32 MG

Formulary OTC

stavudine oral capsule 15 mg, 20 mg, 30 mg, 40 mg Formulary

stearic acid powder Formulary

stearyl alcohol powder Formulary

STERILANCE TL Formulary OTC; QL (150 EA per 30 days)

STERILE LUBRICANT OPHTHALMIC LIQUID 0.7 % Formulary OTC

sterile pad 3"x3" Formulary OTC

STERI-STRIP COMPOUND BENZOIN EXTERNAL TINCTURE

Formulary OTC

STERI-TAMP SEALS BOTTLES/VIALS Formulary OTC

STERI-TAMP SEALS/BAGS Formulary OTC

STERI-TAMP SEALS/SYRINGES Formulary OTC

stevia extract powder 90 % Formulary

STIMATE NASAL SOLUTION 1.5 MG/ML Formulary

STIMEX INSULATED NEEDLE 22G X 2-1/8" , 22G X 4-1/4"

Formulary OTC

STIMULEN EXTERNAL GEL Formulary OTC

STIOLTO RESPIMAT INHALATION AEROSOL SOLUTION 2.5-2.5 MCG/ACT


133

Drug Name Formulary Status Requirements/LimitsSTOMAHESIVE MOLDABLE ADHESIVE STRIP Formulary OTC

STOMAHESIVE PASTE PASTE Formulary OTC

STRIANT BUCCAL 30 MG Formulary

STRIBILD ORAL TABLET 150-150-200-300 MG Formulary

STRIDEX ESSENTIAL EXTERNAL PAD 1 % Formulary OTC

STRI-DEX SENSITIVE SKIN EXTERNAL PAD 0.5 % Formulary OTC

STUART ONE ORAL CAPSULE 27-0.8-200 MG Formulary OTC

SUBOXONE SUBLINGUAL FILM 12-3 MG FormularyQL (60 EA per 30 days); AGE (Min 16 Years)

SUBOXONE SUBLINGUAL FILM 2-0.5 MG FormularyQL (360 EA per 30 days); AGE (Min 16 Years)



SUBSYS SUBLINGUAL LIQUID 100 MCG, 1200 (600 X 2) MCG, 1600 (800 X 2) MCG, 200 MCG, 400 MCG, 600 MCG, 800 MCG


sucralfate oral tablet 1 gm Formulary

sucrose crystals Formulary OTC

SUDAFED 24 HOUR ORAL TABLET EXTENDED RELEASE 24 HOUR 240 MG

Formulary OTC

SUDAFED CHILDRENS ORAL LIQUID 15 MG/5ML Formulary OTC

SUDAFED ORAL TABLET 30 MG Formulary OTC

SUDAFED PE CHILDRENS ORAL SOLUTION 2.5 MG/5ML

Formulary OTC

SUDAFED PE COLD & COUGH CHILD ORAL SOLUTION 2.5-5 MG/5ML

Formulary OTC

SUDAFED PE DAY & NIGHT ORAL 25-10 & 10 MG Formulary OTC

SUDAFED PE MAXIMUM STRENGTH ORAL TABLET 10 MG

Formulary OTC

SUDAFED PRESSURE+PAIN 12 HR ORAL TABLET EXTENDED RELEASE 12 HOUR 120-220 MG

Formulary OTC

sulfacetamide sodium (acne) external lotion 10 % Formulary

sulfacetamide sodium ophthalmic ointment 10 % Formulary

sulfacetamide sodium ophthalmic solution 10 % Formulary

sulfacetamide sodium-sulfur external liquid 9-4 % Formulary

sulfacetamide sodium-sulfur external lotion 10-5 % Formulary

sulfacetamide sodium-sulfur external pad 10-4 % Formulary

sulfacetamide sodium-sulfur external suspension 8-4 % Formulary

sulfacetamide-prednisolone ophthalmic solution 10-0.23 % Formulary

sulfadiazine oral tablet 500 mg Formulary

sulfamethoxazole-trimethoprim oral tablet 400-80 mg, 800-160 mg

Formulary

SULFAMYLON EXTERNAL CREAM 85 MG/GM Formulary

SULFAMYLON EXTERNAL PACKET 5 % Formulary

sulfasalazine oral tablet 500 mg Formulary

134

Drug Name Formulary Status Requirements/Limitssulfasalazine oral tablet delayed release 500 mg Formulary

sulfo-lo external bar 5 % Formulary OTC

sulfur external bar 10 % Formulary OTC

sulfur precipitated powder Formulary

sulindac oral tablet 150 mg, 200 mg Formulary

sumatriptan nasal solution 20 mg/act, 5 mg/act Formulary

sumatriptan succinate oral tablet 100 mg Formulary QL (9 EA per 34 days)

sumatriptan succinate oral tablet 25 mg, 50 mg Formulary QL (18 EA per 34 days)

sumatriptan succinate refill subcutaneous solution cartridge4 mg/0.5ml, 6 mg/0.5ml

Formulary

sumatriptan succinate subcutaneous solution 6 mg/0.5ml Formulary

sumatriptan succinate subcutaneous solution auto-injector4 mg/0.5ml, 6 mg/0.5ml

Formulary

SUMMERS EVE DEODORANT ULTRA EXTERNAL AEROSOL

Formulary OTC

super b-50 complex oral capsule Formulary OTC

super c-500 complex oral tablet extended release Formulary OTC

super cal/mag oral tablet 333.333-166.667 mg Formulary OTC

super moleskin pad Formulary OTC

SUPER OMEGA-3 ORAL CAPSULE Formulary OTC

super thin lancets Formulary OTC; QL (150 EA per 30 days)

supposibase f powder Formulary OTC

SUPPOSIBLEND PELLET Formulary OTC

SUPPRELIN LA SUBCUTANEOUS KIT 50 MG Formulary PA

SUPREP BOWEL PREP KIT ORAL SOLUTION 17.5-3.13-1.6 GM/177ML

Formulary

supress a pediatric oral liquid 5-1-10 mg/ml Formulary OTC

supress dm pediatric oral liquid 5-50 mg/ml Formulary OTC

SUPRESS-PE PEDIATRIC ORAL LIQUID 2.5-50 MG/ML

Formulary OTC

sure comfort alcohol prep pad 70 % 70 % Formulary OTC

sure comfort insulin syringe 28g x 1/2" 0.5 ml 28g x 1/2" 0.5 ml

Formulary OTC

sure comfort insulin syringe 28g x 1/2" 1 ml 28g x 1/2" 1 ml Formulary OTC


Formulary OTC


Formulary OTC



Formulary OTC


Formulary OTC



Formulary OTC

135

Drug Name Formulary Status Requirements/Limitssure comfort insulin syringe 30g x 5/16" 0.5 ml 30g x 5/16" 0.5 ml

Formulary OTC

sure comfort insulin syringe 30g x 5/16" 1 ml 30g x 5/16" 1 ml

Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC

sure comfort insulin syringe 31g x 5/16" 1 ml 31g x 5/16" 1 ml

Formulary OTC

sure comfort lancets 28g Formulary OTC; QL (150 EA per 30 days)

sure comfort lancets 30g Formulary OTC; QL (150 EA per 30 days)

SURE-JECT INSULIN SYRINGE 28G X 1/2" 0.5 ML 28G X 1/2" 0.5 ML

Formulary OTC

SURE-JECT INSULIN SYRINGE 28G X 1/2" 1 ML 28G X 1/2" 1 ML

Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC

SURE-LANCE ULTRA THIN LANCETS Formulary OTC; QL (150 EA per 30 days)

SURELITE LANCETS Formulary OTC; QL (150 EA per 30 days)

SUSPENDOL-S LIQUID Formulary OTC

SUTENT ORAL CAPSULE 12.5 MG, 50 MG Formulary PA

SWEEN EXTERNAL CREAM Formulary OTC

SWEEN PREP EXTERNAL SOLUTION Formulary OTC

SWEETA ORAL SOLUTION Formulary OTC

SWIM EAR OTIC LIQUID 95 % Formulary OTC

swimmers instant ear dry otic liquid 95 % Formulary OTC

SYLATRON SUBCUTANEOUS KIT 200 MCG, 300 MCG, 600 MCG

Formulary

SYMBICORT INHALATION AEROSOL 160-4.5 MCG/ACT, 80-4.5 MCG/ACT


136

Drug Name Formulary Status Requirements/Limitssympathetic nerve needle 19g x 5" , 20g x 5" Formulary OTC

SYNAGIS INTRAMUSCULAR SOLUTION 100 MG/ML, 50 MG/0.5ML

Formulary PA

SYNJARDY ORAL TABLET 12.5-1000 MG, 12.5-500 MG, 5-1000 MG, 5-500 MG


SYNVISC INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE 16 MG/2ML

Formulary PA

SYNVISC ONE INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE 48 MG/6ML

Formulary PA

syringe 10-12 ml 12 ml Formulary OTC


syringe 20g x 1" 12 ml, 20g x 1" 6 ml, 21g x 1" 6 ml, 21g x 1-1/4" 6 ml, 22g x 1" 12 ml, 22g x 1" 6 ml, 22g x 1-1/2" 6 ml, 22g x 1-1/4" 6 ml, 22g x 3/4" 3 ml, 27g x 1-1/4" 3 ml

Formulary OTC





syringe luer slip 1 ml Formulary

syringe luer slip 26g x 3/8" 1 ml, 27g x 1/2" 1 ml Formulary OTC

syringe precisedose dispenser Formulary

SYRSPEND SF ORAL LIQUID Formulary

SYRSPEND SF PH4 ORAL SUSPENSION RECONSTITUTED

Formulary

syrup nf oral syrup 85 % Formulary OTC

SYSTANE BALANCE OPHTHALMIC SOLUTION 0.6 % Formulary OTC

SYSTANE LID WIPES EXTERNAL PAD Formulary OTC

SYSTANE OPHTHALMIC GEL 0.4-0.3 % Formulary OTC

SYSTANE OPHTHALMIC SOLUTION 0.4-0.3 % Formulary OTC

SYSTANE OVERNIGHT THERAPY OPHTHALMIC GEL 0.3 %

Formulary OTC

SYSTANE PRESERVATIVE FREE OPHTHALMIC SOLUTION 0.4-0.3 %

Formulary OTC

SYSTANE ULTRA OPHTHALMIC SOLUTION 0.4-0.3 %

Formulary OTC

SYSTANE ULTRA PF OPHTHALMIC SOLUTION 0.4-0.3 %

Formulary OTC

TABLOID ORAL TABLET 40 MG Formulary

tacrolimus external ointment 0.03 %, 0.1 % Formulary PA

tacrolimus oral capsule 0.5 mg, 1 mg, 5 mg Formulary

tadalafil (pah) oral tablet 20 mg Formulary PA

talc powder Formulary

TAMIFLU ORAL CAPSULE 30 MG, 45 MG, 75 MG Formulary

tamoxifen citrate oral tablet 10 mg, 20 mg Formulary

tamsulosin hcl oral capsule 0.4 mg Formulary

TANDEM ORAL CAPSULE 162-115.2 MG Formulary OTC

tangerine oil Formulary OTC

137

Drug Name Formulary Status Requirements/Limitstannic acid powder Formulary

TARGRETIN EXTERNAL GEL 1 % Formulary

taron forte oral capsule Formulary

TARON-CRYSTALS ORAL PACKET 3300-1002 MG Formulary

TARON-PREX ORAL CAPSULE 30-1.2-265 MG Formulary

TARSUM EXTERNAL SHAMPOO 10-5 % Formulary OTC

tartaric acid granules Formulary

taurine oral capsule 500 mg Formulary OTC

taurine powder Formulary

tazarotene external cream 0.1 % Formulary PA

TAZORAC EXTERNAL CREAM 0.05 % Formulary PA

TAZORAC EXTERNAL GEL 0.05 %, 0.1 % Formulary PA

TAZTIA XT ORAL CAPSULE EXTENDED RELEASE 24 HOUR 120 MG, 180 MG, 240 MG, 300 MG, 360 MG

Formulary

tb syringe 1 ml Formulary

tdm solution external solution Formulary

tea tree oil oil Formulary

TEAR FLO OPHTHALMIC STRIP Formulary OTC

TEARS NATURALE PM OPHTHALMIC OINTMENT 3-94 %

Formulary OTC

TECHLITE AST LANCETS Formulary OTC; QL (150 EA per 30 days)

TECHLITE LANCETS Formulary OTC; QL (150 EA per 30 days)

TECHLITE LANCETS 30G Formulary OTC; QL (150 EA per 30 days)

TECNU FIRST AID EXTERNAL GEL 0.2-2.5 % Formulary OTC

TEGADERM CONTACT LAYER PAD 8"X10" Formulary OTC

TEGADERM FOAM ADHESIVE PAD 2-3/4"X2-3/4" , 2-3/4"X3" , 4"X4-1/2" , 5-5/8"X5-5/8" , 5-5/8"X6-1/8" , 7-1/2"X8-3/4"

Formulary OTC

TEGADERM HYDROGEL WOUND FILLER EXTERNAL GEL

Formulary OTC

telmisartan oral tablet 20 mg, 40 mg, 80 mg Formulary

telmisartan-hctz oral tablet 40-12.5 mg, 80-12.5 mg, 80-25 mg

Formulary

temazepam oral capsule 15 mg, 22.5 mg, 30 mg, 7.5 mg Formulary

temozolomide oral capsule 100 mg, 140 mg, 180 mg, 20 mg, 250 mg, 5 mg

Formulary

temsirolimus intravenous solution 25 mg/ml Formulary

tenofovir disoproxil fumarate oral tablet 300 mg Formulary

terazosin hcl oral capsule 1 mg, 2 mg, 5 mg Formulary QL (34 EA per 34 days)

terazosin hcl oral capsule 10 mg Formulary QL (68 EA per 34 days)

terbinafine hcl oral tablet 250 mg Formulary

terbutaline sulfate oral tablet 2.5 mg, 5 mg Formulary

terconazole vaginal cream 0.4 % Formulary QL (45 GM per 30 days)

terconazole vaginal cream 0.8 % Formulary QL (20 GM per 30 days)

terconazole vaginal suppository 80 mg Formulary QL (3 EA per 30 days)

terocin external lotion 2.5-0.025-10-25 % Formulary OTC

138

Drug Name Formulary Status Requirements/Limitsterocin external patch 4-4 % Formulary OTC

teroderm-plus external cream Formulary

TESTOPEL IMPLANT PELLET 75 MG Formulary

testosterone cypionate intramuscular solution 100 mg/ml, 200 mg/ml

Formulary

testosterone enanthate intramuscular solution 200 mg/ml Formulary

testosterone transdermal gel 12.5 mg/act (1%), 25 mg/2.5gm (1%), 50 mg/5gm (1%)

Formulary

testosterone transdermal gel 20.25 mg/1.25gm (1.62%), 20.25 mg/act (1.62%), 40.5 mg/2.5gm (1.62%)

Formulary PA

tetanus-diphtheria toxoids td intramuscular suspension 2-2 lf/0.5ml


tetrabenazine oral tablet 12.5 mg, 25 mg Formulary PA

tetracycline hcl oral capsule 250 mg, 500 mg Formulary

TETRA-FORMULA CGH/SORE THROAT MOUTH/THROAT LOZENGE 10-15 MG

Formulary OTC

tgt alcohol swabs pad 70 % 70 % Formulary OTC

tgt first aid cleansing external liquid 2.5-0.13 % Formulary OTC

tgt lancet micro thin 33g Formulary OTC; QL (150 EA per 30 days)

tgt lancet thin 26g Formulary OTC; QL (150 EA per 30 days)

tgt lancet ultra thin 30g Formulary OTC; QL (150 EA per 30 days)

tgt lubricant eye drops ophthalmic solution 0.95 % Formulary OTC

tgt lubricant redness reliever ophthalmic solution 0.03-0.5 %

Formulary OTC

tgt omeprazole oral tablet delayed release 20 mg Formulary OTC

THALOMID ORAL CAPSULE 100 MG, 150 MG, 200 MG, 50 MG

Formulary PA

THE ITCH ERASER EXTERNAL SOLUTION 2 % Formulary OTC

THEOCHRON ORAL TABLET EXTENDED RELEASE 12 HOUR 100 MG, 200 MG, 300 MG

Formulary

theophylline anhydrous powder Formulary

theophylline er oral tablet extended release 12 hour 450 mg Formulary

theophylline er oral tablet extended release 24 hour 400 mg, 600 mg

Formulary

THERACOF PLUS COUGH/COLD REL ORAL LIQUID 5-10-100-325 MG/5ML

Formulary OTC

THERACYS INTRAVESICAL SUSPENSION RECONSTITUTED 81 MG/VIAL

Formulary

THERA-D 4000 ORAL TABLET 4000 UNIT Formulary OTC

THERAFLU COLD & COUGH ORAL PACKET 10-20-20 MG

Formulary OTC

THERAFLU EXPRESSMAX ORAL LIQUID 12.5-5-325 MG/15ML

Formulary OTC

THERAFLU SEVERE COLD & COUGH ORAL PACKET Formulary OTC

THERAFLU SEVERE COLD DAYTIME ORAL TABLET 15-5-325 MG

Formulary OTC

THERAFLU SEVERE COLD NIGHTTIME ORAL PACKET 25-10-500 MG

Formulary OTC

139

Drug Name Formulary Status Requirements/LimitsTHERAFLU SEVERE COLD NIGHTTIME ORAL TABLET 5-2-10-325 MG

Formulary OTC

THERAFLU SEVERE COLD ORAL PACKET 20-10-500 MG

Formulary OTC

THERAFLU SEVERE COLD/CGH NIGHT ORAL PACKET 25-10-650 MG

Formulary OTC

THERAFLU WARMING RELIEF SINUS ORAL LIQUID 12.5-5-325 MG/15ML

Formulary OTC

THERA-GESIC EXTERNAL CREAM 0.5-15 % Formulary OTC

THERANATAL COMPLETE ORAL 27-1 & 300 MG Formulary OTC

THERANATAL OVAVITE ORAL THERAPY PACK 18-1 & 125 MG

Formulary OTC

THERAPLEX T EXTERNAL SHAMPOO 1 % Formulary OTC

THERASEAL HAND PROTECTION EXTERNAL LOTION 1 %

Formulary OTC

THERATEARS NUTRITION ORAL CAPSULE Formulary OTC

THERATEARS OPHTHALMIC GEL 1 % Formulary OTC

THERATEARS OPHTHALMIC SOLUTION 0.25 % Formulary OTC

thiamine hcl powder Formulary

thiamine oral capsule 50 mg Formulary OTC

THINLETS GP LANCETS Formulary OTC; QL (150 EA per 30 days)

thioridazine hcl oral tablet 10 mg, 100 mg, 25 mg, 50 mg Formulary AGE (Min 18 Years)

thiotepa injection solution reconstituted 15 mg Formulary

thiothixene oral capsule 1 mg, 10 mg, 2 mg, 5 mg Formulary AGE (Min 18 Years)

threonine powder Formulary

thymol crystals Formulary

THYROLAR-1 ORAL TABLET 60 (12.5-50) MG (MCG) Formulary

THYROLAR-1/2 ORAL TABLET 30 (6.25-25) MG (MCG)

Formulary

THYROLAR-1/4 ORAL TABLET 15 (3.1-12.5) MG (MCG)

Formulary

THYROLAR-2 ORAL TABLET 120 (25-100) MG (MCG) Formulary

THYROLAR-3 ORAL TABLET 180 (37.5-150) MG (MCG)

Formulary

tiagabine hcl oral tablet 2 mg, 4 mg Formulary

ticlopidine hcl oral tablet 250 mg Formulary

TIGER BALM LINIMENT EXTERNAL LIQUID 16-28 % Formulary OTC

TIGER BALM MUSCLE RUB EXTERNAL CREAM 3-5-15 %

Formulary OTC

TIGER BALM NECK & SHOULDER RUB EXTERNAL CREAM 10-11 %

Formulary OTC

TIGER BALM PAIN RELIEVING EXTERNAL PATCH 80-24-16 MG

Formulary OTC

TIGER BALM PAIN RELIEVING LG EXTERNAL PATCH 70-230 MG

Formulary OTC

TILIA FE ORAL TABLET 1-20/1-30/1-35 MG-MCG Formulary QL (28 EA per 28 days)

timolol maleate ophthalmic gel forming solution 0.25 %, 0.5 %

Formulary

140

Drug Name Formulary Status Requirements/Limitstimolol maleate ophthalmic solution 0.25 %, 0.5 % Formulary

timolol maleate oral tablet 10 mg, 20 mg, 5 mg Formulary

TINACTIN EXTERNAL AEROSOL 1 % Formulary OTC

TINACTIN EXTERNAL AEROSOL POWDER 1 % Formulary OTC

TINACTIN JOCK ITCH EXTERNAL CREAM 1 % Formulary OTC

TIVICAY ORAL TABLET 10 MG, 25 MG, 50 MG Formulary

tizanidine hcl oral capsule 2 mg, 4 mg, 6 mg Formulary

tizanidine hcl oral tablet 2 mg, 4 mg Formulary

TN DICKINSONS WITCH HAZEL EXTERNAL PAD Formulary OTC

TOBI PODHALER INHALATION CAPSULE 28 MG FormularyST; QL (56 EA per 28 days); AGE (Min 6 Years)

TOBRADEX OPHTHALMIC OINTMENT 0.3-0.1 % Formulary

TOBRADEX OPHTHALMIC SUSPENSION 0.3-0.1 % Formulary

tobramycin ophthalmic solution 0.3 % Formulary

tobramycin-dexamethasone ophthalmic suspension 0.3-0.1 %

Formulary

TODAY SPONGE VAGINAL 1000 MG Formulary OTC

todays health thin lancets 28g Formulary OTC; QL (150 EA per 30 days)

todays health thin lancets 30g Formulary OTC; QL (150 EA per 30 days)

tolazamide oral tablet 250 mg, 500 mg Formulary

tolbutamide oral tablet 500 mg Formulary

tolmetin sodium oral capsule 400 mg Formulary

tolnaftate external cream 1 % Formulary OTC

tolnaftate external powder 1 % Formulary OTC

tolnaftate external solution 1 % Formulary OTC

tolterodine tartrate er oral capsule extended release 24 hour 2 mg, 4 mg


tolterodine tartrate oral tablet 1 mg, 2 mg Formulary QL (60 EA per 30 days)

toomey syringe 70 ml Formulary

topcare lancets micro-thin 33g Formulary OTC; QL (150 EA per 30 days)

topcare ultra comfort ins syr 29g x 1/2" 0.3 ml 29g x 1/2" 0.3 ml

Formulary OTC


Formulary OTC

topcare ultra comfort ins syr 29g x 1/2" 1 ml 29g x 1/2" 1 ml

Formulary OTC


Formulary OTC


Formulary OTC

topcare ultra comfort ins syr 30g x 5/16" 1 ml 30g x 5/16" 1 ml

Formulary OTC


Formulary OTC


Formulary OTC

141

Drug Name Formulary Status Requirements/Limitstopcare ultra comfort ins syr 31g x 5/16" 1 ml 31g x 5/16" 1 ml

Formulary OTC

TOPICAINE 5 EXTERNAL GEL 5 % Formulary OTC

topiramate oral capsule sprinkle 15 mg, 25 mg Formulary

topiramate oral tablet 100 mg, 200 mg, 25 mg, 50 mg Formulary

topotecan hcl intravenous solution 4 mg/4ml Formulary

topotecan hcl intravenous solution reconstituted 4 mg Formulary

torsemide oral tablet 10 mg, 100 mg, 20 mg, 5 mg Formulary

TOVIAZ ORAL TABLET EXTENDED RELEASE 24 HOUR 4 MG, 8 MG

Formulary

TRACLEER ORAL TABLET 125 MG, 62.5 MG Formulary PA

TRACLEER ORAL TABLET SOLUBLE 32 MG Formulary PA

TRADJENTA ORAL TABLET 5 MG Formulary ST

tragacanth powder Formulary

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


tramadol hcl er oral tablet extended release 24 hour 100 mg, 200 mg, 300 mg


tramadol hcl oral tablet 50 mg Formulary PA; QL (126 EA per 7 days)

trandolapril oral tablet 1 mg, 2 mg, 4 mg Formulary

tranexamic acid oral tablet 650 mg Formulary QL (30 EA per 30 days)

TRANQUILITY BRIEFS KIT Formulary OTC

TRANSANOSIL EXTERNAL LOTION 0.025-10-30 % Formulary OTC

transderm-iq external ointment 4-0.0375-10-20 % Formulary OTC

tranylcypromine sulfate oral tablet 10 mg Formulary

TRANZAREL EXTERNAL GEL 4 % Formulary

TRAVATAN Z OPHTHALMIC SOLUTION 0.004 % Formulary

travel sickness oral tablet chewable 25 mg Formulary OTC

trazodone hcl oral tablet 100 mg, 150 mg, 300 mg, 50 mg Formulary

TREANDA INTRAVENOUS SOLUTION RECONSTITUTED 100 MG, 25 MG

Formulary

T-RELIEF PAIN ARNICA + 12 EXTERNAL OINTMENT Formulary OTC

T-RELIEF PAIN RELIEF EXTERNAL CREAM Formulary OTC

TRELSTAR MIXJECT INTRAMUSCULAR SUSPENSION RECONSTITUTED 11.25 MG, 22.5 MG, 3.75 MG

Formulary PA

tretinoin external cream 0.025 %, 0.05 %, 0.1 % Formulary AGE (Max 18 Years)

tretinoin external gel 0.01 %, 0.025 % Formulary AGE (Max 18 Years)

tretinoin oral capsule 10 mg Formulary

TREXALL ORAL TABLET 10 MG, 15 MG, 5 MG, 7.5 MG

Formulary

triamcinolone acetonide aerosol 55 mcg/act nasal (otc) 55 mcg/act

Formulary

triamcinolone acetonide external cream 0.025 %, 0.1 %, 0.5 %

Formulary

triamcinolone acetonide external lotion 0.025 %, 0.1 % Formulary

142

Drug Name Formulary Status Requirements/Limitstriamcinolone acetonide external ointment 0.025 %, 0.1 %, 0.5 %

Formulary

triamcinolone acetonide injection suspension 40 mg/ml Formulary

TRIAMINIC CHEST/NASAL CONGEST ORAL LIQUID 2.5-50 MG/5ML

Formulary OTC

TRIAMINIC COLD & ALLERGY ORAL SYRUP 1-2.5 MG/5ML

Formulary OTC

TRIAMINIC COLD/COUGH DAY TIME ORAL SYRUP 2.5-5 MG/5ML

Formulary OTC

TRIAMINIC COLD/COUGH ORAL 2.5-5 &2.5-6.25 MG/5ML

Formulary OTC

TRIAMINIC COUGH/RUNNY NOSE ORAL TABLET CHEWABLE 1-5 MG

Formulary OTC

TRIAMINIC COUGH/SORE THROAT ORAL TABLET CHEWABLE 160-5 MG

Formulary OTC

TRIAMINIC FEVER REDUCER ORAL SYRUP 160 MG/5ML

Formulary OTC

TRIAMINIC FLU/COUGH/FEVER ORAL LIQUID 7.5-160-1 MG/5ML

Formulary OTC

TRIAMINIC LONG ACTING COUGH ORAL LIQUID 7.5 MG/5ML

Formulary OTC

TRIAMINIC LONG ACTING COUGH ORAL STRIP 7.5 MG

Formulary OTC

TRIAMINIC NIGHT TIME COLD/CGH ORAL SYRUP 6.25-2.5 MG/5ML

Formulary OTC

TRIAMINIC SORE THROAT MOUTH/THROAT SOLUTION 0.5 %

Formulary OTC

triamino oral tablet Formulary OTC

triamterene-hctz oral capsule 37.5-25 mg Formulary

triamterene-hctz oral tablet 37.5-25 mg, 75-50 mg Formulary

triazolam oral tablet 0.125 mg, 0.25 mg Formulary QL (34 EA per 34 days)

tri-buffered aspirin oral tablet 325 mg Formulary OTC

trichloroacetic acid crystals Formulary

tricitrates oral solution 550-500-334 mg/5ml Formulary

trifluoperazine hcl oral tablet 1 mg, 10 mg, 2 mg, 5 mg Formulary AGE (Min 18 Years)

trifluridine ophthalmic solution 1 % Formulary

trihexyphenidyl hcl oral elixir 0.4 mg/ml Formulary

trihexyphenidyl hcl oral tablet 2 mg, 5 mg Formulary

TRI-LO-SPRINTEC ORAL TABLET 0.18/0.215/0.25 MG-25 MCG

Formulary PA

trimethobenzamide hcl oral capsule 300 mg Formulary

trimethoprim oral tablet 100 mg Formulary

trimipramine maleate oral capsule 100 mg, 25 mg, 50 mg Formulary

TRINATE ORAL TABLET Formulary

triple antibiotic external ointment 3.5-400-5000 Formulary OTC

TRIPLE FLEX ORAL TABLET 750-400-375 MG Formulary OTC

triple helix collagen external powder Formulary OTC

TRIPLE PASTE EXTERNAL OINTMENT 12.8 % Formulary OTC

143

Drug Name Formulary Status Requirements/Limitstriprolidine hcl oral liquid 0.625 mg/ml Formulary OTC

TRISPEC PSE PEDIATRIC ORAL LIQUID 30-10-187 MG/5ML

Formulary OTC

TRIUMEQ ORAL TABLET 600-50-300 MG Formulary

TRI-VI-SOL ORAL SOLUTION 750-400-35 UNIT-MG/ML

Formulary OTC

TROCAINE THROAT MOUTH/THROAT LOZENGE 10 MG

Formulary OTC

TROCAL COUGH SUPPRESSANT MOUTH/THROAT LOZENGE 7.5 MG

Formulary OTC

TROCHIBASE CLASSIC FLAKES Formulary OTC

trochibase s flakes Formulary OTC

TROGARZO INTRAVENOUS SOLUTION 200 MG/1.33ML

Formulary PA

trolamine liquid 99 % Formulary

TROMBONEX-D ORAL CAPSULE Formulary OTC

trospium chloride oral tablet 20 mg Formulary

TRUEPLUS GLUCOSE ORAL GEL Formulary OTC

TRUEPLUS GLUCOSE ORAL TABLET CHEWABLE Formulary OTC

TRUEPLUS INSULIN SYRINGE 28G X 1/2" 0.5 ML 28G X 1/2" 0.5 ML

Formulary OTC

TRUEPLUS INSULIN SYRINGE 28G X 1/2" 1 ML 28G X 1/2" 1 ML

Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC

TRUEPLUS LANCETS 26G Formulary OTC; QL (150 EA per 30 days)




TRU-FIT ICE/HEAT ANKLE/GEL PAK PAD Formulary OTC

TRUVADA ORAL TABLET 200-300 MG Formulary

trymine cg oral liquid 225-7.5 mg/5ml Formulary OTC

144

Drug Name Formulary Status Requirements/Limitstryptophan powder Formulary

TUMS E-X 750 ORAL TABLET CHEWABLE 750 MG Formulary OTC

TUMS LASTING EFFECTS ORAL TABLET CHEWABLE 500 MG

Formulary OTC

TUMS ULTRA 1000 ORAL TABLET CHEWABLE 1000 MG

Formulary OTC

tuohy epidural needle tw 14g x 3" , 17g x 3-1/2" , 20g x 3-1/2"

Formulary OTC

turpentine liquid Formulary OTC

turpentine oil oil Formulary OTC

TUSICOF ORAL TABLET 10-20-400 MG Formulary OTC

TUSNEL C ORAL SYRUP 30-10-100 MG/5ML Formulary OTC

TUSNEL PEDIATRIC ORAL LIQUID 15-5-50 MG/5ML, 7.5-50 MG/ML

Formulary OTC; AGE (Min 6 Years)

TUSNEL-DM PEDIATRIC ORAL LIQUID 7.5-2.5-25 MG/ML

Formulary OTC

tussin cf max multi-symptom oral liquid 5-10-200 mg/5ml Formulary OTC

tussin cough dm oral syrup 100-10 mg/5ml Formulary OTC

tussin cough long-acting oral syrup 15 mg/5ml Formulary OTC

tussin dm max oral liquid 10-200 mg/5ml Formulary OTC

TUSSI-PRES ORAL LIQUID 5-10-200 MG/5ML Formulary OTC

TUSSI-PRES PE PEDIATRIC ORAL LIQUID 2.5-100 MG/5ML

Formulary OTC

TUSSI-PRES PEDIATRIC ORAL LIQUID 2.5-5-75 MG/5ML

Formulary OTC

TUSSLIN PEDIATRIC ORAL LIQUID 2.5-7.5-88 MG/ML

Formulary OTC

TWINRIX INTRAMUSCULAR SUSPENSION 720-20 Formulary AGE (Min 19 Years)

TYLENOL CHILDRENS PLUS MS COLD ORAL SUSPENSION 2.5-1-5-160 MG/5ML

Formulary OTC

TYLENOL COLD & HEAD ORAL TABLET 5-325-200 MG

Formulary OTC

TYLENOL COLD MAX ORAL LIQUID 10-5-325 MG/15ML

Formulary OTC

TYLENOL COLD MULTI-SYMPTOM ORAL LIQUID 5-6.25-10-325 MG/15ML

Formulary OTC

TYLENOL COLD/FLU SEVERE ORAL TABLET 5-10-200-325 MG

Formulary OTC

TYLENOL COLD/FLU SEVERE ORAL TABLET THERAPY PACK

Formulary OTC

TYLENOL EXTRA STRENGTH ORAL TABLET 500 MG

Formulary OTC

TYLENOL INFANTS ORAL SUSPENSION 160 MG/5ML

Formulary OTC

TYLENOL ORAL CAPSULE 325 MG Formulary OTC

TYLENOL ORAL TABLET 325 MG Formulary OTC

TYLENOL PM EXTRA STRENGTH ORAL TABLET 500-25 MG

Formulary OTC

145

Drug Name Formulary Status Requirements/LimitsTYLENOL SINUS SEVERE ORAL TABLET 5-325-200 MG

Formulary OTC

TYLENOL WARMING COUGH/CONGEST ORAL LIQUID 5-10-200-325 MG/15ML

Formulary OTC

TYPHIM VI INTRAMUSCULAR SOLUTION 25 MCG/0.5ML


tyrosine oral packet 1000 mg Formulary OTC

TYVASO REFILL INHALATION SOLUTION 0.6 MG/ML

Formulary PA

ubidecarenone powder Formulary

ULCEREASE MOUTH/THROAT LIQUID 0.6 % Formulary OTC

ULCEREASE MOUTH/THROAT SOLUTION 0.6-1.5 % Formulary OTC

ULORIC ORAL TABLET 40 MG, 80 MG Formulary QL (34 EA per 34 days)

ULTICARE ALCOHOL SWABS PAD Formulary OTC

ULTICARE ALCOHOL SWABS PAD 70 % 70 % Formulary OTC

ULTICARE INSULIN SAFETY SYR 29G X 1/2" 0.5 ML 29G X 1/2" 0.5 ML

Formulary

ULTICARE INSULIN SAFETY SYR 29G X 1/2" 1 ML 29G X 1/2" 1 ML

Formulary

ULTICARE INSULIN SYRINGE 28G X 1/2" 0.5 ML 28G X 1/2" 0.5 ML

Formulary OTC

ULTICARE INSULIN SYRINGE 28G X 1/2" 1 ML 28G X 1/2" 1 ML

Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC

146

Drug Name Formulary Status Requirements/LimitsULTICARE INSULIN SYRINGE 31G X 5/16" 0.5 ML 31G X 5/16" 0.5 ML

Formulary OTC


Formulary OTC

ULTICARE SYRINGE 22G X 1-1/2" 3 ML Formulary OTC

ULTICARE TUBERCULIN SAFETY SYR 25G X 1" 1 ML, 25G X 5/8" 1 ML

Formulary OTC

ultilet alcohol swabs pad Formulary OTC

ULTILET CLASSIC LANCETS Formulary OTC; QL (150 EA per 30 days)

ULTILET INSULIN SYRINGE 30G X 1/2" 0.5 ML 30G X 1/2" 0.5 ML

Formulary OTC

ULTILET INSULIN SYRINGE 30G X 1/2" 1 ML 30G X 1/2" 1 ML

Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC

ULTILET INSULIN SYRINGE 31G X 15/64" 0.3 ML (OTC) 31G X 15/64" 0.3 ML

Formulary

ULTILET INSULIN SYRINGE 31G X 15/64" 0.3 ML (RX) 31G X 15/64" 0.3 ML

Formulary


Formulary OTC


Formulary OTC


Formulary OTC

ULTILET INSULIN SYRINGE SHORT 30G X 1/2" 0.3 ML 30G X 1/2" 0.3 ML

Formulary OTC


Formulary OTC


Formulary OTC

ULTILET INSULIN SYRINGE SHORT 30G X 5/16" 1 ML 30G X 5/16" 1 ML

Formulary OTC


Formulary OTC


Formulary OTC

ULTILET INSULIN SYRINGE SHORT 31G X 5/16" 1 ML 31G X 5/16" 1 ML

Formulary OTC

ULTILET LANCETS Formulary OTC; QL (150 EA per 30 days)

ultra comfort insulin syringe 30g x 5/16" 0.3 ml 30g x 5/16" 0.3 ml

Formulary OTC

147

Drug Name Formulary Status Requirements/LimitsULTRA FRESH OPHTHALMIC SOLUTION 0.5 % Formulary OTC

ULTRA FRESH PM OPHTHALMIC OINTMENT Formulary OTC

ULTRA MEGA GOLD ORAL TABLET EXTENDED RELEASE

Formulary OTC

ULTRA MIDE 25 EXTERNAL LOTION 25 % Formulary OTC

ultracin external lotion 0.025-10-28 % Formulary OTC

ULTRACIN M EXTERNAL GEL 5 % Formulary OTC

ULTRACIN T EXTERNAL LOTION 10 % Formulary OTC

ULTRACIN-M EXTERNAL GEL 10 % Formulary OTC

ultra-comfort insulin syringe 28g x 1/2" 0.5 ml 28g x 1/2" 0.5 ml

Formulary OTC

ultra-comfort insulin syringe 28g x 1/2" 1 ml 28g x 1/2" 1 ml

Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC


Formulary OTC

ultrasone external cream Formulary OTC

ULTRA-THIN II INS SYR SHORT 30G X 5/16" 0.3 ML 30G X 5/16" 0.3 ML

Formulary OTC


Formulary OTC

ULTRA-THIN II INS SYR SHORT 30G X 5/16" 1 ML 30G X 5/16" 1 ML

Formulary OTC


Formulary OTC


Formulary OTC

ULTRA-THIN II INS SYR SHORT 31G X 5/16" 1 ML 31G X 5/16" 1 ML

Formulary OTC

ULTRA-THIN II INSULIN SYRINGE 29G X 1/2" 0.3 ML 29G X 1/2" 0.3 ML

Formulary OTC

ULTRA-THIN II INSULIN SYRINGE 29G X 1/2" 0.5 ML 29G X 1/2" 0.5 ML

Formulary OTC

ULTRA-THIN II INSULIN SYRINGE 29G X 1/2" 1 ML 29G X 1/2" 1 ML

Formulary OTC

148

Drug Name Formulary Status Requirements/LimitsULTRA-THIN II LANCETS Formulary OTC; QL (150 EA per 30 days)

UMCKA ELDERBERRY COLD+FLU ORAL SYRUP Formulary OTC

UMCKA FASTACTIVES COLD+FLU ORAL PACKET Formulary OTC

UMECTA MOUSSE EXTERNAL FOAM 40 % Formulary

undecylenic acid liquid Formulary

UNDELENIC EXTERNAL TINCTURE Formulary OTC

unibase external cream Formulary OTC

UNILET COMFORTOUCH LANCET Formulary OTC; QL (150 EA per 30 days)

UNILET EXCELITE Formulary OTC; QL (150 EA per 30 days)

UNILET EXCELITE II Formulary OTC; QL (150 EA per 30 days)

UNILET G.P. LANCET Formulary OTC; QL (150 EA per 30 days)

UNILET G.P. SUPERLITE LANCET Formulary OTC; QL (150 EA per 30 days)

UNILET GP 28 ULTRA THIN Formulary OTC; QL (150 EA per 30 days)

UNILET LANCET Formulary OTC; QL (150 EA per 30 days)

UNILET MICRO-THIN 33G Formulary OTC; QL (150 EA per 30 days)

UNILET SUPERLITE LANCET Formulary OTC; QL (150 EA per 30 days)

UNILET SUPER-THIN 30G Formulary OTC; QL (150 EA per 30 days)

UNILET ULTRA-THIN 28G Formulary OTC; QL (150 EA per 30 days)

UNI-SOLVE EXTERNAL PAD Formulary OTC

UNIVERSAL 1 LANCETS THIN 26G Formulary OTC; QL (150 EA per 30 days)

UNIVERSAL 1 LANCETS THIN 33G Formulary OTC; QL (150 EA per 30 days)

UNIVERSAL 1 LANCETS ULTRA THIN Formulary OTC; QL (150 EA per 30 days)

universal ph in vitro strip Formulary OTC

urea 20 intensive hydrating external cream 20 % Formulary OTC

urea beads Formulary OTC

urea external cream 40 %, 45 % Formulary

urea hydrating external foam 35 % Formulary

urea nail external gel 45 % Formulary

urea nail external stick 50 % Formulary

urea peroxide powder Formulary OTC

urea powder Formulary

urinary pain relief oral tablet 95 mg Formulary OTC

URO-MAG ORAL CAPSULE 140 MG Formulary OTC

ursodiol oral capsule 300 mg Formulary

ursodiol oral tablet 250 mg, 500 mg Formulary

vagicaine vaginal cream 20-3 % Formulary OTC

VAGIFEM VAGINAL TABLET 10 MCG Formulary

valacyclovir hcl oral tablet 1 gm, 500 mg Formulary

valerian oral capsule 500 mg Formulary OTC

valerian root oral capsule 450 mg Formulary OTC

valganciclovir hcl oral solution reconstituted 50 mg/ml Formulary

valganciclovir hcl oral tablet 450 mg Formulary

VALINE 1000 ORAL PACKET 1 GM Formulary OTC

valine oral packet 50 mg Formulary OTC

149

Drug Name Formulary Status Requirements/Limitsvaline powder Formulary

valproate sodium intravenous solution 100 mg/ml, 500 mg/5ml

Formulary

valproate sodium oral solution 250 mg/5ml Formulary

valproic acid oral capsule 250 mg Formulary

valsartan oral tablet 160 mg, 320 mg, 40 mg, 80 mg Formulary QL (34 EA per 34 days)

valsartan-hydrochlorothiazide oral tablet 160-12.5 mg, 160-25 mg, 320-12.5 mg, 320-25 mg, 80-12.5 mg

Formulary

VALSTAR INTRAVESICAL SOLUTION 40 MG/ML Formulary

value health insulin syringe 29g x 1/2" 0.5 ml 29g x 1/2" 0.5 ml

Formulary OTC

value health insulin syringe 29g x 1/2" 1 ml 29g x 1/2" 1 ml Formulary OTC

value plus lancet standard 21g Formulary OTC; QL (150 EA per 30 days)

value plus lancets super thin Formulary OTC; QL (150 EA per 30 days)

value plus lancets thin 26g Formulary OTC; QL (150 EA per 30 days)

valumark lancet super thin 30g Formulary OTC; QL (150 EA per 30 days)

valumark lancet ultra thin 28g Formulary OTC; QL (150 EA per 30 days)

VAMOUSSE LICE TREATMENT EXTERNAL FOAM Formulary OTC

VANACHOL ORAL CAPSULE Formulary OTC

VANACLEAR PD ORAL LIQUID 0.313 MG/ML Formulary OTC

VANACOF AC ORAL LIQUID 12.5-25 MG/30ML Formulary OTC

VANACOF DM ORAL LIQUID 10-18-200 MG/15ML Formulary OTC

VANACOF ORAL LIQUID 30-1-12.5 MG/5ML Formulary OTC

VANACOF-8 ORAL LIQUID 25-50 MG/15ML Formulary OTC

vanadium oral capsule 7.5 mg Formulary OTC

VANAMINE PD ORAL LIQUID 6.25 MG/ML Formulary OTC

VANATAB AC ORAL TABLET 12.5-25 MG Formulary OTC

VANATAB DM ORAL TABLET 5-9-198 MG Formulary OTC

vancomycin hcl in dextrose intravenous solution 1-5 gm/200ml-%, 1-5 gm/250ml-%, 500-5 mg/100ml-%, 750-5 mg/150ml-%

Formulary

vancomycin hcl in nacl intravenous solution 1-0.9 gm/200ml-%, 500-0.9 mg/100ml-%, 750-0.9 mg/150ml-%

Formulary

vancomycin hcl intravenous solution reconstituted 10 gm, 1000 mg, 500 mg, 5000 mg, 750 mg

Formulary

vancomycin hcl oral capsule 125 mg, 250 mg Formulary

VANDAZOLE VAGINAL GEL 0.75 % Formulary

VANICREAM DIAPER RASH EXTERNAL OINTMENT 1.1-40 %

Formulary OTC

VANIPLY EXTERNAL OINTMENT 1 % Formulary OTC

VANISHPOINT SAFETY SYRINGE 25G X 1-1/2" 10 ML, 25G X 1-1/2" 5 ML, 27G X 1-1/2" 10 ML, 27G X 1-1/2" 5 ML

Formulary OTC

VANTAS SUBCUTANEOUS KIT 50 MG Formulary PA

VAPOR PATCH EXTERNAL PATCH Formulary OTC

VAQTA INTRAMUSCULAR SUSPENSION 25 UNIT/0.5ML, 50 UNIT/ML


150

Drug Name Formulary Status Requirements/LimitsVARIVAX SUBCUTANEOUS INJECTABLE 1350 PFU/0.5ML


VASHE WOUND THERAPY EXTERNAL SOLUTION Formulary OTC

VASOCLEAR-A OPHTHALMIC SOLUTION 0.02-0.25 %

Formulary OTC

VASOFLEX D1 ORAL TABLET 900-100 MG Formulary OTC

VCF VAGINAL CONTRACEPTIVE VAGINAL FILM 28 %

Formulary OTC

VCF VAGINAL CONTRACEPTIVE VAGINAL FOAM 12.5 %

Formulary OTC

VCF VAGINAL CONTRACEPTIVE VAGINAL GEL 4 % Formulary OTC

VECTIBIX INTRAVENOUS SOLUTION 100 MG/5ML, 400 MG/20ML

Formulary

veegum Formulary OTC

VELCADE INJECTION SOLUTION RECONSTITUTED 3.5 MG

Formulary

venaliv oral tablet 900-100-100 mg Formulary OTC

VENIA EXTERNAL PATCH 4-4 % Formulary OTC

venlafaxine hcl er oral capsule extended release 24 hour150 mg, 37.5 mg, 75 mg

Formulary

venlafaxine hcl er oral tablet extended release 24 hour 150 mg, 37.5 mg, 75 mg

Formulary ST

venlafaxine hcl oral tablet 100 mg, 25 mg, 37.5 mg, 50 mg, 75 mg

Formulary

VENTAVIS INHALATION SOLUTION 10 MCG/ML, 20 MCG/ML

Formulary

verapamil hcl er oral capsule extended release 24 hour 100 mg, 120 mg, 180 mg, 200 mg, 240 mg, 300 mg, 360 mg

Formulary

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

Formulary

verapamil hcl intravenous solution 2.5 mg/ml Formulary

verapamil hcl oral tablet 120 mg, 40 mg, 80 mg Formulary

versabase cream Formulary

versabase gel Formulary

VERSAPLUS ORAL SYRUP Formulary

VERSIVA XC PAD 5-1/2"X5-1/2" Formulary OTC

VESICARE ORAL TABLET 10 MG, 5 MG Formulary

VIBERZI ORAL TABLET 100 MG, 75 MG Formulary PA

VIBRAMYCIN ORAL SYRUP 50 MG/5ML Formulary

VICKS DAYQUIL MUCUS CONTROL DM ORAL LIQUID 10-200 MG/15ML

Formulary OTC

VICKS NYQUIL CHILDRENS CLD/CGH ORAL LIQUID 2-15 MG/15ML

Formulary OTC

VICKS NYQUIL COLD & FLU NIGHT ORAL LIQUID 15-6.25-325 MG/15ML, 30-650-4 MG/30ML

Formulary OTC

VICKS NYQUIL COUGH ORAL LIQUID 12.5-30 MG/30ML

Formulary OTC

151

Drug Name Formulary Status Requirements/LimitsVICKS NYQUIL SEVERE COLD & FLU ORAL TABLET 5-6.25-10-325 MG

Formulary OTC

VICKS SINEX DAYQUIL/NYQUIL ORAL Formulary OTC

VICKS VAPO STEAM INHALATION LIQUID 6.2 % Formulary OTC

VICKS VAPODROPS MOUTH/THROAT LOZENGE 1.7 MG, 3.3 MG

Formulary OTC

VICKS VAPOINHALER INHALATION INHALER Formulary OTC

VICKS VAPORUB EXTERNAL OINTMENT 4.73-1.2-2.6 %

Formulary OTC

VICODIN ES ORAL TABLET 7.5-300 MG Formulary PA; QL (84 EA per 7 days)

VICODIN HP ORAL TABLET 10-300 MG Formulary PA; QL (63 EA per 7 days)

VICODIN ORAL TABLET 5-300 MG Formulary PA; QL (126 EA per 7 days)

VICTOZA SUBCUTANEOUS SOLUTION PEN-INJECTOR 18 MG/3ML

Formulary

VIDA MIA UNILET LANCETS 28G Formulary OTC; QL (150 EA per 30 days)

VIDEX ORAL SOLUTION RECONSTITUTED 2 GM, 4 GM

Formulary

vigabatrin oral packet 500 mg Formulary PA

VIGAMOX OPHTHALMIC SOLUTION 0.5 % Formulary

VIIBRYD ORAL TABLET 10 MG Formulary PA; QL (68 EA per 34 days)

VIIBRYD ORAL TABLET 20 MG, 40 MG Formulary PA; QL (34 EA per 34 days)

VIMPAT INTRAVENOUS SOLUTION 200 MG/20ML Formulary

VIMPAT ORAL SOLUTION 10 MG/ML Formulary

VIMPAT ORAL TABLET 100 MG, 150 MG, 200 MG, 50 MG

Formulary

VINATE M ORAL TABLET 27-1 MG Formulary

vinblastine sulfate intravenous solution 1 mg/ml Formulary

VINCASAR PFS INTRAVENOUS SOLUTION 1 MG/ML Formulary

VINCE DENTAL POWDER Formulary OTC

vinorelbine tartrate intravenous solution 10 mg/ml, 50 mg/5ml

Formulary

VIRACEPT ORAL TABLET 250 MG, 625 MG Formulary

virtussin dac oral solution 30-10-100 mg/5ml Formulary OTC

VISI-FLOW IRRIGATION STARTER KIT Formulary OTC

vita-c oral crystals Formulary OTC

VITA-CALCIUM ORAL WAFER 333-133 MG-UNIT Formulary OTC

VITADYE EXTERNAL LOTION 5 % Formulary OTC

VITAFOL ULTRA ORAL CAPSULE 29-0.6-0.4-200 MG Formulary

VITALINE BIOTIN FORTE/ZINC ORAL TABLET 0.8 MG

Formulary OTC

VITALINE COQ10 ORAL TABLET 200 MG, 60 MG Formulary OTC

VITA-MAG ORAL TABLET 133-5-10 MG Formulary OTC

VITAMAX ORAL TABLET CHEWABLE 60 MG Formulary OTC

VITAMELTS ENERGY VITAMIN B-12 ORAL TABLET DISPERSIBLE 1500 MCG

Formulary OTC

vitamin a & d oral capsule 5000-400 unit Formulary OTC

152

Drug Name Formulary Status Requirements/Limitsvitamin a & d oral tablet 10000-400 unit Formulary OTC

VITAMIN A FISH ORAL CAPSULE 7500 UNIT Formulary OTC

vitamin a oral capsule 10000 unit, 8000 unit Formulary OTC

vitamin a palmitate liquid Formulary

vitamin a palmitate oral tablet 10000 unit, 15000 unit Formulary OTC

vitamin a wrinkle treatment external gel Formulary OTC

vitamin a-beta carotene oral tablet 10000-1000 unit, 15000-10000 unit

Formulary OTC

vitamin b complex-c oral capsule Formulary OTC

vitamin b-1 oral tablet 50 mg Formulary OTC

vitamin b-12 oral liquid 1000 mcg/15ml Formulary OTC

vitamin b-12 oral lozenge 50 mcg, 500 mcg Formulary OTC

vitamin b-12 oral tablet 100 mcg, 1000 mcg, 500 mcg Formulary OTC

vitamin b12 sublingual liquid 3000 mcg/ml Formulary OTC

vitamin b-12 sublingual tablet sublingual 500 mcg Formulary OTC

vitamin b-2 oral tablet 25 mg, 50 mg Formulary OTC

vitamin b-6 er oral tablet extended release 200 mg Formulary OTC

vitamin b-6 oral tablet 100 mg Formulary OTC

vitamin c (calcium ascorbate) oral solution reconstituted Formulary OTC

vitamin c drops mouth/throat lozenge 60 mg Formulary OTC

vitamin c gummies oral tablet chewable 125 mg Formulary OTC

vitamin c oral liquid , 500 mg/5ml Formulary OTC

vitamin c oral powder Formulary OTC

vitamin c oral tablet 100 mg, 250 mg Formulary OTC

vitamin c oral tablet chewable Formulary OTC

vitamin c plus wild rose hips oral tablet chewable 500 mg Formulary OTC

vitamin c-rose hips er oral tablet extended release 1000 mg, 500 mg

Formulary OTC

vitamin d2 oral tablet 2000 unit Formulary OTC

vitamin d3 oral capsule 10000 unit, 2000 unit, 5000 unit, 50000 unit

Formulary OTC

vitamin d3 oral liquid 5000 unit/ml Formulary OTC

vitamin d3 oral tablet 50000 unit Formulary OTC

vitamin d3 oral tablet chewable 1000 unit, 400 unit Formulary OTC

vitamin d-400 oral tablet 400 unit Formulary OTC

VITAMIN E & C BEAUTY LOTION EXTERNAL LOTION

Formulary OTC

VITAMIN E & K BEAUTIFUL SKIN EXTERNAL OIL Formulary OTC

vitamin e acetate liquid 1 unit/mg Formulary

vitamin e beauty external oil 24000 unit/52ml Formulary OTC

vitamin e external cream Formulary OTC

vitamin e external liquid 24000 unit Formulary OTC

vitamin e oral capsule 100 unit Formulary OTC

vitamin e oral tablet 400 unit Formulary OTC

vitamin e succinate powder Formulary

153

Drug Name Formulary Status Requirements/Limitsvitamin e/selenium oral capsule 400-50 unit-mcg Formulary OTC

vitamin k1 powder Formulary OTC

vitamins acd-fluoride oral solution 0.25 mg/ml Formulary

VITAMINS E & A BEAUTY OIL EXTERNAL OIL 1000-14000 UNIT/52ML

Formulary OTC

VITAMINS E & D BEAUTY OIL EXTERNAL OIL 400-14000 UNIT/52ML

Formulary OTC

VITA-RAY EXTERNAL CREAM 10-200000-3000 Formulary OTC

VITONIC ORAL LIQUID Formulary OTC

VIVA DROPS OPHTHALMIC SOLUTION 1 % Formulary OTC

viva external patch 2.5-4-2 % Formulary OTC

VIVABEN ORAL CAPSULE Formulary OTC

VIVITROL INTRAMUSCULAR SUSPENSION RECONSTITUTED 380 MG

Formulary

VIVOTIF ORAL CAPSULE DELAYED RELEASE Formulary AGE (Min 19 Years)

VOGELXO PUMP TRANSDERMAL GEL 12.5 MG/ACT (1%)

Formulary PA

VOGELXO TRANSDERMAL GEL 50 MG/5GM (1%) Formulary PA

VOLTAREN TRANSDERMAL GEL 1 % Formulary

VOPAC 5 EXTERNAL CREAM 5 % Formulary OTC

voriconazole oral suspension reconstituted 40 mg/ml Formulary PA

voriconazole oral tablet 200 mg, 50 mg Formulary PA

vp insulin syringe 29g x 1/2" 0.3 ml 29g x 1/2" 0.3 ml Formulary OTC

VYVANSE ORAL CAPSULE 10 MG, 20 MG, 30 MG, 40 MG, 50 MG, 60 MG, 70 MG


VYVANSE ORAL TABLET CHEWABLE 10 MG, 20 MG, 30 MG, 40 MG, 50 MG, 60 MG


WAL-DRYL ANTI-ITCH EXTERNAL LIQUID 2-0.1 % Formulary OTC

WAL-DRYL EXTERNAL CREAM 2-0.1 % Formulary OTC

WAL-DRYL PE ALLERGY & SINUS ORAL TABLET 25-10 MG

Formulary OTC

WAL-FEX D ALLERGY & CONGESTION ORAL TABLET EXTENDED RELEASE 24 HOUR 180-240 MG

Formulary OTC

WAL-FLU COLD & SORE THROAT ORAL PACKET 20-10-325 MG

Formulary OTC

WAL-FLU SEV COLD/CGH DAY/NIGHT ORAL PACKET

Formulary OTC

WALGREENS LANCETS Formulary OTC; QL (150 EA per 30 days)

walgreens lancets micro thin Formulary OTC; QL (150 EA per 30 days)

walgreens lancets super thin Formulary OTC; QL (150 EA per 30 days)

WALGREENS THIN LANCETS Formulary OTC; QL (150 EA per 30 days)

WALGREENS ULTRA THIN LANCETS Formulary OTC; QL (150 EA per 30 days)

WAL-ITIN D ORAL TABLET EXTENDED RELEASE 12 HOUR 5-120 MG

Formulary OTC

WAL-PHED PE DAYTIME/NIGHTTIME ORAL Formulary OTC

WAL-SLEEP Z LIQUID SHOTS ORAL LIQUID 50 MG/50ML

Formulary OTC

154

Drug Name Formulary Status Requirements/LimitsWAL-SLEEP Z ORAL TABLET DISPERSIBLE 25 MG Formulary OTC

wal-tap cold/allergy oral liquid 2-5 mg/10ml Formulary OTC

WAL-TUSSIN CF MAX ORAL LIQUID 5-10-200-325 MG/10ML

Formulary OTC

wal-tussin cough relief oral tablet chewable 7.5 mg Formulary OTC

WAL-ZYR CHILDRENS ORAL TABLET CHEWABLE 10 MG, 5 MG

Formulary OTC

WAL-ZYR ORAL CAPSULE 10 MG Formulary OTC

warfarin sodium oral tablet 1 mg, 10 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg

Formulary

wart remover maximum strength external gel 17 % Formulary OTC

wart remover maximum strength external liquid 17 % Formulary OTC

WATCHHALER DEVICE Formulary QL (2 EA per 365 days)

water oral oral liquid Formulary OTC

water tabs oral tablet Formulary OTC

wax for braces wax Formulary OTC

wax, white wax Formulary

WEBCOL ALCOHOL PREP LARGE PAD 70 % 70 % Formulary OTC

WEBCOL ALCOHOL PREP MEDIUM PAD 70 % 70 % Formulary OTC

wee care oral suspension 15 mg/1.25ml Formulary OTC

wegmans complete prenatal+dha oral 28-0.975 & 200 mg Formulary OTC

WEISS EPIDURAL NEEDLE 20G X 2" Formulary OTC

WEISS EPIDURAL NEEDLE TW 17G X 5" , 18G X 3-1/2" , 18G X 5"

Formulary OTC

WELCHOL ORAL TABLET 625 MG Formulary

WELLMIND MENTAL FOCUS ORAL TABLET CHEWABLE

Formulary OTC

WHITE PED ARTERIAL NEEDLE 19G X 1-1/2" , 20G X 1-1/2"

Formulary OTC

white petrolatum external ointment Formulary

WIDE-SEAL DIAPHRAGM 60 VAGINAL DIAPHRAGM 2 %

Formulary


Formulary


Formulary


Formulary


Formulary


Formulary


Formulary


Formulary

WINGS MATERNITY PANTS 2X-3X Formulary OTC

155

Drug Name Formulary Status Requirements/LimitsWINRHO SDF INJECTION SOLUTION 1500 UNIT/1.3ML, 15000 UNIT/13ML, 2500 UNIT/2.2ML, 5000 UNIT/4.4ML

Formulary

wintergreen oil oil Formulary OTC

witch hazel external liquid Formulary OTC

witch hazel external solution 86 % Formulary OTC

WITEPSOL PELLET Formulary

wound gel external gel Formulary OTC

wound gel spray external gel Formulary OTC

WYMZYA FE ORAL TABLET CHEWABLE 0.4-35 MG-MCG


xanthan gum powder Formulary

XARELTO ORAL TABLET 10 MG, 15 MG, 20 MG Formulary

XEOMIN INTRAMUSCULAR SOLUTION RECONSTITUTED 100 UNIT, 50 UNIT

Formulary PA

XERAC AC EXTERNAL SOLUTION 6.25 % Formulary

XEROFORM PETROLAT GAUZE 1"X8" EXTERNAL Formulary

XGEVA SUBCUTANEOUS SOLUTION 120 MG/1.7ML Formulary

XIAFLEX INJECTION SOLUTION RECONSTITUTED 0.9 MG

Formulary PA

XIFAXAN ORAL TABLET 200 MG, 550 MG Formulary PA

XOLAIR SUBCUTANEOUS SOLUTION RECONSTITUTED 150 MG


xolido external cream 2 % Formulary OTC

X-SEB T PEARL EXTERNAL SHAMPOO 10 % Formulary OTC

XTRA-CARE EXTERNAL LOTION Formulary OTC

XULANE TRANSDERMAL PATCH WEEKLY 150-35 MCG/24HR

Formulary

xylitol powder Formulary

XYREM ORAL SOLUTION 500 MG/ML Formulary PA; QL (540 ML per 30 days)

YES FOR WOMEN EXTERNAL GEL Formulary OTC

YF-VAX SUBCUTANEOUS INJECTABLE Formulary AGE (Min 19 Years)

YUVAFEM VAGINAL TABLET 10 MCG Formulary

ZADITOR OPHTHALMIC SOLUTION 0.025 % Formulary OTC

zafirlukast oral tablet 10 mg, 20 mg Formulary

zaleplon oral capsule 10 mg Formulary QL (68 EA per 34 days)

zaleplon oral capsule 5 mg Formulary QL (34 EA per 34 days)

ZANOSAR INTRAVENOUS SOLUTION RECONSTITUTED 1 GM

Formulary

ZANTAC 150 MAXIMUM STRENGTH ORAL TABLET 150 MG

Formulary OTC

ZANTAC 75 ORAL TABLET 75 MG Formulary OTC

Z-BUM EXTERNAL CREAM 22.5 % Formulary OTC

ZEASORB EXTERNAL POWDER Formulary OTC

ZEGERID OTC CAPSULE 20-1100 MG ORAL 20-1100 MG


156

Drug Name Formulary Status Requirements/LimitsZELBORAF ORAL TABLET 240 MG Formulary

ZENPEP ORAL CAPSULE DELAYED RELEASE PARTICLES 10000 UNIT, 15000-51000 UNIT, 20000-68000 UNIT, 25000 UNIT, 3000-10000 UNIT, 40000-136000 UNIT, 5000 UNIT

Formulary PA

ZEPHREX-D ORAL TABLET ABUSE-DETERRENT 30 MG

Formulary OTC

ZE-PLUS ORAL CAPSULE Formulary OTC

ZEVALIN Y-90 INTRAVENOUS KIT 3.2 MG/2ML Formulary

ZICAM ALLERGY RELIEF NASAL GEL Formulary OTC

ZICAM COLD REMEDY ORAL TABLET DISPERSIBLE Formulary OTC

zidovudine oral capsule 100 mg Formulary

zidovudine oral syrup 50 mg/5ml Formulary

zidovudine oral tablet 300 mg Formulary

ZIKS ARTHRITIS PAIN RELIEF EXTERNAL CREAM 0.025-1-12 %

Formulary OTC

ZILACTIN MOUTH/THROAT GEL 10 % Formulary OTC

ZILACTIN-B MOUTH/THROAT GEL 10 % Formulary OTC

ZIMS MAX-FREEZE EXTERNAL GEL 3.7 % Formulary OTC

zinc + vitamin c mouth/throat lozenge 20-120 mg Formulary OTC

ZINC 15 ORAL TABLET 66 MG Formulary OTC

zinc acetate powder Formulary

zinc aspartate oral tablet 40 mg Formulary OTC

zinc chloride granules Formulary

zinc gluconate oral tablet 15 mg, 50 mg Formulary OTC

zinc methionate oral capsule 50 mg Formulary OTC

zinc mouth/throat lozenge 10 mg Formulary OTC

zinc oral tablet 100 mg, 30 mg Formulary OTC

zinc oxide external ointment 20 % Formulary OTC

zinc oxide external paste 25 % Formulary OTC

zinc oxide powder Formulary

zinc stearate powder Formulary OTC

zinc sulfate heptahydrate powder Formulary

zinc sulfate oral tablet 220 (50 zn) mg Formulary OTC

zinc-c-b6 mouth/throat lozenge 15-60-5 mg Formulary OTC

zincolate oral capsule 10-20 mg Formulary OTC

ZINC-OXYDE PLUS EXTERNAL OINTMENT 0.44-20 %

Formulary OTC

zinc-vitamin c oral tablet dispersible 15-60 mg Formulary OTC

ziprasidone hcl oral capsule 20 mg, 40 mg, 60 mg, 80 mg Formulary AGE (Min 18 Years)

ZITHROMAX ORAL PACKET 1 GM Formulary QL (8 EA per 34 days)

ZITHROMAX ORAL SUSPENSION RECONSTITUTED 100 MG/5ML

Formulary

zn-50 oral capsule 50 mg Formulary OTC

ZOLADEX SUBCUTANEOUS IMPLANT 10.8 MG Formulary PA; QL (1 EA per 90 days)

ZOLADEX SUBCUTANEOUS IMPLANT 3.6 MG Formulary PA

157

Drug Name Formulary Status Requirements/Limitszoledronic acid intravenous concentrate 4 mg/5ml Formulary PA

zoledronic acid intravenous solution 4 mg/100ml, 5 mg/100ml

Formulary PA

ZOLINZA ORAL CAPSULE 100 MG Formulary PA

zolmitriptan oral tablet 2.5 mg, 5 mg Formulary ST; QL (6 EA per 34 days)

zolmitriptan oral tablet dispersible 2.5 mg, 5 mg Formulary ST; QL (6 EA per 34 days)

zolpidem tartrate er oral tablet extended release 12.5 mg, 6.25 mg


zolpidem tartrate oral tablet 10 mg, 5 mg Formulary

ZOMIG NASAL SOLUTION 2.5 MG Formulary ST

ZOMIG NASAL SOLUTION 5 MG Formulary ST; QL (36 EA per 34 days)

zonisamide oral capsule 100 mg, 25 mg, 50 mg Formulary

ZORTRESS ORAL TABLET 0.25 MG, 0.5 MG, 0.75 MG Formulary

ZOSTAVAX SUBCUTANEOUS SUSPENSION RECONSTITUTED 19400 UNT/0.65ML


ZOSTRIX HOT & COLD THERAPY EXTERNAL KIT 0.025 & 4 %

Formulary OTC

ZOSTRIX HP EXTERNAL CREAM 0.1 % Formulary OTC

ZOSTRIX-HP EXTERNAL STICK 0.075 % Formulary OTC

ZOVIRAX EXTERNAL CREAM 5 % Formulary PA; QL (5 GM per 34 days)

Z-TUSS AC ORAL LIQUID 2-9 MG/5ML Formulary OTC

ZYCLARA EXTERNAL CREAM 3.75 % Formulary

ZYLET OPHTHALMIC SUSPENSION 0.5-0.3 % Formulary

ZYNCOF ORAL SYRUP 20-400 MG/5ML Formulary OTC

ZYRTEC ALLERGY ORAL CAPSULE 10 MG Formulary OTC

ZYRTEC ALLERGY ORAL TABLET 10 MG Formulary OTC

ZYRTEC ALLERGY ORAL TABLET DISPERSIBLE 10 MG

Formulary OTC

ZYRTEC-D ALLERGY & CONGESTION ORAL TABLET EXTENDED RELEASE 12 HOUR 5-120 MG

Formulary OTC

ZYTAZE ORAL CAPSULE 25-500 MG Formulary OTC

ZZZQUIL ORAL LIQUID 50 MG/30ML Formulary OTC

158

Index1st relief spray .......................................... 11st tier unifine pentips .............................. 11st tier unilet comfortouch ....................... 12-deoxy-d-glucose .................................... 150+ adult eye health .................................17-keto dhea ............................................... 1A & D ZINC OXIDE............................... 1a thru z advanced ..................................... 1a thru z advantage .................................... 1a thru z select ............................................1A+D CRACKED SKIN RELIEF.............1a1c test at-home ........................................1a-25 ...........................................................1abacavir sulfate ........................................ 1abacavir sulfate-lamivudine ..................... 1abacavir-lamivudine-zidovudine .............. 1ABANATUSS PED................................. 1ABATRACE............................................ 1ABATREX............................................... 1ABATRON...............................................1ABATRON AF.........................................1ABATUSS DMX..................................... 1ABILIFY MAINTENA............................1abiraterone acetate ...................................1ABRAXANE............................................1ABREVA..................................................1acacia ....................................................... 1acamprosate calcium ................................2acarbose ................................................... 2ACCU-CHEK FASTCLIX LANCET......2ACCU-CHEK SOFT TOUCH LANCETS................................................ 2ACCU-CHEK SOFTCLIX LANCETS....2ACCUTREND CHOLESTEROL............ 2ACCUTREND CHOLESTEROL CONTROL............................................... 2ACCUTREND PLUS...............................2ACE AEROSOL CLOUD ENHANCER............................................ 2ACE KNEE BRACE W/STABILIZERS.................................... 2acebutolol hcl ........................................... 2ACEROLA C 500.................................... 2acesulfame potassium ...............................2ACETA-GESIC........................................2acetaminophen ..........................................2acetaminophen-codeine ............................2acetaminophen-codeine #2 .......................2acetaminophen-codeine #3 .......................2acetaminophen-codeine #4 .......................2ACETASOL HC.......................................2acetazolamide ...........................................2acetazolamide er .......................................2acetic acid .................................................2acetic acid glacial .................................... 2acetone ......................................................2acetylcysteine ............................................2acetyl-l-carnitine hcl ................................ 2ACID GONE............................................ 2acid reducer maximum strength ............... 2acidophilus ............................................... 2

acidophilus probiotic ................................2acidophilus/bifidus ................................... 2acidophilus/citrus pectin .......................... 2acidophilus/pectin .................................... 2acitretin .................................................... 2acne medication 10 ...............................2, 3acne medication 5 .....................................3ACNEFREE ACNE CLEARING SYSTEM.................................................. 3ACNEFREE SEVERE CLEARING SYST........................................................ 3ACT TOTAL CARE................................ 3ACTHIB................................................... 3ACTICARNITINE SF..............................3ACTICON................................................ 3actidom dmx ............................................. 3actidose/sorbitol ....................................... 3actidose-aqua ........................................... 3ACTIFLOVIT EAR HEALTH................ 3ACTIFOAM COLLAGEN SPONGE...... 3acti-lance lite lancets 28g .........................3acti-lance special lancets 17g .................. 3acti-lance universal 23g ........................... 3ACTIMMUNE......................................... 3ACTINEL.................................................3ACTISEP..................................................3ACTITROM............................................. 3ACTIVE Q............................................... 3ACTIVE Q MAXIMUM STRENGTH....3ACTIVE-Q............................................... 3ACTIVE-Q EXTRA STRENGTH...........3ACTIVITE EC......................................... 3ACTIVON ARTHRITIS ULTRA ST...... 3acyclovir ................................................... 3ADACEL..................................................3ADAGEN................................................. 3adapalene ................................................. 3ADCIRCA................................................ 4ADDERALL XR......................................4adefovir dipivoxil ......................................4adenosylcobalamin ...................................4adhesive bandages sheer .......................... 4adjustable lancing device ......................... 4ADRENAL C FORMULA.......................4ADRENALIN...........................................4ADRUCIL................................................ 4adult gummy ............................................. 4adult mask .................................................4adult wash cloths with aloe ...................... 4adult-lock weekly pill remind ................... 4ADVAIR DISKUS................................... 4advanced acne wash .................................4ADVANCED CALCIUM/D/MAGNESIUM..................4advanced hand sanitizer ...........................4ADVIL......................................................4ADVIL ALLERGY & CONGESTION... 4ADVIL ALLERGY SINUS..................... 4ADVIL COLD & SINUS LIQUI-GELS........................................................ 4ADVIL COLD/SINUS............................. 4

ADVIL PM...............................................4ADVIL SINUS CONGESTION & PAIN.........................................................4ADVOCATE INSULIN SYRINGE.........4AEROCHAMBER PLUS FLO-VU.........4AEROCHAMBER PLUS FLO-VU LARGE.....................................................5AEROCHAMBER PLUS FLO-VU SMALL.................................................... 5AEROCHAMBER PLUS FLO-VU W/MASK..................................................5AFEDITAB CR........................................5AFLURIA.................................................5AFLURIA PRESERVATIVE FREE....... 5AFREZZA................................................ 5AFRIN CHILDRENS...............................5AFRIN MENTHOL SPRAY....................5AFTERA.................................................. 5AGAMATRIX ULTRA-THIN LANCETS................................................ 5AHIST...................................................... 5aimsco lubricated ..................................... 5AIRAVITE............................................... 5AIRBORNE..............................................5AIRS DISPOSABLE NEBULIZER........ 5AIRZONE PEAK FLOW METER.......... 5ak-poly-bac ...............................................5AL12.........................................................5ALA SEB................................................. 5ALA SEB T.............................................. 5ALAHIST DM......................................... 5ALA-HIST IR...........................................5ALA-HIST PE..........................................5alanine 1000 ............................................. 5alba-lybe nr .............................................. 5albendazole ...............................................5ALBOLENE.............................................5ALBUKED 25..........................................5ALBUKED 5............................................5albuterol sulfate ........................................5albuterol sulfate er ................................... 5alclometasone dipropionate ..................... 5alcohol (rubbing) ......................................5alcohol anhydrous .................................... 5alcohol prep ..........................................5, 6alcohol swabs ........................................... 6alcohol wipes ............................................6alcohol, usp .............................................. 6alendronate sodium .................................. 6aler-cap .................................................... 6aler-dryl ....................................................6alertness aid ............................................. 6alevazol .....................................................6ALEVE.....................................................6ALFERON N............................................6alfuzosin hcl er ......................................... 6alga ...........................................................6ALGAL-900 DHA................................... 6ALIMTA.................................................. 6ALIVE MULTI-VITAMIN CHILDRENS............................................6

159

ALIVIO.................................................... 6alka-aid .....................................................6ALKA-SELTZER.................................... 6ALKA-SELTZER HEARTBURN + GAS.......................................................... 6all day allergy childrens ...........................6all day pain relief ..................................... 6allantoin ....................................................6ALL-DRY SIZE 3.................................... 6ALLEGRA ALLERGY............................6ALLEGRA ALLERGY CHILDRENS.... 6ALLEGRA-D ALLERGY & CONGESTION........................................ 6aller-ease .................................................. 6allergy childrens .......................................6allergy eye ................................................ 6allergy multi-symptom day/nght ...............6allergy spray 24 hour ............................... 6ALLEVYN PLUS CAVITY.................... 7ALLI.........................................................7allopurinol ................................................ 7ALMACONE........................................... 7almond oil bitter flavor .............................7ALOCANE PLUS.................................... 7ALOE GRANDE......................................7aloe vera ................................................... 7aloe vera freeze dried ............................... 7aloe vera moisturizing .............................. 7ALOE VESTA 2-N-1 PROTECTIVE..... 7ALOE VESTA CLEAR ANTIFUNGAL........................................ 7ALOE VESTA MULTI PURPOSE......... 7ALOE VESTA PROTECTIVE................ 7ALOE VESTA SKIN PROTECTANT.... 7aloe/lidocaine pain reliever ......................7alosetron hcl ............................................. 7alp high3 ...................................................7ALPAWASH............................................7ALPHAGAN P.........................................7alpha-lipoic acid .......................................7ALPHANATE/VWF COMPLEX/HUMAN...............................7ALPHANINE SD..................................... 7alph-e ........................................................7alph-e-mixed .............................................7alph-e-mixed 1000 ....................................7alprazolam ............................................7, 8alprazolam er ........................................... 7ALPRAZOLAM INTENSOL.................. 7ALTACAINE........................................... 8ALTAFLUOR.......................................... 8ALTAVERA............................................ 8alum ammonium ....................................... 8aluminum acetate ..................................... 8aluminum bottle seal ................................ 8aluminum chloride hexahydrate ...............8aluminum chlorohydrate .......................... 8aluminum hydroxide dried gel ..................8aluminum hydroxide gel ........................... 8ALVESCO................................................8ALWAYS MAXI MAXIMUM PROTECTION......................................... 8alyacen 1/35 ............................................. 8

alyacen 7/7/7 ............................................ 8amantadine hcl ......................................... 8ambi 12.5cpd/100gfn/30pse ......................8ambi 12.5cpd/1dcpm/30pse ...................... 8ambi 40pse/400gfn ................................... 8ambi 60pse/400gfn ................................... 8ambi 60pse/4cpm ......................................8AMBI FADE............................................ 8amcinonide ............................................... 8AMERICERIN......................................... 8AMERIWASH......................................... 8AMETHIA................................................8AMETHIA LO......................................... 8AMETHYST............................................ 8AMICAR.................................................. 8amiloride hcl .............................................8amiloride-hydrochlorothiazide .................8aminoacetic acid .......................................8AMINOPMRMS...................................... 8AMINORELIEF RMS............................. 8aminosalicylic acid-5 ............................... 8amiodarone hcl .........................................8AMITIZA................................................. 8amitriptyline hcl ....................................... 8amlodipine besy-benazepril hcl ................9amlodipine besylate ..................................9amlodipine besylate-valsartan ................. 9amlodipine-atorvastatin ........................... 9amlodipine-valsartan-hctz ........................9ammonia aromatic ....................................9ammonium carbonate ............................... 9ammonium chloride ..................................9ammonium hydroxide ............................... 9ammonium lactate .................................... 9amoxicillin ................................................ 9amoxicillin-pot clavulanate ......................9amphetamine-dextroamphetamine ........... 9ampicillin ..................................................9ANA-LEX................................................ 9ANASEPT................................................ 9ANASEPT ANTIMICROBIAL............... 9anastrozole ............................................... 9ANBESOL................................................9ANBESOL MAXIMUM STRENGTH.... 9ANDROGEL............................................ 9ANDROGEL PUMP................................ 9ANECREAM............................................9animal chews ............................................ 9anise ..........................................................9ANORO ELLIPTA...................................9antacid .................................................... 10antacid anti-gas ......................................10antacid anti-gas max strength ................ 10antacid extra strength .............................10antacid multi-symptom ........................... 10antacid soft chews .................................. 10ANTARA............................................... 10anthelios 50 mineral ...............................10anti-allergy ............................................. 10antibacterial liquid soap ........................ 10anti-diarrheal ......................................... 10antifungal ................................................10anti-itch .................................................. 10

ANTI-ITCH INTENSIVE HEALING... 10anti-oxidant ............................................ 10antioxidant formula sg ............................10antiseptic ................................................ 10ANTISEPTIC HAND RINSE................ 10antiseptic skin cleanser .......................... 10ANUSOL-HC.........................................10AO-SEPT CONTACT LENS HOLDER................................................10APETIGEN............................................ 10APETIGEN-PLUS................................. 10ap-hist dm ............................................... 10APLIGRAF............................................ 10apothesar ................................................ 10apraclonidine hcl ....................................10aprepitant ............................................... 10APRI.......................................................10APRISO..................................................10APTIVUS............................................... 10AQUA CARE.........................................10aquabase .................................................10AQUADEKS.......................................... 10AQUAFRESH DR SEUSS EXTRA SOFT...................................................... 10aquanaz .................................................. 11AQUAPHILIC........................................11AQUAPHILIC/CARBAMIDE.............. 11AQUASONIC 100................................. 11AQUEOUS SELENIUM........................11aqueous vitamin e ...................................11AQUORAL............................................ 11ARANELLE...........................................11ARANESP (ALBUMIN FREE).............11ARCALYST...........................................11ARCAPTA NEOHALER.......................11arctic relief pain relieving ......................11ARGIMENT AT.....................................11arginine .................................................. 12arginine2000 .......................................... 12ARGYLE STERILE SALINE................12ARGYLE STERILE WATER................12aripiprazole ............................................ 12ARISTADA............................................12ARISTADA INITIO...............................12arkaliox ...................................................12ARLASILK PHOSPHOLIPID PLN...... 12ARMOUR THYROID........................... 12arnica ......................................................12arnicare arthritis .................................... 12ARRANON............................................ 12arthritis pain relieving ............................12artificial tears ......................................... 12ARZERRA............................................. 12ARZOL SILVER NIT APPLICATORS..................................... 12asafetida ................................................. 12ascocid-iso-ph ........................................ 12ASCOMP-CODEINE.............................12ascorbic acid .......................................... 12ascorbyl palmitate .................................. 12ASCRIPTIN........................................... 12asepto oral thermometer ........................ 12ASILNASAL RMS................................ 12

160

ASMANEX 120 METERED DOSES....12ASMANEX 30 METERED DOSES......12aspartame ............................................... 12aspartate mg & k .................................... 12ASPERCREME W/LIDOCAINE.......... 12aspir-81 .................................................. 13aspirin .....................................................13aspirin-dipyridamole er ..........................13aspirtab maximum strength .................... 13ASSURE ID INSULIN SAFETY SYR..13ASSURE LANCETS..............................13ASTHMAPACK FOR CHILDREN...... 13atazanavir sulfate ................................... 13atenolol ...................................................13atenolol-chlorthalidone .......................... 13athletes foot maximum strength ..............13atomoxetine hcl .......................................13ATOPICLAIR........................................ 13atorvastatin calcium ............................... 13atovaquone ............................................. 13atovaquone-proguanil hcl ...................... 13ATRAC-TAIN........................................13ATRIPLA............................................... 13ATROVENT HFA................................. 13atuss da ...................................................13AUBRA.................................................. 13auraphene-b ............................................13aurora lancet super thin 30g .................. 13aurora lancet thin 23g ............................13AUTOJECT 2.........................................13AUTOLET PLATFORMS..................... 13autopen ................................................... 13avalin ...................................................... 13AVAR CLEANSER............................... 13AVAR-E EMOLLIENT......................... 13AVASTIN.............................................. 13AVEENO BABY GENTLE CONDITION..........................................14AVEENO BABY SOOTHING WASH. 14AVEENO INTENSE RELIEF............... 14AVEENO POSITIVELY RADIANT WASH.................................................... 14AVENOVA/NEUTROX........................ 14AVERTEAX.......................................... 14AVITENE...............................................14AVITENE FLOUR.................................14AVO CREAM........................................ 14AVONEX............................................... 14AVONEX PEN.......................................14AVONEX PREFILLED......................... 14av-phos 250 neutral ................................14axillary block needle .............................. 14AXSAIN.................................................14AYR SALINE NASAL.......................... 14AYR SALINE NASAL DROPS............ 14AYR SALINE NASAL GEL................. 14AYR SALINE NASAL NO-DRIP.........14AYR SALINE NASAL RINSE............. 14azacitidine .............................................. 14AZASAN................................................14azathioprine ............................................14azec .........................................................14azelaic acid .............................................14

azelastine hcl .......................................... 14azithromycin ........................................... 14AZOPT................................................... 14AZURETTE........................................... 14b complete ...............................................14b complex ................................................14b complex formula 1 ............................... 14b complex-folic acid ............................... 14b-1 ...........................................................14b-100 cr .................................................. 15b-12 .........................................................15b-12 tr ..................................................... 15b-2 ...........................................................15B-2-400...................................................15b-6 ...........................................................15BABY ANBESOL................................. 15baby lotion ..............................................15baby super daily d3 ................................ 15baby teething pain medicine ...................15baby thermometer ...................................15baciim ..................................................... 15bacitracin ................................................15bacitracin zinc ........................................ 15bacitra-neomycin-polymyxin-hc .............15back pain-off ...........................................15baclofen .................................................. 15BACTROBAN NASAL......................... 15balamine dm ........................................... 15balanced b-50 ......................................... 15balanced b-50 complex ...........................15BAL-CARE DHA.................................. 15BALNEOL............................................. 15balsalazide disodium .............................. 15BALZIVA.............................................. 15BAND-AID SURGIPAD SURGICAL.. 15BANOPHEN.......................................... 15BANZEL................................................ 15BARACLUDE........................................15BASAGLAR KWIKPEN....................... 15base g almond oil (sweet) .......................15basic fuchsin hcl ..................................... 15BAYER BACK & BODY......................15BAYER BREEZE 2 CONTROL........... 15BAYER BREEZE 2 SYSTEM...............15BAYER BREEZE 2 TEST.....................16BAYER CONTOUR.............................. 16BAYER CONTOUR LINK MONITOR............................................. 16BAYER CONTOUR MONITOR.......... 16BAYER CONTOUR TEST....................16BAYER MICROLET LANCETS.......... 16BAYER WOMENS................................16BAZA CLEANSE & PROTECT........... 16BC FAST PAIN RELIEF....................... 16BC FAST PAIN RELIEF ARTHRITIS. 16b-caro-t ...................................................16b-complex high potency ..........................16BD ALLERGY SYRINGE.................... 16BD AUTOSHIELD................................ 16BD AUTOSHIELD DUO...................... 16BD BLUNT FILTER NEEDLE............. 16BD DISP NEEDLE................................ 16BD DISP NEEDLE TW......................... 16

BD DISP NEEDLES.............................. 16BD ECLIPSE NEEDLE......................... 16BD ECLIPSE SYRINGE....................... 16BD HYPODERMIC NEEDLE.............. 16BD INSULIN SYR ULTRAFINE II ......16BD INSULIN SYRINGE................. 16, 17BD INSULIN SYRINGE HALF-UNIT.17BD INSULIN SYRINGE MICROFINE.......................................... 17BD INSULIN SYRINGE U/F................17BD INSULIN SYRINGE U/F 1/2UNIT 17BD INSULIN SYRINGE U-500............17BD INSULIN SYRINGE ULTRAFINE..........................................17BD LANCET ULTRAFINE 30G...........17BD LANCET ULTRAFINE 33G...........17BD LUER-LOK SYRINGE................... 18BD PEN NEEDLE ORIGINAL U/F......18BD SAFETYGLIDE INSULIN SYRINGE...............................................18BD SAFETYGLIDE NEEDLE..............18BD SAFETYGLIDE SYRINGE/NEEDLE.............................. 18BD SAFETY-LOK INSULIN SYRINGE...............................................18BD SHARPS COLLECTOR..................18BD SWAB SINGLE USE REGULAR.. 18BD SWABS SINGLE USE BUTTERFLY.........................................18BD SYRINGE/NEEDLE SLIP TIP....... 18BD TB SYRINGE.................................. 18BD VEO INSULIN SYRINGE U/F.......18BEBULIN...............................................18bec/zinc ...................................................18bee pollen ............................................... 18BEELITH............................................... 18BELBUCA............................................. 18belladonna alkaloids-opium ................... 18belladonna-opium ...................................18BENADRYL ALLERGY.......................18BENADRYL ALLERGY CHILDRENS..........................................18BENADRYL ITCH RELIEF................. 19BENADRYL ITCH STOPPING............19BENADRYL-D ALLERGY/SINUS CHILD....................................................19benazepril hcl ......................................... 19benazepril-hydrochlorothiazide ............. 19BENEFIBER.......................................... 19BENEFIBER FOR CHILDREN............ 19BENEFIBER ON THE GO....................19BENEFIBER PLUS B VITS & FA........19BENEFIBER PLUS CALCIUM............ 19BENEFIBER PLUS HEART HEALTH................................................ 19benfotiamine multi-b ...............................19bentonite ................................................. 19benzaldehyde .......................................... 19benzalkonium chloride ........................... 19BENZEDREX........................................ 19BENZEPRO........................................... 19BENZEPRO CREAMY WASH............ 19BENZEPRO SHORT CONTACT......... 19

161

benzocaine .............................................. 19BENZODENT........................................ 19benzoic acid ............................................19benzoin ....................................................19benzonatate .............................................19BENZ-O-STHETIC................................19benzoyl peroxide .....................................19benzoyl peroxide cleanser ...................... 19benzoyl peroxide wash ............................19benzoyl peroxide-erythromycin .............. 19benzphetamine hcl .................................. 19benztropine mesylate .............................. 19benzyl alcohol .........................................19benzyl benzoate .......................................19bergamot oil ........................................... 19BERINERT............................................ 19BERRI-FREEZ PAIN RELIEVING 19, 20BERRI-FREEZ PLUS............................20beta carotene provitamin a .....................20BETADINE............................................ 20BETADINE SURGICAL SCRUB.........20BETADINE SWABSTICKS..................20betaine anhydrous .................................. 20betaine hcl .............................................. 20betamethasone dipropionate .................. 20betamethasone dipropionate aug ........... 20betamethasone valerate ..........................20BETAQUIK............................................20BETASERON........................................ 20betaxolol hcl ........................................... 20bethanechol chloride .............................. 20BETHKIS............................................... 20BEVESPI AEROSPHERE..................... 20bexarotene .............................................. 20BIATAIN HEEL ADH FOAM DRESSING............................................ 20BIATAIN SACRAL FOAM DRESSING............................................ 20bicalutamide ........................................... 20BICARSIM.............................................20BICARSIM FORTE............................... 20BICNU....................................................20BIKTARVY........................................... 20biobron sf ................................................20biocotron ................................................ 20biodesp dm ..............................................20bioflavonoid citrus ..................................20BIO-FLAX............................................. 20BIOFLONEX......................................... 20BIOFREEZE.......................................... 20BIOFREEZE ROLL-ON COLORLESS......................................... 21BIOGAIA GASTRUS............................21biogtuss ...................................................21BIOGUARD NON-ADHERENT DRESSING............................................ 21BIOLLE GEL TEARS........................... 21bionatuss dxp ..........................................21BIOPATCH PROTECTIVE DISK/CHG............................................. 21BIORX SPONIX ANTI-FUNGAL........ 21BIORX SPONIX ARTHR & MUSC..... 21biospec dmx ............................................ 21

biotalan clear ......................................... 21BIO-THERM PAIN RELIEVING......... 21biotin .......................................................21biotin forte .............................................. 21biotin plus keratin ...................................21biotin-d ................................................... 21biotuss .....................................................21biovol ...................................................... 21bisacodyl ec ............................................ 21bismatrol .................................................21bismatrol maximum strength .................. 21bismuth citrate ........................................21bismuth subcarbonate .............................21bismuth subgallate ..................................21bismuth subnitrate .................................. 21bismuth subsalicylate ............................. 21bisoprolol fumarate ................................ 21bisoprolol-hydrochlorothiazide ..............21bite/itch ...................................................21BI-ZETS/BENZOTROCHES................ 21bladder 2.2 ..............................................21bleomycin sulfate ....................................21BLINK TEARS...................................... 21BLISOVI 24 FE......................................21BLISOVI FE 1.5/30............................... 21BLISOVI FE 1/20.................................. 21blood pressure monitor/wrist ................. 22BOIL EASE MAXIMUM STRENGTH........................................... 22BONE DENSITY................................... 22BOOST PUDDING................................22BOOSTRIX............................................ 22borage .....................................................22borax .......................................................22boric acid ................................................22boron ...................................................... 22BOTOX.................................................. 22BOUDREAUXS BABY KISSES.......... 22BOUDREAUXS BUTT PASTE............ 22BOUDREAUXS RASH PREVENTOR 22bp 10-1 ....................................................22bp cleansing wash .................................. 22bp wash ...................................................22BPROTECTED MULTI-VITE.............. 22BPROTECTED PEDIA IRON...............22BPROTECTED PEDIA POLY-VITE....22BRAINSTRONG PRENATAL..............22BRASIVOL............................................ 22BRAUN NO TOUCH + FOREHEAD...22BREVIBLOC IN NACL........................ 22brewers yeast ..........................................22BRIJ 30...................................................22BRILINTA............................................. 22brilliant green .........................................22brimonidine tartrate ............................... 22BRIVIACT............................................. 22brohist d ..................................................22bromelain ................................................22bromi-lotion ............................................22bromocriptine mesylate .......................... 22bronchial asthma relief .......................... 22BRONKAID...........................................23bronkids .................................................. 23

brontuss dx ............................................. 23brotapp dm ............................................. 23BROVANA............................................ 23btrex ........................................................23BUCKLEYS CHEST CONGESTION...23BUCKLEYS COUGH............................23budesonide ..............................................23BUFFERIN.............................................23BUFFERIN EXTRA STRENGTH........ 23BUFFERIN LOW DOSE....................... 23BULL FROG WATER ARMOR SPORT....................................................23bumetanide ............................................. 23BUPHENYL...........................................23buprenorphine ........................................ 23buprenorphine hcl .................................. 23bupropion hcl ......................................... 23bupropion hcl er (smoking det) .............. 23bupropion hcl er (sr) .............................. 23bupropion hcl er (xl) ...............................23burn relief/lidocaine/aloe ....................... 23buspirone hcl .......................................... 23busulfan .................................................. 23butalbital-acetaminophen .......................23butalbital-apap-caff-cod .........................23butalbital-apap-caffeine ......................... 23butalbital-aspirin-caffeine ......................23butorphanol tartrate ............................... 23BUTRANS............................................. 23butylated hydroxytoluene ....................... 24butylparaben ...........................................24BYDUREON..........................................24BYETTA 10 MCG PEN.........................24BYETTA 5 MCG PEN...........................24c-1500/rose hips sr ................................. 24c1500/rose hips/bioflavonoid ................. 24ca phosphate dibasic dihyd .................... 24cabergoline .............................................24cadeau dha ............................................. 24caffeine anhydrous ................................. 24caffeine citrate ........................................24cal/mag ................................................... 24CALADRYL.......................................... 24CALADRYL CLEAR............................ 24CALAGEL MAXIMUM STRENGTH..24CALAGESIC..........................................24calahist clear .......................................... 24calamine ................................................. 24calamine phenolated ...............................24calamine-zinc oxide ................................24CAL-CARB FORTE.............................. 24CALCET PETITES................................24CALCI-CHEW.......................................24calci-max ................................................ 24calcipotriene ...........................................24calcitonin (salmon) .................................24CALCITRATE....................................... 24cal-citrate ............................................... 24calcitriol ................................................. 24calcium ................................................... 25calcium + d3 ...........................................24calcium 1200 .......................................... 24calcium 500 + d3 ....................................24

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calcium 600 ............................................ 24calcium 600 + d ......................................24calcium 600+d3 ......................................24calcium 600+d3 plus minerals ...............25calcium acetate .......................................25calcium acetate (phos binder) ................ 25calcium ascorbate ...................................25calcium aspartate ................................... 25calcium carbonate .................................. 25calcium carbonate antacid ..................... 25calcium carbonate-vitamin d ..................25calcium citrate ........................................25calcium citrate + d3 ............................... 25calcium citrate malate-vit d ....................25calcium citrate plus ................................ 25calcium citrate tetrahydrate ................... 25calcium citrate-vitamin d ........................25calcium citrate-vitamin d3 ......................25calcium gluconate ...................................25calcium gummies .................................... 25calcium high potency/vitamin d ..............25calcium hydroxide .................................. 25calcium lactate ....................................... 25calcium oyster shell ................................ 25calcium pantothenate ............................. 25calcium phosphate tribasic .....................25calcium plus vitamin d3 ..........................25calcium saccharate .................................25calcium soft chews ..................................25calcium sulfate ........................................25calcium-magnesium-zinc ........................ 25calcium-vitamin d ................................... 25calcium-vitamin d3 ................................. 25calcium-vitamin d-minerals ....................25calendula ................................................ 26cal-glu .....................................................26cal-lac .....................................................26calmag thins ........................................... 26cal-mint ...................................................26CALMOL-4............................................26calna ....................................................... 26CALTRATE 600+D...............................26CALTRATE 600+D PLUS MINERALS............................................26CALTRATE 600+D3 SOFT.................. 26CALTRATE GUMMY BITES.............. 26CALTRATE MINIS PLUS MINERALS............................................26CAMILA................................................ 26CAMPHO-PHENIQUE..........................26camphor ..................................................26camphor blocks .......................................26camphor spirit ........................................ 26CAMPHOTREX.................................... 26CAMPTOSAR........................................26CANASA................................................26candesartan cilexetil ...............................26candesartan cilexetil-hctz .......................26CANKAID..............................................26capcof ..................................................... 26capecitabine ............................................26capmist dm ..............................................26capron dm ...............................................26

capron dmt ..............................................26capsaicin .................................................26capsaicin hot patch .................................26CAPSIDERM......................................... 26capsule 1 clear veggie ............................ 26captopril ................................................. 26CAPZASIN-HP...................................... 26CARAFATE...........................................27caraway oil ............................................. 27CARBAGLU.......................................... 27carbamazepine ........................................27carbamazepine er ................................... 27CARBAPHEN CH................................. 27CARBAPHEN PED CH.........................27carbidopa-levodopa ................................27carbidopa-levodopa er ........................... 27carbidopa-levodopa-entacapone ............27CARBOHOL 940................................... 27carbopol 940 nf ...................................... 27carboxymethylcellulose sodium ..............27CARBZERO...........................................27cardamom ...............................................27CARDENZ............................................. 27CAREFINE PEN NEEDLES................. 27careone insulin syringe .......................... 27careone lancet thin 23g .......................... 27careone lancet ultra thin 28g ................. 27CA-REZZ............................................... 27ca-rezz gentle ..........................................27ca-rezz norisc ......................................... 27CARNI Q-GEL FORTE.........................27CARRACOLLOID 4"X4"..................... 27CARRASMART.................................... 27CARRASORB H....................................27CARRASYN V WOUND DRESSING. 28CARRINGTON DERMAL WOUND....28carteolol hcl ............................................28CARTIA XT...........................................28carvedilol ................................................28cascara sagrada ..................................... 28castellani paint modified ........................ 28CASTIVA COOLING............................28CASTIVA WARMING..........................28castor oil .................................................28castor oil stimulant laxative ................... 28castor oil sulfated ................................... 28CATAPRES-TTS-1................................28CATAPRES-TTS-2................................28CATAPRES-TTS-3................................28CAVAREST...........................................28CAVILON EMOLLIENT...................... 28CAVILON FOOT & DRY SKIN...........28CAVILON NO STING BARRIER FILM...................................................... 28CAVILON ONE-STEP SKIN CARE.... 28CAVILON SKIN CLEANSER.............. 28CAZIANT.............................................. 28cefaclor ...................................................28cefadroxil ................................................28cefdinir ....................................................28cefixime ...................................................28cefpodoxime proxetil .............................. 28cefprozil .................................................. 28

ceftriaxone sodium ................................. 29ceftriaxone sodium in dextrose ...............28ceftriaxone sodium-dextrose ...................29cefuroxime axetil .................................... 29CELACYN............................................. 29celecoxib .................................................29celery seed .............................................. 29cellulase ..................................................29cellulose ..................................................29CELONTIN............................................ 29CENTRATEX........................................ 29centravites adults ....................................29CENTRUM............................................ 29CENTRUM FLAVOR BURST DRINK................................................... 29CENTRUM SPECIALIST PRENATAL........................................... 29CEO-TWO..............................................29CEPACOL EXTRA STRENGTH..........29CEPACOL SORE THROAT................. 29CEPACOL SORE THROAT & COUGH..................................................29CEPACOL SORE THROAT EX ST..... 29CEPASTAT............................................29cephalexin ...............................................29CERACADE.......................................... 29CERALYTE 70...................................... 29CERAVE BABY....................................29CERAVE ITCH RELIEF....................... 29CERAVE SUNSCREEN SPF50............ 29CEROVEL..............................................29cesium .....................................................29CESIUM 1000........................................29cesium 500 ..............................................29CETAPHIL GENTLE CLEANSING.... 29cetirizine hcl ........................................... 29CETRAXAL...........................................29cetyl alcohol ........................................... 29CHANTIX.............................................. 30CHANTIX CONTINUING MONTH PAK........................................................ 30CHANTIX STARTING MONTH PAK.30CHAP-EX TROPICALS........................30charcoal activated .................................. 30CHAR-FLO WITH SORBITOL............ 30chelated calcium .....................................30chelated magnesium ............................... 30chelated zinc ........................................... 30CHEMSTRIP CALIBRATION............. 30CHEMSTRIP UGK................................30CHENODAL.......................................... 30CHERACOL-D COUGH....................... 30cherry ......................................................30cherry concentrate ..................................30chest rub ................................................. 30CHEW Q................................................ 30chewable iron ......................................... 30CHIGG AWAY......................................30childrens aspirin free ..............................30CHILDRENS MOTRIN.........................30childrens pain reliever ............................30childrens plus multi-sympt cld ................30childrens silfedrine ................................. 30

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CHILDRENS SOOTHE.........................30chlo hist .................................................. 30CHLO TUSS.......................................... 30chlophed ................................................. 30chloral hydrate ....................................... 30CHLORASEPTIC.................................. 30chlordiazepoxide hcl ...............................30chlorella ..................................................30chlorhexidine gluconate ......................... 30chlorhexidine gluconate cloth ................ 30chloroform .............................................. 30chlorophyll ..............................................30chloroquine phosphate ........................... 31chlorothiazide .........................................31CHLORPHEN SR.................................. 31chlorpromazine hcl .................................31chlorthalidone ........................................ 31CHLOR-TRIMETON............................ 31CHLOR-TRIMETON ALLERGY.........31chlorzoxazone .........................................31chocolated laxative .................................31cholecalciferol ........................................ 31cholesterol .............................................. 31cholesterol acetate ..................................31cholestyramine ........................................31cholestyramine light ............................... 31choline .................................................... 31choline citrate .........................................31choline sr ................................................ 31choline-mag trisalicylate ........................31CHONDROITIN SULFATE COMPLEX.............................................31CHROMACAPS.................................... 31chromium ................................................31chromium aspartate ................................31chromium gtf ...........................................31chromium picolate ..................................31chromium picolinate ...............................31chrysin .................................................... 31CICLODAN........................................... 31ciclopirox ................................................31ciclopirox olamine ..................................31ciclopirox treatment ............................... 31cilostazol .................................................31cimetidine ............................................... 31cinnamon ................................................ 32cinnamon oil ........................................... 32CINRYZE...............................................32CIPRODEX............................................ 32ciprofloxacin ...........................................32ciprofloxacin hcl .....................................32cisplatin .................................................. 32citalopram hydrobromide .......................32CITRA PH..............................................32CITRANATAL 90 DHA........................32CITRANATAL ASSURE...................... 32CITRANATAL B-CALM......................32CITRANATAL DHA.............................32CITRANATAL HARMONY.................32CITRANATAL RX................................32citric acid anhydrous ..............................32citric acid monohydrate ..........................32citronella oil ........................................... 32

CITRUCEL............................................ 32CITRULLINE 1000............................... 32CITRULLINE200.................................. 32cladribine ................................................32clarithromycin ........................................ 32clarithromycin er ....................................32CLARITIN............................................. 32CLARITIN CHILDRENS......................32CLARITIN REDITABS.........................32CLARITIN-D 12 HOUR........................32CLARITIN-D 24 HOUR........................33classic prenatal .......................................33CLEAN & CLEAR ACNE CLEANSER........................................... 33CLEAN & CLEAR ADVANTAGE MARK.................................................... 33CLEAN SIGHTS....................................33CLEAN ZING........................................ 33CLEANLET LANCETS 28G................ 33CLEAR EYES REDNESS RELIEF.......33clear zinc spf 50 ......................................33CLEARASIL DAILY CLEAR ACNE...33CLEARCANAL EAR WAX REMOVAL............................................ 33CLEARLAX...........................................33CLEARLIFE ALLERGY RELIEF........ 33clemastine fumarate ............................... 33CLEOCIN...............................................33CLERZ PLUS.........................................33CLEVER CHOICE BP MONITOR/WRIST................................33CLINDACIN ETZ..................................33clindamycin hcl .......................................33clindamycin palmitate hcl ...................... 33clindamycin phos-benzoyl perox ............ 33clindamycin phosphate ........................... 33CLINDESSE.......................................... 33clioquinol ................................................33clobetasol propionate ............................. 33clobetasol propionate e .......................... 33clobetasol propionate emulsion ..............33clofarabine ..............................................33clomipramine hcl ....................................33clonazepam .............................................34clonidine hcl ........................................... 34clonidine hcl (analgesia) ........................ 34clopidogrel bisulfate ...............................34clorazepate dipotassium ......................... 34CLORPACTIN.......................................34clotrimazole ............................................ 34clotrimazole 3 ......................................... 34clotrimazole anti-fungal ......................... 34clotrimazole-betamethasone ...................34clove oil .................................................. 34clozapine .................................................34co q-10 ....................................................34COAGUCHEK XS PLUS SYSTEM..... 34COAGUCHEK XS PT TEST.................34coal tar ................................................... 34COARTEM............................................ 34COATS ALOE....................................... 34COATS ALOE JUICE DRINK..............34COATS ALOE LINIMENT...................34

cocoa butter ............................................34cocoa butter skin .................................... 34cod liver oil .............................................34codeine sulfate ........................................34coditussin ac ........................................... 34coditussin dac ......................................... 34coenzyme q10 ......................................... 34coenzyme q-10 ........................................ 34co-enzyme q10-vitamin e ........................ 35cola syrup ............................................... 35COLACE................................................ 35colchicine ................................................35colchicine-probenecid ............................ 35cold & cough childrens .......................... 35cold & cough day/night child ................. 35cold remedy ............................................ 35cold sore treatment .................................35cold therapy pain relief .......................... 35COLD-EEZE.......................................... 35colestipol hcl ...........................................35COLLASIL OSA....................................35collodion .................................................35collodion flexible .................................... 35COLOCORT.......................................... 35COMBIGAN.......................................... 35COMBIVENT RESPIMAT................... 35COMFORT ASSIST INSULIN SYRINGE...............................................35comfort assured lancets 28g ...................35comfort assured lancets 33g ...................35COMFORT CLEAN/COMFORT SHIELD..................................................35COMFORT EZ PEN NEEDLES........... 35COMPAT STAY-PUT NJ DOUBLE LUME.....................................................35COMPLERA.......................................... 35complete lice treatment .......................... 36complete natal dha ................................. 36completenate ...........................................36COMPOUND W MAXIMUM STRENGTH........................................... 36COMPOUND W ONE STEP INVISIBLE............................................ 36compoz ....................................................36COMTREX COLD & COUGH MAX ST........................................................... 36COMTREX COLD/COUGH DAY/NITE MS...................................... 36COMTREX DEEP CHEST COLD........36CO-NATAL FA..................................... 36CONCEPT DHA.................................... 36CONCEPT OB....................................... 36CONCEPTIONXR MOTILITY SUPPORT.............................................. 36CONCERTA.......................................... 36condoms ..................................................36constulose ............................................... 36CONTAC COLD+FLU MAX ST..........36CONTOUR NEXT CONTROL............. 36CONTOUR NEXT EZ........................... 36CONTOUR NEXT LINK...................... 36CONTOUR NEXT MONITOR............. 36CONTOUR NEXT ONE........................36

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CONTOUR NEXT TEST...................... 36control denture adhesive ........................ 36control syringe disposable ......................36convex eye protector ...............................36cool n heat ex st ...................................... 36cool n heat maximum strength ................36COPAXONE.......................................... 36copper sulfate ......................................... 36COPPERMIN......................................... 36co-q 10 omega-3 fish oil .........................36coq10 ...................................................... 36coq-10 .....................................................36coral calcium ..........................................37CORICIDIN HBP COLD/FLU.............. 37CORICIDIN HBP COUGH/COLD....... 37CORICIDIN HBP DAY/NIGHT COLD..................................................... 37CORICIDIN HBP NIGHTTIME COLD..................................................... 37CORIFACT............................................ 37corn oil ................................................... 37CORN REMOVER WATERPROOF.... 37corn starch ..............................................37corn/callus remover ................................37CORRECTOL EXTRA GENTLE......... 37CORTIFOAM........................................ 37cortisone acetate .....................................37CORTIZONE-10/ALOE........................ 37CORVITA 150....................................... 37COSAMIN ASU FOR JOINT HEALTH................................................ 37COSAMIN VERDE FOR JOINT HEALTH................................................ 37cottonseed oil ..........................................37COTTONTAILS DIAPER RASH CREAMY...............................................37cough & chest congestion dm .................37cough & cold .......................................... 37cough drops ............................................ 37cough relief .............................................37coughtab ................................................. 37cramp tabs .............................................. 37cranberry ................................................ 37cream base with liposome ...................... 37creatine ...................................................37creatine monohydrate .............................37creatine5000 ...........................................37CREON.................................................. 37CR-GTF..................................................37CRITIC-AID CLEAR AF...................... 37CRIXIVAN............................................ 37cromolyn sodium .................................... 38CROTAN................................................38croton oil ................................................ 38CR-PLUS................................................38CRYOSERV...........................................38CRYSELLE-28...................................... 38cu-25 .......................................................38cu-5 .........................................................38CULTURELLE GENTLE-GO KIDS.... 38CULTURELLE KIDS............................38cupric sulfate .......................................... 38CURAD GERM SHIELD...................... 38

CURAFIL WOUND DRESSING.......... 38CURASOL WOUND DRESSING........ 38CURITY ALCOHOL PREPS................ 38CURITY ALCOHOL SWABS.............. 38CURITY GAUZE SPONGE.................. 38CURITY MESH GAUZE BNDG 4"X30' .....................................................38CURITY NURSING.............................. 38CURX ANTIMICROBIAL....................38CUTINOVA HYDRO 2"X2-3/8".......... 38cvs adhesive gauze ..................................38cvs aftersun aloe/lidocaine .....................38CVS AIRSHIELD.................................. 38cvs alcohol prep pads ............................. 38cvs allergy relief childrens ..................... 38cvs allergy relief d .................................. 38cvs all-purpose skin protect ....................38cvs antacid childrens .............................. 38cvs anti-diarrheal ................................... 38cvs anti-itch sensitive ..............................38cvs astringent solution ............................38cvs b complex plus c ............................... 38cvs baby safety swabs ............................. 38cvs backache relief ................................. 38cvs calcium ............................................. 38cvs calcium 600 plus ...............................38cvs cherry menthol drops ....................... 38cvs chest rub medicated ..........................39cvs cleansing eyelid wipes ......................39cvs cleansing skin ................................... 39cvs cold remedy ...................................... 39cvs corn/callus remover ..........................39cvs creamy acne face wash .....................39cvs d3 ......................................................39cvs dairy relief ex st ................................39cvs daytime/nighttime cold/flu ................39cvs daytime/nighttime cough .................. 39cvs diabetes health support .................... 39cvs digestive probiotic ............................ 39cvs diuretic maximum strength ...............39cvs e oil ...................................................39cvs early result pregnancy ......................39cvs easy fiber/calcium ............................ 39cvs enema disposable ............................. 39cvs epsom salt .........................................39cvs ethyl alcohol ..................................... 39cvs eye .....................................................39cvs fiber gummies ................................... 39cvs gas relief ...........................................39cvs gas relief extra strength ....................39cvs gauze sterile ......................................39cvs gluco-chondroit plus uc-ii ................ 39cvs glucosamine-chondroitin ..................39cvs glucosamine-chondroit-msm ............ 39cvs glucose bits .......................................39cvs glucose shot ...................................... 39cvs glycerin adult ....................................39cvs hair regrowth for women ..................39cvs hand wash advanced antibac ........... 39cvs heartburn relief ex st ........................ 39cvs heatwraps/back/hip .......................... 39cvs hemorrhoidal ....................................39cvs hot steam .......................................... 39

cvs hydrocolloid pads .............................39cvs inner ear plus ................................... 39cvs instant food thickener ....................... 39cvs iron ................................................... 39cvs isopropyl alcohol wipes ....................39cvs itch relief .......................................... 40cvs lancets 21g ........................................40cvs lancets micro thin 33g ...................... 40cvs lancets original .................................40cvs lancets thin 26g ................................ 40cvs lancets ultra thin 30g ........................40cvs lancets ultra-thin 30g ....................... 40cvs laxative dietary supplemnt ............... 40cvs l-lysine .............................................. 40cvs lubricant drops ................................. 40cvs magnesium citrate ............................ 40cvs manuka honey wound ....................... 40cvs melatonin ..........................................40cvs melatonin extra strength ...................40cvs miconazole 1 combo pack ................ 40cvs miconazole 3 combo pack ................ 40cvs mineral oil ........................................ 40cvs mineral oil enema .............................40cvs mini enema kids ................................40cvs multi-purpose ................................... 40cvs nasal allergy spray ........................... 40cvs nasal decongestant ........................... 40cvs nasal mist ..........................................40cvs natural fiber supplement .................. 40cvs natural fish oil .................................. 40cvs nerve pain relief ............................... 40cvs non-drying sinus pe .......................... 40cvs omeprazole ....................................... 40cvs oral pain reliever ..............................40cvs pain relief ......................................... 40cvs pain relief regular st .........................40cvs phosphate saline laxative ................. 40cvs potassium gluconate .........................40cvs prenatal ............................................ 40cvs prenatal gummy ................................40cvs prep ...................................................40cvs protective ..........................................40cvs saline wound wash ........................... 40cvs selenium ............................................40cvs silver ................................................. 40cvs sinus relief day/night ........................ 41cvs skin relief .......................................... 41cvs sore muscle rub ................................ 41cvs sore throat max strength .................. 41cvs sore throat relief pops ...................... 41cvs steam inhaler .................................... 41cvs stool softener .................................... 41cvs stuffy nose & cold child ....................41cvs super cranberry urinary ................... 41cvs tension headache .............................. 41cvs therapeutic ........................................41cvs triacting cough/runny nose ...............41cvs triple magnesium complex ................41cvs ultra thin lancets ...............................41cvs vaporizer warm steam ...................... 41cvs wound wash advanced ......................41cvs yogurt+calcium gummies .................41cvs zinc oxide diaper .............................. 41

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cyanocobalamin ......................................41cyclobenzaprine hcl ................................41CYCLOMYDRIL...................................41cyclopentolate hcl ...................................41cyclophosphamide .................................. 41cyclosporine ............................................41cyclosporine modified .............................41cyproheptadine hcl ................................. 41CYSTADANE........................................41CYSTAGON.......................................... 41CYSTECH..............................................41cystine .....................................................41cytarabine (pf) ........................................ 41CYTO-Q MAX.......................................41d 1000 ..................................................... 41d 2000 ..................................................... 41dacarbazine ............................................ 41daily care skin protectant ....................... 41daily ovulation predictor ........................ 42daily vite multivitamin/iron .................... 42dairy relief .............................................. 42dakins ......................................................42dakins (1/2 strength) ...............................42dakins (1/4 strength) ...............................42DAKRINA..............................................42danazol ................................................... 42dandruff shampoo ...................................42dantrolene sodium .................................. 42dapsone ...................................................42DARAPRIM...........................................42daunorubicin hcl .....................................42day time multi-sympt cold/flu ................. 42DAYTIME COLD MEDICINE............. 42daytime cough .........................................42daytime severe cold & flu .......................42DAYTRANA..........................................42DDROPS................................................ 42DEBACTEROL......................................42DECARA................................................42decitabine ............................................... 42DECONEX DMX...................................42DECONEX IR........................................42dehydroepiandrosterone .........................42del clens ..................................................42DELBASE COMPOUNDING............... 42DELSYM COUGH CHILDRENS.........42DELTUSS DP........................................ 42DELZICOL............................................ 42demeclocycline hcl ................................. 42DEMEROL.............................................42DEMSER................................................42DENDRACIN NEURODENDRAXCIN........................42DENTAPAINE.......................................42DEPACON............................................. 42DEPEN TITRATABS............................ 42DEPO-PROVERA..................................43DEQUASINE......................................... 43DERMA CIDOL 2000........................... 43dermacloud .............................................43DERMAGESIC...................................... 43DERMAGRAN...................................... 43DERMAL THERAPY FINGER CARE.43

DERMAL WOUND CLEANSER......... 43DERMAMED.........................................43DERMAPLEX........................................43DERMAREST PSORIASIS...................43DERMASTAT........................................43DERMASYN..........................................43DERMAZENE....................................... 43DERMOPLAST..................................... 43DESCOVY............................................. 43DESENEX FOOT/SNEAKER SPRAY.43DESGEN DM.........................................43desipramine hcl ...................................... 43DESITIN MAXIMUM STRENGTH.....43desmopressin ace spray refrig ................43desmopressin acetate ..............................43desmopressin acetate spray ....................43desonide ..................................................43despec dm-g ............................................43desvenlafaxine succinate er ....................43DEVROM...............................................43DEWEES CARMINATIVE...................43dexamethasone ....................................... 43DEXAMETHASONE INTENSOL........43dexamethasone sodium phosphate ......... 44dexrazoxane ............................................44dextroamphetamine sulfate .....................44dextrose .................................................. 44dextrose anhydrous .................................44dhea ........................................................ 44DHS ZINC..............................................44DIAB DAILY CARE............................. 44DIABETIC BASICS HEALTHY FOOT......................................................44DIABETIC TUSSIN ALLERGY...........44DIABETIC TUSSIN COLD/FLU..........44DIABETIC TUSSIN NIGHT COLD/FLU............................................ 44DIABETISWEET...................................44diabet-x daily prevention ........................44DIADERM FOOT REJUVENATING...44DIALYVITE.......................................... 44DIALYVITE 800................................... 44DIALYVITE 800 PLUS D.....................44DIALYVITE 800/IRON.........................44DIALYVITE/ZINC................................ 44diaper rash ............................................. 44DIASTIX................................................ 44diazepam .................................................44DIAZEPAM INTENSOL.......................44dibucaine ................................................ 44diclofenac potassium .............................. 44diclofenac sodium ...................................44diclofenac sodium er .............................. 44dicloxacillin sodium ............................... 45dicyclomine hcl .......................................45DI-DAK-SOL.........................................45didanosine .............................................. 45dieters super tea ..................................... 45dietex forte ..............................................45diethylpropion hcl ...................................45diethylpropion hcl er .............................. 45DIFFERIN.............................................. 45diflunisal .................................................45

digestive enzyme ultra ............................ 45DIGITEK................................................45digoxin .................................................... 45DILANTIN.............................................45DILAUDID............................................ 45diltiazem cd .............................................45diltiazem hcl ........................................... 45diltiazem hcl er ....................................... 45diltiazem hcl er beads .............................45diltiazem hcl er coated beads ................. 45dilt-xr ...................................................... 45dimenhydrinate .......................................45DIMETAPP COLD/ALLERGY............ 45DIMETAPP DM COLD/COUGH......... 45DIMETAPP LONG ACT COUGH/COLD......................................45diphenhydramine hcl .............................. 45diphenhydramine hcl (sleep) .................. 45diphenoxylate-atropine ...........................45diphtheria-tetanus toxoids dt ..................46dipyridamole ...........................................46disulfiram ................................................46divalproex sodium .................................. 46divalproex sodium er .............................. 46dl-leucine ................................................ 46dl-pa-500 ................................................ 46DML....................................................... 46DOANS PILLS.......................................46DOANS PM EXTRA STRENGTH....... 46DOC OMEGA........................................46docetaxel .................................................46docusate sodium ..................................... 46DOCUSOL KIDS...................................46DOCUSOL PLUS MINI-ENEMA.........46dofetilide .................................................46DOLOGEN.............................................46dologesic-df ............................................ 46dolorex ....................................................46DOMEBORO......................................... 46dometuss-da/children ............................. 46donepezil hcl ...........................................46dorzolamide hcl ...................................... 46dorzolamide hcl-timolol mal .................. 46DOUBLE-TUSSIN DM......................... 46DOVER IRRIGATION TRAY.............. 46doxazosin mesylate ................................. 46doxepin hcl ............................................. 46doxorubicin hcl .................................46, 47doxycycline hyclate .................................47doxycycline monohydrate ....................... 47doxylamine succinate ............................. 47DR BOLDTS HINEY HEALER............47DR SMITHS DIAPER........................... 47DR SMITHS DIAPER RASH................47DR SMITHS RASH + SKIN................. 47DRAMAMINE.......................................47DRITHO-CREME HP............................47DRIXORAL COLD/ALLERGY............47DRIXORAL COUGH/SORE THROAT................................................47dronabinol .............................................. 47DROPLET LANCETS ULTRA THIN 30G......................................................... 47

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drospirenone-ethinyl estradiol ............... 47DROXIA................................................ 47drug mart lancets thin 26g ..................... 47DRUG MART UNILET LANCETS 28G......................................................... 47DRUG MART UNILET LANCETS 30G......................................................... 47dry skin treatment adv therapy ...............47drymax extra ...........................................47DRYSOL................................................ 47DULCOLAX.......................................... 47DULCOLAX MILK OF MAGNESIA...47DULERA................................................47duloxetine hcl ......................................... 47DURAFLEX COMFORT...................... 47DURAFLU............................................. 47DURAPROXIN......................................47DURAPROXIN ES................................ 47DURASAFE SPINAL/EPIDURAL....... 48DURATION SPRAY............................. 48DURAVENT DM...................................48DURAVENT PE.................................... 48DUREZOL............................................. 48dutasteride .............................................. 48dutasteride-tamsulosin hcl ..................... 48D-VI-SOL...............................................48d-xylose ...................................................48DY-O-DERM VITILIGO STAIN..........48E.E.S. GRANULES................................48ear wax cleansing ...................................48EASIVENT............................................ 48EASIVENT MASK LARGE..................48EASIVENT MASK MEDIUM.............. 48EASIVENT MASK SMALL................. 48easy fiber ................................................ 48EASY TOUCH ALCOHOL PREP MEDIUM............................................... 48EASY TOUCH ALLERGY SYRINGE.48EASY TOUCH FLIPLOCK INSULIN SY...........................................................48EASY TOUCH FLURINGE.................. 48EASY TOUCH INSULIN SAFETY SYR........................................................ 48EASY TOUCH INSULIN SYRINGE.......................................................... 48, 49EASY TOUCH LANCETS 26G............49EASY TOUCH LANCETS 26G/TWIST............................................49EASY TOUCH LANCETS 28G............49EASY TOUCH LANCETS 28G/TWIST............................................49EASY TOUCH LANCETS 30G............49EASY TOUCH LANCETS 30G/TWIST............................................49EASY TOUCH LANCETS 32G............49EASY TOUCH LANCETS 32G/TWIST............................................49EASY TOUCH LANCETS 33G/TWIST............................................49EASY TOUCH SHEATHLOCK SYRINGE...............................................49EASY TWIST & CAP LANCETS........ 49EASYGEL..............................................49

ecee plus ................................................. 49econazole nitrate .................................... 49ECOTRIN...............................................49ECOTRIN MAXIMUM STRENGTH... 49e-cream complex .....................................49ED A-HIST.............................................50ed a-hist dm ............................................ 50ed bron gp ...............................................50ED CHLORPED.....................................50ED CHLORPED D.................................50edetate disodium .....................................50ed-spaz ....................................................50EDURANT.............................................50efavirenz ................................................. 50EFFER-K................................................50effervescent pain relief ........................... 50effervescent pot chloride ........................ 50EGRIFTA............................................... 50ELDERTONIC.......................................50ELIDEL.................................................. 50ELIGARD.............................................. 50ELIQUIS................................................ 50elite ca/mg .............................................. 50elite calcium ........................................... 50ELITE ZINC...........................................50ELITEK.................................................. 50ELITE-OB.............................................. 50elite-thin insulin syringe .........................50ELIXOPHYLLIN...................................50ELIXSURE COUGH............................. 50ELIXSURE FEVER/PAIN.....................51ELLA......................................................51ELLURA................................................ 51ELMIRON..............................................51ELTA DERMAL....................................51EMCYT.................................................. 51EMETROL............................................. 51EMJOI TENS......................................... 51empty capsule size 1 clear ...................... 51EMTRIVA..............................................51EMULSION SB..................................... 51enalapril maleate ....................................51enalapril-hydrochlorothiazide ................51ENBREL................................................ 51ENBREL SURECLICK......................... 51ENDOXCIN........................................... 51ENDUR-ACIN....................................... 51ENEMEEZ MINI................................... 51ENFAMIL ENFALYTE.........................51ENFAMIL EXPECTA........................... 51ENGERIX-B.......................................... 51ENLITE GLUCOSE SENSOR.............. 51enoxaparin sodium ................................. 51ENPRESSE-28....................................... 51entecavir ................................................. 51ENTEX T............................................... 51ENTRESTO............................................51ENTSOL NASAL.................................. 51enulose ....................................................51e-oil .........................................................51epa/gla .................................................... 51ephedrine hcl .......................................... 51epidural needle ....................................... 51

epinastine hcl ..........................................51epinephrine .............................................52epinephrine pf .........................................52EPIPEN 2-PAK...................................... 52EPIPEN JR 2-PAK.................................52epirubicin hcl ..........................................52EPISORB................................................52EPITOL.................................................. 52EPIVIR HBV..........................................52eplerenone .............................................. 52eprosartan mesylate ............................... 52epsom salt ............................................... 52eq allergy relief ...................................... 52eq allergy relief childrens .......................52eq allergy/sinus headache ...................... 52eq aspirin ................................................52EQ BABY CHEST RUB........................52eq calcium citrate+d3 petites .................52eq cough sugar free ................................ 52eq cryogenic wart removal sys ............... 52eq daily fiber ...........................................52eq dairy digestive fast acting ..................52eq feminine wash sensitive ..................... 52eq ibuprofen pm ......................................52EQ MUCUS ER..................................... 52eq multi-symptom cold children ............. 52eq omeprazole .........................................52eq pain relief/rapid burst ........................52eq sinus relief max st .............................. 52eq tioconazole 1 ......................................52eql 2 in 1 probiotic ................................. 52eql advanced relief ................................. 52eql alcohol swabs ................................... 52eql aller-ease .......................................... 53eql allergy ...............................................53eql aloe vera after sun ............................ 53eql antacid ultra strength ....................... 53eql antibacterial hand soap ....................53eql anti-nausea ....................................... 53eql biotin .................................................53eql color lancets 21g .............................. 53eql color lancets micro 33g .................... 53eql congestion relief ............................... 53eql denture brush/pick ............................ 53eql denture cleanser ............................... 53eql digestive enzymes ..............................53eql ear drops ...........................................53eql effervescent cold relief ......................53eql ethyl alcohol (rubbing) ..................... 53eql everyday clean .................................. 53eql eye drops ac ......................................53eql fiber therapy ..................................... 53eql gas prevention .................................. 53eql gentle skin cleanser .......................... 53eql insulin syringe .................................. 53eql lutein ................................................. 53eql mouthwash/gargle ............................ 53eql mucus-dm ..........................................53eql multi-purpose ....................................53eql omega 3 fish oil ................................ 53eql omeprazole ....................................... 53eql one daily womens ............................. 53eql redness relief .................................... 53

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eql scalp relief max strength .................. 53eql super thin lancets 30g .......................53eql thin lancets 26g .................................53eql ultra protection spf50 ....................... 53eql vitamin d3 ......................................... 54eql wet cleansing towelettes ................... 54EQUALACTIN...................................... 54ERBITUX...............................................54ergocalciferol ......................................... 54ergoloid mesylates ..................................54ery ...........................................................54ERYPED 200......................................... 54ERY-TAB...............................................54ERYTHROCIN LACTOBIONATE...... 54ERYTHROCIN STEARATE.................54erythromycin ...........................................54erythromycin base .................................. 54erythromycin ethylsuccinate ...................54escavite lq ............................................... 54escitalopram oxalate .............................. 54esmolol hcl ..............................................54esomeprazole magnesium .......................54ESOTERICA FADE NIGHTTIME....... 54ESOTERICA SENSITIVE SKIN.......... 54ESTARYLLA.........................................54estazolam ................................................ 54estradiol ..................................................54estradiol valerate ....................................54estradiol-norethindrone acet ..................54estro support es ...................................... 54estropipate .............................................. 54eszopiclone ............................................. 55ethambutol hcl ........................................ 55ethosuximide ...........................................55ethoxy diglycol ........................................55ethyl alcohol ........................................... 55ethyl alcohol (rubbing) ...........................55ethyl chloride ..........................................55ethyl oleate ............................................. 55etidronate disodium ................................55etodolac .................................................. 55etodolac er ..............................................55ETOPOPHOS.........................................55etoposide .................................................55eucalyptol ............................................... 55eucalyptus oil ..........................................55EUCERIN...............................................55EUCERIN ECZEMA RELIEF...............55EUCERIN ORIGINAL HEALING........55EUFLEXXA...........................................55eugenol ................................................... 55EURAX.................................................. 55EVAC-U-GEN....................................... 55evening primrose oil ...............................55EXACTECH R-S-G TEST.....................55EXACTECH TEST................................ 55EXACTUSS TR..................................... 55EXAPHEN............................................. 55EXAPHEN CH.......................................55EXAPHEX TR....................................... 55EXCEDRIN PM..................................... 55EXCEDRIN TENSION HEADACHE...55EXCEL AP............................................. 55

EXCEL-GEL.......................................... 55EXEL COMFORT POINT INSULIN SYR.................................................. 55, 56EXELON................................................ 56exemestane ..............................................56EXFOLIX EXFOLIATING FOOT SOAP......................................................56EXJADE.................................................56EX-LAX................................................. 56EX-LAX MAXIMUM STRENGTH......56exoten-c pain relief .................................56exotic-hc ................................................. 56EXTRESS-30......................................... 56eye allergy relief .....................................56eye drops .................................................56eye itch relief .......................................... 56EYE STREAM....................................... 56E-Z JECT LANCET MICRO-THIN 33G......................................................... 56E-Z JECT LANCET SUPER THIN 30G......................................................... 56E-Z JECT LANCETS.............................56E-Z JECT LANCETS 21G.....................56E-Z JECT LANCETS THIN 26G.......... 56EZ SMART BLOOD GLUCOSE LANCETS.............................................. 56ezetimibe .................................................56ezetimibe-simvastatin ............................. 56EZFE 200............................................... 56E-Z-GAS II .............................................56EZ-LETS LANCETS 21G..................... 56EZ-LETS LANCETS 23G..................... 56EZ-LETS LANCETS 28G..................... 56fabb .........................................................57face mask respirator r-95 part ............... 57FAGRON VERSIFIX.............................57famciclovir ..............................................57famotidine ...............................................57FARESTON........................................... 57FARXIGA.............................................. 57FASLODEX........................................... 57FAST FREEZE PRO STYLE THERAPY..............................................57fast-heat heating pad .............................. 57father johns medicine ............................. 57FATTYBLEND......................................57fa-vitamin b-6-vitamin b-12 ....................57FAYOSIM.............................................. 57FC FEMALE CONDOM....................... 57fd&c blue #2 ........................................... 57fd&c red #40 aluminum lake .................. 57fd&c yellow #5 ........................................57fdc blue 1 ................................................ 57fdc green #3 ............................................ 57fdc red #3 ................................................57fdc yellow 6 .............................................57FEIBA.................................................... 57felbamate ................................................ 57felodipine er ............................................57FEM PH..................................................57FEMINEASE..........................................57fenofibrate .............................................. 57fenofibrate micronized ............................57

fenofibric acid .........................................57fenoprofen calcium ................................. 57fentanyl ................................................... 58fentanyl citrate ........................................57fentanyl citrate (pf) .................................57FER-IN-SOL.......................................... 58ferocon ....................................................58ferraplus 90 ............................................ 58ferretts .................................................... 58ferretts chewable iron .............................58ferretts ips ...............................................58ferrex 150 ............................................... 58FERREX 150 FORTE PLUS................. 58FERREX 28............................................58ferric subsulfate ......................................58FERRIMIN 150......................................58FERROCITE.......................................... 58FERROCITE PLUS............................... 58ferrous gluconate ....................................58ferrous sulfate .........................................58ferrous sulfate er .................................... 58FEVERALL INFANTS..........................58FEVERALL JUNIOR STRENGTH...... 58fexofenadine hcl childrens ......................58fiber ........................................................ 58fiber laxative ...........................................58FIBERCON............................................ 58FIBEREX F15........................................ 58FIFTY50 ALCOHOL PREP.................. 58FIFTY50 SUPERIOR COMFORT SYR........................................................ 58filter needle .............................................58finasteride ...............................................58FINE 30.................................................. 58FIRAZYR...............................................59first aid antibiotic ................................... 59first aid antiseptic spray ......................... 59fish oil ..................................................... 59fish oil + d3 ............................................ 59fish oil adult gummies .............................59fish oil-flax oil-borage oil .......................59flavor packets ......................................... 59flavoxate hcl ........................................... 59flecainide acetate ....................................59FLEET BISACODYL............................ 59FLEET LIQUID GLYCERIN SUPP..... 59FLEET NATURALS CLEANSING ENEMA..................................................59FLEET OIL............................................ 59FLEET PEDIATRIC.............................. 59FLEXICHAMBER.................................59FLEXICHAMBER CHILD MASK/LARGE...................................... 59FLINTSTONES TODDLER..................59FLOGEN................................................ 59FLONASE ALLERGY RELIEF............59FLONASE SENSIMIST........................ 59FLORA ASSIST.....................................59FLORANEX...........................................59FLORASTOR.........................................59FLORASTOR KIDS.............................. 59FLORICAL............................................ 59FLOVENT DISKUS.............................. 59

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FLOVENT HFA.....................................59flow-eze vented needle ............................59floxuridine .............................................. 59flu hbp .....................................................59FLUCAINE............................................ 59FLUCELVAX QUADRIVALENT........59fluconazole ........................................59, 60fludarabine phosphate ............................60fludrocortisone acetate ...........................60flunisolide ............................................... 60fluocinolone acetonide ........................... 60fluocinolone acetonide body ...................60fluocinolone acetonide scalp .................. 60fluocinonide ............................................ 60fluoride mouth rinse ............................... 60fluorometholone ......................................60fluorouracil .............................................60fluoxetine hcl .......................................... 60fluoxetine hcl (pmdd) ..............................60fluphenazine decanoate .......................... 60fluphenazine hcl ......................................60flurazepam hcl ........................................ 60flurbiprofen .............................................60flurbiprofen sodium ................................ 60flutamide .................................................60fluticasone propionate ............................60fluticasone-salmeterol ............................ 60FLUVIRIN............................................. 60fluvoxamine maleate ...............................60FLUZONE HIGH-DOSE....................... 60FLUZONE QUADRIVALENT............. 61FOCALIN...............................................61FOCALIN XR........................................ 61FOILLE.................................................. 61FOLET DHA..........................................61FOLGARD............................................. 61FOLGARD OS....................................... 61FOLIC + B12......................................... 61folic acid ................................................. 61folinic-plus ..............................................61FOLITAB 500........................................ 61FOLIVANE-F........................................ 61FOLIVANE-PLUS.................................61FOLOTYN............................................. 61food color black ......................................61food color blue ........................................61food color blue royal .............................. 61food color brown .................................... 61food color flesh .......................................61food color green ..................................... 61food color lime green ............................. 61food color orange ................................... 61food color red ......................................... 61food color yellow .................................... 61FORA D40 GLUCOSE/PRESSURE..... 61FORA LANCETS.................................. 61FORMADON......................................... 61formaldehyde .......................................... 61FORMA-RAY........................................ 61FORTEO................................................ 61fosamprenavir calcium ........................... 61fosinopril sodium ....................................61fosinopril sodium-hctz ............................ 61

fosphenytoin sodium ............................... 61freds pharmacy unilet lanc 28g .............. 61FREE & CLEAR.................................... 62freedom cepapro .....................................62FREEDOM ODT BASE........................ 62FREESTYLE CONTROL SOLUTION.62FREESTYLE FLASH SYSTEM........... 62FREESTYLE FREEDOM......................62FREESTYLE FREEDOM LITE............ 62FREESTYLE INSULINX SYSTEM..... 62FREESTYLE INSULINX TEST........... 62FREESTYLE LANCETS.......................62FREESTYLE LIBRE 14 DAY READER................................................ 62FREESTYLE LIBRE 14 DAY SENSOR.................................................62FREESTYLE LIBRE READER............ 62FREESTYLE LIBRE SENSOR SYSTEM................................................ 62FREESTYLE LITE TEST......................62FREESTYLE PRECISION INS SYR....62FREESTYLE PRECISION NEO SYSTEM................................................ 62FREESTYLE SIDEKICK II .................. 62FREESTYLE SYSTEM......................... 62FREESTYLE TEST............................... 62fructose ................................................... 62fruit c ...................................................... 62fullers earth ............................................ 62FUNGI-NAIL.........................................62FUNGI-NAIL TOE & FOOT.................62FUNGOID TINCTURE......................... 62FUNGOID-D..........................................62furosemide .............................................. 62FUSION..................................................62FUZEON................................................ 62FYAVOLV.............................................62gabapentin .............................................. 63GABITRIL............................................. 63galantamine hydrobromide .................... 63galantamine hydrobromide er ................ 63garlic/epa ................................................63garlic-lecithin ......................................... 63garlic-parsley ......................................... 63gas relief ................................................. 63GASTROCROM.................................... 63GAS-X....................................................63GAS-X CHILDRENS............................ 63GAS-X EXTRA STRENGTH................63GAS-X PREVENTION..........................63GAS-X WITH MAALOX EX ST..........63GAVILYTE-C........................................63GAVILYTE-G........................................63GAVILYTE-N WITH FLAVOR PACK..................................................... 63GAVISCON........................................... 63GAVISCON EXTRA STRENGTH....... 63G-BUCAL-C.......................................... 63G-DOLOGEN........................................ 63ge-150 .....................................................63GEBAUERS INSTANT ICE................. 63gelatin .....................................................63GELFOAM SPONGE............................ 63

GELFOAM SPONGE SIZE 100............63GEL-KAM..............................................63GELONASAL........................................ 63GELUSIL............................................... 63gemcitabine hcl .................................63, 64gemfibrozil ..............................................64GENCONTUSS......................................64GENOTROPIN...................................... 64GENOTROPIN MINIQUICK................64gentamicin sulfate ...................................64GENTEAL..............................................64GENTEAL MILD.................................. 64GENTEAL MILD TO MODERATE.....64GENTEAL TEARS PF.......................... 64gentian violet .......................................... 64gentle laxative .........................................64GENTLE RAIN......................................64gentle skin cleanser ................................ 64GENTLE-LET GP LANCETS...............64GENTLE-LET LANCETS.....................64GENVOYA............................................ 64geravine .................................................. 64geriatric vitamin ..................................... 64gerisilk bath oil .......................................64GERMBLOC HEALTH.........................64GILENYA.............................................. 65GILTUSS COUGH & COLD................ 65ginger root ..............................................65ginseng ....................................................65gla-45 ......................................................65glass syringe 3 ml ................................... 65glatiramer acetate .................................. 65glen pe .................................................... 65glenmax peb ............................................65glenmax peb dm ......................................65glenmax peb dm forte ............................. 65glentuss ...................................................65g-levocarnitine s/f ...................................65glimepiride ..............................................65glipizide .................................................. 65glipizide er ..............................................65glipizide xl .............................................. 65glipizide-metformin hcl ...........................65global inject ease insulin syr .................. 65global insulin syringes ............................65GLUCAGEN HYPOKIT....................... 65GLUCAGON EMERGENCY................65GLUCOCOM AUTOLINK TELEMONITOR....................................65GLUCOCOM LANCETS 28G.............. 65GLUCOCOM LANCETS 30G.............. 65GLUCOCOM LANCETS 33G.............. 65GLUCOPRO INSULIN SYRINGE. 65, 66glucosamine chond complex/msm .......... 66glucosamine chondroitin complx ............66glucosamine complex/vitamin d3 ........... 66glucosamine hcl ......................................66glucosamine sulfate ................................ 66glucosamine-chondroitin ........................66glucosamine-chondroitin-msm ............... 66glucosamine-chondroitin-vit d3 ............. 66glucosamine-msm ................................... 66glucose ....................................................66

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GLUCOSE NURSETTE........................ 66glutamine ................................................ 66glutathione ..............................................66glutol .......................................................66glyburide .................................................66glyburide micronized ..............................66glyburide-metformin ...............................66glycerin ...................................................66glycerin (adult) ....................................... 66glycerin (infants & children) ..................66glyceryl monostearate ............................ 66glycine .................................................... 66glycine500 .............................................. 66glycolic acid ..................................... 66, 67glycopyrrolate ........................................ 67GLYDO.................................................. 67GLYXAMBI.......................................... 67g-myco nail ............................................. 67gnp 24 hour nasal allergy ...................... 67gnp 4x probiotic ......................................67gnp advanced eye health ........................ 67gnp alcohol denatured ............................67gnp alcohol swabs .................................. 67gnp animal shapes plus iron ...................67gnp b-50 complex ................................... 67gnp b-complex plus vitamin c .................67gnp calamine .......................................... 67gnp calcium 600 plus d/mineral ............. 67gnp calcium plus 600 +d ........................67gnp capsaicin ..........................................67gnp childrens chewables/ex c ................. 67gnp coq-10 & fish oil ..............................67gnp ethyl alcohol .................................... 67gnp fish oil .............................................. 67gnp gentian violet ................................... 67gnp glycerin/rose water ..........................67gnp headache relief extra str ..................67gnp insulin syringe ................................. 67gnp iodides ............................................. 67gnp iodine ............................................... 67gnp isopropyl alcohol wipes ...................67gnp lancets ..............................................67gnp lancets 21g .......................................67gnp lancets micro thin 33g ..................... 67gnp lancets super thin 30g ......................67gnp lancets thin 26g ............................... 67gnp lice egg remover .............................. 68gnp liquid bandage .................................68gnp l-lysine ............................................. 68gnp micro thin lancets 33g ..................... 68gnp niacin ............................................... 68gnp omeprazole ...................................... 68gnp pain relief/benzocaine ..................... 68gnp peppermint spirit ............................. 68gnp potassium .........................................68gnp shampoo & body wash .................... 68gnp sinus wash refill ...............................68gnp sodium silicate .................................68gnp super thin lancets 30g ......................68gnp terbinafine hydrochloride ................68gnp ultra com insulin syringe .................68gnp urinary pain relief ........................... 68gnp vitamin d super strength .................. 68

gnp vitamin d-400 ...................................68GOLD BOND MULTI-SYMPTOM......68GOLD BOND RAPID RELIEF............. 68GOLD BOND ULTIMATE................... 68GONIOSOL............................................68GONIOTAIRE....................................... 68GONIOVISC.......................................... 68GOOD START 5% GLUCOSE WATER..................................................69goodsense all day allergy ....................... 69goodsense cough dm ...............................69goodsense eye drops ...............................69goodsense flu/cold/cough/night ..............69goodsense flu/cold/daytime .................... 69goodsense ibuprofen ...............................69goodsense ibuprofen childrens ...............69goodsense ibuprofen infants ...................69goodsense lancets 30g ............................ 69goodsense lancets 33g ............................ 69goodsense lubricant eye drops ............... 69goodsense miconazole 1 ......................... 69goodsense nicotine ................................. 69goodsense nighttime cold & flu .............. 69goodsense petroleum jelly ...................... 69goodsense redness relief plus ................. 69goodsense sinus congest/pain .................69goodsense sleeptime ............................... 69goodsense sore throat spray ...................69gordomatic ..............................................69GORDONS NO 5...................................69gordons urea ...........................................69GORDONS-VITE A.............................. 69GORDO-POOL...................................... 69GRANDPAS OATMEAL SOAP...........69GRANDPAS THYLOX SOAP..............69GRANIX................................................ 69grape seed ...............................................69green soap .............................................. 69green tea extract .....................................69griseofulvin microsize .............................69grx wound ............................................... 69G-TRON PED........................................ 69G-TUSICOF........................................... 69guaifenesin ..............................................69guaifenesin-codeine ................................69guanfacine hcl ........................................ 70guanfacine hcl er .................................... 70guanidine hcl .......................................... 70gumsol .................................................... 70GYNE-LOTRIMIN................................ 70GYNE-LOTRIMIN 3............................. 70H2Q........................................................ 70halobetasol propionate ...........................70haloperidol ............................................. 70haloperidol decanoate ............................70haloperidol lactate ................................. 70hand wipes ..............................................70HARD NAILS........................................70HAVRIX................................................ 70HC DERMAPAX................................... 70H-CHLOR 12......................................... 70H-CHLOR 6........................................... 70headache relief pm ................................. 70

healthy accents unilet lancets .................70hearing aid batteries .............................. 70heartburn antacid ex st ...........................70heartburn treatment 24 hour .................. 70h-e-b incontrol alcohol ...........................70h-e-b incontrol lancets 28g .....................70h-e-b incontrol lancets 30g .....................70h-e-b incontrol lancets 33g .....................70HEET TRIPLE ACTION....................... 70hematinic/folic acid ................................ 70HEMATOGEN.......................................70HEMATOGEN FA.................................70HEMOCYTE..........................................70hemorrhoidal .......................................... 70hemorrhoidal cooling ............................. 70hemorrhoidal max st/aloe .......................70heparin (porcine) in nacl ........................70heparin sodium (porcine) ....................... 71heparin sodium (porcine) pf ................... 71HERCEPTIN.......................................... 71hetastarch-nacl .......................................71HEXALEN............................................. 71HIBICLENS........................................... 71high potency iron ....................................71histaflex .................................................. 71HISTEX..................................................71HISTEX PD............................................71HISTEX PDX.........................................71HISTEX-AC...........................................71HISTEX-DM.......................................... 71HISTEX-PE............................................71hm calamine ........................................... 71hm castor oil ...........................................71hm clear fiber ......................................... 71hm ethyl rubbing alcohol ........................71hm iodides ...............................................71hm iodine ................................................ 71hm iron ................................................... 71hm melatonin quick dissolve ...................71hm nighttime sleep aid ............................71hm omeprazole ....................................... 71hm probiotic digestive health ................. 71hm rolled gauze bandage ....................... 71HM SALONPAS PAIN RELIEF........... 71hm severe cold/cough/flu ........................71hm super vitamin b12 ............................. 71hm vitamin b12 ....................................... 71hm z-sleep ............................................... 71HOLD.....................................................71HOMATROPAIRE................................ 71HONEY BEARS W/IRON-ZINC..........71HPR PLUS HYDROGEL...................... 71hrt essential ............................................ 71huber needle ........................................... 71HUGGIES NATURAL CARE WIPES..71HUMALOG............................................72HUMALOG MIX 50/50.........................72HUMALOG MIX 75/25.........................72HUMATE-P........................................... 72humidifier ............................................... 72HUMIRA................................................72HUMIRA PEDIATRIC CROHNS START................................................... 72

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HUMIRA PEN....................................... 72HUMIRA PEN-CD/UC/HS STARTER.72HUMIRA PEN-PS/UV/ADOL HS START................................................... 72HUMULIN 70/30................................... 72HUMULIN 70/30 KWIKPEN................72HUMULIN N......................................... 72HUMULIN N KWIKPEN......................72HUMULIN R......................................... 72HUMULIN R U-500 (CONCENTRATED)............................. 72HUMULIN R U-500 KWIKPEN...........72HURRICAINE................................. 72, 73HURRICAINE ONE.............................. 73HURRIVIEW......................................... 73HURRIVIEW II ..................................... 73HYALGAN............................................ 73HYCAMTIN.......................................... 73hydralazine hcl ....................................... 73HYDROCELL ADHESIVE DRESSING............................................ 73hydrocerin .............................................. 73hydrochloric acid ................................... 73hydrochlorothiazide ................................73hydrocod polst-cpm polst er ................... 73hydrocodone-acetaminophen ................. 73hydrocodone-homatropine ..................... 73hydrocodone-ibuprofen .......................... 73hydrocortisone ........................................73hydrocortisone ace-pramoxine ...............73hydrocortisone butyrate ......................... 73hydrocortisone valerate ..........................73HYDROGEL.......................................... 73hydromet .................................................74hydromorphone hcl .................................74hydromorphone hcl pf ............................ 74hydrophilic ..............................................74hydrophilic petrolatum ........................... 74hydroxychloroquine sulfate .................... 74hydroxyprogesterone caproate ...............74hydroxypropyl cellulose ......................... 74hydroxyurea ............................................74hydroxyzine hcl .......................................74hydroxyzine pamoate ..............................74HYLATOPIC PLUS...............................74HYOPHEN.............................................74hyoscyamine sulfate ................................74hyoscyamine sulfate er ........................... 74hyoscyamine sulfate sl ............................ 74HYPERCARE........................................ 74HYPERRHO S/D................................... 74hypodermic needle ..................................74HYPOTEARS........................................ 74hypromellose .......................................... 74HYSEPT.................................................74HYVEE ADVANCED ANTACID........ 74HY-VEE LANCETS.............................. 74hy-vee thin lancets .................................. 74ibandronate sodium ................................74ibuprofen ................................................ 74ibuprofen 100 junior strength .................74ibuprofen pm ...........................................74ICAR...................................................... 74

ICAR-C.................................................. 74ice blue ................................................... 75ICY HOT................................................75ICY HOT LIDOCAINE PLUS MENTHOL............................................ 75idarubicin hcl ......................................... 75IFEX....................................................... 75ifosfamide ............................................... 75imatinib mesylate ....................................75imipramine hcl ........................................75imipramine pamoate ...............................75imiquimod ...............................................75immune support ...................................... 75IMODIUM A-D..................................... 75IMODIUM MULTI-SYMPTOM RELIEF.................................................. 75IMOVAX RABIES................................ 75IMPROVUE........................................... 75indapamide ............................................. 75indole-3-carbinol ....................................75indomethacin .......................................... 75indomethacin er ......................................75INFANRIX.............................................75infants gas relief ..................................... 75INFED.................................................... 75INFUMORPH 200................................. 75INFUMORPH 500................................. 75inositol .................................................... 75inositol hexanicotinate ........................... 75INOSITOL-5.......................................... 75INSPIRACHAMBER/LARGE.............. 75INSPIRACHAMBER/MEDIUM...........75INSPIRACHAMBER/MOUTHPIECE..75INSPIRACHAMBER/SMALL.............. 75INSPIREASE......................................... 75INSTACLEAN.......................................76INSTA-GLUCOSE................................ 76instant ear-dry ........................................ 76instant hand sanitizer ............................. 76INSTAT..................................................76INSUFLON............................................ 76insulin syringe ........................................ 76insulin syringe/needle .............................76INSUPEN ULTRAFIN.......................... 76INTEGRA.............................................. 76INTELENCE.......................................... 76intense cough reliever ex st .................... 76INTERDRY AG TEXTILE 10"X144".. 76INTRASITE GEL APPLIPAK.............. 76INTRON A............................................. 76INTROVALE......................................... 76INVEGA SUSTENNA...........................76INVEGA TRINZA................................. 76INVIRASE............................................. 76INVOKANA.......................................... 76iodides tincture ....................................... 76iodine ................................................ 76, 77iodine strong ...........................................77iodine strong (lugol's) ............................ 77iodine tincture .........................................77iodoform ................................................. 77IONIL..................................................... 77IONIL-T................................................. 77

IONSYS..................................................77IPOL....................................................... 77ipratropium bromide .............................. 77ipratropium-albuterol .............................77irinotecan hcl ..........................................77IROFOL..................................................77iron (ferrous sulfate) .............................. 77iron 100 plus ...........................................77iron 100/c ............................................... 77iron 21/7 ................................................. 77iron 27 .................................................... 77iron chews pediatric ............................... 77iron slow release .................................... 77irrigating eyewash ..................................77ISENTRESS........................................... 77ISENTRESS HD.................................... 77isoleucine ................................................77ISOLEUCINE 1000............................... 77isomalt lollipop base .............................. 77isoniazid ..................................................77isopropyl alcohol ....................................77isopropyl alcohol (rubbing) ....................77isopropyl alcohol wipes ..........................77isopropyl myristate ................................. 77isopropyl palmitate .................................77ISOPTO TEARS.................................... 77isosorbide dinitrate .................................78isosorbide dinitrate er ............................ 77isosorbide mononitrate ...........................78isosorbide mononitrate er ...................... 78isradipine ................................................78itch relief .................................................78ITCH-X.................................................. 78itraconazole ............................................ 78IVAREST MEDICATED POISON IVY.........................................................78IVAREST POISON IVY ITCH............. 78ivermectin ............................................... 78ivy wash poison ivy cleanser .................. 78IXEMPRA KIT...................................... 78IXIARO.................................................. 78J & J ALL-PURPOSE FIRST AID........ 78J & J DENTAL FLOSS FOR KIDS.......78JANTOVEN........................................... 78JANUMET............................................. 78JANUMET XR.......................................78JANUVIA...............................................78JARDIANCE..........................................78JENTADUETO...................................... 78jessners ................................................... 78jock itch spray ........................................ 78JOHNSONS BABY CORNSTARCH....78JOHNSONS BABY OIL GEL............... 78JOHNSONS BABY POWDER..............78JUNEL 1/20............................................78JUVEN................................................... 78k 100 ....................................................... 78k-99 .........................................................78KAITLIB FE.......................................... 78KALBITOR............................................78KALETRA............................................. 78KANGAROO ENTRIFLUSH PUMP SET.........................................................78

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KANGAROO JOEY PUMP SET.......... 78KANK-A MOUTH PAIN...................... 79KANK-A SOFTBRUSH........................ 79kaolin ...................................................... 79KAOPECTATE......................................79KAPVAY............................................... 79karaya gum ............................................. 79KARBOZYME.......................................79K-BICARB.............................................79KELNOR 1/35........................................79kelp ......................................................... 79kelp-b6-lecithin-vinegar ......................... 79KENALOG.............................................79KENDALL ALGINATE DRESS 8"X8"......................................................79KENDALL ANTIMICROBIAL BANDAGE............................................ 79KENDALL CA ALGINATE 6"X10".... 79KENDALL HYDROPHILIC FOAM DRESS....................................................79KENDALL TRANSPARENT FILM DRESS....................................................79KEPIVANCE......................................... 79KERAMATRIX REPLICINE 10CMX10CM.........................................79KERR TRIPLE DYE SWABS...............79ketoconazole ........................................... 79ketorolac tromethamine ..........................79KETOSTIX............................................ 79kettle neti pot sinus wash ........................79KEY OMEGA........................................ 79k-iii ..........................................................79KINERASE............................................ 79kinney lancets ......................................... 79kinney thin lancets .................................. 79kinray insulin syringe ....................... 79, 80KINRIX.................................................. 80KIONEX.................................................80KITABIS PAK....................................... 80KLOR-CON........................................... 80KLOR-CON 10...................................... 80KLOR-CON M10...................................80KLOR-CON M15...................................80KLOR-CON M20...................................80KLOR-CON SPRINKLE....................... 80kls cold & flu ms day/night .....................80kls esomeprazole magnesium ................. 80kls omeprazole ........................................80K-MAG.................................................. 80K-MAG ASPARTATE.......................... 80K-MAG-70............................................. 80kmart valu insulin syringe 29g ............... 80kmart valu insulin syringe 30g ............... 80kojic acid ................................................ 80KONSYL................................................80konsyl daily fiber .................................... 80KONSYL-D............................................80korean ginseng ....................................... 80kp hydrocortisone-aloe ...........................80kp mag-oxide magnesium ....................... 80kp silicone scar therapy gel ....................80K-PHOS..................................................80K-PHOS NO 2........................................80

kpn prenatal ............................................80kroger insulin syringe .......................80, 81kroger lancets ......................................... 81kroger lancets 21g .................................. 81kroger lancets micro thin 33g ................ 81kroger lancets super thin ........................81kroger lancets thin ..................................81kroger lancets thin 26g ...........................81kroger lancets ultrathin 30g ................... 81KT TAPE PRO.......................................81K-TAN PLUS.........................................81KUVAN..................................................81KWAN LOONG PAIN RELIEVING....81KYLEENA............................................. 81labetalol hcl ............................................81LAC-HYDRIN FIVE............................. 81LAC-HYDRIN TWELVE......................81lactated ringers .......................................81lactic acid ............................................... 81lactic acid e ............................................ 81lacto-bifidus-600 .................................... 81lactose .....................................................81lactose monohydrate ...............................81l-alanine ..................................................81LAMISIL ADVANCED........................ 81LAMISIL AT......................................... 81LAMISIL AT SPRAY............................81LAMISILK PROTECT.......................... 81lamivudine .............................................. 81lamivudine-zidovudine ............................81lamotrigine ............................................. 81lamotrigine er ......................................... 81LANACANE ANTI-BACTERIAL........82LANACANE MAXIMUM STRENGTH........................................... 82lancets .....................................................82lancets 28g ..............................................82lancets 30g ..............................................82lancets micro thin 33g ............................ 82lancets super thin 28g .............................82lancets thin ............................................. 82LANCETS ULTRA THIN..................... 82lancets ultra thin 30g ..............................82lanolin .....................................................82lanolin anhydrous ...................................82lanolin hydrous-grx ................................ 82lansoprazole ........................................... 82LANTUS................................................ 82LANTUS SOLOSTAR...........................82l-arginine ................................................ 82l-arginine hcl .......................................... 82LARIN 1/20............................................82l-aspartic acid .........................................82latanoprost ..............................................82LATUDA................................................82lavender oil .............................................82laxative ................................................... 82laxative pills ........................................... 82LAZANDA.............................................82l-carnitine ............................................... 82l-carnitine hcl ......................................... 82l-citrulline ...............................................82l-cysteine .................................................82

l-cysteine hcl ...........................................82l-cystine .................................................. 82leader insulin syringe ....................... 82, 83lecithin .................................................... 83lecithin-kelp-b6-cider vinegar ................83leflunomide ............................................. 83lemon bioflavanoid ................................. 83lemon oil ................................................. 83lemon-glycerin ........................................83LENZAPATCH......................................83LETAIRIS.............................................. 83letrozole .................................................. 83leucine .................................................... 83leucovorin calcium ................................. 83LEUKERAN.......................................... 83leuprolide acetate ................................... 83levalbuterol hcl .......................................83levalbuterol tartrate ............................... 83LEVEMIR.............................................. 83LEVEMIR FLEXTOUCH..................... 83levetiracetam .......................................... 83levetiracetam er ......................................83levetiracetam in nacl .............................. 83levobunolol hcl ....................................... 83levocarnitine ...........................................83levocarnitine (dietary) ............................83levocarnitine-b5-taurine .........................83levocetirizine dihydrochloride ................83levofloxacin ...................................... 83, 84levoleucovorin calcium ...........................84LEVO-T..................................................84LEXIVA................................................. 84l-glutamic acid ........................................84l-glutamine ..............................................84l-glutathione ........................................... 84l-histidine ................................................84LIALDA................................................. 84LICE B GONE....................................... 84LICE B GONE CAP SATURATED......84lice cure .................................................. 84lice killing maximum strength ................ 84LICEFREEE...........................................84LICEMD COMPLETE...........................84LICIDE TREATMENT..........................84lidocaine ................................................. 84lidocaine hcl ........................................... 84lidocaine viscous .................................... 84lidocaine-hydrocortisone ace ................. 84lidocaine-prilocaine ............................... 84lidocaine-transparent dressing ...............84LIDOPATCH PAIN RELIEF................ 84LIDOPRO...............................................84LIDOZENGEL.......................................84LILETTA (52 MG)................................ 84lime oil ....................................................84limencin .................................................. 84lindane .................................................... 84linezolid .................................................. 84LINZESS................................................ 84liothyronine sodium ................................84lip balm ...................................................85lip balm base natural ..............................85LIP MEDEX...........................................85

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lipochol nr .............................................. 85lipochol plus ........................................... 85LIPO-GEL.............................................. 85lipoic acid ............................................... 85LIPOIL................................................... 85LIPOTRIAD...........................................85LIPOTRIAD VISIONARY....................85lipovan base ............................................85LIQ-10.................................................... 85LIQSORB...............................................85LIQUACEL............................................ 85LIQUIMAT............................................ 85lisinopril ................................................. 85lisinopril-hydrochlorothiazide ................85l-isoleucine ............................................. 85LISTERINE NATURALS ANTISEPTIC......................................... 85lite touch lancets .....................................85LITETOUCH INSULIN SYRINGE...... 85LITETOUCH LANCETS.......................85lithium .....................................................86lithium carbonate ................................... 86lithium carbonate er ............................... 86LITTLE COLDS COUGH FORMULA.86LITTLE COLDS DECONGESTANT... 86LITTLE REMEDIES POISON TREAT................................................... 86LITTLE TUMMYS LAXATIVE...........86LIVALO................................................. 86live better lancet super thin .................... 86live better lancet ultra thin ..................... 86liver .........................................................86liver extract .............................................86l-lysine .................................................... 86l-lysine hcl .............................................. 86l-methionine ............................................86LMX 4.................................................... 86LMX 4 PLUS......................................... 86LO LOESTRIN FE.................................86local anesthesia needle ...........................86LODRANE D......................................... 86LOHIST-D..............................................86lohist-dm .................................................86longs insulin syringe ...............................86longs lancets thin ....................................86loperamide hcl ........................................86lopinavir-ritonavir ..................................86loratadine ............................................... 86loratadine childrens ............................... 86lorazepam ............................................... 86LORAZEPAM INTENSOL................... 86l-ornithine ...............................................86l-ornithine hydrochloride ....................... 86LORTUSS DM.......................................86LORTUSS EX........................................86LORTUSS LQ........................................86losartan potassium ................................. 87losartan potassium-hctz ..........................87LOTRIMIN AF...................................... 87LOTRIMIN ULTRA.............................. 87lovastatin ................................................ 87loxapine succinate .................................. 87LOZIBASE S......................................... 87

l-phenylalanine .......................................87l-proline .................................................. 87l-serine ....................................................87l-tyrosine .................................................87lubricant drops/dual-action ....................87lubricant eye drops .................................87LUBRISKIN...........................................87LUCENTIS.............................................87LUDENS COUGH DROPS................... 87LUDENS THROAT DROPS................. 87LUPRON DEPOT (1-MONTH)............ 87LUPRON DEPOT (3-MONTH)............ 87LUPRON DEPOT (4-MONTH)............ 87LUPRON DEPOT (6-MONTH)............ 87LUPRON DEPOT-PED (1-MONTH)....87LUPRON DEPOT-PED (3-MONTH)....87lutein .......................................................87LUVENA FEMININE WIPES.............. 87LYCELLE.............................................. 87LYRICA................................................. 87lysine4000 ...............................................87LYSODREN...........................................87M2 C.......................................................87MAALOX.............................................. 88MAALOX ADVANCED MAX ST....... 88MAALOX JUNIOR PLUS ANTIGAS..88MACUGEN............................................88mafenide hcl ........................................... 88MAG-200............................................... 88mag-al .....................................................88magdelay ................................................ 88MAGELLAN INSULIN SAFETY SYR........................................................ 88MAGIC3 INTERMITTENT CATHETER........................................... 88MAGIMIN..............................................88magnacaps ..............................................88MAGNEBIND 200.................................88MAGNEBIND 300.................................88magnesium ..............................................88magnesium aspartate ..............................88magnesium carbonate .............................88magnesium carbonate heavy .................. 88magnesium chloride ............................... 88magnesium chloride-calcium ................. 88magnesium citrate .................................. 88magnesium fizz-plus ............................... 88magnesium gluconate ............................. 88magnesium oxide .................................... 88magnesium stearate ................................88magnesium sulfate .................................. 89magnum-75 .............................................89MAGONATE......................................... 89mag-sr plus calcium ............................... 89MAG-TAB SR....................................... 89MAKENA.............................................. 89malathion ................................................89malic acid ............................................... 89manganese .............................................. 89manganese aspartate ..............................89manganese gluconate ............................. 89MANGIMIN...........................................89mannitol ..................................................89

MAOX....................................................89MAPAP HEADACHE PLUS................ 89MAR-COF BP........................................89MAR-COF CG EXPECTORANT......... 89marshmallow artificial flavor .................89MASTISOL ADHESIVE....................... 89MATULANE..........................................89MAVYRET............................................ 89MAXI-COMFORT INSULIN SYRINGE...............................................89MAXIMUM D3..................................... 89ME-500...................................................89mecholyl ..................................................89meclizine hcl ........................................... 89MEDADYNE ORAL PAIN RELIEF.... 89MEDERMA............................................89MEDERMA AG FACIAL CLEANSER........................................... 89MEDERMA PM.....................................89medic insulin syringe ..............................89medicated body .......................................89medicated douche ................................... 89medicated wipes ..................................... 90MEDICONE...........................................90MEDI-DERM/L-RX.............................. 90MEDI-DERM-RX.................................. 90MEDI-FIRST ANTISEPTIC CLEANER..............................................90MEDI-FIRST/LIDOCAINE...................90MEDIHONEY WOUND/BURN DRESSING............................................ 90medi-laxx ................................................ 90MEDI-LYTE.......................................... 90medi-patch-lidocaine ..............................90MEDIPLAST..........................................90MEDIPORE + PAD ADHESIVE DRESS....................................................90MEDISENSE GLUCOSE KETONE CONTR.................................................. 90MEDISENSE HI/MID/LOW CONTROL............................................. 90MEDISENSE HIGH/LOW CONTROL 90MEDISENSE MID CONTROL.............90MEDISENSE THIN LANCETS............ 90medi-tussin dm double strength ..............90MEDROX...............................................90medroxyprogesterone acetate .................90mefenamic acid .......................................90mefloquine hcl ........................................ 90mega coq10 .............................................90MEGA MULTIVITAMIN..................... 90megestrol acetate ....................................90meijer alcohol swabs .............................. 90MEIJER LANCETS............................... 90MEIJER LANCETS THIN.................... 90MEIJER LANCETS UNIVERSAL 21G......................................................... 90MEIJER LANCETS UNIVERSAL 33G......................................................... 90MEIJER SUPER THIN LANCETS....... 90melatonin ................................................ 91melatonin er ............................................91melatonin tr ............................................ 91

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MELLOW-TONE.................................. 91meloxicam ...............................................91melphalan ............................................... 91melphalan hcl ......................................... 91memantine hcl .........................................91memantine hcl er .................................... 91MENACTRA..........................................91mencaps .................................................. 91m-end dmx .............................................. 91M-END PE............................................. 91MENEST................................................ 91menstrual pain relief .............................. 91menstrual relief max strength .................91menthol ................................................... 91MENVEO...............................................91meperidine hcl ........................................ 91mercaptopurine ...................................... 91mesalamine .............................................91mesalamine-cleanser .............................. 91mesna ......................................................91MESNEX................................................91MESTINON........................................... 91METAMUCIL........................................91METAMUCIL MULTIHEALTH FIBER.....................................................91METAMUCIL SMOOTH TEXTURE...91metaproterenol sulfate ............................91METAXALL.......................................... 91metformin hcl ..........................................92metformin hcl er ..................................... 92methadone hcl .........................................92METHADONE HCL INTENSOL......... 92methazolamide ........................................92methenamine hippurate .......................... 92methenamine mandelate ......................... 92methimazole ............................................92methionine .............................................. 92methitest ..................................................92methocarbamol .......................................92methotrexate ........................................... 92methotrexate sodium ...............................92methotrexate sodium (pf) ........................92methyl alcohol ........................................ 92methyl salicylate ..................................... 92methyl sulfone .........................................92methylcellulose ....................................... 92methylcobalamin .................................... 92methyldopa ............................................. 92methylparaben ........................................ 92methylphenidate hcl ................................92methylphenidate hcl er ........................... 92methylprednisolone ................................ 92methylprednisolone acetate ....................92methylprednisolone sodium succ ............92metipranolol ........................................... 93metoclopramide hcl ................................ 93metolazone ..............................................93metoprolol succinate er .......................... 93metoprolol tartrate ................................. 93metoprolol-hydrochlorothiazide .............93METRO.................................................. 93METROCREAM....................................93METROGEL.......................................... 93

METROLOTION................................... 93metronidazole ......................................... 93metronidazole in nacl ............................. 93mexiletine hcl ..........................................93MEXSANA............................................ 93MG/TAURINE FORTE......................... 93MI PASTE PLUS................................... 93MIBELAS 24 FE....................................93MICATIN...............................................93miconazole 3 ...........................................93miconazole 7 ...........................................93miconazole nitrate .................................. 93microfiber cleaning cloths ......................93MICROGESTIN 1/20.............................93MICROKLENZ......................................93MICROLET LANCETS.........................93midazolam hcl .........................................93midodrine hcl ..........................................93MIDOL CAFFEINE FREE.................... 93MIDOL COMPLETE.............................93MIGERGOT...........................................93miglitol ....................................................93miglustat ................................................. 94MIL-A-MULSION.................................94MILCO-ZYME...................................... 94milk of magnesia concentrate .................94MILLGUARD........................................ 94MILTAB #1............................................94mineral oil .............................................. 94mineral oil light ...................................... 94mineral oil-hydrophil petrolat ................94MINIMED GUARDIAN LINK 3.......... 94MINIMED PRO-SET INFUSION 42".. 94MINITRAN............................................ 94minocycline hcl .......................................94minoxidil .................................................94minoxidil for women ...............................94MIRALAX............................................. 94MIRCERA..............................................94MIRENA (52 MG)................................. 94mirtazapine .............................................94misoprostol ............................................. 94mitomycin ............................................... 94mitoxantrone hcl .....................................94M-M-R II ................................................94mn-50 ......................................................94moexipril hcl ...........................................94moexipril-hydrochlorothiazide ...............94moisture barrier ..................................... 94MOISTURE GUARD............................ 94MOISTUREL......................................... 94moisturizing skin protectant ................... 94molybdenum ............................................94mometasone furoate ......................... 94, 95MONOCAL............................................95MONOJECT ALLERGIST TRAY........ 95MONOJECT BLUNTIP CANNULA.... 95MONOJECT HYPODERMIC NEEDLE................................................ 95MONOJECT INSULIN SYRINGE....... 95MONOJECT LIFESHIELD SYRINGE.95MONOJECT MAGELLAN SAFETY NDL........................................................95

MONOJECT MAGELLAN SYRINGE.95MONOJECT SYRINGE........................ 95MONOJECT ULTRA COMFORT SYRINGE.........................................95, 96MONOLET LANCETS......................... 96MONOLET OPD LANCETS................ 96MONOVISC...........................................96montelukast sodium ................................ 96MONUROL............................................96MORPHABOND ER............................. 96morphine sulfate ............................... 96, 97morphine sulfate (concentrate) .............. 96morphine sulfate (pf) .............................. 96morphine sulfate er .................................96morphine sulfate er beads ...................... 96MOTRIN INFANTS DROPS................ 97mouth rinse ............................................. 97MOVANTIK.......................................... 97MOXEZA...............................................97moxifloxacin hcl ..................................... 97MOZOBIL..............................................97ms insulin syringe ...................................97MUCINEX............................................. 98MUCINEX COUGH CHILDRENS.......97MUCINEX COUGH FOR KIDS........... 97MUCINEX D......................................... 97MUCINEX D MAX STRENGTH......... 97MUCINEX DM......................................97MUCINEX DM MAXIMUM STRENGTH........................................... 97MUCINEX FAST-MAX........................97MUCINEX FAST-MAX COLD & SINUS.................................................... 97MUCINEX FAST-MAX COLD FLU... 97MUCINEX FAST-MAX CONGEST COUGH..................................................97MUCINEX FAST-MAX DAY/NIGHT.97MUCINEX FAST-MAX DAY/NIGHT M/S......................................................... 97MUCINEX FAST-MAX DAY/NIGHT TAB........................................................ 97MUCINEX FOR KIDS.......................... 97MUCINEX MAXIMUM STRENGTH..98MUCINEX SINUS-MAX CONGESTION...................................... 98MUCINEX SINUS-MAX DAY/NIGHT..........................................98MUCINEX SINUS-MAX PRESS & PAIN.......................................................98MUCINEX STUFFY NOSE/COLD CHILD....................................................98mucus relief cold/sinus max st ................98mucus relief d ......................................... 98mucus relief er ........................................ 98mucus relief pe ........................................98mucus-dm max ........................................98multi-delyn/iron ...................................... 98multi-draw needle ...................................98MULTIGEN........................................... 98MULTIGEN FOLIC...............................98MULTIGEN PLUS................................ 98multi-minerals ........................................ 98multi-purpose cold compress ..................98

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multi-symptom cold plus child ................98multi-vit/fluoride .....................................98multivitamin gummies childrens .............98multivitamins/fluoride ............................ 98mupirocin ................................................98MURI-LUBE..........................................98MURO 128............................................. 98muscle rub ultra strength ....................... 98mustard oil ..............................................98MUSTARGEN....................................... 98M-VIT.................................................... 98MYCOCIDE CX CALLUS EXFOLIATOR.......................................98mycophenolate mofetil ............................98mycophenolate sodium ........................... 99MYGLUCOHEALTH LANCETS 30G.99MYLANTA............................................ 99MYLERAN............................................ 99MYNATAL............................................ 99mynate 90 plus ........................................99mynephrocaps .........................................99MYOBLOC............................................ 99MYORISAN...........................................99nabumetone ............................................ 99nac .......................................................... 99nadolol ....................................................99nadolol-bendroflumethiazide ..................99NAIL SCRUB........................................ 99NAIL-EX................................................99nalbuphine hcl ........................................ 99naloxone hcl ........................................... 99naltrexone hcl ......................................... 99NAMENDA XR TITRATION PACK...99NAMZARIC...........................................99NAPHCON-A........................................ 99naproxen .................................................99naproxen dr ............................................ 99naproxen sodium .................................... 99naratriptan hcl ........................................99NARCAN............................................... 99NASACORT ALLERGY 24HR............ 99NASACORT ALLERGY 24HR CHILDREN............................................99nasal allergy 24 hour ............................. 99nasal aspirator ....................................... 99nasal decongestant ................................. 99nasal decongestant spray ....................... 99NASAL EASE ALLERGY RELIEVER.............................................99NASALCROM.......................................99NASOGEL........................................... 100NASONEB NEBULIZER STARTER. 100NASOPEN PE......................................100NATACYN.......................................... 100natapres ................................................ 100nateglinide ............................................ 100NATROBA...........................................100natural bitterness ..................................100natural fiber laxative ............................ 100natural vitamin e moisturizing ............. 100NATURAL WHEY..............................100NATURE-THROID............................. 100NEBUPENT......................................... 100

NECON 0.5/35 (28) ............................. 100neomycin sulfate ................................... 100neomycin-bacitracin zn-polymyx ..........100neomycin-polymyxin b gu .....................100neomycin-polymyxin-dexameth ............ 100neomycin-polymyxin-gramicidin .......... 100neomycin-polymyxin-hc ........................100NEOSPORIN + PAIN RELIEF MAX ST......................................................... 100NEOSPORIN ORIGINAL................... 100NEOSPORIN PLUS MAX ST.............100NEOSPORIN PLUS PAIN RELIEF MS........................................................ 100NEOSTRATA FACIAL CLEANSER. 100NEOTUSS-D........................................100NEPHRONEX......................................100NEPHRO-VITE....................................100NEULASTA.........................................100NEUPOGEN........................................ 100NEURO-K-250 T.D. ............................ 101neuromax .............................................. 101NEUROPEN.........................................101NEUROTIPS........................................ 101NEUTROGENA BODY...................... 101NEUTROGENA CLEAR PORE......... 101NEUTROGENA T/GEL STUBBORN ITCH.....................................................101nevirapine .............................................101nevirapine er .........................................101NEW DIGNITY ODOR ELIMINATOR..................................... 101NEW IMAGE SKIN BARRIER/FLANGE............................101NEW IMAGE SKIN/FLANGE/TAPE 101new terocin ........................................... 101NEXAFED........................................... 101NEXAFED SINUS PRESSURE + PAIN.....................................................101NEXAVAR.......................................... 101NEXCARE PREMIUM ADHESIVE GAUZE................................................ 101NEXIUM 24HR................................... 101NEXPLANON......................................101niacin .................................................... 101niacin er ................................................101niacin er (antihyperlipidemic) ..............101niacin flush free .................................... 101niacinamide .......................................... 101nicardipine hcl ......................................101NICODERM CQ.................................. 101NICORETTE........................................101nicotinamide adenine dinucleo .............101nicotine ................................................. 102nicotine polacrilex ................................102nicotine step 1 .......................................102nicotine step 2 .......................................102nicotine step 3 .......................................102NICOTROL..........................................102NIFEDICAL XL...................................102nifedipine .............................................. 102nifedipine er ..........................................102nifedipine er osmotic release ................102nilutamide .............................................102

nimodipine ............................................ 102NINJACOF...........................................102NINJACOF-A...................................... 102NINJACOF-XG....................................102NIPENT................................................102NISEKO SUNSCREEN SPF 25.......... 102nisoldipine er ........................................102NITEBITE............................................ 102nite-time cold/flu relief ......................... 102NITRO-BID..........................................102nitrofurantoin ....................................... 102nitrofurantoin macrocrystal ................. 102nitrofurantoin monohyd macro ............ 102nitroglycerin ......................................... 102nitroglycerin er .....................................102NIVANEX DMX................................. 102NIX CREME RINSE............................102nizatidine .............................................. 102NIZORAL A-D.................................... 102NOBLE FORMULA............................ 102NOBLE FORMULA HC......................102nohist-lq ................................................102NOKOR ADMIX NEEDLE.................102non-stick ............................................... 102NOREL AD..........................................102NOREL CS...........................................102norethindrone acetate ...........................103norethindrone acet-ethinyl est ..............103norgestim-eth estrad triphasic ..............103NORMLSHIELD................................. 103nortriptyline hcl ....................................103NORVIR...............................................103NO-STING SKIN-PREP......................103NOVA SUREFLEX LANCETS.......... 103NOVAFERRUM 125........................... 103NOVAFERRUM 50............................. 103NOVAFERRUM PEDIATRIC DROPS.............................................................. 103NOVOLOG.......................................... 103NOVOLOG FLEXPEN........................103NOVOLOG MIX 70/30....................... 103NOVOLOG MIX 70/30 FLEXPEN.....103NOVOLOG PENFILL......................... 103NOXICARE......................................... 103np thyroid ............................................. 103NPLATE...............................................103NUEDEXTA........................................ 103NUFERA.............................................. 103NU-GEL............................................... 103NU-MAG..............................................103NUPERCAINAL..................................103NUTRA BALANCE PROTEIN COOKIE...............................................103NUTRA SHAKE..................................103NUTRA/PRO CHOCOLATE.............. 103NUTRATEAR......................................103NUTR-E-SOL...................................... 103nutritional shake high protein .............. 103NUTROPIN AQ NUSPIN 10...............103NUTROPIN AQ NUSPIN 20...............103NUTROPIN AQ NUSPIN 5.................103NUVARING.........................................104NYAMYC............................................ 104

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NYMALIZE......................................... 104nystatin ................................................. 104nystatin-triamcinolone ..........................104NYSTOP.............................................. 104NYTOL MAXIMUM STRENGTH.....104OASIS MOISTURIZING MOUTHWASH....................................104OBSTETRIX DHA.............................. 104OBSTETRIX EC..................................104OC8...................................................... 104OCEAN BLUE MINICAPS D/OMEGA3......................................... 104OCEAN BLUE MINICAPS OMEGA-3............................................................ 104OCEAN BLUE OPTIMAL HEALTH.104OCEAN COMPLETE SINUS RINSE.104OCEAN NASAL SPRAY.................... 104oceanic selenium .................................. 104OCUSOFT LID SCRUB COMPLIANCE.................................... 104ODEFSEY............................................ 104ODOR EATERS ANTIFUNGAL........104odor spray .............................................104OFF ACTIVE....................................... 104OFF FAMILYCARE CLEAN FEEL...104ofloxacin ............................................... 104OGESTREL..........................................104olanzapine .................................... 104, 105olive oil ................................................. 105olmesartan medoxomil ......................... 105olmesartan medoxomil-hctz ..................105olopatadine hcl ..................................... 105omega dha ............................................ 105OMEGA POWER................................ 105omega-3 ................................................ 105omega-3 fish oil .................................... 105omega-3 fish oil ex st ............................105omega-3 fish oil-vitamin d3 ..................105OMEGA-3 IQ.......................................105omega-3-acid ethyl esters .....................105omeprazole ........................................... 105omeprazole magnesium ........................ 105omeprazole-sodium bicarbonate .......... 105OMNIFLEX DIAPHRAGM................ 105ONCASPAR.........................................105ondansetron .......................................... 105ondansetron hcl .................................... 105one step pregnancy ...............................105ONE-A-DAY ADULT VITACRAVES+DHA..........................105ONE-A-DAY WOMENS 50+ ADVANTAGE.....................................105ONETOUCH DELICA LANCETS 33G....................................................... 105ONETOUCH DELICA LANCETS FINE..................................................... 105ONETOUCH FINEPOINT LANCETS105ONETOUCH PING METER REMOTE..............................................105ONETOUCH ULTRASOFT LANCETS............................................ 105ONEXTON...........................................105ONFI.....................................................105

opium .................................................... 105OPTICLEANSE GHI........................... 105OPTIONS CONCEPTROL..................105OPTIONS GYNOL II CONTRACEPTIVE............................. 106OPTIUM BLOOD GLUCOSE MONITOR........................................... 106OPTIUM GLUCOSE MONITOR SYSTEM.............................................. 106OPTIUM TEST.................................... 106OPTIUMEZ TEST............................... 106ORA-FILM...........................................106ORA-HESIVE BASE...........................106oral analgesic max st ............................106oral anesthetic ...................................... 106oral electrolytes ....................................106ORAL SWAB PETITE........................ 106oral syringe bottle adapter ................... 106ORALONE...........................................106ORAMAGIC PLUS............................. 106orange oil ............................................. 106ORAZINC............................................ 106ORFADIN............................................ 106organic coconut oil ...............................106ornithine ............................................... 106orphenadrine citrate .............................106orphenadrine citrate er ........................ 106ORTHOVISC....................................... 106OS-CAL................................................106OS-CAL EXTRA D3........................... 106OS-CAL ULTRA................................. 106oseltamivir phosphate ...........................106OSTEO-PORETICAL..........................106ostomy protective ..................................106ovulation predictor ............................... 106oxalic acid ............................................ 106oxaliplatin .............................................106oxandrolone ..........................................106oxaprozin .............................................. 106oxazepam .............................................. 106oxcarbazepine ...............................106, 107oxybutynin chloride .............................. 107oxybutynin chloride er ..........................107oxycodone hcl ....................................... 107oxycodone hcl er ...................................107oxycodone-acetaminophen ................... 107oxycodone-ibuprofen ............................ 107OXYCONTIN...................................... 107oxymorphone hcl .................................. 107oxymorphone hcl er .............................. 107OXYTROL FOR WOMEN..................107OXYZAL WET DRESSING............... 107oyster calcium + d ................................107oyster calcium/d3 ................................. 107oyster shell calcium .............................. 107oyster shell calcium 250+d .................. 107oyster shell calcium 500+d .................. 107oyster shell calcium plus d ................... 107oyster shell calcium/d ...........................107oyster shell calcium/d3 .........................108P & S.................................................... 108p-1000 ...................................................108PA CLA................................................108

pa fish oil/vit d3 triple st .......................108pa glucosamine-chondroitin .................108pa prenatal formula ..............................108pa probiotic complex ............................ 108paclitaxel .............................................. 108pain & fever childrens ..........................108pain relief ............................................. 108pain relief day & night ex st ................. 108pain relief roll-on ................................. 108pain reliever extra strength .................. 108pain reliever pm ....................................108pain reliever pm ex st ........................... 108pain reliever/fever reducer ...................108pain relieving ........................................108PALADIN............................................ 108pamidronate disodium ..........................108pancreatin .............................................108PANCREAZE...................................... 108PANOXYL...........................................108PANOXYL WASH.............................. 108PANOXYL-4 CREAMY WASH.........108panto-250 ..............................................108pantoprazole sodium ............................ 108pantothenic acid ................................... 108papaya enzyme ..................................... 108paraffin wax beads ............................... 108PARAGARD INTRAUTERINE COPPER...............................................108paricalcitol ........................................... 108PARODONTAX.................................. 108paromomycin sulfate ............................ 108paroxetine hcl ....................................... 109paroxetine hcl er ...................................109parvenzyme digestive enzyme ...............109PAZEO................................................. 109pc lancets super thin 30g ......................109PCCA MBK (FATTY ACID) BASE...109peanut oil ..............................................109pearberry fragrance ............................. 109PECGEN DMX.................................... 109pectin .................................................... 109PEDIACARE CHILDRENS LONG-ACT...................................................... 109PEDIACARE CHILDRENS MULTI-SYMP................................................... 109PEDIACARE MULTI-SYMPTOM.....109PEDIA-LAX.........................................109PEDIA-LAX FIBER GUMMIES........ 109PEDIALYTE ADVANCED CARE.....109PEDIARIX........................................... 109PEDIAVENT........................................109PEDIAVIT............................................109PEDVAX HIB......................................109peg 300 ................................................. 109PEGANONE........................................ 109PEGASYS............................................ 109PEGASYS PROCLICK....................... 109PEGINTRON....................................... 109penicillin g potassium ...........................109penicillin v potassium ...........................109PENTACEL..........................................109PENTASA............................................ 109pentoxifylline er ....................................109

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PENTRAX GOLD............................... 109peppermint oil .......................................110peppermint spirit .................................. 110PEPTO-BISMOL................................. 110PEPTO-BISMOL MAX STRENGTH. 110PEPTO-BISMOL TO-GO....................110PERFORM ATOMIC HEAT...............110PERFORM PAIN RELIEVING...........110PERFORM PAIN RELIEVING ROLL-ON............................................ 110PERFOROMIST.................................. 110PERIDIN-C.......................................... 110perindopril erbumine ............................110PERIOMED..........................................110permethrin ............................................ 110PERNOX.............................................. 110PEROXYL............................................110PEROXYL SPOT TREATMENT........110perphenazine ........................................ 110perphenazine-amitriptyline .................. 110PERRY PRENATAL........................... 110peruvian balsam ................................... 110petroleum jelly ......................................110PHARMABASE BARRIER................ 110PHARMACY COUNTER LANCETS 110PHAZYME MAXIMUM STRENGTH.............................................................. 110PHAZYME ULTRA STRENGTH...... 110PHENADOZ........................................ 110PHENAZO........................................... 110phenazopyridine hcl ............................. 110phenelzine sulfate ................................. 110phenobarbital ............................... 110, 111phenol ................................................... 111PHENOL EZ SWABS..........................111phenoxybenzamine hcl ..........................111phentermine hcl .................................... 111phenylalanine ....................................... 111phenytoin .............................................. 111PHENYTOIN INFATABS...................111phenytoin sodium ..................................111phenytoin sodium extended .................. 111PHLEXY-10.........................................111PHOS-FLUR ORTHO DEFENSE.......111phos-nak ............................................... 111PHOSPHASAL.................................... 111phosphatidyl choline .............................111phosphatidylcholine ..............................111phosphatidylserine ................................111PHOSPHOLINE IODIDE....................111PHOTOFRIN........................................111phytonadione ........................................ 111PHYTOPLEX Z-GUARD....................111PIFELTRO........................................... 111pilocarpine hcl ......................................111pimecrolimus ........................................ 111pindolol .................................................111pioglitazone hcl .................................... 111pioglitazone hcl-glimepiride .................111pioglitazone hcl-metformin hcl .............111piroxicam ..............................................111PLAN B ONE-STEP............................ 111plasticized base .....................................111

PLIAGEL............................................. 111PLO ULTRAMAX...............................111PLURONIC.......................................... 111pmx-1184 silicone .................................111PNEUMOVAX 23............................... 112pnv-dha .................................................112pnv-omega ............................................ 112pnv-select ..............................................112podofilox ...............................................112podophyllum resin ................................ 112poison ivy wash fast acting ...................112POLAR FREEZE................................. 112poloxamer 188 ......................................112poly bacitracin ......................................112POLY HIST FORTE............................ 112polyethylene glycol 1000 ...................... 112polyethylene glycol 1450 ...................... 112polyethylene glycol 3350 ...................... 112polyethylene glycol 400 ........................ 112polyethylene glycol 8000 ...................... 112poly-hist dm .......................................... 112poly-hist pd ........................................... 112polymyxin b sulfate ...............................112polymyxin b-trimethoprim .................... 112polyoxyl 40 stearate ..............................112polysorbate 20 ...................................... 112polysorbate 80 ...................................... 112POLYSPORIN..................................... 112poly-tussin ac ........................................112POLY-VENT DM................................ 112POLY-VENT IR...................................112POLY-VI-SOL..................................... 112POLY-VI-SOL/IRON.......................... 112potassimin .............................................112potassium bitartrate ............................. 112potassium bromide ............................... 112potassium chloride ............................... 112potassium citrate .................................. 112potassium citrate er .............................. 112potassium citrate-citric acid .................112potassium gluconate ............................. 112potassium gluconate anhydrous ........... 112potassium hydroxide .............................112potassium iodide ...................................113potassium iodide (antidote) .................. 113potassium nitrate .................................. 113potassium permanganate ......................113potassium sodium tartrate .................... 113potassium sorbate .................................113povidone-iodine .................................... 113povidone-iodine paint sponge .............. 113povidone-iodine prep ............................113povidone-iodine scrub sponge ..............113power oral care system .........................113PR NATAL 400....................................113PR NATAL 400 EC............................. 113PR NATAL 430....................................113PR NATAL 430 EC............................. 113PRADAXA...........................................113PRALUENT......................................... 113PRAMEGEL........................................ 113pramipexole dihydrochloride ............... 113pramoxine hcl ....................................... 113

prasugrel hcl .........................................113pravastatin sodium ............................... 113prazosin hcl .......................................... 113PRECISION GLUCOSE CONTROL..113PRECISION GLUCOSE CONTROL SOLN....................................................113PRECISION GLUCOSE KETONE CONTR................................................ 113PRECISION GLUCOSE/KETONE CONTR................................................ 113PRECISION LINK...............................113PRECISION PCX.................................113PRECISION PCX PLUS TEST........... 113PRECISION POINT OF CARE TEST 113PRECISION QID MONITOR..............113PRECISION QID TEST.......................113PRECISION SOF-TACT MONITOR..113PRECISION SOF-TACT TEST...........113PRECISION SUREDOSE PLUS SYR...................................................... 113, 114PRECISION SURE-DOSE SYRINGE 114PRECISION THINS GP LANCETS... 114PRECISION XTRA............................. 114PRECISION XTRA BLOOD GLUCOSE............................................114PRECISION XTRA KETONE............ 114PRECISION XTRA MONITOR..........114PRED MILD.........................................114prednicarbate ....................................... 114prednisolone ......................................... 114prednisolone acetate .............................114prednisolone sodium phosphate ........... 114prednisone ............................................ 114PREDNISONE INTENSOL.................114preferred plus insulin syringe ...............114preferred plus lancets colored ..............114preferred plus lancets thin ....................115PREGNITUDE.....................................115PREMARIN......................................... 115PREMIER UROSTOMY..................... 115PREMPHASE...................................... 115PREMPRO........................................... 115prenatal ................................................ 115prenatal formula ...................................115prenatal formula a-free ........................ 115prenatal low iron .................................. 115prenatal multi +dha ............................. 115prenatal multivitamin plus dha .............115PRENATE............................................ 115PRENATE PIXIE.................................115prep protective skin barrier ..................115PREPARATION H...............................115PREPARATION H TOTABLES......... 115pres gen pediatric .................................115PRESGEN B.........................................115PRETZ..................................................115PREVACARE ANTIMICROBIAL..... 115PREVACARE EXTRA PROTECTIVE.............................................................. 115PREVACARE PERSONAL PROTECT............................................ 115PREVACARE TOTAL SKIN CARE.. 115PREVACID 24HR............................... 115

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PREVALITE........................................ 115PREVNAR 13...................................... 115PREZCOBIX........................................115PREZISTA........................................... 115PRIFTIN...............................................115PRILOSEC OTC.................................. 115PRIMATENE ASTHMA..................... 116primidone ..............................................116PRO NUTRIENTS OMEGA 3............ 116PROAIR HFA...................................... 116probenecid ............................................ 116PROBIOMAX PLUS DF..................... 116probiotic ............................................... 116probiotic digestive support ...................116probiotic-prebiotic ................................116PROCARE PLUS UNDERWEAR MEDIUM............................................. 116PRO-CEPTION.................................... 116prochlorperazine .................................. 116prochlorperazine maleate .....................116PROCOMYCIN................................... 116PROCRIT............................................. 116PROCTOCORT....................................116PROCTOFOAM...................................116PROCTOSOL HC................................ 116PRODIGY INSULIN SYRINGE.........116PRODIGY NO CODING BLOOD GLUC................................................... 116PRODIGY TWIST TOP LANCETS 28G....................................................... 116PROFE..................................................116PROFERRIN ES.................................. 116PROFERRIN-FORTE.......................... 116PROFILNINE SD.................................116progesterone .........................................116progesterone micronized ...................... 117PROGLYCEM..................................... 117PROLENSA......................................... 117PROLIA................................................117PROLIDA.............................................117PROMACTA........................................117promethazine hcl .................................. 117promethazine vc/codeine ...................... 117promethazine-codeine .......................... 117promethazine-dm .................................. 117PROMETHEGAN................................117PROMOLAXIN................................... 117PRONUTRIENTS CALCIUM+D3..... 117PRONUTRIENTS SUPER B COMPLEX...........................................117propafenone hcl ....................................117propafenone hcl er ................................117propranolol hcl .....................................117propranolol hcl er ................................ 117propranolol-hctz ...................................117propylene glycol ................................... 117propylparaben ...................................... 117propylthiouracil ....................................117PRO-RED AC...................................... 117PROSHIELD SKIN CARE.................. 117protein .................................................. 117PROTEINEX........................................117PROTEINEX P100...............................117

protriptyline hcl ....................................117PROVENT SLEEP APNEA THERAPY............................................117PROVENTIL HFA...............................118PROVIDA DHA...................................118PROVIEW............................................118pseudoeph-bromphen-dm ..................... 118pseudoephedrine hcl .............................118pseudoephedrine hcl er ........................ 118psorcon ................................................. 118PSS SELECT GP LANCETS...............118PSS SELECT SAFETY LANCETS.....118psyllium husk ........................................ 118PULMICORT.......................................118PULMICORT FLEXHALER...............118PULMOZYME.....................................118PURACYN PLUS DUO-CARE.......... 118pure l-citrulline .....................................118purefe ob plus ....................................... 118purified water ....................................... 118PURILON.............................................118px allergy relief d ................................. 118px allergy sinus pe ................................118px antacid extra strength ......................118px artificial tears .................................. 118px daytime cold .....................................118px daytime multi-symptom ....................118px gas relief extra strength ...................118px ibuprofen cold & sinus .................... 118px insulin syringe ..................................118px lancets ultra thin ..............................118px minoxidil for men .............................118px nasal four .........................................118px nitetime multi-symptom ....................118px omeprazole .......................................118PYLERA.............................................. 118pyrazinamide ........................................ 118pyridostigmine bromide ........................118pyridostigmine bromide er ................... 118pyridoxal-5 phosphate ..........................119pyridoxine hcl ....................................... 119PYRIDOXINE/MINERALS................ 119pyrilamine-phenylephrine .................... 119pyruvic acid .......................................... 119qc alcohol swabs .................................. 119qc arthritis ............................................ 119qc calamine ...........................................119qc castor oil .......................................... 119qc iodides ..............................................119qc iodine tincture ..................................119qc lancets super thin 30g ......................119qc lancets ultra thin ..............................119QC MEDIFIN PE................................. 119qc natural vegetable ............................. 119qc non-adherent ....................................119qc unilet lancets 28g .............................119qc unilet lancets micro thin .................. 119Q-GEL.................................................. 119quercetin ...............................................119quetiapine fumarate ..............................119quetiapine fumarate er ......................... 119QUILLICHEW ER...............................119QUILLIVANT XR............................... 119

quinapril hcl ......................................... 119quinapril-hydrochlorothiazide ............. 119quinidine gluconate er ..........................119quinidine sulfate ................................... 119quinine sulfate ...................................... 119ra 8 hour pain relief ............................. 119ra acetaminophen flu cold ....................119ra acid reducer plus antacid ................ 119ra acne maximum ................................. 119ra advanced eye health .........................119ra alcohol swabs ...................................119ra anorectal .......................................... 120ra antifungal pen .................................. 120ra b-12 .................................................. 120ra back & body pain relief ................... 120ra b-complex/vitamin c cr .....................120ra ca/mg/zn/cu ...................................... 120ra calamine ...........................................120ra calcium hi-cal .................................. 120ra calcium hi-cal/vitamin d .................. 120ra calcium high potency ....................... 120ra calcium-boron ..................................120ra cold remedy multi-symptom ............. 120ra cold/sinus max ..................................120ra corn cushions small ......................... 120ra corn removers ultra thin .................. 120ra dark tanning .....................................120ra day/night/cold/flu relief ....................120ra daytime cold/flu relief ...................... 120ra ear wax cleansing system .................120ra ethyl alcohol .....................................120ra exfoliating moisturizer ..................... 120RA E-ZJECT COLOR LANCETS 33G.............................................................. 120RA E-ZJECT LANCETS 28G............. 120RA E-ZJECT LANCETS THIN 26G...120RA E-ZJECT LANCETS THIN 28G...120RA E-ZJECT LANCETS ULTRA THIN.................................................... 120ra feminine care douche ....................... 120ra fever reducer/pain reliever .............. 120ra fiber weight management .................120ra first aid iodine ..................................120ra first aid non-stick ............................. 120ra first aid saline wound wash ............. 120ra fish oil .............................................. 120RA FISH OIL EXTRA STRENGTH...120ra foaming hand soap refill .................. 120ra gel toe separator .............................. 120ra glucosamine-chondroitin ................. 120ra glucosamine-chondroitin-d3 ............120ra glucosamine-chondroit-msm ............120ra hot/cold gel sleeve ............................121ra hydrogen peroxide ........................... 121ra insulin syringe ..................................121ra intimacy gels/him/her .......................121ra isopropyl alcohol wipes ................... 121ra lice solution ......................................121RA LOTION.........................................121ra lubricant eye drops .......................... 121ra lutein ................................................ 121RA LYCOPENE...................................121ra melatonin ......................................... 121

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ra miconazole 3 combo pack ................ 121ra mouth pain anesthetic ...................... 121ra mucus relief d max strength ............. 121ra multihealth fiber ...............................121ra nasal strip/drug free/large ............... 121ra nighttime cold/flu relief ....................121ra oatmeal moisturizing ........................121ra omega 3-6-9 ..................................... 121ra omeprazole .......................................121ra omeprazole-sodium bicarb .............. 121ra oyster shell calcium/d ...................... 121ra pain relief .........................................121ra personal lubricant ............................121ra prenatal ............................................121ra probiotic complex ............................ 121ra probiotic digestive care ................... 121ra probiotic gummies ............................121RA RENEWAL ACNE TREATMENT.............................................................. 121RA RENEWAL SHOWER & BATH..121ra saccharin ..........................................121ra saline nasal spray ............................ 121ra saline wound wash ........................... 121ra sensitive anti-itch ............................. 121ra severe cold/night cold&flu ...............121ra severe congestion/cold max ............. 121ra shower & bath body .........................121ra silky lubricant moisturizer ............... 122ra sinus wash nasal relief .....................122ra sinus wash neti pot ...........................122ra slow release iron ..............................122ra stay awake ........................................122ra sterile saline nasal mist ....................122ra therapeutic ....................................... 122ra triple antibiotic ................................ 122RA TUGABOOS BABY......................122ra vaginal infection screening ..............122ra vitamin b-12 ..................................... 122ra vitamin c ...........................................122ra wart remover ....................................122ra yeast relief plus ................................ 122rabano yodado ......................................122RABAVERT........................................ 122rabeprazole sodium .............................. 122racepinephrine hcl ................................122RADIACARE POST HEALING......... 122raloxifene hcl ........................................122ramipril .................................................122ranitidine hcl ........................................ 122RAPAMUNE........................................122RASH AWAY......................................122RASH RELIEF.....................................122raspberry flavor ....................................122raspberry syrup .................................... 122reality insulin syringe ...........................122reality lancets ....................................... 122reality swabs .........................................122reality trigger lancets ........................... 122REA-LO............................................... 122REBETOL............................................ 122REBIF...................................................123REBIF REBIDOSE.............................. 122

REBIF REBIDOSE TITRATION PACK................................................... 122REBIF TITRATION PACK.................123RECOMBIVAX HB.............................123RECTICARE........................................123red cross cotton sterile ......................... 123red yeast rice extract ............................ 123REDNESS RELIEF..............................123reeses pinworm medicine ..................... 123REFENESEN CHEST CONG/PAIN RLF.......................................................123REFENESEN CHST CONG/PAIN PE 123REFRESH............................................ 123REFRESH LACRI-LUBE....................123REFRESH LIQUIGEL.........................123REFRESH OPTIVE............................. 123REFRESH OPTIVE MEGA-3............. 123REFRESH OPTIVE SENSITIVE........ 123REFRESH P.M.....................................123REFRESH TEARS...............................123REGENECARE HA.............................123REGRANEX........................................ 123relagesic ............................................... 123relcof c ..................................................123RELENZA DISKHALER.................... 123RELIADERM.......................................123RELIEF PAIN RELIEVING................123RELION ALCOHOL SWABS............ 123RELION ALL-IN-ONE....................... 123RELION BLOOD GLUCOSE TEST...123RELION GLUCOSE SHOT................ 123RELION INSULIN SYRINGE.... 123, 124RELI-ON INSULIN SYRINGE...123, 124RELION LANCETS MICRO-THIN 33G....................................................... 124RELION LANCETS STANDARD 21G....................................................... 124RELION LANCETS THIN 26G..........124RELION LANCETS ULTRA-THIN 30G....................................................... 124RELION ULTRA THIN LANCETS 30G....................................................... 124RELION ULTRA THIN PLUS LANCETS............................................ 124RELISTOR...........................................124RELPAX.............................................. 124REMEDY ANTIMICROBIAL CLEANSER......................................... 124REMEDY CALAZIME....................... 124REMEDY CLEANSING BODY......... 124REMEDY PHYTOPLEX ANTIFUNGAL.................................... 124REMEDY SKIN REPAIR....................124REMODULIN...................................... 124REMOVE ADHESIVE REMOVER WIPES.................................................. 124RENACIDIN........................................ 124RENAGEL........................................... 124renal vitamin .........................................125renuu nl .................................................125repaglinide ............................................125REPATHA............................................125REPATHA SURECLICK.................... 125

REPLACE SR...................................... 125RESCON.............................................. 125RESCRIPTOR......................................125reserpine ...............................................125resorcinol ..............................................125RESOURCE THICKENUP WATER.. 125RESPAIRE-30......................................125RESTASIS............................................125RESTORE CLEANSER & MOISTURIZER................................... 125RETAINE PM...................................... 125RETIN-A.............................................. 125REVEAL COLON DISEASE.............. 125REVEAL DNA PATERNITY TEST...125REVEAL GET PREGNANT QUICK. 125REVEAL MULTI-DRUG TESTING CUP...................................................... 125REVEAL URINARY TRACT.............125REVITADERM WOUND CARE........125REVLIMID.......................................... 125REVONTO...........................................125REXALL LANCETS ULTRA THIN 30G....................................................... 125REZAMID............................................125RHINARIS........................................... 125RHINASE.............................................125RIASTAP............................................. 125RIAX.................................................... 125RIBASPHERE......................................125riboflavin .............................................. 125riboflavin-5-phosphate sodium .............125RICOLA CHERRY HONEY HERB... 125RICOLA HERB................................... 126RICOLA LEMON MINT.....................126RICOLA W/ECHINACEA.................. 126RIDAURA............................................126rifabutin ................................................ 126rifampin ................................................ 126RIGHTEST GL300 LANCETS........... 126riluzole ..................................................126rimantadine hcl .....................................126ringers irrigation ..................................126RISAMINE...........................................126RISPERDAL CONSTA....................... 126risperidone ............................................126ritonavir ................................................126RITUXAN............................................ 126rivastigmine .......................................... 126rivastigmine tartrate .............................126rixubis ...................................................126rizatriptan benzoate ..............................126ROBATHOL........................................ 126ROBITUSSIN CHILD COUGH/COLD CF..............................126ROBITUSSIN COUGH+CHEST CONG DM........................................... 126ROBITUSSIN DAY/NIGHT VALUE PAK...................................................... 126ROBITUSSIN LINGERING COUGHGELS......................................126ROBITUSSIN MULTI-SYMPTOM MAX.....................................................126ROBITUSSIN NIGHTTIME COUGH 126

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ROBITUSSIN NIGHTTIME COUGH DM........................................................126ROBITUSSIN PK COLD DAY/NGHT DM........................................................126ROBITUSSIN PK COLD DAY/NGHT MS........................................................ 126ROBITUSSIN SEVERE NIGHTTIME.............................................................. 127ROBITUSSIN TO GO COUGH/COLD CF..............................127ROLAIDS.............................................127ropinirole hcl ........................................127rose oil ..................................................127rose water ............................................. 127rosin ......................................................127rosuvastatin calcium .............................127ROTARIX............................................ 127ROTATEQ........................................... 127rotex ......................................................127ROZEREM...........................................127ru-hist d ................................................ 127rutin ...................................................... 127rydex g .................................................. 127rymed .................................................... 127rynex pse ...............................................127SABRIL................................................127saccharin .............................................. 127SAFE TUSSIN PM.............................. 127SAFELET IV CATHETER..................127safety insulin syringes .......................... 127SAFETY SEAL LANCETS.................127SAFETY-GARD NEEDLE 18G..........127SAFETY-LOK SYRINGE................... 127safflower oil ..........................................127SAF-GEL..............................................127SALEM SUMP TUBE 12FR............... 127salicylic acid .........................................127salicylic acid wart remover .................. 127salicylic acid-cleanser ..........................127saline .................................................... 127SALMON............................................. 127sam-e .................................................... 128SAM-E COMPLETE........................... 128sam-g.l.a. .............................................. 128SAMSCA..............................................128SANTYL.............................................. 128SARNA................................................ 128SASTID SOAP.....................................128SAVELLA............................................128SAVELLA TITRATION PACK..........128sb alcohol prep ..................................... 128sb bacitracin ......................................... 128sb cold & flu hbp .................................. 128sb fib lax orange ................................... 128sb insulin syringe ..................................128sb lancets thin .......................................128sb lancets ultra thin .............................. 128sb lice treatment ................................... 128sb omeprazole .......................................128sb stool softener ....................................128scarcin .................................................. 128SCYTERA............................................128se-100 ................................................... 128

SEBUDERM........................................ 128SEBULEX............................................ 128SECONAL............................................128SECURA EPC SKIN CARE STARTER............................................ 128SECURA EXTRA PROTECTIVE...... 128SECURA MOISTURIZING CLEANSER......................................... 128SECURA PERSONAL CLEANSER...128SECURA TOTAL BODY CLEANSER......................................... 128SECURA TWO-STEP......................... 128SELECT-OB........................................ 128selegiline hcl .................................128, 129selenicaps-200 ...................................... 129selenimin ...............................................129selenium er ........................................... 129selenium sulfide .................................... 129SELSUN BLUE DEEP CLEANSING.129SELZENTRY....................................... 129senna .....................................................129senna leaves ..........................................129SENNA PROMPT................................129senna s .................................................. 129SENOKOT EXTRA STRENGTH....... 129SENOKOT S........................................ 129SENSI-CARE BODY...........................129SENSI-CARE PERINEAL/SKIN........ 129SENSI-CARE PROTECTIVE BARRIER.............................................129SENSIPAR........................................... 129SENSITIVE EYES ENZYME CLEANER............................................129SENSODYNE MAXIMUM STRENGTH......................................... 129SE-PLUS PROTEIN............................ 129SEREVENT DISKUS.......................... 129sertraline hcl .........................................129sesame oil ............................................. 129sevelamer carbonate .............................129severe cold & flu day/night .................. 129shampoo & body wash rinse-free .........129SHAMROCK LATEX EXAM GLOVES.............................................. 129shea butter ............................................ 129SHINGRIX...........................................129SHOPKO ALCOHOL SWABS........... 129SHOPKO UNILET LANCETS 30G....129SHUR-SEAL CONTRACEPTIVE...... 129silace .....................................................129sildenafil citrate ....................................129silica ..................................................... 129silodosin ................................................129silver nitrate ......................................... 130silver sulfadiazine .................................130SIMBRINZA........................................ 130simethicone ...........................................130SIMILAC GO & GROW TODDLER..130SIMILAC HUMAN MILK FORTIFIER..........................................130SIMILAC PRO-SENSITIVE OPTIGRO.............................................130SIMILAC STERILIZED WATER.......130

simple syrup ..........................................130simvastatin ............................................130SINADRIN PE COMPLETE SINUS REL...................................................... 130sinus & cold-d ...................................... 130sinus & congestion day/night ............... 130sinus congestion/pain daytime ..............130sinus relief ............................................ 130sirolimus ............................................... 130siterol ....................................................130skin protectant ...................................... 130skin tag remover ................................... 130SKINTEGRITY HYDROGEL.............130SKYLA.................................................130sleep aid ................................................130SLEEP-N-HEEL.................................. 130SLO-NIACIN....................................... 130SLOW FE............................................. 130slow iron ............................................... 130slow magnesium/calcium ......................130slow release iron .................................. 130sm alcohol prep .................................... 130sm allergy relief ....................................130sm b super vitamin complex ................. 130sm biotin ............................................... 130sm calamine ..........................................130sm chest congestion relief dm ...............130SM CORAL CALCIUM...................... 131sm cosmetic puffs jumbo .......................131sm cough drops .....................................131sm daytime cold & cough child ............ 131sm dental rinse anti-plaque .................. 131sm ethyl alcohol (rubbing) ................... 131sm foaming antacid .............................. 131sm fruit coolers .....................................131sm glucosamine hcl-msm ......................131SM GLUCOSAMINE/CALCIUM + D131sm hemorrhoidal ...................................131sm ibuprofen jr ..................................... 131sm iodides ............................................. 131sm iodine tincture ................................. 131sm lancets 33g ...................................... 131sm melatonin .........................................131sm natural herb cough drops ................131sm omega-3-6-9 fatty acids .................. 131sm omeprazole ......................................131sm one daily prenatal ........................... 131sm pain relief/menthol .......................... 131sm prenatal vitamins ............................ 131sm slow release iron ............................. 131sm vitamin b1 ........................................131SMART SENSE COLOR LANCETS 33G....................................................... 131SMART SENSE STANDARD LANCETS............................................ 131SMART SENSE SUPER THIN LANCETS............................................ 131SMART SENSE THIN LANCETS 26G....................................................... 131smoothfit cuff ........................................ 131sod citrate-citric acid ........................... 131sodium acetate ......................................131sodium ascorbate ..................................131

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sodium benzoate ................................... 131sodium bicarbonate .............................. 131sodium bisulfite .....................................131sodium borate ....................................... 131sodium bromide .................................... 131sodium butyrate .................................... 131sodium chloride .................................... 132sodium chloride (hypertonic) ....... 131, 132sodium citrate ....................................... 132sodium citrate dihydrate .......................132sodium fluoride .....................................132sodium hydroxide ................................. 132sodium metabisulfite .............................132sodium nitrate .......................................132sodium nitrite ........................................132sodium perborate ..................................132sodium phosphate dibasic .................... 132sodium phosphate monobasic ...............132sodium polystyrene sulfonate ............... 132sodium propionate ................................132sodium saccharin ..................................132sodium silicate ......................................132sodium starch glycolate ........................132sodium sulfite ........................................132SOLIRIS...............................................132SOLOSITE WOUND GEL.................. 132solvatech plus ....................................... 132SOMBRA COOL THERAPY..............132SOMBRA WARM THERAPY............132SOOTHE & COOL INZO BARRIER. 132SOOTHE XP XTRA PROTECTION.. 132sorbic acid ............................................ 132sorbitol ..................................................132sorbutuss nr .......................................... 132sore throat ............................................ 132sore throat lozenges ..............................132SORINE................................................133sotalol hcl ............................................. 133sotalol hcl (af) ...................................... 133soya lecithin ..........................................133soybean oil ............................................133spearmint oil .........................................133spinosad ................................................133SPIRIVA HANDIHALER................... 133spironolactone ...................................... 133spironolactone-hctz .............................. 133sportbalm ..............................................133SPORTSCREME..................................133spot acne treatment .............................. 133SPRAYZOIN........................................133squaric acid di-n-butyl ester .................133squaric acid in butanol .........................133stahist ad ...............................................133STALEVO 100.....................................133STALEVO 125.....................................133STALEVO 150.....................................133STALEVO 200.....................................133STALEVO 75.......................................133STANBACK HEADACHE POWDERS...........................................133stavudine ...............................................133stearic acid ........................................... 133stearyl alcohol ...................................... 133

STERILANCE TL................................133sterile .................................................... 133STERILE LUBRICANT...................... 133STERI-STRIP COMPOUND BENZOIN............................................ 133STERI-TAMP SEALS BOTTLES/VIALS................................133STERI-TAMP SEALS/BAGS............. 133STERI-TAMP SEALS/SYRINGES.....133stevia extract .........................................133STIMATE.............................................133STIMEX INSULATED NEEDLE....... 133STIMULEN..........................................133STIOLTO RESPIMAT.........................133STOMAHESIVE MOLDABLE ADHESIVE.......................................... 134STOMAHESIVE PASTE.....................134STRIANT............................................. 134STRIBILD............................................ 134STRIDEX ESSENTIAL.......................134STRI-DEX SENSITIVE SKIN............ 134STUART ONE..................................... 134SUBOXONE........................................ 134SUBSYS...............................................134sucralfate .............................................. 134sucrose ..................................................134SUDAFED............................................134SUDAFED 24 HOUR.......................... 134SUDAFED CHILDRENS.................... 134SUDAFED PE CHILDRENS.............. 134SUDAFED PE COLD & COUGH CHILD..................................................134SUDAFED PE DAY & NIGHT...........134SUDAFED PE MAXIMUM STRENGTH......................................... 134SUDAFED PRESSURE+PAIN 12 HR134sulfacetamide sodium ........................... 134sulfacetamide sodium (acne) ................ 134sulfacetamide sodium-sulfur .................134sulfacetamide-prednisolone ..................134sulfadiazine ...........................................134sulfamethoxazole-trimethoprim ............134SULFAMYLON...................................134sulfasalazine ................................. 134, 135sulfo-lo ..................................................135sulfur .....................................................135sulfur precipitated ................................ 135sulindac ................................................ 135sumatriptan ...........................................135sumatriptan succinate ...........................135sumatriptan succinate refill ..................135SUMMERS EVE DEODORANT ULTRA.................................................135super b-50 complex .............................. 135super c-500 complex .............................135super cal/mag ....................................... 135super moleskin ......................................135SUPER OMEGA-3...............................135super thin lancets ..................................135supposibase f ........................................ 135SUPPOSIBLEND.................................135SUPPRELIN LA.................................. 135SUPREP BOWEL PREP KIT..............135

supress a pediatric ................................135supress dm pediatric .............................135SUPRESS-PE PEDIATRIC................. 135sure comfort alcohol prep .................... 135sure comfort insulin syringe ......... 135, 136sure comfort lancets 28g ...................... 136sure comfort lancets 30g ...................... 136SURE-JECT INSULIN SYRINGE...... 136SURE-LANCE ULTRA THIN LANCETS............................................ 136SURELITE LANCETS........................ 136SUSPENDOL-S................................... 136SUTENT...............................................136SWEEN................................................ 136SWEEN PREP......................................136SWEETA..............................................136SWIM EAR.......................................... 136swimmers instant ear dry ..................... 136SYLATRON.........................................136SYMBICORT.......................................136sympathetic nerve needle ......................137SYNAGIS.............................................137SYNJARDY......................................... 137SYNVISC.............................................137SYNVISC ONE....................................137syringe .................................................. 137syringe 10-12 ml ...................................137syringe 20-25 ml ...................................137syringe 2-3 ml .......................................137syringe 30-35 ml ...................................137syringe 50-60 ml ...................................137syringe 5-6 ml .......................................137syringe luer slip .................................... 137syringe precisedose dispenser .............. 137SYRSPEND SF.................................... 137SYRSPEND SF PH4............................ 137syrup nf ................................................. 137SYSTANE............................................ 137SYSTANE BALANCE........................ 137SYSTANE LID WIPES....................... 137SYSTANE OVERNIGHT THERAPY 137SYSTANE PRESERVATIVE FREE...137SYSTANE ULTRA..............................137SYSTANE ULTRA PF........................ 137TABLOID............................................ 137tacrolimus .............................................137tadalafil (pah) .......................................137talc ........................................................ 137TAMIFLU............................................ 137tamoxifen citrate ...................................137tamsulosin hcl .......................................137TANDEM.............................................137tangerine ...............................................137tannic acid ............................................ 138TARGRETIN....................................... 138taron forte .............................................138TARON-CRYSTALS.......................... 138TARON-PREX.....................................138TARSUM............................................. 138tartaric acid ..........................................138taurine .................................................. 138tazarotene ............................................. 138TAZORAC........................................... 138

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TAZTIA XT......................................... 138tb syringe 1 ml ...................................... 138tdm solution .......................................... 138tea tree oil .............................................138TEAR FLO........................................... 138TEARS NATURALE PM.................... 138TECHLITE AST LANCETS............... 138TECHLITE LANCETS........................138TECHLITE LANCETS 30G................ 138TECNU FIRST AID.............................138TEGADERM CONTACT LAYER......138TEGADERM FOAM ADHESIVE...... 138TEGADERM HYDROGEL WOUND FILLER................................................ 138telmisartan ............................................138telmisartan-hctz .................................... 138temazepam ............................................ 138temozolomide ........................................138temsirolimus ......................................... 138tenofovir disoproxil fumarate ...............138terazosin hcl ......................................... 138terbinafine hcl .......................................138terbutaline sulfate .................................138terconazole ........................................... 138terocin ...........................................138, 139teroderm-plus ....................................... 139TESTOPEL.......................................... 139testosterone ...........................................139testosterone cypionate .......................... 139testosterone enanthate ..........................139tetanus-diphtheria toxoids td ................139tetrabenazine ........................................ 139tetracycline hcl ..................................... 139TETRA-FORMULA CGH/SORE THROAT..............................................139tgt alcohol swabs .................................. 139tgt first aid cleansing ............................139tgt lancet micro thin 33g ...................... 139tgt lancet thin 26g .................................139tgt lancet ultra thin 30g ........................ 139tgt lubricant eye drops ..........................139tgt lubricant redness reliever ............... 139tgt omeprazole ...................................... 139THALOMID.........................................139THE ITCH ERASER............................139THEOCHRON..................................... 139theophylline anhydrous ........................ 139theophylline er ......................................139THERACOF PLUS COUGH/COLD REL...................................................... 139THERACYS.........................................139THERA-D 4000................................... 139THERAFLU COLD & COUGH..........139THERAFLU EXPRESSMAX..............139THERAFLU SEVERE COLD............. 140THERAFLU SEVERE COLD & COUGH................................................139THERAFLU SEVERE COLD DAYTIME............................................139THERAFLU SEVERE COLD NIGHTTIME................................139, 140THERAFLU SEVERE COLD/CGH NIGHT..................................................140

THERAFLU WARMING RELIEF SINUS.................................................. 140THERA-GESIC....................................140THERANATAL COMPLETE............. 140THERANATAL OVAVITE................ 140THERAPLEX T................................... 140THERASEAL HAND PROTECTION 140THERATEARS.................................... 140THERATEARS NUTRITION............. 140thiamine ................................................ 140thiamine hcl .......................................... 140THINLETS GP LANCETS..................140thioridazine hcl .....................................140thiotepa .................................................140thiothixene ............................................ 140threonine ...............................................140thymol ................................................... 140THYROLAR-1.....................................140THYROLAR-1/2..................................140THYROLAR-1/4..................................140THYROLAR-2.....................................140THYROLAR-3.....................................140tiagabine hcl ......................................... 140ticlopidine hcl ....................................... 140TIGER BALM LINIMENT................. 140TIGER BALM MUSCLE RUB........... 140TIGER BALM NECK & SHOULDER RUB......................................................140TIGER BALM PAIN RELIEVING..... 140TIGER BALM PAIN RELIEVING LG.............................................................. 140TILIA FE..............................................140timolol maleate ............................. 140, 141TINACTIN........................................... 141TINACTIN JOCK ITCH......................141TIVICAY..............................................141tizanidine hcl ........................................ 141TN DICKINSONS WITCH HAZEL... 141TOBI PODHALER.............................. 141TOBRADEX........................................ 141tobramycin ............................................141tobramycin-dexamethasone ..................141TODAY SPONGE............................... 141todays health thin lancets 28g .............. 141todays health thin lancets 30g .............. 141tolazamide ............................................ 141tolbutamide ...........................................141tolmetin sodium .................................... 141tolnaftate ...............................................141tolterodine tartrate ............................... 141tolterodine tartrate er ...........................141toomey syringe ......................................141topcare lancets micro-thin 33g .............141topcare ultra comfort ins syr ........ 141, 142TOPICAINE 5......................................142topiramate ............................................ 142topotecan hcl ........................................ 142torsemide .............................................. 142TOVIAZ............................................... 142TRACLEER......................................... 142TRADJENTA.......................................142tragacanth ............................................ 142tramadol hcl ......................................... 142

tramadol hcl er ..................................... 142tramadol hcl er (biphasic) ....................142trandolapril .......................................... 142tranexamic acid .................................... 142TRANQUILITY BRIEFS.................... 142TRANSANOSIL.................................. 142transderm-iq ......................................... 142tranylcypromine sulfate ........................142TRANZAREL...................................... 142TRAVATAN Z.....................................142travel sickness .......................................142trazodone hcl ........................................ 142TREANDA...........................................142T-RELIEF PAIN ARNICA + 12..........142T-RELIEF PAIN RELIEF....................142TRELSTAR MIXJECT........................142tretinoin ................................................ 142TREXALL............................................142triamcinolone acetonide ............... 142, 143TRIAMINIC CHEST/NASAL CONGEST............................................143TRIAMINIC COLD & ALLERGY..... 143TRIAMINIC COLD/COUGH..............143TRIAMINIC COLD/COUGH DAY TIME.................................................... 143TRIAMINIC COUGH/RUNNY NOSE.............................................................. 143TRIAMINIC COUGH/SORE THROAT..............................................143TRIAMINIC FEVER REDUCER........143TRIAMINIC FLU/COUGH/FEVER... 143TRIAMINIC LONG ACTING COUGH................................................143TRIAMINIC NIGHT TIME COLD/CGH..........................................143TRIAMINIC SORE THROAT............ 143triamino ................................................ 143triamterene-hctz ....................................143triazolam ...............................................143tri-buffered aspirin ............................... 143trichloroacetic acid .............................. 143tricitrates .............................................. 143trifluoperazine hcl ................................ 143trifluridine ............................................ 143trihexyphenidyl hcl ............................... 143TRI-LO-SPRINTEC.............................143trimethobenzamide hcl ......................... 143trimethoprim .........................................143trimipramine maleate ........................... 143TRINATE.............................................143triple antibiotic ..................................... 143TRIPLE FLEX..................................... 143triple helix collagen ..............................143TRIPLE PASTE................................... 143triprolidine hcl ......................................144TRISPEC PSE PEDIATRIC................ 144TRIUMEQ............................................144TRI-VI-SOL......................................... 144TROCAINE THROAT.........................144TROCAL COUGH SUPPRESSANT.. 144TROCHIBASE CLASSIC................... 144trochibase s ...........................................144TROGARZO........................................ 144

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trolamine .............................................. 144TROMBONEX-D................................ 144trospium chloride ................................. 144TRUEPLUS GLUCOSE...................... 144TRUEPLUS INSULIN SYRINGE...... 144TRUEPLUS LANCETS 26G...............144TRUEPLUS LANCETS 28G...............144TRUEPLUS LANCETS 30G...............144TRUEPLUS LANCETS 33G...............144TRU-FIT ICE/HEAT ANKLE/GEL PAK...................................................... 144TRUVADA.......................................... 144trymine cg ............................................. 144tryptophan ............................................ 145TUMS E-X 750.................................... 145TUMS LASTING EFFECTS............... 145TUMS ULTRA 1000............................145tuohy epidural needle tw ...................... 145turpentine ..............................................145turpentine oil ........................................ 145TUSICOF............................................. 145TUSNEL C........................................... 145TUSNEL PEDIATRIC.........................145TUSNEL-DM PEDIATRIC................. 145tussin cf max multi-symptom ................ 145tussin cough dm .................................... 145tussin cough long-acting ...................... 145tussin dm max ....................................... 145TUSSI-PRES........................................ 145TUSSI-PRES PE PEDIATRIC............ 145TUSSI-PRES PEDIATRIC.................. 145TUSSLIN PEDIATRIC........................145TWINRIX.............................................145TYLENOL............................................145TYLENOL CHILDRENS PLUS MS COLD................................................... 145TYLENOL COLD & HEAD............... 145TYLENOL COLD MAX..................... 145TYLENOL COLD MULTI-SYMPTOM.......................................... 145TYLENOL COLD/FLU SEVERE.......145TYLENOL EXTRA STRENGTH....... 145TYLENOL INFANTS..........................145TYLENOL PM EXTRA STRENGTH.145TYLENOL SINUS SEVERE...............146TYLENOL WARMING COUGH/CONGEST............................ 146TYPHIM VI......................................... 146tyrosine ................................................. 146TYVASO REFILL............................... 146ubidecarenone ...................................... 146ULCEREASE.......................................146ULORIC............................................... 146ULTICARE ALCOHOL SWABS....... 146ULTICARE INSULIN SAFETY SYR 146ULTICARE INSULIN SYRINGE...................................................... 146, 147ULTICARE SYRINGE........................147ULTICARE TUBERCULIN SAFETY SYR...................................................... 147ultilet alcohol swabs .............................147ULTILET CLASSIC LANCETS......... 147ULTILET INSULIN SYRINGE.......... 147

ULTILET INSULIN SYRINGE SHORT.................................................147ULTILET LANCETS...........................147ultra comfort insulin syringe ................ 147ULTRA FRESH................................... 148ULTRA FRESH PM............................ 148ULTRA MEGA GOLD........................148ULTRA MIDE 25................................ 148ultracin ................................................. 148ULTRACIN M..................................... 148ULTRACIN T...................................... 148ULTRACIN-M.....................................148ultra-comfort insulin syringe ................148ultrasone ...............................................148ULTRA-THIN II INS SYR SHORT....148ULTRA-THIN II INSULIN SYRINGE.............................................................. 148ULTRA-THIN II LANCETS............... 149UMCKA ELDERBERRY COLD+FLU.............................................................. 149UMCKA FASTACTIVES COLD+FLU......................................... 149UMECTA MOUSSE............................149undecylenic acid ................................... 149UNDELENIC....................................... 149unibase ..................................................149UNILET COMFORTOUCH LANCET.............................................................. 149UNILET EXCELITE........................... 149UNILET EXCELITE II ........................149UNILET G.P. LANCET.......................149UNILET G.P. SUPERLITE LANCET.149UNILET GP 28 ULTRA THIN............149UNILET LANCET...............................149UNILET MICRO-THIN 33G...............149UNILET SUPERLITE LANCET.........149UNILET SUPER-THIN 30G............... 149UNILET ULTRA-THIN 28G.............. 149UNI-SOLVE.........................................149UNIVERSAL 1 LANCETS THIN 26G.............................................................. 149UNIVERSAL 1 LANCETS THIN 33G.............................................................. 149UNIVERSAL 1 LANCETS ULTRA THIN.................................................... 149universal ph .......................................... 149urea .......................................................149urea 20 intensive hydrating ..................149urea hydrating ...................................... 149urea nail ............................................... 149urea peroxide ........................................149urinary pain relief ................................ 149URO-MAG...........................................149ursodiol .................................................149vagicaine .............................................. 149VAGIFEM............................................149valacyclovir hcl .................................... 149valerian .................................................149valerian root ......................................... 149valganciclovir hcl ................................. 149valine ............................................ 149, 150VALINE 1000...................................... 149valproate sodium .................................. 150

valproic acid .........................................150valsartan ...............................................150valsartan-hydrochlorothiazide ............. 150VALSTAR............................................150value health insulin syringe ..................150value plus lancet standard 21g .............150value plus lancets super thin ................ 150value plus lancets thin 26g ................... 150valumark lancet super thin 30g ............ 150valumark lancet ultra thin 28g ............. 150VAMOUSSE LICE TREATMENT.....150VANACHOL........................................150VANACLEAR PD............................... 150VANACOF...........................................150VANACOF AC.................................... 150VANACOF DM................................... 150VANACOF-8....................................... 150vanadium .............................................. 150VANAMINE PD.................................. 150VANATAB AC....................................150VANATAB DM................................... 150vancomycin hcl ..................................... 150vancomycin hcl in dextrose .................. 150vancomycin hcl in nacl ......................... 150VANDAZOLE..................................... 150VANICREAM DIAPER RASH...........150VANIPLY............................................ 150VANISHPOINT SAFETY SYRINGE.150VANTAS..............................................150VAPOR PATCH.................................. 150VAQTA................................................ 150VARIVAX............................................151VASHE WOUND THERAPY.............151VASOCLEAR-A..................................151VASOFLEX D1................................... 151VCF VAGINAL CONTRACEPTIVE. 151VECTIBIX........................................... 151veegum ..................................................151VELCADE........................................... 151venaliv .................................................. 151VENIA..................................................151venlafaxine hcl ......................................151venlafaxine hcl er ................................. 151VENTAVIS.......................................... 151verapamil hcl ........................................151verapamil hcl er ....................................151versabase .............................................. 151VERSAPLUS....................................... 151VERSIVA XC...................................... 151VESICARE.......................................... 151VIBERZI.............................................. 151VIBRAMYCIN.................................... 151VICKS DAYQUIL MUCUS CONTROL DM....................................151VICKS NYQUIL CHILDRENS CLD/CGH............................................ 151VICKS NYQUIL COLD & FLU NIGHT..................................................151VICKS NYQUIL COUGH.................. 151VICKS NYQUIL SEVERE COLD & FLU...................................................... 152VICKS SINEX DAYQUIL/NYQUIL..152VICKS VAPO STEAM........................152

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VICKS VAPODROPS......................... 152VICKS VAPOINHALER.....................152VICKS VAPORUB..............................152VICODIN............................................. 152VICODIN ES....................................... 152VICODIN HP....................................... 152VICTOZA............................................ 152VIDA MIA UNILET LANCETS 28G.152VIDEX..................................................152vigabatrin ............................................. 152VIGAMOX...........................................152VIIBRYD............................................. 152VIMPAT...............................................152VINATE M...........................................152vinblastine sulfate .................................152VINCASAR PFS..................................152VINCE..................................................152vinorelbine tartrate ...............................152VIRACEPT.......................................... 152virtussin dac ......................................... 152VISI-FLOW IRRIGATION STARTER.............................................................. 152vita-c .....................................................152VITA-CALCIUM.................................152VITADYE............................................ 152VITAFOL ULTRA...............................152VITALINE BIOTIN FORTE/ZINC.....152VITALINE COQ10..............................152VITA-MAG..........................................152VITAMAX........................................... 152VITAMELTS ENERGY VITAMIN B-12.......................................................... 152vitamin a ............................................... 153vitamin a & d ................................152, 153VITAMIN A FISH............................... 153vitamin a palmitate ...............................153vitamin a wrinkle treatment ..................153vitamin a-beta carotene ........................153vitamin b complex-c ..............................153vitamin b-1 ............................................153vitamin b12 ........................................... 153vitamin b-12 ..........................................153vitamin b-2 ............................................153vitamin b-6 ............................................153vitamin b-6 er ....................................... 153vitamin c ............................................... 153vitamin c (calcium ascorbate) .............. 153vitamin c drops ..................................... 153vitamin c gummies ................................ 153vitamin c plus wild rose hips ................ 153vitamin c-rose hips er ........................... 153vitamin d2 ............................................. 153vitamin d3 ............................................. 153vitamin d-400 ........................................153vitamin e ............................................... 153VITAMIN E & C BEAUTY LOTION 153VITAMIN E & K BEAUTIFUL SKIN 153vitamin e acetate ...................................153vitamin e beauty ....................................153vitamin e succinate ............................... 153vitamin e/selenium ................................154vitamin k1 ............................................. 154vitamins acd-fluoride ............................154

VITAMINS E & A BEAUTY OIL...... 154VITAMINS E & D BEAUTY OIL...... 154VITA-RAY...........................................154VITONIC..............................................154viva ....................................................... 154VIVA DROPS...................................... 154VIVABEN............................................ 154VIVITROL........................................... 154VIVOTIF.............................................. 154VOGELXO...........................................154VOGELXO PUMP...............................154VOLTAREN........................................ 154VOPAC 5............................................. 154voriconazole ......................................... 154vp insulin syringe ..................................154VYVANSE...........................................154WAL-DRYL.........................................154WAL-DRYL ANTI-ITCH................... 154WAL-DRYL PE ALLERGY & SINUS.............................................................. 154WAL-FEX D ALLERGY & CONGESTION.................................... 154WAL-FLU COLD & SORE THROAT154WAL-FLU SEV COLD/CGH DAY/NIGHT........................................154WALGREENS LANCETS.................. 154walgreens lancets micro thin ................154walgreens lancets super thin ................ 154WALGREENS THIN LANCETS........154WALGREENS ULTRA THIN LANCETS............................................ 154WAL-ITIN D........................................154WAL-PHED PE DAYTIME/NIGHTTIME.................... 154WAL-SLEEP Z.................................... 155WAL-SLEEP Z LIQUID SHOTS........154wal-tap cold/allergy ............................. 155WAL-TUSSIN CF MAX..................... 155wal-tussin cough relief ......................... 155WAL-ZYR............................................155WAL-ZYR CHILDRENS.................... 155warfarin sodium ................................... 155wart remover maximum strength ..........155WATCHHALER.................................. 155water oral ............................................. 155water tabs ............................................. 155wax for braces ...................................... 155wax, white .............................................155WEBCOL ALCOHOL PREP LARGE 155WEBCOL ALCOHOL PREP MEDIUM............................................. 155wee care ................................................155wegmans complete prenatal+dha ........ 155WEISS EPIDURAL NEEDLE.............155WEISS EPIDURAL NEEDLE TW..... 155WELCHOL.......................................... 155WELLMIND MENTAL FOCUS.........155WHITE PED ARTERIAL NEEDLE... 155white petrolatum ...................................155WIDE-SEAL DIAPHRAGM 60.......... 155WIDE-SEAL DIAPHRAGM 65.......... 155WIDE-SEAL DIAPHRAGM 70.......... 155WIDE-SEAL DIAPHRAGM 75.......... 155

WIDE-SEAL DIAPHRAGM 80.......... 155WIDE-SEAL DIAPHRAGM 85.......... 155WIDE-SEAL DIAPHRAGM 90.......... 155WIDE-SEAL DIAPHRAGM 95.......... 155WINGS MATERNITY PANTS 2X-3X.............................................................. 155WINRHO SDF..................................... 156wintergreen oil ..................................... 156witch hazel ............................................156WITEPSOL.......................................... 156wound gel ............................................. 156wound gel spray ....................................156WYMZYA FE......................................156xanthan gum ......................................... 156XARELTO........................................... 156XEOMIN.............................................. 156XERAC AC..........................................156XEROFORM PETROLAT GAUZE 1"X8"....................................................156XGEVA................................................ 156XIAFLEX.............................................156XIFAXAN............................................ 156XOLAIR...............................................156xolido .................................................... 156X-SEB T PEARL................................. 156XTRA-CARE....................................... 156XULANE..............................................156xylitol .................................................... 156XYREM................................................156YES FOR WOMEN............................. 156YF-VAX...............................................156YUVAFEM.......................................... 156ZADITOR............................................ 156zafirlukast ............................................. 156zaleplon ................................................ 156ZANOSAR........................................... 156ZANTAC 150 MAXIMUM STRENGTH......................................... 156ZANTAC 75.........................................156Z-BUM................................................. 156ZEASORB............................................156ZEGERID OTC....................................156ZELBORAF......................................... 157ZENPEP............................................... 157ZEPHREX-D........................................157ZE-PLUS.............................................. 157ZEVALIN Y-90................................... 157ZICAM ALLERGY RELIEF...............157ZICAM COLD REMEDY................... 157zidovudine .............................................157ZIKS ARTHRITIS PAIN RELIEF...... 157ZILACTIN............................................157ZILACTIN-B........................................157ZIMS MAX-FREEZE.......................... 157zinc ........................................................157zinc + vitamin c .................................... 157ZINC 15................................................157zinc acetate ........................................... 157zinc aspartate ....................................... 157zinc chloride ......................................... 157zinc gluconate .......................................157zinc methionate .....................................157zinc oxide ..............................................157

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zinc stearate ..........................................157zinc sulfate ............................................157zinc sulfate heptahydrate ......................157zinc-c-b6 ............................................... 157zincolate ................................................157ZINC-OXYDE PLUS...........................157zinc-vitamin c ....................................... 157ziprasidone hcl ..................................... 157ZITHROMAX...................................... 157zn-50 ..................................................... 157ZOLADEX........................................... 157zoledronic acid ..................................... 158ZOLINZA.............................................158zolmitriptan .......................................... 158zolpidem tartrate .................................. 158zolpidem tartrate er .............................. 158ZOMIG.................................................158zonisamide ............................................ 158ZORTRESS.......................................... 158ZOSTAVAX........................................ 158ZOSTRIX HOT & COLD THERAPY 158ZOSTRIX HP....................................... 158ZOSTRIX-HP.......................................158ZOVIRAX............................................ 158Z-TUSS AC..........................................158ZYCLARA........................................... 158ZYLET................................................. 158ZYNCOF.............................................. 158ZYRTEC ALLERGY...........................158ZYRTEC-D ALLERGY & CONGESTION.................................... 158ZYTAZE.............................................. 158ZZZQUIL............................................. 158

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VIRGINIA PREMIER HEALTH PLAN MEDICAID FORMULARY · 2019-09-27 · 7-keto dhea powder: Formulary. A & D ZINC OXIDE EXTERNAL CREAM. Formulary. OTC: a thru z advanced oral tablet. Formulary: