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Kaiser Permanente Insurance Company Formulary
Kaiser Permanente Insurance Company Formulary For California PPO and Out-of-Area plans PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER WHEN YOU PARTICIPATE IN OUR PPO AND OUT-OF-AREA HEALTH INSURANCE PLANS OFFERED BY KAISER PERMANENTE INSURANCE COMPANY. This formulary was updated on May 5, 2015 and is effective as of May 5, 2015. For more recent information or other questions, please call MedImpact 24 hours a day, seven days a week (closed holidays) at 1-800-788-2949. You can also access the Kaiser Permanente Insurance Company (KPIC) formulary on our website: kp.org/kpic What is the Kaiser Permanente Insurance Company (KPIC) Formulary? A formulary is a list of covered drugs. The KPIC Formulary is an open formulary of unrestricted drugs that are covered under your KPIC health insurance plan. The formulary consists of generic and brand drugs. Unless specifically excluded under your plan, all FDA-approved drugs are part of your plan’s open formulary. What drugs are covered? KPIC will generally cover brand and generic drugs listed on the KPIC Formulary as long as the drug is medically necessary, the prescription is filled at a MedImpact Pharmacy and other coverage rules are followed. What drugs are not covered? Drugs not listed on the KPIC Formulary are not covered and can be found under the Outpatient Prescription Drug Benefits, Limitations & Exclusions section of your Certificate of Insurance. Are there any restrictions on the drugs covered on the KPIC Formulary? Some covered drugs may have additional requirements or limits on coverage, such as quantity limits. For certain drugs, KPIC may limit the amount of the drug dispensed to a certain days’ supply. Quantity limits, if any, can be found under the Outpatient Prescription Drug Benefits, Limitations & Exclusions section of your Certificate of Insurance. What is a brand-name drug? Brand-name drugs are usually manufactured and sold by the drug company that originally researched and developed the drug. When the patent on a brand-name drug expires, other drug companies may manufacture and sell an FDA-approved generic version of the drug with the same active ingredient(s) at lower prices. 1 KPIC PPO/OOA Formulary - revised May 5, 2015 What is a generic drug? A generic drug is approved by the FDA as having the same active ingredient as the brand-name drug. Generally, generic drugs cost less than brand-name drugs. What drugs are eligible to be mailed from the mail order pharmacy? Most drugs can be mailed from our mail order pharmacy. Some drugs (for example, drugs that are extremely high cost or require special handling) may not be eligible for mailing. Drugs cannot be mailed outside the United States. You can order refills through our mail-order service online at www.walgreensmail.com or by phone. There is no extra charge for mail order. The appropriate cost share (according to your prescription drug benefit) will apply. Your prescription drug benefit may have a lower cost share if you use the mail order pharmacy. Please refer to your Certificate of Insurance for complete details of your prescription drug benefit or call KPIC Customer Service at 1-800-788-0710. KPIC Formulary The most current KPIC Formulary list begins on page 3; it provides coverage information about some of the drugs covered by KPIC. All dosage forms and strengths for a particular drug listed may not be on the KPIC Formulary. Some drugs have multiple dosage forms. In such cases, some dosages may be on the KPIC Formulary and others not. KPIC may add or remove drugs from the KPIC Formulary during the year. These changes to the formulary are based on new information or new drugs that become available. The table below identifies drugs based on their drug category – generic or brand. Typically, you will pay a generic drug copayment for generic drugs and a brand drug copayment for brand drugs as shown in your Schedule of Coverage. However, if you request a brand name drug when a generic is prescribed, you may be responsible for paying the brand-name copayment plus the difference in cost between the generic drug and the brand-name drug. Please refer to your Certificate of Insurance for details. 2 KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY BRAND DRUG 40PSE-4BRM 60PSE-4CPM ACETADRYL ACETA-GESIC ACETAMINOPHEN PM ACETAMINOPHEN PM XTRA STRENGTH ACETAMINOPHENDIPHENHYDRAMINE ADT ROBITUSSIN COUGH-COLD-FLU ADULT ROBITUSSIN NIGHT M-S CLD ADULT TUSSIN CHEST CONGESTION ADULT WAL-TUSSIN AEROBID AEROSPAN AHIST AK-DEX ALA-HIST IR ALAVERT ALDEX AN ALER-CAP ALER-TAB ALKA-SELTZER PLUS ALLERGY ALL DAY ALLERGY ALL DAY ALLERGY RELIEF ALL DAY ALLERGY-D ALLEGRA ALLEGRA ALLERGY ALLEGRA ODT ALLEGRA-D 12 HOUR ALLEGRA-D 24 HOUR ALLER-CHLOR ALLERCLEAR ALLERCLEAR D-12HR ALLERCLEAR D-24HR ALLER-EASE ALLER-FEX ALLER-G-TIME ALLERGY ALLERGY & COLD PE ALLERGY & CONGESTION ALLERGY & CONGESTION RELIEF ALLERGY & SINUS ALLERGY & SINUS HEADACHE ALLERGY 4-HOUR ALLERGY COMPLETE-D ALLERGY CREAM ALLERGY D-12 ALLERGY MEDICATION ALLERGY MEDICINE ALLERGY PLUS-SEVERE SINUS HA ALLERGY PLUS-SINUS HEADACHE ALLERGY RELIEF 3 GENERIC DRUG PSEUDOEPHEDRINE/BROMPHENIRAMIN PSEUDOEPHED/CHLORPHENIRAMINE ACETAMINOPHEN/DIPHENHYDRAMINE ACETAMINOPHEN/DIPHENHYDRAMINE ACETAMINOPHEN/DIPHENHYDRAMINE ACETAMINOPHEN/DIPHENHYDRAMINE ACETAMINOPHEN/DIPHENHYDRAMINE ACETAMINOPHEN/DIPHENHYDRAMINE DIPHENHYDRA/PHENYLEPH/ACETAMIN DIPHENHYDRA/PHENYLEPH/ACETAMIN GUAIFENESIN GUAIFENESIN FLUNISOLIDE FLUNISOLIDE CHLORCYCLIZINE HCL DEXAMETHASONE SOD PHOSPHATE DEXBROMPHENIRAMINE MALEATE LORATADINE DOXYLAMINE SUCCINATE DIPHENHYDRAMINE HCL DIPHENHYDRAMINE HCL DIPHENHYDRAMINE HCL CETIRIZINE HCL CETIRIZINE HCL CETIRIZINE HCL/PSEUDOEPHEDRINE FEXOFENADINE HCL FEXOFENADINE HCL FEXOFENADINE HCL FEXOFENADINE/PSEUDOEPHEDRINE FEXOFENADINE/PSEUDOEPHEDRINE CHLORPHENIRAMINE MALEATE LORATADINE LORATADINE/PSEUDOEPHEDRINE LORATADINE/PSEUDOEPHEDRINE FEXOFENADINE HCL FEXOFENADINE HCL DIPHENHYDRAMINE HCL CETIRIZINE HCL DIPHENHYDRA/PHENYLEPH/ACETAMIN LORATADINE/PSEUDOEPHEDRINE LORATADINE/PSEUDOEPHEDRINE DIPHENHYDRA/PHENYLEPH/ACETAMIN DIPHENHYDRA/PHENYLEPH/ACETAMIN CHLORPHENIRAMINE MALEATE CETIRIZINE HCL/PSEUDOEPHEDRINE DIPHENHYDRAMINE HCL CETIRIZINE HCL/PSEUDOEPHEDRINE DIPHENHYDRAMINE HCL DIPHENHYDRAMINE HCL DIPHENHYDRA/PHENYLEPH/ACETAMIN DIPHENHYDRA/PHENYLEPH/ACETAMIN CETIRIZINE HCL KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY BRAND DRUG ALLERGY RELIEF D ALLERGY RELIEF D12 ALLERGY RELIEF D-24 ALLERGY RELIEF-D ALLERGY RELIEF-NASAL DECONGEST ALLERGY RELIEF-SINUS HEADACHE ALLERGY SEVERE ALLERGY-CONGESTION RELIEF ALLERGY-CONGESTION RELIEF-D ALLERGY-D ALLERGY-TIME ALLERHIST-1 ALLER-TEC ALLER-TEC D ALLFEN ALVESCO ANDEHIST ANTIHIST ANTIHISTAMINE ANTIHISTAMINE ALLERGY ANTI-ITCH ARBINOXA ARNUITY ELLIPTA ASMANEX ASMANEX HFA ASTELIN ASTEPRO BANOPHEN BECONASE AQ BENADRYL BENADRYL ALLERGY BENADRYL ALLERGY PLUS COLD BENADRYL ALLERGY PLUS SINUS BENADRYL ITCH STOPPING BENADRYL SEVERE ALLERGY-SINUS BIDEX BPM BPM PSEUDO BROMALINE BROMAX BROMPHENIRAMINE-PSEUDOEPHEDR BROMPHENIRAMINEPSEUDOEPHEDRIN BROMSPIRO BROTAPP BROVEX BROVEX CT BROVEX PSB BROVEX PSE 4 GENERIC DRUG FEXOFENADINE/PSEUDOEPHEDRINE LORATADINE/PSEUDOEPHEDRINE LORATADINE/PSEUDOEPHEDRINE CETIRIZINE HCL/PSEUDOEPHEDRINE LORATADINE/PSEUDOEPHEDRINE DIPHENHYDRA/PHENYLEPH/ACETAMIN ACETAMINOPHEN/DIPHENHYDRAMINE LORATADINE/PSEUDOEPHEDRINE LORATADINE/PSEUDOEPHEDRINE CETIRIZINE HCL/PSEUDOEPHEDRINE CHLORPHENIRAMINE MALEATE CLEMASTINE FUMARATE CETIRIZINE HCL CETIRIZINE HCL/PSEUDOEPHEDRINE GUAIFENESIN CICLESONIDE PSEUDOEPHEDRINE/BROMPHENIRAMIN DIPHENHYDRAMINE HCL DIPHENHYDRAMINE HCL DIPHENHYDRAMINE HCL DIPHENHYDRAMINE HCL CARBINOXAMINE MALEATE FLUTICASONE FUROATE MOMETASONE FUROATE MOMETASONE FUROATE AZELASTINE HCL AZELASTINE HCL AZELASTINE HCL DIPHENHYDRAMINE HCL BECLOMETHASONE DIPROPIONATE DIPHENHYDRAMINE HCL DIPHENHYDRAMINE HCL DIPHENHYDRA/PHENYLEPH/ACETAMIN DIPHENHYDRA/PHENYLEPH/ACETAMIN BENADRYL COMPLETE ALLERGY DIPHENHYDRAMINE HCL DIPHENHYDRA/PHENYLEPH/ACETAMIN GUAIFENESIN BROMPHENIRAMINE MALEATE PSEUDOEPHEDRINE/BROMPHENIRAMIN PSEUDOEPHEDRINE/BROMPHENIRAMIN BROMPHENIRAMINE MALEATE BROMPHENIRAMINE MALEATE BROMPHENIRAMINE TANNATE PSEUDOEPHEDRINE/BROMPHENIRAMIN PSEUDOEPHEDRINE/BROMPHENIRAMIN BROMPHENIRAMINE MALEATE PSEUDOEPHEDRINE/BROMPHENIRAMIN BROMPHENIRAMINE TANNATE BROMPHENIRAMINE TANNATE PSEUDOEPHEDRINE/BROMPHENIRAMIN PSEUDOEPHEDRINE/BROMPHENIRAMIN KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY BRAND DRUG BROVEX SR BUDESONIDE EC CETIRI-D CETIRIZINE-PSEUDOEPHEDRINE CETIRIZINE-PSEUDOEPHEDRINE ER CHEST CONGESTION CHEST CONGESTION RELIEF CHILD DELSYM COUGH+COLD CHILD MUCINEX CHEST CONGESTION CHILDREN'S ALL DAY ALLERGY CHILDREN'S ALLEGRA ALLERGY CHILDREN'S ALLERGY CHILDREN'S ALLERGY COMPLETE CHILDREN'S ALLERGY RELIEF CHILDREN'S ALLER-TEC CHILDREN'S BENADRYL ALLERGY CHILDREN'S CETIRIZINE HCL CHILDREN'S CHEST CONGESTION CHILDREN'S CLARITIN CHILDREN'S COLD & ALLERGY CHILDREN'S COMPLETE ALLERGY CHILDREN'S LORATADINE CHILDREN'S MUCINEX CHILDREN'S MUCUS RELIEF CHILDREN'S WAL-DRYL ALLERGY CHILDREN'S WAL-ZYR CHILDREN'S ZYRTEC CHILDREN'S ZYRTEC ALLERGY CHILD'S BENADRYL ALLERGY CHILDS TYLENOL COLD-ALLERGY CHILD'S ZYRTEC ALLERGY CHLOR HIST CHLORPHEN-PSE CHLORTABS CHLOR-TRIMETON CHLOR-TRIMETON ALLERGY CLARINEX CLARINEX-D 12 HOUR CLARINEX-D 24 HOUR CLARITIN CLARITIN-D 12 HOUR CLARITIN-D 24 HOUR CLARITIN-D 24HR COLD & ALLERGY COLD & FLU RELIEF COLD RELIEF COMPLETE ALLERGY COMPLETE ALLERGY MEDICINE 5 GENERIC DRUG PSEUDOEPHEDRINE/BROMPHENIRAMIN BUDESONIDE BUDESONIDE CARBINOXAMINE MALEATE CETIRIZINE HCL/PSEUDOEPHEDRINE CETIRIZINE HCL CETIRIZINE HCL/PSEUDOEPHEDRINE CETIRIZINE HCL/PSEUDOEPHEDRINE GUAIFENESIN GUAIFENESIN DIPHENHYDRA/PHENYLEPH/ACETAMIN GUAIFENESIN CETIRIZINE HCL FEXOFENADINE HCL CETIRIZINE HCL CETIRIZINE HCL CETIRIZINE HCL CETIRIZINE HCL DIPHENHYDRAMINE HCL CETIRIZINE HCL GUAIFENESIN LORATADINE PSEUDOEPHEDRINE/BROMPHENIRAMIN DIPHENHYDRAMINE HCL LORATADINE DIPHENHYDRA/PHENYLEPH/ACETAMIN GUAIFENESIN DIPHENHYDRAMINE HCL CETIRIZINE HCL CETIRIZINE HCL CETIRIZINE HCL DIPHENHYDRAMINE HCL DIPHENHYDRA/PHENYLEPH/ACETAMIN CETIRIZINE HCL CHLORPHENIRAMINE MALEATE PSEUDOEPHED/CHLORPHENIRAMINE CHLORPHENIRAMINE MALEATE CHLORPHENIRAMINE MALEATE CHLORPHENIRAMINE MALEATE DESLORATADINE DESLORATADINE/PSEUDOEPHEDRINE DESLORATADINE/PSEUDOEPHEDRINE LORATADINE LORATADINE/PSEUDOEPHEDRINE LORATADINE/PSEUDOEPHEDRINE P-EPHED SUL/LORATADINE CLEMASTINE FUMARATE PSEUDOEPHEDRINE/BROMPHENIRAMIN DIPHENHYDRA/PHENYLEPH/ACETAMIN ACETAMINOPHEN/DIPHENHYDRAMINE DIPHENHYDRAMINE HCL DIPHENHYDRAMINE HCL KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY BRAND DRUG COMPOZ COUGH & SEVERE COLD COUGH CONTROL COUGH SYRUP COUGHTAB COUGHTAB 400 CPM PSE CPM-PSE CUTIVATE DAILYHIST-1 DALLERGY PSE DAYHIST DAYHIST ALLERGY DECONAMINE DELSYM COUGH+COLD DERMA-PAX DEXAMETHASONE SODIUM PHOSPHATE DEXASOL DIABETIC SILTUSSIN DAS-NA DIABETIC TUSSIN EX DIABETIC TUSSIN MUCUS RELIEF DICEL DICOPANOL DIPHEDRYL DIPHEDRYL ALLERGY DIPHEN DIPHEN/LIDO VISC/MAALOX 1:1:1 DIPHENHIST DIPHENHYDRAMINE-NS DOXYTEX DURA-TAP/PD DYMISTA DYTAN DYTUSS ED CHLORPED ED CHLORPED JR ED-CHLORTAN ED-CHLOR-TAN ELOCON ENTOCORT EC EXPECTORANT EXPECTORANT COUGH SYRUP EZ NITE SLEEP FAST SLEEP FENESIN IR 6 GENERIC DRUG DIPHENHYDRAMINE HCL DIPHENHYDRA/PHENYLEPH/ACETAMIN GUAIFENESIN GUAIFENESIN GUAIFENESIN GUAIFENESIN PSEUDOEPHED/CHLORPHENIRAMINE PSEUDOEPHED/CHLORPHENIRAMINE CROMOLYN SODIUM FLUTICASONE PROPIONATE CYPROHEPTADINE HCL CLEMASTINE FUMARATE PSEUDOEPHEDRINE/CPM/METHYLSCOP CLEMASTINE FUMARATE CLEMASTINE FUMARATE PSEUDOEPHED/CHLORPHENIRAMINE DIPHENHYDRA/PHENYLEPH/ACETAMIN DIPHENHYDRAMINE HCL DESLORATADINE DEXAMETHASONE SOD PHOSPHATE DEXAMETHASONE SOD PHOSPHATE DEXCHLORPHENIRAMINE MALEATE GUAIFENESIN GUAIFENESIN GUAIFENESIN PSEUDOEPHED/CHLORPHENIRAMINE DIPHENHYDRAMINE HCL DIPHENHYDRAMINE HCL DIPHENHYDRAMINE HCL DIPHENHYDRAMINE HCL DIPHENHYDRAMINE/LIDO/MAALOX DIPHENHYDRAMINE HCL DIPHENHYDRAMINE HCL DIPHENHYDRAMINE IN 0.9 % NACL DOXYLAMINE SUCCINATE PSEUDOEPHEDRINE HCL/CHLOR-MAL AZELASTINE/FLUTICASONE DIPHENHYDRAMINE TANNATE DIPHENHYDRAMINE HCL CHLORPHENIRAMINE MALEATE CHLORPHENIRAMINE MALEATE CHLORPHENIRAMINE MALEATE CHLORPHENIRAMINE TANNATE MOMETASONE FUROATE BUDESONIDE GUAIFENESIN GUAIFENESIN DIPHENHYDRAMINE HCL DOXYLAMINE SUCCINATE GUAIFENESIN FEXOFENADINE HCL FEXOFENADINE/PSEUDOEPHEDRINE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY BRAND DRUG FEXOFENADINE-PSE ER FLONASE FLONASE ALLERGY RELIEF FLOVENT DISKUS FLOVENT HFA FLU & SEVERE COLD FLU & SORE THROAT RELIEF FLU RELIEF THERAPY FLU RELIEF THERAPY NIGHTTIME FLU-SEVERE COLD & COUGH FLU-SEVERE COLD & COUGH RELIEF GANIDIN NR GASTROCROM GENAHIST GENAPHED PLUS GERI-TUSSIN G-FENESIN GG 200 NR GRASTEK GUAIFENESIN SYRUP GUAIFENESIN ER GUAIFENESIN NR HEADACHE PM HEADACHE PM FORMULA HISTEX HISTEX PD HUMIBID E HYDROXYZINE PAMOATE INTENSE COLD & FLU IOPHEN NR ITCH RELIEF J-TAN D PD J-TAN PD KARBINAL ER KENALOG KENALOG-10 KENALOG-40 KIDS-EEZE CHEST RELIEF LIQUITUSS GG LODRANE LODRANE 24 LODRANE 24D LODRANE D LOHIST 12D LOHIST 12HR LOHIST-D LOHIST-PD LOHIST-PSB 7 GENERIC DRUG FEXOFENADINE/PSEUDOEPHEDRINE FLUTICASONE PROPIONATE FLUTICASONE PROPIONATE FLUTICASONE PROPIONATE FLUTICASONE PROPIONATE DIPHENHYDRA/PHENYLEPH/ACETAMIN DIPHENHYDRA/PHENYLEPH/ACETAMIN DIPHENHYDRA/PHENYLEPH/ACETAMIN DIPHENHYDRA/PHENYLEPH/ACETAMIN FLUNISOLIDE DIPHENHYDRA/PHENYLEPH/ACETAMIN DIPHENHYDRA/PHENYLEPH/ACETAMIN FLUTICASONE PROPIONATE GUAIFENESIN CROMOLYN SODIUM DIPHENHYDRAMINE HCL PSEUDOEPHED/CHLORPHENIRAMINE GUAIFENESIN GUAIFENESIN GUAIFENESIN GRASS POLLEN-TIMOTHY, STD GUAIFENESIN GUAIFENESIN GUAIFENESIN ACETAMINOPHEN/DIPHENHYDRAMINE ACETAMINOPHEN/DIPHENHYDRAMINE TRIPROLIDINE HCL TRIPROLIDINE HCL GUAIFENESIN HYDROXYZINE HCL DIPHENHYDRA/PHENYLEPH/ACETAMIN GUAIFENESIN DIPHENHYDRAMINE HCL PSEUDOEPHEDRINE/BROMPHENIRAMIN BROMPHENIRAMINE MALEATE CARBINOXAMINE MALEATE TRIAMCINOLONE ACETONIDE TRIAMCINOLONE ACETONIDE TRIAMCINOLONE ACETONIDE GUAIFENESIN LEVOCETIRIZINE DIHYDROCHLORIDE GUAIFENESIN PSEUDOEPHEDRINE/BROMPHENIRAMIN BROMPHENIRAMINE MALEATE PSEUDOEPHEDRINE/BROMPHENIRAMIN PSEUDOEPHEDRINE/BROMPHENIRAMIN PSEUDOEPHEDRINE/BROMPHENIRAMIN BROMPHENIRAMINE MALEATE PSEUDOEPHED/CHLORPHENIRAMINE PSEUDOEPHEDRINE/BROMPHENIRAMIN PSEUDOEPHEDRINE/BROMPHENIRAMIN KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY BRAND DRUG LORADAMED LORATA-D LORATADINE ALLERGY LORATADINE D LORATA-DINE D LORATADINE HIVES RELIEF LORATADINE-D MAPAP PM MAXICHLOR PSE MEDIFIN EXPECTORANT MEDIFIN EXPECTORANT MUCUS RLF MEDI-PHEDRYL MEDI-SLEEP MEDI-TABS MEDI-TABS PM MEDI-TUSSIN MUCINEX MUCINEX ALLERGY MUCINEX FAST-MAX NITE COLD-FLU MUCOSA MUCUS ER MUCUS RELIEF MUCUS RELIEF CHEST MUCUS-ER MYCI CHLOR-TAN NARAMIN NASACORT NASACORT AQ NASAL ALLERGY SPRAY NASALCROM NASONEX NEUTRAHIST NIGHTTIME SLEEP AID NIGHTTIME SLEEP GEL NIGHTTIME SLEEP-AID NON-ASPIRIN PM NON-ASPIRIN PM EX-STRENGTH NON-ASPIRIN SLEEP AID NON-DROWSY ALLERGY NYTOL NYTOL QUICKCAPS OMNARIS ONETAB ALLERGY & SINUS ONETAB COLD & FLU OPTIVAR ORALAIR ORALONE ORGAN-I NR ORGANIDIN NR ORMIR 8 GENERIC DRUG LORATADINE LORATADINE/PSEUDOEPHEDRINE LORATADINE LORATADINE/PSEUDOEPHEDRINE LORATADINE/PSEUDOEPHEDRINE LORATADINE LORATADINE/PSEUDOEPHEDRINE ACETAMINOPHEN/DIPHENHYDRAMINE PSEUDOEPHED/CHLORPHENIRAMINE GUAIFENESIN GUAIFENESIN DIPHENHYDRAMINE HCL DOXYLAMINE SUCCINATE ACETAMINOPHEN/DIPHENHYDRAMINE ACETAMINOPHEN/DIPHENHYDRAMINE GUAIFENESIN MOMETASONE FUROATE GUAIFENESIN FEXOFENADINE HCL DIPHENHYDRA/PHENYLEPH/ACETAMIN GUAIFENESIN GUAIFENESIN GUAIFENESIN GUAIFENESIN GUAIFENESIN CHLORPHENIRAMINE TANNATE DIPHENHYDRAMINE HCL TRIAMCINOLONE ACETONIDE TRIAMCINOLONE ACETONIDE CROMOLYN SODIUM CROMOLYN SODIUM MOMETASONE FUROATE PSEUDOEPHED/CHLORPHENIRAMINE DIPHENHYDRAMINE HCL DIPHENHYDRAMINE HCL DOXYLAMINE SUCCINATE ACETAMINOPHEN/DIPHENHYDRAMINE ACETAMINOPHEN/DIPHENHYDRAMINE ACETAMINOPHEN/DIPHENHYDRAMINE LORATADINE DIPHENHYDRAMINE HCL DIPHENHYDRAMINE HCL OLOPATADINE HCL CICLESONIDE DIPHENHYDRA/PHENYLEPH/ACETAMIN DIPHENHYDRA/PHENYLEPH/ACETAMIN AZELASTINE HCL GR POL-ORC/SW VER/RYE/KENT/TIM TRIAMCINOLONE ACETONIDE GUAIFENESIN GUAIFENESIN DIPHENHYDRAMINE HCL KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY BRAND DRUG PAIN & SLEEP PAIN RELIEF PM PAIN RELIEVER PAIN RELIEVER PM PALGIC PATADAY PATANASE PATANOL PAZEO PEDIATRIC COUGH-COLD PEDIAVENT PERCOGESIC EXTRA STRENGTH PHARBECHLOR PHARBEDRYL PHENADOZ PHENERGAN PM PAIN RELIEF PROMETHAZINE HCL-0.9% NACL PROMETHEGAN PSE BPM PSEUDO PLUS COLD & ALLERGY PULMICORT PULMICORT FLEXHALER Q-DRYL QNASL QNASL CHILDREN Q-TAPP Q-TUSSIN QUENALIN QVAR RAGWITEK REFENESEN RELCOF DN PSE RELCOF PSE RESPA-BR RESPAHIST REST SIMPLY RESTFULLY SLEEP RHINOCORT AQUA RI-TUSSIN ROBAFEN ROBITUSSIN ROBITUSSIN MUCUS-CHEST CONGEST RYNEX PSE SCOT-TUSSIN SEMPREX-D SEVERE ALLERGY SEVERE ALLERGY-SINUS HEADACHE SEVERE COLD SEVERE COLD PE SEVERE COLD-SINUS RELIEF PE 9 GENERIC DRUG ACETAMINOPHEN/DIPHENHYDRAMINE ACETAMINOPHEN/DIPHENHYDRAMINE ACETAMINOPHEN/DIPHENHYDRAMINE ACETAMINOPHEN/DIPHENHYDRAMINE CARBINOXAMINE MALEATE OLOPATADINE HCL OLOPATADINE HCL OLOPATADINE HCL OLOPATADINE HCL GUAIFENESIN DEXBROMPHENIRAMINE MALEATE ACETAMINOPHEN/DIPHENHYDRAMINE CHLORPHENIRAMINE MALEATE DIPHENHYDRAMINE HCL PROMETHAZINE HCL PROMETHAZINE HCL ACETAMINOPHEN/DIPHENHYDRAMINE PROMETHAZINE HCL PROMETHAZINE HCL IN 0.9 % NACL PROMETHAZINE HCL PSEUDOEPHEDRINE/BROMPHENIRAMIN PSEUDOEPHED/CHLORPHENIRAMINE BUDESONIDE BUDESONIDE DIPHENHYDRAMINE HCL BECLOMETHASONE DIPROPIONATE BECLOMETHASONE DIPROPIONATE PSEUDOEPHEDRINE/BROMPHENIRAMIN GUAIFENESIN DIPHENHYDRAMINE HCL BECLOMETHASONE DIPROPIONATE WEED POLLEN-SHORT RAGWEED GUAIFENESIN PSEUDOEPHEDRINE/CPM/METHYLSCOP PSEUDOEPHEDRINE/CPM/METHYLSCOP BROMPHENIRAMINE MALEATE PSEUDOEPHEDRINE/BROMPHENIRAMIN DIPHENHYDRAMINE HCL DIPHENHYDRAMINE HCL BUDESONIDE GUAIFENESIN GUAIFENESIN GUAIFENESIN GUAIFENESIN PSEUDOEPHEDRINE/BROMPHENIRAMIN GUAIFENESIN PSEUDOEPHEDRINE HCL/ACRIVAS ACETAMINOPHEN/DIPHENHYDRAMINE DIPHENHYDRA/PHENYLEPH/ACETAMIN DIPHENHYDRA/PHENYLEPH/ACETAMIN DIPHENHYDRA/PHENYLEPH/ACETAMIN DIPHENHYDRA/PHENYLEPH/ACETAMIN KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY BRAND DRUG SILADRYL SILDEC SILPHEN SILTUSSIN DAS SILTUSSIN SA SIMPLY SLEEP SINUS & ALLERGY SLEEP AID SLEEP II SLEEP TABLET SLEEP TABS SLEEP TIME SLEEP-AID SLEEP-EZE 3 SLEEPGELS SLEEPING SOMINEX SOMINEX MAX STRENGTH SUDAFED PE NIGHTTIME COLD SUDAFED PE SEVERE COLD SUDAHIST SUDAL 12 SUDOGEST COLD & ALLERGY SUDOGEST SINUS & ALLERGY SUPREME ANTACID SYNAGIS PER DIEM TAB TUSSIN TAVIST ND TAVIST-1 THERAFLU THERAFLU SEVERE COLD & COUGH THERAFLU WARMING RELIEF TIME-HIST QD TL-HIST PD TOBRAMYCIN 300MG IN SALINE NS TRIACTIN TRIACTING COLD AND ALLERGY TRIACTING ORANGE TRIAMINIC TRIAMINIC COLD & ALLERGY TRIANEX TRICHOPHYTON TRIDERM TRIESENCE TRIPOHIST TUSSIN TUSSIN CHEST CONGESTION TUSSIN HONEY TUSSIN MUCUS-CHEST CONGESTION TYLENOL PM EXTRA STRENGTH 10 GENERIC DRUG DIPHENHYDRAMINE HCL PSEUDOEPHEDRINE/BROMPHENIRAMIN DIPHENHYDRAMINE HCL GUAIFENESIN GUAIFENESIN DIPHENHYDRAMINE HCL PSEUDOEPHED/CHLORPHENIRAMINE DIPHENHYDRAMINE HCL DIPHENHYDRAMINE HCL DIPHENHYDRAMINE HCL DIPHENHYDRAMINE HCL DIPHENHYDRAMINE HCL DIPHENHYDRAMINE HCL DIPHENHYDRAMINE HCL DIPHENHYDRAMINE HCL DIPHENHYDRAMINE HCL DIPHENHYDRAMINE HCL DIPHENHYDRAMINE HCL DIPHENHYDRA/PHENYLEPH/ACETAMIN DIPHENHYDRA/PHENYLEPH/ACETAMIN PSEUDOEPHED/CHLORPHENIRAMINE P-EPD TAN/CHLOR-TAN PSEUDOEPHED/CHLORPHENIRAMINE PSEUDOEPHED/CHLORPHENIRAMINE CALCIUM CARB/MAGNESIUM HYDROX GUAIFENESIN LORATADINE CLEMASTINE FUMARATE DIPHENHYDRA/PHENYLEPH/ACETAMIN DIPHENHYDRA/PHENYLEPH/ACETAMIN DIPHENHYDRA/PHENYLEPH/ACETAMIN PSEUDOEPHEDRINE/CPM/METHYLSCOP PSEUDOEPHEDRINE/BROMPHENIRAMIN TOBRAMYCIN SO4 GUAIFENESIN PSEUDOEPHED/CHLORPHENIRAMINE PSEUDOEPHED/CHLORPHENIRAMINE TRIAMCINOLONE ACETONIDE DIPHENHYDRAMINE HCL PSEUDOEPHED/CHLORPHENIRAMINE TRIAMCINOLONE ACETONIDE TRICHOPHYTON ALLERGENIC EXT TRIAMCINOLONE ACETONIDE TRIAMCINOLONE ACETONIDE/PF TRIPROLIDINE HCL TRIPROLIDINE HCL GUAIFENESIN GUAIFENESIN GUAIFENESIN GUAIFENESIN ACETAMINOPHEN/DIPHENHYDRAMINE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ALLERGY ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO BRAND DRUG TYLENOL SEVERE ALLERGY UCERIS ULTRA SLEEP UNISOM UNISOM SLEEP AID UNISOM SLEEPMELTS VALU-DRYL VALU-DRYL ALLERGY MEDICINE VALU-TAPP VANAHIST PD VAZOL VERAMYST VICKS QLEARQUIL ALLERGY VICKS QLEARQUIL NIGHTTIME VISRX VISTARIL WAL-DRYL WAL-DRYL ALLERGY WAL-DRYL SEVERE ALLERGY-SINUS WAL-FEX ALLERGY WAL-FEX D 12 HOUR WAL-FEX D 24 HOUR WAL-FINATE WAL-FINATE-D WAL-FLU NIGHT SEVERE COLD WAL-FLU SEVERE COLD & COUGH WAL-ITIN WAL-ITIN ALLER-MELTS WAL-ITIN D WAL-ITIN D 12 HOUR WAL-NADOL PM WAL-PHED WAL-PHED PE WAL-PHED PE NIGHTTIME COLD WAL-SLEEP Z WAL-SOM WAL-TAP WAL-TUSSIN WAL-VERT WAL-ZYR WAL-ZYR D XYZAL ZETONNA Z-SLEEP ZYRTEC ZYRTEC-D ZZZQUIL 8 HOUR 8 HOUR PAIN RELIEF 8 HOUR PAIN RELIEVER ACEPHEN ACETADRINK 11 GENERIC DRUG ACETAMINOPHEN/DIPHENHYDRAMINE BUDESONIDE DOXYLAMINE SUCCINATE DIPHENHYDRAMINE HCL DOXYLAMINE SUCCINATE DIPHENHYDRAMINE HCL DIPHENHYDRAMINE HCL DIPHENHYDRAMINE HCL PSEUDOEPHEDRINE/BROMPHENIRAMIN TRIPROLIDINE HCL BROMPHENIRAMINE MALEATE FLUTICASONE FUROATE LORATADINE DIPHENHYDRAMINE HCL PSEUDOEPHEDRINE/CPM/METHYLSCOP HYDROXYZINE PAMOATE DIPHENHYDRAMINE HCL DIPHENHYDRAMINE HCL DIPHENHYDRA/PHENYLEPH/ACETAMIN FEXOFENADINE HCL FEXOFENADINE/PSEUDOEPHEDRINE FEXOFENADINE/PSEUDOEPHEDRINE CHLORPHENIRAMINE MALEATE PSEUDOEPHED/CHLORPHENIRAMINE DIPHENHYDRA/PHENYLEPH/ACETAMIN DIPHENHYDRA/PHENYLEPH/ACETAMIN LORATADINE LORATADINE LORATADINE/PSEUDOEPHEDRINE LORATADINE/PSEUDOEPHEDRINE ACETAMINOPHEN/DIPHENHYDRAMINE PSEUDOEPHED/CHLORPHENIRAMINE DIPHENHYDRA/PHENYLEPH/ACETAMIN DIPHENHYDRA/PHENYLEPH/ACETAMIN DIPHENHYDRAMINE HCL DIPHENHYDRAMINE HCL PSEUDOEPHEDRINE/BROMPHENIRAMIN GUAIFENESIN LORATADINE CETIRIZINE HCL CETIRIZINE HCL/PSEUDOEPHEDRINE LEVOCETIRIZINE DIHYDROCHLORIDE CICLESONIDE DIPHENHYDRAMINE HCL CETIRIZINE HCL CETIRIZINE HCL/PSEUDOEPHEDRINE DIPHENHYDRAMINE HCL ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO BRAND DRUG ACETAMINOPHEN 8 HOUR ACETAMINOPHEN ER ACETAMINOPHEN ES ACETAMINOPHEN EXTRA STRENGTH ACETAMINOPHEN PAIN RELIEF AKYNZEO ALOXI AMBIZINE ANTI-NAUSEA ANTIVERT ANZEMET APHEN ARTHRITIS PAIN ARTHRITIS PAIN RELIEF ARTHRITIS PAIN RELIEVER ASPIRIN FREE ATHENOL BETATEMP BONINE CESAMET CHILD NON-ASPIRIN CHILD PAIN REL-FEVER REDUCER CHILD PAIN RELIEF CHILD TRIAMINIC FEVER REDUCER CHILDREN'S ACETAMINOPHEN CHILDREN'S EASY-MELTS CHILDREN'S FEVER REDUCER CHILDREN'S FEVER REDUCING CHILDREN'S MAPAP CHILDREN'S MEDI-TABS CHILDREN'S NON-ASPIRIN CHILDREN'S PAIN & FEVER CHILDREN'S PAIN RELIEF CHILDREN'S PAIN RELIEVER CHILDREN'S Q-PAP CHILDREN'S SILAPAP CHILDREN'S TACTINAL CHILDREN'S TYLENOL CHILDREN'S TYLENOL MELTAWAYS CHILD'S ACCUDIAL ACETAMINOPHEN COMPAZINE COMPRO CYCLIVERT DICLEGIS DRAMAMINE DRAMAMINE LESS DROWSY DRIMINATE ED-APAP 12 GENERIC DRUG ACETAMINOPHEN 500MG ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN NETUPITANT/PALONOSETRON HCL PALONOSETRON HCL MECLIZINE HCL PHOSP ACID/DEXTROSE/FRUCTOSE MECLIZINE HCL DOLASETRON MESYLATE ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN MECLIZINE HCL NABILONE ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN COLA SYRUP PROCHLORPERAZINE MALEATE PROCHLORPERAZINE MALEATE CYCLIZINE HCL DOXYLAMINE/PYRIDOXINE HCL DIMENHYDRINATE DIMENHYDRINATE MECLIZINE HCL DIMENHYDRINATE DRONABINOL ACETAMINOPHEN KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO BRAND DRUG EMEND EMETROL EXTENDED PAIN RELIEF EXTRA STRENGTH NON-ASPIRIN FEVER REDUCER & PAIN RELIEVER FEVERALL FORMULA EM GENEBS GRANISOL INFANT FEVER-PAIN RELIEVER INFANT PAIN & FEVER INFANT PAIN RELIEF INFANT TRIAMINIC FEVER REDUCER INFANTAIRE INFANT'S ACETAMINOPHEN INFANTS' MAPAP INFANT'S NON-ASPIRIN INFANTS' NON-ASPIRIN INFANTS' PAIN & FEVER INFANT'S PAIN RELIEF INFANTS' PAIN RELIEF INFANTS PAIN RELIEVER INFANT'S PAIN RELIEVER INFANTS' PAIN RELIEVER INFANTS TYLENOL INFANTS' TYLENOL ISOPTO HYOSCINE JR ACETAMINOPHEN JR. STR NON-ASPIRIN JR. STR NON-ASPIRIN PAIN JR. STRENGTH PAIN RELIEVER JR. TYLENOL MELTAWAYS JUNIOR MAPAP JUNIOR PAIN RELIEVER KYTRIL LITTLE FEVERS LITTLE REMEDIES FEVER & PAIN MAPAP MAPAP ARTHRITIS PAIN MAPAP INFANT MARINOL MASOPHEN MEDI-MECLIZINE MEDI-TABS EXTRA STRENGTH MEDI-TABS PAIN RELIEVER MOTION RELIEF MOTION SICKNESS MOTION SICKNESS II MOTION SICKNESS RELIEF MOTION SICKNESS RELIEF II 13 GENERIC DRUG APREPITANT PHOSP ACID/DEXTROSE/FRUCTOSE ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN PHOSP ACID/DEXTROSE/FRUCTOSE ACETAMINOPHEN GRANISETRON HCL GRANISETRON HCL ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN SCOPOLAMINE HYDROBROMIDE ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN GRANISETRON HCL ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN DRONABINOL ACETAMINOPHEN MECLIZINE HCL MECLIZINE HCL ACETAMINOPHEN ACETAMINOPHEN MECLIZINE HCL DIMENHYDRINATE MECLIZINE HCL DIMENHYDRINATE MECLIZINE HCL KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO ANTIEMESIS/ANTIVERTIGO BRAND DRUG MOTION-TIME NAUSATROL INSTYDOSE NAUSEA CONTROL NAUSEA RELIEF NAUZENE NON-ASPIRIN NON-ASPIRIN 8 HOUR NON-ASPIRIN EXTRA STRENGTH NON-ASPIRIN JR STRENGTH NON-ASPIRIN PAIN RELIEF NORTEMP OFIRMEV ONDANSETRON HCL IN DEXTROSE ONDANSETRON HCL-D5W ONDANSETRON HCL-NS ONDANSETRON IN SODIUM CHLORIDE ONDANSETRON ODT PAIN & FEVER PAIN RELIEF PAIN RELIEF ADULT PAIN RELIEF COOL ICE PAIN RELIEF EXTRA STRENGTH PAIN RELIEVER JUNIOR STRENGTH PEDIACARE FEVER REDUCER PHARBETOL Q-PAP Q-PAP EXTRA STRENGTH SANCUSO SCOPACE SILAPAP TACTINAL TIGAN TRANSDERM-SCOP TRAVEL SICKNESS TRIAMINIC FEVER REDUCER TYLENOL TYLENOL 8 HOUR TYLENOL ARTHRITIS TYLENOL EXTRA STRENGTH TYLENOL EXTRA STRENGTH ARTHRIT TYLENOL SORE THROAT TYLOPHEN VERTICALM WAL-DRAM ZOFRAN ZOFRAN ODT ZUPLENZ 14 GENERIC DRUG MECLIZINE HCL PHOSP ACID/DEXTROSE/FRUCTOSE PHOSP ACID/DEXTROSE/FRUCTOSE PHOSP ACID/DEXTROSE/FRUCTOSE DEXTROSE/FRUCTOSE/SODIUM CIT ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ONDANSETRON HCL ONDANSETRON HCL/D5W/PF ONDANSETRON HCL IN D5W ONDANSETRON HCL IN 0.9 % NACL ONDANSETRON IN 0.9 % NACL/PF ONDANSETRON ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN PROCHLORPERAZINE EDISYLATE PROCHLORPERAZINE MALEATE ACETAMINOPHEN ACETAMINOPHEN GRANISETRON SCOPOLAMINE HYDROBROMIDE SCOPOLAMINE HYDROBROMIDE ACETAMINOPHEN ACETAMINOPHEN TRIMETHOBENZAMIDE HCL SCOPOLAMINE DIMENHYDRINATE ACETAMINOPHEN TRIMETHOBENZAMIDE HCL ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN ACETAMINOPHEN MECLIZINE HCL DIMENHYDRINATE ONDANSETRON HCL ONDANSETRON ONDANSETRON KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA BRAND DRUG ACCOLATE ACCUNEB ADRENACLICK ADRENALIN ADRENALIN CHLORIDE ADVAIR DISKUS ADVAIR HFA AEROBID-M ALERTNESS AID ALOCRIL ANORO ELLIPTA ARCAPTA NEOHALER ASTHMANEFRIN REFILL ASTHMANEFRIN STARTER KIT ATROVENT ATROVENT HFA AUVI-Q AWAKE BREO ELLIPTA BRONCHIAL MIST BRONCOMAR-1 BRONKAID DUAL ACTION BROVANA CAFCIT CAFFEINE AND SODIUM BENZOATE CAFFEINE CITRATE COMBIVENT COMBIVENT RESPIMAT COPD DALIRESP DIFIL-G 400 DILEX-G 200 DILEX-G 400 DOPAMINE HCL IN 5% DEXTROSE DULERA DUONEB DY-G LIQUID DYLIX DYPHYLLINE GG ED-BRON G ELIXOPHYLLIN EPINEPHRINE HCL-0.9% NACL EPINEPHRINE HCL-D5W EPINEPHRINE HCL-NS EPINEPHRINE-D5W EPIPEN EPIPEN 2-PAK EPIPEN JR 15 GENERIC DRUG ZAFIRLUKAST ALBUTEROL SULFATE EPINEPHRINE EPINEPHRINE EPINEPHRINE FLUTICASONE/SALMETEROL FLUTICASONE/SALMETEROL FLUNISOLIDE/MENTHOL ALBUTEROL SULFATE CAFFEINE NEDOCROMIL SODIUM AMINOPHYLLINE UMECLIDINIUM BRM/VILANTEROL TR INDACATEROL MALEATE RACEPINEPHRINE HCL RACEPINEPHRINE HCL IPRATROPIUM BROMIDE IPRATROPIUM BROMIDE EPINEPHRINE CAFFEINE FLUTICASONE/VILANTEROL EPINEPHRINE GUAIFEN/THEOP ANHYD/P-EPHED EPHEDRINE SULFATE/GUAIFENESIN ARFORMOTEROL TARTRATE CAFFEINE CITRATED CAFFEINE/SODIUM BENZOATE CAFFEINE CITRATED IPRATROPIUM/ALBUTEROL SULFATE IPRATROPIUM/ALBUTEROL SULFATE GUAIFENESIN/DYPHYLLINE ROFLUMILAST GUAIFENESIN/DYPHYLLINE GUAIFENESIN/DYPHYLLINE GUAIFENESIN/DYPHYLLINE DOPAMINE HCL DOPAMINE HCL/D5W MOMETASONE/FORMOTEROL IPRATROPIUM/ALBUTEROL SULFATE GUAIFENESIN/DYPHYLLINE DYPHYLLINE GUAIFENESIN/DYPHYLLINE GUAIFENESIN/THEOPHYLLINE THEOPHYLLINE ANHYDROUS EPINEPHRINE EPINEPHRINE HCL IN 0.9 % NACL EPINEPHRINE HCL/D5W EPINEPHRINE IN 0.9% NACL/PF EPINEPHRINE HCL/D5W EPINEPHRINE EPINEPHRINE EPINEPHRINE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA ASTHMA BRAND DRUG EPIPEN JR 2-PAK FORADIL INCRUSE ELLIPTA IPRATROPIUM-ALBUTEROL ISUPREL JAY-PHYL LEVALBUTEROL CONCENTRATE LEVOPHED BITARTRATE LUFYLLIN LUFYLLIN-GG MAXAIR AUTOHALER NO DOZ NOREPINEPHRINE BITAR-0.9% NACL NOREPINEPHRINE BITARTRATE-D5W NOREPINEPHRINE BITARTRATE-NS PERFOROMIST PILL SPLITTER PRIMATENE MIST PROAIR HFA PROAIR RESPICLICK PROVENTIL HFA RACEPINEPHRINE S2 RACEPINEPHRINE SEREVENT DISKUS SINGULAIR SPIRIVA SPIRIVA RESPIMAT STAY AWAKE STRIVERDI RESPIMAT SYMBICORT THEO-24 THEOCHRON THEOPHYLLINE THEOPHYLLINE IN 5% DEXTROSE TUDORZA PRESSAIR TWINJECT VENTOLIN HFA VIVARIN VOSPIRE ER XOLAIR XOPENEX XOPENEX CONCENTRATE XOPENEX HFA 16 GENERIC DRUG EPINEPHRINE FORMOTEROL FUMARATE UMECLIDINIUM BROMIDE IPRATROPIUM BROMIDE IPRATROPIUM/ALBUTEROL SULFATE ISOPROTERENOL HCL ISOPROTERENOL HCL GUAIFENESIN/DYPHYLLINE LEVALBUTEROL HCL LEVALBUTEROL HCL NOREPINEPHRINE BITARTRATE DYPHYLLINE GUAIFENESIN/DYPHYLLINE PIRBUTEROL ACETATE METAPROTERENOL SULFATE MONTELUKAST SODIUM CAFFEINE NOREPI BIT IN 0.9 % NACL/PF NOREPINEPHRINE BITARTRATE NOREPINEPHRINE BITARTRATE/D5W NOREPINEPHRINE BIT/0.9 % NACL FORMOTEROL FUMARATE MISCELLANEOUS MEDICAL SUPPLY EPINEPHRINE ALBUTEROL SULFATE ALBUTEROL SULFATE ALBUTEROL SULFATE RACEPINEPHRINE HCL RACEPINEPHRINE HCL SALMETEROL XINAFOATE MONTELUKAST SODIUM TIOTROPIUM BROMIDE TIOTROPIUM BROMIDE CAFFEINE OLODATEROL HCL BUDESONIDE/FORMOTEROL FUMARATE TERBUTALINE SULFATE THEOPHYLLINE ANHYDROUS THEOPHYLLINE ANHYDROUS THEOPHYLLINE ANHYDROUS THEOPHYLLINE ANHYDROUS THEOPHYLLINE/D5W THERMOMETER PROBE COVERS ACLIDINIUM BROMIDE EPINEPHRINE ALBUTEROL SULFATE CAFFEINE ALBUTEROL SULFATE OMALIZUMAB LEVALBUTEROL HCL LEVALBUTEROL HCL LEVALBUTEROL TARTRATE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION ASTHMA ASTHMA ASTHMA AUTONOMIC NERVOUS SYSTEM DISORDERS AUTONOMIC NERVOUS SYSTEM DISORDERS AUTONOMIC NERVOUS SYSTEM DISORDERS AUTONOMIC NERVOUS SYSTEM DISORDERS AUTONOMIC NERVOUS SYSTEM DISORDERS AUTONOMIC NERVOUS SYSTEM DISORDERS AUTONOMIC NERVOUS SYSTEM DISORDERS AUTONOMIC NERVOUS SYSTEM DISORDERS AUTONOMIC NERVOUS SYSTEM DISORDERS AUTONOMIC NERVOUS SYSTEM DISORDERS AUTONOMIC NERVOUS SYSTEM DISORDERS AUTONOMIC NERVOUS SYSTEM DISORDERS AUTONOMIC NERVOUS SYSTEM DISORDERS AUTONOMIC NERVOUS SYSTEM DISORDERS AUTONOMIC NERVOUS SYSTEM DISORDERS AUTONOMIC NERVOUS SYSTEM DISORDERS AUTONOMIC NERVOUS SYSTEM DISORDERS AUTONOMIC NERVOUS SYSTEM DISORDERS AUTONOMIC NERVOUS SYSTEM DISORDERS AUTONOMIC NERVOUS SYSTEM DISORDERS AUTONOMIC NERVOUS SYSTEM DISORDERS AUTONOMIC NERVOUS SYSTEM DISORDERS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BRAND DRUG ZYFLO ZYFLO CR ARICEPT ARICEPT ODT BLOXIVERZ DONEPEZIL HCL ODT ENLON ENLON-PLUS EXELON GALANTAMINE HYDROBROMIDE MESTINON MYTELASE NAMENDA NAMENDA XR NEOSTIGMINE METHYLSULFATE PROSTIGMIN RAZADYNE RAZADYNE ER REGONOL RIVASTIGMINE AMITRIPTYLINE-CHLORDIAZEPOXIDE AMITRIPTYLINE-PERPHENAZINE ANAFRANIL APLENZIN BRINTELLIX BRISDELLE BUDEPRION SR BUDEPRION XL BUPROPION HCL SR BUPROPION XL CELEXA CHLORDIAZEPOXIDE-AMITRIPTYLINE CITALOPRAM HBR CYMBALTA DESVENLAFAXINE ER DESVENLAFAXINE FUMARATE ER EFFEXOR EFFEXOR XR FETZIMA 17 GENERIC DRUG ZAFIRLUKAST ZILEUTON ZILEUTON DONEPEZIL HCL DONEPEZIL HCL NEOSTIGMINE METHYLSULFATE DONEPEZIL HCL DONEPEZIL HCL EDROPHONIUM CHLORIDE EDROPHONIUM CHLORIDE/ATROPINE RIVASTIGMINE GALANTAMINE HBR GALANTAMINE HBR PYRIDOSTIGMINE BROMIDE AMBENONIUM CHLORIDE MEMANTINE HCL MEMANTINE HCL PHYSOSTIGMINE SALICYLATE NEOSTIGMINE BROMIDE PYRIDOSTIGMINE BROMIDE GALANTAMINE HBR GALANTAMINE HBR PYRIDOSTIGMINE BROMIDE RIVASTIGMINE TARTRATE AMITRIPTYLINE HCL AMITRIP HCL/CHLORDIAZEPOXIDE PERPHENAZINE/AMITRIPTYLINE HCL AMOXAPINE CLOMIPRAMINE HCL BUPROPION HBR VORTIOXETINE HYDROBROMIDE PAROXETINE MESYLATE BUPROPION HCL BUPROPION HCL BUPROPION HCL BUPROPION HCL BUPROPION HCL CITALOPRAM HYDROBROMIDE AMITRIP HCL/CHLORDIAZEPOXIDE CITALOPRAM HYDROBROMIDE CLOMIPRAMINE HCL DULOXETINE HCL DESIPRAMINE HCL DESVENLAFAXINE DESVENLAFAXINE FUMARATE DOXEPIN HCL DULOXETINE HCL VENLAFAXINE HCL VENLAFAXINE HCL ESCITALOPRAM OXALATE LEVOMILNACIPRAN HYDROCHLORIDE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BEHAVIORAL HEALTH - ANTIDEPRESSANTS BRAND DRUG FLUOXETINE DR FLUOXETINE HCL GENERIC DRUG FLUOXETINE HCL FLUVOXAMINE MALEATE ER FORFIVO XL KHEDEZLA LEXAPRO LUVOX CR MARPLAN NARDIL NORPRAMIN OLEPTRO ER PAMELOR PARNATE PAXIL PAXIL CR PERPHENAZINE-AMITRIPTYLINE PEXEVA PRISTIQ ER PROZAC PROZAC WEEKLY PRUDOXIN REMERON SARAFEM SELFEMRA SILENOR SURMONTIL TOFRANIL TOFRANIL-PM VENLAFAXINE HCL ER VIIBRYD VIVACTIL WELLBUTRIN WELLBUTRIN SR WELLBUTRIN XL ZOLOFT ZONALON 18 FLUVOXAMINE MALEATE FLUVOXAMINE MALEATE BUPROPION HCL IMIPRAMINE HCL IMIPRAMINE PAMOATE DESVENLAFAXINE ESCITALOPRAM OXALATE FLUVOXAMINE MALEATE MAPROTILINE HCL ISOCARBOXAZID MIRTAZAPINE PHENELZINE SULFATE NEFAZODONE HCL DESIPRAMINE HCL NORTRIPTYLINE HCL TRAZODONE HCL NORTRIPTYLINE HCL TRANYLCYPROMINE SULFATE PAROXETINE HCL PAROXETINE HCL PAROXETINE HCL PERPHENAZINE/AMITRIPTYLINE HCL PAROXETINE MESYLATE PHENELZINE SULFATE DESVENLAFAXINE SUCCINATE PROTRIPTYLINE HCL FLUOXETINE HCL FLUOXETINE HCL DOXEPIN HCL MIRTAZAPINE FLUOXETINE HCL FLUOXETINE HCL SERTRALINE HCL DOXEPIN HCL ST. JOHN'S WORT TRIMIPRAMINE MALEATE IMIPRAMINE HCL IMIPRAMINE PAMOATE TRANYLCYPROMINE SULFATE TRAZODONE HCL TRIMIPRAMINE MALEATE VENLAFAXINE HCL VENLAFAXINE HCL VILAZODONE HYDROCHLORIDE PROTRIPTYLINE HCL BUPROPION HCL BUPROPION HCL BUPROPION HCL SERTRALINE HCL DOXEPIN HCL KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BRAND DRUG ABILIFY ABILIFY DISCMELT ABILIFY MAINTENA ADASUVE ADDERALL ADDERALL XR ALPRAZOLAM ER ALPRAZOLAM INTENSOL ALPRAZOLAM ODT ALPRAZOLAM XR AMBIEN AMBIEN CR AMMONIA AROMATIC AMMONIA INHALANT AMPHETAMINE SALT COMBO AMYTAL SODIUM ANTABUSE ATIVAN BELSOMRA BUTISOL SODIUM CAMPRAL CARBAMAZEPINE ER CARBAMAZEPINE XR CARBATROL CATAPRES CATAPRES-TTS 1 CATAPRES-TTS 2 CATAPRES-TTS 3 CLONIDINE HCL ER CLOZAPINE ODT CLOZARIL COLACE COLACE CLEAR COL-RITE CONCERTA DAYTRANA DEPADE DESOXYN DEXEDRINE 19 GENERIC DRUG ARIPIPRAZOLE ARIPIPRAZOLE ARIPIPRAZOLE ACAMPROSATE CALCIUM LOXAPINE DEXTROAMPHETAMINE/AMPHETAMINE DEXTROAMPHETAMINE/AMPHETAMINE ALPRAZOLAM ALPRAZOLAM ALPRAZOLAM ALPRAZOLAM ALPRAZOLAM ZOLPIDEM TARTRATE ZOLPIDEM TARTRATE AMMONIA AMMONIA DEXTROAMPHETAMINE/AMPHETAMINE AMOBARBITAL SODIUM DISULFIRAM LORAZEPAM SUVOREXANT BUSPIRONE HCL BUTABARBITAL SODIUM ACAMPROSATE CALCIUM CARBAMAZEPINE CARBAMAZEPINE CARBAMAZEPINE CARBAMAZEPINE CLONIDINE HCL CLONIDINE CLONIDINE CLONIDINE CHLORAL HYDRATE CHLORDIAZEPOXIDE HCL CHLORPROMAZINE HCL CLONIDINE CLONIDINE HCL CLONIDINE HCL CLORAZEPATE DIPOTASSIUM CLOZAPINE CLOZAPINE CLOZAPINE DOCUSATE SODIUM DOCUSATE SODIUM DOCUSATE SODIUM METHYLPHENIDATE HCL METHYLPHENIDATE NALTREXONE HCL METHAMPHETAMINE HCL DEXTROAMPHETAMINE SULFATE DEXMEDETOMIDINE HCL DEXMETHYLPHENIDATE HCL KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BRAND DRUG DEXMETHYLPHENIDATE HCL ER DEXTROAMPHETAMINE SULFATE ER DEXTROAMPHETAMINE-AMPHET ER DIASTAT DIASTAT ACUDIAL DIOCTO DIOCTYL DOC-Q-LACE DOCU LIQUID DOCU SOFT DOCUPRENE DOCUSIL DOCUSOFT S DOCUSOL DOCUSOL KIDS DOK DOPRAM DORAL DSS DULCOLAX STOOL SOFTENER EDLUAR EMSAM ENEMEEZ EPITOL EQUETRO EVEKEO EVZIO FANAPT FAZACLO FOCALIN FOCALIN XR GEODON GUANFACINE HCL ER HALCION HALDOL HALDOL DECANOATE 100 HALDOL DECANOATE 50 20 GENERIC DRUG DEXMETHYLPHENIDATE HCL DEXTROAMPHETAMINE SULFATE DEXTROAMPHETAMINE SULFATE DEXTROAMPHETAMINE/AMPHETAMINE DIAZEPAM DIAZEPAM DIAZEPAM DOCUSATE SODIUM DOCUSATE SODIUM DISULFIRAM DOCUSATE SODIUM DOCUSATE SODIUM DOCUSATE SODIUM DOCUSATE SODIUM DOCUSATE SODIUM DOCUSATE SODIUM DOCUSATE SODIUM DOCUSATE SODIUM DOCUSATE SODIUM DOXAPRAM HCL QUAZEPAM DOXAPRAM HCL DROPERIDOL DOCUSATE SODIUM DOCUSATE SODIUM ZOLPIDEM TARTRATE SELEGILINE DOCUSATE SODIUM CARBAMAZEPINE CARBAMAZEPINE ESTAZOLAM ESZOPICLONE AMPHETAMINE SULFATE NALOXONE HCL ILOPERIDONE CLOZAPINE FLUMAZENIL FLUPHENAZINE DECANOATE FLUPHENAZINE HCL FLURAZEPAM HCL DEXMETHYLPHENIDATE HCL DEXMETHYLPHENIDATE HCL ZIPRASIDONE HCL GLUTETHIMIDE GUANFACINE HCL GUANFACINE HCL TRIAZOLAM HALOPERIDOL LACTATE HALOPERIDOL DECANOATE HALOPERIDOL DECANOATE HALOPERIDOL HALOPERIDOL DECANOATE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BRAND DRUG HALOPERIDOL DECANOATE 100 HETLIOZ INTERMEZZO INTUNIV INVEGA INVEGA SUSTENNA KAPVAY LATUDA LITHIUM LITHIUM CARBONATE ER LITHOBID LORAZEPAM LORAZEPAM INTENSOL LORAZEPAM-0.9% NACL LORAZEPAM-D5W LOXAPINE LOXITANE L-TRYPTOPHAN LUMINAL SODIUM LUNESTA LYDIA PINKHAM HERBAL MEDI-DOZE MELADOX MELATONEX MELATONIN MELATONIN 1MG TAB MELATONIN WITH VITAMIN B-6 MELATONIN-CHAMOMILE METADATE CD METADATE ER METHYLIN METHYLIN ER METHYLPHENIDATE ER METHYLPHENIDATE HCL CD METHYLPHENIDATE LA METHYLPHENIDATE SR MIDNITE MOBAN NAVANE NEMBUTAL SODIUM NEO-FRADIN 21 GENERIC DRUG HALOPERIDOL DECANOATE HALOPERIDOL LACTATE TASIMELTEON ZOLPIDEM TARTRATE GUANFACINE HCL PALIPERIDONE PALIPERIDONE PALMITATE CLONIDINE HCL LURASIDONE HCL LITHIUM CITRATE LITHIUM CARBONATE LITHIUM CARBONATE LITHIUM CITRATE LITHIUM CARBONATE LORAZEPAM LORAZEPAM/0.9% SODIUM CHLORIDE LORAZEPAM/D5W LOXAPINE SUCCINATE LOXAPINE SUCCINATE TRYPTOPHAN PHENOBARBITAL SODIUM ESZOPICLONE ETHYL ALCOHOL/HERBAL DRUGS MELATONIN/GABA/VALERIAN MELATONIN MELATONIN/PYRIDOXINE HCL (B6) CALCIUM PHOSPHATE/MELATONIN MELATONIN MELATONIN/PYRIDOXAL PHOSPHATE MELATONIN/CHAMOMILE FLOWERS MEPROBAMATE METHYLPHENIDATE HCL METHYLPHENIDATE HCL METHAMPHETAMINE HCL METHYLPHENIDATE HCL METHYLPHENIDATE HCL METHYLPHENIDATE HCL METHYLPHENIDATE HCL METHYLPHENIDATE HCL METHYLPHENIDATE HCL METHYLPHENIDATE HCL MIDAZOLAM HCL MELATONIN/HERBAL NO.233 MOLINDONE HCL MODAFINIL NALOXONE HCL NALTREXONE HCL THIOTHIXENE PENTOBARBITAL SODIUM NEOMYCIN SULFATE NEOMYCIN SULFATE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BRAND DRUG NEXICLON XR NIRAVAM NUVIGIL OLANZAPINE ODT OLANZAPINE-FLUOXETINE HCL ORAP PEDIA-LAX STOOL SOFTENER GENERIC DRUG CLONIDINE HCL ALPRAZOLAM ARMODAFINIL OLANZAPINE OLANZAPINE OLANZAPINE/FLUOXETINE HCL PIMOZIDE OXAZEPAM DOCUSATE SODIUM PENTOBARBITAL SODIUM PERPHENAZINE PHENOBARBITAL-NS PHILLIPS' LAXATIVE PRECEDEX PROCENTRA PROMOLAXIN PROVIGIL QUILLIVANT XR RESTONE RESTORIL REVIA RISPERDAL RISPERDAL CONSTA RISPERDAL M-TAB RISPERIDONE ODT RITALIN RITALIN LA RITALIN-SR ROMAZICON ROZEREM SAPHRIS SECONAL SODIUM SEROQUEL SEROQUEL XR SILACE SINTRALYNE-PM SLEEP SOF-LAX SOMNICIN SOMNOTE SONATA SORE THROAT LOZENGE SORE THROAT SPRAY STOOL SOFTENER STRATTERA SYMBYAX TEGRETOL 22 PHENOBARBITAL PHENOBARBITAL SODIUM PHENOBARBITAL/0.9 % SOD CHLOR DOCUSATE SODIUM DEXMEDETOMIDINE HCL DEXTROAMPHETAMINE SULFATE DOCUSATE SODIUM MODAFINIL QUAZEPAM QUETIAPINE FUMARATE METHYLPHENIDATE HCL MELATONIN/TRYPTOPHAN TEMAZEPAM NALTREXONE HCL RISPERIDONE RISPERIDONE MICROSPHERES RISPERIDONE RISPERIDONE RISPERIDONE METHYLPHENIDATE HCL METHYLPHENIDATE HCL METHYLPHENIDATE HCL FLUMAZENIL RAMELTEON ASENAPINE MALEATE SECOBARBITAL SODIUM QUETIAPINE FUMARATE QUETIAPINE FUMARATE DOCUSATE SODIUM MELATONIN/GABA/HERBAL NO.183 MELATONIN/HERBAL COMPLEX #184 DOCUSATE SODIUM MELATON/5-HYDROXY/TRYPT/B6/MAG CHLORAL HYDRATE ZALEPLON BENZOCAINE/MENTHOL PHENOL/SODIUM PHENOLATE DOCUSATE SODIUM ATOMOXETINE HCL OLANZAPINE/FLUOXETINE HCL CARBAMAZEPINE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER BEHAVIORAL HEALTH - OTHER CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA BRAND DRUG TEGRETOL XR TENEX THROAT SPRAY TRANXENE T-TAB VACUANT VALIUM VANSPAR VERSACLOZ VIVITROL VYVANSE WOMENS STOOL SOFTENER WRESTONE XANAX XANAX XR XYREM ZENZEDI ZOLPIDEM TARTRATE ER ZOLPIMIST ZYPREXA ZYPREXA RELPREVV ZYPREXA ZYDIS ADENOCARD AKTEN AMIODARONE HCL-D5W CORDARONE CORVERT GLYDO LIDAMANTLE LIDOCAINE HCL IN 5% DEXTROSE LIDOCAINE HCL VISCOUS LIDOPIN LIDORX MULTAQ MULTIVITAMIN AND FLUORIDE MULTI-VITAMIN W-FLUORIDE-IRON MULTIVITAMINS W-FLUORIDE-IRON 23 GENERIC DRUG CARBAMAZEPINE TEMAZEPAM GUANFACINE HCL THIORIDAZINE HCL THIOTHIXENE PHENOL/SODIUM PHENOLATE CLORAZEPATE DIPOTASSIUM TRIAZOLAM TRIFLUOPERAZINE HCL DOCUSATE SODIUM DIAZEPAM BUSPIRONE HCL CLOZAPINE NALTREXONE MICROSPHERES LISDEXAMFETAMINE DIMESYLATE DOCUSATE SODIUM MELATONIN/TRYPTOPHAN ALPRAZOLAM ALPRAZOLAM SODIUM OXYBATE ZALEPLON DEXTROAMPHETAMINE SULFATE ZIPRASIDONE HCL ZOLPIDEM TARTRATE ZOLPIDEM TARTRATE ZOLPIDEM TARTRATE OLANZAPINE OLANZAPINE PAMOATE OLANZAPINE ADENOSINE ADENOSINE LIDOCAINE HCL/PF AMIODARONE HCL AMIODARONE HCL/D5W AMIODARONE HCL IBUTILIDE FUMARATE DISOPYRAMIDE PHOSPHATE FLECAINIDE ACETATE LIDOCAINE HCL IBUTILIDE FUMARATE LIDOCAINE HCL LIDOCAINE LIDOCAINE HCL LIDOCAINE HCL/D5W/PF LIDOCAINE HCL LIDOCAINE HCL LIDOCAINE HCL MEXILETINE HCL DRONEDARONE HCL PEDI MULTIVIT NO.2 W-FLUORIDE PEDI MV #45/FLUORIDE/IRON PEDI MV #45/FLUORIDE/IRON KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - ARRHYTHMIA CARDIOVASCULAR DISEASE - CARDIAC STIMULANT CARDIOVASCULAR DISEASE - CARDIAC STIMULANT CARDIOVASCULAR DISEASE - CARDIAC STIMULANT CARDIOVASCULAR DISEASE - CARDIAC STIMULANT CARDIOVASCULAR DISEASE - CARDIAC STIMULANT CARDIOVASCULAR DISEASE - CARDIAC STIMULANT CARDIOVASCULAR DISEASE - CARDIAC STIMULANT CARDIOVASCULAR DISEASE - CARDIAC STIMULANT CARDIOVASCULAR DISEASE - CARDIAC STIMULANT CARDIOVASCULAR DISEASE - CARDIAC STIMULANT CARDIOVASCULAR DISEASE - CARDIAC STIMULANT CARDIOVASCULAR DISEASE - CARDIAC STIMULANT CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION BRAND DRUG NEXTERONE NORPACE NORPACE CR PACERONE PHLUORIVIT + FE POLYVITAMIN WITH IRON-FLUORIDE PROPAFENONE HCL ER RADIAGUARD RYTHMOL RYTHMOL SR TAMBOCOR TIKOSYN XOLIDO XOLIDO XP XYLOCAINE XYLOCAINE IV XYLOCAINE-MPF DIGITEK DIGOX DIGOXIN DOBUTAMINE HCL IN DEXTROSE INAMRINONE LANOXIN LANOXIN PEDIATRIC MILRINONE IN 5% DEXTROSE SOMA ACCUPRIL ACCURETIC ACEON ADALAT CC ADCIRCA ADEMPAS ADULT GLYCERIN AFEDITAB CR ALDACTAZIDE ALDACTONE ALTACE ALTOPREV ALUVEA AMILORIDE-HYDROCHLOROTHIAZIDE AMLODIPINE BESYLATE-BENAZEPRIL 24 GENERIC DRUG AMIODARONE IN DEXTROSE,ISO-OSM DISOPYRAMIDE PHOSPHATE DISOPYRAMIDE PHOSPHATE AMIODARONE HCL MULTIVITS WITH IRON & FLUORIDE MULTIVITS WITH IRON & FLUORIDE PROCAINAMIDE HCL PROPAFENONE HCL PROPAFENONE HCL QUINIDINE GLUCONATE QUINIDINE SULFATE LIDOCAINE HCL PROPAFENONE HCL PROPAFENONE HCL FLECAINIDE ACETATE DOFETILIDE LIDOCAINE HCL LIDOCAINE HCL LIDOCAINE HCL LIDOCAINE HCL/PF LIDOCAINE HCL CARISOPRODOL DIGOXIN DIGOXIN DOBUTAMINE HCL DOBUTAMINE HCL/D5W INAMRINONE LACTATE DIGOXIN DIGOXIN MILRINONE LACTATE/D5W MILRINONE LACTATE CARISOPRODOL QUINAPRIL HCL QUINAPRIL/HYDROCHLOROTHIAZIDE ACEBUTOLOL HCL PERINDOPRIL ERBUMINE NIFEDIPINE TADALAFIL RIOCIGUAT GLYCERIN NIFEDIPINE SPIRONOLACT/HYDROCHLOROTHIAZID SPIRONOLACTONE ALPROSTADIL RAMIPRIL LOVASTATIN UREA AMILORIDE HCL AMILORIDE/HYDROCHLOROTHIAZIDE AMLODIPINE BESYLATE AMLODIPINE BESYLATE/BENAZEPRIL KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION BRAND DRUG AMLODIPINE-VALSARTAN AMLODIPINE-VALSARTAN-HCTZ AMTURNIDE ANTI-RESIDUE SHAMPOO AQUA CARE AQUA GLYCOLIC AQUANIL ATACAND ATACAND HCT ATENOLOL-CHLORTHALIDONE ATRAC-TAIN AVALIDE AVAPRO AZOR BENAZEPRIL-HYDROCHLOROTHIAZIDE BENICAR BENICAR HCT BETAPACE BETAPACE AF BETOPTIC S BIDIL BISOPROLOL-HYDROCHLOROTHIAZIDE BREVIBLOC BYSTOLIC CALAN CALAN SR CALMME CANDESARTANHYDROCHLOROTHIAZID CAPTOPRIL-HYDROCHLOROTHIAZIDE CARB-O-PHILIC CARDENE I.V. CARDENE SR CARDIZEM CARDIZEM CD CARDIZEM LA CARDURA CARDURA XL CARMOL CARMOL 10 CARMOL 20 CARMOL 40 CARTIA XT 25 GENERIC DRUG AMLODIPINE/VALSARTAN AMLODIPINE/VALSARTAN/HCTHIAZID AMMONIUM CHLORIDE ALISKIREN/AMLODIPIN/HCTHIAZIDE GLYCERIN UREA GLYCERIN SKIN CLEANSER COMB NO.15 CANDESARTAN CILEXETIL CANDESARTAN/HYDROCHLOROTHIAZID ATENOLOL ATENOLOL/CHLORTHALIDONE UREA IRBESARTAN/HYDROCHLOROTHIAZIDE IRBESARTAN AMLODIPINE BES/OLMESARTAN MED BENAZEPRIL HCL BENAZEPRIL/HYDROCHLOROTHIAZIDE OLMESARTAN MEDOXOMIL OLMESARTAN/HYDROCHLOROTHIAZIDE SOTALOL HCL SOTALOL HCL BETAXOLOL HCL BETAXOLOL HCL ISOSORB DINIT/HYDRALAZINE HCL BISOPROLOL FUMARATE BISOPROLOL FUMARATE/HCTZ ESMOLOL HCL BUMETANIDE NEBIVOLOL HCL VERAPAMIL HCL VERAPAMIL HCL HERBAL DRUGS CANDESARTAN CILEXETIL CANDESARTAN/HYDROCHLOROTHIAZID CAPTOPRIL CAPTOPRIL/HYDROCHLOROTHIAZIDE UREA NICARDIPINE HCL NICARDIPINE HCL DILTIAZEM HCL DILTIAZEM HCL DILTIAZEM HCL DOXAZOSIN MESYLATE DOXAZOSIN MESYLATE UREA UREA UREA UREA CARTEOLOL HCL DILTIAZEM HCL CARVEDILOL KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION BRAND DRUG CEM-UREA CEROVEL CHILD SUPPOSITORY CLEVIPREX CLORPRES COLON HERBAL CLEANSER COREG COREG CR CORGARD CORLOPAM CORN HUSKERS CORZIDE COVERA-HS COZAAR DEMADEX DEMSER DIBENZYLINE DILACOR XR DILT-CD DILTIA XT DILTIAZEM 12HR ER DILTIAZEM 24HR CD DILTIAZEM 24HR ER DILTIAZEM ER DILTIAZEM HCL-NS DILTIAZEM-D5W DILT-XR DILTZAC ER DIOVAN DIOVAN HCT DIURETIC SOFTGEL DIUREX MAX DIURIL DIURIL SODIUM DUTOPROL DYAZIDE DYNACIRC CR DYRENIUM EDARBI EDARBYCLOR EDECRIN ENALAPRILAT ENALAPRIL-HYDROCHLOROTHIAZIDE ENDOCET EPANED 26 GENERIC DRUG UREA UREA GLYCERIN CHLOROTHIAZIDE CHLOROTHIAZIDE SODIUM CHLORTHALIDONE CLEVIDIPINE BUTYRATE CLONIDINE HCL/CHLORTHALIDONE HERBAL DRUGS CARVEDILOL CARVEDILOL PHOSPHATE NADOLOL FENOLDOPAM MESYLATE GLYCERIN NADOLOL/BENDROFLUMETHIAZIDE VERAPAMIL HCL LOSARTAN POTASSIUM TORSEMIDE METYROSINE PHENOXYBENZAMINE HCL DILTIAZEM HCL DILTIAZEM HCL DILTIAZEM HCL DILTIAZEM HCL DILTIAZEM HCL DILTIAZEM HCL DILTIAZEM HCL DILTIAZEM HCL DILTIAZEM HCL IN 0.9% NACL DILTIAZEM HCL/D5W DILTIAZEM HCL DILTIAZEM HCL VALSARTAN VALSARTAN/HYDROCHLOROTHIAZIDE PAMABROM PAMABROM CHLOROTHIAZIDE CHLOROTHIAZIDE SODIUM DOXAZOSIN MESYLATE METOPROLOL SUCCINATE/HCTZ TRIAMTERENE/HYDROCHLOROTHIAZID ISRADIPINE TRIAMTERENE AZILSARTAN MEDOXOMIL AZILSARTAN MED/CHLORTHALIDONE ETHACRYNIC ACID ENALAPRIL MALEATE ENALAPRILAT DIHYDRATE ENALAPRIL/HYDROCHLOROTHIAZIDE OXYCODONE HCL/ACETAMINOPHEN ENALAPRIL MALEATE EPLERENONE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION BRAND DRUG EPOPROSTENOL SODIUM EXFORGE EXFORGE HCT FELODIPINE ER FLOLAN FOSINOPRIL-HYDROCHLOROTHIAZIDE FRAGARIA VITIS FUROSEMIDE-0.9 % NACL FUROSEMIDE-0.9% NACL GLYCERIN GLYCERIN AND ROSE WATER GORDO-UREA GORMEL GORMEL 10 HEALON PF HEEL BALM HEMANGEOL HYDRALAZINE W/HCTZ HYDRO 35 HYDRO 40 HYTRIN HYZAAR INDERAL LA INDERAL XL INFANT GLYCERIN INNOPRAN XL INSPRA INTROL IRBESARTAN-HYDROCHLOROTHIAZIDE ISOPTIN SR ISTALOL KERAFOAM KERALAC KERLONE KEROL LASIX LETAIRIS LEVATOL LISINOPRIL-HYDROCHLOROTHIAZIDE 27 GENERIC DRUG EPOPROSTENOL SODIUM (GLYCINE) EPROSARTAN MESYLATE ESMOLOL HCL AMLODIPINE/VALSARTAN AMLODIPINE/VALSARTAN/HCTHIAZID FELODIPINE FENOLDOPAM MESYLATE EPOPROSTENOL SODIUM (GLYCINE) FOSINOPRIL SODIUM FOSINOPRIL/HYDROCHLOROTHIAZIDE HERBAL DRUGS FUROSEMIDE FUROSEMIDE IN 0.9 % NACL FUROSEMIDE IN 0.9 % NACL GLYCERIN UREA UREA UREA GUANABENZ ACETATE UREA PROPRANOLOL HCL HYDRALAZINE HCL HYDRALAZINE/HYDROCHLOROTHIAZID UREA UREA HYDROCHLOROTHIAZIDE TERAZOSIN HCL LOSARTAN/HYDROCHLOROTHIAZIDE INDAPAMIDE PROPRANOLOL HCL PROPRANOLOL HCL GLYCERIN PROPRANOLOL HCL EPLERENONE GLYCERIN IRBESARTAN IRBESARTAN/HYDROCHLOROTHIAZIDE VERAPAMIL HCL ISRADIPINE TIMOLOL MALEATE UREA UREA BETAXOLOL HCL UREA LABETALOL HCL FUROSEMIDE AMBRISENTAN PENBUTOLOL SULFATE LISINOPRIL LISINOPRIL/HYDROCHLOROTHIAZIDE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION BRAND DRUG LOPRESSOR LOPRESSOR HCT LOSARTAN-HYDROCHLOROTHIAZIDE LOTENSIN LOTENSIN HCT LOTREL MAGNACET MATZIM LA MAVIK MAXIMUM ENERGY MAXZIDE MAXZIDE-25 MG METHYLDOPAHYDROCHLOROTHIAZIDE METOPROLOL TARTRATE METOPROLOLHYDROCHLOROTHIAZIDE MEVACOR MICARDIS MICARDIS HCT MICROZIDE MIDAMOR MINIPRESS MOEXIPRIL-HYDROCHLOROTHIAZIDE NADOLOL-BENDROFLUMETHIAZIDE NICARDIPINE HCL-D5W NIFEDIAC CC NIFEDICAL XL NIFEDIPINE ER NITROPRESS NORVASC NORWEGIAN FORMULA NUTRAPLUS NYMALIZE OASIS OPSUMIT ORENITRAM ER OSMITROL OXYCODONE-ACETAMINOPHEN 28 GENERIC DRUG METOPROLOL TARTRATE METOPROLOL/HYDROCHLOROTHIAZIDE LOSARTAN POTASSIUM LOSARTAN/HYDROCHLOROTHIAZIDE BENAZEPRIL HCL BENAZEPRIL/HYDROCHLOROTHIAZIDE AMLODIPINE BESYLATE/BENAZEPRIL LOVASTATIN OXYCODONE HCL/ACETAMINOPHEN MANNITOL DILTIAZEM HCL TRANDOLAPRIL HERBAL DRUGS TRIAMTERENE/HYDROCHLOROTHIAZID TRIAMTERENE/HYDROCHLOROTHIAZID METHYCLOTHIAZIDE METHYLDOPA METHYLDOPA/HYDROCHLOROTHIAZIDE METHYLDOPATE HCL METOLAZONE METOPROLOL SUCCINATE METOPROLOL/HYDROCHLOROTHIAZIDE LOVASTATIN TELMISARTAN TELMISARTAN/HYDROCHLOROTHIAZID HYDROCHLOROTHIAZIDE AMILORIDE HCL PRAZOSIN HCL MINOXIDIL MOEXIPRIL HCL MOEXIPRIL/HYDROCHLOROTHIAZIDE NADOLOL NADOLOL/BENDROFLUMETHIAZIDE NICARDIPINE HCL NICARDIPINE IN D5W NIFEDIPINE NIFEDIPINE NIFEDIPINE NIFEDIPINE NIMODIPINE NISOLDIPINE NITROPRUSSIDE SODIUM AMLODIPINE BESYLATE GLYCERIN UREA NIMODIPINE GLYCERIN MACITENTAN TREPROSTINIL DIOLAMINE MANNITOL OXYCODONE HCL/ACETAMINOPHEN KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION BRAND DRUG PEDIA-LAX PERCOCET PERMED HAIR SHAMPOO PHENTOLAMINE MESYLATE PRIMLEV PRINIVIL PRINZIDE PROCARDIA PROCARDIA XL PROGLYCEM PROPRANOLOL HCL ER PROPRANOLOLHYDROCHLOROTHIAZID PROSTIN VR PEDIATRIC QUINAPRIL-HYDROCHLOROTHIAZIDE RAINBATH REA LO 30 REA LO 39 REA LO 40 REMEVEN REMODULIN RESECTISOL RE-U40 REVATIO ROXICET SANI-SUPP SECTRAL SILDENAFIL SODIUM DIURIL SODIUM EDECRIN SORINE SOTALOL SOTALOL AF SOTALOL HCL SOTYLIZE SPIRONOLACTONE-HCTZ SULAR SUPER ENERGY SUPPOSITORY TARKA TAZTIA XT TEKAMLO TEKTURNA TEKTURNA HCT 29 GENERIC DRUG GLYCERIN OXYCODONE HCL/ACETAMINOPHEN PERINDOPRIL ERBUMINE GLYCERIN PINDOLOL PRAZOSIN HCL OXYCODONE HCL/ACETAMINOPHEN LISINOPRIL LISINOPRIL/HYDROCHLOROTHIAZIDE NIFEDIPINE NIFEDIPINE DIAZOXIDE PROPRANOLOL HCL PROPRANOLOL HCL PROPRANOLOL/HYDROCHLOROTHIAZID ALPROSTADIL QUINAPRIL HCL QUINAPRIL/HYDROCHLOROTHIAZIDE GLYCERIN RAMIPRIL UREA UREA UREA UREA TREPROSTINIL SODIUM MANNITOL RESERPINE UREA SILDENAFIL CITRATE OXYCODONE HCL/ACETAMINOPHEN GLYCERIN ACEBUTOLOL HCL SILDENAFIL CITRATE CHLOROTHIAZIDE SODIUM ETHACRYNATE SODIUM SOTALOL HCL SOTALOL HCL SOTALOL HCL SOTALOL HCL SPIRONOLACTONE SPIRONOLACT/HYDROCHLOROTHIAZID NISOLDIPINE HERBAL DRUGS GLYCERIN TRANDOLAPRIL/VERAPAMIL HCL DILTIAZEM HCL ALISKIREN/AMLODIPINE BESYLATE ALISKIREN HEMIFUMARATE ALISKIREN/HYDROCHLOROTHIAZIDE TELMISARTAN KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION BRAND DRUG TELMISARTAN-AMLODIPINE TELMISARTANHYDROCHLOROTHIAZID TENORETIC 100 TENORETIC 50 TENORMIN TEVETEN TEVETEN HCT THALITONE TIAZAC TIMOPTIC TIMOPTIC-XE TL 45% UREA TOPROL XL TRACLEER TRANDATE TRANDOLAPRIL-VERAPAMIL TRANDOLAPRIL-VERAPAMIL ER TRIAMTERENE W/HCTZ TRIAMTERENE-HCTZ TRIAMTERENEHYDROCHLOROTHIAZID TRIBENZOR TWYNSTA TYLOX TYVASO U40 ULTRA MIDE 25 UMECTA UMECTA PD UNIRETIC UNIVASC URAMAXIN URAMAXIN GT UREA 40 UREACIN-10 UREACIN-20 UTOPIC VALSARTAN-HYDROCHLOROTHIAZIDE VALTURNA VASERETIC VASOTEC VECAMYL VELETRI VENTAVIS VERAPAMIL ER VERAPAMIL ER PM 30 GENERIC DRUG TELMISARTAN/AMLODIPINE TELMISARTAN/HYDROCHLOROTHIAZID ATENOLOL/CHLORTHALIDONE ATENOLOL/CHLORTHALIDONE ATENOLOL TERAZOSIN HCL EPROSARTAN MESYLATE EPROSARTAN/HYDROCHLOROTHIAZIDE CHLORTHALIDONE DILTIAZEM HCL TIMOLOL MALEATE TIMOLOL MALEATE TIMOLOL MALEATE UREA METOPROLOL SUCCINATE TORSEMIDE BOSENTAN LABETALOL HCL TRANDOLAPRIL TRANDOLAPRIL/VERAPAMIL HCL TRANDOLAPRIL/VERAPAMIL HCL TRIAMTERENE/HYDROCHLOROTHIAZID TRIAMTERENE/HYDROCHLOROTHIAZID TRIAMTERENE/HYDROCHLOROTHIAZID OLMESARTAN/AMLODIPIN/HCTHIAZID TELMISARTAN/AMLODIPINE OXYCODONE HCL/ACETAMINOPHEN TREPROSTINIL UREA UREA UREA UREA MOEXIPRIL/HYDROCHLOROTHIAZIDE MOEXIPRIL HCL UREA UREA UREA UREA UREA UREA UREA VALSARTAN VALSARTAN/HYDROCHLOROTHIAZIDE ALISKIREN/VALSARTAN ENALAPRIL/HYDROCHLOROTHIAZIDE ENALAPRIL MALEATE MECAMYLAMINE HCL EPOPROSTENOL SODIUM (ARGININE) ILOPROST TROMETHAMINE VERAPAMIL HCL VERAPAMIL HCL VERAPAMIL HCL KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - HYPERTENSION CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY BRAND DRUG VERAPAMIL SR VERELAN VERELAN PM WIBI XARTEMIS XR XOLOX X-VIATE ZAROXOLYN ZEBETA ZESTORETIC ZESTRIL ZIAC ADVICOR ALGAL OMEGA-3 DHA ALGAL-900 DHA ALMEBEX PLUS B-12 ANTARA ATABEX DHA CARDIO OMEGA BENEFITS CARDIOSTAT CARDIOSTEROL CHOLEST CARE CHOLESTEROL FIGHTER CHOLESTYRAMINE CHOLESTYRAMINE LIGHT CHOLINOID CHONDROITIN SULFATE COLESTID COROMEGA COROMEGA GO PAK COROMEGA GO-PAK COROMEGA PRENATAL OMEGA BABY CRESTOR DHA DHA ALGAL-900 DHA COMPLETE DHA PRENATAL DRY EYE OMEGA BENEFITS ENDUR-ACIN EPA-DHA 720 EXPECTA LIPIL FENOGLIDE FIBRICOR FISH OIL FISH OIL + D3 FISH OIL + VITAMIN D-3 FISH OIL CONCENTRATE FISH OIL HIGH POTENCY 31 GENERIC DRUG VERAPAMIL HCL VERAPAMIL HCL VERAPAMIL HCL GLYCERIN OXYCODONE HCL/ACETAMINOPHEN OXYCODONE HCL/ACETAMINOPHEN UREA METOLAZONE BISOPROLOL FUMARATE LISINOPRIL/HYDROCHLOROTHIAZIDE LISINOPRIL BISOPROLOL FUMARATE/HCTZ NIACIN/LOVASTATIN DOCOSAHEXANOIC ACID DOCOSAHEXANOIC ACID CHOLINE BIT/B COMP/B12/NIACIN FENOFIBRATE,MICRONIZED DOCOSAHEXANOIC ACID/EPA ATORVASTATIN CALCIUM OMEGA-3S/DHA/EPA/FISH OIL/D3 OMEGA-3/DHA/EPA/FISH OIL PHYTOSTEROL/OM-3/DHA/EPA/FISH PHYTOSTEROL COMBINATION NO.1 LECI/SITOSTEROLS/NIA/BETN/CHIT CHOLESTYRAMINE (WITH SUGAR) CHOLESTYRAMINE/ASPARTAME INOSI/CHOLINE BIT/VIT BCOMP&C CHONDROITIN SULFATE A COLESTIPOL HCL COLESTIPOL HCL FISH OIL/OMEGA-3/VIT C/VIT E OMEGA-3/DHA/EPA/FISH OIL FISH OIL/OMEGA-3/VIT C/VIT E OMEGA-3/DHA/EPA/FISH OIL ROSUVASTATIN CALCIUM DOCOSAHEXANOIC ACID DOCOSAHEXANOIC ACID DOCOSAHEXANOIC ACID DOCOSAHEXANOIC ACID OMEGA-3S/DHA/EPA/FISH OIL/D3 NIACIN OMEGA-3/DHA/EPA/FISH OIL DOCOSAHEXANOIC ACID FENOFIBRATE FENOFIBRIC ACID FENOFIBRATE FENOFIBRIC ACID DOCOSAHEXANOIC ACID/EPA OMEGA-3S/DHA/EPA/FISH OIL/D3 OMEGA3/DHA/EPA/FISH OIL/VIT D3 OMEGA-3 FATTY ACIDS OMEGA-3/DHA/EPA/FISH OIL KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY BRAND DRUG FISH OIL OMEGA-3 FISH OIL PEARLS FISH OIL ULTRA FISH OIL WITH KRILL FISH OIL-OMEGA-3-VIT D FISH OIL-PHYTOSTEROLS FISH OIL-VIT D3 FISH-FLAX-BORAGE OIL FISH-FLAX-BORAGE OILS FLAXSEED-FISH-BORAGE OIL FLEX OMEGA BENEFITS FORTIFIED CHROMIUM PICOLINATE GRAM-O-LECI JUXTAPID KYNAMRO LESCOL LESCOL XL LIPICHOL 540 LIPITOR LIPOCHOL LIPOCHOL PLUS LIPOFEN LIPOGEN LIPOTRIAD LIPTRUZET LIVALO LOFIBRA LOPID LOVAZA MAREPA MAXEPA MEGAKRILL MEGARED PLANT-OMEGA-3 NIACIN ER NIACIN FLUSH FREE NIACIN FLUSH-FREE NIACIN INOSITOL NIACIN SR 250MG NIACOR NIASPAN NICOMIDE-T NO FLUSH NIACIN OCEAN BLUE OMEGA-3 OCEAN BLUE OMEGA-3 + D3 OMEGA 3 OMEGA 3 FISH OIL OMEGA 3 LIQUID 32 GENERIC DRUG OMEGA-3 FATTY ACIDS/FISH OIL OMEGA-3 FATTY ACIDS/FISH OIL OMEGA-3/DHA/EPA/FISH OIL KRILL OIL/OMEGA-3/DHA/EPA OMEGA-3S/DHA/EPA/FISH OIL/D3 PHYTOSTEROL/OM-3/DHA/EPA/FISH OMEGA3/DHA/EPA/FISH OIL/VIT D3 FISH,SAF,FLX,BRG OILS/O3,6,9#2 FSH/FLX/PRM/BLK/BOR/OM3,6,9 #6 FLAXSEED OIL FISH OIL/BORAGE/FLAX/OM3,6,9#1 OMEGA3/DHA/EPA/FISH OIL/VIT D3 FLUVASTATIN SODIUM LECITHIN/INOSI/CHOL/CAL/CHROM GEMFIBROZIL LECITHIN LOMITAPIDE MESYLATE KRILL OIL MIPOMERSEN SODIUM LECITHIN FLUVASTATIN SODIUM FLUVASTATIN SODIUM OM3/DHA/EPA/LIPIDS/ASTAX/KRILL ATORVASTATIN CALCIUM METHIONINE/INOSI/CHOL/LYS/B12 METHIONINE/INOSITOL/CHOLINE/FA FENOFIBRATE INOSITOL/CHOLINE/VIT B COMP ANTIOX#13/MIN/FA/LUTEIN/ZEAXAN EZETIMIBE/ATORVASTATIN CALCIUM PITAVASTATIN CALCIUM FENOFIBRATE GEMFIBROZIL OMEGA-3 ACID ETHYL ESTERS DOCOSAHEXANOIC ACID/EPA/VIT E OMEGA-3 FATTY ACIDS KRILL/OMEGA-3/DHA/EPA/LIPIDS OMEGA-3 FATTY ACIDS/DHA/EPA NIACIN NIACIN (INOSITOL NIACINATE) NIACIN (INOSITOL NIACINATE) NIACIN (INOSITOL NIACINATE) NIACIN NIACIN NIACIN NIACINAMIDE NIACIN (INOSITOL NIACINATE) OMEGA-3S/DHA/EPA/FISH OIL OMEGA-3S/DHA/EPA/FISH OIL/D3 OMEGA-3 FATTY ACIDS/FISH OIL OMEGA-3 FATTY ACIDS KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY CARDIOVASCULAR DISEASE - LIPID IRREGULARITY BRAND DRUG OMEGA 3-6-9 OMEGA 3-6-9 COMPLEX OMEGA 3-6-9 FATTY ACIDS OMEGA 3-FISH-FLAX-BORAGE OIL OMEGA ESSENTIALS OMEGA ESSENTIALS BASIC OMEGA POWER OMEGA-3 OMEGA-3 + VITAMIN D3 OMEGA-3 2100 OMEGA-3 FISH OIL OMEGA-3 IQ CHILDREN'S OMEGA-3 KRILL OIL OMEGA-3+ VITAMIN D3 OMEGA-3-FISH OIL-VIT D3 POLICOSANOL-GARLIC-NIACIN PRAVACHOL PRENATAL DHA PREVALITE QUESTRAN QUESTRAN LIGHT RESTORA SALMON OIL SALMON OIL-1000 SEA OMEGA + D SEA-OMEGA 30 SEA-OMEGA 50 SIMCOR SLO-NIACIN SUPER DHA GEMS SUPER EPA SUPER OMEGA-3 SUPER TWIN EPA-DHA THEROMEGA THEROMEGA SPORT TRICOR TRIGLIDE TRILIPIX TRIPLE OMEGA TRIPLE OMEGA 3-6-9 VASCAZEN VASCEPA VAYAROL VITAMIN-D + OMEGA-3 VYTORIN WELCHOL ZETIA ZOCOR ZYNCOL 33 GENERIC DRUG FISH OIL/BORAGE/FLAX/OM3,6,9#1 FISH OIL/BORAGE/FLAX/OM3,6,9#1 FSH/FLX/PRM/BLK/BOR/OM3,6,9 #5 FISH OIL/BORAGE/FLAX/OM3,6,9#1 OMEGA-3S/DHA/EPA/FISH OIL/D3 OMEGA-3S/DHA/EPA/FISH OIL OMEGA-3S/DHA/EPA/FISH OIL OMEGA-3 FATTY ACIDS OMEGA 3/DHA/EPA/OTHER OM3/D3 OMEGA-3/DHA/EPA/DPA/FISH OIL OMEGA-3 ACID ETHYL ESTERS OMEGA-3 FATTY ACIDS/FISH OIL OMEGA-3S/DHA/EPA/FISH OIL KRILL OIL/OMEGA-3/DHA/EPA OMEGA3/DHA/EPA/FISH OIL/VIT D3 OMEGA3/DHA/EPA/FISH OIL/VIT D3 POLICOS/INOSITOL NIAC/GARLIC PRAVASTATIN SODIUM PRAVASTATIN SODIUM DOCOSAHEXANOIC ACID CHOLESTYRAMINE/ASPARTAME CHOLESTYRAMINE (WITH SUGAR) CHOLESTYRAMINE/ASPARTAME OM-3/DHA/EPA/FISH OIL/L. CASEI SALMON OIL/OMEGA-3 FATTY ACIDS SALMON OIL/OMEGA-3 FATTY ACIDS OMEGA3/DHA/EPA/FISH OIL/VIT D3 OMEGA-3 FATTY ACIDS/FISH OIL OMEGA-3/DHA/EPA/FISH OIL NIACIN/SIMVASTATIN SIMVASTATIN NIACIN OMEGA-3/DHA/EPA/FISH OIL OMEGA-3 FATTY ACIDS/VITAMIN E FSH/FLX/PRM/BLK/BOR/OM3,6,9 #5 OMEGA-3 FATTY ACIDS OMEGA-3/DHA/EPA/FISH OIL OMEGA-3/DHA/EPA/FISH OIL FENOFIBRATE NANOCRYSTALLIZED FENOFIBRATE NANOCRYSTALLIZED FENOFIBRIC ACID (CHOLINE) FISH OIL/BORAGE/FLAX/OM3,6,9#1 FISH OIL/BORAGE/FLAX/OM3,6,9#1 OMEGA-3S/DHA/EPA/FISH OIL ICOSAPENT ETHYL PHYTOSTEROL/OM-3/DHA/EPA/FISH OMEGA-3S/DHA/EPA/FISH OIL/D3 EZETIMIBE/SIMVASTATIN COLESEVELAM HCL EZETIMIBE SIMVASTATIN POLICOSANOL COMBINATION NO.3 KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION CARDIOVASCULAR DISEASE - MISCELLANEOUS AGENTS CARDIOVASCULAR DISEASE - MISCELLANEOUS AGENTS CARDIOVASCULAR DISEASE - MISCELLANEOUS AGENTS CARDIOVASCULAR DISEASE - MISCELLANEOUS AGENTS CARDIOVASCULAR DISEASE - MISCELLANEOUS AGENTS CARDIOVASCULAR DISEASE - MISCELLANEOUS AGENTS CARDIOVASCULAR DISEASE - MISCELLANEOUS AGENTS CARDIOVASCULAR DISEASE - VASODILATION CARDIOVASCULAR DISEASE - VASODILATION CARDIOVASCULAR DISEASE - VASODILATION CARDIOVASCULAR DISEASE - VASODILATION CARDIOVASCULAR DISEASE - VASODILATION CARDIOVASCULAR DISEASE - VASODILATION CARDIOVASCULAR DISEASE - VASODILATION CARDIOVASCULAR DISEASE - VASODILATION CARDIOVASCULAR DISEASE - VASODILATION CARDIOVASCULAR DISEASE - VASODILATION CARDIOVASCULAR DISEASE - VASODILATION CARDIOVASCULAR DISEASE - VASODILATION CARDIOVASCULAR DISEASE - VASODILATION CARDIOVASCULAR DISEASE - VASODILATION CARDIOVASCULAR DISEASE - VASODILATION CARDIOVASCULAR DISEASE - VASODILATION CARDIOVASCULAR DISEASE - VASODILATION CARDIOVASCULAR DISEASE - VASODILATION CARDIOVASCULAR DISEASE - VASODILATION CARDIOVASCULAR DISEASE - VASODILATION CARDIOVASCULAR DISEASE - VASODILATION CARDIOVASCULAR DISEASE - VASODILATION CARDIOVASCULAR DISEASE - VASODILATION CARDIOVASCULAR DISEASE - VASODILATION CARDIOVASCULAR DISEASE - VASODILATION CARDIOVASCULAR DISEASE - VASODILATION CARDIOVASCULAR DISEASE - VASODILATION CARDIOVASCULAR DISEASE - VASODILATION CARDIOVASCULAR DISEASE - VASODILATION CARDIOVASCULAR DISEASE - VASODILATION CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS BRAND DRUG AMLODIPINE-ATORVASTATIN CADUET JUVISYNC NORTHERA PROAMATINE RANEXA DILATRATE-SR IMDUR ISMO ISOCHRON ISODITRATE ISORDIL ISORDIL TITRADOSE ISOSORBIDE MONONITRATE ER MINITRAN MONOKET NITRO-BID NITRO-DUR NITROGLYCERIN IN D5W NITROGLYCERIN PATCH NITROLINGUAL NITROMIST NITRONAL NITROSTAT NITRO-TIME PERSANTINE RECTIV AFTERA ALTAVERA ALYACEN AMETHIA AMETHIA LO AMETHYST APRI ARANELLE ASHLYNA AUBRA AVIANE AZURETTE BALZIVA BEYAZ BREVICON 34 GENERIC DRUG AMLODIPINE/ATORVASTATIN AMLODIPINE/ATORVASTATIN SITAGLIPTIN/SIMVASTATIN MIDODRINE HCL DROXIDOPA MIDODRINE HCL RANOLAZINE AMYL NITRITE ISOSORBIDE DINITRATE DIPYRIDAMOLE ERGOLOID MESYLATES ISOSORBIDE MONONITRATE ISOSORBIDE MONONITRATE ISOSORBIDE DINITRATE ISOSORBIDE DINITRATE ISOSORBIDE DINITRATE ISOSORBIDE DINITRATE ISOSORBIDE DINITRATE ISOSORBIDE MONONITRATE ISOSORBIDE MONONITRATE ISOXSUPRINE HCL NITROGLYCERIN ISOSORBIDE MONONITRATE NITROGLYCERIN NITROGLYCERIN NITROGLYCERIN NITROGLYCERIN/D5W NITROGLYCERIN NITROGLYCERIN NITROGLYCERIN NITROGLYCERIN NITROGLYCERIN NITROGLYCERIN NYLIDRIN HCL PAPAVERINE HCL DIPYRIDAMOLE NITROGLYCERIN LEVONORGESTREL LEVONORGESTREL-ETHIN ESTRADIOL NORETHINDRONE-ETHINYL ESTRAD L-NORGEST-ETH ESTR/ETHIN ESTRA L-NORGEST-ETH ESTR/ETHIN ESTRA LEVONORGESTREL-ETHIN ESTRADIOL DESOGESTREL-ETHINYL ESTRADIOL NORETHINDRONE-ETHINYL ESTRAD L-NORGEST-ETH ESTR/ETHIN ESTRA LEVONORGESTREL-ETHIN ESTRADIOL LEVONORGESTREL-ETHIN ESTRADIOL DESOG-E.ESTRADIOL/E.ESTRADIOL NORETHINDRONE-ETHINYL ESTRAD DROSPIR/ETH ESTRA/LEVOMEFOL CA NORETHINDRONE-ETHINYL ESTRAD KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS BRAND DRUG BRIELLYN CAMILA CAMRESE CAMRESE LO CAZIANT CERVIDIL CESIA CHATEAL CONCEPTROL CRYSELLE CYCLAFEM CYCLESSA DASETTA DAYSEE DEBLITANE DELYLA DEMULEN 1-50-28 DEPO-PROVERA DESOGEN DESOGESTR-ETH ESTRAD ETH ESTRA DROSPIRENONE-ETHINYL ESTRADIOL ECONTRA EZ ELINEST ELLA EMOQUETTE ENCARE ENPRESSE ENSKYCE ERRIN ESTARYLLA ESTROSTEP FE FALLBACK SOLO FALMINA FEMCON FE GENERESS FE GIANVI GILDAGIA GILDESS GILDESS 24 FE GILDESS FE GYNOL II GYNOL II EXTRA STRENGTH HEATHER HEMABATE INTROVALE JENCYCLA JOLESSA JOLIVETTE JUNEL JUNEL FE KARIVA 35 GENERIC DRUG NORETHINDRONE-ETHINYL ESTRAD NORETHINDRONE L-NORGEST-ETH ESTR/ETHIN ESTRA L-NORGEST-ETH ESTR/ETHIN ESTRA DESOGESTREL-ETHINYL ESTRADIOL DINOPROSTONE DESOGESTREL-ETHINYL ESTRADIOL LEVONORGESTREL-ETHIN ESTRADIOL NONOXYNOL 9 NORGESTREL-ETHINYL ESTRADIOL NORETHINDRONE-ETHINYL ESTRAD DESOGESTREL-ETHINYL ESTRADIOL NORETHINDRONE-ETHINYL ESTRAD L-NORGEST-ETH ESTR/ETHIN ESTRA NORETHINDRONE LEVONORGESTREL-ETHIN ESTRADIOL ETHYNODIOL D-ETHINYL ESTRADIOL MEDROXYPROGESTERONE ACETATE DESOGESTREL-ETHINYL ESTRADIOL DESOGESTREL-ETHINYL ESTRADIOL DESOG-E.ESTRADIOL/E.ESTRADIOL ETHINYL ESTRADIOL/DROSPIRENONE LEVONORGESTREL NORGESTREL-ETHINYL ESTRADIOL ULIPRISTAL ACETATE DESOGESTREL-ETHINYL ESTRADIOL NONOXYNOL 9 LEVONORGESTREL-ETHIN ESTRADIOL DESOGESTREL-ETHINYL ESTRADIOL NORETHINDRONE NORGESTIMATE-ETHINYL ESTRADIOL NORETHINDRONE-E.ESTRADIOL-IRON LEVONORGESTREL LEVONORGESTREL-ETHIN ESTRADIOL NORETH-ETHINYL ESTRADIOL/IRON NORETH-ETHINYL ESTRADIOL/IRON ETHINYL ESTRADIOL/DROSPIRENONE NORETHINDRONE-ETHINYL ESTRAD NORETHINDRONE AC-ETH ESTRADIOL NORETHINDRONE-E.ESTRADIOL-IRON NORETHINDRONE-E.ESTRADIOL-IRON NONOXYNOL 9 NONOXYNOL 9 NORETHINDRONE CARBOPROST TROMETHAMINE LEVONORGESTREL-ETHIN ESTRADIOL NORETHINDRONE LEVONORGESTREL-ETHIN ESTRADIOL NORETHINDRONE NORETHINDRONE AC-ETH ESTRADIOL NORETHINDRONE-E.ESTRADIOL-IRON DESOG-E.ESTRADIOL/E.ESTRADIOL KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS BRAND DRUG KELNOR 1-35 KURVELO LARIN LARIN FE LAYOLIS FE LEENA LESSINA LEVONEST LEVONORGESTREL-ETH ESTRADIOL LEVONORG-ETH ESTRAD ETH ESTRAD LEVORA-28 LO LOESTRIN FE LO MINASTRIN FE LOESTRIN LOESTRIN 24 FE LOESTRIN FE LOMEDIA 24 FE LO-OVRAL-28 LO-OVRAL-8 LORYNA LOSEASONIQUE LOW-OGESTREL LUTERA LYBREL LYZA MARLISSA MEDROXYPROGESTERONE ACETATE METHERGINE MICROGESTIN MICROGESTIN FE MICRONOR MINASTRIN 24 FE MIRCETTE MODICON MONO-LINYAH MONONESSA MY WAY MYZILRA NATAZIA NECON NEXT CHOICE NEXT CHOICE ONE DOSE NIKKI NORA-BE NORDETTE-28 NORDETTE-8 NORETHINDRONE-ETHIN ESTRADIOL NORETHINDRON-ETHINYL ESTRADIOL NORETHIN-ETH ESTRA FERROUS FUM 36 GENERIC DRUG ETHYNODIOL D-ETHINYL ESTRADIOL LEVONORGESTREL-ETHIN ESTRADIOL NORETHINDRONE AC-ETH ESTRADIOL NORETHINDRONE-E.ESTRADIOL-IRON NORETH-ETHINYL ESTRADIOL/IRON NORETHINDRONE-ETHINYL ESTRAD LEVONORGESTREL-ETHIN ESTRADIOL LEVONORGESTREL-ETHIN ESTRADIOL LEVONORGESTREL LEVONORGESTREL-ETHIN ESTRADIOL L-NORGEST-ETH ESTR/ETHIN ESTRA LEVONORGESTREL-ETHIN ESTRADIOL NORETHINDRONE-E.ESTRADIOL-IRON NORETHINDRONE-E.ESTRADIOL-IRON NORETHINDRONE AC-ETH ESTRADIOL NORETHINDRONE-E.ESTRADIOL-IRON NORETHINDRONE-E.ESTRADIOL-IRON NORETHINDRONE-E.ESTRADIOL-IRON NORGESTREL-ETHINYL ESTRADIOL NORGESTREL-ETHINYL ESTRADIOL ETHINYL ESTRADIOL/DROSPIRENONE L-NORGEST-ETH ESTR/ETHIN ESTRA NORGESTREL-ETHINYL ESTRADIOL LEVONORGESTREL-ETHIN ESTRADIOL LEVONORGESTREL-ETHIN ESTRADIOL NORETHINDRONE LEVONORGESTREL-ETHIN ESTRADIOL MEDROXYPROGESTERONE ACET METHYLERGONOVINE MALEATE METHYLERGONOVINE MALEATE NORETHINDRONE AC-ETH ESTRADIOL NORETHINDRONE-E.ESTRADIOL-IRON NORETHINDRONE NORETHINDRONE-E.ESTRADIOL-IRON DESOG-E.ESTRADIOL/E.ESTRADIOL NORETHINDRONE-ETHINYL ESTRAD NORGESTIMATE-ETHINYL ESTRADIOL NORGESTIMATE-ETHINYL ESTRADIOL LEVONORGESTREL LEVONORGESTREL-ETHIN ESTRADIOL ESTRADIOL VALERATE/DIENOGEST NORETHINDRONE-ETHINYL ESTRAD LEVONORGESTREL LEVONORGESTREL ETHINYL ESTRADIOL/DROSPIRENONE NORETHINDRONE LEVONORGESTREL-ETHIN ESTRADIOL LEVONORGESTREL-ETHIN ESTRADIOL NORETHINDRONE NORETH-ETHINYL ESTRADIOL/IRON NORETHINDRONE AC-ETH ESTRADIOL NORETH-ETHINYL ESTRADIOL/IRON KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS BRAND DRUG NORGESTREL-ETHINY ESTRA NORINYL 1+35 NORINYL 1+50 NORLYROC NOR-Q-D NORTREL OCELLA OGESTREL OPCICON ONE-STEP ORSYTHIA ORTHO MICRONOR ORTHO TRI-CYCLEN ORTHO TRI-CYCLEN LO ORTHO-CEPT ORTHO-CYCLEN ORTHO-NOVUM OVCON-35 OVCON-50 OXYTOCIN OXYTOCIN-0.9% NACL OXYTOCIN-D5-1/2NS OXYTOCIN-D5-1/4NS OXYTOCIN-D5-NS OXYTOCIN-D5W OXYTOCIN-D5W-LACTATED RINGERS OXYTOCIN-LACTATED RINGERS PHILITH PIMTREA PIRMELLA PITOCIN PLAN B PLAN B ONE-STEP PORTIA PREPIDIL PREVIFEM PROSTIN E2 VAGINAL SUPPOSITORY PROVERA QUARTETTE QUASENSE RECLIPSEN SAFYRAL SEASONALE SEASONIQUE SHAROBEL SOLIA SPRINTEC SRONYX SYEDA TAKE ACTION TARINA FE TILIA FE 37 GENERIC DRUG NORGESTIMATE-ETHINYL ESTRADIOL NORGESTREL-ETHINYL ESTRADIOL NORETHINDRONE-ETHINYL ESTRAD NORETHINDRONE-MESTRANOL NORETHINDRONE NORETHINDRONE NORETHINDRONE-ETHINYL ESTRAD ETHINYL ESTRADIOL/DROSPIRENONE NORGESTREL-ETHINYL ESTRADIOL LEVONORGESTREL LEVONORGESTREL-ETHIN ESTRADIOL NORETHINDRONE NORGESTIMATE-ETHINYL ESTRADIOL NORGESTIMATE-ETHINYL ESTRADIOL DESOGESTREL-ETHINYL ESTRADIOL NORGESTIMATE-ETHINYL ESTRADIOL NORETHINDRONE-ETHINYL ESTRAD NORETHINDRONE-ETHINYL ESTRAD NORETHINDRONE-ETHINYL ESTRAD OXYTOCIN/0.9 % SODIUM CHLORIDE OXYTOCIN/D5W-0.45% SODIUM CL OXYTOCIN/D5W-0.2% SODIUM CL OXYTOCIN/D5W-0.9% SODIUM CL OXYTOCIN/DEXTROSE 5% OXYTOCIN/D5LR OXYTOCIN/RINGERS LACTATE NORETHINDRONE-ETHINYL ESTRAD DESOG-E.ESTRADIOL/E.ESTRADIOL NORETHINDRONE-ETHINYL ESTRAD OXYTOCIN LEVONORGESTREL LEVONORGESTREL LEVONORGESTREL-ETHIN ESTRADIOL DINOPROSTONE NORGESTIMATE-ETHINYL ESTRADIOL DINOPROSTONE MEDROXYPROGESTERONE ACETATE L-NORGEST-ETH ESTR/ETHIN ESTRA LEVONORGESTREL-ETHIN ESTRADIOL DESOGESTREL-ETHINYL ESTRADIOL DROSPIR/ETH ESTRA/LEVOMEFOL CA LEVONORGESTREL-ETHIN ESTRADIOL L-NORGEST-ETH ESTR/ETHIN ESTRA NORETHINDRONE DESOGESTREL-ETHINYL ESTRADIOL NORGESTIMATE-ETHINYL ESTRADIOL LEVONORGESTREL-ETHIN ESTRADIOL ETHINYL ESTRADIOL/DROSPIRENONE LEVONORGESTREL NORETHINDRONE-E.ESTRADIOL-IRON NORETHINDRONE-E.ESTRADIOL-IRON KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS CONTRACEPTION/OXYTOCICS COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD BRAND DRUG TODAY CONTRACEPTIVE SPONGE TRI-ESTARYLLA TRI-LEGEST FE TRI-LINYAH TRINESSA TRI-NORINYL TRI-PREVIFEM TRI-SPRINTEC TRIVORA-28 VCF VELIVET VESTURA VIORELE VYFEMLA WERA WYMZYA FE YASMIN 28 YAZ ZARAH ZENCHENT ZENCHENT FE ZEOSA ZOVIA 1-35E ZOVIA 1-50E 10PEH-400GFN 10PEH-400GFN-20DM 10PEH-4CPM 10PEH-4CPM-20DM 12 HOUR COLD RELIEF 12 HOUR DECONGESTANT 12 HOUR NASAL RELIEF 12 HOUR NASAL SPRAY 12 HOUR RELIEF 12.5CPD-100GFN-30PSE 12.5CPD-120GFN-5PEH 12.5CPD-1DCPM-30PSE 15DM-100GFN-5PEH 15DM-5PEH-2CPM 20DM-100GFN-10PEH 20DM-4CPM 25CPD-200GFN 25DPH-7.5PEH 2CPM-15DM-5PEH 30PSE-150GFN-15DM 30PSE-3BRM-15DM 3BRM-15DM-30PSE 3BRM-30DM-50PSE 4 WAY 40PSE-400GFN 40PSE-400GFN-20DM 40PSE-4BRM-20DM 50PSE-3BRM-30DM 38 GENERIC DRUG NONOXYNOL 9 NORGESTIMATE-ETHINYL ESTRADIOL NORETHINDRONE-E.ESTRADIOL-IRON NORGESTIMATE-ETHINYL ESTRADIOL NORGESTIMATE-ETHINYL ESTRADIOL NORETHINDRONE-ETHINYL ESTRAD NORGESTIMATE-ETHINYL ESTRADIOL NORGESTIMATE-ETHINYL ESTRADIOL LEVONORGESTREL-ETHIN ESTRADIOL NONOXYNOL 9 DESOGESTREL-ETHINYL ESTRADIOL ETHINYL ESTRADIOL/DROSPIRENONE DESOG-E.ESTRADIOL/E.ESTRADIOL NORETHINDRONE-ETHINYL ESTRAD NORETHINDRONE-ETHINYL ESTRAD NORETH-ETHINYL ESTRADIOL/IRON ETHINYL ESTRADIOL/DROSPIRENONE ETHINYL ESTRADIOL/DROSPIRENONE ETHINYL ESTRADIOL/DROSPIRENONE NORETHINDRONE-ETHINYL ESTRAD NORETH-ETHINYL ESTRADIOL/IRON NORETH-ETHINYL ESTRADIOL/IRON ETHYNODIOL D-ETHINYL ESTRADIOL ETHYNODIOL D-ETHINYL ESTRADIOL GUAIFENESIN/PHENYLEPHRINE HCL GUAIFENESIN/D-METHORPHAN HB/PE PHENYLEPHRINE/CHLORPHENIRAMINE DM/PHENYLEPH/CHLORPHENIRAMINE PSEUDOEPHEDRINE HCL PSEUDOEPHEDRINE HCL OXYMETAZOLINE HCL OXYMETAZOLINE HCL PSEUDOEPHEDRINE/DEXBROMPHENIR PSEUDOEPH/CHLOPHEDIANOL/GG PHENYLEPHRINE/CHLOPHEDIANOL/GG D-CHLORPHENIRA/PSE/CHLOPHEDIAN GUAIFENESIN/D-METHORPHAN HB/PE DM/PHENYLEPH/CHLORPHENIRAMINE GUAIFENESIN/D-METHORPHAN HB/PE DEXTROMETHORPHAN HBR/CHLOR-MAL CHLOPHEDIANOL HCL/GUAIFENESIN PHENYLEPHRINE/DIPHENHYDRAMINE DM/PHENYLEPH/CHLORPHENIRAMINE GUAIFENESIN/DM/PSEUDOEPHEDRINE D-METHORPHAN HB/P-EPD HCL/BPM D-METHORPHAN HB/P-EPD HCL/BPM D-METHORPHAN HB/P-EPD HCL/BPM PHENYLEPHRINE HCL GUAIFENESIN/PSEUDOEPHEDRNE HCL GUAIFENESIN/DM/PSEUDOEPHEDRINE D-METHORPHAN HB/P-EPD HCL/BPM D-METHORPHAN HB/P-EPD HCL/BPM KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD BRAND DRUG 60PSE-400GFN 60PSE-400GFN-20DM 60PSE-4CPM-20DM 7.5PEH-4BRM-15DM ABATUSS DMX ABROPERNOL ABSORBINE PAIN RELIEVING ACCUHIST ACCUHIST PDX ACTA-TABS ACTA-TABS PE ACTIFED COLD & ALLERGY ACTIFED COLD & SINUS ACUFLEX ADLT WAL-TUSSIN COUGH-COLD CF ADT ROBITUSSIN NIGHT NASAL RLF ADT ROBITUSSIN PEAK CLD DM MAX ADULT COUGH FORMULA DM MAX ADULT NASAL DECONGESTANT ADULT ROBITUSSIN ADULT ROBITUSSIN COUGH-COLD D ADULT ROBITUSSIN LINGERING CLD ADULT ROBITUSSIN M-S COLD ADULT ROBITUSSIN NASAL RELIEF ADULT ROBITUSSIN PEAK COLD ADULT ROBITUSSIN PEAK COLD M-S ADULT TUSSIN COUGH CONGEST DM ADULT TUSSIN DM ADULT TUSSIN MULTI-SYMP COLD ADULT WAL-TUSSIN DM ADULT WAL-TUSSIN DM MAX ADVANCED FORMULA EYE DROPS ADVIL ADVIL ALLERGY-CONGESTION RLF ADVIL COLD & SINUS ADVIL CONGESTION RELIEF ADVIL PM AEROHIST AEROHIST PLUS AEROKID AFRIN AIRACOF ALACOL DM ALA-HIST AC ALAHIST DHC ALA-HIST DM ALAHIST LQ ALA-HIST PE ALBATUSSIN ALBATUSSIN NN ALBATUSSIN-NN 39 GENERIC DRUG GUAIFENESIN/PSEUDOEPHEDRNE HCL GUAIFENESIN/DM/PSEUDOEPHEDRINE D-METHORPHAN HB/P-EPHED HCL/CP BROMPHENIRAM/PHENYLEPHRINE/DM DEXCHLORPHENIR/PSEUDOEPHED/DM HOMEOPATHIC DRUGS MENTHOL PHENYLEPHRINE/CHLORPHENIRAMINE DM/PHENYLEPH/CHLORPHENIRAMINE P-EPHED HCL/TRIPROLIDINE HCL PHENYLEPHRINE/CHLORPHENIRAMINE PHENYLEPHRINE/CHLORPHENIRAMINE P-EPHED HCL/ACETAMINOPHN/CP ACETAMINOPHEN/PHENYLTOLX GUAIFENESIN/D-METHORPHAN HB/PE PHENYLEPHRINE/ACETAMINOPHEN/CP GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/DEXTROMETHORPHAN PSEUDOEPHEDRINE HCL DEXTROMETHORPHAN HBR GUAIFENESIN/DM/PSEUDOEPHEDRINE DEXTROMETHORPHAN HBR GUAIFENESIN/D-METHORPHAN HB/PE PHENYLEPHRINE HCL/ACETAMINOPHN GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/DEXTROMETHORPHAN TETRAHYDRZ/DEXT 70/PEG 400/PVP CHLORPHEN/PSEUDOEPH/IBUPROFEN CHLORPHEN/PHENYLEPH/IBUPROFEN IBUPROFEN/PSEUDOEPHEDRINE HCL IBUPROFEN/PHENYLEPHRINE HCL IBUPROFEN/DIPHENHYDRAMINE CIT CHLORPHENIRAMINE/METHSCOPOLAMN CHLOR-MAL/PHENYLEPH/METHSCOP CHLOR-MAL/PHENYLEPH/METHSCOP OXYMETAZOLINE HCL AFRIN NASAL SPRAY DIPHENHYDRAMIN/PE/CODEINE PHOS BROMPHENIRAM/PHENYLEPHRINE/DM PHENYLEPHRINE HCL/CODEINE PHENYLEPHRINE HCL/DIHYDROCO BT BROMPHENIRAM/PHENYLEPHRINE/DM PHENYLEPHRINE/DIPHENHYDRAMINE DEXBROMPHENIRAMIN/PHENYLEPHRIN PYRILAMINE/PE/DEXTROMETHORPHAN POT GUAIACO/DM HB/PE/PYRIL PHENYLEPHRINE/CARBETAPENTAN/GG KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD BRAND DRUG ALDEX D ALDEX DM ALDEX GS ALDEX GS DM ALDEX-CT ALERSULE ALERTNESS ALERTRIS-HEEL ALEVE COLD & SINUS ALEVE PM ALEVE SINUS & HEADACHE ALEVE-D SINUS & COLD ALEVE-D SINUS & HEADACHE ALI-FLEX ALKA-SELTZER PLUS ALLERG-COUGH ALKA-SELTZER PLUS COLD ALKA-SELTZER PLUS COLD+FLU ALKA-SELTZER PLUS COLD-COUGH ALKA-SELTZER PLUS DAY ALKA-SELTZER PLUS DAY & NIGHT ALKA-SELTZER PLUS FLU ALKA-SELTZER PLUS MUCUS-CONGES ALKA-SELTZER PLUS NIGHT ALKA-SELTZER PLUS SINUS-COUGH ALKA-SELTZER PLUS-D ALL DAY PAIN RELIEF ALLANHIST PDX ALLANTAN ALLANVAN-DM ALLANVAN-S ALLERFED COLD & ALLERGY ALLERFRIM ALLERGY & CONGEST RELIEF ALLERGY & SINUS RELIEF ALLERGY MULTI-SYMPTOM ALLERGY PLUS SINUS ALLERGY RELIEF MULTI-SYMPTOM ALLERGY SINUS HEADACHE ALLERGY SINUS PE ALLERGY SINUS-D ALLERSOL ALLERX 10 ALLERX 30 ALLERX DF ALLERX DF 30 ALLERX PE ALLERX-D ALLFEN CD ALLFEN CDX ALLFEN DM ALL-NITE ALL-NITE COLD-FLU RELIEF 40 GENERIC DRUG PHENYLEPHRINE/PYRILAMINE PYRILAMINE/PE/DEXTROMETHORPHAN GUAIFENESIN/PSEUDOEPHEDRNE HCL GUAIFENESIN/DM/PSEUDOEPHEDRINE PHENYLEPHRINE/DIPHENHYDRAMINE PHENYLEPHRINE/CHLORPHENIRAMINE HOMEOPATHIC DRUGS HOMEOPATHIC DRUGS NAPROXEN SODIUM/P-EPHED HCL NAPROXEN NA-DIPHENHYDRAMIN HCL NAPROXEN SODIUM/P-EPHED HCL NAPROXEN SODIUM/P-EPHED HCL NAPROXEN SODIUM/P-EPHED HCL ACETAMINOPHEN/PHENYLTOLX DM/PE/ACETAMINOPHEN/DOXYLAMINE CHLORPHENIR/PHENYLEPH/ASPIRIN DM/P-EPHED/ACETAMINOPH/DOXYLAM CHLORPHEN/PHENYLEPH/DM/ASPIRIN D-METHORPHAN/PE/ACETAMINOPHEN DM/PE/ACETAMINOPHEN/DOXYLAMINE DM HB/PE/ACETAMINOPHEN/CHLORPH GUAIFENESIN/DEXTROMETHORPHAN DM/PE/ACETAMINOPHEN/DOXYLAMINE D-METHORPHAN/PE/ACETAMINOPHEN DM HB/PSEUDOEPHED/ACETAMIN/CP NAPROXEN SODIUM/P-EPHED HCL D-METHORPHAN HB/P-EPD HCL/BPM PHENYLEPHRINE/CHLOR-TAN DM-PE-PYRILAMINE TANNATES PHENYLEPHRINE/PYRILAMINE TAN PHENYLEPHRINE/CHLORPHENIRAMINE PSEUDOEPHEDRINE/TRIPROLIDINE PSEUDOEPHED/DIPHENHYDRAMINE PHENYLEPHRINE/DIPHENHYDRAMINE DIPHENHYDRA/PHENYLEPH/ACETAMIN PHENYLEPHRINE/DIPHENHYDRAMINE PHENYLEPHRINE/ACETAMINOPHEN/CP PSEUDOEPHED/ACETAMINOPH/DIPHEN PHENYLEPHRINE/ACETAMINOPHEN/CP P-EPHED HCL/ACETAMINOPHEN/CP NAPHAZOLINE HCL PSEUDOEPHEDRIN/METHSCOP/CPM/PE PSEUDOEPHEDRIN/METHSCOP/CPM/PE CHLORPHENIRAMINE/METHSCOPOLAMN CHLORPHENIRAMINE/METHSCOPOLAMN CHLOR-MAL/PHENYLEPH/METHSCOP PSEUDOEPHEDRINE/METHYLSCOPOLAM GUAIFENESIN/CODEINE PHOSPHATE GUAIFENESIN/CODEINE PHOSPHATE GUAIFENESIN/DEXTROMETHORPHAN D-METHORPHAN/ACETAMIN/DOXYLAMN D-METHORPHAN/ACETAMIN/DOXYLAMN KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD BRAND DRUG ALTAFRIN ALTAZINE ALTIPRES ALTIPRES PEDIATRIC ALTIPRES-B AMBIFED AMBIFED CD AMBIFED CDX AMBIFED DM AMBIFED-G AMBIFED-G CD AMBIFED-G CDX AMBIFED-G DM AMBITUSSIN AC ANAPLEX DM ANDEHIST-DM ANEFRIN ANTITUSSIVE DM ANU-MED AP-HIST DM APIS COMPOSITUM APRODINE AQUANAZ AQUASOL E AQUAVIT-E ARCTIC RELIEF ARNICA ARSURANEEL ARTHRITIS ASPERCREME HEAT ASPERCREME MAX ASTHMA ATUSS DS AURUMHEEL BABEE-COF BACK BALACALL DM BALAMINE DM BARIJODEEL BELLADONNA COMPOSITUM BENADRYL-D ALLERGY-SINUS BENGAY BENGAY ULTRA STRENGTH BENGAY VANISHING SCENT BENZEDREX BERRI-FREEZ BICLORA BICLORA-D BIO T PRES BIO T PRES PEDIATRIC BIO T PRES-B 41 GENERIC DRUG PHENYLEPHRINE HCL TETRAHYDROZOLINE HCL GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/D-METHORPHAN HB/PE BROMPHENIRAM/PHENYLEPHRINE/DM GUAIFENESIN/PSEUDOEPHEDRNE HCL P-EPHED HCL/CODEINE/GUAIFEN P-EPHED HCL/CODEINE/GUAIFEN GUAIFENESIN/DM/PSEUDOEPHEDRINE GUAIFENESIN/PSEUDOEPHEDRNE HCL P-EPHED HCL/CODEINE/GUAIFEN P-EPHED HCL/CODEINE/GUAIFEN GUAIFENESIN/DM/PSEUDOEPHEDRINE GUAIFENESIN/CODEINE PHOSPHATE D-METHORPHAN HB/P-EPD HCL/BPM D-METHORPHAN HB/P-EPD HCL/BPM OXYMETAZOLINE HCL GUAIFENESIN/DEXTROMETHORPHAN PHENYLEPHRINE HCL BROMPHENIRAM/PHENYLEPHRINE/DM HOMEOPATHIC DRUGS PSEUDOEPHEDRINE/TRIPROLIDINE GUAIFENESIN/D-METHORPHAN HB/PE VITAMIN E VITAMIN E MENTHOL/CAMPHOR HOMEOPATHIC DRUGS HOMEOPATHIC DRUGS HOMEOPATHIC DRUGS MENTHOL MENTHOL HOMEOPATHIC DRUGS D-METHORP TAN/P-EPHED TAN/CP HOMEOPATHIC DRUGS TERP HYDRATE/COCILL/SODIUM CIT HOMEOPATHIC DRUGS BROMPHENIRAM/PHENYLEPHRINE/DM DM/PHENYLEPH/CHLORPHENIRAMINE HOMEOPATHIC DRUGS HOMEOPATHIC DRUGS PHENYLEPHRINE/DIPHENHYDRAMINE MENTHOL MENTHOL MENTHOL PROPYLHEXEDRINE BENZONATATE MENTHOL CHLORCYCLIZINE/CHLOPHEDIANOL CHLORCYCLIZ/PSE/CHLOPHEDIANOL GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/D-METHORPHAN HB/PE BROMPHENIRAM/PHENYLEPHRINE/DM KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD BRAND DRUG BIO-B KIDS BIOBRON DX BIOBRON SF BIOCOTRON BIOCOTRON-D BIODESP DM BIO-DTUSS DMX BIOFLEXOR BIOFREEZE BIOGESIC BIOGIL BIOGTUSS NF BIONATUSS DXP BIONEL BIONEL PEDIATRIC BIOREGESIC BIOSPEC DMX BIO-S-PRES DX BIOTUSS BIOTUSS PEDIATRIC BIPHENOX TENSION HEADACHE BLEEDING BLUE GEL BONE BP 8 BP 8 COUGH BPM PE BPM PE DM BPM-DM-PHEN BPM-PHENYLEPH-DM BPM-PSE-DM BROHIST D BROMALINE DM BROMAX D BROMAXEFED DM RF BROMFED DM BROMHIST-DM BROMHIST-PDX BROMPHENEX DM BROMPHENIRAMINE-PHENYLEPHRINE BROMPHENIRAMINE-PSEUDOEPHEDDM BROM-PHENYL-DEX BROMPLEX DM BROM-PSE-DM BRONCHALIS-HEEL BRONCHIAL ASTHMA RELIEF BRONCHITIS BRONCOTRON BRONCOTRON PED BRONCOTRON-D BRONCOTRON-S 42 GENERIC DRUG DM/PHENYLEPH/CHLORPHENIRAMINE GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/D-METHORPHAN HB/PE D-METHORPHAN HB/P-EPD HCL/BPM MENTHOL MENTHOL ACETAMINOPHEN/PHENYLTOLX GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/D-METHORPHAN HB/PE D-METHORPHAN/PE/DEXBROMPHENIR GUAIFENESIN/DM/PSEUDOEPHEDRINE GUAIFENESIN/DM/PSEUDOEPHEDRINE ACETAMINOPHEN/PHENYLTOLX GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/D-METHORPHAN HB/PE ACETAMINOPHEN/PHENYLTOLX HOMEOPATHIC DRUGS MENTHOL BLUE ICE GEL HOMEOPATHIC DRUGS GUAIFENESIN/DM/PSEUDOEPHEDRINE GUAIFENESIN/DM/PSEUDOEPHEDRINE PHENYLEPHRINE/BROMPHENIRAMINE BROMPHENIRAM/PHENYLEPHRINE/DM BROMPHENIRAM/PHENYLEPHRINE/DM BROMPHENIRAM/PHENYLEPHRINE/DM D-METHORPHAN HB/P-EPD HCL/BPM PHENYLEPHRINE/BROMPHENIRAMINE D-METHORPHAN HB/P-EPD HCL/BPM PHENYLEPHRINE/BROMPHENIRAMINE D-METHORPHAN HB/P-EPD HCL/BPM D-METHORPHAN HB/P-EPD HCL/BPM GUAIFEN/DM HB/P-EPHEDRINE/BPM GUAIFEN/D-METHORPHAN HB/PE/BPM D-METHORPHAN HB/P-EPD HCL/BPM PHENYLEPHRINE/BROMPHENIRAMIN D-METHORPHAN HB/P-EPD HCL/BPM BROMPHENIRAM/PHENYLEPHRINE/DM D-METHORPHAN HB/P-EPD HCL/BPM D-METHORPHAN HB/P-EPD HCL/BPM HOMEOPATHIC DRUGS GUAIFENESIN/EPHEDRINE HCL HOMEOPATHIC DRUGS GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/DEXTROMETHORPHAN KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD BRAND DRUG BRONKIDS BRONTUSS DX BRONTUSS SF BROTAPP DM BROVEX ADT BROVEX CB BROVEX CBX BROVEX PB BROVEX PB C BROVEX PB CX BROVEX PB DM BROVEX PD BROVEX PEB BROVEX PEB DM BROVEX PSB DM BROVEX PSE DM BRYANCONEEL BUCKLEY'S COUGH MIXTURE CAFGESIC FORTE CALCOHEEL CALENDULA CALMING CANTHARIS COMPOSITUM CAPCOF CAPMIST DM CAPRON DM CARBAPHEN 12 CARBAPHEN 12 PED CARBAPHEN CH CARBAPHEN PED CH CARBATUSS CARBATUSS-CL CARBA-XP CARBO-COMPOSITUM CARDEC CARDEC DM CCP CAFFEINE FREE CENHIST CENTERGY CENTERGY DM CENTUSS DM CENTUSSIN DHC CEPACOL SORETHROAT-COUGH CERON CERON-DM CERTUSS-D CHAMOMILLA CHELIDONIUM CHERACOL D CHERATUSSIN AC CHERATUSSIN DAC CHERRY MENTHOL 43 GENERIC DRUG DM/PHENYLEPH/CHLORPHENIRAMINE GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/D-METHORPHAN HB/PE D-METHORPHAN HB/P-EPD HCL/BPM PHENYLEPHRINE/BROMPHENIRAMIN BROMPHENIRAMINE/CODEINE PHOS BROMPHENIRAMINE/CODEINE PHOS PHENYLEPHRINE/BROMPHENIRAMINE BROMPHENIRAMINE/PE/CODEINE BROMPHENIRAMINE/PE/CODEINE BROMPHENIRAM/PHENYLEPHRINE/DM P-EPD TAN/BROMPHENIRAMIN PHENYLEPHRINE/BROMPHENIRAMINE BROMPHENIRAM/PHENYLEPHRINE/DM D-METHORPHAN HB/P-EPD HCL/BPM D-METHORPHAN HB/P-EPD HCL/BPM HOMEOPATHIC DRUGS DEXTROMETHORPHAN HBR MG SAL/ACETAMINOPHN/P-TLOX/CAF HOMEOPATHIC DRUGS HOMEOPATHIC DRUGS HOMEOPATHIC DRUGS HOMEOPATHIC DRUGS CHLORPHENIRAMINE/PE/CODEINE GUAIFENESIN/DM/PSEUDOEPHEDRINE PYRILAMINE/DEXTROMETHORPHAN HB CHLORPHENIR/PHENYLEPH/CARBETAP CHLORPHENIR/PHENYLEPH/CARBETAP CHLORPHENIRAM/PE/CHLOPHEDIANOL CHLORPHENIRAM/PE/CHLOPHEDIANOL PHENYLEPHRINE/CARBETAPENTAN/GG POT GUAIACOLSUL/CARBETAPENT/PE GUAIFENESIN/CARBETAPENTANE CIT HOMEOPATHIC DRUGS PHENYLEPHRINE/CHLORPHENIRAMINE DM/PHENYLEPH/CHLORPHENIRAMINE GUAIFEN/PHENYLEPH/ACETAMINOPHN PHENYLEPHRINE/BROMPHENIRAMINE PHENYLEPHRINE/CHLORPHENIRAMINE DM/PHENYLEPH/CHLORPHENIRAMINE BROMPHENIRAM/PHENYLEPHRINE/DM BROMPHENIRAM/PE/DIHYDROCODEINE DEXTROMETHORPHAN HBR/B-CAINE PHENYLEPHRINE/CHLORPHENIRAMINE DM/PHENYLEPH/CHLORPHENIRAMINE PSEUDOEPH/CHLOPHEDIANOL/GG HOMEOPATHIC DRUGS HOMEOPATHIC DRUGS GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/CODEINE PHOSPHATE P-EPHED HCL/CODEINE/GUAIFEN EUCALYPTUS OIL/MENTHOL KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD BRAND DRUG CHEST CHEST CONGESTION & PAIN RELIEF CHEST CONGESTION & SINUS CHEST CONGESTION PLUS COUGH CHEST CONGESTION RELIEF D CHEST CONGESTION RELIEF DM CHEST CONGESTION RELIEF PE CHEST CONGESTION-COUGH RELIEF CHEST CONGESTION-PAIN RLF PE CHEST-SINUS CONGESTION RELIEF CHILD ALLERGY & SINUS D CHILD BENADRYL-D ALLERGY-SINUS CHILD CHEST CONGESTION + COUGH CHILD COUGH & SORE THROAT CHILD DELSYM COUGH+CHEST DM CHILD DELSYM COUGH-COLD NIGHT CHILD DELSYM NIGHTTIME C-C CHILD DOMETUSS-DA CHILD MUCINEX M-S COLD DAY-NTE CHILD MUCUS RELIEF COUGH CHILD MULTI-SYMPTOM COLD-FEVER CHILD NIGHT TIME COLD & COUGH CHILD NIGHT TIME COUGH-COLD CHILD PLUS COUGH-RUNNY NOSE CHILD SORE THROAT LOZENGE CHILD TRIACTING COLD-COUGH CHILD TRIAMINIC COLD & ALLERGY CHILD TRIAMINIC COUGH-CONGEST CHILD TRIAMINIC COUGH-SORE THR CHILD TRIAMINIC M-S FEVER-COLD CHILD TRIAMINIC-D MT-SYM COLD CHILD TYLENOL PLUS COUGH-RUNNY CHILD TYLENOL PLUS COUGH-SORE CHILD WAL-TAP COLD-ALLERGY CHILDREN PLUS MULTI-SYMPT COLD CHILDREN TRIAMINIC COLD-COUGH CHILDREN WAL-TUSSIN CHILDREN'S COLD & COUGH CHILDREN'S COLD & COUGH DM CHILDREN'S COLD & COUGH RELIEF CHILDRENS COUGH CHILDREN'S COUGH CHILDREN'S COUGH & RUNNY NOSE CHILDREN'S COUGH-RUNNY NOSE CHILDREN'S DIBROMM DM CHILDREN'S DIMETAPP COLD-FLU CHILDREN'S FLU RELIEF CHILDREN'S MAPAP COUGH-SINUS CHILDREN'S MOTRIN COLD CHILDREN'S MULTI-SYMPTOM COLD CHILDREN'S PLUS COLD CHILDREN'S PLUS FLU 44 GENERIC DRUG HOMEOPATHIC DRUGS GUAIFENESIN/ACETAMINOPHEN GUAIFENESIN/PHENYLEPHRINE HCL GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/PSEUDOEPHEDRNE HCL GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/PHENYLEPHRINE HCL GUAIFENESIN/DEXTROMETHORPHAN GUAIFEN/PHENYLEPH/ACETAMINOPHN GUAIFENESIN/PHENYLEPHRINE HCL PHENYLEPHRINE/DIPHENHYDRAMINE PHENYLEPHRINE/DIPHENHYDRAMINE GUAIFENESIN/DEXTROMETHORPHAN D-METHORPHAN HB/ACETAMINOPHEN GUAIFENESIN/DEXTROMETHORPHAN PHENYLEPHRINE/DIPHENHYDRAMINE PHENYLEPHRINE/DIPHENHYDRAMINE PHENYLEPHRINE/CHLORPHENIRAMINE DIPHENHYDRAM/PE/DM/ACETAMIN/GG GUAIFENESIN/DEXTROMETHORPHAN PHENYLEPHRINE/DM/ACETAMINOP/GG PHENYLEPHRINE/DIPHENHYDRAMINE PHENYLEPHRINE/DIPHENHYDRAMINE DEXTROMETHORPHN/ACETAMINOPH/CP HEXYLRESORCINOL DEXTROMETHORPHAN/PHENYLEPHRINE PHENYLEPHRINE/BROMPHENIRAMINE GUAIFENESIN/DEXTROMETHORPHAN D-METHORPHAN HB/ACETAMINOPHEN DM HB/PE/ACETAMINOPHEN/CHLORPH D-METHORPHAN HB/P-EPHED HCL/CP DEXTROMETHORPHN/ACETAMINOPH/CP D-METHORPHAN HB/ACETAMINOPHEN PHENYLEPHRINE/BROMPHENIRAMINE DM HB/PE/ACETAMINOPHEN/CHLORPH DIPHENHYDRAMINE/PHENYLEPHR/DM DEXTROMETHORPHAN HBR BROMPHENIRAM/PHENYLEPHRINE/DM BROMPHENIRAM/PHENYLEPHRINE/DM DEXTROMETHORPHAN HBR/CHLOR-MAL GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/DEXTROMETHORPHAN DEXTROMETHORPHN/ACETAMINOPH/CP DEXTROMETHORPHAN HBR/CHLOR-MAL BROMPHENIRAM/PHENYLEPHRINE/DM DM HB/PE/ACETAMINOPHEN/CHLORPH DM HB/PE/ACETAMINOPHEN/CHLORPH DEXTROMETHORPHN/ACETAMINOPH/CP IBUPROFEN/PSEUDOEPHEDRINE HCL GUAIFENESIN/D-METHORPHAN HB/PE PHENYLEPHRINE/ACETAMINOPHEN/CP DM HB/PE/ACETAMINOPHEN/CHLORPH KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD BRAND DRUG CHILDREN'S PLUS M-S COLD CHILDRENS PLUS M-S COLD CHILDRENS PLUS M-S COLD RELIEF CHILDREN'S SILFEDRINE CHILDREN'S SUDAFED CHILDREN'S SUDAFED PE CHILDREN'S SUDO GEST CHILDREN'S TRIAMINIC CHILDREN'S TYLENOL PLUS CHILDRENS TYLENOL PLUS COLD CHILDRENS TYLENOL PLUS FLU CHILDRN COLD-COUGH-SORE THROAT CHILDS ALLERGY CHILD'S DIBROMM COLD-ALLERGY CHILD'S MUCUS RELIEF M-S COLD CHILDS PLUS COLD & ALLERGY CHILD'S SUDAFED PE COUGH-COLD CHILDS TRIACTING COLD & COUGH CHILDS TYLENOL PLUS COLD-COUGH CHLO HIST CHLO TUSS CHLO TUSS EX CHLORASEPTIC TOTAL CHLORDEX GP CHLOR-MES D CHLORPHEN-DEX-PSE CHLORPHEN-PSE-DM TANNATE CHLOR-PHENYLEPHRINE CLOFERA CO-APAP COCCULUS COMPOSITUM CODAL-DM CODAR AR CODAR D CODAR GF CODEINE-GUAIFENESIN CODITUSS DM COLD COLD & ALLERGY PE COLD & ALLERGY RELIEF COLD & COUGH COLD & COUGH DM COLD & COUGH NIGHTTIME COLD & FLU BP COLD & FLU RELIEF PLUS COLD & FLU SEVERE COLD & HOT EXTRA STRENGTH COLD & HOT PAIN RELIEF COLD & HOT PATCHES PAIN RELIEF COLD & SINUS COLD & SINUS PAIN RELIEF COLD & SINUS RELIEF 45 GENERIC DRUG DM HB/PE/ACETAMINOPHEN/CHLORPH DM HB/PE/ACETAMINOPHEN/CHLORPH DM HB/PE/ACETAMINOPHEN/CHLORPH PSEUDOEPHEDRINE HCL PSEUDOEPHEDRINE HCL PHENYLEPHRINE HCL PSEUDOEPHEDRINE HCL XYLOMETAZOLINE HCL PHENYLEPHRINE HCL/ACETAMINOPHN DM HB/PE/ACETAMINOPHEN/CHLORPH DM HB/PE/ACETAMINOPHEN/CHLORPH PHENYLEPHRINE/DM/ACETAMINOP/GG D-METHORPHAN HB/P-EPHED HCL/CP PHENYLEPHRINE/BROMPHENIRAMINE GUAIFENESIN/D-METHORPHAN HB/PE DIPHENHYDRA/PHENYLEPH/ACETAMIN DEXTROMETHORPHAN/PHENYLEPHRINE PHENYLEPHRINE/DIPHENHYDRAMINE D-METHORPHAN/PE/ACETAMINOPHEN D-BROMP MAL/CHLOPHEDIANOL HCL DEXBROMPHEN/PHENYLEPH/CHLOPHED CHLOPHEDIANOL HCL/GUAIFENESIN DEXTROMETH/BENZOCAINE/MENTHOL GUAIFEN/D-METHORPHAN HB/PE/CP CHLOR-MAL/PHENYLEPH/METHSCOP D-METHORPHAN HB/P-EPHED HCL/CP D-METHORP TAN/P-EPHED TAN/CP PHENYLEPHRINE/CHLORPHENIRAMINE PSEUDOEPHEDRINE/CHLOPHEDIANOL DM HB/PSEUDOEPHED/ACETAMIN/CP HOMEOPATHIC DRUGS PYRILAMINE/PE/DEXTROMETHORPHAN CHLORPHENIRAMINE/CODEINE PHOS PSEUDOEPHEDRINE HCL/CODEINE GUAIFENESIN/CODEINE PHOSPHATE GUAIFENESIN/CODEINE PHOSPHATE PYRILAMINE/PE/DEXTROMETHORPHAN HOMEOPATHIC DRUGS PHENYLEPHRINE/CHLORPHENIRAMINE PHENYLEPHRINE/CHLORPHENIRAMINE BROMPHENIRAM/PHENYLEPHRINE/DM BROMPHENIRAM/PHENYLEPHRINE/DM PHENYLEPHRINE/DIPHENHYDRAMINE ACETAMINOPHEN/CHLORPHENIRAMINE DM/PE/ACETAMINOPHEN/DOXYLAMINE PHENYLEPHRINE/DM/ACETAMINOP/GG MENTHOL MENTHOL MENTHOL GUAIFEN/PHENYLEPH/ACETAMINOPHN IBUPROFEN/PSEUDOEPHEDRINE HCL IBUPROFEN/PSEUDOEPHEDRINE HCL KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD BRAND DRUG COLD AND COUGH COLD AND COUGH CHILDRENS COLD HEAD CONGESTION COLD MULTI-SYMPTOM COLD MULTI-SYMPTOM DAYTIME COLD MULTI-SYMPTOM NIGHTTIME COLD MULTI-SYMPTOM SEVERE COLD RELIEF HEAD CONGESTION COLD RELIEF MULTI-SYMPTOM COLD RELIEF PLUS COLD RELIEVER COLD SEVERE CONGESTION COLD-COUGH SINUS RELIEF PE COLD-FLU RELIEF COLDONYL COMPLETE SINUS RELIEF COMTREX COLD & COUGH COMTREX COLD-COUGH DAY-NIGHT COMTREX COLD-COUGH NIGHTTIME COMTREX DEEP CHEST COLD COMTREX FLU THERAPY COMTREX SEVERE COLD-SINUS CONEX CONGESTAC CONGEST-EZE CONGEST-EZE PE CONGESTION RELIEF CONSTIPATION CONTAC CONTAC COLD-FLU CONTAC COLD-FLU NIGHT CONTAC D COLD CONTRAGESIC COOL & HEAT COOL GEL COOL 'N HEAT CORFEN-DM CORICIDIN CORICIDIN HBP CORICIDIN HBP COLD-MULTI SYMPT CORYZA-DM CORZALL CORZALL PLUS CORZALL-PE COTAB A COTAB AX COTABFLU COUGH COUGH & COLD COUGH & COLD BP COUGH & COLD MUCUS RELIEF CF 46 GENERIC DRUG BROMPHENIRAM/PHENYLEPHRINE/DM D-METHORPHAN HB/P-EPD HCL/BPM DM HB/PE/ACETAMINOPHEN/CHLORPH DM HB/PE/ACETAMINOPHEN/CHLORPH PHENYLEPHRINE/DM/ACETAMINOP/GG DM/PE/ACETAMINOPHEN/DOXYLAMINE PHENYLEPHRINE/DM/ACETAMINOP/GG DM HB/PE/ACETAMINOPHEN/CHLORPH DM HB/PE/ACETAMINOPHEN/CHLORPH CHLORPHENIR/PHENYLEPH/ASPIRIN PHENYLEPHRINE/ACETAMINOPHEN/CP PHENYLEPHRINE/DM/ACETAMINOP/GG PHENYLEPHRINE/DM/ACETAMINOP/GG DM/PE/ACETAMINOPHEN/DOXYLAMINE GUAIFEN/PHENYLEPH/ACETAMINOPHN COMPLETE ALLERGY & SINUS PHENYLEPH/ACETAMIN/DEXBROMPHEN DM HB/PSEUDOEPHED/ACETAMIN/CP DM HB/PE/ACETAMINOPHEN/CHLORPH DM HB/PE/ACETAMINOPHEN/CHLORPH GUAIFENESIN/ACETAMINOPHEN PHENYLEPHRINE/ACETAMINOPHEN/CP PHENYLEPHRINE/ACETAMINOPHEN/CP P-EPHED HCL/D-BROMP MAL GUAIFENESIN/P-EPHED HCL GUAIFENESIN/PSEUDOEPHEDRNE HCL GUAIFENESIN/PHENYLEPHRINE HCL IBUPROFEN/PHENYLEPHRINE HCL HOMEOPATHIC DRUGS DM/P-EPHED/ACETAMINOPHN/DIPHEN PHENYLEPHRINE HCL/ACETAMINOPHN D-METHORPHAN/ACETAMIN/DOXYLAMN PHENYLEPHRINE HCL ACETAMINOPHEN/PHENYLTOLX MENTHOL MENTHOL MENTHOL DM/PHENYLEPH/CHLORPHENIRAMINE ACETAMINOPHEN/CHLORPHENIRAMINE ACETAMINOPHEN/CHLORPHENIRAMINE D-METHORPHAN/ACETAMIN/DOXYLAMN DM/PHENYLEPH/PYRIL/DEXCHLROPHE CARBETAPENTANE/PSEUDOEPHEDRINE PYRIL MAL/P-EPHED HCL/CARBPNTN DEXCHLORPHENIRAM-PE-CARBETAPEN CHLORPHENIRAMINE/CODEINE PHOS CHLORPHENIRAMINE/CODEINE PHOS CHLOR-MAL/CODEINE/ACETAMINOPHN GUAIFENESIN/DEXTROMETHORPHAN DEXTROMETHORPHAN HBR/CHLOR-MAL DEXTROMETHORPHAN HBR/CHLOR-MAL GUAIFENESIN/D-METHORPHAN HB/PE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD BRAND DRUG COUGH & COLD PE COUGH & RUNNY NOSE COUGH & SORE THROAT COUGH AND COLD MULTI-SYMPTOM COUGH CONTROL CF COUGH CONTROL DM COUGH CONTROL DM MAX COUGH DM ER COUGH DROPS COUGH FORMULA DM COUGH RELIEF COUGH SUPPRESSANT COUGH SUPPRESSANT/EXPECTORANT COUGH SYRUP DM COUGH-HEAD CONGESTION RELIEF C-PHEN DM C-PHEN DROPS C-PHEN SYRUP CPM 8-PE 20-MSC 1.25 CPM-PE CPM-PE-DM CPM-PSE DM CPM-PYR-PE CRALONIN CREOMULSION CREO-TERPIN CRUROHEEL C-TAN D C-TANNA 12 C-TANNA 12D DALLERGY DALLERGY DM DALLERGY PE DALLERGY-JR DAY TIME DAY TIME COLD-FLU DAY TIME COLD-FLU RELIEF DAY TIME COUGH DAY TIME PE DAYTIME DAY-TIME DAYTIME & NIGHTTIME COLD DAYTIME & NITETIME SINUS DAYTIME COLD & COUGH DAYTIME COLD & FLU DAYTIME COLD & FLU RELIEF DAYTIME COLD MULTI-SYMPTOM DAYTIME COLD-FLU DAYTIME COLD-FLU RELIEF DAYTIME COUGH DAYTIME MUCUS RELIEF DM DAYTIME SINUS 47 GENERIC DRUG PHENYLEPHRINE/DM/ACETAMINOP/GG DEXTROMETHORPHAN HBR/CHLOR-MAL DEXTROMETHORPHAN HBR/B-CAINE PSEUDOEPH/DM/GUAIFEN/ACETAMIN GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/DEXTROMETHORPHAN DEXTROMETHORPHAN POLISTIREX EUCALYPTUS OIL/MENTHOL GUAIFENESIN/DEXTROMETHORPHAN DEXTROMETHORPHAN HBR DEXTROMETHORPHAN HBR GUAIFENESIN/D-METHORPHAN HB GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/DM/PSEUDOEPHEDRINE DM/PHENYLEPH/CHLORPHENIRAMINE PHENYLEPHRINE/CHLORPHENIRAMINE PHENYLEPHRINE/CHLORPHENIRAMINE CHLOR-MAL/PHENYLEPH/METHSCOP PHENYLEPHRINE/CHLORPHENIRAMINE DM/PHENYLEPH/CHLORPHENIRAMINE D-METHORPHAN HB/P-EPHED HCL/CP PHENYLEPHRINE/PYRILAMINE MA/CP HOMEOPATHIC DRUGS DEXTROMETHORPHAN HBR GUAIFENESIN/DEXTROMETHORPHAN HOMEOPATHIC DRUGS PHENYLEPHRINE/BROMPHENIRAMIN CAR-B-PEN TA/CHLOR-TAN CAR-B-PEN TA/PHENYLEPHRINE/PYR CHLORCYCLIZINE/PHENYLEPHRINE D-METHORPHAN HB/P-EPD HCL/BPM CHLOR-MAL/PHENYLEPH/METHSCOP PHENYLEPHRINE/CHLORPHENIRAMINE D-METHORPHAN/PE/ACETAMINOPHEN D-METHORPHAN/PE/ACETAMINOPHEN D-METHORPHAN/PE/ACETAMINOPHEN DEXTROMETHORPHAN HBR D-METHORPHAN/PE/ACETAMINOPHEN DM/PSEUDOEPHED/ACETAMINOPHEN DM/PSEUDOEPHED/ACETAMINOPHEN DM HB/PE/ACETAMINOPHEN/CHLORPH PHENYLEPHRINE/ACETAMIN/DOXYLAM D-METHORPHAN HB/ACETAMINOPHEN D-METHORPHAN/PE/ACETAMINOPHEN DM/PSEUDOEPHED/ACETAMINOPHEN D-METHORPHAN/PE/ACETAMINOPHEN DM/PSEUDOEPHED/ACETAMINOPHEN D-METHORPHAN/PE/ACETAMINOPHEN DEXTROMETHORPHAN HBR GUAIFENESIN/DEXTROMETHORPHAN PHENYLEPHRINE HCL/ACETAMINOPHN KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD BRAND DRUG DAYTIME SINUS RELIEF DAYTIMECOLD DAYTIME-NIGHTTIME DAYTIME-NIGHTTIME COLD-FLU DAYTIME-NIGHTTIME COUGH DAYTIME-NITETIME DCP DE-CHLOR DM DE-CHLOR DR DECON-A DECONEX DECONEX DM DECONEX DMX DECONEX IR DECON-G DECONGESTANT DECONGESTANT INHALER DECOREL FORTE PLUS DEHISTINE DELSYM DELSYM COUGH & COLD DELSYM COUGH+CHEST CONGEST DM DELSYM COUGH+SOOTHING ACTION DELSYM MULTI-SYMPTOM DELSYM NIGHTTIME COUGH-COLD DELSYM NIGHTTIME MULTISYMPTOM DELTUSS DMX DELTUSS DP DESGEN DESGEN DM DESPEC DESPEC DM DESPEC NR DESPEC-DM DESPEC-EXP DESPEC-PDC DESPEC-TAB DEX PC DEXPHEN M DEXPHEN W-C DEX-TUSS DHM-PE DIABETIC SILTUSSIN-DM DIABETIC SILTUSSIN-DM MAX STR DIABETIC TUSSIN DIABETIC TUSSIN DM DIABETIC TUSSIN MAX-STRENGTH DIABETIC TUSSIN NIGHTTIME DIARRHEA DICEL CD DICEL DM 48 GENERIC DRUG PHENYLEPHRINE HCL/ACETAMINOPHN D-METHORPHAN/PE/ACETAMINOPHEN DM/PE/ACETAMINOPHEN/DOXYLAMINE DM/PE/ACETAMINOPHEN/DOXYLAMINE DEXTROMETHORPHAN HB/DOXYLAMINE DM/PE/ACETAMINOPHEN/DOXYLAMINE DM/PHENYLEPH/CHLORPHENIRAMINE DM/PHENYLEPH/CHLORPHENIRAMINE DM/PHENYLEPH/CHLORPHENIRAMINE PHENYLEPHRINE/BROMPHENIRAMINE GUAIFENESIN/PHENYLEPHRINE HCL GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/PHENYLEPHRINE HCL GUAIFEN/PHENYLEPHRINE/BPM PSEUDOEPHEDRINE HCL L-DESOXYEPHEDRINE PHENYLEPHRINE/DM/ACETAMINOP/GG CHLOR-MAL/PHENYLEPH/METHSCOP DEXTROMETHORPHAN POLISTIREX D-METHORPHAN/ACETAMIN/DOXYLAMN GUAIFENESIN/DEXTROMETHORPHAN DEXTROMETHORPHAN HBR/MENTHOL DM/PE/ACETAMINOPHEN/DOXYLAMINE PHENYLEPHRINE/DIPHENHYDRAMINE D-METHORPHAN/ACETAMIN/DOXYLAMN DEXCHLORPHENIR/PSEUDOEPHED/DM PSEUDOEPHEDRINE/DEXCHLORPHENIR GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/DM/PSEUDOEPHEDRINE GUAIFEN/P-EPHED HCL/DIHY-COD PHENYLEPHRINE/DHCODEINE BT/CP GUAIFENESIN/PSEUDOEPHEDRNE HCL DM/PHENYLEPH/CHLORPHENIRAMINE PHENYLEPH/DEXCHLOR/METHSCOPOL DEXCHLORPHEN/PHENYLEPH/CODEINE DEXTROMETHORPHAN POLISTIREX GUAIFENESIN/CODEINE PHOSPHATE PHENYLEPHRINE/DIPHENHYDRAMINE GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/DEXTROMETHORPHAN MENTHOL GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/DEXTROMETHORPHAN DEXTROMETHOR/ACETAMIN/DIPHEN HOMEOPATHIC DRUGS BROMPHENIRAM-PSE-CHLOPHEDIANOL D-METHORP TAN/P-EPHED TAN/CP KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD BRAND DRUG DIHYDROCODEINE-BPM-PE DIHYDRO-CP DIHYDRO-GP DIHYDRO-PE DIMAPHEN DIMAPHEN DM DIMETANE-DX DIMETAPP DIMETAPP COLD & CONGESTION DIMETAPP DM DIMETAPP LONG-ACTING DM MAX DM-CHLORPHEN-PHENYLEPHRINE DM-CPM-PE-GG DM-PE-CPM DM-PHENYLEPHRINE-CHLORPHEN DM-PSE-BPM DOLOGEN DOLOGEN 325 DOLOGESIC DOLOREX DOMETUSS G DOMETUSS-DMX DONATUSS DC DONATUSS XP DONATUSSIN DONATUSSIN DM DOUBLE TUSSIN DM DRISTAN DRISTAN COLD DRIXORAL DROPERTEEL DRYMAX DRYMAX AF DUODENOHEEL DUONATE-12 DURABAC FORTE DURAFLU DURAVENT DM DURAVENT PE ECHINACEA PC ED A-HIST ED A-HIST DM ED A-HIST PSE ED BRON GP ED CHLORPED D ED-A-HIST DM EFFERVESCENT COLD RELIEF EFFERVESCENT COLD RELIEF PLUS ENDACOF ENDACOF AC ENDACOF-C 49 GENERIC DRUG BROMPHENIRAM/PE/DIHYDROCODEINE P-EPHED HCL/DHCODEINE BT/CP GUAIFEN/P-EPHED HCL/DIHY-COD PHENYLEPHRINE/DHCODEINE BT/CP PHENYLEPHRINE/BROMPHENIRAMINE BROMPHENIRAM/PHENYLEPHRINE/DM D-METHORPHAN HB/P-EPD HCL/BPM BROMPHENIRAM/PHENYLEPHRINE/DM PHENYLEPHRINE/DIPHENHYDRAMINE D-METHORPHAN HB/P-EPD HCL/BPM DEXTROMETHORPHAN HBR/CHLOR-MAL GUAIFENESIN/DEXTROMETHORPHAN DM/PHENYLEPH/CHLORPHENIRAMINE GUAIFEN/D-METHORPHAN HB/PE/CP DM/PHENYLEPH/CHLORPHENIRAMINE DM/PHENYLEPH/CHLORPHENIRAMINE D-METHORPHAN HB/P-EPD HCL/BPM ACETAMINOPHEN/D-BROMPHENIRAMIN ACETAMINOPHEN/D-BROMPHENIRAMIN ACETAMINOPHEN/PHENYLTOLX ACETAMINOPHEN/PHENYLTOLX PHENYLEPHRINE/DM/ACETAMINOP/GG GUAIFENESIN/D-METHORPHAN HB/PE PHENYLEPH/DIHYDROCODEINE/GUAIF GUAIFENESIN/DM/PSEUDOEPHEDRINE DM/PHENYLEPH/CHLORPHENIRAMINE DM TAN/PE TAN/DEXCHLORPHEN TAN GUAIFENESIN/DEXTROMETHORPHAN OXYMETAZOLINE HCL PHENYLEPHRINE/ACETAMINOPHEN/CP PSEUDOEPHEDRINE/DEXBROMPHENIR HOMEOPATHIC DRUGS PSEUDOEPHEDRINE/CPM/METHYLSCOP CHLORPHENIR/PSE/CHLOPHEDIANOL HOMEOPATHIC DRUGS PHENYLEPHRINE/PYRIL TAN MG SAL/ACETAMINOPHN/P-TLOX/CAF PSEUDOEPH/DM/GUAIFEN/ACETAMIN GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/PHENYLEPHRINE HCL HOMEOPATHIC DRUGS PHENYLEPHRINE/CHLORPHENIRAMINE DM/PHENYLEPH/CHLORPHENIRAMINE PSEUDOEPHEDRINE/TRIPROLIDINE GUAIFENESIN/PHENYLEPHRINE HCL PHENYLEPHRINE/CHLORPHENIRAMINE DM/PHENYLEPH/CHLORPHENIRAMINE PHENYLEPHRINE/ACETAMINOPHEN/CP PHENYLEPHRINE/ACETAMINOPHEN/CP DM/PHENYLEPH/CHLORPHENIRAMINE BROMPHENIRAMINE/CODEINE PHOS CHLORPHENIRAMINE/CODEINE PHOS KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD BRAND DRUG ENDACOF-DC ENDACOF-DM ENDACOF-PD ENDACON ENDAL CD ENTEX LQ ENTEX PAC ENTEX T ENTRE-B ENTRE-COUGH ENTRE-COUGH TANNATE ENTRE-HIST PSE ENTRE-S ENZYME EPHEDRINE SULFATE-0.9% NACL EPHRINE NOSE DROPS ESOCOR P ESSENTIAL DAILY EXACTUSS EXACTUSS TR EXALL EXALL-D EXAPHEN EXAPHEN CH EXAPHEX TR EXCEDRIN BACK & BODY EXCEDRIN PM EXCEDRIN SINUS HEADACHE EXECLEAR-C EXECLEAR-DM EXEFEN DMX EXEFEN IR EXEFEN-IR EXHAUSTION EXPECTORANT DM EXPECTORANT MAX STRENGTH EXPECTUSS EXTRA ACTION COUGH EYE DROPS FAST ACTING NASAL FEMININE FENESIN DM IR FENESIN PE IR FLANAX FLEX GEL FLEXALL FLEXTRA-650 FLEXTRA-DS FLU FLU & SORE THROAT FLU BP 50 GENERIC DRUG PSEUDOEPHEDRINE HCL/CODEINE BROMPHENIRAM/PHENYLEPHRINE/DM D-METHORPHAN HB/P-EPD HCL/BPM GUAIFENESIN/D-METHORPHAN HB/PE CHLORPHENIRAMINE/PE/CODEINE GUAIFENESIN/PHENYLEPHRINE HCL GUAIFENESIN/DM/PSEUDOEPHEDRINE GUAIFENESIN/PSEUDOEPHEDRNE HCL PHENYLEPHRINE/BROMPHENIRAMIN GUAIFENESIN/DM/PSEUDOEPHEDRINE GUAIFENESIN/DM/PSEUDOEPHEDRINE PSEUDOEPHEDRINE/TRIPROLIDINE D-METHORP TAN/P-EPHED TAN/CP HOMEOPATHIC DRUGS EPHEDRINE SULFATE EPHEDRINE SULFATE IN 0.9% NACL PHENYLEPHRINE HCL D-METHORPHAN HB/P-EPHED HCL/CP MULTIVIT WITH CALCIUM,IRON,MIN GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/CARBETAPENTANE CIT PSEUDOEPHED/CARBETAPENTANE/GG PHENYLEPHRINE/CHLORPHENIRAMINE CHLORPHENIRAM/PE/CHLOPHEDIANOL GUAIFENESIN/PHENYLEPHRINE HCL ASPIRIN/ACETAMINOPHEN/CAL CARB ACETAMINOPHEN/DP-HYDRAMINE PHENYLEPHRINE HCL/ACETAMINOPHN GUAIFENESIN/CODEINE PHOSPHATE GUAIFENESIN/DM/PSEUDOEPHEDRINE GUAIFENESIN/DM/PSEUDOEPHEDRINE GUAIFENESIN/PSEUDOEPHEDRNE HCL GUAIFENESIN/PSEUDOEPHEDRNE HCL HOMEOPATHIC DRUGS GUAIFENESIN/DEXTROMETHORPHAN DEXTROMETHORPHAN/PSEUDOEPHED GUAIFENESIN/CARBETAPENTANE CIT GUAIFENESIN/DEXTROMETHORPHAN TETRAHYDROZOLINE HCL PHENYLEPHRINE HCL HOMEOPATHIC DRUGS GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/PHENYLEPHRINE HCL MENTHOL MENTHOL MENTHOL/ALOE VERA EXTRACT ACETAMINOPHEN/PHENYLTOLX ACETAMINOPHEN/PHENYLTOLX DEXTROMETHORPHN/ACETAMINOPH/CP PHENYLEPHRINE/ACETAMINOPHN/PNM DEXTROMETHORPHN/ACETAMINOPH/CP KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD BRAND DRUG FLU FORMULA FLU RELIEF BP FLU RELIEF THERAPY DAYTIME FLU RLF THERAPY COLD & CHEST FLU-SEVERE COLD-CONGESTION FLU-SEVERE COLD-COUGH FLUTABS FOOT POWDER FORMULA E FRUIT FROSTERS GANI-TUSS NR GANI-TUSS-DM NR GASTRICUMEEL G-BRONCO-D G-DOLOGEN GENAC GENAPHED GENTEX 30 G-FENESIN DM GILPHEX TR GILTUSS GILTUSS PED-C GILTUSS PEDIATRIC GILTUSS TR GOLD BOND FOOT GOLD BOND MEDICATED FOOT GOLD BOND PAIN RELIEVING GOODY'S PM GORDON'S VITE E GORDO-VITE E G-P-TUSS DXP GRIPP-HEEL G-SUPRESS DX G-TRON G-TRON PED G-TUSICOF GUAIATUSSIN AC GUAICON DMS GUAIFEN-DEXTROMPSEUDOEPHEDRIN GUAIFENESIN AC GUAIFENESIN DAC GUAIFENESIN DM GUAIFENESIN DM NR GUAIFENESIN-CODEINE GUAIFENESIN-DEXTROMETHORPHAN GUAIFENESIN-PHENYLEPHRINE GUAIFENESIN-PHENYLEPHRINE HCL GUIADRINE DX GUIATEX PE GUIATUSS DM G-ZYNCOF HAIR AND SKIN 51 GENERIC DRUG DM/PE/ACETAMINOPH/DIPHENHYDRAM DEXTROMETHORPHN/ACETAMINOPH/CP D-METHORPHAN/PE/ACETAMINOPHEN GUAIFEN/PHENYLEPH/ACETAMINOPHN DM HB/PSEUDOEPHED/ACETAMIN/CP D-METHORPHAN/PE/ACETAMINOPHEN PSEUDOEPH/DM/GUAIFEN/ACETAMIN MENTHOL VITAMIN E PECTIN GUAIFENESIN/CODEINE PHOSPHATE GUAIFENESIN/DEXTROMETHORPHAN HOMEOPATHIC DRUGS GUAIFENESIN/D-METHORPHAN HB/PE ACETAMINOPHEN/D-BROMPHENIRAMIN PSEUDOEPHEDRINE/TRIPROLIDINE PSEUDOEPHEDRINE HCL PHENYLEPHRINE/CARBETAPENTAN/GG GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/PHENYLEPHRINE HCL GUAIFENESIN/D-METHORPHAN HB/PE PHENYLEPHRINE/CODEINE/GUAIFEN GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/D-METHORPHAN HB/PE MENTHOL MENTHOL MENTHOL ACETAMINOPHEN/DP-HYDRAMINE VITAMIN E VITAMIN E D-METHORPHAN/PE/DEXBROMPHENIR HOMEOPATHIC DRUGS GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/CODEINE PHOSPHATE GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/DM/PSEUDOEPHEDRINE GUAIFENESIN/CODEINE PHOSPHATE P-EPHED HCL/CODEINE/GUAIFEN GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/CODEINE PHOSPHATE GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/PHENYLEPHRINE HCL GUAIFENESIN/PHENYLEPHRINE HCL GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/PHENYLEPHRINE HCL GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/DEXTROMETHORPHAN HOMEOPATHIC DRUGS KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD BRAND DRUG HALLS HAYFEVER HEAD CONGESTION HEAD CONGESTION & COLD RELIEF HEAD CONGESTION COLD RELIEF HEADACHE HEADACHE II HEADACHE RELIEF PM HEMORRHOID RELIEF HEMORRHOID SOLUBLE TABLET HEMORRHOID SUPPOSITORY HEMORRHOIDAL SUPPOSITORY HEPEEL HERBAL HISTEX SR HISTEX-DM HISTEX-PE HIST-PSE HOLD HONEY LEMON HOT STEAM HYCODAN HYDROCOD-CPM-PSEUDOEPHEDRINE HYDROCODONE BIT-HOMATROPINE MB HYDROCODONE BT-HOMATROPINE MBR HYDROCODONE COMPOUND HYDROCODONE-CHLORPHENIRAMNE ER HYDROCODONE-HOMATROPINE MBR HYDROMET HYDRO-TUSSIN DHC IBUPROFEN COLD IBUPROFEN COLD & SINUS IBUPROFEN COLD-SINUS IBUPROFEN PM IBUPROFEN-DIPHENHYDRAMINE HCL ICE BLUE DROPS ICE BLUE GEL ICE GEL ICY HOT ICY HOT NATURALS ICY HOT NO MESS ICY HOT PAIN RELIEVING INDAMIX DM INFANT NON-ASA COLD INFANTS' COLD INFECTION INFLAMMATION INJURY INTENSE COUGH INTENSE COUGH RELIEVER INTESTINE IOPHEN DM-NR 52 GENERIC DRUG MENTHOL HOMEOPATHIC DRUGS DM HB/PE/ACETAMINOPHEN/CHLORPH PHENYLEPHRINE/DM/ACETAMINOP/GG DM HB/PE/ACETAMINOPHEN/CHLORPH HOMEOPATHIC DRUGS HOMEOPATHIC DRUGS ACETAMINOPHEN/DP-HYDRAMINE PHENYLEPHRINE HCL HOMEOPATHIC DRUGS HOMEOPATHIC DRUGS PHENYLEPHRINE HCL HOMEOPATHIC DRUGS MENTHOL PHENYLEPHRINE/CHLORPHENIRAMINE TRIPROLIDINE/PHENYLEPHRINE/DM PHENYLEPHRINE/TRIPROLIDINE PSEUDOEPHEDRINE/TRIPROLIDINE DEXTROMETHORPHAN HBR EUCALYPTUS OIL/MENTHOL CAMPHOR/EUCALYPT/MENTH/BENZOIN HYDROCODONE BIT/HOMATROP ME-BR PSEUDOEPHED/HYDROCODONE/CPM HYDROCODONE BIT/HOMATROP ME-BR HYDROCODONE BIT/HOMATROP ME-BR HYDROCODONE BIT/HOMATROP ME-BR HYDROCODONE/CHLORPHEN P-STIREX HYDROCODONE BIT/HOMATROP ME-BR HYDROCODONE BIT/HOMATROP ME-BR P-EPHED HCL/DHCODEINE BT/CP IBUPROFEN/PSEUDOEPHEDRINE HCL IBUPROFEN/PSEUDOEPHEDRINE HCL IBUPROFEN/PSEUDOEPHEDRINE HCL IBUPROFEN/DIPHENHYDRAMINE CIT IBUPROFEN/DIPHENHYDRAMINE HCL EUCALYPTUS OIL/MENTHOL MENTHOL MENTHOL MENTHOL MENTHOL MENTHOL MENTHOL D-METHORP TAN/P-EPD TAN/D-CP DM/PSEUDOEPHED/ACETAMINOPHEN DM/PSEUDOEPHED/ACETAMINOPHEN HOMEOPATHIC DRUGS HOMEOPATHIC DRUGS HOMEOPATHIC DRUGS GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/DEXTROMETHORPHAN HOMEOPATHIC DRUGS GUAIFENESIN/DEXTROMETHORPHAN KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD BRAND DRUG IOPHEN-C NR J-COF DHC J-MAX J-MAX DHC J-TAN D KIDKARE KLIMAKTHEEL K-TAN LAGESIC LAMIOFLUR LEG CRAMPS WITH QUININE LEXUSS 210 LIGHTHEADED LIQUIBID D-R LIQUIBID PD-R LITHIUMEEL LITTLE NOSES LITTLE REMEDIES COUGH-IMMUNE LITTLE REMEDIES HONEY COUGH LIVETAN DM LOHIST LOHIST PEB DM LOHIST-DM LOHIST-PEB LOHIST-PSB-DM LONG ACTING NASAL DECONGESTANT LONG ACTING NASAL SPRAY LORTUSS DM LORTUSS EX LORTUSS LQ LUSAIR LUSONAL MAPAP COLD FORMULA MAPAP SINUS MAPAP SINUS MAX-STRENGTH MAR-COF BP MAR-COF CG MASCULINE MAXICHLOR DM MAXICHLOR PEH MAXICHLOR PEH DM MAXICHLOR PSE DM MAXIFED MAXIFED CD MAXIFED CDX MAXIFED DM MAXIFED DMX MAXIFED-G MAXIFED-G CD MAXIFED-G CDX MAXIFLU CD MAXIFLU CDX 53 GENERIC DRUG GUAIFENESIN/CODEINE PHOSPHATE BROMPHENRM/PSEUDOEPH/DIHYDROCD GUAIFENESIN/PHENYLEPHRINE HCL DIHYDROCODEINE/GUAIFENESIN PHENYLEPHRINE/BROMPHENIRAMIN D-METHORPHAN HB/P-EPHED HCL/CP HOMEOPATHIC DRUGS PHENYLEPHRINE/PYRILAMINE TAN ACETAMINOPHEN/PHENYLTOLX HOMEOPATHIC DRUGS HOMEOPATHIC DRUGS CHLORPHENIRAMINE/CODEINE PHOS HOMEOPATHIC DRUGS GUAIFENESIN/PHENYLEPHRINE HCL GUAIFENESIN/PHENYLEPHRINE HCL HOMEOPATHIC DRUGS PHENYLEPHRINE HCL ELDERBERRY FRUIT/HONEY HONEY DM/PHENYLEPH/DIPHENHYDRAM TANN PHENYLEPHRINE/CHLORPHENIRAMINE BROMPHENIRAM/PHENYLEPHRINE/DM BROMPHENIRAM/PHENYLEPHRINE/DM PHENYLEPHRINE/BROMPHENIRAMINE D-METHORPHAN HB/P-EPD HCL/BPM PSEUDOEPHEDRINE HCL OXYMETAZOLINE HCL DOXYLAMINE/PSEUDOEPHEDRINE/DM P-EPHED HCL/CODEINE/GUAIFEN DOXYLAMINE/PSEUDOEPHEDRINE HCL GUAIFENESIN/PHENYLEPHRINE HCL PHENYLEPHRINE HCL D-METHORPHAN/PE/ACETAMINOPHEN PHENYLEPHRINE HCL/ACETAMINOPHN P-EPHED HCL/ACETAMINOPHEN BROMPHENIRA/PSEUDOEPHED/CODEIN GUAIFENESIN/CODEINE PHOSPHATE HOMEOPATHIC DRUGS DEXTROMETHORPHAN HBR/CHLOR-MAL PHENYLEPHRINE/CHLORPHENIRAMINE DM/PHENYLEPH/CHLORPHENIRAMINE D-METHORPHAN HB/P-EPHED HCL/CP GUAIFENESIN/PSEUDOEPHEDRNE HCL P-EPHED HCL/CODEINE/GUAIFEN P-EPHED HCL/CODEINE/GUAIFEN GUAIFENESIN/DM/PSEUDOEPHEDRINE GUAIFENESIN/DM/PSEUDOEPHEDRINE GUAIFENESIN/PSEUDOEPHEDRNE HCL P-EPHED HCL/CODEINE/GUAIFEN P-EPHED HCL/CODEINE/GUAIFEN P/EPHED/CODEINE/ACETAMINOPH/GG P/EPHED/CODEINE/ACETAMINOPH/GG KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD BRAND DRUG MAXIFLU DM MAXIMUM DAILY MULTIVITAMIN MAXIPHEN MAXIPHEN CD MAXIPHEN CDX MAXIPHEN DM MAXIPHEN DMX M-CLEAR M-CLEAR WC MEDENT-PEI MEDI-BROM MEDICATED BODY POWDER MEDICATED FOOT MEDICIDIN-D MEDIFIN CP MEDIHONEY MEDIKOFF MEDI-PHEDRINE MEDI-PHENYL MEDI-TUSSIN DM MEDI-TUSSIN DM DIABETIC M-END DM M-END DMX M-END MAX D M-END PE M-END WC MENSTRUAL MENSTRUAL COMPLETE MENSTRUAL PAIN RELIEF MENSTRUAL RELIEF MENTHOL COUGH DROPS MENTHOL DROPS MERCURIS-HEEL MESEHIST DM MESEHIST WC MIDOL MIDOL COMPLETE MIDOL PM MINERAL FREEZ MOLYBDAN COMPOSITUM MOTRIN PM MUCAPHED MUCINEX COLD & SINUS MUCINEX COLD-FLU & SORE THROAT MUCINEX COUGH MUCINEX D MUCINEX DM MUCINEX FAST-MAX COLD-FLU MUCINEX FAST-MAX COLD-SINUS MUCINEX FAST-MAX CONGESTCOUGH MUCINEX FAST-MAX DAY-NITE COLD MUCINEX FAST-MAX DM MAX 54 GENERIC DRUG PSEUDOEPH/DM/GUAIFEN/ACETAMIN MULTIVIT WITH CALCIUM,IRON,MIN GUAIFENESIN/PHENYLEPHRINE HCL PHENYLEPHRINE/CODEINE/GUAIFEN PHENYLEPHRINE/CODEINE/GUAIFEN GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/CODEINE PHOSPHATE GUAIFENESIN/CODEINE PHOSPHATE GUAIFENESIN/PHENYLEPHRINE HCL D-METHORPHAN HB/P-EPD HCL/BPM MENTHOL MENTHOL PHENYLEPHRINE/ACETAMINOPHEN/CP GUAIFENESIN/ACETAMINOPHEN HONEY EUCALYPTUS OIL/MENTHOL PSEUDOEPHEDRINE HCL PHENYLEPHRINE HCL GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/DEXTROMETHORPHAN D-METHORPHAN HB/P-EPHED HCL/CP DEXBROMPHEN/PSEUDOEPHEDRINE/DM DEXBROMPHENIRAMINE/PSE/CODEINE BROMPHENIRAMINE/PE/CODEINE BROMPHENIRA/PSEUDOEPHED/CODEIN HOMEOPATHIC DRUGS ACETAMINOPHN/PYRIL MAL/CAFFEIN ACETAMINOPHEN/PYRILAM/PAMABROM ACETAMINOPHN/PYRIL MAL/CAFFEIN EUCALYPTUS OIL/MENTHOL EUCALYPTUS OIL/MENTHOL HOMEOPATHIC DRUGS D-METHORPHAN HB/P-EPHED HCL/CP BROMPHENIRA/PSEUDOEPHED/CODEIN ACETAMINOPHN/PYRIL MAL/CAFFEIN ACETAMINOPHN/PYRIL MAL/CAFFEIN ACETAMINOPHEN/DP-HYDRAMINE MENTHOL HOMEOPATHIC DRUGS IBUPROFEN/DIPHENHYDRAMINE CIT GUAIFENESIN/PHENYLEPHRINE HCL GUAIFEN/PHENYLEPH/ACETAMINOPHN PHENYLEPHRINE/DM/ACETAMINOP/GG GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/PSEUDOEPHEDRNE HCL GUAIFENESIN/DEXTROMETHORPHAN PHENYLEPHRINE/DM/ACETAMINOP/GG GUAIFEN/PHENYLEPH/ACETAMINOPHN GUAIFENESIN/D-METHORPHAN HB/PE DIPHENHYDRAM/PE/DM/ACETAMIN/GG GUAIFENESIN/DEXTROMETHORPHAN KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD BRAND DRUG MUCINEX FAST-MAX SEVERE COLD MUCINEX SINUS-MAX MUCINEX SINUS-MAX DAY-NIGHT MUCOSA DM MUCUS AND COUGH RELIEF MUCUS DM MUCUS DM MAX MUCUS RELIEF COLD & SINUS MUCUS RELIEF CONGEST-COUGH MUCUS RELIEF COUGH MUCUS RELIEF D MUCUS RELIEF DM MUCUS RELIEF DM MAX MUCUS RELIEF PE MUCUS RELIEF PLUS MUCUS RELIEF SEV CONGEST-COLD MUCUS RELIEF SINUS MUCUS RLF COLD-FLU-SORE THROAT MUCUS RLF SEVERE SINUS CONGEST MULIMEN MULTIPLE VITAMINS FOR WOMEN MULTI-SYMPTOM ALLERGY RELIEF MULTI-SYMPTOM COLD MULTI-SYMPTOM COLD-COUGH MULTIVITAMINS W-CALCIUM-IRON MUSCLE & JOINT MYCI-GC MYDFRIN MYHIST-DM MYHIST-PD MYTUSSIN AC MYTUSSIN DAC NALDECON DX NALDEX NALEX AC NARIZ NASAL & SINUS DECONGESTANT NASAL DECON (PSEUDOEPHEDRINE) NASAL DECONGESTANT NASAL DECONGESTANT INHALER NASAL DECONGESTANT PE NASAL DECONGESTANT-ANTIHIST NASAL DECONGEST-ANTIHISTAMINE NASAL FOUR NASAL MIST NASAL RELIEF NASAL SPRAY NASAL SPRAY EXTRA MOISTURIZING NASAL SPRAY ORIGINAL NASAL SPRAY SINUS NASAL SPRAY X-MOIST 55 GENERIC DRUG PHENYLEPHRINE/DM/ACETAMINOP/GG GUAIFEN/PHENYLEPH/ACETAMINOPHN DIPHENHYD/PE/ACETAMINOPHEN/GG GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/DEXTROMETHORPHAN GUAIFEN/PHENYLEPH/ACETAMINOPHN GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/PHENYLEPHRINE HCL GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/PHENYLEPHRINE HCL PHENYLEPHRINE/DM/ACETAMINOP/GG PHENYLEPHRINE/DM/ACETAMINOP/GG GUAIFENESIN/PHENYLEPHRINE HCL PHENYLEPHRINE/DM/ACETAMINOP/GG GUAIFEN/PHENYLEPH/ACETAMINOPHN HOMEOPATHIC DRUGS MULTIVIT WITH CALCIUM,IRON,MIN PHENYLEPHRINE/ACETAMINOPHEN/CP DM HB/PE/ACETAMINOPHEN/CHLORPH DM HB/PSEUDOEPHED/ACETAMIN/CP MULTIVIT WITH CALCIUM,IRON,MIN MENTHOL GUAIFENESIN/CODEINE PHOSPHATE PHENYLEPHRINE HCL PYRILAMINE/PE/DEXTROMETHORPHAN PHENYLEPHRINE/PYRILAMINE MA/CP GUAIFENESIN/CODEINE PHOSPHATE P-EPHED HCL/CODEINE/GUAIFEN GUAIFENESIN/DEXTROMETHORPHAN DEXCHLORPHENIR/PHENYLEPHRINE BROMPHENIRAMINE/CODEINE PHOS NAPHAZOLINE HCL GUAIFENESIN/PHENYLEPHRINE HCL PSEUDOEPHEDRINE HCL PSEUDOEPHEDRINE HCL OXYMETAZOLINE HCL LEVMETAMFETAMINE PHENYLEPHRINE HCL PSEUDOEPHEDRINE/TRIPROLIDINE PSEUDOEPHEDRINE/TRIPROLIDINE PHENYLEPHRINE HCL OXYMETAZOLINE HCL OXYMETAZOLINE HCL OXYMETAZOLINE HCL OXYMETAZOLINE HCL OXYMETAZOLINE HCL OXYMETAZOLINE HCL OXYMETAZOLINE HCL KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD BRAND DRUG NASOHIST NASOHIST DM NASOPEN NASOPEN PE NASOPEN-CH NASOTUSS NATURAL HERB NATURAL HERB COUGH DROPS NAUSEA NEO AC NEO DM NEOFRIN NEO-SYNEPHRINE NEO-SYNEPHRINE 12 HOUR NEO-TUSS NEOTUSS PLUS NEOTUSS-D NERVOHEEL NEURALGIA NEUTRAHIST PDX NEXAFED NEXAFED SINUS PRESSURE-PAIN NICOTINE GUM NIGHT TIME NIGHT TIME COLD NIGHT TIME COLD & FLU NIGHT TIME COLD-FLU NIGHT TIME COLD-FLU RELIEF NIGHT TIME COUGH NIGHT TIME COUGH & SORE THROAT NIGHT TIME FORMULA NIGHT-TIME NIGHTTIME COLD NIGHTTIME COLD & FLU NIGHTTIME COLD-FLU NIGHTTIME COLD-FLU RELIEF NIGHTTIME COUGH NIGHTTIME COUGH & SORE THROAT NIGHTTIME COUGH RELIEF NIGHTTIME COUGH-COLD NIGHTTIME D COLD-FLU RELIEF NIGHTTIME SINUS NINJACOF NINJACOF-A NINJACOF-XG NITE TIME NITE TIME COLD & FLU NITE TIME COLD-FLU NITE TIME COLD-FLU RELIEF NITE TIME COUGH NITE TIME-D COLD-FLU NITETIME 56 GENERIC DRUG PHENYLEPHRINE/CHLORPHENIRAMINE DM/PHENYLEPH/CHLORPHENIRAMINE CHLORCYCLIZINE/PSEUDOEPHEDRINE THONZYLAMINE/PHENYLEPHRINE CHLORCYCLIZINE/PHENYLEPHRINE CHLORCYCLIZ/PHENYLEPH/CODEINE MENTHOL MENTHOL/HERBAL COMPLEX NO. 141 HOMEOPATHIC DRUGS PYRIL MAL/PSEUDOEPHED/CODEINE DM/PHENYLEPH/CHLORPHENIRAMINE PHENYLEPHRINE HCL PHENYLEPHRINE HCL OXYMETAZOLINE HCL GUAIFENESIN/DEXTROMETHORPHAN DM/PHENYLEPH/CHLORPHENIRAMINE GUAIFENESIN/DM/P-EPHED/CHLORPH HOMEOPATHIC DRUGS HOMEOPATHIC DRUGS D-METHORPHAN HB/P-EPHED HCL/CP PSEUDOEPHEDRINE HCL PSEUDOEPHEDRINE/ACETAMINOPHEN NICOTINE POLACRILEX DM/P-EPHED/ACETAMINOPH/DOXYLAM DM/P-EPHED/ACETAMINOPH/DOXYLAM D-METHORPHAN/ACETAMIN/DOXYLAMN DM/P-EPHED/ACETAMINOPH/DOXYLAM DM/P-EPHED/ACETAMINOPH/DOXYLAM DEXTROMETHORPHAN HB/DOXYLAMINE D-METHORPHAN/ACETAMIN/DOXYLAMN DM/P-EPHED/ACETAMINOPH/DOXYLAM DM/P-EPHED/ACETAMINOPH/DOXYLAM DM HB/PE/ACETAMINOPHEN/CHLORPH D-METHORPHAN/ACETAMIN/DOXYLAMN D-METHORPHAN/ACETAMIN/DOXYLAMN D-METHORPHAN/ACETAMIN/DOXYLAMN DEXTROMETHORPHAN HB/DOXYLAMINE D-METHORPHAN/ACETAMIN/DOXYLAMN DEXTROMETHORPHAN HB/DOXYLAMINE PHENYLEPHRINE/DIPHENHYDRAMINE DM/P-EPHED/ACETAMINOPH/DOXYLAM PHENYLEPHRINE/ACETAMIN/DOXYLAM PYRILAMINE/CHLOPHEDIANOL PYRILAM/CHLOPHED/ACETAMINOPHEN GUAIFENESIN/CODEINE PHOSPHATE DM/P-EPHED/ACETAMINOPH/DOXYLAM D-METHORPHAN/ACETAMIN/DOXYLAMN DM/P-EPHED/ACETAMINOPH/DOXYLAM D-METHORPHAN/ACETAMIN/DOXYLAMN DEXTROMETHORPHAN HB/DOXYLAMINE DM/P-EPHED/ACETAMINOPH/DOXYLAM D-METHORPHAN/ACETAMIN/DOXYLAMN KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD BRAND DRUG NITE-TIME NITETIME COLD & FLU NITE-TIME COLD & FLU NITE-TIME COLD-FLU RELIEF NITETIME COUGH NITETIME MULTI-SYMPTOM NIVA-HIST DM NIVANEX DMX NO DRIP NO DRIP NASAL RELIEF NOHIST NOHIST DMX NOHIST-DM NOHIST-LQ NOHIST-PDX NON ASPIRIN SINUS NON-ASPIRIN ALLERGY SINUS PM NON-ASPIRIN ALLERGY-SINUS NON-ASPIRIN CHILD'S COLD NON-ASPIRIN FLU NON-ASPIRIN SEVERE CONGESTION NON-ASPIRIN SINUS NON-DROWSY SINUS NON-DRYING SINUS NON-DRYING SINUS PE NON-PSEUDO COLD RELIEF NON-PSEUDO SINUS PAIN & PRESSU NOREL AD NOREL CS NOREL SR NORTUSS-D.E. NORTUSS-DE NORTUSS-EX NOSE DROPS NOSE SPRAY NOTUSS AC NOTUSS DC NOTUSS-NX NOTUSS-NXD NOTUSS-PE NOVAGESIC NRS-NASAL RELIEF NU-COPD NUPRIN NU-WAY NYQUIL D OBREDON OCULOHEEL ONE DAILY MAXIMUM ONE DAILY WITH CALCIUM-IRON ONE DAILY WOMEN'S ONE-A-DAY WOMEN'S 57 GENERIC DRUG D-METHORPHAN/ACETAMIN/DOXYLAMN D-METHORPHAN/ACETAMIN/DOXYLAMN D-METHORPHAN/ACETAMIN/DOXYLAMN DM/PE/ACETAMINOPHEN/DOXYLAMINE DEXTROMETHORPHAN HB/DOXYLAMINE D-METHORPHAN/ACETAMIN/DOXYLAMN BROMPHENIRAM/PHENYLEPHRINE/DM GUAIFENESIN/D-METHORPHAN HB/PE OXYMETAZOLINE HCL OXYMETAZOLINE HCL PHENYLEPHRINE/CHLORPHENIRAMINE DM/PHENYLEPH/CHLORPHENIRAMINE DM/PHENYLEPH/CHLORPHENIRAMINE PHENYLEPHRINE/CHLORPHENIRAMINE DM/PHENYLEPH/CHLORPHENIRAMINE PHENYLEPHRINE HCL/ACETAMINOPHN PSEUDOEPHED/ACETAMINOPH/DIPHEN P-EPHED HCL/ACETAMINOPHEN/CP P-EPHED HCL/ACETAMINOPHEN/CP DM/PSEUDOEPHED/ACETAMINOPHEN PHENYLEPHRINE/DM/ACETAMINOP/GG PSEUDOEPHEDRINE/ACETAMINOPHEN PSEUDOEPHEDRINE/ACETAMINOPHEN GUAIFENESIN/PSEUDOEPHEDRNE HCL GUAIFENESIN/PHENYLEPHRINE HCL PHENYLEPHRINE/DM/ACETAMINOP/GG PHENYLEPHRINE HCL/ACETAMINOPHN PHENYLEPHRINE/ACETAMINOPHEN/CP DM/PHENYLEPH/CHLORPHENIRAMINE PHENYLEPH/ACETAMINOP/P-TLOX/CP GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/DEXTROMETHORPHAN PHENYLEPHRINE HCL OXYMETAZOLINE HCL CHLORPHENIRAMINE/CODEINE PHOS PSEUDOEPHEDRINE HCL/CODEINE CHLORCYCLIZINE/CODEINE CHLORCYCLI/PSEUDOEPHED/CODEINE PHENYLEPHRINE HCL/CODEINE ACETAMINOPHEN/PHENYLTOLX OXYMETAZOLINE HCL GUAIFENESIN/PHENYLEPHRINE HCL MENTHOL PHENYLEPHRINE HCL DM/P-EPHED/ACETAMINOPH/DOXYLAM GUAIFENESIN/HYDROCODONE HOMEOPATHIC DRUGS FOLIC ACID/MV,FE,OTHER MIN MULTIVIT WITH CALCIUM,IRON,MIN MULTIVIT WITH CALCIUM,IRON,MIN MULTIVITS,CA,MINERALS/IRON/FA KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD BRAND DRUG ONETAB CONGESTION & COUGH ONSET FORTE OPTI-CLEAR ORGANIX ORIGINAL NASAL SPRAY ORNEX ORNEX MAX-STRENGTH OSTEOHEEL P CHLOR PAEONIA-HEEL PAIN MEDICINE P.M. PAIN PADS PAIN RELIEF ALLERGY PAIN RELIEF COLD PAIN RELIEF COLD & COUGH PAIN RELIEF SINUS PE PAIN RELIEVER ALLERGY SINUS PAIN RELIEVER COLD PAIN RELIEVER FLU PAIN RELIEVER SINUS PAIN RELIEVING PAIN RELIEVING GEL PAIN RELIEVING PATCH PAMPRIN MULTI-SYMPTOM PANATUSS DXP PANATUSS DXP PEDIATRIC PANATUSS PED PANCREAS PANMIST S PBM ALLERGY PDM GG PE HCL-CPM-MSN PECGEN DMX PECGEN PSE PE-CP-K GUAIACOL PE-CPM-MSN PECTUS-HEEL PEDIA RELIEF PEDIA RELIEF COUGH-COLD PEDIA RELIEF INFANT PEDIACARE ALLERGY & COLD PEDIACARE COUGH-COLD PEDIACARE DECONGESTANT PEDIACARE MULTI-SYMPTOM COLD PEDIAHIST DM PEDIATEX PS PEDIATEX TD PEDIATEX TDM PE-GG PE-HIST DM PERCOGESIC PERSPIRATION 58 GENERIC DRUG GUAIFENESIN/PHENYLEPHRINE HCL PHENYLEPHRINE/ACETAMINOPHEN/CP TETRAHYDROZOLINE HCL MENTHOL/PECTIN OXYMETAZOLINE HCL PSEUDOEPHEDRINE/ACETAMINOPHEN PSEUDOEPHEDRINE/ACETAMINOPHEN HOMEOPATHIC DRUGS GUAIFEN/PHENYLEPHR/CHLORPHENIR HOMEOPATHIC DRUGS ACETAMINOPHEN/DP-HYDRAMINE MENTHOL PHENYLEPHRINE/ACETAMINOPHEN/CP PHENYLEPHRINE/DM/ACETAMINOP/GG D-METHORPHAN HB/ACETAMINOPHEN PHENYLEPHRINE HCL/ACETAMINOPHN P-EPHED HCL/ACETAMINOPHEN/CP DM HB/PSEUDOEPHED/ACETAMIN/CP DM/PSEUDOEPHED/ACETAMINOPHEN PSEUDOEPHEDRINE/ACETAMINOPHEN MENTHOL MENTHOL MENTHOL ACETAMINOPHEN/PYRILAM/PAMABROM D-METHORPHAN/PE/DEXBROMPHENIR D-METHORPHAN/PE/DEXBROMPHENIR D-CHLORPHENIRA/PSE/CHLOPHEDIAN HOMEOPATHIC DRUGS GUAIFENESIN/PSEUDOEPHEDRNE HCL D-METHORPHAN HB/P-EPD HCL/BPM GUAIFENESIN/D-METHORPHAN HB/PE CHLOR-MAL/PHENYLEPH/METHSCOP GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/DM/PSEUDOEPHEDRINE POT GUAIACOLSUL/CARBETAPENT/PE CHLOR-MAL/PHENYLEPH/METHSCOP HOMEOPATHIC DRUGS DEXTROMETHORPHAN/PSEUDOEPHED D-METHORPHAN HB/P-EPHED HCL/CP PSEUDOEPHEDRINE HCL PHENYLEPHRINE/DIPHENHYDRAMINE D-METHORPHAN HB/P-EPHED HCL/CP PHENYLEPHRINE HCL DEXTROMETHORPHAN/PHENYLEPHRINE D-METHORPHAN HB/P-EPD HCL/BPM PSEUDOEPHED & TRIPROLID POLIST PSEUDOEPHEDRINE/TRIPROLIDINE TRIPROLIDINE/PSEUDOEPHEDRIN/DM GUAIFENESIN/PHENYLEPHRINE HCL DM/PHENYLEPH/CHLORPHENIRAMINE ACETAMINOPHEN/DIPHENHYDRAMINE HOMEOPATHIC DRUGS KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD BRAND DRUG PHENABID PHENABID DM PHENAGESIC PHENAGIL PHENAGIL CH PHENA-PLUS PHENA-S PHENCARB GG PHENFLU CD PHENFLU CDX PHENFLU DM PHENYLEPH-CHLORPHEN PEDIATRIC PHENYLEPHRINE HCL-0.9% NACL PHENYLEPHRINE HCL-D5W PHENYLEPHRINE-GUAIFENESIN PHENYLEPHRINE-PYRILAMINE PHENYLGESIC PHENYLHISTINE DH PHENYLTOLOXAMINE PE CPM PLURATUSS PM PAIN RELIEVER PMS MAXIMUM STRENGTH PMS MULTI SYMPTOM POLY HIST CB POLY HIST DHC POLY HIST DM POLY HIST FORTE POLY HIST NC POLY HIST PD POLY TAN DM POLY-650 POLY-HIST DM POLY-HIST PD POLY-TUSSIN POLY-TUSSIN AC POLY-TUSSIN D POLY-TUSSIN DHC POLY-TUSSIN DM POLY-TUSSIN EX POLY-VENT DM POLY-VENT IR POLY-VENT PLUS POPULUS COMPOSITUM PRE-MENSTRUAL RELIEF PREMSYN PMS PRES GEN PRES GEN PEDIATRIC PRESGEN B PRESSURE & PAIN PRIMATENE ASTHMA PRO-CHLO 59 GENERIC DRUG PHENYLEPHRINE/CHLORPHENIRAMINE DM/PHENYLEPH/CHLORPHENIRAMINE ACETAMINOPHEN/PHENYLTOLX PHENYLEPHRINE/CHLORPHENIRAMINE CHLORPHENIRAM/PE/CHLOPHEDIANOL PHENYLEPHRINE/PYRILAMINE MA/CP PHENYLEPHRINE/PYRILAMINE MA/CP PHENYLEPHRINE/CARBETAPENTAN/GG PE-CODEINE-ACETAMINOPHEN-GUAIF PE-CODEINE-ACETAMINOPHEN-GUAIF PHENYLEPHRINE/DM/ACETAMINOP/GG PHENYLEPHRINE/CHLOR-TAN PHENYLEPHRINE HCL PHENYLEPHRINE HCL IN 0.9% NACL PHENYLEPHRINE HCL/D5W/PF GUAIFENESIN/PHENYLEPHRINE HCL PHENYLEPHRINE/PYRILAMINE ACETAMINOPHEN/PHENYLTOLX P-EPHED HCL/COD/CHLORPHENIR PHENYLEPHRINE/P-TLOX CI/CP BROMPHENIRAMINE/PE/CODEINE ACETAMINOPHEN/DP-HYDRAMINE ACETAMINOPHEN/PYRILAM/PAMABROM ACETAMINOPHEN/PYRILAM/PAMABROM GUAIFENESIN/CARBETAPENTANE CIT PYRILAM/PHENYLE/DIHYDROCODEINE PYRILAMINE/PE/DEXTROMETHORPHAN DOXYLAMINE/PHENYLEPHRINE HCL PSEUDOEPHED/CODEINE/TRIPROLIDN PHENYLEPHRINE/PYRILAMINE MA/CP DM TAN/PE TAN/PYRIL/D-BROM TAN ACETAMINOPHEN/PHENYLTOLX THONZYLAMINE/PHENYLEPHRINE/DM THONZYLAMINE/CHLOPHEDIANOL CHLORCYCLIZINE/CODEINE BROMPHENIRAMINE/PE/CODEINE CHLORCYCLI/PSEUDOEPHED/CODEINE BROMPHENIRAM/PE/DIHYDROCODEINE DM/PHENYLEPH/CHLORPHENIRAMINE PHENYLEPH/DIHYDROCODEINE/GUAIF GUAIFENESIN/DM/PSEUDOEPHEDRINE GUAIFENESIN/PSEUDOEPHEDRNE HCL GUAIFEN/PSEUDOEPHED/ACETAMINOP HOMEOPATHIC DRUGS ACETAMINOPHEN/PYRILAM/PAMABROM ACETAMINOPHEN/PYRILAM/PAMABROM GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/D-METHORPHAN HB/PE BROMPHENIRAM/PHENYLEPHRINE/DM PHENYLEPHRINE HCL/ACETAMINOPHN GUAIFENESIN/EPHEDRINE HCL PYRILAMINE/PE/CHLOPHEDIANOL KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD BRAND DRUG PRO-CLEAR AC PRO-CLEAR CAPS PROLEX DMX PROMETHAZINE VC PROMETHAZINE VC-CODEINE PROMETHAZINE-CODEINE PROMETHAZINE-DM PROMETHAZINE-PHENYLEPHRINE PRO-RED AC PROTID PSE BROM PSEUDO COUGH PSEUDO DM GG PSEUDOEPHEDRINE ER PSEUDOEPHEDRINE GG PSEUDOEPHEDRINE-CODEINE PSEUDOGEST PSORINOHEEL PULMARI-GP PYRICHLOR PE PYRIL D PYRIL DM PYRILAMINE-PHENYLEPHRINE PYRIL-CHLOR-PHEN PYRIL-PHENYLEPH-DM PYRROXATE COLD & CONGEST QFLEX Q-TAPP DM Q-TUSSIN DM QUADTANN RECOFEN D RECTACAINE REDNESS RELIEF REDNESS RELIEVER REDNESS RELIEVER EYE DROPS REFENESEN DM REFENESEN PE RELAGESIC RELCOF C RELCOF CPM RELCOF DN PE RELCOF PE RELHIST REME HIST DM REME TUSSIN DM RESCON RESCON-DM RESCON-GG RESCON-JR. RESCON-MX RESPA A.R. RESPA C&C IR 60 GENERIC DRUG CODEINE PHOSPHATE/PYRIL MAL GUAIFENESIN/CODEINE PHOSPHATE POT GUAIACO/D-METHORPHAN HB PHENYLEPHRINE HCL/PROMETH HCL PROMETHAZINE/PHENYLEPH/CODEINE PROMETHAZINE HCL/CODEINE D-METHORPHAN HB/PROMETH HCL PHENYLEPHRINE HCL/PROMETH HCL DEXCHLORPHEN/PHENYLEPH/CODEINE PHENYLEPHRINE/ACETAMINOPHEN/CP D-METHORPHAN HB/P-EPD HCL/BPM GUAIFENESIN/DM/PSEUDOEPHEDRINE GUAIFENESIN/DM/PSEUDOEPHEDRINE PSEUDOEPHEDRINE HCL GUAIFENESIN/PSEUDOEPHEDRNE HCL PSEUDOEPHEDRINE HCL/CODEINE PSEUDOEPHEDRINE HCL HOMEOPATHIC DRUGS GUAIFENESIN/CARBETAPENTANE CIT PHENYLEPHRINE/PYRILAMINE MA/CP PHENYLEPHRINE/PYRILAMINE PYRILAMINE/PE/DEXTROMETHORPHAN PHENYLEPHRINE/PYRILAMINE PHENYLEPHRINE/PYRILAMINE MA/CP PYRILAMINE/PE/DEXTROMETHORPHAN PHENYLEPHRINE HCL/ACETAMINOPHN ACETAMINOPHEN/PHENYLTOLX D-METHORPHAN HB/P-EPD HCL/BPM GUAIFENESIN/DEXTROMETHORPHAN CAR-B-PEN TA/EPHED TAN/PE/CP GUAIFENESIN/DEXTROMETHORPHAN PHENYLEPHRINE HCL NAPHAZOLINE HCL/PEG 300 TETRAHYDROZOLINE HCL NAPHAZOLINE HCL/PEG 300 GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/PHENYLEPHRINE HCL ACETAMINOPHEN/PHENYLTOLX GUAIFENESIN/CODEINE PHOSPHATE CHLORPHENIRAMINE/METHSCOPOLAMN CHLOR-MAL/PHENYLEPH/METHSCOP CHLOR-MAL/PHENYLEPH/METHSCOP PHENYLEPHRINE/BROMPHENIRAMIN PYRILAMINE/PE/DEXTROMETHORPHAN DM/PHENYLEPH/CHLORPHENIRAMINE CHLOR-MAL/PHENYLEPH/METHSCOP D-METHORPHAN HB/P-EPHED HCL/CP GUAIFENESIN/PHENYLEPHRINE HCL DEXCHLORPHENIR/PHENYLEPHRINE DEXCHLORPHENIR/PHENYLEPHRINE P-EPHED HCL/CHLOR-MAL/BELL ALK DM/PE/ACETAMINOPH/DIPHENHYDRAM KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD BRAND DRUG RESPAHIST-II RESPAIRE-30 RESPERAL-DM RESPIVENT DF RESPIVENT DF 30 RESPIVENT-D REZIRA RHEUMA-HEEL RHINOFLEX RHINOFLEX-650 RICOLA RITIFED RI-TUSSIN DM ROBAFEN AC ROBAFEN CF ROBAFEN COUGH ROBAFEN DM COUGH ROBAFEN DM MAX ROBAFEN-DM ROBAFEN-DM CLEAR ROBITUSSIN COLD-FLU DAY ROBITUSSIN COLD-FLU NIGHT ROBITUSSIN COUGH & COLD ROBITUSSIN COUGH & COLD CF ROBITUSSIN COUGH & COLD CF MAX ROBITUSSIN COUGH-CHEST-CONG DM ROBITUSSIN COUGH-COLD ROBITUSSIN DM MAX ROBITUSSIN DM TO GO ROBITUSSIN LONG-ACTING ROBITUSSIN NIGHTTIME COUGH DM ROBITUSSIN PEDIATRIC ROBITUSSIN PEDIATRIC COUGH ROBITUSSIN-COUGH-CHEST-CONG ROBITUSSIN-DM COUGH RONDEC-DM R-TANNA R-TANNA PEDIATRIC RU-HIST D RU-HIST FORTE RU-HIST-D RU-TUSS RU-TUSS DM RYCONTUSS RYDEX RYDEX DM RYDEX G RYMED RYNA-12 RYNA-12 S RYNA-12X 61 GENERIC DRUG PHENYLEPHRINE/BROMPHENIRAMINE GUAIFENESIN/PSEUDOEPHEDRNE HCL D-METHORPHAN HB/P-EPD HCL/BPM CHLORPHENIRAMINE/METHSCOPOLAMN CHLORPHENIRAMINE/METHSCOPOLAMN PSEUDOEPHEDRINE/METHYLSCOPOLAM P-EPHED HCL/HYDROCODONE HOMEOPATHIC DRUGS ACETAMINOPHEN/PHENYLTOLX ACETAMINOPHEN/PHENYLTOLX MENTHOL PSEUDOEPHEDRINE/TRIPROLIDINE GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/CODEINE PHOSPHATE GUAIFENESIN/D-METHORPHAN HB/PE DEXTROMETHORPHAN HBR GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/DEXTROMETHORPHAN ROBITUSSIN CF D-METHORPHAN/PE/ACETAMINOPHEN D-METHORPHAN/ACETAMIN/DOXYLAMN PHENYLEPHRINE/DIPHENHYDRAMINE GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/DEXTROMETHORPHAN DEXTROMETHORPHAN HBR/CHLOR-MAL GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/DEXTROMETHORPHAN DEXTROMETHORPHAN HBR/CHLOR-MAL DEXTROMETHORPHAN HB/DOXYLAMINE DEXTROMETHORPHAN/PSEUDOEPHED DEXTROMETHORPHAN HBR GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/DEXTROMETHORPHAN D-METHORPHAN HB/P-EPD HCL/BPM PHENYLEPHRINE/CHLOR-TAN PHENYLEPHRINE/CHLOR-TAN PHENYLEPHRINE/BROMPHENIRAMINE PHENYLEPHRINE/PYRILAMINE MA/CP PHENYLEPHRINE/PYRILAMINE P-EPHED HCL/CHLOR-MAL/BELL ALK GUAIFENESIN/DM/PSEUDOEPHEDRINE DM/PHENYLEPH/CHLORPHENIRAMINE BROMPHENIRA/PSEUDOEPHED/CODEIN GUAIFENESIN/DM/PSEUDOEPHEDRINE GUAIFENESIN/PSEUDOEPHEDRNE HCL DEXCHLORPHENIR/PHENYLEPHRINE PHENYLEPHRINE/PYRILAMINE TAN PHENYLEPHRINE/PYRILAMINE TAN GUAIFEN/PHENYLEPHRINE/PYRIL KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD BRAND DRUG RYNATAN RYNATAN PEDIATRIC RYNATUSS RYNEX DM RYNEX PE RYNEZE S.T.37 SABAL-HOMACCORD SAFETUSSIN CD SAFETUSSIN DM SAFETUSSIN PM SALONSIP AQUA-PATCH SCOT-TUSSIN DM SCOT-TUSSIN DM COUGH CHASER SCOT-TUSSIN SENIOR SEPASOOTHE SERADEX SERADEX-LA SEVERE COLD & FLU SEVERE COLD CONGESTION SEVERE COLD MULTI-SYMPTOM SEVERE COLD-FLU NIGHTTIME SEVERE CONGESTION SEVERE CONGESTION & COUGH MAX SEVERE SINUS SEVERE SINUS CONGESTION SILAFED SILDEC PE-DM SILDEC-DM SILDEC-PE SILPHEN DM SILTUSSIN DM SILTUSSIN DM DAS COUGH FORMULA SIMUC-DM SINA-12X SINUS SINUS & ALLERGY PE SINUS & COLD-D SINUS 12-HOUR SINUS CONGESTION & PAIN SINUS CONGESTION-PAIN SINUS CONGESTION-PAIN RELIEF SINUS DAYTIME-NIGHTTIME SINUS DECONGESTANT SINUS FORMULA SINUS HEADACHE SINUS HEADACHE DEGONGESTANT SINUS HEADACHE PE SINUS MAXIMUM STRENGTH SINUS NASAL SINUS NASAL SPRAY SINUS NIGHTTIME 62 GENERIC DRUG PHENYLEPHRINE/CHLOR-TAN PHENYLEPHRINE/CHLOR-TAN CAR-B-PEN TA/EPHED TAN/PE/CP BROMPHENIRAM/PHENYLEPHRINE/DM PHENYLEPHRINE/BROMPHENIRAMINE CHLORPHENIRAMINE/METHSCOPOLAMN HEXYLRESORCINOL HOMEOPATHIC DRUGS DEXTROMETHORPHAN/PHENYLEPHRINE GUAIFENESIN/DEXTROMETHORPHAN DEXTROMETHORPHAN HB/DOXYLAMINE MENTHOL DEXTROMETHORPHAN HBR/CHLOR-MAL DEXTROMETHORPHAN HBR GUAIFENESIN/DEXTROMETHORPHAN HEXYLRESORCINOL/MENTHOL BROMPHENIRAMIN/PE/CARBETAPENT PHENYLEPHRINE/BROMPHENIRAMINE DOXYLAM/PE/DM/ACETAMINOPHEN/GG PSEUDOEPH/DM/GUAIFEN/ACETAMIN PHENYLEPHRINE/DM/ACETAMINOP/GG DM/PE/ACETAMINOPHEN/DOXYLAMINE OXYMETAZOLINE HCL GUAIFENESIN/D-METHORPHAN HB/PE GUAIFEN/PHENYLEPH/ACETAMINOPHN GUAIFEN/PSEUDOEPHED/ACETAMINOP PSEUDOEPHEDRINE/TRIPROLIDINE DM/PHENYLEPH/CHLORPHENIRAMINE D-METHORPHAN HB/P-EPD HCL/BPM PHENYLEPHRINE/CHLORPHENIRAMINE DEXTROMETHORPHAN HBR GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/PHENYLEPHRINE TANN HOMEOPATHIC DRUGS PHENYLEPHRINE/CHLORPHENIRAMINE NAPROXEN SODIUM/P-EPHED HCL PSEUDOEPHEDRINE HCL GUAIFEN/PHENYLEPH/ACETAMINOPHN PHENYLEPHRINE HCL/ACETAMINOPHN GUAIFEN/PHENYLEPH/ACETAMINOPHN PHENYLEPHRINE/ACETAMIN/DOXYLAM PHENYLEPHRINE HCL PHENYLEPHRINE HCL/ACETAMINOPHN PSEUDOEPHEDRINE/ACETAMINOPHEN PSEUDOEPHEDRINE/ACETAMINOPHEN PHENYLEPHRINE HCL/ACETAMINOPHN PHENYLEPHRINE HCL/ACETAMINOPHN OXYMETAZOLINE HCL OXYMETAZOLINE HCL PHENYLEPHRINE/TRIPROLIDINE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD BRAND DRUG SINUS PAIN RELIEF SINUS PRESSURE-CONG RELIEF PE SINUS RELIEF SINUS RELIEF CONGESTION & PAIN SINUS RELIEF NASAL SPRAY SINUS RELIEF-CONGESTION & PAIN SINUTAB SINUS SINUTROL PE SKIN SOMBRA COOL THERAPY SONAHIST SONAHIST DM SORBUGEN NR SORBUTUSS SORE MUSCLE RUB SORE THROAT & COUGH SORE THROAT RELIEF SPASCUPREEL SPASM-PAIN SPIGELIA COMPOSITUM SPIGELON STAFLEX STAHIST STAHIST AD STATUSS GREEN STERILE EYE DROPS STOMACH STOPAIN STRAMONIUM STRUMEEL SUDAFED SUDAFED 12 HOUR SUDAFED 12 HR PRESSURE-PAIN SUDAFED 12 HR SINUS-PAIN SUDAFED 12-HOUR SUDAFED 24-HOUR SUDAFED OM SUDAFED PE SUDAFED PE COLD & COUGH SUDAFED PE NON-DRYING SINUS SUDAFED PE PRESSURE+PAIN+COLD SUDAFED PE PRESSURE+PAIN+COUGH SUDAFED PE SINUS & ALLERGY SUDAFED PE SINUS HEADACHE SUDAFED SINUS SUDAFED TRIPLE ACTION SUDAL-12 SUDATEX G SUDATEX-DM SUDOGEST SUDOGEST PE 63 GENERIC DRUG PHENYLEPHRINE HCL/ACETAMINOPHN PHENYLEPHRINE HCL OXYMETAZOLINE HCL PHENYLEPHRINE/ACETAMINOPHEN/CP OXYMETAZOLINE HCL PHENYLEPHRINE/ACETAMINOPHEN/CP PHENYLEPHRINE HCL/ACETAMINOPHN PHENYLEPHRINE/ACETAMINOPHEN/CP HOMEOPATHIC DRUGS MENTHOL PHENYLEPHRINE/CHLORPHENIRAMINE DM/PHENYLEPH/CHLORPHENIRAMINE GUAIFENESIN/DEXTROMETHORPHAN GUAIFEN/D-METHORPHAN HB/K CIT MENTHOL DEXTROMETHORPHAN HBR/B-CAINE SORE THROAT LOZENGES PECTIN HOMEOPATHIC DRUGS HOMEOPATHIC DRUGS HOMEOPATHIC DRUGS HOMEOPATHIC DRUGS ACETAMINOPHEN/PHENYLTOLX CPM/P-EPHED/ATROP/HYOS/SCOP HB CHLORCYCLIZINE/PSEUDOEPHEDRINE CHLORCYCLI/PSEUDOEPHED/CODEINE TETRAHYDROZOLINE HCL HOMEOPATHIC DRUGS MENTHOL HOMEOPATHIC DRUGS HOMEOPATHIC DRUGS PSEUDOEPHEDRINE HCL PSEUDOEPHEDRINE HCL NAPROXEN SODIUM/P-EPHED HCL NAPROXEN SODIUM/P-EPHED HCL PSEUDOEPHEDRINE HCL PSEUDOEPHEDRINE HCL OXYMETAZOLINE HCL PHENYLEPHRINE HCL PHENYLEPHRINE/DM/ACETAMINOP/GG GUAIFENESIN/PHENYLEPHRINE HCL PHENYLEPHRINE/DM/ACETAMINOP/GG D-METHORPHAN/PE/ACETAMINOPHEN PHENYLEPHRINE/CHLORPHENIRAMINE PHENYLEPHRINE HCL/ACETAMINOPHN P-EPHED HCL/ACETAMINOPHEN GUAIFEN/PSEUDOEPHED/ACETAMINOP PSEUDOEPHED PL/CHLORPHEN POLAC GUAIFENESIN/PSEUDOEPHEDRNE HCL GUAIFENESIN/DM/PSEUDOEPHEDRINE PSEUDOEPHEDRINE HCL PHENYLEPHRINE HCL KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD BRAND DRUG SULFUR-HEEL SUPER TROCHE DM SUPHEDRIN SUPHEDRIN 12-HOUR SUPHEDRINE SUPHEDRINE 12-HOUR SUPHEDRINE PE SUPHEDRINE SINUS CONGESTION SUPRESS A SUPRESS DM SUPRESS-DX SUPRESS-PE SYZYGIUM COMPOSITUM TAB A VITE TAB TUSSIN DM TANABID TANABID SR TAVIST TEKRAL TENAR DM TENAR PSE TENSION HEADACHE RELIEVER TESSALON TESSALON PERLE TG 10PEH-380GFN TG 10PEH-380GFN-15DM TG 45PSE-400GFN TG 45PSE-400GFN-15DM THERAFLU COLD & COUGH THERAFLU COLD-SORE THROAT THERAFLU DAY-NGT COLD & COUGH THERAFLU FLU-CHEST CONGESTION THERAFLU MAX-D SEVERE COLD-FLU THERAFLU MULTI-SYMPTOM COLD THERAFLU SINUS & COLD THERAPEUTIC BLUE GEL THERAPEUTIC M THERAPEUTIC MINERAL ICE THROAT THROAT DROPS THROAT LOZENGE TL-DEX DM TL-DMX TL-HIST CD TL-HIST CM TL-HIST DM TRAUMEEL TREXBROM TRIACTING COLD & COUGH TRIACTING COUGH & RUNNY NOSE TRIACTING COUGH & SORE THROAT TRIACTING EXPECTORANT 64 GENERIC DRUG HOMEOPATHIC DRUGS DEXTROMETHORPHAN HBR/B-CAINE PSEUDOEPHEDRINE HCL PSEUDOEPHEDRINE HCL PSEUDOEPHEDRINE HCL PSEUDOEPHEDRINE HCL DIPHENHYDRAM/PE/DM/ACETAMIN/GG PSEUDOEPHEDRINE HCL D-METHORPHAN/PE/DEXBROMPHENIR GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/PHENYLEPHRINE HCL HOMEOPATHIC DRUGS MULTIVIT WITH CALCIUM,IRON,MIN GUAIFENESIN/DEXTROMETHORPHAN PHENYLEPHRINE/BROMPHENIRAMIN PHENYLEPHRINE/BROMPHENIRAMINE PSEUDOEPHEDRINE/ACETAMINOPHEN PSEUDOEPHED/DIPHENHYDRAMINE GUAIFENESIN/DM/PSEUDOEPHEDRINE GUAIFENESIN/PSEUDOEPHEDRNE HCL ACETAMINOPHEN/PHENYLTOLX BENZONATATE BENZONATATE GUAIFENESIN/PHENYLEPHRINE HCL GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/PSEUDOEPHEDRNE HCL GUAIFENESIN/DM/PSEUDOEPHEDRINE DEXTROMETHORPHAN/PE/PHENIRAMIN PHENYLEPHRINE/ACETAMINOPHN/PNM DM/PE/ACETAMINOPH/DIPHENHYDRAM GUAIFENESIN/ACETAMINOPHEN PSEUDOEPH/DM/GUAIFEN/ACETAMIN D-METHORPHAN/PE/ACETAMINOPHEN PHENYLEPHRINE/ACETAMINOPHN/PNM MENTHOL MULTIVIT WITH CALCIUM,IRON,MIN MENTHOL HOMEOPATHIC DRUGS PECTIN BENZOCAINE/CETYLPYRIDINIUM CHL GUAIFENESIN/DM/PSEUDOEPHEDRINE GUAIFENESIN/PHENYLEPHRINE HCL BROMPHENIRAMINE/PE/CODEINE CHLORPHENIRAMINE/CODEINE PHOS BROMPHENIRAM/PHENYLEPHRINE/DM HOMEOPATHIC DRUGS BROMPHENIRAMIN/PE/CARBETAPENT DEXTROMETHORPHAN/PHENYLEPHRINE DEXTROMETHORPHAN HBR/CHLOR-MAL D-METHORPHAN HB/ACETAMINOPHEN GUAIFENESIN/PSEUDOEPHEDRNE HCL KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD BRAND DRUG TRIACTING M-SYM COLD-COUGH TRIACTING NIGHT TIME TRIAMINIC COLD & COUGH TRIAMINIC COLD-ALLERGY PE TRIAMINIC COLD-COUGH-FEVER TRIAMINIC DAYTIME COLD-COUGH TRIAMINIC NIGHT TIME TRIAMINIC NIGHTTIME COLD-COUGH TRIAMINIC-D TRIAMINICIN TRICODE AR TRICODE GF TRICODENE TRI-DEX PE TRIGOFEN TRIGOFEN DM TRIONATE TRIP-PSE TRIPTIFED TRISPEC DEX TRISPEC DMX TRISPEC PSE TRITAL DM TRYMINE CD TRYMINE CG TRYMINE D TUSDEC-DM TUSICOF TUSNEL TUSNEL C TUSNEL DIABETIC TUSNEL PED-C TUSNEL PEDIATRIC TUSNEL-A TUSNEL-DM PEDIATRIC TUSSAFED EX TUSSANIL TUSSI PRES-B TUSSI-12 TUSSI-12 S TUSSI-12D TUSSI-12D S TUSSICAPS TUSSIGON TUSSIN CF TUSSIN CF MAX TUSSIN COLD SEVERE CONGESTION TUSSIN COLD-CONGESTION TUSSIN COUGH TUSSIN COUGH DM TUSSIN COUGH-CHEST CONGESTION TUSSIN COUGH-COLD-FLU 65 GENERIC DRUG D-METHORPHAN HB/P-EPHED HCL/CP DEXTROMETHORPHAN HBR/CHLOR-MAL DEXTROMETHORPHAN/PHENYLEPHRINE PHENYLEPHRINE/CHLORPHENIRAMINE DM HB/PSEUDOEPHED/ACETAMIN/CP DEXTROMETHORPHAN/PHENYLEPHRINE D-METHORPHAN HB/P-EPHED HCL/CP PHENYLEPHRINE/DIPHENHYDRAMINE D-METHORPHAN HB/P-EPHED HCL/CP P-EPHED HCL/ACETAMINOPHEN/CP CHLORPHEN/PSEUDOEPHED/CODEINE P-EPHED HCL/CODEINE/GUAIFEN AMMON CHL/DM/CP/SODIUM CIT DM/PHENYLEPH/CHLORPHENIRAMINE PHENYLEPHRINE/CHLORPHENIRAMINE DM/PHENYLEPH/CHLORPHENIRAMINE CAR-B-PEN TA/CHLOR-TAN PSEUDOEPHEDRINE/TRIPROLIDINE PSEUDOEPHEDRINE/TRIPROLIDINE GUAIFENESIN/PSEUDOEPHEDRNE HCL GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/DM/PSEUDOEPHEDRINE DM/PHENYLEPH/CHLORPHENIRAMINE TRIPROLIDINE/PSEUDOEPHED/CHLOP GUAIFENESIN/CODEINE PHOSPHATE PSEUDOEPHEDRINE/TRIPROLIDINE BROMPHENIRAM/PHENYLEPHRINE/DM GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/DM/PSEUDOEPHEDRINE P-EPHED HCL/CODEINE/GUAIFEN GUAIFENESIN/DEXTROMETHORPHAN P-EPHED HCL/CODEINE/GUAIFEN GUAIFENESIN/DM/PSEUDOEPHEDRINE PSEUDOEPH/DM/GUAIFEN/ACETAMIN GUAIFENESIN/DM/PSEUDOEPHEDRINE GUAIFENESIN/D-METHORPHAN HB/PE PHENYLEPHRINE/CHLORPHENIRAMINE BROMPHENIRAM/PHENYLEPHRINE/DM CAR-B-PEN TA/CHLOR-TAN CAR-B-PEN TA/CHLOR-TAN CAR-B-PEN TA/PHENYLEPHRINE/PYR CAR-B-PEN TA/PHENYLEPHRINE/PYR HYDROCODONE/CHLORPHEN P-STIREX HYDROCODONE BIT/HOMATROP ME-BR GUAIFENESIN/DM/PSEUDOEPHEDRINE GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/PSEUDOEPHEDRNE HCL GUAIFENESIN/DM/PSEUDOEPHEDRINE DEXTROMETHORPHAN HBR GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/DEXTROMETHORPHAN DM HB/PE/ACETAMINOPHEN/CHLORPH KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD BRAND DRUG TUSSIN DM TUSSIN DM CLEAR TUSSIN DM COUGH TUSSIN DM COUGH & CHEST TUSSIN DM COUGH-CHEST CONGEST TUSSIN DM MAX TUSSIN MAXIMUM STRENGTH TUSSIN PE TUSSINMAX TUSSIONEX TUSSI-PRES TUSSI-PRES B TUSSI-PRES PE TUSSI-PRES PEDIATRIC TUSSLIN TUSSO-C TUSSO-DMR TUSSO-ZMR TYLENOL ALLERGY M-S NIGHTTIME TYLENOL ALLERGY MULTI-SYMPTOM TYLENOL COLD TYLENOL COLD & FLU SEVERE TYLENOL COLD HEAD CONGEST SEVR TYLENOL COLD HEAD CONGESTION TYLENOL COLD MULTI-SYMPTOM TYLENOL COLD MULTI-SYMPTOMS TYLENOL COLD SEVERE CONGESTION TYLENOL COLD-FLU SEVERE TYLENOL SINUS TYLENOL SINUS CONGESTION-PAIN TYLENOL WARMING COLD M-S TYZINE ULTIMATE TEEN ULTRA CAP ULTRA DM FREE & CLEAR ULTRA FLU ULTRA TUSS ULTREX VALU-TAPP DECONGESTANT VANACOF VANACOF APE VANACOF CD VANACOF DM VANACOF DX VANACOF G VANACOF GPE VANACOF-8 VANACOF-PE VANATAB DX VAPOR INHALER VAPORIZING STEAM VARICOSE 66 GENERIC DRUG GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/DEXTROMETHORPHAN GUAIFENESIN/DEXTROMETHORPHAN DEXTROMETHORPHAN HBR GUAIFENESIN/PHENYLEPHRINE HCL DEXTROMETHORPHAN HBR HYDROCODONE/CHLORPHEN P-STIREX GUAIFENESIN/D-METHORPHAN HB/PE BROMPHENIRAM/PHENYLEPHRINE/DM GUAIFENESIN/PHENYLEPHRINE HCL GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/CODEINE PHOSPHATE GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/CARBETAPENTANE CIT DIPHENHYDRA/PHENYLEPH/ACETAMIN PE/ACETAMIN/DIPHENHYDRAMIN/CPM DM HB/PE/ACETAMINOPHEN/CHLORPH PHENYLEPHRINE/DM/ACETAMINOP/GG GUAIFEN/PHENYLEPH/ACETAMINOPHN DM HB/PE/ACETAMINOPHEN/CHLORPH DM HB/PE/ACETAMINOPHEN/CHLORPH DM/PE/ACETAMINOPHEN/DOXYLAMINE PSEUDOEPH/DM/GUAIFEN/ACETAMIN PHENYLEPHRINE/DM/ACETAMINOP/GG GUAIFEN/PSEUDOEPHED/ACETAMINOP GUAIFEN/PHENYLEPH/ACETAMINOPHN DM/PE/ACETAMINOPHEN/DOXYLAMINE TETRAHYDROZOLINE HCL MULTIVIT WITH CALCIUM,IRON,MIN DM HB/PSEUDOEPHED/ACETAMIN/CP GUAIFENESIN/DEXTROMETHORPHAN DM HB/PSEUDOEPHED/ACETAMIN/CP GUAIFENESIN/DEXTROMETHORPHAN DM HB/PSEUDOEPHED/ACETAMIN/CP PSEUDOEPHEDRINE HCL D-CHLORPHENIRA/PSE/CHLOPHEDIAN THONZYLAMINE/PHENYL/CHLOPHED DEXCHLORPHEN/PHENYLEPH/CODEINE GUAIFENESIN/D-METHORPHAN HB/PE PSEUDOEPH/CHLOPHEDIANOL/GG CHLOPHEDIANOL HCL/GUAIFENESIN PHENYLEPHRINE/CHLOPHEDIANOL/GG PYRILAMINE/CHLOPHEDIANOL CHLORCYCLIZIN-PE-CHLOPHEDIANOL PSEUDOEPH/CHLOPHEDIANOL/GG LEVMETAMFETAMINE CAMPHOR/EUCALYPTUS/MENTHOL HOMEOPATHIC DRUGS KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD BRAND DRUG VASO VAZCULEP VAZOBID VAZOBID-PD VAZOTAB VAZOTAN V-COF VERTIGOHEEL V-HIST VICKS 44 VICKS 44 CUSTOM CARE VICKS CHILDREN'S NYQUIL VICKS COUGH DROPS VICKS DAYQUIL VICKS DAYQUIL COUGH VICKS DAYQUIL MUCUS CONTROL VICKS DAYQUIL SEVERE COLD-FLU VICKS DAYQUIL SINEX VICKS DAYQUIL-NYQUIL VICKS DAYQUIL-NYQUIL COLD-FLU VICKS DAYQUIL-NYQUIL SEVERE VICKS INHALER VICKS NATURE FUSION VICKS NATURE FUSION COUGH VICKS NYQUIL VICKS NYQUIL COLD & FLU VICKS NYQUIL COUGH VICKS NYQUIL SEVERE COLD-FLU VICKS NYQUIL SINEX VICKS QLEARQUIL VICKS QLEARQUIL DAYTIME VICKS SINEX VICKS VAPODROPS VICKS VAPOSTEAM VIRACON VIRAVAN-P VIRAVAN-PDM VIRDEC VIRDEC DM VIRTUSSIN AC VIRTUSSIN DAC VISINE VISINE LONG LASTING VISTRA 650 VITAMIN E VITAMIN E NATURAL BLEND VITEC VITUZ WAL-ACT D COLD & ALLERGY WAL-DRYL-D ALLERY & SINUS WAL-FLU COLD & SORE THROAT 67 GENERIC DRUG PSEUDOEPHEDRINE/CPM/METHYLSCOP PHENYLEPHRINE HCL PHENYLEPHRINE/BROMPHENIRAMIN PHENYLEPHRINE/BROMPHENIRAMINE PHENYLEPHRINE/BROMPHENIRAMIN BROMPHEN/PHENYLEPH/CARBET TANN BROMPHENIRAMIN/PE/CARBETAPENT HOMEOPATHIC DRUGS PHENYLEPHRINE/BROMPHENIRAMINE DEXTROMETHORPHAN HBR DEXTROMETHORPHAN HBR DEXTROMETHORPHAN HBR/CHLOR-MAL MENTHOL D-METHORPHAN/PE/ACETAMINOPHEN DEXTROMETHORPHAN HBR GUAIFENESIN/DEXTROMETHORPHAN PHENYLEPHRINE/DM/ACETAMINOP/GG PHENYLEPHRINE HCL/ACETAMINOPHN DM/PE/ACETAMINOPHEN/DOXYLAMINE DM/PE/ACETAMINOPHEN/DOXYLAMINE DOXYLAM/PE/DM/ACETAMINOPHEN/GG L-DESOXYEPHEDRINE D-METHORPHAN/ACETAMIN/DOXYLAMN DEXTROMETHORPHAN HBR D-METHORPHAN/ACETAMIN/DOXYLAMN DEXTROMETHORPHN/ACETAMINOPH/CP DEXTROMETHORPHAN HB/DOXYLAMINE DM/PE/ACETAMINOPHEN/DOXYLAMINE PHENYLEPHRINE/ACETAMIN/DOXYLAM OXYMETAZOLINE HCL PHENYLEPHRINE HCL/ACETAMINOPHN OXYMETAZOLINE HCL MENTHOL CAMPHOR/EUCALYPT/MENTH/BENZOIN HOMEOPATHIC DRUGS PSEUDOEPHED TAN/PYRILAMINE TAN DM,P-EPHED,PYRILAMINE TANNATES PHENYLEPHRINE/CHLORPHENIRAMINE DM/PHENYLEPH/CHLORPHENIRAMINE GUAIFENESIN/CODEINE PHOSPHATE P-EPHED HCL/CODEINE/GUAIFEN TETRAHYDROZOLINE HCL OXYMETAZOLINE HCL ACETAMINOPHEN/PHENYLTOLX VITAMIN E ACETATE VITAMIN E MIXED VITAMIN E HYDROCODONE/CHLORPHENIRAMINE PSEUDOEPHEDRINE/TRIPROLIDINE PHENYLEPHRINE/DIPHENHYDRAMINE PHENYLEPHRINE/ACETAMINOPHN/PNM KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD BRAND DRUG WAL-FLU NIGHT TIME WAL-FLU SEVERE COLD WAL-FLU SEVERE COLD-COUGH WAL-FOUR WAL-PHED 12 HOUR WAL-PHED PE COLD-COUGH WAL-PHED PE SINUS & ALLERGY WAL-PHED PE TRIPLE RELIEF WAL-PROFEN WAL-PROFEN D WAL-TAP DM WAL-TUSSIN COUGH WAL-TUSSIN COUGH & COLD CF WAL-TUSSIN DM WOMEN'S DAILY FORMULA WOMEN'S DAILY MULTIVITAMIN WOMEN'S ONE DAILY Y-COF DM Y-COF DMX YODEFAN-NF YPSILOHEEL Z-COF 12DM Z-COF 8 DM Z-COF I Z-DEX Z-DEX 12D Z-DEX SYRUP ZEEL ZEPHREX-D ZFLEX ZGESIC ZIM'S MAX-FREEZE ZODEN ZODEN DM ZODEN PD ZODRYL AC 25 ZODRYL AC 30 ZODRYL AC 35 ZODRYL AC 40 ZODRYL AC 50 ZODRYL AC 60 ZODRYL AC 80 ZODRYL DAC 25 ZODRYL DAC 30 ZODRYL DAC 35 ZODRYL DAC 40 ZODRYL DAC 50 ZODRYL DAC 60 ZODRYL DAC 80 ZODRYL DEC 25 ZODRYL DEC 30 ZODRYL DEC 35 68 GENERIC DRUG PHENYLEPHRINE/ACETAMINOPHN/PNM PHENYLEPHRINE HCL/ACETAMINOPHN D-METHORPHAN/PE/ACETAMINOPHEN PHENYLEPHRINE HCL PSEUDOEPHEDRINE HCL PHENYLEPHRINE/DM/ACETAMINOP/GG PHENYLEPHRINE/CHLORPHENIRAMINE GUAIFEN/PHENYLEPH/ACETAMINOPHN IBUPROFEN/PSEUDOEPHEDRINE HCL IBUPROFEN/PSEUDOEPHEDRINE HCL BROMPHENIRAM/PHENYLEPHRINE/DM DEXTROMETHORPHAN HBR GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/DEXTROMETHORPHAN MULTIVIT WITH CALCIUM,IRON,MIN MULTIVIT WITH CALCIUM,IRON,MIN MULTIVIT WITH CALCIUM,IRON,MIN D-METHORPHAN/PE/DEXBROMPHENIR BROMPHENIRAM/PHENYLEPHRINE/DM POTASSIUM GUAIACOLSULFONATE HOMEOPATHIC DRUGS GUAIFENESIN/DM/PSEUDOEPHEDRINE GUAIFENESIN/DM/PSEUDOEPHEDRINE GUAIFENESIN/DM/PSEUDOEPHEDRINE GUAIFENESIN/D-METHORPHAN HB/PE DM/PHENYLEPH/CHLORPHENIRAMINE GUAIFENESIN/D-METHORPHAN HB/PE HOMEOPATHIC DRUGS PSEUDOEPHEDRINE HCL ACETAMINOPHEN/PHENYLTOLX ACETAMINOPHEN/PHENYLTOLX MENTHOL GUAIFENESIN/PHENYLEPHRINE HCL DM/PHENYLEPH/CHLORPHENIRAMINE PHENYLEPHRINE/DIPHENHYDRAMINE CHLORPHENIRAMINE/CODEINE PHOS CHLORPHENIRAMINE/CODEINE PHOS CHLORPHENIRAMINE/CODEINE PHOS CHLORPHENIRAMINE/CODEINE PHOS CHLORPHENIRAMINE/CODEINE PHOS CHLORPHENIRAMINE/CODEINE PHOS CHLORPHENIRAMINE/CODEINE PHOS CHLORPHEN/PSEUDOEPHED/CODEINE CHLORPHEN/PSEUDOEPHED/CODEINE CHLORPHEN/PSEUDOEPHED/CODEINE CHLORPHEN/PSEUDOEPHED/CODEINE CHLORPHEN/PSEUDOEPHED/CODEINE CHLORPHEN/PSEUDOEPHED/CODEINE CHLORPHEN/PSEUDOEPHED/CODEINE P-EPHED HCL/CODEINE/GUAIFEN P-EPHED HCL/CODEINE/GUAIFEN P-EPHED HCL/CODEINE/GUAIFEN KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD COUGH AND COLD DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE BRAND DRUG ZODRYL DEC 40 ZODRYL DEC 50 ZODRYL DEC 60 ZODRYL DEC 80 ZONATUSS ZOTEX ZOTEX 12 ZOTEX-12D ZOTEX-C ZOTEX-D ZOTEX-EX ZOTEX-GP ZOTEX-PE Z-TUSS AC Z-TUSS DM Z-TUSS E ZUTRIPRO ZYNCOF 10 WASH A.E.R A.E.R TRAVELER ABSORICA ACANYA ACNE CARE ACZONE ALA-QUIN ALC-FREE ALCOHOL,DEHYDRATED ALCORTIN A ALOQUIN ALPHAGAN P ALUM POWDER A-MANTLE AMERIWASH AMNESTEEM ANTIBACTERIAL ANTIBACTERIAL CLEANSING ANTI-BACTERIAL CLEANSING ANTIBACTERIAL LIQUID SOAP ANTIBACTERIAL WIPES ANTIBIOTIC ANTISEPTIC ANTISEPTIC BIO-HAND ANTISEPTIC CLEANSER ANTISEPTIC PERINEAL WASH II ANTISEPTIC SKIN CLEANSER ANTISEPTIC SOLUTION ANTISEPTIC WOUND-SKIN APOP ASC LOTIONIZED CLEANSER 69 GENERIC DRUG P-EPHED HCL/CODEINE/GUAIFEN P-EPHED HCL/CODEINE/GUAIFEN P-EPHED HCL/CODEINE/GUAIFEN P-EPHED HCL/CODEINE/GUAIFEN BENZONATATE GUAIFENESIN/D-METHORPHAN HB/PE DM-PE-PYRILAMINE TANNATES DM/PHENYLEPH/CHLORPHENIRAMINE PYRIL MA/PE/CODEINE PHOS GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/D-METHORPHAN HB/PE GUAIFENESIN/PHENYLEPHRINE HCL PHENYLEPHRINE/BROMPHENIRAMINE CHLORPHENIRAMINE/CODEINE PHOS GUAIFENESIN/D-METHORPHAN HB/PE P-EPHED HCL/CODEINE/GUAIFEN PSEUDOEPHED/HYDROCODONE/CPM GUAIFENESIN/DEXTROMETHORPHAN SULFACETAMIDE SODIUM GLYCERIN/WITCH HAZEL GLYCERIN/WITCH HAZEL ISOTRETINOIN CLINDAMYCIN PHOS/BENZOYL PEROX WITCH HAZEL LEAF/ALCOHOL DAPSONE ADAPALENE CLIOQUINOL/HYDROCORTISONE BENZALKONIUM CHLORIDE ETHYL ALCOHOL HYDROCORTISONE/IODOQUIN/ALOE#2 IODOQUINOL/ALOE POLYSACCHAR #1 BRIMONIDINE TARTRATE AMMONIUM ALUM ALUMINUM ACETATE ALUMINUM ACETATE TRICLOSAN ISOTRETINOIN TRICLOSAN TRICLOSAN BENZETHONIUM CHLORIDE TRICLOSAN BENZALKONIUM CHLORIDE BACITRACIN ZINC POVIDONE-IODINE ETHYL ALCOHOL EUCALYPT/MENTH/CAMPH/PEP/W-H BENZETHONIUM CHLORIDE CHLORHEXIDINE GLUCONATE POVIDONE-IODINE BENZETHONIUM CHLORIDE SULFACETAMIDE SODIUM/BAKUCHIOL TRICLOSAN KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE BRAND DRUG AZELEX BABY WASH BACIIM GENERIC DRUG AZELAIC ACID SKIN CLEANSER BACITRACIN BACITRACIN BACITRACIN ZINC BACITRACIN ETHYL ALCOHOL/BAY OIL METHYLBENZETHONIUM CHLORIDE BENZETHONIUM CHLORIDE BENZOYL PEROXIDE/HYDROCORTISON CLINDAMYCIN PHOS/BENZOYL PEROX BENZALKONIUM CHLORIDE BENZALKONIUM CHLORIDE BACITRAYCIN PLUS BAY RUM BEDSIDE-CARE BEDSIDE-CARE PERINEAL BENCORT BENZACLIN BENZ-ALL BENZOIN BETADINE BETASEPT BLEPH-10 BODI LINE BODI WHIRL BATH CALMOSEPTINE CA-REZZ CETAKLENZ CLARAVIS CLINDAMYCIN PHOS-BENZOYL PEROX CLINDAMYCIN-BENZOYL PEROXIDE COLD SORE COLD SORE TREATMENT CURE CHROME DERMA CIDOL 2000 DERMAFIX DERMASORB AF DERMAZENE DIFFERIN DUAC DUAC CS DYNAHEX EPI-CLENZ EPIDUO EXODERM EYE WASH E-Z SCRUB PREOPERATIVE FABIOR FINACEA FINACEA PLUS FIRST AID ANTISEPTIC FLAGYL FLAGYL ER FORMADON 70 POVIDONE-IODINE CHLORHEXIDINE GLUCONATE SULFACETAMIDE SODIUM ETHYL ALCOHOL SKIN CLEANSER BRIMONIDINE TARTRATE MENTHOL/ZINC OXIDE TRICLOSAN SKIN CLEANSER CHLORHEXIDINE GLUCONATE ISOTRETINOIN CLINDAMYCIN PHOS/BENZOYL PEROX CLINDAMYCIN PHOS/BENZOYL PEROX TANNIC ACID BENZALKONIUM CHLORIDE BENZALKONIUM CHLORIDE DAPSONE CHLOROXYLENOL SOD CHLORIDE/B-6/ZINC ACET/ALC CLIOQUINOL/HC/EMOLLIENT CMB#88 HYDROCORTISONE/IODOQUINOL ADAPALENE CLINDAMYCIN PHOS/BENZOYL PEROX CLINDAMYCIN/BENZOYL PRX/SKN #5 CHLORHEXIDIN/ISOPROPYL ALCOHOL ETHYL ALCOHOL ADAPALENE/BENZOYL PEROXIDE ETHYL ALCOHOL SODIUM THIOSULFATE/SAL ACID SOD BORATE/BORIC AC/WATER/NACL POVIDONE-IODINE TAZAROTENE AZELAIC ACID AZELAIC ACID/CERAMIDE 1,3,6-11 POVIDONE-IODINE METRONIDAZOLE METRONIDAZOLE FORMALDEHYDE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE BRAND DRUG FORMALAZ FORMA-RAY GELRITE GEL-STAT GENTLE RAIN GENTLE SKIN CLEANSER GERM DEFENSE GOLD BOND QUICK SPRAY GORDOMATIC GRX DYNE HAND SANITIZER HAND SOAP HEMORRHOID PAD HEMORRHOIDAL HYGIENE HEMORRHOIDAL PADS HIBICLENS HIBISTAT TOWELETTE HOSPITAL ANTISEPTIC HURRISEPT HYDROCORTISONE-IODOQUINOL HYDRO-IODOQUINOL 2-1 HYGIENIC CLEANSING PADS IODEX IODIDES IODINE STRONG IODOFLEX IODOSORB KENDALL ANTIMICROBIAL KLARON LAZERFORMALYDE LID SCRUB COMPLIANCE LOBANA BODY LUGOL'S MEDI PADS MEDICATED CLEANSING CLOTHS MEDICATED DOUCHE MEDICATED HEMORRHOID MEDICATED PADS MEDICATED WIPES MEDIWASH MERCUROCHROME MERTHIOLATE METROCREAM METROGEL METROGEL-VAGINAL METROLOTION MICROKLENZ MIRVASO 71 GENERIC DRUG FORMALDEHYDE FORMALDEHYDE FORMALDEHYDE ETHYL ALCOHOL ETHYL ALCOHOL TRICLOSAN PARAB/CET ALC/STRYL ALC/PG/SLS ETHYL ALCOHOL BENZETHONIUM CHLORIDE/MENTHOL ALUM/SALICYLIC ACID/TALC/BENT POVIDONE-IODINE ETHYL ALCOHOL TRICLOSAN GLYCERIN/WITCH HAZEL LEAF WITCH HAZEL GLYCERIN/WITCH HAZEL LEAF CHLORHEXIDINE GLUCONATE CHLORHEXIDINE GLUCONATE POVIDONE-IODINE ETHYL ALCOHOL HYDROCORTISONE/IODOQUINOL HYDROGEN PEROXIDE HYDROCORTISONE/ALOE POL/IODOQU GLYCERIN/WITCH HAZEL LEAF POVIDONE-IODINE AMMONIUM IODIDE/POTASSIUM IOD IODINE/POTASSIUM IODIDE CADEXOMER IODINE CADEXOMER IODINE IVERMECTIN BENZALKONIUM CHLORIDE SULFACETAMIDE SODIUM FORMALDEHYDE EYELID CLEANSER COMB NO.4 CHLOROXYLENOL IODINE/POTASSIUM IODIDE GLYCERIN/WITCH HAZEL LEAF WITCH HAZEL LEAF POVIDONE-IODINE SKIN CLEANSER GLYCERIN/WITCH HAZEL LEAF GLYCERIN/ALOE VERA/WITCH HAZEL SOD BORATE/BORIC AC/WATER/NACL MERBROMIN BENZALKONIUM CHLORIDE METRONIDAZOLE METRONIDAZOLE METRONIDAZOLE METRONIDAZOLE METRONIDAZOLE BENZETHONIUM CHLORIDE BRIMONIDINE TARTRATE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE BRAND DRUG MYORISAN NEOSPORIN NEUAC NORITATE NORMLGEL AG NUVESSA ONEXTON ORAL CLEANSER OVACE OVACE PLUS OVACE PLUS WASH OXYZAL WET DRESSING PAROEX PEDI-WHIRL PERIANAL CLEANSING PERICLEAN PERIDEX PERIGIENE PERINEAL SKIN CLEANSER PERIOGARD PERI-WASH PEROXIDE SORE MOUTH CLEANSER PEROXYL DENTAL RINSE PEROXYL ORAL CLEANSER PETERSON'S OINTMENT PHENEEN PHISOHEX PRE-MOISTENED HEMORRHOIDAL PRE-MOISTENED MEDICATED WIPES PREPARATION H PREPARATION H TOTABLES PURELL PURELL PURIFYING ESSENTIAL RASH RELIEF ANTIBACTERIAL REMEDY RENEWAL ANTIBACTERIAL LIQ SOAP REVITADERM ROSADAN SAF-CLENS AF SALINE WOUND WASH SANIPADS WITH ALOE SARNA SENSITIVE SCRUB CARE POVIDONE IODINE SEB-PREV SECURA SECURA MOISTURIZING SILVER GEL SILVER-SEPT SILVRSTAT SKIN CARE 72 GENERIC DRUG ISOTRETINOIN BENZALKONIUM CHLORIDE CLINDAMYCIN PHOS/BENZOYL PEROX METRONIDAZOLE SILVER CARBONATE METRONIDAZOLE CLINDAMYCIN PHOS/BENZOYL PEROX HYDROGEN PEROXIDE SULFACETAMIDE SODIUM SULFACETAMIDE SODIUM SULFACETAMIDE SODIUM BENZALK CHL/OXYQUINOLINE CHLORHEXIDINE GLUCONATE BENZALKONIUM CHLORIDE SKIN CLEANSER CHLOROXYLENOL CHLORHEXIDINE GLUCONATE CHLOROXYLENOL BENZETHONIUM CHLORIDE CHLORHEXIDINE GLUCONATE POVIDONE-IODINE HYDROGEN PEROXIDE HYDROGEN PEROXIDE HYDROGEN PEROXIDE TANNIC ACID/ZINC OXIDE/PHENOL BENZALKONIUM CHLORIDE HEXACHLOROPHENE GLYCERIN/WITCH HAZEL LEAF WITCH HAZEL LEAF WITCH HAZEL WITCH HAZEL ETHYL ALCOHOL ETHYL ALCOHOL BACITRACIN/DIMETHICONE/ZINC BENZALKONIUM CHLORIDE TRICLOSAN BENZALKONIUM CHLORIDE METRONIDAZOLE SKIN CLEANSER BENZETHONIUM CHLORIDE GLYCERIN/ALOE VERA/WITCH HAZEL TRICLOSAN POVIDONE-IODINE SULFACETAMIDE SODIUM BENZETHONIUM CHLORIDE BENZETHONIUM CHLORIDE SILVER CHLORIDE SILVER NITRATE SILVER NITRATE APPLICATOR SILVER SILVER CAMPHOR/GLYCERIN/ALCOHOL/WATER KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ACNE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE BRAND DRUG SKIN SHIELD SKLICE SODIUM SULFACETAMIDE SOOLANTRA SOTRET SPECTRO-JEL SPRAY & FOAM SPROAM ALL-BODY STROMECTOL STYPTOCAINE SULFAC SULFAMIDE SULFO LO SUMMER'S EVE DOUCHE SWEEN PREP TAZORAC TERSASEPTIC TINCTURE IODINE TINCTURE MERTHIOLATE TUCKS TUCKS TAKE-ALONGS VANDAZOLE VANOXIDE-HC VELTIN VERSICLEAR VITAZOL VYTONE Z-CLINZ ZENATANE ZIANA 3 DAY VAGINAL 3-DAY VAGINAL CREAM 4-N-1 ABREVA ACTICIN ADVANCED HEALING AF AKNE-MYCIN AK-POLY-BAC ALEVAZOL ALINIA ALOE VESTA SKIN CONDITIONER 2 ALTABAX AMERIGEL BARRIER AMERIGEL PREVENTIVE BARRIER AMPHOTERICIN 100MG/STERIL H2O ANTIBIOTIC + PAIN RELIEF ANTIBIOTIC EAR SOLUTION 73 GENERIC DRUG BENZETHONIUM CHLORIDE IVERMECTIN SULFACETAMIDE SODIUM IVERMECTIN ISOTRETINOIN ME-BENZ/PHENOL BENZETHONIUM CHLORIDE BENZETHONIUM CHLORIDE IVERMECTIN ALUMINUM SULFATE SULFACETAMIDE SODIUM SULFACETAMIDE SODIUM SULFACETAMIDE SODIUM SULFUR POVIDONE-IODINE CHLOROXYLENOL TAZAROTENE TRICLOSAN IODINE/SODIUM IODIDE BENZALKONIUM CHLORIDE WITCH HAZEL WITCH HAZEL METRONIDAZOLE BENZOYL PEROXIDE/HYDROCORTISON CLINDAMYCIN/TRETINOIN SODIUM THIOSULFATE/SAL ACID METRONIDAZOLE HYDROCORTISONE/IODOQUINOL/ALOE WITCH HAZEL SKIN CLEANSER ISOTRETINOIN CLINDAMYCIN/TRETINOIN MICONAZOLE NITRATE CLOTRIMAZOLE DIMETHICONE DOCOSANOL PERMETHRIN ACYCLOVIR DIMETHICONE TOLNAFTATE ERYTHROMYCIN BASE BACITRACIN/POLYMYXIN B SULFATE CLOTRIMAZOLE NITAZOXANIDE DIMETHICONE RETAPAMULIN DIMETHICONE DIMETHICONE AMPHOTERICIN AMPHOTERICIN B NEOMY SULF/POLYMYX B SULF/PRAM NEOMYCIN/POLYMYXIN B SULF/HC KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE BRAND DRUG ANTIBIOTIC PLUS ANTIBIOTIC-PRAMOXINE ANTIFUNGAL ANTI-FUNGAL ANTIFUNGAL CREAM ANTI-FUNGAL CREAM ATHLETE'S FOOT ATHLETE'S FOOT AF ATHLETE'S FOOT CREAM ATHLETE'S FOOT SPRAY ATHLETIC FOOT CREAM AVAR AVAR LS AVAR-E AVAR-E GREEN AVAR-E LS AVAR-E LS CREAM AZOLEN TINCTURE BACITRACIN WITH PAIN RELIEF BACITRACIN-POLYMYXIN BACTROBAN BACTROBAN NASAL BAZA ANTIFUNGAL BAZA CLEANSE & PROTECT BAZA CREAM HOSPITAL CARE PACK BEDDING SPRAY BENSAL HP BENZAMYCIN BENZAMYCINPAK BOUDREAUXS BP 10-1 BREEZEE MIST CAVILON DURABLE BARRIER CENTANY CENTANY AT CERISA CICLODAN CLARIFOAM EF CLARIS CLEANSING WASH CLENIA CLEOCIN CLEOCIN PHOSPHATE CLEOCIN T CLINDACIN ETZ CLINDACIN P CLINDACIN PAC CLINDA-DERM CLINDAGEL 74 GENERIC DRUG NEOMY SULF/POLYMYX B SULF/PRAM NEOMY SULF/POLYMYX B SULF/PRAM CLOTRIMAZOLE MICONAZOLE NITRATE MICONAZOLE NITRATE MICONAZOLE NITRATE CLOTRIMAZOLE TERBINAFINE HCL TOLNAFTATE MICONAZOLE NITRATE CLOTRIMAZOLE SULFACETAMIDE SODIUM/SULFUR SULFACETAMIDE SODIUM/SULFUR SULFACETAMIDE SODIUM/SULFUR SULFACETAMIDE SODIUM/SULFUR SULFACETAMIDE SODIUM/SULFUR SULFACETAMIDE SODIUM/SULFUR MICONAZOLE NITRATE BACITRACIN/LIDOCAINE BACITRACIN/POLYMYXIN B SULFATE MUPIROCIN MUPIROCIN CALCIUM MICONAZOLE NITRATE DIMETHICONE MICONAZOLE/LANOLIN/SKIN CLN PERMETHRIN BENZOIC ACID/SALICYLIC ACID ERYTHROMYCIN/BENZOYL PEROXIDE ERYTHROMYCIN/BENZOYL PEROXIDE DIMETHICONE SULFACETAMIDE SODIUM/SULFUR UNDECYLENIC ACID/AL CL-HYDRATE CALCIUM CITRATE DIMETHICONE MUPIROCIN MUPIROCIN SULFACETAMIDE SODIUM/SULFUR CICLOPIROX CICLOPIROX SULFACETAMIDE SODIUM/SULFUR SULFACETAMIDE SOD/SULFUR/UREA SULFACETAMIDE SOD/SULFUR/UREA SULFACETAMIDE SODIUM/SULFUR CLINDAMYCIN PHOSPHATE CLINDAMYCIN PHOSPHATE CLINDAMYCIN PHOSPHATE CLINDAMYCIN PHOS/SKIN CLNSR 19 CLINDAMYCIN PHOSPHATE CLINDAMYCIN PHOS/SKIN CLNSR 19 CLINDAMYCIN PHOSPHATE CLINDAMYCIN PHOSPHATE CLINDAMYCIN PHOSPHATE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE BRAND DRUG CLINDAREACH CLINDESSE CLINDETS CLOTRIM ANTIFUNGAL CLOTRIMAZOLE 3 CLOTRIMAZOLE AF CLOTRIMAZOLE-3 CLOTRIMAZOLE-7 CLOTRIMAZOLE-BETAMETHASONE CNL 8 COMPLETE LICE TREATMENT COOL BOTTOMS CORTISPORIN CORTOMYCIN CRITIC-AID CRUEX DENAVIR DERMAFUNGAL DESENEX DOUBLE ANTIBIOTIC ECOZA ELIMITE ELON DUAL DEFENSE EMGEL E-MYCIN ERTACZO ERY ERYGEL ERY-TAB ERYTHROCIN STEARATE ERYTHROMYCIN ERYTHROMYCIN-BENZOYL PEROXIDE EURAX EVOCLIN EXELDERM EXTINA FIRST AID FIRST AID ABX PAIN RELIEF FIRST AID ANTIBIOTIC FOOT & SNEAKER FUNGI CURE FUNGI-GUARD FUNGI-NAIL FUNGOID & HC FUNGOID TINCTURE FUNGOID-D GARAMYCIN GENTAK 75 GENERIC DRUG CLINDAMYCIN PHOSPHATE CLINDAMYCIN PHOSPHATE CLINDAMYCIN PHOSPHATE CLOTRIMAZOLE CLOTRIMAZOLE CLOTRIMAZOLE CLOTRIMAZOLE CLOTRIMAZOLE FOOT CREAM CLOTRIMAZOLE CLOTRIMAZOLE CLOTRIMAZOLE/BETAMETHASONE DIP CICLOPIROX/NAIL LACQUER REMOVR PIP BUTOX/PYRETHRINS/PERMETH DIMETHICONE NEOMY SULF/POLYMYX B SULF/HC NEOMYCIN/POLYMYXIN B SULF/HC MICONAZOLE NITRATE CLOTRIMAZOLE PENCICLOVIR MICONAZOLE NITRATE CLOTRIMAZOLE BACITRACIN ZINC/POLYMYX B SULF ECONAZOLE NITRATE ECONAZOLE NITRATE PERMETHRIN UNDECYLENIC ACID ERYTHROMYCIN BASE/ETHANOL ERYTHROMYCIN BASE SERTACONAZOLE NITRATE ERYTHROMYCIN BASE/ETHANOL ERYTHROMYCIN BASE/ETHANOL ERYTHROMYCIN BASE ERYTHROMYCIN STEARATE ERYTHROMYCIN BASE ERYTHROMYCIN/BENZOYL PEROXIDE CROTAMITON CLINDAMYCIN PHOSPHATE SULCONAZOLE NITRATE KETOCONAZOLE NEOMYCIN/BACITRAC ZN/POLYMYXIN NEOMY SULF/POLYMYX B SULF/PRAM NEOMY SULF/BACITRAC ZN/POLY TOLNAFTATE CLOTRIMAZOLE TOLNAFTATE ACETIC ACID/RESOR/SAL ACID MICONAZOLE NITRATE/HC MICONAZOLE NITRATE TOLNAFTATE GENTAMICIN SULFATE GENTAMICIN SULFATE GENTAMICIN SULFATE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE BRAND DRUG GENTASOL GORDOCHOM GYNE-LOTRIMIN GYNE-LOTRIMIN-7 HALOTIN HONGO CURA HOUSEHOLD LICE CONTROL ILOTYCIN INZO ANTIFUNGAL JOCK ITCH JOCK ITCH RELIEF JUBLIA KENDALL MOISTURE BARRIER KENDALL MOISTURIZING KERYDIN KETOCON KETOCON + PLUS KETODAN KURIC LAMISIL LAMISIL AF LAMISIL AF DEFENSE LAMISIL AT LICE BEDDING LICE COMPLETE KIT 1-2-3 LICE CREAM RINSE LICE EGG REMOVER LICE KILLING LICE PYRINYL SHAMPOO LICE SHAMPOO LICE SOLUTION LICE TREATMENT LICEMD LICIDE LIDOVIR LOPROX LOTRIMIN LOTRIMIN AF LOTRIMIN ULTRA LOTRISONE LUZU LYCELLE MEDERMA PM MEDI-FIRST ANTI-FUNGAL MENTAX MICADERM MICATIN MICONAZOLE 1 76 GENERIC DRUG GENTAMICIN SULFATE UNDECYLENIC ACID/CHLOROXYLENOL CLOTRIMAZOLE CLOTRIMAZOLE HALOPROGIN UNDECYLENIC ACID PIPERONYL BUTOXIDE/PYRETHRINS ERYTHROMYCIN BASE MICONAZOLE NITRATE CLOTRIMAZOLE CLOTRIMAZOLE EFINACONAZOLE DIMETHICONE DIMETHICONE TAVABOROLE KETOCONAZOLE/HYDROCORTISONE KETOCONAZOLE/HYDROCORTISONE KETOCONAZOLE KETOCONAZOLE KETOCONAZOLE TERBINAFINE HCL TOLNAFTATE TOLNAFTATE TERBINAFINE PERMETHRIN PIP BUTOX/PYRETHRINS/PERMETH PERMETHRIN POTASS HYD/GLYCO/PQ10/HE-CELL PERMETHRIN PIPERONYL BUTOXIDE/PYRETHRINS PIPERONYL BUTOXIDE/PYRETHRINS PIP BUTOX/PYRETHRINS/PERMETH PERMETHRIN DIMETHICONE PIPERONYL BUTOXIDE/PYRETHRINS ACYCLOVIR/LIDOCAINE HCL LINDANE CICLOPIROX CLOTRIMAZOLE CLOTRIMAZOLE BUTENAFINE HCL CLOTRIMAZOLE/BETAMETHASONE DIP LULICONAZOLE CITRIC/CITRONELLYL/HYDROX/METH MAFENIDE ACETATE MALATHION DIMETHICONE TOLNAFTATE BUTENAFINE HCL MICONAZOLE NITRATE MICONAZOLE NITRATE MICONAZOLE NITRATE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE BRAND DRUG MICONAZOLE 3 MICONAZOLE 7 MICONAZORB AF MICRO-GUARD MIRANEL AF MITRAZOL MOISTURE GUARD MOISTURIZING SKIN PROTECTANT MONISTAT 1 MONISTAT 3 MONISTAT 7 MONISTAT DUAL-PAK MONISTAT SOOTHING CARE MONISTAT-DERM MULTI ANTIBIOTIC PLUS MYCELEX MYCO NAIL MYCO NAIL A MYCOSTATIN NAFTIN NATROBA NATURAL COLD SORE NEOMYCIN-BACITRACIN-POLYMYXIN NEOMYCIN-POLYMYXIN B NEOMYCIN-POLYMYXIN-HC NEOMYCIN-POLYMYXIN-HYDROCORT NEO-POLYCIN NEOSPORIN + PAIN RELIEF NEOSPORIN G.U. IRRIGANT NEOSPORIN PLUS NEUTRAPHOR NIX NIZORAL NIZORAL A-D NORMLSHIELD NUZOLE NYAMYC NYSTATIN-TRIAMCINOLONE NYSTOP ODOR CONTROL FOOT-SNEAKER ONE STEP PERINEAL OVIDE OXISTAT PCE PEDIADERM AF PEDICULICIDE 11 PEDI-DRI PEDIPIROX-4 PENLAC 77 GENERIC DRUG MICONAZOLE NITRATE MICONAZOLE NITRATE MICONAZOLE NITRATE MICONAZOLE NITRATE MICONAZOLE NITRATE MICONAZOLE NITRATE DIMETHICONE DIMETHICONE MICONAZOLE NITRATE MICONAZOLE NITRATE MICONAZOLE NITRATE MICONAZOLE NITRATE DIMETHICONE MICONAZOLE NITRATE NEOMY SULF/POLYMYX B SULF/PRAM MUPIROCIN CLOTRIMAZOLE TRIACETIN UNDECYLENIC ACID NYSTATIN NAFTIFINE HCL SPINOSAD DIMETHICONE NEOMY SULF/BACITRA/POLYMYXIN B NEOMY SULF/POLYMYXIN B SULFATE NEOMYCIN/POLYMYXIN B SULF/HC NEOMYCIN/POLYMYXIN B SULF/HC NEOMY SULF/BACITRA/POLYMYXIN B NEOMY SULF/POLYMYX B SULF/PRAM NEOMY SULF/POLYMYXIN B SULFATE NEOMY SULF/POLYMYX B SULF/PRAM DIMETHICONE PERMETHRIN KETOCONAZOLE KETOCONAZOLE DIMETHICONE MICONAZOLE NITRATE NYSTATIN NYSTATIN NYSTATIN/TRIAMCIN NYSTATIN TOLNAFTATE DIMETHICONE MALATHION OXICONAZOLE NITRATE ERYTHROMYCIN BASE NYSTATIN/EMOLLIENT COMBO NO.54 PIPERONYL BUTOXIDE/PYRETHRINS NYSTATIN CICLOPIROX/NAIL LACQ/FT DEOD#4 CICLOPIROX PERMETHRIN KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE BRAND DRUG PLEXION PLEXION SCT PODACTIN POLY BACITRACIN POLYCIN POLYSPORIN PRASCION PRASCION FC PRASCION RA PRASCION TS PROCOMYCIN PROSHIELD GLOVE PROSHIELD PLUS PYRETHRIN LICE TREATMENT PYRINEX Q-NAFTATE RASH RELIEF ANTIFUNGAL REMEDY 4-IN-1 CLEANSING REMEDY ANTIFUNGAL REMEDY CLEANSING BODY REMEDY DIMETHICONE REMEDY NUTRASHIELD REMEDY PHYTOPLEX ANTIFUNGAL REMEDY SKIN REPAIR RESTORE CLEANSER & MOISTURIZER RESTORE DIMETHICREME RID RINGWORM ROMYCIN ROSAC ROSADERM ROSANIL ROSULA ROSULA CLK SE 10-5 SS SECURA ANTIFUNGAL SECURA DIMETHICONE SILVADENE SITAVIG SOD SULFACETAMIDE-SULFUR WASH SODIUM SULFACETAMIDE-SULFUR SODIUM SULFA-SULFUR-MERATAN SOOTHE & COOL SOOTHE & COOL INZO BARRIER SPECTAZOLE SS 10-2 SSD SSD AF SSS 10-4 SSS 10-5 78 GENERIC DRUG SULFACETAMIDE SODIUM/SULFUR SULFACET SOD/SULFUR/WITCH HAZ TOLNAFTATE BACITRACIN ZINC/POLYMYX B SULF BACITRACIN/POLYMYXIN B SULFATE BACITRACIN/POLYMYXIN B SULFATE SULFACETAMIDE SODIUM/SULFUR SULFACETAMIDE SODIUM/SULFUR SULFACETM NA/AVOBENZONE/SULFUR SULFACETAMIDE SODIUM/SULFUR NEOMY SULF/BACITRA/POLYMY/LIDO DIMETHICONE DIMETHICONE PIPERONYL BUTOXIDE/PYRETHRINS PIPERONYL BUTOXIDE/PYRETHRINS TOLNAFTATE MICONAZOLE NIT/DIMETH/ZINC OX DIMETHICONE MICONAZOLE NITRATE DIMETHICONE DIMETHICONE DIMETHICONE MICONAZOLE NITRATE DIMETHICONE DIMETHICONE DIMETHICONE PERMETHRIN CLOTRIMAZOLE ERYTHROMYCIN BASE SULFACETAMIDE SODIUM/SULFUR SULFACETAMD/SULFR/SKNCLNSR10 SULFACETAMD/SULFR/SKNCLNSR10 SULFACETAMIDE SOD/SULFUR/UREA SULFACET SOD/SULF/UREA/MERA/TI SULFACET SOD/SULFUR/WITCH HAZ MICONAZOLE NITRATE DIMETHICONE SILVER SULFADIAZINE SILVER SULFADIAZINE ACYCLOVIR SULFACETAMIDE SOD/SULFUR/UREA SULFACETAMIDE SOD/SULFUR/UREA SULFACET SOD/SULF/UREA/MERA/TI TOLNAFTATE/ZNOX/CHLOROXYLENOL DIMETHICONE ECONAZOLE NITRATE SPINOSAD SULFACETAMIDE SODIUM/SULFUR SILVER SULFADIAZINE SILVER SULFADIAZINE SULFACETAMIDE SODIUM/SULFUR SULFACETAMIDE SODIUM/SULFUR KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFECTIVE DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY BRAND DRUG STOP LICE SULFACETAMIDE SODIUM-SULFUR SULFACLEANSE 8-4 SULFAMYLON SULZEE SUMADAN SUMADAN XLT SUMAXIN SUMAXIN CP SUMAXIN TS SWEEN 24 TERBINAFINE TERBINAFINE HYDROCHLORIDE THERASEAL THERMAZENE TINACTIN TOPISULF TRI-BIOZENE TRIPLE ANTIBIOTIC TRIPLE ANTIBIOTIC EXTRA TRIPLE ANTIBIOTIC PLUS TRIPLE ANTIBIOTIC-PAIN RELIEF TRIPLE DYE TRIPLE PASTE AF ULESFIA ULTRATHON UNDELENIC VAGISTAT-3 VANIPLY VEREGEN VIRTI-SULF VUSION WAL-SPORIN XERESE XOLEGEL ZEASORB ZEASORB-AF ZENCIA ZETACET ZILACTIN ZILACTIN-L ZOVIRAX ACLOVATE ALA-CORT ALA-SCALP 79 GENERIC DRUG PERMETHRIN SULFACETAMIDE SODIUM/SULFUR SULFACETAMIDE SODIUM/SULFUR MAFENIDE ACETATE SULFACETAMIDE SODIUM/SULFUR SULFACETAMIDE SODIUM/SULFUR SULFACT SOD/SULUR/AVOB/OTN/OCT SULFACETAMIDE SODIUM/SULFUR SULFACETAMIDE/SULFUR/CLEANSR23 SULFACETAMIDE SODIUM/SULFUR DIMETHICONE TERBINAFINE HCL TERBINAFINE HCL TERBINAFINE HCL TETRACYCLINE HCL DIMETHICONE SILVER SULFADIAZINE TOLNAFTATE TOLNAFTATE FOOT CREAM SULFACETAMIDE SODIUM/SULFUR TRIACETIN NEOMYCN/BACI ZN/PMYX BS/PRAMOX NEOMY SULF/BACITRA/POLYMYXIN B NEOMYCN/BACI ZN/PMYX BS/PRAMOX TRIPLE ANTIBIOTIC OINTMENT TRIPLE ANTIBIOTIC OINTMENT PLU NEOMYCN/BACI ZN/PMYX BS/PRAMOX NEOMYCN/BACI ZN/PMYX BS/PRAMOX GENTIAN VIOL/BRLNT GRN/PROFLAV MICONAZOLE NITRATE BENZYL ALCOHOL DIETHYLTOLUAMIDE UNDECYLENIC ACID MICONAZOLE NITRATE DIMETHICONE SINECATECHINS SULFACETAMIDE SODIUM/SULFUR MICONAZOLE NITRATE/ZINC OX/PET BACITRACIN ZINC/POLYMYX B SULF ACYCLOVIR/HYDROCORTISONE KETOCONAZOLE MICONAZOLE NITRATE MICONAZOLE NITRATE SULFACETAMIDE SODIUM/SULFUR SULFACETAMIDE SODIUM/SULFUR BENZYL ALCOHOL BENZYL ALCOHOL ACYCLOVIR ALCLOMETASONE DIPROPIONATE HYDROCORTISONE HYDROCORTISONE ALCLOMETASONE DIPROPIONATE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY BRAND DRUG ANTI-ITCH CREME ANTI-ITCH PLUS ANTI-ITCH SPRAY ANUCORT-HC ANUSOL-HC APEXICON APEXICON E AQUA GLYCOLIC HC AQUANIL HC AVEENO BAYCADRON BETA HC BETA-VAL CAPEX SHAMPOO CARMOL HC CELESTONE CLOBETASOL EMOLLIENT CLOBETASOL EMULSION CLOBEX CLODAN CLODERM COLOCORT CORDRAN CORDRAN SP CORMAX CORTAID CORTALO CORTEF CORTENEMA CORTICOOL 1% GEL CORTIFOAM CORTISONE CORTISONE + COOLING RELIEF CORTIZONE 10 CORTIZONE-10 CORTIZONE-10 PLUS DEPO-MEDROL DERMAREST ECZEMA DERMA-SMOOTHE-FS DERMASORB HC DERMASORB TA DERMATOP DESONATE DESONIL DESONIL + PLUS DESOWEN 80 GENERIC DRUG AMCINONIDE HYDROCORTISONE/ALOE/VIT.E/A&D HYDROCORTISONE/ALOE/VIT.E/A&D HYDROCORTISONE HYDROCORTISONE ACETATE HYDROCORTISONE DIFLORASONE DIACETATE DIFLORASONE DIACETATE/EMOLL HYDROCORTISONE/SKIN CLNSR #25 HYDROCORTISONE HYDROCORTISONE/OATMEAL/ALOE/E DEXAMETHASONE HYDROCORTISONE BETAMETHASONE DIPROPIONATE BETAMETHASONE VALERATE BETAMETHASONE VALERATE FLUOCINOLONE ACETONIDE HYDROCORTISONE ACETATE/UREA BETAMETHASONE CLOBETASOL PROPIONATE/EMOLL CLOBETASOL PROPIONATE/EMOLL CLOBETASOL PROPIONATE CLOBETASOL PROPIONATE CLOCORTOLONE PIVALATE CLOBETASOL PROPIONATE CLOCORTOLONE PIVALATE HYDROCORTISONE FLURANDRENOLIDE FLURANDRENOLIDE CLOBETASOL PROPIONATE HYDROCORTISONE HYDROCORTISONE ACETATE/ALOE V HYDROCORTISONE HYDROCORTISONE HYDROCORTISONE HYDROCORTISONE ACETATE HYDROCORTISONE HYDROCORTISONE HYDROCORTISONE HYDROCORTISONE HYDROCORTISONE METHYLPREDNISOLONE ACETATE HYDROCORTISONE FLUOCINOLONE ACETONIDE HYDROCORTISONE/SKIN CLNSR #35 TRIAMCINOLONE/EMOLLIENT CMB#86 PREDNICARBATE DESONIDE DESONIDE DESONIDE/EMOLLIENT COMBO NO.3 DESONIDE/EMOLLIENT COMBO NO.3 DESONIDE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY BRAND DRUG DEXAMETHASONE INTENSOL DEXPAK DICLOFENAC SODIUM ER DIPROLENE DIPROLENE AF DIPROSONE ECZEMA ANTI-ITCH FIRST-HYDROCORTISONE FLECTOR FLUOCINONIDE EMOLLIENT FLUOCINONIDE-E GLUCOSAMINE-MSM GRX HICORT 25 HALAC HALOG HALONATE HALONATE PAC HC-1% HEMORRHOID HEMORRHOIDAL HC HEMRIL HYDRO SKIN HYDROCORTISONE HYDROCORTISONE PLUS HYDROCORTISONE PLUS 12 HYDROCORTISONE WITH ALOE HYDROCORTISONE-ALOE HYDROCREAM HYDROSKIN ILUVIEN ITCH-X ITCH-X HC LOCOID LOCOID LIPOCREAM LUXIQ MAXIDEX MEDI-CORTISONE MEDI-HOSE PANTY SZ 1 MEDI-HOSE PANTY SZ 2 MEDI-HOSE PANTY SZ 3 MEDI-HOSE PANTY SZ 4 MEDI-HOSE PANTY SZ 5 81 GENERIC DRUG DESOXIMETASONE DEXAMETHASONE DEXAMETHASONE DEXAMETHASONE DICLOFENAC SODIUM DICLOFENAC SODIUM DIFLORASONE DIACETATE BETAMETHASONE/PROPYLENE GLYC BETAMETHASONE/PROPYLENE GLYC BETAMETHASONE DIPROPIONATE HYDROCORTISONE HYDROCORTISONE DICLOFENAC EPOLAMINE FLUOCINOLONE ACETONIDE FLUOCINONIDE FLUOCINONIDE/EMOLLIENT BASE FLUOCINONIDE/EMOLLIENT BASE GLUCOSAMINE SULFATE/MSM HYDROCORTISONE ACETATE HALOBETASOL/AMMONIUM LACTATE HALOBETASOL PROPIONATE HALCINONIDE HALOBETASOL/AMMONIUM LACTATE HALOBETASOL/AMMONIUM LACTATE HYDROCORTISONE ACETATE HYDROCORTISONE ACETATE HYDROCORTISONE ACETATE HYDROCORTISONE HC/MINERAL OIL/PETROLAT,WHT HYDROCORTISONE ACETATE HYDROCORTISONE BUTYRATE HYDROCORTISONE CREAM HYDROCORTISONE HYDROCORTISONE HYDROCORTISONE VALERATE HYDROCORTISONE ACETATE/ALOE V HYDROCORTISONE ACETATE/ALOE V HYDROCORTISONE HYDROCORTISONE FLUOCINOLONE ACETONIDE HYDROCORTISONE HYDROCORTISONE HYDROCORTISONE BUTYRATE HYDROCORTISONE BUTYRATE/EMOLL BETAMETHASONE VALERATE DEXAMETHASONE HYDROCORTISONE ACETATE DO NOT GIVE OUT CODE DO NOT GIVE OUT CODE DO NOT GIVE OUT CODE DO NOT GIVE OUT CODE DO NOT GIVE OUT CODE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY BRAND DRUG MEDI-HOSE PANTY SZ 6 MEDI-HOSE PANTY SZ 7 MEDI-HOSE PKG SIZE 1 MEDI-HOSE PKG SIZE 2 MEDI-HOSE PKG SIZE 3 MEDI-HOSE PKG SIZE 4 MEDI-HOSE PKG SIZE 5 MEDI-HOSE PKG SIZE 6 MEDI-HOSE PKG SIZE 7 MEDI-HOSE THIGH HIGH SZ 1 MEDI-HOSE THIGH HIGH SZ 2 MEDI-HOSE THIGH HIGH SZ 3 MEDI-HOSE THIGH HIGH SZ 4 MEDI-HOSE THIGH HIGH SZ 5 MEDI-HOSE THIGH HIGH SZ 6 MEDI-HOSE THIGH HIGH SZ 7 MOMEXIN MSM WITH GLUCOSAMINE NEO-SYNALAR NOBLE FORMULA HC NUCORT NU-DERM TOLEREEN NUZON OLUX OLUX-E OLUX-OLUX-E OZURDEX PANDEL PEDIADERM HC PEDIADERM TA PENNSAID PROCTOCARE-HC PROCTOCORT PROCTOCREAM-HC PROCTO-PAK PROCTOSOL-HC PROCTOZONE-HC PSORCON RECORT PLUS RECTACORT-HC RECTASOL-HC RETISERT SCALACORT SCALACORT DK SCALP RELIEF SCALPICIN SOLARAZE SOOTHING CARE SYNALAR SYNALAR TS 82 GENERIC DRUG DO NOT GIVE OUT CODE DO NOT GIVE OUT CODE DO NOT GIVE OUT CODE DO NOT GIVE OUT CODE DO NOT GIVE OUT CODE DO NOT GIVE OUT CODE DO NOT GIVE OUT CODE DO NOT GIVE OUT CODE DO NOT GIVE OUT CODE DO NOT GIVE OUT CODE DO NOT GIVE OUT CODE DO NOT GIVE OUT CODE DO NOT GIVE OUT CODE DO NOT GIVE OUT CODE DO NOT GIVE OUT CODE DO NOT GIVE OUT CODE METHYLPREDNISOLONE ACETATE MOMETASONE FUROAT/AMMONIUM LAC GLUCOSAMINE SULFATE/MSM NEOMYCIN SULFATE/FLUOCINOLONE HYDROCORTISONE HYDROCORTISONE ACETATE/ALOE V HYDROCORTISONE HYDROCORTISONE ACETATE/ALOE V CLOBETASOL PROPIONATE CLOBETASOL PROPIONATE/EMOLL CLOBETASOL PROPIONATE/EMOLL DEXAMETHASONE HYDROCORTISONE PROBUTATE HYDROCORTISONE/EMOL NO.45 TRIAMCINOLONE/EMOLLIENT CMB#45 DICLOFENAC SODIUM PREDNICARBATE HYDROCORTISONE HYDROCORTISONE HYDROCORTISONE HYDROCORTISONE HYDROCORTISONE HYDROCORTISONE DIFLORASONE DIACETATE HYDROCORTISONE HYDROCORTISONE ACETATE HYDROCORTISONE ACETATE FLUOCINOLONE ACETONIDE HYDROCORTISONE HYDROCORT/SAL ACID/SULF/SHMP#1 HYDROCORTISONE HYDROCORTISONE DICLOFENAC SODIUM HYDROCORTISONE FLUOCINOLONE ACETONIDE FLUOCINOLONE/SKIN CLNSR28 KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIINFLAMMATORY DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS BRAND DRUG TEMOVATE TEMOVATE EMOLLIENT TEXACORT TOPICORT U-CORT ULTRAVATE ULTRAVATE PAC ULTRAVATE X VANOS VERDESO VOLTAREN VOLTAREN-XR WESTCORT ZEMA-PAK ALEVICYN ALLEGRA INTENSIVE RELIEF ALLERGY RELIEF SPRAY AMLACTIN ANTI ITCH AVEENO ANTI-ITCH BANOPHEN ANTI-ITCH BENADRYL ITCH RELIEF BIOFREEZE-ILEX CALACLEAR CALADRYL CALADRYL CLEAR CALAGEL CALAGESIC CALAHIST CLEAR CALAMINE MEDICATED CALAMINE-ANTIHISTAMINE CALDYPHEN CALDYPHEN CLEAR CALLERGY CLEAR CALOHIST DERMAGESIC DERMASARRA DIPHENHIST WITH ZINC ACETATE FREEZE IT GOLD BOND HC DERMA-PAX IVY WASH MEN-PHOR POISON IVY POISON IVY ANTI-ITCH POISON IVY TREATMENT POLAR FREEZE PRAMEGEL ANTI-ITCH PRAMOX PRAX PROCTOFOAM SARNA 83 GENERIC DRUG CLOBETASOL PROPIONATE CLOBETASOL PROPIONATE/EMOLL HYDROCORTISONE DESOXIMETASONE HYDROCORTISONE ACETATE/UREA HALOBETASOL PROPIONATE HALOBETASOL/AMMONIUM LACTATE HALOBETASOL/LACTIC ACID FLUOCINONIDE DESONIDE DICLOFENAC SODIUM DICLOFENAC SODIUM HYDROCORTISONE VALERATE DEXAMETHASONE NA MG FL/NA PHO/NACL/HA/NA HYP DIPHENHYDRAMINE HCL/ALLANTOIN DIPHENHYDRAMINE HCL/ZINC ACET PRAMOXINE HCL/AMMONIUM LACTATE DIPHENHYDRAMINE HCL/ZINC ACETI PRAMOX HCL/CAMPH/OATMEAL/CALA DIPHENHYDRAMINE HCL/ZINC ACET DIPHENHYDRAMINE HCL/ZINC ACET MENTHOL/CAMPHOR PRAMOXINE HCL/CAMPH/ZINC ACET PRAMOXINE HCL/CALAMINE PRAMOXINE HCL/ZINC ACETATE DIPHENHYDRAMIN/BENZETHON/ZINC PRAMOXINE HCL/CALAMINE PRAMOXINE HCL/CAMPH/ZINC ACET PRAMOXINE HCL/CALAMINE PRAMOXINE HCL/CALAMINE DIPHENHYDRAMINE HCL/CALAMINE PRAMOXINE HCL/CAMPH/ZINC ACET PRAMOXINE HCL/CAMPH/ZINC ACET DIPHENHYDRAMINE HCL/CALAMINE PYRIL MAL/BENZOCAINE/ZNOX MENTHOL/CAMPHOR DIPHENHYDRAMINE HCL/ZINC ACET MENTHOL/CAMPHO/YERB MAT/ALOE/E PRAMOXINE HCL/MENTHOL DIPHENHYDRAMINE HCL/HC PRAMOXINE HCL MENTHOL/CAMPHOR SKIN CLEANSER COMB NO.22 SKIN CLEANSER COMB NO.13 MENTHOL/CAMPHOR/BENZYL ALCOHOL MENTHOL/CAMPHOR PRAMOXINE HCL/MENTHOL PRAMOXINE HCL PRAMOXINE HCL PRAMOXINE HCL MENTHOL/CAMPHOR KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - ANTIPRURITIC DRUGS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS BRAND DRUG SARNA ULTRA SENSITIVE ANTI-ITCH SOLARHIST SPORTS RUB PAIN RELIEVING TIGER BALM VAGISIL ZANFEL Z-XTRA 1ST RELIEF 2 IN 1 DANDRUFF SHAMPOO A&D A+D A+D ZINC OXIDE ABSORBASE ABSORBINE JR. ACNE & BLACKHEAD TERMINATOR ACNE CLEANSER ACNE CLEANSING BAR ACNE CLEARING SYSTEM ACNE CONTROL CLEANSER ACNE CREAM ACNE FOAMING FACE WASH ACNE FOAMING WASH ACNE MEDICATION ACNE PADS ACNE SPOT TREATMENT ACNE TREATMENT ACNE TREATMENT PACK ACNECLEAR ACNOMEL ADAZIN ADRUCIL ADVANCED EYE RELIEF ADVANCED RECOVERY ADVANCED WOUND AFLEXERYL-LC AFLEXERYL-MC AIR SALONPAS AKWA TEARS AL-12 ALA SEB ALA SEB T ALA-DERM ALCIS ALCOHOL PADS WITH BENZOCAINE ALCOHOL SWABS WITH BENZOCAINE ALEVEER ALICLEN ALIVIO ALLCLENZ ALOE BURN RELIEF 84 GENERIC DRUG PRAMOXINE/MENTHOL/PETROLATUM PRAMOXINE HCL PRAMOXINE HCL/DIPHENHYDRAMINE MENTHOL/CAMPHOR MENTHOL/CAMPHOR PRAMOXINE HCL SKIN CLEANSER COMBINATION NO.8 PYRIL MAL/BENZOCAINE/ZNOX LIDOCAINE/MENTHOL PYRITHIONE ZINC VITAMINS A AND D VITS A & D/WHITE PET/LANOLIN DIMETHIC/ZINC OX/VIT A&D/ALOE MINERAL OIL/PETROLATUM,WHITE THYMOL/MENTHOL ACETIC ACID BENZOYL PEROXIDE SALICYLIC ACID BENZOYL PEROXIDE BENZ PEROX MICRO/SKIN CLNSR#24 BENZOYL PEROXIDE BENZOYL PEROXIDE BENZOYL PEROXIDE BENZOYL PEROXIDE BENZOYL PEROXIDE SALICYLIC ACID BENZOYL PEROXIDE BENZOYL PEROXIDE BENZOYL PEROXIDE BENZOYL PEROXIDE RESORCINOL/SULFUR LIDOCAINE/BENZOCAIN/ME-SAL/CAP FLUOROURACIL GLYCERIN/PROPYLENE GLYCOL GLYCERIN/DIMETHICONE POLOXAMER 188/SORBITOL/UREA LIDOCAINE HCL/MENTHOL CAPSAICIN/MENTHOL METHYL SALICYLATE/MENTH/CAMPH LANOLIN/MIN OIL/PETROLAT,WHT AMMONIUM LACTATE SALICYLIC ACID/SULFUR SALICYLIC ACID/COAL TAR/SULFUR EMOLLIENT BASE TROLAMINE SALICYLATE ISOPROPYL ALCOHOL/BENZOCAINE ISOPROPYL ALCOHOL/BENZOCAINE CAPSAICIN/MENTHOL SALICYLIC ACID CAPSAICIN/MENTHOL POLOXAMER 188/SORBITOL SOLN LIDOCAINE/ALOE VERA KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS BRAND DRUG ALOE GRANDE ALOE VERA ALOE VERA BURN RELIEF ALOE VERA PAIN RELIEVING ALOE VERA-LIDOCAINE ALOE VESTA CLEANSING ALOE-LIDOCAINE ALPHA KERI OIL ALPHABATH ALPHASOFT ALTACAINE ALTALUBE ALTAMIST ALTERNAGEL AMERICAINE AMERICERIN AMERIGEL AMERIGEL PREMIUM CARE AMERIGEL WOUND WASH AMERIPHOR AMERISTORE AMLACTIN XL AMVISC AMVISC PLUS ANACAINE ANALGESIC ANALGESIC BALM ANALGESIC CREME ANALPRAM HC ANAMANTLE HC ANAMANTLE HC FORTE ANANA FORTE ANASEPT ANASEPT SKIN-WOUND CLEANSER ANBESOL ANECREAM ANECREAM5 ANESTAFOAM ANESTHETIC ORAL GEL ANTI MONKEY BUTT ANTI-DANDRUFF ANTI-DANDRUFF WITH MENTHOL ANTISEPTIC & ANESTHETIC ANTISEPTIC MOUTH CLEANSER ANTI-SNORE AQUA LACTEN AQUAMED AQUAPHOR AQUAPHOR WITH NATURAL HEALING ARCTIC HEAT 85 GENERIC DRUG VIT A PALM/VIT E ACETATE/ALOE LIDOCAINE/ALOE VERA LIDOCAINE/MENTHOL/ALOE VERA LIDOCAINE/ALOE VERA ALOE VERA/COLLAGEN LIDOCAINE/ALOE VERA LANOLIN/MINERAL OIL/PEG LANOLIN/MINERAL OIL LANOLIN/MIN OIL/PEG/CASTOR OIL TETRACAINE HCL MINERAL OIL/PETROLATUM,WHITE SODIUM CHLORIDE ALUMINUM HYDROXIDE BENZOCAINE PETROLATUM,WHITE ZINC ACETATE/MEADOWSWEET/OAK ZINC OXIDE SOD CHLORIDE/POT CHL/CAL/OAK MINERAL OIL/HYDROPHIL PETROLAT PETROLATUM,WHITE/WATER SOD LACTATE/AMM LACT/POT LACT AMMONIUM LACTATE HYALURONATE SODIUM HYALURONATE SODIUM BENZOCAINE METHYL SALICYLATE/MENTHOL METHYL SALICYLATE/MENTHOL TROLAMINE SALICYLATE HYDROCORTISONE/PRAMOXINE LIDOCAINE/HYDROCORTISONE AC LIDOCAINE/HYDROCORTISONE AC BROMELAINS SODIUM HYPOCHLORITE SODIUM HYPOCHLORITE BENZOCAINE LIDOCAINE LIDOCAINE LIDOCAINE BENZOCAINE TALC/CALAMINE COAL TAR SELENIUM SULFIDE/MENTHOL ANTI-ITCH CREAM LIDOCAINE HCL/BENZALK CHL CARBAMIDE PEROXIDE ETOH/EUC OIL/MENTH/PEP/WINTERG LACTIC ACID/UREA ALCOHOL/PROPYLENE GLYCOL MINERAL OIL/HYDROPHIL PETROLAT PETROLATUM,WHITE METHYL SALICYLATE/MENTHOL KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS BRAND DRUG ARTHRICREAM ARTHRICREAM RUB ARTHRICREME ARTHRITIS HOT PAIN RELIEF ARTHRITIS RELIEF ARTIFICIAL TEARS ASPERCREME ASPER-FLEX ASTRINGENT SOLUTION ATOPICLAIR ATRAPRO CP ATRAPRO DERMAL SPRAY ATRAPRO HYDROGEL AURAPHENE-B AURO AURSTAT AVEENO BABY AVEENO BATH AVEENO CLEAR COMPLEXION AVEENO DAILY MOISTURIZING AVEENO INTENSE RELIEF AVEENO MOISTURIZING CREAM AVO CREAM AVOSIL AYR AYR SALINE B.F.I BABY ANTI MONKEY BUTT BABY AYR SALINE BABY CHEST RUB BABY DARLINGS BABY OIL BABY POWDER PURE CORNSTARCH BABY SHAMPOO BABY TEETHING GEL BABY TEETHING PAIN MEDICINE BACTINE BALMEX BALNEOL BALNEOL FOR HER BALNETAR BANALG BASLE BATH OIL BAZA CLEAR BAZA PROTECT BENGAY ARTHRITIS FORMULA BENGAY GREASELESS BENOXYL-CR ADVANCED BENPROX BENZAC AC BENZAC W 5 86 GENERIC DRUG TROLAMINE SALICYLATE TROLAMINE SALICYLATE/ALOE VERA TROLAMINE SALICYLATE METHYL SALICYLATE/MENTHOL TROLAMINE SALICYLATE GLYCERIN/PROPYLENE GLYCOL TROLAMINE SALICYLATE TROLAMINE SALICYLATE CALCIUM ACETATE/ALUMINUM SULF VITE AC/GRAPE/HYALURONIC ACID EMOLLIENT COMBO NO.47 & NO.60 ELECT WTR/SOD CH/SOD HY/HYP AC EMOLLIENT COMBINATION NO.60 CARBAMIDE PEROXIDE CARBAMIDE PEROXIDE EM#53/NAMGF/CYC/PHOS/NAHC/NACL COLLOIDAL OATMEAL COLLOIDAL OATMEAL SALICYLIC ACID DIMETHICONE/COLLOIDAL OATMEAL GLY/DIMETH/PETROLAT,WHT/WATER COLLOIDAL OATMEAL EMOLLIENT COMBINATION NO.10 SODIUM SALICYLATE/OINT,PEG/BHT SODIUM CHLORIDE SODIUM CHLORIDE BISMUTH FORMIC IODIDE CALAMINE/CORN STARCH SODIUM CHLORIDE EUC OIL/ALOE/LAV&ROSEM OILS/PT COLLOIDAL OATMEAL LANOLIN/MINERAL OIL CORN STARCH SOAP BENZOCAINE BENZOCAINE LIDOCAINE HCL/BENZALK CHL BALSAM PERU/ZINC OXIDE MINERAL OIL/LAN OIL/PROP GLY MINERAL OIL/LAN OIL/PROP GLY COAL TAR/LANOLIN EUCALYPTUS/ME-SAL/MENTHOL/CAMP HYDROPHILIC CREAM LANOLIN/MINERAL OIL COD LIVER/VIT A&D/PETROLAT,WHT DIMETHICONE/ZINC OXIDE METHYL SALICYLATE/MENTHOL METHYL SALICYLATE/MENTHOL BENZOYL PEROXIDE BENZOYL PEROXIDE/ALOE VERA BENZOYL PEROXIDE BENZOYL PEROXIDE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS BRAND DRUG BENZAC W WASH BENZASHAVE BENZEFOAM BENZEFOAM ULTRA BENZEPRO BENZIQ BENZIQ LS BENZODENT BENZOIN TINCTURE BENZ-O-STHETIC BENZOTIC BENZ-PROTECT BETA CARE BETA MED BETA XMA BETASAL BETATAR SHAMPOO BIAFINE BIONECT BIO-THERM BI-ZETS BLISTEX BLOOD CLOTTING BODI KLEEN BODI LINE ANTISEPTIC SOAP BODI PROTECT BODI WHIRL OIL BODY LOTION BODY OIL BODY POWDER MEDICATED BOIL EASE BOIL RELIEF BORAX BORO-PACKS BP BP FOAM BP WASH BP WASH ACNE TREATMENT BP-50% UREA BPO BPO-10 BPO-5 BREATHE RIGHT BREATHE RIGHT SNORE RELIEF BREVOXYL-4 BREVOXYL-8 BROMI-LOTION BROMI-TALC BROMI-TALC PLUS 87 GENERIC DRUG BENZOYL PEROXIDE BENZOYL PEROXIDE BENZOYL PEROXIDE BENZOYL PEROXIDE BENZOYL PEROXIDE BENZOYL PEROXIDE/ALOE VERA BENZOYL PEROXIDE/ALOE VERA BENZOCAINE BENZOIN COMPOUND BENZOIN BENZOCAINE BENZOCAINE BENZOYL PEROXIDE BENZOIN COMPOUND CETYL ALC/STEARYL ALC/PG/SLS PYRITHIONE ZINC ALOE VERA/DIMETHICONE SALICYLIC ACID COAL TAR EMOLLIENT COMBINATION NO.10 HYALURONATE SODIUM CAPSAICIN/ME-SALICYLATE/MENTH BENZOCAINE DIMETHICONE/OXYBENZONE/OCTINOX LIDOCAINE/BENZETHON CL ALOE V/CL-XYLENOL/PHENOXYETH SOAP EMOLLIENT COMBINATION NO. 4 EMOLLIENT COMBINATION NO. 5 CETYL ALCOHOL CETYL ALCOHOL MENTHOL/ZINC OXIDE BENZOCAINE BENZOCAINE SODIUM BORATE CALCIUM ACETATE/ALUMINUM SULF BENZOYL PEROXIDE BENZOYL PEROXIDE BENZOYL PEROXIDE BENZOYL PEROXIDE UREA/LACTIC AC/ZN UNDECYLENATE BENZOYL PEROXIDE BENZOYL PEROXIDE BENZOYL PEROXIDE ETOH/EUC OIL/MENTH/PEP/WINTERG ALC/MENT/EUGN/PEP/WINT/GLY/ANS BENZOYL PEROXIDE BENZOYL PEROXIDE BROMELAINS ALUMINUM CHLORIDE AMMONIUM ALUM/TALC/BENTONITE AMMONIUM ALUM/TALC/BENTONITE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS BRAND DRUG BUMM BALM BURN BURN JEL PLUS BURN RELIEF BURN RELIEF W-ALOE CALAMINE PHENOLATED CALDESENE CALICYLIC CALLUS REMOVER CALLUS REMOVERS CALMODROX CALMOL 4 CALMOL-4 CALYPXO CAM CAMPHO-PHENIQUE CAMPHOR & PHENOL CANK-OXIDE CAPSAICIN HOT PATCH CAPSICUM HOT PATCH CAPTRACIN CAPZASIN CAPZASIN-HP CAPZASIN-P CARAC CARBAMOXIDE CARB-O-LAC HP CARB-O-LAC5 CARB-O-LAN10 CARB-O-LAN20 CARB-O-SAL5 CARLESTA CARMOL SCALP CARRAFOAM SKIN CARE CARRAKLENZ CARRASYN V CARRINGTON MOISTURE BARRIER CASTBLAST CASTELLANI PAINT CASTELLANI PAINT MODIFIED CASTIVA COOLING CASTIVA WARMING CASTOR OIL CAVILON MOISTURIZING BODY CELACYN CEPACOL FIZZLERS CEPACOL SENSATIONS COOLING CEPACOL SENSATIONS HYDRA CEPACOL SORE THROAT CERAVE CERAVE PM 88 GENERIC DRUG ZINC OXIDE BENZOCAINE/MENTH/BENZETHONIUM LIDOCAINE HCL/VIT E/TEA TREE LIDOCAINE/ALOE VERA LIDOCAINE/ALOE VERA CALAMINE/PHENOL LIQUID ZINC OXIDE/CORN STARCH SALICYLIC ACID SALICYLIC ACID SALICYLIC ACID MENTHOL/ZINC OXIDE COCOA BUTTER/ZINC OXIDE ZINC OXIDE METHYL SALICYLATE/MENTHOL CETYL ALCOHOL/STEARYL ALCOHOL CAMPHOR/PHENOL CAMPHOR/PHENOL CARBAMIDE PEROXIDE CAPSAICIN CAPSAICIN CAPSAICIN/MENTHOL CAPSAICIN CAPSAICIN CAPSAICIN FLUOROURACIL CARBAMIDE PEROXIDE AMMONIUM LACTATE/UREA AMMONIUM LACTATE/UREA EMOLLIENT COMBINATION NO.50 EMOLLIENT COMBINATION NO.50 SAL ACID/UREA/PETROLATUM,WHITE DIMETHICONE/ZINC OXIDE SULFACETAMIDE SODIUM/UREA POT SORBATE/VIT E/MO/ALO VER ALOE VERA/NA LAURYL SO4 TROMETHAM/PANTOT AC/PVP/CARBOM PETROLATUM,WHITE TRICHLOROMONOFLUOROMETHANE PHENOL PHENOL MENTH/ME-SALICYL IN CASTOR OIL CAPSAICIN IN CASTOR OIL EMOLLIENT COMBINATION NO.93 EMOLLIENT COMBINATION NO.60 BENZOCAINE BENZOCAINE/MENTHOL BENZOCAINE BENZOCAINE/MENTHOL CEPHALEXIN CERAMIDES 1,3,6-11 CERAMIDE 1,3,6-11/B3/HYALUR AC KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS BRAND DRUG CERTAIN CETACAINE CETACAINE ANESTHETIC CETACAINE MEDICAL KIT E CETA-KLENZ CETAPHIL RESTORADERM CETYLCIDE II CHAMOSYN CHAP EX CHEMET CHERACOL CHEST RUB CHILDREN'S SALINE CHILDREN'S SALINE NASAL SPRAY CHILD'S BENADRYL ITCH COOLING CHLORASEPTIC CHLORASEPTIC MAX CHLORASEPTIC SORE THROAT CIRCUDERM CITRA PH CLEAN & CLEAR ADVANTAGE CLEANSE & TREAT PLUS CLEANSE AND TREAT CLEANSING PADS CLEANSING SKIN CREAM CLEAR AWAY CLEARASIL DAILY CLEAR CLINAC BPO CLOVERINE COCOA BUTTER COCONUT OIL COCONUT OIL CREAM COLD & HOT COLD AND HOT PAIN-RELIEF COMFORT SHIELD COMPLEX 15 COMPOUND BENZOIN COMPOUND BENZOIN TINCTURE COMPOUND W CONDYLOX CONSTANT CLENS CONTI COOL HEAT CREAM COOLING BURN CORN & CALLUS REMOVER CORN REMOVER CORN-CALLUS REMOVER CRITIC-AID CLEAR 89 GENERIC DRUG ALUMINUM CHLORIDE TETRACAINE/BENZOCAINE/BUTAMBEN TETRACAINE/BENZOCAINE/BUTAMBEN TETRACAINE/BENZOCAINE/BUTAMBEN PARAB/CET ALC/STRYL ALC/PG/SLS EMOLLIENT COMBINATION NO.62 CETYL ALCOHOL ALK DIMETHYL ETHYL/BENZ AMCHL MENTHOL/ZINC OX/ALOE/CHAM OIL VITAMIN E/OCTINOXATE SUCCIMER PHENOL EUCALYPTUS OIL/MENTHOL/CAMPHOR SODIUM CHLORIDE SODIUM CHLORIDE CAMPHOR PHENOL BENZOCAINE/MENTHOL BENZOCAINE/MENTHOL BALSAM PERU/CASTOR OIL SODIUM CITRATE SALICYLIC ACID SALICYLIC AC/BENZ PEROX/EMOLL SALICYLIC ACID/BENZOYL PEROXID SALICYLIC ACID MENTHOL/CAMPHOR/PHENOL SALICYLIC ACID BENZOYL PEROXIDE BENZOYL PEROXIDE PETROLATUM,WHITE COCAINE HCL EMOLLIENT COMBINATION NO.75 EMOLLIENT COMBINATION NO.61 METHYL SALICYLATE/MENTHOL METHYL SALICYLATE/MENTHOL COLLOIDAL OATMEAL ALOE VERA/DIMETHICONE/CHLORHEX LECITHIN/GLYCERIN/DIMETHICONE BENZOIN/ALOE VERA/STORAX/TOLU BENZOIN COMPOUND SALICYLIC ACID PODOFILOX NAPH,MB-DB/K PH,MBDB/ZINC/UREA SOAP METHYL SALICYLATE/MENTHOL BENZOCAINE/TRICLOSAN SALICY AC/HYDROCOL DR/FM BNDGE SALICYLIC ACID CORN STARCH SALICYLIC ACID VIT E ACETATE/DMC/ZNOX/PET,WH KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS BRAND DRUG CUTAR DAILY CARE ALCOHOL FREE STRIDE DAILY FACE WASH DAILY MOISTURIZING LOTION DAKIN'S DANDREX DANDRUFF SHAMPOO DEBROX DEEP BLUE DEEP SEA DELAZINC DELOS DEL-RAY SPECIAL SHAMPOO DENDRACIN DENDRACIN NEURODENDRAXCIN DENT-O-KAIN DERMABASE DERMACERIN DERMACLOUD DERMADAILY DERMADROX DERMAFLEX DERMAMED DERMANAIL DERMAPHOR DERMAPLEX DERMAREST PSORIASIS DERMASEPTIN DERMASORB XM DERMAVANTAGE DERMAZINC DERMEND DERMOPLAST DESITIN DESITIN CLEAR DESQUAM-X DEXTRAN 70 IN DEXTROSE 10% DHS CONDITIONING RINSE DHS SAL DHS TAR DHS TAR GEL DHS ZINC DIABETIDERM DIAPER RASH DIAPER RASH OINTMENT DIAPER RASH PASTE DIAPER RASH RELIEF DIAPER RELIEF DI-DAK-SOL DISP DOUCHE EXTRA CLNS V&W DML 90 GENERIC DRUG COAL TAR SALICYLIC ACID SALICYLIC ACID DIMETHICONE/COLLOIDAL OATMEAL SODIUM HYPOCHLORITE SELENIUM SULFIDE PYRITHIONE ZINC CARBAMIDE PEROXIDE MSM/ALO VER/EMU OIL/HRB66 SODIUM CHLORIDE ZINC OXIDE BENZOYL PEROXIDE SODIUM LAURYL SULFATE CAPSAICIN/ME-SALICYLATE/MENTH CAPSAICIN/ME-SALICYLATE/MENTH BENZOCAINE EMOLLIENT BASE MINERAL OIL/PETROLATUM,WHITE COLD CREAM/ZINC OXIDE/STAR/LAN MO/ALO V/PET,WH/CETYL ALC/H2O ALUMINUM HYDROXIDE LIDOCAINE ALUMINUM HYDROXIDE MANDELIC AC/1,3-BUTANEDIOL/IPA MINERAL OIL/HYDROPHIL PETROLAT EMOLLIENT #56/HYALURONIC ACID SALICYLIC ACID MENTHOL/ZINC OXIDE UREA/EMOLLIENT CMB NO.18 LANOLIN/MINERAL OIL PYRITHIONE ZINC EMOLLIENT COMBINATION NO.77 BENZOCAINE/BENZETHON CL COD LIVER OIL/ZINC OXIDE VITS A & D/WHITE PET/LANOLIN BENZOYL PEROXIDE DEXPANTHENOL DEXTRAN 70/DEXTROSE 10 %-WATER PANTOTHENIC ACID SALICYLIC ACID COAL TAR COAL TAR PYRITHIONE ZINC EMOLLIENT BASE ZINC OXIDE COD LIVER OIL/ZINC OXIDE COD LIVER OIL/ZINC OXIDE ZINC OXIDE COD LIVER OIL/ZINC OXIDE SODIUM HYPOCHLORITE ACETIC ACID GLY/BENZYL ALC/PETROLAT,WHT KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS BRAND DRUG DML FACIAL MOISTURIZER DML FORTE DOBELL'S DOLORACIN-L-RX DOMEBORO DR SCHOLL'S CLEAR AWAY DR. SCHOLL'S FOOT POWDER DR. SMITH'S ADULT BARRIER DR. SMITH'S DIAPER DR. SMITH'S DIAPER RASH DR. SMITH'S RASH-N-ALL DR. SMITH'S RASH-SKIN DRAW OUT SALVE DROXY DRY SKIN BATH OIL DRY SKIN CARE DRY SKIN CREAM DRY SKIN FORMULA BAR DRY SKIN LOTION DRY SKIN THERAPY DRY SKIN THERAPY PLUS DRY SKIN TREATMENT DRYSOL DUAL ACTION DUOFILM DURAFLEX DURASAL EAR DROPS EAR SYSTEM EAR WAX DROPS EAR WAX REMOVAL EARWAX TREATMENT ECZEMA ECZEMA RELIEF EFFACLAR DUO EFUDEX ELENZAPATCH ELETONE ELON ELTA ELTA LITE TAR ELTA SEAL MOISTURE BARRIER ELTA TAR EMLA EMOLLIA EMOLLIENT EMU-LAC EMULSION SB ENDOXCIN EPICERAM EPIDERM EPIFOAM 91 GENERIC DRUG OXYBENZONE/SUNSCREEN/HYALUR AC PANTOT AC/GLYCERIN/PET HY-PHL SODIUM BORATE LIDOCAIN/ME-SALICYL/CAPS/MENTH CALCIUM ACETATE/ALUMINUM SULF SALICYLIC ACID SAL ACID/METHYL SALICYLATE/TLC ZINC OXIDE ZINC OXIDE ZINC OXIDE LAN/MIN OIL/ZNOX/PETROLAT,WHT PETROLATUM,WHITE/LANOLIN MIN OIL/ICHTHAM/SOAP/PET,WH EMOLLIENT BASE LANOLIN/MINERAL OIL SOD CHLORIDE/LAN/MO/PET,WH MINERAL OIL/PETROLATUM,WHITE SOAP GLYCERIN/MINERAL OIL LANOLIN ALCOHOL/MO/W.PET/CERES EMOLLIENT COMBINATION NO. 1 PETROLATUM,WHITE ALUMINUM CHLORIDE BENZOYL PEROXIDE SALICYLIC ACID ME-SAL/GLUCOS/MSM/CAY/MEN/ALOE SALICYLIC ACID CARBAMIDE PEROXIDE CARBAMIDE PEROXIDE CARBAMIDE PEROXIDE CARBAMIDE PEROXIDE CARBAMIDE PEROXIDE COLLOIDAL OATMEAL COLLOIDAL OATMEAL BENZOYL PEROXIDE MICRONIZED FLUOROURACIL LIDOCAINE HCL/MENTHOL EMOLLIENT COMBINATION NO. 25 OXYQUINOLINE/EMOLLIENT BASE EMOLLIENT COAL TAR ZINC OXIDE COAL TAR LIDOCAINE/PRILOCAINE EMOLLIENT COMBINATION NO.39 EMOLLIENT BASE AMMONIUM LACTATE/EMU OIL EMOLLIENT COMBINATION NO.32 LIDOCAINE HCL/MENTHOL EMOLLIENT COMBINATION NO.32 METHYL SALICYLATE/MENTHOL HYDROCORTISONE/PRAMOXINE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS BRAND DRUG EUCERIN EUCERIN CALMING BODY WASH EUCERIN ECZEMA RELIEF EUCERIN INTENSIVE REPAIR EUCERIN PROFESSIONAL REPAIR EUCERIN SKIN CALMING EUFLEXXA EXACTACAIN EXCEL AP EXCEL-GEL EXFOLIATING MOISTURIZER EXOTEN-C EXTRA CLEANSING DOUCHE EYE CREAM EYESCRUB FACIAL CARE FACIAL CLEANSER FAST CLEARING SPOT FEMININE CARE DOUCHE FEMININE MOIST & LUBRICATING FINGER CREAM FINGERS SKIN FIRST-AID FLANDERS BUTTOCKS OINTMENT FLUOROPLEX FOAM INCONTINENCE KIT FOOT MOISTURIZER FOOT SOFTENER FOR STY RELIEF FORDUSTIN FREEZONE FRESH FOAMING GALZIN GEBAUER'S 114 GEL-ONE GENADUR GENTEAL PM GENTLE CREAM GENTLE MOISTURIZING LOTION GERI PROTECT GERI RINSE-FREE GERI-HYDROLAC GERI-SHAMPOO GERI-SOFT GLYCERIN-ROSE WATER GLYCINE SOYA PROTEIN GLY-OXIDE 92 GENERIC DRUG ETHYL CHLORIDE EUCALYPTUS OIL LANOLIN ALCOHOL/MO/W.PET/CERES COLLOIDAL OATMEAL EMOLLIENT COMBINATION NO.72 EMOLLIENT COMBINATION NO.96 EMOLLIENT COMBINATION NO.69 HYALURONATE SODIUM TETRACAINE/BENZOCAINE/BUTAMBEN POVIDONE-IODINE/ISOPROPYL ALC PANTOTHENIC ACID/ALOE VERA SAL ACID/UREA/PETROLATUM,WHITE CAPSAICIN/ME-SALICYLATE/MENTH ACETIC ACID PANTOT AC/MO/PET H-PH/SORB SOL EDETATE DISODIUM/PEG EMOLLIENT BASE EMOLLIENT BASE SALICYLIC ACID ACETIC ACID CHLORHEX GL/GLYCERIN/HE-CELL FINASTERIDE EMOLLIENT BASE EMOLLIENT BASE LIDOCAINE HCL/BENZALK CHL BALSAM PERU/ZINC OXIDE FLUOROURACIL FLUOROURACIL POT SORBATE/VIT E/MO/ALO VER SAL ACID/UREA/PETROLATUM,WHITE SAL ACID/UREA/PETROLATUM,WHITE MINERAL OIL/PETROLATUM,WHITE NA BICARB/MEBENZ/STARCH/SILICA SALICYLIC ACID/COLLODION, FLEX GLYCERIN/SOAP/WATER ZINC ACETATE DICHLOROTETRAFLUOROETHANE HYALURONATE SOD, CROSS-LINKED BIO/CARB/EQUIS/ETHAN/CHIT/MSM MINERAL OIL/PETROLATUM,WHITE VITAMIN E/VIT A&D/ZINC OXIDE VIT E ACETATE/GLY/DIMETH/WATER LAN/MIN OIL/ZNOX/PETROLAT,WHT SOAP AMMONIUM LACTATE SOAP MINERAL OIL/PETROLAT,WHT/WATER GLUTARALDEHYDE GLYCERIN SOY PROTEIN CARBAMIDE PEROXIDE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS BRAND DRUG GOLD BOND ULTIMATE GOLD BOND ULTIMATE DIABETIC GOLD BOND ULTIMATE HEALING GORDOBALM GORDOFILM GORDOGESIC GORDON'S NO. FIVE GORDON'S VITE A GORDO-VITE A GRANULEX GREASELESS GRX RINSE-FREE GRX VITAMIN E H.E.A.R. HC PRAM H-CHLOR 12 HEALON5 HEALTHY SCALP SHAMPOO HEMORRHOIDAL-ANALGESIC HERPECIN L HIGH POTENCY CAPSAICIN HPA LANOLIN HPR HPR PLUS HPR PLUS-MB HYDROGEL HURRICAINE HURRICAINE ONE HYALGAN HYDRASYN25 HYDRATING HEALING HYDRISALIC HYDRISINOL HYDROCERIN HYDROCERIN PLUS HYDROCORTISONE-PRAMOXINE HYDROCORTISONE-PRAMOXINE HCL HYDROCREAM BASE HYDRO-LAN HYDROLATUM HYDROPHOR HYGEL HYGIENE 1 HYLASE HYLATOPIC HYLATOPIC PLUS HYLATOPIC PLUS-AURSTAT HYLENEX HYLIRA HYPERCARE HYPER-HEAL HYSEPT ILEX 93 GENERIC DRUG EMOLLIENT COMBINATION NO.31 DIMETHICONE/PETR/VIT A,C,E/ALO DIMETHICONE/PETR/VIT A,C,E/ALO ME-SALICYLATE/ACET/ISOPROPANOL SALICYLIC ACID/COLLODION, FLEX METHYL SALICYLATE FOOT DEODORANT COMB. NO.3 VITAMIN A VITAMIN A TRYPSIN/BALSAM PERU/CASTOR OIL EUCALYPTUS OIL/MENTHOL/CAMPHOR SOAP EMOLLIENT COMBINATION NO.49 CARBAMIDE PEROXIDE HYDROCORTISONE/PRAMOXINE SODIUM HYPOCHLORITE HYALURONATE SODIUM SALICYLIC ACID DIBUCAINE DMC/OXYBEN/OCTNX/OCT SAL/MERAD CAPSAICIN MODIFIED LANOLIN EMOLLIENT COMBINATION NO.44 EMOLLIENT COMBINATION NO.53 EMOL53/NAMGFS/HA/NAHYPOCHLORIT BENZOCAINE BENZOCAINE HYALURONATE SODIUM UREA/ALPHA HYDROXY ACIDS MINERAL OIL/HYDROPHIL PETROLAT SALICYLIC ACID VEGETABLE OIL/CASTOR OIL MINERAL OIL/I-PROP MYR/WATER EMOLLIENT COMBINATION NO.34 HYDROCORTISONE/PRAMOXINE HYDROCORTISONE/PRAMOXINE EMOLLIENT BASE EMOLLIENT COMBINATION NO.51 PETROLATUM,WHITE PETROLATUM,WHITE HYALURONATE SODIUM EDETATE SOD/PEG/SOD LAURYL SUL HYALURONATE SODIUM/HE-CELL/PEG EMOLLIENT COMBINATION NO.44 EMOLLIENT COMBINATION NO.53 EMOL53/NAMGFS/HA/NAHYPOCHLORIT HYALURONIDASE, HUMAN RECOMB. HYALURONATE SODIUM ALUMINUM CHLORIDE ALOE/LAC AC/CERAMIDES 3,3B,6,1 SODIUM HYPOCHLORITE ZINC/PETROLATUM,WHITE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS BRAND DRUG ILOPAN INJECTION IMPRUV INCONTINENCE SKIN CARE INCONTINENCE SKIN CARE KIT INOVA INOVA 4-1 INOVA 8-2 INSTANT BITE & STING RELIEF INSTANT PAIN RELIEF INTENSE TOOTHACHE PAIN RELIEF INVISIBLE ACNE IODEX WITH METHYL SALICYLATE IONAX SCRUB IONIL IONIL PLUS IONIL T IONIL T PLUS ISOPROPYL-WINTERGREEN JOHNSON'S BABY POWDER KEFLEX KELO-COTE KENDALL SOOTHING KERA TEK KERADAN KERALYT KERALYT SCALP KERI KERI ADVANCED MOISTURE THERAPY KERI ORIGINAL MOISTURE THERAPY KERI SENSITIVE SKIN KERODEX 51 KERODEX 71 KEROL AD KEROL ZX K-Y K-Y LUBRICATING JELLY LAC-HYDRIN LAC-HYDRIN FIVE LAC-HYDRIN TWELVE LACLOTION LACTATED RINGERS LACTINOL HX LADY ANTI MONKEY BUTT LAMISILK LANACANE ANTI-ITCH LANACANE FIRST AID LANACANE WITH ALOE LANOLIN GRX LANOLOR DRY SKIN 94 GENERIC DRUG DEXPANTHENOL MINERAL OIL/I-PROP MYR/WATER MIN OIL/ALO VER/PET,WH/SLS MIN OIL/ALO VER/PET,WH/SLS BENZOYL PEROXIDE/VIT E MIX SALICYLIC AC/BENZOYL PER/VIT E SALICYLIC AC/BENZOYL PER/VIT E BENZOCAINE CAMPHOR/PHENOL BENZOCAINE BENZOYL PEROXIDE IODINE/METHYL SALICYLATE SOAP SALICYLIC ACID/BENZALK CHL SALICYLIC ACID COAL TAR COAL TAR ISOPROPYL ALCOHOL METHYL SALICYLATE/ISOPROPANOL TALC CEPHALEXIN POLYDIMETHYLSILOXANES/SILICON ZINC OXIDE METHYL SALICYLATE/MENTHOL EMOLLIENT COMBINATION NO.65 SALICYLIC ACID SALICYLIC ACID EMOLLIENT COMBINATION NO. 19 EMOLLIENT COMBINATION NO. 22 EMOLLIENT COMBINATION NO. 20 EMOLLIENT COMBINATION NO. 14 EMOLLIENT COMBINATION NO.78 HYDROPHILIC CREAM UREA/LACTIC AC/ZN UNDECYLENATE UREA/LACTIC AC/ZN UNDECYLENATE CHLORHEX GL/GLYCERIN/HE-CELL CHLORHEX GL/GLYCERIN/HE-CELL AMMONIUM LACTATE AMMONIUM LACTATE AMMONIUM LACTATE AMMONIUM LACTATE RINGERS SOLUTION,LACTATED LACTIC ACID LACTIC ACID CALAMINE/CORN STARCH CORN/LUFFA CYLINDRICA BENZOCAINE/BENZETHON CL BENZOCAINE/BENZETHON CL BENZOCAINE/BENZETHON CL LANOLIN LANOLIN LANOLIN KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS BRAND DRUG LAN-O-SOOTHE LANTISEPTIC LATRIX LATRIX XM LAVOCLEN-4 LAVOCLEN-8 LAZER LC-4 LC-5 LENZAGEL LENZAPATCH LIDALL LIDAMANTLE HC LIDOCAINE HCL-EPINEPHRINE LIDOCAINE-HYDROCORTISONE LIDOCAINE-PRILOCAINE LIDOCORT LIDOCREAM LIDODERM LIDODEXTRAPINE LIDOPATCH LIDOPRO LIDOVEX LIGHT NIGHT CREAM LIMENCIN LIP BALM MEDICATED LIP MOISTURIZER LIP-GUARD LIQUA-GEL LIQUID BANDAGE LIQUID CORN & CALLUS REMOVER LIQUIMAT LITTLE REMEDIES LITTLE REMEDIES STUFFY NOSE L-LYSINE LMX 4 LMX 4 PLUS LMX 5 LOBANA BATH OIL LOBANA PERI-GARDE LORENZA LOUTREX LOZENGES LUBRICANT EYE LUBRICANT PM LUBRICATING GEL LUBRICATING JELLY LUBRICATING MOISTURE LOTION LUBRICATING SKIN LUBRIDERM ADVANCED THERAPY LUBRIDERM DAILY MOISTURE 95 GENERIC DRUG LANOLIN LANOLIN UREA/LACTIC ACID/SALICYL ACID UREA/LACTIC AC/ZN UNDECYLENATE BENZOYL PEROXIDE BENZOYL PEROXIDE VIT A PALM/VITAMIN E ACETATE LIDOCAINE LIDOCAINE LIDOCAINE HCL/MENTHOL LIDOCAINE HCL/MENTHOL LIDOCAINE/MENTHOL LIDOCAINE/HYDROCORTISONE AC LIDOCAINE HCL/EPINEPHRINE HYDROCORTISONE/LIDOCAINE/ALOE LIDOCAINE/PRILOCAINE HYDROCORTISONE/LIDOCAINE/ALOE LIDOCAINE LIDOCAINE LIDOCAINE HCL/MENTHOL LIDOCAINE/MENTHOL LIDOCAIN/ME-SALICYL/CAPS/MENTH LIDOCAINE EMOLLIENT BASE LIDOCAINE/MENTHOL LIP BALM VITAMIN E/MENTH/CAMPH/OCTINOX BENZOPHENONE MENTHOL/CAMPHOR/ALLANTOIN/PHE GLYCERIN/BORIC ACID DYCLONINE HCL/BENZETHONIUM CL SALICYLIC ACID SULFUR/ALCOHOL SODIUM CHLORIDE SODIUM CHLORIDE EMOLLIENT COMBINATION NO. 24 LIDOCAINE LIDOCAINE/TRANSPARENT DRESSING LIDOCAINE MINERAL OIL VITAMIN E/VIT A&D/CL-XYLENOL LIDOCAINE/MENTHOL EMOLLIENT COMBINATION NO.85 BENZOCAINE/MENTHOL GLYCERIN/PROPYLENE GLYCOL MINERAL OIL/PETROLATUM,WHITE CHLORHEX GL/GLYCERIN/HE-CELL CHLORHEX GL/GLYCERIN/HE-CELL EMOLLIENT SOD CHLORIDE/LAN/MO/PET,WH EMOLLIENT COMBINATION NO.71 EMOLLIENT COMBINATION NO.92 KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS BRAND DRUG LUBRIDERM SENSITIVE SKIN LUBRIDERM SKIN NOURISHING LUBRISILK LUBRI-SKIN LUBRISOFT M9 MAC MAPO MARLEX LIQUID SOAP MASSENGILL DISPOSABLE DOUCHE MAXILUBE MB HYDROGEL MECHOLYL MEDERMA MEDERMA FOR KIDS MEDICATED BODY MEDICATED CHEST RUB MEDICATED CLEANSING MEDICATED HEAT PATCH MEDICATED LIP BALM MEDI-DERM MEDI-DERM-L MEDI-DERM-L-RX MEDI-FIRST BURN MEDI-PATCH MEDIPLAST CORN-CALLUS-WART MEDI-RUB MEDROX MENTHODERM MERCUROCLEAR METED METHAGUAL MEXSANA MG217 MEDICATED TAR MG217 PSORIASIS MG217 SAL-ACID MIADERM MIMYX MINERIN MINERIN LOTION MOBISYL MOISTURE BARRIER MOISTURE EYES MOISTURIZING CREAM MOISTURIZING LOTION MOISTURIZING THERAPY MONOCETE EZ MOSCO CALLUS-CORN REMOVER MOSCO CORN REMOVER 96 GENERIC DRUG GLY/MIN OIL/PETROLAT,WHT/WATER GLY/DIMETH/URE/PET,WH/CET ALC GLY/MIN OIL/PETROLAT,WHT/WATER SOD CHLORIDE/LAN/MO/PET,WH MINERAL OIL/PETROLAT,WHT/WATER SODIUM CITRATE CAPSAICIN/MENTHOL MAGNESIUM SULFATE MINERAL OIL SOAP ACETIC ACID CHLORHEX GL/GLYCERIN/HE-CELL EM#53/NAMGF/CYC/PHOS/NAHC/NACL METHACHOLINE/METHYL SALICYLATE ALLANTOIN/ONION/PEG/WATER ALLANTOIN/ONION/PEG/WATER MENTHOL/ZINC OXIDE MEDICATED CALLUS REMOVER EUCALYPT/MEN/CAMP/TURP/PET,WH SALICYLIC ACID CAPSAICIN MENTHOL/CAMPHOR/PHEN/SALICYLIC CAPSAICIN/ME-SALICYLATE/MENTH LIDOCAIN/ME-SALICYL/CAPS/MENTH LIDOCAIN/ME-SALICYL/CAPS/MENTH LIDOCAINE HCL/BENZALK CHL LIDOCAIN/ME-SALICYL/CAPS/MENTH SALICYLIC ACID EUCALYPT/MEN/CAMP/TURP/PET,WH CAPSAICIN/MENTHOL METHYL SALICYLATE/MENTHOL LIDOCAINE HCL/BENZALK CHL SALICYLIC ACID/SULFUR ME-SALICYLATE/GUAIA/PET,WH METHYL SALICYLATE ZINC OXIDE COAL TAR COAL TAR SALICYLIC ACID EMOLLIENT COMBINATION NO.63 EMOLLIENT COMBINATION NO.35 MINERAL OIL/PETROLATUM,WHITE MINERAL OIL/I-PROP MYR/WATER TROLAMINE SALICYLATE MINERAL OIL/PETROLATUM,WHITE GLYCERIN/PROPYLENE GLYCOL GLY/DIMETH/PETROLAT,WHT/WATER MINERAL OIL/I-PROP MYR/WATER MINERAL OIL/PETROLATUM,WHITE MONOCHLOROACETIC ACID SALICYLIC ACID SALICYLIC ACID KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS BRAND DRUG MOSCO-CAIN MOUTH CLEANSER MOUTH SORE MULTI-PURPOSE MOISTURE BARRIER MUPPET BABY POWDER MURINE EAR WAX REMOVAL SYSTEM MUSCLE RELIEF MUSCLE RUB MUSCLE RUB ULTRA STRENGTH MUSTARGEN MYOFLEX NAIL SCRUB NASADROPS NASAL MOIST NASAL MOISTURIZING NATURAL CARE GEL NATURAL OATMEAL BATH TREATMENT NATURAL PAIN RELIEVING NEOBENZ MICRO NEOBENZ MICRO SD NEOSALUS NEOSALUS CP NEOSPORIN MOISTURIZING CREAM NEOSPORIN NEO TO GO NEUVAXIN NEW SKIN NEW TEROCIN NIVATOPIC PLUS NIVEA NIVEA ORIGINAL NIVEA SOFT NO FUNGUS NOBLE FORMULA NOBLE FORMULA S NOMLANDS NORMLGEL NOURIVA REPAIR NOVACORT NULLO NUOX NUPERCAINAL NUPRIN ARTHRITIS PATCH NUTRADERM NUTRADERM 30 NUVAIL OATMEAL BATH OATMEAL MOISTURIZING OC8 OCEAN ODOR-EATERS OILATUM 97 GENERIC DRUG BENZOCAINE CARBAMIDE PEROXIDE BENZOCAINE MENTHOL/ZINC OX/ALOE/CHAM OIL TALC CARBAMIDE PEROXIDE CAPSAICIN METHYL SALICYLATE/MENTH/CAMPH METHYL SALICYLATE/MENTH/CAMPH MECHLORETHAMINE HCL TROLAMINE SALICYLATE CALCIUM CARBONATE/NA HYPOCHLOR SODIUM CHLORIDE SODIUM CHLORIDE SODIUM CHLORIDE ALOE/DEXPANTHENOL/HYALURON AC COLLOIDAL OATMEAL MENTHOL/CAMPHOR/IRR CNTR-IRTN1 BENZOYL PEROXIDE MICROSPHERES BENZOYL PEROXIDE MICROSPHERES EMOLLIENT COMBINATION NO.38 EMOLLIENT COMBINATION NO.47 COLLOIDAL OATMEAL PRAMOXINE HCL/BENZALKONIUM CHL CAPSAICIN/MENTHOL BENZETHONIUM CHLORIDE CAPSAICIN/ME-SALICYLATE/MENTH EMOLLIENT COMBINATION NO.53 EMOLLIENT COMBINATION NO.66 EMOLLIENT COMBINATION NO.68 EMOLLIENT COMBINATION NO.67 TEA TREE OIL PYRITHIONE ZINC SALICYLIC ACID/PYRITHIONE ZINC RESORCINOL/CALAMINE SODIUM CHLORIDE MINERAL OIL/PETROLATUM,WHITE HYDROCORTISONE/PRAMOXINE/ALOE CHLOROPHYLLIN COPPER COMPLEX BENZOYL PEROXIDE/SULFUR DIBUCAINE CAPSICUM OLEORESIN MINERAL OIL GLY/DIMETH/URE/PET,WH/CET ALC POLY-UREAURETHANE COLLOIDAL OATMEAL DIMETHICONE/COLLOIDAL OATMEAL BENZOYL PEROXIDE GLYCERIN/HYALURONATE SODIUM OCEAN SALINE NASAL SPRAY FOOT DEODORANT COMB. NO.2 SOAP KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS BRAND DRUG OIL-FREE ACNE WASH ONE-STEP PLANTAR WART REMOVER ONE-STEP WART REMOVER ON-THE-SPOT OPTASE ORA RELIEF ORABASE ORA-BLEND ORAL ANALGESIC ORAL ANESTHETIC ORAL ANESTHETIC PASTE ORAL CLEANSING ORAL PAIN RELIEF ORAL PAIN RELIEVER ORAL RELIEF ORAMAGIC PLUS ORIGINAL ABSORBINE JR. ORIGINAL FORMULA ORIGINAL OINTMENT ORTHO-NESIC ORTHOVISC OSCION OSTIDERM OUTGRO OXALIS OXIPOR VHC P&S PACNEX PACNEX HP PACNEX LP PACNEX MX PAIN EASE PAIN RELIEF ANESTHETIC PAIN RELIEF SWABS-BENZOCAINE PAIN RELIEVING OINTMENT PAIN RELIEVING RUB PAIN-RELIEF PANOXYL PANOXYL 5 PANOXYL-4 PANOXYL-8 PANRETIN PARAFFIN WAX PAZOL XS PC TAR PCCA EMOLLIENT PEDIATRIC OINTMENT PEDI-BORO SOAK PELEVERUS PELEVERUS CLEAR 98 GENERIC DRUG SALICYLIC ACID OLIVE OIL SALICYLIC ACID SALICYLIC ACID BENZOYL PEROXIDE TRYPSIN/BALSAM PERU/CASTOR OIL PHENOL BENZOCAINE COMPOUNDING VEHICLE SUSP NO.2 BENZOCAINE BENZOCAINE BENZOCAINE CARBAMIDE PEROXIDE BENZOCAINE BENZOCAINE PHENOL BENZOCAINE THYMOL/MENTHOL SOAP CAMPHOR CAPSAICIN/CAMPHOR/MENTHOL HYALURONATE SODIUM BENZOYL PEROXIDE ALUMINUM CHLOROHYDRATE BENZOCAINE OXALIC ACID COAL TAR PHENOL/SODIUM CHLORIDE BENZOYL PEROXIDE BENZOYL PEROXIDE BENZOYL PEROXIDE BENZOYL PEROXIDE NORFLURANE/HFC 245FA BENZOCAINE ISOPROPYL ALCOHOL/BENZOCAINE BENZOCAINE METHYL SALICYLATE/MENTH/CAMPH METHYL SALICYLATE/MENTH/CAMPH BENZOYL PEROXIDE BENZOYL PEROXIDE BENZOYL PEROXIDE BENZOYL PEROXIDE ALITRETINOIN PANTOTHENIC ACID PARAFFIN SALICYLIC ACID/COAL TAR/SULFUR COAL TAR EMOLLIENT BASE COD LIVER OIL/ZINC OXIDE CALCIUM ACETATE/ALUMINUM SULF ZINC ACETATE ZINC ACETATE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS BRAND DRUG PELEVERUS GOLD PENETRAN + PLUS PEN-KERA PENTRAVAN PERANEX HC PERIGUARD PERINEAL CLEANSING FOAM PERISHIELD PERNOX PERNOX SCRUB CLEANSER PERSA-GEL PERSONAL LUBRICANT PERSONAL LUBRICATING JELLY PETROLATUM PETROLEUM JELLY PFCB PHARMABASE BARRIER PHARMABASE NATURAL PHARMACIST PAIN RELIEF PHARMACIST'S CREME PHENASEPTIC PHENOL EZ PHISODAN PHYSIOLYTE PHYSIOSOL PICATO PINEAPPLE EXTRACT PINNACAINE PLANTAR WART REMOVER PLIAGLIS PODOCON-25 PODODERM POISON IVY RELIEF POLAR FROST PONARIS NASAL EMOLLIENT PONTOCAINE PORE UNCLOGGING PR BENZOYL PEROXIDE PR CREAM PRAMCORT PRAMOSONE PRAMOSONE E PRE-ATTACHED LTA KIT PRECISE PAIN RELIEVING PREPSITE PRESERA PRETTY FEET & HANDS PROCORT PROCTOFOAM-HC 99 GENERIC DRUG ZINC ACETATE AMMONIA SOLUTION, STRONG/MSM EMOLLIENT COMBINATION NO.58 CREAM BASE NO.126 LIDOCAINE/HYDROCORTISONE AC VIT A/VITAMIN D3/E/ALOE V/ZNOX POT SORBATE/VIT E/ALOE V/UREA ZINC OXIDE SALICYLIC ACID/SULFUR SALICYLIC ACID/SULFUR BENZOYL PEROXIDE CHLORHEX GL/GLYCERIN/HE-CELL CHLORHEX GL/GLYCERIN/HE-CELL MINERAL OIL/HYDROPHIL PETROLAT PETROLATUM,WHITE EMOLLIENT BASE ZINC OXIDE CREAM BASE NO.110 CAPSAICIN/ME-SALICYLATE/MENTH CAPSIC OLEO/ME-SALICYLATE/MEN PHENOL PHENOL PHENOL LIQUID SODIUM SALICYLATE/SULFUR PHYSIOLOGICAL IRRIG SOL CMB #1 PHYSIOLOGICAL IRRIG SOL CMB #1 INGENOL MEBUTATE BROMELAINS BENZOCAINE SALICYLIC ACID LIDOCAINE/TETRACAINE PODOPHYLLUM RESIN PODOPHYLLUM RESIN PODOFILOX BENZOCAINE MENTHOL/ALOE VERA EXTRACT EUCALYPTUS/PEPPERMINT OIL TETRACAINE SALICYLIC ACID POTASSIUM HYDROXIDE BENZOYL PEROXIDE MICROSPHERES PROTECT CMB2/CERAMIDE 1,3,6-11 HYDROCORTISONE/PRAMOXINE HYDROCORTISONE/PRAMOXINE HYDROCORTISONE/PRAMOXINE/EMOLL LIDOCAINE HCL METHYL SALICYLATE/MENTHOL POLOXAMER EMOLLIENT COMBINATION NO.80 EMOLLIENT BASE HYDROCORTISONE/PRAMOXINE HYDROCORTISONE/PRAMOXINE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS BRAND DRUG PRODERM PROMISEB PROMISEB COMPLETE PROSCAR PROSHIELD FOAM & SPRAY PROSHIELD SKIN CARE PROSHIELD SPRAY PROTECTIVE PROTECTIVE OINTMENT PROTEIN PROVENZA PROVISC PRUCLAIR PRUMYX PRUTECT PRUVEL PSORIASIN PSORIASIS MEDICATED PURALUBE PUROXCIN QROXIN QUSAMINE-ST QUTENZA RADIAPLEXRX RAPID CLEAR RASH RELIEF CLEAR RASH RELIEF-SILVER RASH RELIEF-ZINC OXIDE RECEDO RECIPHEXAMINE RECTICARE REFRESH LACRI-LUBE REFRESH P.M. REGENECARE REGENECARE HA RELYYKS RELYYT REMEDY CALAZIME REMEDY CLEAR-AID REMEDY PHYTOPLEX Z-GUARD REMEDY WITH PHYTOPLEX Z-GUARD RENEWAL RENEWAL DAILY MOISTURE LOTION RENEWAL HEALING RENEWAL MOISTURIZING CREAM RENOVO RESINOL RESOURCE THICKENUP RESTORE MOISTURE BARRIER RESTORE SKIN CONDITIONING REVINA REZAMID 100 GENERIC DRUG BALSAM PERU/CASTOR OIL EMOLLIENT COMBINATION NO.43 EMOLLIENT #43/SKIN CLEANSER#27 FINASTERIDE SKIN CLEANSER COMB NO.34 POLOXAMER/GLYCERIN/DIMETH/H2O SKIN CLEANSER COMB NO.34 TALC/ZINC OXIDE PETROLATUM,WHITE PROTEIN SUPPLEMENT LIDOCAINE HCL/MENTHOL HYALURONATE SODIUM VITE AC/GRAPE/HYALURONIC ACID EMOLLIENT COMBINATION NO.35 EMOLLIENT COMBINATION NO.10 EMOLLIENT COMBINATION NO. 25 COAL TAR SALICYLIC ACID MINERAL OIL/PETROLATUM,WHITE LIDOCAINE HCL/MENTHOL CAPSAICIN/MENTHOL SALICYLIC ACID CAPSAICIN/SKIN CLEANSER HYALURON SOD/ALLANTOIN/ALOE XT SALICYLIC ACID DIMETHICONE/PETROLATUM,WHITE DIMETHICONE/ZINC OXIDE/SILVER DIMETHICONE/ZINC OXIDE POLYDIMETHYLSILOXANES/SILICON LIDOCAINE HCL/MENTHOL LIDOCAINE MINERAL OIL/PETROLATUM,WHITE MINERAL OIL/PETROLATUM,WHITE LIDOCAINE HCL/COLLAGEN LIDOCAINE/HYALUR AC/ALOE/COLL LIDOCAINE/MENTHOL CAPSAICIN/MENTHOL CALAMINE/MENTHOL/PETROLAT/ZINC PETROLATUM,WHITE ZINC OXIDE/PETROLATUM,WHITE PETROLATUM,WHITE COLLOIDAL OATMEAL DIMETHICONE/COLLOIDAL OATMEAL PETROLATUM,WHITE CERAMIDES 1,3,6-11 CAPSAICIN/MENTHOL RESOR/CALA/ZNOX/PET,WH/LAN CORN STARCH VIT A PALM/VIT D2/E/B-O/PET,WH EMOLLIENT COMBINATION NO.36 TRYPSIN/BALSAM PERU/CASTOR OIL RESORCINOL/SULFUR KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS BRAND DRUG RHINARIS RIAX RINGERS INJECTION RINGERS IRRIGATION RINNOVI RISABAL-PH RISAMINE ROBATHOL ROLL ON DEODORANT ROSULA NS SA SA 6% SALACTIC FILM SALACYN SALEX SALINE MIST SALINE NASAL GEL SALINE NASAL MIST SALINE NASAL SPRAY SALINE NOSE SPRAY SALJET SALINE SALJET SALINE RINSE SALKERA SALONPAS SALONPAS-HOT SAL-PLANT SALVAX SALVAX DUO PLUS SANTYL SARATOGA SASTID SAYMAN SALVE SCALP ITCH-DANDRUFF RELIEF SCALP TREATMENT SCAR SCAR GEL SCAR RELIEF SCAR TREATMENT SCLEROSOL SCYTERA SE BPO SEA SOFT SEA-CLENS SEBASORB SEBEX SEBULEX SHAMPOO SECURA EXTRA PROTECTIVE SECURA PROTECTIVE SELECT BRAND DISPOSABLE DOUCHE SELRX 101 GENERIC DRUG SODIUM CHLORIDE BENZOYL PEROXIDE RINGERS SOLUTION RINGERS SOLUTION UREA/EMOL/BAK CL/PVP/GRP SD XT MINERAL OIL/PETROLATUM,WHITE MENTHOL/ZINC OXIDE COTTONSEED OIL ALUMINUM CHLORIDE SULFACETAMIDE SODIUM/UREA SALICYLIC ACID/CERAMIDE CMB #1 SALICYLIC ACID SALICYLIC ACID/COLLODION, FLEX SALICYLIC ACID SALICYLIC ACID SALICYLIC ACID SODIUM CHLORIDE SODIUM CHLORIDE/ALOE VERA SODIUM CHLORIDE SODIUM CHLORIDE SODIUM CHLORIDE SODIUM CHLORIDE SODIUM CHLORIDE SALICYLIC ACID/AMMON LACT/ALOE CAPSAICIN/MENTHOL CAPSAICIN SALICYLIC ACID SALICYLIC ACID SALICYLIC ACID/UREA COLLAGENASE CLOSTRIDIUM HIST. EUCALYPT/ZNOX/BORIC AC/PET,WH SALICYLIC ACID/SULFUR ZINC OXIDE/PETROLATUM,WHITE SALICYLIC ACID SULFACETAMIDE SODIUM/UREA ALLANTOIN/ONION/PEG/WATER ALLANTOIN/ONION/PEG/WATER ALLANTOIN/ONION/PEG/WATER SILICONE ADHESIVE TALC COAL TAR BENZOYL PEROXIDE SODIUM CHLORIDE NACL IRRIGAT/DECYL GLUCOSIDE SALICYLIC ACID/SULFUR SALICYLIC ACID/SULFUR SALICYLIC ACID/SULFUR ZINC OXIDE PETROLATUM,WHITE ACETIC ACID SELENIUM SULFIDE SELENIUM SULFIDE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS BRAND DRUG SELSEB SELSUN BLUE SELSUN BLUE NATURALS SENSI-CARE SENSI-CARE MOISTURIZING 2 SENSITIVE SKIN MOISTURE SEPTI-SOFT SEVERE DRY SHIELD SKIN SHUR-CLENS SILICONE DISC SILICONE ROLL SILICONE SCAR SILICONE SHEET SILICONE TAPE SILK SKIN SILVERA SIMPLY SALINE SINELEE SINUS WASH SALT SKARJEL SKEETER STIK SKIN BALM SKIN CARE LOTION SKIN PROTECTANT SKIN RELIEF MOISTURE SKIN REPAIR SKIN SCREEN SKIN TREATMENT SODIUM HYALURONATE SOLAICE SOLARCAINE SOLARCAINE ALOE EXTRA SONAFINE SOOTHE & COOL BODY LOTION SOOTHE & COOL BODY POWDER SOOTHE & COOL MEDSEPTIC SOOTHE & COOL MOIST BARRIER SOOTHE & COOL PERINEAL WASH SOOTHE & COOL SKIN CREAM SOOTHE & COOL SKIN PASTE SOOTHE LUBRICANT SOOTHING BATH TREATMENT SORBITOL SORBITOL-MANNITOL SORE THROAT SOY PRO PROTEIN SPECIAL CARE LOTION SPORTS PAIN RELIEF SPORTSCREME 102 GENERIC DRUG SELENIUM SULFIDE SELENIUM SULFIDE SALICYLIC ACID ALOE VERA/COLLAGEN DIMETHICONE/PETROLATUM,WHITE GLYCERIN/DIMETHICONE SOAP MINERAL OIL/HYDROPHIL PETROLAT ISOPROPANOL/ETHYLCELLULOSE POLOXAMER SILICONES/ADHESIVE TAPE SILICONES/ADHESIVE TAPE ALOE/LA/CERAMIDE/SILICONE&TAPE SILICONES/ADHESIVE TAPE SILICONES/ADHESIVE TAPE LANOLIN/MINERAL OIL LIDOCAINE/CAPSAICIN/MENTHOL SODIUM CHLORIDE CAPSAICIN/MENTHOL SODIUM CHLORIDE EMOLLIENT COMBINATION NO.74 BENZOCAINE/MENTHOL PANTOTHENIC ACID/ALOE VERA GLYCERIN/MINERAL OIL ZINC OXIDE DIMETHICONE/COLLOIDAL OATMEAL VIT A/VITE AC/ALOE V/EMU OIL SILICONE/LAN/ISOPROPANOL/PGLY AMMONIUM LACTATE SODIUM CHLORIDE SODIUM CITRATE HYALURONATE SODIUM CAPSAICIN/MENTHOL BENZOCAINE/TRICLOSAN LIDOCAINE/ALOE VERA EMOLLIENT COMBINATION NO.10 GLYCERIN/LAN/MIN OIL/ALOE VERA CORN STARCH LANOLIN PETROLATUM/VIT A&D/ALOE VERA LANOLIN/ALOE VERA/PROP GLY VITAMINS A AND D/ALOE VERA ZINC OXIDE/PETROLATUM,WHITE GLYCERIN/PROPYLENE GLYCOL COLLOIDAL OATMEAL SORBITOL SOLUTION MANNITOL/SORBITOL SOLUTION BENZOCAINE/MENTHOL SOY PROTEIN GLYCERIN/MINERAL OIL TROLAMINE SALICYLATE TROLAMINE SALICYLATE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS BRAND DRUG SPRAY AND STRETCH SPRAYZOIN STAPHASEPTIC STERILE TALC STERILUBE STICK DEODORANT STUDIO 35 MOISTURIZING SKIN SUMMER'S EVE DISPOSABLE DOUCHE SUMMER'S EVE INTIM CLN CLOTH SUPARTZ SUPER DUPER DIAPER DOO SUPER TROCHE PLUS SUPERSOFT SURGEL SURGILUBE SWEEN CREAM SWEET OIL SYNERA SYNVEXIA SYNVEXIA TC SYSTANE T+PLUS TAR DISTILLATE TAR OIL TAR SHAMPOO TARGRETIN TARSUM GEL-SHAMPOO TEA TREE OIL TEARS AGAIN TEARS NATURALE PM TEARS RENEWED TENDER CARE LANOLIN TERA-GEL TAR TEROCIN TERSI FOAM TETCAINE TETRAVISC TETRAVISC FORTE TETRIX T-GEL THERA BATH THERA-DERM THERAFLU VAPOR PATCH THERA-GEL THERA-GESIC THERA-GESIC PLUS THERA-P HAND AND BODY LOTION THERAPEUTIC THERAPEUTIC GEL THERAPEUTIC MOISTURIZING 103 GENERIC DRUG NORFLURANE/HFC 245FA BENZOIN LIDOCAINE HCL/BENZETHONIUM CL TALC MINERAL OIL/PETROLATUM,WHITE ALUMINUM CHLOROHYDRATE GLY/DIMETH/PETROLAT,WHT/WATER ACETIC ACID LANOLIN/PROPYLENE GLYCOL/PEG HYALURONATE SODIUM PETROLATUM,WHITE/LANOLIN BENZOCAINE PETROLATUM,WHITE/WATER MINERAL OIL SURGICAL LUBRICANT VITAMINS A AND D OLIVE OIL LIDOCAINE/TETRACAINE LIDOCAINE HCL/MENTHOL LIDOCAINE HCL/MENTHOL MINERAL OIL/PETROLATUM,WHITE COAL TAR TALC COAL TAR COAL TAR COAL TAR BEXAROTENE SALICYLIC ACID/COAL TAR LANOLIN/MIN OIL/PETROLAT,WHT MINERAL OIL/PETROLATUM,WHITE MINERAL OIL/PETROLATUM,WHITE LANOLIN COAL TAR CAPSAICIN/ME-SALICYLATE/MENTH SELENIUM SULFIDE TETRACAINE HCL TETRACAINE HCL TETRACAINE HCL TETRACAINE HCL PROTECT CMB2/CERAMIDE 1,3,6-11 COAL TAR LANOLIN/MINERAL OIL LANOLIN/MINERAL OIL EUCALYPTUS/MENTHOL/CAMPHOR COAL TAR METHYL SALICYLATE/MENTHOL METHYL SALICYLATE/MENTHOL LANOLIN/MINERAL OIL SALICYLIC ACID COAL TAR MINERAL OIL/PETROLATUM,WHITE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS BRAND DRUG THERAPEUTIC SHAMPOO THERAPEUTIC T+PLUS THERA-SAL TINCTURE OF BENZOIN TL 4.25% BPO MX TL TRISEB TL-CERMIDE TOPICAINE TOPICAINE 5 TOPICAL LIGHT MINERAL OIL TRANSANOSIL TRANS-VER-SAL TRIAD TRIAZ TRIPLE CREAM TRIPLE PASTE TRIXAICIN TRIXAICIN HP TROCAINE TROPAZONE TRU-MICIN T-SAL TUGABOOS BABY OIL ULCEREASE ULTRA FRESH PM ULTRA SALINE ULTRA STRENGTH RUB ULTRA THERAPY PAIN RELIEF ULTRACIN ULTRAMINO ULTRASAL-ER ULTRASONE UNGUENTINE UNIDERM MOISTURIZER UNI-SALVE UNI-WASH SKIN CLEANSER UNSCENTED COLD CREAM UREA 50 VAGICAINE VAGICREAM VAGINAL ITCH CREAM VALCHLOR VANICREAM VANICREAM DIAPER RASH VANICREAM LITE VANOXIDE HC VAPORIZING RUB VAPORX BALM VASELINE WHITE PETROLEUM VASHE WOUND THERAPY 104 GENERIC DRUG COAL TAR SALICYLIC ACID SALICYLIC ACID BENZOIN BENZOYL PEROXIDE EMOLLIENT COMBINATION NO.43 EMOLLIENT COMBINATION NO.32 LIDOCAINE LIDOCAINE MINERAL OIL CAPSAICIN/ME-SALICYLATE/MENTH SALICYLIC ACID HYDROPHILIC CREAM BENZOYL PEROXIDE EMOLLIENT COMBINATION NO.55 ZINC OXIDE CAPSAICIN CAPSAICIN BENZOCAINE TROLAMINE SALICYLATE EMOLLIENT COMBINATION NO.48 TROLAMINE SALICYLATE SALICYLIC ACID MINERAL OIL TURPENTINE OIL PHENOL LANOLIN/MIN OIL/PETROLAT,WHT SODIUM CHLORIDE METHYL SALICYLATE/MENTH/CAMPH CAPSAICIN/ME-SALICYLATE/MENTH CAPSAICIN/ME-SALICYLATE/MENTH SOY PROTEIN SALICYLIC ACID EMOLLIENT COMBINATION NO.39 ZINC OX/CAMPHOR/PHENOL/TAN AC LANOLIN PETROLATUM,WHITE SOAP COLD CREAM UREA/LACTIC AC/ZN UNDECYLENATE BENZOCA/RES/ALOE/VIT E/VIT A&D B-CAINE/BENZALK CL/ALOE/VIT E BENZOCAINE/RESORCINOL MECHLORETHAMINE HCL EMOLLIENT BASE DIMETHICONE/ZINC OXIDE PETROLATUM,WHITE/WATER BENZ PEROX/HC/SKIN CLNSR NO.14 EUCALYPTUS OIL/MENTHOL/CAMPHOR EUCALYPTUS OIL/MENTHOL/CAMPHOR PETROLATUM,WHITE SODIUM CHLOR/HYPOCHLOROUS ACID KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS BRAND DRUG VASOLEX VEHICLE-N VEHICLE-N MILD VELMA VELVACHOL VENCEDOR-15 VENELEX VEXA VIASPAN BELZER-UW VICKS BABYRUB VICKS VAPORUB VIRASAL VITAMIN A & D VITAMIN A & D GRX VITAMIN A AND D VITAMIN E & A VITAMIN E & C VITAMIN E & D VITAMIN E & K VITAMIN E PLUS VITAMIN E WITH VIT A&D VITAQUICK VITA-RAY VITRASE VOSOL WART REMOVER WART STICK WATER WHITE PETROLATUM WHITE PETROLEUM WINTERGREEN OIL WOUND WASH SALINE XCLAIR XENADERM XERAC AC XIAFLEX XOTEN XOTEN-C X-SEB T PEARL X-SEB T PLUS XTRACARE XYLOCAINE WITH EPINEPHRINE XYLOCAINE-MPF WITH EPINEPHRINE YODORA ZACARE ZACLIR ZENIEVA ZERUVIA ZIKS ZILACTIN-B ZINC OXIDE DIAPER CREAM 105 GENERIC DRUG TRYPSIN/BALSAM PERU/CASTOR OIL ALC/ISOPROPANOL/PROP GLY/WATER ALC/ISOPROPANOL/PROP GLY/WATER LIDOCAINE/METHYL SAL/MENTHOL MO/PET,WH/CET/ST ALC/SLS/CHOL BENZOCAINE BALSAM PERU/CASTOR OIL LIDOCAINE/ALLANTOIN/PETROLATUM ORGAN PRESERVATION SOLN-BELZER EUC OIL/ALOE/LAV&ROSEM OILS/PT EUCALYPT/MEN/CAMPH/TURP/PET,WH SALICYLIC ACID VITAMIN A PETROLATUM,WHITE/LANOLIN VITS A & D/WHITE PET/LANOLIN VITAMINS A AND D VIT A/VIT E AC/SAFFLOWER OIL ASCORB PALM/VIT E ACETATE/B5 VIT D3/VIT E AC/SAFFLOWER OIL VIT E AC/VIT K/SAFFLOWER OIL VIT E ACETATE/E13/LAN/COCOA VITAMIN E, VITAMIN A,AND VIT D CORN STARCH VIT A PALM/VIT E ACETATE/ALOE HYALURONIDASE,OVINE ACETIC ACID SALICYLIC ACID SALICYLIC ACID WATER FOR IRRIGATION,STERILE PETROLATUM,WHITE PETROLATUM,WHITE METHYL SALICYLATE SODIUM CHLORIDE HYALURO/DL-E AC/E12/ALLAN/SHEA TRYPSIN/BALSAM PERU/CASTOR OIL ALUMINUM CHLORIDE COLLAGENASE CLOSTRIDIUM HIST. METHYL SALICYLATE/MENTHOL CAPSAICIN/ME-SALICYLATE/MENTH SALICYLIC ACID/COAL TAR COAL TAR GLY/LAN/ME-BENZ/NA LAURYL SO4 LIDOCAINE HCL/EPINEPHRINE LIDOCAINE HCL/EPINEPHRINE/PF BENZ AC/SAL ACID/ZNOX/BORIC AC BENZOYL PEROXIDE/HYALURONT SOD BENZOYL PEROXIDE EMOLLIENT COMBINATION NO.35 LIDOCAINE HCL/MENTHOL CAPSAICIN/ME-SALICYLATE/MENTH BENZOCAINE DIMETHIC/ZINC OX/VIT A&D/ALOE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - MISCELLANEOUS DERMATOLOGY - PIGMENTATION DISORDERS DERMATOLOGY - PIGMENTATION DISORDERS DERMATOLOGY - PIGMENTATION DISORDERS DERMATOLOGY - PIGMENTATION DISORDERS DERMATOLOGY - PIGMENTATION DISORDERS DERMATOLOGY - PIGMENTATION DISORDERS DERMATOLOGY - PIGMENTATION DISORDERS DERMATOLOGY - PIGMENTATION DISORDERS DERMATOLOGY - PIGMENTATION DISORDERS DERMATOLOGY - PIGMENTATION DISORDERS DERMATOLOGY - PIGMENTATION DISORDERS DERMATOLOGY - PIGMENTATION DISORDERS DERMATOLOGY - PIGMENTATION DISORDERS DERMATOLOGY - PIGMENTATION DISORDERS DERMATOLOGY - PIGMENTATION DISORDERS DERMATOLOGY - PIGMENTATION DISORDERS DERMATOLOGY - PIGMENTATION DISORDERS DERMATOLOGY - PIGMENTATION DISORDERS DERMATOLOGY - PIGMENTATION DISORDERS DERMATOLOGY - PIGMENTATION DISORDERS DERMATOLOGY - PIGMENTATION DISORDERS DERMATOLOGY - PIGMENTATION DISORDERS DERMATOLOGY - PIGMENTATION DISORDERS DERMATOLOGY - PIGMENTATION DISORDERS DERMATOLOGY - PIGMENTATION DISORDERS DERMATOLOGY - PIGMENTATION DISORDERS DERMATOLOGY - PIGMENTATION DISORDERS DERMATOLOGY - PIGMENTATION DISORDERS DERMATOLOGY - PIGMENTATION DISORDERS DERMATOLOGY - PIGMENTATION DISORDERS DERMATOLOGY - PIGMENTATION DISORDERS DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA BRAND DRUG ZINC-OXYDE PLUS ZNP BAR ZODERM ZOSTRIX ZOSTRIX DIABETIC ZOSTRIX HIGH POTENCY ZOSTRIX HP Z-PRAM 8-MOP ACLARO ACLARO PD BABY SUNBLOCK C-CLARIFYING SERUM CETAPHIL DAILY MOISTURIZING SP CETAPHIL DERMACONTROL CHILDREN'S SUNBLOCK C-THERAPY NIGHT CREAM EPIQUIN MICRO ESOTERICA FADE CREAM EUCERIN DAILY PROTECTION KERI AGE DEFY & PROTECT LUBRIDERM LUSTRA-AF NU-DERM SUNFADER OIL-FREE MOISTURE OXSORALEN OXSORALEN-ULTRA RADIADERM R1-R2 RADIADERM R2 SUNBLOCK SUNSCREEN TOTAL BLOCK TRI-LUMA TROPICAL STYLE UVADEX ACUWASH AMEVIVE ASTAGRAF XL BETAMIDE BODI LUX BOYOL CALCIJEX CALCIPOTRIENE-BETAMETHASONE DP CALCITRENE CARRASYN GEL 106 GENERIC DRUG MENTHOL/ZINC OXIDE PYRITHIONE ZINC BENZOYL PEROXIDE/UREA CAPSAICIN CAPSAICIN CAPSAICIN CAPSAICIN HYDROCORT/PRAMOXN/SKN CLNSR#16 METHOXSALEN HYDROQUINONE/AVOBENZ/OCTINOX HYDROQUINONE/AVOBENZ/OCTINOX OXYBENZONE/OCTINOXATE/OCTOCRYL HYDROQUINONE/ASCORBIC ACID OXYBENZONE/PADIMATE O AVOBENZONE/OCTOCRYL/OCTYL SAL OXYBEN/HOMOSAL/CINOX/SUNSCREEN COPPERTONE SUNBLOCK SPF15 COPPERTONE SUNBLOCK SPF30 COPPERTONE SUNBLOCK SPF40 COPPERTONE SUNBLOCK SPF50 HYDROQUINONE/VIT C/VIT E ACET HYDROQUINONE MICROSPHERES HYDROQUINONE/OXYBENZONE/PADIMA ENS/OCTIN/OCT SAL/TIT DIO/ZNOX OXYBENZONE/OCTINOXATE OXYBENZONE/OCTINOX/OCTYL SAL VIT E AC/AVOBNZ/OCTINOX/H-QUIN OXYBENZONE/OCTINOX/H-QUINONE OXYBENZONE/OCTINOXATE METHOXSALEN METHOXSALEN, RAPID AVOBENZ/HOMOSAL/OCTIN/OCT/EM52 AVOBENZ/HOMOSAL/OCTINOX/OCTOCR OXYBENZONE/OCTINOXATE OXYBENZONE/PADIMATE O TIO2/ZNOX/OXYBEN/OCTNX/O-CRYL FLUOCINOLONE/TRETINOIN/H-QUIN PADIMATE O/OCTINOXATE METHOXSALEN ACITRETIN SKIN CLEANSER COMB NO.19 ALEFACEPT TACROLIMUS UREA/HYDROPHILIC CREAM SKIN CLEANSER COMBINATION NO.2 ICHTHAMMOL CALCITRIOL CALCIPOTRIENE CALCIPOTRIENE/BETAMETHASONE CALCIPOTRIENE CALCITRIOL ALLANTOIN KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DERMATOLOGY - PSORIASIS/ECZEMA DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES BRAND DRUG CARRASYN SPRAY GEL CLOBETA CLOBETA + PLUS COSENTYX (2 SYRINGES) COSENTYX PEN COSENTYX PEN (2 PENS) COSENTYX SYRINGE CUTEMOL EMOLLIENT D.R. SENSITIVE SKIN DOVONEX DRITHOCREME HP DRITHO-SCALP ELIDEL FLEXITOL HECORIA JOHNSON'S FOOT PROGRAF PROTOPIC PYROGALLIC ACID REHYLA REMEDY 4-IN-1 BODY RESTORE SKIN CLEANSER RESTORE WOUND CLEANSER ROCALTROL SORBOLENE SORIATANE SORILUX TACLONEX TACLONEX SCALP TENA TOETAL FRESH TRI-CHLOR TRIPLE HELIX COLLAGEN UNICARE MOISTURIZING VECTICAL ZITHRANOL ZITHRANOL-RR ACTOPLUS MET ACTOPLUS MET XR ACTOS AFREZZA AMARYL APIDRA APIDRA SOLOSTAR AVANDAMET AVANDARYL AVANDIA 107 GENERIC DRUG ALLANTOIN CLOBETASOL PROPIONATE/COAL TAR CLOBETASOL PROPIONATE/COAL TAR SECUKINUMAB SECUKINUMAB SECUKINUMAB SECUKINUMAB ALLANTOIN URE/CETYL ALC/STEARYL ALC/PG CALCIPOTRIENE ANTHRALIN ANTHRALIN PIMECROLIMUS UREA/ALLANTOIN/VIT E ACETATE GREEN SOAP TACROLIMUS FOOT CLEANSER COMBINATION NO.1 TACROLIMUS TACROLIMUS PYROGALLOL SKIN CLEANSER COMBINATION #23 ALLANTOIN SKIN CLEANSER COMB NO.20 SKIN CLEANSER COMB NO.21 CALCITRIOL GLY/MIN OIL/PET,WH/CTS/H2O ACITRETIN CALCIPOTRIENE CALCIPOTRIENE/BETAMETHASONE CALCIPOTRIENE/BETAMETHASONE TACROLIMUS SOAP/EMOLLIENT BASE UREA/CAMPHOR/MENTHOL/EUCALYPTL TRICHLOROACETIC ACID TRICHLOROACETIC ACID COLLAGEN,BOVINE ALLANTOIN CALCITRIOL ANTHRALIN MICRONIZED ANTHRALIN ACARBOSE PIOGLITAZONE HCL/METFORMIN HCL PIOGLITAZONE HCL/METFORMIN HCL PIOGLITAZONE HCL INSULIN REGULAR, HUMAN GLIMEPIRIDE INSULIN GLULISINE INSULIN GLULISINE ROSIGLITAZONE/METFORMIN HCL ROSIGLITAZONE/GLIMEPIRIDE ROSIGLITAZONE MALEATE BROMOCRIPTINE MESYLATE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES BRAND DRUG BYDUREON BYDUREON PEN BYETTA CYCLOSET DEX4 GLUCOSE DEX4 GLUCOSE BITS DIABETA DUETACT ENFAMIL FARXIGA FORTAMET GERBER GOOD START GLIPIZIDE ER GLIPIZIDE XL GLIPIZIDE-METFORMIN GLUCAGEN GLUCAGON EMERGENCY KIT GLUCO BURST GLUCO SHOT GLUCOPHAGE GLUCOPHAGE XR GLUCOSE GLUCOSE BITS GLUCOSE GEL GLUCOTROL GLUCOTROL XL GLUCOVANCE GLUMETZA GLUTOL GLUTOSE 15 GLUTOSE 45 GLYBURIDE MICRONIZED GLYBURIDE-METFORMIN HCL GLYNASE GLYSET GLYXAMBI HUMALOG HUMALOG MIX 50-50 HUMALOG MIX 75-25 HUMULIN 70/30 KWIKPEN HUMULIN 70-30 HUMULIN N HUMULIN N KWIKPEN HUMULIN R INSTA-GLUCOSE INVOKAMET INVOKANA JANUMET 108 GENERIC DRUG EXENATIDE MICROSPHERES EXENATIDE MICROSPHERES EXENATIDE CHLORPROPAMIDE BROMOCRIPTINE MESYLATE DEXTROSE DEXTROSE GLYBURIDE PIOGLITAZONE HCL/GLIMEPIRIDE DEXTROSE DAPAGLIFLOZIN PROPANEDIOL METFORMIN HCL DEXTROSE GLIMEPIRIDE GLIPIZIDE GLIPIZIDE GLIPIZIDE GLIPIZIDE/METFORMIN HCL GLUCAGON,HUMAN RECOMBINANT GLUCAGON,HUMAN RECOMBINANT DEXTROSE DEXTROSE METFORMIN HCL METFORMIN HCL DEXTROSE DEXTROSE DEXTROSE GLIPIZIDE GLIPIZIDE GLYBURIDE/METFORMIN HCL METFORMIN HCL DEXTROSE DEXTROSE DEXTROSE GLYBURIDE GLYBURIDE,MICRONIZED GLYBURIDE/METFORMIN HCL GLYBURIDE,MICRONIZED MIGLITOL EMPAGLIFLOZIN/LINAGLIPTIN INSULIN LISPRO INSULIN NPL/INSULIN LISPRO INSULIN NPL/INSULIN LISPRO INSULIN NPH HUM/REG INSULIN HM INSULIN NPH HUM/REG INSULIN HM INSULIN NPH HUMAN ISOPHANE INSULIN NPH HUMAN ISOPHANE INSULIN REGULAR, HUMAN DEXTROSE/DEXTRIN/MALTOSE CANAGLIFLOZIN/METFORMIN HCL CANAGLIFLOZIN SITAGLIPTIN PHOS/METFORMIN HCL KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES DIABETES BRAND DRUG JANUMET XR JANUVIA JARDIANCE JENTADUETO KAZANO KOMBIGLYZE XR KORLYM LANTUS LANTUS SOLOSTAR LEVEMIR LEVEMIR FLEXPEN LEVEMIR FLEXTOUCH METAGLIP METFORMIN HCL ER MIFEPREX NESINA NOVOLIN 70-30 NOVOLIN N NOVOLIN R NOVOLOG NOVOLOG FLEXPEN NOVOLOG MIX 70-30 NOVOLOG MIX 70-30 FLEXPEN ONGLYZA OSENI PARLODEL PIOGLITAZONE-GLIMEPIRIDE PIOGLITAZONE-METFORMIN PRANDIMET PRANDIN PRECOSE REGRANEX RELION RIOMET ROCK CANDY STARLIX SYMLIN SYMLINPEN 120 SYMLINPEN 60 TANZEUM TOUJEO SOLOSTAR TRADJENTA TRUEPLUS GLUCOSE TRULICITY ULTILET VICTOZA 2-PAK 109 GENERIC DRUG SITAGLIPTIN PHOS/METFORMIN HCL SITAGLIPTIN PHOSPHATE EMPAGLIFLOZIN LINAGLIPTIN/METFORMIN HCL ALOGLIPTIN BENZ/METFORMIN HCL SAXAGLIPTIN HCL/METFORMIN HCL MIFEPRISTONE INSULIN GLARGINE,HUM.REC.ANLOG INSULIN GLARGINE,HUM.REC.ANLOG INSULIN DETEMIR INSULIN DETEMIR INSULIN DETEMIR GLIPIZIDE/METFORMIN HCL METFORMIN HCL METFORMIN HCL MIFEPRISTONE NATEGLINIDE ALOGLIPTIN BENZOATE INSULIN NPH HUM/REG INSULIN HM INSULIN NPH HUMAN ISOPHANE INSULIN REGULAR, HUMAN INSULIN ASPART INSULIN ASPART INSULN ASP PRT/INSULIN ASPART INSULN ASP PRT/INSULIN ASPART SAXAGLIPTIN HCL ALOGLIPTIN BENZ/PIOGLITAZONE BROMOCRIPTINE MESYLATE PIOGLITAZONE HCL PIOGLITAZONE HCL/GLIMEPIRIDE PIOGLITAZONE HCL/METFORMIN HCL REPAGLINIDE/METFORMIN HCL REPAGLINIDE ACARBOSE BECAPLERMIN DEXTROSE/VITAMIN D3 REPAGLINIDE METFORMIN HCL DEXTROSE NATEGLINIDE PRAMLINTIDE ACETATE PRAMLINTIDE ACETATE PRAMLINTIDE ACETATE ALBIGLUTIDE TOLAZAMIDE TOLBUTAMIDE INSULIN GLARGINE,HUM.REC.ANLOG LINAGLIPTIN DEXTROSE/VITAMIN D3 DULAGLUTIDE DEXTROSE LIRAGLUTIDE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION DIABETES DIABETES EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS BRAND DRUG VICTOZA 3-PAK XIGDUO XR ACETASOL HC ACETIC ACID-ALUMINUM AERO OTIC HC ANTIPYRINE-BENZOCAINE AURALGAN AURAX AURODEX AUROGUARD BOROFAIR CETRAXAL CHLOROXYLENOL-PRAMOXINE HCL CHLORPHENYLCAINE CILOXAN CIPRO CIPRO HC CIPRODEX CLEARCANAL COLY-MYCIN S CORTAMOX CORTANE-B CORTISPORIN-TC CRESYLATE DERMOTIC EAR DROPS FOR SWIMMERS EAR DRY EAR DRYING AGENT EAR WAX CLEANSING EARACHE RELIEF EARSOL-HC EXOTIC-HC FLOXIN HYDROCORTISONE-ACETIC ACID MINERAL OIL LIGHT MIN-O-EAR MURINE EARIGATE MYOXIN NEOTIC OCUFLOX OTIC CARE OTIC EDGE OTICIN OTICIN HC OTO-END 10 OTOGESIC OTOMAX-HC OTOZIN 110 GENERIC DRUG LIRAGLUTIDE DAPAGLIFLOZIN/METFORMIN HCL ACETIC ACID/HYDROCORTISONE ACETIC ACID/ALUMINUM ACETATE HC/PRAMOXINE HCL/CHLOROXYLENOL ANTIPYRINE/BENZOCAINE AA/ANTIPYRN/BCAINE/POLICO#1/AL ANTIPYRINE/BENZOCAINE ANTIPYRINE/BENZOCAINE ANTIPYRINE/BENZOCAINE ACETIC ACID/ALUMINUM ACETATE CIPROFLOXACIN HCL CHLOROXYLENOL/PRAMOXINE HCL PHENYLEPHRINE/ANTIPY/B-CAINE CIPROFLOXACIN HCL CIPROFLOXACIN HCL CIPROFLOXACIN/HYDROCORTISONE CIPROFLOXACIN HCL/DEXAMETH CIPROFLOXACIN HCL CARBAMIDE PEROXIDE/NACL/NAHCO3 NEOMY SULF/COLIST SUL/HC/THONZ HC/PRAMOXINE HCL/CHLOROXYLENOL HC/PRAMOX HCL/CL-XYLENOL/WATER NEOMY SULF/COLIST SUL/HC/THONZ CRESYL ACETATE FLUOCINOLONE ACETONIDE OIL ISOPROPYL ALCOHOL/GLYCERIN ISOPROPYL ALCOHOL/GLYCERIN ISOPROPYL ALCOHOL/GLYCERIN CARBAMIDE PEROXIDE/SEA WATER SULF/HG/HOMEOPATHIC/CHAM FLW HYDROCORTISONE/YERBA SANTA HC/PRAMOXINE HCL/CHLOROXYLENOL OFLOXACIN FLUOCINOLONE ACETONIDE OIL ACETIC ACID/HYDROCORTISONE MINERAL OIL MINERAL OIL MINERAL OIL SEA WATER CHLOROXYLENOL/BENZOC/HYDROCORT ANTIPYRINE/BENZOCAIN/GLY/ZINC OFLOXACIN OFLOXACIN ANTIPYRINE/BENZOCAINE AA/ANTPY/BCAINE/POLICO/AL ACET CHLOROXYLENOL/PRAMOXINE HCL HC/PRAMOXINE HCL/CHLOROXYLENOL HC/PRAMOXINE HCL/CHLOROXYLENOL PHENYLEPHRINE/ANTIPY/B-CAINE HC/PRAMOXINE HCL/CHLOROXYLENOL ANTIPYRINE/BENZOCAIN/GLY/ZINC KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS EAR - GENERAL DISORDERS ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION BRAND DRUG PR OTIC SOLUTION PRAMOTIC PRAMOXINE-HC PROQUIN XR SWIM EAR TREAGAN OTIC TRIOXIN VOSOL HC ZINOTIC ZINOTIC ES AURYXIA BUFFERED SALT CALPHRON CERALYTE-50 CERALYTE-70 CERALYTE-90 CERAORS 75 CERASPORT CERASPORT EX1 DELFLEX WITH 1.5% DEXTROSE DELFLEX WITH 2.5% DEXTROSE DELFLEX WITH 4.25% DEXTROSE DEXTROSE 10%-ELECTROLYTE 48 DEXTROSE 5%-0.2% NACL-KCL DEXTROSE 5%-0.225% NACL-KCL DEXTROSE 5%-0.3% NACL-KCL DEXTROSE 5%-0.33% NACL-KCL DEXTROSE 5%-0.45% NACL-KCL DEXTROSE 5%-1/2NS-KCL DEXTROSE 5%-1/3NS-KCL DEXTROSE 5%-1/4NS-KCL DEXTROSE 5%-ELECTROLYTE #48 DEXTROSE 5%-NS-KCL DEXTROSE 5%-POTASSIUM CHLORIDE DIANEAL PD-2 W/3.5% DEXTROSE DIANEAL PD-2 W-1.5% DEXTROSE DIANEAL PD-2 W-2.5% DEXTROSE DIANEAL PD-2 W-4.25% DEXTROSE DIANEAL WITH 1.5% DEXTROSE DIANEAL WITH 2.5% DEXTROSE DIANEAL WITH 4.25% DEXTROSE DRIPDROP EFFER-K ELIPHOS ENFALYTE ENFAMIL ENFALYTE EPIKLOR FOSRENOL GERIAIDE GLYCOPHOS HYPERLYTE CR 111 GENERIC DRUG AA/ANTPY/BCAINE/POLICO/AL ACET CHLOROXYLENOL/PRAMOXINE HCL HC/PRAMOX HCL/CL-XYLENOL/WATER CIPROFLOXACIN HCL ISOPROPYL ALCOHOL/GLYCERIN AA/ANTIPYRN/BCAINE/POLICO#1/AL CHLOROXYLENOL/BENZOC/HYDROCORT ACETIC ACID/HYDROCORTISONE CHLOROXYLENOL/GLYC/PRAMOX/ZINC CHLOROXYLENOL/GLYC/PRAMOX/ZINC FERRIC CITRATE SODIUM CL/POTASSIUM CHLORIDE CALCIUM ACETATE CALCIUM ACETATE NACL/POT CHL/SOD CIT/RICE SYR NACL/POT CHL/SOD CIT/RICE SYR SODIUM/CHLORIDE/POTASS/CITRATE NACL/POT CHL/SOD CIT/RICE SYR NACL/POT CHL/SOD CIT/RICE SYR NACL/POT CHL/SOD CIT/RICE SYR PERIT. DIALYSIS#19 & DEX 1.5 % PERIT. DIALYSIS 7 & DEX 2.5 % PERIT. DIALYSIS 8 & DEX 4.25 % ELECTROLYTE-48 SOLUTION/D10W POTASSIUM CHLORIDE/D5-0.2%NACL POTASSIUM CHLORIDE/D5-0.2%NACL POTASSIUM CHLORIDE/D5-0.3%NACL POTASSIUM CHLORIDE/D5-0.3%NACL POTASSIUM CHLORIDE/D5-0.45NACL POTASSIUM CHLORIDE/D5-0.45NACL POTASSIUM CHLORIDE/D5-0.3%NACL POTASSIUM CHLORIDE/D5-0.2%NACL ELECTROLYTE-48 SOLUTION/D5W POTASSIUM CHLORIDE/D5-0.9%NACL POTASSIUM CHLORIDE IN D5W DIALYSIS SOLUTIONS PERIT. DIALYSIS#4 & DEXT 1.5 % PERIT. DIALYSIS 13 & DEX 2.5 % PERIT. DIALYSIS 3 & DEX 4.25 % PERIT. DIALYSIS#6 & DEX 1.5 % PERIT. DIALYSIS 7 & DEX 2.5 % PERIT. DIALYSIS 8 & DEX 4.25 % NA/K/CL/CITRATE/ZN/MG/CARBOHYD POTASSIUM BICARBONATE/CIT AC CALCIUM ACETATE ELECTROLYTE,ORAL ELECTROLYTE,ORAL POTASSIUM CHLORIDE LANTHANUM CARBONATE NACL/POT CHLORIDE/SOD CIT/MV SODIUM GLYCEROPHOSPHATE SODIUM/K+/MAG/CA/CHLOR/ACETATE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION BRAND DRUG INPERSOL WITH 1.5% DEXTROSE INPERSOL WITH 4.25% DEXTROSE IONOSOL B WITH DEXTROSE 5% IONOSOL MB-DEXTROSE 5% ISOLYTE H WITH DEXTROSE ISOLYTE M WITH DEXTROSE ISOLYTE P WITH DEXTROSE ISOLYTE S K EFFERVESCENT KALEXATE KAOCHLOR-EFF KAON-CL 10 KAYEXALATE KENDALL 0.9% NACL WITH CAP KIONEX KLOR-CON KLOR-CON 10 KLOR-CON 8 KLOR-CON M10 KLOR-CON M15 KLOR-CON M20 KLOR-CON-EF K-PRIME K-SOL K-TAB K-TAB ER MAGNEBIND 300 MAGNEBIND 400 RX MARLEXATE MEDI-LYTE MICRO-K MOI-STIR MONOJECT 0.9% SODIUM CHLORIDE MONOJECT PREFILL MONOJECT PREFILL ADVANCED MOUTHKOTE NEUT NORMAL SALINE FLUSH NORMOSOL-M AND DEXTROSE NORMOSOL-R NORMOSOL-R AND DEXTROSE NORMOSOL-R PH 7.4 NUTRILYTE NUTRILYTE II ORALYTE PEDIALYTE PEDIALYTE ADVANCED CARE PEDIALYTE ELECTROLYTE SINGLES PEDIA-POP PEDIATRIC ELECTROLYTE PEDIATRIC FREEZER POPS PEDIAVANCE 112 GENERIC DRUG DIALYSIS SOLUTIONS DIALYSIS SOLUTIONS ELECTROLYTE-B SOLUTION/D5W ELECTROLYTE-MB SOLUTION/D5W ELECTROLYTE-H SOLUTION/D5W ELECTROLYTE-M SOLUTION/D5W ELECTROLYTE-P SOLUTION/D5W ELECTROLYTE-S (PH 7.4) POTASSIUM BICARBONATE/CIT AC SODIUM POLYSTYRENE SULFONATE POTASSIUM CHLORIDE/POT BICARB POTASSIUM CHLORIDE SODIUM POLYSTYRENE SULFONATE 0.9 % SODIUM CHLORIDE SODIUM POLYSTYRENE SULFONATE POTASSIUM CHLORIDE POTASSIUM CHLORIDE POTASSIUM CHLORIDE POTASSIUM CHLORIDE POTASSIUM CHLORIDE POTASSIUM CHLORIDE POTASSIUM BICARBONATE/CIT AC POTASSIUM BICARBONATE/CIT AC POTASSIUM CHLORIDE POTASSIUM CHLORIDE POTASSIUM CHLORIDE CALCIUM CARBONATE/MAG CARB CALCIUM CARBONATE/MAG CARB/FA SODIUM POLYSTYRENE SULFONATE POT CHLORIDE/CAL PHOS/MAG POTASSIUM CHLORIDE LYTES/CARBOXYMETHYLCELLULOSE 0.9 % SODIUM CHLORIDE 0.9 % SODIUM CHLORIDE 0.9 % SODIUM CHLORIDE LYTES/YERBA SANTA SODIUM BICARBONATE 0.9 % SODIUM CHLORIDE ELECTROLYTE-M SOLUTION/D5W ELECTROLYTE-R SOLUTION ELECTROLYTE-R SOLUTION/D5W ELECTROLYTE-R (PH 7.4) SOD/POT/MAG/CAL/CHLO/ACE/GLUC SODIUM/K+/MAG/CA/CHLOR/ACETATE ELECTROLYTE,ORAL ELECTROLYTE,ORAL ELECTROLYTE,ORAL ELECTROLYTE,ORAL SOD CIT/POT CL/POT CIT/CALC CL ELECTROLYTE,ORAL ELECTROLYTE,ORAL SOD/POTASS/CHLOR/ZINC/DEX/FRUC KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ELECTROLYTE REGULATION ENDOCRINE DISORDER - FERTILITY ENDOCRINE DISORDER - FERTILITY ENDOCRINE DISORDER - FERTILITY ENDOCRINE DISORDER - FERTILITY ENDOCRINE DISORDER - FERTILITY ENDOCRINE DISORDER - FERTILITY ENDOCRINE DISORDER - FERTILITY ENDOCRINE DISORDER - FERTILITY BRAND DRUG PHOSLO PHOSLYRA PHOS-NAK PLASMA-LYTE 148 PLASMA-LYTE 56 IN DEXTROSE PLASMA-LYTE A PH 7.4 POSIFLUSH SALINE POTASSIUM CHL-NORMAL SALINE POTASSIUM CHLORIDE POTASSIUM CHLORIDE IN D5LR POTASSIUM CHLORIDE-NACL POTASSIUM CHLORIDE-NS POTASSIUM CL-LIDOCAINE-NS POTASSIUM PHOS-D5W POTASSIUM PHOS-NS POTASSIUM PHOSPHATE POTASSIUM PHOSPHATE-NS QUIC-K RENAGEL RENVELA SAFE WASH SALINE FLUSH SAMSCA SODIUM BICARBONATE-D5W SODIUM PHOSPHATE SODIUM PHOSPHATE-NS SPS STERILE SALINE SWABFLUSH SYREX THAM THERMOTABS TPN ELECTROLYTES TPN ELECTROLYTES II VAPRISOL VELPHORO BRAVELLE CHORIONIC GONADOTROPIN CLOMID CRINONE ENDOMETRIN FIRST-PROGESTERONE VGS 100 FIRST-PROGESTERONE VGS 200 113 GENERIC DRUG CALCIUM ACETATE CALCIUM ACETATE NAPH,MB-DB/K PH,MBDB ELECTROLYTE-148 SOLUTION ELECTROLYTE-56 SOLUTION/D5W ELECTROLYTE-A SOLUTION 0.9 % SODIUM CHLORIDE POTASSIUM POTASSIUM ACETATE POTASSIUM CHLORIDE IN 0.9%NACL POT CHLORIDE/POT BICARB/CIT AC POTASSIUM CHLORIDE IN LR-D5 POTASSIUM CHLORIDE-0.45% NACL POTASSIUM CHLORIDE IN 0.9%NACL POTASSIUM CL/LIDO/0.9 % NACL POTASSIUM PHOSPHATE/D5W POTASSIUM PHOS IN 0.9 % NACL POTASSIUM PHOS,M-BASIC-D-BASIC POTASSIUM PHOS IN 0.9 % NACL POTASSIUM BICARBONATE SEVELAMER HCL SEVELAMER CARBONATE 0.9 % SODIUM CHLORIDE 0.9 % SODIUM CHLORIDE TOLVAPTAN SEVELAMER CARBONATE SODIUM ACETATE SODIUM BICARB IN STERILE WATER SODIUM BICARBONATE SODIUM BICARBONATE IN D5W SODIUM LACTATE SODIUM PHOS,M-BASIC-D-BASIC SODIUM PHOSPHATE IN 0.9 % NACL SODIUM POLYSTYRENE SULFONATE SODIUM POLYSTYRENE SULFONATE 0.9 % SODIUM CHLORIDE 0.9 % SODIUM CHLORIDE 0.9 % SODIUM CHLORIDE TROMETHAMINE SODIUM CL/POTASSIUM CHLORIDE SODIUM/K+/MAG/CA/CHLOR/ACETATE SODIUM/K+/MAG/CA/CHLOR/ACETATE CONIVAPTAN HCL/D5W SUCROFERRIC OXYHYDROXIDE UROFOLLITROPIN CHORIONIC GONADOTROPIN, HUMAN CLOMIPHENE CITRATE CLOMIPHENE CITRATE PROGESTERONE,MICRONIZED PROGESTERONE,MICRONIZED PROGESTERONE PROGESTERONE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION ENDOCRINE DISORDER - FERTILITY ENDOCRINE DISORDER - FERTILITY ENDOCRINE DISORDER - FERTILITY ENDOCRINE DISORDER - FERTILITY ENDOCRINE DISORDER - FERTILITY ENDOCRINE DISORDER - FERTILITY ENDOCRINE DISORDER - FERTILITY ENDOCRINE DISORDER - FERTILITY ENDOCRINE DISORDER - FERTILITY ENDOCRINE DISORDER - FERTILITY ENDOCRINE DISORDER - FERTILITY ENDOCRINE DISORDER - FERTILITY ENDOCRINE DISORDER - FERTILITY ENDOCRINE DISORDER - FERTILITY ENDOCRINE DISORDER - FERTILITY ENDOCRINE DISORDER - FERTILITY ENDOCRINE DISORDER - FERTILITY ENDOCRINE DISORDER - FERTILITY ENDOCRINE DISORDER - FERTILITY ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER BRAND DRUG FIRST-PROGESTERONE VGS 25 FIRST-PROGESTERONE VGS 400 FIRST-PROGESTERONE VGS 50 FOLLISTIM AQ GONAL-F GONAL-F RFF GONAL-F RFF REDI-JECT LUVERIS MENOPUR NOVAREL OVIDREL PREGNYL PROCHIEVE PROGESTERONE IN OIL PROGESTERONE SUPPOSITORY PROMETRIUM REPRONEX SEROPHENE ACTHREL ACTONEL AREDIA ATELVIA BINOSTO BONIVA CALCITONIN-SALMON CETROTIDE DDAVP DESMOPRESSIN ACETATE DIDRONEL DUMMY LUPRON EGRIFTA ELIGARD EVISTA FORTEO FORTICAL FOSAMAX FOSAMAX PLUS D GANIRELIX ACETATE GANITE GENOTROPIN H.P. ACTHAR HECTOROL HUMATROPE INCRELEX 114 GENERIC DRUG PROGESTERONE PROGESTERONE PROGESTERONE FOLLITROPIN BETA,RECOMB FOLLITROPIN ALFA, RECOMB FOLLITROPIN ALFA, RECOMB FOLLITROPIN ALFA, RECOMB LUTROPIN ALFA MENOTROPINS CHORIONIC GONADOTROPIN, HUMAN CHORIOGONADOTROPIN ALFA CHORIONIC GONADOTROPIN, HUMAN PROGESTERONE,MICRONIZED PROGESTERONE PROGESTERONE PROGESTERONE,MICRONIZED PROGESTERONE,MICRONIZED MENOTROPINS CLOMIPHENE CITRATE CORTICORELIN OVINE TRIFLUTATE RISEDRONATE SODIUM ALENDRONATE SODIUM PAMIDRONATE DISODIUM RISEDRONATE SODIUM ALENDRONATE SODIUM IBANDRONATE SODIUM CABERGOLINE CALCITONIN,SALMON,SYNTHETIC CETRORELIX ACETATE DANAZOL DESMOPRESSIN (NONREFRIGERATED) DESMOPRESSIN (NONREFRIGERATED) ETIDRONATE DISODIUM DOXERCALCIFEROL LEUPROLIDE ACETATE TESAMORELIN ACETATE LEUPROLIDE ACETATE ETIDRONATE DISODIUM RALOXIFENE HCL TERIPARATIDE CALCITONIN,SALMON,SYNTHETIC ALENDRONATE SODIUM ALENDRONATE SODIUM/VITAMIN D3 GALLIUM NITRATE SOMATROPIN CORTICOTROPIN DOXERCALCIFEROL SOMATROPIN IBANDRONATE SODIUM MECASERMIN LEUPROLIDE ACETATE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - OTHER ENDOCRINE DISORDER - THYROID ENDOCRINE DISORDER - THYROID ENDOCRINE DISORDER - THYROID ENDOCRINE DISORDER - THYROID ENDOCRINE DISORDER - THYROID ENDOCRINE DISORDER - THYROID ENDOCRINE DISORDER - THYROID ENDOCRINE DISORDER - THYROID ENDOCRINE DISORDER - THYROID BRAND DRUG LUPRON DEPOT LUPRON DEPOT-PED MIACALCIN MYALEPT NATPARA NORDITROPIN NORDITROPIN FLEXPRO NORDITROPIN NORDIFLEX NUTROPIN NUTROPIN AQ NUTROPIN AQ NUSPIN OMNITROPE OSPHENA PARICALCITOL PITRESSIN PROLIA RECLAST SAIZEN SENSIPAR SEROSTIM SKELID SOMAVERT STIMATE SUPPRELIN LA SYNAREL TEV-TROPIN TRELSTAR TRELSTAR DEPOT TRELSTAR LA VANTAS VASOPRESSIN-D5W VASOPRESSIN-NS VASOSTRICT XGEVA ZEMPLAR ZOLADEX ZOMETA ZORBTIVE ARMOUR THYROID CYTOMEL IODOPEN IOSAT LEVOTHROID LEVOTHYROXINE 12.5MCG/1ML SUSP LEVOXYL 115 GENERIC DRUG LEUPROLIDE ACETATE LEUPROLIDE ACETATE CALCITONIN,SALMON,SYNTHETIC METRELEPTIN PARATHYROID HORMONE SOMATROPIN SOMATROPIN SOMATROPIN SOMATROPIN SOMATROPIN SOMATROPIN SOMATROPIN OSPEMIFENE PAMIDRONATE DISODIUM VASOPRESSIN DENOSUMAB RALOXIFENE HCL ZOLEDRONIC ACID/MANNITOL&WATER RISEDRONATE SODIUM SOMATROPIN CINACALCET HCL SOMATROPIN TILUDRONATE DISODIUM PEGVISOMANT DESMOPRESSIN ACETATE HISTRELIN AC NAFARELIN ACETATE SOMATROPIN TRIPTORELIN PAMOATE TRIPTORELIN PAMOATE TRIPTORELIN PAMOATE HISTRELIN AC VASOPRESSIN VASOPRESSIN IN D5W VASOPRESSIN IN 0.9 % NACL VASOPRESSIN DENOSUMAB PARICALCITOL GOSERELIN ACETATE ZOLEDRONIC ACID ZOLEDRONIC ACID SOMATROPIN THYROID,PORK LIOTHYRONINE SODIUM SODIUM IODIDE POTASSIUM IODIDE LEVOTHYROXINE SODIUM LEVOTHYROXINE LEVOTHYROXINE SODIUM LEVOTHYROXINE SODIUM LIOTHYRONINE SODIUM KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION ENDOCRINE DISORDER - THYROID ENDOCRINE DISORDER - THYROID ENDOCRINE DISORDER - THYROID ENDOCRINE DISORDER - THYROID ENDOCRINE DISORDER - THYROID ENDOCRINE DISORDER - THYROID ENDOCRINE DISORDER - THYROID ENDOCRINE DISORDER - THYROID ENDOCRINE DISORDER - THYROID ENDOCRINE DISORDER - THYROID ENDOCRINE DISORDER - THYROID ENDOCRINE DISORDER - THYROID ENDOCRINE DISORDER - THYROID ENDOCRINE DISORDER - THYROID ENDOCRINE DISORDER - THYROID ENDOCRINE DISORDER - THYROID ENDOCRINE DISORDER - THYROID ENDOCRINE DISORDER - THYROID ENDOCRINE DISORDER - THYROID ENDOCRINE DISORDER - THYROID ENDOCRINE DISORDER - THYROID EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS BRAND DRUG NATURE-THROID NP THYROID SSKI STRONG IODINE SYNTHROID TAPAZOLE THYROLAR-1 THYROLAR-1/2 THYROLAR-1/4 THYROLAR-2 THYROLAR-3 THYROSAFE THYROSHIELD TIROSINT TRIOSTAT UNITHROID WESTHROID WESTHROID-P WP THYROID ACULAR ACULAR LS ACUVAIL ADVANCED EYE RELIEF REDNESS AK-TROL ALAMAST ALAWAY ALCAINE ALLERGY EYE ALLERGY EYE DROPS ALODOX ALOMIDE ALREX ALTACHLORE ALTAFLUOR ANTIHISTAMINE EYE DROPS AVELOX AVELOX ABC PACK AVENOVA AZASITE BEPREVE BESIVANCE BLEPHAMIDE BLEPHAMIDE S.O.P. BROMDAY CELLUGEL CHILDREN'S ALAWAY CLEAR EYES COMPLETE CLEAR EYES ITCHY EYE RELIEF 116 GENERIC DRUG METHIMAZOLE THYROID,PORK THYROID,PORK PROPYLTHIOURACIL POTASSIUM IODIDE POTASSIUM IODIDE/IODINE LEVOTHYROXINE SODIUM METHIMAZOLE LIOTRIX LIOTRIX LIOTRIX LIOTRIX LIOTRIX POTASSIUM IODIDE POTASSIUM IODIDE LEVOTHYROXINE SODIUM LIOTHYRONINE SODIUM LEVOTHYROXINE SODIUM THYROID,PORK THYROID,PORK THYROID,PORK KETOROLAC TROMETHAMINE KETOROLAC TROMETHAMINE KETOROLAC TROMETHAMINE/PF NAPHAZOLINE HCL/HYPROMELLOSE NEO/POLYMYX B SULF/DEXAMETH PEMIROLAST POTASSIUM KETOTIFEN FUMARATE PROPARACAINE HCL KETOTIFEN FUMARATE KETOTIFEN FUMARATE DOXYCYCLINE/EYELID CLNS NO.2&3 LODOXAMIDE TROMETHAMINE LOTEPREDNOL ETABONATE SODIUM CHLORIDE BENOXINATE HCL/FLUORESCEIN NA KETOTIFEN FUMARATE MOXIFLOXACIN HCL MOXIFLOXACIN HCL HYPOCHLOROUS ACID/SODIUM CHLOR AZITHROMYCIN AZITHROMYCIN BEPOTASTINE BESILATE BESIFLOXACIN HCL SULFACETM NA/PREDNISOL AC SULFACETM NA/PREDNISOL AC BROMFENAC SODIUM BROMFENAC SODIUM HYPROMELLOSE KETOTIFEN FUMARATE NAPHAZO HCL/HPM/PS 80/ZN SULF NAPHAZOLINE HCL/ZN SULF/GLY KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS BRAND DRUG CLEAR EYES REDNESS RELIEF DEXASPORIN DISCOVISC DUOVISC DUREZOL ELESTAT EMADINE EQ GENTLE EYE ALLERGY RELIEF EYE DROPS ADVANCED RELIEF EYE DROPS ALLERGY RELIEF EYE DROPS REDNESS RELIEF EYE ITCH RELIEF FLAREX FLO-PRED FLUCAINE FLUORESCEIN-BENOXINATE FLUORESCEIN-PROPARACAINE FLUORESCEIN-PROPARACAINE HCL FLURESS FLUROX FML FML FORTE FML S.O.P. GENTEAL MILD GENTEAL MILD TO MODERATE GENTEAL SEVERE GONAK GONIOSOFT GONIOTAIRE GONIOVISC ILEVRO IQUIX ISOPTO TEARS ITCHY EYE JETREA LASTACAFT LEVAQUIN LOTEMAX LUBRICANT EYE DROPS LUBRICANT REDNESS EYE DROPS LUBRICANT REDNESS RELIEVER MAXIMUM REDNESS RELIEF MAXITROL 117 GENERIC DRUG NAPHAZOLINE HCL/GLYCERIN CYCLOSPORINE NEO/POLYMYX B SULF/DEXAMETH CHONDR SULF A SOD/HYALURONATE CHONDR SULF A SOD/HYALURONATE DIFLUPREDNATE EPINASTINE HCL EMEDASTINE DIFUMARATE EPINASTINE HCL HYPROMELLOSE NAPHAZOLINE HCL/PHENIRAMINE TETRAHYDRZ/DEXT 70/PEG 400/PVP TETRAHYDROZOLINE HCL/ZN SULF NAPHAZOLINE HCL/GLYCERIN KETOTIFEN FUMARATE FLUOROMETHOLONE ACETATE PREDNISOLONE ACETATE PROPARACAINE/FLUORESCEIN SOD BENOXINATE HCL/FLUORESCEIN NA PROPARACAINE/FLUORESCEIN SOD PROPARACAINE/FLUORESCEIN SOD FLUOROMETHOLONE FLURBIPROFEN SODIUM BENOXINATE HCL/FLUORESCEIN NA BENOXINATE HCL/FLUORESCEIN NA FLUOROMETHOLONE FLUOROMETHOLONE FLUOROMETHOLONE GANCICLOVIR GATIFLOXACIN HYPROMELLOSE HYPROMELLOSE HYPROMELLOSE HYPROMELLOSE HYPROMELLOSE HYPROMELLOSE HYPROMELLOSE NEPAFENAC LEVOFLOXACIN HYPROMELLOSE KETOTIFEN FUMARATE OCRIPLASMIN/PF KETOROLAC TROMETHAMINE ALCAFTADINE LEVOFLOXACIN LEVOFLOXACIN LOTEPREDNOL ETABONATE HYPROMELLOSE NAPHAZOLINE HCL/HYPROMELLOSE TETRAHYDROZOLINE HCL/PEG NAPHAZOLINE HCL/HYPROMELLOSE NEO/POLYMYX B SULF/DEXAMETH KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS BRAND DRUG METHADEX MILLIPRED MOXEZA MURO-128 NAPHAZOLINE HCL W/ANTAZOLINE NAPHCON-A NATACYN NEBCIN NEOCIDIN NEOMYCIN-BACITRACIN-POLY-HC NEOMYCIN-POLYMYXIN-DEXAMETH NEOMYCIN-POLYMYXIN-GRAMICIDIN NEO-POLYCIN HC NEVANAC NOROXIN OCUCOAT OCUDOX OCUFEN OCUTRICIN OMNIPRED OPCON-A ORAPRED ORAPRED ODT PARCAINE PEDIAPRED POLY-DEX POLYMYXIN B SUL-TRIMETHOPRIM POLY-PRED POLYTRIM PRED FORTE PRED MILD PRED-G PREDNISOL PREDNISOLONE SODIUM PHOSPHATE PROLENSA PURE & GENTLE EYE DROPS QUIXIN REDNESS LUBRICANT EYE DROPS REFRESH RELIEF DROPS RELIEF EYE DROPS RESTASIS SANDIMMUNE SOCHLOR SPRIX SULFACETAMIDE-PREDNISOLONE SYSTANE GEL TOBRADEX 118 GENERIC DRUG NEO/POLYMYX B SULF/DEXAMETH PREDNISOLONE SOD PHOSPHATE MOXIFLOXACIN HCL MOXIFLOXACIN HCL SODIUM CHLORIDE NAPHAZOLINE HCL/ANTAZOLINE NAPHAZOLINE HCL/PHENIRAMINE NATAMYCIN TOBRAMYCIN SULFATE NEOMYCIN/POLYMYXN B/GRAMICIDIN NEOMY SULF/BACITRAC ZN/POLY/HC NEO/POLYMYX B SULF/DEXAMETH NEOMYCIN/POLYMYXN B/GRAMICIDIN NEOMY SULF/BACITRAC ZN/POLY/HC NEPAFENAC NORFLOXACIN HYPROMELLOSE DOXY/EYELID CLNS #3/EYE EML #1 FLURBIPROFEN SODIUM NEOMYCIN/POLYMYXN B/GRAMICIDIN PREDNISOLONE ACETATE NAPHAZOLINE HCL/PHENIRAMINE PREDNISOLONE SOD PHOSPHATE PREDNISOLONE SOD PHOSPHATE PROPARACAINE HCL PREDNISOLONE SOD PHOSPHATE NEO/POLYMYX B SULF/DEXAMETH POLYMYXIN B SULF/TRIMETHOPRIM NEOMY SULF/POLYMYX B SULF/PRED POLYMYXIN B SULF/TRIMETHOPRIM PREDNISOLONE ACETATE PREDNISOLONE ACETATE GENTAMICIN/PREDNISOL AC PREDNISOLONE SOD PHOSPHATE PREDNISOLONE ACETATE PREDNISOLONE SOD PHOSPHATE PREDNISOLONE SOD PHOSPHATE BROMFENAC SODIUM PROPARACAINE HCL HYPROMELLOSE LEVOFLOXACIN NAPHAZOLINE HCL/PEG 300 KETOTIFEN FUMARATE TETRAHYDROZOLINE HCL/ZN SULF TETRAHYDROZOLINE HCL/ZN SULF CYCLOSPORINE CYCLOSPORINE SODIUM CHLORIDE KETOROLAC TROMETHAMINE SULFACETAMIDE/PREDNISOLONE SP HYPROMELLOSE TOBRAMYCIN/DEXAMETHASONE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GENERAL DISORDERS EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA BRAND DRUG TOBRADEX ST TOBRAMYCIN-DEXAMETHASONE TOBRASOL TOBREX TORADOL TRIPLE ANTIBIOTIC HC VERIPRED 20 VEXOL VIGAMOX VIROPTIC VISCOAT VISINE ADVANCED VISINE ALLERGY RELIEF VISINE TOTALITY VISINE-A VITRASERT XIBROM ZADITOR ZIRGAN ZITHROMAX ZITHROMAX TRI-PAK ZMAX ZYLET ZYMAR ZYMAXID ZYRTEC ITCHY EYE AK-PENTOLATE ATROPEN ATROPINE CARE AZOPT BETAGAN BETIMOL COMBIGAN COSOPT COSOPT PF CYCLOGYL CYCLOMYDRIL CYLATE DIAMOX SEQUELS DORZOLAMIDE-TIMOLOL HOMATROPAIRE HOMATROPINE HOMATROPINE HYDROBROMIDE IOPIDINE 119 GENERIC DRUG TOBRAMYCIN/DEXAMETHASONE TOBRAMYCIN SULFATE TOBRAMYCIN/DEXAMETHASONE TOBRAMYCIN TOBRAMYCIN KETOROLAC TROMETHAMINE TRIFLURIDINE NEOMY SULF/BACITRAC ZN/POLY/HC PREDNISOLONE SOD PHOSPHATE RIMEXOLONE MOXIFLOXACIN HCL TRIFLURIDINE CHONDR SULF A SOD/HYALURONATE TETRAHYDRZ/DEXT 70/PEG 400/PVP TETRAHYDROZOLINE HCL/ZN SULF TETRAHYD/ZN/PEG 400/HYPROM/GLY NAPHAZOLINE HCL/PHENIRAMINE GANCICLOVIR BROMFENAC SODIUM KETOTIFEN FUMARATE GANCICLOVIR AZITHROMYCIN AZITHROMYCIN AZITHROMYCIN TOBRAMYCIN/LOTEPRED ETAB GATIFLOXACIN GATIFLOXACIN KETOTIFEN FUMARATE ACETAZOLAMIDE ACETAZOLAMIDE SODIUM CYCLOPENTOLATE HCL APRACLONIDINE HCL ATROPINE SULFATE ATROPINE SULFATE ATROPINE SULFATE BRINZOLAMIDE LEVOBUNOLOL HCL TIMOLOL BRIMONIDINE TARTRATE/TIMOLOL DORZOLAMIDE HCL/TIMOLOL MALEAT DORZOLAMIDE/TIMOLOL/PF CYCLOPENTOLATE HCL CYCLOPENTOLATE/PHENYLEPHRINE CYCLOPENTOLATE HCL CYCLOPENTOLATE HCL ACETAZOLAMIDE DORZOLAMIDE HCL DORZOLAMIDE HCL/TIMOLOL MALEAT HOMATROPINE HBR HOMATROPINE HBR HOMATROPINE HBR APRACLONIDINE HCL KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - GLAUCOMA EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS BRAND DRUG ISOPTO ATROPINE ISOPTO CARBACHOL ISOPTO CARPINE ISOPTO HOMATROPINE LUMIGAN MIOCHOL-E MIOSTAT MITOSOL MYDRAL MYDRIACYL NEPTAZANE OPTIPRANOLOL PAREMYD PHOSPHOLINE IODIDE PILOPINE HS RESCULA SALAGEN SAL-TROPINE SIMBRINZA TIMOPTIC OCUDOSE TRAVATAN TRAVATAN Z TRAVOPROST TRUSOPT XALATAN ZIOPTAN AKORN BALANCED SALT AKWA TEARS RENEWED AQUASOL A ARTIFICIAL TEARS LUBRICATION G B-12 B-12 DOTS BALANCED SALT BION TEARS BSS BSS PLUS CAPSULE #000 COLLYRIUM COSAMIN DS CYANOCOBALAMIN INJECTION CYSTARAN DRY EYE RELIEF DRY EYES ENUCLENE 120 GENERIC DRUG ATROPINE SULFATE CARBACHOL PILOCARPINE HCL HOMATROPINE HBR LATANOPROST LEVOBUNOLOL HCL BIMATOPROST METHAZOLAMIDE METIPRANOLOL ACETYLCHOLINE CHLORIDE CARBACHOL MITOMYCIN MITOMYCIN TROPICAMIDE TROPICAMIDE METHAZOLAMIDE METIPRANOLOL HYDROXYAMPHETAMINE/TROPICAMIDE ECHOTHIOPHATE IODIDE PILOCARPINE HCL PILOCARPINE HCL UNOPROSTONE ISOPROPYL PILOCARPINE HCL ATROPINE SULFATE BRINZOLAMIDE/BRIMONIDINE TART TIMOLOL MALEATE/PF TRAVOPROST (BENZALKONIUM) TRAVOPROST TRAVOPROST (BENZALKONIUM) TROPICAMIDE DORZOLAMIDE HCL LATANOPROST TAFLUPROST/PF BALANCED SALT IRRIG SOLN NO.2 DEXTRAN 70/HYPROMELLOSE VITAMIN A PALMITATE POLYVINYL ALCOHOL CYANOCOBALAMIN (VITAMIN B-12) B-12 1000MCG CYANOCOBALAMIN (VITAMIN B-12) BALANCED SALT IRRIG SOLN NO.2 DEXTRAN 70/HYPROMELLOSE/PF BALANCED SALT IRRIG SOLN NO.2 BALANCED SALT IRRIG SOLN NO.1 GELATIN CAPSULES (EMPTY) SOD BORATE/BORIC AC/WATER/NACL GLUCOSAMINE/CHONDRO SU A CYANOCOBALAMIN (VITAMIN B-12) CYSTEAMINE HCL PEG 400/HYPROMELLOSE/GLYCERIN PETROLAT,WHT/MIN OIL/SOD CHL TYLOXAPOL KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS BRAND DRUG EQ REVIVE PLUS EYE DROP TEARS EYE IRRIGATING SOLUTION EYE-STREAM EYLEA FRESHKOTE GELFILM GEL-JET GELATIN GENTEAL GENTLE LUBRICANT EYE GLUCOSAMINE-CHONDROITIN HYPOTEARS IRRIGATING OPHTH SOLUTION IRRIGATING SOLUTION LACRISERT LIQUID B12 LIQUID B-12 LIQUITEARS LUBRICANT DRY EYE RELIEF LUBRICATING EYE DROPS LUBRICATING PLUS LUBRIFRESH PM LUCENTIS MACUGEN MEDI-WASH MOISTURIZING LUBRICANT MUROCEL NASCOBAL NATURAL BALANCE TEARS NATURAL TEARS NATURE'S TEARS NIGHTTIME RELIEF OCUSOFT BABY OCUSOFT LID SCRUB OCUSOFT LID SCRUB PLUS OSTEO BI-FLEX PHYSICIANS EZ USE B-12 RAPID B-12 ENERGY REFRESH CELLUVISC REFRESH CLASSIC REFRESH CONTACTS REFRESH LIQUIGEL REFRESH OPTIVE REFRESH OPTIVE ADVANCED REFRESH OPTIVE SENSITIVE REFRESH PLUS REFRESH TEARS RETAINE CMC 121 GENERIC DRUG CARBOXYMETHYLCELLULOSE SODIUM PEG 400/HYPROMELLOSE/GLYCERIN SOD BORATE/BORIC AC/WATER/NACL BALANCED SALT SOLN NON-SURG #3 AFLIBERCEPT EYE LUBRICANT COMBINATION NO.1 GELATIN GELATIN GELATIN CARBOXYMETHYLCELL/HYPROMELLOSE HYPROMELLOSE/PF GLUCOSAMINE CHONDROITI COMPLEX GLUCOSAMINE/CHONDRO SU A POLYETHYLENE GLYCOL/POLYVINYL NA PHOS,M-B/SODIUM CHLORIDE SODIUM/POTASSIUM/SOD CHL HYDROXYPROPYL CELLULOSE CYANOCOBALAMIN (VITAMIN B-12) CYANOCOBALAMIN (VITAMIN B-12) POLYVINYL ALCOHOL CARBOXYMETHYLCELLULOSE SODIUM CARBOXYMETHYLCELLULOS/GLYCERIN CARBOXYMETHYLCELLULOSE SODIUM MINERAL OIL/PETROLATUM,WHITE RANIBIZUMAB PEGAPTANIB SODIUM SOD BORATE/BORIC AC/WATER/NACL CARBOXYMETHYLCELLULOSE SODIUM METHYLCELLULOSE CYANOCOBALAMIN (VITAMIN B-12) HYPROMELLOSE DEXTRAN 70/HYPROMELLOSE/PF HYPROMELLOSE PETROLAT,WHT/MIN OIL/SOD CHL EYELID CLEANSER COMBINATION #3 EYELID CLEANSER COMB NO.7 EYELID CLEANSER COMBINATION #3 GLUC/CHON-MSM#1/C/MANG/BOS/BOR CYANOCOBALAMIN (VITAMIN B-12) POLYSORBATE 20 POLYSORBATE 80 CYANOCOBALAMIN (VITAMIN B-12) CARBOXYMETHYLCELLULOSE SODIUM POLYVINYL ALCOHOL/POVIDONE/PF CARBOXYMETHYLCELLULOSE SODIUM CARBOXYMETHYLCELLULOSE SODIUM CARBOXYMETHYLCELLULOS/GLYCERIN CARBOXYMETHYL/GLY/POLY80/PF CARBOXYMETHYLCELL/GLYCERIN/PF CARBOXYMETHYLCELLULOSE SODIUM CARBOXYMETHYLCELLULOSE SODIUM CARBOXYMETHYLCELLULOSE SODIUM KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS EYE - MISCELLANEOUS FLUID REPLACEMENT FLUID REPLACEMENT FLUID REPLACEMENT FLUID REPLACEMENT FLUID REPLACEMENT FLUID REPLACEMENT FLUID REPLACEMENT FLUID REPLACEMENT FLUID REPLACEMENT FLUID REPLACEMENT FLUID REPLACEMENT FLUID REPLACEMENT FLUID REPLACEMENT FLUID REPLACEMENT FLUID REPLACEMENT FLUID REPLACEMENT GOUT AND RELATED DISEASES GOUT AND RELATED DISEASES GOUT AND RELATED DISEASES GOUT AND RELATED DISEASES GOUT AND RELATED DISEASES GOUT AND RELATED DISEASES GOUT AND RELATED DISEASES BRAND DRUG RETAINE HPMC RETAINE MGD RETAINE PM REVIVE PLUS SOOTHE HYDRATION SOOTHE XP STERILE EYE WASH STERILE LUBRICANT STERILID SYSTANE BALANCE SYSTANE LIQUID GEL SYSTANE ULTRA TEARFAIR TEARS AGAIN ADVANCED TEARS AGAIN MC TEARS NATURALE TEARS NATURALE FORTE TEARS NATURALE FREE TEARS NATURALE-II TEARS PURE THERA TEARS ULTRA FRESH ULTRA LUBRICANT EYE VISUDYNE VITAMELTS ENERGY VITAMIN B-12 VIVA-DROPS ZALTRAP ATP DEXTROSE 10%-0.2% NACL DEXTROSE 10%-0.45% NACL DEXTROSE 10%-0.9% NACL DEXTROSE 10%-1/4NS DEXTROSE 2.5%-0.45% NACL DEXTROSE 5%-0.2% NACL DEXTROSE 5%-0.225% NACL DEXTROSE 5%-0.3% NACL DEXTROSE 5%-0.33% NACL DEXTROSE 5%-0.45% NACL DEXTROSE 5%-0.9% NACL DEXTROSE IN LACTATED RINGERS DEXTROSE IN RINGERS INJECTION DEXTROSE IN WATER DEXTROSE WITH SODIUM CHLORIDE ALOPRIM COLCRYS ELITEK KRYSTEXXA 122 GENERIC DRUG HYPROMELLOSE/PF LIGHT MINERAL OIL/MIN OIL/PF MINERAL OIL/PETROLATUM,WHITE CARBOXYMETHYLCELLULOSE SODIUM POVIDONE MINERAL OIL, LIGHT/MINERAL OIL SOD BORATE/BORIC AC/WATER/NACL CARBOXYMETHYLCELLULOSE SODIUM EYELID CLEANSER COMBINATION #1 PROPYLENE GLYCOL PROPYLENE GLYCOL/PEG 400 PROPYLENE GLYCOL/PEG 400 POLYVINYL ALCOHOL EYELID EMOLLIENT COMB NO.1 DEXTRAN 70/HYPROMELLOSE DEXTRAN 70/HYPROMELLOSE DEXTRAN/HYPROMELLOSE/GLYCERIN DEXTRAN 70/HYPROMELLOSE/PF DEXTRAN 70/HYPROMELLOSE DEXTRAN 70/HYPROMELLOSE CARBOXYMETHYLCELLULOSE SODIUM CARBOXYMETHYLCELLULOSE SODIUM PROPYLENE GLYCOL/PEG 400 VERTEPORFIN CYANOCOBALAMIN (VITAMIN B-12) VITAMIN B12 CYANOCOBALAMIN (VITAMIN B-12) POLYSORBATE 80/PF ZIV-AFLIBERCEPT ADENOSINE TRIPHOSPHATE DEXTROSE 10 % AND 0.2 % NACL DEXTROSE 10 % AND 0.45 % NACL DEXTROSE 10 % AND 0.9 % NACL DEXTROSE 10 % AND 0.2 % NACL DEXTROSE 2.5 % AND 0.45 % NACL DEXTROSE 5 %-0.2 % NACL DEXTROSE 5 %-0.2 % NACL DEXTROSE 5 % AND 0.3 % NACL DEXTROSE 5 % AND 0.3 % NACL DEXTROSE 5 %-0.45 % NACL DEXTROSE 5 % AND 0.9 % NACL DEXTROSE 5%-LACTATED RINGERS DEXTROSE 5% IN RINGERS DEXTROSE 10 % IN WATER DEXTROSE 2.5 % AND 0.45 % NACL ALLOPURINOL ALLOPURINOL SODIUM ALLOPURINOL SODIUM COLCHICINE COLCHICINE RASBURICASE PEGLOTICASE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION GOUT AND RELATED DISEASES GOUT AND RELATED DISEASES GOUT AND RELATED DISEASES GOUT AND RELATED DISEASES GOUT AND RELATED DISEASES HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS BRAND DRUG MITIGARE PROBENECID-COLCHICINE ULORIC ZYLOPRIM ACD ACD-A ACTIVASE ADVATE ADVATE H ADVATE L ADVATE M ADVATE SH ADVATE UH AGGRASTAT AGGRENOX AGRYLIN ALBUKED-25 ALBUKED-5 ALBUMIN (HUMAN) ALBUMINAR-25 ALBUMINAR-5 ALBURX ALBUTEIN ALPHANATE ALPHANINE SD ALPROLIX AMICAR ANGIOMAX ARANESP ARGATROBAN ARGATROBAN-SODIUM CHLORIDE ARIXTRA ASTRINGYN ATRYN AVITENE BEBULIN BEBULIN VH IMMUNO BENEFIX BIOCLATE BRILINTA BUMINATE CATHFLO ACTIVASE CEPROTIN CITRATE PHOSPHATE DEXTROSE CLOPIDOGREL CORIFACT COUMADIN CYKLOKAPRON 123 GENERIC DRUG COLCHICINE PROBENECID COLCHICINE/PROBENECID FEBUXOSTAT ALLOPURINOL DEXTROSE/SOD CITRATE/CITRIC AC CITRATE DEXTROSE SOLUTION ALTEPLASE ANTIHEMOPH.FVIII,FULL LENGTH ANTIHEMOPH.FVIII,FULL LENGTH ANTIHEMOPH.FVIII,FULL LENGTH ANTIHEMOPH.FVIII,FULL LENGTH ANTIHEMOPH.FVIII,FULL LENGTH ANTIHEMOPH.FVIII,FULL LENGTH TIROFIBAN-0.9% SODIUM CHLORIDE ASPIRIN/DIPYRIDAMOLE ANAGRELIDE HCL ALBUMIN HUMAN ALBUMIN HUMAN ALBUMIN HUMAN ALBUMIN HUMAN ALBUMIN HUMAN ALBUMIN HUMAN ALBUMIN HUMAN ANTIHEMOPHILIC FACTOR/VWF FACTOR IX FACTOR IX REC, FC FUSION PROTN AMINOCAPROIC ACID AMINOCAPROIC ACID ANAGRELIDE HCL BIVALIRUDIN DARBEPOETIN ALFA IN POLYSORBAT ARGATROBAN IN 0.9 % SOD CHLOR FONDAPARINUX SODIUM FERRIC SUBSULFATE ANTITHROMBIN III, HUMAN RECOMB MICROFIBRILLAR COLLAGEN FACTOR IX COMPLEX (PCC) COMB.6 FACTOR IX COMPLEX (PCC) COMB.6 FACTOR IX HUMAN RECOMBINANT ANTIHEMOPHILIC FACTOR, HUM REC TICAGRELOR ALBUMIN HUMAN ALTEPLASE PROTEIN C CONCENTRATE, HUMAN CILOSTAZOL CITRATE PHOSPHATE DEXTROS SOLN CLOPIDOGREL BISULFATE FACTOR XIII WARFARIN SODIUM TRANEXAMIC ACID KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS BRAND DRUG DEXTRAN 70 IN DEXTROSE 5% DROXIA EFFIENT ELIQUIS ELOCTATE ENDO-AVITENE EPOGEN EVICEL FEIBA NF FEIBA VH IMMUNO FLEXBUMIN FRAGMIN GELFOAM GELFOAM COMPRESSED GRANIX HELIXATE FS HEMOFIL M HEPARIN FLUSH HEPARIN LOCK HEPARIN SODIUM HEPARIN SODIUM IN 0.45% NACL HEPARIN SODIUM IN 0.9% NACL HEPARIN SODIUM IN 5% DEXTROSE HEPARIN SODIUM-0.9% NACL HEPARIN SODIUM-D5W HEPARIN SODIUM-NS HESPAN HETASTARCH IN NS HEXTEND LACTATED ELECTROLYTE HUMATE-P HYDREA INNOHEP INTEGRILIN IPRIVASK JANTOVEN KCENTRA KEDBUMIN KOATE-DVI KOGENATE FS LEUKINE LMD 10% WITH 0.9% SOD CHLORIDE LMD 10% WITH 5% DEXTROSE LOVENOX LYSTEDA MEPHYTON MIRCERA MONOCLATE-P MONONINE MONSEL'S 124 GENERIC DRUG DEXTRAN 70/D5W HYDROXYUREA PRASUGREL HCL APIXABAN ANTIHEMOPH.FVIII REC,FC FUSION MICROFIBRILLAR COLLAGEN ENOXAPARIN SODIUM EPOETIN ALFA THROMBIN(HUM PLAS)/FIBRINOG/CA ANTI-INHIBITOR COAGULANT COMP. ANTI-INHIBITOR COAGULANT COMP. ALBUMIN HUMAN FONDAPARINUX SODIUM DALTEPARIN SODIUM,PORCINE GELATIN SPONGE,ABSORBABLE GELATIN SPONGE,ABSORBABLE TBO-FILGRASTIM ANTIHEMOPH.FVIII,FULL LENGTH ANTIHEMOPHILIC FACTOR, HUMAN HEPARIN SOD,PORCINE-0.9 % NACL HEPARIN SODIUM,PORCINE HEPARIN SODIUM,PORCINE HEPARIN SOD,PORK IN 0.45% NACL HEPARIN SODIUM,PORCINE/NS/PF HEPARIN SODIUM,PORCINE/D5W HEPARIN SOD,PORCINE-0.9 % NACL HEPARIN (PORCINE) IN D5W/PF HEPARIN SOD,PORCINE-0.9 % NACL HETASTARCH IN 0.9 % NACL HETASTARCH IN 0.9 % NACL HETASTARCH/E-LYTES,LACTATE ANTIHEMOPHILIC FACTOR/VWF HYDROXYUREA HYDROXYUREA TINZAPARIN SODIUM,PORCINE EPTIFIBATIDE DESIRUDIN WARFARIN SODIUM HUMAN PROTHROMBIN COMPLX(PCC) ALBUMIN HUMAN ANTIHEMOPHILIC FACTOR, HUMAN ANTIHEMOPH.FVIII,FULL LENGTH SARGRAMOSTIM DEXTRAN 40 IN 0.9 % NACL DEXTRAN 40/D5W ENOXAPARIN SODIUM TRANEXAMIC ACID PHYTONADIONE METHOXY PEG-EPOETIN BETA ANTIHEMOPHILIC FACTOR, HUMAN FACTOR IX FERRIC SUBSULFATE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS BRAND DRUG NEULASTA NEUMEGA NEUPOGEN NOVOEIGHT NOVOSEVEN NOVOSEVEN RT NPLATE OBIZUR OCTAPLAS OMONTYS OXYCEL PANHEMATIN PLASBUMIN-25 PLASBUMIN-5 PLASMANATE PLAVIX PLETAL PRADAXA PROCRIT PROFILNINE PROFILNINE SD PROMACTA RECOMBINATE RECOTHROM REFLUDAN REOPRO RETAVASE RIASTAP RIXUBIS SAVAYSA SOLIRIS SURGICEL SURGICEL NU-KNIT SURGIFOAM SYRINGE AVITENE TACHOSIL THROMBATE III THROMBIN-JMI TISSEEL VHSD TNKASE TRENTAL TRETTEN TRICITRASOL VITAMIN K1 VITAMIN K2 VOLUVEN 125 GENERIC DRUG PEGFILGRASTIM OPRELVEKIN FILGRASTIM ANTIHEMOPH.FVIII,B-DOM TRUNCAT COAGULATION FACTOR VIIA,RECOMB COAGULATION FACTOR VIIA,RECOMB ROMIPLOSTIM ANTIHEMOPHILIC FVIII,REC PORC PLASMA HUMAN, BLOOD GROUP A PEGINESATIDE CELLULOSE,OXIDIZED HEMIN PENTOXIFYLLINE PHYTONADIONE ALBUMIN HUMAN ALBUMIN HUMAN PLASMA PROTEIN FRACTION CLOPIDOGREL BISULFATE CILOSTAZOL DABIGATRAN ETEXILATE MESYLATE EPOETIN ALFA FACTOR IX COMPLEX (PCC) COMB.4 FACTOR IX COMPLEX (PCC) COMB.4 ELTROMBOPAG OLAMINE PROTAMINE SULFATE ANTIHEMOPHILIC FACTOR, HUM REC THROMBIN (RECOMBINANT) LEPIRUDIN,RECOMBINANT ABCIXIMAB RETEPLASE FIBRINOGEN FACTOR IX HUMAN RECOMBINANT EDOXABAN TOSYLATE ECULIZUMAB CELLULOSE,OXIDIZED CELLULOSE,OXIDIZED GELATIN SPONGE,ABSORBABLE MICROFIBRILLAR COLLAGEN FIBRINOGEN/THROMBIN (HUM PLAS) ANTITHROMBIN III (HUM PLAS) THROMBIN (BOVINE) TICLOPIDINE HCL THROMBIN(HUM PLAS)/FIB/APRO/CA TENECTEPLASE TRANEXAMIC ACID PENTOXIFYLLINE FACTOR XIII A-SUBUNIT,RECOMB SODIUM CITRATE DIHYDRATE PHYTONADIONE HES 130/0.4 IN 0.9 % NACL WARFARIN SODIUM KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HEMATOLOGICAL DISORDERS HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY BRAND DRUG WILATE XARELTO XYNTHA XYNTHA SOLOFUSE ZONTIVITY ABD PADS 5X9" ACTIVELLA ADAPTIC 3X8" ADHESIVE REM UNISOLVE 402300 ALORA ANADROL-50 ANDRODERM ANDROGEL ANDROID ANDROXY ANGELIQ AVEED AXIRON AYGESTIN CATH TRAY W/10CC SYR & 3PVI CENESTIN CLIMARA CLIMARA PRO COMBIPATCH COVARYX COVARYX H.S. DELATESTRYL DELESTROGEN DEPO-ESTRADIOL DEPO-TESTOSTERONE DHEA DHEA 25 DIGNITY EXTRA PAD 26950 DIVIGEL DUAVEE EEMT EEMT H.S. ELESTRIN ENJUVIA ESSIAN ESSIAN H.S. ESTRACE ESTRADERM ESTRADIOL-NORETHINDRONE ACETAT ESTRASORB ESTRING ESTROGEL ESTROGEN & METHYLTESTOSTERONE ESTROGEN-METHYLTESTOSTERONE 126 GENERIC DRUG ANTIHEMOPHILIC FACTOR/VWF RIVAROXABAN ANTIHEMOPH.FVIII,B-DOMAIN DEL ANTIHEMOPH.FVIII,B-DOMAIN DEL VORAPAXAR SULFATE ESTRADIOL/NORETHINDRONE ACET ESTRADIOL OXYMETHOLONE TESTOSTERONE TESTOSTERONE METHYLTESTOSTERONE FLUOXYMESTERONE DROSPIRENONE/ESTRADIOL TESTOSTERONE UNDECANOATE TESTOSTERONE NORETHINDRONE ACETATE ESTROGENS,CONJ.,SYNTHETIC A ESTRADIOL ESTRADIOL/LEVONORGESTREL ESTRADIOL/NORETHINDRONE ACET ESTROGEN,ESTER/ME-TESTOSTERONE ESTROGEN,ESTER/ME-TESTOSTERONE TESTOSTERONE ENANTHATE ESTRADIOL VALERATE ESTRADIOL CYPIONATE TESTOSTERONE CYPIONATE PRASTERONE (DHEA) PRASTERONE (DHEA) ESTRADIOL ESTROGENS,CONJ/BAZEDOXIFENE ESTROGEN,ESTER/ME-TESTOSTERONE ESTROGEN,ESTER/ME-TESTOSTERONE ESTRADIOL ESTROGENS,CONJ.,SYNTHETIC B ESTROGEN,ESTER/ME-TESTOSTERONE ESTROGEN,ESTER/ME-TESTOSTERONE ESTRADIOL ESTRADIOL ESTRADIOL ESTRADIOL VALERATE ESTRADIOL/NORETHINDRONE ACET ESTRADIOL ESTRADIOL ESTRADIOL ESTROGEN,ESTER/ME-TESTOSTERONE ESTROGEN,ESTER/ME-TESTOSTERONE ESTROPIPATE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY BRAND DRUG EVAMIST FEEDING GRAVITY BAG 1000ML FEMHRT FEMRING FEMTRACE FIRST-TESTOSTERONE FIRST-TESTOSTERONE MC FORTESTA HUGGIES SNUG/DRY 4161279 HYDROCOLLOID DRESSING 4X5" HYDROFILM DRESSING JEVANTIQUE JINTELI LOPREEZA LUPANETA PACK MAKENA MEDIPORE WOUND DRESSING 2 X 2 MENEST MENOSTAR MEPILEX 4X4" MEPILEX LITE DRESSING 4X4" METHITEST MIC-KEY EXTENSION SET W/2PORT MIC-KEY G-TUBE 24FR MIMVEY MIMVEY LO MINIVELLE NATESTO NON-ADHERENT DRESSING 3X8" ORTHO-PREFEST OSTOMY BELT MEDIUM HOL7300 OXANDRIN POUCH DRAIN 413334 POUCH DRAIN NATURA 413174 PREFEST PREMARIN PREMPHASE PREMPRO PROGESTERONE CREAM PROMOGRAN PRISMA AG MATRIX SEASORB AG PADS STRIANT TEGADERM FILM 2 3/8X 2 3/4" TESTIM TESTOPEL TESTRED 127 GENERIC DRUG ESTRADIOL NORETHINDRONE AC-ETH ESTRADIOL ESTRADIOL ACETATE ESTRADIOL ACETATE TESTOSTERONE PROPIONATE TESTOSTERONE PROPIONATE TESTOSTERONE NORETHINDRONE AC-ETH ESTRADIOL NORETHINDRONE AC-ETH ESTRADIOL ESTRADIOL/NORETHINDRONE ACET LEUPROLIDE/NORETHINDRONE ACET HYDROXYPROGESTERONE CAPROATE ESTROGENS,ESTERIFIED ESTRADIOL METHYLTESTOSTERONE ESTRADIOL/NORETHINDRONE ACET ESTRADIOL/NORETHINDRONE ACET ESTRADIOL TESTOSTERONE NORETHINDRONE ACETATE ESTRADIOL/NORGESTIMATE OXANDROLONE OXANDROLONE ESTRADIOL/NORGESTIMATE ESTROGENS, CONJUGATED ESTROGEN,CON/M-PROGEST ACET ESTROGEN,CON/M-PROGEST ACET PROGESTERONE 200MG TESTOSTERONE TESTOSTERONE TESTOSTERONE TESTOSTERONE TESTOSTERONE CYPIONATE TESTOSTERONE ENANTHATE METHYLTESTOSTERONE TRI-ESTROGEN-PROGESTERONE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY HORMONAL DEFICIENCY IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION BRAND DRUG VAGIFEM VIVELLE-DOT VOGELXO WAFER SUR FIT #125259 WAFER SUR FIT #125271 WAFER SUR-FIT 4X4 125265 WAFER SUR-FIT CONVATEC 411806 WAFER SUR-FIT CONVATEC 413168 WAFER SUR-FIT CONVATEC 413182 WAFER/FLANGE SENSURA 10011 ACTHIB ADACEL TDAP ADENOVIRUS TYPE 4 ADENOVIRUS TYPE 4 AND TYPE 7 ADENOVIRUS TYPE 7 AFLURIA AFLURIA 2011-2012 AFLURIA 2011-2012 (PF) AFLURIA 2012-2013 AFLURIA 2013-2014 AFLURIA 2014-2015 AGRIFLU ATGAM ATTENUVAX VACCINE WITH DILUENT BCG VACCINE (TICE STRAIN) BEXSERO BIOTHRAX BIVIGAM BOOSTRIX BOOSTRIX TDAP BOTULISM ANTITOXIN HEPTAVALENT CARIMUNE NF NANOFILTERED CERVARIX COMVAX CYTOGAM DAPTACEL DTAP DECAVAC DIPHTHERIA-TETANUS TOXOID DIPHTHERIA-TETANUS TOXOIDS-PED ENGERIX-B ENGERIX-B ADULT ENGERIX-B PEDIATRIC-ADOLESCENT FLEBOGAMMA FLEBOGAMMA DIF FLUARIX FLUARIX 2011-2012 FLUARIX 2012-2013 FLUARIX 2013-2014 FLUARIX 2014-2015 FLUARIX QUAD 2013-2014 FLUARIX QUAD 2014-2015 FLUBLOK 2012-2013 128 GENERIC DRUG ESTRADIOL ESTRADIOL TESTOSTERONE HAEMOPH B POLY CONJ-TET TOX/PF DIPH,PERTUSS(ACELL),TET VAC/PF ADENOVIRUS VACCINE LIVE TYPE-4 ADENOVIRUS VAC LIVE TYPE-4 & 7 ADENOVIRUS VACCINE LIVE TYPE-7 INFLUENZA TV-S 09-10 VACCINE FLU VACCINE TVSP2011-12(9 YR+) FLU VACCINE TS2011-12(9YR+)/PF FLU VACCINE 2012-13 (5YR+)/PF FLU VACC TS 2013-14 (5YR+)/PF FLU VACCINE TS 2014-15 (5 YR+) INFLUENZA TVS 10-11 VACCINE/PF LYMPHOCYTE IMMUNE GLOBULIN MEASLES VACCINE,LIVE,ATTEN/PF BCG LIVE MENINGOCOCCAL B VACC,4-COMP/PF ANTHRAX VACCINE IMMUNE GLOBULIN,GAMMA(IGG) DIPHTH,PERTUSS(ACELL),TET VAC DIPHTH,PERTUSS(ACELL),TET VAC BOTULISM ANTITOXIN 7/MALTOSE IMMUNE GLOBULIN,GAMMA(IGG) HUMAN PAPILLOMAV VACC BIVAL/PF HEP B VACCINE/HIB CONJ-MENG/PF CYTOMEGALOVIRUS IMMUNE GLOBULN DIPH,PERTUSS(ACELL),TET PED/PF TETANUS AND DIPHTHERIA TOX/PF TETANUS,DIPHTHERIA TOXD PED/PF TETANUS,DIPHTHERIA TOXD PED/PF HEPATITIS B VIRUS VACCINE/PF HEPATITIS B VIRUS VACCINE/PF HEPATITIS B VIRUS VACCINE/PF IMMUNE GLOBULIN,GAMMA(IGG) IMMUNE GLOBULIN,GAMMA(IGG) INFLUENZA TVS 09-10 VACCINE/PF FLU VACCINE TS2011-12(3YR+)/PF FLU VACCINE TS2012-13(3YR+)/PF FLU VACC TS 2013-14(36MOS+)/PF FLU VACC TS 2014-15(36MOS+)/PF FLU VACC QS 2013-14(36MOS+)/PF FLU VACC QS 2014-15(36MOS+)/PF FLU VAC TV 2012(18-49YR)RCM/PF KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION BRAND DRUG FLUBLOK 2013-2014 FLUBLOK 2014-2015 FLUCELVAX FLUCELVAX 2014-2015 FLULAVAL FLULAVAL 2011-2012 FLULAVAL 2012-2013 FLULAVAL 2013-2014 FLULAVAL 2014-2015 FLULAVAL QUAD 2013-2014 FLULAVAL QUAD 2014-2015 FLUMIST FLUMIST QUAD 2014-2015 FLUVIRIN FLUVIRIN 2011-2012 FLUVIRIN 2012-2013 FLUVIRIN 2013-2014 FLUVIRIN 2014-2015 FLUZONE FLUZONE 2011-2012 FLUZONE 2011-2012 (PF) FLUZONE 2012-2013 FLUZONE 2013-2014 FLUZONE 2014-2015 FLUZONE HIGH-DOSE FLUZONE HIGH-DOSE 2011-12 (PF) FLUZONE HIGH-DOSE 2012-13 FLUZONE HIGH-DOSE 2013-2014 FLUZONE HIGH-DOSE 2014-2015 FLUZONE INTRADERM QUAD 2014-15 FLUZONE INTRADERMAL FLUZONE INTRADERMAL 2012-2013 FLUZONE INTRADERMAL 2013-2014 FLUZONE INTRADERMAL 2014-2015 FLUZONE PEDI 2012-2013 FLUZONE PEDI 2013-2014 FLUZONE QUAD 2013-2014 FLUZONE QUAD 2014-2015 FLUZONE QUAD PEDI 2013-2014 FLUZONE QUAD PEDI 2014-2015 GAMASTAN S-D GAMMAGARD LIQUID GAMMAGARD S-D GAMMAKED GAMMAPLEX GAMUNEX GAMUNEX-C GARDASIL GARDASIL 9 HAVRIX HEPAGAM B HIZENTRA 129 GENERIC DRUG FLU VAC TV 2013(18-49YR)RCM/PF FLU VAC TV 2014(18 YR+)RCM/PF FLU VACC 12-13(18+)CELL DER/PF FLU VACC TS 14-15 (18+)CELL/PF INFLUENZA TV-S 09-10 VACCINE FLU VACCINE TS 2011-12(18 YR+) FLU VACCINE TS 2012-13(18 YR+) FLU VACC TS 2013-14(36MOS+) FLU VACC TS 2014-15(36MOS+)/PF FLU VACCINE QS 2013-14(36MOS+) FLU VACC QS 2014-15(36MOS+)/PF FLU VACCINE 2012 (2-49YRS) FLU VACC QV LIVE 2014(2-49YRS) INFLUENZA TV-S 10-11 VACCINE FLU VACCINE TS 2011-12 (4 YR+) FLU VACCINE TS 2012-13 (4 YR+) FLU VACCINE TS 2013-14 (4 YR+) FLU VACCINE TS 2014-15 (4 YR+) INFLUENZA TV-S 09-10 VACCINE FLU VACCINE TS 2011-12(6 MOS+) FLU VACCINE 2011 (36 MOS+)/PF FLU VACCINE 2012-13(36MOS+)/PF FLU VACC TS 2013-14(36MOS+)/PF FLU VACC TS 2014-15(36MOS+)/PF INFLUENZA TVS 09-10 VACCINE/PF INFLUENZA TVS 11-12 VACCINE/PF FLU VACC TS 2012-13(65YR+)/PF FLU VACC TS 2013-14 (65YR+)/PF FLU VACC TS 2014-15 (65YR+)/PF FLU VACC QS 2014 (18-64YRS)/PF INFLUENZA TVS 11-12 VACCINE/PF FLU VACCINE 2012 (18-64YRS)/PF FLU VACC TS 2013 (18-64YRS)/PF FLU VACC TS 2014 (18-64YRS)/PF FLU VACCINE 2012(6-35MOS)/PF FLU VACC TS 2013 (6-35MOS)/PF FLU VACC QS 2013-14(36MOS+)/PF FLU VACC QS 2014-15(36MOS+)/PF FLU VACCINE 2013(6-35MOS)/PF FLU VACCINE 2014(6-35MOS)/PF IMMUNE GLOBULIN,GAMMA(IGG) IMMUNE GLOBULIN,GAMMA(IGG) IMMUNE GLOBULIN,GAMMA(IGG) IMMUNE GLOB,GAM CAPRYLATE(IGG) IMMUNE GLOBULIN,GAMMA(IGG) IMMUNE GLOB,GAM CAPRYLATE(IGG) IMMUNE GLOB,GAM CAPRYLATE(IGG) HUMAN PAPILOMVIRUS VAC,QVAL/PF HPV VACCINE 9-VALENT/PF HEPATITIS A VIRUS VACCINE/PF HEPATITIS B IMMUN GLOB/MALTOSE IMMUNE GLOBULIN,GAMMA(IGG) KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION BRAND DRUG HYPERHEP B S-D HYPERRAB S-D HYPERRHO S-D HYPERTET S-D HYQVIA IMOGAM RABIES-HT IMOVAX RABIES VACCINE INFANRIX DTAP INFANRIX PF INFLUENZA A (H1N1) 2009 IPOL IXIARO JE-VAX KINRIX MENACTRA MENHIBRIX MENOMUNE-A-C-Y-W-135 MENVEO A-C-Y-W-135-DIP MENVEO MENA COMPONENT MENVEO MENCYW-135 COMPONENT MERUVAX II VACCINE W-DILUENT MICRHOGAM MICRHOGAM ULTRA-FILTERED PLUS M-M-R II VACCINE MUMPSVAX VACCINE W-DILUENT NABI-HB OCTAGAM PEDIARIX PEDVAXHIB PENTACEL PENTACEL ACTHIB COMPONENT PENTACEL DTAP-IPV COMPONENT PHYSICIANS EZ USE FLU 2012-13 PNEUMOVAX 23 PREVNAR 13 PRIVIGEN PROQUAD QUADRACEL DTAP-IPV RABAVERT RECOMBIVAX HB RHOGAM RHOGAM ULTRA-FILTERED PLUS RHOPHYLAC ROTARIX ROTATEQ SINGLE USE EZ FLU 2012-2013 SINGLE USE EZ FLU 2013-2014 SINGLE USE EZ FLU 2014-2015 TENIVAC TETANUS DIPHTHERIA TOXOIDS TETANUS TOXOID ADSORBED TETANUS-DIPHTERIA-DECAVAC 130 GENERIC DRUG HEPATITIS B IMMUNE GLOBULIN RABIES IMMUNE GLOBULIN/PF RHO(D) IMMUNE GLOBULIN TETANUS IMMUNE GLOBULIN/PF IGG/HYALURONIDASE,RECOMBINANT RABIES IMMUNE GLOBULIN/PF RABIES VACC, HUMAN DIPLOID/PF DIPH,PERTUSS(ACELL),TET PED/PF DIPH,PERTUSS(ACELL),TET PED/PF INFLUENZA A (H1N1)VAC 2009/PF POLIOMYELITIS VACCINE, KILLED JAPANESE ENCEPHALITIS VACC/PF JAPANESE ENCEPHALITIS VACCINE DIPH,PERTUS(ACEL),TET,POLIO/PF MENING VAC A,C,Y,W-135 DIP/PF MENINGOCOCCAL VAC C,Y/HIB/PF MENINGOCOC VAC A,C,Y,W-135/PF MENING VAC A,C,Y,W-135 DIP/PF MENING A CONJ VACC, 1 OF 2/PF MENING C,Y,W-135 VAC 2 OF 2/PF RUBELLA VIRUS LIVE VACCINE/PF RHO(D) IMMUNE GLOBULIN RHO(D) IMMUNE GLOBULIN MEASLES,MUMPS&RUBELLA VACC/PF MUMPS VACCINE,LIVE/PF HEPATITIS B IMMUNE GLOBULIN IMMUNE GLOBULIN,G(IGG)/MALTOSE HEP B VACCINE/DP(A)T-POLIO/PF HAEMPH B POLYSAC CONJ-MENIN/PF DP(A)T-POLIO/HIB CONJ-TET/PF HAEMOPH B POLY CONJ-TET TOX/PF DIPH,PERTUS(ACEL),TET,POLIO/PF FLU VACCINE TS 2012-13 (4 YR+) PNEUMOCOCCAL 23-VAL P-SAC VAC PNEUMOC 13-VAL CONJ-DIP CRM/PF IMMUNE GLOBULIN,GAMMA(IGG) MEASLES,MUMPS,RUB,VARICELLA/PF DIPH,PERTUS(ACEL),TET,POLIO/PF RABIES VACCINE (PCEC)/PF HEPATITIS B VIRUS VACCINE/PF RHO(D) IMMUNE GLOBULIN RHO(D) IMMUNE GLOBULIN RHO(D) IMMUNE GLOBULIN ROTAVIRUS VAC,LIVE ATT, 89-12 ROTAVIRUS VACCINE,LIVE ORAL PV FLU VACCINE TS2012-13(4YR+)/PF FLU VACC QS 2013-14(36MOS+)/PF FLU VACC TS 14-15 (18+)CELL/PF TETANUS AND DIPHTHERIA TOX/PF TETANUS & DIPHTHERIA TOX,ADULT TETANUS TOXOID, ADSORBED/PF TETANUS AND DIPHTHERIA TOX/PF KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNIZATION IMMUNOSUPPRESSION/MODULATION IMMUNOSUPPRESSION/MODULATION IMMUNOSUPPRESSION/MODULATION IMMUNOSUPPRESSION/MODULATION IMMUNOSUPPRESSION/MODULATION IMMUNOSUPPRESSION/MODULATION IMMUNOSUPPRESSION/MODULATION IMMUNOSUPPRESSION/MODULATION IMMUNOSUPPRESSION/MODULATION IMMUNOSUPPRESSION/MODULATION IMMUNOSUPPRESSION/MODULATION IMMUNOSUPPRESSION/MODULATION IMMUNOSUPPRESSION/MODULATION IMMUNOSUPPRESSION/MODULATION IMMUNOSUPPRESSION/MODULATION IMMUNOSUPPRESSION/MODULATION IMMUNOSUPPRESSION/MODULATION IMMUNOSUPPRESSION/MODULATION IMMUNOSUPPRESSION/MODULATION IMMUNOSUPPRESSION/MODULATION IMMUNOSUPPRESSION/MODULATION IMMUNOSUPPRESSION/MODULATION IMMUNOSUPPRESSION/MODULATION IMMUNOSUPPRESSION/MODULATION IMMUNOSUPPRESSION/MODULATION IMMUNOSUPPRESSION/MODULATION INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL BRAND DRUG THERACYS THYMOGLOBULIN TRIHIBIT TRIPEDIA TRUMENBA TWINRIX TYPHIM VI VAQTA VARIVAX VACCINE VARIZIG VIVAGLOBIN VIVOTIF BERNA WINRHO SDF YF-VAX ZOSTAVAX ACTIMMUNE AFINITOR AFINITOR DISPERZ ALDARA ALFERON N AZASAN CELLCEPT CYCLOSPORINE MODIFIED GENGRAF IMURAN INTRON A MYCOPHENOLIC ACID MYFORTIC NEORAL NULOJIX ORTHOCLONE OKT-3 PROLEUKIN RAPAMUNE SIMULECT ZORTRESS ZYCLARA ACTICLATE ADOXA AMOX TR-POTASSIUM CLAVULANATE AMOXICILLIN ER AMOXICILLIN-CLAVULANATE ER AMOXIL AMPICILLIN-SULBACTAM ARKALIOX 131 GENERIC DRUG BCG LIVE LYMPHOCYTE IMMU GLOB.,RABBIT DP(A)T PED/HIB CONJ-TET/PF DIPH,PERTUSS(ACELL),TET PED/PF N.MENINGITIDIS B,LIPID FHBP RC HEPATITIS A & B VACCINE/PF TYPHOID VACC VI CAPSULR POLYS HEPATITIS A VIRUS VACCINE/PF VARICELLA VACCINE LIVE/PF VARICELLA-ZOSTER IMMUNE GLOB IMMUNE GLOBULIN,GAMMA(IGG) TYPHOID VACC,LIVE,ATTENUATED RHO(D) IMMUNE GLOBULIN/MALTOSE YELLOW FEVER VACCINE LIVE/PF ZOSTER VACCINE LIVE/PF INTERFERON GAMMA-1B,RECOMB. EVEROLIMUS EVEROLIMUS IMIQUIMOD INTERFERON ALFA-N3 AZATHIOPRINE AZATHIOPRINE AZATHIOPRINE SODIUM MYCOPHENOLATE MOFETIL CYCLOSPORINE, MODIFIED CYCLOSPORINE, MODIFIED IMIQUIMOD AZATHIOPRINE INTERFERON ALFA-2B,RECOMB. MYCOPHENOLATE MOFETIL MYCOPHENOLATE SODIUM MYCOPHENOLATE SODIUM CYCLOSPORINE, MODIFIED BELATACEPT MUROMONAB-CD3 ALDESLEUKIN SIROLIMUS BASILIXIMAB SIROLIMUS EVEROLIMUS IMIQUIMOD DOXYCYCLINE HYCLATE DOXYCYCLINE MONOHYDRATE AMOXICILLIN/POTASSIUM CLAV AMOXICILLIN AMOXICILLIN AMOXICILLIN/POTASSIUM CLAV AMOXICILLIN AMPICILLIN SODIUM AMPICILLIN TRIHYDRATE AMPICILLIN SODIUM/SULBACTAM NA SULBUTIAMINE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL BRAND DRUG AUGMENTIN AUGMENTIN ES-600 AUGMENTIN XR AVELOX IV AVIDOXY AVIDOXY DK AVYCAZ AZACTAM AZACTAM-ISO-OSMOTIC DEXTROSE AZO AZO DINE AZO STANDARD AZO-GESIC AZO-TABS BACTRIM BACTRIM DS BENOXYLDOXY 30 BENOXYLDOXY 60 BIAXIN BIAXIN XL BICILLIN C-R BICILLIN L-A CAYSTON CECLOR CEDAX CEFACLOR ER CEFAZOLIN CEFAZOLIN SODIUM-0.9% NACL CEFEPIME CEFEPIME-DEXTROSE CEFOTETAN CEFOTETAN & DEXTROSE CEFOXITIN CEFOXITIN SODIUM CEFTIN CEFTRIAXONE CEFUROXIME CEFUROXIME AXETIL CIPRO I.V. 132 GENERIC DRUG AMOXICILLIN/POTASSIUM CLAV AMOXICILLIN/POTASSIUM CLAV AMOXICILLIN/POTASSIUM CLAV MOXIFLOXACIN IN NACL (ISO-OSM) DOXYCYCLINE MONOHYDRATE DOXYCYCLINE/SALICY/OCT/ZINC OX CEFTAZIDIME/AVIBACTAM AZTREONAM AZTREONAM/DEXTROSE-WATER PHENAZOPYRIDINE HCL PHENAZOPYRIDINE HCL PHENAZOPYRIDINE HCL PHENAZOPYRIDINE HCL PHENAZOPYRIDINE HCL AZTREONAM SULFAMETHOXAZOLE/TRIMETHOPRIM SULFAMETHOXAZOLE/TRIMETHOPRIM DOXYCYCLINE/BENZOYL PEROXIDE DOXYCYCLINE/BENZOYL PEROXIDE CLARITHROMYCIN CLARITHROMYCIN PEN G BENZ/PEN G PROCAINE PENICILLIN G BENZATHINE AZTREONAM LYSINE CEFACLOR CEFTIBUTEN CEFACLOR CEFACLOR CEFADROXIL CEFAZOLIN SODIUM/DEXTROSE,ISO CEFAZOLIN SODIUM CEFAZOLIN SODIUM IN 0.9 % NACL CEFDINIR CEFDITOREN PIVOXIL CEFEPIME HCL/DEXTROSE, ISO-OSM CEFEPIME HCL CEFEPIME HCL/D5W CEFOTAXIME SODIUM CEFOTETAN DISODIUM CEFOTETAN DISOD/DEXTROSE,ISO CEFOXITIN SODIUM CEFOXITIN SODIUM/DEXTROSE,ISO CEFPODOXIME PROXETIL CEFPROZIL CEFTAZIDIME CEFTIBUTEN CEFUROXIME AXETIL CEFTRIAXONE NA/DEXTROSE,ISO CEFUROXIME AXETIL CEFUROXIME SODIUM CIPROFLOXACIN LACTATE/D5W KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL BRAND DRUG CIPRO XR CIPROFLOXACIN ER CIPROFLOXACIN-D5W CLAFORAN CLARITHROMYCIN ER CUBICIN CYSTEX PLUS DIFICID DORIBAX DORYX DOXY 100 DOXYCYCLINE IR-DR DYNACIN E.E.S. 200 E.E.S. 400 ERYPED 200 ERYPED 400 ERYTHROCIN LACTOBIONATE ERYTHROMYCIN-SULFISOXAZOLE FACTIVE FORTAZ FORTAZ IN ISO-OSMOTIC DEXTROSE FURADANTIN HIPREX HYOPHEN IMIPENEM-CILASTATIN SODIUM INVANZ KETEK KETEK PAK LEVOFLOXACIN-D5W MACROBID MACRODANTIN MAXIPIME MEFOXIN MERREM MINOCIN MONODOX MONUROL MORGIDOX MOXATAG 133 GENERIC DRUG CIPROFLOXACIN/CIPROFLOXA HCL CIPROFLOXACIN CIPROFLOXACIN/CIPROFLOXA HCL CIPROFLOXACIN LACTATE/D5W CEFOTAXIME SODIUM CLARITHROMYCIN CLARITHROMYCIN DAPTOMYCIN METHENAMINE/SODIUM SALICYLATE DEMECLOCYCLINE HCL DICLOXACILLIN SODIUM FIDAXOMICIN DORIPENEM DOXYCYCLINE HYCLATE DOXYCYCLINE HYCLATE DOXYCYCLINE HYCLATE DOXYCYCLINE MONOHYDRATE DOXYCYCLINE MONOHYDRATE MINOCYCLINE HCL ERYTHROMYCIN ETHYLSUCCINATE ERYTHROMYCIN ETHYLSUCCINATE ERYTHROMYCIN ETHYLSUCCINATE ERYTHROMYCIN ETHYLSUCCINATE ERYTHROMYCIN LACTOBIONATE ERYTHROMYCIN ETHYLSUCCINATE ERY E-SUCC/SULFISOXAZOLE GEMIFLOXACIN MESYLATE CEFTAZIDIME CEFTAZIDIME NA/DEXTROSE,ISO NITROFURANTOIN METHENAMINE HIPPURATE METHENAM/ME BLUE/BA/SALICY/HYO IMIPENEM/CILASTATIN SODIUM ERTAPENEM SODIUM TELITHROMYCIN TELITHROMYCIN LEVOFLOXACIN/D5W LINEZOLID NITROFURANTOIN MONOHYD/M-CRYST NITROFURANTOIN MACROCRYSTAL CEFEPIME HCL CEFOXITIN SODIUM/D5W MEROPENEM MEROPENEM METHENAMINE HIPPURATE METHENAMINE MANDELATE MINOCYCLINE HCL MINOCYCLINE HCL DOXYCYCLINE MONOHYDRATE FOSFOMYCIN TROMETHAMINE DOXYCYCLINE HYCLATE AMOXICILLIN KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL BRAND DRUG NAFCILLIN NITROFURANTOIN MONO-MACRO NUTRIDOX OMNICEF ORACEA ORAXYL OXACILLIN PENICILLIN G POTASS-0.9% NACL PENICILLIN GK-ISO-OSM DEXTROSE PENICILLIN V POTASSIUM PERIOSTAT PFIZERPEN PHOSENAMINE PHOSPHASAL PIPERACILLIN PIPERACILLIN-TAZOBACTAM PRIMAXIN PRIMAXIN I.M. PRIMSOL PRODIUM PROSED-DS PYRIDIUM RE-AZO ROCEPHIN SEPTRA SEPTRA DS SIVEXTRO SOLODYN SPECTRACEF SULFAMETHOXAZOLE-TMP DS SULFAMETHOXAZOLETRIMETHOPRIM SULFATRIM SUPRAX SYNERCID TAZICEF TEFLARO TIMENTIN TRIMOX TYGACIL UNASYN UR N-C URELLE URETRON D-S 134 GENERIC DRUG NAFCILLIN IN DEXTROSE,ISO-OSM NAFCILLIN SODIUM NITROFURANTOIN NITROFURANTOIN MONOHYD/M-CRYST DOXYCYCLINE/OMEGA-3 #1/EYE MSK CEFDINIR DOXYCYCLINE MONOHYDRATE DOXYCYCLINE HYCLATE OXACILLIN SODIUM/DEXTROSE,ISO OXACILLIN SODIUM PENICILLIN G POT IN 0.9% NACL PENICILLIN G POTASSIUM PENICILLIN G PROCAINE PENICILLIN G SODIUM PEN G POT/DEXTROSE-WATER DOXYCYCLINE HYCLATE PENICILLIN G POTASSIUM PHENAZOPYRIDINE HCL METHEN/M-BLUE/SAL/NA PHOS/HYOS MTH/ME BLUE/SOD PHOS/PHEN/HYOS PIPERACILLIN SODIUM PIPERACILLIN SODIUM/TAZOBACTAM IMIPENEM/CILASTATIN SODIUM IMIPENEM/CILASTATIN SODIUM TRIMETHOPRIM PHENAZOPYRIDINE HCL METHENAM/ME BLUE/BA/SALICY/HYO PHENAZOPYRIDINE HCL PHENAZOPYRIDINE HCL CEFTRIAXONE SODIUM SULFAMETHOXAZOLE/TRIMETHOPRIM SULFAMETHOXAZOLE/TRIMETHOPRIM TEDIZOLID PHOSPHATE MINOCYCLINE HCL CEFDITOREN PIVOXIL SULFADIAZINE SULFAMETHOXAZOLE/TRIMETHOPRIM SULFAMETHOXAZOLE/TRIMETHOPRIM SULFAMETHOXAZOLE/TRIMETHOPRIM CEFIXIME QUINUPRISTIN/DALFOPRISTIN CEFTAZIDIME CEFTAROLINE FOSAMIL ACETATE TICARCILLIN/K CLAVULANATE TRIMETHOPRIM AMOXICILLIN TIGECYCLINE AMPICILLIN SODIUM/SULBACTAM NA MTH/ME BLUE/SOD PHOS/PHEN/HYOS MTH/ME BLUE/SOD PHOS/PHEN/HYOS METHEN/M-BLUE/SAL/NA PHOS/HYOS KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - BACTERIAL INFECTIOUS DISEASE - FUNGAL INFECTIOUS DISEASE - FUNGAL INFECTIOUS DISEASE - FUNGAL INFECTIOUS DISEASE - FUNGAL INFECTIOUS DISEASE - FUNGAL INFECTIOUS DISEASE - FUNGAL INFECTIOUS DISEASE - FUNGAL INFECTIOUS DISEASE - FUNGAL INFECTIOUS DISEASE - FUNGAL INFECTIOUS DISEASE - FUNGAL INFECTIOUS DISEASE - FUNGAL INFECTIOUS DISEASE - FUNGAL INFECTIOUS DISEASE - FUNGAL INFECTIOUS DISEASE - FUNGAL INFECTIOUS DISEASE - FUNGAL INFECTIOUS DISEASE - FUNGAL INFECTIOUS DISEASE - FUNGAL INFECTIOUS DISEASE - FUNGAL INFECTIOUS DISEASE - FUNGAL INFECTIOUS DISEASE - FUNGAL INFECTIOUS DISEASE - FUNGAL INFECTIOUS DISEASE - FUNGAL INFECTIOUS DISEASE - FUNGAL INFECTIOUS DISEASE - FUNGAL INFECTIOUS DISEASE - FUNGAL INFECTIOUS DISEASE - FUNGAL BRAND DRUG UREX URIBEL URIMAR-T URIN D.S. URINARY PAIN RELIEF URINARY TRACT URISTAT URO-BLUE UROGESIC-BLUE URO-L URO-MP URYL USTELL UTA UTICAP UTIRA-C UTRONA-C VANCOCIN HCL VIBRAMYCIN WOMAN'S WELLBEING UTI RELIEF ZERBAXA ZINACEF ZINACEF ISO-OSMOTIC DEXTROSE ZOSYN ZYVOX ABELCET AMBISOME AMPHOTEC ANCOBON CANCIDAS CRESEMBA DIFLUCAN DIFLUCAN IN DEXTROSE DIFLUCAN IN SALINE ERAXIS (WATER DILUENT) FIRST-BXN FIRST-DUKE'S FIRST-MARY'S FLUCONAZOLE IN DEXTROSE FLUCONAZOLE IN SALINE FLUCONAZOLE-NACL GRIFULVIN V GRISEOFULVIN GRIS-PEG MYCAMINE NOXAFIL ONMEL 135 GENERIC DRUG METHENAMINE HIPPURATE MTH/ME BLUE/SOD PHOS/PHEN/HYOS METHEN/M-BLUE/SAL/NA PHOS/HYOS MTH/ME BLUE/SOD PHOS/PHEN/HYOS PHENAZOPYRIDINE HCL PHENAZOPYRIDINE HCL PHENAZOPYRIDINE HCL METHEN/SOD PHOS/METH BLUE/HYOS METHEN/SOD PHOS/METH BLUE/HYOS MTH/ME BLUE/SOD PHOS/PHEN/HYOS MTH/ME BLUE/SOD PHOS/PHEN/HYOS METHEN/SOD PHOS/METH BLUE/HYOS METHEN/M-BLUE/SAL/NA PHOS/HYOS METHEN/M-BLUE/SAL/NA PHOS/HYOS METHEN/M-BLUE/SAL/NA PHOS/HYOS MTH/ME BLUE/SOD PHOS/PHEN/HYOS MTH/ME BLUE/SOD PHOS/PHEN/HYOS VANCOMYCIN HCL VANCOMYCIN HCL DOXYCYCLINE CALCIUM PHENAZOPYRIDINE HCL CEFTOLOZANE/TAZOBACTAM CEFUROXIME SODIUM CEFUROXIME SODIUM/DEXTROSE,ISO PIPERACILLIN SODIUM/TAZOBACTAM LINEZOLID AMPHOTERICIN B LIPID COMPLEX AMPHOTERICIN B LIPOSOME AMPHOTERICIN B CHOLESTERYL SUL FLUCYTOSINE CASPOFUNGIN ACETATE ISAVUCONAZONIUM SULFATE FLUCONAZOLE FLUCONAZOLE IN DEXTROSE,ISO-OS FLUCONAZOLE IN NACL,ISO-OSM ANIDULAFUNGIN NYSTATIN/LIDOCAINE/DIPHENHYD NYSTATIN/HYDROCORTISONE/DIPHEN NYSTATIN/TCN/HC/DIPHENHYDRAMIN FLUCONAZOLE FLUCONAZOLE IN DEXTROSE,ISO-OS FLUCONAZOLE IN NACL,ISO-OSM FLUCONAZOLE IN NACL,ISO-OSM FLUCYTOSINE GRISEOFULVIN, MICROSIZE GRISEOFULVIN, MICROSIZE GRISEOFULVIN ULTRAMICROSIZE GRISEOFULVIN ULTRAMICROSIZE ITRACONAZOLE MICAFUNGIN SODIUM POSACONAZOLE ITRACONAZOLE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION INFECTIOUS DISEASE - FUNGAL INFECTIOUS DISEASE - FUNGAL INFECTIOUS DISEASE - FUNGAL INFECTIOUS DISEASE - FUNGAL INFECTIOUS DISEASE - FUNGAL INFECTIOUS DISEASE - FUNGAL INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS BRAND DRUG ORAVIG SPORANOX TERBINEX VFEND VFEND IV AMINOACETIC ACID BETHKIS CAPASTAT SULFATE CHLORAMPHENICOL SOD SUCCINATE CLEOCIN HCL CLEOCIN PALMITATE CLEOCIN PHOSPHATE IN D5W CLINDAMYCIN PEDIATRIC CLINDAMYCIN PHOSPHATE-D5W COLISTIMETHATE COLY-MYCIN M PARENTERAL DALVANCE GENTAMICIN SULFATE IN NS GLYCINE ISONARIF KITABIS PAK LINCOCIN MYAMBUTOL MYCOBUTIN ORBACTIV PASER PRIFTIN RIFADIN RIFAMATE RIFATER RIMACTANE SEROMYCIN SIRTURO THALOMID TOBI TOBI PODHALER TOBRAMYCIN SULFATE IN NS TRECATOR VANCOMYCIN 136 GENERIC DRUG MICONAZOLE ITRACONAZOLE TERBINAFINE/HYDROXY CHITOSAN VORICONAZOLE VORICONAZOLE VORICONAZOLE AMIKACIN SULFATE GLYCINE UROLOGIC SOLUTION TOBRAMYCIN CAPREOMYCIN SULFATE CHLORAMPHENICOL SOD SUCC CLINDAMYCIN HCL CLINDAMYCIN PALMITATE HCL CLINDAMYCIN PHOSPHATE/D5W CLINDAMYCIN HCL CLINDAMYCIN PALMITATE HCL CLINDAMYCIN PALMITATE HCL CLINDAMYCIN PHOSPHATE/D5W COLISTIN (COLISTIMETHATE NA) COLISTIN (COLISTIMETHATE NA) CYCLOSERINE DALBAVANCIN HCL ETHAMBUTOL HCL GENTAMICIN IN NACL, ISO-OSM GLYCINE UROLOGIC SOLUTION RIFAMPIN/ISONIAZID ISONIAZID KANAMYCIN SULFATE TOBRAMYCIN/NEBULIZER LINCOMYCIN HCL ETHAMBUTOL HCL RIFABUTIN ORITAVANCIN DIPHOSPHATE AMINOSALICYLIC ACID POLYMYXIN B SULFATE RIFAPENTINE PYRAZINAMIDE RIFABUTIN RIFAMPIN RIFAMPIN/ISONIAZID RIFAMPIN RIFAMP/ISONIAZID/PYRAZINAMIDE RIFAMPIN CYCLOSERINE BEDAQUILINE FUMARATE STREPTOMYCIN SULFATE THALIDOMIDE TOBRAMYCIN IN 0.225% NACL TOBRAMYCIN TOBRAMYCIN/SODIUM CHLORIDE ETHIONAMIDE VANCOMYCIN IN DEXTROSE,ISO-OSM KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - MISCELLANEOUS INFECTIOUS DISEASE - PARASITIC INFECTIOUS DISEASE - PARASITIC INFECTIOUS DISEASE - PARASITIC INFECTIOUS DISEASE - PARASITIC INFECTIOUS DISEASE - PARASITIC INFECTIOUS DISEASE - PARASITIC INFECTIOUS DISEASE - PARASITIC INFECTIOUS DISEASE - PARASITIC INFECTIOUS DISEASE - PARASITIC INFECTIOUS DISEASE - PARASITIC INFECTIOUS DISEASE - PARASITIC INFECTIOUS DISEASE - PARASITIC INFECTIOUS DISEASE - PARASITIC INFECTIOUS DISEASE - PARASITIC INFECTIOUS DISEASE - PARASITIC INFECTIOUS DISEASE - PARASITIC INFECTIOUS DISEASE - PARASITIC INFECTIOUS DISEASE - PARASITIC INFECTIOUS DISEASE - PARASITIC INFECTIOUS DISEASE - PARASITIC INFECTIOUS DISEASE - PARASITIC INFECTIOUS DISEASE - PARASITIC INFECTIOUS DISEASE - PARASITIC INFECTIOUS DISEASE - PARASITIC INFECTIOUS DISEASE - PARASITIC INFECTIOUS DISEASE - PARASITIC INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL BRAND DRUG VANCOMYCIN HCL-0.9% NACL VANCOMYCIN HCL-D5W VANCOMYCIN-0.9% NACL VANCOMYCIN-D5W VIBATIV XIFAXAN ALBENZA ARALEN PHOSPHATE ATOVAQUONE-PROGUANIL HCL BILTRICIDE COARTEM DARAPRIM MALARONE MEPRON METRO IV NEBUPENT PENTAM 300 PIN-X PLAQUENIL PRIMAQUINE QUALAQUIN REESE PINWORM TINDAMAX YODOXIN ABACAVIR ABACAVIR-LAMIVUDINE-ZIDOVUDINE APTIVUS ATRIPLA BARACLUDE COMBIVIR COMPLERA COPEGUS CRIXIVAN CYTOVENE EDURANT EMTRIVA EPIVIR EPIVIR HBV EPZICOM 137 GENERIC DRUG VANCOMYCIN/0.9% SOD CHLORIDE VANCOMYCIN HCL/D5W VANCOMYCIN/0.9% SOD CHLORIDE VANCOMYCIN HCL/D5W TELAVANCIN HCL RIFAXIMIN ALBENDAZOLE CHLOROQUINE PHOSPHATE ATOVAQUONE ATOVAQUONE/PROGUANIL HCL PRAZIQUANTEL CHLOROQUINE PHOSPHATE ARTEMETHER/LUMEFANTRINE PYRIMETHAMINE HYDROXYCHLOROQUINE SULFATE ATOVAQUONE/PROGUANIL HCL MEBENDAZOLE MEFLOQUINE HCL ATOVAQUONE METRONIDAZOLE/SODIUM CHLORIDE PENTAMIDINE ISETHIONATE PAROMOMYCIN SULFATE PENTAMIDINE ISETHIONATE PYRANTEL PAMOATE HYDROXYCHLOROQUINE SULFATE PRIMAQUINE PHOSPHATE QUININE SULFATE QUININE SULFATE PYRANTEL PAMOATE TINIDAZOLE TINIDAZOLE IODOQUINOL ABACAVIR SULFATE ABACAVIR/LAMIVUDINE/ZIDOVUDINE ACYCLOVIR SODIUM ADEFOVIR DIPIVOXIL TIPRANAVIR EFAVIRENZ/EMTRICITAB/TENOFOVIR ENTECAVIR CIDOFOVIR LAMIVUDINE/ZIDOVUDINE EMTRICITAB/RILPIVIRINE/TENOFOV RIBAVIRIN INDINAVIR SULFATE GANCICLOVIR SODIUM DIDANOSINE RILPIVIRINE HCL EMTRICITABINE ENTECAVIR LAMIVUDINE LAMIVUDINE ABACAVIR SULFATE/LAMIVUDINE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL BRAND DRUG EVOTAZ FAMVIR FLUMADINE FOSCAVIR FUZEON HARVONI HEPSERA INCIVEK INFERGEN INTELENCE INVIRASE ISENTRESS KALETRA LAMIVUDINE HBV LAMIVUDINE-ZIDOVUDINE LEXIVA MODERIBA NEVIRAPINE ER NORVIR OLYSIO PEGASYS PEGASYS PROCLICK PEGINTRON PEGINTRON REDIPEN PERAMIVIR PREZCOBIX PREZISTA RAPIVAB REBETOL RELENZA RESCRIPTOR RETROVIR REYATAZ RIBAPAK RIBASPHERE RIBATAB RIBAVIRIN SELZENTRY SOVALDI STRIBILD SUSTIVA SYLATRON SYLATRON 4-PACK SYNAGIS TAMIFLU 138 GENERIC DRUG ATAZANAVIR SULFATE/COBICISTAT FAMCICLOVIR FAMCICLOVIR RIMANTADINE HCL FOSCARNET SODIUM FOSCARNET SODIUM ENFUVIRTIDE GANCICLOVIR SODIUM LEDIPASVIR/SOFOSBUVIR ADEFOVIR DIPIVOXIL TELAPREVIR INTERFERON ALFACON-1 ETRAVIRINE SAQUINAVIR MESYLATE RALTEGRAVIR POTASSIUM LOPINAVIR/RITONAVIR LAMIVUDINE LAMIVUDINE LAMIVUDINE/ZIDOVUDINE FOSAMPRENAVIR CALCIUM RIBAVIRIN NEVIRAPINE NEVIRAPINE RITONAVIR SIMEPREVIR SODIUM PEGINTERFERON ALFA-2A PEGINTERFERON ALFA-2A PEGINTERFERON ALFA-2B PEGINTERFERON ALFA-2B PERAMIVIR/PF DARUNAVIR/COBICISTAT DARUNAVIR ETHANOLATE PERAMIVIR/PF RIBAVIRIN ZANAMIVIR DELAVIRDINE MESYLATE ZIDOVUDINE ATAZANAVIR SULFATE RIBAVIRIN RIBAVIRIN RIBAVIRIN RIMANTADINE HCL MARAVIROC SOFOSBUVIR STAVUDINE ELVITEGR/COBICIST/EMTRIC/TENOF EFAVIRENZ PEGINTERFERON ALFA-2B PEGINTERFERON ALFA-2B PALIVIZUMAB OSELTAMIVIR PHOSPHATE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFECTIOUS DISEASE - VIRAL INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE BRAND DRUG TIVICAY TRIUMEQ TRIZIVIR TRUVADA TYBOST TYZEKA VALACYCLOVIR VALCYTE VALTREX VICTRELIS VIDEX VIDEX EC VIEKIRA PAK VIRACEPT VIRAMUNE VIRAMUNE XR VIRAZOLE VIREAD VISTIDE VITEKTA ZERIT ZIAGEN ACTEMRA ADULT LOW DOSE ASPIRIN EC ADVIL LIQUI-GELS ADVIL MIGRAINE A-HYDROCORT ALEVE ALL DAY RELIEF A-METHAPRED ANAPROX ANAPROX DS ARAVA ARCALYST ARISTOSPAN ARTHRI-FLEX ARTHROTEC 50 ARTHROTEC 75 ASMALPRED ASMALPRED PLUS ASPERDRINK ASPIR 81 ASPIRIN EC ASPIR-LOW ASPIR-TRIN BAYER ADVANCED BAYER CHEWABLE ASPIRIN BERINERT 139 GENERIC DRUG DOLUTEGRAVIR SODIUM ABACAVIR/DOLUTEGRAVIR/LAMIVUDI ABACAVIR/LAMIVUDINE/ZIDOVUDINE EMTRICITABINE/TENOFOVIR COBICISTAT TELBIVUDINE VALACYCLOVIR HCL VALGANCICLOVIR HCL VALGANCICLOVIR HCL VALACYCLOVIR HCL BOCEPREVIR DIDANOSINE DIDANOSINE OMBITA/PARITAP/RITON/DASABUVIR NELFINAVIR MESYLATE NEVIRAPINE NEVIRAPINE RIBAVIRIN TENOFOVIR DISOPROXIL FUMARATE CIDOFOVIR ELVITEGRAVIR STAVUDINE ABACAVIR SULFATE ZIDOVUDINE TOCILIZUMAB ASPIRIN IBUPROFEN IBUPROFEN HYDROCORTISONE SOD SUCCINATE NAPROXEN SODIUM NAPROXEN SODIUM METHYLPREDNISOLONE SOD SUCC NAPROXEN SODIUM NAPROXEN SODIUM LEFLUNOMIDE RILONACEPT TRIAMCINOLONE HEXACETONIDE GLUC/MSM/COLL2/HYAL/ANTIARTH#3 DICLOFENAC SODIUM/MISOPROSTOL DICLOFENAC SODIUM/MISOPROSTOL PREDNISOLONE SOD PH/PEAK FLOW PREDNISOLONE SOD PH/PEAK FLOW ASPIRIN ASPIRIN ASPIRIN 325MG ASPIRIN ASPIRIN LOW 81MG ASPIRIN ASPIRIN ASPIRIN ASPIRIN C1 ESTERASE INHIBITOR KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE BRAND DRUG BETAMETHASONE ACETATE-SOD PHOS CALDOLOR CAMBIA CARTIVISC CATAFLAM CELEBREX CHILD IBUPROFEN CHILDREN'S ADVIL CHILDREN'S ASPIRIN CHILDREN'S IBUPROFEN CHILDREN'S MEDI-PROFEN CHILDREN'S MOTRIN CHILDREN'S PROFEN IB CHILDREN'S PROFENIB CIDAFLEX CIDATRINE CINRYZE CLINORIL COMFORT PAC-IBUPROFEN COMFORT PAC-MELOXICAM COMFORT PAC-NAPROXEN CONDROLITE COSAFLEX COSAMIN ASU CUPRIMINE DAYPRO DEPEN DEXAMETHASONE-NS DICLOFENAC SODIUM-MISOPROSTOL DONA DUEXIS EC-NAPROSYN ECOTRIN ECPIRIN ENBREL ETODOLAC ER EZ USE JOINT-TUNNEL-TRIGGER FELDENE FENOPROFEN CALCIUM FENTANYL CITRATE FIRAZYR FLEX ABILITY FLEXABLE MAXIMUM STRENGTH FLEXI JOINT GENICIN GLUCOSAMINE 140 GENERIC DRUG BETAMET ACET/BETAMET NA PH IBUPROFEN DICLOFENAC POTASSIUM GLUCOSAMINE/CHONDROITIN A/MSM DICLOFENAC POTASSIUM CELECOXIB CELECOXIB IBUPROFEN IBUPROFEN ASPIRIN IBUPROFEN IBUPROFEN IBUPROFEN IBUPROFEN IBUPROFEN GLUCOSAMINE HCL/CHONDR SU A NA GLUCOSAMINE SULFATE C1 ESTERASE INHIBITOR SULINDAC IBUPROFEN/IRR CNT-IRRIT CMB #2 MELOXICAM/IRR CNTR-IRR CMB #2 NAPROXEN/IRR CNTR-IRRIT CMB #2 GLUCOSAMINE/CHONDROITIN A/MSM CORTISONE ACETATE GLUC SU/CHONDRO SU A/VIT C/MN GLUCOSAMINE/CONDROITIN/HRB#182 PENICILLAMINE OXAPROZIN PENICILLAMINE DEXAMETHASONE IN 0.9 % NACL DICLOFENAC POTASSIUM DICLOFENAC SODIUM/MISOPROSTOL GLUCOSAMINE SULFATE IBUPROFEN/FAMOTIDINE NAPROXEN ASPIRIN ASPIRIN ETANERCEPT ETODOLAC ETODOLAC TRIAMCINOLONE/LIDOCAINE PIROXICAM ICATIBANT ACETATE GLUCOSAMINE SULF/CHONDROITIN A GLUCOSAMINE/CHONDROITIN SULF A GLUC SU/MSM/CHONDRO SU A/C/MN FLUDROCORTISONE ACETATE FLURBIPROFEN GLUCOSAMINE SULFATE GLUCOSAMINE HCL/MSM KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE BRAND DRUG GLUCOSAMINE & CHONDROITIN GLUCOSAMINE CHONDROITIN GLUCOSAMINE CHONDROITIN MSM GLUCOSAMINE CHONDROITIN PLUS GLUCOSAMINE COMPLEX GLUCOSAMINE COMPLEX-MSM GLUCOSAMINE MSM GLUCOSAMINE PLUS VITAMIN D GLUCOSAMINE RELIEF GLUCOSAMINE SULFATE GLUCOSAMINE/CHONDROITIN GLUCOSAMINE/CHRONDROITIN GLUCOSAMINE-CHONDROITIN COMPLX GLUCOSAMINE-CHONDROITIN-D3 GLUCOSAMINE-CHONDROITIN-MSM GLUCOSAMINE-CHONDROITIN-VIT D3 GLUCOSAMINE-FISH OIL GLUCOSAMINE-MSM COMPLEX GLUCOSAMINE-VITAMIN D3 GLUCOTEN HALFPRIN HUMIRA HUMIRA PEDIATRIC CROHN'S IBU-DROPS IBUPROFEN IB ILARIS INDOCIN INFANTS IBU-DROPS INFANTS IBUPROFEN INFANT'S IBUPROFEN INFANTS' IBUPROFEN INFANTS MEDI-PROFEN INFANT'S MOTRIN INFANTS' MOTRIN INFANTS PROFENIB I-PRIN JOINT SUPPORT KALBITOR KINERET LITE COAT ASPIRIN LO-DOSE ASPIRIN EC LOW DOSE ASPIRIN EC MEDI-FLEXX TABLET MEDI-PROFEN MEDIPROXEN MEDROL 141 GENERIC DRUG GLUC 2KCL/CHONDR/COLL HY/HY AC GLUC SU/CHONDRO SU A/VIT C/MN GLUCOSAMINE/MSM/CHONDROITIN A GLUC/CHND/OM3/DHA/EPA/FISH/STR GLUCOSAMINE/D3/BOSWELLIA SERRA GLUC SU/MSM/MAGNESIUM/VIT C GLUCOSAMINE HCL/MSM GLUCOSAMINE HCL/VITAMIN D3 GLUCOSAMINE SULFATE 2KCL GLUCOSAMINE HCL/CHONDRO SU A GLUCOSAMINE 500/CHROND 400 GLU/CHON-MSM#1/D3/C/MN/BOS/BOR GLUCOSAM/CHON-COL.CPLX/D3/C/MN GLU/CHON-MSM#1/D3/C/MN/BOS/BOR GLUCOSAMINE/CHONDROITIN/VIT D3 GLUC SU/OMEGA-3/VITAMIN E GLUCOS/MSM/COLG II/C/MAN/HRB21 GLUCOSAMINE/D3/BOSWELLIA SERRA GLUCOSAM & CHONDROIT-MV & MIN3 ASPIRIN ADALIMUMAB ADALIMUMAB IBUPROFEN IBUPROFEN IBUPROFEN 200 IBUPROFEN CANAKINUMAB/PF INDOMETHACIN INDOMETHACIN IBUPROFEN IBUPROFEN IBUPROFEN IBUPROFEN IBUPROFEN IBUPROFEN IBUPROFEN IBUPROFEN IBUPROFEN GLUC HCL/CSA/COLL HY/HYALUR AC ECALLANTIDE KETOPROFEN ANAKINRA LEFLUNOMIDE ASPIRIN ASPIRIN ASPIRIN MECLOFENAMATE SODIUM GLUCOSAMINE/CHONDROITIN A/MSM IBUPROFEN NAPROXEN SODIUM METHYLPREDNISOLONE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE BRAND DRUG GENERIC DRUG MEFENAMIC ACID MELOXICAM METHOTREXATE METHOTREXATE SODIUM MILLIPRED DP MINIPRIN MOBIC MONOVISC MOTRIN MOTRIN IB MSM GLUCOSAMINE COMPLEX MSM-GLUCOSAMINE MYOCHRYSINE NALFON NAPRELAN NAPRELAN CR DOSE CARD NAPROSYN NAPROXEN SODIUM CR OPTIFLEX COMPLETE OPTIFLEX-G ORENCIA OTEZLA OTREXUP PHYSICIANS EZ USE M-PRED PONSTEL PREDNISONE INTENSOL PRELONE PROVIL PRYFLEX RASUVO RAYOS RELAFEN RELAMINE RHEUMATREX RIDAURA RUCONEST SIMPONI SIMPONI ARIA SOLU-CORTEF SOLU-MEDROL ST JOSEPH ASPIRIN ST. JOSEPH ASPIRIN 142 METHOTREXATE SODIUM METHOTREXATE SODIUM/PF METHYLPREDNISOLONE METHYLPREDNISOLONE SOD SUCC PREDNISOLONE ASPIRIN MELOXICAM HYALURONATE SODIUM, STABILIZED IBUPROFEN IBUPROFEN GLUC HCL/MSM/C/MN/WILLOW/GING GLUCOSAMINE SULFATE/MSM GOLD SODIUM THIOMALATE NABUMETONE FENOPROFEN CALCIUM NAPROXEN SODIUM NAPROXEN SODIUM NAPROXEN NAPROXEN NAPROXEN SODIUM NAPROXEN SODIUM GLUCOSAM SUL NA/CHONDR SU A NA GLUCOSAMINE SULFATE ABATACEPT APREMILAST METHOTREXATE/PF OXAPROZIN PHENYLBUTAZONE METHYLPREDNISOLONE/BUPIVACAINE PIROXICAM MEFENAMIC ACID PREDNISOLONE PREDNISONE PREDNISONE PREDNISOLONE IBUPROFEN GLUCOSAM SU/CHONDROITIN/AO MV5 METHOTREXATE/PF PREDNISONE NABUMETONE GLUCOSAM SU/CHONDROITIN/AO MV5 METHOTREXATE SODIUM AURANOFIN C1 ESTERASE INHIBITOR, RECOMB GOLIMUMAB GOLIMUMAB HYDROCORTISONE SOD SUCC/PF METHYLPREDNISOLONE SOD SUCC ASPIRIN ASPIRIN KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE INFLAMMATORY DISEASE LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA BRAND DRUG STANBACK ANALGESIC STELARA SYNOVACIN SYNVISC SYNVISC-ONE TREPADONE TREPADONE-120 TREXALL TRIPLE FLEX TRIPLEFLEX VEGETARIAN GLUCOSAMINE VIMOVO WAL-PROXEN XELJANZ ZIPSOR ZORPRIN ZORVOLEX ARTICADENT DENTAL BUCALSEP BUFFERED LIDOCAINE BUFFERED LIDOCAINE-NS BUPIVACAINE HCL-0.9% NACL BUPIVACAINE HCL-EPINEPHRINE BUPIVACAINE HCL-NS BUPIVACAINE-DEXTROSE BUPIVACAINE-NORMAL SALINE CARBOCAINE CEPACOL CEPACOL DUAL RELIEF CEPACOL SORE THROAT + COATING CEPACOL ULTRA CEPASTAT CHLOROPROCAINE HCL CITANEST FORTE DENTAL CITANEST PLAIN DENTAL DNA MEDICATED COLLECTION EXPAREL G-BUCAL-C LIDOCAINE HCL IN 7.5% DEXTROSE LIDOCAINE HCL-0.9% NACL LIDOCAINE-EPINEPHRINE MARCAINE MARCAINE SPINAL MARCAINE WITH EPINEPHRINE MARCAINE-EPINEPHRINE NAROPIN NESACAINE NESACAINE-MPF ORAGESIC 143 GENERIC DRUG ASPIRIN USTEKINUMAB SULINDAC GLUCOSAMINE SULFATE HYLAN G-F 20 HYLAN G-F 20 TOLMETIN SODIUM GLUCOSAM/CHONDROITIN/DIET CB13 GLUCOSAM/CHONDROITIN/DIET CB13 METHOTREXATE SODIUM GLUCOSAMINE/MSM/CHONDROITIN A GLUCOSAMINE/MSM/CHONDROITIN A GLUCOSAMINE HCL NAPROXEN/ESOMEPRAZOLE MAG NAPROXEN SODIUM TOFACITINIB CITRATE DICLOFENAC POTASSIUM ASPIRIN DICLOFENAC SUBMICRONIZED ARTICAINE/EPINEPHRINE BITART B-CAINE/ZINC CL/PINE/CPYRD LIDOCAINE WITH 8.4% SOD BICARB LIDOCAIN/8.4% NAHCO3/0.9% NACL BUPIVACAINE HCL BUPIVACAINE HCL/0.9 % NACL/PF BUPIVACAINE HCL/EPINEPHRINE BUPIVACAINE HCL/0.9 % NACL/PF BUPIVACAINE HCL/DEX-WATER/PF BUPIVACAINE HCL/0.9 % NACL/PF MEPIVACAINE HCL MENTHOL/CETYLPYRD CL BENZOCAINE/GLYCERIN BENZOCAINE/PECTIN BENZOCAINE/GLYCERIN PHENOL CHLOROPROCAINE HCL/PF PRILOCAINE HCL/EPINEPHRINE BIT PRILOCAINE HCL LIDOCAINE HCL/GLYCERIN BUPIVACAINE LIPOSOME/PF MENTHOL/ZINC/BENZOCAINE/CETYLP LIDOCAINE HCL/D7.5W/PF LIDOCAINE HCL IN 0.9 % NACL/PF LIDOCAINE HCL/EPINEPHRINE BIT BUPIVACAINE HCL BUPIVACAINE HCL/DEX-WATER/PF BUPIVACAINE HCL/EPINEPHRINE/PF BUPIVACAINE HCL/EPINEPHRINE ROPIVACAINE HCL/PF CHLOROPROCAINE HCL CHLOROPROCAINE HCL/PF NACL/BENZYL ALCOHOL/YERBA SANT KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOCAL ANESTHESIA LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT BRAND DRUG ORASEP POLOCAINE POLOCAINE-MPF ROPIVACAINE HCL-0.9% NACL ROPIVACAINE HCL-NS SENSORCAINE SENSORCAINE WITH DEXTROSE SENSORCAINE WITH EPINEPHRINE SENSORCAINE-MPF SENSORCAINE-MPF EPINEPHRINE TOOTHACHE ANA-LEX ANALPRAM ADVANCED ANALPRAM E APRISO ASACOL ASACOL HD AZULFIDINE CANASA CIMZIA COLAZAL DELZICOL DIPENTUM ENTYVIO FORMULATION R GIAZO GRX HEMORRHOIDAL HEMORRHOID OINTMENT HEMORRHOIDAL HEMORRHOIDAL COOLING GEL HEMORRHOIDAL CREAM HEMORRHOIDAL GEL HEMORRHOIDAL H HEMORRHOIDAL OINTMENT HEMORRHOIDAL SUPPOSITORIES HEM-PREP HYDROCORTISONE-LIDOCAINE LIALDA LINZESS MAJOR-PREP HEMORRHOIDAL MEDICONE PENTASA PRAM-HCA PREP-HEM RECTAGEL HC REMICADE ROWASA SFROWASA SULFASALAZINE DR 144 GENERIC DRUG BENZOCAINE/MENTH/CETYLPYRD CL MEPIVACAINE HCL MEPIVACAINE HCL/PF ROPIVACAINE HCL/PF ROPIVACAINE HCL IN 0.9%NACL/PF ROPIVACAINE HCL IN 0.9%NACL/PF BUPIVACAINE HCL BUPIVACAINE HCL/DEX-WATER/PF BUPIVACAINE HCL/EPINEPHRINE BUPIVACAINE HCL/PF BUPIVACAINE HCL/EPINEPHRINE/PF BENZOCAINE/POVIDONE-IODINE/PHE HYDROCORTISONE/LIDOCAINE/ALOE HC/PRAMOX/DIOSMIN#1/ALO#1/PCOS HYDROCORT/PRAMOXIN/EMOL/PRAM#1 MESALAMINE MESALAMINE MESALAMINE SULFASALAZINE BALSALAZIDE DISODIUM MESALAMINE CERTOLIZUMAB PEGOL BALSALAZIDE DISODIUM MESALAMINE OLSALAZINE SODIUM VEDOLIZUMAB PHENYLEPHRINE/SHK LV/MO/PET,WH BALSALAZIDE DISODIUM PHENYLEPH/MINERAL OIL/PETROLAT PHENYLEPHRINE/SHK LV/MO/PET,WH PHENYLEPH/MINERAL OIL/PETROLAT PHENYLEPHRINE HCL/WITCH HAZEL PE/SHARK LIVER/GLY/PET,WH PHENYLEPHRINE HCL/WITCH HAZEL SHARK LIVER OIL/COCOA BUTTER PHENYLEPH/MINERAL OIL/PETROLAT PHENYLEPHRINE HCL/COCOA BUTTER PE/SHARK LIVER/GLY/PET,WH HYDROCORTISONE/LIDOCAINE/ALOE MESALAMINE LINACLOTIDE PHENYLEPH/MINERAL OIL/PETROLAT B-CAINE/MIN OIL/PETROLAT,WHT MESALAMINE HYDROCORT/PRAMOXN/SKN CLNSR#16 PHENYLEPHRINE/MO/SHK LV/PET,WH HYDROCORTISONE/LIDOCAINE/ALOE INFLIXIMAB MESALAMINE W/CLEANSING WIPES MESALAMINE SULFASALAZINE SULFASALAZINE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - BOWEL INFLAMMAT LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER BRAND DRUG SULFAZINE SULFAZINE EC TRONOLANE ZYPRAM ACTIGALL ALOPHEN PILLS AMITIZA AMMONUL ANTI-DIARRHEA ANTIDIARRHEAL ANTI-DIARRHEAL ANTI-DIARRHEAL PLUS ANTI-GAS ANTI-DIARRHEAL PLUS GAS RELIEF BANATROL PLUS BENEFIBER BENEFIBER + CALCIUM SUGAR-FREE BENEFIBER PLUS CALCIUM BENEFIBER PLUS HEART HEALTH BEST FIBER BISAC-EVAC BISA-LAX BISCOLAX BISMATROL BISMUTH BISMUTH MAXIMUM STRENGTH BLACK DRAUGHT LAXATIVE BLACK DRAUGHT SENNA LAXATIVE BOOST KID ESSENTIALS-FIBER BOOST WITH BENEFIBER BRIGHT BEGINNINGS BUPHENYL CALCARB 600 CALCICARB CALCI-CHEW CALCI-MIX CALCIUM CALCIUM STOOL SOFTENER CALCIUM WITH VITAMIN D CAL-MINT CALTRATE 600 CARBAGLU CEO-TWO CESINEX CHENODAL CHILDREN'S BENEFIBER CHILDREN'S KAOPECTATE CHILD'S FIBER SELECT GUMMIES CHOCOLATED LAXATIVE CHOLBAM CITRATE OF MAGNESIA CITROMA CITRUCEL 145 GENERIC DRUG SULFASALAZINE SULFASALAZINE PRAMOXINE HCL/ZINC OXIDE HYDROCORT/PRAMOXN/SKN CLNSR#16 URSODIOL BISACODYL LUBIPROSTONE SODIUM BENZOATE/SOD PHENYLACET LOPERAMIDE HCL LOPERAMIDE HCL BISMUTH SUBSALICYLATE LOPERAMIDE HCL/SIMETHICONE LOPERAMIDE HCL/SIMETHICONE BANANA FLAKES/TOS GUAR GUM WHEAT DEXTRIN/CA #15/ASPARTAME CAL GLUCONATE/CAL LACTATE/GUM WHEAT DEXTRIN/B6/FA/B12 WHEAT DEXTRIN BISACODYL BISACODYL BISACODYL BISMUTH SUBSALICYLATE BISMUTH SUBSALICYLATE BISMUTH SUBSALICYLATE CASANTHRANOL SENNOSIDES PEDIATRIC NUTRIT,IRON,LF&FIBER LACTOSE-REDUCED FOOD/FIBER LACTOSE-REDUCED FOOD/FIBER SODIUM PHENYLBUTYRATE CALCIUM CARBONATE CALCIUM CARBONATE CALCIUM CARBONATE CALCIUM CARBONATE CALCIUM CARBONATE DOCUSATE CALCIUM CALCIUM CARBONATE/VITAMIN D3 CALCIUM CARBONATE CALCIUM CARBONATE CARGLUMIC ACID POTASSIUM BITART/SODIUM BICARB ALBUMEN (ALBUMIN)/TANNIC ACID CHENODIOL WHEAT DEXTRIN BISMUTH SUBSALICYLATE INULIN SENNOSIDES CHOLIC ACID MAGNESIUM CITRATE MAGNESIUM CITRATE METHYLCELLULOSE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER BRAND DRUG CLEAR 2 GO CLEARLAX CLEAR-LAX COLOX COLYTE WITH FLAVOR PACKETS COLYTE WITH FLAVOR PACKS CONSTULOSE CORRECTIVE LAXATIVE CORRECTOL CURAD ENEMA CVF DIAMODE DIARRHEA RELIEF DIOTAME DIOTAME INSTYDOSE DIPHENOXYLATE-ATROPINE DISPOSABLE ENEMA DOC-Q-LAX DOCUSATE SODIUM-SENNA DOCUSOL PLUS DOK PLUS DUCODYL DULCOLAX DULCOLAX BALANCE EASY FIBER ENEMA ENEMA DISPOSABLE ENSURE WITH FIBER ENTEREG ENULOSE EQUALACTIN EX-LAX EX-LAX MAXIMUM STRENGTH EX-LAX MILK OF MAGNESIA FAST RELIEF LAXATIVE FEMATROL LAXATIVE FIBER FIBER CHOICE FIBER FLOW FIBER GUMMIES FIBER LAX FIBER LAXATIVE FIBER PLUS FIBER PLUS CALCIUM FIBER SELECT GUMMIES FIBER SMOOTH FIBER SUPPLEMENT FIBER TABS FIBER THERAPY FIBER WITH PROBIOTIC FIBERCON 146 GENERIC DRUG FOS/MALTODEXTRIN POLYETHYLENE GLYCOL 3350 POLYETHYLENE GLYCOL 3350 PSYLLIUM HUSK/LAXATIVE NO.1 PEG 3350/NA SULF,BICARB,CL/KCL PEG 3350/NA SULF,BICARB,CL/KCL LACTULOSE BISACODYL BISACODYL NA PHOS,M-B/NA PHOS,DI-BA FIBER/MALTODEXTRIN/INULIN/FOS LOPERAMIDE HCL BISMUTH SUBSALICYLATE BISMUTH SUBSALICYLATE BISMUTH SUBSALICYLATE DIPHENOXYLATE HCL/ATROPINE NA PHOS,M-B/NA PHOS,DI-BA SENNOSIDES/DOCUSATE SODIUM DOCUSATE CALCIUM SENNOSIDES/DOCUSATE SODIUM DOCUSATE SODIUM/BENZOCAINE SENNOSIDES/DOCUSATE SODIUM BISACODYL BISACODYL POLYETHYLENE GLYCOL 3350 DEXTRIN MINERAL OIL NA PHOS,M-B/NA PHOS,DI-BA LACTOSE-REDUCED FOOD/FIBER ALVIMOPAN LACTULOSE CALCIUM POLYCARBOPHIL BISACODYL SENNOSIDES MAGNESIUM HYDROXIDE BISACODYL BISACODYL CALCIUM POLYCARBOPHIL INULIN FOS/MALTO/POLYDEXTROSE/SORB 70 INULIN CALCIUM POLYCARBOPHIL CALCIUM POLYCARBOPHIL ACAC/INUL/C-LSE/CHROM/GRN TEA PSYLLIUM HUSK/CA CARBONATE INULIN/CHROMIUM PICOLINATE PSYLLIUM SEED INULIN/SORBITOL CALCIUM POLYCARBOPHIL CALCIUM POLYCARBOPHIL WHEAT DEXTRIN/L.ACID/ASPARTAME CALCIUM POLYCARBOPHIL KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER BRAND DRUG FIBER-LAX FIBER-STAT FIBERTAB FIBER-TABS FULYZAQ GATTEX GAVILAX GAVILYTE-C GAVILYTE-G GAVILYTE-H AND BISACODYL GAVILYTE-N GENERLAC GENTLE LAXATIVE GENTLELAX GERI-KOT GERI-MUCIL GLYCOLAX GOLYTELY HALFLYTELY-BISACODYL HEALTHYLAX HIGH POTENCY CALCIUM HYDROCIL INSTANT HYFIBER IMODIUM MULTI-SYMPTOM RELIEF IMPACT WITH FIBER IMPERIM ISOSOURCE 1.5 CAL ISOSOURCE 1.5 CAL TUBE FEED ISOSOURCE VHN JEVITY 1.2 CAL JEVITY 1.5 CAL KAOLIN PECTIN KAOPECTATE KAO-TIN KOLA-PECTIN DS KONDREMUL KONSYL KONSYL BALANCE KONSYL EASY MIX KONSYL FIBER KONSYL FORMULA-D KONSYL-D K-PEC KRISTALOSE LAX STOOL SOFTENER WITH SENNA LAXA CLEAR LAXACIN LAXATIVE LAXATIVE FEMININE LAXATIVE MAXIMUM STRENGTH 147 GENERIC DRUG CALCIUM POLYCARBOPHIL FOS/MALTODEXTRIN CALCIUM POLYCARBOPHIL CALCIUM POLYCARBOPHIL CROFELEMER TEDUGLUTIDE POLYETHYLENE GLYCOL 3350 PEG 3350/NA SULF,BICARB,CL/KCL PEG 3350/NA SULF,BICARB,CL/KCL BISAC/NACL/NAHCO3/KCL/PEG 3350 SODIUM CHLORIDE/NAHCO3/KCL/PEG LACTULOSE BISACODYL POLYETHYLENE GLYCOL 3350 SENNOSIDES PSYLLIUM HUSK/ASPARTAME POLYETHYLENE GLYCOL 3350 PEG 3350/NA SULF,BICARB,CL/KCL BISAC/NACL/NAHCO3/KCL/PEG 3350 POLYETHYLENE GLYCOL 3350 CALCIUM CARBONATE PSYLLIUM SEED ACACIA IMODIUM A-D LOPERAMIDE HCL/SIMETHICONE NUT.TX.COMP.IMMUNE SYS/SOY FIB LOPERAMIDE HCL LACTOSE-REDUCED FOOD/FIBER LACTOSE-REDUCED FOOD/FIBER LACTOSE-REDUCED FOOD/FIBER LACTOSE-REDUCED FOOD/FIBER LACTOSE-REDUCED FOOD/FIBER KAOLIN/PECTIN ATTAPULGITE BISMUTH SUBSALICYLATE BISMUTH SUBSALICYLATE MINERAL OIL/CARRAGEENAN PSYLLIUM HUSK PSYLLIUM HUSK/INULIN/ASPARTAME PSYLLIUM HUSK CALCIUM POLYCARBOPHIL PSYLLIUM HUSK (WITH DEXTROSE) PSYLLIUM SEED (WITH DEXTROSE) BISMUTH SUBSALICYLATE LACTULOSE LACTULOSE SENNOSIDES/DOCUSATE SODIUM POLYETHYLENE GLYCOL 3350 SENNOSIDES/DOCUSATE SODIUM BISACODYL BISACODYL SENNOSIDES KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER BRAND DRUG LAXATIVE PEG 3350 LAXATIVE PILLS LAXATIVE SUPPOSITORY LAXATIVE-SENNA LIQUAFIBER LIQUID FIBER FLOW LITHOSTAT LOMOTIL LOPERAMIDE LO-PERAMIDE LO-SO PREP KIT LOTRONEX MAALOX MAGIC BULLET MEDI-BISMUTH MEDI-LAX MEDI-LAXX MEDI-MUCIL MEDI-NATURAL MEDI-NATURAL SENNA STOOL SOFT METAFIBER METAMUCIL METAMUCIL FIBER SINGLES METAMUCIL MULTIHEALTH FIBER METAMUCIL OT METAMUCIL PLUS CALCIUM MILK OF MAGNESIA MINERAL OIL ENEMA MINERAL OIL EXTRA HEAVY MIRALAX MOTOFEN MOVANTIK MOVIPREP NARCOSOFT NARCOSOFT II NATURAL CALCIUM NATURAL DAILY FIBER NATURAL FIBER NATURAL FIBER LAXATIVE NATURAL FIBER POWDER NATURAL FIBER SUPPLEMENT NATURAL LAXATIVE NATURAL PSYLLIUM FIBER NATURAL SENNA LAXATIVE NATURAL VEGETABLE FIBER NATURAL VEGETABLE LAXATIVE NATURAL VEGETABLE POWDER NULYTELY WITH FLAVOR PACKS NUTRISOURCE FIBER OAT BRAN OCL 148 GENERIC DRUG POLYETHYLENE GLYCOL 3350 SENNOSIDES BISACODYL SENNOSIDES GLYCERIN/MALTODEXTRIN FOS/MALTODEXTRIN/POLYDEXTROSE ACETOHYDROXAMIC ACID DIPHENOXYLATE HCL/ATROPINE LOPERAMIDE HCL LOPERAMIDE HCL BISACODYL/MAGNESIUM CITRATE ALOSETRON HCL BISMUTH SUBSALICYLATE BISACODYL MAGNESIUM CITRATE BISMUTH SUBSALICYLATE SENNOSIDES SENNOSIDES/DOCUSATE SODIUM PSYLLIUM HUSK SENNOSIDES SENNOSIDES/DOCUSATE SODIUM PSYLLIUM SEED INULIN PSYLLIUM HUSK/ASPARTAME PSYLLIUM HUSK/ASPARTAME PSYLLIUM SEED (WITH SUGAR) PSYLLIUM HUSK/CA CARBONATE MAGNESIUM HYDROXIDE MINERAL OIL MINERAL OIL POLYETHYLENE GLYCOL 3350 DIFENOXIN HCL/ATROPINE SULFATE NALOXEGOL OXALATE PEG3350/SOD SUL/NACL/ASB/C/KCL SENNA/PSYLL/CASC/L.ACID/HB#195 SENNA/PSYLL/CASC/L.ACID/HB#235 CALCIUM CARBONATE PSYLLIUM HUSK (WITH SUGAR) PSYLLIUM HUSK PSYLLIUM HUSK (WITH SUGAR) PSYLLIUM SEED (WITH DEXTROSE) PSYLLIUM HUSK/ASPARTAME SENNOSIDES PSYLLIUM HUSK/ASPARTAME SENNOSIDES PSYLLIUM HUSK (WITH SUGAR) PSYLLIUM SEED (WITH DEXTROSE) PSYLLIUM HUSK (WITH SUGAR) SODIUM CHLORIDE/NAHCO3/KCL/PEG GUAR GUM BRAN SOD SULF/SODIUM/NAHCO3/KCL/PEG KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER BRAND DRUG ORAL SALINE LAXATIVE ORAL SALINE LAXATIVE KIT OSMOPREP OYSCO-500 OYST-CAL-500 OYSTER SHELL CALCIUM P-COL RITE PEDIA-LAX ENEMA PEDIA-LAX FIBER GUMMIES PEDIA-LAX STRIP PEDIASURE ENTERAL WITH FIBER PEDIASURE WITH FIBER PEDIATRIC ENEMA PEG 3350-ELECTROLYTE PEG3350 PEG-3350 PEG-3350 AND ELECTROLYTES PEG-3350 WITH FLAVOR PACKS PEG-PREP PEPTAMEN JUNIOR FIBER PEPTIC RELIEF PEP-T-MED PEPTO-BISMOL PEPTO-BISMOL TO-GO PERDIEM PERI-COLACE PHILLIPS' MILK OF MAGNESIA PHOSPHATE ENEMA PHOSPHATE LAXATIVE PINK BISMUTH POWDERLAX PREP KIT #3 PREPARATION CLEANSING PREPOPIK PROMOTE WITH FIBER PSYLLIUM FIBER PSYLLIUM SEED PURELAX RAVICTI READY TO USE ENEMA REGULOID RELISTOR RESOURCE WITH FIBER SALINE ENEMA SB GENTLE LAX-WOMEN SENEXON SENEXON-S SENNA 149 GENERIC DRUG OPIUM TINCTURE NA PHOS,M-B/NA PHOS,DI-BA NA PHOS,M-B/NA PHOS,DI-BA NAPHOS M-B M-H/NA PHOS,DI-BA CALCIUM CARBONATE CALCIUM CARBONATE OYSTER CALCIUM CALCIUM CARBONATE PAREGORIC SENNOSIDES/DOCUSATE SODIUM NA PHOS,M-B/NA PHOS,DI-BA POLYDEXTROSE/XYLITOL SENNOSIDES PEDIATRIC NUTRIT,IRON,LF&FIBER PEDIATRIC NUTRIT,IRON,LF&FIBER NA PHOS,M-B/NA PHOS,DI-BA PEG 3350/NA SULF,BICARB,CL/KCL POLYETHYLENE GLYCOL 3350 SODIUM CHLORIDE/NAHCO3/KCL/PEG PEG 3350/NA SULF,BICARB,CL/KCL SODIUM CHLORIDE/NAHCO3/KCL/PEG BISAC/NACL/NAHCO3/KCL/PEG 3350 NUTRIT SUPP/INULIN/FOS/FIBER BISMUTH SUBSALICYLATE BISMUTH SUBSALICYLATE BISMUTH SUBSALICYLATE BISMUTH SUBSALICYLATE CALCIUM POLYCARBOPHIL SENNOSIDES/DOCUSATE SODIUM MAGNESIUM HYDROXIDE NA PHOS,M-B/NA PHOS,DI-BA NA PHOS,M-B/NA PHOS,DI-BA BISMUTH SUBSALICYLATE POLYETHYLENE GLYCOL 3350 POLYETHYLENE GLYCOL 3350 BISACODYL/NAPH,MB-DB NA PHOS,M-B/NA PHOS,DI-BA SOD PICOSULF/MAG OX/CITRIC AC LACTOSE-REDUCED FOOD/FIBER PSYLLIUM HUSK PSYLLIUM HUSK POLYETHYLENE GLYCOL 3350 GLYCEROL PHENYLBUTYRATE MINERAL OIL PSYLLIUM HUSK METHYLNALTREXONE BROMIDE LACTOSE-REDUCED FOOD/FIBER NA PHOS,M-B/NA PHOS,DI-BA BISACODYL SENNOSIDES SENNOSIDES/DOCUSATE SODIUM SENNA LEAF EXTRACT KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER LOWER GASTROINTESTINAL DISORDERS - OTHER BRAND DRUG SENNA LAX SENNA LAXATIVE SENNA PLUS SENNA PROMPT SENNA S SENNA SOFT SENNA-C SENNA-C PLUS SENNA-DOCUSATE SODIUM SENNA-EXTRA SENNA-GEN SENNALAX-S SENNA-S SENNO SENNOSIDES-DOCUSATE SODIUM SENOKOT SENOKOT TO GO SENOKOT-S SENOKOTXTRA SEN-O-TAB SMOOTHLAX SOL CARB SOLUBLE FIBER SOLUBLE FIBER THERAPY SOOTHE STIMULANT LAXATIVE PLUS STOMACH RELIEF STOMACH RELIEF ORIGINAL STOOL SOFTENER-LAXATIVE STOOL SOFTENER-STIMULANT LAX SUCLEAR SUPER CALCIUM SUPREP SURFAK TOTAL FIBER TRILYTE WITH FLAVOR PACKETS ULTRA A-D UNIFIBER URSO URSO FORTE VACUANT PLUS VEGETABLE LAXATIVE VISICOL WAL-MUCIL WAL-MUCIL NATURAL FIBER LAX WAL-MUCIL PLUS CALCIUM WAL-PHOSPHATE WEIGHT MANAGEMENT FIBER WOMAN'S LAXATIVE WOMEN'S GENTLE LAXATIVE 150 GENERIC DRUG SENNOSIDES SENNOSIDES SENNOSIDES/DOCUSATE SODIUM SENNOSIDES/PSYLLIUM HUSK SENNOSIDES/DOCUSATE SODIUM SENNOSIDES SENNOSIDES SENNOSIDES/DOCUSATE SODIUM SENNOSIDES/DOCUSATE SODIUM SENNOSIDES SENNOSIDES SENNOSIDES/DOCUSATE SODIUM SENNOSIDES/DOCUSATE SODIUM SENNOSIDES SENNOSIDES/DOCUSATE SODIUM SENNOSIDES SENNOSIDES SENNOSIDES/DOCUSATE SODIUM SENNOSIDES SENNOSIDES POLYETHYLENE GLYCOL 3350 SODIUM PHENYLBUTYRATE MALTODEXTRIN METHYLCELLULOSE METHYLCELLULOSE (WITH SUGAR) BISMUTH SUBSALICYLATE SENNOSIDES/DOCUSATE SODIUM BISMUTH SUBSALICYLATE BISMUTH SUBSALICYLATE SENNOSIDES/DOCUSATE SODIUM SENNOSIDES/DOCUSATE SODIUM PEG 3350-BOWEL 2,TWO PART PREP CALCIUM CARBONATE SODIUM,POTASSIUM,&MAG SULFATES DOCUSATE CALCIUM WHEAT DEXTRIN SODIUM CHLORIDE/NAHCO3/KCL/PEG LOPERAMIDE HCL CELLULOSE URSODIOL URSODIOL URSODIOL DOCUSATE SODIUM/BENZOCAINE PSYLLIUM SEED NA PHOS MONO&DIBASIC/CELLULOSE PSYLLIUM HUSK PSYLLIUM HUSK (WITH SUGAR) PSYLLIUM HUSK/CA CARBONATE NA PHOS,M-B/NA PHOS,DI-BA INULIN/SORBITOL BISACODYL BISACODYL KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION LOWER GASTROINTESTINAL DISORDERS - OTHER MISCELLANEOUS AGENTS MISCELLANEOUS AGENTS MISCELLANEOUS AGENTS MISCELLANEOUS AGENTS MISCELLANEOUS AGENTS MISCELLANEOUS AGENTS MISCELLANEOUS AGENTS MISCELLANEOUS AGENTS MISCELLANEOUS AGENTS MISCELLANEOUS AGENTS MISCELLANEOUS AGENTS MISCELLANEOUS AGENTS NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE BRAND DRUG WOMEN'S LAXATIVE ARALAST ARALAST NP EVOXAC GLASSIA NEXAVIR PROLASTIN PROLASTIN C URECHOLINE ZEMAIRA ABRAXANE ADCETRIS ADRIAMYCIN ALIMTA ALKERAN AMIFOSTINE ARIMIDEX AROMASIN ARRANON ARZERRA AVASTIN BELEODAQ BEXXAR BICNU BLINCYTO BOSULIF BUSULFEX CAMPATH CAMPTOSAR CAPRELSA CASODEX CEENU CERUBIDINE CLOLAR COMETRIQ COSMEGEN CYCLOPHOSPHAMIDE CYRAMZA DACOGEN 151 GENERIC DRUG BISACODYL ALPHA-1-PROTEINASE INHIBITOR ALPHA-1-PROTEINASE INHIBITOR BETHANECHOL CHLORIDE CEVIMELINE HCL CEVIMELINE HCL ALPHA-1-PROTEINASE INHIBITOR GUANIDINE HCL LIVER EXTRACT (BEEF-PORK) ALPHA-1-PROTEINASE INHIBITOR ALPHA-1-PROTEINASE INHIBITOR BETHANECHOL CHLORIDE ALPHA-1-PROTEINASE INHIBITOR PACLITAXEL PROTEIN-BOUND BRENTUXIMAB VEDOTIN DOXORUBICIN HCL PEMETREXED DISODIUM MELPHALAN AMIFOSTINE CRYSTALLINE ANASTROZOLE ANASTROZOLE EXEMESTANE NELARABINE OFATUMUMAB BEVACIZUMAB AZACITIDINE BELINOSTAT TOSITUMOMAB (WITH MALTOSE) BICALUTAMIDE CARMUSTINE BLEOMYCIN SULFATE BLINATUMOMAB BOSUTINIB BUSULFAN ALEMTUZUMAB IRINOTECAN HCL CAPECITABINE VANDETANIB CARBOPLATIN BICALUTAMIDE LOMUSTINE DAUNORUBICIN HCL CISPLATIN CLADRIBINE CLOFARABINE CABOZANTINIB S-MALATE DACTINOMYCIN RAMUCIRUMAB CYTARABINE DACARBAZINE DECITABINE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE BRAND DRUG GENERIC DRUG DACTINOMYCIN DAUNORUBICIN HCL DAUNORUBICIN CITRATE LIPOSOMAL DECITABINE CYTARABINE LIPOSOME/PF DEXRAZOXANE HCL DOCETAXEL DAUNOXOME DEPOCYT DEXRAZOXANE DOCEFREZ DOCETAXEL DOXIL DOXORUBICIN HCL LIPOSOME ELLENCE ELOXATIN ELSPAR EMCYT ERBITUX ERIVEDGE ERWINAZE ETHYOL ETOPOPHOS FARESTON FARYDAK FASLODEX FEMARA FIRMAGON FLUDARA FOLOTYN FUSILEV GAZYVA GEMZAR GILOTRIF GLEEVEC GLEOSTINE GLIADEL HALAVEN HERCEPTIN HEXALEN HYCAMTIN IBRANCE ICLUSIG IDAMYCIN PFS IFEX IFOSFAMIDE-MESNA 152 DOXORUBICIN HCL PEG-LIPOSOMAL DOXORUBICIN HCL DOXORUBICIN HCL PEG-LIPOSOMAL EPIRUBICIN HCL OXALIPLATIN ASPARAGINASE ESTRAMUSTINE PHOSPHATE SODIUM EPIRUBICIN HCL CETUXIMAB VISMODEGIB ASPARAGINASE (ERWINIA CHRYSAN) AMIFOSTINE CRYSTALLINE ETOPOSIDE PHOSPHATE ETOPOSIDE EXEMESTANE TOREMIFENE CITRATE PANOBINOSTAT LACTATE FULVESTRANT LETROZOLE DEGARELIX ACETATE FLOXURIDINE FLUDARABINE PHOSPHATE FLUDARABINE PHOSPHATE FLUTAMIDE PRALATREXATE LEVOLEUCOVORIN CALCIUM OBINUTUZUMAB GEMCITABINE HCL GEMCITABINE HCL AFATINIB DIMALEATE IMATINIB MESYLATE LOMUSTINE CARMUSTINE IN POLIFEPROSAN 20 ERIBULIN MESYLATE TRASTUZUMAB ALTRETAMINE TOPOTECAN HCL PALBOCICLIB PONATINIB HCL IDARUBICIN HCL IDARUBICIN HCL IFOSFAMIDE IFOSFAMIDE IFOSFAMIDE/MESNA KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE BRAND DRUG IMBRUVICA INLYTA IRESSA ISTODAX IXEMPRA JAKAFI JEVTANA KADCYLA KEYTRUDA KYPROLIS LEMTRADA LENVIMA LEUKERAN LEUSTATIN LEVULAN LIPODOX LIPODOX 50 LYNPARZA LYSODREN MARQIBO MATULANE MEGACE MEGACE ES MEKINIST MESNEX METVIXIA MYLERAN MYLOTARG NAVELBINE NEXAVAR NILANDRON NIPENT NOVANTRONE OFORTA ONCASPAR ONTAK ONXOL OPDIVO PERJETA PHOTOFRIN 153 GENERIC DRUG IBRUTINIB AXITINIB GEFITINIB IRINOTECAN HCL ROMIDEPSIN IXABEPILONE RUXOLITINIB PHOSPHATE CABAZITAXEL ADO-TRASTUZUMAB EMTANSINE PEMBROLIZUMAB CARFILZOMIB ALEMTUZUMAB LENVATINIB MESYLATE LETROZOLE LEUCOVORIN CALCIUM CHLORAMBUCIL CLADRIBINE AMINOLEVULINIC ACID HCL DOXORUBICIN HCL PEG-LIPOSOMAL DOXORUBICIN HCL PEG-LIPOSOMAL LOMUSTINE OLAPARIB MITOTANE VINCRISTINE SULFATE LIPOSOMAL PROCARBAZINE HCL MEGESTROL ACETATE MEGESTROL ACETATE MEGESTROL ACETATE TRAMETINIB DIMETHYL SULFOXIDE MELPHALAN HCL MERCAPTOPURINE MESNA MESNA METHYL AMINOLEVULINATE HCL MITOXANTRONE HCL BUSULFAN GEMTUZUMAB OZOGAMICIN VINORELBINE TARTRATE SORAFENIB TOSYLATE NILUTAMIDE PENTOSTATIN MITOXANTRONE HCL FLUDARABINE PHOSPHATE PEGASPARGASE DENILEUKIN DIFTITOX PACLITAXEL NIVOLUMAB OXALIPLATIN PACLITAXEL PENTOSTATIN PERTUZUMAB PORFIMER SODIUM KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE NEOPLASTIC DISEASE BRAND DRUG POMALYST PROVENGE PURINETHOL PURIXAN REVLIMID RITUXAN SOLTAMOX SPRYCEL STIVARGA SUTENT SYLVANT SYNRIBO TABLOID TAFINLAR TARCEVA TASIGNA TAXOTERE TEMODAR TOPOSAR TORISEL TOTECT TREANDA TRISENOX TYKERB VALSTAR VANDETANIB VECTIBIX VELCADE VIDAZA VINCASAR PFS VORAXAZE VOTRIENT VUMON XALKORI XELODA XTANDI YERVOY ZANOSAR ZELBORAF ZEVALIN ZINECARD ZOLINZA ZYDELIG ZYKADIA 154 GENERIC DRUG POMALIDOMIDE SIPULEUCEL-T/LACTATED RINGERS MERCAPTOPURINE MERCAPTOPURINE LENALIDOMIDE RITUXIMAB TAMOXIFEN CITRATE DASATINIB REGORAFENIB SUNITINIB MALATE SILTUXIMAB OMACETAXINE MEPESUCCINATE THIOGUANINE DABRAFENIB MESYLATE TAMOXIFEN CITRATE ERLOTINIB HCL NILOTINIB HCL DOCETAXEL TEMOZOLOMIDE TEMOZOLOMIDE TENIPOSIDE THIOTEPA ETOPOSIDE TOPOTECAN HCL TEMSIROLIMUS DEXRAZOXANE HCL BENDAMUSTINE HCL ARSENIC TRIOXIDE LAPATINIB DITOSYLATE VALRUBICIN PANITUMUMAB BORTEZOMIB AZACITIDINE VINBLASTINE SULFATE VINCRISTINE SULFATE VINCRISTINE SULFATE VINORELBINE TARTRATE GLUCARPIDASE PAZOPANIB HCL TENIPOSIDE CRIZOTINIB CAPECITABINE ENZALUTAMIDE IPILIMUMAB STREPTOZOCIN VEMURAFENIB KIT FOR Y-90/IBRITUMOMAB/ALBUM DEXRAZOXANE HCL VORINOSTAT IDELALISIB CERITINIB KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION NEOPLASTIC DISEASE NEUROLOGICAL DISEASE - MISCELLANEOUS NEUROLOGICAL DISEASE - MISCELLANEOUS NEUROLOGICAL DISEASE - MISCELLANEOUS NEUROLOGICAL DISEASE - MISCELLANEOUS NEUROLOGICAL DISEASE - MISCELLANEOUS NEUROLOGICAL DISEASE - MISCELLANEOUS NEUROLOGICAL DISEASE - MISCELLANEOUS NEUROLOGICAL DISEASE - MISCELLANEOUS NEUROLOGICAL DISEASE - MISCELLANEOUS NEUROLOGICAL DISEASE - MISCELLANEOUS NEUROLOGICAL DISEASE - MISCELLANEOUS NEUROLOGICAL DISEASE - MISCELLANEOUS NEUROLOGICAL DISEASE - MISCELLANEOUS NEUROLOGICAL DISEASE - MISCELLANEOUS NEUROLOGICAL DISEASE - MISCELLANEOUS NEUROLOGICAL DISEASE - MISCELLANEOUS NEUROLOGICAL DISEASE - MISCELLANEOUS NEUROLOGICAL DISEASE - MISCELLANEOUS NEUROLOGICAL DISEASE - MISCELLANEOUS NEUROLOGICAL DISEASE - MISCELLANEOUS NEUROLOGICAL DISEASE - MISCELLANEOUS NEUROLOGICAL DISEASE - MISCELLANEOUS NEUROLOGICAL DISEASE - MISCELLANEOUS NEUROLOGICAL DISEASE - MISCELLANEOUS NEUROLOGICAL DISEASE - MISCELLANEOUS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS BRAND DRUG ZYTIGA AMPYRA AUBAGIO AVONEX AVONEX ADMINISTRATION PACK AVONEX PEN BETASERON COPAXONE EXTAVIA FANATREX GILENYA GRALISE HORIZANT NEURONTIN NUEDEXTA PLEGRIDY PLEGRIDY PEN REBIF REBIF REBIDOSE RILUTEK SAVELLA TECFIDERA TYSABRI XENAZINE ACT ANTI-CAVITY MOUTH RINSE ACT MOUTHWASH ANTICAVITY FLUORIDE ANTI-PLAQUE DENTAL RINSE ANTISEPTIC MOUTH RINSE ARESTIN BIOTENE BREATH SPRAY CAVIRINSE CITRUS ANTISEPTIC CLINPRO 5000 CONTROL RX DENTA 5000 PLUS DENTAGEL DENTAPAINE DENTIVA EPIFLUR FLUORABON FLUOR-A-DAY FLUORIDE FLUORIDEX DAILY DEFENSE FLUORITAB FLURA-DROPS GUMSOL KEPIVANCE LISTERINE ANTISEPTIC 155 GENERIC DRUG ABIRATERONE ACETATE DALFAMPRIDINE TERIFLUNOMIDE INTERFERON BETA-1A INTERFERON BETA-1A/ALBUMIN INTERFERON BETA-1A INTERFERON BETA-1B GLATIRAMER ACETATE INTERFERON BETA-1B GABAPENTIN GABAPENTIN FINGOLIMOD HCL GABAPENTIN GABAPENTIN ENACARBIL GABAPENTIN DEXTROMETHORPHAN HBR/QUINIDINE PEGINTERFERON BETA-1A PEGINTERFERON BETA-1A INTERFERON BETA-1A/ALBUMIN INTERFERON BETA-1A/ALBUMIN RILUZOLE RILUZOLE MILNACIPRAN HCL DIMETHYL FUMARATE NATALIZUMAB TETRABENAZINE SODIUM FLOURIDE CETYLPYRD CL/DOMIPHEN BROMIDE SODIUM FLUORIDE NA PY-PH/ALC/GLY/SLS/H2O EUCALYP/ME-SALICYLATE/MEN/THYM MINOCYCLINE HCL MICROSPHERES FLUORIDE TOOTHPASTE MOUTHWASH SODIUM FLUORIDE EUCALYP/ME-SALICYLATE/MEN/THYM SODIUM FLUORIDE SODIUM FLUORIDE SODIUM FLUORIDE SODIUM FLUORIDE BENZOCAINE/GLYCERIN/CLOVE OIL XYLITOL/ANTISEPTIC COMBO NO.5 SODIUM FLUORIDE SODIUM FLUORIDE SODIUM FLUORIDE SODIUM FLUORIDE SODIUM FLUORIDE SODIUM FLUORIDE SODIUM FLUORIDE ZINC CHLORIDE/BENZOCAINE PALIFERMIN EUCALYP/ME-SALICYLATE/MEN/THYM KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS ORAL/PHARYNGEAL DISORDERS OTHER DRUGS OTHER DRUGS OTHER DRUGS OTHER DRUGS OTHER DRUGS OTHER DRUGS OTHER DRUGS OTHER DRUGS OTHER DRUGS OTHER DRUGS OTHER DRUGS OTHER DRUGS OTHER DRUGS OTHER DRUGS OTHER DRUGS OTHER DRUGS OTHER RESPIRATORY DISORDERS OTHER RESPIRATORY DISORDERS OTHER RESPIRATORY DISORDERS OTHER RESPIRATORY DISORDERS OTHER RESPIRATORY DISORDERS OTHER RESPIRATORY DISORDERS OTHER RESPIRATORY DISORDERS OTHER RESPIRATORY DISORDERS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS BRAND DRUG LOZI-FLUR LUDENT FLUORIDE MOUTH RINSE ANTISEPTIC MOUTHRINSE MOUTHSPRAY NAFRINSE DAILY-NEUTRAL PHOS-FLUR PLAX PREVIDENT PREVIDENT 5000 PREVIDENT 5000 PLUS PROTEXIN REMESENSE RENAF SALESE SF SF 5000 PLUS SODIPHLUOR ZINC ZINC + VITAMIN C ZINC LOZENGE ZINC-15 ZINC-220 ZINCATE ZN-DTPA ZOHYDRO ER ZOLMITRIPTAN ODT ZOMIG ZOMIG ZMT ZYTAZE CUROSURF ESBRIET INFASURF KALYDECO OFEV PULMOZYME SURFAXIN SURVANTA ACETAMINOPH-CAFFDIHYDROCODEIN ACETAMINOPHEN-BUTALBITAL ACETAMINOPHEN-CODEINE ADDED STRENGTH HEADACHE ADDED STRENGTH PAIN RELIEVER ALAGESIC ALAGESIC LQ ALKA-SELTZER ALKA-SELTZER ORIGINAL 156 GENERIC DRUG SODIUM FLUORIDE SODIUM FLUORIDE EUCALYP/ME-SALICYLATE/MEN/THYM EUCALYP/ME-SALICYLATE/MEN/THYM MOUTHWASH SODIUM FLUORIDE SODIUM FLUORIDE NA PY-PH/ALC/GLY/SLS/H2O SODIUM FLUORIDE SODIUM FLUORIDE SODIUM FLUORIDE MENTHOL/PEPPERMINT OIL POTASSIUM OXALATE SODIUM FLUORIDE XYLITOL/ANTISEPTIC COMBO NO.6 SODIUM FLUORIDE SODIUM FLUORIDE SODIUM FLUORIDE SODIUM FLUORIDE ZINC GLUCONATE VIT C/ZINC CITRATE/HERBAL #163 ZINC CHLORIDE ZINC GLUCONATE ZINC GLUCONATE ZINC SULFATE ZINC SULFATE ZINC SULFATE ZINC SULFATE PENTETATE ZINC TRISODIUM HYDROCODONE BITARTRATE ZOLMITRIPTAN ZOLMITRIPTAN ZOLMITRIPTAN ZOLMITRIPTAN ZINC CITRATE/PHYTASE PORACTANT ALFA PIRFENIDONE CALFACTANT IVACAFTOR NINTEDANIB ESYLATE DORNASE ALFA LUCINACTANT BERACTANT DHCODEINE BT/ACETAMINOPHN/CAFF BUTALBITAL/ACETAMINOPHEN ACETAMINOPHEN WITH CODEINE ASPIRIN/ACETAMINOPHEN/CAFFEINE ASPIRIN/ACETAMINOPHEN/CAFFEINE BUTALB/ACETAMINOPHEN/CAFFEINE BUTALB/ACETAMINOPHEN/CAFFEINE ASPIRIN/SOD BICARB/CITRIC ACID ASPIRIN/SOD BICARB/CITRIC ACID KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS BRAND DRUG AMERGE ANABAR ANACIN ANOLOR-300 ANTACID & PAIN RELIEF ARTHRITIS BC ASCOMP WITH CODEINE ASCRIPTIN ASPIRIN BUFFERED ASPIRIN-CAFFEINE ASPIRIN-CAFFEINE-DIHYDROCODEIN AXERT BACK & BODY PAIN RELIEVER BACK PAIN-OFF BALACET 325 BAYER BACK & BODY BAYER MIGRAINE BAYER PLUS BAYER PM BC BC ARTHRITIS BE-FLEX PLUS BELLADONNA-OPIUM BUFFERED ASPIRIN BUFFERIN BUNAVAIL BUPAP BUPRENORPHINE-NALOXONE BUTALB-ACETAMINOPH-CAFF-CODEIN BUTALB-CAFF-ACETAMINOPH-CODEIN BUTALBITAL COMPOUND BUTALBITAL COMPOUND-CODEINE BUTALBITAL-ACETAMINOPHEN-CAFFE BUTALBITAL-ASPIRIN-CAFFEINE BUTRANS CAFERGOT CAFGESIC CAPACET CAPITAL W-CODEINE CARISOPRODOL COMPOUNDCODEINE CARISOPRODOL-ASPIRIN-CODEINE CEPHADYN COCET COCET PLUS CODEINE SULFATE CO-GESIC CRAMP DARVOCET A500 DARVOCET-N 100 DARVOCET-N 50 DARVON DEPODUR 157 GENERIC DRUG NARATRIPTAN HCL SAL-AMIDE/ACETAMINOPHN/P-TLOX ASPIRIN/CAFFEINE BUTALB/ACETAMINOPHEN/CAFFEINE ASPIRIN/SOD BICARB/CITRIC ACID ASPIRIN/SALICYLAMIDE/CAFFEINE CODEINE/BUTALBITAL/ASA/CAFFEIN ASA/CALCIUM CARB/MAG/AL HYDROX ASPIRIN/CALCIUM CARBONATE/MAG ASPIRIN/CAFFEINE DIHYDROCODEINE/ASPIRIN/CAFFEIN ALMOTRIPTAN MALATE ASPIRIN/CAFFEINE MG SALICYLATE/ACETAMINOPH/CAFF PROPOXYPHENE NAP/ACETAMINOPHEN ASPIRIN/CAFFEINE ASPIRIN/ACETAMINOPHEN/CAFFEINE ASA/CALCIUM CARB/MAG/AL HYDROX ASPIRIN/DIPHENHYDRAMINE CITRAT ASPIRIN/CAFFEINE ASPIRIN/CAFFEINE SAL-AMIDE/ACETAMINOPHN/P-TLOX OPIUM/BELLADONNA ALKALOIDS ASPIRIN/CALCIUM CARBONATE/MAG ASPIRIN/CALCIUM CARBONATE/MAG BUPRENORPHINE HCL/NALOXONE HCL BUTALBITAL/ACETAMINOPHEN BUPRENORPHINE HCL/NALOXONE HCL BUTALBIT/ACETAMIN/CAFF/CODEINE BUTALBIT/ACETAMIN/CAFF/CODEINE BUTALBITAL/ASPIRIN/CAFFEINE CODEINE/BUTALBITAL/ASA/CAFFEIN BUTALB/ACETAMINOPHEN/CAFFEINE BUTALBITAL/ASPIRIN/CAFFEINE BUPRENORPHINE ERGOTAMINE TARTRATE/CAFFEINE SAL-AMIDE/ACETAMIN/P-TLOX/CAFF BUTALB/ACETAMINOPHEN/CAFFEINE ACETAMINOPHEN WITH CODEINE CODEINE/CARISOPRODOL/ASPIRIN CODEINE/CARISOPRODOL/ASPIRIN BUTALBITAL/ACETAMINOPHEN ACETAMINOPHEN WITH CODEINE ACETAMINOPHEN WITH CODEINE HYDROCODONE/ACETAMINOPHEN ACETAMINOPHEN/PAMABROM PROPOXYPHENE NAP/ACETAMINOPHEN PROPOXYPHENE NAP/ACETAMINOPHEN PROPOXYPHENE NAP/ACETAMINOPHEN PROPOXYPHENE HCL MORPHINE SULFATE LIPOSOMAL/PF KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS BRAND DRUG DILAUDID-HP DIUREX DOAN'S PM BACK PAIN RELIEF DOLGIC PLUS DURABAC DURACLON DURAXIN ED-FLEX EFFERVESCENT ANTACID EMBEDA ENDODAN EPIDRIN ERGOTAMINE-CAFFEINE ESGIC ESGIC-PLUS EXCEDRIN EXCEDRIN EXTRA STRENGTH EXCEDRIN MENSTRUAL COMPLETE EXCEDRIN MIGRAINE EXCEDRIN TENSION HEADACHE FENTANYL CITRATE-0.9% NACL FENTANYL CITRATE-D5W FENTANYL CITRATE-NS FENTANYL-BUPIVACAINE-NS FENTANYL-ROPIVACAINE-NS FIORICET FIORICET WITH CODEINE FIORINAL FIORINAL WITH CODEINE #3 FLEXTRA PLUS FRENADOL FROVA GOODY'S BODY PAIN GOODY'S EXTRA STRENGTH GOODY'S HEADACHE POWDER GOODY'S MIGRAINE RELIEF HEADACHE FORMULA HEADACHE PAIN HEADACHE RELIEF HYCET HYDROCODONE-ACETAMINOPHEN HYDROCODONE-APAP HYDROCODONE-IBUPROFEN HYDROGESIC HYDROMORPHONE HCL-D5W HYDROMORPHONE HCL-NS HYDROMORPHONE-BUPIVACAINE HYDROMORPHONE-BUPIVACAINE-NS IBUDONE ISOMETHEPT-CAFF-ACETAMINOPHEN ISOMETHEPT-DICHLORALP-ACETAMIN ISOMETHEPTENE-CAFFACETAMINOPH 158 GENERIC DRUG HYDROMORPHONE HCL/PF MAGNESIUM SALICYLATE/CAFFEINE MG SALICYLATE/DP-HYDRAM HCL BUTALB/ACETAMINOPHEN/CAFFEINE SAL-AMIDE/ACETAMIN/P-TLOX/CAFF CLONIDINE HCL/PF SAL-AMIDE/ACETAMINOPHN/P-TLOX SAL-AMIDE/ACETAMINOPHN/P-TLOX ASPIRIN/SOD BICARB/CITRIC ACID MORPHINE SULFATE/NALTREXONE OXYCODONE HCL/ASPIRIN ISOMETHEPT/DICHLPHN/ACETAMINOP ERGOTAMINE TARTRATE/CAFFEINE BUTALB/ACETAMINOPHEN/CAFFEINE BUTALB/ACETAMINOPHEN/CAFFEINE ACETAMINOPHEN/CAFFEINE ASPIRIN/ACETAMINOPHEN/CAFFEINE ASPIRIN/ACETAMINOPHEN/CAFFEINE ASPIRIN/ACETAMINOPHEN/CAFFEINE ACETAMINOPHEN/CAFFEINE FENTANYL CITRATE-0.9 % NACL/PF FENTANYL CITRATE/D5W/PF FENTANYL CITRATE/PF FENTANYL/BUPIVACAINE/NS/PF FENTANYL/ROPIVACAINE/NS/PF BUTALB/ACETAMINOPHEN/CAFFEINE BUTALBIT/ACETAMIN/CAFF/CODEINE BUTALBITAL/ASPIRIN/CAFFEINE CODEINE/BUTALBITAL/ASA/CAFFEIN ACETAMINOPHEN/PHENYLTOLOX/CAFF SALICYLAMIDE/ACETAMINOPHEN FROVATRIPTAN SUCCINATE ASPIRIN/ACETAMINOPHEN ASPIRIN/ACETAMINOPHEN/CAFFEINE ASA/ACETAMINOPHN/CAFFEIN/POT ASPIRIN/ACETAMINOPHEN/CAFFEINE ASPIRIN/ACETAMINOPHEN/CAFFEINE ASPIRIN/ACETAMINOPHEN/CAFFEINE ACETAMINOPHEN/CAFFEINE HYDROCODONE/ACETAMINOPHEN HYDROCODONE/ACETAMINOPHEN HYDROCODONE BIT/ACETAMINOPHEN HYDROCODONE/IBUPROFEN HYDROCODONE/ACETAMINOPHEN HYDROMORPHONE HCL IN D5W/PF HYDROMORPHONE HCL IN 0.9% NACL HYDROMORPHONE/BUPIV/0.9NACL/PF HYDROMORPHONE/BUPIV/0.9NACL/PF HYDROCODONE/IBUPROFEN ISOMETHEPTEN/CAF/ACETAMINOPHEN ISOMETHEPT/DICHLPHN/ACETAMINOP ISOMETHEPTEN/CAF/ACETAMINOPHEN KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS BRAND DRUG LEVACET LORCET LORCET 10-650 LORCET HD LORCET PLUS LORTAB MARGESIC MARGESIC H MARTEN-TAB MAXALT MAXALT MLT MAXIDONE MEDI-SELTZER MEPERIDINE HCL-0.9% NACL MEPERIDINE HCL-NS METHADONE HCL-0.9% NACL MIDRIN MIGERGOT MIGRAGESIC IDA MIGRAINE FORMULA MIGRAINE PAIN-RELIEVER MIGRAINE RELIEF MIGRALAM MIGRATEN MORPHINE SULFATE IN DEXTROSE MORPHINE SULFATE-0.9% NACL MORPHINE SULFATE-D5W MORPHINE SULFATE-NACL,ISO-OSM NARATRIPTAN NODOLOR NORCO NUCYNTA NUCYNTA ER NUMORPHAN OPANA OPANA ER ORBIVAN ORBIVAN CF OXYCODONE HCL-ASPIRIN OXYCODONE HCL-IBUPROFEN OXYCODONE-ASPIRIN OXYMORPHONE HCL ER PAIN-OFF PAIN-RELIEVER PAMPRIN MAX PANLOR SS PENTAZOCINE-ACETAMINOPHEN PENTAZOCINE-NALOXONE HCL PERCODAN PHRENILIN 159 GENERIC DRUG ASA/SALICYLAM/ACETAMINOPH/CAFF HYDROCODONE/ACETAMINOPHEN HYDROCODONE/ACETAMINOPHEN HYDROCODONE/ACETAMINOPHEN HYDROCODONE/ACETAMINOPHEN HYDROCODONE/ACETAMINOPHEN BUTALB/ACETAMINOPHEN/CAFFEINE HYDROCODONE/ACETAMINOPHEN BUTALBITAL/ACETAMINOPHEN RIZATRIPTAN BENZOATE RIZATRIPTAN BENZOATE HYDROCODONE/ACETAMINOPHEN ASPIRIN/SOD BICARB/CITRIC ACID MEPERIDINE HCL IN 0.9 % NACL MEPERIDINE HCL IN 0.9 % NACL METHADONE HCL IN 0.9 % NACL ISOMETHEPT/DICHLPHN/ACETAMINOP ERGOTAMINE TARTRATE/CAFFEINE ISOMETHEPT/DICHLPHN/ACETAMINOP ASPIRIN/ACETAMINOPHEN/CAFFEINE ASPIRIN/ACETAMINOPHEN/CAFFEINE ASPIRIN/ACETAMINOPHEN/CAFFEINE ISOMETHEPTEN/CAF/ACETAMINOPHEN ISOMETHEPTEN/CAF/ACETAMINOPHEN MORPHINE SULFATE/D5W/PF MORPHINE SULFATE IN 0.9 % NACL MORPHINE SULFATE/D5W MORPHINE IN NACL, ISO-OSM/PF NARATRIPTAN HCL NARATRIPTAN HCL ISOMETHEPT/DICHLPHN/ACETAMINOP HYDROCODONE/ACETAMINOPHEN TAPENTADOL HCL TAPENTADOL HCL OXYMORPHONE HCL OXYMORPHONE HCL OXYMORPHONE HCL BUTALB/ACETAMINOPHEN/CAFFEINE BUTALBITAL/ACETAMINOPHEN OXYCODONE HCL/ASPIRIN IBUPROFEN/OXYCODONE HCL OXYCODONE HCL/OXYCODON TER/ASA OXYMORPHONE HCL OXYMORPHONE HCL ASPIRIN/ACETAMINOPHEN/CAFFEINE ACETAMINOPHEN/CAFFEINE ASPIRIN/ACETAMINOPHEN/CAFFEINE DHCODEINE BT/ACETAMINOPHN/CAFF PENTAZOCINE HCL/ACETAMINOPHEN PENTAZOCINE HCL/NALOXONE HCL OXYCODONE HCL/ASPIRIN BUTALBITAL/ACETAMINOPHEN KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PAIN MANAGEMENT - ANALGESICS PARKINSONS DISEASE BRAND DRUG PHRENILIN FORTE POLYGESIC PRIALT PRODRIN PROMACET PROPOXACET-N 100 PROPOXYPHENE HCLACETAMINOPHENNAPPROPOXYPHENE ACETAMINOPHEN RELPAX REMIFENTANIL HCL-NS REPAN REPREXAIN RIZATRIPTAN SEDAPAP STAGESIC STANBACK SUBOXONE SUFENTANIL-BUPIVACAINE-NS SUPER PAIN RELIEF SYNALGOS-DC TALWIN TENCON TENSION HEADACHE TENSION HEADACHE PAIN RELIEVER TENSION HEADACHE RELIEF TRAMADOL HCL-ACETAMINOPHEN TREXIMET TREZIX TRI-BUFFERED ASPIRIN TYLENOL-CODEINE NO.3 TYLENOL-CODEINE NO.4 ULTRACET VANQUISH VERDROCET VICODIN VICODIN ES VICODIN HP VICOPROFEN WOMEN'S ASPIRIN WOMEN'S MENSTRUAL RELIEF XODOL 10-300 XODOL 5-300 XODOL 7.5-300 XYLON 10 ZAMICET ZEBUTAL ZERLOR ZOLVIT ZUBSOLV ZYDONE ANTACID TABLET 160 GENERIC DRUG BUTALBITAL/ACETAMINOPHEN HYDROCODONE/ACETAMINOPHEN ZICONOTIDE ACETATE ISOMETHEPTEN/CAF/ACETAMINOPHEN BUTALBITAL/ACETAMINOPHEN PROPOXYPHENE NAP/ACETAMINOPHEN PROPOXYPHENE HCL PROPOXYPHENE HCL/ACETAMINOPHEN PROPOXYPHENE NAP/ACETAMINOPHEN ELETRIPTAN HBR REMIFENTANIL IN 0.9 % NACL/PF BUTALB/ACETAMINOPHEN/CAFFEINE HYDROCODONE/IBUPROFEN RIZATRIPTAN BENZOATE BUTALBITAL/ACETAMINOPHEN HYDROCODONE/ACETAMINOPHEN ASPIRIN/CAFFEINE BUPRENORPHINE HCL/NALOXONE HCL SUFENTANIL/BUPIVACAINE/NS/PF ASPIRIN/ACETAMINOPHEN/CAFFEINE DIHYDROCODEINE/ASPIRIN/CAFFEIN PENTAZOCINE LACTATE BUTALBITAL/ACETAMINOPHEN ACETAMINOPHEN/CAFFEINE ACETAMINOPHEN/CAFFEINE ACETAMINOPHEN/CAFFEINE TRAMADOL HCL/ACETAMINOPHEN SUMATRIPTAN SUCC/NAPROXEN SOD DHCODEINE BT/ACETAMINOPHN/CAFF ASPIRIN/CALCIUM CARBONATE/MAG ACETAMINOPHEN WITH CODEINE ACETAMINOPHEN WITH CODEINE TRAMADOL HCL/ACETAMINOPHEN ASA/ACETAMINOPHN/MAG/ALH/CAFF HYDROCODONE/ACETAMINOPHEN HYDROCODONE/ACETAMINOPHEN HYDROCODONE/ACETAMINOPHEN HYDROCODONE/ACETAMINOPHEN HYDROCODONE/IBUPROFEN ASPIRIN/CALCIUM CARBONATE ACETAMINOPHEN/PAMABROM HYDROCODONE/ACETAMINOPHEN HYDROCODONE/ACETAMINOPHEN HYDROCODONE/ACETAMINOPHEN HYDROCODONE/IBUPROFEN HYDROCODONE/ACETAMINOPHEN BUTALB/ACETAMINOPHEN/CAFFEINE DHCODEINE BT/ACETAMINOPHN/CAFF HYDROCODONE/ACETAMINOPHEN BUPRENORPHINE HCL/NALOXONE HCL HYDROCODONE/ACETAMINOPHEN MG TRISILICATE/ALH/NAHCO3/AA KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION PARKINSONS DISEASE PARKINSONS DISEASE PARKINSONS DISEASE PARKINSONS DISEASE PARKINSONS DISEASE PARKINSONS DISEASE PARKINSONS DISEASE PARKINSONS DISEASE PARKINSONS DISEASE PARKINSONS DISEASE PARKINSONS DISEASE PARKINSONS DISEASE PARKINSONS DISEASE PARKINSONS DISEASE PARKINSONS DISEASE PARKINSONS DISEASE PARKINSONS DISEASE PARKINSONS DISEASE PARKINSONS DISEASE PARKINSONS DISEASE PARKINSONS DISEASE PARKINSONS DISEASE PARKINSONS DISEASE PARKINSONS DISEASE PARKINSONS DISEASE PARKINSONS DISEASE PARKINSONS DISEASE PARKINSONS DISEASE PARKINSONS DISEASE PARKINSONS DISEASE PARKINSONS DISEASE SEIZURE DISORDER SEIZURE DISORDER SEIZURE DISORDER SEIZURE DISORDER SEIZURE DISORDER SEIZURE DISORDER SEIZURE DISORDER SEIZURE DISORDER SEIZURE DISORDER SEIZURE DISORDER SEIZURE DISORDER SEIZURE DISORDER SEIZURE DISORDER SEIZURE DISORDER SEIZURE DISORDER SEIZURE DISORDER SEIZURE DISORDER SEIZURE DISORDER SEIZURE DISORDER SEIZURE DISORDER SEIZURE DISORDER BRAND DRUG AZILECT CARBIDOPA-LEVODOPA CARBIDOPA-LEVODOPA ER CARBIDOPA-LEVODOPA-ENTACAPONE COMTAN DUOPA FOAMING ANTACID GAVISCON MIRAPEX MIRAPEX ER NEUPRO PARCOPA PRAMIPEXOLE DIHYDROCHLORIDE PRAMIPEXOLE ER REQUIP REQUIP XL RYTARY SINEMET 10-100 SINEMET 25-100 SINEMET 25-250 SINEMET CR STALEVO 100 STALEVO 125 STALEVO 150 STALEVO 200 STALEVO 50 STALEVO 75 TASMAR APTIOM BANZEL CELONTIN CEREBYX DEPAKOTE DEPAKOTE ER DEPAKOTE SPRINKLE DIVALPROEX SODIUM ER FELBATOL FYCOMPA GABITRIL LEVETIRACETAM-NACL MEBARAL ONFI OXTELLAR XR PEGANONE PHENYTEK 161 GENERIC DRUG RASAGILINE MESYLATE CARBIDOPA/LEVODOPA CARBIDOPA/LEVODOPA CARBIDOPA/LEVODOPA/ENTACAPONE ENTACAPONE CARBIDOPA/LEVODOPA ENTACAPONE MG TRISILICATE/ALH/NAHCO3/AA MG TRISILICATE/ALH/NAHCO3/AA PRAMIPEXOLE DI-HCL PRAMIPEXOLE DI-HCL ROTIGOTINE CARBIDOPA/LEVODOPA PRAMIPEXOLE DI-HCL PRAMIPEXOLE DI-HCL ROPINIROLE HCL ROPINIROLE HCL ROPINIROLE HCL CARBIDOPA/LEVODOPA CARBIDOPA/LEVODOPA CARBIDOPA/LEVODOPA CARBIDOPA/LEVODOPA CARBIDOPA/LEVODOPA CARBIDOPA/LEVODOPA/ENTACAPONE CARBIDOPA/LEVODOPA/ENTACAPONE CARBIDOPA/LEVODOPA/ENTACAPONE CARBIDOPA/LEVODOPA/ENTACAPONE CARBIDOPA/LEVODOPA/ENTACAPONE CARBIDOPA/LEVODOPA/ENTACAPONE TOLCAPONE TRIHEXYPHENIDYL HCL ESLICARBAZEPINE ACETATE RUFINAMIDE METHSUXIMIDE FOSPHENYTOIN SODIUM DIVALPROEX SODIUM DIVALPROEX SODIUM DIVALPROEX SODIUM DIVALPROEX SODIUM DIVALPROEX SODIUM FELBAMATE FELBAMATE FOSPHENYTOIN SODIUM PERAMPANEL TIAGABINE HCL LEVETIRACETAM IN NACL (ISO-OS) MEPHOBARBITAL CLOBAZAM OXCARBAZEPINE OXCARBAZEPINE ETHOTOIN PHENYTOIN SODIUM EXTENDED KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION SEIZURE DISORDER SEIZURE DISORDER SEIZURE DISORDER SEIZURE DISORDER SEIZURE DISORDER SEIZURE DISORDER SEIZURE DISORDER SEIZURE DISORDER SKELETAL MUSCLE DISORDER SKELETAL MUSCLE DISORDER SKELETAL MUSCLE DISORDER SKELETAL MUSCLE DISORDER SKELETAL MUSCLE DISORDER SKELETAL MUSCLE DISORDER SKELETAL MUSCLE DISORDER SKELETAL MUSCLE DISORDER SKELETAL MUSCLE DISORDER UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN BRAND DRUG POTIGA SABRIL TRILEPTAL VIMPAT ZONEGRAN CARISOPRODOL COMPOUND CARISOPRODOL-ASPIRIN CHLORZOXAZONE W/ACETAMINOPHEN COMFORT PAC-CYCLOBENZAPRINE COMFORT PAC-TIZANIDINE ORPHENADRINE COMPOUND ORPHENADRINE COMPOUND FORTE SKELAXIN ANIMAL CHEWS ANIMAL SHAPES ANIMAL SHAPES VITAMINS CENTRAL-VITE HP CEROVITE ADVANCED FORMULA CHEWABLE MULTI VITAMIN CHEWABLE-VITE CHILD CHEW VITAMIN CHILD LITTLE ANIMALS VITAMINS CHILDREN'S CHEWABLE CHILDREN'S CHEWABLE COMPLETE CHILDREN'S CHEWABLE VITAMIN CHILDREN'S MULTIVIT W-EXTRA C CHILDREN'S MULTIVITAMINS CHILD'S VITAMIN WITH VITAMIN C DAILY DIET SUPPORT DAILY MULTIPLE VITAMIN DAILY VALUE DAILY VITAMIN DAILY VITAMIN FORMULA DAILY VITE DINO-LIFE WITH EXTRA C ESSENTIAL ONE DAILY EZFE 200 FERREX 150 FERUS FLINTSTONES FLINTSTONES WITH EXTRA C FRUITY CHEWS GUMMI BEAR MULTIVITAMIN GUMMY SWIRLS IFEREX 150 INFUVITE INFUVITE ADULT IRONUP 162 GENERIC DRUG PHENYTOIN SODIUM EXTENDED EZOGABINE VIGABATRIN TIAGABINE HCL OXCARBAZEPINE LACOSAMIDE ZONISAMIDE ZONISAMIDE CARISOPRODOL/ASPIRIN CARISOPRODOL/ASPIRIN CHLORZOXAZONE/ACETAMINOPHEN CYCLOBENZ HCL/IRR CNTR-IRR CB2 TIZANIDINE/IRR CNTR-IRR CMB #2 METAXALONE ORPHENADRINE/ASPIRIN/CAFFEINE ORPHENADRINE/ASPIRIN/CAFFEINE METAXALONE MULTIVITAMIN MULTIVITAMIN MULTIVITAMIN MULTIVITAMIN MULTIVITAMIN/IRON/FOLIC ACID MULTIVITAMIN MULTIVITAMIN MULTIVITAMIN MULTIVITAMIN MULTIVITAMIN MULTIVITAMIN MULTIVITAMIN MULTIVITAMIN MULTIVITAMIN MULTIVITAMIN MULTIVITAMIN MULTIVITAMIN MULTIVITAMIN MULTIVITAMIN MULTIVITAMIN MULTIVITAMIN MULTIVITAMIN MULTIVITAMIN IRON POLYSACCHARIDE COMPLEX IRON POLYSACCHARIDE COMPLEX IRON POLYSACCHARIDE COMPLEX MULTIVITAMIN MULTIVITAMIN MULTIVITAMIN MULTIVITAMIN MULTIVITAMIN IRON POLYSACCHARIDE COMPLEX MVI, PEDI NO.1 WITH VIT K MVI, ADULT NO.4 WITH VIT K IRON POLYSACCHARIDE COMPLEX KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN UPPER GASTROINTESTINAL DISORDERS - DIGESTIVE UPPER GASTROINTESTINAL DISORDERS - DIGESTIVE UPPER GASTROINTESTINAL DISORDERS - DIGESTIVE UPPER GASTROINTESTINAL DISORDERS - DIGESTIVE UPPER GASTROINTESTINAL DISORDERS - DIGESTIVE UPPER GASTROINTESTINAL DISORDERS - DIGESTIVE UPPER GASTROINTESTINAL DISORDERS - DIGESTIVE UPPER GASTROINTESTINAL DISORDERS - DIGESTIVE UPPER GASTROINTESTINAL DISORDERS - DIGESTIVE BRAND DRUG KID'S GUMMY BEAR VITAMINS KIDS VITAMINS KID'S VITAMINS KID'S VITAMINS + EXTRA C KID'S VITAMINS COMPLETE M.V.I.-12 MEGA MULTIVITAMIN MEN'S MULTI-VITAMIN MULTI-DELYN MULTIPLE VITAMINS MULTI-VITAMIN DAILY MULTIVITAMINS MULTIVITAMINS HI-PO MY FAVORITE MULTIPLE MYFERON 150 NIFEREX NOVAFERRUM NOVAFERRUM 50 NU-IRON 150 ONCE DAILY ONE DAILY ESSENTIAL ONE DAILY MULTIVITAMIN ONE-A-DAY ESSENTIAL ONE-A-DAY MEN'S PHARMACIST FAVORITE MULTI-VITE PIC 200 POLY-IRON POLYSACCHARIDE IRON POLYSACCHARIDE IRON 150 POLY-VI-SOL POLY-VITA POLY-VITAMIN POUCH DRAIN 401549 PRO FE SENTRY SPECTRAVITE ADVANCED FORMULA STROVITE SUPER MULTIVITAMIN TAB-A-VITE VIMAR VITAMINS FOR HAIR ZOO CHEWS BEANO DIGESTIVE ENZYME DIGESTIVE ENZYMES ENZYMATIC DIGESTANT ENZYME DIGEST GAS-X PREVENTION KARBOZYME MILCO-ZYME MILK DIGESTANT 163 GENERIC DRUG MULTIVITAMIN PEDIATRIC MULTIVIT COMB 8/FA MULTIVITAMIN MULTIVITAMIN MULTIVITAMIN MVI, ADULT NO.2 WITHOUT VIT K MULTIVITAMIN MULTIVITAMIN MULTIVITAMIN MULTIVITAMIN MULTIVITAMIN MULTIVITAMIN MULTIVITAMIN MULTIVITAMIN IRON POLYSACCHARIDE COMPLEX IRON POLYSACCHARIDE COMPLEX IRON POLYSACCHARIDE COMPLEX IRON POLYSACCHARIDE COMPLEX IRON POLYSACCHARIDE COMPLEX MULTIVITAMIN MULTIVITAMIN MULTIVITAMIN MULTIVITAMIN MULTIVITS-MINERALS/FA/LYCOPENE MULTIVITAMIN IRON POLYSACCHARIDE COMPLEX IRON POLYSACCHARIDE COMPLEX IRON POLYSACCHARIDE COMPLEX IRON POLYSACCHARIDE COMPLEX PEDIATRIC MULTIVIT COMB NO.81 PEDIATRIC MULTIVIT COMB NO.20 MULTIVITAMIN IRON POLYSACCHARIDE COMPLEX MULTIVITAMIN/IRON/FOLIC ACID MULTIVITAMIN/IRON/FOLIC ACID VITAMIN B COMP AND VIT C NO.6 MULTIVITAMIN MULTIVITAMIN MULTIVITAMIN MULTIVITAMIN WOMEN'S ONE A DAY MULTIVITAMIN MULTIVITAMIN ALPHA-D-GALACTOSIDASE ENZYMES,DIGESTIVE ENZYMES,DIGESTIVE ENZYMES,DIGESTIVE ENZYMES,DIGESTIVE ALPHA-D-GALACTOSIDASE PANCREATIN/POTASS/SOD BICARB PEPSIN/GLUTAMIC ACID/BETAINE LACTASE/RENNET KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION UPPER GASTROINTESTINAL DISORDERS - DIGESTIVE UPPER GASTROINTESTINAL DISORDERS - DIGESTIVE UPPER GASTROINTESTINAL DISORDERS - DIGESTIVE UPPER GASTROINTESTINAL DISORDERS - DIGESTIVE UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE UPPER GASTROINTESTINAL DISORDERS - SPASTIC DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE BRAND DRUG MM-ZYME SUCRAID TOXIN CONTROL TRI-ZYME ANTISPASMODIC ATROPINE SULFATE-0.9% NACL ATROPINE SULF-NS BELLADONNA-PHENOBARBITAL CANTIL CHLORDIAZEPOXIDE-CLIDINIUM DIGEX NF DONNATAL GASTRINEX NF LIBRAX ME-PB-HYOS PAMINE FQ PB-HYOS PROCHLORPERAZINE/ISOPROPAMIDE QUADRAPAX RE-PB HYOS SE-DONNA PB HYOS SERVIRA ACID CONTROLLER COMPLETE ACID GONE ACID GONE ANTACID ACID REDUCER COMPLETE ACIPHEX ACIPHEX SPRINKLE ADVANCED ANTACID ADVANCED ANTACID-ANTIGAS ALAMAG ALAMAG-PLUS ALKA-SELTZER HEARTBURN ALKA-SELTZER HEARTBURN+GAS ALMACONE ALMACONE-2 ANTACID & ANTIGAS ANTACID & GAS RELIEF ANTACID ANTI-GAS DOUBLE STR ANTACID DOUBLE STRENGTH ANTACID II PLUS SIMETHICONE ANTACID II WITH SIMETHICONE ANTACID M ANTACID MULTI-SYMPTOM ANTACID PLUS ANTI-GAS ANTACID PLUS EXTRA STRENGTH ANTACID SUPREME ANTACID WITH SIMETHICONE ANTACID-ANTIGAS AXID AXID AR 164 GENERIC DRUG ENZYMES,DIGESTIVE SACROSIDASE CHARCOAL/CALCIUM CARBONATE LIPASE/LACTASE/AMYLASE PHENOBARB/HYOSCY/ATROPINE/SCOP ATROPINE SULFATE IN 0.9% NACL ATROPINE SULFATE IN 0.9% NACL PHENOBARB/HYOSCY/ATROPINE/SCOP MEPENZOLATE BROMIDE CHLORDIAZEPOXIDE/CLIDINIUM BR HYOSCYAMINE SULFATE/PHENYLTOLX PHENOBARB/HYOSCY/ATROPINE/SCOP HYOSCYAMINE SULFATE/PHENYLTOLX IPECAC CHLORDIAZEPOXIDE/CLIDINIUM BR PHENOBARB/HYOSCY/ATROPINE/SCOP METHSCP BR/LA/S.THM/L.PARA/BIF PHENOBARB/HYOSCY/ATROPINE/SCOP ISOPROPAMIDE/PROCHLORPERAZINE PHENOBARB/HYOSCY/ATROPINE/SCOP PHENOBARB/HYOSCY/ATROPINE/SCOP PHENOBARB/HYOSCY/ATROPINE/SCOP PHENOBARB/HYOSCY/ATROPINE/SCOP FAMOTIDINE/CA CARB/MAG HYDROX MAGNESIUM CARBONATE/AL HYDROX MAG CARB/AL HYDROX/ALGINIC AC FAMOTIDINE/CA CARB/MAG HYDROX RABEPRAZOLE SODIUM RABEPRAZOLE SODIUM MAG HYDROX/AL HYDROX/SIMETH MAG HYDROX/AL HYDROX/SIMETH MAGNESIUM HYDROXIDE/AL HYDROX MAG HYDROX/AL HYDROX/SIMETH SODIUM BICARBONATE/SODIUM CIT CALCIUM CARBONATE/SIMETHICONE MAG HYDROX/AL HYDROX/SIMETH MAG HYDROX/AL HYDROX/SIMETH MAG HYDROX/AL HYDROX/SIMETH MAG HYDROX/AL HYDROX/SIMETH MAG HYDROX/AL HYDROX/SIMETH MAG HYDROX/AL HYDROX/SIMETH MAG HYDROX/AL HYDROX/SIMETH MAG HYDROX/AL HYDROX/SIMETH MAG HYDROX/AL HYDROX/SIMETH CALCIUM CARB/MAG HYDROX/SIMETH MAG HYDROX/AL HYDROX/SIMETH MAG HYDROX/AL HYDROX/SIMETH CALCIUM CARB/MAGNESIUM HYDROX MAG HYDROX/AL HYDROX/SIMETH CALCIUM CARBONATE/SIMETHICONE NIZATIDINE NIZATIDINE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE BRAND DRUG CITROCARBONATE ANTACID COMFORT GEL COMPLETE CYTRA-3 DEXILANT DUAL ACTION COMPLETE ESOMEPRAZOLE STRONTIUM E-Z-GAS II GAS-X WITH MAALOX GELUSIL GENATON GERI-LANTA GERI-MOX HEARTBURN ANTACID HELIDAC JR MAALOX PLUS ANTIGAS KAPIDEX LANSOPRAZOL-AMOXICIL-CLARITHRO LIQUID ANTACID MAALOX MAXIMUM STRENGTH MAALOX PLUS EXTRA STRENGTH MAG-AL MAG-AL PLUS MAG-AL PLUS XS MAG-AL ULTIMATE STRENGTH MAGLOX MASANTI MEIJER ANTACID MI ACID MILANTEX MINTOX MINTOX MAXIMUM STRENGTH MYLANTA MYLANTA DOUBLE-STRENGTH MYLANTA SUPREME ANTACID MYLANTEX DOUBLE-STRENGTH NEXIUM NEXIUM 24HR NEXIUM I.V. OMECLAMOX-PAK OMEPRAZOLE-SODIUM BICARBONATE PEPCID COMPLETE PHILLIPS' POTASS CIT-SOD CIT-CITRIC ACID PREVPAC PROBANTHELINE W/PHENOBARBITAL PROPANTHELINE W/PHENOBARBITAL 165 GENERIC DRUG SODIUM BICARBONATE/SODIUM CIT MAG HYDROX/AL HYDROX/SIMETH FAMOTIDINE/CA CARB/MAG HYDROX SOD/POT/K CIT/SOD CIT/CIT ACID DEXLANSOPRAZOLE FAMOTIDINE/CA CARB/MAG HYDROX ESOMEPRAZOLE MAGNESIUM ESOMEPRAZOLE SODIUM SIMETHICONE/SOD BICARB/CIT AC CALCIUM CARBONATE/SIMETHICONE MAG HYDROX/AL HYDROX/SIMETH MAG CARB/AL HYDROX/ALGINIC AC MAG HYDROX/AL HYDROX/SIMETH MAG HYDROX/AL HYDROX/SIMETH MAGNESIUM CARBONATE/AL HYDROX BISMUTH SAL/METRONID/TETRACYC CALCIUM CARBONATE/SIMETHICONE DEXLANSOPRAZOLE LANSOPRAZOLE/AMOXICILN/CLARITH MAG HYDROX/AL HYDROX/SIMETH MAG HYDROX/AL HYDROX/SIMETH MAG HYDROX/AL HYDROX/SIMETH MAGNESIUM HYDROXIDE/AL HYDROX MAG HYDROX/AL HYDROX/SIMETH MAG HYDROX/AL HYDROX/SIMETH MAGNESIUM HYDROXIDE/AL HYDROX MAG HYDROX/AL HYDROX/SIMETH MAG HYDROX/AL HYDROX/SIMETH MAG HYDROX/AL HYDROX/SIMETH MAG HYDROX/AL HYDROX/SIMETH MAG HYDROX/AL HYDROX/SIMETH MAG HYDROX/AL HYDROX/SIMETH MAG HYDROX/AL HYDROX/SIMETH CALCIUM CARB/MAGNESIUM HYDROX MAG HYDROX/AL HYDROX/SIMETH CALCIUM CARB/MAGNESIUM HYDROX MAG HYDROX/AL HYDROX/SIMETH ESOMEPRAZOLE MAGNESIUM ESOMEPRAZOLE MAGNESIUM ESOMEPRAZOLE SODIUM NIZATIDINE OMEPRAZOLE/CLARITH/AMOXICILLIN OMEPRAZOLE MAGNESIUM OMEPRAZOLE/SODIUM BICARBONATE PANTOPRAZOLE SODIUM FAMOTIDINE/CA CARB/MAG HYDROX MAGNESIUM HYDROXIDE SOD/POT/K CIT/SOD CIT/CIT ACID LANSOPRAZOLE/AMOXICILN/CLARITH PROPANTHELINE/PHENOBARBITAL PROPANTHELINE/PHENOBARBITAL KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE UPPER GASTROINTESTINAL DISORDERS - ULCER DISEASE URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS BRAND DRUG PROTONIX PROTONIX IV PYLERA RI MAG PLUS RI-GEL RI-GEL II RIGINIC RI-MAG RI-MOX RI-MOX PLUS ROLAIDS ROLAIDS MULTI-SYMPTOM ROLAIDS PLUS ANTI-GAS RON ACID PLUS RON-ACID RULOX TITRALAC PLUS TRICITRATES TUMS DUAL ACTION VIRTRATE-3 ZEGERID ZEGERID OTC ALFUZOSIN HCL ER AVODART CYSTAGON CYTRA-2 CYTRA-K DETROL DETROL LA ENABLEX FLOMAX JALYN K-PHOS M.F. K-PHOS NEUTRAL K-PHOS NO.2 MYRBETRIQ ORACIT OXYTROL OXYTROL FOR WOMEN PHENAZOFORTE PLUS PHENAZOPYRIDINE PLUS PHOSPHA 250 NEUTRAL POTASSIUM CITRATE-CITRIC ACID PROCYSBI PYRELLE HB RAPAFLO RENACIDIN SANCTURA SANCTURA XR 166 GENERIC DRUG PANTOPRAZOLE SODIUM PANTOPRAZOLE SODIUM BISMUTH/METRONID/TETRACYCLINE RABEPRAZOLE SODIUM MAGALDRATE/SIMETHICONE MAG HYDROX/AL HYDROX/SIMETH MAG HYDROX/AL HYDROX/SIMETH MAG CARB/AL HYDROX/ALGINIC AC MAGALDRATE MAG HYDROX/AL HYDROX/SIMETH MAG HYDROX/AL HYDROX/SIMETH CALCIUM CARB/MAG HYDROX/SIMETH CALCIUM CARB/MAG HYDROX/SIMETH CALCIUM CARBONATE/SIMETHICONE MAGALDRATE/SIMETHICONE MAGALDRATE MAG HYDROX/AL HYDROX/SIMETH CALCIUM CARBONATE/SIMETHICONE SOD/POT/K & SOD CIT/C AC/SUCRO FAMOTIDINE/CA CARB/MAG HYDROX SOD/POT/K CIT/SOD CIT/CIT ACID OMEPRAZOLE/SODIUM BICARBONATE OMEPRAZOLE/SODIUM BICARBONATE ALFUZOSIN HCL ALFUZOSIN HCL DUTASTERIDE CYSTEAMINE BITARTRATE CITRIC ACID/SODIUM CITRATE POTASSIUM CITRATE/CITRIC ACID TOLTERODINE TARTRATE TOLTERODINE TARTRATE DARIFENACIN HYDROBROMIDE FLAVOXATE HCL TAMSULOSIN HCL DUTASTERIDE/TAMSULOSIN HCL NA PHOS,M-B/K PHOS,MONOB PHOSPHORUS #1 NA PHOS,M-B/K PHOS,MONOB MIRABEGRON CITRIC ACID/SODIUM CITRATE OXYBUTYNIN OXYBUTYNIN PHENAZOPY HCL/HYOSCY/BUTABARB PHENAZOPY HCL/HYOSCY/BUTABARB PHOSPHORUS #1 POTASSIUM CITRATE/CITRIC ACID CYSTEAMINE BITARTRATE PHENAZOPY HCL/HYOSCY/BUTABARB SILODOSIN CITRIC ACID/G-LACTONE/MAG CARB TROSPIUM CHLORIDE TROSPIUM CHLORIDE KPIC PPO/OOA Formulary - revised May 5, 2015 CLASSIFICATION URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS URINARY TRACT - FUNCTIONAL DISORDERS VAGINAL DISORDERS VAGINAL DISORDERS VAGINAL DISORDERS VAGINAL DISORDERS VAGINAL DISORDERS VAGINAL DISORDERS VAGINAL DISORDERS VAGINAL DISORDERS VAGINAL DISORDERS VAGINAL DISORDERS VAGINAL DISORDERS VAGINAL DISORDERS VAGINAL DISORDERS VAGINAL DISORDERS VAGINAL DISORDERS VAGINAL DISORDERS VAGINAL DISORDERS VAGINAL DISORDERS VAGINAL DISORDERS VAGINAL DISORDERS VAGINAL DISORDERS VAGINAL DISORDERS VAGINAL DISORDERS VAGINAL DISORDERS VAGINAL DISORDERS BRAND DRUG SHOHL'S MODIFIED SODIUM CITRATE & CITRIC ACID TARON-CRYSTALS THIOLA TOLTERODINE TARTRATE ER TOVIAZ TROSPIUM CHLORIDE ER UROQID-ACID NO.2 UROXATRAL VESICARE VIRT-PHOS 250 NEUTRAL VIS-PHOS N VISQID A-A 1-DAY ACID JELLY FEM PH FEMININE MOIST-LUBRICATING FEMININE WASH FRESH SCENT DOUCHE GYNAZOLE 1 GYNAZOLE-1 K-Y TINGLING LONG LASTING VAGINAL LUBRIN NORFORMS RELAGARD ROMANTIC MIST DOUCHE SAUGELLA SILKY LUBRICATING SUMMER'S EVE FEMININE WASH TERAZOL 3 TERAZOL 7 TIOCONAZOLE 1 TIOCONAZOLE-1 TRIMO-SAN TROPICAL BREEZE DOUCHE VAGISTAT-1 167 GENERIC DRUG CITRIC ACID/SODIUM CITRATE CITRIC ACID/SODIUM CITRATE TAMSULOSIN HCL POTASSIUM CITRATE/CITRIC ACID TIOPRONIN TOLTERODINE TARTRATE TOLTERODINE TARTRATE FESOTERODINE FUMARATE TROSPIUM CHLORIDE TROSPIUM CHLORIDE METHEN MAND/NAPHOS M-B M-H ALFUZOSIN HCL SOLIFENACIN SUCCINATE PHOSPHORUS #1 PHOSPHORUS #1 METHEN MAND/NAPHOS M-B M-H TIOCONAZOLE ACETIC AC/RICINOLEIC/OXYQUINOL ACETIC ACID/OXYQUINOLINE GLYCERIN/MIN OIL/POLYCARBOPHIL VAGINAL ANTISEPTICS COMBO NO.1 OCTOXYNOL 9/CITRIC ACID BUTOCONAZOLE NITRATE BUTOCONAZOLE NITRATE PG/SORBITOL/CELLU/METHYLSAL/E VAGINAL MOISTURIZER COMBO NO.2 PROP GLYCOL ALGINATE VAGINAL DEODORANT COMB NO.1 ACETIC ACID/OXYQUINOLINE OCTOXYNOL 9/CITRIC ACID FEMININE HYGIENE CLEANSER NO.1 VAGINAL MOISTURIZER COMBO NO.4 VAGINAL ANTISEPTICS COMBO NO.1 TERCONAZOLE TERCONAZOLE TERCONAZOLE TIOCONAZOLE TIOCONAZOLE OXYQUINOLINE/SOD.LAURYL SULFAT OCTOXYNOL 9/CITRIC ACID TIOCONAZOLE KPIC PPO/OOA Formulary - revised May 5, 2015
