2018 - trusted hpintroduction trusted health plan is pleased to provide an updated 2018 medicaid...

Trusted Health Plan FormularyVersion 19; E�ective 10/22/18

2018

Introduction ...................................................................................................................................................................................................................................................................................................................................................................................................6The Trusted Health Plan Pharmacy and Therapeutics Committee (P&T) ......................................................................................................................................6Notice .........................................................................................................................................................................................................................................................................................................................................................................................................6Preface ........................................................................................................................................................................................................................................................................................................................................................................................................6Product Selection Criteria .............................................................................................................................................................................6Formulary Components ...................................................................................................................................................................................6Generic Substitution ...................................................................................................................................................................................6Covered Medications without Authorization ..............................................................................................................................................................6Non-Covered Benefits ...................................................................................................................................................................................7Prior Authorization ....................................................................................................................................................................................7Step Therapy ...........................................................................................................................................................................................7Specialty Medications ..................................................................................................................................................................................7Quantity Limits ........................................................................................................................................................................................7Benefit Exception ......................................................................................................................................................................................7Pharmacy Benefit Management ............................................................................................................................................................................7Prior Authorization Information ........................................................................................................................................................................8Acne Therapy ...........................................................................................................................................................................................18Agents for Opioid Withdrawal ...........................................................................................................................................................................19Alcoholism Treatment Agents ............................................................................................................................................................................19Analgesic, Anti-inflammatory or Antipyretic - Non-Opioid ...............................................................................................................................................19Analgesics - Opioid ....................................................................................................................................................................................21Angina Therapy .........................................................................................................................................................................................24Anorectal - Glucocorticoids ............................................................................................................................................................................25Anorectal Combinations .................................................................................................................................................................................25Anterior Pituitary Hormones and Hormone Antagonists ....................................................................................................................................................25Anti-Infective - Immunologic Adjuvants .................................................................................................................................................................26Antianxiety Agents .....................................................................................................................................................................................26Antiarrhythmics ........................................................................................................................................................................................27Antibacterial Agents ...................................................................................................................................................................................28Anticoagulants .........................................................................................................................................................................................32Anticonvulsants ........................................................................................................................................................................................32Antidepressants ........................................................................................................................................................................................35Antidiarrheals .........................................................................................................................................................................................37Antiemetics ............................................................................................................................................................................................37Antifungals ............................................................................................................................................................................................38Antihemophilic Factor Agents ...........................................................................................................................................................................38Antihistamines .........................................................................................................................................................................................39Antihyperlipidemics ....................................................................................................................................................................................40Antihypertensive Therapy Agents ........................................................................................................................................................................41Antineoplastic - Alkylating Agents .....................................................................................................................................................................45Antineoplastic - Antibody/Antibody-Drug Complexes ......................................................................................................................................................45Antineoplastic - Antimetabolites .......................................................................................................................................................................45Antineoplastic - Hedgehog Pathway Inhibitor ............................................................................................................................................................46Antineoplastic - Hormone/Hormone Antagonist Agents .....................................................................................................................................................46Antineoplastic - Immunomodulators ......................................................................................................................................................................47Antineoplastic - Mast Cell Stabilizers .................................................................................................................................................................47Antineoplastic - Metal Complexes .......................................................................................................................................................................47Antineoplastic - Retinoids and Retinoid Receptor Agonists ..............................................................................................................................................47Antineoplastic - Systemic Enzyme Inhibitors ............................................................................................................................................................47Antineoplastic - Topoisomerase Inhibitors ..............................................................................................................................................................48Antiparasitics .........................................................................................................................................................................................48Antiparkinson Therapy ..................................................................................................................................................................................48Antiprotozoal-Antibacterial Agents .....................................................................................................................................................................50Antipsychotics (Neuroleptics) ..........................................................................................................................................................................50Antitussives ...........................................................................................................................................................................................52Antivirals .....................................................................................................................................................................................................................................................................................................................................................................................................52Appetite Stimulants ....................................................................................................................................................................................53Asthma/COPD Therapy Agents .............................................................................................................................................................................53Attention Deficit-Hyperact Disorder (ADHD) Therapy .....................................................................................................................................................55Beta Adrenergic Blockers ...............................................................................................................................................................................56Bipolar Therapy Agents .................................................................................................................................................................................57Blood Albumin and Plasma Proteins ......................................................................................................................................................................58Bradykinin B2 Receptor Antagonists .....................................................................................................................................................................58Calcium and Bone Metabolism Regulators .................................................................................................................................................................58Calcium Channel Blockers and Combinations ..............................................................................................................................................................58Cardiac Inotropes ......................................................................................................................................................................................59Cardiovascular Sympathomimetics and Combinations .......................................................................................................................................................60

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Chelating Agents .......................................................................................................................................................................................60Chemotherapy Rescue-Antidote Agents ....................................................................................................................................................................60CNS Stimulants .........................................................................................................................................................................................60Cognitive Disorder Therapy - Antidementia ..............................................................................................................................................................61Colonic Acidifier (Ammonia Inhibitor) ..................................................................................................................................................................61Contraceptives Implant .................................................................................................................................................................................61Contraceptives Injectable ..............................................................................................................................................................................61Contraceptives Intravaginal ............................................................................................................................................................................61Contraceptives Oral ....................................................................................................................................................................................62Contraceptives Transdermal .............................................................................................................................................................................66Corticosteroids ........................................................................................................................................................................................66Cystic Fibrosis Therapy Agents .........................................................................................................................................................................67Dental-Periodontal Products ............................................................................................................................................................................67Dermatological - Anti-infectives .......................................................................................................................................................................67Dermatological - Antineoplastic or Premalignant Lesions ................................................................................................................................................68Dermatological - Antiparasitics and Combinations .......................................................................................................................................................68Dermatological - Antipruritics .........................................................................................................................................................................68Dermatological - Antipsoriatics ........................................................................................................................................................................68Dermatological - Antiseborrheic Products and Combinations ..............................................................................................................................................68Dermatological - Burn Products .........................................................................................................................................................................68Dermatological - Emollients and Combinations ...........................................................................................................................................................68Dermatological - Glucocorticoids and Combinations ......................................................................................................................................................68Dermatological - Immunomodulating Agents ...............................................................................................................................................................70Dermatological - Immunosuppressive Agents ..............................................................................................................................................................70Dermatological - Keratolytics-Antimitotics .............................................................................................................................................................71Dermatological - NSAID’s ...............................................................................................................................................................................71Dermatological - Rosacea Therapy .......................................................................................................................................................................71Dermatological - Topical Local Anesthetics and Combinations ............................................................................................................................................71Diabetic Therapy .......................................................................................................................................................................................71Diagnostic Drugs - In Vivo .............................................................................................................................................................................73Digestive Aids .........................................................................................................................................................................................73Diuretics ......................................................................................................................................................................................................................................................................................................................................................................................................74Emergency Contraceptives and Combinations ..............................................................................................................................................................75Erectile Dysfunction (ED) Drugs-Sel.cGMP Phosphodiesterase Type5 Inhib .................................................................................................................................75Estrogens and Combinations .............................................................................................................................................................................75Gallstone Solubilizing (Litholysis) Agents and Combinations ............................................................................................................................................76Gastrointestinal Antispasmodics ........................................................................................................................................................................76Gastrointestinal Prokinetic Agents .....................................................................................................................................................................76General Anesthetics ....................................................................................................................................................................................76General Injectable Solutions and Diluents ..............................................................................................................................................................77Genitourinary Irrigants ................................................................................................................................................................................77Hematopoietic Agents ...................................................................................................................................................................................77Hepatic Hormones (Hormones Secreted by the Liver) ......................................................................................................................................................78Hyperuricemia Therapy ..................................................................................................................................................................................78Immunosuppressive - Calcineurin Inhibitors .............................................................................................................................................................78Immunosuppressive - Inosine Monophosphate Dehydrogenase Inhibitors .....................................................................................................................................78Immunosuppressive - Mammalian Target of Rapamycin (mTOR) Inhibitors ....................................................................................................................................79Immunosuppressive - Purine Analogs .....................................................................................................................................................................79Inflammatory Bowel Agents ..............................................................................................................................................................................79Interstitial Cystitis Agents ...........................................................................................................................................................................79Irrigation Solutions ...................................................................................................................................................................................79Irritable Bowel Syndrome (IBS) Agents ..................................................................................................................................................................79Laxatives ......................................................................................................................................................................................................................................................................................................................................................................................................79Local Anesthetics - Parenteral .........................................................................................................................................................................80Medical Supplies and DME - Respiratory Therapy .........................................................................................................................................................81Metabolic Disease Enzyme Replacement, Gaucher’s Disease ................................................................................................................................................83Migraine Therapy .......................................................................................................................................................................................83Minerals and Electrolytes ..............................................................................................................................................................................84Mouth and Throat - Anti-infectives .....................................................................................................................................................................84Mouth and Throat - Glucocorticoids .....................................................................................................................................................................85Mouth and Throat - Local Anesthetics ...................................................................................................................................................................85Mouth and Throat - Xerostomia Therapy ..................................................................................................................................................................85Mucolytics .............................................................................................................................................................................................85Multiple Sclerosis Agent - Interferons .................................................................................................................................................................85Multiple Sclerosis Agent - Potassium Channel Blocker ...................................................................................................................................................85Musculoskeletal Therapy Agents .........................................................................................................................................................................85Narcolepsy and Cataplexy Therapy Agents ................................................................................................................................................................86

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Nasal Preparations .....................................................................................................................................................................................86Neuromuscular Therapy Agents ...........................................................................................................................................................................86Ophthalmic - Anti-allergy ..............................................................................................................................................................................86Ophthalmic - Anti-infectives ...........................................................................................................................................................................87Ophthalmic - Anti-inflammatory .........................................................................................................................................................................87Ophthalmic - Intraocular Pressure Reducing Agents ......................................................................................................................................................87Ophthalmic - Mydriatics and Cycloplegics ...............................................................................................................................................................88Ophthalmic Combinations ................................................................................................................................................................................88Opioid Reversal Agents - Opioid Antagonists ............................................................................................................................................................88Otic (Ear) - Anti-infectives ...........................................................................................................................................................................88Otic (Ear) - Combinations ..............................................................................................................................................................................88Oxytocics ..............................................................................................................................................................................................89Passive Immunizing Agents ..............................................................................................................................................................................89Peptic Ulcer Therapy ...................................................................................................................................................................................89Pharmaceutical Adjuvants ...............................................................................................................................................................................90Phosphate Binders ......................................................................................................................................................................................90Platelet Aggregation Inhibitors and Combinations .......................................................................................................................................................90Posterior Pituitary Hormones ...........................................................................................................................................................................90Progestins .............................................................................................................................................................................................90Prostatic Hypertrophy Agents ...........................................................................................................................................................................91Pseudobulbar Affect (PBA) Agents .......................................................................................................................................................................91Respiratory Combinations ...............................................................................................................................................................................91Sedative-Hypnotics .....................................................................................................................................................................................91Sickle Cell Anemia Agents ..............................................................................................................................................................................92Smoking Deterrents and Combinations ....................................................................................................................................................................92Thyroid Therapy ........................................................................................................................................................................................92Urinary Analgesics .....................................................................................................................................................................................94Urinary Anti-infectives ................................................................................................................................................................................94Urinary Antispasmodics .................................................................................................................................................................................94Urinary pH Modifiers ...................................................................................................................................................................................95Urinary Retention Therapy ..............................................................................................................................................................................95Vaginal Anti-infectives ................................................................................................................................................................................95Vaginal Estrogens ......................................................................................................................................................................................95Vitamin Combinations ...................................................................................................................................................................................95Vitamins .......................................................................................................................................................................................................................................................................................................................................................................................................96Wound Care Therapy .....................................................................................................................................................................................96Acne Therapy ...........................................................................................................................................................................................97Analgesic, Anti-inflammatory or Antipyretic - Non-Opioid ...............................................................................................................................................97Anorectal - Hemorrhoidal Single Agents Other ...........................................................................................................................................................105Anorectal Combinations .................................................................................................................................................................................106Antacids and Combinations ..............................................................................................................................................................................106Antidiarrheals .........................................................................................................................................................................................109Antiemetics ............................................................................................................................................................................................112Antihistamines .........................................................................................................................................................................................113Antiseptic - Biguanides ................................................................................................................................................................................119Antitussives ...........................................................................................................................................................................................119Artificial Tears and Lubricants ........................................................................................................................................................................119Chemicals - Solvents ...................................................................................................................................................................................120Dermatological - Anti-infectives .......................................................................................................................................................................120Dermatological - Antiparasitics and Combinations .......................................................................................................................................................123Dermatological - Antipruritics .........................................................................................................................................................................124Dermatological - Astringents and Combinations ..........................................................................................................................................................124Dermatological - Emollients and Combinations ...........................................................................................................................................................124Dermatological - Glucocorticoids and Combinations ......................................................................................................................................................125Dermatological - Irritants-Counter-Irritants ...........................................................................................................................................................126Dermatological - Keratolytics-Antimitotics .............................................................................................................................................................126Diabetic Therapy .......................................................................................................................................................................................128Dietary Products .......................................................................................................................................................................................128Digestive Aids .........................................................................................................................................................................................128Emergency Contraceptives and Combinations ..............................................................................................................................................................129Expectorants ...........................................................................................................................................................................................129Gastrointestinal Antiflatulents and Combinations .......................................................................................................................................................130Irrigation Solutions ...................................................................................................................................................................................132Laxatives ..............................................................................................................................................................................................132Medical Supplies and DME - Diabetic Supplies ...........................................................................................................................................................139Medical Supplies and DME - GI-GU Ostomy and Irrigation Supplies ........................................................................................................................................163Medical Supplies and DME - Thermometers ................................................................................................................................................................163

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Minerals and Electrolytes ..............................................................................................................................................................................163Mouth and Throat - Non-Opioid Antitussive - Local Anesthetic Combos ....................................................................................................................................169Nasal Preparations .....................................................................................................................................................................................169Nutritional Product - Nutritional Therapy ..............................................................................................................................................................169Ophthalmic - Anti-allergy ..............................................................................................................................................................................169Ophthalmic - Hyperosmolar Agents .......................................................................................................................................................................170Peptic Ulcer Therapy ...................................................................................................................................................................................170Respiratory Combinations ...............................................................................................................................................................................172Sedative-Hypnotics .....................................................................................................................................................................................175Smoking Deterrents and Combinations ....................................................................................................................................................................176Urinary Analgesics .....................................................................................................................................................................................178Vaginal Anti-infectives ................................................................................................................................................................................179Vitamin Combinations ...................................................................................................................................................................................180Vitamins ...............................................................................................................................................................................................188

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IntroductionTrusted Health Plan is pleased to provide an updated 2018 Medicaid Formulary as a referenceand informational tool for physicians, pharmacists and patients. The Trusted Health PlanFormulary is designed to assist practitioners in selecting clinically appropriate and cost-effectiveproducts for their patients.

The Trusted Health Plan Pharmacy and Therapeutics Committee (P&T)The medications on this formulary have been reviewed by the Trusted Health Plan PharmacyP&T Committee. The Committee includes physicians, pharmacists and health professionals. Theclinical information within the formulary is primarily derived from medical literature and isreviewed and approved by the P&T Committee.

NoticeThe information contained in this formulary is provided by Trusted Health Plan, solely for theconvenience of medical providers. This formulary is not intended to be a substitute for theknowledge, expertise, skill and judgment of the medical provider in their choice of prescriptiondrugs. Trusted Health Plan assumes no responsibility for the actions or omissions of any medicalprovider based upon reliance, in whole or in part, on the information contained herein. Themedical provider should consult the drug manufacturer’s product literature or standardreferences for more detailed information.

PrefaceThe Trusted Health Plan formulary is organized by sections. Each section includes therapeuticgroups identified by either drug class or disease state. Products are listed by generic name.Brand and common names are included as a reference to assist in product recognition. TrustedHealth Plan will not cover prescription drugs that are prescribed for experimental, investigationalor non FDA approved indications, dosages, or routes of administration. Trusted Health Plan doesnot cover any medication excluded by District of Columbia Medicaid (https://dc.fhsc.com/downloads/providers/dcrx_pdl_listing.pdf).

Product Selection CriteriaThe MeridianRx P&T Committee considers clinical information on new to market drugs that aretypically included in an outpatient pharmacy benefit. The primary goal of the MeridianRx P&TCommittee is to preserve and evaluate the Trusted Health Plan formulary based upon anobjective analysis of the safety, efficacy, approved indications, adverse effects, contraindications,patient administration/compliance considerations and cost effectiveness. When a new drug isconsidered for formulary inclusion, it will be reviewed relative to similar drugs currently includedin the Trusted Health Plan Formulary. Formulary decisions are communicated quarterly on theTrusted Health Plan website. Therapeutic substitution occurs when a preferred drug is approvedfor use because it has similar treatment effects but is not identical to a nonpreferred drug.

Formulary ComponentsThe Trusted Health Plan Formulary contains the following components: Covered medicationswithout authorization, medications that must meet Step Therapy Protocol, medications thatrequire Prior Authorization, Specialty medications and medications that are subject to QuantityLimits. Members will not be charged a co-pay when Trusted Health Plan covers a medication.

Generic SubstitutionTrusted Health Plan is a mandatory generic plan. The brand and common names listed in theformulary are for reference only. Generic medication will be dispensed where available.

Covered Medications without AuthorizationTrusted Health Plan covers many medications without any authorization required. Thesemedications include many prescription and over-the-counter medications (when ordered by aphysician).

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Non-Covered BenefitsThe following categories are not covered benefits: Medications used for cosmetic purposes, topromote fertility, for sexual dysfunction, for experimental or investigational purposes, ormedications that are not licensed for use in the United States.

Prior AuthorizationDrugs indicated with "PA" require Prior Authorization for coverage. Details of the PA criteria arelisted next to the drug name. Please call the MeridianRx Help Desk at 855-323-4588 or fax acompleted Prior Authorization form to 855-323-4586. All requests must be accompanied bypertinent clinical information and are reviewed within 72 hours.

Step TherapyDrugs indicated with a "ST" require Step Therapy for coverage. The required step is listed next tothe drug name. Step Therapy ensures clinically appropriate and cost-effective drugs are usedbefore other alternatives.

Specialty MedicationsAll specialty medications noted as "SP" are handled by MeridianRx. To order a specialtymedication by fax, send the prescription and a completed prior authorization form to 855-323-4586 or call MeridianRx’s Help Desk at 855-323-4588.

Quantity LimitsDrugs indicated with a "QL" have a set quantity limit imposed. These limits are based on FDArecommended dosing guidelines. The quantity limit is listed next to the drug name. Allmedications are subject to a maximum of 30 days per prescription.

Benefit ExceptionThe process for requesting non formulary medication(s) requires faxing of a completedFormulary Exception form indicating the request for an exception to the formulary. This requestwill need to include pertinent clinical documentation showing trial and failure of all formularyagents. It should also contain information showing the medication is the standard of care for theindication provided (Peer reviewed journal articles may be required). Please call the MeridianRxHelp Desk at 855-323-4588 or fax a completed Formulary Exception form to 855-323-4586.

Pharmacy Benefit ManagementTrusted Health Plan utilizes MeridianRx to manage each member’s pharmacy benefit.MeridianRx provides Trusted Health Plan with a pharmacy network, pharmacy claimsmanagement services, and claims adjudication. MeridianRx’s Help Desk can be contacted at855-323-4588.

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Prior Authorization Information

8

Agents for Opioid Withdrawal

Medication Info Common Name Drug Status Criteria

BUPRENORPHINE-NALOXONE 8-2 MGSL FILM

BUPRENORPHINE-NALOXONE PA Prior Authorization required

SUBOXONE 12 MG-3 MG SL FILM SUBOXONE PA Prior Authorization required

SUBOXONE 2 MG-0.5 MG SL FILM SUBOXONE PA Prior Authorization required



Alcoholism Treatment Agents


VIVITROL 380 MG VIAL VIVITROL PA

VIVITROL 380 MG VIAL + DILUENT VIVITROL PA

Analgesic, Anti-inflammatory or Antipyretic - Non-Opioid


BENLYSTA 120 MG VIAL BENLYSTA PA Prior Authorization required


ENBREL 25 MG KIT ENBREL PA Prior Authorization required

ENBREL 25 MG/0.5 ML SYRINGE ENBREL PA Prior Authorization required

ENBREL 50 MG/ML SURECLICK SYR ENBREL SURECLICK PA Prior Authorization required

ENBREL 50 MG/ML SYRINGE ENBREL PA Prior Authorization required

KINERET 100 MG/0.67 ML SYRINGE KINERET PA Prior Authorization required

Analgesics - Opioid


ACETAMINOPHEN-COD #3 TABLET ACETAMINOPHEN-CODEINE PA,QL


ACETAMINOPHEN-CODEINE 120 MG-12 MG/5 ML SOLUTION

ACETAMINOPHEN-CODEINE PA,QL

ACETAMINOPHEN-CODEINE 120-12MG/5 ML


FENTANYL 100 MCG/HR PATCH FENTANYL PA,QL





HYDROCODONE-ACETAMINOPHEN 5-300 MG TABLET

HYDROCODONE-ACETAMINOPHEN

PA,QL



PA,QL

HYDROMORPHONE 0.5 MG/0.5 ML HYDROMORPHONE HCL PA,QL

HYDROMORPHONE 1 MG/MLSOLUTION

HYDROMORPHONE HCL PA,QL

HYDROMORPHONE 2 MG/MLCARPUJCT


HYDROMORPHONE 2 MG/MLISECURE


HYDROMORPHONE 4 MG TABLET HYDROMORPHONE HCL PA,QL

HYDROMORPHONE 5 MG/5 ML SOLN HYDROMORPHONE HCL PA,QL


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Analgesics - Opioid


HYDROMORPHONE HCL ER 12 MGTAB

HYDROMORPHONE ER PA,QL







LORCET 5-325 MG TABLET LORCET PA,QL

LORTAB 5-325 MG TABLET LORTAB PA,QL

MORPHINE 100 MG/10 ML VIAL MORPHINE SULFATE PA,QL

MORPHINE 15 MG/ML VIAL MORPHINE SULFATE PA,QL


MORPHINE SULF 10 MG SUPPOS MORPHINE SULFATE PA,QL


MORPHINE SULF CR 100 MG TABLET MORPHINE SULFATE CR PA,QL


MORPHINE SULF ER 100 MG TABLET MORPHINE SULFATE ER PA,QL





MORPHINE SULFATE 10 MG/ML VIAL MORPHINE SULFATE PA,QL




MORPHINE SULFATE ER 10 MG CAP MORPHINE SULFATE ER PA,QL











NORCO 5-325 TABLET NORCO PA,QL

OXYCODONE HCL 15 MG TABLET OXYCODONE HCL PA,QL



OXYCODONE-ACETAMINOPHEN 5-325 MG/5 ML SOLUTION

OXYCODONE-ACETAMINOPHEN

PA,QL

TRAMADOL HCL ER 100 MG CAPSULE TRAMADOL HCL ER PA,QL


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Analgesics - Opioid


TRAMADOL HCL ER 100 MG TABLET TRAMADOL HCL ER PA,QL Limited to 30 Tablets per 25 days


ULTRAM ER 300 MG TABLET ULTRAM ER PA,QL Limited to 30 Tablets per 25 days

VICODIN 5-300 MG TABLET VICODIN PA,QL

XODOL 5-300 TABLET XODOL 5-300 PA,QL

Anterior Pituitary Hormones and Hormone Antagonists


LUPRON DEPOT 11.25 MG(LUPANETA)

LUPRON DEPOT (LUPANETA) PA Prior Authorization Required

LUPRON DEPOT 11.25 MG 3MO KIT LUPRON DEPOT PA Prior Authorization Required

LUPRON DEPOT 3.75 MG (LUPANETA) LUPRON DEPOT (LUPANETA) PA Prior Authorization Required

LUPRON DEPOT 3.75 MG KIT LUPRON DEPOT PA Prior Authorization Required

LUPRON DEPOT-PED 11.25 MG 3MOKIT

LUPRON DEPOT-PED PA Prior Authorization required

LUPRON DEPOT-PED 11.25 MG KIT LUPRON DEPOT-PED PA Prior Authorization required

LUPRON DEPOT-PED 15 MG KIT LUPRON DEPOT-PED PA Prior Authorization required

LUPRON DEPOT-PED 30 MG 3MO KIT LUPRON DEPOT-PED PA Prior Authorization required


Anti-Infective - Immunologic Adjuvants


ACTIMMUNE 100 MCG/0.5 ML VIAL ACTIMMUNE PA,SP Prior Authorization required

Antibacterial Agents


THALOMID 100 MG CAPSULE THALOMID PA Prior Authorization Required




Anticonvulsants


ONFI 10 MG TABLET ONFI PA Prior Authorization Required


Antidepressants


CYMBALTA 20 MG CAPSULE CYMBALTA PA,QL Prior Authorization required; limited to 60capsules per 30 days



Antihemophilic Factor Agents


ADVATE 2,401-3,600 UNIT VIAL ADVATE PA Prior Authorization required

ALPHANATE 1,000-400 UNIT VIAL ALPHANATE PA Prior Authorization required


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ALPHANATE 250-100 UNIT VIAL ALPHANATE PA Prior Authorization required


ALPHANINE SD 1,000 UNIT VIAL ALPHANINE SD PA Prior Authorization required


ALPHANINE SD 500 UNIT VIAL ALPHANINE SD PA Prior Authorization required

BENEFIX 1,000 UNIT RANGE BENEFIX PA Prior Authorization required


BENEFIX 250 UNIT RANGE BENEFIX PA Prior Authorization required



FEIBA NF 1,000 UNIT (NOMINAL) FEIBA NF PA Prior Authorization required


FEIBA NF 500 UNIT (NOMINAL) FEIBA NF PA Prior Authorization required

HELIXATE FS 3,000 UNITS VIAL HELIXATE FS PA Prior Authorization required

HEMOFIL M 1,000 UNIT NOMINAL HEMOFIL M PA Prior Authorization required


HEMOFIL M 250 UNIT NOMINAL HEMOFIL M PA Prior Authorization required


KOGENATE FS 3,000 UNIT-BIOSET KOGENATE FS PA Prior Authorization required

KOGENATE FS 3,000 UNITS VIAL KOGENATE FS PA Prior Authorization required

KOVALTRY 3,000 UNIT KIT KOVALTRY PA Prior Authorization required

KOVALTRY 3,000 UNIT VIAL KOVALTRY PA Prior Authorization required

MONONINE 1,000 UNIT VIAL MONONINE PA Prior Authorization required

NOVOSEVEN RT 1 MG VIAL NOVOSEVEN RT PA Prior Authorization required




RECOMBINATE 1,241-1,800 UNIT V RECOMBINATE PA Prior Authorization required


RECOMBINATE 220-400 UNIT VIAL RECOMBINATE PA Prior Authorization required


RECOMBINATE 801-1,240 UNIT VL RECOMBINATE PA Prior Authorization required

RIXUBIS 1,000 UNIT NOMINAL RIXUBIS PA Prior Authorization required


RIXUBIS 250 UNIT NOMINAL RIXUBIS PA Prior Authorization required



Antihyperlipidemics


JUXTAPID 10 MG CAPSULE JUXTAPID PA Prior Authorization required



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Antihyperlipidemics



Antihypertensive Therapy Agents


LETAIRIS 10 MG TABLET LETAIRIS PA Prior Authorization required


Antineoplastic - Alkylating Agents


TEMODAR 100 MG CAPSULE TEMODAR PA Prior Authorization Required

TEMODAR 140 MG CAPSULE TEMODAR PA,QL Prior Auhtorization required; Limited to90 capsules per 30 days

TEMODAR 180 MG CAPSULE TEMODAR PA,QL Prior Authorization required; limited to 60capsules per 30 days

TEMODAR 20 MG CAPSULE TEMODAR PA,QL Prior Authorization Required; limited to120 capsules per 30 days


TEMODAR 5 MG CAPSULE TEMODAR PA,QL Prior Authorization required; Limited to90 capsules per 30 days

TEMOZOLOMIDE 100 MG CAPSULE TEMOZOLOMIDE PA Prior Authorization required






Antineoplastic - Antibody/Antibody-Drug Complexes


PERJETA 420 MG/14 ML VIAL PERJETA PA Prior Authorization required

Antineoplastic - Antimetabolites


CAPECITABINE 150 MG TABLET CAPECITABINE PA Prior Authorization required


XELODA 150 MG TABLET XELODA PA Prior Authorization required


Antineoplastic - Hedgehog Pathway Inhibitor


ERIVEDGE 150 MG CAPSULE ERIVEDGE PA Prior Authorization required

Antineoplastic - Hormone/Hormone Antagonist Agents


ELIGARD 22.5 MG SYRINGE B ELIGARD PA Prior Authorization Required

ELIGARD 22.5 MG SYRINGE KIT ELIGARD PA Prior Authorization Required

ELIGARD 30 MG SYRINGE B ELIGARD PA Prior Authorization Required

ELIGARD 30 MG SYRINGE KIT ELIGARD PA Prior Authorization Required



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LEUPROLIDE 1 MG/0.2 ML VIAL LEUPROLIDE ACETATE PA Prior Authorization Required

LEUPROLIDE 2WK 1 MG/0.2 ML KIT LEUPROLIDE ACETATE PA Prior Authorization Required

LEUPROLIDE 2WK 14 MG/2.8 ML KT LEUPROLIDE ACETATE PA Prior Authorization Required

LEUPROLIDE 2WK 14 MG/2.8 ML VL LEUPROLIDE ACETATE PA Prior Authorization Required


LUPRON DEPOT 45 MG 6MO KIT LUPRON DEPOT PA Prior Authorization Required


LUPRON DEPOT-4 MONTH KIT LUPRON DEPOT PA Prior Authorization Required

TRELSTAR 11.25 MG SYRINGE TRELSTAR PA Prior Authorization Required

TRELSTAR 11.25 MG VIAL TRELSTAR PA Prior Authorization Required





XTANDI 40 MG CAPSULE XTANDI PA Prior Authorization Required

ZOLADEX 10.8 MG IMPLANT SYRN ZOLADEX PA Prior Authorization Required


Antineoplastic - Systemic Enzyme Inhibitors


BOSULIF 100 MG TABLET BOSULIF PA Prior Authorization required


COMETRIQ 100 MG DAILY-DOSE PK COMETRIQ PA Prior Authorization required


COMETRIQ 60 MG DAILY-DOSE PACK COMETRIQ PA Prior Authorization required

GLEEVEC 100 MG TABLET GLEEVEC PA,QL Prior Authorization required; Limited to120 tablets per 30 days


ICLUSIG 15 MG TABLET ICLUSIG PA Prior Authorization required


IMATINIB MESYLATE 100 MG TAB IMATINIB MESYLATE PA,QL Prior Authorization required; Limited to120 tablets per 30 days


JAKAFI 10 MG TABLET JAKAFI PA Prior Authorization required






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TARCEVA 100 MG TABLET TARCEVA QL,SP Prior Authorization required; Limited to30 tablets per 30 days



XALKORI 200 MG CAPSULE XALKORI PA Prior Authorization required


ZELBORAF 240 MG TABLET ZELBORAF PA Prior Authorization required

Antineoplastic - Topoisomerase Inhibitors


HYCAMTIN 0.25 MG CAPSULE HYCAMTIN PA Prior Authorization Required

HYCAMTIN 1 MG CAPSULE HYCAMTIN PA Prior Authorization Required

Antivirals


APTIVUS 100 MG/ML SOLUTION APTIVUS PA Prior Authorization required

APTIVUS 250 MG CAPSULE APTIVUS PA Prior Authorization required

EPCLUSA 400 MG-100 MG TABLET EPCLUSA PA,SP Prior Authorization required

HEPSERA 10 MG TABLET HEPSERA PA Prior Authorization required

MAVYRET 100-40 MG TABLET MAVYRET PA,SP Prior Authorization required

PEGASYS 180 MCG/0.5 ML SYRINGE PEGASYS PA Prior Authorization Required

PEGASYS 180 MCG/ML VIAL PEGASYS PA Prior Authorization Required

PEGASYS PROCLICK 135 MCG/0.5 ML PEGASYS PROCLICK PA Prior Authorization Required

PEGASYS PROCLICK 180 MCG/0.5 PEGASYS PROCLICK PA Prior Authorization Required

PEGINTRON 50 MCG KIT PEGINTRON REDIPEN PA Prior Authorization Required

PEGINTRON REDIPEN 120 MCG PEGINTRON REDIPEN PA Prior Authorization Required



REBETOL 40 MG/ML SOLUTION REBETOL PA Prior Authorization required

RIBAVIRIN 200 MG CAPSULE RIBAVIRIN PA Prior Authorization required

RIBAVIRIN 200 MG TABLET RIBAVIRIN PA Prior Authorization required

RIBAVIRIN 6 GM INHALATION VIAL RIBAVIRIN PA Prior Authorization required

TRUVADA 100 MG-150 MG TABLET TRUVADA PA,SP Prior Authorization required




Asthma/COPD Therapy Agents


XOLAIR 150 MG VIAL XOLAIR PA Prior Authorization required

Bipolar Therapy Agents


ABILIFY 10 MG TABLET ABILIFY PA Prior Authorization required



15







Blood Albumin and Plasma Proteins


CINRYZE 500 UNIT VIAL CINRYZE PA Prior Authorization required

Bradykinin B2 Receptor Antagonists


FIRAZYR 30 MG/3 ML SYRINGE FIRAZYR PA Prior Authorization required

Calcium and Bone Metabolism Regulators


FORTEO 600 MCG/2.4 ML PEN INJ FORTEO PA Prior Authorization required

Chelating Agents


EXJADE 125 MG TABLET EXJADE PA Prior Authorization required



Cystic Fibrosis Therapy Agents


KALYDECO 150 MG TABLET KALYDECO PA Prior Authorization required

TOBI 300 MG/5 ML SOLUTION TOBI PA Prior Authorization required

TOBI PODHALER 28 MG INHALE CAP TOBI PODHALER PA Prior Authorization required

Diabetic Therapy


BYDUREON 2 MG VIAL BYDUREON PA Prior Authorization required

Hematopoietic Agents


ARANESP 100 MCG/0.5 ML SYRINGE ARANESP PA Prior Authorization required

ARANESP 100 MCG/ML VIAL ARANESP PA Prior Authorization required


ARANESP 150 MCG/0.75 ML VIAL ARANESP PA Prior Authorization required



ARANESP 25 MCG/0.42 ML SYRING ARANESP PA Prior Authorization required






ARANESP 500 MCG/1 ML SYRINGE ARANESP PA Prior Authorization required



16




EPOGEN 10,000 UNITS/ML VIAL EPOGEN PA Prior Authorization required


EPOGEN 20,000 UNITS/2 ML VIAL EPOGEN PA Prior Authorization required




NEULASTA 6 MG/0.6 ML SYRINGE NEULASTA PA Prior Authorization required

NEUPOGEN 300 MCG/0.5 ML SYR NEUPOGEN PA Prior Authorization required

NEUPOGEN 300 MCG/ML VIAL NEUPOGEN PA Prior Authorization required


NEUPOGEN 480 MCG/1.6 ML VIAL NEUPOGEN PA Prior Authorization required

NPLATE 250 MCG VIAL NPLATE PA Prior Authorization required


PROCRIT 10,000 UNITS/ML VIAL PROCRIT PA Prior Authorization required






Hepatic Hormones (Hormones Secreted by the Liver)


INCRELEX 40 MG/4 ML VIAL INCRELEX PA Prior Authorization required

Inflammatory Bowel Agents


HUMIRA 20 MG/0.4 ML SYRINGE HUMIRA PA Prior Authorization required

HUMIRA 40 MG/0.8 ML PEN HUMIRA PEN PA Prior Authorization required


HUMIRA PED CROHNS 40 MG/0.8 ML HUMIRA PEDIATRIC CROHN’S PA Prior Authorization required

HUMIRA PEN CROHN-UC-HSSTARTER 40 MG/0.8 ML

HUMIRA PEN CROHN-UC-HSSTARTER

PA Prior Authorization required

HUMIRA PEN PSORIASIS-UVEITISSTARTER 40 MG/0.8 ML

HUMIRA PEN PSORIASIS-UVEITIS


REMICADE 100 MG VIAL REMICADE PA Prior Authorization required

Metabolic Disease Enzyme Replacement, Gaucher’s Disease


CEREZYME 400 UNITS VIAL CEREZYME PA Prior Authorization required

Mucolytics


PULMOZYME 1 MG/ML AMPUL PULMOZYME PA Prior Authorization required


17

Multiple Sclerosis Agent - Interferons


BETASERON 0.3 MG KIT BETASERON PA Prior Authorization required

BETASERON 0.3 MG VIAL BETASERON PA Prior Authorization required

EXTAVIA 0.3 MG KIT EXTAVIA PA Prior Authorization required

EXTAVIA 0.3 MG VIAL EXTAVIA PA Prior Authorization required

REBIF 22 MCG/0.5 ML SYRINGE REBIF PA Prior Authorization required


REBIF REBIDOSE 22 MCG/0.5 ML REBIF REBIDOSE PA Prior Authorization required


REBIF REBIDOSE TITRATION PACK REBIF REBIDOSE PA Prior Authorization required

REBIF TITRATION PACK REBIF PA Prior Authorization required

Multiple Sclerosis Agent - Potassium Channel Blocker


AMPYRA ER 10 MG TABLET AMPYRA PA Prior Authorization required

DALFAMPRIDINE ER 10 MG TABLET DALFAMPRIDINE ER PA Prior Authorization required

Musculoskeletal Therapy Agents


GENVISC 850 25 MG/2.5 ML SYR GENVISC 850 PA Prior Authorization required

HYALGAN 20 MG/2 ML SYRINGE HYALGAN PA Prior Authorization required

HYALGAN 20 MG/2 ML VIAL HYALGAN PA Prior Authorization required

SUPARTZ FX 25 MG/2.5 ML SYR SUPARTZ FX PA Prior Authorization required

SYNVISC SYRINGE SYNVISC PA Prior Authorization required

SYNVISC-ONE SYRINGE SYNVISC-ONE PA Prior Authorization required

TRIVISC 25 MG/2.5 ML SYR TRIVISC PA Prior Authorization required

VISCO-3 25 MG/2.5 ML SYR VISCO-3 PA Prior Authorization required

Passive Immunizing Agents


CYTOGAM 2.5 GM/50 ML VIAL CYTOGAM PA Prior Authorization required

HYPERRHO S-D 1,500 UNIT SYRING HYPERRHO S-D PA Prior Authorization required

RHOGAM ULTRA-FILTERED PLUSSYR

RHOGAM ULTRA-FILTEREDPLUS


SYNAGIS 100 MG/1 ML VIAL SYNAGIS PA Prior Authorization required

SYNAGIS 50 MG/0.5 ML VIAL SYNAGIS PA Prior Authorization required

Progestins


HYDROXYPROGEST 250 MG/ML VIAL HYDROXYPROGESTERONECAPROATE


Pseudobulbar Affect (PBA) Agents


NUEDEXTA 20-10 MG CAPSULE NUEDEXTA PA Prior Authorization required

2018 Trusted Health Plan Medicaid Formulary

18

Acne Therapy


ABSORICA 10 MG CAPSULE ABSORICA




ADAPALENE 0.1% CREAM ADAPALENE

ADAPALENE 0.1% GEL ADAPALENE

ADAPALENE 0.1% LOTION ADAPALENE

ADAPALENE 0.1% SOLUTION ADAPALENE

ADAPALENE 0.3% GEL ADAPALENE

ADAPALENE 0.3% GEL PUMP ADAPALENE

AMNESTEEM 10 MG CAPSULE AMNESTEEM



BENZOYL PEROX 4% CREAMY WASH BENZOYL PEROXIDE

CLARAVIS 10 MG CAPSULE CLARAVIS




CLINDAMYCIN PH 1% GEL CLINDAMYCIN PHOSPHATE

CLINDAMYCIN PH 1% SOLUTION CLINDAMYCIN PHOSPHATE

CLINDAMYCIN PHOS 1% PLEDGET CLINDAMYCIN PHOSPHATE

CLINDAMYCIN PHOSP 1% LOTION CLINDAMYCIN PHOSPHATE

CLINDAMYCIN PHOSPHATE 1% FOAM CLINDAMYCIN PHOSPHATE

CLINDAMYCIN PHOSPHATE 1% GEL CLINDAMYCIN PHOSPHATE

DAPSONE 5% GEL DAPSONE

ERYTHROMYCIN 2% GEL ERYTHROMYCIN

ERYTHROMYCIN 2% PLEDGETS ERYTHROMYCIN

ERYTHROMYCIN 2% SOLUTION ERYTHROMYCIN

ISOTRETINOIN 10 MG CAPSULE ISOTRETINOIN




METRONIDAZOLE 0.75% CREAM METRONIDAZOLE

METRONIDAZOLE 0.75% LOTION METRONIDAZOLE

MYORISAN 10 MG CAPSULE MYORISAN




NORITATE 1% CREAM NORITATE

SODIUM SULFACETAMIDE 10% LOTN SULFACETAMIDE SODIUM

SULFACETAMIDE SOD 10% TOPSUSP

SULFACETAMIDE SODIUM

SULFACETAMIDE-SULFUR 8-4%SUSP

SODIUM SULFACETAMIDE-SULFUR


19

Acne Therapy


TRETINOIN 0.01% GEL TRETINOIN

TRETINOIN 0.025% CREAM TRETINOIN





ZENATANE 10 MG CAPSULE ZENATANE




Agents for Opioid Withdrawal


BUPRENORPHINE-NALOXONE 8-2 MGSL FILM

BUPRENORPHINE-NALOXONE PA Prior Authorization required


SUBOXONE 2 MG-0.5 MG SL FILM SUBOXONE PA Prior Authorization required



Alcoholism Treatment Agents


DISULFIRAM 250 MG TABLET DISULFIRAM

DISULFIRAM 500 MG TABLET DISULFIRAM

VIVITROL 380 MG VIAL VIVITROL PA

VIVITROL 380 MG VIAL + DILUENT VIVITROL PA





BUTALB-ACETAMIN-CAFF 50-300-40 BUTALBITAL-ACETAMINOPHEN-CAFFE

QL

BUTALB-ASPIRIN-CAFFE 50-325-40 BUTALBITAL-ASPIRIN-CAFFEINE

QL

CELEBREX 100 MG CAPSULE CELEBREX




CELECOXIB 100 MG CAPSULE CELECOXIB




DICLOFENAC SOD DR 25 MG TAB DICLOFENAC SODIUM



DICLOFENAC SOD EC 25 MG TAB DICLOFENAC SODIUM


20





DICLOFENAC SOD ER 100 MG TAB DICLOFENAC SODIUM ER

DIFLUNISAL 500 MG TABLET DIFLUNISAL

ENBREL 25 MG KIT ENBREL PA Prior Authorization required

ENBREL 25 MG/0.5 ML SYRINGE ENBREL PA Prior Authorization required

ENBREL 50 MG/ML SURECLICK SYR ENBREL SURECLICK PA Prior Authorization required

ENBREL 50 MG/ML SYRINGE ENBREL PA Prior Authorization required

IBUPROFEN 100 MG/5 ML SUSP IBUPROFEN

IBUPROFEN 400 MG TABLET IBUPROFEN



KETOPROFEN 25 MG CAPSULE KETOPROFEN



KETOPROFEN ER 200 MG CAPSULE KETOPROFEN

KETOROLAC 10 MG TABLET KETOROLAC TROMETHAMINE

KETOROLAC 15 MG/ML CARPUJECT KETOROLAC TROMETHAMINE

KETOROLAC 15 MG/ML ISECURE SYR KETOROLAC TROMETHAMINE

KETOROLAC 15 MG/ML SYRINGE KETOROLAC TROMETHAMINE

KETOROLAC 15 MG/ML VIAL KETOROLAC TROMETHAMINE

KETOROLAC 30 MG/ML CARPUJECT KETOROLAC TROMETHAMINE

KETOROLAC 30 MG/ML ISECURE SYR KETOROLAC TROMETHAMINE

KETOROLAC 30 MG/ML SYRINGE KETOROLAC TROMETHAMINE

KETOROLAC 30 MG/ML VIAL KETOROLAC TROMETHAMINE

KETOROLAC 300 MG/10 ML VIAL KETOROLAC TROMETHAMINE

KETOROLAC 60 MG/2 ML CARPUJECT KETOROLAC TROMETHAMINE

KETOROLAC 60 MG/2 ML SYRINGE KETOROLAC TROMETHAMINE

KETOROLAC 60 MG/2 ML VIAL KETOROLAC TROMETHAMINE

KINERET 100 MG/0.67 ML SYRINGE KINERET PA Prior Authorization required

LEFLUNOMIDE 10 MG TABLET LEFLUNOMIDE

LEFLUNOMIDE 20 MG TABLET LEFLUNOMIDE

MELOXICAM 15 MG TABLET MELOXICAM

MELOXICAM 7.5 MG TABLET MELOXICAM

MELOXICAM 7.5 MG/5 ML SUSP MELOXICAM

METHOTREXATE 2.5 MG TABLET METHOTREXATE

NABUMETONE 500 MG TABLET NABUMETONE

NABUMETONE 750 MG TABLET NABUMETONE

NAPROXEN 125 MG/5 ML SUSPEN NAPROXEN

NAPROXEN 250 MG TABLET NAPROXEN


NAPROXEN 500 MG KIT NAPROXEN



21



NAPROXEN DR 375 MG TABLET NAPROXEN

NAPROXEN DR 500 MG TABLET NAPROXEN

NAPROXEN EC 375 MG TABLET NAPROXEN

NAPROXEN EC 500 MG TABLET NAPROXEN

NAPROXEN SOD CR 375 MG TABLET NAPROXEN SODIUM CR

NAPROXEN SOD CR 500 MG TABLET NAPROXEN SODIUM CR

NAPROXEN SOD ER 375 MG TABLET NAPROXEN SODIUM ER

NAPROXEN SOD ER 500 MG TABLET NAPROXEN SODIUM ER

NAPROXEN SODIUM 275 MG TAB NAPROXEN SODIUM

NAPROXEN SODIUM 550 MG TAB NAPROXEN SODIUM

NAPROXEN SODIUM DS 550 MG TAB NAPROXEN SODIUM DS

OXAPROZIN 600 MG CAPLET OXAPROZIN

OXAPROZIN 600 MG TABLET OXAPROZIN

SULINDAC 150 MG TABLET SULINDAC

SULINDAC 200 MG TABLET SULINDAC

Analgesics - Opioid


ACETAMINOPHEN-COD #2 TABLET ACETAMINOPHEN-CODEINE QL



ACETAMINOPHEN-CODEINE 120 MG-12 MG/5 ML SOLUTION





ACETAMINOPHEN-CODEINE QL

ACETAMINOPHEN-CODEINE 300-30MG/12.5 ML

ACETAMINOPHEN-CODEINE QL

ASCOMP WITH CODEINE CAPSULE ASCOMP WITH CODEINE QL

BUTALB-ACETAMINOPH-CAFF-CODEIN

BUTALB-ACETAMINOPH-CAFF-CODEIN

QL






FIORINAL WITH CODEINE #3 CAP FIORINAL WITH CODEINE #3 QL

FIORINAL-COD 30-50-325-40 CAP FIORINAL WITH CODEINE #3 QL



PA,QL



PA,QL

HYDROMORPHONE 0.5 MG/0.5 ML HYDROMORPHONE HCL PA,QL


HYDROMORPHONE HCL QL


22

Analgesics - Opioid


HYDROMORPHONE 1 MG/MLSOLUTION


HYDROMORPHONE 1 MG/MLSYRINGE


HYDROMORPHONE 110 MG/55 MLPCA SYRINGE (CMPD-RX)


HYDROMORPHONE 2 MG TABLET HYDROMORPHONE HCL QL



HYDROMORPHONE 2 MG/MLISECURE


HYDROMORPHONE 2 MG/MLSYRINGE (CMPD-RX)

HYDROMORPHONE HCL

HYDROMORPHONE 2 MG/ML VIAL HYDROMORPHONE HCL QL

HYDROMORPHONE 3 MG SUPPOS HYDROMORPHONE HCL QL

HYDROMORPHONE 4 MG TABLET HYDROMORPHONE HCL PA,QL


HYDROMORPHONE HCL

HYDROMORPHONE 5 MG/5 ML SOLN HYDROMORPHONE HCL PA,QL

HYDROMORPHONE 8 MG TABLET HYDROMORPHONE HCL QL

HYDROMORPHONE HCL 110 MG/55ML


HYDROMORPHONE HCL 60 MG/30 ML HYDROMORPHONE HCL QL









LORCET 5-325 MG TABLET LORCET PA,QL

LORTAB 5-325 MG TABLET LORTAB PA,QL

MEPERIDINE 100 MG/ML VIAL MEPERIDINE HCL

MORPHINE 10 MG/0.7 ML AUTO-INJ MORPHINE SULFATE QL

MORPHINE 10 MG/ML CARPUJECT MORPHINE SULFATE

MORPHINE 10 MG/ML SYRINGE MORPHINE SULFATE QL


MORPHINE 15 MG/ML VIAL MORPHINE SULFATE PA,QL



MORPHINE 20 MG/ML ORAL SYRINGE MORPHINE SULFATE QL

MORPHINE 30 MG/30 ML SYRINGE MORPHINE SULFATE QL





23

Analgesics - Opioid






MORPHINE SULF 10 MG/5 ML SOLN MORPHINE SULFATE QL

MORPHINE SULF 100 MG/5 ML (20 MG/ML) SOLUTION

MORPHINE SULFATE QL




MORPHINE SULF 30 MG SUPPOS MORPHINE SULFATE QL

MORPHINE SULF 5 MG SUPPOS MORPHINE SULFATE QL









MORPHINE SULFATE 2 MG/ML VIAL MORPHINE SULFATE


MORPHINE SULFATE 25 MG/ML VL MORPHINE SULFATE

MORPHINE SULFATE 5 MG/ML VIAL MORPHINE SULFATE








MORPHINE SULFATE ER 40 MG CAP MORPHINE SULFATE ER







MORPHINE SULFATE IR 15 MG TAB MORPHINE SULFATE QL

MORPHINE SULFATE IR 30 MG TAB MORPHINE SULFATE QL

NORCO 5-325 TABLET NORCO PA,QL

OXYCODONE HCL 10 MG TABLET OXYCODONE HCL QL

OXYCODONE HCL 100 MG/5 ML SOLN OXYCODONE HCL QL


24

Analgesics - Opioid





OXYCODONE HCL 5 MG CAPSULE OXYCODONE HCL QL

OXYCODONE HCL 5 MG TABLET OXYCODONE HCL QL

OXYCODONE HCL 5 MG/5 ML SOLN OXYCODONE HCL QL

OXYCODONE-ACETAMINOPHEN 5-325 MG TAB


QL

OXYCODONE-ACETAMINOPHEN 5-325 MG TABLET


QL

OXYCODONE-ACETAMINOPHEN 5-325 MG/5 ML SOLUTION


PA,QL

OXYCODONE-ASPIRIN 4.8355-325 MGTABLET

OXYCODONE HCL-ASPIRIN

TRAMADOL ER 100 MG TABLET TRAMADOL HCL ER QL Limited to 30 Tablets per 25 days

TRAMADOL HCL 50 MG TABLET TRAMADOL HCL QL

TRAMADOL HCL ER 100 MG CAPSULE TRAMADOL HCL ER PA,QL


TRAMADOL HCL ER 200 MG TABLET TRAMADOL HCL ER QL Limited to 30 Tablets per 25 days


TRAMADOL-ACETAMINOPHEN 37.5-325 MG TAB

TRAMADOL HCL-ACETAMINOPHEN

QL

ULTRAM 50 MG TABLET ULTRAM QL

ULTRAM ER 300 MG TABLET ULTRAM ER PA,QL Limited to 30 Tablets per 25 days

VICODIN 5-300 MG TABLET VICODIN PA,QL

XODOL 5-300 TABLET XODOL 5-300 PA,QL

Angina Therapy


ISOSORBIDE DINITR ER 40 MG TAB ISOSORBIDE DINITRATE ER

ISOSORBIDE DINITRATE 10 MG TAB ISOSORBIDE DINITRATE




ISOSORBIDE MONONIT 10 MG TAB ISOSORBIDE MONONITRATE

ISOSORBIDE MONONIT 20 MG TAB ISOSORBIDE MONONITRATE

ISOSORBIDE MONONIT ER 120 MG ISOSORBIDE MONONITRATEER

ISOSORBIDE MONONIT ER 30 MG TB ISOSORBIDE MONONITRATEER

ISOSORBIDE MONONIT ER 60 MG TB ISOSORBIDE MONONITRATEER

NITROGLYCERIN 0.1 MG/HR PATCH NITROGLYCERIN PATCH


NITROGLYCERIN 0.3 MG TABLET SL NITROGLYCERIN



25

Angina Therapy





NITROGLYCERIN 400 MCG SPRAY NITROGLYCERIN

NITROGLYCERIN 5 MG/ML VIAL NITROGLYCERIN

NITROGLYCERIN ER 2.5 MG CAP NITROGLYCERIN

NITROGLYCERIN ER 6.5 MG CAP NITROGLYCERIN

NITROGLYCERIN ER 9 MG CAPSULE NITROGLYCERIN

NITROGLYCERIN LINGUAL 0.4 MG NITROGLYCERIN

Anorectal - Glucocorticoids


ANUCORT-HC 25 MG SUPPOSITORY ANUCORT-HC

ANUSOL-HC 25 MG SUPPOSITORY ANUSOL-HC

HEMMOREX-HC 25 MGSUPPOSITORY

HEMMOREX-HC

HYDROCORTISONE 1% CREAM HYDROCORTISONE

HYDROCORTISONE AC 25 MG SUPP HYDROCORTISONE ACETATE

HYDROCORTISONE AC 30 MG SUPP HYDROCORTISONE ACETATE

Anorectal Combinations


LIDOCAINE-HC 3-1% CREAM KIT LIDOCAINE-HYDROCORTISONE



DANAZOL 100 MG CAPSULE DANAZOL

DANAZOL 200 MG CAPSULE DANAZOL

LUPRON DEPOT 11.25 MG(LUPANETA)

LUPRON DEPOT (LUPANETA) PA Prior Authorization Required


LUPRON DEPOT 3.75 MG (LUPANETA) LUPRON DEPOT (LUPANETA) PA Prior Authorization Required


LUPRON DEPOT-PED 11.25 MG 3MOKIT

LUPRON DEPOT-PED PA Prior Authorization required


LUPRON DEPOT-PED 15 MG KIT LUPRON DEPOT-PED PA Prior Authorization required

LUPRON DEPOT-PED 30 MG 3MO KIT LUPRON DEPOT-PED PA Prior Authorization required


OCTREOTIDE 1,000 MCG/5 ML VIAL OCTREOTIDE ACETATE

OCTREOTIDE 1,000 MCG/ML VIAL OCTREOTIDE ACETATE

OCTREOTIDE 5,000 MCG/5 ML VIAL OCTREOTIDE ACETATE

OCTREOTIDE ACET 100 MCG/ML AMP OCTREOTIDE ACETATE

OCTREOTIDE ACET 200 MCG/ML VL OCTREOTIDE ACETATE



SANDOSTATIN 0.05 MG/ML AMPUL SANDOSTATIN


26




SANDOSTATIN 0.2 MG/ML VIAL SANDOSTATIN


SANDOSTATIN 1 MG/ML VIAL SANDOSTATIN

Anti-Infective - Immunologic Adjuvants


ACTIMMUNE 100 MCG/0.5 ML VIAL ACTIMMUNE PA,SP Prior Authorization required

Antianxiety Agents


ALPRAZOLAM 0.25 MG TABLET ALPRAZOLAM

ALPRAZOLAM 0.5 MG TABLET ALPRAZOLAM

ALPRAZOLAM 1 MG TABLET ALPRAZOLAM

ALPRAZOLAM 2 MG TABLET ALPRAZOLAM

BUSPIRONE HCL 10 MG TABLET BUSPIRONE HCL




BUSPIRONE HCL 7.5 MG TABLET BUSPIRONE HCL

CHLORDIAZEPOXIDE 10 MGCAPSULE

CHLORDIAZEPOXIDE HCL

CHLORDIAZEPOXIDE 25 MGCAPSULE

CHLORDIAZEPOXIDE HCL

CHLORDIAZEPOXIDE 5 MG CAPSULE CHLORDIAZEPOXIDE HCL

CLONAZEPAM 0.125 MG DIS TAB CLONAZEPAM

CLONAZEPAM 0.125 MG ODT CLONAZEPAM


CLONAZEPAM 0.5 MG DIS TABLET CLONAZEPAM


CLONAZEPAM 0.5 MG TABLET CLONAZEPAM

CLONAZEPAM 1 MG DIS TABLET CLONAZEPAM

CLONAZEPAM 1 MG ODT CLONAZEPAM

CLONAZEPAM 1 MG TABLET CLONAZEPAM

CLONAZEPAM 2 MG ODT CLONAZEPAM

CLONAZEPAM 2 MG TABLET CLONAZEPAM

DIAZEPAM 10 MG TABLET DIAZEPAM

DIAZEPAM 10 MG/2 ML CARPUJECT DIAZEPAM

DIAZEPAM 10 MG/2 ML SYRINGE DIAZEPAM

DIAZEPAM 10 MG/2 ML SYRINGE(CMPD-RX)

DIAZEPAM



DIAZEPAM 5 MG/5 ML ORAL SOLN DIAZEPAM

DIAZEPAM 5 MG/5 ML SOLUTION DIAZEPAM

DIAZEPAM 5 MG/ML ORAL CONC DIAZEPAM


27

Antianxiety Agents


DIAZEPAM 5 MG/ML VIAL DIAZEPAM

DIAZEPAM 50 MG/10 ML VIAL DIAZEPAM

HYDROXYZINE 10 MG/5 ML SOLN HYDROXYZINE HCL SYRUP

HYDROXYZINE 10 MG/5 ML SYRUP HYDROXYZINE HCL SYRUP

HYDROXYZINE 100 MG/2 ML VIAL HYDROXYZINE HCL

HYDROXYZINE 25 MG/ML VIAL HYDROXYZINE HCL

HYDROXYZINE 50 MG/ML VIAL HYDROXYZINE HCL

HYDROXYZINE 500 MG/10 ML VIAL HYDROXYZINE HCL

HYDROXYZINE HCL 10 MG TABLET HYDROXYZINE HCL



LORAZEPAM 0.5 MG TABLET LORAZEPAM

LORAZEPAM 1 MG TABLET LORAZEPAM

LORAZEPAM 2 MG TABLET LORAZEPAM

OXAZEPAM 10 MG CAPSULE OXAZEPAM



Antiarrhythmics


AMIODARONE HCL 200 MG TABLET AMIODARONE HCL

AMIODARONE HCL 400 MG TABLET AMIODARONE HCL

BETAPACE 120 MG TABLET BETAPACE




BETAPACE AF 120 MG TABLET BETAPACE AF



DILTIAZEM 125 MG/25 ML VIAL DILTIAZEM HCL



DILTIAZEM HCL 100 MG VIAL DILTIAZEM HCL

DISOPYRAMIDE 100 MG CAPSULE DISOPYRAMIDE PHOSPHATE

DISOPYRAMIDE 150 MG CAPSULE DISOPYRAMIDE PHOSPHATE

FLECAINIDE ACETATE 100 MG TAB FLECAINIDE ACETATE



LIDOCAINE HCL 1% ABBOJECT LIDOCAINE HCL

LIDOCAINE HCL 1% SYRINGE LIDOCAINE HCL

LIDOCAINE HCL 2% ABBOJECT LIDOCAINE HCL

LIDOCAINE HCL 2% LUER-JET LIDOCAINE HCL


LIDOCAINE HCL 2% VIAL LIDOCAINE HCL


28

Antiarrhythmics


PHENYTOIN 100 MG/2 ML VIAL PHENYTOIN SODIUM

PHENYTOIN 250 MG/5 ML VIAL PHENYTOIN SODIUM

PHENYTOIN 50 MG/ML VIAL PHENYTOIN SODIUM

PROPAFENONE HCL 150 MG TABLET PROPAFENONE HCL

PROPAFENONE HCL 225 MG TAB PROPAFENONE HCL

PROPAFENONE HCL 300 MG TAB PROPAFENONE HCL

PROPAFENONE HCL ER 225 MG CAP PROPAFENONE HCL ER



SORINE 120 MG TABLET SORINE




SOTALOL 120 MG TABLET SOTALOL




SOTALOL AF 120 MG TABLET SOTALOL AF



SOTALOL HCL 150 MG/10 ML VIAL SOTALOL HCL

VERAPAMIL 10 MG/4 ML VIAL VERAPAMIL HCL

VERAPAMIL 120 MG TABLET VERAPAMIL HCL

VERAPAMIL 2.5 MG/ML VIAL VERAPAMIL HCL


VERAPAMIL 5 MG/2 ML VIAL VERAPAMIL HCL




AMOX-CLAV 200-28.5 MG TAB CHEW AMOXICILLIN-CLAVULANATEPOTASS

AMOX-CLAV 200-28.5 MG/5 ML SUS AMOXICILLIN-CLAVULANATEPOTASS

AMOX-CLAV 250-125 MG TABLET AMOXICILLIN-CLAVULANATEPOTASS


AMOX-CLAV 400-57 MG TAB CHEW AMOXICILLIN-CLAVULANATEPOTASS

AMOX-CLAV 400-57 MG/5 ML SUSP AMOXICILLIN-CLAVULANATEPOTASS




29




AMOXICILLIN 125 MG/5 ML SUSP AMOXICILLIN


AMOXICILLIN 250 MG CAPSULE AMOXICILLIN



AMOXICILLIN 500 MG CAPSULE AMOXICILLIN

AMOXICILLIN 875 MG TABLET AMOXICILLIN

AMPICILLIN 125 MG/5 ML SUSP AMPICILLIN TRIHYDRATE

AMPICILLIN 250 MG CAPSULE AMPICILLIN TRIHYDRATE

AMPICILLIN 250 MG/5 ML SUSP AMPICILLIN TRIHYDRATE

AMPICILLIN 500 MG CAPSULE AMPICILLIN TRIHYDRATE

AZITHROMYCIN 1 GM PWD PACKET AZITHROMYCIN

AZITHROMYCIN 100 MG/5 ML SUSP AZITHROMYCIN

AZITHROMYCIN 200 MG/5 ML SUSP AZITHROMYCIN

AZITHROMYCIN 250 MG TABLET AZITHROMYCIN QL Limited to 8 tablets per fill: Limited to 1fill per 25 days

AZITHROMYCIN 500 MG TABLET AZITHROMYCIN QL Limited to 4 tablets per fill: Limited to 1fill per 25 days

AZITHROMYCIN 600 MG TABLET AZITHROMYCIN

AZITHROMYCIN I.V. 500 MG VIAL AZITHROMYCIN

BACITRACIN 50,000 UNIT VIAL BACITRACIN

CEFACLOR 125 MG/5 ML SUSP CEFACLOR

CEFACLOR 250 MG CAPSULE CEFACLOR

CEFACLOR 250 MG/5 ML SUSP CEFACLOR

CEFACLOR 375 MG/5 ML SUSPEN CEFACLOR

CEFACLOR 500 MG CAPSULE CEFACLOR

CEFADROXIL 1 GM TABLET CEFADROXIL

CEFADROXIL 250 MG/5 ML SUSP CEFADROXIL

CEFADROXIL 500 MG CAPSULE CEFADROXIL

CEFADROXIL 500 MG/5 ML SUSP CEFADROXIL

CEFDINIR 125 MG/5 ML SUSP CEFDINIR

CEFDINIR 250 MG/5 ML SUSP CEFDINIR

CEFDINIR 300 MG CAPSULE CEFDINIR

CEFPROZIL 125 MG/5 ML SUSP CEFPROZIL

CEFPROZIL 250 MG TABLET CEFPROZIL

CEFPROZIL 250 MG/5 ML SUSP CEFPROZIL

CEFPROZIL 500 MG TABLET CEFPROZIL

CEFUROXIME 125 MG/5 ML SUSP CEFUROXIME AXETIL

CEFUROXIME AXETIL 250 MG TAB CEFUROXIME

CEFUROXIME AXETIL 500 MG TAB CEFUROXIME

CEPHALEXIN 125 MG/5 ML SUSP CEPHALEXIN

CEPHALEXIN 250 MG CAPSULE CEPHALEXIN


30



CEPHALEXIN 250 MG/5 ML SUSP CEPHALEXIN

CEPHALEXIN 500 MG CAPSULE CEPHALEXIN

CIPRO 10% SUSPENSION CIPRO

CIPRO 5% SUSPENSION CIPRO

CIPROFLOXACIN HCL 100 MG TAB CIPROFLOXACIN HCL




CLARITHROMYCIN 125 MG/5 ML SUS CLARITHROMYCIN

CLARITHROMYCIN 250 MG TABLET CLARITHROMYCIN

CLARITHROMYCIN 250 MG/5 ML SUS CLARITHROMYCIN

CLARITHROMYCIN 500 MG TABLET CLARITHROMYCIN

CLARITHROMYCIN ER 500 MG TAB CLARITHROMYCIN ER

CLINDAMYCIN 75 MG/5 ML SOLN CLINDAMYCIN PALMITATE HCL

CLINDAMYCIN HCL 150 MG CAPSULE CLINDAMYCIN HCL



CLINDAMYCIN PEDIATR 75 MG/5 ML CLINDAMYCIN PEDIATRIC

CLINDAMYCIN PEDIATRIC 75 MG/5 ML CLINDAMYCIN PEDIATRIC

DAPSONE 100 MG TABLET DAPSONE

DAPSONE 25 MG TABLET DAPSONE

DICLOXACILLIN 250 MG CAPSULE DICLOXACILLIN SODIUM

DOXYCYCLINE 50 MG TABLET DOXYCYCLINE HYCLATE

DOXYCYCLINE HYC 100 MG VIAL DOXYCYCLINE HYCLATE

DOXYCYCLINE HYC DR 100 MG TAB DOXYCYCLINE HYCLATE




DOXYCYCLINE HYCLATE 100 MG CAP DOXYCYCLINE HYCLATE

DOXYCYCLINE HYCLATE 100 MG TAB DOXYCYCLINE HYCLATE

DOXYCYCLINE HYCLATE 100 MG VL DOXYCYCLINE HYCLATE

DOXYCYCLINE HYCLATE 50 MG CAP DOXYCYCLINE HYCLATE

ERYTHROMYCIN 200 MG/5 ML GRAN ERYTHROMYCINETHYLSUCCINATE

ERYTHROMYCIN 250 MG FILMTAB ERYTHROMYCIN

ERYTHROMYCIN 500 MG FILMTAB ERYTHROMYCIN

ERYTHROMYCIN DR 250 MG CAP ERYTHROMYCIN

ERYTHROMYCIN ES 400 MG TAB ERYTHROMYCINETHYLSUCCINATE

ERYTHROMYCIN ST 250 MG TAB ERYTHROMYCIN STEARATE

ETHAMBUTOL HCL 100 MG TABLET ETHAMBUTOL HCL

ETHAMBUTOL HCL 400 MG TABLET ETHAMBUTOL HCL

GENTAMICIN 10 MG/ML VIAL GENTAMICIN SULFATE


31



GENTAMICIN 20 MG/2 ML VIAL GENTAMICIN SULFATE

GENTAMICIN 40 MG/ML VIAL GENTAMICIN SULFATE



ISONIAZID 100 MG TABLET ISONIAZID

ISONIAZID 100 MG/ML VIAL ISONIAZID

ISONIAZID 300 MG TABLET ISONIAZID

ISONIAZID 50 MG/5 ML SOLUTION ISONIAZID

LEVOFLOXACIN 250 MG TABLET LEVOFLOXACIN



MINOCYCLINE 100 MG CAPSULE MINOCYCLINE HCL



MINOCYCLINE ER 115 MG TABLET MINOCYCLINE HCL ER





MINOCYCLINE HCL 100 MG TABLET MINOCYCLINE HCL



OFLOXACIN 300 MG TABLET OFLOXACIN

OFLOXACIN 400 MG TABLET OFLOXACIN

PEN G 1.2 MILLION UNIT/2 ML PENICILLIN G PROCAINE

PENICILLIN G 600,000 UNIT/1 ML PENICILLIN G PROCAINE

PENICILLIN G K 5 MILLION UNIT PENICILLIN G POTASSIUM

PENICILLIN G NA 5 MILLION UNIT PENICILLIN G SODIUM

PENICILLIN VK 125 MG/5 ML SOLN PENICILLIN V POTASSIUM

PENICILLIN VK 250 MG TABLET PENICILLIN V POTASSIUM

PENICILLIN VK 250 MG/5 ML SOLN PENICILLIN V POTASSIUM

PENICILLIN VK 250 MG/5 ML SUS PENICILLIN V POTASSIUM

PENICILLIN VK 500 MG TABLET PENICILLIN V POTASSIUM

PYRAZINAMIDE 500 MG TABLET PYRAZINAMIDE

RIFAMPIN 150 MG CAPSULE RIFAMPIN

RIFAMPIN 300 MG CAPSULE RIFAMPIN

RIFAMPIN IV 600 MG VIAL RIFAMPIN

SULFAMETHOXAZOLE-TMP DSTABLET

SULFAMETHOXAZOLE-TRIMETHOPRIM

SULFAMETHOXAZOLE-TMP INJ VIAL SULFAMETHOXAZOLE-TRIMETHOPRIM

SULFAMETHOXAZOLE-TMP SSTABLET

SULFAMETHOXAZOLE-TRIMETHOPRIM

SULFAMETHOXAZOLE-TMP SUSP SULFAMETHOXAZOLE-TRIMETHOPRIM


32



TETRACYCLINE 250 MG CAPSULE TETRACYCLINE HCL

TETRACYCLINE 500 MG CAPSULE TETRACYCLINE HCL





TRIMETHOPRIM 100 MG TABLET TRIMETHOPRIM

VANCOMYCIN 1 GM VIAL VANCOMYCIN HCL

VANCOMYCIN 125 MG/2.5 ML ORALSYRINGE (CMPD-RX)

VANCOMYCIN HCL

VANCOMYCIN 500 MG VIAL VANCOMYCIN HCL

ZITHROMAX 500 MG TABLET ZITHROMAX

ZITHROMAX TRI-PAK 500 MG TAB ZITHROMAX TRI-PAK

Anticoagulants


ENOXAPARIN 100 MG/ML SYRINGE ENOXAPARIN SODIUM QL

ENOXAPARIN 120 MG/0.8 ML SYR ENOXAPARIN SODIUM QL

ENOXAPARIN 150 MG/ML SYRINGE ENOXAPARIN SODIUM QL


ENOXAPARIN 300 MG/3 ML VIAL ENOXAPARIN SODIUM QL




PRADAXA 150 MG CAPSULE PRADAXA

WARFARIN SODIUM 1 MG TABLET WARFARIN SODIUM



WARFARIN SODIUM 2.5 MG TABLET WARFARIN SODIUM





WARFARIN SODIUM 7.5 MG TABLET WARFARIN SODIUM

XARELTO 10 MG TABLET XARELTO QL



Anticonvulsants


CARBAMAZEPINE 100 MG TAB CHEW CARBAMAZEPINE

CARBAMAZEPINE 100 MG/5 ML SUSP CARBAMAZEPINE

CARBAMAZEPINE 200 MG TABLET CARBAMAZEPINE

CARBAMAZEPINE ER 100 MG TABLET CARBAMAZEPINE ER

DIAZEPAM 10 MG RECTAL GEL SYST DIAZEPAM


33

Anticonvulsants


DIAZEPAM 2.5 MG RECTAL GEL SYS DIAZEPAM

DIAZEPAM 20 MG RECTAL GEL SYST DIAZEPAM

DIVALPROEX DR 125 MG CAP SPRNK DIVALPROEX SODIUM

DIVALPROEX SOD DR 125 MG TAB DIVALPROEX SODIUM



DIVALPROEX SOD ER 250 MG TAB DIVALPROEX SODIUM ER

DIVALPROEX SOD ER 500 MG TAB DIVALPROEX SODIUM ER

ETHOSUXIMIDE 250 MG CAPSULE ETHOSUXIMIDE

ETHOSUXIMIDE 250 MG/5 ML SOLN ETHOSUXIMIDE

GABAPENTIN 100 MG CAPSULE GABAPENTIN

GABAPENTIN 250 MG/5 ML SOLN GABAPENTIN


GABAPENTIN 300 MG/6 ML SOLN GABAPENTIN


GABAPENTIN 600 MG TABLET GABAPENTIN

GABAPENTIN 800 MG TABLET GABAPENTIN

LAMOTRIGINE 100 MG TABLET LAMOTRIGINE



LAMOTRIGINE 25 MG DISPER TAB LAMOTRIGINE


LAMOTRIGINE 25 MG TB START KIT LAMOTRIGINE

LAMOTRIGINE 5 MG DISPER TABLET LAMOTRIGINE

LAMOTRIGINE ER 100 MG TABLET LAMOTRIGINE ER






LAMOTRIGINE ODT 100 MG TABLET LAMOTRIGINE ODT




LAMOTRIGINE ODT KIT (BLUE) LAMOTRIGINE ODT (BLUE)

LAMOTRIGINE ODT KIT (GREEN) LAMOTRIGINE ODT (GREEN)

LAMOTRIGINE ODT KIT (ORANGE) LAMOTRIGINE ODT (ORANGE)

LAMOTRIGINE TAB START KIT-BLUE LAMOTRIGINE (BLUE)

LAMOTRIGINE TAB START KT-GREEN LAMOTRIGINE (GREEN)

LAMOTRIGINE TAB START KT-ORANG LAMOTRIGINE (ORANGE)

LEVETIRACETAM 1,000 MG TABLET LEVETIRACETAM

LEVETIRACETAM 100 MG/ML SOLN LEVETIRACETAM

LEVETIRACETAM 250 MG TABLET LEVETIRACETAM


34

Anticonvulsants



LEVETIRACETAM 500 MG/5 ML SOLN LEVETIRACETAM


LEVETIRACETAM ER 500 MG TABLET LEVETIRACETAM ER

LEVETIRACETAM ER 750 MG TABLET LEVETIRACETAM ER

LYRICA 100 MG CAPSULE LYRICA QL


LYRICA 20 MG/ML ORAL SOLUTION LYRICA QL




LYRICA 300 MG CAPSULE LYRICA QL Limited to 60 capsules per 30 days





OXCARBAZEPINE 150 MG TABLET OXCARBAZEPINE


OXCARBAZEPINE 300 MG/5 ML SUSP OXCARBAZEPINE


PHENYTOIN 100 MG/4 ML SUSP PHENYTOIN

PHENYTOIN 125 MG/5 ML SUSP PHENYTOIN

PHENYTOIN 50 MG INFATAB PHENYTOIN

PHENYTOIN 50 MG TABLET CHEW PHENYTOIN

PHENYTOIN SOD EXT 100 MG CAP PHENYTOIN SODIUMEXTENDED



PRIMIDONE 250 MG TABLET PRIMIDONE

PRIMIDONE 50 MG TABLET PRIMIDONE

TIAGABINE HCL 12 MG TABLET TIAGABINE HCL




TOPIRAMATE 100 MG TABLET TOPIRAMATE

TOPIRAMATE 15 MG SPRINKLE CAP TOPIRAMATE


TOPIRAMATE 25 MG SPRINKLE CAP TOPIRAMATE



VALPROIC ACID 250 MG CAPSULE VALPROIC ACID

VALPROIC ACID 250 MG/5 ML ORAL VALPROIC ACID


35

Anticonvulsants


VALPROIC ACID 250 MG/5 ML SOLN VALPROIC ACID

VALPROIC ACID 500 MG/10 ML SOL VALPROIC ACID

ZONISAMIDE 100 MG CAPSULE ZONISAMIDE



Antidepressants


AMITRIPTYLINE HCL 10 MG TAB AMITRIPTYLINE HCL






BUPROPION HCL 100 MG TABLET BUPROPION HCL

BUPROPION HCL 75 MG TABLET BUPROPION HCL

BUPROPION HCL SR 150 MG TABLET BUPROPION HCL SR

BUPROPION HCL XL 150 MG TABLET BUPROPION XL



CITALOPRAM HBR 10 MG TABLET CITALOPRAM HBR

CITALOPRAM HBR 10 MG/5 ML SOLN CITALOPRAM HBR


CITALOPRAM HBR 20 MG/10 ML SOL CITALOPRAM HBR


CLOMIPRAMINE 25 MG CAPSULE CLOMIPRAMINE HCL






DOXEPIN 10 MG CAPSULE DOXEPIN HCL

DOXEPIN 10 MG/ML ORAL CONC DOXEPIN HCL






DULOXETINE HCL DR 20 MG CAP DULOXETINE HCL QL Limited to 60 capsules per 30 days



ESCITALOPRAM 10 MG TABLET ESCITALOPRAM OXALATE


36

Antidepressants




ESCITALOPRAM OXALATE 5 MG/5 ML ESCITALOPRAM OXALATE

FLUOXETINE 20 MG/5 ML SOLUTION FLUOXETINE HCL

FLUOXETINE HCL 10 MG CAPSULE FLUOXETINE HCL

FLUOXETINE HCL 10 MG TABLET FLUOXETINE HCL


FLUOXETINE HCL 20 MG TABLET FLUOXETINE HCL


FLUVOXAMINE ER 100 MG CAPSULE FLUVOXAMINE MALEATE ER

FLUVOXAMINE ER 150 MG CAPSULE FLUVOXAMINE MALEATE ER

FLUVOXAMINE MALEATE 100 MG TAB FLUVOXAMINE MALEATE



IMIPRAMINE HCL 10 MG TABLET IMIPRAMINE HCL



IMIPRAMINE PAMOATE 100 MG CAP IMIPRAMINE PAMOATE

MIRTAZAPINE 15 MG ODT MIRTAZAPINE

MIRTAZAPINE 15 MG TABLET MIRTAZAPINE





MIRTAZAPINE 7.5 MG TABLET MIRTAZAPINE

NORTRIPTYLINE 10 MG/5 ML SOLN NORTRIPTYLINE HCL

NORTRIPTYLINE HCL 10 MG CAP NORTRIPTYLINE HCL




PAROXETINE CR 12.5 MG TABLET PAROXETINE CR

PAROXETINE CR 25 MG TABLET PAROXETINE CR

PAROXETINE CR 37.5 MG TABLET PAROXETINE CR

PAROXETINE ER 12.5 MG TABLET PAROXETINE ER

PAROXETINE ER 25 MG TABLET PAROXETINE ER

PAROXETINE ER 37.5 MG TABLET PAROXETINE ER

PAROXETINE HCL 10 MG TABLET PAROXETINE HCL




PAXIL 10 MG/5 ML SUSPENSION PAXIL

PHENELZINE SULFATE 15 MG TAB PHENELZINE SULFATE

PROZAC 10 MG PULVULE PROZAC


37

Antidepressants




SERTRALINE 20 MG/ML ORAL CONC SERTRALINE HCL

SERTRALINE 20 MG/ML ORAL SOLN SERTRALINE HCL

SERTRALINE HCL 100 MG TABLET SERTRALINE HCL



TRANYLCYPROMINE SULF 10 MGTAB

TRANYLCYPROMINE SULFATE

TRAZODONE 100 MG TABLET TRAZODONE HCL




VENLAFAXINE HCL 100 MG TABLET VENLAFAXINE HCL


VENLAFAXINE HCL 37.5 MG TABLET VENLAFAXINE HCL



VENLAFAXINE HCL ER 150 MG CAP VENLAFAXINE HCL ER

VENLAFAXINE HCL ER 150 MG TAB VENLAFAXINE HCL ER


VENLAFAXINE HCL ER 37.5 MG CAP VENLAFAXINE HCL ER

VENLAFAXINE HCL ER 37.5 MG TAB VENLAFAXINE HCL ER

VENLAFAXINE HCL ER 75 MG CAP VENLAFAXINE HCL ER


Antidiarrheals


DIPHENOXYLATE-ATROPINE 2.5-0.025 MG TABLET

DIPHENOXYLATE-ATROPINE

Antiemetics


DRONABINOL 10 MG CAPSULE DRONABINOL

DRONABINOL 2.5 MG CAPSULE DRONABINOL

DRONABINOL 5 MG CAPSULE DRONABINOL

GRANISETRON HCL 1 MG TABLET GRANISETRON HCL

MECLIZINE 12.5 MG TABLET MECLIZINE HCL

MECLIZINE 25 MG TABLET MECLIZINE HCL

ONDANSETRON 4 MG/5 MLSOLUTION

ONDANSETRON HCL

ONDANSETRON HCL 24 MG TABLET ONDANSETRON HCL QL

ONDANSETRON HCL 4 MG TABLET ONDANSETRON HCL QL Limited to 30 Tablets per 25 days

ONDANSETRON HCL 8 MG TABLET ONDANSETRON HCL QL Limited to 30 Tablets per 25 days

PROCHLORPERAZINE 10 MG/2 ML VL PROCHLORPERAZINEEDISYLATE


38

Antiemetics


PROCHLORPERAZINE 25 MG SUPP PROCHLORPERAZINE

PROCHLORPERAZINE 5 MG/ML VIAL PROCHLORPERAZINEEDISYLATE

TRIMETHOBENZAMIDE 300 MG CAP TRIMETHOBENZAMIDE HCL

Antifungals


FLUCONAZOLE 10 MG/ML SUSP FLUCONAZOLE

FLUCONAZOLE 100 MG TABLET FLUCONAZOLE

FLUCONAZOLE 150 MG TABLET FLUCONAZOLE QL Limited to 2 tablets per fill. Limited to 1fill per 25 days


FLUCONAZOLE 40 MG/ML SUSP FLUCONAZOLE


GRISEOFULVIN 125 MG/5 ML SUSP GRISEOFULVIN

GRISEOFULVIN MICRO 500 MG TAB GRISEOFULVIN

GRISEOFULVIN ULTRA 125 MG TAB GRISEOFULVINULTRAMICROSIZE

GRISEOFULVIN ULTRA 250 MG TAB GRISEOFULVINULTRAMICROSIZE

ITRACONAZOLE 10 MG/ML SOLUTION ITRACONAZOLE

ITRACONAZOLE 100 MG CAPSULE ITRACONAZOLE

KETOCONAZOLE 200 MG TABLET KETOCONAZOLE

NYSTATIN 150,000,000 UNITS PWD NYSTATIN

NYSTATIN 500,000 UNIT ORAL TAB NYSTATIN

NYSTATIN 500,000,000 UNITS PWD NYSTATIN

TERBINAFINE HCL 250 MG TABLET TERBINAFINE HCL



ADVATE 2,401-3,600 UNIT VIAL ADVATE PA Prior Authorization required







ALPHANINE SD 500 UNIT VIAL ALPHANINE SD PA Prior Authorization required









39



FEIBA NF 500 UNIT (NOMINAL) FEIBA NF PA Prior Authorization required

HELIXATE FS 3,000 UNITS VIAL HELIXATE FS PA Prior Authorization required





HUMATE-P 1,200 UNIT VWF:RCO HUMATE-P

HUMATE-P 2,400 UNIT VWF:RCO HUMATE-P

HUMATE-P 600 UNIT VWF:RCO HUMATE-P

KOGENATE FS 3,000 UNIT-BIOSET KOGENATE FS PA Prior Authorization required

KOGENATE FS 3,000 UNITS VIAL KOGENATE FS PA Prior Authorization required

KOVALTRY 3,000 UNIT KIT KOVALTRY PA Prior Authorization required

KOVALTRY 3,000 UNIT VIAL KOVALTRY PA Prior Authorization required

MONONINE 1,000 UNIT VIAL MONONINE PA Prior Authorization required









RECOMBINATE 801-1,240 UNIT VL RECOMBINATE PA Prior Authorization required






Antihistamines


CETIRIZINE HCL 1 MG/ML SOLN CETIRIZINE HCL

CETIRIZINE HCL 1 MG/ML SYRUP CETIRIZINE HCL

CLEMASTINE FUM 2.68 MG TAB CLEMASTINE FUMARATE

CYPROHEPTADINE 2 MG/5 ML SYRUP CYPROHEPTADINE HCL

CYPROHEPTADINE 4 MG TABLET CYPROHEPTADINE HCL

DIPHENHYDRAMINE 50 MG/MLSYRNG

DIPHENHYDRAMINE HCL

DIPHENHYDRAMINE 50 MG/ML VIAL DIPHENHYDRAMINE HCL

FEXOFENADINE HCL 180 MG TABLET FEXOFENADINE HCL

FEXOFENADINE HCL 60 MG TABLET FEXOFENADINE HCL

PROMETHAZINE 12.5 MG SUPPOS PROMETHAZINE HCL

PROMETHAZINE 12.5 MG TABLET PROMETHAZINE HCL

PROMETHAZINE 25 MGSUPPOSITORY

PROMETHAZINE HCL


40

Antihistamines


PROMETHAZINE 25 MG TABLET PROMETHAZINE HCL

PROMETHAZINE 25 MG/ML AMPUL PROMETHAZINE HCL

PROMETHAZINE 25 MG/ML VIAL PROMETHAZINE HCL

PROMETHAZINE 50 MGSUPPOSITORY

PROMETHAZINE HCL

PROMETHAZINE 50 MG TABLET PROMETHAZINE HCL

PROMETHAZINE 50 MG/ML AMPUL PROMETHAZINE HCL

PROMETHAZINE 50 MG/ML VIAL PROMETHAZINE HCL

PROMETHAZINE 6.25 MG/5 ML SOLN PROMETHAZINE HCL

PROMETHAZINE 6.25 MG/5 ML SYRP PROMETHAZINE HCL

Antihyperlipidemics


ATORVASTATIN 10 MG TABLET ATORVASTATIN CALCIUM




CHOLESTYRAMINE LIGHT PACKET CHOLESTYRAMINE LIGHT

CHOLESTYRAMINE LIGHT POWDER CHOLESTYRAMINE LIGHT

COLESTIPOL HCL 1 GM TABLET COLESTIPOL HCL

COLESTIPOL HCL GRANULES COLESTIPOL HCL

COLESTIPOL HCL GRANULESPACKET

COLESTIPOL HCL

COLESTIPOL MICRONIZED 1 GM TAB COLESTIPOL HCL

EZETIMIBE 10 MG TABLET EZETIMIBE

FENOFIBRATE 120 MG TABLET FENOFIBRATE

FENOFIBRATE 130 MG CAPSULE FENOFIBRATE












GEMFIBROZIL 600 MG TABLET GEMFIBROZIL




LOVASTATIN 10 MG TABLET LOVASTATIN



41

Antihyperlipidemics



NIACIN ER 1,000 MG TABLET NIACIN ER

NIACIN ER 500 MG TABLET NIACIN ER

NIACIN ER 750 MG TABLET NIACIN ER

PRAVASTATIN SODIUM 10 MG TAB PRAVASTATIN SODIUM




ROSUVASTATIN CALCIUM 10 MG TAB ROSUVASTATIN CALCIUM




SIMVASTATIN 10 MG TABLET SIMVASTATIN





ZETIA 10 MG TABLET ZETIA



AMLODIPINE-OLMESARTAN 10-20 MG AMLODIPINE-OLMESARTAN QL Limited to 30 Tablets per 30 days




ATENOLOL-CHLORTHALIDONE 100-25 ATENOLOL-CHLORTHALIDONE

ATENOLOL-CHLORTHALIDONE 50-25 ATENOLOL-CHLORTHALIDONE

AZOR 10-20 MG TABLET AZOR QL Limited to 30 Tablets per 30 days




BENAZEPRIL HCL 10 MG TABLET BENAZEPRIL HCL




BENAZEPRIL-HYDROCHLOROTHIAZIDE 10-12.5 MGTAB

BENAZEPRIL-HYDROCHLOROTHIAZIDE



BENAZEPRIL-HYDROCHLOROTHIAZIDE 20-25 MGTAB





42



BIDIL TABLET BIDIL

BISOPROLOL-HYDROCHLOROTHIAZIDE 10-6.25 MGTAB

BISOPROLOL-HYDROCHLOROTHIAZIDE

BISOPROLOL-HYDROCHLOROTHIAZIDE 2.5-6.25 MGTB


BISOPROLOL-HYDROCHLOROTHIAZIDE 5-6.25 MGTAB


CAPTOPRIL 100 MG TABLET CAPTOPRIL

CAPTOPRIL 12.5 MG TABLET CAPTOPRIL



CAPTOPRIL-HYDROCHLOROTHIAZIDE 25-15 MGTABLET

CAPTOPRIL-HYDROCHLOROTHIAZIDE







CLONIDINE 0.1 MG/DAY PATCH CLONIDINE QL Limited to 4 patches per fill: Limited to 1fill per 30 days



CLONIDINE HCL 0.1 MG TABLET CLONIDINE HCL



DOXAZOSIN MESYLATE 1 MG TAB DOXAZOSIN MESYLATE




ENALAPRIL MALEATE 10 MG TAB ENALAPRIL MALEATE

ENALAPRIL MALEATE 2.5 MG TAB ENALAPRIL MALEATE

ENALAPRIL MALEATE 20 MG TAB ENALAPRIL MALEATE

ENALAPRIL MALEATE 5 MG TABLET ENALAPRIL MALEATE

ENALAPRIL-HYDROCHLOROTHIAZIDE10-25 MG TABLET

ENALAPRIL-HYDROCHLOROTHIAZIDE

ENALAPRIL-HYDROCHLOROTHIAZIDE5-12.5 MG TAB

ENALAPRIL-HYDROCHLOROTHIAZIDE

EPOPROSTENOL SODIUM 0.5 MG VL EPOPROSTENOL SODIUM


43



EPOPROSTENOL SODIUM 1.5 MG VL EPOPROSTENOL SODIUM

FLOLAN 0.5 MG VIAL FLOLAN

FLOLAN 1.5 MG VIAL FLOLAN

FOSINOPRIL SODIUM 10 MG TAB FOSINOPRIL SODIUM



FOSINOPRIL-HYDROCHLOROTHIAZIDE 10-12.5 MGTAB

FOSINOPRIL-HYDROCHLOROTHIAZIDE

FOSINOPRIL-HYDROCHLOROTHIAZIDE 20-12.5 MGTAB

FOSINOPRIL-HYDROCHLOROTHIAZIDE

GUANFACINE 1 MG TABLET GUANFACINE HCL

GUANFACINE 2 MG TABLET GUANFACINE HCL

HYDRALAZINE 10 MG TABLET HYDRALAZINE HCL


HYDRALAZINE 20 MG/ML VIAL HYDRALAZINE HCL



IRBESARTAN 150 MG TABLET IRBESARTAN QL Limited to 30 Tablets per 30 days





LISINOPRIL 10 MG TABLET LISINOPRIL

LISINOPRIL 2.5 MG TABLET LISINOPRIL





LISINOPRIL-HYDROCHLOROTHIAZIDE10-12.5 MG TAB

LISINOPRIL-HYDROCHLOROTHIAZIDE

LISINOPRIL-HYDROCHLOROTHIAZIDE20-12.5 MG TAB


LISINOPRIL-HYDROCHLOROTHIAZIDE20-25 MG TAB


LOSARTAN POTASSIUM 100 MG TAB LOSARTAN POTASSIUM QL Limited to 30 Tablets per 30 days



LOSARTAN-HYDROCHLOROTHIAZIDE100-12.5 MG TAB

LOSARTAN-HYDROCHLOROTHIAZIDE

QL Limited to 30 Tablets per 30 days

LOSARTAN-HYDROCHLOROTHIAZIDE100-25 MG TAB



LOSARTAN-HYDROCHLOROTHIAZIDE50-12.5 MG TAB



METHYLDOPA 250 MG TABLET METHYLDOPA


44



METHYLDOPA 500 MG TABLET METHYLDOPA

METOPROLOL-HYDROCHLOROTHIAZIDE 100-25 MGTAB

METOPROLOL-HYDROCHLOROTHIAZIDE





PRAZOSIN 1 MG CAPSULE PRAZOSIN HCL



PROPRANOLOL-HYDROCHLOROTHIAZIDE 40-25 MGTAB

PROPRANOLOL-HYDROCHLOROTHIAZID

PROPRANOLOL-HYDROCHLOROTHIAZIDE 80-25 MGTAB

PROPRANOLOL-HYDROCHLOROTHIAZID

QUINAPRIL 10 MG TABLET QUINAPRIL HCL




QUINAPRIL-HYDROCHLOROTHIAZIDE10-12.5 MG TAB

QUINAPRIL-HYDROCHLOROTHIAZIDE

QUINAPRIL-HYDROCHLOROTHIAZIDE20-12.5 MG TAB


QUINAPRIL-HYDROCHLOROTHIAZIDE20-25 MG TAB


RAMIPRIL 1.25 MG CAPSULE RAMIPRIL

RAMIPRIL 10 MG CAPSULE RAMIPRIL

RAMIPRIL 2.5 MG CAPSULE RAMIPRIL

RAMIPRIL 5 MG CAPSULE RAMIPRIL

SILDENAFIL 10 MG/12.5 ML VIAL SILDENAFIL CITRATE QL Limited to 30mg per 30 days

SILDENAFIL 20 MG TABLET SILDENAFIL QL Limited to 30 Tablets per 30 days

TEKTURNA 150 MG TABLET TEKTURNA

TEKTURNA 300 MG TABLET TEKTURNA

TEKTURNA HCT 150-12.5 MG TAB TEKTURNA HCT

TEKTURNA HCT 150-25 MG TABLET TEKTURNA HCT

TEKTURNA HCT 300-12.5 MG TAB TEKTURNA HCT

TEKTURNA HCT 300-25 MG TABLET TEKTURNA HCT

TERAZOSIN 1 MG CAPSULE TERAZOSIN HCL





45

Antineoplastic - Alkylating Agents


ALKERAN 2 MG TABLET ALKERAN

CYCLOPHOSPHAMIDE 500 MG VIAL CYCLOPHOSPHAMIDE

GLEOSTINE 10 MG CAPSULE GLEOSTINE



HEXALEN 50 MG CAPSULE HEXALEN

LEUKERAN 2 MG TABLET LEUKERAN

MATULANE 50 MG CAPSULE MATULANE

MELPHALAN 2 MG TABLET MELPHALAN

MYLERAN 2 MG TABLET MYLERAN

TEMODAR 100 MG CAPSULE TEMODAR PA Prior Authorization Required

TEMODAR 140 MG CAPSULE TEMODAR PA,QL Prior Auhtorization required; Limited to90 capsules per 30 days


TEMODAR 20 MG CAPSULE TEMODAR PA,QL Prior Authorization Required; limited to120 capsules per 30 days


TEMODAR 5 MG CAPSULE TEMODAR PA,QL Prior Authorization required; Limited to90 capsules per 30 days







Antineoplastic - Antibody/Antibody-Drug Complexes


PERJETA 420 MG/14 ML VIAL PERJETA PA Prior Authorization required





FLUOROURACIL 1,000 MG/20 ML VL FLUOROURACIL

FLUOROURACIL 2,500 MG/50 ML VL FLUOROURACIL

FLUOROURACIL 2.5 GM/50 ML BTL FLUOROURACIL

FLUOROURACIL 2.5 GM/50 ML VIAL FLUOROURACIL

FLUOROURACIL 5 GM/100 ML BTL FLUOROURACIL

FLUOROURACIL 5 GM/100 ML VIAL FLUOROURACIL

FLUOROURACIL 5,000 MG/100 ML FLUOROURACIL

FLUOROURACIL 500 MG/10 ML VIAL FLUOROURACIL

HYDREA 500 MG CAPSULE HYDREA

HYDROXYUREA 500 MG CAPSULE HYDROXYUREA


46



MERCAPTOPURINE 50 MG TABLET MERCAPTOPURINE

TABLOID 40 MG TABLET TABLOID



Antineoplastic - Hedgehog Pathway Inhibitor


ERIVEDGE 150 MG CAPSULE ERIVEDGE PA Prior Authorization required



ANASTROZOLE 1 MG TABLET ANASTROZOLE

ARIMIDEX 1 MG TABLET ARIMIDEX

BICALUTAMIDE 50 MG TABLET BICALUTAMIDE

CASODEX 50 MG TABLET CASODEX









EMCYT 140 MG CAPSULE EMCYT

EXEMESTANE 25 MG TABLET EXEMESTANE

FARESTON 60 MG TABLET FARESTON

FLUTAMIDE 125 MG CAPSULE FLUTAMIDE

LETROZOLE 2.5 MG TABLET LETROZOLE

LEUPROLIDE 1 MG/0.2 ML VIAL LEUPROLIDE ACETATE PA Prior Authorization Required

LEUPROLIDE 2WK 1 MG/0.2 ML KIT LEUPROLIDE ACETATE PA Prior Authorization Required

LEUPROLIDE 2WK 14 MG/2.8 ML KT LEUPROLIDE ACETATE PA Prior Authorization Required

LEUPROLIDE 2WK 14 MG/2.8 ML VL LEUPROLIDE ACETATE PA Prior Authorization Required


LUPRON DEPOT 45 MG 6MO KIT LUPRON DEPOT PA Prior Authorization Required


LUPRON DEPOT-4 MONTH KIT LUPRON DEPOT PA Prior Authorization Required

LYSODREN 500 MG TABLET LYSODREN

MEGESTROL 20 MG TABLET MEGESTROL ACETATE

MEGESTROL 40 MG TABLET MEGESTROL ACETATE

NILUTAMIDE 150 MG TABLET NILUTAMIDE

TAMOXIFEN 10 MG TABLET TAMOXIFEN CITRATE

TAMOXIFEN 20 MG TABLET TAMOXIFEN CITRATE




47







XTANDI 40 MG CAPSULE XTANDI PA Prior Authorization Required



Antineoplastic - Immunomodulators


INTRON A 10 MILLION UNITS VIAL INTRON A

INTRON A 18 MILLION UNIT/3 ML INTRON A


INTRON A 25 MILLION UNIT/2.5 ML INTRON A


Antineoplastic - Mast Cell Stabilizers


CROMOLYN 100 MG/5 ML ORALCONC

CROMOLYN SODIUM

Antineoplastic - Metal Complexes


OXALIPLATIN 100 MG VIAL OXALIPLATIN

OXALIPLATIN 100 MG/20 ML VIAL OXALIPLATIN

Antineoplastic - Retinoids and Retinoid Receptor Agonists


BEXAROTENE 75 MG CAPSULE BEXAROTENE

TARGRETIN 75 MG CAPSULE TARGRETIN







COMETRIQ 60 MG DAILY-DOSE PACK COMETRIQ PA Prior Authorization required








48













ZELBORAF 240 MG TABLET ZELBORAF PA Prior Authorization required

Antineoplastic - Topoisomerase Inhibitors


ETOPOSIDE 50 MG CAPSULE ETOPOSIDE

HYCAMTIN 0.25 MG CAPSULE HYCAMTIN PA Prior Authorization Required

HYCAMTIN 1 MG CAPSULE HYCAMTIN PA Prior Authorization Required

Antiparasitics


ATOVAQUONE-PROGUANIL 250-100MG TABLET

ATOVAQUONE-PROGUANILHCL

ATOVAQUONE-PROGUANIL 62.5-25 ATOVAQUONE-PROGUANILHCL

CHLOROQUINE PH 250 MG TABLET CHLOROQUINE PHOSPHATE

CHLOROQUINE PH 500 MG TABLET CHLOROQUINE PHOSPHATE

HYDROXYCHLOROQUINE 200 MGTAB

HYDROXYCHLOROQUINESULFATE

MEFLOQUINE HCL 250 MG TABLET MEFLOQUINE HCL

Antiparkinson Therapy


AMANTADINE 100 MG CAPSULE AMANTADINE

BENZTROPINE MES 0.5 MG TAB BENZTROPINE MESYLATE

BENZTROPINE MES 1 MG TABLET BENZTROPINE MESYLATE

BENZTROPINE MES 2 MG TABLET BENZTROPINE MESYLATE

BROMOCRIPTINE 2.5 MG TABLET BROMOCRIPTINE MESYLATE

BROMOCRIPTINE 5 MG CAPSULE BROMOCRIPTINE MESYLATE

CARBIDOPA-LEVODOPA 10-100 TAB CARBIDOPA-LEVODOPA



CARBIDOPA-LEVODOPA-ENTACAPONE 12.5-50-200 MG TAB

CARBIDOPA-LEVODOPA-ENTACAPONE




49

Antiparkinson Therapy


CARBIDOPA-LEVODOPA-ENTACAPONE 25-100-200 MG TAB






CARBIDOPA-LEVODOPA-ENTACAPONE 50-200-200 MG TAB


ENTACAPONE 200 MG TABLET ENTACAPONE

PRAMIPEXOLE 0.125 MG TABLET PRAMIPEXOLEDIHYDROCHLORIDE




PRAMIPEXOLE 1 MG TABLET PRAMIPEXOLEDIHYDROCHLORIDE


PRAMIPEXOLE ER 0.375 MG TABLET PRAMIPEXOLE ER




PRAMIPEXOLE ER 3 MG TABLET PRAMIPEXOLE ER



ROPINIROLE HCL 0.25 MG TABLET ROPINIROLE HCL

ROPINIROLE HCL 0.5 MG TABLET ROPINIROLE HCL

ROPINIROLE HCL 1 MG TABLET ROPINIROLE HCL





ROPINIROLE HCL ER 12 MG TABLET ROPINIROLE ER





SELEGILINE HCL 5 MG CAPSULE SELEGILINE HCL

SELEGILINE HCL 5 MG TABLET SELEGILINE HCL

TRIHEXYPHENIDYL 2 MG TABLET TRIHEXYPHENIDYL HCL

TRIHEXYPHENIDYL 2 MG/5 ML ELX TRIHEXYPHENIDYL HCL

TRIHEXYPHENIDYL 5 MG TABLET TRIHEXYPHENIDYL HCL


50

Antiprotozoal-Antibacterial Agents


METRONIDAZOLE 250 MG TABLET METRONIDAZOLE

METRONIDAZOLE 375 MG CAPSULE METRONIDAZOLE

METRONIDAZOLE 500 MG TABLET METRONIDAZOLE

METRONIDAZOLE 500 MG/100 ML METRONIDAZOLE

Antipsychotics (Neuroleptics)


CLOZAPINE 100 MG TABLET CLOZAPINE QL




CLOZAPINE ODT 100 MG TABLET CLOZAPINE ODT QL

CLOZAPINE ODT 12.5 MG TABLET CLOZAPINE ODT

CLOZAPINE ODT 150 MG TABLET CLOZAPINE ODT



FLUPHENAZINE 1 MG TABLET FLUPHENAZINE HCL


FLUPHENAZINE 2.5 MG TABLET FLUPHENAZINE HCL

FLUPHENAZINE 2.5 MG/5 ML ELIX FLUPHENAZINE HCL

FLUPHENAZINE 2.5 MG/ML VIAL FLUPHENAZINE HCL


FLUPHENAZINE 5 MG/ML CONC FLUPHENAZINE HCL

FLUPHENAZINE DEC 125 MG/5 ML FLUPHENAZINE DECANOATE

HALOPERIDOL 0.5 MG TABLET HALOPERIDOL

HALOPERIDOL 1 MG TABLET HALOPERIDOL





HALOPERIDOL DEC 100 MG/ML AMP HALOPERIDOL DECANOATE100

HALOPERIDOL DEC 100 MG/ML VIAL HALOPERIDOL DECANOATE

HALOPERIDOL DEC 50 MG/ML VIAL HALOPERIDOL DECANOATE

HALOPERIDOL DEC 500 MG/5 ML VL HALOPERIDOL DECANOATE

HALOPERIDOL DECAN 50 MG/ML AMP HALOPERIDOL DECANOATE

HALOPERIDOL LAC 2 MG/ML CONC HALOPERIDOL LACTATE

HALOPERIDOL LAC 5 MG/ML AMPUL HALOPERIDOL LACTATE

HALOPERIDOL LAC 5 MG/ML SYRING HALOPERIDOL LACTATE

HALOPERIDOL LAC 5 MG/ML VIAL HALOPERIDOL LACTATE

HALOPERIDOL LAC 50 MG/10 ML VL HALOPERIDOL LACTATE

INVEGA SUSTENNA 117 MG/0.75 ML INVEGA SUSTENNA

INVEGA SUSTENNA 156 MG/ML SYRG INVEGA SUSTENNA



51





OLANZAPINE 10 MG TABLET OLANZAPINE

OLANZAPINE 10 MG VIAL OLANZAPINE QL Limited to 30mg per 25 days


OLANZAPINE 2.5 MG TABLET OLANZAPINE



OLANZAPINE 7.5 MG TABLET OLANZAPINE

OLANZAPINE ODT 10 MG TABLET OLANZAPINE ODT QL Limited to 30 Tablets per 25 days




PERPHENAZINE 16 MG TABLET PERPHENAZINE




PROCHLORPERAZINE 10 MG TAB PROCHLORPERAZINEMALEATE

PROCHLORPERAZINE 5 MG TABLET PROCHLORPERAZINEMALEATE

QUETIAPINE ER 150 MG TABLET QUETIAPINE FUMARATE ER QL Limited to 60 tablets per 30 days





QUETIAPINE FUMARATE 100 MG TAB QUETIAPINE FUMARATE QL Limited to 60 tablets per 30 days






RISPERIDONE 0.25 MG TABLET RISPERIDONE

RISPERIDONE 0.5 MG TABLET RISPERIDONE

RISPERIDONE 1 MG TABLET RISPERIDONE




THIOTHIXENE 1 MG CAPSULE THIOTHIXENE




TRIFLUOPERAZINE 1 MG TABLET TRIFLUOPERAZINE HCL


52






ZIPRASIDONE HCL 20 MG CAPSULE ZIPRASIDONE HCL




Antitussives


BENZONATATE 100 MG CAPSULE BENZONATATE



Antivirals


ACYCLOVIR 200 MG CAPSULE ACYCLOVIR

ACYCLOVIR 200 MG/5 ML SUSP ACYCLOVIR

ACYCLOVIR 400 MG TABLET ACYCLOVIR

ACYCLOVIR 800 MG TABLET ACYCLOVIR

ADEFOVIR DIPIVOXIL 10 MG TAB ADEFOVIR DIPIVOXIL

APTIVUS 100 MG/ML SOLUTION APTIVUS PA Prior Authorization required

APTIVUS 250 MG CAPSULE APTIVUS PA Prior Authorization required

EPCLUSA 400 MG-100 MG TABLET EPCLUSA PA,SP Prior Authorization required

EPIVIR HBV 100 MG TABLET EPIVIR HBV

EPIVIR HBV 25 MG/5 ML SOLN EPIVIR HBV

FAMCICLOVIR 125 MG TABLET FAMCICLOVIR



GANCICLOVIR 500 MG VIAL GANCICLOVIR SODIUM

HEPSERA 10 MG TABLET HEPSERA PA Prior Authorization required

MAVYRET 100-40 MG TABLET MAVYRET PA,SP Prior Authorization required

OSELTAMIVIR PHOS 30 MG CAPSULE OSELTAMIVIR PHOSPHATE



PEGASYS 180 MCG/0.5 ML SYRINGE PEGASYS PA Prior Authorization Required

PEGASYS 180 MCG/ML VIAL PEGASYS PA Prior Authorization Required

PEGASYS PROCLICK 135 MCG/0.5 ML PEGASYS PROCLICK PA Prior Authorization Required

PEGASYS PROCLICK 180 MCG/0.5 PEGASYS PROCLICK PA Prior Authorization Required

PEGINTRON 50 MCG KIT PEGINTRON REDIPEN PA Prior Authorization Required




REBETOL 40 MG/ML SOLUTION REBETOL PA Prior Authorization required

RELENZA 5 MG DISKHALER RELENZA


53

Antivirals


RIBAVIRIN 200 MG CAPSULE RIBAVIRIN PA Prior Authorization required

RIBAVIRIN 200 MG TABLET RIBAVIRIN PA Prior Authorization required

RIBAVIRIN 6 GM INHALATION VIAL RIBAVIRIN PA Prior Authorization required

RIMANTADINE HCL 100 MG TABLET RIMANTADINE HCL

TAMIFLU 30 MG CAPSULE TAMIFLU


TAMIFLU 6 MG/ML SUSPENSION TAMIFLU






VALACYCLOVIR HCL 1 GRAM TABLET VALACYCLOVIR

VALACYCLOVIR HCL 500 MG TABLET VALACYCLOVIR

Appetite Stimulants


MEGESTROL 800 MG/20 ML SUSP MEGESTROL ACETATE

MEGESTROL ACET 40 MG/ML SUSP MEGESTROL ACETATE

MEGESTROL ACET 400 MG/10 ML MEGESTROL ACETATE

MEGESTROL ACET 800 MG/20 ML MEGESTROL ACETATE



ADVAIR 100-50 DISKUS ADVAIR DISKUS



ADVAIR HFA 115-21 MCG INHALER ADVAIR HFA



ALBUTEROL 15 MG/3 ML SOLUTION(CMPD-RX)

ALBUTEROL SULFATE Ventolin HFA is the preferred AlbuterolSulfate Inhaler.

ALBUTEROL 2.5 MG/0.5 ML SOL ALBUTEROL SULFATE Ventolin HFA is the preferred AlbuterolSulfate Inhaler.

ALBUTEROL 20 MG/4 ML SOLUTION(CMPD-RX)

ALBUTEROL SULFATE Ventolin HFA is the preferred AlbuterolSulfate Inhaler.

ALBUTEROL 5 MG/ML SOLUTION ALBUTEROL SULFATE Ventolin HFA is the preferred AlbuterolSulfate Inhaler.

ALBUTEROL SUL 0.63 MG/3 ML SOL ALBUTEROL SULFATE Ventolin HFA is the preferred AlbuterolSulfate Inhaler.

ALBUTEROL SUL 1.25 MG/3 ML SOL ALBUTEROL SULFATE Ventolin HFA is the preferred AlbuterolSulfate Inhaler.

ALBUTEROL SUL 2.5 MG/3 ML SOLN ALBUTEROL SULFATE Ventolin HFA is the preferred AlbuterolSulfate Inhaler.

ALBUTEROL SULF 2 MG/5 ML SYRUP ALBUTEROL SULFATE

ALBUTEROL SULFATE 2 MG TAB ALBUTEROL SULFATE

ALBUTEROL SULFATE 4 MG TAB ALBUTEROL SULFATE


54



ALBUTEROL SULFATE ER 4 MG TAB ALBUTEROL SULFATE

ALBUTEROL SULFATE ER 8 MG TAB ALBUTEROL SULFATE

ATROVENT 17 MCG HFA INHALER ATROVENT HFA

BUDESONIDE 0.25 MG/2 ML SUSP BUDESONIDE

BUDESONIDE 0.5 MG/2 ML SUSP BUDESONIDE

COMBIVENT RESPIMAT 20-100 MCG COMBIVENT RESPIMAT

CROMOLYN 20 MG/2 ML NEB SOLN CROMOLYN SODIUM

DULERA 100 MCG/5 MCG INHALER DULERA

DULERA 200 MCG/5 MCG INHALER DULERA

FLOVENT 100 MCG DISKUS FLOVENT DISKUS



FLOVENT HFA 110 MCG INHALER FLOVENT HFA



FLUTICASONE-SALMETEROL 113-14 FLUTICASONE-SALMETEROL



FORADIL AEROLIZER 12 MCG CAP FORADIL

INCRUSE ELLIPTA 62.5 MCG INH INCRUSE ELLIPTA

IPRATROPIUM BR 0.02% SOLN IPRATROPIUM BROMIDE

LEVALBUTEROL 0.31 MG/3 ML SOL LEVALBUTEROL HCL



LEVALBUTEROL CONC 1.25 MG/0.5 LEVALBUTEROLCONCENTRATE

LEVALBUTEROL TAR HFA 45 MCGINH

LEVALBUTEROL TARTRATEHFA

MONTELUKAST SOD 10 MG TABLET MONTELUKAST SODIUM

MONTELUKAST SOD 4 MGGRANULES

MONTELUKAST SODIUM

MONTELUKAST SOD 4 MG TAB CHEW MONTELUKAST SODIUM

MONTELUKAST SOD 5 MG TAB CHEW MONTELUKAST SODIUM

PROAIR HFA 90 MCG INHALER PROAIR HFA Ventolin HFA is the preferred AlbuterolSulfate Inhaler.

PROVENTIL HFA 90 MCG INHALER PROVENTIL HFA Ventolin HFA is the preferred AlbuterolSulfate Inhaler.

PULMICORT 180 MCG FLEXHALER PULMICORT FLEXHALER

PULMICORT 90 MCG FLEXHALER PULMICORT FLEXHALER

SEREVENT DISKUS 50 MCG SEREVENT DISKUS

SPIRIVA 18 MCG CP-HANDIHALER SPIRIVA

SYMBICORT 160-4.5 MCG INHALER SYMBICORT

SYMBICORT 80-4.5 MCG INHALER SYMBICORT

TERBUTALINE SULF 1 MG/ML VIAL TERBUTALINE SULFATE


55



TERBUTALINE SULFATE 2.5 MG TAB TERBUTALINE SULFATE

TERBUTALINE SULFATE 5 MG TAB TERBUTALINE SULFATE

THEOPHYLLINE 200 MG/100 ML D5W THEOPHYLLINE IN 5%DEXTROSE




THEOPHYLLINE 80 MG/15 ML SOLN THEOPHYLLINE


THEOPHYLLINE ER 100 MG TABLET THEOPHYLLINE ANHYDROUS

THEOPHYLLINE ER 200 MG TABLET THEOPHYLLINE ANHYDROUS

THEOPHYLLINE ER 300 MG TAB THEOPHYLLINE ANHYDROUS

THEOPHYLLINE ER 400 MG TABLET THEOPHYLLINE

THEOPHYLLINE ER 450 MG TAB THEOPHYLLINE ANHYDROUS

THEOPHYLLINE ER 600 MG TABLET THEOPHYLLINE

VENTOLIN HFA 90 MCG INHALER VENTOLIN HFA Ventolin HFA is the preferred AlbuterolSulfate Inhaler.

XOLAIR 150 MG VIAL XOLAIR PA Prior Authorization required

XOPENEX 0.31 MG/3 ML SOLUTION XOPENEX Ventolin HFA is the preferred AlbuterolSulfate Inhaler.

XOPENEX 0.63 MG/3 ML SOLUTION XOPENEX

XOPENEX 1.25 MG/3 ML SOLUTION XOPENEX

XOPENEX CONC 1.25 MG/0.5 ML XOPENEX CONCENTRATE

XOPENEX HFA 45 MCG INHALER XOPENEX HFA

ZAFIRLUKAST 10 MG TABLET ZAFIRLUKAST

ZAFIRLUKAST 20 MG TABLET ZAFIRLUKAST

Attention Deficit-Hyperact Disorder (ADHD) Therapy


CLONIDINE HCL ER 0.1 MG TABLET CLONIDINE HCL ER

DEXMETHYLPHENIDATE 10 MG TAB DEXMETHYLPHENIDATE HCL

DEXMETHYLPHENIDATE 2.5 MG TAB DEXMETHYLPHENIDATE HCL

DEXMETHYLPHENIDATE 5 MG TAB DEXMETHYLPHENIDATE HCL

DEXMETHYLPHENIDATE ER 10 MGCP

DEXMETHYLPHENIDATE HCLER










56

Attention Deficit-Hyperact Disorder (ADHD) Therapy






DEXMETHYLPHENIDATE ER 5 MGCAP


GUANFACINE HCL ER 1 MG TABLET GUANFACINE HCL ER




METHYLPHENIDATE 10 MG TABLET METHYLPHENIDATE HCL



METHYLPHENIDATE ER 10 MG TAB METHYLPHENIDATE ER


METHYLPHENIDATE ER 20 MG CAP METHYLPHENIDATE ER







METHYLPHENIDATE LA 20 MG CAP METHYLPHENIDATE LA



RITALIN LA 20 MG CAPSULE RITALIN LA

Beta Adrenergic Blockers


ATENOLOL 100 MG TABLET ATENOLOL



BISOPROLOL FUMARATE 10 MG TAB BISOPROLOL FUMARATE

BISOPROLOL FUMARATE 5 MG TAB BISOPROLOL FUMARATE

CARVEDILOL 12.5 MG TABLET CARVEDILOL QL

CARVEDILOL 25 MG TABLET CARVEDILOL QL



LABETALOL HCL 100 MG TABLET LABETALOL HCL

LABETALOL HCL 100 MG/20 ML VL LABETALOL HCL

LABETALOL HCL 20 MG/4 ML CRPJ LABETALOL HCL

LABETALOL HCL 20 MG/4 ML SYR LABETALOL HCL

LABETALOL HCL 20 MG/4 MLSYRINGE (CMPD-RX)

LABETALOL HCL



57

Beta Adrenergic Blockers


LABETALOL HCL 200 MG/40 ML VL LABETALOL HCL

LABETALOL HCL 25 MG/5 ML SYR LABETALOL HCL


LABETALOL HCL

LABETALOL HCL 25 MG/5 ML-WATERSYRINGE (CMPD-RX)

LABETALOL HCL-WATER



LABETALOL HCL

LABETALOL HCL 50 MG/10 ML SYRN LABETALOL HCL

METOPROLOL SUCC ER 100 MG TAB METOPROLOL SUCCINATE




METOPROLOL TART 5 MG/5 ML AMP METOPROLOL TARTRATE

METOPROLOL TART 5 MG/5 ML VIAL METOPROLOL TARTRATE

METOPROLOL TARTRATE 100 MGTAB

METOPROLOL TARTRATE

METOPROLOL TARTRATE 25 MG TAB METOPROLOL TARTRATE

METOPROLOL TARTRATE 50 MG TAB METOPROLOL TARTRATE

NADOLOL 20 MG TABLET NADOLOL



PROPRANOLOL 1 MG/ML VIAL PROPRANOLOL HCL

PROPRANOLOL 10 MG TABLET PROPRANOLOL HCL


PROPRANOLOL 20 MG/5 ML SOLN PROPRANOLOL HCL


PROPRANOLOL 40 MG/5 ML SOLN PROPRANOLOL HCL



PROPRANOLOL ER 120 MG CAPSULE PROPRANOLOL HCL ER




TIMOLOL MALEATE 10 MG TABLET TIMOLOL MALEATE









58






ARIPIPRAZOLE 10 MG TABLET ARIPIPRAZOLE






LITHIUM CARBONATE 150 MG CAP LITHIUM CARBONATE


LITHIUM CARBONATE 300 MG TAB LITHIUM CARBONATE


LITHIUM CARBONATE ER 300 MG TB LITHIUM CARBONATE ER

LITHIUM CARBONATE ER 450 MG TB LITHIUM CARBONATE ER

Blood Albumin and Plasma Proteins


CINRYZE 500 UNIT VIAL CINRYZE PA Prior Authorization required

Bradykinin B2 Receptor Antagonists


FIRAZYR 30 MG/3 ML SYRINGE FIRAZYR PA Prior Authorization required

Calcium and Bone Metabolism Regulators


ALENDRONATE SODIUM 10 MG TAB ALENDRONATE SODIUM QL Limited to 30 Tablets per 30 days

ALENDRONATE SODIUM 35 MG TAB ALENDRONATE SODIUM QL

ALENDRONATE SODIUM 40 MG TAB ALENDRONATE SODIUM QL Limited to 30 Tablets per 30 days

ALENDRONATE SODIUM 70 MG TAB ALENDRONATE SODIUM QL

CALCITONIN-SALMON 200 UNITS SP CALCITONIN-SALMON

EVISTA 60 MG TABLET EVISTA

FORTEO 600 MCG/2.4 ML PEN INJ FORTEO PA Prior Authorization required

MIACALCIN 200 UNIT NASAL SPRAY MIACALCIN

MIACALCIN 400 UNIT/2 ML VIAL MIACALCIN

RALOXIFENE HCL 60 MG TABLET RALOXIFENE HCL

Calcium Channel Blockers and Combinations


AMLODIPINE BESYLATE 10 MG TAB AMLODIPINE BESYLATE QL Limited to 30 Tablets per 30 days

AMLODIPINE BESYLATE 2.5 MG TAB AMLODIPINE BESYLATE QL Limited to 30 Tablets per 30 days

AMLODIPINE BESYLATE 5 MG TAB AMLODIPINE BESYLATE QL Limited to 30 Tablets per 30 days

DILTIAZEM 120 MG TABLET DILTIAZEM HCL

DILTIAZEM 12HR ER 120 MG CAP DILTIAZEM 12HR ER



DILTIAZEM 24HR CD 120 MG CAP DILTIAZEM 24HR CD


59

Calcium Channel Blockers and Combinations








DILTIAZEM 24HR ER 180 MG TAB DILTIAZEM 24HR ER












DILTIAZEM ER 120 MG CAPSULE DILTIAZEM ER



NIFEDIPINE 10 MG CAPSULE NIFEDIPINE

NIFEDIPINE 20 MG CAPSULE NIFEDIPINE

NIFEDIPINE ER 30 MG TABLET NIFEDIPINE ER



VERAPAMIL ER 120 MG CAPSULE VERAPAMIL ER

VERAPAMIL ER 120 MG TABLET VERAPAMIL ER

VERAPAMIL ER 180 MG CAPSULE VERAPAMIL ER



VERAPAMIL ER PM 300 MG CAPSULE VERAPAMIL ER PM

VERAPAMIL SR 120 MG CAPSULE VERAPAMIL SR

VERAPAMIL SR 180 MG CAPSULE VERAPAMIL SR

Cardiac Inotropes


DIGOXIN 0.05 MG/ML SOLUTION DIGOXIN

DIGOXIN 0.125 MG TABLET DIGOXIN

DIGOXIN 0.125 MG/2.5 ML SOLN DIGOXIN

DIGOXIN 0.25 MG TABLET DIGOXIN

DIGOXIN 0.25 MG/5 ML SOLUTION DIGOXIN

DIGOXIN 0.25 MG/ML SYRINGE DIGOXIN

DIGOXIN 125 MCG TABLET DIGOXIN


60

Cardiac Inotropes


DIGOXIN 250 MCG TABLET DIGOXIN

DIGOXIN 500 MCG/2 ML AMPULE DIGOXIN

Cardiovascular Sympathomimetics and Combinations


EPINEPHRINE 0.15 MG AUTO-INJCT EPINEPHRINE

EPINEPHRINE 0.3 MG AUTO-INJECT EPINEPHRINE

MIDODRINE HCL 10 MG TABLET MIDODRINE HCL

MIDODRINE HCL 2.5 MG TABLET MIDODRINE HCL

MIDODRINE HCL 5 MG TABLET MIDODRINE HCL

Chelating Agents





Chemotherapy Rescue-Antidote Agents


LEUCOVORIN CALCIUM 10 MG TAB LEUCOVORIN CALCIUM

LEUCOVORIN CALCIUM 100 MG VIAL LEUCOVORIN CALCIUM



MESNA 1 GRAM/10 ML VIAL MESNA

MESNA 100 MG/ML VIAL MESNA

CNS Stimulants


DEXTROAMP-AMPHET ER 10 MG CAP DEXTROAMPHETAMINE-AMPHET ER

QL Limited to 60 capsules per 30 days











DEXTROAMP-AMPHETAMIN 10 MGTAB

DEXTROAMPHETAMINE-AMPHETAMINE





DEXTROAMP-AMPHETAMINE 5 MGTAB


DEXTROAMPHETAMINE 10 MG TAB DEXTROAMPHETAMINESULFATE


61

CNS Stimulants


DEXTROAMPHETAMINE 5 MG TAB DEXTROAMPHETAMINESULFATE

DEXTROAMPHETAMINE 5 MG/5 ML DEXTROAMPHETAMINESULFATE

DEXTROAMPHETAMINE ER 10 MGCAP

DEXTROAMPHETAMINESULFATE ER

DEXTROAMPHETAMINE ER 15 MGCAP

DEXTROAMPHETAMINESULFATE ER

DEXTROAMPHETAMINE ER 5 MG CAP DEXTROAMPHETAMINESULFATE ER

Cognitive Disorder Therapy - Antidementia


DONEPEZIL HCL 10 MG TABLET DONEPEZIL HCL

DONEPEZIL HCL 5 MG TABLET DONEPEZIL HCL

GALANTAMINE 4 MG/ML ORAL SOLN GALANTAMINEHYDROBROMIDE

GALANTAMINE ER 16 MG CAPSULE GALANTAMINE ER



GALANTAMINE HBR 12 MG TABLET GALANTAMINE HBR



RIVASTIGMINE 1.5 MG CAPSULE RIVASTIGMINE

RIVASTIGMINE 13.3 MG/24HR PTCH RIVASTIGMINE

RIVASTIGMINE 3 MG CAPSULE RIVASTIGMINE

RIVASTIGMINE 4.5 MG CAPSULE RIVASTIGMINE

RIVASTIGMINE 4.6 MG/24HR PATCH RIVASTIGMINE

RIVASTIGMINE 6 MG CAPSULE RIVASTIGMINE

RIVASTIGMINE 9.5 MG/24HR PATCH RIVASTIGMINE

Colonic Acidifier (Ammonia Inhibitor)


ENULOSE 10 GM/15 ML SOLUTION ENULOSE

GENERLAC 10 GM/15 ML SOLUTION GENERLAC

LACTULOSE 10 GM/15 ML SOLUTION LACTULOSE

Contraceptives Implant


NEXPLANON 68 MG IMPLANT NEXPLANON

Contraceptives Injectable


MEDROXYPROGESTERONE 150 MG/ML

DEPO-PROVERA

Contraceptives Intravaginal


NUVARING VAGINAL RING NUVARING QL


62

Contraceptives Oral


ALTAVERA-28 TABLET ALTAVERA

ALYACEN 1-35 28 TABLET ALYACEN

ALYACEN 7-7-7-28 TABLET ALYACEN

AMETHIA 0.15-0.03-0.01 MG TAB AMETHIA

AMETHIA LO TABLET AMETHIA LO

APRI 28 DAY TABLET APRI

ARANELLE 28 TABLET ARANELLE

ASHLYNA 0.15-0.03-0.01 MG TAB ASHLYNA

AUBRA EQ-28 TABLET AUBRA EQ

AUBRA-28 TABLET AUBRA

AVIANE-28 TABLET AVIANE

AZURETTE 28 DAY TABLET AZURETTE

BALZIVA 28 TABLET BALZIVA

BEKYREE 28 DAY TABLET BEKYREE

BLISOVI FE 1-20 TABLET BLISOVI FE

BLISOVI FE 1.5-30 TABLET BLISOVI FE

BREVICON 28 TABLET BREVICON

BRIELLYN TABLET BRIELLYN

CAMILA 0.35 MG TABLET CAMILA

CAMRESE 0.15-0.03-0.01 MG TAB CAMRESE

CAMRESE LO TABLET CAMRESE LO

CAZIANT 28 DAY TABLET CAZIANT

CHATEAL EQ-28 TABLET CHATEAL EQ

CHATEAL-28 TABLET CHATEAL

CRYSELLE-28 TABLET CRYSELLE

CYCLAFEM 1-35-28 TABLET CYCLAFEM

CYCLAFEM 7-7-7-28 TABLET CYCLAFEM

CYCLESSA 28 DAY TABLET CYCLESSA

CYRED 28 DAY TABLET CYRED

CYRED EQ 28 DAY TABLET CYRED EQ

DASETTA 1-35-28 TABLET DASETTA

DASETTA 7/7/7-28 TABLET DASETTA

DAYSEE 0.15-0.03-0.01 MG TAB DAYSEE

DEBLITANE 0.35 MG TABLET DEBLITANE

DELYLA-28 TABLET DELYLA

DESOGEN 28 DAY TABLET DESOGEN

DESOGEST-ETH ESTRA 0.15-0.03 MG DESOGESTREL-ETHINYLESTRADIOL

DESOGESTREL-ETHINYL ESTRADTAB

DESOGESTREL-ETHINYLESTRADIOL

DROSPIRENONE-EE 3-0.02 MG TAB DROSPIRENONE-ETHINYLESTRADIOL

DROSPIRENONE-EE 3-0.03 MG TAB DROSPIRENONE-ETHINYLESTRADIOL


63

Contraceptives Oral


ELINEST-28 TABLET ELINEST

EMOQUETTE 28 DAY TABLET EMOQUETTE

ENPRESSE-28 TABLET ENPRESSE

ENSKYCE 28 TABLET ENSKYCE

ERRIN 0.35 MG TABLET ERRIN

ESTARYLLA 0.25 MG-0.035 MGTABLET

ESTARYLLA

ESTARYLLA 0.25-0.035 MG TABLET ESTARYLLA

ETHYNODIOL-ETH ESTRA 1 MG-35MCG

ETHYNODIOL-ETHINYLESTRADIOL

ETHYNODIOL-ETH ESTRA 1 MG-50MCG

ETHYNODIOL-ETHINYLESTRADIOL

FALMINA-28 TABLET FALMINA

FEMYNOR 28 TABLET FEMYNOR

GIANVI 3 MG-0.02 MG TABLET GIANVI

GILDAGIA 0.4 MG-0.035 MG TAB GILDAGIA

HEATHER TABLET HEATHER

INCASSIA 0.35 MG TABLET INCASSIA

ISIBLOOM 28 DAY TABLET ISIBLOOM

JENCYCLA 0.35 MG TABLET JENCYCLA

JOLIVETTE TABLET JOLIVETTE

JULEBER 28 DAY TABLET JULEBER

JUNEL 1 MG-20 MCG TABLET JUNEL

JUNEL 1.5 MG-30 MCG TABLET JUNEL

JUNEL FE 1 MG-20 MCG TABLET JUNEL FE

JUNEL FE 1.5 MG-30 MCG TABLET JUNEL FE

KARIVA 28 DAY TABLET KARIVA

KIMIDESS 28 DAY TABLET KIMIDESS

KURVELO TABLET KURVELO

LARIN 1.5 MG-30 MCG TABLET LARIN

LARIN 21 1-20 TABLET LARIN

LARIN FE 1-20 TABLET LARIN FE

LARIN FE 1.5-30 TABLET LARIN FE

LARISSIA-28 TABLET LARISSIA

LEENA 28 TABLET LEENA

LESSINA-28 TABLET LESSINA

LEVONEST-28 TABLET LEVONEST

LEVONO-E ESTRAD 0.10-0.02-0.01 LEVONORG-ETH ESTRAD ETHESTRAD

LEVONO-E ESTRAD 0.15-0.03-0.01 LEVONORG-ETH ESTRAD ETHESTRAD

LEVONOR-ETH ESTRAD 0.1-0.02 MG LEVONORGESTREL-ETHESTRADIOL

LEVONOR-ETH ESTRAD 0.15-0.03 LEVONORGESTREL-ETHESTRADIOL


64

Contraceptives Oral


LEVONOR-ETH ESTRAD TRIPHASIC LEVONORGESTREL-ETHESTRADIOL

LEVORA-28 TABLET LEVORA-28

LILLOW-28 TABLET LILLOW

LOESTRIN 21 1-20 TABLET LOESTRIN

LOESTRIN 21 1.5-30 TABLET LOESTRIN

LOESTRIN FE 1-20 TABLET LOESTRIN FE

LOESTRIN FE 1.5-30 TABLET LOESTRIN FE

LORYNA 3 MG-0.02 MG TABLET LORYNA

LOSEASONIQUE TABLET LOSEASONIQUE

LOW-OGESTREL-28 TABLET LOW-OGESTREL

LUTERA-28 TABLET LUTERA

LYZA 0.35 MG TABLET LYZA

MARLISSA-28 TABLET MARLISSA

MICROGESTIN 21 1-20 TABLET MICROGESTIN

MICROGESTIN 21 1.5-30 TAB MICROGESTIN

MICROGESTIN FE 1-20 TABLET MICROGESTIN FE

MICROGESTIN FE 1.5-30 TAB MICROGESTIN FE

MILI 0.25-0.035 MG TABLET MILI

MIRCETTE 28 DAY TABLET MIRCETTE

MODICON 28 TABLET MODICON

MONO-LINYAH 28 TABLET MONO-LINYAH

MONONESSA 28 TABLET MONONESSA

MYZILRA-28 TABLET MYZILRA

NECON 0.5-35-28 TABLET NECON

NECON 1-35-28 TABLET NECON



NECON 7-7-7-28 TABLET NECON

NIKKI 3 MG-0.02 MG TABLET NIKKI

NOR-Q-D TABLET NOR-Q-D

NORA-BE TABLET NORA-BE

NORETH-ESTRAD-FE 1-0.02(21)-75 NORETHIN-ETH ESTRA-FERROUS FUM

NORETHIND-ETH ESTRAD 1-0.02 MG NORETHINDRON-ETHINYLESTRADIOL

NORETHINDRONE 0.35 MG TABLET NORETHINDRONE

NORG-EE 0.18-0.215-0.25/0.035 NORGESTIMATE-ETHINYLESTRADIOL

NORG-ETHIN ESTRA 0.25-0.035 MG NORGESTIMATE-ETHINYLESTRADIOL

NORINYL 1-35 28 TABLET NORINYL 1-35

NORLYDA 0.35 MG TABLET NORLYDA

NORLYROC 0.35 MG TABLET NORLYROC


65

Contraceptives Oral


NORTREL 0.5-35-28 TABLET NORTREL

NORTREL 1-35 21 TABLET NORTREL

NORTREL 1-35 28 TABLET NORTREL

NORTREL 7-7-7-28 TABLET NORTREL

OCELLA 3 MG-0.03 MG TABLET OCELLA

ORSYTHIA-28 TABLET ORSYTHIA

ORTHO MICRONOR 0.35 MG TABLET ORTHO MICRONOR

ORTHO TRI-CYCLEN 28 TABLET ORTHO TRI-CYCLEN

ORTHO-CYCLEN 28 TABLET ORTHO-CYCLEN

ORTHO-NOVUM 1-35-28 TABLET ORTHO-NOVUM

ORTHO-NOVUM 7-7-7-28 TABLET ORTHO-NOVUM

OVCON-35 28 TABLET OVCON-35

PHILITH 0.4-0.035 MG TABLET PHILITH

PIMTREA 28 DAY TABLET PIMTREA

PIRMELLA 1-35-28 TABLET PIRMELLA

PIRMELLA 7-7-7-28 TABLET PIRMELLA

PORTIA-28 TABLET PORTIA

PREVIFEM TABLET PREVIFEM

RECLIPSEN 28 DAY TABLET RECLIPSEN

SEASONIQUE 0.15-0.03-0.01 TAB SEASONIQUE

SHAROBEL 0.35 MG TABLET SHAROBEL

SPRINTEC 28 DAY TABLET SPRINTEC

SRONYX 0.10-0.02 MG TABLET SRONYX

SYEDA 28 TABLET SYEDA

TARINA FE 1-20 EQ TABLET TARINA FE 1-20 EQ

TARINA FE 1-20 TABLET TARINA FE

TRI FEMYNOR 28 TABLET TRI FEMYNOR

TRI-ESTARYLLA TABLET TRI-ESTARYLLA

TRI-LEGEST FE-28 DAY TABLET TRI-LEGEST FE

TRI-LINYAH TABLET TRI-LINYAH

TRI-MILI 28 TABLET TRI-MILI

TRI-NORINYL 28 TABLET TRI-NORINYL

TRI-PREVIFEM TABLET TRI-PREVIFEM

TRI-SPRINTEC TABLET TRI-SPRINTEC

TRI-VYLIBRA 28 TABLET TRI-VYLIBRA

TRINESSA TABLET TRINESSA

TRIVORA-28 TABLET TRIVORA-28

TULANA 0.35 MG TABLET TULANA

VELIVET 28 DAY TABLET VELIVET

VESTURA 3 MG-0.02 MG TABLET VESTURA

VIENVA-28 TABLET VIENVA

VIORELE 28 DAY TABLET VIORELE

VYFEMLA 28 TABLET VYFEMLA


66

Contraceptives Oral


VYLIBRA 28 TABLET VYLIBRA

WERA 0.5/0.035 MG 28 TABLET WERA

YASMIN 28 TABLET YASMIN 28

YAZ 28 TABLET YAZ

ZARAH TABLET ZARAH

ZENCHENT 0.4 MG-35 MCG TABLET ZENCHENT

ZOVIA 1-50E TABLET ZOVIA 1-50E

Contraceptives Transdermal


XULANE PATCH XULANE QL

Corticosteroids


DEXAMETHASONE 0.5 MG TABLET DEXAMETHASONE

DEXAMETHASONE 0.5 MG/5 ML ELX DEXAMETHASONE

DEXAMETHASONE 0.5 MG/5 ML LIQ DEXAMETHASONE


DEXAMETHASONE 1 MG TABLET DEXAMETHASONE


DEXAMETHASONE 10 DAY 1.5 MG TB DEXAMETHASONE

DEXAMETHASONE 10 MG/ML VIAL DEXAMETHASONE SODIUMPHOSPHATE

DEXAMETHASONE 100 MG/10 ML VL DEXAMETHASONE SODIUMPHOSPHATE

DEXAMETHASONE 13 DAY 1.5 MG TB DEXAMETHASONE



DEXAMETHASONE 6 DAY 1.5 MG TAB DEXAMETHASONE


FLUDROCORTISONE 0.1 MG TABLET FLUDROCORTISONE ACETATE

HYDROCORTISONE 10 MG TABLET HYDROCORTISONE

HYDROCORTISONE 20 MG TABLET HYDROCORTISONE

METHYLPREDNISOLONE 16 MG TAB METHYLPREDNISOLONE


METHYLPREDNISOLONE 4 MGDOSEPK

METHYLPREDNISOLONE

METHYLPREDNISOLONE 4 MGTABLET

METHYLPREDNISOLONE


PREDNISOLONE 10 MG/5 ML SOLN PREDNISOLONE SODIUMPHOSPHATE





67

Corticosteroids


PREDNISOLONE ODT 10 MG TABLET PREDNISOLONE SODIUMPHOS ODT



PREDNISOLONE SOD PH 25 MG/5 ML PREDNISOLONE SODIUMPHOSPHATE

PREDNISONE 1 MG TABLET PREDNISONE

PREDNISONE 10 MG TAB DOSE PACK PREDNISONE


PREDNISONE 2.5 MG TABLET PREDNISONE


PREDNISONE 5 MG TAB DOSE PACK PREDNISONE


PREDNISONE 5 MG/5 ML SOLUTION PREDNISONE


Cystic Fibrosis Therapy Agents


KALYDECO 150 MG TABLET KALYDECO PA Prior Authorization required

TOBI 300 MG/5 ML SOLUTION TOBI PA Prior Authorization required

TOBI PODHALER 28 MG INHALE CAP TOBI PODHALER PA Prior Authorization required

Dental-Periodontal Products


DOXYCYCLINE HYCLATE 20 MG TAB DOXYCYCLINE HYCLATE

Dermatological - Anti-infectives


CICLOPIROX 0.77% CREAM CICLOPIROX

CICLOPIROX 0.77% GEL CICLOPIROX

CICLOPIROX 0.77% TOPICAL SUSP CICLOPIROX

CICLOPIROX 1% SHAMPOO CICLOPIROX

CICLOPIROX 8% SOLUTION CICLOPIROX

CICLOPIROX 8% TREATMENT KIT CICLOPIROX

ECONAZOLE NITRATE 1% CREAM ECONAZOLE NITRATE

GENTAMICIN 0.1% CREAM GENTAMICIN SULFATE

KETOCONAZOLE 2% CREAM KETOCONAZOLE

KETOCONAZOLE 2% FOAM KETOCONAZOLE

KETOCONAZOLE 2% SHAMPOO KETOCONAZOLE

MUPIROCIN 2% CREAM MUPIROCIN

MUPIROCIN 2% OINTMENT MUPIROCIN

NYSTATIN 100,000 UNIT/GM CREAM NYSTATIN

NYSTATIN 100,000 UNIT/GM OINT NYSTATIN

NYSTATIN 100,000 UNIT/GM POWD NYSTATIN


68

Dermatological - Antineoplastic or Premalignant Lesions


DICLOFENAC SODIUM 3% GEL DICLOFENAC SODIUM

FLUOROURACIL 2% TOPICAL SOLN FLUOROURACIL

FLUOROURACIL 5% CREAM FLUOROURACIL

FLUOROURACIL 5% TOPICAL SOLN FLUOROURACIL

TARGRETIN 1% GEL TARGRETIN

Dermatological - Antiparasitics and Combinations


MALATHION 0.5% LOTION MALATHION

PERMETHRIN 5% CREAM PERMETHRIN

SPINOSAD 0.9% TOPICAL SUSP SPINOSAD

Dermatological - Antipruritics


DOXEPIN 5% CREAM DOXEPIN HCL

Dermatological - Antipsoriatics


CALCIPOTRIENE 0.005% CREAM CALCIPOTRIENE

CALCIPOTRIENE 0.005% OINTMENT CALCIPOTRIENE

CALCIPOTRIENE 0.005% SOLUTION CALCIPOTRIENE

CALCITRIOL 3 MCG/G OINTMENT CALCITRIOL

TAZORAC 0.05% CREAM TAZORAC

TAZORAC 0.05% GEL TAZORAC

TAZORAC 0.1% CREAM TAZORAC

TAZORAC 0.1% GEL TAZORAC

Dermatological - Antiseborrheic Products and Combinations


SELENIUM SULFIDE 2.25% SHAMPOO SELENIUM SULFIDE

SOD SULFACETAMIDE 10%SHAMPOO

SODIUM SULFACETAMIDE

SODIUM SULFACETAMIDE 10% WASH SODIUM SULFACETAMIDE

Dermatological - Burn Products


SILVER SULFADIAZINE 1% CREAM SILVER SULFADIAZINE

Dermatological - Emollients and Combinations


AMMONIUM LACTATE 12% CREAM AMMONIUM LACTATE

Dermatological - Glucocorticoids and Combinations


ALCLOMETASONE DIPR 0.05% OINT ALCLOMETASONEDIPROPIONATE

ALCLOMETASONE DIPRO 0.05% CRM ALCLOMETASONEDIPROPIONATE

BETAMETHASONE DP 0.05% CRM BETAMETHASONEDIPROPIONATE

BETAMETHASONE DP 0.05% LOT BETAMETHASONEDIPROPIONATE


69



BETAMETHASONE DP 0.05% OINT BETAMETHASONEDIPROPIONATE

BETAMETHASONE DP AUG 0.05%CRM

BETAMETHASONE DIPROPAUGMENTED

BETAMETHASONE DP AUG 0.05%GEL


BETAMETHASONE DP AUG 0.05%LOT


BETAMETHASONE DP AUG 0.05% OIN BETAMETHASONE DIPROPAUGMENTED

BETAMETHASONE VA 0.1% CREAM BETAMETHASONE VALERATE

BETAMETHASONE VA 0.1% LOTION BETAMETHASONE VALERATE

BETAMETHASONE VALER 0.1%OINTM

BETAMETHASONE VALERATE

BETAMETHASONE VALER 0.12%FOAM

BETAMETHASONE VALERATE

CLOBETASOL 0.05% CREAM CLOBETASOL PROPIONATE

CLOBETASOL 0.05% GEL CLOBETASOL PROPIONATE

CLOBETASOL 0.05% OINTMENT CLOBETASOL PROPIONATE

CLOBETASOL 0.05% SHAMPOO CLOBETASOL PROPIONATE

CLOBETASOL 0.05% SOLUTION CLOBETASOL PROPIONATE

CLOBETASOL 0.05% TOPICAL LOTN CLOBETASOL PROPIONATE

CLOBETASOL EMOLLIENT 0.05% CRM CLOBETASOL EMOLLIENT

CLOBETASOL EMOLLNT 0.05% FOAM CLOBETASOL EMOLLIENT

CLOBETASOL EMULSION 0.05%FOAM

CLOBETASOL EMULSION

CLOBETASOL PROP 0.05% FOAM CLOBETASOL PROPIONATE

CLOBETASOL PROP 0.05% SPRAY CLOBETASOL PROPIONATE

DESONIDE 0.05% CREAM DESONIDE

DESONIDE 0.05% LOTION DESONIDE

DESONIDE 0.05% OINTMENT DESONIDE

DESOXIMETASONE 0.05% CREAM DESOXIMETASONE

DESOXIMETASONE 0.05% GEL DESOXIMETASONE

DESOXIMETASONE 0.05% OINTMENT DESOXIMETASONE

DESOXIMETASONE 0.25% CREAM DESOXIMETASONE

DESOXIMETASONE 0.25% OINTMENT DESOXIMETASONE

DESOXIMETASONE 0.25% SPRAY DESOXIMETASONE

DIFLORASONE 0.05% CREAM DIFLORASONE DIACETATE

DIFLORASONE 0.05% OINTMENT DIFLORASONE DIACETATE

FLUOCINOLONE 0.01% BODY OIL FLUOCINOLONE ACETONIDE

FLUOCINOLONE 0.01% CREAM FLUOCINOLONE ACETONIDE

FLUOCINOLONE 0.01% SCALP OIL FLUOCINOLONE ACETONIDE

FLUOCINOLONE 0.01% SOLUTION FLUOCINOLONE ACETONIDE

FLUOCINOLONE 0.025% CREAM FLUOCINOLONE ACETONIDE

FLUOCINOLONE 0.025% OINTMENT FLUOCINOLONE ACETONIDE


70



FLUOCINONIDE 0.05% CREAM FLUOCINONIDE

FLUOCINONIDE 0.05% GEL FLUOCINONIDE

FLUOCINONIDE 0.05% OINTMENT FLUOCINONIDE

FLUOCINONIDE 0.05% SOLUTION FLUOCINONIDE

FLUOCINONIDE 0.1% CREAM FLUOCINONIDE

FLUTICASONE PROP 0.005% OINT FLUTICASONE PROPIONATE

FLUTICASONE PROP 0.05% CREAM FLUTICASONE PROPIONATE

FLUTICASONE PROP 0.05% LOTION FLUTICASONE PROPIONATE

HALOBETASOL PROP 0.05% CREAM HALOBETASOL PROPIONATE

HALOBETASOL PROP 0.05%OINTMNT

HALOBETASOL PROPIONATE


HYDROCORTISONE 1% OINTMENT HYDROCORTISONE

HYDROCORTISONE 2.5% CREAM HYDROCORTISONE

HYDROCORTISONE 2.5% LOTION HYDROCORTISONE

HYDROCORTISONE 2.5% OINTMENT HYDROCORTISONE

HYDROCORTISONE BUTY 0.1%CREAM

HYDROCORTISONE BUTYRATE

HYDROCORTISONE BUTYR 0.1%LOTN


HYDROCORTISONE BUTYR 0.1%OINT


HYDROCORTISONE BUTYR 0.1%SOLN


MOMETASONE FUROATE 0.1%CREAM

MOMETASONE FUROATE

MOMETASONE FUROATE 0.1% OINT MOMETASONE FUROATE

MOMETASONE FUROATE 0.1% SOLN MOMETASONE FUROATE

TRIAMCINOLONE 0.025% CREAM TRIAMCINOLONE ACETONIDE

TRIAMCINOLONE 0.025% LOTION TRIAMCINOLONE ACETONIDE

TRIAMCINOLONE 0.025% OINT TRIAMCINOLONE ACETONIDE

TRIAMCINOLONE 0.1% CREAM TRIAMCINOLONE ACETONIDE

TRIAMCINOLONE 0.1% LOTION TRIAMCINOLONE ACETONIDE

TRIAMCINOLONE 0.1% OINTMENT TRIAMCINOLONE ACETONIDE

Dermatological - Immunomodulating Agents


IMIQUIMOD 3.75% CREAM PUMP IMIQUIMOD

IMIQUIMOD 5% CREAM PACKET IMIQUIMOD

Dermatological - Immunosuppressive Agents


PROTOPIC 0.03% OINTMENT PROTOPIC

PROTOPIC 0.1% OINTMENT PROTOPIC

TACROLIMUS 0.03% OINTMENT TACROLIMUS

TACROLIMUS 0.1% OINTMENT TACROLIMUS


71

Dermatological - Keratolytics-Antimitotics


PODOFILOX 0.5% TOPICAL SOLN PODOFILOX

Dermatological - NSAID’s


DICLOFENAC 1.5% TOPICAL SOLN DICLOFENAC SODIUM

DICLOFENAC SODIUM 1% GEL DICLOFENAC SODIUM

Dermatological - Rosacea Therapy


METRONIDAZOLE TOP 1% GEL PUMP METRONIDAZOLE

METRONIDAZOLE TOPICAL 0.75% GL METRONIDAZOLE

METRONIDAZOLE TOPICAL 1% GEL METRONIDAZOLE

Dermatological - Topical Local Anesthetics and Combinations


LIDOCAINE 3% CREAM LIDOCAINE HCL

LIDOCAINE 5% PATCH LIDOCAINE

LIDOCAINE HCL 2% JELLY LIDOCAINE HCL

LIDOCAINE HCL 3% LOTION LIDOCAINE HCL

LIDOCAINE-PRILOCAINE CREAM LIDOCAINE-PRILOCAINE

Diabetic Therapy


ACARBOSE 100 MG TABLET ACARBOSE



ADMELOG 100 UNIT/ML VIAL ADMELOG

ADMELOG SOLOSTAR 100 UNIT/ML ADMELOG SOLOSTAR

APIDRA 100 UNITS/ML VIAL APIDRA

APIDRA SOLOSTAR 100 UNITS/ML APIDRA SOLOSTAR

BYDUREON 2 MG VIAL BYDUREON PA Prior Authorization required

BYETTA 10 MCG DOSE PEN INJ BYETTA QL

BYETTA 5 MCG DOSE PEN INJ BYETTA QL

GLIMEPIRIDE 1 MG TABLET GLIMEPIRIDE



GLIPIZIDE 10 MG TABLET GLIPIZIDE

GLIPIZIDE 5 MG TABLET GLIPIZIDE

GLIPIZIDE ER 10 MG TABLET GLIPIZIDE ER

GLIPIZIDE ER 2.5 MG TABLET GLIPIZIDE ER

GLIPIZIDE ER 5 MG TABLET GLIPIZIDE ER

GLIPIZIDE XL 10 MG TABLET GLIPIZIDE XL

GLIPIZIDE XL 2.5 MG TABLET GLIPIZIDE XL

GLIPIZIDE XL 5 MG TABLET GLIPIZIDE XL

GLIPIZIDE-METFORMIN 2.5-250 MG GLIPIZIDE-METFORMIN

GLIPIZIDE-METFORMIN 2.5-500 MG GLIPIZIDE-METFORMIN

GLIPIZIDE-METFORMIN 5-500 MG GLIPIZIDE-METFORMIN


72

Diabetic Therapy


GLUCAGEN 1 MG HYPOKIT GLUCAGEN

GLUCAGON 1 MG EMERGENCY KIT GLUCAGON EMERGENCY KIT

GLYBURID-METFORMIN 1.25-250 MG GLYBURIDE-METFORMIN HCL

GLYBURIDE 1.25 MG TABLET GLYBURIDE

GLYBURIDE 2.5 MG TABLET GLYBURIDE

GLYBURIDE 5 MG TABLET GLYBURIDE

GLYBURIDE MICRO 1.5 MG TAB GLYBURIDE MICRONIZED

GLYBURIDE MICRO 3 MG TABLET GLYBURIDE MICRONIZED

GLYBURIDE MICRO 6 MG TABLET GLYBURIDE MICRONIZED

GLYBURIDE-METFORMIN 1.25 MG-250MG TABLET

GLYBURIDE-METFORMIN HCL

GLYBURIDE-METFORMIN 2.5-500 MG GLYBURIDE-METFORMIN HCL

GLYBURIDE-METFORMIN 5-500 MG GLYBURIDE-METFORMIN HCL

HUMALOG 100 UNITS/ML CARTRIDGE HUMALOG

HUMALOG 100 UNITS/ML KWIKPEN HUMALOG KWIKPEN U-100

HUMALOG 100 UNITS/ML VIAL HUMALOG

HUMALOG MIX 50-50 KWIKPEN HUMALOG MIX 50-50 KWIKPEN

HUMALOG MIX 50-50 VIAL HUMALOG MIX 50-50

HUMALOG MIX 75-25 KWIKPEN HUMALOG MIX 75-25 KWIKPEN

HUMALOG MIX 75-25 VIAL HUMALOG MIX 75-25

HUMULIN R 500 UNITS/ML VIAL HUMULIN R U-500

JANUMET 50-1,000 MG TABLET JANUMET

JANUMET 50-500 MG TABLET JANUMET

JANUMET XR 100-1,000 MG TABLET JANUMET XR

JANUMET XR 50-1,000 MG TABLET JANUMET XR

JANUMET XR 50-500 MG TABLET JANUMET XR

JANUVIA 100 MG TABLET JANUVIA



KORLYM 300 MG TABLET KORLYM

LANTUS 100 UNIT/ML VIAL LANTUS

LANTUS SOLOSTAR 100 UNIT/ML LANTUS SOLOSTAR

METFORMIN ER 1,000 MG OSM-TAB METFORMIN HCL ER

METFORMIN HCL 1,000 MG TABLET METFORMIN HCL

METFORMIN HCL 500 MG TABLET METFORMIN HCL

METFORMIN HCL 500 MG/5 ML SOLN METFORMIN HCL

METFORMIN HCL 850 MG TABLET METFORMIN HCL

METFORMIN HCL ER 1,000 MG TAB METFORMIN HCL ER

METFORMIN HCL ER 500 MG OSM-TB METFORMIN HCL ER

METFORMIN HCL ER 500 MG TABLET METFORMIN HCL ER

METFORMIN HCL ER 750 MG TABLET METFORMIN HCL ER

NATEGLINIDE 120 MG TABLET NATEGLINIDE

NATEGLINIDE 60 MG TABLET NATEGLINIDE


73

Diabetic Therapy


NOVOLOG 100 UNIT/ML CARTRIDGE NOVOLOG

NOVOLOG 100 UNIT/ML VIAL NOVOLOG

NOVOLOG 100 UNITS/ML FLEXPEN NOVOLOG FLEXPEN

NOVOLOG MIX 70-30 FLEXPEN SYRN NOVOLOG MIX 70-30 FLEXPEN

NOVOLOG MIX 70-30 VIAL NOVOLOG MIX 70-30

ONGLYZA 2.5 MG TABLET ONGLYZA

ONGLYZA 5 MG TABLET ONGLYZA

PIOGLITAZONE HCL 15 MG TABLET PIOGLITAZONE HCL



PIOGLITAZONE-GLIMEPIRIDE 30-2 PIOGLITAZONE-GLIMEPIRIDE

PIOGLITAZONE-GLIMEPIRIDE 30-4 PIOGLITAZONE-GLIMEPIRIDE

PIOGLITAZONE-METFORMIN 15-500 PIOGLITAZONE-METFORMIN

PIOGLITAZONE-METFORMIN 15-850 PIOGLITAZONE-METFORMIN

PRANDIN 0.5 MG TABLET PRANDIN

PRANDIN 1 MG TABLET PRANDIN

PRANDIN 2 MG TABLET PRANDIN

REPAGLINIDE 0.5 MG TABLET REPAGLINIDE

REPAGLINIDE 1 MG TABLET REPAGLINIDE

REPAGLINIDE 2 MG TABLET REPAGLINIDE

SYMLINPEN 120 PEN INJECTOR SYMLINPEN 120

SYMLINPEN 60 PEN INJECTOR SYMLINPEN 60

Diagnostic Drugs - In Vivo


DIPYRIDAMOLE 5 MG/ML VIAL DIPYRIDAMOLE

Digestive Aids


CREON DR 12,000 UNITS CAPSULE CREON





PANCREAZE DR 10,500 UNIT CAP PANCREAZE





ZENPEP DR 10,000 UNIT CAPSULE ZENPEP







74

Diuretics


ACETAZOLAMIDE 125 MG TABLET ACETAZOLAMIDE

ACETAZOLAMIDE 250 MG TABLET ACETAZOLAMIDE

ACETAZOLAMIDE ER 500 MG CAP ACETAZOLAMIDE

AMILORIDE HCL 5 MG TABLET AMILORIDE HCL

AMILORIDE HCL-HYDROCHLOROTHIAZIDE 5-50 MGTAB

AMILORIDE-HYDROCHLOROTHIAZIDE

BUMETANIDE 0.5 MG TABLET BUMETANIDE

BUMETANIDE 1 MG TABLET BUMETANIDE

BUMETANIDE 2 MG TABLET BUMETANIDE

CHLORTHALIDONE 25 MG TABLET CHLORTHALIDONE

CHLORTHALIDONE 50 MG TABLET CHLORTHALIDONE

EPLERENONE 25 MG TABLET EPLERENONE

EPLERENONE 50 MG TABLET EPLERENONE

FUROSEMIDE 10 MG/ML SOLUTION FUROSEMIDE

FUROSEMIDE 10 MG/ML VIAL FUROSEMIDE

FUROSEMIDE 100 MG/10 ML SYRING FUROSEMIDE

FUROSEMIDE 100 MG/10 ML VIAL FUROSEMIDE

FUROSEMIDE 20 MG TABLET FUROSEMIDE



FUROSEMIDE 40 MG/4 ML ORAL SOL FUROSEMIDE

FUROSEMIDE 40 MG/4 ML SYRINGE FUROSEMIDE


FUROSEMIDE 40 MG/5 ML SOLN FUROSEMIDE


HYDROCHLOROTHIAZIDE 12.5 MG CP HYDROCHLOROTHIAZIDE

HYDROCHLOROTHIAZIDE 12.5 MG TB HYDROCHLOROTHIAZIDE

HYDROCHLOROTHIAZIDE 25 MG TAB HYDROCHLOROTHIAZIDE

HYDROCHLOROTHIAZIDE 50 MG TAB HYDROCHLOROTHIAZIDE

INDAPAMIDE 1.25 MG TABLET INDAPAMIDE

INDAPAMIDE 2.5 MG TABLET INDAPAMIDE

INSPRA 25 MG TABLET INSPRA

INSPRA 50 MG TABLET INSPRA

METHAZOLAMIDE 25 MG TABLET METHAZOLAMIDE

METHAZOLAMIDE 50 MG TABLET METHAZOLAMIDE

METOLAZONE 10 MG TABLET METOLAZONE

METOLAZONE 2.5 MG TABLET METOLAZONE

METOLAZONE 5 MG TABLET METOLAZONE

SPIRONOLACTONE 100 MG TABLET SPIRONOLACTONE



TORSEMIDE 10 MG TABLET TORSEMIDE


75

Diuretics





TRIAMTERENE-HYDROCHLOROTHIAZIDE 37.5-25 MGCP

TRIAMTERENE-HYDROCHLOROTHIAZID

TRIAMTERENE-HYDROCHLOROTHIAZIDE 37.5-25 MGTB


TRIAMTERENE-HYDROCHLOROTHIAZIDE 75-50 MGTAB


Emergency Contraceptives and Combinations


ELLA 30 MG TABLET ELLA

Erectile Dysfunction (ED) Drugs-Sel.cGMP Phosphodiesterase Type5 Inhib


SILDENAFIL 100 MG TABLET SILDENAFIL CITRATE QL Limited to 30 Tablets per 30 days



Estrogens and Combinations


ESTRADIOL 0.025 MG PATCH ESTRADIOL


ESTRADIOL 0.0375 MG/DAY PATCH ESTRADIOL


ESTRADIOL 0.05 MG/DAY PATCH ESTRADIOL TRANSDERMALPATCH





ESTRADIOL 0.1 MG/DAY PATCH ESTRADIOL TRANSDERMALPATCH

ESTRADIOL 0.5 MG TABLET ESTRADIOL

ESTRADIOL 1 MG TABLET ESTRADIOL

ESTRADIOL 2 MG TABLET ESTRADIOL

ESTRADIOL TDS 0.025 MG/DAY ESTRADIOL






PREMARIN 0.3 MG TABLET PREMARIN



76

Estrogens and Combinations





PREMPRO 0.3 MG-1.5 MG TABLET PREMPRO

PREMPRO 0.45-1.5 MG TABLET PREMPRO

PREMPRO 0.625-2.5 MG TABLET PREMPRO

PREMPRO 0.625-5 MG TABLET PREMPRO

Gallstone Solubilizing (Litholysis) Agents and Combinations


URSODIOL 250 MG TABLET URSODIOL

URSODIOL 300 MG CAPSULE URSODIOL

URSODIOL 500 MG TABLET URSODIOL

Gastrointestinal Antispasmodics


CHLORDIAZEPOXIDE-CLIDINIUM CAP CHLORDIAZEPOXIDE-CLIDINIUM

DICYCLOMINE 10 MG CAPSULE DICYCLOMINE HCL

DICYCLOMINE 10 MG/5 ML SOLN DICYCLOMINE HCL

DICYCLOMINE 20 MG TABLET DICYCLOMINE HCL

DICYCLOMINE 20 MG/2 ML VIAL DICYCLOMINE HCL

HYOSCYAMINE 0.125 MG ODT HYOSCYAMINE SULFATE

HYOSCYAMINE 0.125 MG TAB SL HYOSCYAMINE SULFATE

HYOSCYAMINE 0.125 MG/5 ML ELIX HYOSCYAMINE SULFATE

HYOSCYAMINE 0.125 MG/ML DROP HYOSCYAMINE SULFATE

HYOSCYAMINE ER 0.375 MG TAB HYOSCYAMINE SULFATE ER

HYOSCYAMINE SR 0.375 MG TAB HYOSCYAMINE SULFATE SR

HYOSCYAMINE SULF 0.125 MG TAB HYOSCYAMINE SULFATE

Gastrointestinal Prokinetic Agents


METOCLOPRAMIDE 10 MG TABLET METOCLOPRAMIDE HCL

METOCLOPRAMIDE 10 MG/10 ML SOL METOCLOPRAMIDE HCL

METOCLOPRAMIDE 10 MG/2 ML VIAL METOCLOPRAMIDE HCL

METOCLOPRAMIDE 5 MG TABLET METOCLOPRAMIDE HCL

METOCLOPRAMIDE 5 MG/5 ML SOLN METOCLOPRAMIDE HCL

METOCLOPRAMIDE HCL 10 MG ODT METOCLOPRAMIDE HCL ODT

METOCLOPRAMIDE HCL 5 MG ODT METOCLOPRAMIDE HCL ODT

General Anesthetics


METHOHEXITAL 100 MG/10 ML-WATER

METHOHEXITAL-STERILEWATER

METHOHEXITAL 100 MG/10 ML-WATER SYRINGE (CMPD-RX)

METHOHEXITAL-STERILEWATER

MIDAZOLAM 100 MG/100 ML-0.9%NACL BAG (CMPD-RX)

MIDAZOLAM HCL-0.9% NACL


77

General Anesthetics


MIDAZOLAM 250 MG/250 ML-0.9%NACL BAG (CMPD-RX)


MIDAZOLAM 50 MG/50 ML-0.9% NACLBAG (CMPD-RX)


MIDAZOLAM-0.9% NACL 100 MG/100 MIDAZOLAM HCL-0.9% NACL




General Injectable Solutions and Diluents


SALINE 0.45% SOLN-EXCEL CON SODIUM CHLORIDE

SODIUM CHLORIDE 0.45% SOLN SODIUM CHLORIDE

SODIUM CHLORIDE 0.45% SOLUTION SODIUM CHLORIDE

SODIUM CHLORIDE 100 MEQ/40 ML SODIUM CHLORIDE

SODIUM CHLORIDE 3% IV SOLN SODIUM CHLORIDE

SODIUM CHLORIDE 4 MEQ/ML VL SODIUM CHLORIDE

SODIUM CHLORIDE 5% IV SOLN SODIUM CHLORIDE

SODIUM CHLORIDE 50 MEQ/20 ML SODIUM CHLORIDE

Genitourinary Irrigants


ACETIC ACID 0.25% IRRIG SOLN ACETIC ACID






ARANESP 150 MCG/0.75 ML VIAL ARANESP PA Prior Authorization required



ARANESP 25 MCG/0.42 ML SYRING ARANESP PA Prior Authorization required






ARANESP 500 MCG/1 ML SYRINGE ARANESP PA Prior Authorization required





EPOGEN 20,000 UNITS/2 ML VIAL EPOGEN PA Prior Authorization required



78





LEUKINE 250 MCG VIAL LEUKINE

NEULASTA 6 MG/0.6 ML SYRINGE NEULASTA PA Prior Authorization required


NEUPOGEN 300 MCG/ML VIAL NEUPOGEN PA Prior Authorization required


NEUPOGEN 480 MCG/1.6 ML VIAL NEUPOGEN PA Prior Authorization required









Hepatic Hormones (Hormones Secreted by the Liver)


INCRELEX 40 MG/4 ML VIAL INCRELEX PA Prior Authorization required

Hyperuricemia Therapy


ALLOPURINOL 100 MG TABLET ALLOPURINOL

ALLOPURINOL 300 MG TABLET ALLOPURINOL

PROBENECID 500 MG TABLET PROBENECID

Immunosuppressive - Calcineurin Inhibitors


CYCLOSPORINE 100 MG CAPSULE CYCLOSPORINE

CYCLOSPORINE 25 MG CAPSULE CYCLOSPORINE

CYCLOSPORINE 50 MG/ML AMPUL CYCLOSPORINE

CYCLOSPORINE MODIFIED 100 MG CYCLOSPORINE MODIFIED

CYCLOSPORINE MODIFIED 100 MG/ML

CYCLOSPORINE MODIFIED



TACROLIMUS 0.5 MG CAPSULE TACROLIMUS

TACROLIMUS 1 MG CAPSULE TACROLIMUS

TACROLIMUS 5 MG CAPSULE TACROLIMUS

Immunosuppressive - Inosine Monophosphate Dehydrogenase Inhibitors


MYCOPHENOLATE 200 MG/ML SUSP MYCOPHENOLATE MOFETIL

MYCOPHENOLATE 250 MG CAPSULE MYCOPHENOLATE MOFETIL

MYCOPHENOLATE 500 MG TABLET MYCOPHENOLATE MOFETIL


79

Immunosuppressive - Mammalian Target of Rapamycin (mTOR) Inhibitors


RAPAMUNE 0.5 MG TABLET RAPAMUNE

RAPAMUNE 1 MG TABLET RAPAMUNE

RAPAMUNE 1 MG/ML ORAL SOLN RAPAMUNE

RAPAMUNE 2 MG TABLET RAPAMUNE

SIROLIMUS 0.5 MG TABLET SIROLIMUS

SIROLIMUS 1 MG TABLET SIROLIMUS

SIROLIMUS 2 MG TABLET SIROLIMUS

Immunosuppressive - Purine Analogs


AZASAN 100 MG TABLET AZASAN

AZASAN 75 MG TABLET AZASAN

AZATHIOPRINE 50 MG TABLET AZATHIOPRINE

Inflammatory Bowel Agents


BUDESONIDE EC 3 MG CAPSULE BUDESONIDE EC

CANASA 1,000 MG SUPPOSITORY CANASA

CORTIFOAM 10% AEROSOL CORTIFOAM


HUMIRA 40 MG/0.8 ML PEN HUMIRA PEN PA Prior Authorization required


HUMIRA PED CROHNS 40 MG/0.8 ML HUMIRA PEDIATRIC CROHN’S PA Prior Authorization required

HUMIRA PEN CROHN-UC-HSSTARTER 40 MG/0.8 ML

HUMIRA PEN CROHN-UC-HSSTARTER


HUMIRA PEN PSORIASIS-UVEITISSTARTER 40 MG/0.8 ML

HUMIRA PEN PSORIASIS-UVEITIS


HYDROCORTISONE 100 MG/60 ML HYDROCORTISONE

REMICADE 100 MG VIAL REMICADE PA Prior Authorization required

SULFASALAZINE 500 MG TABLET SULFASALAZINE

SULFASALAZINE DR 500 MG TAB SULFASALAZINE DR

Interstitial Cystitis Agents


ELMIRON 100 MG CAPSULE ELMIRON

Irrigation Solutions


SODIUM CHLORIDE 0.9% IRRIG. SODIUM CHLORIDE

Irritable Bowel Syndrome (IBS) Agents


AMITIZA 24 MCG CAPSULES AMITIZA

AMITIZA 8 MCG CAPSULE AMITIZA

Laxatives


COLYTE WITH FLAVOR PACKETS COLYTE WITH FLAVORPACKETS

GAVILYTE-C SOLUTION GAVILYTE-C


80

Laxatives


LACTULOSE 10 GM/15 ML SOLUTION LACTULOSE

PEG 3350 ELECTROLYTE SOLN PEG 3350-ELECTROLYTE

PEG 3350-ELECTROLYTE SOLUTION PEG 3350-ELECTROLYTE

POLYETHYLENE GLYCOL 3350 POWD POLYETHYLENE GLYCOL 3350

Local Anesthetics - Parenteral


LIDOCAINE 1%-0.9% NACL SYRINGE(CMPD-RX)

LIDOCAINE HCL-0.9% NACL

LIDOCAINE 10 MG/ML (1%)-0.9% NACLSYRINGE (CMPD-RX)

LIDOCAINE HCL-0.9% NACL

LIDOCAINE 100 MG/5 ML (2%)SYRINGE (CMPD-RX)

LIDOCAINE HCL


LIDOCAINE HCL


LIDOCAINE HCL


LIDOCAINE HCL

LIDOCAINE HCL 0.5% VIAL LIDOCAINE HCL

LIDOCAINE HCL 1% 20 MG/2 MLAMPULE

LIDOCAINE HCL

LIDOCAINE HCL 1% 20 MG/2 ML VL LIDOCAINE HCL

LIDOCAINE HCL 1% 300 MG/30 ML LIDOCAINE HCL

LIDOCAINE HCL 1% 50 MG/5 MLAMPULE

LIDOCAINE HCL

LIDOCAINE HCL 1% 50 MG/5 ML VIAL LIDOCAINE HCL


LIDOCAINE HCL 1% AMPUL LIDOCAINE HCL


LIDOCAINE HCL 1% SYRINGE (CMPD-RX)

LIDOCAINE HCL


LIDOCAINE HCL 1.5% AMPUL LIDOCAINE HCL

LIDOCAINE HCL 10 MG/ML SYRINGE(CMPD-RX)

LIDOCAINE HCL

LIDOCAINE HCL 100 MG/10 MLSYRINGE (CMPD-RX)

LIDOCAINE HCL

LIDOCAINE HCL 100 MG/5 ML SYR LIDOCAINE HCL


LIDOCAINE HCL

LIDOCAINE HCL 2% 100 MG/5 ML LIDOCAINE HCL






LIDOCAINE HCL


81

Local Anesthetics - Parenteral



LIDOCAINE HCL 30 MG/3 ML SYRINGE(CMPD-RX)

LIDOCAINE HCL

LIDOCAINE HCL 4% AMPUL LIDOCAINE HCL

LIDOCAINE HCL 4% SOLUTION LIDOCAINE HCL

Medical Supplies and DME - Respiratory Therapy


ACE AEROSOL CLOUD ENHANCER ACE AEROSOL CLOUDENHANCER

AEROCHAMBER MINI AEROCHAMBER MINI

AEROCHAMBER MV HOLD CHAMBER AEROCHAMBER MV

AEROCHAMBER PLUS FLOW-VU AEROCHAMBER PLUS FLOW-VU

AEROCHAMBER PLUS FLOW-VULARGE

AEROCHAMBER PLUS FLOW-VU

AEROCHAMBER PLUS FLOW-VU MED AEROCHAMBER PLUS FLOW-VU

AEROCHAMBER PLUS FLOW-VUSMALL

AEROCHAMBER PLUS FLOW-VU

AEROCHAMBER PLUS W-FLOWSIGNAL

AEROCHAMBER WITHFLOWSIGNAL

AEROCHAMBER PLUS Z STAT AEROCHAMBER PLUS Z STAT

AEROCHAMBER PLUS Z STAT LARGE AEROCHAMBER PLUS Z STAT

AEROCHAMBER PLUS Z STATMEDIUM

AEROCHAMBER PLUS Z STAT

AEROCHAMBER PLUS Z STAT SMALL AEROCHAMBER PLUS Z STAT

AEROCHAMBER Z-STAT PLUS LARGE AEROCHAMBER Z-STAT PLUS

AEROCHAMBER Z-STAT PLUS W-FLOW

AEROCHAMBER Z-STAT PLUS

AEROCHAMBER Z-STAT PLUS-MED AEROCHAMBER Z-STAT PLUS

AEROCHAMBER Z-STAT PLUS-SMALL AEROCHAMBER Z-STAT PLUS

AEROTRACH HOLDING CHAMBER AEROTRACH PLUS

AEROVENT PLUS HOLDINGCHAMBER

AEROVENT PLUS

BREATHERITE MDI SPACER BREATHERITE

BREATHERITE SPACER-ADULT MASK BREATHERITE SPACER-ADULTMASK

BREATHERITE SPACER-INFANTMASK

BREATHERITE SPACER-INFANT MASK

BREATHERITE SPACER-LARGE MASK BREATHERITE SPACER-LARGEMASK

BREATHERITE SPACER-LG CHLDMSK

BREATHERITE SPACER-LGCHLD MSK

BREATHERITE SPACER-MEDIUMMASK

BREATHERITE SPACER-MEDIUM MASK

BREATHERITE SPACER-NEONATEMSK

BREATHERITE SPACER-NEONATE MSK


82



BREATHERITE SPACER-SM CHLDMSK

BREATHERITE SPACER-SMCHLD MSK

BREATHERITE SPACER-SMALL MASK BREATHERITE SPACER-SMALLMASK

BREATHRITE VALVED MDI CHAMBER BREATHRITE

BREATHRITE VALVED MDI SPACER BREATHRITE

CLEVER CHOICE CHAMBER-LRGMASK

CLEVER CHOICE HOLDINGCHAMBER

CLEVER CHOICE CHAMBER-MEDMASK


CLEVER CHOICE CHAMBER-SMMASK


COMPACT SPACE CHAMBER COMPACT SPACE CHAMBER

COMPACT SPACE CHAMBER PLUS COMPACT SPACE CHAMBERPLUS

COMPACT SPACE CHAMBER-LRGMASK

COMPACT SPACE CHAMBER

COMPACT SPACE CHAMBER-MEDMASK


COMPACT SPACE CHAMBER-SMMASK


E-Z SPACER E-Z SPACER

EASIVENT HOLDING CHAMBER EASIVENT

FLEXICHAMBER FLEXICHAMBER

INSPIRACHAMBER INSPIRACHAMBER

INSPIRACHAMBER WITH MASK-LARGE

INSPIRACHAMBER

INSPIRACHAMBER WITH MASK-MED INSPIRACHAMBER

INSPIRACHAMBER WITH MASK-SMALL

INSPIRACHAMBER

LITEAIRE MDI CHAMBER LITEAIRE

MICROCHAMBER MICROCHAMBER

MICROSPACER FOR AEROSOLDEVICE

MICROSPACER

MONAGHAN Z STAT CHAMBER MONAGHAN Z STAT

MONAGHAN Z STAT CHAMBER-LGMSK

MONAGHAN Z STAT

MONAGHAN Z STAT CHAMBER-MDMSK

MONAGHAN Z STAT

MONAGHAN Z STAT CHAMBER-SMMSK

MONAGHAN Z STAT

OPTICHAMBER DIAMOND VHC OPTICHAMBER DIAMOND

OPTICHAMBER DIAMOND W-LRGMASK

OPTICHAMBER DIAMOND

OPTICHAMBER DIAMOND W-MEDMASK

OPTICHAMBER DIAMOND

OPTICHAMBER DIAMOND W-SMLMASK

OPTICHAMBER DIAMOND


83



POCKET CHAMBER POCKET CHAMBER

PRIMEAIRE CHAMBER PRIMEAIRE

PROCHAMBER HOLDING CHAMBER PROCHAMBER

RITEFLO SPACER RITEFLO

SPACE CHAMBER PLUS SPACE CHAMBER PLUS

VORTEX HOLDING CHAMBER VORTEX

VORTEX HOLDING CHAMBER-CHILDMASK

VORTEX HOLDING CHAMBER-CHILD

VORTEX HOLDING CHAMBER-TODDLER MASK

VORTEX HOLDING CHAMBER-TODDLER

VORTEX VHC FROG CHILD MASK VORTEX VHC FROG MASK

VORTEX VHC LADYBUG TODDLERMSK

VORTEX VHC LADYBUG MASK

Metabolic Disease Enzyme Replacement, Gaucher’s Disease


CEREZYME 400 UNITS VIAL CEREZYME PA Prior Authorization required

Migraine Therapy


DIHYDROERGOTAMINE 1 MG/ML AMP DIHYDROERGOTAMINEMESYLATE

DIHYDROERGOTAMINE 1 MG/ML VL DIHYDROERGOTAMINEMESYLATE

DIHYDROERGOTAMINE MESYLATE 4MG/ML NASAL SPRAY

DIHYDROERGOTAMINEMESYLATE

ERGOTAMINE-CAFFEINE 1-100 MG TB ERGOTAMINE-CAFFEINE

RIZATRIPTAN 10 MG ODT RIZATRIPTAN QL

RIZATRIPTAN 10 MG TABLET RIZATRIPTAN QL

RIZATRIPTAN 5 MG ODT RIZATRIPTAN QL

RIZATRIPTAN 5 MG TABLET RIZATRIPTAN QL

SUMATRIPTAN 20 MG NASAL SPRAY SUMATRIPTAN

SUMATRIPTAN 4 MG/0.5 ML CART SUMATRIPTAN SUCCINATE QL

SUMATRIPTAN 4 MG/0.5 ML INJECT SUMATRIPTAN SUCCINATE QL

SUMATRIPTAN 5 MG NASAL SPRAY SUMATRIPTAN

SUMATRIPTAN 6 MG/0.5 ML INJECT SUMATRIPTAN SUCCINATE QL

SUMATRIPTAN 6 MG/0.5 ML REFILL SUMATRIPTAN SUCCINATE QL

SUMATRIPTAN 6 MG/0.5 ML SYRNG SUMATRIPTAN SUCCINATE QL

SUMATRIPTAN 6 MG/0.5 ML VIAL SUMATRIPTAN SUCCINATE QL

SUMATRIPTAN SUCC 100 MG TABLET SUMATRIPTAN SUCCINATE QL



ZOLMITRIPTAN 2.5 MG ODT ZOLMITRIPTAN ODT

ZOLMITRIPTAN 2.5 MG TABLET ZOLMITRIPTAN QL

ZOLMITRIPTAN 5 MG ODT ZOLMITRIPTAN ODT QL

ZOLMITRIPTAN 5 MG TABLET ZOLMITRIPTAN QL

ZOMIG 2.5 MG TABLET ZOMIG QL


84

Migraine Therapy


ZOMIG 5 MG NASAL SPRAY ZOMIG QL

ZOMIG 5 MG TABLET ZOMIG QL

ZOMIG ZMT 2.5 MG TABLET ZOMIG ZMT QL

ZOMIG ZMT 5 MG TABLET ZOMIG ZMT QL

Minerals and Electrolytes


EFFER-K 25 MEQ TABLET EFF EFFER-K QL

K EFFERVESCENT 25 MEQ TABLET K EFFERVESCENT QL

KLOR-CON M20 TABLET KLOR-CON M20

KLOR-CON-EF 25 MEQ TAB EFF KLOR-CON-EF QL

POTASSIUM 25 MEQ TABLET EFF POTASSIUM BICARBONATE QL

POTASSIUM CHLORIDE 20 MEQ/10ML (1.5 G/10 ML) CONCENTRATE

POTASSIUM CHLORIDEPROAMP

POTASSIUM CL 10 MEQ/100 ML SOL POTASSIUM CHLORIDE

POTASSIUM CL 10 MEQ/5 ML CONC POTASSIUM CHLORIDE


POTASSIUM CL 10% (20 MEQ/15 ML)LIQUID

POTASSIUM CHLORIDE


POTASSIUM CHLORIDE

POTASSIUM CL 2 MEQ/ML VIAL POTASSIUM CHLORIDE

POTASSIUM CL 20 MEQ PACKET POTASSIUM CHLORIDE



POTASSIUM CL 20 MEQ/100 ML-WATER BAG (CMPD-RX)

POTASSIUM CHLORIDE-WATER



POTASSIUM CHLORIDE




POTASSIUM CL ER 10 MEQ CAPSULE POTASSIUM CHLORIDE

POTASSIUM CL ER 10 MEQ TABLET POTASSIUM CHLORIDE


POTASSIUM CL ER 8 MEQ CAPSULE POTASSIUM CHLORIDE


Mouth and Throat - Anti-infectives


CHLORHEXIDINE 0.12% RINSE CHLORHEXIDINE GLUCONATE

CLOTRIMAZOLE 10 MG TROCHE CLOTRIMAZOLE

NYSTATIN 100,000 UNIT/ML SUSP NYSTATIN

NYSTATIN 500,000 UNIT/5 ML SUS NYSTATIN


85

Mouth and Throat - Glucocorticoids


TRIAMCINOLONE 0.1% PASTE TRIAMCINOLONE ACETONIDE

Mouth and Throat - Local Anesthetics


LIDOCAINE HCL 4% SOLUTION LIDOCAINE HCL

Mouth and Throat - Xerostomia Therapy


AQUORAL SPRAY AQUORAL

PILOCARPINE HCL 5 MG TABLET PILOCARPINE HCL

PILOCARPINE HCL 7.5 MG TABLET PILOCARPINE HCL

Mucolytics


PULMOZYME 1 MG/ML AMPUL PULMOZYME PA Prior Authorization required

Multiple Sclerosis Agent - Interferons


AVONEX 30 MCG VIAL KIT AVONEX

AVONEX PREFILLED SYR 30 MCG AVONEX

AVONEX PREFILLED SYR 30 MCG KIT AVONEX

BETASERON 0.3 MG KIT BETASERON PA Prior Authorization required

BETASERON 0.3 MG VIAL BETASERON PA Prior Authorization required

EXTAVIA 0.3 MG KIT EXTAVIA PA Prior Authorization required

EXTAVIA 0.3 MG VIAL EXTAVIA PA Prior Authorization required





REBIF REBIDOSE TITRATION PACK REBIF REBIDOSE PA Prior Authorization required

REBIF TITRATION PACK REBIF PA Prior Authorization required

Multiple Sclerosis Agent - Potassium Channel Blocker


AMPYRA ER 10 MG TABLET AMPYRA PA Prior Authorization required

DALFAMPRIDINE ER 10 MG TABLET DALFAMPRIDINE ER PA Prior Authorization required



BACLOFEN 10 MG TABLET BACLOFEN

BACLOFEN 20 MG TABLET BACLOFEN

CARISOPRODOL 250 MG TABLET CARISOPRODOL

CARISOPRODOL 350 MG TABLET CARISOPRODOL

CYCLOBENZAPRINE 10 MG TABLET CYCLOBENZAPRINE HCL

CYCLOBENZAPRINE 5 MG TABLET CYCLOBENZAPRINE HCL QL

CYCLOBENZAPRINE 7.5 MG TABLET CYCLOBENZAPRINE HCL QL

DANTROLENE SODIUM 100 MG CAP DANTROLENE SODIUM




86



GENVISC 850 25 MG/2.5 ML SYR GENVISC 850 PA Prior Authorization required

HYALGAN 20 MG/2 ML SYRINGE HYALGAN PA Prior Authorization required

HYALGAN 20 MG/2 ML VIAL HYALGAN PA Prior Authorization required

METAXALONE 400 MG TABLET METAXALONE

METAXALONE 800 MG TABLET METAXALONE

METHOCARBAMOL 1,000 MG/10 ML METHOCARBAMOL

METHOCARBAMOL 500 MG TABLET METHOCARBAMOL

METHOCARBAMOL 750 MG TABLET METHOCARBAMOL

ORPHENADRINE ER 100 MG TABLET ORPHENADRINE CITRATE

SUPARTZ FX 25 MG/2.5 ML SYR SUPARTZ FX PA Prior Authorization required

SYNVISC SYRINGE SYNVISC PA Prior Authorization required

SYNVISC-ONE SYRINGE SYNVISC-ONE PA Prior Authorization required

TIZANIDINE HCL 2 MG CAPSULE TIZANIDINE HCL

TIZANIDINE HCL 2 MG TABLET TIZANIDINE HCL


TIZANIDINE HCL 4 MG TABLET TIZANIDINE HCL


TRIVISC 25 MG/2.5 ML SYR TRIVISC PA Prior Authorization required

VISCO-3 25 MG/2.5 ML SYR VISCO-3 PA Prior Authorization required

Narcolepsy and Cataplexy Therapy Agents


MODAFINIL 100 MG TABLET MODAFINIL

MODAFINIL 200 MG TABLET MODAFINIL

Nasal Preparations


AZELASTINE 0.1% (137 MCG) SPRY AZELASTINE HCL

AZELASTINE 0.15% NASAL SPRAY AZELASTINE HCL

FLUNISOLIDE 0.025% SPRAY FLUNISOLIDE

FLUTICASONE PROP 50 MCG SPRAY FLUTICASONE PROPIONATE

IPRATROPIUM 0.03% SPRAY IPRATROPIUM BROMIDE

IPRATROPIUM 0.06% SPRAY IPRATROPIUM BROMIDE

Neuromuscular Therapy Agents


PYRIDOSTIGMINE BR 60 MG TABLET PYRIDOSTIGMINE BROMIDE

PYRIDOSTIGMINE ER 180 MG TAB PYRIDOSTIGMINE BROMIDE ER

Ophthalmic - Anti-allergy


AZELASTINE HCL 0.05% DROPS AZELASTINE HCL

CROMOLYN 4% EYE DROPS CROMOLYN SODIUM


87

Ophthalmic - Anti-infectives


BACITRACIN 500 UNIT/GMOPHTHALMIC OINTMENT

BACITRACIN

BACITRACIN-POLYMYXIN EYE OINT BACITRACIN-POLYMYXIN

CIPROFLOXACIN 0.3% EYE DROP CIPROFLOXACIN HCL

ERYTHROMYCIN 0.5% EYEOINTMENT

ERYTHROMYCIN

GENTAMICIN 0.3% EYE DROP GENTAMICIN SULFATE

GENTAMICIN 0.3% EYE OINTMENT GENTAMICIN SULFATE

GENTAMICIN 3 MG/GM EYE OINT GENTAMICIN SULFATE

GENTAMICIN 3 MG/ML EYE DROP GENTAMICIN SULFATE

LEVOFLOXACIN 0.5% EYE DROPS LEVOFLOXACIN

NEO-POLYCIN EYE OINTMENT NEO-POLYCIN

NEOMYC-BACIT-POLYMIX EYE OINT NEOMYCIN-BACITRACIN-POLYMYXIN

NEOMYC-POLYM-GRAMICID EYEDROP

NEOMYCIN-POLYMYXIN-GRAMICIDIN

OFLOXACIN 0.3% EYE DROPS OFLOXACIN

POLYMYXIN B-TMP EYE DROPS POLYMYXIN B SUL-TRIMETHOPRIM

SULFACETAMIDE 10% EYE DROPS SULFACETAMIDE SODIUM

SULFACETAMIDE 10% EYEOINTMENT

SULFACETAMIDE SODIUM

TOBRAMYCIN 0.3% EYE DROP TOBRAMYCIN

TRIFLURIDINE 1% EYE DROPS TRIFLURIDINE

VIROPTIC 1% EYE DROPS VIROPTIC

Ophthalmic - Anti-inflammatory


DICLOFENAC 0.1% EYE DROPS DICLOFENAC SODIUM

FLUOROMETHOLONE 0.1% DROPS FLUOROMETHOLONE

FML FORTE 0.25% EYE DROPS FML FORTE

KETOROLAC 0.4% OPHTH SOLUTION KETOROLAC TROMETHAMINE

KETOROLAC 0.5% OPHTH SOLUTION KETOROLAC TROMETHAMINE

LOTEMAX 0.5% EYE DROPS LOTEMAX

LOTEMAX 0.5% EYE OINTMENT LOTEMAX

LOTEMAX 0.5% OPHTHALMIC GEL LOTEMAX

PREDNISOLONE AC 1% EYE DROP PREDNISOLONE ACETATE

PREDNISOLONE SOD 1% EYE DROP PREDNISOLONE SODIUMPHOSPHATE

Ophthalmic - Intraocular Pressure Reducing Agents


ALPHAGAN P 0.1% DROPS ALPHAGAN P

ALPHAGAN P 0.15% EYE DROPS ALPHAGAN P

AZOPT 1% EYE DROPS AZOPT

BIMATOPROST 0.03% EYE DROPS BIMATOPROST

BRIMONIDINE 0.2% EYE DROP BRIMONIDINE TARTRATE


88

Ophthalmic - Intraocular Pressure Reducing Agents


BRIMONIDINE TARTRATE 0.15% DRP BRIMONIDINE TARTRATE

DORZOLAMIDE HCL 2% EYE DROPS DORZOLAMIDE HCL

DORZOLAMIDE-TIMOLOL 2%-0.5% DORZOLAMIDE-TIMOLOL

DORZOLAMIDE-TIMOLOL EYE DROPS DORZOLAMIDE-TIMOLOL

LATANOPROST 0.005% EYE DROPS LATANOPROST

LEVOBUNOLOL 0.5% EYE DROPS LEVOBUNOLOL HCL

METIPRANOLOL 0.3% EYE DROPS METIPRANOLOL

PILOCARPINE 1% EYE DROPS PILOCARPINE HCL



TIMOLOL 0.25% GEL-SOLUTION TIMOLOL MALEATE

TIMOLOL 0.25% GFS GEL-SOLUTION TIMOLOL MALEATE

TIMOLOL 0.5% EYE DROP TIMOLOL MALEATE

TIMOLOL 0.5% GEL-SOLUTION TIMOLOL MALEATE

TIMOLOL 0.5% GFS GEL-SOLUTION TIMOLOL MALEATE

TIMOLOL MALEATE 0.25% EYE DROP TIMOLOL MALEATE

TIMOLOL MALEATE 0.5% EYE DROPS TIMOLOL MALEATE

Ophthalmic - Mydriatics and Cycloplegics


ATROPINE 1% EYE DROPS ATROPINE SULFATE

Ophthalmic Combinations


NEO-BACIT-POLY-HC EYE OINTMENT NEOMYCIN-BACITRACIN-POLY-HC

NEO-POLYCIN HC EYE OINTMENT NEO-POLYCIN HC

NEOMYC-POLYM-DEXAMET EYEOINTM

NEOMYCIN-POLYMYXIN-DEXAMETH

NEOMYC-POLYM-DEXAMETH EYEDROP

NEOMYCIN-POLYMYXIN-DEXAMETH

NEOMYCIN-POLY-HC EYE DROPS NEOMYCIN-POLYMYXIN-HC

TOBRAMYCIN-DEXAMETH OPHTHSUSP

TOBRAMYCIN-DEXAMETHASONE

Opioid Reversal Agents - Opioid Antagonists


NALTREXONE 50 MG TABLET NALTREXONE HCL QL

NARCAN 4 MG NASAL SPRAY NARCAN

Otic (Ear) - Anti-infectives


ACETIC ACID 2% EAR SOLUTION ACETIC ACID

OFLOXACIN 0.3% EAR DROPS OFLOXACIN

Otic (Ear) - Combinations


ACETIC ACID-ALUMINUM DROPS ACETIC ACID-ALUMINUM

NEOMYCIN-POLYMYXIN-HC EARSOLN

NEOMYCIN-POLYMYXIN-HYDROCORT


89

Otic (Ear) - Combinations


NEOMYCIN-POLYMYXIN-HC EARSUSP

NEOMYCIN-POLYMYXIN-HC

Oxytocics


METHYLERGONOVINE 0.2 MGTABLET

METHYLERGONOVINEMALEATE

Passive Immunizing Agents


CYTOGAM 2.5 GM/50 ML VIAL CYTOGAM PA Prior Authorization required

GAMMAKED 1 GRAM/10 ML VIAL GAMMAKED


GAMMAKED 2.5 GRAM/25 ML VIAL GAMMAKED



GAMUNEX-C 1 GRAM/10 ML VIAL GAMUNEX-C


GAMUNEX-C 2.5 GRAM/25 ML VIAL GAMUNEX-C



HYPERRHO S-D 1,500 UNIT SYRING HYPERRHO S-D PA Prior Authorization required

RHOGAM ULTRA-FILTERED PLUSSYR

RHOGAM ULTRA-FILTEREDPLUS


SYNAGIS 100 MG/1 ML VIAL SYNAGIS PA Prior Authorization required

SYNAGIS 50 MG/0.5 ML VIAL SYNAGIS PA Prior Authorization required

Peptic Ulcer Therapy


CIMETIDINE 300 MG TABLET CIMETIDINE

CIMETIDINE 300 MG/5 ML SOLN CIMETIDINE



ESOMEPRAZOLE MAG DR 20 MG CAP ESOMEPRAZOLE MAGNESIUM

ESOMEPRAZOLE MAG DR 40 MG CAP ESOMEPRAZOLE MAGNESIUM

LANSOPRAZOLE DR 30 MG CAPSULE LANSOPRAZOLE

LANSOPRAZOLE ODT 15 MG TABLET LANSOPRAZOLE

LANSOPRAZOLE ODT 30 MG TABLET LANSOPRAZOLE

MISOPROSTOL 100 MCG TABLET MISOPROSTOL

MISOPROSTOL 200 MCG TABLET MISOPROSTOL

OMEPRAZOLE DR 10 MG CAPSULE OMEPRAZOLE



PANTOPRAZOLE SOD DR 20 MG TAB PANTOPRAZOLE SODIUM

PANTOPRAZOLE SOD DR 40 MG TAB PANTOPRAZOLE SODIUM

RANITIDINE 15 MG/ML SYRUP RANITIDINE HCL

RANITIDINE 150 MG CAPSULE RANITIDINE HCL


90



RANITIDINE 150 MG/10 ML SYRUP RANITIDINE HCL

RANITIDINE 300 MG CAPSULE RANITIDINE HCL

RANITIDINE 300 MG TABLET RANITIDINE HCL

SUCRALFATE 1 GM TABLET SUCRALFATE

SUCRALFATE 1 GM/10 ML SUSP SUCRALFATE

Pharmaceutical Adjuvants


SODIUM CHLORIDE 10% VIAL SODIUM CHLORIDE



Phosphate Binders


CALCIUM ACETATE 667 MG CAPSULE CALCIUM ACETATE

CALCIUM ACETATE 667 MG GELCAP CALCIUM ACETATE

CALCIUM ACETATE 667 MG TABLET CALCIUM ACETATE

Platelet Aggregation Inhibitors and Combinations


ANAGRELIDE HCL 0.5 MG CAPSULE ANAGRELIDE HCL

ANAGRELIDE HCL 1 MG CAPSULE ANAGRELIDE HCL

CILOSTAZOL 100 MG TABLET CILOSTAZOL

CILOSTAZOL 50 MG TABLET CILOSTAZOL

CLOPIDOGREL 300 MG TABLET CLOPIDOGREL

CLOPIDOGREL 75 MG TABLET CLOPIDOGREL

DIPYRIDAMOLE 25 MG TABLET DIPYRIDAMOLE



Posterior Pituitary Hormones


DESMOPRESSIN 0.01% SOLUTION DESMOPRESSIN ACETATE

DESMOPRESSIN 0.01% SPRAY DESMOPRESSIN ACETATE

DESMOPRESSIN 10 MCG/0.1 ML SPR DESMOPRESSIN ACETATE

DESMOPRESSIN 40 MCG/10 ML VIAL DESMOPRESSIN ACETATE

DESMOPRESSIN AC 4 MCG/MLAMPUL

DESMOPRESSIN ACETATE

DESMOPRESSIN AC 4 MCG/ML VIAL DESMOPRESSIN ACETATE

DESMOPRESSIN ACETATE 0.1 MG TB DESMOPRESSIN ACETATE

DESMOPRESSIN ACETATE 0.2 MG TB DESMOPRESSIN ACETATE

Progestins


HYDROXYPROGEST 250 MG/ML VIAL HYDROXYPROGESTERONECAPROATE


MEDROXYPROGESTERONE 10 MGTAB

DEPO-PROVERA

MEDROXYPROGESTERONE 2.5 MGTAB

DEPO-PROVERA


91

Progestins


MEDROXYPROGESTERONE 5 MGTAB

DEPO-PROVERA

NORETHINDRN 5 MG TB (LUPANETA) NORETHINDRONE AC(LUPANETA)

NORETHINDRONE 5 MG TABLET NORETHINDRONE ACETATE

Prostatic Hypertrophy Agents


ALFUZOSIN HCL ER 10 MG TABLET ALFUZOSIN HCL ER

AVODART 0.5 MG SOFTGEL AVODART

DUTASTERIDE 0.5 MG CAPSULE DUTASTERIDE

FINASTERIDE 5 MG TABLET FINASTERIDE

TAMSULOSIN HCL 0.4 MG CAPSULE TAMSULOSIN HCL

Pseudobulbar Affect (PBA) Agents


NUEDEXTA 20-10 MG CAPSULE NUEDEXTA PA Prior Authorization required

Respiratory Combinations


BROMFED DM COUGH SYRUP BROMFED DM

BROMPHENIR-PSEUDOEPHED-DMSYR

BROMPHENIRAMINE-PSEUDOEPHED-DM

FEXOFENADINE-PSE ER 60-120 TAB FEXOFENADINE-PSE ER QL Limited to 60 tablets per 30 days

HYDROCODONE-HOMATROPINESYRUP

HYDROCODONE-HOMATROPINE MBR

PROMETHAZINE VC-CODEINE SYRUP PROMETHAZINE VC-CODEINE

PROMETHAZINE-CODEINE SYRUP PROMETHAZINE-CODEINE

PROMETHAZINE-DM SOLUTION PROMETHAZINE-DM

PROMETHAZINE-DM SYRUP PROMETHAZINE-DM

PROMETHAZINE-PE-CODEINE SYRUP PROMETHAZINE-PHENYLEPH-CODEINE

ZYRTEC-D TABLET ZYRTEC-D

Sedative-Hypnotics


FLURAZEPAM 15 MG CAPSULE FLURAZEPAM HCL

FLURAZEPAM 30 MG CAPSULE FLURAZEPAM HCL

LORAZEPAM 4 MG/ML CARPUJECT LORAZEPAM

LORAZEPAM 4 MG/ML VIAL LORAZEPAM

LORAZEPAM 40 MG/10 ML VIAL LORAZEPAM

PHENOBARBITAL 100 MG TABLET PHENOBARBITAL


PHENOBARBITAL 16.2 MG TABLET PHENOBARBITAL

PHENOBARBITAL 20 MG/5 ML ELIX PHENOBARBITAL

PHENOBARBITAL 20 MG/5 ML SOLN PHENOBARBITAL




92

Sedative-Hypnotics





TEMAZEPAM 15 MG CAPSULE TEMAZEPAM

TEMAZEPAM 22.5 MG CAPSULE TEMAZEPAM

TEMAZEPAM 30 MG CAPSULE TEMAZEPAM

TEMAZEPAM 7.5 MG CAPSULE TEMAZEPAM

ZOLPIDEM TART 1.75 MG TAB SL ZOLPIDEM TARTRATE QL

ZOLPIDEM TART 3.5 MG TABLET SL ZOLPIDEM TARTRATE QL

ZOLPIDEM TART ER 12.5 MG TAB ZOLPIDEM TARTRATE ER QL

ZOLPIDEM TART ER 6.25 MG TAB ZOLPIDEM TARTRATE ER QL

ZOLPIDEM TARTRATE 10 MG TABLET ZOLPIDEM TARTRATE QL

ZOLPIDEM TARTRATE 5 MG TABLET ZOLPIDEM TARTRATE QL

Sickle Cell Anemia Agents


DROXIA 200 MG CAPSULE DROXIA



Smoking Deterrents and Combinations


CHANTIX 1 MG CONT MONTH BOX CHANTIX QL Limited to 56 tablets per 28 days: Limitedto 6 fills per 365 days

CHANTIX 1 MG TABLET CHANTIX QL Limited to 56 tablets per 28 days: Limitedto 6 fills per 365 days

CHANTIX STARTING MONTH BOX CHANTIX QL Limited to 53 tablets per 28 days; Limitedto 6 fills per 365 days

Thyroid Therapy


LEVO-T 100 MCG TABLET LEVO-T












LEVOTHYROXINE 0.025 MG TABLET LEVOTHYROXINE SODIUM





93

Thyroid Therapy








LEVOTHYROXINE 100 MCG TABLET LEVOTHYROXINE SODIUM

LEVOTHYROXINE 100 MCG VIAL LEVOTHYROXINE SODIUM














LEVOXYL 100 MCG TABLET LEVOXYL











LIOTHYRONINE SOD 10 MCG/ML VL LIOTHYRONINE SODIUM

LIOTHYRONINE SOD 25 MCG TAB LIOTHYRONINE SODIUM



METHIMAZOLE 10 MG TABLET METHIMAZOLE

METHIMAZOLE 5 MG TABLET METHIMAZOLE

PROPYLTHIOURACIL 50 MG TABLET PROPYLTHIOURACIL

SYNTHROID 0.137 MG TABLET SYNTHROID

SYNTHROID 100 MCG TABLET SYNTHROID




94

Thyroid Therapy











UNITHROID 100 MCG TABLET UNITHROID












Urinary Analgesics


PHENAZOPYRIDINE 100 MG TAB PHENAZOPYRIDINE HCL

PHENAZOPYRIDINE 200 MG TAB PHENAZOPYRIDINE HCL

Urinary Anti-infectives


CIPRO XR 1,000 MG TABLET CIPRO XR

CIPROFLOXACIN ER 1,000 MG TAB CIPROFLOXACIN ER

CIPROFLOXACIN ER 500 MG TABLET CIPROFLOXACIN ER QL Limited to 3 per fill; Limited to 1 fill per 25days

NITROFURANTOIN 25 MG/5 ML SUSP NITROFURANTOIN

NITROFURANTOIN MCR 100 MG CAP NITROFURANTOIN



NITROFURANTOIN MONO-MCR 100MG

NITROFURANTOIN MONO-MACRO

Urinary Antispasmodics


DARIFENACIN ER 15 MG TABLET DARIFENACIN ER

DARIFENACIN ER 7.5 MG TABLET DARIFENACIN ER

DETROL LA 2 MG CAPSULE DETROL LA

DETROL LA 4 MG CAPSULE DETROL LA


95

Urinary Antispasmodics


ENABLEX 15 MG TABLET ENABLEX

ENABLEX 7.5 MG TABLET ENABLEX

OXYBUTYNIN 5 MG TABLET OXYBUTYNIN CHLORIDE

OXYBUTYNIN 5 MG/5 ML SYRUP OXYBUTYNIN CHLORIDE

OXYBUTYNIN CL ER 10 MG TABLET OXYBUTYNIN CHLORIDE ER



TOLTERODINE TART ER 2 MG CAP TOLTERODINE TARTRATE ER

TOLTERODINE TART ER 4 MG CAP TOLTERODINE TARTRATE ER

TOLTERODINE TARTRATE 1 MG TAB TOLTERODINE TARTRATE

TOLTERODINE TARTRATE 2 MG TAB TOLTERODINE TARTRATE

TROSPIUM CHLORIDE 20 MG TABLET TROSPIUM CHLORIDE

TROSPIUM CHLORIDE ER 60 MG CAP TROSPIUM CHLORIDE ER

Urinary pH Modifiers


POTASSIUM CITRATE ER 10 MEQ TB POTASSIUM CITRATE ER

POTASSIUM CITRATE ER 15 MEQ TB POTASSIUM CITRATE ER

POTASSIUM CITRATE ER 5 MEQ TAB POTASSIUM CITRATE ER

Urinary Retention Therapy


BETHANECHOL 10 MG TABLET BETHANECHOL CHLORIDE




Vaginal Anti-infectives


CLEOCIN 100 MG VAGINAL OVULE CLEOCIN

CLINDAMYCIN 2% VAGINAL CREAM CLINDAMYCIN PHOSPHATE

METRONIDAZOLE VAGINAL 0.75% GL METRONIDAZOLE

TERCONAZOLE 0.4% CREAM TERCONAZOLE

TERCONAZOLE 0.8% CREAM TERCONAZOLE

TERCONAZOLE 80 MG SUPPOSITORY TERCONAZOLE

Vaginal Estrogens


ESTRADIOL 0.01% CREAM ESTRADIOL

ESTRADIOL 10 MCG VAGINAL INSRT ESTRADIOL

PREMARIN VAGINAL CREAM-APPL PREMARIN

Vitamin Combinations


ATABEX EC CAPLET ATABEX EC

HEMENATAL OB + DHA COMBO PACK HEMENATAL OB + DHA

HEMENATAL OB TABLET HEMENATAL OB

LEVOMEFOLATE DHA CAPSULE LEVOMEFOLATE DHA


96



PNV PRENATAL PLUS MULTIVIT TAB PRENATAL PLUS

PNV-FERROUS FUMARATE-DOCU-FA PNV-FERROUS FUMARATE-DOCU-FA

PREFERA OB TABLET PREFERA OB

PRENAISSANCE NEXT TABLET PRENAISSANCE NEXT

PRENATABS FA TABLET PRENATABS FA

PRENATAL 19 TABLET PRENATAL 19

PRENATAL LOW IRON TABLET PRENATAL LOW IRON

PRENATAL PLUS IRON TABLET PRENATAL PLUS

PRENATAL PLUS TABLET PRENATAL PLUS

PRENATAL VITAMIN PLUS LOW IRON PRENATAL VITAMIN PLUS LOWIRON

PRENATAL-U CAPSULE PRENATAL-U

PRETAB 29 MG-1 MG TABLET PRETAB

VP-GGR-B6 TABLET VP-GGR-B6

VP-HEME OB TABLET VP-HEME OB

ZINGIBER TABLET ZINGIBER

Vitamins


CALCITRIOL 0.25 MCG CAPSULE CALCITRIOL

CALCITRIOL 0.5 MCG CAPSULE CALCITRIOL

CALCITRIOL 1 MCG/ML AMPUL CALCITRIOL

CALCITRIOL 1 MCG/ML SOLUTION CALCITRIOL

CYANOCOBALAMIN 1,000 MCG/ML CYANOCOBALAMIN INJECTION

CYANOCOBALAMIN 10,000 MCG/10 CYANOCOBALAMIN INJECTION

CYANOCOBALAMIN 30,000 MCG/30 CYANOCOBALAMIN INJECTION

FOLIC ACID 1 MG TABLET FOLIC ACID

PYRIDOXINE 100 MG/ML VIAL PYRIDOXINE HCL

THIAMINE 200 MG/2 ML VIAL THIAMINE HCL

VIT D2 1.25 MG (50,000 UNIT) VITAMIN D2

Wound Care Therapy


REGRANEX 0.01% GEL REGRANEX

2018 Trusted Health Plan Medicaid OTC Formulary

97

Acne Therapy


ACNE FOAMING 10% WASH ACNE FOAMING WASH

ACNE TREATMENT 10% GEL ACNE TREATMENT

BENZOYL PEROXIDE 10% GEL BENZOYL PEROXIDE

BENZOYL PEROXIDE 10% WASH BENZOYL PEROXIDE

BENZOYL PEROXIDE 2.5% GEL BENZOYL PEROXIDE

BENZOYL PEROXIDE 5% GEL BENZOYL PEROXIDE

BENZOYL PEROXIDE 5% WASH BENZOYL PEROXIDE

CVS ACNE SPOT TRTMENT 2.5% CRM ACNE SPOT TREATMENT

CVS ACNE TREATMENT 10% GEL ACNE TREATMENT

CVS ADV EXFOLIATING 5% CLEANSR ADVANCED EXFOLIATINGCLEANSER

CVS FOAMING ACNE FACE 10%WASH

FOAMING ACNE FACE WASH

DAYLOGIC ACNE FOAMING 10%WASH

DAYLOGIC ACNE FOAMINGWASH



ACETAMINOPHEN 325 MG GELCAP ACETAMINOPHEN

ACETAMINOPHEN 325 MG TABLET ACETAMINOPHEN

ACETAMINOPHEN 500 MG CAPLET ACETAMINOPHEN

ACETAMINOPHEN 500 MG GELCAP ACETAMINOPHEN

ACETAMINOPHEN 500 MG TABLET ACETAMINOPHEN

ADULT ASPIRIN EC 81 MG TABLET ADULT ASPIRIN

ADULT ASPIRIN REGIMEN EC 81 MG ADULT ASPIRIN REGIMEN

ADVIL 200 MG CAPLET ADVIL

ADVIL 200 MG GEL CAPLET ADVIL

ADVIL 200 MG TABLET ADVIL

ALL DAY PAIN RELIEF 220 MG TAB ALL DAY PAIN RELIEF

ALL DAY PAIN RLF 220 MG CAPLET ALL DAY PAIN RELIEF

ANALGESIC TABLET ANALGESIC

ASPIR EC 81 MG TABLET ASPIR 81

ASPIRIN 325 MG COATED TABLET ASPIRIN

ASPIRIN 325 MG LITE-COAT TAB ASPIRIN

ASPIRIN 325 MG TABLET ASPIRIN

ASPIRIN 81 MG CHEWABLE TABLET ASPIRIN

ASPIRIN EC 325 MG TABLET ASPIRIN EC




BAYER ASPIRIN 325 MG TABLET ASPIRIN

CHILD ASPIRIN 81 MG CHEW TAB CHILDREN’S ASPIRIN

CHILD ASPIRIN 81 MG TAB CHEW CHILDREN’S ASPIRIN

CHILD IBU-DROPS 50 MG/1.25 ML CHILDREN’S IBUPROFEN

CHILD IBUPROFEN 100 MG/5 ML CHILD IBUPROFEN


98



CHILDREN IBUPROFEN 100 MG/5 ML CHILDREN’S IBUPROFEN

CVS ACETAMINOPHEN 325 MG TAB ACETAMINOPHEN

CVS ALL DAY PAIN RLF 220 MG TB ALL DAY PAIN RELIEF

CVS ASPIRIN 325 MG CAPLET ASPIRIN

CVS ASPIRIN 325 MG TABLET ASPIRIN

CVS ASPIRIN 81 MG CHEWABLE TAB ASPIRIN

CVS ASPIRIN EC 325 MG TABLET ASPIRIN EC

CVS ASPIRIN EC 81 MG TABLET ASPIRIN EC

CVS CHILD ASPIRIN 81 MG CHW TB CHILDREN’S ASPIRIN

CVS CHILD ASPIRIN CHEW TAB CHILDREN’S ASPIRIN

CVS CHLD IBUPROFEN 100 MG/5 ML CHILDREN’S IBUPROFEN

CVS HEADACHE RELIEF CAPLET HEADACHE RELIEF

CVS HEADACHE RELIEF GELCAP HEADACHE RELIEF

CVS HEADACHE RELIEF TABLET HEADACHE RELIEF

CVS IBUPROFEN 200 MG CAPLET IBUPROFEN

CVS IBUPROFEN 200 MG CAPSULE IBUPROFEN

CVS IBUPROFEN 200 MG SOFTGEL IBUPROFEN

CVS IBUPROFEN 200 MG TABLET IBUPROFEN

CVS IBUPROFEN IB 200 MG CPLT IBUPROFEN IB

CVS IBUPROFEN IB 200 MG TAB IBUPROFEN IB

CVS IBUPROFEN IB 200 MG TABLET IBUPROFEN

CVS IBUPROFEN JR STR 100 MG TB IBUPROFEN

CVS INF IBUPROFEN 50 MG/1.25 ML INFANTS’ IBUPROFEN

CVS INFANT IBUPROFEN SUSP DROP INFANT’S IBUPROFEN

CVS MIGRAINE RELIEF CAPLET MIGRAINE RELIEF

CVS NAPROXEN SOD 220 MGCAPLET

NAPROXEN SODIUM

CVS NAPROXEN SOD 220 MG TABLET NAPROXEN SODIUM

CVS NAPROXEN SODIUM 220 MGCAP

NAPROXEN SODIUM

CVS NON-ASPIRIN 500 MG CAPLET NON-ASPIRIN EXTRASTRENGTH

CVS NON-ASPIRIN 500 MG GELTAB NON-ASPIRIN EXTRASTRENGTH

CVS NON-ASPIRIN 500 MG TABLET NON-ASPIRIN EXTRASTRENGTH

CVS PAIN RELIEF 325 MG TABLET PAIN RELIEF

CVS PAIN RELIEF 500 MG CAPLET PAIN RELIEF EXTRASTRENGTH

CVS PAIN RELIEF 500 MG EZ-TAB PAIN RELIEF EXTRASTRENGTH

CVS PAIN RELIEF 500 MG GELCAP PAIN RELIEF

CVS PAIN RELIEVER 500 MG CPLT PAIN RELIEVER

CVS SUPER PAIN RELIEF SUPER PAIN RELIEF

CVS SUPER PAIN RELIEF TAB SUPER PAIN RELIEF


99



ECPIRIN EC 325 MG TABLET ECPIRIN

EQ ACETAMINOPHEN 500 MGCAPLET

ACETAMINOPHEN

EQ ACETAMINOPHEN 500 MGGELCAP

ACETAMINOPHEN

EQ ACETAMINOPHEN 500 MGTABLET

ACETAMINOPHEN

EQ ASPIRIN 325 MG TABLET ASPIRIN

EQ ASPIRIN 81 MG CHEWABLE TAB ASPIRIN

EQ ASPIRIN EC 325 MG TABLET ASPIRIN EC

EQ ASPIRIN EC 81 MG TABLET ASPIRIN EC

EQ CHILD IBUPROFEN 100 MG/5 ML CHILDREN’S IBUPROFEN

EQ IBUPROFEN 200 MG CAPLET IBUPROFEN

EQ IBUPROFEN 200 MG SOFTGEL IBUPROFEN

EQ IBUPROFEN 200 MG TABLET IBUPROFEN

EQ IBUPROFEN JR STR 100 MG TAB IBUPROFEN

EQ INF IBUPROFEN 50 MG/1.25 ML INFANTS’ IBUPROFEN

EQ NAPROXEN SOD 220 MG CAPLET NAPROXEN SODIUM

EQ NAPROXEN SOD 220 MG TABLET NAPROXEN SODIUM

EQ NAPROXEN SODIUM 220 MG CAP NAPROXEN SODIUM

EQ PAIN RELIEVER 325 MG TABLET PAIN RELIEVER

EQ PAIN RELIEVER 500 MG CAPLET PAIN RELIEVER

EQL ACETAMINOPHEN 500 MG CPLT ACETAMINOPHEN

EQL ACETAMINOPHEN 500 MGGELCP

ACETAMINOPHEN

EQL ACETAMINOPHEN 500 MG TAB ACETAMINOPHEN

EQL ASPIRIN 325 MG TABLET ASPIRIN

EQL ASPIRIN 81 MG CHEWABLE TAB ASPIRIN

EQL ASPIRIN EC 325 MG TABLET ASPIRIN EC

EQL ASPIRIN EC 81 MG TABLET ASPIRIN EC

EQL CHLD IBUPROFEN 100 MG/5 ML CHILDREN’S IBUPROFEN

EQL HEADACHE RELIEF TABLET HEADACHE RELIEF

EQL IBUPROFEN 200 MG CAPLET IBUPROFEN

EQL IBUPROFEN 200 MG SOFTGEL IBUPROFEN

EQL IBUPROFEN 200 MG TABLET IBUPROFEN

EQL IBUPROFEN JR 100 MG TB CHW IBUPROFEN

EQL INF IBUPROFEN 50 MG/1.25 ML INFANTS IBUPROFEN

EQL MIGRAINE FORMULA CAPLET MIGRAINE FORMULA

EQL NAPROXEN SOD 220 MGCAPLET

NAPROXEN SODIUM

EQL NAPROXEN SODIUM 220 MGCAP

NAPROXEN SODIUM

EQL NAPROXEN SODIUM 220 MG TAB NAPROXEN SODIUM

GNP ACETAMINOPHEN 325 MGGELCP

ACETAMINOPHEN


100



GNP ALL DAY PAIN RLF 220 MG TB ALL DAY PAIN RELIEF

GNP ASPIRIN 325 MG TABLET ASPIRIN

GNP ASPIRIN 81 MG CHEWABLE TAB ASPIRIN

GNP ASPIRIN EC 325 MG TABLET ASPIRIN EC

GNP ASPIRIN EC 81 MG TABLET ASPIRIN EC

GNP CHLD IBUPROFEN 100 MG/5 ML CHILDREN’S IBUPROFEN

GNP HEADACHE RELIEF CAPLET HEADACHE RELIEF

GNP IBUPROFEN 200 MG CAPLET IBUPROFEN

GNP IBUPROFEN 200 MG SOFTGEL IBUPROFEN

GNP IBUPROFEN 200 MG TABLET IBUPROFEN

GNP IBUPROFEN JR STR 100 MG TB IBUPROFEN

GNP INFANT IBUPROFEN SUSPDROP

INFANT’S IBUPROFEN

GNP LITE COAT ASA 325 MG TAB LITE COAT ASPIRIN

GNP MIGRAINE FORMULA CAPLET MIGRAINE FORMULA

GNP MIGRAINE RELIEF CAPLET MIGRAINE RELIEF

GNP NAPROXEN SOD 220 MGCAPLET

NAPROXEN SODIUM

GNP NAPROXEN SOD 220 MGTABLET

NAPROXEN SODIUM

GNP NAPROXEN SODIUM 220 MGCAP

NAPROXEN SODIUM

GNP PAIN RELIEF 325 MG TABLET PAIN RELIEF

GNP PAIN RELIEF 500 MG CAPLET PAIN RELIEF EXTRASTRENGTH

GNP PAIN RELIEF 500 MG GELCAP PAIN RELIEF

GNP PAIN RELIEVER 325 MG TAB PAIN RELIEVER

GNP PAIN RELIEVER 500 MG CAPLT PAIN RELIEVER

GNP PAIN RELIEVER 500 MG TAB PAIN RELIEVER

GS ASPIRIN 325 MG TABLET ASPIRIN

GS ASPIRIN 81 MG CHEWABLE TAB ASPIRIN

GS ASPIRIN EC 325 MG TABLET ASPIRIN EC

GS ASPIRIN EC 81 MG TABLET ASPIRIN EC

GS CHILD IBUPROFEN 100 MG/5 ML CHILDREN’S IBUPROFEN

GS IBUPROFEN 200 MG CAPLET IBUPROFEN

GS IBUPROFEN 200 MG SOFTGEL IBUPROFEN

GS IBUPROFEN 200 MG TABLET IBUPROFEN

GS NAPROXEN SOD 220 MG CAPLET NAPROXEN SODIUM

GS NAPROXEN SOD 220 MG TABLET NAPROXEN SODIUM

GS PAIN RELIEF 500 MG CAPLET PAIN RELIEF

GS PAIN RELIEF 500 MG TABLET PAIN RELIEF

HEADACHE RELIEF CAPLET HEADACHE RELIEF

HEADACHE RELIEF GELCAP HEADACHE RELIEF

HEADACHE RELIEF TABLET HEADACHE RELIEF


101



HM ASPIRIN 325 MG TABLET ASPIRIN

HM ASPIRIN 81 MG CHEWABLE TAB ASPIRIN

HM ASPIRIN EC 325 MG TABLET ASPIRIN EC

HM ASPIRIN EC 81 MG TABLET ASPIRIN EC

HM CHILD IBUPROFEN 100 MG/5 ML CHILDREN’S IBUPROFEN

HM IBUPROFEN 200 MG CAPLET IBUPROFEN

HM IBUPROFEN 200 MG CAPSULE IBUPROFEN

HM IBUPROFEN 200 MG TABLET IBUPROFEN

HM IBUPROFEN IB 200 MG CAPLET IBUPROFEN IB

HM IBUPROFEN IB 200 MG TABLET IBUPROFEN IB

HM INF IBUPROFEN 50 MG/1.25 ML INFANTS’ IBUPROFEN

HM MIGRAINE FORMULA CAPLET MIGRAINE FORMULA

HM MIGRAINE RELIEF CAPLET MIGRAINE RELIEF

HM NAPROXEN SOD 220 MG CAPLET NAPROXEN SODIUM

HM NAPROXEN SODIUM 220 MG CAP NAPROXEN SODIUM

HM PAIN RELIEF 500 MG CAPLET PAIN RELIEF

HM PAIN RELIEF 500 MG TABLET PAIN RELIEF

HM PAIN RELIEVER 325 MG TABLET PAIN RELIEVER

HM PAIN RELIEVER 500 MG TABLET PAIN RELIEVER

I-PRIN 200 MG TABLET I-PRIN

IBU-200 200 MG TABLET IBU-200

IBU-DROPS 40 MG/ML SUSP DRPS IBU-DROPS


IBUPROFEN 200 MG CAPLET IBUPROFEN

IBUPROFEN 200 MG CAPSULE IBUPROFEN

IBUPROFEN 200 MG SOFTGEL IBUPROFEN



IBUPROFEN 50 MG/1.25 ML SUSP IBUPROFEN

IBUPROFEN IB 200 MG CAPLET IBUPROFEN IB

IBUPROFEN JR STR 100 MG CHEW IBUPROFEN

IBUPROFEN JR STR 100 MG TB CHW IBUPROFEN

INFANT IBUPROFEN 50 MG/1.25 ML INFANTS’ IBUPROFEN

INFANTS IBU-DROPS SUSPENSION INFANTS IBU-DROPS

KRO ACETAMINOPHEN 325 MG TAB ACETAMINOPHEN

KRO ACETAMINOPHEN 500 MG CPLT ACETAMINOPHEN

KRO ACETAMINOPHEN 500 MG TAB ACETAMINOPHEN

KRO ALL DAY RLF 220 MG CAPLET ALL DAY RELIEF

KRO ASPIRIN 325 MG TABLET ASPIRIN

KRO ASPIRIN 81 MG CHEWABLE TAB ASPIRIN

KRO ASPIRIN EC 325 MG TABLET ASPIRIN EC

KRO ASPIRIN EC 81 MG TABLET ASPIRIN EC

KRO CHLD IBUPROFEN 100 MG/5 ML CHILDREN’S IBUPROFEN


102



KRO IBUPROFEN 200 MG CAPLET IBUPROFEN

KRO IBUPROFEN 200 MG SOFTGEL IBUPROFEN

KRO IBUPROFEN 200 MG TABLET IBUPROFEN

KRO IBUPROFEN JR STR 100 MG TB IBUPROFEN

KRO MIGRAINE FORMULA CAPLET MIGRAINE FORMULA

KRO NAPROXEN SOD 220 MGCAPLET

NAPROXEN SODIUM

KRO NAPROXEN SODIUM 220 MGTAB

NAPROXEN SODIUM

LITE COAT ASPIRIN 325 MG TAB LITE COAT ASPIRIN

LOW DOSE ASPIRIN EC 81 MG TAB LOW DOSE ASPIRIN EC

MIGRAINE FORMULA CAPLET MIGRAINE FORMULA

MIGRAINE RELIEF CAPLET MIGRAINE RELIEF

MOTRIN IB 200 MG CAPLET MOTRIN IB

NAPROXEN SODIUM 220 MG CAPLET NAPROXEN SODIUM

NAPROXEN SODIUM 220 MGCAPSULE

NAPROXEN SODIUM

NAPROXEN SODIUM 220 MG TABLET NAPROXEN SODIUM

NON ASPIRIN 500 MG CAPLET NON-ASPIRIN EXTRASTRENGTH

NON-ASPIRIN 325 MG TABLET NON-ASPIRIN

NON-ASPIRIN 500 MG CAPLET NON-ASPIRIN EXTRASTRENGTH

NON-ASPIRIN 500 MG GELCAP NON-ASPIRIN EXTRASTRENGTH

NON-ASPIRIN 500 MG GELTAB NON-ASPIRIN EXTRASTRENGTH

NON-ASPIRIN 500 MG TABLET NON-ASPIRIN EXTRASTRENGTH

PAIN RELIEF 325 MG TABLET PAIN RELIEF

PAIN RELIEF 500 MG CAPLET PAIN RELIEF

PAIN RELIEF 500 MG GELCAP PAIN RELIEF

PAIN RELIEF 500 MG TABLET PAIN RELIEF

PAIN RELIEVER 325 MG TABLET PAIN RELIEVER

PAIN RELIEVER 500 MG CAPLET PAIN RELIEVER

PAIN RELIEVER 500 MG GELCAP PAIN RELIEVER

PAIN RELIEVER 500 MG TABLET PAIN RELIEVER

PAIN RELIEVER TABLET PAIN RELIEVER

PROVIL 200 MG TABLET PROVIL

PUB ALL DAY RELIEF 220 MG TAB ALL DAY RELIEF

PUB ALL DAY RLF 220 MG CAPLET ALL DAY RELIEF

PUB ASPIRIN 325 MG TABLET ASPIRIN

PUB ASPIRIN 81 MG CHEWABLE TAB ASPIRIN

PUB CHILDREN’S PROFEN IB SUSP CHILDREN’S PROFEN IB

PUB CHILDREN’S PROFENIB SUSP CHILDREN’S PROFENIB


103



PUB IBUPROFEN 200 MG TABLET IBUPROFEN

PUB IBUPROFEN JR 100 MG CHEW IBUPROFEN

PUB INFANTS PROFENIB DROPS INFANTS PROFENIB

PUB MIGRAINE RELIEF CAPLET MIGRAINE RELIEF

PUB NAPROXEN SOD 220 MG TABLET NAPROXEN SODIUM

PUB PAIN RELIEF 500 MG CAPLET PAIN RELIEF

PUB PAIN RELIEF 500 MG GELTAB PAIN RELIEF

PUB PAIN RELIEF 500 MG TABLET PAIN RELIEF

QC ASPIRIN 325 MG TABLET ASPIRIN

QC ASPIRIN 81 MG CHEWABLE TAB ASPIRIN

QC ASPIRIN EC 325 MG TABLET ASPIRIN EC

QC ASPIRIN EC 81 MG TABLET ASPIRIN EC

QC CHILD IBUPROFEN 100 MG/5 ML CHILDREN’S IBUPROFEN

QC HEADACHE RELIEF TABLET HEADACHE RELIEF

QC IBUPROFEN 100 MG/5 ML SUSP IBUPROFEN

QC IBUPROFEN 200 MG CAPLET IBUPROFEN

QC IBUPROFEN 200 MG SOFTGEL IBUPROFEN

QC IBUPROFEN 200 MG TABLET IBUPROFEN

QC IBUPROFEN IB 200 MG CAPLET IBUPROFEN IB

QC IBUPROFEN IB 200 MG TABLET IBUPROFEN IB

QC INF IBUPROFEN 50 MG/1.25 ML INFANTS’ IBUPROFEN

QC LO-DOSE ASPIRIN EC 81 MG TB LO-DOSE ASPIRIN EC

QC NAPROXEN SOD 220 MG TABLET NAPROXEN SODIUM

QC NON-ASPIRIN 325 MG TABLET NON-ASPIRIN PAIN RELIEF

QC NON-ASPIRIN 500 MG CAPLET NON-ASPIRIN PAIN RELIEF

QC NON-ASPIRIN 500 MG GELCAP NON-ASPIRIN PAIN RELIEF

QC NON-ASPIRIN 500 MG TABLET NON-ASPIRIN PAIN RELIEF

QC NON-ASPIRIN PAIN RELIEF TB NON-ASPIRIN PAIN RELIEF

QC PAIN RELIEF 500 MG CAPLET PAIN RELIEF

RA ACETAMINOPHEN 325 MG TABLET ACETAMINOPHEN

RA ACETAMINOPHEN 500 MGCAPLET

ACETAMINOPHEN

RA ACETAMINOPHEN 500 MGGELCAP

ACETAMINOPHEN

RA ACETAMINOPHEN 500 MG TABLET ACETAMINOPHEN

RA ASPIRIN 325 MG TABLET ASPIRIN

RA ASPIRIN 81 MG CHEWABLE TAB ASPIRIN

RA ASPIRIN EC 325 MG TABLET ASPIRIN EC

RA ASPIRIN EC 81 MG TABLET ASPIRIN EC

RA ATHENOL 325 MG TABLET ATHENOL

RA CHILD ASPIRIN 81 MG CHW TAB CHILDREN’S ASPIRIN

RA CHILD IBUPROFEN 100 MG/5 ML CHILDREN’S IBUPROFEN

RA IBUPROFEN 100 MG/5 ML SUSP IBUPROFEN


104



RA IBUPROFEN 200 MG CAPLET IBUPROFEN

RA IBUPROFEN 200 MG LIQUID GEL IBUPROFEN

RA IBUPROFEN 200 MG SOFTGEL IBUPROFEN

RA IBUPROFEN 200 MG TABLET IBUPROFEN

RA IBUPROFEN JR STR 100 MG CHW IBUPROFEN

RA INFANT IBUPROFEN SUSP DROP INFANT’S IBUPROFEN

RA MIGRAINE RELIEF CAPLET MIGRAINE RELIEF

RA NAPROXEN SOD 220 MG TABLET NAPROXEN SODIUM

RA NAPROXEN SODIUM 220 MG CAP NAPROXEN SODIUM

RA NON-ASPIRIN 500 MG CAPLET NON-ASPIRIN EXTRASTRENGTH

RA PAIN RELIEVER TABLET PAIN RELIEVER

SB ASPIRIN 325 MG TABLET ASPIRIN

SB ASPIRIN EC 81 MG TABLET ASPIRIN EC

SB CHILD ASPIRIN 81 MG CHW TAB CHILDREN’S ASPIRIN

SB CHILD IBUPROFEN 100 MG/5 ML CHILDREN’S IBUPROFEN

SB EX-STRENGTH NON-ASPIRIN TAB EXTRA STRENGTH NON-ASPIRIN

SB IBUPROFEN 200 MG CAPLET IBUPROFEN

SB IBUPROFEN 200 MG TABLET IBUPROFEN

SB INF IBUPROFEN 50 MG/1.25 ML INFANTS’ IBUPROFEN

SB NAPROXEN SOD 220 MG CAPLET NAPROXEN SODIUM

SB NAPROXEN SOD 220 MG TABLET NAPROXEN SODIUM

SB NON-ASPIRIN 325 MG TABLET NON-ASPIRIN

SB NON-ASPIRIN 500 MG CAPLET NON-ASPIRIN EXTRASTRENGTH

SB PAIN RELIEF E-S TABLET PAIN RELIEF EXTRASTRENGTH

SB PAIN RELIEVER 500 MG CAPLET PAIN RELIEVER

SB PAIN RELIEVER 500 MG GELCAP PAIN RELIEVER

SM ADDED STRENGTH HEADACHETAB

ADDED STRENGTH HEADACHE

SM ALL DAY RELIEF 220 MG CAPLT ALL DAY PAIN RELIEF

SM ALL DAY RELIEF 220 MG TAB ALL DAY PAIN RELIEF

SM ASPIRIN 325 MG TABLET ASPIRIN

SM ASPIRIN 81 MG CHEWABLE TAB ASPIRIN

SM ASPIRIN EC 325 MG TABLET ASPIRIN EC

SM ASPIRIN EC 81 MG TABLET ASPIRIN EC

SM CHILD ASPIRIN 81 MG CHW TAB CHILDREN’S ASPIRIN

SM IBUPROFEN 100 MG/5 ML SUSP IBUPROFEN

SM IBUPROFEN 200 MG CAPLET IBUPROFEN

SM IBUPROFEN 200 MG SOFTGEL IBUPROFEN

SM IBUPROFEN 200 MG TABLET IBUPROFEN

SM IBUPROFEN IB 100 MG CHEW TAB IBUPROFEN IB


105



SM IBUPROFEN IB 100 MG TABLET IBUPROFEN

SM IBUPROFEN IB 200 MG CAPLET IBUPROFEN IB

SM IBUPROFEN IB 200 MG TABLET IBUPROFEN

SM INFANT IBUPROFEN SUSP DROP INFANT’S IBUPROFEN

SM MIGRAINE RELIEF CAPLET MIGRAINE RELIEF

SM NAPROXEN SOD 220 MG CAPLET NAPROXEN SODIUM

SM NAPROXEN SOD 220 MG TABLET NAPROXEN SODIUM

SM NAPROXEN SODIUM 220 MG CAP NAPROXEN SODIUM

SM PAIN RELIEF 500 MG GELCAP PAIN RELIEF EXTRASTRENGTH

SM PAIN RELIEVER 325 MG TABLET PAIN RELIEVER

SM PAIN RELIEVER 500 MG CAPLET PAIN RELIEVER

SM PAIN RELIEVER 500 MG GELCAP PAIN RELIEVER

SM PAIN RELIEVER 500 MG GELTAB PAIN RELIEVER

SM PAIN RELIEVER 500 MG TABLET PAIN RELIEVER

TACTINAL 325 MG TABLET TACTINAL

TACTINAL 500 MG CAPLET TACTINAL

TACTINAL 500 MG TABLET TACTINAL

V-R ASPIRIN EC 325 MG TABLET ASPIRIN EC

V-R ASPIRIN EC 81 MG TABLET ASPIRIN EC

V-R IBUPROFEN 200 MG TABLET IBUPROFEN

V-R NAPROXEN SOD 220 MG TABLET NAPROXEN SODIUM

VR ADD-STR PAIN RELIEF CAPLET ADDED STRENGTH PAINRELIEVER

WAL-PROFEN 200 MG CAPLET WAL-PROFEN

WAL-PROFEN 200 MG CAPSULE WAL-PROFEN

WAL-PROFEN 200 MG SOFTGEL WAL-PROFEN

WAL-PROFEN 200 MG TABLET WAL-PROFEN

WAL-PROXEN 220 MG CAPLET WAL-PROXEN

WAL-PROXEN 220 MG TABLET WAL-PROXEN

Anorectal - Hemorrhoidal Single Agents Other


EQ HEMORRHOIDAL 50% PADS HEMORRHOIDAL PADS

EQ HEMORRHOIDAL MED 50% WIPES HEMORRHOIDAL MEDICATEDWIPES

HEMORRHOIDAL HYGIENE PADS HEMORRHOIDAL HYGIENE

KRO MEDICATED 50% WIPES MEDICATED WIPES

MEDICATED 50% PADS MEDICATED PADS

MEDICATED 50% WIPES MEDICATED WIPES

PREPARATION H MEDICATED WIPES PREPARATION H

PREPARATION H TOTABLES WIPES PREPARATION H TOTABLES

TUCKS 50% MEDICATED PADS TUCKS


106

Anorectal Combinations


CVS HEMORRHOIDAL CREAM HEMORRHOIDAL CREAM

CVS HEMORRHOIDAL OINTMENT HEMORRHOIDAL OINTMENT

EQ HEMORRHOIDAL CREAM HEMORRHOIDAL CREAM

EQL HEMORRHOIDAL CREAM HEMORRHOIDAL CREAM

HEMORRHOIDAL COOLING GEL HEMORRHOIDAL COOLINGGEL

HEMORRHOIDAL CREAM HEMORRHOIDAL CREAM

HEMORRHOIDAL OINTMENT HEMORRHOIDAL OINTMENT

HEMORRHOIDAL SUPPOSITORIES HEMORRHOIDAL

PREPARATION H COOLING GEL PREPARATION H

PREPARATION H CREAM PREPARATION H

PUB HEMORRHOIDAL CREAM HEMORRHOIDAL CREAM

PUB HEMORRHOIDAL OINTMENT HEMORRHOIDAL OINTMENT

PUB HEMORRHOIDALSUPPOSITORIES

HEMORRHOIDALSUPPOSITORIES

RA HEMORRHOIDAL CREAM HEMORRHOIDAL CREAM

RA HEMORRHOIDAL H SUPP HEMORRHOIDAL H

RA HEMORRHOIDAL OINTMENT HEMORRHOIDAL OINTMENT

SM HEMORRHOIDAL COOLING GEL HEMORRHOIDAL COOLINGGEL

SM HEMORRHOIDAL CREAM HEMORRHOIDAL CREAM

V-R HEMORRHOIDAL CREAM HEMORRHOIDAL CREAM

Antacids and Combinations


ADV ANTACID-ANTIGAS LIQUID ADVANCED ANTACID-ANTIGAS

ALUM-MAG HYDROXIDE-SIMETH LIQ ALUM-MAG HYDROXIDE-SIMETHICONE

ALUMINUM HYDROXIDE GEL ALUMINUM HYDROXIDE

ANTACID 500 MG CHEW TABLET ANTACID

ANTACID 500 MG CHEWABLE TABLET ANTACID

ANTACID 750 MG CHEW TB ANTACID

ANTACID ANTI-GAS LIQUID ANTACID-ANTIGAS

ANTACID EX-STR 750 MG TAB CHEW ANTACID

ANTACID EX-STR TABLET CHEW CALCIUM ANTACID

ANTACID LIQUID ANTACID

ANTACID M LIQUID ANTACID M

ANTACID MAXIMUM STRENGTH LIQ ANTACID MAXIMUM STRENGTH

ANTACID PLUS ANTI-GAS LIQUID ANTACID PLUS ANTI-GAS

ANTACID PLUS ANTI-GAS RELF LIQ ANTACID PLUS ANTI-GAS

ANTACID PLUS ANTI-GAS SUSP ANTACID PLUS ANTI-GAS

ANTACID SUSPENSION ANTACID

ANTACID ULTRA STR 1,000 MG CHW ANTACID ULTRA STRENGTH

ANTACID ULTRA STR TABCHEWABLE

ANTACID ULTRA STRENGTH


107



ANTACID ULTRA TABLET CHEW ULTRA STRENGTH ANTACID

ANTACID XTRA STRENGTH CHEWTAB

ANTACID EXTRA STRENGTH

ANTACID-ANTIGAS LIQUID ANTACID-ANTIGAS

ANTACID-ANTIGAS TAB CHEW ANTACID-ANTIGAS

ANTACID-SIMETHICONE LIQUID ANTACID WITH SIMETHICONE

CALCIUM ANTACID 1,000 MG TAB CALCIUM ANTACID

CALCIUM ANTACID 500 MG CHW TAB CALCIUM ANTACID

CALCIUM ANTACID EX-STR CHEW CALCIUM ANTACID

CALCIUM ANTACID EX-STR TABLET CALCIUM ANTACID

CALCIUM ANTACID ULTRA-STRCHEW

CALCIUM ANTACID

CALCIUM CARB 1,250 MG/5 ML SUS CALCIUM CARBONATE

CALCIUM CARB 500 MG TAB CHEW CALCIUM CARBONATE

CALCIUM CARBONATE 10 GRAIN TAB CALCIUM CARBONATE

CALCIUM CARBONATE 648 MG TAB CALCIUM CARBONATE

CALCIUM CARBONATE 750 MG CHEW CALCIUM CARBONATE

CHILD SOOTHE 400 MG TAB CHEW CHILDREN’S SOOTHE

COMFORT GEL EX-STRENGTHLIQUID

COMFORT GEL

COMFORT GEL EXTRA STR SUSP COMFORT GEL

COMFORT GEL MAX STR SUSP COMFORT GEL

COMFORT GEL SUSPENSION COMFORT GEL

CVS ANTACID 750 MG CHEW TABLET ANTACID

CVS ANTACID LIQUID ANTACID

CVS ANTACID PLUS ANTI-GAS LIQ ANTACID PLUS ANTI-GAS

CVS ANTACID ULTRA TAB CHEW ANTACID ULTRA STRENGTH

CVS ANTACID XTRA STR CHEW TAB ANTACID EXTRA STRENGTH

CVS ANTACID-ANTIGAS LIQUID ANTACID-ANTIGAS

CVS ANTACID-ANTIGAS MAX STR LQ ANTACID-ANTIGAS

CVS ANTACID-ANTIGAS TAB CHEW ANTACID-ANTIGAS

CVS ANTACID-SIMETHICONE LIQUID ANTACID WITH SIMETHICONE

CVS CALCIUM ANTACID 1,000 MG CALCIUM ANTACID

CVS FLAVOR CHEW ANTACID 750 MG FLAVOR CHEWS ANTACID

CVS KIDS ANTACID 750 MG CHEW ANTACID

CVS SMOOTH ANTACID 750 MGCHEW

SMOOTH ANTACID

EQ ANTACID 500 MG CHEW TABLET ANTACID

EQ ANTACID EXTRA STR CHEW TAB ANTACID EXTRA STRENGTH

EQ ANTACID LIQUID ANTACID

EQ ANTACID ULTRA STR TAB CHEW ANTACID ULTRA STRENGTH

EQ ANTACID-ANTIGAS TAB CHEW ANTACID-ANTIGAS

EQ LIQUID ANTACID SUSP LIQUID ANTACID

EQL ADV ANTACID-ANTIGAS LIQUID ADVANCED ANTACID-ANTIGAS


108



EQL ANTACID 500 MG CHEW TABLET ANTACID

EQL ANTACID EXTRA STR CHEW TAB ANTACID EXTRA STRENGTH

EQL ANTACID LIQUID ANTACID

EQL ANTACID SUSPENSION ANTACID

EQL ANTACID ULTRA STR TAB CHEW ANTACID ULTRA STRENGTH

GNP ANTACID 500 MG CHEW TABLET ANTACID

GNP ANTACID 750 MG TAB CHEW ANTACID

GNP ANTACID ANTI-GAS LIQUID ANTACID-ANTIGAS

GNP ANTACID LIQUID ANTACID

GNP ANTACID SUSPENSION ANTACID

GNP ANTACID ULTRA TAB CHEW ULTRA STRENGTH ANTACID

GNP ANTACID XTRA STR CHEW TAB ANTACID EXTRA STRENGTH

GNP ANTACID-ANTIGAS TAB CHEW ANTACID-ANTIGAS

GNP LIQUID ANTACID SUSPENSION LIQUID ANTACID

GNP MASANTI LIQUID MASANTI

GS ADV ANTACID-ANTIGAS LIQUID ADVANCED ANTACID-ANTIGAS

GS ANTACID PLUS ANTI-GAS LIQ ANTACID PLUS ANTI-GAS

GS CAL ANTACID 500 MG CHEW TAB CALCIUM ANTACID

HM ADV ANTACID-ANTIGAS SUSP ADVANCED ANTACID-ANTIGAS

HM ANTACID ANTI-GAS SUSPENSION ANTACID-ANTIGAS

HM ANTACID-ANTIGAS SUSPENSION ANTACID-ANTIGAS

HM CAL ANTACID 500 MG CHEW TAB CALCIUM ANTACID

HM CAL ANTACID 750 MG CHEW TAB CALCIUM ANTACID

HV ANTACID MAX STRENGTH LIQUID ANTACID MAXIMUM STRENGTH

KRO ADV ANTACID-ANTIGAS LIQUID ADVANCED ANTACID-ANTIGAS

KRO ANTACID-ANTIGAS LIQUID ANTACID-ANTIGAS

LIQUID ANTACID SUSPENSION LIQUID ANTACID

MAGNESIUM OXIDE 400 MG TABLET MAGNESIUM OXIDE

MAGNESIUM-ALUMINUMSUSPENSION

ALUM-MAG HYDROXIDE-SIMETHICONE

MASANTI LIQUID MASANTI

PUB ANTACID 500 MG CHEW TABLET ANTACID

PUB ANTACID-ANTI GAS SUSP ANTACID-ANTIGAS

PUB CALCIUM CARB 1,000 MG TAB CALCIUM CARBONATE

QC ANTACID 500 MG CHEW TABLET ANTACID

QC ANTACID SUSPENSION ANTACID

QC ANTACID XTRA STR CHEW TAB ANTACID EXTRA STRENGTH

QC ANTACID-ANTIGAS MAX STR ANTACID-ANTIGAS

QC ANTACID-ANTIGAS SUSPENSION ANTACID-ANTIGAS

RA ANTACID-ANTIGAS LIQUID ANTACID-ANTIGAS

RA ANTACID-ANTIGAS SUSPENSION ANTACID-ANTIGAS

RA ANTACID-GAS RELIEF LIQUID ANTACID-GAS RELIEF

SB ANTACID 500 MG CHEW TABLET ANTACID


109



SB ANTACID ANTI-GAS D-S LIQ ANTACID ANTI-GAS DOUBLESTR

SB ANTACID SUSPENSION ANTACID

SB ANTACID XTRA STR CHEW TAB ANTACID EXTRA STRENGTH

SB ANTACID-ANTIGAS LIQUID ANTACID-ANTIGAS

SM ADV ANTACID-ANTIGAS LIQUID ADVANCED ANTACID

SM ADV ANTACID-ANTIGAS SUSP ADVANCED ANTACID-ANTIGAS

SM ANTACID 500 MG CHEW TABLET ANTACID

SM ANTACID ANTI-GAS LIQUID ANTACID-ANTIGAS

SM ANTACID MAX STRENGTH SUSP ANTACID MAXIMUM STRENGTH

SM ANTACID SUSPENSION ANTACID

SM ANTACID XTRA STR CHEW TAB ANTACID EXTRA STRENGTH

SM ANTACID-ANTIGAS LIQUID ANTACID-ANTIGAS

SM CAL ANTACID 500 MG CHEW TAB CALCIUM ANTACID

SM CAL ANTACID 500 MG CHW TAB CALCIUM ANTACID

SM CAL ANTACID 750 MG CHEW TAB CALCIUM ANTACID

SM CALCIUM ANTACID TAB CHEW ULTRA STRENGTH ANTACID

SM SMOOTH ANTACID TAB CHEW SMOOTH ANTACID

SMOOTH DISSOLVE ANTACID CHEW SMOOTH DISSOLVINGANTACID

V-R ANTACID XTRA STR CHEW TAB ANTACID EXTRA STRENGTH

Antidiarrheals


ANTI-DIARRHEAL 1 MG/5 ML LIQ ANTI-DIARRHEAL

ANTI-DIARRHEAL 1 MG/7.5 ML SUS ANTI-DIARRHEAL

ANTI-DIARRHEAL 2 MG CAPLET ANTI-DIARRHEAL

ANTI-DIARRHEAL 2 MG SOFTGEL ANTI-DIARRHEAL

ANTI-DIARRHEAL 2 MG TABLET ANTI-DIARRHEAL

BISMUTH 262 MG TABLET CHEW BISMUTH

BISMUTH 262 MG/15 ML SUSP BISMUTH SUBSALICYLATE

BISMUTH 524 MG/30 ML SUSP BISMUTH SUBSALICYLATE

CVS ANTI-DIARRHEAL 2 MG CAPLET ANTI-DIARRHEAL

CVS ANTI-DIARRHEAL 2 MG SFTGEL ANTI-DIARRHEAL

CVS ANTI-DIARRHEAL SUSPENSION ANTI-DIARRHEAL

CVS BISMUTH 262 MG CAPLET BISMUTH

CVS BISMUTH CHEWABLE TABLET BISMUTH

CVS BISMUTH MAX-STRENGTH LIQ BISMUTH MAXIMUMSTRENGTH

CVS BISMUTH REGULAR LIQUID BISMUTH

CVS LOPERAMIDE 1 MG/7.5 ML LIQ LOPERAMIDE

CVS STOMACH RELF 525 MG/30 ML STOMACH RELIEF

CVS STOMACH RELIEF MAX STR LIQ STOMACH RELIEF

CVS STOMACH RLF 262 MG CHEW TB STOMACH RELIEF

DIAMODE 2 MG TABLET DIAMODE


110

Antidiarrheals


DIARRHEA RELIEF 262 MG/15 ML DIARRHEA RELIEF

DIARRHEA RELIEF SUSPENSION DIARRHEA RELIEF

DIGESTIVE RELIEF 262 MG CHW TB DIGESTIVE RELIEF

DIGESTIVE RELIEF CAPLET DIGESTIVE RELIEF

DIGESTIVE RELIEF SUSPENSION DIGESTIVE RELIEF

EQ ANTI-DIARRHEAL 2 MG CAPLET ANTI-DIARRHEAL

EQ ANTI-DIARRHEAL 2 MG SFTGEL ANTI-DIARRHEAL

EQ LOPERAMIDE 1 MG/7.5 ML SUSP LOPERAMIDE

EQ STOMACH RELIEF 262 MG/15 ML STOMACH RELIEF

EQ STOMACH RELIEF 525 MG/15 ML STOMACH RELIEF

EQ STOMACH RLF 262 MG CHEW TAB STOMACH RELIEF

EQL ANTI-DIARRHEAL 2 MG CAPLET ANTI-DIARRHEAL

EQL LOPERAMIDE 1 MG/7.5 ML SUS LOPERAMIDE

EQL STOMACH RELIEF LIQUID STOMACH RELIEF

EQL STOMACH RLF 262 MG CHEW TB STOMACH RELIEF

EQL STOMACH RLF 262 MG/15 ML STOMACH RELIEF



GNP ANTI-DIARRHEAL 2 MG CAPLET ANTI-DIARRHEAL

GNP ANTI-DIARRHEAL 2 MG SFTGEL ANTI-DIARRHEAL

GNP K-PEC SUSPENSION K-PEC

GNP LOPERAMIDE 1 MG/7.5 ML LIQ LOPERAMIDE

GNP PINK BISMUTH 262 MG/15 ML PINK BISMUTH

GNP PINK BISMUTH CAPLET PINK BISMUTH

GNP PINK BISMUTH MAX-STR SUSP PINK BISMUTH

GNP PINK BISMUTH TABLET CHEW PINK BISMUTH

GNP STOMACH RLF 262 MG/15 ML STOMACH RELIEF

GS ANTI-DIARRHEAL 2 MG CAPLET ANTI-DIARRHEAL

GS STOMACH RELIEF 525 MG/30 ML STOMACH RELIEF

GS STOMACH RLF 262 MG CHEW TAB STOMACH RELIEF

HM ANTI-DIARRHEAL 2 MG CAPLET ANTI-DIARRHEAL

HM LOPERAMIDE 1 MG/7.5 ML LIQ LOPERAMIDE

HM LOPERAMIDE 2 MG SOFTGEL LOPERAMIDE

HM STOMACH RELIEF 262 MG/15 ML STOMACH RELIEF



HM STOMACH RLF 262 MG CHEWTAB

STOMACH RELIEF

IMODIUM A-D 2 MG CAPLET IMODIUM A-D

K-PEC SUSPENSION K-PEC

KRO ANTI-DIARRHEAL 2 MG CAPLET ANTI-DIARRHEAL

KRO LOPERAMIDE 1 MG/7.5 ML SUS LOPERAMIDE

KRO STOMACH RELIEF 1,050 MG/30 STOMACH RELIEF


111

Antidiarrheals


KRO STOMACH RLF 262 MG CHEWTB

STOMACH RELIEF

KRO STOMACH RLF 262 MG/15 ML STOMACH RELIEF

LOPERAMIDE 1 MG/5 ML LIQUID LOPERAMIDE

LOPERAMIDE 1 MG/5 ML SOLUTION LOPERAMIDE

LOPERAMIDE 1 MG/7.5 ML LIQUID LOPERAMIDE

LOPERAMIDE 1 MG/7.5 ML SOLN LOPERAMIDE

LOPERAMIDE 1 MG/7.5 ML SUSP LOPERAMIDE

LOPERAMIDE 2 MG CAPLET LOPERAMIDE

LOPERAMIDE 2 MG TABLET LOPERAMIDE

LOPERAMIDE 2 MG/10 ML SOLUTION LOPERAMIDE

LOPERAMIDE 2 MG/15 ML SUSP LOPERAMIDE

PINK BISMUTH 262 MG/15 ML SUSP PINK BISMUTH

PINK BISMUTH CAPLET PINK BISMUTH

PINK BISMUTH MAX-STR SUSP PINK BISMUTH

PINK BISMUTH TABLET CHEW PINK BISMUTH

PUB PINK BISMUTH MAX STR LIQ PINK BISMUTH

PUB STOMACH RLF 262 MG CHEW TB STOMACH RELIEF

PUB STOMACH RLF 262 MG/15 ML STOMACH RELIEF ORIGINAL

QC ANTI-DIARRHEAL 2 MG CAPLET ANTI-DIARRHEAL

QC DIARRHEA RLF 262 MG/15 ML DIARRHEA RELIEF

QC PINK BISMUTH 262 MG CAPLET PINK BISMUTH

QC PINK BISMUTH TABLET CHEW PINK BISMUTH

RA ANTI-DIARRHEAL 2 MG CAPLET ANTI-DIARRHEAL

RA ANTI-DIARRHEAL 2 MG SOFTGEL ANTI-DIARRHEAL

RA LOPERAMIDE 1 MG/7.5 ML SUSP LOPERAMIDE

RA PINK BISMUTH 262 MG/15 ML PINK BISMUTH

RA PINK BISMUTH CAPLET PINK BISMUTH

RA PINK BISMUTH TABLET CHEW PINK BISMUTH

RA STOMACH RELIEF 262 MG/15 ML STOMACH RELIEF

RA STOMACH RELIEF MAX STR LIQ STOMACH RELIEF

SB ANTI-DIARRHEA 2 MG CAPLET ANTI-DIARRHEA

SB BISMUTH CHEWABLE TABLET BISMUTH

SB BISMUTH MAX-STRENGTH LIQ BISMUTH MAXIMUMSTRENGTH

SB BISMUTH REGULAR LIQUID BISMUTH

SB PEPTIC RELIEF 262 MG/15 ML PEPTIC RELIEF

SM ANTI-DIARRHEAL 1 MG/5 ML ANTI-DIARRHEAL

SM ANTI-DIARRHEAL 2 MG CAPLET ANTI-DIARRHEAL

SM ANTI-DIARRHEAL 2 MG SOFTGEL ANTI-DIARRHEAL

SM LOPERAMIDE 1 MG/7.5 ML LIQ LOPERAMIDE

SM STOMACH RELIEF 262 MG/15 ML STOMACH RELIEF

SM STOMACH RELIEF 525 MG/30 ML STOMACH RELIEF


112

Antidiarrheals


SM STOMACH RELIEF CAPLET STOMACH RELIEF

SM STOMACH RELIEF LIQUID STOMACH RELIEF

SM STOMACH RELIEF MAX STR LIQ STOMACH RELIEF

SM STOMACH RLF 262 MG CHEWTAB

STOMACH RELIEF

SOOTHE 262 MG CAPLET SOOTHE

SOOTHE 262 MG CHEWABLE TABLET SOOTHE

SOOTHE 262 MG/15 ML SUSPENSION SOOTHE

SOOTHE REGULAR STRENGTH SUSP SOOTHE

SOOTHE SUSPENSION SOOTHE

STOMACH RELIEF 262 MG CHEW TAB STOMACH RELIEF

STOMACH RELIEF 262 MG/15 ML STOMACH RELIEF

STOMACH RELIEF MAX STR LIQUID STOMACH RELIEF

STOMACH RLF 262 MG/15 ML SUSP STOMACH RELIEF

STOMACH RLF 525 MG/30 ML SUSP STOMACH RELIEF

ULTRA A-D 2 MG CAPLET ULTRA A-D

V-R ANTI-DIARRHEAL 2 MG CAPLET ANTI-DIARRHEAL

Antiemetics


ANTI-NAUSEA LIQUID ANTI-NAUSEA

CVS MOTION SICKNESS 50 MG TAB MOTION SICKNESS

CVS MOTION SICKNESS II TABLET MOTION SICKNESS II

CVS MOTION SICKNESS RELIEF TAB MOTION SICKNESS RELIEF

CVS NAUSEA RELIEF LIQUID NAUSEA RELIEF

DIMENHYDRINATE 50 MG TABLET DIMENHYDRINATE

DRAMAMINE 25 MG TABLET CHEW DRAMAMINE

EQ ANTI-NAUSEA LIQUID ANTI-NAUSEA

EQ MOTION SICKNESS 25 MG TAB MOTION SICKNESS RELIEF

EQL ANTI-NAUSEA LIQUID ANTI-NAUSEA

EQL MOTION SICKNESS 25 MG TAB MOTION SICKNESS RELIEF

GNP ANTI-NAUSEA LIQUID ANTI-NAUSEA

GNP MOTION SICKNES 25 MG TAB MOTION SICKNESS

GNP MOTION SICKNESS 50 MG TAB MOTION SICKNESS RELIEF

GNP NAUSEA RELIEF LIQUID NAUSEA RELIEF

GS NAUSEA RELIEF LIQUID NAUSEA RELIEF

HM ANTI-NAUSEA LIQUID ANTI-NAUSEA

HM MOTION RELIEF 25 MG TABLET MOTION RELIEF

HM MOTION SICKNESS 50 MG TAB MOTION SICKNESS RELIEF

KRO MOTION SICKNESS II TABLET MOTION SICKNESS II

MECLIZINE 12.5 MG CAPLET MECLIZINE HCL

MECLIZINE 12.5 MG TABLET MECLIZINE HCL

MECLIZINE 25 MG TABLET MECLIZINE HCL

MECLIZINE 25 MG TABLET CHEW MECLIZINE HCL


113

Antiemetics


MOTION RELIEF 25 MG TABLET MOTION RELIEF

MOTION SICKNESS 25 MG TABLET MOTION SICKNESS

MOTION SICKNESS 50 MG TABLET MOTION SICKNESS RELIEF

MOTION SICKNESS RELIEF TB CHEW MOTION SICKNESS RELIEF

NAUSEA CONTROL LIQUID NAUSEA CONTROL

NAUSEA CONTROL SOLUTION NAUSEA CONTROL

NAUSEA RELIEF LIQUID NAUSEA RELIEF

RA ANTI-NAUSEA LIQUID ANTI-NAUSEA

RA MOTION SICKNESS 50 MG TAB MOTION SICKNESS RELIEF

RA MOTION SICKNESS RLF TB CHEW MOTION SICKNESS RELIEF

RA TRAVEL SICKNESS 50 MG TAB TRAVEL SICKNESS

SB MOTION SICKNESS 50 MG TAB MOTION SICKNESS

SM ANTI-NAUSEA LIQUID ANTI-NAUSEA

SM MOTION SICKNESS 25 MG TAB MOTION SICKNESS

SM MOTION SICKNESS 50 MG TAB MOTION SICKNESS RELIEF

TRAVEL SICKNESS 50 MG TABLET TRAVEL SICKNESS

WAL-DRAM 50 MG TABLET WAL-DRAM

WAL-DRAM-2 25 MG TABLET WAL-DRAM 2

Antihistamines


24HOUR ALLERGY 10 MG TABLET 24HOUR ALLERGY

ALL DAY ALLERGY 10 MG TABLET ALL DAY ALLERGY

ALL DAY ALLERGY RLF 10 MG TAB ALL DAY ALLERGY RELIEF

ALLER-EASE 180 MG TABLET ALLER-EASE QL Limited to 30 Tablets per 30 days

ALLER-EASE 30 MG/5 ML SUSP ALLER-EASE QL

ALLER-FEX 180 MG TABLET ALLER-FEX QL Limited to 30 Tablets per 30 days

ALLER-TEC 10 MG TABLET ALLER-TEC

ALLERCLEAR 10 MG TABLET ALLERCLEAR

ALLERGY 12.5 MG/5 ML ELIXIR CHILDREN’S ALLERGY

ALLERGY 25 MG CAPSULE ALLERGY

ALLERGY 25 MG SOFTGEL ALLERGY

ALLERGY 25 MG TABLET ALLERGY

ALLERGY 4 MG TABLET ALLERGY

ALLERGY MEDICINE 25 MG TABLET ALLERGY MEDICINE

ALLERGY RELIEF 10 MG ODT ALLERGY RELIEF

ALLERGY RELIEF 10 MG TABLET ALLERGY RELIEF

ALLERGY RELIEF 180 MG TABLET ALLERGY RELIEF QL Limited to 30 Tablets per 30 days

ALLERGY RELIEF 25 MG CAPSULE ALLERGY RELIEF

ALLERGY RELIEF 25 MG SOFTGEL ALLERGY RELIEF

ALLERGY RELIEF 25 MG TABLET ALLERGY RELIEF

ALLERGY RELIEF 5 MG/5 ML SOLN ALLERGY RELIEF

ALLERGY RELIEF ER 12 MG TABLET ALLERGY RELIEF

ALLERGY RELIEF SYRUP ALLERGY RELIEF


114

Antihistamines


ALLERHIST 1.34 MG TABLET ALLERHIST

ALLERHIST-1 1.34 MG TABLET ALLERHIST-1

ANTIHIST 12.5 MG/5 ML ELIXIR ANTIHIST

ANTIHISTAMINE 25 MG CAPSULE ANTIHISTAMINE

ANTIHISTAMINE 25 MG TABLET ANTIHISTAMINE

CETIRIZINE HCL 1 MG/ML SOLN CETIRIZINE HCL

CETIRIZINE HCL 1 MG/ML SYRUP CETIRIZINE HCL

CETIRIZINE HCL 10 MG CHEW TAB CETIRIZINE HCL

CETIRIZINE HCL 10 MG TABLET CETIRIZINE HCL

CETIRIZINE HCL 5 MG CHEW TAB CETIRIZINE HCL

CETIRIZINE HCL 5 MG TABLET CETIRIZINE HCL

CETIRIZINE HCL 5 MG/5 ML SOLN CETIRIZINE HCL

CETIRIZINE HCL 5 MG/5 ML SYRUP CETIRIZINE HCL

CHILD ALL DAY ALLERGY 1 MG/ML CHILDREN’S ALL DAY ALLERGY

CHILD ALLEGRA ALLERGY 30 MG/5ML SUSPENSION

CHILDREN’S ALLEGRAALLERGY

QL

CHILD ALLERGY 5 MG/5 ML SOLN CHILDREN’S ALLERGY

CHILD ALLERGY REL 12.5 MG/5 ML CHILDREN’S ALLERGY RELIEF

CHILD ALLERGY RELIEF 1 MG/ML CHILDREN’S ALLERGY RELIEF

CHILD ALLERGY RLF 12.5 MG/5 ML CHILDREN’S ALLERGY RELIEF

CHILD CETIRIZINE 10 MG CHEW TB CHILDREN’S CETIRIZINE HCL

CHILD CETIRIZINE 5 MG CHEW TAB CHILDREN’S CETIRIZINE HCL

CHILD CETIRIZINE HCL 1 MG/ML CHILDREN’S CETIRIZINE HCL

CHILD LORATADINE 5 MG/5 ML SOL CHILDREN’S LORATADINE

CHILD LORATADINE 5 MG/5 ML SYR CHILDREN’S LORATADINE

CHILD WAL-ITIN 5 MG/5 ML SOLN WAL-ITIN

CHILD WAL-ITIN 5 MG/5 ML SYRUP WAL-ITIN

CHILD WAL-ZYR 1 MG/ML SOLUTION CHILDREN’S WAL-ZYR

CHILD’S ALLER-TEC 1 MG/ML SOLN CHILDREN’S ALLER-TEC

CHILD’S ALLERGY 12.5 MG/5 ML CHILDREN’S ALLERGY

CHILD’S WAL-DRYL 12.5 MG/5 ML CHILDREN’S WAL-DRYLALLERGY

CHILD’S WAL-ZYR 10 MG CHEW TAB CHILDREN’S WAL-ZYR

CHILDREN’S WAL-FEX 30 MG/5 ML CHILDREN’S WAL-FEX QL

CHLORPHENIRAMINE 4 MG TABLET CHLORPHENIRAMINEMALEATE

CHLORPHENIRAMINE ER 12 MG TAB CHLORPHENIRAMINEMALEATE

COMPLETE ALLERGY 12.5 MG/5 ML COMPLETE ALLERGY

CVS ALLERGY (CETRZN) 10 MG TAB ALLERGY RELIEF

CVS ALLERGY 12.5 MG/5 ML LIQ ALLERGY

CVS ALLERGY 25 MG CAPSULE ALLERGY

CVS ALLERGY 25 MG SOFTGEL ALLERGY

CVS ALLERGY 25 MG TABLET ALLERGY


115

Antihistamines


CVS ALLERGY 50 MG/20 ML LIQ ALLERGY RELIEF

CVS ALLERGY RELIEF 10 MG SFTGL ALLERGY RELIEF

CVS ALLERGY RELIEF 10 MG TAB ALLERGY RELIEF

CVS ALLERGY RELIEF 180 MG TAB ALLERGY RELIEF QL Limited to 30 Tablets per 30 days

CVS ALLERGY RELIEF 25 MG CAP ALLERGY RELIEF

CVS ALLERGY RELIEF 25 MG TAB ALLERGY RELIEF

CVS ALLERGY RELIEF 4 MG TABLET ALLERGY RELIEF

CVS ALLERGY RELIEF 5 MG/5 ML CHILDREN’S ALLERGY RELIEF

CVS ALLERGY RELIEF ER 12 MG TB ALLERGY RELIEF

CVS CHILD ALLERGY 10 MG CHW TB CHILDREN’S ALLERGY RELIEF

CVS CHILD ALLERGY 12.5 MG/5 ML CHILDREN’S ALLERGY RELIEF

CVS CHILD ALLERGY RELF 1 MG/ML CHILDREN’S ALLERGY RELIEF

CVS CHILD ALLERGY RLF 30 MG/5 CHILDREN’S ALLERGY RELIEF QL

CVS LORATADINE 10 MG TABLET LORATADINE

CVS NIGHTTIME ALLERGY 25 MG NIGHTTIME ALLERGY RELIEF

DAILYHIST-1 1.34 MG TABLET DAILYHIST-1

DAYHIST ALLERGY 1.34 MG TABLET DAYHIST ALLERGY

DAYHIST TABLET DAYHIST

DIPHEDRYL 12.5 MG/5 ML ELIXIR DIPHEDRYL

DIPHEDRYL 25 MG TABLET DIPHEDRYL

DIPHEDRYL ALLERGY CAPSULE DIPHEDRYL

DIPHENHYDRAMINE 12.5 MG/5 ML DIPHENHYDRAMINE HCL

DIPHENHYDRAMINE 25 MG CAPLET DIPHENHYDRAMINE HCL

DIPHENHYDRAMINE 25 MG CAPSULE DIPHENHYDRAMINE HCL

DIPHENHYDRAMINE 50 MG CAPSULE DIPHENHYDRAMINE HCL

DIPHENHYDRAMINE COUGH SYRUP DIPHENHYDRAMINE HCL

EQ ALLERGY RELIEF 1 MG/ML SOLN ALLERGY RELIEF

EQ ALLERGY RELIEF 10 MG TABLET ALLERGY RELIEF

EQ ALLERGY RELIEF 180 MG TAB ALLERGY RELIEF QL Limited to 30 Tablets per 30 days

EQ ALLERGY RELIEF 25 MG CAP ALLERGY RELIEF

EQ ALLERGY RELIEF 25 MG TABLET ALLERGY RELIEF

EQ CHILD ALLERGY 12.5 MG/5 ML CHILDREN’S ALLERGY RELIEF

EQ CHILD ALLERGY RELF 1 MG/ML CHILDREN’S ALLERGY RELIEF

EQ CHILD ALLERGY RELIEF SOLN CHILDREN’S ALLERGY RELIEF

EQ CHLORTABS 4 MG TABLET CHLORTABS

EQL ALL DAY ALLERGY 10 MG TAB ALL DAY ALLERGY

EQL ALLER-EASE 180 MG TABLET ALLER-EASE QL Limited to 30 Tablets per 30 days

EQL ALLERGY 25 MG TABLET ALLERGY

EQL ALLERGY 4 MG TABLET ALLERGY

EQL ALLERGY RELIEF 10 MG TAB ALLERGY RELIEF

EQL ALLERGY RELIEF 25 MG CAP ALLERGY RELIEF

EQL CHILD ALLERGY 12.5 MG/5 ML CHILDREN’S ALLERGY

EQL CHLD ALL DAY ALLER 1 MG/ML CHILDREN’S ALL DAY ALLERGY


116

Antihistamines


FEXOFENADINE HCL 180 MG TABLET FEXOFENADINE HCL QL Limited to 30 Tablets per 30 days

FEXOFENADINE HCL 30 MG/5 ML FEXOFENADINE HCL QL

GNP ALL DAY ALLERGY 10 MG TAB ALL DAY ALLERGY

GNP ALLERGY 25 MG CAPSULE ALLERGY

GNP ALLERGY 25 MG SOFTGEL ALLERGY

GNP ALLERGY 25 MG TABLET ALLERGY

GNP ALLERGY 4 MG TABLET ALLERGY

GNP ALLERGY RELF 5 MG/5 ML SLN ALLERGY RELIEF

GNP ALLERGY RELIEF 180 MG TAB ALLERGY RELIEF QL Limited to 30 Tablets per 30 days

GNP ALLERGY RELIEF 25 MG CAP ALLERGY RELIEF

GNP CHILD ALLERGY 12.5 MG/5 ML CHILDREN’S ALLERGY

GNP CHLD ALL DAY ALLER 1 MG/ML CHILDREN’S ALL DAY ALLERGY

GNP CHLD LORATADINE 5 MG/5 ML CHILDREN’S LORATADINE

GNP DAYHIST ALLERGY 1.34 MG TB DAYHIST ALLERGY

GNP DIPHEDRYL 12.5 MG/5 ML ELX DIPHEDRYL

GNP DIPHEDRYL 25 MG TABLET DIPHEDRYL

GNP DIPHEDRYL ALLERGY CAP DIPHEDRYL

GNP LORATADINE 10 MG TABLET LORATADINE

GNP LORATADINE 5 MG/5 ML SYRUP LORATADINE

GS ALL DAY ALLERGY 10 MG TAB ALL DAY ALLERGY

GS ALLER-EASE 180 MG TABLET ALLER-EASE QL Limited to 30 Tablets per 30 days

GS ALLERGY RELIEF 10 MG TABLET ALLERGY RELIEF

GS ALLERGY RELIEF 25 MG CAP ALLERGY RELIEF



GS CHILD ALLERGY 12.5 MG/5 ML CHILDREN’S ALLERGY

HM ALL DAY ALLERGY 10 MG TAB ALL DAY ALLERGY

HM ALLERGY 25 MG CAPSULE ALLERGY

HM ALLERGY 25 MG TABLET ALLERGY

HM ALLERGY RELIEF 10 MG ODT ALLERGY RELIEF

HM ALLERGY RELIEF 10 MG TABLET ALLERGY RELIEF

HM ALLERGY RELIEF 25 MG CAP ALLERGY RELIEF

HM ALLERGY RELIEF 4 MG TABLET ALLERGY RELIEF

HM CHILD ALL DAY ALLER 1 MG/ML CHILDREN’S ALL DAY ALLERGY

HM CHILD ALLERGY 12.5 MG/5 ML CHILDREN’S ALLERGY RELIEF

HM CHILD CETIRIZINE 1 MG/ML CHILDREN’S CETIRIZINE HCL

HM CHILD LORATADINE 5 MG/5 ML CHILDREN’S LORATADINE

HM CHLD ALLER COMPLETE 1 MG/ML CHILDREN’S ALLERGYCOMPLETE

HM FEXOFENADINE HCL 180 MG TAB FEXOFENADINE HCL QL Limited to 30 Tablets per 30 days

HM LORATADINE 10 MG TABLET LORATADINE

KRO ALL DAY ALLERGY 10 MG SFGL ALL DAY ALLERGY

KRO ALL DAY ALLERGY 10 MG TAB ALL DAY ALLERGY


117

Antihistamines


KRO ALLERGY 25 MG CAPSULE ALLERGY

KRO ALLERGY 25 MG TABLET ALLERGY

KRO ALLERGY 4 MG TABLET ALLERGY

KRO ALLERGY RELIEF 10 MG TAB ALLERGY RELIEF

KRO ALLERGY RELIEF 180 MG TAB ALLERGY RELIEF QL Limited to 30 Tablets per 30 days

KRO CHILD ALLERGY 12.5 MG/5 ML CHILDREN’S ALLERGY RELIEF

KRO CHILD ALLERGY RELIEF SOLN CHILDREN’S ALLERGY RELIEF

KRO CHLD ALL DAY ALLER 1 MG/ML CHILDREN’S ALL DAY ALLERGY

LORATADINE 10 MG ODT LORATADINE

LORATADINE 10 MG TABLET LORATADINE

LORATADINE 5 MG/5 ML SOLN LORATADINE

LORATADINE 5 MG/5 ML SYRUP LORATADINE

LORATADINE ALLERGY 5 MG/5 ML LORATADINE ALLERGY

LORATADINE HIVES 5 MG/5 ML LORATADINE HIVES RELIEF

NIGHT ALLERGY RLF 25 MG CAPLET NIGHTTIME ALLERGY RELIEF

PUB ALLERGY 12.5 MG/5 ML LIQ ALLERGY

PUB ALLERGY 25 MG CAPSULE ALLERGY

PUB ALLERGY 25 MG TABLET ALLERGY

PUB ALLERGY RELIEF 10 MG TAB ALLERGY RELIEF

PUB ALLERGY RELIEF 180 MG TAB ALLERGY RELIEF QL Limited to 30 Tablets per 30 days

PUB CHILDREN’S ALLERGY 1 MG/ML CHILDREN’S ALLERGY

PUB DAYHIST ALLERGY 1.34 MG TB DAYHIST ALLERGY

QC ALL DAY ALLERGY 10 MG TAB ALL DAY ALLERGY

QC ALLERGY RELIEF 10 MG ODT ALLERGY RELIEF

QC CHILD ALLERGY 12.5 MG/5 ML CHILDREN’S ALLERGY

QC CHLORPHENIRAMINE 4 MG TAB CHLORPHENIRAMINEMALEATE

QC COMPLETE ALLERGY 25 MG CAP COMPLETE ALLERGY

QC COMPLETE ALLERGY 25 MG CPLT COMPLETE ALLERGY

QC FEXOFENADINE HCL 180 MG TAB FEXOFENADINE HCL QL Limited to 30 Tablets per 30 days

QC LORATADINE 10 MG TABLET LORATADINE

RA ALLERGY 25 MG TABLET ALLERGY

RA ALLERGY MED 25 MG CAPSULE ALLERGY MEDICATION

RA ALLERGY MED 25 MG TABLET ALLERGY MEDICATION

RA ALLERGY MED CAPSULE ALLERGY MEDICATION

RA ALLERGY RELIEF 10 MG TABLET ALLERGY RELIEF

RA ALLERGY RELIEF 180 MG TAB ALLERGY RELIEF QL Limited to 30 Tablets per 30 days

RA ALLERGY RELIEF 25 MG CAP ALLERGY RELIEF

RA ALLERGY RELIEF 4 MG TABLET ALLERGY RELIEF

RA CETIRIZINE HCL 10 MG TABLET CETIRIZINE HCL

RA CHILD ALLERGY 12.5 MG/5 ML CHILDREN’S ALLERGY RELIEF

RA CHILD ALLERGY 5 MG/5 ML SOL CHILDREN’S ALLERGY

RA CHILD ALLERGY RELF 1 MG/ML CHILDREN’S ALLERGY RELIEF


118

Antihistamines


RA CHILD CETIRIZINE 10 MG CHEW CHILDREN’S CETIRIZINE HCL

RA CHLORPHENIRAMINE 4 MG TAB CHLORPHENIRAMINEMALEATE

RA COMPLETE ALLERGY MED CPT COMPLETE ALLERGY

RA COMPLETE ALLERGY SOFTGEL COMPLETE ALLERGY

RA DIPHEDRYL 12.5 MG/5 ML ELIX DIPHEDRYL

RA DIPHEDRYL 12.5 MG/5 ML LIQ DIPHEDRYL ALLERGY

RA LORATADINE 10 MG TABLET LORATADINE

RA LORATADINE 5 MG/5 ML SYRUP LORATADINE

SB ALLERGY 10 MG TABLET ALLERGY

SB ALLERGY 12.5 MG/5 ML ELIXIR ALLERGY MEDICINE

SB ALLERGY MED 25 MG TABLET ALLERGY MEDICINE

SB ALLERGY MEDICINE 25 MG CAP ALLERGY MEDICINE

SB CHLORPHENIRAMINE 4 MG TAB CHLORPHENIRAMINEMALEATE

SB LORATADINE 10 MG TABLET LORATADINE

SM ALL DAY ALLERGY 1 MG/ML SYR ALL DAY ALLERGY

SM ALL DAY ALLERGY 10 MG TAB ALL DAY ALLERGY

SM ALLERGY 4 MG TABLET ALLERGY

SM ALLERGY 4-HR 4 MG TABLET ALLERGY 4-HOUR

SM ALLERGY RELIEF 1.34 MG TAB ALLERGY RELIEF

SM ALLERGY RELIEF 10 MG ODT ALLERGY RELIEF

SM ALLERGY RELIEF 12.5 MG/5 ML ALLERGY RELIEF

SM ALLERGY RELIEF 25 MG CAP ALLERGY RELIEF

SM ALLERGY RELIEF 25 MG TABLET ALLERGY RELIEF

SM CHILD ALL DAY ALLER 1 MG/ML CHILDREN’S ALL DAY ALLERGY

SM CHILD ALLERGY 12.5 MG/5 ML CHILDREN’S ALLERGY RELIEF

SM CHILD LORATADINE 5 MG/5 ML CHILDREN’S LORATADINE

SM FEXOFENADINE HCL 180 MG TAB FEXOFENADINE HCL QL Limited to 30 Tablets per 30 days

SM LORATADINE 10 MG ODT LORATADINE

SM LORATADINE 10 MG TABLET LORATADINE

SM LORATADINE 5 MG/5 ML SYRUP LORATADINE

SW ALLERGY RELIEF 10 MG TAB ALLERGY RELIEF

TOTAL ALLERGY 25 MG TABLET TOTAL ALLERGY

V-R VALUDRYL 12.5 MG/5 ML ELX VALU-DRYL

VALU-DRYL ALLERGY MED TAB VALU-DRYL ALLERGYMEDICINE

WAL-DRYL ALLERGY 12.5 MG/5 ML WAL-DRYL ALLERGY

WAL-DRYL ALLERGY 25 MG CAPSULE WAL-DRYL

WAL-DRYL ALLERGY 25 MG MINITAB WAL-DRYL ALLERGY

WAL-DRYL ALLERGY 25 MG SOFTGEL WAL-DRYL

WAL-FEX ALLERGY 180 MG TABLET WAL-FEX ALLERGY QL Limited to 30 Tablets per 30 days

WAL-FINATE 4 MG TABLET WAL-FINATE

WAL-ITIN 10 MG ODT WAL-ITIN


119

Antihistamines


WAL-ITIN 10 MG TABLET WAL-ITIN

WAL-ITIN 5 MG/5 ML SYRUP WAL-ITIN

WAL-ZYR 10 MG SOFTGEL WAL-ZYR

WAL-ZYR 10 MG TABLET WAL-ZYR

WAL-ZYR SOLUTION WAL-ZYR

Antiseptic - Biguanides


CHLORHEXIDINE 2% SOLUTION CHLORHEXIDINE GLUCONATE

CHLORHEXIDINE GLUC 2% CLOTH CHLORHEXIDINE GLUCONATE

CVS HAND WASH 2% SOLUTION HAND WASH

Antitussives


12-HR COUGH RELIEF 30 MG/5 ML 12-HOUR COUGH RELIEF

CHILD COUGH DM ER 30 MG/5 ML CHILDREN’S COUGH DM ER

COUGH DM ER 30 MG/5 ML SUSP COUGH DM ER

CVS CHILD COUGH DM ER 30 MG/5 CHILDREN’S COUGH DM ER

CVS COUGH DM ER 30 MG/5 ML SUS COUGH DM ER

DEXTROMETHORPHAN ER 30 MG/5ML

DEXTROMETHORPHANPOLISTIREX

EQ CHLD COUGH DM ER 30 MG/5 ML CHILDREN’S COUGH DM ER

EQ COUGH DM ER 30 MG/5 ML SUSP COUGH DM ER

GNP COUGH DM ER 30 MG/5 ML SUS COUGH DM ER

GS CHLD COUGH DM ER 30 MG/5 ML CHILDREN’S COUGH DM ER

GS COUGH DM ER 30 MG/5 ML SUSP COUGH DM ER

HM COUGH DM ER 30 MG/5 ML SUSP COUGH DM ER

KRO COUGH DM ER 30 MG/5 ML SUS COUGH DM ER

RA COUGH DM ER 30 MG/5 ML SUSP COUGH DM ER

Artificial Tears and Lubricants


ARTIFICIAL TEARS ARTIFICIAL TEARS

ARTIFICIAL TEARS 1.4 % DROPS ARTIFICIAL TEARS

ARTIFICIAL TEARS 1.4% DROPS ARTIFICIAL TEARS

ARTIFICIAL TEARS DROPS ARTIFICIAL TEARS

ARTIFICIAL TEARS EYE DROPS ARTIFICIAL TEARS

ARTIFICIAL TEARS EYE OINTMENT ARTIFICIAL TEARS

ARTIFICIALS TEARS DROPS ARTIFICIAL TEARS

BION TEARS EYE DROP BION TEARS

BION TEARS EYE DROPS BION TEARS

CVS ARTIFICIAL TEARS DROPS ARTIFICIAL TEARS

CVS DRY EYE RELIEF EYE DROPS DRY EYE RELIEF

CVS NATURAL TEARS DROPS NATURAL TEARS

EQ ARTIFICIAL TEARS DROPS ARTIFICIAL TEARS

EYE DROP TEARS EYE DROP TEARS


120

Artificial Tears and Lubricants


GENTEAL TEARS 0.1%-0.2%-0.3% GENTEAL TEARS

GENTEAL TEARS 0.1%-0.3% DROP GENTEAL TEARS

GNP ARTIFICIAL TEARS DROPS ARTIFICIAL TEARS

GS ARTIFICIAL TEARS EYE DROPS ARTIFICIAL TEARS

HM ARTIFICIAL TEARS EYE DROPS ARTIFICIAL TEARS

LIQUITEARS 1.4 % DROPS LIQUITEARS

LUBRICANT EYE DROPS LUBRICANT EYE

LUBRICANT EYE OINTMENT LUBRICANT EYE

LUBRIFRESH PM EYE OINTMENT LUBRIFRESH PM

NATURAL BALANCE TEARS EYEDROP

NATURAL BALANCE TEARS

NATURE’S TEARS EYE DROPS NATURE’S TEARS

POLYVINYL ALCOHL 1.4 % EYEDROP POLYVINYL ALCOHOL

PUB ARTIFICIAL TEARS ARTIFICIAL TEARS

RA ARTIFICIAL TEARS DROPS ARTIFICIAL TEARS

SM ARTIFICIAL TEARS ARTIFICIAL TEARS

SM DRY EYE RELIEF EYE DROPS DRY EYE RELIEF

TEARFAIR 1.4 % DROPS TEARFAIR

TEARS AGAIN 1.4 % DROPS TEARS AGAIN

TEARS NATURALE FORTE DROPS TEARS NATURALE FORTE

TEARS NATURALE FREE DROPS TEARS NATURALE FREE

ULTRA FRESH PM OINTMENT ULTRA FRESH PM

VISINE DRY EYE RELIEF DROP VISINE DRY EYE RELIEF

VISINE TEARS DROPS VISINE

Chemicals - Solvents


GNP MINERAL OIL MINERAL OIL

MINERAL OIL MINERAL OIL



ANTIBIOTIC OINTMENT ANTIBIOTIC

ANTIBIOTIC PLUS PAIN RELIEF CR ANTIBIOTIC PLUS PAIN RELIEF

ANTIFUNGAL 1% CREAM ANTIFUNGAL CREAM

ANTIFUNGAL 1% POWDER SPRAY ANTIFUNGAL

ANTIFUNGAL 1% SPRAY POWDER ANTIFUNGAL

ATHLETE’S 1% FOOT CREAM ATHLETE’S FOOT

ATHLETE’S FOOT 1% CREAM ATHLETE’S FOOT

ATHLETE’S FOOT 2% POWDER ATHLETE’S FOOT

ATHLETE’S FOOT 2% POWDERSPRAY

ATHLETE’S FOOT SPRAY

ATHLETE’S FOOT AF 1% CREAM ATHLETE’S FOOT AF

ATHLETES FOOT 1% CREAM ATHLETE’S FOOT

BACITRACIN 500 UNIT/GM OINTMNT BACITRACIN


121



BACITRACIN ZN 500 UNIT/GM OINT BACITRACIN ZINC

BACITRACIN-POLYMYXIN OINTMENT BACITRACIN-POLYMYXIN

CLOTRIMAZOLE 1% CREAM CLOTRIMAZOLE

CLOTRIMAZOLE 1% CREAM GRX CLOTRIMAZOLE

CVS AF 1% SPRAY POWDER AF

CVS ANTI-FUNGAL 2% POWDER ANTI-FUNGAL POWDER

CVS ANTIBIOTIC OINTMENT ANTIBIOTIC

CVS ANTIBIOTIC PLUS CREAM ANTIBIOTIC PLUS

CVS ANTIFUNGAL 1% CREAM ANTIFUNGAL CREAM

CVS ATHLETE’S FOOT 1% CREAM ATHLETE’S FOOT

CVS ATHLETE’S FOOT 2% PWD SPRY ATHLETE’S FOOT SPRAY

CVS ATHLETE’S FOOT POWD SPRAY ATHLETE’S FOOT SPRAY

CVS BACITRACIN ZN 500 UNIT/GM BACITRACIN ZINC

CVS CLOTRIMAZOLE 1% CREAM CLOTRIMAZOLE

CVS FOOT & SNEAKER SPRAY PWD FOOT & SNEAKER

CVS ITCH RELIEF 1% CREAM ITCH RELIEF

CVS JOCK ITCH 1% CREAM JOCK ITCH

CVS POLY BACITRACIN OINTMNT POLY BACITRACIN

CVS RINGWORM 1% CREAM RINGWORM

CVS TRIPLE ANTIBIOTIC OINTMENT TRIPLE ANTIBIOTIC

DOUBLE ANTIBIOTIC OINTMENT DOUBLE ANTIBIOTIC

DOUBLE ANTIBIOTIC-PAIN RLF CRM DOUBLE ANTIBIOTIC-PAINRELIEF

EQ ANTIBIOTIC +PAIN RELIEF CRM ANTIBIOTIC + PAIN RELIEF

EQ ATHLETE’S FOOT 1% CREAM ATHLETE’S FOOT

EQ ATHLETE’S FOOT 1% PWD SPRAY ATHLETE’S FOOT

EQ ATHLETE’S FOOT 2% PWD SPRAY ATHLETE’S FOOT SPRAY

EQ FIRST AID ANTISEPTIC SOLN FIRST AID ANTISEPTIC

EQ JOCK ITCH 1% CREAM JOCK ITCH

EQ TERBINAFINE 1% CREAM TERBINAFINE

EQ TRIPLE ANTIBIOTIC OINTMENT TRIPLE ANTIBIOTIC

EQL ANTIFUNGAL 1% CREAM ANTIFUNGAL CREAM

EQL ATHLETE’S FOOT 1% CREAM ATHLETE’S FOOT

EQL BACITRACIN ZN 500 UNIT/GM BACITRACIN ZINC

EQL FIRST AID ANTIBIOTIC OINT FIRST AID ANTIBIOTIC

EQL FIRST AID ANTIBIOTIC-PAIN FIRST AID ANTIBIOTIC-PAINRLF

FIRST AID ABX PAIN RELIEF CRM FIRST AID ABX PAIN RELIEF

FIRST AID BACITRACIN OINTMENT BACITRACIN

GNP ANTIFUNGAL 1% CREAM ANTIFUNGAL

GNP BACITRACIN ZN 500 UNIT/GM BACITRACIN ZINC

GNP MICONAZOLE 2% SPRAYPOWDER

MICONAZOLE NITRATE

GNP MICONAZORB AF 2% POWDER MICONAZORB AF


122



GNP TERBINAFINE 1% CREAM TERBINAFINE

GNP TOLNAFTATE 1% CREAM TOLNAFTATE

GNP TRIPLE ANTIBIOTIC OINTMENT TRIPLE ANTIBIOTIC

HM BACITRACIN ZN 500 UNIT/GM BACITRACIN ZINC

HM DOUBLE ANTIBIOTIC OINTMENT DOUBLE ANTIBIOTIC

HM POVIDONE-IODINE 10% SOLN POVIDONE-IODINE

HM TRIPLE ANTIBIOTIC OINTMENT TRIPLE ANTIBIOTIC

HOSPITAL ANTISEPTIC SOLN HOSPITAL ANTISEPTIC

JOCK ITCH 1% CREAM JOCK ITCH

JOCK ITCH 1% POWDER SPRAY JOCK ITCH

JOCK ITCH RELIEF 1% CREAM JOCK ITCH RELIEF

KRO ANTIBIOTIC-PAIN RELIEF CRM ANTIBIOTIC PLUS PAIN RELIEF

KRO TRIPLE ANTIBIOTIC OINTMENT TRIPLE ANTIBIOTIC

MICONAZOLE 2% SPRAY POWDER MICONAZOLE NITRATE

MICONAZOLE NITRATE 2% CREAM MICONAZOLE NITRATE

MICONAZORB AF 2% POWDER MICONAZORB AF

MULTI ANTIBIOTIC PLUS CREAM MULTI ANTIBIOTIC PLUS

NEOSPORIN ANTIBIOTIC OINTMENT NEOSPORIN

NEOSPORIN OINTMENT NEOSPORIN

ODOR CTRL FOOT-SNEAKER 1%POWD

ODOR CONTROL FOOT-SNEAKER

POLY BACITRACIN OINTMENT POLY BACITRACIN

POLYSPORIN OINTMENT POLYSPORIN

POVIDONE-IODINE 10% OINTMENT POVIDONE-IODINE

POVIDONE-IODINE 10% PREP PAD POVIDONE-IODINE

POVIDONE-IODINE 10% SOLUTION POVIDONE-IODINE

POVIDONE-IODINE 10% SWAB AMPUL POVIDONE-IODINE

POVIDONE-IODINE 10% SWABSTICK POVIDONE-IODINE

POVIDONE-IODINE 7.5% SCRUB POVIDONE-IODINE

POVIDONE-IODINE 7.5% SWABST POVIDONE-IODINE

POVIDONE-IODINE SPONGE STICKS POVIDONE-IODINE

POVIDONE-IODINE WINGED SPONGE POVIDONE-IODINE

PUB ATHLETIC FOOT 1% CREAM ATHLETIC FOOT CREAM

PUB TRIPLE ANTIBIOTIC OINTMENT TRIPLE ANTIBIOTIC

QC BACITRACIN 500 UNIT/GM OINT BACITRACIN

QC POVIDONE-IODINE 10% SOLN POVIDONE-IODINE

QC TOLNAFTATE 1% CREAM TOLNAFTATE

RA ANTIBIOTIC PLUS CREAM ANTIBIOTIC PLUS

RA ANTIFUNGAL 1% CREAM ANTIFUNGAL CREAM

RA ANTIFUNGAL RINGWORM 1%CRM

ANTIFUNGAL RINGWORM

RA ANTISEPTIC 10% SOLUTION ANTISEPTIC

RA ATHLETE’S FOOT 2% PWD SPRAY ATHLETE’S FOOT SPRAY


123



RA BACITRACIN 500 UNIT/GM OINT BACITRACIN

RA BACITRACIN ZN 500 UNIT/GM BACITRACIN ZINC

RA CLOTRIMAZOLE AF 1% CREAM CLOTRIMAZOLE AF

RA DOUBLE ANTIBIOTIC OINT DOUBLE ANTIBIOTIC

RA JOCK ITCH 1% POWDER SPRAY JOCK ITCH

RA JOCK ITCH CREAM JOCK ITCH RELIEF

RA TRIPLE ANTIBIOTIC OINTMENT TRIPLE ANTIBIOTIC

SB POVIDONE-IODINE 10% SOLN POVIDONE-IODINE

SB TRIPLE ANTIBIOTIC OINTMENT TRIPLE ANTIBIOTIC

SM ANTIBIOTIC 500 UNIT/GM OINT ANTIBIOTIC

SM ANTIBIOTIC PLUS CREAM ANTIBIOTIC PLUS

SM ANTIFUNGAL 1% CREAM ANTIFUNGAL CREAM

SM ATHLETE’S 1% FOOT CREAM ATHLETE’S FOOT

SM CLOTRIMAZOLE AF 1% CREAM CLOTRIMAZOLE

SM DOUBLE ANTIBIOTIC OINT DOUBLE ANTIBIOTIC

SM MICONAZOLE NITRATE 2%CREAM

MICONAZOLE NITRATE

SM POVIDONE-IODINE 10% SOLN POVIDONE-IODINE

SM TRIPLE ANTIBIOTIC OINTMENT TRIPLE ANTIBIOTIC

TERBINAFINE 1% CREAM TERBINAFINE

TOLNAFTATE 1% CREAM TOLNAFTATE

TOLNAFTATE 1% POWDER TOLNAFTATE

TOLNAFTATE 1% SOLUTION TOLNAFTATE

TOLNAFTATE 1% SPRAY POWDER TOLNAFTATE

TOLNAFTATE AF 1% CREAM TOLNAFTATE

TRIPLE ANTIBIOTIC OINTMENT TRIPLE ANTIBIOTIC

V-R DOUBLE ANTIBIOTIC OINT DOUBLE ANTIBIOTIC

WAL-SPORIN FIRST AID OINTMENT WAL-SPORIN



BEDDING 0.5% SPRAY BEDDING SPRAY

CVS LICE BEDDING SPRAY LICE BEDDING

CVS LICE KILLING SHAMPOO LICE KILLING

CVS LICE TREATMENT 1% CRM RINS LICE TREATMENT

CVS PERMETHRIN 1% LOTION PERMETHRIN

EQ LICE KILLING SHAMPOO LICE KILLING

EQL LICE KILLING SHAMPOO LICE KILLING

GNP HOME LICE-BEDBUG-DUST MITE HOME LICE-BEDBUG-DUSTMITE

GNP LICE BEDDING SPRAY LICE BEDDING

GNP LICE TREATMENT 1% CRM RINS LICE TREATMENT

GNP LICE TREATMENT SHAMPOO LICE TREATMENT

GS LICE KILLING SHAMPOO LICE KILLING


124



HM LICE KILLING SHAMPOO LICE KILLING

HM LICE TREATMENT 1% CRM RINSE LICE TREATMENT

HM LICE TREATMENT 1% LOTION LICE TREATMENT

KRO LICE KILLING SHAMPOO LICE KILLING

LICE BEDDING SPRAY LICE BEDDING

LICE KILLING SHAMPOO LICE KILLING

LICE TREATMENT 1% CREME RINSE LICE TREATMENT

LICE TREATMENT SHAMPOO LICE TREATMENT

RA LICE PYRINYL SHAMPOO LICE PYRINYL SHAMPOO

RA LICE TREATMENT 1% CRM RINSE LICE TREATMENT

RID ESSENTIAL LICE KIT RID

RID LICE KILLING SHAMPOO RID

SB LICE KILLING SHAMPOO LICE KILLING

SM LICE BEDDING SPRAY LICE BEDDING

SM LICE KILLING SHAMPOO LICE KILLING

SM LICE TREATMENT 1% CRM RINSE LICE TREATMENT

SM LICE TREATMENT PERMETHRIN LICE TREATMENT

STOP LICE 0.5% SPRAY STOP LICE

V-R LICE CREAM RINSE LICE CREAM RINSE

V-R LICE KILLING SHAMPOO LICE KILLING

Dermatological - Antipruritics


CVS ITCH RELIEF 2% GEL ITCH RELIEF

CVS ITCH RELIEF GEL ITCH RELIEF

RA ANTI-ITCH GEL ANTI-ITCH

RA DIPHENHYDRAMINE 2% CREAM DIPHENHYDRAMINE HCL

Dermatological - Astringents and Combinations


PRE-MOISTENED MEDICATED WIPES PRE-MOISTENED MEDICATEDWIPES



AMMONIUM LACTATE 12% CREAM AMMONIUM LACTATE

AMMONIUM LACTATE 12% LOTION AMMONIUM LACTATE

CVS PURE GLYCERIN 99.5% LIQUID GLYCERIN

CVS SKIN TREATMENT BODY LOTION SKIN TREATMENT

CVS VITAMIN E 28,000 UNITS OIL VITAMIN E

E-CREAM E-CREAM

GLYCERIN 99.5% LIQUID GLYCERIN

GLYCERIN 99.5% SKIN PROTECT LQ GLYCERIN

GLYCERIN LIQUID GLYCERIN

GLYCERIN SKIN PROTECTANT LIQ GLYCERIN

GNP GLYCERIN 99.5% LIQUID GLYCERIN


125



HM GLYCERIN 99.5% LIQUID GLYCERIN

LAC-HYDRIN FIVE 5% LOTION LAC-HYDRIN FIVE

RA VITAMIN E 28,000 UNITS OIL VITAMIN E

RA VITAMIN E 4,000 UNITS OIL VITAMIN E

SM GLYCERIN LIQUID GLYCERIN

TOPICAL LIGHT MINERAL OIL TOPICAL LIGHT MINERAL OIL

VITAMIN E 56,000 UNITS OIL VITAMIN E

VITAMIN E 6,000 UNITS CREAM VITAMIN E

VITAMIN E 70,000 UNITS OIL VITAMIN E

VITAMIN E OIL VITAMIN E



ANTI-ITCH 1% CREAM ANTI-ITCH

ANTI-ITCH 1% LOTION ANTI-ITCH

ANTI-ITCH 1% OINTMENT ANTI-ITCH

CORTAID 1% CREAM CORTAID

CORTIZONE-10 1% CREME CORTIZONE-10

CORTIZONE-10 PLUS 1% CREME CORTIZONE-10 PLUS

CORTIZONE-10 PLUS CREME CORTIZONE-10 PLUS

CVS ANTI-ITCH 1% CREAM ANTI-ITCH

CVS CORTISONE + COOLING RLF GL CORTISONE + COOLINGRELIEF

CVS CORTISONE 1% CREAM CORTISONE

CVS CORTISONE 1% GEL CORTISONE

CVS CORTISONE 1% HEALING LOT CORTISONE

CVS CORTISONE 1% LOTION CORTISONE

CVS CORTISONE 1% OINTMENT CORTISONE

CVS CORTISONE WITH ALOE 1%CRM

CORTISONE WITH ALOE

CVS ECZEMA ANTI-ITCH 1% CREAM ECZEMA ANTI-ITCH

CVS HYDROCORTISONE 0.5% CRM HYDROCORTISONE ACETATE

CVS HYDROCORTISONE 1% CREAM HYDROCORTISONE

CVS HYDROCORTISONE 1% OINT HYDROCORTISONE

EQ HYDROCORTISONE 1% CREAM HYDROCORTISONE

EQ HYDROCORTISONE-ALOE 1%CRM

HYDROCORTISONE-ALOE

EQL ANTI-ITCH 1% CREAM ANTI-ITCH

EQL ANTI-ITCH 1% OINTMENT ANTI-ITCH

GNP HYDROCORT ACETATE 1% CR HYDROCORTISONE ACETATE

GNP HYDROCORTISONE 0.5% CRM HYDROCORTISONE ACETATE

GNP HYDROCORTISONE 1% CREAM HYDROCORTISONE

GNP HYDROCORTISONE 1%OINTMENT

HYDROCORTISONE

GS ANTI-ITCH 1% CREAM ANTI-ITCH


126



HM HYDROCORTISONE 1% CREAM HYDROCORTISONE

HYDROCORTISONE 0.5% CREAM HYDROCORTISONE ACETATE

HYDROCORTISONE 0.5% OINTMENT HYDROCORTISONE


HYDROCORTISONE 1% LOTION HYDROCORTISONE

HYDROCORTISONE 1% OINTMENT HYDROCORTISONE

HYDROCORTISONE PLUS 1% CREAM HYDROCORTISONE

HYDROCORTISONE-ALOE 1% CREAM HYDROCORTISONE-ALOE

HYDROSKIN 1% CREAM HYDROSKIN

KRO HYDROCORTISONE 1% CREAM HYDROCORTISONE

NEOSPORIN 1% ANTI-ITCH CREAM NEOSPORIN

NOBLE FORMULA HC 1% CREAM NOBLE FORMULA HC

PREPARATION H HC 1% CREAM PREPARATION H

PUB HYDROCREAM 1% HYDROCREAM

RA ANTI-ITCH 1% CREAM ANTI-ITCH

RA ANTI-ITCH 1% OINTMENT ANTI-ITCH

RA HYDROCORTISONE 1% CREAM HYDROCORTISONE

RECORT PLUS 1% CREAM RECORT PLUS

SB HYDROCORTISONE 1% CREAM HYDROCORTISONE

SB HYDROCORTISONE 1%OINTMENT

HYDROCORTISONE

SB HYDROCORTISONE PLUS 1%CRM

HYDROCORTISONE PLUS

SCALP RELIEF LIQUID SCALP RELIEF

SM HYDROCORTISONE 0.5% CREAM HYDROCORTISONE

SM HYDROCORTISONE 0.5%OINTMNT

HYDROCORTISONE

SM HYDROCORTISONE 1% + CRM HYDROCORTISONE PLUS

SM HYDROCORTISONE 1% CREAM HYDROCORTISONE

SM HYDROCORTISONE 1%OINTMENT

HYDROCORTISONE

SM HYDROCORTISONE-ALOE 1%CRM

HYDROCORTISONE-ALOE

SOOTHING CARE 1% CREAM SOOTHING CARE

V-R HYDROCORTISONE 1% + CRM HYDROCORTISONE PLUS

Dermatological - Irritants-Counter-Irritants


CAPSAICIN 0.025% CREAM CAPSAICIN



CALLUS REMOVERS PADS CALLUS REMOVERS

CALLUS REMOVERS PATCH CALLUS REMOVERS

CLEAR AWAY MEDICATED DISC CLEAR AWAY

COMPOUND W 17% GEL COMPOUND W


127



COMPOUND W INVISIBLE STRIPS COMPOUND W

COMPOUND W PADS COMPOUND W

CORN REMOVER 40% PATCH CORN REMOVER

CORN REMOVER STRIPS CORN REMOVER

CVS CALLUS REMOVER PAD CALLUS REMOVER

CVS CORN REMOVER 40% PATCH CORN REMOVER

CVS CORN REMOVER PAD CORN REMOVER

CVS PLANTAR 40% WART REMOVER PLANTAR WART REMOVER

CVS PLANTAR WART REMOVER PLANTAR WART REMOVER

CVS WART REMOVER WART REMOVER

CVS WART REMOVER 17% GEL PEN WART REMOVER

CVS WART REMOVER 17% LIQUID WART REMOVER

CVS WART REMOVER 40% PATCH WART REMOVER

CVS WART REMOVER LIQUID WART REMOVER

CVS WART REMOVER STRIP WART REMOVER

CVS WART REMOVER STRIPS WART REMOVER

DR SCHOLL’S CLEAR AWAY STRIPS DR SCHOLL’S CLEAR AWAY

EQ LIQUID WART REMOVER 17% LIQ WART REMOVER

GEL CALLUS REMOVERS CUSHION CALLUS REMOVERS

GNP CALLUS REMOVERS PATCH CALLUS REMOVERS

GNP LIQUID WART REMOVER 17% LQ WART REMOVER

GNP WART REMOVER SOLUTION WART REMOVER

GS CORN-CALLUS REMOVER CORN-CALLUS REMOVER

GS WART REMOVER 17% LIQUID WART REMOVER

LIQUID CORN-CALLUS REMOVER LIQUID CORN-CALLUSREMOVER

LIQUID WART REMOVER 17% LIQUID WART REMOVER

MEDIPLAST CORN-CALLUS-WARTPAD

MEDIPLAST CORN-CALLUS-WART

MOSCO 40% CORN REMOVER PADS MOSCO CORN REMOVER

ONE STEP CLEAR WART REMOVER ONE STEP CLEAR WARTREMOVER

RA CORN REMOVER 40% PATCH CORN REMOVER

RA CORN REMOVERS PATCH CORN REMOVER

RA WART REMOVER 17% GEL WART REMOVER

RA WART REMOVER 17% LIQUID WART REMOVER

SAL-PLANT 17% GEL SAL-PLANT

SM MAX STRENGTH WART REMOVER WART REMOVER

SM MEDICATED CORN REMOVERS MEDICATED CORN REMOVERS

WART REMOVER 17% GEL WART REMOVER

WART REMOVER 17% GEL PEN WART REMOVER

WART REMOVER 17% LIQUID WART REMOVER

WART REMOVER 40% PATCH WART REMOVER

WART REMOVER CLEAR STRIP WART REMOVER


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WART REMOVER LIQUID WART REMOVER

WART REMOVER SOLUTION WART REMOVER

WART REMOVER STRIPS WART REMOVER

Diabetic Therapy


HUMULIN 70-30 VIAL HUMULIN 70-30

HUMULIN 70/30 KWIKPEN HUMULIN 70/30 KWIKPEN

HUMULIN N 100 UNITS/ML KWIKPEN HUMULIN N KWIKPEN

HUMULIN N 100 UNITS/ML VIAL HUMULIN N

HUMULIN R 100 UNITS/ML VIAL HUMULIN R

NOVOLIN 70-30 100 UNIT/ML VIAL NOVOLIN 70-30

NOVOLIN 70-30 FLEXPEN NOVOLIN 70-30 FLEXPEN

NOVOLIN N 100 UNITS/ML VIAL NOVOLIN N

NOVOLIN R 100 UNITS/ML VIAL NOVOLIN R

RELION NOVOLIN 70-30 FLEXPEN NOVOLIN 70-30 FLEXPEN

RELION NOVOLIN 70-30 VIAL NOVOLIN 70-30

RELION NOVOLIN N 100 UNIT/ML NOVOLIN N

RELION NOVOLIN R 100 UNIT/ML NOVOLIN R

Dietary Products


ENFAMIL PROSOBEE LIPIL LIQ ENFAMIL PROSOBEE LIPIL

EO28 SPLASH DRINK EO28 SPLASH

HI-CAL LIQUID HI-CAL

NUTRAMENT LIQUID NUTRAMENT

PEDIATRIC BALANCED NUTRITN LIQ PEDIATRIC BALANCEDNUTRITION

PEDIATRIC DRINK WITH FIBER LIQ PEDIATRIC DRINK WITH FIBER

PREGESTIMIL LIPIL NURSETTE PREGESTIMIL

RCF SOY FORMULA W-IRON LIQUID RCF SOY FORMULA

RE-GEN LIQUID RE-GEN

RESOURCE 2.0 LIQUID RESOURCE 2.0

SIMILAC ADVANCE FORMULA SIMILAC ADVANCE

SIMILAC ADVANCE LIQ CONC SIMILAC ADVANCE

SIMILAC EXPERT CARE NEOSURE LQ SIMILAC EXPERT CARENEOSURE

SIMILAC LOW-IRON FORMULA SIMILAC

SIMILAC NEOSURE INFANT FORMULA SIMILAC NEOSURE

Digestive Aids


CVS DAIRY RELIEF 9,000 UNIT DAIRY RELIEF

CVS DAIRY RELIEF 9,000 UNITS DAIRY RELIEF

CVS DAIRY RLF 9,000 UNIT CHEW DAIRY RELIEF

CVS LACTASE 3,000 UNIT CAPLET LACTASE


129

Digestive Aids


DAIRY DIGESTIVE 9,000 UNIT DAIRY DIGESTIVE

DAIRY DIGESTIVE AID 9,000 UNIT DAIRY DIGESTIVE

DAIRY RELIEF 3,000 UNIT CAPLET DAIRY RELIEF

DAIRY RLF 9,000 UNIT TAB CHEW DAIRY RELIEF

EQ DAIRY DIGESTIVE 9,000 UNIT DAIRY DIGESTIVE

EQL DAIRY RELIEF 9,000 UNIT DAIRY RELIEF

FAST ACTING LACTASE 9,000 UNIT FAST ACTING LACTASE

GNP DAIRY RELF 3,000 UNIT CPLT DAIRY RELIEF

GNP DAIRY RLF 9,000 UNIT CHEW DAIRY RELIEF

LACTASE 3,000 UNIT CAPLET LACTASE

LACTASE FAST ACTING 9,000 UNIT LACTASE FAST ACTING

LACTOSE FAST ACTING 9,000 UNIT LACTOSE FAST ACTING

LACTOSE FAST ACTING RLF 9,000 LACTOSE FAST ACTINGRELIEF

PUB DAIRY DIGESTIVE 9,000 UNIT DAIRY DIGESTIVE

RA DAIRY RELIEF 9,000 UNIT DAIRY RELIEF

RA DAIRY RLF 9,000 UNIT CHEW DAIRY RELIEF

SB DAIRY RELIEF CAPLET DAIRY RELIEF

SM DAIRY DIGESTIVE CAPLET DAIRY DIGEST

SM ULTRA DAIRY DIGESTIVE CPLT ULTRA DAIRY DIGESTIVE

ULTRA DAIRY DIGESTIVE CPLET ULTRA DAIRY DIGESTIVE

Emergency Contraceptives and Combinations


AFTERA 1.5 MG TABLET AFTERA

ECONTRA EZ 1.5 MG TABLET ECONTRA EZ

ECONTRA ONE-STEP 1.5 MG TABLET ECONTRA ONE-STEP

FALLBACK SOLO 1.5 MG TABLET FALLBACK SOLO

LEVONORGESTREL 1.5 MG TABLET LEVONORGESTREL

MY CHOICE 1.5 MG TABLET MY CHOICE

MY WAY 1.5 MG TABLET MY WAY

NEW DAY 1.5 MG TABLET NEW DAY

NEXT CHOICE ONE DOSE 1.5 MG TB NEXT CHOICE ONE DOSE

OPCICON ONE-STEP 1.5 MG TABLET OPCICON ONE-STEP

OPTION 2 1.5 MG TABLET OPTION 2

PLAN B ONE-STEP 1.5 MG TABLET PLAN B ONE-STEP

TAKE ACTION 1.5 MG TABLET TAKE ACTION

Expectorants


ADULT WAL-TUSSIN LIQUID ADULT WAL-TUSSIN

CHILDREN’S CHEST CONGEST LIQ CHILDREN’S CHESTCONGESTION

CHILDREN’S MUCUS RELIEF LIQ CHILDREN’S MUCUS RELIEF

COUGH SYRUP 100 MG/5 ML COUGH SYRUP


130

Expectorants


CVS CHILD’S CHEST CONGEST LIQ CHILDREN’S CHESTCONGESTION

CVS TUSSIN 100 MG/5 ML LIQUID TUSSIN

EQL TUSSIN CHEST CONGESTSYRUP

TUSSIN CHEST CONGESTION

EQL TUSSIN MUCUS-CHESTCONGEST

TUSSIN MUCUS-CHESTCONGESTION

EXPECTORANT 100 MG/5 ML SYRUP EXPECTORANT

GNP TUSSIN 100 MG/5 ML SYRUP TUSSIN

GNP TUSSIN MUCUS-CON 200 MG/10 TUSSIN MUCUS-CHESTCONGESTION

GS TUSSIN MUCUS-CONG 100 MG/5 TUSSIN MUCUS-CHESTCONGESTION

GS TUSSIN MUCUS-CONG 200 MG/10 TUSSIN MUCUS-CHESTCONGESTION

GUAIFENESIN 100 MG/5 ML LIQUID GUAIFENESIN

GUAIFENESIN 100 MG/5 ML SOLN GUAIFENESIN

GUAIFENESIN 100 MG/5 ML SYRUP GUAIFENESIN



HM ADULT TUSSIN CHEST CONG LIQ ADULT TUSSIN CHESTCONGESTION

HV TUSSIN MUCUS-CONG 200 MG/10 TUSSIN MUCUS-CHESTCONGESTION

KRO TUSSIN 200 MG/10 ML SYRUP TUSSIN

PEDIATRIC COUGH-COLD SYRUP PEDIATRIC COUGH-COLD

PUB TUSSIN 100 MG/5 ML SYRUP TUSSIN

RA EXPECTORANT COUGH SYRUP EXPECTORANT

RA TUSSIN 100 MG/5 ML SYRUP TUSSIN

RA TUSSIN CHEST CONGESTIONSYR

TUSSIN CHEST CONGESTION

SB COUGH CONTROL SYRUP COUGH CONTROL

SM TUSSIN 100 MG/5 ML LIQUID TUSSIN

SM TUSSIN MUCUS-CONG 200 MG/10 TUSSIN MUCUS-CHESTCONGESTION

TUSSIN 100 MG/5 ML SYRUP TUSSIN

TUSSIN CHEST CONGESTION LIQUID TUSSIN CHEST CONGESTION

TUSSIN HONEY SYRUP TUSSIN HONEY

TUSSIN MUCUS-CONG 200 MG/10 TUSSIN MUCUS-CHESTCONGESTION

WAL-TUSSIN SYRUP WAL-TUSSIN

Gastrointestinal Antiflatulents and Combinations


CVS ANTI-GAS 180 MG SOFTGEL ANTI-GAS

CVS GAS RELIEF 125 MG CHEW TAB GAS RELIEF

CVS GAS RELIEF 125 MG SOFTGEL GAS RELIEF


131



CVS GAS RELIEF 80 MG TAB CHEW GAS RELIEF

CVS GAS RELIEF EX-STR DROPS GAS RELIEF

CVS INFT GAS RLF 20 MG/0.3 DRP INFANTS’ GAS RELIEF

CVS INFT GAS RLF 20 MG/0.3 ML INFANTS’ GAS RELIEF

EQ GAS RELIEF 125 MG SOFTGEL GAS RELIEF

EQ INF GAS RELIEF 20 MG/0.3 ML INFANTS’ GAS RELIEF

EQL GAS RELIEF 125 MG CHEW TAB GAS RELIEF

EQL GAS RELIEF 125 MG SOFTGEL GAS RELIEF

EQL GAS RELIEF 180 MG SOFTGEL GAS RELIEF

EQL GAS RELIEF DROPS GAS RELIEF

GAS RELIEF 125 MG CHEW TABLET GAS RELIEF

GAS RELIEF 125 MG SOFTGEL GAS RELIEF

GAS RELIEF 180 MG SOFTGEL GAS RELIEF

GAS RELIEF 40 MG/0.6 ML DROPS GAS RELIEF

GAS RELIEF 80 MG TABLET CHEW GAS RELIEF

GAS RELIEF 80 TABLET CHEW GAS RELIEF 80

GAS RELIEF DROPS GAS RELIEF

GAS RELIEF DROPS 20 MG/0.3 ML INFANTS’ GAS RELIEF

GNP GAS RELIEF 125 MG CHEW TAB GAS RELIEF

GNP GAS RELIEF 125 MG SOFTGEL GAS RELIEF

GNP GAS RELIEF 80 TAB CHEW GAS RELIEF 80

GNP INFANT GAS RELIEF DROPS INFANT GAS RELIEF

GNP SIMETHICONE 180 MG SOFTGEL SIMETHICONE

GS GAS RELIEF 125 MG SOFTGEL GAS RELIEF

GS SIMETHICONE 20 MG/0.3 ML SIMETHICONE

HM GAS RELIEF 125 MG SOFTGEL GAS RELIEF

HM GAS RELIEF 80 MG TAB CHEW GAS RELIEF

HM INF GAS RELIEF 20 MG/0.3 ML INFANTS’ GAS RELIEF

INFANT GAS RELIEF DROPS INFANT GAS RELIEF

INFANTS’ GAS RLF 20 MG/0.3 ML INFANTS’ GAS RELIEF

KRO GAS RELIEF 180 MG SOFTGEL GAS RELIEF

KRO INFT GAS RLF 20 MG/0.3 ML INFANTS’ GAS RELIEF

PUB GAS RELIEF 125 MG SOFTGEL GAS RELIEF

PUB GAS RELIEF 180 MG SOFTGEL GAS RELIEF

PUB INFANTS’ GAS RELIEF DROPS INFANTS’ GAS RELIEF

QC ANTI-GAS 180 MG SOFTGEL ANTI-GAS

QC GAS RELIEF 125 MG TAB CHEW GAS RELIEF

RA GAS RELIEF 125 MG SOFTGEL GAS RELIEF

RA GAS RELIEF 125 MG TAB CHEW GAS RELIEF

SIMETHICONE 125 MG SOFTGEL SIMETHICONE

SIMETHICONE 125 MG TAB CHEW SIMETHICONE

SIMETHICONE 180 MG SOFTGEL SIMETHICONE

SIMETHICONE 40 MG/0.6 ML DROP SIMETHICONE


132



SIMETHICONE 80 MG TAB CHEW SIMETHICONE

SM GAS REL ANTIFLATUENT 180 MG GAS RELIEF

SM GAS RELIEF 125 MG CHEW TAB GAS RELIEF

SM GAS RELIEF 125 MG SOFTGEL GAS RELIEF

SM GAS RELIEF 80 MG TAB CHEW GAS RELIEF

SM INF GAS RELIEF 20 MG/0.3 ML INFANTS’ GAS RELIEF

V-R GAS RELIEF 80 MG TAB CHEW GAS RELIEF

V-R GAS RELIEF INFANT DROPS INFANTS’ GAS RELIEF

Irrigation Solutions


SODIUM CHLORIDE 1 GM TABLET SODIUM CHLORIDE

SODIUM CHLORIDE 1,000 MG TAB SODIUM CHLORIDE

Laxatives


BISA-LAX EC 5 MG TABLET BISA-LAX

BISACODYL 10 MG SUPPOSITORY BISACODYL

BISACODYL EC 5 MG TABLET BISACODYL

CHOCOLATED LAXATIVE CHOCOLATED LAXATIVE

CITRATE OF MAGNESIA SOLN CITRATE OF MAGNESIA

CLEARLAX POWDER CLEARLAX

CLEARLAX POWDER PACKET CLEARLAX

COL-RITE 250 MG SOFTGEL COL-RITE

CVS BISACODYL 10 MG SUPPOS BISACODYL

CVS BISACODYL EC 5 MG TABLET BISACODYL

CVS C-LAX LAXATIVE EC 5 MG TAB C-LAX LAXATIVE

CVS CITRATE OF MAGNESIA SOLN MAGNESIUM CITRATE

CVS ENEMA DISPOSABLE ENEMA DISPOSABLE

CVS ENEMA DISPOSABLE TWINPACK

ENEMA DISPOSABLE

CVS ENEMA READY TO USE ENEMA

CVS GENTLE LAXATIVE 10 MG SUPP GENTLE LAXATIVE

CVS GENTLE LAXATIVE EC 5 MG TB GENTLE LAXATIVE

CVS GLYCERIN SUPPOSITORY GLYCERIN

CVS LAXATIVE 15 MG PILLS LAXATIVE

CVS LAXATIVE PILLS LAXATIVE

CVS MAGNESIUM CITRATE SOLN MAGNESIUM CITRATE

CVS MILK OF MAGNESIA SUSP MILK OF MAGNESIA

CVS MINERAL OIL MINERAL OIL

CVS MINERAL OIL ENEMA MINERAL OIL

CVS PHOSPHATE ORAL SALINE LAX PHOSPHATE LAXATIVE

CVS PURELAX POWDER PURELAX

CVS PURELAX POWDER PACKET PURELAX

CVS SENNA LAXATIVE 8.6 MG TAB SENNA LAXATIVE


133

Laxatives


CVS SENNA PLUS TABLET SENNA PLUS

CVS SENNA-EXTRA 17.2 MG TABLET SENNA-EXTRA

CVS STOOL SOFTENER 100 MG CAP STOOL SOFTENER

CVS STOOL SOFTENER 100 MG SFTG STOOL SOFTENER

CVS STOOL SOFTENER 250 MG SFGL STOOL SOFTENER

CVS STOOL SOFTENER 50 MGSOFTGEL

STOOL SOFTENER

CVS STOOL SOFTENER SOFTGEL STOOL SOFTENER

CVS STOOL SOFTENER-LAXATIVE TB STOOL SOFTENER-LAXATIVE

CVS STOOL SOFTENER-STIM LAX TB STOOL SOFTENER-STIMULANTLAX

CVS SUPPOSITORY SUPPOSITORY

CVS SUPPOSITORY ADULT SUPPOSITORY

CVS WOMEN’S GENTLE LAX EC 5 MG WOMEN’S GENTLE LAXATIVE

DOCUSATE CAL 240 MG CAPSULE DOCUSATE CALCIUM

DOCUSATE CAL 240 MG SOFTGEL DOCUSATE CALCIUM

DOCUSATE SOD 20 MG/5 ML SYRUP DOCUSATE SODIUM

DOCUSATE SOD 60 MG/15 ML SYRP DOCUSATE SODIUM

DOCUSATE SODIUM 100 MGCAPSULE

DOCUSATE SODIUM

DOCUSATE SODIUM 100 MGSOFTGEL

DOCUSATE SODIUM

DOCUSATE SODIUM 100 MG TABLET DOCUSATE SODIUM

DOCUSATE SODIUM 250 MGCAPSULE

DOCUSATE SODIUM

DOCUSATE SODIUM 250 MGSOFTGEL

DOCUSATE SODIUM

DOCUSATE SODIUM 50 MG/5 ML LIQ DOCUSATE SODIUM

DOCUSATE SODIUM-SENNA TABLET DOCUSATE SODIUM-SENNA

DOCUSATE SODIUM-SENNOSIDESTAB

DOCUSATE SODIUM-SENNOSIDES

DOCUSIL 100 MG SOFTGEL DOCUSIL

DUCODYL EC 5 MG TABLET DUCODYL

ENEMA READY TO USE ENEMA

ENEMA READY-TO-USE ENEMA

EQ CHOCOLATED LAXATIVE CHOCOLATED LAXATIVE

EQ CLEARLAX POWDER CLEARLAX

EQ FIBER THERAPY POWDER FIBER THERAPY

EQ GENTLE LAXATIVE DR 5 MG TAB GENTLE LAXATIVE

EQ LAXATIVE 25 MG TABLET LAXATIVE

EQ MAGNESIUM CITRATE SOLUTION MAGNESIUM CITRATE

EQ MAX STR LAXATIVE PILLS LAXATIVE

EQ MILK OF MAGNESIA SUSPENSION MILK OF MAGNESIA

EQ MINERAL OIL MINERAL OIL

EQ NATURAL LAXATIVE 8.6 MG TAB NATURAL LAXATIVE


134

Laxatives


EQ SENNA-S TABLET SENNA-S

EQ STOOL SOFTENER 100 MG SFTGL STOOL SOFTENER

EQ STOOL SOFTENER-STIM LAX TAB STOOL SOFTENER-STIMULANTLAX

EQ VEGETABLE LAXATIVE TABLET VEGETABLE LAXATIVE

EQ WOMEN’S LAXATIVE 5 MG TAB WOMEN’S LAXATIVE

EQ WOMEN’S LAXATIVE EC 5 MG TB WOMEN’S LAXATIVE

EQL CHOCOLATED LAXATIVE CHOCOLATED LAXATIVE

EQL CLEARLAX POWDER CLEARLAX

EQL ENEMA READY TO USE ENEMA

EQL GENTLE LAXATIVE EC 5 MG TB GENTLE LAXATIVE

EQL LAXATIVE 25 MG TABLET LAXATIVE

EQL MAGNESIUM CITRATESOLUTION

MAGNESIUM CITRATE

EQL MILK OF MAGNESIA SUSP MILK OF MAGNESIA

EQL SENNA LAXATIVE 8.6 MG TAB SENNA LAXATIVE

EQL SENNA-S TABLET SENNA-S

EQL STOOL SOFTENER 100 MG SFGL STOOL SOFTENER

EQL STOOL SOFTENER-STIM LAX TB STOOL SOFTENER-STIMULANTLAX

EVAC-U-GEN 8.6 MG TABLET EVAC-U-GEN

GENTLE LAXATIVE 10 MG SUPPOSIT GENTLE LAXATIVE

GENTLE LAXATIVE 5 MG TABLET GENTLE LAXATIVE

GENTLE LAXATIVE EC 5 MG TABLET GENTLE LAXATIVE

GENTLELAX POWDER GENTLELAX

GERI-KOT 8.6 MG TABLET GERI-KOT

GLYCERIN ADULT SUPPOSITORY ADULT GLYCERIN

GLYCERIN PEDIATRIC SUPPOS GLYCERIN

GLYCERIN PEDIATRIC SUPPOSITORY GLYCERIN

GLYCERIN SUPPOSITORY GLYCERIN

GNP BISA-LAX EC 5 MG TABLET BISA-LAX

GNP CITRATE OF MAGNESIA SOLN CITRATE OF MAGNESIA

GNP CLEARLAX POWDER CLEARLAX

GNP CLEARLAX POWDER PACKET CLEARLAX

GNP ENEMA READY TO USE ENEMA

GNP GLYCERIN SUPPOSITORY GLYCERIN

GNP LAXATIVE 25 MG PILL LAXATIVE

GNP LAXATIVE EC 5 MG TABLET LAXATIVE

GNP MILK OF MAGNESIA SUSP MILK OF MAGNESIA

GNP MINERAL OIL ENEMA MINERAL OIL

GNP NATURAL FIBER POWDER NATURAL FIBER POWDER

GNP SENNA LAX 8.6 MG TABLET SENNA LAX

GNP SENNA PLUS TABLET SENNA PLUS

GNP SENNA-LAX 8.6 MG TABLET SENNA LAX


135

Laxatives


GNP STOOL SOFTENER 100 MG SFGL STOOL SOFTENER

GNP STOOL SOFTENER 250 MG SFGL STOOL SOFTENER

GNP STOOL SOFTENER 50 MG/5 ML STOOL SOFTENER

GNP STOOL SOFTENER 60 MG/15 ML STOOL SOFTENER

GNP STOOL SOFTENER-LAXATIVE TB STOOL SOFTENER-LAXATIVE

GNP STOOL SOFTENER-STIM LAX TB STOOL SOFTENER-STIMULANTLAX

GS CLEARLAX POWDER CLEARLAX

GS MAGNESIUM CITRATE SOLUTION MAGNESIUM CITRATE

GS MILK OF MAGNESIA SUSPENSION MILK OF MAGNESIA

GS MINERAL OIL MINERAL OIL

GS SENNA LAXATIVE 8.6 MG TAB SENNA LAXATIVE

HM CLEARLAX POWDER CLEARLAX

HM ENEMA READY TO USE ENEMA

HM ENEMA READY TO USE TWIN PAK ENEMA

HM LAXATIVE EC 5 MG TABLET LAXATIVE

HM MAGNESIUM CITRATE SOLUTION MAGNESIUM CITRATE

HM MILK OF MAGNESIA SUSPENSION MILK OF MAGNESIA

HM MINERAL OIL MINERAL OIL

HM MINERAL OIL ENEMA MINERAL OIL

HM READY TO USE MIN OIL ENEMA READY TO USE ENEMA

HM SENNA 8.6 MG TABLET SENNA

HM SENNA-S TABLET SENNA-S

HM STOOL SOFTENER 100 MG SFTGL STOOL SOFTENER

HM STOOL SOFTENER 100 MG TAB STOOL SOFTENER

HM STOOL SOFTENER 250 MG SFTGL STOOL SOFTENER

HM STOOL SOFTENER-LAXATIVE TAB STOOL SOFTENER-LAXATIVE

HV MILK OF MAGNESIA SUSPENSION MILK OF MAGNESIA

INFANT & CHILD GLYCERIN SUPPOS GLYCERIN

KRO GENTLELAX 17 GRAM POWDER GENTLELAX

KRO MILK OF MAGNESIA SUSP MILK OF MAGNESIA

LAX STOOL SOFTENER-SENNA TAB LAX STOOL SOFTENER WITHSENNA

LAXACLEAR POWDER LAXACLEAR

LAXATIVE 15 MG PILLS LAXATIVE PILLS

LAXATIVE 25 MG PILL LAXATIVE

LAXATIVE 25 MG PILLS LAXATIVE PILLS

LAXATIVE 5 MG TABLET LAXATIVE

LAXATIVE EC 5 MG TABLET LAXATIVE

LAXATIVE FEMININE 5 MG TAB LAXATIVE FEMININE

LAXATIVE MAX STRENGTH PILLS LAXATIVE MAXIMUMSTRENGTH

MAGNESIUM CITRATE SOLUTION MAGNESIUM CITRATE

MILK OF MAGNESIA CONCENTRATED MILK OF MAGNESIA


136

Laxatives


MILK OF MAGNESIA SUSPENSION MILK OF MAGNESIA

MINERAL OIL MINERAL OIL

MINERAL OIL ENEMA MINERAL OIL

MINERAL OIL, HEAVY MINERAL OIL

NATURAL FIBER POWDER NATURAL FIBER POWDER

NATURAL LAXATIVE TABLET NATURAL LAXATIVE

NATURAL SENNA LAXATIVE TAB NATURAL SENNA LAXATIVE

NATURAL VEGETABLE POWDER NATURAL VEGETABLEPOWDER

ORAL SALINE LAXATIVE LIQUID ORAL SALINE LAXATIVE

PEDIATRIC GLYCERIN SUPPOSITORY GLYCERIN

PHOSPHATE ORAL SALINE LAXATIVE PHOSPHATE LAXATIVE

POLYETHYLENE GLYCOL 3350 POWD POLYETHYLENE GLYCOL 3350

POWDERLAX POWDER POWDERLAX

PSYLLIUM SEED POWDER PSYLLIUM SEED

PUB DOCUSATE SODIUM 100 MGCAP

DOCUSATE SODIUM

PUB LAXATIVE EC 5 MG TABLET LAXATIVE

PUB MILK OF MAGNESIA SUSP MILK OF MAGNESIA

QC GENTLE LAXATIVE 10 MG SUPP GENTLE LAXATIVE

QC LAXATIVE 25 MG TABLET LAXATIVE

QC MAGNESIUM CITRATE SOLUTION MAGNESIUM CITRATE

QC MILK OF MAGNESIA SUSPENSION MILK OF MAGNESIA

QC MINERAL OIL HEAVY MINERAL OIL

QC NATURA-LAX 17 GM POWDER NATURA-LAX

QC NATURAL VEG LAXATIVE TABLET NATURAL VEGETABLELAXATIVE

QC NATURAL VEGETABLE POWDER NATURAL VEGETABLEPOWDER

QC READY TO USE ENEMA ENEMA

QC STOOL SOFTENER 100 MG SFTGL STOOL SOFTENER

QC STOOL SOFTENER-LAXATIVE TAB STOOL SOFTENER-LAXATIVE

RA BISACODYL EC 5 MG TABLET BISACODYL

RA CITRATE OF MAGNESIA SOLN CITRATE OF MAGNESIA

RA COL-RITE 100 MG CAPSULE COL-RITE

RA COL-RITE 100 MG SOFTGEL COL-RITE

RA COL-RITE 250 MG SOFTGEL COL-RITE

RA ENEMA TWIN PACK ENEMA

RA FAST RELIEF LAX 10 MG SUPP FAST RELIEF LAXATIVE

RA GLYCERIN ADULT SUPPOSITORY ADULT GLYCERIN

RA GLYCERIN PEDIATRIC SUPP GLYCERIN

RA LAXATIVE 25 MG PILL LAXATIVE

RA LAXATIVE EC 5 MG TABLET LAXATIVE

RA LAXATIVE PEG 3350 POWDER LAXATIVE PEG 3350


137

Laxatives


RA MILK OF MAGNESIA SUSPENSION MILK OF MAGNESIA

RA MINERAL OIL EXTRA-HEAVY MINERAL OIL EXTRA HEAVY

RA P-COL RITE TABLET P-COL RITE

RA SALINE ENEMA SALINE ENEMA

RA SENNA 8.6 MG TABLET SENNA

RA SENNA PLUS TABLET SENNA PLUS

RA SENNA-LAX 8.6 MG TABLET SENNA LAX

RA STOOL SOFTENER 100 MG CAP STOOL SOFTENER

RA WOMEN’S LAXATIVE TABLET WOMEN’S LAXATIVE

READY TO USE ENEMA READY TO USE ENEMA

READY TO USE MINERAL OIL ENEMA READY TO USE ENEMA

SB BISACODYL EC 5 MG TABLET BISACODYL

SB DOCUSATE SOD 100 MGCAPSULE

DOCUSATE SODIUM

SB WOMEN’S GENTLE LAX EC 5 MG WOMEN’S GENTLE LAXATIVE

SEN-O-TAB SEN-O-TAB

SENEXON 8.6 MG TABLET SENEXON

SENNA 8.6 MG TABLET SENNA

SENNA 8.8 MG/5 ML SYRUP SENNA

SENNA 8.8 MG/5 ML SYRUP GRX SENNA

SENNA CONCENTRATE TABLET SENNA CONCENTRATE

SENNA LAX 8.6 MG TABLET SENNA LAX

SENNA LAXATIVE 8.6 MG TABLET SENNA LAXATIVE

SENNA LAXATIVE TABLET SENNA LAXATIVE

SENNA PLUS TABLET SENNA PLUS

SENNA-DOCUSATE SODIUM TABLET SENNA-DOCUSATE SODIUM

SENNA-GEN NF TABLET SENNA-GEN

SENNA-LAX 8.6 MG TABLET SENNA LAX

SENNA-S TABLET SENNA-S

SENNA-TIME 8.6 MG TABLET SENNA

SENNO TABLET SENNO

SENNOSIDES 8.6 MG TABLET SENNOSIDES

SENNOSIDES-DOCUSATE SODIUMTAB

SENNOSIDES-DOCUSATESODIUM

SENOKOT 8.6 MG TABLET SENOKOT

SM CLEARLAX POWDER CLEARLAX

SM DOCUSATE CAL 240 MGSOFTGEL

DOCUSATE CALCIUM

SM ENEMA READY TO USE ENEMA

SM ENEMA READY TO USE TWIN PAK ENEMA

SM FIBER POWDER FIBER

SM FIBER SMOOTH POWDER FIBER SMOOTH

SM FIBER SMOOTH TEXTURE PWD FIBER SMOOTH

SM GENTLE LAXATIVE EC 5 MG TAB GENTLE LAXATIVE


138

Laxatives


SM GLYCERIN ADULT SUPPOSITORY ADULT GLYCERIN

SM GLYCERIN PEDIATRIC SUPPO GLYCERIN

SM LAXATIVE 10 MG SUPPOSITORY LAXATIVE SUPPOSITORY

SM LAXATIVE 25 MG TABLET LAXATIVE

SM LAXATIVE PEDIATRIC SUPPOS LAXATIVE SUPPOSITORY

SM LAXATIVE TABLET LAXATIVE

SM MAGNESIUM CITRATE SOLUTION MAGNESIUM CITRATE

SM MILK OF MAGNESIA SUSPENSION MILK OF MAGNESIA

SM MINERAL OIL MINERAL OIL

SM MINERAL OIL HEAVY MINERAL OIL

SM NAT LAX PLUS STOOL SOFTENER STOOL SOFTENER

SM READY TO USE ENEMA READY TO USE ENEMA

SM SENNA LAXATIVE 8.6 MG TAB SENNA LAXATIVE

SM SENNA LAXATIVE PILLS SENNA LAXATIVE

SM SENNA-S TABLET SENNA-S

SM STOOL SOFTENER 100 MG SFTGL STOOL SOFTENER



SM STOOL SOFTENER-LAXATIVE TAB STOOL SOFTENER-LAXATIVE

SM STOOL SOFTENER-STIM LAX TAB STOOL SOFTENER-STIMULANTLAX

SM WOMAN’S LAXATIVE 5 MG TAB WOMAN’S LAXATIVE

SMOOTHLAX POWDER SMOOTHLAX

SMOOTHLAX POWDER PACKET SMOOTHLAX

STIMULANT LAXATIVE PLUS TABLET STIMULANT LAXATIVE PLUS

STOOL SOFTENER 100 MG CAPSULE STOOL SOFTENER

STOOL SOFTENER 100 MG SOFTGEL STOOL SOFTENER



STOOL SOFTENER 50 MG/5 ML LIQ STOOL SOFTENER

STOOL SOFTENER 60 MG/15 ML SYR STOOL SOFTENER

STOOL SOFTENER-LAXATIVE TABLET STOOL SOFTENER-LAXATIVE

STOOL SOFTENER-STIM LAX TABLET STOOL SOFTENER-STIMULANTLAX

SW CLEARLAX POWDER CLEARLAX

V-R LAXATIVE CHOCOLATE LAXATIVE

V-R LAXATIVE PILLS REG TAB LAXATIVE PILLS

V-R MILK OF MAGNESIA SUSP MILK OF MAGNESIA

V-R STOOL SOFTENER TABLET STOOL SOFTENER

VR LAXATIVE MAX-STR PILLS LAXATIVE MAXIMUMSTRENGTH

WOMAN’S LAXATIVE TABLET WOMAN’S LAXATIVE

WOMANS LAXATIVE TABLET WOMEN’S LAXATIVE

WOMEN’S LAXATIVE 5 MG TABLET WOMEN’S LAXATIVE


139

Laxatives


WOMEN’S LAXATIVE EC 5 MB TAB WOMEN’S LAXATIVE

Medical Supplies and DME - Diabetic Supplies


1ST TIER COMFORTOUCH 28GLANCT

1ST TIER UNILETCOMFORTOUCH

QL

1ST TIER COMFORTOUCH 30GLANCT

1ST TIER UNILETCOMFORTOUCH

QL

1ST TIER UNIFINE PENTP 5MM 31G 1ST TIER UNIFINE PENTIPS

1ST TIER UNIFINE PNTIP 4MM 32G 1ST TIER UNIFINE PENTIPS



1ST TIER UNIFINE PNTP 12MM 29G 1ST TIER UNIFINE PENTIPS

1ST TIER UNIFINE PNTP 29GX1/2" 1ST TIER UNIFINE PENTIPS

1ST TIER UNIFINE PNTP 31GX1/4" 1ST TIER UNIFINE PENTIPS

1ST TIER UNIFINE PNTP 31GX3/16 1ST TIER UNIFINE PENTIPSPLUS



ACTI-LANCE LITE 28G LANCETS ACTI-LANCE QL

ACTI-LANCE SPECIAL 17G LANCETS ACTI-LANCE QL

ACTI-LANCE UNIVERS 23G LANCETS ACTI-LANCE QL

ADJUSTABLE LANCING DEVICE ADJUSTABLE LANCING DEVICE QL

ADVANCED LANCING DEVICE LANCING DEVICE QL

ADVANCED TRAVEL 28G LANCETS ADVANCED TRAVEL LANCETS QL

ADVANCED TRAVEL 30G LANCETS ADVANCED TRAVEL LANCETS QL

ADVOCATE 26G LANCETS ADVOCATE LANCET QL

ADVOCATE 30G LANCETS ADVOCATE LANCET QL

ADVOCATE INS 0.3 ML 30GX5/16" ADVOCATE SYRINGES




ADVOCATE INS 1 ML 31GX5/16" ADVOCATE SYRINGES

ADVOCATE INS SYR 0.3 ML 29GX1/2 ADVOCATE SYRINGES

ADVOCATE INS SYR 0.5 ML 29GX1/2 ADVOCATE SYRINGES

ADVOCATE INS SYR 1 ML 29GX1/2" ADVOCATE SYRINGES

ADVOCATE INS SYR 1 ML 30GX5/16 ADVOCATE SYRINGES

ADVOCATE PEN NDL 12.7MM 29G ADVOCATE PEN NEEDLES

ADVOCATE PEN NEEDLE 4MM 33G ADVOCATE PEN NEEDLE

ADVOCATE PEN NEEDLES 5MM 31G ADVOCATE PEN NEEDLES

ADVOCATE PEN NEEDLES 8MM 31G ADVOCATE PEN NEEDLES

ALTERNATE SITE 26G LANCETS ALTERNATE SITE LANCETS QL

ASSURE COMFORT 28G LANCETS LANCETS QL


140



ASSURE COMFORT 30G LANCETS LANCETS QL

ASSURE HAEMOLANCE PLUS 28G ASSURE HAEMOLANCE PLUS QL

ASSURE ID PEN NEEDLE 30GX3/16" ASSURE ID PEN NEEDLE



ASSURE ID SYR 0.5 ML 29GX1/2" ASSURE ID INSULIN SAFETY

ASSURE ID SYR 1 ML 29GX1/2" ASSURE ID INSULIN SAFETY

ASSURE LANCE 28G LANCETS ASSURE LANCE QL

ASSURE LANCE PLUS 30G LANCETS ASSURE LANCE PLUS QL

AUTOJECT 2 INJECTION DEVICE AUTOJECT 2

AUTOLET LANCING DEVICE AUTOLET LANCING DEVICE QL

AUTOPEN 1 TO 21 UNITS AUTOPEN

AUTOPEN 2 TO 42 UNITS AUTOPEN

BD AUTOSHIELD DUO NDL 5MMX30G AUTOSHIELD DUO PENNEEDLE

BD AUTOSHIELD NEEDLE 5MMX29G AUTOSHIELD PEN NEEDLE

BD AUTOSHIELD NEEDLE 8MMX29G AUTOSHIELD PEN NEEDLE

BD ECLIPSE 30GX1/2" SYRINGE ECLIPSE SYRINGE

BD INS SYR 0.3 ML 8MMX31G(1/2) INSULIN SYRINGE

BD INS SYR UF 0.3 ML 12.7MMX30G INSULIN SYRINGE

BD INS SYR UF 0.5 ML 12.7MMX30G INSULIN SYRINGE

BD INS SYRN UF 1 ML 12.7MMX30G INSULIN SYRINGE

BD INS SYRNG 0.3 ML 29GX12.7MM INSULIN SYRINGE

BD INS SYRNG 0.5 ML 29GX12.7MM INSULIN SYRINGE

BD INS SYRNG UF 0.3 ML 8MMX31G INSULIN SYRINGE

BD INS SYRNG UF 0.5 ML 8MMX31G INSULIN SYRINGE

BD INSUL SYR 0.3 ML 31GX15/64" INSULIN SYRINGE

BD INSUL SYR 0.5 ML 31GX15/64" INSULIN SYRINGE

BD INSULIN SYR 0.3 ML 28GX1/2" INSULIN SYRINGE


BD INSULIN SYR 0.3 ML 31GX5/16 INSULIN SYRINGE

BD INSULIN SYR 0.3 ML 8MMX31G INSULIN SYRINGE





BD INSULIN SYR 0.5 ML 8MMX31G INSULIN SYRINGE

BD INSULIN SYR 1 ML 12.7MMX30G INSULIN SYRINGE

BD INSULIN SYR 1 ML 25GX1" INSULIN SYRINGE

BD INSULIN SYR 1 ML 25GX5/8" INSULIN SYRINGE


BD INSULIN SYR 1 ML 27GX12.7MM INSULIN SYRINGE



141





BD INSULIN SYR 1 ML 29GX12.7MM INSULIN SYRINGE




BD INSULIN SYR 1 ML 8MMX31G INSULIN SYRINGE

BD INSULIN SYR UF 1 ML 8MMX31G INSULIN SYRINGE

BD INSULIN SYRINGE 1 ML INSULIN SYRINGE

BD INSULIN U100-3/10 ML SYR INSULIN SYRINGE

BD INTEGRA SYR 1 ML 29GX1/2" INTEGRA SYRINGE

BD LANCETS 33G LANCETS QL

BD LUER-LOK SYRINGE 1 ML LUER-LOK SYRINGE

BD MICROTAINER 30G LANCETS BD MICROTAINER LANCETS QL

BD SAFETGLD INS 0.3 ML 13MMX29G SAFETYGLIDE INSULINSYRINGE




BD SAFETYGLD INS 1 ML 13MMX29G SAFETYGLIDE INSULINSYRINGE

BD SAFETYGLID INS 1 ML 6MMX31G SAFETYGLIDE INSULINSYRINGE

BD SAFETYGLIDE SYRINGE 27GX5/8 SAFETYGLIDE SYRINGE

BD SAFTYGLD INS 0.3 ML 6MMX31G SAFETYGLIDE INSULINSYRINGE

BD SAFTYGLD INS 0.5 ML 6MMX31G SAFETYGLIDE INSULINSYRINGE

BD SYR 0.3 ML 6MMX31G (1/2) INSULIN SYRINGE

BD SYRINGE 0.3 ML 12.7MMX30G INSULIN SYRINGE

BD SYRINGE 0.5 ML 12.7MMX30G INSULIN SYRINGE

BD UF MICRO PEN NEEDLE 6MMX32G ULTRA-FINE MICRO PENNEEDLE

BD UF MINI PEN NEEDLE 5MMX31G ULTRA-FINE MINI PEN NEEDLE

BD UF NANO PEN NEEDLE 4MMX32G ULTRA-FINE NANO PENNEEDLE

BD UF ORIG PEN NDL 12.7MMX29G ULTRA-FINE ORIGINAL PENNEEDLE

BD UF SHORT PEN NEEDLE8MMX31G

ULTRA-FINE SHORT PENNEEDLE

BD ULTRA-FINE 33G LANCETS BD ULTRA-FINE QL

BD ULTRA-FINE II 30G LANCETS BD ULTRA-FINE II QL

BD VEO INS 0.3 ML 6MMX31G (1/2) VEO INSULIN SYRINGE


142



BD VEO INS SYRING 1 ML 6MMX31G VEO INSULIN SYRINGE

BD VEO INS SYRN 0.3 ML 6MMX31G VEO INSULIN SYRINGE

BD VEO INS SYRN 0.5 ML 6MMX31G VEO INSULIN SYRINGE

BLOOD LANCETS 30G BLOOD LANCETS QL

BREEZE 2 DISC TEST STRIP BREEZE 2 QL

BULLSEYE MINI SAFETY 28G LANCT BULLSEYE MINI SAFETYLANCETS

QL

CA INS SYR 0.3 ML 30GX5/16" INSULIN SYRINGE




CA INSULIN SYR 0.3 ML 29GX1/2" INSULIN SYRINGE

CA INSULIN SYR 0.5 ML 29GX1/2" INSULIN SYRINGE

CA INSULIN SYR 1 ML 29GX1/2" INSULIN SYRINGE



CAREFINE PEN NEEDLE 12.7MM 29G CAREFINE PEN NEEDLE

CAREFINE PEN NEEDLE 4MM 32G CAREFINE PEN NEEDLE




CAREFINE PEN NEEDLES 6MM 32G CAREFINE PEN NEEDLE

CAREFINE PEN NEEDLES 8MM 31G CAREFINE PEN NEEDLE

CAREONE LANCING DEVICE CAREONE QL

CAREONE SYR 0.3 ML 30GX1/2" INSULIN SYRINGE




CAREONE SYR 1 ML 30GX1/2" INSULIN SYRINGE

CAREONE SYR 1 ML 31GX5/16" INSULIN SYRINGE

CAREONE THIN LANCET CAREONE QL

CAREONE ULTRA THIN LANCET CAREONE QL

CAREONE UNIFINE PENTIP 4MM 32G UNIFINE PENTIPS




CAREONE UNIFINE PENTP 29GX1/2" UNIFINE PENTIPS PLUS

CAREONE UNIFINE PENTP 31GX1/4" UNIFINE PENTIPS PLUS

CAREONE UNIFINE PNTP 12MM 29G UNIFINE PENTIPS

CAREONE UNIFINE PNTP 31GX3/16" UNIFINE PENTIPS PLUS



CARESENS ULTRA THIN 30G LANCET CARESENS QL


143



CARETOUCH PEN NEEDLE 31GX1/4" CARETOUCH PEN NEEDLE





CARETOUCH SYR 0.3 ML 31GX5/16" CARETOUCH INSULINSYRINGE



CARETOUCH SYR 1 ML 30GX5/16" CARETOUCH INSULINSYRINGE

CARETOUCH SYR 1 ML 31GX5/16" CARETOUCH INSULINSYRINGE

CARETOUCH TWIST 28G LANCET CARETOUCH TWIST LANCET QL



CLEVER CHEK ULTRA THIN 30G CLEVER CHEK LANCETS QL

CLICKFINE 31G X 1/4" NEEDLES CLICKFINE

CLICKFINE 31G X 5/16" NEEDLES CLICKFINE

CLICKFINE PEN NEEDLE 32GX5/32" CLICKFINE

CLICKFINE UNIVERSAL 31G X 1/4" CLICKFINE

CLICKFINE UNIVERSAL 31GX5/16" CLICKFINE

COAGUCHEK LANCETS COAGUCHEK QL

COMFORT EZ INS 0.3 ML 30GX1/2" COMFORT EZ

COMFORT EZ INS 0.3 ML 30GX5/16" COMFORT EZ

COMFORT EZ INSULIN SYR 0.3 ML COMFORT EZ

COMFORT EZ INSULIN SYR 0.5 ML COMFORT EZ

COMFORT EZ PEN NEEDLE 12MM29G

COMFORT EZ

COMFORT EZ PEN NEEDLES 4MM32G

COMFORT EZ


COMFORT EZ


COMFORT EZ


COMFORT EZ


COMFORT EZ


COMFORT EZ


COMFORT EZ


COMFORT EZ


144




COMFORT EZ


COMFORT EZ


COMFORT EZ

COMFORT EZ SAFETY 28G LANCETS COMFORT EZ QL

COMFORT EZ SYR 0.3 ML 29GX1/2" COMFORT EZ




COMFORT EZ SYR 1 ML 28GX1/2" COMFORT EZ





COMFORT LANCETS COMFORT LANCETS QL

COMFORT POINT PEN NDL 29GX1/2" INSULIN PEN NEEDLE




CONTOUR METER CONTOUR QL Limited to 1 monitor per 365 days

CONTOUR METER SYSTEM CONTOUR QL Limited to 1 monitor per 365 days

CONTOUR NEXT EZ METER CONTOUR NEXT EZ QL Limited to 1 monitor per 365 days

CONTOUR NEXT EZ METER SYSTEM CONTOUR NEXT EZ QL Limited to 1 monitor per 365 days

CONTOUR NEXT LINK 2.4 METER KT CONTOUR NEXT LINK 2.4 QL Limited to 1 monitor per 365 days

CONTOUR NEXT LINK METER CONTOUR NEXT LINK QL Limited to 1 monitor per 365 days

CONTOUR NEXT METER CONTOUR NEXT QL Limited to 1 monitor per 365 days

CONTOUR NEXT TEST STRIP CONTOUR NEXT TEST STRIP QL

CONTOUR TEST STRIP CONTOUR TEST STRIP QL

CVS MICRO THIN 33G LANCETS MICRO THIN LANCETS QL

CVS THIN 26G LANCETS LANCETS QL

CVS ULTRA THIN 30G LANCETS ULTRA THIN LANCETS QL

DARIO 100 STERILE LANCETS LANCETS QL

DROPLET 30G LANCETS DROPLET LANCETS QL

DROPLET LANCING DEVICE DROPLET LANCING DEVICE QL

DROPLET PEN NEEDLE 29GX1/2" DROPLET PEN NEEDLE









145




DROPSAFE PEN NEEDLE 31GX1/4" DROPSAFE PEN NEEDLE

DROPSAFE PEN NEEDLE 31GX5/16" DROPSAFE PEN NEEDLE

DRUG MART ULTRA COMFORT SYR ULTRA COMFORT

E-Z JECT COLORED LANCETS E-Z JECT LANCETS QL

E-Z JECT LANCETS E-Z JECT LANCETS QL

E-ZJECT COLOR 32G LANCETS E-ZJECT LANCETS QL

E-ZJECT COLOR 33G LANCETS E-ZJECT LANCETS QL

E-ZJECT SUPER THIN 30G LANCETS E-ZJECT LANCETS QL

E-ZJECT THIN LANCETS LANCETS QL

EASY COMFORT 0.3 ML SYRINGE EASY COMFORT INSULINSYRINGE

EASY COMFORT 0.5 ML 30GX1/2" EASY COMFORT INSULINSYRINGE

EASY COMFORT 0.5 ML 31GX5/16" EASY COMFORT INSULINSYRINGE

EASY COMFORT 0.5 ML SYRINGE EASY COMFORT INSULINSYRINGE

EASY COMFORT 1 ML 31GX5/16" EASY COMFORT INSULINSYRINGE

EASY COMFORT 30G LANCETS EASY COMFORT QL

EASY COMFORT INSULIN 1 ML SYR EASY COMFORT INSULINSYRINGE

EASY COMFORT PEN NDL 31GX1/4" EASY COMFORT PEN NEEDLES




EASY COMFORT SYR 1 ML 30GX1/2" EASY COMFORT INSULINSYRINGE

EASY GLIDE PEN NEEDLE 4MM 33G EASY GLIDE PEN NEEDLE

EASY TOUCH 0.3 ML SYR 30GX1/2" EASY TOUCH INSULINSYRINGE


EASY TOUCH 0.5 ML SYR 29GX1/2" EASY TOUCH INSULIN SAFETY


EASY TOUCH 0.5 ML SYR 30GX5/16 EASY TOUCH INSULIN SAFETY

EASY TOUCH 1 ML SYR 27GX1/2" EASY TOUCH INSULINSYRINGE

EASY TOUCH 1 ML SYR 29GX1/2" EASY TOUCH INSULIN SAFETY

EASY TOUCH 1 ML SYR 30GX1/2" EASY TOUCH INSULIN SAFETY

EASY TOUCH 28G LANCETS EASY TOUCH LANCETS QL

EASY TOUCH BUTTON 30G LANCETS EASY TOUCH QL

EASY TOUCH INSULIN 1 ML 29GX1/2 EASY TOUCH SHEATHLOCKINSULIN


146



EASY TOUCH INSULIN 1 ML 30GX1/2 EASY TOUCH SHEATHLOCKINSULIN

EASY TOUCH INSULIN SYR 0.3 ML EASY TOUCH

EASY TOUCH INSULIN SYR 0.5 ML EASY TOUCH

EASY TOUCH INSULIN SYR 1 ML EASY TOUCH

EASY TOUCH INSULN 1 ML 29GX1/2" EASY TOUCH FLIPLOCKINSULIN

EASY TOUCH INSULN 1 ML 30GX1/2" EASY TOUCH FLIPLOCKINSULIN

EASY TOUCH INSULN 1 ML 30GX5/16 EASY TOUCH FLIPLOCKINSULIN

EASY TOUCH INSULN 1 ML 31GX5/16 EASY TOUCH FLIPLOCKINSULIN

EASY TOUCH LUER LOK INSUL 1 ML EASY TOUCH LUER LOCKINSULIN

EASY TOUCH PEN NEEDLE 29GX1/2" EASY TOUCH PEN NEEDLE

EASY TOUCH PEN NEEDLE 30GX5/16 EASY TOUCH PEN NEEDLE







EASY TOUCH PRESSURE 30GLANCET

EASY TOUCH QL

EASY TOUCH PULL-TOP 26G LANCET EASY TOUCH QL



EASY TOUCH SAFETY 26G LANCETS EASY TOUCH QL

EASY TOUCH SAFETY 28G LANCETS EASY TOUCH QL

EASY TOUCH TWIST 26G LANCETS EASY TOUCH QL




EASY TOUCH UNI-SLIP SYR 1 ML EASY TOUCH UNI-SLIP

EASY TWIST & CAP 28G LANCETS EASY TWIST & CAP LANCETS QL

EASY-TOUCH INS 1 ML 31GX5/16" EASY-TOUCH INSULINSYRINGE

EMBRACE 30G LANCETS EMBRACE QL

EQL 33G LANCETS LANCETS QL

EQL INS SYR 1 ML 29GX1/2" INSULIN SYRINGE

EQL INSUL SYR 0.3 ML 31GX5/16" INSULIN SYRINGE

EQL INSUL SYR 0.5 ML 31GX5/16" INSULIN SYRINGE

EQL INSULIN 0.3 ML SYRINGE INSULIN SYRINGE

EQL INSULIN 0.5 ML SYRINGE INSULIN SYRINGE


147



EQL INSULIN 1 ML SYRINGE INSULIN SYRINGE

EQL INSULIN SYR 1 ML 31GX5/16" INSULIN SYRINGE

EQL MICRO THIN 33G LANCETS MICRO THIN LANCETS QL

EXEL INS SYR U100 1 ML 28GX1/2 INSULIN SYRINGE

EXEL U100 0.3 ML 29GX1/2" INSULIN SYRINGE





EXEL U100 1 ML 30GX5/16" INSULIN SYRINGE

EXEL U100 INS SYR 1 ML 29GX1/2 INSULIN SYRINGE

EZ SMART 28G LANCETS EZ SMART LANCETS QL

FIFTY50 INS 0.3 ML 31GX5/16" INSULIN SYRINGE

FIFTY50 INS 0.5 ML 31GX5/16" INSULIN SYRINGE

FIFTY50 INS SYR 1 ML 31GX5/16" INSULIN SYRINGE

FIFTY50 PEN 31G X 3/16" NEEDLE PEN NEEDLE

FIFTY50 PEN 31G X 5/16" NEEDLE PEN NEEDLE

FIFTY50 PEN NEEDLE 32G X 1/4" PEN NEEDLE

FIFTY50 PEN NEEDLE 32G X 5/32" PEN NEEDLE

FIFTY50 SAFETY SEAL 30G LANCET FIFTY50 SAFETY SEALLANCETS

QL

FIFTY50 UNILET 33G LANCETS UNILET LANCETS QL

FINE 30 UNIVERSAL 30G LANCETS FINE 30 UNIVERSAL LANCETS QL

FINGERSTIX LANCETS FINGERSTIX QL

FORA 30G LANCETS FORA LANCETS QL

FORACARE 30G LANCETS FORACARE LANCETS QL

FREESTYLE 28G LANCETS FREESTYLE LANCETS QL

FREESTYLE PREC 0.5 ML 30GX5/16 FREESTYLE PRECISION

FREESTYLE PREC 0.5 ML 31GX5/16 FREESTYLE PRECISION

FREESTYLE PREC 1 ML 30GX5/16" FREESTYLE PRECISION

FREESTYLE PREC 1 ML 31GX5/16" FREESTYLE PRECISION

FREESTYLE UNISTIK 2 LANCETS FREESTYLE UNISTIK 2 QL

GLUCOCOM 28G LANCETS GLUCOCOM LANCETS QL

GLUCOCOM 30G LANCETS GLUCOCOM LANCETS QL

GLUCOCOM 33G LANCETS GLUCOCOM QL

GMATE 30G LANCETS GMATE QL

GNP CLICKFINE 31G X 1/4" NDL CLICKFINE

GNP CLICKFINE 31G X 5/16" NDL CLICKFINE

GNP CLICKFINE PEN NDL 31GX1/4" PEN NEEDLE

GNP CLICKFINE PEN NDL 31GX5/16 PEN NEEDLE

GNP INS SYR 0.3 ML 29GX1/2" INSULIN SYRINGE

GNP INSUL SYR 0.3 ML 31GX5/16" INSULIN SYRINGE

GNP INSUL SYR 0.5 ML 31GX5/16" INSULIN SYRINGE


148



GNP INSULIN SYR 1 ML 31GX5/16" INSULIN SYRINGE

GNP LANCING SYSTEM DEVICE LANCING SYSTEM QL

GNP MICRO THIN 33G LANCETS MICRO THIN LANCETS QL

GNP ULT C 0.3 ML 29GX1/2" (1/2) ULTRA COMFORT

GNP ULT CMFRT 0.5 ML 29GX1/2" ULTRA COMFORT

GNP ULTR CMFRT 0.5 ML 28GX1/2" ULTRA COMFORT

GNP ULTR CMFRT 0.5 ML 30GX5/16 ULTRA COMFORT

GNP ULTR COMFORT 1 ML 29GX1/2" ULTRA COMFORT

GNP ULTRA COMFORT 0.5 ML SYR ULTRA COMFORT

GNP ULTRA COMFORT 1 MLSYRINGE

ULTRA COMFORT

GNP ULTRA COMFORT 3/10 ML SYR ULTRA COMFORT

GNP ULTRA COMFRT 1 ML 28GX1/2" ULTRA COMFORT

GNP UNIVERSAL 1 STANDARD 21G UNIVERSAL 1 QL

GNP UNIVERSAL 1 SUPER THIN 30G UNIVERSAL 1 QL

GNP UNIVERSAL 1 THIN 26G LANCT UNIVERSAL 1 QL

GS UNIVERSAL 1 MICRO THIN 33G UNIVERSAL 1 QL

GS UNIVERSAL 1 THIN 26G LANCET UNIVERSAL 1 QL

GS UNIVERSAL 1 ULTRA THIN 30G UNIVERSAL 1 QL

HEALTHY ACCENTS AUTOLETDEVICE

HEALTHY ACCENTS AUTOLET QL

HEALTHY ACCENTS PENTIP 4MM 32G HEALTHY ACCENTS UNIFINEPENTIP




HEALTHY ACCENTS PENTP 12MM29G

HEALTHY ACCENTS UNIFINEPENTIP

HEALTHY ACCENTS UNILET 30G HEALTHY ACCENTS UNILETLANCET

QL

HEB MICRO THIN 33G LANCETS MICRO THIN LANCETS QL

HEB UNIFINE PNTP PLUS 31GX3/16 UNIFINE PENTIPS PLUS

HEB UNIFINE PNTP PLUS 32GX5/32 UNIFINE PENTIPS PLUS

INCONTROL LANCING DEVICE INCONTROL LANCING DEVICE QL

INCONTROL PEN NEEDLE 12MM 29G INCONTROL PEN NEEDLE





INCONTROL SUPER THIN 30G LANCT INCONTROL SUPER THINLANCETS

QL

INCONTROL ULTRA THIN 28G LANCT INCONTROL ULTRA THINLANCETS

QL


149



INJECT EASE 28G LANCETS INJECT EASE LANCETS QL

INJECT EASE 30G LANCETS INJECT EASE LANCETS QL

INSUL SYR 0.3 ML 8MMX31G (1/2) INSULIN SYRINGE

INSULIN 1 ML SYRINGE INSULIN SYRINGE

INSULIN 1/2 ML SYRINGE INSULIN SYRINGE

INSULIN 3/10 ML SYRINGE INSULIN SYRINGE

INSULIN SYR 0.3 ML 30GX5/16" INSULIN SYRINGE

INSULIN SYR 0.3 ML 31GX1/4(1/2) INSULIN SYRINGE

INSULIN SYRIN 0.3 ML 29GX1/2" INSULIN SYRINGE









INSULIN SYRIN 1 ML 29GX1/2" INSULIN SYRINGE

INSULIN SYRING 0.5 ML 29GX1/2" INSULIN SYRINGE

INSULIN SYRINGE 0.3 ML ULTILET INSULIN SYRINGE

INSULIN SYRINGE 0.3 ML 31GX1/4 INSULIN SYRINGE

INSULIN SYRINGE 0.5 ML ULTILET INSULIN SYRINGE

INSULIN SYRINGE 0.5 ML 31GX1/4 INSULIN SYRINGE

INSULIN SYRINGE 1 ML ULTILET INSULIN SYRINGE

INSULIN SYRINGE 1 ML 28GX1/2" INSULIN SYRINGE






INSULIN SYRINGE U100 1 ML INSULIN SYRINGE

INSUPEN 30G ULTRAFIN NEEDLE INSUPEN

INSUPEN 31G ULTRAFIN NEEDLE INSUPEN

INSUPEN 32G 6MM PEN NEEDLE INSUPEN

INSUPEN 32G 8MM PEN NEEDLE INSUPEN

INSUPEN PEN NEEDLE 29GX1/2" INSUPEN

INSUPEN PEN NEEDLE 29GX12MM INSUPEN








150







INVACARE 30G LANCETS INVACARE LANCETS QL

KINRAY INS SYR 1 ML 31GX5/16" INSULIN SYRINGE

KINRAY SYRING 0.3 ML 31GX5/16" INSULIN SYRINGE

KINRAY SYRING 0.5 ML 31GX5/16" INSULIN SYRINGE

KMART VALU PLUS SYR 1/2 ML INSULIN SYRINGE

KMART VALU PLUS SYRINGE 1 ML INSULIN SYRINGE

KRO INS SYR 0.3 ML 29GX1/2" INSULIN SYRINGE

KRO INS SYRIN 0.3 ML 30GX5/16" INSULIN SYRINGE




KRO INS SYRING 0.5 ML 29GX1/2" INSULIN SYRINGE

KRO INS SYRINGE 1 ML 29GX1/2" INSULIN SYRINGE



KRO INSULIN SYR 1 ML 30GX5/16" INSULIN SYRINGE

KRO UNIVERSAL 1 THIN 26G LANCT UNIVERSAL 1 QL

KROGER INS SYR 0.3 ML 30GX5/16 INSULIN SYRINGE

KROGER INS SYR 0.5 ML 29GX1/2" INSULIN SYRINGE

KROGER INS SYR 1 ML 29GX1/2" INSULIN SYRINGE

KROGER INS SYR 1 ML 31GX5/16" INSULIN SYRINGE

KROGER LANCETS LANCETS QL

KROGER LANCING DEVICE LANCING DEVICE QL

KROGER PEN NEEDLES 31G X 5/16" PEN NEEDLE

KROGER SUPER THIN LANCETS SUPER THIN LANCETS QL

KROGER SYR 0.5 ML 30GX5/16" INSULIN SYRINGE

KROGER SYRING 0.3 ML 31GX5/16" INSULIN SYRINGE

LANCETS 26G LANCETS QL

LANCETS 26G X 1.8MM LANCETS QL

LANCETS 28G LANCETS LANCETS QL

LANCETS 28G X 1.8MM LANCETS QL



LANCETS ULTRA FINE 28G LANCETS QL

LANCETS ULTRA THIN 26G LANCETS ULTRA THIN QL

LANCING DEVICE LANCING DEVICE QL

LEADER INS SYR 0.3 ML 29GX1/2" INSULIN SYRINGE




151




LEADER INS SYR 1 ML 28GX1/2" INSULIN SYRINGE




LEADER INSULIN SYRINGE 0.3 ML INSULIN SYRINGE

LEADER PEN NEEDLE 6MM 31G PEN NEEDLE

LEADER PEN NEEDLES 12MM 29G PEN NEEDLES

LEADER PEN NEEDLES 31G PEN NEEDLES

LEADER SYRING 0.3 ML 31GX5/16" INSULIN SYRINGE

LEADER SYRING 0.5 ML 31GX5/16" INSULIN SYRINGE

LITE TOUCH 28G LANCETS LITE TOUCH QL


LITE TOUCH 31GX1/4" PEN NEEDLE LITE TOUCH


LITE TOUCH INSULIN 0.5 ML SYR LITE TOUCH

LITE TOUCH INSULIN 1 ML SYR LITE TOUCH

LITE TOUCH INSULIN SYR 0.3 ML LITE TOUCH

LITE TOUCH INSULIN SYR 0.5 ML LITE TOUCH

LITE TOUCH INSULIN SYR 1 ML LITE TOUCH

LITE TOUCH PEN NEEDLE 29G LITE TOUCH

LITE TOUCH PEN NEEDLE 31G LITE TOUCH

LITETOUCH INS 0.3 ML 29GX1/2" LITETOUCH INSULIN SYRINGE




LITETOUCH SYR 0.5 ML 28GX1/2" LITETOUCH INSULIN SYRINGE



LITETOUCH SYRIN 1 ML 28GX1/2" LITETOUCH INSULIN SYRINGE



LIVE BETTER PEN NEEDLES 8MM PEN NEEDLE

LIVE BETTER SUPER THIN LANCET SUPER THIN LANCETS QL

LIVE BETTER ULTRA THIN LANCET ULTRA THIN LANCETS QL

LONGS THIN LANCETS 26G THIN LANCETS QL

LONGS THIN LANCETS 30G THIN LANCETS QL

MAXI-COMFORT INS 0.5 ML 28G MAXI-COMFORT

MAXI-COMFORT INS 1 ML 28GX1/2" MAXI-COMFORT

MEDISENSE THIN 28G LANCETS MEDISENSE THIN LANCETS QL

MEDISENSE THIN LANCETS LANCETS QL

MEDLANCE PLUS 21G LANCETS MEDLANCE PLUS QL

MEDLANCE PLUS 30G LANCETS MEDLANCE PLUS QL


152



MEDLANCE PLUS EXTRA 21GLANCET

MEDLANCE PLUS QL

MEDLANCE PLUS LITE 25G LANCETS MEDLANCE PLUS QL

MEIJER LANCETS LANCETS QL

MEIJER UNIVERSAL 1 26G LANCETS UNIVERSAL 1 QL

MICRO THIN 33G LANCETS MICRO THIN LANCETS QL

MICROLET LANCETS MICROLET QL

MINI ULTRA-THIN II PEN NDL 31G MINI ULTRA-THIN II

MONOJECT 1 ML SYRN 27X1/2" MONOJECT INSULIN SYRINGE

MONOJECT 1 ML SYRN 28GX1/2" MONOJECT INSULIN SYRINGE

MONOJECT INSUL SYR U100 MONOJECT INSULIN SYRINGE

MONOJECT INSUL SYR U100 0.5 ML MONOJECT INSULIN SYRINGE

MONOJECT INSUL SYR U100 1 ML MONOJECT INSULIN SYRINGE

MONOJECT INSULIN SYR 0.3 ML MONOJECT INSULIN SYRINGE

MONOJECT INSULIN SYR 0.5 ML MONOJECT INSULIN SYRINGE

MONOJECT INSULIN SYR 1 ML MONOJECT INSULIN SYRINGE

MONOJECT INSULIN SYR U-100 MONOJECT INSULIN SAFETYSYRNG

MONOJECT INSULIN SYRN 3/10 ML MONOJECT INSULIN SYRINGE

MONOJECT SYRINGE 0.3 ML MONOJECT INSULIN SYRINGE

MONOJECT SYRINGE 0.5 ML MONOJECT INSULIN SYRINGE

MONOJECT SYRINGE 1 ML MONOJECT INSULIN SYRINGE

MONOLET THIN 28G LANCETS MONOLET THIN LANCETS QL

MS INS SYR 0.5 ML 29GX1/2" INSULIN SYRINGE

MS INS SYR 1 ML 29GX1/2" INSULIN SYRINGE

MS INS SYRINGE 1 ML 30GX1/2" INSULIN SYRINGE

MS INSUL SYR 0.3 ML 31GX5/16" INSULIN SYRINGE



MS INSULIN SYR 0.3 ML 29GX1/2" INSULIN SYRINGE

MS INSULIN SYR 1 ML 31GX5/16" INSULIN SYRINGE

MS INSULIN SYRINGE 0.3 ML INSULIN SYRINGE

MS PEN NEEDLE 6MM 31G PEN NEEDLE

MYGLUCOHEALTH 30G LANCETS MYGLUCOHEALTH LANCETS QL

NOVA SAFETY 28G LANCETS NOVA SAFETY LANCETS QL

NOVA SUREFLEX THIN LANCETS NOVA SUREFLEX QL

NOVOFINE 30G X 1/3" NEEDLES NOVOFINE

NOVOFINE 32G NEEDLES NOVOFINE 32

NOVOFINE AUTOCOVER 30G NEEDLE NOVOFINE AUTOCOVER

NOVOFINE PLUS PEN NDL 32GX1/6" NOVOFINE PLUS

NOVOTWIST NEEDLE 32G 5MM NOVOTWIST

ON CALL 30G LANCET ON CALL LANCET QL

ON CALL PLUS 30G LANCET ON CALL PLUS LANCET QL


153



ON-THE-GO 30G LANCETS ON-THE-GO QL

ONETOUCH DELICA 30G LANCETS ONETOUCH DELICA QL

ONETOUCH DELICA 33G LANCETS ONETOUCH DELICA QL

ONETOUCH SURESOFT 28G LANCDEV

ONETOUCH SURESOFT QL

ONETOUCH ULTRASOFT LANCETS ONETOUCH LANCETS QL

PC SUPER THIN 30G LANCETS SUPER THIN LANCETS QL

PC UNIFINE PENTIPS 12MM NEEDLE UNIFINE PENTIPS



PEN NEEDLE 12MM 29G PEN NEEDLE

PEN NEEDLE 31G X 1/4" PEN NEEDLE










PEN NEEDLES 12MM 29G PEN NEEDLES





PENTIPS PEN NEEDLE 29GX1/2" PENTIPS





PENTIPS PEN NEEDLE 6MM 31G PENTIPS

PHARMACIST CHOICE 28G LANCETS ULTRA THIN LANCETS QL

PHARMACIST CHOICE 30G LANCETS LANCETS QL

PHARMACIST CHOICE 33G LANCETS LANCETS QL

PREF PLUS INS 0.3 ML 29GX1/2" INSULIN SYRINGE

PREF PLUS SYR 0.5 ML 30GX5/16" INSULIN SYRINGE

PREF PLUS SYRING 1 ML 29GX1/2" INSULIN SYRINGE

PREFERRED PLUS 0.3 ML 30GX5/16 INSULIN SYRINGE

PREFERRED PLUS 0.5 ML 29GX1/2" INSULIN SYRINGE

PREFERRED PLUS LANCETS LANCETS QL

PREFERRED PLUS SYRINGE 0.5 ML INSULIN SYRINGE

PREFERRED PLUS SYRINGE 1 ML INSULIN SYRINGE


154



PREFERRED PLUS THIN LANCETS LANCETS QL

PREFPLS INS SYR 1 ML 30GX5/16" INSULIN SYRINGE

PRESSURE ACTIVATED 28GLANCETS

PRESSURE ACTIVATEDLANCETS

QL

PRO COMFORT 0.5 ML 30GX1/2" PRO COMFORT INSULINSYRINGE



PRO COMFORT 1 ML 30GX1/2" PRO COMFORT INSULINSYRINGE



PRO COMFORT 30G LANCETS PRO COMFORT LANCETS QL

PRO COMFORT 31G LANCET PRO COMFORT LANCET QL

PRO COMFORT PEN NDL 31GX5/16" PRO COMFORT PEN NEEDLE

PRO COMFORT PEN NDL 32G X 1/4" PRO COMFORT PEN NEEDLE

PRO COMFORT PEN NDL 5MM 32G PRO COMFORT PEN NEEDLE

PRODIGY INS SYR 1 ML 28GX1/2" PRODIGY INSULIN SYRINGE

PRODIGY PRESSURE ACTIVATED28G

PRODIGY LANCETS QL

PRODIGY SAFETY 26G LANCETS PRODIGY LANCETS QL

PRODIGY SYRNG 0.5 ML 31GX5/16" PRODIGY INSULIN SYRINGE

PRODIGY SYRNGE 0.3 ML 31GX5/16" PRODIGY INSULIN SYRINGE

PRODIGY TWIST TOP 28G LANCET PRODIGY TWIST TOP LANCET QL

PUB 28G LANCETS LANCETS QL

PUB INS SYRIN 0.3 ML 30GX1/2" INSULIN SYRINGE

PUB INS SYRINGE 1 ML 30GX1/2" INSULIN SYRINGE

PUB INSUL SYR 0.3 ML 31GX5/16" INSULIN SYRINGE



PUB INSULIN SYR 1 ML 31GX5/16" INSULIN SYRINGE

PUB PEN 12MM 29G NEEDLES PEN NEEDLE

PUB PEN 8MM 31G NEEDLES PEN NEEDLE

PUB PEN NEEDLE 6MM 31G PEN NEEDLE

PUB UNIFINE PNTP PLUS 31GX3/16 UNIFINE PENTIPS PLUS

PUSH BUTTON SAFETY 28G LANCET PUSH BUTTON SAFETYLANCETS

QL

QC UNIFINE PENTIPS 32GX5/32" UNIFINE PENTIPS

QC UNIFINE PENTIPS 4MM 32G UNIFINE PENTIPS

QC UNILET SUPER THIN 30G LANCT UNILET LANCETS QL

QC UNILET ULTRA THIN 28G LANCT UNILET LANCETS QL


155



RA E-ZJECT 26G LANCETS E-ZJECT LANCETS QL



RA E-ZJECT COLOR 33G LANCETS E-ZJECT LANCETS QL

RA INS SYR 0.5 ML 29GX1/2" INSULIN SYRINGE

RA INS SYR 0.5 ML 30GX5/16" INSULIN SYRINGE

RA INS SYR 1 ML 29GX1/2" INSULIN SYRINGE

RA INS SYRINGE 1 ML 30GX5/16" INSULIN SYRINGE

RA PEN NEEDLE 31GX3/16" PEN NEEDLE

RA PEN NEEDLE 31GX5/16" PEN NEEDLE

READYLANCE 26G SAFETY LANCETS READYLANCE SAFETYLANCETS

QL


QL


QL

RELI ON 31G X 1/4" NEEDLES NEEDLES

RELI-ON INSULIN 0.3 ML SYR INSULIN SYRINGE

RELI-ON INSULIN 0.5 ML SYR INSULIN SYRINGE

RELI-ON INSULIN 1 ML SYR INSULIN SYRINGE

RELIAMED 28G LANCETS RELIAMED QL

RELIAMED 30G LANCETS RELIAMED QL

RELIAMED LANCING DEVICE ADJUSTABLE LANCING DEVICE QL

RELIAMED MINI LANCING DEVICE RELIAMED MINI LANCINGDEVICE

QL

RELIAMED SAFETY 23G LANCETS RELIAMED QL

RELIAMED SAFETY 28G LANCETS RELIAMED QL

RELIAMED SAFETY SEAL 28G LANCT RELIAMED SAFETY SEALLANCETS

QL

RELIAMED SAFETY SEAL 30G LANCT RELIAMED SAFETY SEALLANCETS

QL

RELIAMED TWIST&CAP 28G LANCETS RELIAMED QL

RELION INS SYR 0.3 ML 29GX1/2" INSULIN SYRINGE

RELION INS SYR 0.3 ML 30GX5/16 INSULIN SYRINGE

RELION INS SYR 0.3 ML 31GX6MM INSULIN SYRINGE

RELION INS SYR 0.5 ML 29GX1/2" INSULIN SYRINGE

RELION INS SYR 0.5 ML 31GX6MM INSULIN SYRINGE

RELION INS SYR 1 ML 29GX1/2" INSULIN SYRINGE




RELION INSULIN SYR 0.5 ML INSULIN SYRINGE

RELION LANCING DEVICE LANCING DEVICE QL

RELION MINI PEN 31G X 1/4" NDL PEN NEEDLE

RELION PEN 29G NEEDLE PEN NEEDLE


156



RELION PEN 31G NEEDLE PEN NEEDLE

RELION PEN NEEDLE 29GX1/2" PEN NEEDLE




RELION PEN NEEDLES 32GX5/32" RELION PEN NEEDLES

RELION SYR 0.5 ML 30GX5/16" INSULIN SYRINGE

RELION SYRING 0.3 ML 31GX5/16" INSULIN SYRINGE

RELION SYRING 0.5 ML 31GX5/16" INSULIN SYRINGE

RELION THIN 26G LANCETS RELION THIN QL

RELION ULTRA THIN 30G LANCETS ULTRA THIN LANCETS QL

RELION ULTRA THIN PLUS 33G ULTRA THIN PLUS LANCETS QL

RELION ULTRA THIN PLUS LANCETS ULTRA THIN PLUS QL

REXALL UNIVERSAL 1 30G LANCETS UNIVERSAL 1 QL

RIGHTEST GL300 30G LANCETS RIGHTEST GL300 LANCETS QL

SAFESNAP INS SYR UNITS-100 0.3 ML SAFESNAP INSULIN SYRINGE

SAFESNAP INS SYR UNITS-100 0.5 ML SAFESNAP INSULIN SYRINGE

SAFESNAP INS SYR UNITS-100 1 ML SAFESNAP INSULIN SYRINGE

SAFETY 28G LANCETS SAFETY LANCETS QL

SAFETY LANCETS 26G SAFETY LANCETS QL

SAFETY SEAL 28G LANCETS SAFETY SEAL LANCETS QL

SAFETY SEAL 30G LANCETS SAFETY SEAL LANCETS QL

SAFETY-LET 30G LANCETS SAFETY-LET QL

SAPS CARE 30G LANCETS LANCETS QL

SAPS TWIST TOP 30G LANCETS LANCETS QL

SCHNUCKS SYR 0.5 ML 29GX1/2" INSULIN SYRINGE

SCHNUCKS SYR 0.5 ML 30GX5/16" INSULIN SYRINGE

SHOPKO AUTOLET LANCING DEVICE AUTOLET LANCING DEVICE QL

SHOPKO ON-THE-GO 30G LANCETS ON-THE-GO QL

SHOPKO UNIFINE PENTIPS 4MM 32G UNIFINE PENTIPS



SHOPKO UNIFINE PNTIPS 12MM 29G UNIFINE PENTIPS PLUS

SHOPKO UNILET SUPER THIN 30G UNILET LANCETS QL

SHOPKO UNILET ULTRA THIN 28G UNILET LANCETS QL

SINGLE-LET LANCETS SINGLE-LET QL

SM COLOR LANCETS 21G COLOR LANCETS QL

SM INS SYR 0.5 ML 29GX1/2" INSULIN SYRINGE

SM INS SYR 0.5 ML 30GX5/16" INSULIN SYRINGE

SM INS SYR 1 ML 29GX1/2" INSULIN SYRINGE

SM INS SYRING 0.3 ML 30GX5/16" INSULIN SYRINGE

SM INS SYRINGE 1 ML 28GX1/2" INSULIN SYRINGE

SM INS SYRINGE 1 ML 30GX5/16" INSULIN SYRINGE


157



SM INSUL SYR 0.3 ML 31GX5/16" INSULIN SYRINGE

SM INSUL SYR 0.5 ML 31GX5/16" INSULIN SYRINGE

SM INSULIN SYR 0.3 ML 29GX1/2" INSULIN SYRINGE

SM INSULIN SYR 0.5 ML 28GX1/2" INSULIN SYRINGE

SM INSULIN SYR 1 ML 31GX5/16" INSULIN SYRINGE

SM LANCETS 21G LANCETS QL

SM MICRO THIN 33G LANCETS MICRO THIN LANCETS QL

SM SUPER THIN 30G LANCETS SUPER THIN LANCETS QL

SM THIN LANCETS 26G THIN LANCETS QL

SM ULT CFT 0.3 ML 30GX5/16(1/2) ULTRA COMFORT

SM ULT CFT 0.3 ML 31GX5/16(1/2) ULTRA COMFORT

SMART SENSE COLOR 33G LANCETS SMART SENSE QL

SMART SENSE STANDARD 21G SMART SENSE LANCETS QL

SMART SENSE SUPER THIN 30G SUPER THIN LANCETS QL

SMART SENSE THIN 26G LANCETS SMART SENSE LANCETS QL

SMARTEST LANCET SMARTEST LANCET QL

SOFT TOUCH LANCETS SOFT TOUCH QL

SOLUS V2 28G LANCETS SOLUS V2 QL

SOLUS V2 30G TWIST LANCETS SOLUS V2 LANCETS QL

STERILANCE TL TWIST 30G LANCET STERILANCE TL QL

SUPER THIN 28G LANCETS SUPER THIN LANCETS QL

SUPER THIN 30G LANCETS SUPER THIN LANCETS QL

SURE COMFORT 0.3 ML SYRINGE SURE COMFORT

SURE COMFORT 0.5 ML SYRINGE SURE COMFORT

SURE COMFORT 1 ML SYRINGE SURE COMFORT

SURE COMFORT 28G LANCETS SURE COMFORT LANCETS QL

SURE COMFORT 3/10 ML SYRINGE SURE COMFORT

SURE COMFORT 30G LANCETS SURE COMFORT LANCETS QL

SURE COMFORT 30G PEN NEEDLE SURE COMFORT

SURE COMFORT 31G PEN NEEDLE SURE COMFORT

SURE COMFORT INS 0.3 ML 31GX1/4 SURE COMFORT INSULINSYRINGE

SURE COMFORT INS 0.5 ML 31GX1/4 SURE COMFORT INSULINSYRINGE

SURE COMFORT INS 1 ML 31GX1/4" SURE COMFORT INSULINSYRINGE

SURE COMFORT PEN NDL 29GX1/2" SURE COMFORT




SURE-FINE PEN NEEDLES 12.7MM SURE-FINE PEN NEEDLES

SURE-FINE PEN NEEDLES 5MM SURE-FINE PEN NEEDLES

SURE-FINE PEN NEEDLES 8MM SURE-FINE PEN NEEDLES

SURE-JECT INS 0.3 ML 31GX5/16" INSULIN SYRINGE


158



SURE-JECT INS 0.5 ML 31GX5/16" INSULIN SYRINGE

SURE-JECT INSU SYR U100 0.3 ML SURE-JECT INSULIN SYRINGE

SURE-JECT INSU SYR U100 0.5 ML SURE-JECT INSULIN SYRINGE

SURE-JECT INSU SYR U100 1 ML SURE-JECT INSULIN SYRINGE

SURE-JECT INSUL SYR U100 1 ML SURE-JECT INSULIN SYRINGE

SURE-JECT INSULIN SYRINGE 1 ML SURE-JECT INSULIN SYRINGE

SURE-LANCE 26G LANCETS SURE-LANCE QL

SURE-LANCE FLAT LANCETS SURE-LANCE QL

SURE-LANCE THIN 28G LANCETS SURE-LANCE QL

SURE-LANCE ULTRA THIN 30G SURE-LANCE QL

SURE-TOUCH LANCET SURE-TOUCH QL

TECHLITE 0.3 ML 29GX12MM (1/2) TECHLITE INSULIN SYRINGE










TECHLITE 28G LANCETS TECHLITE LANCETS QL

TECHLITE 30G LANCETS TECHLITE LANCETS QL

TECHLITE INS SYR 1 ML 29GX12MM TECHLITE INSULIN SYRINGE





TECHLITE PEN NEEDLE 29GX1/2" TECHLITE PEN NEEDLE








TELCARE BGM BLOOD GLUCOSE KIT TELCARE BGM

TELCARE CONTROL SOLUTION TELCARE CONTROL SOLUTION

TELCARE TEST STRIPS TELCARE

TELCARE ULTRA THIN 30G LANCETS TELCARE QL

TERUMO INS SYR 0.3 ML 29GX1/2" INSULIN SYRINGE

TERUMO INS SYRINGE U100-1 ML TERUMO INSULIN SYRINGE

TERUMO INS SYRINGE U100-1/2 ML TERUMO INSULIN SYRINGE


159



TERUMO INS SYRINGE U100-1/3 ML TERUMO INSULIN SYRINGE

TERUMO INS SYRNG U100-1/2 ML TERUMO INSULIN SYRINGE

THIN 26G LANCETS THIN LANCETS QL

THIN LANCETS 28G THIN LANCETS QL

THINPRO INS SYRIN U100-0.3 ML THINPRO INSULIN SYRINGE

THINPRO INS SYRIN U100-0.5 ML THINPRO INSULIN SYRINGE

THINPRO INS SYRIN U100-1 ML THINPRO INSULIN SYRINGE

TODAY’S HLTH PN NEEDLE 6MM 31G PEN NEEDLE

TOPCARE CLICKFINE 31G X 1/4" TOPCARE CLICKFINE

TOPCARE CLICKFINE 31G X 5/16" TOPCARE CLICKFINE

TOPCARE ULTRA COMFORTSYRINGE

TOPCARE ULTRA COMFORT

TOPCARE UNIVERSAL1 33GLANCETS

TOPCARE UNIVERSAL1LANCET

QL

TOPCARE UNIVERSAL1 THIN LANCET TOPCARE UNIVERSAL1 THINLANCET

QL

TRUEDRAW LANCING DEVICE TRUEDRAW QL

TRUEPLUS 26G LANCETS TRUEPLUS LANCETS QL



TRUEPLUS PEN NEEDLE 29GX1/2" TRUEPLUS PEN NEEDLE

TRUEPLUS PEN NEEDLE 31G X 1/4" TRUEPLUS PEN NEEDLE




TRUEPLUS SAFETY 28G LANCET TRUEPLUS LANCETS QL

TRUEPLUS SAFETY 28G LANCETS TRUEPLUS LANCETS QL

TRUEPLUS SUPER THIN 28G LANCET TRUEPLUS LANCETS QL

TRUEPLUS SYR 0.3 ML 29GX1/2" TRUEPLUS INSULIN SYRINGE







TRUEPLUS SYR 1 ML 28GX1/2" TRUEPLUS INSULIN SYRINGE




TRUEPLUS ULTRA THIN 30G LANCET TRUEPLUS LANCETS QL

TWIST LANCETS LANCETS QL

TWIST LANCETS 30G TWIST LANCETS QL

ULT CFT 0.3 ML 29GX1/2" (1/2) ULTRA COMFORT



160




ULTCARE INS SYR 1 ML 31GX5/16" INSULIN SYRINGE

ULTICAR INS 0.3 ML 31GX1/4(1/2) ULTICARE INSULIN SYRINGE

ULTICARE INS 0.3 ML 30GX1/2" ULTICARE

ULTICARE INS 0.3 ML 31GX1/4" ULTICARE INSULIN SYRINGE

ULTICARE INS 0.5 ML 30GX1/2" ULTICARE

ULTICARE INS 0.5 ML 31GX1/4" ULTICARE INSULIN SYRINGE

ULTICARE INS 1 ML 31GX1/4" ULTICARE INSULIN SYRINGE

ULTICARE INS SYR 1 ML 28GX1/2" INSULIN SYRINGE

ULTICARE INS SYR 1 ML 29GX1/2" INSULIN SYRINGE

ULTICARE INS SYR 1 ML 30GX1/2" ULTICARE

ULTICARE PEN NDL 12.7 MM 29G ULTICARE PEN NEEDLE

ULTICARE PEN NEEDLE 31GX3/16" ULTICARE PEN NEEDLE

ULTICARE PEN NEEDLE 4MM 32G ULTICARE PEN NEEDLE


ULTICARE PEN NEEDLE 8 MM 31G ULTICARE PEN NEEDLE


ULTICARE PEN NEEDLES 12MM 29G ULTICARE PEN NEEDLE




ULTICARE SYR 0.3 ML 29GX1/2" ULTICARE








ULTICARE SYR 1 ML 30GX5/16" ULTICARE

ULTICARE SYR 1 ML 31GX5/16" ULTICARE

ULTICARE SYRIN 0.3 ML 29GX1/2" INSULIN SYRINGE

ULTICARE SYRIN 0.5 ML 28GX1/2" INSULIN SYRINGE

ULTICARE SYRINGE 1 ML 29GX1/2" ULTICARE

ULTICARE SYRINGE 1 ML 30GX1/2" ULTICARE

ULTILET 28G LANCETS ULTILET LANCETS QL



ULTILET BASIC 30G LANCETS ULTILET BASIC QL

ULTILET CLASSIC 26G LANCETS ULTILET CLASSIC QL





161



ULTILET INSULIN SYRINGE 0.3 ML ULTILET INSULIN SYRINGE

ULTILET INSULIN SYRINGE 0.5 ML ULTILET INSULIN SYRINGE

ULTILET INSULIN SYRINGE 1 ML ULTILET INSULIN SYRINGE

ULTILET PEN NEEDLE ULTILET PEN NEEDLE

ULTILET PEN NEEDLE 4MM 32G ULTILET PEN NEEDLE

ULTRA COMFORT 0.3 ML 29GX1/2" ULTRA COMFORT

ULTRA COMFORT 0.3 ML SYRINGE ULTRA COMFORT





ULTRA COMFORT 0.5 ML SYRINGE ULTRA COMFORT

ULTRA COMFORT 1 ML 28GX1/2" ULTRA COMFORT




ULTRA COMFORT 1 ML SYRINGE ULTRA COMFORT

ULTRA FINE 30G LANCETS ULTRA FINE LANCETS QL

ULTRA THIN 28G LANCETS ULTRA THIN LANCETS QL




ULTRA-CARE 30G LANCETS ULTRA-CARE LANCETS QL

ULTRA-THIN II 1 ML 31GX5/16" ULTRA-THIN II

ULTRA-THIN II 26G LANCET ULTRA-THIN II QL

ULTRA-THIN II 28G LANCETS ULTRA-THIN II QL

ULTRA-THIN II 30G LANCETS ULTRA-THIN II QL

ULTRA-THIN II INS 0.3 ML 29G ULTRA-THIN II






ULTRA-THIN II INS SYR 1 ML 29G ULTRA-THIN II

ULTRA-THIN II INS SYR 1 ML 30G ULTRA-THIN II

ULTRA-THIN II PEN NDL 29GX1/2" ULTRA-THIN II

ULTRA-THIN II PEN NDL 31GX5/16 ULTRA-THIN II

ULTRALANCE 26G LANCETS ULTRALANCE QL

ULTRALANCE 28G LANCETS ULTRALANCE QL

ULTRATLC LANCETS ULTRATLC LANCETS QL

UNIFINE PENTIPS 12MM 29G UNIFINE PENTIPS

UNIFINE PENTIPS 31GX3/16" UNIFINE PENTIPS



162






UNIFINE PENTIPS 6MM NEEDLE UNIFINE PENTIPS


UNIFINE PENTIPS 8MM NEEDLE UNIFINE PENTIPS

UNIFINE PENTIPS NEEDLES 29G UNIFINE PENTIPS

UNIFINE PENTIPS PLUS 29GX1/2" UNIFINE PENTIPS PLUS






UNILET COMFORTOUCH 26GLANCETS

UNILET COMFORTOUCH QL

UNILET COMFORTOUCH LANCET UNILET COMFORTOUCH QL

UNILET EXCELITE II LANCET UNILET EXCELITE II QL

UNILET EXCELITE LANCET UNILET EXCELITE QL

UNILET GP LANCET UNILET GP LANCET QL

UNILET GP LANCET SUPERLITE UNILET GP LANCET QL

UNILET MICRO THIN 33G LANCET UNILET LANCET QL

UNILET MICRO THIN 33G LANCETS UNILET LANCETS QL

UNILET SUPER THIN 30G LANCETS UNILET LANCETS QL

UNILET ULTRA THIN 28G LANCETS UNILET LANCETS QL

UNISTIK 3 COMFORT LANCET UNISTIK 3 QL

UNISTIK 3 GENTLE 30G LANCETS UNISTIK 3 QL

UNISTIK 3 GENTLE ON-THE-GO 30G UNISTIK 3 QL

UNISTIK CZT COMFORT 28G LANCET UNISTIK CZT QL

UNISTIK PRO 28G LANCET UNISTIK PRO QL

UNISTIK SAFETY 28G LANCET UNISTIK SAFETY QL

UNISTIK SAFETY 30G LANCETS UNISTIK SAFETY QL

UNISTIK TOUCH 28G LANCETS UNISTIK TOUCH QL

UNISTIK TOUCH 30G LANCETS UNISTIK TOUCH QL

UNIVERSAL 1 33G LANCETS UNIVERSAL 1 QL

VALUE PLUS LANCING DEVICE LANCING DEVICE QL

VANISHPOINT 0.5 ML 30GX1/2" SY VANISHPOINT

VANISHPOINT U-100 29X1/2 SYR VANISHPOINT

WALGREENS THIN LANCETS THIN LANCETS QL

WALGREENS ULTRA THIN LANCETS ULTRA THIN LANCETS QL

WM UNIFINE PENTIP PLUS 4MM 32G UNIFINE PENTIPS PLUS





163



YOURX ULTICARE PEN NDL 4MM 32G ULTICARE PEN NEEDLE



Medical Supplies and DME - GI-GU Ostomy and Irrigation Supplies


RELIAMED PROTECT BARRIERWIPES

PROTECTIVE BARRIER WIPES

Medical Supplies and DME - Thermometers


THERMOMETER UNIVERSAL GLASS THERMOMETER



CAL-CITRATE PLUS VITAMIN D TAB CAL-CITRATE

CAL-QUICK LIQUID CAL-QUICK

CALCET CITRATE CREAMY BITES CALCET

CALCET PETITES TABLET CALCET PETITES

CALCITRATE + VIT D CAPLET CALCITRATE + VIT D

CALCIUM + D3 ER TABLET CALCIUM + D3

CALCIUM + VITAMIN D3 GUMMIES CALCIUM + VITAMIN D3

CALCIUM 1,000 + D3 CAPLET CALCIUM 1000 + D3

CALCIUM 250+D TABLET OYSTER SHELL + D

CALCIUM 250-VIT D3 125 TABLET CALCIUM 250-VIT D3

CALCIUM 500 + VIT D CAPLET CALCIUM 500 + VITAMIN D

CALCIUM 500 MG CHEWABLE TABLET CALCIUM

CALCIUM 500 MG TABLET CALCIUM CARBONATE

CALCIUM 500 MG-VIT D3 600 UNIT CALCIUM 500-VIT D3

CALCIUM 500+D TABLET CHEW CALCIUM 500 + VIT D

CALCIUM 500-VIT D3 200 CAPLET CALCIUM 500-VIT D3





CALCIUM 600 + VIT D 400 SOFTGL CALCIUM 600 + VIT D

CALCIUM 600 + VIT D TABLET CALCIUM 600 + VIT D

CALCIUM 600 MG TABLET CALCIUM

CALCIUM 600 WITH VIT D CHEW TB CALCIUM 600 + VIT D

CALCIUM 600+D SOFTGEL CALCIUM CARBONATE/VITAMIN D3

CALCIUM 600-VIT D3 2,500 SFTGL CALCIUM 600-VIT D3




CALCIUM 600-VIT D3 500 SOFTGEL CALCIUM 600-VIT D3


164




CALCIUM 600-VIT D3 800 TAB CALCIUM 600-VIT D3


CALCIUM ADULT GUMMIES CALCIUM ADULT

CALCIUM CARB 260 MG TAB CHEW CALCIUM CARBONATE

CALCIUM CARB 500 (1,250) MG TB CALCIUM CARBONATE

CALCIUM CARBONATE 1.25 GM TAB CALCIUM CARBONATE

CALCIUM CARBONATE 1.5 GM TAB CALCIUM CARBONATE

CALCIUM CARBONATE 650 MG TAB CALCIUM CARBONATE

CALCIUM CARBONATE POWDER CALCIUM CARBONATE

CALCIUM CIT 200-VIT D3 250 TAB CALCIUM CITRATE-VIT D3

CALCIUM CIT 315-VIT D3 250 CPT CALCIUM CITRATE-VIT D3

CALCIUM CIT 315-VIT D3 250 TAB CALCIUM CITRATE-VITAMIN D3

CALCIUM CIT-VIT D 250-200 TAB CALCIUM CITRATE-VITAMIN D

CALCIUM CIT-VIT D 315-200 TAB CALCIUM CITRATE - VITAMIN D

CALCIUM CITRATE - VIT D CAPLET CALCIUM CITRATE - VITAMIN D

CALCIUM CITRATE - VIT D TABLET CALCIUM CITRATE - VITAMIN D

CALCIUM CITRATE - VIT D3 TAB CALCIUM CITRATE - VITAMIND3

CALCIUM CITRATE 200 MG CAPLET CALCIUM CITRATE

CALCIUM CITRATE 200 MG TABLET CALCIUM CITRATE

CALCIUM CITRATE 250 MG CAPLET CALCIUM CITRATE

CALCIUM CITRATE 250 MG TABLET CALCIUM CITRATE

CALCIUM CITRATE GRANULES CALCIUM CITRATE

CALCIUM CITRATE MALATE WITH D CALCIUM CITRATE MALATEWITH D

CALCIUM CITRATE WITH D TABLET CALCIUM CITRATE-VITAMIN D

CALCIUM CITRATE-VIT D CAPLET CALCIUM CITRATE - VITAMIN D

CALCIUM CITRATE-VIT D3 CAPLET CALCIUM CITRATE-VITAMIN D3

CALCIUM CITRATE-VIT D3 TABLET CALCIUM CITRATE-VITAMIN D3

CALCIUM GUMMIES CALCIUM

CALCIUM LACTATE 100 MG TABLET CALCIUM LACTATE

CALCIUM OYS SHELL 250 MG TAB OYSTER SHELL CALCIUM W-VIT D

CALCIUM PETITES SOFTGEL CALCIUM PETITES

CALCIUM WITH VIT D TABLET CALCIUM CITRATE-VITAMIN D

CALCIUM-500 MG TABLETCHEWABLE

CALCIUM

CALCIUM-VITAMIN D3 GUMMIES CALCIUM-VITAMIN D3

CALTRATE 600 + D SOFT CHEW TAB CALTRATE 600 + D

CALTRATE 600 PLUS D3 TABLET CALTRATE 600 PLUS D3

CALTRATE GUMMY BITES CALTRATE GUMMY BITES

CHILD FERROUS SULFATE 15 MG/ML CHILDREN’S FERROUSSULFATE


165



CITRACAL + D ER TABLET CITRACAL + D

CITRACAL + D MAXIMUM CAPLET CITRACAL + D MAXIMUM

CITRACAL + D3 GUMMIES CITRACAL + D3

CITRACAL-VIT D 250 MG-200 TAB CITRACAL-VITAMIN D

CITRACAL-VIT D3 200 MG-250 TAB CITRACAL-VITAMIN D3

CITRUS CALCIUM + D TABLET CITRUS CALCIUM + D

CITRUS CALCIUM 200-VIT D3 250 CITRUS CALCIUM-VITAMIN D3

CVS CALCIUM 250-D3 400 GUMMY CALCIUM-VITAMIN D3

CVS CALCIUM 500 + VIT D TABLET CALCIUM 500 + VITAMIN D

CVS CALCIUM 600 MG TABLET CALCIUM

CVS CALCIUM 600-VIT D3 800 TAB CALCIUM 600-VIT D3

CVS CALCIUM CITRATE-VIT D TAB CALCIUM CITRATE-VITAMIN D

CVS CALCIUM CITRATE-VIT D3 TAB CALCIUM CITRATE-VIT D3

CVS IRON 27 MG TABLET IRON

CVS IRON 65 MG TABLET IRON

CVS LAX DIETARY 500 MG CAPLET LAXATIVE DIETARYSUPPLEMENT

CVS MAGNESIUM 500 MG TABLET MAGNESIUM OXIDE

CVS PEDIATRIC ELECTROLYTE POPS PEDIATRIC ELECTROLYTE

CVS PEDIATRIC ELECTROLYTE SOLN PEDIATRIC ELECTROLYTE

CVS SLOW RELEASE IRON TABLET SLOW RELEASE IRON

CVS YOGURT+CALCIUM GUMMIES YOGURT+CALCIUM GUMMIES

ENFAMIL ENFALYTE SOLUTION ENFAMIL ENFALYTE

EQ CALCIUM 500-VIT D3 400 TAB CALCIUM 500-VIT D3

EQ CALCIUM 600-VIT D3 400 TAB CALCIUM 600-VIT D3

EQ CALCIUM CIT 315-VIT D3 250 CALCIUM CITRATE-VITAMIN D3

EQ CALCIUM CITRATE-D TABLET CALCIUM CITRATE-D

EQ SLOW RELEASE IRON 45 MG TAB SLOW RELEASE IRON

EQL CALCIUM 250-D3 400 GUMMY CALCIUM-VITAMIN D3

EQL CALCIUM 600-VIT D3 800 TAB CALCIUM 600-VIT D3

EQL CALCIUM CITRATE-VIT D3 CPT CALCIUM CITRATE-VITAMIN D3

FERROUS GLUCONATE 240 MG TAB FERROUS GLUCONATE

FERROUS GLUCONATE 324 MG TAB FERROUS GLUCONATE

FERROUS SULF 15 MG (IRON)/MLORAL SYRINGE

FERROUS SULFATE

FERROUS SULF 15 MG IRON/ML DRP FERROUS SULFATE

FERROUS SULF 220 MG/5 ML ELIX FERROUS SULFATE

FERROUS SULF 220 MG/5 ML LIQ FERROUS SULFATE

FERROUS SULF 300 MG/5 ML LIQ FERROUS SULFATE

FERROUS SULF 44 MG IRON/5 ML LQ FERROUS SULFATE

FERROUS SULF EC 324 MG TABLET FERROUS SULFATE

FERROUS SULF EC 325 MG TABLET FERROUS SULFATE

FERROUS SULFATE 325 MG TABLET FERROUS SULFATE


166



FERROUS SULFATE ER 140 MG TAB FERROUS SULFATE

FERROUSUL 325 MG TABLET FERROUSUL

FLINTSTONES BONE SUPPRTGUMMIE

FLINTSTONES BONE SUPPORT

GNP CALCIUM 500-VIT D3 600 TAB CALCIUM 500-VIT D3

GNP CALCIUM 600 MG TABLET CALCIUM

GNP CALCIUM 600 MG-D3 800 UNIT CALCIUM 600-VIT D3

GNP CALCIUM CITRATE-VIT D3 TAB CALCIUM CITRATE - VITAMIND3

GNP IRON 65 MG TABLET IRON

GNP MAGNESIUM 250 MG TABLET MAGNESIUM

GNP PEDIATRIC ELECTROLYTE SOLN PEDIATRIC ELECTROLYTE

HEB PEDIATRIC ELECTROLYTE SOLN PEDIATRIC ELECTROLYTE

HM CALCIUM 500-VIT D3 200 CPLT CALCIUM 500-VIT D3

HM CALCIUM 600-VIT D3 400 TAB CALCIUM 600-VIT D3

HM CALCIUM 600-VIT D3 800 TAB CALCIUM 600-VIT D3

HM CALCIUM CITRATE-VIT D CPLT CALCIUM CITRATE-VIT D

HM CALCIUM CITRATE-VIT D3 TAB CALCIUM CITRATE-VIT D3

HM IRON 65 MG TABLET IRON

HM MAGNESIUM 400 MG CAPLET MAGNESIUM

HM PEDIATRIC ELECTROLYTE SOLN PEDIATRIC ELECTROLYTE

HM SLOW RELEASE IRON 45 MG TAB SLOW RELEASE IRON

HM SLOW RELEASE IRON TABLET SLOW RELEASE IRON

IRON 100-VITAMIN C TABLET IRON 100-VITAMIN C

IRON 27 MG TABLET IRON




KRO SLOW RLS IRON 45 MG TABLET SLOW RELEASE IRON

LIQUID CALCIUM 600-VIT D3 SFGL LIQUID CALCIUM 600-VIT D3

LIQUID CALCIUM WITH VITAMIN D LIQUID CALCIUM + VITAMIN D

LIQUID CALCIUM-VIT D SOFTGEL LIQUID CALCIUM-VIT D

MAGNESIUM 250 MG TABLET MAGNESIUM

MAGNESIUM 400 MG CAPS MAGNESIUM

MAGNESIUM 400 MG SOFTGEL MAGNESIUM

MAGNESIUM 400 MG TABLET MAGNESIUM

MAGNESIUM 500 MG SOFTGEL MAGNESIUM

MAGNESIUM 500 MG TABLET MAGNESIUM OXIDE

MAGNESIUM CHELATED 100 MG TAB MAGNESIUM

MAGNESIUM CITRATE 100 MG TAB MAGNESIUM CITRATE

MAGNESIUM OXIDE 250 MG CAPLET MAGNESIUM OXIDE




167




MAGNESIUM OXIDE 500 MGCAPSULE

MAGNESIUM OXIDE


MAGNESIUM-OXIDE 400 MG TABLET MAGNESIUM OXIDE

NATURAL CALCIUM 500 MG TABLET NATURAL CALCIUM

ORALYTE ELECTROLYTE SOLN ORALYTE

ORALYTE FREEZER POPS ORALYTE

ORALYTE SOLUTION ORALYTE

OS-CAL 500-VIT D3 200 CAPLET OS-CAL 500-VIT D3

OS-CAL 500-VIT D3 600 CAPLET OS-CAL 500-VIT D3

OSTEO-PORETICAL TABLET OSTEO-PORETICAL

OYSCO 500-VIT D3 200 TABLET OYSCO 500-VIT D3

OYSTER SHELL 250 MG + VIT D TB OYSTER SHELL CALCIUM W-VIT D

OYSTER SHELL 500-VIT D3 200 TB OYSTER SHELL CALCIUM-VITD3

OYSTER SHELL CALCIUM 500 MG OYSTER SHELL CALCIUM

OYSTER SHELL CALCIUM 500 MG TB OYSTER SHELL CALCIUM

OYSTER SHELL CALCIUM TABLET OYSTER SHELL CALCIUM

OYSTER SHELL CALCIUM-VIT D TAB OYSTER SHELL CALCIUM W-VIT D

OYSTER SHELL+D 250 MG TABLET OYSTER SHELL + D

OYSTERCAL-D 500 MG-400 UNIT TB OYSTERCAL-D

PARVA-CAL 250 TABLET PARVA-CAL 250

PARVA-CAL 500 TABLET PARVA-CAL 500

PEDI ELECTROLYTE FREEZER POP PEDIATRIC ELECTROLYTE

PEDIALYTE ADVANCED CARE SOLN PEDIALYTE ADVANCED CARE

PEDIALYTE ELECTROLYTE SINGLES PEDIALYTE ELECTROLYTESINGLES

PEDIALYTE FREEZER POPS PEDIALYTE

PEDIALYTE SOLUTION PEDIALYTE

PEDIATRIC ELECTROLYTE PWDPACK

PEDIATRIC ELECTROLYTE

PEDIATRIC ELECTROLYTE SOLUTION PEDIATRIC ELECTROLYTE

POLYSACC IRON 150 COMPLEX C POLYSACCHARIDE IRON 150

POSTURE-D CAPLET POSTURE-D

PROSTEON TABLET PROSTEON

QC CALCIUM 600-VIT D3 400 TAB CALCIUM 600-VIT D3

RA CALCIUM 600 MG TABLET CALCIUM

RA CALCIUM 600-VIT D3 400 TAB CALCIUM 600-VIT D3

RA CALCIUM CITRATE - VIT D TAB CALCIUM CITRATE - VITAMIN D

RA CALCIUM CITRATE-VIT D3 TAB CALCIUM CITRATE-VIT D3

RA HI-CAL PLUS VITAMIN D TAB HI-CAL

RA IRON 65 MG TABLET IRON


168



RA MAGNESIUM 500 MG CAPSULE MAGNESIUM

RA OYSTER SHELL 500-VIT D3 200 OYSTER SHELL CALCIUM-VITD3

RA PEDIATRIC ELECTROLYTE SOLN PEDIATRIC ELECTROLYTE

RA PEDIATRIC FREEZER POPS PEDIATRIC FREEZER POPS

RA SLOW RELEASE IRON 45 MG TAB SLOW RELEASE IRON

RISACAL-D TABLET RISACAL-D

SLOW RELEASE IRON 45 MG TAB SLOW RELEASE IRON

SLOW RELEASE IRON 45 MG TABLET SLOW RELEASE IRON

SM CALCIUM 500 MG TABLET CALCIUM

SM CALCIUM 500-VIT D3 200 CPLT CALCIUM 500-VIT D3

SM CALCIUM 500-VIT D3 400 TAB CALCIUM 500-VIT D3

SM CALCIUM 600 MG TABLET CALCIUM

SM CALCIUM 600 TABLET CALCIUM



SM CALCIUM CITRATE-VIT D CPLT CALCIUM CITRATE - VITAMIN D

SM CALCIUM CITRATE-VIT D3 TAB CALCIUM CITRATE-VIT D3

SM CORAL CALCIUM 1,000 MG TAB CORAL CALCIUM

SM IRON 325 MG TABLET IRON

SM IRON 65 MG TABLET IRON

SM MAGNESIUM 250 MG TABLET MAGNESIUM

SM PEDIATRIC ELECTROLYTE SOLN PEDIATRIC ELECTROLYTE

SM SLOW RELEASE IRON 45 MG TAB SLOW RELEASE IRON

SODIUM CHLORIDE 1 GM TABLET SODIUM CHLORIDE

SUPER CALCIUM 600-VIT D3 400 SUPER CALCIUM 600-VIT D3

SV CALCIUM 600 MG TABLET CALCIUM

SV CALCIUM 600-VIT D3 400 TAB CALCIUM 600-VIT D3

SV CALCIUM 600-VIT D3 500 SFGL CALCIUM 600-VIT D3

SV CALCIUM CITRATE-VIT D3 TAB CALCIUM CITRATE - VITAMIND3

SV IRON 65 MG TABLET IRON

SV MAGNESIUM OXIDE 400 MG TAB MAGNESIUM OXIDE

SV SLOW RELEASE IRON 45 MG TAB SLOW RELEASE IRON

THERACAL D2000 TABLET THERACAL

THERACAL D4000 TABLET THERACAL

THERACAL RAPID REPLETION TAB THERACAL

UPCAL D POWDER UPCAL D

UPCAL D POWDER PACKET UPCAL D

V-R CALCIUM 400 + D 133 CAPLET CALCIUM + VIT D

V-R FERROUS SULFATE 325 MG TAB FERROUS SULFATE


169

Mouth and Throat - Non-Opioid Antitussive - Local Anesthetic Combos


CEPACOL SORETHROAT-COUGH LOZ CEPACOL SORETHROAT-COUGH

Nasal Preparations


CHILD SALINE 0.65% NASAL SPRAY CHILDREN’S SALINE NASALSPRAY

CROMOLYN SODIUM NASALSOLUTION

CROMOLYN SODIUM

CROMOLYN SODIUM NASAL SPRAY CROMOLYN SODIUM

CVS SALINE 0.65% NASAL SPRAY SALINE NASAL SPRAY

CVS SALINE 0.65% NOSE SPRAY SALINE NOSE SPRAY

EQ NASAL 0.65% SPRAY NASAL SPRAY

EQL SALINE 0.65% NASAL SPRAY SALINE NASAL SPRAY

GNP NASAL MOIST 0.65% SPRAY NASAL MOISTURIZING

GNP SALINE 0.65% NOSE SPRAY SALINE NASAL SPRAY

GS NASAL MOIST 0.65% SPRAY NASAL MOISTURIZING

HM SALINE 0.65% NASAL SPRAY SALINE NASAL SPRAY

NASAL 0.65% SPRAY NASAL SPRAY

NASAL MOISTURIZING 0.65% SPRAY NASAL MOISTURIZING

PUB SALINE 0.65% NASAL SPRAY SALINE NASAL SPRAY

RA NASAL RLF SINUS WASH REFILL NASAL RELIEF SINUS WASH

RA SALINE 0.65% NASAL SPRAY SALINE NASAL SPRAY

RA SALINE 0.65% NOSE SPRAY SALINE NOSE SPRAY

SALINE 0.65% NASAL SPRAY SALINE NOSE SPRAY

SALINE 0.65% NOSE SPRAY SALINE NASAL SPRAY

SALINE MIST 0.65% NOSE SPRY SALINE MIST

SB SALINE 0.65% NOSE SPRAY SALINE NOSE SPRAY

SM SALINE 0.65% NASAL SPRAY SALINE NASAL SPRAY

SOD. CHLORIDE 0.65% MIST SODIUM CHLORIDE

ULTRA SALINE 0.65% NASAL SPRAY ULTRA SALINE

V-R NASAL ALLERGY SYM SPRAY NASAL ALLERGY SPRAY

V-R SALINE 0.65% NOSE SPRAY SALINE NASAL SPRAY

Nutritional Product - Nutritional Therapy


NUTREN 1.0 LIQUID NUTREN 1.0



PROMOTE LIQUID PROMOTE

REPLETE 1 CAL LIQUID REPLETE



ALLERGY 0.025% EYE DROPS ALLERGY EYE DROPS

CVS ALLERGY 0.025% EYE DROPS ALLERGY EYE DROPS

CVS EYE ITCH RELIEF 0.025% DRP EYE ITCH RELIEF


170



EQ EYE ITCH RELIEF 0.025% DROP EYE ITCH RELIEF

EQ ITCHY EYE 0.025% DROPS ITCHY EYE

EYE ITCH RELIEF 0.025% DROPS EYE ITCH RELIEF

GS ITCHY EYE 0.025% DROPS ITCHY EYE

HM EYE ITCH RELIEF 0.025% DROP EYE ITCH RELIEF

KETOTIFEN FUM 0.025% EYE DROPS KETOTIFEN FUMARATE

KRO EYE ITCH RLF 0.025% DROPS EYE ITCH RELIEF

KRO ITCHY EYE 0.025% DROPS ITCHY EYE

RA EYE ITCH RELIEF 0.025% DROP EYE ITCH RELIEF

SM EYE ITCH RELIEF 0.025% DROP EYE ITCH RELIEF

WAL-ZYR 0.025% EYE DROPS WAL-ZYR

Ophthalmic - Hyperosmolar Agents


CVS SODIUM CHLORIDE 5% EYE DRP SODIUM CHLORIDE

CVS SODIUM CHLORIDE 5% OINT SODIUM CHLORIDE

RA SODIUM CHLORIDE 5% EYE DROP SODIUM CHLORIDE

SOCHLOR 5% EYE OINTMENT SOCHLOR

SODIUM CHLORIDE 5% EYE DROP SODIUM CHLORIDE

SODIUM CHLORIDE 5% EYE OINT SODIUM CHLORIDE

SODIUM CHLORIDE 5% OPHT SOLN SODIUM CHLORIDE



ACID CONTROL 150 MG TABLET ACID CONTROL

ACID REDUCER 150 MG TABLET ACID REDUCER

ACID REDUCER 200 MG TABLET ACID REDUCER

ACID REDUCER DR 20 MG CAP ACID REDUCER


CVS ACID REDUCER 150 MG TABLET ACID REDUCER

CVS CIMETIDINE 200 MG TABLET CIMETIDINE

CVS LANSOPRAZOLE DR 15 MG CAP LANSOPRAZOLE

CVS OMEPRAZOLE DR 20 MGTABLET

OMEPRAZOLE

CVS OMEPRAZOLE MAG DR 20.6 MG OMEPRAZOLE MAGNESIUM

EQ ACID REDUCER 150 MG TABLET ACID REDUCER

EQ ACID REDUCER 200 MG TABLET ACID REDUCER

EQ LANSOPRAZOLE DR 15 MG CAP LANSOPRAZOLE

EQ OMEPRAZOLE DR 20 MG TABLET OMEPRAZOLE

EQ OMEPRAZOLE MAG DR 20.6 MG OMEPRAZOLE MAGNESIUM

EQ RANITIDINE 150 MG TABLET RANITIDINE HCL

EQL ACID REDUCER 150 MG TABLET ACID REDUCER

EQL LANSOPRAZOLE DR 15 MG CAP LANSOPRAZOLE

EQL OMEPRAZOLE DR 20 MG TABLET OMEPRAZOLE

GNP ACID CONTROL 150 MG TABLET ACID CONTROL


171



GNP CIMETIDINE 200 MG TABLET CIMETIDINE

GNP LANSOPRAZOLE DR 15 MG CAP LANSOPRAZOLE

GNP OMEPRAZOLE DR 20 MGTABLET

OMEPRAZOLE

GS ACID REDUCER 150 MG TABLET ACID REDUCER

GS LANSOPRAZOLE DR 15 MG CAP LANSOPRAZOLE

GS OMEPRAZOLE DR 20 MG TABLET OMEPRAZOLE

HEARTBURN RELIEF 150 MG TAB HEARTBURN RELIEF 150

HEARTBURN RELIEF 150 MG TABLET HEARTBURN RELIEF 150

HEARTBURN RELIEF 200 MG TABLET HEARTBURN RELIEF

HM ACID REDUCER 150 MG TABLET ACID REDUCER

HM LANSOPRAZOLE DR 15 MG CAP LANSOPRAZOLE

HM OMEPRAZOLE DR 20 MG TABLET OMEPRAZOLE

KRO ACID REDUCER 200 MG TABLET ACID REDUCER

KRO HEARTBURN RELIEF 150 MG TB HEARTBURN RELIEF

KRO LANSOPRAZOLE DR 15 MG CAP LANSOPRAZOLE

KRO OMEPRAZOLE DR 20 MGTABLET

OMEPRAZOLE

KRO OMEPRAZOLE MAG DR 20.6 MG OMEPRAZOLE MAGNESIUM

LANSOPRAZOLE DR 15 MG CAPSULE LANSOPRAZOLE

OMEPRAZOLE DR 20 MG TABLET OMEPRAZOLE

OMEPRAZOLE MAG DR 20 MG CAP OMEPRAZOLE MAGNESIUM

OMEPRAZOLE MAG DR 20.6 MG CAP OMEPRAZOLE MAGNESIUM

PUB OMEPRAZOLE DR 20 MGTABLET

OMEPRAZOLE

PUB RANITIDINE 150 MG TABLET RANITIDINE HCL

QC OMEPRAZOLE MAG DR 20.6 MG OMEPRAZOLE MAGNESIUM

RA ACID REDUCER 150 MG TABLET ACID REDUCER

RA LANSOPRAZOLE DR 15 MG CAP LANSOPRAZOLE

RA OMEPRAZOLE DR 20 MG TABLET OMEPRAZOLE

RANITIDINE 150 MG TABLET RANITIDINE HCL

SB ACID REDUCER 150 MG TABLET ACID REDUCER

SB OMEPRAZOLE DR 20 MG TABLET OMEPRAZOLE

SM ACID REDUCER 150 MG TABLET ACID REDUCER

SM ACID REDUCER 200 MG TABLET ACID REDUCER

SM HEARTBURN RELIEF 200 MG TAB HEARTBURN RELIEF

SM LANSOPRAZOLE DR 15 MG CAP LANSOPRAZOLE

SM OMEPRAZOLE DR 20 MG TABLET OMEPRAZOLE

SW ACID REDUCER 150 MG TABLET ACID REDUCER 150

SW OMEPRAZOLE DR 20 MG TABLET OMEPRAZOLE

V-R HEARTBURN RELF 200 MG TB HEARTBURN RELIEF

WAL-ZAN 150 MG TABLET WAL-ZAN 150


172



ADULT WAL-TUSSIN DM SYRUP ADULT WAL-TUSSIN DM

ALL DAY ALLERGY-D TABLET ALL DAY ALLERGY-D

ALL-NITE COLD-FLU RELIEF LIQ ALL-NITE COLD-FLU RELIEF

ALLER-TEC D 5-120 MG TABLET ALLER-TEC D

ALLERCLEAR D-12HR TABLET ALLERCLEAR D-12HR

ALLERCLEAR D-24HR ER TABLET ALLERCLEAR D-24HR QL Limited to 30 Tablets per 30 days

ALLERGY CONGESTION RELIEF TAB ALLERGY-CONGESTIONRELIEF


ALLERGY D-12 TABLET ALLERGY D-12

ALLERGY RELIEF D 12-HOUR TAB ALLERGY RELIEF D

ALLERGY RELIEF D-24HR TABLET ALLERGY RELIEF D-24HR QL Limited to 30 Tablets per 30 days

ALLERGY RELIEF-D 12 HOUR TAB ALLERGY RELIEF-D

ALLERGY RELIEF-NASAL DECONG TB ALLERGY RELIEF-NASALDECONGEST


ALLERGY+CONGESTION RELF-D TAB ALLERGY+CONGESTIONRELIEF-D

ALLERGY-CONGES RELF ER TABLET ALLERGY-CONGESTIONRELIEF


ALLERGY-CONGEST RELIEF ER TAB ALLERGY-CONGESTIONRELIEF


ALLERGY-CONGEST RLF-D 24HR TAB ALLERGY-CONGESTIONRELIEF-D


ALLERGY-CONGESTION RLF 12H TAB ALLERGY-CONGESTIONRELIEF 12HR

ALLERGY-CONGESTION RLF-D 12HR ALLERGY-CONGESTIONRELIEF-D

ALLERGY-CONGST RLF-D 60-120 MG ALLERGY-CONGESTIONRELIEF-D

QL Limited to 60 tablets per 30 days

CETIRIZINE-PSE ER 5-120 MG TAB CETIRIZINE-PSEUDOEPHEDRINE ER

CHERATUSSIN AC SYRUP CHERATUSSIN AC

CHERATUSSIN DAC SYRUP CHERATUSSIN DAC

CHILD BENADRYL PLUS CONGSTSOL

CHILD BENADRYL PLUSCONGESTION

CHILDS TRIACTING COLD & COUGH CHILDS TRIACTING COLD &COUGH

CODEINE-GUAIFEN 10-100 MG/5 ML CODEINE-GUAIFENESIN

COLD MULTI-SYMPTOM NIGHT LIQ COLD MULTI-SYMPTOMNIGHTTIME

COLD-FLU RELIEF LIQUID COLD-FLU RELIEF

CONTAC COLD-FLU NIGHT LIQUID CONTAC COLD-FLU NIGHT

CORICIDIN HBP COLD-MULTI SYMPT CORICIDIN HBP COLD-MULTISYMPT

COUGH & SORE THROAT LIQUID COUGH & SORE THROAT

COUGH SYRUP DM COUGH SYRUP DM

CVS ALLERGY RELIEF D-24HR TAB ALLERGY RELIEF D-24HR QL Limited to 30 Tablets per 30 days

CVS ALLERGY RELIEF-D TABLET ALLERGY RELIEF-D


173



CVS ALLERGY RELIEF-D12 TABLET ALLERGY RELIEF-D12

CVS ALLERGY RLF-D 60-120 MG TB ALLERGY RELIEF-D QL Limited to 60 tablets per 30 days

CVS COLD & COUGH NIGHTTIME LIQ COLD & COUGH NIGHTTIME

CVS LORATADINE-D 24HR TABLET LORATADINE-D QL Limited to 30 Tablets per 30 days

CVS NIGHTTIME COLD-FLU RLF LIQ NIGHTTIME COLD-FLU RELIEF

DIMETAPP COLD & CONGEST LIQUID DIMETAPP COLD &CONGESTION

EQ CHILD NIGHT TIME COLD-COUGHLIQUID

CHILD NIGHT TIME COLD &COUGH

EQ NIGHTTIME COLD-FLU RLF LIQ NIGHTTIME COLD-FLU RELIEF

EQ NITETIME COLD-FLU LIQUID NITETIME COLD-FLU

EQ TUSSIN DM COUGH-CHEST SYR TUSSIN DM

EQL ALL DAY ALLERGY-D TABLET ALL DAY ALLERGY-D

EQL ALLERGY-CONGEST RLF ER TAB ALLERGY-CONGESTIONRELIEF


EQL ALLERGY-CONGESTION 12H TAB ALLERGY-CONGESTIONRELIEF 12HR

EQL NIGHT SEVERE COLD-FLU LIQ NIGHTTIME SEVERE COLD-FLU

EQL NIGHTTIME COLD-FLU RLF LIQ NIGHTTIME COLD-FLU RELIEF

EQL TUSSIN DM COUGH-CHEST SYR TUSSIN DM

EXPECTORANT DM COUGH SYRUP EXPECTORANT DM

FEXOFENADINE-PSE ER 60-120 TAB FEXOFENADINE-PSE ER QL Limited to 60 tablets per 30 days

GNP ALL DAY ALLERGY-D TABLET ALL DAY ALLERGY-D

GNP ALLERGY-CONGES RELF ERTAB

ALLERGY-CONGESTIONRELIEF


GNP COLD MULTI-SYMPTOM NIGHT COLD MULTI-SYMPTOMNIGHTTIME

GNP LORATADINE-D 12 HOUR TAB LORATADINE-D

GNP LORATADINE-D 24HR TABLET LORATADINE-D QL Limited to 30 Tablets per 30 days

GNP NIGHT TIME COLD-FLU LIQ NIGHT TIME COLD-FLU

GNP TUSSIN DM CLEAR SYRUP TUSSIN DM CLEAR

GNP TUSSIN DM SYRUP TUSSIN DM

GS NIGHTTIME COLD-FLU LIQUID NIGHTTIME COLD-FLU

GS TUSSIN DM COUGH SYRUP TUSSIN DM

GS TUSSIN DM COUGH-CHEST SOLN TUSSIN DM COUGH-CHESTCONGEST

GS TUSSIN DM LIQUID TUSSIN DM

GUAIFEN-CODEINE 100-10 MG/5 ML GUAIFENESIN-CODEINE

GUAIFEN-CODEINE 200-20 MG/10 ML GUAIFENESIN-CODEINE

GUAIFENESIN DM SYRUP GUAIFENESIN-DEXTROMETHORPHAN

GUAIFENESIN-CODEINE SYRUP GUAIFENESIN-CODEINE

HM ADULT TUSSIN DM SYRUP ADULT TUSSIN DM

HM ALLERGY COMPLETE-D TABLET ALLERGY COMPLETE-D


174



HM ALLERGY RLF-NASAL DECONGTB

ALLERGY RELIEF-NASALDECONGEST


HM ALLERGY-CONGESTION 12HRTAB

ALLERGY-CONGESTION 12HR

HM NIGHT TIME COLD-FLU LIQ NIGHT TIME COLD-FLU

HV ALLERGY-CONGEST RLF ER TAB ALLERGY-CONGESTIONRELIEF


KRO ALLERGY RLF-D 60-120 MG TB ALLERGY RELIEF-D QL Limited to 60 tablets per 30 days

KRO ALLERGY-CONGEST RLF ERTAB

ALLERGY-CONGESTIONRELIEF


KRO ALLERGY-CONGESTION 12HTAB

ALLERGY-CONGESTIONRELIEF 12HR

KRO CHILD NITE TIME COLD & CGH CHILD NITE TIME COLD &COUGH

KRO NITETIME COLD-FLU LIQUID NITETIME COLD-FLU

KRO NITETIME SEVERE COLD-FLU NITETIME SEVERE COLD & FLU

LORATADINE-D 12 HOUR TABLET LORATADINE-D QL Limited to 60 tablets per 30 days

LORATADINE-D 24HR TABLET LORATADINE-D QL Limited to 30 Tablets per 30 days

LORATADINE-PSEUDOEPHED 10-240 LORATADINE-PSEUDOEPHED QL Limited to 30 Tablets per 30 days

MEIJER ALL DAY ALLERGY-D TAB ALL DAY ALLERGY-D

NIGHT TIME COLD-FLU LIQUID NIGHT TIME COLD-FLU

NIGHTTIME COLD-FLU LIQUID NIGHTTIME COLD-FLU

NIGHTTIME SEVERE COLD-FLU LIQ NIGHTTIME SEVERE COLD-FLU

NITE TIME COLD-FLU LIQUID NITE TIME COLD-FLU

NITE-TIME COLD-FLU LIQUID NITE-TIME COLD-FLU

PUB ALLERGY RELIEF D-24HR TAB ALLERGY RELIEF D-24HR QL Limited to 30 Tablets per 30 days

PUB ALLERGY RELIEF-D TABLET ALLERGY RELIEF-D

PUB NITETIME MULTI-SYMPTOM LIQ NITETIME MULTI-SYMPTOM

PUB TUSSIN DM LIQUID TUSSIN DM

QC LORATADINE-D 24HR TABLET LORATADINE-D QL Limited to 30 Tablets per 30 days

RA ALLERGY-CONGESTION 12HRTAB

ALLERGY-CONGESTIONRELIEF 12HR

RA ANTI-TUSSIVE DM SYRUP ANTITUSSIVE DM

RA CETIRI-D ER TABLET CETIRI-D

RA LORATA-D 24-HOUR TABLET LORATA-D QL Limited to 30 Tablets per 30 days

RA NIGHTTIME COLD-FLU RLF LIQ NIGHTTIME COLD-FLU RELIEF

RA TUSSIN DM COUGH-CHESTSYRUP

TUSSIN DM COUGH-CHESTCONGEST

RA TUSSIN DM SYRUP TUSSIN DM

SB COUGH CONTROL DM SYRUP COUGH CONTROL DM

SEVERE COLD-FLU NIGHTTIME LIQ SEVERE COLD-FLU NIGHTTIME

SM ALL DAY ALLERGY-D TABLET ALL DAY ALLERGY-D

SM LORATA-DINE D 24HR TABLET LORATA-DINE D QL Limited to 30 Tablets per 30 days

SM LORATADINE-D 12 HOUR TABLET LORATADINE-D

SM NITE TIME COLD & FLU RELIEF NIGHT TIME COLD-FLU RELIEF


175



SM NITE TIME COLD-FLU LIQUID NITE TIME COLD-FLU

SM TUSSIN CLEAR SYRUP TUSSIN DM CLEAR

SM TUSSIN DM SYRUP TUSSIN DM

SW ALLERGY RELIEF-D TABLET ALLERGY RELIEF-D

TRIAMINIC NIGHTTIME COLD-COUGH TRIAMINIC NIGHTTIME COLD-COUGH

TUSSIN DM CLEAR SYRUP TUSSIN DM CLEAR

TUSSIN DM COUGH SYRUP TUSSIN DM COUGH

TUSSIN DM SYRUP TUSSIN DM

TYLENOL COLD MAX NIGHT LIQUID TYLENOL COLD MAX

VICKS NYQUIL COLD-FLU LIQUID VICKS NYQUIL

VICKS NYQUIL SEVERE COLD-FLU VICKS NYQUIL SEVERE COLD-FLU

WAL-FEX D 12 HOUR 60-120 TAB WAL-FEX D 12 HOUR QL Limited to 60 tablets per 30 days

WAL-FEX D 24 HOUR 180-240 TAB WAL-FEX D 24 HOUR QL Limited to 30 Tablets per 30 days

WAL-ITIN D 12 HOUR TABLET WAL-ITIN D 12 HOUR

WAL-ITIN D 24 HOUR TABLET WAL-ITIN D QL Limited to 30 Tablets per 30 days

WAL-TUSSIN DM CLEAR SYRUP WAL-TUSSIN DM

WAL-TUSSIN DM SYRUP WAL-TUSSIN DM

WAL-ZYR D TABLET WAL-ZYR D

Sedative-Hypnotics


CVS NIGHTTIME SLEEP 25 MG CPLT NIGHTTIME SLEEP AID

CVS NIGHTTIME SLEEP 25 MG SFGL NIGHTTIME SLEEP AID

CVS NIGHTTIME SLEEP AID 50 MG NIGHTTIME SLEEP AID

CVS SLEEP AID 25 MG TABLET SLEEP AID

CVS SLEEP AID 50 MG SOFTGEL SLEEP AID

CVS SLEEP AID CAPLET SLEEP AID

CVS SLEEP AID SOFTGEL SLEEP AID

DIPHENHYDRAMINE 25 MG CAPLET DIPHENHYDRAMINE HCL

EQ NIGHTTIME SLEEP 25 MG CPLT NIGHTTIME SLEEP AID

EQ NIGHTTIME SLEEP AID 50 MG NIGHTTIME SLEEP AID

EQL NIGHTTIME SLEEP 25 MG CPLT NIGHTTIME SLEEP AID

EQL SLEEP AID 50 MG SOFTGEL SLEEP AID

EQL SLEEP AID 50 MG/30 ML LIQ SLEEP AID

GNP NIGHTTIME SLEEP 25 MG CPLT NIGHTTIME SLEEP AID

GNP SLEEP TIME 50 MG/30 ML LIQ SLEEP TIME

GS NIGHTTIME SLEEP AID 25 MG SLEEP AID

GS SLEEP TIME 25 MG SOFTGEL SLEEP TIME

GS SLEEP TIME 50 MG/30 ML LIQ SLEEP TIME

HM NIGHTTIME SLEEP AID 50 MG NIGHTTIME SLEEP AID

HM Z-SLEEP 25 MG SOFTGEL Z-SLEEP

KRO EZ NITE SLEEP 25 MG SFTGL EZ NITE SLEEP


176

Sedative-Hypnotics


KRO NIGHTTIME SLEEP 25 MG CPLT NIGHTTIME SLEEP AID

KRO SLEEP AID 50 MG SOFTGEL SLEEP AID

NIGHT SLEEP AID 50 MG/30 ML LQ NIGHTTIME SLEEP AID

NIGHTTIME SLEEP AID 25 MG CPLT NIGHTTIME SLEEP AID

NIGHTTIME SLEEP AID 25 MG SFGL NIGHTTIME SLEEP AID

ORMIR 50 MG CAPSULE ORMIR

QC NIGHTTIME SLEEP 25 MG TAB NIGHTTIME SLEEP AID

QC SLEEP AID 50 MG SOFTGEL SLEEP AID

RA NIGHTTIME SLEEP 25 MG CPLT NIGHTTIME SLEEP AID

RA NIGHTTIME SLEEP GEL NIGHTTIME SLEEP GEL

RA SLEEP AID 25 MG CAPLET SLEEP AID

RA SLEEP TABLET SLEEP TABLET

RA SLEEP-AID SOFTGEL SLEEP-AID

RESTFULLY SLEEP 25 MG CAPLET RESTFULLY SLEEP

SB SLEEP TABLET SLEEP TABS

SLEEP AID 25 MG CAPLET SLEEP AID

SLEEP AID 25 MG LIQUID GEL SLEEP AID

SLEEP AID 50 MG LIQUIDGEL SLEEP AID

SLEEP AID 50 MG SOFTGEL SLEEP AID

SLEEP AID TABLET SLEEP AID

SLEEP II 25 MG TABLET SLEEP II

SLEEP TIME 50 MG/30 ML LIQUID SLEEP TIME

SLEEPGELS 50 MG SLEEPGELS

SLEEPING 50 MG CAPSULE SLEEPING

SM NIGHTTIME SLEEP 25 MG CPLT NIGHTTIME SLEEP AID

SM SLEEP AID NIGHT TIME CAPLET SLEEP AID

SM SLEEP AID SOFTGEL SLEEP AID

SM Z-SLEEP 25 MG SOFTGEL Z-SLEEP

SM Z-SLEEP 50 MG/30 ML LIQUID Z-SLEEP

WAL-SLEEP Z 25 MG SOFTGEL WAL-SLEEP Z

WAL-SLEEP Z 50 MG/30 ML LIQUID WAL-SLEEP Z

WAL-SOM 50 MG SOFTGEL WAL-SOM



CVS NICOTINE 14 MG/24HR PATCH NICOTINE PATCH

CVS NICOTINE 2 MG CHEWING GUM NICOTINE GUM

CVS NICOTINE 2 MG LOZENGE NICOTINE LOZENGE

CVS NICOTINE 2 MG MINI LOZENGE NICOTINE LOZENGE


CVS NICOTINE 4 MG CHEWING GUM NICOTINE GUM

CVS NICOTINE 4 MG LOZENGE NICOTINE LOZENGE

CVS NICOTINE 4 MG MINI LOZENGE NICOTINE LOZENGE



177



CVS NTS 21 MG/24HR PATCH NTS

EQ NICOTINE 14 MG/24HR PATCH NICOTINE PATCH

EQ NICOTINE 2 MG CHEWING GUM NICOTINE GUM

EQ NICOTINE 2 MG LOZENGE NICOTINE LOZENGE


EQ NICOTINE 4 MG CHEWING GUM NICOTINE GUM

EQ NICOTINE 4 MG LOZENGE NICOTINE LOZENGE


EQL NICOTINE 2 MG CHEWING GUM NICOTINE GUM

EQL NICOTINE 2 MG LOZENGE NICOTINE LOZENGE

EQL NICOTINE 4 MG CHEWING GUM NICOTINE GUM

EQL NICOTINE 4 MG LOZENGE NICOTINE LOZENGE

GNP NICOTINE 2 MG CHEWING GUM NICOTINE GUM

GNP NICOTINE 2 MG LOZENGE NICOTINE LOZENGE

GNP NICOTINE 2 MG MINI LOZENGE NICOTINE LOZENGE

GNP NICOTINE 21 MG/24HR PATCH NICOTINE PATCH

GNP NICOTINE 4 MG CHEWING GUM NICOTINE GUM

GNP NICOTINE 4 MG LOZENGE NICOTINE LOZENGE

GNP NICOTINE 4 MG MINI LOZENGE NICOTINE LOZENGE

HM NICOTINE 14 MG/24HR PATCH NICOTINE PATCH

HM NICOTINE 2 MG CHEWING GUM NICOTINE GUM

HM NICOTINE 2 MG LOZENGE NICOTINE LOZENGE


HM NICOTINE 4 MG CHEWING GUM NICOTINE GUM

HM NICOTINE 4 MG LOZENGE NICOTINE LOZENGE


KRO NICOTINE 14 MG/24HR PATCH NICOTINE PATCH

KRO NICOTINE 2 MG CHEWING GUM NICOTINE GUM

KRO NICOTINE 2 MG LOZENGE NICOTINE LOZENGE

KRO NICOTINE 2 MG MINI LOZENGE NICOTINE LOZENGE


KRO NICOTINE 4 MG CHEWING GUM NICOTINE GUM

KRO NICOTINE 4 MG LOZENGE NICOTINE LOZENGE

KRO NICOTINE 4 MG MINI LOZENGE NICOTINE LOZENGE


LDR NICOTINE 2 MG CHEWING GUM NICOTINE GUM

LDR NICOTINE 4 MG CHEWING GUM NICOTINE GUM

NICOTINE 14 MG/24HR PATCH NICOTINE PATCH

NICOTINE 2 MG CHEWING GUM NICOTINE GUM

NICOTINE 2 MG LOZENGE NICOTINE LOZENGE

NICOTINE 2 MG MINI LOZENGE NICOTINE LOZENGE




178



NICOTINE 4 MG CHEWING GUM NICOTINE GUM

NICOTINE 4 MG LOZENGE NICOTINE LOZENGE

NICOTINE 4 MG MINI LOZENGE NICOTINE LOZENGE


NICOTINE TRANSDERMAL SYSTEM NICOTINE PATCH

PUB STOP SMOKING AID 2 MG LOZG STOP SMOKING AID

PUB STOP SMOKING AID 4 MG LOZG STOP SMOKING AID

QUIT 2 MG CHEWING GUM QUIT 2

QUIT 2 MG LOZENGE QUIT 2

QUIT 4 MG CHEWING GUM QUIT 4

QUIT 4 MG LOZENGE QUIT 4

RA NICOTINE 14 MG/24HR PATCH NICOTINE PATCH

RA NICOTINE 2 MG CHEWING GUM NICOTINE GUM

RA NICOTINE 2 MG LOZENGE NICOTINE LOZENGE

RA NICOTINE 2 MG MINI LOZENGE NICOTINE LOZENGE


RA NICOTINE 4 MG CHEWING GUM NICOTINE GUM

RA NICOTINE 4 MG LOZENGE NICOTINE LOZENGE

RA NICOTINE 4 MG MINI LOZENGE NICOTINE LOZENGE


SM NICOTINE 14 MG/24HR PATCH NICOTINE PATCH

SM NICOTINE 2 MG CHEWING GUM NICOTINE GUM

SM NICOTINE 2 MG LOZENGE NICOTINE LOZENGE


SM NICOTINE 4 MG CHEWING GUM NICOTINE GUM

SM NICOTINE 4 MG LOZENGE NICOTINE LOZENGE


SW NICOTINE 2 MG CHEWING GUM NICOTINE GUM

SW NICOTINE 2 MG LOZENGE NICOTINE LOZENGE

SW NICOTINE 4 MG CHEWING GUM NICOTINE GUM

SW NICOTINE 4 MG LOZENGE NICOTINE LOZENGE

Urinary Analgesics


CVS URINARY PAIN RLF 95 MG TAB URINARY PAIN RELIEF

EQ URINARY PAIN RLF 95 MG TAB URINARY PAIN RELIEF

GNP URINARY PAIN RLF 95 MG TAB URINARY PAIN RELIEF

GNP URINARY PAIN RLF 97.5 MG URINARY PAIN RELIEF

PHENAZOPYRIDINE 95 MG TABLET PHENAZOPYRIDINE HCL

RA URINARY PAIN RLF 95 MG TAB URINARY PAIN RELIEF

SB URINARY PAIN RLF 97.5 MG TB URINARY PAIN RELIEF

SM URINARY PAIN REL 97.5 MG TB URINARY PAIN RELIEF

SM URINARY PAIN RLF 95 MG TAB URINARY PAIN RELIEF

URINARY PAIN RELIEF 95 MG TAB URINARY PAIN RELIEF


179

Urinary Analgesics


URINARY PAIN RELIEF 97.5 MG TB URINARY PAIN RELIEF

V-R URINARY PAIN RLF 95 MG TAB URINARY PAIN RELIEF

Vaginal Anti-infectives


3-DAY VAGINAL CREAM 3-DAY VAGINAL CREAM

CLOTRIM 1% VAGINAL CREAM CLOTRIMAZOLE

CLOTRIMAZOLE 1% CREAM CLOTRIMAZOLE

CLOTRIMAZOLE 3 2% CREAM CLOTRIMAZOLE-3

CLOTRIMAZOLE INSERT CLOTRIMAZOLE

CLOTRIMAZOLE-3 CREAM CLOTRIMAZOLE-3

CLOTRIMAZOLE-7 CREAM CLOTRIMAZOLE-7

CVS 3-DAY VAGINAL CREAM 3-DAY VAGINAL CREAM

CVS MEDICATE DISPOSABLEDOUCHE

MEDICATED DOUCHE

CVS MICONAZOLE 7 CREAM MICONAZOLE 7

EQ MICONAZOLE 7 CREAM MICONAZOLE 7

EQ MICONAZOLE NITRATE 2% CRM MICONAZOLE NITRATE

EQL MICONAZOLE 7 CREAM MICONAZOLE 7

GNP CLOTRIMAZOLE-3 CREAM CLOTRIMAZOLE-3

GNP MICONAZOLE 7 CREAM MICONAZOLE 7

GYNE-LOTRIMIN 3 DAY 2% CRM GYNE-LOTRIMIN

GYNE-LOTRIMIN-7 1% CREAM GYNE-LOTRIMIN-7

KRO MICONAZOLE 7 CREAM MICONAZOLE 7

MICONAZOLE 100 MG VAG SUPP MICONAZOLE NITRATE

MICONAZOLE 7 100 MG VAG SUPP MICONAZOLE 7

MICONAZOLE 7 CREAM MICONAZOLE 7

MICONAZOLE NITRATE 2% CREAM MICONAZOLE NITRATE

MONISTAT 7 CREAM MONISTAT 7

POVIDONE-IODINE DOUCHE POVIDONE-IODINE

QC MICONAZOLE 7 CREAM MICONAZOLE 7

RA CLOTRIMAZOLE 1% CREAM CLOTRIMAZOLE

RA FEMININE CARE DOUCHE FEMININE CARE DOUCHE

RA MICONAZOLE 7 CREAM MICONAZOLE 7

SB DISP DOUCHE EXTRA CLNS V&W DISP DOUCHE EXTRA CLNSV&W

SM 3-DAY VAGINAL CREAM 3-DAY VAGINAL CREAM

SM CLOTRIMAZOLE 1% CREAM CLOTRIMAZOLE

SM MICONAZOLE 7 100 MG VAG SUP MICONAZOLE 7

SM MICONAZOLE 7 CREAM MICONAZOLE 7

SM MICONAZOLE NITRATE 2%CREAM

MICONAZOLE NITRATE


180



A THRU Z ADVANCED FORMULA TAB A THRU Z

A THRU Z SELECT MULTIVIT TAB A THRU Z SELECT

A THRU Z SELECT TABLET A THRU Z SELECT

ABDEK MULTIVITAMIN CHEW TAB ABDEK MULTIVITAMIN

ABDEK MULTIVITAMIN DROP ABDEK MULTIVITAMIN

ADULT ONE DAILY MULTIVIT TAB ADULT ONE DAILYMULTIVITAMIN

ALIVE PRENATAL GUMMY ALIVE PRENATAL

ANIMAL CHEWS TABLET ANIMAL CHEWS

ANIMAL SHAPES TABLET CHEW ANIMAL SHAPES

AQUADEKS PEDIATRIC LIQUID AQUADEKS

B COMPLEX FORMULA #1 TABLET B COMPLEX # 1

B COMPLEX TABLET VITAMIN B COMPLEX

B-COMPLEX WITH B12 TABLET VITAMIN B COMPLEX

BABY IRON-MULTIVITAMIN DROP BABY IRON-MULTIVITAMIN

BALANCED B-100 TABLET BALANCED B-100

BALANCED B-50 TABLET SA BALANCED B-50

BRAINSTRONG PRENATAL COMBOPAC

BRAINSTRONG PRENATAL

CENTRUM KIDS CHEW TAB CENTRUM KIDS

CENTRUM SPECIALIST PRENATAL CENTRUM SPECIALISTPRENATAL

CENTURY TABLET CENTURY

CENTURY ULTIMATE WOMEN’S TAB CENTURY ULTIMATE WOMEN’S

CEROVITE JR TABLET CHEW CEROVITE JR

CEROVITE SENIOR TABLET CEROVITE SENIOR

CHEW-VITES-IRON TABLET CHEW CHEWABLE-VITE WITH IRON

CHILD CHEW + IRON TAB CHEW CHILD CHEW + IRON

CHILD CHEW VITAMIN TABLET CHILD CHEW VITAMIN

CHILD MULTIVITAMIN PLUS IRON CHILD MULTIVITAMIN PLUSIRON

CHILD MULTIVITAMINS TAB CHEW CHILD MULTIVITAMINS

CHILD VITAMIN-IRON TAB CHEW CHILDREN’S VITAMINS WITHIRON

CHILD’S CHEW MULTIVIT W/IRON CHILDREN’S CHEW MULTIVIT-IRON

CHILD’S CHEW VITAMIN-IRON TAB CHILDREN’S CHEW VITAMIN-IRON

CHILD’S CHEWABLE MULTIVIT TAB CHILDREN’S CHEWABLEMULTIVITMN

CHILD’S CHEWABLE VITAMIN TAB CHILDREN’S CHEWABLEVITAMIN

CHILD’S OMEGA-3 DHA MULTIVITAM CHILD’S OMEGA-3 DHAMULTIVITAM

CHILDREN MULTIVITAMIN CHEW TAB CHILDREN’S MULTIVITAMIN

CHILDREN MULTIVITAMIN GUMMIES CHILDREN’S MULTIVITAMIN


181



CHILDREN’S CHEWABLE VITAMIN CHILDREN’S CHEWABLEVITAMIN

CHILDREN’S CHEWABLES CHILDREN’S CHEWABLE

CHILDREN’S MULTI-VIT GUMMIES CHILDREN’S MULTI-VITGUMMIES

CHILDRENS CHEW VITAMIN TAB CHILDREN’S CHEWABLEVITAMIN

CHILDRENS MULTIVIT TAB CHEW CHILDREN’S CHEWABLEVITAMIN

CHILDRENS VIT-IRON TAB CHEW CHILDREN’S VITAMINS WITHIRON

CHOICEFUL VITAMINS CHEW TABLET CHOICEFUL VITAMINS

CHOICEFUL VITAMINS SOFTGEL CHOICEFUL VITAMINS

CLASSIC PRENATAL TABLET CLASSIC PRENATAL

COMPLETE MULTI 50+ TABLET COMPLETE MULTI 50+

COMPLETE MULTI TABLET COMPLETE MULTI

COMPLETE MULTIVITAMIN TAB COMPLETE MULTIVITAMIN

CVS BAL B-100 TABLET BAL B-100

CVS BAL B-50 TABLET BAL B-50

CVS CHILD CHEW VITAMNCOMPLETE

CHILD CHEWABLE VITAMNCOMPLETE

CVS CHILD GUMMY DINOS GUMMIES GUMMY DINOS

CVS CHILD VIT-MINERAL TAB CHILD VITAMIN WITHMINERALS

CVS CHILD’S VITAMIN-IRON TB CHILD’S VITAMIN WITH IRON

CVS DAILY MULTIPLE TABLET DAILY MULTIPLE VITAMIN

CVS DAILY VIT-IRON-CAL TAB MULTIVITAMINS W-CALCIUM-IRON

CVS GUMMY DINOS GUMMIES GUMMY DINOS

CVS GUMMY DINOS VITAMIN GUMMY DINOS

CVS HAIR, SKIN AND NAILS CPLT HAIR, SKIN AND NAILS

CVS KIDS’ MULTIVITAMIN GUMMY GUMMY

CVS MEN’S MULTI-VIT TABLET MEN’S MULTI-VITAMIN

CVS PRENATAL GUMMY VITAMINS PRENATAL

CVS PRENATAL MULTI-DHA SOFTGEL PRENATAL MULTI-DHA

CVS PRENATAL VITAMIN TABLET PRENATAL VITAMINS

CVS SPECTRAVITE ADVANCED TAB SPECTRAVITE ADVANCEDFORMULA

CVS SPECTRAVITE SENIOR TABLET SPECTRAVITE SENIOR

CVS SPECTRAVITE ULTRA WOMENTB

SPECTRAVITE ULTRA WOMEN

CVS WOMEN’S PRENATAL + DHA WOMEN’S PRENATAL + DHA

DAILY MULTI VITAMIN-IRON TAB MULTIVITAMINS WITH IRON

DAILY MULTIPLE TABLET DAILY MULTIPLE

DAILY MULTIPLE VITAMIN TABLET DAILY MULTIPLE VITAMIN

DAILY MULTIVIT-MINERALS TAB MULTIVITAMINS WITHMINERALS


182



DAILY MULTIVITAMIN-IRON TABLET DAILY MULTIVITAMIN-IRON

DAILY PRENATAL COMBO PACK DAILY PRENATAL

DEKAS PLUS LIQUID DEKAS PLUS

DINO-LIFE EXTRA C TAB CHEW DINO-LIFE WITH EXTRA C

DINO-LIFE IRON-ZINC TAB CHEW DINO-LIFE

DINO-LIFE TABLET CHEWABLE DINO-LIFE

EMERGEN-C KIDZ 250 MG PACKET EMERGEN-C KIDZ

EQ CHILD COMPLETE CHEW TABLET CHILD COMPLETEMULTIVITAMIN

EQ CHILD MULTIVITAMIN GUMMIES CHILDREN’S MULTIVITAMIN

EQ COMPLETE MULTIVITAMIN TAB COMPLETE MULTIVITAMIN

EQL B COMPLEX 50 TABLET VITAMIN B COMPLEX

EQL ONE DAILY MEN’S TABLET MEN’S ONE DAILY

ESCAVITE D TABLET CHEWABLE ESCAVITE D

ESCAVITE LQ DROPS ESCAVITE LQ

ESCAVITE TABLET CHEWABLE ESCAVITE

EXPECTA PRENATAL COMBO PACK EXPECTA PRENATAL

FLINTSTONES + CALCIUM TAB FLINTSTONES PLUS CALCIUM

FLINTSTONES COMPLETE CHEW TAB FLINTSTONES COMPLETE

FLINTSTONES COMPLETE GUMMIES FLINTSTONES COMPLETE

FLINTSTONES COMPLETE TABLET FLINTSTONES COMPLETE

FLINTSTONES EXTRA C GUMMIES FLINTSTONES WITH EXTRA C

FLINTSTONES EXTRA C TAB CHEW FLINTSTONES WITH EXTRA C

FLINTSTONES GUMMIES CHEW TAB FLINTSTONES

FLINTSTONES MULTI-VIT GUMMIES FLINTSTONES MULTI-VITGUMMIES

FLINTSTONES MULTIVIT CHEW TAB FLINTSTONES

FLINTSTONES SOUR-GUM CHEW TAB FLINTSTONES

FLINTSTONES TAB CHEW FLINTSTONES

FLINTSTONES TABLET CHEWABLE FLINTSTONES

FLINTSTONES WITH IRON TAB CHEW FLINTSTONES WITH IRON

FLORIVA 0.25 MG CHEW TABLET FLORIVA

FLORIVA 0.5 MG CHEWABLE TABLET FLORIVA

FLORIVA 1 MG CHEWABLE TABLET FLORIVA

FLORIVA PLUS 0.25 MG/ML DROP FLORIVA PLUS

FLORIVA PLUS 0.25 MG/ML DROPS FLORIVA PLUS

FRUITY VITAMINS TABLET CHEW FRUITY VITAMIN

GNP ANIMAL SHAPES TABLET CHEW ANIMAL SHAPES

GNP CENTURY TABLET CENTURY

GNP CENTURY ULTIMATE WOMENTAB

CENTURY ULTIMATE WOMEN’S

GNP CHILDREN’S CHEWABLES CHILDREN’S CHEWABLES

GNP DAILY PRENATAL COMBO PACK DAILY PRENATAL

GNP ONE DAILY ESSENTIAL TABLET ONE DAILY ESSENTIAL


183



GNP ONE DAILY MAXIMUM TABLET ONE DAILY MAXIMUM

GNP ONE DAILY PLUS IRON TABLET ONE DAILY PLUS IRON

GNP PRENATAL VITAMINS TABLET PRENATAL VITAMINS

GNP ZOO CHEWS GUMMIE TABLET ZOO CHEWS

GS PRENATAL VITAMINS TABLET PRENATAL VITAMINS

GUMMI BEAR MULTIVIT TAB CHEW GUMMI BEAR MULTIVITAMIN

GUMMIES CHILDREN MULTIVITAMIN GUMMIES CHILDRENMULTIVITAMIN

GUMMIES GIRLS’ MULTIVITAMINS GUMMIES GIRLS’MULTIVITAMINS

HI-B COMPLEX TABLET HI B COMPLEX

HM ANIMAL SHAPES COMPLETECHEW

ANIMAL SHAPES COMPLETE

HM COMPLETE MULTI-VIT-MINERAL COMPLETE MULTI-VIT-MINERAL

HM COMPLETE WOMEN TABLET COMPLETE WOMEN

HM HAIR, SKIN AND NAILS CAPLET HAIR, SKIN AND NAILS

HM ONE DAILY ESSENTIAL TABLET ONE DAILY ESSENTIAL

HM ONE DAILY PRENATAL COMBOPK

ONE DAILY PRENATAL

HM ONE DAILY WITH IRON TABLET ONE DAILY WITH IRON

HM PRENATAL TABLET PRENATAL

HONEY BEARS CHEW TAB HONEY BEARS

HONEY BEARS IRON-ZINC TAB CHEW HONEY BEARS

HONEY BEARS-IRON-ZINC TAB CHEW HONEY BEARS

INFANT-TODDLER MULTIVIT DROP INFANT-TODDLERMULTIVITAMIN

INFANT-TODDLER MULTIVIT-IRON INFANT-TODDLER MULTIVIT-IRON

INFANT-TODDLER TRI-VIT DROP INFANT-TODDLER TRI-VITAMIN

KIDS COD LIVER OIL +D TAB CHEW KIDS COD LIVER OIL +D

KIDS MULTIVIT-MINERALS GUMMIES KIDS MULTIVITAMIN-MINERALS

KIDS MULTIVITAMIN COMPLETE TAB KIDS MULTIVITAMINCOMPLETE

KIDSTART CHEWABLE TABLET KIDSTART

KPN PRENATAL TABLET KPN

KPN TABLET KPN

KRO PRENATAL VITAMINS TABLET PRENATAL VITAMINS

LITTLE ANIMALS CHILD TB CHW CHILD LITTLE ANIMALSVITAMINS

LITTLE ANIMALS-IRON TAB CHEW LITTLE ANIMALS PLUS IRON

LYSIPLEX PLUS LIQUID LYSIPLEX PLUS

MEGA MULTIVITAMIN-MINERAL TAB MEGA MULTIVITAMIN WITHMINERAL

MILLTRIUM SENIOR MULTIVIT TAB MILLTRIUM SENIOR

MINI PRENATAL TABLET MINI PRENATAL


184



MTERYTI COMBO PACK MTERYTI

MTERYTI FOLIC 5 COMBO PACK MTERYTI FOLIC 5

MULTI-DAY VITAMIN TABLET MULTI-DAY VITAMINS

MULTI-VIT W-FLUOR 0.25 MG/ML MULTI-VITAMIN W-FLUORIDE

MULTI-VIT W-FLUOR 0.5 MG/ML MULTI-VITAMIN W-FLUORIDE

MULTI-VITAMIN GUMMIES MULTI-VITAMIN

MULTIPLE VITAMIN PLAIN TAB MULTIPLE VITAMINS

MULTIPLE VITAMIN TABLET MULTIPLE VITAMINS

MULTIPLE VITAMIN W-MINERALS TB MULTIPLE VITAMIN

MULTIPLE VITAMIN WITH IRON TAB MULTIVITAMINS WITH IRON

MULTIPLE VITAMINS TABLET MULTIPLE VITAMINS

MULTIVIT & FLUOR 0.5 MG/ML DRP MULTIVITAMIN AND FLUORIDE

MULTIVIT WITH IRON TAB CHEW MULTIVITAMINS WITH IRON

MULTIVIT-FLUOR 0.25 MG TAB CHW MULTIVITAMIN WITH FLUORIDE

MULTIVIT-FLUOR 0.25 MG/ML DROP MULTIVITAMINS WITHFLUORIDE

MULTIVIT-FLUOR 0.5 MG TAB CHEW MULTIVITAMIN WITH FLUORIDE

MULTIVIT-FLUOR 0.5 MG TAB CHW MULTI-VITAMIN WITHFLUORIDE

MULTIVIT-FLUOR 0.5 MG/ML DROP MULTIVITAMINS WITHFLUORIDE

MULTIVIT-FLUOR-IRON 0.25 MG/ML MULTI-VITAMIN W-FLUORIDE-IRON

MULTIVIT-FLUORIDE 1 MG TAB CHW MULTIVITAMIN WITH FLUORIDE

MULTIVIT-IRON CHILD TAB CHEW CHILDREN’S MULTIVITAMIN-IRON

MULTIVIT-IRON-FL 0.25 MG/ML MULTIVITAMINS W-FLUORIDE-IRON

MULTIVIT-IRON-FLUOR 0.25 MG/ML MULTIVITAMIN-IRON-FLUORIDE

MULTIVIT-MINERALS TABLET MULTIVITAMINS WITHMINERALS

MULTIVITAMIN CHILD TAB CHEW CHILDREN’S MULTIVITAMINS

MULTIVITAMIN-CALCIUM-IRON TAB MULTIVITAMINS W-CALCIUM-IRON

MULTIVITAMINS CHEWABLESTABLET

MULTIVITAMINS-A,B,D,E,K,ZN

MULTIVITAMINS PEDIATRIC DROPS MULTIVITAMINS-A,B,D,E,K,ZN

MULTIVITAMINS TABLET MULTIVITAMINS

MULTIVITAMINS-IRON TABLET MULTIVITAMINS WITH IRON

MVC-FLUORIDE 0.25 MG TAB CHEW MVC-FLUORIDE

MVC-FLUORIDE 0.5 MG TAB CHEW MVC-FLUORIDE

MVC-FLUORIDE 1 MG TAB CHEW MVC-FLUORIDE

MVW COMPLETE FORM MULTIVISFGL

MVW COMPLETE FORMULTNMULTIVIT

MVW COMPLETE FORM MULTIVITCHW

MVW COMPLETE FORMULTNMULTIVIT


185



MVW COMPLETE FORMUL D3000CHEW

MVW COMPLETEFORMULATION D3000

MVW COMPLETE FORMUL D3000SFGL


MVW COMPLETE FORMUL D5000SFGL


MVW COMPLETE FORMUL PEDIADRPS

MVW COMPLETE FORMLTNPEDIATRIC

NANO VM 1-3 POWDER NANO VM 1-3

NANO VM 4-8 POWDER NANO VM 4-8

NANOVM 9-18 POWDER NANOVM 9-18

NANOVM T/F POWDER NANOVM T/F

NOVAFERRUM PED MULTIVIT-IRON NOVAFERRUM PEDIATRIC

O-CAL FA TABLET O-CAL FA

OBTREX DHA COMBO PACK OBTREX DHA

ONCE DAILY TABLET ONCE DAILY

ONCE DAILY WITH IRON TABLET ONE DAILY WITH IRON

ONE A DAY PRENATAL DHA PACK ONE A DAY WOMEN’SPRENATAL DHA

ONE DAILY ESSENTIAL TABLET ONE DAILY ESSENTIAL

ONE DAILY FOR WOMEN TABLET ONE DAILY FOR WOMEN

ONE DAILY MAXIMUM TABLET ONE DAILY MAXIMUM

ONE DAILY MULTIVITAMIN-IRON TB ONE DAILY MULTIVITAMIN-IRON

ONE DAILY PLUS IRON TABLET ONE DAILY PLUS IRON

ONE DAILY TABLET ONE DAILY WITH IRON

ONE DAILY WOMEN’S TABLET ONE DAILY WOMEN’S

ONE DAILY WOMENS 50 PLUS TAB ONE DAILY WOMENS 50 PLUS

ONE-A-DAY KID’S GUMMIES ONE-A-DAY KID’S

ONE-A-DAY PRENATAL 1 DHA SFGL ONE-A-DAY WOMEN’SPRENATAL 1

ONE-A-DAY TEEN HIM VITACRAVES ONE-A-DAY TEEN HIMVITACRAVES

P-D NATAL PLUS-FOLIC ACID TAB P-D NATAL PLUS WITH FOLICACID

PEDIA POLY-VITE DROPS PEDIA POLY-VITE

PEDIA POLY-VITE WITH IRON DROP PEDIA POLY-VITE WITH IRON

PEDIA TRI-VITE DROP PEDIA TRI-VITE

PERRY PRENATAL CAPSULE PERRY PRENATAL

PHARMACIST MULTI-VITE TAB PHARMACIST FAVORITE MULTI-VITE

POLY-VI-FLOR 0.25 MG DROPS POLY-VI-FLOR

POLY-VI-FLOR 0.25 MG TAB CHEW POLY-VI-FLOR

POLY-VI-FLOR 0.5 MG TAB CHEW POLY-VI-FLOR

POLY-VI-FLOR 1 MG TAB CHEW POLY-VI-FLOR

POLY-VI-FLOR WITH IRON 0.25 MG POLY-VI-FLOR WITH IRON


186



POLY-VI-FLOR WITH IRON 0.5 MG POLY-VI-FLOR WITH IRON

POLY-VI-SOL DROPS POLY-VI-SOL

POLY-VI-SOL WITH IRON DROPS POLY-VI-SOL WITH IRON

POLY-VITA DROPS POLY-VITA

POLY-VITA WITH IRON DROPS POLY-VITA WITH IRON

POLY-VITAMIN DROPS POLY-VITAMIN

POLY-VITAMIN TAB CHEW POLY-VITAMIN

POLYVIT-FLUOR 0.25 MG/ML DROP POLYVITAMINS-FLUORIDE

POLYVITAMIN W-IRON DROPS POLYVITAMIN WITH IRON

POLYVITAMIN WITH IRON TAB CHEW POLYVITAMIN WITH IRON

PRENATAL + DHA COMBO PACK PRENATAL + DHA

PRENATAL 19 CHEWABLE TABLET PRENATAL 19

PRENATAL 19 TABLET PRENATAL 19

PRENATAL CAPLET PRENATAL

PRENATAL COMPLETE CAPLET PRENATAL COMPLETE

PRENATAL DHA+COMPLETEPRENATAL

PRENATAL DHA+COMPLETEPRENATAL

PRENATAL FORMULA TABLET PRENATAL FORMULA

PRENATAL FORMULA-DHA SOFTGEL PRENATAL FORMULA-DHA

PRENATAL GUMMIES PRENATAL

PRENATAL MULTI + DHA SOFTGEL PRENATAL MULTI + DHA

PRENATAL MULTI-DHA SOFTGEL PRENATAL MULTI-DHA

PRENATAL MULTIVITAMIN TABLET PRENATAL MULTIVITAMIN

PRENATAL MULTIVITAMIN-DHA SFGL PRENATAL MULTIVITAMIN-DHA

PRENATAL ONE DAILY TABLET PRENATAL ONE DAILY

PRENATAL ONE TABLET PRENATAL ONE

PRENATAL PLUS-DHA COMBO PACK PRENATAL PLUS-DHA

PRENATAL TABLET PRENATAL

PRENATAL VITAMIN FORMULA TB PRENATAL VITAMINS

PRENATAL VITAMIN TABLET PRENATAL VITAMIN

PRENATAL VITAMINS TABLET PRENATAL VITAMINS

PRENATAL-1 CAPSULE PRENATAL-1

PUB MULTIVITAMIN 50 PLUS TAB MULTIVITAMIN 50 PLUS

QC PRENATAL TABLET PRENATAL

QUFLORA 0.125 MG GUMMIES QUFLORA

QUFLORA FE 0.25 MG CHEW TABLET QUFLORA FE

QUFLORA FE PED 0.25 MG/ML DROP QUFLORA FE

QUFLORA PED 0.25 MG CHEW TAB QUFLORA

QUFLORA PED 0.25 MG/ML DROP QUFLORA

QUFLORA PED 0.5 MG CHEW TAB QUFLORA

QUFLORA PED 0.5 MG/ML DROP QUFLORA

QUFLORA PED 1 MG CHEW TAB QUFLORA

RA B-COMPLEX TABLET B COMPLEX


187



RA B-COMPLEX-VITAMIN B-12 TAB VITAMIN B COMPLEX

RA BALANCED B-50 TABLET BALANCED B-50

RA CENTRAL-VITE TABLET CENTRAL-VITE

RA CHILD COMPLETE CHEWABLE VIT CHILD COMPLETE CHEWABLEVITAMN

RA ONE DAILY ENERGY TABLET ONE DAILY ENERGY

RA ONE DAILY ESSENTIAL TABLET ONE DAILY ESSENTIAL

RA ONE DAILY MAXIMUM TABLET ONE DAILY MAXIMUM

RA ONE DAILY PRENATAL DHA PACK ONE DAILY PRENATAL

RA PRENATAL FORMULA TABLET PRENATAL FORMULA

RA PRENATAL TABLET PRENATAL VITAMINS

RIGHT STEP PRENATAL VIT TAB RIGHT STEP PRENATALVITAMINS

SCOOBY-DOO ONE A DAY GUMMIES SCOOBY-DOO

SCOOBY-DOO ONE A DAY TABLET SCOOBY-DOO

SENTRY MULTIVIT & MINERAL CPLT SENTRY

SENTRY SENIOR MULTIVIT CAPLET SENTRY SENIOR

SIMILAC PRENATAL COMBO PACK SIMILAC PRENATAL

SM ANIMAL SHAPES COMPLETECHEW

ANIMAL SHAPES COMPLETE

SM ANIMAL SHAPES TAB CHEW MULTIVITAMINS

SM ANIMAL SHAPES W-IRON TAB ANIMAL SHAPES PLUS IRON

SM BALANCED B-50 TABLET BALANCED B-50

SM COMPLETE ADVANCED TABLET COMPLETE

SM COMPLETE MULTI-VIT-MINERAL COMPLETE MULTI-VIT-MINERAL

SM HAIR, SKIN AND NAILS CAPLET HAIR, SKIN AND NAILS

SM MULTIPLE VITAMIN WOMENS TAB MULTIPLE VITAMINS FORWOMEN

SM MULTIVITAMIN W-IRON TAB MULTIVITAMINS WITH IRON

SM MULTIVITAMINS TABLET MULTIVITAMINS

SM ONE DAILY PRENATAL COMBOPK

ONE DAILY PRENATAL

SM PRENATAL TABLET PRENATAL

SM PRENATAL VITAMINS TABLET PRENATAL VITAMINS

SM THERAPEUTIC M TABLET THERAPEUTIC M

STRESS B TABLET STRESS B

STUART ONE CAPSULE STUART ONE

SV PRENATAL TABLET PRENATAL

TEXAVITE LQ DROPS TEXAVITE LQ

THERA-M CAPLET THERA-M

THERANATAL COMPLETE COMBO THERANATAL COMPLETE

THERANATAL CORE NUTRITION TAB THERANATAL

THERANATAL ONE SOFTGEL THERANATAL ONE

THERANATAL OVAVITE COMBO PACK THERANATAL OVAVITE


188



THERANATAL PLUS COMBO PACK THERANATAL PLUS

THERAPEUTIC M TABLET THERAPEUTIC M

THERATRUM COMP 50 PLUS TAB THERATRUM COMPLETE 50PLUS

THERATRUM COMPL 50 PLUS TAB THERATRUM COMPLETE 50PLUS

THRIVITE 19 TABLET THRIVITE 19

TRI-VI-FLOR 0.25 MG DROPS TRI-VI-FLOR

TRI-VI-FLOR 0.5 MG DROPS TRI-VI-FLOR

TRI-VI-SOL DROPS TRI-VI-SOL

TRI-VIT-FLUOR 0.25 MG/ML DROP TRI-VITAMIN WITH FLUORIDE

TRI-VIT-FLUOR 0.5 MG/ML DROP TRI-VITAMIN WITH FLUORIDE

TRI-VIT-FLUOR-IRON 0.25 MG/ML TRI-VIT WITH FLUORIDE-IRON

TRI-VITA DROPS TRI-VITA

TRI-VITAMIN DROPS TRI-VITAMIN

TRI-VITE-FLUORIDE 0.25 MG/ML TRI-VITE WITH FLUORIDE

TRI-VITE-FLUORIDE 0.5 MG/ML TRI-VITE WITH FLUORIDE

TRIPLE-VIT W-FLUOR 0.25 MG/ML TRIPLE-VITAMIN W-FLUORIDE

TROPICAL LIQUID NUTRITION TROPICAL LIQUID NUTRITION

V-R BALANCED B-50 TABLET BALANCED B-50

V-R NATURAL B-100 TABLET NATURAL B-100

VINACAL B PRENATAL COMBO PACK VINACAL B

VISION PLUS LUTEIN VITAMIN TAB VISION PLUS LUTEIN

VIT A,C,D-FLUORIDE 0.25 MG/ML VITAMINS A,C,D ANDFLUORIDE

VIT A,D,C-FLUORIDE 0.25 MG/ML VITAMINS A,D,C ANDFLUORIDE

VITALETS TABLET CHEWABLE VITALETS

VITAMIN B COMPLEX TABLET VITAMIN B COMPLEX

VITAMIN B COMPLEX-VIT C CAP VITAMIN B-COMPLEX WITH VITC

VITRUM SENIOR TABLET VITRUM SENIOR

ZOO CHEWS GUMMIE TABLET ZOO CHEWS

ZOO FRIENDS COMPLETE TAB CHEW ZOO FRIENDS COMPLETE

ZOO FRIENDS GUMMIES ZOO FRIENDS GUMMIES

ZOO FRIENDS ORIGINAL TAB CHEW ZOO FRIENDS ORIGINAL

ZOO FRIENDS TABLET CHEWABLE ZOO FRIENDS

Vitamins


B-1 100 MG TABLET B-1

BABY DDROPS 400 UNIT/DROP BABY DDROPS

BABY VITAMIN D3 400 UNIT/DROP BABY VITAMIN D3

BIO-D-MULSION 400 UNIT/DROP BIO-D-MULSION

CVS B-1 100 MG TABLET B-1


189

Vitamins


CVS FOLIC ACID 800 MCG TABLET FOLIC ACID

CVS VITAMIN A 8,000 UNIT SFTGL VITAMIN A

CVS VITAMIN B-1 100 MG TABLET VITAMIN B-1

CVS VITAMIN B-6 100 MG TABLET VITAMIN B-6

CVS VITAMIN D3 400 UNIT/DROP VITAMIN D3

CVS VITAMIN E 1,000 UNIT CAP VITAMIN E

CVS VITAMIN E 400 UNIT CAPSULE VITAMIN E

CVS VITAMIN E 400 UNIT SOFTGEL VITAMIN E

D-VI-SOL 400 UNITS/ML DROP D-VI-SOL

D-VITA 400 UNIT/ML DROP D-VITA

EQL VITAMIN B-6 100 MG TABLET VITAMIN B-6

EQL VITAMIN E 1,000 UNIT SFTGL VITAMIN E

EQL VITAMIN E 400 UNIT SOFTGEL VITAMIN E

FNP VITAMIN E 400 UNIT TABLET VITAMIN E

FOLIC ACID 0.4 MG TABLET FOLIC ACID

FOLIC ACID 0.8 MG TABLET FOLIC ACID

FOLIC ACID 400 MCG TABLET FOLIC ACID

FOLIC ACID 800 MCG TABLET FOLIC ACID

GNP FOLIC ACID 400 MCG TABLET FOLIC ACID

GNP NIACIN 250 MG TABLET NIACIN

GNP VITAMIN A 10,000 UNIT SFGL VITAMIN A

GNP VITAMIN B-1 100 MG TABLET VITAMIN B-1

GNP VITAMIN B-6 100 MG TABLET VITAMIN B-6

GNP VITAMIN E 200 UNIT SOFTGEL VITAMIN E

GNP VITAMIN E 400 UNIT SOFTGEL VITAMIN E

HM FOLIC ACID 400 MCG TABLET FOLIC ACID

HM NIACIN TR 250 MG TABLET NIACIN

HM VITAMIN B-1 100 MG TABLET VITAMIN B-1

HM VITAMIN B-6 100 MG TABLET VITAMIN B-6

HM VITAMIN E 400 UNIT SOFTGEL VITAMIN E

JUST D 400 UNITS/ML DROP JUST D

NIACIN 100 MG TABLET NIACIN

NIACIN 125 MG CAPSULE SA NIACIN


NIACIN 250 MG TABLET SA NIACIN


NIACIN 500 MG CAPSULE SA NIACIN


NIACIN 750 MG TABLET SA NIACIN

NIACIN ER 1,000 MG CAPLET NIACIN

NIACIN ER 1,000 MG TABLET NIACIN

NIACIN ER 250 MG CAPSULE NIACIN

NIACIN ER 250 MG TABLET NIACIN


190

Vitamins


NIACIN ER 500 MG CAPLET NIACIN

NIACIN ER 500 MG TABLET NIACIN

NIACIN SA 250 MG CAPSULE NIACIN

NIACIN TR 250 MG CAPSULE NIACIN

NIACIN TR 500 MG CAPLET NIACIN

NIACIN TR 500 MG CAPSULE NIACIN

NIACIN TR 500 MG TABLET NIACIN

PEDIA D-VITE 400 UNIT/ML DROP PEDIA D-VITE

PLAIN NIACIN 250 MG TABLET PLAIN NIACIN

PLAIN NIACIN 500 MG TABLET PLAIN NIACIN

PYRIDOXINE 100 MG TABLET PYRIDOXINE HCL

RA FOLIC ACID 0.4 MG TABLET FOLIC ACID

RA FOLIC ACID 800 MCG TABLET FOLIC ACID

RA NIACIN 100 MG TABLET NIACIN

RA NIACIN 500 MG TABLET NIACIN

RA VITAMIN A 10,000 UNIT SFTGL VITAMIN A

RA VITAMIN B-1 100 MG TABLET VITAMIN B-1

RA VITAMIN B-6 100 MG TABLET VITAMIN B-6

RA VITAMIN E 400 UNIT SOFTGEL VITAMIN E

SM FOLIC ACID 0.4 MG TABLET FOLIC ACID

SM FOLIC ACID 400 MCG TABLET FOLIC ACID

SM NIACIN TR 250 MG TABLET NIACIN

SM VITAMIN B-1 100 MG TABLET VITAMIN B-1

SM VITAMIN B-6 100 MG TABLET VITAMIN B-6

SM VITAMIN E 1,000 UNIT SFTGEL VITAMIN E

SM VITAMIN E 200 UNIT SOFTGEL VITAMIN E

SM VITAMIN E 400 UNIT CAPSULE VITAMIN E

SM VITAMIN E 400 UNIT SOFTGEL VITAMIN E

SV FOLIC ACID 800 MCG TABLET FOLIC ACID

SV VITAMIN B-6 100 MG TABLET VITAMIN B-6

SV VITAMIN E 1,000 UNIT SFTGEL VITAMIN E

SV VITAMIN E 200 UNIT SOFTGEL VITAMIN E

SV VITAMIN E 400 UNIT SOFTGEL VITAMIN E

THIAMINE 100 MG TABLET THIAMINE HCL

V-R VITAMIN B-6 100 MG TABLET VITAMIN B-6

V-R VITAMIN E 1,000 UNIT SFTGL VITAMIN E

V-R VITAMIN E 400 UNIT CAPSULE VITAMIN E

V-R VITAMIN E 400 UNIT SOFTGEL VITAMIN E

VITAMIN A 10,000 UNIT CAPSULE VITAMIN A

VITAMIN A 10,000 UNIT SOFTGEL VITAMIN A

VITAMIN A 25,000 UNITS CAPSULE VITAMIN A

VITAMIN A 8,000 UNIT CAPSULE VITAMIN A

VITAMIN A 8,000 UNITS SOFTGEL VITAMIN A


191

Vitamins


VITAMIN A PALM 15,000 UNIT TAB VITAMIN A PALMITATE

VITAMIN B-1 100 MG TABLET VITAMIN B-1

VITAMIN B-6 100 MG TABLET VITAMIN B-6

VITAMIN D2 400 UNIT TABLET VITAMIN D2

VITAMIN D3 400 UNIT/ML DROP VITAMIN D3

VITAMIN E 1,000 UNIT CAPSULE VITAMIN E

VITAMIN E 1,000 UNIT SOFTGEL VITAMIN E

VITAMIN E 1,000 UNITS CAPSULE VITAMIN E

VITAMIN E 1,000 UNITS SOFTGEL VITAMIN E

VITAMIN E 100 UNIT CAPSULE VITAMIN E


VITAMIN E 200 UNIT SOFTGEL VITAMIN E


VITAMIN E 400 UNIT MIXED SFTGL VITAMIN E

VITAMIN E 400 UNIT SOFTGEL VITAMIN E

VITAMIN E 50 UNIT/ML DROPS VITAMIN E


2018 - trusted hpintroduction trusted health plan is pleased to provide an updated 2018 medicaid...

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