non-asa jr tab 160mg 3 $0 NM; * non-aspirin chw 80mg 3 $0 NM; * pain relief dro 80/0.8ml 3 $0 NM; * pain relief liq 500/15ml 3 $0 NM; * pain relief su

Transcription

1 NY_MMP_CY16_2T_STND eff 03/01/2016 藥物名稱 藥物層級您為藥物支 付的費用 止痛藥 - 治療疼痛和發炎的藥物 痛風藥 - 治療痛風的藥物 allopurinol tab 100 mg 1 $0 allopurinol tab 300 mg 1 $0 colchicine w/ probenecid tab 1 $ mg COLCRYS TAB 0.6MG 2 $0 QL (120 tabs / 30 days) probenecid tab 500 mg 1 $0 ULORIC TAB 40MG 2 $0 ST ULORIC TAB 80MG 2 $0 ST 雜類 ACEPHEN SUP 120MG 3 $0 NM; * acephen sup 325mg 3 $0 NM; * acephen sup 650mg 3 $0 NM; * acetamin jr tab 160mg rt 3 $0 NM; * ACETAMINOPHE TAB 650MG 3 $0 NM; * acetaminophen soln 160 mg/5ml 3 $0 NM; * ADVIL JR ST TAB 100MG 3 $0 NM; * all day pain tab 220mg 3 $0 NM; * APAP 500 LIQ 500/5ML 3 $0 NM; * aspirin suppos 300 mg 3 $0 NM; * aspirin suppos 600 mg 3 $0 NM; * aspirin tab 81 mg 3 $0 NM; * aspirin tab 325 mg 3 $0 NM; * aspirin tab delayed release 325 mg 3 $0 NM; * aspirin tab delayed release 500 mg 3 $0 NM; * aspirin tab delayed release 650 mg 3 $0 NM; * child apap tab 80mg 3 $0 NM; * ed-apap liq 80mg/2.5 3 $0 NM; * FEBROL SOL 325/5ML 3 $0 NM; * FEVERALL INF SUP 80MG 3 $0 NM; * 8 hour pain tab 650mg 3 $0 NM; * ibuprofen cap 200 mg 3 $0 NM; * ibuprofen dro 50/ $0 NM; * ibuprofen jr chw 100mg 3 $0 NM; * ibuprofen sus 100/5ml 3 $0 NM; * motrin ib tab 200mg 3 $0 NM; * NAPROXEN SODIUM CAP 220 MG 3 $0 NM; * 1

2 non-asa jr tab 160mg 3 $0 NM; * non-aspirin chw 80mg 3 $0 NM; * pain relief dro 80/0.8ml 3 $0 NM; * pain relief liq 500/15ml 3 $0 NM; * pain relief sus 160/5ml 3 $0 NM; * pain relief tab 500mg 3 $0 NM; * pain relievr tab 325mg 3 $0 NM; * q-pap infant dro 80/0.8ml 3 $0 NM; * tri-buff asa tab 325mg 3 $0 NM; * TRIAMINIC SYP INFANT 3 $0 NM; * 非甾體類消炎藥 - 治療疼痛和發炎的藥物 celecoxib cap 50 mg 1 $0 QL (60 caps / 30 days) celecoxib cap 100 mg 1 $0 QL (60 caps / 30 days) celecoxib cap 200 mg 1 $0 QL (60 caps / 30 days) celecoxib cap 400 mg 1 $0 QL (60 caps / 30 days) diclofenac potassium tab 50 mg 1 $0 diclofenac sodium tab delayed 1 $0 release 25 mg diclofenac sodium tab delayed 1 $0 release 50 mg diclofenac sodium tab delayed release 75 mg 1 $0 diclofenac sodium tab sr 24hr $0 mg diflunisal tab 500 mg 1 $0 etodolac cap 200 mg 1 $0 etodolac cap 300 mg 1 $0 etodolac tab 400 mg 1 $0 etodolac tab 500 mg 1 $0 etodolac tab sr 24hr 400 mg 1 $0 etodolac tab sr 24hr 500 mg 1 $0 etodolac tab sr 24hr 600 mg 1 $0 flurbiprofen tab 50 mg 1 $0 flurbiprofen tab 100 mg 1 $0 ibuprofen susp 100 mg/5ml 1 $0 ibuprofen tab 400 mg 1 $0 ibuprofen tab 600 mg 1 $0 ibuprofen tab 800 mg 1 $0 ketoprofen cap 50 mg 1 $0 ketoprofen cap 75 mg 1 $0 MELOXICAM SUSP 7.5 MG/5ML 1 $0 meloxicam tab 7.5 mg 1 $0 2

3 meloxicam tab 15 mg 1 $0 nabumetone tab 500 mg 1 $0 nabumetone tab 750 mg 1 $0 naproxen dr tab 375mg 1 $0 naproxen dr tab 500mg 1 $0 naproxen sodium tab 275 mg 1 $0 naproxen sodium tab 550 mg 1 $0 naproxen susp 125 mg/5ml 1 $0 naproxen tab 250 mg 1 $0 naproxen tab 375 mg 1 $0 naproxen tab 500 mg 1 $0 piroxicam cap 10 mg 1 $0 piroxicam cap 20 mg 1 $0 sulindac tab 150 mg 1 $0 sulindac tab 200 mg 1 $0 麻醉性鎮痛劑 - 治療疼痛的藥物 acetaminophen w/ codeine soln 1 $0 QL (5000 ml / 30 days) mg/5ml acetaminophen w/ codeine tab 1 $0 QL (400 tabs / 30 days) mg acetaminophen w/ codeine tab 1 $0 QL (400 tabs / 30 days) mg acetaminophen w/ codeine tab 1 $0 QL (400 tabs / 30 days) mg butorphanol tartrate inj 1 mg/ml 1 $0 butorphanol tartrate inj 2 mg/ml 1 $0 nalbuphine hcl inj 10 mg/ml 1 $0 nalbuphine hcl inj 20 mg/ml 1 $0 tramadol hcl tab 50 mg 1 $0 QL (240 tabs / 30 days) tramadol-acetaminophen tab mg 1 $0 QL (240 tabs / 30 days) 麻醉性鎮痛劑,CII - 治療疼痛的藥物 DURAMORPH INJ 0.5MG/ML 1 $0 B/D DURAMORPH INJ 1MG/ML 1 $0 B/D endocet tab 5-325mg 1 $0 QL (360 tabs / 30 days) endocet tab $0 QL (360 tabs / 30 days) endocet tab mg 1 $0 QL (360 tabs / 30 days) fentanyl citrate lozenge on a handle 2 $0 QL (120 lozenges / mcg days), PA fentanyl citrate lozenge on a handle 2 $0 QL (120 lozenges / mcg days), PA fentanyl citrate lozenge on a handle 2 $0 QL (120 lozenges / mcg days), PA 3

4 fentanyl citrate lozenge on a handle 2 $0 QL (120 lozenges / mcg days), PA fentanyl citrate lozenge on a handle 2 $0 QL (120 lozenges / mcg days), PA fentanyl citrate lozenge on a handle 2 $0 QL (120 lozenges / mcg days), PA fentanyl td patch 72hr 12 mcg/hr 1 $0 QL (10 patches / 30 days) fentanyl td patch 72hr 25 mcg/hr 1 $0 QL (10 patches / 30 days) fentanyl td patch 72hr 50 mcg/hr 1 $0 QL (10 patches / 30 days), PA fentanyl td patch 72hr 75 mcg/hr 1 $0 QL (10 patches / 30 days), PA fentanyl td patch 72hr 100 mcg/hr 1 $0 QL (10 patches / 30 days), PA FENTORA TAB 100MCG 2 $0 QL (120 tabs / 30 days), PA FENTORA TAB 200MCG 2 $0 QL (120 tabs / 30 days), PA FENTORA TAB 400MCG 2 $0 QL (120 tabs / 30 days), PA FENTORA TAB 600MCG 2 $0 QL (120 tabs / 30 days), PA FENTORA TAB 800MCG 2 $0 QL (120 tabs / 30 days), PA hydrocodone-acetaminophen soln 1 $0 QL (5400 ml / 30 days) mg/15ml hydrocodone-acetaminophen tab 1 $0 QL (360 tabs / 30 days) mg hydrocodone-acetaminophen tab 1 $0 QL (360 tabs / 30 days) mg hydrocodone-acetaminophen tab mg 1 $0 QL (360 tabs / 30 days) hydrocodone-ibuprofen tab $0 QL (150 tabs / 30 days) mg hydromorphone hcl liqd 1 mg/ml 1 $0 hydromorphone hcl preservative 1 $0 B/D free (pf) inj 10 mg/ml hydromorphone hcl tab 2 mg 1 $0 QL (270 tabs / 30 days) hydromorphone hcl tab 4 mg 1 $0 QL (270 tabs / 30 days) hydromorphone hcl tab 8 mg 1 $0 QL (270 tabs / 30 days) methadone con 10mg/ml 1 $0 QL (120 ml / 30 days) methadone hcl soln 5 mg/5ml 1 $0 QL (600 ml / 30 days) methadone hcl soln 10 mg/5ml 1 $0 QL (600 ml / 30 days) 4

5 methadone hcl tab 5 mg 1 $0 QL (240 tabs / 30 days) methadone hcl tab 10 mg 1 $0 QL (240 tabs / 30 days) MORPHINE SUL INJ 2MG/ML 1 $0 B/D MORPHINE SUL INJ 4MG/ML 1 $0 B/D MORPHINE SUL INJ 8MG/ML 1 $0 B/D morphine sulfate beads cap sr 24hr 1 $0 QL (60 caps / 30 days) 30 mg morphine sulfate beads cap sr 24hr 1 $0 QL (60 caps / 30 days) 45 mg morphine sulfate beads cap sr 24hr 1 $0 QL (60 caps / 30 days) 60 mg morphine sulfate beads cap sr 24hr 1 $0 QL (60 caps / 30 days) 75 mg morphine sulfate beads cap sr 24hr 1 $0 QL (60 caps / 30 days) 90 mg morphine sulfate beads cap sr 24hr 1 $0 QL (60 caps / 30 days) 120 mg morphine sulfate cap sr 24hr 10 mg 1 $0 QL (60 caps / 30 days) morphine sulfate cap sr 24hr 20 mg 1 $0 QL (60 caps / 30 days) morphine sulfate cap sr 24hr 30 mg 1 $0 QL (60 caps / 30 days) morphine sulfate cap sr 24hr 50 mg 1 $0 QL (60 caps / 30 days) morphine sulfate cap sr 24hr 60 mg 1 $0 QL (60 caps / 30 days) morphine sulfate cap sr 24hr 80 mg 2 $0 QL (60 caps / 30 days) morphine sulfate cap sr 24hr 100 mg 2 $0 QL (60 caps / 30 days) morphine sulfate inj pf 0.5 mg/ml 1 $0 B/D morphine sulfate inj pf 1 mg/ml 1 $0 B/D MORPHINE SULFATE IV SOLN 1 MG/ML 1 $0 B/D morphine sulfate iv soln pf 4 mg/ml 1 $0 B/D morphine sulfate iv soln pf 8 mg/ml 1 $0 B/D MORPHINE SULFATE IV SOLN PF 101 $0 B/D MG/ML MORPHINE SULFATE IV SOLN PF 151 $0 B/D MG/ML MORPHINE SULFATE ORAL SOLN 101 $0 MG/5ML MORPHINE SULFATE ORAL SOLN 201 $0 MG/5ML MORPHINE SULFATE ORAL SOLN 1 $0 100 MG/5ML (20 MG/ML) MORPHINE SULFATE TAB 15 MG 1 $0 QL (180 tabs / 30 days) MORPHINE SULFATE TAB 30 MG 1 $0 QL (180 tabs / 30 days) morphine sulfate tab cr 15 mg 1 $0 QL (90 tabs / 30 days) 5

6 morphine sulfate tab cr 30 mg 1 $0 QL (90 tabs / 30 days) morphine sulfate tab cr 60 mg 1 $0 QL (90 tabs / 30 days) morphine sulfate tab cr 100 mg 1 $0 QL (90 tabs / 30 days) morphine sulfate tab cr 200 mg 1 $0 QL (60 tabs / 30 days) oxycodone hcl cap 5 mg 1 $0 QL (180 caps / 30 days) oxycodone hcl conc 100 mg/5ml (201 $0 mg/ml) OXYCODONE HCL SOLN 5 MG/5ML 1 $0 oxycodone hcl tab 5 mg 1 $0 QL (180 tabs / 30 days) oxycodone hcl tab 10 mg 1 $0 QL (180 tabs / 30 days) oxycodone hcl tab 15 mg 1 $0 QL (180 tabs / 30 days) oxycodone hcl tab 20 mg 1 $0 QL (180 tabs / 30 days) oxycodone hcl tab 30 mg 1 $0 QL (180 tabs / 30 days) oxycodone w/ acetaminophen tab 1 $0 QL (360 tabs / 30 days) mg oxycodone w/ acetaminophen tab 1 $0 QL (360 tabs / 30 days) mg oxycodone w/ acetaminophen tab 1 $0 QL (360 tabs / 30 days) mg oxycodone w/ acetaminophen tab 1 $0 QL (360 tabs / 30 days) mg roxicet sol 5-325/5 2 $0 QL (1800 ml / 30 days) 麻醉劑 - 麻痹藥物局部麻醉藥 lidocaine hcl local inj 0.5% 1 $0 B/D lidocaine hcl local inj 1% 1 $0 B/D lidocaine hcl local inj 1.5% 1 $0 B/D lidocaine hcl local inj 2% 1 $0 B/D lidocaine hcl local preservative free 1 $0 B/D (pf) inj 0.5% lidocaine hcl local preservative free 1 $0 B/D (pf) inj 1% 抗感染藥 - 治療感染的藥物抗菌藥 - 雜類 amikacin sulfate inj 1 gm/4ml (250 1 $0 mg/ml) amikacin sulfate inj 500 mg/2ml 1 $0 (250 mg/ml) gentam/nacl inj 0.9mg/ml 1 $0 gentam/nacl inj 1.4mg/ml 1 $0 gentamicin in saline inj 0.8 mg/ml 1 $0 gentamicin in saline inj 1 mg/ml 1 $0 gentamicin in saline inj 1.2 mg/ml 1 $0 6

7 gentamicin in saline inj 1.6 mg/ml 1 $0 gentamicin in saline inj 2 mg/ml 1 $0 gentamicin sulfate inj 10 mg/ml 1 $0 gentamicin sulfate inj 40 mg/ml 1 $0 gentamicin sulfate iv soln 10 mg/ml 1 $0 neomycin sulfate tab 500 mg 1 $0 paromomycin sulfate cap 250 mg 1 $0 streptomycin sulfate for inj 1 gm 1 $0 sulfadiazine tab 500mg 2 $0 tobra/nacl inj 80/0.9 2 $0 tobramycin nebu soln 300 mg/5ml 2 $0 B/D, NM tobramycin sulfate for inj 1.2 gm 1 $0 tobramycin sulfate inj 1.2 gm/30ml 1 $0 (40 mg/ml) tobramycin sulfate inj 2 gm/50ml 1 $0 (40 mg/ml) tobramycin sulfate inj 10 mg/ml 1 $0 tobramycin sulfate inj 80 mg/2ml 1 $0 (40 mg/ml) 抗感染藥 - 雜類 ALBENZA TAB 200MG 2 $0 ALINIA SUS 100/5ML 2 $0 ALINIA TAB 500MG 2 $0 atovaquone susp 750 mg/5ml 2 $0 AZACTAM/DEX INJ 1GM 2 $0 AZACTAM/DEX INJ 2GM 2 $0 aztreonam for inj 1 gm 1 $0 aztreonam for inj 2 gm 1 $0 BILTRICIDE TAB 600MG 2 $0 CAYSTON INH 75MG 2 $0 NM, LA, PA clindamycin hcl cap 75 mg 1 $0 clindamycin hcl cap 150 mg 1 $0 clindamycin hcl cap 300 mg 1 $0 clindamycin palmitate hcl for soln 1 $0 75 mg/5ml (base equiv) clindamycin phosphate in d5w iv 1 $0 soln 300 mg/50ml clindamycin phosphate in d5w iv 1 $0 soln 600 mg/50ml clindamycin phosphate in d5w iv 1 $0 soln 900 mg/50ml clindamycin phosphate inj 9 gm/60ml 1 $0 7

8 clindamycin phosphate inj $0 mg/2ml clindamycin phosphate inj $0 mg/4ml clindamycin phosphate inj 900 mg/6ml 1 $0 clindamycin phosphate iv soln $0 mg/2ml clindamycin phosphate iv soln $0 mg/4ml clindamycin phosphate iv soln $0 mg/6ml colistimethate sodium for inj $0 mg CUBICIN SOL 500MG 2 $0 dapsone tab 25 mg 1 $0 dapsone tab 100 mg 1 $0 DARAPRIM TAB 25MG 2 $0 imipenem-cilastatin intravenous for 1 $0 soln 250 mg imipenem-cilastatin intravenous for 1 $0 soln 500 mg INVANZ INJ 1GM 2 $0 ivermectin tab 3 mg 1 $0 LINEZOLID FOR SUSP 100 MG/5ML 2 $0 linezolid iv soln 2 mg/ml 2 $0 LINEZOLID TAB 600 MG 2 $0 meropenem iv for soln 1 gm 1 $0 meropenem iv for soln 500 mg 1 $0 methenamine hippurate tab 1 gm 1 $0 metronidazole in nacl 0.79% iv soln 1 $0 500 mg/100ml metronidazole tab 250 mg 1 $0 metronidazole tab 500 mg 1 $0 NEBUPENT INH 300MG 2 $0 B/D nitrofurantoin macrocrystalline cap 50 mg nitrofurantoin macrocrystalline cap 100 mg 2 $0 PA; PA applies if 65 years and after a 90 day supply in a calendar year 2 $0 PA; PA applies if 65 years and after a 90 day supply in a calendar year 8

9 nitrofurantoin monohydrate macrocrystalline cap 100 mg 藥物層級您為藥物支 付的費用 2 $0 PA; PA applies if 65 years and after a 90 day supply in a calendar year PENTAM 300 INJ 300MG 2 $0 SIVEXTRO INJ 200MG 2 $0 SIVEXTRO TAB 200MG 2 $0 sulfamethoxazole-trimethoprim iv 1 $0 soln mg/5ml sulfamethoxazole-trimethoprim susp mg/5ml 1 $0 sulfamethoxazole-trimethoprim tab 1 $ mg sulfamethoxazole-trimethoprim tab 1 $ mg SYNERCID INJ 500MG 2 $0 trimethoprim tab 100 mg 1 $0 TYGACIL INJ 50MG 2 $0 vancomycin hcl cap 125 mg 2 $0 vancomycin hcl cap 250 mg 2 $0 vancomycin hcl for inj 10 gm 1 $0 vancomycin hcl for inj 500 mg 1 $0 vancomycin hcl for inj 1000 mg 1 $0 vancomycin hcl for inj 5000 mg 1 $0 vancomycin inj 750mg 1 $0 ZYVOX SUS 100MG/5M 2 $0 ZYVOX TAB 600MG 2 $0 抗真菌藥 - 治療真菌感染的藥物 ABELCET INJ 5MG/ML 2 $0 B/D AMBISOME INJ 50MG 2 $0 B/D amphotericin b for inj 50 mg 1 $0 B/D CANCIDAS INJ 50MG 2 $0 CANCIDAS INJ 70MG 2 $0 fluconazole for susp 10 mg/ml 1 $0 fluconazole for susp 40 mg/ml 1 $0 fluconazole in dextrose inj $0 mg/100ml fluconazole in dextrose inj $0 mg/200ml fluconazole in nacl 0.9% inj $0 mg/100ml fluconazole in nacl 0.9% inj 400 mg/200ml 1 $0 9

10 fluconazole tab 50 mg 1 $0 fluconazole tab 100 mg 1 $0 fluconazole tab 150 mg 1 $0 fluconazole tab 200 mg 1 $0 fluconazole/ inj nacl $0 flucytosine cap 250 mg 2 $0 flucytosine cap 500 mg 2 $0 griseofulvin microsize susp 125 mg/5ml 1 $0 griseofulvin microsize tab 500 mg 1 $0 griseofulvin ultramicrosize tab $0 mg griseofulvin ultramicrosize tab $0 mg itraconazole cap 100 mg 1 $0 PA ketoconazole tab 200 mg 1 $0 PA MYCAMINE INJ 50MG 2 $0 MYCAMINE INJ 100MG 2 $0 NOXAFIL SUS 40MG/ML 2 $0 NOXAFIL TAB 100MG 2 $0 nystatin tab unit 1 $0 terbinafine hcl tab 250 mg 1 $0 QL (90 tabs / 365 days) voriconazole for inj 200 mg 1 $0 voriconazole for susp 40 mg/ml 2 $0 voriconazole tab 50 mg 2 $0 voriconazole tab 200 mg 2 $0 抗瘧藥 - 治療瘧疾的藥物 atovaquone-proguanil hcl tab 1 $ mg atovaquone-proguanil hcl tab mg 1 $0 chloroquine phosphate tab 250 mg 1 $0 chloroquine phosphate tab 500 mg 1 $0 COARTEM TAB MG 2 $0 mefloquine hcl tab 250 mg 1 $0 PRIMAQUINE TAB 26.3MG 2 $0 quinine sulfate cap 324 mg 1 $0 PA 抗逆轉錄病毒藥 - 抑制愛滋病感染的藥物 abacavir sulfate tab 300 mg (base 1 $0 equiv) APTIVUS CAP 250MG 2 $0 APTIVUS SOL 2 $0 10

11 CRIXIVAN CAP 200MG 2 $0 CRIXIVAN CAP 400MG 2 $0 didanosine delayed release capsule 1 $0 125 mg didanosine delayed release capsule 1 $0 200 mg didanosine delayed release capsule 1 $0 250 mg didanosine delayed release capsule 1 $0 400 mg EDURANT TAB 25MG 2 $0 EMTRIVA CAP 200MG 2 $0 EMTRIVA SOL 10MG/ML 2 $0 FUZEON INJ 90MG 2 $0 NM INTELENCE TAB 25MG 2 $0 INTELENCE TAB 100MG 2 $0 INTELENCE TAB 200MG 2 $0 INVIRASE CAP 200MG 2 $0 INVIRASE TAB 500MG 2 $0 ISENTRESS CHW 25MG 2 $0 ISENTRESS CHW 100MG 2 $0 ISENTRESS POW 100MG 2 $0 ISENTRESS TAB 400MG 2 $0 lamivudine oral soln 10 mg/ml 1 $0 lamivudine tab 150 mg 1 $0 lamivudine tab 300 mg 1 $0 LEXIVA SUS 50MG/ML 2 $0 LEXIVA TAB 700MG 2 $0 NEVIRAPINE SUSP 50 MG/5ML 1 $0 nevirapine tab 200 mg 1 $0 nevirapine tab sr 24hr 100 mg 1 $0 nevirapine tab sr 24hr 400 mg 1 $0 NORVIR CAP 100MG 2 $0 NORVIR SOL 80MG/ML 2 $0 NORVIR TAB 100MG 2 $0 PREZISTA SUS 100MG/ML 2 $0 PREZISTA TAB 75MG 2 $0 PREZISTA TAB 150MG 2 $0 PREZISTA TAB 600MG 2 $0 PREZISTA TAB 800MG 2 $0 RESCRIPTOR TAB 100 MG 2 $0 RESCRIPTOR TAB 200MG 2 $0 11

12 藥物層級您為藥物支 付的費用 RETROVIR INJ 10MG/ML 2 $0 REYATAZ CAP 150MG 2 $0 REYATAZ CAP 200MG 2 $0 REYATAZ CAP 300MG 2 $0 REYATAZ POW 50MG 2 $0 SELZENTRY TAB 150MG 2 $0 SELZENTRY TAB 300MG 2 $0 stavudine cap 15 mg 1 $0 stavudine cap 20 mg 1 $0 stavudine cap 30 mg 1 $0 stavudine cap 40 mg 1 $0 stavudine for oral soln 1 mg/ml 1 $0 SUSTIVA CAP 50MG 2 $0 SUSTIVA CAP 200MG 2 $0 SUSTIVA TAB 600MG 2 $0 TIVICAY TAB 50MG 2 $0 TYBOST TAB 150MG 2 $0 VIDEX SOL 2GM 2 $0 VIDEX SOL 4GM 2 $0 VIRACEPT TAB 250MG 2 $0 VIRACEPT TAB 625MG 2 $0 VIRAMUNE XR TAB 100MG 2 $0 VIREAD POW 40MG/GM 2 $0 VIREAD TAB 150MG 2 $0 VIREAD TAB 200MG 2 $0 VIREAD TAB 250MG 2 $0 VIREAD TAB 300MG 2 $0 VITEKTA TAB 85MG 2 $0 VITEKTA TAB 150MG 2 $0 ZIAGEN SOL 20MG/ML 2 $0 zidovudine cap 100 mg 1 $0 zidovudine syrup 10 mg/ml 1 $0 zidovudine tab 300 mg 1 $0 抗逆轉錄病毒組合藥 - 抑制愛滋病感染的藥物 abacavir 2 $0 sulfate-lamivudine-zidovudine tab mg ATRIPLA TAB 2 $0 COMPLERA TAB 2 $0 EPZICOM TAB $0 EVOTAZ TAB $0 GENVOYA TAB 2 $0 12

13 KALETRA SOL 2 $0 KALETRA TAB MG 2 $0 KALETRA TAB MG 2 $0 lamivudine-zidovudine tab $0 mg PREZCOBIX TAB $0 STRIBILD TAB 2 $0 TRIUMEQ TAB 2 $0 TRUVADA TAB $0 QL (30 tabs / 30 days) 抗結核藥 - 治療肺結核的藥物 CAPASTAT SUL INJ 1GM 2 $0 cycloserine cap 250 mg 2 $0 ethambutol hcl tab 100 mg 1 $0 ethambutol hcl tab 400 mg 1 $0 isoniazid inj 100 mg/ml 1 $0 isoniazid syrup 50 mg/5ml 1 $0 isoniazid tab 100 mg 1 $0 isoniazid tab 300 mg 1 $0 paser gra 4gm 2 $0 PRIFTIN TAB 150MG 2 $0 pyrazinamide tab 500 mg 1 $0 rifabutin cap 150 mg 1 $0 rifampin cap 150 mg 1 $0 rifampin cap 300 mg 1 $0 rifampin for inj 600 mg 1 $0 RIFATER TAB 2 $0 SIRTURO TAB 100MG 2 $0 LA, PA TRECATOR TAB 250MG 2 $0 抗病毒藥 - 治療病毒感染的藥物 acyclovir cap 200 mg 1 $0 acyclovir sodium for inj 500 mg 1 $0 B/D acyclovir sodium iv soln 50 mg/ml 1 $0 B/D acyclovir susp 200 mg/5ml 1 $0 acyclovir tab 400 mg 1 $0 acyclovir tab 800 mg 1 $0 adefovir dipivoxil tab 10 mg 2 $0 BARACLUDE SOL.05MG/ML 2 $0 DAKLINZA TAB 30MG 2 $0 NM, PA DAKLINZA TAB 60MG 2 $0 NM, PA entecavir tab 0.5 mg 2 $0 entecavir tab 1 mg 2 $0 13

14 EPIVIR HBV SOL 5MG/ML 2 $0 famciclovir tab 125 mg 1 $0 famciclovir tab 250 mg 1 $0 famciclovir tab 500 mg 1 $0 ganciclovir sodium for inj 500 mg 1 $0 B/D HARVONI TAB MG 2 $0 NM, PA lamivudine tab 100 mg (hbv) 1 $0 moderiba pak 600/day 2 $0 NM moderiba pak 800/day 2 $0 NM moderiba pak 1000/day 2 $0 NM MODERIBA PAK 1200/DAY 2 $0 NM PEG-INTRON KIT 50MCG 2 $0 NM, PA PEG-INTRON KIT 50MCG RP 2 $0 NM, PA PEG-INTRON KIT 80MCG RP 2 $0 NM, PA PEG-INTRON KIT 120 RP 2 $0 NM, PA PEG-INTRON KIT 150 RP 2 $0 NM, PA PEGASYS INJ 2 $0 NM, PA PEGASYS INJ 180MCG/M 2 $0 NM, PA PEGASYS INJ PROCLICK 2 $0 NM, PA PEGINTRON KIT 80MCG 2 $0 NM, PA PEGINTRON KIT 120MCG 2 $0 NM, PA PEGINTRON KIT 150MCG 2 $0 NM, PA REBETOL SOL 40MG/ML 2 $0 NM RELENZA MIS DISKHALE 2 $0 ribapak pak 600/day 2 $0 NM ribapak pak 800/day 2 $0 NM ribapak pak 1000/day 2 $0 NM ribapak pak 1200/day 2 $0 NM ribasphere cap 200mg 1 $0 NM ribasphere tab 200mg 1 $0 NM ribasphere tab 400mg 1 $0 NM ribasphere tab 600mg 2 $0 NM ribavirin cap 200 mg 1 $0 NM ribavirin tab 200 mg 1 $0 NM rimantadine hydrochloride tab $0 mg SOVALDI TAB 400MG 2 $0 NM, PA TAMIFLU CAP 30MG 2 $0 TAMIFLU CAP 45MG 2 $0 TAMIFLU CAP 75MG 2 $0 TAMIFLU SUS 6MG/ML 2 $0 TYZEKA TAB 600MG 2 $0 14

15 藥物層級您為藥物支 付的費用 valacyclovir hcl tab 1 gm 1 $0 valacyclovir hcl tab 500 mg 1 $0 VALCYTE SOL 50MG/ML 2 $0 valganciclovir hcl tab 450 mg (base 2 $0 equivalent) 頭孢菌素 - 治療感染的藥物 cefaclor cap 250 mg 1 $0 cefaclor cap 500 mg 1 $0 cefaclor er tab 500mg 2 $0 cefaclor for susp 125 mg/5ml 1 $0 cefaclor for susp 250 mg/5ml 1 $0 cefaclor for susp 375 mg/5ml 1 $0 cefadroxil cap 500 mg 1 $0 cefadroxil for susp 250 mg/5ml 1 $0 cefadroxil for susp 500 mg/5ml 1 $0 cefadroxil tab 1 gm 1 $0 cefazolin inj 1gm/50ml 2 $0 cefazolin sodium for inj 1 gm 1 $0 cefazolin sodium for inj 10 gm 1 $0 cefazolin sodium for inj 20 gm 1 $0 cefazolin sodium for inj 500 mg 1 $0 cefazolin sodium for iv soln 1 gm 1 $0 CEFAZOLIN SOL 2 $0 cefdinir cap 300 mg 1 $0 cefdinir for susp 125 mg/5ml 1 $0 cefdinir for susp 250 mg/5ml 1 $0 cefepime hcl for inj 1 gm 1 $0 cefepime hcl for inj 2 gm 1 $0 cefixime for susp 100 mg/5ml 1 $0 cefixime for susp 200 mg/5ml 1 $0 cefotaxime sodium for inj 1 gm 1 $0 cefotaxime sodium for inj 2 gm 1 $0 cefotaxime sodium for inj 500 mg 1 $0 cefoxitin sodium for inj 10 gm 1 $0 cefoxitin sodium for iv soln 1 gm 1 $0 cefoxitin sodium for iv soln 2 gm 1 $0 cefpodoxime proxetil for susp 50 1 $0 mg/5ml cefpodoxime proxetil for susp $0 mg/5ml cefpodoxime proxetil tab 100 mg 1 $0 cefpodoxime proxetil tab 200 mg 1 $0 15

16 藥物層級您為藥物支 付的費用 cefprozil for susp 125 mg/5ml 1 $0 cefprozil for susp 250 mg/5ml 1 $0 cefprozil tab 250 mg 1 $0 cefprozil tab 500 mg 1 $0 ceftazidime for inj 1 gm 1 $0 ceftazidime for inj 2 gm 1 $0 ceftazidime for inj 6 gm 1 $0 CEFTAZIDIME/ SOL D5W 1GM 2 $0 CEFTAZIDIME/ SOL D5W 2GM 2 $0 ceftriaxone sodium for inj 1 gm 1 $0 ceftriaxone sodium for inj 2 gm 1 $0 ceftriaxone sodium for inj 10 gm 1 $0 ceftriaxone sodium for inj 250 mg 1 $0 ceftriaxone sodium for inj 500 mg 1 $0 ceftriaxone sodium for iv soln 1 gm 1 $0 ceftriaxone sodium for iv soln 2 gm 1 $0 cefuroxime axetil tab 250 mg 1 $0 cefuroxime axetil tab 500 mg 1 $0 cefuroxime inj 7.5gm 1 $0 cefuroxime sodium for inj 1.5 gm 1 $0 cefuroxime sodium for inj 7.5 gm 1 $0 cefuroxime sodium for inj 750 mg 1 $0 cefuroxime sodium for iv soln $0 gm cephalexin cap 250 mg 1 $0 cephalexin cap 500 mg 1 $0 cephalexin for susp 125 mg/5ml 1 $0 cephalexin for susp 250 mg/5ml 1 $0 SUPRAX CAP 400MG 2 $0 suprax chw 100mg 2 $0 suprax chw 200mg 2 $0 SUPRAX SUS 500/5ML 2 $0 tazicef inj 1gm 1 $0 tazicef inj 2gm 1 $0 tazicef inj 6gm 1 $0 TEFLARO INJ 400MG 2 $0 TEFLARO INJ 600MG 2 $0 紅黴素 / 大環內酯 - 治療感染的藥物 azithromycin for susp 100 mg/5ml 1 $0 azithromycin for susp 200 mg/5ml 1 $0 azithromycin iv for soln 500 mg 1 $0 16

17 藥物層級您為藥物支 付的費用 AZITHROMYCIN POWD PACK FOR 1 $0 SUSP 1 GM azithromycin tab 250 mg 1 $0 azithromycin tab 500 mg 1 $0 azithromycin tab 600 mg 1 $0 clarithromycin for susp 125 mg/5ml 1 $0 clarithromycin for susp 250 mg/5ml 1 $0 clarithromycin tab 250 mg 1 $0 clarithromycin tab 500 mg 1 $0 clarithromycin tab sr 24hr 500 mg 1 $0 DIFICID TAB 200MG 2 $0 e.e.s. 400 tab 400mg 1 $0 ery-tab tab 250mg ec 1 $0 ery-tab tab 333mg ec 1 $0 ery-tab tab 500mg ec 1 $0 erythrocin inj 500mg 2 $0 erythrocin tab 250mg 1 $0 erythromycin ethylsuccinate tab 1 $0 400 mg erythromycin tab 250 mg 1 $0 erythromycin tab 500 mg 1 $0 erythromycin w/ delayed release 1 $0 particles cap 250 mg 氟喹諾酮 - 治療感染的藥物 ciprofloxacin 200 mg/100ml in d5w 1 $0 ciprofloxacin 400 mg/200ml in d5w 1 $0 ciprofloxacin for oral susp $0 mg/5ml (5%) (5 gm/100ml) ciprofloxacin for oral susp 500 mg/5ml (10%) (10 gm/100ml) 1 $0 ciprofloxacin hcl tab 100 mg (base 1 $0 equiv) ciprofloxacin hcl tab 250 mg (base 1 $0 equiv) ciprofloxacin hcl tab 500 mg (base 1 $0 equiv) ciprofloxacin hcl tab 750 mg (base 1 $0 equiv) ciprofloxacin iv soln 200 mg/20ml 1 $0 (1%) ciprofloxacin iv soln 400 mg/40ml (1%) 1 $0 ciprofloxacin-ciprofloxacin hcl tab sr 1 $0 24hr 500 mg (base eq) 17

18 藥物層級您為藥物支 付的費用 ciprofloxacin-ciprofloxacin hcl tab sr 1 $0 24hr 1000 mg(base eq) levofloxacin in d5w iv soln $0 mg/50ml levofloxacin in d5w iv soln $0 mg/100ml levofloxacin in d5w iv soln $0 mg/150ml levofloxacin iv soln 25 mg/ml 1 $0 levofloxacin oral soln 25 mg/ml 1 $0 levofloxacin tab 250 mg 1 $0 levofloxacin tab 500 mg 1 $0 levofloxacin tab 750 mg 1 $0 青黴素 - 治療感染的藥物 amoxicillin & k clavulanate chew tab 1 $ mg amoxicillin & k clavulanate chew tab 1 $ mg amoxicillin & k clavulanate for susp 1 $ mg/5ml amoxicillin & k clavulanate for susp 1 $ mg/5ml amoxicillin & k clavulanate for susp 1 $ mg/5ml amoxicillin & k clavulanate for susp 1 $ mg/5ml amoxicillin & k clavulanate tab 1 $ mg amoxicillin & k clavulanate tab 1 $ mg amoxicillin & k clavulanate tab 1 $ mg amoxicillin & k clavulanate tab sr 12hr mg 1 $0 amoxicillin (trihydrate) cap 250 mg 1 $0 amoxicillin (trihydrate) cap 500 mg 1 $0 amoxicillin (trihydrate) chew tab 1 $0 125 mg amoxicillin (trihydrate) chew tab 250 mg 1 $0 amoxicillin (trihydrate) for susp 1251 $0 mg/5ml amoxicillin (trihydrate) for susp 2001 $0 mg/5ml 18

19 藥物層級您為藥物支 付的費用 amoxicillin (trihydrate) for susp 2501 $0 mg/5ml amoxicillin (trihydrate) for susp 4001 $0 mg/5ml amoxicillin (trihydrate) tab 500 mg 1 $0 amoxicillin (trihydrate) tab 875 mg 1 $0 ampicillin & sulbactam sodium for 1 $0 inj gm ampicillin & sulbactam sodium for 1 $0 inj 2-1 gm ampicillin & sulbactam sodium for 1 $0 inj 10-5 gm ampicillin & sulbactam sodium for iv 1 $0 soln gm ampicillin & sulbactam sodium for iv 1 $0 soln 2-1 gm ampicillin & sulbactam sodium for iv 1 $0 soln 10-5 gm ampicillin cap 250 mg 1 $0 ampicillin cap 500 mg 1 $0 ampicillin for susp 125 mg/5ml 1 $0 ampicillin for susp 250 mg/5ml 1 $0 ampicillin sodium for inj 1 gm 1 $0 ampicillin sodium for inj 2 gm 1 $0 ampicillin sodium for inj 125 mg 1 $0 ampicillin sodium for inj 250 mg 1 $0 ampicillin sodium for inj 500 mg 1 $0 ampicillin sodium for iv soln 1 gm 1 $0 ampicillin sodium for iv soln 2 gm 1 $0 ampicillin sodium for iv soln 10 gm 1 $0 BICILLIN L-A INJ $0 BICILLIN L-A INJ $0 BICILLIN L-A INJ $0 dicloxacillin sodium cap 250 mg 1 $0 dicloxacillin sodium cap 500 mg 1 $0 nafcillin sodium for inj 1 gm 1 $0 nafcillin sodium for inj 2 gm 2 $0 nafcillin sodium for inj 10 gm 2 $0 nafcillin sodium for iv soln 1 gm 1 $0 nafcillin sodium for iv soln 2 gm 2 $0 oxacillin sodium for inj 1 gm 1 $0 oxacillin sodium for inj 2 gm 1 $0 oxacillin sodium for inj 10 gm 2 $0 19

20 藥物層級您為藥物支 付的費用 pen g proc inj $0 PENICILL GK/ INJ DEX 2MU 2 $0 PENICILL GK/ INJ DEX 3MU 2 $0 penicillin g potassium for inj 1 $ unit penicillin g potassium for inj 1 $ unit penicillin g sodium for inj $0 unit penicillin v potassium for soln $0 mg/5ml penicillin v potassium for soln $0 mg/5ml penicillin v potassium tab 250 mg 1 $0 penicillin v potassium tab 500 mg 1 $0 piperacillin sodium-tazobactam 1 $0 sodium for inj gm piperacillin sodium-tazobactam 1 $0 sodium for inj gm piperacillin sodium-tazobactam 1 $0 sodium for inj gm piperacillin sodium-tazobactam 1 $0 sodium for inj gm 四環素 - 治療感染的藥物 doxy 100 inj 100mg 1 $0 doxycycline hyclate cap 50 mg 1 $0 doxycycline hyclate cap 100 mg 1 $0 doxycycline hyclate for inj 100 mg 1 $0 doxycycline hyclate tab 20 mg 1 $0 doxycycline hyclate tab 100 mg 1 $0 doxycycline monohydrate cap 50 mg 1 $0 doxycycline monohydrate cap $0 mg doxycycline monohydrate tab 50 1 $0 mg doxycycline monohydrate tab 75 1 $0 mg doxycycline monohydrate tab $0 mg doxycycline monohydrate tab $0 mg minocycline hcl cap 50 mg 1 $0 minocycline hcl cap 75 mg 1 $0 20

21 minocycline hcl cap 100 mg 1 $0 抗腫瘤藥 - 治療癌症的藥物烷基化藥 BICNU INJ 100MG 2 $0 B/D BUSULFEX INJ 6MG/ML 2 $0 B/D CYCLOPHOSPH CAP 25MG 2 $0 B/D CYCLOPHOSPH CAP 50MG 2 $0 B/D cyclophosphamide for inj 1 gm 2 $0 B/D cyclophosphamide for inj 2 gm 1 $0 B/D cyclophosphamide for inj 500 mg 2 $0 B/D dacarbazine for inj 100 mg 1 $0 B/D dacarbazine for inj 200 mg 1 $0 B/D EMCYT CAP 140MG 2 $0 GLEOSTINE CAP 5MG 2 $0 GLEOSTINE CAP 10MG 2 $0 GLEOSTINE CAP 40MG 2 $0 GLEOSTINE CAP 100MG 2 $0 HEXALEN CAP 50MG 2 $0 IFEX INJ 3GM 2 $0 B/D ifosfamide for inj 1 gm 1 $0 B/D IFOSFAMIDE INJ 3GM 2 $0 B/D ifosfamide iv inj 1 gm/20ml (50 1 $0 B/D mg/ml) ifosfamide iv inj 3 gm/60ml (50 1 $0 B/D mg/ml) LEUKERAN TAB 2MG 2 $0 LOMUSTINE CAP 10 MG 1 $0 LOMUSTINE CAP 40 MG 1 $0 LOMUSTINE CAP 100 MG 1 $0 melphalan hcl for inj 50 mg (base 2 $0 B/D equiv) MUSTARGEN INJ 10MG 2 $0 B/D TREANDA INJ 25MG 2 $0 B/D, NM TREANDA INJ 45/0.5ML 2 $0 B/D, NM TREANDA INJ 100MG 2 $0 B/D, NM TREANDA INJ 180/2ML 2 $0 B/D, NM 氨茴環黴素 daunorubicin hcl inj 5 mg/ml (base 1 $0 B/D equiv) doxorubicin hcl for inj 50 mg 1 $0 B/D doxorubicin hcl inj 2 mg/ml 1 $0 B/D 21

22 doxorubicin hcl liposomal inj (for iv 2 $0 B/D infusion) 2 mg/ml epirubicin hcl iv soln 50 mg/25ml (21 $0 B/D mg/ml) epirubicin hcl iv soln 200 mg/100ml 1 $0 B/D (2 mg/ml) idarubicin hcl iv inj 5 mg/5ml (1 mg/ml) 2 $0 B/D idarubicin hcl iv inj 10 mg/10ml (1 2 $0 B/D mg/ml) idarubicin hcl iv inj 20 mg/20ml (1 2 $0 B/D mg/ml) 抗生素 bleomycin sulfate for inj 15 unit 1 $0 B/D bleomycin sulfate for inj 30 unit 1 $0 B/D mitomycin for iv soln 5 mg 1 $0 B/D mitomycin for iv soln 20 mg 1 $0 B/D mitomycin for iv soln 40 mg 1 $0 B/D 抗代謝物 adrucil inj 2.5g/50m 1 $0 B/D adrucil inj 5gm/100m 1 $0 B/D adrucil inj 500/10ml 1 $0 B/D ALIMTA INJ 100MG 2 $0 B/D ALIMTA INJ 500MG 2 $0 B/D azacitidine for inj 100 mg 2 $0 B/D, NM cladribine inj 1 mg/ml 2 $0 B/D cytarabine inj 20 mg/ml 1 $0 B/D fludarabine phosphate for inj 50 mg 1 $0 B/D fludarabine phosphate inj 25 mg/ml 1 $0 B/D fluorouracil inj 1 gm/20ml (50 1 $0 B/D mg/ml) fluorouracil inj 2.5 gm/50ml (50 1 $0 B/D mg/ml) fluorouracil inj 5 gm/100ml (50 1 $0 B/D mg/ml) fluorouracil inj 500 mg/10ml (50 1 $0 B/D mg/ml) gemcitabine hcl for inj 1 gm 2 $0 B/D gemcitabine hcl for inj 2 gm 2 $0 B/D gemcitabine hcl for inj 200 mg 2 $0 B/D GEMCITABINE INJ 1GM 2 $0 B/D GEMCITABINE INJ 2GM 2 $0 B/D GEMCITABINE INJ 200MG 2 $0 B/D 22

23 mercaptopurine tab 50 mg 1 $0 methotrexate sodium for inj 1 gm 1 $0 B/D methotrexate sodium inj 25 mg/ml 1 $0 B/D methotrexate sodium inj pf 25 1 $0 B/D mg/ml NIPENT INJ 10MG 2 $0 B/D PURIXAN SUS 20MG/ML 2 $0 NM TABLOID TAB 40MG 2 $0 抗有絲分裂, 紫杉醇 ABRAXANE INJ 100MG 2 $0 B/D DOCETAXEL FOR INJ CONC 20 2 $0 B/D MG/ML DOCETAXEL FOR INJ CONC 80 2 $0 B/D MG/4ML (20 MG/ML) DOCETAXEL INJ 20MG/2ML 1 $0 B/D DOCETAXEL INJ 80MG/8ML 2 $0 B/D docetaxel inj 140/7ml 2 $0 B/D DOCETAXEL INJ 160/16ML 2 $0 B/D DOCETAXEL INJ 200MG/20 2 $0 B/D paclitaxel iv conc 30 mg/5ml (6 mg/ml) 1 $0 B/D paclitaxel iv conc 100 mg/16.7ml (61 $0 B/D mg/ml) paclitaxel iv conc 150 mg/25ml (6 1 $0 B/D mg/ml) paclitaxel iv conc 300 mg/50ml (6 1 $0 B/D mg/ml) 抗有絲分裂, 長春花鹼 vinblastine sulfate inj 1 mg/ml 2 $0 B/D vincasar pfs inj 1mg/ml 1 $0 B/D vincristine sulfate iv soln 1 mg/ml 1 $0 B/D vinorelbine tartrate inj 10 mg/ml (base equiv) 1 $0 B/D vinorelbine tartrate inj 50 mg/5ml 1 $0 B/D (10 mg/ml) (base equiv) 生物反應改性劑 AVASTIN INJ 2 $0 B/D, NM, LA AVASTIN INJ 400/16ML 2 $0 B/D, NM, LA BELEODAQ INJ 500MG 2 $0 NM, PA ERIVEDGE CAP 150MG 2 $0 NM, LA, PA FARYDAK CAP 10MG 2 $0 NM, LA, PA FARYDAK CAP 15MG 2 $0 NM, LA, PA FARYDAK CAP 20MG 2 $0 NM, LA, PA 23

24 HERCEPTIN INJ 440MG 2 $0 B/D, NM IBRANCE CAP 75MG 2 $0 NM, LA, PA IBRANCE CAP 100MG 2 $0 NM, LA, PA IBRANCE CAP 125MG 2 $0 NM, LA, PA ISTODAX INJ 10MG 2 $0 B/D, NM KADCYLA INJ 100MG 2 $0 B/D, NM KADCYLA INJ 160MG 2 $0 B/D, NM KEYTRUDA INJ 100MG/4M 2 $0 NM, PA KEYTRUDA SOL 50MG 2 $0 NM, PA LYNPARZA CAP 50MG 2 $0 NM, LA, PA NINLARO CAP 2.3MG 2 $0 NM, PA NINLARO CAP 3MG 2 $0 NM, PA NINLARO CAP 4MG 2 $0 NM, PA PROLEUKIN INJ 22MU 2 $0 B/D, NM RITUXAN INJ 100MG 2 $0 NM, LA, PA RITUXAN INJ 500MG 2 $0 NM, LA, PA VELCADE INJ 3.5MG 2 $0 B/D, NM YERVOY INJ 50MG 2 $0 NM, PA YERVOY INJ 200MG 2 $0 NM, PA ZOLINZA CAP 100MG 2 $0 NM, PA 激素類抗腫瘤藥 anastrozole tab 1 mg 1 $0 bicalutamide tab 50 mg 1 $0 DEPO-PROVERA INJ 400/ML 2 $0 B/D exemestane tab 25 mg 1 $0 FARESTON TAB 60MG 2 $0 FASLODEX INJ 250MG 2 $0 B/D flutamide cap 125 mg 1 $0 letrozole tab 2.5 mg 1 $0 leuprolide acetate inj kit 5 mg/ml 1 $0 NM, PA LUPR DEP-PED INJ 7.5MG 2 $0 NM, PA LUPR DEP-PED INJ 11.25MG 2 $0 NM, PA LUPR DEP-PED INJ 15MG 2 $0 NM, PA LUPR DEP-PED INJ 30MG 2 $0 NM, PA LUPRON DEPOT INJ 3.75MG 2 $0 NM, PA LUPRON DEPOT INJ 11.25MG 2 $0 NM, PA LYSODREN TAB 500MG 2 $0 MEGACE ES SUS 625/5ML 2 $0 PA megestrol acetate susp 40 mg/ml 2 $0 PA; PA if 65 years and MEGESTROL ACETATE SUSP 625 MG/5ML 2 $0 PA 24

25 megestrol acetate tab 20 mg 2 $0 PA; PA if 65 years and megestrol acetate tab 40 mg 2 $0 PA; PA if 65 years and NILANDRON TAB 150MG 2 $0 SOLTAMOX SOL 10MG/5ML 2 $0 tamoxifen citrate tab 10 mg (base 1 $0 equivalent) tamoxifen citrate tab 20 mg (base 1 $0 equivalent) TRELSTAR MIX INJ 3.75MG 2 $0 NM, PA TRELSTAR MIX INJ 11.25MG 2 $0 NM, PA XTANDI CAP 40MG 2 $0 NM, LA, PA ZYTIGA TAB 250MG 2 $0 NM, LA, PA 激酶抑制劑 AFINITOR DIS TAB 2MG 2 $0 NM, PA AFINITOR DIS TAB 3MG 2 $0 NM, PA AFINITOR DIS TAB 5MG 2 $0 NM, PA AFINITOR TAB 2.5MG 2 $0 NM, PA AFINITOR TAB 5MG 2 $0 NM, PA AFINITOR TAB 7.5MG 2 $0 NM, PA AFINITOR TAB 10MG 2 $0 NM, PA ALECENSA CAP 150MG 2 $0 NM, LA, PA BOSULIF TAB 100MG 2 $0 NM, PA BOSULIF TAB 500MG 2 $0 NM, PA CAPRELSA TAB 100MG 2 $0 NM, LA, PA CAPRELSA TAB 300MG 2 $0 NM, LA, PA COMETRIQ KIT 60MG 2 $0 NM, LA, PA COMETRIQ KIT 100MG 2 $0 NM, LA, PA COMETRIQ KIT 140MG 2 $0 NM, LA, PA COTELLIC TAB 20MG 2 $0 NM, LA, PA GILOTRIF TAB 20MG 2 $0 NM, LA, PA GILOTRIF TAB 30MG 2 $0 NM, LA, PA GILOTRIF TAB 40MG 2 $0 NM, LA, PA GLEEVEC TAB 100MG 2 $0 NM, PA GLEEVEC TAB 400MG 2 $0 NM, PA ICLUSIG TAB 15MG 2 $0 NM, LA, PA ICLUSIG TAB 45MG 2 $0 NM, LA, PA IMBRUVICA CAP 140MG 2 $0 NM, LA, PA INLYTA TAB 1MG 2 $0 NM, LA, PA INLYTA TAB 5MG 2 $0 NM, LA, PA IRESSA TAB 250MG 2 $0 NM, LA, PA 25

26 JAKAFI TAB 5MG 2 $0 NM, LA, PA JAKAFI TAB 10MG 2 $0 NM, LA, PA JAKAFI TAB 15MG 2 $0 NM, LA, PA JAKAFI TAB 20MG 2 $0 NM, LA, PA JAKAFI TAB 25MG 2 $0 NM, LA, PA LENVIMA CAP 10MG 2 $0 NM, LA, PA LENVIMA CAP 14MG 2 $0 NM, LA, PA LENVIMA CAP 20MG 2 $0 NM, LA, PA LENVIMA CAP 24MG 2 $0 NM, LA, PA MEKINIST TAB 0.5MG 2 $0 NM, LA, PA MEKINIST TAB 2MG 2 $0 NM, LA, PA NEXAVAR TAB 200MG 2 $0 NM, LA, PA SPRYCEL TAB 20MG 2 $0 NM, PA SPRYCEL TAB 50MG 2 $0 NM, PA SPRYCEL TAB 70MG 2 $0 NM, PA SPRYCEL TAB 80MG 2 $0 NM, PA SPRYCEL TAB 100MG 2 $0 NM, PA SPRYCEL TAB 140MG 2 $0 NM, PA STIVARGA TAB 40MG 2 $0 NM, LA, PA SUTENT CAP 12.5MG 2 $0 NM, PA SUTENT CAP 25MG 2 $0 NM, PA SUTENT CAP 37.5MG 2 $0 NM, PA SUTENT CAP 50MG 2 $0 NM, PA TAFINLAR CAP 50MG 2 $0 NM, LA, PA TAFINLAR CAP 75MG 2 $0 NM, LA, PA TAGRISSO TAB 40MG 2 $0 NM, LA, PA TAGRISSO TAB 80MG 2 $0 NM, LA, PA TARCEVA TAB 25MG 2 $0 NM, LA, PA TARCEVA TAB 100MG 2 $0 NM, LA, PA TARCEVA TAB 150MG 2 $0 NM, LA, PA TASIGNA CAP 150MG 2 $0 NM, PA TASIGNA CAP 200MG 2 $0 NM, PA TYKERB TAB 250MG 2 $0 NM, LA, PA VOTRIENT TAB 200MG 2 $0 NM, LA, PA XALKORI CAP 200MG 2 $0 NM, LA, PA XALKORI CAP 250MG 2 $0 NM, LA, PA ZELBORAF TAB 240MG 2 $0 NM, LA, PA ZYDELIG TAB 100MG 2 $0 NM, LA, PA ZYDELIG TAB 150MG 2 $0 NM, LA, PA ZYKADIA CAP 150MG 2 $0 NM, LA, PA 雜類 26

27 bexarotene cap 75 mg 2 $0 NM, PA DROXIA CAP 200MG 2 $0 DROXIA CAP 300MG 2 $0 DROXIA CAP 400MG 2 $0 hydroxyurea cap 500 mg 1 $0 LONSURF TAB $0 NM, PA LONSURF TAB $0 NM, PA MATULANE CAP 50MG 2 $0 LA mitoxantrone hcl inj conc 20 1 $0 B/D, NM mg/10ml (2 mg/ml) mitoxantrone hcl inj conc 25 1 $0 B/D, NM mg/12.5ml (2 mg/ml) mitoxantrone hcl inj conc 30 1 $0 B/D, NM mg/15ml (2 mg/ml) ODOMZO CAP 200MG 2 $0 NM, LA, PA POMALYST CAP 1MG 2 $0 NM, LA, PA POMALYST CAP 2MG 2 $0 NM, LA, PA POMALYST CAP 3MG 2 $0 NM, LA, PA POMALYST CAP 4MG 2 $0 NM, LA, PA SYLATRON KIT 200MCG 2 $0 NM, PA SYLATRON KIT 300MCG 2 $0 NM, PA SYLATRON KIT 600MCG 2 $0 NM, PA SYNRIBO INJ 3.5MG 2 $0 NM, PA TARGRETIN CAP 75MG 2 $0 NM, PA tretinoin cap 10 mg 2 $0 TRISENOX SOL 10MG/10M 2 $0 B/D 鉑類藥物 carboplatin iv soln 50 mg/5ml 1 $0 B/D carboplatin iv soln 150 mg/15ml 1 $0 B/D carboplatin iv soln 450 mg/45ml 1 $0 B/D carboplatin iv soln 600 mg/60ml 1 $0 B/D cisplatin inj 50 mg/50ml (1 mg/ml) 1 $0 B/D cisplatin inj 100 mg/100ml (1 1 $0 B/D mg/ml) cisplatin inj 200 mg/200ml (1 1 $0 B/D mg/ml) oxaliplatin for iv inj 50 mg 2 $0 B/D oxaliplatin for iv inj 100 mg 2 $0 B/D oxaliplatin iv soln 50 mg/10ml 2 $0 B/D oxaliplatin iv soln 100 mg/20ml 2 $0 B/D 保護劑 amifostine crystalline for inj 500 mg 2 $0 B/D 27

28 dexrazoxane for inj 250 mg 2 $0 B/D ELITEK INJ 1.5MG 2 $0 B/D ELITEK INJ 7.5MG 2 $0 B/D FUSILEV INJ 50MG 2 $0 B/D, NM leucovorin calcium for inj 50 mg 1 $0 B/D leucovorin calcium for inj 100 mg 1 $0 B/D leucovorin calcium for inj 200 mg 1 $0 B/D leucovorin calcium for inj 350 mg 1 $0 B/D leucovorin calcium tab 5 mg 1 $0 leucovorin calcium tab 10 mg 1 $0 leucovorin calcium tab 15 mg 1 $0 leucovorin calcium tab 25 mg 1 $0 leucovorin inj calcium 1 $0 B/D levoleucovor inj 50mg 2 $0 B/D, NM levoleucovor sol 250mg/25 2 $0 B/D, NM mesna inj 100 mg/ml 1 $0 B/D MESNEX TAB 400MG 2 $0 拓撲異構酶抑制劑 etoposide inj 500 mg/25ml (20 1 $0 B/D mg/ml) irinotecan hcl inj 40 mg/2ml (20 1 $0 B/D mg/ml) irinotecan hcl inj 100 mg/5ml (20 mg/ml) 1 $0 B/D irinotecan hcl inj 500 mg/25ml (20 1 $0 B/D mg/ml) toposar inj 1gm/50ml 1 $0 B/D topotecan hcl for inj 4 mg 2 $0 B/D 心血管藥 - 治療心臟和循環疾病的藥物 血管緊張素轉化酶複方抑制劑 - 治療高血壓的藥物 amlodipine besylate-benazepril hcl 1 $0 QL (30 caps / 30 days) cap mg amlodipine besylate-benazepril hcl 1 $0 QL (30 caps / 30 days) cap 5-10 mg amlodipine besylate-benazepril hcl 1 $0 QL (30 caps / 30 days) cap 5-20 mg amlodipine besylate-benazepril hcl 1 $0 QL (30 caps / 30 days) cap 5-40 mg amlodipine besylate-benazepril hcl 1 $0 QL (30 caps / 30 days) cap mg amlodipine besylate-benazepril hcl 1 cap mg $0 28

29 藥物層級您為藥物支 付的費用 benazepril & hydrochlorothiazide 1 $0 tab mg benazepril & hydrochlorothiazide 1 $0 tab mg benazepril & hydrochlorothiazide 1 $0 tab mg benazepril & hydrochlorothiazide 1 $0 tab mg captopril & hydrochlorothiazide tab 1 $ mg captopril & hydrochlorothiazide tab 1 $ mg captopril & hydrochlorothiazide tab 1 $ mg captopril & hydrochlorothiazide tab 1 $ mg enalapril maleate & 1 $0 hydrochlorothiazide tab mg enalapril maleate & 1 $0 hydrochlorothiazide tab mg fosinopril sodium & 1 $0 hydrochlorothiazide tab mg fosinopril sodium & 1 $0 hydrochlorothiazide tab mg lisinopril & hydrochlorothiazide tab 1 $ mg lisinopril & hydrochlorothiazide tab 1 $ mg lisinopril & hydrochlorothiazide tab 1 $ mg moexipril-hydrochlorothiazide tab 1 $ mg moexipril-hydrochlorothiazide tab 1 $ mg moexipril-hydrochlorothiazide tab 1 $ mg quinapril-hydrochlorothiazide tab 1 $ mg quinapril-hydrochlorothiazide tab 1 $ mg quinapril-hydrochlorothiazide tab 1 $ mg 血管緊張素轉化酶抑制劑 - 治療高血壓的藥物 benazepril hcl tab 5 mg 1 $0 benazepril hcl tab 10 mg 1 $0 benazepril hcl tab 20 mg 1 $0 29

30 藥物層級您為藥物支 付的費用 benazepril hcl tab 40 mg 1 $0 captopril tab 12.5 mg 1 $0 captopril tab 25 mg 1 $0 captopril tab 50 mg 1 $0 captopril tab 100 mg 1 $0 enalapril maleate tab 2.5 mg 1 $0 enalapril maleate tab 5 mg 1 $0 enalapril maleate tab 10 mg 1 $0 enalapril maleate tab 20 mg 1 $0 fosinopril sodium tab 10 mg 1 $0 fosinopril sodium tab 20 mg 1 $0 fosinopril sodium tab 40 mg 1 $0 lisinopril tab 2.5 mg 1 $0 lisinopril tab 5 mg 1 $0 lisinopril tab 10 mg 1 $0 lisinopril tab 20 mg 1 $0 lisinopril tab 30 mg 1 $0 lisinopril tab 40 mg 1 $0 moexipril hcl tab 7.5 mg 1 $0 moexipril hcl tab 15 mg 1 $0 perindopril erbumine tab 2 mg 1 $0 perindopril erbumine tab 4 mg 1 $0 perindopril erbumine tab 8 mg 1 $0 quinapril hcl tab 5 mg 1 $0 quinapril hcl tab 10 mg 1 $0 quinapril hcl tab 20 mg 1 $0 quinapril hcl tab 40 mg 1 $0 ramipril cap 1.25 mg 1 $0 ramipril cap 2.5 mg 1 $0 ramipril cap 5 mg 1 $0 ramipril cap 10 mg 1 $0 trandolapril tab 1 mg 1 $0 trandolapril tab 2 mg 1 $0 trandolapril tab 4 mg 1 $0 醛固酮受體拮抗劑 - 治療高血壓的藥物 eplerenone tab 25 mg 1 $0 eplerenone tab 50 mg 1 $0 spironolactone tab 25 mg 1 $0 spironolactone tab 50 mg 1 $0 spironolactone tab 100 mg 1 $0 α 受體阻滯劑 - 治療高血壓的藥物 30

31 doxazosin mesylate tab 1 mg 1 $0 QL (30 tabs / 30 days) doxazosin mesylate tab 2 mg 1 $0 QL (30 tabs / 30 days) doxazosin mesylate tab 4 mg 1 $0 QL (30 tabs / 30 days) doxazosin mesylate tab 8 mg 1 $0 prazosin hcl cap 1 mg 1 $0 prazosin hcl cap 2 mg 1 $0 prazosin hcl cap 5 mg 1 $0 terazosin hcl cap 1 mg 1 $0 terazosin hcl cap 2 mg 1 $0 terazosin hcl cap 5 mg 1 $0 terazosin hcl cap 10 mg 1 $0 血管緊張素 Ⅱ 受體複方拮抗劑 - 治療高血壓的藥物 amlodipine besylate-valsartan tab 1 $0 QL (30 tabs / 30 days) mg amlodipine besylate-valsartan tab 1 $0 QL (30 tabs / 30 days) mg amlodipine besylate-valsartan tab 1 $0 QL (30 tabs / 30 days) mg amlodipine besylate-valsartan tab 1 $ mg amlodipine-valsartan-hydrochlorot 1 $0 QL (30 tabs / 30 days) hiazide tab mg amlodipine-valsartan-hydrochlorot 1 $0 QL (60 tabs / 30 days) hiazide tab mg amlodipine-valsartan-hydrochlorot 1 $0 QL (30 tabs / 30 days) hiazide tab mg amlodipine-valsartan-hydrochlorot 1 $0 QL (30 tabs / 30 days) hiazide tab mg amlodipine-valsartan-hydrochlorot 1 $0 hiazide tab mg AZOR TAB 5-20MG 2 $0 QL (30 tabs / 30 days) AZOR TAB 5-40MG 2 $0 QL (30 tabs / 30 days) AZOR TAB 10-20MG 2 $0 QL (30 tabs / 30 days) AZOR TAB 10-40MG 2 $0 BENICAR HCT TAB $0 BENICAR HCT TAB $0 BENICAR HCT TAB 40-25MG 2 $0 ENTRESTO TAB 24-26MG 2 $0 PA ENTRESTO TAB 49-51MG 2 $0 PA ENTRESTO TAB MG 2 $0 PA irbesartan-hydrochlorothiazide tab 1 $ mg irbesartan-hydrochlorothiazide tab 1 $ mg 31

32 losartan potassium & 1 $0 hydrochlorothiazide tab mg losartan potassium & 1 $0 hydrochlorothiazide tab mg losartan potassium & 1 $0 hydrochlorothiazide tab mg TRIBENZOR20- TAB MG 2 $0 QL (30 tabs / 30 days) TRIBENZOR40- TAB MG 2 $0 QL (30 tabs / 30 days) TRIBENZOR40- TAB 5-25MG 2 $0 QL (30 tabs / 30 days) TRIBENZOR40- TAB $0 QL (30 tabs / 30 days) TRIBENZOR40- TAB 10-25MG 2 $0 valsartan-hydrochlorothiazide tab 1 $ mg valsartan-hydrochlorothiazide tab 1 $ mg valsartan-hydrochlorothiazide tab 1 $ mg valsartan-hydrochlorothiazide tab 1 $ mg valsartan-hydrochlorothiazide tab mg 1 $0 血管緊張素 Ⅱ 受體拮抗劑 - 治療高血壓的藥物 BENICAR TAB 5MG 2 $0 BENICAR TAB 20MG 2 $0 BENICAR TAB 40MG 2 $0 irbesartan tab 75 mg 1 $0 irbesartan tab 150 mg 1 $0 irbesartan tab 300 mg 1 $0 losartan potassium tab 25 mg 1 $0 losartan potassium tab 50 mg 1 $0 losartan potassium tab 100 mg 1 $0 valsartan tab 40 mg 1 $0 valsartan tab 80 mg 1 $0 valsartan tab 160 mg 1 $0 valsartan tab 320 mg 1 $0 抗心律不齊藥 - 控制心律不齊的藥物 amiodarone hcl inj 150 mg/3ml (501 $0 mg/ml) amiodarone hcl inj 450 mg/9ml (501 $0 mg/ml) amiodarone hcl inj 900 mg/18ml 1 $0 (50 mg/ml) amiodarone hcl tab 100 mg 1 $0 32

33 amiodarone hcl tab 200 mg 1 $0 amiodarone hcl tab 400 mg 1 $0 disopyramide phosphate cap 100 mg 2 $0 PA; PA if 65 years and disopyramide phosphate cap 150 mg 2 $0 PA; PA if 65 years and flecainide acetate tab 50 mg 1 $0 flecainide acetate tab 100 mg 1 $0 flecainide acetate tab 150 mg 1 $0 mexiletine hcl cap 150 mg 1 $0 mexiletine hcl cap 200 mg 1 $0 mexiletine hcl cap 250 mg 1 $0 MULTAQ TAB 400MG 2 $0 NORPACE CAP 100MG CR 2 $0 PA; PA if 65 years and NORPACE CAP 150MG CR 2 $0 PA; PA if 65 years and pacerone tab 100mg 1 $0 pacerone tab 200mg 1 $0 pacerone tab 400mg 1 $0 propafenone hcl cap sr 12hr 225 mg 1 $0 propafenone hcl cap sr 12hr 325 mg 1 $0 propafenone hcl cap sr 12hr 425 mg 1 $0 propafenone hcl tab 150 mg 1 $0 propafenone hcl tab 225 mg 1 $0 propafenone hcl tab 300 mg 1 $0 quinidine gluconate tab cr 324 mg 1 $0 quinidine sulfate tab 200 mg 1 $0 quinidine sulfate tab 300 mg 1 $0 sorine tab 80mg 1 $0 sorine tab 120mg 1 $0 sorine tab 160mg 1 $0 sorine tab 240mg 1 $0 sotalol hcl (afib/afl) tab 80 mg 1 $0 sotalol hcl (afib/afl) tab 120 mg 1 $0 sotalol hcl (afib/afl) tab 160 mg 1 $0 sotalol hcl tab 80 mg 1 $0 sotalol hcl tab 120 mg 1 $0 sotalol hcl tab 160 mg 1 $0 sotalol hcl tab 240 mg 1 $0 TIKOSYN CAP 125MCG 2 $0 NM TIKOSYN CAP 250MCG 2 $0 NM 33

34 TIKOSYN CAP 500MCG 2 $0 NM 抗血脂藥,HMG-CoA 還原酶抑制劑 - 治療高膽固醇的藥物 atorvastatin calcium tab 10 mg 1 $0 QL (30 tabs / 30 days) (base equivalent) atorvastatin calcium tab 20 mg 1 $0 QL (30 tabs / 30 days) (base equivalent) atorvastatin calcium tab 40 mg 1 $0 QL (30 tabs / 30 days) (base equivalent) atorvastatin calcium tab 80 mg 1 $0 QL (30 tabs / 30 days) (base equivalent) CRESTOR TAB 5MG 2 $0 QL (30 tabs / 30 days) CRESTOR TAB 10MG 2 $0 QL (30 tabs / 30 days) CRESTOR TAB 20MG 2 $0 QL (30 tabs / 30 days) CRESTOR TAB 40MG 2 $0 QL (30 tabs / 30 days) lovastatin tab 10 mg 1 $0 QL (30 tabs / 30 days) lovastatin tab 20 mg 1 $0 QL (120 tabs / 30 days) lovastatin tab 40 mg 1 $0 QL (60 tabs / 30 days) pravastatin sodium tab 10 mg 1 $0 QL (30 tabs / 30 days) pravastatin sodium tab 20 mg 1 $0 QL (30 tabs / 30 days) pravastatin sodium tab 40 mg 1 $0 QL (30 tabs / 30 days) pravastatin sodium tab 80 mg 1 $0 QL (30 tabs / 30 days) simvastatin tab 5 mg 1 $0 QL (30 tabs / 30 days) simvastatin tab 10 mg 1 $0 QL (30 tabs / 30 days) simvastatin tab 20 mg 1 $0 QL (30 tabs / 30 days) simvastatin tab 40 mg 1 $0 QL (30 tabs / 30 days) simvastatin tab 80 mg 1 $0 QL (30 tabs / 30 days) 抗血脂藥, 雜類 - 治療高膽固醇的藥物 cholestyramine light powder packets 4 gm 1 $0 cholestyramine powder 4 gm/dose 1 $0 cholestyramine powder packets 4 1 $0 gm choline fenofibrate cap dr 45 mg 1 $0 (fenofibric acid equiv) choline fenofibrate cap dr 135 mg (fenofibric acid equiv) 1 $0 colestipol hcl granule packets 5 gm 1 $0 colestipol hcl granules 5 gm 1 $0 colestipol hcl tab 1 gm 1 $0 fenofibrate micronized cap 67 mg 1 $0 fenofibrate micronized cap 134 mg 1 $0 fenofibrate micronized cap 200 mg 1 $0 fenofibrate tab 48 mg 1 $0 34

35 fenofibrate tab 54 mg 1 $0 fenofibrate tab 145 mg 1 $0 fenofibrate tab 160 mg 1 $0 gemfibrozil tab 600 mg 1 $0 JUXTAPID CAP 5MG 2 $0 NM, LA, PA JUXTAPID CAP 10MG 2 $0 NM, LA, PA JUXTAPID CAP 20MG 2 $0 NM, LA, PA JUXTAPID CAP 30MG 2 $0 NM, LA, PA JUXTAPID CAP 40MG 2 $0 NM, LA, PA JUXTAPID CAP 60MG 2 $0 NM, LA, PA KYNAMRO INJ 200MG/ML 2 $0 NM, PA niacin tab cr 500 mg 1 $0 QL (90 tabs / 30 days) (antihyperlipidemic) niacin tab cr 750 mg 1 $0 (antihyperlipidemic) niacin tab cr 1000 mg 1 $0 (antihyperlipidemic) niacor tab 500mg 1 $0 omega-3-acid ethyl esters cap 1 gm 1 $0 prevalite pow 4gm 1 $0 prevalite pow 4gm pk 1 $0 VASCEPA CAP 1GM 2 $0 WELCHOL PAK 3.75GM 2 $0 WELCHOL TAB 625MG 2 $0 ZETIA TAB 10MG 2 $0 β- 受體阻滯劑 / 利尿複方製劑 - 治療高血壓和心臟疾病的藥物 atenolol & chlorthalidone tab $0 mg atenolol & chlorthalidone tab mg 1 $0 bisoprolol & hydrochlorothiazide tab 1 $ mg bisoprolol & hydrochlorothiazide tab 1 $ mg bisoprolol & hydrochlorothiazide tab 1 $ mg metoprolol & hydrochlorothiazide 1 $0 tab mg metoprolol & hydrochlorothiazide 1 $0 tab mg metoprolol & hydrochlorothiazide 1 $0 tab mg propranolol & hydrochlorothiazide tab mg 1 $0 35

36 藥物層級您為藥物支 付的費用 propranolol & hydrochlorothiazide 1 $0 tab mg β- 受體阻滯劑 - 治療高血壓和心臟疾病的藥物 acebutolol hcl cap 200 mg 1 $0 acebutolol hcl cap 400 mg 1 $0 atenolol tab 25 mg 1 $0 atenolol tab 50 mg 1 $0 atenolol tab 100 mg 1 $0 bisoprolol fumarate tab 5 mg 1 $0 bisoprolol fumarate tab 10 mg 1 $0 BYSTOLIC TAB 2.5MG 2 $0 BYSTOLIC TAB 5MG 2 $0 BYSTOLIC TAB 10MG 2 $0 BYSTOLIC TAB 20MG 2 $0 carvedilol tab mg 1 $0 carvedilol tab 6.25 mg 1 $0 carvedilol tab 12.5 mg 1 $0 carvedilol tab 25 mg 1 $0 labetalol hcl tab 100 mg 1 $0 labetalol hcl tab 200 mg 1 $0 labetalol hcl tab 300 mg 1 $0 metoprolol succinate tab sr 24hr 251 $0 QL (60 tabs / 30 days) mg metoprolol succinate tab sr 24hr 501 $0 QL (60 tabs / 30 days) mg metoprolol succinate tab sr 24hr 1 $0 QL (45 tabs / 30 days) 100 mg metoprolol succinate tab sr 24hr 1 $0 200 mg metoprolol tartrate inj 1 mg/ml 1 $0 metoprolol tartrate tab 25 mg 1 $0 metoprolol tartrate tab 50 mg 1 $0 metoprolol tartrate tab 100 mg 1 $0 nadolol tab 20 mg 1 $0 nadolol tab 40 mg 1 $0 nadolol tab 80 mg 1 $0 pindolol tab 5 mg 1 $0 pindolol tab 10 mg 1 $0 propranolol hcl cap sr 24hr 60 mg 1 $0 propranolol hcl cap sr 24hr 80 mg 1 $0 propranolol hcl cap sr 24hr 120 mg 1 $0 propranolol hcl cap sr 24hr 160 mg 1 $0 36

37 藥物層級您為藥物支 付的費用 propranolol hcl inj 1 mg/ml 1 $0 propranolol hcl oral soln 20 mg/5ml 1 $0 propranolol hcl oral soln 40 mg/5ml 1 $0 propranolol hcl tab 10 mg 1 $0 propranolol hcl tab 20 mg 1 $0 propranolol hcl tab 40 mg 1 $0 propranolol hcl tab 60 mg 1 $0 propranolol hcl tab 80 mg 1 $0 timolol maleate tab 5 mg 1 $0 timolol maleate tab 10 mg 1 $0 timolol maleate tab 20 mg 1 $0 鈣通道阻滯劑 - 治療高血壓和心臟疾病的藥物 afeditab tab 30mg cr 1 $0 QL (60 tabs / 30 days) afeditab tab 60mg cr 1 $0 amlodipine besylate tab 2.5 mg 1 $0 QL (45 tabs / 30 days) amlodipine besylate tab 5 mg 1 $0 QL (45 tabs / 30 days) amlodipine besylate tab 10 mg 1 $0 diltiazem hcl cap sr 12hr 60 mg 1 $0 diltiazem hcl cap sr 12hr 90 mg 1 $0 diltiazem hcl cap sr 12hr 120 mg 1 $0 diltiazem hcl cap sr 24hr 120 mg 1 $0 diltiazem hcl cap sr 24hr 180 mg 1 $0 diltiazem hcl cap sr 24hr 240 mg 1 $0 diltiazem hcl coated beads cap sr 1 $0 24hr 120 mg diltiazem hcl coated beads cap sr 1 $0 24hr 180 mg diltiazem hcl coated beads cap sr 1 $0 24hr 240 mg diltiazem hcl coated beads cap sr 1 $0 24hr 300 mg diltiazem hcl coated beads cap sr 1 $0 24hr 360 mg diltiazem hcl extended release 1 $0 beads cap sr 24hr 120 mg diltiazem hcl extended release 1 $0 beads cap sr 24hr 180 mg diltiazem hcl extended release 1 $0 beads cap sr 24hr 240 mg diltiazem hcl extended release 1 $0 beads cap sr 24hr 300 mg diltiazem hcl extended release beads cap sr 24hr 360 mg 1 $0 37

38 diltiazem hcl extended release beads cap sr 24hr 420 mg 1 $0 diltiazem hcl iv soln 25 mg/5ml (5 1 $0 mg/ml) diltiazem hcl iv soln 50 mg/10ml (51 $0 mg/ml) diltiazem hcl iv soln 125 mg/25ml (51 $0 mg/ml) diltiazem hcl tab 30 mg 1 $0 diltiazem hcl tab 60 mg 1 $0 diltiazem hcl tab 90 mg 1 $0 diltiazem hcl tab 120 mg 1 $0 felodipine tab sr 24hr 2.5 mg 1 $0 QL (30 tabs / 30 days) felodipine tab sr 24hr 5 mg 1 $0 QL (60 tabs / 30 days) felodipine tab sr 24hr 10 mg 1 $0 isradipine cap 2.5 mg 1 $0 isradipine cap 5 mg 1 $0 nicardipine hcl cap 20 mg 1 $0 nicardipine hcl cap 30 mg 1 $0 nifedical xl tab 30mg 1 $0 QL (30 tabs / 30 days) nifedical xl tab 60mg 1 $0 nifedipine tab sr 24hr 30 mg 1 $0 QL (60 tabs / 30 days) nifedipine tab sr 24hr 60 mg 1 $0 nifedipine tab sr 24hr 90 mg 1 $0 nifedipine tab sr 24hr osmotic 1 $0 QL (30 tabs / 30 days) release 30 mg nifedipine tab sr 24hr osmotic 1 $0 release 60 mg nifedipine tab sr 24hr osmotic 1 $0 release 90 mg nimodipine cap 30 mg 2 $0 NYMALIZE SOL 60/20ML 2 $0 taztia xt cap 120mg/24 1 $0 taztia xt cap 180mg/24 1 $0 taztia xt cap 240mg/24 1 $0 taztia xt cap 300mg/24 1 $0 taztia xt cap 360mg/24 1 $0 verapamil hcl cap sr 24hr 100 mg 1 $0 verapamil hcl cap sr 24hr 120 mg 1 $0 verapamil hcl cap sr 24hr 180 mg 1 $0 verapamil hcl cap sr 24hr 200 mg 1 $0 verapamil hcl cap sr 24hr 240 mg 1 $0 verapamil hcl cap sr 24hr 300 mg 1 $0 38

39 藥物層級您為藥物支 付的費用 VERAPAMIL HCL CAP SR 24HR $0 MG verapamil hcl iv soln 2.5 mg/ml 1 $0 verapamil hcl tab 40 mg 1 $0 verapamil hcl tab 80 mg 1 $0 verapamil hcl tab 120 mg 1 $0 verapamil hcl tab cr 120 mg 1 $0 verapamil hcl tab cr 180 mg 1 $0 verapamil hcl tab cr 240 mg 1 $0 毛地黃糖苷 - 治療心臟疾病的藥物 digitek tab 0.25mg 1 $0 PA; PA if 65 years and digitek tab 0.125mg 1 $0 QL (30 tabs / 30 days) digoxin inj 0.25 mg/ml 1 $0 DIGOXIN ORAL SOLN 0.05 MG/ML 1 $0 PA; PA if 65 years and digoxin tab 125 mcg (0.125 mg) 1 $0 QL (30 tabs / 30 days) digoxin tab 250 mcg (0.25 mg) 1 $0 PA; PA if 65 years and 直接腎素抑制劑 / 複方製劑 - 治療心臟疾病的藥物 TEKTURNA HCT TAB $0 QL (30 tabs / 30 days) TEKTURNA HCT TAB MG 2 $0 QL (60 tabs / 30 days) TEKTURNA HCT TAB $0 QL (30 tabs / 30 days) TEKTURNA HCT TAB MG 2 $0 TEKTURNA TAB 150MG 2 $0 QL (30 tabs / 30 days) TEKTURNA TAB 300MG 2 $0 利尿劑 - 治療心臟疾病的藥物 acetazolamide cap sr 12hr 500 mg 1 $0 acetazolamide tab 125 mg 1 $0 acetazolamide tab 250 mg 1 $0 amiloride & hydrochlorothiazide tab 1 $ mg amiloride hcl tab 5 mg 1 $0 bumetanide inj 0.25 mg/ml 1 $0 bumetanide tab 0.5 mg 1 $0 bumetanide tab 1 mg 1 $0 bumetanide tab 2 mg 1 $0 chlorothiazide tab 250 mg 1 $0 chlorothiazide tab 500 mg 1 $0 chlorthalidone tab 25 mg 1 $0 chlorthalidone tab 50 mg 1 $0 furosemide inj 10 mg/ml 1 $0 39

40 藥物層級您為藥物支 付的費用 FUROSEMIDE INJ 10 MG/ML 1 $0 furosemide oral soln 10 mg/ml 1 $0 furosemide sol 8mg/ml 1 $0 furosemide tab 20 mg 1 $0 furosemide tab 40 mg 1 $0 furosemide tab 80 mg 1 $0 hydrochlorothiazide cap 12.5 mg 1 $0 hydrochlorothiazide tab 12.5 mg 1 $0 hydrochlorothiazide tab 25 mg 1 $0 hydrochlorothiazide tab 50 mg 1 $0 indapamide tab 1.25 mg 1 $0 indapamide tab 2.5 mg 1 $0 methazolamide tab 25 mg 1 $0 methazolamide tab 50 mg 1 $0 methyclothiazide tab 5 mg 1 $0 metolazone tab 2.5 mg 1 $0 metolazone tab 5 mg 1 $0 metolazone tab 10 mg 1 $0 spironolactone & 1 $0 hydrochlorothiazide tab mg torsemide inj 50mg/5ml 1 $0 torsemide tab 5 mg 1 $0 torsemide tab 10 mg 1 $0 torsemide tab 20 mg 1 $0 torsemide tab 100 mg 1 $0 triamterene & hydrochlorothiazide 1 $0 cap mg triamterene & hydrochlorothiazide 1 $0 tab mg triamterene & hydrochlorothiazide 1 $0 tab mg 雜類 clonidine hcl tab 0.1 mg 1 $0 clonidine hcl tab 0.2 mg 1 $0 clonidine hcl tab 0.3 mg 1 $0 clonidine hcl td patch weekly $0 mg/24hr clonidine hcl td patch weekly $0 mg/24hr clonidine hcl td patch weekly $0 mg/24hr DEMSER CAP 250MG 2 $0 hydralazine hcl inj 20 mg/ml 1 $0 40

41 藥物層級您為藥物支 付的費用 hydralazine hcl tab 10 mg 1 $0 hydralazine hcl tab 25 mg 1 $0 hydralazine hcl tab 50 mg 1 $0 hydralazine hcl tab 100 mg 1 $0 midodrine hcl tab 2.5 mg 1 $0 midodrine hcl tab 5 mg 1 $0 midodrine hcl tab 10 mg 1 $0 minoxidil tab 2.5 mg 1 $0 minoxidil tab 10 mg 1 $0 RANEXA TAB 500MG 2 $0 RANEXA TAB 1000MG 2 $0 硝酸酯 - 治療心臟疾病的藥物 isosorbide dinitrate tab 5 mg 1 $0 isosorbide dinitrate tab 10 mg 1 $0 isosorbide dinitrate tab 20 mg 1 $0 isosorbide dinitrate tab 30 mg 1 $0 isosorbide dinitrate tab cr 40 mg 1 $0 isosorbide mononitrate tab 10 mg 1 $0 isosorbide mononitrate tab 20 mg 1 $0 isosorbide mononitrate tab sr 24hr 1 $0 30 mg isosorbide mononitrate tab sr 24hr 1 $0 60 mg isosorbide mononitrate tab sr 24hr 1 $0 120 mg minitran dis 0.1mg/hr 1 $0 minitran dis 0.2mg/hr 1 $0 minitran dis 0.4mg/hr 1 $0 minitran dis 0.6mg/hr 1 $0 nitro-bid oin 2% 2 $0 NITRO-DUR DIS 0.3MG/HR 2 $0 NITRO-DUR DIS 0.8MG/HR 2 $0 nitroglycerin td patch 24hr $0 mg/hr nitroglycerin td patch 24hr $0 mg/hr nitroglycerin td patch 24hr $0 mg/hr nitroglycerin td patch 24hr $0 mg/hr NITROSTAT SUB 0.3MG 2 $0 NITROSTAT SUB 0.4MG 2 $0 NITROSTAT SUB 0.6MG 2 $0 41

42 肺動脈高壓藥 - 治療肺動脈高壓的藥物 ADEMPAS TAB 0.5MG 2 $0 QL (90 tabs / 30 days), NM, LA, PA ADEMPAS TAB 1.5MG 2 $0 QL (90 tabs / 30 days), NM, LA, PA ADEMPAS TAB 1MG 2 $0 QL (90 tabs / 30 days), NM, LA, PA ADEMPAS TAB 2.5MG 2 $0 QL (90 tabs / 30 days), NM, LA, PA ADEMPAS TAB 2MG 2 $0 QL (90 tabs / 30 days), NM, LA, PA LETAIRIS TAB 5MG 2 $0 QL (30 tabs / 30 days), NM, LA, PA LETAIRIS TAB 10MG 2 $0 QL (30 tabs / 30 days), NM, LA, PA OPSUMIT TAB 10MG 2 $0 QL (30 tabs / 30 days), NM, LA, PA REMODULIN INJ 1MG/ML 2 $0 B/D, NM, LA REMODULIN INJ 2.5MG/ML 2 $0 B/D, NM, LA REMODULIN INJ 5MG/ML 2 $0 B/D, NM, LA REMODULIN INJ 10MG/ML 2 $0 B/D, NM, LA REVATIO SUS 10MG/ML 2 $0 QL (224 ml / 30 days), NM, PA sildenafil citrate tab 20 mg 1 $0 QL (90 tabs / 30 days), NM, PA TRACLEER TAB 62.5MG 2 $0 QL (120 tabs / 30 days), NM, LA, PA TRACLEER TAB 125MG 2 $0 QL (60 tabs / 30 days), NM, LA, PA 中樞神經系統藥 - 治療神經系統紊亂的藥物 抗焦慮劑 - 治療焦慮的藥物 alprazolam tab 0.5 mg 1 $0 QL (240 tabs / 30 days) alprazolam tab 0.25 mg 1 $0 QL (480 tabs / 30 days) alprazolam tab 1 mg 1 $0 QL (120 tabs / 30 days) alprazolam tab 2 mg 1 $0 QL (150 tabs / 30 days) buspirone hcl tab 5 mg 1 $0 buspirone hcl tab 7.5 mg 1 $0 buspirone hcl tab 10 mg 1 $0 buspirone hcl tab 15 mg 1 $0 buspirone hcl tab 30 mg 1 $0 fluvoxamine maleate tab 25 mg 1 $0 QL (45 tabs / 30 days) fluvoxamine maleate tab 50 mg 1 $0 QL (45 tabs / 30 days) fluvoxamine maleate tab 100 mg 1 $0 lorazepam con 2mg/ml 1 $0 QL (150 ml / 30 days) 42

43 lorazepam inj 2 mg/ml 1 $0 lorazepam inj 4 mg/ml 1 $0 lorazepam tab 0.5 mg 1 $0 QL (150 tabs / 30 days) lorazepam tab 1 mg 1 $0 QL (150 tabs / 30 days) lorazepam tab 2 mg 1 $0 QL (150 tabs / 30 days) 抗痙攣劑 - 治療痙攣的藥物 APTIOM TAB 200MG 2 $0 QL (180 tabs / 30 days) APTIOM TAB 400MG 2 $0 QL (90 tabs / 30 days) APTIOM TAB 600MG 2 $0 QL (60 tabs / 30 days) APTIOM TAB 800MG 2 $0 QL (30 tabs / 30 days) BANZEL SUS 40MG/ML 2 $0 PA BANZEL TAB 200MG 2 $0 PA BANZEL TAB 400MG 2 $0 PA carbamazepine cap sr 12hr 100 mg 1 $0 carbamazepine cap sr 12hr 200 mg 1 $0 carbamazepine cap sr 12hr 300 mg 1 $0 carbamazepine chew tab 100 mg 1 $0 carbamazepine susp 100 mg/5ml 1 $0 carbamazepine tab 200 mg 1 $0 carbamazepine tab sr 12hr 200 mg 1 $0 carbamazepine tab sr 12hr 400 mg 1 $0 CELONTIN CAP 300MG 2 $0 clonazepam orally disintegrating 1 $0 QL (240 tabs / 30 days) tab 0.5 mg clonazepam orally disintegrating 1 $0 QL (480 tabs / 30 days) tab 0.25 mg clonazepam orally disintegrating 1 $0 QL (960 tabs / 30 days) tab mg clonazepam orally disintegrating 1 $0 QL (120 tabs / 30 days) tab 1 mg clonazepam orally disintegrating 1 $0 QL (300 tabs / 30 days) tab 2 mg clonazepam tab 0.5 mg 1 $0 QL (240 tabs / 30 days) clonazepam tab 1 mg 1 $0 QL (120 tabs / 30 days) clonazepam tab 2 mg 1 $0 QL (300 tabs / 30 days) clorazepate dipotassium tab 3.75 mg 1 $0 QL (120 tabs / 30 days), PA clorazepate dipotassium tab 7.5 mg 1 $0 QL (120 tabs / 30 days), PA clorazepate dipotassium tab 15 mg 1 $0 QL (180 tabs / 30 days), PA diazepam con 5mg/ml 1 $0 QL (240 ml / 30 days), PA 43

44 diazepam inj 5 mg/ml 1 $0 DIAZEPAM RECTAL GEL DELIVERY 1 $0 SYSTEM 2.5 MG DIAZEPAM RECTAL GEL DELIVERY 1 $0 SYSTEM 10 MG DIAZEPAM RECTAL GEL DELIVERY 1 $0 SYSTEM 20 MG diazepam soln 1 mg/ml 1 $0 QL (1200 ml / 30 days), PA diazepam tab 2 mg 1 $0 QL (120 tabs / 30 days), PA diazepam tab 5 mg 1 $0 QL (120 tabs / 30 days), PA diazepam tab 10 mg 1 $0 QL (120 tabs / 30 days), PA dilantin cap 30mg 2 $0 dilantin cap 100mg 2 $0 dilantin chw 50mg 2 $0 DILANTIN-125 SUS 125/5ML 2 $0 divalproex sodium cap sprinkle $0 mg divalproex sodium tab delayed 1 $0 release 125 mg divalproex sodium tab delayed 1 $0 release 250 mg divalproex sodium tab delayed release 500 mg 1 $0 divalproex sodium tab sr 24 hr $0 mg divalproex sodium tab sr 24 hr $0 mg epitol tab 200mg 1 $0 ethosuximide cap 250 mg 1 $0 ethosuximide soln 250 mg/5ml 1 $0 felbamate susp 600 mg/5ml 2 $0 felbamate tab 400 mg 1 $0 felbamate tab 600 mg 1 $0 FYCOMPA TAB 2MG 2 $0 QL (180 tabs / 30 days), PA FYCOMPA TAB 4MG 2 $0 QL (90 tabs / 30 days), PA FYCOMPA TAB 6MG 2 $0 QL (60 tabs / 30 days), PA FYCOMPA TAB 8MG 2 $0 QL (30 tabs / 30 days), PA 44

45 FYCOMPA TAB 10MG 2 $0 QL (30 tabs / 30 days), PA FYCOMPA TAB 12MG 2 $0 QL (30 tabs / 30 days), PA gabapentin cap 100 mg 1 $0 QL (1080 caps / 30 days) gabapentin cap 300 mg 1 $0 QL (360 caps / 30 days) gabapentin cap 400 mg 1 $0 QL (270 caps / 30 days) gabapentin oral soln 250 mg/5ml 1 $0 QL (2160 ml / 30 days) gabapentin tab 600 mg 1 $0 QL (180 tabs / 30 days) gabapentin tab 800 mg 1 $0 QL (120 tabs / 30 days) GABITRIL TAB 12MG 2 $0 GABITRIL TAB 16MG 2 $0 lamotrigine tab 25 mg 1 $0 lamotrigine tab 100 mg 1 $0 lamotrigine tab 150 mg 1 $0 lamotrigine tab 200 mg 1 $0 lamotrigine tab chewable 1 $0 dispersible 5 mg lamotrigine tab chewable 1 $0 dispersible 25 mg lamotrigine tab sr 24hr 25 mg 1 $0 lamotrigine tab sr 24hr 50 mg 1 $0 lamotrigine tab sr 24hr 100 mg 1 $0 lamotrigine tab sr 24hr 200 mg 1 $0 lamotrigine tab sr 24hr 250 mg 1 $0 lamotrigine tab sr 24hr 300 mg 1 $0 LEVETIRACETA INJ 5MG/ML 2 $0 LEVETIRACETA INJ 10MG/ML 2 $0 LEVETIRACETA INJ 15MG/ML 2 $0 levetiracetam inj 500 mg/5ml (100 1 $0 mg/ml) levetiracetam oral soln 100 mg/ml 1 $0 levetiracetam tab 250 mg 1 $0 levetiracetam tab 500 mg 1 $0 levetiracetam tab 750 mg 1 $0 levetiracetam tab 1000 mg 1 $0 levetiracetam tab sr 24hr 500 mg 1 $0 levetiracetam tab sr 24hr 750 mg 1 $0 LYRICA CAP 25MG 2 $0 QL (120 caps / 30 days) LYRICA CAP 50MG 2 $0 QL (120 caps / 30 days) LYRICA CAP 75MG 2 $0 QL (120 caps / 30 days) LYRICA CAP 100MG 2 $0 QL (120 caps / 30 days) 45

46 LYRICA CAP 150MG 2 $0 QL (120 caps / 30 days) LYRICA CAP 200MG 2 $0 QL (90 caps / 30 days) LYRICA CAP 225MG 2 $0 QL (60 caps / 30 days) LYRICA CAP 300MG 2 $0 QL (60 caps / 30 days) LYRICA SOL 20MG/ML 2 $0 QL (946 ml / 30 days) ONFI SUS 2.5MG/ML 2 $0 PA ONFI TAB 10MG 2 $0 PA ONFI TAB 20MG 2 $0 PA oxcarbazepine susp 300 mg/5ml 1 $0 (60 mg/ml) oxcarbazepine tab 150 mg 1 $0 oxcarbazepine tab 300 mg 1 $0 oxcarbazepine tab 600 mg 1 $0 PEGANONE TAB 250MG 2 $0 PHENOBARB INJ 65MG/ML 2 $0 PA; PA if 65 years and phenobarbital elixir 20 mg/5ml 2 $0 PA; PA if 65 years and phenobarbital sodium inj 130 mg/ml 2 $0 PA; PA if 65 years and phenobarbital tab 15 mg 2 $0 PA; PA if 65 years and phenobarbital tab 16.2 mg 2 $0 PA; PA if 65 years and phenobarbital tab 30 mg 2 $0 PA; PA if 65 years and phenobarbital tab 32.4 mg 2 $0 PA; PA if 65 years and phenobarbital tab 60 mg 2 $0 PA; PA if 65 years and phenobarbital tab 64.8 mg 2 $0 PA; PA if 65 years and phenobarbital tab 97.2 mg 2 $0 PA; PA if 65 years and phenobarbital tab 100 mg 2 $0 PA; PA if 65 years and phenytek cap 200mg 2 $0 phenytek cap 300mg 2 $0 phenytoin chew tab 50 mg 1 $0 phenytoin sodium extended cap 1001 $0 mg phenytoin sodium extended cap 2001 $0 mg phenytoin sodium extended cap 3001 $0 mg 46

47 phenytoin sodium inj 50 mg/ml 1 $0 phenytoin susp 125 mg/5ml 1 $0 POTIGA TAB 50MG 2 $0 POTIGA TAB 200MG 2 $0 QL (180 tabs / 30 days) POTIGA TAB 300MG 2 $0 QL (90 tabs / 30 days) POTIGA TAB 400MG 2 $0 QL (90 tabs / 30 days) primidone tab 50 mg 1 $0 primidone tab 250 mg 1 $0 SABRIL POW 500MG 2 $0 QL (180 packets / 30 days), NM, LA, PA SABRIL TAB 500MG 2 $0 QL (180 tabs / 30 days), NM, LA, PA TEGRETOL SUS 100/5ML 2 $0 TEGRETOL TAB 200MG 2 $0 TEGRETOL-XR TAB 100MG 2 $0 TEGRETOL-XR TAB 200MG 2 $0 TEGRETOL-XR TAB 400MG 2 $0 tiagabine hcl tab 2 mg 1 $0 tiagabine hcl tab 4 mg 1 $0 topiramate sprinkle cap 15 mg 1 $0 topiramate sprinkle cap 25 mg 1 $0 topiramate tab 25 mg 1 $0 topiramate tab 50 mg 1 $0 topiramate tab 100 mg 1 $0 topiramate tab 200 mg 1 $0 valproate sodium inj 100 mg/ml 1 $0 valproate sodium syrup $0 mg/5ml (base equiv) valproic acid cap 250 mg 1 $0 VIMPAT INJ 200MG/20 2 $0 VIMPAT SOL 10MG/ML 2 $0 QL (1200 ml / 30 days) VIMPAT TAB 50MG 2 $0 QL (180 tabs / 30 days) VIMPAT TAB 100MG 2 $0 QL (60 tabs / 30 days) VIMPAT TAB 150MG 2 $0 QL (60 tabs / 30 days) VIMPAT TAB 200MG 2 $0 QL (60 tabs / 30 days) zonisamide cap 25 mg 1 $0 zonisamide cap 50 mg 1 $0 zonisamide cap 100 mg 1 $0 抗老年癡呆藥 - 治療老年癡呆和記憶喪失的藥物 donepezil hydrochloride orally disintegrating tab 5 mg 1 $0 QL (30 tabs / 30 days) 47

48 donepezil hydrochloride orally 1 $0 disintegrating tab 10 mg donepezil hydrochloride tab 5 mg 1 $0 QL (30 tabs / 30 days) donepezil hydrochloride tab 10 mg 1 $0 donepezil hydrochloride tab 23 mg 1 $0 EXELON DIS 4.6MG/24 2 $0 QL (30 patches / 30 days) EXELON DIS 9.5MG/24 2 $0 QL (30 patches / 30 days) EXELON DIS 13.3/24 2 $0 QL (30 patches / 30 days) galantamine hydrobromide cap sr 1 $0 QL (30 caps / 30 days) 24hr 8 mg galantamine hydrobromide cap sr 1 $0 QL (30 caps / 30 days) 24hr 16 mg galantamine hydrobromide cap sr 24hr 24 mg 1 $0 galantamine hydrobromide oral soln 1 $0 4 mg/ml galantamine hydrobromide tab 4 1 $0 QL (180 tabs / 30 days) mg galantamine hydrobromide tab 8 mg 1 $0 QL (90 tabs / 30 days) galantamine hydrobromide tab 12 1 $0 mg memantine hcl oral solution 2 1 $0 PA; PA if < 30 yrs mg/ml memantine hcl tab 5 mg 1 $0 PA; PA if < 30 yrs memantine hcl tab 10 mg 1 $0 PA; PA if < 30 yrs NAMENDA SOL 10MG/5ML 2 $0 PA; PA if < 30 yrs NAMENDA TAB 5MG 2 $0 PA; PA if < 30 yrs NAMENDA TAB 10MG 2 $0 PA; PA if < 30 yrs NAMENDA XR CAP 7MG 2 $0 PA; PA if < 30 yrs NAMENDA XR CAP 14MG 2 $0 PA; PA if < 30 yrs NAMENDA XR CAP 21MG 2 $0 PA; PA if < 30 yrs NAMENDA XR CAP 28MG 2 $0 PA; PA if < 30 yrs NAMENDA XR CAP TITRATIO 2 $0 PA; PA if < 30 yrs NAMZARIC CAP 14-10MG 2 $0 NAMZARIC CAP 28-10MG 2 $0 rivastigmine tartrate cap 1.5 mg 1 $0 rivastigmine tartrate cap 3 mg 1 $0 rivastigmine tartrate cap 4.5 mg 1 $0 rivastigmine tartrate cap 6 mg 1 $0 48

49 rivastigmine td patch 24hr 4.6 mg/24hr rivastigmine td patch 24hr 9.5 mg/24hr rivastigmine td patch 24hr 13.3 mg/24hr 抗抑鬱藥 - 治療抑鬱的藥物 藥物層級您為藥物支 付的費用 1 $0 QL (30 patches / 30 days) 1 $0 QL (30 patches / 30 days) 1 $0 QL (30 patches / 30 days) amitriptyline hcl tab 10 mg 2 $0 PA; PA if 65 years and amitriptyline hcl tab 25 mg 2 $0 PA; PA if 65 years and amitriptyline hcl tab 50 mg 2 $0 PA; PA if 65 years and amitriptyline hcl tab 75 mg 2 $0 PA; PA if 65 years and amitriptyline hcl tab 100 mg 2 $0 PA; PA if 65 years and amitriptyline hcl tab 150 mg 2 $0 PA; PA if 65 years and amoxapine tab 25 mg 1 $0 amoxapine tab 50 mg 1 $0 amoxapine tab 100 mg 1 $0 amoxapine tab 150 mg 1 $0 BRINTELLIX TAB 5MG 2 $0 QL (120 tabs / 30 days) BRINTELLIX TAB 10MG 2 $0 QL (60 tabs / 30 days) BRINTELLIX TAB 20MG 2 $0 QL (30 tabs / 30 days) bupropion hcl tab 75 mg 1 $0 bupropion hcl tab 100 mg 1 $0 bupropion hcl tab sr 12hr 100 mg 1 $0 bupropion hcl tab sr 12hr 150 mg 1 $0 bupropion hcl tab sr 12hr 200 mg 1 $0 bupropion hcl tab sr 24hr 150 mg 1 $0 QL (90 tabs / 30 days) bupropion hcl tab sr 24hr 300 mg 1 $0 QL (30 tabs / 30 days) citalopram hydrobromide oral soln 1 $0 10 mg/5ml citalopram hydrobromide tab 10 mg 1 $0 QL (45 tabs / 30 days) (base equiv) citalopram hydrobromide tab 20 mg 1 $0 QL (45 tabs / 30 days) (base equiv) citalopram hydrobromide tab 40 mg 1 $0 QL (30 tabs / 30 days) (base equiv) clomipramine hcl cap 25 mg 2 $0 PA; PA if 65 years and 49

50 clomipramine hcl cap 50 mg 2 $0 PA; PA if 65 years and clomipramine hcl cap 75 mg 2 $0 PA; PA if 65 years and desipramine hcl tab 10 mg 1 $0 desipramine hcl tab 25 mg 1 $0 desipramine hcl tab 50 mg 1 $0 desipramine hcl tab 75 mg 1 $0 desipramine hcl tab 100 mg 1 $0 desipramine hcl tab 150 mg 1 $0 doxepin hcl cap 10 mg 2 $0 PA; PA if 65 years and doxepin hcl cap 25 mg 2 $0 PA; PA if 65 years and doxepin hcl cap 50 mg 2 $0 PA; PA if 65 years and doxepin hcl cap 75 mg 2 $0 PA; PA if 65 years and doxepin hcl cap 100 mg 2 $0 PA; PA if 65 years and doxepin hcl cap 150 mg 2 $0 PA; PA if 65 years and doxepin hcl conc 10 mg/ml 2 $0 PA; PA if 65 years and duloxetine hcl enteric coated pellets 1 $0 QL (60 caps / 30 days) cap 20 mg duloxetine hcl enteric coated pellets 1 $0 QL (60 caps / 30 days) cap 30 mg duloxetine hcl enteric coated pellets 1 $0 QL (60 caps / 30 days) cap 60 mg EMSAM DIS 6MG/24HR 2 $0 QL (30 patches / 30 days), PA EMSAM DIS 9MG/24HR 2 $0 QL (30 patches / 30 days), PA EMSAM DIS 12MG/24H 2 $0 QL (30 patches / 30 days), PA escitalopram oxalate soln 5 mg/5ml 1 $0 QL (600 ml / 30 days) (base equiv) escitalopram oxalate tab 5 mg 1 $0 QL (45 tabs / 30 days) (base equiv) escitalopram oxalate tab 10 mg 1 $0 QL (45 tabs / 30 days) (base equiv) escitalopram oxalate tab 20 mg 1 $0 QL (60 tabs / 30 days) (base equiv) FETZIMA CAP 20MG 2 $0 QL (180 caps / 30 days) 50

51 FETZIMA CAP 40MG 2 $0 QL (90 caps / 30 days) FETZIMA CAP 80MG 2 $0 QL (30 caps / 30 days) FETZIMA CAP 120MG 2 $0 QL (30 caps / 30 days) FETZIMA CAP TITRATIO 2 $0 fluoxetine hcl cap 10 mg 1 $0 QL (30 caps / 30 days) fluoxetine hcl cap 20 mg 1 $0 QL (120 caps / 30 days) fluoxetine hcl cap 40 mg 1 $0 fluoxetine hcl solution 20 mg/5ml 1 $0 fluoxetine hcl tab 10 mg 1 $0 QL (45 tabs / 30 days) fluoxetine hcl tab 20 mg 1 $0 imipramine hcl tab 10 mg 2 $0 PA; PA if 65 years and imipramine hcl tab 25 mg 2 $0 PA; PA if 65 years and imipramine hcl tab 50 mg 2 $0 PA; PA if 65 years and maprotiline hcl tab 25 mg 1 $0 maprotiline hcl tab 50 mg 1 $0 maprotiline hcl tab 75 mg 1 $0 MARPLAN TAB 10MG 2 $0 QL (180 tabs / 30 days) mirtazapine orally disintegrating tab 1 $0 QL (30 tabs / 30 days) 15 mg mirtazapine orally disintegrating tab 1 $0 30 mg mirtazapine orally disintegrating tab 1 $0 45 mg mirtazapine tab 7.5 mg 1 $0 QL (45 tabs / 30 days) mirtazapine tab 15 mg 1 $0 QL (45 tabs / 30 days) mirtazapine tab 30 mg 1 $0 mirtazapine tab 45 mg 1 $0 nefazodone hcl tab 50 mg 1 $0 nefazodone hcl tab 100 mg 1 $0 nefazodone hcl tab 150 mg 1 $0 nefazodone hcl tab 200 mg 1 $0 nefazodone hcl tab 250 mg 1 $0 nortriptyline hcl cap 10 mg 1 $0 nortriptyline hcl cap 25 mg 1 $0 nortriptyline hcl cap 50 mg 1 $0 nortriptyline hcl cap 75 mg 1 $0 nortriptyline hcl soln 10 mg/5ml 1 $0 paroxetine hcl tab 10 mg 1 $0 QL (45 tabs / 30 days) paroxetine hcl tab 20 mg 1 $0 QL (45 tabs / 30 days) paroxetine hcl tab 30 mg 1 $0 QL (60 tabs / 30 days) 51

52 paroxetine hcl tab 40 mg 1 $0 QL (45 tabs / 30 days) PAXIL SUS 10MG/5ML 2 $0 QL (900 ml / 30 days) phenelzine sulfate tab 15 mg 1 $0 PRISTIQ TAB 25MG 2 $0 QL (30 tabs / 30 days) PRISTIQ TAB 50MG 2 $0 QL (30 tabs / 30 days) PRISTIQ TAB 100MG 2 $0 QL (30 tabs / 30 days) protriptyline hcl tab 5 mg 1 $0 protriptyline hcl tab 10 mg 1 $0 sertraline hcl oral conc 20 mg/ml 1 $0 sertraline hcl tab 25 mg 1 $0 QL (45 tabs / 30 days) sertraline hcl tab 50 mg 1 $0 QL (45 tabs / 30 days) sertraline hcl tab 100 mg 1 $0 SURMONTIL CAP 25MG 2 $0 QL (240 caps / 30 days), PA; PA if 65 years and SURMONTIL CAP 50MG 2 $0 QL (120 caps / 30 days), PA; PA if 65 years and SURMONTIL CAP 100MG 2 $0 QL (60 caps / 30 days), PA; PA if 65 years and tranylcypromine sulfate tab 10 mg 1 $0 trazodone hcl tab 50 mg 1 $0 trazodone hcl tab 100 mg 1 $0 trazodone hcl tab 150 mg 1 $0 trimipramine maleate cap 25 mg 2 $0 QL (240 caps / 30 days), PA; PA if 65 years and trimipramine maleate cap 50 mg 2 $0 QL (120 caps / 30 days), PA; PA if 65 years and trimipramine maleate cap 100 mg 2 $0 QL (60 caps / 30 days), PA; PA if 65 years and venlafaxine hcl cap sr 24hr 37.5 mg 1 $0 QL (30 caps / 30 days) (base equivalent) venlafaxine hcl cap sr 24hr 75 mg 1 $0 QL (30 caps / 30 days) (base equivalent) venlafaxine hcl cap sr 24hr 150 mg 1 $0 QL (60 caps / 30 days) (base equivalent) venlafaxine hcl tab 25 mg 1 $0 venlafaxine hcl tab 37.5 mg 1 $0 venlafaxine hcl tab 50 mg 1 $0 venlafaxine hcl tab 75 mg 1 $0 52

53 venlafaxine hcl tab 100 mg 1 $0 VIIBRYD KIT 2 $0 VIIBRYD KIT STARTER 2 $0 VIIBRYD TAB 10MG 2 $0 QL (30 tabs / 30 days) VIIBRYD TAB 20MG 2 $0 QL (30 tabs / 30 days) VIIBRYD TAB 40MG 2 $0 QL (30 tabs / 30 days) 抗帕金森病藥 - 治療帕金森病的藥物 amantadine hcl cap 100 mg 1 $0 amantadine hcl syrup 50 mg/5ml 1 $0 amantadine hcl tab 100 mg 1 $0 APOKYN INJ 10MG/ML 2 $0 NM, LA, PA AZILECT TAB 0.5MG 2 $0 AZILECT TAB 1MG 2 $0 BENZTROPINE MESYLATE INJ 1 1 $0 MG/ML benztropine mesylate tab 0.5 mg 2 $0 PA; PA if 65 years and benztropine mesylate tab 1 mg 2 $0 PA; PA if 65 years and benztropine mesylate tab 2 mg 2 $0 PA; PA if 65 years and bromocriptine mesylate cap 5 mg 1 $0 bromocriptine mesylate tab 2.5 mg 1 $0 carbidopa & levodopa orally 1 $0 disintegrating tab mg carbidopa & levodopa orally 1 $0 disintegrating tab mg carbidopa & levodopa orally 1 $0 disintegrating tab mg carbidopa & levodopa tab $0 mg carbidopa & levodopa tab $0 mg carbidopa & levodopa tab mg 1 $0 carbidopa & levodopa tab cr $0 mg carbidopa & levodopa tab cr $0 mg CARBIDOPA-LEVODOPA-ENTACAPO1 $0 NE TABS MG CARBIDOPA-LEVODOPA-ENTACAPO1 $0 NE TABS MG 53

54 CARBIDOPA-LEVODOPA-ENTACAPO1 $0 NE TABS MG CARBIDOPA-LEVODOPA-ENTACAPO1 $0 NE TABS MG CARBIDOPA-LEVODOPA-ENTACAPO1 $0 NE TABS MG CARBIDOPA-LEVODOPA-ENTACAPO1 $0 NE TABS MG ENTACAPONE TAB 200 MG 1 $0 NEUPRO DIS 1MG/24HR 2 $0 NEUPRO DIS 2MG/24HR 2 $0 NEUPRO DIS 3MG/24HR 2 $0 NEUPRO DIS 4MG/24HR 2 $0 NEUPRO DIS 6MG/24HR 2 $0 NEUPRO DIS 8MG/24HR 2 $0 pramipexole dihydrochloride tab 0.51 $0 mg pramipexole dihydrochloride tab 1 $ mg pramipexole dihydrochloride tab 1 $ mg pramipexole dihydrochloride tab mg 1 $0 pramipexole dihydrochloride tab 1 1 $0 mg pramipexole dihydrochloride tab 1.51 $0 mg ropinirole hydrochloride tab 0.5 mg 1 $0 ropinirole hydrochloride tab $0 mg ropinirole hydrochloride tab 1 mg 1 $0 ropinirole hydrochloride tab 2 mg 1 $0 ropinirole hydrochloride tab 3 mg 1 $0 ropinirole hydrochloride tab 4 mg 1 $0 ropinirole hydrochloride tab 5 mg 1 $0 selegiline hcl cap 5 mg 1 $0 selegiline hcl tab 5 mg 1 $0 trihexyphenidyl hcl elixir 0.4 mg/ml 2 $0 PA; PA if 65 years and trihexyphenidyl hcl tab 2 mg 2 $0 PA; PA if 65 years and trihexyphenidyl hcl tab 5 mg 2 $0 PA; PA if 65 years and 抗精神病藥 - 治療精神疾病的藥物 54

55 ABILIFY DISC TAB 10MG 2 $0 QL (60 tabs / 30 days) ABILIFY MAIN INJ 300MG 2 $0 QL (1 injection / 28 days) ABILIFY MAIN INJ 400MG 2 $0 QL (1 injection / 28 days) aripiprazole oral solution 1 mg/ml 2 $0 QL (900ml / 30 days) aripiprazole tab 2 mg 2 $0 QL (30 tabs / 30 days) aripiprazole tab 5 mg 2 $0 QL (30 tabs / 30 days) aripiprazole tab 10 mg 2 $0 QL (30 tabs / 30 days) aripiprazole tab 10mg odt 2 $0 QL (60 tabs / 30 days) aripiprazole tab 15 mg 2 $0 QL (30 tabs / 30 days) aripiprazole tab 15mg odt 2 $0 QL (60 tabs / 30 days) aripiprazole tab 20 mg 2 $0 QL (30 tabs / 30 days) aripiprazole tab 30 mg 2 $0 QL (30 tabs / 30 days) chlorpromaz inj 25mg/ml 2 $0 chlorpromaz inj 50mg/2ml 2 $0 chlorpromazine hcl tab 10 mg 1 $0 chlorpromazine hcl tab 25 mg 1 $0 chlorpromazine hcl tab 50 mg 1 $0 chlorpromazine hcl tab 100 mg 1 $0 chlorpromazine hcl tab 200 mg 1 $0 CLOZAPINE ORALLY 1 $0 PA DISINTEGRATING TAB 12.5 MG CLOZAPINE ORALLY 1 $0 PA DISINTEGRATING TAB 25 MG CLOZAPINE ORALLY DISINTEGRATING TAB 100 MG 1 $0 QL (270 tabs / 30 days), PA CLOZAPINE ORALLY DISINTEGRATING TAB 150 MG 2 $0 QL (180 tabs / 30 days), PA CLOZAPINE ORALLY DISINTEGRATING TAB 200 MG 2 $0 QL (135 tabs / 30 days), PA clozapine tab 25 mg 1 $0 clozapine tab 50 mg 1 $0 clozapine tab 100 mg 1 $0 QL (270 tabs / 30 days) clozapine tab 200 mg 1 $0 QL (135 tabs / 30 days) FANAPT PAK 2 $0 ST FANAPT TAB 1MG 2 $0 QL (60 tabs / 30 days), ST FANAPT TAB 2MG 2 $0 QL (60 tabs / 30 days), ST FANAPT TAB 4MG 2 $0 QL (60 tabs / 30 days), ST FANAPT TAB 6MG 2 $0 QL (60 tabs / 30 days), ST 55

56 FANAPT TAB 8MG 2 $0 QL (60 tabs / 30 days), ST FANAPT TAB 10MG 2 $0 QL (60 tabs / 30 days), ST FANAPT TAB 12MG 2 $0 QL (60 tabs / 30 days), ST FAZACLO TAB 150 ODT 2 $0 QL (180 tabs / 30 days), PA FAZACLO TAB 200 ODT 2 $0 QL (135 tabs / 30 days), PA fluphenazine decanoate inj 25 mg/ml 1 $0 fluphenazine hcl elixir 2.5 mg/5ml 1 $0 fluphenazine hcl inj 2.5 mg/ml 1 $0 fluphenazine hcl oral conc 5 mg/ml 1 $0 fluphenazine hcl tab 1 mg 1 $0 fluphenazine hcl tab 2.5 mg 1 $0 fluphenazine hcl tab 5 mg 1 $0 fluphenazine hcl tab 10 mg 1 $0 GEODON INJ 20MG 2 $0 QL (6 ml / 3 days) haloperidol decanoate im soln 50 mg/ml 1 $0 haloperidol decanoate im soln $0 mg/ml haloperidol lactate inj 5 mg/ml 1 $0 haloperidol lactate oral conc 2 1 $0 mg/ml haloperidol tab 0.5 mg 1 $0 haloperidol tab 1 mg 1 $0 haloperidol tab 2 mg 1 $0 haloperidol tab 5 mg 1 $0 haloperidol tab 10 mg 1 $0 haloperidol tab 20 mg 1 $0 INVEGA SUST INJ 39/ $0 QL (1 injection / 28 days) INVEGA SUST INJ 78/0.5ML 2 $0 QL (1 injection / 28 days) INVEGA SUST INJ 117/ $0 QL (1 injection / 28 days) INVEGA SUST INJ 156MG/ML 2 $0 QL (1 injection / 28 days) INVEGA SUST INJ 234/1.5 2 $0 QL (1 injection / 28 days) INVEGA TAB 1.5MG 2 $0 QL (30 tabs / 30 days) 56

57 INVEGA TAB 3MG 2 $0 QL (30 tabs / 30 days) INVEGA TAB 6MG 2 $0 QL (60 tabs / 30 days) INVEGA TAB 9MG 2 $0 QL (30 tabs / 30 days) INVEGA TRINZ INJ 273MG 2 $0 QL (1 syringe / 90 days) INVEGA TRINZ INJ 410MG 2 $0 QL (1 syringe / 90 days) INVEGA TRINZ INJ 546MG 2 $0 QL (1 syringe / 90 days) INVEGA TRINZ INJ 819MG 2 $0 QL (1 syringe / 90 days) LATUDA TAB 20MG 2 $0 QL (240 tabs / 30 days) LATUDA TAB 40MG 2 $0 QL (30 tabs / 30 days) LATUDA TAB 60MG 2 $0 QL (60 tabs / 30 days) LATUDA TAB 80MG 2 $0 QL (60 tabs / 30 days) LATUDA TAB 120MG 2 $0 QL (30 tabs / 30 days) loxapine succinate cap 5 mg 1 $0 loxapine succinate cap 10 mg 1 $0 loxapine succinate cap 25 mg 1 $0 loxapine succinate cap 50 mg 1 $0 molindone hcl tab 5 mg 1 $0 molindone hcl tab 10 mg 1 $0 molindone hcl tab 25 mg 1 $0 olanzapine for im inj 10 mg 1 $0 QL (3 vials / 1 day) olanzapine orally disintegrating tab 1 $0 QL (30 tabs / 30 days) 5 mg olanzapine orally disintegrating tab 1 $0 QL (60 tabs / 30 days) 10 mg olanzapine orally disintegrating tab 1 $0 QL (60 tabs / 30 days) 15 mg olanzapine orally disintegrating tab 1 $0 QL (60 tabs / 30 days) 20 mg olanzapine tab 2.5 mg 1 $0 QL (30 tabs / 30 days) olanzapine tab 5 mg 1 $0 QL (30 tabs / 30 days) olanzapine tab 7.5 mg 1 $0 QL (30 tabs / 30 days) olanzapine tab 10 mg 1 $0 QL (60 tabs / 30 days) olanzapine tab 15 mg 1 $0 QL (60 tabs / 30 days) olanzapine tab 20 mg 1 $0 QL (60 tabs / 30 days) ORAP TAB 1MG 2 $0 ORAP TAB 2MG 2 $0 paliperidone tab sr 24hr 1.5 mg 1 $0 QL (30 tabs / 30 days) paliperidone tab sr 24hr 3 mg 1 $0 QL (30 tabs / 30 days) paliperidone tab sr 24hr 6 mg 1 $0 QL (60 tabs / 30 days) paliperidone tab sr 24hr 9 mg 1 $0 QL (30 tabs / 30 days) perphenazine tab 2 mg 1 $0 perphenazine tab 4 mg 1 $0 57

58 perphenazine tab 8 mg 1 $0 perphenazine tab 16 mg 1 $0 pimozide tab 1 mg 1 $0 pimozide tab 2 mg 1 $0 quetiapine fumarate tab 25 mg 1 $0 QL (90 tabs / 30 days) quetiapine fumarate tab 50 mg 1 $0 QL (90 tabs / 30 days) quetiapine fumarate tab 100 mg 1 $0 QL (90 tabs / 30 days) quetiapine fumarate tab 200 mg 1 $0 QL (90 tabs / 30 days) quetiapine fumarate tab 300 mg 1 $0 QL (90 tabs / 30 days) quetiapine fumarate tab 400 mg 1 $0 QL (90 tabs / 30 days) REXULTI TAB 0.5MG 2 $0 QL (180 tabs / 30 days), ST REXULTI TAB 0.25MG 2 $0 QL (360 tabs / 30 days), ST REXULTI TAB 1MG 2 $0 QL (90 tabs / 30 days), ST REXULTI TAB 2MG 2 $0 QL (60 tabs / 30 days), ST REXULTI TAB 3MG 2 $0 QL (30 tabs / 30 days), ST REXULTI TAB 4MG 2 $0 QL (30 tabs / 30 days), ST RISPERDAL INJ 12.5MG 2 $0 QL (2 injections / 28 days) RISPERDAL INJ 25MG 2 $0 QL (2 injections / 28 days) RISPERDAL INJ 37.5MG 2 $0 QL (2 injections / 28 days) RISPERDAL INJ 50MG 2 $0 QL (2 injections / 28 days) risperidone orally disintegrating tab 1 $0 QL (90 tabs / 30 days) 0.5 mg risperidone orally disintegrating tab 1 $0 QL (90 tabs / 30 days) 0.25 mg risperidone orally disintegrating tab 1 $0 QL (60 tabs / 30 days) 1 mg risperidone orally disintegrating tab 1 $0 QL (60 tabs / 30 days) 2 mg risperidone orally disintegrating tab 1 $0 QL (60 tabs / 30 days) 3 mg risperidone orally disintegrating tab 1 $0 QL (120 tabs / 30 days) 4 mg risperidone soln 1 mg/ml 1 $0 QL (240 ml / 30 days) risperidone tab 0.5 mg 1 $0 QL (90 tabs / 30 days) risperidone tab 0.25 mg 1 $0 QL (90 tabs / 30 days) 58

59 risperidone tab 1 mg 1 $0 QL (60 tabs / 30 days) risperidone tab 2 mg 1 $0 QL (60 tabs / 30 days) risperidone tab 3 mg 1 $0 QL (60 tabs / 30 days) risperidone tab 4 mg 1 $0 QL (120 tabs / 30 days) SAPHRIS SUB 2.5MG 2 $0 QL (240 tabs / 30 days) SAPHRIS SUB 5MG 2 $0 QL (120 tabs / 30 days) SAPHRIS SUB 10MG 2 $0 QL (60 tabs / 30 days) SEROQUEL XR TAB 50MG 2 $0 QL (120 tabs / 30 days) SEROQUEL XR TAB 150MG 2 $0 QL (30 tabs / 30 days) SEROQUEL XR TAB 200MG 2 $0 QL (30 tabs / 30 days) SEROQUEL XR TAB 300MG 2 $0 QL (60 tabs / 30 days) SEROQUEL XR TAB 400MG 2 $0 QL (60 tabs / 30 days) thioridazine hcl tab 10 mg 2 $0 PA; PA if 65 years and thioridazine hcl tab 25 mg 2 $0 PA; PA if 65 years and thioridazine hcl tab 50 mg 2 $0 PA; PA if 65 years and thioridazine hcl tab 100 mg 2 $0 PA; PA if 65 years and thiothixene cap 1 mg 1 $0 thiothixene cap 2 mg 1 $0 thiothixene cap 5 mg 1 $0 thiothixene cap 10 mg 1 $0 trifluoperazine hcl tab 1 mg 1 $0 trifluoperazine hcl tab 2 mg 1 $0 trifluoperazine hcl tab 5 mg 1 $0 trifluoperazine hcl tab 10 mg 1 $0 VERSACLOZ SUS 50MG/ML 2 $0 QL (600 ml / 30 days), PA ziprasidone hcl cap 20 mg 1 $0 QL (60 caps / 30 days) ziprasidone hcl cap 40 mg 1 $0 QL (60 caps / 30 days) ziprasidone hcl cap 60 mg 1 $0 QL (90 caps / 30 days) ziprasidone hcl cap 80 mg 1 $0 QL (90 caps / 30 days) ZYPREXA RELP INJ 210MG 2 $0 QL (2 vials / 28 days), PA ZYPREXA RELP INJ 300MG 2 $0 QL (2 vials / 28 days), PA ZYPREXA RELP INJ 405MG 2 $0 QL (1 vial / 28 days), PA 注意缺陷障礙伴多動症 - 治療注意缺陷多動障礙的藥物 amphetamine-dextroamphetamine cap sr 24hr 5 mg 1 $0 QL (90 caps / 30 days) 59

60 amphetamine-dextroamphetamine 1 $0 QL (90 caps / 30 days) cap sr 24hr 10 mg amphetamine-dextroamphetamine 1 $0 QL (30 caps / 30 days) cap sr 24hr 15 mg amphetamine-dextroamphetamine 1 $0 QL (30 caps / 30 days) cap sr 24hr 20 mg amphetamine-dextroamphetamine 1 $0 QL (30 caps / 30 days) cap sr 24hr 25 mg amphetamine-dextroamphetamine 1 $0 QL (30 caps / 30 days) cap sr 24hr 30 mg amphetamine-dextroamphetamine 1 $0 QL (360 tabs / 30 days) tab 5 mg amphetamine-dextroamphetamine 1 $0 QL (240 tabs / 30 days) tab 7.5 mg amphetamine-dextroamphetamine 1 $0 QL (180 tabs / 30 days) tab 10 mg amphetamine-dextroamphetamine 1 $0 QL (144 tabs / 30 days) tab 12.5 mg amphetamine-dextroamphetamine 1 $0 QL (120 tabs / 30 days) tab 15 mg amphetamine-dextroamphetamine 1 $0 QL (90 tabs / 30 days) tab 20 mg amphetamine-dextroamphetamine 1 $0 QL (60 tabs / 30 days) tab 30 mg guanfacine hcl tab sr 24hr 1 mg (base equiv) 2 $0 PA; PA if 65 years and guanfacine hcl tab sr 24hr 2 mg (base equiv) 2 $0 PA; PA if 65 years and guanfacine hcl tab sr 24hr 3 mg (base equiv) 2 $0 PA; PA if 65 years and guanfacine hcl tab sr 24hr 4 mg (base equiv) 2 $0 PA; PA if 65 years and methylphenidate hcl soln 5 mg/5ml 1 $0 QL (1800 ml / 30 days) methylphenidate hcl soln 10 1 $0 QL (900 ml / 30 days) mg/5ml methylphenidate hcl tab 5 mg 1 $0 QL (180 tabs / 30 days) methylphenidate hcl tab 10 mg 1 $0 QL (180 tabs / 30 days) methylphenidate hcl tab 20 mg 1 $0 QL (90 tabs / 30 days) methylphenidate hcl tab cr 10 mg 1 $0 QL (90 tabs / 30 days) methylphenidate hcl tab cr 20 mg 1 $0 QL (90 tabs / 30 days) STRATTERA CAP 10MG 2 $0 QL (120 caps / 30 days) STRATTERA CAP 18MG 2 $0 QL (120 caps / 30 days) STRATTERA CAP 25MG 2 $0 QL (120 caps / 30 days) STRATTERA CAP 40MG 2 $0 QL (60 caps / 30 days) STRATTERA CAP 60MG 2 $0 QL (30 caps / 30 days) 60

61 STRATTERA CAP 80MG 2 $0 QL (30 caps / 30 days) STRATTERA CAP 100MG 2 $0 QL (30 caps / 30 days) 安眠藥 - 治療失眠的藥物 HETLIOZ CAP 20MG 2 $0 NM, LA, PA ROZEREM TAB 8MG 2 $0 QL (30 tabs / 30 days) SILENOR TAB 3MG 2 $0 QL (60 tabs / 30 days) SILENOR TAB 6MG 2 $0 QL (30 tabs / 30 days) temazepam cap 7.5 mg 1 $0 QL (30 caps / 30 days), PA; PA applies if 65 years and after a 90 day supply in a calendar year temazepam cap 15 mg 1 $0 QL (60 caps / 30 days), PA; PA applies if 65 years and after a 90 day supply in a calendar year zolpidem tartrate tab 5 mg 2 $0 QL (30 tabs / 30 days), PA; PA applies if 65 years and after a 90 day supply in a calendar year zolpidem tartrate tab 10 mg 2 $0 QL (30 tabs / 30 days), PA; PA applies if 65 years and after a 90 day supply in a calendar year 偏頭痛藥 - 治療劇烈頭痛的藥物 dihydroergotamine mesylate inj 1 1 $0 mg/ml naratriptan hcl tab 1 mg (base 1 $0 QL (9 tabs / 30 days) equiv) naratriptan hcl tab 2.5 mg (base 1 $0 QL (9 tabs / 30 days) equiv) RELPAX TAB 20MG 2 $0 QL (12 tabs / 30 days) RELPAX TAB 40MG 2 $0 QL (12 tabs / 30 days) rizatriptan benzoate orally 1 $0 QL (18 tabs / 30 days) disintegrating tab 5 mg rizatriptan benzoate orally 1 $0 QL (18 tabs / 30 days) disintegrating tab 10 mg rizatriptan benzoate tab 5 mg 1 $0 QL (18 tabs / 30 days) rizatriptan benzoate tab 10 mg 1 $0 QL (18 tabs / 30 days) SUMATRIPTAN NASAL SPRAY 5 MG/ACT 1 $0 QL (24 inhalers / 30 days) 61

62 SUMATRIPTAN NASAL SPRAY 20 MG/ACT 1 $0 QL (12 inhalers / 30 days) sumatriptan succinate inj 6 mg/0.5ml 1 $0 QL (12 injections / 30 days) SUMATRIPTAN SUCCINATE SOLUTION AUTO-INJECTOR 4 1 $0 QL (12 injections / 30 days) MG/0.5ML sumatriptan succinate solution auto-injector 6 mg/0.5ml 1 $0 QL (12 injections / 30 days) SUMATRIPTAN SUCCINATE 1 $0 QL (12 injections / 30 SOLUTION CARTRIDGE 4 MG/0.5ML days) SUMATRIPTAN SUCCINATE 1 $0 QL (12 injections / 30 SOLUTION CARTRIDGE 6 MG/0.5ML days) sumatriptan succinate solution prefilled syringe 6 mg/0.5ml 1 $0 QL (12 injections / 30 days) sumatriptan succinate tab 25 mg 1 $0 QL (9 tabs / 30 days) sumatriptan succinate tab 50 mg 1 $0 QL (9 tabs / 30 days) sumatriptan succinate tab 100 mg 1 $0 QL (9 tabs / 30 days) zolmitriptan orally disintegrating 1 $0 QL (12 tabs / 30 days) tab 2.5 mg zolmitriptan orally disintegrating 1 $0 QL (12 tabs / 30 days) tab 5 mg zolmitriptan tab 2.5 mg 1 $0 QL (12 tabs / 30 days) zolmitriptan tab 5 mg 1 $0 QL (12 tabs / 30 days) 雜類 lithium carbonate cap 150 mg 1 $0 lithium carbonate cap 300 mg 1 $0 lithium carbonate cap 600 mg 1 $0 lithium carbonate tab 300 mg 1 $0 lithium carbonate tab cr 300 mg 1 $0 lithium carbonate tab cr 450 mg 1 $0 LITHIUM SOL 8MEQ/5ML 2 $0 NUEDEXTA CAP 20-10MG 2 $0 PA pyridostigmine bromide tab 60 mg 1 $0 riluzole tab 50 mg 1 $0 tetrabenazine tab 12.5 mg 2 $0 QL (240 tabs / 30 days), NM, PA tetrabenazine tab 25 mg 2 $0 QL (120 tabs / 30 days), NM, PA XENAZINE TAB 12.5MG 2 $0 QL (240 tabs / 30 days), NM, LA, PA XENAZINE TAB 25MG 2 $0 QL (120 tabs / 30 days), NM, LA, PA 多發性硬化劑 - 治療多發性硬化的藥物 62

63 AMPYRA TAB 10MG 2 $0 NM, LA, PA BETASERON INJ 0.3MG 2 $0 QL (14 syringes / 28 days), NM, PA COPAXONE INJ 40MG/ML 2 $0 QL (12 syringes / 28 days), NM, PA GILENYA CAP 0.5MG 2 $0 QL (28 caps / 28 days), NM, PA glatopa inj 20mg/ml 2 $0 QL (30 syringes / 30 days), NM, PA TYSABRI INJ 300/15ML 2 $0 NM, LA, PA 肌肉骨骼治療藥物 - 治療肌肉痙攣的藥物 baclofen tab 10 mg 1 $0 baclofen tab 20 mg 1 $0 dantrolene sodium cap 25 mg 1 $0 dantrolene sodium cap 50 mg 1 $0 dantrolene sodium cap 100 mg 1 $0 tizanidine hcl tab 2 mg (base 1 $0 equivalent) tizanidine hcl tab 4 mg (base equivalent) 1 $0 發作性睡病 / 猝倒症 - 治療睡眠紊亂的藥物 NUVIGIL TAB 50MG 2 $0 QL (150 tabs / 30 days), PA NUVIGIL TAB 150MG 2 $0 QL (60 tabs / 30 days), PA NUVIGIL TAB 200MG 2 $0 QL (30 tabs / 30 days), PA NUVIGIL TAB 250MG 2 $0 QL (30 tabs / 30 days), PA XYREM SOL 500MG/ML 2 $0 QL (540 ml / 30 days), LA, PA 精神療法藥 - 雜類 acamprosate calcium tab delayed release 333 mg 1 $0 buprenorphine hcl sl tab 2 mg (base 1 $0 PA equiv) buprenorphine hcl sl tab 8 mg (base 1 $0 PA equiv) buprenorphine hcl-naloxone hcl sl tab mg (base equiv) 1 $0 QL (120 tabs / 30 days), PA buprenorphine hcl-naloxone hcl sl tab 8-2 mg (base equiv) 1 $0 QL (120 tabs / 30 days), PA buproban tab 150mg 1 $0 bupropion hcl (smoking deterrent) 1 $0 tab sr 12hr 150 mg 63

64 CHANTIX PAK 0.5& 1MG 2 $0 PA CHANTIX PAK 1MG 2 $0 PA CHANTIX TAB 0.5MG 2 $0 PA CHANTIX TAB 1MG 2 $0 PA disulfiram tab 250 mg 1 $0 disulfiram tab 500 mg 1 $0 headache tab mg 3 $0 NM; * ibuprofen pm tab mg 3 $0 NM; * naloxone hcl inj 0.4 mg/ml 1 $0 naloxone hcl inj 1 mg/ml 1 $0 naltrexone hcl tab 50 mg 1 $0 nicotine polacrilex gum 2 mg 3 $0 NM; * nicotine polacrilex gum 4 mg 3 $0 NM; * nicotine polacrilex lozenge 2 mg 3 $0 NM; * NICOTINE POLACRILEX LOZENGE 23 $0 NM; * MG nicotine polacrilex lozenge 4 mg 3 $0 NM; * NICOTINE POLACRILEX LOZENGE 43 $0 NM; * MG NICOTINE SYS KIT TRANSDER 3 $0 NM; * nicotine td patch 24hr 7 mg/24hr 3 $0 NM; * nicotine td patch 24hr 14 mg/24hr 3 $0 NM; * nicotine td patch 24hr 21 mg/24hr 3 $0 NM; * NICOTROL INH 2 $0 NICOTROL NS SPR 10MG/ML 2 $0 pain relf pm tab mg 3 $0 NM; * sleep aid tab 25mg 3 $0 NM; * SUBOXONE MIS 2-0.5MG 2 $0 QL (120 SL films / 30 days), PA SUBOXONE MIS 4-1MG 2 $0 QL (120 SL films / 30 days), PA SUBOXONE MIS 8-2MG 2 $0 QL (120 SL films / 30 days), PA SUBOXONE MIS 12-3MG 2 $0 QL (60 SL films / 30 days), PA wal-som cap 50mg 3 $0 NM; * 內分泌和新陳代謝藥 - 治療糖尿病和調節激素的藥物 雄激素 - 調節雄性激素的藥物 ANDRODERM DIS 2MG/24HR 2 $0 QL (30 patches / 30 days), PA ANDRODERM DIS 4MG/24HR 2 $0 QL (30 patches / 30 days), PA 64

65 AXIRON SOL 30MG/ACT 2 $0 QL (440 ml / 30 days), PA oxandrolone tab 2.5 mg 1 $0 PA oxandrolone tab 10 mg 2 $0 PA testosterone cypionate im inj in oil 1 $0 PA 100 mg/ml testosterone cypionate im inj in oil 1 $0 PA 200 mg/ml testosterone enanthate im inj in oil 1 $0 PA 200 mg/ml 抗糖尿病藥, 注射劑 - 治療糖尿病的藥物 ALCOHOL SWABS 2 $0 BYDUREON INJ 2 $0 QL (4 pens / 28 days) BYDUREON INJ 2 $0 QL (4 vials / 28 days) BYETTA INJ 5MCG 2 $0 QL (1 pen / 30 days) BYETTA INJ 10MCG 2 $0 QL (1 pen / 30 days) GAUZE PADS 2" X 2" 2 $0 HUMULIN R INJ U $0 B/D INSULIN PEN NEEDLE 2 $0 INSULIN SAFETY NEEDLES 2 $0 INSULIN SYRINGE 2 $0 LANTUS INJ 100/ML 2 $0 LANTUS INJ SOLOSTAR 2 $0 LEVEMIR INJ 2 $0 LEVEMIR INJ FLEXTOUC 2 $0 NOVOLIN INJ 70/30 2 $0 RELION not covered NOVOLIN N INJ U $0 RELION not covered NOVOLIN R INJ U $0 RELION not covered NOVOLOG INJ 100/ML 2 $0 NOVOLOG INJ FLEXPEN 2 $0 NOVOLOG INJ PENFILL 2 $0 NOVOLOG MIX INJ 70/30 2 $0 NOVOLOG MIX INJ FLEXPEN 2 $0 SYMLINPEN 60 INJ 1000MCG 2 $0 QL (8 pens / 30 days), PA SYMLNPEN 120 INJ 1000MCG 2 $0 QL (4 pens / 30 days), PA TOUJEO SOLO INJ 300IU/ML 2 $0 TRESIBA FLEX INJ 100UNIT 2 $0 TRESIBA FLEX INJ 200UNIT 2 $0 TRULICITY INJ 0.75/0.5 2 $0 QL (4 pens / 28 days) TRULICITY INJ 1.5/0.5 2 $0 QL (4 pens / 28 days) VICTOZA INJ 18MG/3ML 2 $0 QL (3 pens / 30 days) 65

66 抗糖尿病藥, 口服劑 - 治療糖尿病的藥物 acarbose tab 25 mg 1 $0 acarbose tab 50 mg 1 $0 acarbose tab 100 mg 1 $0 FARXIGA TAB 5MG 2 $0 QL (60 tabs / 30 days) FARXIGA TAB 10MG 2 $0 QL (30 tabs / 30 days) glimepiride tab 1 mg 1 $0 QL (240 tabs / 30 days) glimepiride tab 2 mg 1 $0 QL (120 tabs / 30 days) glimepiride tab 4 mg 1 $0 QL (60 tabs / 30 days) glipizide tab 5 mg 1 $0 QL (240 tabs / 30 days) glipizide tab 10 mg 1 $0 QL (120 tabs / 30 days) glipizide tab sr 24hr 2.5 mg 1 $0 QL (240 tabs / 30 days) GLIPIZIDE TAB SR 24HR 2.5 MG 1 $0 QL (240 tabs / 30 days) glipizide tab sr 24hr 5 mg 1 $0 QL (120 tabs / 30 days) glipizide tab sr 24hr 10 mg 1 $0 QL (60 tabs / 30 days) GLIPIZIDE XL TAB 5MG 1 $0 QL (120 tabs / 30 days) glipizide-metformin hcl tab $0 QL (240 tabs / 30 days) mg glipizide-metformin hcl tab $0 QL (120 tabs / 30 days) mg glipizide-metformin hcl tab $0 QL (120 tabs / 30 days) mg INVOKAMET TAB MG 2 $0 QL (120 tabs / 30 days) INVOKAMET TAB $0 QL (60 tabs / 30 days) INVOKAMET TAB $0 QL (60 tabs / 30 days) INVOKAMET TAB $0 QL (60 tabs / 30 days) INVOKANA TAB 100MG 2 $0 QL (90 tabs / 30 days) INVOKANA TAB 300MG 2 $0 QL (30 tabs / 30 days) JANUMET TAB MG 2 $0 QL (60 tabs / 30 days) JANUMET TAB $0 QL (60 tabs / 30 days) JANUMET XR TAB MG 2 $0 QL (60 tabs / 30 days) JANUMET XR TAB $0 QL (60 tabs / 30 days) JANUMET XR TAB $0 QL (30 tabs / 30 days) JANUVIA TAB 25MG 2 $0 QL (30 tabs / 30 days) JANUVIA TAB 50MG 2 $0 QL (30 tabs / 30 days) JANUVIA TAB 100MG 2 $0 QL (30 tabs / 30 days) JENTADUETO TAB $0 QL (60 tabs / 30 days) JENTADUETO TAB $0 QL (60 tabs / 30 days) JENTADUETO TAB $0 QL (60 tabs / 30 days) metformin hcl tab 500 mg 1 $0 QL (150 tabs / 30 days) metformin hcl tab 850 mg 1 $0 QL (90 tabs / 30 days) metformin hcl tab 1000 mg 1 $0 QL (75 tabs / 30 days) 66

67 metformin hcl tab sr 24hr 500 mg 1 $0 QL (120 tabs / 30 days) metformin hcl tab sr 24hr 750 mg 1 $0 QL (60 tabs / 30 days) nateglinide tab 60 mg 1 $0 QL (90 tabs / 30 days) nateglinide tab 120 mg 1 $0 QL (90 tabs / 30 days) pioglitazone hcl tab 15 mg (base 1 $0 QL (30 tabs / 30 days) equiv) pioglitazone hcl tab 30 mg (base 1 $0 QL (30 tabs / 30 days) equiv) pioglitazone hcl tab 45 mg (base 1 $0 QL (30 tabs / 30 days) equiv) repaglinide tab 0.5 mg 1 $0 QL (120 tabs / 30 days) repaglinide tab 1 mg 1 $0 QL (120 tabs / 30 days) repaglinide tab 2 mg 1 $0 QL (240 tabs / 30 days) TRADJENTA TAB 5MG 2 $0 QL (30 tabs / 30 days) XIGDUO XR TAB 5-500MG 2 $0 QL (60 tabs / 30 days) XIGDUO XR TAB MG 2 $0 QL (60 tabs / 30 days) XIGDUO XR TAB MG 2 $0 QL (30 tabs / 30 days) XIGDUO XR TAB $0 QL (30 tabs / 30 days) 二膦酸鹽 - 治療骨質疏鬆的藥物 alendronate sodium tab 5 mg 1 $0 alendronate sodium tab 10 mg 1 $0 alendronate sodium tab 35 mg 1 $0 QL (4 tabs / 28 days) alendronate sodium tab 40 mg 1 $0 alendronate sodium tab 70 mg 1 $0 QL (4 tabs / 28 days) ibandronate sodium tab 150 mg (base equivalent) 1 $0 B/D, QL (1 tab / 30 days) pamidronate disodium iv soln 3 1 $0 B/D mg/ml pamidronate disodium iv soln 9 1 $0 B/D mg/ml pamidronate inj 6mg/ml 1 $0 B/D zoledronic acid inj conc for iv infusion 4 mg/5ml 1 $0 B/D, NM zoledronic acid iv soln 5 mg/100ml 1 $0 B/D, NM 鈣感受器興奮劑 SENSIPAR TAB 30MG 2 $0 QL (120 tabs / 30 days), NM SENSIPAR TAB 60MG 2 $0 QL (60 tabs / 30 days), NM SENSIPAR TAB 90MG 2 $0 QL (120 tabs / 30 days), NM 螯合劑 CHEMET CAP 100MG 2 $0 67

68 DEPEN TITRA TAB 250MG 2 $0 EXJADE TAB 125MG 2 $0 NM, LA, PA EXJADE TAB 250MG 2 $0 NM, LA, PA EXJADE TAB 500MG 2 $0 NM, LA, PA FERRIPROX SOL 100MG/ML 2 $0 NM, LA, PA FERRIPROX TAB 500MG 2 $0 NM, LA, PA kionex pow 1 $0 kionex sus 15gm/60 1 $0 sodium polystyrene sulfonate oral 1 $0 susp 15 gm/60ml sodium polystyrene sulfonate 1 $0 powder SYPRINE CAP 250MG 2 $0 避孕藥 - 避孕藥物 altavera tab 1 $0 apri tab 1 $0 aranelle tab 1 $0 aubra tab $0 aviane tab 1 $0 balziva tab 1 $0 bekyree tab 1 $0 blisovi fe tab 1/20 1 $0 briellyn tab 1 $0 camila tab 0.35mg 1 $0 cryselle-28 tab 28 tabs 1 $0 cyclafem tab 1/35 1 $0 cyclafem tab 7/7/7 1 $0 deblitane tab 0.35mg 1 $0 delyla tab $0 desogest-eth estrad & eth estrad tab /0.01 mg(21/5) 1 $0 desogestrel & ethinyl estradiol tab 1 $ mg-30 mcg drospirenone-ethinyl estradiol tab 1 $ mg DROSPIRENONE-ETHINYL 1 $0 ESTRADIOL TAB MG drospirenone-ethinyl estradiol tab 1 $ mg DROSPIRENONE-ETHINYL 1 $0 ESTRADIOL TAB MG ELLA TAB 30MG 2 $0 emoquette tab 1 $0 68

69 enpresse-28 tab 1 $0 errin tab 0.35mg 1 $0 falmina tab 1 $0 gildagia tab $0 gildess tab 1.5/30 1 $0 heather tab 0.35mg 1 $0 introvale tab 1 $0 JOLIVETTE TAB 0.35MG 1 $0 junel 1.5/30 tab 1 $0 junel 1/20 tab 1 $0 junel fe tab 1.5/30 1 $0 junel fe tab 1/20 1 $0 kariva tab 28 day 1 $0 kelnor tab 1/35 1 $0 kimidess tab 1 $0 larin fe tab 1.5/30 1 $0 larin fe tab 1/20 1 $0 larin tab 1.5/30 1 $0 larin tab 1/20 1 $0 lessina tab 1 $0 levonest tab 1 $0 levonorgestrel & ethinyl estradiol 1 $0 (91-day) tab mg LEVONORGESTREL & ETHINYL 1 $0 ESTRADIOL (91-DAY) TAB MG levonorgestrel & ethinyl estradiol 1 $0 tab 0.1 mg-20 mcg levonorgestrel tab 0.75 mg 1 $0 levonorgestrel tab 1.5 mg 1 $0 levonorgestrel-eth estra tab 1 $ / / mg-mc g levora-28 tab 0.15/30 1 $0 loryna tab mg 1 $0 lutera tab 1 $0 lyza tab 0.35mg 1 $0 marlissa tab 0.15/30 1 $0 medroxyprogesterone acetate im 1 $0 susp 150 mg/ml MONONESSA TAB 1 $0 my way tab 1.5mg 3 $0 NM; * myzilra tab 1 $0 69

70 藥物層級您為藥物支 付的費用 necon tab 0.5/35 1 $0 necon tab 1/35 1 $0 NECON TAB 1/ $0 NECON TAB 7/7/7 1 $0 necon tab 10/ $0 nikki tab mg 1 $0 norelgestromin-ethinyl estradiol td 1 $0 ptwk mcg/24hr NORETHINDRONE ACE & ETHINYL 1 $0 ESTRADIOL TAB 1 MG-20 MCG NORETHINDRONE ACE & ETHINYL 1 $0 ESTRADIOL TAB 1.5 MG-30 MCG NORETHINDRONE ACE & ETHINYL 1 $0 ESTRADIOL-FE TAB 1 MG-20 MCG NORETHINDRONE ACE & ETHINYL 1 $0 ESTRADIOL-FE TAB 1.5 MG-30 MCG norethindrone tab 0.35 mg 1 $0 NORETHINDRONE TAB 0.35 MG 1 $0 NORETHINDRONE-ETH ESTRADIOL 1 $0 TAB /1-35/ MG-MCG norgestimate & ethinyl estradiol tab 1 $ mg-35 mcg norgestimate-eth estrad tab 1 $ / / mg-mcg norgestrel & ethinyl estradiol tab 1 $0 0.3 mg-30 mcg norlyroc tab 0.35mg 1 $0 nortrel tab 0.5/35 1 $0 nortrel tab 1/35 1 $0 nortrel tab 7/7/7 1 $0 NUVARING MIS 2 $0 orsythia tab 1 $0 philith tab $0 pimtrea tab 1 $0 pirmella tab 1/35 1 $0 portia-28 tab 1 $0 previfem tab 1 $0 quasense tab 1 $0 reclipsen tab 1 $0 sharobel tab 0.35mg 1 $0 SOLIA TAB 1 $0 sprintec 28 tab 28 day 1 $0 tarina fe tab 1/20 1 $0 70

71 藥物層級您為藥物支 付的費用 tri-legest tab fe 1 $0 tri-previfem tab 1 $0 tri-sprintec tab 1 $0 TRINESSA TAB 1 $0 trivora-28 tab 1 $0 velivet pak 1 $0 viorele tab 1 $0 vyfemla tab $0 zarah tab mg 1 $0 zenchent tab 1 $0 zovia 1/35e tab 1 $0 zovia 1/50e tab 1 $0 子宮內膜異位 danazol cap 50 mg 1 $0 danazol cap 100 mg 1 $0 danazol cap 200 mg 1 $0 SYNAREL SOL 2MG/ML 2 $0 酶替代品 - 治療酶缺乏的藥物 ADAGEN INJ 250/ML 2 $0 NM, LA, PA ALDURAZYME INJ 2.9MG/5M 2 $0 NM, LA, PA CARBAGLU TAB 200MG 2 $0 NM, LA, PA CERDELGA CAP 84MG 2 $0 NM, PA CEREZYME INJ 200UNIT 2 $0 NM, LA, PA CEREZYME INJ 400UNIT 2 $0 NM, LA, PA CYSTADANE POW 2 $0 NM, LA CYSTAGON CAP 50MG 2 $0 NM, LA, PA CYSTAGON CAP 150MG 2 $0 NM, LA, PA FABRAZYME INJ 5MG 2 $0 NM, LA, PA FABRAZYME INJ 35MG 2 $0 NM, LA, PA KUVAN POW 100MG 2 $0 NM, LA, PA KUVAN POW 500MG 2 $0 NM, LA, PA KUVAN TAB 100MG 2 $0 NM, LA, PA levocarnitine inj 200 mg/ml 1 $0 B/D levocarnitine oral soln 1 gm/10ml 1 $0 B/D (10%) levocarnitine tab 330 mg 1 $0 B/D LUMIZYME INJ 50MG 2 $0 NM, LA, PA MYOZYME INJ 50MG 2 $0 NM, LA, PA NAGLAZYME INJ 1MG/ML 2 $0 NM, LA, PA ORFADIN CAP 2MG 2 $0 NM, LA, PA ORFADIN CAP 5MG 2 $0 NM, LA, PA 71

72 ORFADIN CAP 10MG 2 $0 NM, LA, PA RAVICTI LIQ 1.1GM/ML 2 $0 NM, PA sodium phenylbutyrate oral powder 2 $0 NM 3 gm/teaspoonful ZAVESCA CAP 100MG 2 $0 NM, LA, PA 雌激素 - 調節雌性激素的藥物 DELESTROGEN INJ 10MG/ML 2 $0 estrace vag cre 0.1mg/gm 2 $0 estradiol tab 0.5 mg 2 $0 PA; PA if 65 years and estradiol tab 1 mg 2 $0 PA; PA if 65 years and estradiol tab 2 mg 2 $0 PA; PA if 65 years and estradiol td patch weekly 0.1 mg/24hr 2 $0 PA; PA if 65 years and estradiol td patch weekly 0.05 mg/24hr 2 $0 PA; PA if 65 years and estradiol td patch weekly 0.06 mg/24hr 2 $0 PA; PA if 65 years and estradiol td patch weekly mg/24hr 2 $0 PA; PA if 65 years and estradiol td patch weekly mg/24hr 2 $0 PA; PA if 65 years and estradiol td patch weekly mg/24hr (37.5 mcg/24hr) 2 $0 PA; PA if 65 years and estradiol valerate im in oil 20 mg/ml 1 $0 estradiol valerate im in oil 40 mg/ml 1 $0 jinteli tab 1mg-5mcg 2 $0 PA; PA if 65 years and norethindrone acetate-ethinyl estradiol tab 1 mg-5 mcg 2 $0 PA; PA if 65 years and VAGIFEM TAB 10MCG 2 $0 糖皮質激素 - 治療炎症反應的藥物 a-hydrocort inj 100mg 1 $0 cortisone acetate tab 25 mg 1 $0 dexamethason con 1mg/ml 1 $0 dexamethasone elixir 0.5 mg/5ml 1 $0 dexamethasone sod phosphate preservative free inj 10 mg/ml 1 $0 dexamethasone sodium phosphate 1 $0 inj 10 mg/ml dexamethasone sodium phosphate 1 $0 inj 20 mg/5ml 72

73 dexamethasone sodium phosphate 1 $0 inj 100 mg/10ml dexamethasone sodium phosphate 1 $0 inj 120 mg/30ml dexamethasone soln 0.5 mg/5ml 1 $0 dexamethasone tab 0.5 mg 1 $0 dexamethasone tab 0.75 mg 1 $0 dexamethasone tab 1 mg 1 $0 dexamethasone tab 1.5 mg 1 $0 dexamethasone tab 2 mg 1 $0 dexamethasone tab 4 mg 1 $0 dexamethasone tab 6 mg 1 $0 fludrocortisone acetate tab 0.1 mg 1 $0 hydrocortisone tab 5 mg 1 $0 hydrocortisone tab 10 mg 1 $0 hydrocortisone tab 20 mg 1 $0 methylprednisolone acetate inj susp 1 $0 B/D 40 mg/ml methylprednisolone acetate inj susp 1 $0 B/D 80 mg/ml methylprednisolone sodium 1 $0 B/D succinate for inj 40 mg methylprednisolone sodium 1 $0 B/D succinate for inj 125 mg methylprednisolone sodium 1 $0 B/D succinate for inj 1000 mg methylprednisolone tab 4 mg 1 $0 B/D methylprednisolone tab 4 mg dose 1 $0 B/D pack methylprednisolone tab 8 mg 1 $0 B/D methylprednisolone tab 16 mg 1 $0 B/D methylprednisolone tab 32 mg 1 $0 B/D prednisolone sod phosph oral soln 1 $0 B/D 6.7 mg/5ml (5 mg/5ml base) prednisolone sod phosphate oral soln 15 mg/5ml (base equiv) 1 $0 B/D prednisolone sodium phosphate oral 1 $0 B/D soln 25 mg/5ml (base eq) prednisolone syrup 15 mg/5ml (usp 1 $0 B/D solution equivalent) prednisone con 5mg/ml 2 $0 B/D prednisone oral soln 5 mg/5ml 1 $0 B/D prednisone tab 1 mg 1 $0 B/D prednisone tab 2.5 mg 1 $0 B/D 73

74 prednisone tab 5 mg 1 $0 B/D prednisone tab 5 mg dose pack 1 $0 B/D prednisone tab 10 mg 1 $0 B/D prednisone tab 10 mg dose pack 1 $0 B/D prednisone tab 20 mg 1 $0 B/D prednisone tab 50 mg 1 $0 B/D SOLU-CORTEF INJ 250MG 2 $0 葡萄糖提升劑 - 治療低血糖的藥物 GLUCAGEN INJ HYPOKIT 2 $0 GLUCAGON KIT 1MG 2 $0 KORLYM TAB 300MG 2 $0 NM, LA, PA PROGLYCEM SUS 50MG/ML 2 $0 生長激素 - 調節垂體激素的藥物 NORDITROPIN INJ 5/1.5ML 2 $0 NM, PA NORDITROPIN INJ 10/1.5ML 2 $0 NM, PA NORDITROPIN INJ 15/1.5ML 2 $0 NM, PA NORDITROPIN INJ 30/3ML 2 $0 NM, PA 雜類 cabergoline tab 0.5 mg 1 $0 calcitonin (salmon) nasal soln $0 unit/act FORTICAL SPR 200/ACT 2 $0 INCRELEX INJ 40MG/4ML 2 $0 NM, LA, PA methylergonovine maleate tab $0 mg MIACALCIN INJ 200/ML 2 $0 B/D octreotide acetate inj 50 mcg/ml (0.05 mg/ml) 1 $0 NM, PA octreotide acetate inj 100 mcg/ml 1 $0 NM, PA (0.1 mg/ml) octreotide acetate inj 200 mcg/ml 2 $0 NM, PA (0.2 mg/ml) octreotide acetate inj 500 mcg/ml 2 $0 NM, PA (0.5 mg/ml) octreotide acetate inj 1000 mcg/ml 2 $0 NM, PA (1 mg/ml) PROLIA SOL 60MG/ML 2 $0 QL (1 syringe / 180 days), NM raloxifene hcl tab 60 mg 1 $0 SANDOSTATIN KIT LAR 10MG 2 $0 NM, PA SANDOSTATIN KIT LAR 20MG 2 $0 NM, PA SANDOSTATIN KIT LAR 30MG 2 $0 NM, PA SIGNIFOR INJ 0.3MG/ML 2 $0 NM, LA, PA 74

75 SIGNIFOR INJ 0.6MG/ML 2 $0 NM, LA, PA SIGNIFOR INJ 0.9MG/ML 2 $0 NM, LA, PA SOMATULINE INJ 60/0.2ML 2 $0 NM, PA SOMATULINE INJ 90/0.3ML 2 $0 NM, PA SOMATULINE INJ 120/.5ML 2 $0 NM, PA SOMAVERT INJ 10MG 2 $0 NM, LA, PA SOMAVERT INJ 15MG 2 $0 NM, LA, PA SOMAVERT INJ 20MG 2 $0 NM, LA, PA SOMAVERT INJ 25MG 2 $0 NM, LA, PA SOMAVERT INJ 30MG 2 $0 NM, LA, PA XGEVA INJ 2 $0 NM, PA 甲狀旁腺激素 - 調節副甲狀腺水準的藥物 FORTEO SOL 600/2.4 2 $0 QL (1 pen / 28 days), NM, PA NATPARA INJ 25MCG 2 $0 NM, PA NATPARA INJ 50MCG 2 $0 NM, PA NATPARA INJ 75MCG 2 $0 NM, PA NATPARA INJ 100MCG 2 $0 NM, PA 磷酸鹽結合劑 - 調節鈣和磷水準的藥物 calcium acetate (phosphate binder) 1 $0 cap 667 mg (169 mg ca) calcium acetate (phosphate binder) 1 $0 tab 667 mg RENVELA PAK 0.8GM 2 $0 RENVELA PAK 2.4GM 2 $0 RENVELA TAB 800MG 2 $0 孕激素 - 調節雌性激素的藥物 medroxyprogesterone acetate tab 2.5 mg 1 $0 medroxyprogesterone acetate tab 51 $0 mg medroxyprogesterone acetate tab 1 $0 10 mg norethindrone acetate tab 5 mg 1 $0 甲狀腺藥 - 調節甲狀腺水準的藥物 levothyroxine sodium tab 25 mcg 1 $0 levothyroxine sodium tab 50 mcg 1 $0 levothyroxine sodium tab 75 mcg 1 $0 levothyroxine sodium tab 88 mcg 1 $0 levothyroxine sodium tab 100 mcg 1 $0 levothyroxine sodium tab 112 mcg 1 $0 levothyroxine sodium tab 125 mcg 1 $0 75

76 藥物層級您為藥物支 付的費用 levothyroxine sodium tab 137 mcg 1 $0 levothyroxine sodium tab 150 mcg 1 $0 levothyroxine sodium tab 175 mcg 1 $0 levothyroxine sodium tab 200 mcg 1 $0 levothyroxine sodium tab 300 mcg 1 $0 LEVOXYL TAB 25MCG 1 $0 LEVOXYL TAB 50MCG 1 $0 LEVOXYL TAB 75MCG 1 $0 LEVOXYL TAB 88MCG 1 $0 LEVOXYL TAB 100MCG 1 $0 LEVOXYL TAB 112MCG 1 $0 LEVOXYL TAB 125MCG 1 $0 LEVOXYL TAB 137MCG 1 $0 LEVOXYL TAB 150MCG 1 $0 LEVOXYL TAB 175MCG 1 $0 LEVOXYL TAB 200MCG 1 $0 liothyronine sodium tab 5 mcg 1 $0 liothyronine sodium tab 25 mcg 1 $0 liothyronine sodium tab 50 mcg 1 $0 methimazole tab 5 mg 1 $0 methimazole tab 10 mg 1 $0 propylthiouracil tab 50 mg 1 $0 SYNTHROID TAB 25MCG 2 $0 SYNTHROID TAB 50MCG 2 $0 SYNTHROID TAB 75MCG 2 $0 SYNTHROID TAB 88MCG 2 $0 SYNTHROID TAB 100MCG 2 $0 SYNTHROID TAB 112MCG 2 $0 SYNTHROID TAB 125MCG 2 $0 SYNTHROID TAB 137MCG 2 $0 SYNTHROID TAB 150MCG 2 $0 SYNTHROID TAB 175MCG 2 $0 SYNTHROID TAB 200MCG 2 $0 SYNTHROID TAB 300MCG 2 $0 UNITHROID TAB 25MCG 1 $0 UNITHROID TAB 50MCG 1 $0 UNITHROID TAB 75MCG 1 $0 UNITHROID TAB 88MCG 1 $0 UNITHROID TAB 100MCG 1 $0 UNITHROID TAB 112MCG 1 $0 UNITHROID TAB 125MCG 1 $0 76

77 藥物層級您為藥物支 付的費用 UNITHROID TAB 150MCG 1 $0 UNITHROID TAB 175MCG 1 $0 UNITHROID TAB 200MCG 1 $0 UNITHROID TAB 300MCG 1 $0 抗利尿激素 - 調節垂體激素的藥物 desmopressin acetate inj 4 mcg/ml 1 $0 DESMOPRESSIN ACETATE NASAL 1 $0 SOLN 0.01% (REFRIGERATED) desmopressin acetate nasal spray 1 $0 soln 0.01% desmopressin acetate nasal spray soln 0.01% (refrigerated) 1 $0 desmopressin acetate tab 0.1 mg 1 $0 desmopressin acetate tab 0.2 mg 1 $0 胃腸藥 - 治療胃腸紊亂的藥物抗酸劑 acid gone chw 3 $0 NM; * acid gone sus 3 $0 NM; * ALUM HYDROX SUS 320/5ML 3 $0 NM; * ant/anti-gas chw $0 NM; * antacid sus max st 3 $0 NM; * cal antacid chw 1000mg 3 $0 NM; * calc antacid chw 500mg 3 $0 NM; * calc antacid chw 750mg 3 $0 NM; * foam antacid chw 80-20mg 3 $0 NM; * GAVISCON CHW 3 $0 NM; * GAVISCON SUS 3 $0 NM; * maalox child chw 3 $0 NM; * maalox sus reg st 3 $0 NM; * MAG OXIDE CAP 400MG 3 $0 NM; * MAG-AL LIQ 3 $0 NM; * magnesium oxide tab 250 mg 3 $0 NM; * magnesium oxide tab 400 mg 3 $0 NM; * magnesium oxide tab 420 mg 3 $0 NM; * mi-acid chw 3 $0 NM; * mintox plus chw 3 $0 NM; * SODIUM POW BICARBON 3 $0 NM; * titralac chw 420mg 3 $0 NM; * 止瀉藥 anti-diarrhe liq 1mg/5ml 3 $0 NM; * anti-diarrhe tab 2mg 3 $0 NM; * floranex gra 3 $0 NM; * 77

78 FLORASTOR PAK KIDS 3 $0 NM; * kaopectate sus 262/15ml 3 $0 NM; * lactobacillus tab 3 $0 NM; * loperamide hcl liq 1 mg/7.5ml 3 $0 NM; * peptic relf chw 262mg 3 $0 NM; * probiotic cap 3 $0 NM; * PROBIOTIC CAP COMPLEX 3 $0 NM; * RISA-BID TAB PROBIO 3 $0 NM; * soothe tab 262mg 3 $0 NM; * stomach relf sus 525/15ml 3 $0 NM; * 止吐藥 - 治療噁心和嘔吐的藥物 compro sup 25mg 1 $0 dramamine tab 25mg 3 $0 NM; * dronabinol cap 2.5 mg 1 $0 B/D, QL (60 caps / 30 days) dronabinol cap 5 mg 1 $0 B/D, QL (60 caps / 30 days) dronabinol cap 10 mg 2 $0 B/D, QL (60 caps / 30 days) EMEND CAP 40MG 2 $0 B/D EMEND CAP 80MG 2 $0 B/D EMEND CAP 125MG 2 $0 B/D EMEND PAK 80 & $0 B/D granisetron hcl inj 0.1 mg/ml 1 $0 granisetron hcl inj 1 mg/ml 1 $0 granisetron hcl inj 4 mg/4ml (1 1 $0 mg/ml) granisetron hcl tab 1 mg 1 $0 B/D meclizine hcl tab 12.5 mg 1 $0 meclizine hcl tab 25 mg 1 $0 metoclopramide hcl inj 5 mg/ml 1 $0 metoclopramide hcl soln 5 mg/5ml 1 $0 (10 mg/10ml) metoclopramide hcl tab 5 mg 1 $0 metoclopramide hcl tab 10 mg 1 $0 motion sick chw 25mg 3 $0 NM; * motion sick tab 50mg 3 $0 NM; * ondansetron hcl inj 4 mg/2ml (2 mg/ml) 1 $0 ondansetron hcl inj 40 mg/20ml (2 1 $0 mg/ml) ondansetron hcl oral soln 4 mg/5ml 1 $0 B/D ondansetron hcl tab 4 mg 1 $0 B/D 78

79 ondansetron hcl tab 8 mg 1 $0 B/D ondansetron hcl tab 24 mg 1 $0 B/D ondansetron orally disintegrating 1 $0 B/D tab 4 mg ondansetron orally disintegrating 1 $0 B/D tab 8 mg phenadoz sup 12.5mg 2 $0 PA; PA if 65 years and phenergan sup 12.5mg 2 $0 PA; PA if 65 years and phenergan sup 25mg 2 $0 PA; PA if 65 years and phenergan sup 50mg 2 $0 PA; PA if 65 years and prochlorperazine edisylate inj 5 mg/ml 1 $0 prochlorperazine maleate tab 5 mg 1 $0 (base equivalent) prochlorperazine maleate tab 10 mg 1 $0 (base equivalent) prochlorperazine suppos 25 mg 1 $0 promethazine hcl inj 25 mg/ml 2 $0 PA; PA if 65 years and promethazine hcl inj 50 mg/ml 2 $0 PA; PA if 65 years and promethazine hcl suppos 12.5 mg 2 $0 PA; PA if 65 years and promethazine hcl suppos 25 mg 2 $0 PA; PA if 65 years and promethazine hcl suppos 50 mg 2 $0 PA; PA if 65 years and promethazine hcl syrup 6.25 mg/5ml 2 $0 PA; PA if 65 years and promethazine hcl tab 12.5 mg 2 $0 PA; PA if 65 years and promethazine hcl tab 25 mg 2 $0 PA; PA if 65 years and promethazine hcl tab 50 mg 2 $0 PA; PA if 65 years and promethegan sup 25mg 2 $0 PA; PA if 65 years and promethegan sup 50mg 2 $0 PA; PA if 65 years and TRANSDERM-SC DIS 1MG 2 $0 QL (10 patches / 30 days), PA; PA if 65 years and 79

80 藥物層級您為藥物支 付的費用 解痙藥 - 治療胃部痙攣的藥物 CUVPOSA SOL 1MG/5ML 2 $0 dicyclomine hcl cap 10 mg 1 $0 dicyclomine hcl oral soln 10 mg/5ml 1 $0 dicyclomine hcl tab 20 mg 1 $0 glycopyrrolate inj 4 mg/20ml (0.2 1 $0 mg/ml) glycopyrrolate tab 1 mg 1 $0 glycopyrrolate tab 2 mg 1 $0 H2- 受體拮抗劑 - 治療潰瘍和胃酸的藥物 acid reducer tab 10mg 3 $0 NM; * acid reducer tab 150mg 3 $0 NM; * AXID AR TAB 75MG 3 $0 NM; * famotidine for susp 40 mg/5ml 1 $0 famotidine in nacl 0.9% iv soln 20 1 $0 mg/50ml famotidine inj 20 mg/2ml 1 $0 famotidine inj 40 mg/4ml 1 $0 famotidine inj 200 mg/20ml 1 $0 famotidine tab 20 mg 1 $0 famotidine tab 20mg 3 $0 NM; * famotidine tab 40 mg 1 $0 PEPCID AC CHW 10MG 3 $0 NM; * ranitidine hcl inj 50 mg/2ml (25 1 $0 mg/ml) ranitidine hcl inj 150 mg/6ml (25 1 $0 mg/ml) ranitidine hcl syrup 15 mg/ml (75 1 $0 mg/5ml) ranitidine hcl tab 75 mg 3 $0 NM; * ranitidine hcl tab 150 mg 1 $0 ranitidine hcl tab 300 mg 1 $0 炎症性腸道疾病 APRISO CAP 0.375GM 2 $0 ASACOL HD TAB 800MG 2 $0 balsalazide disodium cap 750 mg 1 $0 budesonide cap sr 24hr 3 mg 2 $0 CANASA SUP 1000MG 2 $0 DELZICOL CAP 400MG 2 $0 DIPENTUM CAP 250MG 2 $0 hydrocortisone enema 100 mg/60ml 1 $0 80

81 HYDROCORTISONE ENEMA $0 MG/60ML mesalamine enema 4 gm 1 $0 mesalamine rectal enema 4 gm & 1 $0 cleanser wipe kit sulfasalazin tab 500mg dr 1 $0 sulfasalazine tab 500 mg 1 $0 UCERIS TAB 9MG 2 $0 通便劑 bisacodyl tab & peg 3350-kcl-sod 1 $0 bicarb-nacl for soln kit constulose sol 10gm/15 1 $0 corn dextrin oral powder 3 $0 NM; * docusate sodium liquid $0 NM; * mg/15ml dok tab 100mg 3 $0 NM; * easy fiber/ chw calcium 3 $0 NM; * enemeez mini ene 3 $0 NM; * enemeez plus ene $0 NM; * enulose sol 10gm/15 1 $0 epsom salt gra 3 $0 NM; * EQUALACTIN CHW 625MG 3 $0 NM; * ex-lax ultra tab 5mg ec 3 $0 NM; * FIBER CHW 3 $0 NM; * fiber laxatv tab 625mg 3 $0 NM; * fiber oral powder 3 $0 NM; * FLEET BISACO ENE 10/30ML 3 $0 NM; * gavilyte-c sol 1 $0 gavilyte-g sol 1 $0 gavilyte-n sol flav pk 1 $0 generlac sol 10gm/15 1 $0 gentle laxat sup 10mg 3 $0 NM; * GOLYTELY SOL 2 $0 HYDROCIL INS POW 95% 3 $0 NM; * konsyl cap 520mg 3 $0 NM; * konsyl pow 28.3% 3 $0 NM; * KONSYL POW 28.3% 3 $0 NM; * konsyl pow 30.9% 3 $0 NM; * KONSYL POW 60.3% 3 $0 NM; * KONSYL POW 71.67% 3 $0 NM; * KONSYL POW 100% 3 $0 NM; * KONSYL-D POW 52.3% 3 $0 NM; * 81

82 lactulose (encephalopathy) solution 1 $0 10 gm/15ml lactulose solution 10 gm/15ml 1 $0 lax diet sup tab 500mg 3 $0 NM; * laxative tab 25mg 3 $0 NM; * magnesium citrate soln 3 $0 NM; * METAMUCIL POW 28% 3 $0 NM; * METAMUCIL POW 63% 3 $0 NM; * METAMUCIL WAF 3 $0 NM; * MILK OF MAGN SUS 2400MG 3 $0 NM; * milk of magn sus frsh mnt 3 $0 NM; * MINERAL OIL 3 $0 NM; * mineral oil enema 3 $0 NM; * MOVIPREP SOL 2 $0 nat fiber pow therapy 3 $0 NM; * naturl fiber pow 68% 3 $0 NM; * NULYTELY SOL FLAV PKS 2 $0 NUTRISOURCE PAK FIBER 3 $0 NM; * NUTRISOURCE POW FIBER 3 $0 NM; * oral saline sol laxative 3 $0 NM; * PEDIA-LAX LIQ 50MG 3 $0 NM; * PEG 3350-KCL-NA 1 $0 BICARB-NACL-NA SULFATE FOR SOLN 236 GM PEG 3350-KCL-NA 1 $0 BICARB-NACL-NA SULFATE FOR SOLN 240 GM peg 3350-kcl-sod bicarb-nacl for 1 $0 soln 420 gm perdiem over tab 15mg 3 $0 NM; * polyethylene glycol 3350 oral 1 $0 packet polyethylene glycol 3350 oral 1 $0 powder psyldex pow 30% 3 $0 NM; * qc natural pow vegetabl 3 $0 NM; * ra col-rite cap 50mg 3 $0 NM; * ra fiber tab 500mg 3 $0 NM; * reguloid pow 48.57% 3 $0 NM; * reguloid pow 58.6% 3 $0 NM; * RELISTOR INJ 8/0.4ML 2 $0 PA RELISTOR INJ 12/0.6ML 2 $0 PA sb fib lax pow 33% 3 $0 NM; * 82

83 sb nat fiber pow 49% 3 $0 NM; * SENNA PROMPT CAP 9-500MG 3 $0 NM; * senna s tab mg 3 $0 NM; * SENNA SYP 3 $0 NM; * senna tab 8.6mg 3 $0 NM; * senna-extra tab 17.2mg 3 $0 NM; * sennosides cap 8.6 mg 3 $0 NM; * sennosides syrup 8.8 mg/5ml 3 $0 NM; * sodium phosphates - enema 3 $0 NM; * soluble fib pow therapy 3 $0 NM; * sorbulax pow 100% 3 $0 NM; * stool softnr cap 50mg 3 $0 NM; * stool softnr cap 100mg 3 $0 NM; * stool softnr cap 240mg 3 $0 NM; * stool softnr syp 60/15ml 3 $0 NM; * stool softnr tab mg 3 $0 NM; * SUPREP BOWEL SOL PREP 2 $0 trilyte sol 1 $0 雜類 alosetron hcl tab 0.5 mg (base equiv) 2 $0 PA alosetron hcl tab 1 mg (base equiv) 2 $0 PA AMITIZA CAP 8MCG 2 $0 QL (60 caps / 30 days) AMITIZA CAP 24MCG 2 $0 QL (60 caps / 30 days) cromolyn sodium oral conc $0 mg/5ml diphenoxylate w/ atropine liq 1 $ mg/5ml diphenoxylate w/ atropine tab 1 $ mg GATTEX KIT 5MG 2 $0 NM, LA, PA LINZESS CAP 145MCG 2 $0 QL (60 caps / 30 days) LINZESS CAP 290MCG 2 $0 QL (30 caps / 30 days) loperamide hcl cap 2 mg 1 $0 misoprostol tab 100 mcg 1 $0 misoprostol tab 200 mcg 1 $0 MOVANTIK TAB 12.5MG 2 $0 QL (60 tabs / 30 days) MOVANTIK TAB 25MG 2 $0 QL (30 tabs / 30 days) SUCRAID SOL 8500/ML 2 $0 LA sucralfate tab 1 gm 1 $0 ursodiol cap 300 mg 1 $0 ursodiol tab 250 mg 1 $0 83

84 ursodiol tab 500 mg 1 $0 XIFAXAN TAB 550MG 2 $0 PA 胰酶 CREON CAP 3000UNIT 2 $0 CREON CAP 6000UNIT 2 $0 CREON CAP 12000UNT 2 $0 CREON CAP 24000UNT 2 $0 CREON CAP 36000UNT 2 $0 ZENPEP CAP 3000UNIT 2 $0 ZENPEP CAP 5000UNIT 2 $0 ZENPEP CAP 10000UNT 2 $0 ZENPEP CAP 15000UNT 2 $0 ZENPEP CAP 20000UNT 2 $0 ZENPEP CAP 25000UNT 2 $0 ZENPEP CAP 40000UNT 2 $0 質子泵抑制劑 - 治療潰瘍和胃酸的藥物 DEXILANT CAP 30MG DR 2 $0 QL (30 caps / 30 days) DEXILANT CAP 60MG DR 2 $0 QL (30 caps / 30 days) dual action chw complete 3 $0 NM; * esomeprazole magnesium cap 1 $0 QL (30 caps / 30 days) delayed release 20 mg (base eq) esomeprazole magnesium cap 1 $0 QL (30 caps / 30 days) delayed release 40 mg (base eq) esomeprazole sodium for 1 $0 intravenous soln 20 mg (base equiv) esomeprazole sodium for 1 $0 intravenous soln 40 mg (base equiv) lansoprazole cap 15mg dr 3 $0 NM; * NEXIUM CAP 20MG 2 $0 QL (30 caps / 30 days) NEXIUM CAP 40MG 2 $0 QL (30 caps / 30 days) NEXIUM GRA 2.5MG DR 2 $0 NEXIUM GRA 5MG DR 2 $0 NEXIUM GRA 10MG DR 2 $0 QL (30 packets / 30 days) NEXIUM GRA 20MG DR 2 $0 QL (30 packets / 30 days) NEXIUM GRA 40MG DR 2 $0 QL (30 packets / 30 days) omepra/bicar cap $0 NM; * omeprazole cap delayed release 10 1 $0 QL (30 caps / 30 days) mg 84

85 omeprazole cap delayed release 20 1 $0 QL (60 caps / 30 days) mg omeprazole cap delayed release 40 1 $0 QL (30 caps / 30 days) mg OMEPRAZOLE TAB 20MG 3 $0 NM; * pantoprazole sodium ec tab 20 mg 1 $0 QL (30 tabs / 30 days) (base equiv) pantoprazole sodium ec tab 40 mg 1 $0 QL (30 tabs / 30 days) (base equiv) PRILOSEC OTC TAB 20MG 3 $0 NM; * 泌尿生殖器藥 - 治療生殖器和尿道疾病的藥物 良性前列腺增生藥 - 治療前列腺增生的藥物 alfuzosin hcl tab sr 24hr 10 mg 1 $0 QL (30 tabs / 30 days) AVODART CAP 0.5MG 2 $0 QL (30 caps / 30 days) dutasteride cap 0.5 mg 1 $0 QL (30 caps / 30 days) dutasteride-tamsulosin hcl cap 1 $0 QL (30 caps / 30 days) mg finasteride tab 5 mg 1 $0 JALYN CAP 2 $0 QL (30 caps / 30 days) tamsulosin hcl cap 0.4 mg 1 $0 雜類 bethanechol chloride tab 5 mg 1 $0 bethanechol chloride tab 10 mg 1 $0 bethanechol chloride tab 25 mg 1 $0 bethanechol chloride tab 50 mg 1 $0 ELMIRON CAP 100MG 2 $0 POTASSIUM CITRATE TAB CR 5 MEQ 1 $0 (540 MG) POTASSIUM CITRATE TAB CR 10 1 $0 MEQ (1080 MG) 尿路解痙藥 - 治療尿失禁的藥物 MYRBETRIQ TAB 25MG 2 $0 QL (60 tabs / 30 days) MYRBETRIQ TAB 50MG 2 $0 QL (30 tabs / 30 days) oxybutynin chloride syrup 5 mg/5ml 1 $0 oxybutynin chloride tab 5 mg 1 $0 oxybutynin chloride tab sr 24hr 5 mg 1 $0 QL (30 tabs / 30 days) oxybutynin chloride tab sr 24hr 10 1 $0 QL (60 tabs / 30 days) mg oxybutynin chloride tab sr 24hr 15 1 $0 QL (60 tabs / 30 days) mg tolterodine tartrate cap sr 24hr 2 mg 1 $0 QL (30 caps / 30 days) 85

86 tolterodine tartrate cap sr 24hr 4 1 $0 QL (30 caps / 30 days) mg tolterodine tartrate tab 1 mg 1 $0 tolterodine tartrate tab 2 mg 1 $0 TOVIAZ TAB 4MG 2 $0 QL (30 tabs / 30 days) TOVIAZ TAB 8MG 2 $0 QL (30 tabs / 30 days) trospium chloride tab 20 mg 1 $0 QL (60 tabs / 30 days) VESICARE TAB 5MG 2 $0 QL (30 tabs / 30 days) VESICARE TAB 10MG 2 $0 QL (30 tabs / 30 days) 陰道抗感染藥 clindamycin phosphate vaginal 1 $0 cream 2% clotrimazole cre 2% 3 $0 NM; * clotrimazole vaginal cream 1% 3 $0 NM; * 3 day vagnal cre 4% 3 $0 NM; * metronidazole vaginal gel 0.75% 1 $0 miconazole 3 cre 4% 3 $0 NM; * miconazole 3 kit combinat 3 $0 NM; * miconazole 3 kit combo pk 3 $0 NM; * miconazole 7 cre tube/kit 3 $0 NM; * miconazole 7 sup 100mg 3 $0 NM; * miconazole nitrate vaginal supp 3 $0 NM; * 1200 mg & 2% cream kit summers eve sol 0.3% 3 $0 NM; * terconazole vaginal cream 0.4% 1 $0 terconazole vaginal cream 0.8% 1 $0 terconazole vaginal suppos 80 mg 1 $0 tioconazole oin 6.5% vag 3 $0 NM; * vagistat-3 kit combo pk 3 $0 NM; * VANDAZOLE GEL 0.75% 1 $0 zazole cre 0.4% 1 $0 ZAZOLE CRE 0.8% 1 $0 血液藥 - 治療血液疾病的藥物抗凝劑 - 血液稀釋劑 COUMADIN TAB 1MG 2 $0 COUMADIN TAB 2.5MG 2 $0 COUMADIN TAB 2MG 2 $0 COUMADIN TAB 3MG 2 $0 COUMADIN TAB 4MG 2 $0 COUMADIN TAB 5MG 2 $0 COUMADIN TAB 6MG 2 $0 COUMADIN TAB 7.5MG 2 $0 86

87 COUMADIN TAB 10MG 2 $0 ELIQUIS TAB 2.5MG 2 $0 ELIQUIS TAB 5MG 2 $0 enoxaparin sodium inj 30 mg/0.3ml 1 $0 enoxaparin sodium inj 40 mg/0.4ml 1 $0 enoxaparin sodium inj 60 mg/0.6ml 1 $0 enoxaparin sodium inj 80 mg/0.8ml 1 $0 enoxaparin sodium inj 100 mg/ml 2 $0 enoxaparin sodium inj 120 mg/0.8ml 2 $0 enoxaparin sodium inj 150 mg/ml 2 $0 enoxaparin sodium inj 300 mg/3ml 1 $0 fondaparinux sodium subcutaneous 1 $0 inj 2.5 mg/0.5ml fondaparinux sodium subcutaneous 2 $0 inj 5 mg/0.4ml fondaparinux sodium subcutaneous 2 $0 inj 7.5 mg/0.6ml fondaparinux sodium subcutaneous 2 $0 inj 10 mg/0.8ml HEP SOD/NACL INJ 25000UNT 2 $0 HEPARIN SOD INJ 2000/ML 2 $0 B/D HEPARIN SOD INJ 2500/ML 2 $0 B/D HEPARIN SODIUM (PORCINE) 40 2 $0 UNIT/ML IN D5W HEPARIN SODIUM (PORCINE) 50 UNIT/ML IN D5W 2 $0 HEPARIN SODIUM (PORCINE) $0 UNIT/ML IN D5W heparin sodium (porcine) inj $0 B/D unit/ml heparin sodium (porcine) inj $0 B/D unit/ml heparin sodium (porcine) inj $0 B/D unit/ml heparin sodium (porcine) inj $0 B/D unit/ml jantoven tab 1mg 1 $0 jantoven tab 2.5mg 1 $0 jantoven tab 2mg 1 $0 jantoven tab 3mg 1 $0 jantoven tab 4mg 1 $0 jantoven tab 5mg 1 $0 jantoven tab 6mg 1 $0 87

88 jantoven tab 7.5mg 1 $0 jantoven tab 10mg 1 $0 PRADAXA CAP 75MG 2 $0 PRADAXA CAP 110MG 2 $0 PRADAXA CAP 150MG 2 $0 warfarin sodium tab 1 mg 1 $0 warfarin sodium tab 2 mg 1 $0 warfarin sodium tab 2.5 mg 1 $0 warfarin sodium tab 3 mg 1 $0 warfarin sodium tab 4 mg 1 $0 warfarin sodium tab 5 mg 1 $0 warfarin sodium tab 6 mg 1 $0 warfarin sodium tab 7.5 mg 1 $0 warfarin sodium tab 10 mg 1 $0 XARELTO STAR TAB 15/20MG 2 $0 XARELTO TAB 10MG 2 $0 XARELTO TAB 15MG 2 $0 XARELTO TAB 20MG 2 $0 造血生長因數 GRANIX INJ 300/0.5 2 $0 NM, PA GRANIX INJ 480/0.8 2 $0 NM, PA LEUKINE INJ 250MCG 2 $0 NM, PA MOZOBIL INJ 2 $0 NM, PA NEUMEGA INJ 5MG 2 $0 NM NEUPOGEN INJ 300/0.5 2 $0 NM, PA NEUPOGEN INJ 300MCG 2 $0 NM, PA NEUPOGEN INJ 480/0.8 2 $0 NM, PA NEUPOGEN INJ 480MCG 2 $0 NM, PA PROCRIT INJ 2000/ML 2 $0 NM, PA PROCRIT INJ 3000/ML 2 $0 NM, PA PROCRIT INJ 4000/ML 2 $0 NM, PA PROCRIT INJ 10000/ML 2 $0 NM, PA PROCRIT INJ 20000/ML 2 $0 NM, PA PROCRIT INJ 40000/ML 2 $0 NM, PA 鐵 ezfe 200 cap 200mg 3 $0 NM; * fer-iron dro 15mg/ml 3 $0 NM; * FERRETTS IPS SOL 3 $0 NM; * ferretts tab 325mg 3 $0 NM; * FERRIMIN 150 TAB 3 $0 NM; * FERROUS FUM TAB 29MG 3 $0 NM; * 88

89 FERROUS FUMA TAB 3 $0 NM; * FERROUS GLUC TAB 225MG 3 $0 NM; * ferrous gluc tab 324mg 3 $0 NM; * FERROUS GLUC TAB 324MG 3 $0 NM; * ferrous gluconate tab 240 mg (27 3 $0 NM; * mg elemental fe) FERROUS SUL LIQ 220/5ML 3 $0 NM; * FERROUS SULF SYP 300/5ML 3 $0 NM; * FERROUS SULF TAB 140MG 3 $0 NM; * FERROUS SULF TAB 324MG EC 3 $0 NM; * ferrous sulf tab 325mg 3 $0 NM; * ferrous sulfate elixir 220 mg/5ml 3 $0 NM; * (44 mg/5ml elemental fe) ferrous sulfate tab ec 325 mg (65 3 $0 NM; * mg fe equivalent) FOLGARD TAB 3 $0 NM; * FOLITAB 500 TAB 3 $0 NM; * foltabs 800 tab 3 $0 NM; * gnp iron tab 45mg 3 $0 NM; * INTEGRA CAP 3 $0 NM; * iron 100 tab plus 3 $0 NM; * iron 100/c tab $0 NM; * IRON CHEWS CHW PEDIATRI 3 $0 NM; * IRON TAB 18MG 3 $0 NM; * IRON TAB 28MG 3 $0 NM; * iron therapy tab 200mg 3 $0 NM; * IRON UP LIQ 3 $0 NM; * MYKIDZ IRON SUS 15/1.5ML 3 $0 NM; * NOVAFERRUM DRO 15MG/ML 3 $0 NM; * NOVAFERRUM LIQ $0 NM; * nu-iron 150 cap 150mg 3 $0 NM; * PROFE CAP 180MG 3 $0 NM; * ra iron tab 27mg 3 $0 NM; * slow iron tab 50mg 3 $0 NM; * SLOW REL FE TAB 140MG CR 3 $0 NM; * SLOW REL FE TAB 143MG CR 3 $0 NM; * slow release tab 45mg 3 $0 NM; * slow release tab 47.5mg 3 $0 NM; * sm iron slow tab 160mg cr 3 $0 NM; * VIT B12/FA TAB 3 $0 NM; * wee care sus 15/ $0 NM; * 雜類 89

90 anagrelide hcl cap 0.5 mg 1 $0 anagrelide hcl cap 1 mg 1 $0 cilostazol tab 50 mg 1 $0 cilostazol tab 100 mg 1 $0 CINRYZE SOL 500 UNIT 2 $0 NM, LA, PA FIRAZYR INJ 30MG/3ML 2 $0 NM, PA pentoxifylline tab cr 400 mg 1 $0 PROMACTA TAB 12.5MG 2 $0 QL (360 tabs / 30 days), NM, LA, PA PROMACTA TAB 25MG 2 $0 QL (180 tabs / 30 days), NM, LA, PA PROMACTA TAB 50MG 2 $0 QL (90 tabs / 30 days), NM, LA, PA PROMACTA TAB 75MG 2 $0 QL (60 tabs / 30 days), NM, LA, PA tranexamic acid inj 100 mg/ml 1 $0 tranexamic acid tab 650 mg 1 $0 血小板聚集抑制劑 AGGRENOX CAP MG 2 $0 ASPIRIN-DIPYRIDAMOLE CAP SR 1 $0 12HR MG BRILINTA TAB 60MG 2 $0 BRILINTA TAB 90MG 2 $0 clopidogrel bisulfate tab 75 mg 1 $0 (base equiv) EFFIENT TAB 5MG 2 $0 EFFIENT TAB 10MG 2 $0 ZONTIVITY TAB 2.08MG 2 $0 免疫製劑 - 治療免疫系統失調的藥物 改善病情的抗風濕藥物 (DMARDS) - 治療類風濕性關節炎的藥物 CIMZIA KIT 2 $0 NM, PA CIMZIA KIT STARTER 2 $0 NM, PA CIMZIA PREFL KIT 200MG/ML 2 $0 NM, PA HUMIRA INJ 10MG/0.2 2 $0 NM, PA HUMIRA KIT 20MG/0.4 2 $0 NM, PA HUMIRA KIT 40MG/0.8 2 $0 NM, PA HUMIRA PEN INJ 40MG/0.8 2 $0 NM, PA HUMIRA PEN INJ CROHNS 2 $0 NM, PA HUMIRA PEN INJ PSORIASI 2 $0 NM, PA hydroxychloroquine sulfate tab $0 mg leflunomide tab 10 mg 1 $0 leflunomide tab 20 mg 1 $0 90

91 methotrexate sodium tab 2.5 mg 1 $0 (base equiv) REMICADE INJ 100MG 2 $0 NM, PA 免疫球蛋白 BIVIGAM INJ 10% 2 $0 NM, PA CARIMUNE NF INJ 6GM 2 $0 NM, PA CARIMUNE NF INJ 12GM 2 $0 NM, PA FLEBOGAMMA INJ 5% 2 $0 NM, PA FLEBOGAMMA INJ 10/200ML 2 $0 NM, PA FLEBOGAMMA INJ 20/400ML 2 $0 NM, PA FLEBOGAMMA INJ DIF 5% 2 $0 NM, PA FLEBOGAMMA INJ DIF 10% 2 $0 NM, PA GAMASTAN S/D INJ 2 $0 B/D, NM GAMMAGARD INJ 1GM/10ML 2 $0 NM, PA GAMMAGARD INJ 2.5GM/25 2 $0 NM, PA GAMMAGARD INJ 5GM/50ML 2 $0 NM, PA GAMMAGARD INJ 10GM/100 2 $0 NM, PA GAMMAGARD INJ 20GM/200 2 $0 NM, PA GAMMAGARD INJ 30GM/300 2 $0 NM, PA GAMMAGARD SD INJ 2.5GM HU 2 $0 NM, PA GAMMAGARD SD INJ 5GM HU 2 $0 NM, PA GAMMAGARD SD INJ 10GM HU 2 $0 NM, PA GAMMAKED INJ 1GM/10ML 2 $0 NM, PA GAMMAKED INJ 2.5GM/25 2 $0 NM, PA GAMMAKED INJ 5GM/50ML 2 $0 NM, PA GAMMAKED INJ 10GM/100 2 $0 NM, PA GAMMAKED INJ 20GM/200 2 $0 NM, PA GAMMAPLEX INJ 2.5GM 2 $0 NM, PA GAMMAPLEX INJ 5GM 2 $0 NM, PA GAMMAPLEX INJ 10GM 2 $0 NM, PA GAMUNEX-C INJ 1GM/10ML 2 $0 NM, PA GAMUNEX-C INJ 2.5GM/25 2 $0 NM, PA GAMUNEX-C INJ 5GM/50ML 2 $0 NM, PA GAMUNEX-C INJ 10GM/100 2 $0 NM, PA GAMUNEX-C INJ 20GM/200 2 $0 NM, PA GAMUNEX-C INJ 40/400ML 2 $0 NM, PA OCTAGAM INJ 1GM 2 $0 NM, PA OCTAGAM INJ 2.5GM 2 $0 NM, PA OCTAGAM INJ 2GM/20ML 2 $0 NM, PA OCTAGAM INJ 5GM 2 $0 NM, PA OCTAGAM INJ 10GM 2 $0 NM, PA OCTAGAM INJ 25GM 2 $0 NM, PA 91

92 PRIVIGEN INJ 5 GRAMS 2 $0 NM, PA PRIVIGEN INJ 10GRAMS 2 $0 NM, PA PRIVIGEN INJ 20GRAMS 2 $0 NM, PA PRIVIGEN INJ 40GRAMS 2 $0 NM, PA 免疫調節劑 ACTIMMUNE INJ 2MU/0.5 2 $0 NM, LA, PA ARCALYST INJ 220MG 2 $0 NM, PA INTRON A INJ 10MU 2 $0 B/D, NM INTRON A INJ 18MU 2 $0 B/D, NM INTRON A INJ 25MU 2 $0 B/D, NM INTRON A INJ 50MU 2 $0 B/D, NM REVLIMID CAP 2.5MG 2 $0 NM, LA, PA REVLIMID CAP 5MG 2 $0 NM, LA, PA REVLIMID CAP 10MG 2 $0 NM, LA, PA REVLIMID CAP 15MG 2 $0 NM, LA, PA REVLIMID CAP 20MG 2 $0 NM, LA, PA REVLIMID CAP 25MG 2 $0 NM, LA, PA THALOMID CAP 50MG 2 $0 NM, PA THALOMID CAP 100MG 2 $0 NM, PA THALOMID CAP 150MG 2 $0 NM, PA THALOMID CAP 200MG 2 $0 NM, PA 免疫抑制劑 azathioprine tab 50 mg 1 $0 B/D BENLYSTA INJ 120MG 2 $0 NM, PA BENLYSTA INJ 400MG 2 $0 NM, PA cyclosporine cap 25 mg 1 $0 B/D cyclosporine cap 100 mg 1 $0 B/D cyclosporine iv soln 50 mg/ml 1 $0 B/D cyclosporine modified cap 25 mg 1 $0 B/D cyclosporine modified cap 50 mg 1 $0 B/D cyclosporine modified cap 100 mg 1 $0 B/D cyclosporine modified oral soln $0 B/D mg/ml gengraf cap 25mg 1 $0 B/D gengraf cap 100mg 1 $0 B/D gengraf sol 100mg/ml 1 $0 B/D mycophenolate mofetil cap 250 mg 1 $0 B/D mycophenolate mofetil for oral susp 2 $0 B/D 200 mg/ml mycophenolate mofetil tab 500 mg 1 $0 B/D mycophenolate sodium tab dr $0 B/D mg (mycophenolic acid equiv) 92

93 mycophenolate sodium tab dr $0 B/D mg (mycophenolic acid equiv) NEORAL CAP 25MG 2 $0 B/D NEORAL CAP 100MG 2 $0 B/D NEORAL SOL 100MG/ML 2 $0 B/D NULOJIX INJ 250MG 2 $0 B/D PROGRAF CAP 0.5MG 2 $0 B/D PROGRAF CAP 1MG 2 $0 B/D PROGRAF CAP 5MG 2 $0 B/D RAPAMUNE SOL 1MG/ML 2 $0 B/D SANDIMMUNE SOL 100MG/ML 2 $0 B/D sirolimus tab 0.5 mg 1 $0 B/D sirolimus tab 1 mg 1 $0 B/D SIROLIMUS TAB 2 MG 2 $0 B/D tacrolimus cap 0.5 mg 1 $0 B/D tacrolimus cap 1 mg 1 $0 B/D tacrolimus cap 5 mg 2 $0 B/D ZORTRESS TAB 0.5MG 2 $0 B/D ZORTRESS TAB 0.25MG 2 $0 B/D ZORTRESS TAB 0.75MG 2 $0 B/D 疫苗 ACTHIB INJ 2 $0 ADACEL INJ 2 $0 BCG VACCINE INJ 2 $0 BEXSERO INJ 2 $0 BOOSTRIX INJ 2 $0 CERVARIX INJ 2 $0 COMVAX INJ 2 $0 DAPTACEL INJ 2 $0 DIP/TET PED INJ 25-5LFU 2 $0 B/D ENGERIX-B INJ 10/0.5ML 2 $0 B/D ENGERIX-B INJ 20MCG/ML 2 $0 B/D GARDASIL 9 INJ 2 $0 GARDASIL INJ 2 $0 HAVRIX INJ 720UNIT 2 $0 HAVRIX INJ 1440UNIT 2 $0 HIBERIX SOL 10MCG 2 $0 IMOVAX RABIE INJ 2.5/ML 2 $0 INFANRIX INJ 2 $0 IPOL INJ INACTIVE 2 $0 IXIARO INJ 2 $0 KINRIX INJ 2 $0 93

94 M-M-R II INJ 2 $0 MENACTRA INJ 2 $0 MENOMUNE INJ A/C/Y/W 2 $0 MENVEO INJ 2 $0 PEDVAX HIB INJ 2 $0 PROQUAD INJ 2 $0 QUADRACEL INJ 2 $0 RABAVERT INJ 2 $0 RECOMBIVA HB INJ 5MCG/0.5 2 $0 B/D RECOMBIVA HB INJ 10MCG/ML 2 $0 B/D RECOMBIVA-HB INJ 40MCG/ML 2 $0 B/D ROTARIX SUS 2 $0 ROTATEQ SOL 2 $0 SYNAGIS INJ 50MG 2 $0 NM SYNAGIS INJ 100MG/ML 2 $0 NM TENIVAC INJ 5-2LF 2 $0 B/D TET/DIP TOX INJ 2-2 LF 2 $0 B/D TRUMENBA INJ 2 $0 TWINRIX INJ 2 $0 TYPHIM VI INJ 2 $0 VAQTA INJ 25/0.5ML 2 $0 VAQTA INJ 50UNT/ML 2 $0 VARIVAX INJ 2 $0 YF-VAX INJ 2 $0 ZOSTAVAX INJ 2 $0 QL (1 vial per lifetime) 營養劑 / 補充劑 - 維生素和補充劑電解質 KLOR-CON 8 TAB 8MEQ ER 1 $0 KLOR-CON 10 TAB 10MEQ ER 1 $0 klor-con m15 tab 15meq er 1 $0 klor-con pow 20meq 1 $0 MAGNESIUM SU INJ 2/50ML 2 $0 MAGNESIUM SU INJ 4/100ML 2 $0 MAGNESIUM SU INJ 20/500ML 2 $0 MAGNESIUM SU INJ 40/ $0 MAGNESIUM SU INJ 80MG/ML 2 $0 magnesium sulfate inj 50% 1 $0 MAGNESIUM SULFATE INJ 50% 1 $0 MG SO4/D5W INJ 10MG/ML 2 $0 MG SO4/D5W INJ 20MG/ML 2 $0 potassium chloride cap cr 8 meq 1 $0 94

95 potassium chloride cap cr 10 meq 1 $0 potassium chloride 1 $0 microencapsulated crys cr tab 10 meq potassium chloride microencapsulated crys cr tab 20 meq 1 $0 POTASSIUM CHLORIDE ORAL SOLN 1 $0 10% (20 MEQ/15ML) POTASSIUM CHLORIDE ORAL SOLN 1 $0 20% (40 MEQ/15ML) potassium chloride tab cr 8 meq (600 mg) 1 $0 POTASSIUM CHLORIDE TAB CR 10 1 $0 MEQ POTASSIUM CHLORIDE TAB CR 20 1 $0 MEQ (1500 MG) rehydralyte sol 3 $0 NM; * SODIUM CHLORIDE INJ 2.5 MEQ/ML 1 $0 (14.6%) SODIUM FLUORIDE CHEW; TAB; 1 $0 1.1 (0.5 F) MG/ML SOLN TPN ELECTROL INJ 2 $0 B/D 靜脈營養 amino acid infusion 6% 1 $0 B/D AMINOSYN 7% INJ /LYTES 2 $0 B/D AMINOSYN II INJ 7% 2 $0 B/D AMINOSYN II INJ 8.5% 2 $0 B/D AMINOSYN II INJ 8.5/LYTE 2 $0 B/D AMINOSYN II INJ 10% 2 $0 B/D AMINOSYN INJ 8.5% 2 $0 B/D AMINOSYN INJ 8.5/LYTE 2 $0 B/D AMINOSYN INJ 10% 2 $0 B/D AMINOSYN M INJ 3.5% 2 $0 B/D AMINOSYN-HBC INJ 7% 2 $0 B/D AMINOSYN-PF INJ 7% 2 $0 B/D AMINOSYN-PF INJ 10% 2 $0 B/D AMINOSYN-RF INJ 5.2% 2 $0 B/D CLINIMIX INJ 2.75/D5W 2 $0 B/D CLINIMIX INJ 4.25/D5W 2 $0 B/D CLINIMIX INJ 4.25/D10 2 $0 B/D CLINIMIX INJ 4.25/D20 2 $0 B/D CLINIMIX INJ 4.25/D25 2 $0 B/D 95

96 CLINIMIX INJ 5%/D15W 2 $0 B/D CLINIMIX INJ 5%/D20W 2 $0 B/D CLINIMIX INJ 5%/D25W 2 $0 B/D FAT EMULSION IV SOLN 20% 2 $0 B/D FREAMINE HBC INJ 6.9% 2 $0 B/D FREAMINE III INJ 10% 2 $0 B/D HEPATAMINE SOL 8% 2 $0 B/D INTRALIPID INJ 20% 2 $0 B/D INTRALIPID INJ 30% 2 $0 B/D NEPHRAMINE INJ 5.4% 2 $0 B/D premasol sol 10% 2 $0 B/D PROCALAMINE INJ 3% 2 $0 B/D PROSOL INJ 20% 2 $0 B/D TRAVASOL INJ 10% 2 $0 B/D TROPHAMINE INJ 10% 2 $0 B/D 靜脈取代解決方案 D5W/LYTES INJ #48 2 $0 D5W/NACL INJ 0.3% 1 $0 D10W/NACL INJ 0.2% 2 $0 DEXTROSE 2.5% W/ SODIUM 1 $0 CHLORIDE 0.45% DEXTROSE 5% IN LACTATED 1 $0 RINGERS DEXTROSE 5% W/ SODIUM 1 $0 CHLORIDE 0.2% DEXTROSE 5% W/ SODIUM 1 $0 CHLORIDE 0.9% DEXTROSE 5% W/ SODIUM 1 $0 CHLORIDE 0.33% DEXTROSE 5% W/ SODIUM 1 $0 CHLORIDE 0.45% DEXTROSE 5% W/ SODIUM 1 $0 CHLORIDE 0.225% DEXTROSE 10% W/ SODIUM 1 $0 CHLORIDE 0.45% DEXTROSE INJ 5% 1 $0 DEXTROSE INJ 10% 1 $0 DEXTROSE INJ 50% 1 $0 DEXTROSE INJ 70% 1 $0 IONOSOL-B/ INJ D5W 2 $0 IONOSOL-MB INJ /D5W 2 $0 ISOLYTE-P INJ /D5W 2 $0 ISOLYTE-S INJ 2 $0 96

97 藥物層級您為藥物支 付的費用 KCL 10 MEQ/L (0.075%) IN 1 $0 DEXTROSE 5% & NACL 0.45% INJ KCL 20 MEQ/L (0.15%) IN 1 $0 DEXTROSE 5% & NACL 0.2% INJ KCL 20 MEQ/L (0.15%) IN 1 $0 DEXTROSE 5% & NACL 0.9% INJ KCL 20 MEQ/L (0.15%) IN 1 $0 DEXTROSE 5% & NACL 0.33% INJ KCL 20 MEQ/L (0.15%) IN 1 $0 DEXTROSE 5% & NACL 0.45% INJ KCL 20 MEQ/L (0.15%) IN NACL 1 $0 0.9% INJ kcl 20 meq/l (0.15%) in nacl 0.45% 1 $0 inj KCL 20 MEQ/L (0.15%) IN NACL 1 $0 0.45% INJ KCL 30 MEQ/L (0.224%) IN 1 $0 DEXTROSE 5% & NACL 0.45% INJ KCL 40 MEQ/L (0.3%) IN 1 $0 DEXTROSE 5% & NACL 0.45% INJ KCL 40 MEQ/L (0.3%) IN NACL 1 $0 0.9% INJ KCL/D5W/NACL INJ 0.3/0.9% 1 $0 KCL/D5W/NACL INJ 0.15/0.2 2 $0 LACTATED RINGER'S SOLUTION 1 $0 NORMOSOL -M INJ /D5W 1 $0 NORMOSOL -R INJ /D5W 2 $0 NORMOSOL-R INJ PH $0 PLASMA-LYTE INJ 56/D5W 2 $0 PLASMA-LYTE INJ $0 PLASMA-LYTE INJ -A 2 $0 POTASSIUM CHLORIDE 20 MEQ/L 1 $0 (0.15%) IN DEXTROSE 5% INJ POTASSIUM CHLORIDE 40 MEQ/L 1 $0 (0.3%) IN DEXTROSE 5% INJ potassium chloride inj 2 meq/ml 1 $0 POTASSIUM CHLORIDE INJ 10 1 $0 MEQ/50ML POTASSIUM CHLORIDE INJ 10 1 $0 MEQ/100ML POTASSIUM CHLORIDE INJ 20 1 $0 MEQ/50ML POTASSIUM CHLORIDE INJ 20 1 $0 MEQ/100ML 97

98 POTASSIUM CHLORIDE INJ 40 1 $0 MEQ/100ML RINGER'S SOLUTION 1 $0 SODIUM CHLORIDE INJ 0.45% 1 $0 SODIUM CHLORIDE INJ 3% 1 $0 SODIUM CHLORIDE INJ 5% 1 $0 SODIUM CHLORIDE IV SOLN 0.9% 1 $0 礦物質 BONE DENSITY TAB 3 $0 NM; * bone meal w/ vitamin d tab 3 $0 NM; * CA CITRATE TAB 250MG 3 $0 NM; * ca citrate tab + d 3 $0 NM; * CA GLUCONATE TAB 50MG 3 $0 NM; * CA LACTATE TAB 100MG 3 $0 NM; * CA/MG/ZN TAB 3 $0 NM; * CAL CIT MAL/ TAB VITAMIND 3 $0 NM; * CAL-CITRATE TAB PLUS D 3 $0 NM; * CAL-QUICK LIQ $0 NM; * CAL/MAG TAB CHEW 3 $0 NM; * CAL/MAG/VITD TAB 3 $0 NM; * CALC CITRATE TAB 200MG 3 $0 NM; * calc citrate tab +d 3 $0 NM; * CALC GUMMIES CHW CHILD 3 $0 NM; * CALCET CHW BITES 3 $0 NM; * CALCET PETIT TAB $0 NM; * CALCI-MIX CAP 1250MG 3 $0 NM; * CALCIONATE SYP 1.8GM/5 3 $0 NM; * CALCIUM 500 TAB 3 $0 NM; * calcium 500 tab +d 3 $0 NM; * calcium 600 chw +d/mnrls 3 $0 NM; * calcium 600 chw w/vit d 3 $0 NM; * calcium 600 tab 3 $0 NM; * calcium 600 tab +d/mnrls 3 $0 NM; * calcium 600 tab vit d/mi 3 $0 NM; * CALCIUM 1000 TAB + D 3 $0 NM; * calcium 1200 chw 3 $0 NM; * CALCIUM &MAG TAB 3 $0 NM; * calcium + d chw 3 $0 NM; * CALCIUM CARB CHW 260MG 3 $0 NM; * CALCIUM CARB POW 800/2GM 3 $0 NM; * calcium carbonate susp $0 NM; * mg/5ml (500 mg/5ml elemental ca) 98

99 calcium carbonate tab 1250 mg 3 $0 NM; * (500 mg elemental ca) calcium carbonate-cholecalciferol 3 $0 NM; * tab 500 mg-400 unit calcium carbonate-cholecalciferol 3 $0 NM; * tab 600 mg-200 unit calcium carbonate-cholecalciferol 3 $0 NM; * tab 600 mg-400 unit calcium carbonate-vitamin d tab 3 $0 NM; * 500 mg-400 unit calcium carbonate-vitamin d tab 3 $0 NM; * 600 mg-400 unit CALCIUM CHW GUMMIES 3 $0 NM; * CALCIUM CIT/ TAB VIT D 3 $0 NM; * calcium citrate-vitamin d tab $0 NM; * mg-250 unit (elemental ca) calcium for chw women 3 $0 NM; * CALCIUM GLUC TAB 500MG 3 $0 NM; * calcium gluconate tab 500 mg 3 $0 NM; * CALCIUM GRA CITRATE 3 $0 NM; * CALCIUM LACT TAB 648MG 3 $0 NM; * calcium lactate tab 650 mg 3 $0 NM; * calcium soft chw chocolat 3 $0 NM; * calcium tab 500 mg 3 $0 NM; * CALCIUM TAB FORMULA 3 $0 NM; * calcium w/ magnesium tab $0 NM; * mg calcium+d3 tab $0 NM; * calcium+d3 tab grad rel 3 $0 NM; * CALCIUM/C/D CHW 500MG 3 $0 NM; * calcium/d3 tab 3 $0 NM; * calcium/d3 tab $0 NM; * calcium/d chw $0 NM; * calcium/magn tab zinc 3 $0 NM; * CALMAG THINS TAB MG 3 $0 NM; * CALTRATE 600 CHW $0 NM; * CHELATED CA TAB 200MG 3 $0 NM; * chew calcium chw 3 $0 NM; * cit calc/d tab $0 NM; * CITRACAL CAL CHW GUMMIES 3 $0 NM; * CITRACAL HRT TAB HEALTH 3 $0 NM; * CORAL CALCIU CAP 3 $0 NM; * CORAL CALCIU CAP 1000MG 3 $0 NM; * 99

100 CORAL CALCIU CAP PLUS 3 $0 NM; * CORAL CAP CALCIUM 3 $0 NM; * EQL CALCIUM CAP VIT D 3 $0 NM; * kp ca/mg/zn tab 3 $0 NM; * kp calcium cap 600+d 3 $0 NM; * kp calcium tab 600+d 3 $0 NM; * liq ca/vit d cap 600mg 3 $0 NM; * LIQUID CALCI CAP WITH D3 3 $0 NM; * LOCALNESIUM TAB 3 $0 NM; * LOCALNESIUM TAB -C 3 $0 NM; * MAG CITRATE TAB 100MG 3 $0 NM; * mag-delay tab 3 $0 NM; * MAG-TAB SR TAB 84MG 3 $0 NM; * MAGINEX TAB 615 MG 3 $0 NM; * MAGNEBIND TAB $0 NM; * MAGNESIUM CAP 300MG 3 $0 NM; * MAGNESIUM CAP 400MG 3 $0 NM; * magnesium oxide tab 400 mg (240 3 $0 NM; * mg elemental mg) magnesium oxide tab 500 mg (mg 3 $0 NM; * supplement) MAGNESIUM TAB 30MG 3 $0 NM; * magnesium tab 200 mg 3 $0 NM; * OSTEO-PORETI TAB 3 $0 NM; * oys shell+d tab $0 NM; * oysco 500 tab 500mg 3 $0 NM; * oyst shell/d tab $0 NM; * PARVA-CAL TAB 500MG 3 $0 NM; * PHOS-NAK POW CONCENTR 3 $0 NM; * RA CA/BORON TAB 3 $0 NM; * ra coral cap calcium 3 $0 NM; * ra magnesium cap 500mg 3 $0 NM; * RA OYS SHL/D TAB 250MG 3 $0 NM; * ra oys shl/d tab 500mg 3 $0 NM; * selenium tab 100 mcg 3 $0 NM; * SELENIUM TAB 200MCG 3 $0 NM; * slow magnes/ tab calcium 3 $0 NM; * SLOW-MAG TAB 3 $0 NM; * sm ca/mg/zn tab 3 $0 NM; * SM CORAL CAL TAB 1000MG 3 $0 NM; * sm magnesium tab 250mg 3 $0 NM; * UPCAL D POW 3 $0 NM; * 100

101 藥物層級您為藥物支 付的費用 維生素 ACEROLA C WAF 500MG 3 $0 NM; * ANTIOXIDANT CAP 3 $0 NM; * AQUA-E LIQ 3 $0 NM; * aquadeks dro 3 $0 NM; * ASCORBIC ACD POW 3 $0 NM; * ascorbic acid chew tab 250 mg 3 $0 NM; * ascorbic acid syrup 500 mg/5ml 3 $0 NM; * ascorbic acid tab 100 mg 3 $0 NM; * ascorbic acid tab 250 mg 3 $0 NM; * ascorbic acid tab 500 mg 3 $0 NM; * B-12 DOTS TAB 500MCG 3 $0 NM; * B-12 TAB 5000MCG 3 $0 NM; * b-complex vitamin cap 3 $0 NM; * b-complex vitamin tab 3 $0 NM; * b-complex w/ c & calcium tab 3 $0 NM; * B-NATAL LOZ 25MG 3 $0 NM; * bee zee tab 3 $0 NM; * beta carotene cap unit 3 $0 NM; * biotin tab 300 mcg 3 $0 NM; * c-500 chw 500mg 3 $0 NM; * calcitriol cap 0.5 mcg 1 $0 B/D calcitriol cap 0.25 mcg 1 $0 B/D calcitriol inj 1 mcg/ml 1 $0 B/D calcitriol oral soln 1 mcg/ml 1 $0 B/D calcium ascorbate tab 500 mg 3 $0 NM; * calcium pantothenate tab 500 mg 3 $0 NM; * central-vite tab performa 3 $0 NM; * CENTRUM CHW SILVER 3 $0 NM; * centrum kids chw complete 3 $0 NM; * cerovite adv liq formula 3 $0 NM; * chewabl vite chw childrns 3 $0 NM; * child chew/ chw extra c 3 $0 NM; * CHILD-MULTI CHW VITAMINS 3 $0 NM; * cholecalciferol cap 400 unit 3 $0 NM; * cholecalciferol cap 2000 unit 3 $0 NM; * cholecalciferol cap 5000 unit 3 $0 NM; * cholecalciferol drops 5000 unit/ml 3 $0 NM; * (1000 unit/0.2ml) cholecalciferol oral liquid $0 NM; * unit/ml cholecalciferol tab 400 unit 3 $0 NM; * 101

102 cholecalciferol tab 1000 unit 3 $0 NM; * cholecalciferol tab 2000 unit 3 $0 NM; * CL PRENATAL TAB MG 3 $0 NM; * cod liver oil cap 3 $0 NM; * cvs vit b-6 tab 200mg 3 $0 NM; * cyanocobalamin inj 1000 mcg/ml 3 $0 NM; * cyanocobalamin liquid $0 NM; * mcg/15ml cyanocobalamin tab 250 mcg 3 $0 NM; * cyanocobalamin tab 500 mcg 3 $0 NM; * cyanocobalamin tab 2000 mcg 3 $0 NM; * cyanocobalamin tab sl 1000 mcg 3 $0 NM; * cyanocobalamin tab sl 2500 mcg 3 $0 NM; * CYTO B2 POW 3 $0 NM; * daily-vite/ tab iron 3 $0 NM; * DIALYVITE 80 TAB ZINC 15 3 $0 NM; * dialyvite tab $0 NM; * e-oil oil 30000unt 3 $0 NM; * ecee plus tab 3 $0 NM; * ELDERTONIC ELX 3 $0 NM; * energy b-12 tab 1500mcg 3 $0 NM; * ergocalciferol cap unit 3 $0 NM; * EZFE FORTE CAP 3 $0 NM; * FOLIC ACID CAP 20MG 3 $0 NM; * folic acid inj 5 mg/ml 3 $0 NM; * folic acid tab 1 mg 3 $0 NM; * FOLIC ACID TAB 1 MG 3 $0 NM; * folic acid tab 400 mcg 3 $0 NM; * folic acid tab 800 mcg 3 $0 NM; * fruit c-100 chw 3 $0 NM; * geravim liq 3 $0 NM; * gummi bear chw multivit 3 $0 NM; * HONEY BEARS CHW 3 $0 NM; * HONEY BEARS CHW IRON-ZIN 3 $0 NM; * hydroxocobalamin inj 1000 mcg/ml 3 $0 NM; * icaps cap 3 $0 NM; * ICAPS LUTEIN TAB ZEAXANTH 3 $0 NM; * icaps mv tab 3 $0 NM; * iromin-g tab 3 $0 NM; * kp b complex tab /c 3 $0 NM; * kp vitamin e cap 100unit 3 $0 NM; * KPN PRENATAL TAB 3 $0 NM; * 102

103 LUMITENE CAP 30MG 3 $0 NM; * MEPHYTON TAB 5MG 3 $0 NM; * meribin cap 5mg 3 $0 NM; * MISSION PREN TAB 3 $0 NM; * MISSION PREN TAB HP 3 $0 NM; * multi-delyn liq 3 $0 NM; * MULTI-DELYN LIQ /IRON 3 $0 NM; * MYKIDZ IRON SUS 10MG/2ML 3 $0 NM; * NASCOBAL SPR 500MCG 3 $0 NM; * NEPHRONEX LIQ 3 $0 NM; * niacin cap cr 250 mg 3 $0 NM; * niacin cap cr 500 mg 3 $0 NM; * niacin tab 50 mg 3 $0 NM; * niacin tab 100 mg 3 $0 NM; * niacin tab 500 mg 3 $0 NM; * niacin tab cr 500 mg 3 $0 NM; * niacin tab cr 750 mg 3 $0 NM; * NIACIN TR TAB 1000MG 3 $0 NM; * niacinamide tab 100 mg 3 $0 NM; * niacinamide tab 500 mg 3 $0 NM; * paricalcitol cap 1 mcg 1 $0 B/D paricalcitol cap 2 mcg 1 $0 B/D paricalcitol cap 4 mcg 1 $0 B/D PERRY PRENAT CAP 3 $0 NM; * phytonadione inj 1 mg/0.5ml (2 3 $0 NM; * mg/ml) phytonadione inj 10 mg/ml 3 $0 NM; * phytonadione tab 100 mcg 3 $0 NM; * polyvitamin dro 3 $0 NM; * polyvitamin dro /iron 3 $0 NM; * PRENATAL TAB 3 $0 NM; * PRENATAL TAB MG 3 $0 NM; * PRENATAL VITAMIN/FOLIC ACID > 1 $0 0.8 MG (GENERIC) pyridoxine hcl inj 100 mg/ml 3 $0 NM; * pyridoxine hcl tab 25 mg 3 $0 NM; * pyridoxine hcl tab 50 mg 3 $0 NM; * pyridoxine hcl tab 100 mg 3 $0 NM; * pyridoxine hcl tab cr 200 mg 3 $0 NM; * ra b-complex tab vit c tr 3 $0 NM; * ra beta caro cap 15mg 3 $0 NM; * ra vit c loz 60mg 3 $0 NM; * 103

104 ra vitamin c tab 1000mg 3 $0 NM; * riboflavin tab 25 mg 3 $0 NM; * riboflavin tab 50 mg 3 $0 NM; * SCOOBY-DOO CHW 3 $0 NM; * slo-niacin tab 250mg cr 3 $0 NM; * sm vitamin c tab 500mg tr 3 $0 NM; * THERA BETA- TAB CAROTENE 3 $0 NM; * THERA-D TAB 4000UNIT 3 $0 NM; * THERANATAL TAB $0 NM; * thiamine hcl inj 100 mg/ml 3 $0 NM; * thiamine hcl tab 50 mg 3 $0 NM; * thiamine hcl tab 100 mg 3 $0 NM; * thiamine mononitrate tab 100 mg 3 $0 NM; * total b/c tab 3 $0 NM; * TRI-VI-SOL SOL 3 $0 NM; * tri-vita sol 3 $0 NM; * tri-vitamin dro 3 $0 NM; * VITALETS CHW 3 $0 NM; * VITAMIN A TAB 15000UNT 3 $0 NM; * vitamin b12 tab 2000mcg 3 $0 NM; * VITAMIN C CHW 1000MG 3 $0 NM; * VITAMIN C SOL 3 $0 NM; * VITAMIN D2 TAB 400UNIT 3 $0 NM; * VITAMIN D2 TAB 2000UNIT 3 $0 NM; * VITAMIN D3 CAP 4000UNIT 3 $0 NM; * vitamin d3 cap 10000unt 3 $0 NM; * vitamin d3 cap 50000unt 3 $0 NM; * VITAMIN D3 LIQ 1200UNIT 3 $0 NM; * VITAMIN D3 TAB 3000UNIT 3 $0 NM; * vitamin d3 tab 5000unit 3 $0 NM; * VITAMIN D3 TAB 50000UNT 3 $0 NM; * vitamin d cap 1000unit 3 $0 NM; * vitamin d chw 400unit 3 $0 NM; * vitamin d chw 1000unit 3 $0 NM; * vitamin e cap 200 unit 3 $0 NM; * vitamin e cap 1000 unit 3 $0 NM; * vitamin e soln 15 unit/0.3ml (50 3 $0 NM; * unit/ml) VITAMIN E TAB 100UNIT 3 $0 NM; * vitamin mixture cap 3 $0 NM; * vitamins a & d cap 3 $0 NM; * vitatrum chw 3 $0 NM; * 104

105 vite/iron chw children 3 $0 NM; * ZOO FRIENDS CHW COMPLETE 3 $0 NM; * 眼藥 - 治療眼部疾病的藥物 抗感染藥 / 消炎藥 - 治療感染和發炎的藥物 bacitracin-polymyxin-neomycin-hc 1 $0 ophth oint 1% blephamide oin s.o.p. 2 $0 neomycin-polymyxin-dexamethaso 1 $0 ne ophth oint 0.1% neomycin-polymyxin-dexamethaso 1 $0 ne ophth susp 0.1% neomycin-polymyxin-hc ophth susp 1 $0 sulfacetamide sodium-prednisolone 1 $0 ophth soln (0.25)% TOBRADEX OIN % 2 $0 TOBRADEX ST SUS $0 tobramycin-dexamethasone ophth 1 $0 susp % ZYLET SUS % 2 $0 抗感染藥 - 治療感染的藥物 bacitracin ophth oint 500 unit/gm 1 $0 bacitracin-polymyxin b ophth oint 1 $0 BESIVANCE SUS 0.6% 2 $0 CILOXAN OIN 0.3% OP 2 $0 ciprofloxacin hcl ophth soln 0.3% 1 $0 erythromycin ophth oint 5 mg/gm 1 $0 gatifloxacin ophth soln 0.5% 1 $0 gentak oin 0.3% op 1 $0 gentamicin sulfate ophth oint 0.3% 1 $0 gentamicin sulfate ophth soln 0.3% 1 $0 ilotycin oin op 1 $0 MOXEZA SOL 0.5% 2 $0 NATACYN SUS 5% OP 2 $0 neomycin-bacitrac zn-polymyx 1 $0 5(3.5)mg-400unt-10000unt op oin neomycin-polymy-gramicid op sol 1 $ mg-unt-mg/ml ofloxacin ophth soln 0.3% 1 $0 polymyxin b-trimethoprim ophth 1 $0 soln unit/ml-0.1% sulfacetamide sodium ophth oint 10% 1 $0 105

106 藥物層級您為藥物支 付的費用 sulfacetamide sodium ophth soln 1 $0 10% tobramycin ophth soln 0.3% 1 $0 TOBREX OIN 0.3% OP 2 $0 trifluridine ophth soln 1% 1 $0 VIGAMOX DRO 0.5% 2 $0 ZIRGAN GEL 0.15% 2 $0 消炎藥 - 治療發炎的藥物 ALREX SUS 0.2% 2 $0 BROMFENAC SODIUM OPHTH SOLN 1 $0 0.09% (BASE EQUIV) (ONCE-DAILY) bromfenac sodium ophth soln 0.09% (base equivalent) 1 $0 dexamethasone sodium phosphate 1 $0 ophth soln 0.1% diclofenac sodium ophth soln 0.1% 1 $0 DUREZOL EMU 0.05% 2 $0 FLUOROMETHOLONE OPHTH SUSP 1 $0 0.1% flurbiprofen sodium ophth soln 1 $0 0.03% ILEVRO DRO 0.3% OP 2 $0 ketorolac tromethamine ophth soln 1 $0 0.4% ketorolac tromethamine ophth soln 1 $0 0.5% LOTEMAX GEL 0.5% 2 $0 LOTEMAX OIN 0.5% 2 $0 LOTEMAX SUS 0.5% 2 $0 MAXIDEX SUS 0.1% OP 2 $0 pred sod pho sol 1% op 2 $0 PREDNISOLONE ACETATE OPHTH 1 $0 SUSP 1% 抗過敏藥 - 治療過敏的藥物 azelastine hcl ophth soln 0.05% 1 $0 BEPREVE DRO 1.5% 2 $0 cromolyn sodium ophth soln 4% 1 $0 EYE ALLERGY SOL RELIEF 3 $0 NM; * eye drops sol 0.05% op 3 $0 NM; * eye drops sol a/r 3 $0 NM; * ketotif fum dro 0.025%op 3 $0 NM; * LASTACAFT SOL 0.25% 2 $0 106

107 PATADAY SOL 0.2% 2 $0 PAZEO DRO 0.7% 2 $0 sm redness dro relief 3 $0 NM; * VISINE-LR SOL 0.025% 3 $0 NM; * 抗青光眼藥 - 治療青光眼的藥物 ALPHAGAN P SOL 0.1% 2 $0 AZOPT SUS 1% OP 2 $0 betaxolol hcl ophth soln 0.5% 1 $0 BETOPTIC-S SUS 0.25% OP 2 $0 brimonidine tartrate ophth soln 1 $0 0.2% BRIMONIDINE TARTRATE OPHTH 1 $0 SOLN 0.15% carteolol hcl ophth soln 1% 1 $0 COMBIGAN SOL 0.2/0.5% 2 $0 dorzolamide hcl ophth soln 2% 1 $0 dorzolamide hcl-timolol maleate 1 $0 ophth soln mg/ml ISTALOL SOL 0.5% OP 2 $0 latanoprost ophth soln 0.005% 1 $0 levobunolol hcl ophth soln 0.5% 1 $0 LEVOBUNOLOL HCL OPHTH SOLN 1 $0 0.25% LUMIGAN SOL 0.01% 2 $0 metipranolol ophth soln 0.3% 1 $0 PHOSPHOLINE SOL 0.125%OP 2 $0 PILOCARPINE HCL OPHTH SOLN 1% 1 $0 PILOCARPINE HCL OPHTH SOLN 2% 1 $0 PILOCARPINE HCL OPHTH SOLN 4% 1 $0 SIMBRINZA SUS 1-0.2% 2 $0 TIMOLOL MALEATE OPHTH GEL 1 $0 FORMING SOLN 0.5% TIMOLOL MALEATE OPHTH GEL 1 $0 FORMING SOLN 0.25% timolol maleate ophth soln 0.5% 1 $0 timolol maleate ophth soln 0.25% 1 $0 TRAVATAN Z DRO 0.004% 2 $0 雜類 artifi tears sol op 3 $0 NM; * artificial sol tears 3 $0 NM; * ENUCLENE SOL OP 3 $0 NM; * eye wash sol 3 $0 NM; * 107

108 FRESHKOTE SOL 2.7-2% 3 $0 NM; * goniotaire sol 2.5% op 3 $0 NM; * HYPOTEARS SOL 1-1% 3 $0 NM; * ISOPTO TEARS SOL 0.5% OP 3 $0 NM; * lubr/dry eye dro % 3 $0 NM; * lubricnt eye dro 0.5% op 3 $0 NM; * lubricnt gel dro 1% 3 $0 NM; * MURO 128 SOL 2% OP 3 $0 NM; * naphazoline hcl ophth soln 0.1% 1 $0 natures tear sol 0.4% 3 $0 NM; * ophthalmic sol 5% op 3 $0 NM; * PROLENSA SOL 0.07% 2 $0 proparacaine hcl ophth soln 0.5% 1 $0 pure & gentl dro 0.3% 3 $0 NM; * ra lubricant dro % 3 $0 NM; * REFRESH CELL DRO 1% OP 3 $0 NM; * refresh p.m. oin op 3 $0 NM; * REFRESH SOL OPTIVE 3 $0 NM; * RESTASIS EMU 0.05% 2 $0 QL (64 vials / 30 days) RETAINE MGD EMU % 3 $0 NM; * sodium chloride hypertonic ophth 3 $0 NM; * oint 5% SOOTHE DRO % 3 $0 NM; * STERILE LUBR DRO 0.7% 3 $0 NM; * SYSTANE BAL SOL RESTOR 3 $0 NM; * SYSTANE GEL 0.3% 3 $0 NM; * systane oin 3 $0 NM; * TEARS AGAIN GEL NGHT/DAY 3 $0 NM; * tgt lubricnt dro eye 3 $0 NM; * th eye tears dro 3 $0 NM; * THERATEARS SOL OP 3 $0 NM; * 呼吸藥 - 治療呼吸疾病的藥物 抗膽鹼能劑 /β 受體激動複方劑 - 治療慢性阻塞性肺病的藥物 ANORO ELLIPT AER $0 QL (60 inhalations / 30 days) COMBIVENT AER RESPIMAT 2 $0 QL (2 inhalers / 30 days) ipratropium-albuterol nebu soln (3) mg/3ml 1 $0 B/D 抗膽鹼能類 - 治療慢性阻塞性肺病的藥物 ATROVENT HFA AER 17MCG 2 $0 QL (2 inhalers / 30 days) 108

109 INCRUSE ELPT INH 62.5MCG 2 $0 QL (1 inhaler / 30 days) ipratropium bromide inhal soln 1 $0 B/D 0.02% ipratropium bromide nasal soln 1 $0 0.03% (21 mcg/spray) ipratropium bromide nasal soln 1 $0 0.06% (42 mcg/spray) 抗組織胺藥 - 治療過敏的藥物 ALA-HIST IR TAB 2MG 3 $0 NM; * all day allg tab 10mg 3 $0 NM; * ALLEGRA ALRG TAB 30MG 3 $0 NM; * aller-ease tab 60mg 3 $0 NM; * allergy chld liq 12.5/5ml 3 $0 NM; * allergy relf cap 25mg 3 $0 NM; * allergy relf tab 10mg 3 $0 NM; * allergy relf tab 25mg 3 $0 NM; * allrgy relf tab 12.5mg 3 $0 NM; * ASTEPRO SPR 0.15% 2 $0 azelastine hcl nasal spray 0.1% 1 $0 (137 mcg/spray) azelastine hcl nasal spray 0.15% 1 $0 (205.5 mcg/spray) cetirizine hcl chew tab 5 mg 3 $0 NM; * cetirizine hcl chew tab 10 mg 3 $0 NM; * cetirizine hcl oral soln 1 mg/ml (5 1 $0 mg/5ml) cetirizine hcl tab 5 mg 3 $0 NM; * cetirizine sol 5mg/5ml 3 $0 NM; * child comple chw allergy 3 $0 NM; * chlorpheniramine maleate tab cr 123 $0 NM; * mg CLARITIN CHW 5MG 3 $0 NM; * CLARITIN RDT TAB 5MG 3 $0 NM; * diphenhydramine hcl cap 50 mg 3 $0 NM; * diphenhydramine hcl inj 50 mg/ml 1 $0 ED CHLORPED LIQ 2MG/ML 3 $0 NM; * ed chlorped syp jr 3 $0 NM; * fexofenadine hcl tab 180 mg 3 $0 NM; * fexofenadine sus 30mg/5ml 3 $0 NM; * hydroxyzine hcl im soln 25 mg/ml 2 $0 PA; PA if 65 years and hydroxyzine hcl im soln 50 mg/ml 2 $0 PA; PA if 65 years and 109

110 hydroxyzine hcl syrup 10 mg/5ml 2 $0 PA; PA if 65 years and hydroxyzine hcl tab 10 mg 2 $0 PA; PA if 65 years and hydroxyzine hcl tab 25 mg 2 $0 PA; PA if 65 years and hydroxyzine hcl tab 50 mg 2 $0 PA; PA if 65 years and hydroxyzine pamoate cap 25 mg 2 $0 PA; PA if 65 years and hydroxyzine pamoate cap 50 mg 2 $0 PA; PA if 65 years and hydroxyzine pamoate cap 100 mg 2 $0 PA; PA if 65 years and J-TAN PD DRO 1MG/ML 3 $0 NM; * levocetirizine dihydrochloride soln 2.5 mg/5ml (0.5 mg/ml) 1 $0 levocetirizine dihydrochloride tab 5 1 $0 mg loratadine tab 10 mg 3 $0 NM; * olopatadine hcl nasal soln 0.6% 1 $0 TRIAMINIC MIS GRAPE 3 $0 NM; * wal-itin syp 5mg/5ml 3 $0 NM; * β 受體激動劑 - 治療哮喘和慢性阻塞性肺病的藥物 albuterol sulfate soln nebu 0.5% (51 $0 B/D mg/ml) albuterol sulfate soln nebu 0.63 mg/3ml (base equiv) 1 $0 B/D albuterol sulfate soln nebu 0.083% 1 $0 B/D (2.5 mg/3ml) albuterol sulfate soln nebu $0 B/D mg/3ml (base equiv) albuterol sulfate syrup 2 mg/5ml 1 $0 albuterol sulfate tab 2 mg 1 $0 albuterol sulfate tab 4 mg 1 $0 albuterol sulfate tab sr 12hr 4 mg 1 $0 albuterol sulfate tab sr 12hr 8 mg 1 $0 levalbuterol hcl soln nebu conc $0 B/D mg/0.5ml (base equiv) PERFOROMIST NEB 20MCG 2 $0 B/D SEREVENT DIS AER 50MCG 2 $0 QL (60 inhalations / 30 days) terbutaline sulfate inj 1 mg/ml 2 $0 terbutaline sulfate tab 2.5 mg 1 $0 110

111 terbutaline sulfate tab 5 mg 1 $0 VENTOLIN HFA AER 2 $0 QL (2 inhalers / 30 days) XOPENEX HFA AER 2 $0 QL (2 inhalers / 30 days) 咳嗽和感冒藥 ADVIL ALLERG TAB CONGEST 3 $0 NM; * ADVIL ALLERG TAB SINUS 3 $0 NM; * ADVIL COLD/ CAP SINUS 3 $0 NM; * afrin child spr 0.25% 3 $0 NM; * ALA-HIST PE TAB 2-10MG 3 $0 NM; * allergy-d tab 5-120mg 3 $0 NM; * ap-hist dm liq $0 NM; * AYR NASAL DRO 0.65% 3 $0 NM; * ayr saline gel nasal 3 $0 NM; * benzonatate cap 100 mg 3 $0 NM; * benzonatate cap 200 mg 3 $0 NM; * BIOSPEC DMX LIQ 3 $0 NM; * BROHIST D TAB 4-10MG 3 $0 NM; * childrens sus plus cld 3 $0 NM; * CHLO TUSS EX LIQ $0 NM; * cld/cgh/sore liq throat 3 $0 NM; * CNTC CLD/FLU TAB MAX ST 3 $0 NM; * CODITUSS DM SYP 3 $0 NM; * cold head tab cong dt 3 $0 NM; * cold multi pak day/nght 3 $0 NM; * cold multi-s tab night 3 $0 NM; * cold/allergy elx children 3 $0 NM; * cold/allery sus child 3 $0 NM; * cold/cough elx child 3 $0 NM; * cold/sinus tab relief 3 $0 NM; * COMPLETE SIN TAB RELIEF 3 $0 NM; * comtrex sev pak cld/sinu 3 $0 NM; * CONEX SOL CLD/ALRG 3 $0 NM; * CONEX TAB 2-60MG 3 $0 NM; * coricidin cap cong/cgh 3 $0 NM; * cough & cold tab 3 $0 NM; * cough & sore liq thrt day 3 $0 NM; * cough cont liq dm max 3 $0 NM; * cough dm liq 30mg/5ml 3 $0 NM; * 12.5cpd/1dcp liq m/30pse 3 $0 NM; * 111

112 cromolyn sodium nasal aerosol soln 3 $0 NM; * 5.2 mg/act (4%) CVS NASAL SPR MIST 3 $0 NM; * day-time cap sinus 3 $0 NM; * decongestant tab 120mg er 3 $0 NM; * DELTUSS DP LIQ 1-30/5ML 3 $0 NM; * dextromethorphan-guaifenesin tab 3 $0 NM; * mg dimetapp liq nighttim 3 $0 NM; * DIMETAPP SYP CGH/COLD 3 $0 NM; * DURAFLU TAB 3 $0 NM; * ed a-hist dm liq 3 $0 NM; * ed bron gp liq 3 $0 NM; * ED CHLORPED DRO D 3 $0 NM; * entre-cough liq 3 $0 NM; * entre-hist liq $0 NM; * exefen-ir tab mg 3 $0 NM; * flu/severe pow cold/cgh 3 $0 NM; * guaifenesin-codeine soln $0 NM; * mg/5ml intense cold tab /flu med 3 $0 NM; * intense coug liq reliever 3 $0 NM; * J-MAX SYP 5-200MG 3 $0 NM; * J-TAN D PD DRO 1-7.5MG 3 $0 NM; * kidkare liq cgh/cold 3 $0 NM; * liquituss gg liq 200/5ml 3 $0 NM; * LODRANE D CAP 4-60MG 3 $0 NM; * LOHIST-D LIQ 3 $0 NM; * lohist-dm syp mg 3 $0 NM; * lohist-peb liq 4-10/5ml 3 $0 NM; * loratadine & pseudoephedrine tab sr 3 $0 NM; * 24hr mg M-END DMX LIQ 3 $0 NM; * mapap cold tab $0 NM; * mucaphed tab mg 3 $0 NM; * MUCINEX CGH GRA 5-100MG 3 $0 NM; * mucinex cold tab sinus 3 $0 NM; * MUCINEX D TAB MG 3 $0 NM; * MUCINEX D TAB $0 NM; * MUCINEX TAB 1200MG 3 $0 NM; * MUCINEX/KIDS GRA 100MG 3 $0 NM; * mucus relief liq 5-100mg 3 $0 NM; * 112

113 mucus relief liq cold/sin 3 $0 NM; * mucus relief tab 400mg 3 $0 NM; * mucus relief tab 600mg er 3 $0 NM; * mucus+chst liq 100/5ml 3 $0 NM; * mucus-dm max tab $0 NM; * mucus-dm tab mg 3 $0 NM; * multi-sympt liq cld nght 3 $0 NM; * multi-sympt pak day/nght 3 $0 NM; * multsym cold liq childrns 3 $0 NM; * nasal decon liq 15mg/5ml 3 $0 NM; * nasal decon syp 30mg/5ml 3 $0 NM; * NASAL DECONG LIQ 30MG/5ML 3 $0 NM; * nasal decong tab 10mg 3 $0 NM; * nasal spr 0.05% 3 $0 NM; * NASOPEN PE LIQ 3 $0 NM; * neotuss liq 3 $0 NM; * NEXAFED SINS TAB + PAIN 3 $0 NM; * nexafed tab 30mg 3 $0 NM; * night-time cap sinus 3 $0 NM; * nohist-lq liq 4-10/5ml 3 $0 NM; * NOREL AD TAB $0 NM; * nyquil d liq cold/flu 3 $0 NM; * organ-i nr tab 200mg 3 $0 NM; * pain relief sus pls cold 3 $0 NM; * pain relieve tab pm 3 $0 NM; * pediacare liq long-act 3 $0 NM; * 10peh/380gfn tab 3 $0 NM; * 10peh/380gfn tab /15dm 3 $0 NM; * PHENAGIL TAB MG 3 $0 NM; * PRETZ SOL 3 $0 NM; * PRO-CHLO LIQ 3 $0 NM; * 40pse/400gfn tab /20dm 3 $0 NM; * pseudoephed-bromphen-dm syrup 3 $0 NM; * mg/5ml pseudoephedr tab 60mg 3 $0 NM; * pyrilamine mal-phenylephrine hcl 3 $0 NM; * tann susp 16-5 mg/5ml pyrilamine-phenylephrine tab 3 $0 NM; * mg q-tapp dm elx 3 $0 NM; * RESCON TAB 2-60MG 3 $0 NM; * RESCON-DM SYP 3 $0 NM; * 113

114 RESPAIRE-30 CAP 3 $0 NM; * RHINARIS GEL 0.2% 3 $0 NM; * RHINARIS SPR 0.2% 3 $0 NM; * robafen cf syp cgh/cld 3 $0 NM; * robafen cgh cap 15mg 3 $0 NM; * robitussin cap cold+flu 3 $0 NM; * robitussin liq 15mg/5ml 3 $0 NM; * ROBITUSSIN LIQ CF 3 $0 NM; * ROBITUSSIN LIQ CGH/COLD 3 $0 NM; * robitussin liq ms max 3 $0 NM; * ROBITUSSIN LIQ NIGHT TM 3 $0 NM; * robitussin syp 7.5/5ml 3 $0 NM; * RYMED TAB 2-10MG 3 $0 NM; * rynex dm liq 3 $0 NM; * rynex pse liq 3 $0 NM; * scot-tussin liq dm sf 3 $0 NM; * SCOT-TUSSIN LIQ SENIOR 3 $0 NM; * STAHIST AD LIQ 3 $0 NM; * STAHIST AD TAB 25-60MG 3 $0 NM; * triacting dt liq cold/cgh 3 $0 NM; * TRIAMINIC SYP COLD/CGH 3 $0 NM; * TUSNEL LIQ 3 $0 NM; * TUSNEL PED DRO $0 NM; * TUSNEL PEDI LIQ $0 NM; * TUSNEL-DM DRO PEDIATRC 3 $0 NM; * tussi-pres liq b 3 $0 NM; * tussin cf liq cgh/cold 3 $0 NM; * tussin dm syp /5 3 $0 NM; * vcks dayquil liq mucus dm 3 $0 NM; * VICK VAPORUB OIN 3 $0 NM; * wal-act tab mg 3 $0 NM; * wal-dryl all tab sinus 3 $0 NM; * wal-dryl-d tab alrg/sin 3 $0 NM; * wal-fex d tab 12 hour 3 $0 NM; * wal-flu cold pak daytime 3 $0 NM; * wal-itin d tab 5-120mg 3 $0 NM; * wal-phed pe tab 4-10mg 3 $0 NM; * wal-phed tab 4-60mg 3 $0 NM; * zonatuss cap 150mg 3 $0 NM; * 白三烯受體拮抗劑 - 治療哮喘和過敏的藥物 montelukast sodium chew tab 4 mg 1 $0 (base equiv) 114

115 montelukast sodium chew tab 5 mg 1 $0 (base equiv) montelukast sodium oral granules 1 $0 packet 4 mg (base equiv) montelukast sodium tab 10 mg 1 $0 (base equiv) zafirlukast tab 10 mg 1 $0 zafirlukast tab 20 mg 1 $0 肥大細胞穩定劑 - 治療過敏的藥物 cromolyn sodium soln nebu 20 1 $0 B/D mg/2ml 雜類 acetylcysteine inhal soln 10% 1 $0 B/D acetylcysteine inhal soln 20% 1 $0 B/D ARALAST NP INJ 500MG 2 $0 NM, LA, PA ARALAST NP INJ 800MG 2 $0 NM, LA, PA ARALAST NP INJ 1000MG 2 $0 NM, LA, PA AUVI-Q INJ 0.3MG 2 $0 AUVI-Q INJ 0.15MG 2 $0 DALIRESP TAB 500MCG 2 $0 EPIPEN 2-PAK INJ 0.3MG 2 $0 EPIPEN-JR INJ 2-PAK 2 $0 ESBRIET CAP 267MG 2 $0 NM, PA KALYDECO PAK 50MG 2 $0 NM, PA KALYDECO PAK 75MG 2 $0 NM, PA KALYDECO TAB 150MG 2 $0 NM, PA OFEV CAP 100MG 2 $0 NM, PA OFEV CAP 150MG 2 $0 NM, PA ORKAMBI TAB $0 NM, PA PROLASTIN-C INJ 1000MG 2 $0 NM, LA, PA PULMOZYME SOL 1MG/ML 2 $0 B/D, NM XOLAIR SOL 150MG 2 $0 NM, LA, PA ZEMAIRA INJ 1000MG 2 $0 NM, LA, PA 鼻用類固醇 - 治療過敏的藥物 flunisolide nasal soln 25 mcg/act 1 $0 QL (2 bottles / 30 days) (0.025%) fluticasone propionate nasal susp 1 $0 QL (1 bottle / 30 days) 50 mcg/act NASONEX SPR 50MCG/AC 2 $0 QL (2 inhalers / 30 days) 類固醇吸入劑 - 治療哮喘的藥物 ARNUITY ELPT INH 100MCG 2 $0 QL (30 inhalations / 30 days) 115

116 ARNUITY ELPT INH 200MCG 2 $0 QL (30 inhalations / 30 days) budesonide inhalation susp $0 B/D mg/2ml budesonide inhalation susp $0 B/D mg/2ml FLOVENT DISK AER 50MCG 2 $0 QL (120 inhalations / 30 days) FLOVENT DISK AER 100MCG 2 $0 QL (120 inhalations / 30 days) FLOVENT DISK AER 250MCG 2 $0 QL (240 inhalations / 30 days) FLOVENT HFA AER 44MCG 2 $0 QL (2 inhalers / 30 days) FLOVENT HFA AER 110MCG 2 $0 QL (2 inhalers / 30 days) FLOVENT HFA AER 220MCG 2 $0 QL (2 inhalers / 30 days) PULMICORT INH 90MCG 2 $0 QL (2 inhalers / 30 days) PULMICORT INH 180MCG 2 $0 QL (2 inhalers / 30 days) 類固醇 /β- 興奮複方劑 - 治療哮喘和慢性阻塞性肺病的藥物 ADVAIR DISKU AER 100/50 2 $0 QL (60 inhalations / 30 days) ADVAIR DISKU AER 250/50 2 $0 QL (60 inhalations / 30 days) ADVAIR DISKU AER 500/50 2 $0 QL (60 inhalations / 30 days) ADVAIR HFA AER 45/21 2 $0 QL (1 inhaler / 30 days) ADVAIR HFA AER 115/21 2 $0 QL (1 inhaler / 30 days) ADVAIR HFA AER 230/21 2 $0 QL (1 inhaler / 30 days) BREO ELLIPTA INH $0 QL (60 blisters / 30 days) BREO ELLIPTA INH $0 QL (60 blisters / 30 days) SYMBICORT AER $0 QL (1 inhaler / 30 days) SYMBICORT AER $0 QL (1 inhaler / 30 days) 黃嘌呤 - 治療慢性阻塞性肺病的藥物 aminophylline inj 25 mg/ml 1 $0 elixophyllin elx 80/15ml 2 $0 theo-24 cap 100mg cr 2 $0 theo-24 cap 200mg cr 2 $0 theo-24 cap 300mg cr 2 $0 theo-24 cap 400mg er 2 $0 116

117 藥物層級您為藥物支 付的費用 theophylline soln 80 mg/15ml 1 $0 theophylline tab sr 12hr 100 mg 1 $0 theophylline tab sr 12hr 200 mg 1 $0 theophylline tab sr 12hr 300 mg 1 $0 theophylline tab sr 12hr 450 mg 1 $0 theophylline tab sr 24hr 400 mg 1 $0 theophylline tab sr 24hr 600 mg 1 $0 局部藥 - 治療耳朵和皮膚疾病的藥物 皮膚科, 痤瘡 adapalene cream 0.1% 1 $0 adapalene gel 0.1% 1 $0 amnesteem cap 10mg 1 $0 amnesteem cap 20mg 1 $0 amnesteem cap 40mg 1 $0 AVITA CRE 0.025% 1 $0 AVITA GEL 0.025% 1 $0 benzoyl peroxide-erythromycin gel 1 $0 5-3% claravis cap 10mg 1 $0 claravis cap 20mg 1 $0 claravis cap 30mg 1 $0 claravis cap 40mg 1 $0 clindamax gel 1% 1 $0 clindamycin phosphate gel 1% 1 $0 clindamycin phosphate lotion 1% 1 $0 clindamycin phosphate soln 1% 1 $0 clindamycin phosphate swab 1% 1 $0 erythromycin gel 2% 1 $0 erythromycin pads 2% 1 $0 erythromycin soln 2% 1 $0 myorisan cap 10mg 1 $0 myorisan cap 20mg 1 $0 myorisan cap 30mg 1 $0 myorisan cap 40mg 1 $0 sulfacetamide sodium lotion 10% 1 $0 (acne) tretinoin cream 0.1% 1 $0 tretinoin cream 0.05% 1 $0 tretinoin cream 0.025% 1 $0 TRETINOIN GEL 0.01% 1 $0 tretinoin gel 0.025% 1 $0 zenatane cap 10mg 1 $0 117

118 zenatane cap 20mg 1 $0 zenatane cap 30mg 1 $0 zenatane cap 40mg 1 $0 皮膚科, 抗生素 ACNE MEDICAT LOT 5% 3 $0 NM; * ACNE MEDICAT LOT 10% 3 $0 NM; * bacitracin oint 500 unit/gm 3 $0 NM; * bacitracin zinc oint 500 unit/gm 3 $0 NM; * BENZOYL PER GEL 2.5% 3 $0 NM; * benzoyl per gel 5% 3 $0 NM; * benzoyl per gel 10% 3 $0 NM; * benzoyl per liq 5% wash 3 $0 NM; * benzoyl per lot 6% 3 $0 NM; * double antib oin 3 $0 NM; * gentamicin sulfate cream 0.1% 1 $0 gentamicin sulfate oint 0.1% 1 $0 mupirocin oint 2% 1 $0 panoxyl bar 10% 3 $0 NM; * panoxyl wash liq 10% 3 $0 NM; * PANOXYL-4 LIQ CREM WSH 3 $0 NM; * SILVER SULFADIAZINE CREAM 1% 1 $0 SSD CRE 1% 1 $0 SULFAMYLON CRE 85MG/GM 2 $0 SULFAMYLON PAK 5% 2 $0 triple antib oin 3 $0 NM; * 皮膚科, 抗真菌藥 antifungal cre 1% 3 $0 NM; * antifungal cre 2% 3 $0 NM; * ath foot spr aer 1% 3 $0 NM; * castellani paint 3 $0 NM; * ciclopirox gel 0.77% 1 $0 ciclopirox olamine cream 0.77% 1 $0 (base equiv) ciclopirox olamine susp 0.77% 1 $0 (base equiv) ciclopirox shampoo 1% 1 $0 clotrimazole cream 1% 1 $0 clotrimazole soln 1% 1 $0 desenex shak pow 2% 3 $0 NM; * desenex spry aer liquid 3 $0 NM; * econazole nitrate cream 1% 1 $0 fungicure spr intens 3 $0 NM; * 118

119 FUNGOID TINC KIT 3 $0 NM; * FUNGOID TINC SOL 2% 3 $0 NM; * GENTIAN VIOL SOL 1% 3 $0 NM; * GENTIAN VIOL SOL 2% 3 $0 NM; * hydrocort cre 1% 3 $0 NM; * ketoconazole cream 2% 1 $0 LAMISIL ADV GEL 1% 3 $0 NM; * lamisil af aer 1% 3 $0 NM; * lamisil af pow defense 3 $0 NM; * LOTRIMIN ULT CRE 1% 3 $0 NM; * nyamyc pow $0 nystatin cream unit/gm 1 $0 nystatin oint unit/gm 1 $0 nystatin topical powder 1 $0 nystop pow $0 terbinafine cre 1% 3 $0 NM; * tolnaftate cream 1% 3 $0 NM; * tolnaftate soln 1% 3 $0 NM; * triple paste oin af 2% 3 $0 NM; * zinc oxide oint 40% 3 $0 NM; * 皮膚科, 止癢劑 hydrocortisone rectal cream 2.5% 1 $0 procto-pak cre 1% 1 $0 proctozone cre -hc 2.5% 1 $0 PRUDOXIN CRE 5% 1 $0 皮膚科, 抗牛皮癬藥 acitretin cap 10 mg 2 $0 PA acitretin cap 17.5 mg 2 $0 PA acitretin cap 25 mg 2 $0 PA calcipotriene cream 0.005% 1 $0 calcipotriene oint 0.005% 1 $0 calcipotriene soln 0.005% (50 1 $0 mcg/ml) calcitrene oin 0.005% 1 $0 8-MOP CAP 10MG 2 $0 TAZORAC CRE 0.1% 2 $0 PA TAZORAC CRE 0.05% 2 $0 PA 皮膚科, 抗皮脂溢劑 ketoconazole shampoo 2% 1 $0 selenium sulfide lotion 2.5% 1 $0 皮膚科, 皮質甾類 119

120 ala cort cre 1% 1 $0 alclometasone dipropionate cream 1 $0 0.05% alclometasone dipropionate oint 1 $0 0.05% apexicon oin 0.05% 1 $0 aquanil hc lot 1% 3 $0 NM; * betamethasone dipropionate 1 $0 augmented cream 0.05% betamethasone dipropionate 1 $0 augmented gel 0.05% betamethasone dipropionate 1 $0 augmented lotion 0.05% betamethasone dipropionate augmented oint 0.05% 1 $0 betamethasone dipropionate cream 1 $0 0.05% betamethasone dipropionate lotion 1 $0 0.05% betamethasone dipropionate oint 1 $0 0.05% betamethasone valerate cream 1 $0 0.1% betamethasone valerate lotion 0.1% 1 $0 betamethasone valerate oint 0.1% 1 $0 clobetasol propionate cream 0.05% 1 $0 clobetasol propionate emollient 1 $0 base cream 0.05% clobetasol propionate gel 0.05% 1 $0 clobetasol propionate oint 0.05% 1 $0 clobetasol propionate soln 0.05% 1 $0 cormax scalp sol 0.05% 1 $0 cortizone-10 gel 1% 3 $0 NM; * DESONIDE CREAM 0.05% 1 $0 desonide lotion 0.05% 1 $0 desonide oint 0.05% 1 $0 desoximetasone cream 0.05% 1 $0 desoximetasone cream 0.25% 1 $0 desoximetasone gel 0.05% 1 $0 DESOXIMETASONE OINT 0.05% 1 $0 desoximetasone oint 0.25% 1 $0 diflorasone diacetate cream 0.05% 1 $0 diflorasone diacetate oint 0.05% 1 $0 120

121 fluocin acet oil body 1 $0 fluocin acet oil scalp 1 $0 fluocinolone acetonide cream 1 $0 0.01% fluocinolone acetonide cream 0.025% 1 $0 fluocinolone acetonide oint 0.025% 1 $0 fluocinolone acetonide soln 0.01% 1 $0 fluocinonide cream 0.05% 1 $0 fluocinonide emulsified base cream 1 $0 0.05% fluocinonide gel 0.05% 1 $0 fluocinonide oint 0.05% 1 $0 fluocinonide soln 0.05% 1 $0 fluticasone propionate cream 0.05% 1 $0 fluticasone propionate oint 0.005% 1 $0 halobetasol propionate cream 0.05% 1 $0 halobetasol propionate oint 0.05% 1 $0 HYDROCORT AC CRE 0.5% 3 $0 NM; * hydrocortisone butyrate cream 0.1% 1 $0 hydrocortisone butyrate oint 0.1% 1 $0 hydrocortisone butyrate soln 0.1% 1 $0 hydrocortisone cream 0.5% 3 $0 NM; * hydrocortisone cream 1% 1 $0 hydrocortisone cream 2.5% 1 $0 hydrocortisone lotion 2.5% 1 $0 hydrocortisone oint 0.5% 3 $0 NM; * hydrocortisone oint 1% 1 $0 hydrocortisone oint 2.5% 1 $0 hydrocortisone valerate cream 0.2% 1 $0 hydrocortisone valerate oint 0.2% 1 $0 hydrocortisone-aloe vera cream 0.5% 3 $0 NM; * hydrocortisone-aloe vera cream 1% 3 $0 NM; * lokara lot 0.05% 1 $0 mometasone furoate cream 0.1% 1 $0 mometasone furoate oint 0.1% 1 $0 mometasone furoate solution 0.1% 1 $0 (lotion) 121

122 ra anti-itch oin 1% 3 $0 NM; * ra hydrocort cre 0.5% 3 $0 NM; * texacort sol 2.5% 2 $0 triamcinolone acetonide cream 1 $0 0.1% triamcinolone acetonide cream 1 $0 0.5% triamcinolone acetonide cream 0.025% 1 $0 triamcinolone acetonide lotion 0.1% 1 $0 triamcinolone acetonide lotion 0.025% 1 $0 triamcinolone acetonide oint 0.1% 1 $0 triamcinolone acetonide oint 0.5% 1 $0 triamcinolone acetonide oint 1 $ % triderm cre 0.1% 1 $0 皮膚科, 局部麻醉劑 lidocaine hcl gel 2% 1 $0 lidocaine hcl soln 4% 1 $0 lidocaine oint 5% 1 $0 lidocaine patch 5% 1 $0 QL (3 patches / 1 day), PA lidocaine-prilocaine cream 1 $0 B/D % 皮膚科, 雜類皮膚和黏膜藥 ABREVA CRE 10% 3 $0 NM; * acyclovir oint 5% 1 $0 BOUDREAUXS OIN 16% 3 $0 NM; * DESITIN CRE 13% 3 $0 NM; * ELIDEL CRE 1% 2 $0 PA fluorouracil cream 5% 1 $0 fluorouracil soln 2% 1 $0 fluorouracil soln 5% 1 $0 imiquimod cream 5% 1 $0 laclotion lot 12% 1 $0 lactic acid (ammonium lactate) 1 $0 cream 12% lactic acid (ammonium lactate) 1 $0 lotion 12% metronidazole cream 0.75% 1 $0 metronidazole gel 0.75% 1 $0 metronidazole lotion 0.75% 1 $0 122

123 MEXSANA POW 3 $0 NM; * PANRETIN GEL 0.1% 2 $0 podofilox soln 0.5% 1 $0 RA CALAMINE LOT 3 $0 NM; * RISAMINE OIN 3 $0 NM; * rosadan cre 0.75% 1 $0 SECURA CRE 30.6% 3 $0 NM; * secura prote cre 10% 3 $0 NM; * SENSI-CARE OIN 49-15% 3 $0 NM; * tacrolimus oint 0.1% 1 $0 PA tacrolimus oint 0.03% 1 $0 PA TARGRETIN GEL 1% 2 $0 NM, PA TRIPLE PASTE OIN 12.8% 3 $0 NM; * VALCHLOR GEL 0.016% 2 $0 NM, LA, PA VOLTAREN GEL 1% 2 $0 zinc oxide oint 20% 3 $0 NM; * ZINC OXIDE PST 25% 3 $0 NM; * 皮膚科, 滅疥癬藥和滅虱藥 eql lice kit solution 3 $0 NM; * EURAX CRE 10% 2 $0 EURAX LOT 10% 2 $0 lice killing liq max st 3 $0 NM; * lice killing sha % 3 $0 NM; * lice trtmnt liq 3 $0 NM; * lice trtmnt liq 1% 3 $0 NM; * malathion lotion 0.5% 1 $0 permethrin cream 5% 1 $0 permethrin lotion 1% 3 $0 NM; * PYRE/PIPERON LIQ 3 $0 NM; * RID ESS LICE KIT % 3 $0 NM; * 皮膚科, 傷口護理劑 acetic acid irrigation soln 0.25% 1 $0 REGRANEX GEL 0.01% 2 $0 PA SANTYL OIN 250/GM 2 $0 SODIUM CHLORIDE IRRIGATION SOLN 0.9% 1 $0 WATER FOR IRRIGATION, STERILE 1 $0 IRRIGATION SOLN 口腔 / 喉嚨 / 牙科藥劑 cevimeline hcl cap 30 mg 1 $0 chlorhexidine gluconate soln 0.12% 1 $0 clotrimazole troche 10 mg 1 $0 123

124 藥物層級您為藥物支 付的費用 lidocaine hcl viscous soln 2% 1 $0 nystatin susp unit/ml 1 $0 periogard sol 0.12% 1 $0 PILOCARPINE HCL TAB 5 MG 1 $0 pilocarpine hcl tab 7.5 mg 1 $0 triamcinolone acetonide dental 1 $0 paste 0.1% 耳藥 - 治療耳朵疾病的藥物 acetic acid 2% in aluminum acetate 1 $0 otic soln acetic acid otic soln 2% 1 $0 CIPRODEX SUS % 2 $0 fluocinolone acetonide (otic) oil 1 $0 0.01% neomycin-polymyxin-hc otic soln 1 $0 1% neomycin-polymyxin-hc otic susp 1 $0 3.5 mg/ml unit/ml-1% ofloxacin otic soln 0.3% 1 $0 124

125 索引 1 10peh/380gfn tab peh/380gfn tab /15dm cpd/1dcp liq m/30pse day vagnal cre 4% pse/400gfn tab /20dm hour pain tab 650mg MOP CAP 10MG A abacavir sulfate tab 300 mg (base equiv) abacavir sulfate-lamivudine-zidovudine tab mg ABELCET INJ 5MG/ML... 9 ABILIFY DISC TAB 10MG ABILIFY MAIN INJ 300MG ABILIFY MAIN INJ 400MG ABRAXANE INJ 100MG ABREVA CRE 10% acamprosate calcium tab delayed release 333 mg acarbose tab 100 mg acarbose tab 25 mg acarbose tab 50 mg acebutolol hcl cap 200 mg acebutolol hcl cap 400 mg ACEPHEN SUP 120MG... 1 acephen sup 325mg... 1 acephen sup 650mg... 1 ACEROLA C WAF 500MG acetamin jr tab 160mg rt... 1 ACETAMINOPHE TAB 650MG... 1 acetaminophen soln 160 mg/5ml... 1 acetaminophen w/ codeine soln mg/5ml... 3 acetaminophen w/ codeine tab mg... 3 acetaminophen w/ codeine tab mg... 3 acetaminophen w/ codeine tab mg... 3 acetazolamide cap sr 12hr 500 mg acetazolamide tab 125 mg acetazolamide tab 250 mg acetic acid 2% in aluminum acetate otic soln acetic acid irrigation soln 0.25% acetic acid otic soln 2% acetylcysteine inhal soln 10% acetylcysteine inhal soln 20% acid gone chw acid gone sus acid reducer tab 10mg acid reducer tab 150mg acitretin cap 10 mg acitretin cap 17.5 mg acitretin cap 25 mg ACNE MEDICAT LOT 10% ACNE MEDICAT LOT 5% ACTHIB INJ ACTIMMUNE INJ 2MU/ acyclovir cap 200 mg acyclovir oint 5% acyclovir sodium for inj 500 mg acyclovir sodium iv soln 50 mg/ml acyclovir susp 200 mg/5ml acyclovir tab 400 mg acyclovir tab 800 mg ADACEL INJ ADAGEN INJ 250/ML adapalene cream 0.1% adapalene gel 0.1% adefovir dipivoxil tab 10 mg ADEMPAS TAB 0.5MG ADEMPAS TAB 1.5MG ADEMPAS TAB 1MG ADEMPAS TAB 2.5MG ADEMPAS TAB 2MG adrucil inj 2.5g/50m adrucil inj 500/10ml adrucil inj 5gm/100m ADVAIR DISKU AER 100/ ADVAIR DISKU AER 250/ ADVAIR DISKU AER 500/ ADVAIR HFA AER 115/ ADVAIR HFA AER 230/ ADVAIR HFA AER 45/ ADVIL ALLERG TAB CONGEST ADVIL ALLERG TAB SINUS

126 ADVIL COLD/ CAP SINUS ADVIL JR ST TAB 100MG... 1 afeditab tab 30mg cr afeditab tab 60mg cr AFINITOR DIS TAB 2MG AFINITOR DIS TAB 3MG AFINITOR DIS TAB 5MG AFINITOR TAB 10MG AFINITOR TAB 2.5MG AFINITOR TAB 5MG AFINITOR TAB 7.5MG afrin child spr 0.25% AGGRENOX CAP MG a-hydrocort inj 100mg ala cort cre 1% ALA-HIST IR TAB 2MG ALA-HIST PE TAB 2-10MG ALBENZA TAB 200MG... 7 albuterol sulfate soln nebu 0.083% (2.5 mg/3ml) albuterol sulfate soln nebu 0.5% (5 mg/ml) albuterol sulfate soln nebu 0.63 mg/3ml (base equiv) albuterol sulfate soln nebu 1.25 mg/3ml (base equiv) albuterol sulfate syrup 2 mg/5ml albuterol sulfate tab 2 mg albuterol sulfate tab 4 mg albuterol sulfate tab sr 12hr 4 mg albuterol sulfate tab sr 12hr 8 mg alclometasone dipropionate cream 0.05% alclometasone dipropionate oint 0.05% ALCOHOL SWABS ALDURAZYME INJ 2.9MG/5M ALECENSA CAP 150MG alendronate sodium tab 10 mg alendronate sodium tab 35 mg alendronate sodium tab 40 mg alendronate sodium tab 5 mg alendronate sodium tab 70 mg alfuzosin hcl tab sr 24hr 10 mg ALIMTA INJ 100MG ALIMTA INJ 500MG ALINIA SUS 100/5ML... 7 ALINIA TAB 500MG... 7 all day allg tab 10mg all day pain tab 220mg... 1 ALLEGRA ALRG TAB 30MG aller-ease tab 60mg allergy chld liq 12.5/5ml allergy relf cap 25mg allergy relf tab 10mg allergy relf tab 25mg allergy-d tab 5-120mg allopurinol tab 100 mg... 1 allopurinol tab 300 mg... 1 allrgy relf tab 12.5mg alosetron hcl tab 0.5 mg (base equiv) 83 alosetron hcl tab 1 mg (base equiv) ALPHAGAN P SOL 0.1% alprazolam tab 0.25 mg alprazolam tab 0.5 mg alprazolam tab 1 mg alprazolam tab 2 mg ALREX SUS 0.2% altavera tab ALUM HYDROX SUS 320/5ML amantadine hcl cap 100 mg amantadine hcl syrup 50 mg/5ml amantadine hcl tab 100 mg AMBISOME INJ 50MG... 9 amifostine crystalline for inj 500 mg amikacin sulfate inj 1 gm/4ml (250 mg/ml)... 6 amikacin sulfate inj 500 mg/2ml (250 mg/ml)... 6 amiloride & hydrochlorothiazide tab 5-50 mg amiloride hcl tab 5 mg amino acid infusion 6% aminophylline inj 25 mg/ml AMINOSYN 7% INJ /LYTES AMINOSYN II INJ 10% AMINOSYN II INJ 7% AMINOSYN II INJ 8.5% AMINOSYN II INJ 8.5/LYTE AMINOSYN INJ 10% AMINOSYN INJ 8.5% AMINOSYN INJ 8.5/LYTE AMINOSYN M INJ 3.5% AMINOSYN-HBC INJ 7% AMINOSYN-PF INJ 10% AMINOSYN-PF INJ 7%

127 AMINOSYN-RF INJ 5.2% amiodarone hcl inj 150 mg/3ml (50 mg/ml) amiodarone hcl inj 450 mg/9ml (50 mg/ml) amiodarone hcl inj 900 mg/18ml (50 mg/ml) amiodarone hcl tab 100 mg amiodarone hcl tab 200 mg amiodarone hcl tab 400 mg AMITIZA CAP 24MCG AMITIZA CAP 8MCG amitriptyline hcl tab 10 mg amitriptyline hcl tab 100 mg amitriptyline hcl tab 150 mg amitriptyline hcl tab 25 mg amitriptyline hcl tab 50 mg amitriptyline hcl tab 75 mg amlodipine besylate tab 10 mg amlodipine besylate tab 2.5 mg amlodipine besylate tab 5 mg amlodipine besylate-benazepril hcl cap mg amlodipine besylate-benazepril hcl cap mg amlodipine besylate-benazepril hcl cap mg amlodipine besylate-benazepril hcl cap 5-10 mg amlodipine besylate-benazepril hcl cap 5-20 mg amlodipine besylate-benazepril hcl cap 5-40 mg amlodipine besylate-valsartan tab mg amlodipine besylate-valsartan tab mg amlodipine besylate-valsartan tab mg amlodipine besylate-valsartan tab mg amlodipine-valsartan-hydrochlorothiazide tab mg amlodipine-valsartan-hydrochlorothiazide tab mg amlodipine-valsartan-hydrochlorothiazide tab mg amlodipine-valsartan-hydrochlorothiazide tab mg amlodipine-valsartan-hydrochlorothiazide tab mg amnesteem cap 10mg amnesteem cap 20mg amnesteem cap 40mg amoxapine tab 100 mg amoxapine tab 150 mg amoxapine tab 25 mg amoxapine tab 50 mg amoxicillin & k clavulanate chew tab mg amoxicillin & k clavulanate chew tab mg amoxicillin & k clavulanate for susp mg/5ml amoxicillin & k clavulanate for susp mg/5ml amoxicillin & k clavulanate for susp mg/5ml amoxicillin & k clavulanate for susp mg/5ml amoxicillin & k clavulanate tab mg amoxicillin & k clavulanate tab mg amoxicillin & k clavulanate tab mg amoxicillin & k clavulanate tab sr 12hr mg amoxicillin (trihydrate) cap 250 mg amoxicillin (trihydrate) cap 500 mg amoxicillin (trihydrate) chew tab 125 mg amoxicillin (trihydrate) chew tab 250 mg amoxicillin (trihydrate) for susp 125 mg/5ml amoxicillin (trihydrate) for susp 200 mg/5ml amoxicillin (trihydrate) for susp 250 mg/5ml amoxicillin (trihydrate) for susp 400 mg/5ml amoxicillin (trihydrate) tab 500 mg amoxicillin (trihydrate) tab 875 mg amphetamine-dextroamphetamine cap sr 24hr 10 mg

128 amphetamine-dextroamphetamine cap sr 24hr 15 mg amphetamine-dextroamphetamine cap sr 24hr 20 mg amphetamine-dextroamphetamine cap sr 24hr 25 mg amphetamine-dextroamphetamine cap sr 24hr 30 mg amphetamine-dextroamphetamine cap sr 24hr 5 mg amphetamine-dextroamphetamine tab 10 mg amphetamine-dextroamphetamine tab 12.5 mg amphetamine-dextroamphetamine tab 15 mg amphetamine-dextroamphetamine tab 20 mg amphetamine-dextroamphetamine tab 30 mg amphetamine-dextroamphetamine tab 5 mg amphetamine-dextroamphetamine tab 7.5 mg amphotericin b for inj 50 mg... 9 ampicillin & sulbactam sodium for inj gm ampicillin & sulbactam sodium for inj 10-5 gm ampicillin & sulbactam sodium for inj 2-1 gm ampicillin & sulbactam sodium for iv soln gm ampicillin & sulbactam sodium for iv soln 10-5 gm ampicillin & sulbactam sodium for iv soln 2-1 gm ampicillin cap 250 mg ampicillin cap 500 mg ampicillin for susp 125 mg/5ml ampicillin for susp 250 mg/5ml ampicillin sodium for inj 1 gm ampicillin sodium for inj 125 mg ampicillin sodium for inj 2 gm ampicillin sodium for inj 250 mg ampicillin sodium for inj 500 mg ampicillin sodium for iv soln 1 gm ampicillin sodium for iv soln 10 gm ampicillin sodium for iv soln 2 gm AMPYRA TAB 10MG anagrelide hcl cap 0.5 mg anagrelide hcl cap 1 mg anastrozole tab 1 mg ANDRODERM DIS 2MG/24HR ANDRODERM DIS 4MG/24HR ANORO ELLIPT AER ant/anti-gas chw antacid sus max st anti-diarrhe liq 1mg/5ml anti-diarrhe tab 2mg antifungal cre 1% antifungal cre 2% ANTIOXIDANT CAP APAP 500 LIQ 500/5ML... 1 apexicon oin 0.05% ap-hist dm liq APOKYN INJ 10MG/ML apri tab APRISO CAP 0.375GM APTIOM TAB 200MG APTIOM TAB 400MG APTIOM TAB 600MG APTIOM TAB 800MG APTIVUS CAP 250MG APTIVUS SOL aquadeks dro AQUA-E LIQ aquanil hc lot 1% ARALAST NP INJ 1000MG ARALAST NP INJ 500MG ARALAST NP INJ 800MG aranelle tab ARCALYST INJ 220MG aripiprazole oral solution 1 mg/ml aripiprazole tab 10 mg aripiprazole tab 10mg odt aripiprazole tab 15 mg aripiprazole tab 15mg odt aripiprazole tab 2 mg aripiprazole tab 20 mg aripiprazole tab 30 mg aripiprazole tab 5 mg ARNUITY ELPT INH 100MCG ARNUITY ELPT INH 200MCG artifi tears sol op artificial sol tears

129 ASACOL HD TAB 800MG ASCORBIC ACD POW ascorbic acid chew tab 250 mg ascorbic acid syrup 500 mg/5ml ascorbic acid tab 100 mg ascorbic acid tab 250 mg ascorbic acid tab 500 mg aspirin suppos 300 mg... 1 aspirin suppos 600 mg... 1 aspirin tab 325 mg... 1 aspirin tab 81 mg... 1 aspirin tab delayed release 325 mg... 1 aspirin tab delayed release 500 mg... 1 aspirin tab delayed release 650 mg... 1 ASPIRIN-DIPYRIDAMOLE CAP SR 12HR MG ASTEPRO SPR 0.15% atenolol & chlorthalidone tab mg atenolol & chlorthalidone tab mg atenolol tab 100 mg atenolol tab 25 mg atenolol tab 50 mg ath foot spr aer 1% atorvastatin calcium tab 10 mg (base equivalent) atorvastatin calcium tab 20 mg (base equivalent) atorvastatin calcium tab 40 mg (base equivalent) atorvastatin calcium tab 80 mg (base equivalent) atovaquone susp 750 mg/5ml... 7 atovaquone-proguanil hcl tab mg atovaquone-proguanil hcl tab mg ATRIPLA TAB ATROVENT HFA AER 17MCG aubra tab AUVI-Q INJ 0.15MG AUVI-Q INJ 0.3MG AVASTIN INJ AVASTIN INJ 400/16ML aviane tab AVITA CRE 0.025% AVITA GEL 0.025% AVODART CAP 0.5MG AXID AR TAB 75MG AXIRON SOL 30MG/ACT AYR NASAL DRO 0.65% ayr saline gel nasal azacitidine for inj 100 mg AZACTAM/DEX INJ 1GM... 7 AZACTAM/DEX INJ 2GM... 7 azathioprine tab 50 mg azelastine hcl nasal spray 0.1% (137 mcg/spray) azelastine hcl nasal spray 0.15% (205.5 mcg/spray) azelastine hcl ophth soln 0.05% AZILECT TAB 0.5MG AZILECT TAB 1MG azithromycin for susp 100 mg/5ml azithromycin for susp 200 mg/5ml azithromycin iv for soln 500 mg AZITHROMYCIN POWD PACK FOR SUSP 1 GM azithromycin tab 250 mg azithromycin tab 500 mg azithromycin tab 600 mg AZOPT SUS 1% OP AZOR TAB 10-20MG AZOR TAB 10-40MG AZOR TAB 5-20MG AZOR TAB 5-40MG aztreonam for inj 1 gm... 7 aztreonam for inj 2 gm... 7 B B-12 DOTS TAB 500MCG B-12 TAB 5000MCG bacitracin oint 500 unit/gm bacitracin ophth oint 500 unit/gm bacitracin zinc oint 500 unit/gm bacitracin-polymyxin b ophth oint bacitracin-polymyxin-neomycin-hc ophth oint 1% baclofen tab 10 mg baclofen tab 20 mg balsalazide disodium cap 750 mg balziva tab BANZEL SUS 40MG/ML BANZEL TAB 200MG BANZEL TAB 400MG BARACLUDE SOL.05MG/ML

130 BCG VACCINE INJ b-complex vitamin cap b-complex vitamin tab b-complex w/ c & calcium tab bee zee tab bekyree tab BELEODAQ INJ 500MG benazepril & hydrochlorothiazide tab mg benazepril & hydrochlorothiazide tab mg benazepril & hydrochlorothiazide tab mg benazepril & hydrochlorothiazide tab mg benazepril hcl tab 10 mg benazepril hcl tab 20 mg benazepril hcl tab 40 mg benazepril hcl tab 5 mg BENICAR HCT TAB BENICAR HCT TAB BENICAR HCT TAB 40-25MG BENICAR TAB 20MG BENICAR TAB 40MG BENICAR TAB 5MG BENLYSTA INJ 120MG BENLYSTA INJ 400MG benzonatate cap 100 mg benzonatate cap 200 mg benzoyl per gel 10% BENZOYL PER GEL 2.5% benzoyl per gel 5% benzoyl per liq 5% wash benzoyl per lot 6% benzoyl peroxide-erythromycin gel 5-3% BENZTROPINE MESYLATE INJ 1 MG/ML 53 benztropine mesylate tab 0.5 mg benztropine mesylate tab 1 mg benztropine mesylate tab 2 mg BEPREVE DRO 1.5% BESIVANCE SUS 0.6% beta carotene cap unit betamethasone dipropionate augmented cream 0.05% betamethasone dipropionate augmented gel 0.05% betamethasone dipropionate augmented lotion 0.05% betamethasone dipropionate augmented oint 0.05% betamethasone dipropionate cream 0.05% betamethasone dipropionate lotion 0.05% betamethasone dipropionate oint 0.05% betamethasone valerate cream 0.1% 120 betamethasone valerate lotion 0.1%. 120 betamethasone valerate oint 0.1% BETASERON INJ 0.3MG betaxolol hcl ophth soln 0.5% bethanechol chloride tab 10 mg bethanechol chloride tab 25 mg bethanechol chloride tab 5 mg bethanechol chloride tab 50 mg BETOPTIC-S SUS 0.25% OP bexarotene cap 75 mg BEXSERO INJ bicalutamide tab 50 mg BICILLIN L-A INJ BICILLIN L-A INJ BICILLIN L-A INJ BICNU INJ 100MG BILTRICIDE TAB 600MG... 7 BIOSPEC DMX LIQ biotin tab 300 mcg bisacodyl tab & peg 3350-kcl-sod bicarb-nacl for soln kit bisoprolol & hydrochlorothiazide tab mg bisoprolol & hydrochlorothiazide tab mg bisoprolol & hydrochlorothiazide tab mg bisoprolol fumarate tab 10 mg bisoprolol fumarate tab 5 mg BIVIGAM INJ 10% bleomycin sulfate for inj 15 unit bleomycin sulfate for inj 30 unit blephamide oin s.o.p blisovi fe tab 1/ B-NATAL LOZ 25MG BONE DENSITY TAB bone meal w/ vitamin d tab BOOSTRIX INJ

131 BOSULIF TAB 100MG BOSULIF TAB 500MG BOUDREAUXS OIN 16% BREO ELLIPTA INH BREO ELLIPTA INH briellyn tab BRILINTA TAB 60MG BRILINTA TAB 90MG BRIMONIDINE TARTRATE OPHTH SOLN 0.15% brimonidine tartrate ophth soln 0.2% 107 BRINTELLIX TAB 10MG BRINTELLIX TAB 20MG BRINTELLIX TAB 5MG BROHIST D TAB 4-10MG BROMFENAC SODIUM OPHTH SOLN 0.09% (BASE EQUIV) (ONCE-DAILY). 106 bromfenac sodium ophth soln 0.09% (base equivalent) bromocriptine mesylate cap 5 mg bromocriptine mesylate tab 2.5 mg budesonide cap sr 24hr 3 mg budesonide inhalation susp 0.25 mg/2ml budesonide inhalation susp 0.5 mg/2ml bumetanide inj 0.25 mg/ml bumetanide tab 0.5 mg bumetanide tab 1 mg bumetanide tab 2 mg buprenorphine hcl sl tab 2 mg (base equiv) buprenorphine hcl sl tab 8 mg (base equiv) buprenorphine hcl-naloxone hcl sl tab mg (base equiv) buprenorphine hcl-naloxone hcl sl tab 8-2 mg (base equiv) buproban tab 150mg bupropion hcl (smoking deterrent) tab sr 12hr 150 mg bupropion hcl tab 100 mg bupropion hcl tab 75 mg bupropion hcl tab sr 12hr 100 mg bupropion hcl tab sr 12hr 150 mg bupropion hcl tab sr 12hr 200 mg bupropion hcl tab sr 24hr 150 mg bupropion hcl tab sr 24hr 300 mg buspirone hcl tab 10 mg buspirone hcl tab 15 mg buspirone hcl tab 30 mg buspirone hcl tab 5 mg buspirone hcl tab 7.5 mg BUSULFEX INJ 6MG/ML butorphanol tartrate inj 1 mg/ml... 3 butorphanol tartrate inj 2 mg/ml... 3 BYDUREON INJ BYETTA INJ 10MCG BYETTA INJ 5MCG BYSTOLIC TAB 10MG BYSTOLIC TAB 2.5MG BYSTOLIC TAB 20MG BYSTOLIC TAB 5MG C c-500 chw 500mg ca citrate tab + d CA CITRATE TAB 250MG CA GLUCONATE TAB 50MG CA LACTATE TAB 100MG CA/MG/ZN TAB cabergoline tab 0.5 mg cal antacid chw 1000mg CAL CIT MAL/ TAB VITAMIND CAL/MAG TAB CHEW CAL/MAG/VITD TAB calc antacid chw 500mg calc antacid chw 750mg calc citrate tab +d CALC CITRATE TAB 200MG CALC GUMMIES CHW CHILD CALCET CHW BITES CALCET PETIT TAB CALCI-MIX CAP 1250MG CALCIONATE SYP 1.8GM/ calcipotriene cream 0.005% calcipotriene oint 0.005% calcipotriene soln 0.005% (50 mcg/ml) calcitonin (salmon) nasal soln 200 unit/act CAL-CITRATE TAB PLUS D calcitrene oin 0.005% calcitriol cap 0.25 mcg calcitriol cap 0.5 mcg calcitriol inj 1 mcg/ml calcitriol oral soln 1 mcg/ml

132 CALCIUM &MAG TAB calcium + d chw CALCIUM 1000 TAB + D calcium 1200 chw CALCIUM 500 TAB calcium 500 tab +d calcium 600 chw +d/mnrls calcium 600 chw w/vit d calcium 600 tab calcium 600 tab +d/mnrls calcium 600 tab vit d/mi calcium acetate (phosphate binder) cap 667 mg (169 mg ca) calcium acetate (phosphate binder) tab 667 mg calcium ascorbate tab 500 mg CALCIUM CARB CHW 260MG CALCIUM CARB POW 800/2GM calcium carbonate susp 1250 mg/5ml (500 mg/5ml elemental ca) calcium carbonate tab 1250 mg (500 mg elemental ca) calcium carbonate-cholecalciferol tab 500 mg-400 unit calcium carbonate-cholecalciferol tab 600 mg-200 unit calcium carbonate-cholecalciferol tab 600 mg-400 unit calcium carbonate-vitamin d tab 500 mg-400 unit calcium carbonate-vitamin d tab 600 mg-400 unit CALCIUM CHW GUMMIES CALCIUM CIT/ TAB VIT D calcium citrate-vitamin d tab 200 mg-250 unit (elemental ca) calcium for chw women CALCIUM GLUC TAB 500MG calcium gluconate tab 500 mg CALCIUM GRA CITRATE CALCIUM LACT TAB 648MG calcium lactate tab 650 mg calcium pantothenate tab 500 mg calcium soft chw chocolat calcium tab 500 mg CALCIUM TAB FORMULA calcium w/ magnesium tab mg CALCIUM/C/D CHW 500MG calcium/d chw calcium/d3 tab calcium/d3 tab calcium/magn tab zinc calcium+d3 tab calcium+d3 tab grad rel CALMAG THINS TAB MG CAL-QUICK LIQ CALTRATE 600 CHW camila tab 0.35mg CANASA SUP 1000MG CANCIDAS INJ 50MG... 9 CANCIDAS INJ 70MG... 9 CAPASTAT SUL INJ 1GM CAPRELSA TAB 100MG CAPRELSA TAB 300MG captopril & hydrochlorothiazide tab mg captopril & hydrochlorothiazide tab mg captopril & hydrochlorothiazide tab mg captopril & hydrochlorothiazide tab mg captopril tab 100 mg captopril tab 12.5 mg captopril tab 25 mg captopril tab 50 mg CARBAGLU TAB 200MG carbamazepine cap sr 12hr 100 mg carbamazepine cap sr 12hr 200 mg carbamazepine cap sr 12hr 300 mg carbamazepine chew tab 100 mg carbamazepine susp 100 mg/5ml carbamazepine tab 200 mg carbamazepine tab sr 12hr 200 mg carbamazepine tab sr 12hr 400 mg carbidopa & levodopa orally disintegrating tab mg carbidopa & levodopa orally disintegrating tab mg carbidopa & levodopa orally disintegrating tab mg carbidopa & levodopa tab mg. 53 carbidopa & levodopa tab mg. 53 carbidopa & levodopa tab mg. 53 carbidopa & levodopa tab cr mg 132

133 carbidopa & levodopa tab cr mg CARBIDOPA-LEVODOPA-ENTACAPONE TABS MG CARBIDOPA-LEVODOPA-ENTACAPONE TABS MG CARBIDOPA-LEVODOPA-ENTACAPONE TABS MG CARBIDOPA-LEVODOPA-ENTACAPONE TABS MG CARBIDOPA-LEVODOPA-ENTACAPONE TABS MG CARBIDOPA-LEVODOPA-ENTACAPONE TABS MG carboplatin iv soln 150 mg/15ml carboplatin iv soln 450 mg/45ml carboplatin iv soln 50 mg/5ml carboplatin iv soln 600 mg/60ml CARIMUNE NF INJ 12GM CARIMUNE NF INJ 6GM carteolol hcl ophth soln 1% carvedilol tab 12.5 mg carvedilol tab 25 mg carvedilol tab mg carvedilol tab 6.25 mg castellani paint CAYSTON INH 75MG... 7 cefaclor cap 250 mg cefaclor cap 500 mg cefaclor er tab 500mg cefaclor for susp 125 mg/5ml cefaclor for susp 250 mg/5ml cefaclor for susp 375 mg/5ml cefadroxil cap 500 mg cefadroxil for susp 250 mg/5ml cefadroxil for susp 500 mg/5ml cefadroxil tab 1 gm cefazolin inj 1gm/50ml cefazolin sodium for inj 1 gm cefazolin sodium for inj 10 gm cefazolin sodium for inj 20 gm cefazolin sodium for inj 500 mg cefazolin sodium for iv soln 1 gm CEFAZOLIN SOL cefdinir cap 300 mg cefdinir for susp 125 mg/5ml cefdinir for susp 250 mg/5ml cefepime hcl for inj 1 gm cefepime hcl for inj 2 gm cefixime for susp 100 mg/5ml cefixime for susp 200 mg/5ml cefotaxime sodium for inj 1 gm cefotaxime sodium for inj 2 gm cefotaxime sodium for inj 500 mg cefoxitin sodium for inj 10 gm cefoxitin sodium for iv soln 1 gm cefoxitin sodium for iv soln 2 gm cefpodoxime proxetil for susp 100 mg/5ml cefpodoxime proxetil for susp 50 mg/5ml cefpodoxime proxetil tab 100 mg cefpodoxime proxetil tab 200 mg cefprozil for susp 125 mg/5ml cefprozil for susp 250 mg/5ml cefprozil tab 250 mg cefprozil tab 500 mg ceftazidime for inj 1 gm ceftazidime for inj 2 gm ceftazidime for inj 6 gm CEFTAZIDIME/ SOL D5W 1GM CEFTAZIDIME/ SOL D5W 2GM ceftriaxone sodium for inj 1 gm ceftriaxone sodium for inj 10 gm ceftriaxone sodium for inj 2 gm ceftriaxone sodium for inj 250 mg ceftriaxone sodium for inj 500 mg ceftriaxone sodium for iv soln 1 gm ceftriaxone sodium for iv soln 2 gm cefuroxime axetil tab 250 mg cefuroxime axetil tab 500 mg cefuroxime inj 7.5gm cefuroxime sodium for inj 1.5 gm cefuroxime sodium for inj 7.5 gm cefuroxime sodium for inj 750 mg cefuroxime sodium for iv soln 1.5 gm. 16 celecoxib cap 100 mg... 2 celecoxib cap 200 mg... 2 celecoxib cap 400 mg... 2 celecoxib cap 50 mg... 2 CELONTIN CAP 300MG central-vite tab performa CENTRUM CHW SILVER centrum kids chw complete cephalexin cap 250 mg

134 cephalexin cap 500 mg cephalexin for susp 125 mg/5ml cephalexin for susp 250 mg/5ml CERDELGA CAP 84MG CEREZYME INJ 200UNIT CEREZYME INJ 400UNIT cerovite adv liq formula CERVARIX INJ cetirizine hcl chew tab 10 mg cetirizine hcl chew tab 5 mg cetirizine hcl oral soln 1 mg/ml (5 mg/5ml) cetirizine hcl tab 5 mg cetirizine sol 5mg/5ml cevimeline hcl cap 30 mg CHANTIX PAK 0.5& 1MG CHANTIX PAK 1MG CHANTIX TAB 0.5MG CHANTIX TAB 1MG CHELATED CA TAB 200MG CHEMET CAP 100MG chew calcium chw chewabl vite chw childrns child apap tab 80mg... 1 child chew/ chw extra c child comple chw allergy CHILD-MULTI CHW VITAMINS childrens sus plus cld CHLO TUSS EX LIQ chlorhexidine gluconate soln 0.12% chloroquine phosphate tab 250 mg chloroquine phosphate tab 500 mg chlorothiazide tab 250 mg chlorothiazide tab 500 mg chlorpheniramine maleate tab cr 12 mg chlorpromaz inj 25mg/ml chlorpromaz inj 50mg/2ml chlorpromazine hcl tab 10 mg chlorpromazine hcl tab 100 mg chlorpromazine hcl tab 200 mg chlorpromazine hcl tab 25 mg chlorpromazine hcl tab 50 mg chlorthalidone tab 25 mg chlorthalidone tab 50 mg cholecalciferol cap 2000 unit cholecalciferol cap 400 unit cholecalciferol cap 5000 unit cholecalciferol drops 5000 unit/ml (1000 unit/0.2ml) cholecalciferol oral liquid 400 unit/ml 101 cholecalciferol tab 1000 unit cholecalciferol tab 2000 unit cholecalciferol tab 400 unit cholestyramine light powder packets 4 gm cholestyramine powder 4 gm/dose cholestyramine powder packets 4 gm. 34 choline fenofibrate cap dr 135 mg (fenofibric acid equiv) choline fenofibrate cap dr 45 mg (fenofibric acid equiv) ciclopirox gel 0.77% ciclopirox olamine cream 0.77% (base equiv) ciclopirox olamine susp 0.77% (base equiv) ciclopirox shampoo 1% cilostazol tab 100 mg cilostazol tab 50 mg CILOXAN OIN 0.3% OP CIMZIA KIT CIMZIA KIT STARTER CIMZIA PREFL KIT 200MG/ML CINRYZE SOL 500 UNIT CIPRODEX SUS % ciprofloxacin 200 mg/100ml in d5w ciprofloxacin 400 mg/200ml in d5w ciprofloxacin for oral susp 250 mg/5ml (5%) (5 gm/100ml) ciprofloxacin for oral susp 500 mg/5ml (10%) (10 gm/100ml) ciprofloxacin hcl ophth soln 0.3% ciprofloxacin hcl tab 100 mg (base equiv) ciprofloxacin hcl tab 250 mg (base equiv) ciprofloxacin hcl tab 500 mg (base equiv) ciprofloxacin hcl tab 750 mg (base equiv) ciprofloxacin iv soln 200 mg/20ml (1%) ciprofloxacin iv soln 400 mg/40ml (1%) ciprofloxacin-ciprofloxacin hcl tab sr 24hr 134

135 1000 mg(base eq) ciprofloxacin-ciprofloxacin hcl tab sr 24hr 500 mg (base eq) cisplatin inj 100 mg/100ml (1 mg/ml). 27 cisplatin inj 200 mg/200ml (1 mg/ml). 27 cisplatin inj 50 mg/50ml (1 mg/ml) cit calc/d tab citalopram hydrobromide oral soln 10 mg/5ml citalopram hydrobromide tab 10 mg (base equiv) citalopram hydrobromide tab 20 mg (base equiv) citalopram hydrobromide tab 40 mg (base equiv) CITRACAL CAL CHW GUMMIES CITRACAL HRT TAB HEALTH CL PRENATAL TAB MG cladribine inj 1 mg/ml claravis cap 10mg claravis cap 20mg claravis cap 30mg claravis cap 40mg clarithromycin for susp 125 mg/5ml clarithromycin for susp 250 mg/5ml clarithromycin tab 250 mg clarithromycin tab 500 mg clarithromycin tab sr 24hr 500 mg CLARITIN CHW 5MG CLARITIN RDT TAB 5MG cld/cgh/sore liq throat clindamax gel 1% clindamycin hcl cap 150 mg... 7 clindamycin hcl cap 300 mg... 7 clindamycin hcl cap 75 mg... 7 clindamycin palmitate hcl for soln 75 mg/5ml (base equiv)... 7 clindamycin phosphate gel 1% clindamycin phosphate in d5w iv soln 300 mg/50ml... 7 clindamycin phosphate in d5w iv soln 600 mg/50ml... 7 clindamycin phosphate in d5w iv soln 900 mg/50ml... 7 clindamycin phosphate inj 300 mg/2ml 8 clindamycin phosphate inj 600 mg/4ml 8 clindamycin phosphate inj 9 gm/60ml.. 7 clindamycin phosphate inj 900 mg/6ml 8 clindamycin phosphate iv soln 300 mg/2ml... 8 clindamycin phosphate iv soln 600 mg/4ml... 8 clindamycin phosphate iv soln 900 mg/6ml... 8 clindamycin phosphate lotion 1% clindamycin phosphate soln 1% clindamycin phosphate swab 1% clindamycin phosphate vaginal cream 2% CLINIMIX INJ 2.75/D5W CLINIMIX INJ 4.25/D CLINIMIX INJ 4.25/D CLINIMIX INJ 4.25/D CLINIMIX INJ 4.25/D5W CLINIMIX INJ 5%/D15W CLINIMIX INJ 5%/D20W CLINIMIX INJ 5%/D25W clobetasol propionate cream 0.05% clobetasol propionate emollient base cream 0.05% clobetasol propionate gel 0.05% clobetasol propionate oint 0.05% clobetasol propionate soln 0.05% clomipramine hcl cap 25 mg clomipramine hcl cap 50 mg clomipramine hcl cap 75 mg clonazepam orally disintegrating tab mg clonazepam orally disintegrating tab 0.25 mg clonazepam orally disintegrating tab 0.5 mg clonazepam orally disintegrating tab 1 mg clonazepam orally disintegrating tab 2 mg clonazepam tab 0.5 mg clonazepam tab 1 mg clonazepam tab 2 mg clonidine hcl tab 0.1 mg clonidine hcl tab 0.2 mg clonidine hcl tab 0.3 mg clonidine hcl td patch weekly 0.1 mg/24hr clonidine hcl td patch weekly 0.2 mg/24hr

136 clonidine hcl td patch weekly 0.3 mg/24hr clopidogrel bisulfate tab 75 mg (base equiv) clorazepate dipotassium tab 15 mg clorazepate dipotassium tab 3.75 mg.. 43 clorazepate dipotassium tab 7.5 mg clotrimazole cre 2% clotrimazole cream 1% clotrimazole soln 1% clotrimazole troche 10 mg clotrimazole vaginal cream 1% CLOZAPINE ORALLY DISINTEGRATING TAB 100 MG CLOZAPINE ORALLY DISINTEGRATING TAB 12.5 MG CLOZAPINE ORALLY DISINTEGRATING TAB 150 MG CLOZAPINE ORALLY DISINTEGRATING TAB 200 MG CLOZAPINE ORALLY DISINTEGRATING TAB 25 MG clozapine tab 100 mg clozapine tab 200 mg clozapine tab 25 mg clozapine tab 50 mg CNTC CLD/FLU TAB MAX ST COARTEM TAB MG cod liver oil cap CODITUSS DM SYP colchicine w/ probenecid tab mg... 1 COLCRYS TAB 0.6MG... 1 cold head tab cong dt cold multi pak day/nght cold multi-s tab night cold/allergy elx children cold/allery sus child cold/cough elx child cold/sinus tab relief colestipol hcl granule packets 5 gm colestipol hcl granules 5 gm colestipol hcl tab 1 gm colistimethate sodium for inj 150 mg... 8 COMBIGAN SOL 0.2/0.5% COMBIVENT AER RESPIMAT COMETRIQ KIT 100MG COMETRIQ KIT 140MG COMETRIQ KIT 60MG COMPLERA TAB COMPLETE SIN TAB RELIEF compro sup 25mg comtrex sev pak cld/sinu COMVAX INJ CONEX SOL CLD/ALRG CONEX TAB 2-60MG constulose sol 10gm/ COPAXONE INJ 40MG/ML CORAL CALCIU CAP CORAL CALCIU CAP 1000MG CORAL CALCIU CAP PLUS CORAL CAP CALCIUM coricidin cap cong/cgh cormax scalp sol 0.05% corn dextrin oral powder cortisone acetate tab 25 mg cortizone-10 gel 1% COTELLIC TAB 20MG cough & cold tab cough & sore liq thrt day cough cont liq dm max cough dm liq 30mg/5ml COUMADIN TAB 10MG COUMADIN TAB 1MG COUMADIN TAB 2.5MG COUMADIN TAB 2MG COUMADIN TAB 3MG COUMADIN TAB 4MG COUMADIN TAB 5MG COUMADIN TAB 6MG COUMADIN TAB 7.5MG CREON CAP 12000UNT CREON CAP 24000UNT CREON CAP 3000UNIT CREON CAP 36000UNT CREON CAP 6000UNIT CRESTOR TAB 10MG CRESTOR TAB 20MG CRESTOR TAB 40MG CRESTOR TAB 5MG CRIXIVAN CAP 200MG CRIXIVAN CAP 400MG cromolyn sodium nasal aerosol soln 5.2 mg/act (4%) cromolyn sodium ophth soln 4% cromolyn sodium oral conc 100 mg/5ml 136

137 cromolyn sodium soln nebu 20 mg/2ml cryselle-28 tab 28 tabs CUBICIN SOL 500MG... 8 CUVPOSA SOL 1MG/5ML CVS NASAL SPR MIST cvs vit b-6 tab 200mg cyanocobalamin inj 1000 mcg/ml cyanocobalamin liquid 1000 mcg/15ml cyanocobalamin tab 2000 mcg cyanocobalamin tab 250 mcg cyanocobalamin tab 500 mcg cyanocobalamin tab sl 1000 mcg cyanocobalamin tab sl 2500 mcg cyclafem tab 1/ cyclafem tab 7/7/ CYCLOPHOSPH CAP 25MG CYCLOPHOSPH CAP 50MG cyclophosphamide for inj 1 gm cyclophosphamide for inj 2 gm cyclophosphamide for inj 500 mg cycloserine cap 250 mg cyclosporine cap 100 mg cyclosporine cap 25 mg cyclosporine iv soln 50 mg/ml cyclosporine modified cap 100 mg cyclosporine modified cap 25 mg cyclosporine modified cap 50 mg cyclosporine modified oral soln 100 mg/ml CYSTADANE POW CYSTAGON CAP 150MG CYSTAGON CAP 50MG cytarabine inj 20 mg/ml CYTO B2 POW D D10W/NACL INJ 0.2% D5W/LYTES INJ # D5W/NACL INJ 0.3% dacarbazine for inj 100 mg dacarbazine for inj 200 mg daily-vite/ tab iron DAKLINZA TAB 30MG DAKLINZA TAB 60MG DALIRESP TAB 500MCG danazol cap 100 mg danazol cap 200 mg danazol cap 50 mg dantrolene sodium cap 100 mg dantrolene sodium cap 25 mg dantrolene sodium cap 50 mg dapsone tab 100 mg... 8 dapsone tab 25 mg... 8 DAPTACEL INJ DARAPRIM TAB 25MG... 8 daunorubicin hcl inj 5 mg/ml (base equiv) day-time cap sinus deblitane tab 0.35mg decongestant tab 120mg er DELESTROGEN INJ 10MG/ML DELTUSS DP LIQ 1-30/5ML delyla tab DELZICOL CAP 400MG DEMSER CAP 250MG DEPEN TITRA TAB 250MG DEPO-PROVERA INJ 400/ML desenex shak pow 2% desenex spry aer liquid desipramine hcl tab 10 mg desipramine hcl tab 100 mg desipramine hcl tab 150 mg desipramine hcl tab 25 mg desipramine hcl tab 50 mg desipramine hcl tab 75 mg DESITIN CRE 13% desmopressin acetate inj 4 mcg/ml DESMOPRESSIN ACETATE NASAL SOLN 0.01% (REFRIGERATED) desmopressin acetate nasal spray soln 0.01% desmopressin acetate nasal spray soln 0.01% (refrigerated) desmopressin acetate tab 0.1 mg desmopressin acetate tab 0.2 mg desogest-eth estrad & eth estrad tab /0.01 mg(21/5) desogestrel & ethinyl estradiol tab 0.15 mg-30 mcg DESONIDE CREAM 0.05% desonide lotion 0.05% desonide oint 0.05% desoximetasone cream 0.05% desoximetasone cream 0.25%

138 desoximetasone gel 0.05% DESOXIMETASONE OINT 0.05% desoximetasone oint 0.25% dexamethason con 1mg/ml dexamethasone elixir 0.5 mg/5ml dexamethasone sod phosphate preservative free inj 10 mg/ml dexamethasone sodium phosphate inj 10 mg/ml dexamethasone sodium phosphate inj 100 mg/10ml dexamethasone sodium phosphate inj 120 mg/30ml dexamethasone sodium phosphate inj 20 mg/5ml dexamethasone sodium phosphate ophth soln 0.1% dexamethasone soln 0.5 mg/5ml dexamethasone tab 0.5 mg dexamethasone tab 0.75 mg dexamethasone tab 1 mg dexamethasone tab 1.5 mg dexamethasone tab 2 mg dexamethasone tab 4 mg dexamethasone tab 6 mg DEXILANT CAP 30MG DR DEXILANT CAP 60MG DR dexrazoxane for inj 250 mg dextromethorphan-guaifenesin tab mg DEXTROSE 10% W/ SODIUM CHLORIDE 0.45% DEXTROSE 2.5% W/ SODIUM CHLORIDE 0.45% DEXTROSE 5% IN LACTATED RINGERS96 DEXTROSE 5% W/ SODIUM CHLORIDE 0.2% DEXTROSE 5% W/ SODIUM CHLORIDE 0.225% DEXTROSE 5% W/ SODIUM CHLORIDE 0.33% DEXTROSE 5% W/ SODIUM CHLORIDE 0.45% DEXTROSE 5% W/ SODIUM CHLORIDE 0.9% DEXTROSE INJ 10% DEXTROSE INJ 5% DEXTROSE INJ 50% DEXTROSE INJ 70% DIALYVITE 80 TAB ZINC dialyvite tab diazepam con 5mg/ml diazepam inj 5 mg/ml DIAZEPAM RECTAL GEL DELIVERY SYSTEM 10 MG DIAZEPAM RECTAL GEL DELIVERY SYSTEM 2.5 MG DIAZEPAM RECTAL GEL DELIVERY SYSTEM 20 MG diazepam soln 1 mg/ml diazepam tab 10 mg diazepam tab 2 mg diazepam tab 5 mg diclofenac potassium tab 50 mg... 2 diclofenac sodium ophth soln 0.1% diclofenac sodium tab delayed release 25 mg... 2 diclofenac sodium tab delayed release 50 mg... 2 diclofenac sodium tab delayed release 75 mg... 2 diclofenac sodium tab sr 24hr 100 mg.. 2 dicloxacillin sodium cap 250 mg dicloxacillin sodium cap 500 mg dicyclomine hcl cap 10 mg dicyclomine hcl oral soln 10 mg/5ml dicyclomine hcl tab 20 mg didanosine delayed release capsule 125 mg didanosine delayed release capsule 200 mg didanosine delayed release capsule 250 mg didanosine delayed release capsule 400 mg DIFICID TAB 200MG diflorasone diacetate cream 0.05% diflorasone diacetate oint 0.05% diflunisal tab 500 mg... 2 digitek tab 0.125mg digitek tab 0.25mg digoxin inj 0.25 mg/ml DIGOXIN ORAL SOLN 0.05 MG/ML digoxin tab 125 mcg (0.125 mg) digoxin tab 250 mcg (0.25 mg) dihydroergotamine mesylate inj 1 mg/ml 138

139 dilantin cap 100mg dilantin cap 30mg dilantin chw 50mg DILANTIN-125 SUS 125/5ML diltiazem hcl cap sr 12hr 120 mg diltiazem hcl cap sr 12hr 60 mg diltiazem hcl cap sr 12hr 90 mg diltiazem hcl cap sr 24hr 120 mg diltiazem hcl cap sr 24hr 180 mg diltiazem hcl cap sr 24hr 240 mg diltiazem hcl coated beads cap sr 24hr 120 mg diltiazem hcl coated beads cap sr 24hr 180 mg diltiazem hcl coated beads cap sr 24hr 240 mg diltiazem hcl coated beads cap sr 24hr 300 mg diltiazem hcl coated beads cap sr 24hr 360 mg diltiazem hcl extended release beads cap sr 24hr 120 mg diltiazem hcl extended release beads cap sr 24hr 180 mg diltiazem hcl extended release beads cap sr 24hr 240 mg diltiazem hcl extended release beads cap sr 24hr 300 mg diltiazem hcl extended release beads cap sr 24hr 360 mg diltiazem hcl extended release beads cap sr 24hr 420 mg diltiazem hcl iv soln 125 mg/25ml (5 mg/ml) diltiazem hcl iv soln 25 mg/5ml (5 mg/ml) diltiazem hcl iv soln 50 mg/10ml (5 mg/ml) diltiazem hcl tab 120 mg diltiazem hcl tab 30 mg diltiazem hcl tab 60 mg diltiazem hcl tab 90 mg dimetapp liq nighttim DIMETAPP SYP CGH/COLD DIP/TET PED INJ 25-5LFU DIPENTUM CAP 250MG diphenhydramine hcl cap 50 mg diphenhydramine hcl inj 50 mg/ml diphenoxylate w/ atropine liq mg/5ml diphenoxylate w/ atropine tab mg disopyramide phosphate cap 100 mg.. 33 disopyramide phosphate cap 150 mg.. 33 disulfiram tab 250 mg disulfiram tab 500 mg divalproex sodium cap sprinkle 125 mg divalproex sodium tab delayed release 125 mg divalproex sodium tab delayed release 250 mg divalproex sodium tab delayed release 500 mg divalproex sodium tab sr 24 hr 250 mg44 divalproex sodium tab sr 24 hr 500 mg44 DOCETAXEL FOR INJ CONC 20 MG/ML 23 DOCETAXEL FOR INJ CONC 80 MG/4ML (20 MG/ML) docetaxel inj 140/7ml DOCETAXEL INJ 160/16ML DOCETAXEL INJ 200MG/ DOCETAXEL INJ 20MG/2ML DOCETAXEL INJ 80MG/8ML docusate sodium liquid 150 mg/15ml. 81 dok tab 100mg donepezil hydrochloride orally disintegrating tab 10 mg donepezil hydrochloride orally disintegrating tab 5 mg donepezil hydrochloride tab 10 mg donepezil hydrochloride tab 23 mg donepezil hydrochloride tab 5 mg dorzolamide hcl ophth soln 2% dorzolamide hcl-timolol maleate ophth soln mg/ml double antib oin doxazosin mesylate tab 1 mg doxazosin mesylate tab 2 mg doxazosin mesylate tab 4 mg doxazosin mesylate tab 8 mg doxepin hcl cap 10 mg doxepin hcl cap 100 mg doxepin hcl cap 150 mg doxepin hcl cap 25 mg

140 doxepin hcl cap 50 mg doxepin hcl cap 75 mg doxepin hcl conc 10 mg/ml doxorubicin hcl for inj 50 mg doxorubicin hcl inj 2 mg/ml doxorubicin hcl liposomal inj (for iv infusion) 2 mg/ml doxy 100 inj 100mg doxycycline hyclate cap 100 mg doxycycline hyclate cap 50 mg doxycycline hyclate for inj 100 mg doxycycline hyclate tab 100 mg doxycycline hyclate tab 20 mg doxycycline monohydrate cap 100 mg. 20 doxycycline monohydrate cap 50 mg doxycycline monohydrate tab 100 mg. 20 doxycycline monohydrate tab 150 mg. 20 doxycycline monohydrate tab 50 mg doxycycline monohydrate tab 75 mg dramamine tab 25mg dronabinol cap 10 mg dronabinol cap 2.5 mg dronabinol cap 5 mg drospirenone-ethinyl estradiol tab mg DROSPIRENONE-ETHINYL ESTRADIOL TAB MG drospirenone-ethinyl estradiol tab mg DROSPIRENONE-ETHINYL ESTRADIOL TAB MG DROXIA CAP 200MG DROXIA CAP 300MG DROXIA CAP 400MG dual action chw complete duloxetine hcl enteric coated pellets cap 20 mg duloxetine hcl enteric coated pellets cap 30 mg duloxetine hcl enteric coated pellets cap 60 mg DURAFLU TAB DURAMORPH INJ 0.5MG/ML... 3 DURAMORPH INJ 1MG/ML... 3 DUREZOL EMU 0.05% dutasteride cap 0.5 mg dutasteride-tamsulosin hcl cap mg E e.e.s. 400 tab 400mg easy fiber/ chw calcium ecee plus tab econazole nitrate cream 1% ed a-hist dm liq ed bron gp liq ED CHLORPED DRO D ED CHLORPED LIQ 2MG/ML ed chlorped syp jr ed-apap liq 80mg/ EDURANT TAB 25MG EFFIENT TAB 10MG EFFIENT TAB 5MG ELDERTONIC ELX ELIDEL CRE 1% ELIQUIS TAB 2.5MG ELIQUIS TAB 5MG ELITEK INJ 1.5MG ELITEK INJ 7.5MG elixophyllin elx 80/15ml ELLA TAB 30MG ELMIRON CAP 100MG EMCYT CAP 140MG EMEND CAP 125MG EMEND CAP 40MG EMEND CAP 80MG EMEND PAK 80 & emoquette tab EMSAM DIS 12MG/24H EMSAM DIS 6MG/24HR EMSAM DIS 9MG/24HR EMTRIVA CAP 200MG EMTRIVA SOL 10MG/ML enalapril maleate & hydrochlorothiazide tab mg enalapril maleate & hydrochlorothiazide tab mg enalapril maleate tab 10 mg enalapril maleate tab 2.5 mg enalapril maleate tab 20 mg enalapril maleate tab 5 mg endocet tab mg... 3 endocet tab 5-325mg... 3 endocet tab enemeez mini ene enemeez plus ene energy b-12 tab 1500mcg

141 ENGERIX-B INJ 10/0.5ML ENGERIX-B INJ 20MCG/ML enoxaparin sodium inj 100 mg/ml enoxaparin sodium inj 120 mg/0.8ml.. 87 enoxaparin sodium inj 150 mg/ml enoxaparin sodium inj 30 mg/0.3ml enoxaparin sodium inj 300 mg/3ml enoxaparin sodium inj 40 mg/0.4ml enoxaparin sodium inj 60 mg/0.6ml enoxaparin sodium inj 80 mg/0.8ml enpresse-28 tab ENTACAPONE TAB 200 MG entecavir tab 0.5 mg entecavir tab 1 mg entre-cough liq entre-hist liq ENTRESTO TAB 24-26MG ENTRESTO TAB 49-51MG ENTRESTO TAB MG ENUCLENE SOL OP enulose sol 10gm/ e-oil oil 30000unt EPIPEN 2-PAK INJ 0.3MG EPIPEN-JR INJ 2-PAK epirubicin hcl iv soln 200 mg/100ml (2 mg/ml) epirubicin hcl iv soln 50 mg/25ml (2 mg/ml) epitol tab 200mg EPIVIR HBV SOL 5MG/ML eplerenone tab 25 mg eplerenone tab 50 mg epsom salt gra EPZICOM TAB EQL CALCIUM CAP VIT D eql lice kit solution EQUALACTIN CHW 625MG ergocalciferol cap unit ERIVEDGE CAP 150MG errin tab 0.35mg ery-tab tab 250mg ec ery-tab tab 333mg ec ery-tab tab 500mg ec erythrocin inj 500mg erythrocin tab 250mg erythromycin ethylsuccinate tab 400 mg erythromycin gel 2% erythromycin ophth oint 5 mg/gm erythromycin pads 2% erythromycin soln 2% erythromycin tab 250 mg erythromycin tab 500 mg erythromycin w/ delayed release particles cap 250 mg ESBRIET CAP 267MG escitalopram oxalate soln 5 mg/5ml (base equiv) escitalopram oxalate tab 10 mg (base equiv) escitalopram oxalate tab 20 mg (base equiv) escitalopram oxalate tab 5 mg (base equiv) esomeprazole magnesium cap delayed release 20 mg (base eq) esomeprazole magnesium cap delayed release 40 mg (base eq) esomeprazole sodium for intravenous soln 20 mg (base equiv) esomeprazole sodium for intravenous soln 40 mg (base equiv) estrace vag cre 0.1mg/gm estradiol tab 0.5 mg estradiol tab 1 mg estradiol tab 2 mg estradiol td patch weekly mg/24hr estradiol td patch weekly mg/24hr (37.5 mcg/24hr) estradiol td patch weekly 0.05 mg/24hr estradiol td patch weekly 0.06 mg/24hr estradiol td patch weekly mg/24hr estradiol td patch weekly 0.1 mg/24hr 72 estradiol valerate im in oil 20 mg/ml.. 72 estradiol valerate im in oil 40 mg/ml.. 72 ethambutol hcl tab 100 mg ethambutol hcl tab 400 mg ethosuximide cap 250 mg ethosuximide soln 250 mg/5ml etodolac cap 200 mg... 2 etodolac cap 300 mg... 2 etodolac tab 400 mg

142 etodolac tab 500 mg... 2 etodolac tab sr 24hr 400 mg... 2 etodolac tab sr 24hr 500 mg... 2 etodolac tab sr 24hr 600 mg... 2 etoposide inj 500 mg/25ml (20 mg/ml) EURAX CRE 10% EURAX LOT 10% EVOTAZ TAB exefen-ir tab mg EXELON DIS 13.3/ EXELON DIS 4.6MG/ EXELON DIS 9.5MG/ exemestane tab 25 mg EXJADE TAB 125MG EXJADE TAB 250MG EXJADE TAB 500MG ex-lax ultra tab 5mg ec EYE ALLERGY SOL RELIEF eye drops sol 0.05% op eye drops sol a/r eye wash sol ezfe 200 cap 200mg EZFE FORTE CAP F FABRAZYME INJ 35MG FABRAZYME INJ 5MG falmina tab famciclovir tab 125 mg famciclovir tab 250 mg famciclovir tab 500 mg famotidine for susp 40 mg/5ml famotidine in nacl 0.9% iv soln 20 mg/50ml famotidine inj 20 mg/2ml famotidine inj 200 mg/20ml famotidine inj 40 mg/4ml famotidine tab 20 mg famotidine tab 20mg famotidine tab 40 mg FANAPT PAK FANAPT TAB 10MG FANAPT TAB 12MG FANAPT TAB 1MG FANAPT TAB 2MG FANAPT TAB 4MG FANAPT TAB 6MG FANAPT TAB 8MG FARESTON TAB 60MG FARXIGA TAB 10MG FARXIGA TAB 5MG FARYDAK CAP 10MG FARYDAK CAP 15MG FARYDAK CAP 20MG FASLODEX INJ 250MG FAT EMULSION IV SOLN 20% FAZACLO TAB 150 ODT FAZACLO TAB 200 ODT FEBROL SOL 325/5ML... 1 felbamate susp 600 mg/5ml felbamate tab 400 mg felbamate tab 600 mg felodipine tab sr 24hr 10 mg felodipine tab sr 24hr 2.5 mg felodipine tab sr 24hr 5 mg fenofibrate micronized cap 134 mg fenofibrate micronized cap 200 mg fenofibrate micronized cap 67 mg fenofibrate tab 145 mg fenofibrate tab 160 mg fenofibrate tab 48 mg fenofibrate tab 54 mg fentanyl citrate lozenge on a handle 1200 mcg... 4 fentanyl citrate lozenge on a handle 1600 mcg... 4 fentanyl citrate lozenge on a handle 200 mcg... 3 fentanyl citrate lozenge on a handle 400 mcg... 3 fentanyl citrate lozenge on a handle 600 mcg... 3 fentanyl citrate lozenge on a handle 800 mcg... 4 fentanyl td patch 72hr 100 mcg/hr... 4 fentanyl td patch 72hr 12 mcg/hr... 4 fentanyl td patch 72hr 25 mcg/hr... 4 fentanyl td patch 72hr 50 mcg/hr... 4 fentanyl td patch 72hr 75 mcg/hr... 4 FENTORA TAB 100MCG... 4 FENTORA TAB 200MCG... 4 FENTORA TAB 400MCG... 4 FENTORA TAB 600MCG... 4 FENTORA TAB 800MCG... 4 fer-iron dro 15mg/ml FERRETTS IPS SOL

143 ferretts tab 325mg FERRIMIN 150 TAB FERRIPROX SOL 100MG/ML FERRIPROX TAB 500MG FERROUS FUM TAB 29MG FERROUS FUMA TAB FERROUS GLUC TAB 225MG ferrous gluc tab 324mg FERROUS GLUC TAB 324MG ferrous gluconate tab 240 mg (27 mg elemental fe) FERROUS SUL LIQ 220/5ML FERROUS SULF SYP 300/5ML FERROUS SULF TAB 140MG FERROUS SULF TAB 324MG EC ferrous sulf tab 325mg ferrous sulfate elixir 220 mg/5ml (44 mg/5ml elemental fe) ferrous sulfate tab ec 325 mg (65 mg fe equivalent) FETZIMA CAP 120MG FETZIMA CAP 20MG FETZIMA CAP 40MG FETZIMA CAP 80MG FETZIMA CAP TITRATIO FEVERALL INF SUP 80MG... 1 fexofenadine hcl tab 180 mg fexofenadine sus 30mg/5ml FIBER CHW fiber laxatv tab 625mg fiber oral powder finasteride tab 5 mg FIRAZYR INJ 30MG/3ML FLEBOGAMMA INJ 10/200ML FLEBOGAMMA INJ 20/400ML FLEBOGAMMA INJ 5% FLEBOGAMMA INJ DIF 10% FLEBOGAMMA INJ DIF 5% flecainide acetate tab 100 mg flecainide acetate tab 150 mg flecainide acetate tab 50 mg FLEET BISACO ENE 10/30ML floranex gra FLORASTOR PAK KIDS FLOVENT DISK AER 100MCG FLOVENT DISK AER 250MCG FLOVENT DISK AER 50MCG FLOVENT HFA AER 110MCG FLOVENT HFA AER 220MCG FLOVENT HFA AER 44MCG flu/severe pow cold/cgh fluconazole for susp 10 mg/ml... 9 fluconazole for susp 40 mg/ml... 9 fluconazole in dextrose inj 200 mg/100ml... 9 fluconazole in dextrose inj 400 mg/200ml... 9 fluconazole in nacl 0.9% inj 200 mg/100ml... 9 fluconazole in nacl 0.9% inj 400 mg/200ml... 9 fluconazole tab 100 mg fluconazole tab 150 mg fluconazole tab 200 mg fluconazole tab 50 mg fluconazole/ inj nacl flucytosine cap 250 mg flucytosine cap 500 mg fludarabine phosphate for inj 50 mg fludarabine phosphate inj 25 mg/ml fludrocortisone acetate tab 0.1 mg flunisolide nasal soln 25 mcg/act (0.025%) fluocin acet oil body fluocin acet oil scalp fluocinolone acetonide (otic) oil 0.01% fluocinolone acetonide cream 0.01%. 121 fluocinolone acetonide cream 0.025% 121 fluocinolone acetonide oint 0.025% fluocinolone acetonide soln 0.01% fluocinonide cream 0.05% fluocinonide emulsified base cream 0.05% fluocinonide gel 0.05% fluocinonide oint 0.05% fluocinonide soln 0.05% FLUOROMETHOLONE OPHTH SUSP 0.1% fluorouracil cream 5% fluorouracil inj 1 gm/20ml (50 mg/ml) 22 fluorouracil inj 2.5 gm/50ml (50 mg/ml) fluorouracil inj 5 gm/100ml (50 mg/ml) fluorouracil inj 500 mg/10ml (50 mg/ml) 143

144 fluorouracil soln 2% fluorouracil soln 5% fluoxetine hcl cap 10 mg fluoxetine hcl cap 20 mg fluoxetine hcl cap 40 mg fluoxetine hcl solution 20 mg/5ml fluoxetine hcl tab 10 mg fluoxetine hcl tab 20 mg fluphenazine decanoate inj 25 mg/ml.. 56 fluphenazine hcl elixir 2.5 mg/5ml fluphenazine hcl inj 2.5 mg/ml fluphenazine hcl oral conc 5 mg/ml fluphenazine hcl tab 1 mg fluphenazine hcl tab 10 mg fluphenazine hcl tab 2.5 mg fluphenazine hcl tab 5 mg flurbiprofen sodium ophth soln 0.03% flurbiprofen tab 100 mg... 2 flurbiprofen tab 50 mg... 2 flutamide cap 125 mg fluticasone propionate cream 0.05%. 121 fluticasone propionate nasal susp 50 mcg/act fluticasone propionate oint 0.005% fluvoxamine maleate tab 100 mg fluvoxamine maleate tab 25 mg fluvoxamine maleate tab 50 mg foam antacid chw 80-20mg FOLGARD TAB FOLIC ACID CAP 20MG folic acid inj 5 mg/ml folic acid tab 1 mg FOLIC ACID TAB 1 MG folic acid tab 400 mcg folic acid tab 800 mcg FOLITAB 500 TAB foltabs 800 tab fondaparinux sodium subcutaneous inj 10 mg/0.8ml fondaparinux sodium subcutaneous inj 2.5 mg/0.5ml fondaparinux sodium subcutaneous inj 5 mg/0.4ml fondaparinux sodium subcutaneous inj 7.5 mg/0.6ml FORTEO SOL 600/ FORTICAL SPR 200/ACT fosinopril sodium & hydrochlorothiazide tab mg fosinopril sodium & hydrochlorothiazide tab mg fosinopril sodium tab 10 mg fosinopril sodium tab 20 mg fosinopril sodium tab 40 mg FREAMINE HBC INJ 6.9% FREAMINE III INJ 10% FRESHKOTE SOL 2.7-2% fruit c-100 chw fungicure spr intens FUNGOID TINC KIT FUNGOID TINC SOL 2% furosemide inj 10 mg/ml FUROSEMIDE INJ 10 MG/ML furosemide oral soln 10 mg/ml furosemide sol 8mg/ml furosemide tab 20 mg furosemide tab 40 mg furosemide tab 80 mg FUSILEV INJ 50MG FUZEON INJ 90MG FYCOMPA TAB 10MG FYCOMPA TAB 12MG FYCOMPA TAB 2MG FYCOMPA TAB 4MG FYCOMPA TAB 6MG FYCOMPA TAB 8MG G gabapentin cap 100 mg gabapentin cap 300 mg gabapentin cap 400 mg gabapentin oral soln 250 mg/5ml gabapentin tab 600 mg gabapentin tab 800 mg GABITRIL TAB 12MG GABITRIL TAB 16MG galantamine hydrobromide cap sr 24hr 16 mg galantamine hydrobromide cap sr 24hr 24 mg galantamine hydrobromide cap sr 24hr 8 mg galantamine hydrobromide oral soln 4 mg/ml galantamine hydrobromide tab 12 mg

145 galantamine hydrobromide tab 4 mg galantamine hydrobromide tab 8 mg GAMASTAN S/D INJ GAMMAGARD INJ 10GM/ GAMMAGARD INJ 1GM/10ML GAMMAGARD INJ 2.5GM/ GAMMAGARD INJ 20GM/ GAMMAGARD INJ 30GM/ GAMMAGARD INJ 5GM/50ML GAMMAGARD SD INJ 10GM HU GAMMAGARD SD INJ 2.5GM HU GAMMAGARD SD INJ 5GM HU GAMMAKED INJ 10GM/ GAMMAKED INJ 1GM/10ML GAMMAKED INJ 2.5GM/ GAMMAKED INJ 20GM/ GAMMAKED INJ 5GM/50ML GAMMAPLEX INJ 10GM GAMMAPLEX INJ 2.5GM GAMMAPLEX INJ 5GM GAMUNEX-C INJ 10GM/ GAMUNEX-C INJ 1GM/10ML GAMUNEX-C INJ 2.5GM/ GAMUNEX-C INJ 20GM/ GAMUNEX-C INJ 40/400ML GAMUNEX-C INJ 5GM/50ML ganciclovir sodium for inj 500 mg GARDASIL 9 INJ GARDASIL INJ gatifloxacin ophth soln 0.5% GATTEX KIT 5MG GAUZE PADS 2" X 2" gavilyte-c sol gavilyte-g sol gavilyte-n sol flav pk GAVISCON CHW GAVISCON SUS gemcitabine hcl for inj 1 gm gemcitabine hcl for inj 2 gm gemcitabine hcl for inj 200 mg GEMCITABINE INJ 1GM GEMCITABINE INJ 200MG GEMCITABINE INJ 2GM gemfibrozil tab 600 mg generlac sol 10gm/ gengraf cap 100mg gengraf cap 25mg gengraf sol 100mg/ml gentak oin 0.3% op gentam/nacl inj 0.9mg/ml... 6 gentam/nacl inj 1.4mg/ml... 6 gentamicin in saline inj 0.8 mg/ml... 6 gentamicin in saline inj 1 mg/ml... 6 gentamicin in saline inj 1.2 mg/ml... 6 gentamicin in saline inj 1.6 mg/ml... 7 gentamicin in saline inj 2 mg/ml... 7 gentamicin sulfate cream 0.1% gentamicin sulfate inj 10 mg/ml... 7 gentamicin sulfate inj 40 mg/ml... 7 gentamicin sulfate iv soln 10 mg/ml... 7 gentamicin sulfate oint 0.1% gentamicin sulfate ophth oint 0.3% gentamicin sulfate ophth soln 0.3% GENTIAN VIOL SOL 1% GENTIAN VIOL SOL 2% gentle laxat sup 10mg GENVOYA TAB GEODON INJ 20MG geravim liq gildagia tab gildess tab 1.5/ GILENYA CAP 0.5MG GILOTRIF TAB 20MG GILOTRIF TAB 30MG GILOTRIF TAB 40MG glatopa inj 20mg/ml GLEEVEC TAB 100MG GLEEVEC TAB 400MG GLEOSTINE CAP 100MG GLEOSTINE CAP 10MG GLEOSTINE CAP 40MG GLEOSTINE CAP 5MG glimepiride tab 1 mg glimepiride tab 2 mg glimepiride tab 4 mg glipizide tab 10 mg glipizide tab 5 mg glipizide tab sr 24hr 10 mg glipizide tab sr 24hr 2.5 mg GLIPIZIDE TAB SR 24HR 2.5 MG glipizide tab sr 24hr 5 mg GLIPIZIDE XL TAB 5MG glipizide-metformin hcl tab mg glipizide-metformin hcl tab mg

146 glipizide-metformin hcl tab mg.. 66 GLUCAGEN INJ HYPOKIT GLUCAGON KIT 1MG glycopyrrolate inj 4 mg/20ml (0.2 mg/ml) glycopyrrolate tab 1 mg glycopyrrolate tab 2 mg gnp iron tab 45mg GOLYTELY SOL goniotaire sol 2.5% op granisetron hcl inj 0.1 mg/ml granisetron hcl inj 1 mg/ml granisetron hcl inj 4 mg/4ml (1 mg/ml) granisetron hcl tab 1 mg GRANIX INJ 300/ GRANIX INJ 480/ griseofulvin microsize susp 125 mg/5ml griseofulvin microsize tab 500 mg griseofulvin ultramicrosize tab 125 mg 10 griseofulvin ultramicrosize tab 250 mg 10 guaifenesin-codeine soln mg/5ml guanfacine hcl tab sr 24hr 1 mg (base equiv) guanfacine hcl tab sr 24hr 2 mg (base equiv) guanfacine hcl tab sr 24hr 3 mg (base equiv) guanfacine hcl tab sr 24hr 4 mg (base equiv) gummi bear chw multivit H halobetasol propionate cream 0.05% 121 halobetasol propionate oint 0.05% haloperidol decanoate im soln 100 mg/ml haloperidol decanoate im soln 50 mg/ml haloperidol lactate inj 5 mg/ml haloperidol lactate oral conc 2 mg/ml.. 56 haloperidol tab 0.5 mg haloperidol tab 1 mg haloperidol tab 10 mg haloperidol tab 2 mg haloperidol tab 20 mg haloperidol tab 5 mg HARVONI TAB MG HAVRIX INJ 1440UNIT HAVRIX INJ 720UNIT headache tab mg heather tab 0.35mg HEP SOD/NACL INJ 25000UNT HEPARIN SOD INJ 2000/ML HEPARIN SOD INJ 2500/ML HEPARIN SODIUM (PORCINE) 100 UNIT/ML IN D5W HEPARIN SODIUM (PORCINE) 40 UNIT/ML IN D5W HEPARIN SODIUM (PORCINE) 50 UNIT/ML IN D5W heparin sodium (porcine) inj 1000 unit/ml heparin sodium (porcine) inj unit/ml heparin sodium (porcine) inj unit/ml heparin sodium (porcine) inj 5000 unit/ml HEPATAMINE SOL 8% HERCEPTIN INJ 440MG HETLIOZ CAP 20MG HEXALEN CAP 50MG HIBERIX SOL 10MCG HONEY BEARS CHW HONEY BEARS CHW IRON-ZIN HUMIRA INJ 10MG/ HUMIRA KIT 20MG/ HUMIRA KIT 40MG/ HUMIRA PEN INJ 40MG/ HUMIRA PEN INJ CROHNS HUMIRA PEN INJ PSORIASI HUMULIN R INJ U hydralazine hcl inj 20 mg/ml hydralazine hcl tab 10 mg hydralazine hcl tab 100 mg hydralazine hcl tab 25 mg hydralazine hcl tab 50 mg hydrochlorothiazide cap 12.5 mg hydrochlorothiazide tab 12.5 mg hydrochlorothiazide tab 25 mg hydrochlorothiazide tab 50 mg HYDROCIL INS POW 95% hydrocodone-acetaminophen soln mg/15ml

147 hydrocodone-acetaminophen tab mg... 4 hydrocodone-acetaminophen tab mg... 4 hydrocodone-acetaminophen tab mg... 4 hydrocodone-ibuprofen tab mg 4 HYDROCORT AC CRE 0.5% hydrocort cre 1% hydrocortisone butyrate cream 0.1% 121 hydrocortisone butyrate oint 0.1% hydrocortisone butyrate soln 0.1% hydrocortisone cream 0.5% hydrocortisone cream 1% hydrocortisone cream 2.5% hydrocortisone enema 100 mg/60ml HYDROCORTISONE ENEMA 100 MG/60ML hydrocortisone lotion 2.5% hydrocortisone oint 0.5% hydrocortisone oint 1% hydrocortisone oint 2.5% hydrocortisone rectal cream 2.5% hydrocortisone tab 10 mg hydrocortisone tab 20 mg hydrocortisone tab 5 mg hydrocortisone valerate cream 0.2%. 121 hydrocortisone valerate oint 0.2% hydrocortisone-aloe vera cream 0.5%121 hydrocortisone-aloe vera cream 1% hydromorphone hcl liqd 1 mg/ml... 4 hydromorphone hcl preservative free (pf) inj 10 mg/ml... 4 hydromorphone hcl tab 2 mg... 4 hydromorphone hcl tab 4 mg... 4 hydromorphone hcl tab 8 mg... 4 hydroxocobalamin inj 1000 mcg/ml hydroxychloroquine sulfate tab 200 mg hydroxyurea cap 500 mg hydroxyzine hcl im soln 25 mg/ml hydroxyzine hcl im soln 50 mg/ml hydroxyzine hcl syrup 10 mg/5ml hydroxyzine hcl tab 10 mg hydroxyzine hcl tab 25 mg hydroxyzine hcl tab 50 mg hydroxyzine pamoate cap 100 mg hydroxyzine pamoate cap 25 mg hydroxyzine pamoate cap 50 mg HYPOTEARS SOL 1-1% I ibandronate sodium tab 150 mg (base equivalent) IBRANCE CAP 100MG IBRANCE CAP 125MG IBRANCE CAP 75MG ibuprofen cap 200 mg... 1 ibuprofen dro 50/ ibuprofen jr chw 100mg... 1 ibuprofen pm tab mg ibuprofen sus 100/5ml... 1 ibuprofen susp 100 mg/5ml... 2 ibuprofen tab 400 mg... 2 ibuprofen tab 600 mg... 2 ibuprofen tab 800 mg... 2 icaps cap ICAPS LUTEIN TAB ZEAXANTH icaps mv tab ICLUSIG TAB 15MG ICLUSIG TAB 45MG idarubicin hcl iv inj 10 mg/10ml (1 mg/ml) idarubicin hcl iv inj 20 mg/20ml (1 mg/ml) idarubicin hcl iv inj 5 mg/5ml (1 mg/ml) IFEX INJ 3GM ifosfamide for inj 1 gm IFOSFAMIDE INJ 3GM ifosfamide iv inj 1 gm/20ml (50 mg/ml) ifosfamide iv inj 3 gm/60ml (50 mg/ml) ILEVRO DRO 0.3% OP ilotycin oin op IMBRUVICA CAP 140MG imipenem-cilastatin intravenous for soln 250 mg... 8 imipenem-cilastatin intravenous for soln 500 mg... 8 imipramine hcl tab 10 mg imipramine hcl tab 25 mg imipramine hcl tab 50 mg imiquimod cream 5% IMOVAX RABIE INJ 2.5/ML INCRELEX INJ 40MG/4ML

148 INCRUSE ELPT INH 62.5MCG indapamide tab 1.25 mg indapamide tab 2.5 mg INFANRIX INJ INLYTA TAB 1MG INLYTA TAB 5MG INSULIN PEN NEEDLE INSULIN SAFETY NEEDLES INSULIN SYRINGE INTEGRA CAP INTELENCE TAB 100MG INTELENCE TAB 200MG INTELENCE TAB 25MG intense cold tab /flu med intense coug liq reliever INTRALIPID INJ 20% INTRALIPID INJ 30% INTRON A INJ 10MU INTRON A INJ 18MU INTRON A INJ 25MU INTRON A INJ 50MU introvale tab INVANZ INJ 1GM... 8 INVEGA SUST INJ 117/ INVEGA SUST INJ 156MG/ML INVEGA SUST INJ 234/ INVEGA SUST INJ 39/ INVEGA SUST INJ 78/0.5ML INVEGA TAB 1.5MG INVEGA TAB 3MG INVEGA TAB 6MG INVEGA TAB 9MG INVEGA TRINZ INJ 273MG INVEGA TRINZ INJ 410MG INVEGA TRINZ INJ 546MG INVEGA TRINZ INJ 819MG INVIRASE CAP 200MG INVIRASE TAB 500MG INVOKAMET TAB INVOKAMET TAB INVOKAMET TAB INVOKAMET TAB MG INVOKANA TAB 100MG INVOKANA TAB 300MG IONOSOL-B/ INJ D5W IONOSOL-MB INJ /D5W IPOL INJ INACTIVE ipratropium bromide inhal soln 0.02% ipratropium bromide nasal soln 0.03% (21 mcg/spray) ipratropium bromide nasal soln 0.06% (42 mcg/spray) ipratropium-albuterol nebu soln (3) mg/3ml irbesartan tab 150 mg irbesartan tab 300 mg irbesartan tab 75 mg irbesartan-hydrochlorothiazide tab mg irbesartan-hydrochlorothiazide tab mg IRESSA TAB 250MG irinotecan hcl inj 100 mg/5ml (20 mg/ml) irinotecan hcl inj 40 mg/2ml (20 mg/ml) irinotecan hcl inj 500 mg/25ml (20 mg/ml) iromin-g tab iron 100 tab plus iron 100/c tab IRON CHEWS CHW PEDIATRI IRON TAB 18MG IRON TAB 28MG iron therapy tab 200mg IRON UP LIQ ISENTRESS CHW 100MG ISENTRESS CHW 25MG ISENTRESS POW 100MG ISENTRESS TAB 400MG ISOLYTE-P INJ /D5W ISOLYTE-S INJ isoniazid inj 100 mg/ml isoniazid syrup 50 mg/5ml isoniazid tab 100 mg isoniazid tab 300 mg ISOPTO TEARS SOL 0.5% OP isosorbide dinitrate tab 10 mg isosorbide dinitrate tab 20 mg isosorbide dinitrate tab 30 mg isosorbide dinitrate tab 5 mg isosorbide dinitrate tab cr 40 mg isosorbide mononitrate tab 10 mg isosorbide mononitrate tab 20 mg isosorbide mononitrate tab sr 24hr

149 mg isosorbide mononitrate tab sr 24hr 30 mg isosorbide mononitrate tab sr 24hr 60 mg isradipine cap 2.5 mg isradipine cap 5 mg ISTALOL SOL 0.5% OP ISTODAX INJ 10MG itraconazole cap 100 mg ivermectin tab 3 mg... 8 IXIARO INJ J JAKAFI TAB 10MG JAKAFI TAB 15MG JAKAFI TAB 20MG JAKAFI TAB 25MG JAKAFI TAB 5MG JALYN CAP jantoven tab 10mg jantoven tab 1mg jantoven tab 2.5mg jantoven tab 2mg jantoven tab 3mg jantoven tab 4mg jantoven tab 5mg jantoven tab 6mg jantoven tab 7.5mg JANUMET TAB JANUMET TAB MG JANUMET XR TAB JANUMET XR TAB JANUMET XR TAB MG JANUVIA TAB 100MG JANUVIA TAB 25MG JANUVIA TAB 50MG JENTADUETO TAB JENTADUETO TAB JENTADUETO TAB jinteli tab 1mg-5mcg J-MAX SYP 5-200MG JOLIVETTE TAB 0.35MG J-TAN D PD DRO 1-7.5MG J-TAN PD DRO 1MG/ML junel 1.5/30 tab junel 1/20 tab junel fe tab 1.5/ junel fe tab 1/ JUXTAPID CAP 10MG JUXTAPID CAP 20MG JUXTAPID CAP 30MG JUXTAPID CAP 40MG JUXTAPID CAP 5MG JUXTAPID CAP 60MG K KADCYLA INJ 100MG KADCYLA INJ 160MG KALETRA SOL KALETRA TAB MG KALETRA TAB MG KALYDECO PAK 50MG KALYDECO PAK 75MG KALYDECO TAB 150MG kaopectate sus 262/15ml kariva tab 28 day KCL 10 MEQ/L (0.075%) IN DEXTROSE 5% & NACL 0.45% INJ KCL 20 MEQ/L (0.15%) IN DEXTROSE 5% & NACL 0.2% INJ KCL 20 MEQ/L (0.15%) IN DEXTROSE 5% & NACL 0.33% INJ KCL 20 MEQ/L (0.15%) IN DEXTROSE 5% & NACL 0.45% INJ KCL 20 MEQ/L (0.15%) IN DEXTROSE 5% & NACL 0.9% INJ kcl 20 meq/l (0.15%) in nacl 0.45% inj KCL 20 MEQ/L (0.15%) IN NACL 0.45% INJ KCL 20 MEQ/L (0.15%) IN NACL 0.9% INJ KCL 30 MEQ/L (0.224%) IN DEXTROSE 5% & NACL 0.45% INJ KCL 40 MEQ/L (0.3%) IN DEXTROSE 5% & NACL 0.45% INJ KCL 40 MEQ/L (0.3%) IN NACL 0.9% INJ KCL/D5W/NACL INJ 0.15/ KCL/D5W/NACL INJ 0.3/0.9% kelnor tab 1/ ketoconazole cream 2% ketoconazole shampoo 2% ketoconazole tab 200 mg ketoprofen cap 50 mg... 2 ketoprofen cap 75 mg... 2 ketorolac tromethamine ophth soln 0.4% 149

150 ketorolac tromethamine ophth soln 0.5% ketotif fum dro 0.025%op KEYTRUDA INJ 100MG/4M KEYTRUDA SOL 50MG kidkare liq cgh/cold kimidess tab KINRIX INJ kionex pow kionex sus 15gm/ KLOR-CON 10 TAB 10MEQ ER KLOR-CON 8 TAB 8MEQ ER klor-con m15 tab 15meq er klor-con pow 20meq konsyl cap 520mg KONSYL POW 100% konsyl pow 28.3% KONSYL POW 28.3% konsyl pow 30.9% KONSYL POW 60.3% KONSYL POW 71.67% KONSYL-D POW 52.3% KORLYM TAB 300MG kp b complex tab /c kp ca/mg/zn tab kp calcium cap 600+d kp calcium tab 600+d kp vitamin e cap 100unit KPN PRENATAL TAB KUVAN POW 100MG KUVAN POW 500MG KUVAN TAB 100MG KYNAMRO INJ 200MG/ML L labetalol hcl tab 100 mg labetalol hcl tab 200 mg labetalol hcl tab 300 mg laclotion lot 12% LACTATED RINGER'S SOLUTION lactic acid (ammonium lactate) cream 12% lactic acid (ammonium lactate) lotion 12% lactobacillus tab lactulose (encephalopathy) solution 10 gm/15ml lactulose solution 10 gm/15ml LAMISIL ADV GEL 1% lamisil af aer 1% lamisil af pow defense lamivudine oral soln 10 mg/ml lamivudine tab 100 mg (hbv) lamivudine tab 150 mg lamivudine tab 300 mg lamivudine-zidovudine tab mg lamotrigine tab 100 mg lamotrigine tab 150 mg lamotrigine tab 200 mg lamotrigine tab 25 mg lamotrigine tab chewable dispersible 25 mg lamotrigine tab chewable dispersible 5 mg lamotrigine tab sr 24hr 100 mg lamotrigine tab sr 24hr 200 mg lamotrigine tab sr 24hr 25 mg lamotrigine tab sr 24hr 250 mg lamotrigine tab sr 24hr 300 mg lamotrigine tab sr 24hr 50 mg lansoprazole cap 15mg dr LANTUS INJ 100/ML LANTUS INJ SOLOSTAR larin fe tab 1.5/ larin fe tab 1/ larin tab 1.5/ larin tab 1/ LASTACAFT SOL 0.25% latanoprost ophth soln 0.005% LATUDA TAB 120MG LATUDA TAB 20MG LATUDA TAB 40MG LATUDA TAB 60MG LATUDA TAB 80MG lax diet sup tab 500mg laxative tab 25mg leflunomide tab 10 mg leflunomide tab 20 mg LENVIMA CAP 10MG LENVIMA CAP 14MG LENVIMA CAP 20MG LENVIMA CAP 24MG lessina tab LETAIRIS TAB 10MG LETAIRIS TAB 5MG

151 letrozole tab 2.5 mg leucovorin calcium for inj 100 mg leucovorin calcium for inj 200 mg leucovorin calcium for inj 350 mg leucovorin calcium for inj 50 mg leucovorin calcium tab 10 mg leucovorin calcium tab 15 mg leucovorin calcium tab 25 mg leucovorin calcium tab 5 mg leucovorin inj calcium LEUKERAN TAB 2MG LEUKINE INJ 250MCG leuprolide acetate inj kit 5 mg/ml levalbuterol hcl soln nebu conc 1.25 mg/0.5ml (base equiv) LEVEMIR INJ LEVEMIR INJ FLEXTOUC LEVETIRACETA INJ 10MG/ML LEVETIRACETA INJ 15MG/ML LEVETIRACETA INJ 5MG/ML levetiracetam inj 500 mg/5ml (100 mg/ml) levetiracetam oral soln 100 mg/ml levetiracetam tab 1000 mg levetiracetam tab 250 mg levetiracetam tab 500 mg levetiracetam tab 750 mg levetiracetam tab sr 24hr 500 mg levetiracetam tab sr 24hr 750 mg LEVOBUNOLOL HCL OPHTH SOLN 0.25% levobunolol hcl ophth soln 0.5% levocarnitine inj 200 mg/ml levocarnitine oral soln 1 gm/10ml (10%) levocarnitine tab 330 mg levocetirizine dihydrochloride soln 2.5 mg/5ml (0.5 mg/ml) levocetirizine dihydrochloride tab 5 mg levofloxacin in d5w iv soln 250 mg/50ml levofloxacin in d5w iv soln 500 mg/100ml levofloxacin in d5w iv soln 750 mg/150ml levofloxacin iv soln 25 mg/ml levofloxacin oral soln 25 mg/ml levofloxacin tab 250 mg levofloxacin tab 500 mg levofloxacin tab 750 mg levoleucovor inj 50mg levoleucovor sol 250mg/ levonest tab levonorgestrel & ethinyl estradiol (91-day) tab mg LEVONORGESTREL & ETHINYL ESTRADIOL (91-DAY) TAB MG levonorgestrel & ethinyl estradiol tab 0.1 mg-20 mcg levonorgestrel tab 0.75 mg levonorgestrel tab 1.5 mg levonorgestrel-eth estra tab / / mg-mcg.. 69 levora-28 tab 0.15/ levothyroxine sodium tab 100 mcg levothyroxine sodium tab 112 mcg levothyroxine sodium tab 125 mcg levothyroxine sodium tab 137 mcg levothyroxine sodium tab 150 mcg levothyroxine sodium tab 175 mcg levothyroxine sodium tab 200 mcg levothyroxine sodium tab 25 mcg levothyroxine sodium tab 300 mcg levothyroxine sodium tab 50 mcg levothyroxine sodium tab 75 mcg levothyroxine sodium tab 88 mcg LEVOXYL TAB 100MCG LEVOXYL TAB 112MCG LEVOXYL TAB 125MCG LEVOXYL TAB 137MCG LEVOXYL TAB 150MCG LEVOXYL TAB 175MCG LEVOXYL TAB 200MCG LEVOXYL TAB 25MCG LEVOXYL TAB 50MCG LEVOXYL TAB 75MCG LEVOXYL TAB 88MCG LEXIVA SUS 50MG/ML LEXIVA TAB 700MG lice killing liq max st lice killing sha % lice trtmnt liq lice trtmnt liq 1% lidocaine hcl gel 2%

152 lidocaine hcl local inj 0.5%... 6 lidocaine hcl local inj 1%... 6 lidocaine hcl local inj 1.5%... 6 lidocaine hcl local inj 2%... 6 lidocaine hcl local preservative free (pf) inj 0.5%... 6 lidocaine hcl local preservative free (pf) inj 1%... 6 lidocaine hcl soln 4% lidocaine hcl viscous soln 2% lidocaine oint 5% lidocaine patch 5% lidocaine-prilocaine cream %. 122 LINEZOLID FOR SUSP 100 MG/5ML... 8 linezolid iv soln 2 mg/ml... 8 LINEZOLID TAB 600 MG... 8 LINZESS CAP 145MCG LINZESS CAP 290MCG liothyronine sodium tab 25 mcg liothyronine sodium tab 5 mcg liothyronine sodium tab 50 mcg liq ca/vit d cap 600mg LIQUID CALCI CAP WITH D liquituss gg liq 200/5ml lisinopril & hydrochlorothiazide tab mg lisinopril & hydrochlorothiazide tab mg lisinopril & hydrochlorothiazide tab mg lisinopril tab 10 mg lisinopril tab 2.5 mg lisinopril tab 20 mg lisinopril tab 30 mg lisinopril tab 40 mg lisinopril tab 5 mg lithium carbonate cap 150 mg lithium carbonate cap 300 mg lithium carbonate cap 600 mg lithium carbonate tab 300 mg lithium carbonate tab cr 300 mg lithium carbonate tab cr 450 mg LITHIUM SOL 8MEQ/5ML LOCALNESIUM TAB LOCALNESIUM TAB -C LODRANE D CAP 4-60MG LOHIST-D LIQ lohist-dm syp mg lohist-peb liq 4-10/5ml lokara lot 0.05% LOMUSTINE CAP 10 MG LOMUSTINE CAP 100 MG LOMUSTINE CAP 40 MG LONSURF TAB LONSURF TAB loperamide hcl cap 2 mg loperamide hcl liq 1 mg/7.5ml loratadine & pseudoephedrine tab sr 24hr mg loratadine tab 10 mg lorazepam con 2mg/ml lorazepam inj 2 mg/ml lorazepam inj 4 mg/ml lorazepam tab 0.5 mg lorazepam tab 1 mg lorazepam tab 2 mg loryna tab mg losartan potassium & hydrochlorothiazide tab mg losartan potassium & hydrochlorothiazide tab mg losartan potassium & hydrochlorothiazide tab mg losartan potassium tab 100 mg losartan potassium tab 25 mg losartan potassium tab 50 mg LOTEMAX GEL 0.5% LOTEMAX OIN 0.5% LOTEMAX SUS 0.5% LOTRIMIN ULT CRE 1% lovastatin tab 10 mg lovastatin tab 20 mg lovastatin tab 40 mg loxapine succinate cap 10 mg loxapine succinate cap 25 mg loxapine succinate cap 5 mg loxapine succinate cap 50 mg lubr/dry eye dro % lubricnt eye dro 0.5% op lubricnt gel dro 1% LUMIGAN SOL 0.01% LUMITENE CAP 30MG LUMIZYME INJ 50MG LUPR DEP-PED INJ 11.25MG LUPR DEP-PED INJ 15MG LUPR DEP-PED INJ 30MG

153 LUPR DEP-PED INJ 7.5MG LUPRON DEPOT INJ 11.25MG LUPRON DEPOT INJ 3.75MG lutera tab LYNPARZA CAP 50MG LYRICA CAP 100MG LYRICA CAP 150MG LYRICA CAP 200MG LYRICA CAP 225MG LYRICA CAP 25MG LYRICA CAP 300MG LYRICA CAP 50MG LYRICA CAP 75MG LYRICA SOL 20MG/ML LYSODREN TAB 500MG lyza tab 0.35mg M maalox child chw maalox sus reg st MAG CITRATE TAB 100MG MAG OXIDE CAP 400MG MAG-AL LIQ mag-delay tab MAGINEX TAB 615 MG MAGNEBIND TAB MAGNESIUM CAP 300MG MAGNESIUM CAP 400MG magnesium citrate soln magnesium oxide tab 250 mg magnesium oxide tab 400 mg magnesium oxide tab 400 mg (240 mg elemental mg) magnesium oxide tab 420 mg magnesium oxide tab 500 mg (mg supplement) MAGNESIUM SU INJ 2/50ML MAGNESIUM SU INJ 20/500ML MAGNESIUM SU INJ 4/100ML MAGNESIUM SU INJ 40/ MAGNESIUM SU INJ 80MG/ML magnesium sulfate inj 50% MAGNESIUM SULFATE INJ 50% magnesium tab 200 mg MAGNESIUM TAB 30MG MAG-TAB SR TAB 84MG malathion lotion 0.5% mapap cold tab maprotiline hcl tab 25 mg maprotiline hcl tab 50 mg maprotiline hcl tab 75 mg marlissa tab 0.15/ MARPLAN TAB 10MG MATULANE CAP 50MG MAXIDEX SUS 0.1% OP meclizine hcl tab 12.5 mg meclizine hcl tab 25 mg medroxyprogesterone acetate im susp 150 mg/ml medroxyprogesterone acetate tab 10 mg medroxyprogesterone acetate tab 2.5 mg medroxyprogesterone acetate tab 5 mg mefloquine hcl tab 250 mg MEGACE ES SUS 625/5ML megestrol acetate susp 40 mg/ml MEGESTROL ACETATE SUSP 625 MG/5ML megestrol acetate tab 20 mg megestrol acetate tab 40 mg MEKINIST TAB 0.5MG MEKINIST TAB 2MG MELOXICAM SUSP 7.5 MG/5ML... 2 meloxicam tab 15 mg... 3 meloxicam tab 7.5 mg... 2 melphalan hcl for inj 50 mg (base equiv) memantine hcl oral solution 2 mg/ml. 48 memantine hcl tab 10 mg memantine hcl tab 5 mg MENACTRA INJ M-END DMX LIQ MENOMUNE INJ A/C/Y/W MENVEO INJ MEPHYTON TAB 5MG mercaptopurine tab 50 mg meribin cap 5mg meropenem iv for soln 1 gm... 8 meropenem iv for soln 500 mg... 8 mesalamine enema 4 gm mesalamine rectal enema 4 gm & cleanser wipe kit mesna inj 100 mg/ml MESNEX TAB 400MG METAMUCIL POW 28%

154 METAMUCIL POW 63% METAMUCIL WAF metformin hcl tab 1000 mg metformin hcl tab 500 mg metformin hcl tab 850 mg metformin hcl tab sr 24hr 500 mg metformin hcl tab sr 24hr 750 mg methadone con 10mg/ml... 4 methadone hcl soln 10 mg/5ml... 4 methadone hcl soln 5 mg/5ml... 4 methadone hcl tab 10 mg... 5 methadone hcl tab 5 mg... 5 methazolamide tab 25 mg methazolamide tab 50 mg methenamine hippurate tab 1 gm... 8 methimazole tab 10 mg methimazole tab 5 mg methotrexate sodium for inj 1 gm methotrexate sodium inj 25 mg/ml methotrexate sodium inj pf 25 mg/ml. 23 methotrexate sodium tab 2.5 mg (base equiv) methyclothiazide tab 5 mg methylergonovine maleate tab 0.2 mg 74 methylphenidate hcl soln 10 mg/5ml methylphenidate hcl soln 5 mg/5ml methylphenidate hcl tab 10 mg methylphenidate hcl tab 20 mg methylphenidate hcl tab 5 mg methylphenidate hcl tab cr 10 mg methylphenidate hcl tab cr 20 mg methylprednisolone acetate inj susp 40 mg/ml methylprednisolone acetate inj susp 80 mg/ml methylprednisolone sodium succinate for inj 1000 mg methylprednisolone sodium succinate for inj 125 mg methylprednisolone sodium succinate for inj 40 mg methylprednisolone tab 16 mg methylprednisolone tab 32 mg methylprednisolone tab 4 mg methylprednisolone tab 4 mg dose pack methylprednisolone tab 8 mg metipranolol ophth soln 0.3% metoclopramide hcl inj 5 mg/ml metoclopramide hcl soln 5 mg/5ml (10 mg/10ml) metoclopramide hcl tab 10 mg metoclopramide hcl tab 5 mg metolazone tab 10 mg metolazone tab 2.5 mg metolazone tab 5 mg metoprolol & hydrochlorothiazide tab mg metoprolol & hydrochlorothiazide tab mg metoprolol & hydrochlorothiazide tab mg metoprolol succinate tab sr 24hr 100 mg metoprolol succinate tab sr 24hr 200 mg metoprolol succinate tab sr 24hr 25 mg metoprolol succinate tab sr 24hr 50 mg metoprolol tartrate inj 1 mg/ml metoprolol tartrate tab 100 mg metoprolol tartrate tab 25 mg metoprolol tartrate tab 50 mg metronidazole cream 0.75% metronidazole gel 0.75% metronidazole in nacl 0.79% iv soln 500 mg/100ml... 8 metronidazole lotion 0.75% metronidazole tab 250 mg... 8 metronidazole tab 500 mg... 8 metronidazole vaginal gel 0.75% mexiletine hcl cap 150 mg mexiletine hcl cap 200 mg mexiletine hcl cap 250 mg MEXSANA POW MG SO4/D5W INJ 10MG/ML MG SO4/D5W INJ 20MG/ML MIACALCIN INJ 200/ML mi-acid chw miconazole 3 cre 4% miconazole 3 kit combinat miconazole 3 kit combo pk miconazole 7 cre tube/kit miconazole 7 sup 100mg miconazole nitrate vaginal supp 1200 mg 154

155 & 2% cream kit midodrine hcl tab 10 mg midodrine hcl tab 2.5 mg midodrine hcl tab 5 mg MILK OF MAGN SUS 2400MG milk of magn sus frsh mnt MINERAL OIL mineral oil enema minitran dis 0.1mg/hr minitran dis 0.2mg/hr minitran dis 0.4mg/hr minitran dis 0.6mg/hr minocycline hcl cap 100 mg minocycline hcl cap 50 mg minocycline hcl cap 75 mg minoxidil tab 10 mg minoxidil tab 2.5 mg mintox plus chw mirtazapine orally disintegrating tab 15 mg mirtazapine orally disintegrating tab 30 mg mirtazapine orally disintegrating tab 45 mg mirtazapine tab 15 mg mirtazapine tab 30 mg mirtazapine tab 45 mg mirtazapine tab 7.5 mg misoprostol tab 100 mcg misoprostol tab 200 mcg MISSION PREN TAB MISSION PREN TAB HP mitomycin for iv soln 20 mg mitomycin for iv soln 40 mg mitomycin for iv soln 5 mg mitoxantrone hcl inj conc 20 mg/10ml (2 mg/ml) mitoxantrone hcl inj conc 25 mg/12.5ml (2 mg/ml) mitoxantrone hcl inj conc 30 mg/15ml (2 mg/ml) M-M-R II INJ moderiba pak 1000/day MODERIBA PAK 1200/DAY moderiba pak 600/day moderiba pak 800/day moexipril hcl tab 15 mg moexipril hcl tab 7.5 mg moexipril-hydrochlorothiazide tab mg moexipril-hydrochlorothiazide tab mg moexipril-hydrochlorothiazide tab mg molindone hcl tab 10 mg molindone hcl tab 25 mg molindone hcl tab 5 mg mometasone furoate cream 0.1% mometasone furoate oint 0.1% mometasone furoate solution 0.1% (lotion) MONONESSA TAB montelukast sodium chew tab 4 mg (base equiv) montelukast sodium chew tab 5 mg (base equiv) montelukast sodium oral granules packet 4 mg (base equiv) montelukast sodium tab 10 mg (base equiv) MORPHINE SUL INJ 2MG/ML... 5 MORPHINE SUL INJ 4MG/ML... 5 MORPHINE SUL INJ 8MG/ML... 5 morphine sulfate beads cap sr 24hr 120 mg... 5 morphine sulfate beads cap sr 24hr 30 mg... 5 morphine sulfate beads cap sr 24hr 45 mg... 5 morphine sulfate beads cap sr 24hr 60 mg... 5 morphine sulfate beads cap sr 24hr 75 mg... 5 morphine sulfate beads cap sr 24hr 90 mg... 5 morphine sulfate cap sr 24hr 10 mg... 5 morphine sulfate cap sr 24hr 100 mg... 5 morphine sulfate cap sr 24hr 20 mg... 5 morphine sulfate cap sr 24hr 30 mg... 5 morphine sulfate cap sr 24hr 50 mg... 5 morphine sulfate cap sr 24hr 60 mg... 5 morphine sulfate cap sr 24hr 80 mg... 5 morphine sulfate inj pf 0.5 mg/ml... 5 morphine sulfate inj pf 1 mg/ml... 5 MORPHINE SULFATE IV SOLN 1 MG/ML. 5 MORPHINE SULFATE IV SOLN PF

156 MG/ML... 5 MORPHINE SULFATE IV SOLN PF 15 MG/ML... 5 morphine sulfate iv soln pf 4 mg/ml... 5 morphine sulfate iv soln pf 8 mg/ml... 5 MORPHINE SULFATE ORAL SOLN 10 MG/5ML... 5 MORPHINE SULFATE ORAL SOLN 100 MG/5ML (20 MG/ML)... 5 MORPHINE SULFATE ORAL SOLN 20 MG/5ML... 5 MORPHINE SULFATE TAB 15 MG... 5 MORPHINE SULFATE TAB 30 MG... 5 morphine sulfate tab cr 100 mg... 6 morphine sulfate tab cr 15 mg... 5 morphine sulfate tab cr 200 mg... 6 morphine sulfate tab cr 30 mg... 6 morphine sulfate tab cr 60 mg... 6 motion sick chw 25mg motion sick tab 50mg motrin ib tab 200mg... 1 MOVANTIK TAB 12.5MG MOVANTIK TAB 25MG MOVIPREP SOL MOXEZA SOL 0.5% MOZOBIL INJ mucaphed tab mg MUCINEX CGH GRA 5-100MG mucinex cold tab sinus MUCINEX D TAB MUCINEX D TAB MG MUCINEX TAB 1200MG MUCINEX/KIDS GRA 100MG mucus relief liq 5-100mg mucus relief liq cold/sin mucus relief tab 400mg mucus relief tab 600mg er mucus+chst liq 100/5ml mucus-dm max tab mucus-dm tab mg MULTAQ TAB 400MG multi-delyn liq MULTI-DELYN LIQ /IRON multi-sympt liq cld nght multi-sympt pak day/nght multsym cold liq childrns mupirocin oint 2% MURO 128 SOL 2% OP MUSTARGEN INJ 10MG my way tab 1.5mg MYCAMINE INJ 100MG MYCAMINE INJ 50MG mycophenolate mofetil cap 250 mg mycophenolate mofetil for oral susp 200 mg/ml mycophenolate mofetil tab 500 mg mycophenolate sodium tab dr 180 mg (mycophenolic acid equiv) mycophenolate sodium tab dr 360 mg (mycophenolic acid equiv) MYKIDZ IRON SUS 10MG/2ML MYKIDZ IRON SUS 15/1.5ML myorisan cap 10mg myorisan cap 20mg myorisan cap 30mg myorisan cap 40mg MYOZYME INJ 50MG MYRBETRIQ TAB 25MG MYRBETRIQ TAB 50MG myzilra tab N nabumetone tab 500 mg... 3 nabumetone tab 750 mg... 3 nadolol tab 20 mg nadolol tab 40 mg nadolol tab 80 mg nafcillin sodium for inj 1 gm nafcillin sodium for inj 10 gm nafcillin sodium for inj 2 gm nafcillin sodium for iv soln 1 gm nafcillin sodium for iv soln 2 gm NAGLAZYME INJ 1MG/ML nalbuphine hcl inj 10 mg/ml... 3 nalbuphine hcl inj 20 mg/ml... 3 naloxone hcl inj 0.4 mg/ml naloxone hcl inj 1 mg/ml naltrexone hcl tab 50 mg NAMENDA SOL 10MG/5ML NAMENDA TAB 10MG NAMENDA TAB 5MG NAMENDA XR CAP 14MG NAMENDA XR CAP 21MG NAMENDA XR CAP 28MG NAMENDA XR CAP 7MG NAMENDA XR CAP TITRATIO NAMZARIC CAP 14-10MG

157 NAMZARIC CAP 28-10MG naphazoline hcl ophth soln 0.1% naproxen dr tab 375mg... 3 naproxen dr tab 500mg... 3 NAPROXEN SODIUM CAP 220 MG... 1 naproxen sodium tab 275 mg... 3 naproxen sodium tab 550 mg... 3 naproxen susp 125 mg/5ml... 3 naproxen tab 250 mg... 3 naproxen tab 375 mg... 3 naproxen tab 500 mg... 3 naratriptan hcl tab 1 mg (base equiv). 61 naratriptan hcl tab 2.5 mg (base equiv) nasal decon liq 15mg/5ml nasal decon syp 30mg/5ml NASAL DECONG LIQ 30MG/5ML nasal decong tab 10mg nasal spr 0.05% NASCOBAL SPR 500MCG NASONEX SPR 50MCG/AC NASOPEN PE LIQ nat fiber pow therapy NATACYN SUS 5% OP nateglinide tab 120 mg nateglinide tab 60 mg NATPARA INJ 100MCG NATPARA INJ 25MCG NATPARA INJ 50MCG NATPARA INJ 75MCG natures tear sol 0.4% naturl fiber pow 68% NEBUPENT INH 300MG... 8 necon tab 0.5/ necon tab 1/ NECON TAB 1/ necon tab 10/ NECON TAB 7/7/ nefazodone hcl tab 100 mg nefazodone hcl tab 150 mg nefazodone hcl tab 200 mg nefazodone hcl tab 250 mg nefazodone hcl tab 50 mg neomycin sulfate tab 500 mg... 7 neomycin-bacitrac zn-polymyx 5(3.5)mg-400unt-10000unt op oin neomycin-polymy-gramicid op sol mg-unt-mg/ml neomycin-polymyxin-dexamethasone ophth oint 0.1% neomycin-polymyxin-dexamethasone ophth susp 0.1% neomycin-polymyxin-hc ophth susp neomycin-polymyxin-hc otic soln 1% 124 neomycin-polymyxin-hc otic susp 3.5 mg/ml unit/ml-1% NEORAL CAP 100MG NEORAL CAP 25MG NEORAL SOL 100MG/ML neotuss liq NEPHRAMINE INJ 5.4% NEPHRONEX LIQ NEUMEGA INJ 5MG NEUPOGEN INJ 300/ NEUPOGEN INJ 300MCG NEUPOGEN INJ 480/ NEUPOGEN INJ 480MCG NEUPRO DIS 1MG/24HR NEUPRO DIS 2MG/24HR NEUPRO DIS 3MG/24HR NEUPRO DIS 4MG/24HR NEUPRO DIS 6MG/24HR NEUPRO DIS 8MG/24HR NEVIRAPINE SUSP 50 MG/5ML nevirapine tab 200 mg nevirapine tab sr 24hr 100 mg nevirapine tab sr 24hr 400 mg NEXAFED SINS TAB + PAIN nexafed tab 30mg NEXAVAR TAB 200MG NEXIUM CAP 20MG NEXIUM CAP 40MG NEXIUM GRA 10MG DR NEXIUM GRA 2.5MG DR NEXIUM GRA 20MG DR NEXIUM GRA 40MG DR NEXIUM GRA 5MG DR niacin cap cr 250 mg niacin cap cr 500 mg niacin tab 100 mg niacin tab 50 mg niacin tab 500 mg niacin tab cr 1000 mg (antihyperlipidemic) niacin tab cr 500 mg niacin tab cr 500 mg (antihyperlipidemic) 157

158 niacin tab cr 750 mg niacin tab cr 750 mg (antihyperlipidemic) NIACIN TR TAB 1000MG niacinamide tab 100 mg niacinamide tab 500 mg niacor tab 500mg nicardipine hcl cap 20 mg nicardipine hcl cap 30 mg nicotine polacrilex gum 2 mg nicotine polacrilex gum 4 mg nicotine polacrilex lozenge 2 mg NICOTINE POLACRILEX LOZENGE 2 MG nicotine polacrilex lozenge 4 mg NICOTINE POLACRILEX LOZENGE 4 MG NICOTINE SYS KIT TRANSDER nicotine td patch 24hr 14 mg/24hr nicotine td patch 24hr 21 mg/24hr nicotine td patch 24hr 7 mg/24hr NICOTROL INH NICOTROL NS SPR 10MG/ML nifedical xl tab 30mg nifedical xl tab 60mg nifedipine tab sr 24hr 30 mg nifedipine tab sr 24hr 60 mg nifedipine tab sr 24hr 90 mg nifedipine tab sr 24hr osmotic release 30 mg nifedipine tab sr 24hr osmotic release 60 mg nifedipine tab sr 24hr osmotic release 90 mg night-time cap sinus nikki tab mg NILANDRON TAB 150MG nimodipine cap 30 mg NINLARO CAP 2.3MG NINLARO CAP 3MG NINLARO CAP 4MG NIPENT INJ 10MG nitro-bid oin 2% NITRO-DUR DIS 0.3MG/HR NITRO-DUR DIS 0.8MG/HR nitrofurantoin macrocrystalline cap 100 mg... 8 nitrofurantoin macrocrystalline cap 50 mg... 8 nitrofurantoin monohydrate macrocrystalline cap 100 mg... 9 nitroglycerin td patch 24hr 0.1 mg/hr. 41 nitroglycerin td patch 24hr 0.2 mg/hr. 41 nitroglycerin td patch 24hr 0.4 mg/hr. 41 nitroglycerin td patch 24hr 0.6 mg/hr. 41 NITROSTAT SUB 0.3MG NITROSTAT SUB 0.4MG NITROSTAT SUB 0.6MG nohist-lq liq 4-10/5ml non-asa jr tab 160mg... 2 non-aspirin chw 80mg... 2 NORDITROPIN INJ 10/1.5ML NORDITROPIN INJ 15/1.5ML NORDITROPIN INJ 30/3ML NORDITROPIN INJ 5/1.5ML NOREL AD TAB norelgestromin-ethinyl estradiol td ptwk mcg/24hr NORETHINDRONE ACE & ETHINYL ESTRADIOL TAB 1 MG-20 MCG NORETHINDRONE ACE & ETHINYL ESTRADIOL TAB 1.5 MG-30 MCG NORETHINDRONE ACE & ETHINYL ESTRADIOL-FE TAB 1 MG-20 MCG NORETHINDRONE ACE & ETHINYL ESTRADIOL-FE TAB 1.5 MG-30 MCG norethindrone acetate tab 5 mg norethindrone acetate-ethinyl estradiol tab 1 mg-5 mcg norethindrone tab 0.35 mg NORETHINDRONE TAB 0.35 MG NORETHINDRONE-ETH ESTRADIOL TAB /1-35/ MG-MCG norgestimate & ethinyl estradiol tab 0.25 mg-35 mcg norgestimate-eth estrad tab / / mg-mcg norgestrel & ethinyl estradiol tab 0.3 mg-30 mcg norlyroc tab 0.35mg NORMOSOL -M INJ /D5W NORMOSOL -R INJ /D5W NORMOSOL-R INJ PH NORPACE CAP 100MG CR NORPACE CAP 150MG CR

159 nortrel tab 0.5/ nortrel tab 1/ nortrel tab 7/7/ nortriptyline hcl cap 10 mg nortriptyline hcl cap 25 mg nortriptyline hcl cap 50 mg nortriptyline hcl cap 75 mg nortriptyline hcl soln 10 mg/5ml NORVIR CAP 100MG NORVIR SOL 80MG/ML NORVIR TAB 100MG NOVAFERRUM DRO 15MG/ML NOVAFERRUM LIQ NOVOLIN INJ 70/ NOVOLIN N INJ U NOVOLIN R INJ U NOVOLOG INJ 100/ML NOVOLOG INJ FLEXPEN NOVOLOG INJ PENFILL NOVOLOG MIX INJ 70/ NOVOLOG MIX INJ FLEXPEN NOXAFIL SUS 40MG/ML NOXAFIL TAB 100MG NUEDEXTA CAP 20-10MG nu-iron 150 cap 150mg NULOJIX INJ 250MG NULYTELY SOL FLAV PKS NUTRISOURCE PAK FIBER NUTRISOURCE POW FIBER NUVARING MIS NUVIGIL TAB 150MG NUVIGIL TAB 200MG NUVIGIL TAB 250MG NUVIGIL TAB 50MG nyamyc pow NYMALIZE SOL 60/20ML nyquil d liq cold/flu nystatin cream unit/gm nystatin oint unit/gm nystatin susp unit/ml nystatin tab unit nystatin topical powder nystop pow O OCTAGAM INJ 10GM OCTAGAM INJ 1GM OCTAGAM INJ 2.5GM OCTAGAM INJ 25GM OCTAGAM INJ 2GM/20ML OCTAGAM INJ 5GM octreotide acetate inj 100 mcg/ml (0.1 mg/ml) octreotide acetate inj 1000 mcg/ml (1 mg/ml) octreotide acetate inj 200 mcg/ml (0.2 mg/ml) octreotide acetate inj 50 mcg/ml (0.05 mg/ml) octreotide acetate inj 500 mcg/ml (0.5 mg/ml) ODOMZO CAP 200MG OFEV CAP 100MG OFEV CAP 150MG ofloxacin ophth soln 0.3% ofloxacin otic soln 0.3% olanzapine for im inj 10 mg olanzapine orally disintegrating tab 10 mg olanzapine orally disintegrating tab 15 mg olanzapine orally disintegrating tab 20 mg olanzapine orally disintegrating tab 5 mg olanzapine tab 10 mg olanzapine tab 15 mg olanzapine tab 2.5 mg olanzapine tab 20 mg olanzapine tab 5 mg olanzapine tab 7.5 mg olopatadine hcl nasal soln 0.6% omega-3-acid ethyl esters cap 1 gm omepra/bicar cap omeprazole cap delayed release 10 mg84 omeprazole cap delayed release 20 mg85 omeprazole cap delayed release 40 mg85 OMEPRAZOLE TAB 20MG ondansetron hcl inj 4 mg/2ml (2 mg/ml) ondansetron hcl inj 40 mg/20ml (2 mg/ml) ondansetron hcl oral soln 4 mg/5ml ondansetron hcl tab 24 mg ondansetron hcl tab 4 mg ondansetron hcl tab 8 mg ondansetron orally disintegrating tab 4 159

160 mg ondansetron orally disintegrating tab 8 mg ONFI SUS 2.5MG/ML ONFI TAB 10MG ONFI TAB 20MG ophthalmic sol 5% op OPSUMIT TAB 10MG oral saline sol laxative ORAP TAB 1MG ORAP TAB 2MG ORFADIN CAP 10MG ORFADIN CAP 2MG ORFADIN CAP 5MG organ-i nr tab 200mg ORKAMBI TAB orsythia tab OSTEO-PORETI TAB oxacillin sodium for inj 1 gm oxacillin sodium for inj 10 gm oxacillin sodium for inj 2 gm oxaliplatin for iv inj 100 mg oxaliplatin for iv inj 50 mg oxaliplatin iv soln 100 mg/20ml oxaliplatin iv soln 50 mg/10ml oxandrolone tab 10 mg oxandrolone tab 2.5 mg oxcarbazepine susp 300 mg/5ml (60 mg/ml) oxcarbazepine tab 150 mg oxcarbazepine tab 300 mg oxcarbazepine tab 600 mg oxybutynin chloride syrup 5 mg/5ml oxybutynin chloride tab 5 mg oxybutynin chloride tab sr 24hr 10 mg 85 oxybutynin chloride tab sr 24hr 15 mg 85 oxybutynin chloride tab sr 24hr 5 mg.. 85 oxycodone hcl cap 5 mg... 6 oxycodone hcl conc 100 mg/5ml (20 mg/ml)... 6 OXYCODONE HCL SOLN 5 MG/5ML... 6 oxycodone hcl tab 10 mg... 6 oxycodone hcl tab 15 mg... 6 oxycodone hcl tab 20 mg... 6 oxycodone hcl tab 30 mg... 6 oxycodone hcl tab 5 mg... 6 oxycodone w/ acetaminophen tab mg... 6 oxycodone w/ acetaminophen tab mg... 6 oxycodone w/ acetaminophen tab mg... 6 oxycodone w/ acetaminophen tab mg... 6 oys shell+d tab oysco 500 tab 500mg oyst shell/d tab P pacerone tab 100mg pacerone tab 200mg pacerone tab 400mg paclitaxel iv conc 100 mg/16.7ml (6 mg/ml) paclitaxel iv conc 150 mg/25ml (6 mg/ml) paclitaxel iv conc 30 mg/5ml (6 mg/ml) paclitaxel iv conc 300 mg/50ml (6 mg/ml) pain relf pm tab mg pain relief dro 80/0.8ml... 2 pain relief liq 500/15ml... 2 pain relief sus 160/5ml... 2 pain relief sus pls cold pain relief tab 500mg... 2 pain relieve tab pm pain relievr tab 325mg... 2 paliperidone tab sr 24hr 1.5 mg paliperidone tab sr 24hr 3 mg paliperidone tab sr 24hr 6 mg paliperidone tab sr 24hr 9 mg pamidronate disodium iv soln 3 mg/ml 67 pamidronate disodium iv soln 9 mg/ml 67 pamidronate inj 6mg/ml panoxyl bar 10% panoxyl wash liq 10% PANOXYL-4 LIQ CREM WSH PANRETIN GEL 0.1% pantoprazole sodium ec tab 20 mg (base equiv) pantoprazole sodium ec tab 40 mg (base equiv) paricalcitol cap 1 mcg paricalcitol cap 2 mcg paricalcitol cap 4 mcg paromomycin sulfate cap 250 mg

161 paroxetine hcl tab 10 mg paroxetine hcl tab 20 mg paroxetine hcl tab 30 mg paroxetine hcl tab 40 mg PARVA-CAL TAB 500MG paser gra 4gm PATADAY SOL 0.2% PAXIL SUS 10MG/5ML PAZEO DRO 0.7% pediacare liq long-act PEDIA-LAX LIQ 50MG PEDVAX HIB INJ PEG 3350-KCL-NA BICARB-NACL-NA SULFATE FOR SOLN 236 GM PEG 3350-KCL-NA BICARB-NACL-NA SULFATE FOR SOLN 240 GM peg 3350-kcl-sod bicarb-nacl for soln 420 gm PEGANONE TAB 250MG PEGASYS INJ PEGASYS INJ 180MCG/M PEGASYS INJ PROCLICK PEG-INTRON KIT 120 RP PEGINTRON KIT 120MCG PEG-INTRON KIT 150 RP PEGINTRON KIT 150MCG PEG-INTRON KIT 50MCG PEG-INTRON KIT 50MCG RP PEGINTRON KIT 80MCG PEG-INTRON KIT 80MCG RP pen g proc inj PENICILL GK/ INJ DEX 2MU PENICILL GK/ INJ DEX 3MU penicillin g potassium for inj unit penicillin g potassium for inj unit penicillin g sodium for inj unit penicillin v potassium for soln 125 mg/5ml penicillin v potassium for soln 250 mg/5ml penicillin v potassium tab 250 mg penicillin v potassium tab 500 mg PENTAM 300 INJ 300MG... 9 pentoxifylline tab cr 400 mg PEPCID AC CHW 10MG peptic relf chw 262mg perdiem over tab 15mg PERFOROMIST NEB 20MCG perindopril erbumine tab 2 mg perindopril erbumine tab 4 mg perindopril erbumine tab 8 mg periogard sol 0.12% permethrin cream 5% permethrin lotion 1% perphenazine tab 16 mg perphenazine tab 2 mg perphenazine tab 4 mg perphenazine tab 8 mg PERRY PRENAT CAP phenadoz sup 12.5mg PHENAGIL TAB MG phenelzine sulfate tab 15 mg phenergan sup 12.5mg phenergan sup 25mg phenergan sup 50mg PHENOBARB INJ 65MG/ML phenobarbital elixir 20 mg/5ml phenobarbital sodium inj 130 mg/ml.. 46 phenobarbital tab 100 mg phenobarbital tab 15 mg phenobarbital tab 16.2 mg phenobarbital tab 30 mg phenobarbital tab 32.4 mg phenobarbital tab 60 mg phenobarbital tab 64.8 mg phenobarbital tab 97.2 mg phenytek cap 200mg phenytek cap 300mg phenytoin chew tab 50 mg phenytoin sodium extended cap 100 mg phenytoin sodium extended cap 200 mg phenytoin sodium extended cap 300 mg phenytoin sodium inj 50 mg/ml phenytoin susp 125 mg/5ml philith tab PHOS-NAK POW CONCENTR PHOSPHOLINE SOL 0.125%OP phytonadione inj 1 mg/0.5ml (2 mg/ml) phytonadione inj 10 mg/ml

162 phytonadione tab 100 mcg PILOCARPINE HCL OPHTH SOLN 1%. 107 PILOCARPINE HCL OPHTH SOLN 2%. 107 PILOCARPINE HCL OPHTH SOLN 4%. 107 PILOCARPINE HCL TAB 5 MG pilocarpine hcl tab 7.5 mg pimozide tab 1 mg pimozide tab 2 mg pimtrea tab pindolol tab 10 mg pindolol tab 5 mg pioglitazone hcl tab 15 mg (base equiv) pioglitazone hcl tab 30 mg (base equiv) pioglitazone hcl tab 45 mg (base equiv) piperacillin sodium-tazobactam sodium for inj gm piperacillin sodium-tazobactam sodium for inj gm piperacillin sodium-tazobactam sodium for inj gm piperacillin sodium-tazobactam sodium for inj gm pirmella tab 1/ piroxicam cap 10 mg... 3 piroxicam cap 20 mg... 3 PLASMA-LYTE INJ PLASMA-LYTE INJ 56/D5W PLASMA-LYTE INJ -A podofilox soln 0.5% polyethylene glycol 3350 oral packet polyethylene glycol 3350 oral powder.. 82 polymyxin b-trimethoprim ophth soln unit/ml-0.1% polyvitamin dro polyvitamin dro /iron POMALYST CAP 1MG POMALYST CAP 2MG POMALYST CAP 3MG POMALYST CAP 4MG portia-28 tab POTASSIUM CHLORIDE 20 MEQ/L (0.15%) IN DEXTROSE 5% INJ POTASSIUM CHLORIDE 40 MEQ/L (0.3%) IN DEXTROSE 5% INJ potassium chloride cap cr 10 meq potassium chloride cap cr 8 meq POTASSIUM CHLORIDE INJ 10 MEQ/100ML POTASSIUM CHLORIDE INJ 10 MEQ/50ML potassium chloride inj 2 meq/ml POTASSIUM CHLORIDE INJ 20 MEQ/100ML POTASSIUM CHLORIDE INJ 20 MEQ/50ML POTASSIUM CHLORIDE INJ 40 MEQ/100ML potassium chloride microencapsulated crys cr tab 10 meq potassium chloride microencapsulated crys cr tab 20 meq POTASSIUM CHLORIDE ORAL SOLN 10% (20 MEQ/15ML) POTASSIUM CHLORIDE ORAL SOLN 20% (40 MEQ/15ML) POTASSIUM CHLORIDE TAB CR 10 MEQ POTASSIUM CHLORIDE TAB CR 20 MEQ (1500 MG) potassium chloride tab cr 8 meq (600 mg) POTASSIUM CITRATE TAB CR 10 MEQ (1080 MG) POTASSIUM CITRATE TAB CR 5 MEQ (540 MG) POTIGA TAB 200MG POTIGA TAB 300MG POTIGA TAB 400MG POTIGA TAB 50MG PRADAXA CAP 110MG PRADAXA CAP 150MG PRADAXA CAP 75MG pramipexole dihydrochloride tab mg pramipexole dihydrochloride tab 0.25 mg pramipexole dihydrochloride tab 0.5 mg pramipexole dihydrochloride tab 0.75 mg pramipexole dihydrochloride tab 1 mg 54 pramipexole dihydrochloride tab 1.5 mg

163 pravastatin sodium tab 10 mg pravastatin sodium tab 20 mg pravastatin sodium tab 40 mg pravastatin sodium tab 80 mg prazosin hcl cap 1 mg prazosin hcl cap 2 mg prazosin hcl cap 5 mg pred sod pho sol 1% op PREDNISOLONE ACETATE OPHTH SUSP 1% prednisolone sod phosph oral soln 6.7 mg/5ml (5 mg/5ml base) prednisolone sod phosphate oral soln 15 mg/5ml (base equiv) prednisolone sodium phosphate oral soln 25 mg/5ml (base eq) prednisolone syrup 15 mg/5ml (usp solution equivalent) prednisone con 5mg/ml prednisone oral soln 5 mg/5ml prednisone tab 1 mg prednisone tab 10 mg prednisone tab 10 mg dose pack prednisone tab 2.5 mg prednisone tab 20 mg prednisone tab 5 mg prednisone tab 5 mg dose pack prednisone tab 50 mg premasol sol 10% PRENATAL TAB PRENATAL TAB MG PRENATAL VITAMIN/FOLIC ACID > 0.8 MG (GENERIC) PRETZ SOL prevalite pow 4gm prevalite pow 4gm pk previfem tab PREZCOBIX TAB PREZISTA SUS 100MG/ML PREZISTA TAB 150MG PREZISTA TAB 600MG PREZISTA TAB 75MG PREZISTA TAB 800MG PRIFTIN TAB 150MG PRILOSEC OTC TAB 20MG PRIMAQUINE TAB 26.3MG primidone tab 250 mg primidone tab 50 mg PRISTIQ TAB 100MG PRISTIQ TAB 25MG PRISTIQ TAB 50MG PRIVIGEN INJ 10GRAMS PRIVIGEN INJ 20GRAMS PRIVIGEN INJ 40GRAMS PRIVIGEN INJ 5 GRAMS probenecid tab 500 mg... 1 probiotic cap PROBIOTIC CAP COMPLEX PROCALAMINE INJ 3% PRO-CHLO LIQ prochlorperazine edisylate inj 5 mg/ml 79 prochlorperazine maleate tab 10 mg (base equivalent) prochlorperazine maleate tab 5 mg (base equivalent) prochlorperazine suppos 25 mg PROCRIT INJ 10000/ML PROCRIT INJ 2000/ML PROCRIT INJ 20000/ML PROCRIT INJ 3000/ML PROCRIT INJ 4000/ML PROCRIT INJ 40000/ML procto-pak cre 1% proctozone cre -hc 2.5% PROFE CAP 180MG PROGLYCEM SUS 50MG/ML PROGRAF CAP 0.5MG PROGRAF CAP 1MG PROGRAF CAP 5MG PROLASTIN-C INJ 1000MG PROLENSA SOL 0.07% PROLEUKIN INJ 22MU PROLIA SOL 60MG/ML PROMACTA TAB 12.5MG PROMACTA TAB 25MG PROMACTA TAB 50MG PROMACTA TAB 75MG promethazine hcl inj 25 mg/ml promethazine hcl inj 50 mg/ml promethazine hcl suppos 12.5 mg promethazine hcl suppos 25 mg promethazine hcl suppos 50 mg promethazine hcl syrup 6.25 mg/5ml. 79 promethazine hcl tab 12.5 mg promethazine hcl tab 25 mg promethazine hcl tab 50 mg

164 promethegan sup 25mg promethegan sup 50mg propafenone hcl cap sr 12hr 225 mg propafenone hcl cap sr 12hr 325 mg propafenone hcl cap sr 12hr 425 mg propafenone hcl tab 150 mg propafenone hcl tab 225 mg propafenone hcl tab 300 mg proparacaine hcl ophth soln 0.5% propranolol & hydrochlorothiazide tab mg propranolol & hydrochlorothiazide tab mg propranolol hcl cap sr 24hr 120 mg propranolol hcl cap sr 24hr 160 mg propranolol hcl cap sr 24hr 60 mg propranolol hcl cap sr 24hr 80 mg propranolol hcl inj 1 mg/ml propranolol hcl oral soln 20 mg/5ml propranolol hcl oral soln 40 mg/5ml propranolol hcl tab 10 mg propranolol hcl tab 20 mg propranolol hcl tab 40 mg propranolol hcl tab 60 mg propranolol hcl tab 80 mg propylthiouracil tab 50 mg PROQUAD INJ PROSOL INJ 20% protriptyline hcl tab 10 mg protriptyline hcl tab 5 mg PRUDOXIN CRE 5% pseudoephed-bromphen-dm syrup mg/5ml pseudoephedr tab 60mg psyldex pow 30% PULMICORT INH 180MCG PULMICORT INH 90MCG PULMOZYME SOL 1MG/ML pure & gentl dro 0.3% PURIXAN SUS 20MG/ML pyrazinamide tab 500 mg PYRE/PIPERON LIQ pyridostigmine bromide tab 60 mg pyridoxine hcl inj 100 mg/ml pyridoxine hcl tab 100 mg pyridoxine hcl tab 25 mg pyridoxine hcl tab 50 mg pyridoxine hcl tab cr 200 mg pyrilamine mal-phenylephrine hcl tann susp 16-5 mg/5ml pyrilamine-phenylephrine tab mg Q qc natural pow vegetabl q-pap infant dro 80/0.8ml... 2 q-tapp dm elx QUADRACEL INJ quasense tab quetiapine fumarate tab 100 mg quetiapine fumarate tab 200 mg quetiapine fumarate tab 25 mg quetiapine fumarate tab 300 mg quetiapine fumarate tab 400 mg quetiapine fumarate tab 50 mg quinapril hcl tab 10 mg quinapril hcl tab 20 mg quinapril hcl tab 40 mg quinapril hcl tab 5 mg quinapril-hydrochlorothiazide tab mg quinapril-hydrochlorothiazide tab mg quinapril-hydrochlorothiazide tab mg quinidine gluconate tab cr 324 mg quinidine sulfate tab 200 mg quinidine sulfate tab 300 mg quinine sulfate cap 324 mg R ra anti-itch oin 1% ra b-complex tab vit c tr ra beta caro cap 15mg RA CA/BORON TAB RA CALAMINE LOT ra col-rite cap 50mg ra coral cap calcium ra fiber tab 500mg ra hydrocort cre 0.5% ra iron tab 27mg ra lubricant dro % ra magnesium cap 500mg RA OYS SHL/D TAB 250MG ra oys shl/d tab 500mg ra vit c loz 60mg ra vitamin c tab 1000mg RABAVERT INJ

165 raloxifene hcl tab 60 mg ramipril cap 1.25 mg ramipril cap 10 mg ramipril cap 2.5 mg ramipril cap 5 mg RANEXA TAB 1000MG RANEXA TAB 500MG ranitidine hcl inj 150 mg/6ml (25 mg/ml) ranitidine hcl inj 50 mg/2ml (25 mg/ml) ranitidine hcl syrup 15 mg/ml (75 mg/5ml) ranitidine hcl tab 150 mg ranitidine hcl tab 300 mg ranitidine hcl tab 75 mg RAPAMUNE SOL 1MG/ML RAVICTI LIQ 1.1GM/ML REBETOL SOL 40MG/ML reclipsen tab RECOMBIVA HB INJ 10MCG/ML RECOMBIVA HB INJ 5MCG/ RECOMBIVA-HB INJ 40MCG/ML REFRESH CELL DRO 1% OP refresh p.m. oin op REFRESH SOL OPTIVE REGRANEX GEL 0.01% reguloid pow 48.57% reguloid pow 58.6% rehydralyte sol RELENZA MIS DISKHALE RELISTOR INJ 12/0.6ML RELISTOR INJ 8/0.4ML RELPAX TAB 20MG RELPAX TAB 40MG REMICADE INJ 100MG REMODULIN INJ 10MG/ML REMODULIN INJ 1MG/ML REMODULIN INJ 2.5MG/ML REMODULIN INJ 5MG/ML RENVELA PAK 0.8GM RENVELA PAK 2.4GM RENVELA TAB 800MG repaglinide tab 0.5 mg repaglinide tab 1 mg repaglinide tab 2 mg RESCON TAB 2-60MG RESCON-DM SYP RESCRIPTOR TAB 100 MG RESCRIPTOR TAB 200MG RESPAIRE-30 CAP RESTASIS EMU 0.05% RETAINE MGD EMU % RETROVIR INJ 10MG/ML REVATIO SUS 10MG/ML REVLIMID CAP 10MG REVLIMID CAP 15MG REVLIMID CAP 2.5MG REVLIMID CAP 20MG REVLIMID CAP 25MG REVLIMID CAP 5MG REXULTI TAB 0.25MG REXULTI TAB 0.5MG REXULTI TAB 1MG REXULTI TAB 2MG REXULTI TAB 3MG REXULTI TAB 4MG REYATAZ CAP 150MG REYATAZ CAP 200MG REYATAZ CAP 300MG REYATAZ POW 50MG RHINARIS GEL 0.2% RHINARIS SPR 0.2% ribapak pak 1000/day ribapak pak 1200/day ribapak pak 600/day ribapak pak 800/day ribasphere cap 200mg ribasphere tab 200mg ribasphere tab 400mg ribasphere tab 600mg ribavirin cap 200 mg ribavirin tab 200 mg riboflavin tab 25 mg riboflavin tab 50 mg RID ESS LICE KIT % rifabutin cap 150 mg rifampin cap 150 mg rifampin cap 300 mg rifampin for inj 600 mg RIFATER TAB riluzole tab 50 mg rimantadine hydrochloride tab 100 mg 14 RINGER'S SOLUTION RISA-BID TAB PROBIO RISAMINE OIN

166 RISPERDAL INJ 12.5MG RISPERDAL INJ 25MG RISPERDAL INJ 37.5MG RISPERDAL INJ 50MG risperidone orally disintegrating tab 0.25 mg risperidone orally disintegrating tab 0.5 mg risperidone orally disintegrating tab 1 mg risperidone orally disintegrating tab 2 mg risperidone orally disintegrating tab 3 mg risperidone orally disintegrating tab 4 mg risperidone soln 1 mg/ml risperidone tab 0.25 mg risperidone tab 0.5 mg risperidone tab 1 mg risperidone tab 2 mg risperidone tab 3 mg risperidone tab 4 mg RITUXAN INJ 100MG RITUXAN INJ 500MG rivastigmine tartrate cap 1.5 mg rivastigmine tartrate cap 3 mg rivastigmine tartrate cap 4.5 mg rivastigmine tartrate cap 6 mg rivastigmine td patch 24hr 13.3 mg/24hr rivastigmine td patch 24hr 4.6 mg/24hr rivastigmine td patch 24hr 9.5 mg/24hr rizatriptan benzoate orally disintegrating tab 10 mg rizatriptan benzoate orally disintegrating tab 5 mg rizatriptan benzoate tab 10 mg rizatriptan benzoate tab 5 mg robafen cf syp cgh/cld robafen cgh cap 15mg robitussin cap cold+flu robitussin liq 15mg/5ml ROBITUSSIN LIQ CF ROBITUSSIN LIQ CGH/COLD robitussin liq ms max ROBITUSSIN LIQ NIGHT TM robitussin syp 7.5/5ml ropinirole hydrochloride tab 0.25 mg.. 54 ropinirole hydrochloride tab 0.5 mg ropinirole hydrochloride tab 1 mg ropinirole hydrochloride tab 2 mg ropinirole hydrochloride tab 3 mg ropinirole hydrochloride tab 4 mg ropinirole hydrochloride tab 5 mg rosadan cre 0.75% ROTARIX SUS ROTATEQ SOL roxicet sol 5-325/ ROZEREM TAB 8MG RYMED TAB 2-10MG rynex dm liq rynex pse liq S SABRIL POW 500MG SABRIL TAB 500MG SANDIMMUNE SOL 100MG/ML SANDOSTATIN KIT LAR 10MG SANDOSTATIN KIT LAR 20MG SANDOSTATIN KIT LAR 30MG SANTYL OIN 250/GM SAPHRIS SUB 10MG SAPHRIS SUB 2.5MG SAPHRIS SUB 5MG sb fib lax pow 33% sb nat fiber pow 49% SCOOBY-DOO CHW scot-tussin liq dm sf SCOT-TUSSIN LIQ SENIOR SECURA CRE 30.6% secura prote cre 10% selegiline hcl cap 5 mg selegiline hcl tab 5 mg selenium sulfide lotion 2.5% selenium tab 100 mcg SELENIUM TAB 200MCG SELZENTRY TAB 150MG SELZENTRY TAB 300MG SENNA PROMPT CAP 9-500MG senna s tab mg SENNA SYP senna tab 8.6mg senna-extra tab 17.2mg sennosides cap 8.6 mg

167 sennosides syrup 8.8 mg/5ml SENSI-CARE OIN 49-15% SENSIPAR TAB 30MG SENSIPAR TAB 60MG SENSIPAR TAB 90MG SEREVENT DIS AER 50MCG SEROQUEL XR TAB 150MG SEROQUEL XR TAB 200MG SEROQUEL XR TAB 300MG SEROQUEL XR TAB 400MG SEROQUEL XR TAB 50MG sertraline hcl oral conc 20 mg/ml sertraline hcl tab 100 mg sertraline hcl tab 25 mg sertraline hcl tab 50 mg sharobel tab 0.35mg SIGNIFOR INJ 0.3MG/ML SIGNIFOR INJ 0.6MG/ML SIGNIFOR INJ 0.9MG/ML sildenafil citrate tab 20 mg SILENOR TAB 3MG SILENOR TAB 6MG SILVER SULFADIAZINE CREAM 1% SIMBRINZA SUS 1-0.2% simvastatin tab 10 mg simvastatin tab 20 mg simvastatin tab 40 mg simvastatin tab 5 mg simvastatin tab 80 mg sirolimus tab 0.5 mg sirolimus tab 1 mg SIROLIMUS TAB 2 MG SIRTURO TAB 100MG SIVEXTRO INJ 200MG... 9 SIVEXTRO TAB 200MG... 9 sleep aid tab 25mg slo-niacin tab 250mg cr slow iron tab 50mg slow magnes/ tab calcium SLOW REL FE TAB 140MG CR SLOW REL FE TAB 143MG CR slow release tab 45mg slow release tab 47.5mg SLOW-MAG TAB sm ca/mg/zn tab SM CORAL CAL TAB 1000MG sm iron slow tab 160mg cr sm magnesium tab 250mg sm redness dro relief sm vitamin c tab 500mg tr sodium chloride hypertonic ophth oint 5% SODIUM CHLORIDE INJ 0.45% SODIUM CHLORIDE INJ 2.5 MEQ/ML (14.6%) SODIUM CHLORIDE INJ 3% SODIUM CHLORIDE INJ 5% SODIUM CHLORIDE IRRIGATION SOLN 0.9% SODIUM CHLORIDE IV SOLN 0.9% SODIUM FLUORIDE CHEW; TAB; 1.1 (0.5 F) MG/ML SOLN sodium phenylbutyrate oral powder 3 gm/teaspoonful sodium phosphates - enema sodium polystyrene sulfonate oral susp 15 gm/60ml sodium polystyrene sulfonate powder. 68 SODIUM POW BICARBON SOLIA TAB SOLTAMOX SOL 10MG/5ML soluble fib pow therapy SOLU-CORTEF INJ 250MG SOMATULINE INJ 120/.5ML SOMATULINE INJ 60/0.2ML SOMATULINE INJ 90/0.3ML SOMAVERT INJ 10MG SOMAVERT INJ 15MG SOMAVERT INJ 20MG SOMAVERT INJ 25MG SOMAVERT INJ 30MG SOOTHE DRO % soothe tab 262mg sorbulax pow 100% sorine tab 120mg sorine tab 160mg sorine tab 240mg sorine tab 80mg sotalol hcl (afib/afl) tab 120 mg sotalol hcl (afib/afl) tab 160 mg sotalol hcl (afib/afl) tab 80 mg sotalol hcl tab 120 mg sotalol hcl tab 160 mg sotalol hcl tab 240 mg sotalol hcl tab 80 mg SOVALDI TAB 400MG

168 spironolactone & hydrochlorothiazide tab mg spironolactone tab 100 mg spironolactone tab 25 mg spironolactone tab 50 mg sprintec 28 tab 28 day SPRYCEL TAB 100MG SPRYCEL TAB 140MG SPRYCEL TAB 20MG SPRYCEL TAB 50MG SPRYCEL TAB 70MG SPRYCEL TAB 80MG SSD CRE 1% STAHIST AD LIQ STAHIST AD TAB 25-60MG stavudine cap 15 mg stavudine cap 20 mg stavudine cap 30 mg stavudine cap 40 mg stavudine for oral soln 1 mg/ml STERILE LUBR DRO 0.7% STIVARGA TAB 40MG stomach relf sus 525/15ml stool softnr cap 100mg stool softnr cap 240mg stool softnr cap 50mg stool softnr syp 60/15ml stool softnr tab mg STRATTERA CAP 100MG STRATTERA CAP 10MG STRATTERA CAP 18MG STRATTERA CAP 25MG STRATTERA CAP 40MG STRATTERA CAP 60MG STRATTERA CAP 80MG streptomycin sulfate for inj 1 gm... 7 STRIBILD TAB SUBOXONE MIS 12-3MG SUBOXONE MIS 2-0.5MG SUBOXONE MIS 4-1MG SUBOXONE MIS 8-2MG SUCRAID SOL 8500/ML sucralfate tab 1 gm sulfacetamide sodium lotion 10% (acne) sulfacetamide sodium ophth oint 10% sulfacetamide sodium ophth soln 10% sulfacetamide sodium-prednisolone ophth soln (0.25)% sulfadiazine tab 500mg... 7 sulfamethoxazole-trimethoprim iv soln mg/5ml... 9 sulfamethoxazole-trimethoprim susp mg/5ml... 9 sulfamethoxazole-trimethoprim tab mg... 9 sulfamethoxazole-trimethoprim tab mg... 9 SULFAMYLON CRE 85MG/GM SULFAMYLON PAK 5% sulfasalazin tab 500mg dr sulfasalazine tab 500 mg sulindac tab 150 mg... 3 sulindac tab 200 mg... 3 SUMATRIPTAN NASAL SPRAY 20 MG/ACT SUMATRIPTAN NASAL SPRAY 5 MG/ACT sumatriptan succinate inj 6 mg/0.5ml 62 SUMATRIPTAN SUCCINATE SOLUTION AUTO-INJECTOR 4 MG/0.5ML sumatriptan succinate solution auto-injector 6 mg/0.5ml SUMATRIPTAN SUCCINATE SOLUTION CARTRIDGE 4 MG/0.5ML SUMATRIPTAN SUCCINATE SOLUTION CARTRIDGE 6 MG/0.5ML sumatriptan succinate solution prefilled syringe 6 mg/0.5ml sumatriptan succinate tab 100 mg sumatriptan succinate tab 25 mg sumatriptan succinate tab 50 mg summers eve sol 0.3% SUPRAX CAP 400MG suprax chw 100mg suprax chw 200mg SUPRAX SUS 500/5ML SUPREP BOWEL SOL PREP SURMONTIL CAP 100MG SURMONTIL CAP 25MG SURMONTIL CAP 50MG SUSTIVA CAP 200MG SUSTIVA CAP 50MG SUSTIVA TAB 600MG

169 SUTENT CAP 12.5MG SUTENT CAP 25MG SUTENT CAP 37.5MG SUTENT CAP 50MG SYLATRON KIT 200MCG SYLATRON KIT 300MCG SYLATRON KIT 600MCG SYMBICORT AER SYMBICORT AER SYMLINPEN 60 INJ 1000MCG SYMLNPEN 120 INJ 1000MCG SYNAGIS INJ 100MG/ML SYNAGIS INJ 50MG SYNAREL SOL 2MG/ML SYNERCID INJ 500MG... 9 SYNRIBO INJ 3.5MG SYNTHROID TAB 100MCG SYNTHROID TAB 112MCG SYNTHROID TAB 125MCG SYNTHROID TAB 137MCG SYNTHROID TAB 150MCG SYNTHROID TAB 175MCG SYNTHROID TAB 200MCG SYNTHROID TAB 25MCG SYNTHROID TAB 300MCG SYNTHROID TAB 50MCG SYNTHROID TAB 75MCG SYNTHROID TAB 88MCG SYPRINE CAP 250MG SYSTANE BAL SOL RESTOR SYSTANE GEL 0.3% systane oin T TABLOID TAB 40MG tacrolimus cap 0.5 mg tacrolimus cap 1 mg tacrolimus cap 5 mg tacrolimus oint 0.03% tacrolimus oint 0.1% TAFINLAR CAP 50MG TAFINLAR CAP 75MG TAGRISSO TAB 40MG TAGRISSO TAB 80MG TAMIFLU CAP 30MG TAMIFLU CAP 45MG TAMIFLU CAP 75MG TAMIFLU SUS 6MG/ML tamoxifen citrate tab 10 mg (base equivalent) tamoxifen citrate tab 20 mg (base equivalent) tamsulosin hcl cap 0.4 mg TARCEVA TAB 100MG TARCEVA TAB 150MG TARCEVA TAB 25MG TARGRETIN CAP 75MG TARGRETIN GEL 1% tarina fe tab 1/ TASIGNA CAP 150MG TASIGNA CAP 200MG tazicef inj 1gm tazicef inj 2gm tazicef inj 6gm TAZORAC CRE 0.05% TAZORAC CRE 0.1% taztia xt cap 120mg/ taztia xt cap 180mg/ taztia xt cap 240mg/ taztia xt cap 300mg/ taztia xt cap 360mg/ TEARS AGAIN GEL NGHT/DAY TEFLARO INJ 400MG TEFLARO INJ 600MG TEGRETOL SUS 100/5ML TEGRETOL TAB 200MG TEGRETOL-XR TAB 100MG TEGRETOL-XR TAB 200MG TEGRETOL-XR TAB 400MG TEKTURNA HCT TAB TEKTURNA HCT TAB MG TEKTURNA HCT TAB TEKTURNA HCT TAB MG TEKTURNA TAB 150MG TEKTURNA TAB 300MG temazepam cap 15 mg temazepam cap 7.5 mg TENIVAC INJ 5-2LF terazosin hcl cap 1 mg terazosin hcl cap 10 mg terazosin hcl cap 2 mg terazosin hcl cap 5 mg terbinafine cre 1% terbinafine hcl tab 250 mg terbutaline sulfate inj 1 mg/ml terbutaline sulfate tab 2.5 mg terbutaline sulfate tab 5 mg

170 terconazole vaginal cream 0.4% terconazole vaginal cream 0.8% terconazole vaginal suppos 80 mg testosterone cypionate im inj in oil 100 mg/ml testosterone cypionate im inj in oil 200 mg/ml testosterone enanthate im inj in oil 200 mg/ml TET/DIP TOX INJ 2-2 LF tetrabenazine tab 12.5 mg tetrabenazine tab 25 mg texacort sol 2.5% tgt lubricnt dro eye th eye tears dro THALOMID CAP 100MG THALOMID CAP 150MG THALOMID CAP 200MG THALOMID CAP 50MG theo-24 cap 100mg cr theo-24 cap 200mg cr theo-24 cap 300mg cr theo-24 cap 400mg er theophylline soln 80 mg/15ml theophylline tab sr 12hr 100 mg theophylline tab sr 12hr 200 mg theophylline tab sr 12hr 300 mg theophylline tab sr 12hr 450 mg theophylline tab sr 24hr 400 mg theophylline tab sr 24hr 600 mg THERA BETA- TAB CAROTENE THERA-D TAB 4000UNIT THERANATAL TAB THERATEARS SOL OP thiamine hcl inj 100 mg/ml thiamine hcl tab 100 mg thiamine hcl tab 50 mg thiamine mononitrate tab 100 mg thioridazine hcl tab 10 mg thioridazine hcl tab 100 mg thioridazine hcl tab 25 mg thioridazine hcl tab 50 mg thiothixene cap 1 mg thiothixene cap 10 mg thiothixene cap 2 mg thiothixene cap 5 mg tiagabine hcl tab 2 mg tiagabine hcl tab 4 mg TIKOSYN CAP 125MCG TIKOSYN CAP 250MCG TIKOSYN CAP 500MCG TIMOLOL MALEATE OPHTH GEL FORMING SOLN 0.25% TIMOLOL MALEATE OPHTH GEL FORMING SOLN 0.5% timolol maleate ophth soln 0.25% timolol maleate ophth soln 0.5% timolol maleate tab 10 mg timolol maleate tab 20 mg timolol maleate tab 5 mg tioconazole oin 6.5% vag titralac chw 420mg TIVICAY TAB 50MG tizanidine hcl tab 2 mg (base equivalent) tizanidine hcl tab 4 mg (base equivalent) tobra/nacl inj 80/ TOBRADEX OIN % TOBRADEX ST SUS tobramycin nebu soln 300 mg/5ml... 7 tobramycin ophth soln 0.3% tobramycin sulfate for inj 1.2 gm... 7 tobramycin sulfate inj 1.2 gm/30ml (40 mg/ml)... 7 tobramycin sulfate inj 10 mg/ml... 7 tobramycin sulfate inj 2 gm/50ml (40 mg/ml)... 7 tobramycin sulfate inj 80 mg/2ml (40 mg/ml)... 7 tobramycin-dexamethasone ophth susp % TOBREX OIN 0.3% OP tolnaftate cream 1% tolnaftate soln 1% tolterodine tartrate cap sr 24hr 2 mg. 85 tolterodine tartrate cap sr 24hr 4 mg. 86 tolterodine tartrate tab 1 mg tolterodine tartrate tab 2 mg topiramate sprinkle cap 15 mg topiramate sprinkle cap 25 mg topiramate tab 100 mg topiramate tab 200 mg topiramate tab 25 mg topiramate tab 50 mg toposar inj 1gm/50ml

171 topotecan hcl for inj 4 mg torsemide inj 50mg/5ml torsemide tab 10 mg torsemide tab 100 mg torsemide tab 20 mg torsemide tab 5 mg total b/c tab TOUJEO SOLO INJ 300IU/ML TOVIAZ TAB 4MG TOVIAZ TAB 8MG TPN ELECTROL INJ TRACLEER TAB 125MG TRACLEER TAB 62.5MG TRADJENTA TAB 5MG tramadol hcl tab 50 mg... 3 tramadol-acetaminophen tab mg... 3 trandolapril tab 1 mg trandolapril tab 2 mg trandolapril tab 4 mg tranexamic acid inj 100 mg/ml tranexamic acid tab 650 mg TRANSDERM-SC DIS 1MG tranylcypromine sulfate tab 10 mg TRAVASOL INJ 10% TRAVATAN Z DRO 0.004% trazodone hcl tab 100 mg trazodone hcl tab 150 mg trazodone hcl tab 50 mg TREANDA INJ 100MG TREANDA INJ 180/2ML TREANDA INJ 25MG TREANDA INJ 45/0.5ML TRECATOR TAB 250MG TRELSTAR MIX INJ 11.25MG TRELSTAR MIX INJ 3.75MG TRESIBA FLEX INJ 100UNIT TRESIBA FLEX INJ 200UNIT tretinoin cap 10 mg tretinoin cream 0.025% tretinoin cream 0.05% tretinoin cream 0.1% TRETINOIN GEL 0.01% tretinoin gel 0.025% triacting dt liq cold/cgh triamcinolone acetonide cream 0.025% triamcinolone acetonide cream 0.1% 122 triamcinolone acetonide cream 0.5%. 122 triamcinolone acetonide dental paste 0.1% triamcinolone acetonide lotion 0.025% triamcinolone acetonide lotion 0.1% triamcinolone acetonide oint 0.025%. 122 triamcinolone acetonide oint 0.1% triamcinolone acetonide oint 0.5% TRIAMINIC MIS GRAPE TRIAMINIC SYP COLD/CGH TRIAMINIC SYP INFANT... 2 triamterene & hydrochlorothiazide cap mg triamterene & hydrochlorothiazide tab mg triamterene & hydrochlorothiazide tab mg TRIBENZOR20- TAB MG TRIBENZOR40- TAB TRIBENZOR40- TAB 10-25MG TRIBENZOR40- TAB MG TRIBENZOR40- TAB 5-25MG tri-buff asa tab 325mg... 2 triderm cre 0.1% trifluoperazine hcl tab 1 mg trifluoperazine hcl tab 10 mg trifluoperazine hcl tab 2 mg trifluoperazine hcl tab 5 mg trifluridine ophth soln 1% trihexyphenidyl hcl elixir 0.4 mg/ml trihexyphenidyl hcl tab 2 mg trihexyphenidyl hcl tab 5 mg tri-legest tab fe trilyte sol trimethoprim tab 100 mg... 9 trimipramine maleate cap 100 mg trimipramine maleate cap 25 mg trimipramine maleate cap 50 mg TRINESSA TAB triple antib oin TRIPLE PASTE OIN 12.8% triple paste oin af 2% tri-previfem tab TRISENOX SOL 10MG/10M tri-sprintec tab TRIUMEQ TAB TRI-VI-SOL SOL

172 tri-vita sol tri-vitamin dro trivora-28 tab TROPHAMINE INJ 10% trospium chloride tab 20 mg TRULICITY INJ 0.75/ TRULICITY INJ 1.5/ TRUMENBA INJ TRUVADA TAB TUSNEL LIQ TUSNEL PED DRO TUSNEL PEDI LIQ TUSNEL-DM DRO PEDIATRC tussin cf liq cgh/cold tussin dm syp / tussi-pres liq b TWINRIX INJ TYBOST TAB 150MG TYGACIL INJ 50MG... 9 TYKERB TAB 250MG TYPHIM VI INJ TYSABRI INJ 300/15ML TYZEKA TAB 600MG U UCERIS TAB 9MG ULORIC TAB 40MG... 1 ULORIC TAB 80MG... 1 UNITHROID TAB 100MCG UNITHROID TAB 112MCG UNITHROID TAB 125MCG UNITHROID TAB 150MCG UNITHROID TAB 175MCG UNITHROID TAB 200MCG UNITHROID TAB 25MCG UNITHROID TAB 300MCG UNITHROID TAB 50MCG UNITHROID TAB 75MCG UNITHROID TAB 88MCG UPCAL D POW ursodiol cap 300 mg ursodiol tab 250 mg ursodiol tab 500 mg V VAGIFEM TAB 10MCG vagistat-3 kit combo pk valacyclovir hcl tab 1 gm valacyclovir hcl tab 500 mg VALCHLOR GEL 0.016% VALCYTE SOL 50MG/ML valganciclovir hcl tab 450 mg (base equivalent) valproate sodium inj 100 mg/ml valproate sodium syrup 250 mg/5ml (base equiv) valproic acid cap 250 mg valsartan tab 160 mg valsartan tab 320 mg valsartan tab 40 mg valsartan tab 80 mg valsartan-hydrochlorothiazide tab mg valsartan-hydrochlorothiazide tab mg valsartan-hydrochlorothiazide tab mg valsartan-hydrochlorothiazide tab mg valsartan-hydrochlorothiazide tab mg vancomycin hcl cap 125 mg... 9 vancomycin hcl cap 250 mg... 9 vancomycin hcl for inj 10 gm... 9 vancomycin hcl for inj 1000 mg... 9 vancomycin hcl for inj 500 mg... 9 vancomycin hcl for inj 5000 mg... 9 vancomycin inj 750mg... 9 VANDAZOLE GEL 0.75% VAQTA INJ 25/0.5ML VAQTA INJ 50UNT/ML VARIVAX INJ VASCEPA CAP 1GM vcks dayquil liq mucus dm VELCADE INJ 3.5MG velivet pak venlafaxine hcl cap sr 24hr 150 mg (base equivalent) venlafaxine hcl cap sr 24hr 37.5 mg (base equivalent) venlafaxine hcl cap sr 24hr 75 mg (base equivalent) venlafaxine hcl tab 100 mg venlafaxine hcl tab 25 mg venlafaxine hcl tab 37.5 mg venlafaxine hcl tab 50 mg venlafaxine hcl tab 75 mg VENTOLIN HFA AER

173 verapamil hcl cap sr 24hr 100 mg verapamil hcl cap sr 24hr 120 mg verapamil hcl cap sr 24hr 180 mg verapamil hcl cap sr 24hr 200 mg verapamil hcl cap sr 24hr 240 mg verapamil hcl cap sr 24hr 300 mg VERAPAMIL HCL CAP SR 24HR 360 MG 39 verapamil hcl iv soln 2.5 mg/ml verapamil hcl tab 120 mg verapamil hcl tab 40 mg verapamil hcl tab 80 mg verapamil hcl tab cr 120 mg verapamil hcl tab cr 180 mg verapamil hcl tab cr 240 mg VERSACLOZ SUS 50MG/ML VESICARE TAB 10MG VESICARE TAB 5MG VICK VAPORUB OIN VICTOZA INJ 18MG/3ML VIDEX SOL 2GM VIDEX SOL 4GM VIGAMOX DRO 0.5% VIIBRYD KIT VIIBRYD KIT STARTER VIIBRYD TAB 10MG VIIBRYD TAB 20MG VIIBRYD TAB 40MG VIMPAT INJ 200MG/ VIMPAT SOL 10MG/ML VIMPAT TAB 100MG VIMPAT TAB 150MG VIMPAT TAB 200MG VIMPAT TAB 50MG vinblastine sulfate inj 1 mg/ml vincasar pfs inj 1mg/ml vincristine sulfate iv soln 1 mg/ml vinorelbine tartrate inj 10 mg/ml (base equiv) vinorelbine tartrate inj 50 mg/5ml (10 mg/ml) (base equiv) viorele tab VIRACEPT TAB 250MG VIRACEPT TAB 625MG VIRAMUNE XR TAB 100MG VIREAD POW 40MG/GM VIREAD TAB 150MG VIREAD TAB 200MG VIREAD TAB 250MG VIREAD TAB 300MG VISINE-LR SOL 0.025% VIT B12/FA TAB VITALETS CHW VITAMIN A TAB 15000UNT vitamin b12 tab 2000mcg VITAMIN C CHW 1000MG VITAMIN C SOL vitamin d cap 1000unit vitamin d chw 1000unit vitamin d chw 400unit VITAMIN D2 TAB 2000UNIT VITAMIN D2 TAB 400UNIT vitamin d3 cap 10000unt VITAMIN D3 CAP 4000UNIT vitamin d3 cap 50000unt VITAMIN D3 LIQ 1200UNIT VITAMIN D3 TAB 3000UNIT VITAMIN D3 TAB 50000UNT vitamin d3 tab 5000unit vitamin e cap 1000 unit vitamin e cap 200 unit vitamin e soln 15 unit/0.3ml (50 unit/ml) VITAMIN E TAB 100UNIT vitamin mixture cap vitamins a & d cap vitatrum chw vite/iron chw children VITEKTA TAB 150MG VITEKTA TAB 85MG VOLTAREN GEL 1% voriconazole for inj 200 mg voriconazole for susp 40 mg/ml voriconazole tab 200 mg voriconazole tab 50 mg VOTRIENT TAB 200MG vyfemla tab W wal-act tab mg wal-dryl all tab sinus wal-dryl-d tab alrg/sin wal-fex d tab 12 hour wal-flu cold pak daytime wal-itin d tab 5-120mg wal-itin syp 5mg/5ml wal-phed pe tab 4-10mg wal-phed tab 4-60mg

174 wal-som cap 50mg warfarin sodium tab 1 mg warfarin sodium tab 10 mg warfarin sodium tab 2 mg warfarin sodium tab 2.5 mg warfarin sodium tab 3 mg warfarin sodium tab 4 mg warfarin sodium tab 5 mg warfarin sodium tab 6 mg warfarin sodium tab 7.5 mg WATER FOR IRRIGATION, STERILE IRRIGATION SOLN wee care sus 15/ WELCHOL PAK 3.75GM WELCHOL TAB 625MG X XALKORI CAP 200MG XALKORI CAP 250MG XARELTO STAR TAB 15/20MG XARELTO TAB 10MG XARELTO TAB 15MG XARELTO TAB 20MG XENAZINE TAB 12.5MG XENAZINE TAB 25MG XGEVA INJ XIFAXAN TAB 550MG XIGDUO XR TAB XIGDUO XR TAB MG XIGDUO XR TAB MG XIGDUO XR TAB 5-500MG XOLAIR SOL 150MG XOPENEX HFA AER XTANDI CAP 40MG XYREM SOL 500MG/ML Y YERVOY INJ 200MG YERVOY INJ 50MG YF-VAX INJ Z zafirlukast tab 10 mg zafirlukast tab 20 mg zarah tab mg ZAVESCA CAP 100MG zazole cre 0.4% ZAZOLE CRE 0.8% ZELBORAF TAB 240MG ZEMAIRA INJ 1000MG zenatane cap 10mg zenatane cap 20mg zenatane cap 30mg zenatane cap 40mg zenchent tab ZENPEP CAP 10000UNT ZENPEP CAP 15000UNT ZENPEP CAP 20000UNT ZENPEP CAP 25000UNT ZENPEP CAP 3000UNIT ZENPEP CAP 40000UNT ZENPEP CAP 5000UNIT ZETIA TAB 10MG ZIAGEN SOL 20MG/ML zidovudine cap 100 mg zidovudine syrup 10 mg/ml zidovudine tab 300 mg zinc oxide oint 20% zinc oxide oint 40% ZINC OXIDE PST 25% ziprasidone hcl cap 20 mg ziprasidone hcl cap 40 mg ziprasidone hcl cap 60 mg ziprasidone hcl cap 80 mg ZIRGAN GEL 0.15% zoledronic acid inj conc for iv infusion 4 mg/5ml zoledronic acid iv soln 5 mg/100ml ZOLINZA CAP 100MG zolmitriptan orally disintegrating tab 2.5 mg zolmitriptan orally disintegrating tab 5 mg zolmitriptan tab 2.5 mg zolmitriptan tab 5 mg zolpidem tartrate tab 10 mg zolpidem tartrate tab 5 mg zonatuss cap 150mg zonisamide cap 100 mg zonisamide cap 25 mg zonisamide cap 50 mg ZONTIVITY TAB 2.08MG ZOO FRIENDS CHW COMPLETE ZORTRESS TAB 0.25MG ZORTRESS TAB 0.5MG ZORTRESS TAB 0.75MG ZOSTAVAX INJ zovia 1/35e tab zovia 1/50e tab

175 ZYDELIG TAB 100MG ZYDELIG TAB 150MG ZYKADIA CAP 150MG ZYLET SUS % ZYPREXA RELP INJ 210MG ZYPREXA RELP INJ 300MG ZYPREXA RELP INJ 405MG ZYTIGA TAB 250MG ZYVOX SUS 100MG/5M... 9 ZYVOX TAB 600MG