...Cambios en la Lista de medicamentos con receta para 2020 Los siguientes cambios entran en...

FORMULARIO ABREVIADO CERRAD0 2020

(Lista parcial de medicamentos cubiertos)

Costo de Clarion Health (Parte D)

Siempre respondemos

Cambios en la Lista de medicamentos con receta para 2020 Los siguientes cambios entran en vigencia el 01/07/20 en el Formulario cerrado de Clarion en español de 2020

Medicamentos agregados a nuestro Formulario Nombre del medicamento Nivel de

medicamento Requisitos/límites

Fecha de entrada en vigencia del cambio

AYVAKIT TAB 100MG 5 LC (90 tabletas/30 días), AP, AL Abril 1, 2020 AYVAKIT TAB 200MG 5 LC (45 tabletas/30 días), AP, AL Abril 1, 2020 AYVAKIT TAB 300MG 5 LC (30 tabletas/30 días), AP, AL Abril 1, 2020 BRUKINSA CAP 80MG 5 LC (120 cápsulas/30 días), AP; AL Marzo 1, 2020 DIAZEPAM GEL 2,5MG 4 Abril 1, 2020 DIAZEPAM GEL 10MG 4 Abril 1, 2020 DIAZEPAM GEL 20MG 4 Abril 1, 2020 DOXEPIN TAB 3MG 3 LC (30 tabletas/30 días) Marzo 1, 2020 DOXEPIN TAB 6MG 3 LC (30 tabletas/30 días) Marzo 1, 2020 DRIZALMA CAP 20MG DR 4 LC (180 cápsulas/30 días), AP Marzo 1, 2020 DRIZALMA CAP 30MG DR 4 LC (120 cápsulas/30 días), AP Marzo 1, 2020 DRIZALMA CAP 40MG DR 4 LC (90 cápsula/30 días), AP Marzo 1, 2020 DRIZALMA CAP 60MG DR 4 LC (60 cápsulas/30 días), AP Marzo 1, 2020 ELURYNG MIS 4 LC (1 anillo/28 días) Marzo 1, 2020 ESBRIET TAB 267MG 5 LC (270 tabletas/30 días), AP Abril 1, 2020 ETONOGESTERE MIS ETHY EST 4 LC (1 anillo/28 días) Marzo 1, 2020 EUTHYROX TAB 25MCG 2 Abril 1, 2020 EUTHYROX TAB 50MCG 2 Abril 1, 2020 EUTHYROX TAB 75MCG 2 Abril 1, 2020 EUTHYROX TAB 88MCG 2 Abril 1, 2020 EUTHYROX TAB 100MCG 2 Abril 1, 2020 EUTHYROX TAB 112MCG 2 Abril 1, 2020 EUTHYROX TAB 125MCG 2 Abril 1, 2020 EUTHYROX TAB 137MCG 2 Abril 1, 2020 EUTHYROX TAB 150MCG 2 Abril 1, 2020

AP: Autorización Previa - LC: Límites de Cantidad - TE: Terapia en Etapas - AL: Acceso Limitado

LEA, POR FAVOR: ESTE DOCUMENTO CONTIENE INFORMACIÓN SOBRE LOS MEDICAMENTOS QUE CUBRIMOS EN ESTE PLAN

Formulario aprobado por el HPMS Identificación de presentación del archivo 20238, versión 20.

Este Formulario se actualizó el 25/08/2020. Para obtener información más reciente o si tiene preguntas, comuníquese con Clarion Health al 1-844-272-1715 o, para usuarios de TTY, 711, durante las 24 horas, los 7 días de la semana, o visite ClarionHealth.org.

Cuando en esta lista de medicamentos (Formulario) dice “nosotros”, “nos”, o “nuestro/a”, hace referencia a Clarion Health. Cuando dice “plan” o “nuestro plan”, hace referencia a Clarion Health (HMO).

Este documento incluye una lista de los medicamentos (Formulario) para nuestro plan que tiene vigencia al 25/08/2020. Para consultar un Formulario actualizado, comuníquese con nosotros. Nuestra información de contacto, junto con la fecha de la última actualización del Formulario, aparece en la portada y contraportada.

Usted generalmente debe utilizar farmacias de la red para usar su beneficio de medicamentos con receta. Los beneficios, Formulario, red de farmacias, prima y/o copagos/coseguro pueden cambiar el 1 de enero de 2020 y de tanto en tanto durante el año.

¿Qué es el Formulario de Clarion Health?Un Formulario es una lista de medicamentos cubiertos seleccionados por Clarion Health consultando a un equipo de proveedores de atención médica, que representa las terapias recetadas que se creen que son una parte necesaria de un programa de tratamiento de calidad. Clarion Health generalmente cubrirá los medicamentos que figuran en nuestro Formulario siempre que el medicamento sea médicamente necesario, obtenga el medicamento con receta en una farmacia de la red de Clarion Health y se acaten otras reglas del plan. Para obtener más información sobre cómo obtener sus medicamentos con receta, consulte su Evidencia de cobertura.

¿Puede cambiar el Formulario (lista de medicamentos)?La mayoría de los cambios en la cobertura de medicamentos ocurre el 1 de enero, pero es posible que Clarion Health agregue o elimine medicamentos de la Lista de medicamentos durante el año, los cambie a otro nivel de costo compartido a otro o añada nuevas restricciones.

Cambios que pueden afectarlo este año - En los siguientes casos, usted se verá afectado por cambios de cobertura durante el año:

Formulario 2020Lista de medicamentos cubiertos

Siempre respondemos

2020 Formulario modelo de la Parte D (integral)

• Nuevos medicamentos genéricos. Podemos eliminar inmediatamente un medicamento de marca de nuestra Lista de medicamentos.

• Si lo reemplazamos con un nuevo medicamento genérico que aparecerá en el mismo nivel de costo compartido o en un nivel más bajo, y con las mismas restricciones o menos. Además, al agregar el nuevo medicamento genérico, podemos decidir mantener el medicamento de marca en nuestra Lista de medicamentos pero inmediatamente moverlo a un nivel de costo compartido diferente o agregar nuevas restricciones. Si actualmente está tomando ese medicamento de marca, quizás no le informemos con antelación antes realizar el cambio, sino que más adelante le proporcionaremos información sobre los cambios específicos que hemos realizado.

° Si realizamos un cambio de este tipo, usted o la persona autorizada a dar recetas pueden solicitarnos que hagamos una excepción y sigamos cubriendo el medicamento de marca para usted. El aviso que le brindaremos también incluirá información sobre cómo solicitar una excepción; también puede encontrar información en la sección a continuación titulada “¿Cómo solicito que se haga una excepción al Formulario de Clarion Health?”

• Medicamentos retirados del mercado. Si la Administración de Alimentos y Medicamentos considera que un medicamento de nuestro Formulario es inseguro o el fabricante del medicamento lo retira del mercado, eliminaremos de inmediato dicho medicamento de nuestro Formulario y les notificaremos a los miembros que toman el medicamento en cuestión.

• Otros cambios. Podemos hacer otros cambios que afecten a los miembros que actualmente toman un medicamento. Por ejemplo, podemos agregar un medicamento genérico que no sea nuevo en el mercado para reemplazar un medicamento de marca que actualmente se encuentre en el Formulario o agregar nuevas restricciones al medicamento de marca o moverlo a otro nivel de costo compartido. O podemos hacer cambios en función de nuevas pautas clínicas. Si eliminamos medicamentos de nuestro Formulario, o agregamos autorizaciones previas, restricciones de límite de cantidad y/o de tratamiento escalonado en un medicamento o movemos un medicamento a un nivel de costo compartido más alto, debemos notificarles a los miembros afectados por el cambio al menos 30 días antes de que el cambio entre en vigencia, o cuando el miembro solicite resurtir el medicamento, momento en el cual el miembro recibirá un suministro del medicamento para 30 días.

° Si realizamos estos otros cambios, usted o la persona autorizada a dar recetas pueden solicitarnos que hagamos una excepción y continuemos cubriéndole el medicamento de marca El aviso que le proporcionaremos también incluirá información sobre cómo solicitar una excepción; también puede encontrar información en la sección a continuación titulada “¿Cómo solicito que se haga una excepción al Formulario de Clarion Health?”

Cambios que no le afectarán si actualmente toma el medicamento. Generalmente, si usted toma algún medicamento de nuestro Formulario de 2020 que estaba cubierto a principio


del año, no discontinuaremos ni reduciremos la cobertura del medicamento durante el año de cobertura 2020, excepto según lo descrito anteriormente. Esto significa que estos medicamentos continuarán estando disponibles por el resto del año de cobertura por el mismo costo compartido y sin restricciones nuevas para aquellos miembros que los toman.

El Formulario adjunto es vigente a partir del 25/08/2020. Para obtener información actualizada sobre los medicamentos cubiertos por Clarion Health, comuníquese connosotros. Nuestra información de contacto aparece en la portada y contraportada.

Nota: En caso de que Clarion Health realice cambios aprobados por el CMSO en el Formulario a mitad de año, actualizaremos el Formulario en nuestro sitio web. Usted también será notificado por escrito si resulta afectado por los cambios.

¿Cómo utilizo el Formulario?Hay dos formas de encontrar su medicamento dentro del Formulario:

Afección médicaEl Formulario comienza en la página 6. Los medicamentos de este Formulario están agrupados en categorías según el tipo de afecciones médicas para cuyo tratamiento se los utiliza. Por ejemplo, los medicamentos utilizados para tratar una afección cardíaca se enumeran en la categoría “Cardiovasculares”. Si sabe para qué se utiliza su medicamento, busque el nombre de la categoría en la lista que comienza a continuación. Luego, busque el medicamento bajo el nombre de la categoría.

Listado alfabéticoSi no está seguro sobre qué categoría consultar, busque su medicamento en el índice que comienza en la página 6. El índice brinda una lista alfabética de todos los medicamentos incluidos en este documento. En el índice figuran tanto los medicamentos de marca como los genéricos. Busque en el índice y encuentre su medicamento. Junto a su medicamento, verá el número de página donde puede encontrar información sobre la cobertura. Diríjase a la página que figura en el índice y encuentre el nombre de su medicamento en la primera columna de la lista.

¿Hay restricciones en mi cobertura?Algunos medicamentos cubiertos pueden tener requisitos o límites adicionales de cobertura. Dichos requisitos y límites pueden incluir:

• Autorización previa Clarion Health exige que usted o su médico obtengan una autorización previa para ciertos medicamentos. Esto significa que necesitará obtener la aprobación de Clarion Health antes de obtener sus medicamentos con receta. Si no consigue esta autorización, es posible que Clarion Health no cubra el medicamento. .

• Límites de cantidad: para ciertos medicamentos, Clarion Health limita la cantidad del medicamento que cubrirá. Por ejemplo, Clarion Health ofrece 10 parches por receta para los parches de fentanilo 50 mcg/hr. Esto puede ser complementario a un suministro estándar para uno o tres meses.



• Tratamiento escalonado: en algunos casos, Clarion Health requiere que usted primero pruebe ciertos medicamentos para tratar su afección médica antes de cubrir otro medicamento para esa afección. Por ejemplo, si el medicamento A y el medicamento B tratan su afección médica, es posible que Clarion Health no cubra el medicamento B, excepto que usted pruebe primero el medicamento A. Si el medicamento A no le funciona, entonces Clarion Health cubrirá el medicamento B.

Para saber si su medicamento tiene requisitos o límites adicionales, consulte el Formulario que comienza en la página 6. También puede obtener más información sobre las restricciones que se aplican a medicamentos cubiertos específicos en nuestro sitio web. Hemos publicado documentos en línea que explican nuestras restricciones para autorizaciones previas y tratamientos escalonados. También puede solicitarnos que le enviemos una copia. Nuestra información de contacto, junto con la fecha de la última actualización del Formulario, aparece en la portada y contraportada.

Puede solicitar a Clarion Health que haga una excepción a estas restricciones o límites, o puede solicitar una lista de otros medicamentos similares que puedan tratar su afección médica. Consulte la sección “¿Cómo solicito una excepción al Formulario de Clarion Health?” en la página 4 para obtener información sobre cómo solicitar una excepción. ¿Qué son los medicamentos de venta libre (OTC por su sigla en inglés)?

Los medicamentos de venta libre son medicamentos sin receta que generalmente no están cubiertos por un plan de medicamentos con receta de Medicare.

¿Qué sucede si mi medicamento no figura en el Formulario?Si su medicamento no está incluido en este Formulario (lista de medicamentos cubiertos), primero debe comunicarse con Servicios para los miembros y preguntar si su medicamento está cubierto. Para más información, comuníquese con nosotros. Nuestra información de contacto, junto con la fecha de la última actualización del Formulario, aparece en la portada y contraportada.

Si sabe que Clarion Health no cubre el medicamento que toma, tiene dos opciones:

• Puede solicitar a Servicios para los miembros una lista de medicamentos similares que estén cubiertos por Clarion Health. Cuando reciba la lista, muéstresela a su médico y solicítele que le recete un medicamento similar que esté cubierto por Clarion Health.

• Puede solicitar a Clarion Health que haga una excepción y que cubra su medicamento. Consulte a continuación para obtener información sobre cómo solicitar una excepción.


¿Cómo solicito que se haga una excepción al Formulario de Clarion Health?Puede solicitar que Clarion Health haga una excepción a nuestras normas de cobertura. Existen varios tipos de excepciones que puede solicitarnos.

• Puede pedirnos que cubramos un medicamento, incluso si no está en nuestro Formulario. Si se aprueba, este medicamento estará cubierto a un nivel de costo compartido predeterminado, y usted no podrá solicitarnos que entreguemos el medicamento a un nivel de costo compartido más bajo.

• Puede pedirnos que cubramos un medicamento del Formulario a un nivel de costo compartido más bajo si el medicamento no está en un nivel de especialidad. Si se aprueba, reducirá el monto que usted debe pagar por el medicamento.

• Puede pedirnos que no apliquemos restricciones o límites de cobertura para su medicamento. Por ejemplo, para ciertos medicamentos, Clarion Health limita la cantidad del medicamento que cubriremos. Si su medicamento tiene un límite de cantidad, puede solicitarnos que hagamos una excepción al límite y cubramos una cantidad mayor.

Generalmente, Clarion Health solo aprobará su pedido de excepción si los medicamentos alternativos incluidos en el Formulario del plan, el medicamento con un costo compartido menor o las restricciones de uso adicionales no fueran tan efectivos para tratar su afección y/o pudieran causarle efectos médicos adversos.

Debe comunicarse con nosotros para solicitarnos una decisión de cobertura inicial para una excepción al Formulario o a la restricción de uso. Cuando solicita una excepción al Formulario o a la restricción de uso, debe presentar una declaración de su médico o de la persona autorizada a dar recetas que respalde dicha solicitud.

Generalmente, debemos tomar una decisión dentro de las 72 horas a partir de la fecha de haber recibido esta declaración. Puede solicitar una excepción acelerada (rápida) si usted o su médico consideran que esperar 72 horas para la toma de la decisión podría perjudicar gravemente su salud. Si se le concede la aceleración del trámite, debemos comunicarle nuestra decisión a más tardar dentro de las 24 horas después de haber recibido la declaración de respaldo de su médico o de otra persona autorizada a dar recetas.

¿Qué debo hacer antes de hablar con mi médico sobre el cambio de mis medicamentos o la solicitud de una excepción?Como miembro nuevo o permanente de nuestro plan, es posible que esté tomando medicamentos que no estén en el Formulario. O quizás esté tomando un medicamento incluido en el Formulario pero su capacidad de conseguirlo es limitada. Por ejemplo, puede necesitar nuestra autorización previa antes de obtener su medicamento con receta. Debe consultar con su médico para decidir si debe cambiar a un medicamento apropiado que nosotros cubramos o solicitar una excepción al Formulario para que le cubramos el medicamento que toma. Mientras habla con su médico para determinar las medidas adecuadas para usted, podemos cubrir su medicamento en ciertos casos durante los primeros 90 días en que usted sea miembro de nuestro plan.


Para cada uno de los medicamentos que no están en el Formulario o si su capacidad para conseguirlos es limitada, cubriremos un suministro temporario para 30 días. Si su receta está indicada para menos días, permitiremos que realice resurtidos para obtener un suministro máximo de hasta 30 días del medicamento. Después del primer suministro para 30 días, no seguiremos pagando estos medicamentos, incluso si ha sido miembro del plan durante menos de 90 días.

Si es residente de un centro de atención a largo plazo y necesita un medicamento que no está en nuestro Formulario o si su capacidad para conseguirlos es limitada, pero ya pasaron los primeros 90 días de membresía en nuestro plan, cubriremos un suministro de emergencia de ese medicamento para 31 días mientras solicita la excepción al Formulario.

Más informaciónPara obtener información más detallada sobre la cobertura para medicamentos con receta de Clarion Health, consulte la Evidencia de cobertura y otra documentación del plan.

Si tiene alguna pregunta sobre Clarion Health, comuníquese con nosotros. Nuestra información de contacto, junto con la fecha de la última actualización del Formulario, aparece en la portada y contraportada.

Si tiene preguntas generales sobre su cobertura para medicamentos con receta de Medicare, llame a Medicare al 1-800-MEDICARE (1-800-633-4227), las 24 horas, los 7 días de la semana. Los usuarios de TTY deben llamar al 1-877- 486-2048. O visite http://www.medicare.gov.

Formulario de Clarion HealthEl Formulario a continuación brinda información sobre la cobertura de los medicamentos cubiertos por Clarion Health. Si tiene dificultades para encontrar su medicamento en la lista, consulte el índice que comienza en la página 6.

La primera columna de la tabla enumera el nombre del medicamento. Los medicamentos de marca están en letra mayúscula (por ejemplo, ELIQUIS) y los medicamentos genéricos figuran en letra minúscula y cursiva (por ejemplo, amoxicillin).

La información incluida en la columna de Requisitos/límites indica si Clarion Health tiene algún requisito especial para la cobertura del medicamento.


Lista de abreviaturas

B/D: Este medicamento con receta puede estar cubierto bajo las Partes B o D de Medicare, según las circunstancias. Puede solicitarse información que describa el uso y circunstancias de uso del medicamento para tomar la decisión.

DL: Límite de días de suministro. Para ciertos medicamentos, solo cubriremos hasta un suministro para 30 días por vez

GC: Período sin cobertura Brindaremos cobertura adicional de este medicamento con receta durante el período sin cobertura Consulte nuestra Evidencia de cobertura para obtener más información sobre esta cobertura.

LA: Disponibilidad limitada. Es posible que este medicamento solo esté disponible en ciertas farmacias. Para más información, consulte nuestro Directorio de farmacias o llame al 1-844-272-1715 (los usuarios de TTY deben llamar al 711), durante las 24 horas, los 7 días de la semana.

NM: No disponible por pedido por correo. Este medicamento con receta no está disponible a través del servicio de pedido por correo. Considere utilizar el pedido por correo para sus medicamentos a largo plazo (mantenimiento) (como medicamentos para la presión arterial alta). Las farmacias minoristas de la red pueden ser las apropiadas para recetas a corto plazo (como antibióticos).

QL: Límites de cantidad. Para ciertos medicamentos, el plan limita la cantidad del medicamento que cubriremos.

PA: Autorización previa. El plan exige que usted o su médico obtengan autorización previa para ciertos medicamentos. Esto significa que usted deberá obtener autorización antes de surtir su receta. Si no recibe aprobación, es posible que no cubramos el medicamento.

ST: Tratamiento escalonado. En algunos casos, Clarion Health requiere que usted primero pruebe ciertos medicamentos para tratar su afección médica antes de cubrir otro medicamento para esa afección. Por ejemplo, si el medicamento A y el medicamento B tratan su afección médica, es posible que Clarion Health no cubra el medicamento B, excepto que usted pruebe primero el medicamento A. Si el medicamento A no le funciona, entonces Clarion Health cubrirá el medicamento B.

Índice de medicamentos

Clarion Health Plan 001Niveles de medicamentos

1 – Medicamentos genéricos preferidos $3 $6 $9

2 – Medicamentos genéricos $10 $20

3 – Medicamentos de marca preferidos y algunos genéricos

$45 $90

4 – Medicamentos de marca no preferidos y algunos genéricos

$95 $190

5 – Medicamentos de especialidad 33% N/A

6 – Medicamentos para cuidados especiales $0 $0

ACLARACIÓN: Se brindan medicamentos en centros de atención a largo plazo, hasta un suministro para 31 días.

Clarion Health es un plan HMO que tiene un contrato con Medicare. La inscripción en Clarion Health depende de la renovación de contrato. El Formulario y la red de farmacias pueden cambiar en cualquier momento. Usted recibirá un aviso cuando sea necesario.

ATENCIÓN: Si usted habla otros idiomas, tiene a su disposición, gratis, servicios de ayuda para idiomas. Llame al 844-824-8771 (TTY/TDD: 711).


PA - Autorización previa QL - Límites de cantidad ST - Tratamiento escalonado NM - No disponible por pedido por correo B/D - Cubierto bajo las Partes B o D de Medicare LA - Disponibilidad limitada GC - Cubrimos este medicamento con receta en el período sin cobertura. Consulte nuestra Evidencia de cobertura para obtener más información sobre esta cobertura. DL - Medicamento limitado a suministro de 30 días.ClarionHealth.org/DrugListChanges

1

Clarion Health 2020 Efectivo a partir del 01/01/2020

Nombre del medicamento Nivel del medicamento Requisitos/Límites

ANALGÉSICOS GOTA

allopurinol tab 100 mg 2 allopurinol tab 300 mg 2 colchicine w/ probenecid tab 0.5-500 mg 2 COLCRYS TAB 0.6MG 3 probenecid tab 500 mg 2 ULORIC TAB 40MG 4 QL (30 tabs / 30 days),

ST ULORIC TAB 80MG 4 QL (30 tabs / 30 days),

ST VARIOS

clonidine hcl inj (for epidural infusion) 100 mcg/ml

2 B/D

clonidine hcl inj (for epidural infusion) 500 mcg/ml

2 B/D

PRIALT INJ 25MCG/ML 4 NM PRIALT INJ 100MCG 4 NM

AINE celecoxib cap 50 mg 3 celecoxib cap 100 mg 3 celecoxib cap 200 mg 3 celecoxib cap 400 mg 3 diclofenac potassium tab 50 mg 2 diclofenac sodium tab delayed release 25 mg 2 diclofenac sodium tab delayed release 50 mg 2 diclofenac sodium tab delayed release 75 mg 2 diclofenac sodium tab er 24hr 100 mg 2 diflunisal tab 500 mg 2 etodolac cap 200 mg 2 etodolac cap 300 mg 2 etodolac cap 400 mg 2 etodolac tab 500 mg 2 fenoprofen calcium tab 600 mg 2 flurbiprofen tab 50mg 2 flurbiprofen tab 100mg 2 Ibu tab 600 mg 1 GC Ibu tab 800mg 1 GC


2

Nombre del medicamento Nivel del

medicamento Requisitos/Límites

ibuprofen susp 100 mg/5ml 1 GC ibuprofen tab 400 mg 1 GC ibuprofen tab 600 mg 1 GC ibuprofen tab 800 mg 1 GC meclofenamate sodium cap 50 mg 2 meclofenamate sodium cap 100 mg 2 meloxicam tab 7.5 mg 1 GC meloxicam tab 15 mg 1 GC nabumetone tab 500 mg 2 nabumetone tab 750 mg 2 naproxen dr tab 375mg 2 naproxen dr tab 500mg 2 naproxen sodium tab 275 mg 2 naproxen sodium tab 550 mg 2 naproxen susp 125 mg/5ml 1 GC naproxen tab 250 mg 1 GC naproxen tab 375 mg 1 GC naproxen tab 500 mg 1 GC piroxicam cap 10 mg 2 piroxicam cap 20 mg 2 salsalate tab 500 mg 2 salsalate tab 750 mg 2 sulindac tab 150 mg 2 sulindac tab 200 mg 2 tolmetin sodium tab 200 mg 2

ANALGÉSICOS OPIOIDES acetaminophen w/ codeine soln 120-12 mg/5ml

2 QL (4500 mL / 30 days); DL

acetaminophen w/ codeine tab 300-15 mg 2 QL (390 tabs / 30 days); DL



ascomp/cod cap 30mg 4 QL (180 caps / 30 days); DL

butalbital-acetaminophen-caff w/ cod cap 50-325-40-30 mg

4 QL (180 caps / 30 days); DL

butalbital-aspirin-caff w/ codeine cap 50- 325-40-30 mg

4 QL (180 caps / 30 days); DL

butorphanol tartrate nasal soln 10 mg/ml 3 QL (40mL / 30 days); DL

tramadol hcl tab 50 mg 2 QL (240 tabs / 30 days); DL


3



tramadol-acetaminophen tab 37.5-325 mg 2 QL (40 tabs / 5 days); DL

ANALGÉSICOS OPIOIDES, CII

endocet tab 2.5-325 2 QL (360 tabs / 30 days); DL

endocet tab 5-325mg 3 QL (360 tabs / 30 days); DL

endocet tab 7.5-325 3 QL (360 tabs / 30 days); DL

endocet tab 10-325mg 3 QL (360 tabs / 30 days); DL

FENTANYL CIT INJ 100MCG 3 DL

fentanyl citrate inj 0.05 mg/ml 3 DL fentanyl citrate lozenge on a handle 200 mcg fentanyl citrate lozenge on a handle 400 mcg fentanyl citrate lozenge on a handle 600 mcg fentanyl citrate lozenge on a handle 800 mcg fentanyl citrate lozenge on a handle 1200 mcg fentanyl citrate lozenge on a handle 1600 mcg fentanyl citrate pf soln cartridge 100 mcg/2ml fentanyl citrate preservative free (pf) inj 100 mcg/2ml

5 QL (120 lozenges / 30 days), PA; DL






3 DL

3 DL

fentanyl td patch 72hr 12 mcg/hr 3 QL (10 patches / 30 days), PA; DL





hydrocodone-acetaminophen soln 7.5-325 mg/15ml

3 QL (3600 mL / 30 days); DL

hydrocodone-acetaminophen soln 10-325 mg/15ml

4 DL

hydrocodone-acetaminophen tab 2.5-325 mg 3 QL (360 tabs / 30 days); DL


4



hydrocodone-acetaminophen tab 5-325 mg 3 QL (360 tabs / 30 days); DL

hydrocodone-acetaminophen tab 7.5-325 mg

3 QL (360 tabs / 30 days); DL

hydrocodone-acetaminophen tab 10-325 mg


hydrocodone-ibuprofen tab 7.5-200 mg 3 QL (150 tabs / 30 days); DL

hydromorphone hcl inj 1 mg/ml 4 DL hydromorphone hcl inj 4 mg/ml 4 DL hydromorphone hcl tab 2 mg 4 QL (180 tabs / 30 days);

DL hydromorphone hcl tab 4 mg 4 QL (180 tabs / 30 days);

DL hydromorphone hcl tab 8 mg 4 QL (180 tabs / 30 days);

DL levorphanol tartrate tab 2 mg 5 QL (240 tabs / 30 days);

DL levorphanol tartrate tab 3 mg 5 QL (180 tabs / 30 days);

DL lorcet hd tab 10-325mg 3 QL (360 tabs / 30 days);

DL lorcet plus tab 7.5-325 3 QL (360 tabs / 30 days);

DL lorcet tab 5-325mg 3 QL (360 tabs / 30 days);

DL methadone hcl conc 10 mg/ml 2 DL methadone hcl soln 5 mg/5ml 3 QL (2000 mL / 30

days); DL methadone hcl tab 5 mg 3 QL (90 tabs / 30 days);

DL methadone hcl tab 10 mg 3 QL (200 tabs / 30 days);

DL methadone hcl tab for oral susp 40 mg 2 DL MORPHINE SUL INJ 2MG/ML 3 QL (1000 mL / 30

days); DL MORPHINE SUL INJ 4MG/ML 3 QL (500 mL / 30 days);

DL MORPHINE SUL INJ 5MG/ML 3 QL (400 mL / 30 days);

DL MORPHINE SUL INJ 150/30ML 3 DL morphine sulfate inj 10 mg/ml 3 DL morphine sulfate iv soln 1 mg/ml 2 DL morphine sulfate iv soln pf 15 mg/ml 2 DL


5



morphine sulfate oral soln 10 mg/5ml 3 QL (900 mL / 30 days); DL

morphine sulfate oral soln 20 mg/5ml 3 QL (900 mL / 30 days); DL

morphine sulfate oral soln 100 mg/5ml (20 mg/ml)

3 QL (300 mL / 30 days); DL

morphine sulfate tab 15 mg 3 QL (180 tabs / 30 days); DL

morphine sulfate tab 30 mg 3 QL (180 tabs / 30 days); DL

morphine sulfate tab er 15 mg 4 QL (90 tabs / 30 days), PA; DL





oxycodone hcl cap 5 mg 3 QL (180 caps / 30 days); DL

oxycodone hcl conc 100 mg/5ml (20 mg/ml)

4 QL (180 mL / 30 days); DL

oxycodone hcl soln 5 mg/5ml 3 QL (900 mL / 30 days); DL

oxycodone hcl tab 5 mg 3 QL (180 tabs / 30 days); DL





oxycodone w/ acetaminophen tab 2.5-325 mg


oxycodone w/ acetaminophen tab 5-325 mg


oxycodone w/ acetaminophen tab 7.5-325 mg


oxycodone w/ acetaminophen tab 10-325 mg



6



oxymorphone hcl tab 5 mg 4 QL (180 tabs / 30 days); DL

oxymorphone hcl tab 10 mg 4 QL (180 tabs / 30 days); DL

ANESTÉSICOS

ANESTÉSICOS LOCALES lidocaine hcl local inj 1% 2 lidocaine hcl local preservative free (pf) inj 2 1.5% lidocaine hcl local preservative free (pf) inj 2 2% lidocaine hcl local preservative free (pf) inj 2 4%

ropivacaine hcl inj 2 mg/ml 2 ropivacaine hcl inj 5 mg/ml 2 ropivacaine hcl inj 7.5 mg/ml 2 ropivacaine hcl inj 10 mg/ml 2

ANTIINFECCIOSOS ANTIBACTERIANOS - VARIOS

amikacin sulfate inj 1 gm/4ml (250 mg/ml) 3 amikacin sulfate inj 500 mg/2ml (250 3 mg/ml)

ARIKAYCE SUS 5 QL (28 mL / 28 days), NM, LA, PA; DL

BETHKIS NEB 300/4ML 5 B/D, NM; DL gentamicin in saline inj 0.8 mg/ml 2 gentamicin in saline inj 1 mg/ml 2 gentamicin in saline inj 1.2 mg/ml 2 gentamicin in saline inj 1.6 mg/ml 2 gentamicin sulfate inj 40 mg/ml 2 neomycin sulfate tab 500 mg 2 paromomycin sulfate cap 250 mg 2 SULFADIAZINE TAB 500MG 3 TOBI PODHALR CAP 28MG 5 QL (224 caps / 56

days), NM, LA; DL tobramycin nebu soln 300 mg/5ml 5 B/D, NM; DL

tobramycin sulfate inj 10 mg/ml (base 2 equivalent)

tobramycin sulfate inj 80 mg/2ml (40 2 mg/ml) (base equiv)

ANTIINFECCIOSOS - VARIOS

albendazole tab 200 mg 3


7



ALINIA TAB 500MG 5 QL (40 tabs / 30 days); DL

atovaquone susp 750 mg/5ml 5 DL aztreonam for inj 1 gm 2 aztreonam for inj 2 gm 4 BILTRICIDE TAB 600MG 3 CAYSTON INH 75MG 5 QL (84 vials / 56 days),

NM, LA; DL clindamycin hcl cap 75 mg 2

clindamycin hcl cap 150 mg 2 clindamycin hcl cap 300 mg 2 clindamycin palmitate hcl for soln 75 mg/5ml (base equiv)

2

clindamycin phosphate in d5w iv soln 300 mg/50ml

2


2


2

clindamycin phosphate iv soln 300 mg/2ml 2

clindamycin phosphate iv soln 900 mg/6ml 2 colistimethate sod for inj 150 mg (colistin base activity)

5 DL

DALVANCE SOL 500MG 5 DL dapsone tab 25 mg 2 dapsone tab 100 mg 2 daptomycin for iv soln 500 mg 5 DL DAPTOMYCIN SOL 350MG 5 DL DARAPRIM TAB 25MG 5 DL ertapenem sodium for inj 1 gm (base equivalent)

3

FIRVANQ SOL 25MG/ML 4

FIRVANQ SOL 50MG/ML 4 imipenem-cilastatin intravenous for soln 250 mg

2

imipenem-cilastatin intravenous for soln 500 mg

2

ivermectin tab 3 mg 2 linezolid for susp 100 mg/5ml 5 DL linezolid iv soln 600 mg/300ml (2 mg/ml) 5 DL linezolid tab 600 mg 3 meropenem iv for soln 1 gm 3 meropenem iv for soln 500 mg 3 methenamine hippurate tab 1 gm 2


8



methenamine mandelate tab 0.5 gm 2 methenamine mandelate tab 1 gm 2 metronidazole cap 375 mg 3 metronidazole in nacl 0.79% iv soln 500 mg/100ml

2

metronidazole tab 250 mg 2

metronidazole tab 500 mg 2 MONUROL PAK GRANULES 4 NEBUPENT INH 300MG 4 B/D nitrofurantoin macrocrystalline cap 50 mg 2 nitrofurantoin macrocrystalline cap 100 mg 2 nitrofurantoin monohydrate macrocrystalline cap 100 mg

2

PENTAM 300 INJ 300MG 4

polymyxin b sulfate for inj 500000 unit 2 praziquantel tab 600 mg 3 SIVEXTRO INJ 200MG 5 QL (6 vials / 30 days);

DL SIVEXTRO TAB 200MG 5 QL (6 tabs / 30 days);

DL sulfamethoxazole-trimethoprim susp 200- 40 mg/5ml

2

sulfamethoxazole-trimethoprim tab 400-80 mg

1 GC

sulfamethoxazole-trimethoprim tab 800- 160 mg

1 GC

TIGECYCLINE FOR IV SOLN 50 MG 5 DL tinidazole tab 250 mg 2 tinidazole tab 500 mg 2 trimethoprim tab 100 mg 2 vancomycin hcl cap 125 mg (base equivalent)

3

vancomycin hcl cap 250 mg (base equivalent)

5 DL

vancomycin hcl for iv soln 1 gm (base equivalent)

3

vancomycin hcl for iv soln 10 gm (base equivalent)

3

vancomycin hcl for iv soln 500 mg (base equivalent)

3

XIFAXAN TAB 200MG 4 QL (9 tabs / 3 days)

ANTIFÚNGICOS ABELCET INJ 5MG/ML 5 B/D; DL AMBISOME INJ 50MG 5 B/D; DL


9



amphotericin b for iv soln 50 mg 2 B/D CASPOFUNGIN ACETATE FOR IV SOLN 50 MG

5 B/D; DL

CASPOFUNGIN ACETATE FOR IV SOLN 70 MG

5 B/D; DL

CRESEMBA CAP 186 MG 5 DL ERAXIS INJ 50MG 4 ERAXIS INJ 100MG 4 fluconazole for susp 10 mg/ml 2 fluconazole for susp 40 mg/ml 2 fluconazole in nacl 0.9% inj 200 mg/100ml 2 fluconazole in nacl 0.9% inj 400 mg/200ml 2 fluconazole tab 50 mg 2 fluconazole tab 100 mg 2 fluconazole tab 150 mg 2 fluconazole tab 200 mg 2 flucytosine cap 250 mg 5 DL flucytosine cap 500 mg 5 DL griseofulvin microsize susp 125 mg/5ml 2 griseofulvin microsize tab 500 mg 2 griseofulvin ultramicrosize tab 125 mg 2 griseofulvin ultramicrosize tab 250 mg 2 itraconazole cap 100 mg 4 QL (120 caps / 30

days), PA ketoconazole tab 200 mg 2 MYCAMINE INJ 50MG 5 DL MYCAMINE INJ 100MG 5 DL NOXAFIL SUS 40MG/ML 5 PA; DL NOXAFIL TAB 100MG 5 QL (93 tabs / 30 days),

PA; DL nystatin tab 500000 unit 2 terbinafine hcl tab 250 mg 1 GC voriconazole for inj 200 mg 2 voriconazole for susp 40 mg/ml 5 DL voriconazole tab 50 mg 5 DL voriconazole tab 200 mg 5 DL

ANTIPALÚDICOS atovaquone-proguanil hcl tab 62.5-25 mg 2 atovaquone-proguanil hcl tab 250-100 mg 2 chloroquine phosphate tab 250 mg 2 chloroquine phosphate tab 500 mg 2 COARTEM TAB 20-120MG 3 mefloquine hcl tab 250 mg 2


10



PRIMAQUINE PHOSPHATE TAB 26.3 MG (15 MG BASE)

3

quinine sulfate cap 324 mg 2 PA AGENTES ANTIRRETROVIRALES abacavir sulfate soln 20 mg/ml (base equiv)

4

abacavir sulfate tab 300 mg (base equiv) 3

APTIVUS CAP 250MG 5 DL APTIVUS SOL 5 DL atazanavir sulfate cap 150 mg (base equiv) 5 DL atazanavir sulfate cap 200 mg (base equiv) 5 DL atazanavir sulfate cap 300 mg (base equiv) 5 DL CRIXIVAN CAP 200MG 3 CRIXIVAN CAP 400MG 3 didanosine delayed release capsule 200 mg 2 didanosine delayed release capsule 250 mg 2 didanosine delayed release capsule 400 mg 2 EDURANT TAB 25MG 5 DL efavirenz cap 50 mg 4 efavirenz cap 200 mg 4 efavirenz tab 600 mg 5 DL EMTRIVA CAP 200MG 3 EMTRIVA SOL 10MG/ML 3 fosamprenavir calcium tab 700 mg (base equiv)

5 DL

FUZEON INJ 90MG 5 NM; DL INTELENCE TAB 25MG 4 INTELENCE TAB 100MG 5 DL INTELENCE TAB 200MG 5 DL INVIRASE TAB 500MG 5 DL ISENTRESS CHW 25MG 3 ISENTRESS CHW 100MG 3 ISENTRESS HD TAB 600MG 5 DL ISENTRESS POW 100MG 3 ISENTRESS TAB 400MG 5 DL lamivudine oral soln 10 mg/ml 2 lamivudine tab 150 mg 3 lamivudine tab 300 mg 3 LEXIVA SUS 50MG/ML 4 nevirapine susp 50 mg/5ml 4 nevirapine tab 200 mg 2 nevirapine tab er 24hr 100 mg 2 nevirapine tab er 24hr 400 mg 2


11



NORVIR POW 100MG 4 NORVIR SOL 80MG/ML 4 PIFELTRO TAB 100MG 5 QL (30 tabs / 30 days);

DL PREZISTA SUS 100MG/ML 4 PREZISTA TAB 75MG 4 PREZISTA TAB 150MG 5 DL PREZISTA TAB 600MG 5 DL PREZISTA TAB 800MG 5 DL RESCRIPTOR TAB 200MG 4 REYATAZ POW 50MG 5 DL ritonavir tab 100 mg 3 SELZENTRY SOL 20MG/ML 5 DL SELZENTRY TAB 25MG 4 SELZENTRY TAB 75MG 5 DL SELZENTRY TAB 150MG 5 DL SELZENTRY TAB 300MG 5 DL stavudine cap 15 mg 2 stavudine cap 20 mg 2 stavudine cap 30 mg 2 stavudine cap 40 mg 2 tenofovir disoproxil fumarate tab 300 mg 3 TIVICAY TAB 10MG 4 TIVICAY TAB 25MG 5 DL TIVICAY TAB 50MG 5 DL TYBOST TAB 150MG 3 VIDEX EC CAP 125MG 3 VIDEX SOL 4GM 4 VIRACEPT TAB 250MG 5 DL VIRACEPT TAB 625MG 5 DL VIREAD POW 40MG/GM 5 DL VIREAD TAB 150MG 5 DL VIREAD TAB 200MG 5 DL VIREAD TAB 250MG 5 DL zidovudine cap 100 mg 2 zidovudine syrup 10 mg/ml 2 zidovudine tab 300 mg 2

AGENTES ANTIRRETROVIRALES COMBINADOS abacavir sulfate-lamivudine tab 600-300 mg

3

abacavir sulfate-lamivudine-zidovudine tab 300-150-300 mg

5 DL

ATRIPLA TAB 5 DL


12



BIKTARVY TAB 5 DL CIMDUO TAB 300-300 5 DL COMPLERA TAB 5 DL DELSTRIGO TAB 5 QL (30 tabs / 30 days);

DL DESCOVY TAB 200/25 5 DL DOVATO TAB 50-300MG 5 QL (30 tabs / 30 days);

DL EVOTAZ TAB 300-150 5 DL GENVOYA TAB 5 DL JULUCA TAB 50-25MG 5 QL (30 tabs / 30 days);

DL KALETRA TAB 100-25MG 4 KALETRA TAB 200-50MG 5 DL lamivudine-zidovudine tab 150-300 mg 4 lopinavir-ritonavir soln 400-100 mg/5ml (80-20 mg/ml)

4

ODEFSEY TAB 5 DL PREZCOBIX TAB 800-150 5 DL STRIBILD TAB 5 DL SYMFI LO TAB 5 DL SYMFI TAB 5 DL SYMTUZA TAB 5 QL (30 tabs / 30 days);

DL TRIUMEQ TAB 5 DL TRUVADA TAB 100-150 5 DL TRUVADA TAB 133-200 5 DL TRUVADA TAB 167-250 5 DL TRUVADA TAB 200-300 5 DL AGENTES ANTITUBERCULOSOS ethambutol hcl tab 100 mg 2 ethambutol hcl tab 400 mg 2 isoniazid syrup 50 mg/5ml 1 GC isoniazid tab 100 mg 1 GC isoniazid tab 300 mg 1 GC PASER GRA 4GM 4 PRIFTIN TAB 150MG 4 pyrazinamide tab 500 mg 2 rifabutin cap 150 mg 2 RIFAMATE CAP 4 rifampin cap 150 mg 2 rifampin cap 300 mg 2 rifampin for inj 600 mg 2


13



RIFATER TAB 4 SIRTURO TAB 100MG 5 LA, PA; DL TRECATOR TAB 250MG 4

ANTIVIRALES acyclovir cap 200 mg 1 GC acyclovir sodium iv soln 50 mg/ml 2 B/D acyclovir susp 200 mg/5ml 2 acyclovir tab 400 mg 2 acyclovir tab 800 mg 2 adefovir dipivoxil tab 10 mg 5 PA; DL BARACLUDE SOL .05MG/ML 4 PA entecavir tab 0.5 mg 4 PA entecavir tab 1 mg 4 PA EPCLUSA TAB 400-100 5 QL (28 tabs / 28 days),

NM, PA; DL EPIVIR HBV SOL 5MG/ML 4 famciclovir tab 125 mg 2 famciclovir tab 250 mg 2 famciclovir tab 500 mg 2 foscarnet sodium inj 24 mg/ml 2 B/D HARVONI TAB 90-400MG 5 QL (28 tabs / 28 days),

NM, PA; DL lamivudine tab 100 mg (hbv) 3

MAVYRET TAB 100-40MG 5 QL (84 tabs / 28 days), NM, PA; DL

oseltamivir phosphate cap 30 mg (base equiv)

3 QL (84 caps / 180 days)





oseltamivir phosphate for susp 6 mg/ml (base equiv)

3 QL (525 mL / 180 days)

PEGASYS INJ 5 QL (4 injections / 28 days), NM; DL

PEGASYS INJ 180MCG/M 5 QL (4 injections / 28 days), NM; DL

PEGASYS INJ PROCLICK 5 QL (4 injections / 28 days), NM; DL

REBETOL SOL 40MG/ML 5 NM; DL RELENZA MIS DISKHALE 3 QL (120 blisters / 365

days) ribasphere cap 200mg 2 NM ribasphere tab 600mg 5 NM; DL


14



ribavirin cap 200 mg 2 NM ribavirin tab 200 mg 2 NM rimantadine hydrochloride tab 100 mg 2 SOVALDI TAB 400MG 5 QL (30 tabs / 30 days),

NM, PA; DL valacyclovir hcl tab 1 gm 2

valacyclovir hcl tab 500 mg 2 valganciclovir hcl for soln 50 mg/ml (base equiv)

5 DL

valganciclovir hcl tab 450 mg (base equivalent)

5 DL

VEMLIDY TAB 25MG 5 PA; DL VOSEVI TAB 5 QL (28 tabs / 28 days),

NM, PA; DL XOFLUZA TAB 20MG 4 QL (4 tabs / 365 days) XOFLUZA TAB 40MG 4 QL (4 tabs / 365 days) ZEPATIER TAB 50-100MG 5 QL (28 tabs / 28 days),

NM, PA; DL CEFALOSPORINAS AVYCAZ INJ 2-0.5GM 5 DL cefaclor cap 250 mg 2 cefaclor cap 500 mg 2 CEFACLOR ER TAB 500MG 3 cefadroxil cap 500 mg 2 cefadroxil for susp 250 mg/5ml 2 cefadroxil for susp 500 mg/5ml 2 cefadroxil tab 1 gm 2 cefazolin sodium for inj 1 gm 2 cefazolin sodium for inj 10 gm 2 cefazolin sodium for inj 500 mg 2 cefdinir cap 300 mg 2 cefdinir for susp 125 mg/5ml 2 cefdinir for susp 250 mg/5ml 2 cefepime hcl for inj 1 gm 2 cefepime hcl for inj 2 gm 3 cefotaxime sodium for inj 10 gm 2 cefotetan disodium for inj 1 gm 2 cefotetan disodium for inj 2 gm 2 cefotetan disodium for inj 10 gm 2 cefoxitin sodium for inj 10 gm 2 cefoxitin sodium for iv soln 1 gm 2 cefoxitin sodium for iv soln 2 gm 2 cefpodoxime proxetil for susp 50 mg/5ml 2


15



cefpodoxime proxetil for susp 100 mg/5ml 2 cefpodoxime proxetil tab 100 mg 2 cefpodoxime proxetil tab 200 mg 2 cefprozil for susp 125 mg/5ml 2 cefprozil for susp 250 mg/5ml 2 cefprozil tab 250 mg 2 cefprozil tab 500 mg 2 ceftazidime for inj 1 gm 2 ceftazidime for inj 2 gm 2 ceftazidime for inj 6 gm 2 ceftibuten cap 400 mg 2 ceftibuten for susp 180 mg/5ml 2 ceftriaxone sodium for inj 1 gm 2 ceftriaxone sodium for inj 2 gm 2 ceftriaxone sodium for inj 10 gm 2 ceftriaxone sodium for inj 250 mg 2 ceftriaxone sodium for inj 500 mg 2 cefuroxime axetil tab 250 mg 2 cefuroxime axetil tab 500 mg 2 cefuroxime sodium for inj 750 mg 2 cefuroxime sodium for iv soln 1.5 gm 2 cephalexin cap 250 mg 1 GC cephalexin cap 500 mg 1 GC cephalexin for susp 125 mg/5ml 3 cephalexin for susp 250 mg/5ml 1 GC cephalexin tab 250 mg 3 cephalexin tab 500 mg 3 SUPRAX CAP 400MG 4 SUPRAX CHW 100MG 4 SUPRAX CHW 200MG 4 TEFLARO INJ 400MG 4 TEFLARO INJ 600MG 5 DL ZERBAXA INJ 1.5GM 5 DL ERITROMICINAS/MACRÓLIDOS azithromycin for susp 100 mg/5ml 2 azithromycin for susp 200 mg/5ml 2 azithromycin iv for soln 500 mg 2 azithromycin powd pack for susp 1 gm 2 azithromycin tab 250 mg 2 azithromycin tab 500 mg 2 azithromycin tab 600 mg 2 clarithromycin for susp 125 mg/5ml 2 clarithromycin for susp 250 mg/5ml 2


16



clarithromycin tab 250 mg 2 clarithromycin tab 500 mg 2 clarithromycin tab er 24hr 500 mg 2 DIFICID TAB 200MG 5 QL (20 tabs / 10 days),

ST; DL e.e.s. 400 tab 400mg 2

ery-tab tab 250mg ec 4 ery-tab tab 333mg ec 4 ery-tab tab 500mg ec 4 ERYTHROCIN INJ 500MG 4 erythrocin tab 250mg 4 erythromycin ethylsuccinate for susp 200 mg/5ml

2

erythromycin ethylsuccinate tab 400 mg 3

erythromycin tab 250 mg 3 erythromycin tab 500 mg 3 erythromycin w/ delayed release particles cap 250 mg

3

FLUOROQUINOLONAS ciprofloxacin 200 mg/100ml in d5w 2 ciprofloxacin 400 mg/200ml in d5w 2 ciprofloxacin hcl tab 100 mg (base equiv) 1 GC ciprofloxacin hcl tab 250 mg (base equiv) 1 GC ciprofloxacin hcl tab 500 mg (base equiv) 1 GC ciprofloxacin hcl tab 750 mg (base equiv) 1 GC ciprofloxacin iv soln 200 mg/20ml (1%) 2 levofloxacin in d5w iv soln 250 mg/50ml 2 levofloxacin in d5w iv soln 500 mg/100ml 2 levofloxacin in d5w iv soln 750 mg/150ml 2 levofloxacin iv soln 25 mg/ml 2 levofloxacin oral soln 25 mg/ml 2 levofloxacin tab 250 mg 2 levofloxacin tab 500 mg 2 levofloxacin tab 750 mg 2 moxifloxacin hcl 400 mg/250ml in sodium chloride 0.8% inj

4

moxifloxacin hcl tab 400 mg (base equiv) 2

ofloxacin tab 300 mg 2 ofloxacin tab 400 mg 2

PENICILINAS amoxicillin & k clavulanate chew tab 200- 2 28.5 mg


17



amoxicillin & k clavulanate chew tab 400- 57 mg

2

amoxicillin & k clavulanate for susp 200- 28.5 mg/5ml

2


2

amoxicillin & k clavulanate for susp 400-57 mg/5ml

2


2

amoxicillin & k clavulanate tab 250-125 mg 2 amoxicillin & k clavulanate tab 500-125 mg 2 amoxicillin & k clavulanate tab 875-125 mg 2 amoxicillin & k clavulanate tab er 12hr 1000-62.5 mg

3

amoxicillin (trihydrate) cap 250 mg 1 GC amoxicillin (trihydrate) cap 500 mg 1 GC amoxicillin (trihydrate) chew tab 125 mg 1 GC amoxicillin (trihydrate) chew tab 250 mg 1 GC amoxicillin (trihydrate) for susp 125 mg/5ml

1 GC

amoxicillin (trihydrate) for susp 200 mg/5ml

1 GC


1 GC


1 GC

amoxicillin (trihydrate) tab 500 mg 1 GC amoxicillin (trihydrate) tab 875 mg 1 GC ampicillin & sulbactam sodium for inj 1.5 (1-0.5) gm

2

ampicillin & sulbactam sodium for inj 3 (2- 1) gm

2

ampicillin & sulbactam sodium for inj 15 (10-5) gm

2

ampicillin cap 500 mg 2

ampicillin sodium for inj 1 gm 2 ampicillin sodium for inj 2 gm 2 ampicillin sodium for inj 125 mg 2 ampicillin sodium for inj 250 mg 2 ampicillin sodium for inj 500 mg 2 ampicillin sodium for iv soln 2 gm 2 ampicillin sodium for iv soln 10 gm 2 BACTOCILL INJ DEX 1GM 3


18



BACTOCILL INJ DEX 2GM 3 BICILLIN C-R INJ 900/300 4 BICILLIN C-R INJ 1200000 4 BICILLIN L-A INJ 600000 4 BICILLIN L-A INJ 1200000 4 BICILLIN L-A INJ 2400000 4 dicloxacillin sodium cap 250 mg 2 dicloxacillin sodium cap 500 mg 2 nafcillin sodium for inj 2 gm 3 nafcillin sodium for iv soln 2 gm 4 nafcillin sodium for iv soln 10 gm 5 DL oxacillin sodium for inj 1 gm (base equivalent)

2

oxacillin sodium for inj 2 gm (base equivalent)

2

oxacillin sodium for inj 10 gm (base equivalent)

5 DL

PEN G PROC INJ 600000 3

PENICILL GK/ INJ DEX 2MU 4 PENICILL GK/ INJ DEX 3MU 4 penicillin g potassium for inj 20000000 unit 2 penicillin g sodium for inj 5000000 unit 5 DL penicillin v potassium for soln 125 mg/5ml 1 GC penicillin v potassium for soln 250 mg/5ml 1 GC penicillin v potassium tab 250 mg 1 GC penicillin v potassium tab 500 mg 1 GC pfizerpen inj 20mu 2 piperacillin sod-tazobactam na for inj 3.375 gm (3-0.375 gm)

3

piperacillin sod-tazobactam sod for inj 2.25 gm (2-0.25 gm)

3


3


3

ZOSYN SOL 2-0.25GM 4 ZOSYN SOL 3-0.375G 4 ZOSYN SOL 4-0.50GM 4

TETRACICLINAS doxy 100 inj 100mg 2 doxycycline hyclate cap 50 mg 2 doxycycline hyclate cap 100 mg 2 doxycycline hyclate tab 20 mg 2


19



doxycycline hyclate tab 100 mg 2 doxycycline monohydrate cap 50 mg 2 doxycycline monohydrate cap 100 mg 2 doxycycline monohydrate for susp 25 mg/5ml

3

doxycycline monohydrate tab 50 mg 2

doxycycline monohydrate tab 75 mg 2 doxycycline monohydrate tab 100 mg 2 doxycycline monohydrate tab 150 mg 2 minocycline hcl cap 50 mg 2 minocycline hcl cap 75 mg 2 minocycline hcl cap 100 mg 2 morgidox cap 1x50mg 2 NUZYRA INJ 100MG 5 DL NUZYRA TAB 150MG 5 DL tetracycline hcl cap 250 mg 2 tetracycline hcl cap 500 mg 2 VIBRAMYCIN SYP 50MG/5ML 4

AGENTES ANTINEOPLÁSICOS AGENTES ALQUILANTES

BENDEKA INJ 100/4ML 5 NM; DL CYCLOPHOSPHAMIDE CAP 25 MG 3 B/D CYCLOPHOSPHAMIDE CAP 50 MG 3 B/D cyclophosphamide for inj 1 gm 4 B/D cyclophosphamide for inj 2 gm 4 B/D cyclophosphamide for inj 500 mg 4 B/D dacarbazine for inj 100 mg 2 EMCYT CAP 140MG 4 GLEOSTINE CAP 10MG 4 PA GLEOSTINE CAP 40MG 4 PA GLEOSTINE CAP 100MG 4 PA IFOSFAMIDE INJ 3GM 3 ifosfamide iv inj 1 gm/20ml (50 mg/ml) 2 ifosfamide iv inj 3 gm/60ml (50 mg/ml) 2 LEUKERAN TAB 2MG 4 TEMODAR INJ 100MG 5 DL

ANTRACICLINAS doxorubicin hcl for inj 10 mg 2 doxorubicin hcl for inj 50 mg 2 epirubicin hcl iv soln 50 mg/25ml (2 2 mg/ml)


20



ANTIBIÓTICOS bleomycin sulfate for inj 15 unit 2 VALSTAR SOL 40MG/ML 5 DL

ANTIMETABOLITOS ALIMTA INJ 100MG 5 DL cytarabine inj pf 20 mg/ml 2 B/D floxuridine for inj 0.5 gm 2 fludarabine phosphate inj 25 mg/ml 2 fluorouracil iv soln 1 gm/20ml (50 mg/ml) 2 gemcitabine hcl for inj 2 gm 5 DL gemcitabine hcl for inj 200 mg 5 DL gemcitabine hcl inj 1 gm/26.3ml (38 mg/ml) (base equiv)

5 DL

gemcitabine hcl inj 2 gm/52.6ml (38 mg/ml) (base equiv)

5 DL

gemcitabine inj 200mg 5 DL mercaptopurine tab 50 mg 2 methotrexate sodium inj 25 mg/ml 2 B/D methotrexate sodium inj 50 mg/2ml (25 mg/ml)

2 B/D

methotrexate sodium inj pf 50 mg/2ml (25 mg/ml)

2 B/D

PURIXAN SUS 20MG/ML 5 NM, PA; DL TABLOID TAB 40MG 4 PA

MODIFICADORES BIOLÓGICOS DE LA RESPUESTA

ARZERRA CON 100/5ML 5 B/D; DL BLINCYTO INJ 35MCG 5 NM; DL CAMPATH INJ 30MG/ML 5 DL DARZALEX SOL 400MG/20 5 NM, LA; DL DAURISMO TAB 25MG 5 QL (120 tabs / 30 days),

NM, LA, PA; DL DAURISMO TAB 100MG 5 QL (30 tabs / 30 days),

NM, LA, PA; DL ERBITUX INJ 200MG 5 DL ERIVEDGE CAP 150MG 5 QL (30 caps / 30 days),

NM, LA, PA; DL FARYDAK CAP 10MG 5 QL (12 caps / 21 days),



NM, LA, PA; DL GAZYVA INJ 25MG/ML 5 LA; DL


21



IBRANCE CAP 75MG 5 QL (42 caps / 28 days), NM, LA, PA; DL



IDHIFA TAB 50MG 5 QL (30 tabs / 30 days), NM, LA, PA; DL

IDHIFA TAB 100MG 5 QL (30 tabs / 30 days), NM, LA, PA; DL

KISQALI 200 PAK FEMARA 5 QL (49 tabs / 28 days), NM, PA; DL



KISQALI TAB 200DOSE 5 QL (63 tabs / 28 days), NM, PA; DL



LYNPARZA TAB 100MG 5 QL (180 tabs / 30 days), NM, LA, PA; DL

LYNPARZA TAB 150MG 5 QL (120 tabs / 30 days), NM, LA, PA; DL

NINLARO CAP 2.3MG 5 QL (6 caps / 28 days), NM, PA; DL

NINLARO CAP 3MG 5 QL (6 caps / 28 days), NM, PA; DL

NINLARO CAP 4MG 5 QL (3 caps / 28 days), NM, PA; DL

ODOMZO CAP 200MG 5 QL (30 caps / 30 days), NM, LA, PA; DL

PORTRAZZA INJ 800/50ML 5 B/D, NM, LA; DL RUBRACA TAB 200MG 5 NM, LA, PA; DL RUBRACA TAB 250MG 5 NM, LA, PA; DL RUBRACA TAB 300MG 5 NM, LA, PA; DL TALZENNA CAP 0.25MG 5 QL (120 caps / 30

days), NM, LA, PA; DL TALZENNA CAP 1MG 5 QL (30 caps / 30 days),

NM, LA, PA; DL TIBSOVO TAB 250MG 5 QL (60 tabs / 30 days),

NM, LA, PA; DL UNITUXIN INJ 5 NM; DL


22



VECTIBIX INJ 400MG 5 B/D; DL VENCLEXTA TAB 10MG 3 QL (1200 tabs / 30

days), NM, LA, PA VENCLEXTA TAB 50MG 3 QL (240 tabs / 30 days),

NM, LA, PA VENCLEXTA TAB 100MG 5 QL (120 tabs / 30 days),

NM, LA, PA; DL VENCLEXTA TAB START PK 5 QL (84 tabs / year), NM,

LA, PA; DL VERZENIO TAB 50MG 5 QL (56 tabs / 28 days),

NM, LA, PA; DL VERZENIO TAB 100MG 5 QL (56 tabs / 28 days),



NM, LA, PA; DL YERVOY INJ 200MG 5 DL ZALTRAP INJ 200/8ML 5 LA; DL ZEJULA CAP 100MG 5 QL (90 caps / 30 days),

NM, LA, PA; DL ZOLINZA CAP 100MG 5 QL (120 caps / 30

days), NM, PA; DL AGENTES ANTINEOPLÁSICOS HORMONALES abiraterone acetate tab 250 mg 5 QL (120 tabs / 30 days),

NM, PA; DL anastrozole tab 1 mg 2

bicalutamide tab 50 mg 2 DEPO-PROVERA INJ 400/ML 4 ELIGARD INJ 7.5MG 4 QL (1 kit / 28 days),

NM, PA ELIGARD INJ 22.5MG 4 QL (1 kit / 84 days),

NM, PA ELIGARD INJ 30MG 4 QL (1 kit / 112 days),

NM, PA ELIGARD INJ 45MG 4 QL (1 kit / 168 days),

NM, PA ERLEADA TAB 60MG 5 NM, LA, PA; DL exemestane tab 25 mg 4 FARESTON TAB 60MG 5 PA; DL FIRMAGON INJ 80MG 4 QL (12 vials / 28 days),

NM, PA FIRMAGON INJ 120MG 5 QL (4 vials / 365 days),

NM, PA; DL flutamide cap 125 mg 2


23



letrozole tab 2.5 mg 2

leuprolide acetate inj kit 5 mg/ml 2 NM, PA

LUPRON DEPOT INJ 3.75MG 5 QL (1 kit / 28 days), NM, PA; DL




LUPRON DEPOT INJ 30MG 5 QL (1 kit / 84 days), NM, PA; DL

LUPRON DEPOT INJ 45MG 5 QL (1 kit / 168 days), NM, PA; DL

LYSODREN TAB 500MG 5 DL

megestrol acetate susp 40 mg/ml 2 PA

megestrol acetate tab 20 mg 2 PA

megestrol acetate tab 40 mg 2 PA

nilutamide tab 150 mg 5 DL SOLTAMOX SOL 10MG/5ML 4 tamoxifen citrate tab 10 mg (base equivalent) tamoxifen citrate tab 20 mg (base equivalent) toremifene citrate tab 60 mg (base equivalent)

2

2

5 PA; DL

TRELSTAR MIX INJ 3.75MG 5 QL (1 injection / 28 days), NM, PA; DL



XTANDI CAP 40MG 5 QL (120 caps / 30 days), NM, LA, PA; DL

ZYTIGA TAB 500MG 5 QL (60 tabs / 30 days), NM, LA, PA; DL

INMUNOMODULADORES

POMALYST CAP 1MG 5 QL (84 caps / 28 days), NM, LA, PA; DL




24



REVLIMID CAP 2.5MG 5 QL (210 caps / 28 days), NM, LA, PA; DL

REVLIMID CAP 5MG 5 QL (105 caps / 28 days), NM, LA, PA; DL





THALOMID CAP 50MG 5 NM, PA; DL THALOMID CAP 100MG 5 NM, PA; DL THALOMID CAP 150MG 5 QL (90 caps / 30 days),

NM, PA; DL THALOMID CAP 200MG 5 QL (60 caps / 30 days),

NM, PA; DL INHIBIDORES DE LA CINASA AFINITOR DIS TAB 2MG 5 NM, PA; DL AFINITOR DIS TAB 3MG 5 NM, PA; DL AFINITOR DIS TAB 5MG 5 NM, PA; DL AFINITOR TAB 2.5MG 5 QL (120 tabs / 30 days),

NM, PA; DL AFINITOR TAB 5MG 5 QL (60 tabs / 30 days),

NM, PA; DL AFINITOR TAB 7.5MG 5 QL (60 tabs / 30 days),

NM, PA; DL AFINITOR TAB 10MG 5 QL (30 tabs / 30 days),

NM, PA; DL ALECENSA CAP 150MG 5 QL (240 caps / 30

days), NM, LA, PA; DL ALUNBRIG PAK 5 QL (60 tabs / 365 days),

NM, LA, PA; DL ALUNBRIG TAB 30MG 5 QL (180 tabs / 30 days),



NM, LA, PA; DL BALVERSA TAB 3MG 5 QL (90 tabs / 30 days),

NM, LA, PA; DL BALVERSA TAB 4MG 5 QL (60 tabs / 30 days),

NM, LA, PA; DL


25



BALVERSA TAB 5MG 5 QL (30 tabs / 30 days), NM, LA, PA; DL

BOSULIF TAB 100MG 5 QL (180 tabs / 30 days), NM, PA; DL



BRAFTOVI CAP 75MG 5 QL (180 caps / 30 days), NM, LA, PA; DL

CABOMETYX TAB 20MG 5 QL (90 tabs / 30 days), NM, LA, PA; DL



CALQUENCE CAP 100MG 5 QL (60 caps / 30 days), NM, LA, PA; DL

CAPRELSA TAB 100MG 5 QL (90 tabs / 30 days), NM, LA, PA; DL

CAPRELSA TAB 300MG 5 QL (30 tabs / 30 days), NM, LA, PA; DL

COMETRIQ KIT 60MG 5 QL (252 caps / 28 days), NM, LA, PA; DL



COPIKTRA CAP 15MG 5 QL (56 caps / 28 days), NM, LA, PA; DL

COPIKTRA CAP 25MG 5 QL (56 caps / 28 days), NM, LA, PA; DL

COTELLIC TAB 20MG 5 QL (63 tabs / 28 days), NM, LA, PA; DL

erlotinib hcl tab 25 mg (base equivalent) 5 NM, PA; DL erlotinib hcl tab 100 mg (base equivalent) 5 QL (150 tabs / 30 days),

NM, PA; DL erlotinib hcl tab 150 mg (base equivalent) 5 QL (90 tabs / 30 days),

NM, PA; DL GILOTRIF TAB 20MG 5 QL (60 tabs / 30 days),

NM, LA, PA; DL GILOTRIF TAB 30MG 5 QL (60 tabs / 30 days),

NM, LA, PA; DL GILOTRIF TAB 40MG 5 QL (30 tabs / 30 days),

NM, LA, PA; DL


26



ICLUSIG TAB 15MG 5 QL (90 tabs / 30 days), NM, LA, PA; DL

ICLUSIG TAB 45MG 5 QL (30 tabs / 30 days), NM, LA, PA; DL

imatinib mesylate tab 100 mg (base equivalent)

5 QL (240 tabs / 30 days), NM, PA; DL

imatinib mesylate tab 400 mg (base equivalent)

5 QL (60 tabs / 30 days), NM, PA; DL

IMBRUVICA CAP 70MG 5 QL (224 caps / 28 days), NM, LA, PA; DL

IMBRUVICA CAP 140MG 5 QL (120 caps / 30 days), NM, LA, PA; DL

IMBRUVICA TAB 140MG 5 QL (112 tabs / 28 days), NM, LA, PA; DL




INLYTA TAB 1MG 5 QL (600 tabs / 30 days), NM, LA, PA; DL

INLYTA TAB 5MG 5 QL (120 tabs / 30 days), NM, LA, PA; DL

IRESSA TAB 250MG 5 QL (30 tabs / 30 days), NM, LA, PA; DL

JAKAFI TAB 5MG 5 QL (300 tabs / 30 days), NM, LA, PA; DL





LENVIMA CAP 4MG 5 QL (180 caps / 30 days), NM, LA, PA; DL

LENVIMA CAP 8 MG 5 QL (180 caps / 30 days), NM, LA, PA; DL


LENVIMA CAP 12MG 5 QL (180 caps / 30 days), NM, LA, PA; DL


27







LORBRENA TAB 25MG 5 QL (120 tabs / 30 days), NM, LA, PA; DL

LORBRENA TAB 100MG 5 QL (30 tabs / 30 days), NM, LA, PA; DL

MEKINIST TAB 0.5MG 5 QL (120 tabs / 30 days), NM, LA, PA; DL

MEKINIST TAB 2MG 5 QL (30 tabs / 30 days), NM, LA, PA; DL

MEKTOVI TAB 15MG 5 QL (180 tabs / 30 days), NM, LA, PA; DL

NERLYNX TAB 40MG 5 QL (180 tabs / 30 days), NM, LA, PA; DL

NEXAVAR TAB 200MG 5 QL (120 tabs / 30 days), NM, LA, PA; DL

PIQRAY 200MG TAB DOSE 5 QL (28 tabs / 28 days), NM, PA; DL



RYDAPT CAP 25MG 5 QL (224 caps / 28 days), NM, PA; DL

SPRYCEL TAB 20MG 5 QL (270 tabs / 30 days), NM, PA; DL






STIVARGA TAB 40MG 5 QL (84 tabs / 28 days), NM, LA, PA; DL


28



SUTENT CAP 12.5MG 5 QL (210 caps / 30 days), NM, PA; DL

SUTENT CAP 25MG 5 QL (120 caps / 30 days), NM, PA; DL

SUTENT CAP 37.5MG 5 QL (90 caps / 30 days), NM, PA; DL

SUTENT CAP 50MG 5 QL (60 caps / 30 days), NM, PA; DL

TAFINLAR CAP 50MG 5 QL (180 caps / 30 days), NM, LA, PA; DL

TAFINLAR CAP 75MG 5 QL (120 caps / 30 days), NM, LA, PA; DL

TAGRISSO TAB 40MG 5 QL (60 tabs / 30 days), NM, LA, PA; DL

TAGRISSO TAB 80MG 5 QL (30 tabs / 30 days), NM, LA, PA; DL

TASIGNA CAP 50MG 5 QL (480 caps / 30 days), NM, PA; DL



TYKERB TAB 250MG 5 QL (180 tabs / 30 days), NM, LA, PA; DL

VITRAKVI CAP 25MG 5 QL (240 caps / 30 days), NM, LA, PA; DL

VITRAKVI CAP 100MG 5 QL (60 caps / 30 days), NM, LA, PA; DL

VITRAKVI SOL 20MG/ML 5 QL (300 mL / 30 days), NM, LA, PA; DL

VIZIMPRO TAB 15MG 5 QL (90 tabs / 30 days), NM, LA, PA; DL



VOTRIENT TAB 200MG 5 QL (120 tabs / 30 days), NM, LA, PA; DL

XALKORI CAP 200MG 5 QL (90 caps / 30 days), NM, LA, PA; DL

XALKORI CAP 250MG 5 QL (60 caps / 30 days), NM, LA, PA; DL

XOSPATA TAB 40MG 5 QL (90 tabs / 30 days), NM, LA, PA; DL


29



ZELBORAF TAB 240MG 5 QL (240 tabs / 30 days), NM, LA, PA; DL

ZYDELIG TAB 100MG 5 QL (90 tabs / 30 days), NM, LA, PA; DL

ZYDELIG TAB 150MG 5 QL (60 tabs / 30 days), NM, LA, PA; DL

ZYKADIA CAP 150MG 5 QL (150 caps / 30 days), NM, LA, PA; DL

ZYKADIA TAB 150MG 5 QL (150 tabs / 30 days), NM, LA, PA; DL

VARIOS bexarotene cap 75 mg 5 NM, PA; DL hydroxyurea cap 500 mg 2 IXEMPRA KIT INJ 15MG 5 DL IXEMPRA KIT INJ 45MG 5 DL LONSURF TAB 15-6.14 5 NM, PA; DL LONSURF TAB 20-8.19 5 NM, PA; DL MATULANE CAP 50MG 5 LA; DL SYLATRON KIT 200MCG 5 DL SYLATRON KIT 300MCG 5 DL SYLATRON KIT 600MCG 5 DL SYLVANT SOL 400MG 5 NM, LA, PA; DL SYNRIBO INJ 3.5MG 5 NM; DL THERACYS INJ 4 TICE BCG INJ 4 tretinoin cap 10 mg 5 DL AGENTES CON PLATINO oxaliplatin for iv inj 50 mg 4 oxaliplatin iv soln 50 mg/10ml 4

AGENTES DE PROTECCIÓN dexrazoxane hcl for inj 500 mg (base equivalent)

5 DL

leucovorin calcium tab 5 mg 2 leucovorin calcium tab 10 mg 2 leucovorin calcium tab 15 mg 2 leucovorin calcium tab 25 mg 2 MESNEX TAB 400MG 4

INHIBIDORES DE LA TOPOISOMERASA irinotecan hcl inj 40 mg/2ml (20 mg/ml) 3 irinotecan hcl inj 500 mg/25ml (20 mg/ml) 3


30



CARDIOVASCULARES COMBINACIONES DE INHIBIDORES DE LA ECA amlodipine besylate-benazepril hcl cap 2.5- 10 mg amlodipine besylate-benazepril hcl cap 5- 10 mg amlodipine besylate-benazepril hcl cap 5- 20 mg amlodipine besylate-benazepril hcl cap 5- 40 mg amlodipine besylate-benazepril hcl cap 10- 20 mg amlodipine besylate-benazepril hcl cap 10- 40 mg benazepril & hydrochlorothiazide tab 5- 6.25 mg benazepril & hydrochlorothiazide tab 10- 12.5 mg benazepril & hydrochlorothiazide tab 20- 12.5 mg benazepril & hydrochlorothiazide tab 20-25 mg captopril & hydrochlorothiazide tab 25-15 mg captopril & hydrochlorothiazide tab 25-25 mg captopril & hydrochlorothiazide tab 50-15 mg captopril & hydrochlorothiazide tab 50-25 mg enalapril maleate & hydrochlorothiazide tab 5-12.5 mg enalapril maleate & hydrochlorothiazide tab 10-25 mg fosinopril sodium & hydrochlorothiazide tab 10-12.5 mg fosinopril sodium & hydrochlorothiazide tab 20-12.5 mg lisinopril & hydrochlorothiazide tab 10-12.5 mg lisinopril & hydrochlorothiazide tab 20-12.5 mg lisinopril & hydrochlorothiazide tab 20-25 mg

2

2

2

2

2

2

2

2

2

2

2

2

2

2

6 GC

6 GC

2

2

6 GC

6 GC

6 GC


31



quinapril-hydrochlorothiazide tab 10-12.5 mg

1 GC

quinapril-hydrochlorothiazide tab 20-12.5 mg

1 GC

quinapril-hydrochlorothiazide tab 20-25 mg 1 GC

INHIBIDORES DE LA ECA benazepril hcl tab 5 mg 6 GC benazepril hcl tab 10 mg 6 GC benazepril hcl tab 20 mg 6 GC benazepril hcl tab 40 mg 6 GC captopril tab 12.5 mg 2 captopril tab 25 mg 2 captopril tab 50 mg 2 captopril tab 100 mg 2 enalapril maleate tab 2.5 mg 1 GC enalapril maleate tab 5 mg 1 GC enalapril maleate tab 10 mg 1 GC enalapril maleate tab 20 mg 1 GC fosinopril sodium tab 10 mg 6 GC fosinopril sodium tab 20 mg 6 GC fosinopril sodium tab 40 mg 6 GC lisinopril tab 2.5 mg 6 GC lisinopril tab 5 mg 6 GC lisinopril tab 10 mg 6 GC lisinopril tab 20 mg 6 GC lisinopril tab 30 mg 6 GC lisinopril tab 40 mg 6 GC moexipril hcl tab 7.5 mg 2 moexipril hcl tab 15 mg 2 perindopril erbumine tab 2 mg 2 perindopril erbumine tab 4 mg 2 perindopril erbumine tab 8 mg 2 quinapril hcl tab 5 mg 6 GC quinapril hcl tab 10 mg 6 GC quinapril hcl tab 20 mg 6 GC quinapril hcl tab 40 mg 6 GC ramipril cap 1.25 mg 6 GC ramipril cap 2.5 mg 6 GC ramipril cap 5 mg 6 GC ramipril cap 10 mg 6 GC trandolapril tab 1 mg 6 GC trandolapril tab 2 mg 6 GC trandolapril tab 4 mg 6 GC


32



ANTAGONISTAS DE LOS RECEPTORES DE LA ALDOSTERONA eplerenone tab 25 mg 2 eplerenone tab 50 mg 2 spironolactone tab 25 mg 1 GC spironolactone tab 50 mg 1 GC spironolactone tab 100 mg 1 GC

ALFABLOQUEANTES doxazosin mesylate tab 1 mg 2 doxazosin mesylate tab 2 mg 2 doxazosin mesylate tab 4 mg 2 doxazosin mesylate tab 8 mg 2 prazosin hcl cap 1 mg 2 prazosin hcl cap 2 mg 2 prazosin hcl cap 5 mg 2 terazosin hcl cap 1 mg (base equivalent) 1 GC terazosin hcl cap 2 mg (base equivalent) 1 GC terazosin hcl cap 5 mg (base equivalent) 1 GC terazosin hcl cap 10 mg (base equivalent) 1 GC

COMBINACIONES DEL ANTAGONISTA DE LOS RECEPTORES DE LA ANGIOTENSINA II amlodipine besylate-valsartan tab 5-160 mg

2

amlodipine besylate-valsartan tab 5-320 mg

2


2


2

candesartan cilexetil-hydrochlorothiazide tab 16-12.5 mg

2

candesartan cilexetil-hydrochlorothiazide tab 32-12.5 mg

2

candesartan cilexetil-hydrochlorothiazide tab 32-25 mg

2

ENTRESTO TAB 24-26MG 3 QL (60 tabs / 30 days) ENTRESTO TAB 49-51MG 3 QL (60 tabs / 30 days) ENTRESTO TAB 97-103MG 3 QL (60 tabs / 30 days) irbesartan-hydrochlorothiazide tab 150- 12.5 mg

6 GC

irbesartan-hydrochlorothiazide tab 300- 12.5 mg

6 GC

losartan potassium & hydrochlorothiazide tab 50-12.5 mg

6 GC


33



losartan potassium & hydrochlorothiazide tab 100-12.5 mg

losartan potassium & hydrochlorothiazide tab 100-25 mg

6 GC

telmisartan-amlodipine tab 40-5 mg 3

telmisartan-amlodipine tab 40-10 mg 3 telmisartan-amlodipine tab 80-5 mg 3 telmisartan-amlodipine tab 80-10 mg 3 telmisartan-hydrochlorothiazide tab 40- 12.5 mg

2

telmisartan-hydrochlorothiazide tab 80- 12.5 mg

2

telmisartan-hydrochlorothiazide tab 80-25 mg

2

valsartan-hydrochlorothiazide tab 80-12.5 mg

2

valsartan-hydrochlorothiazide tab 160-12.5 mg

2

valsartan-hydrochlorothiazide tab 160-25 mg

2

valsartan-hydrochlorothiazide tab 320-12.5 2

valsartan-hydrochlorothiazide tab 320-25 2

ANTAGONISTAS DE LOS RECEPTORES DE LA ANGIOTENSINA II candesartan cilexetil tab 4 mg 2 candesartan cilexetil tab 8 mg 2 candesartan cilexetil tab 16 mg 2 candesartan cilexetil tab 32 mg 2 irbesartan tab 75 mg 6 GC irbesartan tab 150 mg 6 GC irbesartan tab 300 mg 6 GC losartan potassium tab 25 mg 6 GC losartan potassium tab 50 mg 6 GC losartan potassium tab 100 mg 6 GC telmisartan tab 20 mg 2 telmisartan tab 40 mg 2 telmisartan tab 80 mg 2 valsartan tab 40 mg 2 valsartan tab 80 mg 2 valsartan tab 160 mg 2 valsartan tab 320 mg 2

ANTIARRÍTMICOS amiodarone hcl tab 200 mg 2

amiodarone hcl tab 400 mg 2


34



disopyramide phosphate cap 100 mg 2 disopyramide phosphate cap 150 mg 2 dofetilide cap 125 mcg (0.125 mg) 4 dofetilide cap 250 mcg (0.25 mg) 4 dofetilide cap 500 mcg (0.5 mg) 4 flecainide acetate tab 50 mg 2 flecainide acetate tab 100 mg 2 flecainide acetate tab 150 mg 2 ibutilide fumarate inj 1 mg/10ml 2 lidocaine hcl (cardiac) iv pf soln pref syr 50 mg/5ml(1%)

2

lidocaine hcl(cardiac) iv pf soln pref syr 100 mg/5ml (2%)

2

lidocaine iv infusion in d5w inj 4 mg/ml 2 lidocaine iv infusion in d5w inj 8 mg/ml 2 mexiletine hcl cap 150 mg 3 mexiletine hcl cap 200 mg 3 mexiletine hcl cap 250 mg 3 MULTAQ TAB 400MG 3 pacerone tab 100mg 2 pacerone tab 200mg 2 pacerone tab 400mg 2 propafenone hcl cap er 12hr 225 mg 4 propafenone hcl cap er 12hr 325 mg 4 propafenone hcl cap er 12hr 425 mg 4 propafenone hcl tab 150 mg 2 propafenone hcl tab 225 mg 2 propafenone hcl tab 300 mg 2 quinidine sulfate tab 200 mg 2 quinidine sulfate tab 300 mg 2 sorine tab 80mg 2 sorine tab 120mg 2 sorine tab 160mg 2 sorine tab 240mg 2 sotalol hcl (afib/afl) tab 120 mg 2 sotalol hcl tab 80 mg 2 sotalol hcl tab 120 mg 2 sotalol hcl tab 160 mg 2 sotalol hcl tab 240 mg 2

HIPOLIPIDEMIANTES, INHIBIDORES DE LA REDUCTASA HMG-CoA

atorvastatin calcium tab 10 mg (base equivalent)

6 GC


35




6 GC


6 GC


6 GC

fluvastatin sodium cap 20 mg (base equivalent)

2

fluvastatin sodium cap 40 mg (base equivalent)

2

lovastatin tab 10 mg 6 GC lovastatin tab 20 mg 6 GC lovastatin tab 40 mg 6 GC pravastatin sodium tab 10 mg 6 GC pravastatin sodium tab 20 mg 6 GC pravastatin sodium tab 40 mg 6 GC pravastatin sodium tab 80 mg 6 GC rosuvastatin calcium tab 5 mg 2 rosuvastatin calcium tab 10 mg 2 rosuvastatin calcium tab 20 mg 2 rosuvastatin calcium tab 40 mg 2 simvastatin tab 5 mg 6 GC simvastatin tab 10 mg 6 GC simvastatin tab 20 mg 6 GC simvastatin tab 40 mg 6 GC simvastatin tab 80 mg 6 GC

HIPOLIPIDEMIANTES, VARIOS cholestyramine light powder 4 gm/dose 2 cholestyramine powder packets 4 gm 2 choline fenofibrate cap dr 45 mg (fenofibric acid equiv)


choline fenofibrate cap dr 135 mg (fenofibric acid equiv)


colestipol hcl granule packets 5 gm 2

colestipol hcl tab 1 gm 2 ezetimibe tab 10 mg 2 fenofibrate micronized cap 43 mg 2 QL (90 caps / 30 days) fenofibrate micronized cap 67 mg 2 QL (30 caps / 30 days) fenofibrate micronized cap 134 mg 2 QL (30 caps / 30 days) fenofibrate micronized cap 200 mg 2 QL (30 caps / 30 days) fenofibrate tab 48 mg 2 QL (30 tabs / 30 days) fenofibrate tab 54 mg 2 QL (30 tabs / 30 days) fenofibrate tab 145 mg 3 QL (30 tabs / 30 days)


36



fenofibrate tab 160 mg 2 QL (30 tabs / 30 days) fenofibric acid tab 35 mg 2 fenofibric acid tab 105 mg 2 gemfibrozil tab 600 mg 2 JUXTAPID CAP 5MG 5 QL (30 caps / 30 days),

NM, LA, PA; DL JUXTAPID CAP 10MG 5 QL (30 caps / 30 days),





NM, LA, PA; DL niacin tab er 500 mg (antihyperlipidemic) 3

niacin tab er 750 mg (antihyperlipidemic) 3 niacin tab er 1000 mg (antihyperlipidemic) 3 omega-3-acid ethyl esters cap 1 gm 3 PRALUENT INJ 75MG/ML 4 QL (2 injections / 28

days), PA PRALUENT INJ 150MG/ML 4 QL (2 injections / 28

days), PA prevalite pow 4gm pk 2 REPATHA INJ 140MG/ML 4 QL (3 syringes / 28

days), PA REPATHA PUSH INJ 420/3.5 4 QL (1 cartridge / 28

days), PA REPATHA SURE INJ 140MG/ML 4 QL (3 pens / 28 days),

PA VASCEPA CAP 0.5GM 4 ST VASCEPA CAP 1GM 4 ST WELCHOL PAK 3.75GM 4 WELCHOL TAB 625MG 3

COMBINACIONES DE BETABLOQUEANTES/DIURÉTICOS atenolol & chlorthalidone tab 50-25 mg 2 atenolol & chlorthalidone tab 100-25 mg 2 bisoprolol & hydrochlorothiazide tab 2.5- 6.25 mg

1 GC

bisoprolol & hydrochlorothiazide tab 5-6.25 mg

1 GC

bisoprolol & hydrochlorothiazide tab 10- 6.25 mg

1 GC


37



metoprolol & hydrochlorothiazide tab 50- 25 mg

2


2


2

nadolol & bendroflumethiazide tab 40-5 mg 3 propranolol & hydrochlorothiazide tab 40- 25 mg

2

propranolol & hydrochlorothiazide tab 80- 25 mg

2

BETABLOQUEANTES acebutolol hcl cap 200 mg 2 acebutolol hcl cap 400 mg 2 atenolol tab 25 mg 1 GC atenolol tab 50 mg 1 GC atenolol tab 100 mg 1 GC betaxolol hcl tab 10 mg 2 betaxolol hcl tab 20 mg 2 bisoprolol fumarate tab 5 mg 2 bisoprolol fumarate tab 10 mg 2 carvedilol tab 3.125 mg 1 GC carvedilol tab 6.25 mg 1 GC carvedilol tab 12.5 mg 1 GC carvedilol tab 25 mg 1 GC esmolol hcl inj 100 mg/10ml 2 labetalol hcl tab 100 mg 2 labetalol hcl tab 200 mg 2 labetalol hcl tab 300 mg 2 metoprolol succinate tab er 24hr 25 mg (tartrate equiv)

2

metoprolol succinate tab er 24hr 50 mg (tartrate equiv)

2


2


2

metoprolol tartrate tab 25 mg 1 GC metoprolol tartrate tab 50 mg 1 GC metoprolol tartrate tab 100 mg 1 GC nadolol tab 20 mg 2 nadolol tab 40 mg 2 nadolol tab 80 mg 2 pindolol tab 5 mg 2


38



pindolol tab 10 mg 2 propranolol hcl cap er 24hr 60 mg 2 propranolol hcl cap er 24hr 80 mg 2 propranolol hcl cap er 24hr 120 mg 2 propranolol hcl cap er 24hr 160 mg 2 propranolol hcl oral soln 20 mg/5ml 2 propranolol hcl oral soln 40 mg/5ml 2 propranolol hcl tab 10 mg 1 GC propranolol hcl tab 20 mg 1 GC propranolol hcl tab 40 mg 1 GC propranolol hcl tab 60 mg 1 GC propranolol hcl tab 80 mg 1 GC timolol maleate tab 5 mg 2 timolol maleate tab 10 mg 2 timolol maleate tab 20 mg 2

ANTAGONISTAS DEL CALCIO amlodipine besylate tab 2.5 mg (base 2 equivalent) amlodipine besylate tab 5 mg (base 2 equivalent) amlodipine besylate tab 10 mg (base 2 equivalent)

cartia xt cap 120/24hr 2 cartia xt cap 180/24hr 2 cartia xt cap 240/24hr 2 cartia xt cap 300/24hr 2 dilt-xr cap 120mg 2 dilt-xr cap 180mg 2 dilt-xr cap 240mg 2 diltiazem hcl cap er 12hr 60 mg 2 diltiazem hcl cap er 12hr 90 mg 2 diltiazem hcl cap er 12hr 120 mg 2 diltiazem hcl coated beads cap er 24hr 120 2 mg diltiazem hcl coated beads cap er 24hr 180 2 mg diltiazem hcl coated beads cap er 24hr 240 2 mg diltiazem hcl coated beads cap er 24hr 300 2 mg diltiazem hcl extended release beads cap 2 er 24hr 360 mg diltiazem hcl extended release beads cap 2 er 24hr 420 mg


39



diltiazem hcl tab 30 mg 1 GC diltiazem hcl tab 60 mg 1 GC diltiazem hcl tab 90 mg 1 GC diltiazem hcl tab 120 mg 1 GC felodipine tab er 24hr 2.5 mg 2 felodipine tab er 24hr 5 mg 2 felodipine tab er 24hr 10 mg 2 isradipine cap 2.5 mg 2 isradipine cap 5 mg 2 matzim la tab 180mg/24 2 matzim la tab 240mg/24 2 matzim la tab 300mg/24 2 matzim la tab 360mg/24 2 matzim la tab 420mg/24 2 nicardipine hcl cap 20 mg 2 nicardipine hcl cap 30 mg 2 nifedipine tab er 24hr 30 mg 2 nifedipine tab er 24hr 60 mg 2 nifedipine tab er 24hr 90 mg 2 nifedipine tab er 24hr osmotic release 30 mg

2

nifedipine tab er 24hr osmotic release 60 mg

2

nifedipine tab er 24hr osmotic release 90 mg

2

taztia xt cap 120mg/24 2

taztia xt cap 180mg/24 2 taztia xt cap 240mg/24 2 taztia xt cap 300mg er 2 taztia xt cap 360mg/24 2 verapamil hcl cap er 24hr 100 mg 2 verapamil hcl cap er 24hr 120 mg 2 verapamil hcl cap er 24hr 180 mg 2 verapamil hcl cap er 24hr 200 mg 2 verapamil hcl cap er 24hr 240 mg 2 verapamil hcl cap er 24hr 300 mg 2 verapamil hcl cap er 24hr 360 mg 2 verapamil hcl tab 40 mg 1 GC verapamil hcl tab 80 mg 1 GC verapamil hcl tab 120 mg 1 GC verapamil hcl tab er 120 mg 2 verapamil hcl tab er 180 mg 2 verapamil hcl tab er 240 mg 2


40



GLUCÓSIDOS DIGITÁLICOS digitek tab 0.25mg 2 digitek tab 0.125mg 2 digox tab 0.25mg 2 digox tab 0.125mg 2 digoxin oral soln 0.05 mg/ml 2 digoxin tab 125 mcg (0.125 mg) 2 digoxin tab 250 mcg (0.25 mg) 2

DIURÉTICOS acetazolamide cap er 12hr 500 mg 2 acetazolamide tab 125 mg 2 acetazolamide tab 250 mg 2 amiloride & hydrochlorothiazide tab 5-50 mg

2

amiloride hcl tab 5 mg 2 bumetanide inj 0.25 mg/ml 2 bumetanide tab 0.5 mg 2 bumetanide tab 1 mg 2 bumetanide tab 2 mg 2 chlorothiazide tab 250 mg 2 chlorothiazide tab 500 mg 2 chlorthalidone tab 25 mg 2 chlorthalidone tab 50 mg 2 DIURIL SUS 250/5ML 4 furosemide inj 10 mg/ml 2 furosemide oral soln 8 mg/ml 2 furosemide oral soln 10 mg/ml 2 furosemide tab 20 mg 1 GC furosemide tab 40 mg 1 GC furosemide tab 80 mg 1 GC hydrochlorothiazide cap 12.5 mg 1 GC hydrochlorothiazide tab 12.5 mg 1 GC hydrochlorothiazide tab 25 mg 1 GC hydrochlorothiazide tab 50 mg 1 GC indapamide tab 1.25 mg 1 GC indapamide tab 2.5 mg 1 GC KEVEYIS TAB 50MG 5 QL (120 tabs / 30 days),

NM, PA; DL methyclothiazide tab 5 mg 2

metolazone tab 2.5 mg 2 metolazone tab 5 mg 2 metolazone tab 10 mg 2


41



spironolactone & hydrochlorothiazide tab 25-25 mg

2

torsemide tab 5 mg 1 GC torsemide tab 10 mg 1 GC torsemide tab 20 mg 1 GC torsemide tab 100 mg 1 GC triamterene & hydrochlorothiazide cap 37.5-25 mg

1 GC

triamterene & hydrochlorothiazide tab 37.5-25 mg

1 GC

triamterene & hydrochlorothiazide tab 75- 50 mg

1 GC

VARIOS aliskiren fumarate tab 150 mg (base equivalent)

3 ST

aliskiren fumarate tab 300 mg (base equivalent)

3 ST

clonidine hcl tab 0.1 mg 2

clonidine hcl tab 0.2 mg 2 clonidine hcl tab 0.3 mg 2 clonidine td patch weekly 0.1 mg/24hr 2 clonidine td patch weekly 0.2 mg/24hr 2 clonidine td patch weekly 0.3 mg/24hr 2 CORLANOR TAB 5MG 4 QL (60 tabs / 30 days),

PA CORLANOR TAB 7.5MG 4 QL (60 tabs / 30 days),

PA DEMSER CAP 250MG 5 PA; DL hydralazine hcl tab 10 mg 2 hydralazine hcl tab 25 mg 2 hydralazine hcl tab 50 mg 2 hydralazine hcl tab 100 mg 2 midodrine hcl tab 2.5 mg 2 midodrine hcl tab 5 mg 2 midodrine hcl tab 10 mg 2 minoxidil tab 2.5 mg 2 minoxidil tab 10 mg 2 NORTHERA CAP 100MG 5 QL (540 caps / 30

days), NM, LA, PA; DL NORTHERA CAP 200MG 5 QL (360 caps / 30

days), NM, LA, PA; DL NORTHERA CAP 300MG 5 QL (180 caps / 30

days), NM, LA, PA; DL phenoxybenzamine hcl cap 10 mg 5 DL


42



RANEXA TAB 500MG 3 QL (60 tabs / 30 days) RANEXA TAB 1000MG 3 QL (60 tabs / 30 days) ranolazine tab er 12hr 500 mg 3 QL (60 tabs / 30 days) ranolazine tab er 12hr 1000 mg 3 QL (60 tabs / 30 days) TEKTURNA HCT TAB 150-12.5 3 ST TEKTURNA HCT TAB 150-25MG 3 ST TEKTURNA HCT TAB 300-12.5 3 ST TEKTURNA HCT TAB 300-25MG 3 ST VECAMYL TAB 2.5MG 5 PA; DL

NITRATOS isosorbide dinitrate tab 5 mg 2 isosorbide dinitrate tab 10 mg 2 isosorbide dinitrate tab 20 mg 2 isosorbide dinitrate tab 30 mg 2 isosorbide dinitrate tab er 40 mg 2 isosorbide mononitrate tab 10 mg 1 GC isosorbide mononitrate tab 20 mg 1 GC isosorbide mononitrate tab er 24hr 30 mg 2 isosorbide mononitrate tab er 24hr 60 mg 2 isosorbide mononitrate tab er 24hr 120 mg 2 NITRO-BID OIN 2% 3 NITRO-DUR DIS 0.3MG/HR 4 NITRO-DUR DIS 0.8MG/HR 4 nitroglycerin sl tab 0.3 mg 2 nitroglycerin sl tab 0.4 mg 2 nitroglycerin sl tab 0.6 mg 2 nitroglycerin td patch 24hr 0.1 mg/hr 2 nitroglycerin td patch 24hr 0.2 mg/hr 2 nitroglycerin td patch 24hr 0.4 mg/hr 2 nitroglycerin td patch 24hr 0.6 mg/hr 2 nitroglycerin tl soln 0.4 mg/spray (400 mcg/spray)

2

HIPERTENSIÓN PULMONAR ADEMPAS TAB 0.5MG 5 QL (90 tabs / 30 days),

NM, LA, PA; DL ADEMPAS TAB 1.5MG 5 QL (90 tabs / 30 days),

NM, LA, PA; DL ADEMPAS TAB 1MG 5 QL (90 tabs / 30 days),

NM, LA, PA; DL ADEMPAS TAB 2.5MG 5 QL (90 tabs / 30 days),

NM, LA, PA; DL ADEMPAS TAB 2MG 5 QL (90 tabs / 30 days),

NM, LA, PA; DL


43



alyq tab 20mg 5 QL (60 tabs / 30 days), NM, PA; DL

ambrisentan tab 5 mg 5 QL (30 tabs / 30 days), NM, LA, PA; DL

ambrisentan tab 10 mg 5 QL (30 tabs / 30 days), NM, LA, PA; DL

bosentan tab 62.5 mg 5 QL (60 tabs / 30 days), NM, LA, PA; DL

bosentan tab 125 mg 5 QL (60 tabs / 30 days), NM, LA, PA; DL

epoprostenol sodium for inj 0.5 mg 5 B/D, NM, LA; DL epoprostenol sodium for inj 1.5 mg 5 B/D, NM, LA; DL OPSUMIT TAB 10MG 5 QL (30 tabs / 30 days),

NM, LA, PA; DL sildenafil citrate for suspension 10 mg/ml 5 QL (180 mL / 30 days),

NM, PA; DL sildenafil citrate tab 20 mg 3 QL (90 tabs / 30 days),

NM, PA tadalafil tab 20 mg (pah) 5 QL (60 tabs / 30 days),

NM, PA; DL TRACLEER TAB 32MG 5 QL (120 tabs / 30 days),

NM, LA, PA; DL UPTRAVI TAB 200/800 5 QL (400 tabs / year),

NM, LA, PA; DL UPTRAVI TAB 200MCG 5 QL (60 tabs / 30 days),








NM, LA, PA; DL VELETRI INJ 0.5MG 5 B/D, NM, LA; DL VELETRI INJ 1.5MG 5 B/D, NM, LA; DL VENTAVIS SOL 10MCG/ML 5 NM, PA; DL VENTAVIS SOL 20MCG/ML 5 NM, PA; DL


44



SISTEMA NERVIOSO CENTRAL ANSIOLÍTICOS

alprazolam tab 0.5 mg 2 QL (90 tabs / 30 days) alprazolam tab 0.25 mg 2 QL (90 tabs / 30 days) alprazolam tab 1 mg 2 QL (90 tabs / 30 days) alprazolam tab 2 mg 2 QL (150 tabs / 30 days) alprazolam tab er 24hr 0.5 mg 2 QL (30 tabs / 30 days) alprazolam tab er 24hr 1 mg 2 QL (30 tabs / 30 days) alprazolam tab er 24hr 2 mg 2 QL (150 tabs / 30 days) alprazolam tab er 24hr 3 mg 2 QL (90 tabs / 30 days) buspirone hcl tab 5 mg 2 buspirone hcl tab 7.5 mg 2 buspirone hcl tab 10 mg 2 buspirone hcl tab 15 mg 2 buspirone hcl tab 30 mg 2 fluvoxamine maleate tab 25 mg 2 fluvoxamine maleate tab 50 mg 2 fluvoxamine maleate tab 100 mg 2 lorazepam conc 2 mg/ml 2 QL (150 mL / 30 days) lorazepam inj 2 mg/ml 2 lorazepam inj 4 mg/ml 2 lorazepam tab 0.5 mg 2 QL (600 tabs / 30 days) lorazepam tab 1 mg 2 QL (300 tabs / 30 days) lorazepam tab 2 mg 2 QL (150 tabs / 30 days) oxazepam cap 10 mg 2 QL (120 caps / 30 days) oxazepam cap 15 mg 2 QL (120 caps / 30 days) oxazepam cap 30 mg 2 QL (120 caps / 30 days) ANTICONVULSIVANTES APTIOM TAB 200MG 4 PA APTIOM TAB 400MG 5 PA; DL APTIOM TAB 600MG 5 PA; DL APTIOM TAB 800MG 5 PA; DL BANZEL SUS 40MG/ML 4 PA BANZEL TAB 200MG 4 PA BANZEL TAB 400MG 5 PA; DL BRIVIACT SOL 10MG/ML 5 PA; DL BRIVIACT TAB 10MG 5 PA; DL BRIVIACT TAB 25MG 5 PA; DL BRIVIACT TAB 50MG 5 PA; DL BRIVIACT TAB 75MG 5 PA; DL BRIVIACT TAB 100MG 5 PA; DL carbamazepine cap er 12hr 100 mg 2


45



carbamazepine cap er 12hr 200 mg 2 carbamazepine cap er 12hr 300 mg 2 carbamazepine chew tab 100 mg 2 carbamazepine susp 100 mg/5ml 2 carbamazepine tab 200 mg 2 carbamazepine tab er 12hr 100 mg 3 carbamazepine tab er 12hr 200 mg 3 carbamazepine tab er 12hr 400 mg 3 CELONTIN CAP 300MG 4 clobazam suspension 2.5 mg/ml 5 PA; DL clobazam tab 10 mg 3 PA clobazam tab 20 mg 5 PA; DL clonazepam orally disintegrating tab 0.5 mg

2 QL (1200 tabs / 30 days), ST

clonazepam orally disintegrating tab 0.25 mg


clonazepam orally disintegrating tab 0.125 mg


clonazepam orally disintegrating tab 1 mg 2 QL (600 tabs / 30 days), ST

clonazepam orally disintegrating tab 2 mg 2 QL (300 tabs / 30 days), ST

clonazepam tab 0.5 mg 2 QL (1200 tabs / 30 days)

clonazepam tab 1 mg 2 QL (600 tabs / 30 days) clonazepam tab 2 mg 2 QL (300 tabs / 30 days) clorazepate dipotassium tab 3.75 mg 2 QL (720 tabs / 30 days) clorazepate dipotassium tab 7.5 mg 2 QL (360 tabs / 30 days) clorazepate dipotassium tab 15 mg 2 QL (180 tabs / 30 days) DIASTAT ACDL GEL 5-10MG 4 DIASTAT ACDL GEL 12.5-20 4 DIASTAT PED GEL 2.5M GEL 4 diazepam conc 5 mg/ml 2 QL (240 mL / 30 days) diazepam inj 5 mg/ml 2 diazepam oral soln 1 mg/ml 2 QL (1200 mL / 30 days) diazepam tab 2 mg 2 QL (600 tabs / 30 days) diazepam tab 5 mg 2 QL (240 tabs / 30 days) diazepam tab 10 mg 2 QL (120 tabs / 30 days) DILANTIN CAP 30MG 3 divalproex sodium cap delayed release sprinkle 125 mg

2

divalproex sodium tab delayed release 125 mg

2


46




2


2

divalproex sodium tab er 24 hr 250 mg 2 divalproex sodium tab er 24 hr 500 mg 2 EPIDIOLEX SOL 100MG/ML 5 NM, LA, PA; DL epitol tab 200mg 2 ethosuximide cap 250 mg 2 ethosuximide soln 250 mg/5ml 2 felbamate susp 600 mg/5ml 2 felbamate tab 400 mg 2 felbamate tab 600 mg 2 fosphenytoin sodium inj 500 mg/10ml (phenytoin equiv)

2

FYCOMPA SUS 0.5MG/ML 4 PA FYCOMPA TAB 2MG 4 PA FYCOMPA TAB 4MG 4 PA FYCOMPA TAB 6MG 4 PA FYCOMPA TAB 8MG 4 PA FYCOMPA TAB 10MG 4 PA FYCOMPA TAB 12MG 4 PA gabapentin cap 100 mg 2 gabapentin cap 300 mg 2 gabapentin cap 400 mg 2 gabapentin oral soln 250 mg/5ml 2 gabapentin tab 600 mg 2 gabapentin tab 800 mg 2 lamotrigine tab 25 mg 2 lamotrigine tab 100 mg 2 lamotrigine tab 150 mg 2 lamotrigine tab 200 mg 2 lamotrigine tab chewable dispersible 5 mg 2 lamotrigine tab chewable dispersible 25 mg 2 levetiracetam oral soln 100 mg/ml 2 levetiracetam tab 250 mg 2 levetiracetam tab 500 mg 2 levetiracetam tab 750 mg 2 levetiracetam tab 1000 mg 2 levetiracetam tab er 24hr 500 mg 2 levetiracetam tab er 24hr 750 mg 2 LYRICA CAP 25MG 4 QL (720 caps / 30 days) LYRICA CAP 50MG 4 QL (360 caps / 30 days)


47



LYRICA CAP 75MG 4 QL (240 caps / 30 days) LYRICA CAP 100MG 4 QL (180 caps / 30 days) LYRICA CAP 150MG 4 QL (120 caps / 30 days) LYRICA CAP 200MG 4 QL (90 caps / 30 days) LYRICA CAP 225MG 4 QL (90 caps / 30 days) LYRICA CAP 300MG 4 QL (60 caps / 30 days) LYRICA SOL 20MG/ML 4 QL (900 mL / 30 days) oxcarbazepine susp 300 mg/5ml (60 mg/ml)

3

oxcarbazepine tab 150 mg 2 oxcarbazepine tab 300 mg 2 oxcarbazepine tab 600 mg 2 PEGANONE TAB 250MG 4 PHENOBARB INJ 65MG/ML 3 PA phenobarbital elixir 20 mg/5ml 2 PA phenobarbital sodium inj 130 mg/ml 3 PA phenobarbital tab 15 mg 2 PA phenobarbital tab 16.2 mg 2 PA phenobarbital tab 30 mg 2 PA phenobarbital tab 32.4 mg 2 PA phenobarbital tab 60 mg 2 PA phenobarbital tab 64.8 mg 2 PA phenobarbital tab 97.2 mg 2 PA phenobarbital tab 100 mg 2 PA phenytoin chew tab 50 mg 2 phenytoin sodium extended cap 100 mg 2 phenytoin sodium extended cap 200 mg 2 phenytoin sodium extended cap 300 mg 2 phenytoin susp 125 mg/5ml 2 primidone tab 50 mg 2 primidone tab 250 mg 2 roweepra tab 500mg 2 roweepra tab 750mg 2 roweepra tab 1000mg 2 roweepra xr tab 500mg xr 2 roweepra xr tab 750mg xr 2 SABRIL TAB 500MG 5 QL (180 tabs / 30 days),

NM, LA, PA; DL SPRITAM TAB 250MG 4 PA SPRITAM TAB 500MG 4 PA SPRITAM TAB 750MG 4 PA SPRITAM TAB 1000MG 4 PA


48



SYMPAZAN MIS 5MG 5 QL (240 films / 30 days), PA; DL



tiagabine hcl tab 2 mg 3

tiagabine hcl tab 4 mg 3 tiagabine hcl tab 12 mg 3 tiagabine hcl tab 16 mg 3 topiramate sprinkle cap 15 mg 2 topiramate sprinkle cap 25 mg 2 topiramate tab 25 mg 2 topiramate tab 50 mg 2 topiramate tab 100 mg 2 topiramate tab 200 mg 2 valproate sodium oral soln 250 mg/5ml (base equiv)

2

valproic acid cap 250 mg 2 vigabatrin powd pack 500 mg 5 QL (180 packets / 30

days), NM, LA, PA; DL vigabatrin tab 500 mg 5 QL (180 tabs / 30 days),

NM, LA, PA; DL vigadrone pow 500mg 5 QL (180 packets / 30

days), NM, LA, PA; DL VIMPAT SOL 10MG/ML 4 PA VIMPAT TAB 50MG 4 PA VIMPAT TAB 100MG 4 PA VIMPAT TAB 150MG 4 PA VIMPAT TAB 200MG 4 PA zonisamide cap 25 mg 2 zonisamide cap 50 mg 2 zonisamide cap 100 mg 2

ANTIDEMENCIA donepezil hydrochloride orally 2 disintegrating tab 5 mg donepezil hydrochloride orally 2 disintegrating tab 10 mg

donepezil hydrochloride tab 5 mg 2 donepezil hydrochloride tab 10 mg 2 galantamine hydrobromide cap er 24hr 8 2 mg galantamine hydrobromide cap er 24hr 16 2 mg


49



galantamine hydrobromide cap er 24hr 24 mg

2

galantamine hydrobromide oral soln 4 mg/ml

2

galantamine hydrobromide tab 4 mg 2 galantamine hydrobromide tab 8 mg 2 galantamine hydrobromide tab 12 mg 2 memantine hcl oral solution 2 mg/ml 2 PA memantine hcl tab 5 mg 2 QL (60 tabs / 30 days),

PA memantine hcl tab 5 mg (28) & 10 mg (21) titration pak

2 QL (49 tabs / 28 days), PA

memantine hcl tab 10 mg 2 QL (60 tabs / 30 days), PA

rivastigmine tartrate cap 1.5 mg (base equivalent)

2

rivastigmine tartrate cap 3 mg (base equivalent)

2

rivastigmine tartrate cap 4.5 mg (base equivalent)

2

rivastigmine tartrate cap 6 mg (base equivalent)

2

rivastigmine td patch 24hr 4.6 mg/24hr 3 rivastigmine td patch 24hr 9.5 mg/24hr 3 rivastigmine td patch 24hr 13.3 mg/24hr 3

ANTIDEPRESIVOS amitriptyline hcl tab 10 mg 2 PA amitriptyline hcl tab 25 mg 2 PA amitriptyline hcl tab 50 mg 2 PA amitriptyline hcl tab 75 mg 2 PA amitriptyline hcl tab 100 mg 2 PA amitriptyline hcl tab 150 mg 2 PA amoxapine tab 25 mg 2 PA amoxapine tab 50 mg 2 PA amoxapine tab 100 mg 2 PA amoxapine tab 150 mg 2 PA bupropion hcl tab 75 mg 2 bupropion hcl tab 100 mg 2 bupropion hcl tab er 12hr 100 mg 2 bupropion hcl tab er 12hr 150 mg 2 bupropion hcl tab er 12hr 200 mg 2 bupropion hcl tab er 24hr 150 mg 2 bupropion hcl tab er 24hr 300 mg 2


50



citalopram hydrobromide oral soln 10 mg/5ml

2 QL (600 mL / 30 days)

citalopram hydrobromide tab 10 mg (base equiv)

1 GC, QL (120 tabs / 30 days)





clomipramine hcl cap 25 mg 4 PA clomipramine hcl cap 50 mg 4 PA clomipramine hcl cap 75 mg 4 PA desipramine hcl tab 10 mg 2 PA desipramine hcl tab 25 mg 2 PA desipramine hcl tab 50 mg 2 PA desipramine hcl tab 75 mg 2 PA desipramine hcl tab 100 mg 2 PA desipramine hcl tab 150 mg 2 PA DESVENLAFAX TAB 50MG ER 3 QL (240 tabs / 30 days),

ST DESVENLAFAX TAB 100MG ER 3 QL (120 tabs / 30 days),

ST desvenlafaxine succinate tab er 24hr 25 mg (base equiv)


desvenlafaxine succinate tab er 24hr 50 mg (base equiv)


desvenlafaxine succinate tab er 24hr 100 mg (base equiv)


doxepin hcl cap 10 mg 2 PA doxepin hcl cap 25 mg 2 PA doxepin hcl cap 50 mg 2 PA doxepin hcl cap 75 mg 2 PA doxepin hcl cap 100 mg 2 PA doxepin hcl cap 150 mg 2 PA doxepin hcl conc 10 mg/ml 2 PA duloxetine hcl enteric coated pellets cap 20 mg (base eq)


duloxetine hcl enteric coated pellets cap 30 mg (base eq)






EMSAM DIS 6MG/24HR 5 DL EMSAM DIS 9MG/24HR 5 DL


51



EMSAM DIS 12MG/24H 5 DL escitalopram oxalate soln 5 mg/5ml (base equiv)

2 QL (600 mL / 30 days)

escitalopram oxalate tab 5 mg (base equiv)

2 QL (120 tabs / 30 days)





FETZIMA CAP 20MG 4 QL (180 caps / 30 days), PA




FETZIMA CAP TITRATIO 4 QL (28 caps / 28 days), PA

fluoxetine hcl cap 10 mg 1 GC fluoxetine hcl cap 20 mg 1 GC fluoxetine hcl cap 40 mg 1 GC fluoxetine hcl solution 20 mg/5ml 1 GC fluoxetine hcl tab 10 mg 2 ST fluoxetine hcl tab 20 mg 2 ST imipramine hcl tab 10 mg 2 PA imipramine hcl tab 25 mg 2 PA imipramine hcl tab 50 mg 2 PA imipramine pamoate cap 75 mg 2 PA imipramine pamoate cap 100 mg 2 PA imipramine pamoate cap 125 mg 2 PA imipramine pamoate cap 150 mg 2 PA maprotiline hcl tab 25 mg 2 maprotiline hcl tab 50 mg 2 maprotiline hcl tab 75 mg 2 MARPLAN TAB 10MG 4 mirtazapine orally disintegrating tab 15 mg 2 mirtazapine orally disintegrating tab 30 mg 2 mirtazapine orally disintegrating tab 45 mg 2 mirtazapine tab 7.5 mg 2 mirtazapine tab 15 mg 2 mirtazapine tab 30 mg 2 mirtazapine tab 45 mg 2 nefazodone hcl tab 50 mg 3


52



nefazodone hcl tab 100 mg 3 nefazodone hcl tab 150 mg 3 nefazodone hcl tab 200 mg 3 nefazodone hcl tab 250 mg 3 nortriptyline hcl cap 10 mg 2 PA nortriptyline hcl cap 25 mg 2 PA nortriptyline hcl cap 50 mg 2 PA nortriptyline hcl cap 75 mg 2 PA nortriptyline hcl soln 10 mg/5ml 2 PA paroxetine hcl tab 10 mg 2 PA paroxetine hcl tab 20 mg 2 PA paroxetine hcl tab 30 mg 2 PA paroxetine hcl tab 40 mg 2 PA PAXIL SUS 10MG/5ML 4 phenelzine sulfate tab 15 mg 2 protriptyline hcl tab 5 mg 3 protriptyline hcl tab 10 mg 3 sertraline hcl oral concentrate for solution 20 mg/ml

3

sertraline hcl tab 25 mg 2 sertraline hcl tab 50 mg 2 sertraline hcl tab 100 mg 2 tranylcypromine sulfate tab 10 mg 4 trazodone hcl tab 50 mg 1 GC trazodone hcl tab 100 mg 1 GC trazodone hcl tab 150 mg 1 GC trazodone hcl tab 300 mg 2 trimipramine maleate cap 25 mg 2 trimipramine maleate cap 50 mg 2 trimipramine maleate cap 100 mg 2 TRINTELLIX TAB 5MG 4 QL (120 tabs / 30 days),

PA TRINTELLIX TAB 10MG 4 QL (60 tabs / 30 days),

PA TRINTELLIX TAB 20MG 4 QL (30 tabs / 30 days),

PA venlafaxine hcl cap er 24hr 37.5 mg (base equivalent)


venlafaxine hcl cap er 24hr 75 mg (base equivalent)


venlafaxine hcl cap er 24hr 150 mg (base equivalent)


venlafaxine hcl tab 25 mg (base equivalent)

2


53



venlafaxine hcl tab 37.5 mg (base 2 equivalent) venlafaxine hcl tab 50 mg (base 2 equivalent) venlafaxine hcl tab 75 mg (base 2 equivalent) venlafaxine hcl tab 100 mg (base 2 equivalent)

VIIBRYD KIT STARTER 4 QL (30 tabs / 30 days), PA

VIIBRYD TAB 10MG 4 QL (120 tabs / 30 days), PA



AGENTES ANTIPARKINSONIANOS amantadine hcl cap 100 mg 2 amantadine hcl syrup 50 mg/5ml 2 amantadine hcl tab 100 mg 2 APOKYN INJ 10MG/ML 5 QL (90 mL / 30 days),

NM, LA, PA; DL

benztropine mesylate tab 0.5 mg 2 benztropine mesylate tab 1 mg 2 benztropine mesylate tab 2 mg 2 bromocriptine mesylate cap 5 mg (base 3 equivalent) bromocriptine mesylate tab 2.5 mg (base 3 equivalent)

carbidopa & levodopa orally disintegrating 2 tab 10-100 mg



carbidopa & levodopa tab 10-100 mg 2 carbidopa & levodopa tab 25-100 mg 2 carbidopa & levodopa tab 25-250 mg 2 carbidopa & levodopa tab er 25-100 mg 2 carbidopa & levodopa tab er 50-200 mg 2 carbidopa tab 25 mg 5 DL carbidopa-levodopa-entacapone tabs 12.5- 3 50-200 mg


54



carbidopa-levodopa-entacapone tabs 18.75-75-200 mg

3

carbidopa-levodopa-entacapone tabs 25- 100-200 mg

3

carbidopa-levodopa-entacapone tabs 31.25-125-200 mg

3

carbidopa-levodopa-entacapone tabs 37.5- 150-200 mg

3

carbidopa-levodopa-entacapone tabs 50- 200-200 mg

3

entacapone tab 200 mg 3 NEUPRO DIS 1MG/24HR 4 QL (30 patches / 30

days), PA NEUPRO DIS 2MG/24HR 4 QL (30 patches / 30





days), PA pramipexole dihydrochloride tab 0.5 mg 2

pramipexole dihydrochloride tab 0.25 mg 2 pramipexole dihydrochloride tab 0.75 mg 2 pramipexole dihydrochloride tab 0.125 mg 2 pramipexole dihydrochloride tab 1 mg 2 pramipexole dihydrochloride tab 1.5 mg 2 rasagiline mesylate tab 0.5 mg (base equiv)

3

rasagiline mesylate tab 1 mg (base equiv) 3

ropinirole hydrochloride tab 0.5 mg 2 ropinirole hydrochloride tab 0.25 mg 2 ropinirole hydrochloride tab 1 mg 2 ropinirole hydrochloride tab 2 mg 2 ropinirole hydrochloride tab 3 mg 2 ropinirole hydrochloride tab 4 mg 2 ropinirole hydrochloride tab 5 mg 2 selegiline hcl cap 5 mg 2 selegiline hcl tab 5 mg 2 trihexyphenidyl hcl elixir 0.4 mg/ml 2 trihexyphenidyl hcl tab 2 mg 2 trihexyphenidyl hcl tab 5 mg 2


55



ANTIPSICÓTICOS ABILIFY MAIN INJ 300MG 5 QL (2 injections / 28

days); DL ABILIFY MAIN INJ 400MG 5 QL (1 injection / 28

days); DL aripiprazole oral solution 1 mg/ml 3 QL (900 mL / 30 days),

PA aripiprazole orally disintegrating tab 10 mg 3 QL (90 tabs / 30 days),

PA aripiprazole orally disintegrating tab 15 mg 3 QL (60 tabs / 30 days),

PA aripiprazole tab 2 mg 3 QL (450 tabs / 30 days) aripiprazole tab 5 mg 3 QL (180 tabs / 30 days) aripiprazole tab 10 mg 3 QL (90 tabs / 30 days) aripiprazole tab 15 mg 3 QL (60 tabs / 30 days) aripiprazole tab 20 mg 3 QL (45 tabs / 30 days) aripiprazole tab 30 mg 3 QL (30 tabs / 30 days) ARISTADA INJ 441MG/1. 5 QL (2 injections / 28

days); DL ARISTADA INJ 662MG/2 5 QL (2 injections / 28

days); DL ARISTADA INJ 882MG/3 5 QL (1 injection / 28

days); DL ARISTADA INJ 1064MG 5 QL (1 injection / 56

days); DL ARISTADA INJ INITIO 5 QL (2 injections / 365

days); DL chlorpromazine hcl tab 10 mg 2 chlorpromazine hcl tab 25 mg 2 chlorpromazine hcl tab 50 mg 2 chlorpromazine hcl tab 100 mg 2 chlorpromazine hcl tab 200 mg 2 clozapine orally disintegrating tab 12.5 mg 4 QL (2160 tabs / 30

days), ST clozapine orally disintegrating tab 25 mg 4 QL (1080 tabs / 30

days), ST clozapine orally disintegrating tab 100 mg 4 QL (270 tabs / 30 days),

ST clozapine orally disintegrating tab 150 mg 4 QL (180 tabs / 30 days),

ST clozapine orally disintegrating tab 200 mg 4 QL (150 tabs / 30 days),

ST clozapine tab 25 mg 2

clozapine tab 50 mg 2


56



clozapine tab 100 mg 2 clozapine tab 200 mg 2 ergoloid mesylates tab 1 mg 3 FANAPT PAK 4 QL (8 tabs / 30 days),

PA FANAPT TAB 1MG 4 QL (720 tabs / 30 days),







PA fluphenazine decanoate inj 25 mg/ml 2 fluphenazine hcl elixir 2.5 mg/5ml 2 fluphenazine hcl inj 2.5 mg/ml 2 fluphenazine hcl oral conc 5 mg/ml 2 fluphenazine hcl tab 1 mg 2 fluphenazine hcl tab 2.5 mg 2 fluphenazine hcl tab 5 mg 2 fluphenazine hcl tab 10 mg 2 GEODON INJ 20MG 4 haloperidol decanoate im soln 50 mg/ml 2 haloperidol decanoate im soln 100 mg/ml 2 haloperidol lactate inj 5 mg/ml 2 haloperidol lactate oral conc 2 mg/ml 2 haloperidol tab 0.5 mg 1 GC haloperidol tab 1 mg 1 GC haloperidol tab 2 mg 1 GC haloperidol tab 5 mg 1 GC haloperidol tab 10 mg 1 GC haloperidol tab 20 mg 1 GC INVEGA SUST INJ 39/0.25 4 QL (6 injections / 28

days) INVEGA SUST INJ 78/0.5ML 5 QL (3 injections / 28

days); DL INVEGA SUST INJ 117/0.75 5 QL (2 injections / 28

days); DL


57



INVEGA SUST INJ 156MG/ML 5 QL (2 injections / 28 days); DL

INVEGA SUST INJ 234/1.5 5 QL (1 injection / 28 days); DL

INVEGA TRINZ INJ 273MG 5 QL (3 injections / 84 days); DL



INVEGA TRINZ INJ 819MG 5 QL (1 injection / 84 days); DL

LATUDA TAB 20MG 5 QL (240 tabs / 30 days); DL





loxapine succinate cap 5 mg 2 loxapine succinate cap 10 mg 2 loxapine succinate cap 25 mg 2 loxapine succinate cap 50 mg 2 molindone hcl tab 5 mg 2 PA molindone hcl tab 10 mg 2 PA molindone hcl tab 25 mg 2 PA NUPLAZID CAP 34MG 5 QL (30 caps / 30 days),

NM, LA, PA; DL NUPLAZID TAB 10MG 5 QL (90 tabs / 30 days),

NM, LA, PA; DL olanzapine for im inj 10 mg 2 olanzapine orally disintegrating tab 5 mg 3 QL (120 tabs / 30 days) olanzapine orally disintegrating tab 10 mg 3 QL (60 tabs / 30 days) olanzapine orally disintegrating tab 15 mg 3 QL (60 tabs / 30 days) olanzapine orally disintegrating tab 20 mg 3 QL (30 tabs / 30 days) olanzapine tab 2.5 mg 2 QL (240 tabs / 30 days) olanzapine tab 5 mg 2 QL (120 tabs / 30 days) olanzapine tab 7.5 mg 2 QL (90 tabs / 30 days) olanzapine tab 10 mg 2 QL (60 tabs / 30 days) olanzapine tab 15 mg 2 QL (60 tabs / 30 days) olanzapine tab 20 mg 2 QL (30 tabs / 30 days)


58



paliperidone tab er 24hr 1.5 mg 4 QL (240 tabs / 30 days), PA

paliperidone tab er 24hr 3 mg 4 QL (120 tabs / 30 days), PA

paliperidone tab er 24hr 6 mg 4 QL (60 tabs / 30 days), PA

paliperidone tab er 24hr 9 mg 5 QL (60 tabs / 30 days), PA; DL

perphenazine tab 2 mg 2 perphenazine tab 4 mg 2 perphenazine tab 8 mg 2 perphenazine tab 16 mg 2 pimozide tab 1 mg 2 pimozide tab 2 mg 2 quetiapine fumarate tab 25 mg 2 QL (960 tabs / 30 days),

PA quetiapine fumarate tab 50 mg 2 QL (480 tabs / 30 days),

PA quetiapine fumarate tab 100 mg 2 QL (240 tabs / 30 days) quetiapine fumarate tab 200 mg 2 QL (120 tabs / 30 days) quetiapine fumarate tab 300 mg 2 QL (90 tabs / 30 days) quetiapine fumarate tab 400 mg 2 QL (90 tabs / 30 days) quetiapine fumarate tab er 24hr 50 mg 4 PA quetiapine fumarate tab er 24hr 150 mg 4 PA quetiapine fumarate tab er 24hr 200 mg 4 PA quetiapine fumarate tab er 24hr 300 mg 4 PA quetiapine fumarate tab er 24hr 400 mg 4 PA REXULTI TAB 0.5MG 5 QL (240 tabs / 30 days),

PA; DL REXULTI TAB 0.25MG 5 QL (480 tabs / 30 days),

PA; DL REXULTI TAB 1MG 5 QL (120 tabs / 30 days),




PA; DL RISPERDAL INJ 12.5MG 4 QL (8 vials / 28 days) RISPERDAL INJ 25MG 4 QL (4 vials / 28 days) RISPERDAL INJ 37.5MG 5 QL (4 vials / 28 days);

DL


59



RISPERDAL INJ 50MG 5 QL (2 vials / 28 days); DL

risperidone orally disintegrating tab 0.5 mg 3 QL (960 tabs / 30 days) risperidone orally disintegrating tab 0.25 mg

3 QL (1920 tabs / 30 days)

risperidone orally disintegrating tab 1 mg 3 QL (480 tabs / 30 days) risperidone orally disintegrating tab 2 mg 3 QL (240 tabs / 30 days) risperidone orally disintegrating tab 3 mg 3 QL (180 tabs / 30 days) risperidone orally disintegrating tab 4 mg 3 QL (120 tabs / 30 days) risperidone soln 1 mg/ml 2 risperidone tab 0.5 mg 2 QL (960 tabs / 30 days) risperidone tab 0.25 mg 2 QL (1920 tabs / 30

days) risperidone tab 1 mg 2 QL (480 tabs / 30 days) risperidone tab 2 mg 2 QL (240 tabs / 30 days) risperidone tab 3 mg 2 QL (180 tabs / 30 days) risperidone tab 4 mg 2 QL (120 tabs / 30 days) SAPHRIS SUB 2.5MG 4 QL (240 tabs / 30 days),

PA SAPHRIS SUB 5MG 4 QL (120 tabs / 30 days),

PA SAPHRIS SUB 10MG 4 QL (60 tabs / 30 days),

PA thioridazine hcl tab 10 mg 2 thioridazine hcl tab 25 mg 2 thioridazine hcl tab 50 mg 2 thioridazine hcl tab 100 mg 2 thiothixene cap 1 mg 2 thiothixene cap 2 mg 2 thiothixene cap 5 mg 2 thiothixene cap 10 mg 2 trifluoperazine hcl tab 1 mg (base equivalent)

2

trifluoperazine hcl tab 2 mg (base equivalent)

2


2


2

VERSACLOZ SUS 50MG/ML 5 QL (540 mL / 30 days), PA; DL

VRAYLAR CAP 1.5-3MG 4 QL (7 caps / 30 days), PA


60



VRAYLAR CAP 1.5MG 5 QL (120 caps / 30 days), PA; DL

VRAYLAR CAP 3MG 5 QL (60 caps / 30 days), PA; DL

VRAYLAR CAP 4.5MG 5 QL (60 caps / 30 days), PA; DL

VRAYLAR CAP 6MG 5 QL (30 caps / 30 days), PA; DL

ziprasidone hcl cap 20 mg 2 QL (300 caps / 30 days) ziprasidone hcl cap 40 mg 2 QL (150 caps / 30 days) ziprasidone hcl cap 60 mg 2 QL (120 caps / 30 days) ziprasidone hcl cap 80 mg 2 QL (90 caps / 30 days) ZYPREXA RELP INJ 210MG 4 QL (3 vials / 28 days) ZYPREXA RELP INJ 300MG 4 QL (3 vials / 28 days) ZYPREXA RELP INJ 405MG 4 QL (3 vials / 28 days) TRASTORNO POR DÉFICIT DE ATENCIÓN E HIPERACTIVIDAD

amphetamine-dextroamphetamine cap er 24hr 5 mg 3 QL (30 caps / 30 days)

amphetamine-dextroamphetamine cap er 24hr 10 mg










amphetamine-dextroamphetamine tab 5 mg


amphetamine-dextroamphetamine tab 7.5 mg 2 QL (90 tabs / 30 days)

amphetamine-dextroamphetamine tab 10 mg


amphetamine-dextroamphetamine tab 12.5 mg


amphetamine-dextroamphetamine tab 15 mg 2 QL (60 tabs / 30 days)



atomoxetine hcl cap 10 mg (base equiv) 3 QL (30 caps / 30 days) atomoxetine hcl cap 18 mg (base equiv) 3 QL (60 caps / 30 days) atomoxetine hcl cap 25 mg (base equiv) 3 QL (90 caps / 30 days)


61



atomoxetine hcl cap 40 mg (base equiv) 3 QL (30 caps / 30 days) atomoxetine hcl cap 60 mg (base equiv) 3 QL (30 caps / 30 days) atomoxetine hcl cap 80 mg (base equiv) 3 QL (30 caps / 30 days) atomoxetine hcl cap 100 mg (base equiv) 3 QL (30 caps / 30 days) clonidine hcl tab er 12hr 0.1 mg 3 QL (120 tabs / 30 days),

PA dexmethylphenidate hcl tab 2.5 mg 2 QL (60 tabs / 30 days) dexmethylphenidate hcl tab 5 mg 2 QL (60 tabs / 30 days) dexmethylphenidate hcl tab 10 mg 2 QL (60 tabs / 30 days) dextroamphetamine sulfate cap er 24hr 5 mg


dextroamphetamine sulfate cap er 24hr 10 mg


dextroamphetamine sulfate cap er 24hr 15 mg


dextroamphetamine sulfate tab 5 mg 3 QL (180 tabs / 30 days) dextroamphetamine sulfate tab 10 mg 3 QL (180 tabs / 30 days) metadate tab 20mg er 3 QL (90 tabs / 30 days) methamphetamine hcl tab 5 mg 2 QL (150 tabs / 30 days),

PA methylphenid tab 72mg er 4 QL (30 tabs / 30 days) methylphenidate hcl soln 5 mg/5ml 2 QL (1800 mL / 30 days) methylphenidate hcl soln 10 mg/5ml 2 QL (900 mL / 30 days) methylphenidate hcl tab 5 mg 2 QL (90 tabs / 30 days) methylphenidate hcl tab 10 mg 2 QL (90 tabs / 30 days) methylphenidate hcl tab 20 mg 2 QL (150 tabs / 30 days) methylphenidate hcl tab er 10 mg 3 QL (90 tabs / 30 days) methylphenidate hcl tab er 20 mg 3 QL (90 tabs / 30 days) methylphenidate hcl tab er 24hr 18 mg 3 QL (30 tabs / 30 days) methylphenidate hcl tab er 24hr 27 mg 3 QL (30 tabs / 30 days) methylphenidate hcl tab er 24hr 36 mg 3 QL (60 tabs / 30 days) methylphenidate hcl tab er 24hr 54 mg 3 QL (30 tabs / 30 days) methylphenidate hcl tab er osmotic release (osm) 18 mg


methylphenidate hcl tab er osmotic release (osm) 27 mg






zenzedi tab 5mg 3 QL (180 tabs / 30 days) zenzedi tab 10mg 3 QL (180 tabs / 30 days)


62



HIPNÓTICOS

HETLIOZ CAP 20MG 5 QL (30 caps / 30 days), NM, LA, PA; DL

ROZEREM TAB 8MG 4 QL (30 tabs / 30 days)

SILENOR TAB 3MG 3 QL (30 tabs / 30 days)

SILENOR TAB 6MG 3 QL (30 tabs / 30 days)

temazepam cap 7.5 mg 2 QL (30 caps / 30 days)

temazepam cap 15 mg 2 QL (60 caps / 30 days)

temazepam cap 22.5 mg 2 QL (30 caps / 30 days)

temazepam cap 30 mg 2 QL (30 caps / 30 days)

zaleplon cap 5 mg 2 QL (30 caps / 30 days)

zaleplon cap 10 mg 2 QL (30 caps / 30 days)

zolpidem tartrate tab 5 mg 2 QL (30 tabs / 30 days), PA

zolpidem tartrate tab 10 mg 2 QL (30 tabs / 30 days), PA

MIGRAÑA dihydroergotamine mesylate nasal spray 4 mg/ml

5 DL

migergot sup 2/100 5 DL

naratriptan hcl tab 1 mg (base equiv) 2 QL (9 tabs / 28 days)

naratriptan hcl tab 2.5 mg (base equiv) 2 QL (9 tabs / 28 days) rizatriptan benzoate oral disintegrating tab 5 mg (base eq) rizatriptan benzoate oral disintegrating tab 10 mg (base eq) rizatriptan benzoate tab 5 mg (base equivalent) rizatriptan benzoate tab 10 mg (base equivalent)





sumatriptan nasal spray 5 mg/act 3 QL (18 inhalers / 28 days)

sumatriptan nasal spray 20 mg/act 3 QL (12 inhalers / 28days)

sumatriptan succinate inj 6 mg/0.5ml 4 QL (4 mL / 28 days) sumatriptan succinate solution auto- injector 4 mg/0.5ml

4 QL (4 mL / 28 days)

sumatriptan succinate solution auto- injector 6 mg/0.5ml

4 QL (4 mL / 28 days)

sumatriptan succinate solution cartridge 4 mg/0.5ml

4 QL (4 mL / 28 days)

sumatriptan succinate solution prefilled syringe 6 mg/0.5ml

3 QL (8 injections / 28 days)

sumatriptan succinate tab 25 mg 2 QL (9 tabs / 28 days)


63



sumatriptan succinate tab 50 mg 2 QL (9 tabs / 28 days) sumatriptan succinate tab 100 mg 2 QL (9 tabs / 28 days) zolmitriptan orally disintegrating tab 2.5 mg


zolmitriptan orally disintegrating tab 5 mg 3 QL (6 tabs / 28 days) zolmitriptan tab 2.5 mg 2 QL (6 tabs / 28 days) zolmitriptan tab 5 mg 2 QL (6 tabs / 28 days)

VARIOS EQUETRO CAP 100MG 4 EQUETRO CAP 200MG 4 EQUETRO CAP 300MG 4 FIRDAPSE TAB 10MG 5 QL (240 tabs / 30 days),

NM, LA, PA; DL GRALISE STAR MIS 300/600 4 QL (156 tabs / 365

days), PA GRALISE TAB 300MG 4 QL (30 tabs / 30 days),

PA GRALISE TAB 600MG 4 QL (90 tabs / 30 days),

PA GUANIDINE TAB 125MG 3

HORIZANT TAB 300MG ER 4 QL (60 tabs / 30 days), PA

HORIZANT TAB 600MG ER 4 QL (60 tabs / 30 days), PA

lithium carbonate cap 150 mg 1 GC lithium carbonate cap 300 mg 1 GC lithium carbonate cap 600 mg 1 GC lithium carbonate tab 300 mg 1 GC lithium carbonate tab er 300 mg 2 lithium carbonate tab er 450 mg 2 LITHIUM SOL 8MEQ/5ML 3 neostigmine methylsulfate iv soln 5 mg/10 ml (0.5 mg/ml)

2

neostigmine methylsulfate iv soln 10 mg/10 ml (1 mg/ml)

2

NUEDEXTA CAP 20-10MG 4 QL (60 caps / 30 days), PA

pyridostigmine bromide syrup 60 mg/5ml 4 pyridostigmine bromide tab 60 mg 2 REGONOL INJ 5MG/ML 3 riluzole tab 50 mg 3 SAVELLA MIS TITR PAK 4 QL (110 tabs / 365

days), PA


64



SAVELLA TAB 12.5MG 4 QL (60 tabs / 30 days), PA

SAVELLA TAB 25MG 4 QL (60 tabs / 30 days), PA



TEGSEDI INJ 284/1.5 5 QL (4 syringes / 28 days), NM, LA, PA; DL

tetrabenazine tab 12.5 mg 5 QL (240 tabs / 30 days), NM, PA; DL

tetrabenazine tab 25 mg 5 QL (120 tabs / 30 days), NM, PA; DL

AGENTES PARA LA ESCLEROSIS MÚLTIPLE AUBAGIO TAB 7MG 5 QL (30 tabs / 30 days),

NM, LA, PA; DL AUBAGIO TAB 14MG 5 QL (30 tabs / 30 days),

NM, LA, PA; DL BETASERON INJ 0.3MG 5 QL (14 injections / 28

days), NM, PA; DL COPAXONE INJ 40MG/ML 5 QL (12 syringes / 28

days), NM, PA; DL dalfampridine tab er 12hr 10 mg 5 QL (60 tabs / 30 days),

NM, PA; DL GILENYA CAP 0.5MG 5 QL (30 caps / 30 days),

NM, PA; DL glatopa inj 20mg/ml 5 QL (30 syringes / 30

days), NM, PA; DL AGENTES DE TERAPIA OSTEOMUSCULAR

baclofen tab 5 mg 2 baclofen tab 10 mg 2 baclofen tab 20 mg 2 carisoprodol tab 350 mg 2 PA carisoprodol w/ aspirin tab 200-325 mg 2 PA chlorzoxazone tab 500 mg 2 PA cyclobenzaprine hcl tab 5 mg 2 PA cyclobenzaprine hcl tab 10 mg 2 PA dantrolene sodium cap 25 mg 2 dantrolene sodium cap 50 mg 2 dantrolene sodium cap 100 mg 2 GABLOFEN INJ 20000/20 4 B/D methocarbamol tab 500 mg 2 PA methocarbamol tab 750 mg 2 PA


65



orphenadrine citrate tab er 12hr 100 mg 2 PA tizanidine hcl tab 2 mg (base equivalent) 2 tizanidine hcl tab 4 mg (base equivalent) 2 XEOMIN INJ 100UNIT 4 QL (8 injections / 84

days), PA

NARCOLEPSIA/CATAPLEXIA

armodafinil tab 50 mg 3 QL (30 tabs / 30 days), PA




modafinil tab 100 mg 2 QL (60 tabs / 30 days), PA

modafinil tab 200 mg 2 QL (60 tabs / 30 days), PA

XYREM SOL 500MG/ML 5 QL (540 mL / 30 days), NM, LA, PA; DL

PSICOTERAPÉUTICOS - VARIOS acamprosate calcium tab delayed release 333mg 2

buprenorphine hcl sl tab 2 mg (base equiv) 2 QL (60 tabs / 30 days)

buprenorphine hcl sl tab 8 mg (base equiv) 2 QL (60 tabs / 30 days) buprenorphine hcl-naloxone hcl sl film 2- 0.5 mg (base equiv) buprenorphine hcl-naloxone hcl sl film 4-1 mg (base equiv) buprenorphine hcl-naloxone hcl sl film 8-2 mg (base equiv) buprenorphine hcl-naloxone hcl sl film 12-3 mg (base equiv) buprenorphine hcl-naloxone hcl sl tab 2- 0.5 mg (base equiv) buprenorphine hcl-naloxone hcl sl tab 8-2 mg (base equiv) bupropion hcl (smoking deterrent) tab er 12hr 150 mg

2 QL (60 films / 30 days)






2

CHANTIX PAK 0.5& 1MG 3 QL (106 tabs / year)

CHANTIX PAK 1MG 3 QL (336 tabs / year)

CHANTIX TAB 0.5MG 3 QL (336 tabs / year)

CHANTIX TAB 1MG 3 QL (336 tabs / year)


66



chlordiazepoxide-amitriptyline tab 5-12.5 mg

2

chlordiazepoxide-amitriptyline tab 10-25 mg

2

disulfiram tab 250 mg 2 disulfiram tab 500 mg 2 naloxone hcl inj 0.4 mg/ml 1 GC naloxone hcl inj 4 mg/10ml 2 naloxone hcl soln cartridge 0.4 mg/ml 1 GC naloxone hcl soln prefilled syringe 2 mg/2ml

1 GC

naltrexone hcl tab 50 mg 2

NICOTROL INH 4 NICOTROL NS SPR 10MG/ML 4 perphenazine-amitriptyline tab 2-10 mg 2 perphenazine-amitriptyline tab 2-25 mg 2 perphenazine-amitriptyline tab 4-10 mg 2 perphenazine-amitriptyline tab 4-25 mg 2 perphenazine-amitriptyline tab 4-50 mg 2

ENDÓCRINOS Y METABÓLICOS ANDRÓGENOS ANADROL-50 TAB 50MG 5 PA; DL ANDRODERM DIS 2MG/24HR 4 PA ANDRODERM DIS 4MG/24HR 4 PA STRIANT MIS 30MG 4 PA testosterone cypionate im inj in oil 100 mg/ml

2 PA

testosterone cypionate im inj in oil 200 mg/ml

2 PA

testosterone enanthate im inj in oil 200 mg/ml

2 PA

testosterone td gel 12.5 mg/act (1%) 3 PA testosterone td gel 25 mg/2.5gm (1%) 3 PA testosterone td gel 50 mg/5gm (1%) 3 PA

ANTIDIABÉTICOS, INYECTABLES BYDUREON BC INJ 2/0.85ML 3 QL (4 pens / 28 days) BYDUREON PEN INJ 2MG 3 QL (4 pens / 28 days) BYETTA INJ 5MCG 4 QL (1 pen / 28 days) BYETTA INJ 10MCG 4 QL (1 pen / 28 days) FIASP FLEX INJ TOUCH 3 QL (15 pens / 30 days) FIASP INJ 100/ML 3 QL (5 vials / 30 days) GAUZE PADS & DRESSINGS - PADS 2 X 2 3


67



HUMULIN R INJ U-500 3 QL (12 pens / 30 days); (PEN)

HUMULIN R INJ U-500 3 QL (40 mL / 30 days); (CONC)

INSULIN PEN NEEDLE 3 INSULIN SYRINGE (DISP) U-100 0.3 ML 3 INSULIN SYRINGE (DISP) U-100 1 ML 3 INSULIN SYRINGE (DISP) U-100 1/2 ML 3 ISOPROPYL ALCOHOL 0.7ML/ML 3 LANTUS INJ 100/ML 3 QL (50 mL / 30 days) LANTUS SOLOS INJ 100/ML 3 QL (45 mL / 30 days) LEVEMIR INJ 3 QL (50 mL / 30 days) LEVEMIR INJ FLEXTOUC 3 QL (15 pens / 30 days) NEEDLES, INSULIN DISP., SAFETY 3 NOVOLIN INJ 70/30 3 QL (50 mL / 30 days);

(brand RELION not covered)

NOVOLIN N INJ U-100 3 QL (50 mL / 30 days); (brand RELION not covered)

NOVOLIN R INJ U-100 3 QL (50 mL / 30 days); (brand RELION not covered)

NOVOLOG INJ 100/ML 3 QL (50 mL / 30 days) NOVOLOG INJ FLEXPEN 3 QL (15 pens / 30 days) NOVOLOG INJ PENFILL 3 QL (15 pens / 30 days) NOVOLOG MIX INJ 70/30 3 QL (50 mL / 30 days) NOVOLOG MIX INJ FLEXPEN 3 QL (15 pens / 30 days) OZEMPIC INJ 2/1.5ML 3 QL (1 pen / 28 days);

0.25MG OR 0.5MG/DOSE

OZEMPIC INJ 2/1.5ML 3 QL (2 pens / 28 days); 1MG/DOSE

SOLIQUA INJ 100/33 3 QL (5 pens / 25 days) SYMLINPEN 60 INJ 1000MCG 5 QL (8 pens / 28 days),

ST; DL SYMLNPEN 120 INJ 1000MCG 5 QL (4 pens / 28 days),

ST; DL TOUJEO MAX INJ 300IU/ML 3 QL (6 pens / 30 days);

(MAX SOLOSTAR) TOUJEO SOLO INJ 300IU/ML 3 QL (12 pens / 30 days);

(SOLOSTAR) TRESIBA FLEX INJ 100UNIT 3 QL (15 pens / 30 days) TRESIBA FLEX INJ 200UNIT 3 QL (9 pens / 30 days)

(Marca BD)


68



TRESIBA INJ 100UNIT 3 QL (5 vials / 30 days) TRULICITY INJ 0.75/0.5 3 QL (4 pens / 28 days) TRULICITY INJ 1.5/0.5 3 QL (4 pens / 28 days) VICTOZA INJ 18MG/3ML 3 QL (3 pens / 30 days) XULTOPHY INJ 100/3.6 3 QL (5 pens / 30 days) ANTIDIABÉTICOS, ORALES acarbose tab 25 mg 2 acarbose tab 50 mg 2 acarbose tab 100 mg 2 glimepiride tab 1 mg 6 GC, QL (240 tabs / 30

days) glimepiride tab 2 mg 6 GC, QL (120 tabs / 30

days) glimepiride tab 4 mg 6 GC, QL (60 tabs / 30

days) glipizide tab 5 mg 6 GC, QL (240 tabs / 30

days) glipizide tab 10 mg 6 GC, QL (120 tabs / 30

days) glipizide tab er 24hr 2.5 mg 6 GC, QL (240 tabs / 30

days) glipizide tab er 24hr 5 mg 6 GC, QL (120 tabs / 30

days) glipizide tab er 24hr 10 mg 6 GC, QL (60 tabs / 30

days) glipizide-metformin hcl tab 2.5-250 mg 2 QL (240 tabs / 30 days) glipizide-metformin hcl tab 2.5-500 mg 2 QL (120 tabs / 30 days) glipizide-metformin hcl tab 5-500 mg 2 QL (120 tabs / 30 days) INVOKAMET TAB 50-500MG 3 QL (120 tabs / 30 days) INVOKAMET TAB 50-1000 3 QL (60 tabs / 30 days) INVOKAMET TAB 150-500 3 QL (60 tabs / 30 days) INVOKAMET TAB 150-1000 3 QL (60 tabs / 30 days) INVOKAMET XR TAB 50-500MG 3 QL (120 tabs / 30 days) INVOKAMET XR TAB 50-1000 3 QL (60 tabs / 30 days) INVOKAMET XR TAB 150-500 3 QL (60 tabs / 30 days) INVOKAMET XR TAB 150-1000 3 QL (60 tabs / 30 days) INVOKANA TAB 100MG 3 QL (30 tabs / 30 days) INVOKANA TAB 300MG 3 QL (30 tabs / 30 days) JANUMET TAB 50-500MG 3 JANUMET TAB 50-1000 3 JANUMET XR TAB 50-500MG 3 JANUMET XR TAB 50-1000 3 JANUMET XR TAB 100-1000 3 JANUVIA TAB 25MG 3


69



JANUVIA TAB 50MG 3 JANUVIA TAB 100MG 3 JARDIANCE TAB 10MG 3 QL (60 tabs / 30 days) JARDIANCE TAB 25MG 3 QL (30 tabs / 30 days) JENTADUETO TAB 2.5-500 3 JENTADUETO TAB 2.5-850 3 JENTADUETO TAB 2.5-1000 3 JENTADUETO TAB XR 3 metformin hcl tab 500 mg 6 GC, QL (150 tabs / 30

days) metformin hcl tab 850 mg 6 GC, QL (90 tabs / 30

days) metformin hcl tab 1000 mg 6 GC, QL (75 tabs / 30

days) metformin hcl tab er 24hr 500 mg 6 GC metformin hcl tab er 24hr 750 mg 6 GC, QL (60 tabs / 30

days) nateglinide tab 60 mg 2

nateglinide tab 120 mg 2 pioglitazone hcl tab 15 mg (base equiv) 6 GC, QL (30 tabs / 30

days) pioglitazone hcl tab 30 mg (base equiv) 6 GC, QL (30 tabs / 30

days) pioglitazone hcl tab 45 mg (base equiv) 6 GC, QL (30 tabs / 30

days) pioglitazone hcl-metformin hcl tab 15-500 mg


pioglitazone hcl-metformin hcl tab 15-850 mg


repaglinide tab 0.5 mg 2

repaglinide tab 1 mg 2 repaglinide tab 2 mg 2 RIOMET SOL 4 QL (765 mL / 30 days) SYNJARDY TAB 3 QL (60 tabs / 30 days) SYNJARDY TAB 5-500MG 3 QL (60 tabs / 30 days) SYNJARDY TAB 5-1000MG 3 QL (60 tabs / 30 days) SYNJARDY TAB 12.5-500 3 QL (60 tabs / 30 days) SYNJARDY XR TAB 3 QL (60 tabs / 30 days) SYNJARDY XR TAB 5-1000MG 3 QL (60 tabs / 30 days) SYNJARDY XR TAB 10-1000 3 QL (30 tabs / 30 days) SYNJARDY XR TAB 25-1000 3 QL (30 tabs / 30 days) tolazamide tab 250 mg 2 QL (120 tabs / 30 days) tolazamide tab 500 mg 2 QL (60 tabs / 30 days) tolbutamide tab 500 mg 2 QL (180 tabs / 30 days)


70



TRADJENTA TAB 5MG 3

BIFOSFONATOS alendronate sodium oral soln 70 mg/75ml 2 alendronate sodium tab 5 mg 1 GC alendronate sodium tab 10 mg 1 GC alendronate sodium tab 35 mg 1 GC alendronate sodium tab 40 mg 1 GC alendronate sodium tab 70 mg 1 GC ibandronate sodium tab 150 mg (base equivalent)

2 QL (1 tab / 28 days)

pamidronate disodium for inj 30 mg 2

pamidronate disodium for inj 90 mg 2 risedronate sodium tab 35 mg 3 QL (12 tabs / 84 days),

ST risedronate sodium tab 150 mg 3 QL (1 tab / 28 days), ST risedronate sodium tab delayed release 35 mg


risedronate tab 35mg 3 QL (12 tabs / 84 days), ST

AGENTES QUELANTES CHEMET CAP 100MG 4 PA deferasirox tab for oral susp 125 mg 5 NM, PA; DL deferasirox tab for oral susp 250 mg 5 NM, PA; DL deferasirox tab for oral susp 500 mg 5 NM, PA; DL deferoxamine mesylate for inj 2 gm 2 NM deferoxamine mesylate for inj 500 mg 2 NM DEPEN TITRA TAB 250MG 5 PA; DL JADENU SPRKL GRA 90MG 5 NM, LA, PA; DL JADENU SPRKL GRA 180MG 5 NM, LA, PA; DL JADENU SPRKL GRA 360MG 5 NM, LA, PA; DL JADENU TAB 90MG 5 NM, LA, PA; DL JADENU TAB 180MG 5 NM, LA, PA; DL JADENU TAB 360MG 5 NM, LA, PA; DL kionex sus 15gm/60 2 LOKELMA PAK 5GM 4 PA LOKELMA PAK 10GM 4 PA sodium polystyrene sulfonate powder 2 sps sus 15gm/60 2 trientine hcl cap 250 mg 5 PA; DL VELTASSA POW 8.4GM 4 QL (30 packets / 30

days), LA, PA VELTASSA POW 16.8GM 4 QL (30 packets / 30

days), LA, PA


71



VELTASSA POW 25.2GM 4 QL (30 packets / 30 days), LA, PA

ANTICONCEPTIVOS altavera tab 2 alyacen tab 1/35 2 alyacen tab 7/7/7 2 amethia lo tab 2 amethia tab 2 apri tab 2 aranelle tab 2 ashlyna tab 2 aubra tab 0.1-0.02 2 aviane tab 2 azurette tab 28 day 2 balziva tab 2 blisovi 24 tab fe 1/20 2 blisovi fe tab 1.5/30 2 briellyn tab 2 camila tab 0.35mg 2 camrese lo tab 2 camrese tab 2 caziant pak 2 chateal tab 0.15/30 2 cryselle-28 tab 28 tabs 2 cyclafem tab 1/35 2 cyclafem tab 7/7/7 2 cyred tab 2 dasetta tab 1/35 2 dasetta tab 7/7/7 2 daysee tab 2 deblitane tab 0.35mg 2 delyla tab 0.1-0.02 2 DEPO-SQ PROV INJ 104 4 QL (1 injection / 84

days)

desogest-eth estrad & eth estrad tab 0.15- 2 0.02/0.01 mg(21/5) desogestrel & ethinyl estradiol tab 0.15 2 mg-30 mcg drospirenone-ethinyl estradiol tab 3-0.02 2 mg drospirenone-ethinyl estradiol tab 3-0.03 2 mg

elinest tab 2


72



ELLA TAB 30MG 3 emoquette tab 2 enpresse-28 tab 2 enskyce tab 2 errin tab 0.35mg 2 estarylla tab 0.25-35 2 ethynodiol diacetate & ethinyl estradiol tab 1 mg-35 mcg

2

ethynodiol diacetate & ethinyl estradiol tab 1 mg-50 mcg

2

falmina tab 2 femynor tab 0.25-35 2 gianvi tab 3-0.02mg 2 gildess fe tab 1.5/30 2 gildess fe tab 1/20 2 gildess tab 1/20 2 hailey 24 tab fe 2 heather tab 0.35mg 2 incassia tab 0.35mg 2 introvale tab 2 isibloom tab 2 jasmiel tab 3-0.02mg 2 jencycla tab 0.35mg 2 jolessa tab 2 jolivette tab 0.35mg 2 juleber tab 2 junel 1.5/30 tab 2 junel 1/20 tab 2 junel fe 24 tab 1/20 2 junel fe tab 1.5/30 2 junel fe tab 1/20 2 kaitlib fe chw 2 kariva tab 28 day 2 kelnor 1/50 tab 2 kelnor tab 1/35 2 kurvelo tab 0.15/30 2 larin 24 tab fe 1/20 2 larin fe tab 1.5/30 2 larin fe tab 1/20 2 larin tab 1.5/30 2 larin tab 1/20 2 larissia tab 2 layolis fe chw 2


73



leena tab 2 lessina tab 2 levonest tab 2 levonorg-eth est tab 0.1-0.02mg(84) & eth est tab 0.01mg(7)

2

levonorg-eth est tab 0.15-0.03mg(84) & eth est tab 0.01mg(7)

2

levonorgestrel & ethinyl estradiol (91-day) tab 0.15-0.03 mg

2

levonorgestrel & ethinyl estradiol tab 0.1 mg-20 mcg

2

levonorgestrel & ethinyl estradiol tab 0.15 mg-30 mcg

2

levonorgestrel-eth estra tab 0.05- 30/0.075-40/0.125-30mg-mcg

2

levonorgestrel-ethinyl estradiol (continuous) tab 90-20 mcg

2

levora-28 tab 0.15/30 2

loryna tab 3-0.02mg 2 low-ogestrel tab 2 lutera tab 2 lyza tab 0.35mg 2 marlissa tab 0.15/30 2 medroxyprogesterone acetate im susp 150 mg/ml

2 QL (1 injection / 84 days)

medroxyprogesterone acetate im susp prefilled syr 150 mg/ml

2 QL (1 injection / 84 days)

microgestin tab 1.5/30 2

microgestin tab 1/20 2 microgestin tab fe1.5/30 2 microgestin tab fe 1/20 2 mili tab 0.25/35 2 mono-linyah tab 0.25-35 2 mononessa tab 2 myzilra tab 2 necon tab 0.5/35 2 nikki tab 3-0.02mg 2 nora-be tab 0.35mg 2 norethindrone & ethinyl estradiol-fe chew tab 0.4 mg-35 mcg

2

norethindrone & ethinyl estradiol-fe chew tab 0.8 mg-25 mcg

2

norethindrone ace & ethinyl estradiol tab 1 mg-20 mcg

2


74



norethindrone ace & ethinyl estradiol-fe tab 1 mg-20 mcg

2

norethindrone ace-ethinyl estradiol-fe tab 1 mg-20 mcg (24)

2

norethindrone tab 0.35 mg 2 norgestimate & ethinyl estradiol tab 0.25 mg-35 mcg

2

norgestimate-eth estrad tab 0.18- 25/0.215-25/0.25-25 mg-mcg

2

norgestimate-eth estrad tab 0.18- 35/0.215-35/0.25-35 mg-mcg

2

norlyroc tab 0.35mg 2 nortrel tab 0.5/35 2 nortrel tab 1/35 2 nortrel tab 7/7/7 2 NUVARING MIS 4 QL (1 ring / 28 days) ocella tab 3-0.03mg 2 ogestrel tab 2 orsythia tab 2 philith tab 0.4-35 2 pimtrea tab 2 pirmella tab 1/35 2 pirmella tab 7/7/7 2 portia-28 tab 2 previfem tab 2 reclipsen tab 2 setlakin tab 2 sharobel tab 0.35mg 2 sprintec 28 tab 28 day 2 sronyx tab 2 syeda tab 3-0.03mg 2 tarina 24 fe tab 2 tarina fe tab 1/20 2 tilia fe tab 2 tri-estaryll tab 2 tri-legest tab fe 2 tri-linyah tab 2 tri-lo tab estaryll 2 tri-lo- tab marzia 2 tri-lo- tab sprintec 2 tri-mili tab 2 tri-previfem tab 2 tri-sprintec tab 2


75



tri-vylibra tab 2 tri-vylibra tab lo 2 trinessa lo tab 2 trivora-28 tab 2 velivet pak 2 vienva tab 0.1-20 2 viorele tab 2 vyfemla tab 0.4-35 2 vylibra tab 0.25-35 2 wera tab 0.5/35 2 wymzya fe chw 0.4mg-35 2 zarah tab 3-0.03mg 2 zovia 1/35e tab 2

ENDOMETRIOSIS danazol cap 50 mg 3 danazol cap 100 mg 3 danazol cap 200 mg 3 LUPANETA KIT 3.75-5 5 QL (1 kit / 28 days),

NM, PA; DL LUPANETA KIT 11.25-5 5 QL (1 kit / 84 days),

NM, PA; DL methyltestosterone cap 10 mg 3 PA SYNAREL SOL 2MG/ML 5 PA; DL REEMPLAZOS ENZIMÁTICOS CARBAGLU TAB 200MG 5 NM, LA, PA; DL CERDELGA CAP 84MG 5 QL (60 caps / 30 days),

NM, PA; DL CYSTADANE POW 5 NM, LA; DL CYSTAGON CAP 50MG 3 NM, LA, PA CYSTAGON CAP 150MG 3 NM, LA, PA GALAFOLD CAP 123MG 5 QL (14 caps / 28 days),

NM, LA, PA; DL KUVAN POW 100MG 5 NM, LA, PA; DL KUVAN POW 500MG 5 NM, LA, PA; DL KUVAN TAB 100MG 5 NM, LA, PA; DL levocarnitine inj 200 mg/ml 2 levocarnitine oral soln 1 gm/10ml (10%) 2 levocarnitine tab 330 mg 2 miglustat cap 100 mg 5 NM, PA; DL ORFADIN CAP 2MG 5 NM, LA, PA; DL ORFADIN CAP 5MG 5 NM, LA, PA; DL ORFADIN CAP 10MG 5 NM, LA, PA; DL ORFADIN CAP 20MG 5 NM, LA, PA; DL


76



ORFADIN SUS 4MG/ML 5 NM, LA, PA; DL RAVICTI LIQ 1.1GM/ML 5 QL (525 mL / 30 days),

NM, LA, PA; DL sodium phenylbutyrate oral powder 3 gm/teaspoonful

5 NM, PA; DL

sodium phenylbutyrate tab 500 mg 5 NM, PA; DL ESTRÓGENOS

amabelz tab 0.5-0.1 2 amabelz tab 1-0.5mg 2 DEPO-ESTRADI INJ 5MG/ML 4 DIVIGEL GEL 1MG/GM 4 dotti dis 0.1mg 2 QL (8 patches / 28

days) dotti dis 0.05mg 2 QL (8 patches / 28




days) DUAVEE TAB 0.45-20 3 PA estradiol & norethindrone acetate tab 0.5- 0.1 mg

2

estradiol & norethindrone acetate tab 1-0.5 mg

2

estradiol tab 0.5 mg 2 estradiol tab 1 mg 2 estradiol tab 2 mg 2 estradiol td patch twice weekly 0.1 mg/24hr

2 QL (8 patches / 28 days)

estradiol td patch twice weekly 0.05 mg/24hr








estradiol td patch weekly 0.1 mg/24hr 2 QL (4 patches / 28 days)




77



estradiol td patch weekly 0.025 mg/24hr


estradiol td patch weekly 0.075 mg/24hr


estradiol td patch weekly 0.0375 mg/24hr (37.5 mcg/24hr)


estradiol vaginal cream 0.1 mg/gm 3

estradiol vaginal tab 10 mcg 2 estradiol valerate im in oil 20 mg/ml 2 estradiol valerate im in oil 40 mg/ml 2 ESTRING MIS 2MG 4 FEMRING MIS 0.1MG/24 4 FEMRING MIS 0.05/24H 4 fyavolv tab 1-5 2 jinteli tab 1mg-5mcg 2 lopreeza tab 1-0.5mg 2 MENOSTAR DIS 14MCG 4 QL (4 patches /

28 days) mimvey lo tab 0.5-0.1 2 mimvey tab 1-0.5mg 2 norethindrone acetate-ethinyl estradiol tab 1 mg-5 mcg

2

PREMARIN VAG CRE 0.625MG 3 yuvafem tab 10mcg 2

GLUCOCORTICOIDES ARISTOSPAN INJ 5MG/ML 4 ARISTOSPAN INJ 20MG/ML 4 betamethasone sod phosphate & acetate inj susp 6 (3-3) mg/ml

2

cortisone acetate tab 25 mg 2 DEXAMETHASON CON 1MG/ML 2 dexamethasone elixir 0.5 mg/5ml 2 dexamethasone soln 0.5 mg/5ml 2 dexamethasone tab 0.5 mg 1 GC dexamethasone tab 0.75 mg 1 GC dexamethasone tab 1 mg 1 GC dexamethasone tab 1.5 mg 1 GC dexamethasone tab 2 mg 1 GC dexamethasone tab 4 mg 1 GC dexamethasone tab 6 mg 1 GC fludrocortisone acetate tab 0.1 mg 2 hydrocortisone tab 5 mg 2 hydrocortisone tab 10 mg 2


78



hydrocortisone tab 20 mg 2 methylprednisolone tab 4 mg 2 methylprednisolone tab 8 mg 2 methylprednisolone tab 16 mg 2 methylprednisolone tab 32 mg 2 methylprednisolone tab therapy pack 4 mg (21)

2

prednisolone sod phosph oral soln 6.7 mg/5ml (5 mg/5ml base)

2

prednisolone sod phosphate oral soln 15 mg/5ml (base equiv)

2

prednisolone sodium phosphate oral soln 25 mg/5ml (base eq)

2

prednisolone syrup 15 mg/5ml (usp solution equivalent)

2

PREDNISONE CON 5MG/ML 3 prednisone oral soln 5 mg/5ml 1 GC prednisone tab 1 mg 1 GC prednisone tab 2.5 mg 1 GC prednisone tab 5 mg 1 GC prednisone tab 10 mg 1 GC prednisone tab 20 mg 1 GC prednisone tab 50 mg 1 GC prednisone tab therapy pack 5 mg (21) 1 GC prednisone tab therapy pack 5 mg (48) 1 GC prednisone tab therapy pack 10 mg (21) 1 GC prednisone tab therapy pack 10 mg (48) 1 GC SOLU-CORTEF INJ 500MG 4 SOLU-CORTEF INJ 1000MG 4 triamcinolone acetonide inj susp 10 mg/ml 2 triamcinolone acetonide inj susp 40 mg/ml 2

AGENTES QUE AUMENTAN EL NIVEL DE GLUCOSA GLUCAGEN INJ HYPOKIT 3 PROGLYCEM SUS 50MG/ML 4

VARIOS acetylcysteine inj 200 mg/ml 2 ACTHAR INJ 80UNIT 5 QL (35 mL / 28 days),

NM, LA, PA; DL cabergoline tab 0.5 mg 2

calcitonin (salmon) nasal soln 200 unit/act 2 cinacalcet hcl tab 30 mg (base equiv) 3 B/D, NM cinacalcet hcl tab 60 mg (base equiv) 5 B/D, NM; DL cinacalcet hcl tab 90 mg (base equiv) 5 B/D, NM; DL


79



EGRIFTA SOL 1MG 5 QL (60 vials / 30 days), NM, LA, PA; DL

FORTEO SOL 600/2.4 5 QL (2.4 mL / 28 days), NM, PA; DL

GENOTROPIN INJ 0.2MG 3 NM, PA GENOTROPIN INJ 0.4MG 5 NM, PA; DL GENOTROPIN INJ 0.6MG 5 NM, PA; DL GENOTROPIN INJ 0.8MG 5 NM, PA; DL GENOTROPIN INJ 1.2MG 5 NM, PA; DL GENOTROPIN INJ 1.4MG 5 NM, PA; DL GENOTROPIN INJ 1.6MG 5 NM, PA; DL GENOTROPIN INJ 1.8MG 5 NM, PA; DL GENOTROPIN INJ 1MG 5 NM, PA; DL GENOTROPIN INJ 2MG 5 NM, PA; DL GENOTROPIN INJ 5MG 5 NM, PA; DL GENOTROPIN INJ 12MG 5 NM, PA; DL INCRELEX INJ 40MG/4ML 5 NM, LA, PA; DL KORLYM TAB 300MG 5 QL (120 tabs / 30 days),

NM, LA, PA; DL methylergonovine maleate inj 0.2 mg/ml 2

MYALEPT INJ 11.3MG 5 QL (60 vials / 30 days), NM, LA, PA; DL

NATPARA INJ 25MCG 5 QL (2 cartridges / 28 days), NM, PA; DL




NUTROPIN AQ INJ 10MG/2ML 5 NM, LA, PA; DL NUTROPIN AQ INJ 20MG/2ML 5 NM, LA, PA; DL NUTROPIN AQ INJ NUSPIN 5 5 NM, LA, PA; DL octreotide acetate inj 50 mcg/ml (0.05 mg/ml)

4 NM

octreotide acetate inj 100 mcg/ml (0.1 mg/ml)

4 NM


4 NM


5 NM; DL

octreotide acetate inj 1000 mcg/ml (1 mg/ml)

5 NM; DL

oxytocin inj 10 unit/ml 2


80



PROLIA SOL 60MG/ML 4 QL (1 injection / 168 days), NM, PA

raloxifene hcl tab 60 mg 3

SAMSCA TAB 15MG 5 QL (30 tabs / 30 days), NM, LA, PA; DL

SAMSCA TAB 30MG 5 QL (60 tabs / 30 days), NM, LA, PA; DL

SEROSTIM INJ 4MG 5 NM, LA, PA; DL SEROSTIM INJ 5MG 5 NM, LA, PA; DL SEROSTIM INJ 6MG 5 NM, LA, PA; DL SIGNIFOR INJ 0.3MG/ML 5 QL (60 ampules / 30

days), NM, LA, PA; DL SIGNIFOR INJ 0.6MG/ML 5 QL (60 ampules / 30

days), NM, LA, PA; DL SIGNIFOR INJ 0.9MG/ML 5 QL (60 ampules / 30

days), NM, LA, PA; DL SOMATULINE INJ 60/0.2ML 5 QL (2 injections / 28

days), NM, PA; DL SOMATULINE INJ 90/0.3ML 5 QL (2 injections / 28

days), NM, PA; DL SOMATULINE INJ 120/.5ML 5 QL (1 injection / 28

days), NM, PA; DL SOMAVERT INJ 10MG 5 QL (30 vials / 30 days),

NM, LA, PA; DL SOMAVERT INJ 15MG 5 QL (30 vials / 30 days),




NM, LA, PA; DL STRENSIQ INJ 18/0.45 5 NM, LA, PA; DL STRENSIQ INJ 28/0.7ML 5 NM, LA, PA; DL XGEVA INJ 5 QL (1 vial / 28 days),

NM, PA; DL ZORBTIVE INJ 8.8MG 5 NM, PA; DL

AGENTES AGLUTINANTES DE FOSFATO AURYXIA TAB 210MG 3 PA calcium acetate (phosphate binder) cap 667 mg (169 mg ca)

2

calcium acetate (phosphate binder) tab 667 mg

2

sevelamer carbonate packet 0.8 gm 3 sevelamer carbonate packet 2.4 gm 3


81



sevelamer carbonate tab 800 mg 4 PROGESTÁGENOS

medroxyprogesterone acetate tab 2.5 mg 2 medroxyprogesterone acetate tab 5 mg 2 medroxyprogesterone acetate tab 10 mg 2 norethindrone acetate tab 5 mg 2 progesterone micronized cap 100 mg 2 progesterone micronized cap 200 mg 2

AGENTES TIROIDEOS levothyroxine sodium tab 25 mcg 2 levothyroxine sodium tab 50 mcg 2 levothyroxine sodium tab 75 mcg 2 levothyroxine sodium tab 88 mcg 2 levothyroxine sodium tab 100 mcg 2 levothyroxine sodium tab 112 mcg 2 levothyroxine sodium tab 125 mcg 2 levothyroxine sodium tab 137 mcg 2 levothyroxine sodium tab 150 mcg 2 levothyroxine sodium tab 175 mcg 2 levothyroxine sodium tab 200 mcg 2 levothyroxine sodium tab 300 mcg 2 liothyronine sodium tab 5 mcg 2 liothyronine sodium tab 25 mcg 2 liothyronine sodium tab 50 mcg 2 methimazole tab 5 mg 2 methimazole tab 10 mg 2 propylthiouracil tab 50 mg 2 SYNTHROID TAB 25MCG 4 SYNTHROID TAB 50MCG 4 SYNTHROID TAB 75MCG 4 SYNTHROID TAB 88MCG 4 SYNTHROID TAB 100MCG 4 SYNTHROID TAB 112MCG 4 SYNTHROID TAB 125MCG 4 SYNTHROID TAB 137MCG 4 SYNTHROID TAB 150MCG 4 SYNTHROID TAB 175MCG 4 SYNTHROID TAB 200MCG 4 SYNTHROID TAB 300MCG 4 unithroid tab 25mcg 2 unithroid tab 50mcg 2 unithroid tab 75mcg 2 unithroid tab 88mcg 2


82



unithroid tab 100mcg 2 unithroid tab 112mcg 2 unithroid tab 125mcg 2 unithroid tab 150mcg 2 unithroid tab 175mcg 2 unithroid tab 200mcg 2 unithroid tab 300mcg 2

VASOPRESINAS desmopressin acetate nasal spray soln 0.01%

3

desmopressin acetate nasal spray soln 0.01% (refrigerated)

3

desmopressin acetate tab 0.1 mg 2 desmopressin acetate tab 0.2 mg 2 STIMATE SOL 1.5MG/ML 4 NM

GASTROINTESTINALES ANTIEMÉTICOS

aprepitant capsule 40 mg 2 B/D aprepitant capsule 80 mg 2 B/D aprepitant capsule 125 mg 2 B/D aprepitant capsule therapy pack 80 & 125 mg

2 B/D

compro sup 25mg 2 dronabinol cap 2.5 mg 4 PA dronabinol cap 5 mg 4 PA dronabinol cap 10 mg 4 PA EMEND SUS 125MG 4 B/D meclizine hcl tab 12.5 mg 2 meclizine hcl tab 25 mg 2 metoclopramide hcl soln 5 mg/5ml (10 mg/10ml) (base equiv)

1 GC

metoclopramide hcl tab 5 mg (base equivalent)

1 GC

metoclopramide hcl tab 10 mg (base equivalent)

1 GC

ondansetron hcl oral soln 4 mg/5ml 3 B/D ondansetron hcl tab 4 mg 2 B/D ondansetron hcl tab 8 mg 2 B/D ondansetron orally disintegrating tab 4 mg 2 B/D ondansetron orally disintegrating tab 8 mg 2 B/D phenadoz sup 12.5mg 3 prochlorperazine maleate tab 5 mg (base equivalent)

1 GC


83



prochlorperazine maleate tab 10 mg (base equivalent)

1 GC

prochlorperazine suppos 25 mg 2

promethazine hcl suppos 12.5 mg 3 promethazine hcl suppos 25 mg 3 promethazine hcl suppos 50 mg 3 promethazine hcl syrup 6.25 mg/5ml 2 PA promethazine hcl tab 12.5 mg 2 PA promethazine hcl tab 25 mg 2 PA promethazine hcl tab 50 mg 2 PA promethegan sup 25mg 3 promethegan sup 50mg 3 SANCUSO DIS 3.1MG 5 QL (4 patches / 28

days), ST; DL scopolamine td patch 72hr 1 mg/3days 4

ANTIESPASMÓDICOS dicyclomine hcl cap 10 mg 2 dicyclomine hcl oral soln 10 mg/5ml 2 dicyclomine hcl tab 20 mg 2 glycopyrrolate tab 1 mg 2 glycopyrrolate tab 2 mg 2 propantheline bromide tab 15 mg 2

ANTAGONISTAS DE RECEPTORES H2 cimetidine hcl soln 300 mg/5ml 2 cimetidine tab 200 mg 2 cimetidine tab 300 mg 2 cimetidine tab 400 mg 2 cimetidine tab 800 mg 2 famotidine for susp 40 mg/5ml 2 famotidine tab 20 mg 2 famotidine tab 40 mg 2 nizatidine cap 150 mg 2 nizatidine cap 300 mg 2 nizatidine oral soln 15 mg/ml 2 ranitidine hcl cap 150 mg 2 ranitidine hcl cap 300 mg 2 ranitidine hcl syrup 15 mg/ml (75 mg/5ml) 2 ranitidine hcl tab 150 mg 1 GC ranitidine hcl tab 300 mg 1 GC ENFERMEDAD INFLAMATORIA INTESTINAL

APRISO CAP 0.375GM 3 balsalazide disodium cap 750 mg 3


84



budesonide delayed release particles cap 3 mg

4

CANASA SUP 1000MG 5 DL DELZICOL CAP 400MG 4 hydrocortisone enema 100 mg/60ml 2 mesalamine cap dr 400 mg 4 mesalamine suppos 1000 mg 4 mesalamine tab delayed release 800 mg 4 sulfasalazine tab 500 mg 2 sulfasalazine tab delayed release 500 mg 2

LAXANTES constulose sol 10gm/15 2 enulose sol 10gm/15 2 gavilyte-c sol 2 gavilyte-g sol 2 gavilyte-n sol flav pk 2 generlac sol 10gm/15 2 lactulose solution 10 gm/15ml 2 peg 3350-kcl-na bicarb-nacl-na sulfate for soln 236 gm

2

peg 3350-kcl-na bicarb-nacl-na sulfate for soln 240 gm

2

peg 3350-kcl-sod bicarb-nacl for soln 420 gm

2

SUPREP BOWEL SOL PREP KIT 3 trilyte sol 2

VARIOS alosetron hcl tab 0.5 mg (base equiv) 5 PA; DL alosetron hcl tab 1 mg (base equiv) 5 PA; DL AMITIZA CAP 8MCG 3 AMITIZA CAP 24MCG 3 CARAFATE SUS 1GM/10ML 4 cromolyn sodium oral conc 100 mg/5ml 2 diphenoxylate w/ atropine liq 2.5-0.025 mg/5ml

2

diphenoxylate w/ atropine tab 2.5-0.025 mg

2

GATTEX KIT 5MG 5 NM, LA, PA; DL LINZESS CAP 72MCG 3 QL (30 caps / 30 days) LINZESS CAP 145MCG 3 QL (30 caps / 30 days) LINZESS CAP 290MCG 3 QL (30 caps / 30 days) loperamide hcl cap 2 mg 2 misoprostol tab 100 mcg 2


85



misoprostol tab 200 mcg 2 MOVANTIK TAB 12.5MG 3 QL (30 tabs / 30 days) MOVANTIK TAB 25MG 3 QL (30 tabs / 30 days) MYTESI TAB 125MG 4 PA OCALIVA TAB 5MG 5 QL (30 tabs / 30 days),

NM, LA, PA; DL OCALIVA TAB 10MG 5 QL (30 tabs / 30 days),

NM, LA, PA; DL RELISTOR INJ 8/0.4ML 5 PA; DL RELISTOR INJ 12/0.6ML 5 PA; DL RELISTOR TAB 150MG 5 QL (90 tabs / 30 days),

PA; DL SUCRAID SOL 8500/ML 5 LA, PA; DL sucralfate tab 1 gm 2 ursodiol cap 300 mg 3 ursodiol tab 250 mg 3 ursodiol tab 500 mg 3 XERMELO TAB 250MG 5 QL (84 tabs / 28 days),

NM, LA, PA; DL XIFAXAN TAB 550MG 5 QL (60 tabs / 30 days),

PA; DL ENZIMAS PANCREÁTICAS CREON CAP 3000UNIT 3 CREON CAP 6000UNIT 3 CREON CAP 12000UNT 3 CREON CAP 24000UNT 3 CREON CAP 36000UNT 3 ZENPEP CAP 3000UNIT 4 ZENPEP CAP 5000UNIT 4 ZENPEP CAP 10000UNT 4 ZENPEP CAP 15000UNT 4 ZENPEP CAP 20000UNT 4 ZENPEP CAP 25000 4 ZENPEP CAP 40000 5 DL

INHIBIDORES DE LA BOMBA DE PROTONES

DEXILANT CAP 30MG DR 3 QL (30 caps / 30 days), ST

DEXILANT CAP 60MG DR 3 QL (30 caps / 30 days), ST

lansoprazole cap delayed release 15 mg 2 QL (30 caps / 30 days) lansoprazole cap delayed release 30 mg 2 QL (30 caps / 30 days) omeprazole cap delayed release 10 mg 2 QL (60 caps / 30 days)


86



omeprazole cap delayed release 20 mg 2 QL (30 caps / 30 days) omeprazole cap delayed release 40 mg (base equiv)


pantoprazole sodium ec tab 20 mg (base equiv)


pantoprazole sodium ec tab 40 mg (base equiv)


GENITOURINARIOS HIPERPLASIA PROSTÁTICA BENIGNA alfuzosin hcl tab er 24hr 10 mg 2 dutasteride cap 0.5 mg 2 dutasteride-tamsulosin hcl cap 0.5-0.4 mg 3 finasteride tab 5 mg 1 GC tamsulosin hcl cap 0.4 mg 2

VARIOS bethanechol chloride tab 5 mg 2 bethanechol chloride tab 10 mg 2 bethanechol chloride tab 25 mg 2 bethanechol chloride tab 50 mg 2 ELMIRON CAP 100MG 4 flavoxate hcl tab 100 mg 2 LITHOSTAT TAB 250MG 3 potassium citrate tab er 5 meq (540 mg) 2

potassium citrate tab er 10 meq (1080 mg) 2 potassium citrate tab er 15 meq (1620 mg) 2

THIOLA TAB 100MG 5 PA; DL ESPASMOLÍTICOS URINARIOS

MYRBETRIQ TAB 25MG 4 QL (30 tabs / 30 days) MYRBETRIQ TAB 50MG 4 QL (30 tabs / 30 days) oxybutynin chloride syrup 5 mg/5ml 1 GC oxybutynin chloride tab 5 mg 1 GC oxybutynin chloride tab er 24hr 5 mg 2 oxybutynin chloride tab er 24hr 10 mg 2 oxybutynin chloride tab er 24hr 15 mg 2 solifenacin succinate tab 5 mg 4 solifenacin succinate tab 10 mg 4 tolterodine tartrate cap er 24hr 2 mg 3 tolterodine tartrate cap er 24hr 4 mg 3 tolterodine tartrate tab 1 mg 2 tolterodine tartrate tab 2 mg 2 trospium chloride cap er 24hr 60 mg 2 trospium chloride tab 20 mg 2

ANTIINFECCIOSOS VAGINALES CLEOCIN SUP 100MG 4

clindamycin phosphate vaginal cream 2% 2


87



metronidazole vaginal gel 0.75% 2 miconazole 3 sup 200mg 2 terconazole vaginal cream 0.4% 2 terconazole vaginal cream 0.8% 2 terconazole vaginal suppos 80 mg 2 vandazole gel 0.75% 2

HEMATOLÓGICOS ANTICOAGULANTES ELIQUIS ST P TAB 5MG 3 QL (148 tabs / 365

days) ELIQUIS TAB 2.5MG 3 QL (60 tabs / 30 days) ELIQUIS TAB 5MG 3 QL (74 tabs / 30 days) enoxaparin sodium inj 30 mg/0.3ml 4 QL (36 mL / year) enoxaparin sodium inj 40 mg/0.4ml 4 QL (48 mL / year) enoxaparin sodium inj 60 mg/0.6ml 4 QL (72 mL / year) enoxaparin sodium inj 80 mg/0.8ml 4 QL (96 mL / year) enoxaparin sodium inj 100 mg/ml 4 QL (120 mL / year) enoxaparin sodium inj 120 mg/0.8ml 4 QL (96 mL / year) enoxaparin sodium inj 150 mg/ml 4 QL (120 mL / year) fondaparinux sodium subcutaneous inj 2.5 mg/0.5ml

4 QL (30 mL / year)

fondaparinux sodium subcutaneous inj 5 mg/0.4ml

5 QL (24 mL / year); DL

fondaparinux sodium subcutaneous inj 7.5 mg/0.6ml


fondaparinux sodium subcutaneous inj 10 mg/0.8ml


FRAGMIN INJ 2500/0.2 4 QL (6 mL / 30 days) FRAGMIN INJ 5000/0.2 4 QL (6 mL / 30 days) FRAGMIN INJ 7500/0.3 5 QL (9 mL / 30 days); DL FRAGMIN INJ 10000/ML 5 QL (30 mL / 30 days);

DL FRAGMIN INJ 12500UNT 5 QL (15 mL / 30 days);

DL FRAGMIN INJ 15000UNT 5 QL (18 mL / 30 days);

DL FRAGMIN INJ 18000UNT 5 QL (21.6 mL / 30 days);

DL FRAGMIN INJ 95000UNT 5 QL (22.8 mL / 30 days);

DL HEP SOD/D5W INJ 50UNT/ML 3

HEP SOD/NACL INJ 12500UNT 3


88



heparin sod (porcine)-nacl iv soln 1000 unit/500ml-0.9%

2

heparin sodium (porcine) inj 1000 unit/ml 2

heparin sodium (porcine) inj 5000 unit/ml 2 heparin sodium (porcine) inj 10000 unit/ml 2 heparin sodium (porcine) inj 20000 unit/ml 2 heparin sodium (porcine) pf inj 5000 unit/0.5ml

2

jantoven tab 1mg 2

jantoven tab 2.5mg 2 jantoven tab 2mg 2 jantoven tab 3mg 2 jantoven tab 4mg 2 jantoven tab 5mg 2 jantoven tab 6mg 2 jantoven tab 7.5mg 2 jantoven tab 10mg 2 PRADAXA CAP 75MG 4 QL (60 caps / 30 days) PRADAXA CAP 110MG 4 QL (180 caps / year) PRADAXA CAP 150MG 4 QL (60 caps / 30 days) warfarin sodium tab 1 mg 1 GC warfarin sodium tab 2 mg 1 GC warfarin sodium tab 2.5 mg 1 GC warfarin sodium tab 3 mg 1 GC warfarin sodium tab 4 mg 1 GC warfarin sodium tab 5 mg 1 GC warfarin sodium tab 6 mg 1 GC warfarin sodium tab 7.5 mg 1 GC warfarin sodium tab 10 mg 1 GC XARELTO STAR TAB 15/20MG 3 QL (51 tabs / 30 days) XARELTO TAB 2.5MG 3 QL (60 tabs / 30 days) XARELTO TAB 10MG 3 QL (30 tabs / 30 days) XARELTO TAB 15MG 3 QL (60 tabs / 30 days) XARELTO TAB 20MG 3 QL (30 tabs / 30 days)

FACTORES DE CRECIMIENTO HEMATOPOYÉTICO ARANESP INJ 10MCG 4 NM, PA ARANESP INJ 25MCG 4 NM, PA ARANESP INJ 40MCG 4 NM, PA ARANESP INJ 60MCG 4 NM, PA ARANESP INJ 60MCG 5 NM, PA; DL ARANESP INJ 100MCG 4 NM, PA ARANESP INJ 100MCG 5 NM, PA; DL ARANESP INJ 150MCG 4 NM, PA


89



ARANESP INJ 200MCG 4 NM, PA ARANESP INJ 200MCG 5 NM, PA; DL ARANESP INJ 300MCG 4 NM, PA ARANESP INJ 300MCG 5 NM, PA; DL ARANESP INJ 500MCG 4 NM, PA EPOGEN INJ 2000/ML 4 NM, PA EPOGEN INJ 3000/ML 4 NM, PA EPOGEN INJ 4000/ML 4 NM, PA EPOGEN INJ 10000/ML 4 NM, PA EPOGEN INJ 20000/ML 4 NM, PA FULPHILA INJ 6/0.6ML 5 NM, PA; DL GRANIX INJ 300/0.5 5 NM, PA; DL GRANIX INJ 300/1ML 5 NM, PA; DL GRANIX INJ 480/0.8 5 NM, PA; DL GRANIX INJ 480/1.6 5 NM, PA; DL LEUKINE INJ 250MCG 5 NM, PA; DL NEUPOGEN INJ 300/0.5 5 NM, PA; DL NEUPOGEN INJ 300MCG 5 NM, PA; DL NEUPOGEN INJ 480/0.8 5 NM, PA; DL NEUPOGEN INJ 480MCG 5 NM, PA; DL NIVESTYM INJ 300MCG 5 NM, PA; DL NIVESTYM INJ 480MCG 5 NM, PA; DL PROCRIT INJ 2000/ML 4 NM, PA PROCRIT INJ 3000/ML 4 NM, PA PROCRIT INJ 4000/ML 4 NM, PA PROCRIT INJ 10000/ML 4 NM, PA PROCRIT INJ 20000/ML 4 NM, PA PROCRIT INJ 40000/ML 4 NM, PA RETACRIT INJ 2000UNIT 3 NM, PA RETACRIT INJ 3000UNIT 3 NM, PA RETACRIT INJ 4000UNIT 3 NM, PA RETACRIT INJ 10000UNT 3 NM, PA RETACRIT INJ 40000UNT 5 PA; DL UDENYCA INJ 6MG/.6ML 5 NM, PA; DL ZARXIO INJ 300/0.5 5 NM, PA; DL ZARXIO INJ 480/0.8 5 NM, PA; DL

VARIOS aminocaproic acid inj 250 mg/ml 2 anagrelide hcl cap 0.5 mg 4 anagrelide hcl cap 1 mg 4 cilostazol tab 50 mg 2 cilostazol tab 100 mg 2 FIRAZYR INJ 30MG/3ML 5 NM, PA; DL


90



pentoxifylline tab er 400 mg 2

PROMACTA POW 12.5MG 5 QL (180 packets / 30 days), NM, LA, PA; DL

PROMACTA TAB 12.5MG 5 QL (30 tabs / 30 days), NM, LA, PA; DL

PROMACTA TAB 25MG 5 QL (30 tabs / 30 days), NM, LA, PA; DL



RUCONEST INJ 2100UNIT 5 NM, PA; DL

tranexamic acid tab 650 mg 3 QL (30 tabs / 28 days)

ANTIAGREGANTES PLAQUETARIOS

aspirin-dipyridamole cap er 12hr 25-200 3 mg

BRILINTA TAB 60MG 3 QL (60 tabs / 30 days)

BRILINTA TAB 90MG 3 QL (60 tabs / 30 days) clopidogrel bisulfate tab 75 mg (base 2 equiv)

dipyridamole tab 25 mg 2 dipyridamole tab 50 mg 2 dipyridamole tab 75 mg 2 prasugrel hcl tab 5 mg (base equiv) 3 QL (30 tabs / 30 days) prasugrel hcl tab 10 mg (base equiv) 3 QL (30 tabs / 30 days) ticlopidine hcl tab 250 mg 2 ZONTIVITY TAB 2.08MG 4 QL (30 tabs / 30 days),

PA

AGENTES INMUNOLÓGICOS FÁRMACOS ANTIRREUMÁTICOS MODIFICADORES DE LA ENFERMEDAD (FARME)

ENBREL INJ 25/0.5ML 5 QL (16 injections / 28 days), NM, PA; DL

ENBREL INJ 25MG 5 QL (16 injections / 28 days), NM, PA; DL

ENBREL INJ 50MG/ML 5 QL (8 injections / 28 days), NM, PA; DL

ENBREL MINI INJ 50MG/ML 5 QL (8 injections / 28 days), NM, PA; DL

ENBREL SRCLK INJ 50MG/ML 5 QL (8 injections / 28 days), NM, PA; DL

HUMIRA INJ 10/0.1ML 5 NM, PA; DL HUMIRA INJ 10MG/0.2 5 NM, PA; DL HUMIRA INJ 20/0.2ML 5 NM, PA; DL HUMIRA INJ 40/0.4ML 5 NM, PA; DL


91



HUMIRA KIT 20MG/0.4 5 NM, PA; DL HUMIRA KIT 40MG/0.8 5 NM, PA; DL HUMIRA PEDIA INJ CROHNS 5 NM, PA; DL HUMIRA PEN INJ 40/0.4ML 5 NM, PA; DL HUMIRA PEN INJ 40MG/0.8 5 NM, PA; DL HUMIRA PEN INJ CD/UC/HS 5 NM, PA; DL HUMIRA PEN INJ PS/UV 5 NM, PA; DL HUMIRA PEN KIT CD/UC/HS 5 NM, PA; DL HUMIRA PEN KIT PS/UV 5 NM, PA; DL hydroxychloroquine sulfate tab 200 mg 2 leflunomide tab 10 mg 3 leflunomide tab 20 mg 3 methotrexate sodium tab 2.5 mg (base equiv)

2

OTREXUP INJ 10MG 4 QL (1.6 mL / 28 days), NM, PA

OTREXUP INJ 12.5/0.4 4 QL (1.6 mL / 28 days), NM, PA






RASUVO INJ 7.5MG 3 QL (0.6 mL / 28 days), NM, PA

RASUVO INJ 10MG 3 QL (0.8 mL / 28 days), NM, PA

RASUVO INJ 12.5MG 3 QL (1 mL / 28 days), NM, PA





RASUVO INJ 25MG 3 QL (2 mL / 28 days), NM, PA


92




RIDAURA CAP 3MG 5 DL STELARA INJ 45MG/0.5 5 QL (2 vials / 28 days),

NM, LA, PA; DL STELARA INJ 45MG/0.5 5 QL (2 syringes / 28

days), NM, PA; DL STELARA INJ 90MG/ML 5 QL (1 syringe / 28

days), NM, PA; DL XATMEP SOL 2.5MG/ML 4 B/D XELJANZ TAB 5MG 5 QL (60 tabs / 30 days),

NM, PA; DL XELJANZ TAB 10MG 5 QL (60 tabs / 30 days),

NM, PA; DL XELJANZ XR TAB 11MG 5 QL (30 tabs / 30 days),

NM, PA; DL INMUNOGLOBULINAS FLEBOGAMMA INJ 5GM/50ML 5 NM, PA; DL FLEBOGAMMA INJ 10/200ML 5 NM, PA; DL FLEBOGAMMA INJ 20/400ML 5 NM, PA; DL FLEBOGAMMA INJ DIF 5% 5 NM, PA; DL GAMMAGARD INJ 2.5GM/25 5 NM, PA; DL GAMMAGARD SD INJ 5GM HU 5 NM, PA; DL GAMMAGARD SD INJ 10GM HU 5 NM, PA; DL GAMMAKED INJ 1GM/10ML 5 NM, PA; DL GAMUNEX-C INJ 1GM/10ML 5 NM, PA; DL HIZENTRA INJ 1GM/5ML 5 NM, LA, PA; DL HIZENTRA INJ 2GM/10ML 5 NM, LA, PA; DL HIZENTRA INJ 4GM/20ML 5 NM, LA, PA; DL HIZENTRA INJ 10/50ML 5 NM, LA, PA; DL PRIVIGEN INJ 20GRAMS 5 NM, PA; DL INMUNOMODULADORES ACTIMMUNE INJ 2MU/0.5 5 NM, LA, PA; DL ARCALYST INJ 220MG 5 NM, PA; DL INTRON A INJ 10MU 5 DL INTRON A INJ 18MU 5 DL INTRON A INJ 25MU 5 DL INTRON A INJ 50MU 5 DL ORALAIR SUB 300 IR 4 QL (30 tabs / 30 days),

PA INMUNOSUPRESORES azathioprine tab 50 mg 2 B/D BENLYSTA INJ 200MG/ML 5 NM, PA; DL


93



cyclosporine cap 25 mg 3 B/D cyclosporine cap 100 mg 3 B/D cyclosporine modified cap 25 mg 3 B/D cyclosporine modified cap 50 mg 3 B/D cyclosporine modified cap 100 mg 3 B/D cyclosporine modified oral soln 100 mg/ml 2 B/D gengraf cap 25mg 3 B/D gengraf cap 100mg 3 B/D gengraf sol 100mg/ml 2 B/D mycophenolate mofetil cap 250 mg 2 B/D mycophenolate mofetil for oral susp 200 mg/ml

5 B/D; DL

mycophenolate mofetil tab 500 mg 2 B/D mycophenolate sodium tab dr 180 mg (mycophenolic acid equiv)

4 B/D

mycophenolate sodium tab dr 360 mg (mycophenolic acid equiv)

4 B/D

PROGRAF GRA 0.2MG 4 B/D PROGRAF GRA 1MG 4 B/D RAPAMUNE SOL 1MG/ML 5 PA; DL SIMULECT INJ 10MG 4 B/D sirolimus oral soln 1 mg/ml 5 PA; DL sirolimus tab 0.5 mg 4 PA sirolimus tab 1 mg 4 PA sirolimus tab 2 mg 5 PA; DL tacrolimus cap 0.5 mg 2 B/D tacrolimus cap 1 mg 2 B/D tacrolimus cap 5 mg 4 B/D ZORTRESS TAB 0.5MG 5 PA; DL ZORTRESS TAB 0.25MG 4 PA ZORTRESS TAB 0.75MG 5 PA; DL ZORTRESS TAB 1MG 5 PA; DL

VACUNAS ACTHIB INJ 3 ADACEL INJ 3 BCG VACCINE INJ 4 BEXSERO INJ 3 BOOSTRIX INJ 3 DAPTACEL INJ 3 DIP/TET PED INJ 25-5LFU 3 ENGERIX-B INJ 10/0.5ML 3 B/D ENGERIX-B INJ 20MCG/ML 3 B/D GARDASIL 9 INJ 3 PA


94



HAVRIX INJ 720UNIT 3 HAVRIX INJ 1440UNIT 3 HIBERIX SOL 10MCG 3 IMOVAX RABIE INJ 2.5/ML 3 INFANRIX INJ 3 IPOL INJ INACTIVE 3 IXIARO INJ 3 KINRIX INJ 3 M-M-R II INJ 3 MENACTRA INJ 3 MENVEO INJ 3 PEDIARIX INJ 0.5ML 3 PEDVAX HIB INJ 3 PROQUAD INJ 3 QUADRACEL INJ 3 RABAVERT INJ 3 RECOMBIVA HB INJ 5MCG/0.5 3 B/D RECOMBIVA HB INJ 10MCG/ML 3 B/D RECOMBIVA HB INJ 40MCG/ML ROTARIX SUS 3 ROTATEQ SOL 3 SHINGRIX INJ 50MCG 3 PA SYNAGIS INJ 100MG/ML 5 NM, LA, PA; DL TDVAX INJ 2-2 LF 3 TENIVAC INJ 5-2LF 3 TRUMENBA INJ 3 TWINRIX INJ 3 TYPHIM VI INJ 3 VAQTA INJ 25/0.5ML 3 VAQTA INJ 50UNT/ML 3 VARIVAX INJ 3 YF-VAX INJ 3 ZOSTAVAX INJ 3 QL (1 vaccine / 365

days), PA NUTRITIVOS/SUPLEMENTOS ELECTROLITOS

2

calcium gluconate inj 10% fluoritab chw 0.5mg f 2 fluoritab chw 2.2mg 2 K-TAB TAB 8MEQ CR 3 k-vescent tab 25meq ef 2 klor-con 8 tab 8meq er 2 klor-con 10 tab 10meq er 2


95



klor-con m10 tab 10meq er 2 klor-con m15 tab 15meq er 3 klor-con m20 tab 20meq er 2 klor-con pak 20meq 4 klor-con spr cap 8meq 2 ludent chw 0.25mg f 2 MAGNESIUM SU INJ 2GM/50ML 3 MAGNESIUM SU INJ 4G/100ML 3 MAGNESIUM SU INJ 20/500ML 3 MAGNESIUM SU INJ 40G/1000 3 MAGNESIUM SU INJ 80MG/ML 3 magnesium sulfate inj 50% 2 MG SO4/D5W INJ 10MG/ML 4 multivit/fl chw 0.5mg 2 multivit/fl chw 0.25mg 2 multivit/fl chw 1mg 2 pediatric multiple vitamins w/ fl-fe drops 0.25-10 mg/ml

2

pediatric multiple vitamins w/ fluoride soln 0.5 mg/ml

2

pediatric multiple vitamins w/ fluoride soln 0.25 mg/ml

2

pot chloride tab 25meq ef 2 potassium acetate inj 2 meq/ml 2 potassium chloride cap er 8 meq 2 potassium chloride cap er 10 meq 2 potassium chloride microencapsulated crys er tab 10 meq

2

potassium chloride microencapsulated crys er tab 20 meq

2

potassium chloride oral soln 10% (20 meq/15ml)

4

potassium chloride oral soln 20% (40 meq/15ml)

4

potassium chloride powder packet 20 meq 2 potassium chloride tab er 8 meq (600 mg) 2 potassium chloride tab er 10 meq 2 potassium chloride tab er 20 meq (1500 mg)

2

potassium phosphates inj 15 mm/5ml (phos) 22 meq/5ml (k)

2

potassium phosphates inj 45 mm/15ml (phos) 66 meq/15ml (k)

2


96



potassium phosphates inj 150 mm/50ml 2 (phos) 220 meq/50ml (k) SOD ACETATE INJ 2MEQ/ML 2 SOD ACETATE INJ 4MEQ/ML 2 SOD LACTATE INJ 5MEQ/ML 3 sodium bicarbonate iv soln 7.5% 2 sodium bicarbonate iv soln 8.4% 2 sodium fluoride 2.2 mg 2 TPN ELECTROL INJ 2 tri-vit/fe dro /fl 0.25 2 tri-vit/fl dro 0.5mg 2 tri-vit/fl dro 0.25mg 2

IV NUTRICIÓN amino acid infusion 6% 2 B/D AMINOSYN II INJ 10% 4 B/D AMINOSYN II INJ 15% 3 B/D AMINOSYN M INJ 3.5% 4 B/D AMINOSYN-PF INJ 7% 4 B/D AMINOSYN-PF INJ 10% 4 B/D CLINIMIX E INJ 2.75/D5W 4 B/D CLINIMIX E INJ 4.25/D5W 4 B/D CLINIMIX E INJ 4.25/D10 4 B/D CLINIMIX E INJ 5%/D15W 4 B/D CLINIMIX E INJ 5%/D20W 4 B/D CLINIMIX INJ 4.25/D5W 4 B/D CLINIMIX INJ 4.25/D10 4 B/D CLINIMIX INJ 5%/D15W 4 B/D CLINIMIX INJ 5%/D20W 4 B/D clinisol sf inj 15% 2 B/D FREAMINE HBC INJ 6.9% 4 B/D hepatamine sol 8% 2 B/D intralipid inj 20% 2 B/D INTRALIPID INJ 30% 4 B/D KABIVEN EMU 4 B/D NEPHRAMINE INJ 5.4% 4 B/D PERIKABIVEN EMU 4 B/D plenamine inj 15% 2 B/D PREMASOL SOL 10% 4 B/D PROCALAMINE INJ 3% 4 B/D PROSOL INJ 20% 4 B/D TRAVASOL INJ 10% 4 B/D TROPHAMINE INJ 6% 4 B/D TROPHAMINE INJ 10% 4 B/D


97



SOLUCIONES DE REEMPLAZO IV D5W/LYTES INJ #48 3 D10W/NACL INJ 0.2% 3 dextrose 2.5% w/ sodium chloride 0.45% 2 dextrose 5% w/ sodium chloride 0.2% 2 dextrose 5% w/ sodium chloride 0.9% 2 dextrose 5% w/ sodium chloride 0.33% 2 dextrose 5% w/ sodium chloride 0.45% 2 dextrose 5% w/ sodium chloride 0.225% 2 dextrose 10% w/ sodium chloride 0.45% 2 dextrose inj 5% 2 dextrose inj 10% 2 DEXTROSE INJ 20% 3 dextrose inj 25% 2 dextrose inj 30% 2 DEXTROSE INJ 40% 3 dextrose inj 50% 2 dextrose inj 70% 2 IONOSOL-MB INJ D5W 4 ISOLYTE-P INJ /D5W 4 ISOLYTE-S INJ 4 kcl 10 meq/l (0.075%) in dextrose 5% & nacl 0.45% inj

2

kcl 20 meq/l (0.15%) in dextrose 5% & nacl 0.2% inj

2


2


2


2

kcl 20 meq/l (0.15%) in nacl 0.9% inj 2 kcl 20 meq/l (0.15%) in nacl 0.45% inj 2 kcl 30 meq/l (0.224%) in dextrose 5% & nacl 0.2% inj

2


2


2


2

kcl 40 meq/l (0.3%) in nacl 0.9% inj 2 KCL/D5W/LACT INJ 20MEQ/L 3 KCL/D5W/NACL INJ 0.3/0.9% 3


98



NORMOSOL -M INJ /D5W 4 NORMOSOL -R INJ /D5W 4 NORMOSOL-R INJ PH 7.4 4 PLASMA-LYTE INJ -148 4 PLASMA-LYTE INJ -A 4 potassium chloride 20 meq/l (0.15%) in dextrose 5% inj

2

potassium chloride 30 meq/l (0.224%) in dextrose 5% inj

2

potassium chloride 40 meq/l (0.3%) in dextrose 5% inj

2

potassium chloride inj 10 meq/100ml 2 potassium chloride inj 20 meq/100ml 2 potassium chloride inj 30 meq/100ml 2 potassium chloride inj 40 meq/100ml 2 sodium chloride iv soln 0.9% 2 sodium chloride iv soln 0.45% 2 sodium chloride iv soln 3% 2 sodium chloride iv soln 4 meq/ml (23.4%) 2 sodium chloride iv soln 5% 2

VITAMINAS ASCORBIC ACID 80 MG / BIOTIN 0.030 MG / CALCIUM CARBONATE 200 MG / CUPRIC OXIDE 3 MG / FERROUS FUMARATE 60 MG

2

calcitriol cap 0.5 mcg 2 calcitriol cap 0.25 mcg 2 calcitriol oral soln 1 mcg/ml 2 doxercalciferol cap 0.5 mcg 4 doxercalciferol cap 1 mcg 3 doxercalciferol cap 2.5 mcg 4 paricalcitol cap 1 mcg 2 paricalcitol cap 2 mcg 2 paricalcitol cap 4 mcg 2

OFTALMOLÓGICOS ANTIINFECCIOSOS/ANTIINFLAMATORIOS

bacitracin-polymyxin-neomycin-hc ophth oint 1%

1 GC

BLEPHAMIDE OIN S.O.P. 4 BLEPHAMIDE SUS OP 4 neomycin-polymyxin-dexamethasone ophth oint 0.1%

1 GC

neomycin-polymyxin-dexamethasone ophth susp 0.1%

1 GC


99



neomycin-polymyxin-hc ophth susp 2 PRED-G S.O.P OIN OP 4 PRED-G SUS OP 4 sulfacetamide sodium-prednisolone ophth soln 10-0.23(0.25)%

2

TOBRADEX OIN 0.3-0.1% 4

tobramycin-dexamethasone ophth susp 0.3-0.1%

2

ZYLET SUS 0.5-0.3% 4

ANTIINFECCIOSOS AZASITE SOL 1% 4 bacitracin ophth oint 500 unit/gm 2 bacitracin-polymyxin b ophth oint 2 BESIVANCE SUS 0.6% 4 CILOXAN OIN 0.3% OP 4 ciprofloxacin hcl ophth soln 0.3% (base equivalent)

2

erythromycin ophth oint 5 mg/gm 1 GC gatifloxacin ophth soln 0.5% 2 gentak oin 0.3% op 2 gentamicin sulfate ophth soln 0.3% 1 GC levofloxacin ophth soln 0.5% 2 MOXEZA SOL 0.5% 4 moxifloxacin hcl ophth soln 0.5% (base equiv)

2

NATACYN SUS 5% OP 4 neomycin-bacitrac zn-polymyx 5(3.5)mg- 400unt-10000unt op oin

1 GC

neomycin-polymy-gramicid op sol 1.75- 10000-0.025mg-unt-mg/ml

1 GC

ofloxacin ophth soln 0.3% 2

polymyxin b-trimethoprim ophth soln 10000 unit/ml-0.1%

1 GC

sulfacetamide sodium ophth oint 10% 2

sulfacetamide sodium ophth soln 10% 1 GC tobramycin ophth soln 0.3% 1 GC TOBREX OIN 0.3% OP 4 trifluridine ophth soln 1% 2 ZIRGAN GEL 0.15% 4

ANTIINFLAMATORIOS ACUVAIL SOL 0.45% 4 ALREX SUS 0.2% 3


100



dexamethasone sodium phosphate ophth 2 soln 0.1%

diclofenac sodium ophth soln 0.1% 2 DUREZOL EMU 0.05% 3 fluorometholone ophth susp 0.1% 2 flurbiprofen sodium ophth soln 0.03% 2 FML FORTE SUS 0.25% OP 4 FML OIN 0.1% OP 4

ketorolac tromethamine ophth soln 0.4% 2 ketorolac tromethamine ophth soln 0.5% 2

LOTEMAX GEL 0.5% 3 LOTEMAX OIN 0.5% 3 loteprednol etabonate ophth susp 0.5% 3 MAXIDEX SUS 0.1% OP 4 PRED MILD SUS 0.12% OP 4 PRED SOD PHO SOL 1% OP 2 prednisolone acetate ophth susp 1% 2

ANTIALÉRGICOS ALOCRIL SOL 2% 4 ALOMIDE SOL 0.1% OP 4 azelastine hcl ophth soln 0.05% 2 BEPREVE DRO 1.5% 4 cromolyn sodium ophth soln 4% 2 epinastine hcl ophth soln 0.05% 2

ANTIGLAUCOMA ALPHAGAN P SOL 0.1% 3 apraclonidine hcl ophth soln 0.5% (base equivalent)

2

betaxolol hcl ophth soln 0.5% 2 BETIMOL SOL 0.5% 4 BETIMOL SOL 0.25% 4 BETOPTIC-S SUS 0.25% OP 4 bimatoprost ophth soln 0.03% 3 ST brimonidine tartrate ophth soln 0.2% 2 brimonidine tartrate ophth soln 0.15% 2 carteolol hcl ophth soln 1% 2 COMBIGAN SOL 0.2/0.5% 3 dorzolamide hcl ophth soln 2% 2 dorzolamide hcl-timolol maleate ophth soln 22.3-6.8 mg/ml

2

IOPIDINE SOL 1% OP 4 latanoprost ophth soln 0.005% 2 levobunolol hcl ophth soln 0.5% 1 GC


101



LUMIGAN SOL 0.01% 3 PHOSPHOLINE SOL 0.125%OP 4 pilocarpine hcl ophth soln 1% 2 pilocarpine hcl ophth soln 2% 2 pilocarpine hcl ophth soln 4% 2 SIMBRINZA SUS 1-0.2% 3 timolol maleate ophth gel forming soln 0.5%

2

timolol maleate ophth gel forming soln 0.25%

2

timolol maleate ophth soln 0.5% 1 GC timolol maleate ophth soln 0.25% 1 GC TRAVATAN Z DRO 0.004% 4 ST ZIOPTAN DRO 0.0015% 4 ST

VARIOS atropine sul sol 1% op 2 CYSTARAN SOL 0.44% 5 NM, LA, PA; DL RESTASIS EMU 0.05% 3 QL (60 vials / 30 days)

RESPIRATORIOS COMBINACIONES DE ANTICOLINÉRGICOS/AGONISTAS BETA

COMBIVENT AER 20-100 3 ipratropium-albuterol nebu soln 0.5-2.5(3) mg/3ml

2 B/D

STIOLTO AER 2.5-2.5 3

TRELEGY AER ELLIPTA 3

ANTICOLINÉRGICOS ATROVENT HFA AER 17MCG 4 ipratropium bromide inhal soln 0.02% 2 B/D ipratropium bromide nasal soln 0.03% (21 mcg/spray)

2

ipratropium bromide nasal soln 0.06% (42 mcg/spray)

2

SPIRIVA AER 1.25MCG 3 SPIRIVA CAP HANDIHLR 3 SPIRIVA SPR 2.5MCG 3

ANTIHISTAMÍNICOS azelastine hcl nasal spray 0.1% (137 mcg/spray)

2

carbinoxamine maleate soln 4 mg/5ml 2 PA carbinoxamine maleate tab 4 mg 2 PA clemastine fumarate tab 2.68 mg 2 PA cyproheptadine hcl syrup 2 mg/5ml 2 PA cyproheptadine hcl tab 4 mg 2 PA


102



desloratadine tab 5 mg 2 hydroxyzine hcl syrup 10 mg/5ml 2 PA hydroxyzine hcl tab 10 mg 2 PA hydroxyzine hcl tab 25 mg 2 PA hydroxyzine hcl tab 50 mg 2 PA hydroxyzine pamoate cap 25 mg 2 PA hydroxyzine pamoate cap 50 mg 2 PA hydroxyzine pamoate cap 100 mg 2 PA levocetirizine dihydrochloride tab 5 mg 2

AGONISTAS BETA albuterol sulfate inhal aero 108 mcg/act (90mcg base equiv)

3 QL (2 inhalers / 30 days); (generic of ProAir

HFA) albuterol sulfate inhal aero 108 mcg/act (90mcg base equiv)

3 QL (2 inhalers / 30 days); (generic of Proventil HFA)

albuterol sulfate inhal aero 108 mcg/act (90mcg base equiv)

3 QL (2 inhalers / 30 days); (generic of Ventolin HFA)

albuterol sulfate soln nebu 0.5% (5 mg/ml) 1 GC, B/D albuterol sulfate soln nebu 0.63 mg/3ml (base equiv)

1 GC, B/D

albuterol sulfate soln nebu 0.083% (2.5 mg/3ml)

1 GC, B/D

albuterol sulfate soln nebu 1.25 mg/3ml (base equiv)

1 GC, B/D

albuterol sulfate syrup 2 mg/5ml 1 GC albuterol sulfate tab 2 mg 2 albuterol sulfate tab 4 mg 2 albuterol sulfate tab er 12hr 4 mg 2 albuterol sulfate tab er 12hr 8 mg 2 ISUPREL INJ 0.2MG/ML 4 levalbuterol hcl soln nebu 0.31 mg/3ml (base equiv)

2 B/D

levalbuterol hcl soln nebu 0.63 mg/3ml (base equiv)

2 B/D

levalbuterol hcl soln nebu 1.25 mg/3ml (base equiv)

2 B/D

levalbuterol hcl soln nebu conc 1.25 mg/0.5ml (base equiv)

2 B/D

levalbuterol tartrate inhal aerosol 45 mcg/act (base equiv)

2 QL (2 inhalers / 30 days)

metaproterenol sulfate syrup 10 mg/5ml 2

metaproterenol sulfate tab 10 mg 2


103



metaproterenol sulfate tab 20 mg 2 SEREVENT DIS AER 50MCG 3 terbutaline sulfate tab 2.5 mg 2 terbutaline sulfate tab 5 mg 2

MODULADORES DE LEUCOTRIENOS montelukast sodium chew tab 4 mg (base equiv)


montelukast sodium chew tab 5 mg (base equiv)


montelukast sodium oral granules packet 4 mg (base equiv)

2 QL (30 packets / 30 days)

montelukast sodium tab 10 mg (base equiv)


zafirlukast tab 10 mg 2

zafirlukast tab 20 mg 2

ESTABILIZADORES DE MASTOCITOS

cromolyn sodium soln nebu 20 mg/2ml 2 B/D

VARIOS acetylcysteine inhal soln 10% 2 B/D acetylcysteine inhal soln 20% 2 B/D ARALAST NP INJ 1000MG 5 NM, LA, PA; DL DALIRESP TAB 250MCG 4 PA DALIRESP TAB 500MCG 4 PA epinephrine solution auto-injector 0.3 mg/0.3ml (1:1000)

3

epinephrine solution auto-injector 0.15 mg/0.3ml (1:2000)

2

EPIPEN 2-PAK INJ 0.3MG 3 EPIPEN-JR INJ 0.15MG 3 ESBRIET CAP 267MG 5 QL (270 caps / 30

days), NM, PA; DL ESBRIET TAB 267MG 5 QL (270 tabs / 30 days),

NM, PA; DL ESBRIET TAB 801MG 5 QL (90 tabs / 30 days),

NM, PA; DL KALYDECO PAK 25MG 5 QL (56 packets / 28

days), NM, PA; DL KALYDECO PAK 50MG 5 QL (56 packets / 28

days), NM, PA; DL KALYDECO PAK 75MG 5 QL (56 packets / 28

days), NM, PA; DL KALYDECO TAB 150MG 5 QL (60 tabs / 30 days),

NM, PA; DL


104



NUCALA INJ 100MG 5 QL (3 vials / 28 days), NM, LA, PA; DL

NUCALA INJ 100MG/ML 5 QL (3 injections / 28 days), NM, LA, PA; DL

NUCALA INJ 100MG/ML 5 QL (3 syringes / 28 days), NM, LA, PA; DL

OFEV CAP 100MG 5 QL (60 caps / 30 days), NM, PA; DL

OFEV CAP 150MG 5 QL (60 caps / 30 days), NM, PA; DL

ORKAMBI GRA 100-125 5 QL (56 packets / 28 days), NM, PA; DL

ORKAMBI GRA 150-188 5 QL (56 packets / 28 days), NM, PA; DL

ORKAMBI TAB 100-125 5 QL (112 tabs / 28 days), NM, PA; DL

ORKAMBI TAB 200-125 5 QL (120 tabs / 30 days), NM, PA; DL

PROLASTIN-C INJ 1000MG 5 NM, LA, PA; DL PULMOZYME SOL 1MG/ML 5 QL (150 mL / 30 days),

NM, PA; DL theophylline soln 80 mg/15ml 2 theophylline tab er 12hr 100 mg 2 theophylline tab er 12hr 200 mg 2 theophylline tab er 12hr 300 mg 2 theophylline tab er 24hr 400 mg 2 theophylline tab er 24hr 600 mg 2 XOLAIR INJ 75/0.5 5 QL (12 syringes / 28

days), NM, LA, PA; DL XOLAIR INJ 150MG/ML 5 QL (6 syringes / 28

days), NM, LA, PA; DL XOLAIR SOL 150MG 5 QL (6 vials / 28 days),

NM, LA, PA; DL ZEMAIRA INJ 1000MG 5 NM, LA, PA; DL

ESTEROIDES NASALES flunisolide nasal soln 25 mcg/act (0.025%) 2 fluticasone propionate nasal susp 50 2 mcg/act

ESTEROIDES INHALADOS ARNUITY ELPT INH 50MCG 3 ARNUITY ELPT INH 100MCG 3 ARNUITY ELPT INH 200MCG 3 budesonide inhalation susp 0.5 mg/2ml 2 B/D budesonide inhalation susp 0.25 mg/2ml 2 B/D


105



budesonide inhalation susp 1 mg/2ml 2 B/D FLOVENT DISK AER 50MCG 3 FLOVENT DISK AER 100MCG 3 FLOVENT DISK AER 250MCG 3 FLOVENT HFA AER 44MCG 3 FLOVENT HFA AER 110MCG 3 FLOVENT HFA AER 220MCG 3 PULMICORT INH 90MCG 4 PULMICORT INH 180MCG 4

COMBINACIONES DE ESTEROIDES/AGONISTAS BETA ADVAIR DISKU AER 100/50 3 ADVAIR DISKU AER 250/50 3 ADVAIR DISKU AER 500/50 3 ADVAIR HFA AER 45/21 3 ADVAIR HFA AER 115/21 3 ADVAIR HFA AER 230/21 3 BREO ELLIPTA INH 100-25 3 BREO ELLIPTA INH 200-25 3 SYMBICORT AER 80-4.5 3 SYMBICORT AER 160-4.5 3

TOPICOS DERMATOLOGÍA, ACNÉ amnesteem cap 10mg 3 amnesteem cap 20mg 3 amnesteem cap 40mg 3 avita cre 0.025% 2 PA; CREAM benzoyl peroxide-erythromycin gel 5-3% 3 claravis cap 10mg 3 claravis cap 20mg 3 claravis cap 30mg 3 claravis cap 40mg 3 clindamycin phosphate gel 1% 2 clindamycin phosphate lotion 1% 2 clindamycin phosphate soln 1% 3 clindamycin phosphate swab 1% 2 ery pad 2% 2 erythromycin gel 2% 2 erythromycin soln 2% 2 isotretinoin cap 10 mg 2 isotretinoin cap 20 mg 2 isotretinoin cap 30 mg 2 isotretinoin cap 40 mg 2


106



myorisan cap 10mg 3 myorisan cap 20mg 3 myorisan cap 30mg 3 myorisan cap 40mg 3 sulfacetamide sodium lotion 10% (acne) 2 tretinoin cream 0.1% 3 PA tretinoin cream 0.05% 2 PA tretinoin cream 0.025% 2 PA tretinoin gel 0.01% 2 PA tretinoin gel 0.025% 2 PA zenatane cap 10mg 3 zenatane cap 20mg 3 zenatane cap 30mg 3 zenatane cap 40mg 3

DERMATOLOGÍA, ANTIBIÓTICOS BACTROBAN OIN NASAL 2% 4 gentamicin sulfate cream 0.1% 2 gentamicin sulfate oint 0.1% 2 mupirocin oint 2% 2 silver sulfadiazine cream 1% 2 ssd cre 1% 2 SULFAMYLON CRE 85MG/GM 4

DERMATOLOGÍA, ANTIFÚNGICOS ciclodan cre 0.77% 2 ciclopirox gel 0.77% 2 ciclopirox olamine cream 0.77% (base equiv)

2

ciclopirox olamine susp 0.77% (base equiv)

2

ciclopirox solution 8% 2 clotrimazole cream 1% 2 clotrimazole soln 1% 2 clotrimazole w/ betamethasone cream 1- 0.05%

2

clotrimazole w/ betamethasone lotion 1- 0.05%

3

ketoconazole cream 2% 2 nyamyc pow 100000 2 nystatin cream 100000 unit/gm 1 GC nystatin oint 100000 unit/gm 1 GC nystatin topical powder 100000 unit/gm 2 nystatin-triamcinolone cream 100000-0.1 unit/gm-%

4


107



nystatin-triamcinolone oint 100000-0.1 4 unit/gm-%

nystop pow 100000 2 DERMATOLOGÍA, ANTIPSORIÁSICOS

acitretin cap 10 mg 3 PA acitretin cap 17.5 mg 5 PA; DL acitretin cap 25 mg 3 PA calcipotriene oint 0.005% 3 calcipotriene soln 0.005% (50 mcg/ml) 3 methoxsalen rapid cap 10 mg 5 PA; DL TAZORAC CRE 0.05% 4 PA TAZORAC GEL 0.1% 4 PA TAZORAC GEL 0.05% 4 PA

DERMATOLOGÍA, ANTISEBORREICOS ketoconazole shampoo 2% 2 selenium sulfide lotion 2.5% 2

DERMATOLOGÍA, CORTICOESTEROIDES ala-cort cre 1% 1 GC ala-cort cre 2.5% 1 GC alclometasone dipropionate cream 0.05% 2 alclometasone dipropionate oint 0.05% 2 amcinonide lotion 0.1% 2 AMCINONIDE OIN 0.1% 3 betamethasone dipropionate augmented cream 0.05%

2

betamethasone dipropionate augmented gel 0.05%

3

betamethasone dipropionate augmented lotion 0.05%

2

betamethasone dipropionate augmented oint 0.05%

2

betamethasone dipropionate cream 0.05% 2 betamethasone dipropionate lotion 0.05% 2 betamethasone dipropionate oint 0.05% 2 betamethasone valerate cream 0.1% (base equivalent)

2

betamethasone valerate lotion 0.1% (base equivalent)

2

betamethasone valerate oint 0.1% (base equivalent)

2

desonide lotion 0.05% 3

desoximetasone cream 0.05% 3 desoximetasone cream 0.25% 3


108



desoximetasone gel 0.05% 3 desoximetasone oint 0.25% 3 fluocinolone acetonide cream 0.01% 2 fluocinolone acetonide cream 0.025% 2 fluocinolone acetonide oil 0.01% (scalp oil) 2 fluocinolone acetonide oint 0.025% 2 fluocinolone acetonide soln 0.01% 2 fluocinonide cream 0.05% 2 fluocinonide emulsified base cream 0.05% 2 fluocinonide gel 0.05% 2 fluocinonide oint 0.05% 2 fluocinonide soln 0.05% 2 fluticasone propionate cream 0.05% 2 fluticasone propionate oint 0.005% 2 hydrocort oin 1% 1 GC hydrocortisone cream 1% 1 GC hydrocortisone cream 2.5% 1 GC hydrocortisone lotion 2.5% 2 hydrocortisone oint 2.5% 1 GC mometasone furoate cream 0.1% 2 mometasone furoate oint 0.1% 2 mometasone furoate solution 0.1% (lotion) 2 prednicarbate cream 0.1% 2 prednicarbate oint 0.1% 2 triamcinolone acetonide cream 0.1% 1 GC triamcinolone acetonide cream 0.5% 1 GC triamcinolone acetonide cream 0.025% 1 GC triamcinolone acetonide lotion 0.1% 2 triamcinolone acetonide lotion 0.025% 2 triamcinolone acetonide oint 0.1% 1 GC triamcinolone acetonide oint 0.5% 1 GC triamcinolone acetonide oint 0.025% 1 GC triderm cre 0.1% 1 GC

DERMATOLOGÍA, ANESTÉSICOS LOCALES lidocaine hcl soln 4% 2 lidocaine hcl urethral/mucosal gel 2% 2 PA lidocaine oint 5% 4 PA lidocaine patch 5% 4 QL (90 patches / 30

days), PA lidocaine-prilocaine cream 2.5-2.5% 4 PA

DERMATOLOGÍA, VARIOS PIEL Y MEMBRANA MUCOSA acyclovir oint 5% 4 CONDYLOX GEL 0.5% 4


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DENAVIR CRE 1% 5 DL diclofenac sodium gel 1% 4 QL (1000gm / 30 days) EUCRISA OIN 2% 4 PA fluorouracil cream 5% 3 fluorouracil soln 2% 2 fluorouracil soln 5% 2 hydrocortisone acetate w/ pramoxine rectal cream 1-1%

2

imiquimod cream 5% 2 lactic acid (ammonium lactate) cream 12% 2 lactic acid (ammonium lactate) lotion 12% 2 metronidazole cream 0.75% 2 metronidazole gel 0.75% 2 metronidazole lotion 0.75% 3 PANRETIN GEL 0.1% 5 PA; DL PICATO GEL 0.05% 5 PA; DL PICATO GEL 0.015% 5 PA; DL pimecrolimus cream 1% 4 PA podofilox soln 0.5% 2 procto-med cre hc 2.5% 2 procto-pak cre 1% 2 proctosol hc cre 2.5% 2 proctozone cre -hc 2.5% 2 RECTIV OIN 0.4% 4 rosadan cre 0.75% 2 rosadan gel 0.75% 2 tacrolimus oint 0.1% 4 PA tacrolimus oint 0.03% 4 PA TARGRETIN GEL 1% 5 NM; DL VALCHLOR GEL 0.016% 5 NM, LA, PA; DL

DERMATOLOGÍA, ESCABICIDAS Y PEDICULICIDAS lindane shampoo 1% 3 permethrin cream 5% 2

DERMATOLOGÍA, AGENTES PARA EL CUIDADO DE HERIDAS acetic acid irrigation soln 0.25% 2 REGRANEX GEL 0.01% 5 PA; DL SANTYL OIN 250/GM 4 sodium chloride irrigation soln 0.9% 2

AGENTES DE BOCA/GARGANTA/DENTALES cevimeline hcl cap 30 mg 4 chlorhexidine gluconate soln 0.12% 2 clotrimazole troche 10 mg 2


110



dentagel gel 1.1% 2 lidocaine hcl laryngotracheal soln 4% 2 lidocaine hcl viscous soln 2% 1 GC nystatin susp 100000 unit/ml 2 periomed con 0.63% 2 pilocarpine hcl tab 5 mg 2 pilocarpine hcl tab 7.5 mg 2 sf 5000 plus cre 1.1% 2 triamcinolone acetonide dental paste 0.1% 2

ÓTICOS acetic acid otic soln 2% 2 CIPRODEX SUS 0.3-0.1% 3 ciprofloxacin hcl otic soln 0.2% (base 2 equivalent)

fluocinolone acetonide (otic) oil 0.01% 2 hydrocortisone w/ acetic acid otic soln 1- 2 2%

neomycin-polymyxin-hc otic soln 1% 2 neomycin-polymyxin-hc otic susp 3.5 2 mg/ml-10000 unit/ml-1%

ofloxacin otic soln 0.3% 3

ClarionHealth.org/DrugListChanges 111

Índice

A abacavir sulfate soln 20 mg/ml (base equiv) ............................................. 10 abacavir sulfate tab 300 mg (base equiv) ..................................................... 10 abacavir sulfate-lamivudine tab 600-300 mg ................................................. 11 abacavir sulfate-lamivudine-zidovudine tab 300-150-300 mg ........................ 11 ABELCET INJ 5MG/ML ......................... 8 ABILIFY MAIN INJ 300MG .................. 55 ABILIFY MAIN INJ 400MG .................. 55 abiraterone acetate tab 250 mg ......... 22 acamprosate calcium tab delayed release 333 mg ........................................... 65 acarbose tab 100 mg ........................ 68 acarbose tab 25 mg .......................... 68 acarbose tab 50 mg .......................... 68 acebutolol hcl cap 200 mg ................. 37 acebutolol hcl cap 400 mg ................. 37 acetaminophen w/ codeine soln 120-12 mg/5ml............................................. 2 acetaminophen w/ codeine tab 300-15 mg ................................................... 2 acetaminophen w/ codeine tab 300-30 mg ................................................... 2 acetaminophen w/ codeine tab 300-60 mg ................................................... 2 acetazolamide cap er 12hr 500 mg ..... 40 acetazolamide tab 125 mg ................ 40 acetazolamide tab 250 mg ................ 40 acetic acid irrigation soln 0.25% .......109 acetic acid otic soln 2% ...................110 acetylcysteine inhal soln 10% ...........103 acetylcysteine inhal soln 20% ...........103 acetylcysteine inj 200 mg/ml ............. 78 acitretin cap 10 mg .........................107 acitretin cap 17.5 mg .......................107 acitretin cap 25 mg .........................107 ACTHAR INJ 80UNIT ......................... 78 ACTHIB INJ ..................................... 93 ACTIMMUNE INJ 2MU/0.5 .................. 92 ACUVAIL SOL 0.45% ........................ 99 acyclovir cap 200 mg ........................ 13 acyclovir oint 5% ............................108 acyclovir sodium iv soln 50 mg/ml ...... 13

acyclovir susp 200 mg/5ml ................ 13 acyclovir tab 400 mg ........................ 13 acyclovir tab 800 mg ........................ 13 ADACEL INJ ..................................... 93 adefovir dipivoxil tab 10 mg ............... 13 ADEMPAS TAB 0.5MG ........................ 42 ADEMPAS TAB 1.5MG ........................ 42 ADEMPAS TAB 1MG........................... 42 ADEMPAS TAB 2.5MG ........................ 42 ADEMPAS TAB 2MG .......................... 42 ADVAIR DISKU AER 100/50 ............. 105 ADVAIR DISKU AER 250/50 ............. 105 ADVAIR DISKU AER 500/50 ............. 105 ADVAIR HFA AER 115/21 ................. 105 ADVAIR HFA AER 230/21 ................. 105 ADVAIR HFA AER 45/21 .................. 105 AFINITOR DIS TAB 2MG .................... 24 AFINITOR DIS TAB 3MG .................... 24 AFINITOR DIS TAB 5MG .................... 24 AFINITOR TAB 10MG......................... 24 AFINITOR TAB 2.5MG........................ 24 AFINITOR TAB 5MG .......................... 24 AFINITOR TAB 7.5MG........................ 24 ala-cort cre 1% .............................. 107 ala-cort cre 2.5% ........................... 107 albendazole tab 200 mg ...................... 6 albuterol sulfate inhal aero 108 mcg/act (90mcg base equiv) ........................ 102 albuterol sulfate soln nebu 0.083% (2.5 mg/3ml) ........................................ 102 albuterol sulfate soln nebu 0.5% (5 mg/ml) ......................................... 102 albuterol sulfate soln nebu 0.63 mg/3ml (base equiv) .................................. 102 albuterol sulfate soln nebu 1.25 mg/3ml (base equiv) .................................. 102 albuterol sulfate syrup 2 mg/5ml ...... 102 albuterol sulfate tab 2 mg ................ 102 albuterol sulfate tab 4 mg ................ 102 albuterol sulfate tab er 12hr 4 mg .... 102 albuterol sulfate tab er 12hr 8 mg .... 102 alclometasone dipropionate cream 0.05% ................................................... 107 alclometasone dipropionate oint 0.05% ................................................... 107 ALECENSA CAP 150MG ...................... 24


alendronate sodium oral soln 70 mg/75ml ......................................... 70 alendronate sodium tab 10 mg .......... 70 alendronate sodium tab 35 mg .......... 70 alendronate sodium tab 40 mg .......... 70 alendronate sodium tab 5 mg ............ 70 alendronate sodium tab 70 mg .......... 70 alfuzosin hcl tab er 24hr 10 mg .......... 86 ALIMTA INJ 100MG ........................... 20 ALINIA TAB 500MG ............................ 7 aliskiren fumarate tab 150 mg (base equivalent) ...................................... 41 aliskiren fumarate tab 300 mg (base equivalent) ...................................... 41 allopurinol tab 100 mg ........................ 1 allopurinol tab 300 mg ........................ 1 ALOCRIL SOL 2% ............................100 ALOMIDE SOL 0.1% OP ...................100 alosetron hcl tab 0.5 mg (base equiv) . 84 alosetron hcl tab 1 mg (base equiv).... 84 ALPHAGAN P SOL 0.1% ...................100 alprazolam tab 0.25 mg .................... 44 alprazolam tab 0.5 mg ...................... 44 alprazolam tab 1 mg ......................... 44 alprazolam tab 2 mg ......................... 44 alprazolam tab er 24hr 0.5 mg ........... 44 alprazolam tab er 24hr 1 mg ............. 44 alprazolam tab er 24hr 2 mg ............. 44 alprazolam tab er 24hr 3 mg ............. 44 ALREX SUS 0.2% ............................. 99 altavera tab ..................................... 71 ALUNBRIG PAK ................................ 24 ALUNBRIG TAB 180MG ...................... 24 ALUNBRIG TAB 30MG ....................... 24 ALUNBRIG TAB 90MG ....................... 24 alyacen tab 1/35 .............................. 71 alyacen tab 7/7/7 ............................. 71 alyq tab 20mg ................................. 43 amabelz tab 0.5-0.1 ......................... 76 amabelz tab 1-0.5mg ....................... 76 amantadine hcl cap 100 mg ............... 53 amantadine hcl syrup 50 mg/5ml ....... 53 amantadine hcl tab 100 mg ............... 53 AMBISOME INJ 50MG.......................... 8 ambrisentan tab 10 mg ..................... 43 ambrisentan tab 5 mg ...................... 43 amcinonide lotion 0.1% ...................107 AMCINONIDE OIN 0.1% ...................107

amethia lo tab .................................. 71 amethia tab ..................................... 71 amikacin sulfate inj 1 gm/4ml (250 mg/ml) ............................................. 6 amikacin sulfate inj 500 mg/2ml (250 mg/ml) ............................................. 6 amiloride & hydrochlorothiazide tab 5-50 mg ................................................. 40 amiloride hcl tab 5 mg ...................... 40 amino acid infusion 6% ..................... 96 aminocaproic acid inj 250 mg/ml ........ 89 AMINOSYN II INJ 10% ...................... 96 AMINOSYN II INJ 15% ...................... 96 AMINOSYN M INJ 3.5% ..................... 96 AMINOSYN-PF INJ 10% ..................... 96 AMINOSYN-PF INJ 7% ....................... 96 amiodarone hcl tab 100 mg ............... 33 amiodarone hcl tab 200 mg ............... 33 amiodarone hcl tab 400 mg ............... 33 AMITIZA CAP 24MCG ........................ 84 AMITIZA CAP 8MCG .......................... 84 amitriptyline hcl tab 10 mg ................ 49 amitriptyline hcl tab 100 mg .............. 49 amitriptyline hcl tab 150 mg .............. 49 amitriptyline hcl tab 25 mg ................ 49 amitriptyline hcl tab 50 mg ................ 49 amitriptyline hcl tab 75 mg ................ 49 amlodipine besylate tab 10 mg (base equivalent) ...................................... 38 amlodipine besylate tab 2.5 mg (base equivalent) ...................................... 38 amlodipine besylate tab 5 mg (base equivalent) ...................................... 38 amlodipine besylate-benazepril hcl cap 10-20 mg ........................................ 30 amlodipine besylate-benazepril hcl cap 10-40 mg ........................................ 30 amlodipine besylate-benazepril hcl cap 2.5-10 mg ....................................... 30 amlodipine besylate-benazepril hcl cap 5- 10 mg ............................................. 30 amlodipine besylate-benazepril hcl cap 5- 20 mg ............................................. 30 amlodipine besylate-benazepril hcl cap 5- 40 mg ............................................. 30 amlodipine besylate-valsartan tab 10- 160 mg ........................................... 32 amlodipine besylate-valsartan tab 10-


320 mg ........................................... 32 amlodipine besylate-valsartan tab 5-160 mg ................................................. 32 amlodipine besylate-valsartan tab 5-320 mg ................................................. 32 amnesteem cap 10mg .....................105 amnesteem cap 20mg .....................105 amnesteem cap 40mg .....................105 amoxapine tab 100 mg ..................... 49 amoxapine tab 150 mg ..................... 49 amoxapine tab 25 mg ....................... 49 amoxapine tab 50 mg ....................... 49 amoxicillin & k clavulanate chew tab 200- 28.5 mg .......................................... 16 amoxicillin & k clavulanate chew tab 400- 57 mg............................................. 17 amoxicillin & k clavulanate for susp 200- 28.5 mg/5ml ................................... 17 amoxicillin & k clavulanate for susp 250- 62.5 mg/5ml ................................... 17 amoxicillin & k clavulanate for susp 400- 57 mg/5ml ...................................... 17 amoxicillin & k clavulanate for susp 600- 42.9 mg/5ml ................................... 17 amoxicillin & k clavulanate tab 250-125 mg ................................................. 17 amoxicillin & k clavulanate tab 500-125 mg ................................................. 17 amoxicillin & k clavulanate tab 875-125 mg ................................................. 17 amoxicillin & k clavulanate tab er 12hr 1000-62.5 mg ................................. 17 amoxicillin (trihydrate) cap 250 mg .... 17 amoxicillin (trihydrate) cap 500 mg .... 17 amoxicillin (trihydrate) chew tab 125 mg ..................................................... 17 amoxicillin (trihydrate) chew tab 250 mg ..................................................... 17 amoxicillin (trihydrate) for susp 125 mg/5ml........................................... 17 amoxicillin (trihydrate) for susp 200 mg/5ml .......................................... 17 amoxicillin (trihydrate) for susp 250 mg/5ml .......................................... 17 amoxicillin (trihydrate) for susp 400 mg/5ml .......................................... 17 amoxicillin (trihydrate) tab 500 mg .... 17 amoxicillin (trihydrate) tab 875 mg .... 17

amphetamine-dextroamphetamine cap er 24hr 10 mg ..................................... 60 amphetamine-dextroamphetamine cap er 24hr 15 mg ..................................... 60 amphetamine-dextroamphetamine cap er 24hr 20 mg ..................................... 60 amphetamine-dextroamphetamine cap er 24hr 25 mg ..................................... 60 amphetamine-dextroamphetamine cap er 24hr 30 mg ..................................... 60 amphetamine-dextroamphetamine cap er 24hr 5 mg ....................................... 60 amphetamine-dextroamphetamine tab 10 mg ............................................. 60 amphetamine-dextroamphetamine tab 12.5 mg .......................................... 60 amphetamine-dextroamphetamine tab 15 mg ............................................. 60 amphetamine-dextroamphetamine tab 20 mg ............................................. 60 amphetamine-dextroamphetamine tab 30 mg ............................................. 60 amphetamine-dextroamphetamine tab 5 mg ................................................. 60 amphetamine-dextroamphetamine tab 7.5 mg ............................................ 60 amphotericin b for iv soln 50 mg .......... 9 ampicillin & sulbactam sodium for inj 1.5 (1-0.5) gm ...................................... 17 ampicillin & sulbactam sodium for inj 15 (10-5) gm ....................................... 17 ampicillin & sulbactam sodium for inj 3 (2-1) gm ......................................... 17 ampicillin cap 500 mg ....................... 17 ampicillin sodium for inj 1 gm ............ 17 ampicillin sodium for inj 125 mg ......... 17 ampicillin sodium for inj 2 gm ............ 17 ampicillin sodium for inj 250 mg ......... 17 ampicillin sodium for inj 500 mg ......... 17 ampicillin sodium for iv soln 10 gm ..... 17 ampicillin sodium for iv soln 2 gm ....... 17 ANADROL-50 TAB 50MG .................... 66 anagrelide hcl cap 0.5 mg .................. 89 anagrelide hcl cap 1 mg .................... 89 anastrozole tab 1 mg ........................ 22 ANDRODERM DIS 2MG/24HR ............. 66 ANDRODERM DIS 4MG/24HR ............. 66 APOKYN INJ 10MG/ML ....................... 53


apraclonidine hcl ophth soln 0.5% (base equivalent) .....................................100 aprepitant capsule 125 mg ................ 82 aprepitant capsule 40 mg .................. 82 aprepitant capsule 80 mg .................. 82 aprepitant capsule therapy pack 80 & 125 mg ........................................... 82 apri tab ........................................... 71 APRISO CAP 0.375GM ....................... 83 APTIOM TAB 200MG ......................... 44 APTIOM TAB 400MG ......................... 44 APTIOM TAB 600MG ......................... 44 APTIOM TAB 800MG ......................... 44 APTIVUS CAP 250MG ........................ 10 APTIVUS SOL ................................... 10 ARALAST NP INJ 1000MG .................103 aranelle tab ..................................... 71 ARANESP INJ 100MCG ...................... 88 ARANESP INJ 10MCG ........................ 88 ARANESP INJ 150MCG ...................... 88 ARANESP INJ 200MCG ...................... 89 ARANESP INJ 25MCG ........................ 88 ARANESP INJ 300MCG ...................... 89 ARANESP INJ 40MCG ........................ 88 ARANESP INJ 500MCG ...................... 89 ARANESP INJ 60MCG ........................ 88 ARCALYST INJ 220MG ....................... 92 ARIKAYCE SUS .................................. 6 aripiprazole oral solution 1 mg/ml ...... 55 aripiprazole orally disintegrating tab 10 mg ................................................. 55 aripiprazole orally disintegrating tab 15 mg ................................................. 55 aripiprazole tab 10 mg ...................... 55 aripiprazole tab 15 mg ...................... 55 aripiprazole tab 2 mg ........................ 55 aripiprazole tab 20 mg ...................... 55 aripiprazole tab 30 mg ...................... 55 aripiprazole tab 5 mg ........................ 55 ARISTADA INJ 1064MG ..................... 55 ARISTADA INJ 441MG/1. ................... 55 ARISTADA INJ 662MG/2 .................... 55 ARISTADA INJ 882MG/3 .................... 55 ARISTADA INJ INITIO ....................... 55 ARISTOSPAN INJ 20MG/ML ............... 77 ARISTOSPAN INJ 5MG/ML ................. 77 armodafinil tab 150 mg ..................... 65 armodafinil tab 200 mg ..................... 65

armodafinil tab 250 mg ..................... 65 armodafinil tab 50 mg ....................... 65 ARNUITY ELPT INH 100MCG ............. 104 ARNUITY ELPT INH 200MCG ............. 104 ARNUITY ELPT INH 50MCG .............. 104 ARZERRA CON 100/5ML .................... 20 ascomp/cod cap 30mg ........................ 2 ASCORBIC ACID 80 MG / BIOTIN 0.030 MG / CALCIUM CARBONATE 200 MG / CUPRIC OXIDE 3 MG / FERROUS FUMARATE 60 MG ............................. 98 ashlyna tab ...................................... 71 aspirin-dipyridamole cap er 12hr 25-200 mg ................................................. 90 atazanavir sulfate cap 150 mg (base equiv) ............................................. 10 atazanavir sulfate cap 200 mg (base equiv) ............................................. 10 atazanavir sulfate cap 300 mg (base equiv) ............................................. 10 atenolol & chlorthalidone tab 100-25 mg ..................................................... 36 atenolol & chlorthalidone tab 50-25 mg ..................................................... 36 atenolol tab 100 mg .......................... 37 atenolol tab 25 mg ........................... 37 atenolol tab 50 mg ........................... 37 atomoxetine hcl cap 10 mg (base equiv) ..................................................... 60 atomoxetine hcl cap 100 mg (base equiv) ............................................. 61 atomoxetine hcl cap 18 mg (base equiv) ..................................................... 60 atomoxetine hcl cap 25 mg (base equiv) ..................................................... 60 atomoxetine hcl cap 40 mg (base equiv) ..................................................... 61 atomoxetine hcl cap 60 mg (base equiv) ..................................................... 61 atomoxetine hcl cap 80 mg (base equiv) ..................................................... 61 atorvastatin calcium tab 10 mg (base equivalent) ...................................... 34 atorvastatin calcium tab 20 mg (base equivalent) ...................................... 35 atorvastatin calcium tab 40 mg (base equivalent) ...................................... 35 atorvastatin calcium tab 80 mg (base


equivalent) ...................................... 35 atovaquone susp 750 mg/5ml .............. 7 atovaquone-proguanil hcl tab 250-100 mg ................................................... 9 atovaquone-proguanil hcl tab 62.5-25 mg ................................................... 9 ATRIPLA TAB ................................... 11 atropine sul sol 1% op .....................101 ATROVENT HFA AER 17MCG .............101 AUBAGIO TAB 14MG ......................... 64 AUBAGIO TAB 7MG........................... 64 aubra tab 0.1-0.02 ........................... 71 AURYXIA TAB 210MG ........................ 80 aviane tab ....................................... 71 avita cre 0.025% ............................105 AVYCAZ INJ 2-0.5GM ........................ 14 AZASITE SOL 1% ............................. 99 azathioprine tab 50 mg ..................... 92 azelastine hcl nasal spray 0.1% (137 mcg/spray) ....................................101 azelastine hcl ophth soln 0.05% ........100 azithromycin for susp 100 mg/5ml ..... 15 azithromycin for susp 200 mg/5ml ..... 15 azithromycin iv for soln 500 mg ......... 15 azithromycin powd pack for susp 1 gm 15 azithromycin tab 250 mg .................. 15 azithromycin tab 500 mg .................. 15 azithromycin tab 600 mg .................. 15 aztreonam for inj 1 gm ....................... 7 aztreonam for inj 2 gm ....................... 7 azurette tab 28 day .......................... 71 B bacitracin ophth oint 500 unit/gm ...... 99 bacitracin-polymyxin b ophth oint ...... 99 bacitracin-polymyxin-neomycin-hc ophth oint 1% .......................................... 98 baclofen tab 10 mg .......................... 64 baclofen tab 20 mg .......................... 64 baclofen tab 5 mg ............................ 64 BACTOCILL INJ DEX 1GM .................. 17 BACTOCILL INJ DEX 2GM .................. 18 BACTROBAN OIN NASAL 2% .............106 balsalazide disodium cap 750 mg ....... 83 BALVERSA TAB 3MG ......................... 24 BALVERSA TAB 4MG ......................... 24 BALVERSA TAB 5MG ......................... 25 balziva tab ...................................... 71 BANZEL SUS 40MG/ML ..................... 44

BANZEL TAB 200MG ......................... 44 BANZEL TAB 400MG ......................... 44 BARACLUDE SOL .05MG/ML ............... 13 BCG VACCINE INJ ............................. 93 benazepril & hydrochlorothiazide tab 10- 12.5 mg .......................................... 30 benazepril & hydrochlorothiazide tab 20- 12.5 mg .......................................... 30 benazepril & hydrochlorothiazide tab 20- 25 mg ............................................. 30 benazepril & hydrochlorothiazide tab 5- 6.25 mg .......................................... 30 benazepril hcl tab 10 mg ................... 31 benazepril hcl tab 20 mg ................... 31 benazepril hcl tab 40 mg ................... 31 benazepril hcl tab 5 mg ..................... 31 BENDEKA INJ 100/4ML ...................... 19 BENLYSTA INJ 200MG/ML .................. 92 benzoyl peroxide-erythromycin gel 5-3% ................................................... 105 benztropine mesylate tab 0.5 mg ....... 53 benztropine mesylate tab 1 mg .......... 53 benztropine mesylate tab 2 mg .......... 53 BEPREVE DRO 1.5% ....................... 100 BESIVANCE SUS 0.6% ...................... 99 betamethasone dipropionate augmented cream 0.05% ................................. 107 betamethasone dipropionate augmented gel 0.05% ..................................... 107 betamethasone dipropionate augmented lotion 0.05% .................................. 107 betamethasone dipropionate augmented oint 0.05% .................................... 107 betamethasone dipropionate cream 0.05%........................................... 107 betamethasone dipropionate lotion 0.05%........................................... 107 betamethasone dipropionate oint 0.05% ................................................... 107 betamethasone sod phosphate & acetate inj susp 6 (3-3) mg/ml ...................... 77 betamethasone valerate cream 0.1% (base equivalent) ........................... 107 betamethasone valerate lotion 0.1% (base equivalent) ........................... 107 betamethasone valerate oint 0.1% (base equivalent) .................................... 107 BETASERON INJ 0.3MG ..................... 64


betaxolol hcl ophth soln 0.5% ...........100 betaxolol hcl tab 10 mg ..................... 37 betaxolol hcl tab 20 mg ..................... 37 bethanechol chloride tab 10 mg ......... 86 bethanechol chloride tab 25 mg ......... 86 bethanechol chloride tab 5 mg ........... 86 bethanechol chloride tab 50 mg ......... 86 BETHKIS NEB 300/4ML ....................... 6 BETIMOL SOL 0.25% .......................100 BETIMOL SOL 0.5% .........................100 BETOPTIC-S SUS 0.25% OP .............100 bexarotene cap 75 mg ...................... 29 BEXSERO INJ ................................... 93 bicalutamide tab 50 mg .................... 22 BICILLIN C-R INJ 1200000 ................ 18 BICILLIN C-R INJ 900/300 ................. 18 BICILLIN L-A INJ 1200000 ................ 18 BICILLIN L-A INJ 2400000 ................ 18 BICILLIN L-A INJ 600000 .................. 18 BIKTARVY TAB ................................. 12 BILTRICIDE TAB 600MG ...................... 7 bimatoprost ophth soln 0.03% ..........100 bisoprolol & hydrochlorothiazide tab 10- 6.25 mg .......................................... 36 bisoprolol & hydrochlorothiazide tab 2.5- 6.25 mg .......................................... 36 bisoprolol & hydrochlorothiazide tab 5- 6.25 mg .......................................... 36 bisoprolol fumarate tab 10 mg ........... 37 bisoprolol fumarate tab 5 mg ............. 37 bleomycin sulfate for inj 15 unit ......... 20 BLEPHAMIDE OIN S.O.P. ................... 98 BLEPHAMIDE SUS OP ........................ 98 BLINCYTO INJ 35MCG ....................... 20 blisovi 24 tab fe 1/20 ........................ 71 blisovi fe tab 1.5/30 ......................... 71 BOOSTRIX INJ ................................. 93 bosentan tab 125 mg ........................ 43 bosentan tab 62.5 mg ....................... 43 BOSULIF TAB 100MG ........................ 25 BOSULIF TAB 400MG ........................ 25 BOSULIF TAB 500MG ........................ 25 BRAFTOVI CAP 75MG ........................ 25 BREO ELLIPTA INH 100-25 ...............105 BREO ELLIPTA INH 200-25 ...............105 briellyn tab ...................................... 71 BRILINTA TAB 60MG ......................... 90 BRILINTA TAB 90MG ......................... 90

brimonidine tartrate ophth soln 0.15% ................................................... 100 brimonidine tartrate ophth soln 0.2% 100 BRIVIACT SOL 10MG/ML.................... 44 BRIVIACT TAB 100MG ....................... 44 BRIVIACT TAB 10MG ......................... 44 BRIVIACT TAB 25MG ......................... 44 BRIVIACT TAB 50MG ......................... 44 BRIVIACT TAB 75MG ......................... 44 bromocriptine mesylate cap 5 mg (base equivalent) ...................................... 53 bromocriptine mesylate tab 2.5 mg (base equivalent) ...................................... 53 budesonide delayed release particles cap 3 mg ............................................... 84 budesonide inhalation susp 0.25 mg/2ml ................................................... 104 budesonide inhalation susp 0.5 mg/2ml ................................................... 104 budesonide inhalation susp 1 mg/2ml 105 bumetanide inj 0.25 mg/ml ................ 40 bumetanide tab 0.5 mg ..................... 40 bumetanide tab 1 mg ........................ 40 bumetanide tab 2 mg ........................ 40 buprenorphine hcl sl tab 2 mg (base equiv) ............................................. 65 buprenorphine hcl sl tab 8 mg (base equiv) ............................................. 65 buprenorphine hcl-naloxone hcl sl film 12-3 mg (base equiv) ....................... 65 buprenorphine hcl-naloxone hcl sl film 2- 0.5 mg (base equiv) ......................... 65 buprenorphine hcl-naloxone hcl sl film 4- 1 mg (base equiv) ............................ 65 buprenorphine hcl-naloxone hcl sl film 8- 2 mg (base equiv) ............................ 65 buprenorphine hcl-naloxone hcl sl tab 2- 0.5 mg (base equiv) ......................... 65 buprenorphine hcl-naloxone hcl sl tab 8- 2 mg (base equiv) ............................ 65 bupropion hcl (smoking deterrent) tab er 12hr 150 mg .................................... 65 bupropion hcl tab 100 mg .................. 49 bupropion hcl tab 75 mg .................... 49 bupropion hcl tab er 12hr 100 mg....... 49 bupropion hcl tab er 12hr 150 mg....... 49 bupropion hcl tab er 12hr 200 mg....... 49 bupropion hcl tab er 24hr 150 mg....... 49


bupropion hcl tab er 24hr 300 mg ...... 49 buspirone hcl tab 10 mg.................... 44 buspirone hcl tab 15 mg.................... 44 buspirone hcl tab 30 mg.................... 44 buspirone hcl tab 5 mg ..................... 44 buspirone hcl tab 7.5 mg................... 44 butalbital-acetaminophen-caff w/ cod cap 50-325-40-30 mg .............................. 2 butalbital-aspirin-caff w/ codeine cap 50- 325-40-30 mg ................................... 2 butorphanol tartrate nasal soln 10 mg/ml ....................................................... 2 BYDUREON BC INJ 2/0.85ML ............. 66 BYDUREON PEN INJ 2MG ................... 66 BYETTA INJ 10MCG .......................... 66 BYETTA INJ 5MCG ............................ 66 C cabergoline tab 0.5 mg ..................... 78 CABOMETYX TAB 20MG ..................... 25 CABOMETYX TAB 40MG ..................... 25 CABOMETYX TAB 60MG ..................... 25 calcipotriene oint 0.005%.................107 calcipotriene soln 0.005% (50 mcg/ml) ................................................... 107 calcitonin (salmon) nasal soln 200 unit/act ........................................... 78 calcitriol cap 0.25 mcg ...................... 98 calcitriol cap 0.5 mcg ........................ 98 calcitriol oral soln 1 mcg/ml ............... 98 calcium acetate (phosphate binder) cap 667 mg (169 mg ca)......................... 80 calcium acetate (phosphate binder) tab 667 mg ........................................... 80 calcium gluconate inj 10% ................ 94 CALQUENCE CAP 100MG ................... 25 camila tab 0.35mg ........................... 71 CAMPATH INJ 30MG/ML .................... 20 camrese lo tab ................................. 71 camrese tab .................................... 71 CANASA SUP 1000MG ....................... 84 candesartan cilexetil tab 16 mg ......... 33 candesartan cilexetil tab 32 mg ......... 33 candesartan cilexetil tab 4 mg ........... 33 candesartan cilexetil tab 8 mg ........... 33 candesartan cilexetil-hydrochlorothiazide tab 16-12.5 mg ............................... 32 candesartan cilexetil-hydrochlorothiazide tab 32-12.5 mg ............................... 32

candesartan cilexetil-hydrochlorothiazide tab 32-25 mg ................................... 32 CAPRELSA TAB 100MG ...................... 25 CAPRELSA TAB 300MG ...................... 25 captopril & hydrochlorothiazide tab 25-15 mg ................................................. 30 captopril & hydrochlorothiazide tab 25-25 mg ................................................. 30 captopril & hydrochlorothiazide tab 50-15 mg ................................................. 30 captopril & hydrochlorothiazide tab 50-25 mg ................................................. 30 captopril tab 100 mg ......................... 31 captopril tab 12.5 mg ........................ 31 captopril tab 25 mg .......................... 31 captopril tab 50 mg .......................... 31 CARAFATE SUS 1GM/10ML................. 84 CARBAGLU TAB 200MG ..................... 75 carbamazepine cap er 12hr 100 mg 44 carbamazepine cap er 12hr 200 mg 45 carbamazepine cap er 12hr 300 mg 45 carbamazepine chew tab 100 mg 45 carbamazepine susp 100 mg/5ml 45 carbamazepine tab 200 mg ................ 45 carbamazepine tab er 12hr 100 mg 45 carbamazepine tab er 12hr 200 mg 45 carbamazepine tab er 12hr 400 mg 45 carbidopa & levodopa orally disintegrating tab 10-100 mg ................................. 53 carbidopa & levodopa orally disintegrating tab 25-100 mg ................................. 53 carbidopa & levodopa orally disintegrating tab 25-250 mg ................................. 53 carbidopa & levodopa tab 10-100 mg . 53 carbidopa & levodopa tab 25-100 mg . 53 carbidopa & levodopa tab 25-250 mg . 53 carbidopa & levodopa tab er 25-100 mg ..................................................... 53 carbidopa & levodopa tab er 50-200 mg ..................................................... 53 carbidopa tab 25 mg ......................... 53 carbidopa-levodopa-entacapone tabs 12.5-50-200 mg ............................... 53 carbidopa-levodopa-entacapone tabs 18.75-75-200 mg ............................. 54 carbidopa-levodopa-entacapone tabs 25- 100-200 mg ..................................... 54 carbidopa-levodopa-entacapone tabs


31.25-125-200 mg ........................... 54 carbidopa-levodopa-entacapone tabs 37.5-150-200 mg ............................. 54 carbidopa-levodopa-entacapone tabs 50- 200-200 mg .................................... 54 carbinoxamine maleate soln 4 mg/5ml ................................................... 101 carbinoxamine maleate tab 4 mg ......101 carisoprodol tab 350 mg ................... 64 carisoprodol w/ aspirin tab 200-325 mg ..................................................... 64 carteolol hcl ophth soln 1% ..............100 cartia xt cap 120/24hr ...................... 38 cartia xt cap 180/24hr ...................... 38 cartia xt cap 240/24hr ...................... 38 cartia xt cap 300/24hr ...................... 38 carvedilol tab 12.5 mg ...................... 37 carvedilol tab 25 mg ......................... 37 carvedilol tab 3.125 mg .................... 37 carvedilol tab 6.25 mg ...................... 37 CASPOFUNGIN ACETATE FOR IV SOLN 50 MG ................................................... 9 CASPOFUNGIN ACETATE FOR IV SOLN 70 MG ................................................... 9 CAYSTON INH 75MG ........................... 7 caziant pak ...................................... 71 cefaclor cap 250 mg ......................... 14 cefaclor cap 500 mg ......................... 14 CEFACLOR ER TAB 500MG ................. 14 cefadroxil cap 500 mg ...................... 14 cefadroxil for susp 250 mg/5ml .......... 14 cefadroxil for susp 500 mg/5ml .......... 14 cefadroxil tab 1 gm .......................... 14 cefazolin sodium for inj 1 gm ............. 14 cefazolin sodium for inj 10 gm ........... 14 cefazolin sodium for inj 500 mg ......... 14 cefdinir cap 300 mg .......................... 14 cefdinir for susp 125 mg/5ml ............. 14 cefdinir for susp 250 mg/5ml ............. 14 cefepime hcl for inj 1 gm ................... 14 cefepime hcl for inj 2 gm ................... 14 cefotaxime sodium for inj 10 gm ........ 14 cefotetan disodium for inj 1 gm ......... 14 cefotetan disodium for inj 10 gm ........ 14 cefotetan disodium for inj 2 gm ......... 14 cefoxitin sodium for inj 10 gm ........... 14 cefoxitin sodium for iv soln 1 gm ........ 14 cefoxitin sodium for iv soln 2 gm ........ 14

cefpodoxime proxetil for susp 100 mg/5ml ........................................... 15 cefpodoxime proxetil for susp 50 mg/5ml ..................................................... 14 cefpodoxime proxetil tab 100 mg........ 15 cefpodoxime proxetil tab 200 mg........ 15 cefprozil for susp 125 mg/5ml ............ 15 cefprozil for susp 250 mg/5ml ............ 15 cefprozil tab 250 mg ......................... 15 cefprozil tab 500 mg ......................... 15 ceftazidime for inj 1 gm .................... 15 ceftazidime for inj 2 gm .................... 15 ceftazidime for inj 6 gm .................... 15 ceftibuten cap 400 mg ...................... 15 ceftibuten for susp 180 mg/5ml.......... 15 ceftriaxone sodium for inj 1 gm .......... 15 ceftriaxone sodium for inj 10 gm ........ 15 ceftriaxone sodium for inj 2 gm .......... 15 ceftriaxone sodium for inj 250 mg ...... 15 ceftriaxone sodium for inj 500 mg ...... 15 cefuroxime axetil tab 250 mg ............. 15 cefuroxime axetil tab 500 mg ............. 15 cefuroxime sodium for inj 750 mg ...... 15 cefuroxime sodium for iv soln 1.5 gm . 15 celecoxib cap 100 mg.......................... 1 celecoxib cap 200 mg.......................... 1 celecoxib cap 400 mg.......................... 1 celecoxib cap 50 mg ........................... 1 CELONTIN CAP 300MG ...................... 45 cephalexin cap 250 mg ..................... 15 cephalexin cap 500 mg ..................... 15 cephalexin for susp 125 mg/5ml ......... 15 cephalexin for susp 250 mg/5ml ......... 15 cephalexin tab 250 mg ...................... 15 cephalexin tab 500 mg ...................... 15 CERDELGA CAP 84MG ....................... 75 cevimeline hcl cap 30 mg ................ 109 CHANTIX PAK 0.5& 1MG .................... 65 CHANTIX PAK 1MG ........................... 65 CHANTIX TAB 0.5MG ......................... 65 CHANTIX TAB 1MG ........................... 65 chateal tab 0.15/30 .......................... 71 CHEMET CAP 100MG ......................... 70 chlordiazepoxide-amitriptyline tab 10-25 mg ................................................. 66 chlordiazepoxide-amitriptyline tab 5-12.5 mg ................................................. 66 chlorhexidine gluconate soln 0.12% .. 109


chloroquine phosphate tab 250 mg ....... 9 chloroquine phosphate tab 500 mg ....... 9 chlorothiazide tab 250 mg ................. 40 chlorothiazide tab 500 mg ................. 40 chlorpromazine hcl tab 10 mg ............ 55 chlorpromazine hcl tab 100 mg .......... 55 chlorpromazine hcl tab 200 mg .......... 55 chlorpromazine hcl tab 25 mg ............ 55 chlorpromazine hcl tab 50 mg ............ 55 chlorthalidone tab 25 mg .................. 40 chlorthalidone tab 50 mg .................. 40 chlorzoxazone tab 500 mg................. 64 cholestyramine light powder 4 gm/dose ..................................................... 35 cholestyramine powder packets 4 gm . 35 choline fenofibrate cap dr 135 mg (fenofibric acid equiv) ....................... 35 choline fenofibrate cap dr 45 mg (fenofibric acid equiv) ....................... 35 ciclodan cre 0.77% ..........................106 ciclopirox gel 0.77% ........................106 ciclopirox olamine cream 0.77% (base equiv) ............................................106 ciclopirox olamine susp 0.77% (base equiv) ............................................106 ciclopirox solution 8% ......................106 cilostazol tab 100 mg ........................ 89 cilostazol tab 50 mg ......................... 89 CILOXAN OIN 0.3% OP ..................... 99 CIMDUO TAB 300-300 ...................... 12 cimetidine hcl soln 300 mg/5ml 83 cimetidine tab 200 mg ...................... 83 cimetidine tab 300 mg ...................... 83 cimetidine tab 400 mg ...................... 83 cimetidine tab 800 mg ...................... 83 cinacalcet hcl tab 30 mg (base equiv) . 78 cinacalcet hcl tab 60 mg (base equiv) . 78 cinacalcet hcl tab 90 mg (base equiv) . 78 CIPRODEX SUS 0.3-0.1% .................110 ciprofloxacin 200 mg/100ml in d5w 16 ciprofloxacin 400 mg/200ml in d5w 16 ciprofloxacin hcl ophth soln 0.3% (base equivalent) ...................................... 99 ciprofloxacin hcl otic soln 0.2% (base equivalent) .....................................110 ciprofloxacin hcl tab 100 mg (base equiv) ..................................................... 16 ciprofloxacin hcl tab 250 mg (base equiv)

..................................................... 16 ciprofloxacin hcl tab 500 mg (base equiv) ..................................................... 16 ciprofloxacin hcl tab 750 mg (base equiv) ..................................................... 16 ciprofloxacin iv soln 200 mg/20ml (1%) ..................................................... 16 citalopram hydrobromide oral soln 10 mg/5ml ........................................... 50 citalopram hydrobromide tab 10 mg (base equiv) .................................... 50 citalopram hydrobromide tab 20 mg (base equiv) .................................... 50 citalopram hydrobromide tab 40 mg (base equiv) .................................... 50 claravis cap 10mg .......................... 105 claravis cap 20mg .......................... 105 claravis cap 30mg .......................... 105 claravis cap 40mg .......................... 105 clarithromycin for susp 125 mg/5ml .... 15 clarithromycin for susp 250 mg/5ml .... 15 clarithromycin tab 250 mg ................. 16 clarithromycin tab 500 mg ................. 16 clarithromycin tab er 24hr 500 mg...... 16 clemastine fumarate tab 2.68 mg ..... 101 CLEOCIN SUP 100MG ........................ 87 clindamycin hcl cap 150 mg ................. 7 clindamycin hcl cap 300 mg ................. 7 clindamycin hcl cap 75 mg ................... 7 clindamycin palmitate hcl for soln 75 mg/5ml (base equiv) .......................... 7 clindamycin phosphate gel 1% ......... 105 clindamycin phosphate in d5w iv soln 300 mg/50ml ..................................... 7 clindamycin phosphate in d5w iv soln 600 mg/50ml ..................................... 7 clindamycin phosphate in d5w iv soln 900 mg/50ml ..................................... 7 clindamycin phosphate iv soln 300 mg/2ml ............................................. 7 clindamycin phosphate iv soln 900 mg/6ml ............................................. 7 clindamycin phosphate lotion 1%...... 105 clindamycin phosphate soln 1% ........ 105 clindamycin phosphate swab 1% ...... 105 clindamycin phosphate vaginal cream 2% ..................................................... 87 CLINIMIX E INJ 2.75/D5W ................. 96


CLINIMIX E INJ 4.25/D10 .................. 96 CLINIMIX E INJ 4.25/D5W ................. 96 CLINIMIX E INJ 5%/D15W ................. 96 CLINIMIX E INJ 5%/D20W ................. 96 CLINIMIX INJ 4.25/D10 .................... 96 CLINIMIX INJ 4.25/D5W.................... 96 CLINIMIX INJ 5%/D15W ................... 96 CLINIMIX INJ 5%/D20W ................... 96 clinisol sf inj 15% ............................. 96 clobazam suspension 2.5 mg/ml ........ 45 clobazam tab 10 mg ......................... 45 clobazam tab 20 mg ......................... 45 clomipramine hcl cap 25 mg .............. 50 clomipramine hcl cap 50 mg .............. 50 clomipramine hcl cap 75 mg .............. 50 clonazepam orally disintegrating tab 0.125 mg ........................................ 45 clonazepam orally disintegrating tab 0.25 mg ................................................. 45 clonazepam orally disintegrating tab 0.5 mg ................................................. 45 clonazepam orally disintegrating tab 1 mg ................................................. 45 clonazepam orally disintegrating tab 2 mg ................................................. 45 clonazepam tab 0.5 mg ..................... 45 clonazepam tab 1 mg ....................... 45 clonazepam tab 2 mg ....................... 45 clonidine hcl inj (for epidural infusion) 100 mcg/ml ....................................... 1 clonidine hcl inj (for epidural infusion) 500 mcg/ml ....................................... 1 clonidine hcl tab 0.1 mg .................... 41 clonidine hcl tab 0.2 mg .................... 41 clonidine hcl tab 0.3 mg .................... 41 clonidine hcl tab er 12hr 0.1 mg......... 61 clonidine td patch weekly 0.1 mg/24hr 41 clonidine td patch weekly 0.2 mg/24hr 41 clonidine td patch weekly 0.3 mg/24hr 41 clopidogrel bisulfate tab 75 mg (base equiv) ............................................. 90 clorazepate dipotassium tab 15 mg .... 45 clorazepate dipotassium tab 3.75 mg .. 45 clorazepate dipotassium tab 7.5 mg ... 45 clotrimazole cream 1% .................... 106 clotrimazole soln 1% ....................... 106 clotrimazole troche 10 mg ................ 109 clotrimazole w/ betamethasone cream 1-

0.05% .......................................... 106 clotrimazole w/ betamethasone lotion 1- 0.05% .......................................... 106 clozapine orally disintegrating tab 100 mg ................................................. 55 clozapine orally disintegrating tab 12.5 mg ................................................. 55 clozapine orally disintegrating tab 150 mg ................................................. 55 clozapine orally disintegrating tab 200 mg ................................................. 55 clozapine orally disintegrating tab 25 mg ..................................................... 55 clozapine tab 100 mg ........................ 56 clozapine tab 200 mg ........................ 56 clozapine tab 25 mg ......................... 55 clozapine tab 50 mg ......................... 55 COARTEM TAB 20-120MG .................... 9 colchicine w/ probenecid tab 0.5-500 mg ....................................................... 1 COLCRYS TAB 0.6MG .......................... 1 colestipol hcl granule packets 5 gm..... 35 colestipol hcl tab 1 gm ...................... 35 colistimethate sod for inj 150 mg (colistin base activity) ......................... 7 COMBIGAN SOL 0.2/0.5% ............... 100 COMBIVENT AER 20-100 ................. 101 COMETRIQ KIT 100MG ...................... 25 COMETRIQ KIT 140MG ...................... 25 COMETRIQ KIT 60MG ........................ 25 COMPLERA TAB ................................ 12 compro sup 25mg............................. 82 CONDYLOX GEL 0.5% ..................... 108 constulose sol 10gm/15 .................... 84 COPAXONE INJ 40MG/ML ................... 64 COPIKTRA CAP 15MG ........................ 25 COPIKTRA CAP 25MG ........................ 25 CORLANOR TAB 5MG ........................ 41 CORLANOR TAB 7.5MG ...................... 41 cortisone acetate tab 25 mg .............. 77 COTELLIC TAB 20MG ......................... 25 CREON CAP 12000UNT ...................... 85 CREON CAP 24000UNT ...................... 85 CREON CAP 3000UNIT ...................... 85 CREON CAP 36000UNT ...................... 85 CREON CAP 6000UNIT ...................... 85 CRESEMBA CAP 186 MG ...................... 9 CRIXIVAN CAP 200MG ....................... 10


CRIXIVAN CAP 400MG ...................... 10 cromolyn sodium ophth soln 4% .......100 cromolyn sodium oral conc 100 mg/5ml ..................................................... 84 cromolyn sodium soln nebu 20 mg/2ml ................................................... 103 cryselle-28 tab 28 tabs ..................... 71 cyclafem tab 1/35 ............................ 71 cyclafem tab 7/7/7 ........................... 71 cyclobenzaprine hcl tab 10 mg ........... 64 cyclobenzaprine hcl tab 5 mg ............. 64 CYCLOPHOSPHAMIDE CAP 25 MG ....... 19 CYCLOPHOSPHAMIDE CAP 50 MG ....... 19 cyclophosphamide for inj 1 gm .......... 19 cyclophosphamide for inj 2 gm .......... 19 cyclophosphamide for inj 500 mg ....... 19 cyclosporine cap 100 mg ................... 93 cyclosporine cap 25 mg..................... 93 cyclosporine modified cap 100 mg ...... 93 cyclosporine modified cap 25 mg ........ 93 cyclosporine modified cap 50 mg ........ 93 cyclosporine modified oral soln 100 mg/ml ............................................ 93 cyproheptadine hcl syrup 2 mg/5ml ...101 cyproheptadine hcl tab 4 mg ............101 cyred tab ........................................ 71 CYSTADANE POW ............................. 75 CYSTAGON CAP 150MG ..................... 75 CYSTAGON CAP 50MG ...................... 75 CYSTARAN SOL 0.44% .....................101 cytarabine inj pf 20 mg/ml ................ 20 D D10W/NACL INJ 0.2% ...................... 97 D5W/LYTES INJ #48 ......................... 97 dacarbazine for inj 100 mg ................ 19 dalfampridine tab er 12hr 10 mg ........ 64 DALIRESP TAB 250MCG ...................103 DALIRESP TAB 500MCG ...................103 DALVANCE SOL 500MG ....................... 7 danazol cap 100 mg ......................... 75 danazol cap 200 mg ......................... 75 danazol cap 50 mg ........................... 75 dantrolene sodium cap 100 mg .......... 64 dantrolene sodium cap 25 mg ............ 64 dantrolene sodium cap 50 mg ............ 64 dapsone tab 100 mg ........................... 7 dapsone tab 25 mg ............................ 7 DAPTACEL INJ ................................. 93

daptomycin for iv soln 500 mg ............. 7 DAPTOMYCIN SOL 350MG .................... 7 DARAPRIM TAB 25MG ......................... 7 DARZALEX SOL 400MG/20 ................. 20 dasetta tab 1/35............................... 71 dasetta tab 7/7/7 ............................. 71 DAURISMO TAB 100MG ..................... 20 DAURISMO TAB 25MG ....................... 20 daysee tab ....................................... 71 deblitane tab 0.35mg ........................ 71 deferasirox tab for oral susp 125 mg ... 70 deferasirox tab for oral susp 250 mg ... 70 deferasirox tab for oral susp 500 mg ... 70 deferoxamine mesylate for inj 2 gm .... 70 deferoxamine mesylate for inj 500 mg 70 DELSTRIGO TAB ............................... 12 delyla tab 0.1-0.02 ........................... 71 DELZICOL CAP 400MG ...................... 84 DEMSER CAP 250MG ......................... 41 DENAVIR CRE 1% ........................... 109 dentagel gel 1.1% .......................... 110 DEPEN TITRA TAB 250MG .................. 70 DEPO-ESTRADI INJ 5MG/ML .............. 76 DEPO-PROVERA INJ 400/ML ............... 22 DEPO-SQ PROV INJ 104 .................... 71 DESCOVY TAB 200/25 ....................... 12 desipramine hcl tab 10 mg................. 50 desipramine hcl tab 100 mg ............... 50 desipramine hcl tab 150 mg ............... 50 desipramine hcl tab 25 mg................. 50 desipramine hcl tab 50 mg................. 50 desipramine hcl tab 75 mg................. 50 desloratadine tab 5 mg.................... 102 desmopressin acetate nasal spray soln 0.01%............................................. 82 desmopressin acetate nasal spray soln 0.01% (refrigerated) ......................... 82 desmopressin acetate tab 0.1 mg ....... 82 desmopressin acetate tab 0.2 mg ....... 82 desogest-eth estrad & eth estrad tab 0.15-0.02/0.01 mg(21/5) .................. 71 desogestrel & ethinyl estradiol tab 0.15 mg-30 mcg ...................................... 71 desonide lotion 0.05%..................... 107 desoximetasone cream 0.05% ......... 107 desoximetasone cream 0.25% ......... 107 desoximetasone gel 0.05% .............. 108 desoximetasone oint 0.25% ............. 108


DESVENLAFAX TAB 100MG ER ........... 50 DESVENLAFAX TAB 50MG ER ............. 50 desvenlafaxine succinate tab er 24hr 100 mg (base equiv) ............................... 50 desvenlafaxine succinate tab er 24hr 25 mg (base equiv) ............................... 50 desvenlafaxine succinate tab er 24hr 50 mg (base equiv) ............................... 50 DEXAMETHASON CON 1MG/ML .......... 77 dexamethasone elixir 0.5 mg/5ml ...... 77 dexamethasone sodium phosphate ophth soln 0.1% ......................................100 dexamethasone soln 0.5 mg/5ml ....... 77 dexamethasone tab 0.5 mg ............... 77 dexamethasone tab 0.75 mg ............. 77 dexamethasone tab 1 mg .................. 77 dexamethasone tab 1.5 mg ............... 77 dexamethasone tab 2 mg .................. 77 dexamethasone tab 4 mg .................. 77 dexamethasone tab 6 mg .................. 77 DEXILANT CAP 30MG DR ................... 85 DEXILANT CAP 60MG DR ................... 85 dexmethylphenidate hcl tab 10 mg 61 dexmethylphenidate hcl tab 2.5 mg 61 dexmethylphenidate hcl tab 5 mg 61 dexrazoxane hcl for inj 500 mg (base equivalent) ...................................... 29 dextroamphetamine sulfate cap er 24hr 10 mg............................................. 61 dextroamphetamine sulfate cap er 24hr 15 mg............................................. 61 dextroamphetamine sulfate cap er 24hr 5 mg ................................................. 61 dextroamphetamine sulfate tab 10 mg 61 dextroamphetamine sulfate tab 5 mg . 61 dextrose 10% w/ sodium chloride 0.45% ..................................................... 97 dextrose 2.5% w/ sodium chloride 0.45% ..................................................... 97 dextrose 5% w/ sodium chloride 0.2% 97 dextrose 5% w/ sodium chloride 0.225% ..................................................... 97 dextrose 5% w/ sodium chloride 0.33% ..................................................... 97 dextrose 5% w/ sodium chloride 0.45% ..................................................... 97 dextrose 5% w/ sodium chloride 0.9% 97 dextrose inj 10% ............................. 97

DEXTROSE INJ 20%.......................... 97 dextrose inj 25% .............................. 97 dextrose inj 30% .............................. 97 DEXTROSE INJ 40%.......................... 97 dextrose inj 5%................................ 97 dextrose inj 50% .............................. 97 dextrose inj 70% .............................. 97 DIASTAT ACDL GEL 12.5-20 .............. 45 DIASTAT ACDL GEL 5-10MG .............. 45 DIASTAT PED GEL 2.5M GEL .............. 45 diazepam conc 5 mg/ml .................... 45 diazepam inj 5 mg/ml ....................... 45 diazepam oral soln 1 mg/ml ............... 45 diazepam tab 10 mg ......................... 45 diazepam tab 2 mg ........................... 45 diazepam tab 5 mg ........................... 45 diclofenac potassium tab 50 mg ........... 1 diclofenac sodium gel 1% ................ 109 diclofenac sodium ophth soln 0.1% ... 100 diclofenac sodium tab delayed release 25 mg ................................................... 1 diclofenac sodium tab delayed release 50 mg ................................................... 1 diclofenac sodium tab delayed release 75 mg ................................................... 1 diclofenac sodium tab er 24hr 100 mg... 1 dicloxacillin sodium cap 250 mg ......... 18 dicloxacillin sodium cap 500 mg ......... 18 dicyclomine hcl cap 10 mg ................. 83 dicyclomine hcl oral soln 10 mg/5ml ... 83 dicyclomine hcl tab 20 mg ................. 83 didanosine delayed release capsule 200 mg ................................................. 10 didanosine delayed release capsule 250 mg ................................................. 10 didanosine delayed release capsule 400 mg ................................................. 10 DIFICID TAB 200MG ......................... 16 diflunisal tab 500 mg .......................... 1 digitek tab 0.125mg .......................... 40 digitek tab 0.25mg ........................... 40 digox tab 0.125mg ........................... 40 digox tab 0.25mg ............................. 40 digoxin oral soln 0.05 mg/ml.............. 40 digoxin tab 125 mcg (0.125 mg) ........ 40 digoxin tab 250 mcg (0.25 mg) .......... 40 dihydroergotamine mesylate nasal spray 4 mg/ml .......................................... 62


DILANTIN CAP 30MG ........................ 45 diltiazem hcl cap er 12hr 120 mg ....... 38 diltiazem hcl cap er 12hr 60 mg ......... 38 diltiazem hcl cap er 12hr 90 mg ......... 38 diltiazem hcl coated beads cap er 24hr 120 mg ........................................... 38 diltiazem hcl coated beads cap er 24hr 180 mg ........................................... 38 diltiazem hcl coated beads cap er 24hr 240 mg ........................................... 38 diltiazem hcl coated beads cap er 24hr 300 mg ........................................... 38 diltiazem hcl extended release beads cap er 24hr 360 mg................................ 38 diltiazem hcl extended release beads cap er 24hr 420 mg................................ 38 diltiazem hcl tab 120 mg ................... 39 diltiazem hcl tab 30 mg ..................... 39 diltiazem hcl tab 60 mg ..................... 39 diltiazem hcl tab 90 mg ..................... 39 dilt-xr cap 120mg............................. 38 dilt-xr cap 180mg............................. 38 dilt-xr cap 240mg............................. 38 DIP/TET PED INJ 25-5LFU ................. 93 diphenoxylate w/ atropine liq 2.5-0.025 mg/5ml........................................... 84 diphenoxylate w/ atropine tab 2.5-0.025 mg ................................................. 84 dipyridamole tab 25 mg .................... 90 dipyridamole tab 50 mg .................... 90 dipyridamole tab 75 mg .................... 90 disopyramide phosphate cap 100 mg .. 34 disopyramide phosphate cap 150 mg .. 34 disulfiram tab 250 mg ....................... 66 disulfiram tab 500 mg ....................... 66 DIURIL SUS 250/5ML ........................ 40 divalproex sodium cap delayed release sprinkle 125 mg ............................... 45 divalproex sodium tab delayed release 125 mg ........................................... 45 divalproex sodium tab delayed release 250 mg ........................................... 46 divalproex sodium tab delayed release 500 mg ........................................... 46 divalproex sodium tab er 24 hr 250 mg ..................................................... 46 divalproex sodium tab er 24 hr 500 mg ..................................................... 46

DIVIGEL GEL 1MG/GM ....................... 76 dofetilide cap 125 mcg (0.125 mg) ..... 34 dofetilide cap 250 mcg (0.25 mg) ....... 34 dofetilide cap 500 mcg (0.5 mg) ......... 34 donepezil hydrochloride orally disintegrating tab 10 mg ................... 48 donepezil hydrochloride orally disintegrating tab 5 mg ..................... 48 donepezil hydrochloride tab 10 mg ..... 48 donepezil hydrochloride tab 5 mg ....... 48 dorzolamide hcl ophth soln 2%......... 100 dorzolamide hcl-timolol maleate ophth soln 22.3-6.8 mg/ml ....................... 100 dotti dis 0.025mg ............................. 76 dotti dis 0.0375mg ........................... 76 dotti dis 0.05mg ............................... 76 dotti dis 0.075mg ............................. 76 dotti dis 0.1mg ................................. 76 DOVATO TAB 50-300MG .................... 12 doxazosin mesylate tab 1 mg ............. 32 doxazosin mesylate tab 2 mg ............. 32 doxazosin mesylate tab 4 mg ............. 32 doxazosin mesylate tab 8 mg ............. 32 doxepin hcl cap 10 mg ...................... 50 doxepin hcl cap 100 mg .................... 50 doxepin hcl cap 150 mg .................... 50 doxepin hcl cap 25 mg ...................... 50 doxepin hcl cap 50 mg ...................... 50 doxepin hcl cap 75 mg ...................... 50 doxepin hcl conc 10 mg/ml ................ 50 doxercalciferol cap 0.5 mcg ............... 98 doxercalciferol cap 1 mcg .................. 98 doxercalciferol cap 2.5 mcg ............... 98 doxorubicin hcl for inj 10 mg .............. 19 doxorubicin hcl for inj 50 mg .............. 19 doxy 100 inj 100mg .......................... 18 doxycycline hyclate cap 100 mg ......... 18 doxycycline hyclate cap 50 mg ........... 18 doxycycline hyclate tab 100 mg .......... 19 doxycycline hyclate tab 20 mg ........... 18 doxycycline monohydrate cap 100 mg 19 doxycycline monohydrate cap 50 mg... 19 doxycycline monohydrate for susp 25 mg/5ml ........................................... 19 doxycycline monohydrate tab 100 mg . 19 doxycycline monohydrate tab 150 mg . 19 doxycycline monohydrate tab 50 mg ... 19 doxycycline monohydrate tab 75 mg ... 19


dronabinol cap 10 mg ....................... 82 dronabinol cap 2.5 mg ...................... 82 dronabinol cap 5 mg ......................... 82 drospirenone-ethinyl estradiol tab 3-0.02 mg ................................................. 71 drospirenone-ethinyl estradiol tab 3-0.03 mg ................................................. 71 DUAVEE TAB 0.45-20 ....................... 76 duloxetine hcl enteric coated pellets cap 20 mg (base eq) .............................. 50 duloxetine hcl enteric coated pellets cap 30 mg (base eq) .............................. 50 duloxetine hcl enteric coated pellets cap 40 mg (base eq) .............................. 50 duloxetine hcl enteric coated pellets cap 60 mg (base eq) .............................. 50 DUREZOL EMU 0.05% ......................100 dutasteride cap 0.5 mg ..................... 86 dutasteride-tamsulosin hcl cap 0.5-0.4 mg ................................................. 86 E e.e.s. 400 tab 400mg ....................... 16 EDURANT TAB 25MG ........................ 10 efavirenz cap 200 mg ....................... 10 efavirenz cap 50 mg ......................... 10 efavirenz tab 600 mg ........................ 10 EGRIFTA SOL 1MG ........................... 79 ELIGARD INJ 22.5MG ........................ 22 ELIGARD INJ 30MG .......................... 22 ELIGARD INJ 45MG .......................... 22 ELIGARD INJ 7.5MG ......................... 22 elinest tab ....................................... 71 ELIQUIS ST P TAB 5MG ..................... 87 ELIQUIS TAB 2.5MG ......................... 87 ELIQUIS TAB 5MG ............................ 87 ELLA TAB 30MG ............................... 72 ELMIRON CAP 100MG ....................... 86 EMCYT CAP 140MG ........................... 19 EMEND SUS 125MG .......................... 82 emoquette tab ................................. 72 EMSAM DIS 12MG/24H ..................... 51 EMSAM DIS 6MG/24HR ..................... 50 EMSAM DIS 9MG/24HR ..................... 50 EMTRIVA CAP 200MG ........................ 10 EMTRIVA SOL 10MG/ML .................... 10 enalapril maleate & hydrochlorothiazide tab 10-25 mg .................................. 30 enalapril maleate & hydrochlorothiazide

tab 5-12.5 mg .................................. 30 enalapril maleate tab 10 mg .............. 31 enalapril maleate tab 2.5 mg ............. 31 enalapril maleate tab 20 mg .............. 31 enalapril maleate tab 5 mg ................ 31 ENBREL INJ 25/0.5ML ....................... 90 ENBREL INJ 25MG ............................ 90 ENBREL INJ 50MG/ML ....................... 90 ENBREL MINI INJ 50MG/ML ............... 90 ENBREL SRCLK INJ 50MG/ML ............. 90 endocet tab 10-325mg ........................ 3 endocet tab 2.5-325 ........................... 3 endocet tab 5-325mg .......................... 3 endocet tab 7.5-325 ........................... 3 ENGERIX-B INJ 10/0.5ML .................. 93 ENGERIX-B INJ 20MCG/ML ................ 93 enoxaparin sodium inj 100 mg/ml ...... 87 enoxaparin sodium inj 120 mg/0.8ml .. 87 enoxaparin sodium inj 150 mg/ml ...... 87 enoxaparin sodium inj 30 mg/0.3ml .... 87 enoxaparin sodium inj 40 mg/0.4ml .... 87 enoxaparin sodium inj 60 mg/0.6ml .... 87 enoxaparin sodium inj 80 mg/0.8ml .... 87 enpresse-28 tab ............................... 72 enskyce tab ..................................... 72 entacapone tab 200 mg ..................... 54 entecavir tab 0.5 mg ......................... 13 entecavir tab 1 mg ........................... 13 ENTRESTO TAB 24-26MG ................... 32 ENTRESTO TAB 49-51MG ................... 32 ENTRESTO TAB 97-103MG ................. 32 enulose sol 10gm/15 ........................ 84 EPCLUSA TAB 400-100 ...................... 13 EPIDIOLEX SOL 100MG/ML ................ 46 epinastine hcl ophth soln 0.05% ....... 100 epinephrine solution auto-injector 0.15 mg/0.3ml (1:2000) ......................... 103 epinephrine solution auto-injector 0.3 mg/0.3ml (1:1000) ......................... 103 EPIPEN 2-PAK INJ 0.3MG ................. 103 EPIPEN-JR INJ 0.15MG .................... 103 epirubicin hcl iv soln 50 mg/25ml (2 mg/ml) ........................................... 19 epitol tab 200mg .............................. 46 EPIVIR HBV SOL 5MG/ML .................. 13 eplerenone tab 25 mg ....................... 32 eplerenone tab 50 mg ....................... 32 EPOGEN INJ 10000/ML ...................... 89


EPOGEN INJ 2000/ML ....................... 89 EPOGEN INJ 20000/ML ..................... 89 EPOGEN INJ 3000/ML ....................... 89 EPOGEN INJ 4000/ML ....................... 89 epoprostenol sodium for inj 0.5 mg .... 43 epoprostenol sodium for inj 1.5 mg .... 43 EQUETRO CAP 100MG ....................... 63 EQUETRO CAP 200MG ....................... 63 EQUETRO CAP 300MG ....................... 63 ERAXIS INJ 100MG ............................. 9 ERAXIS INJ 50MG .............................. 9 ERBITUX INJ 200MG ......................... 20 ergoloid mesylates tab 1 mg .............. 56 ERIVEDGE CAP 150MG ...................... 20 ERLEADA TAB 60MG ......................... 22 erlotinib hcl tab 100 mg (base equivalent) ...................................... 25 erlotinib hcl tab 150 mg (base equivalent) ...................................... 25 erlotinib hcl tab 25 mg (base equivalent) ..................................................... 25 errin tab 0.35mg .............................. 72 ertapenem sodium for inj 1 gm (base equivalent) ........................................ 7 ery pad 2% ....................................105 ery-tab tab 250mg ec ....................... 16 ery-tab tab 333mg ec ....................... 16 ery-tab tab 500mg ec ....................... 16 ERYTHROCIN INJ 500MG ................... 16 erythrocin tab 250mg ....................... 16 erythromycin ethylsuccinate for susp 200 mg/5ml .......................................... 16 erythromycin ethylsuccinate tab 400 mg ..................................................... 16 erythromycin gel 2% .......................105 erythromycin ophth oint 5 mg/gm ...... 99 erythromycin soln 2%......................105 erythromycin tab 250 mg .................. 16 erythromycin tab 500 mg .................. 16 erythromycin w/ delayed release particles cap 250 mg ........................ 16 ESBRIET CAP 267MG ....................... 103 ESBRIET TAB 267MG ....................... 103 ESBRIET TAB 801MG ....................... 103 escitalopram oxalate soln 5 mg/5ml (base equiv) .................................... 51 escitalopram oxalate tab 10 mg (base equiv) ............................................. 51

escitalopram oxalate tab 20 mg (base equiv) ............................................. 51 escitalopram oxalate tab 5 mg (base equiv) ............................................. 51 esmolol hcl inj 100 mg/10ml .............. 37 estarylla tab 0.25-35 ........................ 72 estradiol & norethindrone acetate tab 0.5-0.1 mg ...................................... 76 estradiol & norethindrone acetate tab 1- 0.5 mg ............................................ 76 estradiol tab 0.5 mg ......................... 76 estradiol tab 1 mg ............................ 76 estradiol tab 2 mg ............................ 76 estradiol td patch twice weekly 0.025 mg/24hr .......................................... 76 estradiol td patch twice weekly 0.0375 mg/24hr .......................................... 76 estradiol td patch twice weekly 0.05 mg/24hr .......................................... 76 estradiol td patch twice weekly 0.075 mg/24hr .......................................... 76 estradiol td patch twice weekly 0.1 mg/24hr .......................................... 76 estradiol td patch weekly 0.025 mg/24hr ..................................................... 77 estradiol td patch weekly 0.0375 mg/24hr (37.5 mcg/24hr) ................. 77 estradiol td patch weekly 0.05 mg/24hr ..................................................... 76 estradiol td patch weekly 0.06 mg/24hr ..................................................... 76 estradiol td patch weekly 0.075 mg/24hr ..................................................... 77 estradiol td patch weekly 0.1 mg/24hr 76 estradiol vaginal cream 0.1 mg/gm ..... 77 estradiol vaginal tab 10 mcg .............. 77 estradiol valerate im in oil 20 mg/ml ... 77 estradiol valerate im in oil 40 mg/ml ... 77 ESTRING MIS 2MG............................ 77 ethambutol hcl tab 100 mg ................ 12 ethambutol hcl tab 400 mg ................ 12 ethosuximide cap 250 mg .................. 46 ethosuximide soln 250 mg/5ml .......... 46 ethynodiol diacetate & ethinyl estradiol tab 1 mg-35 mcg .............................. 72 ethynodiol diacetate & ethinyl estradiol tab 1 mg-50 mcg .............................. 72 etodolac cap 200 mg ........................... 1


etodolac cap 300 mg .......................... 1 etodolac tab 400 mg ........................... 1 etodolac tab 500 mg ........................... 1 EUCRISA OIN 2% ............................109 EVOTAZ TAB 300-150 ....................... 12 exemestane tab 25 mg ..................... 22 ezetimibe tab 10 mg ......................... 35 F falmina tab ...................................... 72 famciclovir tab 125 mg ..................... 13 famciclovir tab 250 mg ..................... 13 famciclovir tab 500 mg ..................... 13 famotidine for susp 40 mg/5ml .......... 83 famotidine tab 20 mg ....................... 83 famotidine tab 40 mg ....................... 83 FANAPT PAK .................................... 56 FANAPT TAB 10MG ........................... 56 FANAPT TAB 12MG ........................... 56 FANAPT TAB 1MG ............................. 56 FANAPT TAB 2MG ............................. 56 FANAPT TAB 4MG ............................. 56 FANAPT TAB 6MG ............................. 56 FANAPT TAB 8MG ............................. 56 FARESTON TAB 60MG ....................... 22 FARYDAK CAP 10MG ......................... 20 FARYDAK CAP 15MG ......................... 20 FARYDAK CAP 20MG ......................... 20 felbamate susp 600 mg/5ml .............. 46 felbamate tab 400 mg ...................... 46 felbamate tab 600 mg ...................... 46 felodipine tab er 24hr 10 mg ............. 39 felodipine tab er 24hr 2.5 mg ............ 39 felodipine tab er 24hr 5 mg ............... 39 FEMRING MIS 0.05/24H .................... 77 FEMRING MIS 0.1MG/24 ................... 77 femynor tab 0.25-35 ........................ 72 fenofibrate micronized cap 134 mg ..... 35 fenofibrate micronized cap 200 mg ..... 35 fenofibrate micronized cap 43 mg ....... 35 fenofibrate micronized cap 67 mg....... 35 fenofibrate tab 145 mg ..................... 35 fenofibrate tab 160 mg ..................... 36 fenofibrate tab 48 mg ....................... 35 fenofibrate tab 54 mg ....................... 35 fenofibric acid tab 105 mg ................. 36 fenofibric acid tab 35 mg................... 36 fenoprofen calcium tab 600 mg ............ 1 FENTANYL CIT INJ 100MCG ................. 3

fentanyl citrate inj 0.05 mg/ml ............. 3 fentanyl citrate lozenge on a handle 1200 mcg .................................................. 3 fentanyl citrate lozenge on a handle 1600 mcg .................................................. 3 fentanyl citrate lozenge on a handle 200 mcg .................................................. 3 fentanyl citrate lozenge on a handle 400 mcg .................................................. 3 fentanyl citrate lozenge on a handle 600 mcg .................................................. 3 fentanyl citrate lozenge on a handle 800 mcg .................................................. 3 fentanyl citrate pf soln cartridge 100 mcg/2ml ........................................... 3 fentanyl citrate preservative free (pf) inj 100 mcg/2ml ..................................... 3 fentanyl td patch 72hr 100 mcg/hr ....... 3 fentanyl td patch 72hr 12 mcg/hr ......... 3 fentanyl td patch 72hr 25 mcg/hr ......... 3 fentanyl td patch 72hr 50 mcg/hr ......... 3 fentanyl td patch 72hr 75 mcg/hr ......... 3 FETZIMA CAP 120MG ........................ 51 FETZIMA CAP 20MG .......................... 51 FETZIMA CAP 40MG .......................... 51 FETZIMA CAP 80MG .......................... 51 FETZIMA CAP TITRATIO ..................... 51 FIASP FLEX INJ TOUCH ..................... 66 FIASP INJ 100/ML ............................. 66 finasteride tab 5 mg.......................... 86 FIRAZYR INJ 30MG/3ML .................... 89 FIRDAPSE TAB 10MG ........................ 63 FIRMAGON INJ 120MG ...................... 22 FIRMAGON INJ 80MG ........................ 22 FIRVANQ SOL 25MG/ML ...................... 7 FIRVANQ SOL 50MG/ML ...................... 7 flavoxate hcl tab 100 mg ................... 86 FLEBOGAMMA INJ 10/200ML .............. 92 FLEBOGAMMA INJ 20/400ML .............. 92 FLEBOGAMMA INJ 5GM/50ML ............. 92 FLEBOGAMMA INJ DIF 5% ................. 92 flecainide acetate tab 100 mg ............ 34 flecainide acetate tab 150 mg ............ 34 flecainide acetate tab 50 mg .............. 34 FLOVENT DISK AER 100MCG ............ 105 FLOVENT DISK AER 250MCG ............ 105 FLOVENT DISK AER 50MCG ............. 105 FLOVENT HFA AER 110MCG ............. 105


FLOVENT HFA AER 220MCG ..............105 FLOVENT HFA AER 44MCG ................105 floxuridine for inj 0.5 gm ................... 20 fluconazole for susp 10 mg/ml ............. 9 fluconazole for susp 40 mg/ml ............. 9 fluconazole in nacl 0.9% inj 200 mg/100ml ......................................... 9 fluconazole in nacl 0.9% inj 400 mg/200ml ......................................... 9 fluconazole tab 100 mg ....................... 9 fluconazole tab 150 mg ....................... 9 fluconazole tab 200 mg ....................... 9 fluconazole tab 50 mg......................... 9 flucytosine cap 250 mg ....................... 9 flucytosine cap 500 mg ....................... 9 fludarabine phosphate inj 25 mg/ml ... 20 fludrocortisone acetate tab 0.1 mg ..... 77 flunisolide nasal soln 25 mcg/act (0.025%) .......................................104 fluocinolone acetonide (otic) oil 0.01% ................................................... 110 fluocinolone acetonide cream 0.01% 108 fluocinolone acetonide cream 0.025%108 fluocinolone acetonide oil 0.01% (scalp oil) ................................................108 fluocinolone acetonide oint 0.025% ...108 fluocinolone acetonide soln 0.01% ....108 fluocinonide cream 0.05% ................108 fluocinonide emulsified base cream 0.05% ...........................................108 fluocinonide gel 0.05% ....................108 fluocinonide oint 0.05% ...................108 fluocinonide soln 0.05% ...................108 fluoritab chw 0.5mg f ....................... 94 fluoritab chw 2.2mg ......................... 94 fluorometholone ophth susp 0.1% .....100 fluorouracil cream 5% .....................109 fluorouracil iv soln 1 gm/20ml (50 mg/ml) ........................................... 20 fluorouracil soln 2% ........................109 fluorouracil soln 5% ........................109 fluoxetine hcl cap 10 mg ................... 51 fluoxetine hcl cap 20 mg ................... 51 fluoxetine hcl cap 40 mg ................... 51 fluoxetine hcl solution 20 mg/5ml ...... 51 fluoxetine hcl tab 10 mg ................... 51 fluoxetine hcl tab 20 mg ................... 51 fluphenazine decanoate inj 25 mg/ml . 56

fluphenazine hcl elixir 2.5 mg/5ml ...... 56 fluphenazine hcl inj 2.5 mg/ml ........... 56 fluphenazine hcl oral conc 5 mg/ml ..... 56 fluphenazine hcl tab 1 mg .................. 56 fluphenazine hcl tab 10 mg ................ 56 fluphenazine hcl tab 2.5 mg ............... 56 fluphenazine hcl tab 5 mg .................. 56 flurbiprofen sodium ophth soln 0.03% ................................................... 100 flurbiprofen tab 100 mg....................... 1 flurbiprofen tab 50 mg ........................ 1 flutamide cap 125 mg ....................... 22 fluticasone propionate cream 0.05%. 108 fluticasone propionate nasal susp 50 mcg/act ........................................ 104 fluticasone propionate oint 0.005% ... 108 fluvastatin sodium cap 20 mg (base equivalent) ...................................... 35 fluvastatin sodium cap 40 mg (base equivalent) ...................................... 35 fluvoxamine maleate tab 100 mg ....... 44 fluvoxamine maleate tab 25 mg ......... 44 fluvoxamine maleate tab 50 mg ......... 44 FML FORTE SUS 0.25% OP .............. 100 FML OIN 0.1% OP ........................... 100 fondaparinux sodium subcutaneous inj 10 mg/0.8ml .................................... 87 fondaparinux sodium subcutaneous inj 2.5 mg/0.5ml ................................... 87 fondaparinux sodium subcutaneous inj 5 mg/0.4ml ........................................ 87 fondaparinux sodium subcutaneous inj 7.5 mg/0.6ml ................................... 87 FORTEO SOL 600/2.4 ........................ 79 fosamprenavir calcium tab 700 mg (base equiv) ............................................. 10 foscarnet sodium inj 24 mg/ml ........... 13 fosinopril sodium & hydrochlorothiazide tab 10-12.5 mg ................................ 30 fosinopril sodium & hydrochlorothiazide tab 20-12.5 mg ................................ 30 fosinopril sodium tab 10 mg ............... 31 fosinopril sodium tab 20 mg ............... 31 fosinopril sodium tab 40 mg ............... 31 fosphenytoin sodium inj 500 mg/10ml (phenytoin equiv) ............................. 46 FRAGMIN INJ 10000/ML .................... 87 FRAGMIN INJ 12500UNT.................... 87


FRAGMIN INJ 15000UNT ................... 87 FRAGMIN INJ 18000UNT ................... 87 FRAGMIN INJ 2500/0.2 ..................... 87 FRAGMIN INJ 5000/0.2 ..................... 87 FRAGMIN INJ 7500/0.3 ..................... 87 FRAGMIN INJ 95000UNT ................... 87 FREAMINE HBC INJ 6.9% .................. 96 FULPHILA INJ 6/0.6ML ...................... 89 furosemide inj 10 mg/ml ................... 40 furosemide oral soln 10 mg/ml .......... 40 furosemide oral soln 8 mg/ml ............ 40 furosemide tab 20 mg....................... 40 furosemide tab 40 mg....................... 40 furosemide tab 80 mg....................... 40 FUZEON INJ 90MG ........................... 10 fyavolv tab 1-5 ................................ 77 FYCOMPA SUS 0.5MG/ML .................. 46 FYCOMPA TAB 10MG ......................... 46 FYCOMPA TAB 12MG ......................... 46 FYCOMPA TAB 2MG .......................... 46 FYCOMPA TAB 4MG .......................... 46 FYCOMPA TAB 6MG .......................... 46 FYCOMPA TAB 8MG .......................... 46 G gabapentin cap 100 mg .................... 46 gabapentin cap 300 mg .................... 46 gabapentin cap 400 mg .................... 46 gabapentin oral soln 250 mg/5ml ....... 46 gabapentin tab 600 mg ..................... 46 gabapentin tab 800 mg ..................... 46 GABLOFEN INJ 20000/20 .................. 64 GALAFOLD CAP 123MG ..................... 75 galantamine hydrobromide cap er 24hr 16 mg............................................. 48 galantamine hydrobromide cap er 24hr 24 mg............................................. 49 galantamine hydrobromide cap er 24hr 8 mg ................................................. 48 galantamine hydrobromide oral soln 4 mg/ml ............................................ 49 galantamine hydrobromide tab 12 mg. 49 galantamine hydrobromide tab 4 mg .. 49 galantamine hydrobromide tab 8 mg .. 49 GAMMAGARD INJ 2.5GM/25 .............. 92 GAMMAGARD SD INJ 10GM HU .......... 92 GAMMAGARD SD INJ 5GM HU ............ 92 GAMMAKED INJ 1GM/10ML ................ 92 GAMUNEX-C INJ 1GM/10ML ............... 92

GARDASIL 9 INJ ............................... 93 gatifloxacin ophth soln 0.5% .............. 99 GATTEX KIT 5MG .............................. 84 GAUZE PADS & DRESSINGS - PADS 2 X 2 .................................................... 66 gavilyte-c sol ................................... 84 gavilyte-g sol ................................... 84 gavilyte-n sol flav pk ......................... 84 GAZYVA INJ 25MG/ML ....................... 20 gemcitabine hcl for inj 2 gm .............. 20 gemcitabine hcl for inj 200 mg ........... 20 gemcitabine hcl inj 1 gm/26.3ml (38 mg/ml) (base equiv) ......................... 20 gemcitabine hcl inj 2 gm/52.6ml (38 mg/ml) (base equiv) ......................... 20 gemcitabine inj 200mg ...................... 20 gemfibrozil tab 600 mg ..................... 36 generlac sol 10gm/15 ....................... 84 gengraf cap 100mg........................... 93 gengraf cap 25mg ............................ 93 gengraf sol 100mg/ml ....................... 93 GENOTROPIN INJ 0.2MG ................... 79 GENOTROPIN INJ 0.4MG ................... 79 GENOTROPIN INJ 0.6MG ................... 79 GENOTROPIN INJ 0.8MG ................... 79 GENOTROPIN INJ 1.2MG ................... 79 GENOTROPIN INJ 1.4MG ................... 79 GENOTROPIN INJ 1.6MG ................... 79 GENOTROPIN INJ 1.8MG ................... 79 GENOTROPIN INJ 12MG .................... 79 GENOTROPIN INJ 1MG ...................... 79 GENOTROPIN INJ 2MG ...................... 79 GENOTROPIN INJ 5MG ...................... 79 gentak oin 0.3% op .......................... 99 gentamicin in saline inj 0.8 mg/ml ........ 6 gentamicin in saline inj 1 mg/ml ........... 6 gentamicin in saline inj 1.2 mg/ml ........ 6 gentamicin in saline inj 1.6 mg/ml ........ 6 gentamicin sulfate cream 0.1% ........ 106 gentamicin sulfate inj 40 mg/ml ........... 6 gentamicin sulfate oint 0.1% ........... 106 gentamicin sulfate ophth soln 0.3% .... 99 GENVOYA TAB .................................. 12 GEODON INJ 20MG ........................... 56 gianvi tab 3-0.02mg ......................... 72 gildess fe tab 1.5/30 ......................... 72 gildess fe tab 1/20 ............................ 72 gildess tab 1/20 ............................... 72


GILENYA CAP 0.5MG ......................... 64 GILOTRIF TAB 20MG ......................... 25 GILOTRIF TAB 30MG ......................... 25 GILOTRIF TAB 40MG ......................... 25 glatopa inj 20mg/ml ......................... 64 GLEOSTINE CAP 100MG .................... 19 GLEOSTINE CAP 10MG ...................... 19 GLEOSTINE CAP 40MG ...................... 19 glimepiride tab 1 mg ........................ 68 glimepiride tab 2 mg ........................ 68 glimepiride tab 4 mg ........................ 68 glipizide tab 10 mg ........................... 68 glipizide tab 5 mg............................. 68 glipizide tab er 24hr 10 mg................ 68 glipizide tab er 24hr 2.5 mg .............. 68 glipizide tab er 24hr 5 mg ................. 68 glipizide-metformin hcl tab 2.5-250 mg ..................................................... 68 glipizide-metformin hcl tab 2.5-500 mg ..................................................... 68 glipizide-metformin hcl tab 5-500 mg . 68 GLUCAGEN INJ HYPOKIT ................... 78 glycopyrrolate tab 1 mg .................... 83 glycopyrrolate tab 2 mg .................... 83 GRALISE STAR MIS 300/600 .............. 63 GRALISE TAB 300MG ........................ 63 GRALISE TAB 600MG ........................ 63 GRANIX INJ 300/0.5 ......................... 89 GRANIX INJ 300/1ML ........................ 89 GRANIX INJ 480/0.8 ......................... 89 GRANIX INJ 480/1.6 ......................... 89 griseofulvin microsize susp 125 mg/5ml 9 griseofulvin microsize tab 500 mg ........ 9 griseofulvin ultramicrosize tab 125 mg .. 9 griseofulvin ultramicrosize tab 250 mg .. 9 GUANIDINE TAB 125MG .................... 63 H hailey 24 tab fe ................................ 72 haloperidol decanoate im soln 100 mg/ml ..................................................... 56 haloperidol decanoate im soln 50 mg/ml ..................................................... 56 haloperidol lactate inj 5 mg/ml........... 56 haloperidol lactate oral conc 2 mg/ml . 56 haloperidol tab 0.5 mg ...................... 56 haloperidol tab 1 mg......................... 56 haloperidol tab 10 mg ....................... 56 haloperidol tab 2 mg......................... 56

haloperidol tab 20 mg ....................... 56 haloperidol tab 5 mg ......................... 56 HARVONI TAB 90-400MG ................... 13 HAVRIX INJ 1440UNIT ...................... 94 HAVRIX INJ 720UNIT ........................ 94 heather tab 0.35mg .......................... 72 HEP SOD/D5W INJ 50UNT/ML ............ 87 HEP SOD/NACL INJ 12500UNT ........... 87 heparin sod (porcine)-nacl iv soln 1000 unit/500ml-0.9% .............................. 88 heparin sodium (porcine) inj 1000 unit/ml ............................................ 88 heparin sodium (porcine) inj 10000 unit/ml ............................................ 88 heparin sodium (porcine) inj 20000 unit/ml ............................................ 88 heparin sodium (porcine) inj 5000 unit/ml ............................................ 88 heparin sodium (porcine) pf inj 5000 unit/0.5ml ....................................... 88 hepatamine sol 8% ........................... 96 HETLIOZ CAP 20MG .......................... 62 HIBERIX SOL 10MCG ........................ 94 HIZENTRA INJ 10/50ML ..................... 92 HIZENTRA INJ 1GM/5ML .................... 92 HIZENTRA INJ 2GM/10ML .................. 92 HIZENTRA INJ 4GM/20ML .................. 92 HORIZANT TAB 300MG ER ................. 63 HORIZANT TAB 600MG ER ................. 63 HUMIRA INJ 10/0.1ML ....................... 90 HUMIRA INJ 10MG/0.2 ...................... 90 HUMIRA INJ 20/0.2ML ....................... 90 HUMIRA INJ 40/0.4ML ....................... 90 HUMIRA KIT 20MG/0.4 ...................... 91 HUMIRA KIT 40MG/0.8 ...................... 91 HUMIRA PEDIA INJ CROHNS .............. 91 HUMIRA PEN INJ 40/0.4ML ................ 91 HUMIRA PEN INJ 40MG/0.8 ................ 91 HUMIRA PEN INJ CD/UC/HS ............... 91 HUMIRA PEN INJ PS/UV ..................... 91 HUMIRA PEN KIT CD/UC/HS ............... 91 HUMIRA PEN KIT PS/UV .................... 91 HUMULIN R INJ U-500 ....................... 67 hydralazine hcl tab 10 mg ................. 41 hydralazine hcl tab 100 mg ................ 41 hydralazine hcl tab 25 mg ................. 41 hydralazine hcl tab 50 mg ................. 41 hydrochlorothiazide cap 12.5 mg ........ 40


hydrochlorothiazide tab 12.5 mg ........ 40 hydrochlorothiazide tab 25 mg ........... 40 hydrochlorothiazide tab 50 mg ........... 40 hydrocodone-acetaminophen soln 10-325 mg/15ml ........................................... 3 hydrocodone-acetaminophen soln 7.5- 325 mg/15ml..................................... 3 hydrocodone-acetaminophen tab 10-325 mg ................................................... 4 hydrocodone-acetaminophen tab 2.5-325 mg ................................................... 3 hydrocodone-acetaminophen tab 5-325 mg ................................................... 4 hydrocodone-acetaminophen tab 7.5-325 mg ................................................... 4 hydrocodone-ibuprofen tab 7.5-200 mg 4 hydrocort oin 1% ............................108 hydrocortisone acetate w/ pramoxine rectal cream 1-1% ..........................109 hydrocortisone cream 1% ................108 hydrocortisone cream 2.5% ..............108 hydrocortisone enema 100 mg/60ml .. 84 hydrocortisone lotion 2.5% ...............108 hydrocortisone oint 2.5% .................108 hydrocortisone tab 10 mg ................. 77 hydrocortisone tab 20 mg ................. 78 hydrocortisone tab 5 mg ................... 77 hydrocortisone w/ acetic acid otic soln 1- 2% ................................................110 hydromorphone hcl inj 1 mg/ml ........... 4 hydromorphone hcl inj 4 mg/ml ........... 4 hydromorphone hcl tab 2 mg ............... 4 hydromorphone hcl tab 4 mg ............... 4 hydromorphone hcl tab 8 mg ............... 4 hydroxychloroquine sulfate tab 200 mg ..................................................... 91 hydroxyurea cap 500 mg .................. 29 hydroxyzine hcl syrup 10 mg/5ml......102 hydroxyzine hcl tab 10 mg ...............102 hydroxyzine hcl tab 25 mg ...............102 hydroxyzine hcl tab 50 mg ...............102 hydroxyzine pamoate cap 100 mg .....102 hydroxyzine pamoate cap 25 mg .......102 hydroxyzine pamoate cap 50 mg .......102 I ibandronate sodium tab 150 mg (base equivalent) ...................................... 70 IBRANCE CAP 100MG ........................ 21

IBRANCE CAP 125MG ........................ 21 IBRANCE CAP 75MG .......................... 21 ibu tab 600mg ................................... 1 ibu tab 800mg ................................... 1 ibuprofen susp 100 mg/5ml ................. 2 ibuprofen tab 400 mg ......................... 2 ibuprofen tab 600 mg ......................... 2 ibuprofen tab 800 mg ......................... 2 ibutilide fumarate inj 1 mg/10ml ........ 34 ICLUSIG TAB 15MG .......................... 26 ICLUSIG TAB 45MG .......................... 26 IDHIFA TAB 100MG .......................... 21 IDHIFA TAB 50MG ............................ 21 IFOSFAMIDE INJ 3GM ....................... 19 ifosfamide iv inj 1 gm/20ml (50 mg/ml) ..................................................... 19 ifosfamide iv inj 3 gm/60ml (50 mg/ml) ..................................................... 19 imatinib mesylate tab 100 mg (base equivalent) ...................................... 26 imatinib mesylate tab 400 mg (base equivalent) ...................................... 26 IMBRUVICA CAP 140MG .................... 26 IMBRUVICA CAP 70MG ...................... 26 IMBRUVICA TAB 140MG .................... 26 IMBRUVICA TAB 280MG .................... 26 IMBRUVICA TAB 420MG .................... 26 IMBRUVICA TAB 560MG .................... 26 imipenem-cilastatin intravenous for soln 250 mg ............................................. 7 imipenem-cilastatin intravenous for soln 500 mg ............................................. 7 imipramine hcl tab 10 mg .................. 51 imipramine hcl tab 25 mg .................. 51 imipramine hcl tab 50 mg .................. 51 imipramine pamoate cap 100 mg ........ 51 imipramine pamoate cap 125 mg ........ 51 imipramine pamoate cap 150 mg ........ 51 imipramine pamoate cap 75 mg ......... 51 imiquimod cream 5% ...................... 109 IMOVAX RABIE INJ 2.5/ML ................. 94 incassia tab 0.35mg .......................... 72 INCRELEX INJ 40MG/4ML .................. 79 indapamide tab 1.25 mg .................... 40 indapamide tab 2.5 mg ..................... 40 INFANRIX INJ .................................. 94 INLYTA TAB 1MG .............................. 26 INLYTA TAB 5MG .............................. 26


INSULIN PEN NEEDLE ....................... 67 INSULIN SYRINGE (DISP) U-100 0.3 ML ..................................................... 67 INSULIN SYRINGE (DISP) U-100 1 ML 67 INSULIN SYRINGE (DISP) U-100 1/2 ML ..................................................... 67 INTELENCE TAB 100MG .................... 10 INTELENCE TAB 200MG .................... 10 INTELENCE TAB 25MG ...................... 10 intralipid inj 20% ............................. 96 INTRALIPID INJ 30% ........................ 96 INTRON A INJ 10MU ......................... 92 INTRON A INJ 18MU ......................... 92 INTRON A INJ 25MU ......................... 92 INTRON A INJ 50MU ......................... 92 introvale tab .................................... 72 INVEGA SUST INJ 117/0.75 ............... 56 INVEGA SUST INJ 156MG/ML ............. 57 INVEGA SUST INJ 234/1.5 ................ 57 INVEGA SUST INJ 39/0.25 ................ 56 INVEGA SUST INJ 78/0.5ML .............. 56 INVEGA TRINZ INJ 273MG................. 57 INVEGA TRINZ INJ 410MG................. 57 INVEGA TRINZ INJ 546MG................. 57 INVEGA TRINZ INJ 819MG................. 57 INVIRASE TAB 500MG ...................... 10 INVOKAMET TAB 150-1000 ............... 68 INVOKAMET TAB 150-500 ................. 68 INVOKAMET TAB 50-1000 ................. 68 INVOKAMET TAB 50-500MG .............. 68 INVOKAMET XR TAB 150-1000 ........... 68 INVOKAMET XR TAB 150-500 ............ 68 INVOKAMET XR TAB 50-1000 ............ 68 INVOKAMET XR TAB 50-500MG .......... 68 INVOKANA TAB 100MG ..................... 68 INVOKANA TAB 300MG ..................... 68 IONOSOL-MB INJ D5W ...................... 97 IOPIDINE SOL 1% OP ...................... 100 IPOL INJ INACTIVE ........................... 94 ipratropium bromide inhal soln 0.02% ................................................... 101 ipratropium bromide nasal soln 0.03% (21 mcg/spray) ...............................101 ipratropium bromide nasal soln 0.06% (42 mcg/spray) ...............................101 ipratropium-albuterol nebu soln 0.5- 2.5(3) mg/3ml ................................101 irbesartan tab 150 mg ...................... 33

irbesartan tab 300 mg....................... 33 irbesartan tab 75 mg ........................ 33 irbesartan-hydrochlorothiazide tab 150- 12.5 mg .......................................... 32 irbesartan-hydrochlorothiazide tab 300- 12.5 mg .......................................... 32 IRESSA TAB 250MG .......................... 26 irinotecan hcl inj 40 mg/2ml (20 mg/ml) ..................................................... 29 irinotecan hcl inj 500 mg/25ml (20 mg/ml) ........................................... 29 ISENTRESS CHW 100MG ................... 10 ISENTRESS CHW 25MG ..................... 10 ISENTRESS HD TAB 600MG ............... 10 ISENTRESS POW 100MG ................... 10 ISENTRESS TAB 400MG .................... 10 isibloom tab ..................................... 72 ISOLYTE-P INJ /D5W ........................ 97 ISOLYTE-S INJ ................................. 97 isoniazid syrup 50 mg/5ml ................. 12 isoniazid tab 100 mg ......................... 12 isoniazid tab 300 mg ......................... 12 ISOPROPYL ALCOHOL 0.7ML/ML ......... 67 isosorbide dinitrate tab 10 mg ............ 42 isosorbide dinitrate tab 20 mg ............ 42 isosorbide dinitrate tab 30 mg ............ 42 isosorbide dinitrate tab 5 mg .............. 42 isosorbide dinitrate tab er 40 mg ........ 42 isosorbide mononitrate tab 10 mg....... 42 isosorbide mononitrate tab 20 mg....... 42 isosorbide mononitrate tab er 24hr 120 mg ................................................. 42 isosorbide mononitrate tab er 24hr 30 mg ................................................. 42 isosorbide mononitrate tab er 24hr 60 mg ................................................. 42 isotretinoin cap 10 mg..................... 105 isotretinoin cap 20 mg..................... 105 isotretinoin cap 30 mg..................... 105 isotretinoin cap 40 mg..................... 105 isradipine cap 2.5 mg ........................ 39 isradipine cap 5 mg .......................... 39 ISUPREL INJ 0.2MG/ML ................... 102 itraconazole cap 100 mg ...................... 9 ivermectin tab 3 mg ............................ 7 IXEMPRA KIT INJ 15MG ..................... 29 IXEMPRA KIT INJ 45MG ..................... 29 IXIARO INJ ...................................... 94


J JADENU SPRKL GRA 180MG ............... 70 JADENU SPRKL GRA 360MG ............... 70 JADENU SPRKL GRA 90MG ................ 70 JADENU TAB 180MG ......................... 70 JADENU TAB 360MG ......................... 70 JADENU TAB 90MG ........................... 70 JAKAFI TAB 10MG ............................ 26 JAKAFI TAB 15MG ............................ 26 JAKAFI TAB 20MG ............................ 26 JAKAFI TAB 25MG ............................ 26 JAKAFI TAB 5MG .............................. 26 jantoven tab 10mg ........................... 88 jantoven tab 1mg ............................. 88 jantoven tab 2.5mg .......................... 88 jantoven tab 2mg ............................. 88 jantoven tab 3mg ............................. 88 jantoven tab 4mg ............................. 88 jantoven tab 5mg ............................. 88 jantoven tab 6mg ............................. 88 jantoven tab 7.5mg .......................... 88 JANUMET TAB 50-1000 ..................... 68 JANUMET TAB 50-500MG .................. 68 JANUMET XR TAB 100-1000............... 68 JANUMET XR TAB 50-1000 ................ 68 JANUMET XR TAB 50-500MG ............. 68 JANUVIA TAB 100MG ........................ 69 JANUVIA TAB 25MG .......................... 68 JANUVIA TAB 50MG .......................... 69 JARDIANCE TAB 10MG ...................... 69 JARDIANCE TAB 25MG ...................... 69 jasmiel tab 3-0.02mg ....................... 72 jencycla tab 0.35mg ......................... 72 JENTADUETO TAB 2.5-1000 ............... 69 JENTADUETO TAB 2.5-500 ................ 69 JENTADUETO TAB 2.5-850 ................ 69 JENTADUETO TAB XR ........................ 69 jinteli tab 1mg-5mcg ........................ 77 jolessa tab ...................................... 72 jolivette tab 0.35mg ......................... 72 juleber tab ...................................... 72 JULUCA TAB 50-25MG ...................... 12 junel 1.5/30 tab ............................... 72 junel 1/20 tab .................................. 72 junel fe 24 tab 1/20 ......................... 72 junel fe tab 1.5/30 ........................... 72 junel fe tab 1/20 .............................. 72 JUXTAPID CAP 10MG ........................ 36

JUXTAPID CAP 20MG......................... 36 JUXTAPID CAP 30MG ........................ 36 JUXTAPID CAP 40MG ........................ 36 JUXTAPID CAP 5MG .......................... 36 JUXTAPID CAP 60MG ........................ 36 K KABIVEN EMU .................................. 96 kaitlib fe chw ................................... 72 KALETRA TAB 100-25MG ................... 12 KALETRA TAB 200-50MG ................... 12 KALYDECO PAK 25MG ..................... 103 KALYDECO PAK 50MG ..................... 103 KALYDECO PAK 75MG ..................... 103 KALYDECO TAB 150MG ................... 103 kariva tab 28 day ............................. 72 kcl 10 meq/l (0.075%) in dextrose 5% & nacl 0.45% inj ................................. 97 kcl 20 meq/l (0.15%) in dextrose 5% & nacl 0.2% inj ................................... 97 kcl 20 meq/l (0.15%) in dextrose 5% & nacl 0.33% inj ................................. 97 kcl 20 meq/l (0.15%) in dextrose 5% & nacl 0.45% inj ................................. 97 kcl 20 meq/l (0.15%) in dextrose 5% & nacl 0.9% inj ................................... 97 kcl 20 meq/l (0.15%) in nacl 0.45% inj ..................................................... 97 kcl 20 meq/l (0.15%) in nacl 0.9% inj 97 kcl 30 meq/l (0.224%) in dextrose 5% & nacl 0.2% inj ................................... 97 kcl 30 meq/l (0.224%) in dextrose 5% & nacl 0.45% inj ................................. 97 kcl 40 meq/l (0.3%) in dextrose 5% & nacl 0.2% inj ................................... 97 kcl 40 meq/l (0.3%) in dextrose 5% & nacl 0.45% inj ................................. 97 kcl 40 meq/l (0.3%) in nacl 0.9% inj .. 97 KCL/D5W/LACT INJ 20MEQ/L ............. 97 KCL/D5W/NACL INJ 0.3/0.9% ............ 97 kelnor 1/50 tab ................................ 72 kelnor tab 1/35 ................................ 72 ketoconazole cream 2% .................. 106 ketoconazole shampoo 2% .............. 107 ketoconazole tab 200 mg..................... 9 ketorolac tromethamine ophth soln 0.4% ................................................... 100 ketorolac tromethamine ophth soln 0.5% ................................................... 100


KEVEYIS TAB 50MG .......................... 40 KINRIX INJ ...................................... 94 kionex sus 15gm/60 ......................... 70 KISQALI 200 PAK FEMARA ................. 21 KISQALI 400 PAK FEMARA ................. 21 KISQALI 600 PAK FEMARA ................. 21 KISQALI TAB 200DOSE ..................... 21 KISQALI TAB 400DOSE ..................... 21 KISQALI TAB 600DOSE ..................... 21 klor-con 10 tab 10meq er .................. 94 klor-con 8 tab 8meq er ..................... 94 klor-con m10 tab 10meq er ............... 95 klor-con m15 tab 15meq er ............... 95 klor-con m20 tab 20meq er ............... 95 klor-con pak 20meq ......................... 95 klor-con spr cap 8meq ...................... 95 KORLYM TAB 300MG ......................... 79 K-TAB TAB 8MEQ CR......................... 94 kurvelo tab 0.15/30 .......................... 72 KUVAN POW 100MG ......................... 75 KUVAN POW 500MG ......................... 75 KUVAN TAB 100MG .......................... 75 k-vescent tab 25meq ef .................... 94 L labetalol hcl tab 100 mg .................... 37 labetalol hcl tab 200 mg .................... 37 labetalol hcl tab 300 mg .................... 37 lactic acid (ammonium lactate) cream 12% ..............................................109 lactic acid (ammonium lactate) lotion 12% ..............................................109 lactulose solution 10 gm/15ml ........... 84 lamivudine oral soln 10 mg/ml ........... 10 lamivudine tab 100 mg (hbv) ............. 13 lamivudine tab 150 mg ..................... 10 lamivudine tab 300 mg ..................... 10 lamivudine-zidovudine tab 150-300 mg ..................................................... 12 lamotrigine tab 100 mg ..................... 46 lamotrigine tab 150 mg ..................... 46 lamotrigine tab 200 mg ..................... 46 lamotrigine tab 25 mg ...................... 46 lamotrigine tab chewable dispersible 25 mg ................................................. 46 lamotrigine tab chewable dispersible 5 mg ................................................. 46 lansoprazole cap delayed release 15 mg ..................................................... 85

lansoprazole cap delayed release 30 mg ..................................................... 85 LANTUS INJ 100/ML .......................... 67 LANTUS SOLOS INJ 100/ML ............... 67 larin 24 tab fe 1/20 ........................... 72 larin fe tab 1.5/30 ............................ 72 larin fe tab 1/20 ............................... 72 larin tab 1.5/30 ................................ 72 larin tab 1/20 ................................... 72 larissia tab ....................................... 72 latanoprost ophth soln 0.005% ........ 100 LATUDA TAB 120MG ......................... 57 LATUDA TAB 20MG ........................... 57 LATUDA TAB 40MG ........................... 57 LATUDA TAB 60MG ........................... 57 LATUDA TAB 80MG ........................... 57 layolis fe chw ................................... 72 leena tab ......................................... 73 leflunomide tab 10 mg ...................... 91 leflunomide tab 20 mg ...................... 91 LENVIMA CAP 10 MG ......................... 26 LENVIMA CAP 12MG .......................... 26 LENVIMA CAP 14 MG ......................... 27 LENVIMA CAP 18 MG ......................... 27 LENVIMA CAP 20 MG ......................... 27 LENVIMA CAP 24 MG ......................... 27 LENVIMA CAP 4MG ........................... 26 LENVIMA CAP 8 MG .......................... 26 lessina tab ....................................... 73 letrozole tab 2.5 mg .......................... 23 leucovorin calcium tab 10 mg ............. 29 leucovorin calcium tab 15 mg ............. 29 leucovorin calcium tab 25 mg ............. 29 leucovorin calcium tab 5 mg .............. 29 LEUKERAN TAB 2MG ......................... 19 LEUKINE INJ 250MCG ....................... 89 leuprolide acetate inj kit 5 mg/ml ....... 23 levalbuterol hcl soln nebu 0.31 mg/3ml (base equiv) .................................. 102 levalbuterol hcl soln nebu 0.63 mg/3ml (base equiv) .................................. 102 levalbuterol hcl soln nebu 1.25 mg/3ml (base equiv) .................................. 102 levalbuterol hcl soln nebu conc 1.25 mg/0.5ml (base equiv) .................... 102 levalbuterol tartrate inhal aerosol 45 mcg/act (base equiv) ...................... 102 LEVEMIR INJ .................................... 67


LEVEMIR INJ FLEXTOUC .................... 67 levetiracetam oral soln 100 mg/ml ..... 46 levetiracetam tab 1000 mg ................ 46 levetiracetam tab 250 mg ................. 46 levetiracetam tab 500 mg ................. 46 levetiracetam tab 750 mg ................. 46 levetiracetam tab er 24hr 500 mg ...... 46 levetiracetam tab er 24hr 750 mg ...... 46 levobunolol hcl ophth soln 0.5% ........100 levocarnitine inj 200 mg/ml ............... 75 levocarnitine oral soln 1 gm/10ml (10%) ..................................................... 75 levocarnitine tab 330 mg ................... 75 levocetirizine dihydrochloride tab 5 mg ................................................... 102 levofloxacin in d5w iv soln 250 mg/50ml ..................................................... 16 levofloxacin in d5w iv soln 500 mg/100ml ....................................... 16 levofloxacin in d5w iv soln 750 mg/150ml ....................................... 16 levofloxacin iv soln 25 mg/ml............. 16 levofloxacin ophth soln 0.5% ............. 99 levofloxacin oral soln 25 mg/ml .......... 16 levofloxacin tab 250 mg .................... 16 levofloxacin tab 500 mg .................... 16 levofloxacin tab 750 mg .................... 16 levonest tab .................................... 73 levonorgestrel & ethinyl estradiol (91- day) tab 0.15-0.03 mg...................... 73 levonorgestrel & ethinyl estradiol tab 0.1 mg-20 mcg ..................................... 73 levonorgestrel & ethinyl estradiol tab 0.15 mg-30 mcg .............................. 73 levonorgestrel-eth estra tab 0.05- 30/0.075-40/0.125-30mg-mcg .......... 73 levonorgestrel-ethinyl estradiol (continuous) tab 90-20 mcg .............. 73 levonorg-eth est tab 0.1-0.02mg(84) & eth est tab 0.01mg(7) ...................... 73 levonorg-eth est tab 0.15-0.03mg(84) & eth est tab 0.01mg(7) ...................... 73 levora-28 tab 0.15/30 ....................... 73 levorphanol tartrate tab 2 mg .............. 4 levorphanol tartrate tab 3 mg .............. 4 levothyroxine sodium tab 100 mcg ..... 81 levothyroxine sodium tab 112 mcg ..... 81 levothyroxine sodium tab 125 mcg ..... 81

levothyroxine sodium tab 137 mcg ..... 81 levothyroxine sodium tab 150 mcg ..... 81 levothyroxine sodium tab 175 mcg ..... 81 levothyroxine sodium tab 200 mcg ..... 81 levothyroxine sodium tab 25 mcg ....... 81 levothyroxine sodium tab 300 mcg ..... 81 levothyroxine sodium tab 50 mcg ....... 81 levothyroxine sodium tab 75 mcg ....... 81 levothyroxine sodium tab 88 mcg ....... 81 LEXIVA SUS 50MG/ML ....................... 10 lidocaine hcl (cardiac) iv pf soln pref syr 50 mg/5ml(1%) ............................... 34 lidocaine hcl laryngotracheal soln 4% 110 lidocaine hcl local inj 1% ..................... 6 lidocaine hcl local preservative free (pf) inj 1.5% ............................................ 6 lidocaine hcl local preservative free (pf) inj 2% ............................................... 6 lidocaine hcl local preservative free (pf) inj 4% ............................................... 6 lidocaine hcl soln 4% ...................... 108 lidocaine hcl urethral/mucosal gel 2%108 lidocaine hcl viscous soln 2% ........... 110 lidocaine hcl(cardiac) iv pf soln pref syr 100 mg/5ml (2%) ............................ 34 lidocaine iv infusion in d5w inj 4 mg/ml ..................................................... 34 lidocaine iv infusion in d5w inj 8 mg/ml ..................................................... 34 lidocaine oint 5% ............................ 108 lidocaine patch 5% ......................... 108 lidocaine-prilocaine cream 2.5-2.5% . 108 lindane shampoo 1% ...................... 109 linezolid for susp 100 mg/5ml .............. 7 linezolid iv soln 600 mg/300ml (2 mg/ml) ............................................. 7 linezolid tab 600 mg ........................... 7 LINZESS CAP 145MCG ...................... 84 LINZESS CAP 290MCG ...................... 84 LINZESS CAP 72MCG ........................ 84 liothyronine sodium tab 25 mcg .......... 81 liothyronine sodium tab 5 mcg ........... 81 liothyronine sodium tab 50 mcg .......... 81 lisinopril & hydrochlorothiazide tab 10- 12.5 mg .......................................... 30 lisinopril & hydrochlorothiazide tab 20- 12.5 mg .......................................... 30 lisinopril & hydrochlorothiazide tab 20-25


mg ................................................. 30 lisinopril tab 10 mg........................... 31 lisinopril tab 2.5 mg ......................... 31 lisinopril tab 20 mg........................... 31 lisinopril tab 30 mg........................... 31 lisinopril tab 40 mg........................... 31 lisinopril tab 5 mg ............................ 31 lithium carbonate cap 150 mg............ 63 lithium carbonate cap 300 mg............ 63 lithium carbonate cap 600 mg............ 63 lithium carbonate tab 300 mg ............ 63 lithium carbonate tab er 300 mg ........ 63 lithium carbonate tab er 450 mg ........ 63 LITHIUM SOL 8MEQ/5ML ................... 63 LITHOSTAT TAB 250MG .................... 86 LOKELMA PAK 10GM ......................... 70 LOKELMA PAK 5GM ........................... 70 LONSURF TAB 15-6.14 ...................... 29 LONSURF TAB 20-8.19 ...................... 29 loperamide hcl cap 2 mg ................... 84 lopinavir-ritonavir soln 400-100 mg/5ml (80-20 mg/ml)................................. 12 lopreeza tab 1-0.5mg ....................... 77 lorazepam conc 2 mg/ml ................... 44 lorazepam inj 2 mg/ml ...................... 44 lorazepam inj 4 mg/ml ...................... 44 lorazepam tab 0.5 mg ....................... 44 lorazepam tab 1 mg ......................... 44 lorazepam tab 2 mg ......................... 44 LORBRENA TAB 100MG ..................... 27 LORBRENA TAB 25MG ....................... 27 lorcet hd tab 10-325mg ...................... 4 lorcet plus tab 7.5-325 ....................... 4 lorcet tab 5-325mg ............................ 4 loryna tab 3-0.02mg ......................... 73 losartan potassium & hydrochlorothiazide tab 100-12.5 mg .............................. 32 losartan potassium & hydrochlorothiazide tab 100-25 mg................................. 33 losartan potassium & hydrochlorothiazide tab 50-12.5 mg................................ 32 losartan potassium tab 100 mg .......... 33 losartan potassium tab 25 mg ............ 33 losartan potassium tab 50 mg ............ 33 LOTEMAX GEL 0.5% ........................100 LOTEMAX OIN 0.5% ........................100 loteprednol etabonate ophth susp 0.5% ................................................... 100

lovastatin tab 10 mg ......................... 35 lovastatin tab 20 mg ......................... 35 lovastatin tab 40 mg ......................... 35 low-ogestrel tab ............................... 73 loxapine succinate cap 10 mg ............ 57 loxapine succinate cap 25 mg ............ 57 loxapine succinate cap 5 mg .............. 57 loxapine succinate cap 50 mg ............ 57 ludent chw 0.25mg f ......................... 95 LUMIGAN SOL 0.01% ...................... 101 LUPANETA KIT 11.25-5 ..................... 75 LUPANETA KIT 3.75-5 ....................... 75 LUPRON DEPOT INJ 11.25MG ............. 23 LUPRON DEPOT INJ 22.5MG ............... 23 LUPRON DEPOT INJ 3.75MG ............... 23 LUPRON DEPOT INJ 30MG ................. 23 LUPRON DEPOT INJ 45MG ................. 23 LUPRON DEPOT INJ 7.5MG ................ 23 lutera tab ........................................ 73 LYNPARZA TAB 100MG ...................... 21 LYNPARZA TAB 150MG ...................... 21 LYRICA CAP 100MG .......................... 47 LYRICA CAP 150MG .......................... 47 LYRICA CAP 200MG .......................... 47 LYRICA CAP 225MG .......................... 47 LYRICA CAP 25MG ............................ 46 LYRICA CAP 300MG .......................... 47 LYRICA CAP 50MG ............................ 46 LYRICA CAP 75MG ............................ 47 LYRICA SOL 20MG/ML ....................... 47 LYSODREN TAB 500MG ..................... 23 lyza tab 0.35mg ............................... 73 M MAGNESIUM SU INJ 20/500ML ........... 95 MAGNESIUM SU INJ 2GM/50ML .......... 95 MAGNESIUM SU INJ 40G/1000 ........... 95 MAGNESIUM SU INJ 4G/100ML .......... 95 MAGNESIUM SU INJ 80MG/ML ............ 95 magnesium sulfate inj 50% ............... 95 maprotiline hcl tab 25 mg .................. 51 maprotiline hcl tab 50 mg .................. 51 maprotiline hcl tab 75 mg .................. 51 marlissa tab 0.15/30 ......................... 73 MARPLAN TAB 10MG ......................... 51 MATULANE CAP 50MG ....................... 29 matzim la tab 180mg/24 ................... 39 matzim la tab 240mg/24 ................... 39 matzim la tab 300mg/24 ................... 39


matzim la tab 360mg/24 ................... 39 matzim la tab 420mg/24 ................... 39 MAVYRET TAB 100-40MG .................. 13 MAXIDEX SUS 0.1% OP ...................100 meclizine hcl tab 12.5 mg.................. 82 meclizine hcl tab 25 mg .................... 82 meclofenamate sodium cap 100 mg ...... 2 meclofenamate sodium cap 50 mg ....... 2 medroxyprogesterone acetate im susp 150 mg/ml ...................................... 73 medroxyprogesterone acetate im susp prefilled syr 150 mg/ml ..................... 73 medroxyprogesterone acetate tab 10 mg ..................................................... 81 medroxyprogesterone acetate tab 2.5 mg ................................................. 81 medroxyprogesterone acetate tab 5 mg ..................................................... 81 mefloquine hcl tab 250 mg .................. 9 megestrol acetate susp 40 mg/ml ...... 23 megestrol acetate tab 20 mg ............. 23 megestrol acetate tab 40 mg ............. 23 MEKINIST TAB 0.5MG ....................... 27 MEKINIST TAB 2MG .......................... 27 MEKTOVI TAB 15MG ......................... 27 meloxicam tab 15 mg ......................... 2 meloxicam tab 7.5 mg ........................ 2 memantine hcl oral solution 2 mg/ml .. 49 memantine hcl tab 10 mg ................. 49 memantine hcl tab 5 mg ................... 49 memantine hcl tab 5 mg (28) & 10 mg (21) titration pak ............................. 49 MENACTRA INJ ................................ 94 MENOSTAR DIS 14MCG..................... 77 MENVEO INJ .................................... 94 mercaptopurine tab 50 mg ................ 20 meropenem iv for soln 1 gm ................ 7 meropenem iv for soln 500 mg ............ 7 mesalamine cap dr 400 mg ............... 84 mesalamine suppos 1000 mg............. 84 mesalamine tab delayed release 800 mg ..................................................... 84 MESNEX TAB 400MG......................... 29 metadate tab 20mg er ...................... 61 metaproterenol sulfate syrup 10 mg/5ml ................................................... 102 metaproterenol sulfate tab 10 mg .....102 metaproterenol sulfate tab 20 mg .....103

metformin hcl tab 1000 mg................ 69 metformin hcl tab 500 mg ................. 69 metformin hcl tab 850 mg ................. 69 metformin hcl tab er 24hr 500 mg ...... 69 metformin hcl tab er 24hr 750 mg ...... 69 methadone hcl conc 10 mg/ml ............. 4 methadone hcl soln 5 mg/5ml .............. 4 methadone hcl tab 10 mg .................... 4 methadone hcl tab 5 mg ...................... 4 methadone hcl tab for oral susp 40 mg . 4 methamphetamine hcl tab 5 mg ......... 61 methenamine hippurate tab 1 gm ......... 7 methenamine mandelate tab 0.5 gm ..... 8 methenamine mandelate tab 1 gm........ 8 methimazole tab 10 mg ..................... 81 methimazole tab 5 mg ...................... 81 methocarbamol tab 500 mg ............... 64 methocarbamol tab 750 mg ............... 64 methotrexate sodium inj 25 mg/ml ..... 20 methotrexate sodium inj 50 mg/2ml (25 mg/ml) ........................................... 20 methotrexate sodium inj pf 50 mg/2ml (25 mg/ml) ...................................... 20 methotrexate sodium tab 2.5 mg (base equiv) ............................................. 91 methoxsalen rapid cap 10 mg .......... 107 methyclothiazide tab 5 mg ................. 40 methylergonovine maleate inj 0.2 mg/ml ..................................................... 79 methylphenid tab 72mg er ................. 61 methylphenidate hcl soln 10 mg/5ml ... 61 methylphenidate hcl soln 5 mg/5ml .... 61 methylphenidate hcl tab 10 mg .......... 61 methylphenidate hcl tab 20 mg .......... 61 methylphenidate hcl tab 5 mg ............ 61 methylphenidate hcl tab er 10 mg ...... 61 methylphenidate hcl tab er 20 mg ...... 61 methylphenidate hcl tab er 24hr 18 mg ..................................................... 61 methylphenidate hcl tab er 24hr 27 mg ..................................................... 61 methylphenidate hcl tab er 24hr 36 mg ..................................................... 61 methylphenidate hcl tab er 24hr 54 mg ..................................................... 61 methylphenidate hcl tab er osmotic release (osm) 18 mg ......................... 61 methylphenidate hcl tab er osmotic


release (osm) 27 mg ........................ 61 methylphenidate hcl tab er osmotic release (osm) 36 mg ........................ 61 methylphenidate hcl tab er osmotic release (osm) 54 mg ........................ 61 methylprednisolone tab 16 mg ........... 78 methylprednisolone tab 32 mg ........... 78 methylprednisolone tab 4 mg ............. 78 methylprednisolone tab 8 mg ............. 78 methylprednisolone tab therapy pack 4 mg (21) .......................................... 78 methyltestosterone cap 10 mg ........... 75 metoclopramide hcl soln 5 mg/5ml (10 mg/10ml) (base equiv) ..................... 82 metoclopramide hcl tab 10 mg (base equivalent) ...................................... 82 metoclopramide hcl tab 5 mg (base equivalent) ...................................... 82 metolazone tab 10 mg ...................... 40 metolazone tab 2.5 mg ..................... 40 metolazone tab 5 mg ........................ 40 metoprolol & hydrochlorothiazide tab 100-25 mg ...................................... 37 metoprolol & hydrochlorothiazide tab 100-50 mg ...................................... 37 metoprolol & hydrochlorothiazide tab 50- 25 mg............................................. 37 metoprolol succinate tab er 24hr 100 mg (tartrate equiv) ................................ 37 metoprolol succinate tab er 24hr 200 mg (tartrate equiv) ................................ 37 metoprolol succinate tab er 24hr 25 mg (tartrate equiv) ................................ 37 metoprolol succinate tab er 24hr 50 mg (tartrate equiv) ................................ 37 metoprolol tartrate tab 100 mg .......... 37 metoprolol tartrate tab 25 mg ............ 37 metoprolol tartrate tab 50 mg ............ 37 metronidazole cap 375 mg .................. 8 metronidazole cream 0.75% .............109 metronidazole gel 0.75% .................109 metronidazole in nacl 0.79% iv soln 500 mg/100ml ......................................... 8 metronidazole lotion 0.75% ..............109 metronidazole tab 250 mg ................... 8 metronidazole tab 500 mg ................... 8 metronidazole vaginal gel 0.75% ....... 87 mexiletine hcl cap 150 mg ................. 34

mexiletine hcl cap 200 mg ................. 34 mexiletine hcl cap 250 mg ................. 34 MG SO4/D5W INJ 10MG/ML ............... 95 miconazole 3 sup 200mg ................... 87 microgestin tab 1.5/30 ...................... 73 microgestin tab 1/20 ......................... 73 microgestin tab fe 1/20 ..................... 73 microgestin tab fe1.5/30 ................... 73 midodrine hcl tab 10 mg .................... 41 midodrine hcl tab 2.5 mg ................... 41 midodrine hcl tab 5 mg ..................... 41 migergot sup 2/100 .......................... 62 miglustat cap 100 mg ....................... 75 mili tab 0.25/35 ............................... 73 mimvey lo tab 0.5-0.1....................... 77 mimvey tab 1-0.5mg ........................ 77 minocycline hcl cap 100 mg ............... 19 minocycline hcl cap 50 mg ................. 19 minocycline hcl cap 75 mg ................. 19 minoxidil tab 10 mg .......................... 41 minoxidil tab 2.5 mg ......................... 41 mirtazapine orally disintegrating tab 15 mg ................................................. 51 mirtazapine orally disintegrating tab 30 mg ................................................. 51 mirtazapine orally disintegrating tab 45 mg ................................................. 51 mirtazapine tab 15 mg ...................... 51 mirtazapine tab 30 mg ...................... 51 mirtazapine tab 45 mg ...................... 51 mirtazapine tab 7.5 mg ..................... 51 misoprostol tab 100 mcg ................... 84 misoprostol tab 200 mcg ................... 85 M-M-R II INJ .................................... 94 modafinil tab 100 mg ........................ 65 modafinil tab 200 mg ........................ 65 moexipril hcl tab 15 mg ..................... 31 moexipril hcl tab 7.5 mg .................... 31 molindone hcl tab 10 mg ................... 57 molindone hcl tab 25 mg ................... 57 molindone hcl tab 5 mg ..................... 57 mometasone furoate cream 0.1% ..... 108 mometasone furoate oint 0.1% ........ 108 mometasone furoate solution 0.1% (lotion).......................................... 108 mono-linyah tab 0.25-35 ................... 73 mononessa tab ................................. 73 montelukast sodium chew tab 4 mg


(base equiv) ...................................103 montelukast sodium chew tab 5 mg (base equiv) ...................................103 montelukast sodium oral granules packet 4 mg (base equiv) ...........................103 montelukast sodium tab 10 mg (base equiv) ............................................103 MONUROL PAK GRANULES .................. 8 morgidox cap 1x50mg ...................... 19 MORPHINE SUL INJ 150/30ML ............. 4 MORPHINE SUL INJ 2MG/ML ................ 4 MORPHINE SUL INJ 4MG/ML ................ 4 MORPHINE SUL INJ 5MG/ML ................ 4 morphine sulfate inj 10 mg/ml ............. 4 morphine sulfate iv soln 1 mg/ml ......... 4 morphine sulfate iv soln pf 15 mg/ml .... 4 morphine sulfate oral soln 10 mg/5ml ... 5 morphine sulfate oral soln 100 mg/5ml (20 mg/ml) ....................................... 5 morphine sulfate oral soln 20 mg/5ml ... 5 morphine sulfate tab 15 mg ................. 5 morphine sulfate tab 30 mg ................. 5 morphine sulfate tab er 100 mg ........... 5 morphine sulfate tab er 15 mg ............. 5 morphine sulfate tab er 200 mg ........... 5 morphine sulfate tab er 30 mg ............. 5 morphine sulfate tab er 60 mg ............. 5 MOVANTIK TAB 12.5MG .................... 85 MOVANTIK TAB 25MG ....................... 85 MOXEZA SOL 0.5% .......................... 99 moxifloxacin hcl 400 mg/250ml in sodium chloride 0.8% inj .................. 16 moxifloxacin hcl ophth soln 0.5% (base equiv) ............................................. 99 moxifloxacin hcl tab 400 mg (base equiv) ..................................................... 16 MULTAQ TAB 400MG......................... 34 multivit/fl chw 0.25mg ...................... 95 multivit/fl chw 0.5mg ........................ 95 multivit/fl chw 1mg .......................... 95 mupirocin oint 2% ...........................106 MYALEPT INJ 11.3MG ........................ 79 MYCAMINE INJ 100MG ........................ 9 MYCAMINE INJ 50MG .......................... 9 mycophenolate mofetil cap 250 mg .... 93 mycophenolate mofetil for oral susp 200 mg/ml ............................................ 93 mycophenolate mofetil tab 500 mg ..... 93

mycophenolate sodium tab dr 180 mg (mycophenolic acid equiv) ................. 93 mycophenolate sodium tab dr 360 mg (mycophenolic acid equiv) ................. 93 myorisan cap 10mg ........................ 106 myorisan cap 20mg ........................ 106 myorisan cap 30mg ........................ 106 myorisan cap 40mg ........................ 106 MYRBETRIQ TAB 25MG ...................... 86 MYRBETRIQ TAB 50MG ...................... 86 MYTESI TAB 125MG .......................... 85 myzilra tab ...................................... 73 N nabumetone tab 500 mg ..................... 2 nabumetone tab 750 mg ..................... 2 nadolol & bendroflumethiazide tab 40-5 mg ................................................. 37 nadolol tab 20 mg ............................ 37 nadolol tab 40 mg ............................ 37 nadolol tab 80 mg ............................ 37 nafcillin sodium for inj 2 gm ............... 18 nafcillin sodium for iv soln 10 gm ....... 18 nafcillin sodium for iv soln 2 gm ......... 18 naloxone hcl inj 0.4 mg/ml ................ 66 naloxone hcl inj 4 mg/10ml ............... 66 naloxone hcl soln cartridge 0.4 mg/ml 66 naloxone hcl soln prefilled syringe 2 mg/2ml ........................................... 66 naltrexone hcl tab 50 mg ................... 66 naproxen dr tab 375mg ....................... 2 naproxen dr tab 500mg ....................... 2 naproxen sodium tab 275 mg............... 2 naproxen sodium tab 550 mg............... 2 naproxen susp 125 mg/5ml ................. 2 naproxen tab 250 mg .......................... 2 naproxen tab 375 mg .......................... 2 naproxen tab 500 mg .......................... 2 naratriptan hcl tab 1 mg (base equiv) . 62 naratriptan hcl tab 2.5 mg (base equiv) ..................................................... 62 NATACYN SUS 5% OP ....................... 99 nateglinide tab 120 mg ..................... 69 nateglinide tab 60 mg ....................... 69 NATPARA INJ 100MCG....................... 79 NATPARA INJ 25MCG ........................ 79 NATPARA INJ 50MCG ........................ 79 NATPARA INJ 75MCG ........................ 79 NEBUPENT INH 300MG ........................ 8


necon tab 0.5/35 ............................. 73 NEEDLES, INSULIN DISP., SAFETY ..... 67 nefazodone hcl tab 100 mg ............... 52 nefazodone hcl tab 150 mg ............... 52 nefazodone hcl tab 200 mg ............... 52 nefazodone hcl tab 250 mg ............... 52 nefazodone hcl tab 50 mg ................. 51 neomycin sulfate tab 500 mg ............... 6 neomycin-bacitrac zn-polymyx 5(3.5)mg-400unt-10000unt op oin ..... 99 neomycin-polymy-gramicid op sol 1.75- 10000-0.025mg-unt-mg/ml ............... 99 neomycin-polymyxin-dexamethasone ophth oint 0.1% ............................... 98 neomycin-polymyxin-dexamethasone ophth susp 0.1% .............................. 98 neomycin-polymyxin-hc ophth susp .... 99 neomycin-polymyxin-hc otic soln 1% 110 neomycin-polymyxin-hc otic susp 3.5 mg/ml-10000 unit/ml-1% ................110 neostigmine methylsulfate iv soln 10 mg/10 ml (1 mg/ml)......................... 63 neostigmine methylsulfate iv soln 5 mg/10 ml (0.5 mg/ml) ...................... 63 NEPHRAMINE INJ 5.4% ..................... 96 NERLYNX TAB 40MG ......................... 27 NEUPOGEN INJ 300/0.5 .................... 89 NEUPOGEN INJ 300MCG .................... 89 NEUPOGEN INJ 480/0.8 .................... 89 NEUPOGEN INJ 480MCG .................... 89 NEUPRO DIS 1MG/24HR .................... 54 NEUPRO DIS 2MG/24HR .................... 54 NEUPRO DIS 3MG/24HR .................... 54 NEUPRO DIS 4MG/24HR .................... 54 NEUPRO DIS 6MG/24HR .................... 54 NEUPRO DIS 8MG/24HR .................... 54 nevirapine susp 50 mg/5ml ............... 10 nevirapine tab 200 mg ...................... 10 nevirapine tab er 24hr 100 mg .......... 10 nevirapine tab er 24hr 400 mg .......... 10 NEXAVAR TAB 200MG ....................... 27 niacin tab er 1000 mg (antihyperlipidemic) ......................... 36 niacin tab er 500 mg (antihyperlipidemic) ..................................................... 36 niacin tab er 750 mg (antihyperlipidemic) ..................................................... 36 nicardipine hcl cap 20 mg.................. 39

nicardipine hcl cap 30 mg .................. 39 NICOTROL INH ................................. 66 NICOTROL NS SPR 10MG/ML ............. 66 nifedipine tab er 24hr 30 mg .............. 39 nifedipine tab er 24hr 60 mg .............. 39 nifedipine tab er 24hr 90 mg .............. 39 nifedipine tab er 24hr osmotic release 30 mg ................................................. 39 nifedipine tab er 24hr osmotic release 60 mg ................................................. 39 nifedipine tab er 24hr osmotic release 90 mg ................................................. 39 nikki tab 3-0.02mg ........................... 73 nilutamide tab 150 mg ...................... 23 NINLARO CAP 2.3MG ........................ 21 NINLARO CAP 3MG ........................... 21 NINLARO CAP 4MG ........................... 21 NITRO-BID OIN 2% .......................... 42 NITRO-DUR DIS 0.3MG/HR ................ 42 NITRO-DUR DIS 0.8MG/HR ................ 42 nitrofurantoin macrocrystalline cap 100 mg ................................................... 8 nitrofurantoin macrocrystalline cap 50 mg ........................................................ 8 nitrofurantoin monohydrate macrocrystalline cap 100 mg ................ 8 nitroglycerin sl tab 0.3 mg ................. 42 nitroglycerin sl tab 0.4 mg ................. 42 nitroglycerin sl tab 0.6 mg ................. 42 nitroglycerin td patch 24hr 0.1 mg/hr . 42 nitroglycerin td patch 24hr 0.2 mg/hr . 42 nitroglycerin td patch 24hr 0.4 mg/hr . 42 nitroglycerin td patch 24hr 0.6 mg/hr . 42 nitroglycerin tl soln 0.4 mg/spray (400 mcg/spray) ...................................... 42 NIVESTYM INJ 300MCG ..................... 89 NIVESTYM INJ 480MCG ..................... 89 nizatidine cap 150 mg ....................... 83 nizatidine cap 300 mg ....................... 83 nizatidine oral soln 15 mg/ml ............. 83 nora-be tab 0.35mg .......................... 73 norethindrone & ethinyl estradiol-fe chew tab 0.4 mg-35 mcg ........................... 73 norethindrone & ethinyl estradiol-fe chew tab 0.8 mg-25 mcg ........................... 73 norethindrone ace & ethinyl estradiol tab 1 mg-20 mcg ................................... 73 norethindrone ace & ethinyl estradiol-fe


tab 1 mg-20 mcg ............................. 74 norethindrone ace-ethinyl estradiol-fe tab 1 mg-20 mcg (24) ...................... 74 norethindrone acetate tab 5 mg ......... 81 norethindrone acetate-ethinyl estradiol tab 1 mg-5 mcg ............................... 77 norethindrone tab 0.35 mg ................ 74 norgestimate & ethinyl estradiol tab 0.25 mg-35 mcg ..................................... 74 norgestimate-eth estrad tab 0.18- 25/0.215-25/0.25-25 mg-mcg ........... 74 norgestimate-eth estrad tab 0.18- 35/0.215-35/0.25-35 mg-mcg ........... 74 norlyroc tab 0.35mg ......................... 74 NORMOSOL -M INJ /D5W .................. 98 NORMOSOL -R INJ /D5W ................... 98 NORMOSOL-R INJ PH 7.4 .................. 98 NORTHERA CAP 100MG ..................... 41 NORTHERA CAP 200MG ..................... 41 NORTHERA CAP 300MG ..................... 41 nortrel tab 0.5/35 ............................ 74 nortrel tab 1/35 ............................... 74 nortrel tab 7/7/7 .............................. 74 nortriptyline hcl cap 10 mg ................ 52 nortriptyline hcl cap 25 mg ................ 52 nortriptyline hcl cap 50 mg ................ 52 nortriptyline hcl cap 75 mg ................ 52 nortriptyline hcl soln 10 mg/5ml ........ 52 NORVIR POW 100MG ........................ 11 NORVIR SOL 80MG/ML ...................... 11 NOVOLIN INJ 70/30 .......................... 67 NOVOLIN N INJ U-100 ...................... 67 NOVOLIN R INJ U-100 ...................... 67 NOVOLOG INJ 100/ML ...................... 67 NOVOLOG INJ FLEXPEN .................... 67 NOVOLOG INJ PENFILL ..................... 67 NOVOLOG MIX INJ 70/30 .................. 67 NOVOLOG MIX INJ FLEXPEN .............. 67 NOXAFIL SUS 40MG/ML ...................... 9 NOXAFIL TAB 100MG .......................... 9 NUCALA INJ 100MG .........................104 NUCALA INJ 100MG/ML ....................104 NUEDEXTA CAP 20-10MG .................. 63 NUPLAZID CAP 34MG ........................ 57 NUPLAZID TAB 10MG ........................ 57 NUTROPIN AQ INJ 10MG/2ML ............ 79 NUTROPIN AQ INJ 20MG/2ML ............ 79 NUTROPIN AQ INJ NUSPIN 5 ............. 79

NUVARING MIS ................................ 74 NUZYRA INJ 100MG .......................... 19 NUZYRA TAB 150MG ......................... 19 nyamyc pow 100000 ....................... 106 nystatin cream 100000 unit/gm ....... 106 nystatin oint 100000 unit/gm ........... 106 nystatin susp 100000 unit/ml........... 110 nystatin tab 500000 unit ..................... 9 nystatin topical powder 100000 unit/gm ................................................... 106 nystatin-triamcinolone cream 100000- 0.1 unit/gm-% ............................... 106 nystatin-triamcinolone oint 100000-0.1 unit/gm-% .................................... 107 nystop pow 100000 ........................ 107 O OCALIVA TAB 10MG .......................... 85 OCALIVA TAB 5MG ............................ 85 ocella tab 3-0.03mg .......................... 74 octreotide acetate inj 100 mcg/ml (0.1 mg/ml) ........................................... 79 octreotide acetate inj 1000 mcg/ml (1 mg/ml) ........................................... 79 octreotide acetate inj 200 mcg/ml (0.2 mg/ml) ........................................... 79 octreotide acetate inj 50 mcg/ml (0.05 mg/ml) ........................................... 79 octreotide acetate inj 500 mcg/ml (0.5 mg/ml) ........................................... 79 ODEFSEY TAB .................................. 12 ODOMZO CAP 200MG ........................ 21 OFEV CAP 100MG ........................... 104 OFEV CAP 150MG ........................... 104 ofloxacin ophth soln 0.3% ................. 99 ofloxacin otic soln 0.3% .................. 110 ofloxacin tab 300 mg ........................ 16 ofloxacin tab 400 mg ........................ 16 ogestrel tab ..................................... 74 olanzapine for im inj 10 mg ............... 57 olanzapine orally disintegrating tab 10 mg ................................................. 57 olanzapine orally disintegrating tab 15 mg ................................................. 57 olanzapine orally disintegrating tab 20 mg ................................................. 57 olanzapine orally disintegrating tab 5 mg ..................................................... 57 olanzapine tab 10 mg........................ 57


olanzapine tab 15 mg ....................... 57 olanzapine tab 2.5 mg ...................... 57 olanzapine tab 20 mg ....................... 57 olanzapine tab 5 mg ......................... 57 olanzapine tab 7.5 mg ...................... 57 omega-3-acid ethyl esters cap 1 gm 36 omeprazole cap delayed release 10 mg85 omeprazole cap delayed release 20 mg86 omeprazole cap delayed release 40 mg86 ondansetron hcl oral soln 4 mg/5ml 82 ondansetron hcl tab 4 mg.................. 82 ondansetron hcl tab 8 mg.................. 82 ondansetron orally disintegrating tab 4 mg ................................................. 82 ondansetron orally disintegrating tab 8 mg ................................................. 82 OPSUMIT TAB 10MG ......................... 43 ORALAIR SUB 300 IR ........................ 92 ORFADIN CAP 10MG ......................... 75 ORFADIN CAP 20MG ......................... 75 ORFADIN CAP 2MG ........................... 75 ORFADIN CAP 5MG ........................... 75 ORFADIN SUS 4MG/ML ..................... 76 ORKAMBI GRA 100-125 ...................104 ORKAMBI GRA 150-188 ...................104 ORKAMBI TAB 100-125 ....................104 ORKAMBI TAB 200-125 ....................104 orphenadrine citrate tab er 12hr 100 mg ..................................................... 65 orsythia tab ..................................... 74 oseltamivir phosphate cap 30 mg (base equiv) ............................................. 13 oseltamivir phosphate cap 45 mg (base equiv) ............................................. 13 oseltamivir phosphate cap 75 mg (base equiv) ............................................. 13 oseltamivir phosphate for susp 6 mg/ml (base equiv) .................................... 13 OTREXUP INJ 10MG .......................... 91 OTREXUP INJ 12.5/0.4 ...................... 91 OTREXUP INJ 15MG .......................... 91 OTREXUP INJ 17.5/0.4 ...................... 91 OTREXUP INJ 20MG .......................... 91 OTREXUP INJ 22.5/0.4 ...................... 91 OTREXUP INJ 25MG .......................... 91 oxacillin sodium for inj 1 gm (base equivalent) ...................................... 18 oxacillin sodium for inj 10 gm (base

equivalent) ...................................... 18 oxacillin sodium for inj 2 gm (base equivalent) ...................................... 18 oxaliplatin for iv inj 50 mg ................. 29 oxaliplatin iv soln 50 mg/10ml ........... 29 oxazepam cap 10 mg ........................ 44 oxazepam cap 15 mg ........................ 44 oxazepam cap 30 mg ........................ 44 oxcarbazepine susp 300 mg/5ml (60 mg/ml) ........................................... 47 oxcarbazepine tab 150 mg ................. 47 oxcarbazepine tab 300 mg ................. 47 oxcarbazepine tab 600 mg ................. 47 oxybutynin chloride syrup 5 mg/5ml 86 oxybutynin chloride tab 5 mg ............. 86 oxybutynin chloride tab er 24hr 10 mg 86 oxybutynin chloride tab er 24hr 15 mg 86 oxybutynin chloride tab er 24hr 5 mg . 86 oxycodone hcl cap 5 mg ...................... 5 oxycodone hcl conc 100 mg/5ml (20 mg/ml) ............................................. 5 oxycodone hcl soln 5 mg/5ml ............... 5 oxycodone hcl tab 10 mg ..................... 5 oxycodone hcl tab 15 mg ..................... 5 oxycodone hcl tab 20 mg ..................... 5 oxycodone hcl tab 30 mg ..................... 5 oxycodone hcl tab 5 mg ...................... 5 oxycodone w/ acetaminophen tab 10-325 mg ................................................... 5 oxycodone w/ acetaminophen tab 2.5- 325 mg ............................................. 5 oxycodone w/ acetaminophen tab 5-325 mg ................................................... 5 oxycodone w/ acetaminophen tab 7.5- 325 mg ............................................. 5 oxymorphone hcl tab 10 mg ................ 6 oxymorphone hcl tab 5 mg .................. 6 oxytocin inj 10 unit/ml ...................... 79 OZEMPIC INJ 2/1.5ML ....................... 67 P pacerone tab 100mg ......................... 34 pacerone tab 200mg ......................... 34 pacerone tab 400mg ......................... 34 paliperidone tab er 24hr 1.5 mg ......... 58 paliperidone tab er 24hr 3 mg ............ 58 paliperidone tab er 24hr 6 mg ............ 58 paliperidone tab er 24hr 9 mg ............ 58 pamidronate disodium for inj 30 mg .... 70


pamidronate disodium for inj 90 mg ... 70 PANRETIN GEL 0.1% .......................109 pantoprazole sodium ec tab 20 mg (base equiv) ............................................. 86 pantoprazole sodium ec tab 40 mg (base equiv) ............................................. 86 paricalcitol cap 1 mcg ....................... 98 paricalcitol cap 2 mcg ....................... 98 paricalcitol cap 4 mcg ....................... 98 paromomycin sulfate cap 250 mg ......... 6 paroxetine hcl tab 10 mg .................. 52 paroxetine hcl tab 20 mg .................. 52 paroxetine hcl tab 30 mg .................. 52 paroxetine hcl tab 40 mg .................. 52 PASER GRA 4GM .............................. 12 PAXIL SUS 10MG/5ML ....................... 52 PEDIARIX INJ 0.5ML ......................... 94 pediatric multiple vitamins w/ fl-fe drops 0.25-10 mg/ml ................................ 95 pediatric multiple vitamins w/ fluoride soln 0.25 mg/ml .............................. 95 pediatric multiple vitamins w/ fluoride soln 0.5 mg/ml ................................ 95 PEDVAX HIB INJ ............................... 94 peg 3350-kcl-na bicarb-nacl-na sulfate for soln 236 gm ............................... 84 peg 3350-kcl-na bicarb-nacl-na sulfate for soln 240 gm ............................... 84 peg 3350-kcl-sod bicarb-nacl for soln 420 gm ........................................... 84 PEGANONE TAB 250MG ..................... 47 PEGASYS INJ ................................... 13 PEGASYS INJ 180MCG/M ................... 13 PEGASYS INJ PROCLICK .................... 13 PEN G PROC INJ 600000 ................... 18 PENICILL GK/ INJ DEX 2MU ............... 18 PENICILL GK/ INJ DEX 3MU ............... 18 penicillin g potassium for inj 20000000 unit ................................................ 18 penicillin g sodium for inj 5000000 unit ..................................................... 18 penicillin v potassium for soln 125 mg/5ml .......................................... 18 penicillin v potassium for soln 250 mg/5ml .......................................... 18 penicillin v potassium tab 250 mg ...... 18 penicillin v potassium tab 500 mg ...... 18 PENTAM 300 INJ 300MG ..................... 8

pentoxifylline tab er 400 mg .............. 90 PERIKABIVEN EMU ........................... 96 perindopril erbumine tab 2 mg ........... 31 perindopril erbumine tab 4 mg ........... 31 perindopril erbumine tab 8 mg ........... 31 periomed con 0.63%....................... 110 permethrin cream 5% ..................... 109 perphenazine tab 16 mg .................... 58 perphenazine tab 2 mg ..................... 58 perphenazine tab 4 mg ..................... 58 perphenazine tab 8 mg ..................... 58 perphenazine-amitriptyline tab 2-10 mg ..................................................... 66 perphenazine-amitriptyline tab 2-25 mg ..................................................... 66 perphenazine-amitriptyline tab 4-10 mg ..................................................... 66 perphenazine-amitriptyline tab 4-25 mg ..................................................... 66 perphenazine-amitriptyline tab 4-50 mg ..................................................... 66 pfizerpen inj 20mu ........................... 18 phenadoz sup 12.5mg ....................... 82 phenelzine sulfate tab 15 mg ............. 52 PHENOBARB INJ 65MG/ML ................. 47 phenobarbital elixir 20 mg/5ml ........... 47 phenobarbital sodium inj 130 mg/ml ... 47 phenobarbital tab 100 mg.................. 47 phenobarbital tab 15 mg ................... 47 phenobarbital tab 16.2 mg ................ 47 phenobarbital tab 30 mg ................... 47 phenobarbital tab 32.4 mg ................ 47 phenobarbital tab 60 mg ................... 47 phenobarbital tab 64.8 mg ................ 47 phenobarbital tab 97.2 mg ................ 47 phenoxybenzamine hcl cap 10 mg ...... 41 phenytoin chew tab 50 mg................. 47 phenytoin sodium extended cap 100 mg ..................................................... 47 phenytoin sodium extended cap 200 mg ..................................................... 47 phenytoin sodium extended cap 300 mg ..................................................... 47 phenytoin susp 125 mg/5ml .............. 47 philith tab 0.4-35 ............................. 74 PHOSPHOLINE SOL 0.125%OP ......... 101 PICATO GEL 0.015% ....................... 109 PICATO GEL 0.05%......................... 109


PIFELTRO TAB 100MG ....................... 11 pilocarpine hcl ophth soln 1% ...........101 pilocarpine hcl ophth soln 2% ...........101 pilocarpine hcl ophth soln 4% ...........101 pilocarpine hcl tab 5 mg ...................110 pilocarpine hcl tab 7.5 mg ................110 pimecrolimus cream 1% ...................109 pimozide tab 1 mg ........................... 58 pimozide tab 2 mg ........................... 58 pimtrea tab ..................................... 74 pindolol tab 10 mg ........................... 38 pindolol tab 5 mg ............................. 37 pioglitazone hcl tab 15 mg (base equiv) ..................................................... 69 pioglitazone hcl tab 30 mg (base equiv) ..................................................... 69 pioglitazone hcl tab 45 mg (base equiv) ..................................................... 69 pioglitazone hcl-metformin hcl tab 15- 500 mg ........................................... 69 pioglitazone hcl-metformin hcl tab 15- 850 mg ........................................... 69 piperacillin sod-tazobactam na for inj 3.375 gm (3-0.375 gm) .................... 18 piperacillin sod-tazobactam sod for inj 2.25 gm (2-0.25 gm)........................ 18 piperacillin sod-tazobactam sod for inj 4.5 gm (4-0.5 gm) ........................... 18 piperacillin sod-tazobactam sod for inj 40.5 gm (36-4.5 gm) ........................ 18 PIQRAY 200MG TAB DOSE ................. 27 PIQRAY 250MG TAB DOSE ................. 27 PIQRAY 300MG TAB DOSE ................. 27 pirmella tab 1/35 ............................. 74 pirmella tab 7/7/7 ............................ 74 piroxicam cap 10 mg .......................... 2 piroxicam cap 20 mg .......................... 2 PLASMA-LYTE INJ -148 ..................... 98 PLASMA-LYTE INJ -A ......................... 98 plenamine inj 15% ........................... 96 podofilox soln 0.5% .........................109 polymyxin b sulfate for inj 500000 unit . 8 polymyxin b-trimethoprim ophth soln 10000 unit/ml-0.1% ......................... 99 POMALYST CAP 1MG ......................... 23 POMALYST CAP 2MG ......................... 23 POMALYST CAP 3MG ......................... 23 POMALYST CAP 4MG ......................... 23

portia-28 tab ................................... 74 PORTRAZZA INJ 800/50ML ................ 21 pot chloride tab 25meq ef .................. 95 potassium acetate inj 2 meq/ml ......... 95 potassium chloride 20 meq/l (0.15%) in dextrose 5% inj................................ 98 potassium chloride 30 meq/l (0.224%) in dextrose 5% inj................................ 98 potassium chloride 40 meq/l (0.3%) in dextrose 5% inj................................ 98 potassium chloride cap er 10 meq ...... 95 potassium chloride cap er 8 meq ........ 95 potassium chloride inj 10 meq/100ml . 98 potassium chloride inj 20 meq/100ml . 98 potassium chloride inj 30 meq/100ml . 98 potassium chloride inj 40 meq/100ml . 98 potassium chloride microencapsulated crys er tab 10 meq ........................... 95 potassium chloride microencapsulated crys er tab 20 meq ........................... 95 potassium chloride oral soln 10% (20 meq/15ml) ...................................... 95 potassium chloride oral soln 20% (40 meq/15ml) ...................................... 95 potassium chloride powder packet 20 meq ................................................ 95 potassium chloride tab er 10 meq ....... 95 potassium chloride tab er 20 meq (1500 mg) ................................................ 95 potassium chloride tab er 8 meq (600 mg) ................................................ 95 potassium citrate tab er 10 meq (1080 mg) ................................................ 86 potassium citrate tab er 15 meq (1620 mg) ................................................ 86 potassium citrate tab er 5 meq (540 mg) ..................................................... 86 potassium phosphates inj 15 mm/5ml (phos) 22 meq/5ml (k) ...................... 95 potassium phosphates inj 150 mm/50ml (phos) 220 meq/50ml (k) .................. 96 potassium phosphates inj 45 mm/15ml (phos) 66 meq/15ml (k) .................... 95 PRADAXA CAP 110MG ....................... 88 PRADAXA CAP 150MG ....................... 88 PRADAXA CAP 75MG ......................... 88 PRALUENT INJ 150MG/ML .................. 36 PRALUENT INJ 75MG/ML .................... 36


pramipexole dihydrochloride tab 0.125 mg ................................................. 54 pramipexole dihydrochloride tab 0.25 mg ..................................................... 54 pramipexole dihydrochloride tab 0.5 mg ..................................................... 54 pramipexole dihydrochloride tab 0.75 mg ..................................................... 54 pramipexole dihydrochloride tab 1 mg 54 pramipexole dihydrochloride tab 1.5 mg ..................................................... 54 prasugrel hcl tab 10 mg (base equiv) .. 90 prasugrel hcl tab 5 mg (base equiv) ... 90 pravastatin sodium tab 10 mg ........... 35 pravastatin sodium tab 20 mg ........... 35 pravastatin sodium tab 40 mg ........... 35 pravastatin sodium tab 80 mg ........... 35 praziquantel tab 600 mg ..................... 8 prazosin hcl cap 1 mg ....................... 32 prazosin hcl cap 2 mg ....................... 32 prazosin hcl cap 5 mg ....................... 32 PRED MILD SUS 0.12% OP ...............100 PRED SOD PHO SOL 1% OP ..............100 PRED-G S.O.P OIN OP ....................... 99 PRED-G SUS OP ............................... 99 prednicarbate cream 0.1% ...............108 prednicarbate oint 0.1% ..................108 prednisolone acetate ophth susp 1% 100 prednisolone sod phosph oral soln 6.7 mg/5ml (5 mg/5ml base) .................. 78 prednisolone sod phosphate oral soln 15 mg/5ml (base equiv) ........................ 78 prednisolone sodium phosphate oral soln 25 mg/5ml (base eq) ........................ 78 prednisolone syrup 15 mg/5ml (usp solution equivalent) .......................... 78 PREDNISONE CON 5MG/ML ............... 78 prednisone oral soln 5 mg/5ml ........... 78 prednisone tab 1 mg ......................... 78 prednisone tab 10 mg ....................... 78 prednisone tab 2.5 mg ...................... 78 prednisone tab 20 mg ....................... 78 prednisone tab 5 mg ......................... 78 prednisone tab 50 mg ....................... 78 prednisone tab therapy pack 10 mg (21) ..................................................... 78 prednisone tab therapy pack 10 mg (48) ..................................................... 78

prednisone tab therapy pack 5 mg (21) ..................................................... 78 prednisone tab therapy pack 5 mg (48) ..................................................... 78 PREMARIN VAG CRE 0.625MG ............ 77 PREMASOL SOL 10% ........................ 96 prevalite pow 4gm pk ....................... 36 previfem tab .................................... 74 PREZCOBIX TAB 800-150 .................. 12 PREZISTA SUS 100MG/ML ................. 11 PREZISTA TAB 150MG ....................... 11 PREZISTA TAB 600MG ....................... 11 PREZISTA TAB 75MG ........................ 11 PREZISTA TAB 800MG ....................... 11 PRIALT INJ 100MCG ............................ 1 PRIALT INJ 25MCG/ML ........................ 1 PRIFTIN TAB 150MG ......................... 12 PRIMAQUINE PHOSPHATE TAB 26.3 MG (15 MG BASE) .................................. 10 primidone tab 250 mg ....................... 47 primidone tab 50 mg ........................ 47 PRIVIGEN INJ 20GRAMS .................... 92 probenecid tab 500 mg ....................... 1 PROCALAMINE INJ 3% ...................... 96 prochlorperazine maleate tab 10 mg (base equivalent) ............................. 83 prochlorperazine maleate tab 5 mg (base equivalent) ...................................... 82 prochlorperazine suppos 25 mg .......... 83 PROCRIT INJ 10000/ML ..................... 89 PROCRIT INJ 2000/ML....................... 89 PROCRIT INJ 20000/ML ..................... 89 PROCRIT INJ 3000/ML ....................... 89 PROCRIT INJ 4000/ML ....................... 89 PROCRIT INJ 40000/ML ..................... 89 procto-med cre hc 2.5% .................. 109 procto-pak cre 1% .......................... 109 proctosol hc cre 2.5% ..................... 109 proctozone cre -hc 2.5% ................. 109 progesterone micronized cap 100 mg . 81 progesterone micronized cap 200 mg . 81 PROGLYCEM SUS 50MG/ML ................ 78 PROGRAF GRA 0.2MG ....................... 93 PROGRAF GRA 1MG .......................... 93 PROLASTIN-C INJ 1000MG............... 104 PROLIA SOL 60MG/ML ....................... 80 PROMACTA POW 12.5MG ................... 90 PROMACTA TAB 12.5MG .................... 90


PROMACTA TAB 25MG ...................... 90 PROMACTA TAB 50MG ...................... 90 PROMACTA TAB 75MG ...................... 90 promethazine hcl suppos 12.5 mg ...... 83 promethazine hcl suppos 25 mg ......... 83 promethazine hcl suppos 50 mg ......... 83 promethazine hcl syrup 6.25 mg/5ml .. 83 promethazine hcl tab 12.5 mg ........... 83 promethazine hcl tab 25 mg .............. 83 promethazine hcl tab 50 mg .............. 83 promethegan sup 25mg .................... 83 promethegan sup 50mg .................... 83 propafenone hcl cap er 12hr 225 mg .. 34 propafenone hcl cap er 12hr 325 mg .. 34 propafenone hcl cap er 12hr 425 mg .. 34 propafenone hcl tab 150 mg .............. 34 propafenone hcl tab 225 mg .............. 34 propafenone hcl tab 300 mg .............. 34 propantheline bromide tab 15 mg....... 83 propranolol & hydrochlorothiazide tab 40-25 mg ........................................ 37 propranolol & hydrochlorothiazide tab 80-25 mg ........................................ 37 propranolol hcl cap er 24hr 120 mg .... 38 propranolol hcl cap er 24hr 160 mg .... 38 propranolol hcl cap er 24hr 60 mg ...... 38 propranolol hcl cap er 24hr 80 mg ...... 38 propranolol hcl oral soln 20 mg/5ml.... 38 propranolol hcl oral soln 40 mg/5ml.... 38 propranolol hcl tab 10 mg ................. 38 propranolol hcl tab 20 mg ................. 38 propranolol hcl tab 40 mg ................. 38 propranolol hcl tab 60 mg ................. 38 propranolol hcl tab 80 mg ................. 38 propylthiouracil tab 50 mg................. 81 PROQUAD INJ .................................. 94 PROSOL INJ 20% ............................. 96 protriptyline hcl tab 10 mg ................ 52 protriptyline hcl tab 5 mg .................. 52 PULMICORT INH 180MCG .................105 PULMICORT INH 90MCG ...................105 PULMOZYME SOL 1MG/ML ................104 PURIXAN SUS 20MG/ML .................... 20 pyrazinamide tab 500 mg .................. 12 pyridostigmine bromide syrup 60 mg/5ml ..................................................... 63 pyridostigmine bromide tab 60 mg ..... 63

Q QUADRACEL INJ ............................... 94 quetiapine fumarate tab 100 mg ........ 58 quetiapine fumarate tab 200 mg ........ 58 quetiapine fumarate tab 25 mg .......... 58 quetiapine fumarate tab 300 mg ........ 58 quetiapine fumarate tab 400 mg ........ 58 quetiapine fumarate tab 50 mg .......... 58 quetiapine fumarate tab er 24hr 150 mg ..................................................... 58 quetiapine fumarate tab er 24hr 200 mg ..................................................... 58 quetiapine fumarate tab er 24hr 300 mg ..................................................... 58 quetiapine fumarate tab er 24hr 400 mg ..................................................... 58 quetiapine fumarate tab er 24hr 50 mg ..................................................... 58 quinapril hcl tab 10 mg ..................... 31 quinapril hcl tab 20 mg ..................... 31 quinapril hcl tab 40 mg ..................... 31 quinapril hcl tab 5 mg ....................... 31 quinapril-hydrochlorothiazide tab 10-12.5 mg ................................................. 31 quinapril-hydrochlorothiazide tab 20-12.5 mg ................................................. 31 quinapril-hydrochlorothiazide tab 20-25 mg ................................................. 31 quinidine sulfate tab 200 mg .............. 34 quinidine sulfate tab 300 mg .............. 34 quinine sulfate cap 324 mg ................ 10 R RABAVERT INJ ................................. 94 raloxifene hcl tab 60 mg .................... 80 ramipril cap 1.25 mg......................... 31 ramipril cap 10 mg ........................... 31 ramipril cap 2.5 mg .......................... 31 ramipril cap 5 mg ............................. 31 RANEXA TAB 1000MG ....................... 42 RANEXA TAB 500MG ......................... 42 ranitidine hcl cap 150 mg .................. 83 ranitidine hcl cap 300 mg .................. 83 ranitidine hcl syrup 15 mg/ml (75 mg/5ml) .......................................... 83 ranitidine hcl tab 150 mg ................... 83 ranitidine hcl tab 300 mg ................... 83 ranolazine tab er 12hr 1000 mg ......... 42 ranolazine tab er 12hr 500 mg ........... 42


RAPAMUNE SOL 1MG/ML ................... 93 rasagiline mesylate tab 0.5 mg (base equiv) ............................................. 54 rasagiline mesylate tab 1 mg (base equiv) ............................................. 54 RASUVO INJ 10MG ........................... 91 RASUVO INJ 12.5MG ........................ 91 RASUVO INJ 15MG ........................... 91 RASUVO INJ 17.5MG ........................ 91 RASUVO INJ 20MG ........................... 91 RASUVO INJ 22.5MG ........................ 91 RASUVO INJ 25MG ........................... 91 RASUVO INJ 30MG ........................... 92 RASUVO INJ 7.5MG .......................... 91 RAVICTI LIQ 1.1GM/ML ..................... 76 REBETOL SOL 40MG/ML .................... 13 reclipsen tab .................................... 74 RECOMBIVA HB INJ 10MCG/ML .......... 94 RECOMBIVA HB INJ 5MCG/0.5 ........... 94 RECOMBIVA-HB INJ 40MCG/ML .......... 94 RECTIV OIN 0.4% ........................... 109 REGONOL INJ 5MG/ML ...................... 63 REGRANEX GEL 0.01% .................... 109 RELENZA MIS DISKHALE ................... 13 RELISTOR INJ 12/0.6ML .................... 85 RELISTOR INJ 8/0.4ML ..................... 85 RELISTOR TAB 150MG ...................... 85 repaglinide tab 0.5 mg ...................... 69 repaglinide tab 1 mg ........................ 69 repaglinide tab 2 mg ........................ 69 REPATHA INJ 140MG/ML ................... 36 REPATHA PUSH INJ 420/3.5 .............. 36 REPATHA SURE INJ 140MG/ML .......... 36 RESCRIPTOR TAB 200MG .................. 11 RESTASIS EMU 0.05% ..................... 101 RETACRIT INJ 10000UNT .................. 89 RETACRIT INJ 2000UNIT ................... 89 RETACRIT INJ 3000UNIT ................... 89 RETACRIT INJ 40000UNT .................. 89 RETACRIT INJ 4000UNIT ................... 89 REVLIMID CAP 10MG ........................ 24 REVLIMID CAP 15MG ........................ 24 REVLIMID CAP 2.5MG ....................... 24 REVLIMID CAP 20MG ........................ 24 REVLIMID CAP 25MG ........................ 24 REVLIMID CAP 5MG .......................... 24 REXULTI TAB 0.25MG ....................... 58 REXULTI TAB 0.5MG ......................... 58

REXULTI TAB 1MG ............................ 58 REXULTI TAB 2MG ............................ 58 REXULTI TAB 3MG ............................ 58 REXULTI TAB 4MG ............................ 58 REYATAZ POW 50MG ........................ 11 ribasphere cap 200mg ...................... 13 ribasphere tab 600mg ....................... 13 ribavirin cap 200 mg ......................... 14 ribavirin tab 200 mg ......................... 14 RIDAURA CAP 3MG ........................... 92 rifabutin cap 150 mg ......................... 12 RIFAMATE CAP ................................. 12 rifampin cap 150 mg ......................... 12 rifampin cap 300 mg ......................... 12 rifampin for inj 600 mg ..................... 12 RIFATER TAB ................................... 13 riluzole tab 50 mg ............................ 63 rimantadine hydrochloride tab 100 mg 14 RIOMET SOL .................................... 69 risedronate sodium tab 150 mg .......... 70 risedronate sodium tab 35 mg ............ 70 risedronate sodium tab delayed release 35 mg ............................................. 70 risedronate tab 35mg ........................ 70 RISPERDAL INJ 12.5MG ..................... 58 RISPERDAL INJ 25MG ....................... 58 RISPERDAL INJ 37.5MG ..................... 58 RISPERDAL INJ 50MG ....................... 59 risperidone orally disintegrating tab 0.25 mg ................................................. 59 risperidone orally disintegrating tab 0.5 mg ................................................. 59 risperidone orally disintegrating tab 1 mg ..................................................... 59 risperidone orally disintegrating tab 2 mg ..................................................... 59 risperidone orally disintegrating tab 3 mg ..................................................... 59 risperidone orally disintegrating tab 4 mg ..................................................... 59 risperidone soln 1 mg/ml ................... 59 risperidone tab 0.25 mg .................... 59 risperidone tab 0.5 mg ...................... 59 risperidone tab 1 mg ......................... 59 risperidone tab 2 mg ......................... 59 risperidone tab 3 mg ......................... 59 risperidone tab 4 mg ......................... 59 ritonavir tab 100 mg ......................... 11


rivastigmine tartrate cap 1.5 mg (base equivalent) ...................................... 49 rivastigmine tartrate cap 3 mg (base equivalent) ...................................... 49 rivastigmine tartrate cap 4.5 mg (base equivalent) ...................................... 49 rivastigmine tartrate cap 6 mg (base equivalent) ...................................... 49 rivastigmine td patch 24hr 13.3 mg/24hr ..................................................... 49 rivastigmine td patch 24hr 4.6 mg/24hr ..................................................... 49 rivastigmine td patch 24hr 9.5 mg/24hr ..................................................... 49 rizatriptan benzoate oral disintegrating tab 10 mg (base eq) ......................... 62 rizatriptan benzoate oral disintegrating tab 5 mg (base eq)........................... 62 rizatriptan benzoate tab 10 mg (base equivalent) ...................................... 62 rizatriptan benzoate tab 5 mg (base equivalent) ...................................... 62 ropinirole hydrochloride tab 0.25 mg .. 54 ropinirole hydrochloride tab 0.5 mg .... 54 ropinirole hydrochloride tab 1 mg ....... 54 ropinirole hydrochloride tab 2 mg ....... 54 ropinirole hydrochloride tab 3 mg ....... 54 ropinirole hydrochloride tab 4 mg ....... 54 ropinirole hydrochloride tab 5 mg ....... 54 ropivacaine hcl inj 10 mg/ml................ 6 ropivacaine hcl inj 2 mg/ml ................. 6 ropivacaine hcl inj 5 mg/ml ................. 6 ropivacaine hcl inj 7.5 mg/ml............... 6 rosadan cre 0.75% ..........................109 rosadan gel 0.75% ..........................109 rosuvastatin calcium tab 10 mg ......... 35 rosuvastatin calcium tab 20 mg ......... 35 rosuvastatin calcium tab 40 mg ......... 35 rosuvastatin calcium tab 5 mg ........... 35 ROTARIX SUS .................................. 94 ROTATEQ SOL.................................. 94 roweepra tab 1000mg....................... 47 roweepra tab 500mg ........................ 47 roweepra tab 750mg ........................ 47 roweepra xr tab 500mg xr ................. 47 roweepra xr tab 750mg xr ................. 47 ROZEREM TAB 8MG .......................... 62 RUBRACA TAB 200MG ....................... 21

RUBRACA TAB 250MG ....................... 21 RUBRACA TAB 300MG ....................... 21 RUCONEST INJ 2100UNIT .................. 90 RYDAPT CAP 25MG ........................... 27 S SABRIL TAB 500MG .......................... 47 salsalate tab 500 mg .......................... 2 salsalate tab 750 mg .......................... 2 SAMSCA TAB 15MG .......................... 80 SAMSCA TAB 30MG .......................... 80 SANCUSO DIS 3.1MG ........................ 83 SANTYL OIN 250/GM....................... 109 SAPHRIS SUB 10MG ......................... 59 SAPHRIS SUB 2.5MG ........................ 59 SAPHRIS SUB 5MG ........................... 59 SAVELLA MIS TITR PAK ..................... 63 SAVELLA TAB 100MG ........................ 64 SAVELLA TAB 12.5MG ....................... 64 SAVELLA TAB 25MG .......................... 64 SAVELLA TAB 50MG .......................... 64 scopolamine td patch 72hr 1 mg/3days ..................................................... 83 selegiline hcl cap 5 mg ...................... 54 selegiline hcl tab 5 mg ...................... 54 selenium sulfide lotion 2.5% ............ 107 SELZENTRY SOL 20MG/ML ................. 11 SELZENTRY TAB 150MG .................... 11 SELZENTRY TAB 25MG ...................... 11 SELZENTRY TAB 300MG .................... 11 SELZENTRY TAB 75MG ...................... 11 SEREVENT DIS AER 50MCG ............. 103 SEROSTIM INJ 4MG .......................... 80 SEROSTIM INJ 5MG .......................... 80 SEROSTIM INJ 6MG .......................... 80 sertraline hcl oral concentrate for solution 20 mg/ml ............................ 52 sertraline hcl tab 100 mg................... 52 sertraline hcl tab 25 mg .................... 52 sertraline hcl tab 50 mg .................... 52 setlakin tab ...................................... 74 sevelamer carbonate packet 0.8 gm ... 80 sevelamer carbonate packet 2.4 gm ... 80 sevelamer carbonate tab 800 mg ....... 81 sf 5000 plus cre 1.1% ..................... 110 sharobel tab 0.35mg ......................... 74 SHINGRIX INJ 50MCG ....................... 94 SIGNIFOR INJ 0.3MG/ML ................... 80 SIGNIFOR INJ 0.6MG/ML ................... 80


SIGNIFOR INJ 0.9MG/ML ................... 80 sildenafil citrate for suspension 10 mg/ml ..................................................... 43 sildenafil citrate tab 20 mg ................ 43 SILENOR TAB 3MG ........................... 62 SILENOR TAB 6MG ........................... 62 silver sulfadiazine cream 1% ............106 SIMBRINZA SUS 1-0.2% ..................101 SIMULECT INJ 10MG ......................... 93 simvastatin tab 10 mg ...................... 35 simvastatin tab 20 mg ...................... 35 simvastatin tab 40 mg ...................... 35 simvastatin tab 5 mg ........................ 35 simvastatin tab 80 mg ...................... 35 sirolimus oral soln 1 mg/ml ............... 93 sirolimus tab 0.5 mg ......................... 93 sirolimus tab 1 mg ........................... 93 sirolimus tab 2 mg ........................... 93 SIRTURO TAB 100MG ....................... 13 SIVEXTRO INJ 200MG ......................... 8 SIVEXTRO TAB 200MG ........................ 8 SOD ACETATE INJ 2MEQ/ML .............. 96 SOD ACETATE INJ 4MEQ/ML .............. 96 SOD LACTATE INJ 5MEQ/ML .............. 96 sodium bicarbonate iv soln 7.5% ........ 96 sodium bicarbonate iv soln 8.4% ........ 96 sodium chloride irrigation soln 0.9% . 109 sodium chloride iv soln 0.45% ........... 98 sodium chloride iv soln 0.9% ............. 98 sodium chloride iv soln 3% ................ 98 sodium chloride iv soln 4 meq/ml (23.4%) .......................................... 98 sodium chloride iv soln 5% ................ 98 sodium fluoride 2.2 mg ..................... 96 sodium phenylbutyrate oral powder 3 gm/teaspoonful ................................ 76 sodium phenylbutyrate tab 500 mg .... 76 sodium polystyrene sulfonate powder . 70 solifenacin succinate tab 10 mg ......... 86 solifenacin succinate tab 5 mg ........... 86 SOLIQUA INJ 100/33 ........................ 67 SOLTAMOX SOL 10MG/5ML ............... 23 SOLU-CORTEF INJ 1000MG ............... 78 SOLU-CORTEF INJ 500MG ................. 78 SOMATULINE INJ 120/.5ML ............... 80 SOMATULINE INJ 60/0.2ML ............... 80 SOMATULINE INJ 90/0.3ML ............... 80 SOMAVERT INJ 10MG ....................... 80

SOMAVERT INJ 15MG ........................ 80 SOMAVERT INJ 20MG ........................ 80 SOMAVERT INJ 25MG ........................ 80 SOMAVERT INJ 30MG ........................ 80 sorine tab 120mg ............................. 34 sorine tab 160mg ............................. 34 sorine tab 240mg ............................. 34 sorine tab 80mg ............................... 34 sotalol hcl (afib/afl) tab 120 mg ......... 34 sotalol hcl tab 120 mg ....................... 34 sotalol hcl tab 160 mg ....................... 34 sotalol hcl tab 240 mg ....................... 34 sotalol hcl tab 80 mg ........................ 34 SOVALDI TAB 400MG ........................ 14 SPIRIVA AER 1.25MCG .................... 101 SPIRIVA CAP HANDIHLR .................. 101 SPIRIVA SPR 2.5MCG ...................... 101 spironolactone & hydrochlorothiazide tab 25-25 mg ........................................ 41 spironolactone tab 100 mg ................ 32 spironolactone tab 25 mg .................. 32 spironolactone tab 50 mg .................. 32 sprintec 28 tab 28 day ...................... 74 SPRITAM TAB 1000MG ...................... 47 SPRITAM TAB 250MG ........................ 47 SPRITAM TAB 500MG ........................ 47 SPRITAM TAB 750MG ........................ 47 SPRYCEL TAB 100MG ........................ 27 SPRYCEL TAB 140MG ........................ 27 SPRYCEL TAB 20MG .......................... 27 SPRYCEL TAB 50MG .......................... 27 SPRYCEL TAB 70MG .......................... 27 SPRYCEL TAB 80MG .......................... 27 sps sus 15gm/60 .............................. 70 sronyx tab ....................................... 74 ssd cre 1% .................................... 106 stavudine cap 15 mg ......................... 11 stavudine cap 20 mg ......................... 11 stavudine cap 30 mg ......................... 11 stavudine cap 40 mg ......................... 11 STELARA INJ 45MG/0.5 ..................... 92 STELARA INJ 90MG/ML...................... 92 STIMATE SOL 1.5MG/ML.................... 82 STIOLTO AER 2.5-2.5...................... 101 STIVARGA TAB 40MG ........................ 27 STRENSIQ INJ 18/0.45 ...................... 80 STRENSIQ INJ 28/0.7ML ................... 80 STRIANT MIS 30MG .......................... 66


STRIBILD TAB.................................. 12 SUCRAID SOL 8500/ML ..................... 85 sucralfate tab 1 gm .......................... 85 sulfacetamide sodium lotion 10% (acne) ................................................... 106 sulfacetamide sodium ophth oint 10% 99 sulfacetamide sodium ophth soln 10% 99 sulfacetamide sodium-prednisolone ophth soln 10-0.23(0.25)% ............... 99 SULFADIAZINE TAB 500MG ................. 6 sulfamethoxazole-trimethoprim susp 200-40 mg/5ml.................................. 8 sulfamethoxazole-trimethoprim tab 400- 80 mg............................................... 8 sulfamethoxazole-trimethoprim tab 800- 160 mg ............................................. 8 SULFAMYLON CRE 85MG/GM ............106 sulfasalazine tab 500 mg ................... 84 sulfasalazine tab delayed release 500 mg ..................................................... 84 sulindac tab 150 mg ........................... 2 sulindac tab 200 mg ........................... 2 sumatriptan nasal spray 20 mg/act .... 62 sumatriptan nasal spray 5 mg/act ...... 62 sumatriptan succinate inj 6 mg/0.5ml . 62 sumatriptan succinate solution auto- injector 4 mg/0.5ml .......................... 62 sumatriptan succinate solution auto- injector 6 mg/0.5ml .......................... 62 sumatriptan succinate solution cartridge 4 mg/0.5ml ..................................... 62 sumatriptan succinate solution prefilled syringe 6 mg/0.5ml .......................... 62 sumatriptan succinate tab 100 mg ..... 63 sumatriptan succinate tab 25 mg ....... 62 sumatriptan succinate tab 50 mg ....... 63 SUPRAX CAP 400MG ......................... 15 SUPRAX CHW 100MG ........................ 15 SUPRAX CHW 200MG ........................ 15 SUPREP BOWEL SOL PREP KIT ........... 84 SUTENT CAP 12.5MG ........................ 28 SUTENT CAP 25MG ........................... 28 SUTENT CAP 37.5MG ........................ 28 SUTENT CAP 50MG ........................... 28 syeda tab 3-0.03mg ......................... 74 SYLATRON KIT 200MCG .................... 29 SYLATRON KIT 300MCG .................... 29 SYLATRON KIT 600MCG .................... 29

SYLVANT SOL 400MG ........................ 29 SYMBICORT AER 160-4.5 ................ 105 SYMBICORT AER 80-4.5 .................. 105 SYMFI LO TAB .................................. 12 SYMFI TAB ....................................... 12 SYMLINPEN 60 INJ 1000MCG ............. 67 SYMLNPEN 120 INJ 1000MCG ............ 67 SYMPAZAN MIS 10MG ....................... 48 SYMPAZAN MIS 20MG ....................... 48 SYMPAZAN MIS 5MG ......................... 48 SYMTUZA TAB .................................. 12 SYNAGIS INJ 100MG/ML .................... 94 SYNAREL SOL 2MG/ML ...................... 75 SYNJARDY TAB ................................. 69 SYNJARDY TAB 12.5-500 ................... 69 SYNJARDY TAB 5-1000MG ................. 69 SYNJARDY TAB 5-500MG ................... 69 SYNJARDY XR TAB ............................ 69 SYNJARDY XR TAB 10-1000 ............... 69 SYNJARDY XR TAB 25-1000 ............... 69 SYNJARDY XR TAB 5-1000MG ............ 69 SYNRIBO INJ 3.5MG ......................... 29 SYNTHROID TAB 100MCG .................. 81 SYNTHROID TAB 112MCG .................. 81 SYNTHROID TAB 125MCG .................. 81 SYNTHROID TAB 137MCG .................. 81 SYNTHROID TAB 150MCG .................. 81 SYNTHROID TAB 175MCG .................. 81 SYNTHROID TAB 200MCG .................. 81 SYNTHROID TAB 25MCG ................... 81 SYNTHROID TAB 300MCG .................. 81 SYNTHROID TAB 50MCG ................... 81 SYNTHROID TAB 75MCG ................... 81 SYNTHROID TAB 88MCG ................... 81 T TABLOID TAB 40MG .......................... 20 tacrolimus cap 0.5 mg ....................... 93 tacrolimus cap 1 mg ......................... 93 tacrolimus cap 5 mg ......................... 93 tacrolimus oint 0.03% ..................... 109 tacrolimus oint 0.1%....................... 109 tadalafil tab 20 mg (pah) ................... 43 TAFINLAR CAP 50MG......................... 28 TAFINLAR CAP 75MG......................... 28 TAGRISSO TAB 40MG........................ 28 TAGRISSO TAB 80MG........................ 28 TALZENNA CAP 0.25MG ..................... 21 TALZENNA CAP 1MG ......................... 21


tamoxifen citrate tab 10 mg (base equivalent) ...................................... 23 tamoxifen citrate tab 20 mg (base equivalent) ...................................... 23 tamsulosin hcl cap 0.4 mg ................. 86 TARGRETIN GEL 1% ........................109 tarina 24 fe tab ................................ 74 tarina fe tab 1/20 ............................. 74 TASIGNA CAP 150MG ....................... 28 TASIGNA CAP 200MG ....................... 28 TASIGNA CAP 50MG ......................... 28 TAZORAC CRE 0.05% ......................107 TAZORAC GEL 0.05% ......................107 TAZORAC GEL 0.1% ........................107 taztia xt cap 120mg/24 ..................... 39 taztia xt cap 180mg/24 ..................... 39 taztia xt cap 240mg/24 ..................... 39 taztia xt cap 300mg er ...................... 39 taztia xt cap 360mg/24 ..................... 39 TDVAX INJ 2-2 LF ............................. 94 TEFLARO INJ 400MG ......................... 15 TEFLARO INJ 600MG ......................... 15 TEGSEDI INJ 284/1.5 ....................... 64 TEKTURNA HCT TAB 150-12.5 ........... 42 TEKTURNA HCT TAB 150-25MG .......... 42 TEKTURNA HCT TAB 300-12.5 ........... 42 TEKTURNA HCT TAB 300-25MG .......... 42 telmisartan tab 20 mg ...................... 33 telmisartan tab 40 mg ...................... 33 telmisartan tab 80 mg ...................... 33 telmisartan-amlodipine tab 40-10 mg . 33 telmisartan-amlodipine tab 40-5 mg ... 33 telmisartan-amlodipine tab 80-10 mg . 33 telmisartan-amlodipine tab 80-5 mg ... 33 telmisartan-hydrochlorothiazide tab 40- 12.5 mg .......................................... 33 telmisartan-hydrochlorothiazide tab 80- 12.5 mg .......................................... 33 telmisartan-hydrochlorothiazide tab 80- 25 mg............................................. 33 temazepam cap 15 mg ..................... 62 temazepam cap 22.5 mg ................... 62 temazepam cap 30 mg ..................... 62 temazepam cap 7.5 mg .................... 62 TEMODAR INJ 100MG ....................... 19 TENIVAC INJ 5-2LF ........................... 94 tenofovir disoproxil fumarate tab 300 mg ..................................................... 11

terazosin hcl cap 1 mg (base equivalent) ..................................................... 32 terazosin hcl cap 10 mg (base equivalent) ...................................... 32 terazosin hcl cap 2 mg (base equivalent) ..................................................... 32 terazosin hcl cap 5 mg (base equivalent) ..................................................... 32 terbinafine hcl tab 250 mg ................... 9 terbutaline sulfate tab 2.5 mg .......... 103 terbutaline sulfate tab 5 mg ............. 103 terconazole vaginal cream 0.4% ......... 87 terconazole vaginal cream 0.8% ......... 87 terconazole vaginal suppos 80 mg ...... 87 testosterone cypionate im inj in oil 100 mg/ml ............................................. 66 testosterone cypionate im inj in oil 200 mg/ml ............................................. 66 testosterone enanthate im inj in oil 200 mg/ml ............................................. 66 testosterone td gel 12.5 mg/act (1%) . 66 testosterone td gel 25 mg/2.5gm (1%)66 testosterone td gel 50 mg/5gm (1%) .. 66 tetrabenazine tab 12.5 mg ................. 64 tetrabenazine tab 25 mg ................... 64 tetracycline hcl cap 250 mg ............... 19 tetracycline hcl cap 500 mg ............... 19 THALOMID CAP 100MG...................... 24 THALOMID CAP 150MG...................... 24 THALOMID CAP 200MG...................... 24 THALOMID CAP 50MG ....................... 24 theophylline soln 80 mg/15ml .......... 104 theophylline tab er 12hr 100 mg....... 104 theophylline tab er 12hr 200 mg....... 104 theophylline tab er 12hr 300 mg....... 104 theophylline tab er 24hr 400 mg....... 104 theophylline tab er 24hr 600 mg....... 104 THERACYS INJ ................................. 29 THIOLA TAB 100MG .......................... 86 thioridazine hcl tab 10 mg ................. 59 thioridazine hcl tab 100 mg ................ 59 thioridazine hcl tab 25 mg ................. 59 thioridazine hcl tab 50 mg ................. 59 thiothixene cap 1 mg ........................ 59 thiothixene cap 10 mg....................... 59 thiothixene cap 2 mg ........................ 59 thiothixene cap 5 mg ........................ 59 tiagabine hcl tab 12 mg ..................... 48


tiagabine hcl tab 16 mg .................... 48 tiagabine hcl tab 2 mg ...................... 48 tiagabine hcl tab 4 mg ...................... 48 TIBSOVO TAB 250MG ....................... 21 TICE BCG INJ .................................. 29 ticlopidine hcl tab 250 mg ................. 90 TIGECYCLINE FOR IV SOLN 50 MG ....... 8 tilia fe tab ....................................... 74 timolol maleate ophth gel forming soln 0.25% ...........................................101 timolol maleate ophth gel forming soln 0.5% .............................................101 timolol maleate ophth soln 0.25% .....101 timolol maleate ophth soln 0.5% .......101 timolol maleate tab 10 mg ................. 38 timolol maleate tab 20 mg ................. 38 timolol maleate tab 5 mg .................. 38 tinidazole tab 250 mg ......................... 8 tinidazole tab 500 mg ......................... 8 TIVICAY TAB 10MG ........................... 11 TIVICAY TAB 25MG........................... 11 TIVICAY TAB 50MG ........................... 11 tizanidine hcl tab 2 mg (base equivalent) ..................................................... 65 tizanidine hcl tab 4 mg (base equivalent) ..................................................... 65 TOBI PODHALR CAP 28MG ................... 6 TOBRADEX OIN 0.3-0.1% ................. 99 tobramycin nebu soln 300 mg/5ml ....... 6 tobramycin ophth soln 0.3% .............. 99 tobramycin sulfate inj 10 mg/ml (base equivalent) ........................................ 6 tobramycin sulfate inj 80 mg/2ml (40 mg/ml) (base equiv) ........................... 6 tobramycin-dexamethasone ophth susp 0.3-0.1% ........................................ 99 TOBREX OIN 0.3% OP ...................... 99 tolazamide tab 250 mg ..................... 69 tolazamide tab 500 mg ..................... 69 tolbutamide tab 500 mg .................... 69 tolmetin sodium tab 200 mg ................ 2 tolterodine tartrate cap er 24hr 2 mg .. 86 tolterodine tartrate cap er 24hr 4 mg .. 86 tolterodine tartrate tab 1 mg ............. 86 tolterodine tartrate tab 2 mg ............. 86 topiramate sprinkle cap 15 mg ........... 48 topiramate sprinkle cap 25 mg ........... 48 topiramate tab 100 mg ..................... 48

topiramate tab 200 mg ..................... 48 topiramate tab 25 mg ....................... 48 topiramate tab 50 mg ....................... 48 toremifene citrate tab 60 mg (base equivalent) ...................................... 23 torsemide tab 10 mg......................... 41 torsemide tab 100 mg ....................... 41 torsemide tab 20 mg......................... 41 torsemide tab 5 mg .......................... 41 TOUJEO MAX INJ 300IU/ML ............... 67 TOUJEO SOLO INJ 300IU/ML .............. 67 TPN ELECTROL INJ............................ 96 TRACLEER TAB 32MG ........................ 43 TRADJENTA TAB 5MG ........................ 70 tramadol hcl tab 50 mg ....................... 2 tramadol-acetaminophen tab 37.5-325 mg ................................................... 3 trandolapril tab 1 mg ........................ 31 trandolapril tab 2 mg ........................ 31 trandolapril tab 4 mg ........................ 31 tranexamic acid tab 650 mg .............. 90 tranylcypromine sulfate tab 10 mg ..... 52 TRAVASOL INJ 10% .......................... 96 TRAVATAN Z DRO 0.004% ............... 101 trazodone hcl tab 100 mg .................. 52 trazodone hcl tab 150 mg .................. 52 trazodone hcl tab 300 mg .................. 52 trazodone hcl tab 50 mg .................... 52 TRECATOR TAB 250MG ...................... 13 TRELEGY AER ELLIPTA .................... 101 TRELSTAR MIX INJ 11.25MG .............. 23 TRELSTAR MIX INJ 22.5MG ................ 23 TRELSTAR MIX INJ 3.75MG ................ 23 TRESIBA FLEX INJ 100UNIT ............... 67 TRESIBA FLEX INJ 200UNIT ............... 67 TRESIBA INJ 100UNIT ....................... 68 tretinoin cap 10 mg .......................... 29 tretinoin cream 0.025% .................. 106 tretinoin cream 0.05% .................... 106 tretinoin cream 0.1% ...................... 106 tretinoin gel 0.01% ......................... 106 tretinoin gel 0.025% ....................... 106 triamcinolone acetonide cream 0.025% ................................................... 108 triamcinolone acetonide cream 0.1% 108 triamcinolone acetonide cream 0.5% 108 triamcinolone acetonide dental paste 0.1% ............................................ 110


triamcinolone acetonide inj susp 10 mg/ml ............................................ 78 triamcinolone acetonide inj susp 40 mg/ml ............................................ 78 triamcinolone acetonide lotion 0.025% ................................................... 108 triamcinolone acetonide lotion 0.1% . 108 triamcinolone acetonide oint 0.025% 108 triamcinolone acetonide oint 0.1% ....108 triamcinolone acetonide oint 0.5% ....108 triamterene & hydrochlorothiazide cap 37.5-25 mg ..................................... 41 triamterene & hydrochlorothiazide tab 37.5-25 mg ..................................... 41 triamterene & hydrochlorothiazide tab 75-50 mg ........................................ 41 triderm cre 0.1% ............................108 trientine hcl cap 250 mg ................... 70 tri-estaryll tab.................................. 74 trifluoperazine hcl tab 1 mg (base equivalent) ...................................... 59 trifluoperazine hcl tab 10 mg (base equivalent) ...................................... 59 trifluoperazine hcl tab 2 mg (base equivalent) ...................................... 59 trifluoperazine hcl tab 5 mg (base equivalent) ...................................... 59 trifluridine ophth soln 1% .................. 99 trihexyphenidyl hcl elixir 0.4 mg/ml .... 54 trihexyphenidyl hcl tab 2 mg.............. 54 trihexyphenidyl hcl tab 5 mg.............. 54 tri-legest tab fe ................................ 74 tri-linyah tab ................................... 74 tri-lo tab estaryll .............................. 74 tri-lo- tab marzia .............................. 74 tri-lo- tab sprintec ............................ 74 trilyte sol ........................................ 84 trimethoprim tab 100 mg .................... 8 tri-mili tab ....................................... 74 trimipramine maleate cap 100 mg ...... 52 trimipramine maleate cap 25 mg ........ 52 trimipramine maleate cap 50 mg ........ 52 trinessa lo tab .................................. 75 TRINTELLIX TAB 10MG...................... 52 TRINTELLIX TAB 20MG...................... 52 TRINTELLIX TAB 5MG ....................... 52 tri-previfem tab ............................... 74 tri-sprintec tab ................................. 74

TRIUMEQ TAB .................................. 12 tri-vit/fe dro /fl 0.25 ......................... 96 tri-vit/fl dro 0.25mg .......................... 96 tri-vit/fl dro 0.5mg ........................... 96 trivora-28 tab .................................. 75 tri-vylibra tab ................................... 75 tri-vylibra tab lo ............................... 75 TROPHAMINE INJ 10% ...................... 96 TROPHAMINE INJ 6% ........................ 96 trospium chloride cap er 24hr 60 mg ... 86 trospium chloride tab 20 mg .............. 86 TRULICITY INJ 0.75/0.5 .................... 68 TRULICITY INJ 1.5/0.5 ...................... 68 TRUMENBA INJ ................................. 94 TRUVADA TAB 100-150 ..................... 12 TRUVADA TAB 133-200 ..................... 12 TRUVADA TAB 167-250 ..................... 12 TRUVADA TAB 200-300 ..................... 12 TWINRIX INJ .................................... 94 TYBOST TAB 150MG.......................... 11 TYKERB TAB 250MG .......................... 28 TYPHIM VI INJ .................................. 94 U UDENYCA INJ 6MG/.6ML .................... 89 ULORIC TAB 40MG.............................. 1 ULORIC TAB 80MG.............................. 1 unithroid tab 100mcg ........................ 82 unithroid tab 112mcg ........................ 82 unithroid tab 125mcg ........................ 82 unithroid tab 150mcg ........................ 82 unithroid tab 175mcg ........................ 82 unithroid tab 200mcg ........................ 82 unithroid tab 25mcg ......................... 81 unithroid tab 300mcg ........................ 82 unithroid tab 50mcg ......................... 81 unithroid tab 75mcg ......................... 81 unithroid tab 88mcg ......................... 81 UNITUXIN INJ .................................. 21 UPTRAVI TAB 1000MCG..................... 43 UPTRAVI TAB 1200MCG..................... 43 UPTRAVI TAB 1400MCG..................... 43 UPTRAVI TAB 1600MCG..................... 43 UPTRAVI TAB 200/800 ...................... 43 UPTRAVI TAB 200MCG ...................... 43 UPTRAVI TAB 400MCG ...................... 43 UPTRAVI TAB 600MCG ...................... 43 UPTRAVI TAB 800MCG ...................... 43 ursodiol cap 300 mg ......................... 85


ursodiol tab 250 mg ......................... 85 ursodiol tab 500 mg ......................... 85 V valacyclovir hcl tab 1 gm ................... 14 valacyclovir hcl tab 500 mg ............... 14 VALCHLOR GEL 0.016% ...................109 valganciclovir hcl for soln 50 mg/ml (base equiv) .................................... 14 valganciclovir hcl tab 450 mg (base equivalent) ...................................... 14 valproate sodium oral soln 250 mg/5ml (base equiv) .................................... 48 valproic acid cap 250 mg................... 48 valsartan tab 160 mg ....................... 33 valsartan tab 320 mg ....................... 33 valsartan tab 40 mg ......................... 33 valsartan tab 80 mg ......................... 33 valsartan-hydrochlorothiazide tab 160- 12.5 mg .......................................... 33 valsartan-hydrochlorothiazide tab 160-25 mg ................................................. 33 valsartan-hydrochlorothiazide tab 320- 12.5 mg .......................................... 33 valsartan-hydrochlorothiazide tab 320-25 mg ................................................. 33 valsartan-hydrochlorothiazide tab 80- 12.5 mg .......................................... 33 VALSTAR SOL 40MG/ML .................... 20 vancomycin hcl cap 125 mg (base equivalent) ........................................ 8 vancomycin hcl cap 250 mg (base equivalent) ........................................ 8 vancomycin hcl for iv soln 1 gm (base equivalent) ........................................ 8 vancomycin hcl for iv soln 10 gm (base equivalent) ........................................ 8 vancomycin hcl for iv soln 500 mg (base equivalent) ........................................ 8 vandazole gel 0.75% ........................ 87 VAQTA INJ 25/0.5ML ........................ 94 VAQTA INJ 50UNT/ML ....................... 94 VARIVAX INJ ................................... 94 VASCEPA CAP 0.5GM ........................ 36 VASCEPA CAP 1GM ........................... 36 VECAMYL TAB 2.5MG ........................ 42 VECTIBIX INJ 400MG ........................ 22 VELETRI INJ 0.5MG .......................... 43 VELETRI INJ 1.5MG .......................... 43

velivet pak ....................................... 75 VELTASSA POW 16.8GM .................... 70 VELTASSA POW 25.2GM .................... 71 VELTASSA POW 8.4GM ...................... 70 VEMLIDY TAB 25MG .......................... 14 VENCLEXTA TAB 100MG .................... 22 VENCLEXTA TAB 10MG ...................... 22 VENCLEXTA TAB 50MG ...................... 22 VENCLEXTA TAB START PK ................ 22 venlafaxine hcl cap er 24hr 150 mg (base equivalent) ............................. 52 venlafaxine hcl cap er 24hr 37.5 mg (base equivalent) ............................. 52 venlafaxine hcl cap er 24hr 75 mg (base equivalent) ...................................... 52 venlafaxine hcl tab 100 mg (base equivalent) ...................................... 53 venlafaxine hcl tab 25 mg (base equivalent) ...................................... 52 venlafaxine hcl tab 37.5 mg (base equivalent) ...................................... 53 venlafaxine hcl tab 50 mg (base equivalent) ...................................... 53 venlafaxine hcl tab 75 mg (base equivalent) ...................................... 53 VENTAVIS SOL 10MCG/ML ................. 43 VENTAVIS SOL 20MCG/ML ................. 43 verapamil hcl cap er 24hr 100 mg ...... 39 verapamil hcl cap er 24hr 120 mg ...... 39 verapamil hcl cap er 24hr 180 mg ...... 39 verapamil hcl cap er 24hr 200 mg ...... 39 verapamil hcl cap er 24hr 240 mg ...... 39 verapamil hcl cap er 24hr 300 mg ...... 39 verapamil hcl cap er 24hr 360 mg ...... 39 verapamil hcl tab 120 mg .................. 39 verapamil hcl tab 40 mg .................... 39 verapamil hcl tab 80 mg .................... 39 verapamil hcl tab er 120 mg .............. 39 verapamil hcl tab er 180 mg .............. 39 verapamil hcl tab er 240 mg .............. 39 VERSACLOZ SUS 50MG/ML ................ 59 VERZENIO TAB 100MG ...................... 22 VERZENIO TAB 150MG ...................... 22 VERZENIO TAB 200MG ...................... 22 VERZENIO TAB 50MG ........................ 22 VIBRAMYCIN SYP 50MG/5ML .............. 19 VICTOZA INJ 18MG/3ML .................... 68 VIDEX EC CAP 125MG ....................... 11


VIDEX SOL 4GM ............................... 11 vienva tab 0.1-20 ............................. 75 vigabatrin powd pack 500 mg ............ 48 vigabatrin tab 500 mg ...................... 48 vigadrone pow 500mg ...................... 48 VIIBRYD KIT STARTER ...................... 53 VIIBRYD TAB 10MG .......................... 53 VIIBRYD TAB 20MG .......................... 53 VIIBRYD TAB 40MG .......................... 53 VIMPAT SOL 10MG/ML ...................... 48 VIMPAT TAB 100MG .......................... 48 VIMPAT TAB 150MG .......................... 48 VIMPAT TAB 200MG.......................... 48 VIMPAT TAB 50MG ........................... 48 viorele tab ....................................... 75 VIRACEPT TAB 250MG ...................... 11 VIRACEPT TAB 625MG ...................... 11 VIREAD POW 40MG/GM .................... 11 VIREAD TAB 150MG ......................... 11 VIREAD TAB 200MG ......................... 11 VIREAD TAB 250MG ......................... 11 VITRAKVI CAP 100MG ....................... 28 VITRAKVI CAP 25MG ........................ 28 VITRAKVI SOL 20MG/ML ................... 28 VIZIMPRO TAB 15MG ........................ 28 VIZIMPRO TAB 30MG ........................ 28 VIZIMPRO TAB 45MG ........................ 28 voriconazole for inj 200 mg ................. 9 voriconazole for susp 40 mg/ml ........... 9 voriconazole tab 200 mg ..................... 9 voriconazole tab 50 mg ....................... 9 VOSEVI TAB .................................... 14 VOTRIENT TAB 200MG ...................... 28 VRAYLAR CAP 1.5-3MG ..................... 59 VRAYLAR CAP 1.5MG ........................ 60 VRAYLAR CAP 3MG ........................... 60 VRAYLAR CAP 4.5MG ........................ 60 VRAYLAR CAP 6MG ........................... 60 vyfemla tab 0.4-35 ........................... 75 vylibra tab 0.25-35........................... 75 W warfarin sodium tab 1 mg ................. 88 warfarin sodium tab 10 mg ................ 88 warfarin sodium tab 2 mg ................. 88 warfarin sodium tab 2.5 mg ............... 88 warfarin sodium tab 3 mg ................. 88 warfarin sodium tab 4 mg ................. 88 warfarin sodium tab 5 mg ................. 88

warfarin sodium tab 6 mg .................. 88 warfarin sodium tab 7.5 mg ............... 88 WELCHOL PAK 3.75GM ...................... 36 WELCHOL TAB 625MG ....................... 36 wera tab 0.5/35 ............................... 75 wymzya fe chw 0.4mg-35 .................. 75 X XALKORI CAP 200MG ........................ 28 XALKORI CAP 250MG ........................ 28 XARELTO STAR TAB 15/20MG ............ 88 XARELTO TAB 10MG ......................... 88 XARELTO TAB 15MG ......................... 88 XARELTO TAB 2.5MG ........................ 88 XARELTO TAB 20MG ......................... 88 XATMEP SOL 2.5MG/ML ..................... 92 XELJANZ TAB 10MG .......................... 92 XELJANZ TAB 5MG ............................ 92 XELJANZ XR TAB 11MG ..................... 92 XEOMIN INJ 100UNIT ........................ 65 XERMELO TAB 250MG ....................... 85 XGEVA INJ ....................................... 80 XIFAXAN TAB 200MG .......................... 8 XIFAXAN TAB 550MG ........................ 85 XOFLUZA TAB 20MG ......................... 14 XOFLUZA TAB 40MG ......................... 14 XOLAIR INJ 150MG/ML .................... 104 XOLAIR INJ 75/0.5 ......................... 104 XOLAIR SOL 150MG ........................ 104 XOSPATA TAB 40MG ......................... 28 XTANDI CAP 40MG ........................... 23 XULTOPHY INJ 100/3.6 ..................... 68 XYREM SOL 500MG/ML ...................... 65 Y YERVOY INJ 200MG .......................... 22 YF-VAX INJ ...................................... 94 yuvafem tab 10mcg .......................... 77 Z zafirlukast tab 10 mg ...................... 103 zafirlukast tab 20 mg ...................... 103 zaleplon cap 10 mg ........................... 62 zaleplon cap 5 mg ............................ 62 ZALTRAP INJ 200/8ML ....................... 22 zarah tab 3-0.03mg .......................... 75 ZARXIO INJ 300/0.5 ......................... 89 ZARXIO INJ 480/0.8 ......................... 89 ZEJULA CAP 100MG .......................... 22 ZELBORAF TAB 240MG ...................... 29 ZEMAIRA INJ 1000MG ..................... 104


zenatane cap 10mg .........................106 zenatane cap 20mg .........................106 zenatane cap 30mg .........................106 zenatane cap 40mg .........................106 ZENPEP CAP 10000UNT ..................... 85 ZENPEP CAP 15000UNT ..................... 85 ZENPEP CAP 20000UNT ..................... 85 ZENPEP CAP 25000 .......................... 85 ZENPEP CAP 3000UNIT ..................... 85 ZENPEP CAP 40000 .......................... 85 ZENPEP CAP 5000UNIT ..................... 85 zenzedi tab 10mg ............................. 61 zenzedi tab 5mg .............................. 61 ZEPATIER TAB 50-100MG .................. 14 ZERBAXA INJ 1.5GM ......................... 15 zidovudine cap 100 mg ..................... 11 zidovudine syrup 10 mg/ml ............... 11 zidovudine tab 300 mg ..................... 11 ZIOPTAN DRO 0.0015% ...................101 ziprasidone hcl cap 20 mg ................. 60 ziprasidone hcl cap 40 mg ................. 60 ziprasidone hcl cap 60 mg ................. 60 ziprasidone hcl cap 80 mg ................. 60 ZIRGAN GEL 0.15% .......................... 99 ZOLINZA CAP 100MG ........................ 22 zolmitriptan orally disintegrating tab 2.5 mg ...................................... 63 zolmitriptan orally disintegrating tab 5 mg ......................................... 63

zolmitriptan tab 2.5 mg ..................... 63 zolmitriptan tab 5 mg ........................ 63 zolpidem tartrate tab 10 mg .............. 62 zolpidem tartrate tab 5 mg ................ 62 zonisamide cap 100 mg ..................... 48 zonisamide cap 25 mg....................... 48 zonisamide cap 50 mg....................... 48 ZONTIVITY TAB 2.08MG .................... 90 ZORBTIVE INJ 8.8MG ........................ 80 ZORTRESS TAB 0.25MG .................... 93 ZORTRESS TAB 0.5MG ...................... 93 ZORTRESS TAB 0.75MG .................... 93 ZORTRESS TAB 1MG ......................... 93 ZOSTAVAX INJ ................................. 94 ZOSYN SOL 2-0.25GM ....................... 18 ZOSYN SOL 3-0.375G ....................... 18 ZOSYN SOL 4-0.50GM ....................... 18 zovia 1/35e tab ................................ 75 ZYDELIG TAB 100MG ........................ 29 ZYDELIG TAB 150MG ........................ 29 ZYKADIA CAP 150MG ........................ 29 ZYKADIA TAB 150MG ........................ 29 ZYLET SUS 0.5-0.3% ........................ 99 ZYPREXA RELP INJ 210MG ................. 60 ZYPREXA RELP INJ 300MG ................. 60 ZYPREXA RELP INJ 405MG ................. 60 ZYTIGA TAB 500MG .......................... 23

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• Hable con Clarion Health 844-354-3258 (TTY: 711) Horarios de atención:

• 1 de octubre - 31 de marzo: lunes a domingo de 8 a. m. a 8 p. m., hora del este

• 1 abril - 30 de septiembre: lunes a viernes de 8 a.m. a 8 p.m., hora del este

Hablará con un representante en tiempo real si llama durante el horario laboral, a menos que sea un día festivo. Si llama y no estamos disponibles, deje un mensaje de voz y responderemos su llamado dentro de las 48 horas.

Obtenga más información ClarionHealth.org

Este Formulario se actualizó el 25/08/2020

Clarion Health es un plan HMO con un contrato con Medicare. La inscripción en Clarion Health depende de la renovación de contrato. Para más información, comuníquese con el plan. Esta información no es una descripción completa de los beneficios. Llame al 844-824-8771 (TTY: 711) para obtener más información. ATENCIÓN: Si usted habla español, tiene a su disposición, gratis, servicios de ayuda para idiomas. Llame al 844-824-8771 (TTY/TDD: 711). ATENTION: If you speak other languages, language assistance services, free of charge, are available to you. Call 844-824-8771 (TTY/TDD: 711).

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