¿Qué es el formulario? ¿Puede cambiar el formulario? ¿Cómo
Formulario Buena Salud de Rocky Mountain Health Plans (RMHP) La familia de planes médicos de RMHP incluye estas entidades: Rocky Mountain Health Maintenance Organization Rocky Mountain HealthCare Options www.rmhp.org Revisado 11/01/2014 Descarte todas las copias anteriores del formulario Los beneficiarios deben usar farmacias de la red para tener acceso a sus beneficios de medicamentos con receta médica. ¿Qué es el formulario? El formulario es una lista de medicamentos cubiertos seleccionados por Rocky Mountain Health Plans (RMHP), en consulta con un equipo de proveedores de atención médica, que representa las terapias recetadas que se consideran necesarias como parte de un programa de tratamiento de calidad. RMHP generalmente cubrirá los medicamentos incluidos en nuestro formulario siempre y cuando el medicamento sea médicamente necesario, la receta se surta en una farmacia de la red y se sigan otras reglas del plan. Si desea más información sobre cómo surtir sus recetas, por favor revise su Evidencia de cobertura. ¿Puede cambiar el formulario? Sí. Si retiramos medicamentos de nuestro formulario, añadimos requisitos de autorización previa o límites de cantidad o cambiamos un medicamento a un nivel superior de costo compartido, informaremos de estos cambios a los miembros afectados. Si la Administración Federal de Alimentos y Medicamentos (FDA, por sus siglas en inglés) de los Estados Unidos considera que un medicamento que se encuentra en nuestro formulario no es seguro o el fabricante del medicamento lo retira del mercado, eliminaremos inmediatamente dicho medicamento de nuestro formulario y le enviaremos un aviso a los afiliados que lo toman. El formulario adjunto está vigente a partir del Noviembre 1, 2014. El formulario se actualiza constantemente. Para obtener información actualizada sobre los medicamentos que cubre RMHP, le agradeceremos llamar al Centro de Atención a Clientes. Los afiliados individuales o miembros de un plan grupal deben llamar a los siguientes teléfonos: 970-243-7050 u 800-346-4643. Los afiliados de Medicaid deben llamar a los siguientes teléfonos: 970-244-7860 u 888-282-8801. ¿Cómo utilizo el formulario? Existen dos formas de encontrar su medicamento en el formulario: Por enfermedad Los medicamentos que se encuentran en este formulario se agrupan en categorías dependiendo del tipo de enfermedad en que se utilizan. Por ejemplo, los medicamentos utilizados para tratar una enfermedad cardiaca se detallan en la categoría “Agentes cardiovasculares”. Luego busque su medicamento en esa categoría. FORM-Buena Salud-Noviembre de 2014 Lista alfabética El índice presenta una lista alfabética de todos los medicamentos incluidos en este documento. En dicho índice se detallan los medicamentos de marca y los genéricos. Busque su medicamento en el índice. Junto a su medicamento, verá el número de página donde podrá encontrar información sobre la cobertura. Vaya a la página que se indica en el índice y encuentre el nombre de su medicamento en la primera columna de la lista. El formulario contiene información sobre la cobertura de algunos de los medicamentos cubiertos por el plan médico. Si tiene problemas para encontrar su medicamento en la lista, consulte el índice. La primera columna del cuadro indica el nombre del medicamento. Los medicamentos de marca aparecen en mayúsculas (por ejemplo, ALLEGRA) y los medicamentos genéricos se describen en letra minúscula (por ejemplo, amoxicilina). La información que se encuentra en la columna Cobertura indica si el plan médico tiene algún requisito especial para la cobertura de su medicamento. Consulte la siguiente clave de abreviaturas del formulario. Consulte la sección “¿Existen restricciones sobre mi cobertura?”, donde encontrará información para obtener autorización previa. ¿Qué son los medicamentos genéricos? El principio activo de un medicamento genérico es el mismo que contiene el medicamento de marca. Los medicamentos genéricos generalmente cuestan menos que los medicamentos de marca y han sido aprobados por la Administración de Alimentos y Medicamentos de los Estados Unidos (FDA, por sus siglas en inglés), organismo que asegura que se cumplan las siguientes condiciones: El medicamento genérico debe contener los mismos principios activos, tener la misma potencia y la misma forma de dosificación que el medicamento de marca. La FDA ha otorgado una calificación de “A” en comparación con el medicamento de marca homólogo y, por lo tanto, ha determinado que el genérico es bioequivalente en términos terapéuticos. Cuando se cumplen los dos criterios mencionados anteriormente, los medicamentos de marca pueden sustituirse por genéricos con la plena certeza de que el producto sustituto tendrá el mismo efecto clínico y perfil de seguridad que el producto recetado. ¿Qué es una sustitución genérica? Algunos medicamentos se venden en una versión genérica que cuesta menos. Los medicamentos que tienen una versión genérica disponible por lo general se surten en la farmacia en la versión genérica en lugar de la de marca, salvo que su médico o usted soliciten el de marca. Los medicamentos genéricos generalmente están incluidos en el nivel 1. Si un medicamento genérico no ofrece ahorros financieros sobre la versión de marca, lo puede colocar en un nivel superior. Los medicamentos que tienen un equivalente genérico se presentan en minúsculas. Cuando sale a la venta una versión genérica de un medicamento de marca, este se clasificará en un nivel superior. Es probable que los afiliados tengan que pagar más por una receta cuando adquieran el producto de marca que se corresponde a un nivel superior. El pago que deberá efectuar el afiliado queda determinado por el plan de beneficios de farmacia. Cuando el sustituto genérico entra en conflicto con los reglamentos o restricciones estatales, el farmacéutico debe obtener primero la aprobación del médico tratante u otro profesional de la salud para sustituir el medicamento de marca por el genérico equivalente. 2 ¿Qué es intercambio terapéutico? Rocky Mountain Health Plans admite, pero no requiere necesariamente el uso del intercambio terapéutico como parte de una estrategia integral de tratamiento del paciente que sea económica y de calidad. El intercambio terapéutico es la práctica de sustituir, con autorización del médico tratante, un medicamento que originalmente se prescribió a un paciente por un medicamento con una composición química diferente. Se espera que los medicamentos utilizados en los programas de intercambio terapéutico produzcan niveles similares de eficacia clínica y resultados médicos sólidos, con base en los datos científicos disponibles. La Academy of Managed Care Pharmacy describe el intercambio terapéutico como programas elaborados por un equipo de médicos, farmacéuticos y otros profesionales médicos que son expertos en el diagnóstico y tratamiento de las enfermedades. Estos programas se diseñan para funcionar en conjunto con otras herramientas que los profesionales de la salud usan para promover resultados médicos de calidad. El uso del intercambio terapéutico ofrece varias ventajas: Valor para los pacientes: cuando el intercambio terapéutico tiene lugar es porque los médicos y otros expertos de la salud han determinado que los pacientes experimentarán resultados clínicos similares o mejores con las medicinas de reemplazo. Puede ser más cómodo para el paciente tomar el medicamento de reemplazo. Por ejemplo, es más probable que el paciente tome el medicamento recetado si se le proporciona un producto terapéuticamente equivalente que sólo necesita tomar dos veces al día en lugar de cuatro. Un medicamento que tiene muchas probabilidades de causar efectos secundarios puede sustituirse por otro que tenga menos probabilidades de causarlos. Un nuevo medicamento que ofrece mejores resultados terapéuticos puede sustituir a otro anterior. Por lo general, hay menos probabilidades de que el paciente omita la dosis y, en consecuencia, puede recibir todo el beneficio clínico del medicamento si le resulta práctico tomarlo, le causa menos efectos secundarios o le proporciona mayor control o alivio de la enfermedad. Asequibilidad: un medicamento de reemplazo que es equivalente en términos terapéuticos simplemente puede costar menos. Una vez que se determina que dos medicamentos producen los mismos resultados positivos para el paciente, conviene que el hospital, el plan médico o la red de farmacias usen la alternativa menos cara. Además, esto puede dar por resultado desembolsos personales menores para el paciente debido a las reducciones de los copagos. En los casos en que dos medicamentos son equivalentes terapéuticos, la AMCP no admite los programas de intercambio terapéutico que dan por resultado costos más altos para los pacientes o los patrocinadores del plan. Sin embargo, el intercambio terapéutico no siempre se relaciona con costos menores de los medicamentos. El intercambio terapéutico ocurre a menudo cuando es posible ahorrar en la atención médica en general. La sustitución de un medicamento por otro más caro puede dar origen a menos fallas del tratamiento, mejor observancia del plan de tratamiento por parte del paciente, menos efectos secundarios y mejores resultados clínicos. Este uso eficiente de los recursos médico contribuye a reducir los gastos médicos, mejora el acceso del paciente a atención médica más asequible y mejora la calidad de vida del paciente. ¿Existe alguna restricción en mi cobertura? Algunos medicamentos cubiertos pueden tener requisitos adicionales o limitaciones en la cobertura. Dichos requisitos y limitaciones pueden incluir: Autorización previa: RMHP requiere que usted o su médico obtengan autorización previa para ciertos medicamentos. Esto significa que deberá obtener la aprobación de RMHP antes de surtir sus recetas. Si no obtiene dicha aprobación, el plan médico puede no cubrir el medicamento. Los 3 medicamentos que están sujetos a autorización previa tienen un símbolo “PA” al lado del nombre del medicamento. o Médicos y farmacias, favor de llamar al 970-248-5031 u 800-641-8921 Fax: 970-248-5034 Límites de cantidad: En el caso de ciertos medicamentos, el plan médico limita la cantidad del medicamento que cubrirá. Por ejemplo, el plan médico proporciona 12 dosis por receta de Imitrex en tabletas. Esto puede ser adicional a la provisión normal para uno o tres meses. Los medicamentos que están sujetos a límites de cantidad tienen un símbolo “QL” al lado del nombre del medicamento. o Limitaciones de reposición: las recetas pueden volver a surtirse cuando se ha consumido 70% o más de la provisión diaria. Tratamiento escalonado: En algunos casos, el plan médico exige que primero pruebe ciertos medicamentos para tratar su enfermedad antes de que cubramos otro medicamento para dicha enfermedad. Por ejemplo, si el medicamento A y el medicamento B sirven para tratar su enfermedad, es posible que no proporcionemos cobertura del medicamento B a menos que usted pruebe primero el medicamento A. Si el medicamento A no le funciona, entonces cubriremos el medicamento B. Los medicamentos que están sujetos a tratamiento escalonado tienen un símbolo “ST” al lado del nombre del medicamento. Límite de edad: En algunos casos, los medicamentos sólo están disponibles para un afiliado que pertenece a una categoría de edad seleccionada. Los medicamentos que están sujetos a límites de edad tienen un símbolo “AL” al lado del nombre del medicamento. Límite de género: Algunos medicamentos sólo están disponibles para afiliados de cierto género. Los medicamentos que están disponibles sólo para cierto género tienen un símbolo “GL” al lado del nombre del medicamento. Para averiguar si su medicamento tiene algún requisito o límite adicional, busque dicho medicamento en el formulario a partir de la página 8. . Exclusiones del formulario RMHP se reserva el derecho de excluir cualquier medicamento del formulario de RMHP, en cualquier momento, por motivos de salud y seguridad o por otras razones que RMHP determine a su exclusivo criterio. Los siguientes medicamentos están excluidos del formulario de RMHP: Todo medicamento que por disposición de la FDA lleve la leyenda: “Precaución, limitado por la ley federal al uso en investigación”. Medicamentos que no estén disponibles, no se comercialicen o no se vendan en los Estados Unidos. Medicamentos obtenidos de una farmacia o proveedor situado fuera de los Estados Unidos, excepto medicamentos obtenidos en relación con una emergencia médica. Todo medicamento que no esté aprobado por la FDA. Todo medicamento que se use en relación con un servicio o suministro que no sea un beneficio (por ejemplo, los medicamentos empleados para la atención dental no están cubiertos). Medicamentos perdidos o robados: RMHP no cubrirá reposiciones de recetas por medicamentos perdidos, robados o dañados. 4 Además, todos los medicamentos de las siguientes categorías se excluyen de la cobertura del formulario de RMHP: Nombre o categoría genérica del medicamento Anorexígenos/medicamentos para bajar Ejemplo: Medicamentos compuestos que se emplean para indicaciones o por vías de administración que no han sido autorizadas por la FDA. Medicamentos compuestos para los cuales existe un fármaco aprobado por la FDA en la potencia y dosis prescritas. Hormonas compuestas no aprobadas por la FDA.* Medicamentos compuestos inyectables para la disfunción eréctil. Medicamentos compuestos que utilizan polvos. [Excepciones: sulfonato de poliestireno (Kayexalate), ácido salicílico, nistatina, cafeína] Fármacos cosméticos. Neurontin tópico y bloqueadores de canales de calcio de uso tópico. Combinaciones dobles y triples de estrógeno. Trimix, prostaglandinas- Propecia, Renova, Vaniqa, Lustra, Botox Cosmetic DHEA Medicamentos dentales. Monodox, Periostat Suplementos dietéticos Hypertensa, Theramine. Soluciones nebulizadas compuestas a partir de polvo Medicamentos que se venden con receta médica que tienen un equivalente de venta libre. Consulte a continuación la explicación de los medicamentos de venta libre. Triamcinolona Claritin, Lac-Hydrin *Estrógeno, progesterona o testosterona implantada quirúrgicamente en forma de gránulos, o progesterona en aceite inyectable no entran dentro de estas exclusiones. Medicamentos de venta libre: Los medicamentos de venta libre, con excepción de la insulina, no están cubiertos. Para los pacientes de diálisis renal: los antiácidos, todos los multivitamínicos, sustitución de calcio, Proferrin y Proferrin Forte se cubren con autorización previa. Los medicamentos de venta libre para dejar de fumar se cubren para derechohabientes de Medicaid con autorización previa; por ejemplo, los parches Nicoderm y la goma de mascar Nicorette. ¿Qué sucede si mi medicamento no se encuentra en el Formulario? Afiliados: Si su medicamento no está incluido en este formulario, debe comunicarse primero con Atención a clientes y confirmar que su medicamento no está cubierto. Si averigua que RMHP no cubre su medicamento, puede solicitarnos que hagamos una excepción a nuestras reglas, restricciones o limitaciones de cobertura. Llame al centro de atención a clientes para solicitar una revisión de excepción 5 al formulario, o encontrará un formulario de solicitud de excepción al formulario en https://www.rmhp.org/members/rx-info/formulary-exceptions-requests-commercial. Existen distintos tipos de excepciones que usted nos puede solicitar. Nos puede pedir que cubramos su medicamento aun cuando el mismo no se encuentre en nuestro formulario. Puede pedirnos que anulemos las restricciones o limitaciones de cobertura con respecto a su medicamento. Por ejemplo, para ciertos medicamentos, RMHP limita la cantidad del medicamento que cubriremos. Si su medicamento tiene un límite de cantidad, puede pedirnos que anulemos dicho límite y cubramos más. Puede pedirnos que proporcionemos un nivel más alto de cobertura para su medicamento. Si su medicamento está en nuestro nivel más alto, sujeto al proceso de excepciones de nivelación, es decir, el nivel 3, puede pedirnos que lo cubramos con el importe de costo compartido que se aplica a los medicamentos que están en el nivel más bajo sujeto al proceso de excepciones de nivelación, es decir, el nivel 2. Esto reduciría la cantidad que usted debe pagar por su medicamento. Por favor, tenga en cuenta que si accedemos a su solicitud de cubrir un medicamento que no se encuentra en nuestro formulario, no puede pedirnos también que brindemos un nivel más alto de cobertura para ese medicamento. Además, no puede pedirnos que brindemos un nivel más alto de cobertura para los medicamentos que se encuentran en el nivel de especialidades. Generalmente, RMHP sólo aprobará su solicitud de una excepción si los medicamentos alternativos incluidos en el formulario del plan, el medicamento de nivel más bajo o las restricciones adicionales a la utilización no fueran tan eficaces para tratar su enfermedad y/o causaran efectos médicos adversos. Información para proveedores: SOLICITUDES DE EXCEPCIÓN AL FORMULARIO: Para solicitar cobertura de un medicamento excluido, comuníquese con la oficina de asistencia farmacéutica de RMHP al 970-248-5031 (1-800-640-8921). Se le enviará por fax un formulario de solicitud de excepción al formulario, mismo que deberá llenar por completo y devolverlo por fax a RMHP al 970-248-5034. AUTORIZACIÓN PREVIA: Algunos medicamentos requieren autorización previa para que RMHP los cubra. Consulte los criterios específicos de PA para todos los medicamentos que requieren autorización previa en nuestro sitio web: http://www.rmhp.org/providers/prior-authorization/prior-authorizationpharmacy. También puede llamar a la oficina de asistencia farmacéutica de RMHP al 970-248-5031 (800-640-8921) y ellos le enviarán por fax un formulario de solicitud de autorización previa. Llene este formulario, adjunte el historial médico pertinente y devuélvalo por fax a la oficina de asistencia farmacéutica de RMHP. Indicadores de la política del formulario T1 = Medicamentos de alto costo (copago más bajo). Puede contener medicamentos genéricos y de marca. T2 = Medicamentos preferentes (bajo copago). Contiene medicamentos genéricos y de marca. T3 = Medicamentos no preferentes (copago medio). Contiene medicamentos genéricos y de marca. T4 = Medicamentos especializados preferentes (copago más alto). Contiene medicamentos de marca y medicamentos especializados genéricos de alto costo T5 = Medicamentos especializados no preferentes (copago más alto). Contiene medicamentos de marca y medicamentos especializados genéricos de alto costo T6 = beneficio médico PA = se requiere autorización previa. QL = límites de cantidad AL = límite de edad GL = límite de género X = medicamento excluido ST = tratamiento escalonado minúsculas = genérico MAYÚSCULAS = medicamentos de marca *Indica varias formas de dosificación 6 POLÍTICA DE REVISIÓN Los formularios de RMHP se revisan por lo menos cada trimestre. La cobertura de medicamentos puede cambiar entre revisiones. EDITOR Agradecemos su retroalimentación, comentarios y sugerencias, ya que mejoramos y actualizamos el formulario de manera continua. No dude en comunicarse con Heather Carwin, Pharm D (970-248-8743, 800-843-0719 ext. 8743) o Steve Nolan, Pharm D (970-248-5182, 800-843-0719 ext. 5182) 7 Nombre Forma de dosificación Nivel Cobertura Comentario Anti-infective Agents Anthelmintics ALBENZA TABS T2 BILTRICIDE TABS T2 MEBENDAZOLE CHEW T2 STROMECTOL TABS T2 amoxicillin * T1 amoxicillin (250mg) CHEW T1 amoxicillin/clavulanate potassium * T1 amoxicillin/clavulanate potassium er CONT.REL.TABS T1 amoxicillin/potassium clavulanate * T1 ampicillin CAPS T1 azithromycin * T1 cefaclor CAPS T1 cefadroxil * T1 cefdinir * T1 cefpodoxime proxetil * T1 cefprozil * T1 Antibacterials cefuroxime axetil * T1 cephalexin * T1 ciprofloxacin SUSPENSION T1 ciprofloxacin er CONT.REL.TABS T1 ciprofloxacin hcl TABS T1 clarithromycin * T1 clarithromycin er CONT.REL.TABS T1 clindamycin hcl CAPS T1 clindamycin palmitate hcl SOLUTION T1 demeclocycline hcl TABS T1 dicloxacillin sodium CAPS T1 doxycycline SUSPENSION T1 doxycycline hyclate * T1 doxycycline hyclate (100mg) TABS T1 doxycycline monohydrate CAPS T1 e.e.s. 400 (400mg) TABS T1 e.s.p. SUSPENSION T1 erythromycin (250mg) CAPS T1 erythromycin ethylsuccinate (400mg) TABS T1 erythromycin/sulfisoxazole SUSPENSION T1 levofloxacin * T1 minocycline hcl CAPS T1 moxifloxacin hcl TABS T1 neomycin sulfate TABS T1 OFLOXACIN TABS T1 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 8 ofloxacin Forma de dosificación TABS penicillin v potassium * T1 sulfamethoxazole/trimethoprim * T1 sulfamethoxazole/trimethoprim ds TABS T1 sulfasalazine * T1 sulfatrim pediatric SUSPENSION T1 sulfazine TABS T1 sulfazine ec T1 tetracycline hcl (250mg) ENTERIC COATED CAPS tetracycline hcl (500mg) CAPS T1 trimox CAPS T1 vancomycin hcl CAPS T1 ALODOX CONVENIENCE KIT KIT T2 AMOXICILLIN (125MG) CHEW T2 AMOXICILLIN (200MG) CHEW T2 AMOXICILLIN (250MG) CHEW T2 AMOXICILLIN (400MG) CHEW T2 AMPICILLIN SUSPENSION T2 CEFACLOR ER CONT.REL.TABS T2 CEPHALEXIN TABS T2 CIPRO (500MG/5ML) SUSPENSION T2 CIPRO (5GM/100ML) SUSPENSION T2 E.E.S. 400 (400MG) TABS T2 Nombre Nivel Comentario T1 T1 E.E.S. GRANULES SUSPENSION T2 ERY-TAB T2 ERYPED 200 ENTERIC COATED SUSPENSION ERYPED 400 SUSPENSION T2 T2 ERYTHROCIN STEARATE TABS T2 ERYTHROMYCIN (250MG) CAPS T2 ERYTHROMYCIN BASE TABS T2 ERYTHROMYCIN ETHYLSUCCINATE (400MG) TABS T2 FIRST-VANCOMYCIN 25 SOLUTION T2 FIRST-VANCOMYCIN 50 SOLUTION T2 KEFLEX (750MG) CAPS T2 NEO-FRADIN SOLUTION T2 PCE ENTERIC COATED TABS T2 SULFADIAZINE Cobertura T2 SUPRAX * T2 TETRACYCLINE HCL (250MG) CAPS T2 TETRACYCLINE HCL (500MG) CAPS T2 VIBRAMYCIN SYRUP T2 XIFAXAN (200MG) TABS T2 AUGMENTIN * T3 AUGMENTIN ES-600 SUSPENSION T3 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 9 AUGMENTIN XR Forma de dosificación CONT.REL.TABS AVELOX TABS T3 AVELOX ABC PACK TABS T3 AZITHROMYCIN PACK T3 AZULFIDINE TABS T3 AZULFIDINE EN-TABS ENTERIC COATED TABS T3 Nombre BACTRIM Nivel Cobertura Comentario T3 T3 BACTRIM DS TABS T3 BIAXIN * T3 BIAXIN XL CONT.REL.TABS T3 BIAXIN XL PAC CONT.REL.TABS T3 CEDAX * T3 CEFACLOR SUSPENSION T3 CEFTIBUTEN * T3 CEFTIN * T3 CIPRO TABS T3 CIPRO (500MG/5ML) SUSPENSION T3 CIPRO (5GM/100ML) SUSPENSION T3 CLEOCIN CAPS T3 CLEOCIN PEDIATRIC GRANULES SOLUTION T3 DIFICID TABS T3 FACTIVE TABS T3 KEFLEX (250MG) CAPS T3 KEFLEX (500MG) CAPS T3 KEFLEX (750MG) CAPS T3 KETEK TABS T3 LEVAQUIN * T3 MINOCIN CAPS T3 MINOCIN KIT KIT T3 MONODOX (100MG) CAPS T3 MONODOX (50MG) CAPS T3 NOROXIN TABS T3 OCUDOX KIT T3 SEPTRA TABS T3 SEPTRA DS TABS T3 VANCOCIN HCL CAPS T3 VIBRAMYCIN SUSPENSION T3 VIBRAMYCIN CAPS T3 ZITHROMAX * T3 ZITHROMAX TRI-PAK TABS T3 ZITHROMAX Z-PAK TABS T3 ZMAX SUSPENSION T3 CAYSTON SOLUTION T4 TOBI NEB SOLUTION T4 TOBI PODHALER CAPS T4 PA Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 10 tobramycin Forma de dosificación NEB SOLUTION XIFAXAN (550MG) TABS T4 ZYVOX * T4 AMIKACIN SULFATE SOLUTION T6 amikacin sulfate SOLUTION T6 AMPICILLIN SODIUM SOLUTION T6 ampicillin sodium SOLUTION T6 AMPICILLIN-SULBACTAM SOLUTION T6 ampicillin-sulbactam SOLUTION T6 AVELOX SOLUTION T6 AZACTAM SOLUTION T6 AZACTAM IN ISO-OSMOTIC DEXTROSE SOLUTION T6 azithromycin SOLUTION T6 AZITHROMYCIN SOLUTION T6 aztreonam SOLUTION T6 baciim SOLUTION T6 BACITRACIN SOLUTION T6 bacitracin SOLUTION T6 BACTOCILL IN DEXTROSE SOLUTION T6 BICILLIN C-R SUSPENSION T6 BICILLIN L-A SUSPENSION T6 CEFAZOLIN SODIUM SOLUTION T6 cefazolin sodium SOLUTION T6 CEFAZOLIN SODIUM SOLUTION T6 CEFAZOLIN SODIUM/DEXTROSE SOLUTION T6 CEFEPIME * T6 cefepime * T6 CEFEPIME SOLUTION T6 CEFOTAXIME SODIUM SOLUTION T6 cefotaxime sodium SOLUTION T6 CEFOTETAN SOLUTION T6 CEFOTETAN/DEXTROSE SOLUTION T6 cefoxitin sodium SOLUTION T6 CEFOXITIN SODIUM SOLUTION T6 Nombre Nivel Cobertura Comentario T4 Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 11 CEFTAZIDIME Forma de dosificación SOLUTION ceftazidime SOLUTION T6 CEFTAZIDIME/DEXTROSE SOLUTION T6 CEFTRIAXONE IN ISO-OSMOTIC DEXTROSE SOLUTION T6 ceftriaxone sodium SOLUTION T6 CEFTRIAXONE/DEXTROSE SOLUTION T6 CEFUROXIME SODIUM SOLUTION T6 cefuroxime sodium SOLUTION T6 CEFUROXIME/DEXTROSE SOLUTION T6 CHLORAMPHENICOL SODIUM SUCCINATE SOLUTION T6 CIPRO I.V. SOLUTION T6 CIPRO I.V.-IN D5W SOLUTION T6 CIPROFLOXACIN SOLUTION T6 ciprofloxacin SOLUTION T6 ciprofloxacin i.v.-in d5w SOLUTION T6 CLAFORAN SOLUTION T6 CLAFORAN/D5W SOLUTION T6 CLEOCIN IN D5W SOLUTION T6 CLEOCIN PHOSPHATE SOLUTION T6 CLEOCIN PHOSPHATE SOLUTION T6 CLINDAMYCIN PHOSPHATE SOLUTION T6 clindamycin phosphate SOLUTION T6 clindamycin phosphate add-vantage SOLUTION T6 clindamycin phosphate in d5w SOLUTION T6 clindamycin phosphate pharmacy bulk package SOLUTION T6 colistimethate sodium SOLUTION T6 COLY-MYCIN M SOLUTION T6 CUBICIN SOLUTION T6 DORIBAX SOLUTION T6 doxy 100 SOLUTION T6 doxycycline hyclate SOLUTION T6 ERYTHROCIN LACTOBIONATE SOLUTION T6 FORTAZ SOLUTION T6 FORTAZ SOLUTION T6 Nombre Nivel T6 Cobertura Comentario Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 12 Nombre Forma de dosificación Nivel gentamicin sulfate SOLUTION T6 gentamicin sulfate pediatric SOLUTION T6 GENTAMICIN SULFATE/0.9% SODIUM CHLORIDE SOLUTION T6 gentamicin sulfate/0.9% sodium chloride SOLUTION T6 gentamicin sulfate/sodium chloride SOLUTION T6 imipenem/cilastatin SOLUTION T6 INVANZ SOLUTION T6 ISOTONIC GENTAMICIN SOLUTION T6 isotonic gentamicin SOLUTION T6 KANAMYCIN SULFATE SOLUTION T6 LEVAQUIN SOLUTION T6 LEVAQUIN SOLUTION T6 levofloxacin SOLUTION T6 levofloxacin in d5w SOLUTION T6 LINCOCIN SOLUTION T6 MEFOXIN SOLUTION T6 meropenem SOLUTION T6 MERREM SOLUTION T6 MINOCIN SOLUTION T6 NAFCILLIN SODIUM SOLUTION T6 nafcillin sodium SOLUTION T6 NALLPEN ISO-OSMOTIC IN DEXTROSE SOLUTION T6 NALLPEN/DEXTROSE SOLUTION T6 oxacillin sodium SOLUTION T6 penicillin g potassium SOLUTION T6 PENICILLIN G POTASSIUM IN ISO-OSMOTIC DEXTROSE SOLUTION T6 PENICILLIN G PROCAINE SUSPENSION T6 PENICILLIN G SODIUM SOLUTION T6 PFIZERPEN-G SOLUTION T6 PIPERACILLIN SODIUM SOLUTION T6 piperacillin sodium/ tazobactam sodium SOLUTION T6 piperacillin sodium/tazobactam sodium SOLUTION T6 piperacillin/tazobactam SOLUTION T6 Cobertura Comentario injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 13 Nombre Forma de dosificación Nivel polymyxin b sulfate SOLUTION T6 PRIMAXIN I.M. SOLUTION T6 PRIMAXIN IV SOLUTION T6 PRIMAXIN IV ADD-VANTAGE SOLUTION T6 ROCEPHIN SOLUTION T6 ROCEPHIN IN ISO-OSMOTIC DEXTROSE SOLUTION T6 STREPTOMYCIN SULFATE SOLUTION T6 SULFAMETHOXAZOLE/TRIMETHOPRIM SOLUTION T6 SYNERCID SOLUTION T6 tazicef SOLUTION T6 TAZICEF SOLUTION T6 TEFLARO SOLUTION T6 TIMENTIN * T6 tobramycin sulfate * T6 TOBRAMYCIN SULFATE ADD-VANTAGE SOLUTION T6 TOBRAMYCIN SULFATE/SODIUM CHLORIDE SOLUTION T6 TYGACIL SOLUTION T6 UNASYN SOLUTION T6 UNASYN ADD-VANTAGE SOLUTION T6 UNASYN BULK PACK SOLUTION T6 VANCOMYCIN HCL SOLUTION T6 vancomycin hcl SOLUTION T6 VANCOMYCIN HCL IN DEXTROSE SOLUTION T6 ZINACEF SOLUTION T6 ZINACEF SOLUTION T6 ZINACEF IN ISO-OSMOTIC DEXTROSE SOLUTION T6 ZINACEF IN ISO-OSMOTIC DILUENT SOLUTION T6 ZITHROMAX SOLUTION T6 ZOSYN SOLUTION T6 ZOSYN SOLUTION T6 ZYVOX SOLUTION T6 ACTICLATE TABS X ADOXA * X Cobertura Comentario injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 14 ADOXA CK Forma de dosificación KIT ADOXA PAK 1/100 TABS X ADOXA PAK 1/150 TABS X Nombre Nivel Cobertura Comentario X ADOXA PAK 1/75 TABS X ADOXA PAK 2/100 TABS X ADOXA TT KIT X AMOXICILLIN ER CONT.REL.TABS X avidoxy TABS X AVIDOXY DK KIT X BETHKIS NEB SOLUTION X CEFDITOREN PIVOXIL TABS X CIPRO XR CONT.REL.TABS X DALVANCE SOLUTION X DORYX X doxycycline ENTERIC COATED CAPS X DOXYCYCLINE HYCLATE * X doxycycline hyclate (20mg) TABS X doxycycline hyclate dr X doxycycline monohydrate ENTERIC COATED TABS DYNACIN TABS X MAXIPIME SOLUTION X minocycline hcl TABS X MONODOX (75MG) CAPS X morgidox 1x100mg CAPS X MORGIDOX 1X100MG KIT X morgidox 2x100mg CAPS X MORGIDOX 2X100MG KIT X MOXATAG CONT.REL.TABS X NICAZELDOXY 30 KIT KIT X Non-self administerable injectable X NICAZELDOXY 60 KIT KIT X NUTRIDOX KIT X ORAXYL CAPS X ORBACTIV SOLUTION X PERIOSTAT TABS X PROQUIN XR CONT.REL.TABS X SIVEXTRO TABS X SIVEXTRO SOLUTION X SPECTRACEF TABS X VIBATIV SOLUTION X bio-statin POWDER T1 fluconazole * T1 Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Antifungals Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 15 flucytosine Forma de dosificación CAPS griseofulvin microsize * T1 griseofulvin ultramicrosize TABS T1 itraconazole CAPS T1 ketoconazole TABS T1 nystatin * T1 Nombre Nivel Cobertura Comentario T1 nystatin SUSPENSION T1 terbinafine hcl TABS T1 BIO-STATIN CAPS T2 FIRST-DUKES MOUTHWASH SUSPENSION T2 FIRST-MARYS MOUTHWASH SUSPENSION T2 NOXAFIL * T2 SPORANOX SOLUTION T2 ANCOBON CAPS T3 DIFLUCAN * T3 FIRST-BXN MOUTHWASH SUSPENSION T3 GRIFULVIN V TABS T3 GRIS-PEG TABS T3 LAMISIL * T3 SPORANOX CAPS T3 SPORANOX PULSEPAK CAPS T3 TERBINEX KIT T3 VFEND * T4 voriconazole * T4 ABELCET SUSPENSION T6 AMBISOME SUSPENSION T6 AMPHOTEC SUSPENSION T6 AMPHOTERICIN B SOLUTION T6 CANCIDAS SOLUTION T6 DIFLUCAN IN NACL SOLUTION T6 ERAXIS SOLUTION T6 fluconazole in dextrose SOLUTION T6 FLUCONAZOLE IN NACL SOLUTION T6 fluconazole in nacl SOLUTION T6 MYCAMINE SOLUTION T6 NOXAFIL SOLUTION T6 VFEND IV SOLUTION T6 voriconazole SOLUTION T6 ONMEL TABS X Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Antimycobacterials Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 16 ethambutol hcl Forma de dosificación TABS isonarif CAPS T1 isoniazid TABS T1 pyrazinamide TABS T1 rifabutin CAPS T1 rifampin CAPS T1 CYCLOSERINE CAPS T2 DAPSONE TABS T2 ISONIAZID SYRUP T2 Nombre Nivel Cobertura Comentario T1 PASER PACK T2 PRIFTIN TABS T2 RIFAMATE CAPS T2 RIFATER TABS T2 SEROMYCIN CAPS T2 TRECATOR TABS T2 MYAMBUTOL TABS T3 MYCOBUTIN CAPS T3 RIFADIN CAPS T3 CAPASTAT SULFATE SOLUTION T6 ISONIAZID SOLUTION T6 RIFADIN SOLUTION T6 rifampin SOLUTION T6 SIRTURO TABS X atovaquone/proguanil hcl TABS T1 chloroquine phosphate TABS T1 Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Antiprotozoals hydroxychloroquine sulfate TABS T1 mefloquine hcl TABS T1 metronidazole * T1 paromomycin sulfate CAPS T1 quinine sulfate CAPS T1 tinidazole TABS T1 ALINIA * T2 COARTEM TABS T2 DARAPRIM TABS T2 NEBUPENT SOLUTION T2 PRIMAQUINE PHOSPHATE TABS T2 YODOXIN TABS T2 ARALEN TABS T3 FLAGYL * T3 FLAGYL ER CONT.REL.TABS T3 MALARONE TABS T3 PLAQUENIL TABS T3 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 17 QUALAQUIN Forma de dosificación CAPS TINDAMAX TABS T3 atovaquone SUSPENSION T4 MEPRON SUSPENSION T4 METRO IV SOLUTION T6 metronidazole in nacl 0.79% SOLUTION T6 NEUTREXIN SOLUTION T6 PENTAM 300 SOLUTION T6 HALFAN TABS X abacavir TABS T1 acyclovir * T1 didanosine CONT.REL.CAPS T1 famciclovir TABS T1 lamivudine TABS T1 lamivudine/zidovudine TABS T1 nevirapine TABS T1 nevirapine er CONT.REL.TABS T1 rimantadine hcl TABS T1 Nombre Nivel Cobertura Comentario T3 Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Antivirals stavudine * T1 valacyclovir hcl TABS T1 zidovudine * T1 abacavir sulfate/lamivudine/zidovudine TABS T2 APTIVUS * T2 COMBIVIR (150MG; 300MG) TABS T2 CRIXIVAN CAPS T2 EDURANT TABS T2 EMTRIVA * T2 EPIVIR SOLUTION T2 EPIVIR HBV SOLUTION T2 EPZICOM TABS T2 INTELENCE TABS T2 INVIRASE * T2 ISENTRESS * T2 KALETRA * T2 NEVIRAPINE SUSPENSION T2 NORVIR * T2 RELENZA DISKHALER AEROSOL T2 RESCRIPTOR TABS T2 REYATAZ CAPS T2 SELZENTRY TABS T2 SUSTIVA * T2 TAMIFLU * T2 PA Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 18 TRUVADA Forma de dosificación TABS VIDEX PEDIATRIC SOLUTION T2 VIRACEPT * T2 Nombre Nivel Cobertura Comentario T2 VIRAMUNE XR (100MG) CONT.REL.TABS T2 VIREAD * T2 ZIAGEN * T2 ZIAGEN (300MG) TABS T2 COMBIVIR (150MG; 300MG) TABS T3 EPIVIR TABS T3 EPIVIR HBV TABS T3 FAMVIR TABS T3 FLUMADINE TABS T3 RETROVIR * T3 TIVICAY TABS T3 VALTREX TABS T3 VIDEX EC CONT.REL.CAPS T3 VIRAMUNE * T3 VIRAMUNE XR (400MG) CONT.REL.TABS T3 ZERIT * T3 ZIAGEN (300MG) TABS T3 ZOVIRAX * T3 adefovir dipivoxil TABS T4 ATRIPLA TABS T4 BARACLUDE * T4 COMPLERA TABS T4 COPEGUS TABS T4 entecavir TABS T4 GANCICLOVIR CAPS T4 HEPSERA TABS T4 LEXIVA * T4 PREZISTA * T4 REBETOL * T4 RIBASPHERE * T4 ribasphere * T4 RIBASPHERE RIBAPAK TABS T4 RIBASPHERE RIBAPAK TABS T4 RIBATAB * T4 ribavirin * T4 STRIBILD TABS T4 TRIUMEQ TABS T4 TRIZIVIR TABS T4 TYZEKA TABS T4 VALCYTE * T4 VIRAZOLE SOLUTION T4 FUZEON * T5 PA PA Self Administerable (Select) Injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 19 INCIVEK Forma de dosificación TABS INFERGEN INJECTION T5 OLYSIO CAPS T5 PEG-INTRON KIT T5 PEG-INTRON REDIPEN KIT T5 PEG-INTRON REDIPEN PAK 4 KIT T5 PEGASYS * T5 PEGASYS PROCLICK SOLUTION T5 PEGINTRON KIT T5 SOVALDI TABS T5 VICTRELIS CAPS T5 ACYCLOVIR SODIUM * T6 acyclovir sodium * T6 cidofovir SOLUTION T6 CYTOVENE SOLUTION T6 FOSCARNET SODIUM SOLUTION T6 FOSCAVIR SOLUTION T6 ganciclovir SOLUTION T6 RETROVIR IV INFUSION SOLUTION T6 SYNAGIS SOLUTION T6 VISTIDE SOLUTION T6 HARVONI TABS X MODERIBA * X moderiba * X MODERIBA 1200 DOSE PACK TABS X MODERIBA 800 DOSE PACK TABS X PLEGRIDY * X PLEGRIDY STARTER PACK * X RIMANTALIST MISC X SITAVIG TABS X TABS T1 Nombre Nivel Cobertura Comentario T5 Self Administerable (Select) Injectable PA Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable PA PA Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Urinary Anti-infectives hyophen methenamine hippurate TABS T1 methenamine mandelate (1gm) TABS T1 nitrofurantoin SUSPENSION T1 nitrofurantoin macrocrystals CAPS T1 nitrofurantoin monohydrate CAPS T1 nitrofurantoin monohydrate/macrocrystals CAPS T1 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 20 phosphasal Forma de dosificación TABS trimethoprim TABS T1 ur n-c TABS T1 uretron d/s (0.12mg; 81.6mg; 10.8mg; 36.2mg; 40.8mg) TABS T1 urin d/s TABS T1 Nombre Nivel Comentario T1 uryl TABS T1 ustell CAPS T1 uta CAPS T1 uticap CAPS T1 utira-c (0.12mg; 81.6mg; 10.8mg; 36.2mg; 40.8mg) TABS T1 utrona-c TABS T1 METHENAMINE MANDELATE (0.5GM) TABS T2 MONUROL PACK T2 PRIMSOL SOLUTION T2 UROGESIC-BLUE (0.12MG; 81.6MG; 10.8MG; 40.8MG) TABS T2 UROQID #2 TABS T2 FURADANTIN SUSPENSION T3 HIPREX TABS T3 MACROBID CAPS T3 MACRODANTIN CAPS T3 PROSED/DS TABS T3 URELLE TABS T3 URETRON D/S (0.12MG; 120MG; 10.8MG; 36.2MG; 40.8MG) TABS T3 UREX TABS T3 URIBEL CAPS T3 URIMAR-T TABS T3 UROGESIC-BLUE (0.12MG; 81.6MG; 10.8MG; 40.8MG) TABS T3 utira-c (0.12mg; 81.6mg; 10.8mg; 36.2mg; 40.8mg) TABS T3 URITACT DS TABS X URITACT-EC ENTERIC COATED CAPS X arbinoxa * T1 carbinoxamine maleate * T1 CLEMASTINE FUMARATE * T1 clemastine fumarate * T1 cyproheptadine hcl * T1 diphenhydramine hcl * T1 pharbedryl CAPS T1 phenadoz SUPPOSITORY T1 phenergan SUPPOSITORY T1 promethazine hcl * T1 UTA Cobertura X Antihistamine Drugs First Generation Antihistamines Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 21 promethazine hcl plain Forma de dosificación SYRUP promethazine vc SYRUP T1 promethegan SUPPOSITORY T1 DEXCHLORPHENIRAMINE MALEATE SYRUP T3 DEXCHLORPHENIRAMINE MALEATE CR CONT.REL.TABS T3 DOLOGESIC LIQUID T3 Nombre Nivel Cobertura Comentario T1 DOXYTEX LIQUID T3 ED CHLORPED SUSPENSION T3 ED-CHLOR-TAN TABS T3 LAGESIC CONT.REL.TABS T3 PALGIC * T3 PEDIATEX TD LIQUID T3 PROMETHAZINE VC PLAIN SYRUP T3 RELAGESIC LIQUID T3 ZGESIC CONT.REL.TABS T3 diphenhydramine hcl SOLUTION T6 PHENERGAN SOLUTION T6 promethazine hcl SOLUTION T6 ACCUHIST LIQUID X aceta-gesic TABS X actifed cold & allergy TABS X ACUFLEX TABS X ADVIL ALLERGY & CONGESTION TABS X ADVIL ALLERGY SINUS TABS X AEROHIST CONT.REL.TABS X AEROKID SYRUP X ALACOL * X ALDEX D SUSPENSION X ALDEX-CT CHEW X ALENAZE-D LIQUID X alenaze-d nr LIQUID X ali-flex TABS X ALKA-SELTZER PLUS COLD EFFERVESCENT X allantan pediatric SUSPENSION X allergy multi-symptom TABS X ALLERSCRIPT MISC X ALLERX DF MISC X ALLERX DF 30 MISC X ALLERX DOSE PACK MISC X ALLERX PE MISC X ALPAIN TABS X altaryl SYRUP X amdry-c CONT.REL.TABS X BENADRYL ALLERGY & COLD TABS X Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 22 BENADRYL ALLERGY & SINUS HEADACHE Forma de dosificación TABS benadryl severe allergy & sinus headache maximum strength TABS X BENADRYL-D ALLERGY & SINUS TABS X benadryl-d allergy & sinus childrens SOLUTION X BENAPHEN PLUS CONT.REL.CAPS X bidhist-d CONT.REL.TABS X biogesic TABS X BIOREGESIC TABS X BIPHENOX TABS X bp poly-650 TABS X bpm CONT.REL.TABS X bpm pe LIQUID X Nombre Nivel Cobertura Comentario X bpm pseudo CONT.REL.TABS X BROHIST D TABS X bromaline SOLUTION X bromax d CONT.REL.TABS X brompheniramine maleate LIQUID X brompheniramine maleate/pseudoephedrine LIQUID X bromspiro LIQUID X brotapp LIQUID X BROVEX PEB LIQUID X BROVEX PSB LIQUID X c-phen * X C-TAN D PLUS SUSPENSION X cardec LIQUID X CENHIST CHEW X centergy LIQUID X ceron SYRUP X childrens cold & allergy ELIXIR X CHILDRENS TYLENOL COLD LIQUID X chlor-mes d SYRUP X chlor-mes jr CONT.REL.CAPS X chlorpheniramine/phenyltoloxamine/phenylephrine LIQUID X CHLORPHENIRAMINE/PSEUDOEPHEDRINE SYRUP X chlorpheniramine/pseudoephedrine cr CONT.REL.CAPS X cold & allergy ELIXIR X cold & allergy TABS X cold & allergy childrens ELIXIR X cold control pe intense cold & flu medicine TABS X cold medicine plus CAPS X comtrex flu therapy maximum strength day/night MISC X comtrex severe cold & sinus maximum strength day/night MISC X CONEX COLD/ALLERGY * X CONTAC COLD/FLU DAY & NIGHT MISC X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 23 CONTAC COLD/FLU DAY/NIGHT Forma de dosificación TABS CONTAC COLD/FLU MAXIMUM STRENGTH TABS X CONTAC DAY/NIGHT ALLERGY/SINUS TABS X CORICIDIN D TABS X coricidin d cold/flu/sinus TABS X cpm-pe (1mg/ml; 3.5mg/ml) LIQUID X Nombre Nivel Cobertura Comentario X cpm-pe (1mg/ml; 3.5mg/ml) LIQUID X cpm/pse SOLUTION X cpm/pyr/pe LIQUID X DALLERGY LIQUID X DALLERGY * X DALLERGY * X DALLERGY * X DALLERGY JR CONT.REL.CAPS X DALLERGY PE * X DALLERGY PSE CONT.REL.TABS X DALLERGY-JR SUSPENSION X DECON-A LIQUID X DECON-A ELIXIR X decongestant plus TABS X DEHISTINE SYRUP X delsym childrens night time cough/cold LIQUID X delsym cough + cold nighttime LIQUID X delsym cough + cold nighttime childrens LIQUID X delsym night time cough/cold LIQUID X delsym night time cough/cold childrens LIQUID X DELTUSS DP LIQUID X dhm/pe LIQUID X DICEL CHEW X DICEL SUSPENSION X DICOPANOL FUSEPAQ SUSPENSION X dimaphen childrens ELIXIR X DIMETAPP COLD & ALLERGY * X dimetapp nighttime cold &congestion LIQUID X disophrol CONT.REL.TABS X dologen TABS X DOLOGESIC TABS X dologesic TABS X dolorex TABS X DOMETUSS-DA/CHILDREN LIQUID X dristan cold TABS X DRIXORAL ALLERGY SINUS CONT.REL.TABS X DRIXORAL COLD/ALLERGY CONT.REL.TABS X DRIXORAL COLD/FLU CONT.REL.TABS X DRYMAX SYRUP X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 24 DYTAN Forma de dosificación CHEW dytuss SYRUP X ED A-HIST * X ed a-hist * X ED CHLORPED D LIQUID X ED CHLORPED D SUSPENSION X ED-A-HIST TABS X entre-b (6mg/5ml; 10mg/5ml) SUSPENSION X entre-b (6mg/5ml; 10mg/5ml) SUSPENSION X gene-r-gesic TABS X genecar TABS X GENEDOLOREX CAPS X hayfebrol SOLUTION X HISTEX TABS X HISTEX LIQUID X HISTEX SR CONT.REL.TABS X J-TAN D * X J-TAN D PD LIQUID X J-TAN D SR CONT.REL.TABS X J-TAN PD LIQUID X k-tan TABS X KARBINAL ER LQCR X LODRANE LIQUID X LODRANE 12 HOUR CONT.REL.TABS X LODRANE 12D CONT.REL.TABS X LODRANE 24 CONT.REL.CAPS X LODRANE 24D CONT.REL.CAPS X LODRANE D CAPS X LODRANE D SUSPENSION X LOHIST LIQUID X lohist-12 CONT.REL.TABS X lohist-12d CONT.REL.TABS X LOHIST-D LIQUID X lohist-peb LIQUID X lohist-psb LIQUID X Nombre Nivel Cobertura Comentario X LORTUSS LQ LIQUID X medicidin-d TABS X mucinex fast-max night time cold & flu * X mucinex multi-symptom cold night time childrens LIQUID X mucinex sinus-max night time congestion & cough LIQUID X myhist-pd LIQUID X NALDEX CONT.REL.TABS X NALEX-A * X NALEX-A 12 SUSPENSION X NALFRX SUSPENSION X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 25 nasohist (1mg/ml; 2mg/ml) Forma de dosificación LIQUID nasohist (1mg/ml; 2mg/ml) LIQUID X neutrahist (0.8mg/ml; 9mg/ml) SOLUTION X Nombre Nivel Cobertura Comentario X neutrahist (0.8mg/ml; 9mg/ml) SOLUTION X NEUTRALIZE TABS X nohist TABS X nohist CONT.REL.TABS X nohist-lq LIQUID X NOREL AD TABS X norel sd SYRUP X NOREL SR CONT.REL.TABS X novagesic TABS X ONSET FORTE TABS X pediacare childrens allergy/cold LIQUID X pediacare childrens nightrest multi-symptom cold SOLUTION X PHENABID TABS X PHENAGIL TABS X phenylephrine/chlorpheniramine SUSPENSION X PROTID CONT.REL.TABS X pse bpm LIQUID X pyril d SUSPENSION X pyril/chlor/phen CONT.REL.TABS X pyrilamine-phenylephrine SUSPENSION X q-tapp ELIXIR X qlearquil nighttime sinu s & congestion CAPS X quenalin SYRUP X qv-allergy SYRUP X r-tanna TABS X R-TANNA PEDIATRIC SUSPENSION X r-tannamine pediatric SUSPENSION X RELAGESIC TABS X relcof cpm CONT.REL.TABS X RELCOF DN PE MISC X RELCOF DN PSE MISC X RELCOF PE CONT.REL.TABS X relcof pse CONT.REL.TABS X relera CONT.REL.TABS X RELHIST CHEW X RESCON TABS X RESCON CONT.REL.TABS X RESCON-JR CONT.REL.TABS X RESCON-JR CONT.REL.TABS X RESCON-MX CONT.REL.TABS X RESPA SA CONT.REL.TABS X RESPA-A.R. CONT.REL.TABS X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 26 Nivel RESPA-BR Forma de dosificación CONT.REL.TABS respahist CONT.REL.CAPS X RESPAHIST-II CONT.REL.TABS X respivent df MISC X respivent df 30 MISC X rhinoflex TABS X RHINOFLEX-650 TABS X rinate pediatric SUSPENSION X robitussin night time cough & cold LIQUID X Nombre Cobertura Comentario X ROBITUSSIN NIGHT TIME COUGH COLD & FLU LIQUID X ROBITUSSIN PEAK COLD NIGHTTIME MULTI-SYMPTOM COLD LIQUID X robitussin peak cold nighttime nasal relief TABS X RU-HIST D TABS X RU-HIST FORTE CONT.REL.TABS X ru-tuss CONT.REL.TABS X RYMED TABS X RYNA-12 TABS X RYNATAN TABS X RYNATAN PEDIATRIC * X rynex pe ELIXIR X rynex pse LIQUID X RYNEZE LIQUID X SCOT-TUSSIN LIQUID X sildec-pe SYRUP X silphen cough SYRUP X SINADRIN PE COMPLETE SINUS RELIEF TABS X sine-off TABS X sine-off night time formula TABS X sinus & allergy pe maximuum strength TABS X sonahist LIQUID X SUDAFED PE DAY & NIGHT MISC X sudafed pe nighttime coldmaximum strength TABS X SUDAFED PE SEVERE COLD MULTI-SYMPTOM TABS X sudafed pe sinus/allergy maximum strength TABS X SUDAHIST CONT.REL.TABS X sudogest sinus & allergy TABS X super cold tabs TABS X super strength sinadrin TABS X tanabid CHEW X tanabid sr CONT.REL.TABS X TEKRAL CONT.REL.TABS X tg 40pse/4brm TABS X th allergy relief + cold TABS X th allergy relief + sinus headache TABS X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 27 th cold & allergy Forma de dosificación ELIXIR th cold & allergy TABS X THERAFLU COLD & SORE THROAT PACK X THERAFLU COLD/COUGH NIGHTTIME STRIP X THERAFLU FLU & SORE THROAT PACK X THERAFLU SEVERE COLD & COUGH NIGHTTIME PACK X Nombre Nivel Cobertura Comentario X THERAFLU SINUS & COLD PACK X theraflu warming relief flu & sore throat LIQUID X theraflu warming relief severe cold nighttime LIQUID X theraflu warming relief sinus & cold LIQUID X tl-hist pd LIQUID X triacting night time cold & cough childrens LIQUID X triacting nighttime cold&cough childrens LIQUID X TRIAMINIC COLD & ALLERGY CHILDRENS SYRUP X TRIAMINIC COLD & COUGH NIGHT TIME CHILDRENS LIQUID X TRIAMINIC COLD/COUGH NIGHTTIME STRIP X TRIAMINIC NIGHT TIME COLD & COUGH SYRUP X trigofen LIQUID X triotann pediatric SUSPENSION X triotann-s pediatric SUSPENSION X TYLENOL ALLERGY COMPLETE TABS X tylenol allergy multi-symptom TABS X TYLENOL ALLERGY MULTI-SYMPTOM DAY/NIGHT MISC X TYLENOL ALLERGY MULTI-SYMPTOM NIGHTTIME TABS X TYLENOL ALLERGY SINUS TABS X TYLENOL CHILDRENS PLUS COLD SUSPENSION X TYLENOL CHILDRENS PLUS COLD & ALLERGY SUSPENSION X TYLENOL MAX-STR FLU NIGHTTIME TABS X TYLENOL SINUS CONGESTION & PAIN DAY/NIGHT MISC X tylenol sinus congestion & pain nighttime TABS X TYLENOL SINUS CONVENIENCE PACK MISC X TYLENOL SINUS NIGHT TIME TABS X v-hist SUSPENSION X VAZOBID SUSPENSION X vazobid-pd SUSPENSION X VAZOL LIQUID X VAZOL-D LIQUID X vazotab CHEW X VICKS NYQUIL SINEX NIGHTTIME SINUS RELIEF CAPS X VICKS NYQUIL SINUS CAPS X VICKS SINEX DAYQUIL/NYQUIL DAYTIME/NIGHTTIME SINUS RELIEF VIRAVAN-P MISC X SUSPENSION X virdec LIQUID X zflex TABS X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 28 ZODEN PD Forma de dosificación LIQUID ZOTEX PE CONT.REL.TABS X zotex-pe CONT.REL.TABS X desloratadine TABS T1 SEMPREX-D CAPS T3 alavert allergy/sinus CONT.REL.TABS X all day allergy-d CONT.REL.TABS X ALLEGRA * X ALLEGRA ODT TABS X ALLEGRA-D 12 HOUR CONT.REL.TABS X ALLEGRA-D 12 HOUR ALLERGY & CONGESTION CONT.REL.TABS X ALLEGRA-D 12 HOUR ALLERGY& CONGESTION CONT.REL.TABS X ALLEGRA-D 24 HOUR CONT.REL.TABS X ALLEGRA-D 24 HOUR ALLERGY & CONGESTION CONT.REL.TABS X ALLEGRA-D 24 HOUR ALLERGY& CONGESTION CONT.REL.TABS X Nombre Nivel Cobertura Comentario X Second Generation Antihistamines allergy relief/nasal decongestant CONT.REL.TABS X cetirizine hcl * X cetirizine hcl/pseudoephedrine hcl er CONT.REL.TABS X CLARINEX * X CLARINEX REDITABS TABS X CLARINEX-D 12 HOUR CONT.REL.TABS X CLARINEX-D 24 HOUR CONT.REL.TABS X CLARITIN-D 12 HOUR CONT.REL.TABS X CLARITIN-D 24 HOUR CONT.REL.TABS X clear-atadine d CONT.REL.TABS X desloratadine odt TABS X FEXOFENADINE HCL TABS X fexofenadine hcl TABS X fexofenadine hcl/pseudoephedrine hcl er CONT.REL.TABS X FEXOFENADINE/PSEUDOEPHEDRINE * X levocetirizine dihydrochloride * X loratadine-d 12hr CONT.REL.TABS X loratadine-d 24hr CONT.REL.TABS X shopko allergy relief-d CONT.REL.TABS X shopko allergy relief-d * X th loratadine-d CONT.REL.TABS X XYZAL * X ZYRTEC-D ALLERGY/CONGESTION CONT.REL.TABS X Antineoplastic Agents anastrozole TABS T1 Oral Cancer Drug bicalutamide TABS T1 Oral Cancer Drug CYCLOPHOSPHAMIDE * T1 Oral Cancer Drug exemestane TABS T1 Oral Cancer Drug flutamide CAPS T1 Oral Cancer Drug Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 29 hydroxyurea Forma de dosificación CAPS T1 Oral Cancer Drug letrozole TABS T1 Oral Cancer Drug megestrol acetate * T1 Oral Cancer Drug Nombre Nivel Cobertura Comentario mercaptopurine TABS T1 Oral Cancer Drug methotrexate TABS T1 Oral Cancer Drug tamoxifen citrate TABS T1 Oral Cancer Drug ALKERAN TABS T2 Oral Cancer Drug DROXIA CAPS T2 Oral Cancer Drug EMCYT CAPS T2 Oral Cancer Drug FARESTON TABS T2 Oral Cancer Drug HEXALEN CAPS T2 Oral Cancer Drug LEUKERAN TABS T2 Oral Cancer Drug LOMUSTINE CAPS T2 Oral Cancer Drug LYSODREN TABS T2 Oral Cancer Drug MATULANE CAPS T2 Oral Cancer Drug MYLERAN TABS T2 Oral Cancer Drug NILANDRON TABS T2 Oral Cancer Drug RHEUMATREX TABS T2 Oral Cancer Drug TABLOID TABS T2 Oral Cancer Drug TREXALL TABS T2 AFINITOR TABS T3 PA Oral Cancer Drug Oral Cancer Drug AFINITOR DISPERZ TABS T3 PA Oral Cancer Drug ARIMIDEX TABS T3 Oral Cancer Drug AROMASIN TABS T3 Oral Cancer Drug BOSULIF TABS T3 capecitabine TABS T3 CAPRELSA TABS T3 CASODEX TABS T3 Oral Cancer Drug CEENU CAPS T3 Oral Cancer Drug PA Oral Cancer Drug PA Oral Cancer Drug Oral Cancer Drug COMETRIQ KIT T3 PA Oral Cancer Drug ERIVEDGE CAPS T3 PA Oral Cancer Drug ETOPOSIDE CAPS T3 Oral Cancer Drug FEMARA TABS T3 GILOTRIF TABS T3 PA Oral Cancer Drug Oral Cancer Drug GLEEVEC TABS T3 PA Oral Cancer Drug HYCAMTIN CAPS T3 Oral Cancer Drug HYDREA CAPS T3 Oral Cancer Drug ICLUSIG TABS T3 IMBRUVICA CAPS T3 PA Oral Cancer Drug INLYTA TABS T3 PA Oral Cancer Drug IRESSA TABS T3 PA Oral Cancer Drug MEGACE ORAL SUSPENSION T3 MEKINIST TABS T3 PA Oral Cancer Drug NEXAVAR TABS T3 PA Oral Cancer Drug POMALYST CAPS T3 PA Oral Cancer Drug PA Oral Cancer Drug Oral Cancer Drug Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 30 PURINETHOL Forma de dosificación TABS REVLIMID CAPS T3 PA Oral Cancer Drug SPRYCEL TABS T3 PA Oral Cancer Drug STIVARGA TABS T3 PA Oral Cancer Drug SUTENT CAPS T3 PA Oral Cancer Drug TAFINLAR CAPS T3 PA Oral Cancer Drug PA Nombre Nivel Cobertura Comentario T3 TARCEVA TABS T3 TARGRETIN CAPS T3 TASIGNA CAPS T3 Oral Cancer Drug Oral Cancer Drug Oral Cancer Drug PA Oral Cancer Drug TEMODAR CAPS T3 Oral Cancer Drug temozolomide CAPS T3 Oral Cancer Drug tretinoin CAPS T3 Oral Cancer Drug TYKERB TABS T3 PA Oral Cancer Drug VANDETANIB TABS T3 PA Oral Cancer Drug VOTRIENT TABS T3 PA Oral Cancer Drug XALKORI CAPS T3 PA Oral Cancer Drug XELODA TABS T3 XTANDI CAPS T3 PA Oral Cancer Drug Oral Cancer Drug ZELBORAF TABS T3 PA Oral Cancer Drug ZOLINZA CAPS T3 PA Oral Cancer Drug ZYKADIA CAPS T3 PA Oral Cancer Drug ZYTIGA TABS T3 PA Oral Cancer Drug JAKAFI TABS T4 PA Oral Cancer Drug INTRON A SOLUTION T5 INTRON-A * T5 INTRON-A W/DILUENT SOLUTION T5 SYLATRON KIT T5 ABRAXANE SUSPENSION T6 ADCETRIS SOLUTION T6 ADRIAMYCIN * T6 adriamycin * T6 adrucil SOLUTION T6 ALFERON N SOLUTION T6 ALIMTA SOLUTION T6 ALKERAN SOLUTION T6 ARRANON SOLUTION T6 ARZERRA SOLUTION T6 PA AVASTIN SOLUTION T6 PA azacitidine SUSPENSION T6 PA Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 31 BELEODAQ Forma de dosificación SOLUTION BEXXAR SOLUTION T6 BEXXAR 131 IODINE INJECTION T6 BICNU SOLUTION T6 bleomycin sulfate SOLUTION T6 BUSULFEX SOLUTION T6 CAMPTOSAR SOLUTION T6 CARBOPLATIN * T6 carboplatin * T6 CERUBIDINE SOLUTION T6 CISPLATIN SOLUTION T6 cisplatin SOLUTION T6 cladribine SOLUTION T6 CLOLAR SOLUTION T6 COSMEGEN SOLUTION T6 CYCLOPHOSPHAMIDE SOLUTION T6 CYTARABINE * T6 cytarabine * T6 cytarabine aqueous SOLUTION T6 DACARBAZINE SOLUTION T6 dacarbazine SOLUTION T6 DACOGEN SOLUTION T6 dactinomycin SOLUTION T6 daunorubicin hcl * T6 DAUNOXOME INJECTION T6 decitabine SOLUTION T6 DEPOCYT SUSPENSION T6 DOCEFREZ SOLUTION T6 DOCETAXEL * T6 DOXIL INJECTION T6 doxorubicin hcl * T6 doxorubicin hcl liposome INJECTION T6 ELIGARD KIT T6 ELLENCE SOLUTION T6 Nombre Nivel T6 Cobertura Comentario PA Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 32 Nombre Forma de dosificación Nivel ELOXATIN SOLUTION T6 ELSPAR SOLUTION T6 EPIRUBICIN HCL * T6 epirubicin hcl * T6 ERBITUX SOLUTION T6 ERWINAZE SOLUTION T6 ETOPOPHOS SOLUTION T6 etoposide SOLUTION T6 FASLODEX SOLUTION T6 FIRMAGON SOLUTION T6 floxuridine SOLUTION T6 FLUDARA SOLUTION T6 FLUDARABINE PHOSPHATE * T6 fludarabine phosphate * T6 fluorouracil SOLUTION T6 FOLOTYN SOLUTION T6 FUDR SOLUTION T6 GAZYVA SOLUTION T6 GEMCITABINE SOLUTION T6 gemcitabine hcl SOLUTION T6 GEMZAR SOLUTION T6 GLIADEL WAFER WAFER T6 HALAVEN SOLUTION T6 HERCEPTIN SOLUTION T6 HYCAMTIN SOLUTION T6 IDAMYCIN PFS SOLUTION T6 idarubicin hcl SOLUTION T6 IFEX SOLUTION T6 IFOSFAMIDE * T6 ifosfamide * T6 IFOSFAMIDE/MESNA KIT T6 IRINOTECAN SOLUTION T6 irinotecan SOLUTION T6 Cobertura Comentario injectable PA PA PA PA PA Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 33 ISTODAX Forma de dosificación SOLUTION IXEMPRA KIT SOLUTION T6 PA JEVTANA SOLUTION T6 PA KADCYLA SOLUTION T6 PA KYPROLIS SOLUTION T6 PA leuprolide acetate KIT T6 LEUSTATIN SOLUTION T6 lipodox INJECTION T6 lipodox 50 INJECTION T6 LUPRON DEPOT KIT T6 LUPRON DEPOT-PED KIT T6 MARQIBO SUSPENSION T6 melphalan hydrochloride SOLUTION T6 methotrexate sodium * T6 mitomycin SOLUTION T6 mitoxantrone hcl SOLUTION T6 MUSTARGEN SOLUTION T6 NAVELBINE SOLUTION T6 NIPENT SOLUTION T6 NOVANTRONE SOLUTION T6 ONCASPAR SOLUTION T6 ONTAK SOLUTION T6 onxol SOLUTION T6 oxaliplatin * T6 PACLITAXEL SOLUTION T6 paclitaxel SOLUTION T6 pentostatin SOLUTION T6 PERJETA SOLUTION T6 PHOTOFRIN SOLUTION T6 PROLEUKIN SOLUTION T6 RITUXAN SOLUTION T6 SUPPRELIN LA KIT T6 SYLVANT SOLUTION T6 PA SYNRIBO SOLUTION T6 PA Nombre Nivel Cobertura Comentario T6 PA Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Self Administerable (Select) PA PA Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 34 Nombre Forma de dosificación Nivel Cobertura TAXOTERE SOLUTION T6 TEMODAR SOLUTION T6 TENIPOSIDE SOLUTION T6 THIOTEPA SOLUTION T6 toposar SOLUTION T6 TOPOTECAN HCL * T6 topotecan hcl * T6 TORISEL SOLUTION T6 PA TREANDA * T6 PA TRELSTAR DEPOT SUSPENSION T6 TRELSTAR DEPOT MIXJECT SUSPENSION T6 TRELSTAR LA SUSPENSION T6 TRELSTAR LA MIXJECT SUSPENSION T6 TRELSTAR MIXJECT SUSPENSION T6 TRISENOX SOLUTION T6 VALSTAR SOLUTION T6 VANTAS KIT T6 VECTIBIX SOLUTION T6 VELCADE SOLUTION T6 VIDAZA SUSPENSION T6 VINBLASTINE SULFATE * T6 vincasar pfs SOLUTION T6 vincristine sulfate SOLUTION T6 vinorelbine tartrate SOLUTION T6 VUMON SOLUTION T6 YERVOY SOLUTION T6 ZANOSAR SOLUTION T6 ZEVALIN IN-111 KIT T6 ZEVALIN Y-90 KIT T6 ZOLADEX IMPLANT T6 CAMPATH SOLUTION X CYRAMZA SOLUTION X Comentario Injectable PA Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Campath is not commercially available. Contact Campath Distribution Program at 1-877422-6728 for access to drug. Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 35 Nombre KEYTRUDA Forma de dosificación SOLUTION Nivel X Cobertura Comentario Non-self administerable injectable LUPANETA PACK KIT X OFORTA TABS X Oral Cancer Drug PURIXAN SUSPENSION X Oral Cancer Drug SOLTAMOX SOLUTION X Oral Cancer Drug ZALTRAP SOLUTION X ZYDELIG TABS X Non-self administerable injectable Oral Cancer Drug belladonna alkaloids/phenobarbital TABS T1 belladonna alkaloids/phenobarbital TABS T1 chlordiazepoxide hcl/clidinium bromide CAPS T1 chlordiazepoxide/clidinium CAPS T1 colidrops pediatric SOLUTION T1 dicyclomine hcl * T1 ed-spaz TABS T1 glycopyrrolate TABS T1 hyomax TABS T1 hyomax -dt CONT.REL.TABS T1 Autonomic Drugs Anticholinergic Agents hyomax-ft TABS T1 hyomax-sl SUBLINGUAL T1 hyomax-sr CONT.REL.TABS T1 hyoscyamine TABS T1 hyoscyamine sulfate * T1 hyoscyamine sulfate er CONT.REL.TABS T1 hyoscyamine sulfate odt TABS T1 hyoscyamine sulfate sr CONT.REL.TABS T1 hyosyne * T1 ipratropium bromide SOLUTION T1 ipratropium bromide SOLUTION T1 me-pb-hyos ELIXIR T1 me-pb-hyos TABS T1 methscopolamine bromide TABS T1 nulev TABS T1 oscimin * T1 oscimin sr CONT.REL.TABS T1 pb-hyos ELIXIR T1 quadrapax ELIXIR T1 re chlordiazepoxide/clidinium CAPS T1 re-pb hyos ELIXIR T1 se-donna pb hyos ELIXIR T1 symax fastabs TABS T1 symax-sl SUBLINGUAL T1 symax-sr CONT.REL.TABS T1 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 36 ANORO ELLIPTA Forma de dosificación AEROSOL ATROVENT HFA AEROSOL T2 BELLADONNA & OPIUM SUPPOSITORY T2 Nombre Nivel Cobertura Comentario T2 BELLADONNA ALKALOIDS & OPIUM SUPPOSITORY T2 CANTIL TABS T2 CUVPOSA SOLUTION T2 DICYCLOMINE HCL SOLUTION T2 DONNATAL ELIXIR T2 DONNATAL EXTENTABS CONT.REL.TABS T2 HOMAPIN-10 TABS T2 PROPANTHELINE BROMIDE TABS T2 SIMETYL ELIXIR T2 SPIRIVA HANDIHALER CAPS T2 SPIRIVA RESPIMAT AEROSOL T2 SYMAX DUOTAB CONT.REL.TABS T2 TUDORZA PRESSAIR AEROSOL T2 ANASPAZ TABS T3 ATROVENT SOLUTION T3 BENTYL * T3 DIGEX NF CAPS T3 DONNATAL TABS T3 GASTRINEX NF CAPS T3 LEVBID CONT.REL.TABS T3 LEVSIN TABS T3 LEVSIN/SL SUBLINGUAL T3 LIBRAX CAPS T3 PAMINE TABS T3 PAMINE FORTE TABS T3 PAMINE FQ KIT T3 ROBINUL TABS T3 ROBINUL FORTE TABS T3 SAL-TROPINE TABS T3 ATROPEN DEVICE T6 ATROPINE SULFATE SOLUTION T6 atropine sulfate SOLUTION T6 BENTYL SOLUTION T6 dicyclomine hcl SOLUTION T6 glycopyrrolate SOLUTION T6 LEVSIN SOLUTION T6 ROBINUL SOLUTION T6 SCOPOLAMINE HYDROBROMIDE SOLUTION T6 BELLADONNA ALKALOIDS TINCTURE X QL (25.80 GM/30 days) Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 37 Nombre GLYCATE Forma de dosificación TABS Nivel Cobertura Comentario X Autonomic Drugs, Miscellaneous CHANTIX TABS T2 CHANTIX CONTINUING MONTH PAK TABS T2 CHANTIX STARTING MONTH PAK TABS T2 NICOTROL INHALER INHALER T2 AL (min: 18y) QL (336/lifetime) AL (min: 18y) QL (336/lifetime) AL (min: 18y) QL (336/lifetime) PA NICOTROL NS SOLUTION T2 PA bethanechol chloride TABS T1 cevimeline hcl CAPS T1 donepezil hcl * T1 donepezil hcl (10mg) TABS T1 Parasympathomimetic (Cholinergic) Agents donepezil hcl (5mg) TABS T1 galantamine TABS T1 galantamine hydrobromide * T1 pilocarpine hcl TABS T1 pilocarpine hydrochloride TABS T1 pyridostigmine bromide TABS T1 rivastigmine tartrate CAPS T1 EXELON SOLUTION T2 GUANIDINE HCL TABS T2 MESTINON SYRUP T2 MESTINON TIMESPAN CONT.REL.TABS T2 PROSTIGMIN TABS T2 ARICEPT (10MG) TABS T3 ARICEPT (5MG) TABS T3 ARICEPT ODT TABS T3 EVOXAC CAPS T3 EXELON PATCH T3 EXELON CAPS T3 MESTINON TABS T3 RAZADYNE * T3 RAZADYNE ER CONT.REL.CAPS T3 SALAGEN TABS T3 URECHOLINE TABS T3 BLOXIVERZ SOLUTION T6 ENLON-PLUS SOLUTION T6 neostigmine methylsulfate SOLUTION T6 PHYSOSTIGMINE SALICYLATE SOLUTION T6 PROSTIGMIN SOLUTION T6 REGONOL SOLUTION T6 ARICEPT (23MG) TABS X Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 38 donepezil hcl (23mg) Forma de dosificación TABS MYTELASE TABS X baclofen TABS T1 carisoprodol (350mg) TABS T1 carisoprodol/aspirin TABS T1 carisoprodol/aspirin/codeine TABS T1 chlorzoxazone TABS T1 cyclobenzaprine hcl (10mg) TABS T1 cyclobenzaprine hcl (5mg) TABS T1 dantrolene sodium (25mg) CAPS T1 dantrolene sodium (50mg) CAPS T1 ed baclofen TABS T1 metaxalone TABS T1 methocarbamol TABS T1 orphenadrine citrate er CONT.REL.TABS T1 tizanidine hcl TABS T1 DANTROLENE SODIUM (100MG) CAPS T2 DANTRIUM CAPS T3 FLEXERIL TABS T3 PARAFON FORTE DSC TABS T3 ROBAXIN TABS T3 ROBAXIN-750 TABS T3 SKELAXIN TABS T3 SOMA (350MG) TABS T3 ZANAFLEX * T3 ANECTINE SOLUTION T6 atracurium besylate SOLUTION T6 cisatracurium besylate SOLUTION T6 DANTRIUM IV SOLUTION T6 GABLOFEN SOLUTION T6 LIORESAL INTRATHECAL SOLUTION T6 NIMBEX SOLUTION T6 NORFLEX SOLUTION T6 orphenadrine citrate SOLUTION T6 pancuronium bromide SOLUTION T6 QUELICIN SOLUTION T6 QUELICIN 1000 SOLUTION T6 revonto SOLUTION T6 ROBAXIN SOLUTION T6 Nombre Nivel Cobertura Comentario X Skeletal Muscle Relaxants Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 39 rocuronium bromide Forma de dosificación SOLUTION vecuronium bromide SOLUTION T6 ZEMURON SOLUTION T6 ACTIVE-CYCLOBENZAPRINE KIT CREAM X AMRIX CONT.REL.CAPS X CARISOPRODOL (250MG) TABS X Nombre Nivel T6 CYCLOBENZAPRINE COMFORT PAC KIT X cyclobenzaprine hcl (7.5mg) TABS X cyclobenzaprine hcl er CONT.REL.CAPS X ENOVARX-BACLOFEN CREAM X ENOVARX-CYCLOBENZAPRINE HCL CREAM X FEXMID TABS X LORZONE TABS X ORPHENADRINE CITRATE POWDER X PRAZOLAMINE MISC X RYANODEX SUSPENSION X SOMA (250MG) TABS X THERABENZAPRINE-60 MISC X THERABENZAPRINE-90 MISC X THERABENZAPRINE-90-5 MISC X TIZANIDINE COMFORT PAC MISC X tizanidine hcl CAPS X alfuzosin hcl er CONT.REL.TABS T1 ergoloid mesylates TABS T1 tamsulosin hcl CAPS T1 DIBENZYLINE CAPS T2 DIHYDROERGOTAMINE MESYLATE SOLUTION T2 ERGOMAR SUBLINGUAL T2 MIGRANAL SOLUTION T2 FLOMAX CAPS T3 RAPAFLO CAPS T3 UROXATRAL CONT.REL.TABS T3 D.H.E. 45 SOLUTION T6 dihydroergotamine mesylate SOLUTION T6 PHENTOLAMINE MESYLATE * T6 albuterol sulfate * T1 albuterol sulfate er CONT.REL.TABS T1 ipratropium bromide/albuterol sulfate SOLUTION T1 levalbuterol NEB SOLUTION T1 metaproterenol sulfate (10mg/5ml) SYRUP T1 Cobertura Comentario Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Sympatholytic (Adrenergic Blocking) Agents NOT COVERED FOR MEDICAID: Covered Alternatives Available Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Sympathomimetic (Adrenergic) Agents Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 40 midodrine hcl Forma de dosificación TABS terbutaline sulfate TABS T1 ADRENACLICK SOAJ T2 ADVAIR DISKUS AEROSOL T2 ADVAIR HFA AEROSOL T2 QL (12GM/30 days) ARCAPTA NEOHALER CAPS T2 QL (30/30 days) AUVI-Q SOAJ T2 COMBIVENT AEROSOL T2 QL (29.40 GM/30 days) COMBIVENT RESPIMAT AEROSOL T2 QL (8GM/30 days) EPINEPHRINE SOAJ T2 EPIPEN SOAJ T2 EPIPEN 2-PAK SOAJ T2 EPIPEN-JR SOAJ T2 EPIPEN-JR 2-PAK SOAJ T2 FORADIL AEROLIZER CAPS T2 levalbuterol hcl NEB SOLUTION T2 METAPROTERENOL SULFATE * T2 METAPROTERENOL SULFATE (10MG/5ML) SYRUP T2 PERFOROMIST NEB SOLUTION T2 PROAIR HFA AEROSOL T2 QL (2/30 days) SEREVENT DISKUS AEROSOL T2 QL (60/30 days) TWINJECT SOAJ T2 VENTOLIN HFA AEROSOL T2 Nombre Nivel Cobertura Comentario T1 ACCUNEB NEB SOLUTION T3 BRETHINE TABS T3 DUONEB SOLUTION T3 Self Administerable (Select) Injectable QL (60/30 days) Self Administerable (Select) Injectable Self Administerable Injectable Self Administerable Injectable Self Administerable Injectable Self Administerable Injectable Self Administerable Injectable (Select) (Select) (Select) (Select) (Select) QL (60/30 days) QL (2/30 days) Quantity listed is # of inhalers Self Administerable (Select) Injectable Quantity listed is # of inhalers MAXAIR AUTOHALER AEROSOL T3 QL (2/30 days) Quantity listed is # of inhalers PROVENTIL HFA AEROSOL T3 QL (2/30 days) Quantity listed is # of inhalers VOSPIRE ER CONT.REL.TABS T3 QL (2/30 days) Quantity listed is # of inhalers XOPENEX NEB SOLUTION T3 XOPENEX CONCENTRATE NEB SOLUTION T3 XOPENEX HFA AEROSOL T3 ADRENALIN SOLUTION T6 ADRENALIN SOLUTION T6 BRETHINE SOLUTION T6 dobutamine hcl SOLUTION T6 dobutamine hcl/d5w SOLUTION T6 DOBUTAMINE/DEXTROSE 5% SOLUTION T6 dobutamine/dextrose 5% SOLUTION T6 DOPAMINE HCL SOLUTION T6 Self Administerable (Select) Injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 41 Nombre Forma de dosificación Nivel dopamine hcl SOLUTION T6 dopamine hcl-dextrose 5% SOLUTION T6 dopamine hcl/dextrose 5% SOLUTION T6 dopamine/d5w SOLUTION T6 ephedrine sulfate SOLUTION T6 epinephrine hcl * T6 ISUPREL SOLUTION T6 LEVOPHED SOLUTION T6 NEO-SYNEPHRINE SOLUTION T6 norepinephrine bitartrate SOLUTION T6 PHENYLEPHRINE HCL SOLUTION T6 phenylephrine hcl SOLUTION T6 terbutaline sulfate SOLUTION T6 VAZCULEP SOLUTION T6 ALLERX-D CONT.REL.TABS X BROVANA NEB SOLUTION X childrens silfedrine LIQUID X congest aid TABS X contac-d TABS X decongestant TABS X Cobertura Comentario injectable decongestant 12hour maximum strength CONT.REL.TABS X decongestant 60 TABS X ELIXSURE CONGESTION GEL X genaphed TABS X LITTLE COLDS DECONGESTANTFORMULA LIQUID X LUSONAL LIQUID X MEDI-PHENYL TABS X NASAL DECONGESTANT * X nasal decongestant * X nasal decongestant TABS X nasal decongestant pe maximum strength TABS X nexafed TABA X non-pseudo sinus decongestant TABS X NORTHERA CAPS X PEDIACARE CHILDRENS DECONGESTANT SOLUTION X pseudoephedrine hcl * X pseudoephedrine hcl er CONT.REL.TABS X psudatabs TABS X respivent-d CONT.REL.TABS X Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 42 shopko nasal decongestant Forma de dosificación CONT.REL.TABS shopko nasal decongestantmaximum strength TABS X simply stuffy TABS X Nombre Nivel Cobertura Comentario X STRIVERDI RESPIMAT AEROSOL X SUDAFED TABS X sudafed 12 hour CONT.REL.TABS X SUDAFED 24 HOUR CONT.REL.TABS X SUDAFED CHILDRENS LIQUID X SUDAFED CONGESTION TABS X SUDAFED NASAL DECONGESTANT MAXIMUM STRENGTH TABS X SUDAFED PE CHILDRENS NASAL DECONGESTANT SOLUTION X SUDAFED PE MAXIMUM STRENGTH TABS X sudanyl TABS X sudogest TABS X sudogest 12 hour CONT.REL.TABS X sudogest childrens * X sudogest pe TABS X sudophed TABS X suphedrine TABS X th 12 hour decongestant CONT.REL.TABS X th congestion TABS X th nasal decongestant pe TABS X unifed LIQUID X zephrex-d TABA X albuked 25 SOLUTION T6 albuked 5 SOLUTION T6 albumin human SOLUTION T6 albumin-zlb SOLUTION T6 albuminar-25 SOLUTION T6 albuminar-5 SOLUTION T6 alburx SOLUTION T6 albutein SOLUTION T6 buminate SOLUTION T6 flexbumin SOLUTION T6 HSA STERILE DILUENT SOLUTION T6 human albumin grifols SOLUTION T6 kedbumin SOLUTION T6 OCTAPLAS BLOOD GROUP A SOLUTION T6 Blood Derivatives Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 43 OCTAPLAS BLOOD GROUP AB Forma de dosificación SOLUTION OCTAPLAS BLOOD GROUP B SOLUTION T6 OCTAPLAS BLOOD GROUP O SOLUTION T6 PANHEMATIN SOLUTION T6 plasbumin-25 SOLUTION T6 plasbumin-5 SOLUTION T6 PLASMANATE SOLUTION T6 Nombre Nivel T6 Cobertura Comentario Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Blood Formation, Coagulation & Thrombosis Antianemia Drugs corvita 150 TABS T1 fe c plus TABS T1 ferocon CAPS T1 ferotrin CAPS T1 ferrocite plus TABS T1 ferrogels forte CAPS T1 folitab CONT.REL.TABS T1 foltrin CAPS T1 hematinic plus vitamins/minerals TABS T1 hematinic/folic acid TABS T1 hematogen CAPS T1 hematogen forte CAPS T1 hemocyte-plus TABS T1 iferex 150 forte CAPS T1 martinic CAPS T1 myferon 150 forte CAPS T1 poly-iron 150 forte CAPS T1 purevit dualfe plus CAPS T1 re dualvit f CAPS T1 re dualvit plus CAPS T1 reocyte plus CAPS T1 se-tan plus CAPS T1 tl icon CAPS T1 tl-fol 500 CONT.REL.TABS T1 tl-hem 150 TABS T1 tricon CAPS T1 trigels-f forte CAPS T1 BIFERARX TABS T2 CENTRATEX CAPS T2 ED CYTE F TABS T2 FE 90 PLUS TABS T2 FERIVA 21/7 TABS T2 FERRALET 90 TABS T2 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 44 FERRAPLUS 90 Forma de dosificación TABS FERREX 150 FORTE PLUS CAPS T2 FERREX 28 TABS T2 Nombre Nivel Cobertura Comentario T2 FERRO-PLEX HEMATINIC TABS T2 FERROTRIN CAPS T2 FUSION PLUS CAPS T2 GENHEMAT TABS T2 HEMATOGEN FA CAPS T2 HEMETAB TABS T2 HEMOCYTE PLUS CAPS T2 HEMOCYTE-F ELIXIR T2 IRCON-FA TABS T2 IRON ASP GLY/ POLYSACCH COMPL/ASCORB CAL/B12/FA/C THREON/SUC MULTIGEN CAPS T2 TABS T2 MULTIGEN FOLIC TABS T2 MULTIGEN PLUS TABS T2 MV FE ASPARTO GLY/FE FUM/SUCC ACID/VIT C/THREONIC ACD/B12/FA MV FE ASPARTO GLY/VIT C/VIT B12/CA THREONATE/SUCC ACD/STOMAC NATALVIRT FLT TABS T2 TABS T2 TABS T2 NEPHRON FA TABS T2 NOVAFERRUM SOLUTION T2 PROFERRIN-FORTE TABS T2 PUREFE PLUS CAPS T2 SENILEZOL ELIXIR T2 TANDEM F CAPS T2 CORVITE 150 TABS T3 CORVITE 150 TABS T3 CORVITE FE TABS T3 FERIVAFA CAPS T3 FOLIVANE-F CAPS T3 FOLIVANE-PLUS CAPS T3 HEMATRON-AF TABS T3 hemocyte-f TABS T3 ICAR-C PLUS TABS T3 INTEGRA F CAPS T3 INTEGRA PLUS CAPS T3 IRON TABS T3 IROSPAN 24/6 MISC T3 IS 24/6 MISC T3 MAXARON FORTE CAPS T3 MAXARON FORTE TABS T3 PROMAR CAPS T3 PROTECTIRON TABS T3 PA Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 45 RENATABS WITH IRON Forma de dosificación MISC TANDEM PLUS CAPS T3 TARON FORTE CAPS T3 VITAFOL * T3 ALBAFORT SOLUTION T6 dexferrum SOLUTION T6 FERAHEME SOLUTION T6 FERRLECIT SOLUTION T6 infed SOLUTION T6 INJECTAFER SOLUTION T6 nulecit SOLUTION T6 sodium ferric gluconate complex/sucrose SOLUTION T6 VENOFER SOLUTION T6 FERIVA CAPS X FETRIN CONT.REL.CAPS X FUMATINIC CONT.REL.CAPS X ICAR-C PLUS SR CONT.REL.CAPS X Nombre Nivel Cobertura Comentario T3 MAXFE TABS X NIRON KOMPLETE TABS X Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Antihemorrhagic Agents aminocaproic acid * T1 aminocaproic acid (500mg) TABS T1 GELFILM OP FILM T2 ACTIFOAM COLLAGEN SPONGE 12.7CM X 8.9CM X 0.6CM MISC T3 ACTIFOAM COLLAGEN SPONGE 7.0CM X 5.0CM X 0.6CM MISC T3 AMICAR * T3 AMINOCAPROIC ACID (1000MG) TABS T3 ASTRINGYN SOLUTION T3 AVITENE FLOUR POWDER T3 AVITENE SHEET/35MM X 35MM PADS T3 AVITENE SHEET/70MM X 35MM PADS T3 AVITENE SHEET/70MM X 70MM PADS T3 ENDO AVITENE SHEET/10MM DIAMETER/50MM X 15MM X 1MM ENDO AVITENE SHEET/5MM DIAMETER/50MM X 5MM X 1MM MISC T3 MISC T3 EVITHROM SOLUTION T3 GELFILM ENVELOPE FILM T3 GELFOAM POWDER T3 GELFOAM DENTAL PACK MISC T3 GELFOAM SPONGE MISC T3 GELFOAM SPONGE COMPRESSED MISC T3 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 46 HELISTAT SPONGE 3"X4"X5MM Forma de dosificación MISC INSTAT 2.5 CM X 5.1 CM PADS T3 INSTAT 7.6 CM X 10.2 CM PADS T3 INSTAT MCH POWDER T3 MONSELS FERRIC SUBSULFATE SOLUTION T3 RECOTHROM SOLUTION T3 RECOTHROM SPRAY KIT SOLUTION T3 SURGIFOAM MISC T3 SYRINGE AVITENE MISC T3 THROMBIN-JMI DILUENT SOLUTION T3 THROMBIN-JMI EPISTAXIS KIT T3 THROMBIN-JMI SYRINGE SPRAY KIT KIT T3 THROMBIN-JMI W/DIL SPRAY PUMP ACTUATOR KIT T3 THROMBOGEN * T3 tranexamic acid TABS T3 ULTRAFOAM MISC T3 ADVATE SOLUTION T6 ALPHANATE/VON WILLEBRAND FACTOR COMPLEX/HUMAN SOLUTION T6 ALPHANINE SD SOLUTION T6 aminocaproic acid SOLUTION T6 BEBULIN SOLUTION T6 BEBULIN VH SOLUTION T6 BENEFIX SOLUTION T6 CORIFACT KIT T6 CYKLOKAPRON SOLUTION T6 ELOCTATE SOLUTION T6 FEIBA NF SOLUTION T6 FEIBA VH IMMUNO SOLUTION T6 HELIXATE FS KIT T6 HEMOFIL M SOLUTION T6 HUMATE-P SOLUTION T6 KCENTRA KIT T6 KOATE-DVI SOLUTION T6 KOGENATE FS KIT T6 KOGENATE FS BIO-SET KIT T6 MONOCLATE-P KIT T6 MONONINE SOLUTION T6 NOVOSEVEN SOLUTION T6 Nombre Nivel Cobertura Comentario T3 Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 47 Nombre Forma de dosificación Nivel NOVOSEVEN RT SOLUTION T6 PROFILNINE SD SOLUTION T6 PROTAMINE SULFATE SOLUTION T6 RECOMBINATE SOLUTION T6 REFACTO KIT T6 RIASTAP SOLUTION T6 RIXUBIS SOLUTION T6 tranexamic acid SOLUTION T6 TRASYLOL SOLUTION T6 WILATE SOLUTION T6 XYNTHA KIT T6 XYNTHA SOLOFUSE KIT T6 ALPROLIX SOLUTION X LYSTEDA TABS X THROMBI-GEL 10 PADS X THROMBI-GEL 100 PADS X THROMBI-GEL 40 PADS X THROMBI-PAD PADS X TRETTEN SOLUTION X anagrelide hydrochloride CAPS T1 cilostazol TABS T1 clopidogrel TABS T1 jantoven TABS T1 ticlopidine hcl TABS T1 warfarin sodium TABS T1 ACD FORMULA A SOLUTION T2 ACD FORMULA B SOLUTION T2 ACD-A SOLUTION T2 ACD-A NOCLOT-50 SOLUTION T2 AGGRENOX CONT.REL.CAPS T2 ANTICOAGULANT CITRATE DEXTROSE SOLUTION A SOLUTION T2 ANTICOAGULANT CITRATE PHOSPHATE DEXTROSE SOLUTION ANTICOAGULANT SODIUM CITRATE SOLUTION T2 SOLUTION T2 TRICITRASOL SOLUTION T2 AGRYLIN CAPS T3 BRILINTA TABS T3 COUMADIN TABS T3 EFFIENT TABS T3 Cobertura Comentario injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Antithrombotic Agents Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 48 ELIQUIS Forma de dosificación TABS PLAVIX TABS T3 PLETAL TABS T3 Nombre Nivel Cobertura Comentario T3 PRADAXA CAPS T3 XARELTO (10MG) TABS T3 XARELTO (15MG) TABS T3 XARELTO (20MG) TABS T3 XARELTO STARTER PACK TBPK T3 enoxaparin sodium SOLUTION T4 enoxaparin sodium SOLUTION T4 fondaparinux sodium SOLUTION T4 IPRIVASK SOLUTION T4 ARIXTRA SOLUTION T5 FRAGMIN SOLUTION T5 INNOHEP SOLUTION T5 LOVENOX SOLUTION T5 ACTIVASE SOLUTION T6 AGGRASTAT SOLUTION T6 ANGIOMAX SOLUTION T6 ARGATROBAN SOLUTION T6 argatroban SOLUTION T6 ARGATROBAN SOLUTION T6 ATRYN SOLUTION T6 CATHFLO ACTIVASE SOLUTION T6 CEPROTIN SOLUTION T6 COUMADIN SOLUTION T6 hep flush-10 SOLUTION T6 hep-lock SOLUTION T6 heparin lock SOLUTION T6 HEPARIN LOCK FLUSH SOLUTION T6 heparin lock flush SOLUTION T6 heparin lock flush for flushing vascular access devices SOLUTION T6 heparin lock flush/nacl for flushing vascular access devices SOLUTION T6 HEPARIN SODIUM SOLUTION T6 heparin sodium SOLUTION T6 QL (94/365 days) PA Non-self administerable injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 49 heparin sodium dcu Forma de dosificación SOLUTION heparin sodium lock flush SOLUTION T6 heparin sodium lock flush KIT T6 heparin sodium lock flushcombination package KIT T6 HEPARIN SODIUM/D5W SOLUTION T6 heparin sodium/d5w SOLUTION T6 HEPARIN SODIUM/NACL 0.45% SOLUTION T6 heparin sodium/nacl 0.9% SOLUTION T6 HEPARIN SODIUM/SODIUM CHLORIDE 0.9% SOLUTION T6 heparin sodium/sodium chloride 0.9% premix SOLUTION T6 INTEGRILIN SOLUTION T6 KINLYTIC SOLUTION T6 monoject pharma grade flush syringe/heparin lock SOLUTION T6 monoject prefill SOLUTION T6 monoject prefill advanced heparin lock flush SOLUTION T6 REFLUDAN SOLUTION T6 REOPRO SOLUTION T6 RETAVASE KIT T6 RETAVASE HALF-KIT KIT T6 sash kit for flushing vascular access devices KIT T6 THROMBATE III W/10 ML STERILE WATER SOLUTION T6 THROMBATE III W/20 ML STERILE WATER SOLUTION T6 TNKASE KIT T6 ZONTIVITY TABS X PROMACTA TABS T4 NEUMEGA SOLUTION T5 ARANESP ALBUMIN FREE SOLUTION T6 EPOGEN SOLUTION T6 GRANIX SOSY T6 LEUKINE * T6 MOZOBIL SOLUTION T6 NEULASTA SOLUTION T6 NEUPOGEN SOLUTION T6 Nombre Nivel T6 Cobertura Comentario Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Hematopoietic Agents Self Administerable (Select) Injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 50 NPLATE Forma de dosificación SOLUTION OMONTYS SOLUTION T6 PROCRIT SOLUTION T6 pentopak CONT.REL.TABS T1 pentoxifylline er CONT.REL.TABS T1 TRENTAL CONT.REL.TABS T3 doxazosin mesylate TABS T1 prazosin hcl CAPS T1 terazosin hcl CAPS T1 CARDURA TABS T3 MINIPRESS CAPS T3 CARDURA XL CONT.REL.TABS X atorvastatin calcium TABS T1 cholestyramine * T1 cholestyramine light * T1 colestipol hcl * T1 Nombre Nivel Cobertura T6 PA Comentario Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Hemorrheologic Agents Cardiovascular Drugs alpha-Adrenergic Blocking Agents Antilipemic Agents colestipol hcl for oral suspension PACK T1 fenofibrate TABS T1 fenofibrate CAPS T1 fenofibrate micronized CAPS T1 fluvastatin CAPS T1 gemfibrozil TABS T1 lovastatin TABS T1 micronized colestipol hcl TABS T1 niacin er CONT.REL.TABS T1 pravastatin sodium TABS T1 prevalite * T1 simvastatin TABS T1 CRESTOR TABS T2 SIMCOR CONT.REL.TABS T2 VYTORIN TABS T2 WELCHOL * T2 ADVICOR CONT.REL.TABS T3 ANTARA CAPS T3 COLESTID * T3 COLESTID FLAVORED * T3 FENOFIBRATE CAPS T3 FENOFIBRIC ACID TABS T3 fenofibric acid dr CONT.REL.CAPS T3 NOT COVERED FOR MEDICAID: Covered Alternatives Available Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 51 FENOGLIDE Forma de dosificación TABS FIBRICOR TABS T3 LESCOL CAPS T3 Nombre Nivel Cobertura Comentario T3 LESCOL XL CONT.REL.TABS T3 LIPOFEN CAPS T3 LOFIBRA TABS T3 LOFIBRA CAPS T3 LOPID TABS T3 MEVACOR TABS T3 NIASPAN CONT.REL.TABS T3 PRAVACHOL TABS T3 QUESTRAN * T3 QUESTRAN LIGHT * T3 TRICOR TABS T3 TRIGLIDE TABS T3 TRILIPIX CONT.REL.CAPS T3 ZETIA TABS T3 ZOCOR TABS T3 ALTOPREV CONT.REL.TABS X JUXTAPID CAPS X KYNAMRO SOSY X LIPITOR TABS X LIPTRUZET TABS X LIVALO TABS X LOVAZA CAPS X omega-3-acid ethyl esters CAPS X VASCAZEN CAPS X VASCEPA CAPS X acebutolol hcl CAPS T1 atenolol TABS T1 atenolol/chlorthalidone TABS T1 betaxolol hcl TABS T1 bisoprolol fumarate TABS T1 bisoprolol fumarate/hydrochlorothiazide TABS T1 carvedilol TABS T1 labetalol hcl TABS T1 metoprolol succinate er CONT.REL.TABS T1 metoprolol tartrate TABS T1 metoprolol/hydrochlorothiazide TABS T1 nadolol (20mg) TABS T1 nadolol (40mg) TABS T1 nadolol (80mg) TABS T1 nadolol/bendroflumethiazide TABS T1 NOT COVERED FOR MEDICAID: Covered Alternatives Available beta-Adrenergic Blocking Agents Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 52 pindolol Forma de dosificación TABS propranolol hcl TABS T1 propranolol hcl er CONT.REL.CAPS T1 sorine TABS T1 sotalol hcl TABS T1 sotalol hcl (af) TABS T1 BYSTOLIC TABS T2 DUTOPROL CONT.REL.TABS T2 LEVATOL TABS T2 NADOLOL (160MG) TABS T2 PROPRANOLOL HCL SOLUTION T2 PROPRANOLOL/HYDROCHLOROTHIAZIDE TABS T2 TIMOLOL MALEATE TABS T2 BETAPACE TABS T3 BETAPACE AF TABS T3 COREG TABS T3 CORGARD TABS T3 CORZIDE TABS T3 INDERAL LA CONT.REL.CAPS T3 INNOPRAN XL CONT.REL.CAPS T3 KERLONE TABS T3 LOPRESSOR TABS T3 Nombre Nivel Cobertura Comentario T1 LOPRESSOR HCT TABS T3 SECTRAL CAPS T3 TENORETIC 100 TABS T3 TENORETIC 50 TABS T3 TENORMIN TABS T3 TOPROL XL CONT.REL.TABS T3 TRANDATE TABS T3 ZEBETA TABS T3 ZIAC TABS T3 BREVIBLOC SOLUTION T6 BREVIBLOC SOLUTION T6 esmolol hcl SOLUTION T6 labetalol hcl SOLUTION T6 LOPRESSOR SOLUTION T6 metoprolol tartrate SOLUTION T6 propranolol hcl SOLUTION T6 SOTALOL HYDROCHLORIDE SOLUTION T6 COREG CR CONT.REL.CAPS X HEMANGEOL SOLUTION X HYPERTENEVIDE-12.5 MISC X Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 53 HYPERTENSOLOL Forma de dosificación MISC INDERAL XL CONT.REL.CAPS Nombre Nivel Cobertura Comentario X X Calcium-Channel Blocking Agents afeditab cr CONT.REL.TABS T1 amlodipine besylate TABS T1 amlodipine besylate/benazepril hcl CAPS T1 amlodipine besylate/benazepril hydrochloride CAPS T1 cartia xt CONT.REL.CAPS T1 dilt-cd CONT.REL.CAPS T1 dilt-xr CONT.REL.CAPS T1 diltiazem cd CONT.REL.CAPS T1 diltiazem hcl TABS T1 diltiazem hcl cd CONT.REL.CAPS T1 diltiazem hcl er * T1 diltiazem hcl er CONT.REL.CAPS T1 diltiazem hcl er * T1 diltzac CONT.REL.CAPS T1 felodipine er CONT.REL.TABS T1 matzim la CONT.REL.TABS T1 nicardipine hcl CAPS T1 nifediac cc CONT.REL.TABS T1 nifedical xl CONT.REL.TABS T1 nifedipine CAPS T1 nifedipine er CONT.REL.TABS T1 nimodipine CAPS T1 nisoldipine (17mg) CONT.REL.TABS T1 nisoldipine (34mg) CONT.REL.TABS T1 nisoldipine (8.5mg) CONT.REL.TABS T1 nisoldipine er (25.5mg) CONT.REL.TABS T1 taztia xt CONT.REL.CAPS T1 trandolapril/verapamil hcl CONT.REL.TABS T1 verapamil hcl (120mg) TABS T1 verapamil hcl (80mg) TABS T1 verapamil hcl er * T1 verapamil hcl sr * T1 CARDENE SR CONT.REL.CAPS T2 DYNACIRC CR CONT.REL.TABS T2 ISRADIPINE CAPS T2 NISOLDIPINE (20MG) CONT.REL.TABS T2 NISOLDIPINE (30MG) CONT.REL.TABS T2 NISOLDIPINE (40MG) CONT.REL.TABS T2 TARKA CONT.REL.TABS T2 VERAPAMIL HCL (40MG) TABS T2 ADALAT CC CONT.REL.TABS T3 amlodipine besylate/atorvastatin calcium TABS T3 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 54 CADUET Forma de dosificación TABS CALAN TABS T3 CALAN SR CONT.REL.TABS T3 CARDIZEM TABS T3 CARDIZEM CD CONT.REL.CAPS T3 CARDIZEM LA CONT.REL.TABS T3 COVERA-HS CONT.REL.TABS T3 DILACOR XR CONT.REL.CAPS T3 ISOPTIN SR CONT.REL.TABS T3 Nombre Nivel Cobertura Comentario T3 LOTREL CAPS T3 NIMOTOP CAPS T3 NISOLDIPINE ER (25.5MG) CONT.REL.TABS T3 NORVASC TABS T3 PROCARDIA CAPS T3 PROCARDIA XL CONT.REL.TABS T3 SULAR CONT.REL.TABS T3 TIAZAC CONT.REL.CAPS T3 VERELAN CONT.REL.CAPS T3 VERELAN PM CONT.REL.CAPS T3 CARDENE I.V. SOLUTION T6 CARDENE IV SOLUTION T6 CARDENE IV SOLUTION T6 DILTIAZEM HCL * T6 diltiazem hcl * T6 nicardipine hcl SOLUTION T6 verapamil hcl SOLUTION T6 amlodipine besylate/valsartan TABS X AZOR TABS X CLEVIPREX EMULSION X EXFORGE TABS X EXFORGE HCT TABS X HYPERTENIPINE-2.5 MISC X NIFEDIPINE POWDER X NYMALIZE SOLUTION X telmisartan/amlodipine TABS X TRIBENZOR TABS X TWYNSTA TABS X TABS T1 digox TABS T1 digoxin TABS T1 disopyramide phosphate CAPS T1 Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Cardiac Drugs amiodarone hcl Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 55 flecainide acetate Forma de dosificación TABS mexiletine hcl CAPS T1 pacerone (200mg) TABS T1 propafenone hcl TABS T1 propafenone hcl er CONT.REL.CAPS T1 quinidine gluconate cr CONT.REL.TABS T1 quinidine gluconate er CONT.REL.TABS T1 quinidine sulfate (200mg) TABS T1 quinidine sulfate (300mg) TABS T1 DIGOXIN SOLUTION T2 NORPACE CR CONT.REL.CAPS T2 QUINIDINE SULFATE (200MG) TABS T2 QUINIDINE SULFATE ER CONT.REL.TABS T2 TIKOSYN CAPS T2 CORDARONE TABS T3 LANOXIN TABS T3 MULTAQ TABS T3 NORPACE CAPS T3 pacerone (100mg) TABS T3 pacerone (400mg) TABS T3 RANEXA CONT.REL.TABS T3 RYTHMOL TABS T3 Nombre Nivel Cobertura Comentario T1 RYTHMOL SR CONT.REL.CAPS T3 TAMBOCOR (100MG) TABS T3 TAMBOCOR (150MG) TABS T3 TAMBOCOR (50MG) TABS T3 ADENOCARD SOLUTION T6 adenosine SOLUTION T6 AMIODARONE HCL SOLUTION T6 amiodarone hcl SOLUTION T6 CORVERT SOLUTION T6 digoxin SOLUTION T6 ibutilide fumarate SOLUTION T6 INAMRINONE SOLUTION T6 LANOXIN SOLUTION T6 LANOXIN PEDIATRIC SOLUTION T6 LIDOCAINE HCL SOLUTION T6 lidocaine hcl SOLUTION T6 lidocaine hcl in d5w SOLUTION T6 lidocaine hcl/dextrose SOLUTION T6 Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 56 milrinone in dextrose Forma de dosificación SOLUTION milrinone lactate SOLUTION T6 NEXTERONE SOLUTION T6 PROCAINAMIDE HCL SOLUTION T6 procainamide hcl SOLUTION T6 QUINIDINE GLUCONATE SOLUTION T6 XYLOCAINE SOLUTION T6 TAMBOCOR (100MG) TABS X TAMBOCOR (150MG) TABS X TAMBOCOR (50MG) TABS X clonidine hcl TABS T1 clonidine hcl PATCH T1 guanfacine hcl TABS T1 hydralazine hcl TABS T1 methyldopa TABS T1 minoxidil TABS T1 CLORPRES TABS T2 GUANABENZ ACETATE TABS T2 METHYLDOPA/HYDROCHLOROTHIAZIDE TABS T2 RESERPINE TABS T2 CATAPRES TABS T3 CATAPRES-TTS-1 PATCH T3 QL (4/30 days) CATAPRES-TTS-2 PATCH T3 QL (4/30 days) CATAPRES-TTS-3 PATCH T3 QL (4/30 days) TENEX TABS T3 clonidine hcl SOLUTION T6 CORLOPAM SOLUTION T6 DURACLON SOLUTION T6 fenoldopam mesylate SOLUTION T6 hydralazine hcl SOLUTION T6 METHYLDOPATE HCL SOLUTION T6 NITROPRESS SOLUTION T6 clonidine hcl er CONT.REL.TABS X KAPVAY CONT.REL.TABS X KAPVAY DOSE PACK MISC X NEXICLON XR * X VECAMYL TABS X TABS T1 Nombre Nivel Cobertura T6 Comentario Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Hypotensive Agents QL (4/30 days) Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Renin-Angiotensin-Aldosterone Sys Inhib benazepril hcl Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 57 benazepril hcl/hydrochlorothiazide Forma de dosificación TABS candesartan cilexetil TABS T1 candesartan cilexetil/hydrochlorothiazide TABS T1 captopril TABS T1 captopril/hydrochlorothiazide (25mg; 15mg) TABS T1 captopril/hydrochlorothiazide (25mg; 25mg) TABS T1 captopril/hydrochlorothiazide (50mg; 15mg) TABS T1 captopril/hydrochlorothiazide (50mg; 25mg) TABS T1 enalapril maleate TABS T1 enalapril maleate/hydrochlorothiazide TABS T1 eplerenone TABS T1 eprosartan mesylate TABS T1 fosinopril sodium TABS T1 Nombre Nivel Cobertura Comentario T1 fosinopril sodium/hydrochlorothiazide TABS T1 irbesartan TABS T1 irbesartan/hydrochlorothiazide TABS T1 lisinopril TABS T1 lisinopril/hydrochlorothiazide TABS T1 losartan potassium TABS T1 losartan potassium/hydrochlorothiazide TABS T1 moexipril hcl TABS T1 moexipril/hydrochlorothiazide TABS T1 perindopril erbumine TABS T1 quinapril hcl TABS T1 quinapril/hydrochlorothiazide TABS T1 ramipril CAPS T1 spironolactone TABS T1 spironolactone/hydrochlorothiazide TABS T1 telmisartan TABS T1 telmisartan/hydrochloroth TABS T1 telmisartan/hydrochlorothiazide TABS T1 trandolapril TABS T1 valsartan TABS T1 valsartan/hydrochlorothiazide TABS T1 CAPTOPRIL/HYDROCHLOROTHIAZIDE (25MG; 15MG) TABS T2 CAPTOPRIL/HYDROCHLOROTHIAZIDE (25MG; 25MG) TABS T2 CAPTOPRIL/HYDROCHLOROTHIAZIDE (50MG; 15MG) TABS T2 CAPTOPRIL/HYDROCHLOROTHIAZIDE (50MG; 25MG) TABS T2 ACCUPRIL TABS T3 ACCURETIC TABS T3 ACEON TABS T3 ALDACTAZIDE TABS T3 ALDACTONE TABS T3 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 58 ALTACE Forma de dosificación CAPS ATACAND TABS T3 ATACAND HCT TABS T3 Nombre Nivel Cobertura Comentario T3 AVALIDE TABS T3 AVAPRO TABS T3 BENICAR TABS T3 BENICAR HCT TABS T3 COZAAR TABS T3 DIOVAN TABS T3 DIOVAN HCT TABS T3 EDARBI TABS T3 EDARBYCLOR TABS T3 HYZAAR TABS T3 INSPRA TABS T3 LOTENSIN TABS T3 LOTENSIN HCT TABS T3 MAVIK TABS T3 MICARDIS TABS T3 MICARDIS HCT TABS T3 PRINIVIL TABS T3 PRINZIDE TABS T3 TEVETEN TABS T3 TEVETEN HCT TABS T3 UNIRETIC TABS T3 UNIVASC TABS T3 VASERETIC TABS T3 VASOTEC TABS T3 ZESTORETIC TABS T3 ZESTRIL TABS T3 enalaprilat INJECTION T6 AMTURNIDE TABS X EPANED SOLUTION X LYTENSOPRIL MISC X LYTENSOPRIL KIT MISC X LYTENSOPRIL-90 MISC X LYTENSOPRIL-90 KIT MISC X TEKAMLO TABS X TEKTURNA TABS X TEKTURNA HCT TABS X VALTURNA TABS X ETHAMOLIN SOLUTION T6 morrhuate sodium SOLUTION T6 scleromate sodium morrhuate SOLUTION T6 Non-self administerable injectable Sclerosing Agents Non-self administerable injectable Non-self administerable injectable Non-self administerable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 59 Nombre Forma de dosificación Nivel SCLEROSOL INTRAPLEURAL AERP T6 SOTRADECOL SOLUTION T6 STERILE TALC POWDER SUSPENSION T6 ASCLERA SOLUTION X VARITHENA FOAM X dipyridamole TABS T1 isochron CONT.REL.TABS T1 isoditrate er CONT.REL.TABS T1 Cobertura Comentario injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Vasodilating Agents ISOSORBIDE DINITRATE * T1 isosorbide dinitrate * T1 isosorbide dinitrate (2.5mg) SUBLINGUAL T1 isosorbide dinitrate (5mg) SUBLINGUAL T1 isosorbide dinitrate er CONT.REL.TABS T1 isosorbide mononitrate TABS T1 isosorbide mononitrate er CONT.REL.TABS T1 isoxsuprine hcl (10mg) TABS T1 isoxsuprine hcl (20mg) TABS T1 minitran (0.1mg/hr) PATCH T1 QL (30/30 days) minitran (0.2mg/hr) PATCH T1 QL (30/30 days) minitran (0.4mg/hr) PATCH T1 QL (30/30 days) minitran (0.6mg/hr) PATCH T1 QL (30/30 days) nitro-time CONT.REL.CAPS T1 nitroglycerin PATCH T1 nitroglycerin cr CONT.REL.CAPS T1 nitroglycerin er CONT.REL.CAPS T1 nitroglycerin lingual SOLUTION T1 nitroglycerin sr CONT.REL.CAPS T1 nitroglycerin transdermal PATCH T1 sildenafil citrate TABS T1 BIDIL TABS T2 ISORDIL TITRADOSE (40MG) TABS T2 ISOSORBIDE DINITRATE (2.5MG) SUBLINGUAL T2 ISOSORBIDE DINITRATE (5MG) SUBLINGUAL T2 ISOXSUPRINE HCL (10MG) TABS T2 ISOXSUPRINE HCL (20MG) TABS T2 NITRO-BID OINTMENT T2 NITROGLYCERIN LINGUAL AEROSOL T2 NITROLINGUAL PUMPSPRAY (0.4MG/SPRAY) SOLUTION T2 NITROMIST AEROSOL T2 NITROSTAT SUBLINGUAL T2 VIAGRA TABS T2 QL (30/30 days) QL (30/30 days) QL (8/30 days) Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 60 CAVERJECT Forma de dosificación SOLUTION T3 PA; QL (6/30 days) CAVERJECT IMPULSE KIT T3 PA; QL (6/30 days) CIALIS (10MG) TABS T3 QL (8/30 days) Nombre Nivel Cobertura CIALIS (2.5MG) TABS T3 QL (30/30 days) CIALIS (20MG) TABS T3 QL (8/30 days) CIALIS (5MG) TABS T3 QL (30/30 days) DILATRATE SR CONT.REL.CAPS T3 EDEX KIT T3 IMDUR CONT.REL.TABS T3 Comentario PA; QL (6/30 days) ISORDIL TITRADOSE (5MG) TABS T3 LEVITRA TABS T3 QL (8/30 days) minitran (0.1mg/hr) PATCH T3 QL (30/30 days) minitran (0.2mg/hr) PATCH T3 QL (30/30 days) minitran (0.4mg/hr) PATCH T3 QL (30/30 days) minitran (0.6mg/hr) PATCH T3 QL (30/30 days) MONOKET TABS T3 NITRO-DUR PATCH T3 NITROLINGUAL PUMPSPRAY (0.4MG/SPRAY) SOLUTION T3 PERSANTINE TABS T3 STAXYN TABS T3 QL (8/30 days) ADCIRCA TABS T4 PA alprostadil SOLUTION T6 dipyridamole SOLUTION T6 NATRECOR SOLUTION T6 NITROGLYCERIN SOLUTION T6 nitroglycerin in 5% dextrose SOLUTION T6 NITROGLYCERIN IN DEXTROSE 5% SOLUTION T6 nitroglycerin in dextrose 5% SOLUTION T6 NITRONAL SOLUTION T6 papaverine hcl SOLUTION T6 PROSTIN VR PEDIATRIC SOLUTION T6 REVATIO SOLUTION T6 AMYL NITRITE SOLUTION X MUSE PELLET X papaverine hcl cr CONT.REL.CAPS X PARA-TIME CONT.REL.CAPS X REVATIO * X sildenafil TABS X STENDRA TABS X SUSPENSION T6 QL (30/30 days) PA Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Cellular Therapy PROVENGE PA Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 61 Nombre Forma de dosificación Nivel Cobertura Comentario Central Nervous System Agents Analgesics and Antipyretics acetaminophen/codeine * T1 acetaminophen/codeine #2 TABS T1 acetaminophen/codeine #3 TABS T1 acetaminophen/codeine #4 TABS T1 acetaminophen/codeine phosphate TABS T1 anolor 300 CAPS T1 ascomp/codeine CAPS T1 asp 300/200/20 CAPS T1 be-flex plus CAPS T1 buprenorphine hcl SUBLINGUAL T1 buprenorphine hcl/naloxone hcl SUBLINGUAL T1 butal/asa/caff TABS T1 butalbital compound TABS T1 butalbital/acetaminophen TABS T1 butalbital/acetaminophen/caffeine * T1 butalbital/acetaminophen/caffeine/codeine CAPS T1 butalbital/apap/caffeine CAPS T1 BUTALBITAL/ASPIRIN/CAFFEINE * T1 butalbital/aspirin/caffeine * T1 butalbital/aspirin/caffeine/codeine CAPS T1 butorphanol tartrate SOLUTION T1 cephadyn TABS T1 choline magnesium trisalicylate * T1 codeine sulfate (30mg) TABS T1 codeine sulfate (60mg) TABS T1 diclofenac potassium TABS T1 diclofenac sodium dr ENTERIC COATED CONT.REL.TABS T1 ENTERIC COATED TABS T1 ed-flex CAPS T1 endocet TABS T1 endodan TABS T1 diclofenac sodium er diclofenac sodium/misoprostol diflunisal T1 T1 esgic (325mg; 50mg; 40mg) CAPS T1 etodolac * T1 etodolac er CONT.REL.TABS T1 fentanyl PATCH T1 QL (15/30 days) fentanyl citrate oral transmucosal LPOP T1 PA flurbiprofen TABS T1 hydrocodone bitartrate/acetaminophen * T1 hydrocodone bitartrate/acetaminophen (300mg; 10mg) TABS T1 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 62 hydrocodone bitartrate/acetaminophen (300mg; 5mg) Forma de dosificación TABS hydrocodone bitartrate/acetaminophen (300mg; 7.5mg) TABS T1 hydrocodone bitartrate/acetaminophen (325mg; 2.5mg) TABS T1 hydrocodone/acetaminophen (325mg; 10mg) TABS T1 hydrocodone/acetaminophen (325mg; 5mg) TABS T1 hydrocodone/acetaminophen (325mg; 7.5mg) TABS T1 hydrocodone/acetaminophen (500mg/15ml; 7.5mg/15ml) SOLUTION T1 hydrocodone/ibuprofen (7.5mg; 200mg) TABS T1 hydromorphone hcl * T1 ibuprofen * T1 indomethacin CAPS T1 indomethacin cr CONT.REL.CAPS T1 Nombre Nivel Cobertura Comentario T1 indomethacin er CONT.REL.CAPS T1 ketoprofen CAPS T1 ketorolac tromethamine TABS T1 lorcet TABS T1 lorcet hd TABS T1 lorcet plus (325mg; 7.5mg) TABS T1 lortab (325mg; 10mg) TABS T1 lortab (325mg; 5mg) TABS T1 lortab (325mg; 7.5mg) TABS T1 margesic CAPS T1 marten-tab TABS T1 mefenamic acid CAPS T1 meloxicam TABS T1 meperidine hcl TABS T1 meperitab TABS T1 methadone hcl * T1 methadone hcl (10mg/5ml) SOLUTION T1 methadone hcl (5mg/5ml) SOLUTION T1 methadone hcl intensol SOLUTION T1 methadose * T1 morphine sulfate (100mg/5ml) SOLUTION T1 morphine sulfate (10mg/5ml) SOLUTION T1 morphine sulfate (20mg/5ml) SOLUTION T1 morphine sulfate (20mg/ml) SOLUTION T1 morphine sulfate er * T1 morphine sulfate er CONT.REL.CAPS T1 nabumetone TABS T1 naproxen * T1 naproxen dr T1 naproxen sodium ENTERIC COATED TABS orphenadrine/asa/caffeine TABS T1 T1 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 63 oxaprozin Forma de dosificación TABS oxycodone hcl * T1 oxycodone hcl (100mg/5ml) SOLUTION T1 oxycodone hcl (5mg) CAPS T1 oxycodone hcl (5mg/5ml) SOLUTION T1 oxycodone/acetaminophen * T1 oxycodone/aspirin TABS T1 oxycodone/ibuprofen TABS T1 oxymorphone hydrochloride TABS T1 Nombre Nivel Cobertura Comentario T1 oxymorphone hydrochloride er CONT.REL.TABS T1 pentazocine/acetaminophen TABS T1 pentazocine/naloxone hcl TABS T1 piroxicam CAPS T1 repan TABS T1 roxicet (325mg; 5mg) TABS T1 salsalate TABS T1 sulindac TABS T1 tencon (325mg; 50mg) TABS T1 tolmetin sodium CAPS T1 tramadol hcl TABS T1 tramadol hcl er (100mg) CONT.REL.TABS T1 tramadol hcl er (200mg) CONT.REL.TABS T1 tramadol hcl er (300mg) CONT.REL.TABS T1 tramadol hydrochloride/acetaminophen TABS T1 verdrocet TABS T1 zamicet SOLUTION T1 zebutal CAPS T1 ACETAMINOPHEN/CAFFEINE/DIHYDROCODEINE BITARTRATE TABS T2 ASPIRIN-CAFFEINE-DIHYDROCODEINE CAPS T2 BUPAP (650MG; 50MG) TABS T2 CAPITAL/CODEINE SUSPENSION T2 CODEINE SULFATE * T2 CODEINE SULFATE (15MG) TABS T2 FENOPROFEN CALCIUM * T2 FENTORA TABS T2 HYDROCODONE/ACETAMINOPHEN (325MG/15ML; 10MG/15ML) HYDROMORPHONE HCL SOLUTION T2 SUPPOSITORY T2 INDOCIN * T2 KETOPROFEN ER CONT.REL.CAPS T2 LEVACET TABS T2 LEVORPHANOL TARTRATE TABS T2 LIQUICET SOLUTION T2 MECLOFENAMATE SODIUM CAPS T2 MELOXICAM SUSPENSION T2 PA Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 64 MEPERIDINE HCL Forma de dosificación SOLUTION MORPHINE SULFATE * T2 MORPHINE SULFATE (20MG/ML) SOLUTION T2 MST 600 TABS T2 NALFON CAPS T2 NUCYNTA TABS T2 OPANA ER CONT.REL.TABS T2 OPANA ER (CRUSH RESISTANT) CONT.REL.TABS T2 ORAMORPH SR CONT.REL.TABS T2 ORPHENADRINE COMPOUND DS TABS T2 OXYCODONE HCL (100MG/5ML) SOLUTION T2 OXYCODONE HCL (5MG) CAPS T2 OXYCODONE HCL (5MG/5ML) SOLUTION T2 Nombre Nivel Comentario T2 OXYCODONE HCL ER CONT.REL.TABS T2 OXYCONTIN CONT.REL.TABS T2 PHRENILIN FORTE CAPS T2 ROXICET * T2 ROXICET (500MG; 5MG) TABS T2 SUBOXONE FILM T2 SYNALGOS-DC CAPS T2 TENCON (650MG; 50MG) TABS T2 TOLMETIN SODIUM TABS T2 TREZIX CAPS T2 ANAPROX TABS T3 ANAPROX DS TABS T3 ARTHROTEC 50 T3 AVINZA ENTERIC COATED ENTERIC COATED CONT.REL.CAPS BUPAP (300MG; 50MG) TABS T3 CAMBIA PACK T3 ARTHROTEC 75 Cobertura QL (60/30 days) T3 T3 CATAFLAM TABS T3 CELEBREX CAPS T3 CLINORIL TABS T3 DAYPRO TABS T3 DEMEROL TABS T3 DILAUDID * T3 DISALCID TABS T3 DOLOPHINE TABS T3 DOLOPHINE HCL TABS T3 DURAGESIC PATCH T3 duraxin CAPS T3 EC-NAPROSYN T3 ESGIC ENTERIC COATED * ESGIC (325MG; 50MG; 40MG) CAPS T3 QL (9/30 days) QL (15/30 days) T3 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 65 ESGIC-PLUS Forma de dosificación * FELDENE CAPS T3 FIORICET * T3 Nombre Nivel Cobertura Comentario T3 FIORICET/CODEINE CAPS T3 FIORINAL CAPS T3 FIORINAL/CODEINE #3 CAPS T3 HYCET SOLUTION T3 KADIAN CONT.REL.CAPS T3 LORTAB (500MG/15ML; 7.5MG/15ML) ELIXIR T3 METHADONE HCL (10MG/5ML) SOLUTION T3 METHADONE HCL (5MG/5ML) SOLUTION T3 METHADOSE SOLUTION T3 METHADOSE SUGAR-FREE SOLUTION T3 MOBIC * T3 MS CONTIN CONT.REL.TABS T3 NAPRELAN CONT.REL.TABS T3 NAPROSYN * T3 NORCO TABS T3 NUCYNTA ER (100MG) CONT.REL.TABS T3 QL (120/30 days) NUCYNTA ER (150MG) CONT.REL.TABS T3 QL (60/30 days) NUCYNTA ER (200MG) CONT.REL.TABS T3 QL (60/30 days) NUCYNTA ER (250MG) CONT.REL.TABS T3 QL (60/30 days) NUCYNTA ER (50MG) CONT.REL.TABS T3 QL (120/30 days) OPANA TABS T3 ORBIVAN CAPS T3 ORBIVAN CF TABS T3 OXYCODONE HCL (100MG/5ML) SOLUTION T3 OXYCODONE HCL (5MG/5ML) SOLUTION T3 PANLOR SS TABS T3 PERCOCET TABS T3 PERCODAN TABS T3 PHRENILIN TABS T3 PONSTEL CAPS T3 ROXICODONE TABS T3 SEDAPAP TABS T3 SUBOXONE SUBLINGUAL T3 SUBUTEX SUBLINGUAL T3 TYLENOL/CODEINE #3 TABS T3 TYLENOL/CODEINE #4 TABS T3 TYLOX CAPS T3 ULTRACET TABS T3 ULTRAM TABS T3 ULTRAM ER CONT.REL.TABS T3 VICOPROFEN TABS T3 VOLTAREN-XR CONT.REL.TABS T3 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 66 zerlor Forma de dosificación TABS ZOHYDRO ER CONT.REL.CAPS T3 QL (60/30 days) LAZANDA SOLUTION T4 PA ALFENTA INJECTION T6 alfentanil INJECTION T6 astramorph SOLUTION T6 BUPRENEX SOLUTION T6 buprenorphine hcl SOLUTION T6 butorphanol tartrate SOLUTION T6 CALDOLOR SOLUTION T6 CODEINE PHOSPHATE SOLUTION T6 DEMEROL SOLUTION T6 DEPODUR SUSPENSION T6 DILAUDID SOLUTION T6 DILAUDID-HP * T6 duramorph SOLUTION T6 fentanyl citrate SOLUTION T6 HYDROMORPHONE HCL SOLUTION T6 hydromorphone hcl SOLUTION T6 HYDROMORPHONE HCL DOSETTE SOLUTION T6 ILARIS SOLUTION T6 INDOCIN IV SOLUTION T6 INDOMETHACIN SOLUTION T6 indomethacin sodium SOLUTION T6 INFUMORPH 200 SOLUTION T6 INFUMORPH 500 SOLUTION T6 KETOROCAINE-L KIT T6 KETOROCAINE-LM KIT T6 KETOROLAC TROMETHAMINE SOLUTION T6 ketorolac tromethamine SOLUTION T6 MEPERIDINE HCL SOLUTION T6 meperidine hcl SOLUTION T6 METHADONE HCL (10MG/ML) SOLUTION T6 MORPHINE SULFATE * T6 Nombre Nivel Cobertura Comentario T3 AL (min: 12y) Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 67 morphine sulfate (0.5mg/ml) Forma de dosificación SOLUTION MORPHINE SULFATE (10MG/ML) SOLUTION T6 morphine sulfate (10mg/ml) SOLUTION T6 MORPHINE SULFATE (150MG/30ML) SOLUTION T6 MORPHINE SULFATE (15MG/ML) SOLUTION T6 morphine sulfate (15mg/ml) SOLUTION T6 MORPHINE SULFATE (1MG/ML) SOLUTION T6 morphine sulfate (1mg/ml) SOLUTION T6 MORPHINE SULFATE (25MG/ML) SOLUTION T6 morphine sulfate (25mg/ml) SOLUTION T6 MORPHINE SULFATE (2MG/ML) SOLUTION T6 MORPHINE SULFATE (4MG/ML) SOLUTION T6 MORPHINE SULFATE (50MG/ML) SOLUTION T6 morphine sulfate (50mg/ml) SOLUTION T6 MORPHINE SULFATE (5MG/ML) SOLUTION T6 morphine sulfate (5mg/ml) SOLUTION T6 MORPHINE SULFATE (8MG/ML) SOLUTION T6 morphine sulfate (8mg/ml) SOLUTION T6 MORPHINE SULFATE ADD-VANTAGE SOLUTION T6 MORPHINE SULFATE IN DEXTROSE 5% SOLUTION T6 nalbuphine hcl SOLUTION T6 NEOPROFEN SOLUTION T6 OFIRMEV SOLUTION T6 OPANA SOLUTION T6 PRIALT SOLUTION T6 STADOL SOLUTION T6 SUBLIMAZE SOLUTION T6 SUFENTA SOLUTION T6 sufentanil citrate SOLUTION T6 TALWIN SOLUTION T6 ULTIVA SOLUTION T6 1/2halfprin X ABSTRAL ENTERIC COATED SUBLINGUAL ACTIQ LPOP X Nombre Nivel T6 Cobertura Comentario Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 68 ACTIVE-PAC/GABAPENTIN Forma de dosificación THPK ADULT ASPIRIN LOW STRENGTH TABS X ANABAR TABS X anacin X ANACIN ENTERIC COATED TABS X ANACIN MAX STRENGTH TABS X aspir-81 X ASPIRIN ENTERIC COATED ENTERIC COATED ENTERIC COATED * aspirin * X aspirin adult low strength ENTERIC COATED CHEW X X ASPIRIN LOW DOSE ENTERIC COATED ENTERIC COATED ENTERIC COATED ENTERIC COATED * aspirin low dose * X aspirin low strength CHEW X aspirtab X aspirtab maximum strength ENTERIC COATED TABS X bayer advanced aspirin extra strength TABS X bayer advanced aspirin regular strength TABS X Nombre aspir-low aspir-trin aspirin childrens aspirin ec aspirin ec low dose aspirin ec low strength aspirin enteric coated adult low strength Nivel X X X X X X X X * X BAYER ASPIRIN PACK X bayer aspirin ec low dose X BAYER BACK & BODY PAIN EXTRA STRENGTH ENTERIC COATED ENTERIC COATED TABS bayer chewable low dose CHEW X BAYER HEART ADVANTAGE TABS X bayer low dose ENTERIC COATED ENTERIC COATED PACK X bayer low strength BC FAST PAIN RELIEF Comentario X bayer aspirin bayer aspirin regimen Cobertura X X X X BC FAST PAIN RELIEF ARTHRITIS STRENGTH PACK X BUNAVAIL FILM X BUTRANS PATCH X cafgesic CAPS X cafgesic forte TABS X childrens aspirin CHEW X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 69 childrens aspirin low strength Forma de dosificación CHEW co-gesic TABS X CONZIP CONT.REL.CAPS X cope TABS X CRAMP TABS TABS X DARVON CAPS X DEWITTS PILLS TABS X DOANS PM EXTRA STRENGTH TABS X DOLGIC PLUS TABS X DUEXIS TABS X EASPRIN ENTERIC COATED ENTERIC COATED ENTERIC COATED ENTERIC COATED ENTERIC COATED ENTERIC COATED CONT.REL.CAPS X X EXALGO ENTERIC COATED T24A EXCEDRIN BACK & BODY TABS X EXCEDRIN TENSION HEADACHE TABS X extra strength bayer TABS X extra strength bayer arthritis pain regimen ENTERIC COATED TABS X Nombre ec-81 aspirin ecotrin low strength ECOTRIN MAXIMUM STRENGTH ECOTRIN REGULAR STRENGTH ecpirin EMBEDA enteric coated aspirin FRENADOL goodsense aspirin low dose Nivel X X X X X X X X X GOODYS BODY PAIN GRALISE TABS X GRALISE STARTER MISC X HALFPRIN ENTERIC COATED ENTERIC COATED TABS X X TABS X TABS X HYDROCODONE BITARTRATE/ACETAMINOPHEN (750MG; 10MG) hydrocodone bitartrate/acetaminophen (750mg; 10mg) hydrocodone/acetaminophen (500mg; 10mg) Comentario X ENTERIC COATED PACK halfprin Cobertura X X hydrocodone/acetaminophen (500mg; 2.5mg) TABS X hydrocodone/acetaminophen (500mg; 5mg) TABS X HYDROCODONE/ACETAMINOPHEN (500MG; 7.5MG) TABS X hydrocodone/acetaminophen (500mg; 7.5mg) TABS X hydrocodone/acetaminophen (650mg; 10mg) TABS X HYDROCODONE/ACETAMINOPHEN (650MG; 7.5MG) TABS X hydrocodone/acetaminophen (650mg; 7.5mg) TABS X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 70 hydrocodone/acetaminophen (660mg; 10mg) Forma de dosificación TABS HYDROCODONE/ACETAMINOPHEN (750MG; 7.5MG) TABS X hydrocodone/acetaminophen (750mg; 7.5mg) TABS X Nombre Nivel Cobertura Comentario X hydrocodone/ibuprofen (10mg; 200mg) TABS X hydrocodone/ibuprofen (2.5mg; 200mg) TABS X hydrocodone/ibuprofen (5mg; 200mg) TABS X hydrogesic CAPS X HYDROMORPHONE HCL ER T24A X hydromorphone hcl er T24A X IBUPROFEN COMFORT PAC KIT X KETOROLAC TROMETHAMINE POWDER X LORCET 10/650 TABS X LORCET PLUS (650MG; 7.5MG) TABS X LORTAB (300MG/15ML; 10MG/15ML) ELIXIR X LORTAB (500MG; 10MG) TABS X LORTAB (500MG; 5MG) TABS X LORTAB (500MG; 7.5MG) TABS X MAGNACET TABS X MAPAP HEADACHE PLUS TABS X margesic-h CAPS X MAXIDONE TABS X MEDI-SELTZER EFFERVESCENT X MELOXICAM COMFORT PAC KIT X MEPERIDINE HCL/PROMETHAZINE HCL CAPS X midol menstrual headache maximum strength TABS X midol teen TABS X miniprin low dose X ms-aid ENTERIC COATED TABS NAPROXEN COMFORT PAC KIT X norwich aspirin TABS X ONSOLIS FILM X OXECTA TABA X p-a-c TABS X PAINAID BRF TABS X painaid pmf TABS X PRIMLEV TABS X X propoxyphene hcl CAPS X REPREXAIN TABS X reprexain TABS X RYBIX ODT TABS X RYZOLT CONT.REL.TABS X SPRIX SOLUTION X ST JOSEPH ADULT CHEW X ST JOSEPH ADULT ANALGESICLOW DOSE BITE SIZE CHEW X st joseph aspirin * X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 71 STANBACK HEADACHE POWDERS Forma de dosificación PACK SUBSYS LIQUID X SYNAPRYN FUSEPAQ SUSPENSION X th aspirin TABS X th aspirin low dose * X th enteric aspirin X THERACODEINE-300 ENTERIC COATED MISC X THERACODOPHEN-325 MISC X THERACODOPHEN-650 MISC X THERACODOPHEN-750 MISC X Nombre Nivel Comentario X THERACODOPHEN-LOW-90 MISC X THERAFELDAMINE MISC X THERAPOXYPHENE-325 MISC X THERAPOXYPHENE-650 MISC X THERAPROFEN-60 MISC X THERAPROFEN-800 MISC X THERAPROFEN-90 MISC X THERAPROXEN MISC X THERAPROXEN-500 MISC X THERAPROXEN-60 MISC X THERAPROXEN-90 MISC X THERATRAMADOL-60 MISC X THERATRAMADOL-90 MISC X TRAMADOL HCL ER * X tramadol hcl er (100mg) CONT.REL.TABS X tramadol hcl er (200mg) CONT.REL.TABS X tramadol hcl er (300mg) CONT.REL.TABS X TREPADICLOFEN-25 MISC X TREPOXEN-250 MISC X TREPOXICAM-7.5 MISC X VICODIN TABS X vicodin TABS X VICODIN ES TABS X vicodin es TABS X vicodin hp TABS X VIMOVO ENTERIC COATED TABS X womens tylenol Cobertura X XARTEMIS XR CONT.REL.TABS X XODOL TABS X XOLOX TABS X xylon TABS X ZIPSOR CAPS X ZOLVIT SOLUTION X ZORPRIN CONT.REL.TABS X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 72 Nivel ZORVOLEX Forma de dosificación CAPS ZUBSOLV SUBLINGUAL X ZYDONE TABS X Nombre Cobertura Comentario X Anorexigenic Agents and Respiratory and CNS Stimulants amphetamine/dextroamphetamine * T1 caffeine citrate SOLUTION T1 dexedrine TABS T1 dexmethylphenidate hcl TABS T1 dexmethylphenidate hcl er CONT.REL.CAPS T1 dextroamphetamine sulfate * T1 dextroamphetamine sulfate er CONT.REL.CAPS T1 metadate er CONT.REL.TABS T1 methamphetamine hcl TABS T1 methylin TABS T1 methylin er CONT.REL.TABS T1 methylphenidate hcl TABS T1 methylphenidate hcl cd CONT.REL.CAPS T1 methylphenidate hcl er * T1 methylphenidate hcl er (18mg) CONT.REL.TABS T1 methylphenidate hcl er (20mg) CONT.REL.TABS T1 methylphenidate hcl er (27mg) CONT.REL.TABS T1 methylphenidate hcl er (36mg) CONT.REL.TABS T1 methylphenidate hcl er (54mg) CONT.REL.TABS T1 methylphenidate hcl sr CONT.REL.TABS T1 methylphenidate hydrochloride SOLUTION T1 zenzedi (10mg) TABS T1 zenzedi (5mg) TABS T1 METHYLIN CHEW T2 METHYLPHENIDATE HCL ER (10MG) CONT.REL.TABS T2 modafinil TABS T2 RITALIN LA (10MG) CONT.REL.CAPS T2 ADDERALL TABS T3 ADDERALL XR CONT.REL.CAPS T3 CAFCIT SOLUTION T3 CONCERTA CONT.REL.TABS T3 DESOXYN TABS T3 DEXEDRINE CONT.REL.CAPS T3 FOCALIN TABS T3 FOCALIN XR CONT.REL.CAPS T3 METADATE CD CONT.REL.CAPS T3 METHYLIN SOLUTION T3 PROCENTRA SOLUTION T3 PROVIGIL TABS T3 RITALIN TABS T3 RITALIN LA (20MG) CONT.REL.CAPS T3 PA PA PA PA Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 73 Nivel RITALIN LA (30MG) Forma de dosificación CONT.REL.CAPS RITALIN LA (40MG) CONT.REL.CAPS T3 RITALIN SR CONT.REL.TABS T3 VYVANSE CAPS T3 ZENZEDI (15MG) TABS T3 ZENZEDI (2.5MG) TABS T3 ZENZEDI (20MG) TABS T3 ZENZEDI (30MG) TABS T3 ZENZEDI (7.5MG) TABS T3 CAFCIT SOLUTION T6 caffeine citrate SOLUTION T6 CAFFEINE/SODIUM BENZOATE SOLUTION T6 DOPRAM SOLUTION T6 doxapram hcl SOLUTION T6 ADIPEX-P * X BELVIQ TABS X benzphetamine hcl TABS X BONTRIL PDM TABS X BONTRIL SLOW RELEASE CONT.REL.CAPS X CONTRAVE CONT.REL.TABS X DAYTRANA PATCH X DIDREX TABS X DIETHYLPROPION HCL TABS X diethylpropion hcl TABS X diethylpropion hcl er CONT.REL.TABS X NUVIGIL TABS X phendimetrazine tartrate TABS X PHENDIMETRAZINE TARTRATE ER CONT.REL.CAPS X phentermine hcl * X QSYMIA CONT.REL.CAPS X Nombre Cobertura Comentario T3 QUILLIVANT XR SUSPENSION X REGIMEX TABS X SENTRAMODAFIN AM-100 MISC X SUPRENZA TABS X * T1 Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Anticonvulsants carbamazepine carbamazepine er * T1 clonazepam TABS T1 clonazepam odt TABS T1 divalproex sodium CAPS T1 divalproex sodium dr T1 divalproex sodium er ENTERIC COATED CONT.REL.TABS epitol TABS T1 T1 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 74 ethosuximide Forma de dosificación * felbamate * T1 gabapentin * T1 lamotrigine * T1 lamotrigine er CONT.REL.TABS T1 levetiracetam * T1 levetiracetam er CONT.REL.TABS T1 oxcarbazepine * T1 phenytoin * T1 phenytoin infatabs CHEW T1 phenytoin sodium extended CAPS T1 primidone TABS T1 tiagabine hydrochloride TABS T1 Nombre Nivel Cobertura Comentario T1 topiragen TABS T1 topiramate * T1 valproic acid * T1 valproic acid CAPS T1 zonisamide CAPS T1 APTIOM TABS T2 BANZEL * T2 CELONTIN CAPS T2 DILANTIN (30MG) CAPS T2 EQUETRO CONT.REL.CAPS T2 FYCOMPA TABS T2 GABITRIL (12MG) TABS T2 GABITRIL (16MG) TABS T2 LAMICTAL CHEW T2 ONFI TABS T2 ONFI SUSPENSION T2 PEGANONE TABS T2 POTIGA TABS T2 TEGRETOL-XR (100MG) CONT.REL.TABS T2 VIMPAT * T2 CARBATROL CONT.REL.CAPS T3 DEPAKENE SYRUP T3 DEPAKENE CAPS T3 DEPAKOTE T3 DEPAKOTE ER ENTERIC COATED CONT.REL.TABS DEPAKOTE SPRINKLES CAPS T3 DILANTIN SUSPENSION T3 AL (min: 12y) AL (min: 2y) AL (min: 18y); QL (90/30 days) T3 DILANTIN (100MG) CAPS T3 DILANTIN INFATABS CHEW T3 FELBATOL * T3 GABITRIL (2MG) TABS T3 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 75 GABITRIL (4MG) Forma de dosificación TABS HORIZANT CONT.REL.TABS T3 KEPPRA * T3 KEPPRA XR CONT.REL.TABS T3 KLONOPIN TABS T3 LAMICTAL TABS T3 LAMICTAL CHEWABLE DISPERSIBLE CHEW T3 LAMICTAL ODT * T3 LAMICTAL STARTER/NOT TAKING CARBAMAZEPINE KIT T3 LAMICTAL STARTER/TAKING CARBAMAZEPINE/NOT TAKING VALPROATE LAMICTAL STARTER/TAKING VALPROATE KIT T3 KIT T3 LAMICTAL XR * T3 LYRICA * T3 MYSOLINE TABS T3 Nombre Nivel Cobertura Comentario T3 NEURONTIN * T3 PHENYTEK CAPS T3 STAVZOR CONT.REL.CAPS T3 TEGRETOL * T3 TEGRETOL-XR (200MG) CONT.REL.TABS T3 TEGRETOL-XR (400MG) CONT.REL.TABS T3 TOPAMAX TABS T3 TOPAMAX SPRINKLE CAPS T3 TRILEPTAL * T3 ZARONTIN * T3 ZONEGRAN CAPS T3 SABRIL * T4 DEPACON SOLUTION T6 fosphenytoin sodium SOLUTION T6 KEPPRA SOLUTION T6 levetiracetam SOLUTION T6 LEVETIRACETAM SOLUTION T6 MAGNESIUM SULFATE SOLUTION T6 magnesium sulfate SOLUTION T6 phenytoin sodium SOLUTION T6 valproate sodium SOLUTION T6 VIMPAT SOLUTION T6 CARBAMAZEPINE POWDER X CEREBYX SOLUTION X OXTELLAR XR CONT.REL.TABS X PHENYTOIN SODIUM POWDER X Prior Authorization Criteria Requirements apply to Medicaid Only PA Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 76 QUDEXY XR Forma de dosificación CS24 THERAPENTIN-60 MISC X THERAPENTIN-90 MISC X TOPIRAMATE ER CS24 X TROKENDI XR CONT.REL.CAPS X Nombre Nivel Cobertura Comentario QL (12/30 days) Quantity limit is # of doses. X Antimanic Agents LITHIUM CARBONATE * T1 lithium carbonate * T1 lithium carbonate er CONT.REL.TABS T1 LITHIUM SOLUTION T2 LITHOBID CONT.REL.TABS T3 epidrin CAPS T1 ergotamine tartrate/caffeine TABS T1 isometheptene mucate/caffeine/acetaminophen TABS T1 isometheptene/dichloralphenazone/ acetaminophen migragesic ida CAPS T1 CAPS T1 naratriptan hcl TABS T1 nodolor CAPS T1 rizatriptan benzoate TABS T1 QL (12/30 days) Quantity limit is # of doses. rizatriptan benzoate odt TABS T1 QL (12/30 days) Quantity limit is # of doses. SUMATRIPTAN SUCCINATE * T1 QL (6 ML/30 days) sumatriptan succinate * T1 QL (6 ML/30 days) sumatriptan succinate TABS T1 QL (12/30 days) Self Administerable (Select) Injectable Self Administerable (Select) Injectable Quantity limit is # of doses. sumatriptan succinate refill PEN T1 QL (6 ML/30 days) zolmitriptan TABS T1 QL (12/30 days) Self Administerable (Select) Injectable Quantity limit is # of doses. QL (12/30 days) Quantity limit is # of doses. QL (12/30 days) Quantity limit is # of doses. Antimigraine Agents zolmitriptan odt TABS T1 CAFERGOT TABS T2 IMITREX SOLUTION T2 MIGERGOT SUPPOSITORY T2 SUMATRIPTAN SOLUTION T2 QL (12/30 days) Quantity limit is # of doses. AMERGE TABS T3 QL (12/30 days) Quantity limit is # of doses. AXERT TABS T3 QL (12/30 days) Quantity limit is # of doses. FROVA TABS T3 QL (12/30 days) Quantity limit is # of doses. IMITREX TABS T3 QL (12/30 days) Quantity limit is # of doses. IMITREX SOLUTION T3 QL (6 ML/30 days) IMITREX STATDOSE REFILL PEN T3 QL (6 ML/30 days) IMITREX STATDOSE SYSTEM SOAJ T3 QL (6 ML/30 days) Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable ISOMETHEPTENE/CAFFEINE/ACETAMINOPHEN TABS T3 MAXALT TABS T3 QL (12/30 days) Quantity limit is # of doses. MAXALT-MLT TABS T3 QL (12/30 days) Quantity limit is # of doses. MIGRAL TABS T3 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 77 MIGRALAM Forma de dosificación CAPS PRODRIN TABS T3 RELPAX TABS T3 QL (12/30 days) Quantity limit is # of doses. ZOMIG TABS T3 QL (12/30 days) Quantity limit is # of doses. ZOMIG SOLUTION T3 ZOMIG NASAL SPRAY SOLUTION T3 ZOMIG ZMT TABS T3 QL (12/30 days) Quantity limit is # of doses. ALSUMA SOAJ X SUMAVEL DOSEPRO SOTJ X TREXIMET TABS X amantadine hcl * T1 benztropine mesylate TABS T1 Nombre Nivel Cobertura Comentario T3 Antiparkinsonian Agents bromocriptine mesylate * T1 cabergoline TABS T1 carbidopa TABS T1 carbidopa/levodopa TABS T1 carbidopa/levodopa er CONT.REL.TABS T1 carbidopa/levodopa odt TABS T1 CARBIDOPA/LEVODOPA/ENTACAPONE TABS T1 entacapone TABS T1 pramipexole dihydrochloride TABS T1 ropinirole er CONT.REL.TABS T1 ropinirole hcl TABS T1 selegiline hcl * T1 trihexyphenidyl hcl * T1 AMANTADINE HCL TABS T2 AZILECT TABS T2 LODOSYN (25MG) TABS T2 TASMAR TABS T2 ZELAPAR TABS T2 COMTAN TABS T3 ELDEPRYL CAPS T3 LODOSYN (25MG) TABS T3 MIRAPEX TABS T3 MIRAPEX ER CONT.REL.TABS T3 NEUPRO PATCH T3 PARCOPA TABS T3 PARLODEL * T3 REQUIP TABS T3 REQUIP XL CONT.REL.TABS T3 SINEMET TABS T3 SINEMET CR CONT.REL.TABS T3 STALEVO 100 TABS T3 STALEVO 125 TABS T3 QL (30/30 days) Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 78 STALEVO 150 Forma de dosificación TABS STALEVO 200 TABS T3 STALEVO 50 TABS T3 Nombre Nivel Cobertura Comentario PA Self Administerable (Select) Injectable Non-self administerable injectable Non-self administerable injectable T3 STALEVO 75 TABS T3 APOKYN SOLUTION T5 benztropine mesylate SOLUTION T6 COGENTIN SOLUTION T6 EMSAM PATCH X alprazolam TABS T1 alprazolam er CONT.REL.TABS T1 alprazolam odt TABS T1 Anxiolytics, Sedatives, and Hypnotics alprazolam xr CONT.REL.TABS T1 buspirone hcl TABS T1 chlordiazepoxide hcl CAPS T1 clorazepate dipotassium TABS T1 diazepam TABS T1 estazolam TABS T1 eszopiclone TABS T1 flurazepam hcl (15mg) CAPS T1 flurazepam hcl (30mg) CAPS T1 hydroxyzine hcl * T1 hydroxyzine pamoate (25mg) CAPS T1 hydroxyzine pamoate (50mg) CAPS T1 lorazepam * T1 meprobamate TABS T1 midazolam hcl SYRUP T1 oxazepam CAPS T1 phenobarbital * T1 PHENOBARBITAL (100MG) TABS T1 phenobarbital (100mg) TABS T1 PHENOBARBITAL (15MG) TABS T1 phenobarbital (15mg) TABS T1 phenobarbital (16.2mg) TABS T1 PHENOBARBITAL (30MG) TABS T1 phenobarbital (30mg) TABS T1 phenobarbital (32.4mg) TABS T1 PHENOBARBITAL (60MG) TABS T1 phenobarbital (60mg) TABS T1 temazepam CAPS T1 triazolam TABS T1 zaleplon CAPS T1 zolpidem tartrate TABS T1 ALPRAZOLAM INTENSOL SOLUTION T2 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 79 BUTISOL SODIUM Forma de dosificación * DIASTAT ACUDIAL GEL T2 DIASTAT PEDIATRIC GEL T2 DIAZEPAM SOLUTION T2 DIAZEPAM GEL T2 DIAZEPAM INTENSOL SOLUTION T2 DORAL TABS T2 EQUAGESIC TABS T2 FLURAZEPAM HCL (15MG) CAPS T2 FLURAZEPAM HCL (30MG) CAPS T2 HYDROXYZINE PAMOATE (100MG) CAPS T2 PHENOBARBITAL (64.8MG) TABS T2 PHENOBARBITAL (97.2MG) TABS T2 Nombre Nivel Cobertura Comentario QL (30/30 days) NOT COVERED FOR MEDICAID: Covered Alternatives Available Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable T2 QUAZEPAM TABS T2 SECONAL CAPS T2 TRYPTOPHAN CAPS T2 AMBIEN TABS T3 ATIVAN TABS T3 HALCION TABS T3 LORAZEPAM INTENSOL SOLUTION T3 LUNESTA TABS T3 NIRAVAM TABS T3 RESTORIL CAPS T3 ROZEREM TABS T3 SONATA CAPS T3 TRANXENE T TABS T3 VALIUM TABS T3 VISTARIL CAPS T3 XANAX TABS T3 XANAX XR CONT.REL.TABS T3 zolpidem tartrate er CONT.REL.TABS T3 AMYTAL SODIUM SOLUTION T6 ATIVAN SOLUTION T6 dexmedetomidine hcl SOLUTION T6 DIAZEPAM * T6 droperidol SOLUTION T6 HYDROXYZINE HCL SOLUTION T6 hydroxyzine hcl SOLUTION T6 lorazepam SOLUTION T6 LUMINAL SOLUTION T6 midazolam hcl SOLUTION T6 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 80 NEMBUTAL Forma de dosificación SOLUTION NEMBUTAL SODIUM SOLUTION T6 PHENOBARBITAL SODIUM SOLUTION T6 PRECEDEX SOLUTION T6 PRECEDEX SOLUTION T6 AMBIEN CR CONT.REL.TABS X CHLORAL HYDRATE SYRUP X Nombre Nivel Cobertura T6 EDLUAR SUBLINGUAL X GABAVALE-5 MISC X GABAZOLAMINE MISC X GABAZOLAMINE-0.5 MISC X GABAZOLPIDEM-5 MISC X HETLIOZ CAPS X INTERMEZZO SUBLINGUAL X MEBARAL TABS X SENTRAZOLAM AM 0.25 MISC X SENTRAZOLPIDEM PM-5 MISC X SOMNOTE CAPS X STRAZEPAM MISC X ZOLPIMIST SOLUTION X ENTERIC COATED TABS T1 T2 NAMENDA ENTERIC COATED * NAMENDA TITRATION PAK TABS T2 CAMPRAL (333MG) T3 INTUNIV ENTERIC COATED CONT.REL.TABS NAMENDA XR CONT.REL.CAPS T3 Comentario Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Central Nervous System Agents, Misc acamprosate calcium dr riluzole CAMPRAL (333MG) T1 T2 T3 NOT COVERED FOR MEDICAID: Covered Alternatives Available NAMENDA XR TITRATION PACK CONT.REL.CAPS T3 RILUTEK TABS T3 STRATTERA CAPS T3 XENAZINE TABS T4 PA XYREM SOLUTION T5 PA flumazenil SOLUTION T6 ROMAZICON SOLUTION T6 NUEDEXTA CAPS X SAVELLA TABS T3 SAVELLA TITRATION PACK MISC T3 Non-self administerable injectable Non-self administerable injectable Fibromyalgia Agents NOT COVERED FOR MEDICAID: Covered Alternatives Available NOT COVERED FOR MEDICAID: Covered Alternatives Available Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 81 Nombre Forma de dosificación Nivel Cobertura Comentario General Anesthetics AMIDATE SOLUTION T6 BREVITAL SODIUM SOLUTION T6 DIPRIVAN EMULSION T6 etomidate SOLUTION T6 fresenius propoven EMULSION T6 KETALAR SOLUTION T6 ketamine hcl SOLUTION T6 LUSEDRA SOLUTION T6 propofol EMULSION T6 compound 347 SOLUTION X ETHRANE SOLUTION X FORANE SOLUTION X isoflurane SOLUTION X PENTOTHAL * X sevoflurane SOLUTION X sojourn SOLUTION X SUPRANE SOLUTION X terrell SOLUTION X ULTANE SOLUTION X depade TABS T1 naltrexone hcl TABS T1 REVIA TABS T3 NALOXONE HCL SOLUTION T6 naloxone hcl SOLUTION T6 EVZIO SOAJ X VIVITROL SUSPENSION X amitriptyline hcl TABS T1 budeprion sr CONT.REL.TABS T1 budeprion xl CONT.REL.TABS T1 buproban CONT.REL.TABS T1 bupropion hcl TABS T1 bupropion hcl er CONT.REL.TABS T1 bupropion hcl sr CONT.REL.TABS T1 bupropion hcl sr CONT.REL.TABS T1 bupropion hcl xl CONT.REL.TABS T1 Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Opiate Antagonists Non-self administerable injectable Non-self administerable injectable Psychotherapeutic Agents chlorpromazine hcl TABS T1 citalopram hydrobromide * T1 clomipramine hcl CAPS T1 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 82 Nivel clozapine Forma de dosificación TABS compazine SUPPOSITORY T1 compro SUPPOSITORY T1 desipramine hcl TABS T1 DOXEPIN HCL * T1 doxepin hcl * T1 duloxetine hcl CAPS T1 escitalopram oxalate * T1 fluoxetine hcl * T1 fluoxetine hcl (10mg) TABS T1 fluoxetine hcl (20mg) TABS T1 fluphenazine hcl TABS T1 fluvoxamine maleate TABS T1 haloperidol TABS T1 haloperidol SOLUTION T1 imipramine hcl TABS T1 Nombre Cobertura Comentario T1 imipramine pamoate CAPS T1 loxapine CAPS T1 loxapine succinate CAPS T1 mirtazapine * T1 mirtazapine odt TABS T1 nefazodone hcl (250mg) TABS T1 nortriptyline hcl * T1 nortriptyline hcl (10mg/5ml) SOLUTION T1 olanzapine TABS T1 olanzapine odt TABS T1 paroxetine hcl * T1 perphenazine TABS T1 phenelzine sulfate TABS T1 prochlorperazine SUPPOSITORY T1 prochlorperazine maleate TABS T1 protriptyline hcl TABS T1 quetiapine fumarate TABS T1 risperidone * T1 risperidone m-tab TABS T1 risperidone odt TABS T1 sertraline hcl * T1 thioridazine hcl TABS T1 thiothixene CAPS T1 tranylcypromine sulfate TABS T1 trazodone hcl TABS T1 trifluoperazine hcl TABS T1 trimipramine maleate CAPS T1 venlafaxine hcl TABS T1 venlafaxine hcl er CONT.REL.CAPS T1 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 83 ziprasidone hcl Forma de dosificación CAPS ABILIFY * T2 ABILIFY DISCMELT TABS T2 AMOXAPINE TABS T2 CHLORDIAZEPOXIDE/AMITRIPTYLINE TABS T2 FLUPHENAZINE HCL * T2 Nombre Nivel Cobertura Comentario T1 MAPROTILINE HCL TABS T2 MARPLAN TABS T2 NAVANE (20MG) CAPS T2 NEFAZODONE HCL (100MG) TABS T2 NEFAZODONE HCL (150MG) TABS T2 NEFAZODONE HCL (200MG) TABS T2 NEFAZODONE HCL (50MG) TABS T2 NORTRIPTYLINE HCL (10MG/5ML) SOLUTION T2 ORAP TABS T2 OXYCODONE HCL ER CONT.REL.TABS T2 PAXIL (10MG/5ML) SUSPENSION T2 PERPHENAZINE/AMITRIPTYLINE TABS T2 SEROQUEL XR CONT.REL.TABS T2 ANAFRANIL CAPS T3 BRINTELLIX TABS T3 CELEXA TABS T3 CLOZARIL TABS T3 COMPAZINE TABS T3 CYMBALTA CAPS T3 ST EFFEXOR XR CONT.REL.CAPS T3 FANAPT TABS T3 FANAPT TITRATION PACK TABS T3 FETZIMA CONT.REL.CAPS T3 ST FETZIMA TITRATION PACK C4PK T3 ST GEODON CAPS T3 LATUDA TABS T3 LEXAPRO * T3 LOXITANE CAPS T3 NARDIL TABS T3 NAVANE (10MG) CAPS T3 NAVANE (2MG) CAPS T3 NAVANE (5MG) CAPS T3 NORPRAMIN TABS T3 PAMELOR CAPS T3 PARNATE TABS T3 PAXIL * T3 PAXIL (10MG/5ML) SUSPENSION T3 PROZAC CAPS T3 REMERON TABS T3 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 84 REMERON SOLTAB Forma de dosificación TABS RISPERDAL * T3 RISPERDAL M-TAB TABS T3 SAPHRIS SUBLINGUAL T3 SEROQUEL TABS T3 SURMONTIL CAPS T3 Nombre Nivel Cobertura Comentario T3 TOFRANIL TABS T3 TOFRANIL-PM CAPS T3 VIIBRYD * T3 VIVACTIL TABS T3 WELLBUTRIN TABS T3 WELLBUTRIN SR CONT.REL.TABS T3 WELLBUTRIN XL CONT.REL.TABS T3 ZOLOFT * T3 ZYBAN CONT.REL.TABS T3 ZYPREXA TABS T3 ZYPREXA ZYDIS TABS T3 ABILIFY SOLUTION T6 ABILIFY MAINTENA SUSPENSION T6 CHLORPROMAZINE HCL SOLUTION T6 fluphenazine decanoate SOLUTION T6 FLUPHENAZINE HCL SOLUTION T6 GEODON SOLUTION T6 HALDOL SOLUTION T6 HALDOL DECANOATE 100 SOLUTION T6 HALDOL DECANOATE 50 SOLUTION T6 haloperidol decanoate SOLUTION T6 haloperidol lactate SOLUTION T6 INVEGA SUSTENNA SUSPENSION T6 olanzapine SOLUTION T6 prochlorperazine edisylate SOLUTION T6 RISPERDAL CONSTA SUSPENSION T6 ZYPREXA SOLUTION T6 ZYPREXA RELPREVV SUSPENSION T6 ADASUVE AEROSOL X APLENZIN CONT.REL.TABS X APPBUTAMONE MISC X APPBUTAMONE-D MISC X BRISDELLE CAPS X NOT COVERED FOR MEDICAID: Covered Alternatives Available Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 85 CLOZAPINE ODT Forma de dosificación TABS DESVENLAFAXINE ER CONT.REL.TABS X DESVENLAFAXINE ER CONT.REL.TABS X ENOVARX-AMITRIPTYLINE KIT X FAZACLO TABS X fluoxetine CAPS X Nombre Nivel Cobertura Comentario X fluoxetine dr CONT.REL.CAPS X FLUOXETINE HCL (60MG) TABS X fluvoxamine maleate er CONT.REL.CAPS X FORFIVO XL CONT.REL.TABS X GABOXETINE MISC X INVEGA CONT.REL.TABS X KHEDEZLA CONT.REL.TABS X LUVOX CR CONT.REL.CAPS X olanzapine/fluoxetine CAPS X OLEPTRO CONT.REL.TABS X paroxetine hcl er CONT.REL.TABS X PAXIL CR CONT.REL.TABS X PEXEVA TABS X PRISTIQ CONT.REL.TABS X PROZAC WEEKLY CONT.REL.CAPS X SARAFEM TABS X selfemra CAPS X SENTRAFLOX AM-10 MISC X SENTRALOPRAM AM-10 MISC X QL (4/28 days) SENTRAVIL PM-25 MISC X SENTROXATINE MISC X SILENOR TABS X SYMBYAX CAPS X TRAZAMINE MISC X VENLAFAXINE HCL ER CONT.REL.TABS X venlafaxine hcl er CONT.REL.TABS X VERSACLOZ SUSPENSION X FEMCAP DEVICE T6 OMNIFLEX DIAPHRAGM DPRH T6 ORTHO DIAPHRAGM ALL-FLEX/65MM DPRH T6 Women's Preventive Healthcare ORTHO DIAPHRAGM ALL-FLEX/70MM DPRH T6 Women's Preventive Healthcare ORTHO DIAPHRAGM ALL-FLEX/75MM DPRH T6 Women's Preventive Healthcare ORTHO DIAPHRAGM ALL-FLEX/80MM DPRH T6 Women's Preventive Healthcare ORTHO DIAPHRAGM COIL SPRING KIT 100 KIT T6 Women's Preventive Healthcare ORTHO DIAPHRAGM COIL SPRING KIT 105 KIT T6 Women's Preventive Healthcare ORTHO DIAPHRAGM COIL SPRING KIT 50 KIT T6 Women's Preventive Healthcare ORTHO DIAPHRAGM FLAT SPRING KIT 55 KIT T6 Women's Preventive Healthcare ORTHO DIAPHRAGM FLAT SPRING KIT 60 KIT T6 Women's Preventive Healthcare Contraceptives QL (3/365 days) Women's Preventive Healthcare Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 86 ORTHO DIAPHRAGM FLAT SPRING KIT 65 Forma de dosificación KIT T6 Women's Preventive Healthcare ORTHO DIAPHRAGM FLAT SPRING KIT 70 KIT T6 Women's Preventive Healthcare ORTHO DIAPHRAGM FLAT SPRING KIT 75 KIT T6 Women's Preventive Healthcare ORTHO DIAPHRAGM FLAT SPRING KIT 80 KIT T6 Women's Preventive Healthcare ORTHO DIAPHRAGM FLAT SPRING KIT 85 KIT T6 Women's Preventive Healthcare ORTHO DIAPHRAGM FLAT SPRING KIT 90 KIT T6 Women's Preventive Healthcare Nombre Nivel ORTHO DIAPHRAGM FLAT SPRING KIT 95 KIT T6 PARAGARD INTRAUTERINE COPPER CONTRACEPTIVE T380A IUD T6 Cobertura Comentario Women's Preventive Healthcare QL (1/365 days) PRENTIF CAVITY-RIM CERVICAL CAP DEVICE T6 PRENTIF FITTING SET MISC T6 WIDE-SEAL SILICONE DIAPHRAGM KIT 60 DPRH T6 QL (3/365 days) Women's Preventive Healthcare WIDE-SEAL SILICONE DIAPHRAGM KIT 65 DPRH T6 QL (3/365 days) Women's Preventive Healthcare WIDE-SEAL SILICONE DIAPHRAGM KIT 70 DPRH T6 QL (3/365 days) Women's Preventive Healthcare WIDE-SEAL SILICONE DIAPHRAGM KIT 75 DPRH T6 QL (3/365 days) Women's Preventive Healthcare WIDE-SEAL SILICONE DIAPHRAGM KIT 80 DPRH T6 QL (3/365 days) Women's Preventive Healthcare WIDE-SEAL SILICONE DIAPHRAGM KIT 85 DPRH T6 QL (3/365 days) Women's Preventive Healthcare WIDE-SEAL SILICONE DIAPHRAGM KIT 90 DPRH T6 QL (3/365 days) Women's Preventive Healthcare WIDE-SEAL SILICONE DIAPHRAGM KIT 95 DPRH T6 QL (3/365 days) Women's Preventive Healthcare FLUORIDEX DAILY DEFENSE SENSITIVITY RELIEF * X fluoridex daily defense sensitivity relief * X MI PASTE PASTE X MI PASTE PLUS PASTE X NAFRINSE DAILY/ACIDULATED SOLUTION X PREVIDENT 5000 ENAMEL PROTECT PASTE X Dental Agents PREVIDENT 5000 SENSITIVE PASTE X Q-CARE Q2 ORAL CLEANSING/SUCTIONING SYSTEM/CHG ORAL RINSE Q-CARE Q4 ORAL CLEANSING/SUCTIONING SYSTEM/CHG ORAL RINSE REMESENSE KIT X KIT X MISC X Devices ACE AEROSOL CLOUD ENHANCER MISC T6 ACTIVITY POUCH MISC T6 ADULT MASK * T6 ADULT MASK LARGE MISC T6 AEROCHAMBER MINI AEROSOL CHAMBER DEVICE T6 AEROCHAMBER MV MISC T6 AEROCHAMBER PLUS FLOW VU MISC T6 AEROCHAMBER PLUS FLOW-VU MISC T6 AEROCHAMBER PLUS FLOW-VU/LARGE MASK MISC T6 AEROCHAMBER PLUS FLOW-VU/MASK MISC T6 AEROCHAMBER PLUS FLOW-VU/MEDIUM MASK MISC T6 AEROCHAMBER PLUS FLOW-VU/SMALL MASK MISC T6 AEROCHAMBER Z-STAT PLUS VALVED HOLDING CHAMBER W/FLOW VU MISC T6 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 87 AEROCHAMBER Z-STAT PLUS/FLOWSIGNAL Forma de dosificación MISC AEROCHAMBER Z-STAT PLUS/LARGE MASK MISC T6 AEROCHAMBER Z-STAT PLUS/MEDIUM MASK MISC T6 AEROCHAMBER Z-STAT PLUS/SMALL MASK MISC T6 AEROCHAMBER/FLOWSIGNAL MISC T6 AEROECLIPSE II BREATH ACTUATED NEBULIZER DISPOSABLE MISC T6 AEROGEAR ASTHMA ACTION KIT T6 AERONEB GO COMPLETE SYSTEM MISC T6 Nombre Nivel Cobertura Comentario T6 AERONEB GO CONVENIENCE UNIT MISC T6 AERONEB GO NEBULIZER HANDSET MISC T6 AERONEB GO NEBULIZER HANDSET/CONNECTOR CABLE MISC T6 AEROTRACH PLUS MISC T6 AIR WATCH MONITOR DEVICE T6 AIRIAL COMPACT COMPRESSORNEBULIZER SYSTEM MISC T6 AIRIAL COMPACT MINI NEBULIZER MISC T6 AIRIAL COMPARTMENT COMPRESSOR PEDIATRIC NEBULIZER MISC T6 AIRIAL PEDIATRIC NEBULIZER/BUILDING BLOCK MISC T6 AIRIAL PEDIATRIC NEBULIZER/DUCK MISC T6 AIRIAL PEDIATRIC NEBULIZER/FIRE ENGINE MISC T6 AIRIAL PEDIATRIC NEBULIZER/PANDA MISC T6 AIRIAL PEDIATRIC NEBULIZER/PENELOPE PANDA MISC T6 AIRIAL PEDIATRIC NEBULIZER/PENGUIN MISC T6 AIRIAL VOYAGER PORTABLE NEBULIZER MISC T6 AIRS DISPOSABLE NEBULIZER KIT KIT T6 AIRS DISPOSABLE NEBULIZERKIT KIT T6 ALL FLOW 1000 PFT FILTER * T6 ALL FLOW 1000 PULMONARY FUNCTION FILTER MISC T6 ALL FLOW 2000 PFT FILTER DEVICE T6 ALL FLOW 3000 PFT FILTER * T6 ALL FLOW 4000 PFT FILTER * T6 ALL FLOW 5000 PFT FILTER * T6 ALL FLOW 6000 PFT FILTER * T6 ALL FLOW 7000 PFT FILTER DEVICE T6 ASTHMA CONTROL KIT KIT T6 ASTHMAPACK I KIT T6 ASTHMAPACK II KIT T6 ASTHMAPACK III KIT T6 BAYER BREEZE 2 BLOOD GLUCOSE MONITORING SYSTEM KIT T6 QL (1/365 days) BAYER CONTOUR BLOOD GLUCOSE MONITORING SYSTEM * T6 QL (1/365 days) BAYER CONTOUR LINK BLOOD GLUCOSE MONITORING SYSTEM BAYER CONTOUR NEXT BLOOD GLUCOSE MONITORING SYSTEM KIT T6 QL (1/365 days) KIT T6 QL (1/365 days) Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 88 Nombre BAYER CONTOUR NEXT EZ BLOOD GLUCOSE MONITORING SYSTEM BAYER CONTOUR NEXT LINK BLOOD GLUCOSE MONITORING SYSTEM BAYER CONTOUR NEXT USB BLOOD GLUCOSE MONITORING SYSTEM BAYER CONTOUR USB BLOOD GLUCOSE MONITORING SYSTEM BESTMED AEROSOL THERAPY NEBULIZER Forma de dosificación KIT Nivel Cobertura T6 QL (1/365 days) KIT T6 QL (1/365 days) KIT T6 QL (1/365 days) KIT T6 QL (1/365 days) MISC T6 BESTMED ULTRASONIC NEBULIZER MISC T6 BREATHERITE MISC T6 BREATHERITE COLLAPSIBLE ADULT SPACER W/MASK MISC T6 BREATHERITE COLLAPSIBLE CHILD SPACER W/MASK MISC T6 BREATHERITE COLLAPSIBLE INFANT SPACER W/MASK MISC T6 BREATHERITE COLLAPSIBLE SMALL CHILD SPACER W/MASK MISC T6 BREATHERITE COLLAPSIBLE SPACER W/ NEONATE MASK MISC T6 BREATHERITE RIGID SPACER W/MASK MISC T6 BREATHERITE VALVED MDI CHAMBER/COLLAPSIBLE DEVICE T6 BREATHERITE VALVED MDI CHAMBER/RIGID DEVICE T6 BREATHERITE W/LARGE MASK MISC T6 BREATHERITE W/MEDIUM MASK MISC T6 BREATHERITE W/SMALL MASK MISC T6 BREEZE 2 BLOOD GLUCOSE MONITORING SYSTEM DEVICE T6 CO MONITOR DEVICE T6 CO MONITOR CALIBRATION KIT T6 CO MONITOR REPLACEMENT T PIECES MISC T6 COMP AIR COMPRESSOR NEBULIZER MISC T6 COMP AIR ELITE COMPACT COMPRESSOR/NEBULIZER MISC T6 COMPAIR COMPRESSOR NEBULIZER MISC T6 COMPAIR XL COMPRESSOR NEBULIZER SYSTEM MISC T6 COMPAIR XLT COMPRESSOR NEBULIZER SYSTEM MISC T6 DEVILBISS PULMO-AIDE COMPRESSOR/NEBULIZER DEVICE T6 DEVILBISS TRAVEL-AIRE COMPRESSOR/NEBULIZER DEVICE T6 DEVILBISS TRAVELER NEBULIZER MISC T6 DIDGET KIT T6 DISPOSABLE MOUTHPIECE FULL RANGE MISC T6 DISPOSABLE MOUTHPIECE LOWRANGE/PEDIATRIC MISC T6 DISPOSABLE MOUTHPIECE/LOW RANGE MISC T6 DISPOSABLE MOUTHPIECE/UNIVERSAL RANGE MISC T6 E-Z SPACER DEVICE T6 E-Z SPACER THE BODY GUARDS PACK DEVICE T6 EASIVENT MISC T6 EASIVENT/MASK-LARGE MISC T6 EASIVENT/MASK-MEDIUM MISC T6 Comentario QL (1/365 days) QL (1/365 days) Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 89 EASIVENT/MASK-SMALL Forma de dosificación MISC EFLOW SCF AEROSOL HEAD MISC T6 EFLOW SCF ELECTRONIC NEBULIZER SYSTEM MISC T6 EFLOW SCF NEBULIZER HANDSET MISC T6 ELITE DC AUTO ADAPTER MISC T6 ELITE NEBULIZER SYSTEM MISC T6 FASTTAKE COMPACT MONITORING SYSTEM KIT T6 FILTER AIR PP MISC T6 FLUTTER DEVICE T6 FULL KIT NEBULIZER SET MISC T6 HEALTHY LIVING COMPRESSOR/NEBULIZER DESK TOP SIZE DEVICE T6 IN-CHECK DIAL INSPIRATORYFLOW TRAINER DEVICE T6 IN-CHECK INSPIRATORY FLOWMETER/NASAL WITH MASK DEVICE T6 IN-CHECK INSPIRATORY FLOWMETER/ORAL DEVICE T6 INNOSPIRE ELEGANCE COMPRESSOR NEBULIZER SYSTEM MISC T6 INNOSPIRE ESSENCE COMPRESSOR NEBULIZER SYSTEM MISC T6 INNOSPIRE REPLACEMENT FILTER MISC T6 INSPIRATION COMPRESSOR NEBULIZER SYSTEM MISC T6 INSPIRATION ELITE COMPRESSOR NEBULIZER SYSTEM MISC T6 INSPIREASE BAGS MISC T6 Nombre Nivel Cobertura Comentario T6 INSPIREASE DRUG DELIVERY SYSTEM MISC T6 INSPIREASE MOUTHPIECE MISC T6 INSPIREASE REPLACEMENT MOUTHPIECE MISC T6 INSPIREASE RESERVOIR BAGS MISC T6 LEXAN POCKET NEBULIZER PLASTIC MISC T6 LITEAIRE DEVICE T6 LITETOUCH MASK LARGE MISC T6 LITETOUCH MASK MEDIUM MISC T6 LITETOUCH MASK SMALL MISC T6 LUMINEB II PISTON NEBULIZER MISC T6 MICRO AIR NEBULIZER MISC T6 MICRO PLUS HIGH EFFICIENCY NEBULIZER/REUSABLE MISC T6 MICROCHAMBER MISC T6 MICROELITE COMPRESSOR NEBULIZER SYSTEM MISC T6 MICROSPACER MISC T6 MINI COMPRESSOR MISC T6 MINI PLUS REUSABLE HIGH EFFICIENCY NEBULIZER MISC T6 MINIELITE COMPRESSOR NEBULIZER SYSTEM MISC T6 MINIELITE COMPRESSOR NEBULIZER SYSTEM WITH BATTERY MISC T6 MINIELITE RECHARGEABLE BATTERY MISC T6 MISTERNEB COMPRESSOR NEBULIZER SYSTEM MISC T6 NEBULIZER MISC T6 QL (1/365 days) Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 90 NEBULIZER AIR TUBE/PLUGS Forma de dosificación MISC NEBULIZER COMPRESSOR MODEL 2655D MISC T6 NEBULIZER COMPRESSOR/DUALFILTER/7' TUBING/AEROSOL T/MTHPIECE NEBULIZER KIT/TUBING/MOUTHPIECE KIT T6 KIT T6 NEBULIZER PEDIATRIC MASK MISC T6 Nombre Nivel Cobertura Comentario T6 NEBULIZER UPDRAFT-STYLE MISC T6 NEBULIZER/ADULT MASK KIT T6 NEBULIZER/PEDIATRIC MASK KIT T6 ONE FLOW FVC MONITORING SPIROMETER * T6 ONETOUCH BASIC SYSTEM KIT T6 QL (1/365 days) ONETOUCH PROFILE SYSTEM KIT T6 QL (1/365 days) ONETOUCH ULTRA 2 KIT T6 QL (1/365 days) ONETOUCH ULTRA MINI KIT T6 QL (1/365 days) ONETOUCH ULTRA SYSTEM KIT KIT T6 QL (1/365 days) ONETOUCH ULTRALINK SYSTEM (DEC) KIT T6 QL (1/365 days) ONETOUCH ULTRALINK SYSTEM (HEX) KIT T6 QL (1/365 days) ONETOUCH ULTRASMART KIT T6 QL (1/365 days) ONETOUCH VERIO IQ BLOOD GLUCOSE MONITORING SYSTEM ONETOUCH VERIO SYNC BLOODGLUCOSE MONITORING SYSTEM OPTICHAMBER ADVANTAGE KIT T6 QL (1/365 days) KIT T6 QL (1/365 days) MISC T6 OPTICHAMBER ADVANTAGE/LARGE MASK MISC T6 OPTICHAMBER ADVANTAGE/MEDIUM FACE MASK MISC T6 OPTICHAMBER ADVANTAGE/SMALL FACE MASK MISC T6 OPTICHAMBER DIAMOND * T6 OPTICHAMBER DIAMOND/LARGEFACE MASK DEVICE T6 OPTICHAMBER DIAMOND/MEDIUM FACE MASK MISC T6 OPTICHAMBER DIAMOND/SMALLFACE MASK MISC T6 OPTIHALER MISC T6 OPTIHALER MDI DRUG DELIVERY SYSTEM DEVICE T6 OPTIONHOME COMPRESSOR NEBULIZER SYSTEM MISC T6 PARI ALTERA NEBULIZER HANDSET MISC T6 PARI ALTERA NEBULIZER SYSTEM MISC T6 PARI BABY DEVICE T6 PARI BABY CONVERSION KIT SIZE 1 MISC T6 PARI BABY CONVERSION KIT SIZE 2 MISC T6 PARI BABY CONVERSION KIT SIZE 3 MISC T6 PARI BABY SIZE 1/PARI LC PLUS DEVICE T6 PARI ERAPID NEBULIZER HANDSET MISC T6 PARI ERAPID NEBULIZER SYSTEM MISC T6 PARI EXPIRATORY FILTER VALVE SET DEVICE T6 PARI LC D NEBULIZER MISC T6 PARI LC PLUS MISC T6 PARI LC PLUS NEBULIZER MISC T6 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 91 PARI LC PLUS NEBULIZER SET/PEDIATRIC MASK Forma de dosificación MISC PARI LC PLUS PEDIATRIC KIT KIT T6 PARI LC SPRINT NEBULIZER SET MISC T6 PARI LC STAR MISC T6 PARI LC STAR NEBULIZER MISC T6 PARI MANUAL INTERRUPTER DEVICE T6 Nombre Nivel Cobertura Comentario T6 PARI MASK SET MISC T6 PARI PRONEB ULTRA II MISC T6 PARI SINUS PULSATING AEROSOL SYSTEM MISC T6 PARI SOFT PLASTIC ADULT MASK MISC T6 PARI SOFT PLASTIC PEDIATRIC MASK MISC T6 PARI TREK S COMBO PACK DEVICE T6 PARI TREK S COMPACT COMPRESSOR DEVICE T6 PARI TREK S COMPACT COMPRESSOR W/ 12V DC ADAPTOR DEVICE T6 PARI TREK S PORTABLE POWER ACCESSORY KIT KIT T6 PARI VIOS PRO LC PLUS AEROSOL DELIVERY SYSTEM MISC T6 PARI VIOS PRO LC SPRINT AEROSOL DELIVERY SYSTEM MISC T6 PEDIATRIC AEROSOL MASK MISC T6 PFLEX MISC T6 PILLOW MASK/ADULT MISC T6 PILLOW MASK/CHILD MISC T6 PILLOW MASK/PEDIATRIC MISC T6 POCKET CHAMBER DEVICE T6 POCKET SPACER DEVICE T6 PRIMEAIRE DUAL-VALVED HOLDING CHAMBER DEVICE T6 PRONEB ULTRA II DELUXE/LC SPRINT DEVICE T6 PRONEB ULTRA II DELUXE/LC STAR MISC T6 PRONEB ULTRA II DELUXE/LCD DEVICE T6 PRONEB ULTRA II PEDIATRIC DEVICE T6 PRONEB ULTRA II WITH LC PLUS DEVICE T6 PRONEB ULTRA II/LC SPRINT MISC T6 PRONEB ULTRA II/LC SPRINT PEDIATRIC MISC T6 PULMO-AIDE COMPRESSOR/PULMO-NEB DISPOSABLE NEBULIZER/FILTER PULMO-AIDE LT COMPRESSOR/NEBULIZER DEVICE T6 DEVICE T6 PULMO-AIDE TRAVELER COMPRESSOR/FILTERS DEVICE T6 PULMOMATE COMPRESSOR W/MIRO-MIST DISPOSABLE NEBULIZER/FILTER PULMONEB LT COMPRESSOR NEBULIZER SYSTEM MISC T6 DEVICE T6 QUAKE DEVICE T6 REPLACEMENT AIR FILTER MISC T6 RITEFLO DEVICE T6 SAMI THE SEAL COMPRESSOR NEBULIZER SYSTEM KIT T6 SIDESTREAM ADULT FACE MASK MISC T6 SIDESTREAM CUSTOM NEBULIZER KIT KIT T6 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 92 SIDESTREAM NEBULIZER/DISPOSABLE Forma de dosificación MISC SIDESTREAM NEBULIZER/REUSABLE MISC T6 SIDESTREAM PEDIATRIC FACEMASK MISC T6 SIDESTREAM PEDIATRIC FACEMASK/SAMI THE SEAL MISC T6 SIDESTREAM PLUS REUSABLE HIGH EFFICIENCY NEBULIZER MISC T6 SILICONE MASK FOR BREATHERITE CHAMBER/ADULT MISC T6 SILICONE MASK FOR BREATHERITE CHAMBER/INFANT MISC T6 SILICONE MASK FOR BREATHERITE CHAMBER/PEDIATRIC MISC T6 SILICONE MASK FOR BREATHRITE CHAMBER/ADULT MISC T6 SOOTHE NEB MESH NEBULIZER MISC T6 SPIRO PD DEVICE T6 THRESHOLD IMT MISC T6 THRESHOLD PEP DEVICE T6 TRUZONE PEAK FLOW METER DEVICE T6 VALVED HOLDING CHAMBER DEVICE T6 VIOS AEROSOL DELIVERY SYSTEM MISC T6 Nombre Nivel Cobertura Comentario T6 VIOS LC PLUS AEROSOL DELIVERY SYSTEM MISC T6 VIOS LC PLUS AEROSOL DELIVERY SYSTEM DELUXE MISC T6 VIOS LC PLUS AEROSOL DELIVERY SYSTEM PEDIATRIC MISC T6 VIOS LC SPRINT AEROSOL DELIVERY SYSTEM MISC T6 VIOS LC SPRINT AEROSOL DELIVERY SYSTEM PEDIATRIC MISC T6 VIOS LC SPRINT DELUXE AEROSOL DELIVERY SYSTEM MISC T6 VIXONE DISPOSABLE NEBULIZER MISC T6 VORTEX HOLDING CHAMBER/MASK/ADULT DEVICE T6 VORTEX HOLDING CHAMBER/MASK/CHILDS DEVICE T6 VORTEX HOLDING CHAMBER/MASK/CHILDS/FROG DEVICE T6 VORTEX HOLDING CHAMBER/MASK/TODDLER DEVICE T6 VORTEX HOLDING CHAMBER/MASK/TODDLER/LADY BUG DEVICE T6 VORTEX VALVED HOLDING CHAMBER DEVICE T6 WATCHHALER DEVICE T6 WINDMILL TRAINER MISC T6 A1C NOW KIT X ACCU-CHEK ACTIVE CARE KIT KIT X ACCU-CHEK ADVANTAGE DIABETES CARE KIT KIT X ACCU-CHEK AVIVA DEVICE X ACCU-CHEK AVIVA PLUS KIT X ACCU-CHEK COMPACT PLUS CARE KIT KIT X ACCU-CHEK NANO SMARTVIEW KIT X ACCU-CHEK VOICEMATE KIT X ACURA BLOOD GLUCOSE MONITORING SYSTEM METER KIT KIT X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 93 Nombre ACURA BLOOD GLUCOSE MONITORING SYSTEM STARTER KIT Forma de dosificación KIT Nivel Cobertura Comentario X ACURA PLUS BLOOD GLUCOSE MONITORING SYSTEM METER KIT ACURA PLUS BLOOD GLUCOSE MONITORING SYSTEM STARTER KIT ADVANCE INTUITION BLOOD GLUCOSE METER KIT X KIT X DEVICE X ADVANCE INTUITION BLOOD GLUCOSE MONITORING SYSTEM ADVANCE MICRO-DRAW METER KIT X DEVICE X ADVOCATE BLOOD GLUCOSE MONITORING SYSTEM * X ADVOCATE BLOOD GLUCOSE MONITORING SYSTEM/TALKING KIT X ADVOCATE REDI-CODE DEVICE X ADVOCATE REDI-CODE+ BLOOD GLUCOSE SYSTEM/SPEAKING ADVOCATE REDI-CODE+ BLOODGLUCOSE MONITORING SYSTEM ADVOCATE REDI-CODE+/ TALKING DEVICE X DEVICE X KIT X ADVOCATE REDI-CODE/TALKING * X AGAMATRIX AMP NO CODE ADVANCED BLOOD GLUCOSE MONITORING SYST AGAMATRIX JAZZ DEVICE X KIT X AGAMATRIX PRESTO KIT X AGAMATRIX PRESTO PRO METER DEVICE X ASSURE 3 METER KIT X ASSURE 4 BLOOD GLUCOSE METER DEVICE X ASSURE PLATINUM BLOOD GLUCOSE METER DEVICE X ASSURE PRO BLOOD GLUCOSE METER DEVICE X AT LAST BLOOD GLUCOSE SYSTEM KIT X BD LATITUDE DIABETES MANAGEMENT SYSTEM KIT X BD LOGIC BLOOD GLUCOSE MONITOR KIT X BLOOD GLUCOSE MONITORING SYSTEM KIT X BLOOD GLUCOSE MONITORING SYSTEM PREMIUM KIT X CARESENS N BLOOD GLUCOSE MONITORING SYSTEM DEVICE X CARESENS N GLUCOSE MONITORING SYSTEM DEVICE X CARESENS N VOICE BLOOD GLUCOSE MONITORING SYSTEM DEVICE X CHOICE DM DIABETES RISK IN-HOME TEST KIT KIT X CHOICE DM FORA G20 BLOOD GLUCOSE MONITORING SYSTEM CLEVER CHEK AUTO CODE VOICE BLOOD GLUCOSE MONITORING SYSTEM CLEVER CHEK AUTO-CODE BLOOD GLUCOSE MONITORING SYSTEM CLEVER CHEK AUTO-CODE VOICE BLOOD GLUCOSE MONITORING SYSTEM CLEVER CHEK BLOOD GLUCOSE MONITORING SYSTEM DEVICE X DEVICE X DEVICE X DEVICE X KIT X CLEVER CHOICE AUTO-CODE PRO BLOOD GLUCOSE MONITORING SYSTEM CLEVER CHOICE MICRO BLOODGLUCOSE MONITORING SYSTEM DEVICE X KIT X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 94 Nombre CLEVER CHOICE MINI BLOOD GLUCOSE MONITORING SYSTEM CONTROL BLOOD GLUCOSE MONITORING SYSTEM Forma de dosificación DEVICE KIT Nivel Cobertura Comentario X X DENTAL NEEDLE 25G/LONG MISC X DENTAL NEEDLE 25G/SHORT MISC X DENTAL NEEDLE 27G/LONG MISC X DENTAL NEEDLE 27G/SHORT MISC X DENTAL NEEDLE 30G/EX-SHORT MISC X DENTAL NEEDLE 30G/SHORT MISC X DENTAL NEEDLE 30GX32MM LONG MISC X DIATRUE PLUS BLOOD GLUCOSE MONITORING SYSTEM DEVICE X EASY CHECK BLOOD GLUCOSE MONITORING SYSTEM * X EASY PLUS BLOOD GLUCOSE MONITOR DEVICE X EASY PLUS BLOOD GLUCOSE MONITORING SYSTEM KIT X EASY PLUS II BLOOD GLUCOSE MONITORING SYSTEM DEVICE X EASY STEP BLOOD GLUCOSE MONITOR DEVICE X EASY STEP BLOOD GLUCOSE MONITOR STARTER KIT KIT X EASY TALK BLOOD GLUCOSE MONITORING SYSTEM/TALKING * X EASY TOUCH GLUCOSE MONITORING SYSTEM KIT X EASY TOUCH HEALTHPRO GLUCOSE MONITORING SYSTEM KIT X EASY TRAK BLOOD GLUCOSE MONITORING SYSTEM * X EASYGLUCO KIT X EASYGLUCO VALUE PACK KIT X EASYMAX L BLOOD GLUCOSE SYSTEM * X EASYMAX N BLOOD GLUCOSE SYSTEM * X EASYMAX NG SELF-MONITORING BLOOD GLUCOSE SYSTEM * X EASYMAX V BLOOD GLUCOSE SYSTEM DEVICE X EASYMAX V BLOOD GLUCOSE SYSTEM/TALKING KIT X EASYMAX V2 SELF-MONITORING BLOOD GLUCOSE SYSTEM/SPEAKING EASYPLUS R13N SELF-MONITORING BLOOD GLUCOSE SYSTEM EASYPLUS V SELF-MONITORING BLOOD GLUCOSE SYSTEM/SPEAKING EASYPRO BLOOD GLUCOSE MONITORING SYSTEM * X KIT X KIT X KIT X EASYPRO PLUS KIT X ECLIPSE BLOOD GLUCOSE MONITORING SYSTEM KIT X ELEMENT AUTOCODE SYSTEM KIT X ELEMENT COMPACT BLOOD GLUCOSE MONITORING SYSTEM DEVICE X ELEMENT PLUS BLOOD GLUCOSE METER DEVICE X EMBRACE BLOOD GLUCOSE MONITORING SYSTEM DEVICE X EMBRACE BLOOD GLUCOSE MONITORING SYSTEM/TALKING DEVICE X EMBRACE EVO BLOOD GLUCOSE MONITORING KIT KIT X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 95 EMBRACE PRO BLOOD GLUCOSE METER Forma de dosificación DEVICE ENVISION AUTOCODE KIT X EVENCARE BLOOD GLUCOSE MONITORING SYSTEM KIT X EVENCARE G2 BLOOD GLUCOSEMONITORING SYSTEM DEVICE X EVENCARE G3 BLOOD GLUCOSEMONITORING SYSTEM DEVICE X EVOLUTION AUTOCODE DEVICE X EZ SMART DIABETES MONITORING SYSTEM DEVICE X Nombre Nivel Cobertura Comentario X EZ SMART PLUS DIABETES MONITORING SYSTEM DEVICE X FIFTY50 GLUCOSE METER 2.0 KIT X FORA G20 BLOOD GLUCOSE MONITORING SYSTEM KIT X FORA G30A BLOOD GLUCOSE MONITORING SYSTEM DEVICE X FORA G71A BLOOD GLUCOSE MONITORING SYSTEM KIT X FORA G90 BLOOD GLUCOSE MONITORING SYSTEM DEVICE X FORA GD20 BLOOD GLUCOSE MONITORING SYSTEM DEVICE X FORA GD50 BLOOD GLUCOSE MONITORING SYSTEM DEVICE X FORA TEST N' GO VOICE BLOOD GLUCOSE MONITORING SYSTEM FORA V10 BLOOD GLUCOSE MONITORING SYSTEM/TALKING DEVICE X DEVICE X FORA V12 BLOOD GLUCOSE MONITORING SYSTEM/NOCODING FORA V12 BLOOD GLUCOSE MONITORING SYSTEM/TALKING DEVICE X DEVICE X FORA V20 BLOOD GLUCOSE MONITORING SYSTEM DEVICE X FORA V22 BLOOD GLUCOSE MONITORING SYSTEM/TALKING KIT X FORA V30A BLOOD GLUCOSE MONITORING SYSTEM * X FORACARE GD40 BLOOD GLUCOSE MONITORING SYSTEM DEVICE X FORACARE PREMIUM V10 BLOOD GLUCOSE MONITORING SYSTEM FORACARE TEST N GO BLOOD GLUCOSE MONITORING SYSTEM FORTISCARE SELF-MONITORING BLOOD GLUCOSE SYSTEM DEVICE X DEVICE X KIT X FREESTYLE FLASH SYSTEM KIT X FREESTYLE FREEDOM KIT X FREESTYLE FREEDOM LITE KIT X FREESTYLE INSULINX BLOOD GLUCOSE MONITORING SYSTEM FREESTYLE LITE BLOOD GLUCOSE MONITORING SYSTEM KIT X DEVICE X FREESTYLE SIDEKICK II VALUEPACK KIT X FREESTYLE SYSTEM KIT KIT X G4 PLATINUM PEDIATRIC RECEIVER KIT KIT X G4 PLATINUM RECEIVER KIT KIT X G4 PLATINUM SENSOR KIT KIT X G4 PLATINUM TRANSMITTER KIT KIT X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 96 G4 SENSOR KIT Forma de dosificación KIT GE100 BLOOD GLUCOSE MONITORING SYSTEM KIT X GHT BLOOD GLUCOSE MONITO RING SYSTEM KIT X Nombre Nivel Cobertura Comentario X GLUCO PERFECT 3 BLOOD GLUCOSE METER DEVICE X GLUCO PERFECT 3 BLOOD GLUCOSE MONITORING SYSTEM/VOICE GLUCOCARD 01 BLOOD GLUCOSE METER DEVICE X DEVICE X GLUCOCARD 01 BLOOD GLUCOSE MONITORING SYSTEM KIT X GLUCOCARD 01-MINI BLOOD GLUCOSE MONITORING SYSTEM GLUCOCARD EXPRESSION AUDIO-ENABLED BLOOD GLUCOSE MONITORING GLUCOCARD VITAL BLOOD GLUCOSE MONITORING SYSTEM KIT X KIT X KIT X GLUCOCARD BLACK GLUCOCARD BLUE GLUCOCARD PINK GLUCOCARD VITAL BLOOD GLUCOSE MONITORING SYSTEM KIT X VITAL BLOOD GLUCOSE MONITORING SYSTEM KIT X VITAL BLOOD GLUCOSE MONITORING SYSTEM KIT X X-METER KIT X GLUCOCOM BLOOD GLUCOSE MONITOR DEVICE X GLUCOCOM BLOOD GLUCOSE MONITORING SYSTEM KIT X GLUCOCOM BLOOD GLUCOSE MONITORING SYSTEM VALUE KIT GLUCOLAB BLOOD GLUCOSE MONITORING SYSTEM KIT X KIT X GLUCONAVII BLOOD GLUCOSE MONITORING SYSTEM KIT X GMATE SMART METER KIT DEVICE X GMATE SMART STARTER KIT KIT X GMATE VOICE BLOOD GLUCOSEMONITORING SYSTEM DEVICE X GUARDIAN REAL-TIME STARTER KIT KIT X GUARDIAN REAL-TIME SYSTEM KIT X GUARDIAN REAL-TIME SYSTEMPEDIATRIC KIT X GUARDIAN RT STARTER KIT KIT X IBG STAR BLOOD GLUCOSE MONITORING SYSTEM KIT X INFINITY BLOOD GLUCOSE MONITORING SYSTEM KIT X INFINITY BLOOD GLUCOSE MONITORING SYSTEM/STARTER KIT KROGER BLOOD GLUCOSE MONITORING KIT KIT X KIT X KROGER PREMIUM BLOOD GLUCOSE MONITORING KIT KIT X LIBERTY BLOOD GLUCOSE METER DEVICE X LIBERTY NEXT GENERATION BLOOD GLUCOSE MONITOR DEVICE X MAXIMA BLOOD GLUCOSE MONITORING SYSTEM KIT X MAXIMA METER KIT KIT X MAXIMA STARTER KIT KIT X MEIJER BLOOD GLUCOSE MONITORING KIT KIT X MEIJER PREMIUM BLOOD GLUCOSE MONITORING KIT KIT X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 97 MEIJER TRUE2GO BLOOD GLUCOSE MONITORING SYSTEM Forma de dosificación KIT MEIJER TRUERESULT BLOOD GLUCOSE MONITORING SYSTEM KIT X MEIJER TRUETRACK BLOOD GLUCOSE MONITORING KIT KIT X Nombre Nivel Cobertura Comentario X MICRODOT BLOOD GLUCOSE MONITORING SYSTEM KIT X MYGLUCOHEALTH BLOOD GLUCOSE MONITORING SYSTEM KIT X NASONEB NASAL NEBULIZER REPLACEMENT MISC X NASONEB NASAL NEBULIZER STARTER KIT MISC X NEXGEN METER KIT KIT X ON CALL EXPRESS BLOOD GLUCOSE METER DEVICE X ON CALL EXPRESS BLOOD GLUCOSE MONITORING SYSTEM KIT X ON CALL PLUS BLOOD GLUCOSE METER * X ON CALL PLUS BLOOD GLUCOSE MONITORING SYSTEM KIT X ON CALL VIVID BLOOD GLUCOSE METER * X ON CALL VIVID BLOOD GLUCOSE MONITORING SYSTEM KIT X ON CALL VIVID PAL BLOOD GLUCOSE METER * X OPTIUM BLOOD GLUCOSE MONITORING SYSTEM * X OPTUMRX BLOOD GLUCOSE METER KIT X OPTUMRX BLOOD GLUCOSE MONITORING SYSTEM KIT X PARADIGM LINK BLOOD GLUCOSE MONITOR KIT X PARADIGM REAL-TIME STARTER KIT KIT X PARI SINUSTAR NASAL AEROSOL DELIVERY SYSTEM MISC X PARI SINUSTAR NASAL NEBULIZER MISC X PHARMACIST CHOICE AUTOCODE BLOOD GLUCOSE MONITORING SYSTEM POCKETCHEM EZ BLOOD GLUCOSE MONITORING SYSTEM KIT X KIT X PRECISION LINK KIT X PRECISION QID MONITOR DEVICE X PRECISION SOF-TACT MONITOR DEVICE X PRECISION XTRA * X PRECISION XTRA MONITOR DEVICE X PRODIGY AUTOCODE BLOOD GLUCOSE METER KIT KIT X PRODIGY AUTOCODE BLOOD GLUCOSE MONITORING SYSTEM PRODIGY AUTOCODE BLOOD GLUCOSE MONITORING/TALKING PRODIGY AUTOCODE PRO BLOOD GLUCOSE MONITORING SYSTEM PRODIGY BLOOD GLUCOSE MONITORING * X KIT X KIT X KIT X PRODIGY BLOOD GLUCOSE MONITORING SYSTEM DEVICE X PRODIGY BLOOD GLUCOSE MONITORING SYSTEM/TALKING DEVICE X PRODIGY BLOOD GLUCOSE MONITORING/TALKING KIT X PRODIGY EJECT BLOOD GLUCOSE METER DEVICE X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 98 PRODIGY POCKET BLOOD GLUCOSE METER KIT Forma de dosificación KIT PRODIGY POCKET BLOOD GLUCSE METER DEVICE X PRODIGY POCKET PRO BLOOD GLUCOSE MONITORING SYSTEM PRODIGY PREFERRED BLOOD GLUCOSE METER KIT KIT X KIT X PRODIGY PREFERRED BLOOD GLUCOSE MONITORING SYSTEM PRODIGY VOICE BLOOD GLUCOSE METER KIT DEVICE X KIT X PRODIGY VOICEPRO BLOOD GLUCOSE MONITORING SYSTEM KIT X QUICKTEK KIT X QUINTET AC BLOOD GLUCOSE MONITORING SYSTEM DEVICE X QUINTET BLOOD GLUCOSE MONITORING SYSTEM DEVICE X REFUAH PLUS BLOOD GLUCOSEMONITORING SYSTEM KIT X RELION MICRO BLOOD GLUCOSE MONITORING SYSTEM KIT X REVEAL BLOOD GLUCOSE MONITOR KIT X RIGHTEST GM100 BLOOD GLUCOSE MONITORING SYSTEM KIT X RIGHTEST GM300 BLOOD GLUCOSE MONITORING SYSTEM KIT X RIGHTEST GM550 BLOOD GLUCOSE MONITORING SYSTEM KIT X Nombre Nivel Cobertura Comentario X SEVEN PLUS STARTER KIT KIT X SMART DIABETES XPRES BLOOD GLUCOSE MONITORING SYSTEM SMARTEST EJECT BLOOD GLUCOSE MONITORING SYSTEM KIT X DEVICE X SMARTEST EJECT STARTER KIT KIT X SMARTEST PERSONA STARTER KIT KIT X SMARTEST PRONTO STARTER KIT KIT X SMARTEST PROTEGE BLOOD GLUCOSE MONITORING SYSTEM DEVICE X SMARTEST PROTEGE STARTER KIT KIT X SOLUS V2 AUDIBLE BLOOD GLUCOSE MANAGEMENT SYSTEM * X SURE EDGE BLOOD GLUCOSE MONITORING SYSTEM DEVICE X SURE-TEST EASYPLUS MINI SELF MONITORING BLOOD GLUCOSE METER SURECHEK BLOOD GLUCOSE MONITORING SYSTEM DEVICE X DEVICE X SURECHEK BLOOD GLUCOSE MONITORING SYSTEM STARTER KIT TELCARE BLOOD GLUCOSE MONITORING SYSTEM KIT X KIT X TGT BLOOD GLUCOSE MONITORING SYSTEM PREMIUM KIT X ULTIMA KIT X ULTRA TRAK PRO BLOOD GLUCOSE MONITORING SYSTEM KIT X ULTRATRAK ACTIVE DEVICE X ULTRATRAK PRO DEVICE X ULTRATRAK ULTIMATE MONITOR DEVICE X VICTORY BLOOD GLUCOSE MONITORING SYSTEM DEVICE X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 99 VOCAL POINT BLOOD GLUCOSE MONITORING SYSTEM Forma de dosificación DEVICE WAVESENSE AMP KIT X WAVESENSE KEYNOTE KIT X WAVESENSE KEYNOTE PRO METER DEVICE X SOLUTION X SOLUTION X Nombre Nivel Cobertura Comentario X Diagnostic Agents EOVIST Cardiac Function THALLOUS CHLORIDE TL 201 Diabetes Mellitus ASCENSIA AUTODISC TEST STRIPS DISK T6 BAYER BREEZE 2 TEST DISC DISK T6 BAYER CONTOUR BLOOD GLUCOSE TEST STRIPS STRIP T6 BAYER CONTOUR NEXT BLOOD GLUCOSE TEST STRIP T6 FASTTAKE TEST STRIPS STRIP T6 ONETOUCH BASIC/PROFILE TEST STRIPS STRIP T6 ONETOUCH BASIC/PROFILE/ONE TOUCH II TEST STRIPS STRIP T6 ONETOUCH ULTRA BLUE STRIP T6 ONETOUCH VERIO TEST STRIPS STRIP T6 SURESTEP PRO TEST STRIPS STRIP T6 SURESTEP TEST STRIPS STRIP T6 ACCU-CHEK ACTIVE STRIPS STRIP X ACCU-CHEK AVIVA STRIP X ACCU-CHEK AVIVA PLUS STRIP X ACCU-CHEK COMFORT CURVE TEST STRIPS STRIP X ACCU-CHEK COMPACT PLUS STRIP X ACCU-CHEK COMPACT TEST DRUM STRIP X ACCU-CHEK INSTANT GLUCOSE STRIP X ACCU-CHEK INSTANT PLUS STRIP X ACCU-CHEK SMARTVIEW STRIPS STRIP X ACCUTREND GLUCOSE STRIP X ACURA BLOOD GLUCOSE TEST STRIPS STRIP X ADVANCE INTUITION TEST STRIPS STRIP X ADVANCE MICRO-DRAW TEST STRIPS STRIP X ADVOCATE REDI-CODE STRIP X ADVOCATE REDI-CODE+ TEST STRIPS STRIP X ADVOCATE TEST STRIPS STRIP X AGAMATRIX AMP NO CODE TEST STRIPS STRIP X AGAMATRIX JAZZ TEST STRIPS STRIP X AGAMATRIX KEYNOTE TEST STRIPS STRIP X AGAMATRIX PRESTO TEST STRIPS STRIP X ASSURE 3 TEST STRIPS STRIP X ASSURE 4 TEST STRIPS STRIP X ASSURE II STRIP X ASSURE II CHECK STRIP STRIP X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 100 ASSURE II TEST STRIPS Forma de dosificación STRIP ASSURE PLATINUM TEST STRIPS STRIP X ASSURE PRO TEST STRIPS STRIP X AT LAST TEST STRIPS STRIP X BG STAR BLOOD GLUCOSE TEST STRIP X BIOSCANNER GLUCOSE TEST STRIPS STRIP X BLOOD GLUCOSE TEST STRIPS STRIP X BLOOD GLUCOSE TEST STRIPS PREMIUM STRIP X CARESENS N BLOOD GLUCOSE TEST STRIPS STRIP X Nombre Nivel Cobertura Comentario X CHOICE DM FORA G20 TEST STRIPS STRIP X CLEVER CHEK AUTO-CODE TEST STRIPS STRIP X CLEVER CHEK AUTO-CODE VOICE TEST STRIPS STRIP X CLEVER CHEK TEST STRIPS STRIP X CLEVER CHOICE AUTO-CODE PRO TEST STRIPS STRIP X CLEVER CHOICE MICRO TEST STRIPS STRIP X CONTROL AST STRIP X CONTROL TEST STRIPS STRIP X DIATRUE PLUS BLOOD GLUCOSE TEST STRIPS STRIP X DUO-CARE TEST STRIPS STRIP X EASY CHECK GLUCOSE TEST STRIPS STRIP X EASY PLUS BLOOD GLUCOSE TEST STRIPS STRIP X EASY PLUS II BLOOD GLUCOSE TEST STRIP X EASY STEP TEST STRIPS STRIP X EASY TALK BLOOD GLUCOSE TEST STRIPS STRIP X EASY TOUCH GLUCOSE TEST STRIPS STRIP X EASY TOUCH HEALTHPRO GLUCOSE TEST STRIPS STRIP X EASY TRAK BLOOD GLUCOSE TEST STRIPS STRIP X EASYGLUCO STRIP X EASYMAX 15 TEST STRIPS STRIP X EASYMAX TEST STRIPS STRIP X EASYPLUS BLOOD GLUCOSE TEST STRIP STRIP X EASYPRO BLOOD GLUCOSE TEST STRIPS STRIP X EASYPRO PLUS STRIP X ECLIPSE TEST STRIPS STRIP X ELEMENT COMPACT TEST STRIPS STRIP X ELEMENT PLUS TEST STRIPS STRIP X ELEMENT TEST STRIPS STRIP X EMBRACE BLOOD GLUCOSE TEST STRIPS STRIP X EMBRACE EVO BLOOD GLUCOSETEST STRIPS STRIP X EMBRACE PRO BLOOD GLUCOSETEST STRIPS STRIP X ENVISION AUTOCODE TEST STRIPS STRIP X EVENCARE + BLOOD GLUCOSE TEST STRIP STRIP X EVENCARE BLOOD GLUCOSE TEST STRIP STRIP X EVENCARE G2 TEST STRIPS STRIP X EVENCARE G3 TEST STRIPS STRIP X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 101 EVOLUTION AUTOCODE Forma de dosificación STRIP EXACTECH R-S-G TEST STRIPS STRIP X EXACTECH TEST STRIPS STRIP X Nombre Nivel Cobertura Comentario X EZ SMART BLOOD GLUCOSE TEST STRIPS STRIP X EZ SMART PLUS BLOOD GLUCOSE TEST STRIPS STRIP X FIFTY50 GLUCOSE TEST STRIP 2.0 STRIP X FORA D10 BLOOD GLUCOSE TEST STRIPS STRIP X FORA D15C BLOOD GLUCOSE TEST STRIPS STRIP X FORA D15G BLOOD GLUCOSE TEST STRIPS STRIP X FORA D15Z BLOOD GLUCOSE TEST STRIPS STRIP X FORA D20 BLOOD GLUCOSE TEST STRIPS STRIP X FORA G20 BLOOD GLUCOSE TEST STRIPS STRIP X FORA G30A BLOOD GLUCOSE TEST STRIPS STRIP X FORA G71A BLOOD GLUCOSE TEST STRIPS STRIP X FORA G90 BLOOD GLUCOSE TEST STRIPS STRIP X FORA GD20 TEST STRIPS STRIP X FORA GD50 BLOOD GLUCOSE TEST STRIPS STRIP X FORA TEST N' GO BLOOD GLUCOSE TEST STRIPS STRIP X FORA V10 BLOOD GLUCOSE TEST STRIPS STRIP X FORA V12 BLOOD GLUCOSE TEST STRIPS STRIP X FORA V20 BLOOD GLUCOSE TEST STRIPS STRIP X FORA V22 BLOOD GLUCOSE TEST STRIPS STRIP X FORA V30A BLOOD GLUCOSE TEST STRIPS STRIP X FORACARE GD40 STRIP X FORACARE PREMIUM V10 TESTSTRIPS STRIP X FORACARE TEST N GO TEST STRIPS STRIP X FORTISCARE BLOOD GLUCOSE TEST STRIP STRIP X FREESTYLE INSULINX BLOOD GLUCOSE TEST STRIP X FREESTYLE INSULINX BLOOD GLUCOSE TEST STRIPS STRIP X FREESTYLE LITE TEST STRIPS STRIP X FREESTYLE TEST STRIPS STRIP X GE100 BLOOD GLUCOSE TEST STRIPS STRIP X GHT TEST STRIPS STRIP X GLUCO PERFECT 3 TEST STRIPS STRIP X GLUCOCARD 01 SENSOR STRIP X GLUCOCARD 01 TEST STRIPS STRIP X GLUCOCARD EXPRESSION BLOOD GLUCOSE TEST STRIPS STRIP X GLUCOCARD VITAL TEST STRIPS STRIP X GLUCOCARD X-SENSOR STRIP X GLUCOCOM TEST STRIPS STRIP X GLUCOLAB TEST STRIPS STRIP X GLUCONAVII BLOOD GLUCOSE TEST STRIPS STRIP X GMATE BLOOD GLUCOSE TEST STRIPS STRIP X INFINITY BLOOD GLUCOSE TEST STRIPS STRIP X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 102 KROGER BLOOD GLUCOSE TESTSTRIPS Forma de dosificación STRIP KROGER PREMIUM BLOOD GLUCOSE TEST STRIPS STRIP X KROGER TEST STRIPS STRIP X LIBERTY NEXT GENERATION BLOOD GLUCOSE TEST STRIPS STRIP X LIBERTY TEST STRIPS STRIP X Nombre Nivel Cobertura Comentario X MAXIMA BLOOD GLUCOSE TESTSTRIPS STRIP X MEIJER BLOOD GLUCOSE TESTSTRIPS STRIP X MEIJER PREMIUM BLOOD GLUCOSE TEST STRIPS STRIP X MEIJER TRUETEST BLOOD GLUCOSE TEST STRIPS STRIP X MEIJER TRUETRACK BLOOD GLUCOSE TEST STRIPS STRIP X MICRODOT TEST STRIPS STRIP X MYGLUCOHEALTH BLOOD GLUCOSE TEST STRIP X NEUTEK 2TEK TEST STRIPS STRIP X NEXGEN TEST STRIPS STRIP X ON CALL EXPRESS BLOOD GLUCOSE TEST STRIPS STRIP X ON CALL PLUS BLOOD GLUCOSE TEST STRIP X ON CALL VIVID BLOOD GLUCOSE TEST STRIP X ON CALL VIVID BLOOD GLUCOSE TEST STRIPS STRIP X OPTIUM TEST STRIPS STRIP X OPTIUMEZ TEST STRIPS STRIP X OPTUMRX BLOOD GLUCOSE TEST STRIP X PHARMACIST CHOICE AUTOCODE BLOOD GLUCOSE TEST STRIPS POCKETCHEM EZ BLOOD GLUCOSE TEST STRIPS STRIP X STRIP X PRECISION PCX STRIP X PRECISION PCX PLUS TEST STRIPS STRIP X PRECISION POINT OF CARE TEST STRIPS STRIP X PRECISION QID TEST STRIPS STRIP X PRECISION SOF-TACT TEST STRIPS STRIP X PRECISION XTRA BLOOD GLUCOSE TEST STRIPS STRIP X PRODIGY AUTOCODE BLOOD GLUCOSE TEST STRIPS STRIP X PRODIGY BLOOD GLUCOSE TEST STRIPS STRIP X PRODIGY EJECT BLOOD GLUCOSE TEST STRIPS STRIP X PRODIGY NO CODING BLOOD GLUCOSE TEST STRIPS STRIP X PRODIGY VOICE BLOOD GLUCOSE TEST STRIPS STRIP X PTS PANELS GLUCOSE TEST STRIP X QUICKTEK TEST STRIPS STRIP X QUINTET AC BLOOD GLUCOSE TEST STRIPS STRIP X QUINTET BLOOD GLUCOSE TEST STRIPS STRIP X REFUAH PLUS BLOOD GLUCOSETEST STRIPS STRIP X RELION BLOOD GLUCOSE TESTSTRIPS STRIP X REVEAL BLOOD GLUCOSE TEST STRIP X RIGHTEST GS100 BLOOD GLUCOSE TEST STRIPS STRIP X RIGHTEST GS300 BLOOD GLUCOSE TEST STRIPS STRIP X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 103 RIGHTEST GS550 BLOOD GLUCOSE TEST STRIPS Forma de dosificación STRIP SMART DIABETES XPRES BLOOD GLUCOSE TEST STRIPS STRIP Nombre Nivel Cobertura Comentario X X SMARTEST BLOOD GLUCOSE TEST STRIPS STRIP X SOLUS V2 AUDIBLE TEST STRIP X SUPREME TEST STRIPS STRIP X SURE EDGE BLOOD GLUCOSE TEST STRIPS STRIP X SURE-TEST EASYPLUS MINI BLOOD GLUCOSE TEST STRIPS STRIP X SURECHEK BLOOD GLUCOSE TEST STRIPS STRIP X TELCARE BLOOD GLUCOSE TEST STRIPS STRIP X TGT BLOOD GLUCOSE TEST STRIPS STRIP X TGT BLOOD GLUCOSE TEST STRIPS PREMIUM STRIP X ULTRATRAK PRO TEST STRIPS STRIP X ULTRATRAK ULTIMATE TEST STRIPS STRIP X UNISTRIP1 GENERIC STRIP X VICTORY AGM-4000 TEST STRIPS STRIP X VOCAL POINT BLOOD GLUCOSE TEST STRIPS STRIP X VOCAL POINT BLOOD GLUCOSETEST STRIPS STRIP X WAVESENSE PRESTO TEST STRIPS STRIP X MEMBRANEBLUE SOLUTION T6 VISIONBLUE SOLUTION T6 GLUTARALDEHYDE SOLUTION T3 FORMA-RAY SOLUTION X formadon SOLUTION X formalaz SOLUTION X FORMALDEHYDE SOLUTION X formaldehyde SOLUTION X formaldehyde neutralized/buffered SOLUTION X lazerformalyde solution SOLUTION X Ocular Disorders Disinfectants (Not for use on skin) Electrolytic, Caloric, and Water Balance Acidifying Agents K-PHOS MF TABS T2 K-PHOS NO 2 TABS T2 AMMONIUM CHLORIDE SOLUTION T6 SOLUTION T1 cytra k crystals PACK T1 cytra-2 SOLUTION T1 cytra-k SOLUTION T1 liqui-dualcitra SOLUTION T1 potassium citrate er CONT.REL.TABS T1 potassium citrate-citric acid crystals PACK T1 Non-self administerable injectable Alkalinizing Agents citric acid/sodium citrate Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 104 potassium citrate/citric acid Forma de dosificación SOLUTION taron-crystals PACK T1 CITROLITH TABS T2 Nombre Nivel Cobertura Comentario T1 CYTRA-3 SYRUP T2 ORACIT SOLUTION T2 SODIUM CITRATE GRAN T2 TRICITRATES SOLUTION T2 POLYCITRA-K CRYSTALS PACK T3 SHOHLS SOLUTION MODIFIED SOLUTION T3 UROCIT-K 10 CONT.REL.TABS T3 UROCIT-K 15 CONT.REL.TABS T3 UROCIT-K 5 CONT.REL.TABS T3 NEUT SOLUTION T6 sodium acetate SOLUTION T6 sodium bicarbonate SOLUTION T6 sodium bicarbonate partial fill SOLUTION T6 SODIUM LACTATE SOLUTION T6 THAM SOLUTION T6 constulose SOLUTION T1 enulose SOLUTION T1 generlac SOLUTION T1 lactulose SOLUTION T1 lactulose SOLUTION T1 Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Ammonia Detoxicants sodium phenylbutyrate POWDER T1 BUPHENYL TABS T2 KRISTALOSE PACK T2 LITHOSTAT TABS T2 BUPHENYL POWDER T3 CARBAGLU TABS T5 AMMONUL SOLUTION T6 RAVICTI LIQUID X n-acetyl-l-cysteine CAPS T1 ALCOHOL 5%/DEXTROSE 5% SOLUTION T6 ALCOHOL ABSOLUTE SOLUTION T6 amino acids SOLUTION T6 AMINOSYN SOLUTION T6 AMINOSYN 7%/ELECTROLYTES SOLUTION T6 aminosyn 8.5%/electrolytes SOLUTION T6 PA Non-self administerable injectable Caloric Agents Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 105 AMINOSYN II Forma de dosificación SOLUTION AMINOSYN II 3.5%/DEXTROSE25% SOLUTION T6 AMINOSYN II 3.5%/DEXTROSE5% SOLUTION T6 AMINOSYN II 3.5/DEXTROSE 25% SOLUTION T6 AMINOSYN II 4.25/DEXTROSE10% SOLUTION T6 AMINOSYN II 4.25/DEXTROSE20% SOLUTION T6 AMINOSYN II 4.25/DEXTROSE20% SOLUTION T6 AMINOSYN II 4.25/DEXTROSE25% SOLUTION T6 AMINOSYN II 4.25/DEXTROSE25% SOLUTION T6 AMINOSYN II 5/DEXTROSE 25 SOLUTION T6 aminosyn ii 8.5%/electrolytes SOLUTION T6 AMINOSYN II M 3.5%/DEXTROSE 5% SOLUTION T6 AMINOSYN II M 4.25/DEXTROSE 10% SOLUTION T6 AMINOSYN M SOLUTION T6 AMINOSYN-HBC SOLUTION T6 aminosyn-hf SOLUTION T6 AMINOSYN-PF SOLUTION T6 AMINOSYN-PF 7% SOLUTION T6 AMINOSYN-RF SOLUTION T6 CLINIMIX 2.75%/DEXTROSE 5% SOLUTION T6 CLINIMIX 4.25%/DEXTROSE 10% SOLUTION T6 CLINIMIX 4.25%/DEXTROSE 20% SOLUTION T6 CLINIMIX 4.25%/DEXTROSE 25% SOLUTION T6 CLINIMIX 4.25%/DEXTROSE 5% SOLUTION T6 CLINIMIX 5%/DEXTROSE 15% SOLUTION T6 CLINIMIX 5%/DEXTROSE 20% SOLUTION T6 CLINIMIX 5%/DEXTROSE 25% SOLUTION T6 CLINIMIX E 2.75%/DEXTROSE 10% SOLUTION T6 CLINIMIX E 2.75%/DEXTROSE 5% SOLUTION T6 CLINIMIX E 4.25%/DEXTROSE 10% SOLUTION T6 CLINIMIX E 4.25%/DEXTROSE 25% SOLUTION T6 CLINIMIX E 4.25%/DEXTROSE 5% SOLUTION T6 CLINIMIX E 5%/DEXTROSE 15% SOLUTION T6 CLINIMIX E 5%/DEXTROSE 20% SOLUTION T6 Nombre Nivel T6 Cobertura Comentario Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 106 Nombre Forma de dosificación Nivel CLINIMIX E 5%/DEXTROSE 25% SOLUTION T6 clinisol sf 15% SOLUTION T6 CYSTEINE HCL SOLUTION T6 cysteine hcl SOLUTION T6 dehydrated alcohol SOLUTION T6 DEXTROSE 2.5% SOLUTION T6 dextrose 10% SOLUTION T6 dextrose 10% flex container SOLUTION T6 dextrose 10% partial fill SOLUTION T6 DEXTROSE 20% SOLUTION T6 dextrose 20% SOLUTION T6 DEXTROSE 25% SOLUTION T6 dextrose 30% SOLUTION T6 dextrose 30% partial fill SOLUTION T6 DEXTROSE 40% SOLUTION T6 dextrose 40% SOLUTION T6 dextrose 5% SOLUTION T6 dextrose 5% viaflex SOLUTION T6 dextrose 50% SOLUTION T6 dextrose 70% SOLUTION T6 FREAMINE HBC 6.9% SOLUTION T6 FREAMINE III SOLUTION T6 freamine iii SOLUTION T6 FREAMINE III 3% SOLUTION T6 hepatamine SOLUTION T6 hepatasol SOLUTION T6 INTRALIPID EMULSION T6 intralipid EMULSION T6 KABIVEN EMULSION T6 l-cysteine hcl SOLUTION T6 LIPOSYN II EMULSION T6 LIPOSYN III EMULSION T6 liposyn iii EMULSION T6 Cobertura Comentario injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 107 NEPHRAMINE Forma de dosificación SOLUTION novamine SOLUTION T6 PERIKABIVEN EMULSION T6 PREMASOL SOLUTION T6 premasol SOLUTION T6 PROCALAMINE SOLUTION T6 PROSOL SOLUTION T6 TRAVASOL SOLUTION T6 TROPHAMINE SOLUTION T6 APPTRIM CAPS X APPTRIM LIFESTYLES OBESITY MANAGEMENT CAPS X Nombre Nivel T6 APPTRIM LIFESTYLES POST-BARIATRIC CAPS X APPTRIM LIFESTYLES PRE-BARIATRIC CAPS X APPTRIM-D CAPS X AXONA PACK X CAMINO PRO 15PE LIQUID X CESINEX SUSPENSION X CESINEX 100 SUSPENSION X CESINEX 125 SUSPENSION X CESINEX 150 SUSPENSION X CESINEX 20 SUSPENSION X CESINEX 25 SUSPENSION X CESINEX 30 SUSPENSION X CESINEX 35 SUSPENSION X CESINEX 40 SUSPENSION X CESINEX 50 SUSPENSION X CESINEX 60 SUSPENSION X CESINEX 80 SUSPENSION X DERMANIC CONT.REL.TABS X ENLYTE CAPS X FOSTEUM PLUS CAPS X FOVEX CAPS X GABADONE CAPS X GLYTACTIN BETTERMILK 10 PACK X GLYTACTIN BETTERMILK 15 PACK X GLYTACTIN RTD 10 LIQUID X GLYTACTIN RTD 15 LIQUID X HYPERTENSA CAPS X LIPICHOL 540 CAPS X LISTER-V CAPS X LUKAID GLA EMULSION X LUNGLAID EMULSION X Cobertura Comentario Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 108 MACUTEK Forma de dosificación TABS NEUREPA CAPS X PCCA ACACIA SYRUP BASE SYRUP X PERCURA CAPS X PKU EASY MICROTABS X PREFLIN ENTERIC COATED CAPS X PROBARIMIN QT TABS X PROTEOLIN TABS X PULMONA CAPS X PURALOR CHEW X Nombre Nivel Cobertura Comentario X PURALOR CI CONT.REL.TABS X RENASTART PACK X RHEUMATE CAPS X SENTRA AM CAPS X SENTRA PM CAPS X SLOESTEROL POWDER X THERAMINE CAPS X THERAMINE PLUS PACK X TL-ICARE CAPS X TOZAL CAPS X TREPADONE CAPS X VASCULERA TABS X VIRILEX CAPS X WHEY PROTEIN DRINK MIX POWDER X TABS T1 Diuretics amiloride hcl amiloride/hydrochlorothiazide TABS T1 bumetanide TABS T1 CHLOROTHIAZIDE TABS T1 chlorothiazide TABS T1 CHLORTHALIDONE TABS T1 chlorthalidone TABS T1 furosemide * T1 furosemide (10mg/ml) SOLUTION T1 hydrochlorothiazide * T1 hydrochlorothiazide (25mg) TABS T1 hydrochlorothiazide (50mg) TABS T1 indapamide TABS T1 metolazone TABS T1 THALITONE TABS T1 torsemide TABS T1 triamterene/hydrochlorothiazide * T1 triamterene/hydrochlorothiazide (25mg; 37.5mg) CAPS T1 DIURIL SUSPENSION T2 DYRENIUM CAPS T2 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 109 EDECRIN Forma de dosificación TABS FUROSEMIDE (8MG/ML) SOLUTION T2 METHYCLOTHIAZIDE TABS T2 TRIAMTERENE/HYDROCHLOROTHIAZIDE (25MG; 50MG) CAPS T2 DEMADEX TABS T3 DYAZIDE CAPS T3 LASIX TABS T3 MAXZIDE TABS T3 MAXZIDE-25 TABS T3 MICROZIDE CAPS T3 MIDAMOR TABS T3 ZAROXOLYN TABS T3 SAMSCA TABS T4 bumetanide SOLUTION T6 chlorothiazide sodium SOLUTION T6 furosemide (10mg/ml) SOLUTION T6 mannitol SOLUTION T6 osmitrol viaflex SOLUTION T6 SODIUM DIURIL SOLUTION T6 SODIUM EDECRIN SOLUTION T6 TORSEMIDE SOLUTION T6 VAPRISOL SOLUTION T6 hydrochlorothiazide (12.5mg) TABS X kalexate POWDER T1 kionex * T1 sodium polystyrene sulfonate * T1 FOSRENOL CHEW T2 RENAGEL TABS T2 RENVELA * T2 SEVELAMER CARBONATE TABS T2 KAYEXALATE POWDER T3 Nombre Nivel Cobertura Comentario T2 Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Ion-removing Agents SPS SUSPENSION T3 RADIOGARDASE CAPS T5 FERRIC CITRATE TABS X VELPHORO CHEW X SOLUTION T1 aminoacetic acid SOLUTION T1 argyle sterile saline 100ml SOLUTION T1 argyle sterile water 100ml SOLUTION T1 Irrigating Solutions acetic acid 0.25% Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 110 curity sterile saline Forma de dosificación SOLUTION glycine SOLUTION T1 lactated ringers irrigation SOLUTION T1 physiolyte SOLUTION T1 ringers irrigation SOLUTION T1 sodium chloride SOLUTION T1 Nombre Nivel Cobertura Comentario T1 sodium chloride 0.9% SOLUTION T1 sodium chloride 0.45% SOLUTION T1 sodium chloride 0.9% SOLUTION T1 sterile water irrigation SOLUTION T1 sterile water irrigation plastic bottle SOLUTION T1 sterile water irrigation w/hanger SOLUTION T1 tis-u-sol SOLUTION T1 tis-u-sol viaflex SOLUTION T1 HYSKON SOLUTION T2 RENACIDIN SOLUTION T2 RESECTISOL SOLUTION T2 SORBITOL SOLUTION T2 SORBITOL-MANNITOL SOLUTION T2 physiosol irrigation SOLUTION T3 PHYSIOSOL IRRIGATION PH 7.4 SOLUTION T3 delflex-lc/1.5% dextrose SOLUTION T6 DELFLEX-LC/2.5% DEXTROSE SOLUTION T6 DELFLEX-LC/4.25% DEXTROSE SOLUTION T6 delflex-lm/1.5% dextrose SOLUTION T6 DELFLEX-LM/2.5% DEXTROSE SOLUTION T6 DELFLEX-LM/4.25% DEXTROSE SOLUTION T6 DELFLEX-SM/1.5% DEXTROSE SOLUTION T6 DELFLEX-SM/2.5% DEXTROSE SOLUTION T6 DELFLEX-SM/4.25% DEXTROSE SOLUTION T6 DIANEAL LOW CALCIUM/1.5% DEXTROSE SOLUTION T6 DIANEAL LOW CALCIUM/2.5% DEXTROSE SOLUTION T6 DIANEAL LOW CALCIUM/4.25%DEXTROSE SOLUTION T6 DIANEAL PD-2/1.5% DEXTROSE SOLUTION T6 DIANEAL PD-2/2.5% DEXTROSE SOLUTION T6 DIANEAL PD-2/4.25% DEXTROSE SOLUTION T6 EXTRANEAL SOLUTION T6 inpersol-lm/1.5% dextrose SOLUTION T6 inpersol-lm/2.5% dextrose SOLUTION T6 Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 111 inpersol-lm/4.25% dextrose Forma de dosificación SOLUTION inpersol/dextrose SOLUTION T6 ULTRABAG/DIANEAL LOW CALCIUM/1.5% DEXTROSE SOLUTION T6 ULTRABAG/DIANEAL LOW CALCIUM/2.5% DEXTROSE SOLUTION T6 ULTRABAG/DIANEAL LOW CALCIUM/4.25% DEXTROSE SOLUTION T6 ULTRABAG/DIANEAL PD-2/1.5% DEXTROSE SOLUTION T6 ULTRABAG/DIANEAL PD-2/2.5% DEXTROSE SOLUTION T6 ULTRABAG/DIANEAL PD-2/4.25% DEXTROSE SOLUTION T6 calcium acetate * T1 cardioplegic SOLUTION T1 ed k+10 CONT.REL.TABS T1 effer-k EFFERVESCENT T1 effervescent pot chloride EFFERVESCENT T1 Nombre Nivel T6 Cobertura Comentario Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Replacement Preparations effervescent potassium EFFERVESCENT T1 effervescent potassium/chloride EFFERVESCENT T1 epiklor PACK T1 epiklor/25 PACK T1 k-effervescent EFFERVESCENT T1 k-prime EFFERVESCENT T1 k-vescent EFFERVESCENT T1 k-vescent PACK T1 klor-con PACK T1 klor-con 10 CONT.REL.TABS T1 klor-con 8 CONT.REL.TABS T1 klor-con m10 CONT.REL.TABS T1 klor-con m20 CONT.REL.TABS T1 klor-con/ef EFFERVESCENT T1 phospha 250 neutral TABS T1 potassium bicarbonate EFFERVESCENT T1 potassium chloride * T1 potassium chloride cr CONT.REL.TABS T1 potassium chloride cr CONT.REL.TABS T1 potassium chloride er * T1 potassium chloride er CONT.REL.TABS T1 potassium chloride er (10meq) CONT.REL.TABS T1 potassium chloride er (8meq) CONT.REL.TABS T1 potassium chloride sr CONT.REL.TABS T1 recal d WAFER T1 virt-phos 250 neutral TABS T1 zinc sulfate CAPS T1 zincate CAPS T1 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 112 CALCIFOL Forma de dosificación WAFER CALCIUM-FOLIC ACID PLUS D WAFER T2 GALZIN CAPS T2 Nombre Nivel Cobertura Comentario T2 GLUTOFAC-MX TABS T2 K-PHOS TABS T2 KLOR-CON 25 PACK T2 KLOR-CON M15 CONT.REL.TABS T2 MAGNEBIND 400 TABS T2 PHOSLYRA SOLUTION T2 POTASSIUM CHLORIDE ER (20MEQ) CONT.REL.TABS T2 CALCIFOLIC-D WAFER T3 EFFER-K EFFERVESCENT T3 ELIPHOS TABS T3 K-LOR HOSPITAL PACK PACK T3 K-PHOS NEUTRAL TABS T3 K-TAB CONT.REL.TABS T3 MICRO-K CONT.REL.CAPS T3 PHOSLO CAPS T3 PLEGISOL SOLUTION T3 PLEGISOL CARDIOPLEGIC SOLUTION SOLUTION T3 ADDAMEL N SOLUTION T6 AMMONIUM MOLYBDATE SOLUTION T6 bacteriostatic sodium chloride SOLUTION T6 bd posiflush SOLUTION T6 calcium chloride SOLUTION T6 calcium gluconate SOLUTION T6 chloromag SOLUTION T6 CHROMIUM CHLORIDE SOLUTION T6 chromium chloride SOLUTION T6 COPPER SULFATE SOLUTION T6 COPPER TRACE METAL SOLUTION T6 DEXTRAN SOLUTION T6 DEXTRAN 70 SOLUTION T6 DEXTRAN HM SOLUTION T6 DEXTROSE 10%/NACL 0.45% SOLUTION T6 DEXTROSE 5% /ELECTROLYTE #48 VIAFLEX SOLUTION T6 DEXTROSE 10%/NACL 0.2% SOLUTION T6 dextrose 10%/nacl 0.2% SOLUTION T6 DEXTROSE 10%/NACL 0.225% SOLUTION T6 Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 113 Nombre Forma de dosificación Nivel dextrose 10%/sodium chloride 0.9% SOLUTION T6 dextrose 2.5%/nacl 0.45% SOLUTION T6 dextrose 2.5%/sodium chloride 0.45% SOLUTION T6 dextrose 5%/lactated ringers SOLUTION T6 dextrose 5%/nacl 0.2% SOLUTION T6 DEXTROSE 5%/NACL 0.225% SOLUTION T6 DEXTROSE 5%/NACL 0.3% SOLUTION T6 dextrose 5%/nacl 0.33% SOLUTION T6 dextrose 5%/nacl 0.45% SOLUTION T6 dextrose 5%/nacl 0.9% SOLUTION T6 DEXTROSE 5%/POTASSIUM CHLORIDE 0.075% SOLUTION T6 dextrose 5%/potassium chloride 0.15% SOLUTION T6 dextrose 5%/ringers SOLUTION T6 dextrose 5%/sodium chloride 0.2% SOLUTION T6 dextrose 5%/sodium chloride 0.33% SOLUTION T6 dextrose 5%/sodium chloride 0.45% SOLUTION T6 dextrose 5%/sodium chloride 0.9% SOLUTION T6 ELECTROLYTE-48/DEXTROSE SOLUTION T6 ELLIOTTS B SOLUTION T6 gentran 40 SOLUTION T6 gentran 40 SOLUTION T6 GLYCOPHOS SOLUTION T6 HESPAN SOLUTION T6 hetastarch 6%/nacl SOLUTION T6 HEXTEND SOLUTION T6 HYPERLYTE-CR SOLUTION T6 IONOSOL-B/DEXTROSE 5% SOLUTION T6 IONOSOL-MB/DEXTROSE 5% SOLUTION T6 IONOSOL-T/DEXTROSE 5% SOLUTION T6 ISOLYTE-H/DEXTROSE 5% SOLUTION T6 isolyte-m/dextrose 5% SOLUTION T6 ISOLYTE-P/DEXTROSE 5% SOLUTION T6 ISOLYTE-S SOLUTION T6 Cobertura Comentario injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 114 ISOLYTE-S PH 7.4 Forma de dosificación SOLUTION ISOLYTE-S/DEXTROSE 5% SOLUTION T6 kcl 0.075%/d5w/nacl 0.2% SOLUTION T6 kcl 0.075%/d5w/nacl 0.45% SOLUTION T6 KCL 0.15%/D10W/NACL 0.2% SOLUTION T6 kcl 0.15%/d5w/ nacl 0.3% SOLUTION T6 KCL 0.15%/D5W/LR SOLUTION T6 kcl 0.15%/d5w/nacl 0.2% SOLUTION T6 KCL 0.15%/D5W/NACL 0.225% SOLUTION T6 kcl 0.15%/d5w/nacl 0.45% SOLUTION T6 KCL 0.15%/D5W/NACL 0.9% SOLUTION T6 kcl 0.15%/d5w/nacl 0.9% SOLUTION T6 kcl 0.224%/d5w/nacl 0.2% SOLUTION T6 KCL 0.3%/D5W/LR SOLUTION T6 KCL 0.3%/D5W/LR IV LAC RING SOLUTION T6 kcl 0.3%/d5w/nacl 0.2% SOLUTION T6 kcl 0.3%/d5w/nacl 0.45% SOLUTION T6 KCL 0.3%/D5W/NACL 0.9% SOLUTION T6 kendall sodium chloride flush SOLUTION T6 lactated ringers SOLUTION T6 lactated ringers dextrose 5% viaflex SOLUTION T6 lactated ringers viaflex SOLUTION T6 LMD 10% DEXTROSE 5% SOLUTION T6 LMD 10% SODIUM CHLORIDE 0.9% SOLUTION T6 magnesium chloride SOLUTION T6 MAGNESIUM SULFATE IN D5W SOLUTION T6 MANGANESE SULFATE SOLUTION T6 MANGANESE TRACE METAL SOLUTION T6 monoject pharma grade flush syringe SOLUTION T6 monoject sodium chloride flush SOLUTION T6 MULTITRACE-4 SOLUTION T6 multitrace-4 concentrate SOLUTION T6 MULTITRACE-4 NEONATAL SOLUTION T6 MULTITRACE-4 PEDIATRIC SOLUTION T6 Nombre Nivel T6 Cobertura Comentario Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 115 Nombre Forma de dosificación Nivel MULTITRACE-5 SOLUTION T6 multitrace-5 concentrate SOLUTION T6 normal saline flush SOLUTION T6 normal saline flush for flushing vascular access devices SOLUTION T6 normal saline i.v. flush SOLUTION T6 NORMOSOL -R SOLUTION T6 normosol-m in d5w SOLUTION T6 NORMOSOL-R SOLUTION T6 NORMOSOL-R IN D5W SOLUTION T6 nutrilyte SOLUTION T6 nutrilyte ii SOLUTION T6 PEDITRACE SOLUTION T6 PENTASPAN SOLUTION T6 PLASMA-LYTE 56 SOLUTION T6 PLASMA-LYTE A SOLUTION T6 PLASMA-LYTE-148 SOLUTION T6 PLASMA-LYTE-148/D5W SOLUTION T6 PLASMA-LYTE-56/D5W SOLUTION T6 plasma-lyte-m/d5w SOLUTION T6 plasma-lyte-r SOLUTION T6 plasma-lyte-r/d5w SOLUTION T6 POTASSIUM ACETATE SOLUTION T6 potassium acetate SOLUTION T6 POTASSIUM CHLORIDE SOLUTION T6 potassium chloride SOLUTION T6 potassium chloride 0.075%/d5w/nacl 0.225% SOLUTION T6 POTASSIUM CHLORIDE 0.15% /NACL 0.45% VIAFLEX SOLUTION T6 potassium chloride 0.15% /nacl 0.45% viaflex SOLUTION T6 potassium chloride 0.15% d5w/nacl 0.33% SOLUTION T6 potassium chloride 0.15% d5w/nacl 0.45% SOLUTION T6 potassium chloride 0.15% d5w/nacl 0.45% viaflex SOLUTION T6 potassium chloride 0.15% nacl 0.9% SOLUTION T6 potassium chloride 0.15% w/nacl 0.9% viaflex SOLUTION T6 Cobertura Comentario injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 116 Nombre Forma de dosificación Nivel potassium chloride 0.15%/d5w SOLUTION T6 POTASSIUM CHLORIDE 0.15%/NACL 0.9% SOLUTION T6 potassium chloride 0.22% d5w/nacl 0.45% SOLUTION T6 potassium chloride 0.224%/d5w SOLUTION T6 potassium chloride 0.224%/d5w/nacl 0.45% SOLUTION T6 potassium chloride 0.224%/dextrose 5% viaflex SOLUTION T6 POTASSIUM CHLORIDE 0.224%D5W/NACL 0.33% SOLUTION T6 potassium chloride 0.224%d5w/nacl 0.45% viaflex SOLUTION T6 POTASSIUM CHLORIDE 0.3%/ NACL 0.9% SOLUTION T6 potassium chloride 0.3%/d5w SOLUTION T6 potassium chloride 0.3%/d5w/viaflex SOLUTION T6 potassium chloride 0.3%/nacl 0.9%/viaflex SOLUTION T6 potassium phosphate SOLUTION T6 potassium phosphates SOLUTION T6 PRISMASOL B22GK 2/0 SOLUTION T6 PRISMASOL B22GK 4/0 SOLUTION T6 PRISMASOL BGK 0/2.5 SOLUTION T6 PRISMASOL BGK 2/0 SOLUTION T6 PRISMASOL BGK 2/3.5 SOLUTION T6 PRISMASOL BGK 4/0/1.2 SOLUTION T6 PRISMASOL BGK 4/2.5 SOLUTION T6 PRISMASOL BK 0/0/1.2 SOLUTION T6 ringers injection SOLUTION T6 saline flush SOLUTION T6 saline flush zr/sterile field SOLUTION T6 SALINE/PHENOL SOLUTION T6 SELENIUM SOLUTION T6 SODIUM CHLORIDE SOLUTION T6 sodium chloride SOLUTION T6 sodium chloride 0.45% SOLUTION T6 sodium chloride 0.45% viaflex SOLUTION T6 sodium chloride bacteriostatic SOLUTION T6 Cobertura Comentario injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 117 SODIUM CHLORIDE BACTERIOSTATIC/BENZYL ALCOHOL Forma de dosificación SOLUTION sodium chloride flush SOLUTION T6 sodium chloride pab SOLUTION T6 sodium phosphate SOLUTION T6 swabflush saline flush SOLUTION T6 tpn electrolytes * T6 tpn electrolytes ii SOLUTION T6 TRACE ELEMENTS 4/PEDIATRIC SOLUTION T6 TRACE METALS ADDITIVE FTV SOLUTION T6 VOLUVEN SOLUTION T6 ZINC GLUCONATE SOLUTION T6 ZINC SULFATE SOLUTION T6 ZINC TRACE METAL SOLUTION T6 * X SODIUM SACCHARIN GRAN X SODIUM SACCHARIN DIHYDRATE POWDER X probenecid TABS T1 probenecid/colchicine TABS T1 SUCRAID SOLUTION T2 ADAGEN SOLUTION T6 ALDURAZYME SOLUTION T6 AMPHADASE SOLUTION T6 CEREDASE SOLUTION T6 CEREZYME SOLUTION T6 ELAPRASE SOLUTION T6 ELELYSO SOLUTION T6 ELITEK SOLUTION T6 FABRAZYME SOLUTION T6 HYLENEX SOLUTION T6 LUMIZYME SOLUTION T6 MYOZYME SOLUTION T6 NAGLAZYME SOLUTION T6 VITRASE SOLUTION T6 Nombre Nivel Cobertura T6 Comentario Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Salt and Sugar Substitutes SACCHARIN SODIUM Uricosuric Agents Enzymes PA PA AL (min: 8y) Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 118 Nombre Forma de dosificación Nivel VPRIV SOLUTION T6 XIAFLEX SOLUTION T6 VIMIZIM SOLUTION X OINTMENT T1 Cobertura Comentario injectable PA Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Eye, Ear, Nose & Throat Preparations Anti-infectives ak-poly-bac bacitracin/polymyxin b OINTMENT T1 chlorhexidine gluconate SOLUTION T1 chlorhexidine gluconate oral rinse SOLUTION T1 ciprofloxacin hcl SOLUTION T1 erythromycin OINTMENT T1 garamycin OINTMENT T1 gatifloxacin SOLUTION T1 gentak OINTMENT T1 gentamicin sulfate * T1 gentasol SOLUTION T1 grafco silver nitrate applicator MISC T1 ilotycin (5mg/gm) OINTMENT T1 levofloxacin SOLUTION T1 neo-polycin OINTMENT T1 neomycin/bacitracin/polymyxin OINTMENT T1 neomycin/polymyxin/bacitracin zinc OINTMENT T1 neomycin/polymyxin/gramicidin SOLUTION T1 ofloxacin SOLUTION T1 ofloxacin SOLUTION T1 paroex SOLUTION T1 periogard SOLUTION T1 polycin OINTMENT T1 polycin b OINTMENT T1 polymyxin b sulfate/trimethoprim sulfate SOLUTION T1 romycin OINTMENT T1 sodium sulfacetamide SOLUTION T1 sulfacetamide sodium SOLUTION T1 tobramycin sulfate SOLUTION T1 tobrasol SOLUTION T1 trifluridine SOLUTION T1 trimethoprim sulfate/polymyxin b sulfate SOLUTION T1 AZASITE SOLUTION T2 BACITRACIN OINTMENT T2 BETADINE OPHTHALMIC PREP SOLUTION T2 CILOXAN OINTMENT T2 CRESYLATE SOLUTION T2 NATACYN SUSPENSION T2 QL (5 ML/30 days) Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 119 SULFACETAMIDE SODIUM Forma de dosificación OINTMENT TOBREX OINTMENT T2 VIGAMOX SOLUTION T2 ZIRGAN GEL T2 ZYMAR SOLUTION T2 ARZOL SILVER NITRATE APP LICATORS MISC T3 Nombre Nivel Cobertura Comentario T2 BESIVANCE SUSPENSION T3 BLEPH-10 SOLUTION T3 CETRAXAL SOLUTION T3 CILOXAN SOLUTION T3 CIPROFLOXACIN SOLUTION T3 GARAMYCIN SOLUTION T3 ilotycin (5mg/gm) OINTMENT T3 IQUIX SOLUTION T3 MOXEZA SOLUTION T3 NEOSPORIN SOLUTION T3 OCUFLOX SOLUTION T3 PERIDEX SOLUTION T3 POLYTRIM SOLUTION T3 QUIXIN SOLUTION T3 SILVER NITRATE * T3 TOBREX SOLUTION T3 QL (10 ML/30 days) QL (5 ML/30 days) VIROPTIC SOLUTION T3 ZYMAXID SOLUTION T3 MITOSOL KIT T6 VITRASERT IMPLANT T6 ARESTIN MISC X acetasol hc SOLUTION T1 aero otic hc SOLUTION T1 bromfenac (0.09%) SOLUTION T1 cortic-nd SOLUTION T1 cortomycin * T1 cyotic SOLUTION T1 dexamethasone sodium phosphate SOLUTION T1 diclofenac sodium SOLUTION T1 exotic-hc SOLUTION T1 FLUNISOLIDE SOLUTION T1 QL (2/30 days) Quantity listed is # of bottles flunisolide SOLUTION T1 QL (2/30 days) Quantity listed is # of bottles QL (2/30 days) Quantity listed is # of bottles Non-self administerable injectable Anti-inflammatory Agents fluocinolone acetonide OIL T1 fluocinolone acetonide ear drops OIL T1 fluor-op SUSPENSION T1 fluorometholone SUSPENSION T1 flurbiprofen sodium SOLUTION T1 fluticasone propionate SUSPENSION T1 QL (5ML/30 days) Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 120 genexotic-hc Forma de dosificación SOLUTION genezoto-hc SOLUTION T1 hydrocortisone/acetic acid SOLUTION T1 ketorolac tromethamine SOLUTION T1 neo-polycin hc OINTMENT T1 neomycin/polymyxin/bacitracin/hydrocortisone OINTMENT T1 neomycin/polymyxin/dexamethasone * T1 neomycin/polymyxin/hc SOLUTION T1 neomycin/polymyxin/hydrocortisone * T1 oto-end 10 SOLUTION T1 otomar SOLUTION T1 otomax-hc SOLUTION T1 poly-dex * T1 pramoxine-hc SOLUTION T1 prednisolone acetate SUSPENSION T1 re pramoxine-hc SOLUTION T1 sulfacetamide sodium/prednisolone sodium phosphate SOLUTION T1 tobramycin/dexamethasone SUSPENSION T1 QL (20ML/30 days) triamcinolone acetonide AEROSOL T1 QL (33GM/30 days) ALREX SUSPENSION T2 BLEPHAMIDE SUSPENSION T2 Nombre Nivel Cobertura Comentario T1 BLEPHAMIDE S.O.P. OINTMENT T2 BROMDAY SOLUTION T2 bromfenac (0.09%) SOLUTION T2 budesonide SUSPENSION T2 CIPRO HC SUSPENSION T2 CIPRODEX SUSPENSION T2 COLY-MYCIN S SUSPENSION T2 CORTISPORIN-TC SUSPENSION T2 FLAREX SUSPENSION T2 FLUNISOLIDE SOLUTION T2 FML OINTMENT T2 FML FORTE SUSPENSION T2 ILEVRO SUSPENSION T2 LOTEMAX * T2 MAXIDEX SUSPENSION T2 NASONEX SUSPENSION T2 NEOMYCIN/POLYMYXIN/HYDROCORTISONE SUSPENSION T2 NEVANAC SUSPENSION T2 POLY-PRED SUSPENSION T2 PRED MILD SUSPENSION T2 PRED-G SUSPENSION T2 PRED-G S.O.P. OINTMENT T2 PREDNISOLONE SODIUM PHOSPHATE SOLUTION T2 QL (17.20 GM/30 days) QL (2/30 days) Quantity listed is # of bottles Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 121 RESTASIS Forma de dosificación EMULSION TOBRADEX OINTMENT T2 VEXOL SUSPENSION T2 ZETONNA AEROSOL T2 ZYLET SUSPENSION T2 ACULAR SOLUTION T3 ACULAR LS SOLUTION T3 BECONASE AQ SUSPENSION T3 Nombre Nivel T2 CORTANE-B AQUEOUS SOLUTION T3 CORTANE-B-OTIC SOLUTION T3 CORTISPORIN SOLUTION T3 DERMOTIC OIL T3 DUREZOL EMULSION T3 FLONASE SUSPENSION T3 FML LIQUIFILM SUSPENSION T3 MAXITROL * T3 NASACORT AQ AEROSOL T3 OCUFEN SOLUTION T3 OMNARIS SUSPENSION T3 OMNIPRED SUSPENSION T3 OTICIN HC NR SOLUTION T3 PRED FORTE SUSPENSION T3 PROLENSA SOLUTION T3 Cobertura Comentario QL (60/30 days) NOT COVERED FOR MEDICAID: Covered Alternatives Available QL (2/30 days) Quantity listed is # of bottles QL (2/30 days) Quantity listed is # of bottles QL (33GM/30 days) NOT COVERED FOR MEDICAID: Covered Alternatives Available QNASL AEROSOL T3 RHINOCORT AQUA SUSPENSION T3 QL (17.20 GM/30 days) TOBRADEX SUSPENSION T3 QL (20ML/30 days) VERAMYST SUSPENSION T3 VOLTAREN SOLUTION T3 VOSOL HC SOLUTION T3 XIBROM SOLUTION T3 OZURDEX IMPLANT T6 RETISERT IMPLANT T6 TRIESENCE SUSPENSION T6 ACUVAIL SOLUTION X TOBRADEX ST SUSPENSION X QL (5ML/30 days) Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Antiallergic Agents azelastine hcl SOLUTION T1 cromolyn sodium SOLUTION T1 epinastine hcl SOLUTION T1 olopatadine hcl SOLUTION T1 ALAMAST SOLUTION T2 ALOCRIL SOLUTION T2 ALOMIDE SOLUTION T2 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 122 azelastine hcl nasal spray Forma de dosificación SOLUTION EMADINE SOLUTION T2 LASTACAFT SOLUTION T2 Nombre Nivel T2 Cobertura Comentario QL (60 ML/30 days) PATADAY SOLUTION T2 QL (2.50 ML/30 days) PATANOL SOLUTION T2 QL (5 ML/30 days) ASTELIN SOLUTION T3 QL (60 ML/30 days) ASTEPRO SOLUTION T3 QL (60 ML/30 days) DYMISTA SUSPENSION T3 ELESTAT SOLUTION T3 OPTIVAR SOLUTION T3 PATANASE SOLUTION T3 BEPREVE SOLUTION X acetazolamide (250mg) TABS T1 acetazolamide er CONT.REL.CAPS T1 betaxolol hcl SOLUTION T1 QL (5 ML/30 days) brimonidine tartrate SOLUTION T1 QL (10 ML/30 days) carteolol hcl SOLUTION T1 QL (5 ML/30 days) dorzolamide hcl SOLUTION T1 Antiglaucoma Agents dorzolamide hcl/timolol maleate SOLUTION T1 QL (10 ML/30 days) latanoprost SOLUTION T1 QL (2.5 ML/30 days) levobunolol hcl (0.5%) SOLUTION T1 QL (5 ML/30 days) methazolamide TABS T1 metipranolol (0.3%) SOLUTION T1 pilocarpine hcl SOLUTION T1 timolol maleate (0.25%) SOLUTION T1 timolol maleate (0.5%) SOLUTION T1 QL (5 ML/30 days) timolol maleate ophthalmic gel forming GEL SOLUTION T1 QL (5 ML/30 days) ACETAZOLAMIDE (125MG) TABS T2 ALPHAGAN P (0.1%) SOLUTION T2 QL (10 ML/30 days) BETOPTIC-S SUSPENSION T2 QL (5 ML/30 days) COMBIGAN SOLUTION T2 QL (10 ML/30 days) ISOPTO CARBACHOL SOLUTION T2 LEVOBUNOLOL HCL (0.25%) SOLUTION T2 QL (5 ML/30 days) LUMIGAN SOLUTION T2 QL (5 ML/60 days) METIPRANOLOL (0.3%) SOLUTION T2 PHOSPHOLINE IODIDE SOLUTION T2 PILOPINE HS GEL T2 SIMBRINZA SUSPENSION T2 TIMOPTIC OCUDOSE SOLUTION T2 ALPHAGAN P (0.15%) SOLUTION T3 QL (15 ML/30 days) QL (10 ML/30 days) AZOPT SUSPENSION T3 QL (10 ML/30 days) BETAGAN SOLUTION T3 QL (5 ML/30 days) BETIMOL SOLUTION T3 QL (10 ML/30 days) COSOPT SOLUTION T3 QL (10 ML/30 days) Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 123 COSOPT PF Forma de dosificación SOLUTION DIAMOX CONT.REL.CAPS T3 ISOPTO CARPINE SOLUTION T3 QL (15 ML/30 days) ISTALOL SOLUTION T3 QL (5 ML/30 days) NEPTAZANE TABS T3 OPTIPRANOLOL SOLUTION T3 TIMOPTIC (0.25%) SOLUTION T3 TIMOPTIC (0.5%) SOLUTION T3 QL (5 ML/30 days) TIMOPTIC-XE GEL SOLUTION T3 QL (5 ML/30 days) TRAVATAN Z SOLUTION T3 QL (5 ML/60 days) TRAVOPROST SOLUTION T3 QL (5 ML/60 days) TRUSOPT SOLUTION T3 XALATAN SOLUTION T3 QL (2.5 ML/30 days) ZIOPTAN SOLUTION T3 QL (30/30 days) acetazolamide sodium SOLUTION T6 MIOCHOL-E SOLUTION T6 MIOSTAT SOLUTION T6 Nombre Nivel T3 Cobertura Comentario QL (60/30 days) Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable EENT Drugs, Miscellaneous acetic acid SOLUTION T1 apraclonidine SOLUTION T1 ACETIC ACID/ALUMINUM ACETATE SOLUTION T2 CAPHOSOL SOLUTION T2 DEBACTEROL SOLUTION T2 INTROL SOLUTION T2 NEUTRASAL PACK T2 NUMOISYN LIQUID T2 bss SOLUTION T3 IOPIDINE SOLUTION T3 NUMOISYN LOZG T3 VOSOL SOLUTION T3 akorn balanced salt solution SOLUTION T6 AMVISC SOLUTION T6 AMVISC PLUS SOLUTION T6 balanced salt SOLUTION T6 balanced salt solution SOLUTION T6 BSS PLUS SOLUTION T6 CELLUGEL SOLUTION T6 DISCOVISC SOLUTION T6 DUOVISC KIT T6 EYLEA SOLUTION T6 Non-self administerable injectable PA Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 124 HEALON Forma de dosificación SOLUTION HEALON GV SOLUTION T6 HEALON5 SOLUTION T6 JETREA SOLUTION T6 PA LACRISERT INSERT T6 QL (60/30 days) LUCENTIS SOLUTION T6 PA MACUGEN SOLUTION T6 ocucoat viscoadherent SOLUTION T6 PROVISC SOLUTION T6 SHELLGEL SOLUTION T6 VISCOAT SOLUTION T6 VISUDYNE SOLUTION T6 APHTHASOL PASTE X AQUORAL AEROSOL X CYSTARAN SOLUTION X PROPYLENE GLYCOL SOLUTION X RESCULA SOLUTION X SOLUTION T1 Nombre Nivel Cobertura T6 Comentario Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Local Anesthetics altacaine antipyrine/benzocaine (5.4%; 1.4%) SOLUTION T1 antipyrine/benzocaine (54mg/ml; 14mg/ml) SOLUTION T1 aurax SOLUTION T1 aurodex SOLUTION T1 chloroxylenol/pramoxine LIQUID T1 cocaine hcl (10%) SOLUTION T1 cocaine hcl (4%) SOLUTION T1 lidocaine hcl SOLUTION T1 lidocaine hcl viscous SOLUTION T1 lidocaine viscous SOLUTION T1 otic care SOLUTION T1 oticin LIQUID T1 parcaine SOLUTION T1 proparacaine hcl SOLUTION T1 tetcaine SOLUTION T1 tetracaine hcl SOLUTION T1 tetravisc SOLUTION T1 tetravisc forte SOLUTION T1 ANTIPYRINE/BENZOCAINE (5.5%; 1.4%) SOLUTION T2 AURALGAN SOLUTION T2 OTIC EDGE SOLUTION T2 PINNACAINE OTIC SOLUTION T2 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 125 RE BENZOTIC Forma de dosificación SOLUTION AKTEN GEL T3 ALCAINE SOLUTION T3 AURALGAN SOLUTION T3 COCAINE HCL (10%) SOLUTION T3 COCAINE HCL (4%) SOLUTION T3 LTA 360 KIT SOLUTION T3 NEOTIC LIQUID T3 OTOZIN LIQUID T3 Nombre Nivel Cobertura Comentario T2 PRAMOTIC LIQUID T3 TREAGAN OTIC SOLUTION T3 LIDOPRO OINTMENT X MEDI-DERM/L CREAM X MEDI-DERM/L-RX CREAM X MEDI-PATCH RX PATCH X MEDI-PATCH/LIDOCAINE PATCH X PR OTIC SOLUTION SOLUTION X RE CHLORPHENYLCAINE SOLUTION X TEROCIN LOTION X TRIOXIN SUSPENSION X ZINOTIC LIQUID X ZINOTIC ES LIQUID X ak-pentolate SOLUTION T1 atropine sulfate SOLUTION T1 atropine-care SOLUTION T1 cyclopentolate hcl SOLUTION T1 cylate SOLUTION T1 homatropaire SOLUTION T1 Mydriatics homatropine hbr SOLUTION T1 mydral SOLUTION T1 tropicamide SOLUTION T1 ATROPINE SULFATE OINTMENT T2 CYCLOMYDRIL SOLUTION T2 ISOPTO HOMATROPINE (2%) SOLUTION T2 ISOPTO HYOSCINE SOLUTION T2 CYCLOGYL SOLUTION T3 ISOPTO ATROPINE SOLUTION T3 ISOPTO HOMATROPINE (5%) SOLUTION T3 MYDRIACYL SOLUTION T3 altafrin SOLUTION T1 neofrin SOLUTION T1 phenylephrine hcl SOLUTION T1 ADRENALIN SOLUTION T2 Vasoconstrictors Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 126 NAPHAZOLINE HCL Forma de dosificación SOLUTION TYZINE SOLUTION T2 TYZINE PEDIATRIC NASAL DROPS SOLUTION T2 MYDFRIN SOLUTION T3 POWDER T2 balsalazide disodium mesalamine CAPS ENEMA T1 T1 mesalamine KIT T1 APRISO CONT.REL.CAPS T2 ASACOL T2 CANASA ENTERIC COATED SUPPOSITORY DIPENTUM CAPS T2 PENTASA CONT.REL.CAPS T2 ASACOL HD T3 COLAZAL ENTERIC COATED CAPS DELZICOL CONT.REL.CAPS T3 LIALDA T3 ROWASA ENTERIC COATED KIT SFROWASA ENEMA T3 LOTRONEX TABS T4 GIAZO TABS X diphenoxylate/atropine TABS T1 lofene TABS T1 lonox TABS T1 loperamide hcl CAPS T1 opium (1%) TINCTURE T1 opium tincture TINCTURE T1 DIPHENOXYLATE/ATROPINE LIQUID T2 MOTOFEN TABS T2 Nombre Nivel Cobertura Comentario T2 Gastrointestinal Drugs Antacids and Adsorbents SODIUM BICARBONATE Anti-inflammatory Agents T2 T3 T3 PA Antidiarrhea Agents OPIUM TINCTURE (PAREGORIC) TINCTURE T2 VSL#3 DS PACK T2 LOMOTIL TABS T3 opium (1%) TINCTURE T3 REZYST IM CHEW T3 REZYST SB CHEW T3 FULYZAQ ENTERIC COATED CAPS X CAPS T1 RESTORA RX X Antiemetics dronabinol Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 127 granisetron hcl Forma de dosificación TABS ondansetron hcl * T1 ondansetron odt TABS T1 Nombre Nivel Cobertura Comentario T1 trimethobenzamide hcl CAPS T1 ANZEMET TABS T2 CESAMET CAPS T2 EMEND GRANISOL CAPS SOLUTION T2 T2 TRANSDERM-SCOP PATCH T2 KYTRIL TABS T3 MARINOL CAPS T3 SANCUSO PATCH T3 TIGAN CAPS T3 ZOFRAN * T3 ZOFRAN ODT TABS T3 ALOXI SOLUTION T6 ANZEMET SOLUTION T6 DIMENHYDRINATE SOLUTION T6 EMEND SOLUTION T6 granisetron hcl SOLUTION T6 KYTRIL SOLUTION T6 ondansetron hcl SOLUTION T6 ondansetron hcl SOLUTION T6 ONDANSETRON HCL SOLUTION T6 ONDANSETRON HCL/DEXTROSE SOLUTION T6 ondansetron hcl/dextrose SOLUTION T6 TIGAN SOLUTION T6 trimethobenzamide hcl SOLUTION T6 ZOFRAN SOLUTION T6 AKYNZEO CAPS X ANTIVERT TABS X COCA COLA SYRUP SYRUP X COCA COLA SYURP SYRUP X DICLEGIS X meclizine hcl ENTERIC COATED TABS SCOPACE TABS X univert TABS X ZUPLENZ FILM X TABS T1 PA Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable X Antiulcer Agents and Acid Suppressants cimetidine Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 128 cimetidine hcl Forma de dosificación SOLUTION famotidine * T1 lansoprazole CONT.REL.CAPS T1 Nombre Nivel TABS T1 lansoprazole/amoxicillin/clarithromycin MISC T1 misoprostol TABS T1 nizatidine * T1 omeprazole CONT.REL.CAPS T1 pantoprazole sodium ENTERIC COATED ENTERIC COATED * T1 sucralfate TABS T1 CARAFATE SUSPENSION T2 DEXILANT CONT.REL.CAPS T2 ranitidine hcl Comentario T1 lansoprazole odt rabeprazole sodium Cobertura T1 T1 FIRST-LANSOPRAZOLE SUSPENSION T2 FIRST-OMEPRAZOLE SUSPENSION T2 PREVACID SOLUTAB TABS T2 PRILOSEC (10MG) PACK T2 PYLERA CAPS T2 AXID * T3 CARAFATE TABS T3 CYTOTEC TABS T3 NEXIUM * T3 PEPCID * T3 PREVACID CONT.REL.CAPS T3 PREVPAC MISC T3 PRILOSEC CONT.REL.CAPS T3 PRILOSEC (2.5MG) PACK T3 PROTONIX * T3 ZANTAC * T3 cimetidine hcl SOLUTION T6 CIMETIDINE HCL/NACL SOLUTION T6 ESOMEPRAZOLE SODIUM SOLUTION T6 esomeprazole sodium SOLUTION T6 FAMOTIDINE SOLUTION T6 famotidine SOLUTION T6 FAMOTIDINE PREMIXED SOLUTION T6 NEXIUM I.V. SOLUTION T6 pantoprazole sodium SOLUTION T6 PEPCID I.V. SOLUTION T6 PROTONIX SOLUTION T6 Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 129 Nombre Forma de dosificación Nivel ranitidine hcl SOLUTION T6 ZANTAC SOLUTION T6 ZANTAC SOLUTION T6 ACIPHEX ENTERIC COATED CAPS X CIMETIDINE POWDER X DEPRIZINE FUSEPAQ SUSPENSION X ESOMEPRAZOLE STRONTIUM CONT.REL.CAPS X GABITIDINE MISC X HELIDAC MISC X OMECLAMOX-PAK MISC X OMEPRAZOLE + SYRSPEND SF ALKA SUSPENSION X Cobertura Comentario injectable ACIPHEX SPRINKLE Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable X omeprazole/sodium bicarbonate CAPS X SENTRADINE MISC X ZANTAC EFFERVESCENT X ZEGERID * X SOLUTION T1 Cathartics and Laxatives gavilyte-c gavilyte-g SOLUTION T1 gavilyte-n/flavor pack SOLUTION T1 peg 3350/electrolytes SOLUTION T1 peg-3350/electrolytes SOLUTION T1 peg-3350/nacl/na bicarbonate/kcl SOLUTION T1 trilyte SOLUTION T1 COLYTE-FLAVOR PACKS (227.1GM; 2.82GM; 6.36GM; 5.53GM; 21.5GM) GOLYTELY (227.1GM; 2.82GM; 6.36GM; 5.53GM; 21.5GM) SOLUTION T2 SOLUTION T2 HALFLYTELY BOWEL PREP/FLAVOR PACKS KIT T2 MINERAL OIL HEAVY OIL T2 MOVIPREP SOLUTION T2 OSMOPREP TABS T2 PREPOPIK PACK T2 SUPREP BOWEL PREP SOLUTION T2 COLYTE-FLAVOR PACKS (240GM; 2.98GM; 6.72GM; 5.84GM; 22.72GM) GOLYTELY (236GM; 2.97GM; 6.74GM; 5.86GM; 22.74GM) SOLUTION T3 SOLUTION T3 NULYTELY/FLAVOR PACKS SOLUTION T3 SUCLEAR KIT T3 CASCARA SAGRADA EXTR X CASCARA SAGRADA AROMATIC EXTR X pegylax POWDER X polyethylene glycol 3350 * X POLYETHYLENE GLYCOL 8000 BASE E OINTMENT X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 130 SENNA Forma de dosificación POWDER VISICOL TABS Nombre Nivel Cobertura Comentario X X Cholelitholytic Agents ursodiol * T1 ACTIGALL CAPS T3 URSO 250 TABS T3 URSO FORTE TABS T3 CHENODAL TABS X Digestants CREON CAPS T2 PANCREAZE CAPS T2 PANCRELIPASE CAPS T2 PERTZYE CAPS T2 ULTRESA CAPS T2 VIOKACE TABS T2 ZENPEP CAPS T2 hydrochloric acid SOLUTION T6 DIGEX CAPS X NUTRESTORE PACK T2 AMITIZA CAPS T3 LINZESS CAPS T3 RELISTOR * T4 ENTYVIO SOLUTION T6 ENTEREG CAPS X GATTEX KIT X XENICAL CAPS X GRAN X Non-self administerable injectable GI Drugs, Miscellaneous PA Self Administerable (Select) Injectable Non-self administerable injectable Self Administerable (Select) Injectable This drug has a PA for Medicaid members only. It is not a benefit for any other member. Lipotropic Agents LECITHIN Prokinetic Agents metoclopramide hcl * T1 REGLAN TABS T3 metoclopramide hcl SOLUTION T6 REGLAN SOLUTION T6 METOZOLV ODT TABS X RIDAURA CAPS T2 gold sodium thiomalate SOLUTION T6 MYOCHRYSINE SOLUTION T6 CAPS T2 Non-self administerable injectable Non-self administerable injectable Gold Compounds Non-self administerable injectable Non-self administerable injectable Heavy Metal Antagonists CHEMET Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 131 CUPRIMINE Forma de dosificación CAPS DEPEN TITRATABS TABS T2 PENTETATE CALCIUM TRISODIUM SOLUTION T2 PENTETATE ZINC TRISODIUM SOLUTION T2 SYPRINE CAPS T2 EXJADE TABS T3 PA FERRIPROX TABS T5 PA BAL IN OIL SOLUTION T6 CALCIUM DISODIUM VERSENATE SOLUTION T6 deferoxamine mesylate SOLUTION T6 DESFERAL SOLUTION T6 ENDRATE SOLUTION T6 NITHIODOTE KIT T6 SODIUM NITRITE SOLUTION T6 SODIUM THIOSULFATE SOLUTION T6 sodium thiosulfate SOLUTION T6 CYANIDE ANTIDOTE PKG KIT X asmalpred SOLUTION T1 ASMANEX TWISTHALER 120 METERED DOSES AEROSOL T1 QL (1/60 days) Quantity listed is # of inhalers ASMANEX TWISTHALER 14 METERED DOSES AEROSOL T1 QL (1/30 days) Quantity listed is # of inhalers ASMANEX TWISTHALER 30 ME TERED DOSES AEROSOL T1 QL (1/30 days) Quantity listed is # of inhalers ASMANEX TWISTHALER 30 METERED DOSES AEROSOL T1 QL (1/30 days) Quantity listed is # of inhalers ASMANEX TWISTHALER 60 METERED DOSES AEROSOL T1 QL (1/30 days) Quantity listed is # of inhalers QL (1/30 days) Quantity listed is # of inhalers Nombre Nivel Cobertura Comentario T2 Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Hormones and Synthetic Substitutes Adrenals ASMANEX TWISTHALER 7 METERED DOSES AEROSOL T1 baycadron ELIXIR T1 budesonide CONT.REL.CAPS T1 budesonide SUSPENSION T1 dexamethasone * T1 dexamethasone (0.5mg) TABS T1 dexamethasone (0.75mg) TABS T1 dexamethasone (1.5mg) TABS T1 dexamethasone (4mg) TABS T1 dexamethasone (6mg) TABS T1 fludrocortisone acetate TABS T1 hydrocortisone TABS T1 methylprednisolone TABS T1 methylprednisolone dose pack TABS T1 prednisolone * T1 prednisolone sodium phosphate (15mg/5ml) SOLUTION T1 prednisolone sodium phosphate (5mg/5ml) SOLUTION T1 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 132 prednisolone sodium phosphate (6.7mg/5ml) Forma de dosificación SOLUTION PREDNISONE TABS T1 prednisone TABS T1 PREDNISONE TABS T1 prednisone TABS T1 zema-pak 10 day TABS T1 zema-pak 13 day TABS T1 zema-pak 6 day TABS T1 AEROSPAN AEROSOL T2 ALVESCO AEROSOL T2 QL (12.20 GM/30 days) BREO ELLIPTA AEROSOL T2 QL (1/30 days) CELESTONE SOLUTION T2 CORTISONE ACETATE TABS T2 DEXAMETHASONE * T2 DEXAMETHASONE (1MG) TABS T2 DEXAMETHASONE (2MG) TABS T2 DEXAMETHASONE INTENSOL SOLUTION T2 DEXPAK 10 DAY TABS T2 DEXPAK 13 DAY TABS T2 Nombre Nivel Cobertura Comentario T1 DEXPAK 6 DAY TABS T2 DULERA AEROSOL T2 QL (13 GM/30 days) FLOVENT DISKUS (100MCG/BLIST) AEROSOL T2 QL (60/30 days) FLOVENT DISKUS (250MCG/BLIST) AEROSOL T2 QL (60/30 days) FLOVENT DISKUS (50MCG/BLIST) AEROSOL T2 QL (60/30 days) FLOVENT HFA AEROSOL T2 FLOVENT HFA AEROSOL T2 MILLIPRED SOLUTION T2 ORAPRED ODT TABS T2 PREDNISOLONE SODIUM PHOSPHATE (25MG/5ML) SOLUTION T2 PREDNISONE SOLUTION T2 PREDNISONE INTENSOL SOLUTION T2 PULMICORT (1MG/2ML) SUSPENSION T2 QL (2/30 days) Quantity listed is # of inhalers Quantity listed is # of inhalers PULMICORT FLEXHALER AEROSOL T2 QL (2/30 days) QVAR AEROSOL T2 QL (17.40 GM/30 days) SYMBICORT AEROSOL T2 QL (10.20 GM/30 days) VERIPRED 20 SOLUTION T2 asmalpred plus SOLUTION T3 CORTEF TABS T3 ENTOCORT EC CONT.REL.CAPS T3 MEDROL TABS T3 MEDROL DOSEPAK TABS T3 MILLIPRED TABS T3 MILLIPRED DP TABS T3 ORAPRED SOLUTION T3 PEDIAPRED SOLUTION T3 Quantity listed is # of inhalers Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 133 Nivel PRELONE Forma de dosificación SYRUP PULMICORT (0.25MG/2ML) SUSPENSION T3 PULMICORT (0.5MG/2ML) SUSPENSION T3 Nombre Cobertura Comentario T3 UCERIS CONT.REL.TABS T3 A-HYDROCORT SOLUTION T6 a-methapred SOLUTION T6 ARISTOSPAN INTRA-ARTICULAR SUSPENSION T6 ARISTOSPAN INTRALESIONAL SUSPENSION T6 betamethasone sodium phosphate/betamethasone acetate SUSPENSION T6 CELESTONE-SOLUSPAN SUSPENSION T6 DEPO-MEDROL SUSPENSION T6 DEXAMETHASONE SODIUM PHOSPHATE SOLUTION T6 dexamethasone sodium phosphate SOLUTION T6 DOUBLEDEX KIT T6 KENALOG-10 SUSPENSION T6 KENALOG-40 SUSPENSION T6 methylprednisolone acetate SUSPENSION T6 methylprednisolone sodiumsuccinate SOLUTION T6 SOLU-CORTEF SOLUTION T6 SOLU-MEDROL SOLUTION T6 triamcinolone acetonide SUSPENSION T6 BETALIDO KIT X BUPIVILOG KIT KIT X DEXLIDO KIT X DEXLIDO-M KIT X DYURAL-40 KIT X DYURAL-80 KIT X DYURAL-L KIT X DYURAL-LM KIT X FLO-PRED SUSPENSION X FLOVENT DISKUS (100MCG/BLIST) AEROSOL X FLOVENT DISKUS (250MCG/BLIST) AEROSOL X INTERARTICULAR JOINT KIT KIT X LIDOLOG KIT KIT X MARBETA-25 KIT X MARBETA-L KIT X MARDEX-25 KIT X MLK F1 KIT KIT X MLK F2 KIT KIT X PA Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 134 MLK F3 KIT Forma de dosificación KIT MLK F4 KIT KIT X MULTI-SPECIALTY KIT KIT X Nombre Nivel Cobertura Comentario X PHYSICIANS EZ USE JOINT TUNNEL AND TRIGGER KIT X PHYSICIANS EZ USE M-PRED KIT X RAYOS ENTERIC COATED X danazol CAPS T1 oxandrolone TABS T1 ANADROL-50 TABS T2 ANDRODERM (2.5MG/24HR) PATCH T2 GL (m) ANDRODERM (2MG/24HR) PATCH T2 ANDRODERM (4MG/24HR) PATCH T2 ANDRODERM (5MG/24HR) PATCH T2 GL (m); QL (30/30 days) GL (m); QL (30/30 days) GL (m) ANDROGEL GEL T2 GL (m) ANDROGEL PUMP GEL T2 GL (m) ANDROID CAPS T2 ANDROXY TABS T2 AXIRON SOLUTION T2 FIRST-TESTOSTERONE OINTMENT T2 FIRST-TESTOSTERONE MC COMPOUNDING KIT CREAM T2 FORTESTA GEL T2 METHITEST TABS T2 STRIANT MISC T2 GL (m) GL (m) Androgens GL (m); QL (180 ML/30 days) GL (m); QL (300 GM/30 days) GL (m); QL (300 GM/30 days) GL (m) TESTOSTERONE (10MG/ACT) GEL T2 TESTRED CAPS T2 OXANDRIN TABS T3 TESTIM GEL T3 GL (m) TESTOSTERONE (1%) GEL T3 GL (m) TESTOSTERONE PUMP GEL T3 GL (m) VOGELXO GEL T3 GL (m) VOGELXO PUMP GEL T3 GL (m) DELATESTRYL SOLUTION T6 GL (m) DEPO-TESTOSTERONE SOLUTION T6 GL (m) TESTOPEL PELLET T6 GL (m) testosterone cypionate SOLUTION T6 GL (m) testosterone enanthate SOLUTION T6 GL (m) AVEED SOLUTION X acarbose TABS T1 chlorpropamide (100mg) TABS T1 Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Antidiabetic Agents Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 135 chlorpropamide (250mg) Forma de dosificación TABS glimepiride TABS T1 glipizide TABS T1 glipizide er CONT.REL.TABS T1 glipizide xl CONT.REL.TABS T1 glipizide/metformin hcl TABS T1 GLYBURIDE TABS T1 glyburide TABS T1 glyburide micronized TABS T1 glyburide/metformin hcl TABS T1 glycron (1.5mg) TABS T1 glycron (3mg) TABS T1 glycron (6mg) TABS T1 metformin hcl TABS T1 metformin hcl er (500mg) CONT.REL.TABS T1 metformin hcl er (750mg) CONT.REL.TABS T1 nateglinide TABS T1 pioglitazone hcl TABS T1 pioglitazone hcl/metformin hcl TABS T1 repaglinide TABS T1 tolazamide (250mg) TABS T1 ACTOPLUS MET XR CONT.REL.TABS T2 CHLORPROPAMIDE (100MG) TABS T2 CHLORPROPAMIDE (250MG) TABS T2 GLYCRON (4.5MG) TABS T2 HUMALOG * T2 HUMALOG KWIKPEN PEN T2 HUMALOG MIX 50/50 SUSPENSION T2 HUMALOG MIX 50/50 KWIKPEN PEN T2 HUMALOG MIX 75/25 SUSPENSION T2 HUMALOG MIX 75/25 KWIKPEN PEN T2 HUMULIN 50/50 SUSPENSION T2 HUMULIN 70/30 SUSPENSION T2 HUMULIN 70/30 KWIKPEN PEN T2 HUMULIN 70/30 PEN PEN T2 HUMULIN N SUSPENSION T2 HUMULIN N KWIKPEN PEN T2 HUMULIN N U-100 PEN PEN T2 HUMULIN R SOLUTION T2 HUMULIN R U-500 (CONCENTRATED) SOLUTION T2 Nombre Nivel Cobertura Comentario T1 Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 136 INVOKANA Forma de dosificación TABS JANUMET TABS T2 JANUMET XR CONT.REL.TABS T2 Nombre Nivel T2 JANUVIA TABS T2 JENTADUETO TABS T2 JUVISYNC TABS T2 LANTUS SOLUTION T2 LANTUS FOR OPTICLIK PEN T2 LANTUS SOLOSTAR PEN T2 LEVEMIR SOLUTION T2 LEVEMIR FLEXPEN PEN T2 LEVEMIR FLEXTOUCH PEN T2 NOVOLIN 70/30 SUSPENSION T2 NOVOLIN 70/30 RELION SUSPENSION T2 NOVOLIN N SUSPENSION T2 NOVOLIN N RELION SUSPENSION T2 NOVOLIN R SOLUTION T2 NOVOLIN R RELION SOLUTION T2 NOVOLOG SOLUTION T2 NOVOLOG FLEXPEN PEN T2 NOVOLOG MIX 70/30 SUSPENSION T2 NOVOLOG MIX 70/30 PREFILLED FLEXPEN PEN T2 NOVOLOG PENFILL PEN T2 RIOMET SOLUTION T2 SYMLIN SOLUTION T2 SYMLINPEN 120 PEN T2 SYMLINPEN 60 PEN T2 TOLAZAMIDE (500MG) TABS T2 TOLBUTAMIDE TABS T2 TRADJENTA TABS T2 VICTOZA PEN T2 XIGDUO XR CONT.REL.TABS T2 ACTOPLUS MET TABS T3 ACTOS TABS T3 AMARYL TABS T3 APIDRA SOLUTION T3 APIDRA SOLOSTAR PEN T3 AVANDAMET TABS T3 Cobertura Comentario ST Self Administerable Injectable Self Administerable Injectable Self Administerable Injectable Self Administerable Injectable Self Administerable Injectable Self Administerable Injectable Self Administerable Injectable Self Administerable Injectable Self Administerable Injectable Self Administerable Injectable Self Administerable Injectable Self Administerable Injectable Self Administerable Injectable Self Administerable Injectable Self Administerable Injectable Self Administerable Injectable Self Administerable Injectable (Select) (Select) (Select) (Select) (Select) (Select) (Select) (Select) (Select) (Select) (Select) (Select) (Select) (Select) (Select) (Select) (Select) Self Administerable (Select) Injectable Self Administerable (Select) Injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 137 AVANDARYL Forma de dosificación TABS AVANDIA TABS T3 BYDUREON SUSPENSION T3 BYDUREON PEN T3 BYETTA PEN T3 DIABETA TABS T3 Nombre Nivel Cobertura Comentario T3 DUETACT TABS T3 FARXIGA TABS T3 GLUCOPHAGE TABS T3 GLUCOPHAGE XR CONT.REL.TABS T3 GLUCOTROL TABS T3 GLUCOTROL XL CONT.REL.TABS T3 GLUCOVANCE TABS T3 GLUMETZA CONT.REL.TABS T3 GLYNASE TABS T3 GLYSET TABS T3 METAGLIP TABS T3 pioglitazone hcl-glimepiride TABS T3 PRANDIMET TABS T3 PRANDIN TABS T3 PRECOSE TABS T3 STARLIX TABS T3 KORLYM TABS T5 APPFORMIN MISC X APPFORMIN-D MISC X CYCLOSET TABS X FORTAMET CONT.REL.TABS X INVOKAMET TABS X JARDIANCE TABS X KAZANO TABS X KOMBIGLYZE XR CONT.REL.TABS X metformin hcl er (1000mg) CONT.REL.TABS X metformin hcl er (500mg) CONT.REL.TABS X NESINA TABS X ONGLYZA TABS X OSENI TABS X TANZEUM PEN X TRULICITY PEN X PROGLYCEM SUSPENSION T2 GLUCAGEN SOLUTION T6 GLUCAGEN HYPOKIT SOLUTION T6 GLUCAGON EMERGENCY KIT KIT T6 ST PA Antihypoglycemic Agents Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Contraceptives Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 138 altavera Forma de dosificación TABS T1 Women's Preventive Healthcare alyacen 1/35 TABS T1 Women's Preventive Healthcare alyacen 7/7/7 TABS T1 Women's Preventive Healthcare amethia TABS T1 Women's Preventive Healthcare amethia lo TABS T1 Women's Preventive Healthcare apri TABS T1 Women's Preventive Healthcare Nombre Nivel Cobertura Comentario aranelle TABS T1 Women's Preventive Healthcare aubra TABS T1 Women's Preventive Healthcare aviane TABS T1 Women's Preventive Healthcare azurette TABS T1 Women's Preventive Healthcare balziva TABS T1 Women's Preventive Healthcare briellyn TABS T1 Women's Preventive Healthcare camila TABS T1 Women's Preventive Healthcare camrese TABS T1 Women's Preventive Healthcare camrese lo TABS T1 Women's Preventive Healthcare caziant TABS T1 Women's Preventive Healthcare cesia TABS T1 Women's Preventive Healthcare chateal TABS T1 Women's Preventive Healthcare cryselle-28 TABS T1 Women's Preventive Healthcare cyclafem 1/35 TABS T1 Women's Preventive Healthcare cyclafem 7/7/7 TABS T1 Women's Preventive Healthcare dasetta 1/35 TABS T1 Women's Preventive Healthcare dasetta 7/7/7 TABS T1 Women's Preventive Healthcare daysee TABS T1 Women's Preventive Healthcare deblitane TABS T1 Women's Preventive Healthcare delyla TABS T1 Women's Preventive Healthcare desogestrel/ethinyl estradiol TABS T1 Women's Preventive Healthcare desogestrel/ethinyl estradiol TABS T1 Women's Preventive Healthcare drospirenone/ethinyl estradiol TABS T1 Women's Preventive Healthcare elinest TABS T1 Women's Preventive Healthcare emoquette TABS T1 Women's Preventive Healthcare enpresse-28 TABS T1 Women's Preventive Healthcare enskyce TABS T1 Women's Preventive Healthcare errin TABS T1 Women's Preventive Healthcare estarylla TABS T1 Women's Preventive Healthcare falmina TABS T1 Women's Preventive Healthcare gianvi TABS T1 Women's Preventive Healthcare gildagia TABS T1 Women's Preventive Healthcare gildess 1.5/30 TABS T1 Women's Preventive Healthcare gildess 1/20 TABS T1 Women's Preventive Healthcare gildess fe 1.5/30 TABS T1 Women's Preventive Healthcare gildess fe 1/20 TABS T1 Women's Preventive Healthcare heather TABS T1 Women's Preventive Healthcare introvale TABS T1 Women's Preventive Healthcare jencycla TABS T1 Women's Preventive Healthcare Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 139 jolessa Forma de dosificación TABS T1 Women's Preventive Healthcare jolivette TABS T1 Women's Preventive Healthcare junel 1.5/30 TABS T1 Women's Preventive Healthcare junel 1/20 TABS T1 Women's Preventive Healthcare junel fe 1.5/30 TABS T1 Women's Preventive Healthcare junel fe 1/20 TABS T1 Women's Preventive Healthcare kariva TABS T1 Women's Preventive Healthcare kelnor 1/35 TABS T1 Women's Preventive Healthcare kurvelo TABS T1 Women's Preventive Healthcare Nombre Nivel Cobertura Comentario larin 1.5/30 TABS T1 Women's Preventive Healthcare larin 1/20 TABS T1 Women's Preventive Healthcare larin fe 1.5/30 TABS T1 Women's Preventive Healthcare larin fe 1/20 TABS T1 Women's Preventive Healthcare leena TABS T1 Women's Preventive Healthcare lessina TABS T1 Women's Preventive Healthcare levonest TABS T1 Women's Preventive Healthcare levonorgestrel TABS T1 Women's Preventive Healthcare levonorgestrel and ethinyl estradiol TABS T1 Women's Preventive Healthcare levonorgestrel/ethinyl estradiol TABS T1 Women's Preventive Healthcare levonorgestrel/ethinyl estradiol TABS T1 Women's Preventive Healthcare levora 0.15/30-28 TABS T1 Women's Preventive Healthcare loryna TABS T1 Women's Preventive Healthcare low-ogestrel TABS T1 Women's Preventive Healthcare lutera TABS T1 Women's Preventive Healthcare lyza TABS T1 Women's Preventive Healthcare marlissa TABS T1 Women's Preventive Healthcare microgestin 1.5/30 TABS T1 Women's Preventive Healthcare microgestin 1/20 TABS T1 Women's Preventive Healthcare microgestin fe TABS T1 Women's Preventive Healthcare microgestin fe 1.5/30 TABS T1 Women's Preventive Healthcare mono-linyah TABS T1 Women's Preventive Healthcare mononessa TABS T1 Women's Preventive Healthcare my way TABS T1 Women's Preventive Healthcare myzilra TABS T1 Women's Preventive Healthcare necon 0.5/35-28 TABS T1 Women's Preventive Healthcare necon 1/35 TABS T1 Women's Preventive Healthcare necon 7/7/7 TABS T1 Women's Preventive Healthcare next choice TABS T1 Women's Preventive Healthcare next choice one dose TABS T1 Women's Preventive Healthcare nikki TABS T1 Women's Preventive Healthcare nora-be TABS T1 Women's Preventive Healthcare norethindrone TABS T1 Women's Preventive Healthcare norethindrone acetate/ethinyl estradiol TABS T1 Women's Preventive Healthcare norethindrone acetate/ethinyl estradiol/ferrous fumarate TABS T1 Women's Preventive Healthcare Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 140 norgestimate/ethinyl estradiol Forma de dosificación TABS T1 Women's Preventive Healthcare norgestimate/ethinyl estradiol TABS T1 Women's Preventive Healthcare norgestrel/ethinyl estradiol TABS T1 Women's Preventive Healthcare norlyroc TABS T1 Women's Preventive Healthcare nortrel 0.5/35 (28) TABS T1 Women's Preventive Healthcare nortrel 1/35 TABS T1 Women's Preventive Healthcare Nombre Nivel Cobertura Comentario nortrel 7/7/7 TABS T1 Women's Preventive Healthcare ocella TABS T1 Women's Preventive Healthcare orsythia TABS T1 Women's Preventive Healthcare philith TABS T1 Women's Preventive Healthcare pimtrea TABS T1 Women's Preventive Healthcare pirmella 1/35 TABS T1 Women's Preventive Healthcare pirmella 7/7/7 TABS T1 Women's Preventive Healthcare portia-28 TABS T1 Women's Preventive Healthcare previfem TABS T1 Women's Preventive Healthcare quasense TABS T1 Women's Preventive Healthcare reclipsen TABS T1 Women's Preventive Healthcare sharobel TABS T1 Women's Preventive Healthcare solia TABS T1 Women's Preventive Healthcare sprintec 28 TABS T1 Women's Preventive Healthcare sronyx TABS T1 Women's Preventive Healthcare syeda TABS T1 Women's Preventive Healthcare tarina fe 1/20 TABS T1 Women's Preventive Healthcare tilia fe TABS T1 Women's Preventive Healthcare tri-estarylla TABS T1 Women's Preventive Healthcare tri-legest fe TABS T1 Women's Preventive Healthcare tri-linyah TABS T1 Women's Preventive Healthcare tri-previfem TABS T1 Women's Preventive Healthcare tri-sprintec TABS T1 Women's Preventive Healthcare trinessa TABS T1 Women's Preventive Healthcare trivora-28 TABS T1 Women's Preventive Healthcare velivet TABS T1 Women's Preventive Healthcare vestura TABS T1 Women's Preventive Healthcare viorele TABS T1 Women's Preventive Healthcare vyfemla TABS T1 Women's Preventive Healthcare wera TABS T1 Women's Preventive Healthcare wymzya fe CHEW T1 Women's Preventive Healthcare xulane PATCH T1 QL (3/30 days) Women's Preventive Healthcare zarah TABS T1 Women's Preventive Healthcare zenchent TABS T1 Women's Preventive Healthcare zenchent fe CHEW T1 Women's Preventive Healthcare zeosa CHEW T1 Women's Preventive Healthcare zovia 1/35e TABS T1 Women's Preventive Healthcare AMETHYST TABS T2 ELLA TABS T2 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 141 LOESTRIN 24 FE Forma de dosificación TABS MINASTRIN 24 FE CHEW T2 NECON 1/50-28 TABS T2 Nombre Nivel Cobertura Comentario QL (1/30 days) Women's Preventive Healthcare QL (3/30 days) Women's Preventive Healthcare T2 NECON 10/11-28 TABS T2 NORINYL 1+50 TABS T2 NUVARING RING T2 OGESTREL TABS T2 ORTHO TRI-CYCLEN LO TABS T2 ZOVIA 1/50E TABS T2 BREVICON-28 TABS T3 CYCLESSA TABS T3 DESOGEN TABS T3 ESTROSTEP FE TABS T3 FEMCON FE CHEW T3 LO/OVRAL-28 TABS T3 LOESTRIN 1.5/30-21 TABS T3 LOESTRIN 1/20-21 TABS T3 LOESTRIN FE 1.5/30 TABS T3 LOESTRIN FE 1/20 TABS T3 LOMEDIA 24 FE TABS T3 LOSEASONIQUE TABS T3 LYBREL TABS T3 MIRCETTE TABS T3 MODICON TABS T3 MODICON-28 TABS T3 NATAZIA TABS T3 NOR-QD TABS T3 NORDETTE-28 TABS T3 NORINYL 1+35 TABS T3 ORTHO EVRA PATCH T3 ORTHO MICRONOR TABS T3 ORTHO TRI-CYCLEN TABS T3 ORTHO-CEPT TABS T3 ORTHO-CEPT-28 TABS T3 ORTHO-CYCLEN TABS T3 ORTHO-NOVUM 1/35 TABS T3 ORTHO-NOVUM 7/7/7 TABS T3 OVCON-35 TABS T3 OVCON-50 28 TABS T3 PLAN B TABS T3 PLAN B ONE-STEP TABS T3 SEASONALE TABS T3 SEASONIQUE TABS T3 TRI-NORINYL 28 TABS T3 YASMIN 28 TABS T3 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 142 YAZ Forma de dosificación TABS IMPLANON IMPLANT T6 MIRENA IUD T6 NEXPLANON IMPLANT T6 Women's Preventive Healthcare SKYLA IUD T6 Women's Preventive Healthcare BEYAZ TABS X Nombre Nivel Cobertura Comentario T3 FALESSA KIT X GENERESS FE CHEW X LO LOESTRIN FE TABS X LO MINASTRIN FE THPK X QUARTETTE TABS X SAFYRAL TABS X clomiphene citrate TABS T1 covaryx TABS T1 covaryx hs TABS T1 eemt TABS T1 eemt hs TABS T1 essian TABS T1 Women's Preventive Healthcare QL (1/365 days) Women's Preventive Healthcare Estrogens and Antiestrogens essian h.s. TABS T1 esterified estrogens/methltestosterone TABS T1 esterified estrogens/methyltestosterone TABS T1 esterified estrogens/methyltestosterone ds TABS T1 esterified estrogens/methyltestosterone hs TABS T1 estradiol TABS T1 estradiol PATCH T1 estradiol/norethindrone acetate TABS T1 estropipate (0.75mg) TABS T1 estropipate (1.5mg) TABS T1 jevantique TABS T1 methyltestosterone/esterified estrogens TABS T1 methyltestosterone/esterified estrogens hs TABS T1 mimvey TABS T1 mimvey lo TABS T1 ortho-est TABS T1 PA QL (4/30 days) raloxifene hydrochloride TABS T1 serophene TABS T1 ANGELIQ TABS T2 CLIMARA PRO PATCH T2 QL (4/30 days) COMBIPATCH (0.05MG/DAY; 0.14MG/DAY) PATCH T2 QL (8/30 days) COMBIPATCH (0.05MG/DAY; 0.25MG/DAY) PATCH T2 DIVIGEL GEL T2 DUAVEE TABS T2 ELESTRIN GEL T2 ESTRACE CREAM T2 PA Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 143 ESTRING Forma de dosificación RING ESTROPIPATE (3MG) TABS T2 EVAMIST SOLUTION T2 FEMRING RING T2 MENEST TABS T2 MENOSTAR PATCH T2 PREMARIN TABS T2 PREMARIN CREAM T2 PREMPHASE TABS T2 Nombre Nivel T2 PREMPRO TABS T2 VAGIFEM TABS T2 VIVELLE-DOT PATCH T2 ACTIVELLA TABS T3 Cobertura Comentario QL (1/90 days) QL (1/90 days) QL (4/30 days) QL (8/30 days) ALORA PATCH T3 CENESTIN TABS T3 QL (8/30 days) CLIMARA PATCH T3 QL (4/30 days) CLOMID TABS T3 PA ESTRACE TABS T3 ESTRADERM PATCH T3 ESTRASORB EMULSION T3 ESTROGEL GEL T3 EVISTA TABS T3 FEMHRT 1/5 TABS T3 FEMHRT LOW DOSE TABS T3 FEMTRACE TABS T3 JINTELI TABS T3 MINIVELLE PATCH T3 OSPHENA TABS T3 PREFEST TABS T3 DELESTROGEN OIL T6 DEPO-ESTRADIOL OIL T6 estradiol valerate OIL T6 PREMARIN SOLUTION T6 ENJUVIA TABS X QL (8/30 days) QL (8/30 days) Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Gonadotropins SYNAREL SOLUTION T2 BRAVELLE SOLUTION T5 PA chorionic gonadotropin SOLUTION T5 PA FOLLISTIM AQ SOLUTION T5 PA MENOPUR SOLUTION T5 PA novarel SOLUTION T5 PA pregnyl w/diluent benzyl alcohol/nacl SOLUTION T5 PA Self Administerable Injectable Self Administerable Injectable Self Administerable Injectable Self Administerable Injectable Self Administerable Injectable Self Administerable (Select) (Select) (Select) (Select) (Select) (Select) Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 144 Nombre Forma de dosificación REPRONEX SOLUTION FOLLISTIM AQ Nivel Cobertura Comentario T5 PA SOLUTION T6 PA GONAL-F SOLUTION T6 PA GONAL-F RFF SOLUTION T6 PA GONAL-F RFF PEN SOLUTION T6 PA GONAL-F RFF REDIJECT SOLUTION T6 PA LUVERIS SOLUTION T6 PA OVIDREL INJECTION T6 PA Self Administerable (Select) Injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable SOLUTION X calcitonin salmon SOLUTION T1 calcitonin-salmon SOLUTION T1 FORTICAL SOLUTION T2 MIACALCIN SOLUTION T3 FORTEO SOLUTION T5 MIACALCIN SOLUTION T5 desmopressin acetate TABS T1 desmopressin acetate SOLUTION T1 minirin SOLUTION T1 DDAVP TABS T3 DDAVP SOLUTION T3 STIMATE SOLUTION T3 DDAVP SOLUTION T6 desmopressin acetate SOLUTION T6 PITRESSIN SYNTHETIC SOLUTION T6 vasopressin SOLUTION T6 ACTHAR HP GEL X H.P. ACTHAR GEL X medroxyprogesterone acetate TABS T1 norethindrone acetate TABS T1 progesterone CAPS T1 CRINONE GEL T2 PA ENDOMETRIN INSERT T2 PA FIRST-PROGESTERONE VGS 100 COMPOUNDING KIT SUPPOSITORY T2 FIRST-PROGESTERONE VGS 200 COMPOUNDING KIT SUPPOSITORY T2 Injectable Leptins MYALEPT Self Administerable (Select) Injectable Parathyroid PA Self Administerable (Select) Injectable Self Administerable (Select) Injectable Pituitary Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Progestins Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 145 Nivel FIRST-PROGESTERONE VGS 25 COMPOUNDING KIT Forma de dosificación SUPPOSITORY FIRST-PROGESTERONE VGS 400 COMPOUNDING KIT SUPPOSITORY T2 Nombre Cobertura Comentario T2 FIRST-PROGESTERONE VGS 50 COMPOUNDING KIT SUPPOSITORY T2 MEGACE ES SUSPENSION T2 PROCHIEVE GEL T2 AYGESTIN TABS T3 PROMETRIUM CAPS T3 PROVERA TABS T3 DEPO-PROVERA SUSPENSION T6 DEPO-PROVERA CONTRACEPTIVE SUSPENSION T6 DEPO-SUBQ PROVERA 104 SUSPENSION T6 medroxyprogesterone acetate SUSPENSION T6 progesterone OIL T6 MAKENA OIL X PROGESTERONE MICRONIZED POWDER X octreotide acetate SOLUTION T6 SANDOSTATIN SOLUTION T6 SANDOSTATIN LAR DEPOT KIT T6 SIGNIFOR SOLUTION X SOMATULINE DEPOT SOLUTION X SAIZEN SOLUTION T4 PA SAIZEN CLICK.EASY SOLUTION T4 PA SEROSTIM SOLUTION T4 PA ZORBTIVE SOLUTION T4 PA GENOTROPIN SOLUTION T5 PA GENOTROPIN MINIQUICK SOLUTION T5 PA HUMATROPE SOLUTION T5 PA HUMATROPE COMBO PACK SOLUTION T5 PA INCRELEX SOLUTION T5 PA; AL (min: 2y) NORDITROPIN FLEXPRO SOLUTION T5 PA NORDITROPIN NORDIFLEX PEN SOLUTION T5 PA NUTROPIN SOLUTION T5 PA NUTROPIN AQ SOLUTION T5 PA NUTROPIN AQ NUSPIN 10 SOLUTION T5 PA NUTROPIN AQ NUSPIN 20 SOLUTION T5 PA PA Non-self administerable injectable Women's Preventive Healthcare Non-self administerable injectable Women's Preventive Healthcare Non-self administerable injectable Non-self administerable injectable Somatostatin Agonists and Antagonists Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Somatotropin Agonists and Antagonists Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 146 Nombre Forma de dosificación Nivel Cobertura NUTROPIN AQ NUSPIN 5 SOLUTION T5 PA NUTROPIN AQ PEN SOLUTION T5 PA OMNITROPE * T5 PA SOMAVERT SOLUTION T5 PA TEV-TROPIN SOLUTION T5 PA EGRIFTA SOLUTION X levothroid TABS T1 levothyroxine sodium TABS T1 levoxyl TABS T1 liothyronine sodium TABS T1 methimazole TABS T1 NATURE-THROID TABS T1 NATURE-THROID NT-2.5 TABS T1 np thyroid TABS T1 np thyroid 30 TABS T1 np thyroid 60 TABS T1 Comentario Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Thyroid and Antithyroid Agents np thyroid 90 TABS T1 propylthiouracil TABS T1 unithroid TABS T1 unithroid direct TABS T1 WESTHROID TABS T1 WESTHROID-P TABS T1 WP THYROID TABS T1 SSKI SOLUTION T2 THYROLAR-1 TABS T2 THYROLAR-1/2 TABS T2 THYROLAR-1/4 TABS T2 THYROLAR-2 TABS T2 THYROLAR-3 TABS T2 ARMOUR THYROID TABS T3 BIO-THROID CAPS T3 CYTOMEL TABS T3 SYNTHROID TABS T3 TAPAZOLE TABS T3 TIROSINT CAPS T3 LEVOTHYROXINE SODIUM SOLUTION T6 levothyroxine sodium SOLUTION T6 liothyronine sodium SOLUTION T6 TRIOSTAT SOLUTION T6 Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 147 Nombre Forma de dosificación Nivel Cobertura Comentario Local Anesthetics BD PUDENDAL/LOCAL BLOCK TRAY 1% LIDOCAINE KIT T6 bupivacaine hcl SOLUTION T6 bupivacaine spinal SOLUTION T6 bupivacaine/epinephrine SOLUTION T6 CARBOCAINE SOLUTION T6 chloroprocaine hcl SOLUTION T6 CITANEST FORTE DENTAL SOLUTION T6 CITANEST PLAIN DENTAL SOLUTION T6 DUOCAINE SOLUTION T6 DURASAFE SPINAL/EPIDURAL TRAY/1% XYLOCAINE/19GX36"CLOSE CATH DURASAFE SPINAL/EPIDURAL TRAY/1% XYLOCAINE/19GX36"OPEN CATH DURASAFE SPINAL/EPIDURAL TRAY/1% XYLOCAINE/20GX36"CLOSE CATH DURASAFE SPINAL/EPIDURAL TRAY/1% XYLOCAINE/20GX36"OPEN CATH EXPAREL KIT T6 KIT T6 KIT T6 KIT T6 SUSPENSION T6 lidocaine hcl SOLUTION T6 LIDOCAINE HCL/DEXTROSE SOLUTION T6 lidocaine/epinephrine SOLUTION T6 MARCAINE SOLUTION T6 MARCAINE SPINAL SOLUTION T6 MARCAINE W/O EPI SOLUTION T6 MARCAINE/EPINEPHRINE SOLUTION T6 MEPIVACAINE HCL SOLUTION T6 MONOJECT BONE MARROW ASPIRATION TRAY/ROSENTHAL NEEDLE 16GX2" MONOJECT BONE MARROW BIOPSY PREPPING TRAY KIT T6 KIT T6 MONOJECT BONE MARROW BIOPSY TRAY/BIOP ASPIR NEEDLE 11GX4" MONOJECT BONE MARROW BIOPSY TRAY/BIOP ASPIR NEEDLE 8GX4" MONOJECT BONE MARROW BIOPSY TRAY/STERNAL-ILIAC NEEDLE 16G NAROPIN KIT T6 KIT T6 KIT T6 SOLUTION T6 NESACAINE SOLUTION T6 NESACAINE-MPF SOLUTION T6 NOVOCAIN SOLUTION T6 polocaine SOLUTION T6 Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 148 polocaine-mpf Forma de dosificación SOLUTION PONTOCAINE SOLUTION T6 PONTOCAINE NIPHANOID SOLUTION T6 ropivacaine SOLUTION T6 ropivacaine hcl SOLUTION T6 sensorcaine SOLUTION T6 sensorcaine-mpf SOLUTION T6 sensorcaine-mpf spinal SOLUTION T6 SENSORCAINE-MPF/EPINEPHRINE SOLUTION T6 sensorcaine-mpf/epinephrine SOLUTION T6 sensorcaine/epinephrine SOLUTION T6 TETRACAINE HCL SOLUTION T6 TURKEL PARACENTESIS PROCEDURE TRAY/8FRENCH KIT T6 XYLOCAINE SOLUTION T6 xylocaine dental SOLUTION T6 XYLOCAINE-MPF SOLUTION T6 XYLOCAINE-MPF/EPINEPHRINE SOLUTION T6 XYLOCAINE/EPINEPHRINE SOLUTION T6 ARTICADENT DENTAL SOLUTION X LETS KIT KIT X Nombre Nivel Cobertura T6 MARLIDO KIT KIT X MARLIDO-25 KIT X TABS T1 finasteride TABS T1 AVODART CAPS T2 JALYN CAPS T3 PROSCAR TABS T3 disulfiram TABS T1 ANTABUSE TABS T3 SOLUTION T1 Comentario Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Miscellaneous Therapeutic Agents disulfiram 5-alpha-Reductase Inhibitors GL (m) GL (m) Alcohol Deterrents Antidotes acetylcysteine leucovorin calcium (25mg) TABS T1 leucovorin calcium (5mg) TABS T1 LEUCOVORIN CALCIUM (10MG) TABS T2 LEUCOVORIN CALCIUM (15MG) TABS T2 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 149 ACETADOTE Forma de dosificación SOLUTION acetylcysteine SOLUTION T6 ANTIZOL SOLUTION T6 CALCIUM FOLINATE SOLUTION T6 CYANOKIT SOLUTION T6 DUODOTE SOAJ T6 fomepizole SOLUTION T6 FUSILEV SOLUTION T6 LEUCOVORIN CALCIUM * T6 leucovorin calcium * T6 methylene blue SOLUTION T6 PRALIDOXIME CHLORIDE SOAJ T6 PROTOPAM CHLORIDE SOLUTION T6 VORAXAZE SOLUTION T6 allopurinol TABS T1 ULORIC TABS T2 COLCRYS TABS T3 ZYLOPRIM TABS T3 allopurinol sodium SOLUTION T6 ALOPRIM SOLUTION T6 KRYSTEXXA SOLUTION T6 MITIGARE CAPS X Nombre Nivel Cobertura T6 PA Comentario Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Antigout Agents ST PA Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Bone Resorption Inhibitors alendronate sodium (10mg) TABS T1 alendronate sodium (35mg) TABS T1 alendronate sodium (5mg) TABS T1 QL (4/30 days) alendronate sodium (70mg) TABS T1 QL (4/30 days) ibandronate sodium TABS T1 QL (1/30 days) risedronate sodium TABS T1 QL (1/30 days) ACTONEL (150MG) TABS T2 QL (1/30 days) ACTONEL (30MG) TABS T2 ACTONEL (35MG) TABS T2 ACTONEL (5MG) TABS T2 ALENDRONATE SODIUM (40MG) TABS T2 ETIDRONATE DISODIUM TABS T2 SKELID TABS T2 ACTONEL (150MG) TABS T3 ALENDRONATE SODIUM SOLUTION T3 QL (4/30 days) QL (1/30 days) Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 150 BONIVA Forma de dosificación TABS DIDRONEL TABS T3 FOSAMAX * T3 Nombre Nivel T3 Cobertura Comentario QL (1/30 days) FOSAMAX (10MG) TABS T3 FOSAMAX (35MG) TABS T3 FOSAMAX (40MG) TABS T3 FOSAMAX (5MG) TABS T3 FOSAMAX (70MG) TABS T3 QL (4/30 days) FOSAMAX PLUS D TABS T3 QL (4/30 days) AREDIA SOLUTION T6 BONIVA SOLUTION T6 GANITE SOLUTION T6 ibandronate sodium SOLUTION T6 PAMIDRONATE DISODIUM * T6 pamidronate disodium * T6 PROLIA SOLUTION T6 RECLAST SOLUTION T6 XGEVA SOLUTION T6 ZOLEDRONIC ACID * T6 zoledronic acid * T6 ZOMETA * T6 ATELVIA ENTERIC COATED EFFERVESCENT X epiflur CHEW T1 AL (max: 5y) Preventative fluoride fluoride CHEW T1 AL (max: 5y) Preventative fluoride fluoritab * T1 AL (max: 5y) Preventative fluoride flura-drops SOLUTION T1 AL (max: 5y) Preventative fluoride karidium SOLUTION T1 AL (max: 5y) Preventative fluoride ludent CHEW T1 AL (max: 5y) Preventative fluoride nafrinse CHEW T1 AL (max: 5y) Preventative fluoride nafrinse drops SOLUTION T1 AL (max: 5y) Preventative fluoride sodiphluor SOLUTION T1 AL (max: 5y) Preventative fluoride sodium fluoride * T1 AL (max: 5y) Preventative fluoride cavarest GEL X cavirinse SOLUTION X clinpro 5000 PASTE X controlrx * X denta 5000 plus CREAM X dentagel GEL X BINOSTO QL (4/30 days) QL (3 ML/90 days) QL (3 ML/90 days) PA PA Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable X Cariostatic Agents Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 151 easygel Forma de dosificación GEL FLORIVA LIQUID X fluor-a-day SOLUTION X FLUOR-A-DAY CHEW X fluoridex daily defense GEL X fluoridex daily defense enhanced whitening GEL X GEL-KAM ORAL CARE RINSE SOLUTION X karigel GEL X karigel-n GEL X Nombre Nivel Cobertura Comentario PA; AL (min: 18y) Self Administerable (Select) Injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable X LOZI-FLUR LOZG X NAFRINSE DAILY/NEUTRAL SOLUTION X NAFRINSE WEEKLY SOLUTION X neutragard advanced GEL X neutral sodium fluoride SOLUTION X perio med SOLUTION X phos-flur GEL X PREVIDENT SOLUTION X PREVIDENT 5000 BOOSTER PASTE X PREVIDENT 5000 BOOSTER PLUS PASTE X PREVIDENT 5000 DRY MOUTH GEL X PREVIDENT 5000 PLUS CREAM X PREVIDENT FLUORIDE GEL X sf GEL X sf 5000 plus CREAM X stannous fluoride oral rinse SOLUTION X THERA-FLUR-N GEL X FIRAZYR SOLUTION T5 BERINERT KIT T6 CINRYZE SOLUTION T6 PA KALBITOR SOLUTION T6 PA RUCONEST SOLUTION X SOLIRIS SOLUTION X leflunomide TABS T1 ARAVA TABS T3 ENBREL * T4 PA ENBREL SURECLICK SOAJ T4 PA HUMIRA KIT T4 PA HUMIRA PEDIATRIC CROHNS DISEASE STARTER PACK KIT T4 PA HUMIRA PEN KIT T4 PA Complement Inhibitors Disease-modifying Antirheumatic Drugs Self Administerable Injectable Self Administerable Injectable Self Administerable Injectable Self Administerable Injectable Self Administerable Injectable (Select) (Select) (Select) (Select) (Select) Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 152 HUMIRA PEN-CROHNS DISEASESTARTER Forma de dosificación KIT HUMIRA PEN-PSORIASIS STARTER KIT T4 PA ACTEMRA SOSY T5 PA CIMZIA KIT T5 PA CIMZIA STARTER KIT KIT T5 PA KINERET SOSY T5 PA ORENCIA SOSY T5 PA SIMPONI * T5 PA XELJANZ TABS T5 PA ACTEMRA SOLUTION T6 PA CIMZIA KIT T6 PA HUMIRA PSKT T6 PA ORENCIA SOLUTION T6 PA REMICADE SOLUTION T6 PA SIMPONI ARIA SOLUTION T6 PA OTEZLA * X OTREXUP SOAJ X RASUVO SOAJ X GANIRELIX ACETATE SOLUTION T5 PA CETROTIDE KIT T6 PA THALOMID CAPS T3 Oral Cancer Drug BETASERON KIT T4 COPAXONE * T4 ACTIMMUNE SOLUTION T5 AVONEX KIT T5 AVONEX PEN KIT T5 EXTAVIA KIT T5 Self Administerable Injectable Self Administerable Injectable Self Administerable Injectable Self Administerable Injectable Self Administerable Injectable Self Administerable Injectable GILENYA CAPS T5 REBIF SOLUTION T5 REBIF REBIDOSE SOLUTION T5 REBIF REBIDOSE TITRATION PACK SOLUTION T5 REBIF TITRATION PACK SOLUTION T5 TECFIDERA CONT.REL.CAPS T5 TECFIDERA STARTER PACK MISC T5 Nombre Nivel Cobertura Comentario T4 PA Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Gonadotropin-releasing Hormone Antagonists Self Administerable (Select) Injectable Non-self administerable injectable Immunomodulatory Agents (Select) (Select) (Select) (Select) (Select) (Select) PA Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Self Administerable (Select) Injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 153 TYSABRI Forma de dosificación SOLUTION AUBAGIO TABS X azathioprine TABS T1 cyclosporine * T1 cyclosporine modified * T1 cyclosporine modified (100mg) CAPS T1 Nombre Nivel T6 Cobertura Comentario PA Non-self administerable injectable Immunosuppressive Agents cyclosporine modified (25mg) CAPS T1 gengraf * T1 hecoria CAPS T1 mycophenolate mofetil * T1 mycophenolic acid dr T1 sirolimus ENTERIC COATED TABS tacrolimus CAPS T1 T1 ASTAGRAF XL CONT.REL.CAPS T2 CELLCEPT SUSPENSION T2 CYCLOSPORINE MODIFIED (50MG) CAPS T2 RAPAMUNE SOLUTION T2 SANDIMMUNE SOLUTION T2 CELLCEPT * T3 IMURAN TABS T3 MYFORTIC T3 NEORAL ENTERIC COATED * PROGRAF CAPS T3 RAPAMUNE TABS T3 T3 SANDIMMUNE CAPS T3 ZORTRESS TABS T4 ATGAM INJECTION T6 AZATHIOPRINE SODIUM SOLUTION T6 BENLYSTA SOLUTION T6 CELLCEPT INTRAVENOUS SOLUTION T6 cyclosporine SOLUTION T6 ORTHOCLONE OKT3 INJECTION T6 PROGRAF SOLUTION T6 SANDIMMUNE SOLUTION T6 SIMULECT SOLUTION T6 THYMOGLOBULIN SOLUTION T6 AZASAN TABS X NULOJIX SOLUTION X PA Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Other Miscellaneous Therapeutic Agents Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 154 levocarnitine Forma de dosificación * CYSTADANE POWDER T2 CYSTAGON CAPS T2 Nombre Nivel Cobertura Comentario T1 DEMSER CAPS T2 ELMIRON CAPS T2 SENSIPAR TABS T2 THIOLA TABS T2 VIASPAN -BELZER UW-CSS COLD STORAGE SOLN SOLUTION T2 CARNITOR * T3 CARNITOR SF SOLUTION T3 TRI-CHLOR LIQUID T3 KUVAN * T4 ORFADIN CAPS T4 ZAVESCA CAPS T4 PA ARCALYST SOLUTION T5 PA; AL (min: 12y) BOTOX SOLUTION T6 PA CARNITOR SOLUTION T6 CARTICEL IMPLANT T6 CAT HAIR EXTRACT SOLUTION T6 DYSPORT SOLUTION T6 PA DYSPORT SOLUTION T6 PA EUFLEXXA SOSY T6 PA HONEY BEE TREATMENT KIT KIT T6 HONEY BEE VENOM SOLUTION T6 HONEY BEE VENOM PROTEIN SOLUTION T6 HYALGAN * T6 INDICLOR SOLUTION T6 INDIUM IN 111 DTPA SOLUTION T6 levocarnitine SOLUTION T6 MIXED VESPID VENOM PROTEIN SOLUTION T6 MIXED VESPID VENOM PROTEIN MDV KIT T6 MIXED VESPID VENOM PROTEIN TREATMENT KIT KIT T6 MYOBLOC SOLUTION T6 NEXAVIR SOLUTION T6 OCTREOSCAN KIT T6 PROSTASCINT KIT T6 RIMSO-50 SOLUTION T6 PA PA PA Self Administerable (Select) Injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 155 STAPHAGE LYSATE I & III Forma de dosificación SOLUTION SUPARTZ SOSY T6 PA SYNVISC SOSY T6 PA SYNVISC ONE SOSY T6 PA VENOMIL HONEY BEE VENOM KIT T6 VENOMIL MIXED VESPID VENOM PROTEIN SOLUTION T6 VENOMIL WASP VENOM PROTEIN KIT T6 VENOMIL WHITE FACED HORNET PROTEIN KIT T6 VENOMIL WHITE FACED HORNET VENOM PROTEIN KIT T6 VENOMIL YELLOW HORNET VENOM PROTEIN KIT T6 VENOMIL YELLOW JACKET VENOM PROTEIN KIT T6 WASP VENOM PROTEIN SOLUTION T6 WASP VENOM PROTEIN TREATMENT KIT KIT T6 WHITE FACED HORNET VENOM PROTEIN MDV SOLUTION T6 WHITE FACED HORNET VENOM PROTEIN TREATMENT KIT KIT T6 WHITE-FACED HORNET VENOM SOLUTION T6 XEOMIN SOLUTION T6 YELLOW HORNET VENOM PROTEIN SOLUTION T6 YELLOW HORNET VENOM PROTEIN MDV SOLUTION T6 YELLOW HORNET VENOM PROTEIN TREATMENT KIT KIT T6 YELLOW JACKET VENOM PROTEIN SOLUTION T6 YELLOW JACKET VENOM PROTEIN KIT KIT T6 YELLOW JACKET VENOM PROTEIN MDV SOLUTION T6 ACUNOL TABS X ALEVICIN CREAM X AMPYRA CONT.REL.TABS X APLIGRAF DISK X Nombre Nivel Cobertura T6 ARGENTUM METALLICUM 8X INJECTION X ARGENTUM-D20 INJECTION X ASTHMA RX TABS X ATROPINUM COMPOSITUM SUBLINGUAL X AURUM LIQUID X AURUMHEEL LIQUID X AVAILNEX CHEW X BIOVANCE SHEE X BOTOX COSMETIC SOLUTION X CACTUS COMPOSITUM LIQUID X PA Comentario Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 156 CALAFOL RX Forma de dosificación TABS CARDIOVID PLUS CAPS X CERDELGA CAPS X CERECOMP INJECTION X CHELIDONIUM COMPOUND LIQUID X COENZYME COMPOSITUM INJECTION X Nombre Nivel Cobertura Comentario X COR COMPOSITUM LIQUID X CRALONIN LIQUID X CUTIS COMPOSITUM INJECTION X DEPLIN TABS X DEPLIN 15 CAPS X DEPLIN 7.5 CAPS X DERMAGRAFT SHEE X DERMATODORON LIQUID X DIGESTODORON LIQUID X DISCUS COMPOSITUM * X DISCUS COMPOSITUM * X DISCUS COMPOSITUM SUBLINGUAL X DISCUS COMPOSITUM LIQUID X DISCUS COMPOSITUM INJECTION X ECHINACEA COMPOSITUM LIQUID X ECHINACEA COMPOSITUM FORTE * X ECZEMOL TABS X ENGYSTOL INJECTION X ENTERAGAM PACK X EPIFIX 14MM DISK X EPIFIX 2CM X 3CM SHEE X EPIFIX 4CM X 4CM SHEE X EPIFIX 5CM X 6CM SHEE X EPIFIX 7CM X 7CM SHEE X ERYSIDORON #1 LIQUID X ERYSIDORON #2 TABS X FALESSA TABS X FOSTEUM CAPS X GALIUM-HEEL INJECTION X GEL-ONE PRSY X GLONOIN HOMACCORD LIQUID X GLYOXAL COMPOSITUM INJECTION X GRAFIX CORE 2CM X 2CM MISC X GRAFIX CORE 5CM X 5CM MISC X GRAFIX PRIME 2CM X 2CM MISC X GRAFIX PRIME 5CM X 5CM MISC X GRAFIX PRIME 7.5CM X 15CM MISC X GRASTEK SUBLINGUAL X GRIPP-HEEL INJECTION X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 157 HEPAR COMPOSITUM Forma de dosificación INJECTION HORMEEL LIQUID X ISAR QUERCUS INJECTION X ISCAR MALI INJECTION X ISCAR MALI SERIES I INJECTION X ISCAR MALI SERIES II INJECTION X Nombre Nivel Cobertura Comentario X ISCAR MALI SERIES O INJECTION X ISCAR MALI SPECIAL INJECTION X ISCAR PINI INJECTION X ISCAR PINI SERIES I INJECTION X ISCAR PINI SERIES II INJECTION X ISCAR PINI SERIES O INJECTION X ISCAR QUERCUS INJECTION X ISCAR QUERCUS SERIES I INJECTION X ISCAR QUERCUS SERIES II INJECTION X ISCAR QUERCUS SERIES O INJECTION X ISCAR QUERCUS SPECIAL INJECTION X L-METHYLFOLATE TABS X L-METHYLFOLATE CALCIUM TABS X L-METHYLFOLATE FORMULA 15 CAPS X L-METHYLFOLATE FORMULA 7.5 CAPS X L-METHYLFOLATE FORTE CAPS X LEVOMEFOLATE CALCIUM/ALGAL POWDER CAPS X LIMBREL CAPS X LIMBREL250 CAPS X LIMBREL500 CAPS X LIMBREL525 CAPS X LYMPHOMYOSOT INJECTION X MELILOTUS HOMACCORD LIQUID X MOMORDICA COMPOSITUM LIQUID X MONOVISC SOSY X MORCIN CREAM X MUCOSA COMPOSITUM INJECTION X NEOX 100 2CM X 2CM SHEE X NEOX 100 4CM X 4CM SHEE X NEOX 100 7CM X 7CM SHEE X NEOX CORD 1K 1.5CM X 1.5CM SHEE X NEOX CORD 1K 2.5CM X 2.5CM SHEE X NEOX CORD 1K 4CM X 3CM SHEE X NEOX CORD 1K 6CM X 3CM SHEE X NEOX CORD 1K 8CM X 3CM SHEE X NEURALGO-RHEUM INJECTION X ORALAIR SUBLINGUAL X ORTHOVISC SOSY X PERLANE GEL X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 158 PERLANE-L Forma de dosificación GEL PLACENTA COMPOSITUM INJECTION X PNEUMODORON #1 LIQUID X Nombre Nivel Cobertura Comentario X PNEUMODORON #2 LIQUID X PRASTERA KIT X PROCYSBI CONT.REL.CAPS X PRYFLEX TABS X PSORINOHEEL LIQUID X PSORIZIDE FORTE TABS X PSORIZIDE ULTRA TABS X PULSATILLA COMPOSITUM INJECTION X Q-TABS TABS X QUINZYME TABS X RAGWITEK SUBLINGUAL X RASPBERRY SYRUP SYRUP X RAUWOLFIA COMPOSITUM * X REJUVESOL SOLUTION X RELAMINE TABS X RENEEL SUBLINGUAL X RESTYLANE GEL X RESTYLANE-L GEL X RHEUMADORON 102A LIQUID X SARAPIN SOLUTION X SCULPTRA SUSPENSION X SKIN SHIELD LIQUID X SOLESTA GEL X SPASCUPREEL INJECTION X SPEEDGEL RX GEL X STERYMINE GEL X STRUMEEL SUBLINGUAL X STRUMEEL FORTE LIQUID X SYZYGIUM COMPOSITUM LIQUID X TEARS AGAIN HYDRATE CAPS X THALAMUS COMPOSITUM SUBLINGUAL X THYREOIDEA COMPOSITUM * X TRANSCYTE SHEE X TRANZGEL GEL X TRAUMANIL GEL X TRAUMEEL INJECTION X TYBOST TABS X UBICHINON COMPOSITUM INJECTION X URI-CLEANSE RX TABS X URI-CONTROL RX TABS X VALERIAN ROOT EXTR X VAYACOG CAPS X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 159 VAYARIN Forma de dosificación CAPS VAYAROL CAPS X VERTIGOHEEL * X VP-GSTN CAPS X vp-precip CAPS X XIGRIS SOLUTION X XYLAREX SOLUTION X yohimbine hcl TABS X ZEEL INJECTION X MESNEX TABS T4 amifostine SOLUTION T6 dexrazoxane SOLUTION T6 ETHYOL SOLUTION T6 mesna SOLUTION T6 MESNEX SOLUTION T6 TOTECT SOLUTION T6 ZINECARD SOLUTION T6 methylergonovine maleate TABS T1 CERVIDIL INSERT T2 MIFEPREX TABS T2 PREPIDIL GEL T2 PROSTIN E2 SUPPOSITORY T2 METHERGINE TABS T3 HEMABATE SOLUTION T6 METHERGINE SOLUTION T6 methylergonovine maleate SOLUTION T6 oxytocin SOLUTION T6 PITOCIN SOLUTION T6 ERGOTRATE MALEATE TABS X ERGOTRATE MALEATE SOLUTION X ANHYDROUS BASE OINTMENT X ANHYDROUS CREAM BASE CREAM X APOTHEDERM CREAM X CARBOGEL 940 GEL X CARBOHOL 940 GEL X CARBOMER GEL AQUEOUS GEL X CARBOMER GEL HYDROALCOHOLIC GEL X CHERRY SYRUP SYRUP X Nombre Nivel Cobertura Comentario X Protective Agents Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Oxytocics Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Pharmaceutical Aids Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 160 Nivel DELIVRA SR Forma de dosificación CREAM FLAVOR BLEND SUSPENSION X FLAVOR PLUS LIQUID X Nombre Cobertura Comentario X FLAVOR SWEET SYRUP X FLAVOR SWEET-SF LIQUID X HYDROGEL GEL X ORA-BLEND SUSPENSION X ORA-BLEND SF SUSPENSION X ORA-PLUS LIQUID X ORA-SWEET SYRUP X ORA-SWEET SF SYRUP X ORAL MIX FLAVORED SUSPENDING VEHICLE LIQUID X ORAL MIX SF LIQUID X ORAL SUSPEND LIQUID X ORAL SYRUP FLAVORED VEHICLE LIQUID X ORAL SYRUP SF LIQUID X PCCA ANHYDROUS BASE OINTMENT X PCCA COBASE #1 OINTMENT X PCCA POLYPEG BASE OINTMENT X PCCA SOLID TRANSDERMAL PENETRATION BASE MISC X PCCA SWEET-SF SYRUP X PCCA SYRUP VEHICLE SYRUP X PCCA-PLUS SUSPENSION X PEG-8 DISTEARATE BASE L OINTMENT X PLO TRANSDERMAL CREAM CREAM X PURIFIED WATER LIQUID X SIMPLE SYRUP SYRUP X SYRPALTA SYRUP X SYRPALTA SYRUP X TRANS-PEN CREAM X TRANSDERMAL PAIN BASE CREAM X VERSAFREE SYRUP X VERSAPLUS SYRUP X AMYVID SOLUTION T6 METASTRON SOLUTION T6 QUADRAMET SOLUTION T6 XOFIGO SOLUTION T6 cromolyn sodium NEB SOLUTION T1 cromolyn sodium SOLUTION T1 montelukast sodium * T1 Radioactive Agents PA Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Respiratory Tract Agents Anti-inflammatory Agents Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 161 zafirlukast Forma de dosificación TABS ACCOLATE TABS T3 GASTROCROM SOLUTION T3 Nombre Nivel Cobertura Comentario T1 SINGULAIR * T3 ZYFLO TABS T3 ZYFLO CR CONT.REL.TABS T3 benzonatate CAPS T1 codeine phosphate/guaifenesin LIQUID T1 dex-tuss (10mg/5ml; 300mg/5ml) LIQUID T1 execlear-c LIQUID T1 gani-tuss nr LIQUID T1 guaifenesin/codeine phospate LIQUID T1 guaifenesin/codeine phosphate SOLUTION T1 hydrocodone bitartrate/chlorpheniramine maleate/pse SOLUTION T1 hydrocodone bitartrate/homatropine methylbromide * T1 hydrocodone polistirex/chlorpheniramine polistirex LQCR T1 hydrocodone/homatropine SYRUP T1 hydromet SYRUP T1 myci-gc SOLUTION T1 mytussin ac SYRUP T1 promethazine vc/codeine (10mg/5ml; 5mg/5ml; 6.25mg/5ml) SYRUP T1 promethazine-dm SYRUP T1 Antitussives promethazine/codeine SYRUP T1 promethazine/dextromethorphan SYRUP T1 robafen ac SYRUP T1 romilar ac SOLUTION T1 tl-hist cm LIQUID T1 tussigon TABS T1 ALBATUSSIN NN LIQUID T3 bromfed dm SYRUP T3 BRONTEX * T3 CGU WC SOLUTION T3 CODAR AR LIQUID T3 CODAR D LIQUID T3 CODAR GF LIQUID T3 CPB WC LIQUID T3 DEX-TUSS (10MG/5ML; 300MG/5ML) LIQUID T3 endacof-c LIQUID T3 lexuss 210 LIQUID T3 M-CLEAR CAPS T3 M-END MAX D LIQUID T3 MAR-COF CG EXPECTORANT LIQUID T3 NOTUSS-AC LIQUID T3 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 162 Nombre PHENYLHISTINE DH Forma de dosificación LIQUID Nivel Cobertura Comentario T3 PROMETHAZINE VC/CODEINE (10MG/5ML; 5MG/5ML; 6.25MG/5ML) REZIRA SYRUP T3 SOLUTION T3 TESSALON CAPS T3 TESSALON PERLES CAPS T3 TRICODE AR LIQUID T3 trymine cg LIQUID T3 TUSSICAPS CONT.REL.CAPS T3 TUSSIONEX PENNKINETIC EXTENDED RELEASE LQCR T3 TUSSO-C LIQUID T3 ZUTRIPRO SOLUTION T3 abatuss dmx LIQUID X ACCUHIST DM PEDIATRIC LIQUID X ACCUHIST PDX LIQUID X AIRACOF SYRUP X ALACOL DM SYRUP X ALBATUSSIN CAPS X albatussin nn LIQUID X ALDEX DM SUSPENSION X ALDEX GS DM TABS X alka-seltzer plus mucus & congestion break up formula CAPS X allanvan-dm SUSPENSION X altarussin dm SYRUP X ap-hist dm LIQUID X ATUSS DS SUSPENSION X balacall dm SYRUP X BALAMINE DM SYRUP X BALTUSSIN SYRUP X betavent LIQUID X BICLORA-D * X bio t pres LIQUID X bio t pres pediatric LIQUID X BIOBRON SF SYRUP X biocotron LIQUID X BIODESP DM SYRUP X biogtuss LIQUID X BIONATUSS DXP LIQUID X BIONEL LIQUID X BIONEL PEDIATRIC LIQUID X BIOSPEC DMX LIQUID X biotuss LIQUID X biotuss pediatric LIQUID X BP 8 COUGH LIQUID X bp 8 cough SUSPENSION X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 163 bpm pe dm Forma de dosificación SYRUP bpm-dm-phen SYRUP X brom mal/phenyl hcl/dex hbr LIQUID X Nombre Nivel Cobertura Comentario X brom/pse/dm SYRUP X bromaline dm ELIXIR X BROMATAN PLUS SUSPENSION X bromhist-dm pediatric SYRUP X BROMHIST-PDX SYRUP X bromphen/pseudoephedrine hcl/dextromethorphan hbr SYRUP X bromphenex dm SYRUP X brompheniramine/phenylephrine/dm LIQUID X brompheniramine/pseudoephedrine/dm LIQUID X BRONCOPECTOL SYRUP X broncotron LIQUID X broncotron ped LIQUID X BRONCOTRON PED DROPS LIQUID X BRONCOTRON-D SUSPENSION X BRONCOTRON-S LIQUID X BRONKIDS * X bronkids * X BRONTUSS DX LIQUID X brontuss sf LIQUID X brontuss sf nr LIQUID X brotapp dm LIQUID X BROVEX PEB DM LIQUID X BROVEX PSB DM LIQUID X c-phen dm * X c-tanna 12 SUSPENSION X CAPMIST DM TABS X CARBAPHEN 12 LIQUID X CARBAPHEN 12 PED SUSPENSION X CARBAPHEN CH SUSPENSION X CARBAPHEN PED CH SUSPENSION X carbodex dm SYRUP X cardec dm LIQUID X centergy dm LIQUID X ceron-dm SYRUP X CERTUSS-D TABS X CHERACOL PLUS LIQUID X CHERACOL-D COUGH LIQUID X cheratussin dac SOLUTION X chest congestion relief dm TABS X CHILDRENS NYQUIL LIQUID X CHLO TUSS LIQUID X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 164 CHLO TUSS Forma de dosificación LIQUID CHLOPHED LIQUID X chlordex gp SYRUP X Nombre Nivel Cobertura Comentario X chlorpheniramine/pseudo/dm tannate SUSPENSION X clear cough dm SYRUP X codal-dm SYRUP X CODITUSS DM SYRUP X cold & cough childrens ELIXIR X cold/cough childrens ELIXIR X coldec dm SYRUP X corfen-dm LIQUID X coricidin hbp chest congestion & cough CAPS X CORICIDIN HBP COUGH & COLD TABS X CORZALL LIQUID X CORZALL PLUS LIQUID X CORZALL-PE LIQUID X cough & cold TABS X cpm-pe-dm (1mg/ml; 3mg/ml; 3.5mg/ml) LIQUID X cpm-pe-dm (1mg/ml; 3mg/ml; 3.5mg/ml) LIQUID X cpm/pse dm SOLUTION X dacex-dm SYRUP X DALLERGY DM SYRUP X de-chlor dm (2mg/5ml; 15mg/5ml; 10mg/5ml) LIQUID X de-chlor dm (2mg/5ml; 15mg/5ml; 10mg/5ml) LIQUID X de-chlor dr SYRUP X delsym cough + chest congestion dm LIQUID X delsym cough + chest congestion dm childrens LIQUID X DELTUSS DMX LIQUID X deltuss dmx LIQUID X DESGEN DM SYRUP X desgen pediatric LIQUID X DESPEC DM SYRUP X despec dm SYRUP X despec eda LIQUID X DESPEC NR LIQUID X DESPEC-DM TABS X DESPEC-EXP SYRUP X DESPEC-PDC LIQUID X dex pc SYRUP X dexphen w/c LIQUID X DEXTROMETHORPHAN HBR/CHLORPHENIRAMINE/PHENYLEPHRINE HCL dextromethorphan hbr/phenylephrine hcl/chlorpheniramine LIQUID X LIQUID X dextromethorphan/guaifenesin SOLUTION X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 165 Nombre DEXTROMETHORPHAN/PSEUDOEPHEDRINE/CHLORPHENIRAM INE diabetic siltussin-dm Forma de dosificación SUSPENSION Nivel Cobertura Comentario X LIQUID X diabetic siltussin-dm maximum strength LIQUID X diabetic tussin dm LIQUID X diabetic tussin for children LIQUID X diabetic tussin maximum strength LIQUID X DICEL CD LIQUID X DICEL DM CHEW X DICEL DM SUSPENSION X DIHYDRO-CP SYRUP X DIHYDRO-PE SYRUP X dihydrocodeine/bpm/phenyleph hcl LIQUID X dimaphen dm cold/cough childrens ELIXIR X DIMETANE DX * X dimetane dx * X DIMETAPP DM COLD & COUGH LIQUID X DIMETAPP LONG ACTING COUGH PLUS COLD SYRUP X dm-pe-chlor LIQUID X dm/cpm/pe/gg SYRUP X dm/pe/cpm LIQUID X dm/pse/bpm SYRUP X dometuss-dmx LIQUID X DONATUSS DC SYRUP X DONATUSS XP SUSPENSION X DONATUSSIN SYRUP X DONATUSSIN SYRUP X DONATUSSIN SYRUP X DONATUSSIN DM LIQUID X DONATUSSIN DM SUSPENSION X DONATUSSIN DM SYRUP X DOUBLE-TUSSIN DM LIQUID X DRYMAX AF SYRUP X DRYMAX AF TABS X DURAVENT DM TABS X ed a-hist dm LIQUID X ED DM CHEW X ed-a-hist dm LIQUID X ENDACOF LIQUID X ENDACOF-DC LIQUID X endacof-dc LIQUID X endacof-dm LIQUID X ENDACON SYRUP X ENDAL CD SYRUP X ENTEX PAC KIT X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 166 Nivel entre-cough Forma de dosificación LIQUID ENTRE-COUGH TANNATE SUSPENSION X entre-s SUSPENSION X ESOCOR P SUSPENSION X EXACTUSS LIQUID X EXALL LIQUID X Nombre Cobertura Comentario X EXALL-D LIQUID X exefen dmx TABS X EXPECTUSS LIQUID X extra action cough SYRUP X FATHER JOHNS MEDICINE PLUS SOLUTION X FENESIN DM IR TABS X G-P-TUSS DXP LIQUID X g-supress dx pediatric LIQUID X g-tron LIQUID X g-tron ped LIQUID X G-TRON PEDIATRIC DROPS LIQUID X G-TUSICOF LIQUID X G-ZYNCOF SYRUP X gani-tuss dm nr LIQUID X genantuss LIQUID X genantussidex LIQUID X gene-t-press LIQUID X genebrom dm SYRUP X GENEBRONCO-D LIQUID X GENEDEL LIQUID X genedotuss-dm LIQUID X GENELAN LIQUID X GENELAN NF LIQUID X GENEPATUSS SYRUP X genetuss (10mg/5ml; 100mg/5ml; 10mg/5ml) SOLUTION X genetuss (10mg/5ml; 100mg/5ml; 10mg/5ml) SOLUTION X genetuss-2 (15mg/5ml; 300mg/5ml; 10mg/5ml) LIQUID X genetuss-2 (15mg/5ml; 300mg/5ml; 10mg/5ml) LIQUID X GENEXPECT DM LIQUID X GENEXPECT-PE LIQUID X GENEXPECT-SF LIQUID X GENTEX 30 LIQUID X gentex lq SYRUP X geri-tussin dm SYRUP X gfn 1200/dm 60 CONT.REL.TABS X GILTUSS LIQUID X GILTUSS PED-C LIQUID X giltuss pediatric LIQUID X GILTUSS TR * X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 167 guaiasorb dm Forma de dosificación LIQUID guaicon dms SYRUP X guaifenesin dac SOLUTION X guaifenesin dm cough & chest congestion maximum strength LIQUID X guaifenesin-dm SYRUP X guaifenesin-dm nr LIQUID X guaifenesin/dextromethorphan TABS X HDC DM SYRUP X Nombre Nivel Cobertura Comentario X healtussin dm SYRUP X HISTEX-DM SYRUP X indamix dm SUSPENSION X iophen dm-nr LIQUID X J-COF DHC LIQUID X J-MAX DHC LIQUID X ken-tuss sf SYRUP X kidkare cough/cold LIQUID X LARTUS LIQUID X lohist-dm SYRUP X lohist-peb-dm LIQUID X lohist-psb-dm LIQUID X LORTUSS DM LIQUID X LORTUSS EX LIQUID X m-end dm LIQUID X M-END DMX LIQUID X M-END PE LIQUID X MARDROPS-DX LIQUID X mesehist dm LIQUID X MUCINEX CHILDRENS MULTI-SYMPTOM COLD LIQUID X MUCINEX CONGESTION & COUGH CHILDRENS LIQUID X mucinex cough childrens LIQUID X MUCINEX COUGH FOR KIDS * X mucinex cough for kids * X MUCINEX DM CONT.REL.TABS X MUCINEX DM MAXIMUM STRENGTH CONT.REL.TABS X mucinex fast-max dm max LIQUID X MUCINEX FAST-MAX SEVERE CONGESTION & COUGH * X mucosa dm TABS X mucus relief cough childrens LIQUID X mucus relief dm TABS X mucusrelief dm TABS X MYHIST-DM LIQUID X mytussin dac SOLUTION X NASOHIST DM (1MG/ML; 3MG/ML; 2MG/ML) LIQUID X NASOHIST DM (1MG/ML; 3MG/ML; 2MG/ML) LIQUID X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 168 Nivel NASOTUSS Forma de dosificación LIQUID NEO DM SUSPENSION X NEO DM LIQUID X NEO DM SYRUP X neotuss LIQUID X NEOTUSS PLUS LIQUID X NEOTUSS-D LIQUID X NEOTUSS-D LIQUID X NEUTRAHIST PDX SOLUTION X neutrahist pdx SOLUTION X nohist dmx CONT.REL.TABS X nohist-dm LIQUID X NOREL CS LIQUID X Nombre Cobertura Comentario X nortuss-de LIQUID X NORTUSS-EX LIQUID X NOTUSS-DC LIQUID X NOTUSS-PE LIQUID X novagest expectorant/codeine SOLUTION X p chlor dm LIQUID X PANATUSS DXP LIQUID X PANATUSS DXP PEDIATRIC LIQUID X PANATUSS PED LIQUID X PANATUSS PED DROPS LIQUID X pbm allergy SYRUP X PDM GG SYRUP X pe-cp-k guaiacol LIQUID X pe-hist dm SYRUP X PECGEN DMX LIQUID X pecgen pse LIQUID X pedi-atric nightrest LIQUID X pedia relief cough/cold LIQUID X PEDIAHIST DM LIQUID X pediahist dm SYRUP X PEDIATEX TDM SUSPENSION X pediatric cough/cold LIQUID X pediatric formula cough and congestion aid LIQUID X phanatuss dm SYRUP X pharmatuss dm SYRUP X PHENABID DM TABS X PHENAGIL CH TABS X phencarb gg SYRUP X pluratuss LIQUID X pres gen LIQUID X pres gen pediatric LIQUID X presgen b LIQUID X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 169 PROLEX DMX Forma de dosificación LIQUID pse brom dm SYRUP X pseudo cough LIQUID X PSEUDOEPHEDRINE/DEXTROMETHORPHAN/GUAIFENESIN SYRUP X pulmari-gp LIQUID X PYRIL DM SUSPENSION X q-tapp dm ELIXIR X q-tussin dm SYRUP X qual-tussin SYRUP X re dcp LIQUID X recofen "d" LIQUID X refenesen dm TABS X Nombre Nivel Cobertura Comentario X relacon-dm nr LIQUID X relasin dm LIQUID X reme hist dm LIQUID X reme tussin dm SYRUP X RESCON DM SYRUP X RESPA DM CONT.REL.TABS X RESPERAL-DM LIQUID X robafen cf cough & cold SYRUP X robafen dm SYRUP X robafen dm clear SYRUP X robafen dm cough & chest congestion max LIQUID X robafen dm cough clear SYRUP X ROBITUSSIN CHILDRENS COUGH & COLD CF LIQUID X ROBITUSSIN CHILDRENS COUGH/COLD LONG-ACTING LIQUID X ROBITUSSIN COUGH & CHEST CONGESTION DM MAX LIQUID X robitussin cough & cold cf max LIQUID X ROBITUSSIN COUGH & COLD D LIQUID X ROBITUSSIN COUGH & COLD DAY/NIGHT PACK MISC X robitussin cough & cold long-acting LIQUID X robitussin cough+chest congestion dm CAPS X ROBITUSSIN COUGH/COLD CF LIQUID X ROBITUSSIN DM SYRUP X robitussin peak cold cough+ chest congestion dm LIQUID X ROBITUSSIN PEAK COLD COUGH+ CHEST CONGESTION DM MAX STRENGHT ROBITUSSIN PEAK COLD DM LIQUID X SYRUP X ROBITUSSIN PEAK COLD MULTI-SYMPTOM COLD LIQUID X robitussin peak cold multi-symptom cold maximum strength LIQUID X robitussin to go cough & chest congestion dm LIQUID X ROBITUSSIN TO GO COUGH & COLD CF LIQUID X RU-TUSS DM SYRUP X RYCONTUSS LIQUID X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 170 RYNATUSS Forma de dosificación TABS rynex dm LIQUID X safe tussin 30 LIQUID X safe tussin dm adult LIQUID X scot-tussin dm LIQUID X SCOT-TUSSIN DM SYRUP X SCOT-TUSSIN SENIOR LIQUID X SERADEX LIQUID X sildec pe-dm SYRUP X siltussin dm das LIQUID X siltussin-dm SYRUP X SIMUC-DM SOLUTION X sonahist dm LIQUID X sorbugen nr LIQUID X SORBUTUSS NR LIQUID X sudatex-dm (20mg; 400mg; 40mg) TABS X sudatex-dm (20mg; 400mg; 40mg) TABS X sudatuss dm (2mg/5ml; 15mg/5ml; 30mg/5ml) SYRUP X sudatuss dm (2mg/5ml; 15mg/5ml; 30mg/5ml) SYRUP X sudatuss-2 SOLUTION X sudatuss-2 df SOLUTION X sudatuss-sf SOLUTION X SUPRESS A PEDIATRIC DROPS LIQUID X SUPRESS DM PEDIATRIC LIQUID X supress-dx pediatric LIQUID X Nombre Nivel Cobertura Comentario X sutan-dm SUSPENSION X SUTTAR-2 SYRUP X SUTTAR-SF SYRUP X TANAFED DMX SUSPENSION X tannihist-12 rf SUSPENSION X tenar dm LIQUID X teo-tus LIQUID X tg 10peh/380gfn/15dm TABS X tg 40pse/4brm/20dm TABS X TG 45PSE/400GFN/15DM TABS X TGQ 15DM/5PEH/2CPM SYRUP X TGQ 30PSE/150GFN/15DM SYRUP X TGQ 30PSE/3BRM/15DM SYRUP X TGQ 50PSE/3BRM/30DM SYRUP X tgq 7.5peh/4brm/15dm LIQUID X th chest congestion relief dm TABS X th childrens mucus relief cough LIQUID X th tussin cf LIQUID X th tussin dm LIQUID X th tussin dm max LIQUID X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 171 THERAFLU COLD & COUGH Forma de dosificación PACK tl-dex dm LIQUID X tl-hist cd LIQUID X Nombre Nivel Cobertura Comentario X tl-hist dm LIQUID X tolu-sed dm LIQUID X trexbrom LIQUID X TREXBROM LIQUID X tri-dex pe LIQUID X TRIAMINIC COLD & COUGH DAY/NIGHT CHILDRENS MISC X TRIAMINIC COUGH & RUNNY NOSE CHILDRENS CHEW X TRIAMINIC-D SYRUP X TRICODE GF LIQUID X trigofen dm LIQUID X TRISPEC DMX (10MG/5ML; 187MG/5ML) LIQUID X TRISPEC DMX (15MG/5ML; 125MG/5ML) LIQUID X TRISPEC DMX (15MG/5ML; 25MG/5ML) LIQUID X TRISPEC DMX PEDIATRIC LIQUID X trispec pse (10mg/5ml; 187mg/5ml; 30mg/5ml) LIQUID X TRISPEC PSE (15MG/5ML; 125MG/5ML; 30MG/5ML) LIQUID X TRISPEC PSE (15MG/5ML; 25MG/5ML; 30MG/5ML) LIQUID X TRISPEC PSE PEDIATRIC (15MG/5ML; 125MG/5ML; 30MG/5ML) TRISPEC PSE PEDIATRIC (15MG/5ML; 25MG/5ML; 30MG/5ML) LIQUID X LIQUID X TRITUSS SYRUP X TUSDEC-DM LIQUID X TUSICOF * X tusicof * X TUSNEL LIQUID X tusnel c SYRUP X tusnel diabetic LIQUID X TUSNEL PED-C SYRUP X TUSNEL PEDIATRIC LIQUID X TUSNEL-DM PEDIATRIC LIQUID X tussafed SYRUP X tussafed ex LIQUID X tussafex ex LIQUID X TUSSAFEX-A LIQUID X TUSSI-12 TABS X TUSSI-12 S SUSPENSION X TUSSI-12D TABS X TUSSI-12D S SUSPENSION X tussi-pres LIQUID X tussi-pres b LIQUID X TUSSI-PRES PEDIATRIC (5MG/5ML; 75MG/5ML; 2.5MG/5ML) LIQUID X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 172 TUSSI-PRES PEDIATRIC (5MG/5ML; 75MG/5ML; 2.5MG/5ML) Forma de dosificación LIQUID tussin cf cough & cold LIQUID Nombre Nivel Cobertura Comentario X X tussin cf cough & cold adults LIQUID X tussin cough dm SYRUP X tussin dm * X tussin dm max LIQUID X TUSSIREX * X tussizone-12 rf SUSPENSION X tusslin LIQUID X tusslin pediatric LIQUID X TUSSO-DMR CAPS X TUSSO-ZMR CAPS X TUSSO-ZR SYRUP X tustan 12s SUSPENSION X v-cof SUSPENSION X VAZOTAN SUSPENSION X VICKS 44M PEDIATRIC COUGH/COLD RELIEF LIQUID X vicks dayquil mucus control dm LIQUID X VICKS DAYQUIL NATURE FUSION COUGH & CHEST CONGESTION VICKS FORMULA 44 CUSTOM CCARE CHESTY COUGH LIQUID X SYRUP X VICKS FORMULA 44E COUGH/CHEST CONGESTION RELIEF SYRUP X VICKS FORMULA 44E PEDIATRIC COUGH/CHEST CONGESTION RELIEF VICKS NYQUIL CHILDRENS COLD/COUGH SYRUP X LIQUID X VIRAVAN-PDM SUSPENSION X VIRAVAN-PDM LIQUID X virdec dm LIQUID X VITUZ SOLUTION X y-cof-dmx LIQUID X z-cof 12dm LIQUID X Z-COF 8DM SUSPENSION X Z-COF DM LIQUID X Z-COF DMX LIQUID X Z-COF I SUSPENSION X Z-DEX LIQUID X z-dex SYRUP X z-dex 12d CONT.REL.TABS X zoden dm LIQUID X ZODRYL AC 25 SUSPENSION X ZODRYL AC 30 SUSPENSION X ZODRYL AC 35 SUSPENSION X ZODRYL AC 40 SUSPENSION X ZODRYL AC 50 SUSPENSION X ZODRYL AC 60 SUSPENSION X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 173 Nivel ZODRYL AC 80 Forma de dosificación SUSPENSION ZODRYL DAC 25 SUSPENSION X ZODRYL DAC 30 SUSPENSION X ZODRYL DAC 35 SUSPENSION X ZODRYL DAC 40 SUSPENSION X ZODRYL DAC 50 SUSPENSION X ZODRYL DAC 60 SUSPENSION X ZODRYL DAC 80 SUSPENSION X ZODRYL DEC 25 SUSPENSION X ZODRYL DEC 30 SUSPENSION X ZODRYL DEC 35 SUSPENSION X ZODRYL DEC 40 SUSPENSION X ZODRYL DEC 50 SUSPENSION X ZODRYL DEC 60 SUSPENSION X ZODRYL DEC 80 SUSPENSION X ZONATUSS CAPS X ZOTEX SYRUP X ZOTEX PEDIATRIC LIQUID X zotex-12d CONT.REL.TABS X Nombre Cobertura Comentario PA; AL (min: 6y) 6 years of age and older X ZOTEX-C SYRUP X ZOTEX-D SYRUP X ZOTEX-D SYRUP X ZOTEX-DM SYRUP X ZOTEX-EX TABS X ZOTEX-G SYRUP X ZYNCOF SYRUP X Cystic Fibrosis Transmembrane Conductance Regulator Modulators KALYDECO TABS T5 Expectorants pe-guai LIQUID T1 pe/gg LIQUID T1 phenylephrine/guaifenesin LIQUID T1 IODINE STRONG SOLUTION T2 GILPHEX TR TABS T3 TUSNEL CAPS T3 ZOTEX -GP TABS T3 ALDEX GS TABS X altarussin SYRUP X altarussin-pe SYRUP X bidex TABS X buckleys chest congestion LIQUID X chest congestion relief expectorant TABS X CONGESTAC TABS X cough syrup SYRUP X DECON-G LIQUID X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 174 despec-tab Forma de dosificación TABS diabetic siltussin das-na LIQUID X diabetic tussin LIQUID X Nombre Nivel Cobertura Comentario X diabetic tussin ex SYRUP X diabetic tussin mucus relief * X ENTEX T TABS X exefen-ir (400mg; 60mg) TABS X exefen-ir (400mg; 60mg) TABS X fenesin ir TABS X G/P CONT.REL.TABS X ganidin-nr LIQUID X GENEXA LA CONT.REL.CAPS X geri-tussin SYRUP X GFN 550/PSE 60 CONT.REL.TABS X gg 200 nr TABS X goodsense mucus relief TABS X guaifenesin * X guaifenesin er CONT.REL.TABS X guaifenesin nr LIQUID X guaifenesin/phenylephrine hcl SYRUP X guaifenesin/phenylephrinehcl SYRUP X HERBAL EXPEC LIQUID X iophen-nr LIQUID X J-MAX SYRUP X KGS-PE LIQUID X LEMOHIST PLUS CAPS X liquibid TABS X liquituss gg LIQUID X LUSAIR LIQUID X MARDROPS-EX LIQUID X MUCINEX CONT.REL.TABS X mucinex chest congestion childrens LIQUID X MUCINEX D CONT.REL.TABS X MUCINEX FOR KIDS * X mucinex for kids * X MUCINEX MAXIMUM STRENGTH CONT.REL.TABS X mucosa TABS X mucus relief TABS X mucus relief childrens LIQUID X mucus relief d TABS X mucus-er CONT.REL.TABS X NARIZ LIQUID X organ-i nr TABS X organidin nr TABS X p chlor gg SOLUTION X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 175 PHANASIN Forma de dosificación LIQUID phanasin SYRUP X pharmasin SYRUP X PSEUDOEPHEDRINE/GUAIFENESIN SYRUP X q-tussin SYRUP X qual-tussin pediatric SOLUTION X Nombre Nivel Cobertura Comentario X refenesen TABS X refenesen 400 TABS X refenesen plus TABS X RESPA-1ST CONT.REL.TABS X RESPAIRE-30 CAPS X robafen SYRUP X ROBITUSSIN CHEST CONGESTION SYRUP X robitussin mucus+chest congestion LIQUID X RYDEX G TABS X RYNA-12X TABS X scot-tussin expectorant LIQUID X siltussin das LIQUID X siltussin sa SYRUP X simuc-gp CONT.REL.TABS X SINA-12X TABS X sudatex g TABS X TENAR PSE LIQUID X TG 45PSE/400GFN TABS X th chest congestion relief TABS X th tussin LIQUID X tl-dmx SYRUP X TRIAMINIC CHEST & NASAL CONGESTION SYRUP X TRISPEC DEX LIQUID X TUSNEL PEDIATRIC LIQUID X TUSSI PRES-B LIQUID X tussin SYRUP X tussin chest congestion SYRUP X VICKS CASERO LIQUID X xpect TABS X xpect-pe CONT.REL.TABS X yodefan-nf chest congestion LIQUID X Mucolytic Agents nebusal (3%) NEB SOLUTION T1 pulmosal NEB SOLUTION T1 sodium chloride NEB SOLUTION T1 HYPERSAL (3.5%) NEB SOLUTION T2 NEBUSAL (6%) NEB SOLUTION T2 HYPER-SAL NEB SOLUTION T3 HYPERSAL (7%) NEB SOLUTION T3 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 176 Nombre PULMOZYME Forma de dosificación SOLUTION Nivel Cobertura Comentario Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable T4 Phosphodiesterase Type 4 Inhibitors DALIRESP TABS X CUROSURF SUSPENSION T2 INFASURF SUSPENSION T2 Pulmonary Surfactants SURFAXIN SUSPENSION T2 SURVANTA INTRATRACHEAL SUSPENSION T2 ARALAST NP SOLUTION T6 PA PROLASTIN * T6 PA PROLASTIN-C SOLUTION T6 PA XOLAIR SOLUTION T6 PA ZEMAIRA SOLUTION T6 PA ESBRIET CAPS X GLASSIA SOLUTION X OFEV CAPS X Respiratory Tract Agents, Miscellaneous Non-self administerable injectable Vasodilating Agents ADEMPAS TABS T4 PA LETAIRIS TABS T4 PA OPSUMIT TABS T4 PA TRACLEER TABS T4 PA TYVASO SOLUTION T4 PA TYVASO REFILL SOLUTION T4 PA TYVASO STARTER SOLUTION T4 PA VENTAVIS SOLUTION T4 PA epoprostenol sodium SOLUTION T6 PA FLOLAN SOLUTION T6 PA REMODULIN SOLUTION T6 PA VELETRI SOLUTION T6 PA ORENITRAM CONT.REL.TABS X HIZENTRA SOLUTION T5 PA VIVAGLOBIN SOLUTION T5 PA ANASCORP SOLUTION T6 ANTIVENIN LATRODECTUS MACTANS KIT T6 ANTIVENIN MICRURUS FULVIUS SOLUTION T6 CARIMUNE NANOFILTERED SOLUTION T6 Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Serums, Toxoids and Vaccines Serums PA Self Administerable (Select) Injectable Self Administerable (Select) Injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 177 CROFAB Forma de dosificación SOLUTION CYTOGAM INJECTION T6 DIGIBIND SOLUTION T6 DIGIFAB SOLUTION T6 FLEBOGAMMA SOLUTION T6 PA FLEBOGAMMA DIF SOLUTION T6 PA GAMASTAN S/D INJECTION T6 GAMMAGARD LIQUID SOLUTION T6 PA GAMMAGARD S/D SOLUTION T6 PA GAMMAGARD S/D IGA LESS THAN 1MCG/ML SOLUTION T6 PA GAMMAKED SOLUTION T6 PA GAMMAPLEX SOLUTION T6 PA GAMUNEX SOLUTION T6 PA GAMUNEX-C SOLUTION T6 PA HEPAGAM B SOLUTION T6 HYPERHEP B S/D SOLUTION T6 HYPERRAB S/D INJECTION T6 PA HYPERRHO S/D INJECTION T6 PA HYPERRHO S/D MINI-DOSE INJECTION T6 PA HYPERTET S/D INJECTION T6 PA IMOGAM RABIES-HT INJECTION T6 PA MICRHOGAM ULTRA-FILTERED PLUS INJECTION T6 PA NABI-HB SOLUTION T6 OCTAGAM SOLUTION T6 PA PRIVIGEN SOLUTION T6 PA RHOGAM ULTRA-FILTERED PLUS INJECTION T6 PA RHOPHYLAC SOLUTION T6 PA WINRHO SDF SOLUTION T6 PA BIVIGAM SOLUTION X HYQVIA KIT X VARIZIG SOLUTION X ADACEL SUSPENSION T6 BOOSTRIX SUSPENSION T6 Nombre Nivel Cobertura T6 PA Comentario Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Self Administerable (Select) Injectable Non-self administerable injectable Toxoids Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 178 DAPTACEL Forma de dosificación SUSPENSION DECAVAC INJECTION T6 DIPHTHERIA/TETANUS TOXOID PEDIATRIC INJECTION T6 DIPHTHERIA/TETANUS TOXOIDS ADSORBED PEDIATRIC SUSPENSION T6 INFANRIX SUSPENSION T6 KINRIX SUSPENSION T6 TENIVAC INJECTION T6 TETANUS TOXOID ADSORBED SOLUTION T6 TETANUS/DIPHTHERIA TOXOIDS-ADSORBED ADULT SUSPENSION T6 TRIHIBIT KIT T6 TRIPEDIA SUSPENSION T6 ACTHIB SOLUTION T6 AFLURIA 2009-2010 SUSPENSION T6 AFLURIA 2011-2012 SUSPENSION T6 AFLURIA 2012-2013 SUSPENSION T6 AFLURIA 2013-2014 SUSPENSION T6 AFLURIA 2014-2015 SUSPENSION T6 AFLURIA PF 2010-2011 SUSPENSION T6 AFLURIA PF 2011-2012 SUSPENSION T6 AFLURIA PF 2012-2013 SUSPENSION T6 AFLURIA PF 2013-2014 SUSPENSION T6 AFLURIA PF 2014-2015 SUSPENSION T6 AGRIFLU 2010-2011 SUSPENSION T6 BCG VACCINE INJECTION T6 BIOTHRAX SUSPENSION T6 CERVARIX SUSPENSION T6 COMVAX SUSPENSION T6 ENGERIX-B * T6 FLUARIX 2010-2011 SUSPENSION T6 FLUARIX 2011-2012 SUSPENSION T6 FLUARIX 2012-2013 SUSPENSION T6 FLUARIX 2013-2014 SUSPENSION T6 FLUARIX 2014-2015 SUSPENSION T6 Nombre Nivel Cobertura T6 Comentario Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Vaccines GL (f); AL (min: 10y, max: 25y) Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 179 Nombre Forma de dosificación Nivel FLUARIX QUADRIVALENT 2013-2014 SUSPENSION T6 FLUARIX QUADRIVALENT 2014-2015 SUSPENSION T6 FLUBLOK 2013-2014 SOLUTION T6 FLUBLOK 2014-2015 SOLUTION T6 FLUCELVAX 2012-2013 SUSPENSION T6 FLUCELVAX 2013-2014 SUSPENSION T6 FLUCELVAX 2014-2015 SUSPENSION T6 FLULAVAL 2010-2011 INJECTION T6 FLULAVAL 2011-2012 INJECTION T6 FLULAVAL 2012-2013 INJECTION T6 FLULAVAL 2013-2014 INJECTION T6 FLULAVAL 2014-2015 INJECTION T6 FLULAVAL QUADRIVALENT 2013-2014 SUSPENSION T6 FLULAVAL QUADRIVALENT 2014-2015 SUSPENSION T6 FLUMIST NASAL VACCINE 2010-2011 LIQUID T6 FLUMIST NASAL VACCINE 2011-2012 LIQUID T6 FLUMIST NASAL VACCINE 2012-2013 LIQUID T6 Cobertura Comentario injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable FLUMIST QUADRIVALENT SUSPENSION T6 FLUVIRIN 2010-2011 INJECTION T6 FLUVIRIN 2011-2012 INJECTION T6 FLUVIRIN 2012-2013 INJECTION T6 FLUVIRIN 2013-2014 INJECTION T6 FLUVIRIN 2014-2015 INJECTION T6 FLUVIRIN PF 2011-2012 SUSPENSION T6 FLUVIRIN PF 2012-2013 SUSPENSION T6 FLUVIRIN PF 2013-2014 SUSPENSION T6 FLUVIRIN PF 2014-2015 SUSPENSION T6 FLUZONE HIGH-DOSE PF 2010-2011 SUSPENSION T6 AL (min: 65y) FLUZONE HIGH-DOSE PF 2011-2012 SUSPENSION T6 AL (min: 65y) FLUZONE HIGH-DOSE PF 2012-2013 SUSPENSION T6 AL (min: 65y) FLUZONE HIGH-DOSE PF 2013-2014 SUSPENSION T6 AL (min: 65y) FLUZONE HIGH-DOSE PF 2014-2015 SUSPENSION T6 AL (min: 65y) FLUZONE INTRADERMAL DEVICE T6 FLUZONE PEDIATRIC PF 2010-2011 SUSPENSION T6 Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 180 Nivel FLUZONE PEDIATRIC PF 2011-2012 Forma de dosificación SUSPENSION FLUZONE PEDIATRIC PF 2012-2013 SUSPENSION T6 FLUZONE PEDIATRIC PF 2013-2014 SUSPENSION T6 FLUZONE PF 2010-2011 SUSPENSION T6 FLUZONE PF 2011-2012 SUSPENSION T6 FLUZONE PF 2012-2013 SUSPENSION T6 FLUZONE PF 2013-2014 SUSPENSION T6 FLUZONE PF 2014-2015 SUSPENSION T6 FLUZONE QUADRIVALENT 2013-2014 SUSPENSION T6 FLUZONE QUADRIVALENT 2014-2015 SUSPENSION T6 FLUZONE SPLIT 2010-2011 INJECTION T6 FLUZONE SPLIT 2011-2012 INJECTION T6 FLUZONE SPLIT 2012-2013 INJECTION T6 FLUZONE SPLIT 2013-2014 INJECTION T6 FLUZONE SPLIT 2014-2015 INJECTION T6 GARDASIL SUSPENSION T6 HAVRIX SUSPENSION T6 HIBERIX SOLUTION T6 IMOVAX RABIES (H.D.C.V.) INJECTION T6 INFLUENZA A (H1N1) MONOVALENT 2009 LIQUID T6 INFLUENZA A (H1N1) MONOVALENT 2009 PF SUSPENSION T6 IPOL INACTIVATED IPV INJECTION T6 IXIARO SUSPENSION T6 Non-self administerable injectable Non-self administerable injectable Travel vaccine JE-VAX SOLUTION T6 Travel vaccine M-M-R II W/DILUENT 10 DOSE INJECTION T6 MENACTRA INJECTION T6 MENHIBRIX SOLUTION T6 MENOMUNE-A/C/Y/W-135 INJECTION T6 MENVEO SOLUTION T6 PEDIARIX SUSPENSION T6 PEDVAX HIB SUSPENSION T6 PENTACEL SUSPENSION T6 PNEUMOVAX 23 INJECTION T6 PNEUMOVAX 23/1 DOSE INJECTION T6 Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Nombre Cobertura T6 AL (min: 9y, max: 26y) Comentario Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 181 Nivel PNEUMOVAX 23/5 DOSE Forma de dosificación INJECTION PREVNAR 13 SUSPENSION T6 PROQUAD INJECTION T6 RABAVERT SUSPENSION T6 RECOMBIVAX HB SUSPENSION T6 ROTARIX SUSPENSION T6 ROTATEQ SOLUTION T6 THERACYS SUSPENSION T6 TICE BCG SUSPENSION T6 TWINRIX SUSPENSION T6 TYPHIM VI SOLUTION T6 VAQTA SUSPENSION T6 VARIVAX INJECTION T6 VIVOTIF BERNA CONT.REL.CAPS T6 Non-self administerable injectable Non-self administerable injectable Travel vaccine YF-VAX INJECTION T6 Travel vaccine ZOSTAVAX SOLUTION T6 MEDICAL PROVIDER EZ FLU SHOT 2013-2014 KIT X MEDICAL PROVIDER EZ FLU SHOT 2014-2015 KIT X MEDICAL PROVIDER EZ FLU SHOT PF 2012-2013 KIT X MEDICAL PROVIDER EZ FLU SHOT PF 2013-2014 KIT X MEDICAL PROVIDER EZ FLU SHOT PF 2014-2015 KIT X PHYSICIANS EZ USE FLU KIT 2012-2013 KIT X Nombre Cobertura T6 Comentario Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Travel vaccine AL (min: 50y) Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Skin and Mucous Membrane Preparations Anti-infectives acticin CREAM T1 acyclovir OINTMENT T1 benziq wash LIQUID T1 benzoyl peroxide * T1 benzoyl peroxide 10 * T1 benzoyl peroxide 5 * T1 benzoyl peroxide cleanser LOTION T1 benzoyl peroxide cleansing LOTION T1 benzoyl peroxide creamy wash LIQUID T1 benzoyl peroxide creamy wash acne kit KIT T1 benzoyl peroxide wash LIQUID T1 bp cleanser LIQUID T1 bp wash LIQUID T1 ciclodan SOLUTION T1 ciclodan CREAM T1 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 182 Nivel ciclopirox Forma de dosificación * ciclopirox SUSPENSION T1 ciclopirox nail lacquer SOLUTION T1 ciclopirox olamine CREAM T1 clearplex x GEL T1 clindacin etz pledgets SWAB T1 clindacin-p SWAB T1 clindamycin phosphate CREAM T1 clindamycin phosphate * T1 clindamycin/benzoyl peroxide GEL T1 clindamycin/benzoyl peroxide GEL T1 clotrimazole * T1 clotrimazole * T1 Nombre Cobertura Comentario T1 clotrimazole/betamethasone dipropionate * T1 del-aqua GEL T1 dermazene CREAM T1 econazole nitrate CREAM T1 ery PADS T1 erythromycin * T1 erythromycin/benzoyl peroxide GEL T1 exoderm LOTION T1 gentamicin sulfate (0.1%) CREAM T1 gentamicin sulfate (0.1%) OINTMENT T1 hydrocortisone/iodoquinol CREAM T1 ketoconazole * T1 lavoclen-4 acne wash kit KIT T1 lavoclen-4 creamy wash (4%) LIQUID T1 lavoclen-8 acne wash kit KIT T1 lavoclen-8 creamy wash (8%) LIQUID T1 lindane * T1 mafenide acetate PACK T1 malathion LOTION T1 metronidazole * T1 metronidazole vaginal GEL T1 mexar wash LIQUID T1 mupirocin OINTMENT T1 mupirocin CREAM T1 mupirocin calcium CREAM T1 neomycin/polymyxin b sulfates SOLUTION T1 neuac GEL T1 nyamyc POWDER T1 nystatin * T1 nystop POWDER T1 oscion cleanser LOTION T1 pedi-dri POWDER T1 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 183 permethrin Forma de dosificación CREAM pr benzoyl peroxide wash LIQUID T1 re 10 wash LIQUID T1 Nombre Nivel Cobertura Comentario T1 rosadan * T1 se bpo wash LIQUID T1 seb-prev wash LIQUID T1 selenium sulfide LOTION T1 selenium sulfide (2.25%) SHAMPOO T1 silver sulfadiazine CREAM T1 sodium sulfacetamide LOTION T1 sodium sulfacetamide * T1 sodium sulfacetamide wash LIQUID T1 ssd CREAM T1 ssd af CREAM T1 sulfacetamide sodium * T1 terconazole * T1 thermazene CREAM T1 tl bpo mx cleanser LIQUID T1 vandazole GEL T1 versiclear LOTION T1 vitazol CREAM T1 zaclir cleansing (4%) LOTION T1 AVC CREAM T2 BACTROBAN NASAL OINTMENT T2 BUCALSEP * T2 CLEOCIN SUPPOSITORY T2 CLINDESSE CREAM T2 DENAVIR CREAM T2 IODINE TINCTURE TINCTURE T2 IODOFLEX PADS T2 KERR TRIPLE DYE SWAB T2 LUGOLS STRONG IODINE SOLUTION T2 METROGEL 1% KIT KIT T2 MICONAZOLE 3 SUPPOSITORY T2 NORITATE CREAM T2 NYSTATIN VAGINAL TABS T2 TRIPLE DYE LIQUID T2 ZOVIRAX CREAM T2 ACANYA GEL T3 AKNE-MYCIN OINTMENT T3 ALA QUIN CREAM T3 ALOQUIN GEL T3 APOP GEL T3 BACTROBAN OINTMENT T3 BACTROBAN CREAM T3 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 184 BENSAL HP Forma de dosificación OINTMENT BENZAC AC GEL T3 BENZAC AC WASH LIQUID T3 Nombre Nivel Cobertura Comentario T3 BENZAC W WASH LIQUID T3 BENZACLIN GEL T3 BENZACLIN WITH PUMP GEL T3 BENZAMYCIN GEL T3 BENZAMYCINPAK PACK T3 BENZIQ GEL T3 BENZIQ LS GEL T3 benzoyl peroxide cleansing wash acne treatment pack KIT T3 benzoyl peroxide cleansing wash/acne treatment pack KIT T3 benzoyl peroxide wash acne treatment pack KIT T3 BORIC ACID GRAN T3 bp 7% wash kit KIT T3 BPO GEL T3 BPO CREAMY WASH COMPLETE PACK KIT T3 bpo creamy wash complete pack KIT T3 BREVOXYL GEL T3 BREVOXYL-4 CREAMY WASH COMPLETE PACK KIT T3 BREVOXYL-8 CREAMY WASH COMPLETE PACK KIT T3 CENTANY OINTMENT T3 CENTANY AT KIT T3 CICLOPIROX TOPICAL SOLUTION KIT KIT T3 CLEOCIN CREAM T3 CLEOCIN-T * T3 CLINAC BPO GEL T3 CLINDACIN ETZ KIT T3 CLINDACIN PAC KIT T3 CLINDAGEL GEL T3 clindamax * T3 CNL8 NAIL KIT KIT T3 DELOS * T3 DERMASORB AF KIT T3 DESQUAM-X WASH LIQUID T3 DUAC GEL T3 ELIMITE CREAM T3 ERTACZO CREAM T3 ERYGEL GEL T3 EURAX * T3 EVOCLIN FOAM T3 EXELDERM * T3 FEM PH GEL T3 GENTAMICIN SULFATE (0.1%) CREAM T3 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 185 GENTAMICIN SULFATE (0.1%) Forma de dosificación OINTMENT GYNAZOLE-1 CREAM T3 HALOTIN CREAM T3 INOVA KIT T3 INOVA 4/1 ACNE CONTROL THERAPY KIT T3 INOVA 8/2 ACNE CONTROL THERAPY KIT T3 Nombre Nivel Cobertura Comentario T3 KETOCON KIT T3 KETOCON PLUS KIT T3 KLARON LOTION T3 LAVOCLEN-4 CREAMY WASH (4%) LIQUID T3 LAVOCLEN-8 CREAMY WASH (8%) LIQUID T3 LOPROX GEL T3 LOPROX SHAMPOO SHAMPOO T3 LOTRISONE * T3 MENTAX CREAM T3 METROCREAM CREAM T3 METROGEL GEL T3 METROGEL-VAGINAL GEL T3 METROLOTION LOTION T3 NAFTIN * T3 NEOBENZ MICRO WASH LIQUID T3 NEOBENZ MICRO WASH PLUS PACK KIT T3 NEOSPORIN GU IRRIGANT SOLUTION T3 NIZORAL SHAMPOO T3 OVACE FOAM T3 OVACE PLUS * T3 OVACE PLUS WASH * T3 OVACE WASH LIQUID T3 OVIDE LOTION T3 OXISTAT * T3 PACNEX MX LIQUID T3 pacnex wash LIQUID T3 PEDIADERM AF COMPLETE KIT KIT T3 PENLAC NAIL LACQUER SOLUTION T3 RELAGARD GEL T3 ROSADAN KIT KIT T3 SE BPO 7-5.5 WASH KIT KIT T3 SEB-PREV LOTION T3 SELENIUM SULFIDE (2.25%) SHAMPOO T3 SELRX SHAMPOO T3 SELSEB SHAMPOO T3 SELSUN SHAMPOO LOTION T3 SILVADENE CREAM T3 SODIUM SULFACETAMIDE WASH LIQUID T3 SULFAMYLON * T3 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 186 SULFURATED LIME Forma de dosificación SOLUTION TERAZOL 3 * T3 TERAZOL 7 CREAM T3 TRIAZ CLEANSER LOTION T3 ULESFIA LOTION T3 VUSION OINTMENT T3 VYTONE CREAM T3 XOLEGEL COREPAK KIT T3 XOLEGEL DUO/HEAD & SHOULDERS KIT T3 Nombre Nivel Cobertura Comentario T3 XOLEGEL DUO/XOLEX KIT T3 ZACARE 4% KIT KIT T3 ZACARE 8% KIT KIT T3 ZACLIR CLEANSING (8%) LOTION T3 zazole * T3 ZOVIRAX OINTMENT T3 ACID JELLY GEL X ACTIVE-PREP KIT V CREAM X ALCORTIN A GEL X ALTABAX OINTMENT X antifungal CREAM X baza antifungal CREAM X BENZACLIN CARE KIT KIT X BENZALKONIUM CHLORIDE SOLUTION X benzashave 10 CREAM X BENZASHAVE 5 CREAM X BENZEFOAM FOAM X BENZEFOAMULTRA FOAM X benzepro FOAM X benzepro short contact FOAM X benzoyl peroxide * X benzoyl peroxide PADS X benzoyl peroxide cleanser LIQUID X benzoyl peroxide short contact FOAM X benzoyl peroxide wash LIQUID X bp foam FOAM X BPO 3% FOAMING CLOTHS MISC X BPO 6% FOAMING CLOTHS MISC X BPO 9% FOAMING CLOTHS MISC X CARMOL SCALP TREATMENT * X carrington antifungal CREAM X CHLORHEXIDINE DIGLUCONATE SOLUTION X CHLORHEXIDINE GLUCONATE SOLUTION X CICLODAN CREAM KIT KIT X CICLODAN SOLUTION KIT KIT X ciclopirox treatment KIT X MFX (AC) Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 187 clean & clear continuous control acne cleanser Forma de dosificación CREAM clearskin CREAM X CLINDAREACH KIT X del-aqua CREAM X DPI ALCOHOL GEL GEL X DUAC CS KIT X Nombre Nivel Cobertura Comentario X ECOZA FOAM X EXTINA FOAM X FREEDOM ALCOHOL GEL GEL X HYDRO-IODOQUINOL 2-1 GEL X HYDROGEN PEROXIDE SOLUTION X invisible acne treatment CREAM X ISOPROPANOL SOLUTION X MFX (AC) ISOPROPYL ALCOHOL SOLUTION X MFX (AC) JUBLIA SOLUTION X KENDALL WET SKIN SCRUB PREP TRAY KIT X KERYDIN SOLUTION X ketoconazole FOAM X ketodan FOAM X KETODAN KIT KIT X LAMISIL SPRAY SOLUTION X LIDOVIR OINTMENT X LUZU CREAM X LYCELLE GEL X massengill SOLUTION X massengill vinegar/water SOLUTION X MEDIHOL BASE GEL X micaderm CREAM X MICATIN CREAM X miconazole nitrate CREAM X micro guard CREAM X NATROBA SUSPENSION X NEOBENZ MICRO CREAM X NEOBENZ MICRO PLUS PACK CREAM X NEOBENZ MICRO SD CREAM X neosporin af jock itch CREAM X NEUAC KIT KIT X NEUTROGENA ON-THE-SPOT ACNE TREATMENT CREAM X nuzole CREAM X ORAVIG TABS X oscion PADS X PACNEX HP PADS X PACNEX LP PADS X PEDIPIROX-4 NAIL KIT X PHISOHEX LIQUID X MFX (AC) Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 188 podactin Forma de dosificación CREAM remedy antifungal CREAM X RIAX FOAM X ROSULA NS PADS X SCALP TREATMENT KIT X se bpo 3% foaming cloths MISC X se bpo 6% foaming cloths MISC X se bpo 9% foaming cloths MISC X secura antifungal CREAM X secura antifungal extra thick CREAM X SKLICE LOTION X SODIUM HYPOCHLORITE SOLUTION X SODIUM SULFACETAMIDE/UREA PADS X Nombre Nivel Cobertura Comentario X soothe & cool inzo antifungal cream CREAM X SPINOSAD SUSPENSION X SULFACETAMIDE SODIUM LOTION X sulfacetamide sodium w/urea PADS X SULFACETAMIDE SODIUM/UREA PADS X sulfacetamide sodium/urea PADS X summers eve extra cleansing vinegar and water SOLUTION X summers eve vinegar & water SOLUTION X TERSI FOAM FOAM X TRIAZ PADS X TRIAZ FOAMING CLOTHS MISC X TRIMO-SAN GEL X UNIVERSAL WATER GEL GEL X XERESE CREAM X XOLEGEL GEL X ZODERM * X ZODERM CLEANSER LIQUID X ala cort CREAM T1 ala-cort LOTION T1 alclometasone dipropionate * T1 alphatrex GEL T1 amcinonide (0.1%) CREAM T1 anucort-hc SUPPOSITORY T1 apexicon OINTMENT T1 augmented betamethasone dipropionate * T1 betamethasone dipropionate * T1 betamethasone valerate * T1 clobetasol propionate * T1 clobetasol propionate FOAM T1 clobetasol propionate e CREAM T1 clobetasol propionate emollient CREAM T1 Anti-inflammatory Agents Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 189 clobetasol propionate emollient Forma de dosificación FOAM clodan SHAMPOO T1 cormax * T1 cormax scalp application SOLUTION T1 cortalo GEL T1 cortamox LOTION T1 del-beta LOTION T1 desonide * T1 desoximetasone * T1 desoximetasone (0.25%) CREAM T1 desoximetasone (0.25%) OINTMENT T1 diflorasone diacetate OINTMENT T1 fluocinolone acetonide * T1 fluocinolone acetonide body OIL T1 fluocinolone acetonide scalp OIL T1 fluocinonide * T1 fluocinonide emollient base CREAM T1 fluocinonide-e CREAM T1 fluticasone propionate * T1 Nombre Nivel Cobertura Comentario T1 grx hicort 25 SUPPOSITORY T1 halac KIT T1 halobetasol propionate * T1 halonate pac KIT T1 hemorrhoidal-hc SUPPOSITORY T1 hemril-30 SUPPOSITORY T1 hydrocortisone ENEMA T1 hydrocortisone * T1 hydrocortisone acetate SUPPOSITORY T1 hydrocortisone acetate/aloe LOTION T1 hydrocortisone acetate/aloe GEL T1 hydrocortisone acetate/pramoxine CREAM T1 hydrocortisone acetate/pramoxine hcl OINTMENT T1 hydrocortisone butyrate * T1 hydrocortisone butyrate (lipid) CREAM T1 hydrocortisone butyrate (lipophilic) CREAM T1 hydrocortisone in absorbase OINTMENT T1 hydrocortisone valerate * T1 lokara LOTION T1 mometasone furoate * T1 nystatin/triamcinolone * T1 prednicarbate * T1 procto-pak CREAM T1 proctocream hc CREAM T1 proctosol hc CREAM T1 proctozone-hc CREAM T1 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 190 rectacort-hc Forma de dosificación SUPPOSITORY scalacort LOTION T1 triamcinolone acetonide PASTE T1 triamcinolone acetonide * T1 triamcinolone acetonide (0.025%) OINTMENT T1 triamcinolone acetonide (0.1%) OINTMENT T1 Nombre Nivel Cobertura Comentario T1 triamcinolone in orabase PASTE T1 triderm * T1 CORTIFOAM FOAM T2 ACLOVATE * T3 ALA SCALP LOTION T3 AMCINONIDE * T3 AMCINONIDE (0.1%) CREAM T3 ANUSOL-HC CREAM T3 ANUSOL-HC SUPPOSITORY T3 APEXICON E CREAM T3 CAPEX SHAMPOO T3 CARMOL-HC CREAM T3 CLOBEX * T3 CLOCORTOLONE PIVALATE CREAM T3 CLOCORTOLONE PIVALATE PUMP CREAM T3 CLODERM CREAM T3 CLODERM PUMP CREAM T3 colocort ENEMA T3 CORDRAN * T3 CORDRAN TAPE TAPE T3 CORTANE-B LOTION T3 CORTENEMA ENEMA T3 CORTISPORIN CREAM T3 CORTISPORIN OINTMENT T3 CUTIVATE * T3 DERMA-SMOOTHE/FS BODY OIL T3 DERMA-SMOOTHE/FS BODY OIL OIL T3 DERMA-SMOOTHE/FS SCALP OIL T3 DERMA-SMOOTHE/FS SCALP OIL OIL T3 DERMASORB TA KIT T3 DERMATOP * T3 DESONATE GEL T3 DESOWEN * T3 DESOWEN CREAM/CETAPHIL LOTION KIT T3 DESOWEN LOTION/CETAPHIL CREAM KIT T3 DESOWEN OINTMENT/CETAPHIL LOTION KIT T3 DESOXIMETASONE (0.05%) CREAM T3 DESOXIMETASONE (0.05%) OINTMENT T3 DIFLORASONE DIACETATE CREAM T3 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 191 DIPROLENE Forma de dosificación * DIPROLENE AF CREAM T3 ELOCON * T3 EPIFOAM FOAM T3 FIRST-HYDROCORTISONE GEL T3 HALOG * T3 KENALOG AEROSOL T3 LOCOID * T3 LOCOID LIPOCREAM CREAM T3 LUXIQ FOAM T3 NEO-SYNALAR CREAM T3 NOVACORT GEL T3 NUCORT LOTION T3 Nombre Nivel Cobertura Comentario T3 NUZON GEL T3 OLUX FOAM T3 OLUX OLUX-E COMPLETE PACK MISC T3 OLUX-E FOAM T3 oralone PASTE T3 PANDEL CREAM T3 PEDIADERM TA KIT T3 PRAMOSONE * T3 PRAMOSONE E CREAM T3 PROCTOCORT CREAM T3 PROCTOCORT SUPPOSITORY T3 proctocream-hc CREAM T3 SYNALAR * T3 SYNALAR CREAM KIT KIT T3 SYNALAR OINTMENT KIT KIT T3 SYNALAR TS KIT T3 TEMOVATE * T3 TEMOVATE E CREAM T3 TEXACORT SOLUTION T3 TOPICORT * T3 TRIAMCINOLONE ACETONIDE (0.5%) OINTMENT T3 TRIAMCINOLONE ACETONIDE IN ABSORBASE OINTMENT T3 TRIANEX OINTMENT T3 U-CORT CREAM T3 ULTRAVATE * T3 ULTRAVATE PAC KIT T3 ULTRAVATE X KIT T3 VANOS CREAM T3 VANOXIDE-HC LOTION T3 VERDESO FOAM T3 WESTCORT OINTMENT T3 ACTIVE-KETOPROFEN KIT CREAM X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 192 AQUA GLYCOLIC HC SCALP & BODY Forma de dosificación KIT calcipotriene/betamethasone dipropionate OINTMENT X CLOBETA CREAM KIT X CLOBETA OINTMENT KIT X CLOBETAPLUS CREAM KIT X CLOBETAPLUS OINTMENT KIT X Nombre Nivel Cobertura Comentario X CLODAN KIT KIT X DERMASORB HC KIT X DESONIL KIT X DESONIL KIT X DESONIL PLUS CREAM KIT KIT X DESONIL PLUS OINTMENT KIT KIT X ENOVARX-IBUPROFEN CREAM X ENOVARX-NAPROXEN CREAM X HALONATE KIT X KETOROLAC 2% GEL GEL X LIDAMANTLE HC * X LIDAMANTLE HC RELIEF PAD PADS X lidocaine hcl/hydrocortisone acetate * X MOMEXIN KIT X NAPRO 15% COMPOUNDING KIT CREAM X NAPRODERM COMPOUNDING KIT CREAM X NEO-SYNALAR KIT KIT X PEDIADERM HC KIT X PERANEX HC PADS X SCALACORT DK KIT X TACLONEX * X VANOXIDE HC KIT X glydo GEL T1 hc pram CREAM T1 hydrocortisone acetate/pramoxine CREAM T1 hydrocortisone acetate/pramoxine hcl KIT T1 lidazone hc * T1 lidocaine * T1 lidocaine CREAM T1 lidocaine hcl * T1 lidocaine hcl jelly GEL T1 lidocaine hcl/hydrocortisone acetate * T1 lidocaine hcl/hydrocortisone acetate (0.5%; 3%) KIT T1 lidocaine hcl/hydrocortisone acetate (1%; 3%) KIT T1 Antipruritics and Local Anesthetics lidocaine hcl/hydrocortisone acetate (2.5%; 3%) KIT T1 lidocaine/prilocaine CREAM T1 lidocort KIT T1 lidopin CREAM T1 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 193 phenazopyridine hcl Forma de dosificación TABS pram-hca KIT T1 pramcort CREAM T1 pramox gel GEL T1 topex topical anesthetic SOLUTION T1 FIRST-MOUTHWASH BLM SUSPENSION T2 PONTOCAINE SOLUTION T2 ANACAINE OINTMENT T3 ANALPRAM ADVANCED KIT T3 ANALPRAM E KIT T3 ANALPRAM-HC * T3 ANALPRAM-HC SINGLES CREAM T3 ANAMANTLE HC * T3 Nombre Nivel Cobertura Comentario T1 ANAMANTLE HC FORTE KIT T3 EMLA CREAM T3 ETHYL CHLORIDE AEROSOL T3 ETHYL CHLORIDE/FINE PINPOINT AEROSOL T3 ETHYL CHLORIDE/FINE STREAM AEROSOL T3 ETHYL CHLORIDE/MEDIUM JET STREAM AEROSOL T3 ETHYL CHLORIDE/MEDIUM STREAM AEROSOL T3 ETHYL CHLORIDE/MIST AEROSOL T3 GEBAUERS PAIN EASE AEROSOL T3 GEBAUERS SPRAY AND STRETCH AEROSOL T3 LIDAMANTLE CREAM T3 LIDOCAINE HCL-HYDROCORTISONE ACETATE WITH ALOE GEL T3 LIDOCAINE/PRILOCAINE KIT T3 LIDODERM PATCH T3 LIDORX GEL T3 PLIAGLIS CREAM T3 PROCORT CREAM T3 PROCTOFOAM HC FOAM T3 PRUDOXIN CREAM T3 PYRIDIUM TABS T3 SYNERA PATCH T3 XYLOCAINE SOLUTION T3 XYLOCAINE JELLY GEL T3 Z-PRAM KIT T3 ZONALON CREAM T3 ALEVEER PATCH X ana-lex KIT X anti-itch clear LOTION X BAND-AID CALAMINE SPRAY AEROSOL X BOIL-EASE OINTMENT X DERMAGESIC LOTION X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 194 DERMAGESIC Forma de dosificación LIQUID ELENZAPATCH PATCH X ENOVARX-LIDOCAINE HCL CREAM X exactacain AEROSOL X GOLD BOND MEDICATED ANTI-ITCH LOTION X hydrocortisone acetate/lidocaine hcl KIT X LIDAMANTLE LOTION X lidocaine LOTION X LIDOCAINE HCL LOTION X lidocaine hcl LOTION X LIDOCAINE HCL/HYDROCORTISONE ACETATE (2%; 2%) KIT X lidocaine hcl/hydrocortisone acetate (2%; 2%) KIT X Nombre Nivel Cobertura Comentario X LIDODEXTRAPINE PATCH X PERANEX HC KIT X QROXIN PATCH X RECIPHEXAMINE PATCH X RELYYKS PATCH X RENOVO PATCH X SARNA ULTRA CREAM X URELIEF PLUS TABS X VAGISIL CREAM X VAGISIL MAXIMUM STRENGTH CREAM X VEXA PATCH X ZYPRAM CREAM X hypercare SOLUTION T1 DRYSOL SOLUTION T3 XERAC AC SOLUTION T3 DICKINSONS WITCH HAZEL LIQUID X TN DICKINSONS WITCH HAZEL LIQUID X WITCH HAZEL LIQUID X avita * T1 AL (max: 50y) tretinoin * T1 AL (max: 50y) Astringents Cell Stimulants and Proliferants tretinoin microsphere GEL T1 AL (max: 50y) tretinoin microsphere pump GEL T1 AL (max: 50y) RETIN-A * T3 AL (max: 50y) RETIN-A MICRO GEL T3 AL (max: 50y) RETIN-A MICRO PUMP (0.04%) GEL T3 AL (max: 50y) RETIN-A MICRO PUMP (0.1%) GEL T3 AL (max: 50y) TRETIN-X CREAM T3 AL (max: 50y) TRETIN-X KIT T3 AL (max: 50y) KEPIVANCE SOLUTION T6 ATRALIN GEL X Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 195 REFISSA Forma de dosificación CREAM RENOVA CREAM X RENOVA PUMP CREAM X Nombre Nivel Cobertura Comentario X RETIN-A MICRO PUMP (0.08%) GEL X TRETINOIN EMOLLIENT CREAM X Depigmenting and Pigmenting Agents methoxsalen CAPS T2 8-MOP CAPS T3 OXSORALEN LOTION T3 OXSORALEN ULTRA CAPS T3 UVADEX SOLUTION T6 ACLARO EMULSION X ACLARO PD EMULSION X alphaquin hp CREAM X ALUSTRA CREAM X ELDOPAQUE FORTE CREAM X ELDOQUIN FORTE CREAM X EPIQUIN MICRO CREAM X EPIQUIN MICRO/PUMP CREAM X hydroquinone * X hydroquinone time release CREAM X hydroquinone/sunscreens * X LUSTRA CREAM X LUSTRA-AF CREAM X LUSTRA-ULTRA CREAM X melpaque hp CREAM X MELQUIN 3 SOLUTION X melquin hp CREAM X nava-sc CREAM X NUQUIN HP * X nuquin hp * X remergent hq CREAM X skin bleaching CREAM X skin bleaching/sunscreen CREAM X tl hydroquinone CREAM X TRI-LUMA CREAM X ULTRAQUIN SOLUTION X CLEOCIN PHOSPHATE SOLUTION T6 GREEN SOAP TINCTURE X hygel GEL T1 lactic acid LOTION T1 lactic acid e CREAM T1 Non-self administerable injectable Detergents Non-self administerable injectable Emollients, Demulcents, and Protectants Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 196 lactic acid w/vitamin e Forma de dosificación CREAM sodium hyaluronate * T1 HYLIRA * T3 MEDROX-RX OINTMENT T3 ammonium lactate * X ATOPICLAIR CREAM X AURSTAT KIT X BENZOIN COMPOUND TINCTURE TINCTURE X BENZOIN TINCTURE TINCTURE X ELETONE CREAM X ELETONE TWINPACK CREAM X hemorrhoidal PADS X hemorrhoidal hygiene pads PADS X HPR FOAM X HPR PLUS * X HPR PLUS/MB HYDROGEL KIT X HYLATOPIC FOAM X HYLATOPIC PLUS * X HYLATOPIC PLUS/AURSTAT KIT X LAC-HYDRIN * X laclotion LOTION X LANOLIN OIL X Nombre Nivel Cobertura Comentario T1 lanolin OINTMENT X LANOLIN ANHYDROUS OINTMENT X MB HYDROGEL KIT X MEDI-DERM CREAM X MEDI-DERM-RX CREAM X METHYL SALICYLATE LIQUID X MIMYX CREAM X NEOSALUS * X NEOSALUS 180 PACK CREAM X NEOSALUS CP CREAM X PETROLATUM WHITE OINTMENT X PETROLATUM YELLOW OINTMENT X pre-moistened witch hazel PADS X preparation h PADS X preparation h totables PADS X PRESERA FOAM X PRUCLAIR CREAM X PRUMYX CREAM X tn dickinsons witch hazel cleansing pads PADS X tn dickinsons witch hazelhemorrhoidal PADS X TROPAZONE LOTION X tucks medicated PADS X tucks medicated cooling PADS X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 197 tucks take alongs Forma de dosificación PADS TURPENTINE SPIRITS SPRT X VAGISIL YEAST-CONTROL SUPPOSITORY X Nombre Nivel Cobertura Comentario X WHITE PETROLATUM OINTMENT X WITCH DOCTOR GEL X YELLOW PETROLATUM OINTMENT X ZENIEVA CREAM X ZENIEVA/PURE CLEANSER KIT X ZIKS ARTHRITIS PAIN RELIEF CREAM X 50% urea nail stick SOLUTION T1 aliclen SHAMPOO T1 aluvea (40%) CREAM T1 Keratolytic Agents avar cleanser (10%; 5%) EMULSION T1 avar-e emollient (10%; 5%) CREAM T1 avar-e green (10%; 5%) CREAM T1 bp 10-1 EMULSION T1 bp cleansing wash EMULSION T1 carmol 40 CREAM T1 cerisa wash EMULSION T1 cerovel * T1 claris clarifying wash EMULSION T1 clenia CREAM T1 clenia foaming wash EMULSION T1 kerol zx SOLUTION T1 latrix SUSPENSION T1 prascion EMULSION T1 prascion fc PADS T1 prascion ra with sunscreens CREAM T1 re 40 GEL T1 re sa 6% * T1 re urea 50 EMULSION T1 re-u40 FOAM T1 rea lo 39 CREAM T1 rea lo 40 * T1 remeven CREAM T1 rosaderm EMULSION T1 rosaderm KIT T1 rosanil cleanser EMULSION T1 sa 6% KIT T1 salacyn * T1 salicylic acid * T1 salicylic acid KIT T1 salicylic acid (27.5%) LIQUID T1 salicylic acid cream KIT T1 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 198 salicylic acid lotion Forma de dosificación KIT salicylic acid wart remover LIQUID T1 se 10-5 ss CREAM T1 sodium sulfacetamide/sulfur * T1 sodium sulfacetamide/sulfur (8%; 4%) SUSPENSION T1 sodium sulfacetamide/sulfur clarifying wash EMULSION T1 sodium sulfacetamide/sulfur cleanser EMULSION T1 sodium sulfacetamide/sulfur cleanser in urea (10%; 5%; 10%) EMULSION T1 Nombre Nivel Cobertura Comentario T1 sodium sulfacetamide/sulfur cleansing cloths PADS T1 sodium sulfacetamide/sulfur green CREAM T1 sodium sulfacetamide/sulfur in urea (10%; 5%; 10%) GEL T1 sodium sulfacetamide/sulfur wash * T1 sodium sulfacetamide/sulfur wash EMULSION T1 sss 10%-5% CREAM T1 sss 10-5 FOAM T1 sulfacetamide sodium/sulfur cleanser EMULSION T1 sulfacleanse 8/4 SUSPENSION T1 suphera CREAM T1 topisulf CREAM T1 u-kera e CREAM T1 u40 FOAM T1 umecta mousse FOAM T1 urea * T1 urea SUSPENSION T1 urea EMULSION T1 urea (35%) LOTION T1 urea (40%) LOTION T1 urea (50%) OINTMENT T1 urea 40% nail film SUSPENSION T1 urea in zinc undecylenate/lactic acid vehicle EMULSION T1 urea nail (45%) GEL T1 urea nail (50%) GEL T1 urea nail stick SOLUTION T1 urea topical SUSPENSION T1 urea-c40 LOTION T1 urea40 GEL T1 virti-sulf CREAM T1 x-viate * T1 zencia LIQUID T1 ALUVEA (39%) CREAM T3 AVAR * T3 avar cleanser (10%; 5%) EMULSION T3 AVAR LS PADS T3 AVAR LS CLEANSER LIQUID T3 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 199 avar-e emollient (10%; 5%) Forma de dosificación CREAM avar-e green (10%; 5%) CREAM T3 AVAR-E LS CREAM T3 CARMOL 40 * T3 CEM-UREA SOLUTION T3 CLARIFOAM EF FOAM T3 GORDOFILM SOLUTION T3 GORDONS UREA OINTMENT T3 HYDRO 40 FOAM FOAM T3 KERAFOAM FOAM T3 KERAFOAM 42 FOAM T3 KERALAC * T3 KERALAC NAILSTIK SOLUTION T3 KERALYT GEL T3 KEROL SUSPENSION T3 KEROL EMULSION T3 KEROL AD EMULSION T3 LATRIX XM EMULSION T3 LOUTREX CREAM T3 PROMISEB CREAM T3 PYROGALLIC ACID OINTMENT T3 ROSANIL KIT T3 ROSULA FOAM T3 ROSULA * T3 ROSULA CLARIFYING WASH EMULSION T3 SALEX SHAMPOO T3 SALEX CREAM KIT T3 SALEX LOTION KIT T3 SALICYLIC ACID IN AMMONIUM LACTATE VEHICLE FOAM T3 SALKERA FOAM T3 SALVAX FOAM T3 sodium sulfacetamide/sulfur KIT T3 Nombre Nivel Cobertura Comentario T3 SODIUM SULFACETAMIDE/SULFUR (10%; 5%) SUSPENSION T3 SODIUM SULFACETAMIDE/SULFUR CLEANSER IN UREA (10%; 5%) SODIUM SULFACETAMIDE/SULFUR CLEANSER IN UREA (10%; 5%; 10%) SODIUM SULFACETAMIDE/SULFUR IN UREA (10%; 5%; 10%) EMULSION T3 EMULSION T3 GEL T3 SSS 10-4 FOAM T3 SULFOAM SHAMPOO T3 SUMADAN KIT KIT T3 SUMADAN WASH LIQUID T3 SUMAXIN PADS T3 SUMAXIN CP KIT KIT T3 SUMAXIN TS SUSPENSION T3 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 200 SUMAXIN WASH Forma de dosificación LIQUID TL TRISEB CREAM T3 UMECTA * T3 UMECTA NAIL FILM SUSPENSION T3 URAMAXIN * T3 URAMAXIN GT GEL T3 UREA (50%) OINTMENT T3 UREA NAILSTICK SOLUTION T3 UTOPIC CREAM T3 VIRASAL LIQUID T3 ALUVEA (43%) CREAM X DERMASORB XM KIT X DURASAL SOLUTION X HYDRO 35 FOAM X KERALYT SCALP KIT X KEROL REDI-CLOTHS MISC X PLEXION * X PLEXION CLEANSER * X PLEXION CLEANSING CLOTH MISC X PLEXION CLEANSING CLOTHS PADS X PLEXION SCT CREAM X PROMISEB COMPLETE KIT X RINNOVI NAIL SYSTEM KIT X ROSULA CLK KIT X salicylic acid * X SALICYLIC ACID (26%) LIQUID X SALVAX DUO PLUS KIT X SODIUM SULFACETAMIDE-SULFFUR WASH W/MERATAN KIT X sodium sulfacetamide/sulfur w/sunscreen KIT X SUMADAN XLT KIT X tl urea LOTION X ULTRASAL-ER SOLUTION X UMECTA PD * X URAMAXIN LOTION X URAMAXIN FOAM X URAMAXIN GT KIT KIT X urea (45%) LOTION X UREA 42% CLOTHS MISC X urea hydrating FOAM X UREA NAIL STCK X urea nail (45%) GEL X UREA NAIL KIT KIT X EMULSION X Nombre Nivel Cobertura Comentario T3 MFX (AC) Keratoplastic Agents BALNETAR LIQUIM Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 201 beta care betatar gel Forma de dosificación SHAMPOO COAL TAR SOLUTION X COAL TAR BASE OINTMENT X CUTAR OIL X DENOREX THERAPEUTIC SHAMPOO X DENOREX THERAPEUTIC 2-IN-1 SHAMPOO X Nombre Nivel Cobertura Comentario X DHS TAR SHAMPOO X DHS TAR GEL SHAMPOO X DOAK OIL OIL X doak tar SHAMPOO X DOAK TAR DISTILLATE LIQUID X ELTA LITE TAR LOTION X ELTA TAR CREAM X ionil-t SHAMPOO X IONIL-T PLUS SHAMPOO X MEDOTAR OINTMENT X MG217 MEDICATED TAR * X mg217 medicated tar shampoo SHAMPOO X MG217 PSORIASIS MEDICATED * X MG217 PSORIASIS MULTI-SYMPTOM * X mg217 psoriasis multi-symptom * X NEUTROGENA T/GEL SHAMPOO X NEUTROGENA T/GEL CONDITIONER LIQUID X neutrogena t/gel extra strength SHAMPOO X NEUTROGENA T/GEL STUBBORN ITCH CONTROL SHAMPOO X pc-tar SHAMPOO X PENTRAX GOLD SHAMPOO X PSORIASIN * X SCYTERA FOAM X TEGRIN CREAM FOR PSORIASIS CREAM X TEGRIN LOTION FOR PSORIASIS LOTION X TEGRIN MEDICATED SOAP BAR X tera-gel tar SHAMPOO X therapeutic shampoo SHAMPOO X THERAPLEX T SHAMPOO X X-SEB T PEARL SHAMPOO X X-SEB T PLUS SHAMPOO X Skin and Mucous Membrane Agents, Misc adapalene * T1 calcipotriene * T1 calcitrene OINTMENT T1 diclofenac sodium GEL T1 fluorouracil * T1 fluorouracil (5%) CREAM T1 imiquimod CREAM T1 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 202 podofilox Forma de dosificación SOLUTION revina OINTMENT T1 tbc AEROSOL T1 Nombre Nivel Cobertura Comentario T1 vasolex OINTMENT T1 PICATO GEL T2 ACZONE GEL T3 ALDARA CREAM T3 ALLEVYN AG GENTLE PADS T3 AVO CREAM EMULSION T3 AZELEX CREAM T3 BIAFINE EMULSION T3 BIONECT * T3 CALCITRIOL OINTMENT T3 CARAC CREAM T3 CONDYLOX * T3 CURITY HYPERTONIC SODIUM CHLORIDE PACKING STRIP 1/2"X15' DIFFERIN MISC T3 * T3 DOVONEX CREAM T3 DOVONEX SCALP SOLUTION T3 DOXYCYCLINE CONT.REL.CAPS T3 DRITHO-CREME HP CREAM T3 DRITHO-SCALP CREAM T3 DURAFIBER PADS T3 DURAFIBER AG PADS T3 EFUDEX CREAM T3 ELIDEL CREAM T3 EMULSION SB EMULSION T3 EPICERAM EMULSION T3 EPIDUO GEL T3 EPISIL LIQUID T3 FABIOR FOAM T3 FINACEA GEL T3 FLUOROPLEX CREAM T3 FLUOROURACIL (0.5%) CREAM T3 GELCLAIR GEL T3 GELX GEL T3 GRANULEX AEROSOL T3 HYLASE WOUND GEL T3 INTERCEED (TC7) (3"X4") ABSORBABLE ADHESION BARRIER PADS T3 INTERCEED (TC7) ABSORBABLE ADHESION BARRIER 1-1/2" X 2" KENDALL ZINC CALCIUM ALGINATE DRESSING ROPE 12" PADS T3 MISC T3 LEVULAN KERASTICK SOLUTION T3 METVIXIA CREAM T3 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 203 MIRVASO Forma de dosificación GEL MUGARD LIQUID T3 NIVATOPIC PLUS CREAM T3 NUOX GEL T3 OASIS BURN MATRIX SHEE T3 OASIS ULTRA TRI-LAYER MATRIX SHEE T3 OASIS ULTRA TRI-LAYER MATRIX FENESTRATED SHEE T3 OASIS ULTRA TRI-LAYER MATRIX MESHED SHEE T3 OASIS WOUND MATRIX SHEE T3 Nombre Nivel Cobertura Comentario T3 OASIS WOUND MATRIX SHEE T3 OPTASE GEL T3 ORACEA CONT.REL.CAPS T3 OXYCEL ABSORBANT COTTON-TYPE PLEDGET 2"X1"X1" PADS T3 OXYCEL ABSORBANT GAUZE-TYPE PAD 3"X3" 8 PLY PADS T3 OXYCEL ABSORBANT GAUZE-TYPE STRIP 18"X2" 4 PLY PADS T3 OXYCEL ABSORBANT GAUZE-TYPE STRIP 36"X1/2" 4 PLY PADS T3 OXYCEL ABSORBANT GAUZE-TYPE STRIP 5"X1/2" 4 PLY PADS T3 PANRETIN GEL T3 PODOCON 25 IN BENZOIN TINCTURE SOLUTION T3 PR CREAM KIT T3 PROTOPIC OINTMENT T3 PRUTECT EMULSION T3 REGRANEX GEL T3 SANTYL OINTMENT T3 SILVERSEAL HYDROGEL DRESSING 2"X3" PADS T3 SILVERSEAL HYDROGEL DRESSING 4"X5" PADS T3 SILVRSTAT WOUND DRESSING GEL T3 SOLARAZE GEL T3 SONAFINE EMULSION T3 SORILUX FOAM T3 SURGICEL ABSORBABLE HEMOSTAT/0.5" X 2" PADS T3 SURGICEL ABSORBABLE HEMOSTAT/2" X 14" PADS T3 SURGICEL ABSORBABLE HEMOSTAT/2"X3" PADS T3 SURGICEL ABSORBABLE HEMOSTAT/4"X8" PADS T3 SURGICEL FIBRILLAR ABSORBABLE HEMOSTAT 1"X2" PADS T3 SURGICEL FIBRILLAR ABSORBABLE HEMOSTAT 2"X4" PADS T3 SURGICEL FIBRILLAR ABSORBABLE HEMOSTAT 4"X4" PADS T3 SURGICEL NU-KNIT ABSORBABLE HEMOSTAT ENDOSCOPIC 1"X3-1/2" SURGICEL NU-KNIT ABSORBABLE HEMOSTAT/1" X 1" PADS T3 PADS T3 SURGICEL NU-KNIT ABSORBABLE HEMOSTAT/3" X 4" PADS T3 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 204 SURGICEL NU-KNIT ABSORBABLE HEMOSTAT/6" X 9" Forma de dosificación PADS SURGICEL SNOW ABSORBABLE HEMOSTAT 1"X2" PADS T3 SURGICEL SNOW ABSORBABLE HEMOSTAT 2"X4" PADS T3 SURGICEL SNOW ABSORBABLE HEMOSTAT 4"X4" PADS T3 TACHOSIL PATCH T3 TAZORAC * T3 TETRIX KIT T3 TL-CERMIDE EMULSION T3 VALCHLOR GEL T3 VECTICAL OINTMENT T3 VELTIN GEL T3 VENELEX OINTMENT T3 VEREGEN OINTMENT T3 VOLTAREN GEL T3 Nombre Nivel Cobertura Comentario T3 XCLAIR CREAM T3 XENADERM OINTMENT T3 ZIANA GEL T3 ZITHRANOL SHAMPOO T3 ZITHRANOL-RR CREAM T3 acitretin CAPS T4 amnesteem CAPS T4 CLARAVIS CAPS T4 claravis CAPS T4 PA NOT COVERED FOR MEDICAID: Covered Alternatives Available myorisan CAPS T4 SORIATANE CAPS T4 sotret CAPS T4 TARGRETIN GEL T4 zenatane CAPS T4 AMEVIVE SOLUTION T6 PA STELARA SOSY T6 PA A.A.G.C. KIT IN TERODERM CREAM X ABSORICA CAPS X ACTIVE-PREP KIT I CREAM X ACTIVE-PREP KIT II CREAM X ACTIVE-PREP KIT III CREAM X ACTIVE-PREP KIT IV CREAM X ACTIVE-TRAMADOL KIT CREAM X AIF #2 DRUG PREPARATION KIT CREAM X AIF #3 DRUG PREPARATION KIT CREAM X ALEVICYN ANTIPRURITIC GEL GEL X ALEVICYN DERMAL SPRAY SOLUTION X ALLANENZYME * X allanenzyme * X Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 205 ALLANFILLENZYME Forma de dosificación * ALLEVYN AG ADHESIVE PADS X ALLEVYN AG GENTLE BORDER PADS X ALLEVYN AG NON-ADHESIVE PADS X ALLEVYN AG SACRUM PADS X ALLEVYN GENTLE PADS X AMERIGEL WOUND DRESSING GEL X ARNICA FLOWER TINCTURE X ARTISS * X ATRAPRO ANTIPRURITIC HYDROGEL GEL X ATRAPRO CP KIT X ATRAPRO DERMAL SPRAY LIQUID X AURSTAT ANTI-ITCH HYDROGEL GEL X Nombre Nivel Cobertura Comentario X AURSTAT ANTI-ITCH HYDROGEL KIT KIT X AVAGE CREAM X BIOSTEP SHEE X BIOSTEP AG SHEE X CARRASMART GEL X CARRASYN HYDROGEL WOUND DRESSING (0) GEL X CARRASYN HYDROGEL WOUND DRESSING (0) GEL X CARRASYN V HYDROGEL WOUNDDRESSING GEL X CARRINGTON ORAL WOUND RINSE SOLUTION X CLEAN & CLEAR ADVANTANGE ACNE CONTROL KIT KIT X CLEANSE AND TREAT PADS X CURAFIL GEL WOUND DRESSING GEL X CURAGEL HYDROGEL ISLAND WOUND DRESSING 3"X4" PADS X CURAGEL HYDROGEL ISLAND WOUND DRESSING 5"X5" PADS X CURAGEL HYDROGEL WOUND DRESSING 2"X3" PADS X CURAGEL HYDROGEL WOUND DRESSING 4"X4" PADS X CURAGEL HYDROGEL WOUND DRESSING 8"X8" PADS X CURAGEL HYDROGEL WOUND DRESSING 8.5"X9.5" PADS X CURASOL GEL WOUND DRESSING GEL X CURITY SODIUM CHLORIDE DRESSING 6"X6-3/4" PADS X DERMASYN GEL X DIAB GEL X DIAB DAILY CARE GEL X DIAB F.D.G. FREEZE-DRIED GEL X diclofenac sodium SOLUTION X ELTA DERMAL GEL GEL X ELTA DERMAL WOUND DRESSING GEL X ELTA DERMAL WOUND GEL GEL X ENDOFORM DERMAL TEMPLATE SHEE X ENDOFORM DERMAL TEMPLATE/FENESTRATED SHEE X ENOVARX-TRAMADOL CREAM X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 206 EVICEL Forma de dosificación KIT FBL KIT CREAM X FEMINEASE CREAM X Nombre Nivel Cobertura Comentario X FINACEA PLUS KIT X finasteride TABS X FLECTOR PATCH X FORTADERM SHEE X FORTADERM ANTIMICROBIAL PHMB SHEE X GENADUR LIQUID X GENADUR KIT KIT X GLYCOLIC ACID SOLUTION X GLYCOLIC ACID 70% HIGH PURITY SOLUTION X GRX WOUND GEL X HEMASEEL APR KIT KIT X HYDROFERA BLUE 4"X4" PADS X HYDROFERA BLUE FOAM DRESSING PADS X HYDROFERA BLUE FOAM DRESSING/MOISTURE RETENTIVE FILM INTRASITE GEL APPLIPAK PADS X GEL X K-Y LIQUIBEADS INSERT X K-Y LONG LASTING CREAM X K-Y SILK-E GEL X K.B.G.L. IN TERODERM CREAM CREAM X KENDALL AMORPHOUS HYDROGEL WOUND DRESSING GEL X KENDALL HYDROGEL IMPREGNATED GAUZE 1"X36" PADS X KENDALL HYDROGEL IMPREGNATED GAUZE 2"X2" PADS X KENDALL HYDROGEL IMPREGNATED GAUZE 4"X4" PADS X KENDALL HYDROGEL IMPREGNATED GAUZE 4"X8" PADS X KENDALL HYDROGEL WOUND DRESSING 3" DISK MISC X KENDALL HYDROGEL WOUND DRESSING 4-3/4" DISK MISC X KENDALL ZINC CALCIUM ALGINATE DRESSING 2"X2" PADS X KENDALL ZINC CALCIUM ALGINATE DRESSING 4"X4" PADS X KENDALL ZINC CALCIUM ALGINATE DRESSING 4"X8" PADS X KOVIA OINTMENT X LATISSE SOLUTION X LAVARE WOUND WASH GEL X LIDOPROFEN CREAM X LUBRIN SUPPOSITORY X LUVENA PREBIOTIC PERSONAL LUBRICANT SOLUTION X LUVENA PREBIOTIC VAGINAL MOISTURIZER & LUBRICANT GEL X massengill feminine wash LIQUID X MENTHOL CRYS X minocycline hcl er CONT.REL.TABS X MUCOTROL WAFER X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 207 norforms Forma de dosificación SUPPOSITORY NP #2 DRUG PREPARATION KIT CREAM X NU-GEL COLLAGEN WOUND DRESSING GEL X NUVAIL SOLUTION X ORAFATE PASTE X PENNSAID SOLUTION X PICO SINGLE USE NEGATIVE PRESSURE WOUND THERAPY SYSTEM PROPECIA KIT X TABS X PROTHELIAL PASTE X PURILON GEL X QUTENZA KIT X RADIAGEL GEL X Nombre Nivel Cobertura Comentario X RECTIV OINTMENT X rephresh GEL X REPHRESH CLEAN BALANCE KIT X REPLENS VAGINAL MOISTURIZER GEL X RESTORE HYDROGEL DRESSING GEL X RESTORE SILVER DRESSING 2"X2" PADS X RESTORE SILVER DRESSING 4"X4" NON-ADHESIVE PADS X RESTORE SILVER DRESSING 4"X4.75" PADS X RESTORE SILVER DRESSING 4"X5" CONTACT LAYER PADS X RESTORE SILVER DRESSING 6"X8" CONTACT LAYER PADS X RESTORE SILVER DRESSING 6"X8" NON-ADHESIVE PADS X REVITADERM WOUND CARE GEL X REXAPHENAC CREAM X RTD WOUND CARE DRESSING 2" X 2" PADS X RTD WOUND CARE DRESSING 4" X 4" PADS X RTD WOUND CARE DRESSING 4" X 5" PADS X SAF-GEL GEL X SALICEPT * X SANARE SCAR THERAPY CREAM X SAUGELLA FEMININE WASH LIQUID X SILVASORB GEL X SKINTEGRITY HYDROGEL GEL X SOLODYN CONT.REL.TABS X SOLOSITE GEL X SPECTRAGEL GEL X STIMULEN GEL X STRI-DEX DAY/NIGHT KIT X SUMMERS EVE CLEANSING WASH/SENSITIVE SKIN/DELICATE BLOSSOM SUMMERS EVE CLEANSING WASH/SENSITIVE SKIN/MORNING PARADISE SUMMERS EVE FEMININE WASH LIQUID X LIQUID X LIQUID X SUMMERS EVE FEMININE WASHCLEANSING MIST LIQUID X Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 208 SUMMERS EVE FEMININE WASHNORMAL SKIN Forma de dosificación LIQUID SUMMERS EVE FEMININE WASHSENSITIVE SKIN LIQUID X SUMMERS EVE FEMININE WASHSENSITIVE SKIN DELICATE BLOSSOM TEGADERM AG MESH DRESSING WITH SILVER 2"X2" LIQUID X PADS X TEGADERM AG MESH DRESSING WITH SILVER 4"X5" PADS X TEGADERM AG MESH DRESSING WITH SILVER 4"X8" PADS X TEGADERM AG MESH DRESSING WITH SILVER 8"X8" PADS X TEGADERM HYDROGEL WOUND FILLER GEL X THERAHONEY GEL X TISSEEL * X tropazone CREAM X VAGISIL FEMININE MOISTURIZER LOTION X VAGISIL FEMININE WASH LIQUID X VANIQA CREAM X VASCUDERM HYDROGEL WOUND DRESSING GEL X VASCUDERM STASIS KIT KIT X VH ESSENTIALS PREBIOTIC VAGINAL SUPPOSITORIES SUPPOSITORY X Nombre Nivel Cobertura Comentario X VH ESSENTIALS VAGINAL MOISTURIZER GEL X VOPAC CREAM X VOPAC GB CREAM X VOPAC KT CREAM X WITCH HAZEL SOLUTION X WOUN'DRES COLLAGEN HYDROGEL WOUND DRESSING GEL X ziox OINTMENT X ZYCLARA CREAM X ZYCLARA PUMP CREAM X flavoxate hcl TABS T1 oxybutynin chloride * T1 oxybutynin chloride er CONT.REL.TABS T1 tolterodine tartrate TABS T1 tolterodine tartrate er CONT.REL.CAPS T1 trospium chloride TABS T1 trospium chloride er CONT.REL.CAPS T1 OXYTROL PATCH T2 DETROL TABS T3 DETROL LA CONT.REL.CAPS T3 DITROPAN XL CONT.REL.TABS T3 ENABLEX CONT.REL.TABS T3 GELNIQUE GEL T3 GELNIQUE GEL T3 MYRBETRIQ CONT.REL.TABS T3 Smooth Muscle Relaxants Genitourinary Smooth Muscle Relaxants ST Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 209 SANCTURA Forma de dosificación TABS SANCTURA XR CONT.REL.CAPS T3 TOVIAZ CONT.REL.TABS T3 VESICARE TABS T3 theochron CONT.REL.TABS T1 theophylline SOLUTION T1 theophylline cr CONT.REL.TABS T1 theophylline er * T1 AMINOPHYLLINE TABS T2 ELIXOPHYLLIN ELIXIR T2 LUFYLLIN TABS T2 THEO-24 CONT.REL.CAPS T2 aminophylline SOLUTION T6 THEOPHYLLINE/D5W SOLUTION T6 theophylline/d5w SOLUTION T6 BRONCOMAR-1 ELIXIR X BRONDIL LIQUID X copd TABS X dg 200 TABS X difil-g 400 TABS X difil-g forte LIQUID X dy-g LIQUID X DYLIX ELIXIR X dyphylline gg TABS X dyphylline-gg ELIXIR X ED-BRON G SYRUP X JAY-PHYL SYRUP X LUFYLLIN-GG ELIXIR X PULMOPHYLLINE MISC X SENOPHYLLINE MISC X biocel TABS T1 choice-tabs TABS T1 corvite free TABS T1 Nombre Nivel Cobertura Comentario T3 Respiratory Smooth Muscle Relaxants Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Vitamins Multivitamin Preparations dialyvite TABS T1 folbee plus TABS T1 folbee plus cz TABS T1 formula b plus TABS T1 genesupp-500 LIQUID T1 genesupp-500 CAPS T1 genetect plus * T1 genetical CAPS T1 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 210 lysiplex plus Forma de dosificación TABS mult-vitamin/fluoride CHEW T1 multi vitamin/fluoride CHEW T1 multi-vit/fluoride SOLUTION T1 multi-vit/iron/fluoride SOLUTION T1 multi-vitamin/fluoride * T1 multi-vitamin/fluoride/iron SOLUTION T1 multivitamin with fluoride CHEW T1 multivitamin/fluoride CHEW T1 multivitamins/fluoride CHEW T1 mvc-fluoride CHEW T1 mynephrocaps CAPS T1 nephronex TABS T1 niacinamide/azelaic ac/ turmer/fa/b6/zinc ox/copper TABS T1 nutrifac zx TABS T1 phluorivit SOLUTION T1 phluorivit + fe SOLUTION T1 poly-vitamin/fluoride SOLUTION T1 poly-vitamin/iron/fluoride (35mg/ml; 400unit/ml; 0.25mg/ml; 10mg/ml; 8mg/ml; 0.4mg/ml; 0.6mg/ml; 0.5mg/ml; 5unit/ml; 1500unit/ml) SOLUTION T1 polyvitamin/fluoride SOLUTION T1 re fac-x TABS T1 re multivit with fluoride CHEW T1 rena-vite rx TABS T1 renal CAPS T1 renalpren CAPS T1 renaphro CAPS T1 Nombre Nivel Cobertura Comentario T1 reno caps CAPS T1 siderol LIQUID T1 strovite plus TABS T1 therobec TABS T1 therobec plus TABS T1 tri-vit/fluoride SOLUTION T1 tri-vitamin/fluoride SOLUTION T1 tri-vitamin/iron/fluoride SOLUTION T1 triphrocaps CAPS T1 triple-vitamin/fluoride SOLUTION T1 v-c forte CAPS T1 vic-forte CAPS T1 vica forte CAPS T1 vicap forte CAPS T1 virt-caps CAPS T1 virt-vite plus TABS T1 vita s forte TABS T1 vita-min CAPS T1 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 211 vitacel Forma de dosificación TABS vitamax pediatric SOLUTION T1 vitamins a/c/d/fluoride SOLUTION T1 vol-care rx TABS T1 CAVAN ONE OMEGA CAPS T2 FOLCAPS CARE ONE CAPS T2 FOLCAPS OMEGA 3 CAPS T2 M-VIT TABS T2 O-CAL FA TABS T2 OB-NATAL ONE CAPS T2 OB-NATAL ONE CAPS T2 PNV FOLIC ACID + IRON MULTIVITAMIN TABS T2 PNV PRENATAL PLUS MULTIVITAMIN TABS T2 Nombre Nivel Cobertura Comentario T1 PRENAPLUS TABS T2 PRENATABS FA TABS T2 PRENATAL TABS T2 PRENATAL LOW IRON TABS T2 PRENATAL PLUS TABS T2 PRENATAL VITAMINS PLUS TABS T2 PREPLUS TABS T2 PRETAB TABS T2 TRICARE TABS T2 ULTIMATECARE ONE CAPS T2 ULTIMATECARE ONE NF CAPS T2 VENATAL-FA TABS T2 VIRT-CARE ONE CAPS T2 VOL-PLUS TABS T2 ADRENAL C FORMULA TABS T3 AP-ZEL TABS T3 ATABEX EC T3 ATABEX PRENATAL ENTERIC COATED TABS B-NEXA TABS T3 BACMIN TABS T3 BAL-CARE DHA MISC T3 BAL-CARE DHA ESSENTIAL MISC T3 BP FOLINATAL PLUS B TABS T3 T3 BP MULTINATAL PLUS * T3 C-NATE DHA CAPS T3 CALCIUM PNV CAPS T3 CAROMEGA TABS T3 CAVAN PRENATAL/EC CALCIUM T3 CAVAN-ALPHA KIT ENTERIC COATED KIT CAVAN-EC SOD DHA MISC T3 CAVAN-FOLATE DHA MISC T3 T3 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 212 CAVAN-FOLATE OB Forma de dosificación TABS CAVAN-HEME OMEGA MISC T3 CHOICE-OB+DHA MISC T3 CITRANATAL 90 DHA MISC T3 CITRANATAL ASSURE MISC T3 CITRANATAL B-CALM MISC T3 Nombre Nivel Cobertura Comentario T3 CITRANATAL B-CALM MISC T3 CITRANATAL DHA MISC T3 CITRANATAL HARMONY CAPS T3 CITRANATAL HARMONY CAPS T3 CITRANATAL RX TABS T3 COD LIVER OIL OIL T3 COMPLETE NATAL DHA MISC T3 COMPLETE-RF PRENATAL TABS T3 COMPLETENATE CHEW T3 CONCEPT DHA CAPS T3 CONCEPT OB CAPS T3 CORENATE-DHA MISC T3 corvita TABS T3 CORVITE TABS T3 CRNATAL MISC T3 DIALYVITE 3000 TABS T3 DIALYVITE 5000 TABS T3 DIALYVITE SUPREME D TABS T3 DIALYVITE/ZINC TABS T3 DIATX ZN TABS T3 DOCOSAVIT CAPS T3 DUET DHA MISC T3 DUET DHA 400 MISC T3 DUET DHA 400EC MISC T3 DUET DHA 430 MISC T3 DUET DHA 430EC MISC T3 DUET DHA BALANCED MISC T3 DUET DHA EC MISC T3 ELITE OB WITH DHA CAPS T3 ELITE-OB TABS T3 ELITE-OB 400 CAPS T3 EXTRA-VIRT PLUS DHA CAPS T3 FEMECAL OB TABS T3 FLORIVA CHEW T3 FOCALGIN-B TABS T3 FOLBECAL TABS T3 FOLCAL DHA CAPS T3 FOLET DHA THPK T3 FOLET ONE CAPS T3 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 213 FOLGARD OS Forma de dosificación TABS FOLIVANE-EC CALCIUM DHA NF MISC T3 FOLIVANE-OB CAPS T3 Nombre Nivel Cobertura Comentario T3 FOLIVANE-PRX DHA NF CAPS T3 FORTAVIT CAPS T3 GENEVIT-FA SYRUP T3 GENTEX ADE TABS T3 GESTICARE T3 GESTICARE DHA ENTERIC COATED MISC GLUTOFAC-ZX TABS T3 T3 HEMENATAL OB TABS T3 HEMENATAL OB + DHA MISC T3 INATAL ADVANCE TABS T3 INATAL GT TABS T3 INATAL ULTRA TABS T3 INFANATE BALANCE CAPS T3 INFANATE DHA CAPS T3 INFANATE PLUS CAPS T3 LACTOCAL-F TABS T3 LEVOMEFOLATE PNV MISC T3 MACNATAL CN DHA CAPS T3 MARNATAL-F CAPS T3 MARNATAL-F PLUS DUO PACK MISC T3 MOMS CHOICE RX MISC T3 MULTI-NATE 30 DHA MISC T3 MULTI-NATE DHA EXTRA MISC T3 MULTICHEW CHEW T3 MYKIDZ IRON FL SUSPENSION T3 MYNATAL CAPS T3 MYNATAL ADVANCE TABS T3 MYNATAL PLUS TABS T3 MYNATAL ULTRACAPLET TABS T3 MYNATAL-Z TABS T3 MYNATE 90 PLUS CONT.REL.TABS T3 NATA KOMPLETE TABS T3 NATACHEW CHEW T3 NATAFORT TABS T3 NATAFORT TABS T3 NATAL-V RX TABS T3 NATALVIRT 90 DHA MISC T3 NATALVIRT CA MISC T3 NATALVIT TABS T3 NATELLE EZ TABS T3 NATELLE ONE CAPS T3 NATELLE-EZ TABS T3 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 214 NAVATAB + DHA Forma de dosificación MISC NEEVO MISC T3 NEEVO DHA CAPS T3 NEEVO DHA CAPS T3 NEPHPLEX RX TABS T3 NEPHRO-VITE RX TABS T3 NEPHROCAPS CAPS T3 NEPHROCAPS QT TABS T3 NESTABS TABS T3 Nombre Nivel Cobertura Comentario T3 NESTABS ABC MISC T3 NESTABS DHA MISC T3 NEWGEN TABS T3 NEXA PLUS CAPS T3 NEXA SELECT CAPS T3 NICADAN TABS T3 NICAZEL TABS T3 NICAZEL FORTE TABS T3 NICOMIDE TABS T3 NUTRI-TAB OB TABS T3 NUTRI-TAB OB + DHA MISC T3 NUTRICAP TABS T3 NUTRIVIT LIQUID T3 O-CAL PRENATAL TABS T3 OB COMPLETE TABS T3 OB COMPLETE CHEW T3 OB COMPLETE 400 CAPS T3 OB COMPLETE 400 CAPS T3 OB COMPLETE ONE CAPS T3 OB COMPLETE PETITE CAPS T3 OB COMPLETE PREMIER TABS T3 OB COMPLETE WITH DHA CAPS T3 OB COMPLETE/DHA CAPS T3 OBSTETRIX DHA MISC T3 OBSTETRIX EC TABS T3 OCUVEL CAPS T3 PAIRE OB MISC T3 PNV FERROUS FUMARATE/DOCUSATE/FOLIC ACID TABS T3 PNV OB+DHA MISC T3 PNV TABS 29-1 TABS T3 PNV-DHA CAPS T3 PNV-DHA+DOCUSATE CAPS T3 PNV-FIRST CAPS T3 PNV-OB/DHA MISC T3 PNV-OMEGA CAPS T3 PNV-SELECT TABS T3 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 215 PNV-TOTAL Forma de dosificación CAPS POLY-VI-FLOR * T3 POLY-VI-FLOR/IRON * T3 POLY-VITAMIN/IRON/FLUORIDE (35MG/ML; 400UNIT/ML; 0.5MG/ML; 10MG/ML; 8MG/ML; 0.4MG/ML; 0.6MG/ML; 0.5MG/ML; 1500UNIT/ML; 5UNIT/ML) SOLUTION T3 PR NATAL 400 MISC T3 PR NATAL 400 EC MISC T3 Nombre Nivel Cobertura Comentario T3 PR NATAL 430 MISC T3 PR NATAL 430 EC MISC T3 PR NATAL 440 EC MISC T3 PREFERA OB TABS T3 PREFERA OB + DHA MISC T3 PREFERAOB ONE CAPS T3 PREFOL-DHA CAPS T3 PRENA1 CHEW CHEW T3 PRENA1 CHEW/QUATREFOLIC CHEW T3 PRENA1 PEARL CONT.REL.CAPS T3 PRENA1 PLUS/QUATREFOLIC MISC T3 PRENA1/QUATREFOLIC CAPS T3 PRENACARE TABS T3 PRENAFIRST TABS T3 PRENAISSANCE CAPS T3 PRENAISSANCE 90 DHA MISC T3 PRENAISSANCE BALANCE CAPS T3 PRENAISSANCE DHA MISC T3 PRENAISSANCE HARMONY DHA MISC T3 PRENAISSANCE NEXT TABS T3 PRENAISSANCE NEXT-B TABS T3 PRENAISSANCE PLUS CAPS T3 PRENAISSANCE PROMISE MISC T3 PRENATA CHEW T3 PRENATABS OBN TABS T3 PRENATABS RX TABS T3 PRENATAL 19 CHEW T3 PRENATAL 19 TABS T3 PRENATAL AD TABS T3 PRENATAL MV & MIN/FE-FA-DHA CAPS T3 PRENATAL PLUS IRON TABS T3 PRENATAL-U CAPS T3 PRENATE CHEW T3 PRENATE AM TABS T3 PRENATE DHA CAPS T3 PRENATE DHA CAPS T3 PRENATE ELITE TABS T3 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 216 PRENATE ELITE Forma de dosificación TABS PRENATE ENHANCE CAPS T3 PRENATE ESSENTIAL CAPS T3 PRENATE ESSENTIAL CAPS T3 PRENATE ESSENTIAL CAPS T3 PRENATE MINI CAPS T3 PRENATE PIXIE CAPS T3 PRENATE RESTORE CAPS T3 PRENATE STAR TABS T3 Nombre Nivel Cobertura Comentario T3 PRENEXA CAPS T3 PRENEXA PREMIER CAPS T3 PREQUE 10 TABS T3 PREQUE 10 TABS T3 PROTECT PLUS * T3 PROTECT PLUS NR CAPS T3 PROTECTBONE WAFER T3 PROTECTNATAL T3 PROVIDA OB ENTERIC COATED CAPS PUREFE OB PLUS CAPS T3 QUFLORA PEDIATRIC * T3 R-NATAL OB CAPS T3 RE DUALVIT OB CAPS T3 RE OB + 90 DHA MISC T3 RE OB + DHA MISC T3 RE PRENATAL MULTIVITAMIN WITH IRON CHEW T3 RE-NATA 29 OB TABS T3 REAPHIRM CAPS T3 RELNATE DHA CAPS T3 RENATABS TABS T3 RENAX TABS T3 RENAX 5.5 TABS T3 REQ 49+ TABS T3 SE-CARE CHEW T3 SE-CARE CONCEIVE TABS T3 SE-NATAL 19 CHEW T3 SE-NATAL 19 TABS T3 SE-NATAL 90 CONT.REL.TABS T3 SE-NATAL ONE TABS T3 SE-PLETE DHA CAPS T3 T3 SE-TAN DHA CAPS T3 SELECT-OB CHEW T3 SELECT-OB CHEW T3 SELECT-OB+DHA MISC T3 SENETONIC LIQUID T3 SETON ET-EC MISC T3 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 217 SETONET Forma de dosificación MISC SIDEROL TABS T3 STROVITE TABS T3 Nombre Nivel Comentario T3 STROVITE ADVANCE TABS T3 STROVITE FORTE TABS T3 STROVITE FORTE SYRUP T3 STROVITE ONE TABS T3 SUPERVITE LIQUID T3 SUPERVITE EC ENTERIC COATED LIQUID T3 SUPPORT Cobertura T3 TANDEM DHA CAPS T3 TANDEM OB CAPS T3 TARON EC CALCIUM MISC T3 TARON-BC MISC T3 TARON-C DHA CAPS T3 TARON-DUO EC MISC T3 TARON-EC CAL T3 TARON-PREX ENTERIC COATED CAPS TL FOLATE TABS T3 TL G-FOL OS TABS T3 TL-ASSURE ONE CAPS T3 TL-ASSURE+DHA MISC T3 TL-CARE DHA CAPS T3 TL-FLUORIVITE CHEW T3 TL-SELECT CAPS T3 TL-SELECT DHA CAPS T3 TRI RX TABS T3 TRI-TABS DHA MISC T3 TRI-VI-FLOR SUSPENSION T3 TRI-VI-FLORO SUSPENSION T3 TRI-VIT/FLUORIDE/IRON SOLUTION T3 TRI-ZEL TABS T3 TRIADVANCE TABS T3 TRICARE DHA 301 CAPS T3 TRICARE PRENATAL COMPLEAT MISC T3 TRICARE PRENATAL DHA ONE CAPS T3 TRIMESIS RX TABS T3 TRINATAL GT TABS T3 TRINATAL RX 1 TABS T3 TRINATAL ULTRA TABS T3 TRINATE TABS T3 TRIPHLUORIVIT SOLUTION T3 TRIVEEN-DUO DHA MISC T3 TRIVEEN-ONE CAPS T3 T3 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 218 TRIVEEN-PRX RNF Forma de dosificación CAPS TRIVEEN-TEN TABS T3 TRIVEEN-U CAPS T3 Nombre Nivel Cobertura Comentario T3 TRUST NATAL DHA MISC T3 ULTIMATE OB DHA MISC T3 ULTIMATECARE ADVANTAGE MISC T3 ULTIMATECARE COMBO MISC T3 ULTRA TABS TABS T3 V-NATAL TABS T3 V-NATAL DHA MISC T3 VEMAVITE-PRX 2 CAPS T3 VENA-BAL DHA MISC T3 VENATAL COMPLETE DHA MISC T3 VINACAL TABS T3 VINACAL B MISC T3 VINATE AZ TABS T3 VINATE AZ EXTRA TABS T3 VINATE C TABS T3 VINATE CALCIUM TABS T3 VINATE CARE CHEW T3 VINATE DHA CAPS T3 VINATE DHA RF CAPS T3 VINATE GT TABS T3 VINATE IC CAPS T3 VINATE II TABS T3 VINATE M TABS T3 VINATE ONE TABS T3 VINATE PN CARE TABS T3 VINATE ULTRA TABS T3 VIRT NATE TABS T3 VIRT-ADVANCE TABS T3 VIRT-BAL DHA MISC T3 VIRT-BAL DHA PLUS MISC T3 VIRT-C DHA CAPS T3 VIRT-PN TABS T3 VIRT-PN DHA CAPS T3 VIRT-PN PLUS CAPS T3 VIRT-SELECT CAPS T3 VIRT-VITE GT TABS T3 VIRTPREX CAPS T3 VITA-NATAL CAPS T3 VITA-PREN TABS T3 VITAFOL ULTRA CAPS T3 VITAFOL-NANO TABS T3 VITAFOL-OB TABS T3 Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 219 VITAFOL-OB+DHA Forma de dosificación MISC VITAFOL-ONE CAPS T3 VITAFOL-PLUS CAPS T3 VITAFOL-PN TABS T3 VITAL-D RX TABS T3 VITAMEDMD ONE RX/QUATREFOLIC CAPS T3 VITAMEDMD PLUS RX/QUATRE FOLIC MISC T3 VITAMEDMD REDICHEW RX CHEW T3 VITAMEDMD REDICHEW RX/QUATREFOLIC CHEW T3 VITAPEARL CONT.REL.CAPS T3 VITAROCA PLUS TABS T3 VITASPIRE TABS T3 VIVA CT PRENATAL CHEW T3 VIVA DHA CAPS T3 VOL-NATE TABS T3 VOL-TAB RX TABS T3 Nombre Nivel Cobertura Comentario T3 VP CH ULTRA CAPS T3 VP-CH PLUS CAPS T3 VP-CH-PNV CAPS T3 VP-ERA OB PLUS TABS T3 VP-GGR-B6 PRENATAL TABS T3 VP-HEME OB TABS T3 VP-HEME OB + DHA MISC T3 VP-HEME ONE CAPS T3 VP-PNV-DHA CAPS T3 VP-ZEL TABS T3 ZATEAN-CH CAPS T3 ZATEAN-PN TABS T3 ZATEAN-PN DHA CAPS T3 ZATEAN-PN PLUS CAPS T3 ZINGIBER TABS T3 ALBAFORT INJECTION T6 infuvite INJECTION T6 infuvite adult INJECTION T6 infuvite pediatric INJECTION T6 M.V.I. ADULT INJECTION T6 M.V.I. PEDIATRIC INJECTION T6 M.V.I.-12 WITHOUT VITAMIN K INJECTION T6 NEURODEP SOLUTION T6 VITAJECT INJECTION T6 ADVANCED AM/PM MISC X L-METHYLFOLATE PNV DHA CAPS X Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 220 LEVOMEFOLATE DHA Forma de dosificación CAPS NEEVO TABS X nicotinamide w/zinc oxide/cupric oxide/folic acid TABS X Nombre Nivel Cobertura Comentario X nicotinamide/zinc oxide/cupric oxide/folic acid TABS X nicotinamide/zinc/copper/fa TABS X PNV-DHA PLUS CAPS X PNV-IRON TABS X PROTECT CARDIO CAPS X ROVIN-NV TABS X ROVIN-NV DHA CAPS X SUPPORT-500 CAPS X SYNAGEX CAPS X SYNATEK CAPS X tl nicotinamide TABS X urosex TABS X SOLUTION T6 airavite TABS T1 fabb TABS T1 folbee TABS T1 folcaps TABS T1 folic acid TABS T1 folic acid/vitamin b-6/vitamin b-12 TABS T1 folplex 2.2 TABS T1 mi-omega nf CAPS T1 nufol TABS T1 tl gard rx TABS T1 virt-vite TABS T1 AMINOBENZOATE POTASSIUM PACK T2 B-6 FOLIC ACID CAPS T2 BP VIT 3 CAPS T2 CIFEREX CAPS T2 Vitamin A AQUASOL A PARENTERAL Non-self administerable injectable Vitamin B Complex FOLPACE RX TABS T2 METHYL-MAX CAPS T2 NEURIN-SL SUBLINGUAL T2 NIACOR TABS T2 POTABA * T2 PRE-FOLIC TABS T2 ANIMI-3 CAPS T3 FOLGARD RX TABS T3 NASCOBAL SOLUTION T3 b-complex INJECTION T6 b-complex 100 SOLUTION T6 Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 221 cobal-1000 Forma de dosificación SOLUTION cyanocobalamin SOLUTION T6 DEXPANTHENOL SOLUTION T6 FOLIC ACID SOLUTION T6 HYDROXOCOBALAMIN SOLUTION T6 PYRIDOXINE HCL SOLUTION T6 thiamine hcl SOLUTION T6 vitamin b-complex 100 INJECTION T6 ALZ-NAC TABS X ANIMI-3 CAPS X ANIMI-3/VITAMIN D CAPS X CARDIOTEK-RX TABS X cavan-x TABS X CENFOL TABS X CEREFOLIN TABS X CEREFOLIN NAC TABS X CEREFOLIN NAC TABS X CYANOCOBALAMIN/LEVOMEFOLATE CALCIUM/PYRIDOXINE HCL DIVISTA TABS X CAPS X DULEEK-DP TABS X DULEEK-MET NEW TABS X endur-acin CONT.REL.TABS X enfolast TABS X ENFOLAST-N TABS X FOLAST TABS X Nombre Nivel T6 folastin TABS X FOLBEE AR TABS X folbic TABS X FOLBIC RF TABS X folic acid TABS X FOLTANX TABS X FOLTANX RF CAPS X FOLTX TABS X FOLTX TABS X L-METHYL-B6-B12 TABS X L-METHYL-MC TABS X L-METHYL-MC NAC TABS X L-METHYLFOLATE CA ME-CBL NAC TABS X L-METHYLFOLATE CA/ME-CBL/NAC TABS X L-METHYLFOLATE CA/P-5-P/ME-CBL TABS X L-METHYLFOLATE CA/P-5-P/ME-CBL CAPS X Cobertura Comentario Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 222 Nombre LEVOMEFOLATE CALCIUM/ACETYLCYSTEINE/MECOBALAMIN/ALGAL POWDER LEVOMEFOLATE CALCIUM/PYRIDOXAL PHOSPHATE/MECOBALAMIN/ALGAL LMTHF/PYRIDOXINE HCL/CYANOCOBALAMIN Forma de dosificación TABS Nivel Cobertura Comentario X CAPS X TABS X METAFOLBIC TABS X METAFOLBIC PLUS TABS X METAFOLBIC PLUS RF TABS X METANX TABS X METANX CAPS X METHYLFOL-ALGAE-B12-ACETYLCYST TABS X NEURPATH-B TABS X niacin * X NIACIN POWDER X niacin TABS X niacin cr CONT.REL.CAPS X niacin er * X niacin pr CONT.REL.TABS X niacin sr * X niacin td * X niacin time release CONT.REL.TABS X NIACIN TR * X niacin tr * X niacin-50 TABS X niacinamide TABS X NIACINAMIDE PROLONGED RELEASE CONT.REL.TABS X PHYSICIANS EZ USE B-12 COMPLIANCE KIT KIT X PODIAPN CAPS X rovin-cf of TABS X SLO-NIACIN CONT.REL.TABS X slo-niacin CONT.REL.TABS X TRIVEEN-CF NAC TABS X virt-vite forte TABS X VITA-RESPA TABS X VITACIRC-B TABS X ascor l 500 SOLUTION T6 ascor l nc SOLUTION T6 ascorbic acid SOLUTION T6 cenolate SOLUTION T6 mega-c/a plus SOLUTION T6 ortho-cs 250 SOLUTION T6 vitamin c 222mg SOLUTION T6 Vitamin C Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 223 ASCORBIC ACID (0) Forma de dosificación GRAN ASCORBIC ACID (0) GRAN X calcitriol * T1 doxercalciferol CAPS T1 ergocalciferol CAPS T1 paricalcitol CAPS T1 vitamin d CAPS T1 DRISDOL CAPS T3 HECTOROL CAPS T3 ROCALTROL * T3 ZEMPLAR CAPS T3 CALCIJEX SOLUTION T6 CALCITRIOL SOLUTION T6 calcitriol SOLUTION T6 doxercalciferol SOLUTION T6 HECTOROL SOLUTION T6 ZEMPLAR SOLUTION T6 DECARA CAPS X decara CAPS X Nombre Nivel Cobertura Comentario X Vitamin D Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Vitamin E octacosanol CAPS X WHEAT GERM OIL X WHEAT GERM OIL CAPS X MEPHYTON TABS T2 phytonadione SOLUTION T6 VITAMIN K1 SOLUTION T6 vitamin k1 SOLUTION T6 Vitamin K Activity Non-self administerable injectable Non-self administerable injectable Non-self administerable injectable Puede encontrar información sobre lo que los símbolos y abreviaturas en esta tabla significan por ir a las páginas de introducción de este documento 224 ÍNDICE 1/2halfprin, 68 50% urea nail stick, 198 8-MOP, 196 A A.A.G.C. KIT IN TERODERM, 205 A1C NOW, 93 abacavir, 18 abacavir sulfate/lamivudine/zidovudine, 18 abatuss dmx, 163 ABELCET, 16 ABILIFY, 84, 85 ABILIFY DISCMELT, 84 ABILIFY MAINTENA, 85 ABRAXANE, 31 ABSORICA, 205 ABSTRAL, 68 acamprosate calcium dr, 81 ACANYA, 184 acarbose, 135 ACCOLATE, 162 ACCU-CHEK ACTIVE CARE KIT, 93 ACCU-CHEK ACTIVE STRIPS, 100 ACCU-CHEK ADVANTAGE DIABETES CARE KIT, 93 ACCU-CHEK AVIVA, 93, 100 ACCU-CHEK AVIVA PLUS, 93, 100 ACCU-CHEK COMFORT CURVE TEST STRIPS, 100 ACCU-CHEK COMPACT PLUS, 93, 100 ACCU-CHEK COMPACT PLUS CARE KIT, 93 ACCU-CHEK COMPACT TEST DRUM, 100 ACCU-CHEK INSTANT GLUCOSE, 100 ACCU-CHEK INSTANT PLUS, 100 ACCU-CHEK NANO SMARTVIEW, 93 ACCU-CHEK SMARTVIEW STRIPS, 100 ACCU-CHEK VOICEMATE, 93 ACCUHIST, 22, 163 ACCUHIST DM PEDIATRIC, 163 ACCUHIST PDX, 163 ACCUNEB, 41 ACCUPRIL, 58 ACCURETIC, 58 ACCUTREND GLUCOSE, 100 ACD FORMULA A, 48 ACD FORMULA B, 48 ACD-A, 48 ACD-A NOCLOT-50, 48 ACE AEROSOL CLOUD ENHANCER, 87 acebutolol hcl, 52 ACEON, 58 ACETADOTE, 150 aceta-gesic, 22 ACETAMINOPHEN/CAFFEINE/DIHYDROCODEINE BITARTRATE, 64 acetaminophen/codeine, 62 acetaminophen/codeine #2, 62 acetaminophen/codeine #3, 62 acetaminophen/codeine #4, 62 acetaminophen/codeine phosphate, 62 acetasol hc, 120 ACETAZOLAMIDE (125MG), 123 acetazolamide (250mg), 123 acetazolamide er, 123 acetazolamide sodium, 124 acetic acid, 110, 124 acetic acid 0.25%, 110 ACETIC ACID/ALUMINUM ACETATE, 124 acetylcysteine, 149, 150 ACID JELLY, 187 Acidifying Agents, 104 ACIPHEX, 130 ACIPHEX SPRINKLE, 130 acitretin, 205 ACLARO, 196 ACLARO PD, 196 ACLOVATE, 191 ACTEMRA, 153 ACTHAR HP, 145 ACTHIB, 179 acticin, 182 ACTICLATE, 14 actifed cold & allergy, 22 ACTIFOAM COLLAGEN SPONGE 12.7CM X 8.9CM X 0.6CM, 46 ACTIFOAM COLLAGEN SPONGE 7.0CM X 5.0CM X 0.6CM, 46 ACTIGALL, 131 ACTIMMUNE, 153 ACTIQ, 68 ACTIVASE, 49 ACTIVE-CYCLOBENZAPRINE KIT, 40 ACTIVE-KETOPROFEN KIT, 192 ACTIVELLA, 144 ACTIVE-PAC/GABAPENTIN, 69 ACTIVE-PREP KIT I, 205 ACTIVE-PREP KIT II, 205 ACTIVE-PREP KIT III, 205 ACTIVE-PREP KIT IV, 205 ACTIVE-PREP KIT V, 187 ACTIVE-TRAMADOL KIT, 205 ACTIVITY POUCH, 87 ACTONEL (150MG), 150 ACTONEL (30MG), 150 ACTONEL (35MG), 150 ACTONEL (5MG), 150 ACTOPLUS MET, 136, 137 ACTOPLUS MET XR, 136 ACTOS, 137 ACUFLEX, 22 ACULAR, 122 ACULAR LS, 122 ACUNOL, 156 ACURA BLOOD GLUCOSE MONITORING SYSTEM METER KIT, 93 ACURA BLOOD GLUCOSE MONITORING SYSTEM STARTER KIT, 94 ACURA BLOOD GLUCOSE TEST STRIPS, 100 ACURA PLUS BLOOD GLUCOSE MONITORING SYSTEM METER KIT, 94 225 ACURA PLUS BLOOD GLUCOSE MONITORING SYSTEM STARTER KIT, 94 ACUVAIL, 122 acyclovir, 18, 20, 182 acyclovir sodium, 20 ACYCLOVIR SODIUM, 20 ACZONE, 203 ADACEL, 178 ADAGEN, 118 ADALAT CC, 54 adapalene, 202 ADASUVE, 85 ADCETRIS, 31 ADCIRCA, 61 ADDAMEL N, 113 ADDERALL, 73 ADDERALL XR, 73 adefovir dipivoxil, 19 ADEMPAS, 177 ADENOCARD, 56 adenosine, 56 ADIPEX-P, 74 ADOXA, 14, 15 ADOXA CK, 15 ADOXA PAK 1/100, 15 ADOXA PAK 1/150, 15 ADOXA PAK 1/75, 15 ADOXA PAK 2/100, 15 ADOXA TT, 15 ADRENACLICK, 41 ADRENAL C FORMULA, 212 ADRENALIN, 41, 126 Adrenals, 132 adriamycin, 31 ADRIAMYCIN, 31 adrucil, 31 ADULT ASPIRIN LOW STRENGTH, 69 ADULT MASK, 87 ADULT MASK LARGE, 87 ADVAIR DISKUS, 41 ADVAIR HFA, 41 ADVANCE INTUITION BLOOD GLUCOSE METER, 94 ADVANCE INTUITION BLOOD GLUCOSE MONITORING SYSTEM, 94 ADVANCE INTUITION TEST STRIPS, 100 ADVANCE MICRO-DRAW METER, 94 ADVANCE MICRO-DRAW TEST STRIPS, 100 ADVANCED AM/PM, 220 ADVATE, 47 ADVICOR, 51 ADVIL ALLERGY & CONGESTION, 22 ADVIL ALLERGY SINUS, 22 ADVOCATE BLOOD GLUCOSE MONITORING SYSTEM, 94 ADVOCATE BLOOD GLUCOSE MONITORING SYSTEM/TALKING, 94 ADVOCATE REDI-CODE, 94, 100 ADVOCATE REDI-CODE/TALKING, 94 ADVOCATE REDI-CODE+ BLOOD GLUCOSE SYSTEM/SPEAKING, 94 ADVOCATE REDI-CODE+ BLOODGLUCOSE MONITORING SYSTEM, 94 ADVOCATE REDI-CODE+ TEST STRIPS, 100 ADVOCATE REDI-CODE+/ TALKING, 94 ADVOCATE TEST STRIPS, 100 aero otic hc, 120 AEROCHAMBER MINI AEROSOL CHAMBER, 87 AEROCHAMBER MV, 87 AEROCHAMBER PLUS FLOW VU, 87 AEROCHAMBER PLUS FLOW-VU, 87 AEROCHAMBER PLUS FLOW-VU/LARGE MASK, 87 AEROCHAMBER PLUS FLOW-VU/MASK, 87 AEROCHAMBER PLUS FLOW-VU/MEDIUM MASK, 87 AEROCHAMBER PLUS FLOW-VU/SMALL MASK, 87 AEROCHAMBER Z-STAT PLUS VALVED HOLDING CHAMBER W/FLOW VU, 87 AEROCHAMBER Z-STAT PLUS/FLOWSIGNAL, 88 AEROCHAMBER Z-STAT PLUS/LARGE MASK, 88 AEROCHAMBER Z-STAT PLUS/MEDIUM MASK, 88 AEROCHAMBER Z-STAT PLUS/SMALL MASK, 88 AEROCHAMBER/FLOWSIGNAL, 88 AEROECLIPSE II BREATH ACTUATED NEBULIZER DISPOSABLE, 88 AEROGEAR ASTHMA ACTION, 88 AEROHIST, 22 AEROKID, 22 AERONEB GO COMPLETE SYSTEM, 88 AERONEB GO CONVENIENCE UNIT, 88 AERONEB GO NEBULIZER HANDSET, 88 AERONEB GO NEBULIZER HANDSET/CONNECTOR CABLE, 88 AEROSPAN, 133 AEROTRACH PLUS, 88 afeditab cr, 54 AFINITOR, 30 AFINITOR DISPERZ, 30 AFLURIA 2009-2010, 179 AFLURIA 2011-2012, 179 AFLURIA 2012-2013, 179 AFLURIA 2013-2014, 179 AFLURIA 2014-2015, 179 AFLURIA PF 2010-2011, 179 AFLURIA PF 2011-2012, 179 AFLURIA PF 2012-2013, 179 AFLURIA PF 2013-2014, 179 AFLURIA PF 2014-2015, 179 AGAMATRIX AMP NO CODE ADVANCED BLOOD GLUCOSE MONITORING SYST, 94 AGAMATRIX AMP NO CODE TEST STRIPS, 100 AGAMATRIX JAZZ, 94, 100 AGAMATRIX JAZZ TEST STRIPS, 100 AGAMATRIX KEYNOTE TEST STRIPS, 100 AGAMATRIX PRESTO, 94, 100 AGAMATRIX PRESTO PRO METER, 94 AGAMATRIX PRESTO TEST STRIPS, 100 AGGRASTAT, 49 AGGRENOX, 48 AGRIFLU 2010-2011, 179 AGRYLIN, 48 A-HYDROCORT, 134 AIF #2 DRUG PREPARATION KIT, 205 AIF #3 DRUG PREPARATION KIT, 205 AIR WATCH MONITOR, 88 AIRACOF, 163 airavite, 221 226 AIRIAL COMPACT COMPRESSORNEBULIZER SYSTEM, 88 AIRIAL COMPACT MINI NEBULIZER, 88 AIRIAL COMPARTMENT COMPRESSOR PEDIATRIC NEBULIZER, 88 AIRIAL PEDIATRIC NEBULIZER/BUILDING BLOCK, 88 AIRIAL PEDIATRIC NEBULIZER/DUCK, 88 AIRIAL PEDIATRIC NEBULIZER/FIRE ENGINE, 88 AIRIAL PEDIATRIC NEBULIZER/PANDA, 88 AIRIAL PEDIATRIC NEBULIZER/PENELOPE PANDA, 88 AIRIAL PEDIATRIC NEBULIZER/PENGUIN, 88 AIRIAL VOYAGER PORTABLE NEBULIZER, 88 AIRS DISPOSABLE NEBULIZER KIT, 88 AIRS DISPOSABLE NEBULIZERKIT, 88 AKNE-MYCIN, 184 akorn balanced salt solution, 124 ak-pentolate, 126 ak-poly-bac, 119 AKTEN, 126 AKYNZEO, 128 ala cort, 189 ALA QUIN, 184 ALA SCALP, 191 ALACOL, 22, 163 ALACOL DM, 163 ala-cort, 189 ALAMAST, 122 alavert allergy/sinus, 29 ALBAFORT, 46, 220 ALBATUSSIN, 162, 163 albatussin nn, 163 ALBATUSSIN NN, 162 ALBENZA, 8 albuked 25, 43 albuked 5, 43 albumin human, 43 albuminar-25, 43 albuminar-5, 43 albumin-zlb, 43 alburx, 43 albutein, 43 albuterol sulfate, 40 albuterol sulfate er, 40 ALCAINE, 126 alclometasone dipropionate, 189 ALCOHOL 5%/DEXTROSE 5%, 105 ALCOHOL ABSOLUTE, 105 Alcohol Deterrents, 149 ALCORTIN A, 187 ALDACTAZIDE, 58 ALDACTONE, 58 ALDARA, 203 ALDEX D, 22, 163 ALDEX DM, 163 ALDEX GS, 163, 174 ALDEX GS DM, 163 ALDEX-CT, 22 ALDURAZYME, 118 ALENAZE-D, 22 alenaze-d nr, 22 ALENDRONATE SODIUM, 150 alendronate sodium (10mg), 150 alendronate sodium (35mg), 150 ALENDRONATE SODIUM (40MG), 150 alendronate sodium (5mg), 150 alendronate sodium (70mg), 150 ALEVEER, 194 ALEVICIN, 156 ALEVICYN ANTIPRURITIC GEL, 205 ALEVICYN DERMAL SPRAY, 205 ALFENTA, 67 alfentanil, 67 ALFERON N, 31 alfuzosin hcl er, 40 aliclen, 198 ali-flex, 22 ALIMTA, 31 ALINIA, 17 Alkalinizing Agents, 104 ALKA-SELTZER PLUS COLD, 22 alka-seltzer plus mucus & congestion break up formula, 163 ALKERAN, 30, 31 all day allergy-d, 29 ALL FLOW 1000 PFT FILTER, 88 ALL FLOW 1000 PULMONARY FUNCTION FILTER, 88 ALL FLOW 2000 PFT FILTER, 88 ALL FLOW 3000 PFT FILTER, 88 ALL FLOW 4000 PFT FILTER, 88 ALL FLOW 5000 PFT FILTER, 88 ALL FLOW 6000 PFT FILTER, 88 ALL FLOW 7000 PFT FILTER, 88 allanenzyme, 205 ALLANENZYME, 205 ALLANFILLENZYME, 206 allantan pediatric, 22 allanvan-dm, 163 ALLEGRA, 29 ALLEGRA ODT, 29 ALLEGRA-D 12 HOUR, 29 ALLEGRA-D 12 HOUR ALLERGY & CONGESTION, 29 ALLEGRA-D 12 HOUR ALLERGY& CONGESTION, 29 ALLEGRA-D 24 HOUR, 29 ALLEGRA-D 24 HOUR ALLERGY & CONGESTION, 29 ALLEGRA-D 24 HOUR ALLERGY& CONGESTION, 29 allergy multi-symptom, 22 allergy relief/nasal decongestant, 29 ALLERSCRIPT, 22 ALLERX DF, 22 ALLERX DF 30, 22 ALLERX DOSE PACK, 22 ALLERX PE, 22 ALLERX-D, 42 ALLEVYN AG ADHESIVE, 206 ALLEVYN AG GENTLE, 203, 206 ALLEVYN AG GENTLE BORDER, 206 ALLEVYN AG NON-ADHESIVE, 206 ALLEVYN AG SACRUM, 206 ALLEVYN GENTLE, 206 allopurinol, 150 allopurinol sodium, 150 ALOCRIL, 122 ALODOX CONVENIENCE KIT, 9 ALOMIDE, 122 ALOPRIM, 150 227 ALOQUIN, 184 ALORA, 144 ALOXI, 128 ALPAIN, 22 alpha‐Adrenergic Blocking Agents, 51 ALPHAGAN P (0.1%), 123 ALPHAGAN P (0.15%), 123 ALPHANATE/VON WILLEBRAND FACTOR COMPLEX/HUMAN, 47 ALPHANINE SD, 47 alphaquin hp, 196 alphatrex, 189 alprazolam, 79 alprazolam er, 79 ALPRAZOLAM INTENSOL, 79 alprazolam odt, 79 alprazolam xr, 79 ALPROLIX, 48 alprostadil, 61 ALREX, 121 ALSUMA, 78 ALTABAX, 187 altacaine, 125 ALTACE, 59 altafrin, 126 altarussin, 163, 174 altarussin dm, 163 altarussin-pe, 174 altaryl, 22 altavera, 139 ALTOPREV, 52 ALUSTRA, 196 ALUVEA (39%), 199 aluvea (40%), 198 ALUVEA (43%), 201 ALVESCO, 133 alyacen 1/35, 139 alyacen 7/7/7, 139 ALZ-NAC, 222 amantadine hcl, 78 AMANTADINE HCL, 78 AMARYL, 137 AMBIEN, 80, 81 AMBIEN CR, 81 AMBISOME, 16 AMCINONIDE, 191 amcinonide (0.1%), 189 AMCINONIDE (0.1%), 191 amdry-c, 22 AMERGE, 77 AMERIGEL WOUND DRESSING, 206 a-methapred, 134 amethia, 139 amethia lo, 139 AMETHYST, 141 AMEVIVE, 205 AMICAR, 46 AMIDATE, 82 amifostine, 160 amikacin sulfate, 11 AMIKACIN SULFATE, 11 amiloride hcl, 109 amiloride/hydrochlorothiazide, 109 amino acids, 105 aminoacetic acid, 110 AMINOBENZOATE POTASSIUM, 221 aminocaproic acid, 46, 47 AMINOCAPROIC ACID (1000MG), 46 aminocaproic acid (500mg), 46 aminophylline, 210 AMINOPHYLLINE, 210 AMINOSYN, 105, 106 AMINOSYN 7%/ELECTROLYTES, 105 aminosyn 8.5%/electrolytes, 105 AMINOSYN II, 106 AMINOSYN II 3.5%/DEXTROSE25%, 106 AMINOSYN II 3.5%/DEXTROSE5%, 106 AMINOSYN II 3.5/DEXTROSE 25%, 106 AMINOSYN II 4.25/DEXTROSE10%, 106 AMINOSYN II 4.25/DEXTROSE20%, 106 AMINOSYN II 4.25/DEXTROSE25%, 106 AMINOSYN II 5/DEXTROSE 25, 106 aminosyn ii 8.5%/electrolytes, 106 AMINOSYN II M 3.5%/DEXTROSE 5%, 106 AMINOSYN II M 4.25/DEXTROSE 10%, 106 AMINOSYN M, 106 AMINOSYN-HBC, 106 aminosyn-hf, 106 AMINOSYN-PF, 106 AMINOSYN-PF 7%, 106 AMINOSYN-RF, 106 amiodarone hcl, 55, 56 AMIODARONE HCL, 56 AMITIZA, 131 amitriptyline hcl, 82 amlodipine besylate, 54, 55 amlodipine besylate/atorvastatin calcium, 54 amlodipine besylate/benazepril hcl, 54 amlodipine besylate/benazepril hydrochloride, 54 amlodipine besylate/valsartan, 55 Ammonia Detoxicants, 105 AMMONIUM CHLORIDE, 104 ammonium lactate, 197 AMMONIUM MOLYBDATE, 113 AMMONUL, 105 amnesteem, 205 AMOXAPINE, 84 amoxicillin, 8 AMOXICILLIN (125MG), 9 AMOXICILLIN (200MG), 9 amoxicillin (250mg), 8 AMOXICILLIN (250MG), 9 AMOXICILLIN (400MG), 9 AMOXICILLIN ER, 15 amoxicillin/clavulanate potassium, 8 amoxicillin/clavulanate potassium er, 8 amoxicillin/potassium clavulanate, 8 AMPHADASE, 118 amphetamine/dextroamphetamine, 73 AMPHOTEC, 16 AMPHOTERICIN B, 16 ampicillin, 8, 11 AMPICILLIN, 9, 11 228 ampicillin sodium, 11 AMPICILLIN SODIUM, 11 ampicillin-sulbactam, 11 AMPICILLIN-SULBACTAM, 11 AMPYRA, 156 AMRIX, 40 AMTURNIDE, 59 AMVISC, 124 AMVISC PLUS, 124 AMYL NITRITE, 61 AMYTAL SODIUM, 80 AMYVID, 161 ANABAR, 69 ANACAINE, 194 anacin, 69 ANACIN, 69 ANACIN MAX STRENGTH, 69 ANADROL-50, 135 ANAFRANIL, 84 anagrelide hydrochloride, 48 ana-lex, 194 Analgesics and Antipyretics, 62 ANALPRAM ADVANCED, 194 ANALPRAM E, 194 ANALPRAM-HC, 194 ANALPRAM-HC SINGLES, 194 ANAMANTLE HC, 194 ANAMANTLE HC FORTE, 194 ANAPROX, 65 ANAPROX DS, 65 ANASCORP, 177 ANASPAZ, 37 anastrozole, 29 ANCOBON, 16 ANDRODERM (2.5MG/24HR), 135 ANDRODERM (2MG/24HR), 135 ANDRODERM (4MG/24HR), 135 ANDRODERM (5MG/24HR), 135 ANDROGEL, 135 ANDROGEL PUMP, 135 Androgens, 135 ANDROID, 135 ANDROXY, 135 ANECTINE, 39 ANGELIQ, 143 ANGIOMAX, 49 ANHYDROUS BASE, 160 ANHYDROUS CREAM BASE, 160 ANIMI-3, 221, 222 ANIMI-3/VITAMIN D, 222 anolor 300, 62 Anorexigenic Agents and Respiratory and CNS Stimulants, 73 ANORO ELLIPTA, 37 ANTABUSE, 149 Antacids and Adsorbents, 127 ANTARA, 51 Anthelmintics, 8 Antiallergic Agents, 122 Antianemia Drugs, 44 Antibacterials, 8 Anticholinergic Agents, 36 ANTICOAGULANT CITRATE DEXTROSE SOLUTION A, 48 ANTICOAGULANT CITRATE PHOSPHATE DEXTROSE SOLUTION, 48 ANTICOAGULANT SODIUM CITRATE, 48 Anticonvulsants, 74 Antidiabetic Agents, 135 Antidiarrhea Agents, 127 Antidotes, 149 Antiemetics, 127 antifungal, 187 Antifungals, 15 Antiglaucoma Agents, 123 Antigout Agents, 150 Antihemorrhagic Agents, 46 Antihistamine Drugs, 21 Antihypoglycemic Agents, 138 Anti‐infective Agents, 8 Anti‐infectives, 119, 182 Anti‐inflammatory Agents, 120, 127, 161, 189 anti-itch clear, 194 Antilipemic Agents, 51 Antimanic Agents, 77 Antimigraine Agents, 77 Antimycobacterials, 16 Antineoplastic Agents, 29 Antiparkinsonian Agents, 78 Antiprotozoals, 17 Antipruritics and Local Anesthetics, 193 Antithrombotic Agents, 48 Antitussives, 162 Antiulcer Agents and Acid Suppressants, 128 ANTIVENIN LATRODECTUS MACTANS, 177 ANTIVENIN MICRURUS FULVIUS, 177 ANTIVERT, 128 Antivirals, 18 ANTIZOL, 150 anucort-hc, 189 ANUSOL-HC, 191 Anxiolytics, Sedatives, and Hypnotics, 79 ANZEMET, 128 apexicon, 189 APEXICON E, 191 ap-hist dm, 163 APHTHASOL, 125 APIDRA, 137 APIDRA SOLOSTAR, 137 APLENZIN, 85 APLIGRAF, 156 APOKYN, 79 APOP, 184 APOTHEDERM, 160 APPBUTAMONE, 85 APPBUTAMONE-D, 85 APPFORMIN, 138 APPFORMIN-D, 138 APPTRIM, 108 APPTRIM LIFESTYLES OBESITY MANAGEMENT, 108 APPTRIM LIFESTYLES POST-BARIATRIC, 108 APPTRIM LIFESTYLES PRE-BARIATRIC, 108 APPTRIM-D, 108 apraclonidine, 124 apri, 139 229 APRISO, 127 APTIOM, 75 APTIVUS, 18 AP-ZEL, 212 AQUA GLYCOLIC HC SCALP & BODY, 193 AQUASOL A PARENTERAL, 221 AQUORAL, 125 ARALAST NP, 177 ARALEN, 17 aranelle, 139 ARANESP ALBUMIN FREE, 50 ARAVA, 152 arbinoxa, 21 ARCALYST, 155 ARCAPTA NEOHALER, 41 AREDIA, 151 ARESTIN, 120 argatroban, 49 ARGATROBAN, 49 ARGENTUM METALLICUM 8X, 156 ARGENTUM-D20, 156 argyle sterile saline 100ml, 110 argyle sterile water 100ml, 110 ARICEPT (10MG), 38 ARICEPT (23MG), 38 ARICEPT (5MG), 38 ARICEPT ODT, 38 ARIMIDEX, 30 ARISTOSPAN INTRA-ARTICULAR, 134 ARISTOSPAN INTRALESIONAL, 134 ARIXTRA, 49 ARMOUR THYROID, 147 ARNICA FLOWER, 206 AROMASIN, 30 ARRANON, 31 ARTHROTEC 50, 65 ARTHROTEC 75, 65 ARTICADENT DENTAL, 149 ARTISS, 206 ARZERRA, 31 ARZOL SILVER NITRATE APP LICATORS, 120 ASACOL, 127 ASACOL HD, 127 ASCENSIA AUTODISC TEST STRIPS, 100 ASCLERA, 60 ascomp/codeine, 62 ascor l 500, 223 ascor l nc, 223 ascorbic acid, 223 ASCORBIC ACID (0), 224 asmalpred, 132, 133 asmalpred plus, 133 ASMANEX TWISTHALER 120 METERED DOSES, 132 ASMANEX TWISTHALER 14 METERED DOSES, 132 ASMANEX TWISTHALER 30 ME TERED DOSES, 132 ASMANEX TWISTHALER 30 METERED DOSES, 132 ASMANEX TWISTHALER 60 METERED DOSES, 132 ASMANEX TWISTHALER 7 METERED DOSES, 132 asp 300/200/20, 62 aspir-81, 69 aspirin, 69 ASPIRIN, 64, 69 aspirin adult low strength, 69 aspirin childrens, 69 aspirin ec, 69 aspirin ec low dose, 69 aspirin ec low strength, 69 aspirin enteric coated adult low strength, 69 aspirin low dose, 69 ASPIRIN LOW DOSE, 69 aspirin low strength, 69 ASPIRIN-CAFFEINE-DIHYDROCODEINE, 64 aspir-low, 69 aspirtab, 69 aspirtab maximum strength, 69 aspir-trin, 69 ASSURE 3 METER, 94 ASSURE 3 TEST STRIPS, 100 ASSURE 4 BLOOD GLUCOSE METER, 94 ASSURE 4 TEST STRIPS, 100 ASSURE II, 100, 101 ASSURE II CHECK STRIP, 100 ASSURE II TEST STRIPS, 101 ASSURE PLATINUM BLOOD GLUCOSE METER, 94 ASSURE PLATINUM TEST STRIPS, 101 ASSURE PRO BLOOD GLUCOSE METER, 94 ASSURE PRO TEST STRIPS, 101 ASTAGRAF XL, 154 ASTELIN, 123 ASTEPRO, 123 ASTHMA CONTROL KIT, 88 ASTHMA RX, 156 ASTHMAPACK I, 88 ASTHMAPACK II, 88 ASTHMAPACK III, 88 astramorph, 67 Astringents, 195 ASTRINGYN, 46 AT LAST BLOOD GLUCOSE SYSTEM, 94 AT LAST TEST STRIPS, 101 ATABEX EC, 212 ATABEX PRENATAL, 212 ATACAND, 59 ATACAND HCT, 59 ATELVIA, 151 atenolol, 52 atenolol/chlorthalidone, 52 ATGAM, 154 ATIVAN, 80 ATOPICLAIR, 197 atorvastatin calcium, 51 atovaquone, 17, 18 atovaquone/proguanil hcl, 17 atracurium besylate, 39 ATRALIN, 195 ATRAPRO ANTIPRURITIC HYDROGEL, 206 ATRAPRO CP, 206 ATRAPRO DERMAL SPRAY, 206 ATRIPLA, 19 ATROPEN, 37 atropine sulfate, 37, 126 ATROPINE SULFATE, 37, 126 230 atropine-care, 126 ATROPINUM COMPOSITUM, 156 ATROVENT, 37 ATROVENT HFA, 37 ATRYN, 49 ATUSS DS, 163 AUBAGIO, 154 aubra, 139 augmented betamethasone dipropionate, 189 AUGMENTIN, 9, 10 AUGMENTIN ES-600, 9 AUGMENTIN XR, 10 AURALGAN, 125, 126 aurax, 125 aurodex, 125 AURSTAT, 197, 206 AURSTAT ANTI-ITCH HYDROGEL, 206 AURSTAT ANTI-ITCH HYDROGEL KIT, 206 AURUM, 156 AURUMHEEL, 156 Autonomic Drugs, 36, 38 Autonomic Drugs, Miscellaneous, 38 AUVI-Q, 41 AVAGE, 206 AVAILNEX, 156 AVALIDE, 59 AVANDAMET, 137 AVANDARYL, 138 AVANDIA, 138 AVAPRO, 59 AVAR, 199, 200 AVAR LS, 199 AVAR LS CLEANSER, 199 AVAR-E LS, 200 AVASTIN, 31 AVC, 184 AVEED, 135 AVELOX, 10, 11 AVELOX ABC PACK, 10 aviane, 139 avidoxy, 15 AVIDOXY DK, 15 AVINZA, 65 avita, 195 AVITENE FLOUR, 46 AVITENE SHEET/35MM X 35MM, 46 AVITENE SHEET/70MM X 35MM, 46 AVITENE SHEET/70MM X 70MM, 46 AVO CREAM, 203 AVODART, 149 AVONEX, 153 AVONEX PEN, 153 AXERT, 77 AXID, 129 AXIRON, 135 AXONA, 108 AYGESTIN, 146 azacitidine, 31 AZACTAM, 11 AZACTAM IN ISO-OSMOTIC DEXTROSE, 11 AZASAN, 154 AZASITE, 119 azathioprine, 154 AZATHIOPRINE SODIUM, 154 azelastine hcl, 122, 123 AZELEX, 203 AZILECT, 78 azithromycin, 8, 11 AZITHROMYCIN, 10, 11 AZOPT, 123 AZOR, 55 aztreonam, 11 AZULFIDINE, 10 AZULFIDINE EN-TABS, 10 azurette, 139 B B-6 FOLIC ACID, 221 baciim, 11 bacitracin, 11, 119 BACITRACIN, 11, 119 bacitracin/polymyxin b, 119 baclofen, 39 BACMIN, 212 bacteriostatic sodium chloride, 113 BACTOCILL IN DEXTROSE, 11 BACTRIM, 10 BACTRIM DS, 10 BACTROBAN, 184 BACTROBAN NASAL, 184 BAL IN OIL, 132 balacall dm, 163 BALAMINE DM, 163 balanced salt, 124 balanced salt solution, 124 BAL-CARE DHA, 212 BAL-CARE DHA ESSENTIAL, 212 BALNETAR LIQUIM, 201 balsalazide disodium, 127 BALTUSSIN, 163 balziva, 139 BAND-AID CALAMINE SPRAY, 194 BANZEL, 75 BARACLUDE, 19 baycadron, 132 bayer advanced aspirin extra strength, 69 bayer advanced aspirin regular strength, 69 bayer aspirin, 69 BAYER ASPIRIN, 69 bayer aspirin ec low dose, 69 bayer aspirin regimen, 69 BAYER BACK & BODY PAIN EXTRA STRENGTH, 69 BAYER BREEZE 2 BLOOD GLUCOSE MONITORING SYSTEM, 88 BAYER BREEZE 2 TEST DISC, 100 bayer chewable low dose, 69 BAYER CONTOUR BLOOD GLUCOSE MONITORING SYSTEM, 88 BAYER CONTOUR BLOOD GLUCOSE TEST STRIPS, 100 BAYER CONTOUR LINK BLOOD GLUCOSE MONITORING SYSTEM, 88 BAYER CONTOUR NEXT BLOOD GLUCOSE MONITORING SYSTEM, 88 231 BAYER CONTOUR NEXT BLOOD GLUCOSE TEST, 100 BAYER CONTOUR NEXT EZ BLOOD GLUCOSE MONITORING SYSTEM, 89 BAYER CONTOUR NEXT LINK BLOOD GLUCOSE MONITORING SYSTEM, 89 BAYER CONTOUR NEXT USB BLOOD GLUCOSE MONITORING SYSTEM, 89 BAYER CONTOUR USB BLOOD GLUCOSE MONITORING SYSTEM, 89 BAYER HEART ADVANTAGE, 69 bayer low dose, 69 bayer low strength, 69 baza antifungal, 187 BC FAST PAIN RELIEF, 69 BC FAST PAIN RELIEF ARTHRITIS STRENGTH, 69 BCG VACCINE, 179 b-complex, 221 b-complex 100, 221 BD LATITUDE DIABETES MANAGEMENT SYSTEM, 94 BD LOGIC BLOOD GLUCOSE MONITOR, 94 bd posiflush, 113 BD PUDENDAL/LOCAL BLOCK TRAY 1% LIDOCAINE, 148 BEBULIN, 47 BEBULIN VH, 47 BECONASE AQ, 122 be-flex plus, 62 BELEODAQ, 32 BELLADONNA & OPIUM, 37 BELLADONNA ALKALOIDS, 37 BELLADONNA ALKALOIDS & OPIUM, 37 belladonna alkaloids/phenobarbital, 36 BELVIQ, 74 BENADRYL ALLERGY & COLD, 22 BENADRYL ALLERGY & SINUS HEADACHE, 23 benadryl severe allergy & sinus headache maximum strength, 23 BENADRYL-D ALLERGY & SINUS, 23 benadryl-d allergy & sinus childrens, 23 BENAPHEN PLUS, 23 benazepril hcl, 57, 58 benazepril hcl/hydrochlorothiazide, 58 BENEFIX, 47 BENICAR, 59 BENICAR HCT, 59 BENLYSTA, 154 BENSAL HP, 185 BENTYL, 37 BENZAC AC, 185 BENZAC AC WASH, 185 BENZAC W WASH, 185 BENZACLIN, 185, 187 BENZACLIN CARE KIT, 187 BENZACLIN WITH PUMP, 185 BENZALKONIUM CHLORIDE, 187 BENZAMYCIN, 185 BENZAMYCINPAK, 185 benzashave 10, 187 BENZASHAVE 5, 187 BENZEFOAM, 187 BENZEFOAMULTRA, 187 benzepro, 187 benzepro short contact, 187 BENZIQ, 185 BENZIQ LS, 185 benziq wash, 182 BENZOIN COMPOUND TINCTURE, 197 BENZOIN TINCTURE, 197 benzonatate, 162 benzoyl peroxide, 182, 185, 187 benzoyl peroxide 10, 182 benzoyl peroxide 5, 182 benzoyl peroxide cleanser, 182, 187 benzoyl peroxide cleansing, 182, 185 benzoyl peroxide cleansing wash acne treatment pack, 185 benzoyl peroxide cleansing wash/acne treatment pack, 185 benzoyl peroxide creamy wash, 182 benzoyl peroxide creamy wash acne kit, 182 benzoyl peroxide short contact, 187 benzoyl peroxide wash, 182, 185, 187 benzoyl peroxide wash acne treatment pack, 185 benzphetamine hcl, 74 benztropine mesylate, 78, 79 BEPREVE, 123 BERINERT, 152 BESIVANCE, 120 BESTMED AEROSOL THERAPY NEBULIZER, 89 BESTMED ULTRASONIC NEBULIZER, 89 beta care betatar gel, 202 beta‐Adrenergic Blocking Agents, 52 BETADINE OPHTHALMIC PREP, 119 BETAGAN, 123 BETALIDO, 134 betamethasone dipropionate, 189 betamethasone sodium phosphate/betamethasone acetate, 134 betamethasone valerate, 189 BETAPACE, 53 BETAPACE AF, 53 BETASERON, 153 betavent, 163 betaxolol hcl, 52, 123 bethanechol chloride, 38 BETHKIS, 15 BETIMOL, 123 BETOPTIC-S, 123 BEXXAR, 32 BEXXAR 131 IODINE, 32 BEYAZ, 143 BG STAR BLOOD GLUCOSE TEST, 101 BIAFINE, 203 BIAXIN, 10 BIAXIN XL, 10 BIAXIN XL PAC, 10 bicalutamide, 29 BICILLIN C-R, 11 BICILLIN L-A, 11 BICLORA-D, 163 BICNU, 32 bidex, 174 bidhist-d, 23 BIDIL, 60 BIFERARX, 44 BILTRICIDE, 8 BINOSTO, 151 232 bio t pres, 163 bio t pres pediatric, 163 BIOBRON SF, 163 biocel, 210 biocotron, 163 BIODESP DM, 163 biogesic, 23 biogtuss, 163 BIONATUSS DXP, 163 BIONECT, 203 BIONEL, 163 BIONEL PEDIATRIC, 163 BIOREGESIC, 23 BIOSCANNER GLUCOSE TEST STRIPS, 101 BIOSPEC DMX, 163 bio-statin, 15 BIO-STATIN, 16 BIOSTEP, 206 BIOSTEP AG, 206 BIOTHRAX, 179 BIO-THROID, 147 biotuss, 163 biotuss pediatric, 163 BIOVANCE, 156 BIPHENOX, 23 bisoprolol fumarate, 52 bisoprolol fumarate/hydrochlorothiazide, 52 BIVIGAM, 178 bleomycin sulfate, 32 BLEPH-10, 120 BLEPHAMIDE, 121 BLEPHAMIDE S.O.P., 121 Blood Derivatives, 43 Blood Formation, Coagulation & Thrombosis, 44 BLOOD GLUCOSE MONITORING SYSTEM, 94 BLOOD GLUCOSE MONITORING SYSTEM PREMIUM, 94 BLOOD GLUCOSE TEST STRIPS, 101 BLOOD GLUCOSE TEST STRIPS PREMIUM, 101 BLOXIVERZ, 38 B-NEXA, 212 BOIL-EASE, 194 Bone Resorption Inhibitors, 150 BONIVA, 151 BONTRIL PDM, 74 BONTRIL SLOW RELEASE, 74 BOOSTRIX, 178 BORIC ACID, 185 BOSULIF, 30 BOTOX, 155, 156 BOTOX COSMETIC, 156 bp 10-1, 198 bp 7% wash kit, 185 bp 8 cough, 163 BP 8 COUGH, 163 bp cleanser, 182 bp cleansing wash, 198 bp foam, 187 BP FOLINATAL PLUS B, 212 BP MULTINATAL PLUS, 212 bp poly-650, 23 BP VIT 3, 221 bp wash, 182 bpm, 23, 164 bpm pe, 23, 164 bpm pe dm, 164 bpm pseudo, 23 bpm-dm-phen, 164 BPO, 185, 187 BPO 3% FOAMING CLOTHS, 187 BPO 6% FOAMING CLOTHS, 187 BPO 9% FOAMING CLOTHS, 187 bpo creamy wash complete pack, 185 BPO CREAMY WASH COMPLETE PACK, 185 BRAVELLE, 144 BREATHERITE, 89 BREATHERITE COLLAPSIBLE ADULT SPACER W/MASK, 89 BREATHERITE COLLAPSIBLE CHILD SPACER W/MASK, 89 BREATHERITE COLLAPSIBLE INFANT SPACER W/MASK, 89 BREATHERITE COLLAPSIBLE SMALL CHILD SPACER W/MASK, 89 BREATHERITE COLLAPSIBLE SPACER W/ NEONATE MASK, 89 BREATHERITE RIGID SPACER W/MASK, 89 BREATHERITE VALVED MDI CHAMBER/COLLAPSIBLE, 89 BREATHERITE VALVED MDI CHAMBER/RIGID, 89 BREATHERITE W/LARGE MASK, 89 BREATHERITE W/MEDIUM MASK, 89 BREATHERITE W/SMALL MASK, 89 BREEZE 2 BLOOD GLUCOSE MONITORING SYSTEM, 89 BREO ELLIPTA, 133 BRETHINE, 41 BREVIBLOC, 53 BREVICON-28, 142 BREVITAL SODIUM, 82 BREVOXYL, 185 BREVOXYL-4 CREAMY WASH COMPLETE PACK, 185 BREVOXYL-8 CREAMY WASH COMPLETE PACK, 185 briellyn, 139 BRILINTA, 48 brimonidine tartrate, 123 BRINTELLIX, 84 BRISDELLE, 85 BROHIST D, 23 brom mal/phenyl hcl/dex hbr, 164 brom/pse/dm, 164 bromaline, 23, 164 bromaline dm, 164 BROMATAN PLUS, 164 bromax d, 23 BROMDAY, 121 bromfed dm, 162 bromfenac (0.09%), 120, 121 bromhist-dm pediatric, 164 BROMHIST-PDX, 164 bromocriptine mesylate, 78 bromphen/pseudoephedrine hcl/dextromethorphan hbr, 164 bromphenex dm, 164 brompheniramine maleate, 23 brompheniramine maleate/pseudoephedrine, 23 brompheniramine/phenylephrine/dm, 164 brompheniramine/pseudoephedrine/dm, 164 bromspiro, 23 BRONCOMAR-1, 210 BRONCOPECTOL, 164 233 broncotron, 164 broncotron ped, 164 BRONCOTRON PED DROPS, 164 BRONCOTRON-D, 164 BRONCOTRON-S, 164 BRONDIL, 210 bronkids, 164 BRONKIDS, 164 BRONTEX, 162 BRONTUSS DX, 164 brontuss sf, 164 brontuss sf nr, 164 brotapp, 23, 164 brotapp dm, 164 BROVANA, 42 BROVEX PEB, 23, 164 BROVEX PEB DM, 164 BROVEX PSB, 23, 164 BROVEX PSB DM, 164 bss, 124 BSS PLUS, 124 BUCALSEP, 184 buckleys chest congestion, 174 budeprion sr, 82 budeprion xl, 82 budesonide, 121, 132 bumetanide, 109, 110 buminate, 43 BUNAVAIL, 69 BUPHENYL, 105 bupivacaine hcl, 148 bupivacaine spinal, 148 bupivacaine/epinephrine, 148 BUPIVILOG KIT, 134 BUPRENEX, 67 buprenorphine hcl, 62, 67 buprenorphine hcl/naloxone hcl, 62 buproban, 82 bupropion hcl, 82 bupropion hcl er, 82 bupropion hcl sr, 82 bupropion hcl xl, 82 buspirone hcl, 79 BUSULFEX, 32 butal/asa/caff, 62 butalbital compound, 62 butalbital/acetaminophen, 62 butalbital/acetaminophen/caffeine, 62 butalbital/acetaminophen/caffeine/codeine, 62 butalbital/apap/caffeine, 62 butalbital/aspirin/caffeine, 62 BUTALBITAL/ASPIRIN/CAFFEINE, 62 butalbital/aspirin/caffeine/codeine, 62 BUTISOL SODIUM, 80 butorphanol tartrate, 62, 67 BUTRANS, 69 BYDUREON, 138 BYETTA, 138 BYSTOLIC, 53 C cabergoline, 78 CACTUS COMPOSITUM, 156 CADUET, 55 CAFCIT, 73, 74 CAFERGOT, 77 caffeine citrate, 73, 74 CAFFEINE/SODIUM BENZOATE, 74 cafgesic, 69 cafgesic forte, 69 CALAFOL RX, 157 CALAN, 55 CALAN SR, 55 CALCIFOL, 113 CALCIFOLIC-D, 113 CALCIJEX, 224 calcipotriene, 193, 202 calcipotriene/betamethasone dipropionate, 193 calcitonin salmon, 145 calcitonin-salmon, 145 calcitrene, 202 calcitriol, 224 CALCITRIOL, 203, 224 calcium acetate, 112 calcium chloride, 113 CALCIUM DISODIUM VERSENATE, 132 CALCIUM FOLINATE, 150 calcium gluconate, 113 CALCIUM PNV, 212 Calcium‐Channel Blocking Agents, 54 CALCIUM-FOLIC ACID PLUS D, 113 CALDOLOR, 67 Caloric Agents, 105 CAMBIA, 65 camila, 139 CAMINO PRO 15PE, 108 CAMPATH, 35 CAMPRAL (333MG), 81 CAMPTOSAR, 32 camrese, 139 camrese lo, 139 CANASA, 127 CANCIDAS, 16 candesartan cilexetil, 58 candesartan cilexetil/hydrochlorothiazide, 58 CANTIL, 37 CAPASTAT SULFATE, 17 capecitabine, 30 CAPEX, 191 CAPHOSOL, 124 CAPITAL/CODEINE, 64 CAPMIST DM, 164 CAPRELSA, 30 captopril, 58 CARAC, 203 CARAFATE, 129 CARBAGLU, 105 carbamazepine, 74 CARBAMAZEPINE, 76 carbamazepine er, 74 234 CARBAPHEN 12, 164 CARBAPHEN 12 PED, 164 CARBAPHEN CH, 164 CARBAPHEN PED CH, 164 CARBATROL, 75 carbidopa, 78 carbidopa/levodopa, 78 carbidopa/levodopa er, 78 carbidopa/levodopa odt, 78 CARBIDOPA/LEVODOPA/ENTACAPONE, 78 carbinoxamine maleate, 21 CARBOCAINE, 148 carbodex dm, 164 CARBOGEL 940, 160 CARBOHOL 940, 160 CARBOMER GEL AQUEOUS, 160 CARBOMER GEL HYDROALCOHOLIC, 160 carboplatin, 32 CARBOPLATIN, 32 cardec, 23, 164 cardec dm, 164 CARDENE I.V., 55 CARDENE IV, 55 CARDENE SR, 54 Cardiac Drugs, 55 Cardiac Function, 100 cardioplegic, 112 CARDIOTEK-RX, 222 Cardiovascular Drugs, 51 CARDIOVID PLUS, 157 CARDIZEM, 55 CARDIZEM CD, 55 CARDIZEM LA, 55 CARDURA, 51 CARDURA XL, 51 CARESENS N BLOOD GLUCOSE MONITORING SYSTEM, 94 CARESENS N BLOOD GLUCOSE TEST STRIPS, 101 CARESENS N GLUCOSE MONITORING SYSTEM, 94 CARESENS N VOICE BLOOD GLUCOSE MONITORING SYSTEM, 94 CARIMUNE NANOFILTERED, 177 Cariostatic Agents, 151 CARISOPRODOL (250MG), 40 carisoprodol (350mg), 39 carisoprodol/aspirin, 39 carisoprodol/aspirin/codeine, 39 carmol 40, 198 CARMOL 40, 200 CARMOL SCALP TREATMENT, 187 CARMOL-HC, 191 CARNITOR, 155 CARNITOR SF, 155 CAROMEGA, 212 CARRASMART, 206 CARRASYN HYDROGEL WOUND DRESSING (0), 206 CARRASYN V HYDROGEL WOUNDDRESSING, 206 carrington antifungal, 187 CARRINGTON ORAL WOUND RINSE, 206 carteolol hcl, 123 cartia xt, 54 CARTICEL, 155 carvedilol, 52 CASCARA SAGRADA, 130 CASCARA SAGRADA AROMATIC, 130 CASODEX, 30 CAT HAIR EXTRACT, 155 CATAFLAM, 65 CATAPRES, 57 CATAPRES-TTS-1, 57 CATAPRES-TTS-2, 57 CATAPRES-TTS-3, 57 Cathartics and Laxatives, 130 CATHFLO ACTIVASE, 49 CAVAN ONE OMEGA, 212 CAVAN PRENATAL/EC CALCIUM, 212 CAVAN-ALPHA KIT, 212 CAVAN-EC SOD DHA, 212 CAVAN-FOLATE DHA, 212 CAVAN-FOLATE OB, 213 CAVAN-HEME OMEGA, 213 cavan-x, 222 cavarest, 151 CAVERJECT, 61 CAVERJECT IMPULSE, 61 cavirinse, 151 CAYSTON, 10 caziant, 139 CEDAX, 10 CEENU, 30 cefaclor, 8 CEFACLOR, 9, 10 CEFACLOR ER, 9 cefadroxil, 8 cefazolin sodium, 11 CEFAZOLIN SODIUM, 11 CEFAZOLIN SODIUM/DEXTROSE, 11 cefdinir, 8 CEFDITOREN PIVOXIL, 15 cefepime, 11 CEFEPIME, 11 cefotaxime sodium, 11 CEFOTAXIME SODIUM, 11 CEFOTETAN, 11 CEFOTETAN/DEXTROSE, 11 cefoxitin sodium, 11 CEFOXITIN SODIUM, 11 cefpodoxime proxetil, 8 cefprozil, 8 ceftazidime, 12 CEFTAZIDIME, 12 CEFTAZIDIME/DEXTROSE, 12 CEFTIBUTEN, 10 CEFTIN, 10 CEFTRIAXONE IN ISO-OSMOTIC DEXTROSE, 12 ceftriaxone sodium, 12 CEFTRIAXONE/DEXTROSE, 12 cefuroxime axetil, 8 cefuroxime sodium, 12 CEFUROXIME SODIUM, 12 CEFUROXIME/DEXTROSE, 12 CELEBREX, 65 CELESTONE, 133, 134 CELESTONE-SOLUSPAN, 134 235 CELEXA, 84 Cell Stimulants and Proliferants, 195 CELLCEPT, 154 CELLCEPT INTRAVENOUS, 154 CELLUGEL, 124 Cellular Therapy, 61 CELONTIN, 75 CEM-UREA, 200 CENESTIN, 144 CENFOL, 222 CENHIST, 23 cenolate, 223 CENTANY, 185 CENTANY AT, 185 centergy, 23, 164 centergy dm, 164 Central Nervous System Agents, 62, 81 Central Nervous System Agents, Misc, 81 CENTRATEX, 44 cephadyn, 62 cephalexin, 8 CEPHALEXIN, 9 CEPROTIN, 49 CERDELGA, 157 CEREBYX, 76 CERECOMP, 157 CEREDASE, 118 CEREFOLIN, 222 CEREFOLIN NAC, 222 CEREZYME, 118 cerisa wash, 198 ceron, 23, 164 ceron-dm, 164 cerovel, 198 CERTUSS-D, 164 CERUBIDINE, 32 CERVARIX, 179 CERVIDIL, 160 CESAMET, 128 cesia, 139 CESINEX, 108 CESINEX 100, 108 CESINEX 125, 108 CESINEX 150, 108 CESINEX 20, 108 CESINEX 25, 108 CESINEX 30, 108 CESINEX 35, 108 CESINEX 40, 108 CESINEX 50, 108 CESINEX 60, 108 CESINEX 80, 108 cetirizine hcl, 29 cetirizine hcl/pseudoephedrine hcl er, 29 CETRAXAL, 120 CETROTIDE, 153 cevimeline hcl, 38 CGU WC, 162 CHANTIX, 38 CHANTIX CONTINUING MONTH PAK, 38 CHANTIX STARTING MONTH PAK, 38 chateal, 139 CHELIDONIUM COMPOUND, 157 CHEMET, 131 CHENODAL, 131 CHERACOL PLUS, 164 CHERACOL-D COUGH, 164 cheratussin dac, 164 CHERRY SYRUP, 160 chest congestion relief dm, 164 chest congestion relief expectorant, 174 childrens aspirin, 69, 70 childrens aspirin low strength, 70 childrens cold & allergy, 23 CHILDRENS NYQUIL, 164 childrens silfedrine, 42 CHILDRENS TYLENOL COLD, 23 CHLO TUSS, 164, 165 CHLOPHED, 165 CHLORAL HYDRATE, 81 CHLORAMPHENICOL SODIUM SUCCINATE, 12 chlordex gp, 165 chlordiazepoxide hcl, 36, 79 chlordiazepoxide hcl/clidinium bromide, 36 CHLORDIAZEPOXIDE/AMITRIPTYLINE, 84 chlordiazepoxide/clidinium, 36 CHLORHEXIDINE DIGLUCONATE, 187 chlorhexidine gluconate, 119 CHLORHEXIDINE GLUCONATE, 187 chlorhexidine gluconate oral rinse, 119 chlor-mes d, 23 chlor-mes jr, 23 chloromag, 113 chloroprocaine hcl, 148 chloroquine phosphate, 17 chlorothiazide, 109, 110 CHLOROTHIAZIDE, 109 chlorothiazide sodium, 110 chloroxylenol/pramoxine, 125 chlorpheniramine/phenyltoloxamine/phenylephrine, 23 chlorpheniramine/pseudo/dm tannate, 165 CHLORPHENIRAMINE/PSEUDOEPHEDRINE, 23 chlorpheniramine/pseudoephedrine cr, 23 chlorpromazine hcl, 82 CHLORPROMAZINE HCL, 85 chlorpropamide (100mg), 135 CHLORPROPAMIDE (100MG), 136 chlorpropamide (250mg), 136 CHLORPROPAMIDE (250MG), 136 chlorthalidone, 109 CHLORTHALIDONE, 109 chlorzoxazone, 39 CHOICE DM DIABETES RISK IN-HOME TEST KIT, 94 CHOICE DM FORA G20 BLOOD GLUCOSE MONITORING SYSTEM, 94 CHOICE DM FORA G20 TEST STRIPS, 101 CHOICE-OB+DHA, 213 choice-tabs, 210 Cholelitholytic Agents, 131 cholestyramine, 51 cholestyramine light, 51 choline magnesium trisalicylate, 62 236 chorionic gonadotropin, 144 chromium chloride, 113 CHROMIUM CHLORIDE, 113 CIALIS (10MG), 61 CIALIS (2.5MG), 61 CIALIS (20MG), 61 CIALIS (5MG), 61 ciclodan, 182 CICLODAN CREAM KIT, 187 CICLODAN SOLUTION KIT, 187 ciclopirox, 183, 187 ciclopirox nail lacquer, 183 ciclopirox olamine, 183 CICLOPIROX TOPICAL SOLUTION KIT, 185 ciclopirox treatment, 187 cidofovir, 20 CIFEREX, 221 cilostazol, 48 CILOXAN, 119, 120 cimetidine, 128, 129 CIMETIDINE, 129, 130 cimetidine hcl, 129 CIMETIDINE HCL/NACL, 129 CIMZIA, 153 CIMZIA STARTER KIT, 153 CINRYZE, 152 CIPRO, 9, 10, 12, 15, 121 CIPRO (500MG/5ML), 9, 10 CIPRO (5GM/100ML), 9, 10 CIPRO HC, 121 CIPRO I.V., 12 CIPRO I.V.-IN D5W, 12 CIPRO XR, 15 CIPRODEX, 121 ciprofloxacin, 8, 12, 119 CIPROFLOXACIN, 12, 120 ciprofloxacin er, 8 ciprofloxacin hcl, 8, 119 ciprofloxacin i.v.-in d5w, 12 cisatracurium besylate, 39 cisplatin, 32 CISPLATIN, 32 citalopram hydrobromide, 82 CITANEST FORTE DENTAL, 148 CITANEST PLAIN DENTAL, 148 CITRANATAL 90 DHA, 213 CITRANATAL ASSURE, 213 CITRANATAL B-CALM, 213 CITRANATAL DHA, 213 CITRANATAL HARMONY, 213 CITRANATAL RX, 213 citric acid/sodium citrate, 104 CITROLITH, 105 cladribine, 32 CLAFORAN, 12 CLAFORAN/D5W, 12 claravis, 205 CLARAVIS, 205 CLARIFOAM EF, 200 CLARINEX, 29 CLARINEX REDITABS, 29 CLARINEX-D 12 HOUR, 29 CLARINEX-D 24 HOUR, 29 claris clarifying wash, 198 clarithromycin, 8 clarithromycin er, 8 CLARITIN-D 12 HOUR, 29 CLARITIN-D 24 HOUR, 29 CLEAN & CLEAR ADVANTANGE ACNE CONTROL KIT, 206 clean & clear continuous control acne cleanser, 188 CLEANSE AND TREAT, 206 clear cough dm, 165 clear-atadine d, 29 clearplex x, 183 clearskin, 188 clemastine fumarate, 21 CLEMASTINE FUMARATE, 21 clenia, 198 clenia foaming wash, 198 CLEOCIN, 10, 12, 184, 185, 196 CLEOCIN IN D5W, 12 CLEOCIN PEDIATRIC GRANULES, 10 CLEOCIN PHOSPHATE, 12, 196 CLEOCIN-T, 185 CLEVER CHEK AUTO CODE VOICE BLOOD GLUCOSE MONITORING SYSTEM, 94 CLEVER CHEK AUTO-CODE BLOOD GLUCOSE MONITORING SYSTEM, 94 CLEVER CHEK AUTO-CODE TEST STRIPS, 101 CLEVER CHEK AUTO-CODE VOICE BLOOD GLUCOSE MONITORING SYSTEM, 94 CLEVER CHEK AUTO-CODE VOICE TEST STRIPS, 101 CLEVER CHEK BLOOD GLUCOSE MONITORING SYSTEM, 94 CLEVER CHEK TEST STRIPS, 101 CLEVER CHOICE AUTO-CODE PRO BLOOD GLUCOSE MONITORING SYSTEM, 94 CLEVER CHOICE AUTO-CODE PRO TEST STRIPS, 101 CLEVER CHOICE MICRO BLOODGLUCOSE MONITORING SYSTEM, 94 CLEVER CHOICE MICRO TEST STRIPS, 101 CLEVER CHOICE MINI BLOOD GLUCOSE MONITORING SYSTEM, 95 CLEVIPREX, 55 CLIMARA, 143, 144 CLIMARA PRO, 143 CLINAC BPO, 185 CLINDACIN ETZ, 185 clindacin etz pledgets, 183 CLINDACIN PAC, 185 clindacin-p, 183 CLINDAGEL, 185 clindamax, 185 clindamycin hcl, 8 clindamycin palmitate hcl, 8 clindamycin phosphate, 12, 183 CLINDAMYCIN PHOSPHATE, 12 clindamycin phosphate add-vantage, 12 clindamycin phosphate in d5w, 12 clindamycin phosphate pharmacy bulk package, 12 clindamycin/benzoyl peroxide, 183 CLINDAREACH, 188 CLINDESSE, 184 237 CLINIMIX 2.75%/DEXTROSE 5%, 106 CLINIMIX 4.25%/DEXTROSE 10%, 106 CLINIMIX 4.25%/DEXTROSE 20%, 106 CLINIMIX 4.25%/DEXTROSE 25%, 106 CLINIMIX 4.25%/DEXTROSE 5%, 106 CLINIMIX 5%/DEXTROSE 15%, 106 CLINIMIX 5%/DEXTROSE 20%, 106 CLINIMIX 5%/DEXTROSE 25%, 106 CLINIMIX E 2.75%/DEXTROSE 10%, 106 CLINIMIX E 2.75%/DEXTROSE 5%, 106 CLINIMIX E 4.25%/DEXTROSE 10%, 106 CLINIMIX E 4.25%/DEXTROSE 25%, 106 CLINIMIX E 4.25%/DEXTROSE 5%, 106 CLINIMIX E 5%/DEXTROSE 15%, 106 CLINIMIX E 5%/DEXTROSE 20%, 106 CLINIMIX E 5%/DEXTROSE 25%, 107 clinisol sf 15%, 107 CLINORIL, 65 clinpro 5000, 151 CLOBETA CREAM, 193 CLOBETA OINTMENT, 193 CLOBETAPLUS CREAM, 193 CLOBETAPLUS OINTMENT, 193 clobetasol propionate, 189, 190 clobetasol propionate e, 189, 190 clobetasol propionate emollient, 189, 190 CLOBEX, 191 CLOCORTOLONE PIVALATE, 191 CLOCORTOLONE PIVALATE PUMP, 191 clodan, 190 CLODAN KIT, 193 CLODERM, 191 CLODERM PUMP, 191 CLOLAR, 32 CLOMID, 144 clomiphene citrate, 143 clomipramine hcl, 82 clonazepam, 74 clonazepam odt, 74 clonidine hcl, 57 clonidine hcl er, 57 clopidogrel, 48 clorazepate dipotassium, 79 CLORPRES, 57 clotrimazole, 183 clotrimazole/betamethasone dipropionate, 183 clozapine, 83 CLOZAPINE ODT, 86 CLOZARIL, 84 C-NATE DHA, 212 CNL8 NAIL KIT, 185 CO MONITOR, 89 CO MONITOR CALIBRATION, 89 CO MONITOR REPLACEMENT T PIECES, 89 COAL TAR, 202 COAL TAR BASE, 202 COARTEM, 17 cobal-1000, 222 COCA COLA SYRUP, 128 COCA COLA SYURP, 128 cocaine hcl (10%), 125 COCAINE HCL (10%), 126 cocaine hcl (4%), 125 COCAINE HCL (4%), 126 COD LIVER OIL, 213 codal-dm, 165 CODAR AR, 162 CODAR D, 162 CODAR GF, 162 CODEINE PHOSPHATE, 67 codeine phosphate/guaifenesin, 162 CODEINE SULFATE, 64 CODEINE SULFATE (15MG), 64 codeine sulfate (30mg), 62 codeine sulfate (60mg), 62 CODITUSS DM, 165 COENZYME COMPOSITUM, 157 COGENTIN, 79 co-gesic, 70 COLAZAL, 127 COLCRYS, 150 cold & allergy, 23 cold & allergy childrens, 23 cold & cough childrens, 165 cold control pe intense cold & flu medicine, 23 cold medicine plus, 23 cold/cough childrens, 165 coldec dm, 165 COLESTID, 51 COLESTID FLAVORED, 51 colestipol hcl, 51 colestipol hcl for oral suspension, 51 colidrops pediatric, 36 colistimethate sodium, 12 colocort, 191 COLY-MYCIN M, 12 COLY-MYCIN S, 121 COLYTE-FLAVOR PACKS, 130 COMBIGAN, 123 COMBIPATCH, 143 COMBIVENT, 41 COMBIVENT RESPIMAT, 41 COMETRIQ, 30 COMP AIR COMPRESSOR NEBULIZER, 89 COMP AIR ELITE COMPACT COMPRESSOR/NEBULIZER, 89 COMPAIR COMPRESSOR NEBULIZER, 89 COMPAIR XL COMPRESSOR NEBULIZER SYSTEM, 89 COMPAIR XLT COMPRESSOR NEBULIZER SYSTEM, 89 compazine, 83 COMPAZINE, 84 Complement Inhibitors, 152 COMPLERA, 19 COMPLETE NATAL DHA, 213 COMPLETENATE, 213 COMPLETE-RF PRENATAL, 213 compound 347, 82 compro, 83 COMTAN, 78 comtrex flu therapy maximum strength day/night, 23 comtrex severe cold & sinus maximum strength day/night, 23 COMVAX, 179 CONCEPT DHA, 213 238 CONCEPT OB, 213 CONCERTA, 73 CONDYLOX, 203 CONEX COLD/ALLERGY, 23 congest aid, 42 CONGESTAC, 174 constulose, 105 CONTAC COLD/FLU DAY & NIGHT, 23 CONTAC COLD/FLU DAY/NIGHT, 24 CONTAC COLD/FLU MAXIMUM STRENGTH, 24 CONTAC DAY/NIGHT ALLERGY/SINUS, 24 contac-d, 42 Contraceptives, 86, 138 CONTRAVE, 74 CONTROL AST, 101 CONTROL BLOOD GLUCOSE MONITORING SYSTEM, 95 CONTROL TEST STRIPS, 101 controlrx, 151 CONZIP, 70 COPAXONE, 153 copd, 210 cope, 70 COPEGUS, 19 COPPER SULFATE, 113 COPPER TRACE METAL, 113 COR COMPOSITUM, 157 CORDARONE, 56 CORDRAN, 191 CORDRAN TAPE, 191 COREG, 53 COREG CR, 53 CORENATE-DHA, 213 corfen-dm, 165 CORGARD, 53 CORICIDIN D, 24 coricidin d cold/flu/sinus, 24 coricidin hbp chest congestion & cough, 165 CORICIDIN HBP COUGH & COLD, 165 CORIFACT, 47 CORLOPAM, 57 cormax, 190 cormax scalp application, 190 cortalo, 190 cortamox, 190 CORTANE-B, 122, 191 CORTANE-B AQUEOUS, 122 CORTANE-B-OTIC, 122 CORTEF, 133 CORTENEMA, 191 cortic-nd, 120 CORTIFOAM, 191 CORTISONE ACETATE, 133 CORTISPORIN, 121, 122, 191 CORTISPORIN-TC, 121 cortomycin, 120 CORVERT, 56 corvita, 44, 213 corvita 150, 44 CORVITE, 45, 213 CORVITE 150, 45 CORVITE FE, 45 corvite free, 210 CORZALL, 165 CORZALL PLUS, 165 CORZALL-PE, 165 CORZIDE, 53 COSMEGEN, 32 COSOPT, 123, 124 COSOPT PF, 124 cough & cold, 165 cough syrup, 174 COUMADIN, 48, 49 covaryx, 143 covaryx hs, 143 COVERA-HS, 55 COZAAR, 59 CPB WC, 162 c-phen, 23, 164 c-phen dm, 164 cpm/pse, 24, 165 cpm/pse dm, 165 cpm/pyr/pe, 24 CRALONIN, 157 CRAMP TABS, 70 CREON, 131 CRESTOR, 51 CRESYLATE, 119 CRINONE, 145 CRIXIVAN, 18 CRNATAL, 213 CROFAB, 178 cromolyn sodium, 122, 161 cryselle-28, 139 C-TAN D PLUS, 23 c-tanna 12, 164 CUBICIN, 12 CUPRIMINE, 132 CURAFIL GEL WOUND DRESSING, 206 CURAGEL HYDROGEL ISLAND WOUND DRESSING 3, 206 CURAGEL HYDROGEL ISLAND WOUND DRESSING 5, 206 CURAGEL HYDROGEL WOUND DRESSING 2, 206 CURAGEL HYDROGEL WOUND DRESSING 4, 206 CURAGEL HYDROGEL WOUND DRESSING 8, 206 CURAGEL HYDROGEL WOUND DRESSING 8.5, 206 CURASOL GEL WOUND DRESSING, 206 CURITY HYPERTONIC SODIUM CHLORIDE PACKING STRIP 1/2, 203 CURITY SODIUM CHLORIDE DRESSING 6, 206 curity sterile saline, 111 CUROSURF, 177 CUTAR, 202 CUTIS COMPOSITUM, 157 CUTIVATE, 191 CUVPOSA, 37 CYANIDE ANTIDOTE PKG, 132 cyanocobalamin, 222 CYANOCOBALAMIN/LEVOMEFOLATE CALCIUM/PYRIDOXINE HCL, 222 CYANOKIT, 150 cyclafem 1/35, 139 cyclafem 7/7/7, 139 CYCLESSA, 142 239 CYCLOBENZAPRINE COMFORT PAC, 40 cyclobenzaprine hcl (10mg), 39 cyclobenzaprine hcl (5mg), 39 cyclobenzaprine hcl (7.5mg), 40 cyclobenzaprine hcl er, 40 CYCLOGYL, 126 CYCLOMYDRIL, 126 cyclopentolate hcl, 126 CYCLOPHOSPHAMIDE, 29, 32 CYCLOSERINE, 17 CYCLOSET, 138 cyclosporine, 154 cyclosporine modified, 154 cyclosporine modified (100mg), 154 cyclosporine modified (25mg), 154 CYCLOSPORINE MODIFIED (50MG), 154 CYKLOKAPRON, 47 cylate, 126 CYMBALTA, 84 cyotic, 120 cyproheptadine hcl, 21 CYRAMZA, 35 CYSTADANE, 155 CYSTAGON, 155 CYSTARAN, 125 cysteine hcl, 107 CYSTEINE HCL, 107 Cystic Fibrosis Transmembrane Conductance Regulator Modulators, 174 cytarabine, 32 CYTARABINE, 32 cytarabine aqueous, 32 CYTOGAM, 178 CYTOMEL, 147 CYTOTEC, 129 CYTOVENE, 20 cytra k crystals, 104 cytra-2, 104 CYTRA-3, 105 cytra-k, 104 D D.H.E. 45, 40 dacarbazine, 32 DACARBAZINE, 32 dacex-dm, 165 DACOGEN, 32 dactinomycin, 32 DALIRESP, 177 DALLERGY, 24, 165 DALLERGY DM, 165 DALLERGY JR, 24 DALLERGY PE, 24 DALLERGY PSE, 24 DALLERGY-JR, 24 DALVANCE, 15 danazol, 135 DANTRIUM, 39 DANTRIUM IV, 39 DANTROLENE SODIUM (100MG), 39 dantrolene sodium (25mg), 39 dantrolene sodium (50mg), 39 DAPSONE, 17 DAPTACEL, 179 DARAPRIM, 17 DARVON, 70 dasetta 1/35, 139 dasetta 7/7/7, 139 daunorubicin hcl, 32 DAUNOXOME, 32 DAYPRO, 65 daysee, 139 DAYTRANA, 74 DDAVP, 145 DEBACTEROL, 124 deblitane, 139 decara, 224 DECARA, 224 DECAVAC, 179 de-chlor dr, 165 decitabine, 32 DECON-A, 24 DECON-G, 174 decongestant, 24, 42 decongestant 12hour maximum strength, 42 decongestant 60, 42 decongestant plus, 24 deferoxamine mesylate, 132 DEHISTINE, 24 dehydrated alcohol, 107 del-aqua, 183, 188 DELATESTRYL, 135 del-beta, 190 DELESTROGEN, 144 delflex-lc/1.5% dextrose, 111 DELFLEX-LC/2.5% DEXTROSE, 111 DELFLEX-LC/4.25% DEXTROSE, 111 delflex-lm/1.5% dextrose, 111 DELFLEX-LM/2.5% DEXTROSE, 111 DELFLEX-LM/4.25% DEXTROSE, 111 DELFLEX-SM/1.5% DEXTROSE, 111 DELFLEX-SM/2.5% DEXTROSE, 111 DELFLEX-SM/4.25% DEXTROSE, 111 DELIVRA SR, 161 DELOS, 185 delsym childrens night time cough/cold, 24 delsym cough + chest congestion dm, 165 delsym cough + chest congestion dm childrens, 165 delsym cough + cold nighttime, 24 delsym cough + cold nighttime childrens, 24 delsym night time cough/cold, 24 delsym night time cough/cold childrens, 24 deltuss dmx, 165 DELTUSS DMX, 165 DELTUSS DP, 24 delyla, 139 DELZICOL, 127 DEMADEX, 110 demeclocycline hcl, 8 DEMEROL, 65, 67 DEMSER, 155 240 DENAVIR, 184 DENOREX THERAPEUTIC, 202 DENOREX THERAPEUTIC 2-IN-1, 202 denta 5000 plus, 151 dentagel, 151 Dental Agents, 87 DENTAL NEEDLE 25G/LONG, 95 DENTAL NEEDLE 25G/SHORT, 95 DENTAL NEEDLE 27G/LONG, 95 DENTAL NEEDLE 27G/SHORT, 95 DENTAL NEEDLE 30G/EX-SHORT, 95 DENTAL NEEDLE 30G/SHORT, 95 DENTAL NEEDLE 30GX32MM LONG, 95 DEPACON, 76 depade, 82 DEPAKENE, 75 DEPAKOTE, 75 DEPAKOTE ER, 75 DEPAKOTE SPRINKLES, 75 DEPEN TITRATABS, 132 Depigmenting and Pigmenting Agents, 196 DEPLIN, 157 DEPLIN 15, 157 DEPLIN 7.5, 157 DEPOCYT, 32 DEPODUR, 67 DEPO-ESTRADIOL, 144 DEPO-MEDROL, 134 DEPO-PROVERA, 146 DEPO-PROVERA CONTRACEPTIVE, 146 DEPO-SUBQ PROVERA 104, 146 DEPO-TESTOSTERONE, 135 DEPRIZINE FUSEPAQ, 130 DERMAGESIC, 194, 195 DERMAGRAFT, 157 DERMANIC, 108 DERMA-SMOOTHE/FS BODY, 191 DERMA-SMOOTHE/FS BODY OIL, 191 DERMA-SMOOTHE/FS SCALP, 191 DERMA-SMOOTHE/FS SCALP OIL, 191 DERMASORB AF, 185 DERMASORB HC, 193 DERMASORB TA, 191 DERMASORB XM, 201 DERMASYN, 206 DERMATODORON, 157 DERMATOP, 191 dermazene, 183 DERMOTIC, 122 DESFERAL, 132 DESGEN DM, 165 desgen pediatric, 165 desipramine hcl, 83 desloratadine, 29 desloratadine odt, 29 desmopressin acetate, 145 DESOGEN, 142 desogestrel/ethinyl estradiol, 139 DESONATE, 191 desonide, 190 DESONIL, 193 DESONIL PLUS CREAM KIT, 193 DESONIL PLUS OINTMENT KIT, 193 DESOWEN, 191 DESOWEN CREAM/CETAPHIL LOTION, 191 DESOWEN LOTION/CETAPHIL CREAM, 191 DESOWEN OINTMENT/CETAPHIL LOTION, 191 desoximetasone, 190 DESOXIMETASONE (0.05%), 191 desoximetasone (0.25%), 190 DESOXYN, 73 despec dm, 165 DESPEC DM, 165 despec eda, 165 DESPEC NR, 165 DESPEC-DM, 165 DESPEC-EXP, 165 DESPEC-PDC, 165 despec-tab, 175 DESQUAM-X WASH, 185 DESVENLAFAXINE ER, 86 Detergents, 196 DETROL, 209 DETROL LA, 209 Devices, 87 DEVILBISS PULMO-AIDE COMPRESSOR/NEBULIZER, 89 DEVILBISS TRAVEL-AIRE COMPRESSOR/NEBULIZER, 89 DEVILBISS TRAVELER NEBULIZER, 89 DEWITTS PILLS, 70 dex pc, 165 dexamethasone, 120, 132, 134 DEXAMETHASONE, 133, 134 dexamethasone (0.5mg), 132 dexamethasone (0.75mg), 132 dexamethasone (1.5mg), 132 DEXAMETHASONE (1MG), 133 DEXAMETHASONE (2MG), 133 dexamethasone (4mg), 132 dexamethasone (6mg), 132 DEXAMETHASONE INTENSOL, 133 dexamethasone sodium phosphate, 120, 134 DEXAMETHASONE SODIUM PHOSPHATE, 134 DEXCHLORPHENIRAMINE MALEATE, 22 DEXCHLORPHENIRAMINE MALEATE CR, 22 dexedrine, 73 DEXEDRINE, 73 dexferrum, 46 DEXILANT, 129 DEXLIDO, 134 DEXLIDO-M, 134 dexmedetomidine hcl, 80 dexmethylphenidate hcl, 73 dexmethylphenidate hcl er, 73 DEXPAK 10 DAY, 133 DEXPAK 13 DAY, 133 DEXPAK 6 DAY, 133 DEXPANTHENOL, 222 dexphen w/c, 165 dexrazoxane, 160 DEXTRAN, 113 DEXTRAN 70, 113 DEXTRAN HM, 113 241 dextroamphetamine sulfate, 73 dextroamphetamine sulfate er, 73 DEXTROMETHORPHAN HBR/CHLORPHENIRAMINE/PHENYLEPHRINE HCL, 165 dextromethorphan hbr/phenylephrine hcl/chlorpheniramine, 165 dextromethorphan/guaifenesin, 165 DEXTROMETHORPHAN/PSEUDOEPHEDRINE/CHLORPHENIRAMIN E, 166 DEXTROSE 10%/NACL 0.45%, 113 DEXTROSE 2.5%, 107 DEXTROSE 5% /ELECTROLYTE #48 VIAFLEX, 113 dextrose 10%, 107, 113, 114 dextrose 10% flex container, 107 dextrose 10% partial fill, 107 dextrose 10%/nacl 0.2%, 113 DEXTROSE 10%/NACL 0.2%, 113 DEXTROSE 10%/NACL 0.225%, 113 dextrose 10%/sodium chloride 0.9%, 114 dextrose 2.5%/nacl 0.45%, 114 dextrose 2.5%/sodium chloride 0.45%, 114 dextrose 20%, 107 DEXTROSE 20%, 107 DEXTROSE 25%, 107 dextrose 30%, 107 dextrose 30% partial fill, 107 dextrose 40%, 107 DEXTROSE 40%, 107 dextrose 5%, 107, 114 dextrose 5% viaflex, 107 dextrose 5%/lactated ringers, 114 dextrose 5%/nacl 0.2%, 114 DEXTROSE 5%/NACL 0.225%, 114 DEXTROSE 5%/NACL 0.3%, 114 dextrose 5%/nacl 0.33%, 114 dextrose 5%/nacl 0.45%, 114 dextrose 5%/nacl 0.9%, 114 DEXTROSE 5%/POTASSIUM CHLORIDE 0.075%, 114 dextrose 5%/potassium chloride 0.15%, 114 dextrose 5%/ringers, 114 dextrose 5%/sodium chloride 0.2%, 114 dextrose 5%/sodium chloride 0.33%, 114 dextrose 5%/sodium chloride 0.45%, 114 dextrose 5%/sodium chloride 0.9%, 114 dextrose 50%, 107 dextrose 70%, 107 dg 200, 210 dhm/pe, 24 DHS TAR, 202 DHS TAR GEL, 202 DIAB, 206 DIAB DAILY CARE, 206 DIAB F.D.G. FREEZE-DRIED, 206 DIABETA, 138 Diabetes Mellitus, 100 diabetic siltussin das-na, 175 diabetic siltussin-dm, 166 diabetic siltussin-dm maximum strength, 166 diabetic tussin, 166, 175 diabetic tussin dm, 166 diabetic tussin ex, 175 diabetic tussin for children, 166 diabetic tussin maximum strength, 166 diabetic tussin mucus relief, 175 Diagnostic Agents, 100 dialyvite, 210 DIALYVITE 3000, 213 DIALYVITE 5000, 213 DIALYVITE SUPREME D, 213 DIALYVITE/ZINC, 213 DIAMOX, 124 DIANEAL LOW CALCIUM/1.5% DEXTROSE, 111 DIANEAL LOW CALCIUM/2.5% DEXTROSE, 111 DIANEAL LOW CALCIUM/4.25%DEXTROSE, 111 DIANEAL PD-2/1.5% DEXTROSE, 111 DIANEAL PD-2/2.5% DEXTROSE, 111 DIANEAL PD-2/4.25% DEXTROSE, 111 DIASTAT ACUDIAL, 80 DIASTAT PEDIATRIC, 80 DIATRUE PLUS BLOOD GLUCOSE MONITORING SYSTEM, 95 DIATRUE PLUS BLOOD GLUCOSE TEST STRIPS, 101 DIATX ZN, 213 diazepam, 79 DIAZEPAM, 80 DIAZEPAM INTENSOL, 80 DIBENZYLINE, 40 DICEL, 24, 166 DICEL CD, 166 DICEL DM, 166 DICKINSONS WITCH HAZEL, 195 DICLEGIS, 128 diclofenac potassium, 62 diclofenac sodium, 62, 120, 202, 206 diclofenac sodium dr, 62 diclofenac sodium er, 62 diclofenac sodium/misoprostol, 62 dicloxacillin sodium, 8 DICOPANOL FUSEPAQ, 24 dicyclomine hcl, 36, 37 DICYCLOMINE HCL, 37 didanosine, 18 DIDGET, 89 DIDREX, 74 DIDRONEL, 151 diethylpropion hcl, 74 DIETHYLPROPION HCL, 74 diethylpropion hcl er, 74 DIFFERIN, 203 DIFICID, 10 difil-g 400, 210 difil-g forte, 210 diflorasone diacetate, 190 DIFLORASONE DIACETATE, 191 DIFLUCAN, 16 DIFLUCAN IN NACL, 16 diflunisal, 62 Digestants, 131 DIGESTODORON, 157 DIGEX, 37, 131 DIGEX NF, 37 DIGIBIND, 178 DIGIFAB, 178 digox, 55 242 digoxin, 55, 56 DIGOXIN, 56 dihydrocodeine/bpm/phenyleph hcl, 166 DIHYDRO-CP, 166 dihydroergotamine mesylate, 40 DIHYDROERGOTAMINE MESYLATE, 40 DIHYDRO-PE, 166 DILACOR XR, 55 DILANTIN, 75 DILANTIN (100MG), 75 DILANTIN (30MG), 75 DILANTIN INFATABS, 75 DILATRATE SR, 61 DILAUDID, 65, 67 DILAUDID-HP, 67 dilt-cd, 54 diltiazem cd, 54 diltiazem hcl, 54, 55 DILTIAZEM HCL, 55 diltiazem hcl cd, 54 diltiazem hcl er, 54 dilt-xr, 54 diltzac, 54 dimaphen childrens, 24 dimaphen dm cold/cough childrens, 166 DIMENHYDRINATE, 128 dimetane dx, 166 DIMETANE DX, 166 DIMETAPP COLD & ALLERGY, 24 DIMETAPP DM COLD & COUGH, 166 DIMETAPP LONG ACTING COUGH PLUS COLD, 166 dimetapp nighttime cold &congestion, 24 DIOVAN, 59 DIOVAN HCT, 59 DIPENTUM, 127 diphenhydramine hcl, 21, 22 diphenoxylate/atropine, 127 DIPHENOXYLATE/ATROPINE, 127 DIPHTHERIA/TETANUS TOXOID PEDIATRIC, 179 DIPHTHERIA/TETANUS TOXOIDS ADSORBED PEDIATRIC, 179 DIPRIVAN, 82 DIPROLENE, 192 DIPROLENE AF, 192 dipyridamole, 60, 61 DISALCID, 65 DISCOVISC, 124 DISCUS COMPOSITUM, 157 Disease‐modifying Antirheumatic Drugs, 152 Disinfectants (Not for use on skin), 104 disophrol, 24 disopyramide phosphate, 55 DISPOSABLE MOUTHPIECE FULL RANGE, 89 DISPOSABLE MOUTHPIECE LOWRANGE/PEDIATRIC, 89 DISPOSABLE MOUTHPIECE/LOW RANGE, 89 DISPOSABLE MOUTHPIECE/UNIVERSAL RANGE, 89 disulfiram, 149 DITROPAN XL, 209 Diuretics, 109 DIURIL, 109 divalproex sodium, 74 divalproex sodium dr, 74 divalproex sodium er, 74 DIVIGEL, 143 DIVISTA, 222 dm/cpm/pe/gg, 166 dm/pe/cpm, 166 dm/pse/bpm, 166 dm-pe-chlor, 166 DOAK OIL, 202 doak tar, 202 DOAK TAR DISTILLATE, 202 DOANS PM EXTRA STRENGTH, 70 dobutamine hcl, 41 dobutamine hcl/d5w, 41 dobutamine/dextrose 5%, 41 DOBUTAMINE/DEXTROSE 5%, 41 DOCEFREZ, 32 DOCETAXEL, 32 DOCOSAVIT, 213 DOLGIC PLUS, 70 dologen, 24 dologesic, 24 DOLOGESIC, 22, 24 DOLOPHINE, 65 DOLOPHINE HCL, 65 dolorex, 24 DOMETUSS-DA/CHILDREN, 24 dometuss-dmx, 166 DONATUSS DC, 166 DONATUSS XP, 166 DONATUSSIN, 166 DONATUSSIN DM, 166 donepezil hcl, 38, 39 donepezil hcl (10mg), 38 donepezil hcl (23mg), 39 donepezil hcl (5mg), 38 DONNATAL, 37 DONNATAL EXTENTABS, 37 dopamine hcl, 42 DOPAMINE HCL, 41 dopamine hcl/dextrose 5%, 42 dopamine hcl-dextrose 5%, 42 dopamine/d5w, 42 DOPRAM, 74 DORAL, 80 DORIBAX, 12 DORYX, 15 dorzolamide hcl, 123 dorzolamide hcl/timolol maleate, 123 DOUBLEDEX, 134 DOUBLE-TUSSIN DM, 166 DOVONEX, 203 DOVONEX SCALP, 203 doxapram hcl, 74 doxazosin mesylate, 51 doxepin hcl, 83 DOXEPIN HCL, 83 doxercalciferol, 224 DOXIL, 32 doxorubicin hcl, 32 doxorubicin hcl liposome, 32 doxy 100, 12 243 doxycycline, 8, 12, 15 DOXYCYCLINE, 15, 203 doxycycline hyclate, 8, 12, 15 DOXYCYCLINE HYCLATE, 15 doxycycline hyclate (100mg), 8 doxycycline hyclate (20mg), 15 doxycycline hyclate dr, 15 doxycycline monohydrate, 8, 15 DOXYTEX, 22 DPI ALCOHOL GEL, 188 DRISDOL, 224 dristan cold, 24 DRITHO-CREME HP, 203 DRITHO-SCALP, 203 DRIXORAL ALLERGY SINUS, 24 DRIXORAL COLD/ALLERGY, 24 DRIXORAL COLD/FLU, 24 dronabinol, 127 droperidol, 80 drospirenone/ethinyl estradiol, 139 DROXIA, 30 DRYMAX, 24, 166 DRYMAX AF, 166 DRYSOL, 195 DUAC, 185, 188 DUAC CS, 188 DUAVEE, 143 DUET DHA, 213 DUET DHA 400, 213 DUET DHA 400EC, 213 DUET DHA 430, 213 DUET DHA 430EC, 213 DUET DHA BALANCED, 213 DUET DHA EC, 213 DUETACT, 138 DUEXIS, 70 DULEEK-DP, 222 DULEEK-MET NEW, 222 DULERA, 133 duloxetine hcl, 83 DUOCAINE, 148 DUO-CARE TEST STRIPS, 101 DUODOTE, 150 DUONEB, 41 DUOVISC, 124 DURACLON, 57 DURAFIBER, 203 DURAFIBER AG, 203 DURAGESIC, 65 duramorph, 67 DURASAFE SPINAL/EPIDURAL TRAY/1% XYLOCAINE/19GX36, 148 DURASAFE SPINAL/EPIDURAL TRAY/1% XYLOCAINE/20GX36, 148 DURASAL, 201 DURAVENT DM, 166 duraxin, 65 DUREZOL, 122 DUTOPROL, 53 DYAZIDE, 110 dy-g, 210 DYLIX, 210 DYMISTA, 123 DYNACIN, 15 DYNACIRC CR, 54 dyphylline gg, 210 dyphylline-gg, 210 DYRENIUM, 109 DYSPORT, 155 DYTAN, 25 dytuss, 25 DYURAL-40, 134 DYURAL-80, 134 DYURAL-L, 134 DYURAL-LM, 134 E e.e.s. 400 (400mg), 8 E.E.S. 400 (400MG), 9 E.E.S. GRANULES, 9 e.s.p., 8 EASIVENT, 89, 90 EASIVENT/MASK-LARGE, 89 EASIVENT/MASK-MEDIUM, 89 EASIVENT/MASK-SMALL, 90 EASPRIN, 70 EASY CHECK BLOOD GLUCOSE MONITORING SYSTEM, 95 EASY CHECK GLUCOSE TEST STRIPS, 101 EASY PLUS BLOOD GLUCOSE MONITOR, 95 EASY PLUS BLOOD GLUCOSE MONITORING SYSTEM, 95 EASY PLUS BLOOD GLUCOSE TEST STRIPS, 101 EASY PLUS II BLOOD GLUCOSE MONITORING SYSTEM, 95 EASY PLUS II BLOOD GLUCOSE TEST, 101 EASY STEP BLOOD GLUCOSE MONITOR, 95 EASY STEP BLOOD GLUCOSE MONITOR STARTER KIT, 95 EASY STEP TEST STRIPS, 101 EASY TALK BLOOD GLUCOSE MONITORING SYSTEM/TALKING, 95 EASY TALK BLOOD GLUCOSE TEST STRIPS, 101 EASY TOUCH GLUCOSE MONITORING SYSTEM, 95 EASY TOUCH GLUCOSE TEST STRIPS, 101 EASY TOUCH HEALTHPRO GLUCOSE MONITORING SYSTEM, 95 EASY TOUCH HEALTHPRO GLUCOSE TEST STRIPS, 101 EASY TRAK BLOOD GLUCOSE MONITORING SYSTEM, 95 EASY TRAK BLOOD GLUCOSE TEST STRIPS, 101 easygel, 152 EASYGLUCO, 95, 101 EASYGLUCO VALUE PACK, 95 EASYMAX 15 TEST STRIPS, 101 EASYMAX L BLOOD GLUCOSE SYSTEM, 95 EASYMAX N BLOOD GLUCOSE SYSTEM, 95 EASYMAX NG SELF-MONITORING BLOOD GLUCOSE SYSTEM, 95 EASYMAX TEST STRIPS, 101 EASYMAX V BLOOD GLUCOSE SYSTEM, 95 EASYMAX V BLOOD GLUCOSE SYSTEM/TALKING, 95 EASYMAX V2 SELF-MONITORING BLOOD GLUCOSE SYSTEM/SPEAKING, 95 EASYPLUS BLOOD GLUCOSE TEST STRIP, 101 EASYPLUS R13N SELF-MONITORING BLOOD GLUCOSE SYSTEM, 95 EASYPLUS V SELF-MONITORING BLOOD GLUCOSE SYSTEM/SPEAKING, 95 EASYPRO BLOOD GLUCOSE MONITORING SYSTEM, 95 EASYPRO BLOOD GLUCOSE TEST STRIPS, 101 244 EASYPRO PLUS, 95, 101 ec-81 aspirin, 70 ECHINACEA COMPOSITUM, 157 ECHINACEA COMPOSITUM FORTE, 157 ECLIPSE BLOOD GLUCOSE MONITORING SYSTEM, 95 ECLIPSE TEST STRIPS, 101 EC-NAPROSYN, 65 econazole nitrate, 183 ecotrin low strength, 70 ECOTRIN MAXIMUM STRENGTH, 70 ECOTRIN REGULAR STRENGTH, 70 ECOZA, 188 ecpirin, 70 ECZEMOL, 157 ed a-hist, 25, 166 ED A-HIST, 25 ed a-hist dm, 166 ed baclofen, 39 ED CHLORPED, 22, 25 ED CHLORPED D, 25 ED CYTE F, 44 ED DM, 166 ed k+10, 112 ED-A-HIST, 25 ed-a-hist dm, 166 EDARBI, 59 EDARBYCLOR, 59 ED-BRON G, 210 ED-CHLOR-TAN, 22 EDECRIN, 110 EDEX, 61 ed-flex, 62 EDLUAR, 81 ed-spaz, 36 EDURANT, 18 eemt, 143 eemt hs, 143 EENT Drugs, Miscellaneous, 124 effer-k, 112 EFFER-K, 113 effervescent pot chloride, 112 effervescent potassium, 112 effervescent potassium/chloride, 112 EFFEXOR XR, 84 EFFIENT, 48 EFLOW SCF AEROSOL HEAD, 90 EFLOW SCF ELECTRONIC NEBULIZER SYSTEM, 90 EFLOW SCF NEBULIZER HANDSET, 90 EFUDEX, 203 EGRIFTA, 147 ELAPRASE, 118 ELDEPRYL, 78 ELDOPAQUE FORTE, 196 ELDOQUIN FORTE, 196 ELECTROLYTE-48/DEXTROSE, 114 Electrolytic, Caloric, and Water Balance, 104 ELELYSO, 118 ELEMENT AUTOCODE SYSTEM, 95 ELEMENT COMPACT BLOOD GLUCOSE MONITORING SYSTEM, 95 ELEMENT COMPACT TEST STRIPS, 101 ELEMENT PLUS BLOOD GLUCOSE METER, 95 ELEMENT PLUS TEST STRIPS, 101 ELEMENT TEST STRIPS, 101 ELENZAPATCH, 195 ELESTAT, 123 ELESTRIN, 143 ELETONE, 197 ELETONE TWINPACK, 197 ELIDEL, 203 ELIGARD, 32 ELIMITE, 185 elinest, 139 ELIPHOS, 113 ELIQUIS, 49 ELITE DC AUTO ADAPTER, 90 ELITE NEBULIZER SYSTEM, 90 ELITE OB WITH DHA, 213 ELITEK, 118 ELITE-OB, 213 ELITE-OB 400, 213 ELIXOPHYLLIN, 210 ELIXSURE CONGESTION, 42 ELLA, 141 ELLENCE, 32 ELLIOTTS B, 114 ELMIRON, 155 ELOCON, 192 ELOCTATE, 47 ELOXATIN, 33 ELSPAR, 33 ELTA DERMAL GEL, 206 ELTA DERMAL WOUND DRESSING, 206 ELTA DERMAL WOUND GEL, 206 ELTA LITE TAR, 202 ELTA TAR, 202 EMADINE, 123 EMBEDA, 70 EMBRACE BLOOD GLUCOSE MONITORING SYSTEM, 95 EMBRACE BLOOD GLUCOSE MONITORING SYSTEM/TALKING, 95 EMBRACE BLOOD GLUCOSE TEST STRIPS, 101 EMBRACE EVO BLOOD GLUCOSE MONITORING KIT, 95 EMBRACE EVO BLOOD GLUCOSETEST STRIPS, 101 EMBRACE PRO BLOOD GLUCOSE METER, 96 EMBRACE PRO BLOOD GLUCOSETEST STRIPS, 101 EMCYT, 30 EMEND, 128 EMLA, 194 Emollients, Demulcents, and Protectants, 196 emoquette, 139 EMSAM, 79 EMTRIVA, 18 EMULSION SB, 203 ENABLEX, 209 enalapril maleate, 58 enalapril maleate/hydrochlorothiazide, 58 enalaprilat, 59 ENBREL, 152 ENBREL SURECLICK, 152 ENDACOF, 166 endacof-c, 162 endacof-dc, 166 ENDACOF-DC, 166 245 endacof-dm, 166 ENDACON, 166 ENDAL CD, 166 ENDO AVITENE SHEET/10MM DIAMETER/50MM X 15MM X 1MM, 46 ENDO AVITENE SHEET/5MM DIAMETER/50MM X 5MM X 1MM, 46 endocet, 62 endodan, 62 ENDOFORM DERMAL TEMPLATE, 206 ENDOFORM DERMAL TEMPLATE/FENESTRATED, 206 ENDOMETRIN, 145 ENDRATE, 132 endur-acin, 222 enfolast, 222 ENFOLAST-N, 222 ENGERIX-B, 179 ENGYSTOL, 157 ENJUVIA, 144 ENLON-PLUS, 38 ENLYTE, 108 ENOVARX-AMITRIPTYLINE, 86 ENOVARX-BACLOFEN, 40 ENOVARX-CYCLOBENZAPRINE HCL, 40 ENOVARX-IBUPROFEN, 193 ENOVARX-LIDOCAINE HCL, 195 ENOVARX-NAPROXEN, 193 ENOVARX-TRAMADOL, 206 enoxaparin sodium, 49 enpresse-28, 139 enskyce, 139 entacapone, 78 entecavir, 19 ENTERAGAM, 157 ENTEREG, 131 enteric coated aspirin, 70 ENTEX PAC, 166 ENTEX T, 175 ENTOCORT EC, 133 entre-cough, 167 ENTRE-COUGH TANNATE, 167 entre-s, 167 ENTYVIO, 131 enulose, 105 ENVISION AUTOCODE, 96, 101 ENVISION AUTOCODE TEST STRIPS, 101 Enzymes, 118 EOVIST, 100 EPANED, 59 ephedrine sulfate, 42 EPICERAM, 203 epidrin, 77 EPIDUO, 203 EPIFIX 14MM, 157 EPIFIX 2CM X 3CM, 157 EPIFIX 4CM X 4CM, 157 EPIFIX 5CM X 6CM, 157 EPIFIX 7CM X 7CM, 157 epiflur, 151 EPIFOAM, 192 epiklor, 112 epiklor/25, 112 epinastine hcl, 122 EPINEPHRINE, 41 epinephrine hcl, 42 EPIPEN, 41 EPIPEN 2-PAK, 41 EPIPEN-JR, 41 EPIPEN-JR 2-PAK, 41 EPIQUIN MICRO, 196 EPIQUIN MICRO/PUMP, 196 epirubicin hcl, 33 EPIRUBICIN HCL, 33 EPISIL, 203 epitol, 74 EPIVIR, 18, 19 EPIVIR HBV, 18, 19 eplerenone, 58 EPOGEN, 50 epoprostenol sodium, 177 eprosartan mesylate, 58 EPZICOM, 18 EQUAGESIC, 80 EQUETRO, 75 ERAXIS, 16 ERBITUX, 33 ergocalciferol, 224 ergoloid mesylates, 40 ERGOMAR, 40 ergotamine tartrate/caffeine, 77 ERGOTRATE MALEATE, 160 ERIVEDGE, 30 errin, 139 ERTACZO, 185 ERWINAZE, 33 ery, 183 ERYGEL, 185 ERYPED 200, 9 ERYPED 400, 9 ERYSIDORON #1, 157 ERYSIDORON #2, 157 ERY-TAB, 9 ERYTHROCIN LACTOBIONATE, 12 ERYTHROCIN STEARATE, 9 erythromycin, 8, 119, 183 erythromycin (250mg), 8 ERYTHROMYCIN (250MG), 9 ERYTHROMYCIN BASE, 9 erythromycin ethylsuccinate (400mg), 8 ERYTHROMYCIN ETHYLSUCCINATE (400MG), 9 erythromycin/benzoyl peroxide, 183 erythromycin/sulfisoxazole, 8 ESBRIET, 177 escitalopram oxalate, 83 ESGIC, 65, 66 ESGIC-PLUS, 66 esmolol hcl, 53 ESOCOR P, 167 esomeprazole sodium, 129 ESOMEPRAZOLE SODIUM, 129 ESOMEPRAZOLE STRONTIUM, 130 essian, 143 essian h.s., 143 246 estarylla, 139 estazolam, 79 esterified estrogens/methltestosterone, 143 esterified estrogens/methyltestosterone, 143 esterified estrogens/methyltestosterone ds, 143 esterified estrogens/methyltestosterone hs, 143 ESTRACE, 143, 144 ESTRADERM, 144 estradiol, 143, 144 estradiol valerate, 144 estradiol/norethindrone acetate, 143 ESTRASORB, 144 ESTRING, 144 ESTROGEL, 144 Estrogens and Antiestrogens, 143 estropipate (0.75mg), 143 estropipate (1.5mg), 143 ESTROPIPATE (3MG), 144 ESTROSTEP FE, 142 eszopiclone, 79 ethambutol hcl, 17 ETHAMOLIN, 59 ethosuximide, 75 ETHRANE, 82 ETHYL CHLORIDE, 194 ETHYL CHLORIDE/FINE PINPOINT, 194 ETHYL CHLORIDE/FINE STREAM, 194 ETHYL CHLORIDE/MEDIUM JET STREAM, 194 ETHYL CHLORIDE/MEDIUM STREAM, 194 ETHYL CHLORIDE/MIST, 194 ETHYOL, 160 ETIDRONATE DISODIUM, 150 etodolac, 62 etodolac er, 62 etomidate, 82 ETOPOPHOS, 33 etoposide, 33 ETOPOSIDE, 30 EUFLEXXA, 155 EURAX, 185 EVAMIST, 144 EVENCARE + BLOOD GLUCOSE TEST STRIP, 101 EVENCARE BLOOD GLUCOSE MONITORING SYSTEM, 96 EVENCARE BLOOD GLUCOSE TEST STRIP, 101 EVENCARE G2 BLOOD GLUCOSEMONITORING SYSTEM, 96 EVENCARE G2 TEST STRIPS, 101 EVENCARE G3 BLOOD GLUCOSEMONITORING SYSTEM, 96 EVENCARE G3 TEST STRIPS, 101 EVICEL, 207 EVISTA, 144 EVITHROM, 46 EVOCLIN, 185 EVOLUTION AUTOCODE, 96, 102 EVOXAC, 38 EVZIO, 82 exactacain, 195 EXACTECH R-S-G TEST STRIPS, 102 EXACTECH TEST STRIPS, 102 EXACTUSS, 167 EXALGO, 70 EXALL, 167 EXALL-D, 167 EXCEDRIN BACK & BODY, 70 EXCEDRIN TENSION HEADACHE, 70 execlear-c, 162 exefen dmx, 167 EXELDERM, 185 EXELON, 38 exemestane, 29 EXFORGE, 55 EXFORGE HCT, 55 EXJADE, 132 exoderm, 183 exotic-hc, 120 EXPAREL, 148 Expectorants, 174 EXPECTUSS, 167 EXTAVIA, 153 EXTINA, 188 extra action cough, 167 extra strength bayer, 70 extra strength bayer arthritis pain regimen, 70 EXTRANEAL, 111 EXTRA-VIRT PLUS DHA, 213 Eye, Ear, Nose & Throat Preparations, 119 EYLEA, 124 EZ SMART BLOOD GLUCOSE TEST STRIPS, 102 EZ SMART DIABETES MONITORING SYSTEM, 96 EZ SMART PLUS BLOOD GLUCOSE TEST STRIPS, 102 EZ SMART PLUS DIABETES MONITORING SYSTEM, 96 E-Z SPACER, 89 E-Z SPACER THE BODY GUARDS PACK, 89 F fabb, 221 FABIOR, 203 FABRAZYME, 118 FACTIVE, 10 FALESSA, 143, 157 falmina, 139 famciclovir, 18 famotidine, 129 FAMOTIDINE, 129 FAMOTIDINE PREMIXED, 129 FAMVIR, 19 FANAPT, 84 FANAPT TITRATION PACK, 84 FARESTON, 30 FARXIGA, 138 FASLODEX, 33 FASTTAKE COMPACT MONITORING SYSTEM, 90 FASTTAKE TEST STRIPS, 100 FATHER JOHNS MEDICINE PLUS, 167 FAZACLO, 86 FBL KIT, 207 FE 90 PLUS, 44 fe c plus, 44 FEIBA NF, 47 FEIBA VH IMMUNO, 47 felbamate, 75 FELBATOL, 75 247 FELDENE, 66 felodipine er, 54 FEM PH, 185 FEMARA, 30 FEMCAP, 86 FEMCON FE, 142 FEMECAL OB, 213 FEMHRT 1/5, 144 FEMHRT LOW DOSE, 144 FEMINEASE, 207 FEMRING, 144 FEMTRACE, 144 FENESIN DM IR, 167 fenesin ir, 175 fenofibrate, 51 FENOFIBRATE, 51 fenofibrate micronized, 51 FENOFIBRIC ACID, 51 fenofibric acid dr, 51 FENOGLIDE, 52 fenoldopam mesylate, 57 FENOPROFEN CALCIUM, 64 fentanyl, 62, 67 fentanyl citrate, 62, 67 fentanyl citrate oral transmucosal, 62 FENTORA, 64 FERAHEME, 46 FERIVA, 44, 46 FERIVA 21/7, 44 FERIVAFA, 45 ferocon, 44 ferotrin, 44 FERRALET 90, 44 FERRAPLUS 90, 45 FERREX 150 FORTE PLUS, 45 FERREX 28, 45 FERRIC CITRATE, 110 FERRIPROX, 132 FERRLECIT, 46 ferrocite plus, 44 ferrogels forte, 44 FERRO-PLEX HEMATINIC, 45 FERROTRIN, 45 FETRIN, 46 FETZIMA, 84 FETZIMA TITRATION PACK, 84 FEXMID, 40 fexofenadine hcl, 29 FEXOFENADINE HCL, 29 fexofenadine hcl/pseudoephedrine hcl er, 29 FEXOFENADINE/PSEUDOEPHEDRINE, 29 FIBRICOR, 52 Fibromyalgia Agents, 81 FIFTY50 GLUCOSE METER 2.0, 96 FIFTY50 GLUCOSE TEST STRIP 2.0, 102 FILTER AIR PP, 90 FINACEA, 203, 207 FINACEA PLUS, 207 finasteride, 149, 207 FIORICET, 66 FIORICET/CODEINE, 66 FIORINAL, 66 FIORINAL/CODEINE #3, 66 FIRAZYR, 152 FIRMAGON, 33 First Generation Antihistamines, 21 FIRST-BXN MOUTHWASH, 16 FIRST-DUKES MOUTHWASH, 16 FIRST-HYDROCORTISONE, 192 FIRST-LANSOPRAZOLE, 129 FIRST-MARYS MOUTHWASH, 16 FIRST-MOUTHWASH BLM, 194 FIRST-OMEPRAZOLE, 129 FIRST-PROGESTERONE VGS 100 COMPOUNDING KIT, 145 FIRST-PROGESTERONE VGS 200 COMPOUNDING KIT, 145 FIRST-PROGESTERONE VGS 25 COMPOUNDING KIT, 146 FIRST-PROGESTERONE VGS 400 COMPOUNDING KIT, 146 FIRST-PROGESTERONE VGS 50 COMPOUNDING KIT, 146 FIRST-TESTOSTERONE, 135 FIRST-TESTOSTERONE MC COMPOUNDING KIT, 135 FIRST-VANCOMYCIN 25, 9 FIRST-VANCOMYCIN 50, 9 FLAGYL, 17 FLAGYL ER, 17 FLAREX, 121 FLAVOR BLEND, 161 FLAVOR PLUS, 161 FLAVOR SWEET, 161 FLAVOR SWEET-SF, 161 flavoxate hcl, 209 FLEBOGAMMA, 178 FLEBOGAMMA DIF, 178 flecainide acetate, 56 FLECTOR, 207 flexbumin, 43 FLEXERIL, 39 FLOLAN, 177 FLOMAX, 40 FLONASE, 122 FLO-PRED, 134 FLORIVA, 152, 213 FLOVENT DISKUS (100MCG/BLIST), 133, 134 FLOVENT DISKUS (250MCG/BLIST), 133, 134 FLOVENT DISKUS (50MCG/BLIST), 133 FLOVENT HFA, 133 floxuridine, 33 FLUARIX 2010-2011, 179 FLUARIX 2011-2012, 179 FLUARIX 2012-2013, 179 FLUARIX 2013-2014, 179 FLUARIX 2014-2015, 179 FLUARIX QUADRIVALENT 2013-2014, 180 FLUARIX QUADRIVALENT 2014-2015, 180 FLUBLOK 2013-2014, 180 FLUBLOK 2014-2015, 180 FLUCELVAX 2012-2013, 180 FLUCELVAX 2013-2014, 180 FLUCELVAX 2014-2015, 180 fluconazole, 15, 16 fluconazole in dextrose, 16 fluconazole in nacl, 16 FLUCONAZOLE IN NACL, 16 248 flucytosine, 16 FLUDARA, 33 fludarabine phosphate, 33 FLUDARABINE PHOSPHATE, 33 fludrocortisone acetate, 132 FLULAVAL 2010-2011, 180 FLULAVAL 2011-2012, 180 FLULAVAL 2012-2013, 180 FLULAVAL 2013-2014, 180 FLULAVAL 2014-2015, 180 FLULAVAL QUADRIVALENT 2013-2014, 180 FLULAVAL QUADRIVALENT 2014-2015, 180 FLUMADINE, 19 flumazenil, 81 FLUMIST NASAL VACCINE 2010-2011, 180 FLUMIST NASAL VACCINE 2011-2012, 180 FLUMIST NASAL VACCINE 2012-2013, 180 FLUMIST QUADRIVALENT, 180 flunisolide, 120 FLUNISOLIDE, 120, 121 fluocinolone acetonide, 120, 190 fluocinolone acetonide body, 190 fluocinolone acetonide ear drops, 120 fluocinolone acetonide scalp, 190 fluocinonide, 190 fluocinonide emollient base, 190 fluocinonide-e, 190 fluor-a-day, 152 FLUOR-A-DAY, 152 fluoride, 151 fluoridex daily defense, 87, 152 fluoridex daily defense enhanced whitening, 152 fluoridex daily defense sensitivity relief, 87 FLUORIDEX DAILY DEFENSE SENSITIVITY RELIEF, 87 fluoritab, 151 fluorometholone, 120 fluor-op, 120 FLUOROPLEX, 203 fluorouracil, 33, 202 FLUOROURACIL (0.5%), 203 fluorouracil (5%), 202 fluoxetine, 83, 86 fluoxetine dr, 86 fluoxetine hcl, 83 fluoxetine hcl (10mg), 83 fluoxetine hcl (20mg), 83 FLUOXETINE HCL (60MG), 86 fluphenazine decanoate, 85 fluphenazine hcl, 83 FLUPHENAZINE HCL, 84, 85 flura-drops, 151 flurazepam hcl (15mg), 79 FLURAZEPAM HCL (15MG), 80 flurazepam hcl (30mg), 79 FLURAZEPAM HCL (30MG), 80 flurbiprofen, 62, 120 flurbiprofen sodium, 120 flutamide, 29 fluticasone propionate, 120, 190 FLUTTER, 90 fluvastatin, 51 FLUVIRIN 2010-2011, 180 FLUVIRIN 2011-2012, 180 FLUVIRIN 2012-2013, 180 FLUVIRIN 2013-2014, 180 FLUVIRIN 2014-2015, 180 FLUVIRIN PF 2011-2012, 180 FLUVIRIN PF 2012-2013, 180 FLUVIRIN PF 2013-2014, 180 FLUVIRIN PF 2014-2015, 180 fluvoxamine maleate, 83, 86 fluvoxamine maleate er, 86 FLUZONE HIGH-DOSE PF 2010-2011, 180 FLUZONE HIGH-DOSE PF 2011-2012, 180 FLUZONE HIGH-DOSE PF 2012-2013, 180 FLUZONE HIGH-DOSE PF 2013-2014, 180 FLUZONE HIGH-DOSE PF 2014-2015, 180 FLUZONE INTRADERMAL, 180 FLUZONE PEDIATRIC PF 2010-2011, 180 FLUZONE PEDIATRIC PF 2011-2012, 181 FLUZONE PEDIATRIC PF 2012-2013, 181 FLUZONE PEDIATRIC PF 2013-2014, 181 FLUZONE PF 2010-2011, 181 FLUZONE PF 2011-2012, 181 FLUZONE PF 2012-2013, 181 FLUZONE PF 2013-2014, 181 FLUZONE PF 2014-2015, 181 FLUZONE QUADRIVALENT 2013-2014, 181 FLUZONE QUADRIVALENT 2014-2015, 181 FLUZONE SPLIT 2010-2011, 181 FLUZONE SPLIT 2011-2012, 181 FLUZONE SPLIT 2012-2013, 181 FLUZONE SPLIT 2013-2014, 181 FLUZONE SPLIT 2014-2015, 181 FML, 121, 122 FML FORTE, 121 FML LIQUIFILM, 122 FOCALGIN-B, 213 FOCALIN, 73 FOCALIN XR, 73 FOLAST, 222 folastin, 222 FOLBECAL, 213 folbee, 210, 221 FOLBEE AR, 222 folbee plus, 210 folbee plus cz, 210 folbic, 222 FOLBIC RF, 222 FOLCAL DHA, 213 folcaps, 221 FOLCAPS CARE ONE, 212 FOLCAPS OMEGA 3, 212 FOLET DHA, 213 FOLET ONE, 213 FOLGARD OS, 214 FOLGARD RX, 221 folic acid, 221, 222 FOLIC ACID, 222 folic acid/vitamin b-6/vitamin b-12, 221 folitab, 44 FOLIVANE-EC CALCIUM DHA NF, 214 249 FOLIVANE-F, 45 FOLIVANE-OB, 214 FOLIVANE-PLUS, 45 FOLIVANE-PRX DHA NF, 214 FOLLISTIM AQ, 144, 145 FOLOTYN, 33 FOLPACE RX, 221 folplex 2.2, 221 FOLTANX, 222 FOLTANX RF, 222 foltrin, 44 FOLTX, 222 fomepizole, 150 fondaparinux sodium, 49 FORA D10 BLOOD GLUCOSE TEST STRIPS, 102 FORA D15C BLOOD GLUCOSE TEST STRIPS, 102 FORA D15G BLOOD GLUCOSE TEST STRIPS, 102 FORA D15Z BLOOD GLUCOSE TEST STRIPS, 102 FORA D20 BLOOD GLUCOSE TEST STRIPS, 102 FORA G20 BLOOD GLUCOSE MONITORING SYSTEM, 96 FORA G20 BLOOD GLUCOSE TEST STRIPS, 102 FORA G30A BLOOD GLUCOSE MONITORING SYSTEM, 96 FORA G30A BLOOD GLUCOSE TEST STRIPS, 102 FORA G71A BLOOD GLUCOSE MONITORING SYSTEM, 96 FORA G71A BLOOD GLUCOSE TEST STRIPS, 102 FORA G90 BLOOD GLUCOSE MONITORING SYSTEM, 96 FORA G90 BLOOD GLUCOSE TEST STRIPS, 102 FORA GD20 BLOOD GLUCOSE MONITORING SYSTEM, 96 FORA GD20 TEST STRIPS, 102 FORA GD50 BLOOD GLUCOSE MONITORING SYSTEM, 96 FORA GD50 BLOOD GLUCOSE TEST STRIPS, 102 FORA TEST N' GO BLOOD GLUCOSE TEST STRIPS, 102 FORA TEST N' GO VOICE BLOOD GLUCOSE MONITORING SYSTEM, 96 FORA V10 BLOOD GLUCOSE MONITORING SYSTEM/TALKING, 96 FORA V10 BLOOD GLUCOSE TEST STRIPS, 102 FORA V12 BLOOD GLUCOSE MONITORING SYSTEM/NO-CODING, 96 FORA V12 BLOOD GLUCOSE MONITORING SYSTEM/TALKING, 96 FORA V12 BLOOD GLUCOSE TEST STRIPS, 102 FORA V20 BLOOD GLUCOSE MONITORING SYSTEM, 96 FORA V20 BLOOD GLUCOSE TEST STRIPS, 102 FORA V22 BLOOD GLUCOSE MONITORING SYSTEM/TALKING, 96 FORA V22 BLOOD GLUCOSE TEST STRIPS, 102 FORA V30A BLOOD GLUCOSE MONITORING SYSTEM, 96 FORA V30A BLOOD GLUCOSE TEST STRIPS, 102 FORACARE GD40, 96, 102 FORACARE GD40 BLOOD GLUCOSE MONITORING SYSTEM, 96 FORACARE PREMIUM V10 BLOOD GLUCOSE MONITORING SYSTEM, 96 FORACARE PREMIUM V10 TESTSTRIPS, 102 FORACARE TEST N GO BLOOD GLUCOSE MONITORING SYSTEM, 96 FORACARE TEST N GO TEST STRIPS, 102 FORADIL AEROLIZER, 41 FORANE, 82 FORFIVO XL, 86 formadon, 104 formalaz, 104 formaldehyde, 104 FORMALDEHYDE, 104 formaldehyde neutralized/buffered, 104 FORMA-RAY, 104 formula b plus, 210 FORTADERM, 207 FORTADERM ANTIMICROBIAL PHMB, 207 FORTAMET, 138 FORTAVIT, 214 FORTAZ, 12 FORTEO, 145 FORTESTA, 135 FORTICAL, 145 FORTISCARE BLOOD GLUCOSE TEST STRIP, 102 FORTISCARE SELF-MONITORING BLOOD GLUCOSE SYSTEM, 96 FOSAMAX, 151 FOSAMAX (10MG), 151 FOSAMAX (35MG), 151 FOSAMAX (40MG), 151 FOSAMAX (5MG), 151 FOSAMAX (70MG), 151 FOSAMAX PLUS D, 151 FOSCARNET SODIUM, 20 FOSCAVIR, 20 fosinopril sodium, 58 fosinopril sodium/hydrochlorothiazide, 58 fosphenytoin sodium, 76 FOSRENOL, 110 FOSTEUM, 108, 157 FOSTEUM PLUS, 108 FOVEX, 108 FRAGMIN, 49 FREAMINE HBC 6.9%, 107 freamine iii, 107 FREAMINE III, 107 FREAMINE III 3%, 107 FREEDOM ALCOHOL GEL, 188 FREESTYLE FLASH SYSTEM, 96 FREESTYLE FREEDOM, 96 FREESTYLE FREEDOM LITE, 96 FREESTYLE INSULINX BLOOD GLUCOSE MONITORING SYSTEM, 96 FREESTYLE INSULINX BLOOD GLUCOSE TEST, 102 FREESTYLE INSULINX BLOOD GLUCOSE TEST STRIPS, 102 FREESTYLE LITE BLOOD GLUCOSE MONITORING SYSTEM, 96 FREESTYLE LITE TEST STRIPS, 102 FREESTYLE SIDEKICK II VALUEPACK, 96 FREESTYLE SYSTEM KIT, 96 FREESTYLE TEST STRIPS, 102 FRENADOL, 70 fresenius propoven, 82 FROVA, 77 FUDR, 33 FULL KIT NEBULIZER SET, 90 FULYZAQ, 127 FUMATINIC, 46 FURADANTIN, 21 furosemide, 109, 110 furosemide (10mg/ml), 109, 110 FUROSEMIDE (8MG/ML), 110 FUSILEV, 150 FUSION PLUS, 45 FUZEON, 19 250 FYCOMPA, 75 G G/P, 175 G4 PLATINUM PEDIATRIC RECEIVER KIT, 96 G4 PLATINUM RECEIVER KIT, 96 G4 PLATINUM SENSOR KIT, 96 G4 PLATINUM TRANSMITTER KIT, 96 G4 SENSOR KIT, 97 GABADONE, 108 gabapentin, 75 GABAVALE-5, 81 GABAZOLAMINE, 81 GABAZOLAMINE-0.5, 81 GABAZOLPIDEM-5, 81 GABITIDINE, 130 GABITRIL (12MG), 75 GABITRIL (16MG), 75 GABITRIL (2MG), 75 GABITRIL (4MG), 76 GABLOFEN, 39 GABOXETINE, 86 galantamine, 38 galantamine hydrobromide, 38 GALIUM-HEEL, 157 GALZIN, 113 GAMASTAN S/D, 178 GAMMAGARD LIQUID, 178 GAMMAGARD S/D, 178 GAMMAGARD S/D IGA LESS THAN 1MCG/ML, 178 GAMMAKED, 178 GAMMAPLEX, 178 GAMUNEX, 178 GAMUNEX-C, 178 ganciclovir, 20 GANCICLOVIR, 19 ganidin-nr, 175 GANIRELIX ACETATE, 153 GANITE, 151 gani-tuss dm nr, 167 gani-tuss nr, 162 garamycin, 119 GARAMYCIN, 120 GARDASIL, 181 GASTRINEX NF, 37 GASTROCROM, 162 Gastrointestinal Drugs, 127 gatifloxacin, 119 GATTEX, 131 gavilyte-c, 130 gavilyte-g, 130 gavilyte-n/flavor pack, 130 GAZYVA, 33 GE100 BLOOD GLUCOSE MONITORING SYSTEM, 97 GE100 BLOOD GLUCOSE TEST STRIPS, 102 GEBAUERS PAIN EASE, 194 GEBAUERS SPRAY AND STRETCH, 194 GELCLAIR, 203 GELFILM ENVELOPE, 46 GELFILM OP, 46 GELFOAM, 46 GELFOAM DENTAL PACK, 46 GELFOAM SPONGE, 46 GELFOAM SPONGE COMPRESSED, 46 GEL-KAM ORAL CARE RINSE, 152 GELNIQUE, 209 GEL-ONE, 157 GELX, 203 GEMCITABINE, 33 gemcitabine hcl, 33 gemfibrozil, 51 GEMZAR, 33 GENADUR, 207 GENADUR KIT, 207 genantuss, 167 genantussidex, 167 genaphed, 42 genebrom dm, 167 GENEBRONCO-D, 167 genecar, 25 GENEDEL, 167 GENEDOLOREX, 25 genedotuss-dm, 167 GENELAN, 167 GENELAN NF, 167 GENEPATUSS, 167 General Anesthetics, 82 GENERESS FE, 143 gene-r-gesic, 25 generlac, 105 genesupp-500, 210 genetect plus, 210 genetical, 210 gene-t-press, 167 GENEVIT-FA, 214 GENEXA LA, 175 genexotic-hc, 121 GENEXPECT DM, 167 GENEXPECT-PE, 167 GENEXPECT-SF, 167 genezoto-hc, 121 gengraf, 154 GENHEMAT, 45 Genitourinary Smooth Muscle Relaxants, 209 GENOTROPIN, 146 GENOTROPIN MINIQUICK, 146 gentak, 119 gentamicin sulfate, 13, 119, 183 gentamicin sulfate (0.1%), 183 GENTAMICIN SULFATE (0.1%), 185, 186 gentamicin sulfate pediatric, 13 gentamicin sulfate/0.9% sodium chloride, 13 GENTAMICIN SULFATE/0.9% SODIUM CHLORIDE, 13 gentamicin sulfate/sodium chloride, 13 gentasol, 119 GENTEX 30, 167 GENTEX ADE, 214 gentex lq, 167 gentran 40, 114 GEODON, 84, 85 geri-tussin, 167, 175 251 geri-tussin dm, 167 GESTICARE, 214 GESTICARE DHA, 214 gfn 1200/dm 60, 167 GFN 550/PSE 60, 175 gg 200 nr, 175 GHT BLOOD GLUCOSE MONITO RING SYSTEM, 97 GHT TEST STRIPS, 102 GI Drugs, Miscellaneous, 131 gianvi, 139 GIAZO, 127 gildagia, 139 gildess 1.5/30, 139 gildess 1/20, 139 gildess fe 1.5/30, 139 gildess fe 1/20, 139 GILENYA, 153 GILOTRIF, 30 GILPHEX TR, 174 GILTUSS, 167 GILTUSS PED-C, 167 giltuss pediatric, 167 GILTUSS TR, 167 GLASSIA, 177 GLEEVEC, 30 GLIADEL WAFER, 33 glimepiride, 136 glipizide, 136 glipizide er, 136 glipizide xl, 136 glipizide/metformin hcl, 136 GLONOIN HOMACCORD, 157 GLUCAGEN, 138 GLUCAGEN HYPOKIT, 138 GLUCAGON EMERGENCY KIT, 138 GLUCO PERFECT 3 BLOOD GLUCOSE METER, 97 GLUCO PERFECT 3 BLOOD GLUCOSE MONITORING SYSTEM/VOICE, 97 GLUCO PERFECT 3 TEST STRIPS, 102 GLUCOCARD 01 BLOOD GLUCOSE METER, 97 GLUCOCARD 01 BLOOD GLUCOSE MONITORING SYSTEM, 97 GLUCOCARD 01 SENSOR, 102 GLUCOCARD 01 TEST STRIPS, 102 GLUCOCARD 01-MINI BLOOD GLUCOSE MONITORING SYSTEM, 97 GLUCOCARD EXPRESSION AUDIO-ENABLED BLOOD GLUCOSE MONITORING, 97 GLUCOCARD EXPRESSION BLOOD GLUCOSE TEST STRIPS, 102 GLUCOCARD VITAL BLOOD GLUCOSE MONITORING SYSTEM, 97 GLUCOCARD VITAL BLOOD GLUCOSE MONITORING SYSTEM BLACK, 97 GLUCOCARD VITAL BLOOD GLUCOSE MONITORING SYSTEM BLUE, 97 GLUCOCARD VITAL BLOOD GLUCOSE MONITORING SYSTEM PINK, 97 GLUCOCARD VITAL TEST STRIPS, 102 GLUCOCARD X-METER, 97 GLUCOCARD X-SENSOR, 102 GLUCOCOM BLOOD GLUCOSE MONITOR, 97 GLUCOCOM BLOOD GLUCOSE MONITORING SYSTEM, 97 GLUCOCOM BLOOD GLUCOSE MONITORING SYSTEM VALUE KIT, 97 GLUCOCOM TEST STRIPS, 102 GLUCOLAB BLOOD GLUCOSE MONITORING SYSTEM, 97 GLUCOLAB TEST STRIPS, 102 GLUCONAVII BLOOD GLUCOSE MONITORING SYSTEM, 97 GLUCONAVII BLOOD GLUCOSE TEST STRIPS, 102 GLUCOPHAGE, 138 GLUCOPHAGE XR, 138 GLUCOTROL, 138 GLUCOTROL XL, 138 GLUCOVANCE, 138 GLUMETZA, 138 GLUTARALDEHYDE, 104 GLUTOFAC-MX, 113 GLUTOFAC-ZX, 214 glyburide, 136 GLYBURIDE, 136 glyburide micronized, 136 glyburide/metformin hcl, 136 GLYCATE, 38 glycine, 111 GLYCOLIC ACID, 207 GLYCOLIC ACID 70% HIGH PURITY, 207 GLYCOPHOS, 114 glycopyrrolate, 36, 37 glycron (1.5mg), 136 glycron (3mg), 136 GLYCRON (4.5MG), 136 glycron (6mg), 136 glydo, 193 GLYNASE, 138 GLYOXAL COMPOSITUM, 157 GLYSET, 138 GLYTACTIN BETTERMILK 10, 108 GLYTACTIN BETTERMILK 15, 108 GLYTACTIN RTD 10, 108 GLYTACTIN RTD 15, 108 GMATE BLOOD GLUCOSE TEST STRIPS, 102 GMATE SMART METER KIT, 97 GMATE SMART STARTER KIT, 97 GMATE VOICE BLOOD GLUCOSEMONITORING SYSTEM, 97 GOLD BOND MEDICATED ANTI-ITCH, 195 Gold Compounds, 131 gold sodium thiomalate, 131 GOLYTELY, 130 Gonadotropin‐releasing Hormone Antagonists, 153 Gonadotropins, 144 GONAL-F, 145 GONAL-F RFF, 145 GONAL-F RFF PEN, 145 GONAL-F RFF REDIJECT, 145 goodsense aspirin low dose, 70 goodsense mucus relief, 175 GOODYS BODY PAIN, 70 GORDOFILM, 200 GORDONS UREA, 200 G-P-TUSS DXP, 167 grafco silver nitrate applicator, 119 GRAFIX CORE 2CM X 2CM, 157 GRAFIX CORE 5CM X 5CM, 157 252 GRAFIX PRIME 2CM X 2CM, 157 GRAFIX PRIME 5CM X 5CM, 157 GRAFIX PRIME 7.5CM X 15CM, 157 GRALISE, 70 GRALISE STARTER, 70 granisetron hcl, 128 GRANISOL, 128 GRANIX, 50 GRANULEX, 203 GRASTEK, 157 GREEN SOAP, 196 GRIFULVIN V, 16 GRIPP-HEEL, 157 griseofulvin microsize, 16 griseofulvin ultramicrosize, 16 GRIS-PEG, 16 grx hicort 25, 190 GRX WOUND, 207 g-supress dx pediatric, 167 g-tron, 167 g-tron ped, 167 G-TRON PEDIATRIC DROPS, 167 G-TUSICOF, 167 guaiasorb dm, 168 guaicon dms, 168 guaifenesin, 162, 168, 175 guaifenesin dac, 168 guaifenesin dm cough & chest congestion maximum strength, 168 guaifenesin er, 175 guaifenesin nr, 175 guaifenesin/codeine phospate, 162 guaifenesin/codeine phosphate, 162 guaifenesin/dextromethorphan, 168 guaifenesin/phenylephrine hcl, 175 guaifenesin/phenylephrinehcl, 175 guaifenesin-dm, 168 guaifenesin-dm nr, 168 GUANABENZ ACETATE, 57 guanfacine hcl, 57 GUANIDINE HCL, 38 GUARDIAN REAL-TIME STARTER KIT, 97 GUARDIAN REAL-TIME SYSTEM, 97 GUARDIAN REAL-TIME SYSTEMPEDIATRIC, 97 GUARDIAN RT STARTER KIT, 97 GYNAZOLE-1, 186 G-ZYNCOF, 167 H H.P. ACTHAR, 145 halac, 190 HALAVEN, 33 HALCION, 80 HALDOL, 85 HALDOL DECANOATE 100, 85 HALDOL DECANOATE 50, 85 HALFAN, 18 HALFLYTELY BOWEL PREP/FLAVOR PACKS, 130 halfprin, 70 HALFPRIN, 70 halobetasol propionate, 190 HALOG, 192 HALONATE, 193 halonate pac, 190 haloperidol, 83, 85 haloperidol decanoate, 85 haloperidol lactate, 85 HALOTIN, 186 HARVONI, 20 HAVRIX, 181 hayfebrol, 25 hc pram, 193 HDC DM, 168 HEALON, 125 HEALON GV, 125 HEALON5, 125 HEALTHY LIVING COMPRESSOR/NEBULIZER DESK TOP SIZE, 90 healtussin dm, 168 heather, 139 Heavy Metal Antagonists, 131 hecoria, 154 HECTOROL, 224 HELIDAC, 130 HELISTAT SPONGE 3, 47 HELIXATE FS, 47 HEMABATE, 160 HEMANGEOL, 53 HEMASEEL APR KIT, 207 hematinic plus vitamins/minerals, 44 hematinic/folic acid, 44 hematogen, 44 HEMATOGEN FA, 45 hematogen forte, 44 Hematopoietic Agents, 50 HEMATRON-AF, 45 HEMENATAL OB, 214 HEMENATAL OB + DHA, 214 HEMETAB, 45 HEMOCYTE PLUS, 45 hemocyte-f, 45 HEMOCYTE-F, 45 hemocyte-plus, 44 HEMOFIL M, 47 Hemorrheologic Agents, 51 hemorrhoidal, 190, 197 hemorrhoidal hygiene pads, 197 hemorrhoidal-hc, 190 hemril-30, 190 hep flush-10, 49 HEPAGAM B, 178 HEPAR COMPOSITUM, 158 heparin lock, 49 heparin lock flush, 49 HEPARIN LOCK FLUSH, 49 heparin lock flush for flushing vascular access devices, 49 heparin lock flush/nacl for flushing vascular access devices, 49 heparin sodium, 49, 50 HEPARIN SODIUM, 49, 50 heparin sodium dcu, 50 heparin sodium lock flush, 50 heparin sodium lock flushcombination package, 50 heparin sodium/d5w, 50 253 HEPARIN SODIUM/D5W, 50 HEPARIN SODIUM/NACL 0.45%, 50 heparin sodium/nacl 0.9%, 50 HEPARIN SODIUM/SODIUM CHLORIDE 0.9%, 50 heparin sodium/sodium chloride 0.9% premix, 50 hepatamine, 107 hepatasol, 107 hep-lock, 49 HEPSERA, 19 HERBAL EXPEC, 175 HERCEPTIN, 33 HESPAN, 114 hetastarch 6%/nacl, 114 HETLIOZ, 81 HEXALEN, 30 HEXTEND, 114 HIBERIX, 181 HIPREX, 21 HISTEX, 25, 168 HISTEX SR, 25 HISTEX-DM, 168 HIZENTRA, 177 HOMAPIN-10, 37 homatropaire, 126 homatropine hbr, 126 HONEY BEE TREATMENT KIT, 155 HONEY BEE VENOM, 155 HONEY BEE VENOM PROTEIN, 155 HORIZANT, 76 HORMEEL, 158 Hormones and Synthetic Substitutes, 132 HPR, 197 HPR PLUS, 197 HPR PLUS/MB HYDROGEL, 197 HSA STERILE DILUENT, 43 HUMALOG, 136 HUMALOG KWIKPEN, 136 HUMALOG MIX 50/50, 136 HUMALOG MIX 50/50 KWIKPEN, 136 HUMALOG MIX 75/25, 136 HUMALOG MIX 75/25 KWIKPEN, 136 human albumin grifols, 43 HUMATE-P, 47 HUMATROPE, 146 HUMATROPE COMBO PACK, 146 HUMIRA, 152, 153 HUMIRA PEDIATRIC CROHNS DISEASE STARTER PACK, 152 HUMIRA PEN, 152, 153 HUMIRA PEN-CROHNS DISEASESTARTER, 153 HUMIRA PEN-PSORIASIS STARTER, 153 HUMULIN 50/50, 136 HUMULIN 70/30, 136 HUMULIN 70/30 KWIKPEN, 136 HUMULIN 70/30 PEN, 136 HUMULIN N, 136 HUMULIN N KWIKPEN, 136 HUMULIN N U-100 PEN, 136 HUMULIN R, 136 HUMULIN R U-500 (CONCENTRATED), 136 HYALGAN, 155 HYCAMTIN, 30, 33 HYCET, 66 hydralazine hcl, 57 HYDREA, 30 HYDRO 35, 201 HYDRO 40 FOAM, 200 hydrochloric acid, 131 hydrochlorothiazide, 109, 110 hydrochlorothiazide (12.5mg), 110 hydrochlorothiazide (25mg), 109 hydrochlorothiazide (50mg), 109 hydrocodone bitartrate/acetaminophen, 62, 63, 70 hydrocodone bitartrate/chlorpheniramine maleate/pse, 162 hydrocodone bitartrate/homatropine methylbromide, 162 hydrocodone polistirex/chlorpheniramine polistirex, 162 hydrocodone/homatropine, 162 hydrocodone/ibuprofen, 63, 71 hydrocortisone, 121, 132, 183, 190, 193, 195 hydrocortisone acetate, 190, 193, 195 hydrocortisone acetate/aloe, 190 hydrocortisone acetate/lidocaine hcl, 195 hydrocortisone acetate/pramoxine, 190, 193 hydrocortisone acetate/pramoxine hcl, 190, 193 hydrocortisone butyrate, 190 hydrocortisone butyrate (lipid), 190 hydrocortisone butyrate (lipophilic), 190 hydrocortisone in absorbase, 190 hydrocortisone valerate, 190 hydrocortisone/acetic acid, 121 hydrocortisone/iodoquinol, 183 HYDROFERA BLUE 4, 207 HYDROFERA BLUE FOAM DRESSING, 207 HYDROFERA BLUE FOAM DRESSING/MOISTURE RETENTIVE FILM, 207 HYDROGEL, 161, 209 HYDROGEN PEROXIDE, 188 hydrogesic, 71 HYDRO-IODOQUINOL 2-1, 188 hydromet, 162 hydromorphone hcl, 63, 67, 71 HYDROMORPHONE HCL, 64, 67, 71 HYDROMORPHONE HCL DOSETTE, 67 hydromorphone hcl er, 71 HYDROMORPHONE HCL ER, 71 hydroquinone, 196 hydroquinone time release, 196 hydroquinone/sunscreens, 196 HYDROXOCOBALAMIN, 222 hydroxychloroquine sulfate, 17 hydroxyurea, 30 hydroxyzine hcl, 79, 80 HYDROXYZINE HCL, 80 HYDROXYZINE PAMOATE (100MG), 80 hydroxyzine pamoate (25mg), 79 hydroxyzine pamoate (50mg), 79 hygel, 196 HYLASE WOUND, 203 HYLATOPIC, 197 HYLATOPIC PLUS, 197 HYLATOPIC PLUS/AURSTAT, 197 HYLENEX, 118 HYLIRA, 197 254 hyomax, 36 hyomax -dt, 36 hyomax-ft, 36 hyomax-sl, 36 hyomax-sr, 36 hyophen, 20 hyoscyamine, 36 hyoscyamine sulfate, 36 hyoscyamine sulfate er, 36 hyoscyamine sulfate odt, 36 hyoscyamine sulfate sr, 36 hyosyne, 36 hypercare, 195 HYPERHEP B S/D, 178 HYPERLYTE-CR, 114 HYPERRAB S/D, 178 HYPERRHO S/D, 178 HYPERRHO S/D MINI-DOSE, 178 HYPER-SAL, 176 HYPERSAL (3.5%), 176 HYPERSAL (7%), 176 HYPERTENEVIDE-12.5, 53 HYPERTENIPINE-2.5, 55 HYPERTENSA, 108 HYPERTENSOLOL, 54 HYPERTET S/D, 178 Hypotensive Agents, 57 HYQVIA, 178 HYSKON, 111 HYZAAR, 59 I ibandronate sodium, 150, 151 IBG STAR BLOOD GLUCOSE MONITORING SYSTEM, 97 ibuprofen, 63 IBUPROFEN COMFORT PAC, 71 ibutilide fumarate, 56 ICAR-C PLUS, 45, 46 ICAR-C PLUS SR, 46 ICLUSIG, 30 IDAMYCIN PFS, 33 idarubicin hcl, 33 iferex 150 forte, 44 IFEX, 33 ifosfamide, 33 IFOSFAMIDE, 33 IFOSFAMIDE/MESNA, 33 ILARIS, 67 ILEVRO, 121 ilotycin (5mg/gm), 119, 120 IMBRUVICA, 30 IMDUR, 61 imipenem/cilastatin, 13 imipramine hcl, 83 imipramine pamoate, 83 imiquimod, 202 IMITREX, 77 IMITREX STATDOSE REFILL, 77 IMITREX STATDOSE SYSTEM, 77 Immunomodulatory Agents, 153 Immunosuppressive Agents, 154 IMOGAM RABIES-HT, 178 IMOVAX RABIES (H.D.C.V.), 181 IMPLANON, 143 IMURAN, 154 INAMRINONE, 56 INATAL ADVANCE, 214 INATAL GT, 214 INATAL ULTRA, 214 IN-CHECK DIAL INSPIRATORYFLOW TRAINER, 90 IN-CHECK INSPIRATORY FLOWMETER/NASAL WITH MASK, 90 IN-CHECK INSPIRATORY FLOWMETER/ORAL, 90 INCIVEK, 20 INCRELEX, 146 indamix dm, 168 indapamide, 109 INDERAL LA, 53 INDERAL XL, 54 INDICLOR, 155 INDIUM IN 111 DTPA, 155 INDOCIN, 64, 67 INDOCIN IV, 67 indomethacin, 63, 67 INDOMETHACIN, 67 indomethacin cr, 63 indomethacin er, 63 indomethacin sodium, 67 INFANATE BALANCE, 214 INFANATE DHA, 214 INFANATE PLUS, 214 INFANRIX, 179 INFASURF, 177 infed, 46 INFERGEN, 20 INFINITY BLOOD GLUCOSE MONITORING SYSTEM, 97 INFINITY BLOOD GLUCOSE MONITORING SYSTEM/STARTER KIT, 97 INFINITY BLOOD GLUCOSE TEST STRIPS, 102 INFLUENZA A (H1N1) MONOVALENT 2009, 181 INFLUENZA A (H1N1) MONOVALENT 2009 PF, 181 INFUMORPH 200, 67 INFUMORPH 500, 67 infuvite, 220 infuvite adult, 220 infuvite pediatric, 220 INJECTAFER, 46 INLYTA, 30 INNOHEP, 49 INNOPRAN XL, 53 INNOSPIRE ELEGANCE COMPRESSOR NEBULIZER SYSTEM, 90 INNOSPIRE ESSENCE COMPRESSOR NEBULIZER SYSTEM, 90 INNOSPIRE REPLACEMENT FILTER, 90 INOVA, 186 INOVA 4/1 ACNE CONTROL THERAPY, 186 INOVA 8/2 ACNE CONTROL THERAPY, 186 inpersol/dextrose, 112 inpersol-lm/1.5% dextrose, 111 inpersol-lm/2.5% dextrose, 111 inpersol-lm/4.25% dextrose, 112 INSPIRATION COMPRESSOR NEBULIZER SYSTEM, 90 INSPIRATION ELITE COMPRESSOR NEBULIZER SYSTEM, 90 255 INSPIREASE BAGS, 90 INSPIREASE DRUG DELIVERY SYSTEM, 90 INSPIREASE MOUTHPIECE, 90 INSPIREASE REPLACEMENT MOUTHPIECE, 90 INSPIREASE RESERVOIR BAGS, 90 INSPRA, 59 INSTAT 2.5 CM X 5.1 CM, 47 INSTAT 7.6 CM X 10.2 CM, 47 INSTAT MCH, 47 INTEGRA F, 45 INTEGRA PLUS, 45 INTEGRILIN, 50 INTELENCE, 18 INTERARTICULAR JOINT KIT, 134 INTERCEED (TC7) (3, 203 INTERCEED (TC7) ABSORBABLE ADHESION BARRIER 1-1/2, 203 INTERMEZZO, 81 intralipid, 107 INTRALIPID, 107 INTRASITE GEL APPLIPAK, 207 INTROL, 124 INTRON A, 31 INTRON-A, 31 INTRON-A W/DILUENT, 31 introvale, 139 INTUNIV, 81 INVANZ, 13 INVEGA, 85, 86 INVEGA SUSTENNA, 85 INVIRASE, 18 invisible acne treatment, 188 INVOKAMET, 138 INVOKANA, 137 IODINE STRONG, 174 IODINE TINCTURE, 184 IODOFLEX, 184 ionil-t, 202 IONIL-T PLUS, 202 IONOSOL-B/DEXTROSE 5%, 114 IONOSOL-MB/DEXTROSE 5%, 114 IONOSOL-T/DEXTROSE 5%, 114 Ion‐removing Agents, 110 iophen dm-nr, 168 iophen-nr, 175 IOPIDINE, 124 IPOL INACTIVATED IPV, 181 ipratropium bromide, 36, 40 ipratropium bromide/albuterol sulfate, 40 IPRIVASK, 49 IQUIX, 120 irbesartan, 58 irbesartan/hydrochlorothiazide, 58 IRCON-FA, 45 IRESSA, 30 irinotecan, 33 IRINOTECAN, 33 IRON, 45 IRON ASP GLY/ POLYSACCH COMPL/ASCORB CAL/B12/FA/C THREON/SUC, 45 IROSPAN 24/6, 45 Irrigating Solutions, 110 IS 24/6, 45 ISAR QUERCUS, 158 ISCAR MALI, 158 ISCAR MALI SERIES I, 158 ISCAR MALI SERIES II, 158 ISCAR MALI SERIES O, 158 ISCAR MALI SPECIAL, 158 ISCAR PINI, 158 ISCAR PINI SERIES I, 158 ISCAR PINI SERIES II, 158 ISCAR PINI SERIES O, 158 ISCAR QUERCUS, 158 ISCAR QUERCUS SERIES I, 158 ISCAR QUERCUS SERIES II, 158 ISCAR QUERCUS SERIES O, 158 ISCAR QUERCUS SPECIAL, 158 ISENTRESS, 18 isochron, 60 isoditrate er, 60 isoflurane, 82 ISOLYTE-H/DEXTROSE 5%, 114 isolyte-m/dextrose 5%, 114 ISOLYTE-P/DEXTROSE 5%, 114 ISOLYTE-S, 114, 115 ISOLYTE-S PH 7.4, 115 ISOLYTE-S/DEXTROSE 5%, 115 isometheptene mucate/caffeine/acetaminophen, 77 ISOMETHEPTENE/CAFFEINE/ACETAMINOPHEN, 77 isonarif, 17 isoniazid, 17 ISONIAZID, 17 ISOPROPANOL, 188 ISOPROPYL ALCOHOL, 188 ISOPTIN SR, 55 ISOPTO ATROPINE, 126 ISOPTO CARBACHOL, 123 ISOPTO CARPINE, 124 ISOPTO HOMATROPINE (2%), 126 ISOPTO HOMATROPINE (5%), 126 ISOPTO HYOSCINE, 126 ISORDIL TITRADOSE (40MG), 60 ISORDIL TITRADOSE (5MG), 61 isosorbide dinitrate, 60 ISOSORBIDE DINITRATE, 60 isosorbide dinitrate (2.5mg), 60 ISOSORBIDE DINITRATE (2.5MG), 60 isosorbide dinitrate (5mg), 60 ISOSORBIDE DINITRATE (5MG), 60 isosorbide dinitrate er, 60 isosorbide mononitrate, 60 isosorbide mononitrate er, 60 isotonic gentamicin, 13 ISOTONIC GENTAMICIN, 13 isoxsuprine hcl (10mg), 60 ISOXSUPRINE HCL (10MG), 60 isoxsuprine hcl (20mg), 60 ISOXSUPRINE HCL (20MG), 60 ISRADIPINE, 54 ISTALOL, 124 ISTODAX, 34 ISUPREL, 42 256 itraconazole, 16 IXEMPRA KIT, 34 IXIARO, 181 J JAKAFI, 31 JALYN, 149 jantoven, 48 JANUMET, 137 JANUMET XR, 137 JANUVIA, 137 JARDIANCE, 138 JAY-PHYL, 210 J-COF DHC, 168 jencycla, 139 JENTADUETO, 137 JETREA, 125 jevantique, 143 JE-VAX, 181 JEVTANA, 34 JINTELI, 144 J-MAX, 168, 175 J-MAX DHC, 168 jolessa, 140 jolivette, 140 J-TAN D, 25 J-TAN D PD, 25 J-TAN D SR, 25 J-TAN PD, 25 JUBLIA, 188 junel 1.5/30, 140 junel 1/20, 140 junel fe 1.5/30, 140 junel fe 1/20, 140 JUVISYNC, 137 JUXTAPID, 52 K K.B.G.L. IN TERODERM CREAM, 207 KABIVEN, 107 KADCYLA, 34 KADIAN, 66 KALBITOR, 152 KALETRA, 18 kalexate, 110 KALYDECO, 174 KANAMYCIN SULFATE, 13 KAPVAY, 57 KAPVAY DOSE PACK, 57 KARBINAL ER, 25 karidium, 151 karigel, 152 karigel-n, 152 kariva, 140 KAYEXALATE, 110 KAZANO, 138 KCENTRA, 47 kcl 0.075%/d5w/nacl 0.2%, 115 kcl 0.075%/d5w/nacl 0.45%, 115 KCL 0.15%/D10W/NACL 0.2%, 115 kcl 0.15%/d5w/ nacl 0.3%, 115 KCL 0.15%/D5W/LR, 115 kcl 0.15%/d5w/nacl 0.2%, 115 KCL 0.15%/D5W/NACL 0.225%, 115 kcl 0.15%/d5w/nacl 0.45%, 115 kcl 0.15%/d5w/nacl 0.9%, 115 KCL 0.15%/D5W/NACL 0.9%, 115 kcl 0.224%/d5w/nacl 0.2%, 115 KCL 0.3%/D5W/LR, 115 KCL 0.3%/D5W/LR IV LAC RING, 115 kcl 0.3%/d5w/nacl 0.2%, 115 kcl 0.3%/d5w/nacl 0.45%, 115 KCL 0.3%/D5W/NACL 0.9%, 115 kedbumin, 43 k-effervescent, 112 KEFLEX (250MG), 10 KEFLEX (500MG), 10 KEFLEX (750MG), 9, 10 kelnor 1/35, 140 KENALOG, 134, 192 KENALOG-10, 134 KENALOG-40, 134 KENDALL AMORPHOUS HYDROGEL WOUND DRESSING, 207 KENDALL HYDROGEL IMPREGNATED GAUZE 1, 207 KENDALL HYDROGEL IMPREGNATED GAUZE 2, 207 KENDALL HYDROGEL IMPREGNATED GAUZE 4, 207 KENDALL HYDROGEL WOUND DRESSING 3, 207 KENDALL HYDROGEL WOUND DRESSING 4-3/4, 207 kendall sodium chloride flush, 115 KENDALL WET SKIN SCRUB PREP TRAY, 188 KENDALL ZINC CALCIUM ALGINATE DRESSING 2, 207 KENDALL ZINC CALCIUM ALGINATE DRESSING 4, 207 KENDALL ZINC CALCIUM ALGINATE DRESSING ROPE 12, 203 ken-tuss sf, 168 KEPIVANCE, 195 KEPPRA, 76 KEPPRA XR, 76 KERAFOAM, 200 KERAFOAM 42, 200 KERALAC, 200 KERALAC NAILSTIK, 200 KERALYT, 200, 201 KERALYT SCALP, 201 Keratolytic Agents, 198 Keratoplastic Agents, 201 KERLONE, 53 KEROL, 200, 201 KEROL AD, 200 KEROL REDI-CLOTHS, 201 kerol zx, 198 KERR TRIPLE DYE, 184 KERYDIN, 188 KETALAR, 82 ketamine hcl, 82 KETEK, 10 KETOCON, 186 KETOCON PLUS, 186 ketoconazole, 16, 183, 188 ketodan, 188 KETODAN KIT, 188 257 ketoprofen, 63 KETOPROFEN ER, 64 KETOROCAINE-L, 67 KETOROCAINE-LM, 67 KETOROLAC 2% GEL, 193 ketorolac tromethamine, 63, 67, 121 KETOROLAC TROMETHAMINE, 67, 71 KEYTRUDA, 36 KGS-PE, 175 KHEDEZLA, 86 kidkare cough/cold, 168 KINERET, 153 KINLYTIC, 50 KINRIX, 179 kionex, 110 KLARON, 186 KLONOPIN, 76 K-LOR HOSPITAL PACK, 113 klor-con, 112 klor-con 10, 112 KLOR-CON 25, 113 klor-con 8, 112 klor-con m10, 112 KLOR-CON M15, 113 klor-con m20, 112 klor-con/ef, 112 KOATE-DVI, 47 KOGENATE FS, 47 KOGENATE FS BIO-SET, 47 KOMBIGLYZE XR, 138 KORLYM, 138 KOVIA, 207 K-PHOS, 104, 113 K-PHOS MF, 104 K-PHOS NEUTRAL, 113 K-PHOS NO 2, 104 k-prime, 112 KRISTALOSE, 105 KROGER BLOOD GLUCOSE MONITORING KIT, 97 KROGER BLOOD GLUCOSE TESTSTRIPS, 103 KROGER PREMIUM BLOOD GLUCOSE MONITORING KIT, 97 KROGER PREMIUM BLOOD GLUCOSE TEST STRIPS, 103 KROGER TEST STRIPS, 103 KRYSTEXXA, 150 K-TAB, 113 k-tan, 25 kurvelo, 140 KUVAN, 155 k-vescent, 112 K-Y LIQUIBEADS, 207 K-Y LONG LASTING, 207 K-Y SILK-E, 207 KYNAMRO, 52 KYPROLIS, 34 KYTRIL, 128 L labetalol hcl, 52, 53 LAC-HYDRIN, 197 laclotion, 197 LACRISERT, 125 lactated ringers, 111, 115 lactated ringers dextrose 5% viaflex, 115 lactated ringers irrigation, 111 lactated ringers viaflex, 115 lactic acid, 196, 197 lactic acid e, 196 lactic acid w/vitamin e, 197 LACTOCAL-F, 214 lactulose, 105 LAGESIC, 22 LAMICTAL, 75, 76 LAMICTAL CHEWABLE DISPERSIBLE, 76 LAMICTAL ODT, 76 LAMICTAL STARTER/NOT TAKING CARBAMAZEPINE, 76 LAMICTAL STARTER/TAKING CARBAMAZEPINE/NOT TAKING VALPROATE, 76 LAMICTAL STARTER/TAKING VALPROATE, 76 LAMICTAL XR, 76 LAMISIL, 16, 188 LAMISIL SPRAY, 188 lamivudine, 18 lamivudine/zidovudine, 18 lamotrigine, 75 lamotrigine er, 75 lanolin, 197 LANOLIN, 197 LANOLIN ANHYDROUS, 197 LANOXIN, 56 LANOXIN PEDIATRIC, 56 lansoprazole, 129 lansoprazole odt, 129 lansoprazole/amoxicillin/clarithromycin, 129 LANTUS, 137 LANTUS FOR OPTICLIK, 137 LANTUS SOLOSTAR, 137 larin 1.5/30, 140 larin 1/20, 140 larin fe 1.5/30, 140 larin fe 1/20, 140 LARTUS, 168 LASIX, 110 LASTACAFT, 123 latanoprost, 123 LATISSE, 207 latrix, 198 LATRIX XM, 200 LATUDA, 84 LAVARE WOUND WASH, 207 lavoclen-4 acne wash kit, 183 lavoclen-4 creamy wash (4%), 183 LAVOCLEN-4 CREAMY WASH (4%), 186 lavoclen-8 acne wash kit, 183 lavoclen-8 creamy wash (8%), 183 LAVOCLEN-8 CREAMY WASH (8%), 186 LAZANDA, 67 lazerformalyde solution, 104 l-cysteine hcl, 107 LECITHIN, 131 leena, 140 leflunomide, 152 258 LEMOHIST PLUS, 175 Leptins, 145 LESCOL, 52 LESCOL XL, 52 lessina, 140 LETAIRIS, 177 letrozole, 30 LETS KIT, 149 leucovorin calcium, 149, 150 LEUCOVORIN CALCIUM, 149, 150 LEUCOVORIN CALCIUM (10MG), 149 LEUCOVORIN CALCIUM (15MG), 149 leucovorin calcium (25mg), 149 leucovorin calcium (5mg), 149 LEUKERAN, 30 LEUKINE, 50 leuprolide acetate, 34 LEUSTATIN, 34 LEVACET, 64 levalbuterol, 40, 41 levalbuterol hcl, 41 LEVAQUIN, 10, 13 LEVATOL, 53 LEVBID, 37 LEVEMIR, 137 LEVEMIR FLEXPEN, 137 LEVEMIR FLEXTOUCH, 137 levetiracetam, 75, 76 LEVETIRACETAM, 76 levetiracetam er, 75 LEVITRA, 61 LEVOBUNOLOL HCL (0.25%), 123 levobunolol hcl (0.5%), 123 levocarnitine, 155 levocetirizine dihydrochloride, 29 levofloxacin, 8, 13, 119 levofloxacin in d5w, 13 LEVOMEFOLATE CALCIUM/ACETYLCYSTEINE/MECOBALAMIN/ALGAL POWDER, 223 LEVOMEFOLATE CALCIUM/ALGAL POWDER, 158 LEVOMEFOLATE CALCIUM/PYRIDOXAL PHOSPHATE/MECOBALAMIN/ALGAL, 223 LEVOMEFOLATE DHA, 221 LEVOMEFOLATE PNV, 214 levonest, 140 levonorgestrel, 140 levonorgestrel and ethinyl estradiol, 140 levonorgestrel/ethinyl estradiol, 140 LEVOPHED, 42 levora 0.15/30-28, 140 LEVORPHANOL TARTRATE, 64 levothroid, 147 levothyroxine sodium, 147 LEVOTHYROXINE SODIUM, 147 levoxyl, 147 LEVSIN, 37 LEVSIN/SL, 37 LEVULAN KERASTICK, 203 LEXAN POCKET NEBULIZER PLASTIC, 90 LEXAPRO, 84 LEXIVA, 19 lexuss 210, 162 LIALDA, 127 LIBERTY BLOOD GLUCOSE METER, 97 LIBERTY NEXT GENERATION BLOOD GLUCOSE MONITOR, 97 LIBERTY NEXT GENERATION BLOOD GLUCOSE TEST STRIPS, 103 LIBERTY TEST STRIPS, 103 LIBRAX, 37 LIDAMANTLE, 193, 194, 195 LIDAMANTLE HC, 193 LIDAMANTLE HC RELIEF PAD, 193 lidazone hc, 193 lidocaine, 56, 125, 148, 193, 195 lidocaine hcl, 56, 125, 148, 193, 195 LIDOCAINE HCL, 56, 148, 194, 195 lidocaine hcl in d5w, 56 lidocaine hcl jelly, 193 lidocaine hcl viscous, 125 lidocaine hcl/dextrose, 56 LIDOCAINE HCL/DEXTROSE, 148 lidocaine hcl/hydrocortisone acetate, 193, 195 LIDOCAINE HCL-HYDROCORTISONE ACETATE WITH ALOE, 194 lidocaine viscous, 125 lidocaine/epinephrine, 148 lidocaine/prilocaine, 193 LIDOCAINE/PRILOCAINE, 194 lidocort, 193 LIDODERM, 194 LIDODEXTRAPINE, 195 LIDOLOG KIT, 134 lidopin, 193 LIDOPRO, 126 LIDOPROFEN, 207 LIDORX, 194 LIDOVIR, 188 LIMBREL, 158 LIMBREL250, 158 LIMBREL500, 158 LIMBREL525, 158 LINCOCIN, 13 lindane, 183 LINZESS, 131 LIORESAL INTRATHECAL, 39 liothyronine sodium, 147 LIPICHOL 540, 108 LIPITOR, 52 lipodox, 34 lipodox 50, 34 LIPOFEN, 52 LIPOSYN II, 107 liposyn iii, 107 LIPOSYN III, 107 Lipotropic Agents, 131 LIPTRUZET, 52 liquibid, 175 LIQUICET, 64 liqui-dualcitra, 104 liquituss gg, 175 lisinopril, 58 lisinopril/hydrochlorothiazide, 58 LISTER-V, 108 259 LITEAIRE, 90 LITETOUCH MASK LARGE, 90 LITETOUCH MASK MEDIUM, 90 LITETOUCH MASK SMALL, 90 LITHIUM, 77 lithium carbonate, 77 LITHIUM CARBONATE, 77 lithium carbonate er, 77 LITHOBID, 77 LITHOSTAT, 105 LITTLE COLDS DECONGESTANTFORMULA, 42 LIVALO, 52 LMD 10% DEXTROSE 5%, 115 LMD 10% SODIUM CHLORIDE 0.9%, 115 L-METHYL-B6-B12, 222 L-METHYLFOLATE, 158, 220, 222 L-METHYLFOLATE CA ME-CBL NAC, 222 L-METHYLFOLATE CA/ME-CBL/NAC, 222 L-METHYLFOLATE CA/P-5-P/ME-CBL, 222 L-METHYLFOLATE CALCIUM, 158 L-METHYLFOLATE FORMULA 15, 158 L-METHYLFOLATE FORMULA 7.5, 158 L-METHYLFOLATE FORTE, 158 L-METHYLFOLATE PNV DHA, 220 L-METHYL-MC, 222 L-METHYL-MC NAC, 222 LMTHF/PYRIDOXINE HCL/CYANOCOBALAMIN, 223 LO LOESTRIN FE, 143 LO MINASTRIN FE, 143 LO/OVRAL-28, 142 Local Anesthetics, 125, 148 LOCOID, 192 LOCOID LIPOCREAM, 192 LODOSYN (25MG), 78 LODRANE, 25 LODRANE 12 HOUR, 25 LODRANE 12D, 25 LODRANE 24, 25 LODRANE 24D, 25 LODRANE D, 25 LOESTRIN 1.5/30-21, 142 LOESTRIN 1/20-21, 142 LOESTRIN 24 FE, 142 LOESTRIN FE 1.5/30, 142 LOESTRIN FE 1/20, 142 lofene, 127 LOFIBRA, 52 LOHIST, 25 lohist-12, 25 lohist-12d, 25 LOHIST-D, 25 lohist-dm, 168 lohist-peb, 25, 168 lohist-peb-dm, 168 lohist-psb, 25, 168 lohist-psb-dm, 168 lokara, 190 LOMEDIA 24 FE, 142 LOMOTIL, 127 LOMUSTINE, 30 lonox, 127 loperamide hcl, 127 LOPID, 52 LOPRESSOR, 53 LOPRESSOR HCT, 53 LOPROX, 186 LOPROX SHAMPOO, 186 loratadine-d 12hr, 29 loratadine-d 24hr, 29 lorazepam, 79, 80 LORAZEPAM INTENSOL, 80 lorcet, 63 LORCET 10/650, 71 lorcet hd, 63 LORTUSS DM, 168 LORTUSS EX, 168 LORTUSS LQ, 25 loryna, 140 LORZONE, 40 losartan potassium, 58 losartan potassium/hydrochlorothiazide, 58 LOSEASONIQUE, 142 LOTEMAX, 121 LOTENSIN, 59 LOTENSIN HCT, 59 LOTREL, 55 LOTRISONE, 186 LOTRONEX, 127 LOUTREX, 200 lovastatin, 51 LOVAZA, 52 LOVENOX, 49 low-ogestrel, 140 loxapine, 83 loxapine succinate, 83 LOXITANE, 84 LOZI-FLUR, 152 LTA 360 KIT, 126 LUBRIN, 207 LUCENTIS, 125 ludent, 151 LUFYLLIN, 210 LUFYLLIN-GG, 210 LUGOLS STRONG IODINE, 184 LUKAID GLA, 108 LUMIGAN, 123 LUMINAL, 80 LUMINEB II PISTON NEBULIZER, 90 LUMIZYME, 118 LUNESTA, 80 LUNGLAID, 108 LUPANETA PACK, 36 LUPRON DEPOT, 34 LUPRON DEPOT-PED, 34 LUSAIR, 175 LUSEDRA, 82 LUSONAL, 42 LUSTRA, 196 LUSTRA-AF, 196 LUSTRA-ULTRA, 196 lutera, 140 LUVENA PREBIOTIC PERSONAL LUBRICANT, 207 260 LUVENA PREBIOTIC VAGINAL MOISTURIZER & LUBRICANT, 207 LUVERIS, 145 LUVOX CR, 86 LUXIQ, 192 LUZU, 188 LYBREL, 142 LYCELLE, 188 LYMPHOMYOSOT, 158 LYRICA, 76 lysiplex plus, 211 LYSODREN, 30 LYSTEDA, 48 LYTENSOPRIL, 59 LYTENSOPRIL KIT, 59 LYTENSOPRIL-90, 59 LYTENSOPRIL-90 KIT, 59 lyza, 140 M M.V.I. ADULT, 220 M.V.I. PEDIATRIC, 220 M.V.I.-12 WITHOUT VITAMIN K, 220 MACNATAL CN DHA, 214 MACROBID, 21 MACRODANTIN, 21 MACUGEN, 125 MACUTEK, 109 mafenide acetate, 183 MAGNACET, 71 MAGNEBIND 400, 113 magnesium chloride, 115 magnesium sulfate, 76 MAGNESIUM SULFATE, 76, 115 MAGNESIUM SULFATE IN D5W, 115 MAKENA, 146 MALARONE, 17 malathion, 183 MANGANESE SULFATE, 115 MANGANESE TRACE METAL, 115 mannitol, 110 MAPAP HEADACHE PLUS, 71 MAPROTILINE HCL, 84 MARBETA-25, 134 MARBETA-L, 134 MARCAINE, 148 MARCAINE SPINAL, 148 MARCAINE W/O EPI, 148 MARCAINE/EPINEPHRINE, 148 MAR-COF CG EXPECTORANT, 162 MARDEX-25, 134 MARDROPS-DX, 168 MARDROPS-EX, 175 margesic, 63, 71 margesic-h, 71 MARINOL, 128 MARLIDO KIT, 149 MARLIDO-25, 149 marlissa, 140 MARNATAL-F, 214 MARNATAL-F PLUS DUO PACK, 214 MARPLAN, 84 MARQIBO, 34 marten-tab, 63 martinic, 44 massengill, 188, 207 massengill feminine wash, 207 massengill vinegar/water, 188 MATULANE, 30 matzim la, 54 MAVIK, 59 MAXAIR AUTOHALER, 41 MAXALT, 77 MAXALT-MLT, 77 MAXARON FORTE, 45 MAXFE, 46 MAXIDEX, 121 MAXIDONE, 71 MAXIMA BLOOD GLUCOSE MONITORING SYSTEM, 97 MAXIMA BLOOD GLUCOSE TESTSTRIPS, 103 MAXIMA METER KIT, 97 MAXIMA STARTER KIT, 97 MAXIPIME, 15 MAXITROL, 122 MAXZIDE, 110 MAXZIDE-25, 110 MB HYDROGEL, 197 M-CLEAR, 162 MEBARAL, 81 MEBENDAZOLE, 8 meclizine hcl, 128 MECLOFENAMATE SODIUM, 64 MEDICAL PROVIDER EZ FLU SHOT 2013-2014, 182 MEDICAL PROVIDER EZ FLU SHOT 2014-2015, 182 MEDICAL PROVIDER EZ FLU SHOT PF 2012-2013, 182 MEDICAL PROVIDER EZ FLU SHOT PF 2013-2014, 182 MEDICAL PROVIDER EZ FLU SHOT PF 2014-2015, 182 medicidin-d, 25 MEDI-DERM, 126, 197 MEDI-DERM/L, 126 MEDI-DERM/L-RX, 126 MEDI-DERM-RX, 197 MEDIHOL BASE, 188 MEDI-PATCH RX, 126 MEDI-PATCH/LIDOCAINE, 126 MEDI-PHENYL, 42 MEDI-SELTZER, 71 MEDOTAR, 202 MEDROL, 133 MEDROL DOSEPAK, 133 MEDROX-RX, 197 medroxyprogesterone acetate, 145, 146 mefenamic acid, 63 mefloquine hcl, 17 MEFOXIN, 13 mega-c/a plus, 223 MEGACE ES, 146 MEGACE ORAL, 30 megestrol acetate, 30 MEIJER BLOOD GLUCOSE MONITORING KIT, 97 MEIJER BLOOD GLUCOSE TESTSTRIPS, 103 MEIJER PREMIUM BLOOD GLUCOSE MONITORING KIT, 97 261 MEIJER PREMIUM BLOOD GLUCOSE TEST STRIPS, 103 MEIJER TRUE2GO BLOOD GLUCOSE MONITORING SYSTEM, 98 MEIJER TRUERESULT BLOOD GLUCOSE MONITORING SYSTEM, 98 MEIJER TRUETEST BLOOD GLUCOSE TEST STRIPS, 103 MEIJER TRUETRACK BLOOD GLUCOSE MONITORING KIT, 98 MEIJER TRUETRACK BLOOD GLUCOSE TEST STRIPS, 103 MEKINIST, 30 MELILOTUS HOMACCORD, 158 meloxicam, 63 MELOXICAM, 64, 71 MELOXICAM COMFORT PAC, 71 melpaque hp, 196 melphalan hydrochloride, 34 MELQUIN 3, 196 melquin hp, 196 MEMBRANEBLUE, 104 MENACTRA, 181 m-end dm, 168 M-END DMX, 168 M-END MAX D, 162 M-END PE, 168 MENEST, 144 MENHIBRIX, 181 MENOMUNE-A/C/Y/W-135, 181 MENOPUR, 144 MENOSTAR, 144 MENTAX, 186 MENTHOL, 207 MENVEO, 181 me-pb-hyos, 36 meperidine hcl, 63, 67 MEPERIDINE HCL, 65, 67, 71 MEPERIDINE HCL/PROMETHAZINE HCL, 71 meperitab, 63 MEPHYTON, 224 MEPIVACAINE HCL, 148 meprobamate, 79 MEPRON, 18 mercaptopurine, 30 meropenem, 13 MERREM, 13 mesalamine, 127 mesehist dm, 168 mesna, 160 MESNEX, 160 MESTINON, 38 MESTINON TIMESPAN, 38 METADATE CD, 73 metadate er, 73 METAFOLBIC, 223 METAFOLBIC PLUS, 223 METAFOLBIC PLUS RF, 223 METAGLIP, 138 METANX, 223 METAPROTERENOL SULFATE, 41 metaproterenol sulfate (10mg/5ml), 40 METAPROTERENOL SULFATE (10MG/5ML), 41 METASTRON, 161 metaxalone, 39 metformin hcl, 136, 138 metformin hcl er (1000mg), 138 metformin hcl er (500mg), 136, 138 metformin hcl er (750mg), 136 methadone hcl, 63 methadone hcl (10mg/5ml), 63 METHADONE HCL (10MG/5ML), 66 METHADONE HCL (10MG/ML), 67 methadone hcl (5mg/5ml), 63 METHADONE HCL (5MG/5ML), 66 methadone hcl intensol, 63 methadose, 63 METHADOSE, 66 METHADOSE SUGAR-FREE, 66 methamphetamine hcl, 73 methazolamide, 123 methenamine hippurate, 20 METHENAMINE MANDELATE (0.5GM), 21 methenamine mandelate (1gm), 20 METHERGINE, 160 methimazole, 147 METHITEST, 135 methocarbamol, 39 methotrexate, 30, 34 methotrexate sodium, 34 methoxsalen, 196 methscopolamine bromide, 36 METHYCLOTHIAZIDE, 110 METHYL SALICYLATE, 197 methyldopa, 57 METHYLDOPA/HYDROCHLOROTHIAZIDE, 57 METHYLDOPATE HCL, 57 methylene blue, 150 methylergonovine maleate, 160 METHYLFOL-ALGAE-B12-ACETYLCYST, 223 methylin, 73 METHYLIN, 73 methylin er, 73 METHYL-MAX, 221 methylphenidate hcl, 73 methylphenidate hcl cd, 73 methylphenidate hcl er, 73 METHYLPHENIDATE HCL ER (10MG), 73 methylphenidate hcl er (18mg), 73 methylphenidate hcl er (20mg), 73 methylphenidate hcl er (27mg), 73 methylphenidate hcl er (36mg), 73 methylphenidate hcl er (54mg), 73 methylphenidate hcl sr, 73 methylphenidate hydrochloride, 73 methylprednisolone, 132, 134 methylprednisolone acetate, 134 methylprednisolone dose pack, 132 methylprednisolone sodiumsuccinate, 134 methyltestosterone/esterified estrogens, 143 methyltestosterone/esterified estrogens hs, 143 metipranolol (0.3%), 123 METIPRANOLOL (0.3%), 123 metoclopramide hcl, 131 metolazone, 109 metoprolol succinate er, 52 metoprolol tartrate, 52, 53 262 metoprolol/hydrochlorothiazide, 52 METOZOLV ODT, 131 METRO IV, 18 METROCREAM, 186 METROGEL, 184, 186 METROGEL 1% KIT, 184 METROGEL-VAGINAL, 186 METROLOTION, 186 metronidazole, 17, 18, 183 metronidazole in nacl 0.79%, 18 metronidazole vaginal, 183 METVIXIA, 203 MEVACOR, 52 mexar wash, 183 mexiletine hcl, 56 MG217 MEDICATED TAR, 202 mg217 medicated tar shampoo, 202 MG217 PSORIASIS MEDICATED, 202 mg217 psoriasis multi-symptom, 202 MG217 PSORIASIS MULTI-SYMPTOM, 202 MI PASTE, 87 MI PASTE PLUS, 87 MIACALCIN, 145 micaderm, 188 MICARDIS, 59 MICARDIS HCT, 59 MICATIN, 188 MICONAZOLE 3, 184 miconazole nitrate, 188 MICRHOGAM ULTRA-FILTERED PLUS, 178 MICRO AIR NEBULIZER, 90 micro guard, 188 MICRO PLUS HIGH EFFICIENCY NEBULIZER/REUSABLE, 90 MICROCHAMBER, 90 MICRODOT BLOOD GLUCOSE MONITORING SYSTEM, 98 MICRODOT TEST STRIPS, 103 MICROELITE COMPRESSOR NEBULIZER SYSTEM, 90 microgestin 1.5/30, 140 microgestin 1/20, 140 microgestin fe, 140 microgestin fe 1.5/30, 140 MICRO-K, 113 micronized colestipol hcl, 51 MICROSPACER, 90 MICROZIDE, 110 MIDAMOR, 110 midazolam hcl, 79, 80 midodrine hcl, 41 midol menstrual headache maximum strength, 71 midol teen, 71 MIFEPREX, 160 MIGERGOT, 77 migragesic ida, 77 MIGRAL, 77 MIGRALAM, 78 MIGRANAL, 40 MILLIPRED, 133 MILLIPRED DP, 133 milrinone in dextrose, 57 milrinone lactate, 57 mimvey, 143 mimvey lo, 143 MIMYX, 197 MINASTRIN 24 FE, 142 MINERAL OIL HEAVY, 130 MINI COMPRESSOR, 90 MINI PLUS REUSABLE HIGH EFFICIENCY NEBULIZER, 90 MINIELITE COMPRESSOR NEBULIZER SYSTEM, 90 MINIELITE COMPRESSOR NEBULIZER SYSTEM WITH BATTERY, 90 MINIELITE RECHARGEABLE BATTERY, 90 MINIPRESS, 51 miniprin low dose, 71 minirin, 145 minitran (0.1mg/hr), 60, 61 minitran (0.2mg/hr), 60, 61 minitran (0.4mg/hr), 60, 61 minitran (0.6mg/hr), 60, 61 MINIVELLE, 144 MINOCIN, 10, 13 MINOCIN KIT, 10 minocycline hcl, 8, 15, 207 minocycline hcl er, 207 minoxidil, 57 MIOCHOL-E, 124 mi-omega nf, 221 MIOSTAT, 124 MIRAPEX, 78 MIRAPEX ER, 78 MIRCETTE, 142 MIRENA, 143 mirtazapine, 83 mirtazapine odt, 83 MIRVASO, 204 Miscellaneous Therapeutic Agents, 149 misoprostol, 129 MISTERNEB COMPRESSOR NEBULIZER SYSTEM, 90 MITIGARE, 150 mitomycin, 34 MITOSOL, 120 mitoxantrone hcl, 34 MIXED VESPID VENOM PROTEIN, 155 MIXED VESPID VENOM PROTEIN MDV, 155 MIXED VESPID VENOM PROTEIN TREATMENT KIT, 155 MLK F1 KIT, 134 MLK F2 KIT, 134 MLK F3 KIT, 135 MLK F4 KIT, 135 M-M-R II W/DILUENT 10 DOSE, 181 MOBIC, 66 modafinil, 73 moderiba, 20 MODERIBA, 20 MODERIBA 1200 DOSE PACK, 20 MODERIBA 800 DOSE PACK, 20 MODICON, 142 MODICON-28, 142 moexipril hcl, 58 moexipril/hydrochlorothiazide, 58 mometasone furoate, 190 MOMEXIN, 193 MOMORDICA COMPOSITUM, 158 263 MOMS CHOICE RX, 214 MONOCLATE-P, 47 MONODOX (100MG), 10 MONODOX (50MG), 10 MONODOX (75MG), 15 MONOJECT BONE MARROW ASPIRATION TRAY/ROSENTHAL NEEDLE 16GX2, 148 MONOJECT BONE MARROW BIOPSY PREPPING TRAY, 148 MONOJECT BONE MARROW BIOPSY TRAY/BIOP ASPIR NEEDLE 11GX4, 148 MONOJECT BONE MARROW BIOPSY TRAY/BIOP ASPIR NEEDLE 8GX4, 148 MONOJECT BONE MARROW BIOPSY TRAY/STERNAL-ILIAC NEEDLE 16G, 148 monoject pharma grade flush syringe, 50, 115 monoject pharma grade flush syringe/heparin lock, 50 monoject prefill, 50 monoject prefill advanced heparin lock flush, 50 monoject sodium chloride flush, 115 MONOKET, 61 mono-linyah, 140 mononessa, 140 MONONINE, 47 MONOVISC, 158 MONSELS FERRIC SUBSULFATE, 47 montelukast sodium, 161 MONUROL, 21 MORCIN, 158 morgidox 1x100mg, 15 MORGIDOX 1X100MG, 15 morgidox 2x100mg, 15 MORGIDOX 2X100MG, 15 MORPHINE SULFATE, 65, 67, 68 morphine sulfate (0.5mg/ml), 68 morphine sulfate (100mg/5ml), 63 morphine sulfate (10mg/5ml), 63 morphine sulfate (10mg/ml), 68 MORPHINE SULFATE (10MG/ML), 68 MORPHINE SULFATE (150MG/30ML), 68 morphine sulfate (15mg/ml), 68 MORPHINE SULFATE (15MG/ML), 68 morphine sulfate (1mg/ml), 68 MORPHINE SULFATE (1MG/ML), 68 morphine sulfate (20mg/5ml), 63 morphine sulfate (20mg/ml), 63 MORPHINE SULFATE (20MG/ML), 65 morphine sulfate (25mg/ml), 68 MORPHINE SULFATE (25MG/ML), 68 MORPHINE SULFATE (2MG/ML), 68 MORPHINE SULFATE (4MG/ML), 68 morphine sulfate (50mg/ml), 68 MORPHINE SULFATE (50MG/ML), 68 morphine sulfate (5mg/ml), 68 MORPHINE SULFATE (5MG/ML), 68 morphine sulfate (8mg/ml), 68 MORPHINE SULFATE (8MG/ML), 68 MORPHINE SULFATE ADD-VANTAGE, 68 morphine sulfate er, 63 MORPHINE SULFATE IN DEXTROSE 5%, 68 morrhuate sodium, 59 MOTOFEN, 127 MOVIPREP, 130 MOXATAG, 15 MOXEZA, 120 moxifloxacin hcl, 8 MOZOBIL, 50 MS CONTIN, 66 ms-aid, 71 MST 600, 65 MUCINEX, 168, 175 mucinex chest congestion childrens, 175 MUCINEX CHILDRENS MULTI-SYMPTOM COLD, 168 MUCINEX CONGESTION & COUGH CHILDRENS, 168 mucinex cough childrens, 168 mucinex cough for kids, 168 MUCINEX COUGH FOR KIDS, 168 MUCINEX D, 168, 175 MUCINEX DM, 168 MUCINEX DM MAXIMUM STRENGTH, 168 mucinex fast-max dm max, 168 mucinex fast-max night time cold & flu, 25 MUCINEX FAST-MAX SEVERE CONGESTION & COUGH, 168 mucinex for kids, 175 MUCINEX FOR KIDS, 175 MUCINEX MAXIMUM STRENGTH, 175 mucinex multi-symptom cold night time childrens, 25 mucinex sinus-max night time congestion & cough, 25 Mucolytic Agents, 176 mucosa, 168, 175 MUCOSA COMPOSITUM, 158 mucosa dm, 168 MUCOTROL, 207 mucus relief, 168, 175 mucus relief childrens, 175 mucus relief cough childrens, 168 mucus relief d, 168, 175 mucus relief dm, 168 mucus-er, 175 mucusrelief dm, 168 MUGARD, 204 MULTAQ, 56 multi vitamin/fluoride, 211 MULTICHEW, 214 MULTIGEN, 45 MULTIGEN FOLIC, 45 MULTIGEN PLUS, 45 MULTI-NATE 30 DHA, 214 MULTI-NATE DHA EXTRA, 214 MULTI-SPECIALTY KIT, 135 MULTITRACE-4, 115 multitrace-4 concentrate, 115 MULTITRACE-4 NEONATAL, 115 MULTITRACE-4 PEDIATRIC, 115 MULTITRACE-5, 116 multitrace-5 concentrate, 116 multi-vit/fluoride, 211 multi-vit/iron/fluoride, 211 Multivitamin Preparations, 210 multivitamin with fluoride, 211 multivitamin/fluoride, 211 multi-vitamin/fluoride, 211 multi-vitamin/fluoride/iron, 211 264 multivitamins/fluoride, 211 mult-vitamin/fluoride, 211 mupirocin, 183 mupirocin calcium, 183 MUSE, 61 MUSTARGEN, 34 MV FE ASPARTO GLY/FE FUM/SUCC ACID/VIT C/THREONIC ACD/B12/FA, 45 MV FE ASPARTO GLY/VIT C/VIT B12/CA THREONATE/SUCC ACD/STOMAC, 45 mvc-fluoride, 211 M-VIT, 212 my way, 140 MYALEPT, 145 MYAMBUTOL, 17 MYCAMINE, 16 myci-gc, 162 MYCOBUTIN, 17 mycophenolate mofetil, 154 mycophenolic acid dr, 154 MYDFRIN, 127 mydral, 126 MYDRIACYL, 126 Mydriatics, 126 myferon 150 forte, 44 MYFORTIC, 154 MYGLUCOHEALTH BLOOD GLUCOSE MONITORING SYSTEM, 98 MYGLUCOHEALTH BLOOD GLUCOSE TEST, 103 MYHIST-DM, 168 myhist-pd, 25 MYKIDZ IRON FL, 214 MYLERAN, 30 MYNATAL, 214 MYNATAL ADVANCE, 214 MYNATAL PLUS, 214 MYNATAL ULTRACAPLET, 214 MYNATAL-Z, 214 MYNATE 90 PLUS, 214 mynephrocaps, 211 MYOBLOC, 155 MYOCHRYSINE, 131 myorisan, 205 MYOZYME, 118 MYRBETRIQ, 209 MYSOLINE, 76 MYTELASE, 39 mytussin ac, 162 mytussin dac, 168 myzilra, 140 N NABI-HB, 178 nabumetone, 63 n-acetyl-l-cysteine, 105 NADOLOL (160MG), 53 nadolol (20mg), 52 nadolol (40mg), 52 nadolol (80mg), 52 nadolol/bendroflumethiazide, 52 nafcillin sodium, 13 NAFCILLIN SODIUM, 13 nafrinse, 151 NAFRINSE DAILY/ACIDULATED, 87 NAFRINSE DAILY/NEUTRAL, 152 nafrinse drops, 151 NAFRINSE WEEKLY, 152 NAFTIN, 186 NAGLAZYME, 118 nalbuphine hcl, 68 NALDEX, 25 NALEX-A, 25 NALEX-A 12, 25 NALFON, 65 NALFRX, 25 NALLPEN ISO-OSMOTIC IN DEXTROSE, 13 NALLPEN/DEXTROSE, 13 naloxone hcl, 82 NALOXONE HCL, 82 naltrexone hcl, 82 NAMENDA, 81 NAMENDA TITRATION PAK, 81 NAMENDA XR, 81 NAMENDA XR TITRATION PACK, 81 NAPHAZOLINE HCL, 127 NAPRELAN, 66 NAPRO 15% COMPOUNDING KIT, 193 NAPRODERM COMPOUNDING KIT, 193 NAPROSYN, 66 naproxen, 63 NAPROXEN COMFORT PAC, 71 naproxen dr, 63 naproxen sodium, 63 naratriptan hcl, 77 NARDIL, 84 NARIZ, 175 NAROPIN, 148 NASACORT AQ, 122 nasal decongestant, 42 NASAL DECONGESTANT, 42 nasal decongestant pe maximum strength, 42 NASCOBAL, 221 NASONEB NASAL NEBULIZER REPLACEMENT, 98 NASONEB NASAL NEBULIZER STARTER KIT, 98 NASONEX, 121 NASOTUSS, 169 NATA KOMPLETE, 214 NATACHEW, 214 NATACYN, 119 NATAFORT, 214 NATAL-V RX, 214 NATALVIRT 90 DHA, 214 NATALVIRT CA, 214 NATALVIRT FLT, 45 NATALVIT, 214 NATAZIA, 142 nateglinide, 136 NATELLE EZ, 214 NATELLE ONE, 214 NATELLE-EZ, 214 NATRECOR, 61 NATROBA, 188 265 NATURE-THROID, 147 NATURE-THROID NT-2.5, 147 NAVANE (10MG), 84 NAVANE (20MG), 84 NAVANE (2MG), 84 NAVANE (5MG), 84 nava-sc, 196 NAVATAB + DHA, 215 NAVELBINE, 34 NEBULIZER, 90, 91 NEBULIZER AIR TUBE/PLUGS, 91 NEBULIZER COMPRESSOR MODEL 2655D, 91 NEBULIZER COMPRESSOR/DUALFILTER/7' TUBING/AEROSOL T/MTHPIECE, 91 NEBULIZER KIT/TUBING/MOUTHPIECE, 91 NEBULIZER PEDIATRIC MASK, 91 NEBULIZER UPDRAFT-STYLE, 91 NEBULIZER/ADULT MASK, 91 NEBULIZER/PEDIATRIC MASK, 91 NEBUPENT, 17 nebusal (3%), 176 NEBUSAL (6%), 176 necon 0.5/35-28, 140 necon 1/35, 140 NECON 1/50-28, 142 NECON 10/11-28, 142 necon 7/7/7, 140 NEEVO, 215, 221 NEEVO DHA, 215 NEFAZODONE HCL (100MG), 84 NEFAZODONE HCL (150MG), 84 NEFAZODONE HCL (200MG), 84 nefazodone hcl (250mg), 83 NEFAZODONE HCL (50MG), 84 NEMBUTAL, 81 NEMBUTAL SODIUM, 81 NEO DM, 169 NEOBENZ MICRO, 186, 188 NEOBENZ MICRO PLUS PACK, 188 NEOBENZ MICRO SD, 188 NEOBENZ MICRO WASH, 186 NEOBENZ MICRO WASH PLUS PACK, 186 NEO-FRADIN, 9 neofrin, 126 neomycin sulfate, 8 neomycin/bacitracin/polymyxin, 119 neomycin/polymyxin b sulfates, 183 neomycin/polymyxin/bacitracin zinc, 119 neomycin/polymyxin/bacitracin/hydrocortisone, 121 neomycin/polymyxin/dexamethasone, 121 neomycin/polymyxin/gramicidin, 119 neomycin/polymyxin/hc, 121 neomycin/polymyxin/hydrocortisone, 121 NEOMYCIN/POLYMYXIN/HYDROCORTISONE, 121 neo-polycin, 119, 121 neo-polycin hc, 121 NEOPROFEN, 68 NEORAL, 154 NEOSALUS, 197 NEOSALUS 180 PACK, 197 NEOSALUS CP, 197 NEOSPORIN, 120, 186 neosporin af jock itch, 188 NEOSPORIN GU IRRIGANT, 186 neostigmine methylsulfate, 38 NEO-SYNALAR, 192, 193 NEO-SYNALAR KIT, 193 NEO-SYNEPHRINE, 42 NEOTIC, 126 neotuss, 169 NEOTUSS PLUS, 169 NEOTUSS-D, 169 NEOX 100 2CM X 2CM, 158 NEOX 100 4CM X 4CM, 158 NEOX 100 7CM X 7CM, 158 NEOX CORD 1K 1.5CM X 1.5CM, 158 NEOX CORD 1K 2.5CM X 2.5CM, 158 NEOX CORD 1K 4CM X 3CM, 158 NEOX CORD 1K 6CM X 3CM, 158 NEOX CORD 1K 8CM X 3CM, 158 NEPHPLEX RX, 215 NEPHRAMINE, 108 NEPHROCAPS, 215 NEPHROCAPS QT, 215 NEPHRON FA, 45 nephronex, 211 NEPHRO-VITE RX, 215 NEPTAZANE, 124 NESACAINE, 148 NESACAINE-MPF, 148 NESINA, 138 NESTABS, 215 NESTABS ABC, 215 NESTABS DHA, 215 neuac, 183 NEUAC KIT, 188 NEULASTA, 50 NEUMEGA, 50 NEUPOGEN, 50 NEUPRO, 78 NEURALGO-RHEUM, 158 NEUREPA, 109 NEURIN-SL, 221 NEURODEP, 220 NEURONTIN, 76 NEURPATH-B, 223 NEUT, 105 NEUTEK 2TEK TEST STRIPS, 103 neutragard advanced, 152 neutrahist pdx, 169 NEUTRAHIST PDX, 169 neutral sodium fluoride, 152 NEUTRALIZE, 26 NEUTRASAL, 124 NEUTREXIN, 18 NEUTROGENA ON-THE-SPOT ACNE TREATMENT, 188 NEUTROGENA T/GEL, 202 NEUTROGENA T/GEL CONDITIONER, 202 neutrogena t/gel extra strength, 202 NEUTROGENA T/GEL STUBBORN ITCH CONTROL, 202 NEVANAC, 121 nevirapine, 18 266 NEVIRAPINE, 18 nevirapine er, 18 NEWGEN, 215 NEXA PLUS, 215 NEXA SELECT, 215 nexafed, 42 NEXAVAR, 30 NEXAVIR, 155 NEXGEN METER KIT, 98 NEXGEN TEST STRIPS, 103 NEXICLON XR, 57 NEXIUM, 129 NEXIUM I.V., 129 NEXPLANON, 143 next choice, 140 next choice one dose, 140 NEXTERONE, 57 niacin, 51, 223 NIACIN, 223 niacin cr, 223 niacin er, 51, 223 niacin pr, 223 niacin sr, 223 niacin td, 223 niacin time release, 223 niacin tr, 223 NIACIN TR, 223 niacin-50, 223 niacinamide, 211, 223 NIACINAMIDE PROLONGED RELEASE, 223 niacinamide/azelaic ac/ turmer/fa/b6/zinc ox/copper, 211 NIACOR, 221 NIASPAN, 52 NICADAN, 215 nicardipine hcl, 54, 55 NICAZEL, 215 NICAZEL FORTE, 215 NICAZELDOXY 30 KIT, 15 NICAZELDOXY 60 KIT, 15 NICOMIDE, 215 nicotinamide w/zinc oxide/cupric oxide/folic acid, 221 nicotinamide/zinc oxide/cupric oxide/folic acid, 221 nicotinamide/zinc/copper/fa, 221 NICOTROL INHALER, 38 NICOTROL NS, 38 nifediac cc, 54 nifedical xl, 54 nifedipine, 54 NIFEDIPINE, 55 nifedipine er, 54 nikki, 140 NILANDRON, 30 NIMBEX, 39 nimodipine, 54 NIMOTOP, 55 NIPENT, 34 NIRAVAM, 80 NIRON KOMPLETE, 46 nisoldipine (17mg), 54 NISOLDIPINE (20MG), 54 NISOLDIPINE (30MG), 54 nisoldipine (34mg), 54 NISOLDIPINE (40MG), 54 nisoldipine (8.5mg), 54 nisoldipine er (25.5mg), 54 NISOLDIPINE ER (25.5MG), 55 NITHIODOTE, 132 NITRO-BID, 60 NITRO-DUR, 61 nitrofurantoin, 20 nitrofurantoin macrocrystals, 20 nitrofurantoin monohydrate, 20 nitrofurantoin monohydrate/macrocrystals, 20 nitroglycerin, 60, 61 NITROGLYCERIN, 60, 61 nitroglycerin cr, 60 nitroglycerin er, 60 nitroglycerin in 5% dextrose, 61 nitroglycerin in dextrose 5%, 61 NITROGLYCERIN IN DEXTROSE 5%, 61 nitroglycerin lingual, 60 NITROGLYCERIN LINGUAL, 60 nitroglycerin sr, 60 nitroglycerin transdermal, 60 NITROLINGUAL PUMPSPRAY (0.4MG/SPRAY), 60, 61 NITROMIST, 60 NITRONAL, 61 NITROPRESS, 57 NITROSTAT, 60 nitro-time, 60 NIVATOPIC PLUS, 204 nizatidine, 129 NIZORAL, 186 nodolor, 77 nohist, 26, 169 nohist dmx, 169 nohist-dm, 169 nohist-lq, 26 non-pseudo sinus decongestant, 42 nora-be, 140 NORCO, 66 NORDETTE-28, 142 NORDITROPIN FLEXPRO, 146 NORDITROPIN NORDIFLEX PEN, 146 NOREL AD, 26 NOREL CS, 169 norel sd, 26 NOREL SR, 26 norepinephrine bitartrate, 42 norethindrone, 140, 145 norethindrone acetate, 140, 145 norethindrone acetate/ethinyl estradiol, 140 norethindrone acetate/ethinyl estradiol/ferrous fumarate, 140 NORFLEX, 39 norforms, 208 norgestimate/ethinyl estradiol, 141 norgestrel/ethinyl estradiol, 141 NORINYL 1+35, 142 NORINYL 1+50, 142 NORITATE, 184 norlyroc, 141 normal saline flush, 116 267 normal saline flush for flushing vascular access devices, 116 normal saline i.v. flush, 116 NORMOSOL -R, 116 normosol-m in d5w, 116 NORMOSOL-R, 116 NORMOSOL-R IN D5W, 116 NOROXIN, 10 NORPACE, 56 NORPACE CR, 56 NORPRAMIN, 84 NOR-QD, 142 NORTHERA, 42 nortrel 0.5/35 (28), 141 nortrel 1/35, 141 nortrel 7/7/7, 141 nortriptyline hcl, 83 nortriptyline hcl (10mg/5ml), 83 NORTRIPTYLINE HCL (10MG/5ML), 84 nortuss-de, 169 NORTUSS-EX, 169 NORVASC, 55 NORVIR, 18 norwich aspirin, 71 NOTUSS-AC, 162 NOTUSS-DC, 169 NOTUSS-PE, 169 NOVACORT, 192 NOVAFERRUM, 45 novagesic, 26 novagest expectorant/codeine, 169 novamine, 108 NOVANTRONE, 34 novarel, 144 NOVOCAIN, 148 NOVOLIN 70/30, 137 NOVOLIN 70/30 RELION, 137 NOVOLIN N, 137 NOVOLIN N RELION, 137 NOVOLIN R, 137 NOVOLIN R RELION, 137 NOVOLOG, 137 NOVOLOG FLEXPEN, 137 NOVOLOG MIX 70/30, 137 NOVOLOG MIX 70/30 PREFILLED FLEXPEN, 137 NOVOLOG PENFILL, 137 NOVOSEVEN, 47, 48 NOVOSEVEN RT, 48 NOXAFIL, 16 NP #2 DRUG PREPARATION KIT, 208 np thyroid, 147 np thyroid 30, 147 np thyroid 60, 147 np thyroid 90, 147 NPLATE, 51 NUCORT, 192 NUCYNTA, 65, 66 NUCYNTA ER (100MG), 66 NUCYNTA ER (150MG), 66 NUCYNTA ER (200MG), 66 NUCYNTA ER (250MG), 66 NUCYNTA ER (50MG), 66 NUEDEXTA, 81 nufol, 221 NU-GEL COLLAGEN WOUND DRESSING, 208 nulecit, 46 nulev, 36 NULOJIX, 154 NULYTELY/FLAVOR PACKS, 130 NUMOISYN, 124 NUOX, 204 nuquin hp, 196 NUQUIN HP, 196 NUTRESTORE, 131 NUTRICAP, 215 NUTRIDOX, 15 nutrifac zx, 211 nutrilyte, 116 nutrilyte ii, 116 NUTRI-TAB OB, 215 NUTRI-TAB OB + DHA, 215 NUTRIVIT, 215 NUTROPIN, 146, 147 NUTROPIN AQ, 146, 147 NUTROPIN AQ NUSPIN 10, 146 NUTROPIN AQ NUSPIN 20, 146 NUTROPIN AQ NUSPIN 5, 147 NUTROPIN AQ PEN, 147 NUVAIL, 208 NUVARING, 142 NUVIGIL, 74 nuzole, 188 NUZON, 192 nyamyc, 183 NYMALIZE, 55 nystatin, 16, 183, 190 NYSTATIN VAGINAL, 184 nystatin/triamcinolone, 190 nystop, 183 O OASIS BURN MATRIX, 204 OASIS ULTRA TRI-LAYER MATRIX, 204 OASIS ULTRA TRI-LAYER MATRIX FENESTRATED, 204 OASIS ULTRA TRI-LAYER MATRIX MESHED, 204 OASIS WOUND MATRIX, 204 OB COMPLETE, 215 OB COMPLETE 400, 215 OB COMPLETE ONE, 215 OB COMPLETE PETITE, 215 OB COMPLETE PREMIER, 215 OB COMPLETE WITH DHA, 215 OB COMPLETE/DHA, 215 OB-NATAL ONE, 212 OBSTETRIX DHA, 215 OBSTETRIX EC, 215 O-CAL FA, 212 O-CAL PRENATAL, 215 ocella, 141 octacosanol, 224 OCTAGAM, 178 OCTAPLAS BLOOD GROUP A, 43, 44 268 OCTAPLAS BLOOD GROUP AB, 44 OCTAPLAS BLOOD GROUP B, 44 OCTAPLAS BLOOD GROUP O, 44 OCTREOSCAN, 155 octreotide acetate, 146 ocucoat viscoadherent, 125 OCUDOX, 10 OCUFEN, 122 OCUFLOX, 120 Ocular Disorders, 104 OCUVEL, 215 OFEV, 177 OFIRMEV, 68 ofloxacin, 9, 119 OFLOXACIN, 8 OFORTA, 36 OGESTREL, 142 olanzapine, 83, 85, 86 olanzapine odt, 83 olanzapine/fluoxetine, 86 OLEPTRO, 86 olopatadine hcl, 122 OLUX, 192 OLUX OLUX-E COMPLETE PACK, 192 OLUX-E, 192 OLYSIO, 20 OMECLAMOX-PAK, 130 omega-3-acid ethyl esters, 52 omeprazole, 129, 130 OMEPRAZOLE + SYRSPEND SF ALKA, 130 omeprazole/sodium bicarbonate, 130 OMNARIS, 122 OMNIFLEX DIAPHRAGM, 86 OMNIPRED, 122 OMNITROPE, 147 OMONTYS, 51 ON CALL EXPRESS BLOOD GLUCOSE METER, 98 ON CALL EXPRESS BLOOD GLUCOSE MONITORING SYSTEM, 98 ON CALL EXPRESS BLOOD GLUCOSE TEST STRIPS, 103 ON CALL PLUS BLOOD GLUCOSE METER, 98 ON CALL PLUS BLOOD GLUCOSE MONITORING SYSTEM, 98 ON CALL PLUS BLOOD GLUCOSE TEST, 103 ON CALL VIVID BLOOD GLUCOSE METER, 98 ON CALL VIVID BLOOD GLUCOSE MONITORING SYSTEM, 98 ON CALL VIVID BLOOD GLUCOSE TEST, 103 ON CALL VIVID BLOOD GLUCOSE TEST STRIPS, 103 ON CALL VIVID PAL BLOOD GLUCOSE METER, 98 ONCASPAR, 34 ondansetron hcl, 128 ONDANSETRON HCL, 128 ondansetron hcl/dextrose, 128 ONDANSETRON HCL/DEXTROSE, 128 ondansetron odt, 128 ONE FLOW FVC MONITORING SPIROMETER, 91 ONETOUCH BASIC SYSTEM, 91 ONETOUCH BASIC/PROFILE TEST STRIPS, 100 ONETOUCH BASIC/PROFILE/ONE TOUCH II TEST STRIPS, 100 ONETOUCH PROFILE SYSTEM, 91 ONETOUCH ULTRA 2, 91 ONETOUCH ULTRA BLUE, 100 ONETOUCH ULTRA MINI, 91 ONETOUCH ULTRA SYSTEM KIT, 91 ONETOUCH ULTRALINK SYSTEM (DEC), 91 ONETOUCH ULTRALINK SYSTEM (HEX), 91 ONETOUCH ULTRASMART, 91 ONETOUCH VERIO IQ BLOOD GLUCOSE MONITORING SYSTEM, 91 ONETOUCH VERIO SYNC BLOODGLUCOSE MONITORING SYSTEM, 91 ONETOUCH VERIO TEST STRIPS, 100 ONFI, 75 ONGLYZA, 138 ONMEL, 16 ONSET FORTE, 26 ONSOLIS, 71 ONTAK, 34 onxol, 34 OPANA, 65, 66, 68 OPANA ER, 65 OPANA ER (CRUSH RESISTANT), 65 Opiate Antagonists, 82 opium (1%), 127 opium tincture, 127 OPIUM TINCTURE (PAREGORIC), 127 OPSUMIT, 177 OPTASE, 204 OPTICHAMBER ADVANTAGE, 91 OPTICHAMBER ADVANTAGE/LARGE MASK, 91 OPTICHAMBER ADVANTAGE/MEDIUM FACE MASK, 91 OPTICHAMBER ADVANTAGE/SMALL FACE MASK, 91 OPTICHAMBER DIAMOND, 91 OPTICHAMBER DIAMOND/LARGEFACE MASK, 91 OPTICHAMBER DIAMOND/MEDIUM FACE MASK, 91 OPTICHAMBER DIAMOND/SMALLFACE MASK, 91 OPTIHALER, 91 OPTIHALER MDI DRUG DELIVERY SYSTEM, 91 OPTIONHOME COMPRESSOR NEBULIZER SYSTEM, 91 OPTIPRANOLOL, 124 OPTIUM BLOOD GLUCOSE MONITORING SYSTEM, 98 OPTIUM TEST STRIPS, 103 OPTIUMEZ TEST STRIPS, 103 OPTIVAR, 123 OPTUMRX BLOOD GLUCOSE METER, 98 OPTUMRX BLOOD GLUCOSE MONITORING SYSTEM, 98 OPTUMRX BLOOD GLUCOSE TEST, 103 ORA-BLEND, 161 ORA-BLEND SF, 161 ORACEA, 204 ORACIT, 105 ORAFATE, 208 ORAL MIX FLAVORED SUSPENDING VEHICLE, 161 ORAL MIX SF, 161 ORAL SUSPEND, 161 ORAL SYRUP FLAVORED VEHICLE, 161 ORAL SYRUP SF, 161 ORALAIR, 158 oralone, 192 ORAMORPH SR, 65 ORAP, 84 ORA-PLUS, 161 ORAPRED, 133 ORAPRED ODT, 133 269 ORA-SWEET, 161 ORA-SWEET SF, 161 ORAVIG, 188 ORAXYL, 15 ORBACTIV, 15 ORBIVAN, 66 ORBIVAN CF, 66 ORENCIA, 153 ORENITRAM, 177 ORFADIN, 155 organ-i nr, 175 organidin nr, 175 orphenadrine citrate, 39 ORPHENADRINE CITRATE, 40 orphenadrine citrate er, 39 ORPHENADRINE COMPOUND DS, 65 orphenadrine/asa/caffeine, 63 orsythia, 141 ORTHO DIAPHRAGM ALL-FLEX/65MM, 86 ORTHO DIAPHRAGM ALL-FLEX/70MM, 86 ORTHO DIAPHRAGM ALL-FLEX/75MM, 86 ORTHO DIAPHRAGM ALL-FLEX/80MM, 86 ORTHO DIAPHRAGM COIL SPRING KIT 100, 86 ORTHO DIAPHRAGM COIL SPRING KIT 105, 86 ORTHO DIAPHRAGM COIL SPRING KIT 50, 86 ORTHO DIAPHRAGM FLAT SPRING KIT 55, 86 ORTHO DIAPHRAGM FLAT SPRING KIT 60, 86 ORTHO DIAPHRAGM FLAT SPRING KIT 65, 87 ORTHO DIAPHRAGM FLAT SPRING KIT 70, 87 ORTHO DIAPHRAGM FLAT SPRING KIT 75, 87 ORTHO DIAPHRAGM FLAT SPRING KIT 80, 87 ORTHO DIAPHRAGM FLAT SPRING KIT 85, 87 ORTHO DIAPHRAGM FLAT SPRING KIT 90, 87 ORTHO DIAPHRAGM FLAT SPRING KIT 95, 87 ORTHO EVRA, 142 ORTHO MICRONOR, 142 ORTHO TRI-CYCLEN, 142 ORTHO TRI-CYCLEN LO, 142 ORTHO-CEPT, 142 ORTHO-CEPT-28, 142 ORTHOCLONE OKT3, 154 ortho-cs 250, 223 ORTHO-CYCLEN, 142 ortho-est, 143 ORTHO-NOVUM 1/35, 142 ORTHO-NOVUM 7/7/7, 142 ORTHOVISC, 158 oscimin, 36 oscimin sr, 36 oscion, 183, 188 oscion cleanser, 183 OSENI, 138 osmitrol viaflex, 110 OSMOPREP, 130 OSPHENA, 144 OTEZLA, 153 Other Miscellaneous Therapeutic Agents, 154 otic care, 125 OTIC EDGE, 125 oticin, 125 OTICIN HC NR, 122 oto-end 10, 121 otomar, 121 otomax-hc, 121 OTOZIN, 126 OTREXUP, 153 OVACE, 186 OVACE PLUS, 186 OVACE PLUS WASH, 186 OVACE WASH, 186 OVCON-35, 142 OVCON-50 28, 142 OVIDE, 186 OVIDREL, 145 oxacillin sodium, 13 oxaliplatin, 34 OXANDRIN, 135 oxandrolone, 135 oxaprozin, 64 oxazepam, 79 oxcarbazepine, 75 OXECTA, 71 OXISTAT, 186 OXSORALEN, 196 OXSORALEN ULTRA, 196 OXTELLAR XR, 76 oxybutynin chloride, 209 oxybutynin chloride er, 209 OXYCEL ABSORBANT COTTON-TYPE PLEDGET 2, 204 OXYCEL ABSORBANT GAUZE-TYPE PAD 3, 204 OXYCEL ABSORBANT GAUZE-TYPE STRIP 18, 204 OXYCEL ABSORBANT GAUZE-TYPE STRIP 36, 204 OXYCEL ABSORBANT GAUZE-TYPE STRIP 5, 204 oxycodone hcl, 64 oxycodone hcl (100mg/5ml), 64 OXYCODONE HCL (100MG/5ML), 65, 66 oxycodone hcl (5mg), 64 OXYCODONE HCL (5MG), 65 oxycodone hcl (5mg/5ml), 64 OXYCODONE HCL (5MG/5ML), 65, 66 OXYCODONE HCL ER, 65, 84 oxycodone/acetaminophen, 64 oxycodone/aspirin, 64 oxycodone/ibuprofen, 64 OXYCONTIN, 65 oxymorphone hydrochloride, 64 oxymorphone hydrochloride er, 64 Oxytocics, 160 oxytocin, 160 OXYTROL, 209 OZURDEX, 122 P p chlor dm, 169 p chlor gg, 175 p-a-c, 71 pacerone (100mg), 56 pacerone (200mg), 56 pacerone (400mg), 56 paclitaxel, 34 PACLITAXEL, 34 270 PACNEX HP, 188 PACNEX LP, 188 PACNEX MX, 186 pacnex wash, 186 PAINAID BRF, 71 painaid pmf, 71 PAIRE OB, 215 PALGIC, 22 PAMELOR, 84 pamidronate disodium, 151 PAMIDRONATE DISODIUM, 151 PAMINE, 37 PAMINE FORTE, 37 PAMINE FQ, 37 PANATUSS DXP, 169 PANATUSS DXP PEDIATRIC, 169 PANATUSS PED, 169 PANATUSS PED DROPS, 169 PANCREAZE, 131 PANCRELIPASE, 131 pancuronium bromide, 39 PANDEL, 192 PANHEMATIN, 44 PANLOR SS, 66 PANRETIN, 204 pantoprazole sodium, 129 papaverine hcl, 61 papaverine hcl cr, 61 PARADIGM LINK BLOOD GLUCOSE MONITOR, 98 PARADIGM REAL-TIME STARTER KIT, 98 PARAFON FORTE DSC, 39 PARAGARD INTRAUTERINE COPPER CONTRACEPTIVE T380A, 87 Parasympathomimetic (Cholinergic) Agents, 38 Parathyroid, 145 PARA-TIME, 61 parcaine, 125 PARCOPA, 78 PARI ALTERA NEBULIZER HANDSET, 91 PARI ALTERA NEBULIZER SYSTEM, 91 PARI BABY, 91 PARI BABY CONVERSION KIT SIZE 1, 91 PARI BABY CONVERSION KIT SIZE 2, 91 PARI BABY CONVERSION KIT SIZE 3, 91 PARI BABY SIZE 1/PARI LC PLUS, 91 PARI ERAPID NEBULIZER HANDSET, 91 PARI ERAPID NEBULIZER SYSTEM, 91 PARI EXPIRATORY FILTER VALVE SET, 91 PARI LC D NEBULIZER, 91 PARI LC PLUS, 91, 92 PARI LC PLUS NEBULIZER, 91, 92 PARI LC PLUS NEBULIZER SET/PEDIATRIC MASK, 92 PARI LC PLUS PEDIATRIC KIT, 92 PARI LC SPRINT NEBULIZER SET, 92 PARI LC STAR, 92 PARI LC STAR NEBULIZER, 92 PARI MANUAL INTERRUPTER, 92 PARI MASK SET, 92 PARI PRONEB ULTRA II, 92 PARI SINUS PULSATING AEROSOL SYSTEM, 92 PARI SINUSTAR NASAL AEROSOL DELIVERY SYSTEM, 98 PARI SINUSTAR NASAL NEBULIZER, 98 PARI SOFT PLASTIC ADULT MASK, 92 PARI SOFT PLASTIC PEDIATRIC MASK, 92 PARI TREK S COMBO PACK, 92 PARI TREK S COMPACT COMPRESSOR, 92 PARI TREK S COMPACT COMPRESSOR W/ 12V DC ADAPTOR, 92 PARI TREK S PORTABLE POWER ACCESSORY KIT, 92 PARI VIOS PRO LC PLUS AEROSOL DELIVERY SYSTEM, 92 PARI VIOS PRO LC SPRINT AEROSOL DELIVERY SYSTEM, 92 paricalcitol, 224 PARLODEL, 78 PARNATE, 84 paroex, 119 paromomycin sulfate, 17 paroxetine hcl, 83, 86 paroxetine hcl er, 86 PASER, 17 PATADAY, 123 PATANASE, 123 PATANOL, 123 PAXIL, 84, 86 PAXIL (10MG/5ML), 84 PAXIL CR, 86 pb-hyos, 36 pbm allergy, 169 PCCA ACACIA SYRUP BASE, 109 PCCA ANHYDROUS BASE, 161 PCCA COBASE #1, 161 PCCA POLYPEG BASE, 161 PCCA SOLID TRANSDERMAL PENETRATION BASE, 161 PCCA SWEET-SF, 161 PCCA SYRUP VEHICLE, 161 PCCA-PLUS, 161 PCE, 9 pc-tar, 202 PDM GG, 169 pe/gg, 174 PECGEN DMX, 169 pecgen pse, 169 pe-cp-k guaiacol, 169 pedia relief cough/cold, 169 pediacare childrens allergy/cold, 26 PEDIACARE CHILDRENS DECONGESTANT, 42 pediacare childrens nightrest multi-symptom cold, 26 PEDIADERM AF COMPLETE KIT, 186 PEDIADERM HC, 193 PEDIADERM TA, 192 pediahist dm, 169 PEDIAHIST DM, 169 PEDIAPRED, 133 PEDIARIX, 181 PEDIATEX TD, 22, 169 PEDIATEX TDM, 169 PEDIATRIC AEROSOL MASK, 92 pediatric cough/cold, 169 pediatric formula cough and congestion aid, 169 pedi-atric nightrest, 169 pedi-dri, 183 PEDIPIROX-4 NAIL, 188 PEDITRACE, 116 PEDVAX HIB, 181 peg 3350/electrolytes, 130 271 peg-3350/electrolytes, 130 peg-3350/nacl/na bicarbonate/kcl, 130 PEG-8 DISTEARATE BASE L, 161 PEGANONE, 75 PEGASYS, 20 PEGASYS PROCLICK, 20 PEGINTRON, 20 PEG-INTRON, 20 PEG-INTRON REDIPEN, 20 PEG-INTRON REDIPEN PAK 4, 20 pe-guai, 174 pegylax, 130 pe-hist dm, 169 penicillin g potassium, 13 PENICILLIN G POTASSIUM IN ISO-OSMOTIC DEXTROSE, 13 PENICILLIN G PROCAINE, 13 PENICILLIN G SODIUM, 13 penicillin v potassium, 9 PENLAC NAIL LACQUER, 186 PENNSAID, 208 PENTACEL, 181 PENTAM 300, 18 PENTASA, 127 PENTASPAN, 116 pentazocine/acetaminophen, 64 pentazocine/naloxone hcl, 64 PENTETATE CALCIUM TRISODIUM, 132 PENTETATE ZINC TRISODIUM, 132 pentopak, 51 pentostatin, 34 PENTOTHAL, 82 pentoxifylline er, 51 PENTRAX GOLD, 202 PEPCID, 129 PEPCID I.V., 129 PERANEX HC, 193, 195 PERCOCET, 66 PERCODAN, 66 PERCURA, 109 PERFOROMIST, 41 PERIDEX, 120 PERIKABIVEN, 108 perindopril erbumine, 58 perio med, 152 periogard, 119 PERIOSTAT, 15 PERJETA, 34 PERLANE, 158, 159 PERLANE-L, 159 permethrin, 184 perphenazine, 83 PERPHENAZINE/AMITRIPTYLINE, 84 PERSANTINE, 61 PERTZYE, 131 PETROLATUM WHITE, 197 PETROLATUM YELLOW, 197 PEXEVA, 86 PFIZERPEN-G, 13 PFLEX, 92 phanasin, 176 PHANASIN, 176 phanatuss dm, 169 pharbedryl, 21 Pharmaceutical Aids, 160 PHARMACIST CHOICE AUTOCODE BLOOD GLUCOSE MONITORING SYSTEM, 98 PHARMACIST CHOICE AUTOCODE BLOOD GLUCOSE TEST STRIPS, 103 pharmasin, 176 pharmatuss dm, 169 PHENABID, 26, 169 PHENABID DM, 169 phenadoz, 21 PHENAGIL, 26, 169 PHENAGIL CH, 169 phenazopyridine hcl, 194 phencarb gg, 169 phendimetrazine tartrate, 74 PHENDIMETRAZINE TARTRATE ER, 74 phenelzine sulfate, 83 phenergan, 21 PHENERGAN, 22 phenobarbital, 79 phenobarbital (100mg), 79 PHENOBARBITAL (100MG), 79 phenobarbital (15mg), 79 PHENOBARBITAL (15MG), 79 phenobarbital (16.2mg), 79 phenobarbital (30mg), 79 PHENOBARBITAL (30MG), 79 phenobarbital (32.4mg), 79 phenobarbital (60mg), 79 PHENOBARBITAL (60MG), 79 PHENOBARBITAL (64.8MG), 80 PHENOBARBITAL (97.2MG), 80 PHENOBARBITAL SODIUM, 81 phentermine hcl, 74 PHENTOLAMINE MESYLATE, 40 phenylephrine hcl, 42, 126 PHENYLEPHRINE HCL, 42 phenylephrine/chlorpheniramine, 26 phenylephrine/guaifenesin, 174 PHENYLHISTINE DH, 163 PHENYTEK, 76 phenytoin, 75, 76 phenytoin infatabs, 75 phenytoin sodium, 75, 76 PHENYTOIN SODIUM, 76 phenytoin sodium extended, 75 philith, 141 PHISOHEX, 188 phluorivit, 211 phluorivit + fe, 211 phos-flur, 152 PHOSLO, 113 PHOSLYRA, 113 phospha 250 neutral, 112 phosphasal, 21 Phosphodiesterase Type 4 Inhibitors, 177 PHOSPHOLINE IODIDE, 123 PHOTOFRIN, 34 PHRENILIN, 65, 66 272 PHRENILIN FORTE, 65 PHYSICIANS EZ USE B-12 COMPLIANCE KIT, 223 PHYSICIANS EZ USE FLU KIT 2012-2013, 182 PHYSICIANS EZ USE JOINT TUNNEL AND TRIGGER, 135 PHYSICIANS EZ USE M-PRED, 135 physiolyte, 111 physiosol irrigation, 111 PHYSIOSOL IRRIGATION PH 7.4, 111 PHYSOSTIGMINE SALICYLATE, 38 phytonadione, 224 PICATO, 203 PICO SINGLE USE NEGATIVE PRESSURE WOUND THERAPY SYSTEM, 208 PILLOW MASK/ADULT, 92 PILLOW MASK/CHILD, 92 PILLOW MASK/PEDIATRIC, 92 pilocarpine hcl, 38, 123 pilocarpine hydrochloride, 38 PILOPINE HS, 123 pimtrea, 141 pindolol, 53 PINNACAINE OTIC, 125 pioglitazone hcl, 136, 138 pioglitazone hcl/metformin hcl, 136 pioglitazone hcl-glimepiride, 138 PIPERACILLIN SODIUM, 13 piperacillin sodium/ tazobactam sodium, 13 piperacillin sodium/tazobactam sodium, 13 piperacillin/tazobactam, 13 pirmella 1/35, 141 pirmella 7/7/7, 141 piroxicam, 64 PITOCIN, 160 PITRESSIN SYNTHETIC, 145 Pituitary, 145 PKU EASY MICROTABS, 109 PLACENTA COMPOSITUM, 159 PLAN B, 142 PLAN B ONE-STEP, 142 PLAQUENIL, 17 plasbumin-25, 44 plasbumin-5, 44 PLASMA-LYTE 56, 116 PLASMA-LYTE A, 116 PLASMA-LYTE-148, 116 PLASMA-LYTE-148/D5W, 116 PLASMA-LYTE-56/D5W, 116 plasma-lyte-m/d5w, 116 plasma-lyte-r, 116 plasma-lyte-r/d5w, 116 PLASMANATE, 44 PLAVIX, 49 PLEGISOL, 113 PLEGISOL CARDIOPLEGIC SOLUTION, 113 PLEGRIDY, 20 PLEGRIDY STARTER PACK, 20 PLETAL, 49 PLEXION, 201 PLEXION CLEANSER, 201 PLEXION CLEANSING CLOTH, 201 PLEXION CLEANSING CLOTHS, 201 PLEXION SCT, 201 PLIAGLIS, 194 PLO TRANSDERMAL CREAM, 161 pluratuss, 169 PNEUMODORON #1, 159 PNEUMODORON #2, 159 PNEUMOVAX 23, 181, 182 PNEUMOVAX 23/1 DOSE, 181 PNEUMOVAX 23/5 DOSE, 182 PNV FERROUS FUMARATE/DOCUSATE/FOLIC ACID, 215 PNV FOLIC ACID + IRON MULTIVITAMIN, 212 PNV OB+DHA, 215 PNV PRENATAL PLUS MULTIVITAMIN, 212 PNV TABS 29-1, 215 PNV-DHA, 215, 221 PNV-DHA PLUS, 221 PNV-DHA+DOCUSATE, 215 PNV-FIRST, 215 PNV-IRON, 221 PNV-OB/DHA, 215 PNV-OMEGA, 215 PNV-SELECT, 215 PNV-TOTAL, 216 POCKET CHAMBER, 92 POCKET SPACER, 92 POCKETCHEM EZ BLOOD GLUCOSE MONITORING SYSTEM, 98 POCKETCHEM EZ BLOOD GLUCOSE TEST STRIPS, 103 podactin, 189 PODIAPN, 223 PODOCON 25 IN BENZOIN TINCTURE, 204 podofilox, 203 polocaine, 148, 149 polocaine-mpf, 149 polycin, 119 polycin b, 119 POLYCITRA-K CRYSTALS, 105 poly-dex, 121 polyethylene glycol 3350, 130 POLYETHYLENE GLYCOL 8000 BASE E, 130 poly-iron 150 forte, 44 polymyxin b sulfate, 14, 119 polymyxin b sulfate/trimethoprim sulfate, 119 POLY-PRED, 121 POLYTRIM, 120 POLY-VI-FLOR, 216 POLY-VI-FLOR/IRON, 216 polyvitamin/fluoride, 211 poly-vitamin/fluoride, 211 POMALYST, 30 PONSTEL, 66 PONTOCAINE, 149, 194 PONTOCAINE NIPHANOID, 149 portia-28, 141 POTABA, 221 potassium acetate, 116 POTASSIUM ACETATE, 116 potassium bicarbonate, 112 potassium chloride, 112, 116, 117 POTASSIUM CHLORIDE, 113, 116, 117 potassium chloride 0.075%/d5w/nacl 0.225%, 116 potassium chloride 0.15% /nacl 0.45% viaflex, 116 273 POTASSIUM CHLORIDE 0.15% /NACL 0.45% VIAFLEX, 116 potassium chloride 0.15% d5w/nacl 0.33%, 116 potassium chloride 0.15% d5w/nacl 0.45%, 116 potassium chloride 0.15% d5w/nacl 0.45% viaflex, 116 potassium chloride 0.15% nacl 0.9%, 116 potassium chloride 0.15% w/nacl 0.9% viaflex, 116 potassium chloride 0.15%/d5w, 117 POTASSIUM CHLORIDE 0.15%/NACL 0.9%, 117 potassium chloride 0.22% d5w/nacl 0.45%, 117 potassium chloride 0.224%/d5w, 117 potassium chloride 0.224%/d5w/nacl 0.45%, 117 potassium chloride 0.224%/dextrose 5% viaflex, 117 POTASSIUM CHLORIDE 0.224%D5W/NACL 0.33%, 117 potassium chloride 0.224%d5w/nacl 0.45% viaflex, 117 POTASSIUM CHLORIDE 0.3%/ NACL 0.9%, 117 potassium chloride 0.3%/d5w, 117 potassium chloride 0.3%/d5w/viaflex, 117 potassium chloride 0.3%/nacl 0.9%/viaflex, 117 potassium chloride cr, 112 potassium chloride er, 112 potassium chloride er (10meq), 112 POTASSIUM CHLORIDE ER (20MEQ), 113 potassium chloride er (8meq), 112 potassium chloride sr, 112 potassium citrate er, 104 potassium citrate/citric acid, 105 potassium citrate-citric acid crystals, 104 potassium phosphate, 117 potassium phosphates, 117 POTIGA, 75 pr benzoyl peroxide wash, 184 PR CREAM, 204 PR NATAL 400, 216 PR NATAL 400 EC, 216 PR NATAL 430, 216 PR NATAL 430 EC, 216 PR NATAL 440 EC, 216 PR OTIC SOLUTION, 126 PRADAXA, 49 PRALIDOXIME CHLORIDE, 150 pramcort, 194 pram-hca, 194 pramipexole dihydrochloride, 78 PRAMOSONE, 192 PRAMOSONE E, 192 PRAMOTIC, 126 pramox gel, 194 pramoxine-hc, 121 PRANDIMET, 138 PRANDIN, 138 prascion, 198 prascion fc, 198 prascion ra with sunscreens, 198 PRASTERA, 159 PRAVACHOL, 52 pravastatin sodium, 51 PRAZOLAMINE, 40 prazosin hcl, 51 PRECEDEX, 81 PRECISION LINK, 98 PRECISION PCX, 103 PRECISION PCX PLUS TEST STRIPS, 103 PRECISION POINT OF CARE TEST STRIPS, 103 PRECISION QID MONITOR, 98 PRECISION QID TEST STRIPS, 103 PRECISION SOF-TACT MONITOR, 98 PRECISION SOF-TACT TEST STRIPS, 103 PRECISION XTRA, 98, 103 PRECISION XTRA BLOOD GLUCOSE TEST STRIPS, 103 PRECISION XTRA MONITOR, 98 PRECOSE, 138 PRED FORTE, 122 PRED MILD, 121 PRED-G, 121 PRED-G S.O.P., 121 prednicarbate, 190 prednisolone, 121, 132, 133 prednisolone acetate, 121 PREDNISOLONE SODIUM PHOSPHATE, 121, 133 prednisolone sodium phosphate (15mg/5ml), 132 PREDNISOLONE SODIUM PHOSPHATE (25MG/5ML), 133 prednisolone sodium phosphate (5mg/5ml), 132 prednisolone sodium phosphate (6.7mg/5ml), 133 prednisone, 133 PREDNISONE, 133 PREDNISONE INTENSOL, 133 PREFERA OB, 216 PREFERA OB + DHA, 216 PREFERAOB ONE, 216 PREFEST, 144 PREFLIN, 109 PREFOL-DHA, 216 PRE-FOLIC, 221 pregnyl w/diluent benzyl alcohol/nacl, 144 PRELONE, 134 PREMARIN, 144 premasol, 108 PREMASOL, 108 pre-moistened witch hazel, 197 PREMPHASE, 144 PREMPRO, 144 PRENA1 CHEW, 216 PRENA1 CHEW/QUATREFOLIC, 216 PRENA1 PEARL, 216 PRENA1 PLUS/QUATREFOLIC, 216 PRENA1/QUATREFOLIC, 216 PRENACARE, 216 PRENAFIRST, 216 PRENAISSANCE, 216 PRENAISSANCE 90 DHA, 216 PRENAISSANCE BALANCE, 216 PRENAISSANCE DHA, 216 PRENAISSANCE HARMONY DHA, 216 PRENAISSANCE NEXT, 216 PRENAISSANCE NEXT-B, 216 PRENAISSANCE PLUS, 216 PRENAISSANCE PROMISE, 216 PRENAPLUS, 212 PRENATA, 216 PRENATABS FA, 212 PRENATABS OBN, 216 PRENATABS RX, 216 274 PRENATAL, 212, 216 PRENATAL 19, 216 PRENATAL AD, 216 PRENATAL LOW IRON, 212 PRENATAL MV & MIN/FE-FA-DHA, 216 PRENATAL PLUS, 212, 216 PRENATAL PLUS IRON, 216 PRENATAL VITAMINS PLUS, 212 PRENATAL-U, 216 PRENATE, 216, 217 PRENATE AM, 216 PRENATE DHA, 216 PRENATE ELITE, 216, 217 PRENATE ENHANCE, 217 PRENATE ESSENTIAL, 217 PRENATE MINI, 217 PRENATE PIXIE, 217 PRENATE RESTORE, 217 PRENATE STAR, 217 PRENEXA, 217 PRENEXA PREMIER, 217 PRENTIF CAVITY-RIM CERVICAL CAP, 87 PRENTIF FITTING SET, 87 preparation h, 197 preparation h totables, 197 PREPIDIL, 160 PREPLUS, 212 PREPOPIK, 130 PREQUE 10, 217 pres gen, 169 pres gen pediatric, 169 PRESERA, 197 presgen b, 169 PRETAB, 212 PREVACID, 129 PREVACID SOLUTAB, 129 prevalite, 51 PREVIDENT, 87, 152 PREVIDENT 5000 BOOSTER, 152 PREVIDENT 5000 BOOSTER PLUS, 152 PREVIDENT 5000 DRY MOUTH, 152 PREVIDENT 5000 ENAMEL PROTECT, 87 PREVIDENT 5000 PLUS, 152 PREVIDENT 5000 SENSITIVE, 87 PREVIDENT FLUORIDE, 152 previfem, 141 PREVNAR 13, 182 PREVPAC, 129 PREZISTA, 19 PRIALT, 68 PRIFTIN, 17 PRILOSEC, 129 PRILOSEC (10MG), 129 PRILOSEC (2.5MG), 129 PRIMAQUINE PHOSPHATE, 17 PRIMAXIN I.M., 14 PRIMAXIN IV, 14 PRIMAXIN IV ADD-VANTAGE, 14 PRIMEAIRE DUAL-VALVED HOLDING CHAMBER, 92 primidone, 75 PRIMLEV, 71 PRIMSOL, 21 PRINIVIL, 59 PRINZIDE, 59 PRISMASOL B22GK 2/0, 117 PRISMASOL B22GK 4/0, 117 PRISMASOL BGK 0/2.5, 117 PRISMASOL BGK 2/0, 117 PRISMASOL BGK 2/3.5, 117 PRISMASOL BGK 4/0/1.2, 117 PRISMASOL BGK 4/2.5, 117 PRISMASOL BK 0/0/1.2, 117 PRISTIQ, 86 PRIVIGEN, 178 PROAIR HFA, 41 PROBARIMIN QT, 109 probenecid, 118 probenecid/colchicine, 118 procainamide hcl, 57 PROCAINAMIDE HCL, 57 PROCALAMINE, 108 PROCARDIA, 55 PROCARDIA XL, 55 PROCENTRA, 73 PROCHIEVE, 146 prochlorperazine, 83, 85 prochlorperazine edisylate, 85 prochlorperazine maleate, 83 PROCORT, 194 PROCRIT, 51 PROCTOCORT, 192 proctocream hc, 190 proctocream-hc, 192 PROCTOFOAM HC, 194 procto-pak, 190 proctosol hc, 190 proctozone-hc, 190 PROCYSBI, 159 PRODIGY AUTOCODE BLOOD GLUCOSE METER KIT, 98 PRODIGY AUTOCODE BLOOD GLUCOSE MONITORING SYSTEM, 98 PRODIGY AUTOCODE BLOOD GLUCOSE MONITORING/TALKING, 98 PRODIGY AUTOCODE BLOOD GLUCOSE TEST STRIPS, 103 PRODIGY AUTOCODE PRO BLOOD GLUCOSE MONITORING SYSTEM, 98 PRODIGY BLOOD GLUCOSE MONITORING, 98 PRODIGY BLOOD GLUCOSE MONITORING SYSTEM, 98 PRODIGY BLOOD GLUCOSE MONITORING SYSTEM/TALKING, 98 PRODIGY BLOOD GLUCOSE MONITORING/TALKING, 98 PRODIGY BLOOD GLUCOSE TEST STRIPS, 103 PRODIGY EJECT BLOOD GLUCOSE METER, 98 PRODIGY EJECT BLOOD GLUCOSE TEST STRIPS, 103 PRODIGY NO CODING BLOOD GLUCOSE TEST STRIPS, 103 PRODIGY POCKET BLOOD GLUCOSE METER KIT, 99 PRODIGY POCKET BLOOD GLUCSE METER, 99 PRODIGY POCKET PRO BLOOD GLUCOSE MONITORING SYSTEM, 99 PRODIGY PREFERRED BLOOD GLUCOSE METER KIT, 99 PRODIGY PREFERRED BLOOD GLUCOSE MONITORING SYSTEM, 99 PRODIGY VOICE BLOOD GLUCOSE METER KIT, 99 275 PRODIGY VOICE BLOOD GLUCOSE TEST STRIPS, 103 PRODIGY VOICEPRO BLOOD GLUCOSE MONITORING SYSTEM, 99 PRODRIN, 78 PROFERRIN-FORTE, 45 PROFILNINE SD, 48 progesterone, 145, 146 PROGESTERONE MICRONIZED, 146 Progestins, 145 PROGLYCEM, 138 PROGRAF, 154 Prokinetic Agents, 131 PROLASTIN, 177 PROLASTIN-C, 177 PROLENSA, 122 PROLEUKIN, 34 PROLEX DMX, 170 PROLIA, 151 PROMACTA, 50 PROMAR, 45 promethazine hcl, 21, 22 promethazine hcl plain, 22 promethazine vc, 22, 162 PROMETHAZINE VC PLAIN, 22 promethazine/codeine, 162 promethazine/dextromethorphan, 162 promethazine-dm, 162 promethegan, 22 PROMETRIUM, 146 PROMISEB, 200, 201 PROMISEB COMPLETE, 201 PRONEB ULTRA II DELUXE/LC SPRINT, 92 PRONEB ULTRA II DELUXE/LC STAR, 92 PRONEB ULTRA II DELUXE/LCD, 92 PRONEB ULTRA II PEDIATRIC, 92 PRONEB ULTRA II WITH LC PLUS, 92 PRONEB ULTRA II/LC SPRINT, 92 PRONEB ULTRA II/LC SPRINT PEDIATRIC, 92 propafenone hcl, 56 propafenone hcl er, 56 PROPANTHELINE BROMIDE, 37 proparacaine hcl, 125 PROPECIA, 208 propofol, 82 propoxyphene hcl, 71 propranolol hcl, 53 PROPRANOLOL HCL, 53 propranolol hcl er, 53 PROPRANOLOL/HYDROCHLOROTHIAZIDE, 53 PROPYLENE GLYCOL, 125 propylthiouracil, 147 PROQUAD, 182 PROQUIN XR, 15 PROSCAR, 149 PROSED/DS, 21 PROSOL, 108 PROSTASCINT, 155 PROSTIGMIN, 38 PROSTIN E2, 160 PROSTIN VR PEDIATRIC, 61 PROTAMINE SULFATE, 48 PROTECT CARDIO, 221 PROTECT PLUS, 217 PROTECT PLUS NR, 217 PROTECTBONE, 217 PROTECTIRON, 45 Protective Agents, 160 PROTECTNATAL, 217 PROTEOLIN, 109 PROTHELIAL, 208 PROTID, 26 PROTONIX, 129 PROTOPAM CHLORIDE, 150 PROTOPIC, 204 protriptyline hcl, 83 PROVENGE, 61 PROVENTIL HFA, 41 PROVERA, 146 PROVIDA OB, 217 PROVIGIL, 73 PROVISC, 125 PROZAC, 84, 86 PROZAC WEEKLY, 86 PRUCLAIR, 197 PRUDOXIN, 194 PRUMYX, 197 PRUTECT, 204 PRYFLEX, 159 pse bpm, 26 pse brom dm, 170 pseudo cough, 170 pseudoephedrine hcl, 42 pseudoephedrine hcl er, 42 PSEUDOEPHEDRINE/DEXTROMETHORPHAN/GUAIFENESIN, 170 PSEUDOEPHEDRINE/GUAIFENESIN, 176 PSORIASIN, 202 PSORINOHEEL, 159 PSORIZIDE FORTE, 159 PSORIZIDE ULTRA, 159 psudatabs, 42 Psychotherapeutic Agents, 82 PTS PANELS GLUCOSE TEST, 103 pulmari-gp, 170 PULMICORT (0.25MG/2ML), 134 PULMICORT (0.5MG/2ML), 134 PULMICORT (1MG/2ML), 133 PULMICORT FLEXHALER, 133 PULMO-AIDE COMPRESSOR/PULMO-NEB DISPOSABLE NEBULIZER/FILTER, 92 PULMO-AIDE LT COMPRESSOR/NEBULIZER, 92 PULMO-AIDE TRAVELER COMPRESSOR/FILTERS, 92 PULMOMATE COMPRESSOR W/MIRO-MIST DISPOSABLE NEBULIZER/FILTER, 92 PULMONA, 109 Pulmonary Surfactants, 177 PULMONEB LT COMPRESSOR NEBULIZER SYSTEM, 92 PULMOPHYLLINE, 210 pulmosal, 176 PULMOZYME, 177 PULSATILLA COMPOSITUM, 159 PURALOR, 109 PURALOR CI, 109 PUREFE OB PLUS, 217 276 PUREFE PLUS, 45 purevit dualfe plus, 44 PURIFIED WATER, 161 PURILON, 208 PURINETHOL, 31 PURIXAN, 36 PYLERA, 129 pyrazinamide, 17 PYRIDIUM, 194 pyridostigmine bromide, 38 PYRIDOXINE HCL, 222 pyril d, 26 PYRIL DM, 170 pyril/chlor/phen, 26 pyrilamine-phenylephrine, 26 PYROGALLIC ACID, 200 Q Q-CARE Q2 ORAL CLEANSING/SUCTIONING SYSTEM/CHG ORAL RINSE, 87 Q-CARE Q4 ORAL CLEANSING/SUCTIONING SYSTEM/CHG ORAL RINSE, 87 qlearquil nighttime sinu s & congestion, 26 QNASL, 122 QROXIN, 195 QSYMIA, 74 Q-TABS, 159 q-tapp, 26, 170 q-tapp dm, 170 q-tussin, 170, 176 q-tussin dm, 170 QUADRAMET, 161 quadrapax, 36 QUAKE, 92 QUALAQUIN, 18 qual-tussin, 170, 176 qual-tussin pediatric, 176 QUARTETTE, 143 quasense, 141 QUAZEPAM, 80 QUDEXY XR, 77 QUELICIN, 39 QUELICIN 1000, 39 quenalin, 26 QUESTRAN, 52 QUESTRAN LIGHT, 52 quetiapine fumarate, 83 QUFLORA PEDIATRIC, 217 QUICKTEK, 99, 103 QUICKTEK TEST STRIPS, 103 QUILLIVANT XR, 74 quinapril hcl, 58 quinapril/hydrochlorothiazide, 58 QUINIDINE GLUCONATE, 57 quinidine gluconate cr, 56 quinidine gluconate er, 56 quinidine sulfate (200mg), 56 QUINIDINE SULFATE (200MG), 56 quinidine sulfate (300mg), 56 QUINIDINE SULFATE ER, 56 quinine sulfate, 17 QUINTET AC BLOOD GLUCOSE MONITORING SYSTEM, 99 QUINTET AC BLOOD GLUCOSE TEST STRIPS, 103 QUINTET BLOOD GLUCOSE MONITORING SYSTEM, 99 QUINTET BLOOD GLUCOSE TEST STRIPS, 103 QUINZYME, 159 QUIXIN, 120 QUTENZA, 208 qv-allergy, 26 QVAR, 133 R RABAVERT, 182 rabeprazole sodium, 129 RADIAGEL, 208 Radioactive Agents, 161 RADIOGARDASE, 110 RAGWITEK, 159 raloxifene hydrochloride, 143 ramipril, 58 RANEXA, 56 ranitidine hcl, 129, 130 RAPAFLO, 40 RAPAMUNE, 154 RASPBERRY SYRUP, 159 RASUVO, 153 RAUWOLFIA COMPOSITUM, 159 RAVICTI, 105 RAYOS, 135 RAZADYNE, 38 RAZADYNE ER, 38 re 10 wash, 184 re 40, 198 RE BENZOTIC, 126 re chlordiazepoxide/clidinium, 36 RE CHLORPHENYLCAINE, 126 re dcp, 170 re dualvit f, 44 RE DUALVIT OB, 217 re dualvit plus, 44 re fac-x, 211 re multivit with fluoride, 211 RE OB + 90 DHA, 217 RE OB + DHA, 217 re pramoxine-hc, 121 RE PRENATAL MULTIVITAMIN WITH IRON, 217 re sa 6%, 198 re urea 50, 198 rea lo 39, 198 rea lo 40, 198 REAPHIRM, 217 REBETOL, 19 REBIF, 153 REBIF REBIDOSE, 153 REBIF REBIDOSE TITRATION PACK, 153 REBIF TITRATION PACK, 153 recal d, 112 RECIPHEXAMINE, 195 RECLAST, 151 reclipsen, 141 277 recofen, 170 RECOMBINATE, 48 RECOMBIVAX HB, 182 RECOTHROM, 47 RECOTHROM SPRAY KIT, 47 rectacort-hc, 191 RECTIV, 208 REFACTO, 48 refenesen, 170, 176 refenesen 400, 176 refenesen dm, 170 refenesen plus, 176 REFISSA, 196 REFLUDAN, 50 REFUAH PLUS BLOOD GLUCOSEMONITORING SYSTEM, 99 REFUAH PLUS BLOOD GLUCOSETEST STRIPS, 103 REGIMEX, 74 REGLAN, 131 REGONOL, 38 REGRANEX, 204 REJUVESOL, 159 relacon-dm nr, 170 RELAGARD, 186 RELAGESIC, 22, 26 RELAMINE, 159 relasin dm, 170 relcof cpm, 26 RELCOF DN PE, 26 RELCOF DN PSE, 26 RELCOF PE, 26 relcof pse, 26 RELENZA DISKHALER, 18 relera, 26 RELHIST, 26 RELION BLOOD GLUCOSE TESTSTRIPS, 103 RELION MICRO BLOOD GLUCOSE MONITORING SYSTEM, 99 RELISTOR, 131 RELNATE DHA, 217 RELPAX, 78 RELYYKS, 195 reme hist dm, 170 reme tussin dm, 170 remedy antifungal, 189 remergent hq, 196 REMERON, 84, 85 REMERON SOLTAB, 85 REMESENSE, 87 remeven, 198 REMICADE, 153 REMODULIN, 177 RENACIDIN, 111 RENAGEL, 110 renal, 211 renalpren, 211 renaphro, 211 RENASTART, 109 RE-NATA 29 OB, 217 RENATABS, 46, 217 RENATABS WITH IRON, 46 rena-vite rx, 211 RENAX, 217 RENAX 5.5, 217 RENEEL, 159 Renin‐Angiotensin‐Aldosterone Sys Inhib, 57 reno caps, 211 RENOVA, 196 RENOVA PUMP, 196 RENOVO, 195 RENVELA, 110 reocyte plus, 44 REOPRO, 50 repaglinide, 136 repan, 64 re-pb hyos, 36 rephresh, 208 REPHRESH CLEAN BALANCE, 208 REPLACEMENT AIR FILTER, 92 Replacement Preparations, 112 REPLENS VAGINAL MOISTURIZER, 208 reprexain, 71 REPREXAIN, 71 REPRONEX, 145 REQ 49+, 217 REQUIP, 78 REQUIP XL, 78 RESCON, 26, 170 RESCON DM, 170 RESCON-JR, 26 RESCON-MX, 26 RESCRIPTOR, 18 RESCULA, 125 RESECTISOL, 111 RESERPINE, 57 RESPA DM, 170 RESPA SA, 26 RESPA-1ST, 176 RESPA-A.R., 26 RESPA-BR, 27 respahist, 27 RESPAHIST-II, 27 RESPAIRE-30, 176 RESPERAL-DM, 170 Respiratory Smooth Muscle Relaxants, 210 Respiratory Tract Agents, 161, 177 Respiratory Tract Agents, Miscellaneous, 177 respivent df, 27 respivent df 30, 27 respivent-d, 42 RESTASIS, 122 RESTORA RX, 127 RESTORE HYDROGEL DRESSING, 208 RESTORE SILVER DRESSING 2, 208 RESTORE SILVER DRESSING 4, 208 RESTORE SILVER DRESSING 6, 208 RESTORIL, 80 RESTYLANE, 159 RESTYLANE-L, 159 RETAVASE, 50 RETAVASE HALF-KIT, 50 RETIN-A, 195, 196 RETIN-A MICRO, 195, 196 RETIN-A MICRO PUMP (0.04%), 195 278 RETIN-A MICRO PUMP (0.08%), 196 RETIN-A MICRO PUMP (0.1%), 195 RETISERT, 122 RETROVIR, 19, 20 RETROVIR IV INFUSION, 20 re-u40, 198 REVATIO, 61 REVEAL BLOOD GLUCOSE MONITOR, 99 REVEAL BLOOD GLUCOSE TEST, 103 REVIA, 82 revina, 203 REVITADERM WOUND CARE, 208 REVLIMID, 31 revonto, 39 REXAPHENAC, 208 REYATAZ, 18 REZIRA, 163 REZYST IM, 127 REZYST SB, 127 RHEUMADORON 102A, 159 RHEUMATE, 109 RHEUMATREX, 30 RHINOCORT AQUA, 122 rhinoflex, 27 RHINOFLEX-650, 27 RHOGAM ULTRA-FILTERED PLUS, 178 RHOPHYLAC, 178 RIASTAP, 48 RIAX, 189 ribasphere, 19 RIBASPHERE, 19 RIBASPHERE RIBAPAK, 19 RIBATAB, 19 ribavirin, 19 RIDAURA, 131 rifabutin, 17 RIFADIN, 17 RIFAMATE, 17 rifampin, 17 RIFATER, 17 RIGHTEST GM100 BLOOD GLUCOSE MONITORING SYSTEM, 99 RIGHTEST GM300 BLOOD GLUCOSE MONITORING SYSTEM, 99 RIGHTEST GM550 BLOOD GLUCOSE MONITORING SYSTEM, 99 RIGHTEST GS100 BLOOD GLUCOSE TEST STRIPS, 103 RIGHTEST GS300 BLOOD GLUCOSE TEST STRIPS, 103 RIGHTEST GS550 BLOOD GLUCOSE TEST STRIPS, 104 RILUTEK, 81 riluzole, 81 rimantadine hcl, 18 RIMANTALIST, 20 RIMSO-50, 155 rinate pediatric, 27 ringers injection, 117 ringers irrigation, 111 RINNOVI NAIL SYSTEM, 201 RIOMET, 137 risedronate sodium, 150 RISPERDAL, 85 RISPERDAL CONSTA, 85 RISPERDAL M-TAB, 85 risperidone, 83 risperidone m-tab, 83 risperidone odt, 83 RITALIN, 73, 74 RITALIN LA (10MG), 73 RITALIN LA (20MG), 73 RITALIN LA (30MG), 74 RITALIN LA (40MG), 74 RITALIN SR, 74 RITEFLO, 92 RITUXAN, 34 rivastigmine tartrate, 38 RIXUBIS, 48 rizatriptan benzoate, 77 rizatriptan benzoate odt, 77 R-NATAL OB, 217 robafen, 162, 170, 176 robafen ac, 162 robafen cf cough & cold, 170 robafen dm, 170 robafen dm clear, 170 robafen dm cough & chest congestion max, 170 robafen dm cough clear, 170 ROBAXIN, 39 ROBAXIN-750, 39 ROBINUL, 37 ROBINUL FORTE, 37 ROBITUSSIN CHEST CONGESTION, 176 ROBITUSSIN CHILDRENS COUGH & COLD CF, 170 ROBITUSSIN CHILDRENS COUGH/COLD LONG-ACTING, 170 ROBITUSSIN COUGH & CHEST CONGESTION DM MAX, 170 robitussin cough & cold cf max, 170 ROBITUSSIN COUGH & COLD D, 170 ROBITUSSIN COUGH & COLD DAY/NIGHT PACK, 170 robitussin cough & cold long-acting, 170 ROBITUSSIN COUGH/COLD CF, 170 robitussin cough+chest congestion dm, 170 ROBITUSSIN DM, 170 robitussin mucus+chest congestion, 176 robitussin night time cough & cold, 27 ROBITUSSIN NIGHT TIME COUGH COLD & FLU, 27 robitussin peak cold cough+ chest congestion dm, 170 ROBITUSSIN PEAK COLD COUGH+ CHEST CONGESTION DM MAX STRENGHT, 170 ROBITUSSIN PEAK COLD DM, 170 ROBITUSSIN PEAK COLD MULTI-SYMPTOM COLD, 170 robitussin peak cold multi-symptom cold maximum strength, 170 ROBITUSSIN PEAK COLD NIGHTTIME MULTI-SYMPTOM COLD, 27 robitussin peak cold nighttime nasal relief, 27 robitussin to go cough & chest congestion dm, 170 ROBITUSSIN TO GO COUGH & COLD CF, 170 ROCALTROL, 224 ROCEPHIN, 14 ROCEPHIN IN ISO-OSMOTIC DEXTROSE, 14 rocuronium bromide, 40 ROMAZICON, 81 romilar ac, 162 romycin, 119 ropinirole er, 78 ropinirole hcl, 78 ropivacaine, 149 ropivacaine hcl, 149 279 rosadan, 184 ROSADAN KIT, 186 rosaderm, 198 ROSANIL, 200 rosanil cleanser, 198 ROSULA, 189, 200, 201 ROSULA CLARIFYING WASH, 200 ROSULA CLK, 201 ROSULA NS, 189 ROTARIX, 182 ROTATEQ, 182 rovin-cf of, 223 ROVIN-NV, 221 ROVIN-NV DHA, 221 ROWASA, 127 ROXICET, 65 ROXICODONE, 66 ROZEREM, 80 r-tanna, 26 R-TANNA PEDIATRIC, 26 r-tannamine pediatric, 26 RTD WOUND CARE DRESSING 2, 208 RTD WOUND CARE DRESSING 4, 208 RUCONEST, 152 RU-HIST D, 27 RU-HIST FORTE, 27 ru-tuss, 27 RU-TUSS DM, 170 RYANODEX, 40 RYBIX ODT, 71 RYCONTUSS, 170 RYDEX G, 176 RYMED, 27 RYNA-12, 27, 176 RYNA-12X, 176 RYNATAN, 27 RYNATAN PEDIATRIC, 27 RYNATUSS, 171 rynex dm, 171 rynex pe, 27 rynex pse, 27 RYNEZE, 27 RYTHMOL, 56 RYTHMOL SR, 56 RYZOLT, 71 S sa 6%, 198 SABRIL, 76 SACCHARIN SODIUM, 118 safe tussin 30, 171 safe tussin dm adult, 171 SAF-GEL, 208 SAFYRAL, 143 SAIZEN, 146 SAIZEN CLICK.EASY, 146 salacyn, 198 SALAGEN, 38 SALEX, 200 SALEX CREAM, 200 SALEX LOTION, 200 SALICEPT, 208 salicylic acid, 198, 199, 201 SALICYLIC ACID (26%), 201 salicylic acid (27.5%), 198 salicylic acid cream, 198 SALICYLIC ACID IN AMMONIUM LACTATE VEHICLE, 200 salicylic acid lotion, 199 salicylic acid wart remover, 199 saline flush, 117 saline flush zr/sterile field, 117 SALINE/PHENOL, 117 SALKERA, 200 salsalate, 64 Salt and Sugar Substitutes, 118 SAL-TROPINE, 37 SALVAX, 200, 201 SALVAX DUO PLUS, 201 SAMI THE SEAL COMPRESSOR NEBULIZER SYSTEM, 92 SAMSCA, 110 SANARE SCAR THERAPY, 208 SANCTURA, 210 SANCTURA XR, 210 SANCUSO, 128 SANDIMMUNE, 154 SANDOSTATIN, 146 SANDOSTATIN LAR DEPOT, 146 SANTYL, 204 SAPHRIS, 85 SARAFEM, 86 SARAPIN, 159 SARNA ULTRA, 195 sash kit for flushing vascular access devices, 50 SAUGELLA FEMININE WASH, 208 SAVELLA, 81 SAVELLA TITRATION PACK, 81 scalacort, 191 SCALACORT DK, 193 SCALP TREATMENT, 189 scleromate sodium morrhuate, 59 Sclerosing Agents, 59 SCLEROSOL INTRAPLEURAL, 60 SCOPACE, 128 SCOPOLAMINE HYDROBROMIDE, 37 SCOT-TUSSIN, 27, 171 scot-tussin dm, 171 SCOT-TUSSIN DM, 171 scot-tussin expectorant, 176 SCOT-TUSSIN SENIOR, 171 SCULPTRA, 159 SCYTERA, 202 se 10-5 ss, 199 se bpo 3% foaming cloths, 189 se bpo 6% foaming cloths, 189 SE BPO 7-5.5 WASH KIT, 186 se bpo 9% foaming cloths, 189 se bpo wash, 184 SEASONALE, 142 SEASONIQUE, 142 SEB-PREV, 186 seb-prev wash, 184 280 SE-CARE, 217 SE-CARE CONCEIVE, 217 SECONAL, 80 Second Generation Antihistamines, 29 SECTRAL, 53 secura antifungal, 189 secura antifungal extra thick, 189 SEDAPAP, 66 se-donna pb hyos, 36 SELECT-OB, 217 SELECT-OB+DHA, 217 selegiline hcl, 78 SELENIUM, 117, 186 selenium sulfide, 184 selfemra, 86 SELRX, 186 SELSEB, 186 SELSUN SHAMPOO, 186 SELZENTRY, 18 SEMPREX-D, 29 SE-NATAL 19, 217 SE-NATAL 90, 217 SE-NATAL ONE, 217 SENETONIC, 217 SENILEZOL, 45 SENNA, 131 SENOPHYLLINE, 210 SENSIPAR, 155 sensorcaine, 149 sensorcaine/epinephrine, 149 sensorcaine-mpf, 149 sensorcaine-mpf spinal, 149 sensorcaine-mpf/epinephrine, 149 SENSORCAINE-MPF/EPINEPHRINE, 149 SENTRA AM, 109 SENTRA PM, 109 SENTRADINE, 130 SENTRAFLOX AM-10, 86 SENTRALOPRAM AM-10, 86 SENTRAMODAFIN AM-100, 74 SENTRAVIL PM-25, 86 SENTRAZOLAM AM 0.25, 81 SENTRAZOLPIDEM PM-5, 81 SENTROXATINE, 86 SE-PLETE DHA, 217 SEPTRA, 10 SEPTRA DS, 10 SERADEX, 171 SEREVENT DISKUS, 41 SEROMYCIN, 17 serophene, 143 SEROQUEL, 84, 85 SEROQUEL XR, 84 SEROSTIM, 146 sertraline hcl, 83 Serums, 177 Serums, Toxoids and Vaccines, 177 SE-TAN DHA, 217 se-tan plus, 44 SETON ET-EC, 217 SETONET, 218 SEVELAMER CARBONATE, 110 SEVEN PLUS STARTER KIT, 99 sevoflurane, 82 sf, 152 sf 5000 plus, 152 SFROWASA, 127 sharobel, 141 SHELLGEL, 125 SHOHLS SOLUTION MODIFIED, 105 shopko allergy relief-d, 29 shopko nasal decongestant, 43 shopko nasal decongestantmaximum strength, 43 siderol, 211 SIDEROL, 218 SIDESTREAM ADULT FACE MASK, 92 SIDESTREAM CUSTOM NEBULIZER KIT, 92 SIDESTREAM NEBULIZER/DISPOSABLE, 93 SIDESTREAM NEBULIZER/REUSABLE, 93 SIDESTREAM PEDIATRIC FACEMASK, 93 SIDESTREAM PEDIATRIC FACEMASK/SAMI THE SEAL, 93 SIDESTREAM PLUS REUSABLE HIGH EFFICIENCY NEBULIZER, 93 SIGNIFOR, 146 sildec pe-dm, 171 sildec-pe, 27 sildenafil, 60, 61 sildenafil citrate, 60 SILENOR, 86 SILICONE MASK FOR BREATHERITE CHAMBER/ADULT, 93 SILICONE MASK FOR BREATHERITE CHAMBER/INFANT, 93 SILICONE MASK FOR BREATHERITE CHAMBER/PEDIATRIC, 93 SILICONE MASK FOR BREATHRITE CHAMBER/ADULT, 93 silphen cough, 27 siltussin das, 176 siltussin dm das, 171 siltussin sa, 176 siltussin-dm, 171 SILVADENE, 186 SILVASORB, 208 SILVER NITRATE, 120 silver sulfadiazine, 184 SILVERSEAL HYDROGEL DRESSING 2, 204 SILVERSEAL HYDROGEL DRESSING 4, 204 SILVRSTAT WOUND DRESSING, 204 SIMBRINZA, 123 SIMCOR, 51 SIMETYL, 37 SIMPLE SYRUP, 161 simply stuffy, 43 SIMPONI, 153 SIMPONI ARIA, 153 SIMUC-DM, 171 simuc-gp, 176 SIMULECT, 154 simvastatin, 51 SINA-12X, 176 SINADRIN PE COMPLETE SINUS RELIEF, 27 SINEMET, 78 SINEMET CR, 78 sine-off, 27 sine-off night time formula, 27 SINGULAIR, 162 281 sinus & allergy pe maximuum strength, 27 sirolimus, 154 SIRTURO, 17 SITAVIG, 20 SIVEXTRO, 15 SKELAXIN, 39 Skeletal Muscle Relaxants, 39 SKELID, 150 Skin and Mucous Membrane Agents, Misc, 202 Skin and Mucous Membrane Preparations, 182 skin bleaching, 196 skin bleaching/sunscreen, 196 SKIN SHIELD, 159 SKINTEGRITY HYDROGEL, 208 SKLICE, 189 SKYLA, 143 SLOESTEROL, 109 slo-niacin, 223 SLO-NIACIN, 223 SMART DIABETES XPRES BLOOD GLUCOSE MONITORING SYSTEM, 99 SMART DIABETES XPRES BLOOD GLUCOSE TEST STRIPS, 104 SMARTEST BLOOD GLUCOSE TEST STRIPS, 104 SMARTEST EJECT BLOOD GLUCOSE MONITORING SYSTEM, 99 SMARTEST EJECT STARTER KIT, 99 SMARTEST PERSONA STARTER KIT, 99 SMARTEST PRONTO STARTER KIT, 99 SMARTEST PROTEGE BLOOD GLUCOSE MONITORING SYSTEM, 99 SMARTEST PROTEGE STARTER KIT, 99 Smooth Muscle Relaxants, 209 sodiphluor, 151 sodium acetate, 105 sodium bicarbonate, 105 SODIUM BICARBONATE, 127 sodium bicarbonate partial fill, 105 sodium chloride, 111, 117, 118, 176 SODIUM CHLORIDE, 117, 118 sodium chloride 0.9%, 111 sodium chloride 0.45%, 111, 117 sodium chloride 0.45% viaflex, 117 sodium chloride 0.9%, 111 sodium chloride bacteriostatic, 117 SODIUM CHLORIDE BACTERIOSTATIC/BENZYL ALCOHOL, 118 sodium chloride flush, 118 sodium chloride pab, 118 SODIUM CITRATE, 105 SODIUM DIURIL, 110 SODIUM EDECRIN, 110 sodium ferric gluconate complex/sucrose, 46 sodium fluoride, 151 sodium hyaluronate, 197 SODIUM HYPOCHLORITE, 189 SODIUM LACTATE, 105 SODIUM NITRITE, 132 sodium phenylbutyrate, 105 sodium phosphate, 118 sodium polystyrene sulfonate, 110 SODIUM SACCHARIN, 118 SODIUM SACCHARIN DIHYDRATE, 118 sodium sulfacetamide, 119, 184, 199, 200, 201 sodium sulfacetamide wash, 184 SODIUM SULFACETAMIDE WASH, 186 sodium sulfacetamide/sulfur, 199, 200, 201 sodium sulfacetamide/sulfur clarifying wash, 199 sodium sulfacetamide/sulfur cleanser, 199 sodium sulfacetamide/sulfur cleansing cloths, 199 sodium sulfacetamide/sulfur green, 199 sodium sulfacetamide/sulfur w/sunscreen, 201 sodium sulfacetamide/sulfur wash, 199 SODIUM SULFACETAMIDE/UREA, 189 SODIUM SULFACETAMIDE-SULFFUR WASH W/MERATAN, 201 sodium thiosulfate, 132 SODIUM THIOSULFATE, 132 sojourn, 82 SOLARAZE, 204 SOLESTA, 159 solia, 141 SOLIRIS, 152 SOLODYN, 208 SOLOSITE, 208 SOLTAMOX, 36 SOLU-CORTEF, 134 SOLU-MEDROL, 134 SOLUS V2 AUDIBLE BLOOD GLUCOSE MANAGEMENT SYSTEM, 99 SOLUS V2 AUDIBLE TEST, 104 SOMA (250MG), 40 SOMA (350MG), 39 Somatostatin Agonists and Antagonists, 146 Somatotropin Agonists and Antagonists, 146 SOMATULINE DEPOT, 146 SOMAVERT, 147 SOMNOTE, 81 SONAFINE, 204 sonahist, 27, 171 sonahist dm, 171 SONATA, 80 soothe & cool inzo antifungal cream, 189 SOOTHE NEB MESH NEBULIZER, 93 SORBITOL, 111 SORBITOL-MANNITOL, 111 sorbugen nr, 171 SORBUTUSS NR, 171 SORIATANE, 205 SORILUX, 204 sorine, 53 sotalol hcl, 53 sotalol hcl (af), 53 SOTALOL HYDROCHLORIDE, 53 SOTRADECOL, 60 sotret, 205 SOVALDI, 20 SPASCUPREEL, 159 SPECTRACEF, 15 SPECTRAGEL, 208 SPEEDGEL RX, 159 SPINOSAD, 189 SPIRIVA HANDIHALER, 37 SPIRIVA RESPIMAT, 37 SPIRO PD, 93 spironolactone, 58 spironolactone/hydrochlorothiazide, 58 282 SPORANOX, 16 SPORANOX PULSEPAK, 16 sprintec 28, 141 SPRIX, 71 SPRYCEL, 31 SPS, 110 sronyx, 141 ssd, 184 ssd af, 184 SSKI, 147 sss 10%-5%, 199 SSS 10-4, 200 sss 10-5, 199 ST JOSEPH ADULT, 71 ST JOSEPH ADULT ANALGESICLOW DOSE BITE SIZE, 71 st joseph aspirin, 71 STADOL, 68 STALEVO 100, 78 STALEVO 125, 78 STALEVO 150, 79 STALEVO 200, 79 STALEVO 50, 79 STALEVO 75, 79 STANBACK HEADACHE POWDERS, 72 stannous fluoride oral rinse, 152 STAPHAGE LYSATE I & III, 156 STARLIX, 138 stavudine, 18 STAVZOR, 76 STAXYN, 61 STELARA, 205 STENDRA, 61 STERILE TALC POWDER, 60 sterile water irrigation, 111 sterile water irrigation plastic bottle, 111 sterile water irrigation w/hanger, 111 STERYMINE, 159 STIMATE, 145 STIMULEN, 208 STIVARGA, 31 STRATTERA, 81 STRAZEPAM, 81 STREPTOMYCIN SULFATE, 14 STRIANT, 135 STRIBILD, 19 STRI-DEX DAY/NIGHT, 208 STRIVERDI RESPIMAT, 43 STROMECTOL, 8 STROVITE, 218 STROVITE ADVANCE, 218 STROVITE FORTE, 218 STROVITE ONE, 218 strovite plus, 211 STRUMEEL, 159 STRUMEEL FORTE, 159 SUBLIMAZE, 68 SUBOXONE, 65, 66 SUBSYS, 72 SUBUTEX, 66 SUCLEAR, 130 SUCRAID, 118 sucralfate, 129 SUDAFED, 27, 43 sudafed 12 hour, 43 SUDAFED 24 HOUR, 43 SUDAFED CHILDRENS, 43 SUDAFED CONGESTION, 43 SUDAFED NASAL DECONGESTANT MAXIMUM STRENGTH, 43 SUDAFED PE CHILDRENS NASAL DECONGESTANT, 43 SUDAFED PE DAY & NIGHT, 27 SUDAFED PE MAXIMUM STRENGTH, 43 sudafed pe nighttime coldmaximum strength, 27 SUDAFED PE SEVERE COLD MULTI-SYMPTOM, 27 sudafed pe sinus/allergy maximum strength, 27 SUDAHIST, 27 sudanyl, 43 sudatex g, 176 sudatuss-2, 171 sudatuss-2 df, 171 sudatuss-sf, 171 sudogest, 27, 43 sudogest 12 hour, 43 sudogest childrens, 43 sudogest pe, 43 sudogest sinus & allergy, 27 sudophed, 43 SUFENTA, 68 sufentanil citrate, 68 SULAR, 55 sulfacetamide sodium, 119, 121, 184, 189, 199 SULFACETAMIDE SODIUM, 120, 189 sulfacetamide sodium w/urea, 189 sulfacetamide sodium/prednisolone sodium phosphate, 121 sulfacetamide sodium/sulfur cleanser, 199 sulfacetamide sodium/urea, 189 SULFACETAMIDE SODIUM/UREA, 189 sulfacleanse 8/4, 199 SULFADIAZINE, 9 sulfamethoxazole/trimethoprim, 9 SULFAMETHOXAZOLE/TRIMETHOPRIM, 14 sulfamethoxazole/trimethoprim ds, 9 SULFAMYLON, 186 sulfasalazine, 9 sulfatrim pediatric, 9 sulfazine, 9 sulfazine ec, 9 SULFOAM, 200 SULFURATED LIME, 187 sulindac, 64 SUMADAN KIT, 200 SUMADAN WASH, 200 SUMADAN XLT, 201 SUMATRIPTAN, 77 sumatriptan succinate, 77 SUMATRIPTAN SUCCINATE, 77 sumatriptan succinate refill, 77 SUMAVEL DOSEPRO, 78 SUMAXIN, 200, 201 SUMAXIN CP KIT, 200 SUMAXIN TS, 200 SUMAXIN WASH, 201 283 SUMMERS EVE CLEANSING WASH/SENSITIVE SKIN/DELICATE BLOSSOM, 208 SUMMERS EVE CLEANSING WASH/SENSITIVE SKIN/MORNING PARADISE, 208 summers eve extra cleansing vinegar and water, 189 SUMMERS EVE FEMININE WASH, 208, 209 SUMMERS EVE FEMININE WASHCLEANSING MIST, 208 SUMMERS EVE FEMININE WASHNORMAL SKIN, 209 SUMMERS EVE FEMININE WASHSENSITIVE SKIN, 209 SUMMERS EVE FEMININE WASHSENSITIVE SKIN DELICATE BLOSSOM, 209 summers eve vinegar & water, 189 SUPARTZ, 156 super cold tabs, 27 super strength sinadrin, 27 SUPERVITE, 218 SUPERVITE EC, 218 suphedrine, 43 suphera, 199 SUPPORT, 218, 221 SUPPORT-500, 221 SUPPRELIN LA, 34 SUPRANE, 82 SUPRAX, 9 SUPREME TEST STRIPS, 104 SUPRENZA, 74 SUPREP BOWEL PREP, 130 SUPRESS A PEDIATRIC DROPS, 171 SUPRESS DM PEDIATRIC, 171 supress-dx pediatric, 171 SURE EDGE BLOOD GLUCOSE MONITORING SYSTEM, 99 SURE EDGE BLOOD GLUCOSE TEST STRIPS, 104 SURECHEK BLOOD GLUCOSE MONITORING SYSTEM, 99 SURECHEK BLOOD GLUCOSE MONITORING SYSTEM STARTER KIT, 99 SURECHEK BLOOD GLUCOSE TEST STRIPS, 104 SURESTEP PRO TEST STRIPS, 100 SURESTEP TEST STRIPS, 100 SURE-TEST EASYPLUS MINI BLOOD GLUCOSE TEST STRIPS, 104 SURE-TEST EASYPLUS MINI SELF MONITORING BLOOD GLUCOSE METER, 99 SURFAXIN, 177 SURGICEL ABSORBABLE HEMOSTAT/0.5, 204 SURGICEL ABSORBABLE HEMOSTAT/2, 204 SURGICEL ABSORBABLE HEMOSTAT/4, 204 SURGICEL FIBRILLAR ABSORBABLE HEMOSTAT 1, 204 SURGICEL FIBRILLAR ABSORBABLE HEMOSTAT 2, 204 SURGICEL FIBRILLAR ABSORBABLE HEMOSTAT 4, 204 SURGICEL NU-KNIT ABSORBABLE HEMOSTAT ENDOSCOPIC 1, 204 SURGICEL NU-KNIT ABSORBABLE HEMOSTAT/1, 204 SURGICEL NU-KNIT ABSORBABLE HEMOSTAT/3, 204 SURGICEL NU-KNIT ABSORBABLE HEMOSTAT/6, 205 SURGICEL SNOW ABSORBABLE HEMOSTAT 1, 205 SURGICEL SNOW ABSORBABLE HEMOSTAT 2, 205 SURGICEL SNOW ABSORBABLE HEMOSTAT 4, 205 SURGIFOAM, 47 SURMONTIL, 85 SURVANTA INTRATRACHEAL, 177 SUSTIVA, 18 sutan-dm, 171 SUTENT, 31 SUTTAR-2, 171 SUTTAR-SF, 171 swabflush saline flush, 118 syeda, 141 SYLATRON, 31 SYLVANT, 34 SYMAX DUOTAB, 37 symax fastabs, 36 symax-sl, 36 symax-sr, 36 SYMBICORT, 133 SYMBYAX, 86 SYMLIN, 137 SYMLINPEN 120, 137 SYMLINPEN 60, 137 Sympatholytic (Adrenergic Blocking) Agents, 40 Sympathomimetic (Adrenergic) Agents, 40 SYNAGEX, 221 SYNAGIS, 20 SYNALAR, 192 SYNALAR CREAM KIT, 192 SYNALAR OINTMENT KIT, 192 SYNALAR TS, 192 SYNALGOS-DC, 65 SYNAPRYN FUSEPAQ, 72 SYNAREL, 144 SYNATEK, 221 SYNERA, 194 SYNERCID, 14 SYNRIBO, 34 SYNTHROID, 147 SYNVISC, 156 SYNVISC ONE, 156 SYPRINE, 132 SYRINGE AVITENE, 47 SYRPALTA, 161 SYZYGIUM COMPOSITUM, 159 T TABLOID, 30 TACHOSIL, 205 TACLONEX, 193 tacrolimus, 154 TAFINLAR, 31 TALWIN, 68 TAMBOCOR (100MG), 56, 57 TAMBOCOR (150MG), 56, 57 TAMBOCOR (50MG), 56, 57 TAMIFLU, 18 tamoxifen citrate, 30 tamsulosin hcl, 40 tanabid, 27 tanabid sr, 27 TANAFED DMX, 171 TANDEM DHA, 218 TANDEM F, 45 TANDEM OB, 218 TANDEM PLUS, 46 tannihist-12 rf, 171 284 TANZEUM, 138 TAPAZOLE, 147 TARCEVA, 31 TARGRETIN, 31, 205 tarina fe 1/20, 141 TARKA, 54 TARON EC CALCIUM, 218 TARON FORTE, 46 TARON-BC, 218 TARON-C DHA, 218 taron-crystals, 105 TARON-DUO EC, 218 TARON-EC CAL, 218 TARON-PREX, 218 TASIGNA, 31 TASMAR, 78 TAXOTERE, 35 tazicef, 14 TAZICEF, 14 TAZORAC, 205 taztia xt, 54 tbc, 203 TEARS AGAIN HYDRATE, 159 TECFIDERA, 153 TECFIDERA STARTER PACK, 153 TEFLARO, 14 TEGADERM AG MESH DRESSING WITH SILVER 2, 209 TEGADERM AG MESH DRESSING WITH SILVER 4, 209 TEGADERM AG MESH DRESSING WITH SILVER 8, 209 TEGADERM HYDROGEL WOUND FILLER, 209 TEGRETOL, 75, 76 TEGRETOL-XR (100MG), 75 TEGRETOL-XR (200MG), 76 TEGRETOL-XR (400MG), 76 TEGRIN CREAM FOR PSORIASIS, 202 TEGRIN LOTION FOR PSORIASIS, 202 TEGRIN MEDICATED SOAP, 202 TEKAMLO, 59 TEKRAL, 27 TEKTURNA, 59 TEKTURNA HCT, 59 TELCARE BLOOD GLUCOSE MONITORING SYSTEM, 99 TELCARE BLOOD GLUCOSE TEST STRIPS, 104 telmisartan, 55, 58 telmisartan/amlodipine, 55 telmisartan/hydrochloroth, 58 telmisartan/hydrochlorothiazide, 58 temazepam, 79 TEMODAR, 31, 35 TEMOVATE, 192 TEMOVATE E, 192 temozolomide, 31 tenar dm, 171 TENAR PSE, 176 TENEX, 57 TENIPOSIDE, 35 TENIVAC, 179 TENORETIC 100, 53 TENORETIC 50, 53 TENORMIN, 53 teo-tus, 171 tera-gel tar, 202 TERAZOL 3, 187 TERAZOL 7, 187 terazosin hcl, 51 terbinafine hcl, 16 TERBINEX, 16 terbutaline sulfate, 41, 42 terconazole, 184 TEROCIN, 126 terrell, 82 TERSI FOAM, 189 TESSALON, 163 TESSALON PERLES, 163 TESTIM, 135 TESTOPEL, 135 TESTOSTERONE (1%), 135 TESTOSTERONE (10MG/ACT), 135 testosterone cypionate, 135 testosterone enanthate, 135 TESTOSTERONE PUMP, 135 TESTRED, 135 TETANUS TOXOID ADSORBED, 179 TETANUS/DIPHTHERIA TOXOIDS-ADSORBED ADULT, 179 tetcaine, 125 tetracaine hcl, 125 TETRACAINE HCL, 149 tetracycline hcl (250mg), 9 TETRACYCLINE HCL (250MG), 9 tetracycline hcl (500mg), 9 TETRACYCLINE HCL (500MG), 9 tetravisc, 125 tetravisc forte, 125 TETRIX, 205 TEVETEN, 59 TEVETEN HCT, 59 TEV-TROPIN, 147 TEXACORT, 192 tg 10peh/380gfn/15dm, 171 tg 40pse/4brm, 27, 171 tg 40pse/4brm/20dm, 171 TG 45PSE/400GFN, 171, 176 TG 45PSE/400GFN/15DM, 171 TGQ 15DM/5PEH/2CPM, 171 TGQ 30PSE/150GFN/15DM, 171 TGQ 30PSE/3BRM/15DM, 171 TGQ 50PSE/3BRM/30DM, 171 tgq 7.5peh/4brm/15dm, 171 TGT BLOOD GLUCOSE MONITORING SYSTEM PREMIUM, 99 TGT BLOOD GLUCOSE TEST STRIPS, 104 TGT BLOOD GLUCOSE TEST STRIPS PREMIUM, 104 th 12 hour decongestant, 43 th allergy relief + cold, 27 th allergy relief + sinus headache, 27 th aspirin, 72 th aspirin low dose, 72 th chest congestion relief, 171, 176 th chest congestion relief dm, 171 th childrens mucus relief cough, 171 th cold & allergy, 28 th congestion, 43 th enteric aspirin, 72 285 th loratadine-d, 29 th nasal decongestant pe, 43 th tussin, 171, 176 th tussin cf, 171 th tussin dm, 171 th tussin dm max, 171 THALAMUS COMPOSITUM, 159 THALITONE, 109 THALLOUS CHLORIDE TL 201, 100 THALOMID, 153 THAM, 105 THEO-24, 210 theochron, 210 theophylline, 210 theophylline cr, 210 theophylline er, 210 theophylline/d5w, 210 THEOPHYLLINE/D5W, 210 THERABENZAPRINE-60, 40 THERABENZAPRINE-90, 40 THERABENZAPRINE-90-5, 40 THERACODEINE-300, 72 THERACODOPHEN-325, 72 THERACODOPHEN-650, 72 THERACODOPHEN-750, 72 THERACODOPHEN-LOW-90, 72 THERACYS, 182 THERAFELDAMINE, 72 THERAFLU COLD & COUGH, 172 THERAFLU COLD & SORE THROAT, 28 THERAFLU COLD/COUGH NIGHTTIME, 28 THERAFLU FLU & SORE THROAT, 28 THERAFLU SEVERE COLD & COUGH NIGHTTIME, 28 THERAFLU SINUS & COLD, 28 theraflu warming relief flu & sore throat, 28 theraflu warming relief severe cold nighttime, 28 theraflu warming relief sinus & cold, 28 THERA-FLUR-N, 152 THERAHONEY, 209 THERAMINE, 109 THERAMINE PLUS, 109 THERAPENTIN-60, 77 THERAPENTIN-90, 77 therapeutic shampoo, 202 THERAPLEX T, 202 THERAPOXYPHENE-325, 72 THERAPOXYPHENE-650, 72 THERAPROFEN-60, 72 THERAPROFEN-800, 72 THERAPROFEN-90, 72 THERAPROXEN, 72 THERAPROXEN-500, 72 THERAPROXEN-60, 72 THERAPROXEN-90, 72 THERATRAMADOL-60, 72 THERATRAMADOL-90, 72 thermazene, 184 therobec, 211 therobec plus, 211 thiamine hcl, 222 THIOLA, 155 thioridazine hcl, 83 THIOTEPA, 35 thiothixene, 83 THRESHOLD IMT, 93 THRESHOLD PEP, 93 THROMBATE III W/10 ML STERILE WATER, 50 THROMBATE III W/20 ML STERILE WATER, 50 THROMBI-GEL 10, 48 THROMBI-GEL 100, 48 THROMBI-GEL 40, 48 THROMBIN-JMI DILUENT, 47 THROMBIN-JMI EPISTAXIS, 47 THROMBIN-JMI SYRINGE SPRAY KIT, 47 THROMBIN-JMI W/DIL SPRAY PUMP ACTUATOR, 47 THROMBI-PAD, 48 THROMBOGEN, 47 THYMOGLOBULIN, 154 THYREOIDEA COMPOSITUM, 159 Thyroid and Antithyroid Agents, 147 THYROLAR-1, 147 THYROLAR-1/2, 147 THYROLAR-1/4, 147 THYROLAR-2, 147 THYROLAR-3, 147 tiagabine hydrochloride, 75 TIAZAC, 55 TICE BCG, 182 ticlopidine hcl, 48 TIGAN, 128 TIKOSYN, 56 tilia fe, 141 TIMENTIN, 14 TIMOLOL MALEATE, 53 timolol maleate (0.25%), 123 timolol maleate (0.5%), 123 timolol maleate ophthalmic gel forming, 123 TIMOPTIC (0.25%), 124 TIMOPTIC (0.5%), 124 TIMOPTIC OCUDOSE, 123 TIMOPTIC-XE, 124 TINDAMAX, 18 tinidazole, 17 TIROSINT, 147 TISSEEL, 209 tis-u-sol, 111 tis-u-sol viaflex, 111 TIVICAY, 19 TIZANIDINE COMFORT PAC, 40 tizanidine hcl, 39, 40 tl bpo mx cleanser, 184 TL FOLATE, 218 tl gard rx, 221 TL G-FOL OS, 218 tl hydroquinone, 196 tl icon, 44 tl nicotinamide, 221 TL TRISEB, 201 tl urea, 201 TL-ASSURE ONE, 218 TL-ASSURE+DHA, 218 TL-CARE DHA, 218 286 TL-CERMIDE, 205 tl-dex dm, 172 tl-dmx, 176 TL-FLUORIVITE, 218 tl-fol 500, 44 tl-hem 150, 44 tl-hist cd, 172 tl-hist cm, 162 tl-hist dm, 172 tl-hist pd, 28 TL-ICARE, 109 TL-SELECT, 218 TL-SELECT DHA, 218 TN DICKINSONS WITCH HAZEL, 195 tn dickinsons witch hazel cleansing pads, 197 tn dickinsons witch hazelhemorrhoidal, 197 TNKASE, 50 TOBI, 10 TOBI PODHALER, 10 TOBRADEX, 122 TOBRADEX ST, 122 tobramycin, 11, 14, 119, 121 tobramycin sulfate, 14, 119 TOBRAMYCIN SULFATE ADD-VANTAGE, 14 TOBRAMYCIN SULFATE/SODIUM CHLORIDE, 14 tobramycin/dexamethasone, 121 tobrasol, 119 TOBREX, 120 TOFRANIL, 85 TOFRANIL-PM, 85 tolazamide (250mg), 136 TOLAZAMIDE (500MG), 137 TOLBUTAMIDE, 137 tolmetin sodium, 64 TOLMETIN SODIUM, 65 tolterodine tartrate, 209 tolterodine tartrate er, 209 tolu-sed dm, 172 TOPAMAX, 76 TOPAMAX SPRINKLE, 76 topex topical anesthetic, 194 TOPICORT, 192 topiragen, 75 topiramate, 75 TOPIRAMATE ER, 77 topisulf, 199 toposar, 35 topotecan hcl, 35 TOPOTECAN HCL, 35 TOPROL XL, 53 TORISEL, 35 torsemide, 109 TORSEMIDE, 110 TOTECT, 160 TOVIAZ, 210 Toxoids, 178 TOZAL, 109 tpn electrolytes, 118 tpn electrolytes ii, 118 TRACE ELEMENTS 4/PEDIATRIC, 118 TRACE METALS ADDITIVE FTV, 118 TRACLEER, 177 TRADJENTA, 137 tramadol hcl, 64, 72 TRAMADOL HCL ER, 72 tramadol hcl er (100mg), 64, 72 tramadol hcl er (200mg), 64, 72 tramadol hcl er (300mg), 64, 72 tramadol hydrochloride/acetaminophen, 64 TRANDATE, 53 trandolapril, 54, 58 trandolapril/verapamil hcl, 54 tranexamic acid, 47, 48 TRANSCYTE, 159 TRANSDERMAL PAIN BASE, 161 TRANSDERM-SCOP, 128 TRANS-PEN, 161 TRANXENE T, 80 tranylcypromine sulfate, 83 TRANZGEL, 159 TRASYLOL, 48 TRAUMANIL, 159 TRAUMEEL, 159 TRAVASOL, 108 TRAVATAN Z, 124 TRAVOPROST, 124 TRAZAMINE, 86 trazodone hcl, 83 TREAGAN OTIC, 126 TREANDA, 35 TRECATOR, 17 TRELSTAR DEPOT, 35 TRELSTAR DEPOT MIXJECT, 35 TRELSTAR LA, 35 TRELSTAR LA MIXJECT, 35 TRELSTAR MIXJECT, 35 TRENTAL, 51 TREPADICLOFEN-25, 72 TREPADONE, 109 TREPOXEN-250, 72 TREPOXICAM-7.5, 72 tretinoin, 31, 195 TRETINOIN EMOLLIENT, 196 tretinoin microsphere, 195 tretinoin microsphere pump, 195 TRETIN-X, 195 TRETTEN, 48 TREXALL, 30 trexbrom, 172 TREXBROM, 172 TREXIMET, 78 TREZIX, 65 TRI RX, 218 triacting night time cold & cough childrens, 28 triacting nighttime cold&cough childrens, 28 TRIADVANCE, 218 triamcinolone acetonide, 121, 134, 191 triamcinolone acetonide (0.025%), 191 triamcinolone acetonide (0.1%), 191 TRIAMCINOLONE ACETONIDE (0.5%), 192 TRIAMCINOLONE ACETONIDE IN ABSORBASE, 192 triamcinolone in orabase, 191 287 TRIAMINIC CHEST & NASAL CONGESTION, 176 TRIAMINIC COLD & ALLERGY CHILDRENS, 28 TRIAMINIC COLD & COUGH DAY/NIGHT CHILDRENS, 172 TRIAMINIC COLD & COUGH NIGHT TIME CHILDRENS, 28 TRIAMINIC COLD/COUGH NIGHTTIME, 28 TRIAMINIC COUGH & RUNNY NOSE CHILDRENS, 172 TRIAMINIC NIGHT TIME COLD & COUGH, 28 TRIAMINIC-D, 172 triamterene/hydrochlorothiazide, 109 TRIANEX, 192 TRIAZ, 187, 189 TRIAZ CLEANSER, 187 TRIAZ FOAMING CLOTHS, 189 triazolam, 79 TRIBENZOR, 55 TRICARE, 212, 218 TRICARE DHA 301, 218 TRICARE PRENATAL COMPLEAT, 218 TRICARE PRENATAL DHA ONE, 218 TRI-CHLOR, 155 TRICITRASOL, 48 TRICITRATES, 105 TRICODE AR, 163 TRICODE GF, 172 tricon, 44 TRICOR, 52 triderm, 191 tri-dex pe, 172 TRIESENCE, 122 tri-estarylla, 141 trifluoperazine hcl, 83 trifluridine, 119 trigels-f forte, 44 TRIGLIDE, 52 trigofen, 28, 172 trigofen dm, 172 trihexyphenidyl hcl, 78 TRIHIBIT, 179 tri-legest fe, 141 TRILEPTAL, 76 tri-linyah, 141 TRILIPIX, 52 TRI-LUMA, 196 trilyte, 130 TRIMESIS RX, 218 trimethobenzamide hcl, 128 trimethoprim, 21, 119 trimethoprim sulfate/polymyxin b sulfate, 119 trimipramine maleate, 83 TRIMO-SAN, 189 trimox, 9 TRINATAL GT, 218 TRINATAL RX 1, 218 TRINATAL ULTRA, 218 TRINATE, 218 trinessa, 141 TRI-NORINYL 28, 142 TRIOSTAT, 147 triotann pediatric, 28 triotann-s pediatric, 28 TRIOXIN, 126 TRIPEDIA, 179 TRIPHLUORIVIT, 218 triphrocaps, 211 TRIPLE DYE, 184 triple-vitamin/fluoride, 211 tri-previfem, 141 TRISENOX, 35 TRISPEC DEX, 176 TRISPEC DMX PEDIATRIC, 172 tri-sprintec, 141 TRI-TABS DHA, 218 TRITUSS, 172 TRIUMEQ, 19 TRIVEEN-CF NAC, 223 TRIVEEN-DUO DHA, 218 TRIVEEN-ONE, 218 TRIVEEN-PRX RNF, 219 TRIVEEN-TEN, 219 TRIVEEN-U, 219 TRI-VI-FLOR, 218 TRI-VI-FLORO, 218 tri-vit/fluoride, 211 TRI-VIT/FLUORIDE/IRON, 218 tri-vitamin/fluoride, 211 tri-vitamin/iron/fluoride, 211 trivora-28, 141 TRI-ZEL, 218 TRIZIVIR, 19 TROKENDI XR, 77 tropazone, 209 TROPAZONE, 197 TROPHAMINE, 108 tropicamide, 126 trospium chloride, 209 trospium chloride er, 209 TRULICITY, 138 TRUSOPT, 124 TRUST NATAL DHA, 219 TRUVADA, 19 TRUZONE PEAK FLOW METER, 93 trymine cg, 163 TRYPTOPHAN, 80 tucks medicated, 197 tucks medicated cooling, 197 tucks take alongs, 198 TUDORZA PRESSAIR, 37 TURKEL PARACENTESIS PROCEDURE TRAY/8FRENCH, 149 TURPENTINE SPIRITS, 198 TUSDEC-DM, 172 tusicof, 172 TUSICOF, 172 TUSNEL, 172, 174, 176 tusnel c, 172 tusnel diabetic, 172 TUSNEL PED-C, 172 TUSNEL PEDIATRIC, 172, 176 TUSNEL-DM PEDIATRIC, 172 tussafed, 172 tussafed ex, 172 tussafex ex, 172 TUSSAFEX-A, 172 288 TUSSI PRES-B, 176 TUSSI-12, 172 TUSSI-12 S, 172 TUSSI-12D, 172 TUSSI-12D S, 172 TUSSICAPS, 163 tussigon, 162 tussin, 173, 176 tussin cf cough & cold, 173 tussin cf cough & cold adults, 173 tussin chest congestion, 176 tussin cough dm, 173 tussin dm, 173 tussin dm max, 173 TUSSIONEX PENNKINETIC EXTENDED RELEASE, 163 tussi-pres, 172 tussi-pres b, 172 TUSSIREX, 173 tussizone-12 rf, 173 tusslin, 173 tusslin pediatric, 173 TUSSO-C, 163 TUSSO-DMR, 173 TUSSO-ZMR, 173 TUSSO-ZR, 173 tustan 12s, 173 TWINJECT, 41 TWINRIX, 182 TWYNSTA, 55 TYBOST, 159 TYGACIL, 14 TYKERB, 31 TYLENOL ALLERGY COMPLETE, 28 tylenol allergy multi-symptom, 28 TYLENOL ALLERGY MULTI-SYMPTOM DAY/NIGHT, 28 TYLENOL ALLERGY MULTI-SYMPTOM NIGHTTIME, 28 TYLENOL ALLERGY SINUS, 28 TYLENOL CHILDRENS PLUS COLD, 28 TYLENOL CHILDRENS PLUS COLD & ALLERGY, 28 TYLENOL MAX-STR FLU NIGHTTIME, 28 TYLENOL SINUS CONGESTION & PAIN DAY/NIGHT, 28 tylenol sinus congestion & pain nighttime, 28 TYLENOL SINUS CONVENIENCE PACK, 28 TYLENOL SINUS NIGHT TIME, 28 TYLENOL/CODEINE #3, 66 TYLENOL/CODEINE #4, 66 TYLOX, 66 TYPHIM VI, 182 TYSABRI, 154 TYVASO, 177 TYVASO REFILL, 177 TYVASO STARTER, 177 TYZEKA, 19 TYZINE, 127 TYZINE PEDIATRIC NASAL DROPS, 127 U u40, 199 UBICHINON COMPOSITUM, 159 UCERIS, 134 U-CORT, 192 u-kera e, 199 ULESFIA, 187 ULORIC, 150 ULTANE, 82 ULTIMA, 99 ULTIMATE OB DHA, 219 ULTIMATECARE ADVANTAGE, 219 ULTIMATECARE COMBO, 219 ULTIMATECARE ONE, 212 ULTIMATECARE ONE NF, 212 ULTIVA, 68 ULTRA TABS, 219 ULTRA TRAK PRO BLOOD GLUCOSE MONITORING SYSTEM, 99 ULTRABAG/DIANEAL LOW CALCIUM/1.5% DEXTROSE, 112 ULTRABAG/DIANEAL LOW CALCIUM/2.5% DEXTROSE, 112 ULTRABAG/DIANEAL LOW CALCIUM/4.25% DEXTROSE, 112 ULTRABAG/DIANEAL PD-2/1.5% DEXTROSE, 112 ULTRABAG/DIANEAL PD-2/2.5% DEXTROSE, 112 ULTRABAG/DIANEAL PD-2/4.25% DEXTROSE, 112 ULTRACET, 66 ULTRAFOAM, 47 ULTRAM, 66 ULTRAM ER, 66 ULTRAQUIN, 196 ULTRASAL-ER, 201 ULTRATRAK ACTIVE, 99 ULTRATRAK PRO, 99, 104 ULTRATRAK PRO TEST STRIPS, 104 ULTRATRAK ULTIMATE MONITOR, 99 ULTRATRAK ULTIMATE TEST STRIPS, 104 ULTRAVATE, 192 ULTRAVATE PAC, 192 ULTRAVATE X, 192 ULTRESA, 131 UMECTA, 201 umecta mousse, 199 UMECTA NAIL FILM, 201 UMECTA PD, 201 UNASYN, 14 UNASYN ADD-VANTAGE, 14 UNASYN BULK PACK, 14 unifed, 43 UNIRETIC, 59 UNISTRIP1 GENERIC, 104 unithroid, 147 unithroid direct, 147 UNIVASC, 59 UNIVERSAL WATER GEL, 189 univert, 128 ur n-c, 21 URAMAXIN, 201 URAMAXIN GT, 201 URAMAXIN GT KIT, 201 urea, 199, 201 urea (35%), 199 urea (40%), 199 urea (45%), 201 urea (50%), 199 UREA (50%), 201 urea 40% nail film, 199 289 UREA 42% CLOTHS, 201 urea hydrating, 201 urea in zinc undecylenate/lactic acid vehicle, 199 UREA NAIL, 201 urea nail (45%), 199, 201 urea nail (50%), 199 UREA NAIL KIT, 201 urea nail stick, 199 UREA NAILSTICK, 201 urea topical, 199 urea40, 199 urea-c40, 199 URECHOLINE, 38 URELIEF PLUS, 195 URELLE, 21 uretron d/s, 21 URETRON D/S, 21 UREX, 21 URIBEL, 21 URI-CLEANSE RX, 159 URI-CONTROL RX, 159 Uricosuric Agents, 118 URIMAR-T, 21 urin d/s, 21 Urinary Anti‐infectives, 20 URITACT DS, 21 URITACT-EC, 21 UROCIT-K 10, 105 UROCIT-K 15, 105 UROCIT-K 5, 105 UROQID #2, 21 urosex, 221 UROXATRAL, 40 URSO 250, 131 URSO FORTE, 131 ursodiol, 131 uryl, 21 ustell, 21 uta, 21 UTA, 21 uticap, 21 UTOPIC, 201 utrona-c, 21 UVADEX, 196 V Vaccines, 179 VAGIFEM, 144 VAGISIL, 195, 198, 209 VAGISIL FEMININE MOISTURIZER, 209 VAGISIL FEMININE WASH, 209 VAGISIL MAXIMUM STRENGTH, 195 VAGISIL YEAST-CONTROL, 198 valacyclovir hcl, 18 VALCHLOR, 205 VALCYTE, 19 VALERIAN ROOT, 159 VALIUM, 80 valproate sodium, 76 valproic acid, 75 valsartan, 58 valsartan/hydrochlorothiazide, 58 VALSTAR, 35 VALTREX, 19 VALTURNA, 59 VALVED HOLDING CHAMBER, 93 VANCOCIN HCL, 10 vancomycin hcl, 9, 14 VANCOMYCIN HCL, 14 VANCOMYCIN HCL IN DEXTROSE, 14 vandazole, 184 VANDETANIB, 31 VANIQA, 209 VANOS, 192 VANOXIDE HC, 193 VANOXIDE-HC, 192 VANTAS, 35 VAPRISOL, 110 VAQTA, 182 VARITHENA, 60 VARIVAX, 182 VARIZIG, 178 VASCAZEN, 52 VASCEPA, 52 VASCUDERM HYDROGEL WOUND DRESSING, 209 VASCUDERM STASIS KIT, 209 VASCULERA, 109 VASERETIC, 59 Vasoconstrictors, 126 Vasodilating Agents, 60, 177 vasolex, 203 vasopressin, 145 VASOTEC, 59 VAYACOG, 159 VAYARIN, 160 VAYAROL, 160 VAZCULEP, 42 VAZOBID, 28 vazobid-pd, 28 VAZOL, 28 VAZOL-D, 28 vazotab, 28 VAZOTAN, 173 v-c forte, 211 v-cof, 173 VECAMYL, 57 VECTIBIX, 35 VECTICAL, 205 vecuronium bromide, 40 VELCADE, 35 VELETRI, 177 velivet, 141 VELPHORO, 110 VELTIN, 205 VEMAVITE-PRX 2, 219 VENA-BAL DHA, 219 VENATAL COMPLETE DHA, 219 VENATAL-FA, 212 VENELEX, 205 venlafaxine hcl, 83, 86 venlafaxine hcl er, 83, 86 290 VENLAFAXINE HCL ER, 86 VENOFER, 46 VENOMIL HONEY BEE VENOM, 156 VENOMIL MIXED VESPID VENOM PROTEIN, 156 VENOMIL WASP VENOM PROTEIN, 156 VENOMIL WHITE FACED HORNET PROTEIN, 156 VENOMIL WHITE FACED HORNET VENOM PROTEIN, 156 VENOMIL YELLOW HORNET VENOM PROTEIN, 156 VENOMIL YELLOW JACKET VENOM PROTEIN, 156 VENTAVIS, 177 VENTOLIN HFA, 41 VERAMYST, 122 verapamil hcl, 54, 55 verapamil hcl (120mg), 54 VERAPAMIL HCL (40MG), 54 verapamil hcl (80mg), 54 verapamil hcl er, 54 verapamil hcl sr, 54 VERDESO, 192 verdrocet, 64 VEREGEN, 205 VERELAN, 55 VERELAN PM, 55 VERIPRED 20, 133 VERSACLOZ, 86 VERSAFREE, 161 VERSAPLUS, 161 versiclear, 184 VERTIGOHEEL, 160 VESICARE, 210 vestura, 141 VEXA, 195 VEXOL, 122 VFEND, 16 VFEND IV, 16 VH ESSENTIALS PREBIOTIC VAGINAL SUPPOSITORIES, 209 VH ESSENTIALS VAGINAL MOISTURIZER, 209 v-hist, 28 VIAGRA, 60 VIASPAN -BELZER UW-CSS COLD STORAGE SOLN, 155 VIBATIV, 15 VIBRAMYCIN, 9, 10 vica forte, 211 vicap forte, 211 vic-forte, 211 VICKS 44M PEDIATRIC COUGH/COLD RELIEF, 173 VICKS CASERO, 176 vicks dayquil mucus control dm, 173 VICKS DAYQUIL NATURE FUSION COUGH & CHEST CONGESTION, 173 VICKS FORMULA 44 CUSTOM CCARE CHESTY COUGH, 173 VICKS FORMULA 44E COUGH/CHEST CONGESTION RELIEF, 173 VICKS FORMULA 44E PEDIATRIC COUGH/CHEST CONGESTION RELIEF, 173 VICKS NYQUIL CHILDRENS COLD/COUGH, 173 VICKS NYQUIL SINEX NIGHTTIME SINUS RELIEF, 28 VICKS NYQUIL SINUS, 28 VICKS SINEX DAYQUIL/NYQUIL DAYTIME/NIGHTTIME SINUS RELIEF, 28 vicodin, 72 VICODIN, 72 vicodin es, 72 VICODIN ES, 72 vicodin hp, 72 VICOPROFEN, 66 VICTORY AGM-4000 TEST STRIPS, 104 VICTORY BLOOD GLUCOSE MONITORING SYSTEM, 99 VICTOZA, 137 VICTRELIS, 20 VIDAZA, 35 VIDEX EC, 19 VIDEX PEDIATRIC, 19 VIGAMOX, 120 VIIBRYD, 85 VIMIZIM, 119 VIMOVO, 72 VIMPAT, 75, 76 VINACAL, 219 VINACAL B, 219 VINATE AZ, 219 VINATE AZ EXTRA, 219 VINATE C, 219 VINATE CALCIUM, 219 VINATE CARE, 219 VINATE DHA, 219 VINATE DHA RF, 219 VINATE GT, 219 VINATE IC, 219 VINATE II, 219 VINATE M, 219 VINATE ONE, 219 VINATE PN CARE, 219 VINATE ULTRA, 219 VINBLASTINE SULFATE, 35 vincasar pfs, 35 vincristine sulfate, 35 vinorelbine tartrate, 35 VIOKACE, 131 viorele, 141 VIOS AEROSOL DELIVERY SYSTEM, 93 VIOS LC PLUS AEROSOL DELIVERY SYSTEM, 93 VIOS LC PLUS AEROSOL DELIVERY SYSTEM DELUXE, 93 VIOS LC PLUS AEROSOL DELIVERY SYSTEM PEDIATRIC, 93 VIOS LC SPRINT AEROSOL DELIVERY SYSTEM, 93 VIOS LC SPRINT AEROSOL DELIVERY SYSTEM PEDIATRIC, 93 VIOS LC SPRINT DELUXE AEROSOL DELIVERY SYSTEM, 93 VIRACEPT, 19 VIRAMUNE, 19 VIRAMUNE XR (100MG), 19 VIRAMUNE XR (400MG), 19 VIRASAL, 201 VIRAVAN-P, 28, 173 VIRAVAN-PDM, 173 VIRAZOLE, 19 virdec, 28, 173 virdec dm, 173 VIREAD, 19 VIRILEX, 109 VIROPTIC, 120 VIRT NATE, 219 VIRT-ADVANCE, 219 VIRT-BAL DHA, 219 291 VIRT-BAL DHA PLUS, 219 VIRT-C DHA, 219 virt-caps, 211 VIRT-CARE ONE, 212 virti-sulf, 199 virt-phos 250 neutral, 112 VIRT-PN, 219 VIRT-PN DHA, 219 VIRT-PN PLUS, 219 VIRTPREX, 219 VIRT-SELECT, 219 virt-vite, 211, 221, 223 virt-vite forte, 223 VIRT-VITE GT, 219 virt-vite plus, 211 VISCOAT, 125 VISICOL, 131 VISIONBLUE, 104 VISTARIL, 80 VISTIDE, 20 VISUDYNE, 125 vita s forte, 211 vitacel, 212 VITACIRC-B, 223 VITAFOL, 46, 219, 220 VITAFOL ULTRA, 219 VITAFOL-NANO, 219 VITAFOL-OB, 219, 220 VITAFOL-OB+DHA, 220 VITAFOL-ONE, 220 VITAFOL-PLUS, 220 VITAFOL-PN, 220 VITAJECT, 220 VITAL-D RX, 220 vitamax pediatric, 212 VITAMEDMD ONE RX/QUATREFOLIC, 220 VITAMEDMD PLUS RX/QUATRE FOLIC, 220 VITAMEDMD REDICHEW RX, 220 VITAMEDMD REDICHEW RX/QUATREFOLIC, 220 vita-min, 211 Vitamin A, 221 Vitamin B Complex, 221 vitamin b-complex 100, 222 Vitamin C, 223 vitamin c 222mg, 223 vitamin d, 224 Vitamin D, 224 Vitamin E, 224 Vitamin K Activity, 224 vitamin k1, 224 VITAMIN K1, 224 Vitamins, 210 vitamins a/c/d/fluoride, 212 VITA-NATAL, 219 VITAPEARL, 220 VITA-PREN, 219 VITA-RESPA, 223 VITAROCA PLUS, 220 VITASPIRE, 220 vitazol, 184 VITRASE, 118 VITRASERT, 120 VITUZ, 173 VIVA CT PRENATAL, 220 VIVA DHA, 220 VIVACTIL, 85 VIVAGLOBIN, 177 VIVELLE-DOT, 144 VIVITROL, 82 VIVOTIF BERNA, 182 VIXONE DISPOSABLE NEBULIZER, 93 V-NATAL, 219 V-NATAL DHA, 219 VOCAL POINT BLOOD GLUCOSE MONITORING SYSTEM, 100 VOCAL POINT BLOOD GLUCOSE TEST STRIPS, 104 VOCAL POINT BLOOD GLUCOSETEST STRIPS, 104 VOGELXO, 135 VOGELXO PUMP, 135 vol-care rx, 212 VOL-NATE, 220 VOL-PLUS, 212 VOL-TAB RX, 220 VOLTAREN, 66, 122, 205 VOLTAREN-XR, 66 VOLUVEN, 118 VOPAC, 209 VOPAC GB, 209 VOPAC KT, 209 VORAXAZE, 150 voriconazole, 16 VORTEX HOLDING CHAMBER/MASK/ADULT, 93 VORTEX HOLDING CHAMBER/MASK/CHILDS, 93 VORTEX HOLDING CHAMBER/MASK/CHILDS/FROG, 93 VORTEX HOLDING CHAMBER/MASK/TODDLER, 93 VORTEX HOLDING CHAMBER/MASK/TODDLER/LADY BUG, 93 VORTEX VALVED HOLDING CHAMBER, 93 VOSOL, 122, 124 VOSOL HC, 122 VOSPIRE ER, 41 VOTRIENT, 31 VP CH ULTRA, 220 VP-CH PLUS, 220 VP-CH-PNV, 220 VP-ERA OB PLUS, 220 VP-GGR-B6 PRENATAL, 220 VP-GSTN, 160 VP-HEME OB, 220 VP-HEME OB + DHA, 220 VP-HEME ONE, 220 VP-PNV-DHA, 220 vp-precip, 160 VPRIV, 119 VP-ZEL, 220 VSL#3 DS, 127 VUMON, 35 VUSION, 187 vyfemla, 141 VYTONE, 187 VYTORIN, 51 VYVANSE, 74 292 W warfarin sodium, 48 WASP VENOM PROTEIN, 156 WASP VENOM PROTEIN TREATMENT KIT, 156 WATCHHALER, 93 WAVESENSE AMP, 100 WAVESENSE KEYNOTE, 100 WAVESENSE KEYNOTE PRO METER, 100 WAVESENSE PRESTO TEST STRIPS, 104 WELCHOL, 51 WELLBUTRIN, 85 WELLBUTRIN SR, 85 WELLBUTRIN XL, 85 wera, 141 WESTCORT, 192 WESTHROID, 147 WESTHROID-P, 147 WHEAT GERM, 224 WHEAT GERM OIL, 224 WHEY PROTEIN DRINK MIX, 109 WHITE FACED HORNET VENOM PROTEIN MDV, 156 WHITE FACED HORNET VENOM PROTEIN TREATMENT KIT, 156 WHITE PETROLATUM, 198 WHITE-FACED HORNET VENOM, 156 WIDE-SEAL SILICONE DIAPHRAGM KIT 60, 87 WIDE-SEAL SILICONE DIAPHRAGM KIT 65, 87 WIDE-SEAL SILICONE DIAPHRAGM KIT 70, 87 WIDE-SEAL SILICONE DIAPHRAGM KIT 75, 87 WIDE-SEAL SILICONE DIAPHRAGM KIT 80, 87 WIDE-SEAL SILICONE DIAPHRAGM KIT 85, 87 WIDE-SEAL SILICONE DIAPHRAGM KIT 90, 87 WIDE-SEAL SILICONE DIAPHRAGM KIT 95, 87 WILATE, 48 WINDMILL TRAINER, 93 WINRHO SDF, 178 WITCH DOCTOR, 198 WITCH HAZEL, 195, 209 womens tylenol, 72 WP THYROID, 147 wymzya fe, 141 X XALATAN, 124 XALKORI, 31 XANAX, 80 XANAX XR, 80 XARELTO (10MG), 49 XARELTO (15MG), 49 XARELTO (20MG), 49 XARELTO STARTER PACK, 49 XARTEMIS XR, 72 XCLAIR, 205 XELJANZ, 153 XELODA, 31 XENADERM, 205 XENAZINE, 81 XENICAL, 131 XEOMIN, 156 XERAC AC, 195 XERESE, 189 XGEVA, 151 XIAFLEX, 119 XIBROM, 122 XIFAXAN (200MG), 9 XIFAXAN (550MG), 11 XIGDUO XR, 137 XIGRIS, 160 XODOL, 72 XOFIGO, 161 XOLAIR, 177 XOLEGEL, 187, 189 XOLEGEL COREPAK, 187 XOLEGEL DUO/HEAD & SHOULDERS, 187 XOLEGEL DUO/XOLEX, 187 XOLOX, 72 XOPENEX, 41 XOPENEX CONCENTRATE, 41 XOPENEX HFA, 41 xpect, 176 xpect-pe, 176 X-SEB T PEARL, 202 X-SEB T PLUS, 202 XTANDI, 31 xulane, 141 x-viate, 199 XYLAREX, 160 XYLOCAINE, 57, 149, 194 xylocaine dental, 149 XYLOCAINE JELLY, 194 XYLOCAINE/EPINEPHRINE, 149 XYLOCAINE-MPF, 149 XYLOCAINE-MPF/EPINEPHRINE, 149 xylon, 72 XYNTHA, 48 XYNTHA SOLOFUSE, 48 XYREM, 81 XYZAL, 29 Y YASMIN 28, 142 YAZ, 143 y-cof-dmx, 173 YELLOW HORNET VENOM PROTEIN, 156 YELLOW HORNET VENOM PROTEIN MDV, 156 YELLOW HORNET VENOM PROTEIN TREATMENT KIT, 156 YELLOW JACKET VENOM PROTEIN, 156 YELLOW JACKET VENOM PROTEIN KIT, 156 YELLOW JACKET VENOM PROTEIN MDV, 156 YELLOW PETROLATUM, 198 YERVOY, 35 YF-VAX, 182 yodefan-nf chest congestion, 176 YODOXIN, 17 yohimbine hcl, 160 Z ZACARE 4% KIT, 187 ZACARE 8% KIT, 187 293 zaclir cleansing (4%), 184 ZACLIR CLEANSING (8%), 187 zafirlukast, 162 zaleplon, 79 ZALTRAP, 36 zamicet, 64 ZANAFLEX, 39 ZANOSAR, 35 ZANTAC, 129, 130 zarah, 141 ZARONTIN, 76 ZAROXOLYN, 110 ZATEAN-CH, 220 ZATEAN-PN, 220 ZATEAN-PN DHA, 220 ZATEAN-PN PLUS, 220 ZAVESCA, 155 zazole, 187 z-cof 12dm, 173 Z-COF 8DM, 173 Z-COF DM, 173 Z-COF DMX, 173 Z-COF I, 173 z-dex, 173 Z-DEX, 173 z-dex 12d, 173 ZEBETA, 53 zebutal, 64 ZEEL, 160 ZEGERID, 130 ZELAPAR, 78 ZELBORAF, 31 ZEMAIRA, 177 zema-pak 10 day, 133 zema-pak 13 day, 133 zema-pak 6 day, 133 ZEMPLAR, 224 ZEMURON, 40 zenatane, 205 zenchent, 141 zenchent fe, 141 zencia, 199 ZENIEVA, 198 ZENIEVA/PURE CLEANSER, 198 ZENPEP, 131 zenzedi (10mg), 73 ZENZEDI (15MG), 74 ZENZEDI (2.5MG), 74 ZENZEDI (20MG), 74 ZENZEDI (30MG), 74 zenzedi (5mg), 73 ZENZEDI (7.5MG), 74 zeosa, 141 zephrex-d, 43 ZERIT, 19 zerlor, 67 ZESTORETIC, 59 ZESTRIL, 59 ZETIA, 52 ZETONNA, 122 ZEVALIN IN-111, 35 ZEVALIN Y-90, 35 zflex, 28 ZGESIC, 22 ZIAC, 53 ZIAGEN, 19 ZIAGEN (300MG), 19 ZIANA, 205 zidovudine, 18 ZIKS ARTHRITIS PAIN RELIEF, 198 ZINACEF, 14 ZINACEF IN ISO-OSMOTIC DEXTROSE, 14 ZINACEF IN ISO-OSMOTIC DILUENT, 14 ZINC GLUCONATE, 118 zinc sulfate, 112 ZINC SULFATE, 118 ZINC TRACE METAL, 118 zincate, 112 ZINECARD, 160 ZINGIBER, 220 ZINOTIC, 126 ZINOTIC ES, 126 ZIOPTAN, 124 ziox, 209 ziprasidone hcl, 84 ZIPSOR, 72 ZIRGAN, 120 ZITHRANOL, 205 ZITHRANOL-RR, 205 ZITHROMAX, 10, 14 ZITHROMAX TRI-PAK, 10 ZITHROMAX Z-PAK, 10 ZMAX, 10 ZOCOR, 52 zoden dm, 173 ZODEN PD, 29 ZODERM, 189 ZODERM CLEANSER, 189 ZODRYL AC 25, 173 ZODRYL AC 30, 173 ZODRYL AC 35, 173 ZODRYL AC 40, 173 ZODRYL AC 50, 173 ZODRYL AC 60, 173 ZODRYL AC 80, 174 ZODRYL DAC 25, 174 ZODRYL DAC 30, 174 ZODRYL DAC 35, 174 ZODRYL DAC 40, 174 ZODRYL DAC 50, 174 ZODRYL DAC 60, 174 ZODRYL DAC 80, 174 ZODRYL DEC 25, 174 ZODRYL DEC 30, 174 ZODRYL DEC 35, 174 ZODRYL DEC 40, 174 ZODRYL DEC 50, 174 ZODRYL DEC 60, 174 ZODRYL DEC 80, 174 ZOFRAN, 128 ZOFRAN ODT, 128 ZOHYDRO ER, 67 294 ZOLADEX, 35 zoledronic acid, 151 ZOLEDRONIC ACID, 151 ZOLINZA, 31 zolmitriptan, 77 zolmitriptan odt, 77 ZOLOFT, 85 zolpidem tartrate, 79, 80 zolpidem tartrate er, 80 ZOLPIMIST, 81 ZOLVIT, 72 ZOMETA, 151 ZOMIG, 78 ZOMIG NASAL SPRAY, 78 ZOMIG ZMT, 78 ZONALON, 194 ZONATUSS, 174 ZONEGRAN, 76 zonisamide, 75 ZONTIVITY, 50 ZORBTIVE, 146 ZORPRIN, 72 ZORTRESS, 154 ZORVOLEX, 73 ZOSTAVAX, 182 ZOSYN, 14 ZOTEX, 29, 174 ZOTEX -GP, 174 ZOTEX PE, 29, 174 ZOTEX PEDIATRIC, 174 zotex-12d, 174 ZOTEX-C, 174 ZOTEX-D, 174 ZOTEX-DM, 174 ZOTEX-EX, 174 ZOTEX-G, 174 zotex-pe, 29 zovia 1/35e, 141 ZOVIA 1/50E, 142 ZOVIRAX, 19, 184, 187 Z-PRAM, 194 ZUBSOLV, 73 ZUPLENZ, 128 ZUTRIPRO, 163 ZYBAN, 85 ZYCLARA, 209 ZYCLARA PUMP, 209 ZYDELIG, 36 ZYDONE, 73 ZYFLO, 162 ZYFLO CR, 162 ZYKADIA, 31 ZYLET, 122 ZYLOPRIM, 150 ZYMAR, 120 ZYMAXID, 120 ZYNCOF, 174 ZYPRAM, 195 ZYPREXA, 85 ZYPREXA RELPREVV, 85 ZYPREXA ZYDIS, 85 ZYRTEC-D ALLERGY/CONGESTION, 29 ZYTIGA, 31 ZYVOX, 11, 14 295
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