2017 drug formulary - kaiser permanentepreferred oral chemotherapy: washington state law requires...

XB0001338-50-17All plans offered and underwritten by Kaiser Foundation Health Plan of Washington or Kaiser Foundation Health Plan of Washington Options, Inc.

Effective November 2017

2017 Drug FormularyFor members with individual and family plans

Core

Connect / Alliant Plus

or covered through small employer groups (1–50 employees)

HIOS ISSUER ID: 25768 and 80473

Drug Formulary INTRODUCTION

What is a formulary? A formulary is a list of generic, brand, and specialty drugs. It is used by practitioners to identify drugs that offer the best overall value, considering effectiveness, safety, and cost.

How is the drug formulary developed? The formulary is developed by the Kaiser Permanente Pharmacy and Therapeutics (P&T) Committee. The P&T Committee is composed of physicians from various medical specialties, pharmacists, and a consumer member. The P&T Committee reviews and selects the most appropriate drugs in each class for the formulary based on safety, effectiveness, and cost. The P&T Committee meets quarterly to review new and existing drugs to ensure that the formulary remains responsive to the needs of members and providers.

How do I search the formulary? Drugs on the formulary are listed by therapeutic class. An alphabetical index is included at the end of this document to assist in locating specific drugs. Drugs are listed by generic name if a generic is available. If there is no generic available, drugs are listed by the brand name. Drugs are organized by class and drug formulary tier. Drugs administered in a provider’s office or in a clinic (e.g., drugs given intravenously) may not be listed on the formulary. For coverage of these drugs, refer to your Benefit Booklet.

How do I use the formulary to understand my drug coverage? Drug coverage is based on an individual’s contracted benefit. Coverage for a specific drug is subject to each member’s medical coverage agreement. Please consult your Benefit Booklet or call Member Service if you have questions about your drug coverage. Kaiser Permanente will only cover FDA-approved drugs used for non-experimental therapies. Most plans exclude experimental and investigational drugs, over-the-counter drugs, drugs used in the treatment of sexual dysfunction disorders, drugs for anticipated illnesses while traveling, or drugs used for cosmetic purposes. Please consult your Benefit Booklet for limitations and exclusions.

Medications not listed in this document are not on the formulary at the time of publication. The most current information is online at www.kp.org/wa/formulary. Non-formulary drugs are not covered unless approved by the health plan as a coverage exception. The prescriber must contact Kaiser Permanente to determine the medical necessity of the non-formulary medication. An alternative formulary medication will be recommended when clinically appropriate. If a coverage exception is not approved, the patient is responsible for the full price of the drug.

Generic drugs are substituted when available and allowed by your prescriber. When a generic is available, the brand-name drug is generally considered non-formulary and subject to a higher cost share.

http://www.ghc.org/

The drug formulary is updated periodically and is subject to change. If a drug will be removed from the formulary, members who filled the drug in the prior three months will be notified by letter of the upcoming change. A formulary change notice will also be posted on the member website at least 45 days prior to the effective date.

Drug Formulary Tiers

Tier Description Tier P Preventative drugs and preferred contraceptives:

The Affordable Care Act (ACA) requires that preventative drugs recommended by the U.S. Preventative Services Task Force (USPSTF) are covered in full.

Tier 1 Preferred generic: Generic drugs are copies of brand name drugs in safety, effectiveness, and quality. They contain the same exact quantities of the same active ingredients and are more affordable than the brand name drug.

Tier 2 Preferred brand: Preferred brand drugs do not have a generic alternative, but were determined by the P&T Committee to have high value in their therapeutic class.

Tier C Preferred oral chemotherapy: Washington State law requires that cancer drugs be covered at a comparable level when received at a doctor’s office or picked up from the pharmacy. This tier was created to ensure comparable coverage of preferred anti-cancer drugs regardless where the drug was received.

Tier M Medical benefit: These drugs are usually given at the provider’s office and are covered under the medical benefit.

What are the methods that Kaiser Permanente uses to ensure appropriate and safe use of formulary drugs?

Prior Authorization (PA) The P&T Committee determines that certain drugs should require prior authorization before they will be covered. These drugs most often have alternatives on the formulary, safety concerns, or a high potential for inappropriate use. To request coverage for prior authorization drugs, you or your prescriber must contact Kaiser Permanente. Drugs requiring prior authorization are indicated with a “PA” superscript next to the drug name.

Step Therapy (ST) Step therapy requires you to try certain preferred drugs before receiving coverage for the drug you were prescribed. Step therapy is added by the P&T Committee. Step therapy automatically looks at your prescription history when you fill the drug you were prescribed. If you have tried the preferred drugs required by step therapy, the drug you were prescribed will automatically be covered. To request step therapy exceptions, you or your prescriber must contact Kaiser Permanente. Drugs requiring step therapy are indicated with a “ST” superscript next to the drug name.

Quantity Limit (QL) A quantity limit defines how much of a particular drug you can get during a specific time period or the maximum days supply that you can get at once. The P&T Committee determines if a drug should have a quantity limit. To request exceptions to quantity limits, your prescriber must contact Kaiser Permanente. Drugs with quantity limits are indicated with “QL” superscript next to the drug name. Drugs Limited to Select Pharmacies Some drugs are required to be dispensed from a preferred specialty pharmacy vendor. Members with an out-of-network benefit may use other pharmacies; however, they may pay a higher cost share. Please consult your Benefit Booklet for limitations and exclusions. Drugs limited to select pharmacies are listed on the www.kp.org/wa/formulary webpage.

Covered Diabetic Supplies Some diabetic supplies may be covered at a Tier 1 cost share if they are filled as a prescription. These items are:

• Preferred blood glucose strips: o One Touch Verio o One Touch Ultra o Prodigy – prior authorization required o Contour Next – prior authorization required o Freestyle – prior authorization required

• Disposable insulin syringes and needles • Lancing devices and lancets

Preferred blood glucose meters are covered only when filled through mail order pharmacy.

Mail Order Pharmacy Service Mail order is convenient and efficiently utilizes Kaiser Permanente’s resources. This service works best for drugs that must be taken on regular basis, such as birth control pills and drugs for high blood pressure, high cholesterol, or other chronic conditions. To begin using mail order, ask your prescriber to send your prescription directly to the Mail Order Pharmacy. To transfer an existing prescription from a retail pharmacy, contact the Mail Order Pharmacy.

Address: Kaiser Permanente Mail Order Pharmacy PO Box 34383 Seattle, WA 98124-1383

Phone: 800-245-RXRX (1-800-245-7979)

Fax: 206-630-7950, or toll-free 1-800-350-1683

Preventative Medications and Preferred Contraceptives In accordance with the Affordable Care Act (ACA) requirements for preventive services, most plans cover preventative care medicines and contraceptives in full. If your plan offers ACA benefits, all prescribed FDA approved contraceptive methods from the Kaiser

Permanente formulary list will be covered in full when obtained in-network. For plans with out-of-network (OON) benefits, contraceptives will be subject to the OON cost-share. The list of the preventative medications covered in full is available on the www.kp.org/wa/formulary webpage.

Please consult your Benefit Booklet under “Preventive Services” or call Member Service if you have questions about your coverage for these drugs.

If you request coverage for a non-preferred contraceptive, we will contact your provider to recommend a preferred generic or therapeutically equivalent product. If you and your provider determine that the preferred contraceptive(s) would be medically inappropriate, your provider must request a contraceptive waiver. If waiver is completed, the requested non-preferred contraceptive will be covered in full.

Excluded Prescription Products for Medications that have Over-The-Counter (OTC) Alternatives There are certain prescription products that have the same or similar products available over-the- counter (OTC) without a prescription. In certain cases, Kaiser Permanente will not cover the prescription product. The following prescription drug products are excluded from coverage: esomeprazole magnesium (Nexium) and omeprazole/sodium bicarbonate (Zegerid).

Medical Benefit Injectable Drugs Some drugs are given in a non-hospital setting such as home infusion, a medical office, a physician's office, or an infusion suite. These drugs are covered under the medical benefit but may require prior authorization or a non-hospital setting. The list of medical benefit injectable drugs is available on the www.kp.org/wa/formulary webpage.

How do I get additional information? Please contact Member Service at 1-888-630-4636 with any questions or concerns regarding the information contained in this document.

The most current drug formulary is available at www.kp.org/wa/formulary.

Table of Contents

ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

PENICILLINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

CEPHALOSPORIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

FIRST GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

SECOND GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

THIRD GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

MACROLIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

TETRACYCLINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

QUINOLONES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

AMINOGLYCOSIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

SULFONAMIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

ANTIMYCOBACTERIAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

ANTIFUNGALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

ANTIVIRALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

ANTIMALARIALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

ANTHELMINTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

MISC. ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

ANTINEOPLASTICS, ETC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

ALKYLATING AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

ANTIMETABOLITES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

ANTIBODIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

HORMONAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

IMMUNOMODULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

MITOTIC INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

ENZYME INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

ANTINEOPLASTICS MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

CHEMOTHERAPY RESCUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

CARDIOVASCULAR DRUGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

CARDIAC GLYCOSIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

ANTIANGINAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

BETA BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

CALCIUM CHANNEL BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

ANTIARRHYTHMICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

ACE INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

ANGIOTENSIN RCPTR BLOCKER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

DIRECT RENIN INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

ANTIHYPERTENSIVES MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

ANTIHYPERTENSIVE COMBO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

DIURETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

VASOPRESSORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

ANTIHYPERLIPIDEMICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

CARDIOVASCULAR - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

DERMATOLOGICALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

ACNE PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

ROSACEA AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

ANTIBIOTICS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

ANTIFUNGALS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

ANTIVIRALS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

ANTI-INFLAMMATORY AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

ANTIPRURITICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

ANTIPSORIATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

ANTISEBORRHEIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

CORTICOSTEROIDS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

IMMUNOMODULATING AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

DERMATOLOGICALS - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

ENDOCRINE AND METABOLIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

CORTICOSTEROIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

ANDROGENS-ANABOLIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

ESTROGENS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

CONTRACEPTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

PROGESTINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

ANTIDIABETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

INSULIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

AMYLIN ANALOGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

INCRETIN MIMETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

SULFONYLUREAS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

BIGUANIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

MEGLITINIDE ANALOGUES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

DIABETIC OTHER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

ALPHA-GLUCOSIDASE INHIBIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

DPP-4 INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

INSULIN SENSITIZING AGENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

ANTIDIABETIC COMBINATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

BISPHOSPHONATES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

CALCITONINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

PARATHYROID HORMONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

RANK LIGAND INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

HORMONE RECEPTOR MDLTR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

LHRH/GNRH AGONIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

GROWTH HORMONES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

SOMATOMEDINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

SOMATOSTATIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

GH RECEPTOR ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

POSTERIOR PITUITARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

CORTICOTROPIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

PROLACTIN INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

VASOPRESSIN ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

METABOLIC MODIFIERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

THYROID AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

GASTROINTESTINAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

LAXATIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

ANTIDIARRHEALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

ULCER DRUGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

ANTIEMETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

DIGESTIVE AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

GASTROINTESTINAL - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

GENITOURINARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

URINARY ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

URINARY ANTISPASMODICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

VAGINAL PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

GENITOURINARY - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

HEMATOLOGICAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

HEMATOPOIETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

ANTICOAGULANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

HEMOSTATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

HEMATOLOGICAL - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

MOUTH/THROAT/DENTAL AGENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

NEUROLOGY, CNS, PSYCH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

ANTIANXIETY AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

ANTIDEPRESSANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

ANTIPSYCHOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

HYPNOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

ADHD, NARCOLEPSY, ETC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

ANTICONVULSANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

ANTIPARKINSON AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

NEUROLOGY, PSYCH - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

NEUROMUSCULAR AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

MUSCULOSKELETAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

ANTIMYASTHENIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

OPHTHALMOLOGY AND OTIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

ARTIFICIAL TEAR/LUBRICANT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

BETA-BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

OPHTHALMIC STEROIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

PROSTAGLANDINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

CYCLOPLEGIC MYDRIATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

DECONGESTANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

MIOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

ADRENERGIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

IMMUNOMODULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

LOCAL ANESTHETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

OPHTHALMICS - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

OTIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

OXYTOCICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

PAIN MANAGEMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

ANALGESICS - NONNARCOTIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

ANALGESICS - OPIOID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

OPIOID ANTAGONIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

ANTI-INFLAMMATORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

MIGRAINE PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

GOUT AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

LOCAL ANESTHETICS-INJ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

RESPIRATORY, ALLERGY, ETC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

ANTIHISTAMINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

NASAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

COUGH/COLD/ALLERGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

ANTIASTHMATIC/COPD AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

RESPIRATORY AGENTS - MISC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

TOXOIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

VACCINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

VITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

VITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

MULTIVITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

MEDICAL DEVICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

DIABETIC SUPPLIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

MEDICAL DEVICES - MISC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

MISCELLANEOUS AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Cefazolin Inj 1gm

Cefazolin Inj 1gm/50ML

SECOND GENERATION

TIER 01 GENERIC

November 2017

cefaclor CAP 250MGPA

cefaclor CAP 500MGPA

ANTI-INFECTIVES

cefprozil sus 125/5ML

cefprozil sus 250/5ML

PENICILLINS

cefprozil TAB 250MG

TIER 01 GENERIC

cefprozil TAB 500MG

amox/k clav sus 200/5ML

cefuroxime TAB 250MG


cefuroxime TAB 500MG


Cefaclor ER TAB 500MGPA


Cefaclor Sus 125/5MLPA

amox/k clav TAB 250-125





TIER 02 PREFERRED

amoxicillin sus 125/5ML

Ceftin Sus 125/5ML


Ceftin Sus 250/5ML


THIRD GENERATION

amoxicillin sus 250MG/5m

TIER 01 GENERIC


cefdinir sus 125/5ML

amoxicillin CAP 250MG

cefdinir sus 250/5ML

amoxicillin CAP 500MG

cefdinir CAP 300MG

amoxicillin TAB 500MG

cefixime sus 100/5ML

amoxicillin TAB 875MG

cefixime sus 200/5ML

ampicillin inj 1gm

cefpodo prox sus 100/5MLPA

ampicillin inj 10gm

cefpodo prox sus 50MG/5MLPA

ampicillin inj 250MG

cefpodoxime TAB 100MGPA

ampicillin inj 500MG

cefpodoxime TAB 200MGPA

ampicillin CAP 250MG

ceftazidime inj 1gm

ampicillin CAP 500MG

ceftriaxone inj 1gm

dicloxacill CAP 250MG

ceftriaxone inj 10gm

dicloxacill CAP 500MG

ceftriaxone inj 2gm

penicilln vk sol 125/5ML

ceftriaxone inj 250MG

penicilln vk sol 250/5ML

ceftriaxone inj 500MG

penicilln vk TAB 250MG

tazicef inj 1gm

penicilln vk TAB 500MG

Cefditoren TAB 200MGPA

Amox/K Clav Chw 200MG

Cefditoren TAB 400MGPA

Amox/K Clav Chw 400MG

Tazicef Inj 1gm

Amoxicillin Chw 125MG

Tazicef Inj 2gm

Amoxicillin Chw 250MG

TIER 02 PREFERRED

Ampicillin CAP 500MG

Cedax CAP 400MGPA

Ampicillin Inj 1gm

Ceftibuten CAP 400MGPA

Ampicillin Inj 125MG

Claforan Inj 1gm

Ampicillin Sus 125/5ML

Claforan Inj 2gm

Ampicillin Sus 250/5ML

Spectracef TAB 400MGPA

Nafcillin Inj 1gm

Suprax CAP 400MG

Nafcillin Inj 2gm

Suprax Sus 500/5ML

Penicilln Vk Sol 125/5ML

Penicilln Vk Sol 250/5ML

MACROLIDES

TIER 02 PREFERRED

TIER 01 GENERIC

Augmentin Sus 125/5ML

azithromycin sus 100/5ML

Bicillin L-a Inj 1200000

azithromycin sus 200/5ML


azithromycin TAB 250MG




CEPHALOSPORIN

clarithromyc sus 125/5ML

FIRST GENERATION

clarithromyc sus 250/5ML

TIER 01 GENERIC

clarithromyc TAB 250MG

cefadroxil sus 250/5ML

clarithromyc TAB 500MG

cefadroxil sus 500/5ML

erythrom ETH sus 200/5ML

cefadroxil CAP 500MG

Azithromycin Pow 1gm PAK

cefadroxil TAB 1gm

Clarithromyc Sus 125/5ML

cefazolin inj 1gm

Clarithromyc Sus 250/5ML

cephalexin sus 125/5ML

TIER 02 PREFERRED

cephalexin sus 250/5ML

Dificid TAB 200MGQL,PA

cephalexin CAP 250MG

Erythrocin Inj 500MG

cephalexin CAP 500MG

Effective November 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 1

TETRACYCLINES

rifabutin CAP 150MG

rifampin CAP 150MG

TIER 01 GENERIC

rifampin CAP 300MG

avidoxy TAB 100MG

Cycloserine CAP 250MG

demeclocycl TAB 150MG

Isoniazid Syp 50MG/5ML

demeclocycl TAB 300MG

TIER 02 PREFERRED

doxy 100 inj 100MG

Paser Gra 4gm

doxycyc mono CAP 100MG

Priftin TAB 150MGPA


Rifamate CAPPA


Rifater TABPA


Trecator TAB 250MG

doxycyc mono TAB 100MG


ANTIFUNGALS



TIER 01 GENERIC

doxycycl HYC inj 100MG

fluconazole sus 10MG/ML

doxycycl HYC CAP 100MG

fluconazole sus 40MG/ML

doxycycl HYC CAP 50MG

fluconazole TAB 100MG

doxycycl HYC TAB 100MG


minocycline CAP 100MG





flucytosine CAP 250MGQL

mondoxyne nl CAP 100MG

flucytosine CAP 500MGQL


griseofulvin sus 125/5ML


griseofulvin TAB micr 500

morgidox CAP 1X50MG

griseofulvin TAB ultr 125

tetracycline CAP 250MGPA

griseofulvin TAB ultr 250

tetracycline CAP 500MGPA

itraconazole CAP 100MGPA

Tetracycline CAP 250MGPA

ketoconazole TAB 200MG

Tetracycline CAP 500MGPA

nystatin TAB 500000

terbinafine TAB 250MG

QUINOLONES

voriconazole TAB 200MGPA

voriconazole TAB 50MGPA

TIER 01 GENERIC

Amphotericin Inj 50MG

ciprofloxacn sus 250MG/5

TIER 02 PREFERRED

ciprofloxacn sus 500MG/5

Ambisome Inj 50MG

ciprofloxacn TAB 250MG

Cancidas Inj 70MG


Caspofungin Inj 70MG


Cresemba CAP 186 MGQL,PA

levofloxacin sol 25MG/ML

Eraxis Inj 50MG

levofloxacin TAB 250MG

Mycamine Inj 100MG


Mycamine Inj 50MG


Noxafil Sus 40MG/MLQL,PA

moxifloxacin TAB 400MG

Sporanox Sol 10MG/MLPA

Ciprofloxacn TAB 100MG

TIER M MEDICAL COPAY

Levofloxacin Sol 25MG/ML

voriconazole sus 40MG/MLPA

TIER 02 PREFERRED

Avelox Inj

ANTIVIRALS

Cipro (5%) Sus 250MG/5

Factive TAB 320MGPA

TIER 01 GENERIC

abaca/lamivu TAB 600-300QL

AMINOGLYCOSIDES

abacav/lamiv TAB /zidovudQL

abacavir sol 20MG/ML

TIER 01 GENERIC

abacavir TAB 300MG

gentamicin inj 40MG/ML

acyclovir sus 200/5ML

neomycin TAB 500MG

acyclovir CAP 200MG

paromomycin CAP 250MGPA

acyclovir NA inj 50MG/ML

tobramycin neb 300/5MLQL,PA

acyclovir TAB 400MG

TIER 02 PREFERRED

acyclovir TAB 800MG

Tobramycin Neb 300/5MLQL,PA

adefov dipiv TAB 10MGQL

cidofovir inj 75MG/ML

SULFONAMIDES

didanosine CAP 125MG

TIER 01 GENERIC


Sulfadiazine TAB 500MG



ANTIMYCOBACTERIAL AGENTS

entecavir TAB 0.5MG

TIER 01 GENERIC

entecavir TAB 1MG

ethambutol TAB 100MG

famciclovir TAB 125MGPA

ethambutol TAB 400MG


isoniazid TAB 100MG


isoniazid TAB 300MG

fosamprenavi TAB 700MGQL

pyrazinamide TAB 500MG



ganciclovir inj 500MG

Peg-intron Kit 80mcg RpQL

lamivud/zido TAB 150-300

Pegasys InjQL

lamivudine sol 10MG/ML

Pegasys Inj ProclickQL

lamivudine TAB 100MG

Pegasys Inj 180mcg/MQL


Pegintron Kit 120mcgQL



lopin/riton sol 80-20/ML


moderiba TAB 200MGQL


nevirapine TAB 200MG

Prezcobix TAB 800-150PA

nevirapine TAB 400MG ER

Prezista Sus 100MG/MLPA

oseltamivir CAP 30MG

Prezista TAB 150MG


Prezista TAB 600MG


Prezista TAB 75MG

ribasphere CAP 200MGQL

Prezista TAB 800MGPA

ribasphere TAB 200MGQL

Rebetol Sol 40MG/MLQL

ribavirin CAP 200MGQL

Relenza Mis Diskhale

ribavirin TAB 200MGQL

Rescriptor TAB 100 MG

rimantadine TAB 100MG

Rescriptor TAB 200MG

stavudine sol 1MG/ML

Reyataz CAP 150MGQL

stavudine CAP 15MG

Reyataz CAP 200MGQL

stavudine CAP 20MG

Reyataz CAP 300MGQL

stavudine CAP 30MG

Reyataz Pow 50MG

stavudine CAP 40MG

Selzentry Sol 20MG/MLQL

valacyclovir TAB 1gm

Selzentry TAB 150MGQL

valacyclovir TAB 500MG

Selzentry TAB 25MG

valganciclov sol 50MG/MLQL

Selzentry TAB 300MGQL

valganciclov TAB 450MGQL

Selzentry TAB 75MG

zidovudine syp 50MG/5ML

Sovaldi TAB 400MGQL,PA

zidovudine CAP 100MG

Stribild TABQL,ST

zidovudine TAB 300MG

Sustiva CAP 200MG

Acyclovir NA Inj 500MG

Sustiva CAP 50MG

Nevirapine Sus 50MG/5ML

Sustiva TAB 600MG

TIER 02 PREFERRED

Tamiflu Sus 6MG/ML

Aptivus CAP 250MGQL

Tivicay TAB 10MG

Atripla TABQL

Tivicay TAB 25MG

Baraclude Sol .05MG/MLQL

Tivicay TAB 50MG

Complera TABQL,ST

Triumeq TABQL

Crixivan CAP 200MG

Truvada TAB 100-150QL

Crixivan CAP 400MG


Descovy TAB 200/25QL


Edurant TAB 25MG


Emtriva CAP 200MG

Tybost TAB 150MGPA

Emtriva Sol 10MG/ML

Tyzeka TAB 600MGQL,PA

Epclusa TAB 400-100QL,PA

Victrelis CAP 200MGQL,PA

Epivir HBV Sol 5MG/ML

Videx Sol 2gm

Genvoya TAB

Videx Sol 4gm

Harvoni TAB 90-400MGQL,PA

Viracept TAB 250MG

Intelence TAB 100MG

Viracept TAB 625MG

Intelence TAB 200MG

Viread Pow 40MG/GmQL

Intelence TAB 25MG

Viread TAB 150MGQL

Invirase CAP 200MG

Viread TAB 200MGQL

Invirase TAB 500MG

Viread TAB 250MGQL

Isentress Chw 100MG

Viread TAB 300MGQL

Isentress Chw 25MG

Ziagen Sol 20MG/ML

Isentress HD TAB 600MG

Isentress TAB 400MG

ANTIMALARIALS

Kaletra TAB 100-25MG

TIER 01 GENERIC

Kaletra TAB 200-50MG

atovaq/progu TAB 250-100PA

Lexiva Sus 50MG/MLQL

atovaq/progu TAB 62.5-25PA

Lexiva TAB 700MGQL

chloroquine TAB 250MG

Norvir CAP 100MG

chloroquine TAB 500MG

Norvir Sol 80MG/ML

hydroxychlor TAB 200MG

Norvir TAB 100MG

mefloquine TAB 250MGPA

Odefsey TABQL

quinine sulf CAP 324MG

Peg-intron Kit 120 RpQL

Chloroquine TAB 250MG

Peg-intron Kit 120mcgQL

Primaquine TAB 26.3MG

Peg-intron Kit 150 RpQL

TIER 02 PREFERRED


Coartem TAB 20-120MG


Daraprim TAB 25MGQL

Peg-intron Kit 50mcg RpQL



ANTHELMINTICS

temozolomide CAP 250MGQL


TIER 01 GENERIC

Cyclophosph CAP 25MG

ivermectin TAB 3MGPA

Cyclophosph CAP 50MG

TIER 02 PREFERRED

Gleostine CAP 10MG

Albenza TAB 200MG

Gleostine CAP 100MG

Biltricide TAB 600MG

Gleostine CAP 40MG

Gleostine CAP 5MG

MISC. ANTI-INFECTIVES

Hexalen CAP 50MGQL

TIER 01 GENERIC

Leukeran TAB 2MG

atovaquone sus 750/5ML

Lomustine CAP 10MG

clindamycin inj 150MG/ML

Lomustine CAP 100MG

clindamycin inj 300/2ML

Lomustine CAP 40MG

clindamycin inj 300MG

Myleran TAB 2MGQL

clindamycin inj 900/6ML

clindamycin sol 75MG/5ML

ANTIMETABOLITES

clindamycin CAP 150MG

TIER 01 GENERIC


methotrexate inj 1gm


methotrexate inj 1gm/40ML

colistimeth inj 150MG

methotrexate inj 100/4ML

dapsone TAB 100MG


dapsone TAB 25MG

methotrexate inj 25MG/ML

lincomycin inj 300MG/ML


linezolid sus 100/5ML

methotrexate inj 50MG/2ML

linezolid TAB 600MG

methotrexate TAB 2.5MG

metronidazol TAB 250MG

Fluorouracil CRE 0.5%

metronidazol TAB 500MG

Methotrexate Inj 25MG/ML

smz-tmp sus 200-40/5

TIER 02 PREFERRED

smz-tmp DS TAB 800-160

Fluoroplex CRE 1%

smz-tmp TAB 400-80MG

TIER C ORAL CHEMO

smz/tmp DS TAB 800-160

capecitabine TAB 150MGQL,PA

sulfatrim PD sus 200-40/5

capecitabine TAB 500MGQL,PA

trimethoprim TAB 100MG

fluorouracil dro 2%

vancomycin inj 1 gm

fluorouracil dro 5%

vancomycin inj 10gm

fluorouracil CRE 5%

vancomycin inj 1000MG

mercaptopur TAB 50MG

vancomycin inj 5gm

Fluorouracil Sol 2%


Fluorouracil Sol 5%


Tabloid TAB 40MG

vancomycin CAP 125MG

vancomycin CAP 250MG

ANTIBODIES

vancomycin 250/5ML

Chloramphen Inj 1gm


Cleocin Phos Inj 600MG

Rituxan Inj 100MGQL,PA

Clindamycin Inj 150MG/ML

Rituxan Inj 500MGQL,PA

Smz-tmp Inj 400-80/5

TIER 02 PREFERRED

HORMONAL AGENTS

Alinia Sus 100/5ML

TIER 01 GENERIC

Alinia TAB 500MG

leuprolide inj 1MG/0.2

Cayston Inh 75MGQL,PA

megestrol ac sus 40MG/ML

Ketek TAB 300MGPA

megestrol ac sus 400MG/10

Ketek TAB 400MGPA

megestrol ac TAB 20MG

Nebupent Inh 300MG

megestrol ac TAB 40MG

Primsol Sol 50MG/5ML

TIER 02 PREFERRED

Sivextro Inj 200MGQL,PA

Lupron Depot Inj 11.25MG

Sivextro TAB 200MGQL


Trimpex Sol 50MG/5ML


Xifaxan TAB 200MGQL,PA

Lupron Depot Inj 30MG

Xifaxan TAB 550MGQL,PA

Lupron Depot Inj 45MG



Invanz Inj 1gmPA

TIER P PREVENTIVE

tamoxifen TAB 10MG

ANTINEOPLASTICS, ETC.

tamoxifen TAB 20MG

TIER C ORAL CHEMO

ALKYLATING AGENTS

anastrozole TAB 1MG

TIER C ORAL CHEMO

bicalutamide TAB 50MG

melphalan TAB 2MGQL

exemestane TAB 25MGPA


flutamide CAP 125MG


letrozole TAB 2.5MG


nilutamide TAB 150MGPA




Emcyt CAP 140MGQL,PA

Caprelsa TAB 300MGQL,PA

Fareston TAB 60MGPA

Cometriq Kit 100MGQL,PA

Lysodren TAB 500MGPA


Xtandi CAP 40MGQL,PA


Zytiga TAB 250MGQL,PA

Gilotrif TAB 20MGQL,PA

Zytiga TAB 500MGQL,PA




Firmagon Inj 120MGPA

Imbruvica CAP 140MGQL,PA

Firmagon Inj 80MGPA

Inlyta TAB 1MGQL,PA

Iressa TAB 250MGQL,PA

IMMUNOMODULATORS

Lenvima CAP 10 MGQL,PA


TIER 01 GENERIC


azathioprine TAB 50MG


cyclosporine inj 50MG/ML

Mekinist TAB 0.5MGQL,PA

cyclosporine sol modified

Mekinist TAB 2MGQL,PA

cyclosporine CAP 100MG

Nexavar TAB 200MGQL,PA

cyclosporine CAP 100MG MD

Sprycel TAB 100MGQL,PA

cyclosporine CAP 25MG


cyclosporine CAP 25MG mod


gengraf sol 100MG/ML


gengraf CAP 100MG


gengraf CAP 25MG


gengraf CAP 50MG

Stivarga TAB 40MGPA

mycophenolat sus 200MG/ML

Sutent CAP 12.5MGQL,PA

mycophenolat CAP 250MG

Sutent CAP 25MGQL,PA

mycophenolat TAB 500MG

Sutent CAP 37.5MGQL,PA

mycophenolic TAB 180MG DR

Sutent CAP 50MGQL,PA

mycophenolic TAB 360MG DR

Tafinlar CAP 50MGQL,PA

sirolimus TAB 0.5MG

Tafinlar CAP 75MGQL,PA

sirolimus TAB 1MG

Tarceva TAB 100MGQL,PA

sirolimus TAB 2MG


tacrolimus CAP 0.5MG


tacrolimus CAP 1MG

Tasigna CAP 150MGQL,PA

tacrolimus CAP 5MG

Tasigna CAP 200MGQL,PA

Cyclosporine CAP 50MG Mod

Tykerb TAB 250MGQL,PA

TIER 02 PREFERRED

Votrient TAB 200MGQL,PA

Rapamune Sol 1MG/ML

Xalkori CAP 200MGQL,PA

TIER C ORAL CHEMO

Xalkori CAP 250MGQL,PA

Revlimid CAP 10MGQL,PA

Zelboraf TAB 240MGQL,PA


Zolinza CAP 100MGQL,PA

Revlimid CAP 2.5MGQL,PA

Zydelig TAB 100MGQL,PA


Zydelig TAB 150MGQL,PA


Zykadia CAP 150MGQL,PA


Thalomid CAP 100MGQL,PA

ANTINEOPLASTICS MISC.



TIER 01 GENERIC


hydroxyurea CAP 500MG

Hydrea CAP 500MG

MITOTIC INHIBITORS

TIER 02 PREFERRED

Intron A Inj 10muQL

TIER C ORAL CHEMO

Intron A Inj 18muQL

Etoposide CAP 50MGQL

Intron A Inj 25muQL

Intron A Inj 50muQL

ENZYME INHIBITORS

TIER C ORAL CHEMO

TIER 02 PREFERRED

bexarotene CAP 75MGQL,PA

Alecensa CAP 150MGQL,PA

tretinoin CAP 10MGQL

TIER C ORAL CHEMO

Matulane CAP 50MGQL

imatinib mes TAB 100MGQL,PA

Picato Gel 0.015%QL

imatinib mes TAB 400MGQL,PA

Picato Gel 0.05%QL

Afinitor Dis TAB 2MGQL,PA

Targretin CAP 75MGQL,PA



CHEMOTHERAPY RESCUE

Afinitor TAB 10MGQL,PA

TIER 01 GENERIC

Afinitor TAB 2.5MGQL,PA

mesna inj 1gm

Afinitor TAB 5MGQL,PA

TIER C ORAL CHEMO

Afinitor TAB 7.5MGQL,PA

leucovor CA TAB 25MG

Bosulif TAB 100MGQL,PA

leucovor CA TAB 5MG

Bosulif TAB 500MGQL,PA

Leucovor CA TAB 10MG

Caprelsa TAB 100MGQL,PA



Leucovor CA TAB 15MG

metoprol suc TAB 200MG ER

Mesnex TAB 400MG



CARDIOVASCULAR DRUGS

metoprol TAR TAB 100MG


CARDIAC GLYCOSIDES


TIER 01 GENERIC

metoprolol TAB 100MG ER

digitek TAB 0.125MG


digitek TAB 0.25MG


digox TAB 0.125MG


digox TAB 0.25MG

nadolol TAB 20MG

digoxin inj 0.25MG/1

nadolol TAB 40MG

digoxin TAB 0.125MG

nadolol TAB 80MG

digoxin TAB 0.25MG

pindolol TAB 10MG

Digoxin Sol 50mcg/ML

pindolol TAB 5MG

TIER 02 PREFERRED

propranolol CAP 120MG ER

Lanoxin PED Inj 0.1MG/ML



ANTIANGINAL AGENTS


TIER 01 GENERIC

propranolol TAB 10MG

isosorb din TAB 10MG






isosorb din TAB 5MG


isosorb mono TAB 10MG

sorine TAB 120MG

isosorb mono TAB 120MG ER

sorine TAB 160MG

isosorb mono TAB 20MG

sorine TAB 240MG


sorine TAB 80MG


sotalol AF TAB 120MG

minitran dis 0.1MG/HR

sotalol AF TAB 160MG


sotalol AF TAB 80MG


sotalol HCL TAB 120MG



nitroglycer dis 0.1MG/HR





Metoprolol TAB 37.5MG


Metoprolol TAB 75MG

nitroglyceri sub 0.6MG

Propranolol Sol 20MG/5ML

nitroglycern sub 0.3MG

Propranolol Sol 40MG/5ML

nitroglycern sub 0.4MG

Timolol Mal TAB 10MG

TIER 02 PREFERRED

Timolol Mal TAB 20MG

Isordil TAB 40MG

Timolol Mal TAB 5MG

Nitro-bid Oin 2%

TIER 02 PREFERRED

Nitro-dur Dis 0.3MG/HR

Brevibloc Sol 10MG/ML

Nitro-dur Dis 0.8MG/HR

Bystolic TAB 10MGPA

Ranexa TAB 1000MGPA

Bystolic TAB 2.5MGPA

Ranexa TAB 500MGPA

Bystolic TAB 20MGPA

Bystolic TAB 5MGPA

BETA BLOCKERS

TIER 01 GENERIC

CALCIUM CHANNEL BLOCKERS

acebutolol CAP 200MG

TIER 01 GENERIC

acebutolol CAP 400MG

afeditab TAB 30MG CR

atenolol TAB 100MG

afeditab TAB 60MG CR

atenolol TAB 25MG

amlodipine TAB 10MG

atenolol TAB 50MG

amlodipine TAB 2.5MG

betaxolol TAB 10MG

amlodipine TAB 5MG

betaxolol TAB 20MG

cartia XT CAP 120/24HR

bisoprol fum TAB 10MG


bisoprol fum TAB 5MG


carvedilol TAB 12.5MG


carvedilol TAB 25MG

dilt-XR CAP 120MG


dilt-XR CAP 180MG


dilt-XR CAP 240MG

esmolol HCL inj 10MG/ML

diltiazem inj 125/25ML

esmolol HCL inj 100MG/10

diltiazem inj 25MG/5ML

labetalol inj 5MG/ML

diltiazem inj 50/10ML

labetalol TAB 100MG

diltiazem CAP 120MG CD

labetalol TAB 200MG

diltiazem CAP 120MG ER

labetalol TAB 300MG






quinidine gl TAB 324MG CR


quinidine gl TAB 324MG ER


quinidine SU TAB 300MG


Procainamide Inj 100MG/ML


Procainamide Inj 500MG/ML


Quinidine Gl Inj 80MG/ML


Quinidine SU TAB 200MG


Quinidine SU TAB 300MG


Quinidine SU TAB 300MG ER

diltiazem TAB 120MG

TIER 02 PREFERRED

diltiazem TAB 30MG

Multaq TAB 400MGPA

diltiazem TAB 60MG

Norpace CAP 100MG CR

diltiazem TAB 90MG

Norpace CAP 150MG CR

felodipine TAB 10MG ER

felodipine TAB 2.5MG ER

ACE INHIBITORS

felodipine TAB 5MG ER

TIER 01 GENERIC

isradipine CAP 2.5MG

benazepril TAB 10MG

isradipine CAP 5MG

benazepril TAB 20MG

nicardipine CAP 20MG

benazepril TAB 40MG

nicardipine CAP 30MG

benazepril TAB 5MG

nifedical XL TAB 30MG

captopril TAB 100MG

nifedical XL TAB 60MG

captopril TAB 12.5MG

nifedipine CAP 10MG

captopril TAB 25MG

nifedipine CAP 20MG

captopril TAB 50MG

nifedipine TAB 30MG ER

enalapril TAB 10MG


enalapril TAB 2.5MG


enalapril TAB 20MG

nimodipine CAP 30MG

enalapril TAB 5MG

nisoldipine TAB 17MG ER

enalaprilat inj 1.25/ML

verapamil inj 2.5MG/ML

fosinopril TAB 10MG

verapamil CAP 100MG ER

fosinopril TAB 20MG


fosinopril TAB 40MG

verapamil CAP 120MG SR

lisinopril TAB 10MG


lisinopril TAB 2.5MG


lisinopril TAB 20MG


lisinopril TAB 30MG


lisinopril TAB 40MG


lisinopril TAB 5MG


moexipril TAB 15MG


moexipril TAB 7.5MG

verapamil TAB 120MG

perindopril TAB 2MG

verapamil TAB 120MG ER

perindopril TAB 4MG


perindopril TAB 8MG


quinapril TAB 10MG

verapamil TAB 40MG

quinapril TAB 20MG

verapamil TAB 80MG

quinapril TAB 40MG

Diltiazem Inj 100MG

quinapril TAB 5MG

Nisoldipine TAB 20MG ER

ramipril CAP 1.25MG


ramipril CAP 10MG


ramipril CAP 2.5MG

ramipril CAP 5MG

ANTIARRHYTHMICS

trandolapril TAB 1MG

TIER 01 GENERIC


amiodarone TAB 200MG


disopyramide CAP 100MG

disopyramide CAP 150MG

ANGIOTENSIN RCPTR BLOCKER

dofetilide CAP 125mcgPA

TIER 01 GENERIC


candesartan TAB 16MGPA



flecainide TAB 100MG


flecainide TAB 150MG


flecainide TAB 50MG

irbesartan TAB 150MG

mexiletine CAP 150MG

irbesartan TAB 300MG


irbesartan TAB 75MG


losartan pot TAB 100MG

pacerone TAB 200MG


propafenone TAB 150MG



telmisartan TAB 20MGPA






candesa/hctz TAB 16-12.5PA

valsartan TAB 160MG

candesa/hctz TAB 32-12.5PA

valsartan TAB 320MG

candesa/hctz TAB 32-25MGPA

valsartan TAB 40MG

enalapr/hctz TAB 10-25MG

valsartan TAB 80MG

enalapr/hctz TAB 5-12.5MG

Eprosart Mes TAB 600MGPA

fosinop/hctz TAB 10/12.5

TIER 02 PREFERRED

fosinop/hctz TAB 20/12.5

Edarbi TAB 40MGPA

irbesar/hctz TAB 150-12.5

Edarbi TAB 80MGPA

irbesar/hctz TAB 300-12.5

lisinop/hctz TAB 10-12.5

DIRECT RENIN INHIBITORS

lisinop/hctz TAB 20-12.5

lisinop/hctz TAB 20-25MG

TIER 02 PREFERRED

losartan/HCT TAB 100-12.5

Tekturna TAB 150MGPA

losartan/HCT TAB 100-25

Tekturna TAB 300MGPA

losartan/HCT TAB 50-12.5

metoprl/hctz TAB 100-25MG

ANTIHYPERTENSIVES MISC.


TIER 01 GENERIC


clonidine dis 0.1/24HR

moexipr/hctz TAB 15-12.5


moexipr/hctz TAB 15-25MG


moexipr/hctz TAB 7.5-12.5

clonidine TAB 0.1MG

qnapril/hctz TAB 10-12.5

clonidine TAB 0.2MG

qnapril/hctz TAB 20-12.5

clonidine TAB 0.3MG

qnapril/hctz TAB 20-25MG

doxazosin TAB 1MG

telmis/amlod TAB 40-10MGPA

doxazosin TAB 2MG


doxazosin TAB 4MG


doxazosin TAB 8MG


eplerenone TAB 25MG

telmisa/hctz TAB 40-12.5PA

eplerenone TAB 50MG

telmisa/hctz TAB 80-12.5PA

guanfacine TAB 1MG

telmisa/hctz TAB 80-25MGPA

guanfacine TAB 2MG

valsart/hctz TAB 160-12.5

hydralazine TAB 10MG

valsart/hctz TAB 160-25MG




valsart/hctz TAB 320-25MG



methyldopa TAB 250MG

Captopr/Hctz TAB 25-15MG

methyldopa TAB 500MG


minoxidil TAB 10MG


minoxidil TAB 2.5MG


phenoxybenza CAP 10MGQL

Metoprl/Hctz TAB 100-50MG

prazosin HCL CAP 1MG

Propran/Hctz TAB 40/25


Propran/Hctz TAB 80/25


terazosin CAP 1MG

DIURETICS

terazosin CAP 10MG

TIER 01 GENERIC

terazosin CAP 2MG

acetazolamid CAP 500MG ER

terazosin CAP 5MG

acetazolamid TAB 125MG

Methyldopate Inj 250/5ML

acetazolamid TAB 250MG

Phentolamine Inj 5MG

amilor/hctz TAB 5-50

Reserpine TAB 0.1MGPA

amiloride TAB 5MG

Reserpine TAB 0.25MGPA

bumetanide TAB 0.5MG

bumetanide TAB 1MG

ANTIHYPERTENSIVE COMBO

bumetanide TAB 2MG

TIER 01 GENERIC

chlorothiaz TAB 500MG

amlod/benazp CAP 10-20MG

chlorthalid TAB 25MG


chlorthalid TAB 50MG

amlod/benazp CAP 2.5-10MG

ethacrynic TAB acd 25MG


furosemide inj 10MG/ML


furosemide inj 100/10ML


furosemide inj 20MG/2ML

atenol/chlor TAB 100-25MG

furosemide inj 40MG/4ML

atenol/chlor TAB 50-25MG

furosemide sol 10MG/ML

benazep/hctz TAB 10-12.5

furosemide TAB 20MG


furosemide TAB 40MG

benazep/hctz TAB 20-25MG

furosemide TAB 80MG


hydrochlorot CAP 12.5MG

bisoprl/hctz TAB 10/6.25

hydrochlorot TAB 12.5MG

bisoprl/hctz TAB 2.5/6.25

hydrochlorot TAB 25MG

bisoprl/hctz TAB 5-6.25MG



hydrochlorot TAB 50MG

fenofibrate CAP 67MG

indapamide TAB 1.25MG

fenofibrate TAB 160

indapamide TAB 2.5MG

fenofibrate TAB 160MG

methazolamid TAB 25MG

fenofibrate TAB 54MG

methazolamid TAB 50MG

fluvastatin CAP 20MG

metolazone TAB 10MG

fluvastatin CAP 40MG

metolazone TAB 2.5MG

gemfibrozil TAB 600MG

metolazone TAB 5MG

lovastatin TAB 10MG

spirono/hctz TAB 25/25

lovastatin TAB 20MG

spironolact TAB 100MG

lovastatin TAB 40MG


omega-3-acid CAP 1gmPA


pravastatin TAB 10MG

torsemide TAB 10MG


torsemide TAB 100MG


torsemide TAB 20MG


torsemide TAB 5MG

prevalite pow 4gm

triamt/hctz CAP 37.5-25

prevalite pow 4gm pk

triamt/hctz TAB 37.5-25

rosuvastatin TAB 10MG

triamt/hctz TAB 75-50MG


Chlorothiaz TAB 250MG


Edecrin TAB 25MG


Furosemide Sol 8MG/ML

simvastatin TAB 10MG

Methyclothia TAB 5MG


Triamt/Hctz CAP 50-25MG


TIER 02 PREFERRED

simvastatin TAB 5MG

Aldactazide TAB 50/50


Diuril Sus 250/5ML

triklo CAP 1gmPA

Dyrenium CAP 100MG

Fenofibric TAB 105MG

Dyrenium CAP 50MG

Fenofibric TAB 35MG

Keveyis TAB 50MGPA

Niacor TAB 500MG

TIER 02 PREFERRED

VASOPRESSORS

Livalo TAB 1MGPA

Livalo TAB 2MGPA

TIER 01 GENERIC

Livalo TAB 4MGPA

dobutam/D5W inj 1MG/ML

Praluent Inj 150MG/MLQL,PA


Praluent Inj 75MG/MLQL,PA


Vascepa CAP 0.5gmPA

dobutamine inj 250MG

Vascepa CAP 1gmPA

dobutamine inj 500MG

Welchol PAK 3.75gmPA

epinephrine inj 0.1MG/ML

Welchol TAB 625MGPA

epinephrine inj 1MG/ML

midodrine TAB 10MG

CARDIOVASCULAR - MISC.

midodrine TAB 2.5MG

midodrine TAB 5MG

TIER 01 GENERIC

Epinephrine Inj 0.15MG

papaverine inj 30MG/ML

Epinephrine Inj 0.3MG

sildenafil TAB 20MGPA

Epinephrine Inj 1MG/ML

Papaverine Sol 30MG/ML

TIER 02 PREFERRED

TIER 02 PREFERRED

Epipen 2-PAK Inj 0.3MG

Adcirca TAB 20MGQL,PA

Epipen-JR Inj 2-PAK

Cialis TAB 2.5MGPA

Cialis TAB 5MGPA

ANTIHYPERLIPIDEMICS

Entresto TAB 24-26MGPA


TIER 01 GENERIC


atorvastatin TAB 10MG

Letairis TAB 10MGQL,PA


Letairis TAB 5MGQL,PA


Opsumit TAB 10MGQL,PA


Tracleer TAB 125MGQL,PA

cholestyram pow 4gm packets

Tracleer TAB 62.5MGQL,PA

cholestyram pow 4gm lite packets

Tyvaso Refil Sol 0.6MG/MLQL,PA

colestipol gra 5gm

Tyvaso Sol 0.6MG/MLQL,PA

colestipol TAB 1gm

Tyvaso Start Sol 0.6MG/MLQL,PA

ezetim/simva TAB 10-10MGPA

Uptravi TAB 1000mcgQL,PA







ezetimibe TAB 10MGPA

Uptravi TAB 200/800QL,PA











Sod SUL/Sulf Emu 10-5%

Ventavis Sol 10mcg/MLQL,PA

Sod SUL/Sulf Lot 10-5%

Ventavis Sol 20mcg/MLQL,PA

TIER 02 PREFERRED

Avar LS Pad 10-2%PA

DERMATOLOGICALS

Avar Pad 9.5-5%PA

Azelex CRE 20%

ACNE PRODUCTS

Differin Lot 0.1%

TIER 01 GENERIC

Epiduo Forte Gel 0.3-2.5%

adapal/ben p gel 0.1-2.5%PA

Epiduo Gel 0.1-2.5%PA

adapalene gel pmp 0.3%

Plexion Clth Pad 9.8-4.8%PA

adapalene gel 0.1%

Veltin GelPA

adapalene gel 0.3%

adapalene CRE 0.1%

ROSACEA AGENTS

amnesteem CAP 10MG

TIER 01 GENERIC

amnesteem CAP 20MG

metronidazol gel 0.75%

amnesteem CAP 40MG

metronidazol CRE 0.75%

avar cleanse emu 10-5%

rosadan gel 0.75%

avita gel 0.025%

rosadan CRE 0.75%

avita CRE 0.025%

TIER 02 PREFERRED

claravis CAP 10MG

Finacea Aer 15%

claravis CAP 20MG

Finacea Gel 15%

claravis CAP 30MG

Mirvaso Gel 0.33%PA

claravis CAP 40MG

Soolantra CRE 1%PA

clindacin mis etz 1%

clindacin-p pad 1%

ANTIBIOTICS - TOPICAL

clindamy/ben gel 1-5%

TIER 01 GENERIC

clindamycin gel tretinoiPA

gentamicin CRE 0.1%

clindamycin gel 1%

mupirocin oin 2%

clindamycin lot 1%

mupirocin CA CRE 2%

clindamycin lot 10MG/ML

mupirocin CRE 2%

clindamycin mis 1%

Gentamicin Oin 0.1%

clindamycin pad 1%

TIER 02 PREFERRED

clindamycin sol 1%

Altabax Oin 1%PA

ery/benzoyl gel 5-3%

Cortisporin CRE 0.5%

erythromycin gel 2%

Cortisporin Oin 1%

erythromycin sol 2%

myorisan CAP 10MG

ANTIFUNGALS - TOPICAL

myorisan CAP 20MG

myorisan CAP 30MG

TIER 01 GENERIC

myorisan CAP 40MG

ciclodan sol 8%

rosanil emu cleanser

ciclodan CRE 0.77%

sod SUL/sulf emu 10-5%

ciclopirox gel 0.77%

sod SUL/sulf lot 10-5%

ciclopirox sha 1%

sulfacetamid lot 10%

ciclopirox sol 8%

sulfacetamid sus 10%

ciclopirox sus 0.77%

tretinoin gel 0.01%

ciclopirox CRE 0.77%

tretinoin gel 0.025%

clotrim/beta lot diprop

tretinoin gel 0.04%

clotrim/beta CRE diprop

tretinoin gel 0.04%pmp

clotrim/beta CRE 1-0.05%

tretinoin gel 0.1%

econazole CRE 1%PA

tretinoin gel 0.1%P.M.

ketoconazole sha 2%

tretinoin CRE 0.025%

ketoconazole CRE 2%

tretinoin CRE 0.05%

naftifine CRE HCL 1%PA

tretinoin CRE 0.1%

naftifine CRE HCL 2%PA

zenatane CAP 10MG

nyamyc pow 100000

zenatane CAP 20MG

nyata pow 100000

zenatane CAP 30MG

nystat/triam oin

zenatane CAP 40MG

nystat/triam CRE

Adapalene Lot 0.1%

nystatin oin 100000

Bp Cleansing Emu 10-4%PA

nystatin pow 100000

Differin CRE 0.1%

nystatin CRE 100000

Retin-a CRE 0.025%

nystop pow 100000

Retin-a CRE 0.05%

TIER 02 PREFERRED

Retin-a CRE 0.1%

Ecoza Aer 1%PA

Retin-a Gel 0.01%

Ertaczo CRE 2%PA

Retin-a Gel 0.025%

Exelderm CRE 1%PA

Retin-a Micr Gel 0.04%

Exelderm Sol 1%PA

Retin-a Micr Gel 0.04%pmp

Luzu CRE 1%PA

Retin-a Micr Gel 0.1%

Naftin Gel 1%PA

Retin-a Micr Gel 0.1%P.M.



ANTIVIRALS - TOPICAL

clobetasol e CRE 0.05%ST

clobetasol gel 0.05%

TIER 02 PREFERRED

clobetasol oin 0.05%ST

Denavir CRE 1%PA

clobetasol sol 0.05%

clobetasol CRE 0.05%ST

ANTI-INFLAMMATORY AGENTS

cormax scalp sol 0.05%

TIER 02 PREFERRED

desonide lot 0.05%

Novoclair CREPA

desonide oin 0.05%

Nuvya CREPA

desonide CRE 0.05%

Voltaren Gel 1%PA

desoximetas gel 0.05%

desoximetas oin 0.05%

ANTIPRURITICS

desoximetas oin 0.25%

TIER 01 GENERIC

desoximetas CRE 0.05%

Doxepin HCL CRE 5%PA

desoximetas CRE 0.25%

TIER 02 PREFERRED

fluocin acet oil body

Prudoxin CRE 5%PA

fluocin acet oil scalp

Zonalon CRE 5%PA

fluocin acet oil 0.01% sc

fluocin acet oil 0.01%bdy

ANTIPSORIATICS

fluocin acet oin 0.025%

TIER 01 GENERIC

fluocin acet sol 0.01%

acitretin CAP 10MG

fluocin acet CRE 0.01%

acitretin CAP 17.5MG

fluocin acet CRE 0.025%

acitretin CAP 25MG

fluocinonide gel 0.05%

calcipotrien oin 0.005%

fluocinonide oin 0.05%

calcipotrien sol 0.005%

fluocinonide sol 0.05%

calcipotrien CRE 0.005%

fluocinonide CRE e 0.05%

calcitrene oin 0.005%

fluocinonide CRE 0.05%

methoxsalen CAP 10MGQL

fluticasone oin 0.005%

tazarotene CRE 0.1%

fluticasone CRE 0.05%

Calcitriol Oin 3mcg/GmPA

halobetasol oin 0.05%

Dritho-creme CRE HP 1%

halobetasol CRE 0.05%

Tazorac CRE 0.1%

hydrocort lot 2.5%

Vectical Oin 3mcg/Gm

hydrocort oin 1%

TIER 02 PREFERRED

hydrocort oin 2.5%

Cosentyx Inj 150MG/MLQL,PA

hydrocort CRE 2.5%

Cosentyx Inj 300doseQL,PA

hydrocort/ab oin 1%

Cosentyx Pen Inj 150MG/MLQL,PA

hydrosortiso oin absorbas

Cosentyx Pen Inj 300doseQL,PA

lokara lot 0.05%

Stelara Inj 45MG/0.5QL,PA

mometasone oin 0.1%

Stelara Inj 90MG/MLQL,PA

mometasone sol 0.1%

Tazorac CRE 0.05%

mometasone CRE 0.1%

Tazorac Gel 0.05%

prednicarbat oin 0.1%PA

Tazorac Gel 0.1%

prednicarbat CRE 0.1%PA

triamcinolon lot 0.025%

ANTISEBORRHEIC AGENTS

triamcinolon lot 0.1%

TIER 01 GENERIC

triamcinolon oin 0.025%

selenium SUL lot 2.5%


selenium SUL sha 2.25%


sod sulfacet sha 10%

triamcinolon CRE 0.025%

Selenium SUL Sha 2.25%



CORTICOSTEROIDS - TOPICAL

triderm CRE 0.1%

TIER 01 GENERIC

triderm CRE 0.5%

ala-cort CRE 2.5%

Amcinonide CRE 0.1%

alclometason oin 0.05%

Amcinonide Lot 0.1%

alclometason CRE 0.05%

Amcinonide Oin 0.1%

alphatrex gel 0.05%

Clocortolone CRE Piv 0.1%PA

aug betamet gel 0.05%

Desowen CRE 0.05%

aug betamet lot 0.05%

Desowen Lot 0.05%

aug betamet oin 0.05%

Diflorasone CRE 0.05%

aug betamet CRE 0.05%

Diflorasone Oin 0.05%

beta diprop gel 0.05%

HC butyrate oin 0.1%

betameth dip lot 0.05%

HC butyrate sol 0.1%

betameth dip oin 0.05%

HC butyrate CRE 0.1%

betameth dip CRE 0.05%

HC pramoxine CRE 2.5-1% (topical)

betameth val aer 0.12%

HC valerate oin 0.2%

betameth val lot 0.1%

HC valerate CRE 0.2%

betameth val oin 0.1%

Synalar CRE 0.025%

betameth val CRE 0.1%

Synalar Oin 0.025%

calcipotrien oin betamethPA

Tridesilon CRE 0.05%



TIER 02 PREFERRED

Veregen Oin 15%PA

Capex Sha 0.01%

Verrunex CREPA

Cordran 24X3 Tap 4mcg/CM

Cordran 80X3 Tap 4mcg/CM

ENDOCRINE AND METABOLIC

Halog CRE 0.1%PA

CORTICOSTEROIDS

Halog Oin 0.1%PA

TIER 01 GENERIC

Pramosone CRE 1-1%

budesonide CAP 3MG DRPA

Pramosone Lot 1%

deltasone TAB 20MG

Pramosone Lot 2.5%

dexameth PHO inj 10MG/ML

Taclonex SusPA

dexameth PHO inj 120MG/30

dexameth PHO inj 20MG/5ML

IMMUNOMODULATING AGENTS

dexameth PHO inj 4MG/ML

TIER 01 GENERIC

dexamethason elx 0.5/5ML

imiquimod CRE 5%

dexamethason TAB 0.5MG

tacrolimus oin 0.03%


tacrolimus oin 0.1%


TIER 02 PREFERRED

dexamethason TAB 4MG

Elidel CRE 1%

dexamethason TAB 6MG

fludrocort TAB 0.1MG

DERMATOLOGICALS - MISC.

hydrocort TAB 10MG

TIER 01 GENERIC

hydrocort TAB 20MG

agoneaze kit 2.5-2.5%

hydrocort TAB 5MG

ammonium lac lot 12%

methylpr ace inj 40MG/ML

ammonium lac CRE 12%

methylpr ace inj 80MG/ML

anodyne lpt kit 2.5-2.5%

methylpr ss inj 125MG

dermacinrx kit prizopak

methylpred TAB 16MG

empricaine kit 2.5-2.5%

methylpred TAB 32MG

glydo gel 2%

methylpred TAB 4MG

leva set kit

methylpred TAB 8MG

leva set kit 2.5-2.5%

pred sod PHO sol 5MG/5ML

lido bdk kit

prednisolone sol 15MG/5ML

lido-prilo kit 2.5-2.5%

prednisolone syp 15MG/5ML

lido/prilocn kit 2.5-2.5%

prednisone TAB 1MG

lido/prilocn CRE 2.5-2.5%

prednisone TAB 10MG

lidocaine gel 2%

prednisone TAB 2.5MG

lidocaine gel 2% jelly

prednisone TAB 20MG

lidocaine oin PAK 5%

prednisone TAB 5MG

lidocaine oin 5%

Cortisone Ac TAB 25MG

lidocaine pad 5%

Dexameth PHO Inj 10MG/ML

lidocaine-pr CRE

Dexamethason Sol 0.5/5ML

lidopril kit 2.5-2.5%

Dexamethason TAB 1MG

lidopril XR kit 2.5-2.5%

Dexamethason TAB 2MG

lindane lot 1%

Prednisolone Sol 25MG/5ML

lindane sha 1%

Prednisone PAK 10MG

liprozonepak kit 2.5-2.5%

Prednisone PAK 5MG

livixil PAK kit 2.5-2.5%

Prednisone Sol 5MG/5ML

malathion lot 0.5%PA

Prednisone TAB 50MG

medolor PAK kit 2.5-2.5%

TIER 02 PREFERRED

permethrin CRE 5%

Depo-medrol Inj 20MG/ML

podofilox sol 0.5%

Dexamethason CON 1MG/ML

prilolid kit 2.5-2.5%

Medrol TAB 2MG

priloxx LP kit 2.5-2.5%

rea LO 40 CRE 40%

ANDROGENS-ANABOLIC

relador PAK kit plus

TIER 01 GENERIC

relador PAK kit 2.5-2.5%

danazol CAP 100MG

urea CRE 40%

danazol CAP 200MG

Lindane Lot 1%

danazol CAP 50MG

Lindane Sha 1%

methyltestos CAP 10MGPA

LP lite PAK kit 2.5-2.5%

oxandrolone TAB 10MGPA

Spinosad Sus 0.9%

oxandrolone TAB 2.5MG

TIER 02 PREFERRED

testost cyp inj 100MG/MLPA

Condylox Gel 0.5%

testost cyp inj 200MG/MLPA

Drysol Sol 20%

testost enan inj 200MG/MLPA

Eurax CRE 10%

testosterone gel P.M. 1%QL,PA

Eurax Lot 10%

testosterone gel 1%(25MG)QL,PA

Sklice Lot 0.5%PA

testosterone gel 1%(50MG)QL,PA

Supracil CREPA

Depo-testost Inj 200MG/MLPA

Synera Dis 70-70MG

Testosterone Gel P.M. 1%QL,PA

Ulesfia Lot 5%

Testosterone Gel 1%(25MG)QL,PA



Testosterone Gel 1%(50MG)QL,PA

deso/ethinyl TAB estradio

QL,PA

drospir/ethi TAB 3-0.03MG

TIER 02 PREFERRED

drospire/ETH TAB estr/lev

Anadrol-50 TAB 50MGPA

drospirenone TAB ethy est

Androxy TAB 10MGPA

econtra EZ TAB 1.5MG

Methitest TAB 10MGPA

elinest TAB

emoquette TAB

ESTROGENS

enpresse-28 TAB

enskyce TAB

TIER 01 GENERIC

errin TAB 0.35MG

estrad val inj 20MG/MLPA

estarylla TAB 0.25-35

estrad val inj 200MG/5PA

ethy ETH est TAB 1-35

estradiol dis 0.025MG weeklyPA

ethynodiol TAB 1-50


fallback TAB 1.5MG


falmina TAB


fayosim TAB


femynor TAB 0.25-35


gianvi TAB 3-0.02MG

estradiol TAB 0.5MGPA

gildagia TAB 0.4-35

estradiol TAB 1MGPA

gildess FE TAB 1.5/30

estradiol TAB 2MGPA

gildess FE TAB 1/20

Climara Dis 0.025MGPA

gildess TAB 1.5/30


gildess TAB 1/20


gildess 24 TAB FE 1/20


heather TAB 0.35MG


introvale TAB

Climara Dis 0.1MGPA

isibloom TAB 0.15-30

Estropipate TAB 0.75MGPA

jencycla TAB 0.35MG

Estropipate TAB 1.5MGPA

jolessa TAB

Estropipate TAB 3MGPA

jolivette TAB 0.35MG

TIER 02 PREFERRED

juleber TAB

Delestrogen Inj 10MG/MLPA

junel FE TAB 1.5/30

Depo-estradi Inj 5MG/MLPA

junel FE TAB 1/20

Duavee TAB 0.45-20PA

junel FE 24 TAB 1/20

junel 1.5/30 TAB

CONTRACEPTIVES

junel 1/20 TAB

TIER P PREVENTIVE

kaitlib FE chw

aftera TAB 1.5MG

kariva TAB 28 day

altavera TAB

kelnor TAB 1/35

alyacen TAB 1/35

kimidess TAB

alyacen TAB 7/7/7

kurvelo TAB 0.15/30

amethia LO TAB

larin FE TAB 1.5/30

amethia TAB

larin FE TAB 1/20

amethyst TAB 90-20mcg

larin TAB 1.5/30

apri TAB

larin TAB 1/20

aranelle TAB

larin 24 TAB FE 1/20

ashlyna TAB

larissia TAB

aubra TAB 0.1-0.02

layolis FE chw

aviane TAB

leena TAB

azurette TAB 28 day

lessina TAB

balziva TAB

levonest TAB

bekyree TAB

levonor/ethi TAB

blisovi FE TAB 1.5/30

levonor/ethi TAB estradio

blisovi FE TAB 1/20

levonor/ethi TAB 0.1-0.02

blisovi 24 TAB FE 1/20

levonorgestr TAB 1.5MG

briellyn TAB

levora-28 TAB 0.15/30

camila TAB 0.35MG

lillow TAB 0.15/30

camrese LO TAB

lomedia 24 TAB FE

camrese TAB

loryna TAB 3-0.02MG

caziant PAK

low-ogestrel TAB

chateal TAB 0.15/30

lutera TAB

cryselle-28 TAB 28 TABS

lyza TAB 0.35MG

cyclafem TAB 1/35

marlissa TAB 0.15/30

cyclafem TAB 7/7/7

medroxypr ac inj 150MG/MLQL,PA

cyred TAB

melodetta chw 24 FE

dasetta TAB 1/35

mibelas 24 chw FE

dasetta TAB 7/7/7

micrgstin 24 TAB FE 1/20

daysee TAB

microgestin TAB FE 1/20

deblitane TAB 0.35MG

microgestin TAB FE1.5/30

delyla TAB 0.1-0.02

microgestin TAB 1.5/30



microgestin TAB 1/20

zovia 1/35e TAB

mono-linyah TAB 0.25-35

zovia 1/50e TAB

mononessa TAB

Depo-sq Prov Inj 104

my way TAB 1.5MG

Ella TAB 30MG

myzilra TAB

Kyleena Iud 19.5MG

necon TAB 0.5/35

Levo-ETH Est TAB 90-20mcg

necon TAB 1/35

Liletta Iud 52MG

necon TAB 10/11-28

LO Loestrin TAB

necon TAB 7/7/7

Mirena Iud System

next choice TAB 1.5MG

Natazia TAB

nikki TAB 3-0.02MG

Necon TAB 1/50-28

nora-be TAB 0.35MG

Nexplanon Imp 68MG

nore/ETH/fer chw 0.4MG-35

Norinyl TAB 1+50-28

noreth/ethin chw FE

Nuvaring Mis

noreth/ethin chw FE 1/20

Ogestrel TAB

noreth/ethin TAB FE 1/20

Paragard Iud T380a

noreth/ethin TAB 1/20

Plan B TAB 1.5MG

norethindron TAB 0.35MG

Safyral TAB

norgest/ethi TAB estradio

Skyla Iud 13.5MG

norgest/ethi TAB 0.25/35

Taytulla CAP

norlyda TAB 0.35MG

Xulane Dis 150-35

norlyroc TAB 0.35MG

nortrel TAB 0.5/35

PROGESTINS

nortrel TAB 1/35

TIER 01 GENERIC

nortrel TAB 7/7/7

medroxypr ac TAB 10MG

ocella TAB 3-0.03MG

medroxypr ac TAB 2.5MG

opcicon TAB 1.5MG

medroxypr ac TAB 5MG

option 2 TAB 1.5MG

norethin ace TAB 5MG

orsythia TAB

progesterone inj 50MG/ML

philith TAB 0.4-35

progesterone CAP 100MG

pimtrea TAB

progesterone CAP 200MG

pirmella TAB 1/35

TIER 02 PREFERRED

pirmella TAB 7/7/7

Makena Inj 250MG/MLPA

portia-28 TAB

previfem TAB

ANTIDIABETIC AGENTS

quasense TAB

INSULIN

rajani TAB

TIER 01 GENERIC

react TAB 1.5MG

Humulin Inj 70/30

reclipsen TAB

Humulin Inj 70/30kwp

rivelsa TAB

Humulin N Inj U-100

setlakin TAB

Humulin N Inj U-100kwp

sharobel TAB 0.35MG

Humulin R Inj U-100

sprintec 28 TAB 28 day

Humulin R Inj U-500

sronyx TAB

TIER 02 PREFERRED

syeda TAB 3-0.03MG

Apidra Inj U-100PA

take action TAB 1.5MG

Fiasp Inj 100/MLPA

tarina FE TAB 1/20

Humalog Inj 100/ML

tilia FE TAB

Humalog JR Inj 100/ML

tri femynor TAB

Humalog Kwik Inj 100/ML

tri-estaryll TAB

Humalog Kwik Inj 200/ML

tri-legest TAB FE

Humalog Mix Inj 50/50

tri-linyah TAB

Humalog Mix Inj 50/50kwp

tri-previfem TAB

Humalog Mix Inj 75/25kwp

tri-sprintec TAB

Humalog Mix Sus 75/25

tri-LO TAB estaryll

Lantus Inj Solostar

tri-LO- TAB marzia

Lantus Inj 100/ML

tri-LO- TAB sprintec

Levemir InjPA

trinessa LO TAB

Levemir Inj FlextoucPA

trinessa TAB

Novolog Inj 100/MLPA

trivora-28 TAB

Novolog Mix Inj 70/30PA

velivet PAK

AMYLIN ANALOGS

vestura TAB 3-0.02MG

TIER 02 PREFERRED

vienva TAB 0.1-20

Symlinpen 60 Inj 1000mcgPA

viorele TAB

Symlnpen 120 Inj 1000mcgPA

vyfemla TAB 0.4-35

INCRETIN MIMETIC AGENTS

wera TAB 0.5/35

TIER 02 PREFERRED

wymzya FE chw 0.4MG-35

Byetta Inj 10mcgPA

zarah TAB 3-0.03MG

Byetta Inj 5mcgPA

zenchent FE chw 0.4MG-35

Victoza Inj 18MG/3MLPA

zenchent TAB



SULFONYLUREAS

Tradjenta TAB 5MGPA

TIER 01 GENERIC

INSULIN SENSITIZING AGENT

glimepiride TAB 1MG

TIER 01 GENERIC

glimepiride TAB 2MG

pioglitazone TAB 30MGPA

glimepiride TAB 4MG

pioglitazone TAB 45MGPA

glipizide ER TAB 10MG

TIER 02 PREFERRED

glipizide ER TAB 2.5MG

Avandia TAB 2MGPA

glipizide ER TAB 5MG

Avandia TAB 4MGPA

glipizide TAB 10MG

Avandia TAB 8MGPA

glipizide TAB 5MG

ANTIDIABETIC COMBINATIONS

glipizide XL TAB 10MG

TIER 02 PREFERRED

glipizide XL TAB 2.5MG

Glyxambi TAB 10-5 MGPA

glipizide XL TAB 5MG

Glyxambi TAB 25-5 MGPA

glyburid mcr TAB 1.5MG

Invokamet TAB 150-1000PA

glyburid mcr TAB 3MG


glyburid mcr TAB 6MG


glyburide TAB 1.25MG

Invokamet TAB 50-500MGPA

glyburide TAB 2.5MG

Jentadueto TAB 2.5-1000PA

glyburide TAB 5MG


Chlorpropam TAB 100MG


Chlorpropam TAB 250MG

Xigduo XR TAB 10-1000PA

Tolazamide TAB 250MG

Xigduo XR TAB 10-500MGPA

Tolazamide TAB 500MG


Tolbutamide TAB 500MG


TIER 02 PREFERRED

Diabeta TAB 1.25MG

BISPHOSPHONATES

Diabeta TAB 2.5MG

TIER 01 GENERIC

Diabeta TAB 5MG

alendronate TAB 10MG

BIGUANIDES


TIER 01 GENERIC

alendronate TAB 5MG

metformin TAB 1000MG


metformin TAB 500MG

ibandronate TAB 150MG

metformin TAB 500MG ER

risedronate TAB 150MGST

metformin TAB 750MG ER


metformin TAB 850MG


TIER 02 PREFERRED


Riomet Sol

Alendronate Sol 70/75ML

Riomet Sol 500/5ML

Alendronate TAB 40MG

MEGLITINIDE ANALOGUES

Etidron Disd TAB 200MG

TIER 01 GENERIC

Etidron Disd TAB 400MG

nateglinide TAB 120MGPA

TIER 02 PREFERRED

nateglinide TAB 60MGPA

Fosamax + D TAB 70-2800

repaglinide TAB 0.5MGPA

Fosamax + D TAB 70-5600

repaglinide TAB 1MGPA


repaglinide TAB 2MGPA

zoledronic inj 4MG/5MLPA

DIABETIC OTHER

Zoledronic Inj 4MGPA

TIER 02 PREFERRED

Cycloset TAB 0.8MGPA

CALCITONINS

Farxiga TAB 10MGPA

TIER 01 GENERIC

Farxiga TAB 5MGPA

calcitonin spr 200/act

Glucagen Inj Hypokit

Fortical Spr 200/Act

Glucagon Kit 1MG

Invokana TAB 100MGPA

PARATHYROID HORMONE

Invokana TAB 300MGPA

TIER 02 PREFERRED

Jardiance TAB 10MGQL,PA

Forteo Sol 600/2.4QL,PA

Jardiance TAB 25MGQL,PA

Proglycem Sus 50MG/ML

RANK LIGAND INHIBITORS

ALPHA-GLUCOSIDASE INHIBIT

TIER C ORAL CHEMO

TIER 01 GENERIC

Prolia Sol 60MG/MLPA

acarbose TAB 100MG

Xgeva InjPA

acarbose TAB 25MG

acarbose TAB 50MG

HORMONE RECEPTOR MDLTR

miglitol TAB 25MGPA

TIER P PREVENTIVE

DPP-4 INHIBITORS

raloxifene TAB 60MGPA

TIER 02 PREFERRED

Januvia TAB 100MGPA

LHRH/GNRH AGONIST

Januvia TAB 25MGPA

TIER 02 PREFERRED

Januvia TAB 50MGPA

Lupaneta Kit 11.25-5PA

Onglyza TAB 2.5MGPA

Lupaneta Kit 3.75-5PA

Onglyza TAB 5MGPA



Lupr Dep-PED Inj 11.25MG

calcitriol CAP 0.25mcg

Lupr Dep-PED Inj 15MG

calcitriol CAP 0.5mcg

Lupr Dep-PED Inj 3m 30MG

doxercalcif CAP 0.5mcg

Lupr Dep-PED Inj 7.5MG

doxercalcif CAP 1mcg

Synarel Sol 2MG/MLQL,PA

doxercalcif CAP 2.5mcg

levocarnitin sol 1gm/10ML

GROWTH HORMONES

levocarnitin TAB 330MG

paricalcitol CAP 1 mcgPA

TIER 02 PREFERRED


Omnitrope Inj 10/1.5MLQL,PA


Omnitrope Inj 5.8MGQL,PA

phenylbutyra pow sodiumQL,PA

Omnitrope Inj 5/1.5MLQL,PA

sodium pheny TAB 500MGQL,PA

TIER 02 PREFERRED

SOMATOMEDINS

Buphenyl TAB 500MGQL,PA

TIER 02 PREFERRED

Carbaglu TAB 200MGQL,PA

Increlex Inj 40MG/4MLQL,PA

Kuvan TAB 100MGQL,PA

Myalept Inj 11.3MGQL,PA

SOMATOSTATIC AGENTS

Sensipar TAB 30MGQL,PA

TIER 01 GENERIC


octreotide inj 100mcg





Fabrazyme Inj 35MGPA

octreotide inj 50mcg/ML

Fabrazyme Inj 5MGPA


Lumizyme Inj 50MGPA

TIER 02 PREFERRED

Sandostatin Kit Lar 10MGQL

THYROID AGENTS


TIER 01 GENERIC


levo-t TAB 75mcg

Signifor Inj 0.3MG/MLQL,PA

levothyroxin TAB 100mcg





Signifor Lar Inj 20MGPA






Somatuline Inj 120/.5MLPA


Somatuline Inj 60/0.2MLPA


Somatuline Inj 90/0.3MLPA



GH RECEPTOR ANTAGONISTS


TIER 02 PREFERRED


Somavert Inj 10MGQL,PA

levothyroxine TAB 0.075MG

Somavert Inj 15MGQL,PA

levoxyl TAB 75mcg

liothyronine TAB 25mcg

POSTERIOR PITUITARY


TIER 01 GENERIC


desmopressin inj 4mcg/ML

methimazole TAB 10MG

desmopressin sol 0.01%

methimazole TAB 5MG

desmopressin spr 0.01%

propylthiour TAB 50MG

desmopressin TAB 0.1MG

unith direct TAB 75mcg

desmopressin TAB 0.2MG

unithroid TAB 75mcg

TIER 02 PREFERRED

Levothyroxin Inj 100mcg

Stimate Sol 1.5MG/ML



CORTICOTROPIN

TIER 02 PREFERRED

TIER 02 PREFERRED

Thyrolar-1 TAB 60MG

H.p. Acthar Inj 80unitQL,PA

Thyrolar-1/2 TAB 30MG

Thyrolar-1/4 TAB 15MG

PROLACTIN INHIBITORS

Thyrolar-2 TAB 120MG

TIER 01 GENERIC

Thyrolar-3 TAB 180MG

cabergoline TAB 0.5MG

GASTROINTESTINAL

VASOPRESSIN ANTAGONISTS

LAXATIVES

TIER 02 PREFERRED

TIER 01 GENERIC

Samsca TAB 15MGQL,PA

constulose sol 10gm/15

Samsca TAB 30MGQL,PA

lactulose sol 10gm/15


METABOLIC MODIFIERS

TIER 02 PREFERRED

TIER 01 GENERIC

Golytely Sol

calcitriol sol 1mcg/ML

Moviprep SolPA



Osmoprep TAB 1.5gm

MAG citrate sol grape

Prepopik PAKPA

MAG citrate sol lemon

Suprep Bowel Sol Prep KitPA

SB bisacodyl TAB 5MG EC

TIER P PREVENTIVE

alophen TAB 5MG EC

ANTIDIARRHEALS

bisacodyl TAB 5MG EC

TIER 01 GENERIC

carters TAB 5MG EC

diphen/atrop TAB 2.5MG

citroma sol cherry

loperamide CAP 2MG

citroma sol lemon

opium tin 10MG/ML

clearlax pow

Diphen/Atrop Liq 2.5/5

correct TAB 5MG EC

correctol TAB 5MG EC

ULCER DRUGS

ducodyl TAB 5MG EC

TIER 01 GENERIC

dulcolax pow balance

atropine SUL inj 0.1MG/ML

eq clearlax pow

b-donna TAB 16.2MG

eql clearlax pow

bella alk/PB TAB 16.2MG

eql gentle TAB laxative

chlord/clidi CAP 5-2.5MG

eql laxative TAB 5MG EC

cimetidine sol 300/5ML

feenamint TAB 5MG EC

cimetidine TAB 200MG

feminine LAX TAB 5MG EC


fleet laxati TAB 5MG EC


gavilax pow


gavilyte-c sol

dicyclomine inj 10MG/ML

gavilyte-n sol flav pk

dicyclomine sol 10MG/5ML

gavilyte-G sol

dicyclomine CAP 10MG

gentle laxat TAB 5MG EC

dicyclomine TAB 20MG

gentlelax pow

esomepra MAG CAP 20MG DRPA

glycolax pow 3350 NF

famotidine inj 10MG/ML

gnp bisa-LAX TAB 5MG EC

famotidine inj 20MG/2ML

gnp clearlax pow

famotidine inj 200/20ML

gnp laxative TAB 5MG EC

famotidine inj 40MG/4ML

kp bisacodyl TAB 5MG EC

famotidine sus 40MG/5ML

laxaclear pow

famotidine TAB 20MG

laxative pol pow glycol

famotidine TAB 40MG

laxative TAB 5MG EC

glycopyrrol inj 0.2MG/ML

natura-LAX pow 3350 NF

glycopyrrol inj 0.4/2ML

peg 3350 pow

glycopyrrol inj 1MG/5ML

peg 3350 sol electrol

glycopyrrol inj 4MG/20ML

peg-3350 sol electrol

glycopyrrol TAB 1MG

peg-3350/KCL sol /sodium

glycopyrrol TAB 2MG

pegylax pow

lansoprazole CAP 15MG DRST

peg3350 pow

lansoprazole CAP 30MG DRST

polyeth GLYC pow 3350 NF

methscopolam TAB 2.5MG

polyeth GLYC pow 3350-grx

methscopolam TAB 5MG

powderlax pow

misoprostol TAB 100mcg

qc laxative TAB 5MG EC

misoprostol TAB 200mcg

ra laxative pow

nizatidine CAP 150MG

ra laxative TAB 5MG EC

nizatidine CAP 300MG

sm clearlax pow

omeprazole CAP 10MG

sm gentle TAB laxative

omeprazole CAP 20MG

sm laxative TAB 5MG EC

omeprazole CAP 40MG

smooth LAX pow

pantoprazole inj sod 40MG

stim laxat TAB 5MG EC

pantoprazole TAB 20MG

sw clearlax pow

pantoprazole TAB 40MG

trilyte sol

phenohytro TAB

vercolate TAB 5MG EC

rabeprazole TAB 20MGST

womans laxat TAB 5MG EC

ranitidine syp 15MG/ML

womens laxat TAB 5MG EC

ranitidine syp 150/10ML

CVS c-LAX TAB 5MG

ranitidine syp 75MG/5ML

CVS purelax pow

ranitidine TAB 150MG

CVS purelax pow 3350

ranitidine TAB 300MG

Dulcolax TAB 5MG EC

sucralfate TAB 1gm

EX-LAX ultra TAB 5MG EC

Atropine SUL Inj 0.05MG/1

HM clearlax pow

Atropine SUL Inj 0.1MG/ML

HM laxative TAB 5MG

Bella/Opium Sup 16.2-30

HM laxative TAB 5MG EC

Bella/Opium Sup 16.2-60

Miralax Pow

Famotidine Inj 20MG/50m

Miralax Pow 3350 NF

Librax CAP 5-2.5MG

MAG citrate sol

Nizatidine Sol 15MG/ML

MAG citrate sol cherry



Propanthelin TAB 15MG

hydrocort ac sup 30MG

TIER 02 PREFERRED

hydrocort ene 100MG

Cantil TAB 25MGPA

hydrocortiso CRE 2.5%

Carafate Sus 1gm/10ML


Dexilant CAP 30MG DRPA

mesalamine ene 4gm

Dexilant CAP 60MG DRPA

mesalamine TAB 1.2gmST

First-omepra Sus 2MG/ML

metoclopram inj 10MG/2ML

Omeprazole + Sus Syrspend

metoclopram inj 5MG/ML

Pylera CAP

metoclopram sol 10/10ML

metoclopram sol 5MG/5ML

ANTIEMETICS

metoclopram TAB 10MG

metoclopram TAB 5MG

TIER 01 GENERIC

procto-MED CRE HC 2.5%

aprepitant CAP 125MG

proctosol HC CRE 2.5%

aprepitant CAP 80MG

proctozone CRE -HC 2.5%

aprepitant PAK 80 & 125

sevelamer pow 0.8gm

dronabinol CAP 10MG

sevelamer pow 2.4gm

dronabinol CAP 2.5MG

sevelamer TAB 800MG

dronabinol CAP 5MG

sulfasalazin TAB 500MG

granisetron TAB 1MGPA

sulfasalazin TAB 500MG DR

meclizine TAB 25MGPA

ursodiol CAP 300MG

ondansetron inj 4MG/2ML

ursodiol TAB 250MG

ondansetron inj 40/20ML

ursodiol TAB 500MG

ondansetron sol 4MG/5ML

Lialda TAB 1.2gmST

ondansetron TAB 24MG

Mesalamine TAB 800MG DRST

ondansetron TAB 4MG

Renvela PAK 0.8gm

ondansetron TAB 4MG odt

Renvela PAK 2.4gm

ondansetron TAB 8MG

Renvela TAB 800MG

ondansetron TAB 8MG odt

TIER 02 PREFERRED

scopolamine dis 1MG/3dayPA

lanthanum chw 1000MGPA

trimethobenz CAP 300MGPA


Dimenhydrin Inj 50MG/ML


Transderm-sc Dis 1.5MGPA

Amitiza CAP 24mcgQL,PA

TIER 02 PREFERRED

Amitiza CAP 8mcgQL,PA

Akynzeo CAP 300-0.5PA

Analpram-HC Lot 2.5%

Anzemet TAB 100MGPA

Asacol HD TAB 800MGST

Anzemet TAB 50MGPA

Canasa Sup 1000MG


Cimzia KitQL,PA

Aloxi Inj 0.25MG/5PA

Cimzia Kit StarterQL,PA

Cimzia Prefl Kit 200MG/MLQL,PA

DIGESTIVE AIDS

Cortifoam Aer 90MG

TIER 01 GENERIC

Dipentum CAP 250MGQL,PA

Pancrelipase CAP 5000unit

Fosrenol Chw 1000MGPA

TIER 02 PREFERRED


Creon CAP 12000unt


Creon CAP 24000unt

Linzess CAP 145mcgPA

Creon CAP 3000unit

Linzess CAP 290mcgPA

Creon CAP 36000unt

Linzess CAP 72mcg

Creon CAP 6000unit

Pentasa CAP 250MG CRST

Zenpep CAP 10000unt

Pentasa CAP 500MG CRST

Zenpep CAP 15000unt

Proctofoam Aer HC 1%

Zenpep CAP 20000unt

Rectiv Oin 0.4%

Zenpep CAP 25000unt

Relistor Inj 12/0.6ML

Zenpep CAP 3000unit

Relistor Inj 8/0.4ML

Zenpep CAP 40000unt

Renagel TAB 400MG

Zenpep CAP 5000unit

Renagel TAB 800MG


GASTROINTESTINAL - MISC.

Remicade Inj 100MGPA

TIER 01 GENERIC

alosetron TAB 0.5MGPA

GENITOURINARY

alosetron TAB 1MGPA

URINARY ANTI-INFECTIVES

anucort-HC sup 25MG

balsalazide CAP 750MG

TIER 01 GENERIC

calc acetate CAP 667MG

methenam hip TAB 1gm

calc acetate TAB 667MG

methenam man TAB 1gm

colocort ene 100MG

methenam man TAB 1000MG

enulose sol 10gm/15

nitrofur mac CAP 100MG

generlac sol 10gm/15


hemmorex-HC sup 30MG


hydrocort ac sup 25MG

nitrofurantn sus 25MG/5ML



nitrofurantn CAP 100MG

alfuzosin TAB 10MG ER

phosphasal TAB

argyl saline sol 0.9%

ur n-c TAB

curity salin sol 0.9% irr

uretron d/s TAB

cytra k gra crystals

urin d/s TAB

dutast/tamsu CAP 0.5-0.4PA

utira-c TAB

dutasteride CAP 0.5MGPA

utrona-c TAB

finasteride TAB 5MG

k citrate sol citr acd

URINARY ANTISPASMODICS

k/NA citrate sol citr acd

phenazo TAB 200MG

TIER 01 GENERIC

phenazopyrid TAB 100MG

bethanechol TAB 10MG

phenazopyrid TAB 200MG


pot citrate TAB 1080MG

bethanechol TAB 5MG

pot citrate TAB 1620MG


pot citrate TAB 540MG ER

darifenacin TAB 15MGPA

sod citrate sol citr acd

darifenacin TAB 7.5MGPA

sodium chlor sol 0.9% irr

flavoxate TAB 100MG

tamsulosin CAP 0.4MG

oxybutynin syp 5MG/5ML

virtrate-k sol 1100-334

oxybutynin TAB 10MG ER

virtrate-2 sol


virtrate-2 sol 500-334

oxybutynin TAB 5MG

virtrate-3 sol


TIER 02 PREFERRED

tolterodine CAP 2MG ERST

Cardura XL TAB 4MGPA

tolterodine CAP 4MG ER

Cardura XL TAB 8MGPA

tolterodine TAB 1MG

Cystagon CAP 150MGPA

tolterodine TAB 2MG

Cystagon CAP 50MGPA

trospium chl CAP 60MG ER

Elmiron CAP 100MG

trospium CL TAB 20MG

Oracit Sol

TIER 02 PREFERRED

Rapaflo CAP 4MGPA

Myrbetriq TAB 25MGPA

Rapaflo CAP 8MGPA

Myrbetriq TAB 50MGPA

Toviaz TAB 4MGPA

HEMATOLOGICAL AGENTS

Toviaz TAB 8MGPA

Vesicare TAB 10MGPA

HEMATOPOIETIC AGENTS

Vesicare TAB 5MGPA

TIER 01 GENERIC

cyanocobalam inj 1000mcg

VAGINAL PRODUCTS

TIER 02 PREFERRED

TIER 01 GENERIC

Aranesp Inj 10mcgPA

clindamycin CRE 2% vag

Aranesp Inj 100mcgPA

estradiol TAB 10mcg


metronidazol gel 0.75%vag


terconazole sup 80MG

Aranesp Inj 25mcgPA

terconazole CRE 0.4%


terconazole CRE 0.8%

Aranesp Inj 40mcgPA

vandazole gel 0.75%


yuvafem TAB 10mcg

Aranesp Inj 60mcgPA

zazole sup 80MG

Cerdelga CAP 84MGQL,PA

zazole CRE 0.8%

Epogen Inj 10000/MLPA

TIER 02 PREFERRED


Estrace Vag CRE 0.1MG/Gm


Estring Mis 2MG


Femring Mis 0.05/24h


Femring Mis 0.1MG/24

Nascobal Spr 500mcg

Gynazole-1 CRE 2%PA

Neulasta Inj 6MG/0.6mQL,PA

Premarin Vag CRE 0.625MG

Neulasta Kit 6MG/0.6mQL,PA

TIER P PREVENTIVE

Neupogen Inj 300/0.5QL

vcf vaginal aer contracp

Neupogen Inj 300mcgQL

vcf vaginal gel contrace

Neupogen Inj 480/0.8QL

Conceptrol Gel 4%

Neupogen Inj 480mcgQL

Encare Sup 100MG

Procrit Inj 10000/MLPA

Gynol II Gel 3%


Shur-seal Gel 2%


Today Sponge Mis


Vcf Vaginal Aer Contracp


Vcf Vaginal Mis Contracp


Promacta TAB 12.5MGQL,PA

GENITOURINARY - MISC.

Promacta TAB 25MGQL,PA

TIER 01 GENERIC


acetic acid sol 0.25%irr




Zarxio Inj 300/0.5QL

sm folic acd TAB 400mcg

Zarxio Inj 480/0.8QL

sm iron slow TAB 160MG CR

Zavesca CAP 100MGQL,PA

sm iron TAB

TIER P PREVENTIVE

sm iron TAB 325MG

carbonyl TAB FE 45MG

sm iron TAB 45MG

ezfe 200 CAP 200MG

wee care sus 15/1.25

fa-8 CAP 800mcg

yl folic aci TAB 400mcg

fa-8 TAB 0.8MG

CVS iron TAB 27MG

feosol TAB 65MG

CVS iron TAB 325MG

fer-iron dro 15MG/ML

Elite Iron TAB 15MG

ferate TAB 27MG

Femiron TAB

fergon TAB 27MG

Feosol TAB 200MG

ferosul elx 220/5ML

Feosol TAB 45MG

ferrex 150 CAP 150MG

Fer-IN-sol Dro 15MG/ML

ferric x-150 CAP 150MG

Fergon TAB 27MG

ferro-bob TAB 325MG

Ferretts FE Chw 18MG

ferrocite TAB 324MG

Ferretts IPS Sol

ferrotabs TAB

Ferretts TAB 325MG

ferrous dro 15MG/ML

Ferrimin 150 TAB

ferrous fum TAB 324MG

Ferrous Fum TAB 29MG

ferrous gluc TAB 225MG

Ferrous Gluc TAB 225MG


Ferrous Gluc TAB 324MG


Ferrous Sulf Syp 300/5ML

ferrous sulf dro 15MG/ML

Ferrous Sulf TAB 140MG

ferrous sulf elx 220/5ML

Ferrous Sulf TAB 324MG EC

ferrous sulf TAB 325MG

Folic Acid Inj 5MG/ML

ferrous sulf TAB 325MG fc

FE sulfate TAB 27MG

ferrous sulf TAB 325MG EC

FE Aspartate TAB

ferrous sulf TAB 5gr

FE TABS TAB 325MG EC

ferrousul TAB 325MG

Hemocyte TAB 324MG

folic acid CAP 800mcg

HM iron TAB 45MG

folic acid TAB 1MG

HM iron TAB 65MG

folic acid TAB 1000mcg

Icar Peds Sus Grape


Iron Chews Chw Pediatri


Iron Chw Pediatri

gnp iron TAB 325MG

Iron High CAP Potency

gnp iron TAB 45MG

Iron TAB 18MG

gnp iron TAB 65MG

Iron TAB 18MG CR

hgh-pot iron TAB 325MG

Iron TAB 28MG

high potency TAB iron

Iron Up Liq

high potency TAB FE 27MG

Mykidz Iron Sus 15/1.5ML

iferex 150 CAP

Novaferrum CAP 50MG

iron slow TAB 45MG

Novaferrum Dro 15MG/ML

iron supplem TAB therapy

Perfect Iron TAB 25MG

iron supplem TAB 325MG

Pic 200 CAP

iron supplmt dro 15MG/ML

Profe CAP 180MG

iron TAB 27MG

Proferrin ES TAB 12 MG

iron TAB 325MG

Slow FE TAB 142MG

iron TAB 45MG

Slow FE TAB 45MG

iron TAB 50MG ER

Slow Rel FE TAB 143MG CR

iron TAB 65MG

TIER C ORAL CHEMO

myferon 150 CAP 150MG

Droxia CAP 200MG

nat-rul iron TAB 325MG

Droxia CAP 300MG

nu-iron 150 CAP 150MG

Droxia CAP 400MG

pedia iron dro 15MG/ML


poly-iron CAP 150MG

Vpriv Inj 400unitQL,PA

px iron TAB 200MG

px iron TAB 27MG

ANTICOAGULANTS

ra iron TAB 27MG

TIER 01 GENERIC

ra iron TAB 325MG

enoxaparin inj 100MG/MLQL

ra iron TAB 65MG

enoxaparin inj 120/0.8QL

slow iron TAB 160MG CR

enoxaparin inj 150MG/MLQL

slow iron TAB 50MG

enoxaparin inj 30/0.3MLQL

slow rel FE TAB 160MG CR

enoxaparin inj 300/3MLQL

slow release TAB iron 45


slow release TAB 143MG


slow release TAB 45MG


slow release TAB 47.5MG

fondaparinux inj 10/0.8MLQL

slow FE TAB 45MG

fondaparinux inj 2.5/0.5QL

slow-release TAB FE 45MG



fondaparinux inj 5/0.4MLQL

Aminocapr Ac Inj 250MG/ML

fondaparinux inj 7.5/0.6QL

TIER 02 PREFERRED

hep sod/D5W inj 20000unt

Actifoam Mis 12.7X8.9

heparin lock inj 10unt/ML

Actifoam Mis 7X5x0.6

heparin lock inj 100/ML

Avitene Pad 35X35MM

heparin lock kit 10unt/ML

Avitene Pad 70X35MM

heparin lock kit 100/ML

Avitene Pad 70X70MM

heparin sod inj 1000/ML

Avitene Pow Flour


Avitene Syrg Mis 1gm


Endo Avitene Mis 10MM Dia

heparin sod inj 5000/0.5

Endo Avitene Mis 5MM Dia

jantoven TAB 1MG

Helistat Mis 5MM

jantoven TAB 10MG

Instat Mch Pow

jantoven TAB 2.5MG

Thrombin-jmi Kit 20000unt

jantoven TAB 2MG

Thrombin-jmi Sol 20000unt

jantoven TAB 3MG

jantoven TAB 4MG

HEMATOLOGICAL - MISC.

jantoven TAB 5MG

TIER 01 GENERIC

jantoven TAB 6MG

anagrelide CAP 0.5MG

jantoven TAB 7.5MG

anagrelide CAP 1MG

sash kit 100/ML

asa/dipyrida CAP 25-200MG

warfarin TAB 1MG

cilostazol TAB 100MG

warfarin TAB 10MG

cilostazol TAB 50MG

warfarin TAB 2.5MG

clopidogrel TAB 300MG

warfarin TAB 2MG

clopidogrel TAB 75MG

warfarin TAB 3MG

dipyridamole TAB 25MG

warfarin TAB 4MG


warfarin TAB 5MG


warfarin TAB 6MG

pentoxifylli TAB 400MG ER

warfarin TAB 7.5MG

prasugrel TAB 10MGPA

Hep Sod/D5W Inj 100/ML

prasugrel TAB 5MGPA

Hep Sod/D5W Inj 25000unt

TIER 02 PREFERRED

Heparin Lock Inj 1unit/ML

Berinert Inj 500unitQL,PA

Heparin/D5W Inj 100/ML

Brilinta TAB 60MGPA

Heparin/D5W Inj 25000unt

Brilinta TAB 90MGPA

Heparin/D5W Inj 50unt/ML

Cinryze Sol 500 UnitQL,PA

Lovenox Inj 100MG/MLQL

Effient TAB 10MGPA

Lovenox Inj 120/0.8QL

Effient TAB 5MGPA

Lovenox Inj 150MG/MLQL

Firazyr Inj 30MG/3MLQL,PA

Lovenox Inj 30/0.3MLQL

Lovenox Inj 300/3MLQL

MOUTH/THROAT/DENTAL AGENT



TIER 01 GENERIC


cevimeline CAP 30MG

Sash Kit 10unt/ML

chlorhex glu sol 0.12%

TIER 02 PREFERRED

clotrimazole loz 10MG

Eliquis TAB 2.5MGPA

clotrimazole tro 10MG

Eliquis TAB 5MGPA

lidocaine sol 2% visc

Fragmin Inj 10000/MLPA

nystatin sus 100000

Fragmin Inj 12500untPA

oralone dent pst 0.1%


paroex sol 0.12%


periogard sol 0.12%

Fragmin Inj 2500/0.2PA

pilocarpine TAB 5MG


triamcinolon pst den 0.1%


TIER 02 PREFERRED

Pradaxa CAP 110MG

Debacterol Sol 30-50%PA

Pradaxa CAP 150MG

Oravig TAB 50MGPA

Pradaxa CAP 75MG

Xarelto Star TAB 15/20MGPA

NEUROLOGY, CNS, PSYCH

Xarelto TAB 10MGPA

ANTIANXIETY AGENTS

Xarelto TAB 15MGPA

TIER 01 GENERIC

Xarelto TAB 20MGPA

alprazolam TAB 0.25MG

alprazolam TAB 0.5MG

HEMOSTATICS

alprazolam TAB 0.5MG ER

TIER 01 GENERIC

alprazolam TAB 0.5MG XR

tranex acid inj 100MG/ML

alprazolam TAB 1MG

tranex acid inj 1000MG

alprazolam TAB 1MG ER

tranex acid TAB 650MGQL

alprazolam TAB 1MG XR

tranexamic inj 100MG/ML

alprazolam TAB 2MG




desipramine TAB 75MG


desvenlafax TAB 100MG ERPA





buspirone TAB 10MG

doxepin HCL CAP 10MG

buspirone TAB 15MG


buspirone TAB 30MG


buspirone TAB 5MG


buspirone TAB 7.5MG


chlordiazep CAP 10MG


chlordiazep CAP 25MG

doxepin HCL CON 10MG/ML

chlordiazep CAP 5MG

duloxetine CAP 20MG

cloraz dipot TAB 15MG

duloxetine CAP 30MG

cloraz dipot TAB 3.75MG

duloxetine CAP 60MG

cloraz dipot TAB 7.5MG

escitalopram sol 5MG/5ML

diazepam TAB 10MG

escitalopram TAB 10MG

diazepam TAB 2MG


diazepam TAB 5MG


hydroxyz pam CAP 25MG

fluoxetine sol 20MG/5ML

hydroxyz pam CAP 50MG

fluoxetine CAP 10MG

hydroxyz HCL syp 10MG/5ML

fluoxetine CAP 20MG

hydroxyz HCL TAB 10MG

fluoxetine CAP 40MG


fluoxetine TAB 10MG


fluoxetine TAB 20MG

lorazepam inj 2MG/ML

fluvoxamine TAB 100MG

lorazepam CON 2MG/ML


lorazepam TAB 0.5MG


lorazepam TAB 1MG

imipram HCL TAB 10MG

lorazepam TAB 2MG


meprobamate TAB 200MG


meprobamate TAB 400MG

mirtazapine TAB 15MG

oxazepam CAP 10MG

mirtazapine TAB 15MG odt

oxazepam CAP 15MG


oxazepam CAP 30MG


Diazepam Inj 10MG/2ML


Diazepam Inj 5MG/ML


Diazepam Sol 1MG/ML

mirtazapine TAB 7.5MG

Hydroxyz Pam CAP 100MG

nefazodone TAB 250MG

nefazodone TAB 50MG

ANTIDEPRESSANTS

nortriptylin CAP 10MG


TIER 01 GENERIC


amitriptylin TAB 10MG



paroxetine TAB 10MG


paroxetine TAB 20MG


paroxetine TAB 30MG


paroxetine TAB 40MG


phenelzine TAB 15MG

bupropion TAB 100MG

protriptylin TAB 10MG

bupropion TAB 100MG ER

protriptylin TAB 5MG

bupropion TAB 100MG SR

sertraline CON 20MG/ML


sertraline TAB 100MG


sertraline TAB 25MG


sertraline TAB 50MG


tranylcyprom TAB 10MG

bupropion TAB 75MG

trazodone TAB 100MG

bupropn HCL TAB 150MG XL

trazodone TAB 150MG

bupropn HCL TAB 300MG XL

trazodone TAB 300MG

citalopram sol 10MG/5ML

trazodone TAB 50MG

citalopram TAB 10MG

trimipramine CAP 100MG

citalopram TAB 20MG


citalopram TAB 40MG


clomipramine CAP 25MG

venlafaxine CAP 150MG ER


venlafaxine CAP 37.5 ER


venlafaxine CAP 75MG ER


venlafaxine TAB 100MG




venlafaxine TAB 37.5MG







Amoxapine TAB 100MG

loxapine CAP 5MG

Amoxapine TAB 150MG

loxapine CAP 50MG

Amoxapine TAB 25MG

olanzapine TAB 10MG

Amoxapine TAB 50MG

olanzapine TAB 15MG

Desvenlafax TAB 100MG ERPA

olanzapine TAB 2.5MG

Desvenlafax TAB 50MG ERPA

olanzapine TAB 20MG

Fluoxetine TAB 60MG

olanzapine TAB 5MG

Maprotiline TAB 25MG

olanzapine TAB 7.5MG


paliperidone TAB ER 1.5MGPA


paliperidone TAB ER 3MGPA

Nefazodone TAB 100MG





perphenazine TAB 16MG

Nortriptylin Sol 10MG/5ML


TIER 02 PREFERRED


Emsam Dis 12MG/24hQL,PA


Emsam Dis 6MG/24HRQL,PA

prochlorper inj 10MG/2ML

Emsam Dis 9MG/24HRQL,PA

prochlorper sup 25MG

Marplan TAB 10MGPA

prochlorper TAB 10MG

Paxil Sus 10MG/5ML

prochlorper TAB 5MG

Viibryd Kit Starter

quetiapine TAB 100MG

Viibryd TAB 10MGPA

quetiapine TAB 150MG ERPA

Viibryd TAB 20MGPA


Viibryd TAB 40MGPA


quetiapine TAB 25MG

ANTIPSYCHOTICS



TIER 01 GENERIC


aripiprazole sol 1MG/ML


aripiprazole TAB 10MG

quetiapine TAB 50MG




risperidone sol 1MG/ML


risperidone TAB 0.25MG


risperidone TAB 0.5MG


risperidone TAB 1MG

chlorpromaz TAB 10MG

risperidone TAB 2MG


risperidone TAB 3MG


risperidone TAB 4MG


thioridazine TAB 10MG



clozapine TAB 100MG


clozapine TAB 200MG


clozapine TAB 25MG

thiothixene CAP 1MG

clozapine TAB 50MG

thiothixene CAP 10MG

compro sup 25MG

thiothixene CAP 2MG

fluphenaz DE inj 25MG/ML

thiothixene CAP 5MG

fluphenazine TAB 1MG

trifluoperaz TAB 1MG



fluphenazine TAB 2.5MG




haloper lac inj 5MG/ML

ziprasidone CAP 20MG

haloper DEC inj 100MG/ML


haloper DEC inj 50MG/ML


haloperidol inj 5MG/ML


haloperidol inj 50/10ML

Chlorpromaz Inj 25MG/ML

haloperidol CON 2MG/ML

Chlorpromaz Inj 50MG/2ML

haloperidol TAB 0.5MG

Fluphenazine CON 5MG/ML

haloperidol TAB 1MG

Fluphenazine Elx 2.5/5ML

haloperidol TAB 10MG

Fluphenazine Inj 2.5MG/ML

haloperidol TAB 2MG

Lithium CARB CAP 150MG

haloperidol TAB 20MG

Lithium CARB CAP 600MG

haloperidol TAB 5MG

Lithium Sol 8meq/5ML

lithium CARB CAP 150MG

TIER 02 PREFERRED


Equetro CAP 100MGPA


Equetro CAP 200MGPA

lithium CARB TAB 300MG

Equetro CAP 300MGPA

lithium CARB TAB 300MG ER

Fanapt PAKPA

lithium CARB TAB 450MG ER

Fanapt TAB 1MGPA

loxapine CAP 10MG

Fanapt TAB 10MGPA

loxapine CAP 25MG

Fanapt TAB 12MGPA



Fanapt TAB 2MGPA

amphet/dextr CAP 5MG ERQL

Fanapt TAB 4MGPA

amphet/dextr TAB 10MG

Fanapt TAB 6MGPA

amphet/dextr TAB 12.5MG

Fanapt TAB 8MGPA


Latuda TAB 120MGPA


Latuda TAB 20MGPA


Latuda TAB 40MGPA


Latuda TAB 80MGPA

amphet/dextr TAB 7.5MG

Rexulti TAB 0.25MGPA

armodafinil TAB 150MGPA

Rexulti TAB 0.5MGPA


Rexulti TAB 1MGPA


Rexulti TAB 2MGPA


Rexulti TAB 3MGPA

atomoxetine CAP 10MGST

Rexulti TAB 4MGPA


Risperdal Inj 12.5MG


Risperdal Inj 25MG


Risperdal Inj 37.5MG


Risperdal Inj 50MG


Saphris Sub 10MGPA


Saphris Sub 5MGPA

caffeine CIT inj 60MG/3ML

Seroquel XR TAB 150MGPA

caffeine CIT sol 20MG/ML


caffeine CIT sol 60MG/3ML


dexedrine TAB 10MG


dexedrine TAB 5MG


dexmethylph TAB 10MG

dexmethylph TAB 2.5MG

HYPNOTICS

dexmethylph TAB 5MG

dextroamphet CAP 10MG ERQL

TIER 01 GENERIC


estazolam TAB 1MGPA


estazolam TAB 2MGPA

dextroamphet TAB 10MG

eszopiclone TAB 1MG

dextroamphet TAB 5MG

eszopiclone TAB 2MG

guanfacine TAB 1MG ER

eszopiclone TAB 3MG


midazolam inj 10MG/2ML


midazolam inj 5MG/ML


phenobarb elx 20MG/5ML

metadate TAB 20MG ERQL

phenobarb sol 20MG/5ML

methamphetam TAB 5MG

phenobarb TAB 16.2MG

methylphenid CAP 10MGQL




methylphenid CAP 20MG ERQL,ST



temazepam CAP 15MG


temazepam CAP 30MG


temazepam CAP 7.5MG


triazolam TAB 0.25MG


zaleplon CAP 10MG


zaleplon CAP 5MG

methylphenid TAB 10MG

zolpidem TAB 10MG

methylphenid TAB 10MG ERQL

zolpidem TAB 5MG


Flurazepam CAP 15MG


Flurazepam CAP 30MG


Phenobarb Inj 130MG/ML


Phenobarb TAB 100MG


Phenobarb TAB 15MG


Phenobarb TAB 30MG


Phenobarb TAB 60MG

modafinil TAB 100MG

Triazolam TAB 0.125MG

modafinil TAB 200MG

TIER 02 PREFERRED

zenzedi TAB 10MG

Rozerem TAB 8MGPA

zenzedi TAB 5MG

Seconal CAP 100MG

Adderall XR CAP 10MGQL

Seconal Sod CAP 100MG



ADHD, NARCOLEPSY, ETC.


TIER 01 GENERIC





Concerta TAB 18MGQL


Concerta TAB 27MGQL


Concerta TAB 36MGQL


Concerta TAB 54MGQL



Methylphenid CAP 60MG LAQL,ST

levetiraceta TAB 500MG ER

Methylphenid TAB 18MG ERQL

levetiraceta TAB 750MG


levetiraceta TAB 750MG ER


oxcarbazepin sus 300MG/5m


oxcarbazepin TAB 150MG

TIER 02 PREFERRED


Vyvanse Chw 10MGQL,PA



phenytoin chw 50MG


phenytoin inj 50MG/ML


phenytoin sus 125/5ML


phenytoin EX CAP 100MG


primidone TAB 250MG

Vyvanse CAP 10MGQL,PA

primidone TAB 50MG


roweepra TAB 1000MG


roweepra TAB 500MG


roweepra TAB 750MG


tiagabine TAB 2MG


tiagabine TAB 4MG


topiramate CAP 15MG

topiramate CAP 25MG

ANTICONVULSANTS

topiramate TAB 100MG

topiramate TAB 200MG

TIER 01 GENERIC

topiramate TAB 25MG

carbamazepin chw 100MG

topiramate TAB 50MG

carbamazepin sus 100/5ML

valproic acd sol 250/5ML

carbamazepin CAP 100MG ER

valproic acd CAP 250MG


vigabatrin PAK 500MGPA


zonisamide CAP 100MG

carbamazepin TAB 100mger

zonisamide CAP 25MG

carbamazepin TAB 200MG

zonisamide CAP 50MG

carbamazepin TAB 200MG ER

Diastat PED Gel 2.5m Gel

carbamazepin TAB 400MG ER

Diazepam Gel 10MG

clonazep odt TAB 0.125MG

Diazepam Gel 2.5MG


Diazepam Gel 20MG


TIER 02 PREFERRED

clonazep odt TAB 1MG

Aptiom TAB 200MGQL,PA

clonazep odt TAB 2MG


clonazepam TAB 0.5MG


clonazepam TAB 1MG


clonazepam TAB 2MG

Banzel Sus 40MG/MLPA

divalproex CAP 125MG

Banzel TAB 200MGPA

divalproex TAB 125MG DR

Banzel TAB 400MGPA


Celontin CAP 300MG

divalproex TAB 250MG ER

Dilantin CAP 30MG


Fycompa TAB 10MGQL,PA

divalproex TAB 500MG ER


epitol TAB 200MG


ethosuximide sol 250/5ML


ethosuximide CAP 250MG


felbamate sus 600/5MLPA


felbamate TAB 400MGPA

Lyrica CAP 100MGQL,PA

felbamate TAB 600MGPA


gabapentin sol 250/5ML


gabapentin sol 300/6ML


gabapentin CAP 100MG






gabapentin TAB 600MG


gabapentin TAB 800MG

Lyrica Sol 20MG/MLQL,PA

lamotrigine chw 25MG

Peganone TAB 250MGPA

lamotrigine chw 5MG

Sabril Pow 500MGPA

lamotrigine TAB 100MG

Sabril TAB 500MGPA


Tegretol-XR TAB 100MG



ANTIPARKINSON AGENTS

levetiraceta sol 100MG/ML

levetiraceta sol 500/5ML

TIER 01 GENERIC


amantadine syp 50MG/5ML


amantadine CAP 100MG


amantadine TAB 100MG



benztropine inj 1MG/ML

tetrabenazin TAB 12.5MGQL,PA

benztropine TAB 0.5MG

tetrabenazin TAB 25MGQL,PA

benztropine TAB 1MG

Ergoloid Mes TAB 1MG OralPA

benztropine TAB 2MG

Extavia Inj 0.3MGQL

bromocriptin CAP 5MG

Fluoxetine CAP 10MG

bromocriptin TAB 2.5MG

Fluoxetine CAP 20MG

carbidopa TAB 25MG

Galantamine Sol 4MG/ML

entacapone TAB 200MG

Perphen/Amit TAB 2-10MG

pramipexole TAB 0.125MG









TIER 02 PREFERRED

pramipexole TAB 1MG

Ampyra TAB 10MGQL,PA

rasagiline TAB 0.5MGPA

Aubagio TAB 14MGQL,PA

rasagiline TAB 1MGPA

Aubagio TAB 7MGQL,PA

ropinirole TAB 0.25MG

Avonex Kit 30mcgQL,PA

ropinirole TAB 0.5MG

Avonex Pen Kit 30mcgQL,PA

ropinirole TAB 1MG

Avonex Prefl Kit 30mcgQL,PA

ropinirole TAB 2MG

Gilenya CAP 0.5MGQL,PA

ropinirole TAB 3MG

Horizant TAB 600MGPA

ropinirole TAB 4MG

Namenda XR CAP TitratioPA

ropinirole TAB 5MG

Namenda XR CAP 14MGPA

selegiline CAP 5MG


selegiline TAB 5MG


tolcapone TAB 100MGPA


trihexyphen elx 0.4MG/ML

Nuedexta CAP 20-10MGPA

trihexyphen TAB 2MG

Rebif Inj 22/0.5QL

trihexyphen TAB 5MG

Rebif Inj 44/0.5QL

CARB/levo ER TAB 25-100MG

Rebif Rebido Inj TitratnQL

CARB/levo ER TAB 50-200MG

Rebif Rebido Inj 22/0.5QL

CARB/levo TAB 10-100MG

Rebif Rebido Inj 44/0.5QL


Rebif Titrtn Inj PackQL


Savella Mis Titr PAKPA

CARB/Levo 50 TAB /Entacap

Savella TAB 100MGPA

CARB/Levo 75 TAB /Entacap

Savella TAB 12.5MGPA

CARB/Levo100 TAB /Entacap

Savella TAB 25MGPA


Savella TAB 50MGPA


Xyrem Sol 500MG/MLQL,PA


TIER P PREVENTIVE

TIER 02 PREFERRED

buproban TAB 150MG

Apokyn Inj 10MG/MLQL,PA

bupropion TAB 150MG

Duopa Sus 4.63-20PA

eq nicotine dis 14MG/24h

eq nicotine dis 21MG/24h

NEUROLOGY, PSYCH - MISC.

eq nicotine dis 7MG/24HR

eq nicotine gum 2mgfruit

TIER 01 GENERIC

eq nicotine gum 2MG cinn

acampro CAL TAB 333MG

eq nicotine gum 2MG mint

disulfiram TAB 250MG

eq nicotine gum 2MG orig

disulfiram TAB 500MG

eq nicotine gum 4mgfruit

donepezil TAB 10MG

eq nicotine gum 4MG cinn

donepezil TAB 5MG

eq nicotine gum 4MG mint

galantamine CAP 16MG ER

eq nicotine gum 4MG orig


eq nicotine gum 4MG ref


eq nicotine gum 4MG strt

galantamine TAB 12MG

eq nicotine loz 2MG cher

galantamine TAB 4MG

eq nicotine loz 2MG cinn

galantamine TAB 8MG

eq nicotine loz 2MG mint

glatiramer inj 20MG/MLQL

eq nicotine loz 4MG chry

glatopa inj 20MG/MLQL

eq nicotine loz 4MG mint

memant titra PAK 5-10MG

eql nicotine dis 14MG/24h

memantine HC sol 2MG/ML

eql nicotine dis 21MG/24h

memantine TAB HCL 10MG

eql nicotine dis 7MG/24HR

memantine TAB HCL 5MG

eql nicotine gum 2MG

pimozide TAB 1MG

eql nicotine gum 2MG ref

pimozide TAB 2MG

eql nicotine gum 2MG strt

rivastigmine CAP 1.5MG

eql nicotine gum 4MG

rivastigmine CAP 3MG

eql nicotine gum 4MG ref

rivastigmine CAP 4.5MG

eql nicotine gum 4MG strt

rivastigmine CAP 6MG

eql nicotine loz 2MG



eql nicotine loz 2MG mint

ra nicotine loz 4MG mint

eql nicotine loz 4MG chry

sm nicotine dis 14MG/24h

eql nicotine loz 4MG mint

sm nicotine dis 21MG

gnp nicotine dis 21MG/24h

sm nicotine dis 21MG/24h

gnp nicotine dis 7MG/24HR

sm nicotine dis 7MG/24HR

gnp nicotine gum 2MG mint

sm nicotine gum 2MG

gnp nicotine gum 2MG orig

sm nicotine gum 2MG mint

gnp nicotine gum 4MG mint

sm nicotine gum 4MG

gnp nicotine gum 4MG orig

sm nicotine gum 4MG mint

gnp nicotine loz mini 2MG

sm nicotine loz 2MG mint

gnp nicotine loz 2MG mint

sm nicotine loz 4MG mint

gnp nicotine loz 4MG mint

stop smoking gum 2MG mint

kls quit2 gum 2MG

stop smoking gum 2MG orig

kls quit2 loz 2MG

stop smoking gum 4MG

kls quit4 gum 4MG

stop smoking loz 2MG

kls quit4 loz 4MG

stop smoking loz 2MG mint

nicorelief gum 2MG mint

stop smoking loz 4MG mint

nicorelief gum 2MG orig

sw nicotine gum 2MG mint

nicorelief gum 4MG mint

sw nicotine gum 4MG

nicorelief gum 4MG orig

sw nicotine loz 2MG mint

nicotine dis step 1

sw nicotine loz 4MG mint

nicotine dis step 2

tgt nicotine dis 14MG/24h

nicotine dis step 3

tgt nicotine dis 21MG/24h

nicotine dis 14MG/24h

tgt nicotine dis 7MG/24HR

nicotine dis 21MG/24h

tgt nicotine gum 2mgfruit

nicotine dis 7MG/24HR

tgt nicotine gum 2MG mint

nicotine gum 2mgfruit

tgt nicotine gum 2MG orig

nicotine gum 2MG

tgt nicotine gum 4MG

nicotine gum 4MG

tgt nicotine gum 4MG mint

nicotine loz mini 2MG

tgt nicotine gum 4MG orig

nicotine loz 2MG chry

tgt nicotine loz 2MG chry

nicotine loz 2MG mint

tgt nicotine loz 2MG mint

nicotine loz 4MG chry

tgt nicotine loz 4MG chry

nicotine loz 4MG cinn

tgt nicotine loz 4MG mint

nicotine loz 4MG mint

thrive gum 2MG mint

nicotine pol gum 2mgfruit

Chantix PAK 0.5& 1MG

nicotine pol gum 2MG

Chantix PAK 1MG

nicotine pol gum 2MG cinn

Chantix TAB 0.5MG

nicotine pol gum 2MG mint

Chantix TAB 1MG

nicotine pol gum 2MG orig

Commit Loz 2MG

nicotine pol gum 2MG ref

Commit Loz 4MG

nicotine pol gum 2MG strt

Commit Loz 4MG Chry

nicotine pol gum 4mgfruit

CVS nicotine dis 14MG/24h

nicotine pol gum 4MG

CVS nicotine dis 7MG/24HR

nicotine pol gum 4MG cinn

CVS nicotine gum 2mgfruit

nicotine pol gum 4MG mint

CVS nicotine gum 2MG cinn

nicotine pol gum 4MG orig

CVS nicotine gum 2MG mint

nicotine pol gum 4MG ref

CVS nicotine gum 2MG orig

nicotine pol gum 4MG strt

CVS nicotine gum 4mgfruit

nicotine pol loz 2MG chry

CVS nicotine gum 4MG cinn

nicotine pol loz 2MG cinn

CVS nicotine gum 4MG mint

nicotine pol loz 2MG mint

CVS nicotine gum 4MG orig

nicotine pol loz 4MG chry

CVS nicotine loz 2MG

nicotine pol loz 4MG cinn

CVS nicotine loz 2MG mint

nicotine pol loz 4MG mint

CVS nicotine loz 4MG mint

nicotine TD dis 14MG/24h

CVS nts dis step 1

nicotine TD dis 21MG/24h

HM nicotine dis 14MG/24h

nicotine TD dis 7MG/24HR

HM nicotine dis 21MG/24h

qc nicotine gum 4MG

HM nicotine gum 2MG mint

ra nicotine dis 14MG/24h

HM nicotine gum 4MG mint

ra nicotine dis 21MG/24h

HM nicotine loz 2MG mint

ra nicotine dis 7MG/24HR

HM nicotine loz 4MG mint

ra nicotine gum 2mgfruit

Nicoderm CQ Dis 14MG/24h

ra nicotine gum 2MG

Nicoderm CQ Dis 21MG/24h

ra nicotine gum 2MG cinn

Nicoderm CQ Dis 7MG/24HR

ra nicotine gum 2MG mint

Nicorette Gum 2mgfruit

ra nicotine gum 4MG

Nicorette Gum 2MG

ra nicotine gum 4MG frut

Nicorette Gum 2MG Cinn

ra nicotine gum 4MG mint

Nicorette Gum 2MG Mint

ra nicotine loz 2MG mint

Nicorette Gum 2MG Orig



Nicorette Gum 4mgfruit

gentak oin 0.3% op

Nicorette Gum 4MG

gentamicin oin 0.3% op

Nicorette Gum 4MG Cinn

gentamicin sol 0.3% op

Nicorette Gum 4MG Mint

ilotycin oin op

Nicorette Gum 4MG Orig

levofloxacin sol 0.5%PA

Nicorette Loz 2MG Chry

moxifloxacin sol 0.5%

Nicorette Loz 2MG Mint

neo/poly/gra sol op

Nicorette Loz 2MG Orig

ofloxacin dro 0.3% op

Nicorette Loz 4MG Chry

polycin oin op

Nicorette Loz 4MG Mint

polymyxin b/ sol trimethp

Nicorette Loz 4MG Orig

sod sulfacet sol 10% op

Nicorette ST Gum 2MG

sulfacet sod sol 10% op

Nicorette ST Gum 2MG Mint

tobramycin sol 0.3% op

Nicorette ST Gum 2MG Orig

trifluridine sol 1% op

Nicorette ST Gum 4MG Mint

trimethoprim sol polymyxn

Nicorette ST Gum 4MG Orig

Bacitracin Oin Op

Nicotine SYS Kit Transder

Gentak Oin 0.3% Op

Nicotrol Inh

Sulfacet Sod Oin 10% Op

Nicotrol Ns Spr 10MG/ML

TIER 02 PREFERRED

SR nicotine gum 2MG

Azasite Sol 1%PA


Besivance Sus 0.6%PA

Tysabri Inj 300/15MLPA

Ciloxan Oin 0.3% Op

Moxeza Sol 0.5%

NEUROMUSCULAR AGENTS

Natacyn Sus 5% Op

Tobrex Oin 0.3% Op

TIER 01 GENERIC

Vigamox Dro 0.5%

riluzole TAB 50MGQL

Zirgan Gel 0.15%PA

MUSCULOSKELETAL AGENTS

ARTIFICIAL TEAR/LUBRICANT

TIER 01 GENERIC

TIER 02 PREFERRED

baclofen TAB 10MG

Lacrisert Mis 5MG Op

baclofen TAB 20MG

carisoprodol TAB 250MGQL,PA

BETA-BLOCKERS

carisoprodol TAB 350MGQL,PA

chlorzoxazon TAB 500MGQL

TIER 01 GENERIC

cyclobenzapr TAB 10MGQL

betaxolol sol 0.5% op

cyclobenzapr TAB 5MGQL

carteolol sol 1% op

dantrolene CAP 100MG

dorzol/timol sol 22.3-6.8

dantrolene CAP 25MG

levobunolol sol 0.5% op

dantrolene CAP 50MG

timolol gel sol 0.25% op

metaxall TAB 800MGQL

timolol gel sol 0.5% op

metaxalone TAB 800MGQL

timolol mal sol 0.25% op

methocarbam inj 100MG/ML

timolol mal sol 0.5% op

methocarbam inj 1000MG

Metipranolol Sol 0.3% Oph

methocarbam TAB 500MGQL

TIER 02 PREFERRED

methocarbam TAB 750MGQL

Betoptic-s Sus 0.25% Op

orphenadrine TAB 100MG ERQL

revonto inj 20MG

OPHTHALMIC STEROIDS

tizanidine TAB 2MG

TIER 01 GENERIC

tizanidine TAB 4MG

fluoromethol sus 0.1% op

Chlorzoxazon TAB 250MG

neo-polycin oin HC 1%op

neo/poly/bac oin /HC 1%op

ANTIMYASTHENIC AGENTS

neo/poly/dex oin 0.1% op

TIER 01 GENERIC

neo/poly/dex sus 0.1% op

pyridostigm TAB 60MG

prednisolone sus 1% op

pyridostigmi TAB ER 180MG

sulf/pred NA sol op

Guanidine TAB 125MG

tobra/dexame sus 0.3-0.1%

TIER 02 PREFERRED

Dexameth PHO Sol 0.1% Op

Mestinon Syp 60MG/5ML

TIER 02 PREFERRED

Regonol Inj 5MG/ML

Alrex Sus 0.2%PA

Blephamide Oin S.o.p.

OPHTHALMOLOGY AND OTIC

Blephamide Sus Op

Durezol Emu 0.05%

ANTI-INFECTIVES

FML Forte Sus 0.25% Op

TIER 01 GENERIC

FML Oin 0.1% Op

ak-poly-bac oin op

Lotemax Gel 0.5%PA

bacit/polymy oin op

Lotemax Oin 0.5%PA

ciprofloxacn sol 0.3% op

Lotemax Sus 0.5%PA

erythromycin oin op

Pred Mild Sus 0.12% Op

erythromycin oin 5MG/gm

Pred-G S.o.p Oin Op

gatifloxacin sol 0.5%



Pred-G Sus Op

olopatadine dro 0.1%

Tobradex Oin 0.3-0.1%

olopatadine sol 0.2%PA

Vexol Sus 1% Op

Bromfenac Sol 0.09% OpPA

Flurbiprofen Sol 0.03% Op

PROSTAGLANDINS

TIER 02 PREFERRED

Alocril Sol 2%PA

TIER 01 GENERIC

Alomide Sol 0.1% Op

latanoprost sol 0.005%

Azopt Sus 1% Op

Bimatoprost Sol 0.03%

Bepreve Dro 1.5%PA

Travoprost Dro 0.004%

Bromsite Dro 0.075%PA

TIER 02 PREFERRED

Cystaran Sol 0.44%QL,PA

Lumigan Sol 0.01%

Emadine Sol 0.05% OpPA

Rescula Sol 0.15%PA

Lastacaft Sol 0.25%PA

Travatan Z Dro 0.004%

Nevanac Sus 0.1%PA

Zioptan Dro 0.0015%PA

Pataday Sol 0.2%PA

Pazeo Dro 0.7%PA

CYCLOPLEGIC MYDRIATICS

Xiidra Dro 5%PA

TIER 01 GENERIC

cyclopentol sol 1% op

OTIC AGENTS

cyclopentol sol 2% op

TIER 01 GENERIC

cyclopentola sol 0.5%

acetasol HC sol otic

homatropaire sol 5% op

acetic acid sol 2% otic

homatropine sol 5% op

fluocin acet oil ear0.01%

tropicamide sol 0.5% op

fluocin acet oil 0.01%

tropicamide sol 1% op

neo/poly/HC sol 1% otic

Atropine SUL Oin 1% Op

neo/poly/HC sus 1% otic

Atropine SUL Sol 1% Op

ofloxacin dro 0.3%otic

Tropicamide Pow

HC/acet acid sol otic

TIER 02 PREFERRED

DECONGESTANTS

Cipro HC Sus Otic

TIER 01 GENERIC

Ciprodex Sus 0.3-0.1%

altafrin sol 10% op

Coly-mycin S Sus Otic

altafrin sol 2.5% op

Cortisporin Sus -tc Otic

phenylephrin sol 10% op

phenylephrin sol 2.5% op

OXYTOCICS

Naphazoline Sol 0.1% Op

MIOTICS

TIER 01 GENERIC

methylergon inj 0.2MG/ML

TIER 01 GENERIC

methylergon TAB 0.2MG

pilocarpine sol 1% op

Methergine TAB 0.2MG


TIER 02 PREFERRED


Cervidil Vag Mis 10MG INS

TIER 02 PREFERRED

Prepidil Gel 0.5MG/3G

Phospholine Sol 0.125%opPA

Prostin E2 Sup 20MG

ADRENERGIC AGENTS

PAIN MANAGEMENT

TIER 01 GENERIC

apraclonidin sol 0.5% opPA

ANALGESICS - NONNARCOTIC

brimonidine sol 0.2% op

TIER 01 GENERIC

but/apap/caf CAPPA

IMMUNOMODULATORS

but/apap/caf TAB

TIER 02 PREFERRED

but/asa/caff CAP

Restasis Emu 0.05%PA

butal/apap TAB 50-325MGPA

Restasis Mul Emu 0.05%PA

capacet CAPPA

cho MAG tris liq 500/5ML

LOCAL ANESTHETICS

diflunisal TAB 500MG

esgic CAPPA

TIER 01 GENERIC

margesic CAPPA

proparacaine sol 0.5% op

marten-TAB tab 50-325MGPA

phrenilin CAP fortePA

OPHTHALMICS - MISC.

salsalate TAB 500MG

TIER 01 GENERIC

salsalate TAB 750MG

azelastine dro 0.05%

zebutal CAPPA

bromfenac sol 0.09% opPA

But/Asa/Caf TAB

cromolyn sod sol 4% op

Tencon TAB 50-325MGPA

diclofenac sol 0.1% op

Vanatol LQ SolPA

dorzolamide sol 2% op

Vanatol S SolPA

epinastine dro 0.05%PA

TIER P PREVENTIVE

flurbiprofen sol 0.03% op

asa low dose TAB 81MG ECQL

ketorolac sol 0.4%

aspir-low TAB 81MG ECQL

ketorolac sol 0.5%



aspir-81 TAB 81MG ECQL

CVS chld asa chw 81MGQL

aspirin adlt TAB 81MGQL

Ecotrin TAB 325MG ECQL

aspirin chil chw 81MGQL

HM aspirin chw 81MGQL

aspirin chld chw 81MGQL

HM aspirin TAB 325MGQL

aspirin chw 81MGQL

MM aspirin TAB 325MGQL

aspirin low chw 81MGQL

SB aspirin TAB 325MGQL

aspirin low TAB 81MGQL

SB aspirin TAB 325MG ECQL

aspirin low TAB 81MG ECQL

SB child asa chw 81MGQL

aspirin TAB 325MGQL

aspirin TAB 325MG ECQL

ANALGESICS - OPIOID

aspirin TAB 5gr ECQL

TIER 01 GENERIC

aspirin TAB 81MGQL

apap/codeine sol 120-12/5QL

aspirin TAB 81MG ECQL

apap/codeine TAB 300-15MGQL

aspirin 81 TAB 81MG ECQL


aspirin-81 chw 81MGQL


aspirtab TAB 324MG ECQL

bupren/nalox sub 2-0.5MG

bayer adv TAB 325MGQL

bupren/nalox sub 8-2MG

bayer asa TAB 325MGQL

buprenorphin inj 0.3MG/ML

bayer low chw 81MGQL

buprenorphin sub 2MGQL

bayer low TAB 81MG ECQL

buprenorphin sub 8MGQL

child asa chw 81MGQL

but/apap/caf CAP codeineQL,PA

child asa LS chw 81MGQL

butorphanol inj 2MG/ML

ecotrin low TAB 81MG ECQL

codeine sulf TAB 15MGQL

ecotrin TAB 325MGQL


ecpirin TAB 325MG ECQL


enteric asa TAB 325MGQL

endocet TAB 10-325MGQL

eq aspirin TAB 325MGQL

endocet TAB 2.5-325QL

eq aspirin TAB 325MG ECQL

endocet TAB 5-325MGQL

eq child asa chw 81MGQL

endocet TAB 7.5-325QL

eql aspirin chw 81MGQL

fentanyl dis 100mcg/hQL,PA

eql aspirin TAB 325MGQL

fentanyl dis 12mcg/HRQL,PA

eql aspirin TAB 325MG ECQL


eql aspirin TAB 81MG ECQL


eql chld asa chw 81MGQL


gnp aspirin chw 81MGQL

fentanyl CIT inj 0.05MG/1QL

gnp aspirin TAB 325MGQL

fentanyl CIT inj 100mcgQL

gnp aspirin TAB 325MG ECQL


gnp aspirin TAB 81MG ECQL


kls aspirin TAB 325MG ECQL


kls aspirin TAB 81MG ECQL

hydroco/apap sol 7.5-325QL

kp aspirin TAB 81MG ECQL

hydroco/apap TAB 10-325MGQL

miniprin low TAB 81MG ECQL

hydroco/apap TAB 5-325MGQL

norwich asa TAB 325MGQL

hydroco/apap TAB 7.5-325QL

px aspirin chw 81MGQL

hydrocod/ibu TAB 10-200MGQL,PA

px aspirin TAB 325MGQL

hydrocod/ibu TAB 2.5-200QL,PA

px aspirin TAB 325MG ECQL

hydrocod/ibu TAB 5-200MGQL,PA

px aspirin TAB 81MG ECQL

hydrocod/ibu TAB 7.5-200QL,PA

qc aspirin TAB 325MGQL

hydromorphon inj 1MG/ML

qc aspirin TAB 325MG ECQL


qc child asa chw 81MGQL


ra aspirin chw 81MGQL

hydromorphon liq 1MG/ML

ra aspirin TAB 325MGQL

hydromorphon TAB 12MG ERQL,PA

ra aspirin TAB 325MG ECQL


ra aspirin TAB 81MG ECQL

hydromorphon TAB 2MGQL

ra child asa chw 81MGQL

hydromorphon TAB 32MG ERQL,ST

sm aspirin chw 81MGQL


sm aspirin TAB 325MGQL


sm aspirin TAB 325MG ECQL


sm aspirin TAB 81MG ECQL

ibudone TAB 5-200MGQL,PA

sm child asa chw 81MGQL

lorcet plus TAB 7.5-325QL

st joseph chw low 81MGQL

lorcet HD TAB 10-325MGQL

tgt aspirin chw childQL

lorcet TAB 5-325MGQL

tgt aspirin chw 81MGQL

lortab TAB 10-325MGQL

tgt aspirin TAB 325MGQL

lortab TAB 5-325MGQL

tgt aspirin TAB 81MGQL

lortab TAB 7.5-325QL

tgt aspirin TAB 81MG ECQL

meperidine inj 100MG/ML

Aspirin TAB 81MGQL

methadone sol 10MG/5MLQL,ST

CVS aspirin TAB 325MGQL

methadone sol 5MG/5MLQL,ST

CVS aspirin TAB 325MG ECQL

methadone CON 10MG/MLQL,ST

CVS aspirin TAB 81MG ECQL



methadone TAB 10MGQL,ST

Morphine SUL Inj 50MG/ML


Morphine SUL Sup 10MG



methadose TAB 40MGQL,ST


morphine SUL inj 1MG/ML



Morphine SUL TAB 15MGQL


Morphine SUL TAB 30MGQL

morphine SUL sol 10MG/5ML

Oxycod/Ibu TAB 5-400MGQL

morphine SUL sol 100/5ML

Oxycodone TAB 10MG ERQL,ST

morphine SUL sol 20MG/5ML


morphine SUL CAP 100MG ERQL,ST







Oxycodone/ Sol ApapQL


Oxymorphone TAB 10MG ERQL,PA



morphine SUL TAB 100MG ERQL,ST









Oxymorphone TAB 7.5MG ERQL,PA

oxycod/apap TAB 10-325MGQL

Tramadol HCL CAP 150MG ERQL,ST

oxycod/apap TAB 2.5-325QL

TIER 02 PREFERRED

oxycod/apap TAB 5-325MGQL

Nucynta ER TAB 100MGQL,PA

oxycod/apap TAB 7.5-325QL


oxycod/asa TABQL


oxycodone sol 5MG/5ML


oxycodone CON 100/5ML


oxycodone CON 20MG/ML

Nucynta TAB 100MGPA

oxycodone TAB 10MGQL

Nucynta TAB 50MGPA


Nucynta TAB 75MGPA


Oxycontin TAB 10MG CRQL,ST



oxycodone TAB 5MGQL


oxymorphone TAB HCL 10MGQL,PA


oxymorphone TAB HCL 5MGQL,PA


oxymorphone TAB 10MG ERQL,PA






OPIOID ANTAGONIST


TIER 01 GENERIC


naloxone inj 0.4MG/ML

oxymorphone TAB 7.5MG ERQL,PA

naltrexone TAB 50MG

reprexain TAB 10-200MGQL,PA

Naloxone Inj 0.4MG/ML

tramadl/apap TAB 37.5-325QL

Naloxone Inj 1MG/ML

tramadol HCL TAB 100MG ERQL,PA

TIER 02 PREFERRED


Narcan Spr


tramadol HCL TAB 50MGQL

ANTI-INFLAMMATORY

xylon TAB 10-200MGQL,PA

TIER 01 GENERIC

Butorphanol Inj 1MG/ML

celecoxib CAP 100MG

Codeine Sulf TAB 15MGQL

celecoxib CAP 200MG


celecoxib CAP 400MG


celecoxib CAP 50MG

Fentanyl CIT Inj 0.05MG/1QL

diclofen pot TAB 50MG

Fentanyl CIT Inj 100mcgQL

diclofenac TAB 100MG ER


diclofenac TAB 25MG DR



Hydromorphon Sup 3MG


Levorphanol TAB 2MGQL

etodolac CAP 200MG

Methadone Sol 10MG/5MLQL,ST

etodolac CAP 300MG

Methadone Sol 5MG/5MLQL,ST

etodolac TAB 400MG

Methadose CON 10MG/MLQL,ST

etodolac TAB 500MG

Methadose SF CON 10MG/MLQL,ST

fenoprofen TAB 600MG

Morphine SUL Inj 10/0.7ML

flurbiprofen TAB 100MG


flurbiprofen TAB 50MG


ibuprofen TAB 400MG

Morphine SUL Inj 150/30ML

ibuprofen TAB 600MG


ibuprofen TAB 800MG




indomethacin inj 1MG

indomethacin CAP 25MG

MIGRAINE PRODUCTS

indomethacin CAP 50MG

TIER 01 GENERIC

ketoprofen CAP 50MG

almotrip mal TAB 12.5MGQL,PA

ketoprofen CAP 75MG

almotrip mal TAB 6.25MGQL,PA

ketorolac inj 15MG/ML

almotriptan TAB 12.5MGQL,PA

ketorolac inj 30MG/ML

almotriptan TAB 6.25MGQL,PA

ketorolac inj 60MG/2ML

dihydroergot inj 1MG/ML

ketorolac TAB 10MGPA

eletriptan TAB 20MGQL,PA

leflunomide TAB 10MG

eletriptan TAB 40MGQL,PA

leflunomide TAB 20MG

ergot/caffen TAB 1-100MG

mefenam acid CAP 250MG

frovatriptan TAB 2.5MGQL,PA

meloxicam TAB 15MG

naratriptan TAB 1MGQL

meloxicam TAB 7.5MG

naratriptan TAB 2.5MGQL

nabumetone TAB 500MG

rizatriptan TAB 10MGQL

nabumetone TAB 750MG

rizatriptan TAB 10MG odtQL

naproxen sod TAB 275MG

rizatriptan TAB 5MGQL

naproxen sod TAB 550MG

rizatriptan TAB 5MG odtQL

naproxen sus 125/5ML

sumatriptan inj 4MG/0.5QL,ST

naproxen TAB 250MG

sumatriptan inj 6MG/0.5QL,ST

naproxen TAB 375MG

sumatriptan spr 20MG/actQL

naproxen TAB 500MG

sumatriptan spr 5MG/actQL

oxaprozin TAB 600MG

sumatriptan TAB 100MGQL

piroxicam CAP 10MG


piroxicam CAP 20MG


profeno TAB 600MG

zolmitriptan TAB 2.5 MGQL

sulindac TAB 150MG

zolmitriptan TAB 2.5MG orally disintegratingQL

sulindac TAB 200MG

zolmitriptan TAB 5MGQL

tolmetin sod CAP 400MG

Dihydroergot Spr 4MG/ML

Meclofen Sod CAP 100MG

Sumatriptan Inj 6MG/0.5QL,ST

Meclofen Sod CAP 50MG

TIER 02 PREFERRED

Naproxen Sus 125/5ML

Ergomar Sub 2MG

Tolmetin Sod CAP 400MG

Migergot Sup 2/100

Tolmetin Sod TAB 200MG

Migranal Spr 4MG/ML

Tolmetin Sod TAB 600MG

Relpax TAB 20MGQL,PA

TIER 02 PREFERRED

Relpax TAB 40MGQL,PA

Arcalyst Inj 220MGQL,PA

Zomig Spr 2.5MGQL,PA

Enbrel Inj 25/0.5MLQL,PA

Zomig Spr 5MGQL,PA

Enbrel Inj 50MG/MLQL,PA

Enbrel Srclk Inj 50MG/MLQL,PA

GOUT AGENTS

Humira Inj 10MG/0.2QL,PA

TIER 01 GENERIC

Humira Kit 20MG/0.4QL,PA

allopurinol TAB 100MG

Humira Kit 40MG/0.8QL,PA

allopurinol TAB 300MG

Humira Pedia Inj CrohnsQL,PA

proben/colch TAB 500-0.5

Humira Pen Inj CrohnsQL,PA

probenecid TAB 500MG

Humira Pen Inj PsoriasiQL,PA

Colchicine CAP 0.6MG

Humira Pen Inj 40MG/0.8QL,PA

Colchicine TAB 0.6MG

Kineret InjQL,PA

TIER 02 PREFERRED

Orencia Clck Inj 125MG/MLQL,PA

Colcrys TAB 0.6MG

Orencia Inj 125MG/MLQL,PA

Uloric TAB 40MGPA

Orencia Inj 50/0.4QL,PA

Uloric TAB 80MGPA

Orencia Inj 87.5/0.7QL,PA

Otezla TAB 10/20/30QL,PA

LOCAL ANESTHETICS-INJ

Otezla TAB 30MGQL,PA

TIER 01 GENERIC

Rasuvo Inj 10MG

lidocaine inj 1%

Rasuvo Inj 12.5MG

lidocaine inj 2%

Rasuvo Inj 15MG

Rasuvo Inj 17.5MG

RESPIRATORY, ALLERGY, ETC

Rasuvo Inj 20MG

ANTIHISTAMINES

Rasuvo Inj 22.5MG

TIER 01 GENERIC

Rasuvo Inj 25MG

arbinoxa sol 4MG/5ML

Rasuvo Inj 27.5MG

arbinoxa TAB 4MG

Rasuvo Inj 30MG

carbinoxamin sol 4MG/5ML

Rasuvo Inj 7.5MG

carbinoxamin TAB 4MG

Ridaura CAP 3MGQL

clemastine TAB 2.68MG

Sprix Spr 15.75MGPA

cyproheptad syp 2MG/5ML

Xeljanz TAB 5MGQL,PA

cyproheptad TAB 4MG

Xeljanz XR TAB 11MGQL,PA

desloratadin TAB 5MG


diphenhydram inj 50MG/ML

Orencia Inj 250MGPA



levocetirizi sol 2.5/5ML

ipratropium/ sol albuter

levocetirizi TAB 5MG

levalbuterol neb 0.31MG

pharbedryl CAP 50MG

levalbuterol neb 0.63MG

phenadoz sup 12.5MG

levalbuterol neb 1.25/0.5PA

phenadoz sup 25MG

montelukast chw 4MG

phenergan sup 12.5MG

montelukast chw 5MG

phenergan sup 25MG

montelukast gra 4MG

phenergan sup 50MG

montelukast TAB 10MG

promethazine sol 6.25/5ML

terbutaline TAB 2.5MG

promethazine sup 12.5MG

terbutaline TAB 5MG

promethazine sup 25MG

theochron TAB 100MG CR

promethazine sup 50MG


promethazine syp 6.25/5ML


promethazine TAB 12.5MG

theophylline sol 80/15ML

promethazine TAB 25MG

theophylline TAB 100MG CR

promethazine TAB 50MG

theophylline TAB 100MG ER

promethegan sup 12.5MG

theophylline TAB 200MG CR

promethegan sup 25MG


promethegan sup 50MG


Clemastine TAB 2.68MG


Desloratadin TAB 2.5 Odt


Desloratadin TAB 5MG Odt


zafirlukast TAB 10MG

NASAL AGENTS

zafirlukast TAB 20MG

zileuton ER TAB 600MGPA

TIER 01 GENERIC

Cromolyn Sod Neb 20MG/2ML

azelastine spr 0.1%

Metaproteren Syp 10MG/5ML

azelastine spr 0.15%

Metaproteren TAB 10MG

fluticasone spr 50mcg

Metaproteren TAB 20MG

ipratropium spr 0.03%

TIER 02 PREFERRED

ipratropium spr 0.06%

Advair Disku Aer 100/50ST

olopatadine spr 0.6%PA


Flunisolide Spr 0.025%


Advair HFA Aer 115/21ST

COUGH/COLD/ALLERGY


TIER 01 GENERIC


acetylcyst sol 10%

Alvesco Aer 160mcgPA

acetylcyst sol 20%

Anoro Ellipt Aer 62.5-25PA

benzonatate CAP 100MG

Asmanex HFA Aer 100 McgST

benzonatate CAP 200MG

Asmanex HFA Aer 200 McgST

hydroc/homat TAB 5-1.5MG

Asmanex 120 Aer 220mcgST

hydrocod/hom syp 5-1.5/5


hydromet syp 5-1.5/5


nebusal neb 3%


prometh VC sol plain


prometh VC/ syp codeine


prometh/cod syp 6.25-10

Atrovent HFA Aer 17mcg

prometh/PE syp 6.25-5/5

Breo Ellipta Inh 100-25PA

prometh/PE/ syp codeine

Breo Ellipta Inh 200-25PA

promethazine syp DM

Brovana Neb 15mcgPA

pulmosal neb 7%

Combivent Aer 20-100

sod chloride neb 0.9%

Daliresp TAB 500mcgPA

sodium chlor neb 3%

Dulera Aer 100-5mcgPA

sodium chlor neb 7%

Dulera Aer 200-5mcgPA

tussigon TAB 5-1.5MG

Flovent Disk Aer 100mcgPA


ANTIASTHMATIC/COPD AGENTS


TIER 01 GENERIC

Flovent HFA Aer 110mcgPA

albuterol neb 0.083%

Flovent HFA Aer 220mcgPA

albuterol neb 0.5%

Flovent HFA Aer 44mcg

albuterol neb 0.63MG/3

Foradil CAP Aerolize

albuterol neb 1.25MG/3

Qvar Aer 40mcg

albuterol syp 2MG/5ML

Qvar Aer 80mcg

albuterol TAB 2MG

Serevent Dis Aer 50mcgST

albuterol TAB 4MG

Spiriva Aer 1.25mcgST

aminophyllin inj 25MG/ML

Spiriva CAP Handihlr

budesonide sus 0.25MG/2

Spiriva Spr 2.5mcg

budesonide sus 0.5MG/2

Stiolto Aer 2.5-2.5

budesonide sus 1MG/2ML

Striverdi Aer 2.5mcgPA

ipratropium sol 0.02%inh

Ventolin HFA AerQL



Fluvirin Inj 2016-17

RESPIRATORY AGENTS - MISC


Fluzone HD Inj PF 15-16

TIER 02 PREFERRED


Esbriet CAP 267MGQL,PA


Esbriet TAB 267MGQL,PA

Fluzone Quad Inj 15-16

Esbriet TAB 801MGQL,PA


Kalydeco TAB 150MGQL,PA


Ofev CAP 100MGQL,PA


Ofev CAP 150MGQL,PA

Fluzone Splt Inj 2015-16

Pulmozyme Sol 1MG/MLQL

Gardasil Inj

Survanta Inh

Gardasil 9 Inj

Havrix Inj 1440unit

TOXOIDS

Havrix Inj 720unit

Hiberix Sol 10mcg

TIER P PREVENTIVE

Influenza Firus Vaccine

Adacel Inj

Ipol Inj Inactive

Boostrix Inj

M-m-r II Inj

Daptacel Inj

Menactra Inj

Dip/Tet PED Inj 25-5lfu

Menhibrix Inj

Infanrix Inj

Menomune Inj A/C/Y/W

Kinrix Inj

Menveo Inj

Pediarix Inj 0.5ML

Pedvax HIB Inj

Pentacel Inj

Pneumovax 23 Inj 25/0.5

Quadracel Inj

Prevnar 13 Inj

Tenivac Inj 5-2LF

Proquad Inj

Tet/Dip Tox Inj 2-2 LF

Recombiva HB Inj 10mcg/ML

Recombiva HB Inj 5mcg/0.5

VACCINES

Recombiva-HB Inj 40mcg/ML

Rotarix Sus

TIER P PREVENTIVE

Rotateq Sol

Acthib Inj

Trumenba Inj

Afluria Inj PF 15-16

Twinrix Inj


Vaqta Inj 25/0.5ML


Vaqta Inj 50unt/ML

Afluria Inj 2015-16

Varivax Inj

Afluria Inj 2016-17

Zostavax Inj

Afluria Inj 2017-18

Afluria Quad Inj PF 16-17

VITAMINS

Afluria Quad Inj PF 17-18

VITAMINS

Afluria Quad Inj 2017-18

TIER 01 GENERIC

Bexsero Inj

phytonadione inj 1MG/0.5

Cervarix Inj

vitamin d CAP 50000unt

Comvax Inj

vitamin k1 inj 1MG/0.5

Engerix-b Inj 10/0.5ML

Vitamin K1 Inj 10MG/ML

Engerix-b Inj 20mcg/ML

TIER 02 PREFERRED

EZ Flu Shot Inj PF 14-15

Mephyton TAB 5MG

EZ Flu Shot Inj 2015-16

TIER P PREVENTIVE

EZ Flu Shot Kit 2015-16

bio-d-mulsio liq 2000unit

EZ Flu Shot Kit 2016-17

bio-d-mulsio liq 400unit

Fluad Inj 2016-17

cvd d3 chw 1000unit

Fluad Inj 2017-18

d 1000 chw 1000unit

Fluarix Quad Inj 2015-16

d 1000 CAP 1000unit


d 1000 TAB 1000unit


d 400 chw 400unit

Flublok Quad Inj 2017-18

d 400 TAB 400unit

Flublok Sol 2015-16

d-vita liq 400unit

Flublok Sol 2016-17

d-3 gummy chw 400unit

Flublok Sol 2017-18

d-400 TAB 400unit

Flucelvax Inj 2015-16

decara CAP 50000unt

Fluclvx Quad Inj 2016-17

delta d3 TAB 400unit

Fluclvx Quad Inj 2017-18

dialyvite d CAP 5000unit

Flulaval Qua Inj 2014-15

d3 adult chw 1000unit


d3 kids chw 400unit


d3 max ST dro 5000unit


d3 maximum CAP 5000unit

Flumist Quad Sus 2015-16

d3 super str CAP 2000unit


d3 CAP 1000unit


d3 CAP 10000




d3 CAP 2000unit

Ddrops Liq

d3 CAP 400unit

Ddrops Liq 1000unit

d3 TAB 1000unit

Ddrops Liq 2000unit

d3 TAB 2000unit

Decara CAP 25000unt

d3 TAB 400unit

D3 Dots TAB 2000unit

d3 2000 TAB 2000unit

HM vit d3 CAP 2000unit

d3-1000 CAP 1000unit

HM vitamin d TAB 1000unit

d3-50 CAP 50000unt

Optimal D3 M CAP

eql vitamin CAP d3

PA vitamin CAP 2000unit

gnp d chw 2000unit

Replesta Nx Waf 14000unt

gnp d CAP 1000unit

Replesta Waf 14000unt

gnp vit d TAB 1000unit

Replesta Waf 50000unt

gnp vit d TAB 5000unit

Super Daily Dro D3

gnp vit d3 TAB 1000unit

Thera-d TAB 4000unit

just d liq 400unit

Upspringbaby Dro Vit D3

optimal-d CAP 50000unt

Vit D3 Drops Liq 400unit

opurity vit chw d 5000un

Vitamelts D TAB 1000 Iu

pedia d-vite dro 400unit

Vitamin D3 Chw 5000unit

ra vitamin CAP 2000unit

Vitamin D3 CAP 4000unit

sm vitamin d TAB 400unit

Vitamin D3 Liq 1000unit

thera-d sprt TAB 2000unit

Vitamin D3 Liq 1200unit

thera-d TAB 2000unit

Vitamin D3 Spr 1000unit

vit d child chw 1000unit

Vitamin D3 TAB 10000unt

vit d gummie chw 400unit

Vitamin D3 TAB 3000unit

vit d3 gumm chw 1000unit

Vitamin D3 TAB 5000unit

vitajoy daly chw d 1000iu

vitamin d chw 1000unit

vitamin d chw 400unit

MULTIVITAMINS

vitamin d dro 400unit

TIER P PREVENTIVE

vitamin d CAP 1000unit

sm prenatal TAB vitamins


Atabex Chw Prenatal


Be Well PAK Rounded

vitamin d TAB 1000unit

Brainstrong Mis Prenatal


CL Prenatal TAB 28-0.8MG


CVS Prenatal Chw Gummy

vitamin d TAB 5000iu

CVS Prenatal TAB

vitamin d-3 CAP 1000unit

Enfamil Mis Expecta

vitamin d-3 CAP 2000unit

Eql Prenatal TAB Formula

vitamin d-3 TAB 1000unit

Gnp Daily Mis Prenatal


Gnp Prenatal TAB 28-0.8MG


Goodsense TAB 28-0.8MG

vitamin d3 chw 1000unit

HM One Daily Mis Prenatal


HM Prenatal TAB


Kp Prenatal TAB Multivit


Multi Prenat TAB

vitamin d3 dro 400unit

One A Day CAP Prenatal

vitamin d3 dro 5000unit

One A Day Mis Prenatal

vitamin d3 CAP 1000unit

One A Day PAK Prenatal

vitamin d3 CAP 10000unt

One-a-day PAK Prenatal


Perry Prenat CAP


Pre-natal TAB Formula


Prenat Multi CAP +dha

vitamin d3 CAP 50000unt

Prenatal CAP Formula

vitamin d3 TAB 1000unit

Prenatal CAP Omega-3


Prenatal Mul CAP +dha


Prenatal MV Mis + DHA


Prenatal One TAB Daily

vitamin d3 TAB 50000uni

Prenatal TAB

vitamin d3 TAB 50000unt

Prenatal TAB Complete

Baby Ddrops Liq 400unit

Prenatal TAB Formula

Baby Super Dro Daily D3

Prenatal TAB Forte

Baby Vit D Dro 400/.028

Prenatal TAB Iron

CVS d3 chw 1000 unt

Prenatal TAB Low Iron

CVS d3 CAP 1000unit

Prenatal TAB Multivit

CVS d3 CAP 2000unit

Prenatal TAB Plus DHA

CVS d3 CAP 400unit

Prenatal TAB Vitamins

CVS d3 CAP 5000unit

Prenatal TAB 27-0.8MG

D-VI-sol Liq 400unit

Prenatal TAB 28-0.8MG

Daily D3 Dro 1000unit

Prenatal Vit TAB Minerals

Ddrops Boost Liq 600/.028



Prenatal Vit TAB 28-0.8MG

Assure Plus Mis Mcro 28G

Prenatal/FE TAB

Assure Plus Mis Norm 21G

Prenatl Mult CAP + DHA

Assure Plus Mis Pediatri

Prentat Mult CAP Plus DHA

Assure Prism Sol Level1/2

Px Prenatal TAB Multivit

Assure Pro Liq Level1/2

Qc Prenatal TAB 28-0.8MG

Assure 3 Liq Control

Ra One Daily Mis

Assure 4 Liq Level1/2

Ra Prenatal TAB Formula

Aurora Lance Mis Thin 23G

Ra Prenatal TAB 28-0.8MG

Aurora Lance Mis 30G

Right Step TAB Prenatal

Auto Lancet Mis

Sm One Daily Mis Prenatal

Auto-lancet Mis Mini

Sm Prenatal TAB Vitamins

Autolet Impr Mis Lanc Dev

Stuart One CAP

Autolet II Kit Clinisaf

Your Life CAP Prenatal

Autolet Lanc Mis Device

Autolet Lite Kit Clinisaf

MEDICAL DEVICES

Autolet Mini Mis

Autolet Plus Mis Lanc Dev

DIABETIC SUPPLIES

Autoshield Mis 29X3/16"

TIER 01 GENERIC

Autoshield Mis 29X5/16"

lancets mis 23G

AT Last Sol Control

Accu-chek Kit Fastclix

Bayer Breeze Liq High Cnt

Accu-chek Kit Mlticlix

Bayer Breeze Liq Low Cntl

Accu-chek Kit Softclix

Bayer Breeze Liq Norm Cnt

Accu-chek Liq Act/Gluc

Bayer Breeze Mis 2 TestQL,PA

Accu-chek Liq Guide

Bayer Micrlt Mis Lanc Dvc

Accu-chek Liq Smart

Bayer Micrlt Mis Lancets

Accu-chek Mis Mlticlix

Bullseye Mis Lancets

Accu-chek Sol

Bullseye Mis Mini Lnc

Accu-chek Sol Compact

BD Lancet Mis Device

Accutrend Sol Glucose

BD Lancet UF Mis 30G

Acti-lance Mis Lite 28G

BD Lancet UF Mis 33G

Acti-lance Mis Spec 17G

BD Microtain Mis Lancets

Acti-lance Mis Univ 23G

BD Pen Needl Mis 29GX1/2"

Acti-lance Mis 28G

BD Pen Needl Mis 31GX3/16

Acura Contrl Sol High

BD Pen Needl Mis 31GX5/16

Acura Contrl Sol Low

BD Pen Needl Mis 32GX4MM

Acura Contrl Sol Normal

Careone Adv Mis Lancing

Adj Lancing Mis Device

Careone Lanc Mis Thin 23G

Adv Lancing Mis Device

Careone Lanc Mis 28G

Adv Travel Mis Lanc 28G

Caresens Sol Control

Advance Liq Control

Clever Check Mis

Advance Liq Intuitio

Clever Check Mis 30G

Advance Norm Liq Control

Clevr Choice Liq High

Advcate Safe Mis Lanc 26G

Clevr Choice Liq Low

Advocate Liq High

Clickfine Mis 31GX1/4"

Advocate Liq Low

Clickfine Mis 31GX5/16

Advocate Mis Lanc Dev

Coaguchek Mis Lancets

Advocate Mis Lanc 30G

Comfort Assu Mis Lanc 28G

Advocate Mis Lancets

Comfort Assu Mis Lanc 33G

Advocate+ Sol Redi-cod

Comfort Mis Lancets

Agamatrix Mis 33G

Comfortouch Mis Lancet

Agamatrix Sol High

Contour Liq High Cnt

Agamatrix Sol Norm/Hgh

Contour Liq Low Cntl

Agamatrix Sol Normal

Contour Liq Norm Cnt

Altrnate Sit Mis Device

Contour Sol Next

Aqua Lance Mis Lanc Dev

Contour Tes NextQL,PA

Assure Cmfrt Mis 28G

Control High Sol Unistrip

Assure Cmfrt Mis 30G

Control Low Sol Unistrip

Assure Dose Sol Norm/Hgh

Control Norm Sol Easy Stp

Assure Dose Sol Normal

Control Sol Liq High/Low

Assure II Liq Level 1

Control Sol Liq HI/Mid/L

Assure II Liq Level1/2

Control Sol Liq Mid

Assure Lance Mis Low Flow

Control Sol Normal

Assure Lance Mis Micro

Cool Control Sol A

Assure Lance Mis Safe 25G

Cool Control Sol B

Assure Lance Mis Safe 30G

CVS Lancets Mis Original

Assure Lance Mis 21G

CVS Lancets Mis Thin 26G

Assure Mis Lancets


Assure Plus Mis High 18G


Assure Plus Mis Low 25G

CVS Lancets Mis 21G



CVS Lancing Mis Device

Evencare G2 Sol Low/High

Diatrue Cont Sol Level 1

Evencare G3 Sol Low/High


Evencare Sol Liq Low/High


Evolution Sol Normal

Droplet Lanc Mis Device

EZ Smart Mis Lancets

Droplet Lanc Mis 30G

Fastclix Mis Lancets

Duo-care Liq Level1/2

Fifty50 Mis Lanc Dev

E-z Ject Mis Lanc 21G

Fifty50 Mis 31GX3/16

E-z Ject Mis Thin 26G

Fifty50 Mis 31GX5/16

E-z Ject Mis 21G

Fifty50 Safe Mis Lancets

E-z Ject Mis 21G Colr

Fifty50 Sol 2.0

E-z Ject Mis 30G

Fine 30 Mis

E-z Ject Mis 32G Colr

Fingerstix Mis Lancets

E-ZJECT Lanc Mis 33G

Fora Control Sol High

Easy Comfort Mis Lanc/30G

Fora Control Sol Low

Easy Comfort Mis 30G

Fora Control Sol Normal

Easy Mini Mis

Fora Mis Lancets

Easy Plus II Sol High

Fora Mis Lancing

Easy Plus II Sol Low

Foracare Gdh Sol High

Easy Talk Sol High

Foracare Gdh Sol Low

Easy Talk Sol Low

Foracare Gdh Sol Normal

Easy Talk Sol Normal

Fortiscare Sol Cntl HI

Easy Touch Mis

Fortiscare Sol Cntl Low

Easy Touch Mis Lanc/21G

Fortiscare Sol Cntl Nml


Freestyle Liq Control


Freestyle Mis Lancets


Freestyle Mis Unistick


Freestyle TesQL,PA


Ge100 Contrl Sol Normal


Global Lanc Mis Device

Easy Touch Mis 29GX1/2"

Global 28G Mis Lancets

Easy Touch Mis 31GX1/4"

Global 30G Mis Lancets

Easy Touch Mis 31GX3/16

Gluc Control Liq Normal

Easy Touch Mis 31GX5/16

Gluc Control Sol

Easy Touch Mis 32GX5MM

Gluc Control Sol Level 1

Easy Touch Mis 32GX6MM

Gluc Control Sol Level 2

Easy Touch Sol Control

Gluc Control Sol Mid

Easy Touch Sol High/Low

Gluc Control Sol Normal

Easy Trak Sol High

Glucocard Liq Level 1

Easy Trak Sol Low

Glucocard Sol Normal

Easy Trak Sol Normal

Glucocard Sol Shine

Easygluco Sol High

Glucocard 01 Liq Norm/Hgh

Easygluco Sol Low

Glucocard 01 Sol Normal

Easygluco Sol Normal

Glucocom Mis 28G

Easygluco Sol Plus

Glucocom Mis 30G

Easymax Sol High

Glucocom Mis 33G

Easymax Sol Low

Glucocom Tes High CON

Easymax Sol Norm/Low

Glucocom Tes Norm CON

Easymax Sol Normal

Glucolet 2 Mis Lancing

Easymax 15 Sol Level 1

Glucose Cont Liq High/Low

Easymax 15 Sol Level 2

Glucose Cont Sol High

Easymax 15 Sol Level1-2

Glucose Cont Sol Normal

Easystep Hgh Sol Control

Glucose Cont Sol Precisio

Easystep Low Sol Control

Glucosource Mis Lanc Dev

Element Cont Liq Normal

Glucosource Mis Lancets

Element Liq High

Gmate Contro Sol Level 2

Element Liq Low

Gmate Lancet Mis 30G

Elemnt Compa Sol Level 2

Gnp Lancets Mis

Elemnt Compa Sol Level 3

Gnp Lancets Mis Micro

Embrace Cntr Liq High

Gnp Lancets Mis Sup Thin

Embrace Evo Liq Level 1

Gnp Lancets Mis Thin

Embrace Evo Liq Level 2

Gnp Lancets Mis Thin 26G

Embrace Lanc Mis Thin 30G

Gnp Lancets Mis 21G

Embrace Pro Liq Glucose

Haemolance Mis High FLO

Embrace Sol Low

Haemolance Mis Low Flow

Eql Lancets Mis Thin 26G

Haemolance Mis Plus

Eql Lancets Mis Thin 30G

Haemolance Mis Plus Low

Eql Lancets Mis 21G Colr

Haemolance Mis Plus Max

Eql Lancets Mis 33G Colr

Haemolance Mis Plus PED

Evencar Mini Sol Normal

Haemolance Mis Retract



Healthpro Sol High/Low

Lancets Thin Mis 26G

Hlthy Accnts Mis Lanc 30G

Lancets Thin Mis 30G

Hypolance Kit Lancing

Lancets Ultr Mis Thin

HC Lancing Mis Device

Lancets Ultr Mis Thin 28G

Incontrol Mis Lanc Dev

Lancets Ultr Mis Thin 30G

Incontrol Mis Lanc 28G

Lancing Devi Mis

Incontrol Mis Lanc 30G

Lb Lancet Mis 28G

Incontrol Mis 29GX12MM

Lb Lancing Mis Device

Infinity Sol High CON

Lite Touch Mis Lanc Dev

Infinity Sol Low CON

Lite Touch Mis Lanc Pen

Infinity Sol Norm CON

Lite Touch Mis Lancets

Insulin Pen Mis 29GX12MM

Litetouch Mis Lancets

Insulin Pen Mis 31GX8MM

Litetouch Mis 29GX12.7

Insulin Syrg Mis 0.3/28G

Litetouch Mis 31GX8MM


Longs Lancet Mis Standard


Longs Lancet Mis Thin


Longs Lancet Mis Ultra Th


Maxima Sol Control


Medisense Liq Gluc-ket


Medisense Liq Gluc/Ket


Medlance Mis Lite 25G


Medlance Mis Plus

Insulin Syrg Mis 1ML

Medlance Mis Plus 30G

Insulin Syrg Mis 1ML/25G

Medlance Mis Unv 21G


Medlance Mis 30G Plus


Medlance Pls Mis Extr 21G


Medlance Pls Mis Lite 25G


Medlance Pls Mis Univ 21G


Medlance Pls Mis 0.8MM


Meijer Lance Mis Universa

Insulin Syrg Mis 28GX1/2"

Meijer Mis Lancets

Insulin Syrg Mis 29GX1/2"

Micro Thin Mis Lanc 33G

Insulin Syrg Mis 30GX5/16

Microdot CON Sol High/Low

Insulin Syrg Mis 31GX5/16

Microlet Mis Lancets

Insupen Mis 32GX4MM

Monolet Mis Lancets

Insupen Sens Mis 32GX6MM

Multi-lancet Mis Device

Insupen Sens Mis 32GX8MM

Myglucohealt Mis Lanc 30G

Insupen Ultr Mis 29GX12MM

Myglucohealt Sol LO/Nl/HI


Neutek 2tek Sol Control


Nexgen Tes Norm CON


Nova Max Glu Liq /Ket CON

IN Control Mis 31GX5MM

Nova Safety Mis Lanc 23G


Nova Safety Mis Lanc 28G


Nova Sure Mis Lancets

IN Touch Sol Glucose

Nova Sureflx Mis Lanc Dev

Kinney Mis Lancets

Novofine Aut Mis 30GX8MM

Kinney Thin Mis Lancets

Novofine Mis 30GX8MM

Lancet Alter Mis Site 26G

Novofine Mis 32GX6MM

Lancet Devic Mis Adjust

On Call Expr Sol Glucose

Lancet Micro Mis Thin 33G

On Call Mis Lancets

Lancet Stand Mis 21G

On Call Plus Mis Lancets

Lancet Super Mis Thin 30G

On Call Plus Sol Control

Lancet Ultra Mis Fine

On Call Vivd Sol Control

Lancet Ultra Mis Thin 28G

On-the-go Mis Lanc 30G

Lancet Ultra Mis Thin 30G

Onetouch Mis Lanc Dev

Lancet Ultra Mis 28G

Onetouch Mis Lancets

Lancets Micr Mis Thin 33G

Onetouch Mis 30G

Lancets Mis

Onetouch Sol Ult Cont

Lancets Mis Thin

Onetouch Sol VerioQL

Lancets Mis Thin 26G

Onetouch Sol Verio-HIQL

Lancets Mis Thin 30G

Onetouch Tes UltraQL

Lancets Mis 21G

Onetouch Tes Ultra BLQL

Lancets Mis 21G Colr

Onetouch Tes VerioQL

Lancets Mis 23G

Onetouch Us Mis Lancets

Lancets Mis 26G

Optumrx Cont Sol Level1/2

Lancets Mis 28G

Pen Needle Mis 29GX1/2"

Lancets Mis 30G

Pen Needles Mis 29GX1/2"

Lancets Mis 33G

Pen Needles Mis 29GX12MM

Lancets Supr Mis Thin 28G

Pen Needles Mis 31GX1/4"

Lancets Thin Mis

Pen Needles Mis 31GX3/16



Pen Needles Mis 31GX5/16

Sterilance Mis 1.8MM


Super Thin Mis Lanc 28G


Super Thin Mis Lancets


Supreme II Liq High/Low


Sure Comfort Mis Lanc Pen

Penlet II Kit Blood

Sure Comfort Mis Lancets

Pocketchem Sol EZ

Sure Comfort Mis 29GX1/2"

Precision Liq Control

Sure Comfort Mis 30GX5/16

Precision Liq Gluc/Ket


Precision Liq Nrml/Mid


Pro Comfort Mis 31GX8MM

Sure-fine Mis 29GX1/2"

Pro Comfort Mis 32GX4MM

Sure-fine Mis 31GX3/16

Prodigy Mis Lanc Dev

Sure-fine Mis 31GX5/16

Prodigy Mis 28G

Sure-lance Mis Lancets

Prodigy NO Tes CodingQL,PA

Sure-lance Mis 26G

Prodigy Sol High

Sure-pen Mis

Prodigy Sol Low

Sure-touch Mis Unv Lanc

Px Lancets Mis Ult Thin

Sureflex Mis Lancets

Px Lancets Mis 28G

Surestep Glu Sol

PC Lancets Mis 30G

Surestep Glu Sol High/Low

Qc Lancets Mis 28G

Surestep Pro Tes High CON

Qc Lancets Mis 30G

Surestep Pro Tes Low CON

Qc Lancing Mis Device

Surestep Pro Tes Norm CON

Quicktek Liq Solution

Surestep Sol Control

Quintet Cont Sol Hgh/Norm

SB Lancets Mis Thin

Ra E-ZJECT Mis Thin 26G

SB Lancets Mis Ultr Thn

Ra E-ZJECT Mis Thin 28G

Tai Doc Sol Norm CON

Ra E-ZJECT Mis Ult Thin

Techlite AST Mis Lancets

Ra E-ZJECT Mis 28G

Techlite Mis Lanc 30G

Ra Pen Needl Mis 31GX3/16

Techlite Mis Lancets

Refuah Plus Sol Control

Telcare Sol Level1/2

Relion Lance Mis Stnd 21G

Tgt Lancet Mis Alternat

Relion Lance Mis Thin 26G

Tgt Lancet Mis 23G

Relion Lance Mis Thin 30G

Tgt Lancet Mis 26G

Relion Lanci Mis Device

Tgt Lancet Mis 28G

Relion Ultra Mis Thin Pls

Tgt Lancet Mis 30G

Rightest Liq High CON

Tgt Lancet Mis 33G

Rightest Liq Norm CON

Tgt Lancing Mis Adv Dev

Rightest Mis Gl300

Tgt Lancing Mis Device

Rightest Mis GD500

Thin Lancets Mis

Safe-t-pro Mis Lancets

Thin Lancets Mis 26G

Safe-t-pro Mis Plus

Thin Lancets Mis 30G

Safety Let Mis Lancets

Tier Uni Pls Mis 31GX8MM

Safety Mis Lancets

Travel Lance Mis 30G

Safety Seal Mis 28G

True Metrix Sol Level 1

Safety Seal Mis 30G


Safety 21G Mis Lancets


Safety 28G Mis Lancets

Truecontrol Liq Level 0

Sapscare Mis Twist

Truecontrol Liq Level 1

Simple Diag Mis Lancing

Truedraw Mis Lanc Dev

Sm Lancets Mis Thin 26G

Truetest Liq Level 1

Sm Lancets Mis Thin 30G


Sm Lancets Mis 21G


Sm Lancets Mis 33G

Truplus Lanc Mis 26G

Smart Sense Mis Lanc 21G







Ulti-lance Mis CLR Tip

Smartest Mis Lancets

Ultilet Mis Lancets

Smartest Sol Control

Ultilet Mis Safety

Soft Touch Mis Lancets

Ultilet Mis 26G

Softclix Mis Lancets

Ultilet Mis 28G

Solus V2 Mis Lanc Dev

Ultilet Mis 30G

Solus V2 Mis Lanc 28G

Ultilet Mis 33G

Solus V2 Mis Lanc 30G

Ultra Thin Mis Lanc 26G

Solus V2 Sol High


Solus V2 Sol Low


Sterilance Mis TL 28G

Ultra Thin Mis Lancets


Ultra Thin Mis 28G


Ultra Thin Mis 30G



Ultra Thin Mis 31G

Aerochamber Mis Plus

Ultra Thin Mis 33G

Aerovent Mis Plus

Ultralance Mis 1.8MM

Arial Mis Chamber

Ultratrk Pro Sol

Breatherite Mis

Ultratrk Pro Sol High/Low

Breatherite Mis LG Mask

Ultratrk Ult Sol High/Low

Breatherite Mis MED Mask

Unifine Pntp Mis 29GX1/2"

Breatherite Mis Sm Mask

Unifine Pntp Mis 29GX12MM

Breatherite Mis Spacer

Unifine Pntp Mis 31GX3/16

Breatherite Mis W/Mask

Unifine Pntp Mis 31GX5/16

Compact Spac Mis Chamber


Compact Spac Mis LG Mask


Compact Spac Mis MD Mask


Compact Spac Mis Sm Mask

Unilet Cmfr Mis Tch 28G

E-z Spacer Mis

Unilet Cmfr Mis Tch 30G

E-z Spacer Mis Body Grd

Unilet Excel Mis 23G

Easivent Mis

Unilet EX II Mis 28G

Easivent Mis Mask LG

Unilet G.p Mis Supr 23G

Easivent Mis Mask MED

Unilet G.p. Mis 21G

Easivent Mis Mask Sm

Unilet GP 28 Mis Ult Thin

Flexichamber Mis

Unilet Lance Mis 21G

Hold Chamber Mis Adlt LG

Unilet Lanct Mis 28G

Hold Chamber Mis Medium


Hold Chamber Mis Small


Inspirachamb Mis Large

Unilet Mis 21G

Inspirachamb Mis Medium

Unilet Super Mis G.p. 23G

Inspirachamb Mis Mouthpce

Unilet Super Mis 23G

Inspirachamb Mis Small

Unistik CZT Mis Comfort

Inspirease Mis Dd Syst

Unistik CZT Mis Normal

Liteaire Mis

Unistik 1 Mis 2.4MM

Microchamber Mis

Unistik 1 Mis 3.0MM

Microspacer Mis

Unistik 2 Mis

Optichamber Mis Adv Lrg

Unistik 2 Mis Comfort

Optichamber Mis Adv MED

Unistik 2 Mis Extra

Optichamber Mis Adv Sm

Unistik 2 Mis Neonatal

Optichamber Mis Advantag

Unistik 2 Mis Normal

Optichamber Mis Dia LG

Unistik 2 Mis Super

Optichamber Mis Dia MD

Unistik 2 Mis 1.8MM

Optichamber Mis Dia Sm

Unistik 3 Mis Comfort

Optichamber Mis Diamond

Unistik 3 Mis Extra

Optichamber Mis Face Mas

Unistik 3 Mis Gent 30G

Optihaler Mis

Unistik 3 Mis Neonatal

Pocket Chamb Mis

Unistik 3 Mis Normal

Pocket Space Mis

Universal 1 Mis Lanc 26G

Riteflo Mis

Universal 1 Mis Lanc 30G

Valvd Holdng Mis Chamber

Vantage Lanc Mis Device

Vortex Valve Mis Chamber

Verasens Liq Level 1

Watchhaler Mis

Victory Sol Control

1ST Choice Mis Lancets

MISCELLANEOUS AGENTS

1ST Tier Uni Mis 29GX12MM


TIER 02 PREFERRED


Chemet CAP 100MG


Cuprimine CAP 250MGQL

Depen Titra TAB 250MGQL

MEDICAL DEVICES - MISC

Exjade TAB 125MGQL,PA

TIER 01 GENERIC


Panda Mask Mis Large


Panda Mask Mis Medium

Ferriprox TAB 500MGQL,PA

Panda Mask Mis Pediatri

Jadenu TAB 180MGQL,PA

Panda Mask Mis Small


TIER 02 PREFERRED


Aerchmbr Pls Mis Flow-VU

Aerchmbr Pls Mis Lrg Mask

Aerchmbr Pls Mis MED Mask

Aerchmbr Pls Mis Sm Mask

Aerchmbr Z- Mis Stat Pls

Aerochamber Mis Chamber

Aerochamber Mis Flosigna

Aerochamber Mis MV



Index

A

Adv Travel Mis Lanc 28G, 36

Alecensa CAP 150MG, 5

Advair Disku Aer 100/50, 33

Alendronate Sol 70/75ML, 15

abaca/lamivu TAB 600-300, 2


alendronate TAB 10MG, 15

abacav/lamiv TAB /zidovud, 2



abacavir sol 20MG/ML, 2

Advair HFA Aer 115/21, 33

Alendronate TAB 40MG, 15

abacavir TAB 300MG, 2



acampro CAL TAB 333MG, 26



acarbose TAB 100MG, 15

Advance Liq Control, 36

alfuzosin TAB 10MG ER, 19


Advance Liq Intuitio, 36

Alinia Sus 100/5ML, 4


Advance Norm Liq Control, 36

Alinia TAB 500MG, 4

Accu-chek Kit Fastclix, 36

Advcate Safe Mis Lanc 26G, 36

allopurinol TAB 100MG, 32

Accu-chek Kit Mlticlix, 36

Advocate Liq High, 36

allopurinol TAB 300MG, 32

Accu-chek Kit Softclix, 36

Advocate Liq Low, 36

almotrip mal TAB 12.5MG, 32

Accu-chek Liq Act/Gluc, 36

Advocate Mis Lanc 30G, 36

almotrip mal TAB 6.25MG, 32

Accu-chek Liq Guide, 36

Advocate Mis Lanc Dev, 36

almotriptan TAB 12.5MG, 32

Accu-chek Liq Smart, 36

Advocate Mis Lancets, 36

almotriptan TAB 6.25MG, 32

Accu-chek Mis Mlticlix, 36

Advocate+ Sol Redi-cod, 36

Alocril Sol 2%, 29

Accu-chek Sol, 36

Aerchmbr Pls Mis Flow-VU, 40

Alomide Sol 0.1% Op, 29

Accu-chek Sol Compact, 36

Aerchmbr Pls Mis Lrg Mask, 40

alophen TAB 5MG EC, 17

Accutrend Sol Glucose, 36

Aerchmbr Pls Mis MED Mask, 40

alosetron TAB 0.5MG, 18

acebutolol CAP 200MG, 6

Aerchmbr Pls Mis Sm Mask, 40

alosetron TAB 1MG, 18

acebutolol CAP 400MG, 6

Aerchmbr Z- Mis Stat Pls, 40

Aloxi Inj 0.25MG/5, 18

acetasol HC sol otic, 29

Aerochamber Mis Chamber, 40

alphatrex gel 0.05%, 11

acetazolamid CAP 500MG ER, 8

Aerochamber Mis Flosigna, 40

alprazolam TAB 0.25MG, 21

acetazolamid TAB 125MG, 8

Aerochamber Mis MV, 40

alprazolam TAB 0.5MG, 21

acetazolamid TAB 250MG, 8

Aerochamber Mis Plus, 40

alprazolam TAB 0.5MG ER, 21

acetic acid sol 0.25%irr, 19

Aerovent Mis Plus, 40

alprazolam TAB 0.5MG XR, 21

acetic acid sol 2% otic, 29

afeditab TAB 30MG CR, 6

alprazolam TAB 1MG, 21

acetylcyst sol 10%, 33

afeditab TAB 60MG CR, 6

alprazolam TAB 1MG ER, 21

acetylcyst sol 20%, 33

Afinitor Dis TAB 2MG, 5

alprazolam TAB 1MG XR, 21

acitretin CAP 10MG, 11


alprazolam TAB 2MG, 21

acitretin CAP 17.5MG, 11



acitretin CAP 25MG, 11

Afinitor TAB 10MG, 5


Acthib Inj, 34

Afinitor TAB 2.5MG, 5


Acti-lance Mis 28G, 36

Afinitor TAB 5MG, 5


Acti-lance Mis Lite 28G, 36

Afinitor TAB 7.5MG, 5

Alrex Sus 0.2%, 28

Acti-lance Mis Spec 17G, 36

Afluria Inj 2015-16, 34

Altabax Oin 1%, 10

Acti-lance Mis Univ 23G, 36


altafrin sol 10% op, 29

Actifoam Mis 12.7X8.9, 21


altafrin sol 2.5% op, 29

Actifoam Mis 7X5x0.6, 21

Afluria Inj PF 15-16, 34

altavera TAB, 13

Acura Contrl Sol High, 36


Altrnate Sit Mis Device, 36

Acura Contrl Sol Low, 36


Alvesco Aer 160mcg, 33

Acura Contrl Sol Normal, 36

Afluria Quad Inj 2017-18, 34

alyacen TAB 1/35, 13

acyclovir CAP 200MG, 2

Afluria Quad Inj PF 16-17, 34

alyacen TAB 7/7/7, 13

Acyclovir NA Inj 500MG, 3

Afluria Quad Inj PF 17-18, 34

amantadine CAP 100MG, 25

acyclovir NA inj 50MG/ML, 2

aftera TAB 1.5MG, 13

amantadine syp 50MG/5ML, 25

acyclovir sus 200/5ML, 2

Agamatrix Mis 33G, 36

amantadine TAB 100MG, 25

acyclovir TAB 400MG, 2

Agamatrix Sol High, 36

Ambisome Inj 50MG, 2

acyclovir TAB 800MG, 2

Agamatrix Sol Norm/Hgh, 36

Amcinonide CRE 0.1%, 11

Adacel Inj, 34

Agamatrix Sol Normal, 36

Amcinonide Lot 0.1%, 11

adapal/ben p gel 0.1-2.5%, 10

agoneaze kit 2.5-2.5%, 12

Amcinonide Oin 0.1%, 11

adapalene CRE 0.1%, 10

ak-poly-bac oin op, 28

amethia LO TAB, 13

adapalene gel 0.1%, 10

Akynzeo CAP 300-0.5, 18

amethia TAB, 13

adapalene gel 0.3%, 10

ala-cort CRE 2.5%, 11

amethyst TAB 90-20mcg, 13

adapalene gel pmp 0.3%, 10

Albenza TAB 200MG, 4

amilor/hctz TAB 5-50, 8

Adapalene Lot 0.1%, 10

albuterol neb 0.083%, 33

amiloride TAB 5MG, 8

Adcirca TAB 20MG, 9

albuterol neb 0.5%, 33

Aminocapr Ac Inj 250MG/ML, 21

Adderall XR CAP 10MG, 24

albuterol neb 0.63MG/3, 33

aminophyllin inj 25MG/ML, 33


albuterol neb 1.25MG/3, 33

amiodarone TAB 200MG, 7


albuterol syp 2MG/5ML, 33

Amitiza CAP 24mcg, 18


albuterol TAB 2MG, 33

Amitiza CAP 8mcg, 18


albuterol TAB 4MG, 33

amitriptylin TAB 100MG, 22


alclometason CRE 0.05%, 11


adefov dipiv TAB 10MG, 2

alclometason oin 0.05%, 11


Adj Lancing Mis Device, 36

Aldactazide TAB 50/50, 9


Adv Lancing Mis Device, 36


anagrelide CAP 1MG, 21

aspirin chil chw 81MG, 30


Analpram-HC Lot 2.5%, 18

aspirin chld chw 81MG, 30

amlod/benazp CAP 10-20MG, 8

anastrozole TAB 1MG, 4

aspirin chw 81MG, 30


Androxy TAB 10MG, 13

aspirin low chw 81MG, 30

amlod/benazp CAP 2.5-10MG, 8

anodyne lpt kit 2.5-2.5%, 12

aspirin low TAB 81MG, 30


Anoro Ellipt Aer 62.5-25, 33

aspirin low TAB 81MG EC, 30


anucort-HC sup 25MG, 18

aspirin TAB 325MG, 30


Anzemet TAB 100MG, 18

aspirin TAB 325MG EC, 30

amlodipine TAB 10MG, 6

Anzemet TAB 50MG, 18

aspirin TAB 5gr EC, 30

amlodipine TAB 2.5MG, 6

apap/codeine sol 120-12/5, 30

aspirin TAB 81MG, 30

amlodipine TAB 5MG, 6

apap/codeine TAB 300-15MG, 30

Aspirin TAB 81MG, 30

ammonium lac CRE 12%, 12


aspirin TAB 81MG EC, 30

ammonium lac lot 12%, 12


aspirin-81 chw 81MG, 30

amnesteem CAP 10MG, 10

Apidra Inj U-100, 14

aspirtab TAB 324MG EC, 30


Apokyn Inj 10MG/ML, 26

Assure 3 Liq Control, 36


apraclonidin sol 0.5% op, 29

Assure 4 Liq Level1/2, 36

Amox/K Clav Chw 200MG, 1

aprepitant CAP 125MG, 18

Assure Cmfrt Mis 28G, 36

Amox/K Clav Chw 400MG, 1

aprepitant CAP 80MG, 18

Assure Cmfrt Mis 30G, 36

amox/k clav sus 200/5ML, 1

aprepitant PAK 80 & 125, 18

Assure Dose Sol Norm/Hgh, 36


apri TAB, 13

Assure Dose Sol Normal, 36


Aptiom TAB 200MG, 25

Assure II Liq Level 1, 36



Assure II Liq Level1/2, 36

amox/k clav TAB 250-125, 1


Assure Lance Mis 21G, 36



Assure Lance Mis Low Flow, 36


Aptivus CAP 250MG, 3

Assure Lance Mis Micro, 36

Amoxapine TAB 100MG, 23

Aqua Lance Mis Lanc Dev, 36

Assure Lance Mis Safe 25G, 36


aranelle TAB, 13

Assure Lance Mis Safe 30G, 36


Aranesp Inj 100mcg, 19

Assure Mis Lancets, 36



Assure Plus Mis High 18G, 36

amoxicillin CAP 250MG, 1


Assure Plus Mis Low 25G, 36

amoxicillin CAP 500MG, 1


Assure Plus Mis Mcro 28G, 36

Amoxicillin Chw 125MG, 1


Assure Plus Mis Norm 21G, 36

Amoxicillin Chw 250MG, 1


Assure Plus Mis Pediatri, 36

amoxicillin sus 125/5ML, 1


Assure Prism Sol Level1/2, 36



Assure Pro Liq Level1/2, 36



AT Last Sol Control, 36

amoxicillin sus 250MG/5m, 1

arbinoxa sol 4MG/5ML, 32

Atabex Chw Prenatal, 35


arbinoxa TAB 4MG, 32

atenol/chlor TAB 100-25MG, 8

amoxicillin TAB 500MG, 1

Arcalyst Inj 220MG, 32

atenol/chlor TAB 50-25MG, 8

amoxicillin TAB 875MG, 1

argyl saline sol 0.9%, 19

atenolol TAB 100MG, 6

amphet/dextr CAP 10MG ER, 24

Arial Mis Chamber, 40



aripiprazole sol 1MG/ML, 23



aripiprazole TAB 10MG, 23

atomoxetine CAP 100MG, 24










amphet/dextr TAB 10MG, 24



amphet/dextr TAB 12.5MG, 24




armodafinil TAB 150MG, 24




atorvastatin TAB 10MG, 9







amphet/dextr TAB 7.5MG, 24

asa low dose TAB 81MG EC, 29


Amphotericin Inj 50MG, 2

asa/dipyrida CAP 25-200MG, 21

atovaq/progu TAB 250-100, 3

ampicillin CAP 250MG, 1

Asacol HD TAB 800MG, 18

atovaq/progu TAB 62.5-25, 3

ampicillin CAP 500MG, 1

ashlyna TAB, 13

atovaquone sus 750/5ML, 4

Ampicillin CAP 500MG, 1

Asmanex 120 Aer 220mcg, 33

Atripla TAB, 3

ampicillin inj 10gm, 1


Atropine SUL Inj 0.05MG/1, 17

Ampicillin Inj 125MG, 1


atropine SUL inj 0.1MG/ML, 17

ampicillin inj 1gm, 1


Atropine SUL Inj 0.1MG/ML, 17

Ampicillin Inj 1gm, 1


Atropine SUL Oin 1% Op, 29

ampicillin inj 250MG, 1


Atropine SUL Sol 1% Op, 29

ampicillin inj 500MG, 1

Asmanex HFA Aer 100 Mcg, 33

Atrovent HFA Aer 17mcg, 33

Ampicillin Sus 125/5ML, 1

Asmanex HFA Aer 200 Mcg, 33

Aubagio TAB 14MG, 26

Ampicillin Sus 250/5ML, 1

aspir-81 TAB 81MG EC, 30

Aubagio TAB 7MG, 26

Ampyra TAB 10MG, 26

aspir-low TAB 81MG EC, 29

aubra TAB 0.1-0.02, 13

Anadrol-50 TAB 50MG, 13

aspirin 81 TAB 81MG EC, 30

aug betamet CRE 0.05%, 11

anagrelide CAP 0.5MG, 21

aspirin adlt TAB 81MG, 30

aug betamet gel 0.05%, 11

aug betamet lot 0.05%, 11

Bayer Breeze Mis 2 Test, 36

Blephamide Sus Op, 28

aug betamet oin 0.05%, 11

bayer low chw 81MG, 30

blisovi 24 TAB FE 1/20, 13

Augmentin Sus 125/5ML, 1

bayer low TAB 81MG EC, 30

blisovi FE TAB 1.5/30, 13

Aurora Lance Mis 30G, 36

Bayer Micrlt Mis Lanc Dvc, 36

blisovi FE TAB 1/20, 13

Aurora Lance Mis Thin 23G, 36

Bayer Micrlt Mis Lancets, 36

Boostrix Inj, 34

Auto Lancet Mis, 36

BD Lancet Mis Device, 36

Bosulif TAB 100MG, 5

Auto-lancet Mis Mini, 36

BD Lancet UF Mis 30G, 36

Bosulif TAB 500MG, 5

Autolet II Kit Clinisaf, 36

BD Lancet UF Mis 33G, 36

Bp Cleansing Emu 10-4%, 10

Autolet Impr Mis Lanc Dev, 36

BD Microtain Mis Lancets, 36

Brainstrong Mis Prenatal, 35

Autolet Lanc Mis Device, 36

BD Pen Needl Mis 29GX1/2", 36

Breatherite Mis, 40

Autolet Lite Kit Clinisaf, 36

BD Pen Needl Mis 31GX3/16, 36

Breatherite Mis LG Mask, 40

Autolet Mini Mis, 36

BD Pen Needl Mis 31GX5/16, 36

Breatherite Mis MED Mask, 40

Autolet Plus Mis Lanc Dev, 36

BD Pen Needl Mis 32GX4MM, 36

Breatherite Mis Sm Mask, 40

Autoshield Mis 29X3/16", 36

Be Well PAK Rounded, 35

Breatherite Mis Spacer, 40

Autoshield Mis 29X5/16", 36

bekyree TAB, 13

Breatherite Mis W/Mask, 40

Avandia TAB 2MG, 15

bella alk/PB TAB 16.2MG, 17

Breo Ellipta Inh 100-25, 33

Avandia TAB 4MG, 15

Bella/Opium Sup 16.2-30, 17

Breo Ellipta Inh 200-25, 33

Avandia TAB 8MG, 15

Bella/Opium Sup 16.2-60, 17

Brevibloc Sol 10MG/ML, 6

avar cleanse emu 10-5%, 10

benazep/hctz TAB 10-12.5, 8

briellyn TAB, 13

Avar LS Pad 10-2%, 10


Brilinta TAB 60MG, 21

Avar Pad 9.5-5%, 10

benazep/hctz TAB 20-25MG, 8

Brilinta TAB 90MG, 21

Avelox Inj, 2


brimonidine sol 0.2% op, 29

aviane TAB, 13

benazepril TAB 10MG, 7

bromfenac sol 0.09% op, 29

avidoxy TAB 100MG, 2


Bromfenac Sol 0.09% Op, 29

avita CRE 0.025%, 10


bromocriptin CAP 5MG, 26

avita gel 0.025%, 10


bromocriptin TAB 2.5MG, 26

Avitene Pad 35X35MM, 21

benzonatate CAP 100MG, 33

Bromsite Dro 0.075%, 29


benzonatate CAP 200MG, 33

Brovana Neb 15mcg, 33


benztropine inj 1MG/ML, 26

budesonide CAP 3MG DR, 12

Avitene Pow Flour, 21

benztropine TAB 0.5MG, 26

budesonide sus 0.25MG/2, 33

Avitene Syrg Mis 1gm, 21

benztropine TAB 1MG, 26

budesonide sus 0.5MG/2, 33

Avonex Kit 30mcg, 26

benztropine TAB 2MG, 26

budesonide sus 1MG/2ML, 33

Avonex Pen Kit 30mcg, 26

Bepreve Dro 1.5%, 29

Bullseye Mis Lancets, 36

Avonex Prefl Kit 30mcg, 26

Berinert Inj 500unit, 21

Bullseye Mis Mini Lnc, 36

Azasite Sol 1%, 28

Besivance Sus 0.6%, 28

bumetanide TAB 0.5MG, 8

azathioprine TAB 50MG, 5

beta diprop gel 0.05%, 11

bumetanide TAB 1MG, 8

azelastine dro 0.05%, 29

betameth dip CRE 0.05%, 11

bumetanide TAB 2MG, 8

azelastine spr 0.1%, 33

betameth dip lot 0.05%, 11

Buphenyl TAB 500MG, 16

azelastine spr 0.15%, 33

betameth dip oin 0.05%, 11

bupren/nalox sub 2-0.5MG, 30

Azelex CRE 20%, 10

betameth val aer 0.12%, 11

bupren/nalox sub 8-2MG, 30

Azithromycin Pow 1gm PAK, 1

betameth val CRE 0.1%, 11

buprenorphin inj 0.3MG/ML, 30

azithromycin sus 100/5ML, 1

betameth val lot 0.1%, 11

buprenorphin sub 2MG, 30

azithromycin sus 200/5ML, 1

betameth val oin 0.1%, 11

buprenorphin sub 8MG, 30

azithromycin TAB 250MG, 1

betaxolol sol 0.5% op, 28

buproban TAB 150MG, 26


betaxolol TAB 10MG, 6

bupropion TAB 100MG, 22


betaxolol TAB 20MG, 6

bupropion TAB 100MG ER, 22

Azopt Sus 1% Op, 29

bethanechol TAB 10MG, 19

bupropion TAB 100MG SR, 22

azurette TAB 28 day, 13



B





b-donna TAB 16.2MG, 17

Betoptic-s Sus 0.25% Op, 28


Baby Ddrops Liq 400unit, 35

bexarotene CAP 75MG, 5


Baby Super Dro Daily D3, 35

Bexsero Inj, 34


Baby Vit D Dro 400/.028, 35

bicalutamide TAB 50MG, 4

bupropn HCL TAB 150MG XL, 22

bacit/polymy oin op, 28

Bicillin L-a Inj 1200000, 1

bupropn HCL TAB 300MG XL, 22

Bacitracin Oin Op, 28


buspirone TAB 10MG, 22

baclofen TAB 10MG, 28



baclofen TAB 20MG, 28

Biltricide TAB 600MG, 4


balsalazide CAP 750MG, 18

Bimatoprost Sol 0.03%, 29


balziva TAB, 13

bio-d-mulsio liq 2000unit, 34

buspirone TAB 7.5MG, 22

Banzel Sus 40MG/ML, 25

bio-d-mulsio liq 400unit, 34

but/apap/caf CAP, 29

Banzel TAB 200MG, 25

bisacodyl TAB 5MG EC, 17

but/apap/caf CAP codeine, 30

Banzel TAB 400MG, 25

bisoprl/hctz TAB 10/6.25, 8

but/apap/caf TAB, 29

Baraclude Sol .05MG/ML, 3

bisoprl/hctz TAB 2.5/6.25, 8

But/Asa/Caf TAB, 29

bayer adv TAB 325MG, 30

bisoprl/hctz TAB 5-6.25MG, 8

but/asa/caff CAP, 29

bayer asa TAB 325MG, 30

bisoprol fum TAB 10MG, 6

butal/apap TAB 50-325MG, 29

Bayer Breeze Liq High Cnt, 36

bisoprol fum TAB 5MG, 6

Butorphanol Inj 1MG/ML, 31

Bayer Breeze Liq Low Cntl, 36

Blephamide Oin S.o.p., 28

butorphanol inj 2MG/ML, 30

Bayer Breeze Liq Norm Cnt, 36

Byetta Inj 10mcg, 14

carbamazepin TAB 100mger, 25

cefuroxime TAB 500MG, 1

Byetta Inj 5mcg, 14

carbamazepin TAB 200MG, 25

celecoxib CAP 100MG, 31

Bystolic TAB 10MG, 6

carbamazepin TAB 200MG ER, 25


Bystolic TAB 2.5MG, 6

carbamazepin TAB 400MG ER, 25


Bystolic TAB 20MG, 6

carbidopa TAB 25MG, 26


Bystolic TAB 5MG, 6

carbinoxamin sol 4MG/5ML, 32

Celontin CAP 300MG, 25

C

carbinoxamin TAB 4MG, 32

cephalexin CAP 250MG, 1

carbonyl TAB FE 45MG, 20

cephalexin CAP 500MG, 1

cabergoline TAB 0.5MG, 16

Cardura XL TAB 4MG, 19

cephalexin sus 125/5ML, 1

caffeine CIT inj 60MG/3ML, 24

Cardura XL TAB 8MG, 19

cephalexin sus 250/5ML, 1

caffeine CIT sol 20MG/ML, 24

Careone Adv Mis Lancing, 36

Cerdelga CAP 84MG, 19

caffeine CIT sol 60MG/3ML, 24

Careone Lanc Mis 28G, 36

Cervarix Inj, 34

calc acetate CAP 667MG, 18

Careone Lanc Mis Thin 23G, 36

Cervidil Vag Mis 10MG INS, 29

calc acetate TAB 667MG, 18

Caresens Sol Control, 36

cevimeline CAP 30MG, 21

calcipotrien CRE 0.005%, 11

carisoprodol TAB 250MG, 28

Chantix PAK 0.5& 1MG, 27

calcipotrien oin 0.005%, 11

carisoprodol TAB 350MG, 28

Chantix PAK 1MG, 27

calcipotrien oin betameth, 11

carteolol sol 1% op, 28

Chantix TAB 0.5MG, 27

calcipotrien sol 0.005%, 11

carters TAB 5MG EC, 17

Chantix TAB 1MG, 27

calcitonin spr 200/act, 15

cartia XT CAP 120/24HR, 6

chateal TAB 0.15/30, 13

calcitrene oin 0.005%, 11


Chemet CAP 100MG, 40

calcitriol CAP 0.25mcg, 16


child asa chw 81MG, 30

calcitriol CAP 0.5mcg, 16


child asa LS chw 81MG, 30

Calcitriol Oin 3mcg/Gm, 11

carvedilol TAB 12.5MG, 6

Chloramphen Inj 1gm, 4

calcitriol sol 1mcg/ML, 16

carvedilol TAB 25MG, 6

chlord/clidi CAP 5-2.5MG, 17

camila TAB 0.35MG, 13


chlordiazep CAP 10MG, 22

camrese LO TAB, 13



camrese TAB, 13

Caspofungin Inj 70MG, 2


Canasa Sup 1000MG, 18

Cayston Inh 75MG, 4

chlorhex glu sol 0.12%, 21

Cancidas Inj 70MG, 2

caziant PAK, 13

chloroquine TAB 250MG, 3

candesa/hctz TAB 16-12.5, 8

Cedax CAP 400MG, 1

Chloroquine TAB 250MG, 3

candesa/hctz TAB 32-12.5, 8

cefaclor CAP 250MG, 1

chloroquine TAB 500MG, 3

candesa/hctz TAB 32-25MG, 8

cefaclor CAP 500MG, 1

Chlorothiaz TAB 250MG, 9

candesartan TAB 16MG, 7

Cefaclor ER TAB 500MG, 1

chlorothiaz TAB 500MG, 8


Cefaclor Sus 125/5ML, 1

Chlorpromaz Inj 25MG/ML, 23



Chlorpromaz Inj 50MG/2ML, 23



chlorpromaz TAB 100MG, 23

Cantil TAB 25MG, 18

cefadroxil CAP 500MG, 1


capacet CAP, 29

cefadroxil sus 250/5ML, 1


capecitabine TAB 150MG, 4

cefadroxil sus 500/5ML, 1


capecitabine TAB 500MG, 4

cefadroxil TAB 1gm, 1


Capex Sha 0.01%, 12

cefazolin inj 1gm, 1

Chlorpropam TAB 100MG, 15

Caprelsa TAB 100MG, 5

Cefazolin Inj 1gm, 1

Chlorpropam TAB 250MG, 15

Caprelsa TAB 300MG, 5

Cefazolin Inj 1gm/50ML, 1

chlorthalid TAB 25MG, 8

Captopr/Hctz TAB 25-15MG, 8

cefdinir CAP 300MG, 1

chlorthalid TAB 50MG, 8


cefdinir sus 125/5ML, 1

Chlorzoxazon TAB 250MG, 28


cefdinir sus 250/5ML, 1

chlorzoxazon TAB 500MG, 28


Cefditoren TAB 200MG, 1

cho MAG tris liq 500/5ML, 29

captopril TAB 100MG, 7

Cefditoren TAB 400MG, 1

cholestyram pow 4gm, 9

captopril TAB 12.5MG, 7

cefixime sus 100/5ML, 1

cholestyram pow 4gm lite, 9


cefixime sus 200/5ML, 1

Cialis TAB 2.5MG, 9


cefpodo prox sus 100/5ML, 1

Cialis TAB 5MG, 9

Carafate Sus 1gm/10ML, 18

cefpodo prox sus 50MG/5ML, 1

ciclodan CRE 0.77%, 10

CARB/Levo 50 TAB /Entacap, 26

cefpodoxime TAB 100MG, 1

ciclodan sol 8%, 10

CARB/Levo 75 TAB /Entacap, 26

cefpodoxime TAB 200MG, 1

ciclopirox CRE 0.77%, 10

CARB/levo ER TAB 25-100MG, 26

cefprozil sus 125/5ML, 1

ciclopirox gel 0.77%, 10

CARB/levo ER TAB 50-200MG, 26

cefprozil sus 250/5ML, 1

ciclopirox sha 1%, 10

CARB/levo TAB 10-100MG, 26

cefprozil TAB 250MG, 1

ciclopirox sol 8%, 10


cefprozil TAB 500MG, 1

ciclopirox sus 0.77%, 10


ceftazidime inj 1gm, 1

cidofovir inj 75MG/ML, 2

CARB/Levo100 TAB /Entacap, 26

Ceftibuten CAP 400MG, 1

cilostazol TAB 100MG, 21


Ceftin Sus 125/5ML, 1

cilostazol TAB 50MG, 21


Ceftin Sus 250/5ML, 1

Ciloxan Oin 0.3% Op, 28


ceftriaxone inj 10gm, 1

cimetidine sol 300/5ML, 17

Carbaglu TAB 200MG, 16


cimetidine TAB 200MG, 17

carbamazepin CAP 100MG ER, 25

ceftriaxone inj 250MG, 1






ceftriaxone inj 500MG, 1


carbamazepin chw 100MG, 25

cefuroxime TAB 250MG, 1

Cimzia Kit, 18

carbamazepin sus 100/5ML, 25

Cimzia Kit Starter, 18

clobetasol CRE 0.05%, 11

Complera TAB, 3

Cimzia Prefl Kit 200MG/ML, 18

clobetasol e CRE 0.05%, 11

compro sup 25MG, 23

Cinryze Sol 500 Unit, 21

clobetasol gel 0.05%, 11

Comvax Inj, 34

Cipro (5%) Sus 250MG/5, 2

clobetasol oin 0.05%, 11

Conceptrol Gel 4%, 19

Cipro HC Sus Otic, 29

clobetasol sol 0.05%, 11

Concerta TAB 18MG, 24

Ciprodex Sus 0.3-0.1%, 29

Clocortolone CRE Piv 0.1%, 11


ciprofloxacn sol 0.3% op, 28

clomipramine CAP 25MG, 22


ciprofloxacn sus 250MG/5, 2



ciprofloxacn sus 500MG/5, 2


Condylox Gel 0.5%, 12

Ciprofloxacn TAB 100MG, 2

clonazep odt TAB 0.125MG, 25

constulose sol 10gm/15, 16

ciprofloxacn TAB 250MG, 2


Contour Liq High Cnt, 36



Contour Liq Low Cntl, 36


clonazep odt TAB 1MG, 25

Contour Liq Norm Cnt, 36

citalopram sol 10MG/5ML, 22

clonazep odt TAB 2MG, 25

Contour Sol Next, 36

citalopram TAB 10MG, 22

clonazepam TAB 0.5MG, 25

Contour Tes Next, 36


clonazepam TAB 1MG, 25

Control High Sol Unistrip, 36


clonazepam TAB 2MG, 25

Control Low Sol Unistrip, 36

citroma sol cherry, 17

clonidine dis 0.1/24HR, 8

Control Norm Sol Easy Stp, 36

citroma sol lemon, 17


Control Sol Liq HI/Mid/L, 36

CL Prenatal TAB 28-0.8MG, 35


Control Sol Liq High/Low, 36

Claforan Inj 1gm, 1

clonidine TAB 0.1MG, 8

Control Sol Liq Mid, 36

Claforan Inj 2gm, 1


Control Sol Normal, 36

claravis CAP 10MG, 10


Cool Control Sol A, 36


clopidogrel TAB 300MG, 21

Cool Control Sol B, 36


clopidogrel TAB 75MG, 21

Cordran 24X3 Tap 4mcg/CM, 12


cloraz dipot TAB 15MG, 22

Cordran 80X3 Tap 4mcg/CM, 12

clarithromyc sus 125/5ML, 1

cloraz dipot TAB 3.75MG, 22

cormax scalp sol 0.05%, 11

Clarithromyc Sus 125/5ML, 1

cloraz dipot TAB 7.5MG, 22

correct TAB 5MG EC, 17

clarithromyc sus 250/5ML, 1

clotrim/beta CRE 1-0.05%, 10

correctol TAB 5MG EC, 17

Clarithromyc Sus 250/5ML, 1

clotrim/beta CRE diprop, 10

Cortifoam Aer 90MG, 18

clarithromyc TAB 250MG, 1

clotrim/beta lot diprop, 10

Cortisone Ac TAB 25MG, 12

clarithromyc TAB 500MG, 1

clotrimazole loz 10MG, 21

Cortisporin CRE 0.5%, 10

clearlax pow, 17

clotrimazole tro 10MG, 21

Cortisporin Oin 1%, 10

clemastine TAB 2.68MG, 32

clozapine TAB 100MG, 23

Cortisporin Sus -tc Otic, 29

Clemastine TAB 2.68MG, 33


Cosentyx Inj 150MG/ML, 11

Cleocin Phos Inj 600MG, 4


Cosentyx Inj 300dose, 11

Clever Check Mis, 36


Cosentyx Pen Inj 150MG/ML, 11

Clever Check Mis 30G, 36

Coaguchek Mis Lancets, 36

Cosentyx Pen Inj 300dose, 11

Clevr Choice Liq High, 36

Coartem TAB 20-120MG, 3

Creon CAP 12000unt, 18

Clevr Choice Liq Low, 36

codeine sulf TAB 15MG, 30


Clickfine Mis 31GX1/4", 36

Codeine Sulf TAB 15MG, 31

Creon CAP 3000unit, 18

Clickfine Mis 31GX5/16, 36



Climara Dis 0.025MG, 13


Creon CAP 6000unit, 18



Cresemba CAP 186 MG, 2



Crixivan CAP 200MG, 3


Colchicine CAP 0.6MG, 32

Crixivan CAP 400MG, 3


Colchicine TAB 0.6MG, 32

Cromolyn Sod Neb 20MG/2ML, 33


Colcrys TAB 0.6MG, 32

cromolyn sod sol 4% op, 29

clindacin mis etz 1%, 10

colestipol gra 5gm, 9

cryselle-28 TAB 28 TABS, 13

clindacin-p pad 1%, 10

colestipol TAB 1gm, 9

Cuprimine CAP 250MG, 40

clindamy/ben gel 1-5%, 10

colistimeth inj 150MG, 4

curity salin sol 0.9% irr, 19

clindamycin CAP 150MG, 4

colocort ene 100MG, 18

cvd d3 chw 1000unit, 34


Coly-mycin S Sus Otic, 29

CVS aspirin TAB 325MG, 30


Combivent Aer 20-100, 33

CVS aspirin TAB 325MG EC, 30

clindamycin CRE 2% vag, 19

Cometriq Kit 100MG, 5

CVS aspirin TAB 81MG EC, 30

clindamycin gel 1%, 10


CVS c-LAX TAB 5MG, 17

clindamycin gel tretinoi, 10


CVS chld asa chw 81MG, 30

clindamycin inj 150MG/ML, 4

Comfort Assu Mis Lanc 28G, 36

CVS d3 CAP 1000unit, 35

Clindamycin Inj 150MG/ML, 4

Comfort Assu Mis Lanc 33G, 36


clindamycin inj 300/2ML, 4

Comfort Mis Lancets, 36


clindamycin inj 300MG, 4

Comfortouch Mis Lancet, 36


clindamycin inj 900/6ML, 4

Commit Loz 2MG, 27

CVS d3 chw 1000 unt, 35

clindamycin lot 1%, 10

Commit Loz 4MG, 27

CVS iron TAB 27MG, 20

clindamycin lot 10MG/ML, 10

Commit Loz 4MG Chry, 27

CVS iron TAB 325MG, 20

clindamycin mis 1%, 10

Compact Spac Mis Chamber, 40

CVS Lancets Mis 21G, 36

clindamycin pad 1%, 10

Compact Spac Mis LG Mask, 40

CVS Lancets Mis Original, 36

clindamycin sol 1%, 10

Compact Spac Mis MD Mask, 40

CVS Lancets Mis Thin 26G, 36

clindamycin sol 75MG/5ML, 4

Compact Spac Mis Sm Mask, 40



d3 TAB 2000unit, 35

desvenlafax TAB 100MG ER, 22

CVS Lancing Mis Device, 37

d3 TAB 400unit, 35

Desvenlafax TAB 100MG ER, 23

CVS nicotine dis 14MG/24h, 27

d3-1000 CAP 1000unit, 35


CVS nicotine dis 7MG/24HR, 27

d3-50 CAP 50000unt, 35


CVS nicotine gum 2MG cinn, 27

Daily D3 Dro 1000unit, 35

Desvenlafax TAB 50MG ER, 23

CVS nicotine gum 2MG mint, 27

Daliresp TAB 500mcg, 33

dexameth PHO inj 10MG/ML, 12

CVS nicotine gum 2MG orig, 27

danazol CAP 100MG, 12

Dexameth PHO Inj 10MG/ML, 12

CVS nicotine gum 2mgfruit, 27


dexameth PHO inj 120MG/30, 12

CVS nicotine gum 4MG cinn, 27


dexameth PHO inj 20MG/5ML, 12

CVS nicotine gum 4MG mint, 27

dantrolene CAP 100MG, 28

dexameth PHO inj 4MG/ML, 12

CVS nicotine gum 4MG orig, 27


Dexameth PHO Sol 0.1% Op, 28

CVS nicotine gum 4mgfruit, 27


Dexamethason CON 1MG/ML, 12

CVS nicotine loz 2MG, 27

dapsone TAB 100MG, 4

dexamethason elx 0.5/5ML, 12

CVS nicotine loz 2MG mint, 27

dapsone TAB 25MG, 4

Dexamethason Sol 0.5/5ML, 12

CVS nicotine loz 4MG mint, 27

Daptacel Inj, 34

dexamethason TAB 0.5MG, 12

CVS nts dis step 1, 27

Daraprim TAB 25MG, 3


CVS Prenatal Chw Gummy, 35

darifenacin TAB 15MG, 19


CVS Prenatal TAB, 35

darifenacin TAB 7.5MG, 19

Dexamethason TAB 1MG, 12

CVS purelax pow, 17

dasetta TAB 1/35, 13

Dexamethason TAB 2MG, 12

CVS purelax pow 3350, 17

dasetta TAB 7/7/7, 13

dexamethason TAB 4MG, 12

cyanocobalam inj 1000mcg, 19

daysee TAB, 13

dexamethason TAB 6MG, 12

cyclafem TAB 1/35, 13

Ddrops Boost Liq 600/.028, 35

dexedrine TAB 10MG, 24

cyclafem TAB 7/7/7, 13

Ddrops Liq, 35

dexedrine TAB 5MG, 24

cyclobenzapr TAB 10MG, 28

Ddrops Liq 1000unit, 35

Dexilant CAP 30MG DR, 18

cyclobenzapr TAB 5MG, 28

Ddrops Liq 2000unit, 35

Dexilant CAP 60MG DR, 18

cyclopentol sol 1% op, 29

Debacterol Sol 30-50%, 21

dexmethylph TAB 10MG, 24

cyclopentol sol 2% op, 29

deblitane TAB 0.35MG, 13

dexmethylph TAB 2.5MG, 24

cyclopentola sol 0.5%, 29

Decara CAP 25000unt, 35

dexmethylph TAB 5MG, 24

Cyclophosph CAP 25MG, 4

decara CAP 50000unt, 34

dextroamphet CAP 10MG ER, 24

Cyclophosph CAP 50MG, 4

Delestrogen Inj 10MG/ML, 13


Cycloserine CAP 250MG, 2

delta d3 TAB 400unit, 34


Cycloset TAB 0.8MG, 15

deltasone TAB 20MG, 12

dextroamphet TAB 10MG, 24

cyclosporine CAP 100MG, 5

delyla TAB 0.1-0.02, 13

dextroamphet TAB 5MG, 24

cyclosporine CAP 100MG MD, 5

demeclocycl TAB 150MG, 2

Diabeta TAB 1.25MG, 15

cyclosporine CAP 25MG, 5

demeclocycl TAB 300MG, 2

Diabeta TAB 2.5MG, 15

cyclosporine CAP 25MG mod, 5

Denavir CRE 1%, 11

Diabeta TAB 5MG, 15

Cyclosporine CAP 50MG Mod, 5

Depen Titra TAB 250MG, 40

dialyvite d CAP 5000unit, 34

cyclosporine inj 50MG/ML, 5

Depo-estradi Inj 5MG/ML, 13

Diastat PED Gel 2.5m Gel, 25

cyclosporine sol modified, 5

Depo-medrol Inj 20MG/ML, 12

Diatrue Cont Sol Level 1, 37

cyproheptad syp 2MG/5ML, 32

Depo-sq Prov Inj 104, 14


cyproheptad TAB 4MG, 32

Depo-testost Inj 200MG/ML, 12


cyred TAB, 13

dermacinrx kit prizopak, 12

Diazepam Gel 10MG, 25

Cystagon CAP 150MG, 19

Descovy TAB 200/25, 3

Diazepam Gel 2.5MG, 25

Cystagon CAP 50MG, 19

desipramine TAB 100MG, 22

Diazepam Gel 20MG, 25

Cystaran Sol 0.44%, 29


Diazepam Inj 10MG/2ML, 22

cytra k gra crystals, 19


Diazepam Inj 5MG/ML, 22

D


Diazepam Sol 1MG/ML, 22


diazepam TAB 10MG, 22

d 1000 CAP 1000unit, 34



d 1000 chw 1000unit, 34

Desloratadin TAB 2.5 Odt, 33


d 1000 TAB 1000unit, 34

desloratadin TAB 5MG, 32

diclofen pot TAB 50MG, 31

d 400 chw 400unit, 34

Desloratadin TAB 5MG Odt, 33

diclofenac sol 0.1% op, 29

d 400 TAB 400unit, 34

desmopressin inj 4mcg/ML, 16

diclofenac TAB 100MG ER, 31

d-3 gummy chw 400unit, 34

desmopressin sol 0.01%, 16

diclofenac TAB 25MG DR, 31

d-400 TAB 400unit, 34

desmopressin spr 0.01%, 16


D-VI-sol Liq 400unit, 35

desmopressin TAB 0.1MG, 16


d-vita liq 400unit, 34

desmopressin TAB 0.2MG, 16

dicloxacill CAP 250MG, 1

d3 2000 TAB 2000unit, 35

deso/ethinyl TAB estradio, 13

dicloxacill CAP 500MG, 1

d3 adult chw 1000unit, 34

desonide CRE 0.05%, 11

dicyclomine CAP 10MG, 17

d3 CAP 10000, 34

desonide lot 0.05%, 11

dicyclomine inj 10MG/ML, 17

d3 CAP 1000unit, 34

desonide oin 0.05%, 11

dicyclomine sol 10MG/5ML, 17

d3 CAP 2000unit, 35

Desowen CRE 0.05%, 11

dicyclomine TAB 20MG, 17

d3 CAP 400unit, 35

Desowen Lot 0.05%, 11

didanosine CAP 125MG, 2

D3 Dots TAB 2000unit, 35

desoximetas CRE 0.05%, 11


d3 kids chw 400unit, 34

desoximetas CRE 0.25%, 11


d3 max ST dro 5000unit, 34

desoximetas gel 0.05%, 11


d3 maximum CAP 5000unit, 34

desoximetas oin 0.05%, 11

Differin CRE 0.1%, 10

d3 super str CAP 2000unit, 34

desoximetas oin 0.25%, 11

Differin Lot 0.1%, 10

d3 TAB 1000unit, 35

Dificid TAB 200MG, 1

dorzol/timol sol 22.3-6.8, 28

E-ZJECT Lanc Mis 33G, 37

Diflorasone CRE 0.05%, 11

dorzolamide sol 2% op, 29

Easivent Mis, 40

Diflorasone Oin 0.05%, 11

doxazosin TAB 1MG, 8

Easivent Mis Mask LG, 40

diflunisal TAB 500MG, 29


Easivent Mis Mask MED, 40

digitek TAB 0.125MG, 6


Easivent Mis Mask Sm, 40

digitek TAB 0.25MG, 6


Easy Comfort Mis 30G, 37

digox TAB 0.125MG, 6

doxepin HCL CAP 100MG, 22

Easy Comfort Mis Lanc/30G, 37

digox TAB 0.25MG, 6


Easy Mini Mis, 37

digoxin inj 0.25MG/1, 6


Easy Plus II Sol High, 37

Digoxin Sol 50mcg/ML, 6


Easy Plus II Sol Low, 37

digoxin TAB 0.125MG, 6


Easy Talk Sol High, 37

digoxin TAB 0.25MG, 6


Easy Talk Sol Low, 37

dihydroergot inj 1MG/ML, 32

doxepin HCL CON 10MG/ML, 22

Easy Talk Sol Normal, 37

Dihydroergot Spr 4MG/ML, 32

Doxepin HCL CRE 5%, 11

Easy Touch Mis, 37

Dilantin CAP 30MG, 25

doxercalcif CAP 0.5mcg, 16

Easy Touch Mis 29GX1/2", 37

dilt-XR CAP 120MG, 6

doxercalcif CAP 1mcg, 16

Easy Touch Mis 31GX1/4", 37


doxercalcif CAP 2.5mcg, 16

Easy Touch Mis 31GX3/16, 37


doxy 100 inj 100MG, 2

Easy Touch Mis 31GX5/16, 37

diltiazem CAP 120MG CD, 6

doxycyc mono CAP 100MG, 2

Easy Touch Mis 32GX5MM, 37

diltiazem CAP 120MG ER, 6


Easy Touch Mis 32GX6MM, 37



Easy Touch Mis Lanc/21G, 37





doxycyc mono TAB 100MG, 2












doxycycl HYC CAP 100MG, 2



doxycycl HYC CAP 50MG, 2

Easy Touch Sol Control, 37


doxycycl HYC inj 100MG, 2

Easy Touch Sol High/Low, 37


doxycycl HYC TAB 100MG, 2

Easy Trak Sol High, 37

Diltiazem Inj 100MG, 7

Dritho-creme CRE HP 1%, 11

Easy Trak Sol Low, 37

diltiazem inj 125/25ML, 6

dronabinol CAP 10MG, 18

Easy Trak Sol Normal, 37

diltiazem inj 25MG/5ML, 6

dronabinol CAP 2.5MG, 18

Easygluco Sol High, 37

diltiazem inj 50/10ML, 6

dronabinol CAP 5MG, 18

Easygluco Sol Low, 37

diltiazem TAB 120MG, 7

Droplet Lanc Mis 30G, 37

Easygluco Sol Normal, 37


Droplet Lanc Mis Device, 37

Easygluco Sol Plus, 37


drospir/ethi TAB 3-0.03MG, 13

Easymax 15 Sol Level 1, 37


drospire/ETH TAB estr/lev, 13

Easymax 15 Sol Level 2, 37

Dimenhydrin Inj 50MG/ML, 18

drospirenone TAB ethy est, 13

Easymax 15 Sol Level1-2, 37

Dip/Tet PED Inj 25-5lfu, 34

Droxia CAP 200MG, 20

Easymax Sol High, 37

Dipentum CAP 250MG, 18


Easymax Sol Low, 37

Diphen/Atrop Liq 2.5/5, 17


Easymax Sol Norm/Low, 37

diphen/atrop TAB 2.5MG, 17

Drysol Sol 20%, 12

Easymax Sol Normal, 37

diphenhydram inj 50MG/ML, 32

Duavee TAB 0.45-20, 13

Easystep Hgh Sol Control, 37

dipyridamole TAB 25MG, 21

ducodyl TAB 5MG EC, 17

Easystep Low Sol Control, 37


dulcolax pow balance, 17

econazole CRE 1%, 10


Dulcolax TAB 5MG EC, 17

econtra EZ TAB 1.5MG, 13

disopyramide CAP 100MG, 7

Dulera Aer 100-5mcg, 33

ecotrin low TAB 81MG EC, 30

disopyramide CAP 150MG, 7

Dulera Aer 200-5mcg, 33

ecotrin TAB 325MG, 30

disulfiram TAB 250MG, 26

duloxetine CAP 20MG, 22

Ecotrin TAB 325MG EC, 30

disulfiram TAB 500MG, 26


Ecoza Aer 1%, 10

Diuril Sus 250/5ML, 9


ecpirin TAB 325MG EC, 30

divalproex CAP 125MG, 25

Duo-care Liq Level1/2, 37

Edarbi TAB 40MG, 8

divalproex TAB 125MG DR, 25

Duopa Sus 4.63-20, 26

Edarbi TAB 80MG, 8


Durezol Emu 0.05%, 28

Edecrin TAB 25MG, 9

divalproex TAB 250MG ER, 25

dutast/tamsu CAP 0.5-0.4, 19

Edurant TAB 25MG, 3


dutasteride CAP 0.5MG, 19

Effient TAB 10MG, 21

divalproex TAB 500MG ER, 25

Dyrenium CAP 100MG, 9

Effient TAB 5MG, 21

dobutam/D5W inj 1MG/ML, 9

Dyrenium CAP 50MG, 9

Element Cont Liq Normal, 37


E

Element Liq High, 37


Element Liq Low, 37

E-z Ject Mis 21G, 37

dobutamine inj 250MG, 9

Elemnt Compa Sol Level 2, 37

E-z Ject Mis 21G Colr, 37

dobutamine inj 500MG, 9

Elemnt Compa Sol Level 3, 37

E-z Ject Mis 30G, 37

dofetilide CAP 125mcg, 7

eletriptan TAB 20MG, 32

E-z Ject Mis 32G Colr, 37


eletriptan TAB 40MG, 32

E-z Ject Mis Lanc 21G, 37


Elidel CRE 1%, 12

E-z Ject Mis Thin 26G, 37

donepezil TAB 10MG, 26

elinest TAB, 13

E-z Spacer Mis, 40

donepezil TAB 5MG, 26

Eliquis TAB 2.5MG, 21

E-z Spacer Mis Body Grd, 40

Eliquis TAB 5MG, 21

epitol TAB 200MG, 25

ery/benzoyl gel 5-3%, 10

Elite Iron TAB 15MG, 20

Epivir HBV Sol 5MG/ML, 3

Erythrocin Inj 500MG, 1

Ella TAB 30MG, 14

eplerenone TAB 25MG, 8

erythrom ETH sus 200/5ML, 1

Elmiron CAP 100MG, 19

eplerenone TAB 50MG, 8

erythromycin gel 2%, 10

Emadine Sol 0.05% Op, 29

Epogen Inj 10000/ML, 19

erythromycin oin 5MG/gm, 28

Embrace Cntr Liq High, 37


erythromycin oin op, 28

Embrace Evo Liq Level 1, 37


erythromycin sol 2%, 10

Embrace Evo Liq Level 2, 37


Esbriet CAP 267MG, 34

Embrace Lanc Mis Thin 30G, 37


Esbriet TAB 267MG, 34

Embrace Pro Liq Glucose, 37

Eprosart Mes TAB 600MG, 8

Esbriet TAB 801MG, 34

Embrace Sol Low, 37

eq aspirin TAB 325MG, 30

escitalopram sol 5MG/5ML, 22

Emcyt CAP 140MG, 5

eq aspirin TAB 325MG EC, 30

escitalopram TAB 10MG, 22

emoquette TAB, 13

eq child asa chw 81MG, 30


empricaine kit 2.5-2.5%, 12

eq clearlax pow, 17


Emsam Dis 12MG/24h, 23

eq nicotine dis 14MG/24h, 26

esgic CAP, 29

Emsam Dis 6MG/24HR, 23

eq nicotine dis 21MG/24h, 26

esmolol HCL inj 100MG/10, 6

Emsam Dis 9MG/24HR, 23

eq nicotine dis 7MG/24HR, 26

esmolol HCL inj 10MG/ML, 6

Emtriva CAP 200MG, 3

eq nicotine gum 2MG cinn, 26

esomepra MAG CAP 20MG DR, 17

Emtriva Sol 10MG/ML, 3

eq nicotine gum 2MG mint, 26

estarylla TAB 0.25-35, 13

enalapr/hctz TAB 10-25MG, 8

eq nicotine gum 2MG orig, 26

estazolam TAB 1MG, 24

enalapr/hctz TAB 5-12.5MG, 8

eq nicotine gum 2mgfruit, 26

estazolam TAB 2MG, 24

enalapril TAB 10MG, 7

eq nicotine gum 4MG cinn, 26

Estrace Vag CRE 0.1MG/Gm, 19

enalapril TAB 2.5MG, 7

eq nicotine gum 4MG mint, 26

estrad val inj 200MG/5, 13


eq nicotine gum 4MG orig, 26

estrad val inj 20MG/ML, 13


eq nicotine gum 4MG ref, 26

estradiol dis 0.025MG, 13

enalaprilat inj 1.25/ML, 7

eq nicotine gum 4MG strt, 26


Enbrel Inj 25/0.5ML, 32

eq nicotine gum 4mgfruit, 26


Enbrel Inj 50MG/ML, 32

eq nicotine loz 2MG cher, 26


Enbrel Srclk Inj 50MG/ML, 32

eq nicotine loz 2MG cinn, 26


Encare Sup 100MG, 19

eq nicotine loz 2MG mint, 26


Endo Avitene Mis 10MM Dia, 21

eq nicotine loz 4MG chry, 26

estradiol TAB 0.5MG, 13

Endo Avitene Mis 5MM Dia, 21

eq nicotine loz 4MG mint, 26

estradiol TAB 10mcg, 19

endocet TAB 10-325MG, 30

eql aspirin chw 81MG, 30

estradiol TAB 1MG, 13

endocet TAB 2.5-325, 30

eql aspirin TAB 325MG, 30

estradiol TAB 2MG, 13

endocet TAB 5-325MG, 30

eql aspirin TAB 325MG EC, 30

Estring Mis 2MG, 19

endocet TAB 7.5-325, 30

eql aspirin TAB 81MG EC, 30

Estropipate TAB 0.75MG, 13

Enfamil Mis Expecta, 35

eql chld asa chw 81MG, 30

Estropipate TAB 1.5MG, 13

Engerix-b Inj 10/0.5ML, 34

eql clearlax pow, 17

Estropipate TAB 3MG, 13

Engerix-b Inj 20mcg/ML, 34

eql gentle TAB laxative, 17

eszopiclone TAB 1MG, 24

enoxaparin inj 100MG/ML, 20

Eql Lancets Mis 21G Colr, 37


enoxaparin inj 120/0.8, 20

Eql Lancets Mis 33G Colr, 37


enoxaparin inj 150MG/ML, 20

Eql Lancets Mis Thin 26G, 37

ethacrynic TAB acd 25MG, 8

enoxaparin inj 30/0.3ML, 20

Eql Lancets Mis Thin 30G, 37

ethambutol TAB 100MG, 2

enoxaparin inj 300/3ML, 20

eql laxative TAB 5MG EC, 17

ethambutol TAB 400MG, 2


eql nicotine dis 14MG/24h, 26

ethosuximide CAP 250MG, 25


eql nicotine dis 21MG/24h, 26

ethosuximide sol 250/5ML, 25


eql nicotine dis 7MG/24HR, 26

ethy ETH est TAB 1-35, 13

enpresse-28 TAB, 13

eql nicotine gum 2MG, 26

ethynodiol TAB 1-50, 13

enskyce TAB, 13

eql nicotine gum 2MG ref, 26

Etidron Disd TAB 200MG, 15

entacapone TAB 200MG, 26

eql nicotine gum 2MG strt, 26

Etidron Disd TAB 400MG, 15

entecavir TAB 0.5MG, 2

eql nicotine gum 4MG, 26

etodolac CAP 200MG, 31

entecavir TAB 1MG, 2

eql nicotine gum 4MG ref, 26

etodolac CAP 300MG, 31

enteric asa TAB 325MG, 30

eql nicotine gum 4MG strt, 26

etodolac TAB 400MG, 31

Entresto TAB 24-26MG, 9

eql nicotine loz 2MG, 26

etodolac TAB 500MG, 31


eql nicotine loz 2MG mint, 27

Etoposide CAP 50MG, 5


eql nicotine loz 4MG chry, 27

Eurax CRE 10%, 12

enulose sol 10gm/15, 18

eql nicotine loz 4MG mint, 27

Eurax Lot 10%, 12

Epclusa TAB 400-100, 3

Eql Prenatal TAB Formula, 35

Evencar Mini Sol Normal, 37

Epiduo Forte Gel 0.3-2.5%, 10

eql vitamin CAP d3, 35

Evencare G2 Sol Low/High, 37

Epiduo Gel 0.1-2.5%, 10

Equetro CAP 100MG, 23

Evencare G3 Sol Low/High, 37

epinastine dro 0.05%, 29


Evencare Sol Liq Low/High, 37

Epinephrine Inj 0.15MG, 9


Evolution Sol Normal, 37

epinephrine inj 0.1MG/ML, 9

Eraxis Inj 50MG, 2

EX-LAX ultra TAB 5MG EC, 17

Epinephrine Inj 0.3MG, 9

Ergoloid Mes TAB 1MG Oral, 26

Exelderm CRE 1%, 10

epinephrine inj 1MG/ML, 9

Ergomar Sub 2MG, 32

Exelderm Sol 1%, 10

Epinephrine Inj 1MG/ML, 9

ergot/caffen TAB 1-100MG, 32

exemestane TAB 25MG, 4

Epipen 2-PAK Inj 0.3MG, 9

errin TAB 0.35MG, 13

Exjade TAB 125MG, 40

Epipen-JR Inj 2-PAK, 9

Ertaczo CRE 2%, 10



Fenofibric TAB 105MG, 9

First-omepra Sus 2MG/ML, 18

Extavia Inj 0.3MG, 26

Fenofibric TAB 35MG, 9

flavoxate TAB 100MG, 19

EZ Flu Shot Inj 2015-16, 34

fenoprofen TAB 600MG, 31

flecainide TAB 100MG, 7

EZ Flu Shot Inj PF 14-15, 34

fentanyl CIT inj 0.05MG/1, 30


EZ Flu Shot Kit 2015-16, 34

Fentanyl CIT Inj 0.05MG/1, 31


EZ Flu Shot Kit 2016-17, 34

fentanyl CIT inj 1000mcg, 30

fleet laxati TAB 5MG EC, 17

EZ Smart Mis Lancets, 37


Flexichamber Mis, 40

ezetim/simva TAB 10-10MG, 9

Fentanyl CIT Inj 100mcg, 31

Flovent Disk Aer 100mcg, 33









Flovent HFA Aer 110mcg, 33

ezetimibe TAB 10MG, 9



ezfe 200 CAP 200MG, 20

fentanyl dis 100mcg/h, 30


F

fentanyl dis 12mcg/HR, 30

Fluad Inj 2016-17, 34


Fluad Inj 2017-18, 34

fa-8 CAP 800mcg, 20


Fluarix Quad Inj 2015-16, 34

fa-8 TAB 0.8MG, 20



Fabrazyme Inj 35MG, 16

Feosol TAB 200MG, 20


Fabrazyme Inj 5MG, 16

Feosol TAB 45MG, 20

Flublok Quad Inj 2017-18, 34

Factive TAB 320MG, 2

feosol TAB 65MG, 20

Flublok Sol 2015-16, 34

fallback TAB 1.5MG, 13

Fer-IN-sol Dro 15MG/ML, 20


falmina TAB, 13

fer-iron dro 15MG/ML, 20


famciclovir TAB 125MG, 2

ferate TAB 27MG, 20

Flucelvax Inj 2015-16, 34


fergon TAB 27MG, 20

Fluclvx Quad Inj 2016-17, 34


Fergon TAB 27MG, 20

Fluclvx Quad Inj 2017-18, 34

famotidine inj 10MG/ML, 17

ferosul elx 220/5ML, 20

fluconazole sus 10MG/ML, 2

famotidine inj 200/20ML, 17

Ferretts FE Chw 18MG, 20

fluconazole sus 40MG/ML, 2

famotidine inj 20MG/2ML, 17

Ferretts IPS Sol, 20

fluconazole TAB 100MG, 2

Famotidine Inj 20MG/50m, 17

Ferretts TAB 325MG, 20


famotidine inj 40MG/4ML, 17

ferrex 150 CAP 150MG, 20


famotidine sus 40MG/5ML, 17

ferric x-150 CAP 150MG, 20


famotidine TAB 20MG, 17

Ferrimin 150 TAB, 20

flucytosine CAP 250MG, 2

famotidine TAB 40MG, 17

Ferriprox TAB 500MG, 40

flucytosine CAP 500MG, 2

Fanapt PAK, 23

ferro-bob TAB 325MG, 20

fludrocort TAB 0.1MG, 12

Fanapt TAB 10MG, 23

ferrocite TAB 324MG, 20

Flulaval Qua Inj 2014-15, 34

Fanapt TAB 12MG, 23

ferrotabs TAB, 20


Fanapt TAB 1MG, 23

ferrous dro 15MG/ML, 20


Fanapt TAB 2MG, 24

Ferrous Fum TAB 29MG, 20


Fanapt TAB 4MG, 24

ferrous fum TAB 324MG, 20

Flumist Quad Sus 2015-16, 34

Fanapt TAB 6MG, 24

ferrous gluc TAB 225MG, 20


Fanapt TAB 8MG, 24

Ferrous Gluc TAB 225MG, 20


Fareston TAB 60MG, 5


Flunisolide Spr 0.025%, 33

Farxiga TAB 10MG, 15


fluocin acet CRE 0.01%, 11

Farxiga TAB 5MG, 15

Ferrous Gluc TAB 324MG, 20

fluocin acet CRE 0.025%, 11

Fastclix Mis Lancets, 37

ferrous sulf dro 15MG/ML, 20

fluocin acet oil 0.01%, 29

fayosim TAB, 13

ferrous sulf elx 220/5ML, 20

fluocin acet oil 0.01% sc, 11

FE Aspartate TAB, 20

Ferrous Sulf Syp 300/5ML, 20

fluocin acet oil 0.01%bdy, 11

FE sulfate TAB 27MG, 20

Ferrous Sulf TAB 140MG, 20

fluocin acet oil body, 11

FE TABS TAB 325MG EC, 20

Ferrous Sulf TAB 324MG EC, 20

fluocin acet oil ear0.01%, 29

feenamint TAB 5MG EC, 17

ferrous sulf TAB 325MG, 20

fluocin acet oil scalp, 11

felbamate sus 600/5ML, 25

ferrous sulf TAB 325MG EC, 20

fluocin acet oin 0.025%, 11

felbamate TAB 400MG, 25

ferrous sulf TAB 325MG fc, 20

fluocin acet sol 0.01%, 11

felbamate TAB 600MG, 25

ferrous sulf TAB 5gr, 20

fluocinonide CRE 0.05%, 11

felodipine TAB 10MG ER, 7

ferrousul TAB 325MG, 20

fluocinonide CRE e 0.05%, 11

felodipine TAB 2.5MG ER, 7

Fiasp Inj 100/ML, 14

fluocinonide gel 0.05%, 11

felodipine TAB 5MG ER, 7

Fifty50 Mis 31GX3/16, 37

fluocinonide oin 0.05%, 11

feminine LAX TAB 5MG EC, 17

Fifty50 Mis 31GX5/16, 37

fluocinonide sol 0.05%, 11

Femiron TAB, 20

Fifty50 Mis Lanc Dev, 37

fluoromethol sus 0.1% op, 28

Femring Mis 0.05/24h, 19

Fifty50 Safe Mis Lancets, 37

Fluoroplex CRE 1%, 4

Femring Mis 0.1MG/24, 19

Fifty50 Sol 2.0, 37

Fluorouracil CRE 0.5%, 4

femynor TAB 0.25-35, 13

Finacea Aer 15%, 10

fluorouracil CRE 5%, 4

fenofibrate CAP 130MG, 9

Finacea Gel 15%, 10

fluorouracil dro 2%, 4


finasteride TAB 5MG, 19

fluorouracil dro 5%, 4


Fine 30 Mis, 37

Fluorouracil Sol 2%, 4


Fingerstix Mis Lancets, 37

Fluorouracil Sol 5%, 4


Firazyr Inj 30MG/3ML, 21

fluoxetine CAP 10MG, 22

fenofibrate TAB 160, 9

Firmagon Inj 120MG, 5

Fluoxetine CAP 10MG, 26

fenofibrate TAB 160MG, 9

Firmagon Inj 80MG, 5


fenofibrate TAB 54MG, 9

Fluoxetine CAP 20MG, 26

fosamprenavi TAB 700MG, 2

gentamicin CRE 0.1%, 10


fosinop/hctz TAB 10/12.5, 8

gentamicin inj 40MG/ML, 2

fluoxetine sol 20MG/5ML, 22

fosinop/hctz TAB 20/12.5, 8

Gentamicin Oin 0.1%, 10

fluoxetine TAB 10MG, 22

fosinopril TAB 10MG, 7

gentamicin oin 0.3% op, 28

fluoxetine TAB 20MG, 22


gentamicin sol 0.3% op, 28

Fluoxetine TAB 60MG, 23


gentle laxat TAB 5MG EC, 17

fluphenaz DE inj 25MG/ML, 23

Fosrenol Chw 1000MG, 18

gentlelax pow, 17

Fluphenazine CON 5MG/ML, 23


Genvoya TAB, 3

Fluphenazine Elx 2.5/5ML, 23


gianvi TAB 3-0.02MG, 13

Fluphenazine Inj 2.5MG/ML, 23

Fragmin Inj 10000/ML, 21

gildagia TAB 0.4-35, 13

fluphenazine TAB 10MG, 23

Fragmin Inj 12500unt, 21

gildess 24 TAB FE 1/20, 13



gildess FE TAB 1.5/30, 13

fluphenazine TAB 2.5MG, 23


gildess FE TAB 1/20, 13


Fragmin Inj 2500/0.2, 21

gildess TAB 1.5/30, 13

Flurazepam CAP 15MG, 24


gildess TAB 1/20, 13

Flurazepam CAP 30MG, 24


Gilenya CAP 0.5MG, 26

flurbiprofen sol 0.03% op, 29

Freestyle Liq Control, 37

Gilotrif TAB 20MG, 5

Flurbiprofen Sol 0.03% Op, 29

Freestyle Mis Lancets, 37


flurbiprofen TAB 100MG, 31

Freestyle Mis Unistick, 37


flurbiprofen TAB 50MG, 31

Freestyle Tes, 37

glatiramer inj 20MG/ML, 26

flutamide CAP 125MG, 4

frovatriptan TAB 2.5MG, 32

glatopa inj 20MG/ML, 26

fluticasone CRE 0.05%, 11

furosemide inj 100/10ML, 8

Gleostine CAP 100MG, 4

fluticasone oin 0.005%, 11

furosemide inj 10MG/ML, 8


fluticasone spr 50mcg, 33

furosemide inj 20MG/2ML, 8


fluvastatin CAP 20MG, 9

furosemide inj 40MG/4ML, 8


fluvastatin CAP 40MG, 9

furosemide sol 10MG/ML, 8

glimepiride TAB 1MG, 15

Fluvirin Inj 2015-16, 34

Furosemide Sol 8MG/ML, 9



furosemide TAB 20MG, 8




glipizide ER TAB 10MG, 15

fluvoxamine TAB 100MG, 22


glipizide ER TAB 2.5MG, 15


Fycompa TAB 10MG, 25

glipizide ER TAB 5MG, 15


Fycompa TAB 12MG, 25

glipizide TAB 10MG, 15

Fluzone HD Inj PF 15-16, 34

Fycompa TAB 2MG, 25

glipizide TAB 5MG, 15


Fycompa TAB 4MG, 25

glipizide XL TAB 10MG, 15


Fycompa TAB 6MG, 25

glipizide XL TAB 2.5MG, 15

Fluzone Quad Inj 15-16, 34

Fycompa TAB 8MG, 25

glipizide XL TAB 5MG, 15


G

Global 28G Mis Lancets, 37


Global 30G Mis Lancets, 37

gabapentin CAP 100MG, 25


Global Lanc Mis Device, 37


Fluzone Splt Inj 2015-16, 34

Gluc Control Liq Normal, 37


FML Forte Sus 0.25% Op, 28

Gluc Control Sol, 37

gabapentin sol 250/5ML, 25

FML Oin 0.1% Op, 28

Gluc Control Sol Level 1, 37

gabapentin sol 300/6ML, 25

folic acid CAP 800mcg, 20

Gluc Control Sol Level 2, 37

gabapentin TAB 600MG, 25

Folic Acid Inj 5MG/ML, 20

Gluc Control Sol Mid, 37

gabapentin TAB 800MG, 25

folic acid TAB 1000mcg, 20

Gluc Control Sol Normal, 37

galantamine CAP 16MG ER, 26

folic acid TAB 1MG, 20

Glucagen Inj Hypokit, 15



Glucagon Kit 1MG, 15



Glucocard 01 Liq Norm/Hgh, 37

Galantamine Sol 4MG/ML, 26

fondaparinux inj 10/0.8ML, 20

Glucocard 01 Sol Normal, 37

galantamine TAB 12MG, 26

fondaparinux inj 2.5/0.5, 20

Glucocard Liq Level 1, 37


fondaparinux inj 5/0.4ML, 21

Glucocard Sol Normal, 37


fondaparinux inj 7.5/0.6, 21

Glucocard Sol Shine, 37

ganciclovir inj 500MG, 3

Fora Control Sol High, 37

Glucocom Mis 28G, 37

Gardasil 9 Inj, 34

Fora Control Sol Low, 37


Gardasil Inj, 34

Fora Control Sol Normal, 37


gatifloxacin sol 0.5%, 28

Fora Mis Lancets, 37

Glucocom Tes High CON, 37

gavilax pow, 17

Fora Mis Lancing, 37

Glucocom Tes Norm CON, 37

gavilyte-c sol, 17

Foracare Gdh Sol High, 37

Glucolet 2 Mis Lancing, 37

gavilyte-G sol, 17

Foracare Gdh Sol Low, 37

Glucose Cont Liq High/Low, 37

gavilyte-n sol flav pk, 17

Foracare Gdh Sol Normal, 37

Glucose Cont Sol High, 37

Ge100 Contrl Sol Normal, 37

Foradil CAP Aerolize, 33

Glucose Cont Sol Normal, 37

gemfibrozil TAB 600MG, 9

Forteo Sol 600/2.4, 15

Glucose Cont Sol Precisio, 37

generlac sol 10gm/15, 18

Fortical Spr 200/Act, 15

Glucosource Mis Lanc Dev, 37

gengraf CAP 100MG, 5

Fortiscare Sol Cntl HI, 37

Glucosource Mis Lancets, 37

gengraf CAP 25MG, 5

Fortiscare Sol Cntl Low, 37

glyburid mcr TAB 1.5MG, 15

gengraf CAP 50MG, 5

Fortiscare Sol Cntl Nml, 37

glyburid mcr TAB 3MG, 15

gengraf sol 100MG/ML, 5

Fosamax + D TAB 70-2800, 15

glyburid mcr TAB 6MG, 15

gentak oin 0.3% op, 28

Fosamax + D TAB 70-5600, 15

glyburide TAB 1.25MG, 15

Gentak Oin 0.3% Op, 28

glyburide TAB 2.5MG, 15

Haemolance Mis Plus Max, 37

HM nicotine loz 4MG mint, 27

glyburide TAB 5MG, 15

Haemolance Mis Plus PED, 37

HM One Daily Mis Prenatal, 35

glycolax pow 3350 NF, 17

Haemolance Mis Retract, 37

HM Prenatal TAB, 35

glycopyrrol inj 0.2MG/ML, 17

halobetasol CRE 0.05%, 11

HM vit d3 CAP 2000unit, 35

glycopyrrol inj 0.4/2ML, 17

halobetasol oin 0.05%, 11

HM vitamin d TAB 1000unit, 35

glycopyrrol inj 1MG/5ML, 17

Halog CRE 0.1%, 12

Hold Chamber Mis Adlt LG, 40

glycopyrrol inj 4MG/20ML, 17

Halog Oin 0.1%, 12

Hold Chamber Mis Medium, 40

glycopyrrol TAB 1MG, 17

haloper DEC inj 100MG/ML, 23

Hold Chamber Mis Small, 40

glycopyrrol TAB 2MG, 17

haloper DEC inj 50MG/ML, 23

homatropaire sol 5% op, 29

glydo gel 2%, 12

haloper lac inj 5MG/ML, 23

homatropine sol 5% op, 29

Glyxambi TAB 10-5 MG, 15

haloperidol CON 2MG/ML, 23

Horizant TAB 600MG, 26

Glyxambi TAB 25-5 MG, 15

haloperidol inj 50/10ML, 23

Humalog Inj 100/ML, 14

Gmate Contro Sol Level 2, 37

haloperidol inj 5MG/ML, 23

Humalog JR Inj 100/ML, 14

Gmate Lancet Mis 30G, 37

haloperidol TAB 0.5MG, 23

Humalog Kwik Inj 100/ML, 14

gnp aspirin chw 81MG, 30

haloperidol TAB 10MG, 23

Humalog Kwik Inj 200/ML, 14

gnp aspirin TAB 325MG, 30


Humalog Mix Inj 50/50, 14

gnp aspirin TAB 325MG EC, 30


Humalog Mix Inj 50/50kwp, 14

gnp aspirin TAB 81MG EC, 30


Humalog Mix Inj 75/25kwp, 14

gnp bisa-LAX TAB 5MG EC, 17


Humalog Mix Sus 75/25, 14

gnp clearlax pow, 17

Harvoni TAB 90-400MG, 3

Humira Inj 10MG/0.2, 32

gnp d CAP 1000unit, 35

Havrix Inj 1440unit, 34

Humira Kit 20MG/0.4, 32

gnp d chw 2000unit, 35

Havrix Inj 720unit, 34

Humira Kit 40MG/0.8, 32

Gnp Daily Mis Prenatal, 35

HC butyrate CRE 0.1%, 11

Humira Pedia Inj Crohns, 32

gnp iron TAB 325MG, 20

HC butyrate oin 0.1%, 11

Humira Pen Inj 40MG/0.8, 32


HC butyrate sol 0.1%, 11

Humira Pen Inj Crohns, 32


HC Lancing Mis Device, 38

Humira Pen Inj Psoriasi, 32

Gnp Lancets Mis, 37

HC pramoxine CRE 2.5-1%, 11

Humulin Inj 70/30, 14

Gnp Lancets Mis 21G, 37

HC valerate CRE 0.2%, 11

Humulin Inj 70/30kwp, 14

Gnp Lancets Mis Micro, 37

HC valerate oin 0.2%, 11

Humulin N Inj U-100, 14

Gnp Lancets Mis Sup Thin, 37

HC/acet acid sol otic, 29

Humulin N Inj U-100kwp, 14

Gnp Lancets Mis Thin, 37

Healthpro Sol High/Low, 38

Humulin R Inj U-100, 14

Gnp Lancets Mis Thin 26G, 37

heather TAB 0.35MG, 13

Humulin R Inj U-500, 14

gnp laxative TAB 5MG EC, 17

Helistat Mis 5MM, 21

hydralazine TAB 100MG, 8

gnp nicotine dis 21MG/24h, 27

hemmorex-HC sup 30MG, 18


gnp nicotine dis 7MG/24HR, 27

Hemocyte TAB 324MG, 20


gnp nicotine gum 2MG mint, 27

Hep Sod/D5W Inj 100/ML, 21


gnp nicotine gum 2MG orig, 27

hep sod/D5W inj 20000unt, 21

Hydrea CAP 500MG, 5

gnp nicotine gum 4MG mint, 27

Hep Sod/D5W Inj 25000unt, 21

hydroc/homat TAB 5-1.5MG, 33

gnp nicotine gum 4MG orig, 27

heparin lock inj 100/ML, 21

hydrochlorot CAP 12.5MG, 8

gnp nicotine loz 2MG mint, 27

heparin lock inj 10unt/ML, 21

hydrochlorot TAB 12.5MG, 8

gnp nicotine loz 4MG mint, 27

Heparin Lock Inj 1unit/ML, 21

hydrochlorot TAB 25MG, 8

gnp nicotine loz mini 2MG, 27

heparin lock kit 100/ML, 21

hydrochlorot TAB 50MG, 9

Gnp Prenatal TAB 28-0.8MG, 35

heparin lock kit 10unt/ML, 21

hydroco/apap sol 7.5-325, 30

gnp vit d TAB 1000unit, 35

heparin sod inj 1000/ML, 21

hydroco/apap TAB 10-325MG, 30

gnp vit d TAB 5000unit, 35


hydroco/apap TAB 5-325MG, 30

gnp vit d3 TAB 1000unit, 35

heparin sod inj 5000/0.5, 21

hydroco/apap TAB 7.5-325, 30

Golytely Sol, 16


hydrocod/hom syp 5-1.5/5, 33

Goodsense TAB 28-0.8MG, 35

Heparin/D5W Inj 100/ML, 21

hydrocod/ibu TAB 10-200MG, 30

granisetron TAB 1MG, 18

Heparin/D5W Inj 25000unt, 21

hydrocod/ibu TAB 2.5-200, 30

griseofulvin sus 125/5ML, 2

Heparin/D5W Inj 50unt/ML, 21

hydrocod/ibu TAB 5-200MG, 30

griseofulvin TAB micr 500, 2

Hexalen CAP 50MG, 4

hydrocod/ibu TAB 7.5-200, 30

griseofulvin TAB ultr 125, 2

hgh-pot iron TAB 325MG, 20

hydrocort ac sup 25MG, 18

griseofulvin TAB ultr 250, 2

Hiberix Sol 10mcg, 34

hydrocort ac sup 30MG, 18

guanfacine TAB 1MG, 8

high potency TAB FE 27MG, 20

hydrocort CRE 2.5%, 11

guanfacine TAB 1MG ER, 24

high potency TAB iron, 20

hydrocort ene 100MG, 18

guanfacine TAB 2MG, 8

Hlthy Accnts Mis Lanc 30G, 38

hydrocort lot 2.5%, 11


HM aspirin chw 81MG, 30

hydrocort oin 1%, 11


HM aspirin TAB 325MG, 30

hydrocort oin 2.5%, 11


HM clearlax pow, 17

hydrocort TAB 10MG, 12

Guanidine TAB 125MG, 28

HM iron TAB 45MG, 20


Gynazole-1 CRE 2%, 19

HM iron TAB 65MG, 20


Gynol II Gel 3%, 19

HM laxative TAB 5MG, 17

hydrocort/ab oin 1%, 11

H

HM laxative TAB 5MG EC, 17

hydrocortiso CRE 2.5%, 18

HM nicotine dis 14MG/24h, 27

hydromet syp 5-1.5/5, 33

H.p. Acthar Inj 80unit, 16

HM nicotine dis 21MG/24h, 27

hydromorphon inj 1MG/ML, 30

Haemolance Mis High FLO, 37

HM nicotine gum 2MG mint, 27


Haemolance Mis Low Flow, 37

HM nicotine gum 4MG mint, 27


Haemolance Mis Plus, 37

HM nicotine loz 2MG mint, 27

hydromorphon liq 1MG/ML, 30

Haemolance Mis Plus Low, 37

Hydromorphon Sup 3MG, 31

Insulin Syrg Mis 0.5/28G, 38

Isentress Chw 25MG, 3

hydromorphon TAB 12MG ER, 30


Isentress HD TAB 600MG, 3



Isentress TAB 400MG, 3

hydromorphon TAB 2MG, 30


isibloom TAB 0.15-30, 13


Insulin Syrg Mis 1ML, 38

Isoniazid Syp 50MG/5ML, 2


Insulin Syrg Mis 1ML/25G, 38

isoniazid TAB 100MG, 2



isoniazid TAB 300MG, 2



Isordil TAB 40MG, 6

hydrosortiso oin absorbas, 11


isosorb din TAB 10MG, 6

hydroxychlor TAB 200MG, 3



hydroxyurea CAP 500MG, 5



hydroxyz HCL syp 10MG/5ML, 22



hydroxyz HCL TAB 10MG, 22

Insulin Syrg Mis 28GX1/2", 38

isosorb mono TAB 10MG, 6


Insulin Syrg Mis 29GX1/2", 38

isosorb mono TAB 120MG ER, 6


Insulin Syrg Mis 30GX5/16, 38

isosorb mono TAB 20MG, 6

Hydroxyz Pam CAP 100MG, 22

Insulin Syrg Mis 31GX5/16, 38


hydroxyz pam CAP 25MG, 22

Insupen Mis 32GX4MM, 38


hydroxyz pam CAP 50MG, 22

Insupen Sens Mis 32GX6MM, 38

isradipine CAP 2.5MG, 7

Hypolance Kit Lancing, 38

Insupen Sens Mis 32GX8MM, 38

isradipine CAP 5MG, 7

I

Insupen Ultr Mis 29GX12MM, 38

itraconazole CAP 100MG, 2


ivermectin TAB 3MG, 4

ibandronate TAB 150MG, 15


J

ibudone TAB 5-200MG, 30


ibuprofen TAB 400MG, 31

Jadenu TAB 180MG, 40

Intelence TAB 100MG, 3


Jadenu TAB 360MG, 40



Jadenu TAB 90MG, 40


Icar Peds Sus Grape, 20

jantoven TAB 10MG, 21

Intron A Inj 10mu, 5

iferex 150 CAP, 20



ilotycin oin op, 28

jantoven TAB 2.5MG, 21


imatinib mes TAB 100MG, 5



imatinib mes TAB 400MG, 5


introvale TAB, 13

Imbruvica CAP 140MG, 5


Invanz Inj 1gm, 4

imipram HCL TAB 10MG, 22


Invirase CAP 200MG, 3



Invirase TAB 500MG, 3


jantoven TAB 7.5MG, 21

Invokamet TAB 150-1000, 15

imiquimod CRE 5%, 12

Januvia TAB 100MG, 15


IN Control Mis 31GX5MM, 38





Invokamet TAB 50-500MG, 15


Jardiance TAB 10MG, 15

Invokana TAB 100MG, 15

IN Touch Sol Glucose, 38

Jardiance TAB 25MG, 15

Invokana TAB 300MG, 15

Incontrol Mis 29GX12MM, 38

jencycla TAB 0.35MG, 13

Ipol Inj Inactive, 34

Incontrol Mis Lanc 28G, 38

Jentadueto TAB 2.5-1000, 15

ipratropium sol 0.02%inh, 33

Incontrol Mis Lanc 30G, 38


ipratropium spr 0.03%, 33

Incontrol Mis Lanc Dev, 38


ipratropium spr 0.06%, 33

Increlex Inj 40MG/4ML, 16

jolessa TAB, 13

ipratropium/ sol albuter, 33

indapamide TAB 1.25MG, 9

jolivette TAB 0.35MG, 13

irbesar/hctz TAB 150-12.5, 8

indapamide TAB 2.5MG, 9

juleber TAB, 13

irbesar/hctz TAB 300-12.5, 8

indomethacin CAP 25MG, 32

junel 1.5/30 TAB, 13

irbesartan TAB 150MG, 7

indomethacin CAP 50MG, 32

junel 1/20 TAB, 13


indomethacin inj 1MG, 32

junel FE 24 TAB 1/20, 13


Infanrix Inj, 34

junel FE TAB 1.5/30, 13

Iressa TAB 250MG, 5

Infinity Sol High CON, 38

junel FE TAB 1/20, 13

Iron Chews Chw Pediatri, 20

Infinity Sol Low CON, 38

just d liq 400unit, 35

Iron Chw Pediatri, 20

Infinity Sol Norm CON, 38

K

Iron High CAP Potency, 20

Influenza Firus Vaccine, 34

iron slow TAB 45MG, 20

k citrate sol citr acd, 19

Inlyta TAB 1MG, 5

iron supplem TAB 325MG, 20

k/NA citrate sol citr acd, 19

Inspirachamb Mis Large, 40

iron supplem TAB therapy, 20

kaitlib FE chw, 13

Inspirachamb Mis Medium, 40

iron supplmt dro 15MG/ML, 20

Kaletra TAB 100-25MG, 3

Inspirachamb Mis Mouthpce, 40

Iron TAB 18MG, 20

Kaletra TAB 200-50MG, 3

Inspirachamb Mis Small, 40

Iron TAB 18MG CR, 20

Kalydeco TAB 150MG, 34

Inspirease Mis Dd Syst, 40

iron TAB 27MG, 20

kariva TAB 28 day, 13

Instat Mch Pow, 21

Iron TAB 28MG, 20

kelnor TAB 1/35, 13

Insulin Pen Mis 29GX12MM, 38

iron TAB 325MG, 20

Ketek TAB 300MG, 4

Insulin Pen Mis 31GX8MM, 38

iron TAB 45MG, 20

Ketek TAB 400MG, 4


iron TAB 50MG ER, 20

ketoconazole CRE 2%, 10


iron TAB 65MG, 20

ketoconazole sha 2%, 10


Iron Up Liq, 20

ketoconazole TAB 200MG, 2


Isentress Chw 100MG, 3

ketoprofen CAP 50MG, 32


ketoprofen CAP 75MG, 32

Lancets Thin Mis 26G, 38

levocarnitin TAB 330MG, 16

ketorolac inj 15MG/ML, 32

Lancets Thin Mis 30G, 38

levocetirizi sol 2.5/5ML, 33

ketorolac inj 30MG/ML, 32

Lancets Ultr Mis Thin, 38

levocetirizi TAB 5MG, 33

ketorolac inj 60MG/2ML, 32

Lancets Ultr Mis Thin 28G, 38

levofloxacin sol 0.5%, 28

ketorolac sol 0.4%, 29

Lancets Ultr Mis Thin 30G, 38

levofloxacin sol 25MG/ML, 2

ketorolac sol 0.5%, 29

Lancing Devi Mis, 38

Levofloxacin Sol 25MG/ML, 2

ketorolac TAB 10MG, 32

Lanoxin PED Inj 0.1MG/ML, 6

levofloxacin TAB 250MG, 2

Keveyis TAB 50MG, 9

lansoprazole CAP 15MG DR, 17


kimidess TAB, 13

lansoprazole CAP 30MG DR, 17


Kineret Inj, 32

lanthanum chw 1000MG, 18

levonest TAB, 13

Kinney Mis Lancets, 38


levonor/ethi TAB, 13

Kinney Thin Mis Lancets, 38


levonor/ethi TAB 0.1-0.02, 13

Kinrix Inj, 34

Lantus Inj 100/ML, 14

levonor/ethi TAB estradio, 13

kls aspirin TAB 325MG EC, 30

Lantus Inj Solostar, 14

levonorgestr TAB 1.5MG, 13

kls aspirin TAB 81MG EC, 30

larin 24 TAB FE 1/20, 13

levora-28 TAB 0.15/30, 13

kls quit2 gum 2MG, 27

larin FE TAB 1.5/30, 13

Levorphanol TAB 2MG, 31

kls quit2 loz 2MG, 27

larin FE TAB 1/20, 13

Levothyroxin Inj 100mcg, 16

kls quit4 gum 4MG, 27

larin TAB 1.5/30, 13


kls quit4 loz 4MG, 27

larin TAB 1/20, 13


kp aspirin TAB 81MG EC, 30

larissia TAB, 13

levothyroxin TAB 100mcg, 16

kp bisacodyl TAB 5MG EC, 17

Lastacaft Sol 0.25%, 29


Kp Prenatal TAB Multivit, 35

latanoprost sol 0.005%, 29


kurvelo TAB 0.15/30, 13

Latuda TAB 120MG, 24


Kuvan TAB 100MG, 16

Latuda TAB 20MG, 24


Kyleena Iud 19.5MG, 14

Latuda TAB 40MG, 24


L

Latuda TAB 80MG, 24


laxaclear pow, 17


labetalol inj 5MG/ML, 6

laxative pol pow glycol, 17


labetalol TAB 100MG, 6

laxative TAB 5MG EC, 17



layolis FE chw, 13



Lb Lancet Mis 28G, 38


Lacrisert Mis 5MG Op, 28

Lb Lancing Mis Device, 38

levothyroxine TAB 0.075MG, 16

lactulose sol 10gm/15, 16, 18

leena TAB, 13

levoxyl TAB 75mcg, 16

lactulose sol 20gm/30, 16

leflunomide TAB 10MG, 32

Lexiva Sus 50MG/ML, 3

lamivud/zido TAB 150-300, 3

leflunomide TAB 20MG, 32

Lexiva TAB 700MG, 3

lamivudine sol 10MG/ML, 3

Lenvima CAP 10 MG, 5

Lialda TAB 1.2gm, 18

lamivudine TAB 100MG, 3


Librax CAP 5-2.5MG, 17



lido bdk kit, 12



lido-prilo kit 2.5-2.5%, 12

lamotrigine chw 25MG, 25

lessina TAB, 13

lido/prilocn CRE 2.5-2.5%, 12

lamotrigine chw 5MG, 25

Letairis TAB 10MG, 9

lido/prilocn kit 2.5-2.5%, 12

lamotrigine TAB 100MG, 25

Letairis TAB 5MG, 9

lidocaine gel 2%, 12


letrozole TAB 2.5MG, 4

lidocaine gel 2% jelly, 12


Leucovor CA TAB 10MG, 5

lidocaine inj 1%, 32


Leucovor CA TAB 15MG, 6

lidocaine inj 2%, 32

Lancet Alter Mis Site 26G, 38

leucovor CA TAB 25MG, 5

lidocaine oin 5%, 12

Lancet Devic Mis Adjust, 38

leucovor CA TAB 5MG, 5

lidocaine oin PAK 5%, 12

Lancet Micro Mis Thin 33G, 38

Leukeran TAB 2MG, 4

lidocaine pad 5%, 12

Lancet Stand Mis 21G, 38

leuprolide inj 1MG/0.2, 4

lidocaine sol 2% visc, 21

Lancet Super Mis Thin 30G, 38

leva set kit, 12

lidocaine-pr CRE, 12

Lancet Ultra Mis 28G, 38

leva set kit 2.5-2.5%, 12

lidopril kit 2.5-2.5%, 12

Lancet Ultra Mis Fine, 38

levalbuterol neb 0.31MG, 33

lidopril XR kit 2.5-2.5%, 12

Lancet Ultra Mis Thin 28G, 38

levalbuterol neb 0.63MG, 33

Liletta Iud 52MG, 14

Lancet Ultra Mis Thin 30G, 38

levalbuterol neb 1.25/0.5, 33

lillow TAB 0.15/30, 13

Lancets Micr Mis Thin 33G, 38

Levemir Inj, 14

lincomycin inj 300MG/ML, 4

Lancets Mis, 38

Levemir Inj Flextouc, 14

lindane lot 1%, 12

Lancets Mis 21G, 38

levetiraceta sol 100MG/ML, 25

Lindane Lot 1%, 12

Lancets Mis 21G Colr, 38

levetiraceta sol 500/5ML, 25

lindane sha 1%, 12

lancets mis 23G, 36

levetiraceta TAB 1000MG, 25

Lindane Sha 1%, 12

Lancets Mis 23G, 38


linezolid sus 100/5ML, 4

Lancets Mis 26G, 38


linezolid TAB 600MG, 4

Lancets Mis 28G, 38

levetiraceta TAB 500MG ER, 25

Linzess CAP 145mcg, 18

Lancets Mis 30G, 38



Lancets Mis 33G, 38

levetiraceta TAB 750MG ER, 25


Lancets Mis Thin, 38

Levo-ETH Est TAB 90-20mcg, 14

liothyronine TAB 25mcg, 16

Lancets Mis Thin 26G, 38

levo-t TAB 75mcg, 16


Lancets Mis Thin 30G, 38

levobunolol sol 0.5% op, 28


Lancets Supr Mis Thin 28G, 38

levocarnitin sol 1gm/10ML, 16

liprozonepak kit 2.5-2.5%, 12

Lancets Thin Mis, 38

lisinop/hctz TAB 10-12.5, 8

Lovenox Inj 300/3ML, 21

medolor PAK kit 2.5-2.5%, 12

lisinop/hctz TAB 20-12.5, 8

Lovenox Inj 40/0.4ML, 21

Medrol TAB 2MG, 12

lisinop/hctz TAB 20-25MG, 8


medroxypr ac inj 150MG/ML, 13

lisinopril TAB 10MG, 7


medroxypr ac TAB 10MG, 14

lisinopril TAB 2.5MG, 7

low-ogestrel TAB, 13

medroxypr ac TAB 2.5MG, 14


loxapine CAP 10MG, 23

medroxypr ac TAB 5MG, 14



mefenam acid CAP 250MG, 32



mefloquine TAB 250MG, 3



megestrol ac sus 400MG/10, 4

Lite Touch Mis Lanc Dev, 38

LP lite PAK kit 2.5-2.5%, 12

megestrol ac sus 40MG/ML, 4

Lite Touch Mis Lanc Pen, 38

Lumigan Sol 0.01%, 29

megestrol ac TAB 20MG, 4

Lite Touch Mis Lancets, 38

Lumizyme Inj 50MG, 16

megestrol ac TAB 40MG, 4

Liteaire Mis, 40

Lupaneta Kit 11.25-5, 15

Meijer Lance Mis Universa, 38

Litetouch Mis 29GX12.7, 38

Lupaneta Kit 3.75-5, 15

Meijer Mis Lancets, 38

Litetouch Mis 31GX8MM, 38

Lupr Dep-PED Inj 11.25MG, 16

Mekinist TAB 0.5MG, 5

Litetouch Mis Lancets, 38

Lupr Dep-PED Inj 15MG, 16

Mekinist TAB 2MG, 5

lithium CARB CAP 150MG, 23

Lupr Dep-PED Inj 3m 30MG, 16

melodetta chw 24 FE, 13

Lithium CARB CAP 150MG, 23

Lupr Dep-PED Inj 7.5MG, 16

meloxicam TAB 15MG, 32


Lupron Depot Inj 11.25MG, 4

meloxicam TAB 7.5MG, 32



melphalan TAB 2MG, 4

Lithium CARB CAP 600MG, 23


memant titra PAK 5-10MG, 26

lithium CARB TAB 300MG, 23

Lupron Depot Inj 30MG, 4

memantine HC sol 2MG/ML, 26

lithium CARB TAB 300MG ER, 23

Lupron Depot Inj 45MG, 4

memantine TAB HCL 10MG, 26

lithium CARB TAB 450MG ER, 23


memantine TAB HCL 5MG, 26

Lithium Sol 8meq/5ML, 23

lutera TAB, 13

Menactra Inj, 34

Livalo TAB 1MG, 9

Luzu CRE 1%, 10

Menhibrix Inj, 34

Livalo TAB 2MG, 9

Lyrica CAP 100MG, 25

Menomune Inj A/C/Y/W, 34

Livalo TAB 4MG, 9


Menveo Inj, 34

livixil PAK kit 2.5-2.5%, 12


meperidine inj 100MG/ML, 30

LO Loestrin TAB, 14


Mephyton TAB 5MG, 34

lokara lot 0.05%, 11

Lyrica CAP 25MG, 25

meprobamate TAB 200MG, 22

lomedia 24 TAB FE, 13


meprobamate TAB 400MG, 22

Lomustine CAP 100MG, 4

Lyrica CAP 50MG, 25

mercaptopur TAB 50MG, 4


Lyrica CAP 75MG, 25

mesalamine ene 4gm, 18


Lyrica Sol 20MG/ML, 25

mesalamine TAB 1.2gm, 18

Longs Lancet Mis Standard, 38

Lysodren TAB 500MG, 5

Mesalamine TAB 800MG DR, 18

Longs Lancet Mis Thin, 38

lyza TAB 0.35MG, 13

mesna inj 1gm, 5

Longs Lancet Mis Ultra Th, 38

M

Mesnex TAB 400MG, 6

loperamide CAP 2MG, 17

Mestinon Syp 60MG/5ML, 28

M-m-r II Inj, 34

lopin/riton sol 80-20/ML, 3

metadate TAB 20MG ER, 24

MAG citrate sol, 17

lorazepam CON 2MG/ML, 22

Metaproteren Syp 10MG/5ML, 33

MAG citrate sol cherry, 17

lorazepam inj 2MG/ML, 22

Metaproteren TAB 10MG, 33

MAG citrate sol grape, 17

lorazepam TAB 0.5MG, 22

Metaproteren TAB 20MG, 33

MAG citrate sol lemon, 17

lorazepam TAB 1MG, 22

metaxall TAB 800MG, 28

Makena Inj 250MG/ML, 14

lorazepam TAB 2MG, 22

metaxalone TAB 800MG, 28

malathion lot 0.5%, 12

lorcet HD TAB 10-325MG, 30

metformin TAB 1000MG, 15

Maprotiline TAB 25MG, 23

lorcet plus TAB 7.5-325, 30



lorcet TAB 5-325MG, 30

metformin TAB 500MG ER, 15


lortab TAB 10-325MG, 30

metformin TAB 750MG ER, 15

margesic CAP, 29

lortab TAB 5-325MG, 30


marlissa TAB 0.15/30, 13

lortab TAB 7.5-325, 30

methadone CON 10MG/ML, 30

Marplan TAB 10MG, 23

loryna TAB 3-0.02MG, 13

methadone sol 10MG/5ML, 30

marten-TAB tab 50-325MG, 29

losartan pot TAB 100MG, 7

Methadone Sol 10MG/5ML, 31

Matulane CAP 50MG, 5


methadone sol 5MG/5ML, 30

Maxima Sol Control, 38


Methadone Sol 5MG/5ML, 31

meclizine TAB 25MG, 18

losartan/HCT TAB 100-12.5, 8

methadone TAB 10MG, 31

Meclofen Sod CAP 100MG, 32

losartan/HCT TAB 100-25, 8


Meclofen Sod CAP 50MG, 32

losartan/HCT TAB 50-12.5, 8


Medisense Liq Gluc-ket, 38

Lotemax Gel 0.5%, 28

Methadose CON 10MG/ML, 31

Medisense Liq Gluc/Ket, 38

Lotemax Oin 0.5%, 28

Methadose SF CON 10MG/ML, 31

Medlance Mis 30G Plus, 38

Lotemax Sus 0.5%, 28

methadose TAB 40MG, 31

Medlance Mis Lite 25G, 38

lovastatin TAB 10MG, 9

methamphetam TAB 5MG, 24

Medlance Mis Plus, 38


methazolamid TAB 25MG, 9

Medlance Mis Plus 30G, 38


methazolamid TAB 50MG, 9

Medlance Mis Unv 21G, 38

Lovenox Inj 100MG/ML, 21

methenam hip TAB 1gm, 18

Medlance Pls Mis 0.8MM, 38

Lovenox Inj 120/0.8, 21

methenam man TAB 1000MG, 18

Medlance Pls Mis Extr 21G, 38

Lovenox Inj 150MG/ML, 21

methenam man TAB 1gm, 18

Medlance Pls Mis Lite 25G, 38


Methergine TAB 0.2MG, 29

Medlance Pls Mis Univ 21G, 38

methimazole TAB 10MG, 16

Metoprl/Hctz TAB 100-50MG, 8

moderiba TAB 200MG, 3

methimazole TAB 5MG, 16

metoprl/hctz TAB 50-25MG, 8

moexipr/hctz TAB 15-12.5, 8

Methitest TAB 10MG, 13

metoprol suc TAB 100MG ER, 6

moexipr/hctz TAB 15-25MG, 8

methocarbam inj 1000MG, 28


moexipr/hctz TAB 7.5-12.5, 8

methocarbam inj 100MG/ML, 28


moexipril TAB 15MG, 7

methocarbam TAB 500MG, 28


moexipril TAB 7.5MG, 7

methocarbam TAB 750MG, 28

metoprol TAR TAB 100MG, 6

mometasone CRE 0.1%, 11

methotrexate inj 100/4ML, 4


mometasone oin 0.1%, 11

methotrexate inj 1gm, 4


mometasone sol 0.1%, 11

methotrexate inj 1gm/40ML, 4

metoprolol TAB 100MG ER, 6

mondoxyne nl CAP 100MG, 2







methotrexate inj 25MG/ML, 4

Metoprolol TAB 37.5MG, 6

mono-linyah TAB 0.25-35, 14

Methotrexate Inj 25MG/ML, 4


Monolet Mis Lancets, 38

methotrexate inj 50MG/2ML, 4

Metoprolol TAB 75MG, 6

mononessa TAB, 14

methotrexate TAB 2.5MG, 4

metronidazol CRE 0.75%, 10

montelukast chw 4MG, 33

methoxsalen CAP 10MG, 11

metronidazol gel 0.75%, 10

montelukast chw 5MG, 33

methscopolam TAB 2.5MG, 17

metronidazol gel 0.75%vag, 19

montelukast gra 4MG, 33

methscopolam TAB 5MG, 17

metronidazol TAB 250MG, 4

montelukast TAB 10MG, 33

Methyclothia TAB 5MG, 9

metronidazol TAB 500MG, 4

morgidox CAP 1X50MG, 2

methyldopa TAB 250MG, 8

mexiletine CAP 150MG, 7

morphine SUL CAP 100MG ER, 31

methyldopa TAB 500MG, 8



Methyldopate Inj 250/5ML, 8



methylergon inj 0.2MG/ML, 29

mibelas 24 chw FE, 13


methylergon TAB 0.2MG, 29

micrgstin 24 TAB FE 1/20, 13


methylphenid CAP 10MG, 24

Micro Thin Mis Lanc 33G, 38



Microchamber Mis, 40

Morphine SUL Inj 10/0.7ML, 31

methylphenid CAP 20MG ER, 24

Microdot CON Sol High/Low, 38

morphine SUL inj 10MG/ML, 31


microgestin TAB 1.5/30, 13

Morphine SUL Inj 10MG/ML, 31


microgestin TAB 1/20, 14

Morphine SUL Inj 150/30ML, 31


microgestin TAB FE 1/20, 13



microgestin TAB FE1.5/30, 13



Microlet Mis Lancets, 38



Microspacer Mis, 40


Methylphenid CAP 60MG LA, 25

midazolam inj 10MG/2ML, 24


methylphenid TAB 10MG, 24

midazolam inj 5MG/ML, 24


methylphenid TAB 10MG ER, 24

midodrine TAB 10MG, 9

morphine SUL sol 100/5ML, 31


midodrine TAB 2.5MG, 9

morphine SUL sol 10MG/5ML, 31

Methylphenid TAB 18MG ER, 25

midodrine TAB 5MG, 9

morphine SUL sol 20MG/5ML, 31


Migergot Sup 2/100, 32

Morphine SUL Sup 10MG, 31


miglitol TAB 25MG, 15



Migranal Spr 4MG/ML, 32



miniprin low TAB 81MG EC, 30



minitran dis 0.1MG/HR, 6

morphine SUL TAB 100MG ER, 31



Morphine SUL TAB 15MG, 31








minocycline CAP 100MG, 2

Morphine SUL TAB 30MG, 31

methylpr ace inj 40MG/ML, 12



methylpr ace inj 80MG/ML, 12



methylpr ss inj 125MG, 12

minoxidil TAB 10MG, 8

Moviprep Sol, 16

methylpred TAB 16MG, 12

minoxidil TAB 2.5MG, 8

Moxeza Sol 0.5%, 28


Miralax Pow, 17

moxifloxacin sol 0.5%, 28


Miralax Pow 3350 NF, 17

moxifloxacin TAB 400MG, 2


Mirena Iud System, 14

Multaq TAB 400MG, 7

methyltestos CAP 10MG, 12

mirtazapine TAB 15MG, 22

Multi Prenat TAB, 35

Metipranolol Sol 0.3% Oph, 28

mirtazapine TAB 15MG odt, 22

Multi-lancet Mis Device, 38

metoclopram inj 10MG/2ML, 18


mupirocin CA CRE 2%, 10

metoclopram inj 5MG/ML, 18


mupirocin CRE 2%, 10

metoclopram sol 10/10ML, 18


mupirocin oin 2%, 10

metoclopram sol 5MG/5ML, 18


my way TAB 1.5MG, 14

metoclopram TAB 10MG, 18

mirtazapine TAB 7.5MG, 22

Myalept Inj 11.3MG, 16

metoclopram TAB 5MG, 18

Mirvaso Gel 0.33%, 10

Mycamine Inj 100MG, 2

metolazone TAB 10MG, 9

misoprostol TAB 100mcg, 17

Mycamine Inj 50MG, 2

metolazone TAB 2.5MG, 9

misoprostol TAB 200mcg, 17

mycophenolat CAP 250MG, 5

metolazone TAB 5MG, 9

MM aspirin TAB 325MG, 30

mycophenolat sus 200MG/ML, 5


modafinil TAB 100MG, 24

mycophenolat TAB 500MG, 5


modafinil TAB 200MG, 24

mycophenolic TAB 180MG DR, 5

mycophenolic TAB 360MG DR, 5

neo/poly/HC sol 1% otic, 29

nicotine pol gum 2MG ref, 27

myferon 150 CAP 150MG, 20

neo/poly/HC sus 1% otic, 29

nicotine pol gum 2MG strt, 27

Myglucohealt Mis Lanc 30G, 38

neomycin TAB 500MG, 2

nicotine pol gum 2mgfruit, 27

Myglucohealt Sol LO/Nl/HI, 38

Neulasta Inj 6MG/0.6m, 19

nicotine pol gum 4MG, 27

Mykidz Iron Sus 15/1.5ML, 20

Neulasta Kit 6MG/0.6m, 19

nicotine pol gum 4MG cinn, 27

Myleran TAB 2MG, 4

Neupogen Inj 300/0.5, 19

nicotine pol gum 4MG mint, 27

myorisan CAP 10MG, 10

Neupogen Inj 300mcg, 19

nicotine pol gum 4MG orig, 27


Neupogen Inj 480/0.8, 19

nicotine pol gum 4MG ref, 27


Neupogen Inj 480mcg, 19

nicotine pol gum 4MG strt, 27


Neutek 2tek Sol Control, 38

nicotine pol gum 4mgfruit, 27

Myrbetriq TAB 25MG, 19

Nevanac Sus 0.1%, 29

nicotine pol loz 2MG chry, 27

Myrbetriq TAB 50MG, 19

Nevirapine Sus 50MG/5ML, 3

nicotine pol loz 2MG cinn, 27

myzilra TAB, 14

nevirapine TAB 200MG, 3

nicotine pol loz 2MG mint, 27

N

nevirapine TAB 400MG ER, 3

nicotine pol loz 4MG chry, 27

Nexavar TAB 200MG, 5

nicotine pol loz 4MG cinn, 27

nabumetone TAB 500MG, 32

Nexgen Tes Norm CON, 38

nicotine pol loz 4MG mint, 27

nabumetone TAB 750MG, 32

Nexplanon Imp 68MG, 14

Nicotine SYS Kit Transder, 28

nadolol TAB 20MG, 6

next choice TAB 1.5MG, 14

nicotine TD dis 14MG/24h, 27

nadolol TAB 40MG, 6

Niacor TAB 500MG, 9

nicotine TD dis 21MG/24h, 27

nadolol TAB 80MG, 6

nicardipine CAP 20MG, 7

nicotine TD dis 7MG/24HR, 27

Nafcillin Inj 1gm, 1

nicardipine CAP 30MG, 7

Nicotrol Inh, 28

Nafcillin Inj 2gm, 1

Nicoderm CQ Dis 14MG/24h, 27

Nicotrol Ns Spr 10MG/ML, 28

naftifine CRE HCL 1%, 10

Nicoderm CQ Dis 21MG/24h, 27

nifedical XL TAB 30MG, 7

naftifine CRE HCL 2%, 10

Nicoderm CQ Dis 7MG/24HR, 27

nifedical XL TAB 60MG, 7

Naftin Gel 1%, 10

nicorelief gum 2MG mint, 27

nifedipine CAP 10MG, 7

naloxone inj 0.4MG/ML, 31

nicorelief gum 2MG orig, 27

nifedipine CAP 20MG, 7

Naloxone Inj 0.4MG/ML, 31

nicorelief gum 4MG mint, 27

nifedipine TAB 30MG ER, 7

Naloxone Inj 1MG/ML, 31

nicorelief gum 4MG orig, 27


naltrexone TAB 50MG, 31

Nicorette Gum 2MG, 27


Namenda XR CAP 14MG, 26

Nicorette Gum 2MG Cinn, 27

nikki TAB 3-0.02MG, 14


Nicorette Gum 2MG Mint, 27

nilutamide TAB 150MG, 4


Nicorette Gum 2MG Orig, 27

nimodipine CAP 30MG, 7


Nicorette Gum 2mgfruit, 27

nisoldipine TAB 17MG ER, 7

Namenda XR CAP Titratio, 26

Nicorette Gum 4MG, 28

Nisoldipine TAB 20MG ER, 7

Naphazoline Sol 0.1% Op, 29

Nicorette Gum 4MG Cinn, 28


naproxen sod TAB 275MG, 32

Nicorette Gum 4MG Mint, 28


naproxen sod TAB 550MG, 32

Nicorette Gum 4MG Orig, 28

Nitro-bid Oin 2%, 6

naproxen sus 125/5ML, 32

Nicorette Gum 4mgfruit, 28

Nitro-dur Dis 0.3MG/HR, 6

Naproxen Sus 125/5ML, 32

Nicorette Loz 2MG Chry, 28

Nitro-dur Dis 0.8MG/HR, 6

naproxen TAB 250MG, 32

Nicorette Loz 2MG Mint, 28

nitrofur mac CAP 100MG, 18


Nicorette Loz 2MG Orig, 28



Nicorette Loz 4MG Chry, 28


naratriptan TAB 1MG, 32

Nicorette Loz 4MG Mint, 28

nitrofurantn CAP 100MG, 19

naratriptan TAB 2.5MG, 32

Nicorette Loz 4MG Orig, 28

nitrofurantn sus 25MG/5ML, 18

Narcan Spr, 31

Nicorette ST Gum 2MG, 28

nitroglycer dis 0.1MG/HR, 6

Nascobal Spr 500mcg, 19

Nicorette ST Gum 2MG Mint, 28


nat-rul iron TAB 325MG, 20

Nicorette ST Gum 2MG Orig, 28


Natacyn Sus 5% Op, 28

Nicorette ST Gum 4MG Mint, 28


Natazia TAB, 14

Nicorette ST Gum 4MG Orig, 28

nitroglyceri sub 0.6MG, 6

nateglinide TAB 120MG, 15

nicotine dis 14MG/24h, 27

nitroglycern sub 0.3MG, 6

nateglinide TAB 60MG, 15

nicotine dis 21MG/24h, 27

nitroglycern sub 0.4MG, 6

natura-LAX pow 3350 NF, 17

nicotine dis 7MG/24HR, 27

nizatidine CAP 150MG, 17

Nebupent Inh 300MG, 4

nicotine dis step 1, 27

nizatidine CAP 300MG, 17

nebusal neb 3%, 33


Nizatidine Sol 15MG/ML, 17

necon TAB 0.5/35, 14


nora-be TAB 0.35MG, 14

necon TAB 1/35, 14

nicotine gum 2MG, 27

nore/ETH/fer chw 0.4MG-35, 14

Necon TAB 1/50-28, 14

nicotine gum 2mgfruit, 27

noreth/ethin chw FE, 14

necon TAB 10/11-28, 14

nicotine gum 4MG, 27

noreth/ethin chw FE 1/20, 14

necon TAB 7/7/7, 14

nicotine loz 2MG chry, 27

noreth/ethin TAB 1/20, 14

Nefazodone TAB 100MG, 23

nicotine loz 2MG mint, 27

noreth/ethin TAB FE 1/20, 14


nicotine loz 4MG chry, 27

norethin ace TAB 5MG, 14


nicotine loz 4MG cinn, 27

norethindron TAB 0.35MG, 14

nefazodone TAB 250MG, 22

nicotine loz 4MG mint, 27

norgest/ethi TAB 0.25/35, 14

nefazodone TAB 50MG, 22

nicotine loz mini 2MG, 27

norgest/ethi TAB estradio, 14

neo-polycin oin HC 1%op, 28

nicotine pol gum 2MG, 27

Norinyl TAB 1+50-28, 14

neo/poly/bac oin /HC 1%op, 28

nicotine pol gum 2MG cinn, 27

norlyda TAB 0.35MG, 14

neo/poly/dex oin 0.1% op, 28

nicotine pol gum 2MG mint, 27

norlyroc TAB 0.35MG, 14

neo/poly/dex sus 0.1% op, 28

nicotine pol gum 2MG orig, 27

Norpace CAP 100MG CR, 7

neo/poly/gra sol op, 28

Norpace CAP 150MG CR, 7

olopatadine dro 0.1%, 29

orsythia TAB, 14

nortrel TAB 0.5/35, 14

olopatadine sol 0.2%, 29

oseltamivir CAP 30MG, 3

nortrel TAB 1/35, 14

olopatadine spr 0.6%, 33


nortrel TAB 7/7/7, 14

omega-3-acid CAP 1gm, 9


nortriptylin CAP 10MG, 22

Omeprazole + Sus Syrspend, 18

Osmoprep TAB 1.5gm, 17


omeprazole CAP 10MG, 17

Otezla TAB 10/20/30, 32



Otezla TAB 30MG, 32



oxandrolone TAB 10MG, 12

Nortriptylin Sol 10MG/5ML, 23

Omnitrope Inj 10/1.5ML, 16

oxandrolone TAB 2.5MG, 12

Norvir CAP 100MG, 3

Omnitrope Inj 5.8MG, 16

oxaprozin TAB 600MG, 32

Norvir Sol 80MG/ML, 3

Omnitrope Inj 5/1.5ML, 16

oxazepam CAP 10MG, 22

Norvir TAB 100MG, 3

On Call Expr Sol Glucose, 38


norwich asa TAB 325MG, 30

On Call Mis Lancets, 38


Nova Max Glu Liq /Ket CON, 38

On Call Plus Mis Lancets, 38

oxcarbazepin sus 300MG/5m, 25

Nova Safety Mis Lanc 23G, 38

On Call Plus Sol Control, 38

oxcarbazepin TAB 150MG, 25

Nova Safety Mis Lanc 28G, 38

On Call Vivd Sol Control, 38


Nova Sure Mis Lancets, 38

On-the-go Mis Lanc 30G, 38


Nova Sureflx Mis Lanc Dev, 38

ondansetron inj 40/20ML, 18

oxybutynin syp 5MG/5ML, 19

Novaferrum CAP 50MG, 20

ondansetron inj 4MG/2ML, 18

oxybutynin TAB 10MG ER, 19

Novaferrum Dro 15MG/ML, 20

ondansetron sol 4MG/5ML, 18


Novoclair CRE, 11

ondansetron TAB 24MG, 18

oxybutynin TAB 5MG, 19

Novofine Aut Mis 30GX8MM, 38



Novofine Mis 30GX8MM, 38

ondansetron TAB 4MG odt, 18

oxycod/apap TAB 10-325MG, 31

Novofine Mis 32GX6MM, 38


oxycod/apap TAB 2.5-325, 31

Novolog Inj 100/ML, 14

ondansetron TAB 8MG odt, 18

oxycod/apap TAB 5-325MG, 31

Novolog Mix Inj 70/30, 14

One A Day CAP Prenatal, 35

oxycod/apap TAB 7.5-325, 31

Noxafil Sus 40MG/ML, 2

One A Day Mis Prenatal, 35

oxycod/asa TAB, 31

nu-iron 150 CAP 150MG, 20

One A Day PAK Prenatal, 35

Oxycod/Ibu TAB 5-400MG, 31

Nucynta ER TAB 100MG, 31

One-a-day PAK Prenatal, 35

oxycodone CON 100/5ML, 31


Onetouch Mis 30G, 38

oxycodone CON 20MG/ML, 31


Onetouch Mis Lanc Dev, 38

oxycodone sol 5MG/5ML, 31


Onetouch Mis Lancets, 38

oxycodone TAB 10MG, 31


Onetouch Sol Ult Cont, 38

Oxycodone TAB 10MG ER, 31

Nucynta TAB 100MG, 31

Onetouch Sol Verio, 38



Onetouch Sol Verio-HI, 38



Onetouch Tes Ultra, 38


Nuedexta CAP 20-10MG, 26

Onetouch Tes Ultra BL, 38


Nuvaring Mis, 14

Onetouch Tes Verio, 38


Nuvya CRE, 11

Onetouch Us Mis Lancets, 38


nyamyc pow 100000, 10

Onglyza TAB 2.5MG, 15


nyata pow 100000, 10

Onglyza TAB 5MG, 15


nystat/triam CRE, 10

opcicon TAB 1.5MG, 14

Oxycodone/ Sol Apap, 31

nystat/triam oin, 10

opium tin 10MG/ML, 17

Oxycontin TAB 10MG CR, 31

nystatin CRE 100000, 10

Opsumit TAB 10MG, 9


nystatin oin 100000, 10

Optichamber Mis Adv Lrg, 40


nystatin pow 100000, 10

Optichamber Mis Adv MED, 40


nystatin sus 100000, 21

Optichamber Mis Adv Sm, 40


nystatin TAB 500000, 2

Optichamber Mis Advantag, 40


nystop pow 100000, 10

Optichamber Mis Dia LG, 40


O

Optichamber Mis Dia MD, 40

oxymorphone TAB 10MG ER, 31

Optichamber Mis Dia Sm, 40

Oxymorphone TAB 10MG ER, 31

ocella TAB 3-0.03MG, 14

Optichamber Mis Diamond, 40


octreotide inj 1000mcg, 16

Optichamber Mis Face Mas, 40



Optihaler Mis, 40



Optimal D3 M CAP, 35



optimal-d CAP 50000unt, 35


octreotide inj 50mcg/ML, 16

option 2 TAB 1.5MG, 14


Odefsey TAB, 3

Optumrx Cont Sol Level1/2, 38


Ofev CAP 100MG, 34

opurity vit chw d 5000un, 35


Ofev CAP 150MG, 34

Oracit Sol, 19


ofloxacin dro 0.3% op, 28

oralone dent pst 0.1%, 21


ofloxacin dro 0.3%otic, 29

Oravig TAB 50MG, 21

oxymorphone TAB 7.5MG ER, 31

Ogestrel TAB, 14

Orencia Clck Inj 125MG/ML, 32

Oxymorphone TAB 7.5MG ER, 31

olanzapine TAB 10MG, 23

Orencia Inj 125MG/ML, 32

oxymorphone TAB HCL 10MG, 31


Orencia Inj 250MG, 32

oxymorphone TAB HCL 5MG, 31

olanzapine TAB 2.5MG, 23

Orencia Inj 50/0.4, 32

P


Orencia Inj 87.5/0.7, 32


PA vitamin CAP 2000unit, 35

orphenadrine TAB 100MG ER, 28

olanzapine TAB 7.5MG, 23

pacerone TAB 200MG, 7

paliperidone TAB ER 1.5MG, 23

penicilln vk TAB 250MG, 1

pimtrea TAB, 14

paliperidone TAB ER 3MG, 23

penicilln vk TAB 500MG, 1

pindolol TAB 10MG, 6


Penlet II Kit Blood, 39

pindolol TAB 5MG, 6


Pentacel Inj, 34

pioglitazone TAB 30MG, 15

Pancrelipase CAP 5000unit, 18

Pentasa CAP 250MG CR, 18

pioglitazone TAB 45MG, 15

Panda Mask Mis Large, 40

Pentasa CAP 500MG CR, 18

pirmella TAB 1/35, 14

Panda Mask Mis Medium, 40

pentoxifylli TAB 400MG ER, 21

pirmella TAB 7/7/7, 14

Panda Mask Mis Pediatri, 40

Perfect Iron TAB 25MG, 20

piroxicam CAP 10MG, 32

Panda Mask Mis Small, 40

perindopril TAB 2MG, 7

piroxicam CAP 20MG, 32

pantoprazole inj sod 40MG, 17


Plan B TAB 1.5MG, 14

pantoprazole TAB 20MG, 17


Plexion Clth Pad 9.8-4.8%, 10

pantoprazole TAB 40MG, 17

periogard sol 0.12%, 21

Pneumovax 23 Inj 25/0.5, 34

papaverine inj 30MG/ML, 9

permethrin CRE 5%, 12

Pocket Chamb Mis, 40

Papaverine Sol 30MG/ML, 9

Perphen/Amit TAB 2-10MG, 26

Pocket Space Mis, 40

Paragard Iud T380a, 14


Pocketchem Sol EZ, 39

paricalcitol CAP 1 mcg, 16


podofilox sol 0.5%, 12



poly-iron CAP 150MG, 20



polycin oin op, 28

paroex sol 0.12%, 21

perphenazine TAB 16MG, 23

polyeth GLYC pow 3350 NF, 17

paromomycin CAP 250MG, 2


polyeth GLYC pow 3350-grx, 17

paroxetine TAB 10MG, 22


polymyxin b/ sol trimethp, 28



portia-28 TAB, 14


Perry Prenat CAP, 35

pot citrate TAB 1080MG, 19


pharbedryl CAP 50MG, 33

pot citrate TAB 1620MG, 19

Paser Gra 4gm, 2

phenadoz sup 12.5MG, 33

pot citrate TAB 540MG ER, 19

Pataday Sol 0.2%, 29

phenadoz sup 25MG, 33

powderlax pow, 17

Paxil Sus 10MG/5ML, 23

phenazo TAB 200MG, 19

Pradaxa CAP 110MG, 21

Pazeo Dro 0.7%, 29

phenazopyrid TAB 100MG, 19


PC Lancets Mis 30G, 39

phenazopyrid TAB 200MG, 19


pedia d-vite dro 400unit, 35

phenelzine TAB 15MG, 22

Praluent Inj 150MG/ML, 9

pedia iron dro 15MG/ML, 20

phenergan sup 12.5MG, 33

Praluent Inj 75MG/ML, 9

Pediarix Inj 0.5ML, 34

phenergan sup 25MG, 33

pramipexole TAB 0.125MG, 26

Pedvax HIB Inj, 34

phenergan sup 50MG, 33


peg 3350 pow, 17

phenobarb elx 20MG/5ML, 24


peg 3350 sol electrol, 17

Phenobarb Inj 130MG/ML, 24


peg-3350 sol electrol, 17

phenobarb sol 20MG/5ML, 24


peg-3350/KCL sol /sodium, 17

Phenobarb TAB 100MG, 24

pramipexole TAB 1MG, 26

Peg-intron Kit 120 Rp, 3


Pramosone CRE 1-1%, 12

Peg-intron Kit 120mcg, 3

phenobarb TAB 16.2MG, 24

Pramosone Lot 1%, 12

Peg-intron Kit 150 Rp, 3


Pramosone Lot 2.5%, 12



prasugrel TAB 10MG, 21



prasugrel TAB 5MG, 21

Peg-intron Kit 50mcg Rp, 3


pravastatin TAB 10MG, 9

Peg-intron Kit 80mcg Rp, 3



peg3350 pow, 17

phenohytro TAB, 17


Peganone TAB 250MG, 25

phenoxybenza CAP 10MG, 8


Pegasys Inj, 3

Phentolamine Inj 5MG, 8

prazosin HCL CAP 1MG, 8

Pegasys Inj 180mcg/M, 3

phenylbutyra pow sodium, 16


Pegasys Inj Proclick, 3

phenylephrin sol 10% op, 29


Pegintron Kit 120mcg, 3

phenylephrin sol 2.5% op, 29

Pre-natal TAB Formula, 35


phenytoin chw 50MG, 25

Precision Liq Control, 39


phenytoin EX CAP 100MG, 25

Precision Liq Gluc/Ket, 39


phenytoin inj 50MG/ML, 25

Precision Liq Nrml/Mid, 39

pegylax pow, 17

phenytoin sus 125/5ML, 25

Pred Mild Sus 0.12% Op, 28

Pen Needle Mis 29GX1/2", 38

philith TAB 0.4-35, 14

pred sod PHO sol 5MG/5ML, 12

Pen Needles Mis 29GX1/2", 38

phosphasal TAB, 19

Pred-G S.o.p Oin Op, 28

Pen Needles Mis 29GX12MM, 38

Phospholine Sol 0.125%op, 29

Pred-G Sus Op, 29

Pen Needles Mis 31GX1/4", 38

phrenilin CAP forte, 29

prednicarbat CRE 0.1%, 11

Pen Needles Mis 31GX3/16, 38

phytonadione inj 1MG/0.5, 34

prednicarbat oin 0.1%, 11

Pen Needles Mis 31GX5/16, 39

Pic 200 CAP, 20

prednisolone sol 15MG/5ML, 12


Picato Gel 0.015%, 5

Prednisolone Sol 25MG/5ML, 12


Picato Gel 0.05%, 5

prednisolone sus 1% op, 28


pilocarpine sol 1% op, 29

prednisolone syp 15MG/5ML, 12



Prednisone PAK 10MG, 12

penicilln vk sol 125/5ML, 1


Prednisone PAK 5MG, 12

Penicilln Vk Sol 125/5ML, 1

pilocarpine TAB 5MG, 21

Prednisone Sol 5MG/5ML, 12

penicilln vk sol 250/5ML, 1

pimozide TAB 1MG, 26

prednisone TAB 10MG, 12

Penicilln Vk Sol 250/5ML, 1

pimozide TAB 2MG, 26


prednisone TAB 2.5MG, 12

Prodigy NO Tes Coding, 39

pyrazinamide TAB 500MG, 2


Prodigy Sol High, 39

pyridostigm TAB 60MG, 28

Prednisone TAB 50MG, 12

Prodigy Sol Low, 39

pyridostigmi TAB ER 180MG, 28


Profe CAP 180MG, 20

Q

Premarin Vag CRE 0.625MG, 19

profeno TAB 600MG, 32

qc aspirin TAB 325MG, 30

Prenat Multi CAP +dha, 35

Proferrin ES TAB 12 MG, 20

qc aspirin TAB 325MG EC, 30

Prenatal CAP Formula, 35

progesterone CAP 100MG, 14

qc child asa chw 81MG, 30

Prenatal CAP Omega-3, 35

progesterone CAP 200MG, 14

Qc Lancets Mis 28G, 39

Prenatal Mul CAP +dha, 35

progesterone inj 50MG/ML, 14

Qc Lancets Mis 30G, 39

Prenatal MV Mis + DHA, 35

Proglycem Sus 50MG/ML, 15

Qc Lancing Mis Device, 39

Prenatal One TAB Daily, 35

Prolia Sol 60MG/ML, 15

qc laxative TAB 5MG EC, 17

Prenatal TAB, 35

Promacta TAB 12.5MG, 19

qc nicotine gum 4MG, 27

Prenatal TAB 27-0.8MG, 35

Promacta TAB 25MG, 19

Qc Prenatal TAB 28-0.8MG, 36

Prenatal TAB 28-0.8MG, 35


qnapril/hctz TAB 10-12.5, 8

Prenatal TAB Complete, 35


qnapril/hctz TAB 20-12.5, 8

Prenatal TAB Formula, 35

prometh VC sol plain, 33

qnapril/hctz TAB 20-25MG, 8

Prenatal TAB Forte, 35

prometh VC/ syp codeine, 33

Quadracel Inj, 34

Prenatal TAB Iron, 35

prometh/cod syp 6.25-10, 33

quasense TAB, 14

Prenatal TAB Low Iron, 35

prometh/PE syp 6.25-5/5, 33

quetiapine TAB 100MG, 23

Prenatal TAB Multivit, 35

prometh/PE/ syp codeine, 33

quetiapine TAB 150MG ER, 23

Prenatal TAB Plus DHA, 35

promethazine sol 6.25/5ML, 33


Prenatal TAB Vitamins, 35

promethazine sup 12.5MG, 33


Prenatal Vit TAB 28-0.8MG, 36

promethazine sup 25MG, 33


Prenatal Vit TAB Minerals, 35

promethazine sup 50MG, 33


Prenatal/FE TAB, 36

promethazine syp 6.25/5ML, 33


Prenatl Mult CAP + DHA, 36

promethazine syp DM, 33


Prentat Mult CAP Plus DHA, 36

promethazine TAB 12.5MG, 33


Prepidil Gel 0.5MG/3G, 29

promethazine TAB 25MG, 33


Prepopik PAK, 17

promethazine TAB 50MG, 33


prevalite pow 4gm, 9

promethegan sup 12.5MG, 33

Quicktek Liq Solution, 39

prevalite pow 4gm pk, 9

promethegan sup 25MG, 33

quinapril TAB 10MG, 7

previfem TAB, 14

promethegan sup 50MG, 33


Prevnar 13 Inj, 34

propafenone TAB 150MG, 7


Prezcobix TAB 800-150, 3



Prezista Sus 100MG/ML, 3


Quinidine Gl Inj 80MG/ML, 7

Prezista TAB 150MG, 3

Propanthelin TAB 15MG, 18

quinidine gl TAB 324MG CR, 7


proparacaine sol 0.5% op, 29

quinidine gl TAB 324MG ER, 7


Propran/Hctz TAB 40/25, 8

Quinidine SU TAB 200MG, 7


Propran/Hctz TAB 80/25, 8

quinidine SU TAB 300MG, 7

Priftin TAB 150MG, 2

propranolol CAP 120MG ER, 6

Quinidine SU TAB 300MG, 7

prilolid kit 2.5-2.5%, 12


Quinidine SU TAB 300MG ER, 7

priloxx LP kit 2.5-2.5%, 12


quinine sulf CAP 324MG, 3

Primaquine TAB 26.3MG, 3


Quintet Cont Sol Hgh/Norm, 39

primidone TAB 250MG, 25

Propranolol Sol 20MG/5ML, 6

Qvar Aer 40mcg, 33

primidone TAB 50MG, 25

Propranolol Sol 40MG/5ML, 6

Qvar Aer 80mcg, 33

Primsol Sol 50MG/5ML, 4

propranolol TAB 10MG, 6

R

Pro Comfort Mis 31GX8MM, 39


Pro Comfort Mis 32GX4MM, 39


ra aspirin chw 81MG, 30

proben/colch TAB 500-0.5, 32


ra aspirin TAB 325MG, 30

probenecid TAB 500MG, 32


ra aspirin TAB 325MG EC, 30

Procainamide Inj 100MG/ML, 7

propylthiour TAB 50MG, 16

ra aspirin TAB 81MG EC, 30

Procainamide Inj 500MG/ML, 7

Proquad Inj, 34

ra child asa chw 81MG, 30

prochlorper inj 10MG/2ML, 23

Prostin E2 Sup 20MG, 29

Ra E-ZJECT Mis 28G, 39

prochlorper sup 25MG, 23

protriptylin TAB 10MG, 22

Ra E-ZJECT Mis Thin 26G, 39

prochlorper TAB 10MG, 23

protriptylin TAB 5MG, 22

Ra E-ZJECT Mis Thin 28G, 39

prochlorper TAB 5MG, 23

Prudoxin CRE 5%, 11

Ra E-ZJECT Mis Ult Thin, 39

Procrit Inj 10000/ML, 19

pulmosal neb 7%, 33

ra iron TAB 27MG, 20


Pulmozyme Sol 1MG/ML, 34



px aspirin chw 81MG, 30



px aspirin TAB 325MG, 30

ra laxative pow, 17


px aspirin TAB 325MG EC, 30

ra laxative TAB 5MG EC, 17


px aspirin TAB 81MG EC, 30

ra nicotine dis 14MG/24h, 27

procto-MED CRE HC 2.5%, 18

px iron TAB 200MG, 20

ra nicotine dis 21MG/24h, 27

Proctofoam Aer HC 1%, 18

px iron TAB 27MG, 20

ra nicotine dis 7MG/24HR, 27

proctosol HC CRE 2.5%, 18

Px Lancets Mis 28G, 39

ra nicotine gum 2MG, 27

proctozone CRE -HC 2.5%, 18

Px Lancets Mis Ult Thin, 39

ra nicotine gum 2MG cinn, 27

Prodigy Mis 28G, 39

Px Prenatal TAB Multivit, 36

ra nicotine gum 2MG mint, 27

Prodigy Mis Lanc Dev, 39

Pylera CAP, 18

ra nicotine gum 2mgfruit, 27

ra nicotine gum 4MG, 27

Renagel TAB 400MG, 18

Risperdal Inj 12.5MG, 24

ra nicotine gum 4MG frut, 27

Renagel TAB 800MG, 18

Risperdal Inj 25MG, 24

ra nicotine gum 4MG mint, 27

Renvela PAK 0.8gm, 18

Risperdal Inj 37.5MG, 24

ra nicotine loz 2MG mint, 27

Renvela PAK 2.4gm, 18

Risperdal Inj 50MG, 24

ra nicotine loz 4MG mint, 27

Renvela TAB 800MG, 18

risperidone sol 1MG/ML, 23

Ra One Daily Mis, 36

repaglinide TAB 0.5MG, 15

risperidone TAB 0.25MG, 23

Ra Pen Needl Mis 31GX3/16, 39

repaglinide TAB 1MG, 15

risperidone TAB 0.5MG, 23

Ra Prenatal TAB 28-0.8MG, 36

repaglinide TAB 2MG, 15

risperidone TAB 1MG, 23

Ra Prenatal TAB Formula, 36

Replesta Nx Waf 14000unt, 35


ra vitamin CAP 2000unit, 35

Replesta Waf 14000unt, 35


rabeprazole TAB 20MG, 17

Replesta Waf 50000unt, 35


rajani TAB, 14

reprexain TAB 10-200MG, 31

Riteflo Mis, 40

raloxifene TAB 60MG, 15

Rescriptor TAB 100 MG, 3

Rituxan Inj 100MG, 4

ramipril CAP 1.25MG, 7

Rescriptor TAB 200MG, 3

Rituxan Inj 500MG, 4

ramipril CAP 10MG, 7

Rescula Sol 0.15%, 29

rivastigmine CAP 1.5MG, 26

ramipril CAP 2.5MG, 7

Reserpine TAB 0.1MG, 8

rivastigmine CAP 3MG, 26

ramipril CAP 5MG, 7

Reserpine TAB 0.25MG, 8

rivastigmine CAP 4.5MG, 26

Ranexa TAB 1000MG, 6

Restasis Emu 0.05%, 29

rivastigmine CAP 6MG, 26

Ranexa TAB 500MG, 6

Restasis Mul Emu 0.05%, 29

rivelsa TAB, 14

ranitidine syp 150/10ML, 17

Retin-a CRE 0.025%, 10

rizatriptan TAB 10MG, 32

ranitidine syp 15MG/ML, 17


rizatriptan TAB 10MG odt, 32

ranitidine syp 75MG/5ML, 17


rizatriptan TAB 5MG, 32

ranitidine TAB 150MG, 17

Retin-a Gel 0.01%, 10

rizatriptan TAB 5MG odt, 32

ranitidine TAB 300MG, 17

Retin-a Gel 0.025%, 10

ropinirole TAB 0.25MG, 26

Rapaflo CAP 4MG, 19

Retin-a Micr Gel 0.04%, 10

ropinirole TAB 0.5MG, 26

Rapaflo CAP 8MG, 19

Retin-a Micr Gel 0.04%pmp, 10

ropinirole TAB 1MG, 26

Rapamune Sol 1MG/ML, 5

Retin-a Micr Gel 0.1%, 10


rasagiline TAB 0.5MG, 26

Retin-a Micr Gel 0.1%P.M., 10


rasagiline TAB 1MG, 26

Revlimid CAP 10MG, 5


Rasuvo Inj 10MG, 32



Rasuvo Inj 12.5MG, 32

Revlimid CAP 2.5MG, 5

rosadan CRE 0.75%, 10

Rasuvo Inj 15MG, 32


rosadan gel 0.75%, 10



rosanil emu cleanser, 10

Rasuvo Inj 20MG, 32

Revlimid CAP 5MG, 5

rosuvastatin TAB 10MG, 9


revonto inj 20MG, 28


Rasuvo Inj 25MG, 32

Rexulti TAB 0.25MG, 24



Rexulti TAB 0.5MG, 24


Rasuvo Inj 30MG, 32

Rexulti TAB 1MG, 24

Rotarix Sus, 34


Rexulti TAB 2MG, 24

Rotateq Sol, 34

rea LO 40 CRE 40%, 12

Rexulti TAB 3MG, 24

roweepra TAB 1000MG, 25

react TAB 1.5MG, 14

Rexulti TAB 4MG, 24


Rebetol Sol 40MG/ML, 3

Reyataz CAP 150MG, 3


Rebif Inj 22/0.5, 26


Rozerem TAB 8MG, 24

Rebif Inj 44/0.5, 26


S

Rebif Rebido Inj 22/0.5, 26

Reyataz Pow 50MG, 3

Sabril Pow 500MG, 25

Rebif Rebido Inj 44/0.5, 26

ribasphere CAP 200MG, 3

Sabril TAB 500MG, 25

Rebif Rebido Inj Titratn, 26

ribasphere TAB 200MG, 3

Safe-t-pro Mis Lancets, 39

Rebif Titrtn Inj Pack, 26

ribavirin CAP 200MG, 3

Safe-t-pro Mis Plus, 39

reclipsen TAB, 14

ribavirin TAB 200MG, 3

Safety 21G Mis Lancets, 39

Recombiva HB Inj 10mcg/ML, 34

Ridaura CAP 3MG, 32

Safety 28G Mis Lancets, 39

Recombiva HB Inj 5mcg/0.5, 34

rifabutin CAP 150MG, 2

Safety Let Mis Lancets, 39

Recombiva-HB Inj 40mcg/ML, 34

Rifamate CAP, 2

Safety Mis Lancets, 39

Rectiv Oin 0.4%, 18

rifampin CAP 150MG, 2

Safety Seal Mis 28G, 39

Refuah Plus Sol Control, 39

rifampin CAP 300MG, 2

Safety Seal Mis 30G, 39

Regonol Inj 5MG/ML, 28

Rifater TAB, 2

Safyral TAB, 14

relador PAK kit 2.5-2.5%, 12

Right Step TAB Prenatal, 36

salsalate TAB 500MG, 29

relador PAK kit plus, 12

Rightest Liq High CON, 39

salsalate TAB 750MG, 29

Relenza Mis Diskhale, 3

Rightest Liq Norm CON, 39

Samsca TAB 15MG, 16

Relion Lance Mis Stnd 21G, 39

Rightest Mis GD500, 39

Samsca TAB 30MG, 16

Relion Lance Mis Thin 26G, 39

Rightest Mis Gl300, 39

Sandostatin Kit Lar 10MG, 16

Relion Lance Mis Thin 30G, 39

riluzole TAB 50MG, 28


Relion Lanci Mis Device, 39

rimantadine TAB 100MG, 3


Relion Ultra Mis Thin Pls, 39

Riomet Sol, 15

Saphris Sub 10MG, 24

Relistor Inj 12/0.6ML, 18

Riomet Sol 500/5ML, 15

Saphris Sub 5MG, 24

Relistor Inj 8/0.4ML, 18

risedronate TAB 150MG, 15

Sapscare Mis Twist, 39

Relpax TAB 20MG, 32


sash kit 100/ML, 21

Relpax TAB 40MG, 32


Sash Kit 10unt/ML, 21

Remicade Inj 100MG, 18


Savella Mis Titr PAK, 26

Savella TAB 100MG, 26

slow rel FE TAB 160MG CR, 20

Somatuline Inj 120/.5ML, 16

Savella TAB 12.5MG, 26

slow release TAB 143MG, 20

Somatuline Inj 60/0.2ML, 16


slow release TAB 45MG, 20

Somatuline Inj 90/0.3ML, 16


slow release TAB 47.5MG, 20

Somavert Inj 10MG, 16

SB aspirin TAB 325MG, 30

slow release TAB iron 45, 20

Somavert Inj 15MG, 16

SB aspirin TAB 325MG EC, 30

slow-release TAB FE 45MG, 20

Soolantra CRE 1%, 10

SB bisacodyl TAB 5MG EC, 17

sm aspirin chw 81MG, 30

sorine TAB 120MG, 6

SB child asa chw 81MG, 30

sm aspirin TAB 325MG, 30

sorine TAB 160MG, 6

SB Lancets Mis Thin, 39

sm aspirin TAB 325MG EC, 30

sorine TAB 240MG, 6

SB Lancets Mis Ultr Thn, 39

sm aspirin TAB 81MG EC, 30

sorine TAB 80MG, 6

scopolamine dis 1MG/3day, 18

sm child asa chw 81MG, 30

sotalol AF TAB 120MG, 6

Seconal CAP 100MG, 24

sm clearlax pow, 17


Seconal Sod CAP 100MG, 24

sm folic acd TAB 400mcg, 20


selegiline CAP 5MG, 26

sm gentle TAB laxative, 17

sotalol HCL TAB 120MG, 6

selegiline TAB 5MG, 26

sm iron slow TAB 160MG CR, 20


selenium SUL lot 2.5%, 11

sm iron TAB, 20


selenium SUL sha 2.25%, 11

sm iron TAB 325MG, 20


Selenium SUL Sha 2.25%, 11

sm iron TAB 45MG, 20

Sovaldi TAB 400MG, 3

Selzentry Sol 20MG/ML, 3

Sm Lancets Mis 21G, 39

Spectracef TAB 400MG, 1

Selzentry TAB 150MG, 3

Sm Lancets Mis 33G, 39

Spinosad Sus 0.9%, 12


Sm Lancets Mis Thin 26G, 39

Spiriva Aer 1.25mcg, 33


Sm Lancets Mis Thin 30G, 39

Spiriva CAP Handihlr, 33


sm laxative TAB 5MG EC, 17

Spiriva Spr 2.5mcg, 33

Sensipar TAB 30MG, 16

sm nicotine dis 14MG/24h, 27

spirono/hctz TAB 25/25, 9


sm nicotine dis 21MG, 27

spironolact TAB 100MG, 9


sm nicotine dis 21MG/24h, 27


Serevent Dis Aer 50mcg, 33

sm nicotine dis 7MG/24HR, 27


Seroquel XR TAB 150MG, 24

sm nicotine gum 2MG, 27

Sporanox Sol 10MG/ML, 2


sm nicotine gum 2MG mint, 27

sprintec 28 TAB 28 day, 14


sm nicotine gum 4MG, 27

Sprix Spr 15.75MG, 32


sm nicotine gum 4MG mint, 27

Sprycel TAB 100MG, 5


sm nicotine loz 2MG mint, 27

Sprycel TAB 140MG, 5

sertraline CON 20MG/ML, 22

sm nicotine loz 4MG mint, 27

Sprycel TAB 20MG, 5

sertraline TAB 100MG, 22

Sm One Daily Mis Prenatal, 36

Sprycel TAB 50MG, 5


sm prenatal TAB vitamins, 35

Sprycel TAB 70MG, 5


Sm Prenatal TAB Vitamins, 36

Sprycel TAB 80MG, 5

setlakin TAB, 14

sm vitamin d TAB 400unit, 35

SR nicotine gum 2MG, 28

sevelamer pow 0.8gm, 18

Smart Sense Mis Lanc 21G, 39

sronyx TAB, 14

sevelamer pow 2.4gm, 18


st joseph chw low 81MG, 30

sevelamer TAB 800MG, 18


stavudine CAP 15MG, 3

sharobel TAB 0.35MG, 14



Shur-seal Gel 2%, 19

Smartest Mis Lancets, 39


Signifor Inj 0.3MG/ML, 16

Smartest Sol Control, 39



smooth LAX pow, 17

stavudine sol 1MG/ML, 3


smz-tmp DS TAB 800-160, 4

Stelara Inj 45MG/0.5, 11

Signifor Lar Inj 20MG, 16

Smz-tmp Inj 400-80/5, 4

Stelara Inj 90MG/ML, 11


smz-tmp sus 200-40/5, 4

Sterilance Mis 1.8MM, 39


smz-tmp TAB 400-80MG, 4

Sterilance Mis TL 28G, 39

sildenafil TAB 20MG, 9

smz/tmp DS TAB 800-160, 4


Simple Diag Mis Lancing, 39

sod chloride neb 0.9%, 33


simvastatin TAB 10MG, 9

sod citrate sol citr acd, 19

stim laxat TAB 5MG EC, 17


sod SUL/sulf emu 10-5%, 10

Stimate Sol 1.5MG/ML, 16


Sod SUL/Sulf Emu 10-5%, 10

Stiolto Aer 2.5-2.5, 33


sod SUL/sulf lot 10-5%, 10

Stivarga TAB 40MG, 5


Sod SUL/Sulf Lot 10-5%, 10

stop smoking gum 2MG mint, 27

sirolimus TAB 0.5MG, 5

sod sulfacet sha 10%, 11

stop smoking gum 2MG orig, 27

sirolimus TAB 1MG, 5

sod sulfacet sol 10% op, 28

stop smoking gum 4MG, 27

sirolimus TAB 2MG, 5

sodium chlor neb 3%, 33

stop smoking loz 2MG, 27

Sivextro Inj 200MG, 4

sodium chlor neb 7%, 33

stop smoking loz 2MG mint, 27

Sivextro TAB 200MG, 4

sodium chlor sol 0.9% irr, 19

stop smoking loz 4MG mint, 27

Sklice Lot 0.5%, 12

sodium pheny TAB 500MG, 16

Stribild TAB, 3

Skyla Iud 13.5MG, 14

Soft Touch Mis Lancets, 39

Striverdi Aer 2.5mcg, 33

Slow FE TAB 142MG, 20

Softclix Mis Lancets, 39

Stuart One CAP, 36

slow FE TAB 45MG, 20

Solus V2 Mis Lanc 28G, 39

sucralfate TAB 1gm, 17

Slow FE TAB 45MG, 20

Solus V2 Mis Lanc 30G, 39

sulf/pred NA sol op, 28

slow iron TAB 160MG CR, 20

Solus V2 Mis Lanc Dev, 39

Sulfacet Sod Oin 10% Op, 28

slow iron TAB 50MG, 20

Solus V2 Sol High, 39

sulfacet sod sol 10% op, 28

Slow Rel FE TAB 143MG CR, 20

Solus V2 Sol Low, 39

sulfacetamid lot 10%, 10

sulfacetamid sus 10%, 10

tacrolimus CAP 5MG, 5

testosterone gel 1%(25MG), 12

Sulfadiazine TAB 500MG, 2

tacrolimus oin 0.03%, 12

Testosterone Gel 1%(25MG), 12

sulfasalazin TAB 500MG, 18

tacrolimus oin 0.1%, 12

testosterone gel 1%(50MG), 12

sulfasalazin TAB 500MG DR, 18

Tafinlar CAP 50MG, 5

Testosterone Gel 1%(50MG), 13

sulfatrim PD sus 200-40/5, 4

Tafinlar CAP 75MG, 5

testosterone gel P.M. 1%, 12

sulindac TAB 150MG, 32

Tai Doc Sol Norm CON, 39

Testosterone Gel P.M. 1%, 12

sulindac TAB 200MG, 32

take action TAB 1.5MG, 14

Tet/Dip Tox Inj 2-2 LF, 34

sumatriptan inj 4MG/0.5, 32

Tamiflu Sus 6MG/ML, 3

tetrabenazin TAB 12.5MG, 26

sumatriptan inj 6MG/0.5, 32

tamoxifen TAB 10MG, 4

tetrabenazin TAB 25MG, 26

Sumatriptan Inj 6MG/0.5, 32

tamoxifen TAB 20MG, 4

tetracycline CAP 250MG, 2

sumatriptan spr 20MG/act, 32

tamsulosin CAP 0.4MG, 19

Tetracycline CAP 250MG, 2

sumatriptan spr 5MG/act, 32

Tarceva TAB 100MG, 5

tetracycline CAP 500MG, 2

sumatriptan TAB 100MG, 32

Tarceva TAB 150MG, 5

Tetracycline CAP 500MG, 2


Tarceva TAB 25MG, 5

tgt aspirin chw 81MG, 30


Targretin CAP 75MG, 5

tgt aspirin chw child, 30

Super Daily Dro D3, 35

tarina FE TAB 1/20, 14

tgt aspirin TAB 325MG, 30

Super Thin Mis Lanc 28G, 39

Tasigna CAP 150MG, 5

tgt aspirin TAB 81MG, 30

Super Thin Mis Lancets, 39

Tasigna CAP 200MG, 5

tgt aspirin TAB 81MG EC, 30

Supracil CRE, 12

Taytulla CAP, 14

Tgt Lancet Mis 23G, 39

Suprax CAP 400MG, 1

tazarotene CRE 0.1%, 11


Suprax Sus 500/5ML, 1

tazicef inj 1gm, 1


Supreme II Liq High/Low, 39

Tazicef Inj 1gm, 1


Suprep Bowel Sol Prep Kit, 17

Tazicef Inj 2gm, 1


Sure Comfort Mis 29GX1/2", 39

Tazorac CRE 0.05%, 11

Tgt Lancet Mis Alternat, 39

Sure Comfort Mis 30GX5/16, 39

Tazorac CRE 0.1%, 11

Tgt Lancing Mis Adv Dev, 39


Tazorac Gel 0.05%, 11

Tgt Lancing Mis Device, 39


Tazorac Gel 0.1%, 11

tgt nicotine dis 14MG/24h, 27

Sure Comfort Mis Lanc Pen, 39

Techlite AST Mis Lancets, 39

tgt nicotine dis 21MG/24h, 27

Sure Comfort Mis Lancets, 39

Techlite Mis Lanc 30G, 39

tgt nicotine dis 7MG/24HR, 27

Sure-fine Mis 29GX1/2", 39

Techlite Mis Lancets, 39

tgt nicotine gum 2MG mint, 27

Sure-fine Mis 31GX3/16, 39

Tegretol-XR TAB 100MG, 25

tgt nicotine gum 2MG orig, 27

Sure-fine Mis 31GX5/16, 39

Tekturna TAB 150MG, 8

tgt nicotine gum 2mgfruit, 27

Sure-lance Mis 26G, 39

Tekturna TAB 300MG, 8

tgt nicotine gum 4MG, 27

Sure-lance Mis Lancets, 39

Telcare Sol Level1/2, 39

tgt nicotine gum 4MG mint, 27

Sure-pen Mis, 39

telmis/amlod TAB 40-10MG, 8

tgt nicotine gum 4MG orig, 27

Sure-touch Mis Unv Lanc, 39


tgt nicotine loz 2MG chry, 27

Sureflex Mis Lancets, 39


tgt nicotine loz 2MG mint, 27

Surestep Glu Sol, 39


tgt nicotine loz 4MG chry, 27

Surestep Glu Sol High/Low, 39

telmisa/hctz TAB 40-12.5, 8

tgt nicotine loz 4MG mint, 27

Surestep Pro Tes High CON, 39

telmisa/hctz TAB 80-12.5, 8

Thalomid CAP 100MG, 5

Surestep Pro Tes Low CON, 39

telmisa/hctz TAB 80-25MG, 8


Surestep Pro Tes Norm CON, 39

telmisartan TAB 20MG, 7


Surestep Sol Control, 39



Survanta Inh, 34


theochron TAB 100MG CR, 33

Sustiva CAP 200MG, 3

temazepam CAP 15MG, 24


Sustiva CAP 50MG, 3

temazepam CAP 30MG, 24


Sustiva TAB 600MG, 3

temazepam CAP 7.5MG, 24

theophylline sol 80/15ML, 33

Sutent CAP 12.5MG, 5

temozolomide CAP 100MG, 4

theophylline TAB 100MG CR, 33

Sutent CAP 25MG, 5


theophylline TAB 100MG ER, 33

Sutent CAP 37.5MG, 5


theophylline TAB 200MG CR, 33

Sutent CAP 50MG, 5



sw clearlax pow, 17



sw nicotine gum 2MG mint, 27



sw nicotine gum 4MG, 27

Tencon TAB 50-325MG, 29


sw nicotine loz 2MG mint, 27

Tenivac Inj 5-2LF, 34


sw nicotine loz 4MG mint, 27

terazosin CAP 10MG, 8

thera-d sprt TAB 2000unit, 35

syeda TAB 3-0.03MG, 14


thera-d TAB 2000unit, 35

Symlinpen 60 Inj 1000mcg, 14


Thera-d TAB 4000unit, 35

Symlnpen 120 Inj 1000mcg, 14


Thin Lancets Mis, 39

Synalar CRE 0.025%, 11

terbinafine TAB 250MG, 2

Thin Lancets Mis 26G, 39

Synalar Oin 0.025%, 11

terbutaline TAB 2.5MG, 33

Thin Lancets Mis 30G, 39

Synarel Sol 2MG/ML, 16

terbutaline TAB 5MG, 33

thioridazine TAB 100MG, 23

Synera Dis 70-70MG, 12

terconazole CRE 0.4%, 19


T

terconazole CRE 0.8%, 19


terconazole sup 80MG, 19


Tabloid TAB 40MG, 4

testost cyp inj 100MG/ML, 12

thiothixene CAP 10MG, 23

Taclonex Sus, 12

testost cyp inj 200MG/ML, 12


tacrolimus CAP 0.5MG, 5

testost enan inj 200MG/ML, 12


tacrolimus CAP 1MG, 5


tranex acid inj 1000MG, 21

trinessa LO TAB, 14

thrive gum 2MG mint, 27

tranex acid inj 100MG/ML, 21

trinessa TAB, 14

Thrombin-jmi Kit 20000unt, 21

tranex acid TAB 650MG, 21

Triumeq TAB, 3

Thrombin-jmi Sol 20000unt, 21

tranexamic inj 100MG/ML, 21

trivora-28 TAB, 14

Thyrolar-1 TAB 60MG, 16

Transderm-sc Dis 1.5MG, 18

Tropicamide Pow, 29

Thyrolar-1/2 TAB 30MG, 16

tranylcyprom TAB 10MG, 22

tropicamide sol 0.5% op, 29

Thyrolar-1/4 TAB 15MG, 16

Travatan Z Dro 0.004%, 29

tropicamide sol 1% op, 29


Travel Lance Mis 30G, 39

trospium chl CAP 60MG ER, 19


Travoprost Dro 0.004%, 29

trospium CL TAB 20MG, 19

tiagabine TAB 2MG, 25

trazodone TAB 100MG, 22

True Metrix Sol Level 1, 39

tiagabine TAB 4MG, 25



Tier Uni Pls Mis 31GX8MM, 39



tilia FE TAB, 14


Truecontrol Liq Level 0, 39

timolol gel sol 0.25% op, 28

Trecator TAB 250MG, 2

Truecontrol Liq Level 1, 39

timolol gel sol 0.5% op, 28

tretinoin CAP 10MG, 5

Truedraw Mis Lanc Dev, 39

timolol mal sol 0.25% op, 28

tretinoin CRE 0.025%, 10

Truetest Liq Level 1, 39

timolol mal sol 0.5% op, 28



Timolol Mal TAB 10MG, 6




tretinoin gel 0.01%, 10

Trumenba Inj, 34



Truplus Lanc Mis 26G, 39

Tivicay TAB 10MG, 3



Tivicay TAB 25MG, 3

tretinoin gel 0.04%pmp, 10


Tivicay TAB 50MG, 3



tizanidine TAB 2MG, 28

tretinoin gel 0.1%P.M., 10

Truvada TAB 100-150, 3

tizanidine TAB 4MG, 28

tri femynor TAB, 14


tobra/dexame sus 0.3-0.1%, 28

tri-estaryll TAB, 14


Tobradex Oin 0.3-0.1%, 29

tri-legest TAB FE, 14


tobramycin neb 300/5ML, 2

tri-linyah TAB, 14

tussigon TAB 5-1.5MG, 33

Tobramycin Neb 300/5ML, 2

tri-LO TAB estaryll, 14

Twinrix Inj, 34

tobramycin sol 0.3% op, 28

tri-LO- TAB marzia, 14

Tybost TAB 150MG, 3

Tobrex Oin 0.3% Op, 28

tri-LO- TAB sprintec, 14

Tykerb TAB 250MG, 5

Today Sponge Mis, 19

tri-previfem TAB, 14

Tysabri Inj 300/15ML, 28

Tolazamide TAB 250MG, 15

tri-sprintec TAB, 14

Tyvaso Refil Sol 0.6MG/ML, 9

Tolazamide TAB 500MG, 15

triamcinolon CRE 0.025%, 11

Tyvaso Sol 0.6MG/ML, 9

Tolbutamide TAB 500MG, 15


Tyvaso Start Sol 0.6MG/ML, 9

tolcapone TAB 100MG, 26


Tyzeka TAB 600MG, 3

tolmetin sod CAP 400MG, 32

triamcinolon lot 0.025%, 11

U

Tolmetin Sod CAP 400MG, 32

triamcinolon lot 0.1%, 11

Ulesfia Lot 5%, 12

Tolmetin Sod TAB 200MG, 32

triamcinolon oin 0.025%, 11

Uloric TAB 40MG, 32

Tolmetin Sod TAB 600MG, 32


Uloric TAB 80MG, 32

tolterodine CAP 2MG ER, 19


Ulti-lance Mis CLR Tip, 39

tolterodine CAP 4MG ER, 19

triamcinolon pst den 0.1%, 21

Ultilet Mis 26G, 39

tolterodine TAB 1MG, 19

triamt/hctz CAP 37.5-25, 9

Ultilet Mis 28G, 39

tolterodine TAB 2MG, 19

Triamt/Hctz CAP 50-25MG, 9

Ultilet Mis 30G, 39

topiramate CAP 15MG, 25

triamt/hctz TAB 37.5-25, 9

Ultilet Mis 33G, 39

topiramate CAP 25MG, 25

triamt/hctz TAB 75-50MG, 9

Ultilet Mis Lancets, 39

topiramate TAB 100MG, 25

Triazolam TAB 0.125MG, 24

Ultilet Mis Safety, 39


triazolam TAB 0.25MG, 24

Ultra Thin Mis 28G, 39


triderm CRE 0.1%, 11



triderm CRE 0.5%, 11


torsemide TAB 100MG, 9

Tridesilon CRE 0.05%, 11



trifluoperaz TAB 10MG, 23

Ultra Thin Mis Lanc 26G, 39







Toviaz TAB 4MG, 19


Ultra Thin Mis Lancets, 39

Toviaz TAB 8MG, 19

trifluridine sol 1% op, 28

Ultralance Mis 1.8MM, 40

Tracleer TAB 125MG, 9

trihexyphen elx 0.4MG/ML, 26

Ultratrk Pro Sol, 40

Tracleer TAB 62.5MG, 9

trihexyphen TAB 2MG, 26

Ultratrk Pro Sol High/Low, 40

Tradjenta TAB 5MG, 15

trihexyphen TAB 5MG, 26

Ultratrk Ult Sol High/Low, 40

tramadl/apap TAB 37.5-325, 31

triklo CAP 1gm, 9

Unifine Pntp Mis 29GX1/2", 40

Tramadol HCL CAP 150MG ER, 31

trilyte sol, 17

Unifine Pntp Mis 29GX12MM, 40

tramadol HCL TAB 100MG ER, 31

trimethobenz CAP 300MG, 18

Unifine Pntp Mis 31GX3/16, 40


trimethoprim sol polymyxn, 28

Unifine Pntp Mis 31GX5/16, 40


trimethoprim TAB 100MG, 4


tramadol HCL TAB 50MG, 31

trimipramine CAP 100MG, 22


trandolapril TAB 1MG, 7





Unilet Cmfr Mis Tch 28G, 40


Trimpex Sol 50MG/5ML, 4

Unilet Cmfr Mis Tch 30G, 40

Unilet EX II Mis 28G, 40

Vanatol LQ Sol, 29

Vigamox Dro 0.5%, 28

Unilet Excel Mis 23G, 40

Vanatol S Sol, 29

Viibryd Kit Starter, 23

Unilet G.p Mis Supr 23G, 40

vancomycin 250/5ML, 4

Viibryd TAB 10MG, 23

Unilet G.p. Mis 21G, 40

vancomycin CAP 125MG, 4


Unilet GP 28 Mis Ult Thin, 40

vancomycin CAP 250MG, 4


Unilet Lance Mis 21G, 40

vancomycin inj 1 gm, 4

viorele TAB, 14

Unilet Lanct Mis 28G, 40

vancomycin inj 1000MG, 4

Viracept TAB 250MG, 3


vancomycin inj 10gm, 4

Viracept TAB 625MG, 3



Viread Pow 40MG/Gm, 3

Unilet Mis 21G, 40

vancomycin inj 5gm, 4

Viread TAB 150MG, 3

Unilet Super Mis 23G, 40


Viread TAB 200MG, 3

Unilet Super Mis G.p. 23G, 40

vandazole gel 0.75%, 19

Viread TAB 250MG, 3

Unistik 1 Mis 2.4MM, 40

Vantage Lanc Mis Device, 40

Viread TAB 300MG, 3


Vaqta Inj 25/0.5ML, 34

virtrate-2 sol, 19

Unistik 2 Mis, 40

Vaqta Inj 50unt/ML, 34

virtrate-2 sol 500-334, 19


Varivax Inj, 34

virtrate-3 sol, 19

Unistik 2 Mis Comfort, 40

Vascepa CAP 0.5gm, 9

virtrate-k sol 1100-334, 19

Unistik 2 Mis Extra, 40

Vascepa CAP 1gm, 9

vit d child chw 1000unit, 35

Unistik 2 Mis Neonatal, 40

vcf vaginal aer contracp, 19

vit d gummie chw 400unit, 35

Unistik 2 Mis Normal, 40

Vcf Vaginal Aer Contracp, 19

Vit D3 Drops Liq 400unit, 35

Unistik 2 Mis Super, 40

vcf vaginal gel contrace, 19

vit d3 gumm chw 1000unit, 35

Unistik 3 Mis Comfort, 40

Vcf Vaginal Mis Contracp, 19

vitajoy daly chw d 1000iu, 35

Unistik 3 Mis Extra, 40

Vectical Oin 3mcg/Gm, 11

Vitamelts D TAB 1000 Iu, 35

Unistik 3 Mis Gent 30G, 40

velivet PAK, 14

vitamin d CAP 1000unit, 35

Unistik 3 Mis Neonatal, 40

Veltin Gel, 10


Unistik 3 Mis Normal, 40

venlafaxine CAP 150MG ER, 22


Unistik CZT Mis Comfort, 40

venlafaxine CAP 37.5 ER, 22

vitamin d CAP 50000unt, 34

Unistik CZT Mis Normal, 40

venlafaxine CAP 75MG ER, 22

vitamin d chw 1000unit, 35

unith direct TAB 75mcg, 16

venlafaxine TAB 100MG, 22

vitamin d chw 400unit, 35

unithroid TAB 75mcg, 16


vitamin d dro 400unit, 35

Universal 1 Mis Lanc 26G, 40

venlafaxine TAB 37.5MG, 22

vitamin d TAB 1000unit, 35

Universal 1 Mis Lanc 30G, 40



Upspringbaby Dro Vit D3, 35



Uptravi TAB 1000mcg, 9

Ventavis Sol 10mcg/ML, 10

vitamin d TAB 5000iu, 35


Ventavis Sol 20mcg/ML, 10

vitamin d-3 CAP 1000unit, 35


Ventolin HFA Aer, 33

vitamin d-3 CAP 2000unit, 35


verapamil CAP 100MG ER, 7

vitamin d-3 TAB 1000unit, 35

Uptravi TAB 200/800, 9




verapamil CAP 120MG SR, 7




vitamin d3 CAP 10000unt, 35



vitamin d3 CAP 1000unit, 35




ur n-c TAB, 19


Vitamin D3 CAP 4000unit, 35

urea CRE 40%, 12



uretron d/s TAB, 19


vitamin d3 CAP 50000unt, 35

urin d/s TAB, 19



ursodiol CAP 300MG, 18

verapamil inj 2.5MG/ML, 7

vitamin d3 chw 1000unit, 35

ursodiol TAB 250MG, 18

verapamil TAB 120MG, 7


ursodiol TAB 500MG, 18

verapamil TAB 120MG ER, 7


utira-c TAB, 19



utrona-c TAB, 19


Vitamin D3 Chw 5000unit, 35

V


vitamin d3 dro 400unit, 35


vitamin d3 dro 5000unit, 35

valacyclovir TAB 1gm, 3

Verasens Liq Level 1, 40

Vitamin D3 Liq 1000unit, 35

valacyclovir TAB 500MG, 3

vercolate TAB 5MG EC, 17

Vitamin D3 Liq 1200unit, 35

valganciclov sol 50MG/ML, 3

Veregen Oin 15%, 12

Vitamin D3 Spr 1000unit, 35

valganciclov TAB 450MG, 3

Verrunex CRE, 12

Vitamin D3 TAB 10000unt, 35

valproic acd CAP 250MG, 25

Vesicare TAB 10MG, 19

vitamin d3 TAB 1000unit, 35

valproic acd sol 250/5ML, 25

Vesicare TAB 5MG, 19


valsart/hctz TAB 160-12.5, 8

vestura TAB 3-0.02MG, 14

Vitamin D3 TAB 3000unit, 35

valsart/hctz TAB 160-25MG, 8

Vexol Sus 1% Op, 29



Victory Sol Control, 40

vitamin d3 TAB 50000uni, 35

valsart/hctz TAB 320-25MG, 8

Victoza Inj 18MG/3ML, 14

vitamin d3 TAB 50000unt, 35


Victrelis CAP 200MG, 3


valsartan TAB 160MG, 8

Videx Sol 2gm, 3

Vitamin D3 TAB 5000unit, 35


Videx Sol 4gm, 3

Vitamin K1 Inj 10MG/ML, 34


vienva TAB 0.1-20, 14

vitamin k1 inj 1MG/0.5, 34


vigabatrin PAK 500MG, 25

Voltaren Gel 1%, 11

Valvd Holdng Mis Chamber, 40

voriconazole sus 40MG/ML, 2

zaleplon CAP 10MG, 24

voriconazole TAB 200MG, 2

zaleplon CAP 5MG, 24

voriconazole TAB 50MG, 2

zarah TAB 3-0.03MG, 14

Vortex Valve Mis Chamber, 40

Zarxio Inj 300/0.5, 20

Votrient TAB 200MG, 5

Zarxio Inj 480/0.8, 20

Vpriv Inj 400unit, 20

Zavesca CAP 100MG, 20

vyfemla TAB 0.4-35, 14

zazole CRE 0.8%, 19

Vyvanse CAP 10MG, 25

zazole sup 80MG, 19


zebutal CAP, 29


Zelboraf TAB 240MG, 5


zenatane CAP 10MG, 10







Vyvanse Chw 10MG, 25

zenchent FE chw 0.4MG-35, 14


zenchent TAB, 14


Zenpep CAP 10000unt, 18







W

Zenpep CAP 3000unit, 18


warfarin TAB 10MG, 21

Zenpep CAP 5000unit, 18


zenzedi TAB 10MG, 24

warfarin TAB 2.5MG, 21

zenzedi TAB 5MG, 24


Ziagen Sol 20MG/ML, 3


zidovudine CAP 100MG, 3


zidovudine syp 50MG/5ML, 3


zidovudine TAB 300MG, 3


zileuton ER TAB 600MG, 33

warfarin TAB 7.5MG, 21

Zioptan Dro 0.0015%, 29

Watchhaler Mis, 40

ziprasidone CAP 20MG, 23

wee care sus 15/1.25, 20


Welchol PAK 3.75gm, 9


Welchol TAB 625MG, 9


wera TAB 0.5/35, 14

Zirgan Gel 0.15%, 28

womans laxat TAB 5MG EC, 17

Zoledronic Inj 4MG, 15

womens laxat TAB 5MG EC, 17

zoledronic inj 4MG/5ML, 15

wymzya FE chw 0.4MG-35, 14

Zolinza CAP 100MG, 5

X

zolmitriptan TAB 2.5 MG, 32

zolmitriptan TAB 2.5MG, 32

Xalkori CAP 200MG, 5

zolmitriptan TAB 5MG, 32

Xalkori CAP 250MG, 5

zolpidem TAB 10MG, 24

Xarelto Star TAB 15/20MG, 21

zolpidem TAB 5MG, 24

Xarelto TAB 10MG, 21

Zomig Spr 2.5MG, 32


Zomig Spr 5MG, 32


Zonalon CRE 5%, 11

Xeljanz TAB 5MG, 32

zonisamide CAP 100MG, 25

Xeljanz XR TAB 11MG, 32


Xgeva Inj, 15


Xifaxan TAB 200MG, 4

Zostavax Inj, 34

Xifaxan TAB 550MG, 4

zovia 1/35e TAB, 14

Xigduo XR TAB 10-1000, 15

zovia 1/50e TAB, 14

Xigduo XR TAB 10-500MG, 15

Zydelig TAB 100MG, 5


Zydelig TAB 150MG, 5


Zykadia CAP 150MG, 5

Xiidra Dro 5%, 29

Zytiga TAB 250MG, 5

Xtandi CAP 40MG, 5

Zytiga TAB 500MG, 5

Xulane Dis 150-35, 14

1

xylon TAB 10-200MG, 31

Xyrem Sol 500MG/ML, 26

1ST Choice Mis Lancets, 40

Y

1ST Tier Uni Mis 29GX12MM, 40


yl folic aci TAB 400mcg, 20


Your Life CAP Prenatal, 36


yuvafem TAB 10mcg, 19

Z

zafirlukast TAB 10MG, 33

zafirlukast TAB 20MG, 33

Kaiser Permanente Nondiscrimination Notice and Language Access Services

KAISER PERMANENTE NONDISCRIMINATION NOTICE

Kaiser Foundation Health Plan of Washington and Kaiser Foundation Health Plan of Washington Options, Inc. (“Kaiser Permanente”) comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, or gender identity. Kaiser Permanente does not exclude people or treat them differently because of race, color, national origin, age, disability, sex, sexual orientation, or gender identity.

Kaiser Permanente: Provides free aids and services to people with disabilities to communicate effectively with us, such as: • Qualified sign language interpreters • Written information in other formats (large print, audio, accessible electronic formats, other formats)

Provides free language services to people whose primary language is not English, such as: • Qualified interpreters • Information written in other languages

If you need these services, contact Kaiser Permanente Member Services.

If you believe that Kaiser Permanente has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, sex, sexual orientation, or gender identity, you can file a grievance by phone, mail, fax, or email. If you need help filing a grievance, a Kaiser Permanente Member Services Representative is available to help you. Language assistance is provided free of charge. The Kaiser Permanente Civil Rights Coordinator will be notified of all grievances related to discrimination on the basis of race, color, national origin, age, disability, sex, sexual orientation, or gender identity.

Phone: 206-630-4636 Toll-free: 1-888-901-4636

TTY Washington Relay Service: 1-800-833-6388 or 711 TTY Idaho Relay Service: 1-800-377-3529 or 711

Fax: 206-901-6205 or toll-free 1-888-874-1765 Address: Kaiser Foundation Health Plan of Washington

Civil Rights Coordinator, Quality GNE-D1E-07 P.O. Box 9812 Renton, WA 98057-9054

Email: [email protected] You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/ lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services 200 Independence Avenue SW., Room 509F HHH Building Washington, DC 20201 1-800-368-1019, 800-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html For Medicare Advantage Plans Only: Kaiser Permanente is an HMO plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal.

© 2017 Kaiser Foundation Health Plan of Washington H5050_XB0001444_55_17 accepted 2017-XB-6_ACA_Notice_Taglines

mailto:[email protected]

http://www.hhs.gov/ocr/office/file/index.html

LANGUAGE ACCESS SERVICES

English: ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-888-901-4636 (TTY: 1-800-833-6388 or 711).

Español (Spanish): ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-888-901-4636 (TTY: 1-800-833-6388 / 711).

中文 (Chinese)：注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-888-901-4636 (TTY: 1-800-833-6388 / 711)。

Tiếng Việt (Vietnamese): CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-888-901-4636 (TTY: 1-800-833-6388 / 711).

한국어(Korean): 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-888-901-4636 (TTY: 1-800-833-6388 / 711) 번으로 전화해 주십시오.

Русский (Russian): ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-888-901-4636 (телетайп: 1-800-833-6388 / 711).

Filipino (Tagalog): PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-888-901-4636 (TTY: 1-800-833-6388 / 711).

Українська (Ukrainian): УВАГА! Якщо ви розмовляєте українською мовою, ви можете звернутися до безкоштовної служби мовної підтримки. Телефонуйте за номером 1-888-901-4636 (телетайп: 1-800-833-6388 / 711).

ភាសាខ្មែរ (Khmer)៖ របយ័ត៖ េ េបើសិនអកនិខ្យមរ, េ សជំនួខ្យផក េ យមិនគិតល គឺចនសំប់បំេ រអក។ ចូរទូ រស័ព 1-888-901-4636 (TTY: 1-800-833-6388 / 711)។ 日本語 (Japanese): 注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。 1-888-901-4636 (TTY: 1-800-833-6388 / 711) まで、お電話にてご連絡ください。

አማርኛ (Amharic) ፥ ማስታወሻ: የሚናገሩት ቋንቋ ኣማርኛ ከሆነ የትርጉም እርዳታ ድርጅቶች፣ በነጻ ሊያግዝዎት ተዘጋጀተዋል፡ ወደ ሚከተለው ቁጥር ይደውሉ 1-888-901-4636 (መስማት ለተሳናቸው: 1-800-833-6388 / 711).

Oromiffa (Oromo): XIYYEEFFANNAA: Afaan dubbattu Oroomiffa, tajaajila gargaarsa afaanii, kanfaltiidhaan ala, ni argama. Bilbilaa 1-888-901-4636 (TTY: 1-800-833-6388 / 711).

ਪੰਜਾਬੀ (Punjabi) ਧਿਆਨ ਧਿਓ: ਜੇ ਤੁਸੀਂ ਪੰਜਾਬੀ ਬੋਲਿ ੇਹੋ, ਤਾਂ ਭਾਸਾ ਧ ਿੱ ਚ ਸਹਾਇਤਾ ਸੇ ਾ ਤੁਹਾਡੇ ਲਈ ਮੁਫਤ ਉਪਲਬਿ ਹੈ। 1-888-901-4636 (TTY: 1-800-833-6388 / 711) ‘ਤੇ ਕਾਲ ਕਰੋ।

تتوافر اللغوية المساعدة خدمات فإن اللغة، اذكر تتحدث كنت إذا :ملحوظة في ومعلومات مساعدة على الحصول حق لديكم :(Arabic) العربية : (6388-833-800-1 / 711) .والبكم الصم هاتف رقم 4636-901-888-1 برقم اتصل .بالمجان لك

Deutsch (German): ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-888-901-4636 (TTY: 1-800-833-6388 / 711).

ພາສາລາວ (Lao): ໂປດຊາບ: ຖ້າວ່າ ທ່ານເວ ້ າພາສາລາວ, ການບໍ ລິ ການຊ່ວຍເຫ ຼື ອດ້ານພາສາ, ໂດຍບໍ່ ເສັຽຄ່າ, ແມ່ນມີ ພ້ອມ ໃຫ້ທ່ານ. ໂທຣ 1-888-901-4636 (TTY: 1-800-833-6388 / 711).

Srpsko-hrvatski (Serbo-Croatian): OBAVJEŠTENJE: Ako govorite srpsko-hrvatski, usluge jezičke pomoći dostupne su vam besplatno. Nazovite 1-888-901-4636 (TTY- Telefon za osobe sa oštećenim govorom ili sluhom: 1-800-833-6388 / 711).

Français (French): ATTENTION: Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Appelez le 1-888-901-4636 (ATS: 1-800-833-6388 / 711).

Română (Romanian): ATENȚIE: Dacă vorbiți limba română, vă stau la dispoziție servicii de asistență lingvistică, gratuit. Sunați la 1-888-901-4636 (TTY: 1-800-833-6388 / 711).

Adamawa (Fulfulde): MAANDO: To a waawi Adamawa, e woodi ballooji-ma to ekkitaaki wolde caahu. Noddu 1-888-901-4636 (TTY: 1-800-833-6388 / 711).

می فراهم شما برای رايگان بصورت زبانی تسهيالت کنيد، می گفتگو فارسی زبان به اگر :توجه :(Farsi) فارسی .بگيريد تماس (TTY: 1-800-833-6388 / 711) 4636-901-888-1 با .باشد

XB0001444-55-17

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