Preferred Drug List. Key: [INJ], [inj] Injectable Drug [OTC] Over the Counter Drug Updated September 2015

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1 Anti- Infectives abacavir [sp] ACETIC ACID/OXYQUINOLINE acyclovir acyclovir [inj] adefovir dipivoxil ALBENZA ALINIA amantadine hcl AMBISOME [INJ] amikacin [inj] amoxicillin amoxicillin- clavulanate er amphotericin [inj] ampicillin [inj] ampicillin/sulbactam [inj] APTIVUS [SP] atovaquone atovaquone- proguanil hcl ATRIPLA [INJ] AUGMENTIN MG/5ML AVELOX AVELOX IV [INJ] AVYCAZ AZACTAM- ISO- OSMOTIC DEXTROSE [INJ] azithromycin [inj] azithromycin [sp] aztreonam [inj] bacitracin [inj] BETHKIS BICILLIN C- R [INJ] BICILLIN L- A [INJ] CANCIDAS [INJ] CAPASTAT SULFATE [INJ] CAYSTON [SP] cefaclor cefazolin [inj] cefazolin/dextrose [inj] cefdinir cefepime [inj] cefepime/dextrose [inj] cefotaxime [inj] cefotetan [inj] cefoxitin [inj] cefoxitin/dextrose [inj] cefpodoxime proxetil cefprozil CEFTAZIDIME ceftazidime [inj] ceftibuten ceftriaxone [inj] ceftriaxone/dextrose [inj] cefuroxime axetil cefuroxime sodium cefuroxime sodium [inj] CEFUROXIME SODIUM 75 G [INJ] cephalexin chloramphenicol [inj] chloroquine phosphate cidofovir [inj] CIPRO SUSPENSION ciprofloxacin ciprofloxacin er ciprofloxacin/dextrose [inj] clarithromycin clarithromycin er clindamycin hcl clindamycin palmitate hcl clindamycin phosphate [inj] clindamycin phosphate/dextrose [inj] clotrimazole COARTEM colistimethate [inj] COMPLERA [SP] CRESEMBA CRIXIVAN [SP] CUBICIN [INJ] DALVANCE [INJ] DAPSONE DARAPRIM demeclocycline hcl dicloxacillin sodium didanosine DORIBAX doxycycline hyclate ketoconazole Generic drugs are listed in lower case letters; Example: azithromycin Page 1

2 doxycycline hyclate [inj] doxycycline monohydrate EDURANT EMTRIVA entecavir EPIVIR HBV SOLUTION EPIVIR SOLUTION ERYTHROCIN LACTOBIONATE [INJ] erythromycin erythromycin del- rel erythromycin ethylsuccinate erythromycin stearate erythromycin w/sulfisoxazole ethambutol hcl famciclovir fluconazole, in dextrose, saline flucytosine FORTAZ IN ISO- OSMOTIC DEXTROSE [INJ] foscarnet sodium FUZEON [INJ] ganciclovir gentamicin sulfate [inj] gentamicin sulfate in ns GENTAMICIN SULFATE IN NS 100 MG/0.1l [INJ] griseofulvin griseofulvin ultramicrosize hydroxychloroquine sulfate imipenem- cilastatin [inj] INTELENCE INVANZ [INJ] INVIRASE ISENTRESS isoniazid isoniazid [inj] itraconazole KALETRA kanamycin sulfate [inj] ketoconazole LAMISIL lamivudine lamivudine- zidovudine levofloxacin hemihydrate levofloxacin hemihydrate [inj] levofloxacin- d5w [inj] LEXIVA mefloquine hcl meropenem [inj] methenamine hippurate methenamine mandelate methylene blue [inj] metronidazole metronidazole [inj] MINOCIN minocycline hcl, er moxifloxacin hcl MYCAMINE [INJ] nafcillin dextrose [inj] nafcillin sodium [inj] NEBUPENT [INJ] neomycin sulfate nevirapine, er nitrofurantoin nitrofurantoin macrocrystal NORVIR NOXAFIL nystatin tablet ocudox ofloxacin tablets OLYSIO ORACEA ORABACTIV [INJ] oxacillin sodium [inj] 1g/50ml oxacillin sodium [inj] paromomycin sulfate penicillin g potassium [inj] penicillin g procaine penicillin g sodium [inj] PENICILLIN GK- ISO- OSM DEXTROSE penicillin v potassium piperacillin- tazobactam [inj] polymyxin b sulfate [inj] PREZISTA PRIFTIN PRIMAQUINE pyrazinamide quinine sulfate RAPIVAB RELENZA Generic drugs are listed in lower case letters; Example: azithromycin Page 2

3 RESCRIPTOR RETROVIR [INJ] REYATAZ ribavirin rifabutin RIFADIN RIFADIN[INJ] rimantadine hcl SELZENTRY SIRTURO SIVEXTRO [INJ] SYLVANT [INJ] SOLODYN 55, 65, 80, 105, 115MG ER SOVALDI SPORANOX stavudine STREPTOMYCIN SULFATE [INJ] STRIBILD STROMECTOL sulfadiazine sulfamethoxazole/trimethoprim sulfamethoxazole/trimethoprim [inj] SUSTIVA SYNERCID [INJ] TEFLARO [INJ] terbinafine TETRACYCLINE TIMENTIN [INJ] tinidazole TIVICAY TOBI PODHALER tobramycin sulfate [inj] trimethoprim TRIUMEQ TRUVADA TYGACIL [INJ] TYZEKA valacyclovir valganciclovir hcl vancomycin hcl [inj] VIBATIV [INJ] VICTRELIS VIDEX VIRACEPT VIREAD voriconazole voriconazole [inj] XIFAXAN ZERBAXA ZIAGEN zidovudine ZOSYN [INJ] ZYVOX ZYVOX [INJ] Antineoplastic & Immunosuppresants ABRAXANE [INJ] [SP] ADCETRIS [INJ] [SP] AFINITOR [SP] AFINITOR DISPERZ [SP] ALIMTA [INJ] ALKERAN amifostine [inj] anastrozole ARRANON [INJ] [SP] ARZERRA [INJ] [SP] AVASTIN [INJ] [SP] azacitidine [inj] [sp] AZASAN azathioprine [sp] azathioprine sodium [inj] [sp] BEXXAR [INJ] bicalutamide BICNU [INJ] bleomycin [inj] BLINCYTO BOSULIF [SP] BUSULFEX [INJ] calcium folinate [inj] CAPRELSA [SP] carboplatin [inj] CEENU CELLCEPT [INJ] [SP] CELLCEPT SUSPENSION [SP] cisplatin [inj] cladribine [inj] CLOLAR [INJ] Generic drugs are listed in lower case letters; Example: azithromycin Page 3

4 cyclophosphamide [inj] cyclophosphamide tablets, capsules cyclosporine [inj] [sp] cyclosporine [sp] amiodarone cyclosporine modified [sp] CYRAMZA cytarabine [inj] dacarbazine [inj] dactinomycin [inj] daunorubicin [inj] DAUNOXOME [INJ] decitabine [inj] [sp] DEPOCYT [INJ] dexrazoxane [inj] DOCEFREZ [INJ] docetaxel [inj] doxorubicin hcl [inj] doxorubicin hcl liposomal [inj] DROXIA ELIGARD ELITEK [INJ] ELSPAR EMCYT epirubicin hcl [inj] ERIVEDGE ETOPOPHOS [INJ] etoposide etoposide [inj] exemestane FARESTON FASLODEX floxuridine [inj] fludarabine phosphate [inj] fluorouracil [inj] flutamide FOLOTYN [INJ] FUSILEV [INJ] GAZYVA [INJ] gemcitabine hcl [inj] GILOTRIF GLEEVEC HALAVEN [INJ] HERCEPTIN [INJ] HEXALEN HYCAMTIN CAPSULES [SP] hydroxyurea IBRANCE ICLUSIG idarubicin hcl [inj] ifosfamide [inj] ifosfamide- mesna IMBRUVICA INLYTA IODOPEN [INJ] irinotecan hcl [inj] ISTODAX [INJ] IXEMPRA JAKAFI JEVTANA [INJ] KADCYLA [INJ] KEPIVANCE [INJ] KEYTRUDA KYPROLIS [INJ] LEMTRADA LENVIMA letrozole leucovorin calcium leucovorin calcium [inj] LEUKERAN leuprolide acetate levoleucovorin calcium lomustine LUPRON DEPOT LUPRON DEPOT 11.25MG LUPRON DEPOT- PED LYNPARZA LYSODREN MARQIBO MATULANE megestrol acetate MEKINIST melphalan hcl [inj] mercaptopurine mesna [inj] MESNEX methotrexate methotrexate [inj] mitomycin [inj] Generic drugs are listed in lower case letters; Example: azithromycin Page 4

5 mitoxantrone [inj] MUSTARGEN [INJ] mycophenolate mofetil mycophenolate acid delayed- release MYLERAN NEXAVAR NILANDRON NULOJIX [INJ] octreotide acetate[inj] ONCASPAR ONTAK [INJ] OPDIVO oxaliplatin paclitaxel [inj] PERJETA [INJ] PHOTOFRIN [INJ] POMALYST PROGRAF PROVENGE [INJ] PURIXAN REVLIMID RITUXAN [INJ] SANDIMMUNE SOLUTION SANDOSTATIN [INJ] SANDOSTATIN LAR DEPOT SIGNIFOR [INJ] SIMULECT [INJ] SOMATULINE DEPOT [INJ] SPRYCEL STIVARGA SUTENT SYNRIBO [INJ] SYLVANT [INJ] TABLOID tacrolimus TAFINLAR tamoxifen citrate TARCEVA TARGRETIN TASIGNA TEMODAR [INJ] temozolomide TENIPOSIDE [INJ] THALOMID thiotepa [inj] topotecan hcl [inj] TORISEL [INJ] TREANDA [INJ] TRELSTAR, DEPOT [INJ], LA tretinoin caps TREXALL TRISENOX [INJ] TYKERB VANTAS VECTIBIX [INJ] VELCADE [INJ] vinblastine sulfate VORAXAZE [INJ] VOTRIENT VUMON [INJ] XALKORI XGEVA [INJ] XOFIGO [INJ] XTANDI YERVOY [INJ] ZALTRAP [INJ] ZANOSAR [INJ] ZELBORAF ZEVALIN ZOLADEX ZOLINZA ZORTRESS ZYDELIG ZYKADIA ZYTIGA Autonomic, Neurology and Psych ABILIFY DISCMELT ABILIFY MAINTENA, ER acetaminophen w/codeine acetaminophen- diphenhydra- alfentanil [inj] alprazolam alprazolam er alprazolam orally disintegrating tablet amitriptyline hcl amitriptyline/chlordiazepoxide amoxapine Generic drugs are listed in lower case letters; Example: azithromycin Page 5

6 amphetamine salt combo, er AMPYRA [SP] AMYTAL [INJ] anectine [inj] APOKYN [INJ] [SP] aripiprazole AZILECT baclofen BANZEL benztropine [inj] benztropine mesylate BRISDELLE buprenorphine [inj] buprenorphine hydrochloride buprenorphine- naloxone bupropion ext- release (12 hour) bupropion hcl bupropion hcl xl er bupropion sr er buspirone hcl butalbital compound butalbital compound w/codeine butalbital- aspirin- caffeine butalbital/apap/caffeine butalbital/caff/apap/codeine butorphanol [inj] butorphanol nasal BUTRANS calcium- folic acid plus d carbamazepine carbamazepine ext- release carbidopa- levodopa er carbidopa- levodopa- entacapone carbidopa/levodopa carbidopa/levodopa orally disintegrating tablets celecoxib CELONTIN chlordiazepoxide hcl chlorpromazine [inj] chlorpromazine hcl chlorzoxazone choline mag trisalicylate citalopram hbr clomipramine hcl clonazepam clonazepam orally disintegrating tablets clonidine [inj] clonidine hcl er clorazepate dipotassium clozapine clozapine odt codeine sulfate COPAXONE [INJ] [SP] cyclobenzaprine hcl dantrolene sodium DAYTRANA desipramine hcl dexmethylphenidate, ERgleo dextroamphetamine sulfate dextroamphetamine sulfate er diazepam diazepam rectal gel diclofenac potassium diclofenac sodium diclofenac sodium- misoprostol delayed release diflunisal dihydroergotamine mesylate DILANTIN DILAUDID- HP 250 MG [INJ] diltiazem [inj] diphenhydramine hcl divalproex sodium divalproex sodium er donepezil hcl doxepin hcl DOXYLAMINE SUCCINATE duloxetine EDROPHONIUM CHLORIDE entacapone ERGOLOID MESYLATES ergotamine- caffeine escitalopram oxalate estrazolam ethosuximide etodolac etodolac er EUFLEXXA EXELON Generic drugs are listed in lower case letters; Example: azithromycin Page 6

7 felbamate fenoprofen calcium fentanyl [inj] fentanyl citrate, [inj], lozenge flumazenil [inj] fluoxetine dr fluoxetine hcl fluphenazine decanoate [inj] fluphenazine hcl flurazepam hcl flurbiprofen fluvoxamine maleate er 24 hr fosphenytoin sodium FYCOMPA gabapentin GABITRIL 12MG, 16MG GABLOFEN [INJ] galantamine GILENYA GRALISE guanidine hcl haloperidol haloperidol [inj] haloperidol decanoate [inj] haloperidol lactate [inj] HYCAMTIN CAPSULES [SP] hydrocodone bit- ibuprofen hydrocodone w/acetaminophen hydromorphone hcl, rectal, [inj] ibuprofen imipramine hcl imipramine pamoate indomethacin indomethacin [inj] indomethacin er INFUMORPH INTUNIV ISOMETHEPTENE MUCATE ketoprofen er ketorolac tromethamine ketorolac tromethamine [inj] lamotrigine lamotrigine er LATUDA levetiracetam, [inj], er levorphanol tartrate LIORESAL [INJ] lithium carbonate tab, er, caps lorazepam lorazepam [inj] loxapine succinate LYRICA maprotiline hcl meclofenamate sodium mefenamic acid meloxicam meperidine hcl [inj] MESTINON MESTINON ER methamphetamine hcl methocarbamol methadone hcl methadone hcl [inj] methylphenidate er methylphenidate hcl midazolam MIRAPEX ER mirtazapine mirtazapine disintegrating tablets modafinil morphine sulfate, [inj], cr, er morphine sulfate tablet MOVANTIK nalbuphine hcl [inj] naloxone hcl [inj] naltrexone hydrochloride nabumetone NAPROSYN naproxen naproxen sodium NAMENDA NAMENDA XR naratriptan hcl NEMBUTAL SODIUM [INJ] NEOPROFEN [INJ] neostigmine methylsulfate [inj] nortriptyline hcl NUCYNTA Generic drugs are listed in lower case letters; Example: azithromycin Page 7

8 NUCYNTA ER NUEDEXTA NUVIGIL OFIRMEV [INJ] olanzapine olanzapine [inj] olanzapine odt olanzapine- fluoxetine hcl ONFI OPANA ER oxaprozin OXTELLAR ER oxycodone hcl oxycodone hcl- ibuprofen oxycodone w/acetaminophen oxycodone w/aspirin OXYCONTIN ER oxymorphone hcl oxymorphone hcl er orphenadrine citrate [inj] orphenadrine citrate er orphenadrine compound ORTHOVISC [INJ] oxazepam oxcarbazepine paroxetine hcl paroxetine hcl er PEGANONE perphenazine perphenazine/amitriptyline phenelzine sulfate phenobarbital phenobarbital sodium [inj] phenytoin phenytoin sodium phenytoin sodium [inj] piroxicam POTIGA pramipexole di- hcl PRIALT [INJ] primidone PRISTIQ ER pyridostigmine bromide QUADRAMET [INJ] quetiapine fumarate QUILLIVANT XR RELPAX RISPERDAL RISPERDAL CONSTA [INJ] RISPERDAL M- TAB DISINTEGRATING rivastigmine rizatriptan rizatriptan disintegrating tablets ROBAXIN [INJ] ropinirole hcl ropinirole hcl er ROZEREM SABRIL SALICYLAMIDE salsalate seconal sodium selegiline hcl SEROQUEL XR SUBOXONE sulindac sumatriptan succinate sumatriptan succinate spray non- aerosol sumatriptan succinate [inj] SUMAVEL DOSEPRO [INJ] SYNVISC [INJ] SYNVISC- ONE [INJ] TALWIN [INJ] TECFIDERA DELAYED RELEASE TEGRETOL XR temazepam thioridazine hcl thiothixene tiagabine hcl tizanidine hcl tolmetin sodium topiramate tramadol hcl TRAMADOL HCL ER tramadol hcl- acetaminophen tranylcypromine sulfate trazodone hcl TREXIMET triazolam Generic drugs are listed in lower case letters; Example: azithromycin Page 8

9 trifluoperazine hcl trihexyphenidyl hcl trimipramine maleate TYSABRI [INJ] ULTIVA [INJ] VALPROATE SODIUM valproate sodium [inj] valproic acid venlafaxine hcl venlafaxine hcl er VIIBRYD VIMPAT [INJ] VIVITROL [INJ] VOLTAREN VYVANSE XENAZINE XYREM zaleplon ziprasidone hcl zolmitriptan zolmitriptan odt zolpidem tartrate zolpidem tartrate er ZOMIG zonisamide ZORVOLEX ZUBSOLV Cardiovascular, Hypertension & Lipids acebutolol hcl ACTIVASE [INJ] adenosine [inj] ADVATE [INJ] [SP] ADVATE H [INJ] [SP] ADVATE L [INJ] [SP] ADVATE N [INJ] [SP] ADVATE SH [INJ] [SP] ADVATE UH [INJ] [SP] AGGRASTAT [INJ] AGGRENOX ER ALPHANATE [INJ] [SP] ALPHANINE SD [INJ] [SP] ALPROLIX amiloride hcl amiloride hcl w/hctz amiodarone hcl amiodarone hcl [inj] amlodipine besylate amlodipine- atorvastatin AMTURNIDE ANGIOMAX [INJ] [SP] ARGATROBAN [INJ] atenolol atenolol w/chlorthalidone atorvastatin calcium ATRYN AZOR BEBULIN [INJ] [SP] BEBULIN VH IMMUNO [INJ] [SP] benazepril hcl benazepril hcl- hctz BENEFIX [INJ] [SP] BENICAR BENICAR HCT betaxolol hcl bisoprolol fumarate bisoprolol fumarate/hctz BRILINTA bumetanide bumetanide [inj] BYSTOLIC candesartan cilexetil candesartan- hydrochlorothiazid captopril captopril/hydrochlorothiazide CATHFLO ACTIVASE [INJ] CEPROTIN [INJ] [SP] chlorothiazide chlorothiazide chlorothiazide sodium [inj] chlorthalidone cholestyramine cholestyramine light cilostazol CLEVIPREX [INJ] clonidine hcl clopidogrel colestipol hcl Generic drugs are listed in lower case letters; Example: azithromycin Page 9

10 COREG CR ER CORIFACT [INJ] [SP] COUMADIN [INJ] CRESTOR DEMSER DIBENZYLINE digoxin DILATRATE- SR EXT- REL diltiazem [inj] diltiazem 24hr cd diltiazem er diltiazem er 24 hour diltiazem hcl dipyridamole [inj] dobutamine [inj] dobutamine/dextrose [inj] dopamine hcl [inj] dopamine hcl in 5% dextrose doxazosin mesylate EDARBI EDARBYCHLOR EDECRIN[INJ] EFFIENT ELIQUIS ELOCTATE [INJ] enalapril maleate enalapril maleate/hctz enalaprilat [inj] enoxaparin sodium eplerenone epoprostenol [inj] EXFORGE EXFORGE HCT FEIBA NF [INJ] felodipine er fenofibrate fenofibrate caps fenofibric acid fenofibric acid delayed release flecainide acetate fluvastatin sodium fondaparinux sodium fosinopril sodium fosinopril/hydrochlorothiazide FRAGMIN furosemide furosemide [inj] gemfibrozil guanfacine hcl HELIXATE FS [INJ] HEMOFIL [INJ] heparin lock flush [inj] heparin sodium in 0.45% nacl [inj] heparin sodium in 5% dextrose [inj] HUMATE- P [INJ] [SP] hydralazine hcl hydrochlorothiazide ibutilide fumarate [inj] indapamide INTEGRILIN [INJ] irbesartan irbesartan/hydrochlorothiazide isosorbide dinitrate isosorbide mononitrate isosorbide mononitrate er isradipine JUXTAPID KOATE- DVI [INJ] labetalol hcl labetalol hcl [inj] LANOXIN PEDIATRIC lidocaine hcl in 7.5% dextrose [inj] LIPOFEN LIPTRUZET lisinopril lisinopril- hctz losartan potassium losartan- hydrochlorothiazide lovastatin LOVAZA mannitol MEPHYTON methyclothiazide methyldopa methyldopa/hydrochlorothiazide methyldopate hcl [inj] metolazone metoprolol succinate er Generic drugs are listed in lower case letters; Example: azithromycin Page 10

11 metoprolol tartrate metoprolol tartrate [inj] metoprolol- hydrochlorothiazide mexiletine hcl milrinone in 5% dextrose milrinone lactate [inj] minoxidil moexipril hcl moexipril/hydrochlorothiazide MONOCLATE- P [INJ] MONONINE MONONINE [INJ] MONOVISC [INJ] nadolol nadolol/bendroflumethiazide NATRECOR [INJ] NEXTERONE niacin er nicardipine hcl nicardipine hcl [inj] nifedipine er nimodipine nitroglycerin nitroglycerin tablets nitroglycerin [inj] nitroglycerin er nitroglycerin in d5w [inj] nitroglycerin spray NITROLINGUAL NITROSTAT norepinephrine bitartrate [inj] NOVOSEVEN [INJ] NPLATE [INJ] OBIZUR papaverine hcl [inj] papaverine hcl er pentoxifylline er perindopril erbumine PHENTOLAMINE MESYLATE [INJ] phenylephrine hcl [inj] PHYTONADIONE pindolol PRADAXA pravastatin sodium prazosin hcl procainamide hcl [inj] PROFILNINE SD [INJ] PROMACTA propafenone hcl propafenone hcl er propranolol hcl propranolol hcl er propranolol hcl- hctz protamine sulfate [inj] quinapril quinapril/hydrochlorothiazide quinidine gluconate [inj] quinidine gluconate er quinidine sulfate quinidine sulfate er ramipril RANEXA RECOMBINATE [INJ] REFLUDAN [INJ] REMODULIN [INJ] REOPRO [INJ] RESECTISOL reserpine RETAVASE RIASTAP SIMCOR ER simvastatin sotalol SOTALOL HCL [INJ] SOTYLIZE spironolactone spironolactone/hydrochlorothiazide TARKA TEKAMLO TEKTURNA TEKTURNA HCT terazosin hcl THROMBATE III [INJ] TIKOSYN timolol maleate torsemide torsemide [inj] trandolapril Generic drugs are listed in lower case letters; Example: azithromycin Page 11

12 TRANEXAMIC ACID tranexamic acid [inj] TRETTEN TRIBENZOR valsartan valsartan/hydrochlorothiazide VASCEPA verapamil er verapamil er pm verapamil hcl [inj] VYTORIN warfarin sodium WELCHOL WILATE XARELTO XYNTHA XYNTHA SOLOFUSE ZETIA ZONTIVITY Dermatological & Topical Therapy ABSORICA acitretin acyclovir ointment ACZONE adapalene alclometasone dipropionate alphaquin hp aluminum chloride 20% topical amcinonide ammonium lactate 12% topical ASCORBICA ANTHRALIN ATRALIN avo cream bacitracin eye ointment bacitracin/polymyxin eye ointment benprox BENZOCAINE benzoyl peroxide betamethasone dipropionate augmented betamethasone valerate bupivacaine hcl bupivacaine/epinephrine [inj] calcipotriene calcitriol CARAC CARBOCAINE 2% [INJ] CHLORHEXIDINE GLUCONATE chloroprocaine [inj] ciclopirox clindamycin phosphate topical clindamycin- benzoyl peroxide clobetasol e clobetasol propionate clotrimazole clotrimazole/betamethasone cocaine hcl topical solution CONDYLOX GEL COSENTYX DENAVIR desonide desoximetasone DEXPANTHENOL diclofenac sodium gel DIFFERIN 0.1% LOTION diflorasone diacetate diflorason diacetate/emollient econazole nitrate eletone ELIDEL emulsion sb EPIDUO erythromycin solution erythromycin- benzoyl peroxide ETHYL ALCOHOL ethyl chloride EURAX FINACEA FINACEA PLUS fluocinolone acetonide cream fluocinolone acetonide ointment fluocinonide fluorouracil fluticasone propionate gentamicin sulfate cream gentamicin sulfate ointment Generic drugs are listed in lower case letters; Example: azithromycin Page 12

13 halobetasol propionate hpr foam hpr plus hydrocortisone hydrocortisone butyrate hydrocortisone butyrate/emoll hydrocortisone acetate/lidocaine hydrocortisone acetate/pramoxine hydrocortisone valerate hydroquinone cream hydroquinone ER imiquimod isotretinoin ketoconazole cream lactic acid lidocaine, hcl, jelly, ointment lidocaine hcl w/epinephrine [inj] lidocaine- prilocaine lindane lustra- ultra mafenide acetate malathion mb hydrogel MEPIVACAINE HCL metronidazole cream MIRVASO mometasone furoate mupirocin NAROPIN [INJ] NESACAINE nuquin hp nystatin ointment nystatin w/triamcinolone ONEXTON OXSORALEN 1% LOTION permethrin podofilox pr cream PRAMOSONE, 1% PRAMOSONE 2.5% LOTION, OINTMENT PRAMOSONE E prednicarbate PROTOPIC pruclair prumyx prutect REGRANEX salicylic acid SANTYL selenium sulfide sensorcaine [inj] silver sulfadiazine sodium sulfacetamide/sulfur sonafine spinosad STELARA [INJ] [SP] sulfacetamide sodium topical sulfacetamide sodium- sulfur SULFAMYLON TACLONEX SUSPENSION TAZORAC tl- cermide TRETIN- X tretinoin cream tretinoin microsphere triamcinolone acetonide 0.1% cream urea VELTIN ZIANA ZOVIRAX CREAM Ear, Nose & Throat acetic acid ear solution acetic acid/aluminum ear solution acetic acid/hydrocortisone ear solution antipyrine w/benzocaine ear solution antipyrine w/benzocaine/poly ear solution ASTEPRO ATROVENT SPRAY azelastine hcl nasal spray chloroxylenol/benzocaine/hc acet ear susp CIPRO CIPRODEX ciprofloxacin hcl FIRST- BXN FIRST- MOUTHWASH BLM hydrocortisone/pramoxine ear solution Generic drugs are listed in lower case letters; Example: azithromycin Page 13

14 hydrocortisone/pramoxine/chloroxylenol ipratropium bromide spray MYALEPT neomycin/polymyxin/hc ofloxacin otic drops oxymetazoline hcl 12 hour sodium fluoride sodium fluoride cream Endocrine/Diabetes 1ST CHOICE LANCETS A- HYDROCORT [INJ] acarbose ACCU- CHEK FASTCLIX, MULTICLIX, SOFTCLIX LANCETS [OTC] ACCU- CHEK SOFTCLIX LANCETS DEVICE [OTC] ACTHAR H.P. [INJ] [SP] ACTHREL [INJ] ACTOPLUS MET XR ALDURAZYME [INJ] [SP] ANDROGEL ARISTOSPAN [INJ] ARMOUR THYROID AXIRON BETAMETHASONE BETAMETHASONE ACETATE betamethasone acetate/betamethasone sodium phosphate [inj] BETAMETHASONE SODIUM PHOSPHATE BRAVELLE [INJ] BYDUREON [INJ] BYDUREON PEN BYETTA [INJ] cabergoline calcitonin salmon nasal calcitriol [inj] CERDELGA [SP] CEREZYME [INJ] [SP] CETROTIDE [INJ] [SP] chorionic gonadotropin [inj] [sp] clomiphene citrate cortisone acetate cosyntropin [INJ] danazol DEPO- MEDROL 20 MG/ML [INJ] desmopressin acetate desmopressin acetate [inj] DEXCOM G4, SENSOR dexamethasone dexamethasone sodium phosphate doxercalciferol ELAPRASE [INJ] ELELYSO [INJ] FABRAZYME [INJ] FEMCAP fludrocortisone acetate FLUOXYMESTERONE FOLLISTIM AQ [INJ] FORA LANCING DEVICE FREESTYLE FREEDOM KIT [OTC] FREESTYLE FREEDOM LITE METER [OTC] FREESTYLE INSULINX GLUCOSE SYSTEM [OTC] FREESTYLE INSULINX TEST STRIPS [OTC] FREESTYLE LITE METER [OTC] FREESTYLE LITE TEST STRIPS [OTC] FREESTYLE TEST STRIPS [OTC] GANIRELIX ACETATE [INJ] glimepiride glipizide glipizide er GLUCAGEN [INJ] GLUCAGON glyburide glyburide micronized glyburide- metformin hcl HUMALOG [INJ] HUMULIN [INJ] [OTC] HUMULIN R 500 UNITS [INJ] hyoscyamine/phenyltoloxamine INVOKANA INVOKAMET JANUMET JANUMET XR JANUVIA JENTADUETO JUVISYNC KENALOG [INJ] Generic drugs are listed in lower case letters; Example: azithromycin Page 14

15 KOMBIGLYZE XR KUVAN LANTUS [INJ] LANTUS SOLOSTAR [INJ] LEVEMIR [INJ] LEVOTHROID levothyroxine sodium levothyroxine sodium [inj] liothyronine [inj] liothyronine tablet LUMIZYME [INJ] MEDROL MENOPUR [INJ] metformin hcl metformin hcl er methimazole METHITEST methylprednisolone methylprednisolone acetate [inj] methylprednisolone sod succ [inj] MIACALCIN [INJ] MINIMED MINIMED RESERVOIR MYOZYME [INJ] NAGLAZYME [INJ] nateglinide [INJ] NOVOFINE NOVOFINE AUTOCOVER NOVOLOG [INJ] NOVOLOG FLEXPEN NOVOLOG MIX ONE TOUCH ULTRA 2 ONE TOUCH ULTRA SMART ONE TOUCH ULTRA SYSTEM ONE TOUCH ULTRA TEST STRIPS ONE TOUCH ULTRAMINI ONE TOUCH VERIO ONE TOUCH VERIO IQ ONE TOUCH VERIO SYNC ONGLYZA OPTIUM OPTIUM EZ ORTHO- DIAPHRAGM oxandrolone pamidronate disodium [inj] PARADIGM INFUSION PARADIGM INSULIN PUMP PARADIGM SILHOUETTE paricalcitol pioglitazone hcl pioglitazone- glimepiride pioglitazone- metformin POLYFIN QR PRANDIMET PRECISION PCX, PCX PLUS, POINT OF CARE,Q- I- D PRECISION XTRA B- KETONE STRIPS [OTC] PRECISION XTRA MONITOR [OTC] PRECISION XTRA TEST STRIPS [OTC] prednisolone prednisolone sodium phosphate [inj] prednisone PRODIGY INSULIN SYRINGE PRODIGY PEN NEEDLE PROGLYCEM propylthiouracil QUICK RELEASE SOFT TEFLON repaglinide RIOMET SAMSCA SENSIPAR SILHOUETTE SILHOUETTE [INJ] SOF- SET SOF- SET MICRO SOFT TOUCH SOLOSITE SOLU- CORTEF [INJ] SOLU- MEDROL [INJ] SOMAVERT [INJ] STIMATE SPRAY SURE- T PARADIGM SYMLINPEN 60 [INJ] SYNAREL testosterone cypionate [inj] testosterone enanthate [inj] THYROID tolazamide tolbutamide Generic drugs are listed in lower case letters; Example: azithromycin Page 15

16 TRADJENTA vasopressin [inj] veripred 20 VGO 20 VGO 30 VGO 40 VICTOZA [INJ] VIMIZIM [INJ] [SP] VPRIV [INJ] XIGDUO XR ZAVESCA ZEMPLAR [INJ] ZOLEDRONIC ACID [INJ] ZOMETA [INJ] Gastroenterology AKYNZEO ALOXI [INJ] AMITIZA ANALPRAM ADVANCED CREAM KIT ANALPRAM 2.5% LOTION ANALPRAM- HC 1% CREAM SINGLES ASACOL HD balsalazide disodium budesonide ec CANASA carafate CHENODAL [SP] cimetidine CITRA PH CORTIFOAM CREON cromolyn sodium oral solution CYSTADANE [SP] DELZICOL DEL- REL dicyclomine hcl dimenhydrinate [inj] diphenoxylate w/atropine dronabinol droperidol [inj] EMEND [INJ] ENTYVIO ENTYVIO [INJ] famotidine famotidine [inj] glycopyrrolate glycopyrrolate [inj] granisetron hcl granisetron hcl [inj] GRANISOL hydrocortisone hydrocortisone acetate hyoscyamine sulfate, odt, er KINEVAC [INJ] lactulose lansoprazol- amoxicil- clarithromycin lansoprazole delayed release LEVSIN LIALDA LINZESS loperamide hcl LOTRONEX meclizine hcl mesalamine metoclopramide hcl metoclopramide hcl [inj] misoprostol MOVIPREP NEXIUM NEXIUM [INJ] nizatidine omeprazole delayed release OMEPRAZOLE- SODIUM BICARBONATE ondansetron hcl ondansetron hcl [inj] ondansetron hcl in dextrose [inj] ondansetron in sodium chloride[inj] ondansetron odt opium pancrelipase pantoprazole sodium paregoric peg electrolyte PENTASA phenobarb/hyoscyamine/atropine/scoplamine polyethylene glycol prochlorperazine edisylate [inj] Generic drugs are listed in lower case letters; Example: azithromycin Page 16

17 prochlorperazine maleate PROCTOFOAM- HC ranitidine ranitidine hcl [inj] RECTIV RELISTOR [INJ] REMICADE [INJ] SANCUSO SCOPOLAMINE HYDROBROMIDE sodium bicarbonate sodium chloride/sodium bicarb SUCLEAR SUCRAID sucralfate sulfasalazine sulfasalazine dr SUPREP TRANSDERM- SCOP trimethobenzamide hcl trimethobenzamide hcl [inj] UCERIS ursodiol VIOKACE ZANTAC RX ZENPEP DEL- REL Immunology, Vaccines & Biotechnology ACTHIB [INJ] ACTIMMUNE [INJ] [SP] ADACEL [INJ] AFLURIA [INJ] ALFERON N [INJ] APLISOL [INJ] ARANESP [INJ] [SP] ARCALYST [INJ] [SP] ATGAM [INJ] AVONEX [INJ] [SP] BETASERON BEXSERO BIOTHRAX [INJ] BOOSTRIX [INJ] BOTOX [INJ] [SP] candin CERVARIX [INJ] COMVAX [INJ] CROFAB [INJ] CYTOGAM [INJ] [SP] EGRIFTA [INJ] [SP] ENGERIX- B [INJ] FLUARIX [INJ] FLULAVAL [INJ] FLULAVAL QUAD [INJ] FLUVIRIN [INJ] FLUZONE [INJ] FLUZONE INTRADERM QUAD [INJ] fomepizole GAMASTAN S- D [INJ] GAMMAGARD LIQUID [INJ] GAMMAGARD S- D [INJ] GAMUNEX [INJ] GAMUNEX- C [INJ] GARDASIL, 9 [INJ] GENOTROPIN [INJ] [SP] GRASTEK HAVRIX HEPAGAM B [INJ] HIZENTRA [INJ] HUMATROPE [INJ] [SP] HYPERHEP B S- D [INJ] HYPERRAB S- D [INJ] HYPERRHO S- D HYPERTET S- D ILARIS [INJ] IMOGAM RABIES- HT [INJ] IMOVAX RABIES VACCINE [INJ] INFANRIX [INJ] INFERGEN [INJ] [SP] INTRON A [INJ] [SP] IPOL [INJ] IXIARO LEUKINE [INJ] M- M- R II VACCINE W/DILUENT [INJ] MENACTRA [INJ] MENOMUNE- A- C- Y- W- 135 [INJ] MOZOBIL [INJ] MYOBLOC [INJ] OMNITROPE [INJ] [SP] Generic drugs are listed in lower case letters; Example: azithromycin Page 17

18 NEULASTA [INJ] NEUMEGA [INJ] NEUPOGEN [INJ] NORDITROPIN [INJ] [SP] PEDIARIX [INJ] PEDVAXHIB [INJ] PEGASYS [INJ] [SP] PEGASYS PROCLICK [INJ] [SP] PLEGRIDY [SP] PNEUMOVAX 23 [INJ] PREVNAR 13 PRIVIGEN [INJ] PROCRIT [INJ] PROLEUKIN [INJ] PROQUAD [INJ] RABAVERT RAGWITEK REBIF [INJ] [SP] REBIF REBIDOSE [INJ] [SP] RECOMBIVAX HB ROTATEQ SEROSTIM [INJ] [SP] SYLATRON [INJ] [SP] TETANUS DIPHTHERIA TOXOIDS [INJ] tetanus toxoid THERACYS [INJ] THYMOGLOBULIN [INJ] TICE BCG [INJ] TRUMENBA TUBERSOL [INJ] TWINRIX [INJ] TYPHIM VI [INJ] VAQTA VARIVAX VACCINE [INJ] VARIZIG [INJ] VIVOTIF BERNA DEL- REL YF- VAX [INJ] Musculoskeletal & Rheumatology ACTEMRA [INJ] [SP] alendronate sodium allopurinol ATELVIA BENLYSTA [INJ] [SP] colchicine COLCRYS CUPRIMINE dihydrocodeine/aspirin/caffeine ENBREL [INJ] [SP] FORTEO [INJ] [SP] HUMIRA [INJ] [SP] ibandronate sodium IBANDRONATE [INJ] KRYSTEXXA [INJ] [SP] leflunomide ORENCIA [INJ] [SP] naproxen delayed release probenecid RIDAURA risedronate risedronate sodium SAVELLA ULORIC Obstetrics & Gynecology altavera alyacen amethia amethia lo amethyst apri aranelle aubra [inj] aviane azurette balziva BEYAZ briellyn caldolor [inj] camrese camrese lo caziant CENESTIN chateal clindamycin phosphate vaginal COMBIPATCH Generic drugs are listed in lower case letters; Example: azithromycin Page 18

19 CRINONE cryselle cyclafem dasetta daysee DEPO- ESTRADIOL [INJ] DEPO- PROVERA 400 MG/ML [INJ] DIVIGEL DUAVEE elinest emoquette ENDOMETRIN ENJUVIA enpresse enskyce ERGONOVINE MALEATE errin estarylla ESTRACE CREAM ESTRACE TABLET estradiol estradiol patch estradiol valerate [inj] estradiol- norethindrone acetate ESTRING estrogen & methyltestosterone estropipate EVAMIST falmina gianvi gildagia gildess gildess fe heather HEMABATE [INJ] IMPLANON introvale isoxsuprine hcl jencycla jolessa jolivette junel junel fe kariva kelnor 1-35 kurvelo leena lessina levonorgestrel levora LO LOESTRIN FE LO MINASTRIN FE loryna low- ogestrel lutera lyza MAKENA [INJ] marlissa medroxyprogesterone acetate [inj] methylergonovine maleate METHYLERGONOVINE MALEATE [INJ] Metronidazole gel MICONAZOLE 1 microgestin microgestin fe MINIVELLE MIRENA mono- linyah mononessa myzilra NATAZIA necon NEXPLANON nora- be norethindrone acetate norethindrone/ethinyl estradiol norethindrone/ethinyl estradiol- iron NUVARING ocella ogestrel orsythia oxytocin [inj] philith pirmella portia PREMARIN PREMARIN [INJ] PREMPHASE Generic drugs are listed in lower case letters; Example: azithromycin Page 19

20 PREMPRO progesterone quasense reclipsen SAFYRAL sprintec sronyx syeda terconazole tilia fe tri- estarylla tri- legest fe tri- linyah trinessa trivora VAGIFEM velivet vestura viorele VIVELLE PATCH wera wymzya fe zarah zenchent zenchent fe zeosa zovia Ophthalmology acetazolamide, er, [inj] ALPHAGAN P 0.1% ALREX apraclonidine eye solution atropine sulfate eye solution atropine sulfate eye ointment azelastine hcl eye solution balanced salt eye irrigation BEPREVE BESIVANCE betaxolol eye solution BETOPTIC S brimonidine eye solution bromfenac eye solution carbachol [INJ] carteolol hcl ciprofloxacin eye solution COMBIGAN cromolyn sodium eye solution cyclopentolate eye solution CYSTARAN [SP] dexamethasone sodium phosphate diclofenac sodium gel dorzolamide hcl dorzolamide- timolol epinastine hcl erythromycin ointment EYLEA [INJ] FLUORESCEIN SODIUM fluorometholone flurbiprofen sodium FML S.O.P. gatifloxacin gentasol homatropine hydrobromide ILEVRO ISOPTO CARBACHOL JETREA [INJ] ketorolac eye solution latanoprost drops levobunolol hcl drops levofloxacin hemihydrate rops LOTEMAX LUCENTIS [INJ] LUMIGAN methazolamide metipranolol drops MOXEZA naphazoline hcl NATACYN neomycin/polymyxin/dexamethasone neomycin/bacitracin/polymyxin/hc neomycin/polymyxin/gramicidin NEVANAC ofloxacin PATADAY PATANOL phenylephrine hcl Generic drugs are listed in lower case letters; Example: azithromycin Page 20

21 PHOSPHOLINE IODIDE DROPS physostigmine salicylate [inj] pilocarpine hcl drops PILOPINE HS polymyxin/trimethoprim eye solution PRED MILD prednisolone acetate prednisolone sodium phosphate drops PROLENSA proparacaine hcl proparacaine- fluorescein RESTASIS sodium chloride drops sulfacetamide sodium ointment sulfacetamide sodium drops sulfacetamide/prednisolone tetracaine drops timolol maleate drops TOBRADEX TOBRADEX ST tobramycin tobramycin sulfate drops tobramycin- dexamethasone TRAVATAN Z travoprost TRIFLURIDINE tropicamide VIGAMOX VISUDYNE [INJ] ZYLET Respiratory, Allergy, Cough & Cold acetylcysteine ADCIRCA [SP] ADVAIR DISKUS ADVAIR HFA albuterol sulfate aminophylline [inj] ANORO ELLIPTA arbinoxa ARCAPTA NEOHALER ARNUITY ELLIPTA ASMANEX, HFA AUVI- Q benzonatate BREO ELLIPTA brompheniramine/pseudoephed budesonide caffeine/sodium benzoate [inj] carbinoxamine cetirizine syrup chlorphen- pse- dm tannate CINRYZE [INJ] [SP] clemastine fumarate COMBIVENT RESPIMAT cromolyn sodium nebulization solution cyproheptadine hcl D- CHLORPHENIRA/PSE/CHLOPHEDIAN 12.5CPD- 1DCPM- 30PSE DALIRESP desloratadine, odt dexchlorpheniramine maleate er DEXTROMETHORPHAN HBR difil- g dihydrocodeine- bpm- pe diphenhydramine [inj] DM/PHENYLEPH/CHLORPHENIRAMINE 10PEH- 4CPM- 20DM DULERA DYMISTA ephedrine sulfate epinephrine [inj] EPIPEN EPIPEN JR. epoprostenol diluent [inj] [sp] FIRAZYR FLOVENT FLOVENT DISKUS FLOVENT HFA flunisolide fluticasone propionate FORADIL Guaifenesin/codeine Hydrocodone/chlorpheniramine er HYDROCODONE/HOMATROPINE hydroxyzine hcl hydroxyzine pamoate Generic drugs are listed in lower case letters; Example: azithromycin Page 21

22 ipratropium bromide ipratropium- albuterol nebulization KALBITOR [INJ] KALYDECO LETAIRIS levalbuterol hcl levocetirizine dihydrochloride metaproterenol sulfate montelukast sodium NASONEX OPSUMIT PERFOROMIST [INJ] phenylephrine/chlorpheniramine 10peh- 4cpm phenylephrine/chlorpheniramine phenylephrine/dihydrocodeine/chlorphenir PROAIR HFA PROAIR RESPICLICK promethazine hcl, sup, tablets, [inj] promethazine vc w/codeine promethazine w/dm promethegan PSEUDOEPH/CHLOPHEDIANOL/GG 12.5CPD- 100GFN- 30PSE pseudoephedrine hcl 12 hour ER pseudoephedrine hcl- d 12 hour pseudoephedrine sulfate ER PULMICORT PULMICORT FLEXHALER PULMOZYME QVAR REVATIO [INJ] SEREVENT DISKUS sildenafil citrate sodium chloride nebulizer SPIRIVA, RESPIMAT SYMBICORT terbutaline sulfate terbutaline sulfate [inj] theophylline anhydrous elixir theophylline anhydrous drops er 12 hr TRACLEER triamcinolone acetonide spray TUDORZA PRESSAIR TUSSICAPS TYVASO VENTAVIS VENTOLIN HFA VERAMYST XOLAIR [INJ] zafirlukast Urologicals alfuzosin hcl er alprostadil [inj] AMINOACETIC ACID aminoacetic acid [inj] AMMONIUM CHLORIDE [INJ] bethanechol chloride CAVERJECT [INJ] CIALIS CYSTAGON [SP] ELMIRON finasteride flavoxate hcl GELNIQUE glycine hyophen k- phos neutral K- PHOS ORIGINAL MUSE MYRBETRIQ ER 24 HR oxybutynin chloride oxybutynin chloride er phenazopyridine hcl phenazopyridine plus phosphasal potassium citrate er RAPAFLO RENACIDIN tamsulosin er tolterodine tartrate TOVIAZ tricitrates trospium chloride er uretron d- s urimar- t urin d.s. Generic drugs are listed in lower case letters; Example: azithromycin Page 22

23 urogesic ustell VESICARE VIAGRA Vitamins, Hematinics & Electrolytes ADDAMEL N [INJ] advanced am/pm albumin human [inj] ALZ- NAC amino acid [inj] AMINOSYN [INJ] AQUASOL A [INJ] [SP] ascorbic acid [inj] b- complex BAL IN OIL [INJ] bal- care dha calcium acetate calcium chloride [inj] calcium gluconate [inj] cavan- alpha kit cavan- ec sod dha CENOLATE [INJ] centratex choice- ob + dha choice- tabs chromium chloride [inj] CLINIMIX [INJ] complete natal dha CONCEPTION XR MOTILITY copper chloride [inj] corvita CUPRIC SULFATE [INJ] cyanocobalamin [inj] DAILYVITE dexferrum DIALYVITE 800 DULEEK- MET NEW eliphos elite ob elite- ob 400 fabb fe 90 plus fe c FERAHEME ferocon ferotrinsic ferraplus 90 ferrex 150 forte ferrex 150 forte plus ferrex 28 ferrocite plus ferrogels forte folbecal folbee folbee plus folbic folbic rf folcaps folcaps omega- 3 folic acid folic acid [inj] folic acid- cyancobal- pyridoxine folivane- f folivane- ob folivane- plus folivane- prx dha nf folplex 2.2 foltanx FREAMINE HBC FREAMINE III GLYCOPHOS [INJ] hematinic plus hematinic with folic acid hematogen hematogen fa hematogen forte hemenatal ob hemenatal ob + dha hemetab HEPATAMINE [INJ] HEPATASOL [INJ] hetastarch w/sodium chloride [inj] hydroxocobalamin iferex 150 forte inatal advance inatal gt Generic drugs are listed in lower case letters; Example: azithromycin Page 23

24 inatal ultra infed [inj] INFUVITE [INJ] intralipid IONOSOL B WITH DEXTROSE 5% ISOLYTE S [INJ] k- phos neutral L- MEFOLATE- PYRIDOX- MECOBALAMIN- NAC L- METHYLFOLATE CALCIUM m.v.i. adult [inj] M.V.I. PEDIATRIC [INJ] M.V.I.- 12 [INJ] macnatal cn dha magnesium chloride [inj] magnesium sulfate [inj] MAGNESIUM SULFATE IN DEXTROSE [INJ] manganese [inj] manganese sulfate [inj] metafolbic metafolbic plus multigen multigen folic multigen plus MULTITRACE- 4 [INJ] MULTITRACE- 5 [INJ] multivitamin w/fluoride & iron multivitamin with fluoride mynatal mynatal caps mynatal advance mynatal plus mynatal- z mynate 90 plus er mynephrocaps NASCOBAL NATAL- V RX natalvirt 90 dha natalvirt ca natalvirt flt nephplex rx NEPHRAMINE [INJ] nephro- vite rx NEUT [INJ] NORMOSOL- M AND DEXTROSE [INJ] NORMOSOL- R AND DEXTROSE [INJ] NORMOSOL- R PH 7.4 [INJ] nutri- tab ob nutrilyte [inj] nutrilyte ii [inj] obstetrix dha PEDITRACE [INJ] PLASMA- LYTE 148 [INJ] pnv ob+dha pnv- dha pnv- first pnv- omega pnv- select pnv- total polysaccharide iron forte poly- iron 150 forte pot chloride/dextrose/ns [inj] potassium acetate [inj] potassium bicarbonate potassium chl- normal saline [inj] potassium chloride potassium chloride/dextrose [inj] pr natal 400 pr natal 400 ec pr natal 430 pr natal 430 ec prefol- dha premasol [inj] prena1 prena1 chew prena1 plus prenaissance prenaissance 90 dha prenaissance balance prenaissance dha prenaissance harmony dha prenaissance next prenaissance plus prenaplus prenatabs fa prenatabs rx prenatal ad prenatal low iron prenatal plus Generic drugs are listed in lower case letters; Example: azithromycin Page 24

25 prenatal- u PROCALAMINE PROSOL pyridoxine hcl relnate dha RENA- VITE RX renal caps renalpren reno caps ringers [inj] se- tan dha pernatal se- tan plus se- natal 19 selenium [inj] setonet setonet- ec sodium acetate [inj] sodium chloride 3% sodium chloride0.45% sodium lactate [inj] strovite STUART ONE taron forte taron prenatal taron- bc taron- c dha taron- duo ec therapeutic hematinic therapeutic vitamin/minerals thiamine hcl tl g- fol os tl gard rx tl icon tl- care dha tl- fol 500 er tl- hem 150 er 24 hr tl- select TPN ELECTROLYTES [INJ] TRACE ELEMENTS [INJ] travasol [inj] tri rx triadvance tricon trigels- f forte trinatal gt trinatal rx 1 trinatal ultra trinate triphrocaps triveen- duo dha triveen- one triveen- prx rnf triveen- ten triveen- u trust natal dha ultimate ob dha ultimatecare one ultimatecare one nf v- c forte v- natal vemavite- prx 2 vena- bal dha venatal complete dha venatal- fa VENOFER [INJ] vinacal vinate az vinate c vinate calcium vinate dha vinate gt vinate ic vinate ii vinate one vinate ultra vinate- m virt- bal dha virt- bal dha plus virt- pn virt- pn dha virt- pn plus virt- select virt- vite virt- vite forte vitafol- ob vitafol- pn vitamin a vitaspire Generic drugs are listed in lower case letters; Example: azithromycin Page 25

26 vol- care rx vol- nate vol- plus vol- tab rx vp- ch plus vp- ch- pnv vp- era ob plus vp- ggr- b6 vp- heme one vp- zel vynatal- fa zatean- ch zatean- pn zatean- pn dha zatean- pn plus zinc chloride zinc sulfate Miscellaneous & Diagnostic Agents acamprosate calcium acetic acid irrigation ADAGEN [INJ] [SP] AMMONUL [INJ] anagrelide hydrochloride ARALAST NP [INJ] [SP] atropen [inj] benzphetamine hcl BREVITAL [INJ] BROMHEXINE HYDROCHLORIDE BUPHENYL TABLETS bupivacaine/dextrose [inj] caffeine citrated caffeine citrated [inj] CARBAGLU [SP] cevimeline hcl CHANTIX CHEMET citric acid CLINIMIX E [INJ] deferoxamine [inj] DELFLEX/DEXTROSE dextrose in lactated ringers dextrose in water dextrose/sodium chloride diethylpropion hcl EDARBYCLOR EOVIST [INJ] ETHAMOLIN etidronate disodium etomidate [inj] EXJADE EXTRANEAL ICODEXTRIN DIALYSIS FERRIPROX FOSRENOL HEXTEND LACTATED ELECTROLYTE INCRELEX [INJ] ISOVUE [INJ] ISOVUE- M [INJ] JADENU ketamine hcl [inj] levocarnitine levocarnitine [inj] LEXISCAN MAGNEVIST [INJ] md- gastroview midodrine hcl NATPARA [INJ] neomycin- polymyxin b [inj] OMNIPAQUE ORFADIN PANHEMATIN [INJ] phendimetrazine tartrate phendimetrazine tartrate er phentermine hcl pilocarpine hcl PROHANCE [INJ] PROLASTIN [INJ] PROLASTIN C [INJ] propofol PROSTAMEN PROTOPAM CHLORIDE [INJ] RAVICTI RENVELA riluzole ringers irrigation SEROTONIN HCL sodium chloride Generic drugs are listed in lower case letters; Example: azithromycin Page 26

27 sodium chloride [inj] sodium chloride irrigation SODIUM PHOSPHATE sodium polystyrene sulfonate sodium thiosulfate [inj] SOLIRIS [INJ] SOTRADECOL [INJ] THALLOUS CHLORIDE TL- 201 THYROGEN [INJ] TRYPSIN UVA URSI LEAF FLUID EXTRACT VISIPAQUE [INJ] water [inj] water intravenous solution water solution irrigation XIAFLEX [INJ] ZEMAIRA [INJ] Generic drugs are listed in lower case letters; Example: azithromycin Page 27