List of Covered Drugs

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1 H9115_MEM2005c Accepted MetroPlus FIDA Plan 2017 年承保藥物清單 ( 處方一覽表 ) 這是會員可透過 MetroPlus FIDA Plan 獲得的藥物清單 MetroPlus FIDA Plan (Medicare-Medicaid Plan) 是一項與 Medicare 及紐約州衛生廳 (Medicaid) 訂立合約的管理式醫療保健計劃, 透過完整統籌 Duals Advantage (FIDA) 示範項目為其參與者提供這兩個項目的福利 承保藥物清單及 / 或藥店和醫療提供者網絡在全年內可能發生變化 在我們做出影響到您的修改之前, 我們將向您傳送通知 福利可能在每年的 1 月 1 日發生變化 您總是可線上檢視 MetroPlus FIDA Plan 最新藥物清單, 網址是 或致電 MetroPlus FIDA Plan 會員服務部, 電話是 FIDA (3432) (TTY:711), 工作時間為週一至週六早 8 點至晚 8 點 晚 8 點後 週日及節假日 : 按上述號碼致電醫療代接服務, 每週 7 天, 每天 24 小時 限制和約束可能適用 欲瞭解更多資訊, 請致電 FIDA Plan 會員服務部或閱讀 FIDA Plan 會員手冊 您需要遵循一定的章程才能享受 MetroPlus FIDA Plan 提供的免費服務 任何承保藥物無自付費用 You can get this information for free in other languages. Call FIDA (3432) (TTY: 711), Monday-Saturday 8am-8pm. After 8pm, Sundays & Holidays: 24/7 Medical Answering Service at number listed above. The call is free. Puede obtener esta información en otros idiomas sin ningún costo. Llame al Plan MetroPlus FIDA al FIDA (3432), usuarios de TTY: 711, de lunes a sábado, de 8:00 a. m. a 8:00 p. m.; domingos y días festivos: Servicio de Recepción de Llamadas para Médicos, las 24 horas del día, los 7 días de la semana al número arriba mencionados. La llamada es gratuita. Ou kapab jwenn enfòmasyon sa yo pou gratis nan lòt lang yo. Rele MetroPlus FIDA Plan nan nimewo FIDA (3432), TTY: 711, Lendi - Samdi, 8 am - 8 pm. Apre 8pm, jou dimanch ak Jou Ferye: Sèvis 24/7 Repondè Medikal Otomatik nan nimewo ki endike anwo a. Koutfil la gratis. È possibile ottenere queste informazioni in altre lingue senza alcun costo. Potete contattare i responsabili del programma MetroPlus Fida al numero FIDA (3432), TTY: 711, dalle ore 8 alle 20 dal lunedì al sabato e dopo le 20 la domenica e nei giorni festivi. È possibile telefonare per una consulenza medica ai numeri indicati, 24 ore su 24, 7 giorni su 7. La chiamata è gratuita.? 如果您有任何問題, 請致電以下電話聯絡 MetroPlus FIDA Plan: FIDA (3432)(TTY:711), 工作時間為週一至週六早 8 點至晚 8 點 晚 8 點後 週日及節假日 : 按上述號碼致電醫療代接服務, 每週 7 天, 每天 24 小時 該電話免費 欲瞭解有關更多資訊, 請造訪 I

2 您可免費取得此資訊的其他語言版本 請於週一至週六上午 8 點至晚上 8 點洽 MetroPlus FIDA Plan, 電話是 FIDA (3432),TTY 專線 :711 晚上 8 點後 週日及假日 : 請撥打上方所列的 24 小時醫療諮詢服務專線 此電話號碼為免付費專線 Вы можете получить эту информацию бесплатно на других языках. Звоните в MetroPlus FIDA Plan по номеру FIDA (3432), для пользователей с нарушениями слуха: 711, с понедельника по субботу, с 8:00 до 20:00. После 20:00, по воскресеньям и праздничным дням: круглосуточная медицинская справочная служба, номера указаны выше. Звонок бесплатный. 이정보는다른언어로도무료로제공됩니다. MetroPlus FIDA Plan 에전화번호 FIDA(3432), TTY: 711 로월요일 - 토요일, 오전 8 시부터오후 8 시사이에연락하시기바랍니다. 오후 8 시이후와일요일및공휴일에는상기표시된번호로전화하시면 24 시간의료 ARS 가제공됩니다. 통화는무료입니다. আপন ন ম ল য অ ভ ষ য় এই তথ পপল ত প ল পমল র প ল স FIDA প ল -এ পস ম -শন, সক য 8 ট ত 8 ট মল য FIDA (3432), TTY: 711 ম বল প কর ত 8 ট পল, ন ও ছ ট ন গ নযল ত: উপল ত নযক ভ ক ত ম বল 24/7 পমন ক য আ স ন স নভ স-এ কযট ন ম য آپ دیگر زبانوں میں یہ معلومات مفت حاصل کر سکتے ہیں سوموار سے سنیچر صبح 8 بجے سے شام 8 بجے تک MetroPlusکو FIDA (3432) FIDA پر کال کریں 711 پر ٹی ٹی وائی کریں شام 8 بجے کے بعد اتوار اور چھٹی کے دنوں میں: اوپر مذکور نمبر پر ہفتہ کے ساتوں دن 24/7 گھنٹے طبی جواب دہندگی خدمت کال مفت ہے 您可免費獲得以其他格式 ( 例如大字印刷 盲文或音訊 ) 編寫的此資訊 請致電聯絡我們, 電話 : FIDA(3432)(TTY:711), 工作時間為週一至週六早 8 點至晚 8 點 晚 8 點後 週日及節假日 : 按上述號碼致電醫療代接服務, 每週 7 天, 每天 24 小時 該電話免費 您可免費獲得以其他語言編寫的此類資訊 要獲得以您的偏好語言編寫的計劃文件和資訊, 或變更您的偏好語言, 請聯絡會員服務部 紐約州已設立了一個名為 消費者宣傳獨立網絡 (ICAN) 的會員申訴項目, 針對 MetroPlus FIDA Plan 提供的任何服務為會員提供免費 匿名的協助 您可致電免費電話 或瀏覽 icannys.org 聯絡 ICAN (TTY 使用者致電 711, 然後按照提示致電 )? 如果您有任何問題, 請致電以下電話聯絡 MetroPlus FIDA Plan: FIDA (3432)(TTY: 711), 工作時間為週一至週六早 8 點至晚 8 點 晚 8 點後 週日及節假日 : 按上述號碼致電醫療代接服務, 每週 7 天, 每天 24 小時 該電話免費 欲瞭解有關更多資訊, 請造訪 II

3 常見問題 (FAQ) 如果您對於承保藥物清單有任何疑問, 請在此尋找答案 您可以閱讀所有常見問題 (FAQ) 以瞭解 更多資訊, 或尋找一個問題和答案 1. 承保藥物清單上包含哪些處方藥? ( 我們將承保藥物清單簡稱為藥物清單 ) 從 1 頁開始的承保藥物清單上所列的各藥物為 MetroPlus FIDA Plan 承保藥物 這些藥物均可在我 們網絡藥房內獲得 如果藥房與我們簽訂合作協定並向您提供服務, 則藥房在我們網絡內 我們把 這些藥房稱為 網絡藥房 下列情況中 MetroPlus FlDA Plan 將承保藥物清單上的所有藥物 : 您的醫生或其他開藥醫生表示您需要這些藥物以康復或維持健康, 藥物對治療您的病症具有醫療必要性, 以及 您在 MetroPlus FlDA Plan 網絡藥房內配藥 MetroPlus FlDA Plan 可能在獲得某些藥物上需要採取其他步驟 ( 請檢視以下第 5 個問題 ) 在 一些情況下, 您在獲得藥物之前可能需要做其他事, 例如先嘗試其他藥物 檢視最新承保藥物清單, 您可瀏覽我們的網站 或致電會員服務部, 電話 是 FIDA (3432),(TTY:711), 工作時間為週一至週六早 8 點至晚 8 點 晚 8 點後 週 日及節假日 : 按上述號碼致電醫療代接服務, 每週 7 天, 每天 24 小時 2. 藥物清單是否會變更? 是 一年當中 MetroPlus FIDA Plan 可能會新增或移除藥物清單中的某些藥物 通常, 只有在以下情況下藥物清單會有所變更 : 現在出現了一種新藥物, 其藥效與藥物清單上的藥物效果相同, 或者 我們瞭解到一種藥物並不安全 我們可能也會變更我們的藥物規則 例如, 我們可以 : 決定一種藥物是否需要事先核准 ( 事先核准是指在您可獲得藥物之前, 您需獲得 MetroPlus FIDA Plan 或您的跨學科小組 (IDT) 的許可 ) 新增或變更您可獲得的藥量 ( 稱為 數量限制 )? 如果您有任何問題, 請致電以下電話聯絡 MetroPlus FIDA Plan: FIDA (3432)(TTY: 711), 工作時間為週一至週六早 8 點至晚 8 點 晚 8 點後 週日及節假日 : 按上述號碼致電醫療代接服務, 每週 7 天, 每天 24 小時 該電話免費 欲瞭解有關更多資訊, 請造訪 III

4 增加或變更藥物逐步治療限制 ( 逐步治療指在我們會承保其他藥物之前, 您必須先試用其他藥物 ) ( 有關這些藥物規則的更多資訊, 請參閱第 V 頁 ) 一旦您正在服用的藥物從藥物清單上除名, 我們將告知您 一旦我們變更藥物的承保規則, 我們將告知您 以下第 3 4 以及 7 個問題就藥物清單變更會發生什麼的問題有更多闡述 您可以隨時線上檢視 MetroPlus FIDA Plan 最新藥物清單, 網址為 您還可以致電會員服務部, 瞭解現行版本的藥物清單, 電話是 FIDA (3432)(TTY: 711), 工作時間為週一至週六早 8 點至晚 8 點 晚 8 點後 週日及節假日 : 按上述號碼致電醫療代接服務, 每週 7 天, 每天 24 小時 3. 如果現在出現了一種與藥物清單上藥物效果相同且價格更低的新藥, 會發生什麼? 如果現出現了一種與藥物清單上藥物效果相同的新藥 : 您的藥劑師可能在您下次配藥時向您提供較便宜的藥物 如果您和您的提供者認定便宜的藥 物對您並不適用, 您的提供者可讓藥劑師繼續向您提供您正在服用的藥物 MetroPlus FlDA Plan 可能決定將較貴的藥物從藥物清單上移除 如果我們因為新藥具有相 同藥效而將您在服用的一種藥物從藥物清單上移除, 我們將在藥物從藥物清單上移除前至 少 60 天前或在您要求續配藥時通知您 隨後您可在藥物清單變更前購買 60 天的藥 如果 發生任何變更, 我們將透過郵件向您傳送書面通知 4. 如果我們發現一種藥物並不安全, 會發生什麼? 如果食品和藥品管理局 (FDA) 表示您服用的藥物並不安全, 我們會立即將此藥從藥物清單上移除 我們亦將發函通知您這種不安全的藥物已從藥物清單上移除 您可以致電 MetroPlus FIDA Plan 會員服務部, 詢問有關我們的藥物清單的變更問題 5. 藥物承保是否有約束或限制? 或者為獲得某些藥品是否要求採取一些措施? 是, 一些藥物有承保規則或限制您所能獲得的藥量 一些情況下, 您 您的醫生或其他開藥醫生在 獲得藥物之前必須先做某件事情 例如 :? 如果您有任何問題, 請致電以下電話聯絡 MetroPlus FIDA Plan: FIDA (3432)(TTY: 711), 工作時間為週一至週六早 8 點至晚 8 點 晚 8 點後 週日及節假日 : 按上述號碼致電醫療代接服務, 每週 7 天, 每天 24 小時 該電話免費 欲瞭解有關更多資訊, 請造訪 IV

5 事先核准 ( 或事先核准 ): 對於一些藥品, 您或您的醫生或其他開藥醫生必須在您配藥之前獲得 MetroPlus FIDA Plan 或您的跨學科小組 (IDT) 的核准 若您未獲得核准,MetroPlus FIDA Plan 可能不承保此藥品 數量限制 : 有時,MetroPlus FIDA Plan 限制您能獲得的藥量 階段治療 : 有時 MetroPlus FIDA Plan 要求您採取逐步治療 這意味著在應對您的醫療病症時, 您將必須按一定順序試用藥物 在我們會承保其他藥物之前, 您可能需要先試用其他藥物 如果您的醫生認為第一種藥物對您並不適用, 之後我們將承保第二種藥物 瞭解您的藥物是否有其他額外要求或限制, 您可從 1 頁開始查看各表格 您亦可透過造訪我們的網站瞭解更多資訊, 網址為 : 我們在網上發佈文件, 解釋我們的事先核准和逐步治療限制 您也可以要求我們向您傳送一份副本 您可對這些限制要求進行 例外處理 瞭解例外處理的更多資訊, 請檢視第 11 個問題 如果您在護理設施或其他長期護理設施內, 並且需要藥物清單外的一種藥物, 或者如果您獲得所需藥物並不方便, 我們可提供協助 我們將承保一次 31 天急救藥物用量 ( 除非您處方箋上註明的天數較少 ), 不論您是否為 MetroPlus FIDA Plan 新會員 這將給您與您的醫生或其他開藥醫生商討留出時間 他或她可協助您決定是否採用藥物清單上的相似藥或是否需要要求例外處理 瞭解例外處理的更多資訊, 請檢視第 11 個問題 6. 您將如何得知您想要的藥物是否有限制或獲得藥物是否需要採取行動? 第 1 頁的承保藥物清單有一張柱狀圖, 標題是 必要行動 約束或使用限制 7. 如果我們變更了藥物承保方式的規則, 會發生什麼? 例如, 如果我們增加了一種藥物的事先核准 ( 核准 ) 數量限制 以及 / 或者逐步治療 我將向您告知如果我們增加藥物的事先核准 數量限制, 以及 / 或者逐步治療限制 我們將在增加限 制或在您要求下次續配藥之前至少提前 60 天通知您 隨後您可在藥物清單變更前購買 60 天的藥 這將給您與您的醫生或其他開藥醫生商討下一步操作的時間 8. 您如何在藥品清單上尋找一種藥物? 尋找藥物有兩個方法 : 您可按字母尋找 ( 如果您知道藥物名稱如何拼字 ), 或者 您可按醫療病症查詢? 如果您有任何問題, 請致電以下電話聯絡 MetroPlus FIDA Plan: FIDA (3432)(TTY: 711), 工作時間為週一至週六早 8 點至晚 8 點 晚 8 點後 週日及節假日 : 按上述號碼致電醫療代接服務, 每週 7 天, 每天 24 小時 該電話免費 欲瞭解有關更多資訊, 請造訪 V

6 按字母查詢, 請翻至第 129 頁檢視字母排序清單部分, 然後在清單上尋找您所需藥物的名稱 按醫療病症查詢, 請翻至第 1 頁查看 按醫療病症排列藥物清單 這一小節中的藥品根據它們用於治療的醫療狀況類型劃分為不同種類 例如, 如果您心臟有問題, 您應該尋找治療心臟和循環症狀的心血管藥物 您可在那裏找到應對心臟問題的藥物 9. 如果您想服用的藥品未在藥物清單上, 該怎麼辦? 如果您在藥物清單上並未看到您的藥物, 請聯絡會員服務部, 電話為 FIDA (3432) (TTY:711), 工作時間為週一至週六早 8 點至晚 8 點 晚 8 點後 週日及節假日 : 按上述號碼致電醫療代接服務, 每週 7 天, 每天 24 小時, 提出您的問題 如果您瞭解到 MetroPlus FIDA Plan 將不會對該藥物進行承保, 您可採取以下一項操作 : 向會員服務部索取一份您想要服用的藥物清單 然後將清單給您的醫生或其他開藥醫生看 他或她可向您開立類似您想要服用且在藥物清單上的藥物 或 您可要求計劃或您的跨學科小組 (IDT) 作例外處理, 承保您的藥物 瞭解例外處理的更多資訊, 請檢視第 11 個問題 10. 如果您新加入 MetroPlus FIDA Plan, 並且在藥物清單上找不到或很難找到您的藥物, 該怎麼辦? 我們竭誠相助 我們必須按需要承保在您成為 MetroPlus FIDA Plan 會員最初 90 天的藥物暫時用 量 這將給您與您的醫生或其他開藥醫生商討留出時間 他或她可協助您決定是否採用藥物清單上 的相似藥或是否需要要求例外處理 我們將向您承保最多 90 天的暫時藥物用量, 如果 : 您在服用的藥物並不在我們的藥物清單上, 或者 健康計劃規則並不能讓您獲得您的開藥醫生開立的藥量, 或者 藥物需要 MetroPlus FIDA Plan 或您的跨學科小組 (IDT) 事先核准, 或者 您所服用的藥物為逐步治療限制的一部分 如果您在護理設施或其他長期護理設施內, 您可獲得的再次配藥藥量為 至多 91 天 在您的計劃的最初 90 天期間, 您可以多次續配藥 這給予您的開藥醫生留出時間將您 的藥物改為藥物清單上的藥物或者要求例外處理 11. 您是否能夠要求例外處理以承保您的藥物?? 如果您有任何問題, 請致電以下電話聯絡 MetroPlus FIDA Plan: FIDA (3432)(TTY: 711), 工作時間為週一至週六早 8 點至晚 8 點 晚 8 點後 週日及節假日 : 按上述號碼致電醫療代接服務, 每週 7 天, 每天 24 小時 該電話免費 欲瞭解有關更多資訊, 請造訪 VI

7 是 您可要求 MetroPlus FIDA Plan 或您的跨學科小組 (IDT) 作例外處理, 承保未在藥物清單上的藥物 您亦可要求 MetroPlus FIDA Plan 或您的跨學科小組 (IDT) 變更藥物規則 例如,MetroPlus FIDA Plan 可能限制了我們將承保藥物的劑量 如果您的藥物有限制, 您可要求我們或您的 IDT 變更限制或承保更多劑量 其他範例 : 您可要求我們或您的跨學科小組 (IDT) 擯棄逐步治療限制或事先核准要求 12. 獲得例外處理需要多少時間? 首先,MetroPlus FIDA Plan 或您的跨學科小組 (IDT) 必須收到來自您的開藥醫生支援您例外處理要求的聲明 您將在我們收到聲明後 72 小時內獲得我們對於您的例外處理要求的決定 如果您或您的開藥醫生認為如果 72 小時的必須等待可能有損您的健康, 您可要求加快例外處理 這就是快速決定 如果您的開藥醫生支援您的要求, 您將在我們收到您的開藥醫生的支援性聲明後 24 小時內獲得決定 13. 您如何要求進行例外處理? 要求例外處理, 您可致電您的保健管理員 您的保健管理員將協助您和您的提供者協助您要求例外 處理 14. 什麼是普通藥物? 普通藥物成分與品牌藥物相同 它們通常比品牌藥價格更低且藥名並不被熟知 普通藥獲食品與藥品管理局 (FDA) 核准 MetroPlus FIDA Plan 承保品牌藥品和普通藥品 15. 什麼是非處方 (OTC) 藥物? OTC 表示 非處方藥 當非處方藥是由您的提供者開立時,MetroPlus FIDA Plan 將承保這些非處方藥 您可閱讀 MetroPlus FIDA Plan 藥物清單瞭解哪些非處方藥在承保之列? 如果您有任何問題, 請致電以下電話聯絡 MetroPlus FIDA Plan: FIDA (3432)(TTY: 711), 工作時間為週一至週六早 8 點至晚 8 點 晚 8 點後 週日及節假日 : 按上述號碼致電醫療代接服務, 每週 7 天, 每天 24 小時 該電話免費 欲瞭解有關更多資訊, 請造訪 VII

8 16. MetroPlus FIDA Plan 是否承保 OTC 非藥產品? 當 OTC 非藥產品是由您的提供者作為處方開立時,MetroPlus FIDA Plan 將為它們提供承保 非藥 OTC 產品包括諸如酒精棉簽和紗布墊等物品 您可閱讀 MetroPlus FIDA Plan 藥物清單瞭解哪些 OTC 非藥產品在承保之列 17. 什麼是您的自付費用? 藥物清單上的藥物您無需支付自付費用 18. 什麼是藥物層級? 在我們的藥品清單上, 層級就是藥物組 第 1 層級為普通藥品 第 2 層級為品牌藥品 第 3 層級藥物為非處方藥和非 Medicare 承保的處方藥? 如果您有任何問題, 請致電以下電話聯絡 MetroPlus FIDA Plan: FIDA (3432)(TTY: 711), 工作時間為週一至週六早 8 點至晚 8 點 晚 8 點後 週日及節假日 : 按上述號碼致電醫療代接服務, 每週 7 天, 每天 24 小時 該電話免費 欲瞭解有關更多資訊, 請造訪 VIII

9 承保藥物清單 從下頁開始的承保藥物清單向您說明 MetroPlus FIDA Plan 承保的藥物資訊 如果您在藥物清單上找藥物有困難, 請翻至位於第 129 頁上的索引部分 圖表第一列是藥物名稱 品牌藥品名稱大寫 ( 如 :COLCRYS), 普通藥品為斜體小寫 ( 如 : penicillin) 必要行動 約束或使用限制柱狀圖向您說明您藥物的 MetroPlus FIDA Plan 承保規則 注意 : 藥品旁的 * 符號表示此藥並非 D 部分藥品 這些藥品有不同的上訴規則 上訴即要求我們審核並且在您認為存在錯誤的情況下變更承保決定的正式方式 例如,MetroPlus FIDA Plan 或您的跨學科小組 (IDT) 可能決定您想要的藥物並未或不再受到 Medicare 或 Medicaid 承保 如果您或您的醫生或其他開藥醫生對該決定有異議, 您可提起上訴 如需取得上訴說明, 請致電以下號碼聯絡會員服務部 : FIDA (3432),TTY:711), 工作時間為週一至週六早 8 點至晚 8 點 晚 8 點後 週日及節假日 : 按上述號碼致電醫療代接服務, 每週 7 天, 每天 24 小時, 或致電獨立消費者宣傳網路 (ICAN), 電話 : (TTY 使用者致電 711, 然後按照提示致電 ) 您亦可閱讀會員手冊, 瞭解如何對決定提起上訴? 如果您有任何問題, 請致電以下電話聯絡 MetroPlus FIDA Plan: FIDA (3432)(TTY: 711), 工作時間為週一至週六早 8 點至晚 8 點 晚 8 點後 週日及節假日 : 按上述號碼致電醫療代接服務, 每週 7 天, 每天 24 小時 該電話免費 欲瞭解有關更多資訊, 請造訪 IX

10 NY_CY17_2T_MMP 生效日期 2017 年 1 月 1 日 藥物名稱 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 片 /30 天 ) 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 tab 500mg 3 $0 NM;* acetaminophen liquid 160 mg/5ml 3 $0 NM;* acetaminophen soln 160 mg/5ml 3 $0 NM;* acetaminophen suppos 120 mg 3 $0 NM;* acetaminophen suppos 650 mg 3 $0 NM;* acetaminophen tab 325 mg 3 $0 NM;* acetaminophen tab cr 650 mg 3 $0 NM;* acetaminophn sus 160/5ml 3 $0 NM;* arthrts pain tab 650mg 3 $0 NM;* aspir-81 tab 81mg ec 3 $0 NM;* aspir-low tab 81mg ec 3 $0 NM;* aspirin chew tab 81 mg 3 $0 NM;* aspirin low chw 81mg 3 $0 NM;* aspirin low tab 81mg ec 3 $0 NM;* aspirin suppos 300 mg 3 $0 NM;* aspirin suppos 600 mg 3 $0 NM;* aspirin tab 325 mg 3 $0 NM;* aspirin tab 325mg ec 3 $0 NM;* aspirin tab delayed release 81 mg 3 $0 NM;* aspirin tab delayed release 325 mg 3 $0 NM;* child asa chw 81mg 3 $0 NM;* child asa ls chw 81mg 3 $0 NM;* chld pain rl tab 80mg 3 $0 NM;* chld silapap liq 160/5ml 3 $0 NM;* 1

11 ecpirin tab 325mg ec 3 $0 NM;* FEVERALL INF SUP 80MG 3 $0 NM;* FEVERALL SUP 120MG 3 $0 NM;* FEVERALL SUP 325MG 3 $0 NM;* FEVERALL SUP 650MG 3 $0 NM;* gnp aspirin chw 81mg 3 $0 NM;* gnp aspirin tab 325mg ec 3 $0 NM;* hm aspirin chw 81mg 3 $0 NM;* hm aspirin tab 325mg 3 $0 NM;* 8 hour pain tab 650mg 3 $0 NM;* mapap cap 500mg 3 $0 NM;* mapap child tab 80mg rt 3 $0 NM;* mapap chw 80mg 3 $0 NM;* mapap liq 160/5ml 3 $0 NM;* mapap tab 325mg 3 $0 NM;* mapap tab 500mg 3 $0 NM;* mapap tab 500mg/rr 3 $0 NM;* non-aspirin tab 325mg 3 $0 NM;* non-aspirin tab 500mg 3 $0 NM;* non-aspirin tab 500mg/rr 3 $0 NM;* pain & fever chw 80mg 3 $0 NM;* pain & fever sol 160/5ml 3 $0 NM;* pain & fever sus 160/5ml 3 $0 NM;* pain & fever tab 325mg 3 $0 NM;* pain & fever tab 500mg 3 $0 NM;* pain relief dro 80/0.8ml 3 $0 NM;* pain relief sus 160/5ml 3 $0 NM;* pain relief tab 325mg 3 $0 NM;* pain relief tab 500mg 3 $0 NM;* pain relieve tab 325mg 3 $0 NM;* pain relieve tab 500mg 3 $0 NM;* pain relieve tab 500mg/rr 3 $0 NM;* pharbetol tab 325mg 3 $0 NM;* pharbetol tab 500mg 3 $0 NM;* q-pap child sus 160/5ml 3 $0 NM;* q-pap infant dro 80/0.8ml 3 $0 NM;* q-pap liq 160/5ml 3 $0 NM;* q-pap tab 325mg 3 $0 NM;* q-pap tab 500mg 3 $0 NM;* qc aspirin tab 325mg 3 $0 NM;* 2

12 sb aspirin tab 325mg 3 $0 NM;* sm aspirin chw 81mg 3 $0 NM;* sm aspirin tab 325mg 3 $0 NM;* sm child asa chw 81mg 3 $0 NM;* sm pain rel cap 500mg 3 $0 NM;* tactinal tab 325mg 3 $0 NM;* tactinal tab 500mg 3 $0 NM;* tri-buff asa tab 325mg 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(240 粒 /30 天 ) celecoxib cap 100 mg 1 $0 QL(120 粒 /30 天 ) celecoxib cap 200 mg 1 $0 QL(60 粒 /30 天 ) celecoxib cap 400 mg 1 $0 QL(30 粒 /30 天 ) diclofenac potassium tab 50 mg 1 $0 QL(120 片 /30 天 ) 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 hm ibuprofen tab 200mg 3 $0 NM;* ibu-200 tab 200mg 3 $0 NM;* ibuprofen cap 200mg 3 $0 NM;* ibuprofen sus 100/5ml 3 $0 NM;* ibuprofen susp 100 mg/5ml 1 $0 ibuprofen susp 100 mg/5ml 3 $0 NM;* ibuprofen tab 200 mg 3 $0 NM;* ibuprofen tab 200mg 3 $0 NM;* ibuprofen tab 400 mg 1 $0 ibuprofen tab 600 mg 1 $0 3

13 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 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 provil tab 200mg 3 $0 NM;* qc ibuprofen tab 200mg 3 $0 NM;* sb ibuprofen tab 200mg 3 $0 NM;* sm ibuprofen tab 200mg 3 $0 NM;* 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 毫升 /30 天 ) mg/5ml acetaminophen w/ codeine tab 1 $0 QL(400 片 /30 天 ) mg acetaminophen w/ codeine tab 1 $0 QL(400 片 /30 天 ) mg acetaminophen w/ codeine tab 1 $0 QL(400 片 /30 天 ) mg butorphanol tartrate inj 1 mg/ml 1 $0 butorphanol tartrate inj 2 mg/ml 1 $0 BUTRANS DIS 5MCG/HR 2 $0 QL(16 貼片 /28 天 ) BUTRANS DIS 7.5/HR 2 $0 QL(8 貼片 /28 天 ) BUTRANS DIS 10MCG/HR 2 $0 QL(8 貼片 /28 天 ) BUTRANS DIS 15MCG/HR 2 $0 QL(4 貼片 /28 天 ) BUTRANS DIS 20MCG/HR 2 $0 QL(4 貼片 /28 天 ) nalbuphine hcl inj 10 mg/ml 1 $0 nalbuphine hcl inj 20 mg/ml 1 $0 4

14 tramadol hcl tab 50 mg 1 $0 QL(240 片 /30 天 ) tramadol-acetaminophen tab mg 1 $0 QL(240 片 /30 天 ) 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 片 /30 天 ) endocet tab $0 QL(360 片 /30 天 ) endocet tab mg 1 $0 QL(360 片 /30 天 ) fentanyl citrate lozenge on a handle 2 $0 QL(120 糖塊 /30 天 ),PA 200 mcg fentanyl citrate lozenge on a handle 2 $0 QL(120 糖塊 /30 天 ),PA 400 mcg fentanyl citrate lozenge on a handle 2 $0 QL(120 糖塊 /30 天 ),PA 600 mcg fentanyl citrate lozenge on a handle 2 $0 QL(120 糖塊 /30 天 ),PA 800 mcg fentanyl citrate lozenge on a handle 2 $0 QL(120 糖塊 /30 天 ),PA 1200 mcg fentanyl citrate lozenge on a handle 2 $0 QL(120 糖塊 /30 天 ),PA 1600 mcg fentanyl td patch 72hr 12 mcg/hr 1 $0 QL(10 貼片 /30 天 ) fentanyl td patch 72hr 25 mcg/hr 1 $0 QL(10 貼片 /30 天 ) fentanyl td patch 72hr 50 mcg/hr 1 $0 QL(10 貼片 /30 天 ),PA fentanyl td patch 72hr 75 mcg/hr 1 $0 QL(10 貼片 /30 天 ),PA fentanyl td patch 72hr 100 mcg/hr 1 $0 QL(10 貼片 /30 天 ),PA FENTORA TAB 100MCG 2 $0 QL(120 片 /30 天 ),PA FENTORA TAB 200MCG 2 $0 QL(120 片 /30 天 ),PA FENTORA TAB 400MCG 2 $0 QL(120 片 /30 天 ),PA FENTORA TAB 600MCG 2 $0 QL(120 片 /30 天 ),PA FENTORA TAB 800MCG 2 $0 QL(120 片 /30 天 ),PA hydrocodone-acetaminophen soln 1 $0 QL(5400 毫升 /30 天 ) mg/15ml hydrocodone-acetaminophen tab 1 $0 QL(360 片 /30 天 ) mg hydrocodone-acetaminophen tab 1 $0 QL(360 片 /30 天 ) mg hydrocodone-acetaminophen tab mg 1 $0 QL(360 片 /30 天 ) hydrocodone-ibuprofen tab $0 QL(150 片 /30 天 ) mg hydromorphone hcl liqd 1 mg/ml 1 $0 hydromorphone hcl preservative free (pf) inj 10 mg/ml 1 $0 B/D 5

15 hydromorphone hcl tab 2 mg 1 $0 QL(270 片 /30 天 ) hydromorphone hcl tab 4 mg 1 $0 QL(270 片 /30 天 ) hydromorphone hcl tab 8 mg 1 $0 QL(270 片 /30 天 ) methadone con 10mg/ml 1 $0 QL(120 毫升 /30 天 ) methadone hcl soln 5 mg/5ml 1 $0 QL(600 毫升 /30 天 ) methadone hcl soln 10 mg/5ml 1 $0 QL(600 毫升 /30 天 ) methadone hcl tab 5 mg 1 $0 QL(240 片 /30 天 ) methadone hcl tab 10 mg 1 $0 QL(240 片 /30 天 ) 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 SUL INJ 150/30ML 1 $0 B/D 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/ml1 $0 B/D morphine sulfate iv soln pf 8 mg/ml1 $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 片 /30 天 ) MORPHINE SULFATE TAB 30 MG 1 $0 QL(180 片 /30 天 ) morphine sulfate tab cr 15 mg 1 $0 QL(90 片 /30 天 ) morphine sulfate tab cr 30 mg 1 $0 QL(90 片 /30 天 ) morphine sulfate tab cr 60 mg 1 $0 QL(90 片 /30 天 ) morphine sulfate tab cr 100 mg 1 $0 QL(90 片 /30 天 ) morphine sulfate tab cr 200 mg 1 $0 QL(60 片 /30 天 ) oxycodone hcl cap 5 mg 1 $0 QL(180 粒 /30 天 ) 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 片 /30 天 ) oxycodone hcl tab 10 mg 1 $0 QL(180 片 /30 天 ) oxycodone hcl tab 15 mg 1 $0 QL(180 片 /30 天 ) 6

16 oxycodone hcl tab 20 mg 1 $0 QL(180 片 /30 天 ) oxycodone hcl tab 30 mg 1 $0 QL(180 片 /30 天 ) oxycodone w/ acetaminophen soln 1 $0 QL(1800 毫升 /30 天 ) mg/5ml oxycodone w/ acetaminophen tab 1 $0 QL(360 片 /30 天 ) mg oxycodone w/ acetaminophen tab 1 $0 QL(360 片 /30 天 ) mg oxycodone w/ acetaminophen tab 1 $0 QL(360 片 /30 天 ) mg oxycodone w/ acetaminophen tab 1 $0 QL(360 片 /30 天 ) mg OXYCONTIN TAB 10MG CR 2 $0 QL(120 片 /30 天 ) OXYCONTIN TAB 15MG CR 2 $0 QL(120 片 /30 天 ) OXYCONTIN TAB 20MG CR 2 $0 QL(120 片 /30 天 ) OXYCONTIN TAB 30MG CR 2 $0 QL(120 片 /30 天 ) OXYCONTIN TAB 40MG CR 2 $0 QL(120 片 /30 天 ) OXYCONTIN TAB 60MG CR 2 $0 QL(120 片 /30 天 ) OXYCONTIN TAB 80MG CR 2 $0 QL(120 片 /30 天 ) roxicet sol 5-325/5 1 $0 QL(1800 毫升 /30 天 ) 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 gentamicin in saline inj 1.6 mg/ml 1 $0 gentamicin in saline inj 2 mg/ml 1 $0 7

17 gentamicin sulfate inj 10 mg/ml 1 $0 gentamicin sulfate inj 40 mg/ml 1 $0 gentamicin sulfate iv soln 10 mg/ml1 $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 tobramycin nebu soln 300 mg/5ml 2 $0 NM,PA tobramycin sulfate for inj 1.2 gm 2 $0 tobramycin sulfate inj 1.2 gm/30ml 1 $0 (40 mg/ml) (base equiv) tobramycin sulfate inj 2 gm/50ml 1 $0 (40 mg/ml) (base equiv) tobramycin sulfate inj 10 mg/ml 1 $0 (base equivalent) tobramycin sulfate inj 80 mg/2ml 1 $0 (40 mg/ml) (base equiv) 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 1 $0 gm/60ml clindamycin phosphate inj 300 mg/2ml 1 $0 8

18 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/6ml colistimethate sodium for inj $0 mg CUBICIN SOL 500MG 2 $0 dapsone tab 25 mg 1 $0 dapsone tab 100 mg 1 $0 emverm chw 100mg 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 IN SODIUM CHLORIDE 2 $0 IV SOLN 600 MG/300ML-0.9% linezolid iv soln 600 mg/300ml (2 2 $0 mg/ml) 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 nitrofurantoin monohydrate macrocrystalline cap 100 mg 2 $0 PA;PA 適用於在一個行事曆年中獲得 90 天供應以後的 65 歲或以上人群 2 $0 PA;PA 適用於在一個行事曆 年中獲得 90 天供應以後的 65 歲或以上人群 2 $0 PA;PA 適用於在一個行事曆 年中獲得 90 天供應以後的 65 歲或以上人群 9

19 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 1 GM 2 $0 VANCOMYCIN INJ 500MG 2 $0 vancomycin inj 750mg 1 $0 VANCOMYCIN INJ 750MG 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 $0 mg/200ml fluconazole tab 50 mg 1 $0 fluconazole tab 100 mg 1 $0 fluconazole tab 150 mg 1 $0 10

20 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 片 /365 天 ) 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 CRIXIVAN CAP 200MG 2 $0 CRIXIVAN CAP 400MG 2 $0 didanosine delayed release capsule 1 $0 125 mg 11

21 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 RETROVIR INJ 10MG/ML 2 $0 REYATAZ CAP 150MG 2 $0 REYATAZ CAP 200MG 2 $0 REYATAZ CAP 300MG 2 $0 12

22 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 10MG 2 $0 TIVICAY TAB 25MG 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 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 DESCOVY TAB 200/25 2 $0 EPZICOM TAB $0 EVOTAZ TAB $0 GENVOYA TAB 2 $0 KALETRA SOL 2 $0 KALETRA TAB MG 2 $0 13

23 KALETRA TAB MG 2 $0 lamivudine-zidovudine tab $0 mg ODEFSEY TAB 2 $0 PREZCOBIX TAB $0 STRIBILD TAB 2 $0 TRIUMEQ TAB 2 $0 TRUVADA TAB $0 QL(60 片 /30 天 ) TRUVADA TAB $0 QL(30 片 /30 天 ) TRUVADA TAB $0 QL(30 片 /30 天 ) TRUVADA TAB $0 QL(30 片 /30 天 ) 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 14

24 DAKLINZA TAB 90MG 2 $0 NM,PA entecavir tab 0.5 mg 2 $0 entecavir tab 1 mg 2 $0 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 lamivudine tab 100 mg (hbv) 1 $0 PEGASYS INJ 2 $0 NM,PA PEGASYS INJ 180MCG/M 2 $0 NM,PA PEGASYS INJ PROCLICK 2 $0 NM,PA REBETOL SOL 40MG/ML 2 $0 NM RELENZA MIS DISKHALE 2 $0 ribasphere cap 200mg 1 $0 NM ribasphere tab 200mg 1 $0 NM ribasphere tab 400mg 2 $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 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 15

25 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 mg/5ml 1 $0 cefpodoxime proxetil for susp $0 mg/5ml cefpodoxime proxetil tab 100 mg 1 $0 cefpodoxime proxetil tab 200 mg 1 $0 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 16

26 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 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 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 17

27 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) 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 moxifloxacin hcl tab 400 mg (base 1 $0 equiv) 青黴素 - 治療感染的藥物 18

28 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 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 inj 10-5 gm 1 $0 ampicillin & sulbactam sodium for iv 1 $0 soln gm ampicillin & sulbactam sodium for iv 1 $0 soln 10-5 gm 19

29 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 1 $0 nafcillin sodium for inj 10 gm 1 $0 nafcillin sodium for iv soln 1 gm 1 $0 nafcillin sodium for iv soln 2 gm 1 $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 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 unit 1 $0 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 sod-tazobactam na for 1 $0 inj gm ( gm) 20

30 piperacillin sod-tazobactam sod for 1 $0 inj 2.25 gm ( gm) piperacillin sod-tazobactam sod for 1 $0 inj 4.5 gm (4-0.5 gm) piperacillin sod-tazobactam sod for 1 $0 inj 40.5 gm ( 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 minocycline hcl cap 100 mg 1 $0 抗腫瘤藥 - 治療癌症的藥物烷基化藥 BENDEKA INJ 100/4ML 2 $0 B/D,NM 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 2 $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 21

31 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 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 100MG 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 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 2 $0 B/D mitomycin for iv soln 20 mg 2 $0 B/D mitomycin for iv soln 40 mg 2 $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 22

32 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 iv soln 10 mg/10ml (1 2 $0 B/D mg/ml) cytarabine inj 20 mg/ml 1 $0 B/D fludarabine phosphate for inj 50 mg1 $0 B/D fludarabine phosphate inj 25 mg/ml1 $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 HCL INJ 1 2 $0 B/D GM/26.3ML (38 MG/ML) (BASE EQUIV) GEMCITABINE HCL INJ 2 2 $0 B/D GM/52.6ML (38 MG/ML) (BASE EQUIV) GEMCITABINE HCL INJ $0 B/D MG/5.26ML (38 MG/ML) (BASE EQUIV) mercaptopurine tab 50 mg 1 $0 methotrexate sodium for inj 1 gm 1 $0 B/D METHOTREXATE SODIUM INJ 50 1 $0 B/D MG/2ML (25 MG/ML) methotrexate sodium inj $0 B/D mg/10ml (25 mg/ml) methotrexate sodium inj pf 50 1 $0 B/D mg/2ml (25 mg/ml) methotrexate sodium inj pf $0 B/D mg/4ml (25 mg/ml) methotrexate sodium inj pf $0 B/D mg/8ml (25 mg/ml) methotrexate sodium inj pf $0 B/D mg/10ml (25 mg/ml) methotrexate sodium inj pf $0 B/D mg/40ml (25 mg/ml) NIPENT INJ 10MG 2 $0 B/D 23

33 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 DOCEFREZ INJ 20MG 2 $0 B/D DOCETAXEL FOR INJ CONC 20 2 $0 B/D MG/ML DOCETAXEL INJ 20MG/2ML 2 $0 B/D DOCETAXEL INJ 80MG/4ML 2 $0 B/D DOCETAXEL INJ 80MG/8ML 2 $0 B/D docetaxel inj 140/7ml 2 $0 B/D DOCETAXEL INJ 160/8ML 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 NM,LA,PA AVASTIN INJ 400/16ML 2 $0 NM,LA,PA 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 HERCEPTIN INJ 440MG 2 $0 NM,PA IBRANCE CAP 75MG 2 $0 NM,LA,PA IBRANCE CAP 100MG 2 $0 NM,LA,PA IBRANCE CAP 125MG 2 $0 NM,LA,PA 24

34 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 TECENTRIQ INJ 1200/20 2 $0 NM,LA,PA VELCADE INJ 3.5MG 2 $0 NM,PA VENCLEXTA TAB 10MG 2 $0 NM,LA,PA VENCLEXTA TAB 50MG 2 $0 NM,LA,PA VENCLEXTA TAB 100MG 2 $0 NM,LA,PA VENCLEXTA TAB START PK 2 $0 NM,LA,PA 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 hydroxyprogesterone caproate im 2 $0 B/D in oil 1.25 gm/5ml letrozole tab 2.5 mg 1 $0 leuprolide acetate inj kit 5 mg/ml 1 $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 megestrol acetate susp 40 mg/ml 2 $0 PA;65 歲及以上者適用 PA MEGESTROL ACETATE SUSP $0 PA MG/5ML megestrol acetate tab 20 mg 2 $0 PA;65 歲及以上者適用 PA megestrol acetate tab 40 mg 2 $0 PA;65 歲及以上者適用 PA 25

35 NILANDRON TAB 150MG 2 $0 nilutamide tab 150 mg 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 CABOMETYX TAB 20MG 2 $0 NM,LA,PA CABOMETYX TAB 40MG 2 $0 NM,LA,PA CABOMETYX TAB 60MG 2 $0 NM,LA,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 ICLUSIG TAB 15MG 2 $0 NM,LA,PA ICLUSIG TAB 45MG 2 $0 NM,LA,PA imatinib mesylate tab 100 mg (base 2 $0 QL(90 片 /30 天 ),NM, equivalent) PA imatinib mesylate tab 400 mg (base 2 $0 QL(60 片 /30 天 ),NM, equivalent) PA IMBRUVICA CAP 140MG 2 $0 NM,LA,PA 26

36 INLYTA TAB 1MG 2 $0 NM,LA,PA INLYTA TAB 5MG 2 $0 NM,LA,PA IRESSA TAB 250MG 2 $0 NM,LA,PA 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 8 MG 2 $0 NM,LA,PA LENVIMA CAP 10 MG 2 $0 NM,LA,PA LENVIMA CAP 14 MG 2 $0 NM,LA,PA LENVIMA CAP 18 MG 2 $0 NM,LA,PA LENVIMA CAP 20 MG 2 $0 NM,LA,PA LENVIMA CAP 24 MG 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 27

37 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 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 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 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 1 $0 B/D oxaliplatin for iv inj 100 mg 1 $0 B/D oxaliplatin iv soln 50 mg/10ml 1 $0 B/D oxaliplatin iv soln 100 mg/20ml 1 $0 B/D 保護劑 28

38 amifostine crystalline for inj 500 mg2 $0 B/D dexrazoxane for inj 250 mg 2 $0 B/D dexrazoxane for inj 500 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 for inj 500 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 levoleucovor sol 250mg/25 2 $0 B/D,NM levoleucovorin calcium inj $0 B/D,NM mg/17.5ml (base equiv) mesna inj 100 mg/ml 1 $0 B/D MESNEX TAB 400MG 2 $0 拓撲異構酶抑制劑 etoposide inj 100 mg/5ml (20 1 $0 B/D mg/ml) 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 toposar inj 100/5ml 1 $0 B/D topotecan hcl for inj 4 mg 2 $0 B/D TOPOTECAN INJ 4MG/4ML 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 cap mg amlodipine besylate-benazepril hcl 1 $0 cap 5-10 mg amlodipine besylate-benazepril hcl 1 $0 cap 5-20 mg 29

39 amlodipine besylate-benazepril hcl 1 $0 cap 5-40 mg amlodipine besylate-benazepril hcl 1 $0 cap mg amlodipine besylate-benazepril hcl 1 $0 cap mg benazepril & hydrochlorothiazide 1 $0 tab mg benazepril & hydrochlorothiazide 1 $0 tab mg benazepril & hydrochlorothiazide 1 $0 tab mg benazepril & hydrochlorothiazide tab mg 1 $0 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 & hydrochlorothiazide tab mg 1 $0 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 mg 1 $0 30

40 quinapril-hydrochlorothiazide tab mg 1 $0 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 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 31

41 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 doxazosin mesylate tab 1 mg 1 $0 QL(30 片 /30 天 ) doxazosin mesylate tab 2 mg 1 $0 QL(30 片 /30 天 ) doxazosin mesylate tab 4 mg 1 $0 QL(30 片 /30 天 ) 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 $ mg amlodipine besylate-valsartan tab 1 $ mg amlodipine besylate-valsartan tab 1 $ mg amlodipine besylate-valsartan tab 1 $ mg amlodipine-valsartan-hydrochlorot 1 $0 hiazide tab mg amlodipine-valsartan-hydrochlorot 1 $0 hiazide tab mg amlodipine-valsartan-hydrochlorot 1 $0 hiazide tab mg amlodipine-valsartan-hydrochlorot 1 $0 hiazide tab mg amlodipine-valsartan-hydrochlorot 1 $0 hiazide tab mg candesartan 1 $0 cilexetil-hydrochlorothiazide tab mg candesartan cilexetil-hydrochlorothiazide tab mg 1 $0 32

42 candesartan cilexetil-hydrochlorothiazide tab mg 1 $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 losartan potassium & 1 $0 hydrochlorothiazide tab mg losartan potassium & 1 $0 hydrochlorothiazide tab mg losartan potassium & 1 $0 hydrochlorothiazide tab mg telmisartan-hydrochlorothiazide tab 1 $ mg telmisartan-hydrochlorothiazide tab 1 $ mg telmisartan-hydrochlorothiazide tab 1 $ mg 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 candesartan cilexetil tab 4 mg 1 $0 candesartan cilexetil tab 8 mg 1 $0 candesartan cilexetil tab 16 mg 1 $0 candesartan cilexetil tab 32 mg 1 $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 33

43 telmisartan tab 20 mg 1 $0 telmisartan tab 40 mg 1 $0 telmisartan tab 80 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 amiodarone hcl tab 200 mg 1 $0 amiodarone hcl tab 400 mg 1 $0 disopyramide phosphate cap $0 PA;65 歲及以上者適用 PA mg disopyramide phosphate cap 150 mg 2 $0 PA;65 歲及以上者適用 PA DOFETILIDE CAP 125 MCG ( $0 NM MG) DOFETILIDE CAP 250 MCG (0.25 MG) 1 $0 NM DOFETILIDE CAP 500 MCG (0.5 MG)1 $0 NM 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;65 歲及以上者適用 PA NORPACE CAP 150MG CR 2 $0 PA;65 歲及以上者適用 PA 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 34

44 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 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 (base equivalent) atorvastatin calcium tab 20 mg 1 $0 (base equivalent) atorvastatin calcium tab 40 mg 1 $0 (base equivalent) atorvastatin calcium tab 80 mg 1 $0 (base equivalent) lovastatin tab 10 mg 1 $0 lovastatin tab 20 mg 1 $0 lovastatin tab 40 mg 1 $0 pravastatin sodium tab 10 mg 1 $0 pravastatin sodium tab 20 mg 1 $0 pravastatin sodium tab 40 mg 1 $0 pravastatin sodium tab 80 mg 1 $0 rosuvastatin calcium tab 5 mg 1 $0 QL(30 片 /30 天 ) rosuvastatin calcium tab 10 mg 1 $0 QL(30 片 /30 天 ) rosuvastatin calcium tab 20 mg 1 $0 QL(30 片 /30 天 ) rosuvastatin calcium tab 40 mg 1 $0 QL(30 片 /30 天 ) simvastatin tab 5 mg 1 $0 simvastatin tab 10 mg 1 $0 simvastatin tab 20 mg 1 $0 simvastatin tab 40 mg 1 $0 simvastatin tab 80 mg 1 $0 QL(30 片 /30 天 ) 抗血脂藥, 雜類 - 治療高膽固醇的藥物 35

45 cholestyramine light powder packets 4 gm 1 $0 cholestyramine powder 4 gm/dose 1 $0 cholestyramine powder packets 4 gm 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 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 片 /30 天 ) (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 gm1 $0 PRALUENT INJ 75MG/ML 2 $0 NM,PA PRALUENT INJ 150MG/ML 2 $0 NM,PA 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 36

46 atenolol & chlorthalidone tab mg 1 $0 bisoprolol & hydrochlorothiazide tab 1 $ mg bisoprolol & hydrochlorothiazide tab 1 $ mg bisoprolol & hydrochlorothiazide tab1 $ mg metoprolol & hydrochlorothiazide 1 $0 tab mg metoprolol & hydrochlorothiazide 1 $0 tab mg metoprolol & hydrochlorothiazide 1 $0 tab mg propranolol & hydrochlorothiazide 1 $0 tab mg propranolol & hydrochlorothiazide tab mg 1 $0 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 mg (tartrate equiv) metoprolol succinate tab sr 24hr 501 $0 mg (tartrate equiv) metoprolol succinate tab sr 24hr 100 mg (tartrate equiv) 1 $0 37

47 metoprolol succinate tab sr 24hr 1 $0 200 mg (tartrate equiv) 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 propranolol hcl inj 1 mg/ml 1 $0 propranolol hcl oral soln 20 mg/5ml1 $0 propranolol hcl oral soln 40 mg/5ml1 $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 afeditab tab 60mg cr 1 $0 amlodipine besylate tab 2.5 mg 1 $0 amlodipine besylate tab 5 mg 1 $0 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 24hr 180 mg 1 $0 38

48 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 1 $0 beads cap sr 24hr 360 mg 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 felodipine tab sr 24hr 5 mg 1 $0 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 nifedical xl tab 60mg 1 $0 nifedipine tab sr 24hr 30 mg 1 $0 nifedipine tab sr 24hr 60 mg 1 $0 nifedipine tab sr 24hr 90 mg 1 $0 nifedipine tab sr 24hr osmotic 1 $0 release 30 mg nifedipine tab sr 24hr osmotic release 60 mg 1 $0 39

49 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 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;65 歲及以上者適用 PA digitek tab 0.125mg 1 $0 QL(30 片 /30 天 ) digoxin inj 0.25 mg/ml 1 $0 DIGOXIN ORAL SOLN 0.05 MG/ML 1 $0 PA;65 歲及以上者適用 PA digoxin tab 125 mcg (0.125 mg) 1 $0 QL(30 片 /30 天 ) digoxin tab 250 mcg (0.25 mg) 1 $0 PA;65 歲及以上者適用 PA 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 40

50 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 FUROSEMIDE INJ 10 MG/ML 1 $0 furosemide oral soln 8 mg/ml 1 $0 furosemide oral soln 10 mg/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 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 0.1 mg/24hr 1 $0 41

51 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 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 NORTHERA CAP 100MG 2 $0 NM,LA,PA NORTHERA CAP 200MG 2 $0 NM,LA,PA NORTHERA CAP 300MG 2 $0 NM,LA,PA 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 42

52 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 肺動脈高壓藥 - 治療肺動脈高壓的藥物 ADCIRCA TAB 20MG 2 $0 NM,PA ADEMPAS TAB 0.5MG 2 $0 QL(90 片 /30 天 ),NM, LA,PA ADEMPAS TAB 1.5MG 2 $0 QL(90 片 /30 天 ),NM, LA,PA ADEMPAS TAB 1MG 2 $0 QL(90 片 /30 天 ),NM, LA,PA ADEMPAS TAB 2.5MG 2 $0 QL(90 片 /30 天 ),NM, LA,PA ADEMPAS TAB 2MG 2 $0 QL(90 片 /30 天 ),NM, LA,PA LETAIRIS TAB 5MG 2 $0 QL(30 片 /30 天 ),NM, LA,PA LETAIRIS TAB 10MG 2 $0 QL(30 片 /30 天 ),NM, LA,PA OPSUMIT TAB 10MG 2 $0 NM,LA,PA REMODULIN INJ 1MG/ML 2 $0 NM,LA,PA REMODULIN INJ 2.5MG/ML 2 $0 NM,LA,PA REMODULIN INJ 5MG/ML 2 $0 NM,LA,PA REMODULIN INJ 10MG/ML 2 $0 NM,LA,PA REVATIO SUS 10MG/ML 2 $0 QL(224 毫升 /30 天 ),NM, PA sildenafil citrate tab 20 mg 1 $0 QL(90 片 /30 天 ),NM, PA UPTRAVI TAB 200/800 2 $0 NM,LA,PA UPTRAVI TAB 200MCG 2 $0 QL(480 片 /30 天 ),NM, LA,PA UPTRAVI TAB 400MCG 2 $0 QL(240 片 /30 天 ),NM, LA,PA 43

53 UPTRAVI TAB 600MCG 2 $0 QL(150 片 /30 天 ),NM, LA,PA UPTRAVI TAB 800MCG 2 $0 QL(120 片 /30 天 ),NM, LA,PA UPTRAVI TAB 1000MCG 2 $0 QL(90 片 /30 天 ),NM, LA,PA UPTRAVI TAB 1200MCG 2 $0 QL(60 片 /30 天 ),NM, LA,PA UPTRAVI TAB 1400MCG 2 $0 QL(60 片 /30 天 ),NM, LA,PA UPTRAVI TAB 1600MCG 2 $0 QL(60 片 /30 天 ),NM, LA,PA VENTAVIS SOL 10MCG/ML 2 $0 NM,PA VENTAVIS SOL 20MCG/ML 2 $0 NM,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 片 /30 天 ) alprazolam tab 0.25 mg 1 $0 QL(480 片 /30 天 ) alprazolam tab 1 mg 1 $0 QL(120 片 /30 天 ) alprazolam tab 2 mg 1 $0 QL(150 片 /30 天 ) 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 片 /30 天 ) fluvoxamine maleate tab 50 mg 1 $0 QL(45 片 /30 天 ) fluvoxamine maleate tab 100 mg 1 $0 lorazepam con 2mg/ml 1 $0 QL(150 毫升 /30 天 ) lorazepam inj 2 mg/ml 1 $0 lorazepam inj 4 mg/ml 1 $0 lorazepam tab 0.5 mg 1 $0 QL(150 片 /30 天 ) lorazepam tab 1 mg 1 $0 QL(150 片 /30 天 ) lorazepam tab 2 mg 1 $0 QL(150 片 /30 天 ) 抗痙攣劑 - 治療痙攣的藥物 APTIOM TAB 200MG 2 $0 QL(180 片 /30 天 ) APTIOM TAB 400MG 2 $0 QL(90 片 /30 天 ) APTIOM TAB 600MG 2 $0 QL(60 片 /30 天 ) APTIOM TAB 800MG 2 $0 QL(30 片 /30 天 ) BANZEL SUS 40MG/ML 2 $0 PA BANZEL TAB 200MG 2 $0 PA 44

54 BANZEL TAB 400MG 2 $0 PA BRIVIACT INJ 50MG/5ML 2 $0 PA BRIVIACT SOL 10MG/ML 2 $0 PA BRIVIACT TAB 10MG 2 $0 PA BRIVIACT TAB 25MG 2 $0 PA BRIVIACT TAB 50MG 2 $0 PA BRIVIACT TAB 75MG 2 $0 PA BRIVIACT TAB 100MG 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 100 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 片 /30 天 ) tab 0.5 mg clonazepam orally disintegrating 1 $0 QL(480 片 /30 天 ) tab 0.25 mg clonazepam orally disintegrating 1 $0 QL(960 片 /30 天 ) tab mg clonazepam orally disintegrating 1 $0 QL(120 片 /30 天 ) tab 1 mg clonazepam orally disintegrating 1 $0 QL(300 片 /30 天 ) tab 2 mg clonazepam tab 0.5 mg 1 $0 QL(240 片 /30 天 ) clonazepam tab 1 mg 1 $0 QL(120 片 /30 天 ) clonazepam tab 2 mg 1 $0 QL(300 片 /30 天 ) clorazepate dipotassium tab 3.75 mg 1 $0 QL(120 片 /30 天 ),PA clorazepate dipotassium tab 7.5 mg 1 $0 QL(120 片 /30 天 ),PA clorazepate dipotassium tab 15 mg 1 $0 QL(180 片 /30 天 ),PA diazepam con 5mg/ml 1 $0 QL(240 毫升 /30 天 ),PA diazepam inj 5 mg/ml 1 $0 diazepam oral soln 1 mg/ml 1 $0 QL(1200 毫升 /30 天 ), PA DIAZEPAM RECTAL GEL DELIVERY 1 $0 SYSTEM 2.5 MG DIAZEPAM RECTAL GEL DELIVERY 1 $0 SYSTEM 10 MG 45

55 DIAZEPAM RECTAL GEL DELIVERY 1 $0 SYSTEM 20 MG diazepam tab 2 mg 1 $0 QL(120 片 /30 天 ),PA diazepam tab 5 mg 1 $0 QL(120 片 /30 天 ),PA diazepam tab 10 mg 1 $0 QL(120 片 /30 天 ),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 delayed 1 $0 release sprinkle 125 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 SUS 0.5MG/ML 2 $0 QL(720 毫升 /30 天 ),PA FYCOMPA TAB 2MG 2 $0 QL(180 片 /30 天 ),PA FYCOMPA TAB 4MG 2 $0 QL(90 片 /30 天 ),PA FYCOMPA TAB 6MG 2 $0 QL(60 片 /30 天 ),PA FYCOMPA TAB 8MG 2 $0 QL(30 片 /30 天 ),PA FYCOMPA TAB 10MG 2 $0 QL(30 片 /30 天 ),PA FYCOMPA TAB 12MG 2 $0 QL(30 片 /30 天 ),PA gabapentin cap 100 mg 1 $0 QL(1080 粒 /30 天 ) gabapentin cap 300 mg 1 $0 QL(360 粒 /30 天 ) gabapentin cap 400 mg 1 $0 QL(270 粒 /30 天 ) gabapentin oral soln 250 mg/5ml 1 $0 QL(2160 毫升 /30 天 ) gabapentin tab 600 mg 1 $0 QL(180 片 /30 天 ) gabapentin tab 800 mg 1 $0 QL(120 片 /30 天 ) GABITRIL TAB 12MG 2 $0 GABITRIL TAB 16MG 2 $0 46

56 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 粒 /30 天 ) LYRICA CAP 50MG 2 $0 QL(120 粒 /30 天 ) LYRICA CAP 75MG 2 $0 QL(120 粒 /30 天 ) LYRICA CAP 100MG 2 $0 QL(120 粒 /30 天 ) LYRICA CAP 150MG 2 $0 QL(120 粒 /30 天 ) LYRICA CAP 200MG 2 $0 QL(90 粒 /30 天 ) LYRICA CAP 225MG 2 $0 QL(60 粒 /30 天 ) LYRICA CAP 300MG 2 $0 QL(60 粒 /30 天 ) LYRICA SOL 20MG/ML 2 $0 QL(946 毫升 /30 天 ) 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 47

57 oxcarbazepine tab 600 mg 1 $0 PEGANONE TAB 250MG 2 $0 PHENOBARB INJ 65MG/ML 2 $0 PA;65 歲及以上者適用 PA phenobarbital elixir 20 mg/5ml 2 $0 PA;65 歲及以上者適用 PA phenobarbital sodium inj $0 PA;65 歲及以上者適用 PA mg/ml phenobarbital tab 15 mg 2 $0 PA;65 歲及以上者適用 PA phenobarbital tab 16.2 mg 2 $0 PA;65 歲及以上者適用 PA phenobarbital tab 30 mg 2 $0 PA;65 歲及以上者適用 PA phenobarbital tab 32.4 mg 2 $0 PA;65 歲及以上者適用 PA phenobarbital tab 60 mg 2 $0 PA;65 歲及以上者適用 PA phenobarbital tab 64.8 mg 2 $0 PA;65 歲及以上者適用 PA phenobarbital tab 97.2 mg 2 $0 PA;65 歲及以上者適用 PA phenobarbital tab 100 mg 2 $0 PA;65 歲及以上者適用 PA 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 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 片 /30 天 ) POTIGA TAB 300MG 2 $0 QL(90 片 /30 天 ) POTIGA TAB 400MG 2 $0 QL(90 片 /30 天 ) primidone tab 50 mg 1 $0 primidone tab 250 mg 1 $0 roweepra tab 500mg 1 $0 SABRIL POW 500MG 2 $0 QL(180 包 /30 天 ),NM, LA,PA SABRIL TAB 500MG 2 $0 QL(180 片 /30 天 ),NM, LA,PA SPRITAM TAB 250MG 2 $0 SPRITAM TAB 500MG 2 $0 SPRITAM TAB 750MG 2 $0 SPRITAM TAB 1000MG 2 $0 TEGRETOL SUS 100/5ML 2 $0 TEGRETOL TAB 200MG 2 $0 48

58 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 毫升 /30 天 ) VIMPAT TAB 50MG 2 $0 QL(180 片 /30 天 ) VIMPAT TAB 100MG 2 $0 QL(60 片 /30 天 ) VIMPAT TAB 150MG 2 $0 QL(60 片 /30 天 ) VIMPAT TAB 200MG 2 $0 QL(60 片 /30 天 ) 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 1 $0 QL(60 片 /30 天 ) disintegrating tab 5 mg donepezil hydrochloride orally 1 $0 disintegrating tab 10 mg donepezil hydrochloride tab 5 mg 1 $0 QL(60 片 /30 天 ) donepezil hydrochloride tab 10 mg 1 $0 donepezil hydrochloride tab 23 mg 1 $0 galantamine hydrobromide cap sr 1 $0 QL(30 粒 /30 天 ) 24hr 8 mg galantamine hydrobromide cap sr 1 $0 QL(30 粒 /30 天 ) 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 mg 1 $0 QL(180 片 /30 天 ) 49

59 galantamine hydrobromide tab 8 mg 1 $0 QL(90 片 /30 天 ) galantamine hydrobromide tab 12 1 $0 mg memantine hcl oral solution 2 1 $0 PA;30 歲及以下者適用 PA mg/ml memantine hcl tab 5 mg 1 $0 PA;30 歲及以下者適用 PA MEMANTINE HCL TAB 10 MG 1 $0 PA;30 歲及以下者適用 PA NAMENDA XR CAP 7MG 2 $0 PA;30 歲及以下者適用 PA NAMENDA XR CAP 14MG 2 $0 PA;30 歲及以下者適用 PA NAMENDA XR CAP 21MG 2 $0 PA;30 歲及以下者適用 PA NAMENDA XR CAP 28MG 2 $0 PA;30 歲及以下者適用 PA NAMENDA XR CAP TITRATIO 2 $0 PA;30 歲及以下者適用 PA 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 rivastigmine td patch 24hr $0 QL(30 貼片 /30 天 ) mg/24hr rivastigmine td patch 24hr $0 QL(30 貼片 /30 天 ) mg/24hr rivastigmine td patch 24hr $0 QL(30 貼片 /30 天 ) mg/24hr 抗抑鬱藥 - 治療抑鬱的藥物 amitriptyline hcl tab 10 mg 2 $0 PA;65 歲及以上者適用 PA amitriptyline hcl tab 25 mg 2 $0 PA;65 歲及以上者適用 PA amitriptyline hcl tab 50 mg 2 $0 PA;65 歲及以上者適用 PA amitriptyline hcl tab 75 mg 2 $0 PA;65 歲及以上者適用 PA amitriptyline hcl tab 100 mg 2 $0 PA;65 歲及以上者適用 PA amitriptyline hcl tab 150 mg 2 $0 PA;65 歲及以上者適用 PA amoxapine tab 25 mg 1 $0 amoxapine tab 50 mg 1 $0 amoxapine tab 100 mg 1 $0 amoxapine tab 150 mg 1 $0 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 片 /30 天 ) 50

60 bupropion hcl tab sr 24hr 300 mg 1 $0 QL(30 片 /30 天 ) citalopram hydrobromide oral soln 1 $0 10 mg/5ml citalopram hydrobromide tab 10 mg 1 $0 QL(45 片 /30 天 ) (base equiv) citalopram hydrobromide tab 20 mg 1 $0 QL(45 片 /30 天 ) (base equiv) citalopram hydrobromide tab 40 mg 1 $0 QL(30 片 /30 天 ) (base equiv) clomipramine hcl cap 25 mg 2 $0 PA;65 歲及以上者適用 PA clomipramine hcl cap 50 mg 2 $0 PA;65 歲及以上者適用 PA clomipramine hcl cap 75 mg 2 $0 PA;65 歲及以上者適用 PA 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;65 歲及以上者適用 PA doxepin hcl cap 25 mg 2 $0 PA;65 歲及以上者適用 PA doxepin hcl cap 50 mg 2 $0 PA;65 歲及以上者適用 PA doxepin hcl cap 75 mg 2 $0 PA;65 歲及以上者適用 PA doxepin hcl cap 100 mg 2 $0 PA;65 歲及以上者適用 PA doxepin hcl cap 150 mg 2 $0 PA;65 歲及以上者適用 PA doxepin hcl conc 10 mg/ml 2 $0 PA;65 歲及以上者適用 PA duloxetine hcl enteric coated pellets 1 $0 QL(180 粒 /30 天 ) cap 20 mg duloxetine hcl enteric coated pellets 1 $0 QL(120 粒 /30 天 ) cap 30 mg duloxetine hcl enteric coated pellets 1 $0 QL(60 粒 /30 天 ) cap 60 mg EMSAM DIS 6MG/24HR 2 $0 QL(30 貼片 /30 天 ),PA EMSAM DIS 9MG/24HR 2 $0 QL(30 貼片 /30 天 ),PA EMSAM DIS 12MG/24H 2 $0 QL(30 貼片 /30 天 ),PA escitalopram oxalate soln 5 mg/5ml 1 $0 QL(600 毫升 /30 天 ) (base equiv) escitalopram oxalate tab 5 mg 1 $0 QL(45 片 /30 天 ) (base equiv) escitalopram oxalate tab 10 mg 1 $0 QL(45 片 /30 天 ) (base equiv) escitalopram oxalate tab 20 mg 1 $0 QL(60 片 /30 天 ) (base equiv) FETZIMA CAP 20MG 2 $0 QL(180 粒 /30 天 ) 51

61 FETZIMA CAP 40MG 2 $0 QL(90 粒 /30 天 ) FETZIMA CAP 80MG 2 $0 QL(30 粒 /30 天 ) FETZIMA CAP 120MG 2 $0 QL(30 粒 /30 天 ) FETZIMA CAP TITRATIO 2 $0 fluoxetine hcl cap 10 mg 1 $0 QL(30 粒 /30 天 ) fluoxetine hcl cap 20 mg 1 $0 QL(120 粒 /30 天 ) fluoxetine hcl cap 40 mg 1 $0 fluoxetine hcl solution 20 mg/5ml 1 $0 fluoxetine hcl tab 10 mg 1 $0 QL(45 片 /30 天 ) fluoxetine hcl tab 20 mg 1 $0 imipramine hcl tab 10 mg 2 $0 PA;65 歲及以上者適用 PA imipramine hcl tab 25 mg 2 $0 PA;65 歲及以上者適用 PA imipramine hcl tab 50 mg 2 $0 PA;65 歲及以上者適用 PA 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 片 /30 天 ) mirtazapine orally disintegrating tab 1 $0 QL(30 片 /30 天 ) 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 片 /30 天 ) mirtazapine tab 15 mg 1 $0 QL(45 片 /30 天 ) 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 片 /30 天 ) paroxetine hcl tab 20 mg 1 $0 QL(45 片 /30 天 ) paroxetine hcl tab 30 mg 1 $0 QL(60 片 /30 天 ) paroxetine hcl tab 40 mg 1 $0 QL(45 片 /30 天 ) PAXIL SUS 10MG/5ML 2 $0 QL(900 毫升 /30 天 ) 52

62 phenelzine sulfate tab 15 mg 1 $0 PRISTIQ TAB 25MG 2 $0 QL(30 片 /30 天 ) PRISTIQ TAB 50MG 2 $0 QL(30 片 /30 天 ) PRISTIQ TAB 100MG 2 $0 QL(30 片 /30 天 ) 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 片 /30 天 ) sertraline hcl tab 50 mg 1 $0 QL(45 片 /30 天 ) sertraline hcl tab 100 mg 1 $0 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 粒 /30 天 ),PA; 65 歲及以上人群適用 PA trimipramine maleate cap 50 mg 2 $0 QL(120 粒 /30 天 ),PA; 65 歲及以上者適用 PA trimipramine maleate cap 100 mg 2 $0 QL(60 粒 /30 天 ),PA; 65 歲及以上者適用 PA TRINTELLIX TAB 5MG 2 $0 QL(120 片 /30 天 ) TRINTELLIX TAB 10MG 2 $0 QL(60 片 /30 天 ) TRINTELLIX TAB 20MG 2 $0 QL(30 片 /30 天 ) venlafaxine hcl cap sr 24hr 37.5 mg 1 $0 QL(30 粒 /30 天 ) (base equivalent) venlafaxine hcl cap sr 24hr 75 mg 1 $0 QL(30 粒 /30 天 ) (base equivalent) venlafaxine hcl cap sr 24hr 150 mg 1 $0 QL(60 粒 /30 天 ) (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 venlafaxine hcl tab 100 mg 1 $0 VIIBRYD KIT STARTER 2 $0 VIIBRYD TAB 10MG 2 $0 QL(30 片 /30 天 ) VIIBRYD TAB 20MG 2 $0 QL(30 片 /30 天 ) VIIBRYD TAB 40MG 2 $0 QL(30 片 /30 天 ) 抗帕金森病藥 - 治療帕金森病的藥物 amantadine hcl cap 100 mg 1 $0 QL(120 粒 /30 天 ) amantadine hcl syrup 50 mg/5ml 1 $0 amantadine hcl tab 100 mg 1 $0 53

63 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;65 歲及以上者適用 PA benztropine mesylate tab 1 mg 2 $0 PA;65 歲及以上者適用 PA benztropine mesylate tab 2 mg 2 $0 PA;65 歲及以上者適用 PA 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 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 54

64 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/ml2 $0 PA;65 歲及以上者適用 PA trihexyphenidyl hcl tab 2 mg 2 $0 PA;65 歲及以上者適用 PA trihexyphenidyl hcl tab 5 mg 2 $0 PA;65 歲及以上者適用 PA 抗精神病藥 - 治療精神疾病的藥物 ABILIFY MAIN INJ 300MG 2 $0 QL(1 劑 /28 天 ) ABILIFY MAIN INJ 300MG 2 $0 QL(1 小瓶 /28 天 ) ABILIFY MAIN INJ 400MG 2 $0 QL(1 劑 /28 天 ) ABILIFY MAIN INJ 400MG 2 $0 QL(1 小瓶 /28 天 ) aripiprazole oral solution 1 mg/ml 2 $0 QL(900 毫升 /30 天 ) aripiprazole orally disintegrating tab 2 $0 QL(60 片 /30 天 ) 10 mg aripiprazole orally disintegrating tab 2 $0 QL(60 片 /30 天 ) 15 mg aripiprazole tab 2 mg 1 $0 QL(30 片 /30 天 ) aripiprazole tab 5 mg 1 $0 QL(30 片 /30 天 ) aripiprazole tab 10 mg 1 $0 QL(30 片 /30 天 ) aripiprazole tab 15 mg 1 $0 QL(30 片 /30 天 ) aripiprazole tab 20 mg 2 $0 QL(30 片 /30 天 ) aripiprazole tab 30 mg 2 $0 QL(30 片 /30 天 ) chlorpromaz inj 25mg/ml 2 $0 55

65 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 1 $0 QL(270 片 /30 天 ),PA DISINTEGRATING TAB 100 MG CLOZAPINE ORALLY 1 $0 QL(180 片 /30 天 ),PA DISINTEGRATING TAB 150 MG CLOZAPINE ORALLY 2 $0 QL(135 片 /30 天 ),PA DISINTEGRATING TAB 200 MG clozapine tab 25 mg 1 $0 clozapine tab 50 mg 1 $0 clozapine tab 100 mg 1 $0 QL(270 片 /30 天 ) clozapine tab 200 mg 1 $0 QL(135 片 /30 天 ) FANAPT PAK 2 $0 FANAPT TAB 1MG 2 $0 QL(60 片 /30 天 ) FANAPT TAB 2MG 2 $0 QL(60 片 /30 天 ) FANAPT TAB 4MG 2 $0 QL(60 片 /30 天 ) FANAPT TAB 6MG 2 $0 QL(60 片 /30 天 ) FANAPT TAB 8MG 2 $0 QL(60 片 /30 天 ) FANAPT TAB 10MG 2 $0 QL(60 片 /30 天 ) FANAPT TAB 12MG 2 $0 QL(60 片 /30 天 ) 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 毫升 /3 天 ) haloperidol decanoate im soln 50 mg/ml 1 $0 haloperidol decanoate im soln $0 mg/ml haloperidol lactate inj 5 mg/ml 1 $0 56

66 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 注射劑 /28 天 ) INVEGA SUST INJ 78/0.5ML 2 $0 QL(1 注射劑 /28 天 ) INVEGA SUST INJ 117/ $0 QL(1 注射劑 /28 天 ) INVEGA SUST INJ 156MG/ML 2 $0 QL(1 注射劑 /28 天 ) INVEGA SUST INJ 234/1.5 2 $0 QL(1 注射劑 /28 天 ) INVEGA TRINZ INJ 273MG 2 $0 QL(1 劑 /90 天 ) INVEGA TRINZ INJ 410MG 2 $0 QL(1 劑 /90 天 ) INVEGA TRINZ INJ 546MG 2 $0 QL(1 劑 /90 天 ) INVEGA TRINZ INJ 819MG 2 $0 QL(1 劑 /90 天 ) LATUDA TAB 20MG 2 $0 QL(240 片 /30 天 ) LATUDA TAB 40MG 2 $0 QL(30 片 /30 天 ) LATUDA TAB 60MG 2 $0 QL(60 片 /30 天 ) LATUDA TAB 80MG 2 $0 QL(60 片 /30 天 ) LATUDA TAB 120MG 2 $0 QL(30 片 /30 天 ) 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 NUPLAZID TAB 17MG 2 $0 QL(60 片 /30 天 ),NM, LA,PA olanzapine for im inj 10 mg 1 $0 QL(3 小瓶 /1 天 ) olanzapine orally disintegrating tab 1 $0 QL(30 片 /30 天 ) 5 mg olanzapine orally disintegrating tab 1 $0 QL(60 片 /30 天 ) 10 mg olanzapine orally disintegrating tab 1 $0 QL(60 片 /30 天 ) 15 mg olanzapine orally disintegrating tab 1 $0 QL(60 片 /30 天 ) 20 mg olanzapine tab 2.5 mg 1 $0 QL(240 片 /30 天 ) olanzapine tab 5 mg 1 $0 QL(120 片 /30 天 ) 57

67 olanzapine tab 7.5 mg 1 $0 QL(30 片 /30 天 ) olanzapine tab 10 mg 1 $0 QL(60 片 /30 天 ) olanzapine tab 15 mg 1 $0 QL(60 片 /30 天 ) olanzapine tab 20 mg 1 $0 QL(60 片 /30 天 ) paliperidone tab sr 24hr 1.5 mg 2 $0 QL(30 片 /30 天 ) paliperidone tab sr 24hr 3 mg 2 $0 QL(30 片 /30 天 ) paliperidone tab sr 24hr 6 mg 2 $0 QL(60 片 /30 天 ) paliperidone tab sr 24hr 9 mg 2 $0 QL(30 片 /30 天 ) perphenazine tab 2 mg 1 $0 perphenazine tab 4 mg 1 $0 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 片 /30 天 ) quetiapine fumarate tab 50 mg 1 $0 QL(90 片 /30 天 ) quetiapine fumarate tab 100 mg 1 $0 QL(90 片 /30 天 ) quetiapine fumarate tab 200 mg 1 $0 QL(90 片 /30 天 ) quetiapine fumarate tab 300 mg 1 $0 QL(90 片 /30 天 ) quetiapine fumarate tab 400 mg 1 $0 QL(90 片 /30 天 ) REXULTI TAB 0.5MG 2 $0 QL(180 片 /30 天 ) REXULTI TAB 0.25MG 2 $0 QL(360 片 /30 天 ) REXULTI TAB 1MG 2 $0 QL(90 片 /30 天 ) REXULTI TAB 2MG 2 $0 QL(60 片 /30 天 ) REXULTI TAB 3MG 2 $0 QL(30 片 /30 天 ) REXULTI TAB 4MG 2 $0 QL(30 片 /30 天 ) RISPERDAL INJ 12.5MG 2 $0 QL(2 注射劑 /28 天 ) RISPERDAL INJ 25MG 2 $0 QL(2 注射劑 /28 天 ) RISPERDAL INJ 37.5MG 2 $0 QL(2 注射劑 /28 天 ) RISPERDAL INJ 50MG 2 $0 QL(2 注射劑 /28 天 ) risperidone orally disintegrating tab 1 $0 QL(90 片 /30 天 ) 0.5 mg risperidone orally disintegrating tab 1 $0 QL(90 片 /30 天 ) 0.25 mg risperidone orally disintegrating tab 1 $0 QL(60 片 /30 天 ) 1 mg risperidone orally disintegrating tab 1 $0 QL(60 片 /30 天 ) 2 mg risperidone orally disintegrating tab 1 $0 QL(60 片 /30 天 ) 3 mg risperidone orally disintegrating tab 1 $0 QL(120 片 /30 天 ) 4 mg 58

68 risperidone soln 1 mg/ml 1 $0 QL(240 毫升 /30 天 ) risperidone tab 0.5 mg 1 $0 QL(90 片 /30 天 ) risperidone tab 0.25 mg 1 $0 QL(90 片 /30 天 ) risperidone tab 1 mg 1 $0 QL(60 片 /30 天 ) risperidone tab 2 mg 1 $0 QL(60 片 /30 天 ) risperidone tab 3 mg 1 $0 QL(60 片 /30 天 ) risperidone tab 4 mg 1 $0 QL(120 片 /30 天 ) SAPHRIS SUB 2.5MG 2 $0 QL(240 片 /30 天 ) SAPHRIS SUB 5MG 2 $0 QL(120 片 /30 天 ) SAPHRIS SUB 10MG 2 $0 QL(60 片 /30 天 ) SEROQUEL XR TAB 50MG 2 $0 QL(120 片 /30 天 ) SEROQUEL XR TAB 150MG 2 $0 QL(30 片 /30 天 ) SEROQUEL XR TAB 200MG 2 $0 QL(30 片 /30 天 ) SEROQUEL XR TAB 300MG 2 $0 QL(60 片 /30 天 ) SEROQUEL XR TAB 400MG 2 $0 QL(60 片 /30 天 ) thioridazine hcl tab 10 mg 2 $0 PA;65 歲及以上者適用 PA thioridazine hcl tab 25 mg 2 $0 PA;65 歲及以上者適用 PA thioridazine hcl tab 50 mg 2 $0 PA;65 歲及以上者適用 PA thioridazine hcl tab 100 mg 2 $0 PA;65 歲及以上者適用 PA 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 毫升 /30 天 ),PA VRAYLAR CAP 1.5-3MG 2 $0 VRAYLAR CAP 1.5MG 2 $0 QL(120 粒 /30 天 ) VRAYLAR CAP 3MG 2 $0 QL(60 粒 /30 天 ) VRAYLAR CAP 4.5MG 2 $0 QL(30 粒 /30 天 ) VRAYLAR CAP 6MG 2 $0 QL(30 粒 /30 天 ) ziprasidone hcl cap 20 mg 1 $0 QL(60 粒 /30 天 ) ziprasidone hcl cap 40 mg 1 $0 QL(60 粒 /30 天 ) ziprasidone hcl cap 60 mg 1 $0 QL(90 粒 /30 天 ) ziprasidone hcl cap 80 mg 1 $0 QL(90 粒 /30 天 ) ZYPREXA RELP INJ 210MG 2 $0 QL(2 小瓶 /28 天 ),PA ZYPREXA RELP INJ 300MG 2 $0 QL(2 小瓶 /28 天 ),PA ZYPREXA RELP INJ 405MG 2 $0 QL(1 小瓶 /28 天 ),PA 注意缺陷障礙伴多動症 - 治療注意缺陷多動障礙的藥物 59

69 amphetamine-dextroamphetamine 1 $0 QL(90 粒 /30 天 ) cap sr 24hr 5 mg amphetamine-dextroamphetamine 1 $0 QL(90 粒 /30 天 ) cap sr 24hr 10 mg amphetamine-dextroamphetamine 1 $0 QL(30 粒 /30 天 ) cap sr 24hr 15 mg amphetamine-dextroamphetamine 1 $0 QL(30 粒 /30 天 ) cap sr 24hr 20 mg amphetamine-dextroamphetamine 1 $0 QL(30 粒 /30 天 ) cap sr 24hr 25 mg amphetamine-dextroamphetamine 1 $0 QL(30 粒 /30 天 ) cap sr 24hr 30 mg amphetamine-dextroamphetamine 1 $0 QL(360 片 /30 天 ) tab 5 mg amphetamine-dextroamphetamine 1 $0 QL(240 片 /30 天 ) tab 7.5 mg amphetamine-dextroamphetamine 1 $0 QL(180 片 /30 天 ) tab 10 mg amphetamine-dextroamphetamine 1 $0 QL(144 片 /30 天 ) tab 12.5 mg amphetamine-dextroamphetamine 1 $0 QL(120 片 /30 天 ) tab 15 mg amphetamine-dextroamphetamine 1 $0 QL(90 片 /30 天 ) tab 20 mg amphetamine-dextroamphetamine 1 $0 QL(60 片 /30 天 ) tab 30 mg guanfacine hcl tab sr 24hr 1 mg 2 $0 PA;65 歲及以上者適用 PA (base equiv) guanfacine hcl tab sr 24hr 2 mg 2 $0 PA;65 歲及以上者適用 PA (base equiv) guanfacine hcl tab sr 24hr 3 mg 2 $0 PA;65 歲及以上者適用 PA (base equiv) guanfacine hcl tab sr 24hr 4 mg (base equiv) 2 $0 PA;65 歲及以上者適用 PA methylphenidate hcl soln 5 mg/5ml 1 $0 QL(1800 毫升 /30 天 ) methylphenidate hcl soln 10 1 $0 QL(900 毫升 /30 天 ) mg/5ml methylphenidate hcl tab 5 mg 1 $0 QL(180 片 /30 天 ) methylphenidate hcl tab 10 mg 1 $0 QL(180 片 /30 天 ) methylphenidate hcl tab 20 mg 1 $0 QL(90 片 /30 天 ) methylphenidate hcl tab cr 10 mg 1 $0 QL(90 片 /30 天 ) methylphenidate hcl tab cr 20 mg 1 $0 QL(90 片 /30 天 ) STRATTERA CAP 10MG 2 $0 QL(120 粒 /30 天 ) STRATTERA CAP 18MG 2 $0 QL(120 粒 /30 天 ) STRATTERA CAP 25MG 2 $0 QL(120 粒 /30 天 ) 60

70 STRATTERA CAP 40MG 2 $0 QL(60 粒 /30 天 ) STRATTERA CAP 60MG 2 $0 QL(30 粒 /30 天 ) STRATTERA CAP 80MG 2 $0 QL(30 粒 /30 天 ) STRATTERA CAP 100MG 2 $0 QL(30 粒 /30 天 ) 安眠藥 - 治療失眠的藥物 eszopiclone tab 1 mg 2 $0 QL(30 片 /30 天 ),PA; PA 適用於在一個行事曆年中獲得 90 天供應以後的 65 歲或以上人群 eszopiclone tab 2 mg 2 $0 QL(30 片 /30 天 ),PA; PA 適用於在一個行事曆年中獲得 90 天供應以後的 65 歲或以上人群 eszopiclone tab 3 mg 2 $0 QL(30 片 /30 天 ),PA; PA 適用於在一個行事曆年中獲得 90 天供應以後的 65 歲或以上人群 HETLIOZ CAP 20MG 2 $0 NM,LA,PA SILENOR TAB 3MG 2 $0 QL(60 片 /30 天 ) SILENOR TAB 6MG 2 $0 QL(30 片 /30 天 ) temazepam cap 7.5 mg 1 $0 QL(30 粒 /30 天 ),PA; PA 適用於在一個行事曆年中獲得 90 天供應以後的 65 歲或以上人群 temazepam cap 15 mg 1 $0 QL(60 粒 /30 天 ),PA; PA 適用於在一個行事曆年中獲得 90 天供應以後的 65 歲或以上人群 zolpidem tartrate tab 5 mg 2 $0 QL(30 片 /30 天 ),PA; PA 適用於在一個行事曆年中獲得 90 天供應以後的 65 歲或以上人群 zolpidem tartrate tab 10 mg 2 $0 QL(30 片 /30 天 ),PA; PA 適用於在一個行事曆年中獲得 90 天供應以後的 65 歲或以上人群 偏頭痛藥 - 治療劇烈頭痛的藥物 cafergot tab 1-100mg 2 $0 dihydroergotamine mesylate inj 1 1 $0 mg/ml migergot sup 2/100 2 $0 61

71 naratriptan hcl tab 1 mg (base 1 $0 QL(12 片 /30 天 ) equiv) naratriptan hcl tab 2.5 mg (base 1 $0 QL(12 片 /30 天 ) equiv) rizatriptan benzoate oral 1 $0 QL(18 片 /30 天 ) disintegrating tab 5 mg (base eq) rizatriptan benzoate oral disintegrating tab 10 mg (base eq) 1 $0 QL(18 片 /30 天 ) rizatriptan benzoate tab 5 mg (base 1 $0 QL(18 片 /30 天 ) equivalent) rizatriptan benzoate tab 10 mg 1 $0 QL(18 片 /30 天 ) (base equivalent) SUMATRIPTAN NASAL SPRAY 5 1 $0 QL(24 吸入器 /30 天 ) MG/ACT SUMATRIPTAN NASAL SPRAY 20 1 $0 QL(12 吸入器 /30 天 ) MG/ACT sumatriptan succinate inj 6 1 $0 QL(12 注射劑 /30 天 ) mg/0.5ml SUMATRIPTAN SUCCINATE 1 $0 QL(18 注射劑 /30 天 ) SOLUTION AUTO-INJECTOR 4 MG/0.5ML sumatriptan succinate solution 1 $0 QL(12 注射劑 /30 天 ) auto-injector 6 mg/0.5ml SUMATRIPTAN SUCCINATE 1 $0 QL(18 注射劑 /30 天 ) SOLUTION CARTRIDGE 4 MG/0.5ML sumatriptan succinate solution 1 $0 QL(12 注射劑 /30 天 ) cartridge 6 mg/0.5ml sumatriptan succinate solution 1 $0 QL(12 注射劑 /30 天 ) prefilled syringe 6 mg/0.5ml sumatriptan succinate tab 25 mg 1 $0 QL(12 片 /30 天 ) sumatriptan succinate tab 50 mg 1 $0 QL(12 片 /30 天 ) sumatriptan succinate tab 100 mg 1 $0 QL(12 片 /30 天 ) zolmitriptan orally disintegrating 1 $0 QL(12 片 /30 天 ) tab 2.5 mg zolmitriptan orally disintegrating 1 $0 QL(12 片 /30 天 ) tab 5 mg zolmitriptan tab 2.5 mg 1 $0 QL(12 片 /30 天 ) zolmitriptan tab 5 mg 1 $0 QL(12 片 /30 天 ) 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 62

72 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 片 /30 天 ),NM, PA TETRABENAZINE TAB 25 MG 2 $0 QL(120 片 /30 天 ),NM, PA 多發性硬化劑 - 治療多發性硬化的藥物 AMPYRA TAB 10MG 2 $0 NM,LA,PA BETASERON INJ 0.3MG 2 $0 QL(14 劑 /28 天 ),NM, PA COPAXONE INJ 40MG/ML 2 $0 QL(12 劑 /28 天 ),NM, PA GILENYA CAP 0.5MG 2 $0 QL(28 粒 /28 天 ),NM, PA glatopa inj 20mg/ml 2 $0 QL(30 劑 /30 天 ),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 carisoprodol tab 350 mg 2 $0 QL(120 片 /30 天 ),PA; 65 歲及以上者適用 PA cyclobenzaprine hcl tab 5 mg 2 $0 PA;65 歲及以上者適用 PA cyclobenzaprine hcl tab 10 mg 2 $0 PA;65 歲及以上者適用 PA dantrolene sodium cap 25 mg 1 $0 dantrolene sodium cap 50 mg 1 $0 dantrolene sodium cap 100 mg 1 $0 methocarbamol tab 500 mg 2 $0 PA;65 歲及以上者適用 PA methocarbamol tab 750 mg 2 $0 PA;65 歲及以上者適用 PA 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 armodafinil tab 50 mg 1 $0 QL(150 片 /30 天 ),PA armodafinil tab 150 mg 1 $0 QL(60 片 /30 天 ),PA ARMODAFINIL TAB 200 MG 1 $0 QL(30 片 /30 天 ),PA armodafinil tab 250 mg 1 $0 QL(30 片 /30 天 ),PA XYREM SOL 500MG/ML 2 $0 QL(540 毫升 /30 天 ),LA, PA 63

73 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 1 $0 QL(120 片 /30 天 ),PA tab mg (base equiv) buprenorphine hcl-naloxone hcl sl 1 $0 QL(120 片 /30 天 ),PA tab 8-2 mg (base equiv) buproban tab 150mg 1 $0 bupropion hcl (smoking deterrent) 1 $0 tab sr 12hr 150 mg 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 gnp nicotine gum 4mg mint 3 $0 NM;* gnp nicotine loz 2mg mint 3 $0 NM;* gnp nicotine loz 4mg mint 3 $0 NM;* gnp nicotine loz mini 2mg 3 $0 NM;* HM NICOTINE DIS 14MG/24H 3 $0 NM;* HM NICOTINE DIS 21MG/24H 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 nicorelief gum 2mg mint 3 $0 NM;* nicorelief gum 2mg orig 3 $0 NM;* nicorelief gum 4mg mint 3 $0 NM;* nicorelief gum 4mg orig 3 $0 NM;* 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 4 mg 3 $0 NM;* NICOTINE TD DIS 7MG/24HR 3 $0 NM;* nicotine td patch 24hr 7 mg/24hr 3 $0 NM;* NICOTINE TD PATCH 24HR 7 MG/24HR 3 $0 NM;* nicotine td patch 24hr 14 mg/24hr 3 $0 NM;* 64

74 NICOTINE TD PATCH 24HR 14 MG/24HR 3 $0 NM;* nicotine td patch 24hr 21 mg/24hr 3 $0 NM;* NICOTINE TD PATCH 24HR 21 3 $0 NM;* MG/24HR NICOTROL INH 2 $0 NICOTROL NS SPR 10MG/ML 2 $0 night time tab 25mg 3 $0 NM;* nighttime tab 25mg 3 $0 NM;* sb sleep tab 25mg 3 $0 NM;* sleep aid tab 25mg 3 $0 NM;* sleep tab 25mg 3 $0 NM;* SM NICOTINE DIS 7MG/24HR 3 $0 NM;* SM NICOTINE DIS 14MG/24H 3 $0 NM;* SM NICOTINE DIS 21MG/24H 3 $0 NM;* sm nicotine gum 2mg 3 $0 NM;* sm nicotine gum 2mg mint 3 $0 NM;* sm nicotine gum 4mg 3 $0 NM;* sm nicotine gum 4mg mint 3 $0 NM;* sm sleep aid tab 25mg 3 $0 NM;* SUBOXONE MIS 2-0.5MG 2 $0 QL(120 SL 片 /30 天 ), PA SUBOXONE MIS 4-1MG 2 $0 QL(120 SL 片 /30 天 ), PA SUBOXONE MIS 8-2MG 2 $0 QL(120 SL 片 /30 天 ), PA SUBOXONE MIS 12-3MG 2 $0 QL(60 SL 片 /30 天 ),PA 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 ANADROL-50 TAB 50MG 2 $0 PA ANDRODERM DIS 2MG/24HR 2 $0 QL(30 貼片 /30 天 ),PA ANDRODERM DIS 4MG/24HR 2 $0 QL(30 貼片 /30 天 ),PA AXIRON SOL 30MG/ACT 2 $0 QL(440 毫升 /30 天 ),PA oxandrolone tab 2.5 mg 1 $0 PA oxandrolone tab 10 mg 1 $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 65

75 ALCOHOL SWABS 2 $0 BYDUREON INJ 2 $0 QL(4 筆墨水匣 /28 天 ) BYDUREON INJ 2 $0 QL(4 小瓶 /28 天 ) BYETTA INJ 5MCG 2 $0 QL(1 筆墨水匣 /30 天 ) BYETTA INJ 10MCG 2 $0 QL(1 筆墨水匣 /30 天 ) GAUZE PADS 2" X 2" 2 $0 HUMULIN R INJ U $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 ( 不承保品牌 RELION) NOVOLIN N INJ U $0 ( 不承保品牌 RELION) NOVOLIN R INJ U $0 ( 不承保品牌 RELION) 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 筆墨水匣 /30 天 ), PA SYMLNPEN 120 INJ 1000MCG 2 $0 QL(4 筆墨水匣 /30 天 ), 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 筆墨水匣 /28 天 ) TRULICITY INJ 1.5/0.5 2 $0 QL(4 筆墨水匣 /28 天 ) VICTOZA INJ 18MG/3ML 2 $0 QL(3 筆墨水匣 /30 天 ) 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 片 /30 天 ) FARXIGA TAB 10MG 2 $0 QL(30 片 /30 天 ) glimepiride tab 1 mg 1 $0 QL(240 片 /30 天 ) glimepiride tab 2 mg 1 $0 QL(120 片 /30 天 ) 66

76 glimepiride tab 4 mg 1 $0 QL(60 片 /30 天 ) glipizide tab 5 mg 1 $0 QL(240 片 /30 天 ) glipizide tab 10 mg 1 $0 QL(120 片 /30 天 ) glipizide tab sr 24hr 2.5 mg 1 $0 QL(240 片 /30 天 ) GLIPIZIDE TAB SR 24HR 2.5 MG 1 $0 QL(240 片 /30 天 ) glipizide tab sr 24hr 5 mg 1 $0 QL(120 片 /30 天 ) glipizide tab sr 24hr 10 mg 1 $0 QL(60 片 /30 天 ) GLIPIZIDE XL TAB 5MG 1 $0 QL(120 片 /30 天 ) glipizide-metformin hcl tab $0 QL(240 片 /30 天 ) mg glipizide-metformin hcl tab $0 QL(120 片 /30 天 ) mg glipizide-metformin hcl tab $0 QL(120 片 /30 天 ) mg glyburide micronized tab 1.5 mg 2 $0 QL(240 片 /30 天 ),PA; 65 歲及以上者適用 PA glyburide micronized tab 3 mg 2 $0 QL(120 片 /30 天 ),PA; 65 歲及以上者適用 PA glyburide micronized tab 6 mg 2 $0 QL(60 片 /30 天 ),PA; 65 歲及以上者適用 PA glyburide tab 1.25 mg 2 $0 QL(480 片 /30 天 ),PA; 65 歲及以上者適用 PA glyburide tab 2.5 mg 2 $0 QL(240 片 /30 天 ),PA; 65 歲及以上者適用 PA glyburide tab 5 mg 2 $0 QL(120 片 /30 天 ),PA; 65 歲及以上者適用 PA INVOKAMET TAB MG 2 $0 QL(120 片 /30 天 ) INVOKAMET TAB $0 QL(60 片 /30 天 ) INVOKAMET TAB $0 QL(60 片 /30 天 ) INVOKAMET TAB $0 QL(60 片 /30 天 ) INVOKANA TAB 100MG 2 $0 QL(90 片 /30 天 ) INVOKANA TAB 300MG 2 $0 QL(30 片 /30 天 ) JANUMET TAB MG 2 $0 QL(60 片 /30 天 ) JANUMET TAB $0 QL(60 片 /30 天 ) JANUMET XR TAB MG 2 $0 QL(60 片 /30 天 ) JANUMET XR TAB $0 QL(60 片 /30 天 ) JANUMET XR TAB $0 QL(30 片 /30 天 ) JANUVIA TAB 25MG 2 $0 QL(30 片 /30 天 ) JANUVIA TAB 50MG 2 $0 QL(30 片 /30 天 ) JANUVIA TAB 100MG 2 $0 QL(30 片 /30 天 ) JENTADUETO TAB $0 QL(60 片 /30 天 ) 67

77 JENTADUETO TAB $0 QL(60 片 /30 天 ) JENTADUETO TAB $0 QL(60 片 /30 天 ) JENTADUETO TAB XR 2 $0 QL(30 片 /30 天 ) JENTADUETO TAB XR 2 $0 QL(60 片 /30 天 ) metformin hcl tab 500 mg 1 $0 QL(150 片 /30 天 ) metformin hcl tab 850 mg 1 $0 QL(90 片 /30 天 ) metformin hcl tab 1000 mg 1 $0 QL(75 片 /30 天 ) metformin hcl tab sr 24hr 500 mg 1 $0 QL(120 片 /30 天 ) metformin hcl tab sr 24hr 750 mg 1 $0 QL(60 片 /30 天 ) nateglinide tab 60 mg 1 $0 QL(90 片 /30 天 ) nateglinide tab 120 mg 1 $0 QL(90 片 /30 天 ) pioglitazone hcl tab 15 mg (base 1 $0 QL(30 片 /30 天 ) equiv) pioglitazone hcl tab 30 mg (base 1 $0 QL(30 片 /30 天 ) equiv) pioglitazone hcl tab 45 mg (base 1 $0 QL(30 片 /30 天 ) equiv) repaglinide tab 0.5 mg 1 $0 QL(120 片 /30 天 ) repaglinide tab 1 mg 1 $0 QL(120 片 /30 天 ) repaglinide tab 2 mg 1 $0 QL(240 片 /30 天 ) TRADJENTA TAB 5MG 2 $0 QL(30 片 /30 天 ) XIGDUO XR TAB 5-500MG 2 $0 QL(60 片 /30 天 ) XIGDUO XR TAB MG 2 $0 QL(60 片 /30 天 ) XIGDUO XR TAB MG 2 $0 QL(30 片 /30 天 ) XIGDUO XR TAB $0 QL(30 片 /30 天 ) 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 片 /28 天 ) alendronate sodium tab 40 mg 1 $0 alendronate sodium tab 70 mg 1 $0 QL(4 片 /28 天 ) pamidronate disodium for inj 30 mg 1 $0 B/D pamidronate disodium for inj 90 mg 1 $0 B/D 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 zoledronic inj 4mg 1 $0 B/D,NM 68

78 鈣感受器興奮劑 SENSIPAR TAB 30MG 2 $0 QL(120 片 /30 天 ),NM SENSIPAR TAB 60MG 2 $0 QL(60 片 /30 天 ),NM SENSIPAR TAB 90MG 2 $0 QL(120 片 /30 天 ),NM 螯合劑 CHEMET CAP 100MG 2 $0 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 AFTERA TAB 1.5MG 3 $0 NM;* 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 1.5/30 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 mg 1 $0 69

79 DROSPIRENONE-ETHINYL 1 $0 ESTRADIOL TAB MG drospirenone-ethinyl estradiol tab 1 $ mg DROSPIRENONE-ETHINYL 1 $0 ESTRADIOL TAB MG econtra ez tab 1.5mg 3 $0 NM;* ELLA TAB 30MG 2 $0 emoquette tab 1 $0 enpresse-28 tab 1 $0 errin tab 0.35mg 1 $0 fallback tab 1.5mg 3 $0 NM;* 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 juleber tab 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 & ethinyl estradiol 1 $0 tab 0.15 mg-30 mcg levonorgestrel tab 1.5 mg 1 $0 70

80 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 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 next choice tab 1.5mg 3 $0 NM;* 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 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 71

81 nortrel tab 1/35 1 $0 nortrel tab 7/7/7 1 $0 NUVARING MIS 2 $0 opcicon tab 1.5mg 3 $0 NM;* 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 sprintec 28 tab 28 day 1 $0 TAKE ACTION TAB 1.5MG 3 $0 NM;* tarina fe tab 1/20 1 $0 tri-legest tab fe 1 $0 tri-lo- tab sprintec 1 $0 tri-previfem tab 1 $0 tri-sprintec tab 1 $0 TRINESSA LO TAB 1 $0 TRINESSA TAB 1 $0 trivora-28 tab 1 $0 velivet pak 1 $0 vienva tab $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 BUPHENYL TAB 500MG 2 $0 NM,LA,PA CARBAGLU TAB 200MG 2 $0 NM,LA,PA 72

82 CERDELGA CAP 84MG 2 $0 NM,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 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 ORFADIN CAP 10MG 2 $0 NM,LA,PA ORFADIN SUS 4MG/ML 2 $0 NM,LA,PA RAVICTI LIQ 1.1GM/ML 2 $0 NM,PA sodium phenylbutyrate oral powder 2 $0 NM,PA 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;65 歲及以上者適用 PA estradiol tab 1 mg 2 $0 PA;65 歲及以上者適用 PA estradiol tab 2 mg 2 $0 PA;65 歲及以上者適用 PA estradiol td patch weekly $0 PA;65 歲及以上者適用 PA mg/24hr estradiol td patch weekly $0 PA;65 歲及以上者適用 PA mg/24hr estradiol td patch weekly $0 PA;65 歲及以上者適用 PA mg/24hr estradiol td patch weekly $0 PA;65 歲及以上者適用 PA mg/24hr estradiol td patch weekly $0 PA;65 歲及以上者適用 PA mg/24hr estradiol td patch weekly mg/24hr (37.5 mcg/24hr) 2 $0 PA;65 歲及以上者適用 PA 73

83 estradiol valerate im in oil 20 mg/ml1 $0 estradiol valerate im in oil 40 mg/ml1 $0 jinteli tab 1mg-5mcg 2 $0 PA;65 歲及以上者適用 PA norethindrone acetate-ethinyl 2 $0 PA;65 歲及以上者適用 PA estradiol tab 1 mg-5 mcg 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 4 mg/ml dexamethasone sodium phosphate 1 $0 inj 10 mg/ml dexamethasone sodium phosphate 1 $0 inj 20 mg/5ml 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 succinate for inj 125 mg 1 $0 B/D 74

84 methylprednisolone sodium 1 $0 B/D succinate for inj 1000 mg methylprednisolone tab 4 mg 1 $0 B/D methylprednisolone tab 8 mg 1 $0 B/D methylprednisolone tab 16 mg 1 $0 B/D methylprednisolone tab 32 mg 1 $0 B/D methylprednisolone tab therapy pack 4 mg (21) 1 $0 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 prednisone tab 5 mg 1 $0 B/D prednisone tab 10 mg 1 $0 B/D prednisone tab 20 mg 1 $0 B/D prednisone tab 50 mg 1 $0 B/D prednisone tab therapy pack 5 mg 1 $0 (21) prednisone tab therapy pack 5 mg 1 $0 (48) prednisone tab therapy pack 10 mg1 $0 (21) prednisone tab therapy pack 10 mg1 $0 (48) 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 HM GLUCOSE CHW ORANGE 3 $0 NM;* HM GLUCOSE CHW RASPBERY 3 $0 NM;* PROGLYCEM SUS 50MG/ML 2 $0 SM GLUCOSE CHW ORANGE 3 $0 NM;* 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 75

85 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 B/D unit/act FORTICAL SPR 200/ACT 2 $0 B/D INCRELEX INJ 40MG/4ML 2 $0 NM,LA,PA KORLYM TAB 300MG 2 $0 NM,LA,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 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 1 $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 劑 /180 天 ),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 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 76

86 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 筆墨水匣 /28 天 ) 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 AURYXIA TAB 210MG 2 $0 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 1 $0 MCG 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 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 $0 MCG LEVOXYL TAB 25MCG 1 $0 LEVOXYL TAB 50MCG 1 $0 77

87 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 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 78

88 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 STIMATE SOL 1.5MG/ML 2 $0 NM 胃腸藥 - 治療胃腸紊亂的藥物抗酸劑 acid gone sus 3 $0 NM;* advanced sus antacid 3 $0 NM;* almacone chw 3 $0 NM;* almacone dbl sus strength 3 $0 NM;* almacone sus 3 $0 NM;* ALUM HYDROX SUS 320/5ML 3 $0 NM;* antacid chw 500mg 3 $0 NM;* antacid chw 750mg 3 $0 NM;* antacid fast sus relief 3 $0 NM;* antacid plus sus gas rel 3 $0 NM;* antacid sus 3 $0 NM;* antacid sus anti-gas 3 $0 NM;* antacid sus max st 3 $0 NM;* antacid sus reg st 3 $0 NM;* antacid/anti sus -gas ds 3 $0 NM;* cal antacid chw 1000mg 3 $0 NM;* cal-gest chw 500mg 3 $0 NM;* calc antacid chw 500mg 3 $0 NM;* calc antacid chw 750mg 3 $0 NM;* calcium carbonate (antacid) tab 6483 $0 NM;* mg GAVISCON CHW 3 $0 NM;* GAVISCON SUS 3 $0 NM;* gnp antacid sus anti-gas 3 $0 NM;* gnp masanti sus reg st 3 $0 NM;* heartburn chw ex st 3 $0 NM;* hm antacid sus anti-gas 3 $0 NM;* mag-al plus liq 3 $0 NM;* magnesium oxide tab 420 mg 3 $0 NM;* mi-acid chw 3 $0 NM;* 79

89 mi-acid sus 3 $0 NM;* mi-acid sus max st 3 $0 NM;* mintox plus chw 3 $0 NM;* mintox sus 3 $0 NM;* qc antacid sus 3 $0 NM;* qc antacid sus anti-gas 3 $0 NM;* rulox sus 3 $0 NM;* sb antacid/ sus antigas 3 $0 NM;* sm antacid sus anti-gas 3 $0 NM;* sm antacid/ sus antigas 3 $0 NM;* sodium bicarbonate tab 650 mg 3 $0 NM;* tums fresher chw 500mg 3 $0 NM;* tums smoothi chw 750mg 3 $0 NM;* 止瀉藥 anti-diarrhe tab 2mg 3 $0 NM;* bismatrol chw 262mg 3 $0 NM;* bismatrol sus 262/15ml 3 $0 NM;* loperamide hcl liq 1 mg/5ml (0.2 3 $0 NM;* mg/ml) peptic relf chw 262mg 3 $0 NM;* peptic relf sus 262/15ml 3 $0 NM;* pink bismuth chw 262mg 3 $0 NM;* sb bismuth sus 262/15ml 3 $0 NM;* sm anti-diar tab 2mg 3 $0 NM;* sm stomach sus 262/15ml 3 $0 NM;* stomach relf chw 262mg 3 $0 NM;* stomach relf sus 262/15ml 3 $0 NM;* 止吐藥 - 治療噁心和嘔吐的藥物 compro sup 25mg 1 $0 driminate tab 50mg 3 $0 NM;* dronabinol cap 2.5 mg 1 $0 B/D,QL(60 粒 /30 天 ) dronabinol cap 5 mg 1 $0 B/D,QL(60 粒 /30 天 ) dronabinol cap 10 mg 1 $0 B/D,QL(60 粒 /30 天 ) 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 EMEND SUS 125MG 2 $0 B/D granisetron hcl inj 0.1 mg/ml 1 $0 granisetron hcl inj 1 mg/ml 1 $0 80

90 granisetron hcl inj 4 mg/4ml (1 1 $0 mg/ml) granisetron hcl tab 1 mg 1 $0 B/D meclizine hcl chew tab 25 mg 3 $0 NM;* meclizine hcl tab 12.5 mg 1 $0 meclizine hcl tab 12.5 mg 3 $0 NM;* 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 tab 50mg 3 $0 NM;* motion-time chw 25mg 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/5ml1 $0 B/D ondansetron hcl tab 4 mg 1 $0 B/D 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;65 歲及以上者適用 PA phenergan sup 12.5mg 2 $0 PA;65 歲及以上者適用 PA phenergan sup 25mg 2 $0 PA;65 歲及以上者適用 PA phenergan sup 50mg 2 $0 PA;65 歲及以上者適用 PA 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;65 歲及以上者適用 PA promethazine hcl inj 50 mg/ml 2 $0 PA;65 歲及以上者適用 PA promethazine hcl suppos 12.5 mg 2 $0 PA;65 歲及以上者適用 PA promethazine hcl suppos 25 mg 2 $0 PA;65 歲及以上者適用 PA promethazine hcl suppos 50 mg 2 $0 PA;65 歲及以上者適用 PA 81

91 promethazine hcl syrup $0 PA;65 歲及以上者適用 PA mg/5ml promethazine hcl tab 12.5 mg 2 $0 PA;65 歲及以上者適用 PA promethazine hcl tab 25 mg 2 $0 PA;65 歲及以上者適用 PA promethazine hcl tab 50 mg 2 $0 PA;65 歲及以上者適用 PA promethegan sup 25mg 2 $0 PA;65 歲及以上者適用 PA promethegan sup 50mg 2 $0 PA;65 歲及以上者適用 PA TRANSDERM-SC DIS 1MG 2 $0 QL(10 貼片 /30 天 ),PA; 65 歲及以上人群適用 PA travel sick chw 25mg 3 $0 NM;* travel sick tab 50mg 3 $0 NM;* 解痙藥 - 治療胃部痙攣的藥物 dicyclomine hcl cap 10 mg 1 $0 dicyclomine hcl oral soln 10 mg/5ml1 $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 control tab 20mg 3 $0 NM;* acid reducer tab 10mg 3 $0 NM;* acid reducer tab 20mg 3 $0 NM;* acid reducer tab 75mg 3 $0 NM;* acid reducer tab 150mg 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 10 mg 3 $0 NM;* famotidine tab 10mg 3 $0 NM;* famotidine tab 20 mg 1 $0 famotidine tab 40 mg 1 $0 heartburn tab 150mg 3 $0 NM;* heartburn tab 200mg 3 $0 NM;* heartburn tab relief 3 $0 NM;* ranitidine hcl inj 50 mg/2ml (25 1 $0 mg/ml) ranitidine hcl inj 150 mg/6ml (25 mg/ml) 1 $0 82

92 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 150 mg 3 $0 NM;* ranitidine hcl tab 300 mg 1 $0 sm acid redu tab 200mg 3 $0 NM;* 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 delayed release 2 $0 particles cap 3 mg CANASA SUP 1000MG 2 $0 DELZICOL CAP 400MG 2 $0 DIPENTUM CAP 250MG 2 $0 hydrocortisone enema $0 mg/60ml HYDROCORTISONE ENEMA $0 MG/60ML mesalamine enema 4 gm 1 $0 mesalamine rectal enema 4 gm & 1 $0 cleanser wipe kit sulfasalazine tab 500 mg 1 $0 sulfasalazine tab delayed release 1 $0 500 mg 通便劑 bisac-evac sup 10mg 3 $0 NM;* bisacodyl suppos 10 mg 3 $0 NM;* bisacodyl tab 5mg ec 3 $0 NM;* bisacodyl tab & peg 3350-kcl-sod 1 $0 bicarb-nacl for soln kit biscolax sup 10mg 3 $0 NM;* calcium polycarbophil tab 625 mg 3 $0 NM;* clearlax pow 3 $0 NM;* constulose sol 10gm/15 1 $0 diocto liq 50mg/5ml 3 $0 NM;* diocto syp 60/15ml 3 $0 NM;* doc-q-lax tab mg 3 $0 NM;* docqlace cap 100mg 3 $0 NM;* docu liq 50mg/5ml 3 $0 NM;* docusate sod cap 100mg 3 $0 NM;* 83

93 docusate sodium cap 100 mg 3 $0 NM;* docusate sodium liquid $0 NM;* mg/15ml docusil cap 100mg 3 $0 NM;* docusol mini ene 3 $0 NM;* dok cap 100mg 3 $0 NM;* dok tab 100mg 3 $0 NM;* ducodyl tab 5mg ec 3 $0 NM;* enemeez mini ene 3 $0 NM;* enemeez plus ene $0 NM;* enulose sol 10gm/15 1 $0 feminine lax tab 5mg ec 3 $0 NM;* fiber laxatv tab 625mg 3 $0 NM;* fiber therap pow 58.6% 3 $0 NM;* fiber-caps tab 625mg 3 $0 NM;* fiber-lax tab 625mg 3 $0 NM;* FLEET BISACO ENE 10/30ML 3 $0 NM;* fleet laxati tab 5mg ec 3 $0 NM;* gavilax pow 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 glycerin sup 1gm 3 $0 NM;* glycolax pow 3350 nf 3 $0 NM;* gnp bisa-lax tab 5mg ec 3 $0 NM;* gnp clearlax pow 3 $0 NM;* gnp laxative tab 5mg ec 3 $0 NM;* gnp milk mag sus 3 $0 NM;* GOLYTELY SOL 2 $0 healthylax pow 3 $0 NM;* hm clearlax pow 3 $0 NM;* hm enema ene r-t-u 3 $0 NM;* hm fiber pow 58.6% 3 $0 NM;* kao-tin cap 240mg 3 $0 NM;* konsyl fiber tab 625mg 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;* 84

94 lactulose (encephalopathy) solution 1 $0 10 gm/15ml lactulose solution 10 gm/15ml 1 $0 lax/stl soft tab mg 3 $0 NM;* laxative sup 10mg 3 $0 NM;* laxative tab 5mg ec 3 $0 NM;* laxative tab 25mg 3 $0 NM;* magnesium citrate soln 3 $0 NM;* milk of magn sus 3 $0 NM;* milk of magn sus 400/5ml 3 $0 NM;* milk of magn sus 1200/15 3 $0 NM;* milk of magn sus cherry 3 $0 NM;* milk of magn sus frsh mnt 3 $0 NM;* milk of magn sus mint 3 $0 NM;* MINERAL OIL 3 $0 NM;* MOVIPREP SOL 2 $0 nat fiber pow therapy 3 $0 NM;* naturl fiber pow therapy 3 $0 NM;* NULYTELY SOL FLAV PKS 2 $0 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 polyethylene glycol 3350 oral 1 $0 packet polyethylene glycol 3350 oral 3 $0 NM;* packet polyethylene glycol 3350 oral 1 $0 powder polyethylene glycol 3350 oral 3 $0 NM;* powder psyllium powder 100% 3 $0 NM;* reguloid pow 28.3% 3 $0 NM;* reguloid pow 48.57% 3 $0 NM;* reguloid pow 58.6% 3 $0 NM;* sb bisacodyl tab 5mg ec 3 $0 NM;* sb milk magn sus 3 $0 NM;* sb milk magn sus mint 3 $0 NM;* senexon tab 8.6mg 3 $0 NM;* 85

95 senexon-s tab mg 3 $0 NM;* senna lax tab 8.6mg 3 $0 NM;* senna plus tab mg 3 $0 NM;* senna tab 8.6mg 3 $0 NM;* senna-lax tab 8.6mg 3 $0 NM;* senna-time s tab mg 3 $0 NM;* senna-time tab 8.6mg 3 $0 NM;* sennalax-s tab mg 3 $0 NM;* senno tab 8.6mg 3 $0 NM;* sennosides syrup 8.8 mg/5ml 3 $0 NM;* sennosides tab 8.6 mg 3 $0 NM;* sennosides-docusate sodium tab 3 $0 NM;* mg silace liq 10mg/ml 3 $0 NM;* silace syp 60/15ml 3 $0 NM;* sm clearlax pow 3 $0 NM;* sm fiber lax tab 500mg 3 $0 NM;* sm fiber pow 28.3% 3 $0 NM;* sm fiber pow 48.57% 3 $0 NM;* sm laxative tab 5mg ec 3 $0 NM;* sm milk magn sus mint 3 $0 NM;* SM MINERAL OIL 3 $0 NM;* sm senna lax tab 8.6mg 3 $0 NM;* sodium phosphates - enema 3 $0 NM;* soluble fib pow therapy 3 $0 NM;* stim laxat tab 5mg ec 3 $0 NM;* stool softnr cap 100mg 3 $0 NM;* stool softnr cap 240mg 3 $0 NM;* stool softnr cap 250mg 3 $0 NM;* stool softnr tab mg 3 $0 NM;* SUPREP BOWEL SOL PREP 2 $0 trilyte sol 1 $0 womans laxat tab 5mg ec 3 $0 NM;* 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 粒 /30 天 ) AMITIZA CAP 24MCG 2 $0 QL(60 粒 /30 天 ) cromolyn sodium oral conc 100 mg/5ml 2 $0 86

96 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 粒 /30 天 ) LINZESS CAP 290MCG 2 $0 QL(30 粒 /30 天 ) 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 片 /30 天 ) MOVANTIK TAB 25MG 2 $0 QL(30 片 /30 天 ) RELISTOR INJ 8/0.4ML 2 $0 PA RELISTOR INJ 12/0.6ML 2 $0 PA 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 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 粒 /30 天 ) DEXILANT CAP 60MG DR 2 $0 QL(30 粒 /30 天 ) esomeprazole magnesium cap 1 $0 QL(30 粒 /30 天 ) delayed release 20 mg (base eq) esomeprazole magnesium cap delayed release 40 mg (base eq) 1 $0 QL(30 粒 /30 天 ) 87

97 esomeprazole sodium for intravenous soln 20 mg (base equiv) esomeprazole sodium for intravenous soln 40 mg (base equiv) 1 $0 1 $0 heartburn tr cap 15mg 3 $0 NM;* lansoprazole cap 15mg dr 3 $0 NM;* lansoprazole cap delayed release 151 $0 QL(30 粒 /30 天 ) mg lansoprazole cap delayed release 153 $0 NM;* mg lansoprazole cap delayed release 301 $0 QL(30 粒 /30 天 ) mg NEXIUM GRA 2.5MG DR 2 $0 NEXIUM GRA 5MG DR 2 $0 NEXIUM GRA 10MG DR 2 $0 QL(30 包 /30 天 ) NEXIUM GRA 20MG DR 2 $0 QL(30 包 /30 天 ) NEXIUM GRA 40MG DR 2 $0 QL(30 包 /30 天 ) omeprazole cap delayed release 10 1 $0 QL(30 粒 /30 天 ) mg omeprazole cap delayed release 20 1 $0 QL(60 粒 /30 天 ) mg omeprazole cap delayed release 40 1 $0 QL(30 粒 /30 天 ) mg OMEPRAZOLE TAB 20MG 3 $0 NM;* pantoprazole sodium ec tab 20 mg 1 $0 QL(30 片 /30 天 ) (base equiv) pantoprazole sodium ec tab 40 mg 1 $0 QL(30 片 /30 天 ) (base equiv) PRILOSEC OTC TAB 20MG 3 $0 NM;* rabeprazole sodium ec tab 20 mg 1 $0 QL(30 片 /30 天 ) 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 片 /30 天 ) dutasteride cap 0.5 mg 1 $0 QL(30 粒 /30 天 ) dutasteride-tamsulosin hcl cap 1 $0 QL(30 粒 /30 天 ) mg finasteride tab 5 mg 1 $0 tamsulosin hcl cap 0.4 mg 1 $0 雜類 bethanechol chloride tab 5 mg 1 $0 bethanechol chloride tab 10 mg 1 $0 88

98 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 片 /30 天 ) MYRBETRIQ TAB 50MG 2 $0 QL(30 片 /30 天 ) oxybutynin chloride syrup 5 mg/5ml1 $0 oxybutynin chloride tab 5 mg 1 $0 oxybutynin chloride tab sr 24hr 5 mg 1 $0 QL(30 片 /30 天 ) oxybutynin chloride tab sr 24hr 10 1 $0 QL(60 片 /30 天 ) mg oxybutynin chloride tab sr 24hr 15 1 $0 QL(60 片 /30 天 ) mg tolterodine tartrate cap sr 24hr 2 1 $0 QL(30 粒 /30 天 ) mg tolterodine tartrate cap sr 24hr 4 1 $0 QL(30 粒 /30 天 ) mg tolterodine tartrate tab 1 mg 1 $0 tolterodine tartrate tab 2 mg 1 $0 TOVIAZ TAB 4MG 2 $0 QL(30 片 /30 天 ) TOVIAZ TAB 8MG 2 $0 QL(30 片 /30 天 ) trospium chloride tab 20 mg 1 $0 QL(60 片 /30 天 ) VESICARE TAB 5MG 2 $0 QL(30 片 /30 天 ) VESICARE TAB 10MG 2 $0 QL(30 片 /30 天 ) 陰道抗感染藥 clindamycin phosphate vaginal 1 $0 cream 2% clotrimazole vaginal cream 1% 3 $0 NM;* metronidazole vaginal gel 0.75% 1 $0 miconazole 7 cre 2% 3 $0 NM;* miconazole 7 sup 100mg 3 $0 NM;* miconazole nitrate vaginal cream 3 $0 NM;* 2% miconazole nitrate vaginal suppos 3 $0 NM;* 100 mg sm micon 7 sup 100mg 3 $0 NM;* terconazole vaginal cream 0.4% 1 $0 terconazole vaginal cream 0.8% 1 $0 89

99 TERCONAZOLE VAGINAL CREAM 0.8% 1 $0 terconazole vaginal suppos 80 mg 1 $0 VANDAZOLE GEL 0.75% 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 COUMADIN TAB 10MG 2 $0 enoxaparin sodium inj 30 mg/0.3ml1 $0 enoxaparin sodium inj 40 mg/0.4ml1 $0 enoxaparin sodium inj 60 mg/0.6ml1 $0 enoxaparin sodium inj 80 mg/0.8ml1 $0 enoxaparin sodium inj 100 mg/ml 1 $0 enoxaparin sodium inj 120 mg/0.8ml 1 $0 enoxaparin sodium inj 150 mg/ml 1 $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 2 $0 UNIT/ML IN D5W heparin sodium (porcine) 100 unit/ml in d5w 2 $0 90

100 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 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 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 91

101 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 cvs iron tab 27mg 3 $0 NM;* ferosul elx 220/5ml 3 $0 NM;* FERROUS GLUC TAB 324MG 3 $0 NM;* ferrous gluconate tab 324 mg (37.53 $0 NM;* mg elemental iron) FERROUS SUL LIQ 220/5ML 3 $0 NM;* FERROUS SULF SYP 300/5ML 3 $0 NM;* FERROUS SULF TAB 324MG EC 3 $0 NM;* ferrous sulfate elixir 220 mg/5ml 3 $0 NM;* (44 mg/5ml elemental fe) ferrous sulfate soln 75 mg/ml (15 mg/ml elemental fe) 3 $0 NM;* ferrous sulfate tab 325 mg (65 mg 3 $0 NM;* elemental fe) ferrous sulfate tab ec 325 mg (65 3 $0 NM;* mg fe equivalent) ferrousul tab 325mg 3 $0 NM;* iferex 150 cap 3 $0 NM;* INFED INJ 50MG/ML 3 $0 NM;* sod ferric gluc cmplx in sucrose iv 3 $0 NM;* soln 12.5 mg/ml (fe eq) VENOFER INJ 20MG/ML 3 $0 NM;* MISCELLANEOUS 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 片 /30 天 ),NM, LA,PA PROMACTA TAB 25MG 2 $0 QL(180 片 /30 天 ),NM, LA,PA 92

102 PROMACTA TAB 50MG 2 $0 QL(90 片 /30 天 ),NM, LA,PA PROMACTA TAB 75MG 2 $0 QL(60 片 /30 天 ),NM, LA,PA tranexamic acid iv soln $0 mg/10ml (100 mg/ml) tranexamic acid tab 650 mg 1 $0 血小板聚集抑制劑 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 HUMIRA INJ 10MG/0.2 2 $0 QL(2 盒 /28 天 ),NM,PA HUMIRA KIT 20MG/0.4 2 $0 QL(2 盒 /28 天 ),NM,PA HUMIRA KIT 40MG/0.8 2 $0 QL(6 盒 /28 天 ),NM,PA HUMIRA PEDIA INJ CROHNS 2 $0 NM,PA HUMIRA PEN INJ 40MG/0.8 2 $0 QL(6 盒 /28 天 ),NM,PA HUMIRA PEN INJ CROHNS 2 $0 NM,PA HUMIRA PEN INJ PSORIASI 2 $0 NM,PA hydroxychloroquine sulfate tab 2001 $0 mg leflunomide tab 10 mg 1 $0 leflunomide tab 20 mg 1 $0 methotrexate sodium tab 2.5 mg 1 $0 (base equiv) REMICADE INJ 100MG 2 $0 NM,PA XELJANZ TAB 5MG 2 $0 QL(60 片 /30 天 ),NM, PA XELJANZ XR TAB 11MG 2 $0 QL(30 片 /30 天 ),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 10/200ML 2 $0 NM,PA 93

103 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 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 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 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 94

104 INTRON A INJ 25MU 2 $0 B/D,NM INTRON A INJ 50MU 2 $0 B/D,NM 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 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 inj 100mg 1 $0 B/D 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) 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 95

105 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 1 $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 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 M-M-R II INJ 2 $0 MENACTRA INJ 2 $0 MENHIBRIX INJ 2 $0 MENOMUNE INJ A/C/Y/W 2 $0 96

106 MENVEO INJ 2 $0 PEDIARIX INJ 0.5ML 2 $0 PEDVAX HIB INJ 2 $0 PENTACEL 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( 終生 1 小瓶 ) 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 MAGNESIUM SU INJ 2GM/50ML 2 $0 MAGNESIUM SU INJ 4G/100ML 2 $0 MAGNESIUM SU INJ 20/500ML 2 $0 MAGNESIUM SU INJ 40G/ $0 MAGNESIUM SU INJ 80MG/ML 2 $0 magnesium sulfate inj 50% 1 $0 MAGNESIUM SULFATE INJ 50% 1 $0 magnesium sulfate iv soln 2 1 $0 gm/50ml (40 mg/ml) MG SO4/D5W INJ 10MG/ML 2 $0 MG SO4/D5W INJ 20MG/ML 2 $0 ped elctrlyt sol grape 3 $0 NM;* 97

107 potassium chloride cap cr 8 meq 1 $0 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 powder packet 1 $0 20 meq 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) SODIUM CHLORIDE INJ 2.5 MEQ/ML 1 $0 (14.6%) sodium fluoride chew; tab; 1.1 (0.51 $0 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 98

108 CLINIMIX INJ 4.25/D25 2 $0 B/D 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 靜脈替換解決方案 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 99

109 ISOLYTE-S INJ 2 $0 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 0.9% INJ 1 $0 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 2 $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 MEQ/100ML 1 $0 100

110 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 MINERALS calcitrate tab 3 $0 NM;* calcitrate tab 950mg 3 $0 NM;* calcium carbonate susp $0 NM;* mg/5ml (500 mg/5ml elemental ca) calcium carbonate tab 600 mg 3 $0 NM;* calcium carbonate tab 1250 mg 3 $0 NM;* (500 mg elemental ca) calcium carbonate-cholecalciferol 3 $0 NM;* chew tab 500 mg-100 unit calcium carbonate-cholecalciferol 3 $0 NM;* tab 500 mg-200 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-200 unit CALCIUM GLUC TAB 500MG 3 $0 NM;* calcium/d chw $0 NM;* mag64 tab 64mg 3 $0 NM;* MAGNEBIND TAB $0 NM;* magnesium oxide tab 400 mg (241.3 mg elemental mg) 3 $0 NM;* magnesium oxide tab 500 mg (mg 3 $0 NM;* supplement) magnesium tab 250 mg 3 $0 NM;* os-cal extra tab d3 3 $0 NM;* oysco 500 tab 500mg 3 $0 NM;* oysco 500+d tab 3 $0 NM;* oyst shell/d tab 500mg 3 $0 NM;* oyster shell calcium tab 500 mg 3 $0 NM;* 雜類 ORA-BLEND SF SUS 3 $0 NM;* ORA-BLEND SUS 3 $0 NM;* ORA-PLUS LIQ 3 $0 NM;* 101

111 ORA-SWEET SF SYP 3 $0 NM;* ORA-SWEET SYP 3 $0 NM;* SUSPENDOL-S LIQ 3 $0 NM;* SYRSPEND SF LIQ 3 $0 NM;* 維生素 animal shape chw 3 $0 NM;* animal shape chw + iron 3 $0 NM;* AQUADEKS CAP 3 $0 NM;* aquadeks dro 3 $0 NM;* ascorbic acid chew tab 250 mg 3 $0 NM;* ascorbic acid chew tab 500 mg 3 $0 NM;* ascorbic acid tab 250 mg 3 $0 NM;* ascorbic acid tab 500 mg 3 $0 NM;* b-complex vitamin tab 3 $0 NM;* balanc b-50 tab 3 $0 NM;* balanc b-100 tab 100mg 3 $0 NM;* biotin cap 5 mg 3 $0 NM;* biotin cap 5000mcg 3 $0 NM;* biotin tab 300 mcg 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 certavite liq antioxid 3 $0 NM;* CERTAVITE TAB SENIOR 3 $0 NM;* certavite/ tab antioxid 3 $0 NM;* cholecalciferol oral liquid $0 NM;* unit/ml cholecalciferol tab 1000 unit 3 $0 NM;* cyanocobalamin inj 1000 mcg/ml 3 $0 NM;* cyanocobalamin tab 1000 mcg 3 $0 NM;* ELDERTONIC ELX 3 $0 NM;* ergocalciferol cap unit 3 $0 NM;* ergocalciferol soln 8000 unit/ml 3 $0 NM;* folic acid inj 5 mg/ml 3 $0 NM;* folic acid tab 1 mg 3 $0 NM;* folic acid tab 400 mcg 3 $0 NM;* geravim liq 3 $0 NM;* hydroxocobalamin inj 1000 mcg/ml 3 $0 NM;* icaps mv tab 3 $0 NM;* MEPHYTON TAB 5MG 3 $0 NM;* 102

112 meribin cap 5mg 3 $0 NM;* multiple vitamins w/ minerals tab 3 $0 NM;* NASCOBAL SPR 500MCG 3 $0 NM;* niacin cap cr 500 mg 3 $0 NM;* niacin tab 50 mg 3 $0 NM;* niacin tab 500 mg 3 $0 NM;* niacin tab cr 500 mg 3 $0 NM;* niacinamide tab 500 mg 3 $0 NM;* ocuvite tab 3 $0 NM;* ONCOVITE TAB 3 $0 NM;* one daily tab 3 $0 NM;* one daily tab mens 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 phytonadione inj 1 mg/0.5ml (2 3 $0 NM;* mg/ml) phytonadione inj 10 mg/ml 3 $0 NM;* poly-vita dro 3 $0 NM;* poly-vita dro /iron 3 $0 NM;* PRENATAL TAB MG 3 $0 NM;* PRENATAL TAB MG 3 $0 NM;* prenatal vitamin/folic acid > 0.8 mg 1 $0 (generic) prosight tab 3 $0 NM;* pyridoxine hcl inj 100 mg/ml 3 $0 NM;* pyridoxine hcl tab 50 mg 3 $0 NM;* pyridoxine hcl tab 100 mg 3 $0 NM;* stress form/ tab zinc 3 $0 NM;* stress formu tab 3 $0 NM;* stress formu tab w/iron 3 $0 NM;* superplex-t tab 3 $0 NM;* tab-a-vite tab 3 $0 NM;* tab-a-vite tab /iron 3 $0 NM;* tab-a-vite tab beta car 3 $0 NM;* THERA BETA- TAB CAROTENE 3 $0 NM;* THERA M PLUS TAB 3 $0 NM;* THERA-M TAB 3 $0 NM;* thiamine hcl inj 100 mg/ml 3 $0 NM;* thiamine hcl tab 100 mg 3 $0 NM;* total b/c tab 3 $0 NM;* 103

113 TRI-VI-SOL SOL 3 $0 NM;* tri-vita sol 3 $0 NM;* vita-bee/c tab 3 $0 NM;* vitamin a cap 8000 unit 3 $0 NM;* vitamin a cap 8000unit 3 $0 NM;* vitamin a cap unit 3 $0 NM;* OPHTHALMIC - DRUGS TO TREAT EYE CONDITIONS ANTI-INFECTIVE/ANTI-INFLAMMATORY - DRUGS TO TREAT INFECTIONS AND INFLAMMATION 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 ANTI-INFECTIVES - DRUGS TO TREAT INFECTIONS 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 mg-unt-mg/ml 1 $0 104

114 ofloxacin ophth soln 0.3% 1 $0 polymyxin b-trimethoprim ophth 1 $0 soln unit/ml-0.1% sulfacetamide sodium ophth oint 1 $0 10% 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 LASTACAFT SOL 0.25% 2 $0 105

115 PATADAY SOL 0.2% 2 $0 PAZEO DRO 0.7% 2 $0 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 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 akwa tears oin op 3 $0 NM;* artifi tears oin op 3 $0 NM;* artifi tears sol 1.4% op 3 $0 NM;* bion tears sol op 3 $0 NM;* CYSTARAN SOL 0.44% 2 $0 NM,LA,PA eye drops dro % 3 $0 NM;* GENTEAL GEL 0.3% 3 $0 NM;* lubricant dro eye 3 $0 NM;* 106

116 lubricating sol % 3 $0 NM;* lubricating sol 0.5% 3 $0 NM;* lubricnt eye dro 0.5% op 3 $0 NM;* lubricnt gel dro $0 NM;* lubrifresh oin p.m. 3 $0 NM;* MURO 128 OIN 5% OP 3 $0 NM;* MURO 128 SOL 2% OP 3 $0 NM;* naphazoline hcl ophth soln 0.1% 1 $0 PROLENSA SOL 0.07% 2 $0 proparacaine hcl ophth soln 0.5% 1 $0 REFRESH CELL DRO 1% OP 3 $0 NM;* refresh lacr oin op 3 $0 NM;* RESTASIS EMU 0.05% 2 $0 QL(64 小瓶 /30 天 ) sodium chloride hypertonic ophth 3 $0 NM;* oint 5% sodium chloride hypertonic ophth 3 $0 NM;* soln 5% SYSTANE GEL 0.3% 3 $0 NM;* tears natura sol free op 3 $0 NM;* tears natura sol ii 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 吸入劑 /30 天 ) COMBIVENT AER $0 QL(2 吸入器 /30 天 ) 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 吸入器 /30 天 ) INCRUSE ELPT INH 62.5MCG 2 $0 QL(1 吸入器 /30 天 ) 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 all day allg chw 10mg 3 $0 NM;* all day allg sol 1mg/ml 3 $0 NM;* all day allg sol 5mg/5ml 3 $0 NM;* all day allg syp 1mg/ml 3 $0 NM;* all day allg tab 10mg 3 $0 NM;* aller-chlor syp 2mg/5ml 3 $0 NM;* 107

117 aller-chlor tab 4mg 3 $0 NM;* allergy cap 25mg 3 $0 NM;* allergy chld liq 12.5/5ml 3 $0 NM;* allergy relf cap 25mg 3 $0 NM;* allergy relf liq 12.5/5ml 3 $0 NM;* allergy relf sol 5mg/5ml 3 $0 NM;* allergy relf syp 5mg/5ml 3 $0 NM;* allergy relf tab 10mg 3 $0 NM;* allergy tab 4mg 3 $0 NM;* allergy tab 10mg 3 $0 NM;* allergy tab 25mg 3 $0 NM;* allergy tab 180mg 3 $0 NM;* allergy-time tab 4mg 3 $0 NM;* azelastine hcl nasal spray 0.1% 1 $0 (137 mcg/spray) azelastine hcl nasal spray 0.15% 1 $0 (205.5 mcg/spray) banophen cap 25mg 3 $0 NM;* banophen cap 50mg 3 $0 NM;* banophen liq 12.5/5ml 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 hcl tab 10 mg 3 $0 NM;* cetirizine sol 5mg/5ml 3 $0 NM;* cetirizine syp 1mg/ml 3 $0 NM;* chld allergy liq 12.5/5ml 3 $0 NM;* chlorphenir tab 4mg 3 $0 NM;* cyproheptadine hcl syrup 2 mg/5ml 2 $0 PA;65 歲及以上者適用 PA cyproheptadine hcl tab 4 mg 2 $0 PA;65 歲及以上者適用 PA diphenhist liq 12.5/5ml 3 $0 NM;* diphenhist tab 25mg 3 $0 NM;* diphenhydramine hcl cap 25 mg 3 $0 NM;* diphenhydramine hcl cap 50 mg 3 $0 NM;* diphenhydramine hcl inj 50 mg/ml 1 $0 fexofenadine hcl tab 60 mg 3 $0 NM;* fexofenadine hcl tab 180 mg 3 $0 NM;* fexofenadine sus 30mg/5ml 3 $0 NM;* fexofenadine tab 60mg 3 $0 NM;* fexofenadine tab 180mg 3 $0 NM;* 108

118 gnp all day tab allergy 3 $0 NM;* gnp allergy cap 25mg 3 $0 NM;* gnp allergy tab 180mg 3 $0 NM;* hm allergy tab 4mg 3 $0 NM;* hm allergy tab 25mg 3 $0 NM;* hydroxyzine hcl im soln 25 mg/ml 2 $0 PA;65 歲及以上者適用 PA hydroxyzine hcl im soln 50 mg/ml 2 $0 PA;65 歲及以上者適用 PA hydroxyzine hcl syrup 10 mg/5ml 2 $0 PA;65 歲及以上者適用 PA hydroxyzine hcl tab 10 mg 2 $0 PA;65 歲及以上者適用 PA hydroxyzine hcl tab 25 mg 2 $0 PA;65 歲及以上者適用 PA hydroxyzine hcl tab 50 mg 2 $0 PA;65 歲及以上者適用 PA hydroxyzine pamoate cap 25 mg 2 $0 PA;65 歲及以上者適用 PA hydroxyzine pamoate cap 50 mg 2 $0 PA;65 歲及以上者適用 PA hydroxyzine pamoate cap 100 mg 2 $0 PA;65 歲及以上者適用 PA levocetirizine dihydrochloride soln 2.5 mg/5ml (0.5 mg/ml) 1 $0 levocetirizine dihydrochloride tab 5 1 $0 mg loratadine sol 5mg/5ml 3 $0 NM;* loratadine syp 5mg/5ml 3 $0 NM;* loratadine tab 10 mg 3 $0 NM;* loratadine tab 10mg 3 $0 NM;* pharbechlor tab 4mg 3 $0 NM;* pharbedryl cap 25mg 3 $0 NM;* q-dryl liq 12.5/5ml 3 $0 NM;* quenalin syp 12.5/5ml 3 $0 NM;* sb allergy tab 10mg 3 $0 NM;* sb allergy tab 25mg med 3 $0 NM;* siladryl alr liq 12.5/5ml 3 $0 NM;* silphen coug syp 12.5/5ml 3 $0 NM;* sm all day tab 10mg 3 $0 NM;* sm all day tab allergy 3 $0 NM;* sm allergy tab 4mg 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 1.25 mg/3ml (base equiv) 1 $0 B/D 109

119 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) SEREVENT DIS AER 50MCG 2 $0 QL(60 吸入劑 /30 天 ) terbutaline sulfate inj 1 mg/ml 2 $0 terbutaline sulfate tab 2.5 mg 1 $0 terbutaline sulfate tab 5 mg 1 $0 VENTOLIN HFA AER 2 $0 QL(2 吸入器 /30 天 ) XOPENEX HFA AER 2 $0 QL(2 吸入器 /30 天 ) 咳嗽和感冒藥 allergy rel/ tab deconges 3 $0 NM;* allergy relf tab d-24 3 $0 NM;* allergy relf tab deconges 3 $0 NM;* allergy-d tab 5-120mg 3 $0 NM;* allergy/cong tab 5-120mg 3 $0 NM;* allgy comp-d tab 5-120mg 3 $0 NM;* aprodine tab mg 3 $0 NM;* benzonatate cap 100 mg 3 $0 NM;* benzonatate cap 150 mg 3 $0 NM;* benzonatate cap 200 mg 3 $0 NM;* brotapp dm liq /5 3 $0 NM;* brotapp liq 3 $0 NM;* cetirizine-pseudoephedrine tab sr 3 $0 NM;* 12hr mg chest conges tab mg 3 $0 NM;* chest conges tab 400mg 3 $0 NM;* chest congst tab rlf pe 3 $0 NM;* child silfed liq 15mg/5ml 3 $0 NM;* cld head cng tab nighttim 3 $0 NM;* cold/allergy elx children 3 $0 NM;* cold/cough elx child 3 $0 NM;* cough & cold tab 3 $0 NM;* cough cont liq dm max 3 $0 NM;* cough syp 100/5ml 3 $0 NM;* coughtab tab 200mg 3 $0 NM;* cromolyn sodium nasal aerosol soln 3 $0 NM;* 5.2 mg/act (4%) 110

120 dimaphen dm elx $0 NM;* ed a-hist tab 4-10mg 3 $0 NM;* endacof-dm liq $0 NM;* extra action syp /5 3 $0 NM;* gnp cld/alle elx children 3 $0 NM;* gnp cold/cgh elx child 3 $0 NM;* gnp mucus-er tab 600mg 3 $0 NM;* gnp tussin liq dm 3 $0 NM;* gnp tussin liq dm max 3 $0 NM;* gnp tussin syp 100/5ml 3 $0 NM;* gnp tussin syp cf 3 $0 NM;* guaifenesin tab sr 12hr 600 mg 3 $0 NM;* guaifenesin tab sr 12hr 1200 mg 3 $0 NM;* hm mucus er tab 600mg 3 $0 NM;* hm tussin liq adlt dm 3 $0 NM;* kidkare liq cgh/cold 3 $0 NM;* lorata-dine tab d 24hr 3 $0 NM;* loratadine-d tab 5-120mg 3 $0 NM;* loratadine-d tab mg 3 $0 NM;* mucaphed tab mg 3 $0 NM;* mucinex dm liq $0 NM;* mucus relief liq 5-100mg 3 $0 NM;* mucus relief liq 100/5ml 3 $0 NM;* mucus relief tab 400mg 3 $0 NM;* mucus relief tab dm 3 $0 NM;* mucus relief tab pe 3 $0 NM;* mucus+chst liq 100/5ml 3 $0 NM;* mucus-dm max tab $0 NM;* mucus-er tab 600mg 3 $0 NM;* mucusrelief tab sinus 3 $0 NM;* nasal 12 hr spr 0.05% 3 $0 NM;* nasal decon syp 30mg/5ml 3 $0 NM;* NASAL DECONG LIQ 30MG/5ML 3 $0 NM;* nasal decong spr 0.05% 3 $0 NM;* nasal decong tab 10mg 3 $0 NM;* nasal decong tab 30mg 3 $0 NM;* no drip nasl spr 0.05% 3 $0 NM;* nrs nasal spr 0.05% 3 $0 NM;* organ-i nr tab 200mg 3 $0 NM;* pedia relief liq cgh/cold 3 $0 NM;* 111

121 pediatric liq cgh/cold 3 $0 NM;* PHENHIST DH LIQ $0 NM;* pseudoephedrine hcl tab 30 mg 3 $0 NM;* q-tussin dm syp /5 3 $0 NM;* q-tussin sol 100/5ml 3 $0 NM;* robafen dm liq /5 3 $0 NM;* robafen dm syp /5 3 $0 NM;* robafen syp 100/5ml 3 $0 NM;* sb cgh contr liq cf 3 $0 NM;* sb cgh contr syp 100/5ml 3 $0 NM;* sb coughtab tab 200mg 3 $0 NM;* siltuss das liq 100/5ml 3 $0 NM;* siltussin dm liq das 3 $0 NM;* siltussin sa syp 100/5ml 3 $0 NM;* siltussin-dm liq diabetic 3 $0 NM;* siltussin-dm syp alc free 3 $0 NM;* sinus relief spr 0.05% 3 $0 NM;* sinus/alergy tab pe max 3 $0 NM;* sinus/allerg tab 4-10mg 3 $0 NM;* sm cld/alrgy elx children 3 $0 NM;* sm cold tab alrgy pe 3 $0 NM;* sm nasal 12h spr 0.05% 3 $0 NM;* sm nasal dec tab 30mg 3 $0 NM;* sm nasal spr 0.05% 3 $0 NM;* sm tussin cf liq 3 $0 NM;* sm tussin dm syp /5 3 $0 NM;* sm tussin syp dm 3 $0 NM;* sudogest pe tab 10mg 3 $0 NM;* sudogest tab 4-60mg 3 $0 NM;* sudogest tab 30mg 3 $0 NM;* suphedrine tab 30mg 3 $0 NM;* tabtussin dm tab mg 3 $0 NM;* tabtussin tab 400mg 3 $0 NM;* tusnel diabt liq /5 3 $0 NM;* tussin adult liq cgh/cong 3 $0 NM;* tussin cf liq 3 $0 NM;* tussin cf liq cgh/cold 3 $0 NM;* tussin dm liq /5 3 $0 NM;* tussin dm liq clear 3 $0 NM;* tussin dm liq max 3 $0 NM;* 112

122 tussin dm mx liq /5 3 $0 NM;* tussin dm syp /5 3 $0 NM;* 白三烯調節劑 montelukast sodium chew tab 4 mg 1 $0 (base equiv) 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 1000MG 2 $0 NM,LA,PA DALIRESP TAB 500MCG 2 $0 deep sea spr 0.65% 3 $0 NM;* 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 NM,PA 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 瓶 /30 天 ) (0.025%) fluticasone propionate nasal susp 1 $0 QL(1 瓶 /30 天 ) 50 mcg/act 類固醇吸入劑 - 治療哮喘的藥物 113

123 ARNUITY ELPT INH 100MCG 2 $0 QL(30 吸入劑 /30 天 ) ARNUITY ELPT INH 200MCG 2 $0 QL(30 吸入劑 /30 天 ) budesonide inhalation susp $0 B/D mg/2ml budesonide inhalation susp $0 B/D mg/2ml FLOVENT DISK AER 50MCG 2 $0 QL(120 吸入劑 /30 天 ) FLOVENT DISK AER 100MCG 2 $0 QL(120 吸入劑 /30 天 ) FLOVENT DISK AER 250MCG 2 $0 QL(240 吸入劑 /30 天 ) FLOVENT HFA AER 44MCG 2 $0 QL(2 吸入器 /30 天 ) FLOVENT HFA AER 110MCG 2 $0 QL(2 吸入器 /30 天 ) FLOVENT HFA AER 220MCG 2 $0 QL(2 吸入器 /30 天 ) PULMICORT INH 90MCG 2 $0 QL(2 吸入器 /30 天 ) PULMICORT INH 180MCG 2 $0 QL(2 吸入器 /30 天 ) 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 吸入劑 /30 天 ) ADVAIR DISKU AER 250/50 2 $0 QL(60 吸入劑 /30 天 ) ADVAIR DISKU AER 500/50 2 $0 QL(60 吸入劑 /30 天 ) ADVAIR HFA AER 45/21 2 $0 QL(1 吸入器 /30 天 ) ADVAIR HFA AER 115/21 2 $0 QL(1 吸入器 /30 天 ) ADVAIR HFA AER 230/21 2 $0 QL(1 吸入器 /30 天 ) BREO ELLIPTA INH $0 QL(60 起泡劑 /30 天 ) BREO ELLIPTA INH $0 QL(60 起泡劑 /30 天 ) SYMBICORT AER $0 QL(1 吸入器 /30 天 ) SYMBICORT AER $0 QL(1 吸入器 /30 天 ) 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 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 114

124 acne medicat gel 5% 3 $0 NM;* acne medicat gel 10% 3 $0 NM;* adapalene cream 0.1% 1 $0 adapalene gel 0.1% 1 $0 AVITA CRE 0.025% 1 $0 PA AVITA GEL 0.025% 1 $0 PA benzoyl peroxide gel 10% 3 $0 NM;* benzoyl peroxide-erythromycin gel 1 $0 5-3% claravis cap 10mg 1 $0 PA claravis cap 20mg 1 $0 PA claravis cap 30mg 1 $0 PA claravis cap 40mg 1 $0 PA 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 PA myorisan cap 20mg 1 $0 PA myorisan cap 30mg 1 $0 PA myorisan cap 40mg 1 $0 PA sulfacetamide sodium lotion 10% 1 $0 (acne) tretinoin cream 0.1% 1 $0 PA tretinoin cream 0.05% 1 $0 PA tretinoin cream 0.025% 1 $0 PA TRETINOIN GEL 0.01% 1 $0 PA tretinoin gel 0.025% 1 $0 PA zenatane cap 10mg 1 $0 PA zenatane cap 20mg 1 $0 PA zenatane cap 30mg 1 $0 PA zenatane cap 40mg 1 $0 PA 皮膚科, 抗生素 bacitr zinc oin 500/gm 3 $0 NM;* bacitracin oin 500/gm 3 $0 NM;* bacitracin oint 500 unit/gm 3 $0 NM;* bacitracin zinc oint 500 unit/gm 3 $0 NM;* 115

125 gentamicin sulfate cream 0.1% 1 $0 gentamicin sulfate oint 0.1% 1 $0 mupirocin oint 2% 1 $0 SILVER SULFADIAZINE CREAM 1% 1 $0 sm first aid oin 500/gm 3 $0 NM;* SSD CRE 1% 1 $0 SULFAMYLON CRE 85MG/GM 2 $0 SULFAMYLON PAK 5% 2 $0 皮膚科, 抗真菌藥 ALEVAZOL OIN 1% 3 $0 NM;* anti-fungal pow 1% 3 $0 NM;* antifungal cre 1% 3 $0 NM;* antifungal cre 2% 3 $0 NM;* athlete foot cre 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 cre 1% 3 $0 NM;* clotrimazole cream 1% 1 $0 clotrimazole cream 1% 3 $0 NM;* clotrimazole soln 1% 1 $0 ketoconazole cream 2% 1 $0 lamisil af aer 1% 3 $0 NM;* miconazole nitrate cream 2% 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 sm antifungl cre 1% 3 $0 NM;* soothe&cool cre inzo 2% 3 $0 NM;* terbinafine cre 1% 3 $0 NM;* terbinafine hcl cream 1% 3 $0 NM;* tolnaftate cre 1% 3 $0 NM;* tolnaftate cream 1% 3 $0 NM;* tolnaftate powder 1% 3 $0 NM;* 皮膚科, 止癢劑 116

126 DOXEPIN HCL CREAM 5% 1 $0 hydrocortisone rectal cream 2.5% 1 $0 procto-med cre hc 2.5% 1 $0 procto-pak cre 1% 1 $0 proctozone cre -hc 2.5% 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 soln 0.005% (50 1 $0 mcg/ml) 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 ala cort cre 1% 1 $0 alclometasone dipropionate cream 1 $0 0.05% alclometasone dipropionate oint 1 $0 0.05% anti-itch cre 1% 3 $0 NM;* betamethasone dipropionate 1 $0 augmented cream 0.05% betamethasone dipropionate 1 $0 augmented gel 0.05% betamethasone dipropionate augmented lotion 0.05% 1 $0 BETAMETHASONE DIPROPIONATE 1 $0 AUGMENTED OINT 0.05% 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 $0 117

127 betamethasone valerate oint 0.1% 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 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 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 hm hydrocort cre 1% plus 3 $0 NM;* hydrocort cre 1% 3 $0 NM;* hydrocort oin 1% 3 $0 NM;* hydrocort/ cre aloe 1% 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 1% 1 $0 hydrocortisone cream 1% 3 $0 NM;* hydrocortisone cream 2.5% 1 $0 hydrocortisone lotion 2.5% 1 $0 hydrocortisone oint 1% 1 $0 hydrocortisone oint 1% 3 $0 NM;* hydrocortisone oint 2.5% 1 $0 hydrocortisone valerate cream 0.2% 1 $0 hydrocortisone valerate oint 0.2% 1 $0 118

128 hydrocortisone-aloe vera cream 1%3 $0 NM;* hydroskin cre 1% 3 $0 NM;* hydroskin lot 1% 3 $0 NM;* mometasone furoate cream 0.1% 1 $0 mometasone furoate oint 0.1% 1 $0 mometasone furoate solution 0.1% 1 $0 (lotion) sb hydrocort oin 1% 3 $0 NM;* sm hydrocort cre 1% 3 $0 NM;* sm hydrocort oin 1% 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 PA lidocaine hcl soln 4% 1 $0 PA lidocaine oint 5% 1 $0 PA lidocaine patch 5% 1 $0 QL(3 貼片 /1 天 ),PA lidocaine-prilocaine cream 1 $0 PA % 皮膚科, 雜類皮膚和黏膜藥 ABREVA CRE 10% 3 $0 NM;* diclofenac sodium gel 1% 1 $0 PA fluorouracil cream 5% 1 $0 fluorouracil soln 2% 1 $0 fluorouracil soln 5% 1 $0 imiquimod cream 5% 1 $0 lactic acid (ammonium lactate) 1 $0 cream 12% lactic acid (ammonium lactate) lotion 12% 1 $0 119

129 metronidazole cream 0.75% 1 $0 metronidazole gel 0.75% 1 $0 metronidazole lotion 0.75% 1 $0 PANRETIN GEL 0.1% 2 $0 podofilox soln 0.5% 1 $0 POLYBASE OIN 3 $0 NM;* rosadan cre 0.75% 1 $0 tacrolimus oint 0.1% 1 $0 tacrolimus oint 0.03% 1 $0 TARGRETIN GEL 1% 2 $0 NM,PA VALCHLOR GEL 0.016% 2 $0 NM,LA,PA zinc oxide oint 20% 3 $0 NM;* 皮膚科, 滅疥癬藥和滅虱藥 EURAX CRE 10% 2 $0 EURAX LOT 10% 2 $0 lice killing sha % 3 $0 NM;* lice treatmt lot 1% 3 $0 NM;* lice treatmt sha % 3 $0 NM;* lice trtmnt liq 1% 3 $0 NM;* malathion lotion 0.5% 1 $0 permethrin cream 5% 1 $0 皮膚科, 傷口護理劑 ACETIC ACID IRRIGATION SOLN 1 $0 0.25% 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 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 120

130 acetic acid 2% in aluminum acetate1 $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 $0 121

131 索引 8 8 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 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 acetamin tab 500mg... 1 acetaminophen liquid 160 mg/5ml... 1 acetaminophen soln 160 mg/5ml... 1 acetaminophen suppos 120 mg... 1 acetaminophen suppos 650 mg... 1 acetaminophen tab 325 mg... 1 acetaminophen tab cr 650 mg... 1 acetaminophen w/ codeine soln mg/5ml... 4 acetaminophen w/ codeine tab mg... 4 acetaminophen w/ codeine tab mg... 4 acetaminophen w/ codeine tab mg... 4 acetaminophn sus 160/5ml... 1 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 control tab 20mg acid gone sus acid reducer tab 10mg acid reducer tab 150mg acid reducer tab 20mg acid reducer tab 75mg acitretin cap 10 mg acitretin cap 17.5 mg acitretin cap 25 mg acne medicat gel 10% acne medicat gel 5% ACTHIB INJ ACTIMMUNE INJ 2MU/ acyclovir cap 200 mg 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% ADCIRCA TAB 20MG 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/ advanced sus antacid afeditab tab 30mg cr afeditab tab 60mg cr AFINITOR DIS TAB 2MG

132 AFINITOR DIS TAB 3MG AFINITOR DIS TAB 5MG AFINITOR TAB 10MG AFINITOR TAB 2.5MG AFINITOR TAB 5MG AFINITOR TAB 7.5MG AFTERA TAB 1.5MG a-hydrocort inj 100mg akwa tears oin op ala cort cre 1% ALBENZA TAB 200MG... 8 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 ALEVAZOL OIN 1% alfuzosin hcl tab sr 24hr 10 mg ALIMTA INJ 100MG ALIMTA INJ 500MG ALINIA SUS 100/5ML... 8 ALINIA TAB 500MG... 8 all day allg chw 10mg all day allg sol 1mg/ml all day allg sol 5mg/5ml all day allg syp 1mg/ml all day allg tab 10mg aller-chlor syp 2mg/5ml aller-chlor tab 4mg allergy cap 25mg allergy chld liq 12.5/5ml allergy rel/ tab deconges allergy relf cap 25mg allergy relf liq 12.5/5ml allergy relf sol 5mg/5ml allergy relf syp 5mg/5ml allergy relf tab 10mg allergy relf tab d allergy relf tab deconges allergy tab 10mg allergy tab 180mg allergy tab 25mg allergy tab 4mg allergy/cong tab 5-120mg allergy-d tab 5-120mg allergy-time tab 4mg allgy comp-d tab 5-120mg allopurinol tab 100 mg... 1 allopurinol tab 300 mg... 1 almacone chw almacone dbl sus strength almacone sus alosetron hcl tab 0.5 mg (base equiv). 86 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% ALUM HYDROX SUS 320/5ML amantadine hcl cap 100 mg amantadine hcl syrup 50 mg/5ml amantadine hcl tab 100 mg AMBISOME INJ 50MG amifostine crystalline for inj 500 mg amikacin sulfate inj 1 gm/4ml (250 mg/ml)... 7 amikacin sulfate inj 500 mg/2ml (250 mg/ml)... 7 amiloride & hydrochlorothiazide tab 5-50 mg amiloride hcl tab 5 mg amino acid infusion 6% aminophylline inj 25 mg/ml AMINOSYN 7% INJ /LYTES

133 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% 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 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

134 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 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 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 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 ANADROL-50 TAB 50MG anagrelide hcl cap 0.5 mg anagrelide hcl cap 1 mg anastrozole tab 1 mg ANDRODERM DIS 2MG/24HR ANDRODERM DIS 4MG/24HR animal shape chw animal shape chw + iron ANORO ELLIPT AER antacid chw 500mg antacid chw 750mg antacid fast sus relief antacid plus sus gas rel antacid sus antacid sus anti-gas antacid sus max st antacid sus reg st antacid/anti sus -gas ds anti-diarrhe tab 2mg antifungal cre 1% antifungal cre 2% anti-fungal pow 1% anti-itch cre 1% APOKYN INJ 10MG/ML apri tab APRISO CAP 0.375GM aprodine tab mg APTIOM TAB 200MG APTIOM TAB 400MG APTIOM TAB 600MG APTIOM TAB 800MG APTIVUS CAP 250MG APTIVUS SOL AQUADEKS CAP aquadeks dro ARALAST NP INJ 1000MG ARALAST NP INJ 500MG aranelle tab ARCALYST INJ 220MG aripiprazole oral solution 1 mg/ml

135 aripiprazole orally disintegrating tab 10 mg aripiprazole orally disintegrating tab 15 mg aripiprazole tab 10 mg aripiprazole tab 15 mg aripiprazole tab 2 mg aripiprazole tab 20 mg aripiprazole tab 30 mg aripiprazole tab 5 mg armodafinil tab 150 mg ARMODAFINIL TAB 200 MG armodafinil tab 250 mg armodafinil tab 50 mg ARNUITY ELPT INH 100MCG ARNUITY ELPT INH 200MCG arthrts pain tab 650mg... 1 artifi tears oin op artifi tears sol 1.4% op ASACOL HD TAB 800MG ascorbic acid chew tab 250 mg ascorbic acid chew tab 500 mg ascorbic acid tab 250 mg ascorbic acid tab 500 mg aspir-81 tab 81mg ec... 1 aspirin chew tab 81 mg... 1 aspirin low chw 81mg... 1 aspirin low tab 81mg ec... 1 aspirin suppos 300 mg... 1 aspirin suppos 600 mg... 1 aspirin tab 325 mg... 1 aspirin tab 325mg ec... 1 aspirin tab delayed release 325 mg... 1 aspirin tab delayed release 81 mg... 1 ASPIRIN-DIPYRIDAMOLE CAP SR 12HR MG aspir-low tab 81mg ec... 1 atenolol & chlorthalidone tab mg atenolol & chlorthalidone tab mg atenolol tab 100 mg atenolol tab 25 mg atenolol tab 50 mg athlete foot cre 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... 8 atovaquone-proguanil hcl tab mg atovaquone-proguanil hcl tab mg ATRIPLA TAB ATROVENT HFA AER 17MCG aubra tab AURYXIA TAB 210MG AVASTIN INJ AVASTIN INJ 400/16ML aviane tab AVITA CRE 0.025% AVITA GEL 0.025% AXIRON SOL 30MG/ACT azacitidine for inj 100 mg AZACTAM/DEX INJ 1GM... 8 AZACTAM/DEX INJ 2GM... 8 azathioprine inj 100mg 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 aztreonam for inj 1 gm... 8 aztreonam for inj 2 gm... 8 B bacitr zinc oin 500/gm bacitracin oin 500/gm bacitracin oint 500 unit/gm bacitracin ophth oint 500 unit/gm

136 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 balanc b-100 tab 100mg balanc b-50 tab balsalazide disodium cap 750 mg balziva tab banophen cap 25mg banophen cap 50mg banophen liq 12.5/5ml BANZEL SUS 40MG/ML BANZEL TAB 200MG BANZEL TAB 400MG BARACLUDE SOL.05MG/ML BCG VACCINE INJ b-complex vitamin 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 BENDEKA INJ 100/4ML BENLYSTA INJ 120MG BENLYSTA INJ 400MG benzonatate cap 100 mg benzonatate cap 150 mg benzonatate cap 200 mg benzoyl peroxide gel 10% benzoyl peroxide-erythromycin gel 5-3% BENZTROPINE MESYLATE INJ 1 MG/ML 54 benztropine mesylate tab 0.5 mg benztropine mesylate tab 1 mg benztropine mesylate tab 2 mg BEPREVE DRO 1.5% BESIVANCE SUS 0.6% 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% 117 betamethasone valerate lotion 0.1% 117 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... 8 bion tears sol op biotin cap 5 mg biotin cap 5000mcg biotin tab 300 mcg bisac-evac sup 10mg bisacodyl suppos 10 mg bisacodyl tab & peg 3350-kcl-sod bicarb-nacl for soln kit bisacodyl tab 5mg ec biscolax sup 10mg bismatrol chw 262mg bismatrol sus 262/15ml bisoprolol & hydrochlorothiazide tab mg bisoprolol & hydrochlorothiazide tab mg

137 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 1.5/ blisovi fe tab 1/ BOOSTRIX INJ BOSULIF TAB 100MG BOSULIF TAB 500MG 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% 106 BRIVIACT INJ 50MG/5ML BRIVIACT SOL 10MG/ML BRIVIACT TAB 100MG BRIVIACT TAB 10MG BRIVIACT TAB 25MG BRIVIACT TAB 50MG BRIVIACT TAB 75MG bromfenac sodium ophth soln 0.09% (base equiv) (once-daily) bromfenac sodium ophth soln 0.09% (base equivalent) bromocriptine mesylate cap 5 mg bromocriptine mesylate tab 2.5 mg brotapp dm liq / brotapp liq budesonide delayed release particles cap 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 BUPHENYL TAB 500MG 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... 4 butorphanol tartrate inj 2 mg/ml... 4 BUTRANS DIS 10MCG/HR... 4 BUTRANS DIS 15MCG/HR... 4 BUTRANS DIS 20MCG/HR... 4 BUTRANS DIS 5MCG/HR... 4 BUTRANS DIS 7.5/HR... 4 BYDUREON INJ BYETTA INJ 10MCG BYETTA INJ 5MCG BYSTOLIC TAB 10MG BYSTOLIC TAB 2.5MG BYSTOLIC TAB 20MG BYSTOLIC TAB 5MG C cabergoline tab 0.5 mg CABOMETYX TAB 20MG CABOMETYX TAB 40MG CABOMETYX TAB 60MG cafergot tab 1-100mg cal antacid chw 1000mg calc antacid chw 500mg calc antacid chw 750mg calcipotriene cream 0.005% calcipotriene soln 0.005% (50 mcg/ml) 128

138 calcitonin (salmon) nasal soln 200 unit/act calcitrate tab calcitrate tab 950mg calcitriol cap 0.25 mcg calcitriol cap 0.5 mcg calcitriol inj 1 mcg/ml calcitriol oral soln 1 mcg/ml calcium acetate (phosphate binder) cap 667 mg (169 mg ca) calcium acetate (phosphate binder) tab 667 mg calcium carbonate (antacid) tab 648 mg calcium carbonate susp 1250 mg/5ml (500 mg/5ml elemental ca) calcium carbonate tab 1250 mg (500 mg elemental ca) calcium carbonate tab 600 mg calcium carbonate-cholecalciferol chew tab 500 mg-100 unit calcium carbonate-cholecalciferol tab 500 mg-200 unit calcium carbonate-cholecalciferol tab 600 mg-200 unit calcium carbonate-cholecalciferol tab 600 mg-400 unit calcium carbonate-vitamin d tab 500 mg-200 unit CALCIUM GLUC TAB 500MG calcium polycarbophil tab 625 mg calcium/d chw cal-gest chw 500mg camila tab 0.35mg CANASA SUP 1000MG CANCIDAS INJ 50MG CANCIDAS INJ 70MG candesartan cilexetil tab 16 mg candesartan cilexetil tab 32 mg candesartan cilexetil tab 4 mg candesartan cilexetil tab 8 mg candesartan cilexetil-hydrochlorothiazide tab mg candesartan cilexetil-hydrochlorothiazide tab mg candesartan cilexetil-hydrochlorothiazide tab mg 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 100 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. 54 carbidopa & levodopa tab mg. 54 carbidopa & levodopa tab mg. 54 carbidopa & levodopa tab cr mg 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

139 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 carisoprodol tab 350 mg 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... 8 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 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. 17 celecoxib cap 100 mg... 3 celecoxib cap 200 mg... 3 celecoxib cap 400 mg... 3 celecoxib cap 50 mg... 3 CELONTIN CAP 300MG cephalexin cap 250 mg cephalexin cap 500 mg cephalexin for susp 125 mg/5ml cephalexin for susp 250 mg/5ml CERDELGA CAP 84MG CEREZYME INJ 400UNIT certavite liq antioxid CERTAVITE TAB SENIOR certavite/ tab antioxid CERVARIX INJ cetirizine hcl chew tab 10 mg cetirizine hcl oral soln 1 mg/ml (5 mg/5ml) cetirizine hcl tab 10 mg cetirizine hcl tab 5 mg cetirizine sol 5mg/5ml cetirizine syp 1mg/ml

140 cetirizine-pseudoephedrine tab sr 12hr mg cevimeline hcl cap 30 mg CHANTIX PAK 0.5& 1MG CHANTIX PAK 1MG CHANTIX TAB 0.5MG CHANTIX TAB 1MG CHEMET CAP 100MG chest conges tab mg chest conges tab 400mg chest congst tab rlf pe child asa chw 81mg... 1 child asa ls chw 81mg... 1 child silfed liq 15mg/5ml chld allergy liq 12.5/5ml chld pain rl tab 80mg... 1 chld silapap liq 160/5ml... 1 chlorhexidine gluconate soln 0.12% chloroquine phosphate tab 250 mg chloroquine phosphate tab 500 mg chlorothiazide tab 250 mg chlorothiazide tab 500 mg chlorphenir tab 4mg 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 oral liquid 400 unit/ml 102 cholecalciferol tab 1000 unit cholestyramine light powder packets 4 gm cholestyramine powder 4 gm/dose cholestyramine powder packets 4 gm.. 36 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 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 1000 mg(base eq) ciprofloxacin-ciprofloxacin hcl tab sr 24hr 500 mg (base eq) cisplatin inj 100 mg/100ml (1 mg/ml). 28 cisplatin inj 200 mg/200ml (1 mg/ml). 28 cisplatin inj 50 mg/50ml (1 mg/ml) 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) cladribine iv soln 10 mg/10ml (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 cld head cng tab nighttim clearlax pow

141 clindamax gel 1% clindamycin hcl cap 150 mg... 8 clindamycin hcl cap 300 mg... 8 clindamycin hcl cap 75 mg... 8 clindamycin palmitate hcl for soln 75 mg/5ml (base equiv)... 8 clindamycin phosphate gel 1% clindamycin phosphate in d5w iv soln 300 mg/50ml... 8 clindamycin phosphate in d5w iv soln 600 mg/50ml... 8 clindamycin phosphate in d5w iv soln 900 mg/50ml... 8 clindamycin phosphate inj 300 mg/2ml. 8 clindamycin phosphate inj 600 mg/4ml. 9 clindamycin phosphate inj 9 gm/60ml.. 8 clindamycin phosphate inj 900 mg/6ml. 9 clindamycin phosphate iv soln 300 mg/2ml... 9 clindamycin phosphate iv soln 900 mg/6ml... 9 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 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 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.. 45 clorazepate dipotassium tab 7.5 mg clotrimazole cre 1% 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 COARTEM TAB MG colchicine w/ probenecid tab mg... 1 COLCRYS TAB 0.6MG... 1 cold/allergy elx children cold/cough elx child colestipol hcl granule packets 5 gm colestipol hcl granules 5 gm colestipol hcl tab 1 gm colistimethate sodium for inj 150 mg... 9 COMBIGAN SOL 0.2/0.5% COMBIVENT AER COMETRIQ KIT 100MG

142 COMETRIQ KIT 140MG COMETRIQ KIT 60MG COMPLERA TAB compro sup 25mg constulose sol 10gm/ COPAXONE INJ 40MG/ML cortisone acetate tab 25 mg COTELLIC TAB 20MG cough & cold tab cough cont liq dm max cough syp 100/5ml coughtab tab 200mg 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 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 cromolyn sodium soln nebu 20 mg/2ml cryselle-28 tab 28 tabs CUBICIN SOL 500MG... 9 cvs iron tab 27mg cyanocobalamin inj 1000 mcg/ml cyanocobalamin tab 1000 mcg cyclafem tab 1/ cyclafem tab 7/7/ cyclobenzaprine hcl tab 10 mg cyclobenzaprine hcl tab 5 mg 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 cyproheptadine hcl syrup 2 mg/5ml cyproheptadine hcl tab 4 mg CYSTADANE POW CYSTAGON CAP 150MG CYSTAGON CAP 50MG CYSTARAN SOL 0.44% cytarabine inj 20 mg/ml D D10W/NACL INJ 0.2% D5W/LYTES INJ # D5W/NACL INJ 0.3% dacarbazine for inj 100 mg dacarbazine for inj 200 mg DAKLINZA TAB 30MG DAKLINZA TAB 60MG DAKLINZA TAB 90MG 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... 9 dapsone tab 25 mg... 9 DAPTACEL INJ daunorubicin hcl inj 5 mg/ml (base equiv) deblitane tab 0.35mg deep sea spr 0.65% DELESTROGEN INJ 10MG/ML delyla tab DELZICOL CAP 400MG DEMSER CAP 250MG DEPEN TITRA TAB 250MG DEPO-PROVERA INJ 400/ML DESCOVY TAB 200/ desipramine hcl tab 10 mg

143 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 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 desoximetasone cream 0.05% desoximetasone cream 0.25% 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 inj 4 mg/ml 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 dexrazoxane for inj 500 mg DEXTROSE 10% W/ SODIUM CHLORIDE 0.45% DEXTROSE 2.5% W/ SODIUM CHLORIDE 0.45% DEXTROSE 5% IN LACTATED RINGERS99 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% diazepam con 5mg/ml diazepam inj 5 mg/ml diazepam oral soln 1 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 tab 10 mg diazepam tab 2 mg diazepam tab 5 mg diclofenac potassium tab 50 mg... 3 diclofenac sodium gel 1% diclofenac sodium ophth soln 0.1% diclofenac sodium tab delayed release 25 mg... 3 diclofenac sodium tab delayed release 50 mg... 3 diclofenac sodium tab delayed release 75 mg... 3 diclofenac sodium tab sr 24hr 100 mg.. 3 dicloxacillin sodium cap 250 mg dicloxacillin sodium cap 500 mg dicyclomine hcl cap 10 mg dicyclomine hcl oral soln 10 mg/5ml

144 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 diflunisal tab 500 mg... 3 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 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 dimaphen dm elx diocto liq 50mg/5ml diocto syp 60/15ml DIP/TET PED INJ 25-5LFU DIPENTUM CAP 250MG diphenhist liq 12.5/5ml diphenhist tab 25mg diphenhydramine hcl cap 25 mg 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.. 34 disopyramide phosphate cap 150 mg.. 34 disulfiram tab 250 mg disulfiram tab 500 mg divalproex sodium cap delayed release 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 mg46 divalproex sodium tab sr 24 hr 500 mg46 DOCEFREZ INJ 20MG DOCETAXEL FOR INJ CONC 20 MG/ML 24 docetaxel inj 140/7ml DOCETAXEL INJ 160/16ML DOCETAXEL INJ 160/8ML DOCETAXEL INJ 200MG/ DOCETAXEL INJ 20MG/2ML

145 DOCETAXEL INJ 80MG/4ML DOCETAXEL INJ 80MG/8ML docqlace cap 100mg doc-q-lax tab mg docu liq 50mg/5ml docusate sod cap 100mg docusate sodium cap 100 mg docusate sodium liquid 150 mg/15ml.. 84 docusil cap 100mg docusol mini ene DOFETILIDE CAP 125 MCG (0.125 MG) 34 DOFETILIDE CAP 250 MCG (0.25 MG).. 34 DOFETILIDE CAP 500 MCG (0.5 MG) dok cap 100mg 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 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 doxepin hcl cap 50 mg doxepin hcl cap 75 mg doxepin hcl conc 10 mg/ml DOXEPIN HCL CREAM 5% 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. 21 doxycycline monohydrate cap 50 mg.. 21 doxycycline monohydrate tab 100 mg. 21 doxycycline monohydrate tab 150 mg. 21 doxycycline monohydrate tab 50 mg.. 21 doxycycline monohydrate tab 75 mg.. 21 driminate tab 50mg 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 ducodyl tab 5mg ec duloxetine hcl enteric coated pellets cap 20 mg duloxetine hcl enteric coated pellets cap 30 mg duloxetine hcl enteric coated pellets cap 60 mg DURAMORPH INJ 0.5MG/ML... 5 DURAMORPH INJ 1MG/ML... 5 DUREZOL EMU 0.05% dutasteride cap 0.5 mg dutasteride-tamsulosin hcl cap mg E e.e.s. 400 tab 400mg econtra ez tab 1.5mg ecpirin tab 325mg ec... 2 ed a-hist tab 4-10mg EDURANT TAB 25MG EFFIENT TAB 10MG EFFIENT TAB 5MG ELDERTONIC ELX ELITEK INJ 1.5MG ELITEK INJ 7.5MG elixophyllin elx 80/15ml ELLA TAB 30MG ELMIRON CAP 100MG EMCYT CAP 140MG

146 EMEND CAP 125MG EMEND CAP 40MG EMEND CAP 80MG EMEND PAK 80 & EMEND SUS 125MG emoquette tab EMSAM DIS 12MG/24H EMSAM DIS 6MG/24HR EMSAM DIS 9MG/24HR EMTRIVA CAP 200MG EMTRIVA SOL 10MG/ML emverm chw 100mg... 9 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 endacof-dm liq endocet tab mg... 5 endocet tab 5-325mg... 5 endocet tab enemeez mini ene enemeez plus ene ENGERIX-B INJ 10/0.5ML ENGERIX-B INJ 20MCG/ML enoxaparin sodium inj 100 mg/ml enoxaparin sodium inj 120 mg/0.8ml.. 90 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 ENTRESTO TAB 24-26MG ENTRESTO TAB 49-51MG ENTRESTO TAB MG enulose sol 10gm/ 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 EPZICOM TAB ergocalciferol cap unit ergocalciferol soln 8000 unit/ml 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

147 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 73 estradiol valerate im in oil 20 mg/ml estradiol valerate im in oil 40 mg/ml eszopiclone tab 1 mg eszopiclone tab 2 mg eszopiclone tab 3 mg ethambutol hcl tab 100 mg ethambutol hcl tab 400 mg ethosuximide cap 250 mg ethosuximide soln 250 mg/5ml etodolac cap 200 mg... 3 etodolac cap 300 mg... 3 etodolac tab 400 mg... 3 etodolac tab 500 mg... 3 etodolac tab sr 24hr 400 mg... 3 etodolac tab sr 24hr 500 mg... 3 etodolac tab sr 24hr 600 mg... 3 etoposide inj 100 mg/5ml (20 mg/ml). 29 etoposide inj 500 mg/25ml (20 mg/ml) EURAX CRE 10% EURAX LOT 10% EVOTAZ TAB exemestane tab 25 mg EXJADE TAB 125MG EXJADE TAB 250MG EXJADE TAB 500MG extra action syp / eye drops dro % F FABRAZYME INJ 35MG FABRAZYME INJ 5MG fallback tab 1.5mg 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 10 mg famotidine tab 10mg famotidine tab 20 mg 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% 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 feminine lax tab 5mg ec 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... 5 fentanyl citrate lozenge on a handle 1600 mcg... 5 fentanyl citrate lozenge on a handle 200 mcg... 5 fentanyl citrate lozenge on a handle 400 mcg... 5 fentanyl citrate lozenge on a handle

148 mcg... 5 fentanyl citrate lozenge on a handle 800 mcg... 5 fentanyl td patch 72hr 100 mcg/hr... 5 fentanyl td patch 72hr 12 mcg/hr... 5 fentanyl td patch 72hr 25 mcg/hr... 5 fentanyl td patch 72hr 50 mcg/hr... 5 fentanyl td patch 72hr 75 mcg/hr... 5 FENTORA TAB 100MCG... 5 FENTORA TAB 200MCG... 5 FENTORA TAB 400MCG... 5 FENTORA TAB 600MCG... 5 FENTORA TAB 800MCG... 5 ferosul elx 220/5ml FERRIPROX SOL 100MG/ML FERRIPROX TAB 500MG FERROUS GLUC TAB 324MG ferrous gluconate tab 324 mg (37.5 mg elemental iron) FERROUS SUL LIQ 220/5ML FERROUS SULF SYP 300/5ML FERROUS SULF TAB 324MG EC ferrous sulfate elixir 220 mg/5ml (44 mg/5ml elemental fe) ferrous sulfate soln 75 mg/ml (15 mg/ml elemental fe) ferrous sulfate tab 325 mg (65 mg elemental fe) ferrous sulfate tab ec 325 mg (65 mg fe equivalent) ferrousul tab 325mg FETZIMA CAP 120MG FETZIMA CAP 20MG FETZIMA CAP 40MG FETZIMA CAP 80MG FETZIMA CAP TITRATIO FEVERALL INF SUP 80MG... 2 FEVERALL SUP 120MG... 2 FEVERALL SUP 325MG... 2 FEVERALL SUP 650MG... 2 fexofenadine hcl tab 180 mg fexofenadine hcl tab 60 mg fexofenadine sus 30mg/5ml fexofenadine tab 180mg fexofenadine tab 60mg fiber laxatv tab 625mg fiber therap pow 58.6% fiber-caps tab 625mg fiber-lax tab 625mg finasteride tab 5 mg FIRAZYR INJ 30MG/3ML FLEBOGAMMA INJ 10/200ML FLEBOGAMMA INJ 20/400ML 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 fleet laxati tab 5mg ec FLOVENT DISK AER 100MCG FLOVENT DISK AER 250MCG FLOVENT DISK AER 50MCG FLOVENT HFA AER 110MCG FLOVENT HFA AER 220MCG FLOVENT HFA AER 44MCG fluconazole for susp 10 mg/ml fluconazole for susp 40 mg/ml fluconazole in dextrose inj 200 mg/100ml fluconazole in dextrose inj 400 mg/200ml fluconazole in nacl 0.9% inj 200 mg/100ml fluconazole in nacl 0.9% inj 400 mg/200ml 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% 118 fluocinolone acetonide cream 0.025% 118 fluocinolone acetonide oint 0.025% fluocinolone acetonide soln 0.01%

149 fluocinonide cream 0.05% fluocinonide emulsified base cream 0.05% fluocinonide gel 0.05% fluocinonide soln 0.05% FLUOROMETHOLONE OPHTH SUSP 0.1% fluorouracil cream 5% fluorouracil inj 1 gm/20ml (50 mg/ml). 23 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) 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... 3 flurbiprofen tab 50 mg... 3 flutamide cap 125 mg fluticasone propionate cream 0.05%. 118 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 folic acid inj 5 mg/ml folic acid tab 1 mg folic acid tab 400 mcg 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% furosemide inj 10 mg/ml FUROSEMIDE INJ 10 MG/ML furosemide oral soln 10 mg/ml furosemide oral soln 8 mg/ml furosemide tab 20 mg furosemide tab 40 mg furosemide tab 80 mg FUSILEV INJ 50MG FUZEON INJ 90MG FYCOMPA SUS 0.5MG/ML 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

150 galantamine hydrobromide oral soln 4 mg/ml galantamine hydrobromide tab 12 mg. 50 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 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 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" gavilax pow 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 HCL INJ 1 GM/26.3ML (38 MG/ML) (BASE EQUIV) GEMCITABINE HCL INJ 2 GM/52.6ML (38 MG/ML) (BASE EQUIV) GEMCITABINE HCL INJ 200 MG/5.26ML (38 MG/ML) (BASE EQUIV) 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... 7 gentam/nacl inj 1.4mg/ml... 7 gentamicin in saline inj 0.8 mg/ml... 7 gentamicin in saline inj 1 mg/ml... 7 gentamicin in saline inj 1.2 mg/ml... 7 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... 8 gentamicin sulfate inj 40 mg/ml... 8 gentamicin sulfate iv soln 10 mg/ml... 8 gentamicin sulfate oint 0.1% gentamicin sulfate ophth oint 0.3% gentamicin sulfate ophth soln 0.3% GENTEAL GEL 0.3% 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 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 141

151 glipizide-metformin hcl tab mg.. 67 GLUCAGEN INJ HYPOKIT GLUCAGON KIT 1MG glyburide micronized tab 1.5 mg glyburide micronized tab 3 mg glyburide micronized tab 6 mg glyburide tab 1.25 mg glyburide tab 2.5 mg glyburide tab 5 mg glycerin sup 1gm glycolax pow 3350 nf glycopyrrolate inj 4 mg/20ml (0.2 mg/ml) glycopyrrolate tab 1 mg glycopyrrolate tab 2 mg gnp all day tab allergy gnp allergy cap 25mg gnp allergy tab 180mg gnp antacid sus anti-gas gnp aspirin chw 81mg... 2 gnp aspirin tab 325mg ec... 2 gnp bisa-lax tab 5mg ec gnp cld/alle elx children gnp clearlax pow gnp cold/cgh elx child gnp laxative tab 5mg ec gnp masanti sus reg st gnp milk mag sus gnp mucus-er tab 600mg gnp nicotine gum 4mg mint gnp nicotine loz 2mg mint gnp nicotine loz 4mg mint gnp nicotine loz mini 2mg gnp tussin liq dm gnp tussin liq dm max gnp tussin syp 100/5ml gnp tussin syp cf GOLYTELY SOL 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 11 griseofulvin ultramicrosize tab 250 mg 11 guaifenesin tab sr 12hr 1200 mg guaifenesin tab sr 12hr 600 mg 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) H halobetasol propionate cream 0.05% 118 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. 57 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 HAVRIX INJ 1440UNIT HAVRIX INJ 720UNIT healthylax pow heartburn chw ex st heartburn tab 150mg heartburn tab 200mg heartburn tab relief heartburn tr cap 15mg 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

152 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 hm allergy tab 25mg hm allergy tab 4mg hm antacid sus anti-gas hm aspirin chw 81mg... 2 hm aspirin tab 325mg... 2 hm clearlax pow hm enema ene r-t-u hm fiber pow 58.6% HM GLUCOSE CHW ORANGE HM GLUCOSE CHW RASPBERY hm hydrocort cre 1% plus hm ibuprofen tab 200mg... 3 hm mucus er tab 600mg HM NICOTINE DIS 14MG/24H HM NICOTINE DIS 21MG/24H hm tussin liq adlt dm HUMIRA INJ 10MG/ HUMIRA KIT 20MG/ HUMIRA KIT 40MG/ HUMIRA PEDIA INJ CROHNS 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 hydrocodone-acetaminophen soln mg/15ml... 5 hydrocodone-acetaminophen tab mg... 5 hydrocodone-acetaminophen tab mg... 5 hydrocodone-acetaminophen tab mg... 5 hydrocodone-ibuprofen tab mg 5 hydrocort cre 1% hydrocort oin 1% hydrocort/ cre aloe 1% hydrocortisone butyrate cream 0.1% 118 hydrocortisone butyrate oint 0.1% hydrocortisone butyrate soln 0.1% hydrocortisone cream 1% hydrocortisone cream 2.5% hydrocortisone enema 100 mg/60ml.. 83 HYDROCORTISONE ENEMA 100 MG/60ML hydrocortisone lotion 2.5% 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% 118 hydrocortisone valerate oint 0.2% hydrocortisone-aloe vera cream 1%. 119 hydromorphone hcl liqd 1 mg/ml... 5 hydromorphone hcl preservative free (pf) inj 10 mg/ml... 5 hydromorphone hcl tab 2 mg... 6 hydromorphone hcl tab 4 mg... 6 hydromorphone hcl tab 8 mg... 6 hydroskin cre 1% hydroskin lot 1% hydroxocobalamin inj 1000 mcg/ml hydroxychloroquine sulfate tab 200 mg hydroxyprogesterone caproate im in oil 1.25 gm/5ml 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

153 hydroxyzine pamoate cap 50 mg I IBRANCE CAP 100MG IBRANCE CAP 125MG IBRANCE CAP 75MG ibu-200 tab 200mg... 3 ibuprofen cap 200mg... 3 ibuprofen sus 100/5ml... 3 ibuprofen susp 100 mg/5ml... 3 ibuprofen tab 200 mg... 3 ibuprofen tab 200mg... 3 ibuprofen tab 400 mg... 3 ibuprofen tab 600 mg... 3 ibuprofen tab 800 mg... 4 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) iferex 150 cap 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 imatinib mesylate tab 100 mg (base equivalent) imatinib mesylate tab 400 mg (base equivalent) IMBRUVICA CAP 140MG imipenem-cilastatin intravenous for soln 250 mg... 9 imipenem-cilastatin intravenous for soln 500 mg... 9 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 INCRUSE ELPT INH 62.5MCG indapamide tab 1.25 mg indapamide tab 2.5 mg INFANRIX INJ INFED INJ 50MG/ML INLYTA TAB 1MG INLYTA TAB 5MG INSULIN PEN NEEDLE INSULIN SAFETY NEEDLES INSULIN SYRINGE INTELENCE TAB 100MG INTELENCE TAB 200MG INTELENCE TAB 25MG 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... 9 INVEGA SUST INJ 117/ INVEGA SUST INJ 156MG/ML INVEGA SUST INJ 234/ INVEGA SUST INJ 39/ INVEGA SUST INJ 78/0.5ML 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 144

154 (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) 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 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 120 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... 9 IXIARO INJ J JAKAFI TAB 10MG JAKAFI TAB 15MG JAKAFI TAB 20MG JAKAFI TAB 25MG JAKAFI TAB 5MG 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 JENTADUETO TAB XR jinteli tab 1mg-5mcg JOLIVETTE TAB 0.35MG juleber tab 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 kao-tin cap 240mg kariva tab 28 day

155 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... 4 ketoprofen cap 75 mg... 4 ketorolac tromethamine ophth soln 0.4% ketorolac tromethamine ophth soln 0.5% 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 konsyl fiber tab 625mg KONSYL POW 100% konsyl pow 30.9% KONSYL POW 60.3% KONSYL POW 71.67% KONSYL-D POW 52.3% KORLYM TAB 300MG 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 LACTATED RINGER'S SOLUTION lactic acid (ammonium lactate) cream 12% lactic acid (ammonium lactate) lotion 12% lactulose (encephalopathy) solution 10 gm/15ml lactulose solution 10 gm/15ml lamisil af aer 1% 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 lansoprazole cap delayed release 15 mg lansoprazole cap delayed release 30 mg LANTUS INJ 100/ML LANTUS INJ SOLOSTAR larin fe tab 1.5/

156 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/stl soft tab mg laxative sup 10mg laxative tab 25mg laxative tab 5mg ec leflunomide tab 10 mg leflunomide tab 20 mg LENVIMA CAP 10 MG LENVIMA CAP 14 MG LENVIMA CAP 18 MG LENVIMA CAP 20 MG LENVIMA CAP 24 MG LENVIMA CAP 8 MG lessina tab LETAIRIS TAB 10MG LETAIRIS TAB 5MG 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 for inj 500 mg leucovorin calcium tab 10 mg leucovorin calcium tab 15 mg leucovorin calcium tab 25 mg leucovorin calcium tab 5 mg 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 0.5% 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 sol 250mg/ levoleucovorin calcium inj 175 mg/17.5ml (base equiv) 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 & ethinyl estradiol tab 0.15 mg-30 mcg levonorgestrel tab 1.5 mg levonorgestrel-eth estra tab / / mg-mcg 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

157 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 sha % lice treatmt lot 1% lice treatmt sha % lice trtmnt liq 1% lidocaine hcl gel 2% lidocaine hcl local inj 0.5%... 7 lidocaine hcl local inj 1%... 7 lidocaine hcl local inj 1.5%... 7 lidocaine hcl local inj 2%... 7 lidocaine hcl local preservative free (pf) inj 0.5%... 7 lidocaine hcl local preservative free (pf) inj 1%... 7 lidocaine hcl soln 4% lidocaine hcl viscous soln 2% lidocaine oint 5% lidocaine patch 5% lidocaine-prilocaine cream %. 119 LINEZOLID FOR SUSP 100 MG/5ML... 9 LINEZOLID IN SODIUM CHLORIDE IV SOLN 600 MG/300ML-0.9%... 9 linezolid iv soln 600 mg/300ml (2 mg/ml)... 9 LINEZOLID TAB 600 MG... 9 LINZESS CAP 145MCG LINZESS CAP 290MCG liothyronine sodium tab 25 mcg liothyronine sodium tab 5 mcg liothyronine sodium tab 50 mcg 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 LONSURF TAB LONSURF TAB loperamide hcl cap 2 mg loperamide hcl liq 1 mg/5ml (0.2 mg/ml) loratadine sol 5mg/5ml loratadine syp 5mg/5ml loratadine tab 10 mg loratadine tab 10mg lorata-dine tab d 24hr loratadine-d tab mg loratadine-d tab 5-120mg 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

158 losartan potassium tab 25 mg losartan potassium tab 50 mg LOTEMAX GEL 0.5% LOTEMAX OIN 0.5% LOTEMAX SUS 0.5% 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 lubricant dro eye lubricating sol % lubricating sol 0.5% lubricnt eye dro 0.5% op lubricnt gel dro lubrifresh oin p.m LUMIGAN SOL 0.01% LUMIZYME INJ 50MG LUPR DEP-PED INJ 11.25MG LUPR DEP-PED INJ 15MG LUPR DEP-PED INJ 30MG 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 mag64 tab 64mg mag-al plus liq MAGNEBIND TAB magnesium citrate soln magnesium oxide tab 400 mg (241.3 mg elemental mg) magnesium oxide tab 420 mg magnesium oxide tab 500 mg (mg supplement) MAGNESIUM SU INJ 20/500ML MAGNESIUM SU INJ 2GM/50ML MAGNESIUM SU INJ 40G/ MAGNESIUM SU INJ 4G/100ML MAGNESIUM SU INJ 80MG/ML magnesium sulfate inj 50% MAGNESIUM SULFATE INJ 50% magnesium sulfate iv soln 2 gm/50ml (40 mg/ml) magnesium tab 250 mg malathion lotion 0.5% mapap cap 500mg... 2 mapap child tab 80mg rt... 2 mapap chw 80mg... 2 mapap liq 160/5ml... 2 mapap tab 325mg... 2 mapap tab 500mg... 2 mapap tab 500mg/rr... 2 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 chew tab 25 mg 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 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... 4 meloxicam tab 15 mg... 4 meloxicam tab 7.5 mg

159 melphalan hcl for inj 50 mg (base equiv) memantine hcl oral solution 2 mg/ml.. 50 MEMANTINE HCL TAB 10 MG memantine hcl tab 5 mg MENACTRA INJ MENHIBRIX INJ MENOMUNE INJ A/C/Y/W MENVEO INJ MEPHYTON TAB 5MG mercaptopurine tab 50 mg meribin cap 5mg meropenem iv for soln 1 gm... 9 meropenem iv for soln 500 mg... 9 mesalamine enema 4 gm mesalamine rectal enema 4 gm & cleanser wipe kit mesna inj 100 mg/ml MESNEX TAB 400MG 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... 6 methadone hcl soln 10 mg/5ml... 6 methadone hcl soln 5 mg/5ml... 6 methadone hcl tab 10 mg... 6 methadone hcl tab 5 mg... 6 methazolamide tab 25 mg methazolamide tab 50 mg methenamine hippurate tab 1 gm... 9 methimazole tab 10 mg methimazole tab 5 mg methocarbamol tab 500 mg methocarbamol tab 750 mg methotrexate sodium for inj 1 gm methotrexate sodium inj 250 mg/10ml (25 mg/ml) METHOTREXATE SODIUM INJ 50 MG/2ML (25 MG/ML) methotrexate sodium inj pf 100 mg/4ml (25 mg/ml) methotrexate sodium inj pf 1000 mg/40ml (25 mg/ml) methotrexate sodium inj pf 200 mg/8ml (25 mg/ml) methotrexate sodium inj pf 250 mg/10ml (25 mg/ml) methotrexate sodium inj pf 50 mg/2ml (25 mg/ml) methotrexate sodium tab 2.5 mg (base equiv) methyclothiazide tab 5 mg methylergonovine maleate tab 0.2 mg 76 methylphenidate hcl soln 10 mg/5ml.. 60 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 8 mg methylprednisolone tab therapy pack 4 mg (21) 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 (tartrate equiv) metoprolol succinate tab sr 24hr 200 mg 150

160 (tartrate equiv) metoprolol succinate tab sr 24hr 25 mg (tartrate equiv) metoprolol succinate tab sr 24hr 50 mg (tartrate equiv) 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... 9 metronidazole lotion 0.75% metronidazole tab 250 mg... 9 metronidazole tab 500 mg... 9 metronidazole vaginal gel 0.75% mexiletine hcl cap 150 mg mexiletine hcl cap 200 mg mexiletine hcl cap 250 mg MG SO4/D5W INJ 10MG/ML MG SO4/D5W INJ 20MG/ML MIACALCIN INJ 200/ML mi-acid chw mi-acid sus mi-acid sus max st miconazole 7 cre 2% miconazole 7 sup 100mg miconazole nitrate cream 2% miconazole nitrate vaginal cream 2%.. 89 miconazole nitrate vaginal suppos 100 mg midodrine hcl tab 10 mg midodrine hcl tab 2.5 mg midodrine hcl tab 5 mg migergot sup 2/ milk of magn sus milk of magn sus 1200/ milk of magn sus 400/5ml milk of magn sus cherry milk of magn sus frsh mnt milk of magn sus mint MINERAL OIL 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 mintox sus 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 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 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)

161 montelukast sodium oral granules packet 4 mg (base equiv) montelukast sodium tab 10 mg (base equiv) MORPHINE SUL INJ 150/30ML... 6 MORPHINE SUL INJ 2MG/ML... 6 MORPHINE SUL INJ 4MG/ML... 6 MORPHINE SUL INJ 8MG/ML... 6 morphine sulfate inj pf 0.5 mg/ml... 6 morphine sulfate inj pf 1 mg/ml... 6 MORPHINE SULFATE IV SOLN 1 MG/ML 6 MORPHINE SULFATE IV SOLN PF 10 MG/ML... 6 MORPHINE SULFATE IV SOLN PF 15 MG/ML... 6 morphine sulfate iv soln pf 4 mg/ml... 6 morphine sulfate iv soln pf 8 mg/ml... 6 MORPHINE SULFATE ORAL SOLN 10 MG/5ML... 6 MORPHINE SULFATE ORAL SOLN 100 MG/5ML (20 MG/ML)... 6 MORPHINE SULFATE ORAL SOLN 20 MG/5ML... 6 MORPHINE SULFATE TAB 15 MG... 6 MORPHINE SULFATE TAB 30 MG... 6 morphine sulfate tab cr 100 mg... 6 morphine sulfate tab cr 15 mg... 6 morphine sulfate tab cr 200 mg... 6 morphine sulfate tab cr 30 mg... 6 morphine sulfate tab cr 60 mg... 6 motion sick tab 50mg motion-time chw 25mg MOVANTIK TAB 12.5MG MOVANTIK TAB 25MG MOVIPREP SOL MOXEZA SOL 0.5% moxifloxacin hcl tab 400 mg (base equiv) MOZOBIL INJ mucaphed tab mg mucinex dm liq mucus relief liq 100/5ml mucus relief liq 5-100mg mucus relief tab 400mg mucus relief tab dm mucus relief tab pe mucus+chst liq 100/5ml mucus-dm max tab mucus-er tab 600mg mucusrelief tab sinus MULTAQ TAB 400MG multiple vitamins w/ minerals tab mupirocin oint 2% MURO 128 OIN 5% OP 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) myorisan cap 10mg myorisan cap 20mg myorisan cap 30mg myorisan cap 40mg MYRBETRIQ TAB 25MG MYRBETRIQ TAB 50MG myzilra tab N nabumetone tab 500 mg... 4 nabumetone tab 750 mg... 4 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... 4 nalbuphine hcl inj 20 mg/ml... 4 naloxone hcl inj 0.4 mg/ml naloxone hcl inj 1 mg/ml naltrexone hcl tab 50 mg NAMENDA XR CAP 14MG NAMENDA XR CAP 21MG NAMENDA XR CAP 28MG NAMENDA XR CAP 7MG NAMENDA XR CAP TITRATIO

162 NAMZARIC CAP 14-10MG NAMZARIC CAP 28-10MG naphazoline hcl ophth soln 0.1% naproxen dr tab 375mg... 4 naproxen dr tab 500mg... 4 naproxen sodium tab 275 mg... 4 naproxen sodium tab 550 mg... 4 naproxen susp 125 mg/5ml... 4 naproxen tab 250 mg... 4 naproxen tab 375 mg... 4 naproxen tab 500 mg... 4 naratriptan hcl tab 1 mg (base equiv).. 62 naratriptan hcl tab 2.5 mg (base equiv) nasal 12 hr spr 0.05% nasal decon syp 30mg/5ml NASAL DECONG LIQ 30MG/5ML nasal decong spr 0.05% nasal decong tab 10mg nasal decong tab 30mg NASCOBAL SPR 500MCG 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 naturl fiber pow therapy NEBUPENT INH 300MG... 9 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... 8 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% 121 neomycin-polymyxin-hc otic susp 3.5 mg/ml unit/ml-1% NEORAL CAP 100MG NEORAL CAP 25MG NEORAL SOL 100MG/ML NEPHRAMINE INJ 5.4% 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 NEXAVAR TAB 200MG NEXIUM GRA 10MG DR NEXIUM GRA 2.5MG DR NEXIUM GRA 20MG DR NEXIUM GRA 40MG DR NEXIUM GRA 5MG DR next choice tab 1.5mg niacin cap cr 500 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) niacin tab cr 750 mg (antihyperlipidemic) niacinamide tab 500 mg niacor tab 500mg nicardipine hcl cap 20 mg nicardipine hcl cap 30 mg nicorelief gum 2mg mint nicorelief gum 2mg orig nicorelief gum 4mg mint

163 nicorelief gum 4mg orig nicotine polacrilex gum 2 mg nicotine polacrilex gum 4 mg nicotine polacrilex lozenge 2 mg nicotine polacrilex lozenge 4 mg NICOTINE TD DIS 7MG/24HR nicotine td patch 24hr 14 mg/24hr NICOTINE TD PATCH 24HR 14 MG/24HR nicotine td patch 24hr 21 mg/24hr NICOTINE TD PATCH 24HR 21 MG/24HR nicotine td patch 24hr 7 mg/24hr NICOTINE TD PATCH 24HR 7 MG/24HR64 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 tab 25mg nighttime tab 25mg nikki tab mg NILANDRON TAB 150MG nilutamide tab 150 mg 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... 9 nitrofurantoin macrocrystalline cap 50 mg... 9 nitrofurantoin monohydrate macrocrystalline cap 100 mg... 9 nitroglycerin td patch 24hr 0.1 mg/hr.. 43 nitroglycerin td patch 24hr 0.2 mg/hr.. 43 nitroglycerin td patch 24hr 0.4 mg/hr. 43 nitroglycerin td patch 24hr 0.6 mg/hr. 43 NITROSTAT SUB 0.3MG NITROSTAT SUB 0.4MG NITROSTAT SUB 0.6MG no drip nasl spr 0.05% non-aspirin tab 325mg... 2 non-aspirin tab 500mg... 2 non-aspirin tab 500mg/rr... 2 NORDITROPIN INJ 10/1.5ML NORDITROPIN INJ 15/1.5ML NORDITROPIN INJ 30/3ML NORDITROPIN INJ 5/1.5ML 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 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 NORTHERA CAP 100MG NORTHERA CAP 200MG NORTHERA CAP 300MG nortrel tab 0.5/

164 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 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 nrs nasal spr 0.05% NUEDEXTA CAP 20-10MG NULOJIX INJ 250MG NULYTELY SOL FLAV PKS NUPLAZID TAB 17MG NUVARING MIS nyamyc pow NYMALIZE SOL 60/20ML 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) ocuvite tab ODEFSEY TAB 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 omega-3-acid ethyl esters cap 1 gm omeprazole cap delayed release 10 mg88 omeprazole cap delayed release 20 mg88 omeprazole cap delayed release 40 mg88 OMEPRAZOLE TAB 20MG ONCOVITE TAB 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 mg ondansetron orally disintegrating tab 8 mg one daily tab one daily tab mens ONFI SUS 2.5MG/ML ONFI TAB 10MG ONFI TAB 20MG

165 opcicon tab 1.5mg OPSUMIT TAB 10MG ORA-BLEND SF SUS ORA-BLEND SUS ORA-PLUS LIQ ORA-SWEET SF SYP ORA-SWEET SYP ORFADIN CAP 10MG ORFADIN CAP 2MG ORFADIN CAP 5MG ORFADIN SUS 4MG/ML organ-i nr tab 200mg ORKAMBI TAB orsythia tab os-cal extra tab d 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 89 oxybutynin chloride tab sr 24hr 15 mg 89 oxybutynin chloride tab sr 24hr 5 mg.. 89 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... 7 oxycodone hcl tab 30 mg... 7 oxycodone hcl tab 5 mg... 6 oxycodone w/ acetaminophen soln mg/5ml... 7 oxycodone w/ acetaminophen tab mg... 7 oxycodone w/ acetaminophen tab mg... 7 oxycodone w/ acetaminophen tab mg... 7 oxycodone w/ acetaminophen tab mg... 7 OXYCONTIN TAB 10MG CR... 7 OXYCONTIN TAB 15MG CR... 7 OXYCONTIN TAB 20MG CR... 7 OXYCONTIN TAB 30MG CR... 7 OXYCONTIN TAB 40MG CR... 7 OXYCONTIN TAB 60MG CR... 7 OXYCONTIN TAB 80MG CR... 7 oysco 500 tab 500mg oysco 500+d tab oyst shell/d tab 500mg oyster shell calcium tab 500 mg 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 & fever chw 80mg... 2 pain & fever sol 160/5ml... 2 pain & fever sus 160/5ml... 2 pain & fever tab 325mg... 2 pain & fever tab 500mg... 2 pain relief dro 80/0.8ml... 2 pain relief sus 160/5ml... 2 pain relief tab 325mg... 2 pain relief tab 500mg... 2 pain relieve tab 325mg... 2 pain relieve tab 500mg... 2 pain relieve tab 500mg/rr... 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 for inj 30 mg pamidronate disodium for inj 90 mg pamidronate disodium iv soln 3 mg/ml 68 pamidronate disodium iv soln 9 mg/ml

166 pamidronate inj 6mg/ml 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... 8 paroxetine hcl tab 10 mg paroxetine hcl tab 20 mg paroxetine hcl tab 30 mg paroxetine hcl tab 40 mg paser gra 4gm PATADAY SOL 0.2% PAXIL SUS 10MG/5ML PAZEO DRO 0.7% ped elctrlyt sol grape pedia relief liq cgh/cold PEDIARIX INJ 0.5ML pediatric liq cgh/cold 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 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 PENTACEL INJ PENTAM 300 INJ 300MG pentoxifylline tab cr 400 mg peptic relf chw 262mg peptic relf sus 262/15ml perindopril erbumine tab 2 mg perindopril erbumine tab 4 mg perindopril erbumine tab 8 mg periogard sol 0.12% permethrin cream 5% perphenazine tab 16 mg perphenazine tab 2 mg perphenazine tab 4 mg perphenazine tab 8 mg pharbechlor tab 4mg pharbedryl cap 25mg pharbetol tab 325mg... 2 pharbetol tab 500mg... 2 phenadoz sup 12.5mg phenelzine sulfate tab 15 mg phenergan sup 12.5mg phenergan sup 25mg phenergan sup 50mg PHENHIST DH LIQ PHENOBARB INJ 65MG/ML phenobarbital elixir 20 mg/5ml phenobarbital sodium inj 130 mg/ml.. 48 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 PHOSPHOLINE SOL 0.125%OP

167 phytonadione inj 1 mg/0.5ml (2 mg/ml) phytonadione inj 10 mg/ml PILOCARPINE HCL OPHTH SOLN 1%. 106 PILOCARPINE HCL OPHTH SOLN 2%. 106 PILOCARPINE HCL OPHTH SOLN 4%. 106 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 pink bismuth chw 262mg pioglitazone hcl tab 15 mg (base equiv) pioglitazone hcl tab 30 mg (base equiv) pioglitazone hcl tab 45 mg (base equiv) piperacillin sod-tazobactam na for inj gm ( gm) piperacillin sod-tazobactam sod for inj 2.25 gm ( gm) piperacillin sod-tazobactam sod for inj 4.5 gm (4-0.5 gm) piperacillin sod-tazobactam sod for inj 40.5 gm ( gm) pirmella tab 1/ piroxicam cap 10 mg... 4 piroxicam cap 20 mg... 4 PLASMA-LYTE INJ PLASMA-LYTE INJ 56/D5W PLASMA-LYTE INJ -A podofilox soln 0.5% POLYBASE OIN polyethylene glycol 3350 oral packet polyethylene glycol 3350 oral powder.. 85 polymyxin b-trimethoprim ophth soln unit/ml-0.1% poly-vita dro poly-vita 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 powder packet 20 meq 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 PRALUENT INJ 150MG/ML PRALUENT INJ 75MG/ML pramipexole dihydrochloride tab mg pramipexole dihydrochloride tab 0.25 mg 158

168 pramipexole dihydrochloride tab 0.5 mg pramipexole dihydrochloride tab 0.75 mg pramipexole dihydrochloride tab 1 mg. 55 pramipexole dihydrochloride tab 1.5 mg 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 2.5 mg prednisone tab 20 mg prednisone tab 5 mg prednisone tab 50 mg prednisone tab therapy pack 10 mg (21) prednisone tab therapy pack 10 mg (48) prednisone tab therapy pack 5 mg (21) prednisone tab therapy pack 5 mg (48) premasol sol 10% PRENATAL TAB MG PRENATAL TAB MG prenatal vitamin/folic acid > 0.8 mg (generic) 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 PROCALAMINE INJ 3% prochlorperazine edisylate inj 5 mg/ml 81 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-med cre hc 2.5% procto-pak cre 1% proctozone cre -hc 2.5% 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

169 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.. 82 promethazine hcl tab 12.5 mg promethazine hcl tab 25 mg promethazine hcl tab 50 mg 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 prosight tab PROSOL INJ 20% protriptyline hcl tab 10 mg protriptyline hcl tab 5 mg provil tab 200mg... 4 pseudoephedrine hcl tab 30 mg psyllium powder 100% PULMICORT INH 180MCG PULMICORT INH 90MCG PULMOZYME SOL 1MG/ML PURIXAN SUS 20MG/ML pyrazinamide tab 500 mg pyridostigmine bromide tab 60 mg pyridoxine hcl inj 100 mg/ml pyridoxine hcl tab 100 mg pyridoxine hcl tab 50 mg Q qc antacid sus qc antacid sus anti-gas qc aspirin tab 325mg... 2 qc ibuprofen tab 200mg... 4 q-dryl liq 12.5/5ml q-pap child sus 160/5ml... 2 q-pap infant dro 80/0.8ml... 2 q-pap liq 160/5ml... 2 q-pap tab 325mg... 2 q-pap tab 500mg... 2 q-tussin dm syp / q-tussin sol 100/5ml QUADRACEL INJ quasense tab quenalin syp 12.5/5ml 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 RABAVERT INJ rabeprazole sodium ec tab 20 mg raloxifene hcl tab 60 mg ramipril cap 1.25 mg ramipril cap 10 mg ramipril cap 2.5 mg

170 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 lacr oin op REGRANEX GEL 0.01% reguloid pow 28.3% reguloid pow 48.57% reguloid pow 58.6% RELENZA MIS DISKHALE RELISTOR INJ 12/0.6ML RELISTOR INJ 8/0.4ML 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 RESCRIPTOR TAB 100 MG RESCRIPTOR TAB 200MG RESTASIS EMU 0.05% 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 ribasphere cap 200mg ribasphere tab 200mg ribasphere tab 400mg ribasphere tab 600mg ribavirin cap 200 mg ribavirin tab 200 mg 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 15 RINGER'S SOLUTION 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

171 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 oral disintegrating tab 10 mg (base eq) rizatriptan benzoate oral disintegrating tab 5 mg (base eq) rizatriptan benzoate tab 10 mg (base equivalent) rizatriptan benzoate tab 5 mg (base equivalent) robafen dm liq / robafen dm syp / robafen syp 100/5ml ropinirole hydrochloride tab 0.25 mg ropinirole hydrochloride tab 0.5 mg ropinirole hydrochloride tab 1 mg ropinirole hydrochloride tab 2 mg ropinirole hydrochloride tab 3 mg ropinirole hydrochloride tab 4 mg ropinirole hydrochloride tab 5 mg rosadan cre 0.75% rosuvastatin calcium tab 10 mg rosuvastatin calcium tab 20 mg rosuvastatin calcium tab 40 mg rosuvastatin calcium tab 5 mg ROTARIX SUS ROTATEQ SOL roweepra tab 500mg roxicet sol 5-325/ rulox sus 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 allergy tab 10mg sb allergy tab 25mg med sb antacid/ sus antigas sb aspirin tab 325mg... 3 sb bisacodyl tab 5mg ec sb bismuth sus 262/15ml sb cgh contr liq cf sb cgh contr syp 100/5ml sb coughtab tab 200mg sb hydrocort oin 1% sb ibuprofen tab 200mg... 4 sb milk magn sus sb milk magn sus mint sb sleep tab 25mg selegiline hcl cap 5 mg selegiline hcl tab 5 mg selenium sulfide lotion 2.5% SELZENTRY TAB 150MG SELZENTRY TAB 300MG senexon tab 8.6mg senexon-s tab mg senna lax tab 8.6mg senna plus tab mg senna tab 8.6mg senna-lax tab 8.6mg sennalax-s tab mg senna-time s tab mg senna-time tab 8.6mg senno tab 8.6mg sennosides syrup 8.8 mg/5ml sennosides tab 8.6 mg sennosides-docusate sodium tab mg 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

172 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 silace liq 10mg/ml silace syp 60/15ml siladryl alr liq 12.5/5ml sildenafil citrate tab 20 mg SILENOR TAB 3MG SILENOR TAB 6MG silphen coug syp 12.5/5ml siltuss das liq 100/5ml siltussin dm liq das siltussin sa syp 100/5ml siltussin-dm liq diabetic siltussin-dm syp alc free 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 sinus relief spr 0.05% sinus/alergy tab pe max sinus/allerg tab 4-10mg sirolimus tab 0.5 mg sirolimus tab 1 mg sirolimus tab 2 mg SIRTURO TAB 100MG SIVEXTRO INJ 200MG SIVEXTRO TAB 200MG sleep aid tab 25mg sleep tab 25mg sm acid redu tab 200mg sm all day tab 10mg sm all day tab allergy sm allergy tab 4mg sm antacid sus anti-gas sm antacid/ sus antigas sm anti-diar tab 2mg sm antifungl cre 1% sm aspirin chw 81mg... 3 sm aspirin tab 325mg... 3 sm child asa chw 81mg... 3 sm cld/alrgy elx children sm clearlax pow sm cold tab alrgy pe sm fiber lax tab 500mg sm fiber pow 28.3% sm fiber pow 48.57% sm first aid oin 500/gm SM GLUCOSE CHW ORANGE sm hydrocort cre 1% sm hydrocort oin 1% sm ibuprofen tab 200mg... 4 sm laxative tab 5mg ec sm micon 7 sup 100mg sm milk magn sus mint SM MINERAL OIL sm nasal 12h spr 0.05% sm nasal dec tab 30mg sm nasal spr 0.05% SM NICOTINE DIS 14MG/24H SM NICOTINE DIS 21MG/24H SM NICOTINE DIS 7MG/24HR sm nicotine gum 2mg sm nicotine gum 2mg mint sm nicotine gum 4mg sm nicotine gum 4mg mint sm pain rel cap 500mg... 3 sm senna lax tab 8.6mg sm sleep aid tab 25mg sm stomach sus 262/15ml sm tussin cf liq sm tussin dm syp / sm tussin syp dm sod ferric gluc cmplx in sucrose iv soln 12.5 mg/ml (fe eq) sodium bicarbonate tab 650 mg sodium chloride hypertonic ophth oint 5% sodium chloride hypertonic ophth soln 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

173 sodium phenylbutyrate oral powder 3 gm/teaspoonful sodium phosphates - enema sodium polystyrene sulfonate oral susp 15 gm/60ml sodium polystyrene sulfonate powder.. 69 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&cool cre inzo 2% 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 spironolactone & hydrochlorothiazide tab mg spironolactone tab 100 mg spironolactone tab 25 mg spironolactone tab 50 mg sprintec 28 tab 28 day SPRITAM TAB 1000MG SPRITAM TAB 250MG SPRITAM TAB 500MG SPRITAM TAB 750MG SPRYCEL TAB 100MG SPRYCEL TAB 140MG SPRYCEL TAB 20MG SPRYCEL TAB 50MG SPRYCEL TAB 70MG SPRYCEL TAB 80MG SSD CRE 1% stavudine cap 15 mg stavudine cap 20 mg stavudine cap 30 mg stavudine cap 40 mg stavudine for oral soln 1 mg/ml stim laxat tab 5mg ec STIMATE SOL 1.5MG/ML STIVARGA TAB 40MG stomach relf chw 262mg stomach relf sus 262/15ml stool softnr cap 100mg stool softnr cap 240mg stool softnr cap 250mg 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... 8 stress form/ tab zinc stress formu tab stress formu tab w/iron 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 sudogest pe tab 10mg sudogest tab 30mg sudogest tab 4-60mg 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... 8 sulfamethoxazole-trimethoprim iv soln mg/5ml sulfamethoxazole-trimethoprim susp mg/5ml sulfamethoxazole-trimethoprim tab 164

174 mg sulfamethoxazole-trimethoprim tab mg SULFAMYLON CRE 85MG/GM SULFAMYLON PAK 5% sulfasalazine tab 500 mg sulfasalazine tab delayed release 500 mg sulindac tab 150 mg... 4 sulindac tab 200 mg... 4 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 superplex-t tab suphedrine tab 30mg SUPRAX CAP 400MG suprax chw 100mg suprax chw 200mg SUPRAX SUS 500/5ML SUPREP BOWEL SOL PREP SUSPENDOL-S LIQ SUSTIVA CAP 200MG SUSTIVA CAP 50MG SUSTIVA TAB 600MG 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 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 SYRSPEND SF LIQ SYSTANE GEL 0.3% T tab-a-vite tab tab-a-vite tab /iron tab-a-vite tab beta car TABLOID TAB 40MG tabtussin dm tab mg tabtussin tab 400mg tacrolimus cap 0.5 mg tacrolimus cap 1 mg tacrolimus cap 5 mg tacrolimus oint 0.03% tacrolimus oint 0.1% tactinal tab 325mg... 3 tactinal tab 500mg... 3 TAFINLAR CAP 50MG TAFINLAR CAP 75MG TAGRISSO TAB 40MG TAGRISSO TAB 80MG TAKE ACTION TAB 1.5MG 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 165

175 equivalent) tamsulosin hcl cap 0.4 mg TARCEVA TAB 100MG TARCEVA TAB 150MG TARCEVA TAB 25MG 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 natura sol free op tears natura sol ii op TECENTRIQ INJ 1200/ 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 telmisartan tab 20 mg telmisartan tab 40 mg telmisartan tab 80 mg telmisartan-hydrochlorothiazide tab mg telmisartan-hydrochlorothiazide tab mg telmisartan-hydrochlorothiazide tab mg 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 cream 1% terbinafine hcl tab 250 mg terbutaline sulfate inj 1 mg/ml terbutaline sulfate tab 2.5 mg terbutaline sulfate tab 5 mg terconazole vaginal cream 0.4% terconazole vaginal cream 0.8% TERCONAZOLE VAGINAL CREAM 0.8% 90 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% 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 M PLUS TAB THERA-M TAB thiamine hcl inj 100 mg/ml thiamine hcl 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 TIMOLOL MALEATE OPHTH GEL FORMING 166

176 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 TIVICAY TAB 10MG TIVICAY TAB 25MG TIVICAY TAB 50MG tizanidine hcl tab 2 mg (base equivalent) tizanidine hcl tab 4 mg (base equivalent) TOBRADEX OIN % TOBRADEX ST SUS tobramycin nebu soln 300 mg/5ml... 8 tobramycin ophth soln 0.3% tobramycin sulfate for inj 1.2 gm... 8 tobramycin sulfate inj 1.2 gm/30ml (40 mg/ml) (base equiv)... 8 tobramycin sulfate inj 10 mg/ml (base equivalent)... 8 tobramycin sulfate inj 2 gm/50ml (40 mg/ml) (base equiv)... 8 tobramycin sulfate inj 80 mg/2ml (40 mg/ml) (base equiv)... 8 tobramycin-dexamethasone ophth susp % TOBREX OIN 0.3% OP tolnaftate cre 1% tolnaftate cream 1% tolnaftate powder 1% tolterodine tartrate cap sr 24hr 2 mg.. 89 tolterodine tartrate cap sr 24hr 4 mg.. 89 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 100/5ml toposar inj 1gm/50ml topotecan hcl for inj 4 mg TOPOTECAN INJ 4MG/4ML 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 TRADJENTA TAB 5MG tramadol hcl tab 50 mg... 5 tramadol-acetaminophen tab mg... 5 trandolapril tab 1 mg trandolapril tab 2 mg trandolapril tab 4 mg tranexamic acid iv soln 1000 mg/10ml (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% travel sick chw 25mg travel sick tab 50mg trazodone hcl tab 100 mg trazodone hcl tab 150 mg trazodone hcl tab 50 mg TREANDA INJ 100MG TREANDA INJ 25MG 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% triamcinolone acetonide cream 0.025% triamcinolone acetonide cream 0.1% 119 triamcinolone acetonide cream 0.5% 119 triamcinolone acetonide dental paste 0.1% triamcinolone acetonide lotion 0.025% 167

177 triamcinolone acetonide lotion 0.1% triamcinolone acetonide oint 0.025%. 119 triamcinolone acetonide oint 0.1% triamcinolone acetonide oint 0.5% triamterene & hydrochlorothiazide cap mg triamterene & hydrochlorothiazide tab mg triamterene & hydrochlorothiazide tab mg tri-buff asa tab 325mg... 3 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 tri-lo- tab sprintec trilyte sol trimethoprim tab 100 mg trimipramine maleate cap 100 mg trimipramine maleate cap 25 mg trimipramine maleate cap 50 mg TRINESSA LO TAB TRINESSA TAB TRINTELLIX TAB 10MG TRINTELLIX TAB 20MG TRINTELLIX TAB 5MG tri-previfem tab TRISENOX SOL 10MG/10M tri-sprintec tab TRIUMEQ TAB TRI-VI-SOL SOL tri-vita sol trivora-28 tab TROPHAMINE INJ 10% trospium chloride tab 20 mg TRULICITY INJ 0.75/ TRULICITY INJ 1.5/ TRUMENBA INJ TRUVADA TAB TRUVADA TAB TRUVADA TAB TRUVADA TAB tums fresher chw 500mg tums smoothi chw 750mg tusnel diabt liq / tussin adult liq cgh/cong tussin cf liq tussin cf liq cgh/cold tussin dm liq / tussin dm liq clear tussin dm liq max tussin dm mx liq / tussin dm syp / TWINRIX INJ TYBOST TAB 150MG TYGACIL INJ 50MG TYKERB TAB 250MG TYPHIM VI INJ TYSABRI INJ 300/15ML TYZEKA TAB 600MG U 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 UPTRAVI TAB 1000MCG UPTRAVI TAB 1200MCG UPTRAVI TAB 1400MCG UPTRAVI TAB 1600MCG UPTRAVI TAB 200/ UPTRAVI TAB 200MCG UPTRAVI TAB 400MCG UPTRAVI TAB 600MCG UPTRAVI TAB 800MCG ursodiol cap 300 mg ursodiol tab 250 mg ursodiol tab 500 mg V VAGIFEM TAB 10MCG valacyclovir hcl tab 1 gm

178 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 vancomycin hcl cap 250 mg vancomycin hcl for inj 10 gm vancomycin hcl for inj 1000 mg vancomycin hcl for inj 500 mg vancomycin hcl for inj 5000 mg VANCOMYCIN INJ 1 GM VANCOMYCIN INJ 500MG vancomycin inj 750mg VANCOMYCIN INJ 750MG VANDAZOLE GEL 0.75% VAQTA INJ 25/0.5ML VAQTA INJ 50UNT/ML VARIVAX INJ VASCEPA CAP 1GM VELCADE INJ 3.5MG velivet pak VENCLEXTA TAB 100MG VENCLEXTA TAB 10MG VENCLEXTA TAB 50MG VENCLEXTA TAB START PK 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 VENOFER INJ 20MG/ML VENTAVIS SOL 10MCG/ML VENTAVIS SOL 20MCG/ML VENTOLIN HFA AER 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 40 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 VICTOZA INJ 18MG/3ML VIDEX SOL 2GM VIDEX SOL 4GM vienva tab VIGAMOX DRO 0.5% 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)

179 vinorelbine tartrate inj 50 mg/5ml (10 mg/ml) (base equiv) viorele tab VIRACEPT TAB 250MG VIRACEPT TAB 625MG VIREAD POW 40MG/GM VIREAD TAB 150MG VIREAD TAB 200MG VIREAD TAB 250MG VIREAD TAB 300MG vita-bee/c tab vitamin a cap unit vitamin a cap 8000 unit vitamin a cap 8000unit VITEKTA TAB 150MG VITEKTA TAB 85MG voriconazole for inj 200 mg voriconazole for susp 40 mg/ml voriconazole tab 200 mg voriconazole tab 50 mg VOTRIENT TAB 200MG VRAYLAR CAP 1.5-3MG VRAYLAR CAP 1.5MG VRAYLAR CAP 3MG VRAYLAR CAP 4.5MG VRAYLAR CAP 6MG vyfemla tab W 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 WELCHOL PAK 3.75GM WELCHOL TAB 625MG womans laxat tab 5mg ec X XALKORI CAP 200MG XALKORI CAP 250MG XARELTO STAR TAB 15/20MG XARELTO TAB 10MG XARELTO TAB 15MG XARELTO TAB 20MG XELJANZ TAB 5MG XELJANZ XR TAB 11MG 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 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% 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 4 170

180 mg/5ml zoledronic acid iv soln 5 mg/100ml zoledronic inj 4mg 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 zonisamide cap 100 mg zonisamide cap 25 mg zonisamide cap 50 mg ZONTIVITY TAB 2.08MG ZORTRESS TAB 0.25MG ZORTRESS TAB 0.5MG ZORTRESS TAB 0.75MG ZOSTAVAX INJ zovia 1/35e tab zovia 1/50e tab 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