1. Healthcare

Offered by:
Offered by
2014
Prospective Members: 1-800-944-1247 • Current Members: 1-800-942-0247
(TTY Relay: Dial 7-1-1) • 8:00 a.m. to 8:00 p.m., 7 days a week
Prescription Drug Formulary
& Network Pharmacies
720 OLIVE WAY, SUITE 300 • SEATTLE, WA 98101-1830
www.healthfirst.chpw.org
H5826_MA_047_2014 _v_01_FormularyPharmacy3tier CMS Approved
Updated 10/2014
Our prescription drug coverage is accepted at
more than 1,000 Washington State pharmacies
and more than 50,000 pharmacies nationwide.
Community HealthFirst prescription drug coverage travels with you. With more than 50,000 contracted
pharmacies nationwide, you have the freedom to fill your prescriptions anywhere you go. See below
for common network pharmacies. Keep in mind, this is not a complete list. Other pharmacies are
available in our network. To find a pharmacy in your area, visit our website at www.healthfirst.chpw.org
or call Customer Service during the hours of 8:00 a.m. to 8:00 p.m., 7 days a week. Current members
should call 1-800-942-0247, prospective members should call 1-800-944-1247 (TTY Relay: Dial 7-1-1).
Community HealthFirst Offers
Nationwide Prescription Drug Coverage
Offered by
Community HealthFirst™ Medicare Advantage
Plans 2014 Prescription Drug Formulary
(List of Covered Drugs)
Community HealthFirst MA Pharmacy Plan (HMO)
Community HealthFirst MA Extra Plan (HMO)
PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER
IN THIS PLAN.
Note to existing members: This formulary has changed since last year. Please review this document to make sure
that it still contains the drugs you take.
When this drug list (formulary) refers to “we,” “us”, or “our,” it means Community Health Plan of Washington. When it
refers to “plan” or “our plan,” it means Community HealthFirst™ MA Special Needs Plan (HMO SNP).
This document includes a list of the drugs (formulary) for our plan which is current as of October 1, 2013. For an
updated formulary, please contact us. Our contact information, along with the date we last updated the formulary,
appears on the front and back cover pages.
You must generally use network pharmacies to use your prescription drug benefit. Benefits, formulary, pharmacy
network, premium and/or copayments/coinsurance may change on January 1, 2014.
Community HealthFirst™ Medicare Advantage Plans are offered by Community Health Plan of Washington, which
is a Federally-Qualified HMO with a Medicare contract. Please contact Community HealthFirst at 1-800-944-1247
(TTY Relay: Dial 7-1-1) if you need information in another format or language than what is listed above. Our Office
hours are 8:00 a.m. – 8:00p.m., 7 days a week.
HPMS Approved Formulary File Submission ID 13230, Version 5
H5826_MA_047_2014 _v_01_FormularyPharmacy3tier CMS Approved
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What is the Community HealthFirst Formulary?
A formulary is a list of covered drugs selected by Community HealthFirst in consultation with a team of health
care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment
program. Community HealthFirst will generally cover the drugs listed in our formulary as long as the drug is
medically necessary, the prescription is filled at a Community HealthFirst network pharmacy, and other plan rules are
followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage.
Can the Formulary (drug list) change?
Generally, if you are taking a drug on our 2014 formulary that was covered at the beginning of the year, we will not
discontinue or reduce coverage of the drug during the 2014 coverage year except when a new, less expensive
generic drug becomes available or when new adverse information about the safety or effectiveness of a drug is
released. Other types of formulary changes, such as removing a drug from our formulary, will not affect members
who are currently taking the drug. It will remain available at the same cost-sharing for those members taking it for
the remainder of the coverage year. We feel it is important that you have continued access for the remainder of the
coverage year to the formulary drugs that were available when you chose our plan, except for cases in which you
can save additional money or we can ensure your safety.
If we remove drugs from our formulary, or add prior authorization, quantity limits and/or step therapy restrictions on
a drug, we must notify affected members of the change at least 60 days before the change becomes effective, or
at the time the member requests a refill of the drug, at which time the member will receive a 60-day supply of the
drug. If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug’s manufacturer
removes the drug from the market, we will immediately remove the drug from our formulary and provide notice to
members who take the drug. The enclosed formulary is current as of october 1, 2013. To get updated information
about the drugs covered by Community HealthFirst, please please visit our web site at www.healthfirst.chpw.org or
call Customer Service at 1-800-942-0247 (TTY Relay: Dial 7-1-1), 8:00 a.m. to 8:00 p.m., 7 days a week.
How do I use the Formulary?
There are two ways to find your drug within the formulary:
Medical Condition
The formulary begins on page 1. The drugs in this formulary are grouped into categories depending on the type of
medical conditions that they are used to treat. For example, drugs used to treat a heart condition are listed under the
category, “Cardiovascular Medications”. If you know what your drug is used for, look for the category name in the list
that begins on page number 37. Then look under the category name for your drug.
Alphabetical Listing
If you are not sure what category to look under, you should look for your drug in the Index that begins on page 37.
The Index provides an alphabetical list of all of the drugs included in this document. Both brand name drugs and
generic drugs are listed in the Index. Look in the Index and find your drug. Next to your drug, you will see the page
number where you can find coverage information. Turn to the page listed in the Index and find the name of your drug
in the first column of the list.
What are generic drugs?
Community HealthFirst covers both brand name drugs and generic drugs. A generic drug is approved by the FDA as
having the same active ingredient as the brand name drug. Generally, generic drugs cost less than brand name drugs.
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Are there any restrictions on my coverage?
Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may
include:
•
Prior Authorization: Community HealthFirst requires you or your physician to get prior authorization for
certain drugs. This means that you will need to get approval from Community HealthFirst before you fill your
prescriptions. If you don’t get approval, Community HealthFirst may not cover the drug.
•
Quantity Limits: For certain drugs, Community HealthFirst limits the amount of the drug that Community
HealthFirst will cover. For example, Community HealthFirst provides 68 tablets per prescription for bupropion
hcl. This may be in addition to a standard one month or three month supply.
•
Step Therapy: In some cases, Community HealthFirst requires you to first try certain drugs to treat your
medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B
both treat your medical condition, Community HealthFirst may not cover Drug B unless you try Drug A first.
If Drug A does not work for you, Community HealthFirst will then cover Drug B.
You can find out if your drug has any additional requirements or limits by looking in the formulary that begins on page
1. You can also get more information about the restrictions applied to specific covered drugs by visiting our web site
at www.healthfirst.chpw.org. Our contact information, along with the date we last updated the formulary, appears on
the front and back cover pages.
You can ask Community HealthFirst to make an exception to these restrictions or limits or for a list of other, similar
drugs that may treat your health condition. See the section, “How do I request an exception to the Community
HealthFirst’s formulary?” on page 3 for information about how to request an exception.
What if my drug is not on the Formulary?
If your drug is not included in this formulary (list of covered drugs), you should first contact Customer Service and
confirm that your drug is not covered. If you learn that Community HealthFirst does not cover your drug, you have
two options:
•
You can ask Customer Service for a list of similar drugs that are covered by Community HealthFirst. When
you receive the list, show it to your doctor and ask him or her to prescribe a similar drug that is covered by
Community HealthFirst.
•
You can ask Community HealthFirst to make an exception and cover your drug. See below for information
about how to request an exception.
How do I request an exception to the Community HealthFirst Formulary?
You can ask Community HealthFirst to make an exception to our coverage rules. There are several types of
exceptions that you can ask us to make.
•
You can ask us to cover your drug even if it is not on our formulary. If approved, this drug will be covered at
a pre-determined cost-sharing level, and you would not be able to ask us to provide the drug at a lower costsharing level.
•
You can ask us to waive coverage restrictions or limits on your drug. For example, for certain drugs,
Community HealthFirst limits the amount of the drug that we will cover. If your drug has a quantity limit, you
can ask us to waive the limit and cover more.
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Generally, Community HealthFirst will only approve your request for an exception if the alternative drugs included
on the plan’s formulary or additional utilization restrictions would not be as effective in treating your condition and/or
would cause you to have adverse medical effects.
You should contact us to ask us for an initial coverage decision for a formulary or utilization restriction exception.
When you are requesting a formulary or utilization restriction exception you should submit a statement
from your physician supporting your request. Generally, we must make our decision within 72 hours of getting
your prescriber’s or prescribing physician’s supporting statement. You can request an expedited (fast) exception if
you or your doctor believe that your health could be seriously harmed by waiting up to 72 hours for a decision. If your
request to expedite is granted, we must give you a decision no later than 24 hours after we get your prescriber’s or
prescribing physician’s supporting statement.
What do I do before I can talk to my doctor about changing my drugs or requesting an exception?
As a new or continuing member in our plan you may be taking drugs that are not on our formulary. Or, you may
be taking a drug that is on our formulary but your ability to get it is limited. For example, you may need a prior
authorization from us before you can fill your prescription. You should talk to your doctor to decide if you should
switch to an appropriate drug that we cover or request a formulary exception so that we will cover the drug you take.
While you talk to your doctor to determine the right course of action for you, we may cover your drug in certain cases
during the first 90 days you are a member of our plan.
For each of your drugs that is not on our formulary or if your ability to get your drugs is limited, we will cover
a temporary 34-day supply (unless you have a prescription written for fewer days) when you go to a network
pharmacy. After your first 34-day supply, we will not pay for these drugs, even if you have been a member of the plan
less than 90 days.
If you are a resident of a long-term care facility, we will allow you to refill your prescription until we have provided you
with a 91 day supply and may be up to a 98 day supply, consistent with the dispensing increment (unless you have
a prescription written for fewer days). We will cover more than one refill of these drugs for the first 90 days you are
a member of our plan. If you need a drug that is not on our formulary or if your ability to get your drugs is limited,
but you are past the first 90 days of membership in our plan, we will cover a 34-day emergency supply of that drug
(unless you have a prescription written for fewer days) while you pursue a formulary exception.
Community HealthFirst will extend an override to current enrollees who experience level of care changes, such as a
change in treatment settings. This allowance will be made for the 30-day period following the level of care change.
For more information
For more detailed information about your Community HealthFirst prescription drug coverage, please review your
Evidence of Coverage and other plan materials.
If you have questions about Community HealthFirst, please call Customer Service at 1-800-942-0247 (TTY Relay:
Dial 7-1-1), 8:00 a.m. to 8:00 p.m., 7 days a week. Or visit www.healthfirst.chpw.org.
If you have general questions about Medicare prescription drug coverage, please call Medicare at 1-800-MEDICARE
(1-800-633-4227) 24 hours a day/7 days a week. TTY/TDD users should call 1-877-486-2048. Or, visit www.
medicare.gov.
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Community HealthFirst Formulary
The formulary that begins on page 1 provides coverage information about some of the drugs covered by Community
HealthFirst. If you have trouble finding your drug in the list, turn to the Index that begins on page 37.
The first column of the chart lists the drug name. Brand name drugs are capitalized (such as CRESTOR) and generic
drugs are listed in lower-case italics (such as simvastatin).
The information in the Requirements/Limits column tells you if Community HealthFirst has any special requirements
for coverage of your drug.
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Planes Medicare Advantage de Community HealthFirst™
Formulario de Medicamentos de Prescripción para 2014
Community HealthFirst MA Pharmacy Plan (HMO)
Community HealthFirst MA Extra Plan (HMO)
POR FAVOR LEA. ESTE DOCUMENTO CONTIENE INFORMACIÓN ACERCA DE LOS MEDICAMENTOS QUE
CUBRIMOS EN ESTE PLAN.
Nota para los miembros existentes: Este formulario ha cambiado desde el año pasado. Por favor revise este
documento para asegurarse de que todavía contiene los medicamentos que usted toma. Los beneficiarios deben
utilizar las farmacias de la red para acceder a su beneficio de medicamentos recetados. Los beneficios, la lista
farmacológica, la red de farmacias, las primas, los copagos y el coaseguro pueden cambiar el 1 de Enero de 2014.
Todos los beneficiarios deben utilizar las farmacias de la red del patrocinador de su plan para tener acceso a su
beneficio de medicamentos con receta médica, excepto bajo circunstancias fuera de la rutina. Es posible que se
apliquen limitaciones de cantidad y restricciones.
Todos los beneficiarios deben utilizar las farmacias de la red del patrocinador de su plan para tener acceso a su
beneficio de medicamentos con receta médica, excepto bajo circunstancias fuera de la rutina. Es posible que se
apliquen limitaciones de cantidad y restricciones.
Los planes de Medicare Advantage de Community HealthFirst™ los ofrece Community Health Plan of Washington,
que es una HMO calificada federalmente con un contrato de Medicare.
Si necesita recibir la información en otro formato o idioma llame a Community HealthFirst al 1-800-944-1247
(TTY Relay: marque 7-1-1). Elhorario de la oficina es de 08:00 a.m. – 8:00 p.m., los 7 días de la semana.
HPMS Approved Formulary File Submission ID 13230, Version 5
H5826_MA_047_2014 _v_01_FormularyPharmacy3tier CMS Approved
vi
¿Qué es el Formulario de Community HealthFirst?
Un formulario es una lista de los medicamentos seleccionados por Community HealthFirst en consulta con un
equipo de proveedores de atención a la salud, el cual representa las terapias con receta médica que se considera
que son una parte necesaria de un programa de tratamiento de calidad. Community HealthFirst generalmente
cubrirá los medicamentos listados en nuestro formulario, siempre que el medicamento sea médicamente necesario,
la receta médica sea abastecida en una farmacia de la red de Community HealthFirst, y se sigan las otras reglas
del plan. Para mayor información sobre cómo abastecer sus recetas médicas, por favor examine su Evidencia de
Cobertura.
¿Puede cambiar el Formulario?
Generalmente, si usted está tomando un medicamento contenido en nuestro formulario 2014 que estaba cubierto a
principios del año, nosotros no descontinuaremos ni reduciremos la cobertura del medicamento durante el año 2014
de cobertura, excepto cuando un nuevo medicamento genérico, menos caro, llegue a estar disponible o cuando se
revele una nueva información adversa acerca de la seguridad o la efectividad de un medicamento. Otros tipos de
cambio en el formulario, tales como el retirar un medicamento de nuestro formulario, no afectarán a los miembros
que estén tomando el medicamento actualmente. Este permanecerá disponible al mismo costo compartido para
aquellos miembros que lo estén tomando durante el resto del año de cobertura. Consideramos que es importante
que usted tenga un acceso continuo durante el resto del año de cobertura a los medicamentos del formulario que
estaban disponibles cuando usted eligió nuestro plan, excepto para los casos en los cuales usted puede ahorrar
dinero adicional o podamos mejorar su seguridad.
Si retiramos los medicamentos de nuestro formulario, o aumentamos el requisito de autorización previa, los límites
de cantidades y/o agregamos restricciones graduales en la terapia con un medicamento, debemos notificar a
los miembros afectados por el cambio al menos 60 días antes de que el cambio llegue a entrar en vigencia, o
en el momento en que el miembro solicite una nueva provisión del medicamento, en cuyo momento el miembro
recibirá una provisión del medicamento para 60 días. Si la Administración de Alimentos y Medicamentos considera
que un medicamento en nuestro formulario es peligroso o el fabricante del medicamento retira el medicamento
del mercado, nosotros retiraremos inmediatamente el medicamento de nuestro formulario y proporcionaremos
notificación a los miembros que estén tomando el medicamento. El formulario adjunto entra en vigencia a partir del
24 de agosto de 2012. Para obtener información actualizada acerca de los medicamentos cubiertos por Community
HealthFirst, por favor visite nuestro sitio Web www.healthfirst.cphw.org o llame al Servicio al Cliente, durante las
horas de 8 am a 8 pm, 7 días a la semana, al 1-800-942-0247, (Los usuarios con TTY deben marcar 711)
¿Cómo uso el Formulario?
Hay dos maneras de encontrar su medicamento dentro del formulario.
Afección médica
El formulario comienza en la página 1 Los medicamentos en este formulario están agrupados en categorías,
dependiendo del tipo de las afecciones médicas que se tratan con su uso. Por ejemplo, los medicamentos
usados para tratar una afección cardiaca están listados bajo la categoría, “Medicamentos Cardiovasculares”. Si
usted sabe para qué se usa su medicamento, busque el nombre de la categoría en la lista que empieza en la
página 37. Luego busque su medicamento bajo el nombre de la categoría.
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Listado alfabético
Si no está seguro sobre qué categoría buscar, debe buscar su medicamento en el Índice que empieza en
la página 1. El Índice proporciona un listado alfabético de todos los medicamentos que se incluyen en este
documento. Tanto los medicamentos de marca, como los medicamentos genéricos están listados en el Índice.
Busque en el Índice para encontrar su medicamento. Junto a su medicamento, verá el número de página donde
puede encontrar la información de cobertura. Vaya a la página listada en el Índice y encuentre el nombre de su
medicamento en la primera columna de la lista.
¿Qué son las drogas genéricas?
Community HealthFirst cubre los medicamentos de marca y los medicamentos genéricos. Un medicamento
genérico está aprobado por la Administración de Alimentos y Medicamentos (FDA) ya que tiene los mismos
ingredientes activos que el medicamento de marca. Los medicamentos genéricos normalmente cuestan menos que
los medicamentos de marca. .
¿Existen algunas restricciones en mi cobertura?
Es posible que algunos medicamentos cubiertos tengan requerimientos adicionales o límites de cobertura. Estos
requerimientos y límites pueden incluir:
•
Autorización previa: Community HealthFirst requiere que usted o su médico obtengan una autorización
previa para ciertos medicamentos. Esto significa que usted necesitará obtener aprobación de Community
HealthFirst antes de abastecer sus recetas médicas. Si usted no obtiene aprobación, es posible que
Community HealthFirst no cubra el medicamento.
•
Límites de cantidad: para ciertos medicamentos, Community HealthFirst limita la cantidad del
medicamento que Community HealthFirst cubrirá. Por ejemplo, Community HealthFirst proporciona 68
tabletas por prescripción de Bupropion hcl. Esto puede ser en adición a una provisión normal para un mes o
para tres meses.
•
Restricciones graduales en la terapia: En algunos casos, Community HealthFirst requiere que usted
pruebe primero ciertos medicamentos para tratar su afección médica antes de que nosotros cubramos otro
medicamento para esa afección. Por ejemplo, si el Medicamento A y el Medicamento B tratan su afección
médica, es posible que Community HealthFirst no cubra el medicamento B a menos que usted pruebe
primero el medicamento A. Si el medicamento A no funciona para usted, entonces Community HealthFirst
cubrirá el medicamento B.
Para averiguar si su medicamento tiene algunos requerimientos adicionales o límites, consulte el formulario que
empieza en la página 1. También puede obtener información adicional acerca de las restricciones que se aplican a
medicamentos específicos cubiertos visitando nuestro sitio Web en www.healthfirst.chpw.org.
Usted puede pedir que Community HealthFirst haga una excepción a estas restricciones o límites. Vea la sección,
“¿Cómo solicito una excepción al formulario de Community HealthFirst?” en la página 9 para información acerca de
cómo solicitar una excepción.
¿Qué sucede si mi medicamento no está en el Formulario?
Si su medicamento no está incluido en este formulario, deberá ponerse en contacto primero con Servicio al
Cliente y preguntar si su medicamento está cubierto. Si usted se entera que Community HealthFirst no cubre su
medicamento, tiene dos opciones:
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•
Puede pedir a Servicio al Cliente una lista de medicamentos similares que están cubiertos por Community
HealthFirst. Cuando usted reciba la lista, muéstresela a su médico y pídale que prescriba un medicamento
similar que está cubierto por Community HealthFirst.
•
Usted puede pedir a Community HealthFirst que haga una excepción y cobra su medicamento. Lea la
siguiente sección para información sobre cómo solicitar una excepción.
¿Cómo puedo solicitar una excepción para el Formulario de Community HealthFirst?
Usted puede pedir que Community HealthFirst haga una excepción a nuestras reglas de cobertura. Existen varios
tipos de excepciones que usted puede pedirnos que hagamos.
•
Usted puede pedirnos que cubramos su medicamento incluso si no está en nuestro formulario.
•
Usted puede pedirnos que suspendamos las restricciones de cobertura o los límites sobre su medicamento.
Por ejemplo, para ciertos medicamentos, Community HealthFirst limita la cantidad del medicamento que
cubriremos. Si su medicamento tiene un límite de cantidad, usted puede pedirnos que no apliquemos el
límite y cubramos más.
Generalmente, Community HealthFirst aprobará su solicitud de una excepción solamente si los medicamentos
alternativos incluidos en el formulario del plan, o las restricciones de utilización adicionales no serían tan eficaces
para tratar su afección y/o causarían que usted tenga efectos médicos adversos.
Usted deberá comunicarse con nosotros para pedirnos una decisión inicial con respecto a una cobertura para
un formulario, o una excepción para la restricción en el uso. Cuando esté solicitando un formulario, o esté
utilizando una excepción a la restricción, deberá presentar una declaración de su médico apoyando su solicitud.
Generalmente, nosotros debemos tomar nuestra decisión en menos de 72 horas de haber recibido la declaración de
apoyo del médico que emitió la receta médica. Usted puede solicitar una excepción acelerada (rápida) si usted o su
médico consideran que su salud podría sufrir serios daños por esperar 72 horas para una decisión. Si se otorga su
solicitud de apresurar la decisión, nosotros debemos darle una decisión no después de las 24 horas posteriores a
cuando recibimos la declaración de apoyo del médico que emitió la receta médica.
¿Qué debo hacer antes de hablar con mi médico acerca de cambiar mis medicamentos o solicitar una
excepción?
Como miembro nuevo o continuo en nuestro plan, usted puede estar tomando medicamentos que no están en
nuestro formulario. O, usted podría estar tomando un medicamento que se encuentra en nuestro formulario pero
su posibilidad de obtenerlo es limitada. Por ejemplo, puede que necesite una autorización previa de nosotros antes
de que pueda surtir su receta. Usted debe hablar con su médico para decidir si debe cambiar a un medicamento
apropiado que cubramos o solicitar una excepción al formulario para que cubramos el medicamento que toma.
Mientras que usted habla con su médico para determinar el curso correcto de acción para usted, podemos cubrir su
medicamento en ciertos casos durante los primeros 90 días que usted sea miembro de nuestro plan.
Para cada uno de sus medicamentos que no esté en nuestro formulario o si su habilidad para obtener sus
medicamentos es limitada, cubriremos un suministro temporal de 34 días (a menos que tenga una receta por menos
días) cuando vaya a una farmacia de la red. Después de su primer suministro de 34 días, no pagaremos por estos
medicamentos, incluso si usted ha sido miembro del plan por menos de 90 días.
Si usted es un residente de un centro de cuidado a largo plazo, le permitiremos surtir su receta hasta que
hayamos proporcionado un suministro de 91 días y puede ser hasta un suministro de 98 días consistente con el
incremento de suministro (a menos que tenga una receta por menos días). Cubriremos más de un suministro de
estos medicamentos durante los primeros 90 días que usted sea un miembro de nuestro plan. Si usted necesita
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un medicamento que no esté en nuestro formulario o si su habilidad para obtener sus medicamentos es limitada,
pero ya ha pasado los primeros 90 días de membresía en nuestro plan, cubriremos un suministro de emergencia
de 34 días de ese medicamento (a menos que tenga una receta por menos días) mientras solicita una excepción al
formulario
Community HealthFirst extenderá una anulación a afiliados actuales que experimentan cambios en el nivel de
cuidado, tal como un cambio en la configuración del tratamiento. Esta autorización se hará por el período de 30 días
siguientes al cambio de nivel de cuidado.
Para mayor información
Para obtener información más detallada acerca de su cobertura de medicamentos con receta médica de Community
HealthFirst, por favor examine su Evidencia de Cobertura y los otros materiales del plan.
Si tiene preguntas acerca de Community HealthFirst, por favor llame a Servicio al Cliente al 1-800-942-0247 (Los
usuarios con TTY deben marcar 711) de 8:00 a.m. a 8:00 p.m., los 7 días de la semana. O visite www.healthfirst.
chpw.org.
Si tiene preguntas generales acerca de la cobertura de Medicare para medicamentos con receta médica, por favor
llame a Medicare al 1-800-MEDICARE (1-800-633-4227) 24 horas al día / 7 días a la semana. Los usuarios de
TTY/TDD deberán llamar al 1-877-486-2048. O visite www.medicare.gov.
El Formulario de Community HealthFirst
El formulario que empieza en la página 1 proporciona información de cobertura acerca de algunos de los
medicamentos cubiertos por Community HealthFirst. Si tiene dificultades para encontrar su medicamento en la lista,
vaya al Índice que empieza en la página 37.
La primera columna de la tabla lista el nombre del medicamento. Los medicamentos de marca están en mayúsculas
(como CRESTOR) y los medicamentos genéricos aparecen en cursiva en minúsculas (por ejemplo, simvastatina).
La información en la columna de Requerimientos/Límites, le indica si Community HealthFirst tiene algunos
requerimientos especiales para la cobertura de su medicamento.
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Below is a list of abbreviations that may appear on the following pages in the Requirements/Limits column
that tells you if there are any special requirements for coverage of your drug.
List of Abbreviations
B/D: This prescription drug may be covered under Medicare Part B or D depending upon the circumstances.
Information may need to be submitted describing the use and setting of the drug to make the determination.
LA: Limited Availability. This prescription may be available only at certain pharmacies. For more
information, please call Customer Service.
PA: Prior Authorization. The Plan requires you or your physician to get prior authorization for certain drugs.
This means that you will need to get approval before you fill your prescriptions. If you don’t get approval, we
may not cover the drug.
QL: Quantity Limit. For certain drugs, the Plan limits the amount of the drug that we will cover.
ST: Step Therapy. In some cases, the Plan requires you to first try certain drugs to treat your medical
condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat
your medical condition, we may not cover Drug B unless you try Drug A first. If Drug A does not work for
you, we will then cover Drug B.
1
Updated 10/28/2014
Commonly Prescribed Therapeutic
Drug Categories
Drug
Name
APTIVUS
ATRIPLA
BARACLUDE ORAL SOLN
BARACLUDE TABS
cidofovir
COMPLERA
CRIXIVAN
didanosine
EDURANT
EMTRIVA
EPIVIR HBV
EPIVIR ORAL SOLN
EPZICOM
famciclovir
foscarnet sodium
FUZEON
ganciclovir
HEPSERA
INCIVEK
INTELENCE TABS 100MG,
200MG
INTELENCE TABS 25MG
INVIRASE CAPS
INVIRASE TABS
ISENTRESS CHEW 100MG
ISENTRESS CHEW 25MG
ISENTRESS PACK
ISENTRESS TABS
KALETRA ORAL SOLN
KALETRA TABS 200MG;
50MG
KALETRA TABS 100MG;
25MG
lamivudine
lamivudine/zidovudine
LEXIVA SUSP
LEXIVA TABS
moderiba tabs 200mg, 400mg
moderiba tabs 600mg
nevirapine
ANTI - INFECTIVES
ANTIFUNGAL AGENTS
Drug
Name
ABELCET
AMBISOME
amphotericin b
CANCIDAS
clotrimazole troc
fluconazole
fluconazole in dextrose
fluconazole in nacl
flucytosine
griseofulvin microsize
griseofulvin ultramicrosize
itraconazole
ketoconazole
LAMISIL PACK
MYCAMINE INJ 50MG
MYCAMINE INJ 100MG
NOXAFIL
nystatin susp
nystatin tabs
SPORANOX ORAL SOLN
terbinafine hcl tabs
VFEND SUSR
voriconazole inj
voriconazole susr
voriconazole tabs 200mg
voriconazole tabs 50mg
RequireDrug ments/
Tier
Limits
3
B/D PA
3
B/D PA
1
B/D PA
3
B/D PA
1
1
1
1
3
1
1
1 QL(360 per
90 days)
1
2
2
3
3
1
1
2
1
3
PA
1
3
PA
3
PA
1
PA
ANTIVIRALS
abacavir
abacavir
sulfate/lamivudine/zidovudine
acyclovir
acyclovir sodium inj
adefovir dipivoxil
amantadine hcl
1
3
1
1
3
1
B/D PA
Requirements/
Limits
Drug
Tier
3
3
2
3
3
B/D PA
3
2
1
3
2
2
2
3
1
1
B/D PA
3
1
3
3
PA
3
2
2
3
3
2
2
3
3
3
2
1
1
2
3
1
3
1
2
Updated 10/28/2014
Drug
Name
nevirapine er
NORVIR
OLYSIO
PREZISTA SUSP
PREZISTA TABS 600MG,
800MG
PREZISTA TABS 150MG,
75MG
RELENZA DISKHALER
Drug
Tier
1
2
3
3
3
Requirements/
Limits
Drug
Name
VALCYTE
VICTRELIS
VIDEX PEDIATRIC
VIRACEPT
VIRAMUNE SUSP
VIRAMUNE XR
VIRAZOLE
VIREAD
ZIAGEN ORAL SOLN
zidovudine
PA
2
2
RESCRIPTOR
RETROVIR IV INFUSION
REYATAZ CAPS 100MG
REYATAZ CAPS 150MG,
200MG, 300MG
ribapak misc
ribapak 200-400 mg tab
ribapak 400-400 mg tab, -600400 mg tab, -600-600 mg tab
ribasphere caps
ribasphere tabs 200mg, 400mg
ribasphere tabs 600mg
ribavirin
rimantadine hcl
SELZENTRY
SOVALDI
stavudine
STRIBILD
SUSTIVA
SYNAGIS INJ
TAMIFLU CAPS 45MG, 75MG
2
2
2
3
TAMIFLU CAPS 30MG
2
TAMIFLU SUSR
2
TIVICAY
TRIZIVIR
TRUVADA
TYZEKA
valacyclovir hcl
3
3
3
3
1
QL(60 per
180 days)
PA
CEPHALOSPORINS
cefaclor
cefaclor er
cefadroxil
cefazolin sodium inj 100gm,
10gm, 1gm, 1gm; 5%, 20gm,
500mg
cefazolin sodium/dextrose
cefdinir
cefditoren pivoxil tabs 200mg
cefepime inj 1gm, 1gm/50ml, 2gm,
2gm/100ml
cefotaxime sodium
cefotetan
cefoxitin sodium
cefpodoxime proxetil
cefprozil
ceftazidime inj 1gm, 2gm, 6gm
ceftibuten
ceftriaxone in iso-osmotic
dextrose
ceftriaxone sodium
ceftriaxone/dextrose
cefuroxime axetil tabs
cefuroxime sodium inj 1.5gm,
7.5gm, 750mg
cefuroxime/dextrose
cephalexin
SUPRAX
1
1
3
1
1
3
1
1
3
3
1
3
2
3
2
Drug
Tier
3
3
2
3
2
2
3
3
2
1
Requirements/
Limits
PA
LA
QL(42 per
180 days)
QL(84 per
180 days)
QL(600 per
180 days)
QL(90 per
90 days)
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
ERYTHROMYCINS / OTHER
MACROLIDES
3
Updated 10/28/2014
Drug
Name
azithromycin inj 500mg
azithromycin pack
azithromycin susr
azithromycin tabs
clarithromycin
clarithromycin er
e.e.s. 400
E.E.S. GRANULES
e.s.p.
ery-tab tbec 250mg, 333mg
ERY-TAB TBEC 500MG
ERYPED 200
ERYPED 400
ERYTHROCIN
LACTOBIONATE
erythrocin stearate
erythromycin
erythromycin base
erythromycin ethylsuccinate
Drug
Tier
1
1
1
1
1
1
1
2
1
1
2
2
2
2
Requirements/
Limits
Requirements/
Limits
Drug
Drug
Name
Tier
clindamycin phosphate in d5w
1
clindamycin phosphate inj
1
150mg/ml, 300mg/2ml,
600mg/4ml, 900mg/6ml
COARTEM
2
colistimethate sodium
1
CUBICIN
3
CYCLOSERINE
2
DAPSONE
2
DARAPRIM
2
DORIBAX INJ 500MG
2
ethambutol hcl
1
gentamicin sulfate
1
gentamicin sulfate pediatric
1
gentamicin sulfate/0.9% sodium
1
chloride
hydroxychloroquine sulfate
1
imipenem/cilastatin
1
INVANZ 1GM VIAL
2
isoniazid
1
isotonic gentamicin inj 0.8mg/ml; 1
0.9%, 1.2mg/ml; 0.9%, 1.6mg/ml;
0.9%, 1mg/ml; 0.9%
mefloquine hcl
1
MEPRON
3
meropenem
1
metro iv
1
metronidazole
1
metronidazole in nacl 0.79%
1
MYCOBUTIN
2
NEBUPENT
2
B/D PA
QL(3 per 84
days)
neomycin sulfate tabs
1
paromomycin sulfate
1
PASER
2
PENTAM 300
2
polymyxin b sulfate
1
PRIFTIN
2
PRIMAQUINE PHOSPHATE
2
pyrazinamide
1
1
1
1
1
MISCELLANEOUS ANTIINFECTIVES
ALBENZA
ALINIA
amikacin sulfate
atovaquone
atovaquone/proguanil hcl
aztreonam
baciim
bacitracin inj
BETHKIS
2
2
1
1
1
1
1
1
3
CAPASTAT SULFATE
CAYSTON
2
3
chloramphenicol sodium
succinate
chloroquine phosphate
clindamycin hcl
clindamycin palmitate hcl
clindamycin phosphate addvantage
1
B/D PA
QL(168 per
84 days)
LA QL(270
per 84 days)
1
1
1
1
4
Updated 10/28/2014
Drug
Name
quinine sulfate
rifabutin
rifampin
SEROMYCIN
SIRTURO
STREPTOMYCIN SULFATE
STROMECTOL
SYNERCID
tinidazole
TOBI
tobramycin
tobramycin sulfate
tobramycin sulfate/sodium
chloride
TRECATOR
TYGACIL
XIFAXAN TABS 200MG
XIFAXAN TABS 550MG
ZYVOX INJ
ZYVOX SUSR
ZYVOX TABS
Requirements/
Limits
Drug
Tier
1
1
1
2
3
LA
2
2
3
1
3
B/D PA
QL(168 per
84 days)
3
B/D PA
QL(168 per
84 days)
1
1
2
2
2
3
3
3
3
Drug
Name
nafcillin sodium inj 1gm vial
nallpen iso-osmotic in dextrose
nallpen/dextrose
oxacillin sodium inj 10gm, 2gm
oxacillin sodium inj 1gm
penicillin g potassium inj
20000000unit, 5mu
penicillin g procaine
penicillin g sodium
penicillin v potassium
pfizerpen-g
piperacillin sodium/tazobactam
sodium
1
1
1
1
1
QUINOLONES
AVELOX INJ
CIPRO SUSR
ciprofloxacin er
ciprofloxacin hcl
ciprofloxacin i.v.-in d5w
ciprofloxacin inj
ciprofloxacin susr
levofloxacin
levofloxacin in d5w
moxifloxacin hcl
ofloxacin
PA
PA
PENICILLINS
amoxicillin
amoxicillin/clavulanate potassium
amoxicillin/clavulanate potassium
er
ampicillin
ampicillin sodium
ampicillin-sulbactam
AUGMENTIN SUSR
125MG/5ML; 31.25MG/5ML
bactocill in dextrose inj 0;
2gm/50ml
bactocill in dextrose inj 0;
1gm/50ml
dicloxacillin sodium
nafcillin sodium inj 10gm, 1gm
add-vantage vial, 2gm
Drug
Tier
1
3
3
3
1
1
Requirements/
Limits
2
2
1
1
1
1
1
1
1
1
1
1
1
1
SULFA'S / RELATED AGENTS
1
1
1
2
TETRACYCLINES
sulfadiazine
sulfamethoxazole/trimethoprim
sulfamethoxazole/trimethoprim ds
demeclocycline hcl
doxy 100
doxycycline hyclate
doxycycline hyclate dr
doxycycline monohydrate caps
doxycycline monohydrate susr
doxycycline monohydrate tabs
150mg, 50mg, 75mg
minocycline hcl
minocycline hcl er
3
1
1
3
1
1
1
1
1
1
1
1
1
1
1
1
5
Updated 10/28/2014
Drug
Name
morgidox caps
ocudox
tetracycline hcl
Requirements/
Limits
Drug
Tier
1
1
1
Drug
Name
ALIMTA
ALKERAN TABS
anastrozole
ARRANON
ARZERRA
AVASTIN
azacitidine
AZASAN
azathioprine
BELEODAQ
bicalutamide
BICNU
bleomycin sulfate
BOSULIF TABS 100MG
BOSULIF TABS 500MG
URINARY TRACT AGENTS
MACRODANTIN CAPS 25MG
methenamine hippurate
methenamine mandelate
nitrofurantoin macrocrystals
nitrofurantoin monohydrate
nitrofurantoin
monohydrate/macrocrystals
nitrofurantoin susp
PRIMSOL
trimethoprim
2
1
1
1
1
1
1
2
1
VANCOMYCIN
vancomycin hcl caps
vancomycin hcl inj 1000mg,
10gm, 5000mg, 500mg, 750mg
3
1
ANTINEOPLASTIC /
IMMUNOSUPPRESSANT DRUGS
ADJUNCTIVE AGENTS
amifostine
dexrazoxane
ELITEK
FUSILEV
KEPIVANCE
leucovorin calcium
mesna
MESNEX TABS
XGEVA
3
3
3
3
3
1
1
3
3
ANTINEOPLASTIC /
IMMUNOSUPPRESSANT DRUGS
ABRAXANE
adriamycin
adrucil
AFINITOR DISPERZ
AFINITOR TABS 2.5MG, 5MG,
7.5MG
AFINITOR TABS 10MG
3
1
1
3
3
3
PA
PA
PA QL(180
per 90 days)
Drug
Tier
3
2
1
3
3
2
3
2
1
3
1
2
1
3
3
BUSULFEX
CAMPTOSAR INJ
300MG/15ML
CAPRELSA TABS 100MG
CAPRELSA TABS 300MG
3
2
carboplatin inj 150mg/15ml,
450mg/45ml, 50mg/5ml,
600mg/60ml
CEENU
CELLCEPT INTRAVENOUS
CELLCEPT SUSR
cisplatin
cladribine
CLOLAR
COMETRIQ
CYCLOPHOSPHAMIDE CAPS
cyclophosphamide inj
cyclophosphamide tabs
cyclosporine
cyclosporine modified
cytarabine aqueous
cytarabine inj 100mg, 100mg/ml,
1gm, 500mg
dacarbazine
1
3
3
2
2
3
1
3
3
3
2
1
1
1
1
1
1
Requirements/
Limits
B/D PA
B/D PA
B/D PA
PA
PA QL(90
per 90 days)
LA
LA QL(90
per 90 days)
B/D PA
B/D PA
PA
B/D PA
B/D PA
B/D PA
B/D PA
1
6
Updated 10/28/2014
Requirements/
Limits
Drug
Drug
Name
Tier
DACOGEN
3
dactinomycin
1
daunorubicin hcl inj 5mg/ml
1
DAUNOXOME
3
decitabine
3
DEPOCYT
3
DOCEFREZ
3
docetaxel inj 140mg/7ml,
3
160mg/16ml, 20mg/2ml, 20mg/ml,
80mg/4ml, 80mg/8ml
DOXIL
3
doxorubicin hcl inj 2mg/ml, 50mg 1
doxorubicin hcl liposome
3
DROXIA
2
ELIGARD
2
PA
ELSPAR
2
EMCYT
2
epirubicin hcl
1
ERBITUX
3
ERIVEDGE
3 PA QL(90
per 90 days)
ERWINAZE
3
ETOPOPHOS
2
etoposide inj
1
exemestane
1
FARESTON
2
FASLODEX
3
FIRMAGON INJ 120MG
3
FIRMAGON INJ 80MG
2
floxuridine
1
fludarabine phosphate
1
fluorouracil
1
flutamide
1
FOLOTYN
3
GAZYVA
3
gemcitabine hcl
3
gengraf
1
B/D PA
GILOTRIF TABS 40MG
3 PA QL(90
per 90 days)
GILOTRIF TABS 30MG
3 PA QL(120
per 90 days)
Drug
Name
GILOTRIF TABS 20MG
GLEEVEC TABS 100MG
GLEEVEC TABS 400MG
HALAVEN
hecoria caps 5mg
hecoria caps 0.5mg, 1mg
HERCEPTIN
HEXALEN
hydroxyurea
ICLUSIG TABS 45MG
ICLUSIG TABS 15MG
idarubicin hcl
ifosfamide
ifosfamide/mesna
IMBRUVICA
INLYTA TABS 1MG
INLYTA TABS 5MG
irinotecan
ISTODAX
IXEMPRA KIT
JAKAFI TABS 10MG, 15MG,
20MG, 5MG
JAKAFI TABS 25MG
JEVTANA
KADCYLA
letrozole
LEUKERAN
leuprolide acetate
lipodox
lipodox 50
LOMUSTINE
LUPRON DEPOT
LUPRON DEPOT-PED
LYSODREN
MATULANE
RequireDrug ments/
Tier
Limits
3 PA QL(180
per 90 days)
3
PA
3 PA QL(180
per 90 days)
3
3
B/D PA
1
B/D PA
3
3
1
3 PA QL(90
per 90 days)
3 PA QL(180
per 90 days)
1
1
3
3 QL(360 per
90 days)
3
PA
3 PA QL(360
per 90 days)
3
3
3
3
PA
3
3
3
1
2
1
3
3
2
3
3
2
3
PA QL(180
per 90 days)
PA
PA
7
Updated 10/28/2014
Drug
Name
MEGACE ES
megestrol acetate
MEKINIST TABS 2MG
MEKINIST TABS 0.5MG
melphalan hydrochloride
mercaptopurine
methotrexate
methotrexate sodium
mitomycin inj 20mg, 5mg
mitomycin inj 40mg
mitoxantrone hcl
MUSTARGEN
mycophenolate mofetil
mycophenolic acid dr
MYFORTIC
NEXAVAR
NILANDRON
NULOJIX
octreotide acetate inj
1000mcg/ml, 500mcg/ml
octreotide acetate inj 100mcg/ml,
200mcg/ml, 50mcg/ml
ONCASPAR
oxaliplatin
paclitaxel
pentostatin
PERJETA
POMALYST
PROGRAF INJ
RAPAMUNE ORAL SOLN
RAPAMUNE TABS 0.5MG,
1MG
RAPAMUNE TABS 2MG
REVLIMID
RITUXAN
SANDIMMUNE ORAL SOLN
SANDOSTATIN LAR DEPOT
SIGNIFOR
SIMULECT
Requirements/
Limits
Drug
Tier
2
1
3 PA QL(90
per 90 days)
3 PA QL(360
per 90 days)
3
1
1
B/D PA
1
B/D PA
1
3
1
2
1
B/D PA
1
B/D PA
2
B/D PA
3
LA PA
2
3
B/D PA
3
RequireDrug ments/
Tier
Limits
1
B/D PA
2
3
PA
Drug
Name
sirolimus
SOLTAMOX
SPRYCEL TABS 100MG,
20MG, 50MG, 80MG
SPRYCEL TABS 140MG
3
SPRYCEL TABS 70MG
3
STIVARGA
3
SUTENT CAPS 12.5MG,
37.5MG
SUTENT CAPS 50MG
3
SUTENT CAPS 25MG
3
SYLVANT INJ 100MG
SYNRIBO
TABLOID
tacrolimus caps 0.5mg, 1mg
tacrolimus caps 5mg
TAFINLAR CAPS 75MG
3
3
2
1
3
3
1
TAFINLAR CAPS 50MG
3
3
3
1
3
3
3
2
2
2
tamoxifen citrate
TARCEVA TABS 100MG,
25MG
TARCEVA TABS 150MG
1
3
TARGRETIN
TASIGNA CAPS 150MG
TASIGNA CAPS 200MG
3
3
3
TEMODAR INJ
THALOMID
thiotepa
toposar
topotecan hcl
TORISEL
TREANDA
TRELSTAR DEPOT
TRELSTAR DEPOT MIXJECT
3
3
3
1
3
3
3
3
3
3
3
3
2
3
3
2
B/D PA
B/D PA
B/D PA
B/D PA
LA
PA
B/D PA
PA
B/D PA
3
3
PA QL(90
per 90 days)
PA QL(180
per 90 days)
PA QL(252
per 84 days)
PA
PA QL(90
per 90 days)
PA QL(180
per 90 days)
B/D PA
B/D PA
PA QL(360
per 90 days)
PA QL(540
per 90 days)
PA
PA QL(90
per 90 days)
PA
PA QL(336
per 84 days)
PA
8
Updated 10/28/2014
Drug
Name
TRELSTAR LA
TRELSTAR LA MIXJECT
TRELSTAR MIXJECT
tretinoin caps
TRISENOX
TYKERB
Drug
Tier
3
3
3
3
3
3
VALSTAR
VANTAS
VECTIBIX
VELCADE
VIDAZA
vinblastine sulfate
vincasar pfs
vincristine sulfate
vinorelbine tartrate
VOTRIENT
3
2
3
3
3
1
1
1
1
3
XALKORI CAPS 200MG
XALKORI CAPS 250MG
3
3
XTANDI
3
YERVOY
ZALTRAP
ZANOSAR
ZELBORAF
3
3
2
3
ZOLADEX
ZOLINZA
ZORTRESS TABS 0.5MG,
0.75MG
ZORTRESS TABS 0.25MG
ZYDELIG
ZYKADIA
ZYTIGA
2
3
3
2
3
3
3
Requirements/
Limits
Drug
Drug
Name
Tier
APTIOM TABS 200MG,
2
400MG, 800MG
APTIOM TABS 600MG
3
BANZEL SUSP
2
BANZEL TABS 200MG
2
BANZEL TABS 400MG
3
carbamazepine
1
carbamazepine er
1
CELONTIN
2
clonazepam
1
clonazepam odt
1
diazepam gel
1
DILANTIN CAPS 30MG
2
divalproex sodium
1
divalproex sodium dr
1
divalproex sodium er
1
epitol
1
ethosuximide
1
felbamate
1
fosphenytoin sodium
1
FYCOMPA
2
gabapentin
1
GABITRIL TABS 12MG, 16MG 2
lamotrigine
1
lamotrigine er
1
levetiracetam er
1
levetiracetam inj 500mg/5ml
1
levetiracetam oral soln
1
levetiracetam tabs
1
LYRICA
2
ONFI SUSP
3
ONFI TABS
2
oxcarbazepine
1
PEGANONE
2
phenobarbital
1
phenobarbital sodium
1
phenytoin
1
phenytoin infatabs
1
phenytoin sodium
1
phenytoin sodium extended
1
LA PA
QL(540 per
90 days)
B/D PA
PA QL(360
per 90 days)
PA
PA QL(180
per 90 days)
PA QL(360
per 90 days)
PA QL(720
per 90 days)
B/D PA
B/D PA
PA
PA QL(360
per 90 days)
AUTONOMIC / CNS DRUGS,
NEUROLOGY / PSYCH
ANTICONVULSANTS
Requirements/
Limits
PA
PA
PA
PA
PA
PA
9
Updated 10/28/2014
Drug
Name
POTIGA
primidone
SABRIL
TEGRETOL-XR TB12 100MG
tiagabine hydrochloride
topiramate
valproate sodium
valproic acid
VIMPAT
zonisamide
Drug
Tier
2
1
3
2
1
1
1
1
2
1
Requirements/
Limits
RequireDrug
Drug ments/
Name
Tier
Limits
rizatriptan benzoate odt
1 QL(108 per
84 days)
sumatriptan nasal soln 20mg/act
1 QL(54 per
84 days)
sumatriptan nasal soln 5mg/act
1 QL(108 per
84 days)
sumatriptan succinate inj
1 QL(48 per
84 days)
sumatriptan succinate refill
1 QL(48 per
84 days)
sumatriptan succinate tabs
1 QL(54 per
84 days)
zolmitriptan
1 QL(54 per
84 days)
zolmitriptan odt
1 QL(54 per
84 days)
LA
PA
PA
ANTIPARKINSONISM AGENTS
APOKYN
AZILECT
benztropine mesylate
bromocriptine mesylate
carbidopa
carbidopa/levodopa
carbidopa/levodopa er
carbidopa/levodopa odt
carbidopa/levodopa/entacapone
entacapone
LODOSYN
pramipexole dihydrochloride
ropinirole er
ropinirole hcl
selegiline hcl
TASMAR
trihexyphenidyl hcl
3
2
1
1
1
1
1
1
1
1
2
1
1
1
1
3
1
LA
MISCELLANEOUS NEUROLOGICAL
THERAPY
MIGRAINE / CLUSTER HEADACHE
THERAPY
dihydroergotamine mesylate inj
dihydroergotamine mesylate
nasal soln
ERGOMAR
migergot
naratriptan hcl
1
1
rizatriptan benzoate
1
2
1
1
QL(24 per
84 days)
AMPYRA
COPAXONE INJ 20MG/ML
3
3
donepezil hcl
EXELON PT24
galantamine hydrobromide
GILENYA
NAMENDA
NAMENDA TITRATION PAK
NAMENDA XR
NAMENDA XR TITRATION
PACK
NUEDEXTA
rivastigmine tartrate
TECFIDERA
TECFIDERA STARTER PACK
TYSABRI
XENAZINE
1
2
1
3
2
2
2
2
2
1
3
3
3
3
LA PA
PA QL(90
per 90 days)
ST
PA
PA
PA
PA
LA PA
LA PA
MUSCLE RELAXANTS /
ANTISPASMODIC THERAPY
QL(54 per
84 days)
QL(108 per
84 days)
anectine
baclofen
chlorzoxazone
dantrolene sodium caps
1
1
1
1
PA
10
Updated 10/28/2014
Drug
Name
enlon
GABLOFEN
LIORESAL INTRATHECAL
MESTINON SYRP
MESTINON TIMESPAN
metaxalone
methocarbamol
neostigmine methylsulfate
orphenadrine citrate
orphenadrine citrate er
pyridostigmine bromide
revonto
tizanidine hcl
Requirements/
Limits
Drug
Tier
1
2
B/D PA
2
B/D PA
2
2
1
PA
1
PA
1
1
1
PA
1
1
1
NARCOTIC ANALGESICS
acetaminophen/caffeine/dihydroc
odeine bitartrate
acetaminophen/codeine #2
1
acetaminophen/codeine #3
1
acetaminophen/codeine oral soln
1
acetaminophen/codeine tabs
300mg; 60mg
acetaminophen/codeine tabs
300mg; 15mg
aspirin-caffeine-dihydrocodeine
1
buprenorphine hcl
codeine sulfate tabs
1
1
demerol inj 100mg/ml
duramorph
endocet
1
1
1
endodan
1
fentanyl citrate
fentanyl citrate oral transmucosal
lpop 1600mcg
fentanyl citrate oral transmucosal
lpop 1200mcg
1
3
1
1
1
3
QL(450 per
90 days)
QL(1080
per 90 days)
QL(1080
per 90 days)
QL(4500
per 30 days)
QL(540 per
90 days)
QL(1080
per 90 days)
QL(900 per
90 days)
QL(540 per
90 days)
QL(1080
per 90 days)
QL(1080
per 90 days)
PA QL(90
per 90 days)
PA QL(120
per 90 days)
RequireDrug
Drug ments/
Name
Tier
Limits
fentanyl citrate oral transmucosal 3 PA QL(180
lpop 800mcg
per 90 days)
fentanyl citrate oral transmucosal 3 PA QL(240
lpop 600mcg
per 90 days)
fentanyl citrate oral transmucosal 3 PA QL(360
lpop 200mcg, 400mcg
per 90 days)
fentanyl patches
1 QL(30 per
90 days)
hydrocodone
1
QL(5550
bitartrate/acetaminophen oral
per 30 days)
soln
hydrocodone
1
QL(1080
bitartrate/acetaminophen tabs
per 90 days)
300mg; 10mg, 300mg; 5mg,
300mg; 7.5mg, 325mg; 2.5mg
hydrocodone/acetaminophen
1
QL(1080
per 90 days)
hydrocodone/ibuprofen
1 QL(150 per
90 days)
hydromorphone hcl er t24a 12mg, 1 QL(180 per
16mg, 8mg
90 days)
hydromorphone hcl inj 1mg/ml,
1
2mg/ml, 4mg/ml, 500mg/50ml
hydromorphone hcl liqd
1
QL(4500
per 90 days)
hydromorphone hcl tabs
1 QL(540 per
90 days)
LAZANDA
3
LA PA
QL(69 per
90 days)
levorphanol tartrate
1 QL(360 per
90 days)
lorcet
1
QL(1080
per 90 days)
lorcet hd
1
QL(1080
per 90 days)
lorcet plus
1
QL(1080
per 90 days)
lortab tabs
1
QL(1080
per 90 days)
meperidine hcl inj
1
methadone hcl inj
1
methadone hcl intensol
1 QL(270 per
90 days)
11
Updated 10/28/2014
RequireDrug
Drug ments/
Name
Tier
Limits
methadone hcl oral soln
1
QL(1350
per 90 days)
methadone hcl tabs
1 QL(270 per
90 days)
methadone hcl tbso
1 QL(90 per
90 days)
methadose conc
1 QL(270 per
90 days)
methadose tbso
1 QL(90 per
90 days)
morphine sulfate er cp24
1 QL(150 per
(multiphase) 120mg
90 days)
morphine sulfate er cp24
1 QL(180 per
(multiphase) 30mg, 45mg, 60mg,
90 days)
75mg, 90mg
morphine sulfate er cp24 100mg
1 QL(180 per
90 days)
morphine sulfate er cp24 80mg
1 QL(225 per
90 days)
morphine sulfate er cp24 10mg,
1 QL(270 per
20mg, 30mg, 50mg, 60mg
90 days)
morphine sulfate er tbcr 200mg
1 QL(90 per
90 days)
morphine sulfate er tbcr 100mg
1 QL(180 per
90 days)
morphine sulfate er tbcr 60mg
1 QL(300 per
90 days)
morphine sulfate er tbcr 15mg,
1 QL(360 per
30mg
90 days)
morphine sulfate inj 0.5mg/ml,
1
10mg/ml, 150mg/30ml, 15mg/ml,
1mg/ml, 25mg/ml, 2mg/ml,
4mg/ml, 50mg/ml, 8mg/ml
morphine sulfate oral soln
1 QL(900 per
20mg/ml
90 days)
morphine sulfate oral soln
1
QL(2700
10mg/5ml, 20mg/5ml
per 90 days)
morphine sulfate supp
1
morphine sulfate tabs
1 QL(540 per
90 days)
oxycodone hcl caps
1
QL(1080
per 90 days)
oxycodone hcl conc
1 QL(540 per
90 days)
RequireDrug
Drug ments/
Name
Tier
Limits
oxycodone hcl oral soln
1
QL(3600
per 90 days)
oxycodone hcl tabs 30mg
1 QL(399 per
90 days)
oxycodone hcl tabs 10mg, 15mg,
1 QL(540 per
20mg
90 days)
oxycodone hcl tabs 5mg
1
QL(1080
per 90 days)
oxycodone/acetaminophen
1
QL(1080
per 90 days)
oxycodone/aspirin
1
QL(1080
per 90 days)
oxycodone/ibuprofen
1 QL(84 per
90 days)
oxymorphone hydrochloride er
1 QL(270 per
90 days)
oxymorphone hydrochloride tabs 1 QL(540 per
5mg
90 days)
oxymorphone hydrochloride tabs 1 QL(600 per
10mg
90 days)
reprexain
1 QL(150 per
90 days)
roxicet tabs
1
QL(1080
per 90 days)
sublimaze
1
vicodin
1
QL(1080
per 90 days)
vicodin es
1
QL(1080
per 90 days)
vicodin hp
1
QL(1080
per 90 days)
zamicet
1
QL(5550
per 30 days)
NON-NARCOTIC ANALGESICS
buprenorphine hcl/naloxone hcl
1
butorphanol tartrate
CELEBREX
clonidine hcl inj
diclofenac potassium
diclofenac sodium dr
diclofenac sodium er
diclofenac sodium transdermal
soln
1
2
1
1
1
1
1
PA QL(270
per 90 days)
ST
B/D PA
12
Updated 10/28/2014
Drug
Name
diclofenac sodium/misoprostol
diflunisal
etodolac
etodolac er
fenoprofen calcium
flurbiprofen
ibuprofen susp
ibuprofen tabs 400mg, 600mg,
800mg
indomethacin
indomethacin er
indomethacin sodium
ketoprofen
ketoprofen er
ketorolac tromethamine
meclofenamate sodium
mefenamic acid
meloxicam susp
meloxicam tabs 15mg
meloxicam tabs 7.5mg
Drug
Tier
1
1
1
1
1
1
1
1
nabumetone
nalbuphine hcl
naloxone hcl
naltrexone hcl
naproxen
naproxen dr
naproxen sodium tabs 275mg,
550mg
oxaprozin
piroxicam
PRIALT INJ 100MCG/ML,
500MCG/20ML
salsalate tabs 750mg
SUBOXONE
1
1
1
1
1
1
1
sulindac
tolmetin sodium
tramadol hcl
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
1
2
Requirements/
Limits
Drug
Name
tramadol hcl er tb24
tramadol
hydrochloride/acetaminophen
VOLTAREN GEL
RequireDrug ments/
Tier
Limits
1 QL(90 per
90 days)
1 QL(720 per
90 days)
2
ST
PSYCHOTHERAPEUTIC DRUGS
QL(90 per
90 days)
B/D PA
PA QL(270
per 90 days)
QL(720 per
90 days)
ABILIFY DISCMELT TBDP
15MG
ABILIFY DISCMELT TBDP
10MG
ABILIFY INJ
ABILIFY MAINTENA
ABILIFY ORAL SOLN
ABILIFY TABS 15MG
2
ABILIFY TABS 10MG
2
ABILIFY TABS 5MG
2
ABILIFY TABS 2MG
2
ABILIFY TABS 30MG
3
ABILIFY TABS 20MG
3
amitriptyline hcl
amoxapine
amphetamine/dextroamphetamine
BRINTELLIX TABS 20MG
1
1
1
2
BRINTELLIX TABS 10MG
2
BRINTELLIX TABS 5MG
2
budeprion sr tb12 150mg
1
budeprion sr tb12 100mg
1
bupropion hcl
bupropion hcl sr tb12 200mg
1
1
bupropion hcl sr tb12 150mg
1
2
2
3
2
2
QL(180 per
90 days)
QL(270 per
90 days)
QL(180 per
90 days)
QL(270 per
90 days)
QL(540 per
90 days)
QL(1350
per 90 days)
QL(90 per
90 days)
QL(180 per
90 days)
PA
QL(90 per
90 days) ST
QL(180 per
90 days) ST
QL(360 per
90 days) ST
QL(270 per
90 days)
QL(360 per
90 days)
QL(180 per
90 days)
QL(270 per
90 days)
13
Updated 10/28/2014
Drug
Name
bupropion hcl sr tb12 100mg
bupropion hcl xl tb24 300mg
bupropion hcl xl tb24 150mg
buspirone hcl
chlorpromazine hcl inj
chlorpromazine hcl tabs
citalopram hydrobromide oral
soln
citalopram hydrobromide tabs
40mg
citalopram hydrobromide tabs
20mg
citalopram hydrobromide tabs
10mg
clomipramine hcl
clonidine hcl er
clorazepate dipotassium
clozapine
clozapine odt
CYMBALTA CPEP 60MG
RequireDrug ments/
Tier
Limits
1 QL(360 per
90 days)
1 QL(180 per
90 days)
1 QL(270 per
90 days)
1
1
1
1
1
1
1
1
1
1
1
1
2
CYMBALTA CPEP 30MG
2
CYMBALTA CPEP 20MG
2
desipramine hcl
dexedrine tabs
dexmethylphenidate hcl
dexmethylphenidate hcl er
dextroamphetamine sulfate
dextroamphetamine sulfate er
diazepam inj 5mg/ml
diazepam intensol
diazepam oral soln
diazepam tabs
doxepin hcl
duloxetine hcl cpep 60mg
1
1
1
1
1
1
1
1
1
1
1
1
duloxetine hcl cpep 30mg
1
Drug
Name
duloxetine hcl cpep 20mg
EMSAM
ergoloid mesylates
escitalopram oxalate oral soln
escitalopram oxalate tabs 20mg
escitalopram oxalate tabs 10mg
escitalopram oxalate tabs 5mg
QL(90 per
90 days)
QL(180 per
90 days)
QL(360 per
90 days)
PA
PA
PA
eszopiclone
FANAPT TABS 12MG
FANAPT TABS 10MG, 8MG
FANAPT TABS 6MG
FANAPT TABS 4MG
FANAPT TABS 2MG
PA QL(180
per 90 days)
PA QL(360
per 90 days)
PA QL(540
per 90 days)
PA
PA
PA
PA
PA
QL(180 per
90 days)
QL(360 per
90 days)
FANAPT TABS 1MG
FANAPT TITRATION PACK
FAZACLO TBDP 150MG,
200MG
FETZIMA CP24 120MG
RequireDrug ments/
Tier
Limits
1 QL(540 per
90 days)
2
1
1
1 QL(90 per
90 days)
1 QL(180 per
90 days)
1 QL(360 per
90 days)
1
ST
2 QL(180 per
90 days)
2 QL(270 per
90 days)
2 QL(360 per
90 days)
2 QL(540 per
90 days)
2
QL(1080
per 90 days)
2
QL(2160
per 90 days)
2 QL(1 per 90
days)
2
2
FETZIMA CP24 80MG
2
FETZIMA CP24 40MG
2
FETZIMA CP24 20MG
2
FETZIMA TITRATION PACK
2
flumazenil
fluoxetine dr
1
1
fluoxetine hcl caps 20mg
fluoxetine hcl caps 40mg
1
1
PA QL(90
per 90 days)
PA QL(135
per 90 days)
PA QL(270
per 90 days)
PA QL(540
per 90 days)
PA QL(28
per 90 days)
QL(12 per
84 days)
QL(180 per
90 days)
14
Updated 10/28/2014
RequireDrug
Drug ments/
Name
Tier
Limits
fluoxetine hcl caps 10mg
1 QL(720 per
90 days)
fluoxetine hcl oral soln
1
fluoxetine hcl tabs 20mg
1
fluoxetine hcl tabs 10mg
1 QL(720 per
90 days)
fluphenazine decanoate
1
fluphenazine hcl
1
fluvoxamine maleate er cp24
1 QL(180 per
150mg
90 days)
fluvoxamine maleate er cp24
1 QL(270 per
100mg
90 days)
fluvoxamine maleate tabs 100mg
1 QL(270 per
90 days)
fluvoxamine maleate tabs 50mg
1 QL(540 per
90 days)
fluvoxamine maleate tabs 25mg
1
QL(1080
per 90 days)
GEODON INJ
2
guanidine hcl
1
haloperidol
1
haloperidol decanoate
1
haloperidol lactate
1
imipramine hcl
1
PA
imipramine pamoate
1
PA
INTUNIV
2
PA
INVEGA SUSTENNA INJ
2
39MG/0.25ML, 78MG/0.5ML
INVEGA SUSTENNA INJ
3
117MG/0.75ML, 156MG/ML,
234MG/1.5ML
INVEGA TB24 9MG
2 QL(122 per
90 days)
INVEGA TB24 6MG
2 QL(180 per
90 days)
INVEGA TB24 3MG
2 QL(360 per
90 days)
INVEGA TB24 1.5MG
2 QL(720 per
90 days)
LATUDA TABS 60MG, 80MG
2 QL(180 per
90 days)
LATUDA TABS 40MG
2 QL(360 per
90 days)
Drug
Name
LATUDA TABS 20MG
LATUDA TABS 120MG
lithium carbonate
lithium carbonate er
lithium citrate
lorazepam conc
lorazepam inj 2mg/ml, 4mg/ml
lorazepam intensol
lorazepam tabs
loxapine caps 25mg
loxapine succinate
maprotiline hcl
MARPLAN
metadate er
methamphetamine hcl
methylphenidate hcl
methylphenidate hcl cd
methylphenidate hcl er
methylphenidate hcl sr
methylphenidate hydrochloride
mirtazapine
mirtazapine odt
modafinil
nefazodone hcl
nortriptyline hcl
olanzapine inj
olanzapine odt tbdp 20mg
olanzapine odt tbdp 15mg
olanzapine odt tbdp 10mg
olanzapine odt tbdp 5mg
olanzapine tabs 20mg
olanzapine tabs 15mg
olanzapine tabs 10mg
RequireDrug ments/
Tier
Limits
2 QL(720 per
90 days)
3 QL(90 per
90 days)
1
1
1
1
PA
1
PA
1
PA
1
PA
1
1
1
2
1
1
1
1
1
1
1
1
1
1
PA
1
1
1
1 QL(90 per
90 days)
1 QL(122 per
90 days)
1 QL(180 per
90 days)
1 QL(360 per
90 days)
1 QL(90 per
90 days)
1 QL(122 per
90 days)
1 QL(180 per
90 days)
15
Updated 10/28/2014
Drug
Name
olanzapine tabs 7.5mg
olanzapine tabs 5mg
olanzapine tabs 2.5mg
olanzapine/fluoxetine
ORAP
oxazepam
paroxetine hcl er tb24 37.5mg
paroxetine hcl er tb24 25mg
paroxetine hcl er tb24 12.5mg
paroxetine hcl tabs 40mg
paroxetine hcl tabs 30mg
paroxetine hcl tabs 20mg
paroxetine hcl tabs 10mg
PAXIL SUSP
perphenazine
perphenazine/amitriptyline
phenelzine sulfate
PRISTIQ TB24 100MG
PRISTIQ TB24 50MG
procentra
protriptyline hcl
quetiapine fumarate tabs 400mg
quetiapine fumarate tabs 300mg
quetiapine fumarate tabs 200mg
quetiapine fumarate tabs 100mg
quetiapine fumarate tabs 50mg
RequireDrug ments/
Tier
Limits
1 QL(241 per
90 days)
1 QL(360 per
90 days)
1 QL(720 per
90 days)
1
2
1
PA
1 QL(180 per
90 days)
1 QL(270 per
90 days)
1 QL(540 per
90 days)
1 QL(135 per
90 days)
1 QL(180 per
90 days)
1 QL(270 per
90 days)
1 QL(540 per
90 days)
2
ST
1
1
PA
1
2 PA QL(360
per 90 days)
2 PA QL(720
per 90 days)
1
1
1 QL(180 per
90 days)
1 QL(241 per
90 days)
1 QL(360 per
90 days)
1 QL(720 per
90 days)
1
QL(1440
per 90 days)
Drug
Name
quetiapine fumarate tabs 25mg
RISPERDAL CONSTA INJ
12.5MG, 25MG
RISPERDAL CONSTA INJ
37.5MG, 50MG
risperidone odt tbdp 4mg
RequireDrug ments/
Tier
Limits
1
QL(2705
per 90 days)
2
3
1
risperidone odt tbdp 3mg
1
risperidone odt tbdp 2mg
1
risperidone odt tbdp 1mg
1
risperidone odt tbdp 0.5mg
1
risperidone odt tbdp 0.25mg
1
risperidone oral soln
1
risperidone tabs 4mg
1
risperidone tabs 3mg
1
risperidone tabs 2mg
1
risperidone tabs 1mg
1
risperidone tabs 0.5mg
1
risperidone tabs 0.25mg
1
ROZEREM
2
SAPHRIS SUBL 10MG
2
SAPHRIS SUBL 5MG
2
SEROQUEL XR TB24 400MG
2
SEROQUEL XR TB24 300MG
2
SEROQUEL XR TB24 200MG
2
SEROQUEL XR TB24 150MG
2
QL(360 per
90 days)
QL(482 per
90 days)
QL(720 per
90 days)
QL(1440
per 90 days)
QL(2880
per 90 days)
QL(5760
per 90 days)
QL(1440
per 90 days)
QL(360 per
90 days)
QL(482 per
90 days)
QL(720 per
90 days)
QL(1440
per 90 days)
QL(2880
per 90 days)
QL(5760
per 90 days)
QL(90 per
90 days) ST
QL(180 per
90 days)
QL(360 per
90 days)
QL(180 per
90 days)
QL(241 per
90 days)
QL(360 per
90 days)
QL(482 per
90 days)
16
Updated 10/28/2014
RequireDrug
Drug ments/
Name
Tier
Limits
SEROQUEL XR TB24 50MG
2
QL(1440
per 90 days)
sertraline hcl conc
1
sertraline hcl tabs 100mg
1 QL(180 per
90 days)
sertraline hcl tabs 50mg
1 QL(360 per
90 days)
sertraline hcl tabs 25mg
1 QL(720 per
90 days)
STRATTERA
2
PA
temazepam
1
PA
thioridazine hcl
1
thiothixene
1
tranylcypromine sulfate
1
trazodone hcl
1
trifluoperazine hcl
1
trimipramine maleate
1
PA
venlafaxine hcl er cp24 150mg
1 QL(180 per
90 days)
venlafaxine hcl er cp24 75mg
1 QL(270 per
90 days)
venlafaxine hcl er cp24 37.5mg
1 QL(540 per
90 days)
venlafaxine hcl er tb24 150mg
1 QL(180 per
90 days)
venlafaxine hcl er tb24 75mg
1 QL(270 per
90 days)
venlafaxine hcl er tb24 37.5mg
1 QL(540 per
90 days)
venlafaxine hcl tabs 100mg, 75mg 1 QL(270 per
90 days)
venlafaxine hcl tabs 50mg
1 QL(450 per
90 days)
venlafaxine hcl tabs 37.5mg
1 QL(540 per
90 days)
venlafaxine hcl tabs 25mg
1 QL(810 per
90 days)
VERSACLOZ
3
LA
VIIBRYD KIT
2 QL(90 per
90 days) ST
VIIBRYD TABS 40MG
2 QL(90 per
90 days) ST
VIIBRYD TABS 20MG
2 QL(180 per
90 days) ST
RequireDrug ments/
Tier
Limits
2 QL(360 per
90 days) ST
3
LA
1 QL(90 per
90 days) ST
1 QL(180 per
90 days) ST
1
1 QL(180 per
90 days)
1 QL(241 per
90 days)
1 QL(360 per
90 days)
1 QL(720 per
90 days)
1 QL(90 per
90 days) ST
1 QL(90 per
90 days) ST
3
LA
Drug
Name
VIIBRYD TABS 10MG
XYREM
zaleplon caps 5mg
zaleplon caps 10mg
zenzedi tabs 10mg, 5mg
ziprasidone hcl caps 80mg
ziprasidone hcl caps 60mg
ziprasidone hcl caps 40mg
ziprasidone hcl caps 20mg
zolpidem tartrate
zolpidem tartrate er
ZYPREXA RELPREVV
CARDIOVASCULAR,
HYPERTENSION / LIPIDS
ANTIARRHYTHMIC AGENTS
adenosine inj 12mg/4ml, 6mg/2ml
amiodarone hcl inj
amiodarone hcl tabs
flecainide acetate
ibutilide fumarate
lidocaine hcl in d5w
lidocaine hcl inj 10mg/ml,
20mg/ml
lidocaine hcl/dextrose inj 7.5%;
5%
mexiletine hcl
pacerone
procainamide hcl
propafenone hcl
propafenone hcl er
quinidine gluconate
quinidine gluconate cr
quinidine sulfate
1
1
1
1
1
1
1
B/D PA
1
1
1
1
1
1
1
1
1
17
Updated 10/28/2014
Drug
Name
quinidine sulfate er
sorine
sotalol hcl
sotalol hcl (af)
TIKOSYN
Requirements/
Limits
Drug
Tier
1
1
1
1
2
Drug
Name
CLORPRES TABS 15MG;
0.3MG
corlopam
DEMSER
DIBENZYLINE
dilt-cd cp24 120mg, 300mg
dilt-xr
diltiazem cd
diltiazem hcl
diltiazem hcl cd
diltiazem hcl er
doxazosin mesylate tabs 1mg,
2mg, 4mg
doxazosin mesylate tabs 8mg
ANTIHYPERTENSIVE THERAPY
acebutolol hcl
afeditab cr
amiloride hcl
amiloride/hydrochlorothiazide
amlodipine besylate
amlodipine besylate/benazepril
hcl
amlodipine besylate/benazepril
hydrochloride
atenolol
atenolol/chlorthalidone
benazepril hcl
benazepril
hcl/hydrochlorothiazide
betaxolol hcl
bisoprolol fumarate
bisoprolol
fumarate/hydrochlorothiazide
bumetanide
candesartan cilexetil
candesartan
cilexetil/hydrochlorothiazide
captopril
captopril/hydrochlorothiazide
cartia xt
carvedilol
chlorothiazide
chlorothiazide sodium
chlorthalidone tabs 25mg, 50mg
clonidine hcl inj
clonidine hcl ptwk
1
1
1
1
1
1
clonidine hcl tabs
clorpres tabs 15mg; 0.1mg,
15mg; 0.2mg
1
1
1
1
2
2
1
1
1
1
1
1
1
1
DUTOPROL
enalapril maleate
enalapril
maleate/hydrochlorothiazide
enalaprilat
eplerenone
epoprostenol sodium
eprosartan mesylate
esmolol hcl
EXFORGE
EXFORGE HCT
felodipine er
fosinopril sodium
fosinopril
sodium/hydrochlorothiazide
furosemide
guanfacine hcl
hydralazine hcl
hydrochlorothiazide
indapamide
irbesartan
irbesartan/hydrochlorothiazide
isradipine
labetalol hcl
lisinopril
lisinopril/hydrochlorothiazide
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Drug
Tier
2
B/D PA
QL(13 per
90 days)
Requirements/
Limits
QL(90 per
90 days)
QL(180 per
90 days)
2
1
1
1
1
1
1
1
2
2
1
1
1
PA
ST
ST
1
1
1
1
1
1
1
1
1
1
1
18
Updated 10/28/2014
Drug
Drug
Name
Tier
losartan potassium
1
losartan
1
potassium/hydrochlorothiazide
mannitol inj 10%, 20%, 25%, 5% 1
matzim la
1
methyclothiazide
1
methyldopa
1
methyldopa/hydrochlorothiazide
1
methyldopate hcl
1
metolazone
1
metoprolol succinate er
1
metoprolol tartrate
1
metoprolol/hydrochlorothiazide
1
minoxidil tabs
1
moexipril hcl
1
moexipril/hydrochlorothiazide
1
nadolol
1
nadolol/bendroflumethiazide
1
nicardipine hcl
1
nifediac cc tb24 90mg
1
nifedical xl
1
nifedipine er
1
nimodipine
1
nisoldipine
1
nisoldipine er
1
osmitrol viaflex inj 15%, 20%
1
perindopril erbumine
1
phentolamine mesylate inj 5mg
1
pindolol
1
prazosin hcl
1
propranolol hcl
1
propranolol hcl er
1
propranolol/hydrochlorothiazide
1
quinapril hcl
1
quinapril/hydrochlorothiazide
1
ramipril
1
REMODULIN
3
reserpine
1
spironolactone
1
Requirements/
Limits
Requirements/
Limits
Drug
Drug
Name
Tier
spironolactone/hydrochlorothiazi 1
de
taztia xt
1
telmisartan
1
telmisartan/amlodipine
1
telmisartan/hydrochlorothiazide
1
terazosin hcl caps 1mg, 2mg, 5mg 1 QL(90 per
90 days)
terazosin hcl caps 10mg
1 QL(180 per
90 days)
timolol maleate
1
torsemide inj 20mg/2ml
1
torsemide tabs
1
trandolapril
1
triamterene/hydrochlorothiazide
1
valsartan
1
valsartan/hydrochlorothiazide
1
veletri
1
PA
verapamil hcl
1
verapamil hcl er
1
verapamil hcl sr
1
CARDIAC GLYCOSIDES
digox
digoxin
LANOXIN TABS 187.5MCG,
62.5MCG
1
1
2
COAGULATION THERAPY
AGGRENOX
aminocaproic acid inj
aminocaproic acid syrp
aminocaproic acid tabs 500mg
BRILINTA
cilostazol
clopidogrel
dipyridamole inj
dipyridamole tabs
EFFIENT
ELIQUIS
enoxaparin sodium inj
120mg/0.8ml, 150mg/ml
LA PA
2
1
1
1
2
1
1
1
1
2
2
3
PA
PA
19
Updated 10/28/2014
Drug
Drug
Name
Tier
enoxaparin sodium inj 100mg/ml, 1
300mg/3ml, 30mg/0.3ml,
40mg/0.4ml, 60mg/0.6ml,
80mg/0.8ml
fondaparinux sodium inj
1
2.5mg/0.5ml
fondaparinux sodium inj
3
10mg/0.8ml, 5mg/0.4ml,
7.5mg/0.6ml
heparin sodium dcu
1
heparin sodium inj 10000unit/ml, 1
1000unit/ml, 20000unit/ml,
5000unit/0.5ml, 5000unit/ml
heparin sodium/d5w
1
heparin sodium/nacl 0.45%
1
heparin sodium/nacl 0.9%
1
heparin sodium/sodium chloride
1
0.9%
heparin sodium/sodium chloride
1
0.9% premix
jantoven
1
NPLATE
3
pentoxifylline er
1
PRADAXA
2
PROMACTA
3
protamine sulfate
1
tranexamic acid
1
warfarin sodium
1
XARELTO TABS 10MG
2
XARELTO TABS 15MG, 20MG 2
Requirements/
Limits
Requirements/
Limits
Drug
Drug
Name
Tier
colestipol hcl
1
colestipol hcl for oral suspension 1
CRESTOR
2 QL(90 per
90 days) ST
fenofibrate
1
fenofibrate micronized
1
fenofibric acid
1
fenofibric acid dr
1
fluvastatin caps 20mg
1 QL(90 per
90 days)
fluvastatin caps 40mg
1 QL(180 per
90 days)
gemfibrozil
1
JUXTAPID
3
LA
lovastatin tabs 10mg
1 QL(90 per
90 days)
lovastatin tabs 20mg, 40mg
1 QL(180 per
90 days)
LOVAZA
2
PA
micronized colestipol hcl
1
niacin er tbcr
1
NIASPAN
2
omega-3-acid ethyl esters
1
PA
pravastatin sodium
1 QL(90 per
90 days)
prevalite
1
SIMCOR TB24 1000MG; 40MG, 2 QL(90 per
500MG; 20MG, 500MG; 40MG
90 days)
SIMCOR TB24 1000MG; 20MG, 2 QL(180 per
750MG; 20MG
90 days)
simvastatin
1 QL(90 per
90 days)
VASCEPA
2
PA
WELCHOL
2
ST
ZETIA
2
PA
PA
LA PA
PA
LIPID/CHOLESTEROL LOWERING
AGENTS
ADVICOR TB24 20MG; 500MG
2
ADVICOR TB24 20MG;
1000MG, 20MG; 750MG, 40MG;
1000MG
amlodipine besylate/atorvastatin
calcium
atorvastatin calcium
2
cholestyramine
cholestyramine light
1
1
QL(90 per
90 days)
QL(180 per
90 days)
MISCELLANEOUS CARDIOVASCULAR
AGENTS
1
1
cardioplegic
dobutamine hcl
dobutamine hcl/d5w
dopamine hcl
dopamine/d5w
QL(90 per
90 days)
1
1
1
1
1
B/D PA
B/D PA
B/D PA
B/D PA
20
Updated 10/28/2014
Drug
Name
milrinone in dextrose
milrinone lactate
norepinephrine bitartrate
RANEXA
RequireDrug ments/
Tier
Limits
1
B/D PA
1
B/D PA
1
2
Drug
Name
methoxsalen
OXSORALEN
OXSORALEN ULTRA
PANRETIN
podofilox
PROTOPIC
prudoxin
REGRANEX
NITRATES
isosorbide dinitrate
isosorbide dinitrate er
isosorbide mononitrate
isosorbide mononitrate er
nitro-bid
nitroglycerin in 5% dextrose
nitroglycerin inj
nitroglycerin lingual
nitroglycerin pt24
nitroglycerin transdermal
NITROSTAT
1
1
1
1
1
1
1
1
1
1
2
B/D PA
B/D PA
THERAPY FOR ACNE
adapalene
amnesteem
avita crea
claravis caps 10mg, 20mg, 40mg
claravis caps 30mg
clindacin etz pledgets
clindacin-p
clindamycin phosphate external
soln
clindamycin phosphate foam
clindamycin phosphate gel
clindamycin phosphate lotn
clindamycin phosphate swab
clindamycin/benzoyl peroxide
ery
erygel
erythromycin
erythromycin/benzoyl peroxide
metronidazole
myorisan caps 10mg, 20mg
myorisan caps 40mg
neuac
rosadan
TAZORAC
tretinoin crea
ANTIPSORIATIC / ANTISEBORRHEIC
1
3
1
1
1
1
1
3
BURN THERAPY
silver sulfadiazine
ssd
1
1
MISCELLANEOUS DERMATOLOGICALS
8-MOP
ammonium lactate
CARAC
diclofenac sodium gel
fluorouracil
imiquimod
LEVULAN KERASTICK
2
1
2
1
1
1
2
Drug
Tier
3
2
3
3
1
2
PA
1
2 PA QL(45
per 90 days)
2
PA
2
3
2
2
SOLARAZE
UVADEX
VALCHLOR
ZYCLARA
ZYCLARA PUMP
DERMATOLOGICALS/TOPICAL
THERAPY
acitretin caps 10mg
acitretin caps 17.5mg, 25mg
calcipotriene
calcipotriene/betamethasone
dipropionate
calcitrene
calcitriol
selenium sulfide lotn
SORIATANE
Requirements/
Limits
PA
1
1
1
1
3
1
1
1
1
1
1
1
1
1
1
1
1
1
1
3
1
1
2
1
PA
PA
PA
PA
21
Updated 10/28/2014
Drug
Name
tretinoin gel
tretinoin microsphere
tretinoin microsphere pump
zenatane
Drug
Tier
1
1
1
1
Requirements/
Limits
PA
PA
PA
Drug
Name
ciclopirox olamine
ciclopirox topical solution kit
clotrimazole external crea
clotrimazole external soln
clotrimazole/betamethasone
dipropionate
econazole nitrate
ketoconazole
ketodan
ketodan kit
nyamyc
nystatin crea
nystatin oint
nystatin powd 100000unit/gm
nystatin/triamcinolone
nystop
pedi-dri
TOPICAL ANESTHETICS
bupivacaine hcl
bupivacaine/epinephrine
carbocaine inj 1.5%
chloroprocaine hcl
lidocaine hcl external soln
lidocaine hcl inj 0.5%, 1%, 1.5%,
2%, 4%
LIDOCAINE HCL INJ 2%
lidocaine hcl jelly
lidocaine hcl mouth/throat soln
lidocaine oint
lidocaine ptch
lidocaine viscous
lidocaine/epinephrine inj
1:100000; 1%, 1:100000; 2%,
1:200000; 0.5%, 1:200000; 1.5%,
1:200000; 2%
lidocaine/prilocaine
LIDODERM
lta 360 kit
marcaine w/o epi 0.75%
sensorcaine inj 0.5%
sensorcaine-mpf inj 0.5%
1
1
1
1
1
1
2
1
1
1
1
1
1
1
2
1
1
1
1
PA
acyclovir
DENAVIR
XERESE
ZOVIRAX CREA
1
2
2
2
TOPICAL CORTICOSTEROIDS
PA
ala cort
alclometasone dipropionate
amcinonide
apexicon e
augmented betamethasone
dipropionate
betamethasone dipropionate
betamethasone valerate
clobetasol propionate
clobetasol propionate e
clobetasol propionate emollient
clodan
cormax scalp application
desonide
desoximetasone
diflorasone diacetate
fluocinolone acetonide
1
1
1
1
1
1
2
TOPICAL ANTIFUNGALS
ciclodan
ciclopirox
ciclopirox nail lacquer
1
1
1
1
1
1
1
1
1
1
1
TOPICAL ANTIVIRALS
TOPICAL ANTIBACTERIALS
gentamicin sulfate
mafenide acetate
mupirocin
mupirocin calcium
sodium sulfacetamide lotn
sulfacetamide sodium
SULFAMYLON CREA
Drug
Tier
1
1
1
1
1
Requirements/
Limits
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
22
Updated 10/28/2014
Drug
Drug
Name
Tier
fluocinolone acetonide body
1
fluocinolone acetonide scalp
1
fluocinonide
1
fluocinonide-e
1
fluticasone propionate crea
1
fluticasone propionate lotn
1
fluticasone propionate oint
1
halobetasol propionate
1
halonate
1
halonate pac
1
hydrocortisone butyrate
1
hydrocortisone butyrate
1
(lipophilic)
hydrocortisone crea 1%, 2.5%
1
hydrocortisone in absorbase
1
hydrocortisone lotn 2.5%
1
hydrocortisone oint 1%, 2.5%
1
hydrocortisone valerate
1
mometasone furoate crea
1
mometasone furoate external soln 1
mometasone furoate oint
1
prednicarbate
1
scalacort
1
triamcinolone acetonide crea
1
triamcinolone acetonide lotn
1
triamcinolone acetonide oint
1
trianex
1
triderm
1
Requirements/
Limits
Drug
Name
PROTOPAM CHLORIDE
IRRIGATING SOLUTIONS
lactated ringers irrigation
neomycin/polymyxin b sulfates
ringers irrigation
tis-u-sol
2
TOPICAL SCABICIDES / PEDICULICIDES
lindane
malathion
permethrin crea
spinosad
1
1
1
1
DIAGNOSTICS / MISCELLANEOUS
AGENTS
ANTIDOTES
acetylcysteine inj
1
1
1
1
MISCELLANEOUS AGENTS
TOPICAL ENZYMES
SANTYL
Drug
Tier
2
Requirements/
Limits
1
acamprosate calcium dr
acetic acid 0.25%
ADAGEN
alendronate sodium tabs 40mg
1
1
3
1
anagrelide hydrochloride
ARALAST NP INJ 400MG,
500MG, 800MG
BUPHENYL TABS
bupivacaine spinal
caffeine citrate inj
caffeine citrate oral soln 20mg/ml
CARBAGLU
cevimeline hcl
CHEMET
CLINIMIX 4.25%/DEXTROSE
5%
CLINIMIX E 2.75%/DEXTROSE
10%
CLINIMIX E 2.75%/DEXTROSE
5%
deferoxamine mesylate
dextrose 10%/nacl 0.45%
dextrose 10%
dextrose 10% flex container
dextrose 10%/nacl 0.2%
dextrose 2.5%/nacl 0.45%
dextrose 2.5%/sodium chloride
0.45%
dextrose 20%
dextrose 25%
dextrose 30%
dextrose 40%
dextrose 5%
1
3
3
1
1
1
3
1
2
2
QL(90 per
90 days)
LA PA
LA
2
2
1
1
1
1
1
1
1
B/D PA
1
1
1
1
1
23
Updated 10/28/2014
Drug
Drug
Name
Tier
dextrose 5%/lactated ringers
1
dextrose 5%/nacl 0.2%
1
dextrose 5%/nacl 0.225%
1
dextrose 5%/nacl 0.33%
1
dextrose 5%/nacl 0.45%
1
dextrose 5%/nacl 0.9%
1
dextrose 5%/ringers
1
dextrose 5%/sodium chloride
1
0.45%
dextrose 50%
1
dextrose 70%
1
dextrose thermoject system
1
disulfiram
1
etidronate disodium
1
EXJADE TBSO 125MG
2
EXJADE TBSO 250MG, 500MG 3
FERRIPROX
3
INCRELEX
3
kionex
1
levocarnitine
1
lmd 10% dextrose 5%
1
lmd 10% sodium chloride 0.9%
1
midodrine hcl
1
ORFADIN
3
pilocarpine hcl
1
PROLASTIN-C
3
RAVICTI
3
RENVELA
2
RILUTEK
3
riluzole
3
sodium chloride 0.9%
1
sodium chloride inj
1
sodium chloride pab
1
sodium phenylbutyrate
3
sodium polystyrene sulfonate
1
powd
sodium polystyrene sulfonate susp 1
15gm/60ml, 30gm/120ml
SODIUM POLYSTYRENE
2
SULFONATE SUSP
50GM/200ML
Requirements/
Limits
Drug
Name
SOLIRIS
sps
sterile water irrigation
SYPRINE
THIOLA
XIAFLEX
zoledronic acid inj 5mg/100ml
RequireDrug ments/
Tier
Limits
3
B/D PA
1
1
3
2
3
LA
1
PA
SMOKING DETERRENTS
buproban
bupropion hcl sr tb12 150mg
CHANTIX
CHANTIX CONTINUING
MONTH PAK
CHANTIX STARTING MONTH
PAK
NICOTROL INHALER
NICOTROL NS
LA
LA
1
1
2
2
2
2
2
EAR, NOSE / THROAT
MEDICATIONS
LA
MISCELLANEOUS AGENTS
azelastine hcl nasal soln 0.15%
azelastine hcl nasal soln
137mcg/spray
chlorhexidine gluconate
mouth/throat soln
chlorhexidine gluconate oral
rinse
denta 5000 plus
dentagel
ipratropium bromide nasal soln
0.06%
ipratropium bromide nasal soln
0.03%
neutral sodium fluoride
oralone
periogard
sf 5000 plus
stannous fluoride oral rinse
triamcinolone acetonide pste
triamcinolone in orabase
TYZINE
LA
LA PA
1
1
QL(180 per
90 days)
1
1
1
1
1
1
QL(75 per
90 days)
QL(90 per
90 days)
1
1
1
1
1
1
1
2
24
Updated 10/28/2014
Drug
Name
TYZINE PEDIATRIC NASAL
DROPS
Drug
Tier
2
Requirements/
Limits
Requirements/
Limits
Drug
Drug
Name
Tier
prednisone oral soln
1
prednisone tabs dose pack 10mg, 1
5mg
prednisone tabs 10mg, 1mg,
1
B/D PA
2.5mg, 20mg, 50mg, 5mg
triamcinolone acetonide inj
1
veripred 20
1
MISCELLANEOUS OTIC
PREPARATIONS
acetasol hc
acetic acid otic soln
acetic acid/aluminum acetate
antipyrine/benzocaine otic soln
5.4%; 1.4%, 54mg/ml; 14mg/ml
fluocinolone acetonide
fluocinolone acetonide ear drops
hydrocortisone/acetic acid
ofloxacin
1
1
1
1
ANTITHYROID AGENTS
methimazole
propylthiouracil
1
1
1
1
1
1
DIABETES THERAPY
acarbose tabs 100mg
1
OTIC STEROID / ANTIBIOTIC
acarbose tabs 50mg
1
CIPRODEX
neomycin/polymyxin/hc
acarbose tabs 25mg
1
ACCU-CHEK ACTIVE
GLUCOSE CONTROL
SOLUTION
ACCU-CHEK ACTIVE STRIPS
ACCU-CHEK AVIVA IN
VITRO SOLN
ACCU-CHEK AVIVA PLUS
ACCU-CHEK COMFORT
CURVE CONTROL SOLUTION
(2 LEVELS)
ACCU-CHEK COMFORT
CURVE LINEARITY
SOLUTION
ACCU-CHEK COMFORT
CURVE TEST STRIPS
ACCU-CHEK COMPACT BLUE
CONTROL SOLUTION (2
LEVELS)
ACCU-CHEK COMPACT PLUS
CARE KIT
ACCU-CHEK NANO
SMARTVIEW
ACCU-CHEK SMARTVIEW
STRIPS
ALCOHOL PREPS PADS
BYDUREON
2
2
1
ENDOCRINE/DIABETES
ADRENAL HORMONES
a-hydrocort
a-methapred inj 40mg
ACTHAR HP
betamethasone sodium
phosphate/betamethasone acetate
cortisone acetate
dexamethasone
dexamethasone intensol
dexamethasone sodium phosphate
fludrocortisone acetate
hydrocortisone tabs
methylprednisolone
methylprednisolone acetate
methylprednisolone dose pack
methylprednisolone
sodiumsuccinate inj 1000mg,
125mg, 40mg
millipred dp
millipred tabs
prednisolone
prednisolone sodium phosphate
prednisone intensol
1
1
3
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
PA
B/D PA
B/D PA
QL(270 per
90 days)
QL(540 per
90 days)
QL(1080
per 90 days)
2
2
2
2
2
2
2
2
2
2
2
2
PA QL(12
per 84 days)
25
Updated 10/28/2014
Drug
Name
BYETTA INJ 5MCG/0.02ML
BYETTA INJ 10MCG/0.04ML
CYCLOSET
GAUZE PADS 2"X2"
glimepiride tabs 4mg
glimepiride tabs 2mg
glimepiride tabs 1mg
glipizide er tb24 10mg
glipizide er tb24 5mg
glipizide er tb24 2.5mg
glipizide tabs 10mg
glipizide tabs 5mg
glipizide xl tb24 10mg
glipizide xl tb24 5mg
glipizide xl tb24 2.5mg
glipizide/metformin hcl tabs
2.5mg; 500mg, 5mg; 500mg
glipizide/metformin hcl tabs
2.5mg; 250mg
GLUCAGEN
GLUCAGEN HYPOKIT
GLUCAGON EMERGENCY
KIT
glyburide micronized tabs 6mg
RequireDrug ments/
Tier
Limits
2 PA QL(3.6
per 90 days)
2 PA QL(7.2
per 90 days)
2 QL(540 per
90 days)
2
1 QL(180 per
90 days)
1 QL(360 per
90 days)
1 QL(720 per
90 days)
1 QL(180 per
90 days)
1 QL(360 per
90 days)
1 QL(720 per
90 days)
1 QL(360 per
90 days)
1 QL(720 per
90 days)
1 QL(180 per
90 days)
1 QL(360 per
90 days)
1 QL(720 per
90 days)
1 QL(360 per
90 days)
1 QL(720 per
90 days)
2
2
2
1
glyburide micronized tabs 3mg
1
glyburide micronized tabs 1.5mg
1
glyburide tabs 5mg
1
QL(180 per
90 days) ST
QL(360 per
90 days) ST
QL(720 per
90 days) ST
QL(360 per
90 days) ST
Drug
Name
glyburide tabs 2.5mg
glyburide tabs 1.25mg
glyburide/metformin hcl tabs
2.5mg; 500mg, 5mg; 500mg
glyburide/metformin hcl tabs
1.25mg; 250mg
HUMALOG
HUMALOG KWIKPEN
HUMALOG MIX 50/50
HUMALOG MIX 50/50
KWIKPEN
HUMALOG MIX 75/25
HUMALOG MIX 75/25
KWIKPEN
HUMULIN 70/30
HUMULIN 70/30 PEN
HUMULIN N
HUMULIN N U-100 PEN
HUMULIN R
HUMULIN R U-500
(CONCENTRATED)
INSULIN PEN NEEDLE
INSULIN SYRINGE (DISP) U100 0.3 ML
INSULIN SYRINGE (DISP) U100 1 ML
INSULIN SYRINGE (DISP) U100 1/2 ML
INVOKANA TABS 300MG
RequireDrug ments/
Tier
Limits
1 QL(720 per
90 days) ST
1
QL(1440
per 90 days)
ST
1 QL(360 per
90 days) ST
1 QL(720 per
90 days) ST
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
INVOKANA TABS 100MG
2
JANUMET
2
JANUMET XR TB24 1000MG;
100MG, 500MG; 50MG
JANUMET XR TB24 1000MG;
50MG
JANUVIA
2
2
2
QL(90 per
90 days)
QL(270 per
90 days)
QL(180 per
90 days)
QL(90 per
90 days)
QL(180 per
90 days)
QL(90 per
90 days)
26
Updated 10/28/2014
Drug
Name
JENTADUETO
JUVISYNC
LANTUS
LANTUS SOLOSTAR
LEVEMIR
LEVEMIR FLEXPEN
metformin hcl er tb24 1000mg,
750mg
metformin hcl er tb24 500mg
metformin hcl er tb24 500mg
metformin hcl tabs 1000mg
metformin hcl tabs 850mg
metformin hcl tabs 500mg
nateglinide tabs 120mg
nateglinide tabs 60mg
NEEDLES, INSULIN DISP.,
SAFETY
NOVOFINE 30GX8MM
NOVOFINE 32GX6MM
NOVOFINE AUTOCOVER
30GX8MM
NOVOLIN 70/30
NOVOLIN 70/30 RELION
NOVOLIN N
NOVOLIN N RELION
NOVOLIN R
NOVOLIN R RELION
NOVOLOG
NOVOLOG FLEXPEN
NOVOLOG MIX 70/30
NOVOLOG MIX 70/30
PREFILLED FLEXPEN
NOVOLOG PENFILL
ONETOUCH ULTRA 2
RequireDrug ments/
Tier
Limits
2 QL(180 per
90 days)
2 QL(90 per
90 days)
2
2
2
2
1 QL(225 per
90 days)
1 QL(360 per
90 days)
1 QL(450 per
90 days)
1 QL(225 per
90 days)
1 QL(270 per
90 days)
1 QL(450 per
90 days)
1 QL(270 per
90 days)
1 QL(540 per
90 days)
2
Requirements/
Limits
Drug
Drug
Name
Tier
ONETOUCH ULTRA BLUE
2
ONETOUCH ULTRA MINI
2
ONETOUCH ULTRA SYSTEM 2
KIT
ONETOUCH VERIO IQ BLOOD 2
GLUCOSE MONITORING
SYSTEM
ONETOUCH VERIO TEST
2
STRIPS
pioglitazone hcl
1 QL(90 per
90 days)
pioglitazone hcl-glimepiride
1 QL(90 per
90 days)
pioglitazone hcl/metformin hcl
1 QL(270 per
90 days)
PRODIGY INSULIN MINI PEN 2
NEEDLES/31G X 3/16"
PRODIGY INSULIN PEN
2
NEEDLES/29G X 1/2"
PRODIGY INSULIN SHORT
2
PENNEEDLES/31G X 5/16"
PRODIGY INSULIN
2
SYRING/U-100/0.3ML/31G X
5/16"
PRODIGY INSULIN
2
SYRINGE/1/2ML/31G X 5/16"
PRODIGY INSULIN
2
SYRINGE/1ML/28G X 1/2"
PROGLYCEM
2
repaglinide tabs 2mg
1 QL(720 per
90 days)
repaglinide tabs 1mg
1
QL(1440
per 90 days)
repaglinide tabs 0.5mg
1
QL(2880
per 90 days)
RIOMET
2
QL(2295
per 90 days)
SYMLINPEN 120
2 PA QL(57
per 90 days)
SYMLINPEN 60
2 PA QL(32
per 90 days)
tolazamide tabs 500mg
1 QL(180 per
90 days)
tolazamide tabs 250mg
1 QL(360 per
90 days)
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
27
Updated 10/28/2014
Drug
Name
tolbutamide
TRADJENTA
V-GO 20
V-GO 30
V-GO 40
RequireDrug ments/
Tier
Limits
1 QL(540 per
90 days)
2 QL(90 per
90 days)
2
2
2
Drug
Drug
Name
Tier
SENSIPAR TABS 60MG, 90MG 3
SENSIPAR TABS 30MG
2
SOMAVERT
3
SYNAREL
3
TESTOPEL
2
testosterone cypionate
1
testosterone enanthate
1
vasopressin
1
VPRIV
3
ZAVESCA
3
ZEMPLAR
2
zoledronic acid inj 4mg, 4mg/5ml 1
MISCELLANEOUS HORMONES
ALDURAZYME
ANADROL-50
ANDROGEL
ANDROGEL PUMP
androxy
cabergoline
3
3
2
2
1
1
calcitonin-salmon
calcitriol
CEREZYME
chorionic gonadotropin
danazol
desmopressin acetate
doxercalciferol
ELAPRASE
ELELYSO
FABRAZYME
fortical
KUVAN TBSO
LUMIZYME
METHITEST
MIACALCIN INJ
MYALEPT
MYOZYME
NAGLAZYME
novarel
oxandrolone tabs 2.5mg
oxandrolone tabs 10mg
pamidronate disodium
paricalcitol
SAMSCA
1
1
3
1
1
1
1
3
3
3
1
3
3
2
2
3
3
3
1
1
3
1
1
3
PA
PA
Requirements/
Limits
LA
LA
THYROID HORMONES
QL(48 per
84 days)
ARMOUR THYROID
levothyroxine sodium inj 200mcg,
500mcg
levothyroxine sodium tabs
levoxyl
liothyronine sodium
np thyroid 30
np thyroid 60
np thyroid 90
THYROLAR-1
THYROLAR-1/2
THYROLAR-1/4
THYROLAR-2
THYROLAR-3
unithroid
PA
LA
LA
2
1
1
1
1
1
1
1
2
2
2
2
2
1
GASTROENTEROLOGY
LA
ANTIDIARRHEALS / ANTISPASMODICS
LA
PA
PA
PA
atropine sulfate inj 0.05mg/ml,
0.1mg/ml
diphenoxylate/atropine
glycopyrrolate
loperamide hcl caps
opium
opium tincture (paregoric)
PA QL(180
per 90 days)
1
1
1
1
1
1
MISCELLANEOUS GASTROINTESTINAL
AGENTS
28
Updated 10/28/2014
Drug
Name
ALOXI
AMITIZA
balsalazide disodium
budesonide cp24
CANASA
CESAMET
CHENODAL
colocort
compro
constulose
CORTIFOAM
CREON
cromolyn sodium conc
CYSTADANE
dimenhydrinate inj
DIPENTUM
dronabinol caps 10mg
dronabinol caps 2.5mg, 5mg
droperidol
EMEND CAPS
EMEND INJ
enulose
gavilyte-c
gavilyte-g
gavilyte-n/flavor pack
generlac
granisetron hcl inj 0.1mg/ml,
1mg/ml
granisetron hcl tabs
granisol
hydrocortisone enem
lactulose
LIALDA
LINZESS
LOTRONEX
meclizine hcl tabs
mesalamine
metoclopramide hcl
ondansetron hcl inj
RequireDrug ments/
Tier
Limits
2 QL(30 per
90 days)
2
1
3
2
3
B/D PA
3
LA PA
1
1
1
2
2
1
2
1
2
3
B/D PA
1
B/D PA
1
2
B/D PA
2
1
1
1
1
1
1
1
1
1
1
2
2
3
1
1
1
1
RequireDrug
Drug ments/
Name
Tier
Limits
ondansetron hcl oral soln
1
B/D PA
ondansetron hcl tabs
1
B/D PA
ondansetron odt
1
B/D PA
pancrelipase
1
peg 3350/electrolytes
1
peg-3350/electrolytes
1
peg-3350/nacl/na bicarbonate/kcl 1
PENTASA
2
polyethylene glycol 3350 pack
1
polyethylene glycol 3350 powd
1
prochlorperazine
1
prochlorperazine edisylate
1
prochlorperazine maleate
1
procto-pak
1
proctosol hc
1
proctozone-hc
1
RECTIV
2
RELISTOR
2
REMICADE
3
PA
SUCRAID
3
sulfasalazine
1
sulfazine
1
sulfazine ec
1
trilyte
1
trimethobenzamide hcl
1
UCERIS
3
ursodiol
1
VIOKACE
2
ZENPEP CPEP 109000UNIT;
2
20000UNIT; 68000UNIT,
136000UNIT; 25000UNIT;
85000UNIT, 16000UNIT;
3000UNIT; 10000UNIT,
55000UNIT; 10000UNIT;
34000UNIT, 82000UNIT;
15000UNIT; 51000UNIT
B/D PA
B/D PA
ULCER THERAPY
carafate susp
cimetidine
cimetidine hcl
1
1
1
29
Updated 10/28/2014
Requirements/
Limits
Drug
Name
esomeprazole sodium
famotidine inj
famotidine premixed
famotidine susr
famotidine tabs 20mg, 40mg
lansoprazole cpdr 30mg
lansoprazole cpdr 15mg
Drug
Tier
1
1
1
1
1
1
1 QL(90 per
90 days)
lansoprazole/amoxicillin/clarithro 1 QL(336 per
mycin
90 days)
misoprostol
1
NEXIUM CPDR 40MG
2
ST
NEXIUM CPDR 20MG
2 QL(90 per
90 days) ST
NEXIUM I.V.
2
NEXIUM PACK 40MG
2
ST
NEXIUM PACK 10MG, 2.5MG, 2 QL(90 per
20MG, 5MG
90 days) ST
nizatidine
1
omeprazole cpdr 40mg
1
omeprazole cpdr 10mg, 20mg
1 QL(90 per
90 days)
omeprazole/sodium bicarbonate
1
caps
pantoprazole sodium inj
1
pantoprazole sodium tbec 40mg
1
pantoprazole sodium tbec 20mg
1 QL(90 per
90 days)
rabeprazole sodium
1
ranitidine hcl caps
1
ranitidine hcl inj
1
ranitidine hcl syrp
1
ranitidine hcl tabs 150mg, 300mg 1
sucralfate
1
Drug
Name
AVONEX PEN
BETASERON
EGRIFTA
ILARIS
INFERGEN
INTRON-A
INTRON-A W/DILUENT INJ
10MU
INTRON-A W/DILUENT INJ
18MU, 50MU
LEUKINE
MOZOBIL
NEULASTA
IMMUNOLOGY, VACCINES /
BIOTECHNOLOGY
BIOTECHNOLOGY DRUGS
ACTIMMUNE
ARCALYST
AVONEX
3
3
3
PA
PA QL(12
per 84 days)
RequireDrug ments/
Tier
Limits
3 PA QL(12
per 84 days)
3 PA QL(45
per 90 days)
3
PA
3
LA PA
3
2
2
3
3
3
3
PA QL(6
per 90 days)
NEUMEGA
NEUPOGEN
OMNITROPE INJ 5.8MG
OMNITROPE INJ 10MG/1.5ML,
5MG/1.5ML
PEG-INTRON
3
3
3
2
PEG-INTRON REDIPEN
3
PEG-INTRON REDIPEN PAK 4
3
PEGASYS
3
PEGASYS PROCLICK
3
PROCRIT INJ 20000UNIT/ML,
40000UNIT/ML
PROCRIT INJ 10000UNIT/ML,
2000UNIT/ML, 3000UNIT/ML,
4000UNIT/ML
PROLEUKIN
REBIF
3
PA QL(12
per 84 days)
PA QL(12
per 84 days)
PA QL(12
per 84 days)
PA QL(12
per 84 days)
PA QL(12
per 84 days)
PA
2
PA
REBIF REBIDOSE
3
REBIF REBIDOSE TITRATION
PACK
3
3
3
3
PA
PA
PA
PA QL(18
per 84 days)
PA QL(18
per 84 days)
PA
30
Updated 10/28/2014
Drug
Name
REBIF TITRATION PACK
SAIZEN
SAIZEN CLICK.EASY
SYLATRON
RequireDrug ments/
Tier
Limits
3 PA QL(36
per 84 days)
3
PA
3
PA
3
VACCINES / MISCELLANEOUS
IMMUNOLOGICALS
ACTHIB
ADACEL
ATGAM
BCG VACCINE
BOOSTRIX
BOTOX
CARIMUNE NANOFILTERED
CERVARIX
COMVAX
DAPTACEL
DIPHTHERIA/TETANUS
TOXOIDS ADSORBED
PEDIATRIC
ENGERIX-B
FLEBOGAMMA DIF INJ 10%,
20GM/400ML
fomepizole
GAMASTAN S/D
GAMMAGARD S/D
GAMMAGARD S/D IGA LESS
THAN 1MCG/ML
GAMUNEX-C INJ
10GM/100ML, 20GM/200ML
GAMUNEX-C INJ 1GM/10ML,
2.5GM/25ML, 5GM/50ML
GARDASIL
GRASTEK
HAVRIX
HIZENTRA
HYPERHEP B S/D
HYPERRHO S/D
IMOGAM RABIES-HT
IMOVAX RABIES (H.D.C.V.)
INFANRIX
2
2
3
2
2
2
3
2
2
2
2
2
3
B/D PA
PA
PA
B/D PA
1
2
3
3
PA
PA
3
PA
2
PA
2
2
2
3
2
2
2
2
2
Requirements/
Limits
Drug
Drug
Name
Tier
IPOL INACTIVATED IPV
2
IXIARO
2
KINRIX
2
M-M-R II W/DILUENT 10
2
DOSE
MENACTRA
2
MENOMUNE-A/C/Y/W-135
2
MENVEO
2
PEDIARIX
2
PEDVAX HIB
2
PENTACEL
2
PRIVIGEN INJ 20GM/200ML,
3
PA
5GM/50ML
PROQUAD
2
RABAVERT
2
RAGWITEK
2
RECOMBIVAX HB
2
B/D PA
ROTARIX
2
ROTATEQ
2
TENIVAC
2
tetanus toxoid adsorbed
1
TETANUS/DIPHTHERIA
2
TOXOIDS-ADSORBED ADULT
THERACYS
2
TICE BCG
2
TWINRIX
2
TYPHIM VI
2
VAQTA
2
VARIVAX
2
VARIZIG
3
YF-VAX
2
ZOSTAVAX
2
MUSCULOSKELETAL /
RHEUMATOLOGY
GOUT THERAPY
allopurinol
aloprim
COLCRYS
KRYSTEXXA
probenecid
1
1
2
3
1
31
Updated 10/28/2014
Drug
Name
probenecid/colchicine
ULORIC
Requirements/
Limits
Drug
Tier
1
2
Drug
Name
RIDAURA
SAVELLA TABS 100MG
ST
OSTEOPOROSIS THERAPY
alendronate sodium oral soln
1
alendronate sodium tabs 35mg,
70mg
alendronate sodium tabs 10mg,
5mg
EVISTA
FORTEO
1
ibandronate sodium inj
ibandronate sodium
1
1
PROLIA
raloxifene hydrochloride
risedronate sodium
QL(964 per
90 days)
QL(13 per
90 days)
QL(90 per
90 days)
1
2
3
2
1
1
PA QL(9
per 84 days)
PA
QL(3 per 90
days)
PA
OTHER RHEUMATOLOGICALS
ACTEMRA INJ 80MG/4ML
ACTEMRA INJ 162MG/0.9ML,
200MG/10ML, 400MG/20ML
BENLYSTA INJ 400MG
BENLYSTA INJ 120MG
CUPRIMINE
ENBREL
2
3
ENBREL SURECLICK
3
HUMIRA
3
HUMIRA PEN
3
HUMIRA PEN-CROHNS
DISEASESTARTER
3
HUMIRA PEN-PSORIASIS
STARTER
3
leflunomide
1
ORENCIA
OTEZLA
3
3
3
2
2
3
Requirements/
Limits
PA
PA
PA QL(26
per 90 days)
PA QL(26
per 90 days)
PA QL(13
per 90 days)
PA QL(13
per 90 days)
PA QL(6
per 180
days)
PA QL(4
per 180
days)
QL(90 per
90 days)
PA
PA
Drug
Tier
2
2 PA QL(180
per 90 days)
SAVELLA TABS 50MG
2 PA QL(360
per 90 days)
SAVELLA TABS 25MG
2 PA QL(720
per 90 days)
SAVELLA TABS 12.5MG
2
PA
QL(1440
per 90 days)
SAVELLA TITRATION PACK
2
PA QL(1
per 90 days)
OBSTETRICS / GYNECOLOGY
ESTROGENS / PROGESTINS
camila
DEPO-PROVERA 400MG/ML
errin
ESTRACE CREA
estradiol ptwk
1
2
1
2
1
estradiol tabs
estradiol valerate
estradiol/norethindrone acetate
estropipate
heather
jencycla
jinteli
jolivette
lyza
MAKENA
medroxyprogesterone acetate
MENEST
mimvey
mimvey lo
nora-be
norethindrone
norethindrone acetate
norlyroc
PREMARIN CREA
PREMPHASE
PREMPRO
1
1
1
1
1
1
1
1
1
3
1
2
1
1
1
1
1
1
2
2
2
QL(13 per
90 days)
32
Updated 10/28/2014
Drug
Name
progesterone
sharobel
VAGIFEM
Drug
Tier
1
1
2
Requirements/
Limits
Drug
Name
daysee
delyla
desogestrel/ethinyl estradiol
drospirenone/ethinyl estradiol
elinest
emoquette
enpresse-28
enskyce
estarylla
falmina
gianvi
gildagia
gildess 1.5/30
gildess 1/20
gildess fe 1.5/30
gildess fe 1/20
introvale
jolessa
junel 1.5/30
junel 1/20
junel fe 1.5/30
junel fe 1/20
kariva
kelnor 1/35
kurvelo
larin 1.5/30
larin 1/20
larin fe 1.5/30
larin fe 1/20
leena
lessina
levonest
levonorgestrel
levonorgestrel and ethinyl
estradiol
levonorgestrel/ethinyl estradiol
levora 0.15/30-28
lomedia 24 fe
loryna
low-ogestrel
MISCELLANEOUS OB/GYN
clindamycin phosphate crea
metronidazole vaginal
miconazole 3
MIRENA
NEXPLANON
PROSTIN E2
terconazole
tranexamic acid
vandazole
xulane
zazole crea 0.4%
1
1
1
2
2
2
1
1
1
1
1
ORAL CONTRACEPTIVES / RELATED
AGENTS
altavera
alyacen 1/35
alyacen 7/7/7
amethia
amethia lo
amethyst
apri
aranelle
aubra
aviane
azurette
balziva
briellyn
camrese
camrese lo
caziant
chateal
cryselle-28
cyclafem 1/35
cyclafem 7/7/7
dasetta 1/35
dasetta 7/7/7
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Drug
Tier
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Requirements/
Limits
1
1
1
1
1
33
Updated 10/28/2014
Drug
Name
lutera
marlissa
microgestin 1.5/30
microgestin 1/20
microgestin fe
microgestin fe 1.5/30
mono-linyah
mononessa
my way
myzilra
necon 0.5/35-28
necon 1/35
necon 1/50-28
necon 10/11-28
necon 7/7/7
next choice one dose
nikki
norgestimate/ethinyl estradiol
nortrel 0.5/35 (28)
nortrel 1/35
nortrel 7/7/7
ocella
ogestrel
orsythia
philith
pimtrea
pirmella 1/35
pirmella 7/7/7
portia-28
previfem
quasense
reclipsen
sprintec 28
sronyx
syeda
tilia fe
tri-estarylla
tri-legest fe
tri-linyah
tri-previfem
Drug
Tier
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Requirements/
Limits
Drug
Name
tri-sprintec
trinessa
trivora-28
velivet
vestura
viorele
vyfemla
wera
wymzya fe
zarah
zenchent
zenchent fe
zovia 1/35e
zovia 1/50e
Drug
Tier
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Requirements/
Limits
OXYTOCICS
HEMABATE
methylergonovine maleate
oxytocin
2
1
1
OPHTHALMOLOGY
ANTIBIOTICS
ak-poly-bac
AZASITE
bacitracin ophthalmic oint
bacitracin/polymyxin b
BESIVANCE
ciprofloxacin hcl
erythromycin
garamycin ophthalmic soln
gatifloxacin
gentak
gentamicin sulfate
levofloxacin
NATACYN
neo-polycin
neomycin/bacitracin/polymyxin
neomycin/polymyxin/gramicidin
ofloxacin
polycin
tobramycin sulfate
1
2
1
1
2
1
1
1
1
1
1
1
2
1
1
1
1
1
1
34
Updated 10/28/2014
Drug
Drug
Name
Tier
trimethoprim sulfate/polymyxin b 1
sulfate
Requirements/
Limits
Drug
Name
diclofenac sodium ophthalmic
soln
flurbiprofen sodium
ketorolac tromethamine
ANTIVIRALS
trifluridine
ZIRGAN
1
2
acetazolamide
acetazolamide er
acetazolamide sodium
methazolamide
1
1
1
1
1
1
1
1
1
1
OTHER GLAUCOMA DRUGS
COMBIGAN
dorzolamide hcl
dorzolamide hcl/timolol maleate
latanoprost
miostat
travoprost
CHOLINESTERASE INHIBITOR
MIOTICS
PHOSPHOLINE IODIDE
1
1
ORAL DRUGS FOR GLAUCOMA
BETA-BLOCKERS
betaxolol hcl
carteolol hcl
levobunolol hcl
metipranolol
timolol maleate
timolol maleate ophthalmic gel
forming
Drug
Tier
1
Requirements/
Limits
2
2
1
1
1
1
1
CYCLOPLEGIC MYDRIATICS
STEROID-ANTIBIOTIC COMBINATIONS
cyclopentolate hcl
tropicamide
neo-polycin hc
neomycin/polymyxin/bacitracin/h
ydrocortisone
neomycin/polymyxin/dexamethaso
ne
neomycin/polymyxin/hydrocortiso
ne
tobramycin/dexamethasone
ZYLET
1
1
DIRECT ACTING MIOTICS
pilocarpine hcl
1
MISCELLANEOUS OPHTHALMOLOGICS
akorn balanced salt solution
azelastine hcl ophthalmic soln
balanced salt solution ophthalmic
soln 0.048%; 0.03%; 0.075%;
0.39%; 0.49%; 0.17%
bss
cromolyn sodium ophthalmic soln
CYSTARAN
epinastine hcl
EYLEA
LUCENTIS
proparacaine hcl
RESTASIS
1
1
1
1
1
3
1
3
3
1
2
1
1
1
2
STEROID-SULFONAMIDE
COMBINATIONS
BLEPHAMIDE
BLEPHAMIDE S.O.P.
sulfacetamide
sodium/prednisolone sodium
phosphate
2
2
1
STEROIDS
dexamethasone sodium phosphate
fluorometholone
FML
PRED MILD
prednisolone acetate
prednisolone sodium phosphate
QL(180 per
90 days)
NON-STEROIDAL ANTIINFLAMMATORY AGENTS
bromfenac
1
1
1
1
1
2
2
1
1
35
Updated 10/28/2014
Drug
Name
Drug
Tier
Requirements/
Limits
Drug
Name
palgic
phenadoz
promethazine hcl inj
promethazine hcl plain
promethazine hcl supp
promethazine hcl syrp
promethazine hcl tabs
promethegan
SULFONAMIDES
sodium sulfacetamide ophthalmic
soln
sulfacetamide sodium
1
1
SYMPATHOMIMETICS
ALPHAGAN P OPHTHALMIC
SOLN 0.1%
apraclonidine
brimonidine tartrate
2
1
1
Drug
Tier
1
1
1
1
1
1
1
1
RESPIRATORY AND ALLERGY
acetylcysteine inhalation soln
ADEMPAS
ADVAIR DISKUS
1
3
2
ANTIHISTAMINE / ANTIALLERGENIC
AGENTS
ADVAIR HFA
2
albuterol sulfate er
albuterol sulfate nebu
albuterol sulfate syrp
albuterol sulfate tabs
aminophylline
ASMANEX 120 METERED
DOSES
ASMANEX 14 METERED
DOSES
ASMANEX 30 METERED
DOSES
ASMANEX 60 METERED
DOSES
ATROVENT HFA
1
1
1
1
1
2
budesonide susp 32mcg/act
budesonide susp 0.25mg/2ml,
0.5mg/2ml
CINRYZE
COMBIVENT RESPIMAT
1
1
cromolyn sodium nebu
DALIRESP
DULERA
1
2
2
FIRAZYR
3
1
adrenalin inj
arbinoxa
carbinoxamine maleate
cetirizine hcl syrp
clemastine fumarate syrp
clemastine fumarate tabs 2.68mg
cyproheptadine hcl
desloratadine
1
1
1
1
1
1
1
1
desloratadine odt
1
diphenhydramine hcl caps 50mg
diphenhydramine hcl elix
diphenhydramine hcl inj
epinephrine hcl
EPIPEN 2-PAK
1
1
1
1
2
EPIPEN-JR 2-PAK
hydroxyzine hcl inj
hydroxyzine hcl oral soln
hydroxyzine hcl tabs
hydroxyzine pamoate
levocetirizine dihydrochloride
oral soln
levocetirizine dihydrochloride
tabs
2
1
1
1
1
1
1
PA
PA
PA
PULMONARY AGENTS
VASOCONSTRICTOR DECONGESTANTS
naphazoline hcl
Requirements/
Limits
QL(90 per
90 days)
QL(90 per
90 days)
PA
PA
QL(12 per
90 days)
QL(12 per
90 days)
PA
PA
PA
QL(90 per
90 days)
2
2
2
2
3
2
B/D PA
LA PA
PA QL(360
per 90 days)
PA QL(36
per 90 days)
B/D PA
QL(720 per
90 days)
QL(42 per
90 days)
QL(180 per
90 days)
QL(360 per
90 days)
QL(77.4 per
90 days)
B/D PA
PA
QL(24 per
90 days)
B/D PA
PA
PA QL(39
per 90 days)
PA
36
Updated 10/28/2014
Drug
Name
flunisolide
fluticasone propionate susp
FORADIL AEROLIZER
ipratropium bromide inhalation
soln
ipratropium bromide/albuterol
sulfate
KALYDECO
LETAIRIS
levalbuterol hcl
metaproterenol sulfate
montelukast sodium
OPSUMIT
PERFOROMIST
PROAIR HFA
RequireDrug ments/
Tier
Limits
1 QL(150 per
90 days)
1 QL(48 per
90 days)
2 QL(180 per
90 days)
1
B/D PA
1
3
3
1
1
1
3
2
2
PULMICORT SUSP 1MG/2ML
PULMOZYME
QVAR AERS 40MCG/ACT
2
3
2
QVAR AERS 80MCG/ACT
2
REVATIO INJ
SEREVENT DISKUS
3
2
sildenafil citrate
1
SPIRIVA HANDIHALER
2
SYMBICORT AERO
80MCG/ACT; 4.5MCG/ACT
SYMBICORT AERO
160MCG/ACT; 4.5MCG/ACT
terbutaline sulfate
theochron
theophylline
theophylline cr
theophylline er
theophylline/d5w
TRACLEER
2
2
1
1
1
1
1
1
3
Drug
Name
triamcinolone acetonide inha
TUDORZA PRESSAIR
TYVASO
TYVASO REFILL
TYVASO STARTER
XOLAIR
B/D PA
zafirlukast
LA PA
B/D PA
RequireDrug ments/
Tier
Limits
1 QL(49.5 per
90 days)
2 QL(3 per 90
days)
3
B/D PA
3
B/D PA
3
B/D PA
3
LA PA
QL(18 per
84 days)
1
UROLOGICALS
ANTICHOLINERGICS /
ANTISPASMODICS
LA PA
B/D PA
QL(51 per
90 days)
B/D PA
B/D PA
QL(65.7 per
90 days)
QL(78.3 per
90 days)
PA
QL(180 per
90 days)
PA QL(270
per 90 days)
QL(180 per
90 days)
PA QL(20.7
per 90 days)
PA QL(30.6
per 90 days)
LA PA
flavoxate hcl
oxybutynin chloride
oxybutynin chloride er
tolterodine tartrate
tolterodine tartrate er
trospium chloride
trospium chloride er
1
1
1
1
1
1
1
BENIGN PROSTATIC
HYPERPLASIA(BPH) THERAPY
alfuzosin hcl er
finasteride tabs 5mg
tamsulosin hcl
1
1
1
CHOLINERGIC STIMULANTS
bethanechol chloride
1
MISCELLANEOUS UROLOGICALS
alprostadil
aminoacetic acid
AMMONIUM CHLORIDE
CYSTAGON
ELMIRON
glycine irrigation soln
K-PHOS
K-PHOS NO 2
potassium citrate tbcr
potassium citrate er
RENACIDIN
1
1
2
2
2
1
2
2
1
1
2
LA
37
Updated 10/28/2014
Drug
Name
Drug
Tier
Requirements/
Limits
Drug
Drug
Name
Tier
klor-con m20
1
klor-con/ef
1
lactated ringers inj 3meq/l;
1
109meq/l; 28meq/l; 4meq/l;
130meq/l
lactated ringers viaflex
1
magnesium chloride inj
1
MAGNESIUM SULFATE IN
2
D5W INJ 5%; 10MG/ML
magnesium sulfate inj
1
NEUT
2
NORMOSOL -R
2
NORMOSOL-R IN D5W
2
nutrilyte ii
1
phospha 250 neutral
1
potassium acetate inj
1
potassium chloride 0.15% /nacl
1
0.45% viaflex
potassium chloride 0.15%
1
d5w/nacl 0.33%
potassium chloride 0.15%
1
d5w/nacl 0.45%
potassium chloride 0.15%
1
d5w/nacl 0.45% viaflex
potassium chloride 0.15% nacl
1
0.9%
potassium chloride 0.15% w/nacl 1
0.9% viaflex
potassium chloride 0.15%/d5w
1
potassium chloride 0.22%
1
d5w/nacl 0.45%
potassium chloride
1
0.224%/d5w/nacl 0.45%
potassium chloride
1
0.224%d5w/nacl 0.45% viaflex
potassium chloride 0.3%/ nacl
1
0.9%
potassium chloride 0.3%/d5w
1
potassium chloride 0.3%/nacl
1
0.9%/viaflex
potassium chloride er cpcr
1
potassium chloride er tbcr 10meq, 1
20meq
VITAMINS, HEMATINICS /
ELECTROLYTES
BLOOD DERIVATIVES
albumin human
albuminar-25
albuminar-5
alburx
albutein
buminate
human albumin grifols
plasbumin-25
plasbumin-5
1
1
1
1
1
1
1
1
1
ELECTROLYTES
calcium acetate caps
calcium acetate tabs 667mg
calcium chloride
calcium gluconate inj
dextrose 5%/potassium chloride
0.15%
effer-k tbef 25meq
effervescent pot chloride
eliphos
k-effervescent
k-vescent tbef
kcl 0.075%/d5w/nacl 0.45%
kcl 0.15%/d5w/ nacl 0.3%
kcl 0.15%/d5w/lr
kcl 0.15%/d5w/nacl 0.2%
kcl 0.15%/d5w/nacl 0.225%
kcl 0.15%/d5w/nacl 0.45%
kcl 0.15%/d5w/nacl 0.9%
kcl 0.3%/d5w/lr iv lac ring
kcl 0.3%/d5w/nacl 0.45%
kcl 0.3%/d5w/nacl 0.9%
klor-con 8
klor-con 10
klor-con 20
klor-con m10
klor-con m15
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Requirements/
Limits
38
Updated 10/28/2014
Drug
Name
potassium chloride inj
potassium chloride liqd
potassium chloride oral soln
potassium phosphate
potassium phosphates
ringers injection
sodium acetate
sodium bicarbonate inj
sodium bicarbonate partial fill
sodium chloride 0.45%
sodium chloride 0.45% viaflex
sodium chloride inj
sodium lactate inj
sodium phosphate
Drug
Tier
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Requirements/
Limits
Drug
Drug
Name
Tier
CLINIMIX E 4.25%/DEXTROSE 2
25%
CLINIMIX E 4.25%/DEXTROSE 2
5%
CLINIMIX E 5%/DEXTROSE
2
15%
CLINIMIX E 5%/DEXTROSE
2
20%
CLINIMIX E 5%/DEXTROSE
2
25%
CLINISOL SF 15%
2
cysteine hcl
1
dextrose 5% /electrolyte #48
1
viaflex
freamine iii
1
HEPATAMINE
2
HEPATASOL
2
hetastarch 6%/nacl
1
intralipid inj 2.25%; 20%
1
IONOSOL-B/DEXTROSE 5%
2
IONOSOL-MB/DEXTROSE 5% 2
ISOLYTE-P/DEXTROSE 5%
2
ISOLYTE-S
2
ISOLYTE-S PH 7.4
2
l-cysteine hcl
1
liposyn iii
1
NEPHRAMINE
2
NORMOSOL-M IN D5W
2
NORMOSOL-R
2
PLASMA-LYTE A
2
PLASMA-LYTE-148
2
PLASMA-LYTE-56/D5W
2
MISCELLANEOUS NUTRITION
PRODUCTS
amino acids
AMINOSYN
AMINOSYN
7%/ELECTROLYTES
AMINOSYN
8.5%/ELECTROLYTES
AMINOSYN II
AMINOSYN II
8.5%/ELECTROLYTES
AMINOSYN M
AMINOSYN-HBC
AMINOSYN-PF
AMINOSYN-PF 7%
AMINOSYN-RF
CLINIMIX 2.75%/DEXTROSE
5%
CLINIMIX 4.25%/DEXTROSE
10%
CLINIMIX 4.25%/DEXTROSE
20%
CLINIMIX 4.25%/DEXTROSE
25%
CLINIMIX 5%/DEXTROSE 15%
CLINIMIX 5%/DEXTROSE 20%
CLINIMIX 5%/DEXTROSE 25%
1
2
2
2
2
2
2
2
2
2
2
2
Requirements/
Limits
2
2
2
2
2
2
39
Updated 10/28/2014
Drug
Drug
Name
Tier
PREMASOL INJ 56MEQ/L;
2
320MG/100ML; 730MG/100ML;
190MG/100ML; 3MEQ/L;
20MG/100ML; 300MG/100ML;
220MG/100ML; 290MG/100ML;
490MG/100ML; 840MG/100ML;
490MG/100ML; 200MG/100ML;
290MG/100ML; 410MG/100ML;
230MG/100ML; 5MEQ/L;
15MG/100ML; 250MG/100ML;
120MG/100ML; 140MG/100ML;
470MG/100ML
premasol inj 52meq/l;
1
1760mg/100ml; 880mg/100ml;
34meq/l; 1760mg/100ml;
372mg/100ml; 406mg/100ml;
526mg/100ml; 492mg/100ml;
492mg/100ml; 526mg/100ml;
356mg/100ml; 356mg/100ml;
390mg/100ml; 34mg/100ml;
152mg/100ml
PROCALAMINE
2
travasol
1
TROPHAMINE
2
Requirements/
Limits
Drug
Name
mvc-fluoride
prenatal vitamins (generic)
sodium fluoride tabs
tri-vit/fluoride
tri-vit/fluoride/iron
triple-vitamin/fluoride
vitamins a/c/d/fluoride
Drug
Tier
1
1
1
1
1
1
1
Requirements/
Limits
VITAMINS / HEMATINICS
fluoritab chew 0.5mg
mult-vitamin/fluoride
multi vitamin/fluoride
multi-vit/fluoride
multi-vit/iron/fluoride oral soln
35mg/ml; 400unit/ml; 10mg/ml;
8mg/ml; 0.4mg/ml; 0.6mg/ml;
0.25mg/ml; 0.5mg/ml; 5unit/ml;
1500unit/ml
multi-vitamin/fluoride chew
60mg; 400unit; 4.5mcg; 0.3mg;
13.5mg; 1.05mg; 1.2mg; 0.5mg;
1.05mg; 2500unit; 15unit
multi-vitamin/fluoride oral soln
35mg/ml; 400unit/ml; 2mcg/ml;
5unit/ml; 8mg/ml; 0.4mg/ml;
0.6mg/ml; 0.5mg/ml; 0.5mg/ml;
1500unit/ml
multivitamin with fluoride
1
1
1
1
1
1
1
1
40
Updated 10/28/2014
Index of Drugs
acetic acid/aluminum acetate .............................. 25
acetylcysteine ................................................. 23, 36
acitretin ................................................................ 21
ACTEMRA .......................................................... 32
ACTHAR HP ....................................................... 25
ACTHIB ............................................................... 31
ACTIMMUNE ..................................................... 30
acyclovir ........................................................... 2, 22
acyclovir sodium .................................................... 2
ADACEL ............................................................. 31
ADAGEN ............................................................. 23
adapalene ............................................................. 21
adefovir dipivoxil ................................................... 2
ADEMPAS .......................................................... 36
adenosine ............................................................. 17
adrenalin .............................................................. 36
adriamycin ............................................................. 6
adrucil .................................................................... 6
ADVAIR DISKUS............................................... 36
ADVAIR HFA ..................................................... 36
ADVICOR ........................................................... 20
afeditab cr ............................................................ 18
AFINITOR ............................................................. 6
AFINITOR DISPERZ............................................ 6
AGGRENOX ....................................................... 19
a-hydrocort .......................................................... 25
akorn balanced salt solution ................................ 35
ak-poly-bac .......................................................... 34
ala cort ................................................................. 22
ALBENZA ............................................................. 4
albumin human..................................................... 38
albuminar-25........................................................ 38
albuminar-5.......................................................... 38
alburx ................................................................... 38
albutein ................................................................ 38
albuterol sulfate ................................................... 36
albuterol sulfate er ............................................... 36
alclometasone dipropionate ................................. 22
ALCOHOL PREPS.............................................. 25
ALDURAZYME.................................................. 28
alendronate sodium........................................ 23, 32
8
8-MOP ................................................................. 21
A
abacavir ................................................................. 2
abacavir sulfate/lamivudine/zidovudine................ 2
ABELCET ............................................................. 2
ABILIFY ............................................................. 13
ABILIFY DISCMELT ........................................ 13
ABILIFY MAINTENA ....................................... 13
ABRAXANE......................................................... 6
acamprosate calcium dr ...................................... 23
acarbose .............................................................. 25
ACCU-CHEK ACTIVE GLUCOSE CONTROL
SOLUTION ..................................................... 25
ACCU-CHEK ACTIVE STRIPS ........................ 25
ACCU-CHEK AVIVA........................................ 25
ACCU-CHEK AVIVA PLUS ............................. 25
ACCU-CHEK COMFORT CURVE CONTROL
SOLUTION (2 LEVELS) ............................... 25
ACCU-CHEK COMFORT CURVE LINEARITY
SOLUTION ..................................................... 25
ACCU-CHEK COMFORT CURVE TEST
STRIPS ............................................................ 25
ACCU-CHEK COMPACT BLUE CONTROL
SOLUTION (2 LEVELS) ............................... 25
ACCU-CHEK COMPACT PLUS CARE KIT ... 25
ACCU-CHEK NANO SMARTVIEW ................ 25
ACCU-CHEK SMARTVIEW STRIPS .............. 25
acebutolol hcl ...................................................... 18
acetaminophen/caffeine/dihydrocodeine bitartrate
......................................................................... 11
acetaminophen/codeine ....................................... 11
acetaminophen/codeine #2 .................................. 11
acetaminophen/codeine #3 .................................. 11
acetasol hc ........................................................... 25
acetazolamide ...................................................... 35
acetazolamide er ................................................. 35
acetazolamide sodium ......................................... 35
acetic acid ........................................................... 25
acetic acid 0.25% ................................................ 23
41
Updated 10/28/2014
amlodipine besylate/benazepril hcl...................... 18
amlodipine besylate/benazepril hydrochloride .... 18
AMMONIUM CHLORIDE ................................. 37
ammonium lactate ................................................ 21
amnesteem ............................................................ 21
amoxapine ............................................................ 13
amoxicillin.............................................................. 5
amoxicillin/clavulanate potassium......................... 5
amoxicillin/clavulanate potassium er .................... 5
amphetamine/dextroamphetamine ....................... 13
amphotericin b ....................................................... 2
ampicillin ............................................................... 5
ampicillin sodium ................................................... 5
ampicillin-sulbactam.............................................. 5
AMPYRA ............................................................ 10
ANADROL-50 ..................................................... 28
anagrelide hydrochloride..................................... 23
anastrozole ............................................................. 6
ANDROGEL........................................................ 28
ANDROGEL PUMP ............................................ 28
androxy ................................................................ 28
anectine ................................................................ 10
antipyrine/benzocaine .......................................... 25
apexicon e ............................................................ 22
APOKYN ............................................................. 10
apraclonidine ....................................................... 36
apri ....................................................................... 33
APTIOM ................................................................ 9
APTIVUS ............................................................... 2
ARALAST NP ..................................................... 23
aranelle ................................................................ 33
arbinoxa ............................................................... 36
ARCALYST ........................................................ 30
ARMOUR THYROID ......................................... 28
ARRANON ............................................................ 6
ARZERRA ............................................................. 6
ASMANEX 120 METERED DOSES ................. 36
ASMANEX 14 METERED DOSES ................... 36
ASMANEX 30 METERED DOSES ................... 36
ASMANEX 60 METERED DOSES ................... 36
aspirin-caffeine-dihydrocodeine .......................... 11
atenolol ................................................................ 18
alfuzosin hcl er .................................................... 37
ALIMTA ............................................................... 6
ALINIA ................................................................. 4
ALKERAN ............................................................ 6
allopurinol ........................................................... 31
aloprim ................................................................ 31
ALOXI ................................................................ 29
ALPHAGAN P .................................................... 36
alprostadil ........................................................... 37
altavera................................................................ 33
alyacen 1/35 ........................................................ 33
alyacen 7/7/7 ....................................................... 33
amantadine hcl ...................................................... 2
AMBISOME ......................................................... 2
amcinonide .......................................................... 22
a-methapred ........................................................ 25
amethia ................................................................ 33
amethia lo ............................................................ 33
amethyst ............................................................... 33
amifostine .............................................................. 6
amikacin sulfate..................................................... 4
amiloride hcl ....................................................... 18
amiloride/hydrochlorothiazide ............................ 18
amino acids ......................................................... 39
aminoacetic acid ................................................. 37
aminocaproic acid ............................................... 19
aminophylline ...................................................... 36
AMINOSYN ....................................................... 39
AMINOSYN 7%/ELECTROLYTES ................. 39
AMINOSYN 8.5%/ELECTROLYTES .............. 39
AMINOSYN II.................................................... 39
AMINOSYN II 8.5%/ELECTROLYTES ........... 39
AMINOSYN M ................................................... 39
AMINOSYN-HBC .............................................. 39
AMINOSYN-PF ................................................. 39
AMINOSYN-PF 7% ........................................... 39
AMINOSYN-RF ................................................. 39
amiodarone hcl .................................................... 17
AMITIZA ............................................................ 29
amitriptyline hcl .................................................. 13
amlodipine besylate ............................................. 18
amlodipine besylate/atorvastatin calcium........... 20
42
Updated 10/28/2014
benztropine mesylate ............................................ 10
BESIVANCE ....................................................... 34
betamethasone dipropionate ................................ 22
betamethasone sodium phosphate/betamethasone
acetate .............................................................. 25
betamethasone valerate ....................................... 22
BETASERON ...................................................... 30
betaxolol hcl ................................................... 18, 35
bethanechol chloride ............................................ 37
BETHKIS ............................................................... 4
bicalutamide........................................................... 6
BICNU ................................................................... 6
bisoprolol fumarate.............................................. 18
bisoprolol fumarate/hydrochlorothiazide ............ 18
bleomycin sulfate ................................................... 6
BLEPHAMIDE .................................................... 35
BLEPHAMIDE S.O.P. ........................................ 35
BOOSTRIX.......................................................... 31
BOSULIF ............................................................... 6
BOTOX ................................................................ 31
briellyn ................................................................. 33
BRILINTA ........................................................... 19
brimonidine tartrate ............................................. 36
BRINTELLIX ...................................................... 13
bromfenac ............................................................ 35
bromocriptine mesylate ........................................ 10
bss ........................................................................ 35
budeprion sr ......................................................... 13
budesonide ..................................................... 29, 36
bumetanide ........................................................... 18
buminate............................................................... 38
BUPHENYL ........................................................ 23
bupivacaine hcl .................................................... 22
bupivacaine spinal ............................................... 23
bupivacaine/epinephrine ...................................... 22
buprenorphine hcl ................................................ 11
buprenorphine hcl/naloxone hcl .......................... 12
buproban .............................................................. 24
bupropion hcl ....................................................... 13
bupropion hcl sr ....................................... 13, 14, 24
bupropion hcl xl ................................................... 14
buspirone hcl ........................................................ 14
atenolol/chlorthalidone ....................................... 18
ATGAM .............................................................. 31
atorvastatin calcium ............................................ 20
atovaquone ............................................................ 4
atovaquone/proguanil hcl ..................................... 4
ATRIPLA .............................................................. 2
atropine sulfate.................................................... 28
ATROVENT HFA .............................................. 36
aubra ................................................................... 33
augmented betamethasone dipropionate............. 22
AUGMENTIN ....................................................... 5
AVASTIN ............................................................. 6
AVELOX .............................................................. 5
aviane .................................................................. 33
avita ..................................................................... 21
AVONEX ............................................................ 30
AVONEX PEN ................................................... 30
azacitidine ............................................................. 6
AZASAN............................................................... 6
AZASITE ............................................................ 34
azathioprine........................................................... 6
azelastine hcl ................................................. 24, 35
AZILECT ............................................................ 10
azithromycin .......................................................... 4
aztreonam .............................................................. 4
azurette ................................................................ 33
B
baciim .................................................................... 4
bacitracin ........................................................ 4, 34
bacitracin/polymyxin b ........................................ 34
baclofen ............................................................... 10
bactocill in dextrose .............................................. 5
balanced salt solution.......................................... 35
balsalazide disodium ........................................... 29
balziva ................................................................. 33
BANZEL ............................................................... 9
BARACLUDE ...................................................... 2
BCG VACCINE .................................................. 31
BELEODAQ ......................................................... 6
benazepril hcl ...................................................... 18
benazepril hcl/hydrochlorothiazide .................... 18
BENLYSTA ........................................................ 32
43
Updated 10/28/2014
carteolol hcl ......................................................... 35
cartia xt ................................................................ 18
carvedilol ............................................................. 18
CAYSTON............................................................. 4
caziant .................................................................. 33
CEENU .................................................................. 6
cefaclor .................................................................. 3
cefaclor er .............................................................. 3
cefadroxil ............................................................... 3
cefazolin sodium..................................................... 3
cefazolin sodium/dextrose ...................................... 3
cefdinir ................................................................... 3
cefditoren pivoxil ................................................... 3
cefepime ................................................................. 3
cefotaxime sodium .................................................. 3
cefotetan ................................................................. 3
cefoxitin sodium ..................................................... 3
cefpodoxime proxetil .............................................. 3
cefprozil.................................................................. 3
ceftazidime ............................................................. 3
ceftibuten ................................................................ 3
ceftriaxone in iso-osmotic dextrose ....................... 3
ceftriaxone sodium ................................................. 3
ceftriaxone/dextrose ............................................... 3
cefuroxime axetil .................................................... 3
cefuroxime sodium ................................................. 3
cefuroxime/dextrose ............................................... 3
CELEBREX ......................................................... 12
CELLCEPT ............................................................ 6
CELLCEPT INTRAVENOUS .............................. 6
CELONTIN............................................................ 9
cephalexin .............................................................. 3
CEREZYME ........................................................ 28
CERVARIX ......................................................... 31
CESAMET ........................................................... 29
cetirizine hcl ......................................................... 36
cevimeline hcl....................................................... 23
CHANTIX............................................................ 24
CHANTIX CONTINUING MONTH PAK ......... 24
CHANTIX STARTING MONTH PAK .............. 24
chateal .................................................................. 33
CHEMET ............................................................. 23
BUSULFEX .......................................................... 6
butorphanol tartrate ............................................ 12
BYDUREON....................................................... 25
BYETTA ............................................................. 26
C
cabergoline .......................................................... 28
caffeine citrate ..................................................... 23
calcipotriene ........................................................ 21
calcipotriene/betamethasone dipropionate ......... 21
calcitonin-salmon ................................................ 28
calcitrene ............................................................. 21
calcitriol ........................................................ 21, 28
calcium acetate .................................................... 38
calcium chloride .................................................. 38
calcium gluconate ............................................... 38
camila .................................................................. 32
CAMPTOSAR ...................................................... 6
camrese................................................................ 33
camrese lo ........................................................... 33
CANASA ............................................................ 29
CANCIDAS .......................................................... 2
candesartan cilexetil ........................................... 18
candesartan cilexetil/hydrochlorothiazide .......... 18
CAPASTAT SULFATE........................................ 4
CAPRELSA .......................................................... 6
captopril .............................................................. 18
captopril/hydrochlorothiazide............................. 18
CARAC ............................................................... 21
carafate................................................................ 29
CARBAGLU ....................................................... 23
carbamazepine ...................................................... 9
carbamazepine er .................................................. 9
carbidopa ............................................................ 10
carbidopa/levodopa ............................................. 10
carbidopa/levodopa er ........................................ 10
carbidopa/levodopa odt....................................... 10
carbidopa/levodopa/entacapone ......................... 10
carbinoxamine maleate ....................................... 36
carbocaine ........................................................... 22
carboplatin ............................................................ 6
cardioplegic......................................................... 20
CARIMUNE NANOFILTERED ........................ 31
44
Updated 10/28/2014
clindamycin phosphate add-vantage...................... 4
clindamycin phosphate in d5w ............................... 4
clindamycin/benzoyl peroxide .............................. 21
CLINIMIX 2.75%/DEXTROSE 5% ................... 39
CLINIMIX 4.25%/DEXTROSE 10% ................. 39
CLINIMIX 4.25%/DEXTROSE 20% ................. 39
CLINIMIX 4.25%/DEXTROSE 25% ................. 39
CLINIMIX 4.25%/DEXTROSE 5% ................... 23
CLINIMIX 5%/DEXTROSE 15% ...................... 39
CLINIMIX 5%/DEXTROSE 20% ...................... 39
CLINIMIX 5%/DEXTROSE 25% ...................... 39
CLINIMIX E 2.75%/DEXTROSE 10% .............. 23
CLINIMIX E 2.75%/DEXTROSE 5% ................ 23
CLINIMIX E 4.25%/DEXTROSE 25% .............. 39
CLINIMIX E 4.25%/DEXTROSE 5% ................ 39
CLINIMIX E 5%/DEXTROSE 15% ................... 39
CLINIMIX E 5%/DEXTROSE 20% ................... 39
CLINIMIX E 5%/DEXTROSE 25% ................... 39
CLINISOL SF 15%.............................................. 39
clobetasol propionate........................................... 22
clobetasol propionate e ........................................ 22
clobetasol propionate emollient........................... 22
clodan ................................................................... 22
CLOLAR................................................................ 6
clomipramine hcl ................................................. 14
clonazepam ............................................................ 9
clonazepam odt ...................................................... 9
clonidine hcl ................................................... 12, 18
clonidine hcl er .................................................... 14
clopidogrel ........................................................... 19
clorazepate dipotassium....................................... 14
clorpres ................................................................ 18
clotrimazole...................................................... 2, 22
clotrimazole/betamethasone dipropionate ........... 22
clozapine .............................................................. 14
clozapine odt ........................................................ 14
COARTEM ............................................................ 4
codeine sulfate ..................................................... 11
COLCRYS ........................................................... 31
colestipol hcl ........................................................ 20
colestipol hcl for oral suspension ........................ 20
colistimethate sodium............................................. 4
CHENODAL ....................................................... 29
chloramphenicol sodium succinate ....................... 4
chlorhexidine gluconate ...................................... 24
chlorhexidine gluconate oral rinse ..................... 24
chloroprocaine hcl .............................................. 22
chloroquine phosphate .......................................... 4
chlorothiazide ...................................................... 18
chlorothiazide sodium ......................................... 18
chlorpromazine hcl .............................................. 14
chlorthalidone ..................................................... 18
chlorzoxazone ...................................................... 10
cholestyramine .................................................... 20
cholestyramine light ............................................ 20
chorionic gonadotropin ....................................... 28
ciclodan ............................................................... 22
ciclopirox............................................................. 22
ciclopirox nail lacquer ........................................ 22
ciclopirox olamine ............................................... 22
ciclopirox topical solution kit .............................. 22
cidofovir ................................................................ 2
cilostazol.............................................................. 19
cimetidine ............................................................ 29
cimetidine hcl ...................................................... 29
CINRYZE............................................................ 36
CIPRO ................................................................... 5
CIPRODEX ......................................................... 25
ciprofloxacin.......................................................... 5
ciprofloxacin er ..................................................... 5
ciprofloxacin hcl .............................................. 5, 34
ciprofloxacin i.v.-in d5w........................................ 5
cisplatin ................................................................. 6
citalopram hydrobromide.................................... 14
cladribine .............................................................. 6
claravis ................................................................ 21
clarithromycin ....................................................... 4
clarithromycin er ................................................... 4
clemastine fumarate ............................................ 36
clindacin etz pledgets .......................................... 21
clindacin-p........................................................... 21
clindamycin hcl ..................................................... 4
clindamycin palmitate hcl ..................................... 4
clindamycin phosphate .............................. 4, 21, 33
45
Updated 10/28/2014
dantrolene sodium................................................ 10
DAPSONE ............................................................. 4
DAPTACEL......................................................... 31
DARAPRIM .......................................................... 4
dasetta 1/35 .......................................................... 33
dasetta 7/7/7 ......................................................... 33
daunorubicin hcl .................................................... 7
DAUNOXOME ..................................................... 7
daysee ................................................................... 33
decitabine ............................................................... 7
deferoxamine mesylate ......................................... 23
delyla .................................................................... 33
demeclocycline hcl ................................................. 5
demerol ................................................................ 11
DEMSER ............................................................. 18
DENAVIR............................................................ 22
denta 5000 plus .................................................... 24
dentagel ................................................................ 24
DEPOCYT ............................................................. 7
DEPO-PROVERA 400MG/ML........................... 32
desipramine hcl .................................................... 14
desloratadine........................................................ 36
desloratadine odt ................................................. 36
desmopressin acetate ........................................... 28
desogestrel/ethinyl estradiol ................................ 33
desonide ............................................................... 22
desoximetasone .................................................... 22
dexamethasone ..................................................... 25
dexamethasone intensol ....................................... 25
dexamethasone sodium phosphate ................. 25, 35
dexedrine .............................................................. 14
dexmethylphenidate hcl ........................................ 14
dexmethylphenidate hcl er ................................... 14
dexrazoxane ........................................................... 6
dextroamphetamine sulfate .................................. 14
dextroamphetamine sulfate er .............................. 14
dextrose 10%/nacl 0.45% ................................... 23
dextrose 5% /electrolyte #48 viaflex ................... 39
dextrose 10% ........................................................ 23
dextrose 10% flex container................................. 23
dextrose 10%/nacl 0.2% ...................................... 23
dextrose 2.5%/nacl 0.45% ................................... 23
colocort................................................................ 29
COMBIGAN ....................................................... 35
COMBIVENT RESPIMAT ................................ 36
COMETRIQ .......................................................... 6
COMPLERA ......................................................... 2
compro................................................................. 29
COMVAX ........................................................... 31
constulose ............................................................ 29
COPAXONE ....................................................... 10
corlopam.............................................................. 18
cormax scalp application .................................... 22
CORTIFOAM ..................................................... 29
cortisone acetate ................................................. 25
CREON ............................................................... 29
CRESTOR ........................................................... 20
CRIXIVAN ........................................................... 2
cromolyn sodium ..................................... 29, 35, 36
cryselle-28 ........................................................... 33
CUBICIN .............................................................. 4
CUPRIMINE ....................................................... 32
cyclafem 1/35....................................................... 33
cyclafem 7/7/7 ..................................................... 33
cyclopentolate hcl ................................................ 35
CYCLOPHOSPHAMIDE ..................................... 6
CYCLOSERINE ................................................... 4
CYCLOSET ........................................................ 26
cyclosporine .......................................................... 6
cyclosporine modified ........................................... 6
CYMBALTA ...................................................... 14
cyproheptadine hcl .............................................. 36
CYSTADANE..................................................... 29
CYSTAGON ....................................................... 37
CYSTARAN ....................................................... 35
cysteine hcl .......................................................... 39
cytarabine .............................................................. 6
cytarabine aqueous ............................................... 6
D
dacarbazine ........................................................... 6
DACOGEN ........................................................... 7
dactinomycin ......................................................... 7
DALIRESP .......................................................... 36
danazol ................................................................ 28
46
Updated 10/28/2014
diphenhydramine hcl ............................................ 36
diphenoxylate/atropine ........................................ 28
DIPHTHERIA/TETANUS TOXOIDS
ADSORBED PEDIATRIC .............................. 31
dipyridamole ........................................................ 19
disulfiram ............................................................. 24
divalproex sodium .................................................. 9
divalproex sodium dr ............................................. 9
divalproex sodium er.............................................. 9
dobutamine hcl ..................................................... 20
dobutamine hcl/d5w ............................................. 20
DOCEFREZ ........................................................... 7
docetaxel ................................................................ 7
donepezil hcl ........................................................ 10
dopamine hcl ........................................................ 20
dopamine/d5w ...................................................... 20
DORIBAX ............................................................. 4
dorzolamide hcl .................................................... 35
dorzolamide hcl/timolol maleate.......................... 35
doxazosin mesylate............................................... 18
doxepin hcl ........................................................... 14
doxercalciferol ..................................................... 28
DOXIL ................................................................... 7
doxorubicin hcl ...................................................... 7
doxorubicin hcl liposome ....................................... 7
doxy 100 ................................................................. 5
doxycycline hyclate ................................................ 5
doxycycline hyclate dr............................................ 5
doxycycline monohydrate....................................... 5
dronabinol ............................................................ 29
droperidol ............................................................ 29
drospirenone/ethinyl estradiol ............................. 33
DROXIA ................................................................ 7
DULERA ............................................................. 36
duloxetine hcl ....................................................... 14
duramorph............................................................ 11
DUTOPROL ........................................................ 18
dextrose 2.5%/sodium chloride 0.45%................ 23
dextrose 20% ....................................................... 23
dextrose 25% ....................................................... 23
dextrose 30% ....................................................... 23
dextrose 40% ....................................................... 23
dextrose 5% ......................................................... 23
dextrose 5%/lactated ringers .............................. 24
dextrose 5%/nacl 0.2% ........................................ 24
dextrose 5%/nacl 0.225%.................................... 24
dextrose 5%/nacl 0.33% ...................................... 24
dextrose 5%/nacl 0.45% ...................................... 24
dextrose 5%/nacl 0.9% ........................................ 24
dextrose 5%/potassium chloride 0.15% .............. 38
dextrose 5%/ringers ............................................ 24
dextrose 5%/sodium chloride 0.45%................... 24
dextrose 50% ....................................................... 24
dextrose 70% ....................................................... 24
dextrose thermoject system.................................. 24
diazepam.......................................................... 9, 14
diazepam intensol ................................................ 14
DIBENZYLINE .................................................. 18
diclofenac potassium ........................................... 12
diclofenac sodium.................................... 12, 21, 35
diclofenac sodium dr ........................................... 12
diclofenac sodium er ........................................... 12
diclofenac sodium/misoprostol............................ 13
dicloxacillin sodium .............................................. 5
didanosine ............................................................. 2
diflorasone diacetate ........................................... 22
diflunisal .............................................................. 13
digox .................................................................... 19
digoxin ................................................................. 19
dihydroergotamine mesylate ............................... 10
DILANTIN ............................................................ 9
dilt-cd .................................................................. 18
diltiazem cd ......................................................... 18
diltiazem hcl ........................................................ 18
diltiazem hcl cd.................................................... 18
diltiazem hcl er .................................................... 18
dilt-xr ................................................................... 18
dimenhydrinate .................................................... 29
DIPENTUM ........................................................ 29
E
e.e.s. 400 ................................................................ 4
E.E.S. GRANULES ............................................... 4
e.s.p. ....................................................................... 4
econazole nitrate .................................................. 22
47
Updated 10/28/2014
epoprostenol sodium ............................................ 18
eprosartan mesylate ............................................. 18
EPZICOM .............................................................. 2
ERBITUX .............................................................. 7
ergoloid mesylates ............................................... 14
ERGOMAR.......................................................... 10
ERIVEDGE............................................................ 7
errin...................................................................... 32
ERWINAZE ........................................................... 7
ery ........................................................................ 21
erygel.................................................................... 21
ERYPED 200 ......................................................... 4
ERYPED 400 ......................................................... 4
ery-tab .................................................................... 4
ERYTHROCIN LACTOBIONATE ...................... 4
erythrocin stearate ................................................. 4
erythromycin .............................................. 4, 21, 34
erythromycin base .................................................. 4
erythromycin ethylsuccinate .................................. 4
erythromycin/benzoyl peroxide ............................ 21
escitalopram oxalate ............................................ 14
esmolol hcl ........................................................... 18
esomeprazole sodium ........................................... 30
estarylla................................................................ 33
ESTRACE ............................................................ 32
estradiol ............................................................... 32
estradiol valerate ................................................. 32
estradiol/norethindrone acetate ........................... 32
estropipate............................................................ 32
eszopiclone ........................................................... 14
ethambutol hcl ........................................................ 4
ethosuximide .......................................................... 9
etidronate disodium ............................................. 24
etodolac ................................................................ 13
etodolac er ........................................................... 13
ETOPOPHOS ........................................................ 7
etoposide ................................................................ 7
EVISTA ............................................................... 32
EXELON.............................................................. 10
exemestane ............................................................. 7
EXFORGE ........................................................... 18
EXFORGE HCT .................................................. 18
EDURANT ............................................................ 2
effer-k .................................................................. 38
effervescent pot chloride ..................................... 38
EFFIENT ............................................................. 19
EGRIFTA ............................................................ 30
ELAPRASE......................................................... 28
ELELYSO ........................................................... 28
ELIGARD ............................................................. 7
elinest .................................................................. 33
eliphos ................................................................. 38
ELIQUIS ............................................................. 19
ELITEK ................................................................. 6
ELMIRON........................................................... 37
ELSPAR ................................................................ 7
EMCYT ................................................................. 7
EMEND............................................................... 29
emoquette ............................................................ 33
EMSAM .............................................................. 14
EMTRIVA............................................................. 2
enalapril maleate................................................. 18
enalapril maleate/hydrochlorothiazide ............... 18
enalaprilat ........................................................... 18
ENBREL ............................................................. 32
ENBREL SURECLICK ...................................... 32
endocet ................................................................ 11
endodan ............................................................... 11
ENGERIX-B ....................................................... 31
enlon .................................................................... 11
enoxaparin sodium ........................................ 19, 20
enpresse-28.......................................................... 33
enskyce ................................................................ 33
entacapone .......................................................... 10
enulose................................................................. 29
epinastine hcl....................................................... 35
epinephrine hcl .................................................... 36
EPIPEN 2-PAK ................................................... 36
EPIPEN-JR 2-PAK ............................................. 36
epirubicin hcl......................................................... 7
epitol ...................................................................... 9
EPIVIR .................................................................. 2
EPIVIR HBV......................................................... 2
eplerenone ........................................................... 18
48
Updated 10/28/2014
fluocinolone acetonide body ................................ 23
fluocinolone acetonide ear drops......................... 25
fluocinolone acetonide scalp................................ 23
fluocinonide.......................................................... 23
fluocinonide-e ...................................................... 23
fluoritab................................................................ 40
fluorometholone ................................................... 35
fluorouracil ...................................................... 7, 21
fluoxetine dr ......................................................... 14
fluoxetine hcl .................................................. 14, 15
fluphenazine decanoate ........................................ 15
fluphenazine hcl ................................................... 15
flurbiprofen .......................................................... 13
flurbiprofen sodium.............................................. 35
flutamide ................................................................ 7
fluticasone propionate ................................... 23, 37
fluvastatin............................................................. 20
fluvoxamine maleate ............................................ 15
fluvoxamine maleate er ........................................ 15
FML ..................................................................... 35
FOLOTYN ............................................................. 7
fomepizole ............................................................ 31
fondaparinux sodium ........................................... 20
FORADIL AEROLIZER ..................................... 37
FORTEO .............................................................. 32
fortical .................................................................. 28
foscarnet sodium .................................................... 2
fosinopril sodium ................................................. 18
fosinopril sodium/hydrochlorothiazide ................ 18
fosphenytoin sodium............................................... 9
freamine iii ........................................................... 39
furosemide ............................................................ 18
FUSILEV ............................................................... 6
FUZEON ................................................................ 2
FYCOMPA ............................................................ 9
EXJADE .............................................................. 24
EYLEA ................................................................ 35
F
FABRAZYME .................................................... 28
falmina................................................................. 33
famciclovir ............................................................. 2
famotidine ............................................................ 30
famotidine premixed ............................................ 30
FANAPT ............................................................. 14
FANAPT TITRATION PACK ........................... 14
FARESTON .......................................................... 7
FASLODEX .......................................................... 7
FAZACLO .......................................................... 14
felbamate ............................................................... 9
felodipine er......................................................... 18
fenofibrate ........................................................... 20
fenofibrate micronized......................................... 20
fenofibric acid ..................................................... 20
fenofibric acid dr ................................................. 20
fenoprofen calcium .............................................. 13
fentanyl citrate..................................................... 11
fentanyl citrate oral transmucosal ...................... 11
fentanyl patches ................................................... 11
FERRIPROX ....................................................... 24
FETZIMA............................................................ 14
FETZIMA TITRATION PACK ......................... 14
finasteride ............................................................ 37
FIRAZYR ............................................................ 36
FIRMAGON.......................................................... 7
flavoxate hcl ........................................................ 37
FLEBOGAMMA DIF ......................................... 31
flecainide acetate................................................. 17
floxuridine ............................................................. 7
fluconazole ............................................................ 2
fluconazole in dextrose .......................................... 2
fluconazole in nacl ................................................ 2
flucytosine.............................................................. 2
fludarabine phosphate ........................................... 7
fludrocortisone acetate........................................ 25
flumazenil ............................................................ 14
flunisolide ............................................................ 37
fluocinolone acetonide .................................. 22, 25
G
gabapentin.............................................................. 9
GABITRIL ............................................................. 9
GABLOFEN ........................................................ 11
galantamine hydrobromide .................................. 10
GAMASTAN S/D................................................ 31
GAMMAGARD S/D ........................................... 31
49
Updated 10/28/2014
glycopyrrolate ...................................................... 28
granisetron hcl ..................................................... 29
granisol ................................................................ 29
GRASTEK ........................................................... 31
griseofulvin microsize ............................................ 2
griseofulvin ultramicrosize .................................... 2
guanfacine hcl ...................................................... 18
guanidine hcl ........................................................ 15
GAMMAGARD S/D IGA LESS THAN
1MCG/ML....................................................... 31
GAMUNEX-C .................................................... 31
ganciclovir ............................................................. 2
garamycin ............................................................ 34
GARDASIL......................................................... 31
gatifloxacin .......................................................... 34
GAUZE PADS 2 ................................................. 26
gavilyte-c ............................................................. 29
gavilyte-g ............................................................. 29
gavilyte-n/flavor pack .......................................... 29
GAZYVA .............................................................. 7
gemcitabine hcl ..................................................... 7
gemfibrozil........................................................... 20
generlac ............................................................... 29
gengraf .................................................................. 7
gentak .................................................................. 34
gentamicin sulfate ..................................... 4, 22, 34
gentamicin sulfate pediatric .................................. 4
gentamicin sulfate/0.9% sodium chloride ............. 4
GEODON ............................................................ 15
gianvi ................................................................... 33
gildagia................................................................ 33
gildess 1.5/30....................................................... 33
gildess 1/20.......................................................... 33
gildess fe 1.5/30 ................................................... 33
gildess fe 1/20 ...................................................... 33
GILENYA ........................................................... 10
GILOTRIF ............................................................. 7
GLEEVEC ............................................................. 7
glimepiride .......................................................... 26
glipizide ............................................................... 26
glipizide er ........................................................... 26
glipizide xl ........................................................... 26
glipizide/metformin hcl........................................ 26
GLUCAGEN ....................................................... 26
GLUCAGEN HYPOKIT .................................... 26
GLUCAGON EMERGENCY KIT ..................... 26
glyburide.............................................................. 26
glyburide micronized ........................................... 26
glyburide/metformin hcl ...................................... 26
glycine ................................................................. 37
H
HALAVEN ............................................................ 7
halobetasol propionate ........................................ 23
halonate................................................................ 23
halonate pac ......................................................... 23
haloperidol ........................................................... 15
haloperidol decanoate ......................................... 15
haloperidol lactate ............................................... 15
HAVRIX .............................................................. 31
heather ................................................................. 32
hecoria ................................................................... 7
HEMABATE ....................................................... 34
heparin sodium..................................................... 20
heparin sodium dcu .............................................. 20
heparin sodium/d5w ............................................. 20
heparin sodium/nacl 0.45% ................................. 20
heparin sodium/nacl 0.9% ................................... 20
heparin sodium/sodium chloride 0.9% ................ 20
heparin sodium/sodium chloride 0.9% premix .... 20
HEPATAMINE.................................................... 39
HEPATASOL ...................................................... 39
HEPSERA .............................................................. 2
HERCEPTIN.......................................................... 7
hetastarch 6%/nacl .............................................. 39
HEXALEN ............................................................. 7
HIZENTRA.......................................................... 31
HUMALOG ......................................................... 26
HUMALOG KWIKPEN ...................................... 26
HUMALOG MIX 50/50 ...................................... 26
HUMALOG MIX 50/50 KWIKPEN ................... 26
HUMALOG MIX 75/25 ...................................... 26
HUMALOG MIX 75/25 KWIKPEN ................... 26
human albumin grifols ......................................... 38
HUMIRA ............................................................. 32
50
Updated 10/28/2014
IMOGAM RABIES-HT....................................... 31
IMOVAX RABIES (H.D.C.V.) ........................... 31
INCIVEK ............................................................... 2
INCRELEX .......................................................... 24
indapamide........................................................... 18
indomethacin ........................................................ 13
indomethacin er ................................................... 13
indomethacin sodium ........................................... 13
INFANRIX .......................................................... 31
INFERGEN .......................................................... 30
INLYTA ................................................................. 7
INSULIN PEN NEEDLE .................................... 26
INSULIN SYRINGE (DISP) U-100 0.3 ML....... 26
INSULIN SYRINGE (DISP) U-100 1 ML.......... 26
INSULIN SYRINGE (DISP) U-100 1/2 ML....... 26
INTELENCE.......................................................... 2
intralipid .............................................................. 39
INTRON-A .......................................................... 30
INTRON-A W/DILUENT ................................... 30
introvale ............................................................... 33
INTUNIV ............................................................. 15
INVANZ ................................................................ 4
INVEGA .............................................................. 15
INVEGA SUSTENNA ........................................ 15
INVIRASE ............................................................. 2
INVOKANA ........................................................ 26
IONOSOL-B/DEXTROSE 5%............................ 39
IONOSOL-MB/DEXTROSE 5% ........................ 39
IPOL INACTIVATED IPV ................................. 31
ipratropium bromide ...................................... 24, 37
ipratropium bromide/albuterol sulfate ................ 37
irbesartan ............................................................. 18
irbesartan/hydrochlorothiazide ........................... 18
irinotecan ............................................................... 7
ISENTRESS ........................................................... 2
ISOLYTE-P/DEXTROSE 5% ............................. 39
ISOLYTE-S ......................................................... 39
ISOLYTE-S PH 7.4 ............................................. 39
isoniazid ................................................................. 4
isosorbide dinitrate .............................................. 21
isosorbide dinitrate er .......................................... 21
isosorbide mononitrate ........................................ 21
HUMIRA PEN .................................................... 32
HUMIRA PEN-CROHNS DISEASESTARTER 32
HUMIRA PEN-PSORIASIS STARTER ............ 32
HUMULIN 70/30 ................................................ 26
HUMULIN 70/30 PEN ....................................... 26
HUMULIN N ...................................................... 26
HUMULIN N U-100 PEN .................................. 26
HUMULIN R ...................................................... 26
HUMULIN R U-500 (CONCENTRATED) ....... 26
hydralazine hcl .................................................... 18
hydrochlorothiazide ............................................ 18
hydrocodone bitartrate/acetaminophen .............. 11
hydrocodone/acetaminophen .............................. 11
hydrocodone/ibuprofen ....................................... 11
hydrocortisone......................................... 23, 25, 29
hydrocortisone butyrate ...................................... 23
hydrocortisone butyrate (lipophilic) ................... 23
hydrocortisone in absorbase ............................... 23
hydrocortisone valerate....................................... 23
hydrocortisone/acetic acid .................................. 25
hydromorphone hcl ............................................. 11
hydromorphone hcl er ......................................... 11
hydroxychloroquine sulfate ................................... 4
hydroxyurea ........................................................... 7
hydroxyzine hcl .................................................... 36
hydroxyzine pamoate ........................................... 36
HYPERHEP B S/D ............................................. 31
HYPERRHO S/D ................................................ 31
I
ibandronate sodium ............................................. 32
ibuprofen ............................................................. 13
ibutilide fumarate ................................................ 17
ICLUSIG ............................................................... 7
idarubicin hcl ........................................................ 7
ifosfamide .............................................................. 7
ifosfamide/mesna ................................................... 7
ILARIS ................................................................ 30
IMBRUVICA ........................................................ 7
imipenem/cilastatin ............................................... 4
imipramine hcl..................................................... 15
imipramine pamoate............................................ 15
imiquimod ............................................................ 21
51
Updated 10/28/2014
isosorbide mononitrate er ................................... 21
isotonic gentamicin ............................................... 4
isradipine............................................................. 18
ISTODAX ............................................................. 7
itraconazole ........................................................... 2
IXEMPRA KIT ..................................................... 7
IXIARO ............................................................... 31
kelnor 1/35 ........................................................... 33
KEPIVANCE ......................................................... 6
ketoconazole ..................................................... 2, 22
ketodan ................................................................. 22
ketodan kit ............................................................ 22
ketoprofen ............................................................ 13
ketoprofen er ........................................................ 13
ketorolac tromethamine ................................. 13, 35
KINRIX................................................................ 31
kionex ................................................................... 24
klor-con 10 ........................................................... 38
klor-con 20 ........................................................... 38
klor-con 8 ............................................................. 38
klor-con m10 ........................................................ 38
klor-con m15 ........................................................ 38
klor-con m20 ........................................................ 38
klor-con/ef ............................................................ 38
K-PHOS ............................................................... 37
K-PHOS NO 2 ..................................................... 37
KRYSTEXXA ..................................................... 31
kurvelo.................................................................. 33
KUVAN ............................................................... 28
k-vescent ............................................................... 38
J
JAKAFI ................................................................. 7
jantoven ............................................................... 20
JANUMET .......................................................... 26
JANUMET XR.................................................... 26
JANUVIA............................................................ 26
jencycla................................................................ 32
JENTADUETO ................................................... 27
JEVTANA ............................................................. 7
jinteli.................................................................... 32
jolessa .................................................................. 33
jolivette ................................................................ 32
junel 1.5/30 .......................................................... 33
junel 1/20 ............................................................. 33
junel fe 1.5/30 ...................................................... 33
junel fe 1/20 ......................................................... 33
JUVISYNC.......................................................... 27
JUXTAPID .......................................................... 20
L
labetalol hcl ......................................................... 18
lactated ringers .................................................... 38
lactated ringers irrigation.................................... 23
lactated ringers viaflex ........................................ 38
lactulose ............................................................... 29
LAMISIL ............................................................... 2
lamivudine .............................................................. 2
lamivudine/zidovudine ........................................... 2
lamotrigine ............................................................. 9
lamotrigine er......................................................... 9
LANOXIN ........................................................... 19
lansoprazole ......................................................... 30
lansoprazole/amoxicillin/clarithromycin ............. 30
LANTUS .............................................................. 27
LANTUS SOLOSTAR ........................................ 27
larin 1.5/30........................................................... 33
larin 1/20.............................................................. 33
larin fe 1.5/30 ....................................................... 33
K
KADCYLA ........................................................... 7
KALETRA ............................................................ 2
KALYDECO ....................................................... 37
kariva................................................................... 33
kcl 0.075%/d5w/nacl 0.45% ................................ 38
kcl 0.15%/d5w/ nacl 0.3% ................................... 38
kcl 0.15%/d5w/lr ................................................. 38
kcl 0.15%/d5w/nacl 0.2% .................................... 38
kcl 0.15%/d5w/nacl 0.225% ................................ 38
kcl 0.15%/d5w/nacl 0.45% .................................. 38
kcl 0.15%/d5w/nacl 0.9% .................................... 38
kcl 0.3%/d5w/lr iv lac ring .................................. 38
kcl 0.3%/d5w/nacl 0.45% .................................... 38
kcl 0.3%/d5w/nacl 0.9% ...................................... 38
k-effervescent ....................................................... 38
52
Updated 10/28/2014
lidocaine/prilocaine ............................................. 22
LIDODERM ........................................................ 22
lindane.................................................................. 23
LINZESS.............................................................. 29
LIORESAL INTRATHECAL ............................. 11
liothyronine sodium ............................................. 28
lipodox.................................................................... 7
lipodox 50............................................................... 7
liposyn iii.............................................................. 39
lisinopril ............................................................... 18
lisinopril/hydrochlorothiazide ............................. 18
lithium carbonate ................................................. 15
lithium carbonate er ............................................. 15
lithium citrate ....................................................... 15
lmd 10% dextrose 5% .......................................... 24
lmd 10% sodium chloride 0.9% ........................... 24
LODOSYN .......................................................... 10
lomedia 24 fe ........................................................ 33
LOMUSTINE ........................................................ 7
loperamide hcl ..................................................... 28
lorazepam............................................................. 15
lorazepam intensol ............................................... 15
lorcet .................................................................... 11
lorcet hd ............................................................... 11
lorcet plus............................................................. 11
lortab .................................................................... 11
loryna ................................................................... 33
losartan potassium ............................................... 19
losartan potassium/hydrochlorothiazide ............. 19
LOTRONEX ........................................................ 29
lovastatin .............................................................. 20
LOVAZA ............................................................. 20
low-ogestrel.......................................................... 33
loxapine ................................................................ 15
loxapine succinate ................................................ 15
lta 360 kit ............................................................. 22
LUCENTIS .......................................................... 35
LUMIZYME ........................................................ 28
LUPRON DEPOT .................................................. 7
LUPRON DEPOT-PED ......................................... 7
lutera .................................................................... 34
LYRICA ................................................................. 9
larin fe 1/20 ......................................................... 33
latanoprost .......................................................... 35
LATUDA ............................................................ 15
LAZANDA.......................................................... 11
l-cysteine hcl ........................................................ 39
leena .................................................................... 33
leflunomide .......................................................... 32
lessina .................................................................. 33
LETAIRIS ........................................................... 37
letrozole ................................................................. 7
leucovorin calcium ................................................ 6
LEUKERAN ......................................................... 7
LEUKINE............................................................ 30
leuprolide acetate .................................................. 7
levalbuterol hcl .................................................... 37
LEVEMIR ........................................................... 27
LEVEMIR FLEXPEN......................................... 27
levetiracetam ......................................................... 9
levetiracetam er ..................................................... 9
levobunolol hcl .................................................... 35
levocarnitine ........................................................ 24
levocetirizine dihydrochloride............................. 36
levofloxacin ..................................................... 5, 34
levofloxacin in d5w................................................ 5
levonest ................................................................ 33
levonorgestrel ...................................................... 33
levonorgestrel and ethinyl estradiol.................... 33
levonorgestrel/ethinyl estradiol .......................... 33
levora 0.15/30-28 ................................................ 33
levorphanol tartrate ............................................ 11
levothyroxine sodium........................................... 28
levoxyl.................................................................. 28
LEVULAN KERASTICK................................... 21
LEXIVA ................................................................ 2
LIALDA .............................................................. 29
lidocaine .............................................................. 22
lidocaine hcl .................................................. 17, 22
lidocaine hcl in d5w ............................................ 17
lidocaine hcl jelly ................................................ 22
lidocaine hcl/dextrose ......................................... 17
lidocaine viscous ................................................. 22
lidocaine/epinephrine .......................................... 22
53
Updated 10/28/2014
metaxalone ........................................................... 11
metformin hcl ....................................................... 27
metformin hcl er ................................................... 27
methadone hcl ................................................ 11, 12
methadone hcl intensol ........................................ 11
methadose ............................................................ 12
methamphetamine hcl .......................................... 15
methazolamide ..................................................... 35
methenamine hippurate .......................................... 6
methenamine mandelate......................................... 6
methimazole ......................................................... 25
METHITEST ....................................................... 28
methocarbamol .................................................... 11
methotrexate ........................................................... 8
methotrexate sodium .............................................. 8
methoxsalen.......................................................... 21
methyclothiazide .................................................. 19
methyldopa ........................................................... 19
methyldopa/hydrochlorothiazide ......................... 19
methyldopate hcl .................................................. 19
methylergonovine maleate ................................... 34
methylphenidate hcl ............................................. 15
methylphenidate hcl cd ........................................ 15
methylphenidate hcl er ......................................... 15
methylphenidate hcl sr ......................................... 15
methylphenidate hydrochloride ........................... 15
methylprednisolone .............................................. 25
methylprednisolone acetate ................................. 25
methylprednisolone dose pack ............................. 25
methylprednisolone sodiumsuccinate .................. 25
metipranolol ......................................................... 35
metoclopramide hcl .............................................. 29
metolazone ........................................................... 19
metoprolol succinate er........................................ 19
metoprolol tartrate ............................................... 19
metoprolol/hydrochlorothiazide .......................... 19
metro iv .................................................................. 4
metronidazole................................................... 4, 21
metronidazole in nacl 0.79% ................................. 4
metronidazole vaginal .......................................... 33
mexiletine hcl ....................................................... 17
MIACALCIN ....................................................... 28
LYSODREN.......................................................... 7
lyza ...................................................................... 32
M
MACRODANTIN ................................................. 6
mafenide acetate .................................................. 22
magnesium chloride ............................................ 38
magnesium sulfate ............................................... 38
MAGNESIUM SULFATE IN D5W ................... 38
MAKENA ........................................................... 32
malathion............................................................. 23
mannitol............................................................... 19
maprotiline hcl .................................................... 15
marcaine w/o epi ................................................. 22
marlissa ............................................................... 34
MARPLAN ......................................................... 15
MATULANE ........................................................ 7
matzim la ............................................................. 19
meclizine hcl ........................................................ 29
meclofenamate sodium ........................................ 13
medroxyprogesterone acetate ............................. 32
mefenamic acid.................................................... 13
mefloquine hcl ....................................................... 4
MEGACE ES ........................................................ 8
megestrol acetate................................................... 8
MEKINIST ............................................................ 8
meloxicam............................................................ 13
melphalan hydrochloride ...................................... 8
MENACTRA ...................................................... 31
MENEST ............................................................. 32
MENOMUNE-A/C/Y/W-135 ............................. 31
MENVEO ............................................................ 31
meperidine hcl ..................................................... 11
MEPRON .............................................................. 4
mercaptopurine ..................................................... 8
meropenem ............................................................ 4
mesalamine .......................................................... 29
mesna..................................................................... 6
MESNEX .............................................................. 6
MESTINON ........................................................ 11
MESTINON TIMESPAN ................................... 11
metadate er .......................................................... 15
metaproterenol sulfate......................................... 37
54
Updated 10/28/2014
multi-vitamin/fluoride .......................................... 40
mult-vitamin/fluoride ........................................... 40
mupirocin ............................................................. 22
mupirocin calcium ............................................... 22
MUSTARGEN....................................................... 8
mvc-fluoride ......................................................... 40
my way ................................................................. 34
MYALEPT........................................................... 28
MYCAMINE ......................................................... 2
MYCOBUTIN ....................................................... 4
mycophenolate mofetil ........................................... 8
mycophenolic acid dr ............................................. 8
MYFORTIC ........................................................... 8
myorisan ............................................................... 21
MYOZYME ......................................................... 28
myzilra.................................................................. 34
miconazole 3........................................................ 33
microgestin 1.5/30 ............................................... 34
microgestin 1/20 .................................................. 34
microgestin fe ...................................................... 34
microgestin fe 1.5/30 ........................................... 34
micronized colestipol hcl ..................................... 20
midodrine hcl....................................................... 24
migergot .............................................................. 10
millipred .............................................................. 25
millipred dp ......................................................... 25
milrinone in dextrose........................................... 21
milrinone lactate ................................................. 21
mimvey ................................................................. 32
mimvey lo............................................................. 32
minocycline hcl ...................................................... 5
minocycline hcl er ................................................. 5
minoxidil .............................................................. 19
miostat ................................................................. 35
MIRENA ............................................................. 33
mirtazapine .......................................................... 15
mirtazapine odt.................................................... 15
misoprostol .......................................................... 30
mitomycin .............................................................. 8
mitoxantrone hcl .................................................... 8
M-M-R II W/DILUENT 10 DOSE ..................... 31
modafinil.............................................................. 15
moderiba................................................................ 2
moexipril hcl ........................................................ 19
moexipril/hydrochlorothiazide ............................ 19
mometasone furoate ............................................ 23
mono-linyah......................................................... 34
mononessa ........................................................... 34
montelukast sodium ............................................. 37
morgidox caps ....................................................... 6
morphine sulfate .................................................. 12
morphine sulfate er.............................................. 12
moxifloxacin hcl .................................................... 5
MOZOBIL........................................................... 30
multi vitamin/fluoride .......................................... 40
multi-vit/fluoride.................................................. 40
multi-vit/iron/fluoride .......................................... 40
multivitamin with fluoride ................................... 40
N
nabumetone .......................................................... 13
nadolol ................................................................. 19
nadolol/bendroflumethiazide ............................... 19
nafcillin sodium...................................................... 5
NAGLAZYME .................................................... 28
nalbuphine hcl ...................................................... 13
nallpen iso-osmotic in dextrose ............................. 5
nallpen/dextrose ..................................................... 5
naloxone hcl ......................................................... 13
naltrexone hcl....................................................... 13
NAMENDA ......................................................... 10
NAMENDA TITRATION PAK .......................... 10
NAMENDA XR................................................... 10
NAMENDA XR TITRATION PACK................. 10
naphazoline hcl .................................................... 36
naproxen .............................................................. 13
naproxen dr .......................................................... 13
naproxen sodium .................................................. 13
naratriptan hcl ..................................................... 10
NATACYN .......................................................... 34
nateglinide............................................................ 27
NEBUPENT ........................................................... 4
necon 0.5/35-28.................................................... 34
necon 1/35 ............................................................ 34
necon 1/50-28....................................................... 34
55
Updated 10/28/2014
nitro-bid ............................................................... 21
nitrofurantoin macrocrystals ................................. 6
nitrofurantoin monohydrate ................................... 6
nitrofurantoin monohydrate/macrocrystals ........... 6
nitrofurantoin susp ................................................. 6
nitroglycerin ......................................................... 21
nitroglycerin in 5% dextrose................................ 21
nitroglycerin lingual ............................................ 21
nitroglycerin transdermal .................................... 21
NITROSTAT ....................................................... 21
nizatidine .............................................................. 30
nora-be ................................................................. 32
norepinephrine bitartrate..................................... 21
norethindrone....................................................... 32
norethindrone acetate .......................................... 32
norgestimate/ethinyl estradiol ............................. 34
norlyroc ................................................................ 32
NORMOSOL -R .................................................. 38
NORMOSOL-M IN D5W ................................... 39
NORMOSOL-R ................................................... 39
NORMOSOL-R IN D5W .................................... 38
nortrel 0.5/35 (28)................................................ 34
nortrel 1/35 .......................................................... 34
nortrel 7/7/7 ......................................................... 34
nortriptyline hcl ................................................... 15
NORVIR ................................................................ 3
novarel ................................................................. 28
NOVOFINE 30GX8MM ..................................... 27
NOVOFINE 32GX6MM ..................................... 27
NOVOFINE AUTOCOVER 30GX8MM............ 27
NOVOLIN 70/30 ................................................. 27
NOVOLIN 70/30 RELION.................................. 27
NOVOLIN N ....................................................... 27
NOVOLIN N RELION ........................................ 27
NOVOLIN R ........................................................ 27
NOVOLIN R RELION ........................................ 27
NOVOLOG .......................................................... 27
NOVOLOG FLEXPEN ....................................... 27
NOVOLOG MIX 70/30 ....................................... 27
NOVOLOG MIX 70/30 PREFILLED FLEXPEN
.......................................................................... 27
NOVOLOG PENFILL ......................................... 27
necon 10/11-28 .................................................... 34
necon 7/7/7 .......................................................... 34
NEEDLES, INSULIN DISP., SAFETY ............. 27
nefazodone hcl ..................................................... 15
neomycin sulfate .................................................... 4
neomycin/bacitracin/polymyxin .......................... 34
neomycin/polymyxin b sulfates ............................ 23
neomycin/polymyxin/bacitracin/hydrocortisone . 35
neomycin/polymyxin/dexamethasone .................. 35
neomycin/polymyxin/gramicidin ......................... 34
neomycin/polymyxin/hc ....................................... 25
neomycin/polymyxin/hydrocortisone................... 35
neo-polycin .......................................................... 34
neo-polycin hc ..................................................... 35
neostigmine methylsulfate ................................... 11
NEPHRAMINE................................................... 39
neuac ................................................................... 21
NEULASTA ........................................................ 30
NEUMEGA ......................................................... 30
NEUPOGEN ....................................................... 30
NEUT .................................................................. 38
neutral sodium fluoride ....................................... 24
nevirapine .............................................................. 2
nevirapine er ......................................................... 3
NEXAVAR ........................................................... 8
NEXIUM ............................................................. 30
NEXIUM I.V....................................................... 30
NEXPLANON .................................................... 33
next choice one dose ............................................ 34
niacin er............................................................... 20
NIASPAN............................................................ 20
nicardipine hcl..................................................... 19
NICOTROL INHALER ...................................... 24
NICOTROL NS................................................... 24
nifediac cc ........................................................... 19
nifedical xl ........................................................... 19
nifedipine er......................................................... 19
nikki ..................................................................... 34
NILANDRON ....................................................... 8
nimodipine ........................................................... 19
nisoldipine ........................................................... 19
nisoldipine er ....................................................... 19
56
Updated 10/28/2014
ORENCIA ............................................................ 32
ORFADIN ............................................................ 24
orphenadrine citrate ............................................ 11
orphenadrine citrate er ........................................ 11
orsythia ................................................................ 34
osmitrol viaflex..................................................... 19
OTEZLA .............................................................. 32
oxacillin sodium ..................................................... 5
oxaliplatin .............................................................. 8
oxandrolone ......................................................... 28
oxaprozin.............................................................. 13
oxazepam.............................................................. 16
oxcarbazepine ........................................................ 9
OXSORALEN ..................................................... 21
OXSORALEN ULTRA ....................................... 21
oxybutynin chloride .............................................. 37
oxybutynin chloride er ......................................... 37
oxycodone hcl....................................................... 12
oxycodone/acetaminophen ................................... 12
oxycodone/aspirin ................................................ 12
oxycodone/ibuprofen ............................................ 12
oxymorphone hydrochloride ................................ 12
oxymorphone hydrochloride er ............................ 12
oxytocin ................................................................ 34
NOXAFIL ............................................................. 2
np thyroid 30 ....................................................... 28
np thyroid 60 ....................................................... 28
np thyroid 90 ....................................................... 28
NPLATE.............................................................. 20
NUEDEXTA ....................................................... 10
NULOJIX .............................................................. 8
nutrilyte ii ............................................................ 38
nyamyc ................................................................. 22
nystatin ............................................................ 2, 22
nystatin/triamcinolone......................................... 22
nystop .................................................................. 22
O
ocella ................................................................... 34
octreotide acetate .................................................. 8
ocudox ................................................................... 6
ofloxacin .................................................... 5, 25, 34
ogestrel ................................................................ 34
olanzapine ..................................................... 15, 16
olanzapine odt ..................................................... 15
olanzapine/fluoxetine .......................................... 16
OLYSIO ................................................................ 3
omega-3-acid ethyl esters.................................... 20
omeprazole .......................................................... 30
omeprazole/sodium bicarbonate ......................... 30
OMNITROPE...................................................... 30
ONCASPAR ......................................................... 8
ondansetron hcl ................................................... 29
ondansetron odt ................................................... 29
ONETOUCH ULTRA 2...................................... 27
ONETOUCH ULTRA BLUE ............................. 27
ONETOUCH ULTRA MINI .............................. 27
ONETOUCH ULTRA SYSTEM KIT ................ 27
ONETOUCH VERIO IQ BLOOD GLUCOSE
MONITORING SYSTEM .............................. 27
ONETOUCH VERIO TEST STRIPS ................. 27
ONFI...................................................................... 9
opium ................................................................... 28
opium tincture (paregoric) .................................. 28
OPSUMIT ........................................................... 37
oralone ................................................................ 24
ORAP .................................................................. 16
P
pacerone ............................................................... 17
paclitaxel ................................................................ 8
palgic.................................................................... 36
pamidronate disodium ......................................... 28
pancrelipase ......................................................... 29
PANRETIN .......................................................... 21
pantoprazole sodium ............................................ 30
paricalcitol ........................................................... 28
paromomycin sulfate .............................................. 4
paroxetine hcl....................................................... 16
paroxetine hcl er .................................................. 16
PASER ................................................................... 4
PAXIL .................................................................. 16
PEDIARIX ........................................................... 31
pedi-dri ................................................................. 22
PEDVAX HIB ..................................................... 31
peg 3350/electrolytes ........................................... 29
57
Updated 10/28/2014
pioglitazone hcl-glimepiride ................................ 27
piperacillin sodium/tazobactam sodium ................ 5
pirmella 1/35 ........................................................ 34
pirmella 7/7/7 ....................................................... 34
piroxicam ............................................................. 13
plasbumin-25........................................................ 38
plasbumin-5.......................................................... 38
PLASMA-LYTE A .............................................. 39
PLASMA-LYTE-148 .......................................... 39
PLASMA-LYTE-56/D5W................................... 39
podofilox .............................................................. 21
polycin .................................................................. 34
polyethylene glycol 3350...................................... 29
polymyxin b sulfate ................................................ 4
POMALYST .......................................................... 8
portia-28 .............................................................. 34
potassium acetate ................................................. 38
potassium chloride ............................................... 39
potassium chloride 0.15% /nacl 0.45% viaflex .... 38
potassium chloride 0.15% d5w/nacl 0.33%......... 38
potassium chloride 0.15% d5w/nacl 0.45%......... 38
potassium chloride 0.15% d5w/nacl 0.45% viaflex
.......................................................................... 38
potassium chloride 0.15% nacl 0.9% .................. 38
potassium chloride 0.15% w/nacl 0.9% viaflex ... 38
potassium chloride 0.15%/d5w ............................ 38
potassium chloride 0.22% d5w/nacl 0.45%......... 38
potassium chloride 0.224%/d5w/nacl 0.45%....... 38
potassium chloride 0.224%d5w/nacl 0.45%
viaflex ............................................................... 38
potassium chloride 0.3%/ nacl 0.9% ................... 38
potassium chloride 0.3%/d5w .............................. 38
potassium chloride 0.3%/nacl 0.9%/viaflex......... 38
potassium chloride er ........................................... 38
potassium citrate .................................................. 37
potassium citrate er.............................................. 37
potassium phosphate ............................................ 39
potassium phosphates .......................................... 39
POTIGA ............................................................... 10
PRADAXA .......................................................... 20
pramipexole dihydrochloride ............................... 10
pravastatin sodium ............................................... 20
peg-3350/electrolytes .......................................... 29
peg-3350/nacl/na bicarbonate/kcl ...................... 29
PEGANONE ......................................................... 9
PEGASYS ........................................................... 30
PEGASYS PROCLICK ...................................... 30
PEG-INTRON ..................................................... 30
PEG-INTRON REDIPEN ................................... 30
PEG-INTRON REDIPEN PAK 4 ....................... 30
penicillin g potassium............................................ 5
penicillin g procaine.............................................. 5
penicillin g sodium ................................................ 5
penicillin v potassium ............................................ 5
PENTACEL ........................................................ 31
PENTAM 300 ....................................................... 4
PENTASA ........................................................... 29
pentostatin ............................................................. 8
pentoxifylline er ................................................... 20
PERFOROMIST ................................................. 37
perindopril erbumine........................................... 19
periogard ............................................................. 24
PERJETA .............................................................. 8
permethrin ........................................................... 23
perphenazine ....................................................... 16
perphenazine/amitriptyline.................................. 16
pfizerpen-g ............................................................. 5
phenadoz.............................................................. 36
phenelzine sulfate ................................................ 16
phenobarbital ........................................................ 9
phenobarbital sodium............................................ 9
phentolamine mesylate ........................................ 19
phenytoin ............................................................... 9
phenytoin infatabs ................................................. 9
phenytoin sodium................................................... 9
phenytoin sodium extended ................................... 9
philith .................................................................. 34
phospha 250 neutral ............................................ 38
PHOSPHOLINE IODIDE ................................... 35
pilocarpine hcl............................................... 24, 35
pimtrea ................................................................ 34
pindolol................................................................ 19
pioglitazone hcl ................................................... 27
pioglitazone hcl/metformin hcl ............................ 27
58
Updated 10/28/2014
PRODIGY INSULIN SYRING/U-100/0.3ML/31G
X 5/16............................................................... 27
PRODIGY INSULIN SYRINGE/1/2ML/31G X
5/16 .................................................................. 27
PRODIGY INSULIN SYRINGE/1ML/28G X 1/2
.......................................................................... 27
progesterone ........................................................ 33
PROGLYCEM ..................................................... 27
PROGRAF ............................................................. 8
PROLASTIN-C.................................................... 24
PROLEUKIN ....................................................... 30
PROLIA ............................................................... 32
PROMACTA ....................................................... 20
promethazine hcl .................................................. 36
promethazine hcl plain ......................................... 36
promethegan ........................................................ 36
propafenone hcl ................................................... 17
propafenone hcl er ............................................... 17
proparacaine hcl .................................................. 35
propranolol hcl .................................................... 19
propranolol hcl er ................................................ 19
propranolol/hydrochlorothiazide......................... 19
propylthiouracil ................................................... 25
PROQUAD .......................................................... 31
PROSTIN E2 ....................................................... 33
protamine sulfate ................................................. 20
PROTOPAM CHLORIDE................................... 23
PROTOPIC .......................................................... 21
protriptyline hcl ................................................... 16
prudoxin ............................................................... 21
PULMICORT ...................................................... 37
PULMOZYME .................................................... 37
pyrazinamide .......................................................... 4
pyridostigmine bromide ....................................... 11
prazosin hcl ......................................................... 19
PRED MILD ....................................................... 35
prednicarbate ...................................................... 23
prednisolone ........................................................ 25
prednisolone acetate ........................................... 35
prednisolone sodium phosphate .................... 25, 35
prednisone ........................................................... 25
prednisone intensol ............................................. 25
PREMARIN ........................................................ 32
PREMASOL........................................................ 40
PREMPHASE ..................................................... 32
PREMPRO .......................................................... 32
prenatal vitamins (generic) ................................. 40
prevalite............................................................... 20
previfem ............................................................... 34
PREZISTA ............................................................ 3
PRIALT ............................................................... 13
PRIFTIN ................................................................ 4
PRIMAQUINE PHOSPHATE.............................. 4
primidone ............................................................ 10
PRIMSOL.............................................................. 6
PRISTIQ .............................................................. 16
PRIVIGEN .......................................................... 31
PROAIR HFA ..................................................... 37
probenecid ........................................................... 31
probenecid/colchicine ......................................... 32
procainamide hcl ................................................. 17
PROCALAMINE ................................................ 40
procentra ............................................................. 16
prochlorperazine ................................................. 29
prochlorperazine edisylate .................................. 29
prochlorperazine maleate ................................... 29
PROCRIT ............................................................ 30
procto-pak ........................................................... 29
proctosol hc ......................................................... 29
proctozone-hc ...................................................... 29
PRODIGY INSULIN MINI PEN NEEDLES/31G
X 3/16 .............................................................. 27
PRODIGY INSULIN PEN NEEDLES/29G X 1/2
......................................................................... 27
PRODIGY INSULIN SHORT
PENNEEDLES/31G X 5/16 ........................... 27
Q
quasense ............................................................... 34
quetiapine fumarate ............................................. 16
quinapril hcl ......................................................... 19
quinapril/hydrochlorothiazide ............................. 19
quinidine gluconate.............................................. 17
quinidine gluconate cr ......................................... 17
quinidine sulfate ................................................... 17
59
Updated 10/28/2014
rifampin .................................................................. 5
RILUTEK ............................................................ 24
riluzole ................................................................. 24
rimantadine hcl ...................................................... 3
ringers injection ................................................... 39
ringers irrigation ................................................. 23
RIOMET .............................................................. 27
risedronate sodium............................................... 32
RISPERDAL CONSTA ....................................... 16
risperidone ........................................................... 16
risperidone odt ..................................................... 16
RITUXAN.............................................................. 8
rivastigmine tartrate ............................................ 10
rizatriptan benzoate ............................................. 10
rizatriptan benzoate odt ....................................... 10
ropinirole er ......................................................... 10
ropinirole hcl ....................................................... 10
rosadan ................................................................ 21
ROTARIX ............................................................ 31
ROTATEQ ........................................................... 31
roxicet .................................................................. 12
ROZEREM .......................................................... 16
quinidine sulfate er .............................................. 18
quinine sulfate ....................................................... 5
QVAR.................................................................. 37
R
RABAVERT ....................................................... 31
rabeprazole sodium ............................................. 30
RAGWITEK........................................................ 31
raloxifene hydrochloride ..................................... 32
ramipril................................................................ 19
RANEXA ............................................................ 21
ranitidine hcl ....................................................... 30
RAPAMUNE ........................................................ 8
RAVICTI............................................................. 24
REBIF.................................................................. 30
REBIF REBIDOSE ............................................. 30
REBIF REBIDOSE TITRATION PACK ........... 30
REBIF TITRATION PACK ............................... 31
reclipsen .............................................................. 34
RECOMBIVAX HB ........................................... 31
RECTIV .............................................................. 29
REGRANEX ....................................................... 21
RELENZA DISKHALER ..................................... 3
RELISTOR .......................................................... 29
REMICADE ........................................................ 29
REMODULIN ..................................................... 19
RENACIDIN ....................................................... 37
RENVELA .......................................................... 24
repaglinide .......................................................... 27
reprexain ............................................................. 12
RESCRIPTOR ....................................................... 3
reserpine .............................................................. 19
RESTASIS .......................................................... 35
RETROVIR IV INFUSION .................................. 3
REVATIO ........................................................... 37
REVLIMID ........................................................... 8
revonto................................................................. 11
REYATAZ ............................................................ 3
ribapak .................................................................. 3
ribasphere.............................................................. 3
ribavirin................................................................. 3
RIDAURA........................................................... 32
rifabutin ................................................................. 5
S
SABRIL ............................................................... 10
SAIZEN ............................................................... 31
SAIZEN CLICK.EASY ....................................... 31
salsalate ............................................................... 13
SAMSCA ............................................................. 28
SANDIMMUNE .................................................... 8
SANDOSTATIN LAR DEPOT............................. 8
SANTYL .............................................................. 23
SAPHRIS ............................................................. 16
SAVELLA ........................................................... 32
SAVELLA TITRATION PACK ......................... 32
scalacort ............................................................... 23
selegiline hcl ........................................................ 10
selenium sulfide.................................................... 21
SELZENTRY ......................................................... 3
SENSIPAR ........................................................... 28
sensorcaine .......................................................... 22
sensorcaine-mpf ................................................... 22
SEREVENT DISKUS .......................................... 37
60
Updated 10/28/2014
SPRYCEL .............................................................. 8
sps ........................................................................ 24
sronyx ................................................................... 34
ssd ........................................................................ 21
stannous fluoride oral rinse ................................. 24
stavudine ................................................................ 3
sterile water irrigation ......................................... 24
STIVARGA ........................................................... 8
STRATTERA ...................................................... 17
STREPTOMYCIN SULFATE .............................. 5
STRIBILD.............................................................. 3
STROMECTOL ..................................................... 5
sublimaze.............................................................. 12
SUBOXONE ........................................................ 13
SUCRAID ............................................................ 29
sucralfate.............................................................. 30
sulfacetamide sodium ..................................... 22, 36
sulfacetamide sodium/prednisolone sodium
phosphate ......................................................... 35
sulfadiazine ............................................................ 5
sulfamethoxazole/trimethoprim.............................. 5
sulfamethoxazole/trimethoprim ds ......................... 5
SULFAMYLON .................................................. 22
sulfasalazine......................................................... 29
sulfazine ............................................................... 29
sulfazine ec ........................................................... 29
sulindac ................................................................ 13
sumatriptan .......................................................... 10
sumatriptan succinate .......................................... 10
sumatriptan succinate refill ................................. 10
SUPRAX ................................................................ 3
SUSTIVA ............................................................... 3
SUTENT ................................................................ 8
syeda .................................................................... 34
SYLATRON ........................................................ 31
SYLVANT ............................................................. 8
SYMBICORT ...................................................... 37
SYMLINPEN 120 ................................................ 27
SYMLINPEN 60 .................................................. 27
SYNAGIS .............................................................. 3
SYNAREL ........................................................... 28
SYNERCID............................................................ 5
SEROMYCIN ....................................................... 5
SEROQUEL XR ........................................... 16, 17
sertraline hcl ....................................................... 17
sf 5000 plus.......................................................... 24
sharobel ............................................................... 33
SIGNIFOR ............................................................ 8
sildenafil citrate................................................... 37
silver sulfadiazine................................................ 21
SIMCOR.............................................................. 20
SIMULECT ........................................................... 8
simvastatin........................................................... 20
sirolimus ................................................................ 8
SIRTURO .............................................................. 5
sodium acetate ..................................................... 39
sodium bicarbonate ............................................. 39
sodium bicarbonate partial fill............................ 39
sodium chloride ............................................. 24, 39
sodium chloride 0.45%........................................ 39
sodium chloride 0.45% viaflex ............................ 39
sodium chloride 0.9%.......................................... 24
sodium chloride pab ............................................ 24
sodium fluoride.................................................... 40
sodium lactate ..................................................... 39
sodium phenylbutyrate ........................................ 24
sodium phosphate ................................................ 39
sodium polystyrene sulfonate .............................. 24
sodium sulfacetamide .................................... 22, 36
SOLARAZE ........................................................ 21
SOLIRIS .............................................................. 24
SOLTAMOX......................................................... 8
SOMAVERT ....................................................... 28
SORIATANE ...................................................... 21
sorine ................................................................... 18
sotalol hcl ............................................................ 18
sotalol hcl (af) ..................................................... 18
SOVALDI ............................................................. 3
spinosad............................................................... 23
SPIRIVA HANDIHALER .................................. 37
spironolactone ..................................................... 19
spironolactone/hydrochlorothiazide ................... 19
SPORANOX ......................................................... 2
sprintec 28 ........................................................... 34
61
Updated 10/28/2014
THIOLA ............................................................... 24
thioridazine hcl .................................................... 17
thiotepa .................................................................. 8
thiothixene ............................................................ 17
THYROLAR-1 .................................................... 28
THYROLAR-1/2 ................................................. 28
THYROLAR-1/4 ................................................. 28
THYROLAR-2 .................................................... 28
THYROLAR-3 .................................................... 28
tiagabine hydrochloride ....................................... 10
TICE BCG ........................................................... 31
TIKOSYN ............................................................ 18
tilia fe ................................................................... 34
timolol maleate............................................... 19, 35
timolol maleate ophthalmic gel forming .............. 35
tinidazole ................................................................ 5
tis-u-sol ................................................................ 23
TIVICAY ............................................................... 3
tizanidine hcl ........................................................ 11
TOBI ...................................................................... 5
tobramycin ............................................................. 5
tobramycin sulfate............................................ 5, 34
tobramycin sulfate/sodium chloride....................... 5
tobramycin/dexamethasone.................................. 35
tolazamide ............................................................ 27
tolbutamide .......................................................... 28
tolmetin sodium .................................................... 13
tolterodine tartrate ............................................... 37
tolterodine tartrate er .......................................... 37
topiramate ............................................................ 10
toposar ................................................................... 8
topotecan hcl .......................................................... 8
TORISEL ............................................................... 8
torsemide .............................................................. 19
TRACLEER ......................................................... 37
TRADJENTA ...................................................... 28
tramadol hcl ......................................................... 13
tramadol hcl er ..................................................... 13
tramadol hydrochloride/acetaminophen .............. 13
trandolapril .......................................................... 19
tranexamic acid .............................................. 20, 33
tranylcypromine sulfate ....................................... 17
SYNRIBO ............................................................. 8
SYPRINE ............................................................ 24
T
TABLOID ............................................................. 8
tacrolimus .............................................................. 8
TAFINLAR ........................................................... 8
TAMIFLU ............................................................. 3
tamoxifen citrate.................................................... 8
tamsulosin hcl...................................................... 37
TARCEVA ............................................................ 8
TARGRETIN ........................................................ 8
TASIGNA ............................................................. 8
TASMAR ............................................................ 10
TAZORAC .......................................................... 21
taztia xt ................................................................ 19
TECFIDERA ....................................................... 10
TECFIDERA STARTER PACK ........................ 10
TEGRETOL-XR ................................................. 10
telmisartan........................................................... 19
telmisartan/amlodipine........................................ 19
telmisartan/hydrochlorothiazide ......................... 19
temazepam ........................................................... 17
TEMODAR ........................................................... 8
TENIVAC ........................................................... 31
terazosin hcl ........................................................ 19
terbinafine hcl ....................................................... 2
terbutaline sulfate................................................ 37
terconazole .......................................................... 33
TESTOPEL ......................................................... 28
testosterone cypionate ......................................... 28
testosterone enanthate ......................................... 28
tetanus toxoid adsorbed ...................................... 31
TETANUS/DIPHTHERIA TOXOIDSADSORBED ADULT ..................................... 31
tetracycline hcl ...................................................... 6
THALOMID.......................................................... 8
theochron............................................................. 37
theophylline ......................................................... 37
theophylline cr ..................................................... 37
theophylline er ..................................................... 37
theophylline/d5w ................................................. 37
THERACYS ........................................................ 31
62
Updated 10/28/2014
TRUVADA ............................................................ 3
TUDORZA PRESSAIR ....................................... 37
TWINRIX ............................................................ 31
TYGACIL .............................................................. 5
TYKERB................................................................ 9
TYPHIM VI ......................................................... 31
TYSABRI ............................................................ 10
TYVASO ............................................................. 37
TYVASO REFILL ............................................... 37
TYVASO STARTER........................................... 37
TYZEKA................................................................ 3
TYZINE ............................................................... 24
TYZINE PEDIATRIC NASAL DROPS ............. 25
travasol ................................................................ 40
travoprost ............................................................ 35
trazodone hcl ....................................................... 17
TREANDA ............................................................ 8
TRECATOR .......................................................... 5
TRELSTAR DEPOT ............................................. 8
TRELSTAR DEPOT MIXJECT ........................... 8
TRELSTAR LA .................................................... 9
TRELSTAR LA MIXJECT .................................. 9
TRELSTAR MIXJECT ......................................... 9
tretinoin ..................................................... 9, 21, 22
tretinoin microsphere .......................................... 22
tretinoin microsphere pump ................................ 22
triamcinolone acetonide .................... 23, 24, 25, 37
triamcinolone in orabase .................................... 24
triamterene/hydrochlorothiazide......................... 19
trianex.................................................................. 23
triderm ................................................................. 23
tri-estarylla .......................................................... 34
trifluoperazine hcl ............................................... 17
trifluridine ........................................................... 35
trihexyphenidyl hcl .............................................. 10
tri-legest fe........................................................... 34
tri-linyah .............................................................. 34
trilyte ................................................................... 29
trimethobenzamide hcl ........................................ 29
trimethoprim .......................................................... 6
trimethoprim sulfate/polymyxin b sulfate ............ 35
trimipramine maleate .......................................... 17
trinessa ................................................................ 34
triple-vitamin/fluoride ......................................... 40
tri-previfem .......................................................... 34
TRISENOX ........................................................... 9
tri-sprintec ........................................................... 34
tri-vit/fluoride ...................................................... 40
tri-vit/fluoride/iron .............................................. 40
trivora-28 ............................................................ 34
TRIZIVIR .............................................................. 3
TROPHAMINE................................................... 40
tropicamide.......................................................... 35
trospium chloride ................................................ 37
trospium chloride er ............................................ 37
U
UCERIS ............................................................... 29
ULORIC ............................................................... 32
unithroid............................................................... 28
ursodiol ................................................................ 29
UVADEX ............................................................. 21
V
VAGIFEM ........................................................... 33
valacyclovir hcl ...................................................... 3
VALCHLOR ........................................................ 21
VALCYTE ............................................................. 3
valproate sodium.................................................. 10
valproic acid ........................................................ 10
valsartan .............................................................. 19
valsartan/hydrochlorothiazide ............................. 19
VALSTAR ............................................................. 9
vancomycin hcl....................................................... 6
vandazole ............................................................. 33
VANTAS ............................................................... 9
VAQTA................................................................ 31
VARIVAX ........................................................... 31
VARIZIG ............................................................. 31
VASCEPA ........................................................... 20
vasopressin ........................................................... 28
VECTIBIX ............................................................. 9
VELCADE ............................................................. 9
veletri ................................................................... 19
velivet ................................................................... 34
63
Updated 10/28/2014
venlafaxine hcl..................................................... 17
venlafaxine hcl er ................................................ 17
verapamil hcl ....................................................... 19
verapamil hcl er .................................................. 19
verapamil hcl sr ................................................... 19
veripred 20 .......................................................... 25
VERSACLOZ ..................................................... 17
vestura ................................................................. 34
VFEND.................................................................. 2
V-GO 20 .............................................................. 28
V-GO 30 .............................................................. 28
V-GO 40 .............................................................. 28
vicodin ................................................................. 12
vicodin es ............................................................. 12
vicodin hp ............................................................ 12
VICTRELIS .......................................................... 3
VIDAZA................................................................ 9
VIDEX PEDIATRIC............................................. 3
VIIBRYD ............................................................ 17
VIMPAT.............................................................. 10
vinblastine sulfate.................................................. 9
vincasar pfs ........................................................... 9
vincristine sulfate .................................................. 9
vinorelbine tartrate ............................................... 9
VIOKACE ........................................................... 29
viorele .................................................................. 34
VIRACEPT ........................................................... 3
VIRAMUNE ......................................................... 3
VIRAMUNE XR ................................................... 3
VIRAZOLE ........................................................... 3
VIREAD ................................................................ 3
vitamins a/c/d/fluoride......................................... 40
VOLTAREN GEL............................................... 13
voriconazole .......................................................... 2
VOTRIENT ........................................................... 9
VPRIV ................................................................. 28
vyfemla ................................................................ 34
X
XALKORI.............................................................. 9
XARELTO ........................................................... 20
XENAZINE ......................................................... 10
XERESE .............................................................. 22
XGEVA.................................................................. 6
XIAFLEX ............................................................ 24
XIFAXAN.............................................................. 5
XOLAIR .............................................................. 37
XTANDI ................................................................ 9
xulane ................................................................... 33
XYREM ............................................................... 17
Y
YERVOY ............................................................... 9
YF-VAX .............................................................. 31
Z
zafirlukast............................................................. 37
zaleplon ................................................................ 17
ZALTRAP.............................................................. 9
zamicet ................................................................. 12
ZANOSAR ............................................................. 9
zarah .................................................................... 34
ZAVESCA ........................................................... 28
zazole.................................................................... 33
ZELBORAF ........................................................... 9
ZEMPLAR ........................................................... 28
zenatane ............................................................... 22
zenchent................................................................ 34
zenchent fe ............................................................ 34
ZENPEP ............................................................... 29
zenzedi .................................................................. 17
ZETIA .................................................................. 20
ZIAGEN ................................................................. 3
zidovudine .............................................................. 3
ziprasidone hcl ..................................................... 17
ZIRGAN .............................................................. 35
ZOLADEX ............................................................. 9
zoledronic acid ............................................... 24, 28
ZOLINZA .............................................................. 9
zolmitriptan .......................................................... 10
W
warfarin sodium .................................................. 20
WELCHOL ......................................................... 20
wera ..................................................................... 34
wymzya fe ............................................................ 34
64
Updated 10/28/2014
zolmitriptan odt ................................................... 10
zolpidem tartrate ................................................. 17
zolpidem tartrate er ............................................. 17
zonisamide ........................................................... 10
ZORTRESS ........................................................... 9
ZOSTAVAX ....................................................... 31
zovia 1/35e........................................................... 34
zovia 1/50e........................................................... 34
ZOVIRAX ........................................................... 22
ZYCLARA ........................................................... 21
ZYCLARA PUMP ............................................... 21
ZYDELIG .............................................................. 9
ZYKADIA ............................................................. 9
ZYLET ................................................................. 35
ZYPREXA RELPREVV ..................................... 17
ZYTIGA ................................................................. 9
ZYVOX.................................................................. 5
65
Updated 10/28/2014
Index of Drugs
AGGRENOX................................................................ 18
a-hydrocort .................................................................. 22
akorn balanced salt solution ........................................ 31
ak-poly-bac .................................................................. 30
ala cort ........................................................................ 20
ALBENZA ...................................................................... 4
albuterol sulfate ........................................................... 32
albuterol sulfate er ....................................................... 32
alclometasone dipropionate......................................... 20
ALCOHOL PREPS ...................................................... 23
ALDURAZYME ............................................................ 25
alendronate sodium ............................................... 21, 28
alfuzosin hcl er ............................................................ 33
ALIMTA ......................................................................... 6
ALINIA ........................................................................... 4
ALKERAN ..................................................................... 6
allopurinol .................................................................... 28
allopurinol sodium ....................................................... 28
aloprim ........................................................................ 28
ALOXI.......................................................................... 25
ALPHAGAN P ............................................................. 32
alprostadil .................................................................... 33
altavera ....................................................................... 29
alyacen 1/35 ................................................................ 29
alyacen 7/7/7 ............................................................... 29
amantadine hcl .............................................................. 2
AMBISOME ................................................................... 2
amcinonide .................................................................. 20
a-methapred ................................................................ 22
amethia ....................................................................... 29
amethia lo .................................................................... 29
amethyst...................................................................... 29
amifostine ...................................................................... 5
amikacin sulfate............................................................. 4
amiloride hcl ................................................................ 16
amiloride/hydrochlorothiazide ...................................... 16
amino acids ................................................................. 35
aminoacetic acid.......................................................... 33
aminocaproic acid ....................................................... 18
aminophylline .............................................................. 32
AMINOSYN ................................................................. 35
AMINOSYN 7%/ELECTROLYTES .............................. 35
8
8-MOP ......................................................................... 19
A
abacavir ......................................................................... 2
ABELCET ...................................................................... 2
ABILIFY ....................................................................... 12
ABILIFY DISCMELT .................................................... 12
ABILIFY MAINTENA .................................................... 12
ABRAXANE ................................................................... 5
acarbose ...................................................................... 23
acebutolol hcl ............................................................... 16
acetaminophen/caffeine/dihydrocodeine bitartrate....... 10
acetaminophen/codeine ............................................... 10
acetaminophen/codeine #3 .......................................... 10
acetasol hc................................................................... 22
acetazolamide.............................................................. 31
acetazolamide er ......................................................... 31
acetazolamide sodium ................................................. 31
acetic acid .................................................................... 22
acetic acid 0.25%......................................................... 21
acetic acid/aluminum acetate ....................................... 22
acetylcysteine ........................................................ 21, 32
ACTEMRA ................................................................... 28
ACTHAR HP ................................................................ 22
ACTHIB........................................................................ 27
acticin........................................................................... 21
ACTIMMUNE ............................................................... 27
acyclovir ................................................................... 2, 20
acyclovir sodium ............................................................ 2
ADACEL ...................................................................... 27
ADAGEN...................................................................... 21
adapalene .................................................................... 19
adrenalin ...................................................................... 32
adriamycin ..................................................................... 5
adrucil ............................................................................ 5
ADVAIR DISKUS ......................................................... 32
ADVAIR HFA ............................................................... 32
ADVICOR .................................................................... 18
afeditab cr .................................................................... 16
AFINITOR .................................................................. 5, 6
AFINITOR DISPERZ...................................................... 5
37
AMINOSYN 8.5%/ELECTROLYTES ........................... 34
AMINOSYN II............................................................... 34
AMINOSYN II 5/DEXTROSE 25 .................................. 35
AMINOSYN II 8.5%/ELECTROLYTES ........................ 34
AMINOSYN M.............................................................. 34
AMINOSYN-HBC ......................................................... 34
AMINOSYN-PF ............................................................ 34
AMINOSYN-PF 7% ...................................................... 34
AMINOSYN-RF ............................................................ 35
amiodarone hcl ............................................................ 16
AMITIZA....................................................................... 25
amitriptyline hcl ............................................................ 12
amlodipine besylate ..................................................... 16
amlodipine besylate/atorvastatin calcium..................... 18
amlodipine besylate/benazepril hcl .............................. 16
amlodipine besylate/benazepril hydrochloride ............. 16
AMMONIUM CHLORIDE ............................................. 33
ammonium lactate........................................................ 19
amnesteem .................................................................. 19
amoxapine ................................................................... 12
amoxicillin ...................................................................... 4
amoxicillin/clavulanate potassium .............................. 4, 5
amoxicillin/clavulanate potassium er .............................. 4
amoxicillin/potassium clavulanate .................................. 5
amphetamine/dextroamphetamine............................... 12
AMPHOTEC .................................................................. 2
amphotericin b ............................................................... 2
ampicillin ........................................................................ 5
ampicillin sodium............................................................ 5
ampicillin-sulbactam....................................................... 5
AMPYRA........................................................................ 9
ANADROL-50 .............................................................. 25
anagrelide hydrochloride.............................................. 21
anastrozole .................................................................... 6
ANDROGEL................................................................. 25
ANDROGEL PUMP ..................................................... 25
androxy ........................................................................ 25
apexicon e ................................................................... 20
APOKYN ........................................................................ 9
apraclonidine ............................................................... 32
apri ............................................................................... 29
APTIVUS ....................................................................... 2
ARALAST NP .............................................................. 21
aranelle ....................................................................... 29
arbinoxa ...................................................................... 32
ARCALYST ................................................................. 27
ARMOUR THYROID ................................................... 25
ARRANON .................................................................... 6
ARZERRA ..................................................................... 6
ASMANEX 120 METERED DOSES ............................ 32
ASMANEX 14 METERED DOSES .............................. 32
ASMANEX 30 METERED DOSES .............................. 32
ASMANEX 60 METERED DOSES .............................. 32
aspirin-caffeine-dihydrocodeine................................... 10
atenolol........................................................................ 16
atenolol/chlorthalidone ................................................ 16
ATGAM ....................................................................... 27
atorvastatin calcium..................................................... 18
atovaquone/proguanil hcl .............................................. 4
ATRIPLA ....................................................................... 2
atropine sulfate ............................................................ 25
ATROVENT HFA......................................................... 32
augmented betamethasone dipropionate .................... 20
AUGMENTIN ................................................................. 5
AVASTIN ....................................................................... 6
AVELOX ........................................................................ 5
aviane.......................................................................... 29
avita............................................................................. 19
AVONEX ..................................................................... 27
AVONEX PEN ............................................................. 27
AZASAN ........................................................................ 6
AZASITE ..................................................................... 30
azathioprine ................................................................... 6
azathioprine sodium ...................................................... 6
azelastine hcl......................................................... 22, 31
AZILECT ....................................................................... 9
azithromycin .................................................................. 3
aztreonam ..................................................................... 4
azurette ....................................................................... 29
B
baciim ............................................................................ 4
bacitracin ................................................................. 4, 30
bacitracin/polymyxin b ................................................. 30
baclofen....................................................................... 10
bactocill in dextrose ....................................................... 5
38
bal-care dha ................................................................. 35
balsalazide disodium.................................................... 25
balziva.......................................................................... 29
BANZEL ......................................................................... 8
BARACLUDE ................................................................. 2
baycadron .................................................................... 22
BCG VACCINE ............................................................ 27
benazepril hcl............................................................... 16
benazepril hcl/hydrochlorothiazide ............................... 16
BENLYSTA .................................................................. 28
benztropine mesylate ..................................................... 9
BESIVANCE ................................................................ 31
betamethasone dipropionate ....................................... 20
betamethasone sodium phosphate/betamethasone
acetate..................................................................... 22
betamethasone valerate .............................................. 20
BETASERON............................................................... 27
betaxolol hcl ........................................................... 16, 31
bethanechol chloride .................................................... 33
bicalutamide................................................................... 6
BICNU............................................................................ 6
bisoprolol fumarate ...................................................... 16
bisoprolol fumarate/hydrochlorothiazide ...................... 16
bleomycin sulfate ........................................................... 6
BLEPHAMIDE.............................................................. 31
BLEPHAMIDE S.O.P. .................................................. 31
BOOSTRIX .................................................................. 27
BOSULIF ....................................................................... 6
BOTOX ........................................................................ 27
briellyn ......................................................................... 29
BRILINTA..................................................................... 18
brimonidine tartrate ...................................................... 32
bromfenac .................................................................... 31
bromocriptine mesylate .................................................. 9
bss ............................................................................... 31
budeprion sr ................................................................. 13
budesonide ............................................................ 25, 32
bumetanide .................................................................. 16
BUPHENYL ................................................................. 21
bupivacaine hcl ............................................................ 20
bupivacaine spinal ....................................................... 21
bupivacaine/epinephrine .............................................. 20
buprenorphine hcl ........................................................ 10
buprenorphine hcl/naloxone hcl................................... 12
buproban ..................................................................... 22
bupropion hcl ............................................................... 13
bupropion hcl sr ........................................................... 13
bupropion hcl xl ........................................................... 13
buspirone hcl ............................................................... 13
BUSULFEX ................................................................... 6
butorphanol tartrate ..................................................... 12
BYDUREON ................................................................ 23
BYETTA ...................................................................... 23
C
cabergoline .................................................................. 25
caffeine citrate ............................................................. 21
calcipotriene ................................................................ 19
calcitonin-salmon......................................................... 25
calcitrene ..................................................................... 19
calcitriol ................................................................. 19, 25
calcium acetate ........................................................... 33
calcium chloride........................................................... 33
camila .......................................................................... 29
CAMPTOSAR................................................................ 6
camrese ...................................................................... 29
camrese lo ................................................................... 29
CANASA ..................................................................... 25
CANCIDAS .................................................................... 2
candesartan cilexetil .................................................... 16
candesartan cilexetil/hydrochlorothiazide .................... 16
CAPASTAT SULFATE .................................................. 4
CAPRELSA ................................................................... 6
captopril....................................................................... 16
captopril/hydrochlorothiazide ....................................... 16
CARAC........................................................................ 19
carafate ....................................................................... 26
CARBAGLU................................................................. 21
carbamazepine .............................................................. 8
carbamazepine er.......................................................... 8
carbidopa/levodopa ....................................................... 9
carbidopa/levodopa er ................................................... 9
carbidopa/levodopa odt ................................................. 9
carbidopa/levodopa/entacapone ................................... 9
carbinoxamine maleate ............................................... 32
carbocaine ................................................................... 20
39
carboplatin ..................................................................... 6
CARIMUNE NANOFILTERED ..................................... 27
carteolol hcl.................................................................. 31
cartia xt ........................................................................ 16
carvedilol...................................................................... 16
CAYSTON ..................................................................... 4
caziant ......................................................................... 29
CEENU .......................................................................... 6
cefaclor .......................................................................... 3
cefaclor er ...................................................................... 3
cefadroxil ....................................................................... 3
cefazolin sodium ............................................................ 3
cefazolin sodium/dextrose ............................................. 3
cefdinir ........................................................................... 3
cefditoren pivoxil ............................................................ 3
cefepime ........................................................................ 3
cefotaxime sodium ......................................................... 3
cefotetan ........................................................................ 3
cefoxitin sodium ............................................................. 3
cefpodoxime proxetil ...................................................... 3
cefprozil ......................................................................... 3
ceftazidime..................................................................... 3
ceftriaxone in iso-osmotic dextrose ................................ 3
ceftriaxone sodium ......................................................... 3
ceftriaxone/dextrose....................................................... 3
cefuroxime axetil ............................................................ 3
cefuroxime sodium ......................................................... 3
cefuroxime/dextrose....................................................... 3
CELEBREX.................................................................. 12
CELLCEPT .................................................................... 6
CELLCEPT INTRAVENOUS ......................................... 6
CELONTIN..................................................................... 8
cephalexin...................................................................... 3
CEREZYME ................................................................. 25
cerubidine ...................................................................... 6
CERVARIX .................................................................. 27
CESAMET ................................................................... 25
cetirizine hcl ................................................................. 32
cevimeline hcl .............................................................. 21
CHANTIX ..................................................................... 22
CHANTIX STARTING MONTH PAK ............................ 22
chateal ......................................................................... 29
CHEMET...................................................................... 21
CHENODAL ................................................................ 25
chloramphenicol sodium succinate................................ 4
chlorhexidine gluconate oral rinse ............................... 22
chloroprocaine hcl ....................................................... 20
chloroquine phosphate .................................................. 4
chlorothiazide .............................................................. 16
chlorothiazide sodium.................................................. 16
chlorpromazine hcl ...................................................... 13
chlorthalidone .............................................................. 17
chlorzoxazone ............................................................. 10
cholestyramine ............................................................ 18
cholestyramine light..................................................... 18
chorionic gonadotropin ................................................ 25
ciclodan ....................................................................... 20
ciclopirox ..................................................................... 20
ciclopirox nail lacquer .................................................. 20
ciclopirox olamine ........................................................ 20
ciclopirox topical solution kit ........................................ 20
cidofovir ......................................................................... 2
cilostazol ..................................................................... 18
cimetidine .................................................................... 26
cimetidine hcl............................................................... 26
CINRYZE .................................................................... 32
CIPRO ........................................................................... 5
CIPRODEX.................................................................. 22
ciprofloxacin .................................................................. 5
ciprofloxacin er .............................................................. 5
ciprofloxacin hcl ....................................................... 5, 31
ciprofloxacin i.v.-in d5w ................................................. 5
cisplatin ......................................................................... 6
citalopram hydrobromide ............................................. 13
cladribine ....................................................................... 6
claravis ........................................................................ 19
clarithromycin ................................................................ 3
clarithromycin er ............................................................ 3
clemastine fumarate .................................................... 32
clindacin-p ................................................................... 19
clindamycin hcl .............................................................. 4
clindamycin palmitate hcl .............................................. 4
clindamycin phosphate ...................................... 4, 19, 29
clindamycin phosphate add-vantage ............................. 4
clindamycin phosphate in d5w....................................... 4
clindamycin/benzoyl peroxide...................................... 19
40
CLINIMIX 2.75%/DEXTROSE 5% ............................... 34
CLINIMIX 4.25%/DEXTROSE 10% ............................. 34
CLINIMIX 4.25%/DEXTROSE 20% ............................. 34
CLINIMIX 4.25%/DEXTROSE 25% ............................. 34
CLINIMIX 4.25%/DEXTROSE 5% ............................... 21
CLINIMIX 5%/DEXTROSE 15% .................................. 34
CLINIMIX 5%/DEXTROSE 20% .................................. 34
CLINIMIX 5%/DEXTROSE 25% .................................. 34
CLINIMIX E 2.75%/DEXTROSE 10% .......................... 21
CLINIMIX E 2.75%/DEXTROSE 5% ............................ 21
CLINIMIX E 4.25%/DEXTROSE 25% .......................... 34
CLINIMIX E 4.25%/DEXTROSE 5% ............................ 34
CLINIMIX E 5%/DEXTROSE 15% ............................... 34
CLINIMIX E 5%/DEXTROSE 20% ............................... 34
CLINIMIX E 5%/DEXTROSE 25% ............................... 34
CLINISOL SF 15% ....................................................... 34
clobetasol propionate ................................................... 20
clobetasol propionate e ................................................ 20
clobetasol propionate emollient ................................... 20
CLOLAR ........................................................................ 6
clomipramine hcl .......................................................... 13
clonazepam ................................................................... 8
clonazepam odt ............................................................. 8
clonidine hcl ........................................................... 12, 17
clopidogrel ................................................................... 18
clorazepate dipotassium .............................................. 13
clorpres ........................................................................ 17
clotrimazole.............................................................. 2, 20
clotrimazole/betamethasone dipropionate ................... 20
clozapine...................................................................... 13
clozapine odt................................................................ 13
COARTEM ..................................................................... 4
codeine phosphate....................................................... 10
codeine sulfate............................................................. 10
co-gesic ....................................................................... 10
COLCRYS ................................................................... 28
colestipol hcl ................................................................ 18
colestipol hcl for oral suspension ................................. 18
colistimethate sodium .................................................... 4
colocort ........................................................................ 25
COMBIGAN ................................................................. 31
COMBIVENT ............................................................... 32
COMBIVENT RESPIMAT ............................................ 32
COMETRIQ ................................................................... 6
COMPLERA .................................................................. 2
compro ........................................................................ 25
COMVAX ..................................................................... 27
constulose ................................................................... 25
COPAXONE .................................................................. 9
cormax scalp application ............................................. 20
CORTIFOAM ............................................................... 25
cortisone acetate ......................................................... 22
CREON ....................................................................... 25
CRESTOR ................................................................... 18
CRIXIVAN ..................................................................... 2
cromolyn sodium ............................................. 25, 31, 32
cryselle-28 ................................................................... 29
CUBICIN ....................................................................... 4
CUPRIMINE ................................................................ 28
cyclafem 1/35 .............................................................. 29
cyclafem 7/7/7 ............................................................. 29
cyclopentolate hcl ........................................................ 31
cyclophosphamide......................................................... 6
CYCLOSERINE............................................................. 4
CYCLOSET ................................................................. 23
cyclosporine .................................................................. 6
cyclosporine modified .................................................... 6
CYMBALTA ................................................................. 13
cyproheptadine hcl ...................................................... 32
CYSTADANE .............................................................. 25
CYSTAGON ................................................................ 33
CYSTARAN ................................................................. 31
cytarabine ...................................................................... 6
cytarabine aqueous ....................................................... 6
D
dacarbazine ................................................................... 6
DACOGEN .................................................................... 6
dactinomycin ................................................................. 6
DALIRESP .................................................................. 32
danazol........................................................................ 25
dantrolene sodium ....................................................... 10
DAPSONE ..................................................................... 4
DAPTACEL ................................................................. 27
DARAPRIM ................................................................... 4
dasetta 1/35 ................................................................ 29
41
dasetta 7/7/7 ................................................................ 29
daunorubicin hcl............................................................. 6
daysee ......................................................................... 29
DECAVAC ................................................................... 27
demeclocycline hcl ......................................................... 5
demerol ........................................................................ 10
DEMSER ..................................................................... 17
DENAVIR ..................................................................... 20
denta 5000 plus ........................................................... 22
dentagel ....................................................................... 22
DEPOCYT ..................................................................... 6
DEPO-PROVERA ........................................................ 29
desipramine hcl............................................................ 13
desloratadine ............................................................... 32
desloratadine odt ......................................................... 32
desmopressin acetate .................................................. 25
desonide ...................................................................... 20
desoximetasone ........................................................... 20
dexamethasone ........................................................... 22
dexamethasone intensol .............................................. 22
dexamethasone sodium phosphate ....................... 22, 31
dexchlorpheniramine maleate ...................................... 32
dexmethylphenidate hcl ............................................... 13
dexrazoxane .................................................................. 5
dextroamphetamine sulfate.......................................... 13
dextroamphetamine sulfate er ..................................... 13
dextrose 10%/nacl 0.45% ........................................... 21
dextrose 2.5% ............................................................. 21
dextrose 5% /electrolyte #48 viaflex............................ 35
dextrose 10% flex container......................................... 21
dextrose 10%/nacl 0.2% .............................................. 21
dextrose 10%/nacl 0.225% .......................................... 21
dextrose 2.5%/sodium chloride 0.45% ......................... 21
dextrose 25% ............................................................... 21
dextrose 30% ............................................................... 21
dextrose 40% ............................................................... 21
dextrose 5% ................................................................. 21
dextrose 5%/lactated ringers ....................................... 21
dextrose 5%/nacl 0.2% ................................................ 21
dextrose 5%/nacl 0.225% ............................................ 21
dextrose 5%/nacl 0.33% .............................................. 21
dextrose 5%/nacl 0.45% .............................................. 21
dextrose 5%/nacl 0.9% ................................................ 21
dextrose 5%/potassium chloride 0.15% ...................... 33
dextrose 5%/ringers .................................................... 21
dextrose 50% .............................................................. 21
dextrose 70% .............................................................. 21
diazepam................................................................. 8, 13
diazepam intensol ....................................................... 13
DIBENZYLINE ............................................................. 17
diclofenac potassium ................................................... 12
diclofenac sodium........................................................ 31
diclofenac sodium dr ................................................... 12
diclofenac sodium er ................................................... 12
diclofenac sodium/misoprostol .................................... 12
dicloxacillin sodium........................................................ 5
didanosine ..................................................................... 2
diflorasone diacetate ................................................... 20
diflunisal ...................................................................... 12
digoxin ......................................................................... 18
dihydroergotamine mesylate ......................................... 9
DILANTIN ...................................................................... 8
dilt-cd........................................................................... 17
diltiazem cd ................................................................. 17
diltiazem hcl................................................................. 17
diltiazem hcl cd ............................................................ 17
diltiazem hcl er ............................................................ 17
dilt-xr ........................................................................... 17
diltzac .......................................................................... 17
dimenhydrinate ............................................................ 25
DIPENTUM.................................................................. 25
diphenhydramine hcl ................................................... 32
diphenoxylate/atropine ................................................ 25
DIPHTHERIA/TETANUS TOXOIDS ADSORBED
PEDIATRIC ............................................................. 27
dipyridamole ................................................................ 18
disulfiram ..................................................................... 21
divalproex sodium ......................................................... 8
divalproex sodium dr ..................................................... 8
divalproex sodium er ..................................................... 8
dobutamine hcl ............................................................ 19
dobutamine hcl/d5w .................................................... 19
dobutamine/dextrose 5%............................................. 19
DOCEFREZ................................................................... 6
docetaxel ....................................................................... 6
donepezil hcl ................................................................. 9
42
dopamine hcl ............................................................... 19
dopamine hcl/dextrose 5%........................................... 19
dopamine hcl-dextrose 5% .......................................... 19
dopamine/d5w ............................................................. 19
DORIBAX....................................................................... 4
dorzolamide hcl............................................................ 31
dorzolamide hcl/timolol maleate ................................... 31
doxazosin mesylate ..................................................... 17
doxepin hcl................................................................... 13
DOXIL ............................................................................ 6
doxorubicin hcl ............................................................... 6
doxorubicin hcl liposome................................................ 6
doxy 100 ........................................................................ 5
doxycycline hyclate ........................................................ 5
doxycycline hyclate dr .................................................... 5
doxycycline monohydrate .............................................. 5
dronabinol .................................................................... 25
droperidol ..................................................................... 26
drospirenone/ethinyl estradiol ...................................... 29
DROXIA ......................................................................... 6
DULERA ...................................................................... 32
duramorph ................................................................... 10
DUTOPROL ................................................................. 17
ELSPAR ........................................................................ 6
EMCYT.......................................................................... 6
EMEND ....................................................................... 26
emoquette ................................................................... 29
EMSAM ....................................................................... 13
EMTRIVA ...................................................................... 2
enalapril maleate ......................................................... 17
enalapril maleate/hydrochlorothiazide ......................... 17
enalaprilat .................................................................... 17
ENBREL ...................................................................... 28
ENBREL SURECLICK ................................................ 28
endocet ....................................................................... 10
endodan ...................................................................... 10
ENGERIX-B................................................................. 27
enoxaparin sodium ...................................................... 18
enpresse-28 ................................................................ 29
enskyce ....................................................................... 29
entacapone ................................................................... 9
enulose........................................................................ 26
epiflur .......................................................................... 35
epinastine hcl .............................................................. 31
epinephrine hcl ............................................................ 32
EPIPEN 2-PAK ............................................................ 32
EPIPEN-JR 2-PAK ...................................................... 32
epirubicin hcl ................................................................. 6
epitol.............................................................................. 8
EPIVIR .......................................................................... 2
EPIVIR HBV .................................................................. 2
eplerenone .................................................................. 17
epoprostenol sodium ................................................... 17
eprosartan mesylate .................................................... 17
EPZICOM ...................................................................... 2
ERBITUX ....................................................................... 6
ergoloid mesylates ...................................................... 13
ERGOMAR .................................................................... 9
ERIVEDGE .................................................................... 6
errin ............................................................................. 29
ery ............................................................................... 19
ERYPED 200................................................................. 3
ERYPED 400................................................................. 3
ery-tab ........................................................................... 3
ERYTHROCIN LACTOBIONATE .................................. 3
erythrocin stearate......................................................... 3
E
e.e.s. 400 ....................................................................... 3
E.E.S. GRANULES ........................................................ 3
e.s.p. .............................................................................. 3
econazole nitrate ......................................................... 20
EDURANT ..................................................................... 2
effer-k........................................................................... 33
effervescent pot chloride .............................................. 33
EFFIENT ...................................................................... 18
EGRIFTA ..................................................................... 27
ELAPRASE .................................................................. 25
ELELYSO .................................................................... 25
ELIGARD ....................................................................... 6
elinest .......................................................................... 29
eliphos ......................................................................... 33
ELIQUIS....................................................................... 18
ELITEK .......................................................................... 5
ELMIRON .................................................................... 33
ELOXATIN ..................................................................... 6
43
erythromycin ...................................................... 3, 19, 31
erythromycin base.......................................................... 3
erythromycin ethylsuccinate........................................... 3
erythromycin/benzoyl peroxide .................................... 20
escitalopram oxalate .................................................... 13
estarylla ....................................................................... 29
ESTRACE .................................................................... 29
estradiol ....................................................................... 29
estradiol valerate ......................................................... 29
estradiol/norethindrone acetate ................................... 29
estropipate ................................................................... 29
ethambutol hcl ............................................................... 4
ethosuximide.................................................................. 8
etidronate disodium...................................................... 21
etodolac ....................................................................... 12
etodolac er ................................................................... 12
ETOPOPHOS ................................................................ 6
etoposide ....................................................................... 6
EVISTA ........................................................................ 28
EXELON ........................................................................ 9
exemestane ................................................................... 6
EXFORGE ................................................................... 17
EXFORGE HCT ........................................................... 17
EXJADE ....................................................................... 21
EYLEA ......................................................................... 31
fentanyl citrate ............................................................. 10
fentanyl citrate oral transmucosal ................................ 10
fentanyl patches .......................................................... 10
FERRIPROX ............................................................... 22
finasteride .................................................................... 33
FIRAZYR ..................................................................... 32
FIRMAGON ................................................................... 6
flavoxate hcl ................................................................ 33
FLEBOGAMMA DIF .................................................... 27
flecainide acetate ........................................................ 16
floxuridine ...................................................................... 6
fluconazole .................................................................... 2
fluconazole in dextrose.................................................. 2
fluconazole in nacl ......................................................... 2
flucytosine ..................................................................... 2
fludarabine phosphate ................................................... 6
fludrocortisone acetate ................................................ 22
flumazenil .................................................................... 13
flunisolide .................................................................... 32
fluocinolone acetonide........................................... 20, 22
fluocinolone acetonide body ........................................ 21
fluocinonide ................................................................. 21
fluocinonide-e .............................................................. 21
fluoritab ....................................................................... 36
fluorometholone........................................................... 31
fluorouracil............................................................... 6, 19
fluoxetine dr................................................................. 13
fluoxetine hcl ............................................................... 13
fluphenazine decanoate .............................................. 13
fluphenazine hcl .......................................................... 13
flurbiprofen .................................................................. 12
flurbiprofen sodium ...................................................... 31
flutamide........................................................................ 6
fluticasone propionate ........................................... 21, 33
fluvastatin .................................................................... 18
fluvoxamine maleate ............................................. 13, 14
fluvoxamine maleate er ............................................... 13
FML ............................................................................. 31
folcal dha ..................................................................... 36
folcaps omega 3 .......................................................... 36
FOLOTYN ..................................................................... 6
fomepizole ................................................................... 27
fondaparinux sodium ................................................... 18
F
FABRAZYME ............................................................... 25
falmina ......................................................................... 29
famciclovir ...................................................................... 2
famotidine .................................................................... 26
famotidine premixed..................................................... 26
FANAPT....................................................................... 13
FANAPT TITRATION PACK ........................................ 13
FARESTON ................................................................... 6
FASLODEX.................................................................... 6
FAZACLO .................................................................... 13
felbamate ....................................................................... 8
felodipine er ................................................................. 17
fenofibrate .................................................................... 18
fenofibrate micronized.................................................. 18
fenofibric acid............................................................... 18
fenoprofen calcium....................................................... 12
44
FORADIL AEROLIZER ................................................ 33
FORTEO ...................................................................... 28
fortical .......................................................................... 25
foscarnet sodium ........................................................... 2
fosinopril sodium .......................................................... 17
fosinopril sodium/hydrochlorothiazide .......................... 17
fosphenytoin sodium ...................................................... 8
FREAMINE III ........................................................ 34, 35
furosemide ................................................................... 17
FUSILEV ........................................................................ 5
FUZEON ........................................................................ 2
GLEEVEC ..................................................................... 6
glimepiride ................................................................... 23
glipizide ....................................................................... 23
glipizide er ................................................................... 23
glipizide xl.................................................................... 23
glipizide/metformin hcl ................................................. 23
GLUCAGEN HYPOKIT ............................................... 23
GLUCAGON EMERGENCY KIT ................................. 23
glyburide...................................................................... 23
glyburide micronized ................................................... 23
glyburide/metformin hcl ............................................... 23
glycine ......................................................................... 33
glycopyrrolate .............................................................. 25
granisetron hcl ............................................................. 26
granisol........................................................................ 26
griseofulvin microsize .................................................... 2
griseofulvin ultramicrosize ............................................. 2
guanfacine hcl ............................................................. 17
guanidine hcl ............................................................... 14
G
gabapentin ..................................................................... 8
GABITRIL ...................................................................... 8
GABLOFEN ................................................................. 10
galantamine hydrobromide ............................................ 9
GAMASTAN S/D .......................................................... 27
GAMMAGARD S/D ...................................................... 27
GAMMAGARD S/D IGA LESS THAN 1MCG/ML ......... 27
GAMUNEX-C ............................................................... 27
ganciclovir ...................................................................... 2
garamycin .................................................................... 31
GARDASIL................................................................... 28
GAUZE PADS 2 ........................................................... 23
gavilyte-c...................................................................... 26
gavilyte-g ..................................................................... 26
gavilyte-n/flavor pack ................................................... 26
gemcitabine hcl .............................................................. 6
gemfibrozil ................................................................... 18
generlac ....................................................................... 26
gengraf........................................................................... 6
gentak .......................................................................... 31
gentamicin sulfate .............................................. 4, 20, 31
gentamicin sulfate/0.9% sodium chloride ....................... 4
GEODON ..................................................................... 14
gianvi ........................................................................... 29
gildagia ........................................................................ 29
gildess 1.5/30............................................................... 29
gildess 1/20.................................................................. 30
gildess fe 1.5/30 ........................................................... 30
gildess fe 1/20.............................................................. 30
GILENYA ....................................................................... 9
H
HALAVEN ..................................................................... 6
halobetasol propionate ................................................ 21
halonate ...................................................................... 21
halonate pac ................................................................ 21
haloperidol................................................................... 14
haloperidol decanoate ................................................. 14
haloperidol lactate ....................................................... 14
HAVRIX ....................................................................... 28
heather ........................................................................ 29
hecoria .......................................................................... 6
HEMABATE................................................................. 30
hemenatal ob............................................................... 36
hemenatal ob + dha..................................................... 36
heparin sodium ............................................................ 18
heparin sodium/d5w .................................................... 18
heparin sodium/nacl 0.45% ......................................... 18
heparin sodium/nacl 0.9% ........................................... 18
heparin sodium/sodium chloride 0.9%......................... 18
heparin sodium/sodium chloride 0.9% premix ............. 18
HEPATAMINE ............................................................. 34
HEPATASOL ............................................................... 34
HEPSERA ..................................................................... 2
45
HERCEPTIN .................................................................. 6
HEXALEN ...................................................................... 6
HIBERIX ...................................................................... 28
HIZENTRA ................................................................... 28
HUMALOG................................................................... 23
HUMALOG KWIKPEN ................................................. 23
HUMALOG MIX 50/50 ................................................. 23
HUMALOG MIX 50/50 KWIKPEN ................................ 23
HUMALOG MIX 75/25 ................................................. 23
HUMALOG MIX 75/25 KWIKPEN ................................ 23
HUMIRA....................................................................... 28
HUMIRA PEN .............................................................. 28
HUMIRA PEN-CROHNS DISEASESTARTER............. 28
HUMIRA PEN-PSORIASIS STARTER ........................ 28
HUMULIN 70/30 .......................................................... 23
HUMULIN 70/30 PEN .................................................. 23
HUMULIN N ................................................................. 23
HUMULIN N U-100 PEN .............................................. 23
HUMULIN R ................................................................. 23
HUMULIN R U-500 (CONCENTRATED) ..................... 23
hydralazine hcl ............................................................. 17
hydrochlorothiazide ...................................................... 17
hydrocodone bitartrate/acetaminophen........................ 10
hydrocodone/acetaminophen ....................................... 10
hydrocodone/ibuprofen ................................................ 10
hydrocortisone ................................................. 21, 22, 26
hydrocortisone butyrate ............................................... 21
hydrocortisone valerate................................................ 21
hydrocortisone/acetic acid ........................................... 22
hydromorphone hcl ...................................................... 10
hydromorphone hcl dosette ......................................... 10
hydroxychloroquine sulfate ............................................ 4
hydroxyurea ................................................................... 7
hydroxyzine hcl ............................................................ 32
hydroxyzine pamoate ................................................... 32
HYPERHEP B S/D ....................................................... 28
HYPERRHO S/D.......................................................... 28
idarubicin hcl ................................................................. 7
ifosfamide ...................................................................... 7
ifosfamide/mesna .......................................................... 7
ILARIS ......................................................................... 27
imipenem/cilastatin ........................................................ 4
imipramine hcl ............................................................. 14
imipramine pamoate .................................................... 14
imiquimod .................................................................... 19
IMOGAM RABIES-HT ................................................. 28
IMOVAX RABIES (H.D.C.V.) ....................................... 28
inatal advance ............................................................. 36
inatal ultra .................................................................... 36
INCIVEK ........................................................................ 2
INCRELEX .................................................................. 22
indapamide .................................................................. 17
indomethacin ............................................................... 12
indomethacin er ........................................................... 12
indomethacin sodium .................................................. 12
INFANRIX ................................................................... 28
INFERGEN .................................................................. 27
INLYTA.......................................................................... 7
INSULIN PEN NEEDLE .............................................. 23
INSULIN SYRINGE (DISP) U-100 0.3 ML ................... 24
INSULIN SYRINGE (DISP) U-100 1 ML ...................... 24
INSULIN SYRINGE (DISP) U-100 1/2 ML ................... 24
INTELENCE .................................................................. 2
intralipid ....................................................................... 34
INTRON-A ................................................................... 27
INTRON-A W/DILUENT .............................................. 27
introvale....................................................................... 30
INTUNIV ...................................................................... 14
INVANZ ......................................................................... 4
INVEGA....................................................................... 14
INVEGA SUSTENNA .................................................. 14
INVIRASE ..................................................................... 2
INVOKANA .................................................................. 24
IONOSOL-B/DEXTROSE 5%...................................... 34
IONOSOL-MB/DEXTROSE 5%................................... 34
IPOL INACTIVATED IPV ............................................. 28
ipratropium bromide .............................................. 22, 33
ipratropium bromide/albuterol sulfate .......................... 33
irbesartan .................................................................... 17
irbesartan/hydrochlorothiazide .................................... 17
I
ibandronate sodium ..................................................... 28
ibuprofen ...................................................................... 12
ibutilide fumarate ......................................................... 16
ICLUSIG ........................................................................ 7
46
irinotecan ....................................................................... 7
ISENTRESS .................................................................. 2
ISOLYTE-M/DEXTROSE 5% ....................................... 34
ISOLYTE-P/DEXTROSE 5% ....................................... 34
ISOLYTE-S .................................................................. 34
ISOLYTE-S PH 7.4 ...................................................... 35
isoniazid ......................................................................... 4
isosorbide dinitrate ....................................................... 19
isosorbide dinitrate er................................................... 19
isosorbide mononitrate................................................. 19
isosorbide mononitrate er ............................................ 19
isotonic gentamicin ........................................................ 4
isradipine ..................................................................... 17
ISTODAX ....................................................................... 7
itraconazole ................................................................... 2
IXEMPRA KIT ................................................................ 7
IXIARO......................................................................... 28
kcl 0.15%/d5w/lr .......................................................... 33
kcl 0.15%/d5w/nacl 0.2% ............................................ 33
kcl 0.15%/d5w/nacl 0.225%......................................... 33
kcl 0.15%/d5w/nacl 0.9% ............................................ 33
kcl 0.3%/d5w/lr iv lac ring ............................................ 34
kcl 0.3%/d5w/nacl 0.45% ............................................ 34
kcl 0.3%/d5w/nacl 0.9% .............................................. 34
k-effervescent .............................................................. 33
kelnor 1/35 .................................................................. 30
KEPIVANCE .................................................................. 5
ketoconazole ........................................................... 2, 20
ketodan ....................................................................... 20
ketodan kit ................................................................... 20
ketoprofen ................................................................... 12
ketoprofen er ............................................................... 12
ketorolac tromethamine ......................................... 12, 31
KINRIX ........................................................................ 28
kionex .......................................................................... 22
klor-con ....................................................................... 34
klor-con 10 .................................................................. 34
klor-con 8 .................................................................... 34
klor-con m10................................................................ 34
klor-con m15................................................................ 34
klor-con m20................................................................ 34
klor-con/ef ................................................................... 34
KRYSTEXXA ............................................................... 28
kurvelo......................................................................... 30
KUVAN ........................................................................ 25
k-vescent ..................................................................... 33
J
JAKAFI........................................................................... 7
jantoven ....................................................................... 18
JANUMET .................................................................... 24
JANUMET XR .............................................................. 24
JANUVIA...................................................................... 24
jencycla ........................................................................ 29
JE-VAX ........................................................................ 28
JEVTANA....................................................................... 7
jinteli............................................................................. 29
jolessa.......................................................................... 30
jolivette......................................................................... 29
junel 1.5/30 .................................................................. 30
junel 1/20 ..................................................................... 30
junel fe 1.5/30 .............................................................. 30
junel fe 1/20 ................................................................. 30
JUVISYNC ................................................................... 24
JUXTAPID ................................................................... 18
L
labetalol hcl ................................................................. 17
laclotion ....................................................................... 19
lactated ringers irrigation ............................................. 21
lactated ringers viaflex................................................. 34
lactulose ...................................................................... 26
LAMISIL ........................................................................ 2
lamivudine ..................................................................... 2
lamivudine/zidovudine ................................................... 2
lamotrigine ..................................................................... 8
lamotrigine er................................................................. 8
lansoprazole ................................................................ 26
LANTUS ...................................................................... 24
K
KADCYLA ...................................................................... 7
KALETRA ...................................................................... 2
kalexate ....................................................................... 22
KALYDECO ................................................................. 33
kariva ........................................................................... 30
kcl 0.075%/d5w/nacl 0.45% ......................................... 33
47
LANTUS SOLOSTAR .................................................. 24
latanoprost ................................................................... 31
LATUDA....................................................................... 14
LAZANDA .................................................................... 11
leena ............................................................................ 30
leflunomide .................................................................. 28
lessina.......................................................................... 30
LETAIRIS ..................................................................... 33
letrozole ......................................................................... 7
leucovorin calcium ......................................................... 5
LEUKERAN ................................................................... 7
LEUKINE ..................................................................... 27
leuprolide acetate........................................................... 7
levalbuterol hcl ............................................................. 33
LEVEMIR ..................................................................... 24
LEVEMIR FLEXPEN .................................................... 24
levetiracetam ................................................................. 9
levetiracetam er ............................................................. 8
levobunolol hcl ............................................................. 31
levocarnitine................................................................. 22
levocetirizine dihydrochloride ....................................... 32
levofloxacin .............................................................. 5, 31
levofloxacin in d5w ......................................................... 5
levonest ....................................................................... 30
levonorgestrel .............................................................. 30
levonorgestrel and ethinyl estradiol.............................. 30
levonorgestrel/ethinyl estradiol .................................... 30
levora 0.15/30-28 ......................................................... 30
levorphanol tartrate ...................................................... 11
levothroid ..................................................................... 25
levothyroxine sodium ................................................... 25
levoxyl .......................................................................... 25
LEXIVA .......................................................................... 2
LIALDA ........................................................................ 26
lidocaine....................................................................... 20
lidocaine hcl ........................................................... 16, 20
lidocaine hcl in d5w ...................................................... 16
lidocaine hcl jelly .......................................................... 20
lidocaine hcl/dextrose .................................................. 16
lidocaine viscous .......................................................... 20
lidocaine/epinephrine ................................................... 20
lidocaine/prilocaine ...................................................... 20
LIDODERM .................................................................. 20
lindane......................................................................... 21
LINZESS ..................................................................... 26
LIORESAL INTRATHECAL ......................................... 10
liothyronine sodium ..................................................... 25
lipodox ........................................................................... 7
lipodox 50 ...................................................................... 7
liposyn iii...................................................................... 35
lisinopril ....................................................................... 17
lisinopril/hydrochlorothiazide ....................................... 17
lithium carbonate ......................................................... 14
lithium carbonate er ..................................................... 14
lithium citrate ............................................................... 14
LODOSYN..................................................................... 9
loperamide hcl ............................................................. 25
lorazepam ................................................................... 14
lorazepam intensol ...................................................... 14
loryna .......................................................................... 30
losartan potassium ...................................................... 17
losartan potassium/hydrochlorothiazide ...................... 17
LOTRONEX................................................................. 26
lovastatin ..................................................................... 18
LOVAZA ...................................................................... 19
low-ogestrel ................................................................. 30
loxapine succinate ....................................................... 14
lta 360 kit ..................................................................... 20
LUCENTIS................................................................... 31
LUMIZYME .................................................................. 25
LUPRON DEPOT .......................................................... 7
LUPRON DEPOT-PED ................................................. 7
lutera ........................................................................... 30
LYRICA ......................................................................... 9
LYSODREN................................................................... 7
M
mafenide acetate ......................................................... 20
magnesium sulfate ...................................................... 34
MAGNESIUM SULFATE IN D5W................................ 34
MAKENA ..................................................................... 29
malathion..................................................................... 21
mannitol....................................................................... 17
maprotiline hcl ............................................................. 14
marcaine w/o epi ......................................................... 20
marlissa ....................................................................... 30
48
MARPLAN ................................................................... 14
MATULANE ................................................................... 7
matzim la ..................................................................... 17
meclizine hcl ................................................................ 26
meclofenamate sodium ................................................ 12
medroxyprogesterone acetate ..................................... 29
mefenamic acid ............................................................ 12
mefloquine hcl................................................................ 4
MEGACE ES ................................................................. 7
megestrol acetate .......................................................... 7
MEKINIST ...................................................................... 7
meloxicam.................................................................... 12
melphalan hydrochloride ................................................ 7
MENACTRA ................................................................. 28
MENEST ...................................................................... 29
MENOMUNE-A/C/Y/W-135 ......................................... 28
MENVEO ..................................................................... 28
meperidine hcl ............................................................. 11
MEPRON ....................................................................... 4
mercaptopurine .............................................................. 7
meropenem.................................................................... 4
mesalamine ................................................................. 26
mesna ............................................................................ 5
MESNEX........................................................................ 5
MESTINON .................................................................. 10
MESTINON TIMESPAN............................................... 10
metadate er.................................................................. 14
metaproterenol sulfate ................................................. 33
metaxalone .................................................................. 10
metformin hcl ............................................................... 24
metformin hcl er ........................................................... 24
methadone hcl ............................................................. 11
methadone hcl intensol ................................................ 11
methadose ................................................................... 11
methadose sugar-free .................................................. 11
methamphetamine hcl.................................................. 14
methazolamide ............................................................ 31
methenamine hippurate ................................................. 5
methimazole ................................................................ 23
METHITEST ................................................................ 25
methocarbamol ............................................................ 10
methotrexate .................................................................. 7
methotrexate sodium ..................................................... 7
methyclothiazide.......................................................... 17
methyldopa .................................................................. 17
methyldopa/hydrochlorothiazide .................................. 17
methyldopate hcl ......................................................... 17
methylergonovine maleate .......................................... 30
methylphenidate hcl .................................................... 14
methylphenidate hcl cd................................................ 14
methylphenidate hcl er ................................................ 14
methylphenidate hcl sr ................................................ 14
methylphenidate hydrochloride.................................... 14
methylprednisolone ..................................................... 22
methylprednisolone acetate......................................... 22
methylprednisolone dose pack .................................... 22
methylprednisolone sodiumsuccinate.......................... 22
metipranolol................................................................. 31
metoclopramide hcl ..................................................... 26
metolazone .................................................................. 17
metoprolol succinate er ............................................... 17
metoprolol tartrate ....................................................... 17
metoprolol/hydrochlorothiazide.................................... 17
metro iv ......................................................................... 4
metronidazole .......................................................... 4, 20
metronidazole in nacl 0.79% ......................................... 4
metronidazole vaginal ................................................. 29
mexiletine hcl............................................................... 16
MIACALCIN ................................................................. 25
miconazole 3 ............................................................... 29
microgestin 1.5/30 ....................................................... 30
microgestin 1/20 .......................................................... 30
microgestin fe .............................................................. 30
microgestin fe 1.5/30 ................................................... 30
midodrine hcl ............................................................... 22
migergot ........................................................................ 9
millipred ....................................................................... 23
millipred dp .................................................................. 22
milrinone in dextrose ................................................... 19
milrinone lactate .......................................................... 19
mimvey ........................................................................ 29
minocycline hcl .............................................................. 5
minocycline hcl er .......................................................... 5
minoxidil ...................................................................... 17
miostat......................................................................... 31
mirtazapine .................................................................. 14
49
mirtazapine odt ............................................................ 14
misoprostol .................................................................. 26
mitomycin....................................................................... 7
mitoxantrone hcl ............................................................ 7
M-M-R II W/DILUENT 10 DOSE .................................. 28
modafinil ...................................................................... 14
moexipril hcl ................................................................. 17
moexipril/hydrochlorothiazide ...................................... 17
mometasone furoate .................................................... 21
mono-linyah ................................................................. 30
mononessa .................................................................. 30
montelukast sodium ..................................................... 33
morgidox caps ............................................................... 5
morphine sulfate .......................................................... 11
morphine sulfate er ...................................................... 11
morphine sulfate in dextrose 5%.................................. 11
MOZOBIL..................................................................... 27
mupirocin ..................................................................... 20
MUSTARGEN ................................................................ 7
my way......................................................................... 30
MYCAMINE ................................................................... 2
MYCOBUTIN ................................................................. 4
mycophenolate mofetil ................................................... 7
MYFORTIC .................................................................... 7
myorisan ...................................................................... 20
MYOZYME................................................................... 25
myzilra ......................................................................... 30
naproxen dr ................................................................. 12
naproxen sodium ......................................................... 12
naratriptan hcl................................................................ 9
NATACYN ................................................................... 31
natalvirt 90 dha ............................................................ 36
natalvirt ca ................................................................... 36
nateglinide ................................................................... 24
NEBUPENT ................................................................... 4
necon 0.5/35-28 .......................................................... 30
necon 1/35 .................................................................. 30
necon 1/50-28 ............................................................. 30
necon 10/11-28 ........................................................... 30
necon 7/7/7 ................................................................. 30
NEEDLES, INSULIN DISP., SAFETY ......................... 24
nefazodone hcl ............................................................ 14
neomycin sulfate ........................................................... 4
neomycin/bacitracin/polymyxin .................................... 31
neomycin/polymyxin b sulfates .................................... 21
neomycin/polymyxin/bacitracin/hydrocortisone ........... 31
neomycin/polymyxin/dexamethasone .......................... 31
neomycin/polymyxin/gramicidin ................................... 31
neomycin/polymyxin/hc ............................................... 22
neomycin/polymyxin/hydrocortisone...................... 22, 31
neo-polycin .................................................................. 31
neo-polycin hc ............................................................. 31
NEPHRAMINE ............................................................ 35
NEULASTA ................................................................. 27
NEUMEGA .................................................................. 27
NEUPOGEN ................................................................ 27
NEUT .......................................................................... 34
neutral sodium fluoride ................................................ 22
nevirapine ...................................................................... 2
NEXAVAR ..................................................................... 7
NEXIUM ...................................................................... 26
NEXIUM I.V. ................................................................ 26
next choice one dose .................................................. 30
NIASPAN .................................................................... 19
nicardipine hcl ............................................................. 17
NICOTROL INHALER ................................................. 22
NICOTROL NS ............................................................ 22
nifediac cc ................................................................... 17
nifedical xl ................................................................... 17
nifedipine er................................................................. 17
N
nabumetone ................................................................. 12
nadolol ......................................................................... 17
nadolol/bendroflumethiazide ........................................ 17
nafcillin sodium .............................................................. 5
NAGLAZYME............................................................... 25
nalbuphine hcl.............................................................. 12
nallpen iso-osmotic in dextrose ...................................... 5
nallpen/dextrose ............................................................ 5
naloxone hcl................................................................. 12
naltrexone hcl .............................................................. 12
NAMENDA ..................................................................... 9
NAMENDA TITRATION PAK ......................................... 9
naphazoline hcl ............................................................ 32
naproxen ...................................................................... 12
50
NILANDRON.................................................................. 7
nimodipine ................................................................... 17
nisoldipine .................................................................... 17
nisoldipine er................................................................ 17
nitro-bid ........................................................................ 19
nitrofurantoin .................................................................. 5
nitrofurantoin macrocrystal............................................. 5
nitrofurantoin monohydrate ............................................ 5
nitroglycerin ................................................................. 19
nitroglycerin in 5% dextrose ......................................... 19
nitroglycerin in dextrose 5% ......................................... 19
nitroglycerin lingual ...................................................... 19
nitroglycerin transdermal.............................................. 19
NITROSTAT ................................................................ 19
nizatidine...................................................................... 26
nora-be ........................................................................ 29
norepinephrine bitartrate .............................................. 19
norethindrone............................................................... 29
norethindrone acetate .................................................. 29
norgestimate/ethinyl estradiol ...................................... 30
NORMOSOL -R ........................................................... 34
NORMOSOL-M IN D5W .............................................. 35
NORMOSOL-R ............................................................ 35
NORMOSOL-R IN D5W............................................... 34
nortrel 0.5/35 (28) ........................................................ 30
nortrel 1/35................................................................... 30
nortrel 7/7/7.................................................................. 30
nortriptyline hcl............................................................. 14
NORVIR ......................................................................... 2
novarel ......................................................................... 25
NOVOFINE 30GX8MM ................................................ 24
NOVOFINE 32GX6MM ................................................ 24
NOVOFINE AUTOCOVER 30GX8MM ........................ 24
NOVOLIN 70/30 ........................................................... 24
NOVOLIN N ................................................................. 24
NOVOLIN R ................................................................. 24
NOVOLOG................................................................... 24
NOVOLOG FLEXPEN ................................................. 24
NOVOLOG MIX 70/30 ................................................. 24
NOVOLOG MIX 70/30 PREFILLED FLEXPEN ............ 24
NOVOLOG PENFILL ................................................... 24
NOXAFIL ....................................................................... 2
NPLATE ....................................................................... 18
NUEDEXTA ................................................................... 9
NULOJIX ....................................................................... 7
nutrilyte........................................................................ 34
nutrilyte ii ..................................................................... 34
nyamyc ........................................................................ 20
nystatin .................................................................... 2, 20
nystatin/triamcinolone.................................................. 20
nystop.......................................................................... 20
O
ocella ........................................................................... 30
octreotide acetate .......................................................... 7
ofloxacin ............................................................ 5, 22, 31
ogestrel ....................................................................... 30
olanzapine ................................................................... 14
olanzapine odt ............................................................. 14
olanzapine/fluoxetine................................................... 14
omeprazole ................................................................. 26
omeprazole/sodium bicarbonate ................................. 26
OMNITROPE............................................................... 27
ONCASPAR .................................................................. 7
ondansetron hcl ........................................................... 26
ondansetron odt .......................................................... 26
ONFI.............................................................................. 9
ONTAK .......................................................................... 7
opium tincture .............................................................. 25
oralone ........................................................................ 22
ORAP .......................................................................... 14
ORENCIA .................................................................... 29
ORFADIN .................................................................... 22
orphenadrine citrate .................................................... 10
orphenadrine citrate er ................................................ 10
orphenadrine/asa/caffeine ........................................... 10
orsythia........................................................................ 30
osmitrol viaflex............................................................. 17
oxacillin sodium ............................................................. 5
oxaliplatin ...................................................................... 7
oxandrolone................................................................. 25
oxaprozin..................................................................... 12
oxazepam.................................................................... 14
oxcarbazepine ............................................................... 9
OXSORALEN .............................................................. 19
OXSORALEN ULTRA ................................................. 19
51
oxybutynin chloride ...................................................... 33
oxybutynin chloride er .................................................. 33
oxycodone hcl .............................................................. 11
oxycodone/acetaminophen .......................................... 11
oxycodone/aspirin ........................................................ 11
oxycodone/ibuprofen.................................................... 11
oxymorphone hydrochloride......................................... 11
oxymorphone hydrochloride er .................................... 11
oxytocin........................................................................ 30
PERFOROMIST .......................................................... 33
perindopril erbumine.................................................... 17
perio med .................................................................... 22
periogard ..................................................................... 22
PERJETA ...................................................................... 7
permethrin ................................................................... 21
perphenazine............................................................... 15
perphenazine/amitriptyline........................................... 15
pfizerpen-g .................................................................... 5
phenadoz .................................................................... 32
phenelzine sulfate ....................................................... 15
phenobarbital................................................................. 9
phenobarbital sodium .................................................... 9
phentolamine mesylate ............................................... 17
phenytoin....................................................................... 9
phenytoin sodium .......................................................... 9
phenytoin sodium extended........................................... 9
philith ........................................................................... 30
PHOSPHOLINE IODIDE ............................................. 31
pilocarpine hcl ....................................................... 22, 31
pindolol ........................................................................ 17
pioglitazone hcl............................................................ 24
pioglitazone hcl/metformin hcl ..................................... 24
pioglitazone hcl-glimepiride ......................................... 24
piperacillin sodium/ tazobactam sodium ........................ 5
piroxicam ..................................................................... 12
PLASMA-LYTE A ........................................................ 35
PLASMA-LYTE-148 .................................................... 35
PLASMA-LYTE-56/D5W ............................................. 35
pnv ob+dha ................................................................. 36
pnv prenatal plus multivitamin ..................................... 36
pnv-first ....................................................................... 36
podofilox ...................................................................... 19
polycin ......................................................................... 31
polyethylene glycol 3350 ............................................. 26
polymyxin b sulfate ........................................................ 4
POMALYST................................................................... 7
portia-28 ...................................................................... 30
potassium acetate ....................................................... 34
potassium chloride ...................................................... 34
potassium chloride 0.15% /nacl 0.45% viaflex............. 34
potassium chloride 0.15% d5w/nacl 0.33% ................. 34
potassium chloride 0.15% d5w/nacl 0.45% viaflex ..... 34
P
pacerone ...................................................................... 16
paclitaxel ........................................................................ 7
palgic ........................................................................... 32
pamidronate disodium.................................................. 25
pancrelipase ................................................................ 26
PANRETIN................................................................... 19
pantoprazole sodium.............................................. 26, 27
paromomycin sulfate ...................................................... 4
paroxetine hcl ........................................................ 14, 15
paroxetine hcl er .......................................................... 14
PASER........................................................................... 4
PAXIL........................................................................... 15
PEDIARIX .................................................................... 28
pedi-dri ......................................................................... 20
PEDVAX HIB ............................................................... 28
peg 3350/electrolytes ................................................... 26
peg-3350/electrolytes................................................... 26
peg-3350/nacl/na bicarbonate/kcl ................................ 26
PEGANONE .................................................................. 9
PEGASYS.................................................................... 27
PEGASYS PROCLICK ................................................ 27
PEG-INTRON .............................................................. 27
PEG-INTRON REDIPEN ............................................. 27
penicillin g potassium ..................................................... 5
penicillin g procaine ....................................................... 5
penicillin g sodium.......................................................... 5
penicillin v potassium ..................................................... 5
PENTACEL .................................................................. 28
PENTAM 300 ................................................................. 4
PENTASA .................................................................... 26
pentostatin ..................................................................... 7
pentoxifylline er ............................................................ 18
52
potassium chloride 0.15% nacl 0.9% ........................... 34
potassium chloride 0.22% d5w/nacl 0.45%.................. 34
potassium chloride 0.3%/ nacl 0.9% ............................ 34
potassium chloride 0.3%/d5w ...................................... 34
potassium chloride er ................................................... 34
potassium chloride sr ................................................... 34
potassium citrate .......................................................... 33
POTIGA ......................................................................... 9
PRADAXA.................................................................... 18
pramipexole dihydrochloride .......................................... 9
pravastatin sodium ....................................................... 19
prazosin hcl.................................................................. 17
PRED MILD ................................................................. 32
prednicarbate ............................................................... 21
prednisolone ................................................................ 23
prednisolone acetate.................................................... 32
prednisolone sodium phosphate ............................ 23, 32
prednisone ................................................................... 23
prednisone intensol ...................................................... 23
PREMARIN .................................................................. 29
PREMASOL ................................................................. 35
PREMPHASE .............................................................. 29
PREMPRO................................................................... 29
prena1 chew/quatrefolic ............................................... 36
prena1 plus/quatrefolic................................................. 36
prena1/quatrefolic ........................................................ 36
prenaissance ............................................................... 36
prenaissance plus ........................................................ 36
prenatabs fa ................................................................. 36
prenatabs obn .............................................................. 36
prenatal plus ................................................................ 36
prenatal plus iron ......................................................... 36
prenatal vitamins plus .................................................. 36
prevalite ....................................................................... 19
previfem ....................................................................... 30
PREZISTA ..................................................................... 2
PRIALT ........................................................................ 12
PRIFTIN ......................................................................... 4
PRIMAQUINE PHOSPHATE ......................................... 4
primidone ....................................................................... 9
PRIMSOL....................................................................... 5
PRISTIQ ...................................................................... 15
PRIVIGEN.................................................................... 28
PROAIR HFA .............................................................. 33
probenecid .................................................................. 28
probenecid/colchicine .................................................. 28
procainamide hcl ......................................................... 16
PROCALAMINE .......................................................... 35
procentra ..................................................................... 15
prochlorperazine.......................................................... 26
prochlorperazine edisylate........................................... 26
prochlorperazine maleate ............................................ 26
PROCRIT .................................................................... 27
procto-pak ................................................................... 26
proctosol hc ................................................................. 26
proctozone-hc.............................................................. 26
PRODIGY INSULIN MINI PEN NEEDLES/31G X 3/16 24
PRODIGY INSULIN PEN NEEDLES/29G X 1/2.......... 24
PRODIGY INSULIN SHORT PENNEEDLES/31G X 5/16
................................................................................ 24
PRODIGY INSULIN SYRING/U-100/0.3ML/31G X 5/16
................................................................................ 24
PRODIGY INSULIN SYRINGE/1/2ML/31G X 5/16...... 24
PRODIGY INSULIN SYRINGE/1ML/28G X 1/2........... 24
progesterone ............................................................... 29
PROGLYCEM ............................................................. 24
PROGRAF .................................................................... 7
PROLASTIN-C ............................................................ 22
PROLEUKIN................................................................ 27
PROLIA ....................................................................... 28
PROMACTA ................................................................ 18
promethazine hcl ......................................................... 32
promethegan ............................................................... 32
propafenone hcl........................................................... 16
propafenone hcl er ...................................................... 16
proparacaine hcl .......................................................... 31
propranolol hcl ............................................................. 17
propranolol hcl er......................................................... 17
propranolol/hydrochlorothiazide .................................. 17
propylthiouracil ............................................................ 23
PROQUAD .................................................................. 28
PROSTIN E2 ............................................................... 29
protamine sulfate ......................................................... 18
PROTOPAM CHLORIDE ............................................ 21
PROTOPIC.................................................................. 19
protriptyline hcl ............................................................ 15
53
prudoxin ....................................................................... 19
PULMICORT................................................................ 33
PULMOZYME .............................................................. 33
pyrazinamide ................................................................. 4
pyridostigmine bromide ................................................ 10
RESTASIS .................................................................. 31
RETROVIR IV INFUSION ............................................. 2
REVATIO .................................................................... 33
REVLIMID ..................................................................... 7
REYATAZ.................................................................. 2, 3
R-GENE 10 ................................................................. 35
ribapak .......................................................................... 3
ribasphere ..................................................................... 3
ribavirin .......................................................................... 3
RIDAURA .................................................................... 29
rifampin ......................................................................... 4
RILUTEK ..................................................................... 22
riluzole ......................................................................... 22
rimantadine hcl .............................................................. 3
ringers injection ........................................................... 34
ringers irrigation........................................................... 21
RIOMET ...................................................................... 24
RISPERDAL CONSTA ................................................ 15
risperidone .................................................................. 15
risperidone odt............................................................. 15
RITUXAN ...................................................................... 7
rivastigmine tartrate ....................................................... 9
rizatriptan benzoate ....................................................... 9
rizatriptan benzoate odt ................................................. 9
ropinirole er ................................................................... 9
ropinirole hcl .................................................................. 9
rosadan ....................................................................... 20
ROTARIX .................................................................... 28
ROTATEQ ................................................................... 28
roxicet.......................................................................... 11
ROZEREM .................................................................. 15
Q
quasense ..................................................................... 30
quetiapine fumarate ..................................................... 15
quinapril hcl.................................................................. 17
quinapril/hydrochlorothiazide ....................................... 17
quinidine gluconate ...................................................... 16
quinidine gluconate cr .................................................. 16
quinidine sulfate ........................................................... 16
quinidine sulfate er ....................................................... 16
quinine sulfate................................................................ 4
QVAR........................................................................... 33
R
RABAVERT ................................................................. 28
ramipril ......................................................................... 17
RANEXA ...................................................................... 19
ranitidine hcl................................................................. 27
RAPAMUNE .................................................................. 7
RAVICTI....................................................................... 22
REBIF .......................................................................... 27
REBIF REBIDOSE ....................................................... 27
REBIF REBIDOSE TITRATION PACK ........................ 27
REBIF TITRATION PACK............................................ 27
reclipsen ...................................................................... 30
RECOMBIVAX HB ....................................................... 28
RECTIV........................................................................ 26
regonol ......................................................................... 10
REGRANEX................................................................. 19
RELENZA DISKHALER ................................................. 2
RELISTOR ................................................................... 26
relnate dha ................................................................... 36
REMICADE .................................................................. 26
REMODULIN ............................................................... 18
RENACIDIN ................................................................. 33
RENVELA .................................................................... 22
reprexain ...................................................................... 11
RESCRIPTOR ............................................................... 2
reserpine ...................................................................... 18
S
SABRIL ......................................................................... 9
SAIZEN ....................................................................... 27
SAIZEN CLICK.EASY ................................................. 27
salsalate ...................................................................... 12
SAMSCA ..................................................................... 25
SANDOSTATIN LAR DEPOT........................................ 7
SANTYL ...................................................................... 21
SAPHRIS .................................................................... 15
SAVELLA .................................................................... 29
SAVELLA TITRATION PACK ...................................... 29
54
scalacort ...................................................................... 21
selegiline hcl .................................................................. 9
selenium sulfide ........................................................... 19
SELZENTRY.................................................................. 3
se-natal one ................................................................. 36
SENSIPAR................................................................... 25
sensorcaine ................................................................. 20
sensorcaine-mpf .......................................................... 20
SEREVENT DISKUS ................................................... 33
SEROMYCIN ................................................................. 4
SEROQUEL XR ........................................................... 15
sertraline hcl ................................................................ 15
seton et-ec ................................................................... 36
setonet ......................................................................... 36
sf 5000 plus ................................................................. 22
SIGNIFOR ..................................................................... 7
sildenafil citrate ............................................................ 33
silver sulfadiazine......................................................... 19
SIMCOR ...................................................................... 19
SIMULECT..................................................................... 7
simvastatin ................................................................... 19
SIRTURO....................................................................... 4
sodium acetate ............................................................ 34
sodium bicarbonate...................................................... 34
sodium bicarbonate partial fill ...................................... 34
sodium chloride ...................................................... 22, 34
sodium chloride 0.45% viaflex ..................................... 34
sodium chloride 0.9%................................................... 22
sodium fluoride ............................................................ 36
sodium lactate.............................................................. 34
sodium phenylbutyrate ................................................. 22
sodium phosphate........................................................ 34
sodium polystyrene sulfonate ...................................... 22
sodium sulfacetamide .................................................. 32
SOLARAZE.................................................................. 19
solia ............................................................................. 30
SOLIRIS....................................................................... 22
SOLTAMOX ................................................................... 7
SOMAVERT................................................................. 25
SORIATANE ................................................................ 19
sorine ........................................................................... 16
sotalol hcl ..................................................................... 16
sotalol hcl (af) .............................................................. 16
spinosad ...................................................................... 21
SPIRIVA HANDIHALER .............................................. 33
spironolactone ............................................................. 18
spironolactone/hydrochlorothiazide ............................. 18
SPORANOX .................................................................. 2
sprintec 28 ................................................................... 30
SPRYCEL ..................................................................... 7
sps............................................................................... 22
sronyx.......................................................................... 30
ssd............................................................................... 19
stagesic ....................................................................... 11
stavudine ....................................................................... 3
sterile water irrigation .................................................. 22
STIVARGA .................................................................... 7
STRATTERA ............................................................... 15
STREPTOMYCIN SULFATE ......................................... 4
STRIBILD ...................................................................... 3
STROMECTOL ............................................................. 4
sublimaze .................................................................... 11
SUBOXONE ................................................................ 12
SUCRAID .................................................................... 26
sucralfate..................................................................... 27
sulfacetamide sodium............................................ 20, 32
sulfacetamide sodium/prednisolone sodium phosphate
................................................................................ 31
sulfadiazine ................................................................... 5
sulfamethoxazole/trimethoprim...................................... 5
sulfamethoxazole/trimethoprim ds ................................. 5
SULFAMYLON ............................................................ 20
sulfasalazine................................................................ 26
sulfazine ...................................................................... 26
sulfazine ec ................................................................. 26
sulindac ....................................................................... 12
sumatriptan ................................................................... 9
sumatriptan succinate ................................................... 9
sumatriptan succinate refill ............................................ 9
SUPRAX ....................................................................... 3
SUSTIVA ....................................................................... 3
SUTENT ........................................................................ 7
syeda........................................................................... 30
SYLATRON ................................................................. 27
SYMBICORT ............................................................... 33
SYMLINPEN 120......................................................... 24
55
SYMLINPEN 60 ........................................................... 24
SYNAGIS ....................................................................... 3
SYNAREL .................................................................... 25
SYNERCID .................................................................... 4
SYNRIBO....................................................................... 7
SYPRINE ..................................................................... 22
THIOLA ....................................................................... 22
thioridazine hcl ............................................................ 15
thiotepa ......................................................................... 8
thiothixene ................................................................... 15
THYROLAR-1.............................................................. 25
THYROLAR-1/2........................................................... 25
THYROLAR-1/4........................................................... 25
THYROLAR-2.............................................................. 25
THYROLAR-3.............................................................. 25
tiagabine hydrochloride ................................................. 9
TICE BCG ................................................................... 28
TIKOSYN .................................................................... 16
tilia fe ........................................................................... 30
timolol maleate ...................................................... 18, 31
timolol maleate ophthalmic gel forming ....................... 31
tinidazole ....................................................................... 4
tis-u-sol........................................................................ 21
tizanidine hcl................................................................ 10
tl-care dha ................................................................... 36
tl-select ........................................................................ 36
TOBI .............................................................................. 4
tobramycin sulfate ................................................... 4, 31
tobramycin sulfate/sodium chloride ............................... 4
tobramycin/dexamethasone ........................................ 31
tolazamide ................................................................... 24
tolbutamide .................................................................. 24
tolmetin sodium ........................................................... 12
tolterodine tartrate ....................................................... 33
topiramate ..................................................................... 9
toposar .......................................................................... 8
topotecan hcl ................................................................. 8
TORISEL ....................................................................... 8
torsemide .................................................................... 18
TPN ELECTROLYTES II ............................................. 34
TRACLEER ................................................................. 33
tramadol hcl ................................................................. 12
tramadol hcl er............................................................. 12
tramadol hydrochloride/acetaminophen ...................... 12
trandolapril .................................................................. 18
tranexamic acid ..................................................... 18, 29
tranylcypromine sulfate ............................................... 15
travasol........................................................................ 35
travoprost .................................................................... 31
T
TABLOID ....................................................................... 7
tacrolimus ...................................................................... 8
TAFINLAR ..................................................................... 8
TAMIFLU ....................................................................... 3
tamoxifen citrate ............................................................ 8
tamsulosin hcl .............................................................. 33
TARCEVA ...................................................................... 8
TARGRETIN .................................................................. 8
TASIGNA ....................................................................... 8
TASMAR ........................................................................ 9
TAZORAC.................................................................... 20
taztia xt ........................................................................ 18
TECFIDERA .................................................................. 9
TECFIDERA STARTER PACK ...................................... 9
TEGRETOL-XR ............................................................. 9
temazepam .................................................................. 15
TEMODAR ..................................................................... 8
TENIVAC ..................................................................... 28
terazosin hcl................................................................. 18
terbinafine hcl ................................................................ 2
terbutaline sulfate......................................................... 33
terconazole .................................................................. 29
TESTOPEL .................................................................. 25
testosterone cypionate ................................................. 25
testosterone enanthate ................................................ 25
tetanus toxoid adsorbed............................................... 28
TETANUS/DIPHTHERIA TOXOIDS-ADSORBED
ADULT..................................................................... 28
tetracycline hcl ............................................................... 5
THALOMID .................................................................... 8
theochron ..................................................................... 33
theophylline.................................................................. 33
theophylline cr.............................................................. 33
theophylline er ............................................................. 33
THERACYS ................................................................. 28
56
TWINRIX ..................................................................... 28
TYGACIL ....................................................................... 4
TYKERB ........................................................................ 8
TYPHIM VI .................................................................. 28
TYSABRI ....................................................................... 9
TYVASO...................................................................... 33
TYZEKA ........................................................................ 3
TYZINE ....................................................................... 22
TYZINE PEDIATRIC NASAL DROPS ......................... 22
trazodone hcl ............................................................... 15
TREANDA...................................................................... 8
TRECATOR ................................................................... 4
TRELSTAR DEPOT ....................................................... 8
TRELSTAR DEPOT MIXJECT....................................... 8
TRELSTAR LA ............................................................... 8
TRELSTAR LA MIXJECT .............................................. 8
TRELSTAR MIXJECT .................................................... 8
tretinoin .................................................................... 8, 20
tretinoin microsphere ................................................... 20
tretinoin microsphere pump ......................................... 20
trezix ............................................................................ 11
triamcinolone acetonide ......................................... 21, 33
triamcinolone in orabase .............................................. 22
triamterene/hydrochlorothiazide ................................... 18
trianex .......................................................................... 21
triderm.......................................................................... 21
tri-estarylla ................................................................... 30
trifluoperazine hcl......................................................... 15
trifluridine ..................................................................... 31
trihexyphenidyl hcl ......................................................... 9
tri-legest fe ................................................................... 30
tri-linyah ....................................................................... 30
trilyte ............................................................................ 26
trimethobenzamide hcl ................................................. 26
trimethoprim ................................................................... 5
trimethoprim sulfate/polymyxin b sulfate ...................... 31
trimipramine maleate ................................................... 15
trinatal gt ...................................................................... 36
trinatal ultra .................................................................. 36
trinessa ........................................................................ 30
tri-previfem ................................................................... 30
TRISENOX .................................................................... 8
tri-sprintec .................................................................... 30
triveen-duo dha ............................................................ 36
trivora-28...................................................................... 30
TRIZIVIR ........................................................................ 3
TROPHAMINE ............................................................. 35
tropicamide .................................................................. 31
trospium chloride.......................................................... 33
trospium chloride er ..................................................... 33
TRUVADA...................................................................... 3
TUDORZA PRESSAIR ................................................ 33
U
UCERIS ....................................................................... 26
ULORIC....................................................................... 28
unithroid ...................................................................... 25
ursodiol........................................................................ 26
UVADEX ..................................................................... 19
V
VAGIFEM .................................................................... 29
valacyclovir hcl .............................................................. 3
VALCYTE ...................................................................... 3
valproate sodium ........................................................... 9
valproic acid .................................................................. 9
valsartan/hydrochlorothiazide ...................................... 18
VALSTAR ...................................................................... 8
vancomycin hcl .............................................................. 5
vandazole .................................................................... 29
VANTAS ........................................................................ 8
VAQTA ........................................................................ 28
VARIVAX ..................................................................... 28
VARIZIG ...................................................................... 28
VASCEPA ................................................................... 19
VECTIBIX ...................................................................... 8
VELCADE ..................................................................... 8
veletri........................................................................... 18
velivet .......................................................................... 30
vemavite-prx 2 ............................................................. 36
vena-bal dha................................................................ 36
venlafaxine hcl............................................................. 16
venlafaxine hcl er ........................................................ 15
verapamil hcl ............................................................... 18
verapamil hcl er ........................................................... 18
verapamil hcl sr ........................................................... 18
veripred 20 .................................................................. 23
57
VFEND........................................................................... 2
V-GO 20....................................................................... 24
V-GO 30....................................................................... 24
V-GO 40....................................................................... 24
vicodin.......................................................................... 12
vicodin es ..................................................................... 12
vicodin hp..................................................................... 12
VICTRELIS .................................................................... 3
VIDAZA .......................................................................... 8
VIDEX PEDIATRIC ........................................................ 3
VIIBRYD ...................................................................... 16
VIMPAT ......................................................................... 9
vinblastine sulfate .......................................................... 8
vincasar pfs.................................................................... 8
vincristine sulfate ........................................................... 8
vinorelbine tartrate ......................................................... 8
VIOKACE ..................................................................... 26
viorele .......................................................................... 30
VIRACEPT ..................................................................... 3
VIRAMUNE .................................................................... 3
VIRAMUNE XR .............................................................. 3
VIRAZOLE ..................................................................... 3
VIREAD ......................................................................... 3
virt-bal dha plus ........................................................... 36
virt-pn ........................................................................... 36
virt-pn dha .................................................................... 36
virt-select ..................................................................... 36
VISICOL....................................................................... 26
vol-nate ........................................................................ 36
VOLTAREN ................................................................. 12
voriconazole................................................................... 2
VOTRIENT..................................................................... 8
vp-ch-pnv ..................................................................... 36
VPRIV .......................................................................... 25
XENAZINE .................................................................... 9
XERESE...................................................................... 20
XGEVA .......................................................................... 5
XIAFLEX ..................................................................... 22
XIFAXAN ....................................................................... 4
XOLAIR ....................................................................... 33
xolox ............................................................................ 12
XTANDI ......................................................................... 8
XYREM ....................................................................... 16
Y
YERVOY ....................................................................... 8
YF-VAX ....................................................................... 28
Z
zafirlukast .................................................................... 33
zaleplon ....................................................................... 16
ZALTRAP ...................................................................... 8
zamicet ........................................................................ 12
ZANOSAR ..................................................................... 8
zarah ........................................................................... 30
zatean-ch .................................................................... 36
ZAVESCA ................................................................... 25
zazole .......................................................................... 29
ZELBORAF ................................................................... 8
ZEMPLAR ................................................................... 25
zenatane ..................................................................... 20
zenchent...................................................................... 30
zenchent fe .................................................................. 30
ZENPEP ...................................................................... 26
zenzedi ........................................................................ 16
ZETIA .......................................................................... 19
ZIAGEN ......................................................................... 3
zidovudine ..................................................................... 3
zingiber........................................................................ 36
ziprasidone hcl ............................................................ 16
ZIRGAN....................................................................... 31
ZOLADEX ..................................................................... 8
zoledronic acid ...................................................... 22, 25
ZOLINZA ....................................................................... 8
zolmitriptan .................................................................... 9
zolmitriptan odt .............................................................. 9
zolpidem tartrate.......................................................... 16
zolpidem tartrate er ..................................................... 16
W
warfarin sodium ........................................................... 18
WELCHOL ................................................................... 19
wera ............................................................................. 30
wymzya fe .................................................................... 30
X
XALKORI ....................................................................... 8
XARELTO .................................................................... 18
58
zonisamide..................................................................... 9
ZORTRESS ................................................................... 8
ZOSTAVAX.................................................................. 28
zovia 1/35e .................................................................. 30
zovia 1/50e .................................................................. 30
ZOVIRAX ..................................................................... 20
ZYCLARA .................................................................... 19
ZYCLARA PUMP ........................................................ 19
ZYLET ......................................................................... 31
ZYPREXA RELPREVV ............................................... 16
ZYTIGA ......................................................................... 8
ZYVOX .......................................................................... 4
59
Community HealthFirst™ Medicare Advantage Plans
Pharmacy Directory
This booklet provides a list of Community HealthFirst Medicare Advantage Plan’s network pharmacies. All network
pharmacies may not be listed in this directory. Pharmacies may have been added or removed from the list after this
directory was printed. To get current information about Community HealthFirst network pharmacies in your area, please
visit our web site at www.healthfirst.chpw.org or call our Customer Service during the hours of 8:00 a.m. to 8:00 p.m., 7
days a week. Current members should call 1-800-942-0247 and prospective members should call 1-800-944-1247 (TTY
Relay: Dial 7-1-1).
Beneficiaries must use network pharmacies to access their prescription drug benefit, except under non-routine
circumstances. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on
January 1, 2013. Quantity limitations and restrictions may apply.
Community HealthFirst™ Medicare Advantage Plans are offered by Community Health Plan of Washington, which is a
Federally-Qualified HMO with a Medicare contract. Please contact Community HealthFirst at 1-800-944-1247
(TTY Relay: Dial 7-1-1) if you need information in another format or language than what is listed above.
Our Office hours are 8:00 a.m. – 8:00p.m., 7 days a week.
Introduction
This booklet provides a list of Community HealthFirst network pharmacies. To get a complete description of your
prescription coverage, including how to fill your prescriptions, please review the Evidence of Coverage and Community
HealthFirst Formulary. If you have additional questions, please call our Customer Service during the hours of 8:00 a.m.
to 8:00 p.m., 7 days a week. Current members should call 1-800-942-0247 and prospective members should call 1-800944-1247 (TTY Relay: Dial 7-1-1). Or, visit www.healthfirst.chpw.org.
We call the pharmacies in this list our “network pharmacies” because we have made arrangements with them to provide
prescription drugs to Plan members. A network pharmacy is a pharmacy where beneficiaries obtain prescription drug
benefits provided by Community HealthFirst. In most cases, your prescriptions are covered under Community
HealthFirst only if they are filled at a network pharmacy or through our mail-order pharmacy service. Once you go to one,
you are not required to continue going to the same pharmacy to fill your prescription. You can go to any of our network
pharmacies. We will fill prescriptions at non-network pharmacies under certain circumstances as described in your
Evidence of Coverage.
Can the list of network pharmacies change?
Yes, Community HealthFirst may add or remove pharmacies from our pharmacy directory. To get current information
about Community HealthFirst network pharmacies in your area, please visit our web site at www.healthfirst.chpw.org or
call Customer Service.
How do I find a Community HealthFirst network pharmacy in my area?
You can visit our web site at www.healthfirst.chpw.org or call Customer Service during the hours of 8:00 a.m. to 8:00
p.m., 7 days a week. Current members should call 1-800-942-0247 and prospective members should call 1-800-9441247 (TTY Relay: Dial 7-1-1).
How do I fill a prescription at a network pharmacy?
To fill your prescription at a network pharmacy, you must show your Community HealthFirst Member ID card. If you do
not have your ID card with you when you fill your prescription, you may have to pay the full cost of the prescription
(rather than paying just your copay). If this happens, you can ask us to reimburse you for our share of the cost by
59
submitting a claim to us. To find out how to submit a claim, look in your Edivdence of Coverare or call our Customer
Service.
How do I fill a prescription through Community HealthFirst’s mail-order pharmacy service?
To get order forms and information about filling your prescriptions by mail, please call 1-888-823-1968. Please note that
you must use the Community HealthFirst mail-order service. Prescription drugs that you get through any other mail-order
service are not covered.
You can use the Community HealthFirst mail-order service to fill prescriptions for any drug that is on the formulary list.
Our plan’s mail-order service requires you to order at least a 30-day supply of the drug and no more than a 90-day
supply.
You are not required to use mail-order service to obtain an extended supply of maintenance medications. Instead, you
have the option of using a retail pharmacy in our network to obtain a supply of maintenance medications. Some retail
pharmacies may agree to accept the mail-order reimbursement rate for an extended supply of medications for up to 90
days per dispensing, which may result in no out-of-pocket payment difference to you. Other retail pharmacies may not
agree to accept the mail-order reimbursement rate for an extended supply of medication. In this case, you will be
responsible for the difference in price. Please look in the pharmacy directory below for retail pharmacies in our network
at which you can obtain an extended supply of maintenance medications or call our Customer Service for more
information.
After you’ve sent your order, you should receive your prescription within 14 days. If for some reason your order cannot
be delivered within 14 days, a mail-order representative may contact you. For more information about mail-order, visit
Community HealthFirst’s web site at www.healthfirst.chpw.org or call our Customer Service during the hours of 8:00 a.m.
to 8:00 p.m., 7 days a week. Current members should call 1-800-942-0247 and prospective members should call 1-800944-1247 (TTY Relay: Dial 7-1-1).
Filling prescriptions outside the network
Generally, we only cover drugs filled at an out-of-network pharmacy in limited, non-routine circumstances when a
network pharmacy is not available. Below are some circumstances when we would cover prescriptions filled at an out-ofnetwork pharmacy. Before you fill your prescription in these situations, call Customer Service to see if there is a
network pharmacy in your area where you can fill your prescription. If you must use an out-of-network pharmacy,
you will generally have to pay the full cost (rather than your normal share of the cost) when you fill your prescription. You
can ask us to reimburse you for our share of the cost by submitting a claim form. You should submit a claim to us if you
fill a prescription at an out-of-network pharmacy as any amount you pay will help you qualify for catastrophic coverage.
To learn how to submit a paper claim, please refer to the paper claims process described next.
You will be allowed a total of three fills at an out-of-network pharmacy within a plan year. If you fill a prescription out-ofnetwork, you will receive a message on your monthly Explanation of Benefits (EOB) that will state “Non-network
pharmacy.” If you request a fourth fill at an out-of-network pharmacy, your request for coverage will be denied. If you feel
that the out-of-network claim should have been covered, contact our Customer Service during the hours of 8:00 a.m. to
8:00 p.m., 7 days a week. Current members should call 1-800-942-0247 and prospective members should call 1-800944-1247 (TTY Relay: Dial 7-1-1).
How do I submit a paper claim?
When you go to a network pharmacy, your claim is automatically submitted to us by the pharmacy. However, if you go to
an out-of-network pharmacy the pharmacy may not be able to submit the claim directly to us. When that happens, you
will have to pay the full cost of your prescription.
60
To submit a paper claim, you must send a copy of the receipt for the prescription drugs from the pharmacy where you bought
them and a completed Prescription Drug Claim Form. Please send the completed Prescription Drug Claim Form and the
receipts to the following address:
Express Scripts
Attn: Med D Accts.
PO Box 2858
Clinton, IA 52733-2858
If you do not have a Prescription Drug Claim Form visit our web site at www.healthfirst.chpw.org or call Customer
Service.
Community HealthFirst Retail Pharmacies Offering Extended Supplies of Medications
You are not required to use mail-order service to obtain an extended supply of maintenance medications. Instead, you
have the option of using a retail pharmacy in our network to obtain an extended supply of maintenance medications.
Some retail pharmacies may agree to accept the mail-order reimbursement rate for an extended supply of medications
for up to 90 days per dispensing, which may result in no out-of-pocket payment difference to you. Other retail
pharmacies may not agree to accept the mail-order reimbursement rate for an extended supply of medication. In this
case, you will be responsible for the difference in price. In the pharmacy directory below, you will find identified those
retail pharmacies in our network that offer extended supplies of maintenance medications.
For more information
For more detailed information about your Community HealthFirst prescription drug coverage, please review the Evidence
of Coverage and Community HealthFirst’s formulary.
If you have questions about Community HealthFirst, please visit our web site at www.healthfirst.chpw.org or call
Customer Service during the hours of 8:00 a.m. to 8:00 p.m., 7 days a week. Current members should call 1-800-9420247 and prospective members should call 1-800-944-1247 (TTY Relay: Dial 7-1-1).
Pharmacy Listing Table of Contents
Retail Pharmacies………………………………………………....page 69
Mail-Order Pharmacies………………………………………….page 120
Home Infusion Pharmacies……………………………………..page 121
Long Term Care Pharmacies…………………………………...page 123
Indian Health Service / Tribal / Urban Indian
Health Program Pharmacies……………………………………page 128
61
Directorio de Farmacias de los Planes Medicare Advantage de Community
HealthFirst™
Este folleto proporciona una lista de farmacias de la red del Plan Medicare Advantage de Community HealthFirst. Es posible
que no todas las farmacias de la red estén listadas en este directorio. Se podría haber agregado o retirado farmacias de la
lista después de que se imprimió este directorio. Para obtener la información actualizada acerca de las farmacias de la red de
Community HealthFirst en su área, por favor visite nuestro sitio Web en www.healthfirst.chpw.org o llame a nuestro
Departamento de Servicio al Cliente al 1-800-942-0247, de 8:00 a.m. a 8:00 p.m., los 7 días de la semana. Miembros actuales
deben llamar al 1-800-942-0247 y los miembros futuros deben llamar al 1-800-944-124. (Los usuarios con TTY deben marcar
711).
Los beneficiarios deben utilizar farmacias de la red para tener acceso a su beneficio de medicamentos con receta médica,
excepto en circunstancias fuera de la rutina. Los beneficios, el formulario, la red de farmacias, las primas y los copagos o
coaseguros pueden cambiar el 1 de enero de 2013. Podrían aplicar límites en cantidades y restricciones.
Los planes de Medicare Advantage de Community HealthFirst™ los ofrece Community Health Plan of Washington,
que es una HMO calificada federalmente con un contrato de Medicare. Si necesita recibir la información en otro formato o
idioma llame a Community HealthFirst al 1-800-944-1247 (TTY Relay: marque 7-1-1). Elhorario de la oficina es de
08:00 a.m. – 8:00 p.m., los 7 días de la semana.
Introducción
Este folleto proporciona una lista de las farmacias que están en la red de Community HealthFirst. Para obtener una
descripción completa de su cobertura de recetas, incluyendo cómo abastecer sus recetas, por favor revise la Evidencia de
Cobertura y el Formulario de Community HealthFirst. Si tiene preguntas adicionales, por favor llame a Servicio al Cliente, de
8:00 a.m. a 8:00 p.m., los 7 días de la semana. Miembros actuales deben llamar al 1-800-942-0247 y los miembros futuros
deben llamar al 1-800-944-1247. (Los usuarios con TTY deben marcar 711) o visite nuestro sitio Web en
www.healthfirst.chpw.org.
Denominamos las farmacias en esta lista nuestras “farmacias de la red” debido a que hemos hecho arreglos con ellos para
proporcionar medicamentos de receta a los miembros del plan. Una farmacia de la red es una farmacia donde los
beneficiarios obtienen los beneficios de medicamentos de receta proporcionados por Community HealthFirst. En la mayoría
de los casos, sus recetas están cubiertas bajo Community HealthFirst solamente si se las abastece en una farmacia de la red
o a través de nuestro servicio de farmacia por correo. Una vez que usted vaya a una farmacia, no se le exige que siga yendo
a la misma farmacia para abastecer su receta, puede ir a cualquiera de las farmacias de nuestra red. Abasteceremos recetas
en farmacias que no son de la red bajo ciertas circunstancias, como se describe en su Evidencia de Cobertura.
¿Puede cambiar la lista de farmacias de la red?
Sí, Community HealthFirst podría agregar o retirar farmacias de nuestro directorio de farmacias. Para obtener información
actualizada acerca de las farmacias de la red de Community HealthFirst en su área, por favor visite nuestro sitio Web en
www.healthfirst.chpw.org o llame a Servicio al Cliente.
¿Cómo encuentro una farmacia de la red de Community HealthFirst en mi área?
Puede visitar nuestro sitio Web en www.healthfirst.chpw.org o llamar al Servicio al Cliente durante las horas de 8:00 a.m. a
8:00 p.m., los 7 días de la semana. Los miembros actuales deben llamar al 1-800-942-0247, los miembros futuros deben
llamar al 1-800-944-1247 (Los usuarios de TTY deben marcar 711).
62
¿Cómo abastezco una receta en una farmacia de la red?
Para abastecer su receta en una farmacia de la red, tiene que mostrar su tarjeta de identificación de Miembro de Community
HealthFirst. Si no tiene su tarjeta de identificación con usted cuando abastezca su receta, podría tener que pagar el costo total
de la receta (en lugar de pagar simplemente su copago). Si esto ocurre, puede pedirnos que le reembolsemos nuestra
porción del costo presentándonos un reclamo. Para averiguar cómo presentar un reclamo, consulte su Evidencia de
Cobertura o llame a nuestro Servicio al Cliente.
¿Cómo abastezco una receta a través del servicio de farmacia por correo de Community HealthFirst?
Para obtener los formularios de pedidos e información acerca de abastecer sus recetas por correo, por favor llame al 1-888823-1968. Por favor tome nota que usted tiene que usar el servicio de compras por correo de Community HealthFirst. Los
medicamentos con receta que usted obtenga a través de cualquier otro servicio de compras por correo no están cubiertos.
Usted puede usar el servicio de compras por correo de Community HealthFirst para abastecer las recetas para cualquier
medicamento que esté en la lista del formulario. El servicio de compras por correo de nuestro plan requiere que usted pida al
menos un suministro para 30 días de medicamento y no más de 90 días.
No se le exige que use los servicios de compra por correo de medicamentos con receta para obtener un suministro más
amplio de medicamentos de mantenimiento. En lugar de eso, usted tiene la opción de usar una farmacia minorista en nuestra
red para obtener un suministro de medicamentos de mantenimiento. Algunas farmacias minoristas podrían estar de acuerdo
en aceptar la tarifa de reembolso de compras por correo para un suministro más amplio de medicamentos para hasta 90 días
por entrega, lo cual podría dar lugar a que usted no pague ninguna diferencia de desembolso. Otras farmacias minoristas
podrían no estar de acuerdo en aceptar la tarifa de reembolso de compras por correo para un suministro más amplio de un
medicamento. En este caso, usted será responsable por la diferencia en el precio. Por favor consulte el directorio de
farmacias a continuación, para las farmacias minoristas en nuestra red en las cuales puede obtener un suministro más amplio
de medicamentos de mantenimiento o llame a Servicio al Cliente para mayor información.
Después de que haya enviado su orden, usted debería recibir su receta en el transcurso de 14 días. Si por alguna razón no
se puede entregar su orden en el transcurso de 14 días, un representante de compras por correo podría ponerse en contacto
con usted. Para mayor información sobre compras por correo, visite el sitio Web de Community HealthFirst en
www.healthfirst.chpw.org o llame a Servicio al Cliente durante las horas de 8 a.m. a 8 p.m., los 7 días de la semana. Los
miembros actuales deben llamar al 1-800-942-0247, los miembros futuros deben llamar al 1-800-944-1247, (Los usuarios con
TTY deben marcar 711).
Abastecer recetas fuera de la red
Generalmente, solamente cubrimos los medicamentos abastecidos en una farmacia fuera de la red en circunstancias
limitadas que no son de rutina cuando no se encuentra disponible una farmacia de la red. A continuación hay algunas
circunstancias en las que cubriríamos recetas abastecidas en una farmacia fuera de la red. Antes de abastecer su receta en
estas situaciones, llame a Servicio al Cliente para ver si existe una farmacia de la red en su área donde usted pueda
abastecer su receta. Si tiene que usar una farmacia fuera de la red, generalmente tendrá que pagar el costo total (en lugar
de pagar su porción normal del costo) cuando abastezca su receta. Puede pedirnos que le reembolsemos nuestra porción del
costo presentando un formulario de reclamo. Debe presentarnos un reclamo si abastece una receta en una farmacia fuera de
la red, ya que cualquier monto que pague, le ayudará a calificar para cobertura contra catástrofes. Para informarse acerca de
cómo presentar un documento de reclamo, por favor refiérase al proceso de reclamos impresos que se describe a
continuación.
63
Usted solamente puede abastecer un total de tres suministros en una farmacia fuera de la red por año del plan. Si abastece
una receta fuera de la red, recibirá un mensaje en su Explicación de Beneficios (EOB) mensual que indicará "farmacia fuera
de la red". Si solicita que le surtan una cuarta receta en una farmacia fuera de la red, su solicitud de cobertura podría ser
denegada. Si cree que un reclamo fuera de la red debería haber sido cubierto, llame a Servicio al Cliente durante las horas
de 8 a.m. a 8 p.m., los 7 días de la semana. Los miembros actuales deben llamar al 1-800-942-0247, los miembros futuros
deben llamar al 1-800-944-1247, (Los usuarios con TTY deben marcar 711).
¿Cómo presento un reclamo por escrito?
Cuando vaya a una farmacia de la red, su reclamo es presentado a nosotros automáticamente por la farmacia. Sin embargo,
si va a una farmacia fuera de la red, es posible que la farmacia no pueda presentarnos el reclamo directamente. Cuando esto
ocurra, usted tendrá que pagar el costo total de su receta.
Para presentar un reclamo por escrito, tiene que enviar una copia del recibo por los medicamentos con receta de la farmacia
donde los compró y un Formulario de Reclamo de Medicamentos con Receta, debidamente llenado. Por favor envíe el
Formulario de Reclamo de Medicamentos con Receta debidamente llenado y los recibos a la siguiente dirección:
Express Scripts
Attn: Med D Accts.
P.O. Box 2858
Clinton, IA 52733-2858
Si usted no tiene un Formulario de Reclamo de Medicamentos con Receta, por favor visite nuestro sitio web
www.healthfirst.chpw.org o llame a Servicio al Cliente.
Farmacias minoristas de Community HealthFirst que ofrecen suministros de medicamentos más amplios
No se le exige que use los servicios de compras por correo de medicamentos con receta para obtener un suministro más
amplio de medicamentos de mantenimiento. En lugar de eso, usted tiene la opción de obtener un suministro más amplio de
medicamentos de mantenimiento en alguna farmacia minorista de nuestra red. Algunas farmacias minoristas podrían estar de
acuerdo en aceptar la tarifa de reembolso de compras por correo para un suministro más amplio de medicamentos, de hasta
90 días por abastecimiento, lo cual podría dar lugar a que usted no pague ninguna diferencia de desembolso directo. Otras
farmacias minoristas que ofrecen podrían no estar de acuerdo en aceptar la tarifa de reembolso de compras por correo para
un suministro más amplio de un medicamento. En este caso, usted será responsable por la diferencia en el precio. En el
directorio de farmacias a continuación, usted encontrará identificadas aquellas farmacias minoristas en nuestra red que
ofrecen un suministro más amplio de medicamentos de mantenimiento.
Para mayor información
Para información más detallada acerca de su cobertura de medicamentos con receta de Community HealthFirst, por favor
consulte la Evidencia de Cobertura y el formulario de Community HealthFirst.
Si tiene preguntas acerca de Community HealthFirst, por favor visite nuestro sitio Web en www.healthfirst.chpw.org o llame a
Servicio al Cliente durante las horas de 8 a.m. a 8 p.m., los 7 días de la semana. Los miembros actuales deben llamar al 1800-942-0247, los miembros futuros deben llamar al 1-800-944-1247, (Los usuarios con TTY deben marcar 711).
64
Índice de la lista de farmacias
Farmacias minoristas ............................................................................. página 69
Farmacias de venta por correo............................................................ página 120
Farmacias de infusión en el hogar ...................................................... página 121
Farmacias de atención a largo plazo .................................................. página 123
Farmacias del programa de salud del Servicio de Salud
para Indígenas / Tribus / Indígenas Urbanos ..................................... página 128
65
Table of Contents: County and City
Longview
Woodland
Adams County
Othello
Ritzville
64
64
70
70
Douglas County
Bridgeport
East Wenatchee
Weatchee
Wenatchee
70
70
70
70
Asotin County
Clarkston
64
Benton County
Benton City
Kennewick
Prosser
Richland
West Richmond
64
64
65
65
65
Ferry County
Republic
71
Franklin County
Connell
Pasco
71
71
Chelan County
Cashmere
Chelan
Leavenworth
Wenatchee
65
66
66
66
Garfield County
Pomeroy
71
71
71
71
71
Jefferson County
Port Hadlock
Port Townsend
73
73
King County
Auburn
Bellevue
Bellvue
73
74
75
Bothell
Burien
Covington
Des Moines
Duvall
Enumclaw
Federal Way
75
75
75
76
76
76
76
Issaquah
Kenmore
Kent
Kirkland
Maple Valley
Mercer Island
Newcastle
Normandy Park
77
77
77
78
79
79
79
79
North Bend
Redmond
Renton
Sammamish
Seatac
Seattle
Shoreline
79
79
80
81
81
81
86
Snoqualmie
Tukwila
Vashon
Woodinville
87
87
87
87
Clallam County
Forks
Port Angeles
66
66
Grant County
Ephrata
Grand Coulee
Mattawa
Moses Lake
Sequim
67
Quincy
72
Clark County
Battle Ground
Camas
Orchards
Vancouver
67
67
67
67
Grays Harbor County
Aberdeen
Elma
Hoquiam
Montesano
72
72
72
72
Washougal
69
Ocean Shores
Westport
72
72
Columbia County
Dayton
69
72
73
73
Kitsap County
Bainbridge Island
87
73
73
Bremerton
Kingston
87
88
Cowlitz County
Castle Rock
69
Island County
Camano Island
Clinton
Coupeville
Kalama
Kelso
69
70
Freeland
Oak Harbor
61
Port Orchard
Poulsbo
Silverdale
88
88
89
Kittitas County
Cle Elum
Ellensburg
89
89
Klickitat County
White Salmon
89
Lewis County
Centralia
Chehalis
Morton
Winlock
Lincoln County
Davenport
Odessa
Mason County
Belfair
Shelton
Okanogan County
Brewster
Okanogan
Omak
Tonasket
Twisp
Pacific County
Ilwaco
Long Beach
Ocean Park
Raymond
South Bend
Pend Oreille County
Newport
89
89
90
90
90
90
90
90
90
91
91
91
91
91
91
91
91
91
91
Pierce County
Auburn
91
Edmonds
Everett
Granite Falls
99
99
101
Bonney Lake
Buckley
Dupont
Eatonville
Edgewood
Firecrest
Gig Harbor
91
92
92
92
92
92
92
Lake Stevens
Lynnwood
Marysville
Mill Creek
Monroe
Mountlake Terrace
Mukilteo
101
101
102
102
102
103
103
Graham
Lakewood
Milton
Orting
Puyallup
Spanaway
Sumner
92
92
93
93
93
94
94
Snohomish
Stanwood
Sultan
Tulalip
Woodinville
103
103
103
103
103
Tacoma
University Place
94
96
San Juan County
Eastsound
Friday Harbor
Lopez Island
97
97
97
Spokane County
Airway Heights
Cheney
Deer Park
Fairfield
Liberty Lake
Mead
Medical Lake
Millwood
103
103
104
104
104
104
104
104
Spokane
Spokane Valley
Veradale
104
107
107
Stevens County
Chewelah
Colville
108
108
Skagit County
Anacortes
Burlington
Concrete
La Conner
Mount Vernon
Sedro Woolley
97
97
97
97
97
98
Serdo Woolley
98
Kettle Falls
Nine Mile Falls
108
108
Skamania County
Stevenson
98
108
109
109
109
109
Snohomish County
Arlington
98
Thurston County
Lacey
Olympia
Tenino
Bothell
Darrington
98
99
Tumwater
Yelm
62
Wahkiakum County
Cathlamet
110
Walla Walla County
College Place
Walla Walla
110
110
Whatcom County
Bellingham
110
Blaine
Everson
Ferndale
Lynden
Sumas
111
111
111
111
111
Whitman County
Colfax
Garfield
Pullman
Saint John
Tekoa
111
111
111
112
112
Yakima County
Grandview
112
Selah
Sunnyside
Toppenish
Union Gap
Yakima
112
112
112
112
113
63
Pharmacies noted with the
"▼" symbol offer a 90 day
supply.
Retail Pharmacies
ADAMS COUNTY
Othello
Chas-wasem▼
800 6th St
Clarkston, WA 99403
(509)758-2565
Clarkston Heights
Pharmacy
2119 5th Ave
Clarkston, WA 99403
(509)758-3376
Othello Family Clinic
Pharmacy
140 E Main St
Othello, WA 99344
(509)488-5256
Costco▼
301 Fifth St
Clarkston, WA 99403
(509)758-8897
Wal-mart▼
1860 E Main St
Othello, WA 99344
(509)488-9324
Owl Tri-state Pharmacy▼
1275 Highland Ave
Clarkston, WA 99403
(509)758-5533
Wal-mart▼
1860 E Main St
Othello, WA 99344
(509)488-9324
Ritzville
Ritzville Drug
209 W Main Ave
Ritzville, WA 99169
(509)659-0250
ASOTIN COUNTY
Wal-mart▼
306 5th St
Clarkston, WA 99403
(509)758-6660
Wal-mart▼
306 5th St
Clarkston, WA 99403
(509)758-6660
Wasem's Drug▼
800 6th St
Clarkston, WA 99403
(509)758-2565
Clarkston
BENTON COUNTY
Albertson's▼
400 Bridge St
Clarkston, WA 99403
(509)758-7475
Benton City
Bi-mart Pharmacy▼
511 3rd St
Clarkston, WA 99403
(509)758-8230
Logar Pharmacy▼
515 9th St Ste A
Benton City, WA 99320
(509)588-8600
64
Kennewick
Albertson's▼
5204 W Clearwater Ave
Kennewick, WA 99336
(509)735-8311
Columbia Basin
Hematology▼
7360 W Deschutes Ave
Kennewick, WA 99336
(509)783-0144
Cork's
821 S Auburn St
Kennewick, WA 99336
(509)586-3128
Costco▼
8505 W Gage Blvd
Kennewick, WA 99336
(509)737-8877
Fred Meyer Pharmacy▼
2811 W 10th Ave
Kennewick, WA 99336
(509)735-8733
Medical Mall Pharmacy▼
521 N Young St
Kennewick, WA 99336
(509)585-5250
Rite Aid▼
101 N Ely St
Kennewick, WA 99336
(509)783-1438
Rite Aid▼
1901 N Steptoe St
Kennewick, WA 99336
(509)783-3413
Safeway Pharmacy▼
W 2825 Kennewick Ave
Kennewick, WA 99336
(509)783-2622
Shopko Pharmacy▼
867 N Columbia Center
Blvd
Kennewick, WA 99336
(509)736-0505
Target Pharmacy▼
1160 N Columbia Center
Blvd
Kennewick, WA 99336
(509)737-1700
Walgreens▼
2800 W Clearwater Ave
Kennewick, WA 99336
(509)783-5412
Walgreens▼
4000 W 27th Ave
Kennewick, WA 99337
(509)582-7781
Wal-mart▼
2720 S Quillan St
Kennewick, WA 99337
(509)586-1574
Wal-mart▼
2720 S Quillan St
Kennewick, WA 99337
(509)586-1574
Yokes Pharmacy▼
1410 W 27th Ave
Kennewick, WA 99337
(509)585-0846
Prosser
Elfers-lyon Pharmacy▼
820 Memorial St Ste 2
Prosser, WA 99350
(509)786-3200
Richland
Albertson's▼
1320 Lee Blvd
Richland, WA 99352
(509)946-0656
Albertson's▼
690 Gage Blvd
Richland, WA 99352
(509)627-5133
Densow's Pharmacy▼
1011 Wright Ave
Richland, WA 99354
(509)943-1164
Fred Meyer Pharmacy▼
101 Wellsian Way
Richland, WA 99352
(509)943-8358
Malleys Compounding
Pharmacy▼
1906 George Washington
Way
Richland, WA 99354
(509)943-9173
Rite Aid▼
1268 Lee Blvd
Richland, WA 99352
(509)946-4684
Rite Aid▼
1549 George Washington
Way
Richland, WA 99352
(509)946-5770
Safeway Pharmacy▼
1803 George Washington
Way
Richland, WA 99352
(509)946-1157
65
Target Pharmacy▼
2941 Queensgate Dr
Richland, WA 99352
(509)627-7500
Walgreens▼
1601 George Washington
Way
Richland, WA 99354
(509)943-2605
Walgreens▼
585 Gage Blvd
Richland, WA 99352
(509)628-3629
Walgreens▼
800 Swift Blvd Ste 160
Richland, WA 99352
(509)943-9121
Wal-mart▼
2801 Duportail St
Richland, WA 99352
(509)628-1370
Wal-mart▼
2801 Duportail St
Richland, WA 99352
(509)628-1370
West Richmond
Yokes Pharmacy▼
1401 Bombing Range Rd
West Richmond, WA 99353
(509)967-8008
CHELAN COUNTY
Cashmere
Doane's Valley Pharmacy▼
119 Cottage Ave
Cashmere, WA 98815
(509)782-2717
Chelan
Lake Chelan Pharmacy
223 E Johnson Ave
Chelan, WA 98816
(509)682-2751
Safeway Pharmacy▼
106 W Manson Rd
Chelan, WA 98816
(509)682-4087
Wal-mart▼
108 Apple Blossom Dr
Chelan, WA 98816
(509)682-4634
Wal-mart▼
108 Apple Blossom Dr
Chelan, WA 98816
(509)682-4634
Leavenworth
Safeway Pharmacy▼
116 Riverbend Dr
Leavenworth, WA 98826
(509)548-5811
Village Pharmacy▼
815 Front St
Leavenworth, WA 98826
(509)548-7622
Wenatchee
Albertson's▼
1128 N Miller St
Wenatchee, WA 98801
(509)662-2942
Columbia Valley Comm H
Phcy▼
600 Orondo Ave Ste 1
Wenatchee, WA 98801
(509)664-3508
Rite Aid▼
1380 N Miller St
Wenatchee, WA 98801
(509)663-7805
Safeway Pharmacy▼
501 N Miller St
Wenatchee, WA 98801
(509)663-5575
Shopko Pharmacy▼
1340 N Wenatchee Ave
Wenatchee, WA 98801
(509)664-5111
Walgreens▼
1050 N Miller St
Wenatchee, WA 98801
(509)665-7539
Wal-mart▼
2000 N Wenatchee Ave
Wenatchee, WA 98801
(509)664-3698
Wal-mart▼
2000 N Wenatchee Ave
Wenatchee, WA 98801
(509)664-3698
Wenatchee Clinic
Pharmacy▼
820 N Chelan Ave
Wenatchee, WA 98801
(509)662-5801
Central Washington Hosp
Phcy▼
933 Red Apple Rd Ste A
Wenatchee, WA 98801
(509)667-3333
CLALLAM COUNTY
Forks
Chinook Pharmacy
11 S Forks Ave
Forks, WA 98331
(360)374-2294
Port Angeles
Albertson's▼
114 E Lauridsen Blvd
Port Angeles, WA 98362
(360)452-4410
Jim's Pharmacy▼
424 2nd St E
Port Angeles, WA 98362
(360)452-4200
Rite Aid▼
1940 E 1st St Ste 110
Port Angeles, WA 98362
(360)457-3456
Rite Aid▼
621 S Lincoln St
Port Angeles, WA 98362
(360)452-9784
Safeway Pharmacy▼
110 E 3rd St
Port Angeles, WA 98362
(360)457-0599
Safeway Pharmacy▼
2709 E Highway 101
Port Angeles, WA 98362
(360)457-7865
Walgreens▼
932 E Front St
Port Angeles, WA 98362
(360)457-4456
66
Wal-mart▼
3411 E Kolonels Way
Port Angeles, WA 98362
(360)452-3105
CLARK COUNTY
Vancouver
Battle Ground
Wal-mart▼
3411 E Kolonels Way
Port Angeles, WA 98362
(360)452-3105
Albertson's▼
2108 W Main St
Battle Ground, WA 98604
(360)687-4092
Albertson's▼
14300 Ne 20th Ave
Vancouver, WA 98686
(360)576-4844
Sequim
Fred Meyer Pharmacy▼
401 Nw 12th Ave
Battle Ground, WA 98604
(360)666-5133
Costco▼
955 W Washington St
Sequim, WA 98382
(360)406-2032
Qfc Pharmacy▼
990 E Washington St Bldg B
Sequim, WA 98382
(360)683-1156
Rite Aid▼
680 W Washington St Bldg C
Sequim, WA 98382
(360)681-0129
Safeway Pharmacy▼
680 W Washington St Bldg F
Sequim, WA 98382
(360)681-2120
Walgreens▼
490 W Washington St
Sequim, WA 98382
(360)681-2018
Wal-mart▼
1110 W Washington St
Sequim, WA 98382
(360)683-9453
Wal-mart▼
1110 W Washington St
Sequim, WA 98382
(360)683-9453
Safeway Pharmacy▼
904 W Main St
Battle Ground, WA 98604
(360)723-9046
Walgreens▼
808 W Main St Ste 101
Battle Ground, WA 98604
(360)687-5136
Camas
Costco▼
19610 Se 1st St
Camas, WA 98607
(360)258-6230
Safeway Pharmacy▼
800 Ne 3rd Ave
Camas, WA 98607
(360)834-6550
Walgreens▼
3328 Ne 3rd Ave
Camas, WA 98607
(360)835-3303
Orchards
Bi-mart Pharmacy▼
11912 4th Plain Blvd Ne
Orchards, WA 98662
(360)944-8368
67
Albertson's▼
5000 E Fourth Plain Blvd
Vancouver, WA 98661
(360)693-5030
Albertson's▼
8300 Ne 137th Ave Ste A
Vancouver, WA 98682
(360)883-1865
Bi-mart Pharmacy▼
2601 Falk Rd
Vancouver, WA 98668
(360)695-7578
Costco▼
6720 Ne 84th St
Vancouver, WA 98665
(360)828-2289
Family Wellness Center
Pc▼
1000 Se Tech Ctr Dr Ste 120
Vancouver, WA 98683
(360)260-2773
Fred Meyer Pharmacy▼
11325 Se Mill Plain Blvd
Vancouver, WA 98664
(360)256-4406
Fred Meyer Pharmacy▼
16600 Se Mcgillivray Blvd
Vancouver, WA 98683
(360)260-3333
Fred Meyer Pharmacy▼
2500 Columbia House Blvd
Vancouver, WA 98661
(360)619-1733
Fred Meyer Pharmacy▼
7411 Ne 117th Ave
Vancouver, WA 98662
(360)896-3533
Qfc Pharmacy▼
3505 Se 192nd Ave
Vancouver, WA 98683
(360)253-3043
Safeway Pharmacy▼
6700 Ne 162nd Ave
Vancouver, WA 98682
(360)944-2686
Fred Meyer Pharmacy▼
7700 Ne Highway 99
Vancouver, WA 98665
(360)699-8133
Rite Aid▼
13511 Se 3rd Way
Vancouver, WA 98684
(360)885-0839
Safeway Pharmacy▼
6701 E Mill Plain Blvd
Vancouver, WA 98661
(360)992-5726
Fred Meyer Pharmacy▼
800 Ne Tenney Rd
Vancouver, WA 98685
(360)571-2573
Rite Aid▼
2800 Ne 162nd Ave
Vancouver, WA 98682
(360)253-5613
Safeway Pharmacy▼
6711 Ne 63rd St
Vancouver, WA 98661
(360)992-5686
Hi-school Pharmacy
6926 Ne Fourth Plain Blvd
Vancouver, WA 98661
(360)693-8374
Safeway Pharmacy▼
11696 Ne 76th St
Vancouver, WA 98662
(360)944-2665
Target Pharmacy▼
16200 Se Mill Plain Blvd
Vancouver, WA 98684
(360)449-6425
Legacy Salmon Creek
Apothecary
2121 Ne 139th St Ste 310
Vancouver, WA 98686
(360)487-3700
Safeway Pharmacy▼
13023 Ne Highway 99
Vancouver, WA 98686
(360)566-7986
Target Pharmacy▼
8801 Ne Hazel Dell Ave
Vancouver, WA 98665
(360)713-0005
Safeway Pharmacy▼
13719 Se Mill Plain Blvd
Vancouver, WA 98684
(360)891-4254
The Vancouver Clinic▼
501 Se 172nd Ave
Vancouver, WA 98684
(360)397-3602
Safeway Pharmacy▼
2615 Ne 112th Ave
Vancouver, WA 98684
(360)449-5205
The Vancouver Clinic
Phcy▼
2525 Ne 139th St
Vancouver, WA 98686
(360)397-3880
Mill Plain Medical And
Phcy▼
8614 E Mill Plain Blvd
Vancouver, WA 98664
(360)253-8993
Olympic Drug▼
13898 Ne 28th St
Vancouver, WA 98682
(360)896-8932
Phsw Pharmacy At Medical
Ctr▼
420 Ne Mother Joseph Pl
Vancouver, WA 98664
(360)514-2294
Phsw Pharmacy At
Memorial▼
100 E 33rd St Ste 101
Vancouver, WA 98663
(360)514-1290
Safeway Pharmacy▼
3707 Main St
Vancouver, WA 98663
(360)993-8604
Safeway Pharmacy▼
408 Ne 81st St
Vancouver, WA 98665
(360)574-8824
68
Vancouver Clinic
Pharmacy▼
700 Ne 87th Ave
Vancouver, WA 98664
(360)397-3314
Walgreens▼
13009 Ne Highway 99
Vancouver, WA 98686
(360)574-0914
Walgreens▼
13503 Se Mill Plain Blvd
Vancouver, WA 98684
(360)256-9875
Walgreens▼
9812 Ne Highway 99
Vancouver, WA 98665
(360)576-4902
Walgreens▼
1900 Ne 162nd Ave Bldg C
Vancouver, WA 98684
(360)891-1809
Wal-mart▼
221e Ne 104th Ave
Vancouver, WA 98664
(360)885-0126
Walgreens▼
1905 Se 164th Ave
Vancouver, WA 98683
(360)885-2938
Walgreens▼
2521 Main St
Vancouver, WA 98660
(360)693-2524
Walgreens▼
2903 Ne Anderson Rd
Vancouver, WA 98661
(360)256-1503
Wal-mart▼
221e Ne 104th Ave
Vancouver, WA 98664
(360)885-0126
Wal-mart▼
430 Se 192nd Ave
Vancouver, WA 98683
(360)256-6361
Wal-mart▼
430 Se 192nd Ave
Vancouver, WA 98683
(360)256-6361
Walgreens▼
6105 Ne 114th Ave
Vancouver, WA 98662
(360)254-3848
Wal-mart▼
7809 Ne Vancouver Plaza
Dr
Vancouver, WA 98662
(360)253-4038
Walgreens▼
6708 Ne 63rd St
Vancouver, WA 98661
(360)696-0759
Wal-mart▼
7809 Ne Vancouver Plaza
Dr
Vancouver, WA 98662
(360)253-4038
Walgreens▼
8511 Ne 162nd Ave
Vancouver, WA 98682
(360)597-0123
Wal-mart▼
9000 Ne Highway 99
Vancouver, WA 98665
(360)571-2207
Walgreens▼
9714 E Mill Plain Blvd
Vancouver, WA 98664
(360)253-7254
Wal-mart▼
9000 Ne Highway 99
Vancouver, WA 98665
(360)571-2207
69
Washougal
Bi-mart Pharmacy▼
3003 Addy St
Washougal, WA 98671
(360)835-0681
Rite Aid▼
3307 Evergreen Blvd Ste 4
Washougal, WA 98671
(360)335-9255
Safeway Pharmacy▼
3307 Evergreen Way Ste 5
Washougal, WA 98671
(360)335-2006
COLUMBIA COUNTY
Dayton
Elk Drug
176 E Main St
Dayton, WA 99328
(509)382-2536
COWLITZ COUNTY
Castle Rock
Castle Rock Pharmacy
117 1st Ave Sw
Castle Rock, WA 98611
(360)274-8211
Kalama
Godfreys Pharmacy
270 1st St Ne
Kalama, WA 98625
(360)673-2600
Kelso
L J's Furness Drug
114 S Pacific Ave
Kelso, WA 98626
(360)425-3280
Rite Aid▼
230 Kelso Dr
Kelso, WA 98626
(360)577-2693
Safeway Pharmacy▼
411 Three Rivers Dr
Kelso, WA 98626
(360)636-5430
Target Pharmacy▼
205 Three Rivers Dr
Kelso, WA 98626
(360)578-7387
Longview
Fred Meyer Pharmacy▼
3184 Ocean Beach Way
Longview, WA 98632
(360)425-6222
Peacehealth St John Med
Ctr▼
1615 Delaware St
Longview, WA 98632
(360)414-7451
Rite Aid▼
364 Triangle Shopping Ctr
Longview, WA 98632
(360)423-4833
Safeway Pharmacy▼
1227 15th Ave
Longview, WA 98632
(360)575-6606
Safeway Pharmacy▼
2930 Ocean Beach Hwy
Longview, WA 98632
(360)575-6246
Wal-mart▼
1486 Dike Access Rd
Woodland, WA 98674
(360)841-9138
Walgreens▼
2939 Ocean Beach Hwy
Longview, WA 98632
(360)232-1021
DOUGLAS COUNTY
Wal-mart▼
3715 Ocean Beach Hwy
Longview, WA 98632
(360)425-2843
Wal-mart▼
3715 Ocean Beach Hwy
Longview, WA 98632
(360)425-2843
Wal-mart▼
540 7th Ave
Longview, WA 98632
(360)414-9602
Wal-mart▼
540 7th Ave
Longview, WA 98632
(360)414-9602
Woodland
Hi-school Pharmacy▼
1365 Lewis River Rd
Woodland, WA 98674
(360)225-9475
Safeway Pharmacy▼
1725 Pacific Ave
Woodland, WA 98674
(360)225-4375
Bridgeport
Gross Drug
2520 Foster Creek Ave
Bridgeport, WA 98813
(509)686-5191
East Wenatchee
Bi-mart Pharmacy▼
780 Grant Rd
East Wenatchee, WA 98802
(509)884-4022
E Wenatchee Food
Pavilion▼
315 Valley Mall Pkwy
East Wenatchee, WA 98802
(509)884-5625
Safeway Pharmacy▼
510 Grant Rd
East Wenatchee, WA 98802
(509)884-0678
Weatchee
Walgreens▼
470 Grant Rd
Weatchee, WA 98802
(509)886-7047
Wenatchee
Wal-mart▼
1486 Dike Access Rd
Woodland, WA 98674
(360)841-9138
70
Costco▼
375 Highline Dr S
Wenatchee, WA 98802
(509)886-0754
Fred Meyer Pharmacy▼
11 Grant Blvd
Wenatchee, WA 98802
(509)881-2833
Tcch Pharmacy▼
515 W Court St
Pasco, WA 99301
(509)547-2204
FERRY COUNTY
Walgreens▼
1200 N 14th Ave Ste 100
Pasco, WA 99301
(509)547-1220
Republic
Republic Drug Store
6 N Clark Ave
Republic, WA 99166
(509)775-3351
FRANKLIN COUNTY
Connell
The Connell Pharmacy▼
140 N Columbia Ave
Connell, WA 99326
(509)234-2415
Pasco
Fiesta Pharmacy▼
115 S 10th Ave
Pasco, WA 99301
(509)545-0596
Medicine Shoppe
Pharmacy▼
1121 W Court St
Pasco, WA 99301
(509)547-7537
Rite Aid▼
1308 N 20th Ave
Pasco, WA 99301
(509)545-9581
Rite Aid▼
215 N 4th Ave
Pasco, WA 99301
(509)547-2231
Walgreens▼
2005 W Court St
Pasco, WA 99301
(509)545-4391
Walgreens▼
5506 Rd 68
Pasco, WA 99301
(509)547-1789
Wal-mart▼
4820 N Road 68
Pasco, WA 99301
(509)543-7947
Wal-mart▼
4820 N Road 68
Pasco, WA 99301
(509)543-7947
Yokes Pharmacy▼
4905 N Road 68
Pasco, WA 99301
(509)545-4884
GARFIELD COUNTY
Pomeroy
Pomeroy Pharmacy▼
764 Main Street
Pomeroy, WA 99347
(509)843-1821
71
GRANT COUNTY
Ephrata
Rite Aid▼
250 Basin St Sw
Ephrata, WA 98823
(509)754-3513
Safeway Pharmacy▼
1150 Basin St Sw
Ephrata, WA 98823
(509)754-3567
Wal-mart▼
1399 Se Blvd
Ephrata, WA 98823
(509)754-8847
Wal-mart▼
1399 Se Blvd
Ephrata, WA 98823
(509)754-8847
Grand Coulee
Safeway Pharmacy▼
101 Grand Coulee Hwy
Grand Coulee, WA 99133
(509)633-0463
Mattawa
Wfhc Pharmacy
601 Government Way
Mattawa, WA 99349
(509)488-5256
Moses Lake
Columbia Basin Natural
Fam Med▼
1025 S Pioneer Way Ste B
Moses Lake, WA 98837
(509)764-4600
Moses Lake Comm Hlth
Ctr▼
605 S Coolidge St
Moses Lake, WA 98837
(509)765-0674
Pioneer Med Center
Pharmacy
550 S Pioneer Way Ste 105
Moses Lake, WA 98837
(509)765-8891
Rite Aid▼
500 S Pioneer Way
Moses Lake, WA 98837
(509)765-1219
Safeway Pharmacy▼
601 S Pioneer Way
Moses Lake, WA 98837
(509)764-4721
Southgate Pharmacy▼
2709 W Broadway Ave
Moses Lake, WA 98837
(509)765-9332
Walgreens▼
200 E Broadway Ave
Moses Lake, WA 98837
(509)765-1217
Wal-mart▼
1005 N Stratford Rd
Moses Lake, WA 98837
(509)766-0168
Wal-mart▼
1005 N Stratford Rd
Moses Lake, WA 98837
(509)766-0168
Quincy
Heartland Pharmacy▼
101 F St Sw
Quincy, WA 98848
(509)787-4437
GRAYS HARBOR
COUNTY
Aberdeen
Aberdeen Health Mart
Pharmacy▼
1812 Sumner Ave
Aberdeen, WA 98520
(360)533-1525
City Center Drug▼
108 E Wishkah St
Aberdeen, WA 98520
(360)532-5182
Rite Aid▼
301 E Wishkah St
Aberdeen, WA 98520
(360)533-6320
Safeway Pharmacy▼
221 W Heron St
Aberdeen, WA 98520
(360)532-8743
Hoquiam
Crown Drug▼
2544 Simpson Ave
Hoquiam, WA 98550
(360)533-0961
Harbor Drug
316 8th St
Hoquiam, WA 98550
(360)532-3061
Rite Aid▼
3130 Simpson Ave
Hoquiam, WA 98550
(360)533-5531
Montesano
Valu Drug▼
201 E Pioneer Ave
Montesano, WA 98563
(360)249-4444
Ocean Shores
Swanson Owl Pharmacy▼
117 N Boone St
Aberdeen, WA 98520
(360)533-3294
Ocean Shores Pharmacy▼
172 W Chance A La Mer Nw
Ocean Shores, WA 98569
(360)289-4647
Wal-mart▼
909 E Wishkah St
Aberdeen, WA 98520
(360)532-7875
Westport
Twin Harbor Drug▼
733 N Montesano St
Westport, WA 98595
(360)268-0505
Wal-mart▼
909 E Wishkah St
Aberdeen, WA 98520
(360)532-7875
ISLAND COUNTY
Elma
Camano Island
Elma Health Mart
Pharmacy▼
221 W Main St
Elma, WA 98541
(360)482-2442
Marks Camano Pharmacy▼
370 Ne Camano Dr Ste 6
Camano Island, WA 98282
(360)387-5757
72
Clinton
Island Drug▼
11042 State Route 525
Clinton, WA 98236
(360)341-3885
Coupeville
Linds Coupville
Pharmacy▼
40 N Main St
Coupeville, WA 98239
(360)678-4010
Freeland
Lind's Freeland
Pharmacy▼
1609 E Main St
Freeland, WA 98249
(360)331-4700
Oak Harbor
Albertson's▼
1450 Sw Erie St
Oak Harbor, WA 98277
(360)279-8829
Island Drug▼
230 Se Pioneer Way
Oak Harbor, WA 98277
(360)675-6688
Kmart Pharmacy▼
32165 Sr 20
Oak Harbor, WA 98277
(360)679-5546
Rite Aid▼
31645 Sr 20
Oak Harbor, WA 98277
(360)679-3522
Saar's Marketplace Food▼
32199 State Route 20
Oak Harbor, WA 98277
(360)675-4511
Walgreens▼
31460 State Rte 20
Oak Harbor, WA 98277
(360)675-3497
Wal-mart▼
1250 Sw Erie St
Oak Harbor, WA 98277
(360)279-0671
Wal-mart▼
1250 Sw Erie St
Oak Harbor, WA 98277
(360)279-0671
JEFFERSON COUNTY
Port Hadlock
Qfc Pharmacy▼
1890 Irondale Rd
Port Hadlock, WA 98339
(360)385-1900
Tri-area Pharmacy▼
65 Oak Bay Rd
Port Hadlock, WA 98339
(360)379-9800
Port Townsend
Dons Pharmacy▼
1151 Water St
Port Townsend, WA 98368
(360)385-0969
Safeway Pharmacy▼
442 W Sims Way
Port Townsend, WA 98368
(360)385-2860
73
KING COUNTY
Auburn
Bartell Drug▼
3902 A St Se
Auburn, WA 98002
(253)939-8563
Fred Meyer Pharmacy▼
801 Auburn Way N
Auburn, WA 98002
(253)931-5584
Healthpoint Auburn
Pharmacy▼
126 Auburn Ave Ste 104
Auburn, WA 98002
(253)804-3591
Peckenpaugh Drug▼
1123 E Main St
Auburn, WA 98002
(253)833-8020
Rite Aid▼
1231 Auburn Way N
Auburn, WA 98002
(253)939-5355
Rite Aid▼
1509 Auburn Way S
Auburn, WA 98002
(253)939-1939
Safeway Pharmacy▼
101 Auburn Way S
Auburn, WA 98002
(253)735-4404
Sam's Club▼
1101 Supermall Way Ste
1275
Auburn, WA 98001
(253)333-8191
Sam's Club▼
1101 Supermall Way Ste
1275
Auburn, WA 98001
(253)333-8191
Steps Of Healing▼
3802 Auburn Way N Ste 301
Auburn, WA 98002
(253)929-8158
Top Food And Drug▼
1702 Auburn Way N
Auburn, WA 98002
(253)804-9616
Walgreens▼
1400 Harvey Rd
Auburn, WA 98002
(253)394-0022
Walgreens▼
1701 Auburn Way S
Auburn, WA 98002
(253)394-0029
Wal-mart▼
1200 Supermall Way
Auburn, WA 98001
(253)735-0708
Wal-mart▼
1200 Supermall Way
Auburn, WA 98001
(253)735-0708
Bellevue
Bartell▼
3620 Factoria Blvd Se
Bellevue, WA 98006
(425)644-7529
Bartell Drug▼
10116 Ne 8th St
Bellevue, WA 98004
(425)454-2468
Bartell Drugs▼
11919 Ne 8th St
Bellevue, WA 98005
(425)454-0146
Qfc Pharmacy▼
1510 145th Pl Se
Bellevue, WA 98007
(425)653-2431
Bartell Drugs▼
653 156th Ave Ne
Bellevue, WA 98007
(425)641-9127
Qfc Pharmacy▼
2636 Bellevue Way Ne
Bellevue, WA 98004
(425)576-9222
Bellegrove Pharmacy▼
1200 112th Ave Ne Ste A100
Bellevue, WA 98004
(425)455-2123
Qfc Pharmacy▼
3550 Factoria Blvd Se
Bellevue, WA 98006
(425)378-0202
Evergreen Integrative
Medicine▼
11520 Ne 20th St
Bellevue, WA 98004
(425)646-4747
Rite Aid▼
120 106th Ave Ne
Bellevue, WA 98004
(425)454-6513
Fred Meyer Pharmacy▼
2041 148th Ne
Bellevue, WA 98007
(425)865-8593
Mediart Family Clinic▼
1530 140th Ave Ne Ste 101
Bellevue, WA 98005
(425)233-8254
O'hana Wellness Center▼
2310 130th Ave Ne Ste 103
Bellevue, WA 98005
(425)881-2310
Pacifica Natural
Medicines▼
4205 148th Ave Ne Ste 103
Bellevue, WA 98007
(425)822-0602
Pharmacy Plus▼
1299 156th Ave Ne Ste 140
Bellevue, WA 98007
(425)644-8887
74
Rite Aid▼
15100 Se 38th St
Bellevue, WA 98006
(425)746-4028
Rite Aid▼
3905 Factoria Mall Se
Bellevue, WA 98006
(425)644-2925
Safeway Pharmacy▼
1645 140th Ave Ne
Bellevue, WA 98005
(425)643-1778
Safeway Pharmacy▼
300 Bellevue Way
Bellevue, WA 98004
(425)749-3889
Sagemed▼
12600 Se 38th St Ste 130
Bellevue, WA 98006
(425)728-8363
Seattle Childrens Hospital
1500 116th Ave Ne
Bellevue, WA 98004
(206)884-9120
Whole Family Clinic▼
1530 140th Ave Ne Ste 101
Bellevue, WA 98005
(206)295-3855
Rite Aid▼
110 Sw 148th St
Burien, WA 98166
(206)835-0166
Tlc Integrative Pharmacy▼
15600 Ne 8th St Ste K8
Bellevue, WA 98008
(425)653-2323
Bellvue
Three Moon Clinic▼
1800 Sw 152nd St Ste A
Burien, WA 98166
(206)838-3878
Top Food And Drug▼
15751 Ne 15th St
Bellevue, WA 98008
(425)748-1361
U And I Pharmacy▼
29 148th Ave Se
Bellevue, WA 98007
(425)747-3800
Walgreens▼
15585 Ne 24th St
Bellvue, WA 98007
(425)643-8281
Bothell
Bartell Drug▼
14130 Juanita Dr Ne
Bothell, WA 98011
(425)821-6275
Walgreens▼
1135 116th Ave Ne Ste 105
Bellevue, WA 98004
(425)453-1130
Healthpoint Bothell
Pharmacy▼
10414 Beardslee Blvd
Bothell, WA 98011
(425)486-0658
Walgreens▼
647 140th Ave Ne
Bellevue, WA 98005
(425)603-1438
Qfc Pharmacy▼
18921 Bothell Way Ne
Bothell, WA 98011
(425)487-3031
Wal-mart▼
12620 Se 41st Pl
Bellevue, WA 98006
(425)643-9034
Rite Aid▼
19107 Bothell Way Ne
Bothell, WA 98011
(425)489-1814
Wal-mart▼
12620 Se 41st Pl
Bellevue, WA 98006
(425)643-9034
Wal-mart▼
15063 Main St
Bellevue, WA 98007
(425)643-9402
Wal-mart▼
15063 Main St
Bellevue, WA 98007
(425)643-9402
Burien
Albertson's▼
12725 1st Ave S
Burien, WA 98168
(206)242-7942
Bartell Drug▼
14901 4th Ave Sw
Burien, WA 98166
(206)242-1202
75
Walgreens▼
14656 Ambaum Blvd Sw
Burien, WA 98166
(206)901-1816
Covington
Costco▼
27520 Covington Way Se
Covington, WA 98042
(253)796-1011
Covington Multicare
Clinic▼
17700 Se 272nd St Ste 100
Covington, WA 98042
(253)372-7220
Rite Aid▼
17125 Se 272nd St
Covington, WA 98042
(253)630-9880
Walgreens▼
27130 172nd Ave Se
Covington, WA 98042
(253)630-6791
Wal-mart▼
17432 Se 270th Pl
Covington, WA 98042
(253)630-8682
Wal-mart▼
17432 Se 270th Pl
Covington, WA 98042
(253)630-8682
Des Moines
Bartell Drug▼
27055 Pacific Hwy S
Des Moines, WA 98198
(253)839-1693
Naturopathic Medicine▼
22015 Marine View Dr S
Des Moines, WA 98198
(206)878-2628
Safeway Pharmacy▼
21401 Pacific Hwy S
Des Moines, WA 98198
(206)824-4784
Walgreens▼
23003 Pacific Hwy S
Des Moines, WA 98198
(206)870-1832
Duvall
Duvall Family Drugs▼
15602 Main St Ne
Duvall, WA 98019
(425)788-2644
Safeway Pharmacy▼
14020 Main St Ne
Duvall, WA 98019
(425)844-1199
Enumclaw
Jim's Pharmacy▼
2820 Griffin Ave Ste 102
Enumclaw, WA 98022
(360)825-6523
Plateau Community
Pharmacy▼
3021 Griffin Ave
Enumclaw, WA 98022
(360)825-2442
Qfc Pharmacy▼
1009 Monroe St
Enumclaw, WA 98022
(360)825-9360
Fred Meyer Pharmacy▼
33702 21st Ave Sw
Federal Way, WA 98023
(253)952-0133
Rite Aid▼
232 Roosevelt Ave
Enumclaw, WA 98022
(360)825-2558
Healthpoint Federal Way
Phcy▼
33431 13th Pl S
Federal Way, WA 98003
(253)815-8045
Safeway Pharmacy▼
152 Roosevelt Ave E
Enumclaw, WA 98022
(360)802-1534
Walgreens▼
1350 2nd St
Enumclaw, WA 98022
(360)825-5739
Highland Pharmacy▼
31260 Pacific Hwy S Ste 10
Federal Way, WA 98003
(253)839-1399
Onuri Pharmacy▼
33507 9th Ave S Ste B Ste 2
Federal Way, WA 98003
(253)719-8554
Federal Way
Albertson's▼
31009 Pacific Hwy S
Federal Way, WA 98003
(253)946-4033
Costco▼
35100 Enchanted Pkwy S
Federal Way, WA 98003
(253)874-4431
Federal Way Pharmacy▼
33501 1st Way S
Federal Way, WA 98003
(253)874-1650
Franciscan Pharmacy First
Ave▼
30809 1st Ave S
Federal Way, WA 98003
(253)529-8888
Franciscan Pharmacy St
Francis▼
34503 9th Ave S Ste 110
Federal Way, WA 98003
(253)944-4040
76
Rite Aid▼
2131 Sw 336th St
Federal Way, WA 98023
(253)952-2803
Rite Aid▼
32015 Pacific Hwy S
Federal Way, WA 98003
(253)945-6011
Safeway Pharmacy▼
1207 S 320th St
Federal Way, WA 98003
(253)946-1505
Target Pharmacy▼
2201 S Commons
Federal Way, WA 98003
(253)733-7521
Walgreens▼
28817 Military Rd S
Federal Way, WA 98003
(253)839-1027
Walgreens▼
34008 Hoyt Rd Sw
Federal Way, WA 98023
(253)838-5963
Qfc Pharmacy▼
1540 Gilman Blvd
Issaquah, WA 98027
(425)392-7500
Rite Aid▼
18022 Ne 68th Ave
Kenmore, WA 98028
(425)424-2320
Wal-mart▼
1900 S 314th St
Federal Way, WA 98003
(253)941-3555
Qfc Pharmacy▼
4560 Klahanie Dr Se
Issaquah, WA 98027
(425)392-8551
Safeway Pharmacy▼
6850 Ne Bothell Way
Kenmore, WA 98028
(425)486-1661
Rite Aid▼
1065 Nw Gilman Blvd
Issaquah, WA 98027
(425)392-2865
Kent
Wal-mart▼
1900 S 314th St
Federal Way, WA 98003
(253)941-3555
Wal-mart▼
34520 16th Ave S
Federal Way, WA 98003
(253)835-4976
Wal-mart▼
34520 16th Ave S
Federal Way, WA 98003
(253)835-4976
Issaquah
Bartell Drugs▼
5700 E Lake Sammamish
Pkwy
Issaquah, WA 98029
(425)391-6408
Costco▼
1801 10th Ave Nw
Issaquah, WA 98027
(425)313-9200
Fred Meyer Pharmacy▼
6100 E Lake Sammamish
Pkwy
Issaquah, WA 98029
(425)416-1133
Medical Center Pharmacy▼
450 Nw Gilman Blvd Ste
107
Issaquah, WA 98027
(425)392-8650
A And H Pharmaceutical
Svcs
25022 104th Ave Se Ste E
Kent, WA 98031
Rite Aid▼
3066 Issaquah Pine Lake Se (253)852-1123
Issaquah, WA 98027
(425)391-1582
Bartell Drug▼
Safeway Pharmacy▼
735 Nw Gilman Blvd
Issaquah, WA 98027
(425)507-1042
Swedish Issaquah Retail
Phcy▼
751 Ne Blakely Dr
Issaquah, WA 98029
(425)313-5200
Target Pharmacy▼
755 Nw Gilman Blvd
Issaquah, WA 98027
(425)507-1020
Walgreens▼
6300 E Lake Sammamish
Pkwy
Issaquah, WA 98029
(425)369-0265
12946 Se Kent Kangley Rd
Kent, WA 98030
(253)631-6874
Fred Meyer Pharmacy▼
10201 Se 240th St
Kent, WA 98031
(253)859-5533
Fred Meyer Pharmacy▼
16735 Se 272nd St
Kent, WA 98402
(253)639-7433
Fred Meyer Pharmacy▼
25250 Pacific Hwy S
Kent, WA 98031
(253)941-2905
Kenmore
Healthpoint Kent
Pharmacy▼
403 E Meeker St Ste 300
Kent, WA 98030
(253)372-3661
Ostrom Drugs▼
6744 Ne 181st St
Kenmore, WA 98028
(425)486-7711
Propac Pharmacy
7102 S 220th St
Kent, WA 98032
(855)535-7183
77
Rite Aid▼
10407 Se 256th St
Kent, WA 98030
(253)854-5343
Top Food And Drug▼
26015 104th Ave Se
Kent, WA 98030
(253)850-6480
Costco▼
8629 120th Ave Ne
Kirkland, WA 98033
(425)822-0414
Rite Aid▼
105 Washington Ave N
Kent, WA 98032
(253)373-0156
United Care Pharmacy▼
18230 E Valley Hwy Ste 188
Kent, WA 98032
(206)371-7697
Evergreen Pharmacy▼
12911 120th Ave Ne
Kirkland, WA 98034
(425)821-8888
Rite Aid▼
20518 108th Ave Se
Kent, WA 98031
(253)854-2999
Walgreens▼
25605 104th Ave Se
Kent, WA 98030
(253)813-6968
Evergreen Prof Ctr
Pharmacy▼
12303 Ne 130th Ln Ste 210
Kirkland, WA 98034
(425)899-2790
Rite Aid▼
26200 Pacific Hwy S
Kent, WA 98032
(253)941-4660
Walgreens▼
27112 132nd Ave Se
Kent, WA 98042
(253)638-3324
Kirkland
Safeway Pharmacy▼
13101 Se Kent Kangley Hwy
Kent, WA 98031
Assured Pharmacy▼
(253)638-0831
12071 124th Ave Ne
Kirkland, WA 98034
(425)820-1030
Safeway Pharmacy▼
17051 272nd Se
Kent, WA 98042
Bartell Drug▼
(253)631-2450
10625 Ne 68th St
Safeway Pharmacy▼
20830 108th Ave Se
Kent, WA 98031
(253)852-9319
Safeway Pharmacy▼
210 Washington Ave S
Kent, WA 98032
(253)852-5115
Target Pharmacy▼
26301 104th Ave Se
Kent, WA 98031
(253)518-1190
Kirkland, WA 98033
(425)822-2241
Bartell Drug▼
14442 124th Ave Ne
Kirkland, WA 98034
(425)821-7899
Bartell Drug▼
6619 132nd Ave Ne
Kirkland, WA 98033
(425)881-5678
Cornerstone Family Health
Cln▼
13115 121st Way Ne Ste C
Kirkland, WA 98034
(425)821-1800
78
Fred Meyer Pharmacy▼
12221 120th Ave Ne
Kirkland, WA 98034
(425)820-3233
Pacmed Clinic Pharmacy
12910 Totem Lake Blvd Ne
Kirkland, WA 98034
(425)814-5003
Qfc Pharmacy▼
11224 Ne 124th St
Kirkland, WA 98034
(425)820-0440
Qfc Pharmacy▼
211 Park Pl
Kirkland, WA 98033
(425)822-4123
Rite Aid▼
12530 Totem Lake Blvd
Kirkland, WA 98034
(425)821-1500
Rite Aid▼
9820 Ne 132nd St
Kirkland, WA 98034
(425)823-4466
Safeway Pharmacy▼
10020 Ne 137th Ave
Kirkland, WA 98033
(425)821-0708
Safeway Pharmacy▼
12519 85th St Ne
Kirkland, WA 98033
(425)822-9235
Safeway Pharmacy▼
14444 124th Ave Ne
Kirkland, WA 98033
(425)821-7455
Walgreens▼
11607 98th Ave Ne
Kirkland, WA 98034
(425)825-8841
Walgreens▼
12405 Ne 85th St
Kirkland, WA 98033
(425)822-9202
Maple Valley
Bartell Drug▼
22117 Se 237th St
Maple Valley, WA 98038
(425)432-1234
Rite Aid▼
3023 Se 78th Ave
Mercer Island, WA 98040
(206)236-0776
Rite Aid▼
8441 Se 68th St
Mercer Island, WA 98040
(206)232-3000
Walgreens▼
7707 Se 27th St Ste 100
Mercer Island, WA 98040
(206)232-1197
Alpine Integrated
Medicine▼
22635 Ne Marketplace Dr
Redmond, WA 98053
(425)949-5961
Bartell Drug▼
7370 170th Ave Ne
Redmond, WA 98052
(425)895-8242
Bartell Drug▼
8862 161st Ave Ne
Redmond, WA 98052
(425)883-9532
Newcastle
Bartell Drug▼
6939 Coal Creek Pkwy Se
Newcastle, WA 98059
(425)644-4416
Normandy Park
Access Pharmacy▼
17833 1st Ave S Ste C
Normandy Park, WA 98148
(206)246-0040
Fred Meyer Pharmacy▼
17667 Ne 76th St
Redmond, WA 98052
(425)556-8033
Pharmaca Integrative
Pharmacy▼
15840 Redmond Way
Redmond, WA 98052
(425)885-2323
North Bend
Qfc Pharmacy▼
23475 Ne Novelty Hill Rd
Redmond, WA 98053
(425)636-0440
Fred Meyer Pharmacy▼
26520 Maple Valley Black
Maple Valley, WA 98038
(425)433-2333
Qfc Pharmacy▼
460 E Northbend Way
North Bend, WA 98045
(425)888-2357
Qfc Pharmacy▼
8867 161st Ave Ne
Redmond, WA 98052
(425)869-7474
Safeway Pharmacy▼
26916 Maple Valley Hwy
Maple Valley, WA 98038
(425)432-3077
Safeway Pharmacy▼
460 Sw Mount Blvd
North Bend, WA 98045
(425)831-2126
Rite Aid▼
14880 Ne 24th St
Redmond, WA 98052
(425)883-0900
Mercer Island
Redmond
Albertson's▼
2755 77th Ave Se
Mercer Island, WA 98040
(206)232-2222
Albertson's▼
3925 236th Ave Ne
Redmond, WA 98053
(425)836-8706
79
Rite Aid▼
17220 Redmond Way
Redmond, WA 98052
(425)883-1516
Safeway Pharmacy▼
630 228th Ave Ne
Redmond, WA 98074
(425)868-6181
Jolly's Pharmacy
1412 Sw 43rd St Ste 120
Renton, WA 98057
(425)251-6335
Safeway Pharmacy▼
4300 4th St Ne
Renton, WA 98059
(425)235-6251
Target Pharmacy▼
17700 Ne 76th St
Redmond, WA 98052
(425)202-1000
Laura J Hieb Nd▼
304 Main Ave S Ste 201
Renton, WA 98057
(425)282-5304
Safeway Pharmacy▼
6911 Coal Creek Pkwy Se
Renton, WA 98056
(425)644-2726
Renton
Pacmed Clinic Pharmacy
601 S Carr Rd Ste 100
Renton, WA 98055
(425)227-3122
Sam's Club▼
901 S Grady Way
Renton, WA 98057
(425)793-7937
Albertson's▼
14215 Se Petrovitsky Rd
Renton, WA 98058
(425)235-7772
Bartell Drug▼
4700 Ne 4th St
Renton, WA 98059
(425)793-1015
Bartell Drugs▼
17254 140th Se
Renton, WA 98058
(425)226-7000
Core Injury Management▼
425 Sw 41st St
Renton, WA 98057
(425)226-1190
Fred Meyer Pharmacy▼
17801 108th Ave Se
Renton, WA 98055
(425)235-5383
Fred Meyer Pharmacy▼
365 Renton Center Way Sw
Renton, WA 98055
(425)204-5233
Healthpoint Central Fill
Phcy▼
947 Powell Ave Sw
Renton, WA 98057
(877)233-0246
Pain Associates Of
Washington▼
4300 Talbot Rd S Ste 200
Renton, WA 98055
(425)271-1255
Ready Meds Pharmacy▼
1412 Sw 43rd St Ste 120
Renton, WA 98057
(425)251-6335
Rite Aid▼
17615 140th Ave Se
Renton, WA 98058
(425)204-1585
Sam's Club▼
901 S Grady Way
Renton, WA 98057
(425)793-7937
Target Pharmacy▼
1215 Landing Way
Renton, WA 98055
(425)207-0078
The Prescription Pad
Pharmacy▼
3915 Talbot Rd S
Renton, WA 98055
(425)656-4050
Rite Aid▼
3116 Ne Sunset Blvd
Renton, WA 98056
(425)793-0787
The Prescription Pad
Pharmacy▼
400 S 43rd St
Renton, WA 98055
(425)917-6226
Rite Aid▼
601 S Grady Way Ste P
Renton, WA 98055
(425)226-4390
Walgreens▼
275 Rainer Ave S
Renton, WA 98055
(425)277-0212
Safeway Pharmacy▼
200 S 3rd St
Renton, WA 98055
(425)226-0325
Walgreens▼
3011 Ne Sunset Blvd
Renton, WA 98056
(425)207-0053
80
Walgreens▼
4105 Ne 4th St
Renton, WA 98059
(425)207-1278
Ballard Plaza Pharmacy▼
1801 Nw Market St Ste 104
Seattle, WA 98107
(206)782-7200
Bartell Drug▼
2345 42nd Ave Sw
Seattle, WA 98116
(206)932-7437
Wal-mart▼
743 Rainier Ave S
Renton, WA 98057
(425)227-9307
Bartell Drug▼
1101 Madison St
Seattle, WA 98104
(206)340-1171
Bartell Drug▼
2700 Ne University Village
St
Seattle, WA 98105
(206)525-0705
Wal-mart▼
743 Rainier Ave S
Renton, WA 98057
(425)227-9307
Sammamish
Bartell Drug▼
526 228th Ave Ne
Sammamish, WA 98074
(425)868-1112
Seatac
Safeway Pharmacy▼
4011 S 164th St
Seatac, WA 98188
(206)248-0300
Seattle
Afh Pharamcy▼
1017 E Union St
Seattle, WA 98122
(206)568-2486
Ahp Pharmacy▼
1120 Cherry St Ste 124
Seattle, WA 98104
(206)624-1391
Anderson Med Specialty
Assoc▼
2150 N 107th St Ste 400
Seattle, WA 98133
(206)629-2186
Bartell Drug▼
120 N 85th St
Seattle, WA 98103
(206)784-7600
Bartell Drug▼
1404 3rd Ave
Seattle, WA 98101
(206)624-1401
Bartell Drug▼
1407 Broadway Ave
Seattle, WA 98122
(206)726-3495
Bartell Drug▼
1628 5th Ave
Seattle, WA 98101
(206)622-0581
Bartell Drug▼
1820 N 45th St
Seattle, WA 98103
(206)632-3313
Bartell Drug▼
21615 Pacific Hwy S
Seattle, WA 98198
(206)878-4628
Bartell Drug▼
2222 32nd Ave W
Seattle, WA 98199
(206)282-2880
81
Bartell Drug▼
3018 Ne 125th St
Seattle, WA 98125
(206)362-7572
Bartell Drug▼
4344 University Way Ne
Seattle, WA 98105
(206)632-3513
Bartell Drug▼
4706 42nd Ave Sw
Seattle, WA 98116
(206)932-8045
Bartell Drug▼
5605 22nd Ave Nw
Seattle, WA 98107
(206)783-3050
Bartell Drug▼
600 1st Ave N
Seattle, WA 98109
(206)284-1354
Bartell Drug▼
6401 12th Ave Ne
Seattle, WA 98115
(206)525-3754
Bartell Drug▼
9600 15th Ave Sw
Seattle, WA 98106
(206)763-2727
Bartell Drugs▼
1929 Queen Anne Ave N
Seattle, WA 98109
(206)285-1737
Community▼
1001 Broadway Ste 102
Seattle, WA 98122
(206)324-2335
Fred Meyer Pharmacy▼
13000 Lake City Way Ne
Seattle, WA 98125
(206)440-2419
Bartell Drugs▼
2345 Rainier Ave S
Seattle, WA 98144
(206)325-5725
Costco▼
1175 N 205th St
Seattle, WA 98133
(206)542-0497
Fred Meyer Pharmacy▼
14300 1st Ave S
Seattle, WA 98168
(206)433-6446
Bartell Drugs▼
910 4th Ave
Seattle, WA 98134
(206)624-8394
Costco▼
4401 4th Ave S
Seattle, WA 98134
(206)682-6244
Fred Meyer Pharmacy▼
18325 Aurora Ave N
Seattle, WA 98133
(206)546-0753
Bob Johnsons Pharmacy
1407 Nw 85th St
Seattle, WA 98117
(206)782-5822
Country Doctor
Community Cln▼
500 19th Ave E
Seattle, WA 98112
(206)299-1620
Fred Meyer Pharmacy▼
915 Nw 45th St
Seattle, WA 98107
(206)297-4333
Des Moines Drug
627 227th St S
Seattle, WA 98198
(206)878-2345
Harborview Medical
Center▼
325 9th Ave
Seattle, WA 98104
(206)744-3219
Dong Nai Pharmacy▼
620 S Jackson St
Seattle, WA 98104
(206)624-4238
Holly Park Pharmacy▼
3815 S Othellos St
Seattle, WA 98118
(206)788-3562
Downtown Public Hlth Cntr
Phcy
2124 4th Ave
Seattle, WA 98121
(206)296-4637
International Comm Hlth
Svcs▼
720 8th Ave S Ste 100
Seattle, WA 98104
(206)788-3770
Children's Hospital
Pharmacy
4800 Sand Point Way Ne
Seattle, WA 98105
(206)987-2138
Eastern's Pharmacy
515 Minor Ave
Seattle, WA 98104
(206)622-6094
Katterman's Sand Point
Phcy
5400 Sand Point Way Ne
Seattle, WA 98105
(206)524-2211
Columbia Pharmacy▼
4741 Rainier Ave S
Seattle, WA 98118
(206)723-5233
Fred Meyer Pharmacy▼
100 Nw 85th St
Seattle, WA 98117
(206)783-2272
Buck Pavilion Pharmacy▼
Mason Clinic 1100 9th Ave
Seattle, WA 98101
(206)223-6877
Cabrini Medical Tower
Phcy▼
901 Boren Ave
Seattle, WA 98104
(206)682-1011
Chesterfield Pharmacy▼
720 7th Ave Ste 100
Seattle, WA 98104
(206)838-6070
82
Kelley Ross Ltc Pharmacy
2324 Eastlake Ave E
Seattle, WA 98102
(206)838-4590
Kelley-ross Pharmacy▼
904 7th Ave Ste 103
Seattle, WA 98104
(206)324-6990
Mikhail O Kisselev Nd▼
11524 15th Ave Ne Ste C
Seattle, WA 98125
(206)361-0108
Northwest Prescription▼
1530 N 115th St Ste 100
Seattle, WA 98133
(206)365-2255
King Plaza Pharmacy▼
7101 Mlk Jr Way S Ste 101b
Seattle, WA 98118
(206)721-5009
Navos▼
2600 Sw Holden St
Seattle, WA 98126
(206)933-7219
Nw Naturopathy And
Acupuncture▼
6300 9th Ave Ne Ste 310
Seattle, WA 98115
(206)524-0863
Lafferry's Pharmacy▼
5312 17th Ave Nw
Seattle, WA 98107
(206)783-5133
Neighborcare Health▼
1629 N 45th St
Seattle, WA 98103
(206)548-2964
Lindeman Pavilion
Pharmacy▼
1201 Terry Ave Ste X2-pn
Seattle, WA 98101
(206)625-7202
Neighborcare Health▼
1930 Post Aly
Seattle, WA 98101
(206)728-4143
Lowry's Prescriptions▼
10330 Meridian Ave N
Seattle, WA 98133
(206)368-6060
Luke's Pharmacy▼
611 Maynard Ave S
Seattle, WA 98104
(206)621-8883
Maple Leaf Pharmacy
8830 Roosevelt Way Ne
Seattle, WA 98115
(206)729-7514
Medicine Man▼
323 North 85th
Seattle, WA 98103
(206)789-0800
Meridian Pharmacy▼
11011 Meridian Ave N
Seattle, WA 98133
(206)403-1137
Neighborcare Health▼
4400 37th Ave S
Seattle, WA 98118
(206)461-6957
Nguyens Pharmacy And
Gifts▼
1221 S Main St Ste 103
Seattle, WA 98144
(206)323-6003
Nguyens Pharmacy And
Gifts▼
2120 Rainier Ave S
Seattle, WA 98144
(206)323-9525
North Public Health Ctr
Phcy
10501 Meridian Ave N
Seattle, WA 98133
(206)296-4908
Northwest Kidney Center
Phcy
700 Broadway
Seattle, WA 98122
(206)343-4870
83
Pacific Drugs▼
822 1st Ave
Seattle, WA 98104
(206)624-1454
Pacmed Clinic Pharmacy
10416 5th Ave Ne
Seattle, WA 98125
(206)517-6635
Pacmed Clinic Pharmacy
1101 Madison Ste 306
Seattle, WA 98104
(206)505-1397
Pacmed Clinic Pharmacy
1200 12th Ave S
Seattle, WA 98144
(206)621-4109
Park's Pharmacy▼
401 Ne Ravenna Blvd Ste A
Seattle, WA 98115
(206)527-3010
Pharmaca Integrative▼
1815 N 45th St Ste 110
Seattle, WA 98103
(206)547-1208
Pharmaca Integrative
Pharmacy▼
4707 California Ave Sw
Seattle, WA 98116
(206)932-4225
Pharmaca Integrative
Phcy▼
4130 East Madison
Seattle, WA 98112
(206)324-1188
Pharmacare Specialty
Phcy▼
1001 Madison St
Seattle, WA 98104
(206)381-1259
Plan Parenthood Of Grt Nw
Phcy
2001 E Madison St
Seattle, WA 98122
(206)963-2686
Premier Pharmacy▼
5405 Rainier Ave S
Seattle, WA 98118
(206)722-8882
Qfc Pharmacy▼
11100 Roosevelt Way Ne
Seattle, WA 98125
(206)361-0188
Qfc Pharmacy▼
1531 Ne 145th St
Seattle, WA 98155
(206)366-4672
Qfc Pharmacy▼
2746 Ne 45th St
Seattle, WA 98105
(206)729-3080
Qfc Pharmacy▼
417 Broadway E
Seattle, WA 98102
(206)328-6960
Qfc Pharmacy▼
4550 42nd Ave Sw
Seattle, WA 98116
(206)923-6391
Qfc Pharmacy▼
500 Mercer St
Seattle, WA 98109
(260)352-4030
Rite Aid▼
2603 Third Ave
Seattle, WA 98121
(206)441-8790
Qfc Pharmacy▼
600 Richmond Beach Rd
Seattle, WA 98177
(206)542-5469
Rite Aid▼
2707 Rainier Ave S
Seattle, WA 98144
(206)721-5018
Qfc Pharmacy▼
9999 Holman Rd Nw
Seattle, WA 98117
(206)782-4100
Rite Aid▼
5217 California Ave Sw
Seattle, WA 98136
(206)937-2191
Que Areste Nd▼
1605 12th Ave Ste 16
Seattle, WA 98122
(206)328-2926
Rite Aid▼
655 Nw Richmond Beach
Rd
Seattle, WA 98177
(206)542-9688
Rite Aid▼
1300 Madison St
Seattle, WA 98104
(206)322-9316
Rite Aid▼
13201 N Aurora Ave
Seattle, WA 98133
(206)364-7676
Rite Aid▼
802 3rd Ave
Seattle, WA 98104
(206)623-0577
Rite Aid▼
8500 35th Ave Ne
Seattle, WA 98115
(206)527-8373
Rite Aid▼
17171 Bothell Way Ne Ste
15
Seattle, WA 98155
(206)363-6364
Rite Aid▼
9200 Rainier Ave S
Seattle, WA 98118
(206)760-1076
Rite Aid▼
201 Broadway E
Seattle, WA 98102
(206)324-7111
Safeway Pharmacy▼
12318 15th Ave Ne
Seattle, WA 98125
(206)306-0508
Rite Aid▼
2600 Sw Barton St Ste D
Seattle, WA 98126
(206)938-4253
Safeway Pharmacy▼
138 Sw 148th St
Seattle, WA 98166
(206)243-2796
84
Safeway Pharmacy▼
1410 E John St
Seattle, WA 98112
(206)323-4935
Safeway Pharmacy▼
516 1st Ave W
Seattle, WA 98119
(206)494-1700
Safeway Pharmacy▼
1423 Nw Market St
Seattle, WA 98107
(206)782-8688
Safeway Pharmacy▼
7300 Ne Roosevelt Way
Seattle, WA 98115
(206)524-1649
Safeway Pharmacy▼
15332 Aurora Ave N
Seattle, WA 98133
(206)362-4940
Safeway Pharmacy▼
7340 35th Ave Ne
Seattle, WA 98115
(206)494-1255
Safeway Pharmacy▼
17202 15th Ave Ne
Seattle, WA 98155
(206)364-4618
Safeway Pharmacy▼
8340 15th Ave Nw
Seattle, WA 98117
(206)782-7480
Safeway Pharmacy▼
2100 Queen Anne Ave N
Seattle, WA 98109
(206)284-4226
Safeway Pharmacy▼
8704 Greenwood Ave N
Seattle, WA 98103
(206)494-0440
Safeway Pharmacy▼
2201 E Madison St
Seattle, WA 98112
(206)494-1520
Safeway Pharmacy▼
9262 Rainier Ave S
Seattle, WA 98118
(206)494-1130
Safeway Pharmacy▼
2622 California Ave Sw
Seattle, WA 98116
(206)937-2221
Safeway Pharmacy▼
9620 28th Ave Sw
Seattle, WA 98126
(206)923-9110
Safeway Pharmacy▼
3020 Ne 45th St
Seattle, WA 98105
(206)524-9931
Sam's Club▼
13550 Aurora Ave N
Seattle, WA 98133
(206)361-1594
Safeway Pharmacy▼
3820 Rainier Ave S
Seattle, WA 98118
(206)725-9887
Sam's Club▼
13550 Aurora Ave N
Seattle, WA 98133
(206)361-1594
Sea-mar Chc Pharmacy▼
8720 14th Ave S
Seattle, WA 98108
(206)762-3397
85
Seattle Cancer Care
Alliance▼
825 Eastlake Ave E
Seattle, WA 98109
(206)288-1375
Seattlemeds Pharmacy▼
1305 Madison St
Seattle, WA 98104
(206)382-2087
Simon Wellness▼
6300 9th Ave Ne Ste 310
Seattle, WA 98115
(206)524-0863
Swedish First Hill
Pharmacy▼
747 Broadway
Seattle, WA 98122
(206)386-3784
Swedish Orthopedic Inst
Phcy▼
601 Broadway
Seattle, WA 98122
(206)215-9110
Swedish Pharmacy Cherry
Hill▼
550 17th Ave Ste 180
Seattle, WA 98122
(206)320-2699
Target Pharmacy▼
1401 2nd Ave
Seattle, WA 98101
(206)494-3251
Target Pharmacy▼
302 Ne Northgate Way
Seattle, WA 98125
(206)494-0898
Union Center Pharmacy▼
2324 Eastlake Ave E Ste
405
Seattle, WA 98102
(206)441-9174
Uwmc Ambulatory
Pharmacy▼
1959 Ne Pacific St
Seattle, WA 98195
(206)598-4363
Vital Therapeutics▼
1836 Westlake Ave N Ste
201
Seattle, WA 98109
(206)729-6100
Walgreens▼
1205 Ne 50th St
Seattle, WA 98105
(206)204-0145
Walgreens▼
14352 Lake City Way Ne
Seattle, WA 98125
(206)361-9753
Walgreens▼
1531 Broadway Blvd
Seattle, WA 98122
(206)204-0599
Walgreens▼
222 Pike St
Seattle, WA 98101
(206)903-8392
Walgreens▼
2400 S Jackson St
Seattle, WA 98144
(206)329-6850
Walgreens▼
4412 Rainier Ave S
Seattle, WA 98118
(206)760-7880
Walgreens▼
4468 Stone Way N
Seattle, WA 98103
(206)547-1226
White Center Pharmacy▼
9601 16th Ave Sw
Seattle, WA 98106
(206)763-2500
Walgreens▼
500 15th Ave E
Seattle, WA 98112
(206)709-4569
Shoreline
Walgreens▼
5409 15th Ave Nw
Seattle, WA 98107
(206)781-0056
Walgreens▼
566 Denny Way
Seattle, WA 98109
(206)204-1982
Walgreens▼
6330 35th Ave Sw
Seattle, WA 98126
(206)938-2759
Walgreens▼
8500 15th Ave Nw Ste A
Seattle, WA 98117
(206)706-5210
Walgreens▼
859 Ne Northgate Way
Seattle, WA 98125
(206)417-0520
Walgreens▼
8701 Greenwood Ave N
Seattle, WA 98103
(206)706-9140
Walgreens▼
9456 16th Ave Sw
Seattle, WA 98106
(206)767-2294
86
Bartell Drug▼
18420 Aurora Ave N
Shoreline, WA 98133
(206)542-2948
Rite Aid▼
20330 Ballinger Way Ne
Shoreline, WA 98155
(206)368-0034
Shoreline Natural
Medicine▼
646 Nw Richmond Beach
Rd
Shoreline, WA 98177
(206)542-8687
Top Food And Drug▼
1201 N 175th St
Shoreline, WA 98133
(206)533-2861
Walgreens▼
14510 Aurora Ave N
Shoreline, WA 98133
(206)361-8826
Walgreens▼
17518 15th Ave Ne
Shoreline, WA 98155
(206)361-7474
Walgreens▼
17524 Aurora Ave N
Shoreline, WA 98133
(206)542-4964
Snoqualmie
Snoqualmie Village
Pharmacy▼
7730 Center Blvd Se
Snoqualmie, WA 98065
(425)396-7474
The Falls Phcy United
Drugs
8112 Railroad Ave Se
Snoqualmie, WA 98065
(425)888-6858
Tukwila
Bartell Drug▼
14277 Pacific Hwy S
Tukwila, WA 98168
(206)431-9652
KITSAP COUNTY
Woodinville
Rite Aid▼
14035 Ne Woodinville
Duvall
Woodinville, WA 98072
(425)485-6468
Safeway Pharmacy▼
19150 Woodinville Duvall
Rd
Woodinville, WA 98077
(425)788-6658
Target Pharmacy▼
13950 Ne 178th Pl
Woodinville, WA 98072
(425)492-1820
Costco▼
400 Costco Dr
Tukwila, WA 98188
(206)575-8147
The Natural Path To
Healing▼
15610 Ne Woodinville
Duvall
Woodinville, WA 98072
(425)489-5900
Target Pharmacy▼
301 Strander Blvd
Tukwila, WA 98188
(206)575-0682
Top Food And Drug▼
17641 Garden Way Ne
Woodinville, WA 98072
(425)398-6710
Walgreens▼
3716 S 144th St
Tukwila, WA 98168
(206)204-1284
Walgreens▼
17520 Avondale Rd Ne
Woodinville, WA 98077
(425)844-0302
Vashon
Vashon Pharmacy
17617 Vashon Hwy Sw
Vashon, WA 98070
(206)463-9118
Bainbridge Island
Rite Aid▼
301 High School Rd Ne
Bainbridge Island, WA
98110
(206)842-4065
Safeway Pharmacy▼
253 High School Rd Ne
Bainbridge Island, WA
98110
(206)842-0127
Winslow Drug▼
290 Winslow Way E
Bainbridge Island, WA
98110
(206)842-2652
Bremerton
Albertson's▼
2900 Wheaton Way
Bremerton, WA 98310
(360)377-0933
Apothecary Shoppe
2500 Cherry Ave Ste 101
Bremerton, WA 98310
(360)479-4900
Fred Meyer Pharmacy▼
5050 State Highway 303 Ne
Woodinville Med Ctr Phcy▼ Bremerton, WA 98311
(360)792-2833
1700 140th Ave Ne Unit
E101
Woodinville, WA 98072
Peninsula Community
(425)485-2900
Health Svs▼
2508 Wheaton Way
Bremerton, WA 98310
(360)616-3131
Vashon Women's Health
Center▼
17407 Vashon Hwy Sw
Vashon, WA 98070
(206)463-2777
87
Peninsula Community Hlth Srvs▼
616 6th St
Bremerton, WA 98337
(360)475-3731
Rite Aid▼
4117 Kitsap Way
Bremerton, WA 98312
(360)479-2415
Rite Aid▼
4220 Wheaton Way
Bremerton, WA 98310
(360)479-3450
Safeway Pharmacy▼
1401 Ne Mcwilliams Rd
Bremerton, WA 98311
(360)373-7226
Safeway Pharmacy▼
900 Callow Ave
Bremerton, WA 98312
(360)792-9262
Walgreens▼
3333 Wheaton Way
Bremerton, WA 98310
(360)782-0907
Walgreens▼
3929 Kitsap Way
Bremerton, WA 98312
(360)917-1041
Walgreens▼
6432 State Hwy 303 Ne
Bremerton, WA 98311
(360)307-8741
Wal-mart▼
6797 State Hwy 303 Ne
Bremerton, WA 98311
(360)698-3446
Wal-mart▼
6797 State Hwy 303 Ne
Bremerton, WA 98311
(360)698-3446
Safeway Pharmacy▼
3355 Bethel Rd Se
Port Orchard, WA 98366
(360)876-6064
Kingston
South Park Pharmacy▼
1743 Village Ln Se
Port Orchard, WA 98366
(360)871-1020
Albertson's▼
8196 Ne State Highway 104
Kingston, WA 98346
(360)297-1811
Rite Aid▼
27000 Miller Bay Rd Ne
Kingston, WA 98346
(360)297-5200
Port Orchard
Walgreens▼
3099 Bethel Rd Se
Port Orchard, WA 98366
(360)876-5212
Wal-mart▼
3497 Bethel Rd Se
Port Orchard, WA 98366
(360)874-9063
Albertson's▼
1434 Olney St Se
Port Orchard, WA 98366
(360)895-0613
Wal-mart▼
3497 Bethel Rd Se
Port Orchard, WA 98366
(360)874-9063
Albertson's▼
390 Sw Sedgewick Rd
Port Orchard, WA 98367
(360)876-2698
Poulsbo
Fred Meyer Pharmacy▼
1900 Se Sedgwick Rd
Port Orchard, WA 98366
(360)874-7173
Ikinya Pharmacy▼
20700 Bond Rd Ne Ste 110
Poulsbo, WA 98370
(360)930-8264
Kitsap Pharmacy▼
20148 10th Ave Ne
Poulsbo, WA 98370
Peninsula Community Hlth (360)779-5335
Svcs▼
320 S Kitsap Blvd
Peninsula Comm Htlh Svcs Port Orchard, WA 98366
Phcy▼
(360)874-5583
19917 7th Ave Ne
Rite Aid▼
3282 Bethel Rd Se
Port Orchard, WA 98366
(360)876-0969
88
Poulsbo, WA 98370
(360)697-7636
Poulsbo Compounding Pharmacy▼
325 Ne Hostmark St
Poulsbo, WA 98370
(360)779-2737
Rite Aid▼
19475 Ne 17th Ave
Poulsbo, WA 98370
(360)697-2209
KITTITAS COUNTY
Cle Elum
Super One Pharmacy▼
200 E Mountain View Ave
Ellensburg, WA 98926
(509)962-7777
Cavallini's Pharmacy▼
106 E 1st St
Cle Elum, WA 98922
(509)674-2571
KLICKITAT COUNTY
Wal-mart▼
21200 Olhava Way Nw
Poulsbo, WA 98370
(360)697-2091
Cle Elum Drug▼
219 E 1st St
Cle Elum, WA 98922
(509)674-2155
Hi-school Pharmacy▼
250 E Jewett Blvd
White Salmon, WA 98672
(509)493-4842
Silverdale
Ellensburg
LEWIS COUNTY
Albertson's▼
2222 Nw Bucklin Hill Rd
Silverdale, WA 98383
(360)692-8596
Bi-mart Pharmacy▼
608 E Mountain View Ave
Ellensburg, WA 98926
(509)925-6996
Centralia
Costco▼
10000 Mickelberry Rd Nw
Silverdale, WA 98383
(360)308-2116
Ellensburg Downtown Hm
Phcy▼
414 N Pearl St
Ellensburg, WA 98926
(509)925-1514
Wal-mart▼
21200 Olhava Way Nw
Poulsbo, WA 98370
(360)697-2091
Natural Options Health
Clinic▼
9481 Bayshore Dr Nw
Silverdale, WA 98383
(360)698-4141
Ellensburg Pharmacy▼
521 E Mountain View Ave
Ellensburg, WA 98926
(509)962-1430
Rite Aid▼
2860 Nw Bucklin Hill Rd
Silverdale, WA 98383
(360)692-3410
Fred Meyer Pharmacy▼
201 S Water St
Ellensburg, WA 98926
(509)962-0533
Target Pharmacy▼
3201 Nw Randall Way
Silverdale, WA 98383
(360)536-6010
Rite Aid▼
700 S Main St
Ellensburg, WA 98926
(509)925-4232
Walgreens▼
9709 Silverdale Way Nw
Silverdale, WA 98383
(360)692-7536
Safeway Pharmacy▼
400 North Ruby St
Ellensburg, WA 98926
(509)962-5096
89
White Salmon
Halls Drug Center▼
505 S Tower Ave
Centralia, WA 98531
(360)736-5000
Providence Centralia
Hospital
914 S Scheuber Rd
Centralia, WA 98531
(360)807-7997
Rite Aid▼
1200 Harrison Ave
Centralia, WA 98531
(360)807-2014
Safeway Pharmacy▼
1129 Harrison Ave
Centralia, WA 98531
(360)330-5229
Chehalis
Kmart Pharmacy▼
1201 Nw Louisiana Ave
Chehalis, WA 98532
(360)748-9681
Rite Aid▼
551 S Market Blvd
Chehalis, WA 98532
(360)748-8801
Safeway Pharmacy▼
1100 S Market Blvd
Chehalis, WA 98532
(360)740-6750
Walgreens▼
1610 Nw Louisiana Ave
Chehalis, WA 98532
(360)740-1876
Wal-mart▼
1601 Nw Louisiana Ave
Chehalis, WA 98532
(360)748-0858
Wal-mart▼
1601 Nw Louisiana Ave
Chehalis, WA 98532
(360)748-0858
Morton
Colton Pharmacy
377 S 2nd St
Morton, WA 98356
(360)496-5902
Lincoln County Hlth Mrt
Phcy▼
621 Morgan St
Davenport, WA 99122
(509)725-3310
Odessa
Odessa Drug▼
19 W 1st Ave
Odessa, WA 99159
(509)982-2541
MASON COUNTY
Belfair
Qfc Pharmacy▼
201 Ne State Route 300
Belfair, WA 98528
(360)275-9671
Rite Aid▼
23940 Ne State Route 3
Belfair, WA 98528
(360)275-8964
Safeway Pharmacy▼
23961 Ne State Route 3
Belfair, WA 98528
(360)275-0953
Winlock
Shelton
Cedar Village Pharmacy
206 E Walnut St
Winlock, WA 98596
(360)785-4711
LINCOLN COUNTY
Davenport
Davenport Good Neighbor
Phcy▼
525 Morgan St
Davenport, WA 99122
(509)725-1151
Fred Meyer Pharmacy▼
301 E Wallace Kneeland
Blvd
Shelton, WA 98584
(360)432-5373
Medicine Shoppe
Pharmacy▼
207 Professional Way
Shelton, WA 98584
(360)426-4272
90
Neil's Pharmacy▼
512 W Franklin St
Shelton, WA 98584
(360)426-3328
Safeway Pharmacy▼
600 Franklin St
Shelton, WA 98584
(360)426-0718
Wal-mart▼
100 E Wallace Kneeland
Blvd
Shelton, WA 98584
(360)427-0171
Wal-mart▼
100 E Wallace Kneeland
Blvd
Shelton, WA 98584
(360)427-0171
OKANOGAN COUNTY
Brewster
Brewster Health Mart
Drug▼
811 State Hwy 97 Ninth
Brewster, WA 98812
(509)689-2421
Family Health Centers▼
525 W Jay St
Brewster, WA 98812
(509)689-4406
Okanogan Douglas
Hospital Phcy
507 Hospital Way
Brewster, WA 98812
(509)689-2517
Okanogan
PACIFIC COUNTY
Okanogan Valley
Pharmacy▼
236 2nd Ave N
Okanogan, WA 98840
(509)422-9958
Ilwaco
Omak
Omak Pharmacy▼
903 Engh Rd Ste A
Omak, WA 98841
(509)422-1500
Rite Aid▼
609 Omache Dr
Omak, WA 98841
(509)826-2806
Wal-mart▼
902 Engh Rd
Omak, WA 98841
(509)826-6146
Wal-mart▼
902 Engh Rd
Omak, WA 98841
(509)826-6146
Tonasket
Ilwaco Pharmacy▼
101 1st Ave S
Ilwaco, WA 98624
(360)642-3133
PIERCE COUNTY
Long Beach
Top▼
1406 Lake Tapps Pkwy Se
Auburn, WA 98092
(253)876-1761
Long Beach Pharmacy▼
101 Bolstad Ave E
Long Beach, WA 98631
(360)642-3200
Ocean Park
Ocean Park Pharmacy▼
1501 Bay Ave
Ocean Park, WA 98640
(360)665-5181
Raymond
Sagens Pharmacy▼
515 Commercial St
Raymond, WA 98577
(360)942-2634
South Bend
Roy's Health Mart
Pharmacy▼
318 S Whitcomb Ave
Tonasket, WA 98855
(509)486-2149
Twisp
Ulrich Valley Health Mart
Phcy
420 Methow Hwy S
Twisp, WA 98856
(509)997-2191
Seeber's Health Mart▼
336 S Washington Ave
Newport, WA 99156
(509)447-2484
South Bend Pharmacy
101 Willapa Ave
South Bend, WA 98586
(360)875-5757
PEND OREILLE
COUNTY
Auburn
Walgreens▼
1502 Lake Tapps Pkwy Se
Auburn, WA 98092
(253)394-0019
Bonney Lake
Fred Meyer Pharmacy▼
20901 State Route 410 E
Bonney Lake, WA 98391
(253)891-7333
Multicare Bonney Lake
Pharmacy▼
10004 204th Ave E Ste 1200
Bonney Lake, WA 98391
(253)447-3355
Rite Aid▼
21302 State Rte 410 E
Bonney Lake, WA 98391
(253)862-2822
Target Pharmacy▼
9400 192nd Ave E
Bonney Lake, WA 98391
(253)862-6401
Newport
Safeway Pharmacy▼
121 W Walnut St
Newport, WA 99156
(509)447-3972
91
Wal-mart▼
19205 Sr 410 E
Bonney Lake, WA 98391
(253)826-9151
Wal-mart▼
19205 Sr 410 E
Bonney Lake, WA 98391
(253)826-9151
Bartell Drug▼
5500 Olympic Dr Nw
Gig Harbor, WA 98335
(253)858-7455
Buckley
Costco▼
10990 Harbor Hill Dr
Gig Harbor, WA 98335
(253)853-8609
Chuck's Drugs
787 Main St
Buckley, WA 98321
(360)829-0451
Dupont
Dupont Pharmacy▼
1545 Wilmington Dr Ste 160
Dupont, WA 98327
(253)964-3400
Eatonville
Kirk's Pharmacy▼
104 Mashell Ave N
Eatonville, WA 98328
(360)832-3121
Edgewood
Walgreens▼
729 Meridian Ave E
Edgewood, WA 98371
(253)927-3380
Firecrest
Firecrest Pharmacy▼
1107 Regents Blvd
Firecrest, WA 98466
(253)830-5242
Gig Harbor
Albertson's▼
11330 51st Ave Nw
Gig Harbor, WA 98332
(253)853-4755
Costless Senior Services
14218 92nd Ave Nw Ste D
Gig Harbor, WA 98329
(253)857-7677
Franciscan Phcy St
Anthony▼
11511 Canterwood Blvd Nw
Gig Harbor, WA 98332
(253)530-2653
Mt Rainier Clinic
Wholistic▼
6712 Kimball Dr Ste 100
Gig Harbor, WA 98335
(253)853-8853
Multicare Gig Harbor
Pharmacy▼
4545 Point Fosdick Dr Nw
Gig Harbor, WA 98335
(253)530-8030
Olympic Health Care
Services▼
4700 Pt Fosdick Rd Nw
Gig Harbor, WA 98335
(253)858-9941
Purdy Cost Less
Prescriptions▼
14218 92nd Ave Nw
Gig Harbor, WA 98329
(253)857-7797
Rite Aid▼
4818 Point Fosdick Dr Nw
Gig Harbor, WA 98335
(253)851-6939
92
Safeway Pharmacy▼
4831 Point Fosdick Dr Nw
Gig Harbor, WA 98335
(253)851-6870
Target Pharmacy▼
11400 51st Ave Nw
Gig Harbor, WA 98335
(253)858-7799
Walgreens▼
4840 Borgen Blvd
Gig Harbor, WA 98332
(253)853-9340
Graham
Rite Aid▼
22201 Meridian Ave E
Graham, WA 98338
(253)846-9455
Safeway Pharmacy▼
10105 224th St E
Graham, WA 98338
(253)847-7634
Walgreens▼
22320 Meridian Ave E
Graham, WA 98338
(253)875-1824
Lakewood
Community Healthcare
Pharmacy▼
10510 Gravelly Lake Dr Sw
Lakewood, WA 98499
(253)589-7190
Franciscan Pharmacy St
Clare▼
11315 Bridgeport Way Sw
Lakewood, WA 98499
(253)985-6290
Good Pharmacy▼
8741 S Tacoma Way
Lakewood, WA 98499
(253)584-9164
Safeway Pharmacy▼
900 Meridian E
Milton, WA 98354
(253)952-0390
International Pharmacy▼
11228 Bridgeport Sw
Lakewood, WA 98499
(253)302-4553
Orting
Lakewood Pharmacy▼
9601 South Tacoma Way
Lakewood, WA 98499
(253)581-3426
Rite Aid▼
5700 100th St Sw Ste 100
Lakewood, WA 98499
(253)588-3666
Walgreens▼
8224 Steilacoom Blvd Sw
Lakewood, WA 98498
(253)581-0494
Wal-mart▼
7001 Bridgeport Way W
Lakewood, WA 98499
(253)512-0960
Wal-mart▼
7001 Bridgeport Way W
Lakewood, WA 98499
(253)512-0960
Milton
Albertson's▼
2800 Milton Way Ste 10
Milton, WA 98354
(253)952-8436
Rite Aid▼
900 Meridian E
Milton, WA 98354
(253)952-2680
Cope's Pharmacy▼
134 Washington Ave S
Orting, WA 98360
(360)893-2117
Safeway Pharmacy▼
215 Whitesell St Nw
Orting, WA 98360
(360)893-0843
Puyallup
Albertson's▼
11012 Canyon Rd E
Puyallup, WA 98373
(253)537-3808
Costco▼
1201 39th Ave Sw
Puyallup, WA 98373
(253)445-7542
Good Samaritan Behavioral Hlth▼
325 E Pioneer Ave
Puyallup, WA 98372
(253)697-8333
Kirk's Pharmacy▼
11212 Sunrise Blvd E
Puyallup, WA 98374
(253)770-3408
Kirk's Pharmacy▼
3909 10th St Se Ste 2
Puyallup, WA 98374
(253)848-2011
Multicare Good Samaritan
Phcy▼
1450 5th St Se Ste 1200
Puyallup, WA 98372
(253)697-3494
Partner Oncology▼
1519 3rd St Se Ste 260
Puyallup, WA 98372
(253)770-1700
Rite Aid▼
11220 E Canyon Rd
Puyallup, WA 98373
(253)537-3071
Franciscan Pharmacy▼
15214 Canyon Rd E Ste 110
Puyallup, WA 98375
Rite Aid▼
(253)539-6030
12811 Meridian St E
Puyallup, WA 98373
Fred Meyer Pharmacy▼
(253)770-4700
1100 N Meridian Ste 12
Puyallup, WA 98371
Rite Aid▼
(253)840-8183
1323 E Main Ave
Puyallup, WA 98372
Fred Meyer Pharmacy▼
(253)848-3564
17404 Meridian E
Puyallup, WA 98375
Rite Aid▼
(253)445-7873
9502 176th St E
Puyallup, WA 98375
(253)846-5386
93
Safeway Pharmacy▼
11501 Canyon Rd E
Puyallup, WA 98373
(253)536-5296
Walgreens▼
11718 Meridian E
Puyallup, WA 98373
(253)770-6484
Wal-mart▼
20307 Mountain Hwy E
Spanaway, WA 98387
(253)846-6260
Safeway Pharmacy▼
13308 Meridan St E
Puyallup, WA 98373
(253)435-1742
Walgreens▼
14308 Meridian E
Puyallup, WA 98373
(253)604-1051
Sumner
Safeway Pharmacy▼
5616 176th St E
Puyallup, WA 98375
(253)414-1741
Wal-mart▼
16502 Meridian E
Puyallup, WA 98375
(253)446-1754
Safeway Pharmacy▼
611 S Meridian
Puyallup, WA 98371
(253)841-1534
Target Pharmacy▼
10302 156th St E
Puyallup, WA 98374
(253)604-1067
Target Pharmacy▼
3310 S Meridian
Puyallup, WA 98373
(253)864-4617
Top Food & Drug▼
201 37th Ave Se
Puyallup, WA 98374
(253)770-7720
Walgreens▼
10302 Sunrise Blvd E
Puyallup, WA 98374
(253)604-1013
Walgreens▼
11523 Canyon Rd E
Puyallup, WA 98373
(253)539-4165
Wal-mart▼
16502 Meridian E
Puyallup, WA 98375
(253)446-1754
Wal-mart▼
310 31st Ave Se
Puyallup, WA 98374
(253)770-9889
Wal-mart▼
310 31st Ave Se
Puyallup, WA 98374
(253)770-9889
Spanaway
Fred Meyer Pharmacy▼
22303 Mountain Hwy E
Spanaway, WA 98387
(253)875-4033
Rite Aid▼
22311 E Mountain Hwy
Spanaway, WA 98387
(253)846-0542
Wal-mart▼
20307 Mountain Hwy E
Spanaway, WA 98387
(253)846-6260
94
Fred Meyer Pharmacy▼
1201 Valley Ave
Sumner, WA 98390
(253)826-8433
Nicholson's Sumner
Pharmacy▼
910 Alder Ave
Sumner, WA 98390
(253)863-8141
Safeway Pharmacy▼
21301 Highway 410
Sumner, WA 98390
(253)862-2533
Tacoma
Albertson's▼
104 Military Rd S
Tacoma, WA 98444
(253)538-2611
Albertson's▼
2401 N Pearl St
Tacoma, WA 98406
(253)752-7919
Albertson's▼
8611 Steilacoom Blvd Sw
Tacoma, WA 98498
(253)582-4149
Allenmore Outpatient
Pharmacy▼
1901 S Union Ave
Tacoma, WA 98405
(253)459-6746
Bartell Drug▼
3601 6th Ave
Tacoma, WA 98406
(253)761-1248
Fred Meyer Pharmacy▼
4505 S 19th St
Tacoma, WA 98405
(253)756-9322
Chung Pharmacy▼
9122 South Tacoma Way
Tacoma, WA 98499
(253)584-2484
Fred Meyer Pharmacy▼
6901 S 19th St
Tacoma, WA 98466
(253)534-3033
Community Healthcare
Pharmacy▼
1102 S I St
Tacoma, WA 98405
(253)284-2324
Fred Meyer Pharmacy▼
7250 Pacific Ave
Tacoma, WA 98408
(253)475-1994
Community Healthcare
Pharmacy▼
11225 Pacific Ave S
Tacoma, WA 98444
(253)536-6257
Community Healthcare
Pharmacy▼
1708 E 44th St
Tacoma, WA 98404
(253)284-2226
Cost Less Prescriptions
5431 Pacific Ave
Tacoma, WA 98408
(253)474-9493
Cost Pharmacy-fircrest
1109 Regents Blvd
Tacoma, WA 98466
(253)564-5200
Costco▼
2219 S 37th St
Tacoma, WA 98409
(253)671-6002
Franciscan Pharmacy St Joseph▼
1708 Yakima Ave Ste 201
Tacoma, WA 98405
(253)426-6920
Kmart Pharmacy▼
1414 E 72nd St
Tacoma, WA 98404
(253)537-6668
Lincoln Pharmacy▼
821 S 38th St
Tacoma, WA 98418
(253)473-1155
Mai Linh Pharmacy▼
1211 S 11th St
Tacoma, WA 98405
(253)383-2576
Multicare Clinic
Pharmacy▼
521 Mlk Jr Way
Tacoma, WA 98405
(253)403-4920
Multicare Mary Bridge Phcy▼
311 S L St
Tacoma, WA 98405
(253)403-1411
Multicare Medical Center
Phcy▼
315 Mlk Jr Way
Tacoma, WA 98405
(253)403-2403
95
Multicare Westgate
Pharmacy▼
2209 N Pearl St Ste 100
Tacoma, WA 98406
(253)459-7144
Natural Health And Edu Svcs▼
201 N I St Ste C
Tacoma, WA 98403
(253)503-8792
Northwest Medical Specialties▼
1624 S I St Ste 407
Tacoma, WA 98405
(253)428-8740
Parkland Marketplace
Pharmacy▼
13322 Pacific Ave S
Tacoma, WA 98444
(253)531-3711
Puget Sound Pharmacy▼
1112 6th Ave Ste 101
Tacoma, WA 98405
(253)572-0180
Rankos Stadium Pharmacy
101 N Tacoma Ave
Tacoma, WA 98403
(253)383-2411
Rite Aid▼
15801 Pacific Ave S
Tacoma, WA 98444
(253)531-7427
Rite Aid▼
1850 S Mildred St
Tacoma, WA 98465
(253)460-9599
Rite Aid▼
1912 N Pearl St
Tacoma, WA 98406
(253)879-0140
Rite Aid▼
3840 W Bridgeport Way
Tacoma, WA 98466
(253)564-2255
Safeway Pharmacy▼
6201 6th Ave
Tacoma, WA 98406
(253)566-9217
Walgreens▼
3540 N Pearl St
Tacoma, WA 98407
(253)759-2378
Rite Aid▼
7041 Pacific Ave
Tacoma, WA 98408
(253)474-0115
Safeway Pharmacy▼
707 S 56th St
Tacoma, WA 98408
(253)471-1730
Walgreens▼
3737 Pacific Ave
Tacoma, WA 98418
(253)473-5215
Rumed
3602 Center St # 4
Tacoma, WA 98409
(253)627-2212
Tacoma Medical Center
Pharmacy▼
1206 S 11th St Ste 1
Tacoma, WA 98405
(253)383-5359
Walgreens▼
4315 6th Ave
Tacoma, WA 98406
(253)756-5159
Safeway Pharmacy▼
10223 Gravelly Lake Dr Sw
Tacoma, WA 98499
(253)581-7181
Safeway Pharmacy▼
1112 S M St
Tacoma, WA 98405
(253)572-7753
Safeway Pharmacy▼
1302 38th St S
Tacoma, WA 98418
(253)471-5511
Safeway Pharmacy▼
1624 72nd St E
Tacoma, WA 98404
(253)537-2435
Safeway Pharmacy▼
2411 N Proctor St
Tacoma, WA 98406
(253)759-9889
Safeway Pharmacy▼
2637 N Pearl St
Tacoma, WA 98407
(253)759-9271
Target Pharmacy▼
10509 Gravelly Lake Dr Sw
Tacoma, WA 98499
(253)414-1232
Target Pharmacy▼
3320 S 23rd St
Tacoma, WA 98405
(253)414-0303
Top Food And Drug▼
3130 S 23rd St
Tacoma, WA 98405
(253)591-3110
Walgreens▼
12105 Pacific Ave S
Tacoma, WA 98444
(253)535-9302
Walgreens▼
15225 Pacific Ave S
Tacoma, WA 98444
(253)538-6916
Walgreens▼
2024 6th Ave
Tacoma, WA 98403
(253)272-2311
96
Walgreens▼
5602 Pacific Ave
Tacoma, WA 98408
(253)203-0074
Walgreens▼
8405 Pacific Ave
Tacoma, WA 98444
(253)536-3778
Walgreens▼
9505 Bridgeport Way Sw
Tacoma, WA 98499
(253)582-2230
Wal-mart▼
1965 S Union Ave
Tacoma, WA 98405
(253)627-4094
Wal-mart▼
1965 S Union Ave
Tacoma, WA 98405
(253)627-4094
University Place
Albertson's▼
3905 Bridgeport Way W
University Place, WA 98466
(253)565-7997
Lopez Island
Bartell Drug▼
2700 Bridgeport Way Ste D
University Place, WA 98466 Lopez Island Pharmacy
(253)460-1879
352 Lopez Rd
Lopez Island, WA 98261
(360)468-2616
Franciscan Hospice Ltc
Phcy▼
2901 Bridgeport Way W
SKAGIT COUNTY
University Place, WA 98466
(253)534-7033
Anacortes
Fred Meyer Pharmacy▼
Family Pharmacy▼
6305 Bridgeport Way W
University Place, WA 98467 1213 24th St Ste 400
Anacortes, WA 98221
(253)460-4033
(360)293-2124
Healthy Self Naturopathic
Svcs▼
2607 Bridgeport Way W
University Place, WA 98466
(253)238-7922
Medicap Pharmacy▼
1415 Commercial Ave Ste B
Anacortes, WA 98221
(360)299-2374
Walgreens▼
2650 Bridgeport Way W
University Place, WA 98466
(253)564-0351
Rite Aid▼
1517 Commercial Ave
Anacortes, WA 98221
(360)293-2119
Safeway Pharmacy▼
Walgreens▼
911 11th St
7451 Cirque Dr W
University Place, WA 98467 Anacortes, WA 98221
(360)293-4148
(253)564-7569
SAN JUAN COUNTY
Eastsound
Rays Pharmacy▼
5 Templin Ctr
Eastsound, WA 98245
(360)376-2230
Friday Harbor
Friday Harbor Drug▼
210 Spring Ave W
Friday Harbor, WA 98250
(360)378-4421
Walgreens▼
909 17th St
Anacortes, WA 98221
(360)299-2816
Haggen Food And Drug▼
757 Haggen Dr
Burlington, WA 98233
(360)814-1561
Walgreens▼
623 S Burlington Blvd
Burlington, WA 98233
(360)707-2741
Concrete
East Valley Pharmacy▼
7438 S D Ave Ste C
Concrete, WA 98237
(360)853-8109
La Conner
La Conner Drug▼
708 E Morris St
La Conner, WA 98257
(360)466-3124
Mount Vernon
Haggen Food And
Pharmacy▼
2601 E Division St
Mount Vernon, WA 98274
(360)848-6930
Hilltop Pharmacy▼
1223 E Division St
Mount Vernon, WA 98274
(360)428-1710
Burlington
Costco▼
1725 S Burlington Blvd
Burlington, WA 98233
(360)757-5702
Fred Meyer Pharmacy▼
920 S Burlington Blvd
Burlington, WA 98233
(360)757-9133
97
Rite Aid▼
242 E College Way
Mount Vernon, WA 98273
(360)424-7958
Safeway Pharmacy▼
315 E College Way
Mount Vernon, WA 98273
(360)424-0467
Sea Mar Community Health
Ctr▼
1400 N Laventure
Mount Vernon, WA 98273
(360)542-8800
Skagit Regional Clinics
Phcy▼
1410 E Kincaid St
Mount Vernon, WA 98274
(360)428-6465
Skagit Valley Hosp
Pharmacy▼
1415 E Kincaid St
Mount Vernon, WA 98274
(360)428-2425
Skagit Valley Hospital Op
Phcy▼
1415 E Kincaid St
Mount Vernon, WA 98274
(360)428-8238
Wal-mart▼
2301 Freeway Dr
Mount Vernon, WA 98273
(360)428-3911
Wal-mart▼
2301 Freeway Dr
Mount Vernon, WA 98273
(360)428-3911
Sedro Woolley
Rite Aid▼
851 Moore St
Sedro Woolley, WA 98284
(360)856-2153
Skagit Regional Clinics
Phcy▼
1990 Hospital Dr Ste 120
Sedro Woolley, WA 98284
(360)854-2760
Walgreens▼
320 Harrison St
Sedro Woolley, WA 98284
(360)855-0735
Safeway Pharmacy▼
3532 172nd St Ne
Arlington, WA 98223
(360)651-6194
Serdo Woolley
Smokey Point Pharmacy▼
3823 172nd St Ne
Arlington, WA 98223
(360)653-2500
Hoagland Pharmacy
South▼
640 Sr Hwy 20
Serdo Woolley, WA 98284
(360)503-1676
SKAMANIA COUNTY
Stevenson
Wind River Pharmacy▼
280 Sw 2nd St
Stevenson, WA 98648
(509)427-5480
SNOHOMISH COUNTY
Arlington
Arlington Pharmacy▼
540 N West Ave
Arlington, WA 98223
(360)435-5771
Haggen Food &
Pharmacy▼
20115 74th Ave Ne
Arlington, WA 98223
(360)403-3861
Rite Aid▼
17226 Smokey Point Blvd
Arlington, WA 98223
(360)657-4410
Safeway Pharmacy▼
20500 Olympic Pl
Arlington, WA 98223
(360)403-3378
98
Wal-mart▼
4010 172nd St Ne
Arlington, WA 98223
(360)386-4539
Wal-mart▼
4010 172nd St Ne
Arlington, WA 98223
(360)386-4539
Bothell
Bartell Drug▼
22833 Bothell Hwy
Bothell, WA 98021
(425)481-7810
Bartell Drugs▼
18001 Bothell Everett Hwy
Bothell, WA 98012
(425)402-6485
Fred Meyer Pharmacy▼
21045 Bothell Everett Hwy
Bothell, WA 98021
(425)398-7033
Pacific Medical Center Phcy
1909 214th St Se Ste 300
Bothell, WA 98021
(425)412-6350
Rite Aid▼
22631 Se Bothell Way
Bothell, WA 98021
(425)481-8667
Safeway Pharmacy▼
20711 Bothell Everett Hwy
Bothell, WA 98012
(425)486-4473
Safeway Pharmacy▼
24040 Bothell Everett Hwy
Bothell, WA 98021
(425)482-2829
Walgreens▼
20812 Bothell Everett Hwy
Bothell, WA 98021
(425)398-0204
Darrington
Darrington Pharmacy▼
1200 Seemann St
Darrington, WA 98241
(360)436-1200
Edmonds
Bartell Drug▼
23028 100th Ave W
Edmonds, WA 98020
(425)670-2860
Edmonds Pharmacy▼
21701 76th Ave Ste 104a
Edmonds, WA 98026
(425)563-6381
Edmonds Pharmacy▼
7631 212th St Sw
Edmonds, WA 98026
(425)977-4880
Edmonds Wellness Clinic▼
7935 216th St Sw Ste E
Edmonds, WA 98026
(425)672-2113
Highland Pharmacy
22618 Highway 99 Ste 109
Edmonds, WA 98026
(425)673-8533
Naturopathic Family
Physician▼
23700 Edmonds Way
Edmonds, WA 98026
(206)724-1253
Pavilion Pharmacy▼
7320 216th St Sw Ste 100
Edmonds, WA 98026
(425)673-3700
Qfc Pharmacy▼
22828 100th Ave W
Edmonds, WA 98020
(425)778-2144
Rite Aid▼
22515 Highway 99
Edmonds, WA 98026
(425)670-2667
Safeway Pharmacy▼
23632 Highway 99
Edmonds, WA 98026
(425)775-1030
The Compounding
Apothecary▼
300 Admiral Way Ste 107
Edmonds, WA 98020
(425)672-9888
Top Food And Drug▼
21900 Highway 99
Edmonds, WA 98026
(425)672-1520
Everett
112th Street Chc
Pharmacy▼
1019 112th St Sw
Everett, WA 98204
(425)551-6521
Albertson's▼
520 128th St Sw
Everett, WA 98204
(425)347-1007
Albertson's▼
6727 Evergreen Way
Everett, WA 98203
(425)353-7539
Bartell Drug▼
11020 19th Ave Se
Everett, WA 98208
(425)337-7197
Bartell Drug▼
1825 Broadway
Everett, WA 98201
(425)303-2584
Bartell Drug▼
5006 132nd St Se Ste A
Everett, WA 98208
(425)357-6162
Bartell Drugs▼
3909 Hoyt Ave
Everett, WA 98201
(425)317-3620
Broadway Chc Pharmacy▼
1410 Broadway
Everett, WA 98201
(425)789-2050
Costco▼
10200 19th Ave Se
Everett, WA 98208
(425)379-7487
Family Pharmacy▼
7315 212th St Sw Ste 100
Edmonds, WA 98026
(425)778-7778
99
Everett Foot Clinic▼
3401 Rucker Ave
Everett, WA 98201
(425)259-3757
Fred Meyer Pharmacy▼
12906 Bothwell
Everett, WA 98208
(425)357-2033
Fred Meyer Pharmacy▼
8530 Evergreen Way
Everett, WA 98208
(425)348-8433
Haggen Food And
Pharmacy▼
8915 Market Place Dr
Everett, WA 98205
(425)377-7110
Jodi Bergs Intgrtve Fmly
Hlth▼
3903 Colby Ave
Everett, WA 98201
(425)258-2325
Mcquinn Naturopathic▼
2808 Hoyt Ave Ste 201
Everett, WA 98201
(425)293-0107
Medical Center Pharmacy▼
1330 Rockefeller Ave #150
Everett, WA 98201
(425)261-3559
Molina Healthcare▼
15 Sw Everett Mall Way
Everett, WA 98204
(952)653-2568
Physical Rehabilitation▼
919 128th St Sw
Everett, WA 98204
(425)347-8614
Providence Mill Creek
Phcy▼
12800 Bothell Everett Hwy
Everett, WA 98208
(425)316-5454
Qfc Pharmacy▼
2615 Broadway
Everett, WA 98201
(425)259-6262
Safeway Pharmacy▼
7601 Evergreen Way
Everett, WA 98203
(425)355-9303
Sevan Pharmacy▼
620 Se Everett Mall Way
Everett, WA 98208
(425)348-5353
Qfc Pharmacy▼
4919 Evergreen Way
Everett, WA 98203
(425)259-3444
Shiraz Specialty
Pharmacy▼
205 E Casino Rd Ste B16
Everett, WA 98208
(425)356-3276
Rite Aid▼
10103 Evergreen Way
Everett, WA 98204
(425)347-2180
Sound Holistic Health▼
2804 Grand Ave Ste 300
Everett, WA 98201
(425)258-4633
Rite Aid▼
4920a Evergreen Way
Everett, WA 98203
(425)252-4109
Target Pharmacy▼
405 Se Everett Mall Way
Everett, WA 98208
(425)353-7967
Safeway Pharmacy▼
11031 19th Ave Se
Everett, WA 98204
(425)337-0684
Walgreens▼
11216 4th Ave W
Everett, WA 98204
(425)355-9940
Safeway Pharmacy▼
1715 Broadway Ave
Everett, WA 98201
(425)339-9448
Walgreens▼
13110 Bothell Everett Hwy
Everett, WA 98208
(425)379-7274
Safeway Pharmacy▼
4128 Rucker Ave
Everett, WA 98201
(425)252-1911
Walgreens▼
2205 Broadway
Everett, WA 98201
(425)252-5213
Safeway Pharmacy▼
5802 134th Pl Se
Everett, WA 98208
(425)332-6179
Walgreens▼
6807 Evergreen Way
Everett, WA 98203
(425)438-9380
100
Wal-mart▼
11400 Highway 99
Everett, WA 98204
(425)923-1751
Wal-mart▼
11400 Highway 99
Everett, WA 98204
(425)923-1751
Granite Falls
Pharm-a-save
207 E Stanley St
Granite Falls, WA 98252
(360)691-7778
Rite Aid▼
608 W Stanley St
Granite Falls, WA 98252
(360)691-4659
Lake Stevens
Bartell Drug▼
621 Highway 9
Lake Stevens, WA 98258
(425)334-4028
Rite Aid▼
303 91st Ave Ne
Lake Stevens, WA 98258
(425)335-4513
Target Pharmacy▼
9601 Market Pl
Lake Stevens, WA 98258
(425)397-8944
Walgreens▼
718 91st Ave Ne
Lake Stevens, WA 98258
(425)334-1523
Lynnwood
Albertson's▼
12811 Beverly Park Rd
Lynnwood, WA 98087
(425)347-3145
Albertson's▼
19500 Highway 99
Lynnwood, WA 98036
(425)670-9723
Bartell Drug▼
17633 Highway 99
Lynnwood, WA 98037
(425)743-7555
Bartell Drugs▼
3625 148th St Sw Ste B
Lynnwood, WA 98087
(425)742-1120
Bethel Pharmacy▼
17424 Highway 99 Ste 206
Lynnwood, WA 98037
(425)741-0075
Fred Meyer Pharmacy▼
2902 164th St Sw
Lynnwood, WA 98037
(425)787-4933
Fred Meyer Pharmacy▼
4615 196th St Sw
Lynnwood, WA 98036
(425)670-0233
Lynnwood Chc Ppharmacy▼
4111 194th St Sw
Lynnwood, WA 98036
(425)835-5202
Pharmacy Care▼
4629 168th St Sw Ste A
Lynnwood, WA 98037
(425)743-2211
101
Rite Aid▼
18600b 33rd Ave W
Lynnwood, WA 98037
(425)771-9427
Rite Aid▼
7500 196th St Sw Ste A
Lynnwood, WA 98036
(425)774-6669
Safeway Pharmacy▼
14826 Highway 99
Lynnwood, WA 98087
(425)743-6808
Safeway Pharmacy▼
19715 Highway 99
Lynnwood, WA 98036
(425)778-4862
Target Pharmacy▼
18305 Alderwood Mall Pkwy
Lynnwood, WA 98037
(425)673-1395
Walgreens▼
16423 Larch Way
Lynnwood, WA 98037
(425)741-8283
Walgreens▼
16824 Hwy 99
Lynnwood, WA 98037
(425)741-4302
Walgreens▼
20725 Highway 99
Lynnwood, WA 98036
(425)712-0512
Wal-mart▼
1400 164th St Sw
Lynnwood, WA 98087
(425)741-3646
Wal-mart▼
1400 164th St Sw
Lynnwood, WA 98087
(425)741-3646
Marysville Pharmacy▼
9417 State Ave
Marysville, WA 98270
(360)653-4857
Rite Aid▼
3202 132nd St Se
Mill Creek, WA 98012
(425)379-7105
Wal-mart▼
17222 Highway 99
Lynnwood, WA 98037
(425)741-1284
Rite Aid▼
251 Marysville Mall
Marysville, WA 98270
(360)659-0492
Safeway Pharmacy▼
13314 Bothell Everett Hwy
Mill Creek, WA 98012
(425)337-4805
Marysville
Safeway Pharmacy▼
1258 State Ave
Marysville, WA 98270
(360)659-2882
Monroe
Wal-mart▼
17222 Highway 99
Lynnwood, WA 98037
(425)741-1284
Albertson's▼
301 Marysville Mall # 60
Marysville, WA 98270
(360)659-8952
Target Pharmacy▼
16818 Twin Lakes Ave
Marysville, WA 98271
(360)386-4021
Albertson's▼
19881 State Rd 2
Monroe, WA 98272
(360)794-5870
Mill Creek
Fred Meyer Pharmacy▼
18805 State Route 2
Monroe, WA 98272
(360)805-8133
Bartell Drugs▼
4420 76th St Ne
Marysville, WA 98270
(360)651-7410
Albertson's▼
3322 132nd St Se
Mill Creek, WA 98012
(425)338-1891
Neary Naturopathic Clinic▼
14841 179th Ave Se Ste 230
Monroe, WA 98272
(360)794-8183
Costco▼
16616 Twin Lakes Ave
Marysville, WA 98271
(360)652-4539
Mill Creek Pharmacy▼
1025 153rd St Se Ste 104
Mill Creek, WA 98012
(425)481-7575
Olympic Naturopathic Wellness▼
14841 179th Ave Se Ste 230
Monroe, WA 98272
(360)794-8183
Fred Meyer Pharmacy▼
9925 State Ave
Marysville, WA 98270
(360)653-0733
Purity Integrative Health
Ctr▼
15118 Main St Ste 500
Mill Creek, WA 98012
(425)337-7029
Pharm A Save Monroe▼
17788 147th St Se
Monroe, WA 98272
(360)794-4641
Haggen Food & Pharmacy▼
3711 88th St Ne
Marysville, WA 98270
(360)530-7761
Qfc Pharmacy▼
926 164th St Se
Mill Creek, WA 98012
(425)743-4806
Rite Aid▼
18906 State Route 2
Monroe, WA 98272
(360)794-0943
Hilton Pharmacy▼
220 State Ave
Marysville, WA 98270
(360)659-3222
Rite Aid▼
16222 Bothell Everett Hwy
Mill Creek, WA 98012
(425)741-8649
Safeway Pharmacy▼
19651 Highway 2
Monroe, WA 98272
(360)794-9644
Bartell Drug▼
6602 64th St Ne
Marysville, WA 98270
(360)658-5218
102
Valley View Clinical
Phrmcsts▼
14692 179th Ave Se Ste 200
Monroe, WA 98272
(360)794-5555
Mountlake Terrace
Albertson's▼
4301 212th St Sw
Mountlake Terrace, WA
98043
(425)775-5011
Bartell Drug▼
22803 44th Ave W
Mountlake Terrace, WA
98043
(425)771-3738
Mukilteo
Rite Aid▼
11700 Mukilteo Speedway
Mukilteo, WA 98275
(425)514-0620
Walgreens▼
10200 Mukilteo Speedway
Mukilteo, WA 98275
(425)315-9213
Snohomish
Kusler's Pharmacy▼
700 Avenue D
Snohomish, WA 98290
(360)568-7787
Rite Aid▼
205 Pine St
Snohomish, WA 98290
(360)563-0223
The Snohomish
Naturopathic▼
1101 Avenue D Ste D103
Snohomish, WA 98290
(360)568-2686
Top Food And Drug▼
1301 Avenue D
Snohomish, WA 98290
(360)568-5154
Stanwood
Bartell Drugs▼
7205 267th St Nw
Stanwood, WA 98292
(360)939-0572
Haggen Food &
Pharmacy▼
26603 72nd Ave Nw
Stanwood, WA 98292
(360)629-5520
Albertson's▼
17520 State Route 9 Se
Snohomish, WA 98296
(360)668-1407
Qfc Pharmacy▼
27008 92nd Ave Nw
Stanwood, WA 98292
(360)629-2500
Bartell Drug▼
1115 13th St
Snohomish, WA 98290
(360)568-0548
Rite Aid▼
26817 88th Dr Nw
Stanwood, WA 98292
(360)629-9519
Sultan
Sultan Pharmacy And Nat
Care
505 W Stevens Ave
Sultan, WA 98294
(360)793-8813
Tulalip
Rite Aid▼
3733 116th St Ne
Tulalip, WA 98271
(360)653-5178
Wal-mart▼
8924 Quilceda Blvd
Tulalip, WA 98271
(360)657-1223
Wal-mart▼
8924 Quilceda Blvd
Tulalip, WA 98271
(360)657-1223
Woodinville
Costco▼
24008 Sno Wood Rd
Woodinville, WA 98072
(425)806-7728
SPOKANE COUNTY
Airway Heights
Yokes Pharmacy▼
12825 W Sunset Hwy
Airway Heights, WA 99001
(509)244-5822
Cheney
Bi-mart Pharmacy▼
2221 1st St
Cheney, WA 99004
(509)235-4705
Fred Meyer Pharmacy▼
2801 Bickford Ave
Snohomish, WA 98290
(360)563-3733
103
Cheney Owl Health Mart
Phcy▼
120 F St
Cheney, WA 99004
(509)235-8441
Medicine Man Liberty
Lake▼
23801 E Appleway Ave
Liberty Lake, WA 99019
(509)255-7611
Safeway Pharmacy▼
2710 1st St
Cheney, WA 99004
(509)235-6030
Safeway Pharmacy▼
1233 N Liberty Lake Rd
Liberty Lake, WA 99019
(509)893-1202
Deer Park
Walgreens▼
1502 N Liberty Lake Rd
Liberty Lake, WA 99019
(509)570-0485
Bi-mart Pharmacy▼
412 S Main Ave
Deer Park, WA 99006
(509)276-9016
Mead
Albertson's▼
12312 N Division St
Spokane, WA 99218
(509)466-0357
Albertson's▼
3010 E 57th Ave
Spokane, WA 99223
(509)443-6502
Albertson's▼
510 W 37th Ave
Spokane, WA 99203
(509)455-4437
Albertson's▼
6520 N Nevada St
Spokane, WA 99208
(509)489-5287
Chas
401 S Main St
Deer Park, WA 99006
(509)434-0293
Yokes Pharmacy▼
14202 N Market St
Mead, WA 99021
(509)242-0201
Medicine Shoppe
Pharmacy▼
11 E H St Ste A
Deer Park, WA 99006
(509)276-5081
Medical Lake
Albertson's▼
9001 N Indian Trail Rd
Spokane, WA 99208
(509)465-8590
Medical Lake Owl Hm
Pharmacy▼
123 Lake St
Medical Lake, WA 99022
(509)299-5113
Bates Pharmaceutical
Svcs▼
3704 N Nevada Ste B
Spokane, WA 99207
(509)489-4500
Millwood
Bates Pharmacy▼
3704 N Nevada St
Spokane, WA 99207
(509)489-4500
Yokes Pharmacy▼
810 S Main St
Deer Park, WA 99006
(509)276-2939
Fairfield
Fairfield Owl Pharmacy▼
208 Main St
Fairfield, WA 99012
(509)283-4299
Liberty Lake
Albertson's▼
1304 N Liberty Lake Rd
Liberty Lake, WA 99019
(509)891-6967
Walgreens▼
2702 N Argonne Rd
Millwood, WA 99212
(509)892-1637
Spokane
1st Avenue Pharmacy▼
6 E 1st Ave
Spokane, WA 99202
(509)624-3017
104
Chas▼
3919 N Maple St
Spokane, WA 99205
(509)343-1116
Chas Denny Murphy
1001 W 2nd Ave
Spokane, WA 99201
(509)835-1205
Chas Pharmacy▼
5921 N Market St
Spokane, WA 99208
(509)343-1116
Chas-nhos▼
1803 W Maxwell Ave
Spokane, WA 99201
(509)444-8888
Costco▼
5601 E Sprague Ave
Spokane, WA 99212
(509)842-0002
Costco▼
7619 N Division St
Spokane, WA 99208
(509)466-3315
Deaconess Outpatient
Pharmacy▼
800 W 5th Ave
Spokane, WA 99204
(509)473-3784
Evergreen Naturopathic▼
315 W 9th Ave Ste 105
Spokane, WA 99204
(509)755-5100
Fifth And Browne
Pharmacy▼
104 W 5th Ave Ste 180e
Spokane, WA 99204
(509)838-4117
Fred Meyer Pharmacy▼
12120 N Division St
Spokane, WA 99208
(509)465-4433
Fred Meyer Pharmacy▼
400 So Thor St
Spokane, WA 99202
(509)532-4033
Hart And Dilatush
Pharmacy▼
601 W Riverside Ste 140
Spokane, WA 99201
(509)624-2111
Kmart Pharmacy▼
4110 E Sprague Ave
Spokane, WA 99202
(509)534-7367
Lidgerwood Owl Hm
Pharmacy▼
5901 N Lidgerwood St
Spokane, WA 99208
(509)483-3566
Medical Oncology
Associates Ps▼
6001 N Mayfair St
Spokane, WA 99208
(509)462-2273
Medicine Shoppe
Pharmacy▼
1327 W Northwest Blvd
Spokane, WA 99205
(509)327-1504
Northwest Health Systems
2818 N Sullivan Rd Bldg 2e
Spokane, WA 99216
(509)744-9891
Payless Drug Ltc Pharmacy
1224 E Westview Ct
Spokane, WA 99218
(800)330-3665
Rite Aid▼
112 N Howard St Ste 115
Spokane, WA 99201
(509)838-1851
Rite Aid▼
12420 N Division St
Spokane, WA 99218
(509)466-1946
105
Rite Aid▼
1443 N Argonne Rd
Spokane, WA 99212
(509)928-9121
Rite Aid▼
2215 A West Wellesley Ave
Spokane, WA 99205
(509)328-7887
Rite Aid▼
2929 E 29th Ave
Spokane, WA 99223
(509)535-9056
Rite Aid▼
4514 Regal St S
Spokane, WA 99223
(509)448-9063
Rite Aid▼
5520 N Division St
Spokane, WA 99208
(509)489-6010
Rite Aid▼
810 E 29th Ave
Spokane, WA 99203
(509)838-3508
Rite Aid▼
9007 N Indian Trail Rd
Spokane, WA 99208
(509)464-2791
Rite Aid▼
9120 N Division St
Spokane, WA 99218
(509)464-4480
Riverpoint Pharmacy▼
528 E Spokane Falls Blvd
Spokane, WA 99202
(509)343-6252
Rosauers Pharmacy▼
10618 E Sprague Ave
Spokane, WA 99206
(509)924-5560
Safeway Pharmacy▼
2507 W Wellesley Ave
Spokane, WA 99205
(509)325-4396
Rosauers Pharmacy▼
1724 W Francis
Spokane, WA 99205
(509)325-3431
Safeway Pharmacy▼
2509 29th Ave E
Spokane, WA 99223
(509)532-9182
Rosauers Pharmacy▼
1808 W 3rd Ave
Spokane, WA 99204
(509)624-0126
Safeway Pharmacy▼
3919 N Market St
Spokane, WA 99207
(509)482-3480
Rosauers Pharmacy▼
2610 E 29th Ave
Spokane, WA 99223
(509)535-3623
Safeway Pharmacy▼
902 W Francis Ave
Spokane, WA 99205
(509)327-6114
Rosauers Pharmacy▼
907 W 14th
Spokane, WA 99204
(509)624-2371
Safeway Pharmacy▼
E 933 Mission Ave
Spokane, WA 99202
(509)482-2089
Rosauers Pharmacy▼
9414 N Division
Spokane, WA 99218
(509)467-6806
Safeway Pharmacy▼
W 1616 Northwest Blvd
Spokane, WA 99205
(509)327-5010
Sacred Heart Med Ctr Op
Phcy▼
101 W 8th Ave
Spokane, WA 99204
(509)474-3088
Shopko Pharmacy▼
4515 S Regal St
Spokane, WA 99223
(509)448-9585
Safeway Pharmacy▼
10100 N Newport Hwy
Spokane, WA 99218
(509)465-3676
Safeway Pharmacy▼
1441 N Argonne Rd
Spokane, WA 99212
(509)921-8032
Shopko Pharmacy▼
E 13414 Sprague Ave
Spokane, WA 99216
(509)924-1744
Shopko Pharmacy▼
N 9520 Newport Hwy
Spokane, WA 99218
(509)466-7414
106
Sixth Ave Medical
Pharmacy▼
508 W 6th Ave
Spokane, WA 99204
(509)455-9345
Spokane Falls Family Clin
Phcy▼
120 W Mission Ave
Spokane, WA 99201
(866)983-9279
Target Pharmacy▼
9770 N Newport Hwy
Spokane, WA 99218
(509)466-7226
Walgreens▼
12 E Empire Ave
Spokane, WA 99207
(509)325-0781
Walgreens▼
12315 Highway 395
Spokane, WA 99218
(509)466-7461
Walgreens▼
1708 W Northwest Blvd
Spokane, WA 99205
(509)323-0309
Walgreens▼
2105 E Wellesley Ave
Spokane, WA 99207
(509)483-0342
Walgreens▼
2830 S Grand Blvd
Spokane, WA 99203
(509)455-3736
Walgreens▼
400 E 5th Ave Ste 102
Spokane, WA 99202
(509)838-0175
Walgreens▼
7905 N Division St
Spokane, WA 99208
(509)467-8361
Wal-mart▼
1221 S Hayford Rd
Spokane, WA 99224
(509)459-0614
Wal-mart▼
1221 S Hayford Rd
Spokane, WA 99224
(509)459-0614
Wal-mart▼
2301 West Wellesley Ave
Spokane, WA 99205
(509)327-2015
Wal-mart▼
2301 West Wellesley Ave
Spokane, WA 99205
(509)327-2015
Wal-mart▼
9212 N Colton St
Spokane, WA 99218
(509)464-2736
Spokane Valley
Albertson's▼
13606 E 32nd Ave
Spokane Valley, WA 99216
(509)892-3659
Valley Mission Homecare
Phcy▼
12509 E Mission Ave Ste
103
Spokane Valley, WA 99216
(509)928-6400
Albertson's▼
8851 E Trent Ave
Spokane Valley, WA 99212
(509)924-9052
Walgreens▼
12312 E Sprague Ave
Spokane Valley, WA 99216
(509)921-0659
Chas
924 S Pines Rd
Spokane Valley, WA 99206
(509)343-1116
Wal-mart▼
15727 E Broadway Ave
Spokane Valley, WA 99037
(509)922-9047
Fred Meyer Pharmacy▼
15609 E Sprague Ave
Spokane Valley, WA 99037
(509)921-5383
Medicine Shoppe
Pharmacy▼
12414 E Sprague Ave
Spokane Valley, WA 99216
(509)924-1222
Wal-mart▼
9212 N Colton St
Spokane, WA 99218
(509)464-2736
Rite Aid▼
12115 E Sprague Ave
Spokane Valley, WA 99206
(509)924-4922
Well Life Latah Pharmacy▼
4235 S Cheney Spokane Rd
Spokane, WA 99224
(509)838-0896
Safeway Pharmacy▼
14020 E Sprague Ave
Spokane Valley, WA 99216
(509)891-6319
Yokes Pharmacy▼
210 E North Foothills Dr
Spokane, WA 99207
(509)325-6933
Trading Company
Pharmacy▼
13014 E Sprague Ave
Spokane Valley, WA 99216
(509)926-2200
Yokes Pharmacy▼
3321 W Indian Trail Rd
Spokane, WA 99208
(509)325-8720
107
Wal-mart▼
15727 E Broadway Ave
Spokane Valley, WA 99037
(509)922-9047
Wal-mart▼
5025 E Sprague Ave
Spokane Valley, WA 99212
(509)534-1037
Wal-mart▼
5025 E Sprague Ave
Spokane Valley, WA 99212
(509)534-1037
Yokes Pharmacy▼
9329 E Montgomery Ave
Spokane Valley, WA 99206
(509)343-3379
Veradale
Walgreens▼
15510 E Sprague Ave
Veradale, WA 99037
(509)891-0735
STEVENS COUNTY
Kettle Falls
Chewelah
Kettle Falls Health Mart
Phcy▼
280 E 3rd Ave
Kettle Falls, WA 99141
(509)738-2223
Akers United Drug
406 Park St N
Chewelah, WA 99109
(509)935-8441
Valley Health Mart Drug▼
102 E Main Ave
Chewelah, WA 99109
(509)935-8611
Colville
Providence Health
Services Wa▼
1200 E Columbia Ave
Colville, WA 99114
(509)684-7727
Safeway Pharmacy▼
391 N Main St
Colville, WA 99114
(509)684-8481
Super One Pharmacy▼
1250 North Highway
Colville, WA 99114
(509)684-3151
Wal-mart▼
810 N Highway St
Colville, WA 99114
(509)684-2973
Wal-mart▼
810 N Highway St
Colville, WA 99114
(509)684-2973
Nine Mile Falls
Lake Spokane Pharmacy▼
5919 Highway 291 Ste 5
Nine Mile Falls, WA 99026
(509)443-4178
THURSTON COUNTY
Lacey
Costco▼
1470 Marvin Rd Ne
Lacey, WA 98516
(360)412-3488
Fred Meyer Pharmacy▼
700 Sleater-kinney Rd Se
Lacey, WA 98503
(360)438-6483
Metmeds Pharmacy▼
5707 Lacey Blvd Se
Lacey, WA 98503
(360)459-5401
Qfc Pharmacy▼
4775 Whitman Ln Se
Lacey, WA 98509
(360)438-6314
Rite Aid▼
4776 Whitman Ln Se
Lacey, WA 98513
(360)412-5962
Rite Aid▼
691 Sleater Kinney Rd Se
Lacey, WA 98503
(360)491-4111
108
Safeway Pharmacy▼
1243 Marvin Rd Ne
Lacey, WA 98516
(360)252-2235
Safeway Pharmacy▼
4700 Yelm Rd Se
Lacey, WA 98503
(360)438-0081
Safeway Pharmacy▼
6200 Pacific Ave Se
Lacey, WA 98503
(360)486-3401
Shopko Pharmacy▼
5500 Martin Way
Lacey, WA 98506
(425)456-4057
Target Pharmacy▼
665 Sleater Kinney Rd Se
Lacey, WA 98503
(360)486-8927
Walgreens▼
4540 Lacey Blvd Se
Lacey, WA 98503
(360)438-2353
Walgreens▼
8333 Martin Way E
Lacey, WA 98516
(360)455-0029
Wal-mart▼
1401 Galaxy Dr Ne
Lacey, WA 98503
(360)456-7862
Wal-mart▼
1401 Galaxy Dr Ne
Lacey, WA 98503
(360)456-7862
Olympia
Albertson's▼
3520 Pacific Ave Se
Olympia, WA 98501
(360)491-0330
Medical Center Pharmacy▼
3525 Ensign Rd Ne
Olympia, WA 98506
(360)491-7521
Providence Mother Joseph
Ctr
3333 Ensign Rd Ne
Olympia, WA 98506
(360)493-4572
Ralph's Thriftway
Pharmacy▼
1908 4th Ave E
Olympia, WA 98506
(360)352-4426
Rite Aid▼
305 Cooper Point Rd Nw
Olympia, WA 98502
(360)754-8014
Rite Aid▼
8230 Martin Way E
Olympia, WA 98516
(360)456-0444
Safeway Pharmacy▼
3215 Harrison Ave Nw
Olympia, WA 98502
(360)956-3827
Sea Mar Community Health
Ctrs▼
3030 Limited Ln Nw
Olympia, WA 98502
(360)704-7575
Target Pharmacy▼
2925 Harrison Ave Nw
Olympia, WA 98502
(360)570-4617
Top Food And Drug▼
1313 Cooper Point Rd Sw
Olympia, WA 98502
(360)754-1504
Vista Oncology▼
141 Lilly Rd Ne
Olympia, WA 98506
(360)413-8880
Walgreens▼
1510 Cooper Point Rd Sw
Olympia, WA 98502
(360)570-8008
Yauger Park Pharmacy▼
400 Yauger Way Sw
Olympia, WA 98502
(360)357-3371
Tenino
Hedden's Pharmacy
196 W Sussex Ave
Tenino, WA 98589
(360)264-2575
Tumwater
Safeway Pharmacy▼
4280 Martin Way E
Olympia, WA 98516
(360)456-0709
Albertson's▼
705 Trosper Rd Sw
Tumwater, WA 98512
(360)705-3679
Safeway Pharmacy▼
520 Cleveland Ave
Olympia, WA 98501
(360)943-7600
109
Costco▼
5500 Littlerock Rd Sw
Tumwater, WA 98512
(360)357-7290
Fred Meyer Pharmacy▼
555 Trosper Rd Sw
Tumwater, WA 98501
(360)753-7933
Martin's Southgate Drug▼
5201 Capitol Blvd S
Tumwater, WA 98501
(360)584-2644
Walgreens▼
702 Trosper Rd Sw
Tumwater, WA 98512
(360)943-5178
Wal-mart▼
5600 Littlerock Rd Sw
Tumwater, WA 98512
(360)350-6030
Wal-mart▼
5600 Littlerock Rd Sw
Tumwater, WA 98512
(360)350-6030
Yelm
Rite Aid▼
909 E Yelm Ave
Yelm, WA 98597
(360)458-9011
Safeway Pharmacy▼
1109 Yelm Ave E
Yelm, WA 98597
(360)458-8835
Tim's Pharmacy▼
106 1st St S
Yelm, WA 98597
(360)458-8467
Wal-mart▼
17100 State Route 507 Se
Yelm, WA 98597
(360)400-8062
Wal-mart▼
17100 State Route 507 Se
Yelm, WA 98597
(360)400-8062
WAHKIAKUM COUNTY
Cathlamet
Cathlamet Pharmacy▼
74 Main St
Cathlamet, WA 98612
(360)795-3691
WALLA WALLA
COUNTY
College Place
Wal-mart▼
1700 Se Meadowbrook Blvd
College Place, WA 99324
(509)525-3626
Wal-mart▼
1700 Se Meadowbrook Blvd
College Place, WA 99324
(509)525-3626
Bi-mart Pharmacy▼
1649 Plaza Way
Walla Walla, WA 99362
(509)529-9350
Family Med Ctr Pharmacy▼
1120 W Rose St
Walla Walla, WA 99362
(866)983-9279
Rite Aid▼
2028 E Isaacs Ave
Walla Walla, WA 99362
(509)529-1917
Safeway Pharmacy▼
1600 Plaza Way
Walla Walla, WA 99362
(509)522-4672
Safeway Pharmacy▼
215 E Rose St
Walla Walla, WA 99362
(509)522-0227
Shopko Pharmacy▼
1651 W Rose St
Walla Walla, WA 99362
(509)525-9207
Tallmans Pharmacy▼
4 W Main St
Walla Walla, WA 99362
(509)525-1010
Walla Walla
Adventist Health
Community▼
1111 S 2nd Ave
Walla Walla, WA 99362
(509)527-8333
Albertson's▼
450 N Wilbur Ave
Walla Walla, WA 99362
(509)529-3706
Walgreens▼
633 W Tietan St
Walla Walla, WA 99362
(509)529-1570
Custom Prescription
Shoppe▼
1313 E Maple St Ste 101
Bellingham, WA 98225
(360)685-4242
Fairhaven Pharmacy
1115 Harris Ave
Bellingham, WA 98225
(360)734-3340
Fred Meyer Pharmacy▼
1225 W Bakerview Rd
Bellingham, WA 98226
(360)788-2933
Fred Meyer Pharmacy▼
800 Lakeway Dr
Bellingham, WA 98226
(360)676-1105
Haggen Food And
Pharmacy▼
1401 12th St
Bellingham, WA 98225
(360)733-9277
Haggen Food And
Pharmacy▼
2814 Meridian St
Bellingham, WA 98225
(360)671-3305
Haggen Food And
Pharmacy▼
2900 Woburn St
Bellingham, WA 98226
(360)715-5320
Bellingham
Haggen Pharmacy▼
4545 Cordata Pkwy
Bellingham, WA 98226
(360)676-7373
Costco▼
4299 Guide Meridian St
Bellingham, WA 98226
(360)738-7851
Hoagland's Pharmacy▼
2330 Yew St
Bellingham, WA 98229
(360)734-5413
WHATCOM COUNTY
110
Meridian Cost Cutter▼
4131 Meridian St
Bellingham, WA 98226
(360)671-7456
Walgreens▼
4090 Guide Meridian
Bellingham, WA 98226
(360)734-0229
Rite Aid▼
1225 E Sunset Dr Ste 110
Bellingham, WA 98226
(360)671-5041
Wal-mart▼
4420 Meridian St
Bellingham, WA 98226
(360)647-1611
Rite Aid▼
1400 Cornwall Ave
Bellingham, WA 98225
(360)733-1980
Rite Aid▼
220 36th St
Bellingham, WA 98225
(360)734-8254
Rite Aid▼
222 Telegraph Rd
Bellingham, WA 98226
(360)676-8570
Rite Aid▼
3227 Northwest Ave
Bellingham, WA 98225
(360)647-2175
Sunset Cost Cutter
Pharmacy▼
1275 E Sunset Dr
Bellingham, WA 98226
(360)650-1537
Target Pharmacy▼
30 Bellis Fair Pkwy
Bellingham, WA 98226
(360)734-0220
Walgreens▼
1070 E Sunset Dr
Bellingham, WA 98226
(360)647-2713
Wal-mart▼
4420 Meridian St
Bellingham, WA 98226
(360)647-1611
Blaine
Rite Aid▼
1733 H St Ste 500
Blaine, WA 98230
(360)332-1616
Everson
Lynden
Fairway Drug▼
1758 Front St Ste 106
Lynden, WA 98264
(360)354-1226
Rite Aid▼
8090 Guide Meridian Rd
Lynden, WA 98264
(360)354-4284
Safeway Pharmacy▼
8071 Guide Meridan Rd
Lynden, WA 98264
(360)318-0698
Sumas
Sumas Drug▼
315 Cherry St
Sumas, WA 98295
(360)988-2681
Valley Drug▼
208 E Main St
Everson, WA 98247
(360)966-3481
WHITMAN COUNTY
Ferndale
Tick Klock Drugs▼
109 S Main St
Colfax, WA 99111
(509)397-2111
Haggen Food And
Pharmacy▼
1815 Main St
Ferndale, WA 98248
(360)380-7210
Rite Aid▼
5715 4th Ave
Ferndale, WA 98248
(360)384-1551
Colfax
Garfield
Garfield Pharmacy
207 N 3rd Ste 2
Garfield, WA 99130
(509)635-0100
Pullman
Walgreens▼
1901 Main St
Ferndale, WA 98248
(360)384-7658
111
Rite Aid▼
1630 Grand Ave S
Pullman, WA 99163
(509)334-7222
Safeway Pharmacy▼
430 Se Bishop Blvd
Pullman, WA 99163
(509)334-0819
Shopko Pharmacy▼
S 1450 Grand Ave
Pullman, WA 99163
(509)332-0503
Sids Professional
Pharmacy▼
825 S E Bishop Ste 301 B
Pullman, WA 99163
(509)334-6506
Wal-mart▼
695 Se Bishop Blvd
Pullman, WA 99163
(509)334-2981
Wal-mart▼
695 Se Bishop Blvd
Pullman, WA 99163
(509)334-2981
Wsu Health And Wellness
Svc▼
1125 Se Washington St
Pullman, WA 99163
(509)335-5742
Saint John
St John Pharmacy▼
18 E Front St
Saint John, WA 99171
(509)648-3430
Tekoa
Tekoa Pharmacy▼
124 N Crosby
Tekoa, WA 99033
(509)284-4205
YAKIMA COUNTY
Grandview
Wal-mart▼
2675 E Lincoln Ave
Sunnyside, WA 98944
(509)839-7030
Safeway Pharmacy▼
610 E Wine Country Rd
Grandview, WA 98930
(509)882-1060
Wal-mart▼
2675 E Lincoln Ave
Sunnyside, WA 98944
(509)839-7030
Yakima Vally Farm
Workers▼
1000 Wallace Way
Grandview, WA 98930
(866)983-9279
Toppenish
Gibbons Pharmacy▼
117 S Toppenish Ave
Toppenish, WA 98948
(509)865-2722
Selah
Howard's Drug▼
119 E 3rd Ave
Selah, WA 98942
(509)697-6125
Selah Save-on Foods
Pharmacy▼
800 N Park Ctr
Selah, WA 98942
(509)697-6188
Safeway Pharmacy▼
711 W First St
Toppenish, WA 98948
(509)865-4700
Yakima Vly Farm Wrkrs
Clinic▼
518 W 1st Ave
Toppenish, WA 98948
(509)865-3355
Union Gap
Sunnyside
Bi-mart Pharmacy▼
110 W South Hill Rd
Sunnyside, WA 98944
(509)839-0766
Rite Aid▼
2010 Yakima Valley Hwy
Ste C
Sunnyside, WA 98944
(509)839-2711
Safeway Pharmacy▼
613 N 6th St
Sunnyside, WA 98944
(509)839-2103
112
Costco▼
2310 Longfibre Rd
Union Gap, WA 98903
(509)454-5249
Rite Aid▼
2519 Main St
Union Gap, WA 98903
(509)453-3603
Shopko Pharmacy▼
2530 Rudkin Rd
Union Gap, WA 98903
(509)248-9567
Yakima
Albertson's▼
1610 W Lincoln Ave
Yakima, WA 98902
(509)452-6567
Albertson's▼
401 S 40th St
Yakima, WA 98908
(509)965-2336
North Star Lodge Pharmacy
808 N 39th Ave
Yakima, WA 98902
(509)574-3404
Rite Aid▼
12 N 9th Ave
Yakima, WA 98902
(509)452-2600
Rite Aid▼
2204 W Nob Hill Blvd Ste B
Bartons Center Pharmacy▼ Yakima, WA 98902
(509)453-4414
1011 W Spruce St
Yakima, WA 98902
(509)248-6232
Rite Aid▼
5606 Summitview Ave
Yakima, WA 98908
Bi-mart Pharmacy▼
(509)965-2037
1207 N 40th Ave
Yakima, WA 98908
(509)457-1628
Bi-mart Pharmacy▼
309 S 5th Ave
Yakima, WA 98902
(509)452-6648
Central Wa Family
Medicine▼
1806 W Lincoln Ave
Yakima, WA 98902
(509)494-6702
Fred Meyer Pharmacy▼
1206 N 40th Ave
Yakima, WA 98908
(509)576-6833
Kmart Pharmacy▼
2304 E Nob Hill Blvd
Yakima, WA 98901
(509)575-7552
Memorial Pharmacy▼
402 S 12th Ave
Yakima, WA 98902
(509)573-3808
Rosauers Pharmacy▼
410 S 72 Ave
Yakima, WA 98908
(509)972-0284
Safeway Pharmacy▼
205 N 5th Ave
Yakima, WA 98902
(509)457-8869
Terrace Village Hm
Pharmacy▼
4040 Terrace Heights Dr
Yakima, WA 98901
(509)248-3311
Tieton Village Drug▼
3708 Tieton Dr
Yakima, WA 98902
(509)966-6850
Walgreens▼
4001 Summitview Ave Ste 1
Yakima, WA 98908
(509)972-2986
Walgreens▼
610 W Yakima Ave
Yakima, WA 98902
(509)469-0246
Walgreens▼
6400 W Nob Hill Blvd
Yakima, WA 98908
(509)965-0541
Wal-mart▼
1600 E Chestnut Ave
Yakima, WA 98901
(509)248-3855
Safeway Pharmacy▼
5702 Summitview Ave
Yakima, WA 98908
(509)965-3870
Wal-mart▼
1600 E Chestnut Ave
Yakima, WA 98901
(509)248-3855
Safeway Pharmacy▼
905 E Mead Ave
Yakima, WA 98903
(509)248-8782
Wal-mart▼
6600 W Nob Hill Blvd
Yakima, WA 98908
(509)966-3814
Shopko Pharmacy▼
5801 Summitview Ave
Yakima, WA 98908
(509)965-6393
Wal-mart▼
6600 W Nob Hill Blvd
Yakima, WA 98908
(509)966-3814
113
Washington Hematology
Oncology▼
3911 Castlevale Rd Ste 201
Yakima, WA 98902
(509)454-9499
Wray's Chalet Thriftway▼
5605 Summitview Ave
Yakima, WA 98908
(509)966-0530
Wray's Thriftway▼
7200 W Nob Hill Blvd
Yakima, WA 98908
(509)965-0202
Yakima Neighborhood
Pharmacy▼
12 S 8th St
Yakima, WA 98901
(509)853-2354
Yakima Valley Farm Wkrs
Clinic▼
602 E Nob Hill Blvd
Yakima, WA 98901
(866)983-9279
114
Mail Order Pharmacies /
Farmacias de SHGLGR
por correo
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3DUDREWHQHUPiVLQIRUPDFLyQVREUHODVIDUPDFLDVGHSHGLGRSRUFRUUHRFRPXQtTXHVHFRQQXHVWUR'HSDUWDPHQWR
GH6HUYLFLRDOFOLHQWHDO5HWUDQVPLVLyQ77<0DUTXHGHDPDSPORVGtDV
GHODVHPDQD
Mail Order Pharmacies
Express Scripts
32%R[
6W/RXLV02
115
Home Infusion Pharmacies /
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7RJHWPRUHLQIRUPDWLRQDERXWWKHKRPHLQIXVLRQSKDUPDFLHVSOHDVHFDOORXU&XVWRPHU6HUYLFH'HSDUWPHQWDW
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116
BENTON COUNTY
SPOKANE COUNTY
Kennewick
Spokane
Option Care
7325 Deschutes Ave Ste C
Kennewick, WA 99336
(509)783-2273
Coram Specialty Infusion
Svcs
520 E North Foothills Dr
Spokane, WA 99207
(509)482-4266
KING COUNTY
Kent
Accredo Health Group
22408 68th Ave S
Kent, WA 98032
(253)872-2121
Redmond
Coram Specialty Infusion
Svcs
14935 Ne 87th St Ste 101
Redmond, WA 98052
(425)883-3525
Walgreens Infusion
Services
1328 N Ash St
Spokane, WA 99201
(509)326-0306
Spokane Valley
Lifecare Solutions
11703 E Sprague Ave Ste 3
Spokane Valley, WA 99206
(509)921-6560
WHATCOM COUNTY
Bellingham
Seattle
Option Care
13035 Gateway Dr Ste 131
Seattle, WA 98168
(800)277-5805
SNOHOMISH COUNTY
Everett
Infusion Solutions
134 Prince Ave Ste B
Bellingham, WA 98226
(360)933-4892
Option Care
477 W Horton Rd
Bellingham, WA 98226
(800)755-0484
Option Care
8120 Evergreen Way
Everett, WA 98203
(800)737-0613
117
Long Term Care Pharmacies /
Farmacias de atención a largo plazo
5HVLGHQWVRIDORQJWHUPFDUHIDFLOLW\PD\DFFHVVWKHLUSUHVFULSWLRQGUXJVFRYHUHGXQGHU&RPPXQLW\+HDOWK)LUVW
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7RJHWPRUHLQIRUPDWLRQDERXWWKHORQJWHUPFDUHSKDUPDFLHVSOHDVHFDOORXU&XVWRPHU6HUYLFH'HSDUWPHQWDW
77<5HOD\'LDOIURPDPWRSPGD\VDZHHN
/RVUHVLGHQWHVGHXQFHQWURGHDWHQFLyQDODUJRSOD]RSXHGHQWHQHUDFFHVRDVXVPHGLFDPHQWRVFRQUHFHWD
PpGLFDFXELHUWRVSRU&RPPXQLW\+HDOWK)LUVWSRUPHGLRGHODIDUPDFLDGHDWHQFLyQDODUJRSOD]RXRWUDIDUPDFLDGH
DWHQFLyQDODUJRSOD]RGHODUHG
3DUDREWHQHUPiVLQIRUPDFLyQVREUHODV)DUPDFLDVGHDWHQFLyQGHODUJRSOD]RFRPXQtTXHVHFRQQXHVWUR
'HSDUWDPHQWRGH6HUYLFLRDOFOLHQWHDO5HWUDQVPLVLyQ77<0DUTXHGHDPDSP
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118
ASOTIN COUNTY
GARFIELD COUNTY
KING COUNTY
Clarkston
Pomeroy
Auburn
Wasem's Drug▼
800 6th St
Clarkston, WA 99403
(509)758-2565
Pomeroy Pharmacy▼
764 Main Street
Pomeroy, WA 99347
(509)843-1821
Genoa Healthcare
4508 Auburn Way N Ste
A104
Auburn, WA 98002
(253)373-9944
CLARK COUNTY
GRANT COUNTY
Vancouver
Quincy
Qol Meds
2704 I St Ne
Auburn, WA 98002
(253)288-2111
Chs Pharmacy
6600 Ne 112th Ct Ste 103
Vancouver, WA 98662
(360)694-7377
Heartland Pharmacy▼
101 F St Sw
Quincy, WA 98848
(509)787-4437
Bellevue
Hi-school Pharmacy
6926 Ne Fourth Plain Blvd
Vancouver, WA 98661
(360)693-8374
GRAYS HARBOR
COUNTY
Bellegrove Pharmacy▼
1200 112th Ave Ne Ste A100
Bellevue, WA 98004
(425)455-2123
Montesano
Kent
Valu Drug▼
201 E Pioneer Ave
Montesano, WA 98563
(360)249-4444
A And H Pharmaceutical
Svcs
25022 104th Ave Se Ste E
Kent, WA 98031
(253)852-1123
Propac Pharmacy
1201 Se Tech Center Dr
Vancouver, WA 98683
(800)839-9836
Signature Pharmacy
1300 Se Cardinal Ct Ste 190
Vancouver, WA 98683
(360)448-4479
ISLAND COUNTY
COWLITZ COUNTY
Island Drug▼
11042 State Route 525
Clinton, WA 98236
(360)341-3885
Castle Rock
Castle Rock Pharmacy
117 1st Ave Sw
Castle Rock, WA 98611
(360)274-8211
Clinton
Oak Harbor
Island Drug▼
230 Se Pioneer Way
Oak Harbor, WA 98277
(360)675-6688
119
Pharmerica
18016 S 72nd Ave
Kent, WA 98032
(425)251-0118
Kirkland
Evergreen Pharmaceutical
12220 113th Ave Ne
Kirkland, WA 98034
(425)814-1925
Redmond
Consonus Pharmacy
Services
14729 Ne 87th St
Redmond, WA 98052
(866)698-5120
Renton
Jolly's Pharmacy
1412 Sw 43rd St Ste 120
Renton, WA 98057
(425)251-6335
Northwest Medication
Mgmt
4120 Stone Way N
Seattle, WA 98103
(206)547-1765
Ottersens Pharmaceutical
13023 Greenwood Ave N
Seattle, WA 98133
(206)365-4048
Premier Ltc Pharmacy
1618 S Lane St Ste 204
Seattle, WA 98144
(206)323-0868
Providence Infusion Phcy
Svs
2201 Lind Ave Sw Ste 130
Renton, WA 98057
(425)687-4429
Surecare Rx
1605 S 93rd St Ste B
Seattle, WA 98108
(206)767-0411
Seattle
Shoreline
Bob Johnsons Pharmacy
1407 Nw 85th St
Seattle, WA 98117
(206)782-5822
Fircrest School Pharmacy
15230 15th Ave Ne
Shoreline, WA 98155
(206)361-3568
Genoa Healthcare
1010 S 146th Ste 1
Seattle, WA 98168
(206)242-4446
Genoa Healthcare
1600 E Olive St Bldg D
Seattle, WA 98122
(425)835-7110
KITSAP COUNTY
Bremerton
Lowry's Prescriptions▼
10330 Meridian Ave N
Seattle, WA 98133
(206)368-6060
Centralia
Halls Drug Center▼
505 S Tower Ave
Centralia, WA 98531
(360)736-5000
Halls Long Term Care Phcy
505 S Tower Ave Ste 2b
Centralia, WA 98531
(360)736-5000
PIERCE COUNTY
Buckley
Rainier School
2120 Ryan Rd
Buckley, WA 98321
(360)829-3004
Gig Harbor
Costless Senior Services
14218 92nd Ave Nw Ste D
Gig Harbor, WA 98329
(253)857-7677
Lakewood
Genoa Healthcare
5455 Almira Dr Ne Ste 329
Bremerton, WA 98311
(360)415-6700
Port Orchard
Kelley Ross Ltc Pharmacy
2324 Eastlake Ave E
Seattle, WA 98102
(206)838-4590
LEWIS COUNTY
State Of Wa Veterans Home
1141 Beach Dr E
Port Orchard, WA 98366
(360)895-4700
Bridgeport Pharmacy
Services
7424 Bridgeport Way W
Lakewood, WA 98499
(253)582-2282
Genoa Healthcare
9330 59th Ave Sw Ste 179
Lakewood, WA 98499
(253)620-5132
International Pharmacy Ltc
11228 Bridgeport Way Sw
Lakewood, WA 98499
(253)302-4559
120
Tacoma
Lincoln Pharmacy
821b S 38th St
Tacoma, WA 98418
(253)473-1155
Western State Hosp
Pharmacy
9601 Steilacoom Blvd Sw
Tacoma, WA 98498
(253)756-2521
University Place
Pavilion Homecare
Pharmacy
7320 216th St Sw Ste 100b
Edmonds, WA 98026
(425)673-3700
Spokane
Everett
Genoa Healthcare
3322 Broadway Ste 230
Everett, WA 98201
(425)789-3050
Bates Pharmaceutical
Svcs▼
3704 N Nevada Ste B
Spokane, WA 99207
(509)489-4500
Payless Drug Ltc Pharmacy
111 Se Everett Mall Way
Everett, WA 98203
(425)257-9645
Evergreen Pharmaceutical
350 E 3rd Ave
Spokane, WA 99202
(509)838-4826
Franciscan Hospice Ltc
Phcy▼
2901 Bridgeport Way W
Shiraz Specialty Pharmacy
University Place, WA 98466 205 E Casino Rd Ste B16
(253)534-7033
Everett, WA 98208
(425)356-3276
SKAGIT COUNTY
Marysville
Anacortes
Medicap Pharmacy▼
1415 Commercial Ave Ste B
Anacortes, WA 98221
(360)299-2374
Lakeland Village
South 2320 Salnave Rd
Medical Lake, WA 99022
(509)299-1930
Arlington Pharmacy
9417 State Ave
Marysville, WA 98270
(360)659-5919
Mountlake Terrace
La Conner
La Conner Drug▼
708 E Morris St
La Conner, WA 98257
(360)466-3124
Mercury Pharmacy Services
21718 66th Ave W
Mountlake Terrace, WA
98043
(425)673-5200
SNOHOMISH COUNTY
SPOKANE COUNTY
Edmonds
Medical Lake
Edmonds Phcy Stevens
Hlth Ctr
21701 76th Ave W Ste 104b
Edmonds, WA 98026
(425)563-6381
Eastern State Hospital
800 Maple
Medical Lake, WA 99022
(509)565-4598
121
Northwest Health Systems
107 S Division St Ste 209
Spokane, WA 99202
(509)789-3366
Northwest Health Systems
2818 N Sullivan Rd Bldg 2e
Spokane, WA 99216
(509)744-9891
Payless Drug Ltc Pharmacy
1224 E Westview Ct
Spokane, WA 99218
(800)330-3665
Reliant Rx
120 N Pine St Ste 156
Spokane, WA 99202
(509)343-3400
Sacred Heart Med Ctr Op
Phcy▼
101 W 8th Ave
Spokane, WA 99204
(509)474-3088
Spokane Valley
WHATCOM COUNTY
Yakima
Pharmerica
2114 N Pines Rd Ste 4
Spokane Valley, WA 99206
(509)893-1011
Bellingham
Consulting And Pharmacy
Svcs
1221 S 40th Ave
Yakima, WA 98908
(509)575-0272
STEVENS COUNTY
Custom Prescription
Shoppe▼
1313 E Maple St Ste 101
Bellingham, WA 98225
(360)685-4242
Colville
Providence Health
Services Wa▼
1200 E Columbia Ave
Colville, WA 99114
(509)684-7727
THURSTON COUNTY
Lacey
Kirk's Chs Pharmacy
6149 Martin Way E
Lacey, WA 98516
(360)493-8614
Puget Pharmacy Services
1751 Circle Ln Se
Lacey, WA 98503
(360)456-5389
Hoagland Pharmacy Ltc
1414 Meador Ave Ste H102
Bellingham, WA 98229
(360)734-5413
Hoagland's Pharmacy▼
2330 Yew St
Bellingham, WA 98229
(360)734-5413
WHITMAN COUNTY
Pullman
Sid's Ltc Pharmacy
825 Se Bishop Blvd Ste 301
B
Pullman, WA 99163
(509)334-6506
YAKIMA COUNTY
Olympia
Selah
Northwest Specialty
Pharmacy
1908 4th Ave E Ste B
Olympia, WA 98506
(360)596-0108
Providence Mother Joseph
Ctr
3333 Ensign Rd Ne
Olympia, WA 98506
(360)493-4572
Yakima Valley School
609 Speyers Rd
Selah, WA 98942
(509)698-1345
Toppenish
Gibbons Pharmacy▼
117 S Toppenish Ave
Toppenish, WA 98948
(509)865-2722
122
Genoa Healthcare
402 S 4th Ave
Yakima, WA 98902
(509)248-5153
River Village Pharmacy
2609 River Rd
Yakima, WA 98902
(509)469-3198
Yakima Vly Memorial Hosp
Phcy
2811 Tieton Dr
Yakima, WA 98902
(509)575-8036
Indian Health Service / Tribal / Urban Indian Health Program ,78Pharmacies /
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7ULEXV3URJUDPDGHVDOXGSDUDLQGtJHQDVXUEDQRV,78DWUDYpVGHODUHGGHIDUPDFLDVGH&RPPXQLW\+HDOWK)LUVW
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123
CLALLAM COUNTY
MASON COUNTY
STEVENS COUNTY
Neah Bay
Shelton
Wellpinit
Sophia Trettevick Indian
Hlth
Highway 112 Clinic Rd
Neah Bay, WA 98357
(360)645-2431
Kamilche Pharmacy
90 Se Klah Che Min Dr
Shelton, WA 98584
(360)432-3990
David C Wynecoop Mem
Clnc
6203 Agency Loop Rd
Wellpinit, WA 99040
(509)258-4517
FERRY COUNTY
OKANOGAN COUNTY
WHATCOM COUNTY
Nespelem
Inchelium
Inchelium Community
Clinic
Inchelium-kettle Falls Hwy
Inchelium, WA 99138
(509)722-3331
GRAYS HARBOR
COUNTY
Taholah
Roger Saux Health Center
407 Connux St
Taholah, WA 98587
(360)276-4405
KING COUNTY
Seattle
Seattle Indian Health Board
611 12th Ave S
Seattle, WA 98114
(206)324-9360
Bellingham
Colville Indian Health Ctr
Agency Campus Hwy 155
Nespelem, WA 99155
(509)634-2914
Omak
Lummi Tribal Health Center
2592 Kwina Rd
Bellingham, WA 98226
(360)384-0464
YAKIMA COUNTY
Omak Health Station
Pharmacy
617 Benton St
Omak, WA 98841
(509)422-7454
PIERCE COUNTY
Tacoma
Puyallup Tribal Health
2209 E 32nd St Bldg 15
Tacoma, WA 98404
(253)593-0232
SNOHOMISH COUNTY
Tulalip
Tulalip Pharmacy
8825 34th Ave Ne Ste A
Tulalip, WA 98271
(360)651-4619
124
Toppenish
Yakama Indian Hlth Ctr
Phcy
401 Buster Rd
Toppenish, WA 98948
(509)865-1703
Index:
Chas Denny Murphy..............................104
112th Street Chc Pharmacy ....................99
Chas Pharmacy ....................................105
1st Avenue Pharmacy ...........................104
Chas-nhos .............................................105
A And H Pharmaceutical Svcs ........77, 119
Aberdeen Health Mart Pharmacy ............72
Chas-wasem ...........................................64
Access Pharmacy ...................................79
Cheney Owl Health Mart Phcy ..............104
Accredo Health Group ...........................117
Chesterfield Pharmacy ............................82
Adventist Health Community .................110
Children's Hospital Pharmacy .................82
Afh Pharamcy .........................................81
Chinook Pharmacy ..................................66
Ahp Pharmacy ........................................81
Chs Pharmacy .......................................119
Akers United Drug .................................108
Chuck's Drugs .........................................92
Albertson's ....64, 65, 66, 67, 73, 75, 76, 79
Chung Pharmacy ....................................95
80, 87, 88, 89, 92, 93, 94, 96, 99, 101, City Center Drug......................................72
102, 103, 104, 107, 109, 110, 113
Clarkston Heights Pharmacy ..................64
Allenmore Outpatient Pharmacy .............94
Cle Elum Drug .........................................89
Alpine Integrated Medicine .....................79
Colton Pharmacy ....................................90
Anderson Med Specialty Assoc ..............81
Columbia Basin Hematology ..................64
Apothecary Shoppe .................................87
Columbia Basin Natural Fam Med ..........71
Arlington Pharmacy .........................98, 121
Columbia Pharmacy ...............................82
Assured Pharmacy ..................................78
Columbia Valley Comm H Phcy ..............66
Ballard Plaza Pharmacy ..........................81
Colville Indian Health Ctr .......................124
Bartell ......................................................74
Community ..............................................82
Bartell Drug ...73, 74, 75, 76, 77, 78, 79, 80
Community Healthcare Pharmacy ....92, 95
81, 86, 87, 92, 95, 97, 98, 99, 101, 102, Consonus Pharmacy Services ..............120
103
Consulting And Pharmacy Svcs ............122
Bartell Drugs .....74, 77, 80, 82, 98, 99, 101
Cope's Pharmacy ....................................93
102, 103
Coram Specialty Infusion Svcs..............117
Bartons Center Pharmacy .....................113
Core Injury Management .........................80
Bates Pharmaceutical Svcs ..........104, 121
Bates Pharmacy ....................................104
Cork's ......................................................64
Cornerstone Family Health Cln ...............78
Bellegrove Pharmacy ......................74, 119
Bethel Pharmacy ...................................101
Cost Less Prescriptions ..........................95
Bi-mart Pharmacy ...64, 67, 69, 70, 89, 103
Cost Pharmacy-fircrest ...........................95
Costco .....64, 67, 70, 75, 76, 77, 78, 82, 87
104, 110, 112, 113
89, 92, 93, 95, 97, 99, 102, 103, 105, 108, Bob Johnsons Pharmacy ................82, 120
109, 110, 112
Brewster Health Mart Drug ......................90
Costless Senior Services ................92, 120
Bridgeport Pharmacy Services ..............120
Country Doctor Community Cln ..............82
Broadway Chc Pharmacy .......................99
Covington Multicare Clinic ......................75
Buck Pavilion Pharmacy .........................82
Crown Drug .............................................72
Cabrini Medical Tower Phcy....................82
Custom Prescription Shoppe ........110, 122
Castle Rock Pharmacy ....................69, 119
Darrington Pharmacy ..............................99
Cathlamet Pharmacy .............................110
Davenport Good Neighbor Phcy..............90
Cavallini's Pharmacy ...............................89
David C Wynecoop Mem Clnc ..............124
Cedar Village Pharmacy .........................90
Deaconess Outpatient Pharmacy .........105
Central Wa Family Medicine .................113
Densow's Pharmacy ...............................65
Central Washington Hosp Phcy ..............66
Des Moines Drug ....................................82
Chas ..............................................104, 107
Doane's Valley Pharmacy .......................65
125
Dong Nai Pharmacy ................................82
Dons Pharmacy ......................................73
Downtown Public Hlth Cntr Phcy ............82
Dupont Pharmacy ...................................92
Duvall Family Drugs ................................76
E Wenatchee Food Pavilion ...................70
East Valley Pharmacy .............................97
Eastern State Hospital ..........................121
Eastern's Pharmacy ................................82
Edmonds Pharmacy ...............................99
Edmonds Phcy Stevens Hlth Ctr ...........121
Edmonds Wellness Clinic .......................99
Elfers-lyon Pharmacy ..............................65
Elk Drug ..................................................69
Ellensburg Downtown Hm Phcy .............89
Ellensburg Pharmacy ..............................89
Elma Health Mart Pharmacy ...................72
Everett Foot Clinic .................................100
Evergreen Integrative Medicine...............74
Evergreen Naturopathic ........................105
Evergreen Pharmaceutical ............119, 121
Evergreen Pharmacy...............................78
Evergreen Prof Ctr Pharmacy .................78
Fairfield Owl Pharmacy .........................104
Fairhaven Pharmacy .............................110
Fairway Drug .........................................111
Family Health Centers ............................90
Family Med Ctr Pharmacy .....................110
Family Pharmacy ..............................97, 99
Family Wellness Center Pc ....................67
Federal Way Pharmacy ..........................76
Fiesta Pharmacy .....................................71
Fifth And Browne Pharmacy .................105
Fircrest School Pharmacy .....................120
Firecrest Pharmacy .................................92
Franciscan Hospice Ltc Phcy .........97, 121
Franciscan Pharmacy .............................93
Franciscan Pharmacy First Ave ..............76
Franciscan Pharmacy St Clare ...............92
Franciscan Pharmacy St Francis ............76
Franciscan Pharmacy St Joseph ............95
Franciscan Phcy St Anthony ...................92
Fred Meyer Pharmacy .....64, 65, 67, 68, 70
71, 73, 74, 76, 77, 78, 79, 80, 82, 87, 88, 89, 90, 91, 93, 94, 95, 97, 98, 100, 101, 102, 103, 105, 107, 108, 109, 110, 113
Friday Harbor Drug..................................97
Garfield Pharmacy.................................111
Genoa Healthcare .........119, 120, 121, 122
Gibbons Pharmacy ........................112, 122
Godfreys Pharmacy ................................69
Good Pharmacy ......................................93
Good Samaritan Behavioral Hlth .............93
Gross Drug ..............................................70
Haggen Food & Pharmacy ......98, 102, 103
Haggen Food And Drug...........................97
Haggen Food And Pharmacy ..97, 100, 110
111
Haggen Pharmacy.................................110
Halls Drug Center ............................89, 120
Halls Long Term Care Phcy ..................120
Harbor Drug.............................................72
Harborview Medical Center .....................82
Hart And Dilatush Pharmacy .................105
Healthpoint Auburn Pharmacy ................73
Healthpoint Bothell Pharmacy ................75
Healthpoint Central Fill Phcy ...................80
Healthpoint Federal Way Phcy ...............76
Healthpoint Kent Pharmacy ....................77
Healthy Self Naturopathic Svcs ...............97
Heartland Pharmacy........................72, 119
Hedden's Pharmacy ..............................109
Highland Pharmacy ...........................76, 99
Hilltop Pharmacy .....................................97
Hilton Pharmacy ....................................102
Hi-school Pharmacy ............68, 70, 89, 119
Hoagland Pharmacy Ltc ........................122
Hoagland Pharmacy South .....................98
Hoagland's Pharmacy ...................110, 122
Holly Park Pharmacy ..............................82
Howard's Drug.......................................112
Ikinya Pharmacy......................................88
Ilwaco Pharmacy .....................................91
Inchelium Community Clinic .................124
Infusion Solutions ..................................117
International Comm Hlth Svcs ................82
International Pharmacy ...........................93
International Pharmacy Ltc ...................120
Island Drug ......................................73, 119
Jim's Pharmacy ................................66, 76
Jodi Bergs Intgrtve Fmly Hlth ................100
Jolly's Pharmacy .............................80, 120
126
Kamilche Pharmacy ..............................124
Katterman's Sand Point Phcy .................82
Kelley Ross Ltc Pharmacy ..............82, 120
Kelley-ross Pharmacy .............................83
Kettle Falls Health Mart Phcy ................108
King Plaza Pharmacy ..............................83
Kirk's Chs Pharmacy .............................122
Kirk's Pharmacy ................................92, 93
Kitsap Pharmacy .....................................88
Kmart Pharmacy..........73, 89, 95, 105, 113
Kusler's Pharmacy ................................103
L J's Furness Drug ..................................70
La Conner Drug ...............................97, 121
Lafferry's Pharmacy ................................83
Lake Chelan Pharmacy ...........................66
Lake Spokane Pharmacy ......................108
Lakeland Village ...................................121
Lakewood Pharmacy ..............................93
Laura J Hieb Nd ......................................80
Legacy Salmon Creek Apothecary ..........68
Lidgerwood Owl Hm Pharmacy ............105
Lifecare Solutions ..................................117
Lincoln County Hlth Mrt Phcy ..................90
Lincoln Pharmacy ...........................95, 121
Lindeman Pavilion Pharmacy .................83
Linds Coupville Pharmacy ......................73
Lind's Freeland Pharmacy ......................73
Logar Pharmacy ......................................64
Long Beach Pharmacy ............................91
Lopez Island Pharmacy ...........................97
Lowry's Prescriptions ......................83, 120
Luke's Pharmacy ....................................83
Lummi Tribal Health Center ..................124
Lynnwood Chc Ppharmacy ...................101
Mai Linh Pharmacy .................................95
Malleys Compounding Pharmacy ...........65
Maple Leaf Pharmacy .............................83
Marks Camano Pharmacy ......................72
Martin's Southgate Drug .......................109
Marysville Pharmacy .............................102
Mcquinn Naturopathic ...........................100
Mediart Family Clinic ..............................74
Medical Center Pharmacy .......77, 100, 109
Medical Lake Owl Hm Pharmacy .........104
Medical Mall Pharmacy ...........................64
Medical Oncology Associates Ps ..........105
Medicap Pharmacy .........................97, 121
Medicine Man ..........................................83
Medicine Man Liberty Lake ...................104
Medicine Shoppe Pharmacy .....71, 90, 104
105, 107
Memorial Pharmacy ..............................113
Mercury Pharmacy Services .................121
Meridian Cost Cutter..............................111
Meridian Pharmacy .................................83
Metmeds Pharmacy ..............................108
Mikhail O Kisselev Nd .............................83
Mill Creek Pharmacy .............................102
Mill Plain Medical And Phcy ....................68
Molina Healthcare .................................100
Moses Lake Comm Hlth Ctr ....................72
Mt Rainier Clinic Wholistic ......................92
Multicare Bonney Lake Pharmacy ..........91
Multicare Clinic Pharmacy ......................95
Multicare Gig Harbor Pharmacy ..............92
Multicare Good Samaritan Phcy .............93
Multicare Mary Bridge Phcy ....................95
Multicare Medical Center Phcy ...............95
Multicare Westgate Pharmacy ................95
Natural Health And Edu Svcs ..................95
Natural Options Health Clinic ..................89
Naturopathic Family Physician ...............99
Naturopathic Medicine ............................76
Navos ......................................................83
Neary Naturopathic Clinic .....................102
Neighborcare Health ...............................83
Neil's Pharmacy ......................................90
Nguyens Pharmacy And Gifts .................83
Nicholson's Sumner Pharmacy ...............94
North Public Health Ctr Phcy ..................83
North Star Lodge Pharmacy ..................113
Northwest Health Systems ...........105, 121
Northwest Kidney Center Phcy ...............83
Northwest Medical Specialties ................95
Northwest Medication Mgmt .................120
Northwest Prescription ............................83
Northwest Specialty Pharmacy .............122
Nw Naturopathy And Acupuncture ..........83
Ocean Park Pharmacy ............................91
Ocean Shores Pharmacy ........................72
Odessa Drug ...........................................90
127
O'hana Wellness Center .........................74
Okanogan Douglas Hospital Phcy ..........90
Okanogan Valley Pharmacy ....................91
Olympic Drug ..........................................68
Olympic Health Care Services ................92
Olympic Naturopathic Wellness ...........102
Omak Health Station Pharmacy ............124
Omak Pharmacy .....................................91
Onuri Pharmacy ......................................76
Option Care ...........................................117
Ostrom Drugs ..........................................77
Othello Family Clinic Pharmacy ..............64
Ottersens Pharmaceutical ....................120
Owl Tri-state Pharmacy ...........................64
Pacific Drugs ...........................................83
Pacific Medical Center Phcy ...................98
Pacifica Natural Medicines .....................74
Pacmed Clinic Pharmacy ...........78, 80, 83
Pain Associates Of Washington .............80
Parkland Marketplace Pharmacy ............95
Park's Pharmacy .....................................83
Partner Oncology ....................................93
Pavilion Homecare Pharmacy ...............121
Pavilion Pharmacy ..................................99
Payless Drug Ltc Pharmacy ..........105, 121
Peacehealth St John Med Ctr .................70
Peckenpaugh Drug .................................73
Peninsula Comm Htlh Svcs Phcy ...........88
Peninsula Community Health Svs ..........87
Peninsula Community Hlth Srvs .............88
Peninsula Community Hlth Svcs .............88
Pharm A Save Monroe ..........................102
Pharmaca Integrative ..............................83
Pharmaca Integrative Pharmacy .......79, 83
Pharmaca Integrative Phcy .....................84
Pharmacare Specialty Phcy ....................84
Pharmacy Care .....................................101
Pharmacy Plus ........................................74
Pharm-a-save........................................101
Pharmerica ....................................119, 122
Phsw Pharmacy At Medical Ctr ..............68
Phsw Pharmacy At Memorial ..................68
Physical Rehabilitation ..........................100
Pioneer Med Center Pharmacy ...............72
Plan Parenthood Of Grt Nw Phcy............84
Plateau Community Pharmacy ...............76
Pomeroy Pharmacy .........................71, 119
Poulsbo Compounding Pharmacy ..........88
Premier Ltc Pharmacy ..........................120
Premier Pharmacy ..................................84
Propac Pharmacy ............................77, 119
Providence Centralia Hospital .................89
Providence Health Services Wa ....108, 122
Providence Infusion Phcy Svs ...............120
Providence Mill Creek Phcy ..................100
Providence Mother Joseph Ctr ......109, 122
Puget Pharmacy Services .....................122
Puget Sound Pharmacy ..........................95
Purdy Cost Less Prescriptions ................92
Purity Integrative Health Ctr ..................102
Puyallup Tribal Health ...........................124
Qfc Pharmacy .....67, 68, 73, 74, 75, 76, 77
78, 79, 84, 90, 99, 100, 102, 103, 108
Qol Meds ...............................................119
Que Areste Nd.........................................84
Rainier School .......................................120
Ralph's Thriftway Pharmacy .................109
Rankos Stadium Pharmacy ....................95
Rays Pharmacy .......................................97
Ready Meds Pharmacy ...........................80
Reliant Rx..............................................121
Republic Drug Store ................................71
Rite Aid ....64, 65, 66, 67, 68, 69, 70, 71, 72
73, 74, 75, 76, 77, 78, 79, 80, 84, 86, 87,
88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98,
99, 100, 101, 102, 103, 105, 107, 108,
109, 110, 111, 112, 113
Ritzville Drug ...........................................64
River Village Pharmacy .........................122
Riverpoint Pharmacy .............................105
Roger Saux Health Center ....................124
Rosauers Pharmacy ......................106, 113
Roy's Health Mart Pharmacy ..................91
Rumed.....................................................96
Saar's Marketplace Food ........................73
Sacred Heart Med Ctr Op Phcy.....106, 121
Safeway Pharmacy ...64, 65, 66, 67, 68, 69
70, 71, 72, 73, 74, 76, 77, 78, 79, 80, 81,
84, 85, 87, 88, 89, 90, 91, 92, 93, 94, 96,
97, 98, 99, 100, 101, 102, 104, 106, 107,
108, 109, 110, 111, 112, 113
Sagemed .................................................74
128
Sagens Pharmacy ...................................91
Sam's Club ............................73, 74, 80, 85
Sea Mar Community Health Ctr ..............98
Sea Mar Community Health Ctrs ..........109
Sea-mar Chc Pharmacy ..........................85
Seattle Cancer Care Alliance ..................85
Seattle Childrens Hospital ......................75
Seattle Indian Health Board ..................124
Seattlemeds Pharmacy ...........................85
Seeber's Health Mart ..............................91
Selah Save-on Foods Pharmacy...........112
Sevan Pharmacy ...................................100
Shiraz Specialty Pharmacy ...........100, 121
Shopko Pharmacy .....65, 66, 106, 108, 110
112, 113
Shoreline Natural Medicine .....................86
Sid's Ltc Pharmacy ...............................122
Sids Professional Pharmacy .................112
Signature Pharmacy ..............................119
Simon Wellness ......................................85
Sixth Ave Medical Pharmacy.................106
Skagit Regional Clinics Phcy ..................98
Skagit Valley Hosp Pharmacy .................98
Skagit Valley Hospital Op Phcy ...............98
Smokey Point Pharmacy ........................98
Snoqualmie Village Pharmacy ................87
Sophia Trettevick Indian Hlth.................124
Sound Holistic Health ...........................100
South Bend Pharmacy ............................91
South Park Pharmacy .............................88
Southgate Pharmacy ..............................72
Spokane Falls Family Clin Phcy ...........106
St John Pharmacy .................................112
State Of Wa Veterans Home .................120
Steps Of Healing .....................................74
Sultan Pharmacy And Nat Care ............103
Sumas Drug...........................................111
Sunset Cost Cutter Pharmacy ...............111
Super One Pharmacy ......................89, 108
Surecare Rx ..........................................120
Swanson Owl Pharmacy .........................72
Swedish First Hill Pharmacy ...................85
Swedish Issaquah Retail Phcy ...............77
Swedish Orthopedic Inst Phcy ................85
Swedish Pharmacy Cherry Hill ...............85
Tacoma Medical Center Pharmacy .........96
Tallmans Pharmacy...............................110
Target Pharmacy .65, 68, 70, 76, 77, 78, 80
85, 87, 89, 91, 92, 94, 96, 100, 101, 102, 106, 108, 109, 111
Tcch Pharmacy........................................71
Tekoa Pharmacy....................................112
Terrace Village Hm Pharmacy...............113
The Compounding Apothecary................99
The Connell Pharmacy ............................71
The Falls Phcy United Drugs ..................87
The Natural Path To Healing ...................87
The Prescription Pad Pharmacy .............80
The Snohomish Naturopathic ................103
The Vancouver Clinic ..............................68
The Vancouver Clinic Phcy .....................68
Three Moon Clinic ...................................75
Tick Klock Drugs....................................111
Tieton Village Drug ................................113
Tim's Pharmacy ....................................109
Tlc Integrative Pharmacy.........................75
Top...........................................................91
Top Food & Drug .....................................94
Top Food And Drug....74, 75, 78, 86, 87, 96
99, 103, 109
Trading Company Pharmacy.................107
Tri-area Pharmacy...................................73
Tulalip Pharmacy ..................................124
Twin Harbor Drug ....................................72
U And I Pharmacy ...................................75
Ulrich Valley Health Mart Phcy ................91
Union Center Pharmacy ..........................86
United Care Pharmacy ............................78
Uwmc Ambulatory Pharmacy .................86
Valley Drug............................................111
Valley Health Mart Drug ........................108
Valley Mission Homecare Phcy ............107
Valley View Clinical Phrmcsts ..............103
Valu Drug.........................................72, 119
Vancouver Clinic Pharmacy ....................68
Vashon Pharmacy ...................................87
Vashon Women's Health Center .............87
Village Pharmacy ....................................66
Vista Oncology ......................................109
Vital Therapeutics ...................................86
129
Walgreens .....65, 66, 67, 68, 69, 70, 71, 72
73, 74, 75, 76, 77, 78, 79, 80, 81, 86, 87, 88, 89, 90, 91, 92, 93, 94, 96, 97, 98, 99, 100, 101, 103, 104, 106, 107, 108, 109, 110, 111, 113
Walgreens Infusion Services .................117
Wal-mart .64, 65, 66, 67, 69, 70, 71, 72, 73
74, 75, 77, 81, 88, 89, 90, 91, 92, 93, 94, 96, 98, 101, 102, 103, 107, 108, 109, 110, 111, 112, 113
Wasem's Drug .................................64, 119
Washington Hematology Oncology .......114
Well Life Latah Pharmacy .....................107
Wenatchee Clinic Pharmacy ..................66
Western State Hosp Pharmacy ............121
Wfhc Pharmacy ......................................71
White Center Pharmacy ..........................86
Whole Family Clinic ................................75
Wind River Pharmacy .............................98
Winslow Drug .........................................87
Woodinville Med Ctr Phcy .......................87
Wray's Chalet Thriftway ........................114
Wray's Thriftway ....................................114
Wsu Health And Wellness Svc .............112
Yakama Indian Hlth Ctr Phcy ................124
Yakima Neighborhood Pharmacy..........114
Yakima Valley Farm Wkrs Clinic ...........114
Yakima Valley School............................122
Yakima Vally Farm Workers ..................112
Yakima Vly Farm Wrkrs Clinic ..............112
Yakima Vly Memorial Hosp Phcy ..........122
Yauger Park Pharmacy .........................109
Yokes Pharmacy .......65, 71, 103, 104, 107
130
Our prescription drug coverage is accepted at
more than 1,000 Washington State pharmacies
and more than 50,000 pharmacies nationwide.
Community HealthFirst prescription drug coverage travels with you. With more than 50,000 contracted
pharmacies nationwide, you have the freedom to fill your prescriptions anywhere you go. See below
for common network pharmacies. Keep in mind, this is not a complete list. Other pharmacies are
available in our network. To find a pharmacy in your area, visit our website at www.healthfirst.chpw.org
or call Customer Service during the hours of 8:00 a.m. to 8:00 p.m., 7 days a week. Current members
should call 1-800-942-0247, prospective members should call 1-800-944-1247 (TTY Relay: Dial 7-1-1).
Community HealthFirst Offers
Nationwide Prescription Drug Coverage
Offered by
Offered by:
Offered by
2014
Prospective Members: 1-800-944-1247 • Current Members: 1-800-942-0247
(TTY Relay: Dial 7-1-1) • 8:00 a.m. to 8:00 p.m., 7 days a week
Prescription Drug Formulary
& Network Pharmacies
720 OLIVE WAY, SUITE 300 • SEATTLE, WA 98101-1830
www.healthfirst.chpw.org
H5826_MA_47_2014 _v_01_FormularyPharmacy3tier CMS Approved