2016 承保藥物清單（處方集）

Transcription

1 06 L.A. Care Cal MediConnect Plan (Medicare-Medicaid Plan) 承保藥物清單 ( 處方集 ) 請詳閱 : 本文件包含本計劃承保藥物的資訊 本處方集更新日期為 06 年 月 日 如有問題, 請在一週 7 天, 每天 小時 ( 包括假日 ) 致電 L.A. Care Cal MediConnect Plan 會員服務部, 電話 (TTY: 7) 如需詳細資訊, 請上網瀏覽 H858_560_06Formulary CH_Accepted Formulary ID: , Version 8

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3 這是會員可在 L.A. Care Cal MediConnect Plan 獲得的藥物清單 L.A. Care Cal MediConnect Plan (Medicare-Medicaid Plan) 是一項與聯邦醫療保險和 Medi-Cal 簽約的保健計劃, 向投保人提供這兩項計劃的福利 承保藥物清單及 ( 或 ) 藥房和醫療服務提供者網絡可能會在一年之中變更 我們會在做出影響您的變更之前先通知您 福利和 ( 或 ) 共付額可能在每年 月 日變更 您總是可以在線上 或致電 (TTY: 7) 查詢 L.A. Care Cal MediConnect Plan 最新的承保藥物清單 您可以免費取得本資訊的其他格式, 例如大字版 點字或語音版 請致電 (TTY: 7) 這是免費電話 可能有侷限 共付額和限制 如需更多資訊, 請致電 L.A. Care Cal MediConnect Plan 會員服務部或閱讀 L.A. Care Cal MediConnect Plan 的會員手冊 處方藥的共付額可能因您獲得的 額外協助 額度而異 更多詳情, 請聯絡計劃 You can get this information for free in other languages. Call (TTY: 7). The call is free. Puede obtener esta información gratis en otros idiomas. Llame al (TTY: 7). La llamada es gratis. Դուք կարող եք այս տեղեկությունները անվճար ստանալ այլ լեզուներով: Զանգահարեք (TTY: 7) հեռախոսահամարով: Հեռախոսազանգը անվճար է: 이정보는다른언어로도무료로구하실수있습니다 (TTY: 7) 로전화하시면되며통화료는무료입니다. Вы можете бесплатно получить эту информацию на других языках. Позвоните по номеру телефона (TTY: 7). Звонок бесплатный. Makukuha ninyo ang impormasyong ito nang libre sa ibang mga wika. Tumawag sa (TTY: 7). Ang tawag ay libre. 本資訊備有其他語言版本供您免費索取 請致電 (TTY: 7) 這是免費電話? 如果您有問題, 請在一週七天, 每天 小時 ( 包括假日 ) 致電 L.A. Care Cal MediConnect Plan, 電話號碼 (TTY: 7) 這是免費電話 如需詳細資訊, 請上網瀏覽 i

4 Quý vị có thể được cấp thông tin này miễn phí bằng nhiều ngôn ngữ.vui lòng gọi số (TTY: 7). Số điện thoại này miễn phí. ii? 如果您有問題, 請在一週七天, 每天 小時 ( 包括假日 ) 致電 L.A. Care Cal MediConnect Plan, 電話號碼 (TTY: 7) 這是免費電話 如需詳細資訊, 請上網瀏覽

5 常見問題集 (FAQ) 在此處尋找您對於承保藥物清單的問題解答 您可以閱讀全部的常見問題集瞭解更多資訊, 或是尋找特定的問題和解答. 承保藥物清單上有哪些處方藥?( 我們將承保藥物清單簡稱為 藥物清單 ) 藥物清單上的藥物是 L.A. Care Cal MediConnect Plan 承保的藥物 這些藥物可在我們網絡內的藥房購買 如果我們與一家藥房簽訂協議一起合作並向您提供服務, 那家藥房就在我們的網絡內 我們將這些藥房稱為 網絡藥房 L.A. Care Cal MediConnect Plan 在以下情況承保藥物清單上所有醫療必要性的藥物 : 您的醫生或其他開立處方者表示您需要這些藥物以便好轉或保持健康, 而且 您會在 L.A. Care Cal MediConnect Plan 網絡藥房配領處方藥 在某些情況中, 您必須採取一些行動才能獲得藥物 ( 請看以下第 5 題 ) 您也可以在我們的網站 或致電會員服務部 (TTY: 7) 查詢最新的承保藥物清單. 藥物清單會變更嗎? 會 L.A. Care Cal MediConnect Plan 可能會在一年之中增減藥物清單上的藥物 一般而言, 藥物清單只會在以下情況變更 : 市面上出現一種較便宜的藥物, 而且藥效與藥物清單上的藥物一樣好, 或是 我們得知一種藥物不安全 我們也可能會改變藥物的規定 例如, 我們可能 : 決定要求或不要求某種藥物的事先核准 ( 事先核准是您在取得藥物之前需要 L.A. Care Cal MediConnect Plan 的許可 ) 增加或改變您可以獲得的藥量 ( 稱為 數量限制 ) 增加或改變藥物的逐步治療限制 ( 逐步治療是指您必須先嘗試一種藥物, 我們才會承保另一種藥物 ) ( 如需這些藥物規定的更多資訊, 請看第 iv 頁 ) 當您服用的一種藥物從藥物清單撤出時, 我們會告訴您 當我們改變承保藥物的規定時, 我們也會告訴您 以下第 3 和 7 題會提供藥物清單變更時的更多資訊? 如果您有問題, 請在一週七天, 每天 小時 ( 包括假日 ) 致電 L.A. Care Cal MediConnect Plan, 電話號碼 (TTY: 7) 這是免費電話 如需詳細資訊, 請上網瀏覽 iii

6 您總是可以在線上 查詢 L.A. Care Cal MediConnect Plan 最新的藥物清單 您也可以致電會員服務部 (TTY: 7) 查詢最新的藥物清單 3. 如果市面上出現一種比較便宜的藥物, 而且藥效與藥物清單上的藥物一樣好怎麼辦? 如果您服用的一種藥物因為市面上出現一種比較便宜, 而且藥效與藥物清單上的藥物一樣好而被撤出藥物清單, 我們會告訴您 我們會在撤出藥物清單之前至少 60 天或是當您要求續配時告訴您 然後您可以在該藥物從藥物清單撤出之前獲得 60 天的份量 這樣可以讓您有時間和醫生或其他開立處方者討論接下來該怎麼做 本通知會附在您的每月藥房福利說明書 ( EOB). 當我們發現一種藥物不安全時會怎麼辦? 如果食品暨藥物管理局 ( FDA) 表示您服用的一種藥物不安全, 我們會立刻撤出藥物清單 我們也會寄信告訴您 如果您收到其中一封信, 請和您的醫生討論找出一種對您安全的替代藥物 5. 藥物承保有任何侷限或限制嗎? 還是需要採取任何行動以便獲得某些藥物? 是的, 某些藥物有承保規定或是對您可以獲得的藥量有限制 在某些情況中, 您或您的醫生或其他開立處方者必須採取一些行動才能獲得藥物 例如 : 事先核准 ( 或事先授權 ): 對於某些藥物, 您或您的醫生或其他開立處方者必須獲得 L.A. Care Cal MediConnect Plan 的核准才能配領您的處方藥 如果您未取得核准, L.A. Care Cal MediConnect Plan 可能不會承保該藥物 數量限制 : 有時候 L.A. Care Cal MediConnect Plan 會限制您可以獲得的藥量 逐步治療 : 有時候 L.A. Care Cal MediConnect Plan 要求您採取逐步治療 這是指您必須以某種順序使用藥物來治療您的醫學狀況 您必須先嘗試一種藥物, 我們才會承保另一種藥物 如果您的醫生認為第一種藥物對您無效, 我們才會承保第二種藥物 查閱第 頁的表格, 即可找到您的藥物是否有額外規定或限制 您也可以造訪我們的網站 尋找詳細資訊 我們已在線上刊載文件, 解釋我們事先授權和逐步治療的限制 您也可以要求我們寄一份給您 iv? 如果您有問題, 請在一週七天, 每天 小時 ( 包括假日 ) 致電 L.A. Care Cal MediConnect Plan, 電話號碼 (TTY: 7) 這是免費電話 如需詳細資訊, 請上網瀏覽

7 您可以對這些限制提出 例外處理 要求 請參閱第 題有關例外處理的詳細資訊 如果您住在療養院或其他長期護理設施, 而且需要一種不在藥物清單上的藥物, 或是您無法輕易取得需要的藥物, 我們可以幫助您 無論您是否是新的 L.A. Care Cal MediConnect Plan 會員, 我們都會為您需要的藥物承保 3 天的緊急份量 ( 除非處方箋開立的天數較少 ), 以便您有時間和醫生或其他開立處方者討論, 他們可以幫助您決定您是否可以服用藥物清單上的另一種類似藥物, 或是否要求例外處理 請參閱第 題有關例外處理的詳細資訊 6. 您怎麼知道您想要的藥物是否有限制或需要採取什麼行動來獲得藥物? 承保藥物清單的第 頁有一欄稱為 必要的行動 限制或使用上限 7. 如果我們改變承保某些藥物的規定會如何? 例如, 如果我們增加藥物的事先授權 ( 核准 ) 數量限制, 及 ( 或 ) 逐步治療限制 我們會告訴您我們是否對某種藥物增加了事先核准 數量限制, 及 ( 或 ) 逐步治療侷限 我們會在增加限制之前至少 60 天或是在您下次要求藥房續配藥物時告訴您 然後, 您可以在承保規定變更之前獲得 60 天的藥量 這樣可以讓您有時間和醫生或其他開立處方者討論接下來該怎麼做 8. 如何查詢一種藥物是否列在藥物清單中? 有兩種方式可以尋找藥物 : 您可以按字母順序搜尋 ( 如果您知道如何拼出藥物名稱 ), 或是 您可以按照醫學狀況搜尋 要按照字母順序搜尋, 請翻到字母清單部分 您可以從藥物清單末尾的索引來搜尋 藥物會按字母順序列出 要按照醫學狀況搜尋, 請翻到第 x 頁標示 按照醫學狀況排列的藥物清單 的部份, 這一部份的藥物視其治療的病症類型分門別類 例如, 如果您有一種心臟狀況, 您應該查看類別 : 心血管藥劑 其他 您可以在此處找到治療心臟狀況的藥物? 如果您有問題, 請在一週七天, 每天 小時 ( 包括假日 ) 致電 L.A. Care Cal MediConnect Plan, 電話號碼 (TTY: 7) 這是免費電話 如需詳細資訊, 請上網瀏覽 v

8 9. 如果您想服用的藥物不在藥物清單上怎麼辦? 如果您在藥物清單上沒有查到您的藥物, 請致電會員服務部, 電話號碼是 (TTY: 7) 如果您得知 L.A. Care Cal MediConnect Plan 不會承保該藥物, 您可以採取以下一種行動 : 向會員服務部索取一份與您想服用的藥物類似的清單, 然後將該清單出示給您的醫生或其他開立處方者 他們可以開立藥物清單上與您想服用的藥物類似的藥物 或是 您可要求保健計劃進行例外處理以承保您的藥物 請參閱第 題有關例外處理的詳細資訊 0. 如果您是 L.A. Care Cal MediConnect Plan 的新會員, 而且在藥物清單上找不到您的藥物或是取得您的藥物遇到困難怎麼辦? 我們可以幫忙 我們會在您成為 L.A. Care Cal MediConnect Plan 會員後的最初 90 天承保一次暫時 30 天藥物用量, 以便您有時間和醫生或其他開立處方者討論, 他們可以幫助您決定您是否可以服用藥物清單上的另一種類似藥物, 或是否要求例外處理 我們在以下情況會承保 30 天的藥物用量 : 您服用一種不在藥物清單上的藥物, 或是 保健計劃規定不讓您取得開立處方者所囑咐的用量, 或是 藥物需要 L.A. Care Cal MediConnect Plan 的事先核准, 或是 您正在服用一種屬於逐步治療限制的藥物 如果您住在療養院或其他長期護理設施, 您最多可以續配 98 天的處方藥 您可以在加入計劃的最初 90 天中多次續配藥物 這會讓您的開立處方者有時間將您的藥物改成藥物清單上的藥物或是要求例外處理 護理層級的變更您的護理層級變更時, 我們會為您的藥物提供過渡供應 護理層級的變更可能包括以下各項 :. 會員從醫院轉入長期護理設施. 會員從醫院出院返家 3. 會員搬離聯邦醫療保險 A 部分的專業護理設施, 需要回到 D 部分計劃處方集. 會員放棄安寧護理狀態, 回到標準聯邦醫療保險 A 部分和 B 部分福利 vi? 如果您有問題, 請在一週七天, 每天 小時 ( 包括假日 ) 致電 L.A. Care Cal MediConnect Plan, 電話號碼 (TTY: 7) 這是免費電話 如需詳細資訊, 請上網瀏覽

9 5. 會員搬離長期護理設施, 回到社區 6. 會員從精神病院出院, 需要高度個人化的藥物療法 藥房可能致電 聯絡 L.A. Care Cal MediConnect Plan 藥房服務部, 處理銷售點越權處置問題, 以確保會員可以獲得他們的藥物而無任何延誤. 您可以提出承保您藥物的例外處理要求嗎? 可以 您可以要求 L.A. Care Cal MediConnect Plan 破例承保一種沒有列在藥物清單中的藥物 您也可以要求我們更改對於您藥物的規定 例如, L.A. Care Cal MediConnect Plan 可能會限制對於某種藥物的承保份量 如果您的藥物有上限規定, 您可要求我們更改這項限制而承保更多藥量 其他例子 : 您可以要求我們撤銷逐步治療限制或是事先核准要求. 取得例外處理需要多少時間? 首先, 我們必須收到您的開立處方者聲明, 支持您對於例外處理的要求 我們收到聲明後, 會在 7 小時內對您的例外處理要求做出決定 如果您或您的開立處方者認為等候 7 小時做出決定會對您的健康造成危害, 您可以要求快速例外處理 這是更快速的決定 如果您的開立處方者支持您的要求, 我們會在收到您的開立處方者的支持聲明後 小時內做出決定 3. 如何提出例外處理要求? 要提出例外處理要求, 請致電會員服務部 會員服務部會與您和您的醫療服務提供者合作, 幫您提出例外處理要求. 何謂普通藥? 普通藥的成份與品牌藥相同 它們通常比品牌藥便宜, 而且它們的名稱較不為人所知 普通藥經過美國食品暨藥物管理局 ( FDA) 的核准 L.A. Care Cal MediConnect Plan 承保品牌藥和普通藥? 如果您有問題, 請在一週七天, 每天 小時 ( 包括假日 ) 致電 L.A. Care Cal MediConnect Plan, 電話號碼 (TTY: 7) 這是免費電話 如需詳細資訊, 請上網瀏覽 vii

10 5. 什麼是成藥? OTC 是指 非處方藥 L.A. Care Cal MediConnect Plan 承保一些由您的醫療服務提供者開立的成藥 您可以在 L.A. Care Cal MediConnect Plan 藥物清單查看哪些成藥可獲得承保 6. L.A. Care Cal MediConnect Plan 是否承保非藥物成藥? L.A. Care Cal MediConnect Plan 承保一些由您的醫療服務提供者開立的非藥物成藥 您可以在 L.A. Care Cal MediConnect Plan 藥物清單查看哪些非藥物成藥可獲得承保 7. 您的共付額是多少? 您可以在 L.A. Care Cal MediConnect Plan 藥物清單查看每一種藥物的共付額 住在療養院或其他長期護理設施的 L.A. Care Cal MediConnect Plan 會員不必支付共付額 有些在社區內接受長期護理的會員也不必支付共付額 共付額按層級排列 層級是指共付額相同的藥物組 第一級藥物 它們是普通藥 共付額從 $0 至 $.95, 根據您的 Medicaid 資格層級而定 第二級藥物 它們是品牌藥 共付額從 $0 至 $7.0, 根據您的 Medicaid 資格層級而定 第三級藥物 它們是非聯邦醫療保險處方藥 共付額是 $0 第四級藥物 它們是非聯邦醫療保險非處方藥 共付額是 $0 承保藥物清單 以下的承保藥物清單會說明 L.A. Care Cal MediConnect Plan 承保的藥物資訊 如果您在清單中尋找藥物時遇到困難, 請翻到第 頁開始的索引 表格的第一欄列出藥物名稱 品牌藥名稱用大寫字母表示 ( 例如 CYMBALTA), 普通藥則用小寫斜體字母列出 ( 例如 metformin) 必要行動 限制或使用上限 一欄的資訊會說明 L.A. Care Cal MediConnect Plan 承保您的藥物是否有任何規定 viii? 如果您有問題, 請在一週七天, 每天 小時 ( 包括假日 ) 致電 L.A. Care Cal MediConnect Plan, 電話號碼 (TTY: 7) 這是免費電話 如需詳細資訊, 請上網瀏覽

11 承保備註縮寫 縮寫說明解釋 使用管理限制 事先授權限制 L.A. Care Cal MediConnect Plan 要求您 ( 或您的醫生 ) 在配領這種處 方藥之前取得事先授權 若未取得事先核准, L.A. Care Cal MediConnect Plan 可能不會承保該藥物 NSO B 部分與 D 部分決定的事先授權限制 只限新會員的事先授權限制 這種藥物也許有資格根據聯邦醫療保險 B 部分或 D 部分獲得付款 要求您 ( 或您的醫生 ) 在配領這種藥物之前取得 L.A. Care Cal MediConnect Plan 事先授權, 以便確定此種藥物可獲得聯邦醫療保險 D 部分承保, 然後才能配領這種藥物 若未取得事先核准, L.A. Care Cal MediConnect Plan 可能不會承保該藥物 如果這是您的新處方藥, 也就是第一次向您開立這種藥物, 您 ( 或您的醫生 ) 在配領這種藥物之前需要向 L.A. Care Cal MediConnect Plan 取得事先授權 若未取得事先核准, L.A. Care Cal MediConnect Plan 可能不會承保該藥物 QL 數量限制 L.A. Care Cal MediConnect Plan 限制在一定時間範圍承保該藥物的數量 ST 逐步治療限制 您必須先嘗試另一種藥物來治療您的醫學狀況, L.A. Care Cal MediConnect Plan 才會提供該藥物的承保 只有在其他藥物對您 無效時, 該藥物才會獲得承保 承保的其他特殊要求 LD 有限分發藥物 本處方藥僅在某些藥房出售 詳情請參閱您的醫療服務提供者 / 藥房名錄或在一週 7 天, 每天 小時 ( 包括假日 ) 致電會員服務部, 電話號碼是 (TTY: 7) 附註 : 藥物名稱旁邊的星號 (*) 代表藥物不是 D 部分藥物 您不會被要求支付這些藥物的共付額 這些藥物也有不同的上訴規定 如果您認為我們做出錯誤的決定, 上訴是一種正式方式, 要求我們審核對您所做的承保決定並加以更改 例如, 我們也許決定您想要的某種藥是聯邦醫療保險或 Medi-Cal 不承保或不再承保的藥物 如果您或您的醫生不同意我們的決定, 您可以提出上訴 如果您有疑問, 請致電 洽詢會員服務部 (TTY: 7) 您亦可閱讀會員手冊以瞭解如何對一項決定提出上訴? 如果您有問題, 請在一週七天, 每天 小時 ( 包括假日 ) 致電 L.A. Care Cal MediConnect Plan, 電話號碼 (TTY: 7) 這是免費電話 如需詳細資訊, 請上網瀏覽 ix

12 按照醫學狀況排列的藥物清單 這一部份的藥物視其治療的病症類型分門別類 例如, 如果您有一種心臟狀況, 您應該查看類別 : 心血管藥劑 其他 您可以在此處找到治療心臟狀況的藥物 您可以翻到第 ix 頁查閱本表格的符號和縮寫所代表的意義 x? 如果您有問題, 請在一週七天, 每天 小時 ( 包括假日 ) 致電 L.A. Care Cal MediConnect Plan, 電話號碼 (TTY: 7) 這是免費電話 如需詳細資訊, 請上網瀏覽

13 ADHD/ ANTI-NARCOLEPSY/ ANTI-OBESITY/ ANOREXIANTS AMPHETAMINES amphetamine/ dextroamphetamine ER cap 5mg, 0mg, 5mg, 0mg, 5mg, 30mg amphetamine/ dextroamphetamine tab 5mg, 7.5mg, 0mg,.5mg, 5mg, 0mg, 30mg dextroamphetamine ER cap 5mg, 0mg, 5mg dextroamphetamine tab 5mg, 0mg methamphetamine tab 5mg VYVANSE CAP 0MG, 0MG, 30MG, 0MG, 50MG, 60MG, 70MG ANOREXIANTS NON-AMPHETAMINE phentermine cap 5mg* 3 phentermine cap 30mg* 3 phentermine cap 37.5mg* 3 phentermine tab 37.5mg* 3 QSYMIA CAP.5-69MG* 3 QSYMIA CAP 5-9MG* 3 QSYMIA CAP MG* 3 QSYMIA CAP 7.5-6MG* 3 ANTI-OBESITY AGENTS BELVIQ TAB 0MG* 3 ATTENTION-DEFICIT/ HYPERACTIVITY DISORDER (ADHD) AGENTS guanfacine ER tab mg, mg, 3mg, mg STRATTERA CAP 0MG, 8MG, 5MG, 0MG, QL=60 Caps/30 Days 60MG, 80MG, 00MG STIMULANTS - MISC. dexmethylphenidate ER cap 5mg, 0mg, 5mg, 0mg, 30mg, 0mg dexmethylphenidate tab.5mg, 5mg, 0mg methylphenidate chew tab.5mg, 5mg, 0mg methylphenidate ER cap 0mg, 0mg, 30mg, 0mg, 50mg, 60mg methylphenidate ER tab 0mg, 0mg METHYLPHENIDATE ER TAB 8MG, 7MG, 36MG, 5MG methylphenidate soln 5mg/ 5ml, 0mg/ 5ml methylphenidate tab 5mg, 0mg, 0mg modafinil tab 00mg, 00mg QL=60 Tabs/30 Days NUVIGIL TAB 50MG, 50MG, 00MG, 50MG QL=30 Tabs/30 Days AMINOGLYCOSIDES AMINOGLYCOSIDES

14 amikacin sulfate inj 50mg/ ml gentamicin inj 0mg/ ml, 0mg/ ml gentamicin/ nacl inj 0.8mg/ ml, mg/ ml,.mg/ ml,.6mg/ ml GENTAMICIN/ NACL INJ 0.9MG/ ML,.MG/ ML neomycin tab 500mg paromomycin cap 50mg STREPTOMYCIN INJ GM TOBI PODHALER 8MG NM tobramycin inj 0mg/ ml, 80mg/ ml tobramycin neb 300mg/ 5ml NM TOBRAMYCIN/ NACL INJ 0.8MG/ ML ANALGESICS - ANTI-INFLAMMATORY ANTIRHEUMATIC - ENZYME INHIBITORS XELJANZ TAB 5MG NM QL=60 Tabs/30 Days ANTIRHEUMATIC ANTIMETABOLITES RHEUMATREX TAB DOSE CK.5MG ANTI-TNF-ALPHA - MONOCLONAL ANTIBODIES HUMIRA KIT 0MG/ 0.ML, 0MG/ 0.ML, 0MG/ NM 0.8ML SIMPONI INJ 50MG/ 0.5ML, 00MG/ ML NM GOLD COMPOUNDS RIDAURA CAP 3MG INTERLEUKIN- BLOCKERS ARCALYST INJ 0MG NM INTERLEUKIN- RECEPTOR ANTAGONIST (IL-RA) KINERET INJ 00MG/ 0.67ML NM INTERLEUKIN-BETA BLOCKERS ILARIS INJ 80MG NM INTERLEUKIN-6 RECEPTOR INHIBITORS ACTEMRA INJ 6MG/ 0.9ML NM ACTEMRA IV INJ 00MG/ 0ML NM NONSTEROIDAL ANTI-INFLAMMATORY AGENTS (NSAIDS) celecoxib cap 50mg, 00mg, 00mg, 00mg QL=60 Caps/30 Days diclofenac ER tab 5mg, 50mg, 75mg diclofenac potassium tab 50mg diclofenac XR tab 00mg diclofenac/ misoprostol tab 50-0.mg, 75-0.mg etodolac cap 00mg, 300mg etodolac ER tab 00mg, 500mg, 600mg etodolac tab 00mg, 500mg FENOPROFEN 00MG CAP

15 fenoprofen tab 600mg flurbiprofen tab 50mg, 00mg ibuprofen cap 00mg* ibuprofen chew tab 00mg* ibuprofen susp 00mg/ 5ml (Rx Only) ibuprofen susp 0mg/ ml* ibuprofen tab 00mg* ibuprofen tab 00mg* ibuprofen tab 00mg, 600mg, 800mg (Rx Only) INDOCIN SUSP 5MG/ 5ML indomethacin cap 5mg, 50mg indomethacin ER cap 75mg ketoprofen cap 50mg, 75mg ketorolac inj 5mg/ ml, 30mg/ ml ketorolac tab 0mg MECLOFENAMATE SODIUM CAP 50MG, 00MG mefenamic acid cap 50mg meloxicam susp 7.5mg/ 5ml meloxicam tab 7.5mg, 5mg MOBIC SUSP 7.5MG/ 5ML nabumetone tab 500mg, 750mg naproxen DR tab 375mg, 500mg naproxen sodium tab 75mg, 550mg NAPROXEN SUSP 5MG/ 5ML naproxen tab 50mg, 375mg, 500mg oxaprozin tab 600mg piroxicam cap 0mg, 0mg sulindac tab 50mg, 00mg tolmetin cap 00mg TOLMETIN TAB 600MG PHOSPHODIESTERASE (PDE) INHIBITORS OTEZLA 8-DAY STARTER CK OTEZLA TAB 30MG OTEZLA TAB STARTER CK PYRIMIDINE SYNTHESIS INHIBITORS leflunomide tab 0mg, 0mg SELECTIVE COSTIMULATION MODULATORS ORENCIA INJ 50MG ORENCIA SC INJ 5MG/ ML SOLUBLE TUMOR NECROSIS FACTOR RECEPTOR AGENTS ENBREL INJ 5MG, 50MG ENBREL SURECLICK INJ 50MG QL=00 Tabs/00 Days QL=0 Tabs/5 Days NM QL=55 Tabs/8 Days NM QL=60 Tabs/30 Days NM QL=60 Tabs/30 Days NM NM NM NM 3

16 ANALGESICS - NONNARCOTIC ANALGESIC COMBINATIONS aspirin/ acetaminophen/ caffeine tab mg* ANALGESICS OTHER acetaminophen cap 500mg* acetaminophen chew tab 60mg* acetaminophen chew tab 80mg* acetaminophen CR tab 650mg* acetaminophen dispersible tab 60mg* acetaminophen dispersible tab 80mg* acetaminophen elixir 60mg/ 5ml* acetaminophen liquid 60mg/ 5ml* acetaminophen liquid 67mg/ 5ml* ACETAMINOPHEN LIQUID 500MG/ 5ML* acetaminophen soln 00mg/ ml* acetaminophen soln 60mg/ 5ml* acetaminophen supp 0mg* acetaminophen supp 35mg* acetaminophen supp 650mg* ACETAMINOPHEN SUPP 80MG* acetaminophen susp 60mg/ 5ml* acetaminophen susp 80mg/ 0.8ml* ACETAMINOPHEN SYRUP 60MG/ 5ML* acetaminophen tab 35mg* acetaminophen tab 500mg* SALICYLATES ASCRIPTIN TAB 35MG* aspirin chew tab 8mg* aspirin EC tab 35mg* aspirin EC tab 500mg* aspirin EC tab 8mg* aspirin tab 35mg* aspirin tab 500mg* aspirin tab 8mg* diflunisal tab 500mg ANALGESICS - OPIOID OPIOID AGONISTS codeine sulfate tab 5mg, 30mg codeine sulfate tab 60mg duramorph inj 0.5mg/ ml, mg/ ml EMBEDA CAP 0-0.8MG, 30-.MG, 50-MG, 60-.MG, 80-3.MG, 00-MG QL=00 Tabs/00 Days QL=00 Tabs/00 Days QL=00 Tabs/00 Days QL=0 Tabs/30 Days QL=80 Tabs/30 Days QL=60 Caps/30 Days

17 EXALGO TAB 8MG, MG, 6MG, 3MG fentanyl lollipop 00mcg, 00mcg, 600mcg, 800mcg, 00mcg, 600mcg fentanyl patch mcg, 5mcg, 50mcg, 75mcg, 00mcg hydromorphone ER tab mg HYDROMORPHONE ER TAB 3MG hydromorphone ER tab 8mg, 6mg hydromorphone inj 0mg/ ml hydromorphone susp mg/ ml hydromorphone tab mg hydromorphone tab mg hydromorphone tab 8mg HYSINGLA ER TAB 0MG, 30MG 0MG, 60MG, 80MG, 00MG, 0MG LAZANDA NASAL SPRAY 00MCG, 00MCG LEVORPHANOL TAB MG meperitab tab 00mg meperitab tab 50mg methadone soln 0mg/ 5ml methadone soln 5mg/ 5ml methadone tab 5mg, 0mg morphine sulfate conc soln 0mg/ ml morphine sulfate ER beads 30mg, 5mg, 60mg, 75mg, 90mg, 0mg morphine sulfate ER cap 0mg, 0mg, 30mg, 50mg, 60mg, 80mg, 00mg morphine sulfate ER tab 5mg, 30mg, 60mg, 00mg, 00mg MORPHINE SULFATE PF INJ MG/ ML, MG/ ML, 8MG/ ML, 0MG/ ML morphine sulfate soln 0mg/ 5ml morphine sulfate soln 0mg/ 5ml morphine sulfate tab 5mg, 30mg NUCYNTA ER TAB 50MG, 00MG, 50MG, 00MG, 50MG oxycodone cap 5mg oxycodone conc 00mg/ 5ml oxycodone soln 5mg/ 5ml oxycodone tab 0mg, 5mg, 0mg, 30mg oxycodone tab 5mg OXYCONTIN TAB 0MG, 5MG, 0MG, 30MG, 0MG, 60MG OXYCONTIN TAB 80MG QL=60 Tabs/30 Days QL=0 Lozenges/30 Days QL=0 Patches/30 Days QL=60 Tabs/30 Days QL=60 Tabs/30 Days QL=30 Tabs/30 Days QL=00 ml/30 Days QL=50 Tabs/30 Days QL=0 Tabs/30 Days QL=0 Tabs/30 Days QL=30 Tabs/30 Days QL=30 Bottles/30 Days QL=0 Tabs/30 Days QL=360 Tabs/30 Days QL=70 Tabs/30 Days QL=800 ml/30 Days QL=3600 ml/30 Days QL=360 Tabs/30 Days QL=80 ml/30 Days QL=60 Caps/30 Days QL=60 Caps/30 Days QL=0 Tabs/30 Days QL=800 ml/30 Days QL=900 ml/30 Days QL=80 Tabs/30 Days QL=60 Tabs/30 Days QL=360 Caps/30 Days QL=70 ml/30 Days QL=500 ml/30 Days QL=80 Tabs/30 Days QL=360 Tabs/30 Days QL=60 Tabs/30 Days QL=0 Tabs/30 Days 5

18 oxymorphone ER tab 5mg, 7.5mg, 0mg, 5mg, 0mg, 30mg, 0mg oxymorphone tab 5mg, 0mg tramadol ER tab 00mg, 00mg, 300mg tramadol tab 50mg OPIOID COMBINATIONS acetaminophen/ codeine soln 0-mg/ 5ml acetaminophen/ codeine tab 300-5mg, mg, mg hydrocodone 0mg/ ibuprofen 00mg tab hydrocodone 5mg/ ibuprofen 00mg tab hydrocodone/ acetaminophen soln mg/ 5ml hydrocodone/ acetaminophen tab.5-35mg, 5-35mg, mg, 0-35mg hydrocodone/ acetaminophen tab 5-300mg, mg, 0-300mg hydrocodone/ ibuprofen tab mg, 0-00mg oxycodone/ acetaminophen tab.5-35mg, 5-35mg, mg, 0-35mg oxycodone/ aspirin tab mg oxycodone/ ibuprofen tab 5-00mg ROXICET SOLN 5-35MG tramadol/ acetaminophen tab mg OPIOID RTIAL AGONISTS buprenorphine inj 0.3mg/ ml buprenorphine SL tab mg, 8mg buprenorphine/ naloxone SL tab -0.5mg, 8-mg butorphanol inj mg/ ml, mg/ ml butorphanol soln 0mg/ ml BUTRANS TCH 5MCG, 7.5MCG, 0MCG, 5MCG, 0MCG pentazocine/ naloxone tab mg SUBOXONE SL FILM -3MG SUBOXONE SL FILM -0.5MG, -MG, 8-MG ANDROGENS-ANABOLIC ANABOLIC STEROIDS ANADROL TAB 50MG oxandrolone tab.5mg, 0mg ANDROGENS ANDRODERM TCH MG ANDRODERM TCH MG ANDROGEL % (5MG) QL=60 Tabs/30 Days QL=360 Tabs/30 Days QL=60 Tabs/30 Days QL=0 Tabs/30 Days QL=980 ml/30 Days QL=390 Tabs/30 Days QL=80 Tabs/30 Days QL=80 Tabs/30 Days QL=500 ml/30 Days QL=360 Tabs/30 Days QL=390 Tabs/30 Days QL=80 Tabs/30 Days QL=360 Tabs/30 Days QL=360 Tabs/30 Days QL=0 Tabs/30 Days QL=800 ml/30 Days QL=300 Tabs/30 Days QL= Bottles/30 Days QL= Patches/8 Days QL=360 Tabs/30 Days QL=60 Film/30 Days QL=90 Film/30 Days QL=60 Patches/30 Days QL=30 Patches/30 Days QL=30 Packets/30 Days 6

19 ANDROGEL % (50MG) ANDROGEL.6% (.5GM) ANDROGEL.6% (.5GM) ANDROGEL PUMP % ANDROGEL PUMP.6% danazol cap 50mg, 00mg, 00mg testosterone cypionate inj 00mg/ ml, 00mg/ ml testosterone enanthate inj 00mg/ ml ANORECTAL AGENTS INTRARECTAL STEROIDS colocort enema 00mg/ 60ml hydrocortisone enema 00mg/ 60ml UCERIS RECTAL FOAM MG RECTAL STEROIDS procto-pak rectal cream % proctozone-hc cream.5% ANTACIDS ANTACID COMBINATIONS aluminum hydroxide/ magnesium carbonate chew tab 60-05mg* aluminum hydroxide/ magnesium trisilicate chew tab 80-0mg* aluminum/ magnesium hydroxide/ simethicone chew tab mg* aluminum/ magnesium hydroxide/ simethicone susp mg/ 5ml* aluminum/ magnesium hydroxide/ simethicone susp mg/ 5ml* CALCIUM CARBONATE/ SIMETHICONE CHEW TAB MG* ANTACIDS - ALUMINUM SALTS ALUMINUM HYDROXIDE GEL SUSP 30MG/ 5ML* ANTACIDS - BICARBONATE sodium bicarbonate tab 650mg* ANTACIDS - CALCIUM SALTS calcium carbonate (antacid) chew tab 000mg* calcium carbonate (antacid) chew tab 00mg* calcium carbonate (antacid) chew tab 0mg* calcium carbonate (antacid) chew tab 500mg* calcium carbonate (antacid) chew tab 600mg* calcium carbonate (antacid) chew tab 750mg* CALCIUM CARBONATE (ANTACID) TAB 68MG* QL=60 Packets/30 Days QL=30 Packets/30 Days QL=60 Packets/30 Days QL= Bottles/30 Days QL= Bottles/30 Days 7

20 ANTACIDS - MAGNESIUM SALTS magnesium oxide tab 50mg* magnesium oxide tab 00mg* magnesium oxide tab 0mg* ANTHELMINTICS ANTHELMINTICS ALBENZA TAB 00MG ivermectin tab 3mg ANTIANGINAL AGENTS ANTIANGINALS-OTHER RANEXA TAB 500MG, 000MG NITRATES isosorbide dinitrate ER tab 0mg ISOSORBIDE DINITRATE TAB 30MG isosorbide dinitrate tab 5mg, 0mg, 0mg isosorbide mononitrate ER tab 30mg, 60mg, 0mg isosorbide mononitrate tab 0mg, 0mg minitran patch 0.mg, 0.mg, 0.mg, 0.6mg NITRO-DUR TCH 0.3MG, 0.8MG nitroglycerin mucosal spray 0.mg nitroglycerin patch 0.mg, 0.mg, 0.mg, 0.6mg NITROSTAT SL TAB 0.3MG, 0.MG, 0.6MG ANTIANXIETY AGENTS ANTIANXIETY AGENTS - MISC. buspirone tab 5mg, 0mg, 5mg hydroxyzine inj 5mg/ ml, 50mg/ ml hydroxyzine pamoate cap 5mg, 50mg, 00mg hydroxyzine syrup 0mg/ 5ml hydroxyzine tab 0mg, 5mg, 50mg meprobamate tab 00mg, 00mg BENZODIAZEPINES alprazolam ER tab 0.5mg, mg, mg, 3mg alprazolam ODT 0.5mg, 0.5mg, mg, mg alprazolam tab 0.5mg, 0.5mg, mg, mg chlordiazepoxide cap 5mg, 0mg, 5mg clorazepate tab 3.75mg, 7.5mg, 5mg DIAZEM INTENSOL CONC 5MG/ ML DIAZEM SOLN MG/ ML diazepam tab mg, 5mg, 0mg lorazepam conc mg/ ml lorazepam tab 0.5mg, mg, mg oxazepam cap 0mg, 5mg, 30mg 8

21 ANTIARRHYTHMICS ANTIARRHYTHMICS TYPE I-A disopyramide cap 00mg, 50mg NORCE CR CAP 00MG, 50MG procainamide inj 00mg/ ml, 500mg/ ml quinidine gluconate CR tab 3mg quinidine gluconate inj 80mg/ ml quinidine sulfate tab 00mg, 300mg ANTIARRHYTHMICS TYPE I-B mexiletine cap 50mg, 00mg, 50mg ANTIARRHYTHMICS TYPE I-C flecainide tab 50mg, 00mg, 50mg propafenone ER cap 5mg, 35mg, 5mg propafenone tab 50mg, 5mg, 300mg ANTIARRHYTHMICS TYPE III amiodarone inj 50mg/ 3ml amiodarone tab 00mg, 00mg MULTAQ TAB 00MG NEXTERONE INJ 50MG/ 00ML, 360MG/ 00ML TIKOSYN CAP 5MCG, 50MCG, 500MCG ANTIASTHMATIC AND BRONCHODILATOR AGENTS ANTIASTHMATIC - MONOCLONAL ANTIBODIES XOLAIR INJ 50MG NM ANTI-INFLAMMATORY AGENTS cromolyn neb 0mg/ ml BRONCHODILATORS - ANTICHOLINERGICS ATROVENT HFA INHALER 7MCG INCRUSE ELLIPTA INHALER 6.5MCG ipratropium inhalation soln 0.0% SPIRIVA.5MCG/ ACT INH SPIRIVA CAP HANDIHALER 8MCG SPIRIVA RESPIMAT.5MCG LEUKOTRIENE MODULATORS montelukast chew tab mg, 5mg montelukast granules mg montelukast tab 0mg zafirlukast tab 0mg, 0mg SELECTIVE PHOSPHODIESTERASE (PDE) INHIBITORS DALIRESP TAB 500MCG STEROID INHALANTS ARNUITY ELLIPTA INHALER 00MCG, 00MCG QL= Inhalers/30 Days ASMANEX HFA INHALER 00MCG, 00MCG QL= Inhalers/30 Days 9

22 ASMANEX INHALER 0MCG, 0MCG budesonide 0.5 mg/ ml inh soln budesonide neb 0.5mg/ ml, 0.5mg/ ml FLOVENT DISKUS 50MCG, 00MCG, 50MCG FLOVENT HFA INHALER 0MCG, 0MCG FLOVENT HFA INHALER MCG PULMICORT NEB MG/ ML SYMTHOMIMETICS ADVAIR DISKUS 00MCG, 50MCG, 500MCG ADVAIR HFA INHALER 5MCG, 5MCG, 30MCG albuterol neb 0.63mg/ 3ml,.5mg/ 3ml,.5mg/ 3ml, 5mg/ ml albuterol sulfate ER tab mg, 8mg albuterol syrup mg/ 5ml albuterol tab mg, mg BREO ELLIPTA INHALER 00-5MCG, 00-5MCG COMBIVENT RESPIMAT 0-00MCG DULERA INHALER 00-5MCG, 00-5MCG FORADIL CAP MCG ipratropium/ albuterol soln mg/ 3ml levalbuterol conc.5mg/ 0.5ml levalbuterol neb 0.3mg/ 3ml, 0.63mg/ 3ml METAPROTERENOL SYRUP 0MG/ 5ML SEREVENT INHALER 50MCG STIOLTO.5-.5MCG INH terbutaline inj mg/ ml terbutaline tab.5mg, 5mg VENTOLIN HFA INHALER 08MCG XANTHINES aminophylline inj 5mg/ ml ELIXOPHYLLIN SOLN 80MG/ 5ML theophylline ER tab 00mg, 00mg, 300mg, 00mg, 50mg, 600mg theophylline soln 80mg/ 5ml ANTICOAGULANTS COUMARIN ANTICOAGULANTS jantoven tab mg, mg,.5mg, 3mg, mg, 5mg, 6mg, 7.5mg, 0mg warfarin tab mg, mg,.5mg, 3mg, mg, 5mg, 6mg, 7.5mg, 0mg DIRECT FACTOR XA INHIBITORS ELIQUIS TAB.5MG, 5MG QL= Inhalers/30 Days QL=60 Neb/30 Days QL=60 Neb/30 Days QL= Inhalers/30 Days QL= Inhalers/30 Days QL= Inhalers/30 Days QL=60 Neb/30 Days QL= Inhalers/30 Days QL= Inhalers/30 Days QL= Inhalers/30 Days QL= Inhalers/30 Days QL= Inhalers/30 Days 0

23 XARELTO TAB 0MG, 5MG, 0MG XARELTO TAB STARTER CK HERINS AND HERINOID-LIKE AGENTS enoxaparin inj 30mg, 0mg, 60mg, 80mg, 00mg, 0mg, 50mg, 300mg fondaparinux inj.5mg/ 0.5ml fondaparinux inj 5mg/ 0.ml, 7.5mg/ 0.6ml, 0mg/ 0.8ml FRAGMIN INJ 500UNIT, 0000UNIT FRAGMIN INJ 5000UNIT, 5000UNIT, 5000UNIT, 8000UNIT FRAGMIN INJ 7500UNIT, 95000UNIT heparin inj 000unit/ ml, 5000unit/ ml, 0000unit/ ml, 0000unit/ ml heparin/ d5w inj 0unit/ ml, 50unit/ ml, 00unit/ ml THROMBIN INHIBITORS argatroban inj 00mg/ ml ARGATROBAN INJ 5MG/ 5ML PRADAXA 0MG CAP PRADAXA CAP 75MG, 50MG ANTICONVULSANTS AM GLUTAMATE RECEPTOR ANTAGONISTS FYCOM TAB MG, MG, 6MG, 8MG, 0MG, MG ANTICONVULSANTS - BENZODIAZEPINES clonazepam ODT 0.5mg, 0.5mg, 0.5mg, mg, mg clonazepam tab 0.5mg, mg, mg DIASTAT RECTAL GEL.5MG, 0MG, 0MG DIAZEM RECTAL GEL.5MG, 0MG, 0MG ONFI SUSP.5MG/ ML ONFI TAB 0MG, 0MG ANTICONVULSANTS - MISC. APTIOM TAB 00MG, 00MG, 600MG, 800MG BANZEL SUSP 0MG/ ML BANZEL TAB 00MG, 00MG carbamazepine chew tab 00mg carbamazepine ER cap 00mg, 00mg, 300mg carbamazepine ER tab 00mg, 00mg carbamazepine susp 00mg/ 5ml carbamazepine tab 00mg epitol tab 00mg gabapentin cap 00mg, 300mg, 00mg gabapentin soln 50mg/ 5ml QL=3 Syringes/7 Days NM NM NM NSO NSO NSO NSO

24 gabapentin tab 600mg, 800mg LAMICTAL TAB STARTER KIT LAMICTAL XR KIT lamotrigine chew tab 5mg, 5mg lamotrigine ER tab 5mg, 50mg, 00mg, 00mg, 50mg, 300mg lamotrigine ODT 5mg, 50mg, 00mg, 00mg lamotrigine tab 5mg, 00mg, 50mg, 00mg LEVETIRACETAM 0MG/ ML INJ LEVETIRACETAM 5MG/ ML INJ LEVETIRACETAM 5MG/ ML INJ levetiracetam ER tab 500mg, 750mg levetiracetam inj 500mg/ 5ml levetiracetam soln 00mg/ ml levetiracetam tab 50mg, 500mg, 750mg, 000mg LYRICA CAP 5MG, 50MG, 75MG, 00MG, 50MG, 00MG, 5MG, 300MG LYRICA SOLN 0MG/ ML oxcarbazepine oral susp 300mg/ 5ml oxcarbazepine tab 50mg, 300mg, 600mg OXTELLAR XR TAB 50MG, 300MG, 600MG POTIGA TAB 50MG, 00MG, 300MG, 00MG primidone tab 50mg, 50mg QUDEXY XR CAP 5MG, 50MG, 00MG, 50MG, 00MG TEGRETOL-XR TAB 00MG TOPIRAMATE ER CAP 5MG, 50MG, 00MG, 50MG, 00MG topiramate sprinkle cap 5mg, 5mg topiramate tab 5mg, 50mg, 00mg, 00mg TROKENDI XR CAP 5MG, 50MG, 00MG, 00MG VIMT INJ 0MG/ ML VIMT SOLN 0MG/ ML VIMT TAB 50MG, 00MG, 50MG, 00MG zonisamide cap 5mg, 50mg, 00mg CARBAMATES felbamate susp 600mg/ 5ml felbamate tab 00mg, 600mg GABA MODULATORS GABITRIL TAB MG, 6MG SABRIL POWDER 500MG SABRIL TAB 500MG tiagabine tab mg, mg NSO QL=90 Tabs/30 Days NSO NSO NSO QL=60 Tabs/30 Days NM NM

25 HYDANTOINS DILANTIN CAP 30MG fosphenytoin inj 00mg/ ml PEGANONE TAB 50MG phenytoin cap 00mg phenytoin chew tab 50mg phenytoin inj 50mg/ ml phenytoin susp 5mg/ 5ml SUCCINIMIDES CELONTIN CAP 300MG ethosuximide cap 50mg ethosuximide soln 50mg/ 5ml VALPROIC ACID divalproex DR tab 5mg, 50mg, 500mg divalproex ER tab 50mg, 500mg divalproex sprinkle cap 5mg valproic acid cap 50mg valproic acid inj 00mg/ ml valproic acid syrup 50mg/ 5ml ANTIDEPRESSANTS ALPHA- RECEPTOR ANTAGONISTS (TETRACYCLICS) mirtazapine ODT 5mg, 30mg, 5mg mirtazapine tab 7.5mg, 5mg, 30mg, 5mg ANTIDEPRESSANTS - MISC. APLENZIN TAB 7MG, 38MG, 5MG bupropion SR tab 00mg, 50mg, 00mg bupropion tab 75mg, 00mg bupropion XL tab 50mg, 300mg maprotiline tab 5mg, 50mg, 75mg MODIFIED CYCLICS BRINTELLIX TAB 5MG, 0MG, 0MG NEFAZODONE TAB 00MG, 50MG, 00MG nefazodone tab 50mg, 50mg trazodone tab 50mg, 00mg, 50mg, 300mg VIIBRYD TAB 0MG, 0MG, 0MG MONOAMINE OXIDASE INHIBITORS (MAOIS) EMSAM TCH 6MG, 9MG, MG MARPLAN TAB 0MG phenelzine tab 5mg tranylcypromine tab 0mg SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS) citalopram soln 0mg/ 5ml ST ST QL=30 Tabs/30 Days ST 3

26 citalopram tab 0mg, 0mg, 0mg escitalopram soln 5mg/ 5ml escitalopram tab 5mg, 0mg, 0mg fluoxetine cap 0mg, 0mg, 0mg fluoxetine soln 0mg/ 5ml fluoxetine tab 0mg, 0mg fluvoxamine ER cap 00mg, 50mg fluvoxamine tab 5mg, 50mg, 00mg paroxetine ER tab.5mg, 5mg, 37.5mg paroxetine tab 0mg, 0mg, 30mg, 0mg XIL SUSP 0MG/ 5ML PEXEVA TAB 0MG, 0MG, 30MG, 0MG sertraline conc 0mg/ ml sertraline tab 5mg, 50mg, 00mg SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS) DESVENLAFAXINE ER TAB 50MG, 00MG duloxetine cap 0mg, 30mg, 60mg DULOXETINE DR CAP 0MG FETZIMA CAP TITRATION CK FETZIMA ER CAP 0MG, 0MG, 80MG, 0MG IRENKA CAP 0MG KHEDEZLA TAB 50MG, 00MG PRISTIQ TAB 5MG, 50MG, 00MG venlafaxine ER cap 37.5mg, 75mg, 50mg VENLAFAXINE ER TAB 5MG venlafaxine ER tab 37.5mg, 75mg, 50mg venlafaxine tab 5mg, 37.5mg, 50mg, 75mg, 00mg TRICYCLIC AGENTS amitriptyline tab 0mg, 5mg, 50mg, 75mg, 00mg, 50mg amoxapine tab 5mg, 50mg, 00mg, 50mg clomipramine cap 5mg, 50mg, 75mg desipramine tab 0mg, 5mg, 50mg, 75mg, 00mg, 50mg doxepin cap 0mg, 5mg, 50mg, 75mg, 00mg, 50mg doxepin conc 0mg/ ml imipramine pamoate cap 75mg, 00mg, 5mg, 50mg imipramine tab 0mg, 5mg, 50mg nortriptyline cap 0mg, 5mg, 50mg, 75mg nortriptyline soln 0mg/ 5ml protriptyline tab 5mg, 0mg SURMONTIL CAP 5MG, 50MG, 00MG trimipramine 00mg cap ST ST ST QL=60 Caps/30 Days ST QL=30 Caps/30 Days ST QL=30 Caps/30 Days ST QL=30 Caps/30 Days ST QL=30 Caps/30 Days ST ST NSO NSO NSO NSO NSO NSO NSO NSO

27 trimipramine 5mg cap trimipramine 50mg cap ANTIDIABETICS ALPHA-GLUCOSIDASE INHIBITORS acarbose tab 5mg, 50mg, 00mg GLYSET TAB 5MG, 50MG, 00MG ANTIDIABETIC COMBINATIONS AVANDAMET TAB -500MG, -000MG, -500MG, -000MG glipizide/ metformin tab.5-50mg,.5-500mg, 5-500mg glyburide/ metformin tab.5-50mg,.5-500mg, 5-500mg JANUMET TAB MG, MG JANUMET XR TAB MG, MG, MG KOMBIGLYZE XR TAB 5-500MG,.5-000MG, 5-000MG pioglitazone/ glimepiride tab 30-mg, 30-mg pioglitazone/ metformin tab 5-500mg, 5-850mg SYNJARDY.5-000MG TAB SYNJARDY.5-500MG TAB SYNJARDY 5-000MG TAB SYNJARDY 5-500MG TAB XIGDUO XR TAB 5-000MG XIGDUO XR TAB 5-500MG, 0-500MG, 0-000MG BIGUANIDES metformin 500mg er tab metformin 750mg er tab metformin tab 500mg, 850mg, 000mg DIABETIC OTHER GLUCAGEN HYPOKIT GLUCAGON KIT GLUCOSE CHEW TAB GM* GLUCOSE CHEW TAB GM* GLUCOSE CHEW TAB 5GM* glucose gel 0%* KORLYM TAB 300MG PROGLYCEM SUSP 50MG/ ML DIPEPTIDYL PEPTIDASE- (DPP-) INHIBITORS JANUVIA TAB 5MG, 50MG, 00MG ONGLYZA TAB.5MG, 5MG INCRETIN MIMETIC AGENTS (GLP- RECEPTOR AGONISTS) NSO NSO QL=60 Tabs/30 Days QL=60 Tabs/30 Days QL=30 Tabs/30 Days QL=60 Tabs/30 Days QL=60 Tabs/30 Days QL=60 Tabs/30 Days QL=60 Tabs/30 Days QL=60 Tabs/30 Days QL=30 Tabs/30 Days NM QL=30 Tabs/30 Days QL=30 Tabs/30 Days 5

28 BYDUREON INJ 3.08MG/ ML BYDUREON PEN INJ MG VICTOZA INJ 8MG/ 3ML INSULIN HUMULIN R U-500 INJ LANTUS INJ LANTUS SOLOSTAR PEN-INJECTOR LEVEMIR FLEXTOUCH INJ LEVEMIR INJ NOVOLIN 70/ 30 INJ NOVOLIN N INJ NOVOLIN R INJ NOVOLOG FLEXPEN INJ NOVOLOG INJ NOVOLOG MIX FLEXPEN INJ NOVOLOG MIX INJ NOVOLOG PENFILL INJ TOUJEO 300UNIT/ ML SYR INSULIN SENSITIZING AGENTS AVANDIA TAB MG, MG, 8MG pioglitazone tab 5mg, 30mg, 5mg MEGLITINIDE ANALOGUES nateglinide tab 60mg, 0mg repaglinide tab 0.5mg, mg, mg SODIUM-GLUCOSE CO-TRANSPORTER (SGLT) INHIBITORS FARXIGA TAB 5MG, 0MG JARDIANCE TAB 0MG, 5MG SULFONYLUREAS CHLORPROMIDE TAB 00MG, 50MG glimepiride tab mg, mg, mg glipizide ER tab.5mg, 5mg, 0mg glipizide tab 5mg, 0mg glyburide micronized tab.5mg, 3mg, 6mg glyburide tab.5mg,.5mg, 5mg tolazamide tab 50mg, 500mg TOLBUTAMIDE TAB 500MG ANTIDIARRHEALS ANTIDIARRHEAL AGENTS - MISC. bismuth subsalicylate chew tab 6mg* bismuth subsalicylate susp 6mg/ 5ml* bismuth subsalicylate susp 55mg/ 5ml* bismuth subsalicylate tab 6mg* QL=30 Tabs/30 Days QL=30 Tabs/30 Days 6

29 ANTIPERISTALTIC AGENTS diphenoxylate/ atropine liquid mg/ 5ml diphenoxylate/ atropine tab mg loperamide cap mg loperamide liquid mg/ 5ml* loperamide liquid mg/ 7.5ml* loperamide tab mg* ANTIDOTES ANTIDOTES fomepizole inj gm/ ml ANTIDOTES - CHELATING AGENTS CHEMET CAP 00MG EXJADE TAB 5MG, 50MG, 500MG FERRIPROX 00MG/ ML SOLN FERRIPROX TAB 500MG JADENU 80MG TAB JADENU 360MG TAB JADENU 90MG TAB OPIOID ANTAGONISTS NALOXONE INJ MG/ ML naltrexone tab 50mg ANTIEMETICS 5-HT3 RECEPTOR ANTAGONISTS granisetron inj 0.mg/ ml, mg/ ml granisetron tab mg ondansetron mg/ ml syr ondansetron inj mg/ ml ondansetron ODT mg, 8mg ondansetron soln mg/ 5ml ondansetron tab mg, 8mg, mg ANTIEMETICS - ANTICHOLINERGIC dimenhydrinate tab 50mg* meclizine chew tab 5mg* meclizine tab.5mg, 5mg (Rx Only) TRANSDERM-SCOP TCH.5MG trimethobenzamide cap 300mg ANTIEMETICS - MISCELLANEOUS AKYNZEO CAP MG CESAMET CAP MG dronabinol cap.5mg, 5mg, 0mg SUBSTANCE P/ NEUROKININ (NK) RECEPTOR ANTAGONISTS EMEND CAP 0MG, 80MG, 5MG NM NM LD NM NM NM NM QL=9 Tabs/ Days QL= Caps/7 Days QL=3 Caps/ Days 7

30 EMEND CAP THERAPY CK QL=3 Caps/ Days ANTIFUNGALS ANTIFUNGAL - GLUCAN SYNTHESIS INHIBITORS (ECHINOCANDINS) CANCIDAS INJ 50MG, 70MG NM ERAXIS INJ 00MG MYCAMINE INJ 50MG, 00MG ANTIFUNGALS ABELCET INJ 5MG/ ML AMBISOME INJ 50MG AMPHOTERICIN B INJ 50MG flucytosine cap 50mg, 500mg griseofulvin micro susp 5mg/ ml griseofulvin tab 5mg, 50mg, 500mg nystatin tab unit terbinafine tab 50mg IMIDAZOLE-RELATED ANTIFUNGALS fluconazole susp 0mg/ ml, 0mg/ ml fluconazole tab 50mg, 00mg, 50mg, 00mg fluconazole/ dextrose inj 00mg/ 00ml itraconazole cap 00mg ketoconazole tab 00mg NOXAFIL SUSP 0MG/ ML NOXAFIL TAB 00MG NM voriconazole inj 00mg voriconazole susp 0mg/ ml voriconazole tab 50mg, 00mg NM ANTIHISTAMINES ANTIHISTAMINES - ALKYLAMINES chlorpheniramine maleate CR tab mg* chlorpheniramine maleate syrup mg/ 5ml* chlorpheniramine maleate tab mg* ANTIHISTAMINES - ETHANOLAMINES carbinoxamine soln mg/ 5ml carbinoxamine tab mg clemastine fumarate tab.3mg* clemastine tab.68mg diphenhydramine cap 5mg* diphenhydramine chew tab.5mg* diphenhydramine disperse tab.5mg* diphenhydramine elixir.5mg/ 5ml (Rx only) diphenhydramine inj 50mg/ ml diphenhydramine liquid.5mg/ 5ml* 8

31 DIPHENHYDRAMINE ORAL STRIP.5MG* diphenhydramine tab 5mg* ANTIHISTAMINES - NON-SEDATING cetirizine chew tab 0mg* cetirizine chew tab 5mg* cetirizine soln 5mg/ 5ml cetirizine tab 0mg* cetirizine tab 5mg* desloratadine tab 5mg levocetirizine dihydrochloride tab 5mg levocetirizine soln.5mg/ 5ml LORATADINE ODT 5MG* loratadine rapidly-disintegrating tab 0mg* loratadine syrup 5mg/ 5ml* loratadine tab 0mg* ANTIHISTAMINES - PHENOTHIAZINES promethazine inj 5mg/ ml, 50mg/ ml promethazine supp.5mg, 5mg, 50mg promethazine syrup 6.5mg/ 5ml promethazine tab.5mg, 5mg, 50mg PROMETHAZINE VC SYRUP 6.5-5MG/ 5ML ANTIHISTAMINES - PIPERIDINES cyproheptadine syrup mg/ 5ml cyproheptadine tab mg ANTIHYPERLIPIDEMICS ANTIHYPERLIPIDEMICS - MISC. KYNAMRO INJ 00MG/ ML omega-3 acid ethyl esters cap gm VASCE CAP GM BILE ACID SEQUESTRANTS cholestyramine light powder gm/ dose cholestyramine light powder packet gm colestipol granules canister 5gm colestipol tab gm WELCHOL K 3.75GM WELCHOL TAB 65MG FIBRIC ACID DERIVATIVES FENOFIBRATE CAP 50MG, 50MG fenofibrate micronized cap 3mg, 67mg, 30mg, 3mg, 00mg fenofibrate tab 8mg, 5mg, 5mg, 60mg gemfibrozil tab 600mg QL=30 Tabs/30 Days QL=30 Tabs/30 Days QL=30 Tabs/30 Days QL=30 Tabs/30 Days QL=300 ml/30 Days QL=30 Tabs/30 Days NM 9

32 TRIGLIDE TAB 60MG TRILIPIX CAP 5MG, 35MG HMG COA REDUCTASE INHIBITORS atorvastatin tab 0mg, 0mg, 0mg, 80mg CRESTOR TAB 0MG QL=5 Tabs/30 Days CRESTOR TAB 5MG, 0MG, 0MG QL=30 Tabs/30 Days fluvastatin 80mg ER tab fluvastatin cap 0mg, 0mg LESCOL XL TAB 80MG lovastatin tab 0mg, 0mg, 0mg pravastatin tab 0mg, 0mg, 0mg, 80mg SIMCOR TAB 500-0MG, 500-0MG, 750-0MG, 000-0MG, 000-0MG simvastatin tab 5mg, 0mg, 0mg, 0mg, 80mg INTESTINAL CHOLESTEROL ABSORPTION INHIBITORS ZETIA TAB 0MG QL=30 Tabs/30 Days MICROSOMAL TRIGLYCERIDE TRANSFER PROTEIN (MTP) INHIBITORS JUXTAPID CAP 5MG, 0MG, 0MG, 30MG, 0MG, NM 60MG NICOTINIC ACID DERIVATIVES NIACOR TAB 500MG NIASN ER TAB 500MG, 750MG, 000MG ANTIHYPERTENSIVES ACE INHIBITORS benazepril tab 5mg, 0mg, 0mg, 0mg captopril tab.5mg, 5mg, 50mg, 00mg enalapril tab.5mg, 5mg, 0mg, 0mg fosinopril tab 0mg, 0mg, 0mg lisinopril tab.5mg, 5mg, 0mg, 0mg, 30mg, 0mg moexipril tab 7.5mg, 5mg perindopril tab mg, mg, 8mg quinapril tab 5mg, 0mg, 0mg, 0mg ramipril cap.5mg,.5mg, 5mg, 0mg trandolapril tab mg, mg, mg AGENTS FOR PHEOCHROMOCYTOMA DEMSER CAP 50MG NM phenoxybenzamine 0mg cap ANGIOTENSIN II RECEPTOR ANTAGONISTS candesartan tab mg, 8mg, 6mg, 3mg EPROSARTAN MESYLATE TAB 600MG irbesartan tab 75mg, 50mg, 300mg losartan tab 5mg, 50mg, 00mg 0

33 telmisartan tab 0mg, 0mg, 80mg valsartan tab 0mg, 80mg, 60mg, 30mg ANTIADRENERGIC ANTIHYPERTENSIVES clonidine patch 0.mg, 0.mg, 0.3mg clonidine tab 0.mg, 0.mg, 0.3mg doxazosin tab mg, mg, mg, 8mg guanfacine IR tab mg, mg methyldopa tab 50mg, 500mg prazosin cap mg, mg, 5mg terazosin cap mg, mg, 5mg, 0mg ANTIHYPERTENSIVE COMBINATIONS amlodipine/ benazepril cap.5-0mg, 5-0mg, 5-0mg, 0-0mg, 5-0mg, 0-0mg amlodipine/ telmisartan tab 0-5mg, 0-0mg, 80-5mg, 80-0mg amlodipine/ valsartan tab 5-60mg, 5-30mg, 0-60mg, 0-30mg amlodipine/ valsartan/ hydrochlorothiazide tab (all strengths) atenolol/ chlorthalidone tab 50-5mg, 00-5mg benazepril/ hydrochlorothiazide tab 5-6.5mg, 0-.5mg, 0-.5mg, 0-5mg bisoprolol/ hydrochlorothiazide tab.5-6.5mg, 5-6.5mg, 0-6.5mg candesartan/ hydrochlorothiazide tab 6-.5mg, 3-.5mg, 3-5mg captopril/ hydrochlorothiazide tab 5-5mg, 5-5mg, 50-5mg, 50-5mg DUTOPROL ER TAB 5-.5MG, 50-.5MG, 00-.5MG enalapril/ hydrochlorothiazide tab 5-.5mg, 0-5mg fosinopril/ hydrochlorothiazide tab 0-.5mg, 0-.5mg irbesartan/ hydrochlorothiazide tab 50-.5mg, mg lisinopril/ hydrochlorothiazide tab 0-.5mg, 0-.5mg, 0-5mg losartan/ hydrochlorothiazide tab 50-.5mg, 00-.5mg, 00-5mg methyldopa/ hydrochlorothiazide tab 50-5mg, 50-5mg metoprolol/ hydrochlorothiazide tab 50-5mg, 00-5mg, 00-50mg

34 moexipril/ hydrochlorothiazide tab mg, 5-.5mg, 5-5mg nadolol/ bendroflumethiazide tab 0-5mg, 80-5mg propranolol/ hydrochlorothiazide tab 0-5mg, 80-5mg quinapril/ hydrochlorothiazide tab 0-.5mg, 0-.5mg, 0-5mg telmisartan/ hydrochlorothiazide tab 0-.5mg, 80-.5mg, 80-5mg trandolapril mg/ verapamil 0mg ER tab trandolapril mg/ verapamil 80mg ER tab trandolapril mg/ verapamil 0mg ER tab trandolapril mg/ verapamil 0mg ER tab valsartan/ hydrochlorothiazide tab 80-.5mg, 60-.5mg, 60-5mg, 30-.5mg, 30-5mg SELECTIVE ALDOSTERONE RECEPTOR ANTAGONISTS (SARAS) eplerenone tab 5mg, 50mg VASODILATORS hydralazine inj 0mg/ ml hydralazine tab 0mg, 5mg, 50mg, 00mg minoxidil tab.5mg, 0mg ANTI-INFECTIVE AGENTS - MISC. ANTI-INFECTIVE AGENTS - MISC. AZACTAM/ DEXTROSE INJ GM/ 50ML, GM/ 50ML aztreonam inj gm baciim inj 50000unit CAYSTON INHALATION SOLN 75MG colistimethate inj 50mg DALVANCE INJ 500MG metronidazole cap 375mg metronidazole tab 50mg, 500mg metronidazole/ nacl inj 500mg/ 00ml NEBUPENT NEB 300MG PENTAM INJ 300MG tinidazole tab 50mg, 500mg trimethoprim tab 00mg vancomycin cap 5mg, 50mg vancomycin inj 500mg, 000mg, 0gm ANTI-INFECTIVE MISC. - COMBINATIONS SULFAMETHOXAZOLE/ TRIMETHOPRIM INJ 00-80MG/ 5ML sulfamethoxazole/ trimethoprim susp 00-0mg/ 5ml NM NM ST QL=56 Caps/0 Days

35 sulfamethoxazole/ trimethoprim tab 00-80mg, mg ANTIPROTOZOAL AGENTS ALINIA SUSP 00MG/ 5ML ALINIA TAB 500MG atovaquone susp 750mg/ 5ml CARBAPENEMS DORIBAX INJ 500MG imipenem/ cilastatin inj 50mg, 500mg INVANZ INJ GM meropenem inj 500mg CHLORAMPHENICOLS CHLORAMPHENICAL INJ GM CYCLIC LIPOPEPTIDES CUBICIN INJ 500MG GLYCYLCYCLINES TYGACIL INJ 50MG LEPROSTATICS DAPSONE TAB 5MG, 00MG LINCOSAMIDES clindamycin cap 75mg, 50mg, 300mg clindamycin inj 600mg/ ml clindamycin syrup 75mg/ 5ml clindamycin/ d5w inj 300mg/ 50ml, 600mg/ 50ml, 900mg/ 50ml LINCOCIN INJ 300MG/ ML OXAZOLIDINONES linezolid 0mg/ ml susp linezolid inj mg/ ml linezolid tab 600mg SIVEXTRO INJ 00MG SIVEXTRO TAB 00MG ZYVOX SUSP 00MG/ 5ML POLYMYXINS polymyxin B sulfate inj unit STREPTOGRAMINS SYNERCID INJ 500MG ANTIMALARIALS ANTIMALARIAL COMBINATIONS atovaquone/ proguanil tab 6.5-5mg, 50-00mg COARTEM TAB 0-0MG NM NM NM NM NM NM QL=6 Vials/5 Days NM QL=6 Tabs/5 Days NM NM 3

36 ANTIMALARIALS chloroquine tab 50mg, 500mg DARAPRIM TAB 5MG hydroxychloroquine tab 00mg mefloquine tab 50mg PRIMAQUINE TAB 6.3MG quinine sulfate cap 3mg ANTIMYASTHENIC AGENTS ANTIMYASTHENIC AGENTS GUANIDINE TAB 5MG MESTINON TIMESN TAB 80MG pyridostigmine tab 60mg ANTIMYASTHENIC/ CHOLINERGIC AGENTS ANTIMYASTHENIC/ CHOLINERGIC AGENTS pyridostigmine bromide 80mg ER tab ANTIMYCOBACTERIAL AGENTS ANTI TB COMBINATIONS RIFAMATE CAP MG RIFATER TAB MG ANTIMYCOBACTERIAL AGENTS CASTAT INJ GM ethambutol tab 00mg, 00mg isoniazid inj 00mg/ ml isoniazid syrup 50mg/ 5ml isoniazid tab 00mg, 300mg SER GRANULE GM PRIFTIN 50MG TAB pyrazinamide tab 500mg rifabutin cap 50mg rifampin cap 50mg, 300mg rifampin inj 600mg SIRTURO TAB 00MG NM TRECATOR TAB 50MG ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES ALKYLATING AGENTS BICNU INJ 00MG NM BUSULFEX INJ 6MG/ ML carboplatin inj 50mg/ 5ml cisplatin inj mg/ ml CYCLOPHOSPHAMIDE CAP 5MG, 50MG GLEOSTINE 5MG CAP GLEOSTINE CAP 0MG, 0MG, 00MG

37 HEXALEN CAP 50MG ifosfamide inj gm LEUKERAN TAB MG LOMUSTINE CAP 0MG, 0MG, 00MG melphalan inj 50mg MUSTARGEN INJ 0MG oxaliplatin inj 00mg/ 0ml THIOTE 5MG INJ TREANDA INJ 5MG, 00MG ZANOSAR INJ GM ANTIMETABOLITES adrucil 500mg/ 0ml inj ALIMTA INJ 500MG ARRANON INJ 5MG/ ML azacitidine inj 00mg cladribine inj mg/ ml CLOLAR INJ MG/ ML cytarabine inj 0mg/ ml, 00mg/ ml decitabine inj 50mg fludarabine inj 50mg fluorouracil inj 50mg/ ml FOLOTYN INJ 0MG/ ML gemcitabine inj gm mercaptopurine tab 50mg methotrexate inj 5mg/ ml, 50mg/ ml methotrexate tab.5mg PURIXAN SUSP 0MG/ ML TABLOID TAB 0MG TREXALL TAB 5MG, 7.5MG, 0MG, 5MG ANTINEOPLASTIC - ANGIOGENESIS INHIBITORS AVASTIN 00MG/ 6ML INJ AVASTIN INJ 00MG/ ML CYRAMZA 00MG/ 0ML INJ CYRAMZA 500MG/ 50ML INJ ZALTRAP INJ 00MG/ ML ANTINEOPLASTIC - ANTIBODIES ARZERRA INJ 00MG/ 5ML DARZALEX 00MG/ 5ML INJ EMPLICITI 300MG INJ ERBITUX SOLN 00MG/ 50ML HERCEPTIN INJ 0MG KADCYLA INJ 00MG KEYTRUDA 00MG/ ML INJ NM NM NM NSO NM NM NM NSO NM NM NSO NM NSO NM NSO NM LD NM NSO NM NSO NM NM NM NSO NM NSO 5

38 KEYTRUDA IV SOLN 50MG OPDIVO INJ 0MG/ ML PERJETA INJ 30MG/ ML RITUXAN INJ 0MG/ ML VECTIBIX INJ 00MG/ 5ML YERVOY INJ 50MG/ 0ML ANTINEOPLASTIC - HEDGEHOG THWAY INHIBITORS ERIVEDGE CAP 50MG ODOMZO 00MG CAP ANTINEOPLASTIC - HORMONAL AND RELATED AGENTS anastrozole tab mg bicalutamide tab 50mg ELIGARD INJ 7.5MG,.5MG, 30MG, 5MG EMCYT CAP 0MG exemestane tab 5mg FARESTON TAB 60MG FASLODEX INJ 50MG/ 5ML FIRMAGON INJ 0MG FIRMAGON INJ 80MG flutamide cap 5mg letrozole tab.5mg leuprolide inj 5mg/ ml LUPRON DEPOT INJ 3.75MG, 7.5MG,.5MG,.5MG, 30MG, 5MG LYSODREN TAB 500MG megestrol acetate susp 0mg/ ml megestrol acetate tab 0mg, 0mg NILANDRON TAB 50MG SOLTAMOX ORAL SOLN 0MG/ 5ML tamoxifen citrate tab 0mg, 0mg TRELSTAR DEPOT MIXJECT INJ 3.75MG TRELSTAR LA MIXJECT INJ.5MG TRELSTAR MIXJECT INJ.5MG XTANDI CAP 0MG ZYTIGA TAB 50MG ANTINEOPLASTIC - IMMUNOMODULATORS POMALYST CAP MG, MG, 3MG, MG ANTINEOPLASTIC ANTIBIOTICS bleomycin sulfate inj 30unit COSMEGEN INJ 0.5MG daunorubicin inj 5mg/ ml DAUNOXOME MG/ ML INJ doxorubicin inj mg/ ml NM NSO NM NSO NM NSO NM NM NM NSO NM NSO LD NM NSO NM NM NM NSO NSO NM NSO NSO NSO NM NM NM NM NSO QL=0 Caps/30 Days NM NSO NM NSO NM 6

39 epirubicin inj mg/ ml idarubicin inj mg/ ml mitomycin inj 0mg mitoxantrone inj mg/ ml ANTINEOPLASTIC COMBINATIONS LONSURF 5-6.MG TAB LONSURF 0-8.9MG TAB ANTINEOPLASTIC ENZYME INHIBITORS AFINITOR DISPERZ TAB MG, 3MG, 5MG AFINITOR TAB.5MG, 5MG, 7.5MG, 0MG ALECENSA 50MG CAP BELEODAQ IV INJ 500MG BOSULIF TAB 00MG, 500MG CAPRELSA TAB 00MG, 300MG COMETRIQ CAP CK COTELLIC 0MG TAB FARYDAK CAP 0MG, 5MG, 0MG GILOTRIF TAB 0MG, 30MG, 0MG GLEEVEC TAB 00MG, 00MG IBRANCE CAP 75MG, 00MG, 5MG ICLUSIG TAB 5MG, 5MG IMBRUVICA CAP 0MG INLYTA TAB MG, 5MG IRESSA 50MG TAB ISTODAX INJ 0MG JAKAFI TAB 5MG, 0MG, 5MG, 0MG, 5MG LENVIMA THERAPY CK 0MG, MG, 0MG, MG LYNRZA CAP 50MG MEKINIST TAB 0.5MG, MG NEXAVAR TAB 00MG NINLARO.3MG CAP NINLARO 3MG CAP NINLARO MG CAP SPRYCEL TAB 0MG, 50MG, 70MG, 80MG, 00MG, 0MG STIVARGA TAB 0MG SUTENT CAP.5MG, 5MG, 37.5MG, 50MG TAFINLAR CAP 50MG, 75MG TAGRISSO 0MG TAB TAGRISSO 80MG TAB TARCEVA TAB 5MG, 00MG, 50MG TASIGNA CAP 50MG, 00MG NM NSO NM NSO NM NSO NM NSO QL=30 Tabs/30 Days NM NSO NM NSO NM NSO NM NSO NM NSO LD NM NSO NM NSO NM NSO QL=30 Tabs/30 Days NM NSO NM NSO NM NSO NM NSO QL=0 Caps/30 Days NM NSO QL=0 Tabs/30 Days NM NSO NM NSO NM NSO QL=60 Tabs/30 Days NM NSO NM NSO NM NSO LD NM NSO NM NSO NM NSO NM NSO NM NSO NM NSO QL=0 Tabs/30 Days NM NSO NM NSO QL=0 Caps/30 Days LD NM NSO LD NM NSO NM NSO NM NSO 7

40 TORISEL SOLN 5MG/ ML TYKERB TAB 50MG VELCADE INJ 3.5MG VOTRIENT TAB 00MG XALKORI CAP 00MG, 50MG ZELBORAF TAB 0MG ZOLINZA CAP 00MG ZYDELIG TAB 00MG, 50MG ZYKADIA CAP 50MG ANTINEOPLASTIC ENZYMES ERWINAZE INJ 0000UNIT ONCASR INJ 750UNIT/ ML ANTINEOPLASTICS MISC. ACTIMMUNE INJ 00MCG/ 0.5ML bexarotene 75mg cap dacarbazine inj 00mg hydroxyurea cap 500mg INTRON-A INJ UNIT, UNIT INTRON-A INJ UNIT, UNIT MATULANE CAP 50MG PROLEUKINE IV SOLN UNIT SYLATRON INJ 96MCG, MCG, 888MCG SYNRIBO INJ 3.5MG TARGRETIN CAP 75MG tretinoin cap 0mg TRISENOX INJ 0MG/ 0ML UVADEX SOLN 0MCG/ ML CHEMOTHERAPY ADJUNCTS ELITEK INJ.5MG KEPIVANCE INJ 6.5MG CHEMOTHERAPY RESCUE/ ANTIDOTE AGENTS amifostine inj 500mg dexrazoxane inj 0mg/ ml FUSILEV INJ 50MG leucovorin inj 00mg, 350mg leucovorin tab 5mg, 0mg, 5mg, 5mg LEVOLEUCOVORIN INJ 0MG/ ML mesna inj 00mg/ ml MESNEX TAB 00MG MITOTIC INHIBITORS ABRAXANE IV SUSP 00MG DOCEFREZ INJ 0MG, 80MG DOCETAXEL INJ 0MG/ ML NM LD NM NSO NM NM NSO NM NSO NM NSO NM NSO NSO NM NSO NM NSO NM NM NM NSO NM NM NM NSO NM NM NSO NM NM NM NM NM 8

41 DOCETAXEL INJ 0MG/ ML ETOPOPHOS INJ 00MG etoposide inj 0mg/ ml HALAVEN INJ MG/ ML IXEMPRA INJ 5MG JEVTANA INJ 60MG/.5ML paclitaxel inj 6mg/ ml VINBLASTINE INJ MG/ ML vincasar PFS inj mg/ ml vincristine inj mg/ ml vinorelbine inj 0mg/ ml TOPOISOMERASE I INHIBITORS irinotecan inj 0mg/ ml topotecan inj mg ANTIRKINSON AGENTS ANTIRKINSON ADJUVANTS carbidopa tab 5mg ANTIRKINSON ANTICHOLINERGICS benztropine inj mg/ ml benztropine tab 0.5mg, mg, mg trihexyphenidyl soln 0.mg/ ml trihexyphenidyl tab mg, 5mg ANTIRKINSON COMT INHIBITORS entacapone tab 00mg tolcapone tab 00mg ANTIRKINSON DOMINERGICS amantadine cap 00mg amantadine syrup 50mg/ 5ml APOKYN INJ 0MG/ ML bromocriptine cap 5mg bromocriptine tab.5mg carbidopa/ levodopa ER tab 5-00mg, 50-00mg carbidopa/ levodopa ODT 0-00mg, 5-00mg, 5-50mg carbidopa/ levodopa tab 0-00mg, 5-00mg, 5-50mg CARBIDO/ LEVODO/ ENTACAPONE TAB (ALL STRENGTHS) NEUPRO TCH MG, MG, 3MG, MG, 6MG, 8MG pramipexole 0.375mg ER tab pramipexole 0.75mg ER tab pramipexole.5mg ER tab pramipexole.5mg ER tab NM NM NM NM NM 9

42 pramipexole 3mg ER tab pramipexole.5mg ER tab pramipexole tab 0.5mg, 0.5mg, 0.5mg, 0.75mg, mg,.5mg ropinirole ER tab mg, mg, 6mg, 8mg, mg ropinirole tab 0.5mg, 0.5mg, mg, mg, 3mg, mg, 5mg STALEVO TAB 50MG, 75MG, 00MG, 5MG, 50MG, 00MG ANTIRKINSON MONOAMINE OXIDASE INHIBITORS AZILECT TAB 0.5MG, MG selegiline cap 5mg selegiline tab 5mg ANTIPSYCHOTICS/ ANTIMANIC AGENTS ANTIMANIC AGENTS lithium carbonate cap 50mg, 300mg, 600mg lithium carbonate ER tab 300mg, 50mg lithium carbonate tab 300mg lithium citrate soln 8meq/ 5ml ANTIPSYCHOTICS - MISC. EQUETRO CAP 00MG, 00MG, 300MG GEODON INJ 0MG LATUDA TAB 0MG, 0MG, 60MG, 80MG, 0MG NSO QL=30 Tabs/30 Days ziprasidone cap 0mg, 0mg, 60mg, 80mg BENZISOXAZOLES FANAPT TAB MG, MG, MG, 6MG, 8MG, 0MG, NSO MG FANAPT TAB TITRATION CK NSO INVEGA SUSTENNA INJ 39MG, 78MG, 7MG, NSO 56MG, 3MG INVEGA TAB.5MG, 3MG, 6MG, 9MG NSO paliperidone.5mg ER tab NSO paliperidone 3mg ER tab NSO paliperidone 6mg ER tab NSO paliperidone 9mg ER tab NSO RISPERDAL INJ.5MG, 5MG, 37.5MG, 50MG risperidone ODT 0.5mg, 0.5mg, mg, mg, 3mg, mg risperidone soln mg/ ml risperidone tab 0.5mg, 0.5mg, mg, mg, 3mg, mg BUTYROPHENONES haloperidol decanoate inj 50mg/ ml, 00mg/ ml haloperidol inj 5mg/ ml haloperidol oral conc mg/ ml 30

43 haloperidol tab 0.5mg, mg, mg, 5mg, 0mg, 0mg DIBENZAPINES CLOZAPINE ODT.5MG, 5MG, 00MG, 50MG, 00MG clozapine tab 5mg, 50mg, 00mg, 00mg FAZACLO TAB.5MG, 5MG, 00MG, 50MG, 00MG loxapine cap 5mg, 0mg, 5mg, 50mg olanzapine inj 0mg olanzapine ODT 5mg, 0mg, 5mg, 0mg olanzapine tab.5mg, 5mg, 7.5mg, 0mg, 5mg, 0mg quetiapine tab 5mg, 50mg, 00mg, 00mg, 300mg, 00mg SAPHRIS SL TAB.5MG, 5MG, 0MG SEROQUEL XR TAB 50MG, 50MG, 00MG, 300MG, 00MG VERSACLOZ SUSP 50MG/ ML ZYPREXA 0MG INJ DIHYDROINDOLONES MOLINDONE 0MG TAB MOLINDONE 5MG TAB MOLINDONE 5MG TAB PHENOTHIAZINES chlorpromazine inj 5mg/ ml chlorpromazine tab 0mg, 5mg, 50mg, 00mg, 00mg compro supp 5mg fluphenazine decanoate inj 5mg/ ml fluphenazine elixir.5mg/ 5ml fluphenazine inj.5mg/ ml fluphenazine oral conc 5mg/ ml fluphenazine tab mg,.5mg, 5mg, 0mg perphenazine tab mg, mg, 8mg, 6mg prochlorperazine inj 5mg/ ml prochlorperazine supp 5mg prochlorperazine tab 5mg, 0mg thioridazine tab 0mg, 5mg, 50mg, 00mg trifluoperazine tab mg, mg, 5mg, 0mg QUINOLINONE DERIVATIVES ABILIFY MAINTENA INJ 300MG, 00MG ARIPIPRAZOLE ODT 0MG, 5MG aripiprazole tab mg, 5mg, 0mg, 5mg, 0mg, 30mg REXULTI 0.5MG TAB REXULTI 0.5MG TAB NSO QL=60 Tabs/30 Days NSO NSO NSO QL=60 Tabs/30 Days QL=60 Tabs/30 Days NSO QL=30 Tabs/30 Days NSO QL=30 Tabs/30 Days 3

44 REXULTI MG TAB NSO QL=30 Tabs/30 Days REXULTI MG TAB NSO QL=30 Tabs/30 Days REXULTI 3MG TAB NSO QL=30 Tabs/30 Days REXULTI MG TAB NSO QL=30 Tabs/30 Days THIOXANTHENES thiothixene cap mg, mg, 5mg, 0mg ANTISEPTICS & DISINFECTANTS CHLORINE ANTISEPTICS CHLORHEXIDINE GLUCONATE LIQUID %* QL=0 ml/365 Days chlorhexidine gluconate liquid %* QL=0 ml/365 Days CHLORHEXIDINE GLUCONATE DS %* QL=38 Packets/365 Days IODINE ANTISEPTICS POVIDONE-IODINE D 0%* povidone-iodine soln 0%* povidone/ iodine soln 7.5%* ANTIVIRALS ANTIRETROVIRALS abacavir tab 300mg abacavir/ lamivudine/ zidovudine tab mg APTIVUS CAP 50MG NM APTIVUS SOLN 00MG/ ML NM ATRIPLA TAB MG NM COMPLERA TAB MG NM CRIXIVAN CAP 00MG, 00MG didanosine cap 5mg, 00mg, 50mg, 00mg EDURANT TAB 5MG NM EMTRIVA CAP 00MG EMTRIVA SOLN 0MG/ ML EPZICOM TAB MG NM EVOTAZ TAB MG NM FUZEON INJ 90MG NM GENVOYA MG TAB NM INTELENCE TAB 00MG, 00MG NM INTELENCE TAB 5MG INVIRASE CAP 00MG INVIRASE TAB 500MG NM ISENTRESS CHEW TAB 00MG NM ISENTRESS CHEW TAB 5MG ISENTRESS POWDER CK 00MG ISENTRESS TAB 00MG NM KALETRA SOLN 80-0MG/ ML NM KALETRA TAB 00-5MG 3

45 KALETRA TAB 00-50MG lamivudine soln 0mg/ ml lamivudine tab 50mg, 300mg lamivudine/ zidovudine tab mg LEXIVA SUSP 50MG/ ML LEXIVA TAB 700MG nevirapine 00mg ER tab nevirapine ER tab 00mg NEVIRAPINE SUSP 50MG/ 5ML nevirapine tab 00mg NORVIR CAP 00MG NORVIR SOLN 80MG/ ML NORVIR TAB 00MG PREZCOBIX TAB MG PREZISTA SUSP 00MG/ ML PREZISTA TAB 600MG, 800MG PREZISTA TAB 75MG, 50MG RESCRIPTOR TAB 00MG, 00MG RETROVIR INJ 0MG/ ML REYATAZ CAP 50MG, 00MG, 300MG REYATAZ POWDER CKET 50MG SELZENTRY TAB 50MG, 300MG stavudine cap 5mg, 0mg, 30mg, 0mg stavudine oral soln mg/ ml STRIBILD TAB MG SUSTIVA CAP 50MG, 00MG SUSTIVA TAB 600MG TIVICAY TAB 50MG TRIUMEQ TAB MG TRUVADA TAB MG TYBOST TAB 50MG VIDEX SOLN GM VIRACEPT TAB 50MG, 65MG VIRAMUNE SUSP 50MG/ 5ML VIRAMUNE XR TAB 00MG VIREAD POWDER 0MG/ GM VIREAD TAB 50MG, 00MG, 50MG, 300MG VITEKTA TAB 85MG, 50MG ZIAGEN SOLN 0MG/ ML zidovudine cap 00mg zidovudine syrup 0mg/ ml zidovudine tab 300mg CMV AGENTS NM NM NM NM NM NM NM NM NM NM NM NM QL=60 Tabs/30 Days NM NM NM NM NM 33

46 cidofovir inj 75mg/ ml ganciclovir inj 500mg VALCYTE SOLN 50MG/ ML valganciclovir tab 50mg HETITIS AGENTS adefovir tab 0mg BARACLUDE SOLN 0.05MG/ ML entecavir tab 0.5mg, mg EPIVIR HBV SOLN 5MG/ ML HARVONI TAB 90-00MG lamivudine tab 00mg moderiba tab 00mg MODERIBA TAB DOSE CK PEG-INTRON INJ (ALL STRENGTHS) PEGASYS INJ 80MCG/ 0.5ML, 80MCG/ ML PEGASYS PROCLICK INJ 35MCG/ 0.5ML, 80MCG/ 0.5ML RIBAK TAB 00MG RIBAK TAB 600MG ribasphere cap 00mg ribasphere tab 00mg, 00mg ribasphere tab 600mg ribavirin cap 00mg ribavirin tab 00mg SOVALDI TAB 00MG TYZEKA TAB 600MG HERPES AGENTS acyclovir cap 00mg acyclovir inj 50mg/ ml acyclovir susp 00mg/ 5ml acyclovir tab 00mg, 800mg famciclovir tab 5mg, 50mg, 500mg valacyclovir tab 500mg, gm INFLUENZA AGENTS RELENZA DISKHALER 5MG rimantadine tab 00mg TAMIFLU CAP 30MG TAMIFLU CAP 5MG, 75MG TAMIFLU SUSP 6MG/ ML RESPIRATORY SYNCYTIAL VIRUS (RSV) AGENTS VIRAZOLE SOLN 6GM ASPIRIN NM NM NM QL=30 Tabs/30 Days NM NM NM NM NM NM NM QL=30 Tabs/30 Days QL=56 Blisters/80 Days QL=8 Caps/80 Days QL=8 Caps/80 Days QL=9 Bottles/80 Days NM 3

47 ANALGESICS - NONNARCOTIC aspirin EC tab 650mg* ASSORTED CLASSES CHELATING AGENTS CUPRIMINE CAP 50MG DEPEN TITRATABS 50MG SYPRINE CAP 50MG IMMUNOMODULATORS REVLIMID CAP.5MG, 0MG REVLIMID CAP 5MG, 0MG, 5MG, 5MG THALOMID CAP 50MG, 00MG, 50MG, 00MG IMMUNOSUPPRESSIVE AGENTS ASTAGRAF XL CAP 0.5MG, MG, 5MG ATGAM INJ 50MG/ ML AZASAN TAB 75MG, 00MG azathioprine tab 50mg CELLCEPT IV INJ 500MG cyclosporine cap 5mg, 00mg cyclosporine inj 50mg/ ml cyclosporine modified cap 5mg, 00mg CYCLOSPORINE MODIFIED CAP 50MG cyclosporine modified soln 00mg/ ml ENVARSUS 0.75MG ER TAB ENVARSUS MG ER TAB ENVARSUS MG ER TAB gengraf cap 5mg, 00mg gengraf soln 00mg/ ml mycophenolate cap 50mg mycophenolate mofetil susp 00mg/ ml mycophenolate sodium tab 80mg, 360mg mycophenolate tab 500mg NULOJIX INJ 50MG PROGRAF INJ 5MG/ ML RAMUNE SOLN MG/ ML SANDIMMUNE SOLN 00MG/ ML SIMULECT INJ 0MG sirolimus tab 0.5mg, mg, mg tacrolimus cap 0.5mg, mg, 5mg THYMOGLOBULIN INJ 5MG ZORTRESS TAB 0.5MG, 0.5MG, 0.75MG IRRIGATION SOLUTIONS lactated ringers irrigation NM NSO QL=30 Caps/30 Days LD NM NSO QL=30 Caps/30 Days NM NSO NM NM NM NM NSO 35

48 physiolyte irrigation soln physiosol irrigation soln ringers irrigation sterile water irrigation LYMPHATIC AGENTS SYLVANT INJ 00MG POTASSIUM REMOVING RESINS kionex powder sodium polystyrene sulfonate susp 5gm/ 60ml SYSTEMIC LUPUS ERYTHEMATOSUS AGENTS BENLYSTA INJ 0MG BETA BLOCKERS ALPHA-BETA BLOCKERS carvedilol tab 3.5mg, 6.5mg,.5mg, 5mg labetalol inj 5mg/ ml labetalol tab 00mg, 00mg, 300mg BETA BLOCKERS CARDIO-SELECTIVE acebutolol cap 00mg, 00mg atenolol tab 5mg, 50mg, 00mg betaxolol tab 0mg, 0mg bisoprolol tab 5mg, 0mg BYSTOLIC TAB.5MG, 5MG, 0MG, 0MG metoprolol ER tab 5mg, 50mg, 00mg, 00mg metoprolol tab 5mg, 50mg, 00mg metoprolol tartrate inj mg/ ml BETA BLOCKERS NON-SELECTIVE INNOPRAN XL CAP 80MG, 0MG nadolol tab 0mg, 0mg, 80mg pindolol tab 5mg, 0mg propranolol ER cap 60mg, 80mg, 0mg, 60mg propranolol inj mg/ ml propranolol oral soln 0mg/ 5ml, 0mg/ 5ml propranolol tab 0mg, 0mg, 0mg, 60mg, 80mg sorine tab 80mg, 0mg, 60mg, 0mg sotalol AF tab 0mg sotalol tab 80mg, 60mg, 0mg timolol maleate tab 5mg, 0mg, 0mg BIOLOGICALS MISC BIOLOGICALS MISC ADAGEN INJ 50UNIT CALCIUM CHANNEL BLOCKERS CALCIUM CHANNEL BLOCKERS NM NM NM 36

49 afeditab CR tab 30mg, 60mg amlodipine tab.5mg, 5mg, 0mg CARDENE INJ 0MG/ 00ML, 0MG/ 00ML cartia XT cap 0mg, 80mg, 0mg 300mg dilt-xr cap 0mg, 80mg, 0mg diltiazem CD cap 0mg, 0mg, 300mg diltiazem ER cap 60mg, 90mg, 0mg, 80mg, 360mg, 0mg DILTIAZEM INJ 00MG diltiazem inj 50mg/ 0ml diltiazem tab 30mg, 60mg, 90mg, 0mg felodipine tab.5mg, 5mg, 0mg isradipine cap.5mg, 5mg matzim LA tab 80mg, 0mg, 300mg, 360mg, 0mg nicardipine cap 0mg, 30mg nicardipine inj.5mg/ ml nifedical XL tab 30mg, 60mg nifedipine cap 0mg, 0mg nifedipine ER tab 30mg, 60mg, 90mg nimodipine cap 30mg nisoldipine ER tab 8.5mg, 7mg, 0mg, 30mg, 3mg, 0mg taztia-xt cap 0mg, 80mg, 0mg, 300mg, 360mg verapamil 0 mg er tab verapamil 80 mg er tab verapamil 0 mg er tab verapamil ER cap 00mg, 0mg, 80mg, 00mg, 0mg, 300mg, 360mg verapamil ER tab 0mg, 80mg, 0mg verapamil inj.5mg/ ml VERAMIL TAB 0MG verapamil tab 80mg, 0mg CARDIOTONICS CARDIAC GLYCOSIDES digoxin inj 0.5mg/ ml digoxin oral soln 0.05mg/ ml digoxin tab 0.5mg digoxin tab 0.5mg CARDIOVASCULAR AGENTS - MISC. CARDIOVASCULAR AGENTS MISC. - COMBINATIONS amlodipine/ atorvastatin tab (all strengths) BIDIL TAB MG QL=30 Tabs/30 Days 37

50 PROSTAGLANDIN VASODILATORS REMODULIN INJ MG/ ML,.5MG/ ML, 5MG/ ML, NM 0MG/ ML TYVASO INHALATION SOLN 0.6MG/ ML NM VENTAVIS SOLN 0MCG/ ML, 0MCG/ ML NM PULMONARY HYPERTENSION - ENDOTHELIN RECEPTOR ANTAGONISTS LETAIRIS TAB 5MG, 0MG NM QL=30 Tabs/30 Days OPSUMIT TAB 0MG NM TRACLEER TAB 6.5MG, 5MG LD NM QL=60 Tabs/30 Days PULMONARY HYPERTENSION - PHOSPHODIESTERASE INHIBITORS ADCIRCA TAB 0MG NM sildenafil tab 0mg PULMONARY HYPERTENSION - SOL GUANYLATE CYCLASE STIMULATOR ADEMS TAB 0.5MG, MG,.5MG, MG,.5MG NM SINUS NODE INHIBITORS CORLANOR 5MG TAB CORLANOR 7.5MG TAB CEPHALOSPORINS CEPHALOSPORINS - ST GENERATION cefadroxil cap 500mg cefadroxil susp 50mg/ 5ml, 500mg/ 5ml cefadroxil tab gm cefazolin inj 500mg, gm, 0mg CEFAZOLIN/ D5W INJ GM/ 50ML cephalexin cap 50mg, 500mg cephalexin susp 5mg/ 5ml, 50mg/ 5ml cephalexin tab 50mg, 500mg CEPHALOSPORINS - ND GENERATION cefaclor cap 50mg, 500mg CEFACLOR SUSP 5MG/ 5ML, 50MG/ 5ML, 375MG/ 5ML CEFOTETAN INJ GM, GM, 0GM cefoxitin inj gm, gm, 0gm CEFOXITIN/ DEXTROSE INJ GM-%, GM-.% cefprozil susp 5mg/ 5ml, 50mg/ 5ml cefprozil tab 50mg, 500mg cefuroxime inj 750mg,.5gm, 7.5gm cefuroxime tab 50mg, 500mg CEPHALOSPORINS - 3RD GENERATION CEDAX SUSP 80MG/ 5ML cefdinir cap 300mg cefdinir susp 5mg/ 5ml, 50mg/ 5ml 38

51 cefixime susp 00mg/ 5ml, 00mg/ 5ml cefotaxime inj 500mg, gm, gm, 0gm cefpodoxime susp 50mg/ 5ml, 00mg/ 5ml cefpodoxime tab 00mg, 00mg ceftazidime inj gm, gm, 6gm CEFTAZIDIME/ DEXTROSE INJ GM/ 50ML, GM/ 50ML ceftriaxone inj 50mg, 500mg, gm, gm, 0gm SUPRAX CAP 00MG tazicef gm inj tazicef gm inj tazicef 6gm inj CEPHALOSPORINS - TH GENERATION CEFEPIME 0MG/ ML INJ CEFEPIME 0MG/ ML INJ cefepime inj gm, gm CEPHALOSPORINS - 5TH GENERATION TEFLARO IV SOLN 00MG, 600MG CONTRACEPTIVES COMBINATION CONTRACEPTIVES - ORAL amethia tab apri tab aranelle tab ashlyna 9 day pack aubra tab aviane tab balziva tab bekyree 8 day pack BEYAZ TAB blisovi FE / 0 8 day pack blisovi FE / 0 8 day pack briellyn tab cryselle-8 tab cyclafem tab delyla tab desogestrel/ ethinyl estradiol tab drospirenone 3mg/ ethinyl estradiol 0.0mg/ inert ingredients mg pack drospirenone/ ethinyl estradiol tab emoquette tab enpresse-8 tab ethinyl estradiol 0.03mg/ ethinyl estradiol 0.0mg/ inert ingredients mg/ levonorgestrel 0.05mg/ levono NM 39

52 falmina tab gianvi tab gildagia tab gildess FE tab gildess tab introvale tab junel FE tab junel FE tab junel tab kariva tab kelnor tab kimidess 8 day pack larin FE tab larin tab layolis FE 8 pack leena tab lessina tab levonest tab levonorgestrel/ ethinyl estradiol tab levora-8 tab lomedia FE tab loryna tab lutera tab marlissa tab microgestin FE tab microgestin tab mononessa tab NATAZIA TAB necon tab nikki tab noreth/ ferrous fumarate/ ethinyl estradiol chew tab norethindrone ace-ethinyl estradiol-fe tab nortrel tab ocella tab orsythia tab ORTHO-TRI CYCLEN LO TAB pimtrea tab pirmella tab portia-8 tab previfem tab QUARTETTE TAB quasense tab reclipsen tab 0

53 setlakin 9 day pack sprintec-8 tab sronyx tab tarina FE tab tri-legest FE tab tri-previfem tab tri-sprintec tab trinessa tab trivora-8 tab velivet tab vestura tab vyfemla tab wymzya FE tab zenchent FE tab zenchent tab zovia tab COMBINATION CONTRACEPTIVES - TRANSDERMAL xulane patch 50-35mcg COMBINATION CONTRACEPTIVES - VAGINAL NUVARING VAGINAL RING EMERGENCY CONTRACEPTIVES LEVONORGESTREL TAB 0.75MG* 3 levonorgestrel tab.5mg* PROGESTIN CONTRACEPTIVES - INJECTABLE medroxyprogesterone inj 50mg/ ml PROGESTIN CONTRACEPTIVES - ORAL camila tab deblitane tab errin tab jolivette tab lyza tab nora-be tab norethindrone tab norlyroc tab sharobel tab CORTICOSTEROIDS GLUCOCORTICOSTEROIDS A-HYDROCORT INJ 00MG budesonide EC cap 3mg CORTISONE ACETATE TAB 5MG dexamethasone conc mg/ ml dexamethasone elixir 0.5mg/ 5ml NM

54 dexamethasone inj 0mg/ ml, 0mg/ 30ml dexamethasone tab 0.5mg, 0.75mg,.5mg, mg, 6mg DEXAMETHASONE TAB MG, MG hydrocortisone tab 5mg, 0mg, 0mg KENALOG INJ 0MG/ ML, 0MG/ ML MEDROL TAB MG, MG, 8MG, 6MG, 3MG methylprednisolone inj 0mg/ ml, 80mg/ ml methylprednisolone sodium succinate inj 0mg, 5mg methylprednisolone tab mg, 8mg, 6mg, 3mg methylprednisolone tab dose pak mg prednisolone ODT 0mg, 5mg, 30mg prednisolone sodium phosphate soln 6.7mg/ 5ml, 5mg/ 5ml PREDNISONE INTENSOL CONC 5MG/ ML prednisone soln 5mg/ 5ml prednisone tab mg,.5mg, 5mg, 0mg, 0mg, 50mg SOLU-CORTEF INJ 50MG UCERIS TAB 9MG MINERALOCORTICOIDS fludrocortisone tab 0.mg COUGH/ COLD/ ALLERGY ANTITUSSIVES benzonatate cap 00mg* benzonatate cap 00mg* dextromethorphan hbr cap 5mg* dextromethorphan hbr liquid 5mg/ 5ml* dextromethorphan hbr liquid 5mg/ 5ml* dextromethorphan hbr liquid 7.5mg/ 5ml* dextromethorphan hbr syrup 0mg/ 5ml* dextromethorphan hbr syrup 5mg/ 5ml* dextromethorphan hbr syrup 7.5mg/ 5ml* hydrocodone w/ homatropine syrup 5-.5mg/ 5ml* hydrocodone/ homatropine tab 5-.5mg* 3 COUGH/ COLD/ ALLERGY COMBINATIONS brompheniramine/ phenylephrine elixir -.5mg/ 5ml* brompheniramine/ phenylephrine liquid -0mg/ 5ml* BROMPHENIRAMINE/ PHENYLEPHRINE TAB -0MG* brompheniramine/ pseudoephedrine elixir -5mg/ 5ml* BROMPHENIRAMINE/ PSEUDOEPHEDRINE LIQUID -7.5MG/ ML* BROMPHENIRAMINE/ PSEUDOEPHEDRINE LIQUID -0MG/ ML* QL=30 Tabs/30 Days QL=90 Caps/30 Days QL=90 Caps/30 Days

55 chlorpheniramine-dm liquid -5mg/ 5ml* chlorpheniramine/ DM tab -0mg* chlorpheniramine/ DM tab -30mg* chlorpheniramine/ phenylephrine liquid -0mg/ 5ml* chlorpheniramine/ phenylephrine tab -0mg* chlorpheniramine/ pseudoephedrine tab -60mg* dextromethorphan-guaifenesin cap 0-00mg* dextromethorphan-guaifenesin liquid 0-00mg/ 5ml* dextromethorphan-guaifenesin liquid 5-00mg/ 5ml* dextromethorphan-guaifenesin syrup 0-00mg/ 5ml* DEXTROMETHORPHAN/ GUAIFENESIN GRANULES CKET 5-00MG* dextromethorphan/ guaifenesin liquid 0-00mg/ 5ml* dextromethorphan/ guaifenesin liquid 0-00mg/ 5ml* dextromethorphan/ guaifenesin liquid 0-300mg/ 5ml* dextromethorphan/ guaifenesin liquid 30-00mg/ 5ml* dextromethorphan/ guaifenesin SR tab (hr) mg* dextromethorphan/ guaifenesin SR tab (hr) 60-00mg* dextromethorphan/ guaifenesin tab 0-00mg* doxylamine-dm liquid 6.5-5mg/ 5ml* guaifenesin-codeine soln 00-0mg/ 5ml* guaifenesin/ codeine liquid 00-8mg/ 5ml* guaifenesin/ codeine liquid 5-7.5mg/ 5ml* guaifenesin/ codeine soln mg/ 5ml* LOHIST-D LIQUID -30MG/ 5ML* loratadine/ pseudoephedrine SR tab (hr) 5-0mg* loratadine/ pseudoephedrine SR tab (hr) 0-0mg* phenylephrine w/ DM liquid mg/ 5ml* phenylephrine w/ DM liquid mg/ 5ml* phenylephrine w/ DM liquid mg/ 5ml* phenylephrine w/ DM liquid mg/ 5ml* phenylephrine w/ DM liquid mg/ ml* phenylephrine w/ DM liquid mg/ 5ml* phenylephrine w/ DM liquid mg/ ml* phenylephrine w/ DM syrup mg/ 5ml* phenylephrine w/ DM-gg liquid mg/ 5ml* phenylephrine w/ DM-gg liquid mg/ 5ml* phenylephrine/ brompheniramine/ DM elixir.5--5mg/ 5ml* phenylephrine/ brompheniramine/ DM liquid 0--0mg/ 5ml* QL=60 Tabs/30 Days QL=60 Tabs/30 Days 3

56 phenylephrine/ brompheniramine/ DM liquid.5--5mg/ 5ml* phenylephrine/ brompheniramine/ DM liquid mg/ 5ml* PHENYLEPHRINE/ CHLORPHEN/ DM LIQUID MG/ ML* PHENYLEPHRINE/ CHLORPHEN/ DM LIQUID 0--.5MG/ 5ML* phenylephrine/ chlorphen/ DM liquid 0--5mg/ 5ml* PHENYLEPHRINE/ CHLORPHEN/ DM SYRUP 0--0MG/ 5ML* PHENYLEPHRINE/ CHLORPHEN/ DM SYRUP 5--0MG/ 5ML* phenylephrine/ guaifenesin liquid.5-00mg/ 5ml* phenylephrine/ guaifenesin liquid 5-00mg/ 5ml* PHENYLEPHRINE/ GUAIFENESIN SYRUP.5-50MG/ 5ML* PHENYLEPHRINE/ GUAIFENESIN SYRUP 5-00MG/ 5ML* phenylephrine/ guaifenesin tab 0-380mg* phenylephrine/ guaifenesin tab 0-00mg* phenylephrine/ guaifenesin tab 5-00mg* PHENYLEPHRINE/ PROMETHAZINE W/ CODEINE SYRUP MG/ 5ML* promethazine w/ codeine syrup 6.5-0mg/ 5ml* promethazine/ DM syrup 6.5-5mg/ 5ml* pseudoeph/ doxylamine/ DM w/ acetaminophen liquid mg/ 30ml* pseudoephed/ bromphen/ DM elixir 5--5mg/ 5ml* pseudoephed/ bromphen/ DM syrup 30--0mg/ 5ml* pseudoephed/ chlorphen/ DM liquid 5--5mg/ 5ml* pseudoephed/ chlorphen/ DM liquid mg/ 5ml* pseudoephedrine w/ DM liquid mg/ 5ml* pseudoephedrine w/ DM liquid mg/ 5ml* PSEUDOEPHEDRINE W/ DM TAB MG* PSEUDOEPHEDRINE W/ DM TAB MG* PSEUDOEPHEDRINE W/ DM TAB MG* PSEUDOEPHEDRINE W/ DM TAB MG* PSEUDOEPHEDRINE/ GUAIFENESIN LIQUID MG/ ML* PSEUDOEPHEDRINE/ GUAIFENESIN SR TAB (HR) 0-00MG*

57 PSEUDOEPHEDRINE/ GUAIFENESIN SR TAB (HR) MG* pseudoephedrine/ guaifenesin syrup 30-00mg/ 5ml* pseudoephedrine/ guaifenesin tab 0-00mg* pseudoephedrine/ guaifenesin tab 60-00mg* RESCON DM SYRUP 30--0MG/ 5ML* triprolidine/ pseudoephedrine tab.5-60mg* EXPECTORANTS guaifenesin liquid 00mg/ 5ml* guaifenesin liquid 00mg/ 5ml* guaifenesin SR tab (hr) 600mg* guaifenesin syrup 00mg/ 5ml* guaifenesin tab 00mg* guaifenesin tab 00mg* MUCOLYTICS acetylcysteine inhalation soln 0%, 0% DERMATOLOGICALS ACNE PRODUCTS adapalene cream 0.% adapalene gel 0.%, 0.3% amnesteem cap 0mg, 0mg, 0mg avita cream 0.05% avita gel 0.05% benzoyl peroxide 5.5%* benzoyl peroxide cream 0%* benzoyl peroxide gel 0%* benzoyl peroxide gel 5%* benzoyl peroxide liquid 0%* benzoyl peroxide liquid 5%* BENZOYL PEROXIDE LOTION 0%* BENZOYL PEROXIDE LOTION 5%* benzoyl peroxide lotion 6%* claravis cap 0mg, 0mg, 0mg clindamycin phosphate foam % clindamycin phosphate gel % clindamycin phosphate lotion % clindamycin phosphate soln % clindamycin phosphate swab % clindamycin/ benzoyl peroxide gel -5% DIFFERIN LOTION 0.% EPIDUO % GEL EPIDUO GEL 0.-.5% ery pad % QL= Bottles/30 Days QL= Tubes/30 Days QL= Bottles/30 Days 5

58 erythromycin topical gel % erythromycin topical soln % erythromycin/ benzoyl peroxide gel 5-3% myorisan cap 0mg, 0mg, 0mg sulfacetamide sodium lotion 0% TRETIN-X CREAM % tretinoin 0.05% gel tretinoin cream 0.05%, 0.05%, 0.% tretinoin gel 0.05%, 0.0% tretinoin micro gel 0.0%, 0.% zenatane 30mg cap zenatane cap 0mg, 0mg, 0mg ANTIBIOTICS - TOPICAL bacitracin ointment 500unit/ gm* bacitracin zinc ointment 500unit/ gm* bacitracin-polymyxin b ointment* gentamicin sulfate cream 0.% gentamicin sulfate ointment 0.% mupirocin cream % mupirocin ointment % triple antibiotic ointment* ANTIFUNGALS - TOPICAL ciclopirox cream 0.77% ciclopirox gel 0.77% ciclopirox nail lacquer 8% ciclopirox shampoo % ciclopirox susp 0.77% clotrimazole cream % clotrimazole soln % clotrimazole/ betamethasone cream -0.05% clotrimazole/ betamethasone lotion -0.05% econazole nitrate cream % ERTACZO CREAM % ketoconazole 0mg/ ml foam ketoconazole cream % ketoconazole shampoo % miconazole nitrate cream %* miconazole nitrate powder %* naftifine cream % NAFTIN CREAM % NAFTIN GEL %, % nystatin cream 00000unit nystatin ointment 00000unit 6

59 nystatin topical powder 00000unit nystatin/ triamcinolone cream unit/ gm-% nystatin/ triamcinolone ointment unit/ gm-% OXISTAT CREAM % OXISTAT LOTION % terbinafine cream %* tolnaftate aerosol %* tolnaftate aerosol powder %* tolnaftate cream %* tolnaftate powder %* tolnaftate soln %* ANTIHISTAMINES-TOPICAL diphenhydramine cream %* diphenhydramine gel %* diphenhydramine soln %* diphenhydramine/ zinc acetate cream -0.%* diphenhydramine/ zinc acetate cream -0.%* diphenhydramine/ zinc acetate liquid -0.%* ANTI-INFLAMMATORY AGENTS - TOPICAL diclofenac topical soln.5% PENNSAID SOLN % VOLTAREN GEL % QL=5 Tubes/ Days ANTINEOPLASTIC OR PREMALIGNANT LESION AGENTS - TOPICAL CARAC CREAM 0.5% diclofenac gel 3% FLUOROURACIL CREAM 0.05% fluorouracil cream 5% fluorouracil soln %, 5% NRETIN GEL % NM PICATO GEL 0.05% NM QL=3 Tubes/0 Days PICATO GEL 0.05% NM QL= Tubes/0 Days TARGRETIN GEL % NM VALCHLOR GEL 0.06% NM NSO QL= Tubes/30 Days ANTIPRURITICS - TOPICAL prudoxin cream 5% ANTIPSORIATICS 8-MOP CAP 0MG acitretin cap 0mg, 7.5mg, 5mg calcipotriene cream 0.005% calcipotriene ointment 0.005% calcipotriene soln 0.005% CALCITRIOL OINTMENT 3MCG/ GM COSENTYX 50MG/ ML AUTO-INJECTOR NM 7

60 COSENTYX 50MG/ ML SYR methoxsalen cap 0mg STELARA INJ 5MG/ 0.5ML STELARA INJ 90MG/ ML TAZORAC CREAM 0.05%, 0.% TAZORAC GEL 0.05%, 0.% VECTICAL OINTMENT 3MCG/ GM ANTISEBORRHEIC PRODUCTS selenium sulfide shampoo.5% ANTIVIRALS - TOPICAL acyclovir ointment 5% DENAVIR CREAM % BURN PRODUCTS silver sulfadiazine cream % ssd cream % SULFAMYLON CREAM 85MG/ GM CORTICOSTEROIDS - TOPICAL ala cort cream % alclometasone cream 0.05% alclometasone ointment 0.05% amcinonide cream 0.% AMCINONIDE OINTMENT 0.% apexicon ointment 0.05% augmented betamethasone cream 0.05% augmented betamethasone gel 0.05% augmented betamethasone lotion 0.05% augmented betamethasone ointment 0.05% betamethasone dipropionate cream 0.05% betamethasone dipropionate gel 0.05% betamethasone dipropionate lotion 0.05% betamethasone valerate cream 0.% betamethasone valerate foam 0.% betamethasone valerate lotion 0.% betamethasone valerate ointment 0.% calcipotriene/ betamethasone ointment % clobetasol E cream 0.05% clobetasol gel 0.05% clobetasol lotion 0.05% clobetasol ointment 0.05% clobetasol propionate 0.05% spray clobetasol shampoo 0.05% clobetasol soln 0.05% clobetasol topical foam 0.05% NM NM QL= Syringes/8 Days NM 8

61 cormax 0.05% topical soln DESONATE GEL 0.05% desonide cream 0.05% desonide lotion 0.05% desonide ointment 0.05% DESOXIMETASONE CREAM 0.05% desoximetasone cream 0.5% desoximetasone gel 0.05% desoximetasone ointment 0.5% diflorasone cream 0.05% diflorasone ointment 0.05% fluocinolone acetonide cream 0.0%, 0.05% fluocinolone acetonide oil 0.0% fluocinolone acetonide ointment 0.05% fluocinolone acetonide soln 0.0% fluocinonide cream 0.% fluocinonide E cream 0.05% fluocinonide gel 0.05% fluocinonide ointment 0.05% fluocinonide soln 0.05% fluticasone cream 0.05% fluticasone ointment 0.005% fluticasone propionate lotion 0.05% halobetasol cream 0.05% halobetasol ointment 0.05% hydrocortisone acetate cream %* HYDROCORTISONE ACETATE OINTMENT %* hydrocortisone butyrate cream 0.% hydrocortisone butyrate ointment 0.% hydrocortisone butyrate soln 0.% hydrocortisone cream 0.5%* hydrocortisone cream %,.5% hydrocortisone gel %* hydrocortisone lotion.5% hydrocortisone ointment 0.5%* hydrocortisone ointment %* hydrocortisone ointment %,.5% hydrocortisone soln %* hydrocortisone valerate cream 0.% hydrocortisone valerate ointment 0.% hydrocortisone/ aloe vera cream 0.5%* hydrocortisone/ aloe vera cream %* LOCOID LOTION 0.% QL= Tubes/30 Days QL= Tubes/30 Days 9

62 lokara lotion 0.05% mometasone furoate cream 0.% mometasone furoate lotion 0.% mometasone furoate ointment 0.% prednicarbate cream 0.% prednicarbate ointment 0.% PSORCON 0.05% CREAM TOPICORT CREAM 0.05% triamcinolone cream 0.05%, 0.%, 0.5% triamcinolone lotion 0.05%, 0.% triamcinolone ointment 0.05%, 0.%, 0.5% triamcinolone spray TRIANEX OINTMENT 0.05% triderm cream 0.% EMOLLIENTS ammonium lactate cream % ammonium lactate lotion % lactic acid lotion 5%* ENZYMES - TOPICAL SANTYL OINTMENT 50UNIT/ GM IMMUNOMODULATING AGENTS - TOPICAL imiquimod cream 5% ZYCLARA CREAM.5% IMMUNOSUPPRESSIVE AGENTS - TOPICAL ELIDEL CREAM % tacrolimus ointment 0.03%, 0.% KERATOLYTIC/ ANTIMITOTIC AGENTS podofilox soln 0.5% salicylic acid gel 7%* salicylic acid gel %* salicylic acid liquid 7%* salicylic acid liquid %* salicylic acid liquid 3%* salicylic acid pad %* salicylic acid pad 0%* SALICYLIC ACID SOLN.%* salicylic acid soln.6%* salicylic acid soln 7%* salicylic acid strip 0%* LINIMENTS CAPSICUM OLEORESIN CREAM 0.05%* LOCAL ANESTHETICS - TOPICAL 50

63 capsaicin cream 0.05%* capsaicin cream 0.075%* capsaicin cream 0.%* lidocaine gel % lidocaine ointment 5% lidocaine patch 5% lidocaine soln % lidocaine/ prilocaine cream.5-.5% MISC. TOPICAL ALUMINUM ACETATE SOLN* CALAMINE LOTION* zinc oxide ointment 0%* zinc oxide ointment 0%* zinc oxide ointment 0%* ZINC OXIDE STE 5%* ZINC OXIDE STE 0%* ROSACEA AGENTS FINACEA 5% FOAM FINACEA GEL 5% metronidazole cream 0.75% metronidazole gel 0.75%, % metronidazole lotion 0.75% SCABICIDES & PEDICULICIDES EURAX CREAM 0% lice shampoo* lindane lotion % lindane shampoo % malathion lotion 0.5% permethrin aerosol 0.5%* permethrin cream 5% permethrin creme rinse %* permethrin lotion %* permethrin spray/ pyrethins-piperonyl butoxide shampoo kit* pyrethrins-piperonyl butoxide liq 0.3-3%* pyrethrins/ piperonyl butoxide liquid 0.33-%* pyrethrins/ piperonyl butoxide shampoo 0.33-%* PYRETHRINS/ PIPERONYL BUTOXIDE SHAMPOO KIT 0.33-%* WOUND CARE PRODUCTS ALLCLENZ WOUND CLEANSER* REGRANEX GEL 0.0% QL=90 Patches/30 Days NM QL= Tubes/5 Days 5

64 DIAGNOSTIC PRODUCTS DIAGNOSTIC TESTS ACETONE (URINE) TEST STRIP* QL= Bottles/30 Days ASSURE TEST STRIPS PLATINUM* GLUCOSE URINE TEST-(GLUCOSE OXIDASE) STRIP* DIETARY PRODUCTS/ DIETARY MANAGEMENT PRODUCTS NUTRITIONAL SUPPLEMENTS NUTRITIONAL SUPPLEMENT FLAVOR CK* NUTRITIONAL SUPPLEMENT LIQUID* NUTRITIONAL SUPPLEMENT CK* NUTRITIONAL SUPPLEMENT POWDER* DIGESTIVE AIDS DIGESTIVE ENZYMES CREON CAP (ALL STRENGTHS) NCREAZE CAP (ALL STRENGTHS) ST ULTRESA CAP (ALL STRENGTHS) ST DIURETICS CARBONIC ANHYDRASE INHIBITORS acetazolamide inj 500mg acetazolamide SR cap 500mg acetazolamide tab 5mg, 50mg methazolamide tab 5mg, 50mg DIURETIC COMBINATIONS amiloride/ hydrochlorothiazide tab 5-50mg spironolactone/ hydrochlorothiazide tab 5-5mg triamterene/ hydrochlorothiazide cap mg, 50-5mg triamterene/ hydrochlorothiazide tab mg, 75-50mg LOOP DIURETICS bumetanide inj 0.5mg/ ml bumetanide tab 0.5mg, mg, mg EDECRIN TAB 5MG furosemide inj 0mg/ ml furosemide soln 8mg/ ml, 0mg/ ml furosemide tab 0mg, 0mg, 80mg torsemide tab 5mg, 0mg, 0mg, 00mg POTASSIUM SRING DIURETICS amiloride tab 5mg spironolactone tab 5mg, 50mg, 00mg 5

65 THIAZIDES AND THIAZIDE-LIKE DIURETICS chlorothiazide inj 500mg CHLOROTHIAZIDE TAB 50MG chlorothiazide tab 500mg chlorthalidone tab 5mg, 50mg DIURIL SUSP 50MG/ 5ML hydrochlorothiazide cap.5mg hydrochlorothiazide tab.5mg, 5mg, 50mg indapamide tab.5mg,.5mg METHYCLOTHIAZIDE TAB 5MG metolazone tab.5mg, 5mg, 0mg ENDOCRINE AND METABOLIC AGENTS - MISC. BONE DENSITY REGULATORS ALENDRONATE SOLN 70MG/ 75ML ALENDRONATE TAB 0MG alendronate tab 5mg, 0mg, 35mg, 70mg calcitonin nasal spray 00unit etidronate disodium tab 00mg, 00mg FORTEO SOLN 600MCG/.ML NM FORTICAL NASAL SPRAY 00UNIT ibandronate inj 3mg/ 3ml ST ibandronate tab 50mg ST QL= Tabs/30 Days MIACALCIN INJ 00UNIT/ ML NATRA INJ 5MCG, 50MCG, 75MCG, 00MCG pamidronate inj 3mg/ ml, 9mg/ ml MIDRONATE INJ 6MG/ ML PROLIA SOLN 60MG/ ML NM risedronate sodium 35mg tab ST risedronate sodium tab 50mg ST risedronate tab 5mg, 30mg, 35mg ST XGEVA INJ 0MG/.7ML NM zoledronic acid inj 5mg/ 00ml zoledronic acid inj conc mg/ 5ml ZOMETA INJ MG/ 00ML NM GROWTH HORMONE RECEPTOR ANTAGONISTS SOMAVERT INJ 0MG, 5MG, 0MG, 5MG, 30MG NM GROWTH HORMONES NORDITROPIN FLEXPRO INJ 5MG/.5ML, 0MG/ NM.5ML, 5MG/.5ML NORDITROPIN NORDIFLEX PEN 30MG/ 3ML NM HORMONE RECEPTOR MODULATORS raloxifene tab 60mg 53

66 INSULIN-LIKE GROWTH FACTORS (SOMATOMEDINS) INCRELEX INJ 0MG/ ML LHRH/ GNRH AGONIST ANALOG PITUITARY SUPPRESSANTS LUPRON DEPOT PEDIATRIC INJ.5MG, 5MG SYNAREL SOLN MG/ ML METABOLIC MODIFIERS ALDURAZYME INJ.9MG/ 5ML calcitriol cap 0.5mcg, 0.5mcg calcitriol inj mcg/ ml calcitriol soln mcg/ ml CARBAGLU TAB 00MG doxercalciferol cap 0.5mcg, mcg,.5mcg doxercalciferol inj mcg/ ml ELAPRASE INJ MG/ ML FABRAZYME INJ 35MG KUVAN POWDER CKET 500MG KUVAN TAB 00MG levocarnitine inj 00mg/ ml levocarnitine soln gm/ 0ml levocarnitine tab 330mg LUMIZYME INJ 50MG MYOZYME INJ 50MG NAGLAZYME INJ MG/ ML ORFADIN CAP MG, 5MG, 0MG paricalcitol cap mcg, mcg, mcg RICALCITOL INJ MCG/ ML RAVICTI LIQUID.GM/ ML SENSIR TAB 30MG, 60MG, 90MG sodium phenylbutyrate powder 3gm ZEMPLAR INJ MCG/ ML, 5MCG/ ML POSTERIOR PITUITARY HORMONES desmopressin acetate 0.0% nasal soln desmopressin inj mcg/ ml desmopressin nasal spray 0.0% desmopressin tab 0.mg, 0.mg STIMATE NASAL SPRAY.5MG/ ML PROLACTIN INHIBITORS cabergoline tab 0.5mg SOMATOSTATIC AGENTS octreotide inj 50mcg, 00mcg, 00mcg, 500mcg, 000mg SIGNIFOR INJ 0.3MG/ ML, 0.6MG/ ML, 0.9MG/ ML LD NM NM NM LD NM NM NM LD NM NM NM NM NM NM NM NM NM QL=60 Vials/30 Days 5

67 SOMATULINE DEPOT INJ 60MG/ 0.ML, 90MG/ 0.3ML, 0MG/ 0.5ML ESTROGENS ESTROGEN COMBINATIONS COMBITCH MG, MG estradiol/ norethindrone tab mg, -0.5mg jinteli tab mg-5mcg lopreeza tab mg, -0.5mg mimvey LO tab mg mimvey tab -0.5mg norethindrone acetate/ ethinyl estradiol tab 0.5mg-.5mcg, mg-5mcg PREMPHASE TAB MG PREMPRO TAB (ALL STRENGTHS) ESTROGENS estradiol tab 0.5mg, mg, mg estradiol twice weekly patch 0.05mg, mg, 0.05mg, 0.075mg, 0.mg estradiol valerate inj 0mg/ ml, 0mg/ ml estradiol weekly patch 0.05mg, mg, 0.05mg, 0.06mg, 0.075mg, 0.mg estropipate tab 0.75mg,.5mg, 3mg PREMARIN TAB 0.3MG, 0.5MG, 0.65MG, 0.9MG,.5MG FLUOROQUINOLONES FLUOROQUINOLONES AVELOX INJ 00MG/ 50ML ciprofloxacin ER tab 500mg, 000mg ciprofloxacin IV soln 00mg/ 0ml ciprofloxacin susp 50mg/ 5ml, 500mg/ 5ml ciprofloxacin tab 00mg, 50mg, 500mg, 750mg ciprofloxacin/ D5W inj 00mg/ 00ml levofloxacin 5mg/ ml (50ml) inj levofloxacin inj 5mg/ ml levofloxacin inj 5mg/ ml, 500mg/ 00ml levofloxacin soln 5mg/ ml levofloxacin tab 50mg, 500mg, 750mg MOXIFLOXACIN.6MG/ ML INJ moxifloxacin tab 00mg ofloxacin tab 00mg GASTROINTESTINAL AGENTS - MISC. ANTIFLATULENTS NM 55

68 simethicone cap 5mg* simethicone cap 80mg* simethicone chew tab 5mg* simethicone chew tab 80mg* simethicone liquid 0mg/ 0.6ml* SIMETHICONE LIQUID* SIMETHICONE ORAL STRIP 6.5MG* simethicone susp 0mg/ 0.6ml* GALLSTONE SOLUBILIZING AGENTS CHENODAL TAB 50MG ursodiol cap 300mg ursodiol tab 50mg, 500mg GASTROINTESTINAL ANTIALLERGY AGENTS cromoyln sodium oral soln 00mg/ 5ml GASTROINTESTINAL STIMULANTS metoclopramide inj 5mg/ ml metoclopramide soln 5mg/ 5ml metoclopramide tab 5mg, 0mg INFLAMMATORY BOWEL AGENTS APRISO CAP 0.375GM ASACOL HD TAB 800MG balsalazide cap 750mg CANASA SUPP 000MG CIMZIA INJ 00MG/ ML DELZICOL CAP 00MG DIPENTUM CAP 50MG LIALDA TAB.GM mesalamine kit gm PENTASA CAP 50MG, 500MG REMICADE INJ 00MG sulfasalazine tab 500mg sulfazine EC tab 500mg INTESTINAL ACIDIFIERS enulose soln 0gm/ 5ml generlac soln 0mg/ 5ml IRRITABLE BOWEL SYNDROME (IBS) AGENTS alosetron tab 0.5mg, mg LINZESS CAP 5MCG, 90MCG PERIPHERAL OPIOID RECEPTOR ANTAGONISTS MOVANTIK TAB.5MG, 5MG RELISTOR MG/ 0.6ML SYR RELISTOR 8MG/ 0.ML SYR NM NM ST NM QL=30 Caps/30 Days 56

69 RELISTOR INJ 0MG/ ML PHOSPHATE BINDER AGENTS AURYXIA TAB 0MG calcium acetate cap 667mg FOSRENOL CHEW TAB 500MG, 750MG, 000MG FOSRENOL POWDER CKET 750MG, 000MG PHOSLYRA SOLN 667MG/ 5ML RENVELA CKET 0.8GM,.GM RENVELA/ SEVELAMER CARBONATE TAB 800MG SHORT BOWEL SYNDROME (SBS) AGENTS GATTEX INJ 5MG GENITOURINARY AGENTS - MISCELLANEOUS ALKALINIZERS potassium citrate CR tab 5meq, 0meq, 5meq CYSTINOSIS AGENTS CYSTAGON CAP 50MG, 50MG GENITOURINARY IRRIGANTS neomycin/ polymyxin B irrigation soln 0/ ml sodium chloride irrigation soln 0.9% INTERSTITIAL CYSTITIS AGENTS ELMIRON CAP 00MG PROSTATIC HYPERTROPHY AGENTS alfuzosin ER tab 0mg AVODART CAP 0.5MG dutasteride 0.5mg cap dutasteride 0.5mg/ tamsulosin 0.mg cap finasteride tab 5mg JALYN CAP MG RAFLO CAP MG, 8MG tamsulosin cap 0.mg URINARY ANALGESICS phenazopyridine tab 95mg* phenazopyridine tab 97.mg* phenazopyridine tab 97.5mg* URINARY STONE AGENTS LITHOSTAT TAB 50MG THIOLA TAB 00MG GOUT AGENTS GOUT AGENT COMBINATIONS colchicine/ probenecid tab mg GOUT AGENTS NM 57

70 allopurinol tab 00mg, 300mg COLCHICINE TAB 0.6MG COLCRYS TAB 0.6MG MITIGARE 0.6MG CAP ULORIC TAB 0MG, 80MG URICOSURICS probenecid tab 500mg HEMATOLOGICAL AGENTS - MISC. BRADYKININ B RECEPTOR ANTAGONISTS FIRAZYR INJ 30MG/ 3ML COMPLEMENT INHIBITORS BERINERT INJ KIT 500UNIT CINRYZE INJ 500UNIT RUCONEST INJ 00UNIT HEMATORHEOLOGIC AGENTS pentoxifylline ER tab 00mg PLATELET AGGREGATION INHIBITORS AGGRENOX CAP 5-00MG anagrelide cap 0.5mg, mg ASPIRIN 5MG/ DIPYRIDAMOLE 00MG CAP BRILINTA 60MG TAB BRILINTA TAB 90MG cilostazol tab 50mg, 00mg clopidogrel tab 75mg dipyridamole tab 5mg, 50mg, 75mg EFFIENT TAB 5MG, 0MG HEMATOPOIETIC AGENTS AGENTS FOR GAUCHER DISEASE CEREZYME INJ 00UNIT VPRIV INJ 00UNIT ZAVESCA CAP 00MG AGENTS FOR SICKLE CELL ANEMIA DROXIA CAP 00MG, 300MG, 00MG COBALAMINS B- SL tab 3000mcg* B- SL tab 5000mcg* B- SL tab 500mcg* VITAMIN B LOZENGE 50MCG* vitamin B- CR tab 000* vitamin B- loz 500mcg* vitamin B- sub 000mcg* vitamin B- sub 500mcg* ST NM NM NM NM NM NM NM 58

71 vitamin B- tab 000mcg* vitamin B- tab 00mcg* vitamin B- tab 000mcg* vitamin B- tab 50mcg* vitamin B- tab 500mcg* vitamin B- tab 50mcg* FOLIC ACID/ FOLATES folic acid tab mg* 3 folic acid tab 00mcg* folic acid tab 800mcg* HEMATOPOIETIC GROWTH FACTORS ARANESP 0MCG/ 0.ML SYR ARANESP ALBUMIN FREE INJ 00MCG, 50MCG, 00MCG, 300MCG, 500MCG ARANESP ALBUMIN FREE INJ 5MCG, 0MCG, 60MCG EPOGEN INJ 000UNIT/ ML, 3000UNIT/ ML, 000UNIT/ ML, 0000UNIT/ ML, 0000UNIT/ ML LEUKINE INJ 50MCG NEULASTA INJ 6MG/ 0.6ML NEUPOGEN INJ 300MCG/ ML, 600MCG/ ML PROMACTA TAB.5MG, 5MG, 50MG, 75MG ZARXIO 300MCG/ 0.5ML SYR ZARXIO 80MCG/ 0.8ML SYR IRON ferrous sulfate CR tab mg* ferrous sulfate CR tab 60mg* ferrous sulfate CR tab 5mg* ferrous sulfate CR tab 7.5mg* ferrous sulfate CR tab 50mg* FERROUS SULFATE EC TAB 3MG* ferrous sulfate EC tab 35mg* ferrous sulfate elixir 0mg/ 5ml* FERROUS SULFATE LIQUID 0MG/ 5ML* ferrous sulfate soln 75mg/ ml* FERROUS SULFATE SYRUP 300MG/ 5ML* ferrous sulfate tab 00mg* ferrous sulfate tab 7mg* ferrous sulfate tab 35mg* STEM CELL MOBILIZERS MOZOBIL INJ 0MG/ ML HEMOSTATICS NM NM NM NM NM NM NM QL=00 Tabs/00 Days QL=00 ml/00 Days QL=50 ml/50 Days QL=00 ml/00 Days QL=00 Tabs/00 Days NM 59

72 HEMOSTATICS - SYSTEMIC tranexamic acid inj 00mg/ ml tranexamic acid tab 650mg HYPNOTICS BARBITURATE HYPNOTICS BUTISOL TAB 30MG, 50MG NSO phenobarbital elixir 0mg/ 5ml NSO phenobarbital tab 5mg, 6.mg, 30mg, 3.mg, 60mg, NSO 6.8mg, 97.mg, 00mg SECONAL CAP 00MG NSO NON-BARBITURATE HYPNOTICS estazolam tab mg, mg eszopiclone tab mg, mg, 3mg QL=30 Tabs/30 Days flurazepam cap 5mg, 30mg temazepam cap 7.5mg, 5mg,.5mg, 30mg triazolam tab 0.5mg, 0.5mg zaleplon cap 5mg, 0mg QL=90 Caps/365 Days zolpidem tab 5mg, 0mg QL=90 Tabs/365 Days HYPNOTICS/ SEDATIVES/ SLEEP DISORDER AGENTS ANTIHISTAMINE HYPNOTICS diphenhydramine cap 50mg* diphenhydramine tab 5mg* diphenhydramine tab 50mg* doxylamine succinate tab 5mg* NON-BARBITURATE HYPNOTICS FLURAZEM CAP 5MG triazolam tab 0.5mg, 0.5mg SELECTIVE MELATONIN RECEPTOR AGONISTS HETLIOZ CAP 0MG NM ROZEREM TAB 8MG QL=30 Tabs/30 Days LAXATIVES BULK LAXATIVES calcium polycarbophil tab 65mg* fiber powder* METAMUCIL WAFER* psyllium cap 0.5gm* psyllium powder 00%* psyllium powder 8.3%* psyllium powder 30%* psyllium powder 30.9%* psyllium powder 33%* psyllium powder 8.57%* 60

73 psyllium powder 9%* PSYLLIUM POWDER 5.3%* PSYLLIUM POWDER 55.6%* psyllium powder 58.6%* PSYLLIUM POWDER 60.3%* PSYLLIUM POWDER 63%* psyllium powder 68%* PSYLLIUM POWDER 7.67%* PSYLLIUM POWDER 9%* psyllium powder 95%* PSYLLIUM POWDER CKET 00%* PSYLLIUM POWDER CKET 8%* PSYLLIUM POWDER CKET 8.3%* PSYLLIUM POWDER CKET 58.%* PSYLLIUM POWDER CKET 58.6%* PSYLLIUM POWDER CKET 60.3%* PSYLLIUM POWDER CKET 95%* LAXATIVE COMBINATIONS gavilyte-c powder gavilyte-g soln gavilyte-n powder METAMUCIL PLUS CALCIUM CAP* MOVIPREP SOLN peg 3350/ electrolyte soln peg 3350/ kcl/ sodium bicarbonate/ sodium chloride soln sennosides/ docusate sodium tab mg* trilyte powder LAXATIVES - MISCELLANEOUS constulose soln 0gm/ 5ml glycerin supp gm* glycerin supp.gm* glycerin supp gm* glycerin supp.gm* glycerin supp 80.7%* lactulose soln 0gm/ 5ml polyethylene glycol 3350 oral packet* polyethylene glycol powder 3350 SORBITOL ORAL SOLUTION 70%* LUBRICANT LAXATIVES MINERAL OIL (BULK)* mineral oil enema* MINERAL OIL LIGHT (BULK)* MINERAL OIL* 6

74 SALINE LAXATIVES magnesium citrate soln* magnesium hydroxide susp 00mg/ 5ml* sodium phosphates - enema* STIMULANT LAXATIVES bisacodyl supp 0mg* bisacodyl tab delayed release 5mg* sennosides syrup 8.8mg/ 5ml* sennosides tab 5mg* sennosides tab 7.mg* sennosides tab 5mg* sennosides tab 8.6mg* SURFACTANT LAXATIVES docusate calcium cap 0mg* docusate sodium cap 00mg* docusate sodium cap 50mg* docusate sodium cap 50mg* docusate sodium enema 83mg* docusate sodium liquid 50mg/ 5ml* DOCUSATE SODIUM LIQUID 50MG/ 5ML* docusate sodium syrup 60mg/ 5ml* docusate sodium tab 00mg* LOCAL ANESTHETICS-RENTERAL LOCAL ANESTHETICS - AMIDES lidocaine inj 0.5%, % MACROLIDES AZITHROMYCIN azithromycin 50mg pack azithromycin inj 500mg azithromycin susp 00mg/ 5ml, 00mg/ 5ml azithromycin tab 50mg, 500mg, 600mg CLARITHROMYCIN clarithromycin ER tab 500mg clarithromycin susp 5mg/ 5ml, 50mg/ 5ml clarithromycin tab 50mg, 500mg ERYTHROMYCINS E.E.S GRANULE 00MG/ 5ML ERY-TAB 50MG, 333MG, 500MG ERYPED SUSP 00MG/ 5ML, 00MG/ 5ML ERYTHROCIN LACTOBIONATE INJ 500MG ERYTHROMYCIN TAB 50MG, 500MG MEDICAL DEVICES 6

75 BANDAGES-DRESSINGS-TAPE GAUZE D CONTRACEPTIVES CONDOMS LATEX LUBRICATED* CONDOMS LATEX NON-LUBRICATED* DIABETIC SUPPLIES LANCETS* MISC. DEVICES ALCOHOL SWAB RENTERAL THERAPY SUPPLIES INSULIN SYRINGE INSULIN SYRINGE (BD) NOVOFINE/ NOVOTWIST/ PEN NEEDLE RESPIRATORY THERAPY SUPPLIES AEROCHAMBER PLUS W/ MASK* MIGRAINE PRODUCTS MIGRAINE PRODUCTS DIHYDROERGOTAMINE MESYLATE 0.5MG/ ACT NASAL SPRAY dihydroergotamine mesylate inj mg/ ml ERGOMAR SL TAB MG SEROTONIN AGONISTS IMITREX NASAL SPRAY 5MG, 0MG naratriptan tab mg,.5mg rizatriptan ODT 5mg, 0mg rizatriptan tab 5mg, 0mg sumatriptan mg/ ml auto-injector sumatriptan mg cartridge sumatriptan 6mg cartridge sumatriptan auto-injector 6mg/ 0.5ml sumatriptan inj 6mg/ 0.5ml SUMATRIPTAN NASAL SPRAY 5MG, 0MG sumatriptan tab 5mg, 50mg, 00mg zolmitriptan ODT.5mg, 5mg zolmitriptan tab.5mg, 5mg ZOMIG NASAL SPRAY.5MG MINERALS & ELECTROLYTES BICARBONATES sodium lactate inj 5meq/ ml CALCIUM CALCIUM CARBONATE CAP 50MG* QL= Kits/365 Days QL= Bottles/30 Days QL= Sprays/30 Days QL=8 Tabs/30 Days QL=36 Tabs/60 Days QL=36 Tabs/60 Days QL=8 Injections/30 Days QL=8 Injections/30 Days QL=8 Injections/30 Days QL=8 Injections/30 Days QL=0 Injections/30 Days QL= Sprays/30 Days QL=8 Tabs/30 Days QL=8 Tabs/30 Days QL=8 Tabs/30 Days QL= Sprays/30 Days 63

76 CALCIUM CARBONATE CHEW TAB 50MG* CALCIUM CARBONATE CHEW TAB 60MG* calcium carbonate chew tab 500mg* calcium carbonate susp 50mg/ 5ml* calcium carbonate tab 50mg* calcium carbonate tab 500mg* calcium carbonate tab 600mg* calcium carbonate/ cholecalciferol cap 600mg-500unit* CALCIUM CARBONATE/ CHOLECALCIFEROL CHEW TAB 500MG-00UNIT* calcium carbonate/ cholecalciferol chew tab 500mg-00unit* calcium carbonate/ cholecalciferol chew tab 500mg-600unit* CALCIUM CARBONATE/ CHOLECALCIFEROL CHEW TAB 600MG-800UNIT* calcium carbonate/ cholecalciferol tab 50mg-5unit* calcium carbonate/ cholecalciferol tab 500mg-5unit* calcium carbonate/ cholecalciferol tab 500mg-00unit* calcium carbonate/ cholecalciferol tab 500mg-00unit* calcium carbonate/ cholecalciferol tab 500mg-600unit* calcium carbonate/ cholecalciferol tab 600mg-00unit* calcium carbonate/ cholecalciferol tab 600mg-00unit* calcium carbonate/ cholecalciferol tab 600mg-800unit* calcium carbonate/ vitamin D cap 600mg-00unit* calcium carbonate/ vitamin D tab 00mg-50unit* calcium carbonate/ vitamin D tab 50mg-5unit* calcium carbonate/ vitamin D tab 50mg-00unit* calcium carbonate/ vitamin D tab 35mg-00unit* calcium carbonate/ vitamin D tab 35mg-50unit* calcium carbonate/ vitamin D tab 500mg-5unit* calcium carbonate/ vitamin D tab 500mg-00unit* calcium carbonate/ vitamin D tab 500mg-00unit* calcium carbonate/ vitamin D tab 600mg-5unit* calcium carbonate/ vitamin D tab 600mg-00unit* calcium carbonate/ vitamin D tab 600mg-00unit* CALCIUM GLUBIONATE SYRUP.8GM/ 5ML* CALCIUM GLUCONATE TAB 500MG* CALCIUM GLUCONATE TAB 50MG* calcium lactate tab 650mg* calcium tab 500mg* calcium tab 600mg* 6

77 calcium/ phosphorus w/ vitamin D tab 05mg-8mg-0unit* calcium/ vitamin D tab 600mg-00unit* oyster shell calcium tab 500mg* CHLORIDE AMMONIUM CHLORIDE INJ 5MEQ/ ML ELECTROLYTE MIXTURES d.5w/ nacl inj 0.5% d5w/ lactated ringers inj d5w/ nacl inj 0.%, 0.33%, 0.5%, 0.9% D5W/ NACL INJ 0.%, 0.5% IONOSOL-B/ D5W INJ IONOSOL-MB/ D5W INJ ISOLYTE-S INJ ISOLYTE/ D5W INJ KCL 0.5%/ D5W/ NACL 0.5% KCL 0.3%/ D5W/ NACL 0.9% KCL/ D5W/ LR 0MEQ kcl/ d5w/ nacl inj lactated ringers soln normosol-m/ dextrose inj NORMOSOL-R INJ NORMOSOL-R/ DEXTROSE INJ oral electrolyte solution* PLASMA-LYTE INJ PLASMA-LYTE/ D5W INJ potassium chloride/ d5w inj 0.5%, 0.5%, 0.3% potassium chloride/ nacl inj % ringers injection tpn electrolytes soln FLUORIDE sodium fluoride tab mg MAGNESIUM magnesium oxide tab 50mg* magnesium oxide tab 00mg* magnesium oxide tab 500mg* magnesium sulfate inj 50% magnesium tab 00mg* magnesium tab 00mg* magnesium tab 50mg* POTASSIUM K-TAB 8MEQ, 0MEQ klor-con 0meq ER cap 65

78 klor-con 8meq ER cap KLOR-CON TAB 5MEQ potassium chloride ER cap 8meq, 0meq potassium chloride ER tab 8meq, 0meq, 0meq potassium chloride inj meq potassium chloride liquid 0meq/ 5ml, 0meq/ 5ml SODIUM sodium chloride inj 0.5%, 0.9%, 3%, 5%,.6% MOUTH/ THROAT/ DENTAL AGENTS ANESTHETICS TOPICAL ORAL lidocaine viscous soln % ANTI-INFECTIVES - THROAT clotrimazole troche 0mg nystatin susp 00000unit/ ml ANTISEPTICS - MOUTH/ THROAT chlorhexidine gluconate soln 0.% periogard soln 0.% STEROIDS - MOUTH/ THROAT triamcinolone in orabase paste 0.% THROAT PRODUCTS - MISC. cevimeline cap 30mg pilocarpine tab 5mg, 7.5mg MULTIVITAMINS B-COMPLEX W/ C B-complex w/ vitamin C cap* MULTIPLE VITAMINS W/ MINERALS multiple vitamins w/ minerals tab* MULTIVITAMINS multiple vitamin tab* QL=00 Tabs/00 Days PED MV W/ IRON pediatric multiple vitamins w/ iron drops 0mg/ ml* QL=50 ml/50 Days PEDIATRIC MULTIPLE VITAMINS pediatric multiple vitamin w/ vitamin C soln 35mg/ ml* QL=50 ml/50 Days PEDIATRIC VITAMINS pediatric vitamins adc drops 500unit-00unit-35mg/ ml* PRENATAL VITAMINS PRENATAL VITAMIN (OTC)* PRENATAL VITAMINS PRENATAL VITAMINS W/ IRON (OTC)* MUSCULOSKELETAL THERAPY AGENTS CENTRAL MUSCLE RELAXANTS 66

79 baclofen tab 0mg, 0mg carisoprodol tab 350mg chlorzoxazone tab 500mg cyclobenzaprine tab 5mg, 7.5mg, 0mg METAXALONE TAB 00MG metaxalone tab 800mg methocarbamol tab 500mg, 750mg orphenadrine citrate inj 30mg/ ml orphenadrine ER tab 00mg tizanidine cap mg, mg, 6mg tizanidine tab mg, mg DIRECT MUSCLE RELAXANTS dantrolene cap 5mg, 50mg, 00mg MUSCLE RELAXANT COMBINATIONS carisoprodol/ aspirin tab 00-35mg carisoprodol/ aspirin/ codeine tab mg NASAL AGENTS - SYSTEMIC AND TOPICAL NASAL AGENTS - MISC. saline nasal spray 0.65%* NASAL ANTIALLERGY azelastine nasal spray 0.% (37mcg/ spray), 0.5% (05.5mcg/ spray) cromolyn sodium nasal aerosol soln 5.mg/ act* olopatadine 0.6% nasal inhaler TANASE NASAL SPRAY 0.6% NASAL ANTICHOLINERGICS ipratropium nasal spray 0.03%, 0.06% NASAL STEROIDS fluticasone nasal spray 50mcg QL= Bottles/5 Days NASONEX NASAL SPRAY 50MCG QL= Bottles/5 Days TRIAMCINOLONE ACETONIDE NASAL AEROSOL SUSPENSION 55MCG* triamcinolone nasal spray 55mcg QL= Bottles/5 Days VERAMYST NASAL SPRAY 7.5MCG QL= Bottles/5 Days SYMTHOMIMETIC DECONGESTANTS pseudoephedrine liquid 5mg/ 5ml* pseudoephedrine SR tab (hr) 0mg* PSEUDOEPHEDRINE SR TAB (HR) 0MG* QL=30 Tabs/30 Days pseudoephedrine tab 30mg* pseudoephedrine tab 60mg* NEUROMUSCULAR AGENTS ALS AGENTS 67

80 riluzole tab 50mg NUTRIENTS CARBOHYDRATES dextrose inj 5%, 0% LIPIDS fat emulsion IV soln 0% intralipid inj 0% nutrilipid inj 0% MISC. NUTRITIONAL SUBSTANCES omega-3 fatty acids cap 000mg* omega-3 fatty acids cap 00mg* PROTEINS AMINO ACIDS ORAL LIQUID* 3 AMINO ACIDS ORAL POWDER* 3 AMINOSYN 7%/ ELECTROLYTES AMINOSYN II INJ 7%, 8.5%, 0%, 5% AMINOSYN INJ 7%, 0% AMINOSYN M INJ 3.5% AMINOSYN-RF INJ 5.% aminosyn/ electrolyte inj 8.5% CLINIMIX E.5%/ DEXTROSE INJ CLINIMIX E INJ.75%,.5%, 5% CLINIMIX INJ.5%, 5% clinisol sf inj 5% FREAMINE HBC 6.9% hepatamine inj 8% NEPHRAMINE INJ 5.% plenamine 5% inj PREMASOL SOLN 0% premasol soln 6% PROCALAMINE INJ 3% PROSOL INJ 0% TRAVASOL INJ 0% TROPHAMINE INJ 6%, 0% OPHTHALMIC AGENTS ARTIFICIAL TEARS AND LUBRICANTS artificial tear ophth solution* LACRISERT OPHTH INSERT polyvinyl alcohol ophth soln.%* white petrolatum/ mineral oil ophth ointment* BETA-BLOCKERS - OPHTHALMIC betaxolol ophth soln 0.5% QL=60 Caps/30 Days QL=60 Caps/30 Days 68

81 BETIMOL 0.5% OPHTH SOLN BETIMOL OPHTH SOLN 0.5% BETOPTIC-S OPHTH SUSP 0.5% carteolol ophth soln % COMBIGAN OPHTH SOLN 0.%-0.5% dorzolamide/ timolol ophth soln.3-6.8mg/ ml ISTALOL OPHTH SOLN 0.5% levobunolol ophth soln 0.5% metipranolol ophth soln 0.3% timolol maleate ophth gel 0.5%, 0.5% timolol maleate ophth soln 0.5%, 0.5% CYCLOPLEGIC MYDRIATICS atropine ophth soln % MIOTICS PHOSPHOLINE IODIDE OPHTH SOLN 0.5% pilocarpine ophth soln %, %, % OPHTHALMIC ADRENERGIC AGENTS ALPHAGAN P OPHTH SOLN 0.%, 0.5% apraclonidine ophth soln 0.5% brimonidine ophth soln 0.5%, 0.% IOPIDINE OPHTH SOLN 0.5%, % SIMBRINZA OPHTH SOLN -0.% OPHTHALMIC ANTI-INFECTIVES AZASITE OPHTH SOLN % BACITRACIN OPHTH OINTMENT 500UNIT/ GM bacitracin/ polymyxin B ophth ointment BESIVANCE OPHTH SUSP 0.6% ciprofloxacin ophth soln 0.3% erythromycin ophth ointment 5mg/ gm gatifloxacin ophth soln 0.5% gentak ophth ointment 0.3% gentamicin ophth ointment 0.3% gentamicin ophth soln 0.3% ilotycin ophth ointment 5mg levofloxacin ophth soln 0.5% MOXEZA OPHTH SOLN 0.5% NATACYN OPHTH SUSP 5% neomycin/ bacitracin/ polymyxin ophth ointment 5(3.5)mg-00unit-0000unit neomycin/ polymyxin/ gramicidin ophth soln.75mg-0000unit-0.05mg ofloxacin ophth soln 0.3% ST ST 69

82 polymyxin B/ trimethoprim ophth soln 0000unit/ ml-0.% sodium sulfacetamide ophth soln 0% SULFACETAMIDE SODIUM OPHTH OINTMENT 0% tobramycin ophth soln 0.3% trifluridine ophth soln % VIGAMOX OPHTH SOLN 0.5% ZIRGAN OPHTH GEL 0.5% OPHTHALMIC DECONGESTANTS AK-CON OPHTH SOLN 0.% naphazoline w/ pheniramine ophth soln %* naphazoline w/ pheniramine ophth soln %* NAPHAZOLINE/ GLYCERIN OPHTH SOLN %* OPHTHALMIC IMMUNOMODULATORS RESTASIS OPHTH EMULSION 0.05% OPHTHALMIC LOCAL ANESTHETICS proparacaine ophth soln 0.5% OPHTHALMIC STEROIDS ALREX OPHTH SUSP 0.% BLEPHAMIDE OPHTH SUSP 0-0.% dexamethasone sodium phosphate ophth soln 0.% DUREZOL OPHTH EMULSION 0.05% fluorometholone ophth susp 0.% LOTEMAX OPHTH GEL 0.5% LOTEMAX OPHTH OINTMENT 0.5% LOTEMAX OPHTH SUSP 0.5% MAXIDEX OPHTH SUSP 0.% neomycin/ polymyxin/ bacitracin/ hydrocortisone ophth ointment % neomycin/ polymyxin/ dexamethasone ophth ointment 0.% neomycin/ polymyxin/ dexamethasone ophth soln 0.% neomycin/ polymyxin/ hydrocortisone ophth susp % PRED MILD OPHTH SUSP 0.% PRED-G OPHTH SUSP 0.3-% prednisolone ophth soln % prednisolone sodium phosphate ophth soln % sulfacetamide sodium/ prednisolone ophth soln 0-0.3% TOBRADEX OPHTH OINTMENT % tobramycin/ dexamethasone ophth susp % VEXOL OPHTH SUSP % 70

83 ZYLET OPHTH SOLN % OPHTHALMICS - MISC. ALOCRIL OPHTH SOLN % ALOMIDE OPHTH SOLN 0.% azelastine ophth soln 0.05% AZOPT OPHTH SUSP % bromfenac ophth soln 0.09% cromolyn sodium ophth soln % diclofenac ophth soln 0.% dorzolamide ophth soln % epinastine ophth soln 0.05% eye wash soln* flurbiprofen ophth soln 0.03% ILEVRO OPHTH SUSP 0.3% ketorolac ophth soln 0.%, 0.5% ketotifen fumarate ophth soln 0.05%* NEVANAC OPHTH SUSP 0.% olopatadine mg/ ml ophth soln TADAY OPHTH SOLN 0.% sodium chloride hypertonic ophth ointment 5%* sodium chloride hypertonic ophth soln 5%* TYLOXAPOL OPHTH SOLN 0.5%* PROSTAGLANDINS - OPHTHALMIC BIMATOPROST OPHTH SOLN 0.03% latanoprost ophth soln 0.005% LUMIGAN OPHTH SOLN 0.0% TRAVATAN Z OPHTH SOLN 0.00% travoprost ophth soln 0.00% OTIC AGENTS OTIC AGENTS - MISCELLANEOUS acetic acid otic soln % carbamide peroxide 6.5% otic soln* OTIC ANTI-INFECTIVES ofloxacin otic soln 0.3% OTIC COMBINATIONS CIPRODEX OTIC SUSP 0.3-% COLY-MYCIN S OTIC SUSP 3MG-0MG/ ML CORTISPORIN-TC OTIC SUSP 3MG-0MG/ ML neomycin/ polymyxin/ hydrocortisone otic soln % neomycin/ polymyxin/ hydrocortisone otic susp % OTIC STEROIDS fluocinolone acetonide otic oil 0.0% QL=5 ml/30 Days QL=5 ml/30 Days QL=5 ml/30 Days QL=5 ml/30 Days QL=5 ml/30 Days 7

84 hydrocortisone/ acetic acid otic soln -% OXYTOCICS OXYTOCICS methylergonovine tab 0.mg SSIVE IMMUNIZING AGENTS IMMUNE SERUMS BIVIGAM INJ 0GM/ 00ML CARIMUNE INJ 6GM FLEBOGAMMA 0% INJ GAMASTAN S/ D INJ GAMMAGARD INJ.5GM/ 5ML GAMMAKED GM/ 0ML INJ GAMMAPLEX INJ 0GM/ 00ML GAMUNEX-C INJ GM/ 0ML OCTAGAM INJ GM/ 0ML, 5GM/ 500ML PRIVIGEN INJ 0GM/ 00ML MONOCLONAL ANTIBODIES SYNAGIS INJ 50MG/ 0.5ML PENICILLINS AMINOPENICILLINS amoxicillin cap 50mg, 500mg amoxicillin chew tab 5mg AMOXICILLIN CHEW TAB 50MG amoxicillin susp 5mg/ 5ml, 00mg/ 5ml, 50mg/ 5ml, 00mg/ 5ml amoxicillin tab 500mg, 875mg ampicillin cap 50mg, 500mg AMPICILLIN INJ 5MG ampicillin inj gm, 0gm ampicillin susp 5mg/ 5ml, 50mg/ 5ml NATURAL PENICILLINS BICILLIN L-A INJ 00000UNIT/ ML, 00000UNIT/ ML BICILLIN L-A INJ UNIT/ ML penicillin g potassium inj unit PENICILLIN G/ DEXTROSE INJ 0000UNIT, 60000UNIT PENICILLIN G/ PROCAINE INJ UNIT PENICILLIN G/ SODIUM INJ UNIT penicillin v potassium soln 5mg/ 5ml, 50mg/ 5ml penicillin v potassium tab 50mg, 500mg PENICILLIN COMBINATIONS QL=8 Tabs/365 Days NM NM NM NM NM NM NM NM NM NM NM 7

85 amoxicillin/ clavulanate chew tab 00mg, 00mg amoxicillin/ clavulanate ER tab mg amoxicillin/ clavulanate susp 00mg, 50mg, 00mg, 600mg amoxicillin/ clavulanate tab 50mg, 500mg, 875mg ampicillin 0mg/ ml/ sulbactam 0mg/ ml inj ampicillin/ sulbactam inj -gm, 0-5gm AUGMENTIN SUSP 5-3.5MG/ 5ML BICILLIN C-R INJ 00000UNIT/ ML piperacillin/ tazobactam inj mg, -0.5mg ZOSYN/ DEXTROSE INJ -0.5GM/ ML, GM/ 50ML PENICILLINASE-RESISTANT PENICILLINS dicloxacillin cap 50mg, 500mg nafcillin inj gm, 0gm NAFCILLIN/ DEXTROSE INJ GM/ 50ML oxacillin inj gm, 0gm OXACILLIN/ DEXTROSE INJ GM/ 50ML, GM/ 50ML PROGESTINS PROGESTINS medroxyprogesterone tab.5mg, 5mg, 0mg norethindrone acetate tab 5mg progesterone cap 00mg, 00mg PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. AGENTS FOR CHEMICAL DEPENDENCY acamprosate tab 333mg disulfiram tab 50mg, 500mg ANTI-CATAPLECTIC AGENTS XYREM SOLN 500MG/ ML LD NM QL=50 ml/30 Days ANTIDEMENTIA AGENTS donepezil ODT 5mg, 0mg QL=30 Tabs/30 Days donepezil tab 3mg ST QL=30 Tabs/30 Days donepezil tab 5mg, 0mg QL=60 Tabs/30 Days EXELON TCH.6MG, 9.5MG, 3.3MG galantamine ER cap 8mg, 6mg, mg galantamine soln mg/ ml galantamine tab mg, 8mg, mg memantine 0mg tab memantine 0mg/ memantine 5mg pack memantine mg/ ml soln memantine 5mg tab 73

86 NAMENDA SOLN MG/ ML NAMENDA TAB 5MG, 0MG NAMENDA TAB TITRATION K NAMENDA XR CAP 7MG, MG, MG, 8MG NAMENDA XR CK rivastigmine 3.3mg/ hr patch rivastigmine.6mg/ hr patch rivastigmine 9.5mg/ hr patch rivastigmine tab.5mg, 3mg,.5mg, 6mg COMBINATION PSYCHOTHERAPEUTICS chlordiazepoxide/ amitriptyline tab 5-.5mg, 0-5mg olanzapine/ fluoxetine cap 3-5mg, 6-5mg, 6-50mg, -5mg, -50mg perphenazine/ amitriptyline tab -0mg, -5mg, -0mg, -5mg, -50mg FIBROMYALGIA AGENTS SAVELLA TAB.5MG, 5MG, 50MG, 00MG SAVELLA TAB TITRATION CK MOVEMENT DISORDER DRUG THERAPY tetrabenazine.5mg tab tetrabenazine 5mg tab XENAZINE TAB.5MG, 5MG MULTIPLE SCLEROSIS AGENTS AMPYRA TAB 0MG AUBAGIO TAB 7MG, MG AVONEX INJ 30MCG COXONE 0MG/ ML SYR COXONE INJ 0MG/ ML EXTAVIA INJ GILENYA TAB 0.5MG REBIF INJ MCG, 88MCG REBIF INJ TITRATION CK REBIF REBIDOSE INJ TITRATION CK TECFIDERA CAP 0MG, 0MG TECFIDERA CAP STARTER CK TYSABRI INJ 0MG/ ML PSEUDOBULBAR AFFECT (PBA) AGENTS NUEDEXTA CAP 0-0MG PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. ERGOLOID MESYLATE TAB MG ORAP TAB MG, MG pimozide mg tab NSO NSO QL=60 Tabs/30 Days NM NM NM NM NM QL=30 Tabs/30 Days NM QL= Injections/8 Days NM QL= Injections/8 Days NM QL=30 Injections/30 Days NM ST QL= Kits/30 Days NM QL=30 Tabs/30 Days NM QL= Injections/8 Days NM QL= Injections/8 Days NM QL= Kits/8 Days NM NM NM QL=60 Caps/30 Days 7

87 pimozide mg tab SMOKING DETERRENTS buproban tab 50mg CHANTIX CONTINUING MONTHS OF THERAPY MG CK CHANTIX K CHANTIX TAB 0.5MG, MG nicotine lozenge mg* QL=3600 Lozenges/365 Days nicotine lozenge mg* QL=3600 Lozenges/365 Days nicotine patch mg/ hr* QL=80 Patches/365 Days nicotine patch mg/ hr* QL=80 Patches/365 Days nicotine patch 7mg/ hr* QL=80 Patches/365 Days NICOTINE TCH KIT* QL=80 Patches/365 Days nicotine polacrilex gum mg* QL=30 Blisters/365 Days nicotine polacrilex gum mg* QL=30 Blisters/365 Days NICOTROL INHALER 0MG NICOTROL NASAL SPRAY 0MG/ ML RESPIRATORY AGENTS - MISC. ALPHA-PROTEINASE INHIBITOR (HUMAN) ARALAST NP INJ 00MG NM GLASSIA INJ 000MG/ 50ML NM PROLASTIN-C INJ 000MG NM ZEMAIRA INJ 000MG NM CYSTIC FIBROSIS AGENTS KALYDECO CKET 50MG, 75MG NM QL=60 Packets/30 Days KALYDECO TAB 50MG NM QL=60 Tabs/30 Days PULMOZYME SOLN MG/ ML NM PULMONARY FIBROSIS AGENTS ESBRIET CAP 67MG NM OFEV CAP 00MG, 50MG NM SULFONAMIDES SULFONAMIDES SULFADIAZINE TAB 500MG TETRACYCLINES TETRACYCLINES demeclocycline tab 50mg, 300mg doxycycline hyclate cap 50mg, 00mg doxycycline hyclate tab 0mg, 00mg doxycycline inj 00mg doxycycline monohydrate cap 50mg, 00mg doxycycline monohydrate tab 50mg, 00mg doxycycline monohydrate tab 50mg, 75mg, 50mg 75

88 doxycycline susp 5mg/ 5ml minocycline cap 50mg, 75mg, 00mg minocycline tab 50mg, 75mg, 00mg TETRACYCLINE CAP 50MG, 500MG THYROID AGENTS ANTITHYROID AGENTS methimazole tab 5mg, 0mg propylthiouracil tab 50mg THYROID HORMONES levothyroxine tab (all strengths) levoxyl tab 5mcg, 50mcg, 75mcg, 88mcg, 00mcg, mcg, 5mcg, 37mcg, 50mcg, 75mcg, 00mcg liothyronine inj 0mcg/ ml liothyronine tab 5mcg, 5mcg, 50mcg SYNTHROID TAB (ALL STRENGTHS) THYROLAR TAB 5MG, 30MG, 60MG, 0MG, 80MG unithroid tab 5mcg, 50mcg, 75mcg, 88mcg, 00mcg, mcg, 5mcg, 50mcg, 75mcg, 00mcg, 300mcg TOXOIDS TOXOID COMBINATIONS ADACEL INJ BOOSTRIX INJ DAPTACEL INJ DIPHTHERIA/ TETANUS INJ INFANRIX INJ QUADRACEL INJ TENIVAC SYR TETANUS/ DIPHTHERIA TOXOID INJ ULCER DRUGS ANTISSMODICS atropine inj 0.05mg/ ml, 0.mg/ ml dicyclomine cap 0mg DICYCLOMINE SOLN 0MG/ 5ML dicyclomine tab 0mg glycopyrrolate inj mg/ 0ml glycopyrrolate tab mg, mg methscopolamine tab.5mg, 5mg PRONTHELINE TAB 5MG H- ANTAGONISTS cimetidine oral soln 300mg/ 5ml cimetidine tab 00mg, 300mg, 00mg, 800mg 76

89 famotidine inj 0mg/ ml famotidine susp 0mg/ 5ml famotidine tab 0mg* famotidine tab 0mg, 0mg FAMOTIDINE/ NACL INJ 0.9%-0MG/ 50ML nizatidine cap 50mg, 300mg nizatidine soln 5mg/ ml ranitidine cap 50mg, 300mg ranitidine inj 5mg/ ml ranitidine syrup 5mg/ ml ranitidine tab 50mg, 300mg MISC. ANTI-ULCER sucralfate tab gm PROTON PUMP INHIBITORS esomeprazole inj 0mg, 0mg lansoprazole cap 5mg, 30mg ST omeprazole cap 0mg, 0mg, 0mg pantoprazole tab 0mg, 0mg rabeprazole sodium tab 0mg ULCER DRUGS - PROSTAGLANDINS misoprostol tab 00mcg, 00mcg ULCER THERAPY COMBINATIONS lansoprazole/ amoxicillin/ clarithromycin cap pack PYLERA CAP 0-5-5MG URINARY ANTI-INFECTIVES URINARY ANTI-INFECTIVES MACRODANTIN CAP 5MG QL=360 Caps/365 Days methenamine hippurate tab gm nitrofurantoin macro 5mg cap QL=360 Caps/365 Days nitrofurantoin macro 5mg/ nitrofurantoin mono 75mg QL=80 Caps/365 Days cap nitrofurantoin macro cap 00mg QL=360 Caps/365 Days nitrofurantoin macro cap 50mg QL=360 Caps/365 Days nitrofurantoin mono cap 00mg QL=80 Caps/365 Days nitrofurantoin susp 5mg/ 5ml URINARY ANTISSMODICS BETA-3 ADRENERGIC AGONISTS MYRBETRIQ ER TAB 5MG, 50MG URINARY ANTISSMODIC - ANTIMUSCARINICS (ANTICHOLINERGIC) oxybutynin ER tab 5mg, 0mg, 5mg oxybutynin syrup 5mg/ 5ml oxybutynin tab 5mg 77

90 tolterodine tab mg, mg tolterodine tartrate ER cap mg, mg trospium chloride ER cap 60mg trospium tab 0mg VESICARE TAB 5MG, 0MG BACTERIAL VACCINES ACTHIB INJ BCG VACCINE INJ BEXSERO SYR MENACTRA INJ MENOMUNE A-C-Y-W INJ MENVEO INJ PEDVAX HIB INJ TRUMENBA INJ TYPHIM VI 5MCG/ 0.5ML SYR TYPHIM VI INJ MIXED VACCINE COMBINATIONS COMVAX INJ VIRAL VACCINES CERVARIX INJ ENGERIX-B INJ GARDASIL INJ HAVRIX INJ IMOVAX RABIES (H.D.C.V) INJ IPOL INJ IXIARO INJ M-M-R II WITH DILUENT INJ PROQUAD INJ RABAVERT INJ RECOMBIVAX-HB INJ ROTARIX ORAL SUSP ROTATEQ ORAL SUSP TWINRIX INJ VAQTA INJ VARIVAX INJ YF-VAX INJ ZOSTAVAX INJ SPERMICIDES NONOXYNOL-9 FILM 8%* NONOXYNOL-9 FOAM.5%* VACCINES VAGINAL PRODUCTS 78

91 NONOXYNOL-9 GEL %* NONOXYNOL-9 GEL 3%* NONOXYNOL-9 GEL %* NONOXYNOL-9 VAGINAL SUPP 00MG* VAGINAL ANTI-INFECTIVES AVC VAGINAL CREAM 5% clindamycin vaginal cream % clotrimazole vaginal cream %* clotrimazole vaginal cream %* metronidazole vaginal gel 0.75% miconazole nitrate vaginal cream %* miconazole nitrate vaginal cream %* miconazole nitrate vaginal kit* miconazole nitrate vaginal supp 00mg* miconazole nitrate vaginal supp 00mg/ % cream kit* miconazole nitrate vaginal supp 00mg/ % cream 9 gm kit* terconazole vaginal cream 0.%, 0.8% terconazole vaginal supp 80mg tioconazole vaginal ointment 6.5%* vandazole vaginal gel 0.75% zazole vaginal cream 0.%, 0.8% VAGINAL ESTROGENS ESTRING VAGINAL RING MG PREMARIN VAGINAL CREAM 0.65MG/ GM VAGINAL PROGESTINS CRINONE % VAGINAL GEL CRINONE 8% VAGINAL GEL VASOPRESSORS ANAPHYLAXIS THERAPY AGENTS EPIPEN INJ 0.3MG/ 0.3ML EPIPEN JR INJ 0.5MG/ 0.3ML NEUROGENIC ORTHOSTATIC HYPOTENSION (NOH) - AGENTS NORTHERA CAP 00MG, 00MG, 300MG VASOPRESSORS midodrine tab.5mg, 5mg, 0mg VITAMINS OIL SOLUBLE VITAMINS AQUASOL A INJ 50000/ ML* 3 cholecalciferol cap 0000unit* cholecalciferol cap 000unit* cholecalciferol cap 000unit* ST QL= Injections/5 Days QL= Injections/5 Days NM 79

92 cholecalciferol cap 00unit* cholecalciferol cap 50000unit* cholecalciferol cap 5000unit* cholecalciferol drops 000unit/ 0.03ml* cholecalciferol drops 00unit/ 0.03ml* cholecalciferol drops 5000unit/ ml* cholecalciferol oral liquid 00unit/ ml* cholecalciferol tab 000unit* cholecalciferol tab 000unit* cholecalciferol tab 00unit* cholecalciferol tab 5000unit* E600 cap 600unit* ergocalciferol cap 50000unit* ergocalciferol soln 8000unit/ ml* ERGOCALCIFEROL TAB 000UNIT* ERGOCALCIFEROL TAB 00UNIT* MEPHYTON TAB 5MG* phytonadione tab 00mcg* vita-plus E cap 00unit* vitamin E cap 000unit* vitamin E cap 00unit* vitamin E cap 00unit* WATER SOLUBLE VITAMINS ASCORBIC ACID WAFER 500MG* B- tab 50mg* fruit C-00 chew* niacin CR cap 50mg* niacin CR cap 500mg* NIACIN CR TAB 000MG* niacin CR tab 50mg* niacin CR tab 500mg* niacin CR tab 750mg* niacin ER cap 5mg* niacin ER cap 00mg* niacin tab 00mg* niacin tab 50mg* niacin tab 500mg* niacin tab 50mg* pyridoxine CR tab 00mg* pyridoxine tab 00mg* pyridoxine tab 00mg* pyridoxine tab 50mg* pyridoxine tab 5mg*

93 pyridoxine tab 500mg* pyridoxine tab 50mg* thiamine mononitrate tab 00mg* thiamine tab 50mg, 00mg, 50mg* vitamin B- tab 00mg* vitamin B- tab 5mg* vitamin B- tab 50mg* vitamin C chew tab 50mg* vitamin C chew tab 500mg* vitamin C CR cap 500mg CR* vitamin C CR tab 500mg* vitamin C drops 60mg* vitamin C syrup 500/ 5ml* vitamin C tab 000mg* vitamin C tab 00mg* vitamin C tab 50mg* vitamin C tab 500mg* vitamin C TR tab 500mg* vitamin C w/ rosehip TR tab 000mg* 8

94 ALPHABETICAL LISTING OF DRUGS Other 8-MOP CAP 0MG 7 A abacavir tab 300mg 3 abacavir/ lamivudine/ 3 zidovudine tab mg ABELCET INJ 5MG/ ML 8 ABILIFY MAINTENA 3 INJ 300MG, 00MG ABRAXANE IV SUSP 8 00MG acamprosate tab 333mg 73 acarbose tab 5mg, 50mg, 5 00mg acebutolol cap 00mg, 36 00mg acetaminophen cap 500mg* acetaminophen chew tab 60mg* acetaminophen chew tab 80mg* acetaminophen CR tab 650mg* acetaminophen dispersible tab 60mg* acetaminophen dispersible tab 80mg* acetaminophen elixir 60mg/ 5ml* acetaminophen liquid 60mg/ 5ml* acetaminophen liquid 67mg/ 5ml* ACETAMINOPHEN LIQUID 500MG/ 5ML* acetaminophen soln 00mg/ ml* acetaminophen soln 60mg/ 5ml* acetaminophen supp 0mg* acetaminophen supp 35mg* acetaminophen supp 650mg* ACETAMINOPHEN SUPP 80MG* acetaminophen susp 60mg/ 5ml* acetaminophen susp 80mg/ 0.8ml* ACETAMINOPHEN SYRUP 60MG/ 5ML* acetaminophen tab 35mg* acetaminophen tab 500mg* acetaminophen/ codeine 6 soln 0-mg/ 5ml acetaminophen/ codeine 6 tab 300-5mg, mg, mg acetazolamide inj 500mg 5 acetazolamide SR cap 5 500mg acetazolamide tab 5mg, 5 50mg acetic acid otic soln % 7 ACETONE (URINE) 5 TEST STRIP* acetylcysteine inhalation 5 soln 0%, 0% acitretin cap 0mg, 7 7.5mg, 5mg ACTEMRA INJ 6MG/ 0.9ML ACTEMRA IV INJ 00MG/ 0ML ACTHIB INJ 78 ACTIMMUNE INJ 8 00MCG/ 0.5ML acyclovir cap 00mg 3 acyclovir inj 50mg/ ml 3 acyclovir ointment 5% 8 acyclovir susp 00mg/ 5ml 3 acyclovir tab 00mg, 3 800mg ADACEL INJ 76 ADAGEN INJ 50UNIT 36 adapalene cream 0.% 5 adapalene gel 0.%, 0.3% 5 ADCIRCA TAB 0MG 38 adefovir tab 0mg 3 ADEMS TAB 0.5MG, 38 MG,.5MG, MG,.5MG adrucil 500mg/ 0ml inj 5 ADVAIR DISKUS 0 00MCG, 50MCG, 500MCG ADVAIR HFA INHALER 0 5MCG, 5MCG, 30MCG AEROCHAMBER PLUS 63 W/ MASK* afeditab CR tab 30mg, 37 60mg AFINITOR DISPERZ 7 TAB MG, 3MG, 5MG AFINITOR TAB.5MG, 7 5MG, 7.5MG, 0MG AGGRENOX CAP MG A-HYDROCORT INJ 00MG AK-CON OPHTH SOLN 70 0.% AKYNZEO CAP MG ala cort cream % 8 ALBENZA TAB 00MG 8 albuterol neb 0.63mg/ 3ml, 0.5mg/ 3ml,.5mg/ 3ml, 5mg/ ml albuterol sulfate ER tab 0 mg, 8mg albuterol syrup mg/ 5ml 0 albuterol tab mg, mg 0 alclometasone cream % alclometasone ointment % ALCOHOL SWAB 63 ALDURAZYME INJ 5.9MG/ 5ML ALECENSA 50MG CAP 7 8

95 ALPHABETICAL LISTING OF DRUGS ALENDRONATE SOLN 53 70MG/ 75ML ALENDRONATE TAB 53 0MG alendronate tab 5mg, 53 0mg, 35mg, 70mg alfuzosin ER tab 0mg 57 ALIMTA INJ 500MG 5 ALINIA SUSP 00MG/ 3 5ML ALINIA TAB 500MG 3 ALLCLENZ WOUND 5 CLEANSER* allopurinol tab 00mg, mg ALOCRIL OPHTH SOLN 7 % ALOMIDE OPHTH SOLN 7 0.% alosetron tab 0.5mg, mg 56 ALPHAGAN P OPHTH 69 SOLN 0.%, 0.5% alprazolam ER tab 0.5mg, 8 mg, mg, 3mg alprazolam ODT 0.5mg, 8 0.5mg, mg, mg alprazolam tab 0.5mg, 8 0.5mg, mg, mg ALREX OPHTH SUSP 70 0.% ALUMINUM ACETATE 5 SOLN* ALUMINUM 7 HYDROXIDE GEL SUSP 30MG/ 5ML* aluminum hydroxide/ 7 magnesium carbonate chew tab 60-05mg* aluminum hydroxide/ 7 magnesium trisilicate chew tab 80-0mg* aluminum/ magnesium 7 hydroxide/ simethicone chew tab mg* aluminum/ magnesium 7 hydroxide/ simethicone susp mg/ 5ml* aluminum/ magnesium 7 hydroxide/ simethicone susp mg/ 5ml* amantadine cap 00mg 9 amantadine syrup 50mg/ 9 5ml AMBISOME INJ 50MG 8 amcinonide cream 0.% 8 AMCINONIDE 8 OINTMENT 0.% amethia tab 39 amifostine inj 500mg 8 amikacin sulfate inj 50mg/ ml amiloride tab 5mg 5 amiloride/ 5 hydrochlorothiazide tab 5-50mg AMINO ACIDS ORAL 68 LIQUID* AMINO ACIDS ORAL 68 POWDER* aminophylline inj 5mg/ ml 0 AMINOSYN 7%/ 68 ELECTROLYTES AMINOSYN II INJ 7%, %, 0%, 5% AMINOSYN INJ 7%, 0% 68 AMINOSYN M INJ 3.5% 68 aminosyn/ electrolyte inj % AMINOSYN-RF INJ 5.% 68 amiodarone inj 50mg/ 9 3ml amiodarone tab 00mg, 9 00mg amitriptyline tab 0mg, 5mg, 50mg, 75mg, 00mg, 50mg amlodipine tab.5mg, 37 5mg, 0mg amlodipine/ atorvastatin 37 tab (all strengths) amlodipine/ benazepril cap.5-0mg, 5-0mg, 5-0mg, 0-0mg, 5-0mg, 0-0mg amlodipine/ telmisartan tab 0-5mg, 0-0mg, 80-5mg, 80-0mg amlodipine/ valsartan tab 5-60mg, 5-30mg, 0-60mg, 0-30mg amlodipine/ valsartan/ hydrochlorothiazide tab (all strengths) AMMONIUM CHLORIDE INJ 5MEQ/ ML ammonium lactate cream % ammonium lactate lotion % amnesteem cap 0mg, 0mg, 0mg amoxapine tab 5mg, 50mg, 00mg, 50mg amoxicillin cap 50mg, 500mg amoxicillin chew tab 5mg AMOXICILLIN CHEW TAB 50MG amoxicillin susp 5mg/ 5ml, 00mg/ 5ml, 50mg/ 5ml, 00mg/ 5ml amoxicillin tab 500mg, 875mg amoxicillin/ clavulanate chew tab 00mg, 00mg amoxicillin/ clavulanate ER tab mg amoxicillin/ clavulanate susp 00mg, 50mg, 00mg, 600mg amoxicillin/ clavulanate tab 50mg, 500mg, 875mg

96 ALPHABETICAL LISTING OF DRUGS amphetamine/ dextroamphetamine ER cap 5mg, 0mg, 5mg, 0mg, 5mg, 30mg amphetamine/ dextroamphetamine tab 5mg, 7.5mg, 0mg,.5mg, 5mg, 0mg, 30mg AMPHOTERICIN B INJ 8 50MG ampicillin 0mg/ ml/ 73 sulbactam 0mg/ ml inj ampicillin cap 50mg, 7 500mg AMPICILLIN INJ 5MG 7 ampicillin inj gm, 0gm 7 ampicillin susp 5mg/ 7 5ml, 50mg/ 5ml ampicillin/ sulbactam inj 73 -gm, 0-5gm AMPYRA TAB 0MG 7 ANADROL TAB 50MG 6 anagrelide cap 0.5mg, mg 58 anastrozole tab mg 6 ANDRODERM TCH 6 MG ANDRODERM TCH 6 MG ANDROGEL % (5MG) 6 ANDROGEL % (50MG) 7 ANDROGEL.6% 7 (.5GM) ANDROGEL.6% 7 (.5GM) ANDROGEL PUMP % 7 ANDROGEL PUMP 7.6% apexicon ointment 0.05% 8 APLENZIN TAB 7MG, 3 38MG, 5MG APOKYN INJ 0MG/ ML 9 apraclonidine ophth soln % apri tab 39 APRISO CAP 0.375GM 56 APTIOM TAB 00MG, 00MG, 600MG, 800MG APTIVUS CAP 50MG 3 APTIVUS SOLN 00MG/ 3 ML AQUASOL A INJ 50000/ 79 ML* ARALAST NP INJ 75 00MG aranelle tab 39 ARANESP 0MCG/ 59 0.ML SYR ARANESP ALBUMIN 59 FREE INJ 00MCG, 50MCG, 00MCG, 300MCG, 500MCG ARANESP ALBUMIN 59 FREE INJ 5MCG, 0MCG, 60MCG ARCALYST INJ 0MG argatroban inj 00mg/ ml ARGATROBAN INJ 5MG/ 5ML ARIPIPRAZOLE ODT 3 0MG, 5MG aripiprazole tab mg, 5mg, 3 0mg, 5mg, 0mg, 30mg ARNUITY ELLIPTA 9 INHALER 00MCG, 00MCG ARRANON INJ 5MG/ ML 5 artificial tear ophth 68 solution* ARZERRA INJ 00MG/ 5 5ML ASACOL HD TAB MG ASCORBIC ACID 80 WAFER 500MG* ASCRIPTIN TAB 35MG* ashlyna 9 day pack 39 ASMANEX HFA 9 INHALER 00MCG, 00MCG ASMANEX INHALER 0 0MCG, 0MCG ASPIRIN 5MG/ 58 DIPYRIDAMOLE 00MG CAP aspirin chew tab 8mg* aspirin EC tab 35mg* aspirin EC tab 500mg* aspirin EC tab 650mg* 35 aspirin EC tab 8mg* aspirin tab 35mg* aspirin tab 500mg* aspirin tab 8mg* aspirin/ acetaminophen/ caffeine tab mg* ASSURE TEST STRIPS 5 PLATINUM* ASTAGRAF XL CAP MG, MG, 5MG atenolol tab 5mg, 50mg, 36 00mg atenolol/ chlorthalidone tab 50-5mg, 00-5mg ATGAM INJ 50MG/ ML 35 atorvastatin tab 0mg, 0 0mg, 0mg, 80mg atovaquone susp 750mg/ 3 5ml atovaquone/ proguanil tab mg, 50-00mg ATRIPLA TAB MG atropine inj 0.05mg/ ml, 76 0.mg/ ml atropine ophth soln % 69 ATROVENT HFA 9 INHALER 7MCG AUBAGIO TAB 7MG, 7 MG aubra tab 39 augmented betamethasone 8 cream 0.05% augmented betamethasone 8 gel 0.05% 8

97 ALPHABETICAL LISTING OF DRUGS augmented betamethasone 8 lotion 0.05% augmented betamethasone 8 ointment 0.05% AUGMENTIN SUSP MG/ 5ML AURYXIA TAB 0MG 57 AVANDAMET TAB 5-500MG, -000MG, -500MG, -000MG AVANDIA TAB MG, 6 MG, 8MG AVASTIN 00MG/ 6ML 5 INJ AVASTIN INJ 00MG/ 5 ML AVC VAGINAL CREAM 79 5% AVELOX INJ 00MG/ 55 50ML aviane tab 39 avita cream 0.05% 5 avita gel 0.05% 5 AVODART CAP 0.5MG 57 AVONEX INJ 30MCG 7 azacitidine inj 00mg 5 AZACTAM/ DEXTROSE INJ GM/ 50ML, GM/ 50ML AZASAN TAB 75MG, 35 00MG AZASITE OPHTH SOLN 69 % azathioprine tab 50mg 35 azelastine nasal spray 67 0.% (37mcg/ spray), 0.5% (05.5mcg/ spray) azelastine ophth soln % AZILECT TAB 0.5MG, 30 MG azithromycin 50mg pack 6 azithromycin inj 500mg 6 azithromycin susp 00mg/ 6 5ml, 00mg/ 5ml azithromycin tab 50mg, 6 500mg, 600mg AZOPT OPHTH SUSP % 7 aztreonam inj gm B B- tab 50mg* 80 B- SL tab 3000mcg* 58 B- SL tab 5000mcg* 58 B- SL tab 500mcg* 58 baciim inj 50000unit bacitracin ointment 6 500unit/ gm* BACITRACIN OPHTH 69 OINTMENT 500UNIT/ GM bacitracin zinc ointment 6 500unit/ gm* bacitracin/ polymyxin B 69 ophth ointment bacitracin-polymyxin b 6 ointment* baclofen tab 0mg, 0mg 67 balsalazide cap 750mg 56 balziva tab 39 BANZEL SUSP 0MG/ ML BANZEL TAB 00MG, 00MG BARACLUDE SOLN MG/ ML BCG VACCINE INJ 78 B-complex w/ vitamin C 66 cap* bekyree 8 day pack 39 BELEODAQ IV INJ 7 500MG BELVIQ TAB 0MG* benazepril tab 5mg, 0mg, 0 0mg, 0mg benazepril/ hydrochlorothiazide tab 5-6.5mg, 0-.5mg, 0-.5mg, 0-5mg BENLYSTA INJ 0MG 36 benzonatate cap 00mg* benzonatate cap 00mg* benzoyl peroxide 5.5%* 5 benzoyl peroxide cream 5 0%* benzoyl peroxide gel 0%* 5 benzoyl peroxide gel 5%* 5 benzoyl peroxide liquid 5 0%* benzoyl peroxide liquid 5% 5 * BENZOYL PEROXIDE 5 LOTION 0%* BENZOYL PEROXIDE 5 LOTION 5%* benzoyl peroxide lotion 6% 5 * benztropine inj mg/ ml 9 benztropine tab 0.5mg, 9 mg, mg BERINERT INJ KIT UNIT BESIVANCE OPHTH 69 SUSP 0.6% betamethasone 8 dipropionate cream 0.05% betamethasone 8 dipropionate gel 0.05% betamethasone 8 dipropionate lotion 0.05% betamethasone valerate 8 cream 0.% betamethasone valerate 8 foam 0.% betamethasone valerate 8 lotion 0.% betamethasone valerate 8 ointment 0.% betaxolol ophth soln 0.5% 68 betaxolol tab 0mg, 0mg 36 BETIMOL 0.5% OPHTH 69 SOLN BETIMOL OPHTH SOLN % BETOPTIC-S OPHTH 69 SUSP 0.5% bexarotene 75mg cap 8 BEXSERO SYR 78 85

98 ALPHABETICAL LISTING OF DRUGS BEYAZ TAB 39 bicalutamide tab 50mg 6 BICILLIN C-R INJ UNIT/ ML BICILLIN L-A INJ UNIT/ ML, 00000UNIT/ ML BICILLIN L-A INJ UNIT/ ML BICNU INJ 00MG BIDIL TAB MG 37 BIMATOPROST OPHTH 7 SOLN 0.03% bisacodyl supp 0mg* 6 bisacodyl tab delayed 6 release 5mg* bismuth subsalicylate chew 6 tab 6mg* bismuth subsalicylate susp 6 6mg/ 5ml* bismuth subsalicylate susp 6 55mg/ 5ml* bismuth subsalicylate tab 6 6mg* bisoprolol tab 5mg, 0mg 36 bisoprolol/ hydrochlorothiazide tab.5-6.5mg, 5-6.5mg, 0-6.5mg BIVIGAM INJ 0GM/ 7 00ML bleomycin sulfate inj 6 30unit BLEPHAMIDE OPHTH 70 SUSP 0-0.% blisovi FE / 0 8 day 39 pack blisovi FE / 0 8 day 39 pack BOOSTRIX INJ 76 BOSULIF TAB 00MG, 7 500MG BREO ELLIPTA 0 INHALER 00-5MCG, 00-5MCG briellyn tab 39 BRILINTA 60MG TAB 58 BRILINTA TAB 90MG 58 brimonidine ophth soln %, 0.% BRINTELLIX TAB 5MG, 3 0MG, 0MG bromfenac ophth soln % bromocriptine cap 5mg 9 bromocriptine tab.5mg 9 brompheniramine/ phenylephrine elixir -.5mg/ 5ml* brompheniramine/ phenylephrine liquid -0mg/ 5ml* BROMPHENIRAMINE/ PHENYLEPHRINE TAB -0MG* brompheniramine/ pseudoephedrine elixir -5mg/ 5ml* BROMPHENIRAMINE/ PSEUDOEPHEDRINE LIQUID -7.5MG/ ML* BROMPHENIRAMINE/ PSEUDOEPHEDRINE LIQUID -0MG/ ML* budesonide 0.5 mg/ ml inh 0 soln budesonide EC cap 3mg budesonide neb 0.5mg/ 0 ml, 0.5mg/ ml bumetanide inj 0.5mg/ ml 5 bumetanide tab 0.5mg, 5 mg, mg buprenorphine inj 0.3mg/ 6 ml buprenorphine SL tab mg, 6 8mg buprenorphine/ naloxone 6 SL tab -0.5mg, 8-mg buproban tab 50mg 75 bupropion SR tab 00mg, 3 50mg, 00mg bupropion tab 75mg, 3 00mg bupropion XL tab 50mg, 3 300mg buspirone tab 5mg, 0mg, 8 5mg BUSULFEX INJ 6MG/ ML BUTISOL TAB 30MG, 60 50MG butorphanol inj mg/ ml, 6 mg/ ml butorphanol soln 0mg/ ml 6 BUTRANS TCH 6 5MCG, 7.5MCG, 0MCG, 5MCG, 0MCG BYDUREON INJ 3.08MG/ 6 ML BYDUREON PEN INJ 6 MG BYSTOLIC TAB.5MG, 36 5MG, 0MG, 0MG C cabergoline tab 0.5mg 5 CALAMINE LOTION* 5 calcipotriene cream % calcipotriene ointment % calcipotriene soln 0.005% 7 calcipotriene/ 8 betamethasone ointment % calcitonin nasal spray 53 00unit calcitriol cap 0.5mcg, 5 0.5mcg calcitriol inj mcg/ ml 5 CALCITRIOL 7 OINTMENT 3MCG/ GM calcitriol soln mcg/ ml 5 calcium acetate cap 667mg 57 calcium carbonate 7 (antacid) chew tab 000mg* 86

99 ALPHABETICAL LISTING OF DRUGS calcium carbonate (antacid) chew tab 00mg* calcium carbonate (antacid) chew tab 0mg* calcium carbonate (antacid) chew tab 500mg* calcium carbonate (antacid) chew tab 600mg* calcium carbonate (antacid) chew tab 750mg* CALCIUM CARBONATE (ANTACID) TAB 68MG* CALCIUM CARBONATE CAP 50MG* CALCIUM CARBONATE CHEW TAB 50MG* CALCIUM CARBONATE CHEW TAB 60MG* calcium carbonate chew tab 500mg* calcium carbonate susp 50mg/ 5ml* calcium carbonate tab 50mg* calcium carbonate tab 500mg* calcium carbonate tab 600mg* calcium carbonate/ cholecalciferol cap 600mg-500unit* CALCIUM CARBONATE/ CHOLECALCIFEROL CHEW TAB 500MG-00UNIT* calcium carbonate/ cholecalciferol chew tab 500mg-00unit* calcium carbonate/ cholecalciferol chew tab 500mg-600unit* CALCIUM CARBONATE/ CHOLECALCIFEROL CHEW TAB 600MG-800UNIT* calcium carbonate/ cholecalciferol tab 50mg-5unit* calcium carbonate/ cholecalciferol tab 500mg-5unit* calcium carbonate/ cholecalciferol tab 500mg-00unit* calcium carbonate/ cholecalciferol tab 500mg-00unit* calcium carbonate/ cholecalciferol tab 500mg-600unit* calcium carbonate/ cholecalciferol tab 600mg-00unit* calcium carbonate/ cholecalciferol tab 600mg-00unit* calcium carbonate/ cholecalciferol tab 600mg-800unit* CALCIUM CARBONATE/ SIMETHICONE CHEW TAB MG* calcium carbonate/ vitamin D cap 600mg-00unit* calcium carbonate/ vitamin D tab 00mg-50unit* calcium carbonate/ vitamin D tab 50mg-5unit* calcium carbonate/ vitamin D tab 50mg-00unit* calcium carbonate/ vitamin D tab 35mg-00unit* calcium carbonate/ vitamin D tab 35mg-50unit* calcium carbonate/ vitamin 6 D tab 500mg-5unit* calcium carbonate/ vitamin 6 D tab 500mg-00unit* calcium carbonate/ vitamin 6 D tab 500mg-00unit* calcium carbonate/ vitamin 6 D tab 600mg-5unit* calcium carbonate/ vitamin 6 D tab 600mg-00unit* calcium carbonate/ vitamin 6 D tab 600mg-00unit* CALCIUM 6 GLUBIONATE SYRUP.8GM/ 5ML* CALCIUM GLUCONATE 6 TAB 500MG* CALCIUM GLUCONATE 6 TAB 50MG* calcium lactate tab 6 650mg* calcium polycarbophil tab 60 65mg* calcium tab 500mg* 6 calcium tab 600mg* 6 calcium/ phosphorus w/ 65 vitamin D tab 05mg-8mg-0unit* calcium/ vitamin D tab mg-00unit* camila tab CANASA SUPP 000MG 56 CANCIDAS INJ 50MG, 8 70MG candesartan tab mg, 8mg, 0 6mg, 3mg candesartan/ hydrochlorothiazide tab 6-.5mg, 3-.5mg, 3-5mg CASTAT INJ GM CAPRELSA TAB 00MG, 7 300MG capsaicin cream 0.05%* 5 capsaicin cream 0.075%* 5 capsaicin cream 0.%* 5 87

100 ALPHABETICAL LISTING OF DRUGS CAPSICUM OLEORESIN 50 CREAM 0.05%* captopril tab.5mg, 0 5mg, 50mg, 00mg captopril/ hydrochlorothiazide tab 5-5mg, 5-5mg, 50-5mg, 50-5mg CARAC CREAM 0.5% 7 CARBAGLU TAB 00MG 5 carbamazepine chew tab 00mg carbamazepine ER cap 00mg, 00mg, 300mg carbamazepine ER tab 00mg, 00mg carbamazepine susp 00mg/ 5ml carbamazepine tab 00mg carbamide peroxide 6.5% 7 otic soln* carbidopa tab 5mg 9 carbidopa/ levodopa ER 9 tab 5-00mg, 50-00mg carbidopa/ levodopa ODT mg, 5-00mg, 5-50mg carbidopa/ levodopa tab mg, 5-00mg, 5-50mg CARBIDO/ 9 LEVODO/ ENTACAPONE TAB (ALL STRENGTHS) carbinoxamine soln mg/ 8 5ml carbinoxamine tab mg 8 carboplatin inj 50mg/ 5ml CARDENE INJ 0MG/ 37 00ML, 0MG/ 00ML CARIMUNE INJ 6GM 7 carisoprodol tab 350mg 67 carisoprodol/ aspirin tab mg carisoprodol/ aspirin/ 67 codeine tab mg carteolol ophth soln % 69 cartia XT cap 0mg, 37 80mg, 0mg 300mg carvedilol tab 3.5mg, mg,.5mg, 5mg CAYSTON INHALATION SOLN 75MG CEDAX SUSP 80MG/ 38 5ML cefaclor cap 50mg, mg CEFACLOR SUSP 38 5MG/ 5ML, 50MG/ 5ML, 375MG/ 5ML cefadroxil cap 500mg 38 cefadroxil susp 50mg/ 38 5ml, 500mg/ 5ml cefadroxil tab gm 38 cefazolin inj 500mg, gm, 38 0mg CEFAZOLIN/ D5W INJ 38 GM/ 50ML cefdinir cap 300mg 38 cefdinir susp 5mg/ 5ml, 38 50mg/ 5ml CEFEPIME 0MG/ ML 39 INJ CEFEPIME 0MG/ ML 39 INJ cefepime inj gm, gm 39 cefixime susp 00mg/ 5ml, 39 00mg/ 5ml cefotaxime inj 500mg, gm, 39 gm, 0gm CEFOTETAN INJ GM, 38 GM, 0GM cefoxitin inj gm, gm, 38 0gm CEFOXITIN/ DEXTROSE 38 INJ GM-%, GM-.% cefpodoxime susp 50mg/ 39 5ml, 00mg/ 5ml cefpodoxime tab 00mg, 39 00mg cefprozil susp 5mg/ 5ml, 38 50mg/ 5ml cefprozil tab 50mg, mg ceftazidime inj gm, gm, 39 6gm CEFTAZIDIME/ 39 DEXTROSE INJ GM/ 50ML, GM/ 50ML ceftriaxone inj 50mg, mg, gm, gm, 0gm cefuroxime inj 750mg, 38.5gm, 7.5gm cefuroxime tab 50mg, mg celecoxib cap 50mg, 00mg, 00mg, 00mg CELLCEPT IV INJ MG CELONTIN CAP 300MG 3 cephalexin cap 50mg, mg cephalexin susp 5mg/ 38 5ml, 50mg/ 5ml cephalexin tab 50mg, mg CEREZYME INJ 58 00UNIT CERVARIX INJ 78 CESAMET CAP MG 7 cetirizine chew tab 0mg* 9 cetirizine chew tab 5mg* 9 cetirizine soln 5mg/ 5ml 9 cetirizine tab 0mg* 9 cetirizine tab 5mg* 9 cevimeline cap 30mg 66 CHANTIX CONTINUING 75 MONTHS OF THERAPY MG CK CHANTIX K 75 CHANTIX TAB 0.5MG, 75 MG CHEMET CAP 00MG 7 CHENODAL TAB 50MG 56 88

101 ALPHABETICAL LISTING OF DRUGS CHLORAMPHENICAL 3 INJ GM chlordiazepoxide cap 5mg, 8 0mg, 5mg chlordiazepoxide/ 7 amitriptyline tab 5-.5mg, 0-5mg CHLORHEXIDINE 3 GLUCONATE LIQUID %* chlorhexidine gluconate 3 liquid %* CHLORHEXIDINE 3 GLUCONATE DS %* chlorhexidine gluconate 66 soln 0.% chloroquine tab 50mg, 500mg chlorothiazide inj 500mg 53 CHLOROTHIAZIDE TAB 53 50MG chlorothiazide tab 500mg 53 chlorpheniramine maleate 8 CR tab mg* chlorpheniramine maleate 8 syrup mg/ 5ml* chlorpheniramine maleate 8 tab mg* chlorpheniramine/ DM tab 3-0mg* chlorpheniramine/ DM tab 3-30mg* chlorpheniramine/ 3 phenylephrine liquid -0mg/ 5ml* chlorpheniramine/ 3 phenylephrine tab -0mg* chlorpheniramine/ 3 pseudoephedrine tab -60mg* chlorpheniramine-dm 3 liquid -5mg/ 5ml* chlorpromazine inj 5mg/ 3 ml chlorpromazine tab 0mg, 3 5mg, 50mg, 00mg, 00mg CHLORPROMIDE 6 TAB 00MG, 50MG chlorthalidone tab 5mg, 53 50mg chlorzoxazone tab 500mg 67 cholecalciferol cap unit* cholecalciferol cap unit* cholecalciferol cap unit* cholecalciferol cap 80 00unit* cholecalciferol cap unit* cholecalciferol cap unit* cholecalciferol drops unit/ 0.03ml* cholecalciferol drops 80 00unit/ 0.03ml* cholecalciferol drops unit/ ml* cholecalciferol oral liquid 80 00unit/ ml* cholecalciferol tab unit* cholecalciferol tab unit* cholecalciferol tab 80 00unit* cholecalciferol tab unit* cholestyramine light 9 powder gm/ dose cholestyramine light 9 powder packet gm ciclopirox cream 0.77% 6 ciclopirox gel 0.77% 6 ciclopirox nail lacquer 8% 6 ciclopirox shampoo % 6 ciclopirox susp 0.77% 6 cidofovir inj 75mg/ ml 3 cilostazol tab 50mg, 00mg 58 cimetidine oral soln mg/ 5ml cimetidine tab 00mg, mg, 00mg, 800mg CIMZIA INJ 00MG/ ML 56 CINRYZE INJ 500UNIT 58 CIPRODEX OTIC SUSP % ciprofloxacin ER tab mg, 000mg ciprofloxacin IV soln 55 00mg/ 0ml ciprofloxacin ophth soln % ciprofloxacin susp 50mg/ 55 5ml, 500mg/ 5ml ciprofloxacin tab 00mg, 55 50mg, 500mg, 750mg ciprofloxacin/ D5W inj 55 00mg/ 00ml cisplatin inj mg/ ml citalopram soln 0mg/ 5ml 3 citalopram tab 0mg, 0mg, 0mg cladribine inj mg/ ml 5 claravis cap 0mg, 0mg, 5 0mg clarithromycin ER tab 6 500mg clarithromycin susp 6 5mg/ 5ml, 50mg/ 5ml clarithromycin tab 50mg, 6 500mg clemastine fumarate tab 8.3mg* clemastine tab.68mg 8 clindamycin cap 75mg, 3 50mg, 300mg clindamycin inj 600mg/ 3 ml clindamycin phosphate 5 foam % clindamycin phosphate gel 5 % 89

102 ALPHABETICAL LISTING OF DRUGS clindamycin phosphate 5 lotion % clindamycin phosphate 5 soln % clindamycin phosphate 5 swab % clindamycin syrup 75mg/ 3 5ml clindamycin vaginal cream 79 % clindamycin/ benzoyl 5 peroxide gel -5% clindamycin/ d5w inj 3 300mg/ 50ml, 600mg/ 50ml, 900mg/ 50ml CLINIMIX E.5%/ 68 DEXTROSE INJ CLINIMIX E INJ.75%, 68.5%, 5% CLINIMIX INJ.5%, 5% 68 clinisol sf inj 5% 68 clobetasol E cream 0.05% 8 clobetasol gel 0.05% 8 clobetasol lotion 0.05% 8 clobetasol ointment 0.05% 8 clobetasol propionate % spray clobetasol shampoo 0.05% 8 clobetasol soln 0.05% 8 clobetasol topical foam % CLOLAR INJ MG/ ML 5 clomipramine cap 5mg, 50mg, 75mg clonazepam ODT 0.5mg, 0.5mg, 0.5mg, mg, mg clonazepam tab 0.5mg, mg, mg clonidine patch 0.mg, 0.mg, 0.3mg clonidine tab 0.mg, 0.mg, 0.3mg clopidogrel tab 75mg 58 clorazepate tab 3.75mg, 8 7.5mg, 5mg clotrimazole cream % 6 clotrimazole soln % 6 clotrimazole troche 0mg 66 clotrimazole vaginal cream 79 %* clotrimazole vaginal cream 79 %* clotrimazole/ 6 betamethasone cream -0.05% clotrimazole/ 6 betamethasone lotion -0.05% CLOZAPINE ODT 3.5MG, 5MG, 00MG, 50MG, 00MG clozapine tab 5mg, 50mg, 3 00mg, 00mg COARTEM TAB 3 0-0MG codeine sulfate tab 5mg, 30mg codeine sulfate tab 60mg COLCHICINE TAB MG colchicine/ probenecid tab mg COLCRYS TAB 0.6MG 58 colestipol granules canister 9 5gm colestipol tab gm 9 colistimethate inj 50mg colocort enema 00mg/ 7 60ml COLY-MYCIN S OTIC 7 SUSP 3MG-0MG/ ML COMBIGAN OPHTH 69 SOLN 0.%-0.5% COMBITCH MG, MG COMBIVENT 0 RESPIMAT 0-00MCG COMETRIQ CAP CK 7 COMPLERA TAB MG compro supp 5mg 3 COMVAX INJ 78 CONDOMS LATEX 63 LUBRICATED* CONDOMS LATEX 63 NON-LUBRICATED* constulose soln 0gm/ 5ml 6 COXONE 0MG/ ML 7 SYR COXONE INJ 0MG/ 7 ML CORLANOR 5MG TAB 38 CORLANOR 7.5MG TAB 38 cormax 0.05% topical soln 9 CORTISONE ACETATE TAB 5MG CORTISPORIN-TC OTIC 7 SUSP 3MG-0MG/ ML COSENTYX 50MG/ ML 7 AUTO-INJECTOR COSENTYX 50MG/ ML 8 SYR COSMEGEN INJ 0.5MG 6 COTELLIC 0MG TAB 7 CREON CAP (ALL 5 STRENGTHS) CRESTOR TAB 0MG 0 CRESTOR TAB 5MG, 0 0MG, 0MG CRINONE % VAGINAL 79 GEL CRINONE 8% VAGINAL 79 GEL CRIXIVAN CAP 00MG, 3 00MG cromolyn neb 0mg/ ml 9 cromolyn sodium nasal 67 aerosol soln 5.mg/ act* cromolyn sodium ophth 7 soln % cromoyln sodium oral soln 56 00mg/ 5ml cryselle-8 tab 39 CUBICIN INJ 500MG 3 CUPRIMINE CAP 50MG 35 cyclafem tab 39 90

103 ALPHABETICAL LISTING OF DRUGS cyclobenzaprine tab 5mg, mg, 0mg CYCLOPHOSPHAMIDE CAP 5MG, 50MG cyclosporine cap 5mg, 35 00mg cyclosporine inj 50mg/ ml 35 cyclosporine modified cap 35 5mg, 00mg CYCLOSPORINE 35 MODIFIED CAP 50MG cyclosporine modified soln 35 00mg/ ml cyproheptadine syrup mg/ 9 5ml cyproheptadine tab mg 9 CYRAMZA 00MG/ 5 0ML INJ CYRAMZA 500MG/ 5 50ML INJ CYSTAGON CAP 50MG, 57 50MG cytarabine inj 0mg/ ml, 5 00mg/ ml D d.5w/ nacl inj 0.5% 65 d5w/ lactated ringers inj 65 d5w/ nacl inj 0.%, 0.33%, %, 0.9% D5W/ NACL INJ 0.%, % dacarbazine inj 00mg 8 DALIRESP TAB 500MCG 9 DALVANCE INJ 500MG danazol cap 50mg, 00mg, 7 00mg dantrolene cap 5mg, 67 50mg, 00mg DAPSONE TAB 5MG, 3 00MG DAPTACEL INJ 76 DARAPRIM TAB 5MG DARZALEX 00MG/ 5 5ML INJ daunorubicin inj 5mg/ ml 6 DAUNOXOME MG/ ML 6 INJ deblitane tab decitabine inj 50mg 5 delyla tab 39 DELZICOL CAP 00MG 56 demeclocycline tab 50mg, mg DEMSER CAP 50MG 0 DENAVIR CREAM % 8 DEPEN TITRATABS 35 50MG desipramine tab 0mg, 5mg, 50mg, 75mg, 00mg, 50mg desloratadine tab 5mg 9 desmopressin acetate 5 0.0% nasal soln desmopressin inj mcg/ ml 5 desmopressin nasal spray 5 0.0% desmopressin tab 0.mg, 5 0.mg desogestrel/ ethinyl 39 estradiol tab DESONATE GEL 0.05% 9 desonide cream 0.05% 9 desonide lotion 0.05% 9 desonide ointment 0.05% 9 DESOXIMETASONE 9 CREAM 0.05% desoximetasone cream 9 0.5% desoximetasone gel 0.05% 9 desoximetasone ointment 9 0.5% DESVENLAFAXINE ER TAB 50MG, 00MG dexamethasone conc mg/ ml dexamethasone elixir 0.5mg/ 5ml dexamethasone inj 0mg/ ml, 0mg/ 30ml dexamethasone sodium 70 phosphate ophth soln 0.% dexamethasone tab 0.5mg, 0.75mg,.5mg, mg, 6mg DEXAMETHASONE TAB MG, MG dexmethylphenidate ER cap 5mg, 0mg, 5mg, 0mg, 30mg, 0mg dexmethylphenidate tab.5mg, 5mg, 0mg dexrazoxane inj 0mg/ ml 8 dextroamphetamine ER cap 5mg, 0mg, 5mg dextroamphetamine tab 5mg, 0mg dextromethorphan hbr cap 5mg* dextromethorphan hbr liquid 5mg/ 5ml* dextromethorphan hbr liquid 5mg/ 5ml* dextromethorphan hbr liquid 7.5mg/ 5ml* dextromethorphan hbr syrup 0mg/ 5ml* dextromethorphan hbr syrup 5mg/ 5ml* dextromethorphan hbr syrup 7.5mg/ 5ml* DEXTROMETHORPHAN 3 / GUAIFENESIN GRANULES CKET 5-00MG* dextromethorphan/ 3 guaifenesin liquid 0-00mg/ 5ml* dextromethorphan/ 3 guaifenesin liquid 0-00mg/ 5ml* dextromethorphan/ 3 guaifenesin liquid 0-300mg/ 5ml* dextromethorphan/ 3 guaifenesin liquid 30-00mg/ 5ml* 9

104 ALPHABETICAL LISTING OF DRUGS dextromethorphan/ 3 guaifenesin SR tab (hr) mg* dextromethorphan/ 3 guaifenesin SR tab (hr) 60-00mg* dextromethorphan/ 3 guaifenesin tab 0-00mg* dextromethorphan-guaifen 3 esin cap 0-00mg* dextromethorphan-guaifen 3 esin liquid 0-00mg/ 5ml* dextromethorphan-guaifen 3 esin liquid 5-00mg/ 5ml* dextromethorphan-guaifen 3 esin syrup 0-00mg/ 5ml* dextrose inj 5%, 0% 68 DIASTAT RECTAL GEL.5MG, 0MG, 0MG DIAZEM INTENSOL 8 CONC 5MG/ ML DIAZEM RECTAL GEL.5MG, 0MG, 0MG DIAZEM SOLN MG/ 8 ML diazepam tab mg, 5mg, 8 0mg diclofenac ER tab 5mg, 50mg, 75mg diclofenac gel 3% 7 diclofenac ophth soln 0.% 7 diclofenac potassium tab 50mg diclofenac topical soln 7.5% diclofenac XR tab 00mg diclofenac/ misoprostol tab 50-0.mg, 75-0.mg dicloxacillin cap 50mg, mg dicyclomine cap 0mg 76 DICYCLOMINE SOLN 76 0MG/ 5ML dicyclomine tab 0mg 76 didanosine cap 5mg, 3 00mg, 50mg, 00mg DIFFERIN LOTION 0.% 5 diflorasone cream 0.05% 9 diflorasone ointment 0.05% 9 diflunisal tab 500mg digoxin inj 0.5mg/ ml 37 digoxin oral soln 0.05mg/ 37 ml digoxin tab 0.5mg 37 digoxin tab 0.5mg 37 DIHYDROERGOTAMIN 63 E MESYLATE 0.5MG/ ACT NASAL SPRAY dihydroergotamine 63 mesylate inj mg/ ml DILANTIN CAP 30MG 3 diltiazem CD cap 0mg, 37 0mg, 300mg diltiazem ER cap 60mg, 37 90mg, 0mg, 80mg, 360mg, 0mg DILTIAZEM INJ 00MG 37 diltiazem inj 50mg/ 0ml 37 diltiazem tab 30mg, 60mg, 37 90mg, 0mg dilt-xr cap 0mg, 80mg, 37 0mg dimenhydrinate tab 50mg* 7 DIPENTUM CAP 50MG 56 diphenhydramine cap 8 5mg* diphenhydramine cap 60 50mg* diphenhydramine chew tab 8.5mg* diphenhydramine cream 7 %* diphenhydramine disperse 8 tab.5mg* diphenhydramine elixir 8.5mg/ 5ml (Rx only) diphenhydramine gel %* 7 diphenhydramine inj 50mg/ 8 ml diphenhydramine liquid 8.5mg/ 5ml* DIPHENHYDRAMINE 9 ORAL STRIP.5MG* diphenhydramine soln %* 7 diphenhydramine tab 9 5mg* diphenhydramine tab 9 5mg* diphenhydramine tab 60 50mg* diphenhydramine/ zinc 7 acetate cream -0.%* diphenhydramine/ zinc 7 acetate cream -0.%* diphenhydramine/ zinc 7 acetate liquid -0.%* diphenoxylate/ atropine 7 liquid mg/ 5ml diphenoxylate/ atropine tab mg DIPHTHERIA/ TETANUS 76 INJ dipyridamole tab 5mg, 58 50mg, 75mg disopyramide cap 00mg, 9 50mg disulfiram tab 50mg, mg DIURIL SUSP 50MG/ 53 5ML divalproex DR tab 5mg, 3 50mg, 500mg divalproex ER tab 50mg, 3 500mg divalproex sprinkle cap 3 5mg DOCEFREZ INJ 0MG, 8 80MG DOCETAXEL INJ 0MG/ 8 ML DOCETAXEL INJ 0MG/ 9 ML docusate calcium cap 6 0mg* 9

105 ALPHABETICAL LISTING OF DRUGS docusate sodium cap 6 00mg* docusate sodium cap 6 50mg* docusate sodium cap 6 50mg* docusate sodium enema 6 83mg* docusate sodium liquid 6 50mg/ 5ml* DOCUSATE SODIUM 6 LIQUID 50MG/ 5ML* docusate sodium syrup 6 60mg/ 5ml* docusate sodium tab 6 00mg* donepezil ODT 5mg, 0mg 73 donepezil tab 3mg 73 donepezil tab 5mg, 0mg 73 DORIBAX INJ 500MG 3 dorzolamide ophth soln % 7 dorzolamide/ timolol ophth 69 soln.3-6.8mg/ ml doxazosin tab mg, mg, mg, 8mg doxepin cap 0mg, 5mg, 50mg, 75mg, 00mg, 50mg doxepin conc 0mg/ ml doxercalciferol cap 5 0.5mcg, mcg,.5mcg doxercalciferol inj mcg/ 5 ml doxorubicin inj mg/ ml 6 doxycycline hyclate cap 75 50mg, 00mg doxycycline hyclate tab 75 0mg, 00mg doxycycline inj 00mg 75 doxycycline monohydrate 75 cap 50mg, 00mg doxycycline monohydrate 75 tab 50mg, 00mg doxycycline monohydrate 75 tab 50mg, 75mg, 50mg doxycycline susp 5mg/ 76 5ml doxylamine succinate tab 60 5mg* doxylamine-dm liquid mg/ 5ml* dronabinol cap.5mg, 7 5mg, 0mg drospirenone 3mg/ ethinyl 39 estradiol 0.0mg/ inert ingredients mg pack drospirenone/ ethinyl 39 estradiol tab DROXIA CAP 00MG, MG, 00MG DULERA INHALER MCG, 00-5MCG duloxetine cap 0mg, 30mg, 60mg DULOXETINE DR CAP 0MG duramorph inj 0.5mg/ ml, mg/ ml DUREZOL OPHTH 70 EMULSION 0.05% dutasteride 0.5mg cap 57 dutasteride 0.5mg/ 57 tamsulosin 0.mg cap DUTOPROL ER TAB 5-.5MG, 50-.5MG, 00-.5MG E E.E.S GRANULE 00MG/ 6 5ML E600 cap 600unit* 80 econazole nitrate cream 6 % EDECRIN TAB 5MG 5 EDURANT TAB 5MG 3 EFFIENT TAB 5MG, 58 0MG ELAPRASE INJ MG/ 5 ML ELIDEL CREAM % 50 ELIGARD INJ 7.5MG, 6.5MG, 30MG, 5MG ELIQUIS TAB.5MG, 0 5MG ELITEK INJ.5MG 8 ELIXOPHYLLIN SOLN 0 80MG/ 5ML ELMIRON CAP 00MG 57 EMBEDA CAP 0-0.8MG, 30-.MG, 50-MG, 60-.MG, 80-3.MG, 00-MG EMCYT CAP 0MG 6 EMEND CAP 0MG, 7 80MG, 5MG EMEND CAP THERAPY 8 CK emoquette tab 39 EMPLICITI 300MG INJ 5 EMSAM TCH 6MG, 3 9MG, MG EMTRIVA CAP 00MG 3 EMTRIVA SOLN 0MG/ 3 ML enalapril tab.5mg, 5mg, 0 0mg, 0mg enalapril/ hydrochlorothiazide tab 5-.5mg, 0-5mg ENBREL INJ 5MG, 3 50MG ENBREL SURECLICK 3 INJ 50MG ENGERIX-B INJ 78 enoxaparin inj 30mg, 0mg, 60mg, 80mg, 00mg, 0mg, 50mg, 300mg enpresse-8 tab 39 entacapone tab 00mg 9 entecavir tab 0.5mg, mg 3 enulose soln 0gm/ 5ml 56 ENVARSUS 0.75MG ER 35 TAB ENVARSUS MG ER 35 TAB ENVARSUS MG ER 35 TAB 93

106 ALPHABETICAL LISTING OF DRUGS EPIDUO % GEL 5 EPIDUO GEL 0.-.5% 5 epinastine ophth soln % EPIPEN INJ 0.3MG/ ML EPIPEN JR INJ 0.5MG/ ML epirubicin inj mg/ ml 7 epitol tab 00mg EPIVIR HBV SOLN 5MG/ 3 ML eplerenone tab 5mg, 50mg EPOGEN INJ 000UNIT/ 59 ML, 3000UNIT/ ML, 000UNIT/ ML, 0000UNIT/ ML, 0000UNIT/ ML EPROSARTAN 0 MESYLATE TAB 600MG EPZICOM TAB MG EQUETRO CAP 00MG, 30 00MG, 300MG ERAXIS INJ 00MG 8 ERBITUX SOLN 00MG/ 5 50ML ergocalciferol cap unit* ergocalciferol soln unit/ ml* ERGOCALCIFEROL 80 TAB 000UNIT* ERGOCALCIFEROL 80 TAB 00UNIT* ERGOLOID MESYLATE 7 TAB MG ERGOMAR SL TAB MG 63 ERIVEDGE CAP 50MG 6 errin tab ERTACZO CREAM % 6 ERWINAZE INJ UNIT ery pad % 5 ERYPED SUSP 00MG/ 6 5ML, 00MG/ 5ML ERY-TAB 50MG, 6 333MG, 500MG ERYTHROCIN 6 LACTOBIONATE INJ 500MG erythromycin ophth 69 ointment 5mg/ gm ERYTHROMYCIN TAB 6 50MG, 500MG erythromycin topical gel 6 % erythromycin topical soln 6 % erythromycin/ benzoyl 6 peroxide gel 5-3% ESBRIET CAP 67MG 75 escitalopram soln 5mg/ 5ml escitalopram tab 5mg, 0mg, 0mg esomeprazole inj 0mg, 77 0mg estazolam tab mg, mg 60 estradiol tab 0.5mg, mg, 55 mg estradiol twice weekly 55 patch 0.05mg, mg, 0.05mg, 0.075mg, 0.mg estradiol valerate inj 0mg/ 55 ml, 0mg/ ml estradiol weekly patch mg, mg, 0.05mg, 0.06mg, 0.075mg, 0.mg estradiol/ norethindrone 55 tab mg, -0.5mg ESTRING VAGINAL 79 RING MG estropipate tab 0.75mg, 55.5mg, 3mg eszopiclone tab mg, mg, 60 3mg ethambutol tab 00mg, 00mg ethinyl estradiol 0.03mg/ 39 ethinyl estradiol 0.0mg/ inert ingredients mg/ levonorgestrel 0.05mg/ levono ethosuximide cap 50mg 3 ethosuximide soln 50mg/ 3 5ml etidronate disodium tab 53 00mg, 00mg etodolac cap 00mg, 300mg etodolac ER tab 00mg, 500mg, 600mg etodolac tab 00mg, 500mg ETOPOPHOS INJ 00MG 9 etoposide inj 0mg/ ml 9 EURAX CREAM 0% 5 EVOTAZ TAB MG EXALGO TAB 8MG, 5 MG, 6MG, 3MG EXELON TCH.6MG, MG, 3.3MG exemestane tab 5mg 6 EXJADE TAB 5MG, 7 50MG, 500MG EXTAVIA INJ 7 eye wash soln* 7 F FABRAZYME INJ 35MG 5 falmina tab 0 famciclovir tab 5mg, 3 50mg, 500mg famotidine inj 0mg/ ml 77 famotidine susp 0mg/ 5ml 77 famotidine tab 0mg* 77 famotidine tab 0mg, 0mg 77 FAMOTIDINE/ NACL 77 INJ 0.9%-0MG/ 50ML FANAPT TAB MG, 30 MG, MG, 6MG, 8MG, 0MG, MG FANAPT TAB 30 TITRATION CK 9

107 ALPHABETICAL LISTING OF DRUGS FARESTON TAB 60MG 6 FARXIGA TAB 5MG, 6 0MG FARYDAK CAP 0MG, 7 5MG, 0MG FASLODEX INJ 50MG/ 6 5ML fat emulsion IV soln 0% 68 FAZACLO TAB.5MG, 3 5MG, 00MG, 50MG, 00MG felbamate susp 600mg/ 5ml felbamate tab 00mg, 600mg felodipine tab.5mg, 5mg, 37 0mg FENOFIBRATE CAP 9 50MG, 50MG fenofibrate micronized cap 9 3mg, 67mg, 30mg, 3mg, 00mg fenofibrate tab 8mg, 9 5mg, 5mg, 60mg FENOPROFEN 00MG CAP fenoprofen tab 600mg 3 fentanyl lollipop 00mcg, 5 00mcg, 600mcg, 800mcg, 00mcg, 600mcg fentanyl patch mcg, 5 5mcg, 50mcg, 75mcg, 00mcg FERRIPROX 00MG/ ML 7 SOLN FERRIPROX TAB 500MG 7 ferrous sulfate CR tab 59 mg* ferrous sulfate CR tab 59 60mg* ferrous sulfate CR tab 59 5mg* ferrous sulfate CR tab mg* ferrous sulfate CR tab 59 50mg* FERROUS SULFATE EC 59 TAB 3MG* ferrous sulfate EC tab 59 35mg* ferrous sulfate elixir 59 0mg/ 5ml* FERROUS SULFATE 59 LIQUID 0MG/ 5ML* ferrous sulfate soln 75mg/ 59 ml* FERROUS SULFATE 59 SYRUP 300MG/ 5ML* ferrous sulfate tab 00mg* 59 ferrous sulfate tab 7mg* 59 ferrous sulfate tab 35mg* 59 FETZIMA CAP TITRATION CK FETZIMA ER CAP 0MG, 0MG, 80MG, 0MG fiber powder* 60 FINACEA 5% FOAM 5 FINACEA GEL 5% 5 finasteride tab 5mg 57 FIRAZYR INJ 30MG/ 58 3ML FIRMAGON INJ 0MG 6 FIRMAGON INJ 80MG 6 FLEBOGAMMA 0% INJ 7 flecainide tab 50mg, 9 00mg, 50mg FLOVENT DISKUS 0 50MCG, 00MCG, 50MCG FLOVENT HFA 0 INHALER 0MCG, 0MCG FLOVENT HFA 0 INHALER MCG fluconazole susp 0mg/ ml, 8 0mg/ ml fluconazole tab 50mg, 8 00mg, 50mg, 00mg fluconazole/ dextrose inj 8 00mg/ 00ml flucytosine cap 50mg, 8 500mg fludarabine inj 50mg 5 fludrocortisone tab 0.mg fluocinolone acetonide 9 cream 0.0%, 0.05% fluocinolone acetonide oil 9 0.0% fluocinolone acetonide 9 ointment 0.05% fluocinolone acetonide otic 7 oil 0.0% fluocinolone acetonide soln 9 0.0% fluocinonide cream 0.% 9 fluocinonide E cream % fluocinonide gel 0.05% 9 fluocinonide ointment % fluocinonide soln 0.05% 9 fluorometholone ophth 70 susp 0.% FLUOROURACIL 7 CREAM 0.05% fluorouracil cream 5% 7 fluorouracil inj 50mg/ ml 5 fluorouracil soln %, 5% 7 fluoxetine cap 0mg, 0mg, 0mg fluoxetine soln 0mg/ 5ml fluoxetine tab 0mg, 0mg fluphenazine decanoate inj 3 5mg/ ml fluphenazine elixir.5mg/ 3 5ml fluphenazine inj.5mg/ ml 3 fluphenazine oral conc 3 5mg/ ml fluphenazine tab mg, 3.5mg, 5mg, 0mg FLURAZEM CAP 60 5MG flurazepam cap 5mg, 60 30mg 95

108 ALPHABETICAL LISTING OF DRUGS flurbiprofen ophth soln % flurbiprofen tab 50mg, 3 00mg flutamide cap 5mg 6 fluticasone cream 0.05% 9 fluticasone nasal spray 67 50mcg fluticasone ointment % fluticasone propionate 9 lotion 0.05% fluvastatin 80mg ER tab 0 fluvastatin cap 0mg, 0mg 0 fluvoxamine ER cap 00mg, 50mg fluvoxamine tab 5mg, 50mg, 00mg folic acid tab mg* 59 folic acid tab 00mcg* 59 folic acid tab 800mcg* 59 FOLOTYN INJ 0MG/ 5 ML fomepizole inj gm/ ml 7 fondaparinux inj.5mg/ 0.5ml fondaparinux inj 5mg/ 0.ml, 7.5mg/ 0.6ml, 0mg/ 0.8ml FORADIL CAP MCG 0 FORTEO SOLN 600MCG/ 53.ML FORTICAL NASAL 53 SPRAY 00UNIT fosinopril tab 0mg, 0mg, 0 0mg fosinopril/ hydrochlorothiazide tab 0-.5mg, 0-.5mg fosphenytoin inj 00mg/ 3 ml FOSRENOL CHEW TAB MG, 750MG, 000MG FOSRENOL POWDER 57 CKET 750MG, 000MG FRAGMIN INJ 500UNIT, 0000UNIT FRAGMIN INJ 5000UNIT, 5000UNIT, 5000UNIT, 8000UNIT FRAGMIN INJ 7500UNIT, 95000UNIT FREAMINE HBC 6.9% 68 fruit C-00 chew* 80 furosemide inj 0mg/ ml 5 furosemide soln 8mg/ ml, 5 0mg/ ml furosemide tab 0mg, 5 0mg, 80mg FUSILEV INJ 50MG 8 FUZEON INJ 90MG 3 FYCOM TAB MG, MG, 6MG, 8MG, 0MG, MG G gabapentin cap 00mg, 300mg, 00mg gabapentin soln 50mg/ 5ml gabapentin tab 600mg, 800mg GABITRIL TAB MG, 6MG galantamine ER cap 8mg, 73 6mg, mg galantamine soln mg/ ml 73 galantamine tab mg, 8mg, 73 mg GAMASTAN S/ D INJ 7 GAMMAGARD INJ 7.5GM/ 5ML GAMMAKED GM/ 7 0ML INJ GAMMAPLEX INJ 7 0GM/ 00ML GAMUNEX-C INJ GM/ 7 0ML ganciclovir inj 500mg 3 GARDASIL INJ 78 gatifloxacin ophth soln % GATTEX INJ 5MG 57 GAUZE D 63 gavilyte-c powder 6 gavilyte-g soln 6 gavilyte-n powder 6 gemcitabine inj gm 5 gemfibrozil tab 600mg 9 generlac soln 0mg/ 5ml 56 gengraf cap 5mg, 00mg 35 gengraf soln 00mg/ ml 35 gentak ophth ointment % gentamicin inj 0mg/ ml, 0mg/ ml gentamicin ophth ointment % gentamicin ophth soln % gentamicin sulfate cream 6 0.% gentamicin sulfate ointment 6 0.% gentamicin/ nacl inj 0.8mg/ ml, mg/ ml,.mg/ ml,.6mg/ ml GENTAMICIN/ NACL INJ 0.9MG/ ML,.MG/ ML GENVOYA MG TAB GEODON INJ 0MG 30 gianvi tab 0 gildagia tab 0 gildess FE tab 0 gildess tab 0 GILENYA TAB 0.5MG 7 GILOTRIF TAB 0MG, 7 30MG, 0MG GLASSIA INJ 000MG/ 75 50ML GLEEVEC TAB 00MG, 7 00MG GLEOSTINE 5MG CAP GLEOSTINE CAP 0MG, 0MG, 00MG 96

109 ALPHABETICAL LISTING OF DRUGS glimepiride tab mg, mg, 6 mg glipizide ER tab.5mg, 6 5mg, 0mg glipizide tab 5mg, 0mg 6 glipizide/ metformin tab mg,.5-500mg, 5-500mg GLUCAGEN HYPOKIT 5 GLUCAGON KIT 5 GLUCOSE CHEW TAB 5 GM* GLUCOSE CHEW TAB 5 GM* GLUCOSE CHEW TAB 5 5GM* glucose gel 0%* 5 GLUCOSE URINE TEST- 5 (GLUCOSE OXIDASE) STRIP* glyburide micronized tab 6.5mg, 3mg, 6mg glyburide tab.5mg, 6.5mg, 5mg glyburide/ metformin tab mg,.5-500mg, 5-500mg glycerin supp gm* 6 glycerin supp.gm* 6 glycerin supp gm* 6 glycerin supp.gm* 6 glycerin supp 80.7%* 6 glycopyrrolate inj mg/ 76 0ml glycopyrrolate tab mg, 76 mg GLYSET TAB 5MG, 5 50MG, 00MG granisetron inj 0.mg/ ml, 7 mg/ ml granisetron tab mg 7 griseofulvin micro susp 8 5mg/ ml griseofulvin tab 5mg, 8 50mg, 500mg guaifenesin liquid 00mg/ 5 5ml* guaifenesin liquid 00mg/ 5 5ml* guaifenesin SR tab (hr) 5 600mg* guaifenesin syrup 00mg/ 5 5ml* guaifenesin tab 00mg* 5 guaifenesin tab 00mg* 5 guaifenesin/ codeine liquid mg/ 5ml* guaifenesin/ codeine liquid mg/ 5ml* guaifenesin/ codeine soln mg/ 5ml* guaifenesin-codeine soln mg/ 5ml* guanfacine ER tab mg, mg, 3mg, mg guanfacine IR tab mg, mg GUANIDINE TAB 5MG H HALAVEN INJ MG/ 9 ML halobetasol cream 0.05% 9 halobetasol ointment % haloperidol decanoate inj 30 50mg/ ml, 00mg/ ml haloperidol inj 5mg/ ml 30 haloperidol oral conc mg/ 30 ml haloperidol tab 0.5mg, 3 mg, mg, 5mg, 0mg, 0mg HARVONI TAB MG HAVRIX INJ 78 heparin inj 000unit/ ml, 5000unit/ ml, 0000unit/ ml, 0000unit/ ml heparin/ d5w inj 0unit/ ml, 50unit/ ml, 00unit/ ml hepatamine inj 8% 68 HERCEPTIN INJ 0MG 5 HETLIOZ CAP 0MG 60 HEXALEN CAP 50MG 5 HUMIRA KIT 0MG/ 0.ML, 0MG/ 0.ML, 0MG/ 0.8ML HUMULIN R U-500 INJ 6 hydralazine inj 0mg/ ml hydralazine tab 0mg, 5mg, 50mg, 00mg hydrochlorothiazide cap 53.5mg hydrochlorothiazide tab 53.5mg, 5mg, 50mg hydrocodone 0mg/ 6 ibuprofen 00mg tab hydrocodone 5mg/ 6 ibuprofen 00mg tab hydrocodone w/ homatropine syrup 5-.5mg/ 5ml* hydrocodone/ 6 acetaminophen soln mg/ 5ml hydrocodone/ 6 acetaminophen tab.5-35mg, 5-35mg, mg, 0-35mg hydrocodone/ 6 acetaminophen tab 5-300mg, mg, 0-300mg hydrocodone/ homatropine tab 5-.5mg* hydrocodone/ ibuprofen 6 tab mg, 0-00mg hydrocortisone acetate 9 cream %* HYDROCORTISONE 9 ACETATE OINTMENT %* hydrocortisone butyrate 9 cream 0.% hydrocortisone butyrate 9 ointment 0.% 97

110 ALPHABETICAL LISTING OF DRUGS hydrocortisone butyrate 9 soln 0.% hydrocortisone cream 0.5% 9 * hydrocortisone cream %, 9.5% hydrocortisone enema 7 00mg/ 60ml hydrocortisone gel %* 9 hydrocortisone lotion.5% 9 hydrocortisone ointment 9 0.5%* hydrocortisone ointment 9 %* hydrocortisone ointment 9 %,.5% hydrocortisone soln %* 9 hydrocortisone tab 5mg, 0mg, 0mg hydrocortisone valerate 9 cream 0.% hydrocortisone valerate 9 ointment 0.% hydrocortisone/ acetic acid 7 otic soln -% hydrocortisone/ aloe vera 9 cream 0.5%* hydrocortisone/ aloe vera 9 cream %* hydromorphone ER tab 5 mg HYDROMORPHONE ER 5 TAB 3MG hydromorphone ER tab 5 8mg, 6mg hydromorphone inj 0mg/ 5 ml hydromorphone susp mg/ 5 ml hydromorphone tab mg 5 hydromorphone tab mg 5 hydromorphone tab 8mg 5 hydroxychloroquine tab 00mg hydroxyurea cap 500mg 8 hydroxyzine inj 5mg/ ml, 50mg/ ml hydroxyzine pamoate cap 5mg, 50mg, 00mg hydroxyzine syrup 0mg/ 5ml hydroxyzine tab 0mg, 5mg, 50mg HYSINGLA ER TAB 0MG, 30MG 0MG, 60MG, 80MG, 00MG, 0MG I ibandronate inj 3mg/ 3ml 53 ibandronate tab 50mg 53 IBRANCE CAP 75MG, 7 00MG, 5MG ibuprofen cap 00mg* 3 ibuprofen chew tab 3 00mg* ibuprofen susp 00mg/ 5ml 3 (Rx Only) ibuprofen susp 0mg/ ml* 3 ibuprofen tab 00mg* 3 ibuprofen tab 00mg* 3 ibuprofen tab 00mg, 3 600mg, 800mg (Rx Only) ICLUSIG TAB 5MG, 7 5MG idarubicin inj mg/ ml 7 ifosfamide inj gm 5 ILARIS INJ 80MG ILEVRO OPHTH SUSP 7 0.3% ilotycin ophth ointment 69 5mg IMBRUVICA CAP 7 0MG imipenem/ cilastatin inj 3 50mg, 500mg imipramine pamoate cap 75mg, 00mg, 5mg, 50mg imipramine tab 0mg, 5mg, 50mg imiquimod cream 5% IMITREX NASAL 63 SPRAY 5MG, 0MG IMOVAX RABIES 78 (H.D.C.V) INJ INCRELEX INJ 0MG/ 5 ML INCRUSE ELLIPTA 9 INHALER 6.5MCG indapamide tab.5mg, 53.5mg INDOCIN SUSP 5MG/ 3 5ML indomethacin cap 5mg, 3 50mg indomethacin ER cap 75mg 3 INFANRIX INJ 76 INLYTA TAB MG, 5MG 7 INNOPRAN XL CAP 36 80MG, 0MG INSULIN SYRINGE 63 INSULIN SYRINGE (BD) 63 INTELENCE TAB 3 00MG, 00MG INTELENCE TAB 5MG 3 intralipid inj 0% 68 INTRON-A INJ UNIT, UNIT INTRON-A INJ UNIT, UNIT introvale tab 0 INVANZ INJ GM 3 INVEGA SUSTENNA INJ 30 39MG, 78MG, 7MG, 56MG, 3MG INVEGA TAB.5MG, 30 3MG, 6MG, 9MG INVIRASE CAP 00MG 3 INVIRASE TAB 500MG 3 IONOSOL-B/ D5W INJ 65 IONOSOL-MB/ D5W INJ 65 IOPIDINE OPHTH SOLN %, % IPOL INJ 78 98

111 ALPHABETICAL LISTING OF DRUGS ipratropium inhalation soln 9 0.0% ipratropium nasal spray %, 0.06% ipratropium/ albuterol soln mg/ 3ml irbesartan tab 75mg, 0 50mg, 300mg irbesartan/ hydrochlorothiazide tab 50-.5mg, mg IRENKA CAP 0MG IRESSA 50MG TAB 7 irinotecan inj 0mg/ ml 9 ISENTRESS CHEW TAB 3 00MG ISENTRESS CHEW TAB 3 5MG ISENTRESS POWDER 3 CK 00MG ISENTRESS TAB 00MG 3 ISOLYTE/ D5W INJ 65 ISOLYTE-S INJ 65 isoniazid inj 00mg/ ml isoniazid syrup 50mg/ 5ml isoniazid tab 00mg, 300mg isosorbide dinitrate ER tab 8 0mg ISOSORBIDE 8 DINITRATE TAB 30MG isosorbide dinitrate tab 8 5mg, 0mg, 0mg isosorbide mononitrate ER 8 tab 30mg, 60mg, 0mg isosorbide mononitrate tab 8 0mg, 0mg isradipine cap.5mg, 5mg 37 ISTALOL OPHTH SOLN % ISTODAX INJ 0MG 7 itraconazole cap 00mg 8 ivermectin tab 3mg 8 IXEMPRA INJ 5MG 9 IXIARO INJ 78 J JADENU 80MG TAB 7 JADENU 360MG TAB 7 JADENU 90MG TAB 7 JAKAFI TAB 5MG, 7 0MG, 5MG, 0MG, 5MG JALYN CAP MG 57 jantoven tab mg, mg, 0.5mg, 3mg, mg, 5mg, 6mg, 7.5mg, 0mg JANUMET TAB MG, MG JANUMET XR TAB MG, MG, MG JANUVIA TAB 5MG, 5 50MG, 00MG JARDIANCE TAB 0MG, 6 5MG JEVTANA INJ 60MG/ 9.5ML jinteli tab mg-5mcg 55 jolivette tab junel FE tab 0 junel FE tab 0 junel tab 0 JUXTAPID CAP 5MG, 0 0MG, 0MG, 30MG, 0MG, 60MG K KADCYLA INJ 00MG 5 KALETRA SOLN MG/ ML KALETRA TAB MG KALETRA TAB MG KALYDECO CKET 75 50MG, 75MG KALYDECO TAB 50MG 75 kariva tab 0 KCL 0.5%/ D5W/ NACL % KCL 0.3%/ D5W/ NACL % KCL/ D5W/ LR 0MEQ 65 kcl/ d5w/ nacl inj 65 kelnor tab 0 KENALOG INJ 0MG/ ML, 0MG/ ML KEPIVANCE INJ 6.5MG 8 ketoconazole 0mg/ ml 6 foam ketoconazole cream % 6 ketoconazole shampoo % 6 ketoconazole tab 00mg 8 ketoprofen cap 50mg, 3 75mg ketorolac inj 5mg/ ml, 3 30mg/ ml ketorolac ophth soln 0.%, 7 0.5% ketorolac tab 0mg 3 ketotifen fumarate ophth 7 soln 0.05%* KEYTRUDA 00MG/ 5 ML INJ KEYTRUDA IV SOLN 6 50MG KHEDEZLA TAB 50MG, 00MG kimidess 8 day pack 0 KINERET INJ 00MG/ 0.67ML kionex powder 36 klor-con 0meq ER cap 65 klor-con 8meq ER cap 66 KLOR-CON TAB 5MEQ 66 KOMBIGLYZE XR TAB MG,.5-000MG, 5-000MG KORLYM TAB 300MG 5 K-TAB 8MEQ, 0MEQ 65 KUVAN POWDER 5 CKET 500MG KUVAN TAB 00MG 5 KYNAMRO INJ 00MG/ 9 ML L labetalol inj 5mg/ ml 36 labetalol tab 00mg, 36 00mg, 300mg 99

112 ALPHABETICAL LISTING OF DRUGS LACRISERT OPHTH 68 INSERT lactated ringers irrigation 35 lactated ringers soln 65 lactic acid lotion 5%* 50 lactulose soln 0gm/ 5ml 6 LAMICTAL TAB STARTER KIT LAMICTAL XR KIT lamivudine soln 0mg/ ml 33 lamivudine tab 00mg 3 lamivudine tab 50mg, mg lamivudine/ zidovudine tab mg lamotrigine chew tab 5mg, 5mg lamotrigine ER tab 5mg, 50mg, 00mg, 00mg, 50mg, 300mg lamotrigine ODT 5mg, 50mg, 00mg, 00mg lamotrigine tab 5mg, 00mg, 50mg, 00mg LANCETS* 63 lansoprazole cap 5mg, 77 30mg lansoprazole/ amoxicillin/ 77 clarithromycin cap pack LANTUS INJ 6 LANTUS SOLOSTAR 6 PEN-INJECTOR larin FE tab 0 larin tab 0 latanoprost ophth soln % LATUDA TAB 0MG, 30 0MG, 60MG, 80MG, 0MG layolis FE 8 pack 0 LAZANDA NASAL 5 SPRAY 00MCG, 00MCG leena tab 0 leflunomide tab 0mg, 3 0mg LENVIMA THERAPY 7 CK 0MG, MG, 0MG, MG LESCOL XL TAB 80MG 0 lessina tab 0 LETAIRIS TAB 5MG, 38 0MG letrozole tab.5mg 6 leucovorin inj 00mg, 8 350mg leucovorin tab 5mg, 0mg, 8 5mg, 5mg LEUKERAN TAB MG 5 LEUKINE INJ 50MCG 59 leuprolide inj 5mg/ ml 6 levalbuterol conc.5mg/ 0 0.5ml levalbuterol neb 0.3mg/ 0 3ml, 0.63mg/ 3ml LEVEMIR FLEXTOUCH 6 INJ LEVEMIR INJ 6 LEVETIRACETAM 0MG/ ML INJ LEVETIRACETAM 5MG/ ML INJ LEVETIRACETAM 5MG/ ML INJ levetiracetam ER tab 500mg, 750mg levetiracetam inj 500mg/ 5ml levetiracetam soln 00mg/ ml levetiracetam tab 50mg, 500mg, 750mg, 000mg levobunolol ophth soln % levocarnitine inj 00mg/ ml 5 levocarnitine soln gm/ 5 0ml levocarnitine tab 330mg 5 levocetirizine 9 dihydrochloride tab 5mg levocetirizine soln.5mg/ 9 5ml levofloxacin 5mg/ ml 55 (50ml) inj levofloxacin inj 5mg/ ml 55 levofloxacin inj 5mg/ ml, mg/ 00ml levofloxacin ophth soln % levofloxacin soln 5mg/ ml 55 levofloxacin tab 50mg, mg, 750mg LEVOLEUCOVORIN INJ 8 0MG/ ML levonest tab 0 LEVONORGESTREL TAB 0.75MG* levonorgestrel tab.5mg* levonorgestrel/ ethinyl 0 estradiol tab levora-8 tab 0 LEVORPHANOL TAB 5 MG levothyroxine tab (all 76 strengths) levoxyl tab 5mcg, 50mcg, 76 75mcg, 88mcg, 00mcg, mcg, 5mcg, 37mcg, 50mcg, 75mcg, 00mcg LEXIVA SUSP 50MG/ 33 ML LEXIVA TAB 700MG 33 LIALDA TAB.GM 56 lice shampoo* 5 lidocaine gel % 5 lidocaine inj 0.5%, % 6 lidocaine ointment 5% 5 lidocaine patch 5% 5 lidocaine soln % 5 lidocaine viscous soln % 66 lidocaine/ prilocaine cream % LINCOCIN INJ 300MG/ 3 ML lindane lotion % 5 lindane shampoo % 5 linezolid 0mg/ ml susp 3 linezolid inj mg/ ml 3 00

113 ALPHABETICAL LISTING OF DRUGS linezolid tab 600mg 3 LINZESS CAP 5MCG, 56 90MCG liothyronine inj 0mcg/ ml 76 liothyronine tab 5mcg, 76 5mcg, 50mcg lisinopril tab.5mg, 5mg, 0 0mg, 0mg, 30mg, 0mg lisinopril/ hydrochlorothiazide tab 0-.5mg, 0-.5mg, 0-5mg lithium carbonate cap 30 50mg, 300mg, 600mg lithium carbonate ER tab mg, 50mg lithium carbonate tab mg lithium citrate soln 8meq/ 30 5ml LITHOSTAT TAB 50MG 57 LOCOID LOTION 0.% 9 LOHIST-D LIQUID 3-30MG/ 5ML* lokara lotion 0.05% 50 lomedia FE tab 0 LOMUSTINE CAP 0MG, 5 0MG, 00MG LONSURF 5-6.MG 7 TAB LONSURF 0-8.9MG 7 TAB loperamide cap mg 7 loperamide liquid mg/ 7 5ml* loperamide liquid mg/ 7 7.5ml* loperamide tab mg* 7 lopreeza tab mg, mg LORATADINE ODT 9 5MG* loratadine 9 rapidly-disintegrating tab 0mg* loratadine syrup 5mg/ 5ml* 9 loratadine tab 0mg* 9 loratadine/ 3 pseudoephedrine SR tab (hr) 5-0mg* loratadine/ 3 pseudoephedrine SR tab (hr) 0-0mg* lorazepam conc mg/ ml 8 lorazepam tab 0.5mg, mg, 8 mg loryna tab 0 losartan tab 5mg, 50mg, 0 00mg losartan/ hydrochlorothiazide tab 50-.5mg, 00-.5mg, 00-5mg LOTEMAX OPHTH GEL % LOTEMAX OPHTH 70 OINTMENT 0.5% LOTEMAX OPHTH SUSP % lovastatin tab 0mg, 0mg, 0 0mg loxapine cap 5mg, 0mg, 3 5mg, 50mg LUMIGAN OPHTH 7 SOLN 0.0% LUMIZYME INJ 50MG 5 LUPRON DEPOT INJ MG, 7.5MG,.5MG,.5MG, 30MG, 5MG LUPRON DEPOT 5 PEDIATRIC INJ.5MG, 5MG lutera tab 0 LYNRZA CAP 50MG 7 LYRICA CAP 5MG, 50MG, 75MG, 00MG, 50MG, 00MG, 5MG, 300MG LYRICA SOLN 0MG/ ML LYSODREN TAB 500MG 6 lyza tab M MACRODANTIN CAP 77 5MG magnesium citrate soln* 6 magnesium hydroxide susp 6 00mg/ 5ml* magnesium oxide tab 8 50mg* magnesium oxide tab 8 50mg* magnesium oxide tab 8 00mg* magnesium oxide tab 8 00mg* magnesium oxide tab 8 0mg* magnesium oxide tab mg* magnesium sulfate inj 50% 65 magnesium tab 00mg* 65 magnesium tab 00mg* 65 magnesium tab 50mg* 65 malathion lotion 0.5% 5 maprotiline tab 5mg, 3 50mg, 75mg marlissa tab 0 MARPLAN TAB 0MG 3 MATULANE CAP 50MG 8 matzim LA tab 80mg, 37 0mg, 300mg, 360mg, 0mg MAXIDEX OPHTH SUSP 70 0.% meclizine chew tab 5mg* 7 meclizine tab.5mg, 7 5mg (Rx Only) MECLOFENAMATE 3 SODIUM CAP 50MG, 00MG MEDROL TAB MG, MG, 8MG, 6MG, 3MG medroxyprogesterone inj 50mg/ ml medroxyprogesterone tab 73.5mg, 5mg, 0mg 0

114 ALPHABETICAL LISTING OF DRUGS mefenamic acid cap 50mg 3 mefloquine tab 50mg megestrol acetate susp 6 0mg/ ml megestrol acetate tab 6 0mg, 0mg MEKINIST TAB 0.5MG, 7 MG meloxicam susp 7.5mg/ 5ml 3 meloxicam tab 7.5mg, 3 5mg melphalan inj 50mg 5 memantine 0mg tab 73 memantine 0mg/ 73 memantine 5mg pack memantine mg/ ml soln 73 memantine 5mg tab 73 MENACTRA INJ 78 MENOMUNE A-C-Y-W 78 INJ MENVEO INJ 78 meperitab tab 00mg 5 meperitab tab 50mg 5 MEPHYTON TAB 5MG* 80 meprobamate tab 00mg, 8 00mg mercaptopurine tab 50mg 5 meropenem inj 500mg 3 mesalamine kit gm 56 mesna inj 00mg/ ml 8 MESNEX TAB 00MG 8 MESTINON TIMESN TAB 80MG METAMUCIL PLUS 6 CALCIUM CAP* METAMUCIL WAFER* 60 METAPROTERENOL 0 SYRUP 0MG/ 5ML METAXALONE TAB 67 00MG metaxalone tab 800mg 67 metformin 500mg er tab 5 metformin 750mg er tab 5 metformin tab 500mg, 5 850mg, 000mg methadone soln 0mg/ 5ml 5 methadone soln 5mg/ 5ml 5 methadone tab 5mg, 0mg 5 methamphetamine tab 5mg methazolamide tab 5mg, 5 50mg methenamine hippurate tab 77 gm methimazole tab 5mg, 76 0mg methocarbamol tab 500mg, mg methotrexate inj 5mg/ ml, 5 50mg/ ml methotrexate tab.5mg 5 methoxsalen cap 0mg 8 methscopolamine tab 76.5mg, 5mg METHYCLOTHIAZIDE 53 TAB 5MG methyldopa tab 50mg, 500mg methyldopa/ hydrochlorothiazide tab 50-5mg, 50-5mg methylergonovine tab 7 0.mg methylphenidate chew tab.5mg, 5mg, 0mg methylphenidate ER cap 0mg, 0mg, 30mg, 0mg, 50mg, 60mg methylphenidate ER tab 0mg, 0mg METHYLPHENIDATE ER TAB 8MG, 7MG, 36MG, 5MG methylphenidate soln 5mg/ 5ml, 0mg/ 5ml methylphenidate tab 5mg, 0mg, 0mg methylprednisolone inj 0mg/ ml, 80mg/ ml methylprednisolone sodium succinate inj 0mg, 5mg methylprednisolone tab mg, 8mg, 6mg, 3mg methylprednisolone tab dose pak mg metipranolol ophth soln % metoclopramide inj 5mg/ 56 ml metoclopramide soln 5mg/ 56 5ml metoclopramide tab 5mg, 56 0mg metolazone tab.5mg, 53 5mg, 0mg metoprolol ER tab 5mg, 36 50mg, 00mg, 00mg metoprolol tab 5mg, 36 50mg, 00mg metoprolol tartrate inj 36 mg/ ml metoprolol/ hydrochlorothiazide tab 50-5mg, 00-5mg, 00-50mg metronidazole cap 375mg metronidazole cream % metronidazole gel 0.75%, 5 % metronidazole lotion 0.75% 5 metronidazole tab 50mg, 500mg metronidazole vaginal gel % metronidazole/ nacl inj 500mg/ 00ml mexiletine cap 50mg, 9 00mg, 50mg MIACALCIN INJ 53 00UNIT/ ML miconazole nitrate cream 6 %* miconazole nitrate powder 6 %* miconazole nitrate vaginal 79 cream %* miconazole nitrate vaginal 79 cream %* 0

115 ALPHABETICAL LISTING OF DRUGS miconazole nitrate vaginal 79 kit* miconazole nitrate vaginal 79 supp 00mg* miconazole nitrate vaginal 79 supp 00mg/ % cream kit* miconazole nitrate vaginal 79 supp 00mg/ % cream 9 gm kit* microgestin FE tab 0 microgestin tab 0 midodrine tab.5mg, 5mg, 79 0mg mimvey LO tab mg 55 mimvey tab -0.5mg 55 MINERAL OIL (BULK)* 6 mineral oil enema* 6 MINERAL OIL LIGHT 6 (BULK)* MINERAL OIL* 6 minitran patch 0.mg, 8 0.mg, 0.mg, 0.6mg minocycline cap 50mg, 76 75mg, 00mg minocycline tab 50mg, 76 75mg, 00mg minoxidil tab.5mg, 0mg mirtazapine ODT 5mg, 3 30mg, 5mg mirtazapine tab 7.5mg, 3 5mg, 30mg, 5mg misoprostol tab 00mcg, 77 00mcg MITIGARE 0.6MG CAP 58 mitomycin inj 0mg 7 mitoxantrone inj mg/ ml 7 M-M-R II WITH 78 DILUENT INJ MOBIC SUSP 7.5MG/ 3 5ML modafinil tab 00mg, 00mg moderiba tab 00mg 3 MODERIBA TAB DOSE 3 CK moexipril tab 7.5mg, 5mg 0 moexipril/ hydrochlorothiazide tab mg, 5-.5mg, 5-5mg MOLINDONE 0MG 3 TAB MOLINDONE 5MG 3 TAB MOLINDONE 5MG TAB 3 mometasone furoate cream 50 0.% mometasone furoate lotion 50 0.% mometasone furoate 50 ointment 0.% mononessa tab 0 montelukast chew tab mg, 9 5mg montelukast granules mg 9 montelukast tab 0mg 9 morphine sulfate conc soln 5 0mg/ ml morphine sulfate ER beads 5 30mg, 5mg, 60mg, 75mg, 90mg, 0mg morphine sulfate ER cap 5 0mg, 0mg, 30mg, 50mg, 60mg, 80mg, 00mg morphine sulfate ER tab 5 5mg, 30mg, 60mg, 00mg, 00mg MORPHINE SULFATE 5 PF INJ MG/ ML, MG/ ML, 8MG/ ML, 0MG/ ML morphine sulfate soln 5 0mg/ 5ml morphine sulfate soln 5 0mg/ 5ml morphine sulfate tab 5mg, 5 30mg MOVANTIK TAB 56.5MG, 5MG MOVIPREP SOLN 6 MOXEZA OPHTH SOLN % MOXIFLOXACIN.6MG/ 55 ML INJ moxifloxacin tab 00mg 55 MOZOBIL INJ 0MG/ 59 ML MULTAQ TAB 00MG 9 multiple vitamin tab* 66 multiple vitamins w/ 66 minerals tab* mupirocin cream % 6 mupirocin ointment % 6 MUSTARGEN INJ 0MG 5 MYCAMINE INJ 50MG, 8 00MG mycophenolate cap 50mg 35 mycophenolate mofetil susp 35 00mg/ ml mycophenolate sodium tab 35 80mg, 360mg mycophenolate tab 500mg 35 myorisan cap 0mg, 0mg, 6 0mg MYOZYME INJ 50MG 5 MYRBETRIQ ER TAB 77 5MG, 50MG N nabumetone tab 500mg, 3 750mg nadolol tab 0mg, 0mg, 36 80mg nadolol/ bendroflumethiazide tab 0-5mg, 80-5mg nafcillin inj gm, 0gm 73 NAFCILLIN/ DEXTROSE 73 INJ GM/ 50ML naftifine cream % 6 NAFTIN CREAM % 6 NAFTIN GEL %, % 6 NAGLAZYME INJ MG/ 5 ML NALOXONE INJ MG/ 7 ML naltrexone tab 50mg 7 03

116 ALPHABETICAL LISTING OF DRUGS NAMENDA SOLN MG/ 7 ML NAMENDA TAB 5MG, 7 0MG NAMENDA TAB 7 TITRATION K NAMENDA XR CAP 7 7MG, MG, MG, 8MG NAMENDA XR CK 7 naphazoline w/ 70 pheniramine ophth soln %* naphazoline w/ 70 pheniramine ophth soln %* NAPHAZOLINE/ 70 GLYCERIN OPHTH SOLN %* naproxen DR tab 375mg, 3 500mg naproxen sodium tab 3 75mg, 550mg NAPROXEN SUSP 3 5MG/ 5ML naproxen tab 50mg, 3 375mg, 500mg naratriptan tab mg,.5mg 63 NASONEX NASAL 67 SPRAY 50MCG NATACYN OPHTH SUSP 69 5% NATAZIA TAB 0 nateglinide tab 60mg, 6 0mg NATRA INJ 5MCG, 53 50MCG, 75MCG, 00MCG NEBUPENT NEB 300MG necon tab 0 NEFAZODONE TAB 3 00MG, 50MG, 00MG nefazodone tab 50mg, 3 50mg neomycin tab 500mg neomycin/ bacitracin/ 69 polymyxin ophth ointment 5(3.5)mg-00unit-0000uni t neomycin/ polymyxin B 57 irrigation soln 0/ ml neomycin/ polymyxin/ 70 bacitracin/ hydrocortisone ophth ointment % neomycin/ polymyxin/ 70 dexamethasone ophth ointment 0.% neomycin/ polymyxin/ 70 dexamethasone ophth soln 0.% neomycin/ polymyxin/ 69 gramicidin ophth soln.75mg-0000unit-0.05m g neomycin/ polymyxin/ 70 hydrocortisone ophth susp % neomycin/ polymyxin/ 7 hydrocortisone otic soln % neomycin/ polymyxin/ 7 hydrocortisone otic susp % NEPHRAMINE INJ 5.% 68 NEULASTA INJ 6MG/ ML NEUPOGEN INJ MCG/ ML, 600MCG/ ML NEUPRO TCH MG, 9 MG, 3MG, MG, 6MG, 8MG NEVANAC OPHTH SUSP 7 0.% nevirapine 00mg ER tab 33 nevirapine ER tab 00mg 33 NEVIRAPINE SUSP 33 50MG/ 5ML nevirapine tab 00mg 33 NEXAVAR TAB 00MG 7 NEXTERONE INJ 9 50MG/ 00ML, 360MG/ 00ML niacin CR cap 50mg* 80 niacin CR cap 500mg* 80 NIACIN CR TAB MG* niacin CR tab 50mg* 80 niacin CR tab 500mg* 80 niacin CR tab 750mg* 80 niacin ER cap 5mg* 80 niacin ER cap 00mg* 80 niacin tab 00mg* 80 niacin tab 50mg* 80 niacin tab 500mg* 80 niacin tab 50mg* 80 NIACOR TAB 500MG 0 NIASN ER TAB 0 500MG, 750MG, 000MG nicardipine cap 0mg, 37 30mg nicardipine inj.5mg/ ml 37 nicotine lozenge mg* 75 nicotine lozenge mg* 75 nicotine patch mg/ hr* 75 nicotine patch mg/ hr* 75 nicotine patch 7mg/ hr* 75 NICOTINE TCH KIT* 75 nicotine polacrilex gum 75 mg* nicotine polacrilex gum 75 mg* NICOTROL INHALER 75 0MG NICOTROL NASAL 75 SPRAY 0MG/ ML nifedical XL tab 30mg, 37 60mg nifedipine cap 0mg, 0mg 37 nifedipine ER tab 30mg, 37 60mg, 90mg nikki tab 0 NILANDRON TAB 6 50MG nimodipine cap 30mg 37 NINLARO.3MG CAP 7 0

117 ALPHABETICAL LISTING OF DRUGS NINLARO 3MG CAP 7 NINLARO MG CAP 7 nisoldipine ER tab 8.5mg, 37 7mg, 0mg, 30mg, 3mg, 0mg NITRO-DUR TCH 8 0.3MG, 0.8MG nitrofurantoin macro 5mg 77 cap nitrofurantoin macro 77 5mg/ nitrofurantoin mono 75mg cap nitrofurantoin macro cap 77 00mg nitrofurantoin macro cap 77 50mg nitrofurantoin mono cap 77 00mg nitrofurantoin susp 5mg/ 77 5ml nitroglycerin mucosal 8 spray 0.mg nitroglycerin patch 0.mg, 8 0.mg, 0.mg, 0.6mg NITROSTAT SL TAB 8 0.3MG, 0.MG, 0.6MG nizatidine cap 50mg, mg nizatidine soln 5mg/ ml 77 NONOXYNOL-9 FILM 78 8%* NONOXYNOL-9 FOAM 78.5%* NONOXYNOL-9 GEL % 79 * NONOXYNOL-9 GEL 3% 79 * NONOXYNOL-9 GEL % 79 * NONOXYNOL-9 79 VAGINAL SUPP 00MG* nora-be tab NORDITROPIN 53 FLEXPRO INJ 5MG/.5ML, 0MG/.5ML, 5MG/.5ML NORDITROPIN 53 NORDIFLEX PEN 30MG/ 3ML noreth/ ferrous fumarate/ 0 ethinyl estradiol chew tab norethindrone ace-ethinyl 0 estradiol-fe tab norethindrone acetate tab 73 5mg norethindrone acetate/ 55 ethinyl estradiol tab 0.5mg-.5mcg, mg-5mcg norethindrone tab norlyroc tab normosol-m/ dextrose inj 65 NORMOSOL-R INJ 65 NORMOSOL-R/ 65 DEXTROSE INJ NORCE CR CAP 9 00MG, 50MG NORTHERA CAP 79 00MG, 00MG, 300MG nortrel tab 0 nortriptyline cap 0mg, 5mg, 50mg, 75mg nortriptyline soln 0mg/ 5ml NORVIR CAP 00MG 33 NORVIR SOLN 80MG/ 33 ML NORVIR TAB 00MG 33 NOVOFINE/ 63 NOVOTWIST/ PEN NEEDLE NOVOLIN 70/ 30 INJ 6 NOVOLIN N INJ 6 NOVOLIN R INJ 6 NOVOLOG FLEXPEN 6 INJ NOVOLOG INJ 6 NOVOLOG MIX 6 FLEXPEN INJ NOVOLOG MIX INJ 6 NOVOLOG PENFILL INJ 6 NOXAFIL SUSP 0MG/ 8 ML NOXAFIL TAB 00MG 8 NUCYNTA ER TAB 5 50MG, 00MG, 50MG, 00MG, 50MG NUEDEXTA CAP 7 0-0MG NULOJIX INJ 50MG 35 nutrilipid inj 0% 68 NUTRITIONAL 5 SUPPLEMENT FLAVOR CK* NUTRITIONAL 5 SUPPLEMENT LIQUID* NUTRITIONAL 5 SUPPLEMENT CK* NUTRITIONAL 5 SUPPLEMENT POWDER* NUVARING VAGINAL RING NUVIGIL TAB 50MG, 50MG, 00MG, 50MG nystatin cream 00000unit 6 nystatin ointment unit nystatin susp 00000unit/ 66 ml nystatin tab unit 8 nystatin topical powder unit nystatin/ triamcinolone 7 cream unit/ gm-% nystatin/ triamcinolone 7 ointment unit/ gm-% O ocella tab 0 OCTAGAM INJ GM/ 7 0ML, 5GM/ 500ML octreotide inj 50mcg, 5 00mcg, 00mcg, 500mcg, 000mg ODOMZO 00MG CAP 6 OFEV CAP 00MG, 75 50MG 05

118 ALPHABETICAL LISTING OF DRUGS ofloxacin ophth soln 0.3% 69 ofloxacin otic soln 0.3% 7 ofloxacin tab 00mg 55 olanzapine inj 0mg 3 olanzapine ODT 5mg, 3 0mg, 5mg, 0mg olanzapine tab.5mg, 5mg, 3 7.5mg, 0mg, 5mg, 0mg olanzapine/ fluoxetine cap 7 3-5mg, 6-5mg, 6-50mg, -5mg, -50mg olopatadine 0.6% nasal 67 inhaler olopatadine mg/ ml ophth 7 soln omega-3 acid ethyl esters 9 cap gm omega-3 fatty acids cap mg* omega-3 fatty acids cap 68 00mg* omeprazole cap 0mg, 77 0mg, 0mg ONCASR INJ 8 750UNIT/ ML ondansetron mg/ ml syr 7 ondansetron inj mg/ ml 7 ondansetron ODT mg, 7 8mg ondansetron soln mg/ 5ml 7 ondansetron tab mg, 8mg, 7 mg ONFI SUSP.5MG/ ML ONFI TAB 0MG, 0MG ONGLYZA TAB.5MG, 5 5MG OPDIVO INJ 0MG/ ML 6 OPSUMIT TAB 0MG 38 oral electrolyte solution* 65 ORAP TAB MG, MG 7 ORENCIA INJ 50MG 3 ORENCIA SC INJ 3 5MG/ ML ORFADIN CAP MG, 5 5MG, 0MG orphenadrine citrate inj 67 30mg/ ml orphenadrine ER tab 67 00mg orsythia tab 0 ORTHO-TRI CYCLEN 0 LO TAB OTEZLA 8-DAY 3 STARTER CK OTEZLA TAB 30MG 3 OTEZLA TAB STARTER 3 CK oxacillin inj gm, 0gm 73 OXACILLIN/ 73 DEXTROSE INJ GM/ 50ML, GM/ 50ML oxaliplatin inj 00mg/ 5 0ml oxandrolone tab.5mg, 6 0mg oxaprozin tab 600mg 3 oxazepam cap 0mg, 5mg, 8 30mg oxcarbazepine oral susp 300mg/ 5ml oxcarbazepine tab 50mg, 300mg, 600mg OXISTAT CREAM % 7 OXISTAT LOTION % 7 OXTELLAR XR TAB 50MG, 300MG, 600MG oxybutynin ER tab 5mg, 77 0mg, 5mg oxybutynin syrup 5mg/ 5ml 77 oxybutynin tab 5mg 77 oxycodone cap 5mg 5 oxycodone conc 00mg/ 5 5ml oxycodone soln 5mg/ 5ml 5 oxycodone tab 0mg, 5 5mg, 0mg, 30mg oxycodone tab 5mg 5 oxycodone/ acetaminophen 6 tab.5-35mg, 5-35mg, mg, 0-35mg oxycodone/ aspirin tab mg oxycodone/ ibuprofen tab mg OXYCONTIN TAB 5 0MG, 5MG, 0MG, 30MG, 0MG, 60MG OXYCONTIN TAB 80MG 5 oxymorphone ER tab 5mg, 6 7.5mg, 0mg, 5mg, 0mg, 30mg, 0mg oxymorphone tab 5mg, 6 0mg oyster shell calcium tab mg* P paclitaxel inj 6mg/ ml 9 paliperidone.5mg ER tab 30 paliperidone 3mg ER tab 30 paliperidone 6mg ER tab 30 paliperidone 9mg ER tab 30 pamidronate inj 3mg/ ml, 53 9mg/ ml MIDRONATE INJ 53 6MG/ ML NCREAZE CAP (ALL 5 STRENGTHS) NRETIN GEL % 7 pantoprazole tab 0mg, 77 0mg paricalcitol cap mcg, 5 mcg, mcg RICALCITOL INJ 5 MCG/ ML paromomycin cap 50mg paroxetine ER tab.5mg, 5mg, 37.5mg paroxetine tab 0mg, 0mg, 30mg, 0mg SER GRANULE GM TADAY OPHTH 7 SOLN 0.% TANASE NASAL 67 SPRAY 0.6% XIL SUSP 0MG/ 5ML 06

119 ALPHABETICAL LISTING OF DRUGS pediatric multiple vitamin 66 w/ vitamin C soln 35mg/ ml* pediatric multiple vitamins 66 w/ iron drops 0mg/ ml* pediatric vitamins adc 66 drops 500unit-00unit-35mg/ ml* PEDVAX HIB INJ 78 peg 3350/ electrolyte soln 6 peg 3350/ kcl/ sodium 6 bicarbonate/ sodium chloride soln PEGANONE TAB 50MG 3 PEGASYS INJ 80MCG/ 3 0.5ML, 80MCG/ ML PEGASYS PROCLICK 3 INJ 35MCG/ 0.5ML, 80MCG/ 0.5ML PEG-INTRON INJ (ALL 3 STRENGTHS) penicillin g potassium inj unit PENICILLIN G/ 7 DEXTROSE INJ 0000UNIT, 60000UNIT PENICILLIN G/ 7 PROCAINE INJ UNIT PENICILLIN G/ SODIUM 7 INJ UNIT penicillin v potassium soln 7 5mg/ 5ml, 50mg/ 5ml penicillin v potassium tab 7 50mg, 500mg PENNSAID SOLN % 7 PENTAM INJ 300MG PENTASA CAP 50MG, MG pentazocine/ naloxone tab mg pentoxifylline ER tab 58 00mg perindopril tab mg, mg, 0 8mg periogard soln 0.% 66 PERJETA INJ 30MG/ ML 6 permethrin aerosol 0.5%* 5 permethrin cream 5% 5 permethrin creme rinse % 5 * permethrin lotion %* 5 permethrin spray/ 5 pyrethins-piperonyl butoxide shampoo kit* perphenazine tab mg, 3 mg, 8mg, 6mg perphenazine/ amitriptyline 7 tab -0mg, -5mg, -0mg, -5mg, -50mg PEXEVA TAB 0MG, 0MG, 30MG, 0MG phenazopyridine tab 57 95mg* phenazopyridine tab mg* phenazopyridine tab mg* phenelzine tab 5mg 3 phenobarbital elixir 0mg/ 60 5ml phenobarbital tab 5mg, 60 6.mg, 30mg, 3.mg, 60mg, 6.8mg, 97.mg, 00mg phenoxybenzamine 0mg 0 cap phentermine cap 5mg* phentermine cap 30mg* phentermine cap 37.5mg* phentermine tab 37.5mg* phenylephrine w/ DM 3 liquid mg/ 5ml* phenylephrine w/ DM 3 liquid mg/ 5ml* phenylephrine w/ DM 3 liquid mg/ 5ml* phenylephrine w/ DM 3 liquid mg/ 5ml* phenylephrine w/ DM 3 liquid mg/ ml* phenylephrine w/ DM liquid mg/ 5ml* phenylephrine w/ DM liquid mg/ ml* phenylephrine w/ DM syrup mg/ 5ml* phenylephrine w/ DM-gg liquid mg/ 5ml* phenylephrine w/ DM-gg liquid mg/ 5ml* phenylephrine/ brompheniramine/ DM elixir.5--5mg/ 5ml* phenylephrine/ brompheniramine/ DM liquid 0--0mg/ 5ml* phenylephrine/ brompheniramine/ DM liquid.5--5mg/ 5ml* phenylephrine/ brompheniramine/ DM liquid mg/ 5ml* PHENYLEPHRINE/ CHLORPHEN/ DM LIQUID MG/ ML* PHENYLEPHRINE/ CHLORPHEN/ DM LIQUID 0--.5MG/ 5ML* phenylephrine/ chlorphen/ DM liquid 0--5mg/ 5ml* PHENYLEPHRINE/ CHLORPHEN/ DM SYRUP 0--0MG/ 5ML* PHENYLEPHRINE/ CHLORPHEN/ DM SYRUP 5--0MG/ 5ML* phenylephrine/ guaifenesin liquid.5-00mg/ 5ml* phenylephrine/ guaifenesin liquid 5-00mg/ 5ml*

120 ALPHABETICAL LISTING OF DRUGS PHENYLEPHRINE/ GUAIFENESIN SYRUP.5-50MG/ 5ML* PHENYLEPHRINE/ GUAIFENESIN SYRUP 5-00MG/ 5ML* phenylephrine/ guaifenesin tab 0-380mg* phenylephrine/ guaifenesin tab 0-00mg* phenylephrine/ guaifenesin tab 5-00mg* PHENYLEPHRINE/ PROMETHAZINE W/ CODEINE SYRUP MG/ 5ML* phenytoin cap 00mg 3 phenytoin chew tab 50mg 3 phenytoin inj 50mg/ ml 3 phenytoin susp 5mg/ 5ml 3 PHOSLYRA SOLN MG/ 5ML PHOSPHOLINE IODIDE 69 OPHTH SOLN 0.5% physiolyte irrigation soln 36 physiosol irrigation soln 36 phytonadione tab 00mcg* 80 PICATO GEL 0.05% 7 PICATO GEL 0.05% 7 pilocarpine ophth soln %, 69 %, % pilocarpine tab 5mg, 7.5mg 66 pimozide mg tab 7 pimozide mg tab 75 pimtrea tab 0 pindolol tab 5mg, 0mg 36 pioglitazone tab 5mg, 6 30mg, 5mg pioglitazone/ glimepiride 5 tab 30-mg, 30-mg pioglitazone/ metformin tab mg, 5-850mg piperacillin/ tazobactam inj mg, -0.5mg pirmella tab 0 piroxicam cap 0mg, 0mg 3 PLASMA-LYTE INJ 65 PLASMA-LYTE/ D5W 65 INJ plenamine 5% inj 68 podofilox soln 0.5% 50 polyethylene glycol oral packet* polyethylene glycol powder polymyxin B sulfate inj unit polymyxin B/ trimethoprim 70 ophth soln 0000unit/ ml-0.% polyvinyl alcohol ophth 68 soln.%* POMALYST CAP MG, 6 MG, 3MG, MG portia-8 tab 0 potassium chloride ER cap 66 8meq, 0meq potassium chloride ER tab 66 8meq, 0meq, 0meq potassium chloride inj 66 meq potassium chloride liquid 66 0meq/ 5ml, 0meq/ 5ml potassium chloride/ d5w inj %, 0.5%, 0.3% potassium chloride/ nacl 65 inj % potassium citrate CR tab 57 5meq, 0meq, 5meq POTIGA TAB 50MG, 00MG, 300MG, 00MG povidone/ iodine soln 7.5% 3 * POVIDONE-IODINE 3 D 0%* povidone-iodine soln 0%* 3 PRADAXA 0MG CAP PRADAXA CAP 75MG, 50MG pramipexole 0.375mg ER 9 tab pramipexole 0.75mg ER 9 tab pramipexole.5mg ER tab 9 pramipexole.5mg ER 9 tab pramipexole 3mg ER tab 30 pramipexole.5mg ER tab 30 pramipexole tab 0.5mg, mg, 0.5mg, 0.75mg, mg,.5mg pravastatin tab 0mg, 0 0mg, 0mg, 80mg prazosin cap mg, mg, 5mg PRED MILD OPHTH 70 SUSP 0.% PRED-G OPHTH SUSP % prednicarbate cream 0.% 50 prednicarbate ointment 50 0.% prednisolone ODT 0mg, 5mg, 30mg prednisolone ophth soln 70 % prednisolone sodium 70 phosphate ophth soln % prednisolone sodium phosphate soln 6.7mg/ 5ml, 5mg/ 5ml PREDNISONE INTENSOL CONC 5MG/ ML prednisone soln 5mg/ 5ml prednisone tab mg,.5mg, 5mg, 0mg, 0mg, 50mg PREMARIN TAB 0.3MG, MG, 0.65MG, 0.9MG,.5MG PREMARIN VAGINAL 79 CREAM 0.65MG/ GM PREMASOL SOLN 0% 68 premasol soln 6% 68 PREMPHASE TAB MG 08

121 ALPHABETICAL LISTING OF DRUGS PREMPRO TAB (ALL 55 STRENGTHS) PRENATAL VITAMIN 66 (OTC)* PRENATAL VITAMINS 66 PRENATAL VITAMINS 66 W/ IRON (OTC)* previfem tab 0 PREZCOBIX TAB MG PREZISTA SUSP 00MG/ 33 ML PREZISTA TAB 600MG, MG PREZISTA TAB 75MG, 33 50MG PRIFTIN 50MG TAB PRIMAQUINE TAB 6.3MG primidone tab 50mg, 50mg PRISTIQ TAB 5MG, 50MG, 00MG PRIVIGEN INJ 0GM/ 7 00ML probenecid tab 500mg 58 procainamide inj 00mg/ 9 ml, 500mg/ ml PROCALAMINE INJ 3% 68 prochlorperazine inj 5mg/ 3 ml prochlorperazine supp 3 5mg prochlorperazine tab 5mg, 3 0mg procto-pak rectal cream 7 % proctozone-hc cream 7.5% progesterone cap 00mg, 73 00mg PROGLYCEM SUSP 5 50MG/ ML PROGRAF INJ 5MG/ ML 35 PROLASTIN-C INJ MG PROLEUKINE IV SOLN UNIT PROLIA SOLN 60MG/ 53 ML PROMACTA TAB 59.5MG, 5MG, 50MG, 75MG promethazine inj 5mg/ ml, 9 50mg/ ml promethazine supp.5mg, 9 5mg, 50mg promethazine syrup 9 6.5mg/ 5ml promethazine tab.5mg, 9 5mg, 50mg PROMETHAZINE VC 9 SYRUP 6.5-5MG/ 5ML promethazine w/ codeine syrup 6.5-0mg/ 5ml* promethazine/ DM syrup 6.5-5mg/ 5ml* propafenone ER cap 9 5mg, 35mg, 5mg propafenone tab 50mg, 9 5mg, 300mg PRONTHELINE TAB 76 5MG proparacaine ophth soln % propranolol ER cap 60mg, 36 80mg, 0mg, 60mg propranolol inj mg/ ml 36 propranolol oral soln 36 0mg/ 5ml, 0mg/ 5ml propranolol tab 0mg, 36 0mg, 0mg, 60mg, 80mg propranolol/ hydrochlorothiazide tab 0-5mg, 80-5mg propylthiouracil tab 50mg 76 PROQUAD INJ 78 PROSOL INJ 0% 68 protriptyline tab 5mg, 0mg prudoxin cream 5% 7 pseudoeph/ doxylamine/ DM w/ acetaminophen liquid mg/ 30ml* pseudoephed/ bromphen/ DM elixir 5--5mg/ 5ml* pseudoephed/ bromphen/ DM syrup 30--0mg/ 5ml* pseudoephed/ chlorphen/ DM liquid 5--5mg/ 5ml* pseudoephed/ chlorphen/ DM liquid mg/ 5ml* pseudoephedrine liquid 5mg/ 5ml* pseudoephedrine SR tab (hr) 0mg* PSEUDOEPHEDRINE SR TAB (HR) 0MG* pseudoephedrine tab 30mg* pseudoephedrine tab 60mg* pseudoephedrine w/ DM liquid mg/ 5ml* pseudoephedrine w/ DM liquid mg/ 5ml* PSEUDOEPHEDRINE W/ DM TAB MG* PSEUDOEPHEDRINE W/ DM TAB MG* PSEUDOEPHEDRINE W/ DM TAB MG* PSEUDOEPHEDRINE W/ DM TAB MG* PSEUDOEPHEDRINE/ GUAIFENESIN LIQUID MG/ ML* PSEUDOEPHEDRINE/ GUAIFENESIN SR TAB (HR) 0-00MG* PSEUDOEPHEDRINE/ GUAIFENESIN SR TAB (HR) MG*

122 ALPHABETICAL LISTING OF DRUGS pseudoephedrine/ 5 guaifenesin syrup 30-00mg/ 5ml* pseudoephedrine/ 5 guaifenesin tab 0-00mg* pseudoephedrine/ 5 guaifenesin tab 60-00mg* PSORCON 0.05% 50 CREAM psyllium cap 0.5gm* 60 psyllium powder 00%* 60 psyllium powder 8.3%* 60 psyllium powder 30%* 60 psyllium powder 30.9%* 60 psyllium powder 33%* 60 psyllium powder 8.57%* 60 psyllium powder 9%* 6 PSYLLIUM POWDER 6 5.3%* PSYLLIUM POWDER %* psyllium powder 58.6%* 6 PSYLLIUM POWDER %* PSYLLIUM POWDER 6 63%* psyllium powder 68%* 6 PSYLLIUM POWDER %* PSYLLIUM POWDER 6 9%* psyllium powder 95%* 6 PSYLLIUM POWDER 6 CKET 00%* PSYLLIUM POWDER 6 CKET 8%* PSYLLIUM POWDER 6 CKET 8.3%* PSYLLIUM POWDER 6 CKET 58.%* PSYLLIUM POWDER 6 CKET 58.6%* PSYLLIUM POWDER 6 CKET 60.3%* PSYLLIUM POWDER 6 CKET 95%* PULMICORT NEB MG/ 0 ML PULMOZYME SOLN 75 MG/ ML PURIXAN SUSP 0MG/ 5 ML PYLERA CAP MG pyrazinamide tab 500mg pyrethrins/ piperonyl 5 butoxide liquid 0.33-%* pyrethrins/ piperonyl 5 butoxide shampoo 0.33-% * PYRETHRINS/ 5 PIPERONYL BUTOXIDE SHAMPOO KIT 0.33-%* pyrethrins-piperonyl 5 butoxide liq 0.3-3%* pyridostigmine bromide 80mg ER tab pyridostigmine tab 60mg pyridoxine CR tab 00mg* 80 pyridoxine tab 00mg* 80 pyridoxine tab 00mg* 80 pyridoxine tab 50mg* 80 pyridoxine tab 5mg* 80 pyridoxine tab 500mg* 8 pyridoxine tab 50mg* 8 Q QSYMIA CAP.5-69MG* QSYMIA CAP 5-9MG* QSYMIA CAP MG* QSYMIA CAP 7.5-6MG* QUADRACEL INJ 76 QUARTETTE TAB 0 quasense tab 0 QUDEXY XR CAP 5MG, 50MG, 00MG, 50MG, 00MG quetiapine tab 5mg, 3 50mg, 00mg, 00mg, 300mg, 00mg quinapril tab 5mg, 0mg, 0 0mg, 0mg quinapril/ hydrochlorothiazide tab 0-.5mg, 0-.5mg, 0-5mg quinidine gluconate CR tab 9 3mg quinidine gluconate inj 9 80mg/ ml quinidine sulfate tab 9 00mg, 300mg quinine sulfate cap 3mg R RABAVERT INJ 78 rabeprazole sodium tab 77 0mg raloxifene tab 60mg 53 ramipril cap.5mg, 0.5mg, 5mg, 0mg RANEXA TAB 500MG, 8 000MG ranitidine cap 50mg, mg ranitidine inj 5mg/ ml 77 ranitidine syrup 5mg/ ml 77 ranitidine tab 50mg, mg RAFLO CAP MG, 57 8MG RAMUNE SOLN MG/ 35 ML RAVICTI LIQUID 5.GM/ ML REBIF INJ MCG, 7 88MCG REBIF INJ TITRATION 7 CK REBIF REBIDOSE INJ 7 TITRATION CK reclipsen tab 0 RECOMBIVAX-HB INJ 78 REGRANEX GEL 0.0% 5 RELENZA DISKHALER 3 5MG 0

123 ALPHABETICAL LISTING OF DRUGS RELISTOR MG/ 0.6ML 56 SYR RELISTOR 8MG/ 0.ML 56 SYR RELISTOR INJ 0MG/ 57 ML REMICADE INJ 00MG 56 REMODULIN INJ MG/ 38 ML,.5MG/ ML, 5MG/ ML, 0MG/ ML RENVELA CKET GM,.GM RENVELA/ 57 SEVELAMER CARBONATE TAB 800MG repaglinide tab 0.5mg, 6 mg, mg RESCON DM SYRUP MG/ 5ML* RESCRIPTOR TAB 33 00MG, 00MG RESTASIS OPHTH 70 EMULSION 0.05% RETROVIR INJ 0MG/ 33 ML REVLIMID CAP.5MG, 35 0MG REVLIMID CAP 5MG, 35 0MG, 5MG, 5MG REXULTI 0.5MG TAB 3 REXULTI 0.5MG TAB 3 REXULTI MG TAB 3 REXULTI MG TAB 3 REXULTI 3MG TAB 3 REXULTI MG TAB 3 REYATAZ CAP 50MG, 33 00MG, 300MG REYATAZ POWDER 33 CKET 50MG RHEUMATREX TAB DOSE CK.5MG RIBAK TAB 00MG 3 RIBAK TAB 600MG 3 ribasphere cap 00mg 3 ribasphere tab 00mg, 3 00mg ribasphere tab 600mg 3 ribavirin cap 00mg 3 ribavirin tab 00mg 3 RIDAURA CAP 3MG rifabutin cap 50mg RIFAMATE CAP MG rifampin cap 50mg, 300mg rifampin inj 600mg RIFATER TAB MG riluzole tab 50mg 68 rimantadine tab 00mg 3 ringers injection 65 ringers irrigation 36 risedronate sodium 35mg 53 tab risedronate sodium tab 53 50mg risedronate tab 5mg, 30mg, 53 35mg RISPERDAL INJ.5MG, 30 5MG, 37.5MG, 50MG risperidone ODT 0.5mg, mg, mg, mg, 3mg, mg risperidone soln mg/ ml 30 risperidone tab 0.5mg, mg, mg, mg, 3mg, mg RITUXAN INJ 0MG/ ML 6 rivastigmine 3.3mg/ hr 7 patch rivastigmine.6mg/ hr 7 patch rivastigmine 9.5mg/ hr 7 patch rivastigmine tab.5mg, 7 3mg,.5mg, 6mg rizatriptan ODT 5mg, 63 0mg rizatriptan tab 5mg, 0mg 63 ropinirole ER tab mg, 30 mg, 6mg, 8mg, mg ropinirole tab 0.5mg, mg, mg, mg, 3mg, mg, 5mg ROTARIX ORAL SUSP 78 ROTATEQ ORAL SUSP 78 ROXICET SOLN MG ROZEREM TAB 8MG 60 RUCONEST INJ 58 00UNIT S SABRIL POWDER 500MG SABRIL TAB 500MG salicylic acid gel 7%* 50 salicylic acid gel %* 50 salicylic acid liquid 7%* 50 salicylic acid liquid %* 50 salicylic acid liquid 3%* 50 salicylic acid pad %* 50 salicylic acid pad 0%* 50 SALICYLIC ACID SOLN 50.%* salicylic acid soln.6%* 50 salicylic acid soln 7%* 50 salicylic acid strip 0%* 50 saline nasal spray 0.65%* 67 SANDIMMUNE SOLN 35 00MG/ ML SANTYL OINTMENT 50 50UNIT/ GM SAPHRIS SL TAB 3.5MG, 5MG, 0MG SAVELLA TAB.5MG, 7 5MG, 50MG, 00MG SAVELLA TAB 7 TITRATION CK SECONAL CAP 00MG 60 selegiline cap 5mg 30 selegiline tab 5mg 30 selenium sulfide shampoo 8.5% SELZENTRY TAB 33 50MG, 300MG

124 ALPHABETICAL LISTING OF DRUGS sennosides syrup 8.8mg/ 6 5ml* sennosides tab 5mg* 6 sennosides tab 7.mg* 6 sennosides tab 5mg* 6 sennosides tab 8.6mg* 6 sennosides/ docusate 6 sodium tab mg* SENSIR TAB 30MG, 5 60MG, 90MG SEREVENT INHALER 0 50MCG SEROQUEL XR TAB 3 50MG, 50MG, 00MG, 300MG, 00MG sertraline conc 0mg/ ml sertraline tab 5mg, 50mg, 00mg setlakin 9 day pack sharobel tab SIGNIFOR INJ 0.3MG/ 5 ML, 0.6MG/ ML, 0.9MG/ ML sildenafil tab 0mg 38 silver sulfadiazine cream 8 % SIMBRINZA OPHTH 69 SOLN -0.% SIMCOR TAB 500-0MG, MG, 750-0MG, 000-0MG, 000-0MG simethicone cap 5mg* 56 simethicone cap 80mg* 56 simethicone chew tab 56 5mg* simethicone chew tab 56 80mg* simethicone liquid 0mg/ ml* SIMETHICONE LIQUID* 56 SIMETHICONE ORAL 56 STRIP 6.5MG* simethicone susp 0mg/ ml* SIMPONI INJ 50MG/ 0.5ML, 00MG/ ML SIMULECT INJ 0MG 35 simvastatin tab 5mg, 0mg, 0 0mg, 0mg, 80mg sirolimus tab 0.5mg, mg, 35 mg SIRTURO TAB 00MG SIVEXTRO INJ 00MG 3 SIVEXTRO TAB 00MG 3 sodium bicarbonate tab 7 650mg* sodium chloride hypertonic 7 ophth ointment 5%* sodium chloride hypertonic 7 ophth soln 5%* sodium chloride inj 0.5%, %, 3%, 5%,.6% sodium chloride irrigation 57 soln 0.9% sodium fluoride tab mg 65 sodium lactate inj 5meq/ ml 63 sodium phenylbutyrate 5 powder 3gm sodium phosphates - 6 enema* sodium polystyrene 36 sulfonate susp 5gm/ 60ml sodium sulfacetamide 70 ophth soln 0% SOLTAMOX ORAL 6 SOLN 0MG/ 5ML SOLU-CORTEF INJ 50MG SOMATULINE DEPOT 55 INJ 60MG/ 0.ML, 90MG/ 0.3ML, 0MG/ 0.5ML SOMAVERT INJ 0MG, 53 5MG, 0MG, 5MG, 30MG SORBITOL ORAL 6 SOLUTION 70%* sorine tab 80mg, 0mg, 36 60mg, 0mg sotalol AF tab 0mg 36 sotalol tab 80mg, 60mg, 36 0mg SOVALDI TAB 00MG 3 SPIRIVA.5MCG/ ACT 9 INH SPIRIVA CAP 9 HANDIHALER 8MCG SPIRIVA RESPIMAT 9.5MCG spironolactone tab 5mg, 5 50mg, 00mg spironolactone/ 5 hydrochlorothiazide tab 5-5mg sprintec-8 tab SPRYCEL TAB 0MG, 7 50MG, 70MG, 80MG, 00MG, 0MG sronyx tab ssd cream % 8 STALEVO TAB 50MG, 30 75MG, 00MG, 5MG, 50MG, 00MG stavudine cap 5mg, 0mg, 33 30mg, 0mg stavudine oral soln mg/ 33 ml STELARA INJ 5MG/ 8 0.5ML STELARA INJ 90MG/ ML 8 sterile water irrigation 36 STIMATE NASAL 5 SPRAY.5MG/ ML STIOLTO.5-.5MCG 0 INH STIVARGA TAB 0MG 7 STRATTERA CAP 0MG, 8MG, 5MG, 0MG, 60MG, 80MG, 00MG STREPTOMYCIN INJ GM STRIBILD TAB MG SUBOXONE SL FILM 6-3MG SUBOXONE SL FILM 6-0.5MG, -MG, 8-MG sucralfate tab gm 77

125 ALPHABETICAL LISTING OF DRUGS sulfacetamide sodium 6 lotion 0% SULFACETAMIDE 70 SODIUM OPHTH OINTMENT 0% sulfacetamide sodium/ 70 prednisolone ophth soln 0-0.3% SULFADIAZINE TAB MG SULFAMETHOXAZOLE/ TRIMETHOPRIM INJ 00-80MG/ 5ML sulfamethoxazole/ trimethoprim susp 00-0mg/ 5ml sulfamethoxazole/ 3 trimethoprim tab 00-80mg, mg SULFAMYLON CREAM 8 85MG/ GM sulfasalazine tab 500mg 56 sulfazine EC tab 500mg 56 sulindac tab 50mg, 00mg 3 sumatriptan mg/ ml 63 auto-injector sumatriptan mg cartridge 63 sumatriptan 6mg cartridge 63 sumatriptan auto-injector 63 6mg/ 0.5ml sumatriptan inj 6mg/ 0.5ml 63 SUMATRIPTAN NASAL 63 SPRAY 5MG, 0MG sumatriptan tab 5mg, 63 50mg, 00mg SUPRAX CAP 00MG 39 SURMONTIL CAP 5MG, 50MG, 00MG SUSTIVA CAP 50MG, 33 00MG SUSTIVA TAB 600MG 33 SUTENT CAP.5MG, 7 5MG, 37.5MG, 50MG SYLATRON INJ 8 96MCG, MCG, 888MCG SYLVANT INJ 00MG 36 SYNAGIS INJ 50MG/ 7 0.5ML SYNAREL SOLN MG/ 5 ML SYNERCID INJ 500MG 3 SYNJARDY MG TAB SYNJARDY.5-500MG 5 TAB SYNJARDY 5-000MG 5 TAB SYNJARDY 5-500MG 5 TAB SYNRIBO INJ 3.5MG 8 SYNTHROID TAB (ALL 76 STRENGTHS) SYPRINE CAP 50MG 35 T TABLOID TAB 0MG 5 tacrolimus cap 0.5mg, 35 mg, 5mg tacrolimus ointment 0.03%, 50 0.% TAFINLAR CAP 50MG, 7 75MG TAGRISSO 0MG TAB 7 TAGRISSO 80MG TAB 7 TAMIFLU CAP 30MG 3 TAMIFLU CAP 5MG, 3 75MG TAMIFLU SUSP 6MG/ 3 ML tamoxifen citrate tab 0mg, 6 0mg tamsulosin cap 0.mg 57 TARCEVA TAB 5MG, 7 00MG, 50MG TARGRETIN CAP 75MG 8 TARGRETIN GEL % 7 tarina FE tab TASIGNA CAP 50MG, 7 00MG tazicef gm inj 39 tazicef gm inj 39 tazicef 6gm inj 39 TAZORAC CREAM %, 0.% TAZORAC GEL 0.05%, 8 0.% taztia-xt cap 0mg, 37 80mg, 0mg, 300mg, 360mg TECFIDERA CAP 7 0MG, 0MG TECFIDERA CAP 7 STARTER CK TEFLARO IV SOLN 39 00MG, 600MG TEGRETOL-XR TAB 00MG telmisartan tab 0mg, 0mg, 80mg telmisartan/ hydrochlorothiazide tab 0-.5mg, 80-.5mg, 80-5mg temazepam cap 7.5mg, 60 5mg,.5mg, 30mg TENIVAC SYR 76 terazosin cap mg, mg, 5mg, 0mg terbinafine cream %* 7 terbinafine tab 50mg 8 terbutaline inj mg/ ml 0 terbutaline tab.5mg, 5mg 0 terconazole vaginal cream 79 0.%, 0.8% terconazole vaginal supp 79 80mg testosterone cypionate inj 7 00mg/ ml, 00mg/ ml testosterone enanthate inj 7 00mg/ ml TETANUS/ DIPHTHERIA 76 TOXOID INJ tetrabenazine.5mg tab 7 tetrabenazine 5mg tab 7 TETRACYCLINE CAP 76 50MG, 500MG THALOMID CAP 50MG, 35 00MG, 50MG, 00MG 3

126 ALPHABETICAL LISTING OF DRUGS theophylline ER tab 0 00mg, 00mg, 300mg, 00mg, 50mg, 600mg theophylline soln 80mg/ 0 5ml thiamine mononitrate tab 8 00mg* thiamine tab 50mg, 00mg, 8 50mg* THIOLA TAB 00MG 57 thioridazine tab 0mg, 3 5mg, 50mg, 00mg THIOTE 5MG INJ 5 thiothixene cap mg, mg, 3 5mg, 0mg THYMOGLOBULIN INJ 35 5MG THYROLAR TAB 5MG, 76 30MG, 60MG, 0MG, 80MG tiagabine tab mg, mg TIKOSYN CAP 5MCG, 9 50MCG, 500MCG timolol maleate ophth gel %, 0.5% timolol maleate ophth soln %, 0.5% timolol maleate tab 5mg, 36 0mg, 0mg tinidazole tab 50mg, 500mg tioconazole vaginal 79 ointment 6.5%* TIVICAY TAB 50MG 33 tizanidine cap mg, mg, 67 6mg tizanidine tab mg, mg 67 TOBI PODHALER 8MG TOBRADEX OPHTH 70 OINTMENT % tobramycin inj 0mg/ ml, 80mg/ ml tobramycin neb 300mg/ 5ml tobramycin ophth soln % tobramycin/ 70 dexamethasone ophth susp % TOBRAMYCIN/ NACL INJ 0.8MG/ ML tolazamide tab 50mg, 6 500mg TOLBUTAMIDE TAB 6 500MG tolcapone tab 00mg 9 tolmetin cap 00mg 3 TOLMETIN TAB 600MG 3 tolnaftate aerosol %* 7 tolnaftate aerosol powder 7 %* tolnaftate cream %* 7 tolnaftate powder %* 7 tolnaftate soln %* 7 tolterodine tab mg, mg 78 tolterodine tartrate ER cap 78 mg, mg TOPICORT CREAM % TOPIRAMATE ER CAP 5MG, 50MG, 00MG, 50MG, 00MG topiramate sprinkle cap 5mg, 5mg topiramate tab 5mg, 50mg, 00mg, 00mg topotecan inj mg 9 TORISEL SOLN 5MG/ 8 ML torsemide tab 5mg, 0mg, 5 0mg, 00mg TOUJEO 300UNIT/ ML 6 SYR tpn electrolytes soln 65 TRACLEER TAB MG, 5MG tramadol ER tab 00mg, 6 00mg, 300mg tramadol tab 50mg 6 tramadol/ acetaminophen 6 tab mg trandolapril mg/ verapamil 0mg ER tab trandolapril mg/ verapamil 80mg ER tab trandolapril mg/ verapamil 0mg ER tab trandolapril mg/ verapamil 0mg ER tab trandolapril tab mg, mg, 0 mg tranexamic acid inj 00mg/ 60 ml tranexamic acid tab 650mg 60 TRANSDERM-SCOP 7 TCH.5MG tranylcypromine tab 0mg 3 TRAVASOL INJ 0% 68 TRAVATAN Z OPHTH 7 SOLN 0.00% travoprost ophth soln % trazodone tab 50mg, 3 00mg, 50mg, 300mg TREANDA INJ 5MG, 5 00MG TRECATOR TAB 50MG TRELSTAR DEPOT 6 MIXJECT INJ 3.75MG TRELSTAR LA MIXJECT 6 INJ.5MG TRELSTAR MIXJECT 6 INJ.5MG tretinoin 0.05% gel 6 tretinoin cap 0mg 8 tretinoin cream 0.05%, %, 0.% tretinoin gel 0.05%, 6 0.0% tretinoin micro gel 0.0%, 6 0.% TRETIN-X CREAM % TREXALL TAB 5MG, 5 7.5MG, 0MG, 5MG

127 ALPHABETICAL LISTING OF DRUGS TRIAMCINOLONE 67 ACETONIDE NASAL AEROSOL SUSPENSION 55MCG* triamcinolone cream %, 0.%, 0.5% triamcinolone in orabase 66 paste 0.% triamcinolone lotion %, 0.% triamcinolone nasal spray 67 55mcg triamcinolone ointment %, 0.%, 0.5% triamcinolone spray 50 triamterene/ 5 hydrochlorothiazide cap mg, 50-5mg triamterene/ 5 hydrochlorothiazide tab mg, 75-50mg TRIANEX OINTMENT % triazolam tab 0.5mg, mg triazolam tab 0.5mg, mg triderm cream 0.% 50 trifluoperazine tab mg, 3 mg, 5mg, 0mg trifluridine ophth soln % 70 TRIGLIDE TAB 60MG 0 trihexyphenidyl soln 0.mg/ 9 ml trihexyphenidyl tab mg, 9 5mg tri-legest FE tab TRILIPIX CAP 5MG, 0 35MG trilyte powder 6 trimethobenzamide cap 7 300mg trimethoprim tab 00mg trimipramine 00mg cap trimipramine 5mg cap 5 trimipramine 50mg cap 5 trinessa tab triple antibiotic ointment* 6 tri-previfem tab triprolidine/ 5 pseudoephedrine tab.5-60mg* TRISENOX INJ 0MG/ 8 0ML tri-sprintec tab TRIUMEQ TAB MG trivora-8 tab TROKENDI XR CAP 5MG, 50MG, 00MG, 00MG TROPHAMINE INJ 6%, 68 0% trospium chloride ER cap 78 60mg trospium tab 0mg 78 TRUMENBA INJ 78 TRUVADA TAB MG TWINRIX INJ 78 TYBOST TAB 50MG 33 TYGACIL INJ 50MG 3 TYKERB TAB 50MG 8 TYLOXAPOL OPHTH 7 SOLN 0.5%* TYPHIM VI 5MCG/ ML SYR TYPHIM VI INJ 78 TYSABRI INJ 0MG/ ML 7 TYVASO INHALATION 38 SOLN 0.6MG/ ML TYZEKA TAB 600MG 3 U UCERIS RECTAL FOAM 7 MG UCERIS TAB 9MG ULORIC TAB 0MG, 58 80MG ULTRESA CAP (ALL 5 STRENGTHS) unithroid tab 5mcg, 76 50mcg, 75mcg, 88mcg, 00mcg, mcg, 5mcg, 50mcg, 75mcg, 00mcg, 300mcg ursodiol cap 300mg 56 ursodiol tab 50mg, 500mg 56 UVADEX SOLN 0MCG/ 8 ML V valacyclovir tab 500mg, 3 gm VALCHLOR GEL 0.06% 7 VALCYTE SOLN 50MG/ 3 ML valganciclovir tab 50mg 3 valproic acid cap 50mg 3 valproic acid inj 00mg/ ml 3 valproic acid syrup 50mg/ 3 5ml valsartan tab 0mg, 80mg, 60mg, 30mg valsartan/ hydrochlorothiazide tab 80-.5mg, 60-.5mg, 60-5mg, 30-.5mg, 30-5mg vancomycin cap 5mg, 50mg vancomycin inj 500mg, 000mg, 0gm vandazole vaginal gel % VAQTA INJ 78 VARIVAX INJ 78 VASCE CAP GM 9 VECTIBIX INJ 00MG/ 6 5ML VECTICAL OINTMENT 8 3MCG/ GM VELCADE INJ 3.5MG 8 velivet tab venlafaxine ER cap 37.5mg, 75mg, 50mg VENLAFAXINE ER TAB 5MG 5

128 ALPHABETICAL LISTING OF DRUGS venlafaxine ER tab 37.5mg, 75mg, 50mg venlafaxine tab 5mg, 37.5mg, 50mg, 75mg, 00mg VENTAVIS SOLN 38 0MCG/ ML, 0MCG/ ML VENTOLIN HFA 0 INHALER 08MCG VERAMYST NASAL 67 SPRAY 7.5MCG verapamil 0 mg er tab 37 verapamil 80 mg er tab 37 verapamil 0 mg er tab 37 verapamil ER cap 00mg, 37 0mg, 80mg, 00mg, 0mg, 300mg, 360mg verapamil ER tab 0mg, 37 80mg, 0mg verapamil inj.5mg/ ml 37 VERAMIL TAB 0MG 37 verapamil tab 80mg, 37 0mg VERSACLOZ SUSP 3 50MG/ ML VESICARE TAB 5MG, 78 0MG vestura tab VEXOL OPHTH SUSP 70 % VICTOZA INJ 8MG/ 6 3ML VIDEX SOLN GM 33 VIGAMOX OPHTH 70 SOLN 0.5% VIIBRYD TAB 0MG, 3 0MG, 0MG VIMT INJ 0MG/ ML VIMT SOLN 0MG/ ML VIMT TAB 50MG, 00MG, 50MG, 00MG VINBLASTINE INJ MG/ 9 ML vincasar PFS inj mg/ ml 9 vincristine inj mg/ ml 9 vinorelbine inj 0mg/ ml 9 VIRACEPT TAB 50MG, 33 65MG VIRAMUNE SUSP 33 50MG/ 5ML VIRAMUNE XR TAB 33 00MG VIRAZOLE SOLN 6GM 3 VIREAD POWDER 33 0MG/ GM VIREAD TAB 50MG, 33 00MG, 50MG, 300MG VITAMIN B 58 LOZENGE 50MCG* vitamin B- CR tab 000* 58 vitamin B- loz 500mcg* 58 vitamin B- sub mcg* vitamin B- sub mcg* vitamin B- tab mcg* vitamin B- tab 00mcg* 59 vitamin B- tab mcg* vitamin B- tab 50mcg* 59 vitamin B- tab 500mcg* 59 vitamin B- tab 50mcg* 59 vitamin B- tab 00mg* 8 vitamin B- tab 5mg* 8 vitamin B- tab 50mg* 8 vitamin C chew tab 8 50mg* vitamin C chew tab 8 500mg* vitamin C CR cap 500mg 8 CR* vitamin C CR tab 500mg* 8 vitamin C drops 60mg* 8 vitamin C syrup 500/ 5ml* 8 vitamin C tab 000mg* 8 vitamin C tab 00mg* 8 vitamin C tab 50mg* 8 vitamin C tab 500mg* 8 vitamin C TR tab 500mg* 8 vitamin C w/ rosehip TR 8 tab 000mg* vitamin E cap 000unit* 80 vitamin E cap 00unit* 80 vitamin E cap 00unit* 80 vita-plus E cap 00unit* 80 VITEKTA TAB 85MG, 33 50MG VOLTAREN GEL % 7 voriconazole inj 00mg 8 voriconazole susp 0mg/ 8 ml voriconazole tab 50mg, 8 00mg VOTRIENT TAB 00MG 8 VPRIV INJ 00UNIT 58 vyfemla tab VYVANSE CAP 0MG, 0MG, 30MG, 0MG, 50MG, 60MG, 70MG W warfarin tab mg, mg, 0.5mg, 3mg, mg, 5mg, 6mg, 7.5mg, 0mg WELCHOL K 3.75GM 9 WELCHOL TAB 65MG 9 white petrolatum/ mineral 68 oil ophth ointment* wymzya FE tab X XALKORI CAP 00MG, 8 50MG XARELTO TAB 0MG, 5MG, 0MG XARELTO TAB STARTER CK XELJANZ TAB 5MG XENAZINE TAB 7.5MG, 5MG XGEVA INJ 0MG/ 53.7ML XIGDUO XR TAB MG 6

129 ALPHABETICAL LISTING OF DRUGS XIGDUO XR TAB MG, 0-500MG, 0-000MG XOLAIR INJ 50MG 9 XTANDI CAP 0MG 6 xulane patch 50-35mcg XYREM SOLN 500MG/ 73 ML Y YERVOY INJ 50MG/ 6 0ML YF-VAX INJ 78 Z zafirlukast tab 0mg, 0mg 9 zaleplon cap 5mg, 0mg 60 ZALTRAP INJ 00MG/ 5 ML ZANOSAR INJ GM 5 ZARXIO 300MCG/ 0.5ML 59 SYR ZARXIO 80MCG/ 0.8ML 59 SYR ZAVESCA CAP 00MG 58 zazole vaginal cream 0.%, % ZELBORAF TAB 0MG 8 ZEMAIRA INJ 000MG 75 ZEMPLAR INJ MCG/ 5 ML, 5MCG/ ML zenatane 30mg cap 6 zenatane cap 0mg, 0mg, 6 0mg zenchent FE tab zenchent tab ZETIA TAB 0MG 0 ZIAGEN SOLN 0MG/ 33 ML zidovudine cap 00mg 33 zidovudine syrup 0mg/ ml 33 zidovudine tab 300mg 33 zinc oxide ointment 0%* 5 zinc oxide ointment 0%* 5 zinc oxide ointment 0%* 5 ZINC OXIDE STE 5% 5 * ZINC OXIDE STE 0% 5 * ziprasidone cap 0mg, 30 0mg, 60mg, 80mg ZIRGAN OPHTH GEL % zoledronic acid inj 5mg/ 53 00ml zoledronic acid inj conc 53 mg/ 5ml ZOLINZA CAP 00MG 8 zolmitriptan ODT.5mg, 63 5mg zolmitriptan tab.5mg, 63 5mg zolpidem tab 5mg, 0mg 60 ZOMETA INJ MG/ 53 00ML ZOMIG NASAL SPRAY 63.5MG zonisamide cap 5mg, 50mg, 00mg ZORTRESS TAB 0.5MG, MG, 0.75MG ZOSTAVAX INJ 78 ZOSYN/ DEXTROSE INJ GM/ ML, GM/ 50ML zovia tab ZYCLARA CREAM.5% 50 ZYDELIG TAB 00MG, 8 50MG ZYKADIA CAP 50MG 8 ZYLET OPHTH SOLN % ZYPREXA 0MG INJ 3 ZYTIGA TAB 50MG 6 ZYVOX SUSP 00MG/ 3 5ML 7

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