North Shore-LIJ FIDA LiveWell - North Shore

Transcription

Pou Jwenn Plis Enfòmasyon:
Rele Sèvis Patisipan:
(855) 776-7545
Oswa ale sou sitwèb:
NSLIJHealthPlans.com/FIDALiveWell
North Shore-LIJ
FIDA LiveWell
(Medicare-Medicaid Plan)
Lis Medikaman ki Garanti yo
(Fòmilè)
2015
Nou fè bon kalite swen sante
vin fasil pou jwenn.
TANPRI LI:
DOKIMAN SA A GEN ENFÒMASYON SOU MEDIKAMAN NOU GARANTI NAN PLAN SA A
Sèvis Patisipan: (855) 776-7545
H3129_RX15_52V3_HC Alternate Format
North Shore-LIJ FIDA LiveWell (Plan Medicare-Medicaid) |
Lis 2015 pou Medikaman Garanti (Lis Medikaman Ofisyèl)
Sa a se lis medikaman yo ke Patispan yo jwenn nan North Shore-LIJ FIDA LiveWell
(Plan Medicare-Medicaid).
 North Shore-LIJ FIDA Health Plan, Inc. se yon plan swen jere ki gen kontra avèk toude
Medicare ak Depatman Sante Leta New York (Medicaid) pou bay avantaj toude pwogram
yo ba Patisipan yo grasa Demonstrasyon Fully Integrated Duals Advantage (Avantaj Doub
ki Konplètman Entegre, FIDA).
 Avantaj yo, Lis Medikaman ki Garanti, ak famasi ak rezo pwofesyonèl swen sante yo ka chanje
detanzantan pandan tout ane a epi nan dat 1ye janvye chak ane.
 Ou kapab toujou tcheke Lis mizajou North Shore-LIJ FIDA LiveWell sou Lis Medikaman
Garanti yo nan sit wèb www.NSLIJHealthPlans.com/FIDALiveWell oswa lè ou rele North
Shore-LIJ FIDA LiveWell Sèvis Patisipan nan nimewo (855) 776-7545.
 Ka gen limit ak restriksyon ki anvigè. Pou jwenn plis enfòmasyon, rele Sèvis Patisipan North
Shore-LIJ FIDA LiveWell oswa li Tiliv Enfòmasyon Patisipan North Shore-LIJ FIDA LiveWell.
 Pa gen okenn peman dirèk (kopeman) ki nesese pou resevwa medikaman garanti yo.
 Ou kapab jwenn enfòmasyon sa yo gratis nan lòt fòma, tankou Bray oswa gwo lèt. Rele
nimewo (855) 776-7545. Koutfil la se gratis.
 You can get this information for free in other languages. Call (855) 776-7545 and TTY/TDD
711 during Monday through Sunday, 8 a.m. to 8 p.m. The call is free.
 Puede obtener esta información de manera gratuita en otros idiomas. Llame al (855) 776-7545
y TTY/TDD 711 de lunes a domingos de 8:00 am a 8:00 pm. La llamada es gratuita.
 您可免費取得以其他語言撰寫的資訊。請於週一至週日上午 8 時至下午 8 時致電(855) 776-7545，
TTY/TDD 使用者：711。此為免付費電話。
 Данная информация доступна бесплатно на других языках. Звоните по номеру
(855) 776-7545 или 711 (линия TTY/TDD) с понедельника по воскресенье с 8:00 до 20:00.
Звонок бесплатный.
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Si w gen kesyon, tanpri rele North Shore-LIJ FIDA LiveWell nan (855) 776-7545, Lendi
jiska Dimanch, depi 8:00 am jiska 8:00 pm. Koutfil la gratis. Pou jwenn plis enfòmasyon,
ale nan NSLIJHealthPlans.com/FIDALiveWell.
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 이 정보는 다른 언어로도 제공됩니다(무료). 월요일-일요일 8:00 am – 8:00 pm 중
(855) 776-7545 나 TTY/TDD 711 로 전화 주십시오. 통화료는 무료입니다.
 Ou ka jwenn enfòmasyon sa a gratis nan lòt lang. Rele nan (855) 776-7545 ak nan TTY/TDD
(pou moun ki gen pwoblèm tande oswa moun ki bèbè) 711 de lendi a dimanch 8:00 am 8:00 pm. Koutfil la gratis.
 È possibile ricevere queste informazioni in altre lingue gratuitamente. Contatta il (855)
776-7545 e TTY/TDD 711 dal lunedì alla domenica dalle ore 8:00 alle ore 20:00. Il servizio
è gratuito.
 Eta New York te kreye yon pwogram medyasyon pou patisipan ki rele Rezo Defans
Konsomatè Endepandan (ICAN: Independent Consumer Advocacy Network) pou bay
Patisipan yo èd gratis epi konfidansyèl sou tout sèvis North Shore-LIJ FIDA LiveWell ofri yo.
Ou ka jwenn ICAN gratis nan 1-844-614-8800 oswa sou entènèt nan icannys.org.
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Kesyon Moun Poze Souvan [Frequently Asked
Questions (FAQ)]
Jwenn repons isit la pou kesyon ou gen sou Lis nan Medikaman Garanti yo. Ou kapab li tout FAQ
yo pou aprann plis, oswa pou chèche yon kesyon ak repons espesifik.
1.
Ki medikaman sou preskripsyon ki sou Lis nan Medikaman Garanti
a? (Tinon pou Lis sou Medikaman Garanti a se “Lis Medikaman.”)
Medikaman yo sou Lis nan Medikaman Garanti a ki kòmanse nan paj 11 se medikaman yo ki
garanti grasa North Shore-LIJ FIDA LiveWell. Medikaman sa yo disponib nan famasi nan rezo
nou. Yon famasi nan rezo nou si nou gen yon akò avèk yo pou travay avèk nou ak bay ou sèvis.
Nou rele famasi sa yo “famasi nan rezo.”
 North Shore-LIJ FIDA LiveWell pral garanti tout medikaman nan Lis Medikaman an si:
 doktè ou, oswa yon lòt moun nan rezo a k ap ekri preskripsyon an di ke ou bezwen yo pou
geri oswa rete ansante,
 medikaman an nesesè pou kondisyon ou, ak
 ou plen preskripsyon an nan yon famasi nan rezo North Shore-LIJ FIDA LiveWell.
 North Shore-LIJ FIDA LiveWell gen dwa fè demach siplemantè yo pou jwenn aksè ba sèten
medikaman (gade kesyon #5 anba a). Nan kèk sikonstans yo, pètèt ou ap oblije fè yon bagay
anvan ou resevwa yon medikaman, tankou eseye lòt medikaman anvan.
Epitou ou kapab jwenn yon lis mizajou sou medikaman ke nou garanti lè ou ale nan sit wèb nou
nan www.NSLIJHealthPlans.com/FIDALiveWell oswa rele Sèvis Patisipan nan nimewo
(855) 776-7545
2.
Èske Lis Medikaman an janm chanje?
Wi. North Shore-LIJ FIDA LiveWell gen dwa chanje oswa retire medikaman yo nan Lis Medikaman
an pandan ane a. Anjeneral, Lis Medikaman an pral chanje sèlman si:
 yon medikaman nouvo devlope ki travay osi byen ke yon medikaman ki nan Lis Medikaman
an kounye a, oswa
 nou vin konnen ke yon medikaman danjere.
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Epitou nou gen dwa chanje règ nou sou medikaman yo. Pa egzanp, nou kapab:
 Deside pou egzije oswa pa egzije apwobasyon alavans pou yon medikaman. (Apwobasyon
alavans se pèmisyon ki soti nan men North Shore-LIJ FIDA LiveWell oswa Ekip
Entèdisiplinè ou (Interdisciplinary Team, IDT) anvan ou kapab resevwa yon medikaman.)
 Ajoute oswa chanje kantite medikaman an ou kapab resevwa (nou rele sa a “limit sou
kantite”).
 Ajoute oswa chaje terapi-pa-etap pou yon medikaman. (Terapi etap vle di ou oblije eseye
yon medikaman anvan nou peye pou yon lòt medikaman.)
(Pou jwenn plis enfòmasyon sou règ medikaman sa yo, ale nan paj 5.)
Nou pral fè ou konnen lè yo retire yon medikaman nan Lis Medikaman an. Epitou nou pral di
ou lè nou chanje règ nou sou pwoteksyon yon medikaman. Kesyon 3, 4, ak 7 anba a gen plis
enfòmasyon sou kisa ki rive lè Lis Medikaman an chanje.
 Ou kapab toujou tcheke Lis Medikaman mizajou North Shore-LIJ FIDA LiveWell nan sit wèb
www.NSLIJHealthPlans.com/FIDALiveWell. Epitou ou gen dwa rele Sèvis Patisipan pou
tcheke Lis Medikaman aktyèl la lè ou rele nimewo (855) 776-7545.
3.
Kisa ki rive lè gen yon medikaman ki pi bon mache ki travay osi
byen ke yon medikaman ki nan Lis Medikaman an kounye a?
Si gen yon medikaman ki pi bon mache ki travay osi byen ke yon medikaman ki nan Lis
Medikaman an kounye a:

Famasyen ou pral bay ou medikaman an ki pi bon mache pwochen fwa ou plen
preskripsyon ou. Si ou ak founisè swen sante ou deside ke medikaman an ki pi bon mache
pa bon pou ou, founisè swen sante ou kapab di famasyen an pou kontinye bay
ou medikaman an ke ou ap pran kounye a.

North Shore-LIJ FIDA LiveWell gen dwa deside pou retire medikaman an ki pi chè nan
Lis Medikaman an. Si ou ap pran yon medikaman ke nou te retire nan Lis Medikaman an
paske yon medikaman ki pi bon mache travay osi byen vin devlope, nou pral di ou omwen
60 jou anvan nou retire li nan Lis Medikaman an oswa lè ou mande pou yon renouvèlman.
Lè sa a, ou pral resevwa yon rezèv medikaman pou 60 jou anvan yo fè chajman an nan
Lis Medikaman an.
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
Yo pral notifye ou nan Ekspliksyon sou Benefis ou si ou te dènyèman plen yon
preskripsyon pou medikaman an. Si ou poko resevwa li, men ou te sèvi avèk medikaman
an nan dènye 180 jou yo, nou pral voye ou yon lèt k ap pale sou chanjman an. Antouka, yo
pral fè ou konnen omwen 60 jou anvan chanjman an ap fèt.
4.
Kisa ki rive lè yo dekouvri ke yon medikaman danjere?
Si Administrasyon an pou Manje ak Medikaman (Food and Drug Administration, FDA) di yon
medikaman danjere, nou pral retire li nan Lis Medikaman an imedyatman. Epitou nou pral voye ou
yon lèt ak rele ou pou di ou ke medikaman danjere a te retire nan Lis Medikaman an. Plis pase rele
ou, nou pral voye ou yon lèt tou ba doktè oswa praktisyonè ou k ap ekri preskripsyon an ak ki pral
travay avèk ou pou jwenn yon lòt medikaman ki travay byen pou kondisyon ou. SI ou gen kesyon,
ou kapab kontakte doktè ou dirèkteman, oswa ou kapab rele North Shore-LIJ FIDA LiveWell nan
nimewo (855) 776-7545.
5.
Èske gen restriksyon oswa limit sou pwoteksyon pou medikaman?
Oswa èske gen nenpòt kondisyon obligatwa pou satisfè pou jwenn
sèten medikaman yo?
Wi, gen kèk medikaman ki gen règ oswa limit sou kantite ou kapab resevwa. Gen kèk ka kote ou
dwe fè yon bagay anvan ou kapab resevwa medikaman an. Pa egzanp:
 Apwobasyon alavans (oswa ototrizasyon alavans): Pou kèk medikaman, ou oswa doktè
ou oswa lòt moun an k ap ekri preskripsyon an pou ou oblije resevwa apwobasyon nan men
North Shore-LIJ FIDA LiveWell oswa Ekip Entèdisiplinè (IDT) anvan ou plen preskripsyon
ou. Si ou pa resevwa apwobasyon, North Shore-LIJ FIDA LiveWell pa gen dwa peye pou
medikaman an.
 Limit sou kantite: Gen de fwa North Shore-LIJ FIDA LiveWell mete limit sou kantite
medikaman ou kapab resevwa.
 Terapi-pa-etap: Gen de fwa North Shore-LIJ FIDA LiveWell egzije ou pou patisipe nan
terapi-pa-etap. Sa vle di ou oblije eseye medikaman nan yon sèten fason selon kondisyon
medikal ou. Nou ta kapab mande ou pou eseye yon medikaman anvan nou peye pou yon lòt
medikaman. Si doktè ou panse premye medikaman an pa travay pou ou, se lè sa anou pral
peye pou dezyèm la.
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Gade tablo yo nan paj 11 pou wè si medikaman ou gen kondisyon siplimantè pou satisfè oswa si li
gen limit. Epitou ou kapab jwenn plis enfòmasyon lè ou ale nan sit wèb nou nan
www.NSLIJHealthPlans.com/FIDALiveWell. Nou afiche dokiman sou sit wèb nou k ap eksplike
restriksyon nou sou otorizasyon alavans ak terapi-pa-etap. Epitou ou gen dwa mande nou pou
voye ou yon kopi.
Ou kapab mande pou yon “ekspesyon” nan limit sa yo. Tanpri gade kesyon 11 pou jwenn plis
enfòmasyon sou ekspesyon yo.
 Si ou nan yon etablisman enfimyè oswa yon lòt etablisman swen alontèm ak bezwen
yon medikaman ki pa nan Lis Medikaman an, oswa si li pa fasil pou ou jwenn medikaman
an ou bezwen, nou kapab ede. Nou pral garanti yon rezèv dijans 31 jou pou medikaman an ou
bezwen (amwenske ou gen yon preskripsyon pou mwens jou), si wi ou non ou se yon Patispan
nouvo nan North Shore-LIJ FIDA LiveWell. Sa ap ba ou tan pou pale avèk doktè ou oswa avèk
lòt moun ki gen otorizasyon pou preskri medikaman. Li kapab ede ou deside si gen yon
medikaman sanblab sou Lis Medikaman ou kapab pran pito oswa si pou mande yon
eksepsyon. Tanpri gade kesyon 11 pou jwenn plis enfòmasyon sou ekspesyon yo.
6.
Kijan ou pral konnen si medikaman nouvo a gen limitasyon
sou li oswa si gen kondisyon obligatwa pou satisfè pou resevwa
medikaman an?
Lis la sou Medikaman Garanti nan paj 11 gen yon kolòn ki make “Aksyon, restriksyon oswa limit
nan itilizasyon obligatwa yo.”
7.
Kisa ki pral rive si nou chanje règ nou sou fason nou garanti kèk
medikaman yo? Pa egzanp, si nou ajoute restriksyon sou yon
medikaman ki egzije otorizasyon alavans (apwobasyon), limit
sou kantite, ak/oswa terapi-pa-etap?
Nou pral fè ou konnen si nou ajoute restriksyon sou yon medikaman pou apwobasyon,
limit sou kantite, ak/oswa terapi-pa-etap. Nou pral fè ou konnen omwen 60 jou anvan nou ajoute
restriksyon oswa lè ou mande pou yon renouvèlman. Lè sa a, ou kapab resevwa yon rezèv 60 jou
nan medikaman an anvan nou fè chanjman an nan Lis Medikaman an. Sa a bay ou tan pou pale
avèk doktè ou oswa lòt moun an k ap ekri preskripsyon an sou kisa pou ou fè nan pidevan an.
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8.
Kijan pou jwenn yon medikaman nan Lis Medikaman an?
Ou kapab jwenn yon medikaman nan de (2) fason:

Ou kapab chèche nan lòd lèt alfabè (si ou konnen kijan pou eple nan medikaman an nan
lang angle), oswa

Ou kapab chèche selon kondisyon medikal.
Pou chèche nan lòd lèt alfabè, ale nan seksyon Lis Alfabetik la (nan lang angle) nan paj 79.
Lè sa a chèche non medikaman ou nan lis la.
Pou chèche selon kondisyon medikal, jwenn seksyon an ki make “Lis nan Medikaman selon
kondisyon medikal” nan paj 11. Lè sa a chèche kondisyon medikal ou. Pa egzanp, si ou gen yon
kondisyon kè, se nan kategori sa a ou oblije chèche. Se la a ou ap jwenn medikaman yo ki trete
kondisyon kè.
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E si medikaman an mwen vle pran pa nan Lis Medikaman an?
Si ou pa wè medikaman ou nan Lis Medikaman an, rele Sèvis Patisipan nan nimewo
(855) 776-7545 epi mande pou enfòmasyon sou li. Si ou vin konnen ke North Shore-LIJ
FIDA LiveWell pap pral garanti medikaman an, ou gen dwa fè youn nan bagay sa yo:
 Mande Sèvis Patisipan pou yon lis nan medikaman yo tankou sa a ou ta vle pran.
Lè sa a montre lis la ba doktè ou oswa lòt moun an k ap ekri preskripsyon an. Li kapab
preskri yon medikaman nan Lis Medikaman an ki tankou sa a ou vle pran Oswa
 Ou kapab mande plan an oswa Ekip Entèdisiplinè (IDT) ou pou fè yon eksepsyon
pou garanti medikaman an. Tanpri gade kesyon 11 pou jwenn plis enfòmasyon sou
ekspesyon yo.
10. E si ou se yon Patispan nouvo nan North Shore-LIJ FIDA LiveWell
epi mwen pa kapab jwenn medikaman ou nan Lis Medikaman an
oswa ou gen yon pwoblèm jwenn medikaman ou?
Nou kapab ede. Nou oblije garanti yon resèv tanporè 90 jou pou medikaman ou, jan li nesesè,
pandan premye 90 jou yo ou se yon Patispan nan North Shore-LIJ FIDA LiveWell. Sa ap ba ou tan
pou pale avèk doktè ou oswa avèk lòt moun ki gen otorizasyon pou preskri medikaman. Li kapab
ede ou deside si gen yon medikaman sanblab sou Lis Medikaman ou kapab pran pito oswa si pou
mande yon eksepsyon.
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Nou pral garanti yon resèv tanporè jiska 90 jou nan medikaman ou si:
 ou ap pran yon medikaman ki pa nan Lis Medikaman an, oswa
 règ nan plan sante pa pèmèt ou pou resevwa kantite medikaman ke moun k ap ekri
preskripsyon an pou ou te kòmande, oswa
 North Shore-LIJ FIDA LiveWell oswa Ekip Entèdisiplinè (IDT) ou dwe bay apwobasyon
alavans, oswa
 ou ap pran yon medikaman ki yon pati restriksyon terapi-pa-etap.
Si ou rete nan yon etablisman enfimye (mezon retret) oswa yon lòt etablisman swen alontèm,
ou gen dwa plen preskripsyon pou jiska 93 jou. Ou gen dwa renouvle medikaman an plizyè
fwa pandan peryòd tan an. Sa a bay moun k ap ekri preskripsyon an pou ou tan pou chanje
medikaman ou pou sa yo ki nan Lis Medikaman an oswa mande pou yon eksepsyon.
Nou pèmèt yon tranzisyon apwopriye pou moun yo k ap patisipe nan terepi medikaman kounye
a ke North Shore-LIJ FIDA LiveWell pa garanti, oswa dwe satisfè kondisyon otorizasyon alavans,
terapi-pa-etap, oswa limit sou kantite. Sa gen ladan:

Patispan North Shore-LIJ FIDA LiveWell nouvo pandan kòmansman ane a

Patispan North Shore-LIJ FIDA LiveWell yo ki soti nan yon lòt plan pwoteksyon epi ki elijib
pandan kòmansman ane a

Endividyèl yo ki soti nan yon plan pou ale nan yon lòt apre kòmansman ane a

Patispan yo ki rete nan etablisman swen alontèm yo (long-term care, LTC) ki gen ladan
Patispan yo k ap admèt oswa egzeyate nan yon etablisman LTC

Nan kèk ka yo, Patispan aktyèl yo ki afekte pa chanjman nan lis medikaman ofisyèl la
chanje avèk chak kontra.
Anplis ke rezèv tanporè 90 jou a, North Shore-LIJ FIDA LiveWell pral bay yon rezèv dijans
jiska 31 jou si ou pral admèt oswa egzeyate nan yon etablisman Swen Alontèm, jan li nesesè.
Pou jwenn plis enfòmasyon, tanpri rele North Shore-LIJ FIDA LiveWell nan nimewo
(855) 776-7545.
11. Èske ou kapab mande pou yon eksepsyon pou garanti
medikaman ou?
Wi. Ou kapab mande North Shore-LIJ FIDA LiveWell oswa Ekip Entèdisiplinè (IDT) ou pou fè yon
eksepsyon pou garanti yon medikaman ki pa nan Lis Medikaman an.
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Epitou ou gen dwa mande North Shore-LIJ FIDA LiveWell oswa IDT ou pou chanje règ yo ki gen
rapò avèk medikaman ou.
 Plan Sante, North Shore-LIJ FIDA LiveWell gen dwa mete limit sou yon medikaman li pral
garanti. Si gen yon limit sou medikaman ou, ou gen dwa mande IDT ou pou chanje limit la
oswa garanti plis.
 Lòt egzanp yo: Ou gen dwa mande nou oswa IDT ou pou sispann restriksyon yo sou
kondisyon terapi-pa-etap oswa apwobasyon alavans.
12. Konbyen tan li pran pou resevwa yon eksepsyon?
Premyèman, North Shore-LIJ FIDA LiveWell oswa Ekip Entèdisiplinè (IDT) ou dwe resevwa yon
deklasyon ki soti nan men moun k ap ekri preskripsyon an pou ou k ap sipòte demann ou pou yon
eksepsyon. Apre nou fin resevwa deklarasyon an, ou pral jwenn yon desizyon sou demann
eksepsyon ou nan lespas 75 èdtan.
Si ou oswa moun k ap ekri preskripsyon an pou ou panse ke sante ou gen dwa mete nan danje si
ou oblije tann 72 èdtan, ou gen dwa mande pou yon eksepsyon ekspeditif. Sa a se yon desizyon ki
fèt pi vit. Si moun k ap ekri preskripsyon an pou ou sipòte demann ou, ou pral resevwa yon
desizyon nan lespas 72 èdtan depi yo resevwa deklarasyon sipò a ki soti nan men moun k ap ekri
preskripsyon an pou ou.
13. Ou kapab mande pou yon eksepsyon nan ki fason?
Pou mande pou yon eksepsyon, rele Manadjè Swen ou. Manadjè Swen ou pral travay avèk ou ak
founisè swen sante ou pou ede ou mande pou yon eksepsyon.
14. Kisa medikaman jenerik yo ye?
Medikaman jenerik yo fèt avèk menm engredyan tankou medikaman non mak yo. Nòmalman
yo pi bon mache ke medikaman non mak yo ak nòmalman pa gen non popilè. Se Administrasyon
an pou Manje ak Medikaman (Food and Drug Administration, FDA) ki apwouve medikaman
jenerik yo.
North Shore-LIJ FIDA LiveWell garanti toude medikaman non mak ak medikaman jenerik yo.
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15. Kisa ki medikaman OTC yo?
OTC (over-the-counter) vle di “medikaman ki achte san preskripsyon.” North Shore-LIJ FIDA
LiveWell garanti kèk medikaman OTC yo lè founisè swen sante ou mande pou yo avèk
preskripsyon.
Ou kapab li Lis Medikaman North Shore-LIJ FIDA LiveWell pou wè ki medikaman OTC ki garanti.
16. Èske North Shore-LIJ FIDA LiveWell garanti pwodwi OTC ki pa
medikaman?
North Shore-LIJ FIDA LiveWell garanti kèk pwodwi OTC ki pa medikaman, tankou twal gaz,
pansman adezif ak konprime fè, lè founisè swen sante ou kòmande yo avèk preskripsyon.
Ou kapab li Lis Medikaman North Shore-LIJ FIDA LiveWell Drug pou wè ki pwodwi OTC ki pa
medikaman garanti yo.
17. Ki kantite lajan ou gen pou peye kòm yon peman dirèk (kopeman)?
Yo pap pral chaje ou yon peman dirèk (kopeman) pou medikaman yo ki pa nan Lis Medikaman an.
18. Kisa ki nivo medikaman yo?
Nivo yo se gwoup medikaman yo. Chak medikaman nan Lis Medikaman North Shore-LIJ
FIDA LiveWell tonbe nan youn nan twa nivo. Pa gen okenn peman dirèk (kopeman) pou
medikaman nan nenpòt nivo yo.
 Nivo 1 medikaman yo se medikaman jenerik yo.
 Nivo 2 medikaman yo se medikaman non mak yo.
 Medikaman Nivo 3 yo se medikaman ki pa garanti pa Medicare (Medicaid).
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Lis nan Medikaman Garanti
Medikaman yo sou Lis nan Medikaman Garanti a nan paj pwochen lan bay ou enfòmasyon
sou medikaman yo ki garanti grasa North Shore-LIJ FIDA LiveWell. Si ou gen pwoblèm jwenn
medikaman ou nan lis la, ale nan Endèks la ki nan paj 79.
Premye kolòn tablo a gen non medikaman yo. Medikaman non mak yo gen lèt majiskil
yo (pa egzanp, TYLENOL) ak medikaman jenerik yo ekri nan lèt italik miniskil (pa egzanp,
acetominophen).
Enfòmasyon an nan kolòn lan sou aksyon, restriksyon oswa limit nan itilizasyon obligatwa yo di ou
si North Shore-LIJ FIDA LiveWell gen okenn règ k ap garanti medikaman ou.
Se isit la ou ap jwenn definisyon kòd yo ki itilize nan kolòn “Aksyon, restriksyon oswa limit
nan itilizasyon obligatwa yo”:
* = Sa a se yon medikaman Medicaid epi gen règ diferan pou fè yon kontestasyon
NM = Ou pa kapab kòmande medikaman sa a pa lapòs: Medikaman sa a pa kapab resevwa
pa lapòs
B/D = Medikaman sa a gen dwa nan lis swa Pati B oswa Pati D
LA = Gen limite sou kantite medikaman sa a: medikaman sa yo pa nesesèman disponib nan chak
famasi oswa yo gen kondisyon espesyal pou satisfè ki gen rapò avèk transpò, livrezon, oswa aksè
pasyan.
PA = Otorizasyon alavans (apwobasyon): Ou oblije gen apwobasyon ki soti nan men North
Shore-LIJ FIDA LiveWell oswa Ekip Entèdisiplinè (IDT) ou anvan ou resevwa medikaman sa a.
QL = Gen limit sou kantite: Gen limit sou kantite pou medikaman sa a
ST = Terapi-pa-etap: ou oblije eseye yon lòt medikaman anvan ou resevwa sa a.
PA = Otorizasyon alavans (apwobasyon): Ou oblije gen apwobasyon ki soti nan men North
Shore-LIJ FIDA LiveWell oswa Ekip Entèdisiplinè (IDT) ou anvan ou resevwa medikaman sa a.
Remak: Zetwal la (*) bò kote medikaman an vle di ke medikaman an pa yon medikaman “Pati D.”
Medikaman sa yo gen règ diferan pou fè kontestasyon yo. Yon kontestasyon se yon fason fòmèl
pou mande pou yon revizyon oswa chanjman nan yon desizyon sou pwoteksyon si ou kwè ke yon
erè te fèt. Plan Sante, North Shore-LIJ FIDA LiveWell oswa Ekip Entèdisiplinè (IDT) ou ta kapab
deside ke yon medikaman ou vle pa garanti osa pa garanti ankò selon Medicare oswa Medicaid.
Si ou doktè ou oswa lòt moun an k ap ekri preskripsyon an dakò avèk desizyon an, ou kapab fè
yon kontestasyon. Pou mande pou enstriksyon sou kijan pou fè yon kontestasyon, rele Sèvis
Patisipan nan nimewo (855) 776-7545 oswa Pwogram Medyasyon pou Patisipan FIDA nan
nimewo (844) 614-8800. Epitou ou kapab li Manyèl Patisipan an pou aprann plis sou fason pou
fè kontestasyon kont yon desizyon.
?
11
Non medikaman an
Nivo
Konbyen lajan Aksyon, restriksyon
medikaman an oswa limit nan
pral koute
itilizasyon
obligatwa yo
ANALJEZIK - MEDIKAMAN POU TRETE DOULÈ AK ENFLAMASYON
GOUT (ENFLAMASYON NAN JWENTI PYE AK MEN YO) - MEDIKAMAN POU TRETE GOUT
allopurinol tab 100 mg
1
$0
allopurinol tab 300 mg
1
$0
colchicine w/ probenecid tab 0.5-500 mg
1
$0
COLCRYS TAB 0.6MG
2
$0
QL (120 grenn / 30 jou)
probenecid tab 500 mg
1
$0
ULORIC TAB 40MG
2
$0
ST
ULORIC TAB 80MG
2
$0
ST
DIVÈS
acetamin jr tab 160mg rt
ACETAMINOPHE TAB 650MG
acetaminophen soln 160 mg/5ml
ADULT ASA TAB 81MG QM
ADVIL JR ST TAB 100MG
all day pain tab 220mg
APAP 500 LIQ 500/5ML
ASCRIPTIN TAB
ASPIRIN SUP 60MG
ASPIRIN SUP 120MG
ASPIRIN SUP 200MG
aspirin suppos 300 mg
aspirin suppos 600 mg
aspirin tab 81 mg
aspirin tab 325 mg
ASPIRIN TAB 650MG EC
aspirin tab delayed release 325 mg
bayer low chw 81mg
BUFFERIN TAB 81MG
BUFFERIN TAB 500MG
CHILD MOTRIN CHW 50MG
chld asafree elx 80/2.5ml
doans ex st tab 580mg
ed-apap liq 80mg/2.5
ELIXSURE GEL F/P BGUM
eq aspirin tab 500mg ec
FEBROL SOL 325/5ML
FEVERALL INF SUP 80MG
FEVERALL SUP 120MG
FEVERALL SUP 325MG
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
* = Pa limite nan yon medikaman Pati D; B/D = Medikaman Pati B oswa D; LA = Aksè
limite; NM = Ou pa kapab kòmande li pa lapòs; PA = Ou bezwen otorizasyon alavans;
QL = Gen yon limit nan kantite; ST = Terapi gradyèl (ki fèt nan etap). Ou kapab jwenn enfòma
?
Si w gen kesyon, tanpri rele North Shore-LIJ FIDA LiveWell nan (855) 776-7545, Lendi jiska
Dimanch, depi 8:00 am jiska 8:00 pm. Koutfil la gratis. Pou jwenn plis enfòmasyon, ale nan
NSLIJHealthPlans.com/FIDALiveWell.
12
Non medikaman an
Nivo
pral koute
itilizasyon
obligatwa yo
FEVERALL SUP 650MG
3
$0
NM; *
8 hour pain tab 650mg
3
$0
NM; *
ibuprofen cap 200 mg
3
$0
NM; *
ibuprofen dro 50/1.25
3
$0
NM; *
ibuprofen jr chw 100mg
3
$0
NM; *
ibuprofen sus 100/5ml
3
$0
NM; *
motrin ib tab 200mg
3
$0
NM; *
NAPROXEN SODIUM CAP 220 MG
3
$0
NM; *
non-asa jr tab 160mg
3
$0
NM; *
non-aspirin chw 80mg
3
$0
NM; *
non-aspirin chw 160mg jr
3
$0
NM; *
NON-ASPIRIN TAB 500MG QM
3
$0
NM; *
pain relief dro 80/0.8ml
3
$0
NM; *
pain relief liq 500/15ml
3
$0
NM; *
pain relief sus 160/5ml
3
$0
NM; *
pain relief tab 325mg
3
$0
NM; *
pain relief tab 500mg
3
$0
NM; *
pain relievr tab 325mg
3
$0
NM; *
q-pap infant dro 80/0.8ml
3
$0
NM; *
ra aspirin tab 500mg
3
$0
NM; *
st joseph as chw 81mg
3
$0
NM; *
ST JOSEPH CHW 75MG ADU
3
$0
NM; *
STANBACK AF POW 950MG
3
$0
NM; *
tri-buff asa tab 325mg
3
$0
NM; *
TRIAMINIC SYP INFANT
3
$0
NM; *
tylenol chld tab 80mg
3
$0
NM; *
NSAIDS - MEDIKAMAN POU TRETE DOULÈ AK ENFLAMASYON
CELEBREX CAP 50MG
2
$0
QL (60 kapsil / 30 jou)
CELEBREX CAP 100MG
2
$0
CELEBREX CAP 200MG
2
$0
CELEBREX CAP 400MG
2
$0
diclofenac potassium tab 50 mg
1
$0
diclofenac sodium tab delayed release 25 mg
1
$0
1
$0
1
$0
diclofenac sodium tab sr 24hr 100 mg
1
$0
diflunisal tab 500 mg
1
$0
etodolac cap 200 mg
1
$0
etodolac cap 300 mg
1
$0
etodolac tab 400 mg
1
$0
etodolac tab 500 mg
1
$0
etodolac tab sr 24hr 400 mg
1
$0
1
$0
?
13
Non medikaman an
pral koute
itilizasyon
obligatwa yo
1
$0
flurbiprofen tab 50 mg
1
$0
flurbiprofen tab 100 mg
1
$0
ibuprofen susp 100 mg/5ml
1
$0
ibuprofen tab 400 mg
1
$0
1
$0
1
$0
ketoprofen cap 50 mg
1
$0
ketoprofen cap 75 mg
1
$0
MELOXICAM SUSP 7.5 MG/5ML
1
$0
meloxicam tab 7.5 mg
1
$0
meloxicam tab 15 mg
1
$0
nabumetone tab 500 mg
1
$0
nabumetone tab 750 mg
1
$0
naproxen dr tab 375mg
1
$0
naproxen dr tab 500mg
1
$0
naproxen sodium tab 275 mg
1
$0
naproxen sodium tab 550 mg
1
$0
naproxen susp 125 mg/5ml
1
$0
naproxen tab 250 mg
1
$0
naproxen tab 375 mg
1
$0
naproxen tab 500 mg
1
$0
piroxicam cap 10 mg
1
$0
piroxicam cap 20 mg
1
$0
sulindac tab 150 mg
1
$0
sulindac tab 200 mg
1
$0
ANALJEZIK OPIYOYID - MEDIKAMAN POU TRETE DOULÈ
acetaminophen w/ codeine soln 120-12 mg/5ml 1
$0
QL (5000 mL / 30 jou)
acetaminophen w/ codeine tab 300-15 mg
1
$0
1
$0
1
$0
butorphanol tartrate inj 1 mg/ml
1
$0
butorphanol tartrate inj 2 mg/ml
1
$0
hydrocodone-acetaminophen soln 7.5-325
1
$0
QL (5400 mL / 30 jou)
mg/15ml
hydrocodone-acetaminophen tab 5-325 mg
1
$0
hydrocodone-acetaminophen tab 7.5-325 mg
1
$0
hydrocodone-acetaminophen tab 10-325 mg
1
$0
hydrocodone-ibuprofen tab 7.5-200 mg
1
$0
tramadol hcl tab 50 mg
1
$0
tramadol-acetaminophen tab 37.5-325 mg
1
$0
ANALJEZIK OPIYOYID, CII - MEDIKAMAN POU TRETE DOULÈ
DURAMORPH INJ 0.5MG/ML
1
$0
B/D
?
Nivo
14
Non medikaman an
Nivo
pral koute
itilizasyon
obligatwa yo
$0
B/D
$0
$0
$0
$0
QL (120 pastiy / 30 jou),
PA
$0
PA
$0
PA
$0
PA
$0
PA
$0
PA
$0
QL (10 plak / 30 jou)
$0
$0
QL (10 plak / 30 jou),
PA
$0
PA
$0
PA
$0
$0
B/D
DURAMORPH INJ 1MG/ML
endocet tab 5-325mg
endocet tab 7.5-325
endocet tab 10-325mg
fentanyl citrate lozenge on a handle 200 mcg
1
1
1
1
2
2
2
2
2
2
fentanyl td patch 72hr 12 mcg/hr
1
1
1
1
1
hydromorphone hcl liqd 1 mg/ml
hydromorphone hcl preservative free (pf) inj
10 mg/ml
hydromorphone hcl tab 2 mg
LAZANDA SPR 100MCG
1
1
1
1
1
2
$0
$0
$0
$0
LAZANDA SPR 400MCG
2
$0
QL (30 bottles / 30 jou),
PA
PA
QL (120 mL / 30 jou)
QL (600 mL / 30 jou)
QL (600 mL / 30 jou)
B/D
B/D
B/D
methadone con 10mg/ml
1
$0
methadone hcl soln 5 mg/5ml
1
$0
methadone hcl soln 10 mg/5ml
1
$0
methadone hcl tab 5 mg
1
$0
methadone hcl tab 10 mg
1
$0
MORPHINE SUL INJ 2MG/ML
1
$0
1
$0
1
$0
MORPHINE SULFATE (CONCENTRATE)
1
$0
ORAL SOLN 20 MG/ML
?
15
Non medikaman an
morphine sulfate beads cap sr 24hr 30 mg
morphine sulfate cap sr 24hr 10 mg
morphine sulfate inj pf 0.5 mg/ml
morphine sulfate inj pf 1 mg/ml
MORPHINE SULFATE IV SOLN 1 MG/ML
MORPHINE SULFATE IV SOLN PF 10 MG/ML
MORPHINE SULFATE ORAL SOLN
10 MG/5ML
MORPHINE SULFATE ORAL SOLN
20 MG/5ML
MORPHINE SULFATE TAB 15 MG
MORPHINE SULFATE TAB 30 MG
morphine sulfate tab cr 15 mg
oxycodone hcl cap 5 mg
OXYCODONE HCL CONC 100 MG/5ML
(20 MG/ML)
oxycodone hcl soln 5 mg/5ml
oxycodone hcl tab 5 mg
oxycodone w/ acetaminophen tab 2.5-325 mg
oxycodone w/ acetaminophen tab 5-325 mg
Nivo
1
1
1
1
1
1
1
1
1
1
1
2
2
1
1
1
1
1
1
pral koute
itilizasyon
obligatwa yo
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
B/D
$0
B/D
$0
B/D
$0
B/D
$0
B/D
$0
1
$0
1
1
1
1
1
1
1
1
1
$0
$0
$0
$0
$0
$0
$0
$0
$0
1
1
1
1
1
1
1
1
1
1
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
?
16
Non medikaman an
Nivo
pral koute
itilizasyon
obligatwa yo
roxicet sol 5-325/5
2
$0
QL (1800 mL / 30 jou
soln)
roxicet tab 5-325mg
1
$0
ANESTEZI - MEDIKAMAN POU FÈ OU PÈDI SANSASYON
ANESTEZI LOKAL
lidocaine hcl local inj 0.5%
1
lidocaine hcl local inj 1%
1
lidocaine hcl local inj 1.5%
1
lidocaine hcl local inj 2%
1
lidocaine hcl local preservative free (pf) inj 0.5% 1
lidocaine hcl local preservative free (pf) inj 1%
1
ANTI-ENFEKSYON - MEDIKAMAN POU TRETE ENFEKSYON
ANTI-BAKTERI - DIVÈS
amikacin sulfate inj 1 gm/4ml (250 mg/ml)
1
amikacin sulfate inj 500 mg/2ml (250 mg/ml)
1
gentam/nacl inj 0.9mg/ml
1
gentam/nacl inj 1.4mg/ml
1
gentamicin in saline inj 0.8 mg/ml
1
gentamicin in saline inj 1 mg/ml
1
1
1
gentamicin in saline inj 2 mg/ml
1
gentamicin sulfate inj 10 mg/ml
1
gentamicin sulfate inj 40 mg/ml
1
gentamicin sulfate iv soln 10 mg/ml
1
neomycin sulfate tab 500 mg
1
paromomycin sulfate cap 250 mg
1
streptomycin sulfate for inj 1 gm
1
sulfadiazine tab 500mg
2
tobra/nacl inj 80/0.9
2
tobramycin nebu soln 300 mg/5ml
2
tobramycin sulfate for inj 1.2 gm
1
tobramycin sulfate inj 1.2 gm/30ml (40 mg/ml)
1
tobramycin sulfate inj 2 gm/50ml (40 mg/ml)
1
tobramycin sulfate inj 10 mg/ml
1
tobramycin sulfate inj 80 mg/2ml (40 mg/ml)
1
ANTI-ENFEKSYON - DIVÈS
ALBENZA TAB 200MG
2
ALINIA SUS 100/5ML
2
ALINIA TAB 500MG
2
atovaquone susp 750 mg/5ml
2
AZACTAM INJ 1GM
2
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
B/D
B/D
B/D
B/D
B/D
B/D
B/D, NM
$0
$0
$0
$0
$0
?
17
Non medikaman an
AZACTAM INJ 2GM
AZACTAM/DEX INJ 1GM
AZACTAM/DEX INJ 2GM
aztreonam for inj 1 gm
aztreonam for inj 2 gm
BILTRICIDE TAB 600MG
CAYSTON INH 75MG
clindamycin hcl cap 75 mg
clindamycin palmitate hcl for soln 75 mg/5ml
(base equiv)
clindamycin phosphate inj 9 gm/60ml
clindamycin phosphate inj 300 mg/2ml
clindamycin phosphate iv soln 300 mg/2ml
colistimethate sodium for inj 150 mg
CUBICIN SOL 500MG
dapsone tab 25 mg
dapsone tab 100 mg
DARAPRIM TAB 25MG
e.s.p. sus 200-600
erythromycin-sulfisoxazole for susp
200-600 mg/5ml
imipenem-cilastatin intravenous for soln 250 mg
imipenem-cilastatin intravenous for soln 500 mg
INVANZ INJ 1GM
meropenem iv for soln 1 gm
meropenem iv for soln 500 mg
methenamine hippurate tab 1 gm
metronidazole in nacl 0.79% iv soln
500 mg/100ml
metronidazole tab 250 mg
metronidazole tab 500 mg
NEBUPENT INH 300MG
nitrofurantoin macrocrystalline cap 50 mg
nitrofurantoin macrocrystalline cap 100 mg
nitrofurantoin monohydrate macrocrystalline cap
100 mg
PENTAM 300 INJ 300MG
Nivo
2
2
2
1
1
2
2
1
1
1
1
pral koute
itilizasyon
obligatwa yo
$0
$0
$0
$0
$0
$0
$0
NM, LA, PA
$0
$0
$0
$0
1
1
1
1
1
1
1
1
2
1
1
2
1
1
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
1
1
2
1
1
1
1
$0
$0
$0
$0
$0
$0
$0
1
1
2
2
2
2
$0
$0
$0
$0
$0
$0
2
$0
B/D
B/D
PA; 90 day limit if >64 yr
?
18
Non medikaman an
SIVEXTRO INJ 200MG
SIVEXTRO TAB 200MG
sulfamethoxazole-trimethoprim iv soln
400-80 mg/5ml
sulfamethoxazole-trimethoprim susp
200-40 mg/5ml
sulfamethoxazole-trimethoprim tab 400-80 mg
SYNERCID INJ 500MG
trimethoprim tab 100 mg
TYGACIL INJ 50MG
vancomycin hcl cap 125 mg
vancomycin hcl cap 250 mg
vancomycin hcl for inj 10 gm
vancomycin hcl for inj 500 mg
vancomycin inj 750mg
ZYVOX SOL 2MG/ML
ZYVOX SUS 100MG/5M
ZYVOX TAB 600MG
Nivo
2
2
1
pral koute
itilizasyon
obligatwa yo
$0
$0
$0
1
$0
1
1
2
1
2
2
2
1
1
1
1
1
2
2
2
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
ANTIFONJIK - MEDIKAMAN POU TRETE ENFEKSYON FONJIK
ABELCET INJ 5MG/ML
2
$0
AMBISOME INJ 50MG
2
$0
amphotericin b for inj 50 mg
1
$0
CANCIDAS INJ 50MG
2
$0
CANCIDAS INJ 70MG
2
$0
ERAXIS INJ 50MG
2
$0
ERAXIS INJ 100MG
2
$0
fluconazole for susp 10 mg/ml
1
$0
fluconazole for susp 40 mg/ml
1
$0
fluconazole in dextrose inj 200 mg/100ml
1
$0
fluconazole in dextrose inj 400 mg/200ml
1
$0
fluconazole in nacl 0.9% inj 200 mg/100ml
1
$0
fluconazole in nacl 0.9% inj 400 mg/200ml
1
$0
fluconazole tab 50 mg
1
$0
1
$0
1
$0
1
$0
flucytosine cap 250 mg
2
$0
flucytosine cap 500 mg
2
$0
griseofulvin microsize susp 125 mg/5ml
1
$0
griseofulvin microsize tab 500 mg
1
$0
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
?
19
Non medikaman an
Nivo
pral koute
itilizasyon
obligatwa yo
$0
$0
$0
PA
$0
PA
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
griseofulvin ultramicrosize tab 125 mg
1
griseofulvin ultramicrosize tab 250 mg
1
itraconazole cap 100 mg
1
ketoconazole tab 200 mg
1
MYCAMINE INJ 50MG
2
MYCAMINE INJ 100MG
2
NOXAFIL SUS 40MG/ML
2
NOXAFIL TAB 100MG
2
nystatin tab 500000 unit
1
terbinafine hcl tab 250 mg
1
voriconazole for inj 200 mg
1
voriconazole for susp 40 mg/ml
2
voriconazole tab 50 mg
2
voriconazole tab 200 mg
2
ANTIMALARYA - MEDIKAMAN POU TRETE MALARYA
atovaquone-proguanil hcl tab 62.5-25 mg
1
$0
atovaquone-proguanil hcl tab 250-100 mg
1
$0
chloroquine phosphate tab 250 mg
1
$0
chloroquine phosphate tab 500 mg
1
$0
COARTEM TAB 20-120MG
2
$0
mefloquine hcl tab 250 mg
1
$0
PRIMAQUINE TAB 26.3MG
2
$0
quinine sulfate cap 324 mg
1
$0
PA
AJAN ANTIRETWOVIRAL - MEDIKAMAN POU SIPRIME VIRIS VIH/ENFEKSYON SIDA
abacavir sulfate tab 300 mg (base equiv)
1
$0
APTIVUS CAP 250MG
2
$0
APTIVUS SOL
2
$0
CRIXIVAN CAP 200MG
2
$0
CRIXIVAN CAP 400MG
2
$0
didanosine delayed release capsule 125 mg
1
$0
1
$0
1
$0
1
$0
EDURANT TAB 25MG
2
$0
EMTRIVA CAP 200MG
2
$0
EMTRIVA SOL 10MG/ML
2
$0
EPIVIR SOL 10MG/ML
2
$0
FUZEON INJ 90MG
2
$0
NM
INTELENCE TAB 25MG
2
$0
INTELENCE TAB 100MG
2
$0
INTELENCE TAB 200MG
2
$0
INVIRASE CAP 200MG
2
$0
INVIRASE TAB 500MG
2
$0
?
20
Non medikaman an
ISENTRESS CHW 25MG
ISENTRESS CHW 100MG
ISENTRESS POW 100MG
ISENTRESS TAB 400MG
lamivudine tab 150 mg
LEXIVA SUS 50MG/ML
LEXIVA TAB 700MG
NEVIRAPINE SUSP 50 MG/5ML
nevirapine tab 200 mg
nevirapine tab sr 24hr 400 mg
NORVIR CAP 100MG
NORVIR SOL 80MG/ML
NORVIR TAB 100MG
PREZISTA SUS 100MG/ML
PREZISTA TAB 75MG
PREZISTA TAB 150MG
PREZISTA TAB 600MG
PREZISTA TAB 800MG
RESCRIPTOR TAB 100 MG
RESCRIPTOR TAB 200MG
RETROVIR INJ 10MG/ML
REYATAZ CAP 150MG
REYATAZ CAP 200MG
REYATAZ CAP 300MG
SELZENTRY TAB 150MG
SELZENTRY TAB 300MG
stavudine cap 15 mg
stavudine cap 20 mg
stavudine cap 30 mg
stavudine cap 40 mg
stavudine for oral soln 1 mg/ml
SUSTIVA CAP 50MG
SUSTIVA CAP 200MG
SUSTIVA TAB 600MG
TIVICAY TAB 50MG
TYBOST TAB 150MG
VIDEX SOL 2GM
VIDEX SOL 4GM
VIRACEPT TAB 250MG
VIRACEPT TAB 625MG
VIRAMUNE XR TAB 100MG
VIREAD POW 40MG/GM
Nivo
2
2
1
2
1
1
2
2
1
1
1
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
1
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2
pral koute
itilizasyon
obligatwa yo
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
?
21
Non medikaman an
Nivo
pral koute
itilizasyon
obligatwa yo
VIREAD TAB 150MG
2
$0
VIREAD TAB 200MG
2
$0
VIREAD TAB 250MG
2
$0
VIREAD TAB 300MG
2
$0
ZIAGEN SOL 20MG/ML
2
$0
zidovudine cap 100 mg
1
$0
zidovudine syrup 10 mg/ml
1
$0
zidovudine tab 300 mg
1
$0
KONBINEZON AJAN ANTIRETWOVIRAL - MEDIKAMAN POU SIPRIME VIRIS
VIH/ENFEKSYON SIDA
abacavir sulfate-lamivudine-zidovudine tab
2
$0
300-150-300 mg
ATRIPLA TAB
2
$0
COMPLERA TAB
2
$0
EPZICOM TAB 600-300
2
$0
KALETRA SOL
2
$0
KALETRA TAB 100-25MG
2
$0
KALETRA TAB 200-50MG
2
$0
lamivudine-zidovudine tab 150-300 mg
2
$0
STRIBILD TAB
2
$0
TRIUMEQ TAB
2
$0
TRUVADA TAB 200-300
2
$0
AJAN ANTITIBÈKILOZ - MEDIKAMAN POU TRETE TIBÈKILOZ
CAPASTAT SUL INJ 1GM
2
cycloserine cap 250 mg
1
ethambutol hcl tab 100 mg
1
ethambutol hcl tab 400 mg
1
isoniazid inj 100 mg/ml
1
isoniazid syrup 50 mg/5ml
1
isoniazid tab 100 mg
1
isoniazid tab 300 mg
1
paser gra 4gm
2
PRIFTIN TAB 150MG
2
pyrazinamide tab 500 mg
1
rifabutin cap 150 mg
1
rifampin cap 150 mg
1
rifampin cap 300 mg
1
rifampin for inj 600 mg
1
RIFATER TAB
2
SIRTURO TAB 100MG
2
TRECATOR TAB 250MG
2
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
LA, PA
ANTIVIRAL - MEDIKAMAN POU TRETE ENFEKSYON VIRAL
?
22
Non medikaman an
acyclovir cap 200 mg
acyclovir sodium for inj 500 mg
acyclovir sodium for inj 1000 mg
acyclovir sodium iv soln 50 mg/ml
acyclovir susp 200 mg/5ml
acyclovir tab 400 mg
acyclovir tab 800 mg
adefovir dipivoxil tab 10 mg
BARACLUDE SOL .05MG/ML
BARACLUDE TAB 0.5MG
BARACLUDE TAB 1MG
entecavir tab 0.5 mg
entecavir tab 1 mg
EPIVIR HBV SOL 5MG/ML
famciclovir tab 125 mg
foscarnet sodium inj 24 mg/ml
ganciclovir sodium for inj 500 mg
moderiba pak 600/day
OLYSIO CAP 150MG
REBETOL SOL 40MG/ML
RELENZA MIS DISKHALE
ribapak pak 600/day
ribapak pak 800/day
ribapak pak 1000/day
ribapak pak 1200/day
ribasphere cap 200mg
ribasphere tab 200mg
ribavirin cap 200 mg
ribavirin tab 200 mg
rimantadine hydrochloride tab 100 mg
SOVALDI TAB 400MG
TAMIFLU CAP 30MG
TAMIFLU CAP 45MG
TAMIFLU CAP 75MG
TAMIFLU SUS 6MG/ML
Nivo
1
1
1
1
1
1
1
2
2
2
2
2
2
2
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2
1
1
1
2
1
1
1
2
2
2
2
2
pral koute
itilizasyon
obligatwa yo
$0
$0
B/D
$0
B/D
$0
B/D
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
B/D
$0
$0
NM, PA
$0
NM, PA
$0
NM, PA
$0
NM, PA
$0
NM, PA
$0
NM, PA
$0
$0
NM, PA
$0
NM, PA
$0
NM, PA
$0
NM, PA
$0
NM, PA
$0
NM, PA
$0
NM, PA
$0
NM, PA
$0
NM, PA
$0
NM, PA
$0
$0
NM, PA
$0
$0
$0
$0
?
23
Non medikaman an
Nivo
pral koute
itilizasyon
obligatwa yo
TYZEKA TAB 600MG
2
$0
valacyclovir hcl tab 1 gm
1
$0
valacyclovir hcl tab 500 mg
1
$0
VALCYTE SOL 50MG/ML
2
$0
VALCYTE TAB 450MG
2
$0
VICTRELIS CAP 200MG
2
$0
NM, PA
SEFALOSPORIN (CEPHALOSPORINS) - MEDIKAMAN POU TRETE ENFEKSYON
cefaclor cap 250 mg
1
$0
cefaclor cap 500 mg
1
$0
cefaclor er tab 500mg
2
$0
cefaclor for susp 125 mg/5ml
1
$0
1
$0
1
$0
cefadroxil cap 500 mg
1
$0
cefadroxil for susp 250 mg/5ml
1
$0
cefadroxil for susp 500 mg/5ml
1
$0
cefadroxil tab 1 gm
1
$0
cefazolin inj 1gm/50ml
2
$0
cefazolin sodium for inj 1 gm
1
$0
1
$0
1
$0
cefazolin sodium for inj 500 mg
1
$0
cefazolin sodium for iv soln 1 gm
1
$0
cefdinir cap 300 mg
1
$0
cefdinir for susp 125 mg/5ml
1
$0
cefdinir for susp 250 mg/5ml
1
$0
cefepime hcl for inj 1 gm
1
$0
cefepime hcl for inj 2 gm
1
$0
cefotaxime sodium for inj 1 gm
1
$0
1
$0
1
$0
cefotaxime sodium for inj 500 mg
1
$0
cefoxitin sodium for inj 1 gm
1
$0
1
$0
1
$0
cefpodoxime proxetil for susp 50 mg/5ml
1
$0
cefpodoxime proxetil for susp 100 mg/5ml
1
$0
cefpodoxime proxetil tab 100 mg
1
$0
cefpodoxime proxetil tab 200 mg
1
$0
cefprozil for susp 125 mg/5ml
1
$0
cefprozil for susp 250 mg/5ml
1
$0
cefprozil tab 250 mg
1
$0
cefprozil tab 500 mg
1
$0
?
24
Non medikaman an
ceftazidime for inj 1 gm
CEFTAZIDIME/ SOL D5W 1GM
CEFTAZIDIME/ SOL D5W 2GM
ceftriaxone sodium for inj 1 gm
ceftriaxone sodium for inj 250 mg
ceftriaxone sodium for inj 500 mg
ceftriaxone sodium for iv soln 1 gm
ceftriaxone sodium for iv soln 2 gm
cefuroxime axetil tab 250 mg
cefuroxime axetil tab 500 mg
cefuroxime inj 7.5gm
cefuroxime sodium for inj 1.5 gm
cefuroxime sodium for inj 7.5 gm
cefuroxime sodium for inj 750 mg
cefuroxime sodium for iv soln 1.5 gm
cephalexin cap 250 mg
cephalexin cap 500 mg
cephalexin for susp 125 mg/5ml
cephalexin for susp 250 mg/5ml
SUPRAX CAP 400MG
suprax chw 100mg
suprax chw 200mg
suprax sus 100/5ml
suprax sus 200/5ml
SUPRAX SUS 500/5ML
suprax tab 400mg
tazicef inj 1gm
tazicef inj 2gm
tazicef inj 6gm
TEFLARO INJ 400MG
TEFLARO INJ 600MG
Nivo
1
1
1
2
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
1
1
1
2
2
pral koute
itilizasyon
obligatwa yo
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
ERITWOMISIN/MAKROLID - MEDIKAMAN POU TRETE ENFEKSYON
azithromycin for susp 100 mg/5ml
1
$0
azithromycin for susp 200 mg/5ml
1
$0
azithromycin iv for soln 500 mg
1
$0
AZITHROMYCIN POWD PACK FOR
1
$0
SUSP 1 GM
azithromycin tab 250 mg
1
$0
1
$0
?
25
Non medikaman an
Nivo
pral koute
itilizasyon
obligatwa yo
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
1
clarithromycin for susp 125 mg/5ml
1
clarithromycin for susp 250 mg/5ml
1
clarithromycin tab 250 mg
1
clarithromycin tab 500 mg
1
clarithromycin tab sr 24hr 500 mg
1
DIFICID TAB 200MG
2
e.e.s. 400 tab 400mg
1
E.E.S. GRAN SUS 200/5ML
2
ery-tab tab 250mg ec
2
2
2
ERYPED SUS 200/5ML
2
ERYPED SUS 400/5ML
2
erythrocin inj 500mg
2
erythrocin tab 250mg
1
erythromycin ethylsuccinate tab 400 mg
1
erythromycin tab 250 mg
1
erythromycin tab 500 mg
1
erythromycin w/ delayed release particles
1
cap 250 mg
ZMAX SUS 2GM
2
FLUOROKINOLON - MEDIKAMAN POU TRETE ENFEKSYON
ciprofloxacin 200 mg/100ml in d5w
1
ciprofloxacin 400 mg/200ml in d5w
1
ciprofloxacin for oral susp 250 mg/5ml (5%)
1
(5 gm/100ml)
1
(10 gm/100ml)
ciprofloxacin hcl tab 100 mg (base equiv)
1
1
1
1
ciprofloxacin iv soln 200 mg/20ml (1%)
1
ciprofloxacin iv soln 400 mg/40ml (1%)
1
ciprofloxacin-ciprofloxacin hcl tab sr 24hr
1
500 mg (base eq)
ciprofloxacin-ciprofloxacin hcl tab sr 24hr
1
1000 mg(base eq)
levofloxacin in d5w iv soln 250 mg/50ml
1
1
1
levofloxacin iv soln 25 mg/ml
1
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
?
26
Non medikaman an
Nivo
levofloxacin oral soln 25 mg/ml
1
levofloxacin tab 250 mg
1
1
1
PENISILIN - MEDIKAMAN POU TRETE ENFEKSYON
amoxicillin & k clavulanate chew tab
1
200-28.5 mg
amoxicillin & k clavulanate chew tab 400-57 mg 1
amoxicillin & k clavulanate for susp
1
200-28.5 mg/5ml
1
250-62.5 mg/5ml
1
400-57 mg/5ml
1
600-42.9 mg/5ml
amoxicillin & k clavulanate tab 250-125 mg
1
1
1
amoxicillin & k clavulanate tab sr 12hr
1
1000-62.5 mg
amoxicillin (trihydrate) cap 250 mg
1
amoxicillin (trihydrate) cap 500 mg
1
amoxicillin (trihydrate) chew tab 125 mg
1
amoxicillin (trihydrate) chew tab 250 mg
1
amoxicillin (trihydrate) for susp 125 mg/5ml
1
1
1
1
amoxicillin (trihydrate) tab 500 mg
1
amoxicillin (trihydrate) tab 875 mg
1
ampicillin & sulbactam sodium for inj 1-0.5 gm
1
ampicillin & sulbactam sodium for inj 2-1 gm
1
1
ampicillin & sulbactam sodium for iv soln
1
1-0.5 gm
ampicillin & sulbactam sodium for iv soln 2-1 gm 1
ampicillin & sulbactam sodium for iv soln
1
10-5 gm
ampicillin cap 250 mg
1
ampicillin cap 500 mg
1
ampicillin for susp 125 mg/5ml
1
ampicillin for susp 250 mg/5ml
1
pral koute
itilizasyon
obligatwa yo
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
?
27
Non medikaman an
ampicillin sodium for inj 1 gm
ampicillin sodium for inj 2 gm
ampicillin sodium for inj 125 mg
ampicillin sodium for iv soln 1 gm
BICILLIN L-A INJ 600000
dicloxacillin sodium cap 250 mg
dicloxacillin sodium cap 500 mg
nafcillin sodium for inj 1 gm
nafcillin sodium for iv soln 1 gm
nafcillin sodium for iv soln 2 gm
oxacillin sodium for inj 1 gm
pen g proc inj 600000
PENICILL GK/ INJ DEX 2MU
PENICILL GK/ INJ DEX 3MU
penicillin g potassium for inj 5000000 unit
penicillin g potassium for inj 20000000 unit
penicillin g sodium for inj 5000000 unit
penicillin v potassium for soln 125 mg/5ml
penicillin v potassium for soln 250 mg/5ml
penicillin v potassium tab 250 mg
penicillin v potassium tab 500 mg
piperacillin sodium-tazobactam sodium for inj
2-0.25 gm
3-0.375 gm
4-0.5 gm
36-4.5 gm
TIMENTIN INJ 3.1GM
TIMENTIN INJ 31GM
Nivo
1
1
1
1
1
1
1
1
2
2
2
1
1
1
2
2
1
2
1
1
2
2
2
2
1
1
1
1
1
1
1
1
pral koute
itilizasyon
obligatwa yo
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
1
$0
1
$0
1
$0
2
2
$0
$0
TETRASIKLIN - MEDIKAMAN POU TRETE ENFEKSYON
doxycycline hyclate cap 50 mg
1
$0
?
28
Non medikaman an
Nivo
pral koute
itilizasyon
obligatwa yo
doxycycline hyclate cap 100 mg
1
$0
doxycycline hyclate for inj 100 mg
1
$0
doxycycline hyclate tab 20 mg
1
$0
doxycycline hyclate tab 100 mg
1
$0
doxycycline monohydrate cap 50 mg
1
$0
doxycycline monohydrate cap 100 mg
1
$0
doxycycline monohydrate tab 50 mg
1
$0
1
$0
1
$0
1
$0
minocycline hcl cap 50 mg
1
$0
1
$0
1
$0
VIBRAMYCIN SYP 50MG/5ML
2
$0
AJAN ANTINEOPLAZIK - MEDIKAMAN POU TRETE KANSÈ
AJAN ALKILAN
BICNU INJ 100MG
2
$0
B/D
BUSULFEX INJ 6MG/ML
2
$0
B/D
CYCLOPHOSPH CAP 25MG
2
$0
B/D
CYCLOPHOSPH CAP 50MG
2
$0
B/D
cyclophosphamide for inj 1 gm
1
$0
B/D
cyclophosphamide for inj 2 gm
1
$0
B/D
cyclophosphamide for inj 500 mg
1
$0
B/D
cyclophosphamide tab 25 mg
1
$0
B/D
cyclophosphamide tab 50 mg
1
$0
B/D
dacarbazine for inj 200 mg
1
$0
B/D
EMCYT CAP 140MG
2
$0
HEXALEN CAP 50MG
2
$0
IFEX INJ 3GM
2
$0
B/D
ifosfamide for inj 1 gm
1
$0
B/D
IFOSFAMIDE INJ 3GM
2
$0
B/D
ifosfamide iv inj 1 gm/20ml (50 mg/ml)
1
$0
B/D
ifosfamide iv inj 3 gm/60ml (50 mg/ml)
1
$0
B/D
LEUKERAN TAB 2MG
2
$0
LOMUSTINE CAP 10 MG
1
$0
LOMUSTINE CAP 40 MG
1
$0
LOMUSTINE CAP 100 MG
1
$0
melphalan hcl for inj 50 mg (base equiv)
2
$0
B/D
MUSTARGEN INJ 10MG
2
$0
B/D
TREANDA INJ 25MG
2
$0
B/D, NM
TREANDA INJ 100MG
2
$0
B/D, NM
ANTRASIKLIN
?
29
Non medikaman an
adriamyc inj 50mg
daunorubicin hcl inj 5 mg/ml (base equiv)
doxorubicin hcl for inj 50 mg
doxorubicin hcl inj 2 mg/ml
doxorubicin hcl liposomal inj (for iv infusion)
2 mg/ml
epirubicin hcl inj 50 mg/25ml (2 mg/ml)
epirubicin hcl inj 200 mg/100ml (2 mg/ml)
idarubicin hcl iv inj 5 mg/5ml (1 mg/ml)
Nivo
1
1
1
1
2
1
1
2
2
2
pral koute
itilizasyon
obligatwa yo
$0
B/D
$0
B/D
$0
B/D
$0
B/D
$0
B/D
$0
$0
$0
$0
$0
B/D
B/D
B/D
B/D
B/D
ANTIBYOTIK
bleomycin sulfate for inj 15 unit
1
$0
B/D
bleomycin sulfate for inj 30 unit
1
$0
B/D
mitomycin for inj 5 mg
1
$0
B/D
1
$0
B/D
1
$0
B/D
ANTIMETABOLIT
adrucil inj 2.5g/50m
1
$0
B/D
adrucil inj 5gm/100m
1
$0
B/D
adrucil inj 500/10ml
1
$0
B/D
ALIMTA INJ 100MG
2
$0
B/D
ALIMTA INJ 500MG
2
$0
B/D
azacitidine for inj 100 mg
2
$0
B/D, NM
cladribine inj 1 mg/ml
2
$0
B/D
cytarabine inj 20 mg/ml
1
$0
B/D
fludarabine phosphate for inj 50 mg
1
$0
B/D
fludarabine phosphate inj 25 mg/ml
1
$0
B/D
fluorouracil inj 1 gm/20ml (50 mg/ml)
1
$0
B/D
fluorouracil inj 2.5 gm/50ml (50 mg/ml)
1
$0
B/D
fluorouracil inj 500 mg/10ml (50 mg/ml)
1
$0
B/D
gemcitabine hcl for inj 1 gm
2
$0
B/D
gemcitabine hcl for inj 2 gm
2
$0
B/D
gemcitabine hcl for inj 200 mg
2
$0
B/D
GEMCITABINE INJ 1GM
2
$0
B/D
GEMCITABINE INJ 2GM
2
$0
B/D
GEMCITABINE INJ 200MG
2
$0
B/D
mercaptopurine tab 50 mg
1
$0
methotrexate sodium for inj 1 gm
1
$0
B/D
methotrexate sodium inj 25 mg/ml
1
$0
B/D
methotrexate sodium inj pf 25 mg/ml
1
$0
B/D
NIPENT INJ 10MG
2
$0
B/D
TABLOID TAB 40MG
2
$0
?
30
Non medikaman an
ANTIMITOTIK, TAKZYOID
DOCETAXEL FOR INJ CONC 20 MG/ML
DOCETAXEL FOR INJ CONC 80 MG/4ML
(20 MG/ML)
DOCETAXEL INJ 80MG/8ML
docetaxel inj 140/7ml
paclitaxel iv conc 30 mg/5ml (6 mg/ml)
paclitaxel iv conc 100 mg/16.7ml (6 mg/ml)
ANTIMITOTIK, VINCA ALKALOYID
vinblastine inj 1mg/ml
vincasar pfs inj 1mg/ml
vincristine sulfate iv soln 1 mg/ml
vinorelbine tartrate inj 10 mg/ml
vinorelbine tartrate inj 50 mg/5ml (10 mg/ml)
MODIFIKATÈ REPONS BYOLOJIK
AVASTIN INJ
ERIVEDGE CAP 150MG
HERCEPTIN INJ 440MG
ISTODAX INJ 10MG
KADCYLA INJ 100MG
KADCYLA INJ 160MG
PROLEUKIN INJ 22MU
RITUXAN INJ 500MG
VELCADE INJ 3.5MG
ZOLINZA CAP 100MG
ÒMONAL AJAN ANTINEOPLAZIK
anastrozole tab 1 mg
bicalutamide tab 50 mg
DEPO-PROVERA INJ 400/ML
exemestane tab 25 mg
FARESTON TAB 60MG
FASLODEX INJ 250MG
flutamide cap 125 mg
letrozole tab 2.5 mg
leuprolide acetate inj kit 5 mg/ml
LUPR DEP-PED INJ 7.5MG
LUPR DEP-PED INJ 11.25MG
LUPR DEP-PED INJ 15MG
LUPR DEP-PED INJ 30MG
LUPRON DEPOT INJ 3.75MG
Nivo
pral koute
itilizasyon
obligatwa yo
2
2
$0
$0
B/D
B/D
2
2
1
1
1
1
$0
$0
$0
$0
$0
$0
B/D
B/D
B/D
B/D
B/D
B/D
2
1
1
1
1
$0
$0
$0
$0
$0
B/D
B/D
B/D
B/D
B/D
2
2
2
2
2
2
2
2
2
2
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
B/D, NM
NM, LA, PA
B/D, NM
B/D, NM
B/D, NM
B/D, NM
B/D, NM
NM, PA
B/D, NM
NM, PA
1
1
2
1
2
2
1
1
1
2
2
2
2
2
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
B/D
B/D
NM, PA
NM, PA
NM, PA
NM, PA
NM, PA
NM, PA
?
31
Non medikaman an
Nivo
LUPRON DEPOT INJ 11.25MG
LYSODREN TAB 500MG
MEGACE ES SUS 625/5ML
megestrol acetate susp 40 mg/ml
megestrol acetate tab 20 mg
megestrol acetate tab 40 mg
NILANDRON TAB 150MG
SOLTAMOX SOL 10MG/5ML
tamoxifen citrate tab 10 mg (base equivalent)
TRELSTAR DEP INJ 3.75MG
TRELSTAR LA INJ 11.25MG
XTANDI CAP 40MG
ZYTIGA TAB 250MG
INIBITÈ KINAZ
AFINITOR DIS TAB 2MG
AFINITOR TAB 2.5MG
AFINITOR TAB 5MG
AFINITOR TAB 7.5MG
AFINITOR TAB 10MG
BOSULIF TAB 100MG
BOSULIF TAB 500MG
CAPRELSA TAB 100MG
CAPRELSA TAB 300MG
COMETRIQ KIT 60MG
COMETRIQ KIT 100MG
COMETRIQ KIT 140MG
GILOTRIF TAB 20MG
GILOTRIF TAB 30MG
GILOTRIF TAB 40MG
GLEEVEC TAB 100MG
GLEEVEC TAB 400MG
ICLUSIG TAB 15MG
ICLUSIG TAB 45MG
IMBRUVICA CAP 140MG
INLYTA TAB 1MG
INLYTA TAB 5MG
JAKAFI TAB 5MG
JAKAFI TAB 10MG
JAKAFI TAB 15MG
JAKAFI TAB 20MG
2
2
2
2
2
2
2
2
1
1
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
pral koute
itilizasyon
obligatwa yo
$0
NM, PA
$0
$0
PA
$0
PA
$0
PA
$0
PA
$0
$0
$0
$0
$0
NM, PA
$0
NM, PA
$0
NM, LA, PA
$0
NM, PA
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
NM, PA
NM, PA
NM, PA
NM, PA
NM, PA
NM, PA
NM, PA
NM, PA
NM, PA
NM, LA, PA
NM, LA, PA
NM, PA
NM, PA
NM, PA
NM, LA, PA
NM, LA, PA
NM, LA, PA
NM, PA
NM, PA
NM, LA, PA
NM, LA, PA
NM, LA, PA
NM, LA, PA
NM, LA, PA
NM, LA, PA
NM, LA, PA
NM, LA, PA
NM, LA, PA
?
32
Non medikaman an
Nivo
JAKAFI TAB 25MG
MEKINIST TAB 0.5MG
MEKINIST TAB 2MG
NEXAVAR TAB 200MG
SPRYCEL TAB 20MG
SPRYCEL TAB 50MG
SPRYCEL TAB 70MG
SPRYCEL TAB 80MG
SPRYCEL TAB 100MG
SPRYCEL TAB 140MG
STIVARGA TAB 40MG
SUTENT CAP 12.5MG
SUTENT CAP 25MG
SUTENT CAP 37.5MG
SUTENT CAP 50MG
TAFINLAR CAP 50MG
TAFINLAR CAP 75MG
TARCEVA TAB 25MG
TARCEVA TAB 100MG
TARCEVA TAB 150MG
TASIGNA CAP 150MG
TASIGNA CAP 200MG
TYKERB TAB 250MG
VOTRIENT TAB 200MG
XALKORI CAP 200MG
XALKORI CAP 250MG
ZELBORAF TAB 240MG
ZYDELIG TAB 100MG
ZYDELIG TAB 150MG
ZYKADIA CAP 150MG
DIVÈS
DROXIA CAP 200MG
DROXIA CAP 300MG
DROXIA CAP 400MG
hydroxyurea cap 500 mg
MATULANE CAP 50MG
mitoxantrone hcl inj conc 20 mg/10ml (2 mg/ml)
mitoxantrone hcl inj conc 25 mg/12.5ml
(2 mg/ml)
POMALYST CAP 1MG
POMALYST CAP 2MG
POMALYST CAP 3MG
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
1
pral koute
itilizasyon
obligatwa yo
$0
NM, LA, PA
$0
NM, PA
$0
NM, PA
$0
NM, LA, PA
$0
NM, PA
$0
NM, PA
$0
NM, PA
$0
NM, PA
$0
NM, PA
$0
NM, PA
$0
NM, LA, PA
$0
NM, PA
$0
NM, PA
$0
NM, PA
$0
NM, PA
$0
NM, PA
$0
NM, PA
$0
NM, PA
$0
NM, PA
$0
NM, PA
$0
NM, PA
$0
NM, PA
$0
NM, LA, PA
$0
NM, PA
$0
NM, LA, PA
$0
NM, LA, PA
$0
NM, LA, PA
$0
NM, LA, PA
$0
NM, LA, PA
$0
NM, LA, PA
2
2
2
1
2
1
1
$0
$0
$0
$0
$0
$0
$0
B/D, NM
B/D, NM
1
2
2
2
$0
$0
$0
$0
B/D, NM
NM, LA, PA
NM, LA, PA
NM, LA, PA
?
33
Non medikaman an
POMALYST CAP 4MG
SYLATRON KIT 296MCG
SYLATRON KIT 444MCG
SYLATRON KIT 888MCG
TARGRETIN CAP 75MG
tretinoin cap 10 mg
TRISENOX SOL 10MG/10M
AJAN KI GEN BAZ PLATIMYÒM
carboplatin iv soln 50 mg/5ml
cisplatin inj 50 mg/50ml (1 mg/ml)
oxaliplatin for iv inj 50 mg
oxaliplatin for iv inj 100 mg
oxaliplatin iv soln 50 mg/10ml
oxaliplatin iv soln 100 mg/20ml
AJAN PWOTEKTIF
amifostine crystalline for inj 500 mg
dexrazoxane for inj 250 mg
ELITEK INJ 1.5MG
ELITEK INJ 7.5MG
leucovorin calcium for inj 50 mg
leucovorin calcium tab 5 mg
leucovorin inj calcium
mesna inj 100 mg/ml
MESNEX TAB 400MG
Nivo
2
2
2
2
2
2
2
pral koute
itilizasyon
obligatwa yo
$0
NM, LA, PA
$0
NM, PA
$0
NM, PA
$0
NM, PA
$0
NM, PA
$0
$0
B/D
1
1
1
1
1
1
1
2
2
2
2
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
2
2
2
2
1
1
1
1
1
1
1
1
1
1
2
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
?
34
Non medikaman an
Nivo
pral koute
itilizasyon
obligatwa yo
INIBITÈ TOPWZONERAZ
etoposide inj 500mg/25ml (20 mg/ml)
1
$0
B/D
irinotecan hcl inj 40 mg/2ml (20 mg/ml)
2
$0
B/D
2
$0
B/D
2
$0
B/D
toposar inj 1gm/50ml
1
$0
B/D
topotecan hcl for inj 4 mg
2
$0
B/D
KADYOVASKILÈ - MEDIKAMAN POU TRETE KONDISYON KÈ AK SIKILASYON
KONBINEZYON INIBITÈ ANZIM-KONVÈTI-ANJYOTANSEN (ACE) - MEDIKAMAN POU TRETE
TANSYON
amlodipine besylate-benazepril hcl cap
1
$0
2.5-10 mg
amlodipine besylate-benazepril hcl cap 5-10 mg 1
$0
$0
$0
1
$0
10-20 mg
1
$0
10-40 mg
benazepril & hydrochlorothiazide tab 5-6.25 mg 1
$0
$0
$0
benazepril & hydrochlorothiazide tab 20-25 mg
1
$0
captopril & hydrochlorothiazide tab 25-15 mg
1
$0
1
$0
1
$0
1
$0
enalapril maleate & hydrochlorothiazide tab
1
$0
5-12.5 mg
1
$0
10-25 mg
fosinopril sodium & hydrochlorothiazide tab
1
$0
10-12.5 mg
1
$0
20-12.5 mg
lisinopril & hydrochlorothiazide tab 10-12.5 mg
1
$0
1
$0
lisinopril & hydrochlorothiazide tab 20-25 mg
1
$0
moexipril-hydrochlorothiazide tab 7.5-12.5 mg
1
$0
moexipril-hydrochlorothiazide tab 15-12.5 mg
1
$0
moexipril-hydrochlorothiazide tab 15-25 mg
1
$0
quinapril-hydrochlorothiazide tab 10-12.5 mg
1
$0
?
35
Non medikaman an
pral koute
itilizasyon
obligatwa yo
1
$0
quinapril-hydrochlorothiazide tab 20-25 mg
1
$0
INIBITÈ ANZIM-KONVÈTI-ANJYOTANSEN (ACE) - MEDIKAMAN POU TRETE TANSYON
benazepril hcl tab 5 mg
1
$0
1
$0
1
$0
1
$0
captopril tab 12.5 mg
1
$0
captopril tab 25 mg
1
$0
captopril tab 50 mg
1
$0
captopril tab 100 mg
1
$0
enalapril maleate tab 2.5 mg
1
$0
enalapril maleate tab 5 mg
1
$0
1
$0
1
$0
fosinopril sodium tab 10 mg
1
$0
1
$0
1
$0
lisinopril tab 2.5 mg
1
$0
lisinopril tab 5 mg
1
$0
lisinopril tab 10 mg
1
$0
1
$0
1
$0
1
$0
moexipril hcl tab 7.5 mg
1
$0
moexipril hcl tab 15 mg
1
$0
perindopril erbumine tab 2 mg
1
$0
1
$0
1
$0
quinapril hcl tab 5 mg
1
$0
1
$0
1
$0
1
$0
ramipril cap 1.25 mg
1
$0
ramipril cap 2.5 mg
1
$0
ramipril cap 5 mg
1
$0
ramipril cap 10 mg
1
$0
trandolapril tab 1 mg
1
$0
1
$0
1
$0
RESEPTÈ ANTAGONIS ALDOSTERON - MEDIKAMAN POU TRETE TANSYON
eplerenone tab 25 mg
1
$0
eplerenone tab 50 mg
1
$0
?
Nivo
36
Non medikaman an
Nivo
pral koute
itilizasyon
obligatwa yo
$0
$0
$0
spironolactone tab 25 mg
1
1
1
BLOKAN ALFA - MEDIKAMAN POU TRETE TANSYON
doxazosin mesylate tab 1 mg
1
$0
1
$0
1
$0
1
$0
prazosin hcl cap 1 mg
1
$0
1
$0
1
$0
terazosin hcl cap 1 mg
1
$0
1
$0
1
$0
1
$0
KONBINEZON ANTAGONIS RESEPTÈ II ANJYOTANSEN - MEDIKAMAN POU TRETE TANSYON
amlodipine besylate-valsartan tab 5-160 mg
1
$0
1
$0
1
$0
1
$0
AZOR TAB 5-20MG
2
$0
AZOR TAB 5-40MG
2
$0
AZOR TAB 10-20MG
2
$0
AZOR TAB 10-40MG
2
$0
BENICAR HCT TAB 20-12.5
2
$0
BENICAR HCT TAB 40-12.5
2
$0
BENICAR HCT TAB 40-25MG
2
$0
EXFORGE TAB 5-160MG
2
$0
EXFORGE TAB 5-320MG
2
$0
EXFORGE TAB 10-160MG
2
$0
EXFORGE TAB 10-320MG
2
$0
EXFORGEH/5- TAB 160-12.5
2
$0
EXFORGEH/5- TAB 160-25
2
$0
EXFORGEH/10- TAB 160-12.5
2
$0
2
$0
2
$0
losartan potassium & hydrochlorothiazide tab
1
$0
50-12.5 mg
1
$0
100-12.5 mg
1
$0
100-25 mg
TRIBENZOR20- TAB 5-12.5MG
2
$0
?
37
Non medikaman an
TRIBENZOR40- TAB 5-12.5MG
TRIBENZOR40- TAB 5-25MG
TRIBENZOR40- TAB 10-12.5
TRIBENZOR40- TAB 10-25MG
valsartan-hydrochlorothiazide tab 80-12.5 mg
valsartan-hydrochlorothiazide tab 160-25 mg
Nivo
2
2
2
2
1
1
1
1
1
pral koute
itilizasyon
obligatwa yo
$0
$0
$0
$0
$0
$0
$0
$0
$0
ANTAGONIS RESEPTÈ II ANJYOTANSEN - MEDIKAMAN POU TRETE TANSYON
BENICAR TAB 5MG
2
$0
BENICAR TAB 20MG
2
$0
BENICAR TAB 40MG
2
$0
DIOVAN TAB 40MG
2
$0
DIOVAN TAB 80MG
2
$0
DIOVAN TAB 160MG
2
$0
DIOVAN TAB 320MG
2
$0
losartan potassium tab 25 mg
1
$0
1
$0
1
$0
valsartan tab 40 mg
1
$0
valsartan tab 80 mg
1
$0
valsartan tab 160 mg
1
$0
valsartan tab 320 mg
1
$0
ANTIARITMIK - MEDIKAMAN POU KONTWOLE RITM KÈ
amiodarone hcl inj 150 mg/3ml (50 mg/ml)
1
$0
1
$0
1
$0
amiodarone hcl tab 100 mg
1
$0
1
$0
1
$0
disopyramide phosphate cap 100 mg
2
$0
PA
disopyramide phosphate cap 150 mg
2
$0
PA
flecainide acetate tab 50 mg
1
$0
1
$0
1
$0
mexiletine hcl cap 150 mg
1
$0
1
$0
1
$0
MULTAQ TAB 400MG
2
$0
NORPACE CAP 100MG CR
2
$0
PA
NORPACE CAP 150MG CR
2
$0
PA
pacerone tab 100mg
1
$0
?
38
Non medikaman an
Nivo
pral koute
itilizasyon
obligatwa yo
pacerone tab 200mg
1
$0
pacerone tab 400mg
1
$0
propafenone hcl cap sr 12hr 225 mg
1
$0
1
$0
1
$0
propafenone hcl tab 150 mg
1
$0
1
$0
1
$0
quinidine gluconate tab cr 324 mg
1
$0
quinidine sulfate tab 200 mg
1
$0
quinidine sulfate tab 300 mg
1
$0
sorine tab 80mg
1
$0
sorine tab 120mg
1
$0
sorine tab 160mg
1
$0
sorine tab 240mg
1
$0
sotalol hcl (afib/afl) tab 80 mg
1
$0
1
$0
1
$0
sotalol hcl tab 80 mg
1
$0
1
$0
1
$0
1
$0
TIKOSYN CAP 125MCG
2
$0
NM
TIKOSYN CAP 250MCG
2
$0
NM
TIKOSYN CAP 500MCG
2
$0
NM
ANTILIPEMIK, INIBITÈ REDIKTAZ HMG-COA - MEDIKAMAN POU TRETE KOLESTEWÒL
atorvastatin calcium tab 10 mg (base equivalent) 1
$0
$0
$0
$0
CRESTOR TAB 5MG
2
$0
CRESTOR TAB 10MG
2
$0
CRESTOR TAB 20MG
2
$0
CRESTOR TAB 40MG
2
$0
lovastatin tab 10 mg
1
$0
1
$0
1
$0
pravastatin sodium tab 10 mg
1
$0
1
$0
1
$0
1
$0
simvastatin tab 5 mg
1
$0
1
$0
?
39
Non medikaman an
Nivo
pral koute
itilizasyon
obligatwa yo
1
$0
1
$0
1
$0
ANTILIPEMIK, DIVÈS - MEDIKAMAN POU TRETE KOLESTEWÒL
cholestyramine light powder packets 4 gm
1
$0
cholestyramine powder 4 gm/dose
1
$0
cholestyramine powder packets 4 gm
1
$0
choline fenofibrate cap dr 45 mg (fenofibric
1
$0
acid equiv)
1
$0
acid equiv)
colestipol hcl granule packets 5 gm
1
$0
colestipol hcl granules 5 gm
1
$0
colestipol hcl tab 1 gm
1
$0
fenofibrate micronized cap 43 mg
1
$0
1
$0
1
$0
1
$0
1
$0
fenofibrate tab 48 mg
1
$0
1
$0
1
$0
1
$0
gemfibrozil tab 600 mg
1
$0
niacin tab cr 500 mg (antihyperlipidemic)
1
$0
1
$0
1
$0
niacor tab 500mg
1
$0
omega-3-acid ethyl esters cap 1 gm
1
$0
prevalite pow 4gm
1
$0
VASCEPA CAP 1GM
2
$0
WELCHOL PAK 3.75GM
2
$0
WELCHOL TAB 625MG
2
$0
ZETIA TAB 10MG
2
$0
KONBINEZON BLOKAN BETA/DYURÈZ - MEDIKAMAN POU TRETE TANSYON
AK KONDISYON KÈ
atenolol & chlorthalidone tab 50-25 mg
1
$0
atenolol & chlorthalidone tab 100-25 mg
1
$0
bisoprolol & hydrochlorothiazide tab 2.5-6.25 mg 1
$0
bisoprolol & hydrochlorothiazide tab 5-6.25 mg
1
$0
bisoprolol & hydrochlorothiazide tab 10-6.25 mg 1
$0
metoprolol & hydrochlorothiazide tab 50-25 mg 1
$0
$0
?
40
Non medikaman an
Nivo
pral koute
itilizasyon
obligatwa yo
$0
propranolol & hydrochlorothiazide tab 40-25 mg 1
$0
propranolol & hydrochlorothiazide tab 80-25 mg 1
$0
BLOKAN BETA - MEDIKAMAN POU TRETE TANSYON AK KONDISYON KÈ
acebutolol hcl cap 200 mg
1
$0
acebutolol hcl cap 400 mg
1
$0
atenolol tab 25 mg
1
$0
atenolol tab 50 mg
1
$0
atenolol tab 100 mg
1
$0
bisoprolol fumarate tab 5 mg
1
$0
bisoprolol fumarate tab 10 mg
1
$0
BYSTOLIC TAB 2.5MG
2
$0
BYSTOLIC TAB 5MG
2
$0
BYSTOLIC TAB 10MG
2
$0
BYSTOLIC TAB 20MG
2
$0
carvedilol tab 3.125 mg
1
$0
1
$0
1
$0
carvedilol tab 25 mg
1
$0
labetalol hcl tab 100 mg
1
$0
1
$0
1
$0
metoprolol succinate tab sr 24hr 25 mg
1
$0
1
$0
1
$0
1
$0
metoprolol tartrate inj 1 mg/ml
1
$0
metoprolol tartrate tab 25 mg
1
$0
1
$0
1
$0
nadolol tab 20 mg
1
$0
nadolol tab 40 mg
1
$0
nadolol tab 80 mg
1
$0
pindolol tab 5 mg
1
$0
pindolol tab 10 mg
1
$0
propranolol hcl cap sr 24hr 60 mg
1
$0
1
$0
1
$0
1
$0
propranolol hcl inj 1 mg/ml
1
$0
propranolol hcl oral soln 20 mg/5ml
1
$0
propranolol hcl oral soln 40 mg/5ml
1
$0
propranolol hcl tab 10 mg
1
$0
?
41
Non medikaman an
timolol maleate tab 5 mg
Nivo
1
1
1
1
1
1
1
pral koute
itilizasyon
obligatwa yo
$0
$0
$0
$0
$0
$0
$0
BLOKAN KANAL KALSYÒM - MEDIKAMAN POU TRETE TANSYON AK KONDISYON KÈ
afeditab tab 30mg cr
1
$0
afeditab tab 60mg cr
1
$0
amlodipine besylate tab 2.5 mg
1
$0
amlodipine besylate tab 5 mg
1
$0
amlodipine besylate tab 10 mg
1
$0
diltiazem hcl cap sr 12hr 60 mg
1
$0
1
$0
1
$0
1
$0
1
$0
1
$0
diltiazem hcl coated beads cap sr 24hr 120 mg
1
$0
1
$0
1
$0
1
$0
1
$0
diltiazem hcl extended release beads cap sr
1
$0
24hr 120 mg
1
$0
24hr 180 mg
1
$0
24hr 240 mg
1
$0
24hr 300 mg
1
$0
24hr 360 mg
1
$0
24hr 420 mg
diltiazem hcl iv soln 25 mg/5ml (5 mg/ml)
1
$0
1
$0
1
$0
diltiazem hcl tab 30 mg
1
$0
1
$0
1
$0
1
$0
?
42
Non medikaman an
diltzac cap 120mg/24
felodipine tab sr 24hr 2.5 mg
felodipine tab sr 24hr 5 mg
felodipine tab sr 24hr 10 mg
isradipine cap 2.5 mg
isradipine cap 5 mg
nicardipine hcl cap 20 mg
nicardipine hcl cap 30 mg
nifedical xl tab 30mg
nifedical xl tab 60mg
nifedipine tab sr 24hr 30 mg
nifedipine tab sr 24hr osmotic 30 mg
nimodipine cap 30 mg
NYMALIZE SOL 60/20ML
taztia xt cap 120mg/24
verapamil hcl cap sr 24hr 100 mg
VERAPAMIL HCL CAP SR 24HR 360 MG
verapamil hcl iv soln 2.5 mg/ml
verapamil hcl tab 40 mg
verapamil hcl tab cr 120 mg
Nivo
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
pral koute
itilizasyon
obligatwa yo
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
GLIKOZID DIJITALIN - MEDIKAMAN POU TRETE KONDISYON KÈ
digoxin inj 0.25 mg/ml
1
$0
DIGOXIN ORAL SOLN 0.05 MG/ML
1
$0
PA
?
43
Non medikaman an
pral koute
itilizasyon
obligatwa yo
digoxin tab 125 mcg (0.125 mg)
1
$0
digoxin tab 250 mcg (0.25 mg)
1
$0
PA
LANOXIN TAB 0.25MG
2
$0
PA
LANOXIN TAB 0.125MG
2
$0
INIBITÈ RNEN DIRÈK/KONBINEZON - MEDIKAMAN POU TRETE KONDISYON KÈ
AMTURNIDE150 TAB -5-12.5
2
$0
2
$0
AMTURNIDE300 TAB -5-25MG
2
$0
2
$0
AMTURNIDE300 TAB -10-25MG
2
$0
TEKAMLO TAB 150-5MG
2
$0
TEKAMLO TAB 150-10MG
2
$0
TEKAMLO TAB 300-5MG
2
$0
TEKAMLO TAB 300-10MG
2
$0
TEKTURNA HCT TAB 150-12.5
2
$0
TEKTURNA HCT TAB 150-25MG
2
$0
TEKTURNA HCT TAB 300-12.5
2
$0
TEKTURNA HCT TAB 300-25MG
2
$0
TEKTURNA TAB 150MG
2
$0
TEKTURNA TAB 300MG
2
$0
DYURÈZ - MEDIKAMAN POU TRETE KONDISYON KÈ
acetazolamide cap sr 12hr 500 mg
1
$0
acetazolamide tab 125 mg
1
$0
acetazolamide tab 250 mg
1
$0
amiloride & hydrochlorothiazide tab 5-50 mg
1
$0
amiloride hcl tab 5 mg
1
$0
bumetanide inj 0.25 mg/ml
1
$0
bumetanide tab 0.5 mg
1
$0
bumetanide tab 1 mg
1
$0
bumetanide tab 2 mg
1
$0
chlorothiazide tab 250 mg
1
$0
chlorothiazide tab 500 mg
1
$0
chlorthalidone tab 25 mg
1
$0
chlorthalidone tab 50 mg
1
$0
DIURIL SUS 250/5ML
2
$0
DYRENIUM CAP 50MG
2
$0
DYRENIUM CAP 100MG
2
$0
EDECRIN TAB 25MG
2
$0
furosemide inj 10 mg/ml
1
$0
furosemide oral soln 10 mg/ml
1
$0
furosemide sol 8mg/ml
1
$0
furosemide tab 20 mg
1
$0
1
$0
?
Nivo
44
Non medikaman an
Nivo
hydrochlorothiazide cap 12.5 mg
hydrochlorothiazide tab 12.5 mg
hydrochlorothiazide tab 25 mg
hydrochlorothiazide tab 50 mg
indapamide tab 1.25 mg
indapamide tab 2.5 mg
methazolamide tab 25 mg
methazolamide tab 50 mg
methyclothiazide tab 5 mg
metolazone tab 2.5 mg
metolazone tab 5 mg
metolazone tab 10 mg
spironolactone & hydrochlorothiazide tab
25-25 mg
torsemide inj 20mg/2ml
torsemide inj 50mg/5ml
torsemide tab 5 mg
torsemide tab 10 mg
torsemide tab 20 mg
torsemide tab 100 mg
triamterene & hydrochlorothiazide cap
37.5-25 mg
triamterene & hydrochlorothiazide tab
37.5-25 mg
triamterene & hydrochlorothiazide tab 75-50 mg
DIVÈS
clonidine hcl tab 0.1 mg
clonidine hcl td patch weekly 0.1 mg/24hr
DEMSER CAP 250MG
hydralazine hcl inj 20 mg/ml
hydralazine hcl tab 10 mg
midodrine hcl tab 2.5 mg
midodrine hcl tab 5 mg
midodrine hcl tab 10 mg
minoxidil tab 2.5 mg
1
1
1
1
1
1
1
1
1
1
1
1
1
1
pral koute
itilizasyon
obligatwa yo
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
1
1
1
1
1
1
1
$0
$0
$0
$0
$0
$0
$0
1
$0
1
$0
1
1
1
1
1
1
2
1
1
1
1
1
1
1
1
1
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
?
45
Non medikaman an
Nivo
pral koute
itilizasyon
obligatwa yo
$0
$0
$0
minoxidil tab 10 mg
1
RANEXA TAB 500MG
2
RANEXA TAB 1000MG
2
NITRAT - MEDIKAMAN POU TRETE KONDISYON KÈ
isosorbide dinitrate tab 5 mg
1
$0
1
$0
1
$0
1
$0
isosorbide dinitrate tab cr 40 mg
1
$0
isosorbide mononitrate tab 10 mg
1
$0
isosorbide mononitrate tab 20 mg
1
$0
isosorbide mononitrate tab sr 24hr 30 mg
1
$0
1
$0
1
$0
minitran dis 0.1mg/hr
1
$0
1
$0
1
$0
1
$0
nitro-bid oin 2%
2
$0
NITRO-DUR DIS 0.3MG/HR
2
$0
NITRO-DUR DIS 0.8MG/HR
2
$0
nitroglycerin td patch 24hr 0.1 mg/hr
1
$0
1
$0
1
$0
1
$0
NITROLINGUAL SPR PUMPSPRA
2
$0
NITROSTAT SUB 0.3MG
2
$0
NITROSTAT SUB 0.4MG
2
$0
NITROSTAT SUB 0.6MG
2
$0
IPÈTANSYON ATERYÈL POUMON - MEDIKAMAN POU TRETE IPÈTANSYON POUMON
ADCIRCA TAB 20MG
2
$0
QL (60 grenn / 30 jou),
NM, PA
ADEMPAS TAB 0.5MG
2
$0
NM, PA
ADEMPAS TAB 1.5MG
2
$0
NM, PA
ADEMPAS TAB 1MG
2
$0
NM, PA
ADEMPAS TAB 2.5MG
2
$0
NM, PA
ADEMPAS TAB 2MG
2
$0
NM, PA
?
46
Non medikaman an
Nivo
pral koute
itilizasyon
obligatwa yo
LETAIRIS TAB 5MG
2
$0
NM, LA, PA
LETAIRIS TAB 10MG
2
$0
NM, LA, PA
REMODULIN INJ 1MG/ML
2
$0
B/D, NM, LA
REMODULIN INJ 2.5MG/ML
2
$0
B/D, NM, LA
2
$0
B/D, NM, LA
2
$0
B/D, NM, LA
REVATIO SUS 10MG/ML
2
$0
NM, PA
sildenafil citrate tab 20 mg
2
$0
NM, PA
TRACLEER TAB 62.5MG
2
$0
NM, LA, PA
TRACLEER TAB 125MG
2
$0
NM, LA, PA
SISTÈM NÈVE SANTRAL - MEDIKAMAN POU TRETE TWOUB SISTÈM NÈVE
ANTI-ANKSYETE - MEDIKAMAN POU TRETE ANSYETE
alprazolam con 1 mg/ml
1
alprazolam tab 0.5 mg
1
alprazolam tab 0.25 mg
1
alprazolam tab 1 mg
1
alprazolam tab 2 mg
1
buspirone hcl tab 5 mg
1
buspirone hcl tab 7.5 mg
1
1
1
1
fluvoxamine maleate tab 25 mg
1
1
1
lorazepam con 2mg/ml
1
lorazepam inj 2 mg/ml
1
lorazepam inj 4 mg/ml
1
lorazepam tab 0.5 mg
1
lorazepam tab 1 mg
1
lorazepam tab 2 mg
1
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
QL (300 mL / 30 jou)
QL (150 mL / 30 jou)
ANTI-KONVILSYON - MEDIKAMAN POU TRETE KRIZ
APTIOM TAB 200MG
2
$0
APTIOM TAB 400MG
2
$0
APTIOM TAB 600MG
2
$0
APTIOM TAB 800MG
2
$0
BANZEL SUS 40MG/ML
2
$0
PA
?
47
Non medikaman an
Nivo
BANZEL TAB 200MG
BANZEL TAB 400MG
carbamazepine cap sr 12hr 100 mg
carbamazepine chew tab 100 mg
carbamazepine susp 100 mg/5ml
carbamazepine tab 200 mg
carbamazepine tab sr 12hr 200 mg
carbamazepine tab sr 12hr 400 mg
CELONTIN CAP 300MG
clonazepam orally disintegrating tab 0.5 mg
2
2
1
1
1
1
1
1
1
1
2
1
1
1
clonazepam orally disintegrating tab 1 mg
clonazepam orally disintegrating tab 2 mg
clonazepam tab 0.5 mg
1
1
1
clonazepam tab 1 mg
clonazepam tab 2 mg
clorazepate dipotassium tab 3.75 mg
1
1
1
clorazepate dipotassium tab 7.5 mg
1
clorazepate dipotassium tab 15 mg
1
diazepam con 5mg/ml
1
diazepam inj 5 mg/ml
DIAZEPAM RECTAL GEL DELIVERY SYSTEM
2.5 MG
10 MG
20 MG
diazepam soln 1 mg/ml
1
1
pral koute
itilizasyon
obligatwa yo
$0
PA
$0
PA
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
QL (1200 grenn / 30
jou)
$0
QL (2400 grenn / 30
jou)
$0
QL (4800 grenn / 30
jou)
$0
$0
$0
QL (1200 grenn / 30
jou)
$0
$0
$0
PA
$0
PA
$0
PA
$0
QL (240 mL / 30 jou),
PA
$0
$0
1
$0
1
$0
1
$0
QL (1200 mL / 30 jou),
PA
diazepam tab 2 mg
1
$0
PA
diazepam tab 5 mg
1
$0
PA
?
48
Non medikaman an
Nivo
diazepam tab 10 mg
1
dilantin cap 30mg
dilantin cap 100mg
dilantin chw 50mg
DILANTIN-125 SUS 125/5ML
divalproex sodium cap sprinkle 125 mg
divalproex sodium tab delayed release 125 mg
divalproex sodium tab sr 24 hr 250 mg
divalproex sodium tab sr 24 hr 500 mg
epitol tab 200mg
ethosuximide cap 250 mg
ethosuximide soln 250 mg/5ml
felbamate susp 600 mg/5ml
felbamate tab 400 mg
felbamate tab 600 mg
FYCOMPA TAB 2MG
2
2
2
2
1
1
1
1
1
1
1
1
1
2
1
2
2
FYCOMPA TAB 4MG
2
FYCOMPA TAB 6MG
2
FYCOMPA TAB 8MG
2
FYCOMPA TAB 10MG
2
FYCOMPA TAB 12MG
2
gabapentin cap 100 mg
1
gabapentin oral soln 250 mg/5ml
gabapentin tab 600 mg
gabapentin tab 800 mg
GABITRIL TAB 12MG
GABITRIL TAB 16MG
lamotrigine tab 25 mg
1
1
1
1
1
2
2
1
1
1
1
pral koute
itilizasyon
obligatwa yo
$0
PA
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
PA
$0
PA
$0
PA
$0
PA
$0
PA
$0
PA
$0
QL (1080 kapsil / 30
jou)
$0
$0
$0
QL (2160 mL / 30 jou)
$0
$0
$0
$0
$0
$0
$0
$0
?
49
Non medikaman an
lamotrigine tab chewable dispersible 5 mg
lamotrigine tab chewable dispersible 25 mg
lamotrigine tab sr 24hr 25 mg
levetiracetam inj 500 mg/5ml (100 mg/ml)
levetiracetam oral soln 100 mg/ml
levetiracetam tab 250 mg
levetiracetam tab sr 24hr 500 mg
levetiracetam tab sr 24hr 750 mg
LYRICA CAP 25MG
LYRICA CAP 50MG
LYRICA CAP 75MG
LYRICA CAP 100MG
LYRICA CAP 150MG
LYRICA CAP 200MG
LYRICA CAP 225MG
LYRICA CAP 300MG
LYRICA SOL 20MG/ML
ONFI SUS 2.5MG/ML
ONFI TAB 10MG
ONFI TAB 20MG
oxcarbazepine susp 300 mg/5ml (60 mg/ml)
oxcarbazepine tab 150 mg
PEGANONE TAB 250MG
PHENOBARB INJ 65MG/ML
phenobarbital elixir 20 mg/5ml
phenobarbital sodium inj 130 mg/ml
phenobarbital tab 15 mg
phenobarbital tab 16.2 mg
Nivo
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2
2
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2
pral koute
itilizasyon
obligatwa yo
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
QL (946 mL / 30 jou)
$0
PA
$0
PA
$0
PA
$0
$0
$0
$0
$0
$0
PA
$0
PA
$0
PA
$0
PA
$0
PA
$0
PA
$0
PA
$0
PA
$0
PA
$0
PA
?
50
Non medikaman an
Nivo
phenytek cap 200mg
phenytek cap 300mg
phenytoin chew tab 50 mg
phenytoin sodium extended cap 100 mg
phenytoin sodium inj 50 mg/ml
phenytoin susp 125 mg/5ml
POTIGA TAB 50MG
POTIGA TAB 200MG
POTIGA TAB 300MG
POTIGA TAB 400MG
primidone tab 50 mg
primidone tab 250 mg
SABRIL POW 500MG
2
2
2
1
1
1
1
1
1
2
2
2
2
1
1
2
SABRIL TAB 500MG
2
TEGRETOL SUS 100/5ML
TEGRETOL TAB 200MG
TEGRETOL-XR TAB 100MG
tiagabine hcl tab 2 mg
tiagabine hcl tab 4 mg
topiramate sprinkle cap 15 mg
topiramate sprinkle cap 25 mg
topiramate tab 25 mg
valproate sodium inj 100 mg/ml
valproate sodium syrup 250 mg/5ml (base equiv)
valproic acid cap 250 mg
VIMPAT INJ 200MG/20
VIMPAT SOL 10MG/ML
VIMPAT TAB 50MG
VIMPAT TAB 100MG
VIMPAT TAB 150MG
VIMPAT TAB 200MG
zonisamide cap 25 mg
2
2
2
2
2
1
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
1
1
pral koute
itilizasyon
obligatwa yo
$0
PA
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
QL (180 Sachè / 30
jou), NM, LA, PA
$0
NM, LA, PA
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
QL (1200 mL / 30 jou)
$0
$0
$0
$0
$0
$0
?
51
Non medikaman an
pral koute
itilizasyon
obligatwa yo
1
$0
ANTI-DEMANS - MEDIKAMAN POU TRETE DEMANS AK PÈT MEMWA
donepezil hydrochloride orally disintegrating
1
$0
tab 5 mg
1
$0
tab 10 mg
donepezil hydrochloride tab 5 mg
1
$0
1
$0
1
$0
EXELON DIS 4.6MG/24
2
$0
EXELON DIS 9.5MG/24
2
$0
EXELON DIS 13.3/24
2
$0
galantamine hydrobromide cap sr 24hr 8 mg
1
$0
1
$0
1
$0
galantamine hydrobromide oral soln 4 mg/ml
1
$0
galantamine hydrobromide tab 4 mg
1
$0
1
$0
1
$0
NAMENDA SOL 10MG/5ML
2
$0
PA; PA if <30 yr
NAMENDA TAB 5MG
2
$0
PA; PA if <30 yr
NAMENDA TAB 10MG
2
$0
PA; PA if <30 yr
NAMENDA XR CAP 7MG
2
$0
PA; PA if <30 yr
NAMENDA XR CAP 14MG
2
$0
PA; PA if <30 yr
NAMENDA XR CAP 21MG
2
$0
PA; PA if <30 yr
NAMENDA XR CAP 28MG
2
$0
PA; PA if <30 yr
NAMENDA XR CAP TITRATIO
2
$0
PA; PA if <30 yr
rivastigmine tartrate cap 1.5 mg
1
$0
rivastigmine tartrate cap 3 mg
1
$0
rivastigmine tartrate cap 4.5 mg
1
$0
rivastigmine tartrate cap 6 mg
1
$0
ANTI-DEPRESIF - MEDIKAMAN POU TRETE DEPRESYON
amitriptyline hcl tab 10 mg
2
$0
PA
2
$0
PA
2
$0
PA
2
$0
PA
2
$0
PA
2
$0
PA
amoxapine tab 25 mg
1
$0
amoxapine tab 50 mg
1
$0
amoxapine tab 100 mg
1
$0
amoxapine tab 150 mg
1
$0
BRINTELLIX TAB 5MG
2
$0
?
Nivo
52
Non medikaman an
Nivo
BRINTELLIX TAB 10MG
BRINTELLIX TAB 20MG
bupropion hcl tab 75 mg
bupropion hcl tab 100 mg
bupropion hcl tab sr 12hr 100 mg
citalopram hydrobromide oral soln 10 mg/5ml
citalopram hydrobromide tab 10 mg (base equiv)
clomipramine hcl cap 25 mg
desipramine hcl tab 10 mg
doxepin hcl cap 10 mg
doxepin hcl conc 10 mg/ml
duloxetine hcl enteric coated pellets cap 20 mg
EMSAM DIS 6MG/24HR
2
2
1
1
1
1
1
1
1
1
1
1
1
2
2
2
1
1
1
1
1
1
2
2
2
2
2
2
2
1
1
1
2
EMSAM DIS 9MG/24HR
2
EMSAM DIS 12MG/24H
2
escitalopram oxalate soln 5 mg/5ml (base equiv)
escitalopram oxalate tab 5 mg (base equiv)
FETZIMA CAP 20MG
1
1
1
1
2
pral koute
itilizasyon
obligatwa yo
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
PA
$0
PA
$0
PA
$0
$0
$0
$0
$0
$0
$0
PA
$0
PA
$0
PA
$0
PA
$0
PA
$0
PA
$0
PA
$0
$0
$0
$0
PA
$0
PA
$0
PA
$0
QL (600 mL / 30 jou)
$0
$0
$0
$0
?
53
Non medikaman an
FETZIMA CAP 40MG
FETZIMA CAP 80MG
FETZIMA CAP 120MG
FETZIMA CAP TITRATIO
fluoxetine hcl cap 10 mg
fluoxetine hcl solution 20 mg/5ml
fluoxetine hcl tab 10 mg
fluoxetine hcl tab 20 mg
imipramine hcl tab 10 mg
maprotiline hcl tab 25 mg
MARPLAN TAB 10MG
mirtazapine orally disintegrating tab 15 mg
mirtazapine tab 7.5 mg
mirtazapine tab 15 mg
nefazodone hcl tab 50 mg
nortriptyline hcl cap 10 mg
nortriptyline hcl soln 10 mg/5ml
paroxetine hcl tab 10 mg
PAXIL SUS 10MG/5ML
phenelzine sulfate tab 15 mg
PRISTIQ TAB 50MG
PRISTIQ TAB 100MG
protriptyline hcl tab 5 mg
Nivo
2
2
2
2
1
1
1
1
1
1
2
2
2
1
1
1
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
1
2
2
1
pral koute
itilizasyon
obligatwa yo
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
PA
$0
PA
$0
PA
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
QL (900 mL / 30 jou)
$0
$0
$0
$0
?
54
Non medikaman an
Nivo
protriptyline hcl tab 10 mg
sertraline hcl oral conc 20 mg/ml
sertraline hcl tab 25 mg
SURMONTIL CAP 25MG
1
1
1
1
1
2
SURMONTIL CAP 50MG
2
SURMONTIL CAP 100MG
2
pral koute
itilizasyon
obligatwa yo
$0
$0
$0
$0
$0
$0
QL (240 kapsil / 30 jou),
PA
$0
PA
$0
PA
$0
$0
$0
$0
$0
tranylcypromine sulfate tab 10 mg
1
trazodone hcl tab 50 mg
1
1
1
venlafaxine hcl cap sr 24hr 37.5 mg
1
(base equivalent)
venlafaxine hcl cap sr 24hr 75 mg
1
$0
(base equivalent)
venlafaxine hcl cap sr 24hr 150 mg
1
$0
(base equivalent)
venlafaxine hcl tab 25 mg
1
$0
venlafaxine hcl tab 37.5 mg
1
$0
1
$0
1
$0
1
$0
VIIBRYD KIT
2
$0
VIIBRYD TAB 10MG
2
$0
VIIBRYD TAB 20MG
2
$0
VIIBRYD TAB 40MG
2
$0
AJAN ANTI-PARKINSONS - MEDIKAMAN POU TRETE MALADI PARKINSONS
amantadine hcl cap 100 mg
1
$0
amantadine hcl syrup 50 mg/5ml
1
$0
amantadine hcl tab 100 mg
1
$0
APOKYN INJ 10MG/ML
2
$0
NM, LA, PA
AZILECT TAB 0.5MG
2
$0
AZILECT TAB 1MG
2
$0
benztropine mesylate inj 1 mg/ml
1
$0
benztropine mesylate tab 0.5 mg
2
$0
PA
benztropine mesylate tab 1 mg
2
$0
PA
benztropine mesylate tab 2 mg
2
$0
PA
bromocriptine mesylate cap 5 mg
1
$0
bromocriptine mesylate tab 2.5 mg
1
$0
?
55
Non medikaman an
carbidopa & levodopa orally disintegrating tab
10-100 mg
25-100 mg
25-250 mg
carbidopa & levodopa tab 10-100 mg
carbidopa & levodopa tab cr 25-100 mg
carbidopa & levodopa tab cr 50-200 mg
CARBIDOPA-LEVODOPA-ENTACAPONE
TABS 12.5-50-200 MG
TABS 18.75-75-200 MG
TABS 25-100-200 MG
TABS 31.25-125-200 MG
TABS 37.5-150-200 MG
TABS 50-200-200 MG
entacapone tab 200 mg
NEUPRO DIS 1MG/24HR
NEUPRO DIS 2MG/24HR
NEUPRO DIS 3MG/24HR
NEUPRO DIS 4MG/24HR
NEUPRO DIS 6MG/24HR
NEUPRO DIS 8MG/24HR
pramipexole dihydrochloride tab 0.5 mg
pramipexole dihydrochloride tab 1 mg
ropinirole hydrochloride tab 0.5 mg
ropinirole hydrochloride tab 0.25 mg
ropinirole hydrochloride tab 1 mg
Nivo
1
pral koute
itilizasyon
obligatwa yo
$0
1
$0
1
$0
1
1
1
1
1
1
$0
$0
$0
$0
$0
$0
1
$0
1
$0
1
$0
1
$0
1
$0
1
2
2
2
2
2
2
1
1
1
1
1
1
1
1
1
1
1
1
1
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
?
56
Non medikaman an
Nivo
pral koute
itilizasyon
obligatwa yo
selegiline hcl cap 5 mg
1
$0
selegiline hcl tab 5 mg
1
$0
ANTI-SIKOTIK - MEDIKAMAN POU TRETE MALADI SIKOZ
ABILIFY DISC TAB 10MG
2
$0
ABILIFY DISC TAB 15MG
2
$0
ABILIFY INJ 9.75MG
2
$0
QL (4 mL / 1 day)
ABILIFY MAIN INJ 300MG
2
$0
QL (1 Fyòl / 28 jou)
ABILIFY MAIN INJ 400MG
2
$0
QL (1 Fyòl / 28 jou)
ABILIFY SOL 1MG/ML
2
$0
QL (900 mL / 30 jou)
ABILIFY TAB 2MG
2
$0
ABILIFY TAB 5MG
2
$0
ABILIFY TAB 10MG
2
$0
ABILIFY TAB 15MG
2
$0
ABILIFY TAB 20MG
2
$0
ABILIFY TAB 30MG
2
$0
chlorpromaz inj 25mg/ml
2
$0
chlorpromazine hcl tab 10 mg
1
$0
1
$0
1
$0
1
$0
1
$0
CLOZAPINE ORALLY DISINTEGRATING TAB 1
$0
PA
12.5 MG
$0
PA
25 MG
$0
100 MG
PA
clozapine tab 25 mg
1
$0
clozapine tab 50 mg
1
$0
clozapine tab 100 mg
1
$0
clozapine tab 200 mg
1
$0
FANAPT PAK
2
$0
ST
FANAPT TAB 1MG
2
$0
ST
FANAPT TAB 2MG
2
$0
ST
FANAPT TAB 4MG
2
$0
ST
FANAPT TAB 6MG
2
$0
ST
FANAPT TAB 8MG
2
$0
ST
?
57
Non medikaman an
Nivo
FANAPT TAB 10MG
2
FANAPT TAB 12MG
2
FAZACLO TAB 12.5/ODT
FAZACLO TAB 25MG ODT
FAZACLO TAB 100/ODT
2
2
2
FAZACLO TAB 150MG
2
FAZACLO TAB 200MG
2
fluphenazine decanoate inj 25 mg/ml
fluphenazine hcl elixir 2.5 mg/5ml
fluphenazine hcl inj 2.5 mg/ml
fluphenazine hcl oral conc 5 mg/ml
fluphenazine hcl tab 1 mg
fluphenazine hcl tab 2.5 mg
GEODON INJ 20MG
haloperidol decanoate im soln 50 mg/ml
haloperidol decanoate im soln 100 mg/ml
haloperidol lactate inj 5 mg/ml
haloperidol lactate oral conc 2 mg/ml
haloperidol tab 0.5 mg
haloperidol tab 1 mg
INVEGA SUST INJ 39/0.25
INVEGA SUST INJ 78/0.5ML
INVEGA SUST INJ 156MG/ML
INVEGA TAB 1.5MG
INVEGA TAB 3MG
INVEGA TAB 6MG
INVEGA TAB 9MG
LATUDA TAB 20MG
LATUDA TAB 40MG
LATUDA TAB 60MG
1
1
1
1
1
1
1
1
2
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2
2
pral koute
itilizasyon
obligatwa yo
$0
ST
$0
ST
$0
PA
$0
PA
$0
PA
$0
PA
$0
PA
$0
$0
$0
$0
$0
$0
$0
$0
$0
QL (6 mL / 3 jou)
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
QL (1 injection / 28 jou)
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
?
58
Non medikaman an
Nivo
LATUDA TAB 80MG
LATUDA TAB 120MG
loxapine succinate cap 5 mg
olanzapine for im inj 10 mg
olanzapine orally disintegrating tab 5 mg
olanzapine tab 2.5 mg
olanzapine tab 5 mg
olanzapine tab 7.5 mg
olanzapine tab 10 mg
ORAP TAB 1MG
ORAP TAB 2MG
perphenazine tab 2 mg
quetiapine fumarate tab 25 mg
RISPERDAL INJ 12.5MG
2
2
1
1
1
1
1
1
1
1
2
1
1
1
1
1
1
2
2
1
1
1
1
1
1
1
1
1
1
2
RISPERDAL INJ 25MG
2
RISPERDAL INJ 37.5MG
2
RISPERDAL INJ 50MG
2
risperidone orally disintegrating tab 0.5 mg
risperidone orally disintegrating tab 0.25 mg
risperidone orally disintegrating tab 1 mg
1
1
1
1
1
1
pral koute
itilizasyon
obligatwa yo
$0
$0
$0
$0
$0
$0
$0
QL (3 Fyòls / 1 day)
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
QL (2 injections / 28
jou)
$0
jou)
$0
jou)
$0
jou)
$0
$0
$0
$0
$0
$0
?
59
Non medikaman an
Nivo
pral koute
itilizasyon
obligatwa yo
risperidone soln 1 mg/ml
1
$0
QL (240 mL / 30 jou)
risperidone tab 0.5 mg
1
$0
risperidone tab 0.25 mg
1
$0
risperidone tab 1 mg
1
$0
1
$0
1
$0
1
$0
SAPHRIS SUB 5MG
2
$0
SAPHRIS SUB 10MG
2
$0
SEROQUEL XR TAB 50MG
2
$0
2
$0
2
$0
2
$0
2
$0
thioridazine hcl tab 10 mg
2
$0
PA
2
$0
PA
2
$0
PA
2
$0
PA
thiothixene cap 1 mg
1
$0
1
$0
1
$0
1
$0
trifluoperazine hcl tab 1 mg
1
$0
1
$0
1
$0
1
$0
VERSACLOZ SUS 50MG/ML
2
$0
QL (600 mL / 30 jou),
PA
ziprasidone hcl cap 20 mg
1
$0
1
$0
1
$0
1
$0
TWOUB IPÈAKTIVITE DEFISI ATANSYON - MEDIKAMAN POU TRETE ADHD (TWOUB
IPÈAKTIVITE DEFISI ATANSYON)
amphetamine-dextroamphetamine cap sr 24hr
1
$0
5 mg
1
$0
10 mg
1
$0
15 mg
1
$0
20 mg
?
60
Non medikaman an
Nivo
25 mg
30 mg
amphetamine-dextroamphetamine tab 5 mg
amphetamine-dextroamphetamine tab 7.5 mg
INTUNIV TAB 1MG
INTUNIV TAB 2MG
INTUNIV TAB 3MG
INTUNIV TAB 4MG
methylphenidate hcl soln 5 mg/5ml
methylphenidate hcl soln 10 mg/5ml
methylphenidate hcl tab 5 mg
methylphenidate hcl tab cr 10 mg
methylphenidate hcl tab cr 20 mg
STRATTERA CAP 10MG
STRATTERA CAP 18MG
STRATTERA CAP 25MG
STRATTERA CAP 40MG
STRATTERA CAP 60MG
STRATTERA CAP 80MG
STRATTERA CAP 100MG
IPNOZ - MEDIKAMAN POU TRETE LENSOMNI
ROZEREM TAB 8MG
SILENOR TAB 3MG
SILENOR TAB 6MG
temazepam cap 7.5 mg
1
pral koute
itilizasyon
obligatwa yo
$0
1
$0
1
1
1
1
1
1
1
2
2
2
2
1
1
1
1
1
1
1
2
2
2
2
2
2
2
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
2
2
2
1
$0
$0
$0
$0
temazepam cap 15 mg
1
$0
zolpidem tartrate tab 5 mg
2
$0
zolpidem tartrate tab 10 mg
2
$0
QL (1800 mL / 30 jou)
QL (900 mL / 30 jou)
?
61
Non medikaman an
Nivo
MIGRÈN - MEDIKAMAN POU TRETE MALTÈT GRAV
cafergot tab 1-100mg
2
dihydroergotamine mesylate inj 1 mg/ml
1
naratriptan hcl tab 1 mg (base equiv)
1
naratriptan hcl tab 2.5 mg (base equiv)
1
RELPAX TAB 20MG
2
RELPAX TAB 40MG
2
rizatriptan benzoate orally disintegrating tab
1
5 mg
rizatriptan benzoate orally disintegrating tab
1
10 mg
rizatriptan benzoate tab 5 mg
1
rizatriptan benzoate tab 10 mg
1
SUMATRIPTAN NASAL SPRAY 5 MG/ACT
1
1
sumatriptan succinate inj 6 mg/0.5ml
1
SUMATRIPTAN SUCCINATE SOLUTION
1
AUTO-INJECTOR 4 MG/0.5ML
sumatriptan succinate solution auto-injector
1
6 mg/0.5ml
1
CARTRIDGE 4 MG/0.5ML
1
CARTRIDGE 6 MG/0.5ML
sumatriptan succinate solution prefilled syringe 1
6 mg/0.5ml
sumatriptan succinate tab 25 mg
1
1
1
zolmitriptan orally disintegrating tab 2.5 mg
1
zolmitriptan orally disintegrating tab 5 mg
1
zolmitriptan tab 2.5 mg
1
zolmitriptan tab 5 mg
1
DIVÈS
lithium carbonate cap 150 mg
1
1
1
lithium carbonate tab 300 mg
1
lithium carbonate tab cr 300 mg
1
lithium carbonate tab cr 450 mg
1
LITHIUM SOL 8MEQ/5ML
2
NUEDEXTA CAP 20-10MG
2
pral koute
itilizasyon
obligatwa yo
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
QL (24 Inalatès / 30 jou)
QL (6 mL / 30 jou)
QL (6 mL / 30 jou)
$0
QL (6 mL / 30 jou)
$0
QL (6 mL / 30 jou)
$0
QL (6 mL / 30 jou)
$0
QL (6 mL / 30 jou)
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
PA
?
62
Non medikaman an
Nivo
pral koute
itilizasyon
obligatwa yo
pyridostigmine bromide tab 60 mg
1
$0
riluzole tab 50 mg
1
$0
XENAZINE TAB 12.5MG
2
$0
NM, LA, PA
XENAZINE TAB 25MG
2
$0
NM, LA, PA
AJAN PARALEZI APARÈY NÈ - MEDIKAMAN POU TRETE PARALEZI APARÈY NÈ
BETASERON INJ 0.3MG
2
$0
QL (14 Sereng / 28 jou),
NM, PA
COPAXONE INJ 40MG/ML
2
$0
QL (12 Sereng / 28 jou),
NM, PA
COPAXONE KIT 20MG/ML
2
$0
QL (30 Sereng per 30
jou), NM, PA
GILENYA CAP 0.5MG
2
$0
NM, PA
TYSABRI INJ 300/15ML
2
$0
NM, LA, PA
AJAN TERAPI MISKULOSKÈLETAL - MEDIKAMAN POU TRETE FASYAL
baclofen tab 10 mg
1
$0
baclofen tab 20 mg
1
$0
cyclobenzaprine hcl tab 5 mg
1
$0
PA
cyclobenzaprine hcl tab 10 mg
1
$0
PA
dantrolene sodium cap 25 mg
1
$0
1
$0
1
$0
tizanidine hcl tab 2 mg
1
$0
tizanidine hcl tab 4 mg
1
$0
NARKOLÈPSI/KATAPLÈKSI - MEDIKAMAN POU TWOUB DÒMI
NUVIGIL TAB 50MG
2
$0
PA
NUVIGIL TAB 150MG
2
$0
PA
NUVIGIL TAB 200MG
2
$0
PA
NUVIGIL TAB 250MG
2
$0
PA
XYREM SOL 500MG/ML
2
$0
QL (540 mL / 30 jou),
LA, PA
SIKOTERAPETIK - DIVÈS
acamprosate calcium tab delayed release
1
$0
333 mg
buprenorphine hcl sl tab 2 mg (base equiv)
1
$0
PA
buprenorphine hcl sl tab 8 mg (base equiv)
1
$0
PA
?
63
Non medikaman an
buprenorphine hcl-naloxone hcl sl tab 2-0.5 mg
(base equiv)
buprenorphine hcl-naloxone hcl sl tab 8-2 mg
(base equiv)
buproban tab 150mg
CHANTIX PAK 0.5& 1MG
CHANTIX TAB 0.5MG
CHANTIX TAB 1MG
diphenhydramine-acetaminophen tab
25-500 mg (sleep)
disulfiram tab 250 mg
disulfiram tab 500 mg
headache tab 25-500mg
ibuprofen pm tab 200-38mg
naloxone hcl inj 0.4 mg/ml
naloxone hcl inj 1 mg/ml
naltrexone hcl tab 50 mg
nicotine polacrilex gum 4 mg
nicotine polacrilex lozenge 2 mg
NICOTINE POLACRILEX LOZENGE 2 MG
nicotine polacrilex lozenge 4 mg
NICOTINE POLACRILEX LOZENGE 4 MG
NICOTINE SYS KIT TRANSDER
nicotine td patch 24hr 7 mg/24hr
NICOTROL INH
NICOTROL NS SPR 10MG/ML
simply sleep tab 25mg
sleep aid tab 25mg
sleep aid tab 50mg
SUBOXONE MIS 2-0.5MG
SUBOXONE MIS 4-1MG
SUBOXONE MIS 8-2MG
SUBOXONE MIS 12-3MG
thrive gum 2mg mint
thrive gum 4mg mint
wal-som cap 50mg
Nivo
1
1
1
2
2
2
3
1
1
3
3
1
1
1
3
3
3
3
3
3
3
3
3
2
2
3
3
3
2
2
2
2
3
3
3
pral koute
itilizasyon
obligatwa yo
$0
PA
$0
PA
$0
$0
PA
$0
PA
$0
PA
$0
NM; *
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
QL (4 Bwat / 30 jou), PA
NM; *
NM; *
NM; *
?
64
Non medikaman an
Nivo
pral koute
itilizasyon
obligatwa yo
ANDOKRIN AK METABOLIK - MEDIKAMAN POU TRETE AK KONTOWLE ÒMÒN
ANDROJÈN - MEDIKAMAN POU KONTWOLE ÒMÒN GASON
ANDRODERM DIS 2MG/24HR
2
$0
ANDRODERM DIS 4MG/24HR
2
$0
androxy tab 10mg
oxandrolone tab 2.5 mg
oxandrolone tab 10 mg
TESTIM GEL 1%(50MG)
2
1
1
2
$0
$0
$0
$0
testosterone cypionate im inj in oil 100 mg/ml
1
$0
1
$0
testosterone enanthate im inj in oil 200 mg/ml
1
$0
ANTIDYABETIK, PIKI - MEDIKAMAN POU TRETE DYABÈT (SIK)
ALCOHOL SWABS
2
$0
GAUZE PADS 2" X 2"
2
$0
HUMULIN R INJ U-500
2
$0
INSULIN PEN NEEDLE
2
$0
INSULIN SAFETY NEEDLES
2
$0
INSULIN SYRINGE
2
$0
LANTUS INJ 100/ML
2
$0
LANTUS INJ SOLOSTAR
2
$0
LEVEMIR INJ
2
$0
LEVEMIR INJ FLEXPEN
2
$0
LEVEMIR INJ FLEXTOUC
2
$0
NOVOLIN INJ 70/30
2
$0
NOVOLIN N INJ U-100
2
$0
NOVOLIN R INJ U-100
2
$0
NOVOLOG INJ 100/ML
2
$0
NOVOLOG INJ FLEXPEN
2
$0
NOVOLOG INJ PENFILL
2
$0
NOVOLOG MIX INJ 70/30
2
$0
NOVOLOG MIX INJ FLEXPEN
2
$0
SYMLINPEN 60 INJ 1000MCG
2
$0
SYMLNPEN 120 INJ 1000MCG
2
$0
VICTOZA INJ 18MG/3ML
2
$0
PA
PA
PA
PA
PA
QL (300 grams / 30
jou), PA
B/D
RELION not covered
RELION not covered
RELION Pa garanti
QL (8 Estilo / 30 jou),
PA
QL (4 Estilo / 30 jou),
PA
QL (3 Estilo / 30 jou)
?
65
Non medikaman an
Nivo
pral koute
itilizasyon
obligatwa yo
ANTIDYABETIK, NAN BOUCH - MEDIKAMAN POU TRETE DYABÈT (SIK)
acarbose tab 25 mg
1
$0
acarbose tab 50 mg
1
$0
acarbose tab 100 mg
1
$0
glimepiride tab 1 mg
1
$0
1
$0
1
$0
glipizide tab 5 mg
1
$0
glipizide tab 10 mg
1
$0
glipizide tab sr 24hr 2.5 mg
1
$0
glipizide tab sr 24hr 5 mg
1
$0
glipizide tab sr 24hr 10 mg
1
$0
glipizide-metformin hcl tab 2.5-250 mg
1
$0
glipizide-metformin hcl tab 2.5-500 mg
1
$0
glipizide-metformin hcl tab 5-500 mg
1
$0
INVOKAMET TAB 50-500MG
2
$0
INVOKAMET TAB 50-1000
2
$0
2
$0
2
$0
INVOKANA TAB 100MG
2
$0
INVOKANA TAB 300MG
2
$0
JANUMET TAB 50-500MG
2
$0
JANUMET TAB 50-1000
2
$0
JANUMET XR TAB 50-500MG
2
$0
JANUMET XR TAB 50-1000
2
$0
JANUMET XR TAB 100-1000
2
$0
JANUVIA TAB 25MG
2
$0
JANUVIA TAB 50MG
2
$0
JANUVIA TAB 100MG
2
$0
JENTADUETO TAB 2.5-500
2
$0
2
$0
2
$0
metformin hcl tab 500 mg
1
$0
1
$0
1
$0
metformin hcl tab sr 24hr 500 mg
1
$0
metformin hcl tab sr 24hr 750 mg
1
$0
nateglinide tab 60 mg
1
$0
nateglinide tab 120 mg
1
$0
pioglitazone hcl tab 15 mg (base equiv)
1
$0
1
$0
1
$0
repaglinide tab 0.5 mg
1
$0
?
66
Non medikaman an
Nivo
pral koute
itilizasyon
obligatwa yo
repaglinide tab 1 mg
1
$0
repaglinide tab 2 mg
1
$0
RIOMET SOL
2
$0
QL (946 mL / 30 jou)
TRADJENTA TAB 5MG
2
$0
BIFOSFONAT - MEDIKAMAN POU TRETE DEFISIANS NAN ZO
alendronate sodium tab 5 mg
1
$0
1
$0
1
$0
1
$0
1
$0
ibandronate sodium tab 150 mg (base
1
$0
B/D, QL (1 tab / 30 jou)
equivalent)
pamidronate disodium iv soln 3 mg/ml
1
$0
B/D
pamidronate disodium iv soln 9 mg/ml
1
$0
B/D
pamidronate inj 6mg/ml
1
$0
B/D
zoledronic acid inj conc for iv infusion 4 mg/5ml 2
$0
B/D, NM
ZOMETA INJ 4MG/100
2
$0
B/D, NM
AGONIS RESEPTÈ KALSYÒM
SENSIPAR TAB 30MG
2
$0
NM
SENSIPAR TAB 60MG
2
$0
NM
SENSIPAR TAB 90MG
2
$0
NM
AJAN KELATAN
CHEMET CAP 100MG
2
$0
DEPEN TITRA TAB 250MG
2
$0
EXJADE TAB 125MG
2
$0
NM, LA, PA
EXJADE TAB 250MG
2
$0
NM, LA, PA
EXJADE TAB 500MG
2
$0
NM, LA, PA
kionex pow
1
$0
kionex sus 15gm/60
1
$0
sodium polystyrene sulfonate oral susp
1
$0
15 gm/60ml
sps sus 15gm/60
1
$0
SYPRINE CAP 250MG
2
$0
KONTRASEPTIF - MEDIKAMAN POU PLANIN
altavera tab
apri tab
aranelle tab
aubra tab 0.1-0.02
aviane tab
1
1
1
1
1
$0
$0
$0
$0
$0
?
67
Non medikaman an
balziva tab
briellyn tab
camila tab 0.35mg
cryselle-28 tab 28 grenn
cyclafem tab 1/35
cyclafem tab 7/7/7
delyla tab 0.1-0.02
drospirenone-ethinyl estradiol tab 3-0.02 mg
DROSPIRENONE-ETHINYL ESTRADIOL TAB
3-0.02 MG
drospirenone-ethinyl estradiol tab 3-0.03 mg
3-0.03 MG
ELLA TAB 30MG
emoquette tab
enpresse-28 tab
errin tab 0.35mg
falmina tab
gildagia tab 0.4-35
gildess tab 1.5/30
heather tab 0.35mg
introvale tab
JOLIVETTE TAB 0.35MG
junel 1.5/30 tab
junel 1/20 tab
junel fe tab 1.5/30
junel fe tab 1/20
kariva tab 28 day
larin fe tab 1.5/30
larin fe tab 1/20
larin tab 1.5/30
larin tab 1/20
lessina tab
levonest tab
levonorgestrel & ethinyl estradiol (91-day) tab
0.15-0.03 mg
levonorgestrel & ethinyl estradiol tab
0.1 mg-20 mcg
levonorgestrel tab 0.75 mg
levonorgestrel tab 1.5 mg
levora-28 tab 0.15/30
loryna tab 3-0.02mg
low-ogestrel tab
Nivo
1
1
1
1
1
1
1
1
1
pral koute
itilizasyon
obligatwa yo
$0
$0
$0
$0
$0
$0
$0
$0
$0
1
1
$0
$0
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
1
$0
1
1
1
1
1
$0
$0
$0
$0
$0
?
68
Non medikaman an
lutera tab
lyza tab 0.35mg
marlissa tab 0.15/30
medroxyprogesterone acetate im susp
150 mg/ml
microgestin tab 1.5/30
microgestin tab 1/20
microgestin tab fe1.5/30
microgestin tab fe 1/20
MONONESSA TAB
my way tab 1.5mg
my way tab 1.5mg
myzilra tab
necon tab 0.5/35
necon tab 1/35
NECON TAB 1/50-28
NECON TAB 7/7/7
necon tab 10/11-28
next choice tab 1.5mg
nikki tab 3-0.02mg
norelgestromin-ethinyl estradiol td ptwk
150-35 mcg/24hr
norethindrone tab 0.35 mg
NORETHINDRONE TAB 0.35 MG
NORETHINDRONE-ETH ESTRADIOL TAB
0.5-35/1-35/0.5-35 MG-MCG
norgestimate-eth estrad tab
0.18-35/0.215-35/0.25-35 mg-mcg
norlyroc tab 0.35mg
nortrel tab 0.5/35
nortrel tab 1/35
nortrel tab 7/7/7
NUVARING MIS
orsythia tab
philith tab 0.4-35
pimtrea tab
pirmella tab 1/35
portia-28 tab
previfem tab
quasense tab
reclipsen tab
sharobel tab 0.35mg
SOLIA TAB
Nivo
1
1
1
1
pral koute
itilizasyon
obligatwa yo
$0
$0
$0
$0
1
1
1
1
1
1
3
1
1
1
1
1
2
1
1
1
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
1
1
1
$0
$0
$0
1
$0
1
1
1
1
2
1
1
1
1
1
1
1
1
1
1
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
NM; *
?
69
Non medikaman an
sprintec 28 tab 28 day
syeda tab 3-0.03mg
tri-legest tab fe
tri-previfem tab
tri-sprintec tab
TRINESSA TAB
trivora-28 tab
velivet pak
viorele tab
vyfemla tab 0.4-35
zarah tab 3-0.03mg
zenchent tab
Nivo
1
1
1
1
1
1
1
1
1
1
1
1
pral koute
itilizasyon
obligatwa yo
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
ANDOMETRYOZ
danazol cap 50 mg
1
$0
danazol cap 100 mg
1
$0
danazol cap 200 mg
1
$0
SYNAREL SOL 2MG/ML
2
$0
RANPLASMAN ANZIM - MEDIKAMAN POU TRETE DEFISIANS ANZIMATIK
ADAGEN INJ 250/ML
2
$0
NM, LA, PA
ALDURAZYME INJ 2.9MG/5M
2
$0
NM, LA, PA
CARBAGLU TAB 200MG
2
$0
NM, LA, PA
CEREZYME INJ 200UNIT
2
$0
NM, PA
CEREZYME INJ 400UNIT
2
$0
NM, PA
CYSTADANE POW
2
$0
NM
CYSTAGON CAP 50MG
2
$0
NM, PA
CYSTAGON CAP 150MG
2
$0
NM, PA
FABRAZYME INJ 5MG
2
$0
NM, PA
FABRAZYME INJ 35MG
2
$0
NM, PA
KUVAN POW 100MG
2
$0
NM, PA
KUVAN TAB 100MG
2
$0
NM, PA
levocarnitine inj 200 mg/ml
1
$0
B/D
levocarnitine oral soln 1 gm/10ml (10%)
1
$0
B/D
levocarnitine tab 330 mg
1
$0
B/D
LUMIZYME INJ 50MG
2
$0
NM, PA
MYOZYME INJ 50MG
2
$0
NM, PA
NAGLAZYME INJ 1MG/ML
2
$0
NM, LA, PA
ORFADIN CAP 2MG
2
$0
NM, PA
ORFADIN CAP 5MG
2
$0
NM, PA
ORFADIN CAP 10MG
2
$0
NM, PA
sodium phenylbutyrate oral powder
2
$0
NM
3 gm/teaspoonful
ZAVESCA CAP 100MG
2
$0
NM, LA, PA
?
70
Non medikaman an
Nivo
pral koute
itilizasyon
obligatwa yo
ESTWOJÈN - MEDIKAMAN POU KONTWOLE ÒMÒN FANM
COMBIPATCH DIS .05/.14
2
$0
COMBIPATCH DIS .05/.25
2
$0
estradiol tab 0.5 mg
2
$0
estradiol tab 1 mg
2
$0
estradiol tab 2 mg
2
$0
estradiol td patch weekly 0.1 mg/24hr
2
$0
2
$0
2
$0
2
$0
2
$0
2
$0
(37.5 mcg/24hr)
ESTRADIOL VALERATE IM IN OIL 10 MG/ML
1
$0
estradiol valerate im in oil 20 mg/ml
1
$0
1
$0
PREMARIN VAG CRE 0.625MG
2
$0
VAGIFEM TAB 10MCG
2
$0
GLIKOKÒTIKOYID - MEDIKAMAN POU TRETE REPONS ENFLAMATWA
a-hydrocort inj 100mg
1
$0
cortisone acetate tab 25 mg
1
$0
dexamethason con 1mg/ml
1
$0
dexamethasone elixir 0.5 mg/5ml
1
$0
dexamethasone sod phosphate preservative
1
$0
free inj 10 mg/ml
dexamethasone sodium phosphate inj 10 mg/ml 1
$0
dexamethasone sodium phosphate inj
1
$0
20 mg/5ml
1
$0
100 mg/10ml
1
$0
120 mg/30ml
dexamethasone soln 0.5 mg/5ml
1
$0
dexamethasone tab 0.5 mg
1
$0
1
$0
dexamethasone tab 1 mg
1
$0
1
$0
1
$0
1
$0
1
$0
fludrocortisone acetate tab 0.1 mg
1
$0
hydrocortisone tab 5 mg
1
$0
1
$0
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
PA
?
71
Non medikaman an
methylprednisolone acetate inj susp 40 mg/ml
methylprednisolone sodium succinate for inj
40 mg
125 mg
1000 mg
methylprednisolone tab 4 mg
methylprednisolone tab 4 mg dose pack
prednisolone sod phosph oral soln 6.7 mg/5ml
(5 mg/5ml base)
prednisolone sod phosphate oral soln 15 mg/5ml
(base equiv)
prednisolone sodium phosphate oral soln
25 mg/5ml (base eq)
prednisolone syrup 15 mg/5ml (usp solution
equivalent)
prednisone con 5mg/ml
prednisone oral soln 5 mg/5ml
prednisone tab 1 mg
prednisone tab 2.5 mg
prednisone tab 5 mg
prednisone tab 5 mg dose pack
prednisone tab 10 mg
prednisone tab 10 mg dose pack
SOLU-CORTEF INJ 250MG
Nivo
1
1
1
1
pral koute
itilizasyon
obligatwa yo
$0
$0
B/D
$0
B/D
$0
B/D
1
$0
B/D
1
$0
B/D
1
1
1
1
1
1
$0
$0
$0
$0
$0
$0
B/D
B/D
B/D
B/D
B/D
B/D
1
$0
B/D
1
$0
B/D
1
$0
B/D
2
1
1
1
1
1
1
1
1
1
2
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
AJAN K AP MONTE NIVO GLIKÒZ - MEDIKAMAN POU TRETE NIVO SIK NAN SAN KI BA
GLUCAGEN INJ HYPOKIT
2
$0
GLUCAGON KIT 1MG
2
$0
PROGLYCEM SUS 50MG/ML
2
$0
ÒMÒN KWASANS IMEN - MEDIKAMAN POU KONTWOLE ÒMÒN PITWITÈ
NORDITROPIN INJ 5/1.5ML
2
$0
NM, PA
2
$0
NM, PA
2
$0
NM, PA
NORDITROPIN INJ 30/3ML
2
$0
NM, PA
TEV-TROPIN INJ 5MG
2
$0
NM, PA
?
72
Non medikaman an
Nivo
DIVÈS
cabergoline tab 0.5 mg
calcitonin (salmon) nasal soln 200 unit/act
FORTICAL SPR 200/ACT
INCRELEX INJ 40MG/4ML
methylergonovine maleate tab 0.2 mg
MIACALCIN INJ 200/ML
octreotide acetate inj 50 mcg/ml (0.05 mg/ml)
octreotide acetate inj 1000 mcg/ml (1 mg/ml)
PROLIA SOL 60MG/ML
1
1
2
2
1
2
1
1
1
2
2
2
pral koute
itilizasyon
obligatwa yo
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
NM, LA, PA
B/D
NM, PA
NM, PA
NM, PA
NM, PA
NM, PA
QL (1 syringe / 180 jou),
NM
raloxifene hcl tab 60 mg
1
$0
SANDOSTATIN KIT LAR 10MG
2
$0
NM, PA
2
$0
NM, PA
2
$0
NM, PA
SOMATULINE INJ 60/0.2ML
2
$0
NM, PA
SOMATULINE INJ 90/0.3ML
2
$0
NM, PA
SOMATULINE INJ 120/.5ML
2
$0
NM, PA
SOMAVERT INJ 10MG
2
$0
NM, LA, PA
SOMAVERT INJ 15MG
2
$0
NM, LA, PA
SOMAVERT INJ 20MG
2
$0
NM, LA, PA
SOMAVERT INJ 25MG
2
$0
NM, LA, PA
SOMAVERT INJ 30MG
2
$0
NM, LA, PA
XGEVA INJ
2
$0
NM, PA
ÒMÒN PARATIROIDYÈN - MEDIKAM POU KONTWOLE NIVO ÒMÒN PARATIROIDYÈN
FORTEO SOL 600/2.4
2
$0
QL (1 pen / 28 jou), NM,
PA
AJAN LYAN NAN FOSFAT - MEDIKAMAN POU KONTWOLE NIVO KALSYÒM AK FOSFAT
calcium acetate (phosphate binder) cap 667 mg 1
$0
(169 mg ca)
FOSRENOL CHW 500MG
2
$0
FOSRENOL CHW 750MG
2
$0
FOSRENOL CHW 1000MG
2
$0
PHOSLYRA SOL
2
$0
RENVELA PAK 0.8GM
2
$0
RENVELA PAK 2.4GM
2
$0
RENVELA TAB 800MG
2
$0
PWOJESTIN - MEDIKAMAN POU KONTWOLE ÒMÒN FANM
medroxyprogesterone acetate tab 2.5 mg
1
$0
?
73
Non medikaman an
Nivo
pral koute
itilizasyon
obligatwa yo
medroxyprogesterone acetate tab 5 mg
1
$0
medroxyprogesterone acetate tab 10 mg
1
$0
norethindrone acetate tab 5 mg
1
$0
AJAN TIWOYID - MEDIKAMAN POU KONTWOLE NIVO TIWOYID
levothyroxine sodium tab 25 mcg
1
$0
1
$0
1
$0
1
$0
1
$0
1
$0
1
$0
1
$0
1
$0
1
$0
1
$0
1
$0
LEVOXYL TAB 25MCG
1
$0
LEVOXYL TAB 50MCG
1
$0
LEVOXYL TAB 75MCG
1
$0
LEVOXYL TAB 88MCG
1
$0
LEVOXYL TAB 100MCG
1
$0
LEVOXYL TAB 112MCG
1
$0
LEVOXYL TAB 125MCG
1
$0
LEVOXYL TAB 137MCG
1
$0
LEVOXYL TAB 150MCG
1
$0
LEVOXYL TAB 175MCG
1
$0
LEVOXYL TAB 200MCG
1
$0
liothyronine sodium tab 5 mcg
1
$0
1
$0
1
$0
methimazole tab 5 mg
1
$0
methimazole tab 10 mg
1
$0
propylthiouracil tab 50 mg
1
$0
SYNTHROID TAB 25MCG
2
$0
SYNTHROID TAB 50MCG
2
$0
SYNTHROID TAB 75MCG
2
$0
SYNTHROID TAB 88MCG
2
$0
SYNTHROID TAB 100MCG
2
$0
2
$0
2
$0
2
$0
2
$0
2
$0
?
74
Non medikaman an
Nivo
pral koute
itilizasyon
obligatwa yo
2
$0
2
$0
UNITHROID TAB 25MCG
1
$0
UNITHROID TAB 50MCG
1
$0
UNITHROID TAB 75MCG
1
$0
UNITHROID TAB 88MCG
1
$0
UNITHROID TAB 100MCG
1
$0
1
$0
1
$0
1
$0
1
$0
1
$0
1
$0
VAZOPRESIN - MEDIKAMAN POU KONTWOLE ÒMÒN PITWITÈ
desmopressin acetate inj 4 mcg/ml
1
$0
DESMOPRESSIN ACETATE NASAL SOLN
1
$0
0.01% (REFRIGERATED)
desmopressin acetate nasal spray soln 0.01%
1
$0
1
$0
(refrigerated)
desmopressin acetate tab 0.1 mg
1
$0
desmopressin acetate tab 0.2 mg
1
$0
GASTWOENTESTINAL - MEDIKAMAN POU TRETE TWOUB NAN VANT AK TRIP (ENTESTEN)
ANTIASID
acid gone chw
acid gone sus
ALUM HYDROX SUS 320/5ML
aluminum hydroxide gel susp 600 mg/5ml
ant/anti-gas chw 1000-60
antacid sus max st
cal antacid chw 1000mg
calc antacid chw 500mg
calc antacid chw 750mg
CALCIUM CARB TAB 648MG
fast dissolv chw antacid
foam antacid chw 80-20mg
GAVISCON CHW
GAVISCON SUS
maalox child chw
maalox multi sus symp max
maalox sus reg st
MAALOX TC SUS
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
?
75
Non medikaman an
Nivo
pral koute
itilizasyon
obligatwa yo
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
MAG OXIDE CAP 400MG
3
MAG-AL LIQ
3
magnesium oxide tab 250 mg
3
3
3
mi-acid chw
3
mintox plus chw
3
ri-mox plus sus
3
sodium bicarbonate tab 325 mg
3
sodium bicarbonate tab 650 mg
3
SODIUM POW BICARBON
3
titralac chw 420mg
3
URO-MAG CAP 140MG
3
ANTI-DYARE
anti-diarrhe liq 1mg/5ml
3
anti-diarrhe tab 2mg
3
diges probio cap 250mg
3
floranex gra
3
FLORASTOR PAK KIDS
3
kaopectate sus 262/15ml
3
lactobacillus tab
3
loperamide hcl liq 1 mg/7.5ml
3
peptic relf chw 262mg
3
probiotic cap
3
PROBIOTIC CAP FORMULA
3
RISA-BID TAB PROBIO
3
soothe tab 262mg
3
stomach relf sus 525/15ml
3
ANTIEMETIK - MEDIKAMAN POU KÈ PLEN AK VOMISMAN
compro sup 25mg
1
dramamine tab 25mg
3
dronabinol cap 2.5 mg
1
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
dronabinol cap 5 mg
1
$0
dronabinol cap 10 mg
2
$0
EMEND CAP 40MG
EMEND CAP 80MG
EMEND CAP 125MG
EMEND PAK 80 & 125
granisetron hcl inj 0.1 mg/ml
granisetron hcl inj 1 mg/ml
1
2
2
2
1
1
$0
$0
$0
$0
$0
$0
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
B/D, QL (60 kapsil / 30
jou)
jou)
jou)
B/D
B/D
B/D
B/D
?
76
Non medikaman an
granisetron hcl inj 4 mg/4ml (1 mg/ml)
granisetron hcl tab 1 mg
meclizine hcl tab 12.5 mg
meclizine hcl tab 25 mg
metoclopramide hcl inj 5 mg/ml
metoclopramide hcl soln 5 mg/5ml (10 mg/10ml)
metoclopramide hcl tab 5 mg
metoclopramide hcl tab 10 mg
motion sick chw 25mg
motion sick tab 50mg
ondansetron hcl inj 4 mg/2ml (2 mg/ml)
ondansetron hcl inj 40 mg/20ml (2 mg/ml)
ondansetron hcl oral soln 4 mg/5ml
ondansetron hcl tab 4 mg
ondansetron orally disintegrating tab 4 mg
ondansetron orally disintegrating tab 8 mg
prochlorperazine edisylate inj 5 mg/ml
prochlorperazine maleate tab 5 mg
(base equivalent)
prochlorperazine maleate tab 10 mg
(base equivalent)
prochlorperazine suppos 25 mg
promethazine hcl inj 25 mg/ml
promethazine hcl inj 50 mg/ml
TRANSDERM-SC DIS 1.5MG
Nivo
1
1
1
1
1
1
1
1
3
3
1
1
1
1
1
1
1
1
1
1
pral koute
itilizasyon
obligatwa yo
$0
$0
B/D
$0
$0
$0
$0
$0
$0
$0
NM; *
$0
NM; *
$0
$0
$0
B/D
$0
B/D
$0
B/D
$0
B/D
$0
B/D
$0
B/D
$0
$0
1
$0
1
2
2
2
$0
$0
$0
$0
vertin-32 tab
3
ANTISPASMODIK - MEDIKAMAN POU FASYAL NAN VANT
CUVPOSA SOL 1MG/5ML
2
dicyclomine hcl cap 10 mg
1
dicyclomine hcl oral soln 10 mg/5ml
1
dicyclomine hcl tab 20 mg
1
glycopyrrolate inj 4 mg/20ml (0.2 mg/ml)
1
glycopyrrolate tab 1 mg
1
glycopyrrolate tab 2 mg
1
$0
PA
PA
PA
NM; *
$0
$0
$0
$0
$0
$0
$0
RESEPTÈ ANTAGONIS H2- - MEDIKAMAN POU ILSÈ AK ASID NAN LESTOMAK
acid reducer tab 10mg
3
$0
NM; *
acid reducer tab 150mg
3
$0
NM; *
AXID AR TAB 75MG
3
$0
NM; *
cimetidine tab 200 mg
3
$0
NM; *
famotidine for susp 40 mg/5ml
1
$0
?
77
Non medikaman an
Nivo
pral koute
itilizasyon
obligatwa yo
$0
$0
$0
$0
$0
$0
NM; *
$0
$0
NM; *
$0
$0
$0
$0
NM; *
$0
$0
$0
NM; *
famotidine in nacl 0.9% iv soln 20 mg/50ml
1
famotidine inj 20 mg/2ml
1
1
1
famotidine tab 20 mg
1
famotidine tab 20mg
3
famotidine tab 40 mg
1
PEPCID AC CHW 10MG
3
ranitidine hcl inj 50 mg/2ml (25 mg/ml)
1
ranitidine hcl inj 150 mg/6ml (25 mg/ml)
1
ranitidine hcl syrup 15 mg/ml (75 mg/5ml)
1
ranitidine hcl tab 75 mg
3
1
1
ranitidine tab 75mg
3
MALADI ENFLAMATWA ENTESTEN
APRISO CAP 0.375GM
2
$0
ASACOL HD TAB 800MG
2
$0
balsalazide disodium cap 750 mg
1
$0
budesonide cap sr 24hr 3 mg
2
$0
CANASA SUP 1000MG
2
$0
DELZICOL CAP 400MG
2
$0
DIPENTUM CAP 250MG
2
$0
hydrocortisone enema 100 mg/60ml
1
$0
HYDROCORTISONE ENEMA 100 MG/60ML
1
$0
LIALDA TAB 1.2GM
2
$0
mesalamine enema 4 gm
1
$0
mesalamine rectal enema 4 gm & cleanser
1
$0
wipe kit
PENTASA CAP 250MG CR
2
$0
PENTASA CAP 500MG CR
2
$0
sulfasalazine tab 500 mg
1
$0
sulfazine ec tab 500mg
1
$0
UCERIS TAB 9MG
2
$0
LAKSATIF
ALOE VERA LIQ JUICE DR
3
$0
NM; *
BENEFIBER CHW
3
$0
NM; *
BENEFIBER POW
3
$0
NM; *
BLK DRAUGHT CHW 10MG
3
$0
NM; *
BLK DRAUGHT SYP 90/15ML
3
$0
NM; *
constulose sol 10gm/15
1
$0
corn dextrin oral powder
3
$0
NM; *
cvs fiber chw gummies
3
$0
NM; *
?
78
Non medikaman an
d.o.s. cap 250mg
docusate sodium liquid 150 mg/15ml
dok tab 100mg
DULCOLAX KIT BOWEL
easy fiber/ chw calcium
enemeez mini ene
enemeez plus ene 20-283
enulose sol 10gm/15
epsom salt gra
EQL NATURAL POW FIBER
EQUALACTIN CHW 625MG
ex-lax ultra tab 5mg ec
FIBER CHW
fiber laxatv tab 625mg
fiber oral powder
FIBER POW
FLEET BISACO ENE 10/30ML
gavilyte-c sol
gavilyte-g sol
gavilyte-n sol flav pk
generlac sol 10gm/15
gentle laxat sup 10mg
GOLYTELY SOL
HYDROCIL INS POW 95%
konsyl cap 520mg
konsyl pow 28.3%
KONSYL POW 28.3%
konsyl pow 30.9%
KONSYL POW 60.3%
KONSYL POW 71.67%
KONSYL POW 100%
KONSYL-D POW 52.3%
lactulose (encephalopathy) solution 10 gm/15ml
lactulose solution 10 gm/15ml
lax diet sup tab 500mg
laxative chw 15mg
magnesium citrate soln
METAMUCIL POW 28%
METAMUCIL POW 63%
METAMUCIL WAF
MILK OF MAGN SUS 800/5ML
MILK OF MAGN SUS 2400MG
milk of magn sus frsh mnt
Nivo
3
3
3
3
3
3
3
1
3
3
3
3
3
3
3
3
3
1
1
1
1
3
2
3
3
3
3
3
3
3
3
3
1
1
3
3
3
3
3
3
3
3
3
pral koute
itilizasyon
obligatwa yo
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
$0
$0
$0
$0
NM; *
$0
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
$0
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
?
79
Non medikaman an
MINERAL OIL
mineral oil enema
MOVIPREP SOL
nat fiber pow therapy
naturl fiber pow 68%
NULYTELY SOL FLAV PKS
NUTRISOURCE PAK FIBER
oral saline sol laxative
PEDIA-LAX LIQ 50MG
peg 3350-kcl-na bicarb-nacl-na sulfate for soln
236 gm
PEG 3350-KCL-NA BICARB-NACL-NA
SULFATE FOR SOLN 240 GM
peg 3350-kcl-sod bicarb-nacl for soln 420 gm
perdiem over tab 15mg
polyethylene glycol 3350 oral packet
polyethylene glycol 3350 oral powder
psyldex pow 30%
psyllium powder 100%
qc natural pow vegetabl
ra col-rite cap 50mg
ra fiber tab 500mg
reguloid pow 48.57%
reguloid pow 58.6%
RELISTOR INJ 8/0.4ML
RELISTOR INJ 12/0.6ML
RELISTOR KIT 12/0.6ML
sb fib lax pow 33%
SB NAT FIBER POW 49%
sen-o-tabs tab 187mg
SENNA PROMPT CAP 9-500MG
SENNA SYP
senna tab 25mg
SENNA TAB 187MG
senna-extra tab 17.2mg
sennosides cap 8.6 mg
sennosides syrup 8.8 mg/5ml
sennosides tab 8.6 mg
sennosides-docusate sodium tab 8.6-50 mg
sodium phosphates - enema
soluble fib pow therapy
sorbulax pow 100%
stool softnr cap 50mg
Nivo
3
3
2
3
3
2
3
3
3
1
pral koute
itilizasyon
obligatwa yo
$0
NM; *
$0
NM; *
$0
$0
NM; *
$0
NM; *
$0
$0
NM; *
$0
NM; *
$0
NM; *
$0
1
$0
1
3
1
1
3
3
3
3
3
3
3
2
2
2
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
PA
PA
PA
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
?
80
Non medikaman an
stool softnr syp 60/15ml
stool softnr tab 8.6-50mg
SUPREP BOWEL SOL PREP
total fiber pow
trilyte sol
DIVÈS
AMITIZA CAP 8MCG
AMITIZA CAP 24MCG
cromolyn sodium oral conc 100 mg/5ml
diphenoxylate w/ atropine liq 2.5-0.025 mg/5ml
diphenoxylate w/ atropine tab 2.5-0.025 mg
LINZESS CAP 145MCG
LINZESS CAP 290MCG
loperamide hcl cap 2 mg
LOTRONEX TAB 0.5MG
LOTRONEX TAB 1MG
misoprostol tab 100 mcg
misoprostol tab 200 mcg
SUCRAID SOL 8500/ML
sucralfate tab 1 gm
ursodiol cap 300 mg
ursodiol tab 250 mg
ursodiol tab 500 mg
XIFAXAN TAB 550MG
ANZIM PANKREYATIK
CREON CAP 3000UNIT
CREON CAP 6000UNIT
CREON CAP 12000UNT
CREON CAP 24000UNT
CREON CAP 36000UNT
ZENPEP CAP 3000UNIT
ZENPEP CAP 5000UNIT
ZENPEP CAP 10000UNT
ZENPEP CAP 15000UNT
ZENPEP CAP 20000UNT
ZENPEP CAP 25000UNT
Nivo
3
3
3
3
2
3
1
pral koute
itilizasyon
obligatwa yo
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
$0
NM; *
$0
2
2
2
1
1
2
2
1
2
2
1
1
2
1
1
1
1
2
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
2
2
2
2
2
2
2
2
2
2
2
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
PA
PA
PA
INIBITÈ PONP PWOTON - MEDIKAMAN POU ILSÈ AK ASID NAN LESTOMAK
DEXILANT CAP 30MG DR
2
$0
DEXILANT CAP 60MG DR
2
$0
dual action chw complete
3
$0
NM; *
?
81
Non medikaman an
Nivo
pral koute
itilizasyon
obligatwa yo
$0
esomeprazole sodium for intravenous soln
1
20 mg (base equiv)
esomeprazole sodium for intravenous soln
1
$0
40 mg (base equiv)
lansoprazole cap 15mg dr
3
$0
NM; *
NEXIUM CAP 20MG
2
$0
NEXIUM CAP 40MG
2
$0
NEXIUM GRA 2.5MG DR
2
$0
NEXIUM GRA 5MG DR
2
$0
NEXIUM GRA 10MG DR
2
$0
QL (30 Sachè / 30 jou)
NEXIUM GRA 20MG DR
2
$0
NEXIUM GRA 40MG DR
2
$0
omeprazole cap 20.6mgdr
3
$0
NM; *
omeprazole cap delayed release 10 mg
1
$0
1
$0
1
$0
OMEPRAZOLE TAB 20MG
3
$0
NM; *
omeprazole-sodium bicarbonate cap
3
$0
NM; *
20-1100 mg
pantoprazole sodium ec tab 20 mg (base equiv) 1
$0
pantoprazole sodium ec tab 40 mg (base equiv) 1
$0
PRILOSEC OTC TAB 20MG
3
$0
NM; *
JENITO-IRINÈ - MALADI POU TRET KONDISYON JENITO AK APARÈY IRINÈ
IPÈPLAZI PROSTATIK BENEN - MEDIKAMAN POU TRETE PWOSTAT KI TWÒ GWO
alfuzosin hcl tab sr 24hr 10 mg
1
$0
AVODART CAP 0.5MG
2
$0
finasteride tab 5 mg
1
$0
JALYN CAP
2
$0
tamsulosin hcl cap 0.4 mg
1
$0
DIVÈS
bethanechol chloride tab 5 mg
1
$0
1
$0
1
$0
1
$0
ELMIRON CAP 100MG
2
$0
POTASSIUM CITRATE TAB CR 5 MEQ
1
$0
(540 MG)
1
$0
(1080 MG)
ANTISPASMODIK (ANTI-FASYAL) IRINÈ - MEDIKAMAN POU TRETE ENKONTINANS IRINÈ
MYRBETRIQ TAB 25MG
2
$0
MYRBETRIQ TAB 50MG
2
$0
?
82
Non medikaman an
Nivo
oxybutynin chloride syrup 5 mg/5ml
1
oxybutynin chloride tab 5 mg
1
oxybutynin chloride tab sr 24hr 5 mg
1
1
1
TOLTERODINE TARTRATE CAP SR 24HR
1
2 MG
TOLTERODINE TARTRATE CAP SR 24HR
1
4 MG
tolterodine tartrate tab 1 mg
1
tolterodine tartrate tab 2 mg
1
TOVIAZ TAB 4MG
2
TOVIAZ TAB 8MG
2
trospium chloride tab 20 mg
1
VESICARE TAB 5MG
2
VESICARE TAB 10MG
2
ANTI-ENFEKSYON VAJINAL
clindamycin phosphate vaginal cream 2%
1
clotrimazole cre 2%
3
clotrimazole vaginal cream 1%
3
3 day vagnal cre 4%
3
metronidazole vaginal gel 0.75%
1
miconazole 3 cre 4%
3
miconazole 3 kit combinat
3
miconazole 3 kit combo pk
3
miconazole 7 cre tube/kit
3
miconazole 7 sup 100mg
3
miconazole nitrate vaginal supp 1200 mg &
3
2% cream kit
povidone/iod sol 10%
3
summers eve sol 0.3%
3
terconazole vaginal cream 0.4%
1
terconazole vaginal cream 0.8%
1
terconazole vaginal suppos 80 mg
1
tioconazole oin 6.5% vag
3
vagistat-3 kit combo pk
3
VANDAZOLE GEL 0.75%
1
zazole cre 0.4%
1
ZAZOLE CRE 0.8%
1
EMATOLOJIK - MEDIKAMAN POU TRETE TWOUB SAN
pral koute
itilizasyon
obligatwa yo
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
ANTI-KOWAGILAN - PWODWI POU FÈ SAN VIN PI LIKID
COUMADIN TAB 1MG
2
$0
COUMADIN TAB 2.5MG
2
$0
?
83
Non medikaman an
COUMADIN TAB 2MG
COUMADIN TAB 3MG
COUMADIN TAB 4MG
COUMADIN TAB 5MG
COUMADIN TAB 6MG
COUMADIN TAB 7.5MG
COUMADIN TAB 10MG
ELIQUIS TAB 2.5MG
ELIQUIS TAB 5MG
enoxaparin sodium inj 30 mg/0.3ml
enoxaparin sodium inj 100 mg/ml
enoxaparin sodium inj 150 mg/ml
enoxaparin sodium inj 300 mg/3ml
fondaparinux sodium inj 2.5 mg/0.5ml
fondaparinux sodium inj 5 mg/0.4ml
fondaparinux sodium inj 7.5 mg/0.6ml
fondaparinux sodium inj 10 mg/0.8ml
HEP SOD/D5W INJ 25000UNT
HEP SOD/NACL INJ 25000UNT
HEPARIN SOD INJ 2000/ML
HEPARIN SOD INJ 2500/ML
HEPARIN SODIUM (PORCINE) 2 UNIT/ML
IN SODIUM CHLORIDE 0.9%
IN D5W
heparin sodium (porcine) inj 1000 unit/ml
jantoven tab 1mg
jantoven tab 2.5mg
jantoven tab 2mg
jantoven tab 3mg
jantoven tab 4mg
jantoven tab 5mg
jantoven tab 6mg
jantoven tab 7.5mg
jantoven tab 10mg
PRADAXA CAP 75MG
Nivo
2
2
2
2
2
2
2
2
2
1
1
1
1
2
2
2
1
1
2
2
2
2
2
2
2
2
pral koute
itilizasyon
obligatwa yo
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
B/D
$0
B/D
$0
2
$0
1
1
1
1
1
1
1
1
1
1
1
1
1
2
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
B/D
B/D
B/D
B/D
?
84
Non medikaman an
Nivo
pral koute
itilizasyon
obligatwa yo
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
PRADAXA CAP 150MG
2
warfarin sodium tab 1 mg
1
1
warfarin sodium tab 2.5 mg
1
1
1
1
1
warfarin sodium tab 7.5 mg
1
1
XARELTO STAR TAB 15/20MG
2
XARELTO TAB 10MG
2
XARELTO TAB 15MG
2
XARELTO TAB 20MG
2
FAKTÈ KWASANS EMATOPOYETIK
GRANIX INJ 300/0.5
2
$0
NM, PA
GRANIX INJ 480/0.8
2
$0
NM, PA
LEUKINE INJ 250MCG
2
$0
NM, PA
MOZOBIL INJ
2
$0
NM, PA
NEUMEGA INJ 5MG
2
$0
NM
NEUPOGEN INJ 300/0.5
2
$0
NM, PA
NEUPOGEN INJ 300MCG
2
$0
NM, PA
NEUPOGEN INJ 480/0.8
2
$0
NM, PA
NEUPOGEN INJ 480MCG
2
$0
NM, PA
PROCRIT INJ 2000/ML
2
$0
NM, PA
PROCRIT INJ 3000/ML
2
$0
NM, PA
PROCRIT INJ 4000/ML
2
$0
NM, PA
PROCRIT INJ 10000/ML
2
$0
NM, PA
2
$0
NM, PA
2
$0
NM, PA
FÈ
BIFERA TAB 28MG
3
$0
NM; *
DEXFERRUM INJ 50MG/ML
3
$0
NM; *
ezfe 200 cap 200mg
3
$0
NM; *
FEOSOL TAB 45MG
3
$0
NM; *
fer-iron dro 15mg/ml
3
$0
NM; *
FERRETTS IPS SOL
3
$0
NM; *
ferretts tab 325mg
3
$0
NM; *
FERRIMIN 150 TAB
3
$0
NM; *
FERROUS FUM TAB 29MG
3
$0
NM; *
FERROUS FUMA TAB
3
$0
NM; *
FERROUS GLUC TAB 225MG
3
$0
NM; *
ferrous gluc tab 324mg
3
$0
NM; *
?
85
Non medikaman an
FERROUS GLUC TAB 324MG
ferrous gluconate tab 240 mg (27 mg
elemental fe)
ferrous gluconate tab 325 mg (36 mg
elemental fe)
FERROUS SUL LIQ 220/5ML
FERROUS SULF SYP 300/5ML
FERROUS SULF TAB 140MG
FERROUS SULF TAB 324MG EC
ferrous sulf tab 325mg
ferrous sulfate elixir 220 mg/5ml
(44 mg/5ml elemental fe)
ferrous sulfate tab ec 325 mg
(65 mg fe equivalent)
FOLGARD TAB
FOLITAB 500 TAB
foltabs 800 tab
gnp iron tab 45mg
INTEGRA CAP
iron 100 tab plus
iron 100/c tab 100-250
iron chews chw pediatri
IRON TAB 18MG
IRON TAB 18MG CR
iron tab 28mg
IRON TAB 28MG
iron therapy tab 200mg
IRON UP LIQ
MYKIDZ IRON SUS 15/1.5ML
NOVAFERRUM DRO 15MG/ML
NOVAFERRUM LIQ 125
nu-iron 150 cap 150mg
PROFE CAP 180MG
ra iron tab 27mg
slow iron tab 50mg
SLOW REL FE TAB 140MG CR
SLOW REL FE TAB 143MG CR
slow release tab 45mg
slow release tab 47.5mg
SLOW RELEASE TAB 143MG
sm iron slow tab 160mg cr
VIT B12/FA TAB
wee care sus 15/1.25
Nivo
3
3
pral koute
itilizasyon
obligatwa yo
$0
NM; *
$0
NM; *
3
$0
NM; *
3
3
3
3
3
3
$0
$0
$0
$0
$0
$0
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
3
$0
NM; *
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
?
86
Non medikaman an
Nivo
pral koute
itilizasyon
obligatwa yo
DIVÈS
anagrelide hcl cap 0.5 mg
anagrelide hcl cap 1 mg
cilostazol tab 50 mg
cilostazol tab 100 mg
CINRYZE SOL 500 UNIT
FIRAZYR INJ 30MG/3ML
pentoxifylline tab cr 400 mg
PROMACTA TAB 12.5MG
1
1
1
1
2
2
1
2
$0
$0
$0
$0
$0
$0
$0
$0
PROMACTA TAB 25MG
2
$0
PROMACTA TAB 50MG
2
$0
PROMACTA TAB 75MG
2
$0
tranexamic acid inj 100 mg/ml
1
$0
tranexamic acid tab 650 mg
1
$0
INIBITÈ AGREGASYON PLATLÈT (PLAKAT PLATLÈT)
AGGRENOX CAP 25-200MG
2
$0
BRILINTA TAB 90MG
2
$0
clopidogrel bisulfate tab 75 mg (base equiv)
1
$0
EFFIENT TAB 5MG
2
$0
EFFIENT TAB 10MG
2
$0
ZONTIVITY TAB 2.08MG
2
$0
AJAN IMUNOLOJIK - MEDIKAMAN POU TRETE SISTÈM IMINITÈ
NM, LA, PA
NM, PA
NM, LA, PA
NM, LA, PA
NM, LA, PA
NM, LA, PA
MEDIKAMAN ANTIRUMATISMO K AP MODIFYE MALADI (DISEASE-MODIFYING
ANTI-RHEUMATIC DRUGS, DMARDS) - MEDIKAMAN POU TRETE ATRIT RIMATOYID
CIMZIA KIT
2
$0
NM, PA
CIMZIA KIT STARTER
2
$0
NM, PA
CIMZIA PREFL KIT 200MG/ML
2
$0
NM, PA
HUMIRA KIT 20MG/0.4
2
$0
NM, PA
HUMIRA KIT 40MG/0.8
1
$0
NM, PA
HUMIRA PEN KIT 40MG/0.8
2
$0
NM, PA
HUMIRA PEN KIT CROHNS
2
$0
NM, PA
HUMIRA PEN KIT PSORIASI
2
$0
NM, PA
hydroxychloroquine sulfate tab 200 mg
1
$0
leflunomide tab 10 mg
1
$0
leflunomide tab 20 mg
1
$0
methotrexate sodium tab 2.5 mg (base equiv)
1
$0
REMICADE INJ 100MG
2
$0
NM, PA
?
87
Non medikaman an
Nivo
pral koute
itilizasyon
obligatwa yo
IMUNOGLOBULIN
BIVIGAM INJ 10%
2
$0
NM, PA
CARIMUNE NF INJ 3GM
2
$0
NM, PA
CARIMUNE NF INJ 6GM
2
$0
NM, PA
CARIMUNE NF INJ 12GM
2
$0
NM, PA
FLEBOGAMMA INJ 5%
2
$0
NM, PA
FLEBOGAMMA INJ 10%
2
$0
NM, PA
FLEBOGAMMA INJ DIF 5%
2
$0
NM, PA
GAMASTAN S/D INJ
2
$0
B/D, NM
GAMMAGARD INJ 1GM/10ML
2
$0
NM, PA
GAMMAGARD INJ 2.5GM/25
2
$0
NM, PA
GAMMAGARD INJ 5GM/50ML
2
$0
NM, PA
GAMMAGARD INJ 10GM/100
2
$0
NM, PA
2
$0
NM, PA
2
$0
NM, PA
GAMMAGARD SD INJ 2.5GM HU
2
$0
NM, PA
GAMMAGARD SD INJ 5GM HU
2
$0
NM, PA
GAMMAGARD SD INJ 10GM HU
2
$0
NM, PA
GAMMAKED INJ 1GM/10ML
2
$0
NM, PA
GAMMAKED INJ 2.5GM/25
2
$0
NM, PA
GAMMAKED INJ 5GM/50ML
2
$0
NM, PA
GAMMAKED INJ 10GM/100
2
$0
NM, PA
GAMMAKED INJ 20GM/200
2
$0
NM, PA
GAMMAPLEX INJ 2.5GM
2
$0
NM, PA
GAMMAPLEX INJ 5GM
2
$0
NM, PA
GAMMAPLEX INJ 10GM
2
$0
NM, PA
GAMUNEX-C INJ 1GM/10ML
2
$0
NM, PA
GAMUNEX-C INJ 2.5GM/25
2
$0
NM, PA
GAMUNEX-C INJ 5GM/50ML
2
$0
NM, PA
GAMUNEX-C INJ 10GM/100
2
$0
NM, PA
GAMUNEX-C INJ 20GM/200
2
$0
NM, PA
OCTAGAM INJ 1GM
2
$0
NM, PA
OCTAGAM INJ 2.5GM
2
$0
NM, PA
OCTAGAM INJ 5GM
2
$0
NM, PA
OCTAGAM INJ 10GM
2
$0
NM, PA
OCTAGAM INJ 25GM
2
$0
NM, PA
PRIVIGEN INJ 5 GRAMS
2
$0
NM, PA
PRIVIGEN INJ 10GRAMS
2
$0
NM, PA
2
$0
NM, PA
2
$0
NM, PA
MODIFIKATÈ SISTÈM IMINITÈ
ACTIMMUNE INJ 2MU/0.5
2
$0
NM, LA, PA
ARCALYST INJ 220MG
2
$0
NM, PA
?
88
Non medikaman an
INTRON-A INJ 10MU
INTRON-A INJ 18MU
INTRON-A INJ 25MU
INTRON-A INJ 50MU
PEG-INTRON KIT 50MCG
PEG-INTRON KIT 50MCG RP
PEG-INTRON KIT 80MCG RP
PEG-INTRON KIT 120 RP
PEG-INTRON KIT 150 RP
REVLIMID CAP 2.5MG
REVLIMID CAP 5MG
REVLIMID CAP 10MG
REVLIMID CAP 15MG
REVLIMID CAP 20MG
REVLIMID CAP 25MG
THALOMID CAP 50MG
THALOMID CAP 100MG
THALOMID CAP 150MG
THALOMID CAP 200MG
SIPRESYON IMINITÈ
azathioprine tab 50 mg
CELLCEPT SUS 200MG/ML
cyclosporine cap 25 mg
cyclosporine cap 100 mg
cyclosporine iv soln 50 mg/ml
cyclosporine modified cap 25 mg
cyclosporine modified oral soln 100 mg/ml
gengraf cap 25mg
gengraf cap 100mg
gengraf sol 100mg/ml
mycophenolate mofetil cap 250 mg
mycophenolate mofetil tab 500 mg
mycophenolate sodium tab dr 180 mg
(mycophenolic acid equiv)
(mycophenolic acid equiv)
NEORAL CAP 25MG
NEORAL CAP 100MG
Nivo
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
pral koute
itilizasyon
obligatwa yo
$0
B/D, NM
$0
B/D, NM
$0
B/D, NM
$0
B/D, NM
$0
NM, PA
$0
NM, PA
$0
NM, PA
$0
NM, PA
$0
NM, PA
$0
NM, PA
$0
NM, PA
$0
NM, PA
$0
NM, LA, PA
$0
NM, LA, PA
$0
NM, LA, PA
$0
NM, LA, PA
$0
NM, LA, PA
$0
NM, LA, PA
$0
NM, PA
$0
NM, PA
$0
NM, PA
$0
NM, PA
1
2
1
1
1
1
1
1
1
1
1
1
1
1
1
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
2
$0
B/D
2
2
$0
$0
B/D
B/D
?
89
Non medikaman an
Nivo
NEORAL SOL 100MG/ML
NULOJIX INJ 250MG
PROGRAF CAP 0.5MG
PROGRAF CAP 1MG
PROGRAF CAP 5MG
RAPAMUNE SOL 1MG/ML
RAPAMUNE TAB 1MG
RAPAMUNE TAB 2MG
SANDIMMUNE CAP 25MG
SANDIMMUNE CAP 100MG
SANDIMMUNE SOL 100MG/ML
sirolimus tab 0.5 mg
tacrolimus cap 0.5 mg
tacrolimus cap 1 mg
tacrolimus cap 5 mg
ZORTRESS TAB 0.5MG
ZORTRESS TAB 0.25MG
ZORTRESS TAB 0.75MG
VAKSEN
ACTHIB INJ
ADACEL INJ
BCG VACCINE INJ
BOOSTRIX INJ
CERVARIX INJ
COMVAX INJ
DAPTACEL INJ
DIP/TET PED INJ 25-5LFU
ENGERIX-B INJ 10/0.5ML
ENGERIX-B INJ 20MCG/ML
GARDASIL INJ
HAVRIX INJ 720UNIT
HAVRIX INJ 1440UNIT
HIBERIX SOL 10MCG
IMOVAX RABIE INJ 2.5/ML
INFANRIX INJ
IPOL INJ INACTIVE
IXIARO INJ
M-M-R II INJ LIVE
MENACTRA INJ
MENOMUNE INJ A/C/Y/W
MENVEO INJ
PEDVAX HIB INJ
PROQUAD INJ
2
2
2
2
2
2
2
2
2
2
2
1
1
1
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
pral koute
itilizasyon
obligatwa yo
$0
B/D
$0
B/D
$0
B/D
$0
B/D
$0
B/D
$0
B/D
$0
B/D
$0
B/D
$0
B/D
$0
B/D
$0
B/D
$0
B/D
$0
B/D
$0
B/D
$0
B/D
$0
B/D
$0
B/D
$0
B/D
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
B/D
B/D
B/D
?
90
Non medikaman an
Nivo
RABAVERT INJ
2
RECOMBIVA HB INJ 5MCG/0.5
2
RECOMBIVA HB INJ 10MCG/ML
2
RECOMBIVA-HB INJ 40MCG/ML
2
ROTARIX SUS
2
ROTATEQ SOL
2
SYNAGIS INJ 50MG
2
SYNAGIS INJ 100MG/ML
2
TENIVAC INJ 5-2LF
2
TET/DIP TOX INJ 2-2 LF
2
TETANUS TOX INJ 5LF ADS
2
TWINRIX INJ
2
TYPHIM VI INJ
2
VAQTA INJ 25/0.5ML
2
VAQTA INJ 50UNT/ML
2
VARIVAX INJ
2
YF-VAX INJ
2
ZOSTAVAX INJ
2
NUTRISYONÈL/KONPRIME - VITAMIN AK KONPRIME
ELEKTWOLIT
KLOR-CON 8 TAB 8MEQ ER
KLOR-CON 10 TAB 10MEQ ER
klor-con m15 tab
klor-con pow 20meq
MAGNESIUM SU INJ 40MG/ML
MAGNESIUM SU INJ 80MG/ML
magnesium sulfate inj 50%
MAGNESIUM SULFATE INJ 50%
MG SO4/D5W INJ 10MG/ML
MG SO4/D5W INJ 20MG/ML
potassium chloride cap cr 8 meq
potassium chloride cap cr 10 meq
potassium chloride microencapsulated crys cr
tab 10 meq
tab 20 meq
potassium chloride oral liq 10% (20 meq/15ml)
POTASSIUM CHLORIDE TAB CR 8 MEQ
(600 MG)
(1500 MG)
pral koute
itilizasyon
obligatwa yo
$0
$0
B/D
$0
B/D
$0
B/D
$0
$0
$0
NM
$0
NM
$0
B/D
$0
B/D
$0
B/D
$0
$0
$0
$0
$0
$0
$0
QL (1 Fyòl per lifetime)
1
1
1
1
2
2
1
1
2
2
1
1
1
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
1
$0
1
1
1
$0
$0
$0
1
1
$0
$0
?
91
Non medikaman an
Nivo
rehydralyte sol
SODIUM CHLORIDE INJ 2.5 MEQ/ML (14.6%)
SODIUM FLUORIDE CHEW; TAB; 1.1 (0.5 F)
MG/ML SOLN
TPN ELECTROL INJ
NITRISYON IV
amino acid infusion 6%
AMINOSYN 7% INJ /LYTES
AMINOSYN II INJ 7%
AMINOSYN II INJ 8.5%
AMINOSYN II INJ 8.5/LYTE
AMINOSYN II INJ 10%
AMINOSYN INJ 8.5%
AMINOSYN INJ 8.5/LYTE
AMINOSYN INJ 10%
AMINOSYN M INJ 3.5%
AMINOSYN-HBC INJ 7%
AMINOSYN-PF INJ 7%
AMINOSYN-PF INJ 10%
AMINOSYN-RF INJ 5.2%
CLINIMIX INJ 2.75/D5W
CLINIMIX INJ 4.25/D5W
CLINIMIX INJ 4.25/D10
CLINIMIX INJ 5%/D15W
FREAMINE HBC INJ 6.9%
FREAMINE III INJ 10%
HEPATAMINE SOL 8%
INTRALIPID INJ 20%
INTRALIPID INJ 30%
NEPHRAMINE INJ 5.4%
premasol sol 10%
PROCALAMINE INJ 3%
PROSOL INJ 20%
travasol inj 10%
TROPHAMINE INJ 10%
3
1
1
pral koute
itilizasyon
obligatwa yo
$0
NM; *
$0
$0
2
$0
B/D
1
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
B/D
RANPLASMAN SOLISYON IV
D5W/LYTES INJ #48
2
$0
D5W/NACL INJ 0.3%
1
$0
D10W/NACL INJ 0.2%
2
$0
?
92
Non medikaman an
Nivo
pral koute
itilizasyon
obligatwa yo
$0
DEXTROSE 2.5% W/ SODIUM CHLORIDE
1
0.45%
DEXTROSE 5% IN LACTATED RINGERS
1
$0
DEXTROSE 5% W/ SODIUM CHLORIDE 0.2% 1
$0
$0
$0
$0
DEXTROSE 5% W/ SODIUM CHLORIDE
1
$0
0.225%
1
$0
0.45%
DEXTROSE INJ 5%
1
$0
DEXTROSE INJ 10%
1
$0
DEXTROSE INJ 50%
1
$0
dextrose inj 70%
1
$0
IONOSOL-B/ INJ D5W
2
$0
IONOSOL-MB INJ /D5W
2
$0
ISOLYTE-P INJ /D5W
2
$0
isolyte-s inj
2
$0
KCL 10 MEQ/L (0.075%) IN DEXTROSE 5% & 1
$0
NACL 0.45% INJ
KCL 20 MEQ/L (0.15%) IN DEXTROSE 5% &
1
$0
NACL 0.2% INJ
1
$0
NACL 0.9% INJ
1
$0
NACL 0.33% INJ
1
$0
NACL 0.45% INJ
KCL 20 MEQ/L (0.15%) IN NACL 0.9% INJ
1
$0
kcl 20 meq/l (0.15%) in nacl 0.45% inj
1
$0
1
$0
KCL 30 MEQ/L (0.224%) IN DEXTROSE 5% & 1
$0
NACL 0.45% INJ
1
$0
NACL 0.45% INJ
1
$0
KCL/D5W/NACL INJ 0.3/0.9%
1
$0
KCL/D5W/NACL INJ 0.15/0.2
2
$0
LACTATED RINGER'S SOLUTION
1
$0
normosol -m inj /d5w
1
$0
NORMOSOL -R INJ /D5W
2
$0
NORMOSOL-R INJ PH 7.4
2
$0
PLASMA-LYTE INJ 56/D5W
2
$0
?
93
Non medikaman an
Nivo
PLASMA-LYTE INJ -148
PLASMA-LYTE INJ -A
POTASSIUM CHLORIDE 20 MEQ/L (0.15%) IN
DEXTROSE 5% INJ
DEXTROSE 5% INJ
potassium chloride inj 2 meq/ml
potassium chloride inj 10 meq/50 ml
POTASSIUM CHLORIDE INJ 10 MEQ/100 ML
RINGER'S SOLUTION
SODIUM CHLORIDE INJ 0.45%
SODIUM CHLORIDE INJ 3%
SODIUM CHLORIDE INJ 5%
SODIUM CHLORIDE IV SOLN 0.9%
MINEWO
BEELITH TAB
BONE DENSITY TAB
bone meal w/ vitamin d tab
buffered tab salt
CA CITRATE TAB 250MG
ca citrate tab + d
CA GLUCONATE TAB 50MG
CA LACTATE TAB 100MG
CA/MG TAB
CA/MG/ZN TAB
CAL CIT MAL/ TAB VITAMIND
CAL-CITRATE TAB PLUS D
CAL-GLU CAP 500MG
cal-mag aspa tab 333-167
CAL-QUICK LIQ 500-400
CAL/MAG TAB CHEW
CAL/MAG/VITD TAB
CALC CITRATE TAB 200MG
calc citrate tab +d
CALC GUMMIES CHW CHILD
CALCET CHW BITES
CALCET PETIT TAB 200-250
CALCI-MIX CAP 1250MG
CALCIONATE SYP 1.8GM/5
CALCIUM 500 TAB
2
2
1
pral koute
itilizasyon
obligatwa yo
$0
$0
$0
1
$0
1
1
1
1
1
1
1
1
1
1
1
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
?
94
Non medikaman an
calcium 500 tab +d
calcium 600 chw +d/mnrls
calcium 600 tab
calcium 600 tab vit d/mi
CALCIUM 1000 TAB + D
calcium 1200 chw
CALCIUM &MAG TAB
calcium + d chw
CALCIUM CARB CHW 260MG
CALCIUM CARB POW 800/2GM
calcium carbonate susp 1250 mg/5ml
(500 mg/5ml elemental ca)
calcium carbonate tab 1250 mg
(500 mg elemental ca)
calcium carbonate-cholecalciferol tab
500 mg-400 unit
calcium carbonate-cholecalciferol tab
600 mg-200 unit
calcium carbonate-vitamin d tab 500 mg-125 unit
CALCIUM CHW GUMMIES
CALCIUM CIT/ TAB VIT D
calcium citrate tab 950 mg (200 mg
elemental ca)
calcium citrate-vitamin d tab 200 mg-250 unit
(elemental ca)
calcium for chw women
CALCIUM GLUC TAB 500MG
calcium gluconate tab 500 mg
CALCIUM GRA CITRATE
CALCIUM LACT TAB 648MG
calcium lactate tab 650 mg
calcium soft chw chocolat
calcium tab 500 mg
calcium tab 600 mg
CALCIUM TAB FORMULA
calcium w/ magnesium tab 500-250 mg
calcium w/ vitamin d tab 600 mg-125 unit
calcium w/ vitamin d tab 600 mg-200 unit
calcium+d3 tab 600-800
Nivo
3
3
3
3
3
3
3
3
3
3
3
pral koute
itilizasyon
obligatwa yo
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
3
$0
NM; *
3
$0
NM; *
3
$0
NM; *
3
3
3
3
3
3
3
3
$0
$0
$0
$0
$0
$0
$0
$0
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
3
$0
NM; *
3
3
3
3
3
3
3
3
3
3
3
3
3
3
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
?
95
Non medikaman an
calcium+d3 tab grad rel
CALCIUM/C/D CHW 500MG
CALCIUM/D3 TAB
calcium/d3 tab 600-800
calcium/d chw 500-400
calcium/magn tab zinc
CALMAG THINS TAB 200-50MG
caltrate 600 chw 600-800
CALTRATE 600 CHW +D PLUS
caltrate 600 tab
calvite p&d tab
CHELATED CA TAB 200MG
cit calc/d tab 315-250
CITRACAL CAL CHW GUMMIES
CITRACAL HRT TAB HEALTH
CORAL CALCIU CAP
CORAL CALCIU CAP 1000MG
CORAL CALCIU CAP PLUS
CORAL CAP CALCIUM
elite magnes tab 100mg
EQL CALCIUM CAP VIT D
kp ca/mg/zn tab
kp calcium cap 600+d
kp calcium tab 600+d
liq ca/vit d cap 600mg
LIQUID CALCI CAP WITH D3
LOCALNESIUM TAB
LOCALNESIUM TAB -C
MAG CITRATE TAB 100MG
MAG-200 TAB
mag-delay tab
MAG-TAB SR TAB 84MG
MAGINEX TAB 615 MG
MAGN SULFATE CAP 70MG
magnacaps cap 100mg
MAGNEBIND TAB 200
MAGNEBIND TAB 300
MAGNESIUM CAP 300MG
MAGNESIUM CAP 400MG
MAGNESIUM GL TAB 550MG
magnesium oxide tab 400 mg (240 mg
elemental mg)
Nivo
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
pral koute
itilizasyon
obligatwa yo
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
?
96
Non medikaman an
Nivo
magnesium oxide tab 400 mg (241.3 mg
elemental mg)
magnesium oxide tab 500 mg (mg supplement)
MAGNESIUM TAB 30MG
magnesium tab 200 mg
magnesium tab 250 mg
MG GLUCONATE TAB 250MG
os-cal + d3 tab 500-200
OSTEO-PORETI TAB
oys shell+d tab 250-125
oysco 500 tab 500mg
OYSCO 500+D CHW
oyst shell/d tab 500-200
oyst shell/d tab 500mg
oyst-cal d tab 250mg
PARVA-CAL TAB 250-100
PARVA-CAL TAB 500MG
PHOS-NAK POW CONCENTR
RA CA/BORON TAB
ra coral cap calcium
ra magnesium cap 500mg
RA OYS SHL/D TAB 250MG
ra oys shl/d tab 500mg
selenium tab 100 mcg
SELENIUM TAB 200MCG
slow magnes/ tab calcium
SLOW-MAG TAB
sm ca/mg/zn tab
SM CORAL CAL TAB 1000MG
sm magnesium tab 250mg
UPCAL D POW
VITAMIN
A-25 CAP 25000UNT
ACEROLA C WAF 500MG
ANTIOXIDANT CAP
APATATE LIQ
AQUA-E LIQ
aquadeks dro
ASCORBIC ACD POW
ascorbic acid cap cr 500 mg
ascorbic acid chew tab 250 mg
ascorbic acid syrup 500 mg/5ml
ascorbic acid tab 100 mg
3
pral koute
itilizasyon
obligatwa yo
$0
NM; *
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
3
3
3
3
3
3
3
3
3
3
3
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
?
97
Non medikaman an
ascorbic acid tab cr 500 mg
b complex tab form 1
B-1 TAB 500MG
B-12 DOTS TAB 500MCG
B-12 TAB 2500MCG
B-12 TAB 5000MCG
b-50 tr tab
b-100 complx tab
b-complex tab 50 tr
b-complex vitamin cap
b-complex vitamin sublingual liquid
b-complex vitamin tab
b-complex w/ c & calcium tab
b-complex w/ c cap
B-NATAL LOZ 25MG
bee zee tab
beta carotene cap 25000 unit
bio-d-mulsio liq 400unit
bio-d-mulsio liq 2000unit
biotin tab 300 mcg
brewers yeast tab
c-500 chw 500mg
calciferol dro 8000/ml
calcitriol cap 0.5 mcg
calcitriol cap 0.25 mcg
calcitriol inj 1 mcg/ml
calcitriol oral soln 1 mcg/ml
calcium ascorbate tab 500 mg
calcium pantothenate tab 500 mg
CALNA TAB
central-vite tab performa
CENTRUM CHW SILVER
centrum kids chw complete
cerovite adv liq formula
chewabl vite chw childrns
child chew/ chw extra c
CHILD-MULTI CHW VITAMINS
cholecalciferol cap 2000 unit
cholecalciferol cap 5000 unit
Nivo
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
1
1
1
1
3
3
3
3
3
3
3
3
3
3
3
3
pral koute
itilizasyon
obligatwa yo
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
B/D
$0
B/D
$0
B/D
$0
B/D
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
?
98
Non medikaman an
cholecalciferol drops 5000 unit/ml
(1000 unit/0.2ml)
cholecalciferol oral liquid 400 unit/ml
cholecalciferol tab 400 unit
CL PRENATAL TAB 28-0.8MG
COD LIVER OIL
cod liver oil cap
cvs vit b-6 tab 200mg
cyanocobalamin inj 1000 mcg/ml
cyanocobalamin liquid 1000 mcg/15ml
cyanocobalamin tab 50 mcg
cyanocobalamin tab cr 1000 mcg
cyanocobalamin tab sl 1000 mcg
cyanocobalamin tab sl 2500 mcg
CYTO B2 POW
D3 DOTS TAB 2000UNIT
daily-vite/ tab iron
DECARA CAP 25000UNT
DIALYVITE 80 TAB ZINC 15
dialyvite tab 800
e-oil oil 30000unt
ecee plus tab
ELDERTONIC ELX
energy b-12 tab 1500mcg
ergocalciferol cap 50000 unit
EZFE FORTE CAP
FA-8 CAP 800MCG
fa-8 tab 0.8mg
FOLIC ACID CAP 5MG
FOLIC ACID CAP 20MG
folic acid inj 5 mg/ml
folic acid tab 1 mg
FOLIC ACID TAB 1 MG
folic acid tab 400 mcg
folic acid tab 800 mcg
folic acid tab 800mcg
Nivo
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
pral koute
itilizasyon
obligatwa yo
$0
NM; *
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
?
99
Non medikaman an
fruit c-100 chw
geravim liq
GERIATRIC LIQ VITAMIN
GNP DAILY MIS PRENATAL
gummi bear chw multivit
HONEY BEARS CHW
HONEY BEARS CHW IRON-ZIN
hydroxocobalamin inj 1000 mcg/ml
icaps cap
ICAPS LUTEIN TAB ZEAXANTH
icaps mv tab
iromin-g tab
kp vitamin e cap 100unit
KPN PRENATAL TAB
LUMITENE CAP 30MG
mega-maratho tab 100 tr
MEPHYTON TAB 5MG
meribin cap 5mg
MISSION PREN TAB
MISSION PREN TAB HP
multi-delyn liq
MULTI-DELYN LIQ /IRON
multi-vit tab
MYKIDZ IRON SUS 10MG/2ML
nail-ex tab 2.5mg
NASCOBAL SPR 500MCG
NEPHRONEX LIQ
neuro-k-250 tab 250mg
neuro-k-500 tab
niacin cap cr 250 mg
niacin cap cr 500 mg
niacin tab 50 mg
niacin tab 100 mg
niacin tab 250 mg
niacin tab 500 mg
niacin tab cr 500 mg
niacin tab cr 750 mg
NIACIN TR TAB 1000MG
niacinamide tab 100 mg
niacinamide tab 500 mg
nutr-e-sol liq 400/15ml
NUTRICION TAB PORVIDA
pantothenic acid tab 100 mg
Nivo
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
pral koute
itilizasyon
obligatwa yo
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
?
100
Non medikaman an
pantothenic acid tab 500 mg
paricalcitol cap 1 mcg
PERRY PRENAT CAP
phytonadione inj 1 mg/0.5ml (2 mg/ml)
phytonadione inj 10 mg/ml
phytonadione tab 100 mcg
polyvitamin dro
polyvitamin dro /iron
PRENATAL TAB
PRENATAL TAB 27-0.8MG
PRENATAL VITAMIN/FOLIC ACID > 0.8 MG
(GENERIC)
PROTEXIN SYP
pyridoxine hcl inj 100 mg/ml
pyridoxine hcl tab 25 mg
pyridoxine hcl tab cr 200 mg
ra b-complex tab vit c tr
ra beta caro cap 15mg
ra vit c loz 60mg
ra vitamin c tab 1000mg
riboflavin tab 25 mg
ROCALTROL CAP 0.5MCG
ROCALTROL CAP 0.25MCG
ROCALTROL SOL 1MCG/ML
SCOOBY-DOO CHW
slo-niacin tab 250mg cr
STUART PRENA PAK + DHA
super b-100 tab
SUPER POW NU-THERA
TAB-A-VITE TAB WOMENS
THERA BETA- TAB CAROTENE
THERA-D TAB 4000UNIT
THERANATAL TAB 27-1
thiamine hcl inj 100 mg/ml
thiamine hcl tab 50 mg
Nivo
3
1
1
1
3
3
3
3
3
3
3
3
1
3
3
3
3
3
3
3
3
3
3
3
3
3
2
2
2
3
3
3
3
3
3
3
3
3
3
3
3
3
pral koute
itilizasyon
obligatwa yo
$0
NM; *
$0
B/D
$0
B/D
$0
B/D
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
B/D
B/D
B/D
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
?
101
Non medikaman an
thiamine mononitrate tab 100 mg
total b/c tab
TRI-VI-SOL DRO /IRON
TRI-VI-SOL SOL
tri-vita sol
tri-vitamin dro
vit c & e cap combo
vita-bee/c tab
VITA-MAG TAB
vita-plus e cap 400unit
VITALETS CHW
vitalize liq ginseng
vitamin a cap 8000unit
vitamin a cap 10000 unit
VITAMIN A TAB
vitamin a tab 10000 unit
VITAMIN A TAB 15000UNT
vitamin b12 tab 2000mcg
VITAMIN C CHW 1000MG
VITAMIN C SOL
VITAMIN D2 TAB 400UNIT
VITAMIN D3 CAP 400UNIT
VITAMIN D3 CAP 4000UNIT
vitamin d3 cap 10000unt
vitamin d3 cap 50000unt
VITAMIN D3 LIQ 1200UNIT
vitamin d3 tab 5000unit
VITAMIN D3 TAB 50000UNT
vitamin d cap 1000unit
vitamin d chw 400unit
vitamin d chw 1000unit
vitamin e cap 200 unit
VITAMIN E CHW 400UNIT
vitamin e soln 15 unit/0.3ml (50 unit/ml)
VITAMIN E TAB 100UNIT
VITAMIN E TAB 200UNIT
vitamin e tab 400 unit
VITAMIN K TAB 100MCG
vitamin mixture cap
Nivo
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
pral koute
itilizasyon
obligatwa yo
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
?
102
Non medikaman an
Nivo
pral koute
itilizasyon
obligatwa yo
vitamins a & d cap
3
$0
NM; *
vitatrum chw
3
$0
NM; *
vite/iron chw children
3
$0
NM; *
yl folic aci tab 400mcg
3
$0
NM; *
ZOO FRIENDS CHW COMPLETE
3
$0
NM; *
OFTALMIK - MEDIKAMAN POU TRETE KONDISYON ZYE
ANTI-ENFEKSYON/ANTI-ENFLAMATWA - MEDIKAMAN POU TRETE ENFEKSYON AK
ENFLAMASYON
bacitracin-polymyxin-neomycin-hc ophth oint 1% 1
$0
blephamide oin s.o.p.
2
$0
neomycin-polymyxin-dexamethasone ophth
1
$0
oint 0.1%
1
$0
susp 0.1%
neomycin-polymyxin-hc ophth susp
1
$0
sulfacetamide sodium-prednisolone ophth soln
1
$0
10-0.23(0.25)%
TOBRADEX OIN 0.3-0.1%
2
$0
TOBRADEX ST SUS 0.3-0.05
2
$0
tobramycin-dexamethasone ophth susp
1
$0
0.3-0.1%
ZYLET SUS 0.5-0.3%
2
$0
ANTI-ENFEKSYON - MEDIKAMAN POU TRETE ENFEKSYON
bacitracin ophth oint 500 unit/gm
1
$0
bacitracin-polymyxin b ophth oint
1
$0
BESIVANCE SUS 0.6%
2
$0
CILOXAN OIN 0.3% OP
2
$0
ciprofloxacin hcl ophth soln 0.3%
1
$0
erythromycin ophth oint 5 mg/gm
1
$0
gatifloxacin ophth soln 0.5%
1
$0
gentak oin 0.3% op
1
$0
gentamicin sulfate ophth oint 0.3%
1
$0
gentamicin sulfate ophth soln 0.3%
1
$0
MOXEZA SOL 0.5%
2
$0
NATACYN SUS 5% OP
2
$0
neomycin-bacitrac zn-polymyx
1
$0
5(3.5)mg-400unt-10000unt op oin
neomycin-polymy-gramicid op sol
1
$0
1.75-10000-0.025mg-unt-mg/ml
ofloxacin ophth soln 0.3%
1
$0
polymyxin b-trimethoprim ophth soln
1
$0
10000 unit/ml-0.1%
?
103
Non medikaman an
Nivo
pral koute
itilizasyon
obligatwa yo
sulfacetamide sodium ophth oint 10%
1
$0
sulfacetamide sodium ophth soln 10%
1
$0
tobramycin ophth soln 0.3%
1
$0
TOBREX OIN 0.3% OP
2
$0
trifluridine ophth soln 1%
1
$0
VIGAMOX DRO 0.5%
2
$0
ANTI-ENFLAMATWA - MEDIKAMAN POU TRETE ENFLAMASYON
ALREX SUS 0.2%
2
$0
BROMFENAC SODIUM OPHTH SOLN 0.09%
1
$0
(BASE EQUIV) (ONCE-DAILY)
dexamethasone sodium phosphate ophth
1
$0
soln 0.1%
diclofenac sodium ophth soln 0.1%
1
$0
DUREZOL EMU 0.05%
2
$0
FLUOROMETHOLONE OPHTH SUSP 0.1%
1
$0
flurbiprofen sodium ophth soln 0.03%
1
$0
ILEVRO DRO 0.3% OP
2
$0
ketorolac tromethamine ophth soln 0.4%
1
$0
ketorolac tromethamine ophth soln 0.5%
1
$0
LOTEMAX GEL 0.5%
2
$0
LOTEMAX OIN 0.5%
2
$0
LOTEMAX SUS 0.5%
2
$0
MAXIDEX SUS 0.1% OP
2
$0
NEVANAC SUS 0.1%
2
$0
pred sod pho sol 1% op
2
$0
PREDNISOLONE ACETATE OPHTH SUSP 1% 1
$0
ANTI-ALÈJI - MEDIKAMAN POU TRETE ALÈJI
altafrin sol 0.12%
3
$0
NM; *
azelastine hcl ophth soln 0.05%
1
$0
BEPREVE DRO 1.5%
2
$0
cromolyn sodium ophth soln 4%
1
$0
EYE ALLERGY SOL RELIEF
3
$0
NM; *
eye drops sol 0.05% op
3
$0
NM; *
eye drops sol a/r
3
$0
NM; *
ketotif fum dro 0.025%op
3
$0
NM; *
LASTACAFT SOL 0.25%
2
$0
PATADAY SOL 0.2%
2
$0
PATANOL SOL 0.1% OP
2
$0
VASOCLEAR A SOL OP
3
$0
NM; *
visine-a sol op
3
$0
NM; *
VISINE-LR SOL 0.025%
3
$0
NM; *
?
104
Non medikaman an
Nivo
ANTI-GLOKÒM - MEDIKAMAN POU TRETE GLOKÒM
ALPHAGAN P SOL 0.1%
2
AZOPT SUS 1% OP
2
betaxolol hcl ophth soln 0.5%
1
BETOPTIC-S SUS 0.25% OP
2
brimonidine tartrate ophth soln 0.2%
1
BRIMONIDINE TARTRATE OPHTH
1
SOLN 0.15%
carteolol hcl ophth soln 1%
1
COMBIGAN SOL 0.2/0.5%
2
dorzolamide hcl ophth soln 2%
1
dorzolamide hcl-timolol maleate ophth soln
1
22.3-6.8 mg/ml
ISTALOL SOL 0.5% OP
2
latanoprost ophth soln 0.005%
1
levobunolol hcl ophth soln 0.5%
1
LEVOBUNOLOL HCL OPHTH SOLN 0.25%
1
LUMIGAN SOL 0.01%
2
metipranolol ophth soln 0.3%
1
PHOSPHOLINE SOL 0.125%OP
2
PILOCARPINE HCL OPHTH SOLN 1%
1
1
1
SIMBRINZA SUS 1-0.2%
2
TIMOLOL MALEATE OPHTH GEL FORMING
1
SOLN 0.5%
1
SOLN 0.25%
timolol maleate ophth soln 0.5%
1
timolol maleate ophth soln 0.25%
1
TRAVATAN Z DRO 0.004%
2
DIVÈS
artifi tears sol op
artificial sol tears
BLINK TEARS DRO 0.25% OP
CLEAR EYES DRO DRY EYES
COMPUTER EYE SOL DROPS
ENUCLENE SOL OP
eye wash sol
FRESHKOTE SOL 2.7-2%
GENTEAL GEL
GENTEAL MILD DRO 0.2%
goniotaire sol 2.5% op
3
3
3
3
3
3
3
3
3
3
3
pral koute
itilizasyon
obligatwa yo
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
?
105
Non medikaman an
Nivo
pral koute
itilizasyon
obligatwa yo
GONIOVISC SOL 2%
3
$0
NM; *
HYPOTEARS SOL 1-1%
3
$0
NM; *
ISOPTO TEARS SOL 0.5% OP
3
$0
NM; *
lubr/dry eye dro 0.5-0.9%
3
$0
NM; *
lubricnt eye dro 0.5% op
3
$0
NM; *
lubricnt gel dro 1%
3
$0
NM; *
MURO 128 SOL 2% OP
3
$0
NM; *
naphazoline hcl ophth soln 0.1%
1
$0
natures tear sol 0.4%
3
$0
NM; *
NUTRATEAR SOL 0.6%
3
$0
NM; *
optics mini dro
3
$0
NM; *
PROLENSA SOL 0.07%
2
$0
proparacaine hcl ophth soln 0.5%
1
$0
pure & gentl dro 0.3%
3
$0
NM; *
ra lubricant dro 0.4-0.3%
3
$0
NM; *
REFRESH CELL DRO 1% OP
3
$0
NM; *
refresh p.m. oin op
3
$0
NM; *
REFRESH SOL OPTIVE
3
$0
NM; *
RESTASIS EMU 0.05%
2
$0
QL (64 Fyòls / 30 jou)
RETAINE MGD EMU 0.5-0.5%
3
$0
NM; *
sodium chloride hypertonic ophth oint 5%
3
$0
NM; *
sodium chloride hypertonic ophth soln 5%
3
$0
NM; *
SOOTHE DRO 0.6-0.6%
3
$0
NM; *
STERILE LUBR DRO 0.7%
3
$0
NM; *
SYSTANE BAL SOL RESTOR
3
$0
NM; *
systane dro contacts
3
$0
NM; *
SYSTANE GEL 0.3%
3
$0
NM; *
SYSTANE LIQ DRO 0.4-0.3%
3
$0
NM; *
systane oin
3
$0
NM; *
TEARS AGAIN GEL NGHT/DAY
3
$0
NM; *
tgt lubricnt dro eye
3
$0
NM; *
th eye tears dro
3
$0
NM; *
THERATEARS SOL OP
3
$0
NM; *
VIVA DROPS DRO 1%
3
$0
NM; *
RESPIRATWA - MEDIKAMAN POU TRETE TWOUB RESPIRASYON
KONBINEZON ANTI-KOLINÈRJIK/AGONIS BETA - MEDIKAMAN POU TRETE COPD (Chronic
Obstructive Pulmonary Disease, Maladi Blokis Pilmonè Kwonik)
ANORO ELLIPT AER 62.5-25
2
$0
QL (1 Inalatè / 30 jou)
COMBIVENT AER RESPIMAT
2
$0
ipratropium-albuterol nebu soln 0.5-2.5(3)
1
$0
B/D
mg/3ml
?
106
Non medikaman an
Nivo
ANTI-KOLINÈRJIK - MEDIKAMAN POU TRETE COPD
ATROVENT HFA AER 17MCG
2
ipratropium bromide inhal soln 0.02%
1
ipratropium bromide nasal soln 0.03%
1
(21 mcg/spray)
ipratropium bromide nasal soln 0.06%
1
(42 mcg/spray)
SPIRIVA CAP HANDIHLR
2
TUDORZA PRES AER 400/ACT
2
ANTI-ISTAMIN - MEDIKAMAN POU TRETE ALÈJI
ALA-HIST IR TAB 2MG
3
ALDEX AN CHW 5MG
3
all day allg tab 10mg
3
ALLEGRA ALRG SUS 30MG/5ML
3
ALLEGRA ALRG TAB 30MG
3
aller-ease tab 60mg
3
allergy chld liq 12.5/5ml
3
allergy relf cap 25mg
3
allergy relf tab 10mg
3
allergy relf tab 25mg
3
allrgy relf tab 12.5mg
3
altaryl elx 12.5/5ml
3
ASTEPRO SPR 0.15%
2
azelastine hcl nasal spray 0.15%
1
(205.5 mcg/spray)
azelastine hcl nasal spray 137 mcg/spray
1
(1 mg/ml)
cetirizine hcl chew tab 5 mg
3
cetirizine hcl chew tab 10 mg
3
cetirizine hcl oral soln 1 mg/ml (5 mg/5ml)
1
cetirizine hcl tab 5 mg
3
cetirizine sol 5mg/5ml
3
child comple chw allergy
3
chlorpheniramine maleate tab 4 mg
3
chlorpheniramine maleate tab cr 12 mg
3
CLARITIN CAP 10MG
3
CLARITIN CHW 5MG
3
CLARITIN RDT TAB 5MG
3
dayhist alrg tab 12 hour
3
diphenhydramine hcl cap 50 mg
3
diphenhydramine hcl inj 50 mg/ml
1
ED CHLORPED LIQ 2MG/ML
3
ed chlorped syp jr
3
pral koute
itilizasyon
obligatwa yo
$0
$0
$0
B/D
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
?
107
Non medikaman an
fexofenadine hcl tab 180 mg
hydroxyzine hcl im soln 25 mg/ml
hydroxyzine hcl im soln 50 mg/ml
J-TAN PD DRO 1MG/ML
levocetirizine dihydrochloride soln 2.5 mg/5ml
(0.5 mg/ml)
levocetirizine dihydrochloride tab 5 mg
loratadine tab 10 mg
PATANASE SPR 0.6%
TRIAMINIC MIS GRAPE
triaminic tab 10mg
wal-itin syp 5mg/5ml
Nivo
3
2
2
3
1
1
3
2
3
3
3
pral koute
itilizasyon
obligatwa yo
$0
NM; *
$0
PA
$0
PA
$0
NM; *
$0
$0
$0
$0
$0
$0
$0
AGONIS BETA - MEDIKAMAN POU TRETE OPRESYON AK COPD
albuterol sulfate soln nebu 0.5% (5 mg/ml)
1
$0
albuterol sulfate soln nebu 0.63 mg/3ml (base
1
$0
equiv)
albuterol sulfate soln nebu 0.083% (2.5 mg/3ml) 1
$0
1
$0
equiv)
albuterol sulfate syrup 2 mg/5ml
1
$0
albuterol sulfate tab 2 mg
1
$0
albuterol sulfate tab 4 mg
1
$0
albuterol sulfate tab sr 12hr 4 mg
1
$0
albuterol sulfate tab sr 12hr 8 mg
1
$0
FORADIL CAP AEROLIZE
2
$0
levalbuterol hcl soln nebu conc 1.25 mg/0.5ml
1
$0
(base equiv)
PERFOROMIST NEB 20MCG
2
$0
PROAIR HFA AER
2
$0
SEREVENT DIS AER 50MCG
2
$0
terbutaline sulfate inj 1 mg/ml
1
$0
terbutaline sulfate tab 2.5 mg
1
$0
terbutaline sulfate tab 5 mg
1
$0
XOPENEX HFA AER
2
$0
TOUS AK GRIP
ADVIL ALLERG TAB CONGEST
ADVIL ALLERG TAB SINUS
ADVIL COLD/ CAP SINUS
afrin child spr 0.25%
AFRIN MENTHL SPR 0.05%
afrin saline spr 0.65%
ALA-HIST PE TAB 2-10MG
ALDEX GS DM TAB
3
3
3
3
3
3
3
3
$0
$0
$0
$0
$0
$0
$0
$0
NM; *
NM; *
NM; *
NM; *
B/D
B/D
B/D
B/D
B/D
B/D
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
?
108
Non medikaman an
ALDEX GS TAB 30-190MG
ALDEX-CT CHW 12.5-5MG
allergy-d tab 5-120mg
allergy/cong tab relief
altarussin syp -pe
ap-hist dm liq 7.5-4-15
asthma relf tab 12.5-200
AYR NASAL DRO 0.65%
AYR SALINE GEL NASAL
benzonatate cap 100 mg
benzonatate cap 200 mg
BICLORA LIQ
BICLORA TAB 25-25MG
BIOSPEC DMX LIQ
BROHIST D TAB 4-10MG
BROVEX PSB LIQ
BROVEX PSB LIQ DM
CAPCOF SYP
CAPMIST DM TAB
cardec dm dro
cardec dro
cheratussin sol dac
CHILD ADVIL SUS COLD
childrens sus plus cld
chld decongs liq 15mg/5ml
CHLO TUSS EX LIQ 12.5-100
cld/cgh/sore liq throat
CLOFERA LIQ
CNTC CLD/FLU PAK DAY/NGHT
CNTC CLD/FLU TAB MAX ST
CODAR AR LIQ
CODAR D LIQ
CODAR GF LIQ
CODITUSS DM SYP
cold head tab cong dt
cold medicin cap plus
cold multi pak day/nght
cold multi-s tab night
cold relief tab plus
cold/allergy elx children
cold/allery sus child
cold/cough elx child
cold/sinus tab relief
Nivo
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
pral koute
itilizasyon
obligatwa yo
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
?
109
Non medikaman an
COMPLETE SIN TAB RELIEF
comtrex sev pak cld/sinu
CONEX SOL CLD/ALRG
CONEX TAB 2-60MG
contac tab cold+flu
coricidin cap cong/cgh
coricidin liq hbp
cough & cold tab
cough & sore liq thrt day
cough cont liq dm max
COUGH D SYP
cough dm liq 30mg/5ml
12.5cpd/1dcp liq m/30pse
cromolyn sodium nasal aerosol soln
5.2 mg/act (4%)
cvs nasal spr mist
DALLERGY SYP
day time liq cough
day-time cap sinus
day/nite mis cold/flu
de-chlor dm liq liquid
DECON-A LIQ DROPS
decongestant tab 120mg er
delsym child liq cgh/cold
DELTUSS DP LIQ 1-30/5ML
DEX-TUSS LIQ 300-10/5
DEXATREX D ELX CF-NASAL
dextromethorphan-guaifenesin tab 20-400 mg
DIABETIC CAP COLD/FLU
DICEL CD LIQ
dimetane dx syp
dimetapp liq nighttim
DIMETAPP SYP CGH/COLD
DONATUSSIN SYP
DRYMAX AF TAB 15-4-25
DURAFLU TAB
ed a-hist dm liq
ed bron gp liq
ED CHLORPED DRO D
entre-b sus 6-10mg/5
entre-cough liq
entre-hist liq 0.938-10
ENTSOL NASAL GEL
Nivo
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
pral koute
itilizasyon
obligatwa yo
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
?
110
Non medikaman an
exefen dmx tab
exefen-ir tab 60-400mg
father johns syp 10mg/5ml
fexofenadine-pseudoephedrine tab sr 24hr
180-240 mg
flu/cold/cgh pow daytime
flu/severe pow cold/cgh
gnp day time liq cold/flu
gnp ibuprofn tab cold/sin
gnp tussin liq nighttim
guaifenesin syrup 100 mg/5ml
guaifenesin-codeine soln 100-10 mg/5ml
intense cold tab /flu med
intense coug liq reliever
J-MAX SYP 5-200MG
J-TAN D PD DRO 1-7.5MG
kidkare liq cgh/cold
liquituss gg liq 200/5ml
LITTLE NOSES DRO 0.125%
LODRANE D CAP 4-60MG
LOHIST-D LIQ
lohist-dm syp 5-2-10mg
lohist-peb liq 4-10/5ml
loratadine & pseudoephedrine tab sr 24hr
10-240 mg
LORTUSS DM LIQ
LORTUSS EX LIQ
LORTUSS LQ LIQ
LUSAIR LIQ
m-clear wc liq
m-end dm liq
M-END DMX LIQ
M-END MAX D LIQ
M-END PE LIQ
m-end wc liq
mapap cold tab 10-5-325
MAR-COF BP LIQ
MEDI-GRAINE TAB
mucaphed tab 10-400mg
MUCINEX CGH GRA 5-100MG
mucinex cold tab sinus
MUCINEX D TAB 60-600MG
MUCINEX D TAB 120-1200
Nivo
3
3
3
3
pral koute
itilizasyon
obligatwa yo
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
?
111
Non medikaman an
MUCINEX TAB 1200MG
MUCINEX/KIDS GRA 50MG
MUCINEX/KIDS GRA 100MG
mucus relief liq 5-100mg
mucus relief liq cold/sin
mucus relief tab 400mg
mucus+chst liq 100/5ml
mucus-dm max tab 60-1200
mucus-dm tab 30-600mg
mucus-er tab 600mg
multi-sympt liq cld nght
multi-sympt pak day/nght
multsym cold liq childrns
nasal decon liq 15mg/5ml
nasal decon syp 30mg/5ml
NASAL DECONG LIQ 30MG/5ML
nasal decong tab 10mg
nasal decong tab 30mg
nasal relief tab 5-325mg
nasal relief tab night
nasal spr 0.05%
NASOHIST DM DRO
nasohist dro 1-2mg/ml
NASOPEN PE LIQ
NEO-SYNEPHRI SPR 0.5%
neotuss liq
neutrahist dro 0.8-9mg
nexafed tab 30mg
night time liq cold/flu
night time liq cough
night-time cap sinus
nohist-lq liq 4-10/5ml
NOREL AD TAB 4-10-325
NOREL CS LIQ
ONSET FORTE TAB
organ-i nr tab 200mg
pain relief sus pls cold
pain relieve tab pm
ped formula liq 100-10/5
pedi-atric liq niterest
pediacare liq long-act
10peh/380gfn tab
10peh/380gfn tab /15dm
Nivo
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
pral koute
itilizasyon
obligatwa yo
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
?
112
Non medikaman an
10peh/400gfn tab /20dm
PHENAGIL TAB 3.5-10MG
phenylephrine-brompheniramine-dm liquid
10-4-20 mg/5ml
PHENYLHIST LIQ DH
POLY-TUSSIN LIQ 10-9.375
POLY-TUSSIN LIQ AC
POLY-TUSSIND LIQ 10-9.375
PRETZ SOL
PRO-CHLO LIQ
PRO-CLEAR AC SYP
40pse/400gfn tab /20dm
pseudoephed-bromphen-dm liquid
20-4-20 mg/5ml
pseudoephedr tab 60mg
PYRIL DM SUS
pyrilamine mal-phenylephrine hcl tann susp
16-5 mg/5ml
q-tapp dm elx
refenesen tab chst cng
RESCON TAB 2-60MG
RESCON-DM SYP
RESPAIRE-30 CAP
RHINARIS GEL 0.2%
RHINARIS SPR 0.2%
ritifed syp 1.25-30
robafen cf syp cgh/cld
robafen cgh cap 15mg
robitussin cap cold+flu
robitussin liq 15mg/5ml
ROBITUSSIN LIQ CF
ROBITUSSIN LIQ CGH/COLD
robitussin liq ms max
ROBITUSSIN LIQ NIGHT TM
robitussin liq to go dm
robitussin syp 7.5/5ml
robitussin syp 15mg/5ml
RU-HIST-D LIQ 30-10/5
RU-HIST-D TAB 30-10MG
RYMED TAB 2-10MG
rynex dm liq
rynex pse liq
scot-tussin liq dm sf
Nivo
3
3
3
pral koute
itilizasyon
obligatwa yo
$0
NM; *
$0
NM; *
$0
NM; *
3
3
3
3
3
3
3
3
3
$0
$0
$0
$0
$0
$0
$0
$0
$0
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
3
3
3
$0
$0
$0
NM; *
NM; *
NM; *
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
?
113
Non medikaman an
SCOT-TUSSIN LIQ ORIGINAL
SCOT-TUSSIN LIQ SENIOR
sinus max st tab 30-500mg
sinus pain/ tab pressure
sm tussin cf liq
STAHIST AD LIQ
STAHIST AD TAB 25-60MG
STATUSS LIQ GREEN
sudafed 12hr tab 120mg cr
SUDAFED 24HR TAB 240MG
THERAFLU FLU PAK SORE THR
theraflu nt liq warm rlf
THERAFLU POW
THERAFLU POW MAX-D
triacting dt liq cold/cgh
triaminic liq
TRIAMINIC NT MIS COLD/CGH
TRIAMINIC SOL COLD/CGH
TRIAMINIC SYP CHST/NSL
TRIAMINIC SYP COLD/ALL
TRIAMINIC SYP COLD/CGH
TRIAMINIC SYP FEVER
TRICODE AR LIQ
TRICODE GF LIQ
trymine cg liq 225-7.5
tusnel c syp
TUSNEL LIQ
TUSNEL PED DRO 7.5-50
TUSNEL PEDI LIQ 15-5-50
TUSNEL-DM DRO PEDIATRC
tussi-pres liq pe ped
tussin cf liq cgh/cold
tussin dm syp 100-10/5
vcks dayquil liq mucus dm
VICK VAPORUB OIN
wal-act tab 2.5-60mg
wal-dryl all tab sinus
wal-dryl-d tab alrg/sin
wal-fex d tab 12 hour
wal-flu cold pak daytime
wal-itin d tab 5-120mg
wal-phed pe tab 4-10mg
wal-phed tab 4-60mg
Nivo
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
pral koute
itilizasyon
obligatwa yo
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
?
114
Non medikaman an
Nivo
pral koute
itilizasyon
obligatwa yo
4-way fast spr 1%
3
$0
NM; *
z-cof 12dm liq
3
$0
NM; *
Z-TUSS AC LIQ 2-9/5ML
3
$0
NM; *
Z-TUSS E LIQ
3
$0
NM; *
ZODRYL AC 25 SUS
3
$0
NM; *
ZODRYL AC 30 SUS
3
$0
NM; *
ZODRYL AC 35 SUS
3
$0
NM; *
ZODRYL AC 40 SUS
3
$0
NM; *
ZODRYL DAC SUS 25
3
$0
NM; *
ZODRYL DAC SUS 30
3
$0
NM; *
ZODRYL DAC SUS 35
3
$0
NM; *
ZODRYL DAC SUS 40
3
$0
NM; *
ZODRYL DEC25 SUS
3
$0
NM; *
ZODRYL DEC30 SUS
3
$0
NM; *
ZODRYL DEC35 SUS
3
$0
NM; *
ZODRYL DEC40 SUS
3
$0
NM; *
zonatuss cap 150mg
3
$0
NM; *
RESEPTÈ ANTAGONIS LEUKOTRIENE - MEDIKAMAN POU TRETE OPRESYON AK ALÈJI
montelukast sodium chew tab 4 mg (base equiv) 1
$0
montelukast sodium chew tab 5 mg (base equiv) 1
$0
montelukast sodium oral granules packet 4 mg
1
$0
(base equiv)
montelukast sodium tab 10 mg (base equiv)
1
$0
zafirlukast tab 10 mg
1
$0
zafirlukast tab 20 mg
1
$0
ESTABILIZATÈ SÈLIL MAST - MEDIKAMAN POU TRETE ALÈJI
cromolyn sodium soln nebu 20 mg/2ml
1
$0
B/D
DIVÈS
acetylcysteine inhal soln 10%
1
$0
B/D
acetylcysteine inhal soln 20%
1
$0
B/D
ARALAST NP INJ 400MG
2
$0
NM, LA, PA
2
$0
NM, LA, PA
2
$0
NM, LA, PA
2
$0
NM, LA, PA
AUVI-Q INJ 0.3MG
2
$0
AUVI-Q INJ 0.15MG
2
$0
DALIRESP TAB 500MCG
2
$0
EPIPEN 2-PAK INJ 0.3MG
2
$0
EPIPEN-JR INJ 2-PAK
2
$0
PROLASTIN-C INJ 1000MG
2
$0
NM, LA, PA
PULMOZYME SOL 1MG/ML
2
$0
B/D, NM
SODIUM CHLOR NEB 0.45%
3
$0
NM; *
?
115
Non medikaman an
Nivo
pral koute
itilizasyon
obligatwa yo
XOLAIR SOL 150MG
2
$0
NM, LA, PA
ZEMAIRA INJ 1000MG
2
$0
NM, LA, PA
ESTEWOYID NAN NEN - MEDIKAMAN POU TRETE ALÈJI
flunisolide nasal soln 25 mcg/act (0.025%)
1
$0
QL (2 bottles / 30 jou)
fluticasone propionate nasal susp 50 mcg/act
1
$0
QL (1 bottle / 30 jou)
NASONEX SPR 50MCG/AC
2
$0
QL (2 bottles / 30 jou)
ESTEWOYID INALAN - MEDIKAMAN POU TRETE OPRESYON
ASMANEX 14 AER 220MCG
2
$0
2
$0
2
$0
2
$0
2
$0
budesonide inhalation susp 0.5 mg/2ml
1
$0
B/D
budesonide inhalation susp 0.25 mg/2ml
1
$0
B/D
FLOVENT DISK AER 50MCG
2
$0
2
$0
2
$0
FLOVENT HFA AER 44MCG
2
$0
2
$0
2
$0
QVAR AER 40MCG
2
$0
QVAR AER 80MCG
2
$0
KONBINEZON ESTEWOYID/AGONIS BETA - MEDIKAMAN POU TRETE OPRESYON AK COPD
ADVAIR DISKU AER 100/50
2
$0
2
$0
2
$0
ADVAIR HFA AER 45/21
2
$0
2
$0
2
$0
BREO ELLIPTA INH 100-25
2
$0
DULERA AER 100-5MCG
2
$0
DULERA AER 200-5MCG
2
$0
SYMBICORT AER 80-4.5
2
$0
SYMBICORT AER 160-4.5
2
$0
GZANTIN - MEDIKAMAN POU TRETE COPD
aminophylline inj 25 mg/ml
1
$0
elixophyllin elx 80/15ml
2
$0
theo-24 cap 100mg cr
2
$0
2
$0
2
$0
theo-24 cap 400mg er
2
$0
theophylline soln 80 mg/15ml
1
$0
?
116
Non medikaman an
pral koute
itilizasyon
obligatwa yo
theophylline tab sr 12hr 100 mg
1
$0
1
$0
1
$0
1
$0
1
$0
1
$0
SOU PO - MEDIKAMAN POU TRETE ZÒRÈY AK KONDISYON PO
DÈRMATOLOJI, AKNE
adapalene cream 0.1%
adapalene gel 0.1%
amnesteem cap 10mg
amnesteem cap 20mg
amnesteem cap 40mg
AVITA CRE 0.025%
AVITA GEL 0.025%
benzoyl peroxide-erythromycin gel 5-3%
claravis cap 10mg
claravis cap 20mg
claravis cap 30mg
claravis cap 40mg
clindamycin phosphate gel 1%
clindamycin phosphate lotion 1%
clindamycin phosphate soln 1%
clindamycin phosphate swab 1%
erythromycin gel 2%
erythromycin pads 2%
erythromycin soln 2%
myorisan cap 10mg
myorisan cap 20mg
myorisan cap 40mg
sulfacetamide sodium lotion 10% (acne)
tretinoin cream 0.1%
tretinoin gel 0.01%
tretinoin gel 0.025%
zenatane cap 10mg
zenatane cap 20mg
zenatane cap 40mg
DÈRMATOLOJI, ANTIBYOTIK
ACNE MEDICAT LOT 5%
ACNE MEDICAT LOT 10%
Nivo
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
3
3
$0
$0
NM; *
NM; *
?
117
Non medikaman an
Nivo
antibiotic cre plus
bacitracin oint 500 unit/gm
bacitracin zinc oint 500 unit/gm
BENZOYL PER GEL 2.5%
benzoyl per gel 5%
benzoyl per gel 10%
benzoyl per liq 5% wash
benzoyl per lot 6%
BP CLEANSING LOT 4%
bp wash liq 5.25%
clean&clear cre 10%
double antib oin
gentamicin sulfate cream 0.1%
gentamicin sulfate oint 0.1%
mafenide acetate packet for topical soln 5%
(50 gm)
mupirocin oint 2%
neosporin+pn oin relf max
PANOXYL BAR 10%
panoxyl wash liq 10%
PANOXYL-4 LIQ CREM WSH
PANOXYL-8 LIQ CREM WSH
sb triple oin antibiot
SILVER SULFADIAZINE CREAM 1%
SSD CRE 1%
SULFAMYLON CRE 85MG/GM
triple antib oin
DÈRMATOLOJI, ANTI-FONJIK
antifungal cre 1%
antifungal cre 2%
ath foot spr aer 1%
castellani paint
ciclopirox gel 0.77%
ciclopirox olamine cream 0.77% (base equiv)
ciclopirox olamine susp 0.77% (base equiv)
ciclopirox shampoo 1%
clotrimazole cream 1%
clotrimazole soln 1%
desenex aer 2%
desenex cre 1%
desenex spry aer liquid
econazole nitrate cream 1%
fungicure spr intens
3
3
3
3
3
3
3
3
3
3
3
3
1
1
1
pral koute
itilizasyon
obligatwa yo
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
$0
$0
1
3
3
3
3
3
3
1
1
2
3
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
3
3
3
3
1
1
1
1
1
1
3
3
3
1
3
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
?
118
Non medikaman an
FUNGOID TINC KIT
FUNGOID TINC SOL 2%
GENTIAN VIOL SOL 1%
GENTIAN VIOL SOL 2%
ketoconazole cream 2%
LAMISIL ADV GEL 1%
lamisil af aer 1%
lamisil af pow defense
LAMISIL AT SPR 1%
LOTRIMIN ULT CRE 1%
mitrazol pow 2%
NIZORAL A-D SHA 1%
nyamyc pow 100000
nystatin cream 100000 unit/gm
nystatin oint 100000 unit/gm
nystatin topical powder
nystop pow 100000
pedi-dri pow 100000
terbinafine cre 1%
tolnaftate cream 1%
tolnaftate soln 1%
triple paste oin af 2%
DÈRMATOLOJI, ANTI-PIRITIK
procto-pak cre 1%
proctosol hc cre 2.5%
proctozone cre -hc 2.5%
PRUDOXIN CRE 5%
DÈRMATOLOJI, ANTI-PSORYATIK
acitretin cap 10 mg
acitretin cap 17.5 mg
acitretin cap 25 mg
calcipotriene cream 0.005%
calcipotriene oint 0.005%
calcipotriene soln 0.005% (50 mcg/ml)
calcitrene oin 0.005%
8-MOP CAP 10MG
TAZORAC CRE 0.1%
TAZORAC CRE 0.05%
DÈRMATOLOJI, ANTI-SEBOREIK
ketoconazole shampoo 2%
selenium sulfide lotion 2.5%
Nivo
3
3
3
3
1
3
3
3
3
3
3
3
1
1
1
1
1
1
3
3
3
3
pral koute
itilizasyon
obligatwa yo
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
$0
$0
$0
$0
$0
$0
$0
NM; *
$0
NM; *
$0
NM; *
$0
NM; *
1
1
1
1
$0
$0
$0
$0
2
2
2
1
1
1
1
2
2
2
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
1
1
$0
$0
PA
PA
PA
PA
PA
?
119
Non medikaman an
Nivo
DÈRMATOLOJI, ANTI-VIRAL
acyclovir oint 5%
DENAVIR CRE 1%
1
2
$0
$0
1
1
1
1
1
2
3
1
$0
$0
$0
$0
$0
$0
$0
$0
1
$0
1
$0
1
$0
1
1
1
1
1
1
1
1
1
1
1
3
3
3
1
1
1
1
1
1
1
1
1
1
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
DÈRMATOLOJI, KORTIKOTERAPI
ala cort cre 1%
alclometasone dipropionate cream 0.05%
alclometasone dipropionate oint 0.05%
amcinonide cream 0.1%
amcinonide lotion 0.1%
amcinonide oin 0.1%
aquanil hc lot 1%
betamethasone dipropionate augmented
cream 0.05%
gel 0.05%
lotion 0.05%
oint 0.05%
betamethasone dipropionate cream 0.05%
betamethasone dipropionate lotion 0.05%
betamethasone dipropionate oint 0.05%
betamethasone valerate cream 0.1%
betamethasone valerate lotion 0.1%
betamethasone valerate oint 0.1%
clobetasol e cre 0.05%
clobetasol propionate cream 0.05%
clobetasol propionate gel 0.05%
clobetasol propionate oint 0.05%
clobetasol propionate soln 0.05%
cortaid spr 1%
cortizone-10 gel 1%
demarest cre dricort
DESONIDE CREAM 0.05%
desonide lotion 0.05%
desonide oint 0.05%
desoximetasone cream 0.05%
desoximetasone cream 0.25%
desoximetasone gel 0.05%
DESOXIMETASONE OINT 0.05%
desoximetasone oint 0.25%
diflorasone diacetate cream 0.05%
diflorasone diacetate oint 0.05%
pral koute
itilizasyon
obligatwa yo
NM; *
NM; *
NM; *
NM; *
?
120
Non medikaman an
fluocin acet oil body
fluocinolone acetonide cream 0.01%
fluocinolone acetonide cream 0.025%
fluocinolone acetonide oint 0.025%
fluocinolone acetonide soln 0.01%
fluocinonide cream 0.05%
fluocinonide emulsified base cream 0.05%
fluocinonide gel 0.05%
fluocinonide oint 0.05%
fluocinonide soln 0.05%
fluticasone propionate cream 0.05%
fluticasone propionate oint 0.005%
halobetasol propionate cream 0.05%
halobetasol propionate oint 0.05%
hc-1% hemorr oin 1%
HYDROCORT AC CRE 0.5%
HYDROCORT/ OIN ALOE 1%
hydrocortisone butyrate cream 0.1%
hydrocortisone butyrate oint 0.1%
hydrocortisone butyrate soln 0.1%
hydrocortisone cream 0.5%
hydrocortisone cream 1%
hydrocortisone cream 1%
hydrocortisone cream 2.5%
hydrocortisone lotion 2.5%
hydrocortisone oint 0.5%
hydrocortisone oint 1%
hydrocortisone oint 2.5%
hydrocortisone valerate cream 0.2%
hydrocortisone valerate oint 0.2%
hydrocortisone-aloe vera cream 0.5%
hydrocortisone-aloe vera cream 1%
LOKARA LOT 0.05%
mometasone furoate cream 0.1%
mometasone furoate oint 0.1%
mometasone furoate solution 0.1% (lotion)
ra anti-itch oin 1%
ra hydrocort cre 0.5%
texacort sol 2.5%
triamcinolone acetonide cream 0.1%
triamcinolone acetonide lotion 0.1%
Nivo
1
1
1
1
1
1
1
1
1
1
1
1
1
1
3
3
3
1
1
1
3
1
3
1
1
3
1
1
1
1
3
3
1
1
1
1
3
3
2
1
1
1
1
pral koute
itilizasyon
obligatwa yo
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
NM; *
$0
NM; *
$0
NM; *
$0
$0
$0
$0
NM; *
$0
$0
NM; *
$0
$0
$0
NM; *
$0
$0
$0
$0
$0
NM; *
$0
NM; *
$0
$0
$0
$0
$0
NM; *
$0
NM; *
$0
$0
$0
$0
$0
?
121
Non medikaman an
Nivo
pral koute
itilizasyon
obligatwa yo
$0
$0
$0
$0
$0
$0
NM; *
triamcinolone acetonide lotion 0.025%
1
triamcinolone acetonide oint 0.1%
1
1
1
triderm cre 0.1%
1
TUCKS OIN 1%
3
DÈRMATOLOJI, ANESTEZI LOKAL
lidocaine hcl gel 2%
1
$0
lidocaine hcl soln 4%
1
$0
lidocaine oint 5%
1
$0
lidocaine patch 5%
1
$0
QL (3 plak / 1 day), PA
lidocaine-prilocaine cream 2.5-2.5%
1
$0
B/D
DÈRMATOLOJI, , PO DIVÈS AK MANBRÀN MIKIS
ABREVA CRE 10%
3
$0
NM; *
BOUDREAUXS OIN 16%
3
$0
NM; *
DESITIN CRE 13%
3
$0
NM; *
diaper rash oin 40%
3
$0
NM; *
diaper rash oin creamy
3
$0
NM; *
ELIDEL CRE 1%
2
$0
PA
fluorouracil cream 5%
1
$0
fluorouracil soln 2%
1
$0
fluorouracil soln 5%
1
$0
imiquimod cream 5%
1
$0
laclotion lot 12%
1
$0
lactic acid (ammonium lactate) cream 12%
1
$0
lactic acid (ammonium lactate) lotion 12%
1
$0
metronidazole cream 0.75%
1
$0
metronidazole gel 0.75%
1
$0
metronidazole lotion 0.75%
1
$0
MEXSANA POW
3
$0
NM; *
PANRETIN GEL 0.1%
2
$0
podofilox soln 0.5%
1
$0
RA CALAMINE LOT
3
$0
NM; *
risamine oin
3
$0
NM; *
rosadan cre 0.75%
1
$0
SECURA CRE 30.6%
3
$0
NM; *
secura prote cre 10%
3
$0
NM; *
SENSI-CARE OIN 49-15%
3
$0
NM; *
TARGRETIN GEL 1%
2
$0
NM, PA
TRIPLE PASTE OIN 12.8%
3
$0
NM; *
VALCHLOR GEL 0.016%
2
$0
NM, LA, PA
VOLTAREN GEL 1%
2
$0
zinc oxide oint 20%
3
$0
NM; *
?
122
Non medikaman an
Nivo
ZINC OXIDE PST 25%
3
DÈRMATOLOJI, SCABISID AK PEDIKLISID
A-200 GEL 0.33-4%
3
BARC LIQ
3
complete kit lice
3
eql lice kit solution
3
EURAX CRE 10%
2
EURAX LOT 10%
2
lice killing liq max st
3
lice killing sha 0.33-4%
3
lice trtmnt liq
3
lice trtmnt liq 1%
3
licide aer 0.5%
3
LICIDE TREAT KIT
3
malathion lotion 0.5%
1
permethrin cream 5%
1
permethrin lotion 1%
3
PRONTO AER 0.4%
3
PYRE/PIPERON LIQ
3
rid ess lice kit 0.33-4%
3
SCHOOLTIME SHA
3
DÈRMATOLOJI, AJAN POU SWEN BLESI
acetic acid irrigation soln 0.25%
1
REGRANEX GEL 0.01%
2
SANTYL OIN 250/GM
2
SODIUM CHLORIDE IRRIGATION SOLN 0.9% 1
WATER FOR IRRIGATION, STERILE
1
IRRIGATION SOLN
AJAN BOUCH/GÒJ/DANTÈ
cevimeline hcl cap 30 mg
1
chlorhexidine gluconate soln 0.12%
1
clotrimazole troche 10 mg
1
lidocaine hcl viscous soln 2%
1
nystatin susp 100000 unit/ml
1
periogard sol 0.12%
1
pilocarpine hcl tab 5 mg
1
pilocarpine hcl tab 7.5 mg
1
triamcinolone acetonide dental paste 0.1%
1
OTIC - MEDIKAMAN POU TRETE KONDISYON ZÒRÈY
acetic acid 2% in aluminum acetate otic soln
1
acetic acid otic soln 2%
1
CIPRODEX SUS 0.3-0.1%
2
pral koute
itilizasyon
obligatwa yo
$0
NM; *
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
NM; *
PA
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
?
123
Non medikaman an
fluocinolone acetonide (otic) oil 0.01%
neomycin-polymyxin-hc otic soln 1%
neomycin-polymyxin-hc otic susp 3.5
mg/ml-10000 unit/ml-1%
ofloxacin otic soln 0.3%
Nivo
pral koute
itilizasyon
obligatwa yo
1
1
1
1
?
124
ENDÈKS
1
10peh/380gfn tab............................... 112
10peh/380gfn tab /15dm ...................... 112
10peh/400gfn tab /20dm ...................... 113
12.5cpd/1dcp liq m/30pse..................... 110
3
3 day vagnal cre 4% .............................83
4
40pse/400gfn tab /20dm ...................... 113
4-way fast spr 1% .............................. 115
8
8 hour pain tab 650mg ..........................13
8-MOP CAP 10MG............................. 119
A
A-200 GEL 0.33-4% ........................... 123
A-25 CAP 25000UNT ............................97
abacavir sulfate tab 300 mg (base equiv) ....20
abacavir sulfate-lamivudine-zidovudine tab
300-150-300 mg ..................................22
ABELCET INJ 5MG/ML .........................19
ABILIFY DISC TAB 10MG ......................57
ABILIFY DISC TAB 15MG ......................57
ABILIFY INJ 9.75MG ............................57
ABILIFY MAIN INJ 300MG .....................57
ABILIFY MAIN INJ 400MG .....................57
ABILIFY SOL 1MG/ML ..........................57
ABILIFY TAB 10MG .............................57
ABILIFY TAB 15MG .............................57
ABILIFY TAB 20MG .............................57
ABILIFY TAB 2MG ...............................57
ABILIFY TAB 30MG .............................57
ABILIFY TAB 5MG ...............................57
ABREVA CRE 10% ............................ 122
acamprosate calcium tab delayed release 333
mg ..................................................63
acarbose tab 100 mg ............................66
acarbose tab 25 mg ..............................66
acarbose tab 50 mg ..............................66
acebutolol hcl cap 200 mg ......................41
acebutolol hcl cap 400 mg ......................41
ACEROLA C WAF 500MG .....................97
acetamin jr tab 160mg rt ........................12
ACETAMINOPHE TAB 650MG ................12
acetaminophen soln 160 mg/5ml ..............12
acetaminophen w/ codeine soln 120-12 mg/5ml
?
...................................................... 14
acetaminophen w/ codeine tab 300-15 mg .. 14
acetazolamide cap sr 12hr 500 mg ........... 44
acetazolamide tab 125 mg ..................... 44
acetazolamide tab 250 mg ..................... 44
acetic acid 2% in aluminum acetate otic soln
.................................................... 123
acetic acid irrigation soln 0.25% ............ 123
acetic acid otic soln 2% ....................... 123
acetylcysteine inhal soln 10% ............... 115
acetylcysteine inhal soln 20% ............... 115
acid gone chw .................................... 75
acid gone sus .................................... 75
acid reducer tab 10mg .......................... 77
acid reducer tab 150mg ........................ 77
acitretin cap 10 mg ............................ 119
acitretin cap 17.5 mg .......................... 119
acitretin cap 25 mg ............................ 119
ACNE MEDICAT LOT 10% .................. 117
ACNE MEDICAT LOT 5%.................... 117
ACTHIB INJ ...................................... 90
ACTIMMUNE INJ 2MU/0.5 .................... 88
acyclovir cap 200 mg ........................... 23
acyclovir oint 5% ............................... 120
acyclovir sodium for inj 1000 mg .............. 23
acyclovir sodium for inj 500 mg ............... 23
acyclovir sodium iv soln 50 mg/ml ............ 23
acyclovir susp 200 mg/5ml ..................... 23
acyclovir tab 400 mg ............................ 23
acyclovir tab 800 mg ............................ 23
ADACEL INJ ..................................... 90
ADAGEN INJ 250/ML ........................... 70
adapalene cream 0.1% ....................... 117
adapalene gel 0.1% ........................... 117
ADCIRCA TAB 20MG........................... 46
adefovir dipivoxil tab 10 mg .................... 23
ADEMPAS TAB 0.5MG ......................... 46
ADEMPAS TAB 1.5MG ......................... 46
ADEMPAS TAB 1MG ........................... 46
ADEMPAS TAB 2.5MG ......................... 46
ADEMPAS TAB 2MG ........................... 46
adriamyc inj 50mg ............................... 30
adrucil inj 2.5g/50m ............................. 30
125
adrucil inj 500/10ml ..............................30
adrucil inj 5gm/100m.............................30
ADULT ASA TAB 81MG QM ...................12
ADVAIR DISKU AER 100/50 ................. 116
ADVAIR DISKU AER 250/50 ................. 116
ADVAIR DISKU AER 500/50 ................. 116
ADVAIR HFA AER 115/21 .................... 116
ADVAIR HFA AER 230/21 .................... 116
ADVAIR HFA AER 45/21 ..................... 116
ADVIL ALLERG TAB CONGEST ............ 108
ADVIL ALLERG TAB SINUS ................. 108
ADVIL COLD/ CAP SINUS ................... 108
ADVIL JR ST TAB 100MG ......................12
afeditab tab 30mg cr .............................42
afeditab tab 60mg cr .............................42
AFINITOR DIS TAB 2MG .......................32
AFINITOR TAB 10MG ...........................32
AFINITOR TAB 2.5MG ..........................32
AFINITOR TAB 5MG ............................32
AFINITOR TAB 7.5MG ..........................32
afrin child spr 0.25% ........................... 108
AFRIN MENTHL SPR 0.05%................. 108
afrin saline spr 0.65% ......................... 108
AGGRENOX CAP 25-200MG ..................87
a-hydrocort inj 100mg ...........................71
ala cort cre 1% .................................. 120
ALA-HIST IR TAB 2MG ....................... 107
ALA-HIST PE TAB 2-10MG .................. 108
ALBENZA TAB 200MG .........................17
albuterol sulfate soln nebu 0.083% (2.5
mg/3ml) .......................................... 108
albuterol sulfate soln nebu 0.5% (5 mg/ml) 108
equiv) ............................................. 108
equiv) ............................................. 108
albuterol sulfate syrup 2 mg/5ml ............. 108
albuterol sulfate tab 2 mg ..................... 108
albuterol sulfate tab 4 mg ..................... 108
albuterol sulfate tab sr 12hr 4 mg............ 108
albuterol sulfate tab sr 12hr 8 mg............ 108
alclometasone dipropionate cream 0.05% . 120
alclometasone dipropionate oint 0.05% .... 120
ALCOHOL SWABS ..............................65
?
ALDEX AN CHW 5MG........................ 107
ALDEX GS DM TAB .......................... 108
ALDEX GS TAB 30-190MG.................. 109
ALDEX-CT CHW 12.5-5MG ................. 109
ALDURAZYME INJ 2.9MG/5M ................ 70
alendronate sodium tab 10 mg ................ 67
alendronate sodium tab 5 mg.................. 67
alfuzosin hcl tab sr 24hr 10 mg ................ 82
ALIMTA INJ 100MG ............................. 30
ALIMTA INJ 500MG ............................. 30
ALINIA SUS 100/5ML ........................... 17
ALINIA TAB 500MG ............................. 17
all day allg tab 10mg .......................... 107
all day pain tab 220mg.......................... 12
ALLEGRA ALRG SUS 30MG/5ML ......... 107
ALLEGRA ALRG TAB 30MG ................ 107
aller-ease tab 60mg ........................... 107
allergy chld liq 12.5/5ml ...................... 107
allergy relf cap 25mg .......................... 107
allergy relf tab 10mg .......................... 107
allergy relf tab 25mg .......................... 107
allergy/cong tab relief ......................... 109
allergy-d tab 5-120mg ........................ 109
allopurinol tab 100 mg .......................... 12
allopurinol tab 300 mg .......................... 12
allrgy relf tab 12.5mg.......................... 107
ALOE VERA LIQ JUICE DR ................... 78
ALPHAGAN P SOL 0.1% .................... 105
alprazolam con 1 mg/ml ........................ 47
alprazolam tab 0.25 mg ........................ 47
alprazolam tab 0.5 mg .......................... 47
alprazolam tab 1 mg ............................ 47
alprazolam tab 2 mg ............................ 47
ALREX SUS 0.2% ............................. 104
altafrin sol 0.12% .............................. 104
altarussin syp -pe .............................. 109
altaryl elx 12.5/5ml ............................ 107
altavera tab ....................................... 67
ALUM HYDROX SUS 320/5ML ............... 75
aluminum hydroxide gel susp 600 mg/5ml .. 75
amantadine hcl cap 100 mg ................... 55
amantadine hcl syrup 50 mg/5ml ............. 55
amantadine hcl tab 100 mg .................... 55
126
AMBISOME INJ 50MG ..........................19
amcinonide cream 0.1% ...................... 120
amcinonide lotion 0.1% ....................... 120
amcinonide oin 0.1% .......................... 120
amifostine crystalline for inj 500 mg ...........34
amikacin sulfate inj 1 gm/4ml (250 mg/ml) ...17
amikacin sulfate inj 500 mg/2ml (250 mg/ml) 17
amiloride & hydrochlorothiazide tab 5-50 mg 44
amiloride hcl tab 5 mg ...........................44
amino acid infusion 6% ..........................92
aminophylline inj 25 mg/ml ................... 116
AMINOSYN 7% INJ /LYTES ...................92
AMINOSYN II INJ 10% ..........................92
AMINOSYN II INJ 7% ...........................92
AMINOSYN II INJ 8.5% .........................92
AMINOSYN II INJ 8.5/LYTE ....................92
AMINOSYN INJ 10% ............................92
AMINOSYN INJ 8.5% ...........................92
AMINOSYN INJ 8.5/LYTE ......................92
AMINOSYN M INJ 3.5% ........................92
AMINOSYN-HBC INJ 7% .......................92
AMINOSYN-PF INJ 10% ........................92
AMINOSYN-PF INJ 7% .........................92
AMINOSYN-RF INJ 5.2% .......................92
amiodarone hcl inj 150 mg/3ml (50 mg/ml) ..38
amiodarone hcl inj 450 mg/9ml (50 mg/ml) ..38
amiodarone hcl inj 900 mg/18ml (50 mg/ml) .38
amiodarone hcl tab 100 mg.....................38
AMITIZA CAP 24MCG ..........................81
AMITIZA CAP 8MCG ............................81
amitriptyline hcl tab 10 mg ......................52
amitriptyline hcl tab 100 mg ....................52
amitriptyline hcl tab 150 mg ....................52
amlodipine besylate tab 10 mg.................42
amlodipine besylate tab 2.5 mg ................42
amlodipine besylate tab 5 mg ..................42
amlodipine besylate-benazepril hcl cap 10-20
mg ..................................................35
mg ..................................................35
amlodipine besylate-benazepril hcl cap 2.5-10
?
mg .................................................. 35
mg .................................................. 35
mg .................................................. 35
mg .................................................. 35
...................................................... 37
...................................................... 37
amlodipine besylate-valsartan tab 5-160 mg 37
amlodipine besylate-valsartan tab 5-320 mg 37
amnesteem cap 10mg ........................ 117
amnesteem cap 20mg ........................ 117
amnesteem cap 40mg ........................ 117
amoxapine tab 100 mg ......................... 52
amoxapine tab 150 mg ......................... 52
amoxapine tab 25 mg ........................... 52
amoxapine tab 50 mg ........................... 52
amoxicillin & k clavulanate chew tab 200-28.5
mg .................................................. 27
amoxicillin & k clavulanate chew tab 400-57 mg
...................................................... 27
amoxicillin & k clavulanate for susp 200-28.5
mg/5ml ............................................ 27
mg/5ml ............................................ 27
amoxicillin & k clavulanate for susp 400-57
mg/5ml ............................................ 27
mg/5ml ............................................ 27
amoxicillin & k clavulanate tab 250-125 mg . 27
amoxicillin & k clavulanate tab sr 12hr
1000-62.5 mg .................................... 27
amoxicillin (trihydrate) cap 250 mg ........... 27
amoxicillin (trihydrate) cap 500 mg ........... 27
amoxicillin (trihydrate) chew tab 125 mg..... 27
amoxicillin (trihydrate) chew tab 250 mg ..... 27
amoxicillin (trihydrate) for susp 125 mg/5ml. 27
amoxicillin (trihydrate) tab 500 mg ............ 27
amoxicillin (trihydrate) tab 875 mg ............ 27
127
10 mg ..............................................60
15 mg ..............................................60
20 mg ..............................................60
25 mg ..............................................61
30 mg ..............................................61
5 mg ................................................60
......................................................61
......................................................61
......................................................61
......................................................61
......................................................61
amphetamine-dextroamphetamine tab 5 mg 61
......................................................61
amphotericin b for inj 50 mg ....................19
ampicillin & sulbactam sodium for inj 1-0.5 gm
......................................................27
......................................................27
ampicillin & sulbactam sodium for inj 2-1 gm 27
ampicillin & sulbactam sodium for iv soln 1-0.5
gm ..................................................27
ampicillin & sulbactam sodium for iv soln 10-5
gm ..................................................27
ampicillin & sulbactam sodium for iv soln 2-1
gm ..................................................27
ampicillin cap 250 mg ...........................27
ampicillin cap 500 mg ...........................27
ampicillin for susp 125 mg/5ml .................27
ampicillin for susp 250 mg/5ml .................27
ampicillin sodium for inj 1 gm...................28
ampicillin sodium for inj 125 mg ...............28
ampicillin sodium for inj 2 gm...................28
ampicillin sodium for iv soln 1 gm .............28
?
ampicillin sodium for iv soln 10 gm ........... 28
ampicillin sodium for iv soln 2 gm ............. 28
AMTURNIDE150 TAB -5-12.5 ................. 44
AMTURNIDE300 TAB -10-12.5 ............... 44
AMTURNIDE300 TAB -10-25MG ............. 44
AMTURNIDE300 TAB -5-12.5 ................. 44
AMTURNIDE300 TAB -5-25MG .............. 44
anagrelide hcl cap 0.5 mg ...................... 87
anagrelide hcl cap 1 mg ........................ 87
anastrozole tab 1 mg............................ 31
ANDRODERM DIS 2MG/24HR ............... 65
ANDRODERM DIS 4MG/24HR ............... 65
androxy tab 10mg ............................... 65
ANORO ELLIPT AER 62.5-25 ............... 106
ant/anti-gas chw 1000-60 ...................... 75
antacid sus max st............................... 75
antibiotic cre plus .............................. 118
anti-diarrhe liq 1mg/5ml ........................ 76
anti-diarrhe tab 2mg ............................. 76
antifungal cre 1% .............................. 118
antifungal cre 2% .............................. 118
ANTIOXIDANT CAP ............................ 97
APAP 500 LIQ 500/5ML ........................ 12
APATATE LIQ .................................... 97
ap-hist dm liq 7.5-4-15 ........................ 109
APOKYN INJ 10MG/ML ........................ 55
apri tab ............................................ 67
APRISO CAP 0.375GM ........................ 78
APTIOM TAB 200MG ........................... 47
APTIOM TAB 400MG ........................... 47
APTIOM TAB 600MG ........................... 47
APTIOM TAB 800MG ........................... 47
APTIVUS CAP 250MG ......................... 20
APTIVUS SOL ................................... 20
aquadeks dro ..................................... 97
AQUA-E LIQ ...................................... 97
aquanil hc lot 1% .............................. 120
ARALAST NP INJ 1000MG .................. 115
ARALAST NP INJ 400MG ................... 115
ARALAST NP INJ 500MG ................... 115
ARALAST NP INJ 800MG ................... 115
aranelle tab ....................................... 67
ARCALYST INJ 220MG ........................ 88
artifi tears sol op ............................... 105
artificial sol tears ............................... 105
ASACOL HD TAB 800MG ..................... 78
128
ASCORBIC ACD POW ..........................97
ascorbic acid cap cr 500 mg....................97
ascorbic acid chew tab 250 mg ................97
ascorbic acid syrup 500 mg/5ml ...............97
ascorbic acid tab 100 mg .......................97
ascorbic acid tab 1000 mg ......................98
ascorbic acid tab cr 500 mg ....................98
ASCRIPTIN TAB .................................12
ASMANEX 120 AER 220MCG ............... 116
ASMANEX 14 AER 220MCG ................ 116
ASMANEX 30 AER 110MCG ................ 116
ASMANEX 30 AER 220MCG ................ 116
ASMANEX 60 AER 220MCG ................ 116
ASPIRIN SUP 120MG ...........................12
ASPIRIN SUP 200MG ...........................12
ASPIRIN SUP 60MG ............................12
aspirin suppos 300 mg ..........................12
aspirin suppos 600 mg ..........................12
aspirin tab 325 mg ...............................12
ASPIRIN TAB 650MG EC ......................12
aspirin tab 81 mg .................................12
aspirin tab delayed release 325 mg ...........12
ASTEPRO SPR 0.15% ........................ 107
asthma relf tab 12.5-200 ...................... 109
atenolol & chlorthalidone tab 100-25 mg .....40
atenolol & chlorthalidone tab 50-25 mg.......40
atenolol tab 100 mg ..............................41
atenolol tab 25 mg ...............................41
atenolol tab 50 mg ...............................41
ath foot spr aer 1% ............................. 118
atorvastatin calcium tab 10 mg (base
equivalent) .........................................39
equivalent) .........................................39
equivalent) .........................................39
equivalent) .........................................39
atovaquone susp 750 mg/5ml ..................17
atovaquone-proguanil hcl tab 250-100 mg ...20
atovaquone-proguanil hcl tab 62.5-25 mg....20
ATRIPLA TAB ....................................22
?
ATROVENT HFA AER 17MCG ............. 107
aubra tab 0.1-0.02 ............................... 67
AUVI-Q INJ 0.15MG .......................... 115
AUVI-Q INJ 0.3MG ............................ 115
AVASTIN INJ ..................................... 31
aviane tab ......................................... 67
AVITA CRE 0.025% ........................... 117
AVITA GEL 0.025% ........................... 117
AVODART CAP 0.5MG ........................ 82
AXID AR TAB 75MG ............................ 77
AYR NASAL DRO 0.65% .................... 109
AYR SALINE GEL NASAL ................... 109
azacitidine for inj 100 mg ....................... 30
AZACTAM INJ 1GM............................. 17
AZACTAM INJ 2GM............................. 18
AZACTAM/DEX INJ 1GM ...................... 18
AZACTAM/DEX INJ 2GM ...................... 18
azathioprine tab 50 mg ......................... 89
azelastine hcl nasal spray 0.15% (205.5
mcg/spray) ...................................... 107
azelastine hcl nasal spray 137 mcg/spray (1
mg/ml) ........................................... 107
azelastine hcl ophth soln 0.05% ............ 104
AZILECT TAB 0.5MG ........................... 55
AZILECT TAB 1MG ............................. 55
azithromycin for susp 100 mg/5ml ............ 25
azithromycin for susp 200 mg/5ml ............ 25
azithromycin iv for soln 500 mg ............... 25
AZITHROMYCIN POWD PACK FOR SUSP 1
GM ................................................. 25
azithromycin tab 250 mg ....................... 25
AZOPT SUS 1% OP .......................... 105
AZOR TAB 10-20MG ........................... 37
AZOR TAB 10-40MG ........................... 37
AZOR TAB 5-20MG ............................. 37
AZOR TAB 5-40MG ............................. 37
aztreonam for inj 1 gm .......................... 18
aztreonam for inj 2 gm .......................... 18
B
b complex tab form 1............................ 98
B-1 TAB 500MG ................................. 98
b-100 complx tab ................................ 98
B-12 DOTS TAB 500MCG ..................... 98
B-12 TAB 2500MCG ............................ 98
129
B-12 TAB 5000MCG .............................98
b-50 tr tab..........................................98
bacitracin oint 500 unit/gm .................... 118
bacitracin ophth oint 500 unit/gm ............ 103
bacitracin zinc oint 500 unit/gm .............. 118
bacitracin-polymyxin b ophth oint ............ 103
bacitracin-polymyxin-neomycin-hc ophth oint
1% ................................................ 103
baclofen tab 10 mg...............................63
baclofen tab 20 mg...............................63
balsalazide disodium cap 750 mg .............78
balziva tab .........................................68
BANZEL SUS 40MG/ML ........................47
BANZEL TAB 200MG ...........................48
BANZEL TAB 400MG ...........................48
BARACLUDE SOL .05MG/ML .................23
BARACLUDE TAB 0.5MG ......................23
BARACLUDE TAB 1MG ........................23
BARC LIQ ....................................... 123
bayer low chw 81mg .............................12
BCG VACCINE INJ ..............................90
b-complex tab 50 tr ..............................98
b-complex vitamin cap...........................98
b-complex vitamin sublingual liquid ...........98
b-complex vitamin tab ...........................98
b-complex w/ c & calcium tab ..................98
b-complex w/ c cap ..............................98
bee zee tab ........................................98
BEELITH TAB ....................................94
benazepril & hydrochlorothiazide tab 10-12.5
mg ..................................................35
benazepril & hydrochlorothiazide tab 20-12.5
mg ..................................................35
benazepril & hydrochlorothiazide tab 20-25 mg
......................................................35
benazepril & hydrochlorothiazide tab 5-6.25 mg
......................................................35
benazepril hcl tab 10 mg ........................36
benazepril hcl tab 5 mg .........................36
BENEFIBER CHW ...............................78
BENEFIBER POW ...............................78
BENICAR HCT TAB 20-12.5 ...................37
BENICAR HCT TAB 40-12.5 ...................37
BENICAR HCT TAB 40-25MG .................37
?
BENICAR TAB 20MG ........................... 38
BENICAR TAB 40MG ........................... 38
BENICAR TAB 5MG ............................ 38
benzonatate cap 100 mg ..................... 109
benzonatate cap 200 mg ..................... 109
benzoyl per gel 10% .......................... 118
BENZOYL PER GEL 2.5% ................... 118
benzoyl per gel 5% ............................ 118
benzoyl per liq 5% wash...................... 118
benzoyl per lot 6% ............................. 118
benzoyl peroxide-erythromycin gel 5-3% .. 117
benztropine mesylate inj 1 mg/ml ............. 55
benztropine mesylate tab 0.5 mg ............. 55
benztropine mesylate tab 1 mg................ 55
benztropine mesylate tab 2 mg................ 55
BEPREVE DRO 1.5% ........................ 104
BESIVANCE SUS 0.6% ...................... 103
beta carotene cap 25000 unit.................. 98
betamethasone dipropionate augmented cream
0.05% ............................................ 120
betamethasone dipropionate augmented gel
0.05% ............................................ 120
betamethasone dipropionate augmented lotion
0.05% ............................................ 120
betamethasone dipropionate augmented oint
0.05% ............................................ 120
betamethasone dipropionate cream 0.05% 120
betamethasone dipropionate lotion 0.05% 120
betamethasone dipropionate oint 0.05% .. 120
betamethasone valerate cream 0.1% ...... 120
betamethasone valerate lotion 0.1% ....... 120
betamethasone valerate oint 0.1% ......... 120
BETASERON INJ 0.3MG ...................... 63
betaxolol hcl ophth soln 0.5% ............... 105
bethanechol chloride tab 10 mg ............... 82
bethanechol chloride tab 5 mg ................ 82
BETOPTIC-S SUS 0.25% OP ............... 105
bicalutamide tab 50 mg ......................... 31
BICILLIN L-A INJ 1200000 ..................... 28
BICILLIN L-A INJ 2400000 ..................... 28
BICILLIN L-A INJ 600000 ...................... 28
BICLORA LIQ .................................. 109
BICLORA TAB 25-25MG ..................... 109
BICNU INJ 100MG .............................. 29
130
BIFERA TAB 28MG ..............................85
BILTRICIDE TAB 600MG .......................18
bio-d-mulsio liq 2000unit ........................98
bio-d-mulsio liq 400unit ..........................98
BIOSPEC DMX LIQ ............................ 109
biotin tab 300 mcg ...............................98
bisoprolol & hydrochlorothiazide tab 10-6.25
mg ..................................................40
bisoprolol & hydrochlorothiazide tab 2.5-6.25
mg ..................................................40
bisoprolol & hydrochlorothiazide tab 5-6.25 mg
......................................................40
bisoprolol fumarate tab 10 mg .................41
bisoprolol fumarate tab 5 mg ...................41
BIVIGAM INJ 10% ...............................88
bleomycin sulfate for inj 15 unit ................30
bleomycin sulfate for inj 30 unit ................30
blephamide oin s.o.p. .......................... 103
BLINK TEARS DRO 0.25% OP .............. 105
BLK DRAUGHT CHW 10MG ...................78
BLK DRAUGHT SYP 90/15ML ................78
B-NATAL LOZ 25MG ............................98
BONE DENSITY TAB ...........................94
bone meal w/ vitamin d tab .....................94
BOOSTRIX INJ ...................................90
BOSULIF TAB 100MG ..........................32
BOSULIF TAB 500MG ..........................32
BOUDREAUXS OIN 16% ..................... 122
BP CLEANSING LOT 4% ..................... 118
bp wash liq 5.25% .............................. 118
BREO ELLIPTA INH 100-25 ................. 116
brewers yeast tab ................................98
briellyn tab .........................................68
BRILINTA TAB 90MG ...........................87
BRIMONIDINE TARTRATE OPHTH SOLN
0.15% ............................................ 105
brimonidine tartrate ophth soln 0.2%........ 105
BRINTELLIX TAB 10MG ........................53
BRINTELLIX TAB 20MG ........................53
BRINTELLIX TAB 5MG .........................52
BROHIST D TAB 4-10MG .................... 109
BROMFENAC SODIUM OPHTH SOLN 0.09%
(BASE EQUIV) (ONCE-DAILY) .............. 104
bromocriptine mesylate cap 5 mg .............55
bromocriptine mesylate tab 2.5 mg............55
BROVEX PSB LIQ ............................. 109
?
BROVEX PSB LIQ DM ....................... 109
budesonide cap sr 24hr 3 mg.................. 78
budesonide inhalation susp 0.25 mg/2ml .. 116
budesonide inhalation susp 0.5 mg/2ml ... 116
buffered tab salt.................................. 94
BUFFERIN TAB 500MG........................ 12
BUFFERIN TAB 81MG ......................... 12
bumetanide inj 0.25 mg/ml ..................... 44
bumetanide tab 0.5 mg ......................... 44
bumetanide tab 1 mg ........................... 44
bumetanide tab 2 mg ........................... 44
buprenorphine hcl sl tab 2 mg (base equiv) . 63
buprenorphine hcl sl tab 8 mg (base equiv) . 63
buprenorphine hcl-naloxone hcl sl tab 2-0.5 mg
(base equiv) ...................................... 64
buprenorphine hcl-naloxone hcl sl tab 8-2 mg
(base equiv) ...................................... 64
buproban tab 150mg ............................ 64
bupropion hcl tab 100 mg ...................... 53
bupropion hcl tab 75 mg ........................ 53
bupropion hcl tab sr 12hr 100 mg ............. 53
buspirone hcl tab 10 mg ........................ 47
buspirone hcl tab 5 mg ......................... 47
buspirone hcl tab 7.5 mg ....................... 47
BUSULFEX INJ 6MG/ML ...................... 29
butorphanol tartrate inj 1 mg/ml ............... 14
butorphanol tartrate inj 2 mg/ml ............... 14
BYSTOLIC TAB 10MG ......................... 41
BYSTOLIC TAB 2.5MG ........................ 41
BYSTOLIC TAB 20MG ......................... 41
BYSTOLIC TAB 5MG ........................... 41
C
c-500 chw 500mg................................ 98
ca citrate tab + d ................................. 94
CA CITRATE TAB 250MG ..................... 94
CA GLUCONATE TAB 50MG ................. 94
CA LACTATE TAB 100MG .................... 94
CA/MG TAB ...................................... 94
CA/MG/ZN TAB .................................. 94
cabergoline tab 0.5 mg ......................... 73
131
cafergot tab 1-100mg ............................62
cal antacid chw 1000mg ........................75
CAL CIT MAL/ TAB VITAMIND ................94
CAL/MAG TAB CHEW ..........................94
CAL/MAG/VITD TAB ............................94
calc antacid chw 500mg.........................75
calc antacid chw 750mg.........................75
calc citrate tab +d ................................94
CALC CITRATE TAB 200MG ..................94
CALC GUMMIES CHW CHILD ................94
CALCET CHW BITES ...........................94
CALCET PETIT TAB 200-250 .................94
calciferol dro 8000/ml ............................98
CALCI-MIX CAP 1250MG ......................94
CALCIONATE SYP 1.8GM/5 ...................94
calcipotriene cream 0.005% .................. 119
calcipotriene oint 0.005% ..................... 119
calcipotriene soln 0.005% (50 mcg/ml) ..... 119
calcitonin (salmon) nasal soln 200 unit/act ...73
CAL-CITRATE TAB PLUS D ...................94
calcitrene oin 0.005% .......................... 119
calcitriol cap 0.25 mcg ...........................98
calcitriol cap 0.5 mcg ............................98
calcitriol inj 1 mcg/ml.............................98
calcitriol oral soln 1 mcg/ml .....................98
CALCIUM &MAG TAB...........................95
calcium + d chw ..................................95
CALCIUM 1000 TAB + D .......................95
calcium 1200 chw ................................95
CALCIUM 500 TAB ..............................94
calcium 500 tab +d ...............................95
calcium 600 chw +d/mnrls ......................95
calcium 600 tab ...................................95
calcium 600 tab vit d/mi .........................95
calcium acetate (phosphate binder) cap 667 mg
(169 mg ca) .......................................73
calcium ascorbate tab 500 mg .................98
CALCIUM CARB CHW 260MG ................95
CALCIUM CARB POW 800/2GM..............95
CALCIUM CARB TAB 648MG .................75
calcium carbonate susp 1250 mg/5ml (500
mg/5ml elemental ca) ............................95
calcium carbonate tab 1250 mg (500 mg
elemental ca)......................................95
calcium carbonate-cholecalciferol tab 500
mg-400 unit........................................95
?
calcium carbonate-cholecalciferol tab 600
mg-200 unit ....................................... 95
calcium carbonate-vitamin d tab 500 mg-125
unit ................................................. 95
unit ................................................. 95
unit ................................................. 95
unit ................................................. 95
unit ................................................. 95
CALCIUM CHW GUMMIES.................... 95
CALCIUM CIT/ TAB VIT D ..................... 95
calcium citrate tab 950 mg (200 mg elemental
ca) .................................................. 95
calcium citrate-vitamin d tab 200 mg-250 unit
(elemental ca) .................................... 95
calcium for chw women ......................... 95
CALCIUM GLUC TAB 500MG ................ 95
calcium gluconate tab 500 mg ................. 95
CALCIUM GRA CITRATE...................... 95
CALCIUM LACT TAB 648MG ................. 95
calcium lactate tab 650 mg .................... 95
calcium pantothenate tab 500 mg ............ 98
calcium soft chw chocolat ...................... 95
calcium tab 500 mg ............................. 95
calcium tab 600 mg ............................. 95
CALCIUM TAB FORMULA .................... 95
calcium w/ magnesium tab 500-250 mg ..... 95
calcium w/ vitamin d tab 600 mg-125 unit ... 95
calcium w/ vitamin d tab 600 mg-200 unit ... 95
CALCIUM/C/D CHW 500MG .................. 96
calcium/d chw 500-400 ......................... 96
CALCIUM/D3 TAB............................... 96
calcium/d3 tab 600-800 ......................... 96
calcium/magn tab zinc .......................... 96
calcium+d3 tab 600-800 ........................ 95
calcium+d3 tab grad rel......................... 96
CAL-GLU CAP 500MG ......................... 94
cal-mag aspa tab 333-167 ..................... 94
CALMAG THINS TAB 200-50MG ............. 96
CALNA TAB ...................................... 98
CAL-QUICK LIQ 500-400 ...................... 94
CALTRATE 600 CHW +D PLUS .............. 96
caltrate 600 chw 600-800 ...................... 96
caltrate 600 tab .................................. 96
132
calvite p&d tab ....................................96
camila tab 0.35mg ...............................68
CANASA SUP 1000MG .........................78
CANCIDAS INJ 50MG...........................19
CANCIDAS INJ 70MG...........................19
CAPASTAT SUL INJ 1GM ......................22
CAPCOF SYP .................................. 109
CAPMIST DM TAB............................. 109
CAPRELSA TAB 100MG .......................32
CAPRELSA TAB 300MG .......................32
......................................................35
......................................................35
......................................................35
......................................................35
captopril tab 100 mg .............................36
captopril tab 12.5 mg ............................36
captopril tab 25 mg...............................36
captopril tab 50 mg...............................36
CARBAGLU TAB 200MG .......................70
carbamazepine cap sr 12hr 100 mg ..........48
carbamazepine chew tab 100 mg .............48
carbamazepine susp 100 mg/5ml .............48
carbamazepine tab 200 mg.....................48
carbamazepine tab sr 12hr 200 mg ...........48
carbamazepine tab sr 12hr 400 mg ...........48
10-100 mg .........................................56
25-100 mg .........................................56
25-250 mg .........................................56
carbidopa & levodopa tab 10-100 mg.........56
carbidopa & levodopa tab cr 25-100 mg......56
carbidopa & levodopa tab cr 50-200 mg......56
TABS 12.5-50-200 MG ..........................56
TABS 18.75-75-200 MG ........................56
?
TABS 25-100-200 MG .......................... 56
TABS 31.25-125-200 MG ...................... 56
TABS 37.5-150-200 MG ........................ 56
TABS 50-200-200 MG .......................... 56
carboplatin iv soln 150 mg/15ml .............. 34
carboplatin iv soln 50 mg/5ml.................. 34
cardec dm dro .................................. 109
cardec dro ...................................... 109
CARIMUNE NF INJ 12GM ..................... 88
CARIMUNE NF INJ 3GM ...................... 88
CARIMUNE NF INJ 6GM ...................... 88
carteolol hcl ophth soln 1% .................. 105
carvedilol tab 12.5 mg .......................... 41
carvedilol tab 25 mg ............................. 41
carvedilol tab 3.125 mg ......................... 41
carvedilol tab 6.25 mg .......................... 41
castellani paint ................................. 118
CAYSTON INH 75MG .......................... 18
cefaclor cap 250 mg ............................ 24
cefaclor cap 500 mg ............................ 24
cefaclor er tab 500mg ........................... 24
cefaclor for susp 125 mg/5ml .................. 24
cefadroxil cap 500 mg .......................... 24
cefadroxil for susp 250 mg/5ml ................ 24
cefadroxil for susp 500 mg/5ml ................ 24
cefadroxil tab 1 gm .............................. 24
cefazolin inj 1gm/50ml .......................... 24
cefazolin sodium for inj 1 gm .................. 24
cefazolin sodium for inj 10 gm ................. 24
cefazolin sodium for inj 20 gm ................. 24
cefazolin sodium for inj 500 mg ............... 24
cefazolin sodium for iv soln 1 gm ............. 24
cefdinir cap 300 mg ............................. 24
cefdinir for susp 125 mg/5ml ................... 24
cefdinir for susp 250 mg/5ml ................... 24
cefepime hcl for inj 1 gm ....................... 24
cefepime hcl for inj 2 gm ....................... 24
cefotaxime sodium for inj 1 gm ................ 24
cefotaxime sodium for inj 10 gm .............. 24
133
cefotaxime sodium for inj 2 gm.................24
cefotaxime sodium for inj 500 mg .............24
cefoxitin sodium for inj 1 gm ....................24
cefoxitin sodium for inj 10 gm ..................24
cefoxitin sodium for inj 2 gm ....................24
cefpodoxime proxetil for susp 100 mg/5ml ...24
cefpodoxime proxetil for susp 50 mg/5ml ....24
cefpodoxime proxetil tab 100 mg ..............24
cefpodoxime proxetil tab 200 mg ..............24
cefprozil for susp 125 mg/5ml ..................24
cefprozil for susp 250 mg/5ml ..................24
cefprozil tab 250 mg .............................24
cefprozil tab 500 mg .............................24
ceftazidime for inj 1 gm ..........................25
CEFTAZIDIME/ SOL D5W 1GM ...............25
CEFTAZIDIME/ SOL D5W 2GM ...............25
ceftriaxone sodium for inj 1 gm ................25
ceftriaxone sodium for inj 10 gm ...............25
ceftriaxone sodium for inj 2 gm ................25
ceftriaxone sodium for inj 250 mg .............25
ceftriaxone sodium for inj 500 mg .............25
ceftriaxone sodium for iv soln 1 gm ...........25
ceftriaxone sodium for iv soln 2 gm ...........25
cefuroxime axetil tab 250 mg ...................25
cefuroxime axetil tab 500 mg ...................25
cefuroxime inj 7.5gm.............................25
cefuroxime sodium for inj 1.5 gm ..............25
cefuroxime sodium for inj 7.5 gm ..............25
cefuroxime sodium for inj 750 mg .............25
cefuroxime sodium for iv soln 1.5 gm .........25
CELEBREX CAP 100MG .......................13
CELEBREX CAP 200MG .......................13
CELEBREX CAP 400MG .......................13
CELEBREX CAP 50MG.........................13
CELLCEPT SUS 200MG/ML ...................89
CELONTIN CAP 300MG ........................48
central-vite tab performa ........................98
CENTRUM CHW SILVER ......................98
centrum kids chw complete .....................98
cephalexin cap 250 mg ..........................25
cephalexin cap 500 mg ..........................25
cephalexin for susp 125 mg/5ml ...............25
cephalexin for susp 250 mg/5ml ...............25
CEREZYME INJ 200UNIT ......................70
?
CEREZYME INJ 400UNIT ..................... 70
cerovite adv liq formula ......................... 98
CERVARIX INJ .................................. 90
cetirizine hcl chew tab 10 mg ................ 107
cetirizine hcl chew tab 5 mg ................. 107
cetirizine hcl oral soln 1 mg/ml (5 mg/5ml) 107
cetirizine hcl tab 5 mg ......................... 107
cetirizine sol 5mg/5ml ......................... 107
cevimeline hcl cap 30 mg .................... 123
CHANTIX PAK 0.5& 1MG ...................... 64
CHANTIX TAB 0.5MG .......................... 64
CHANTIX TAB 1MG ............................ 64
CHELATED CA TAB 200MG .................. 96
CHEMET CAP 100MG ......................... 67
cheratussin sol dac ............................ 109
chewabl vite chw childrns ...................... 98
CHILD ADVIL SUS COLD ................... 109
child chew/ chw extra c ......................... 98
child comple chw allergy ..................... 107
CHILD MOTRIN CHW 50MG .................. 12
CHILD-MULTI CHW VITAMINS ............... 98
childrens sus plus cld ......................... 109
chld asafree elx 80/2.5ml ....................... 12
chld decongs liq 15mg/5ml ................... 109
CHLO TUSS EX LIQ 12.5-100 .............. 109
chlorhexidine gluconate soln 0.12% ........ 123
chloroquine phosphate tab 250 mg ........... 20
chloroquine phosphate tab 500 mg ........... 20
chlorothiazide tab 250 mg ...................... 44
chlorothiazide tab 500 mg ...................... 44
chlorpheniramine maleate tab 4 mg ........ 107
chlorpheniramine maleate tab cr 12 mg ... 107
chlorpromaz inj 25mg/ml ....................... 57
chlorpromazine hcl tab 10 mg ................. 57
chlorpromazine hcl tab 100 mg................ 57
chlorpromazine hcl tab 200 mg................ 57
chlorthalidone tab 25 mg ....................... 44
chlorthalidone tab 50 mg ....................... 44
cholecalciferol cap 2000 unit .................. 98
cholecalciferol cap 5000 unit .................. 98
cholecalciferol drops 5000 unit/ml (1000
unit/0.2ml)......................................... 99
cholecalciferol oral liquid 400 unit/ml ......... 99
cholecalciferol tab 1000 unit ................... 99
134
cholecalciferol tab 2000 unit ....................99
cholecalciferol tab 400 unit .....................99
cholestyramine light powder packets 4 gm ..40
cholestyramine powder 4 gm/dose ............40
cholestyramine powder packets 4 gm ........40
acid equiv) .........................................40
choline fenofibrate cap dr 45 mg (fenofibric acid
equiv) ...............................................40
ciclopirox gel 0.77% ........................... 118
ciclopirox olamine cream 0.77% (base equiv)
.................................................... 118
ciclopirox olamine susp 0.77% (base equiv)
.................................................... 118
ciclopirox shampoo 1% ........................ 118
cilostazol tab 100 mg ............................87
cilostazol tab 50 mg ..............................87
CILOXAN OIN 0.3% OP ...................... 103
cimetidine tab 200 mg ...........................77
CIMZIA KIT ........................................87
CIMZIA KIT STARTER ..........................87
CIMZIA PREFL KIT 200MG/ML ...............87
CINRYZE SOL 500 UNIT .......................87
CIPRODEX SUS 0.3-0.1% ................... 123
ciprofloxacin 200 mg/100ml in d5w............26
ciprofloxacin 400 mg/200ml in d5w............26
ciprofloxacin for oral susp 250 mg/5ml (5%) (5
gm/100ml) .........................................26
(10 gm/100ml) ....................................26
ciprofloxacin hcl ophth soln 0.3% ............ 103
ciprofloxacin hcl tab 100 mg (base equiv) ....26
ciprofloxacin iv soln 200 mg/20ml (1%) .......26
ciprofloxacin iv soln 400 mg/40ml (1%) .......26
ciprofloxacin-ciprofloxacin hcl tab sr 24hr 1000
mg(base eq) .......................................26
ciprofloxacin-ciprofloxacin hcl tab sr 24hr 500
mg (base eq) ......................................26
cisplatin inj 100 mg/100ml (1 mg/ml) ..........34
cisplatin inj 200 mg/200ml (1 mg/ml) ..........34
cisplatin inj 50 mg/50ml (1 mg/ml) .............34
cit calc/d tab 315-250 ............................96
citalopram hydrobromide oral soln 10 mg/5ml
......................................................53
?
citalopram hydrobromide tab 10 mg (base
equiv) .............................................. 53
equiv) .............................................. 53
equiv) .............................................. 53
CITRACAL CAL CHW GUMMIES ............ 96
CITRACAL HRT TAB HEALTH ............... 96
CL PRENATAL TAB 28-0.8MG ............... 99
cladribine inj 1 mg/ml ........................... 30
claravis cap 10mg ............................. 117
claravis cap 20mg ............................. 117
claravis cap 30mg ............................. 117
claravis cap 40mg ............................. 117
clarithromycin for susp 125 mg/5ml .......... 26
clarithromycin for susp 250 mg/5ml .......... 26
clarithromycin tab 250 mg ...................... 26
clarithromycin tab 500 mg ...................... 26
clarithromycin tab sr 24hr 500 mg ............ 26
CLARITIN CAP 10MG ........................ 107
CLARITIN CHW 5MG ......................... 107
CLARITIN RDT TAB 5MG ................... 107
cld/cgh/sore liq throat ......................... 109
clean&clear cre 10% .......................... 118
CLEAR EYES DRO DRY EYES ............ 105
clindamycin hcl cap 150 mg ................... 18
clindamycin hcl cap 300 mg ................... 18
clindamycin hcl cap 75 mg ..................... 18
clindamycin palmitate hcl for soln 75 mg/5ml
(base equiv) ...................................... 18
clindamycin phosphate gel 1% .............. 117
clindamycin phosphate inj 300 mg/2ml ...... 18
clindamycin phosphate inj 9 gm/60ml ........ 18
clindamycin phosphate iv soln 300 mg/2ml . 18
clindamycin phosphate lotion 1% ........... 117
clindamycin phosphate soln 1% ............. 117
clindamycin phosphate swab 1% ........... 117
clindamycin phosphate vaginal cream 2% .. 83
CLINIMIX INJ 2.75/D5W ....................... 92
CLINIMIX INJ 4.25/D10 ........................ 92
CLINIMIX INJ 4.25/D20 ........................ 92
CLINIMIX INJ 4.25/D25 ........................ 92
135
CLINIMIX INJ 4.25/D5W ........................92
CLINIMIX INJ 5%/D15W ........................92
CLINIMIX INJ 5%/D20W ........................92
CLINIMIX INJ 5%/D25W ........................92
clobetasol e cre 0.05% ........................ 120
clobetasol propionate cream 0.05% ......... 120
clobetasol propionate gel 0.05% ............. 120
clobetasol propionate oint 0.05% ............ 120
clobetasol propionate soln 0.05% ........... 120
CLOFERA LIQ .................................. 109
clomipramine hcl cap 25 mg....................53
......................................................48
......................................................48
clonazepam orally disintegrating tab 0.5 mg .48
clonazepam orally disintegrating tab 1 mg ...48
clonazepam orally disintegrating tab 2 mg ...48
clonazepam tab 0.5 mg .........................48
clonazepam tab 1 mg ............................48
clonazepam tab 2 mg ............................48
clonidine hcl tab 0.1 mg .........................45
clonidine hcl td patch weekly 0.1 mg/24hr ...45
clopidogrel bisulfate tab 75 mg (base equiv) 87
clorazepate dipotassium tab 15 mg ...........48
clorazepate dipotassium tab 3.75 mg .........48
clorazepate dipotassium tab 7.5 mg ..........48
clotrimazole cre 2% ..............................83
clotrimazole cream 1% ........................ 118
clotrimazole soln 1% ........................... 118
clotrimazole troche 10 mg .................... 123
clotrimazole vaginal cream 1%.................83
CLOZAPINE ORALLY DISINTEGRATING TAB
100 MG ............................................57
12.5 MG............................................57
25 MG ..............................................57
clozapine tab 100 mg ............................57
clozapine tab 200 mg ............................57
?
clozapine tab 25 mg ............................. 57
clozapine tab 50 mg ............................. 57
CNTC CLD/FLU PAK DAY/NGHT .......... 109
CNTC CLD/FLU TAB MAX ST .............. 109
COARTEM TAB 20-120MG.................... 20
COD LIVER OIL ................................. 99
cod liver oil cap .................................. 99
CODAR AR LIQ................................ 109
CODAR D LIQ ................................. 109
CODAR GF LIQ................................ 109
CODITUSS DM SYP .......................... 109
colchicine w/ probenecid tab 0.5-500 mg .... 12
COLCRYS TAB 0.6MG ......................... 12
cold head tab cong dt ......................... 109
cold medicin cap plus ......................... 109
cold multi pak day/nght ....................... 109
cold multi-s tab night .......................... 109
cold relief tab plus ............................. 109
cold/allergy elx children ....................... 109
cold/allery sus child ........................... 109
cold/cough elx child ........................... 109
cold/sinus tab relief ............................ 109
colestipol hcl granule packets 5 gm .......... 40
colestipol hcl granules 5 gm ................... 40
colestipol hcl tab 1 gm .......................... 40
colistimethate sodium for inj 150 mg ......... 18
COMBIGAN SOL 0.2/0.5% .................. 105
COMBIPATCH DIS .05/.14 .................... 71
COMBIPATCH DIS .05/.25 .................... 71
COMBIVENT AER RESPIMAT.............. 106
COMETRIQ KIT 100MG........................ 32
COMETRIQ KIT 140MG........................ 32
COMETRIQ KIT 60MG ......................... 32
COMPLERA TAB ................................ 22
complete kit lice ................................ 123
COMPLETE SIN TAB RELIEF .............. 110
compro sup 25mg ............................... 76
COMPUTER EYE SOL DROPS ............ 105
comtrex sev pak cld/sinu ..................... 110
COMVAX INJ..................................... 90
CONEX SOL CLD/ALRG ..................... 110
CONEX TAB 2-60MG ......................... 110
constulose sol 10gm/15 ........................ 78
contac tab cold+flu ............................ 110
COPAXONE INJ 40MG/ML .................... 63
COPAXONE KIT 20MG/ML .................... 63
136
CORAL CALCIU CAP ...........................96
CORAL CALCIU CAP 1000MG ................96
CORAL CALCIU CAP PLUS ...................96
CORAL CAP CALCIUM .........................96
coricidin cap cong/cgh ......................... 110
coricidin liq hbp ................................. 110
corn dextrin oral powder ........................78
cortaid spr 1% .................................. 120
cortisone acetate tab 25 mg ....................71
cortizone-10 gel 1% ............................ 120
cough & cold tab ............................... 110
cough & sore liq thrt day ...................... 110
cough cont liq dm max ........................ 110
COUGH D SYP ................................. 110
cough dm liq 30mg/5ml ....................... 110
COUMADIN TAB 10MG.........................84
COUMADIN TAB 1MG ..........................83
COUMADIN TAB 2.5MG ........................83
COUMADIN TAB 2MG ..........................84
COUMADIN TAB 3MG ..........................84
COUMADIN TAB 4MG ..........................84
COUMADIN TAB 5MG ..........................84
COUMADIN TAB 6MG ..........................84
COUMADIN TAB 7.5MG ........................84
CREON CAP 12000UNT .......................81
CREON CAP 24000UNT .......................81
CREON CAP 3000UNIT ........................81
CREON CAP 36000UNT .......................81
CREON CAP 6000UNIT ........................81
CRESTOR TAB 10MG ..........................39
CRESTOR TAB 20MG ..........................39
CRESTOR TAB 40MG ..........................39
CRESTOR TAB 5MG ............................39
CRIXIVAN CAP 200MG .........................20
CRIXIVAN CAP 400MG .........................20
cromolyn sodium nasal aerosol soln 5.2 mg/act
(4%) .............................................. 110
cromolyn sodium ophth soln 4% ............. 104
cromolyn sodium oral conc 100 mg/5ml ......81
cromolyn sodium soln nebu 20 mg/2ml ..... 115
cryselle-28 tab 28 tabs ..........................68
CUBICIN SOL 500MG...........................18
CUVPOSA SOL 1MG/5ML .....................77
cvs fiber chw gummies ..........................78
cvs nasal spr mist .............................. 110
cvs vit b-6 tab 200mg ............................99
?
cyanocobalamin inj 1000 mcg/ml ............. 99
cyanocobalamin liquid 1000 mcg/15ml ...... 99
cyanocobalamin tab 100 mcg ................. 99
cyanocobalamin tab 1000 mcg ................ 99
cyanocobalamin tab 2000 mcg ................ 99
cyanocobalamin tab 50 mcg ................... 99
cyanocobalamin tab cr 1000 mcg ............. 99
cyanocobalamin tab sl 1000 mcg ............. 99
cyanocobalamin tab sl 2500 mcg ............. 99
cyclafem tab 1/35 ................................ 68
cyclafem tab 7/7/7 ............................... 68
cyclobenzaprine hcl tab 10 mg ................ 63
cyclobenzaprine hcl tab 5 mg.................. 63
CYCLOPHOSPH CAP 25MG ................. 29
CYCLOPHOSPH CAP 50MG ................. 29
cyclophosphamide for inj 1 gm ................ 29
cyclophosphamide for inj 2 gm ................ 29
cyclophosphamide for inj 500 mg ............. 29
cyclophosphamide tab 25 mg ................. 29
cyclophosphamide tab 50 mg ................. 29
cycloserine cap 250 mg ........................ 22
cyclosporine cap 100 mg ....................... 89
cyclosporine cap 25 mg ........................ 89
cyclosporine iv soln 50 mg/ml ................. 89
cyclosporine modified cap 100 mg............ 89
cyclosporine modified cap 25 mg ............. 89
cyclosporine modified cap 50 mg ............. 89
cyclosporine modified oral soln 100 mg/ml .. 89
CYSTADANE POW ............................. 70
CYSTAGON CAP 150MG ...................... 70
CYSTAGON CAP 50MG ....................... 70
cytarabine inj 20 mg/ml ......................... 30
CYTO B2 POW .................................. 99
D
d.o.s. cap 250mg ................................ 79
D10W/NACL INJ 0.2%.......................... 92
D3 DOTS TAB 2000UNIT ...................... 99
D5W/LYTES INJ #48 ........................... 92
D5W/NACL INJ 0.3% ........................... 92
dacarbazine for inj 200 mg ..................... 29
daily-vite/ tab iron ................................ 99
DALIRESP TAB 500MCG .................... 115
DALLERGY SYP .............................. 110
danazol cap 100 mg ............................ 70
137
danazol cap 200 mg .............................70
danazol cap 50 mg ...............................70
dantrolene sodium cap 100 mg ................63
dantrolene sodium cap 25 mg..................63
dantrolene sodium cap 50 mg..................63
dapsone tab 100 mg .............................18
dapsone tab 25 mg ..............................18
DAPTACEL INJ...................................90
DARAPRIM TAB 25MG .........................18
daunorubicin hcl inj 5 mg/ml (base equiv) ....30
day time liq cough .............................. 110
day/nite mis cold/flu ............................ 110
dayhist alrg tab 12 hour ....................... 107
day-time cap sinus ............................. 110
DECARA CAP 25000UNT ......................99
de-chlor dm liq liquid ........................... 110
DECON-A LIQ DROPS ....................... 110
decongestant tab 120mg er .................. 110
delsym child liq cgh/cold ...................... 110
DELTUSS DP LIQ 1-30/5ML ................. 110
delyla tab 0.1-0.02 ...............................68
DELZICOL CAP 400MG ........................78
demarest cre dricort ........................... 120
DEMSER CAP 250MG ..........................45
DENAVIR CRE 1% ............................ 120
DEPEN TITRA TAB 250MG ....................67
DEPO-PROVERA INJ 400/ML .................31
desenex aer 2% ................................ 118
desenex cre 1% ................................ 118
desenex spry aer liquid ........................ 118
desipramine hcl tab 10 mg ......................53
desipramine hcl tab 100 mg ....................53
desipramine hcl tab 150 mg ....................53
desipramine hcl tab 75 mg......................53
DESITIN CRE 13% ............................ 122
desmopressin acetate inj 4 mcg/ml ...........75
DESMOPRESSIN ACETATE NASAL SOLN
0.01% (REFRIGERATED) ......................75
......................................................75
(refrigerated) ......................................75
desmopressin acetate tab 0.1 mg .............75
desmopressin acetate tab 0.2 mg .............75
?
DESONIDE CREAM 0.05%.................. 120
desonide lotion 0.05% ........................ 120
desonide oint 0.05% .......................... 120
desoximetasone cream 0.05% .............. 120
desoximetasone cream 0.25% .............. 120
desoximetasone gel 0.05% .................. 120
DESOXIMETASONE OINT 0.05% ......... 120
desoximetasone oint 0.25% ................. 120
dexamethason con 1mg/ml .................... 71
dexamethasone elixir 0.5 mg/5ml ............. 71
dexamethasone sod phosphate preservative
free inj 10 mg/ml ................................. 71
dexamethasone sodium phosphate inj 10
mg/ml .............................................. 71
mg/10ml ........................................... 71
mg/30ml ........................................... 71
mg/5ml ............................................ 71
dexamethasone sodium phosphate ophth soln
0.1% ............................................. 104
dexamethasone soln 0.5 mg/5ml ............. 71
dexamethasone tab 0.5 mg .................... 71
dexamethasone tab 0.75 mg .................. 71
dexamethasone tab 1 mg ...................... 71
dexamethasone tab 1.5 mg .................... 71
DEXATREX D ELX CF-NASAL ............. 110
DEXFERRUM INJ 50MG/ML .................. 85
DEXILANT CAP 30MG DR .................... 81
DEXILANT CAP 60MG DR .................... 81
dexrazoxane for inj 250 mg .................... 34
dextromethorphan-guaifenesin tab 20-400 mg
.................................................... 110
0.45% .............................................. 93
DEXTROSE 2.5% W/ SODIUM CHLORIDE
0.45% .............................................. 93
DEXTROSE 5% IN LACTATED RINGERS . 93
DEXTROSE 5% W/ SODIUM CHLORIDE 0.2%
...................................................... 93
0.225% ............................................ 93
138
0.33% ..............................................93
0.45% ..............................................93
DEXTROSE 5% W/ SODIUM CHLORIDE 0.9%
......................................................93
DEXTROSE INJ 10% ............................93
DEXTROSE INJ 5% .............................93
DEXTROSE INJ 50% ............................93
dextrose inj 70% ..................................93
DEX-TUSS LIQ 300-10/5 ..................... 110
DIABETIC CAP COLD/FLU .................. 110
DIALYVITE 80 TAB ZINC 15 ...................99
dialyvite tab 800 ..................................99
diaper rash oin 40% ........................... 122
diaper rash oin creamy ........................ 122
diazepam con 5mg/ml ...........................48
diazepam inj 5 mg/ml ............................48
DIAZEPAM RECTAL GEL DELIVERY
SYSTEM 10 MG ..................................48
SYSTEM 2.5 MG .................................48
SYSTEM 20 MG ..................................48
diazepam soln 1 mg/ml ..........................48
diazepam tab 10 mg .............................49
diazepam tab 2 mg...............................48
diazepam tab 5 mg...............................48
DICEL CD LIQ .................................. 110
diclofenac potassium tab 50 mg ...............13
diclofenac sodium ophth soln 0.1% ......... 104
......................................................13
......................................................13
......................................................13
diclofenac sodium tab sr 24hr 100 mg ........13
dicloxacillin sodium cap 250 mg ...............28
dicloxacillin sodium cap 500 mg ...............28
dicyclomine hcl cap 10 mg ......................77
dicyclomine hcl oral soln 10 mg/5ml ..........77
dicyclomine hcl tab 20 mg ......................77
didanosine delayed release capsule 125 mg 20
DIFICID TAB 200MG ............................26
?
diflorasone diacetate cream 0.05% ......... 120
diflorasone diacetate oint 0.05% ............ 120
diflunisal tab 500 mg ............................ 13
diges probio cap 250mg ........................ 76
digoxin inj 0.25 mg/ml ........................... 43
DIGOXIN ORAL SOLN 0.05 MG/ML ......... 43
digoxin tab 125 mcg (0.125 mg) .............. 44
digoxin tab 250 mcg (0.25 mg) ................ 44
dihydroergotamine mesylate inj 1 mg/ml .... 62
dilantin cap 100mg .............................. 49
dilantin cap 30mg ................................ 49
dilantin chw 50mg ............................... 49
DILANTIN-125 SUS 125/5ML ................. 49
diltiazem hcl cap sr 12hr 120 mg.............. 42
diltiazem hcl cap sr 12hr 60 mg ............... 42
diltiazem hcl cap sr 12hr 90 mg ............... 42
...................................................... 42
...................................................... 42
...................................................... 42
...................................................... 42
...................................................... 42
24hr 120 mg ...................................... 42
24hr 180 mg ...................................... 42
24hr 240 mg ...................................... 42
24hr 300 mg ...................................... 42
24hr 360 mg ...................................... 42
24hr 420 mg ...................................... 42
diltiazem hcl iv soln 125 mg/25ml (5 mg/ml) 42
diltiazem hcl iv soln 25 mg/5ml (5 mg/ml) ... 42
diltiazem hcl iv soln 50 mg/10ml (5 mg/ml) .. 42
diltiazem hcl tab 120 mg........................ 42
diltiazem hcl tab 30 mg ......................... 42
diltiazem hcl tab 60 mg ......................... 42
139
diltiazem hcl tab 90 mg ..........................42
diltzac cap 120mg/24 ............................43
diltzac cap 180mg/24 ............................43
diltzac cap 240mg/24 ............................43
diltzac cap 300mg/24 ............................43
dimetane dx syp ................................ 110
dimetapp liq nighttim ........................... 110
DIMETAPP SYP CGH/COLD ................ 110
DIOVAN TAB 160MG ...........................38
DIOVAN TAB 320MG ...........................38
DIOVAN TAB 40MG .............................38
DIOVAN TAB 80MG .............................38
DIP/TET PED INJ 25-5LFU.....................90
DIPENTUM CAP 250MG .......................78
diphenhydramine hcl cap 50 mg ............. 107
diphenhydramine hcl inj 50 mg/ml ........... 107
diphenhydramine-acetaminophen tab 25-500
mg (sleep) .........................................64
diphenoxylate w/ atropine liq 2.5-0.025 mg/5ml
......................................................81
diphenoxylate w/ atropine tab 2.5-0.025 mg .81
disopyramide phosphate cap 100 mg .........38
disopyramide phosphate cap 150 mg .........38
disulfiram tab 250 mg ............................64
disulfiram tab 500 mg ............................64
DIURIL SUS 250/5ML ...........................44
divalproex sodium cap sprinkle 125 mg ......49
......................................................49
......................................................49
......................................................49
divalproex sodium tab sr 24 hr 250 mg .......49
divalproex sodium tab sr 24 hr 500 mg .......49
doans ex st tab 580mg ..........................12
DOCETAXEL FOR INJ CONC 20 MG/ML ...31
DOCETAXEL FOR INJ CONC 80 MG/4ML (20
MG/ML) ............................................31
docetaxel inj 140/7ml ............................31
DOCETAXEL INJ 80MG/8ML ..................31
docusate sodium liquid 150 mg/15ml .........79
dok tab 100mg ....................................79
DONATUSSIN SYP ............................ 110
tab 10 mg ..........................................52
?
tab 5 mg ........................................... 52
donepezil hydrochloride tab 10 mg ........... 52
donepezil hydrochloride tab 23 mg ........... 52
donepezil hydrochloride tab 5 mg ............. 52
dorzolamide hcl ophth soln 2% .............. 105
dorzolamide hcl-timolol maleate ophth soln
22.3-6.8 mg/ml ................................. 105
double antib oin ................................ 118
doxazosin mesylate tab 1 mg.................. 37
doxepin hcl cap 10 mg .......................... 53
doxepin hcl cap 100 mg ........................ 53
doxepin hcl cap 150 mg ........................ 53
doxepin hcl conc 10 mg/ml ..................... 53
doxorubicin hcl for inj 50 mg ................... 30
doxorubicin hcl inj 2 mg/ml ..................... 30
doxorubicin hcl liposomal inj (for iv infusion) 2
mg/ml .............................................. 30
doxycycline hyclate cap 100 mg .............. 29
doxycycline hyclate cap 50 mg ................ 28
doxycycline hyclate for inj 100 mg ............ 29
doxycycline hyclate tab 100 mg ............... 29
doxycycline hyclate tab 20 mg ................ 29
doxycycline monohydrate cap 100 mg ....... 29
doxycycline monohydrate cap 50 mg ........ 29
doxycycline monohydrate tab 100 mg........ 29
doxycycline monohydrate tab 150 mg........ 29
doxycycline monohydrate tab 50 mg ......... 29
doxycycline monohydrate tab 75 mg ......... 29
dramamine tab 25mg ........................... 76
dronabinol cap 10 mg ........................... 76
dronabinol cap 2.5 mg .......................... 76
dronabinol cap 5 mg ............................ 76
drospirenone-ethinyl estradiol tab 3-0.02 mg 68
3-0.02 MG ........................................ 68
drospirenone-ethinyl estradiol tab 3-0.03 mg 68
3-0.03 MG ........................................ 68
DROXIA CAP 200MG .......................... 33
DROXIA CAP 300MG .......................... 33
140
DROXIA CAP 400MG ...........................33
DRYMAX AF TAB 15-4-25 ................... 110
dual action chw complete .......................81
DULCOLAX KIT BOWEL .......................79
DULERA AER 100-5MCG .................... 116
DULERA AER 200-5MCG .................... 116
......................................................53
......................................................53
......................................................53
DURAFLU TAB ................................. 110
DURAMORPH INJ 0.5MG/ML .................14
DURAMORPH INJ 1MG/ML ....................15
DUREZOL EMU 0.05% ....................... 104
DYRENIUM CAP 100MG .......................44
DYRENIUM CAP 50MG.........................44
E
e.e.s. 400 tab 400mg ............................26
E.E.S. GRAN SUS 200/5ML ...................26
e.s.p. sus 200-600 ...............................18
easy fiber/ chw calcium .........................79
ecee plus tab ......................................99
econazole nitrate cream 1% .................. 118
ed a-hist dm liq ................................. 110
ed bron gp liq ................................... 110
ED CHLORPED DRO D ...................... 110
ED CHLORPED LIQ 2MG/ML ............... 107
ed chlorped syp jr .............................. 107
ed-apap liq 80mg/2.5 ............................12
EDECRIN TAB 25MG ...........................44
EDURANT TAB 25MG ..........................20
EFFIENT TAB 10MG ............................87
EFFIENT TAB 5MG ..............................87
ELDERTONIC ELX ..............................99
ELIDEL CRE 1% ............................... 122
ELIQUIS TAB 2.5MG ............................84
ELIQUIS TAB 5MG ..............................84
elite magnes tab 100mg.........................96
ELITEK INJ 1.5MG...............................34
ELITEK INJ 7.5MG...............................34
elixophyllin elx 80/15ml ........................ 116
ELIXSURE GEL F/P BGUM ....................12
ELLA TAB 30MG .................................68
ELMIRON CAP 100MG .........................82
?
EMCYT CAP 140MG ........................... 29
EMEND CAP 125MG ........................... 76
EMEND CAP 40MG ............................. 76
EMEND CAP 80MG ............................. 76
EMEND PAK 80 & 125 ......................... 76
emoquette tab .................................... 68
EMSAM DIS 12MG/24H ........................ 53
EMSAM DIS 6MG/24HR ....................... 53
EMSAM DIS 9MG/24HR ....................... 53
EMTRIVA CAP 200MG ......................... 20
EMTRIVA SOL 10MG/ML ...................... 20
10-25 mg .......................................... 35
5-12.5 mg ......................................... 35
enalapril maleate tab 10 mg ................... 36
enalapril maleate tab 2.5 mg .................. 36
enalapril maleate tab 20 mg ................... 36
enalapril maleate tab 5 mg ..................... 36
endocet tab 10-325mg .......................... 15
endocet tab 5-325mg ........................... 15
endocet tab 7.5-325 ............................. 15
enemeez mini ene ............................... 79
enemeez plus ene 20-283 ..................... 79
energy b-12 tab 1500mcg ...................... 99
ENGERIX-B INJ 10/0.5ML ..................... 90
ENGERIX-B INJ 20MCG/ML .................. 90
enoxaparin sodium inj 100 mg/ml ............. 84
enoxaparin sodium inj 120 mg/0.8ml ......... 84
enoxaparin sodium inj 150 mg/ml ............. 84
enoxaparin sodium inj 30 mg/0.3ml .......... 84
enoxaparin sodium inj 300 mg/3ml ........... 84
enpresse-28 tab ................................. 68
entacapone tab 200 mg ........................ 56
entecavir tab 0.5 mg ............................ 23
entecavir tab 1 mg ............................... 23
entre-b sus 6-10mg/5 ......................... 110
entre-cough liq ................................. 110
entre-hist liq 0.938-10 ......................... 110
ENTSOL NASAL GEL ........................ 110
ENUCLENE SOL OP ......................... 105
enulose sol 10gm/15 ............................ 79
e-oil oil 30000unt ................................ 99
141
EPIPEN 2-PAK INJ 0.3MG ................... 115
EPIPEN-JR INJ 2-PAK ........................ 115
epirubicin hcl inj 200 mg/100ml (2 mg/ml)....30
epirubicin hcl inj 50 mg/25ml (2 mg/ml) .......30
epitol tab 200mg ..................................49
EPIVIR HBV SOL 5MG/ML .....................23
EPIVIR SOL 10MG/ML ..........................20
eplerenone tab 25 mg ...........................36
eplerenone tab 50 mg ...........................36
epsom salt gra ....................................79
EPZICOM TAB 600-300 ........................22
eq aspirin tab 500mg ec.........................12
EQL CALCIUM CAP VIT D .....................96
eql lice kit solution .............................. 123
EQL NATURAL POW FIBER...................79
EQUALACTIN CHW 625MG ...................79
ERAXIS INJ 100MG .............................19
ERAXIS INJ 50MG ...............................19
ergocalciferol cap 50000 unit ...................99
ERIVEDGE CAP 150MG .......................31
errin tab 0.35mg ..................................68
ERYPED SUS 200/5ML .........................26
ERYPED SUS 400/5ML .........................26
ery-tab tab 250mg ec ............................26
ery-tab tab 333mg ec ............................26
ery-tab tab 500mg ec ............................26
erythrocin inj 500mg .............................26
erythrocin tab 250mg ............................26
erythromycin ethylsuccinate tab 400 mg .....26
erythromycin gel 2% ........................... 117
erythromycin ophth oint 5 mg/gm ............ 103
erythromycin pads 2% ......................... 117
erythromycin soln 2% .......................... 117
erythromycin tab 250 mg ........................26
erythromycin tab 500 mg ........................26
erythromycin w/ delayed release particles cap
250 mg .............................................26
erythromycin-sulfisoxazole for susp 200-600
mg/5ml .............................................18
escitalopram oxalate soln 5 mg/5ml (base
equiv) ...............................................53
escitalopram oxalate tab 10 mg (base equiv)53
escitalopram oxalate tab 20 mg (base equiv) 53
escitalopram oxalate tab 5 mg (base equiv) .53
esomeprazole sodium for intravenous soln 20
mg (base equiv) ..................................82
?
esomeprazole sodium for intravenous soln 40
mg (base equiv) .................................. 82
estradiol tab 0.5 mg ............................. 71
estradiol tab 1 mg ............................... 71
estradiol tab 2 mg ............................... 71
estradiol td patch weekly 0.025 mg/24hr .... 71
estradiol td patch weekly 0.0375 mg/24hr (37.5
mcg/24hr) ......................................... 71
estradiol td patch weekly 0.05 mg/24hr ...... 71
estradiol td patch weekly 0.06 mg/24hr ...... 71
estradiol td patch weekly 0.075 mg/24hr .... 71
estradiol td patch weekly 0.1 mg/24hr ....... 71
...................................................... 71
estradiol valerate im in oil 20 mg/ml .......... 71
...................................................... 71
ethambutol hcl tab 100 mg ..................... 22
ethambutol hcl tab 400 mg ..................... 22
ethosuximide cap 250 mg ...................... 49
ethosuximide soln 250 mg/5ml ................ 49
etodolac cap 200 mg ............................ 13
etodolac cap 300 mg ............................ 13
etodolac tab 400 mg ............................ 13
etodolac tab 500 mg ............................ 13
etodolac tab sr 24hr 400 mg ................... 13
etoposide inj 500mg/25ml (20 mg/ml) ........ 35
EURAX CRE 10% ............................. 123
EURAX LOT 10% ............................. 123
exefen dmx tab................................. 111
exefen-ir tab 60-400mg ....................... 111
EXELON DIS 13.3/24 ........................... 52
EXELON DIS 4.6MG/24 ........................ 52
EXELON DIS 9.5MG/24 ........................ 52
exemestane tab 25 mg ......................... 31
EXFORGE TAB 10-160MG .................... 37
EXFORGE TAB 10-320MG .................... 37
EXFORGE TAB 5-160MG ..................... 37
EXFORGE TAB 5-320MG ..................... 37
EXFORGEH/10- TAB 160-12.5 ............... 37
EXFORGEH/10- TAB 160-25.................. 37
EXFORGEH/10- TAB 320-25.................. 37
EXFORGEH/5- TAB 160-12.5 ................. 37
EXFORGEH/5- TAB 160-25 ................... 37
142
EXJADE TAB 125MG ...........................67
EXJADE TAB 250MG ...........................67
EXJADE TAB 500MG ...........................67
ex-lax ultra tab 5mg ec ..........................79
EYE ALLERGY SOL RELIEF ................ 104
eye drops sol 0.05% op ....................... 104
eye drops sol a/r ................................ 104
eye wash sol .................................... 105
ezfe 200 cap 200mg .............................85
EZFE FORTE CAP ..............................99
F
FA-8 CAP 800MCG ..............................99
fa-8 tab 0.8mg ....................................99
FABRAZYME INJ 35MG ........................70
FABRAZYME INJ 5MG .........................70
falmina tab .........................................68
famciclovir tab 125 mg ..........................23
famotidine for susp 40 mg/5ml .................77
famotidine in nacl 0.9% iv soln 20 mg/50ml..78
famotidine inj 20 mg/2ml ........................78
famotidine inj 200 mg/20ml .....................78
famotidine inj 40 mg/4ml ........................78
famotidine tab 20 mg ............................78
famotidine tab 20mg .............................78
famotidine tab 40 mg ............................78
FANAPT PAK .....................................57
FANAPT TAB 10MG .............................58
FANAPT TAB 12MG .............................58
FANAPT TAB 1MG ..............................57
FANAPT TAB 2MG ..............................57
FANAPT TAB 4MG ..............................57
FANAPT TAB 6MG ..............................57
FANAPT TAB 8MG ..............................57
FARESTON TAB 60MG.........................31
FASLODEX INJ 250MG.........................31
fast dissolv chw antacid .........................75
father johns syp 10mg/5ml.................... 111
FAZACLO TAB 100/ODT .......................58
FAZACLO TAB 12.5/ODT ......................58
FAZACLO TAB 150MG .........................58
FAZACLO TAB 200MG .........................58
FAZACLO TAB 25MG ODT ....................58
FEBROL SOL 325/5ML .........................12
felbamate susp 600 mg/5ml ....................49
?
felbamate tab 400 mg ........................... 49
felbamate tab 600 mg ........................... 49
felodipine tab sr 24hr 10 mg ................... 43
felodipine tab sr 24hr 2.5 mg .................. 43
felodipine tab sr 24hr 5 mg ..................... 43
fenofibrate micronized cap 130 mg ........... 40
fenofibrate micronized cap 43 mg ............ 40
fenofibrate micronized cap 67 mg ............ 40
fenofibrate tab 145 mg .......................... 40
fenofibrate tab 160 mg .......................... 40
fenofibrate tab 48 mg ........................... 40
fenofibrate tab 54 mg ........................... 40
...................................................... 15
...................................................... 15
...................................................... 15
...................................................... 15
...................................................... 15
...................................................... 15
fentanyl td patch 72hr 100 mcg/hr ............ 15
fentanyl td patch 72hr 12 mcg/hr .............. 15
FEOSOL TAB 45MG ............................ 85
fer-iron dro 15mg/ml............................. 85
FERRETTS IPS SOL ........................... 85
ferretts tab 325mg ............................... 85
FERRIMIN 150 TAB............................. 85
FERROUS FUM TAB 29MG ................... 85
FERROUS FUMA TAB ......................... 85
FERROUS GLUC TAB 225MG ............... 85
ferrous gluc tab 324mg ......................... 85
FERROUS GLUC TAB 324MG ............... 86
ferrous gluconate tab 240 mg (27 mg elemental
fe) .................................................. 86
ferrous gluconate tab 325 mg (36 mg elemental
fe) .................................................. 86
FERROUS SUL LIQ 220/5ML ................. 86
FERROUS SULF SYP 300/5ML .............. 86
143
FERROUS SULF TAB 140MG .................86
FERROUS SULF TAB 324MG EC ............86
ferrous sulf tab 325mg...........................86
ferrous sulfate elixir 220 mg/5ml (44 mg/5ml
elemental fe) ......................................86
ferrous sulfate tab ec 325 mg (65 mg fe
equivalent) .........................................86
FETZIMA CAP 120MG ..........................54
FETZIMA CAP 20MG ...........................53
FETZIMA CAP 40MG ...........................54
FETZIMA CAP 80MG ...........................54
FETZIMA CAP TITRATIO ......................54
FEVERALL INF SUP 80MG ....................12
FEVERALL SUP 120MG ........................12
FEVERALL SUP 325MG ........................12
FEVERALL SUP 650MG ........................13
fexofenadine hcl tab 180 mg ................. 108
fexofenadine-pseudoephedrine tab sr 24hr
180-240 mg ..................................... 111
FIBER CHW .......................................79
fiber laxatv tab 625mg ...........................79
fiber oral powder .................................79
FIBER POW .......................................79
finasteride tab 5 mg ..............................82
FIRAZYR INJ 30MG/3ML .......................87
FLEBOGAMMA INJ 10% .......................88
FLEBOGAMMA INJ 5% .........................88
FLEBOGAMMA INJ DIF 5% ....................88
flecainide acetate tab 100 mg ..................38
flecainide acetate tab 150 mg ..................38
flecainide acetate tab 50 mg ...................38
FLEET BISACO ENE 10/30ML ................79
floranex gra........................................76
FLORASTOR PAK KIDS ........................76
FLOVENT DISK AER 100MCG .............. 116
FLOVENT DISK AER 250MCG .............. 116
FLOVENT DISK AER 50MCG ............... 116
FLOVENT HFA AER 110MCG ............... 116
FLOVENT HFA AER 220MCG ............... 116
FLOVENT HFA AER 44MCG ................ 116
flu/cold/cgh pow daytime ...................... 111
flu/severe pow cold/cgh ....................... 111
fluconazole for susp 10 mg/ml .................19
fluconazole for susp 40 mg/ml .................19
fluconazole in dextrose inj 200 mg/100ml ....19
fluconazole in dextrose inj 400 mg/200ml ....19
?
fluconazole in nacl 0.9% inj 200 mg/100ml .. 19
fluconazole in nacl 0.9% inj 400 mg/200ml .. 19
fluconazole tab 100 mg ......................... 19
fluconazole tab 50 mg .......................... 19
flucytosine cap 250 mg ......................... 19
flucytosine cap 500 mg ......................... 19
fludarabine phosphate for inj 50 mg .......... 30
fludarabine phosphate inj 25 mg/ml .......... 30
fludrocortisone acetate tab 0.1 mg............ 71
flunisolide nasal soln 25 mcg/act (0.025%) 116
fluocin acet oil body ........................... 121
fluocinolone acetonide (otic) oil 0.01% ..... 124
fluocinolone acetonide cream 0.01% ....... 121
fluocinolone acetonide cream 0.025% ..... 121
fluocinolone acetonide oint 0.025% ........ 121
fluocinolone acetonide soln 0.01% ......... 121
fluocinonide cream 0.05%.................... 121
fluocinonide emulsified base cream 0.05% 121
fluocinonide gel 0.05%........................ 121
fluocinonide oint 0.05% ....................... 121
fluocinonide soln 0.05% ...................... 121
FLUOROMETHOLONE OPHTH SUSP 0.1%
.................................................... 104
fluorouracil cream 5% ......................... 122
fluorouracil inj 1 gm/20ml (50 mg/ml)......... 30
fluorouracil inj 2.5 gm/50ml (50 mg/ml) ...... 30
fluorouracil inj 500 mg/10ml (50 mg/ml)...... 30
fluorouracil soln 2% ........................... 122
fluorouracil soln 5% ........................... 122
fluoxetine hcl cap 10 mg........................ 54
fluoxetine hcl solution 20 mg/5ml ............. 54
fluoxetine hcl tab 10 mg ........................ 54
fluoxetine hcl tab 20 mg ........................ 54
fluphenazine decanoate inj 25 mg/ml ........ 58
fluphenazine hcl elixir 2.5 mg/5ml ............ 58
fluphenazine hcl inj 2.5 mg/ml ................. 58
fluphenazine hcl oral conc 5 mg/ml ........... 58
fluphenazine hcl tab 1 mg ...................... 58
fluphenazine hcl tab 10 mg .................... 58
fluphenazine hcl tab 2.5 mg.................... 58
fluphenazine hcl tab 5 mg ...................... 58
flurbiprofen sodium ophth soln 0.03% ...... 104
144
flurbiprofen tab 100 mg ..........................14
flurbiprofen tab 50 mg ...........................14
flutamide cap 125 mg ............................31
fluticasone propionate cream 0.05% ........ 121
fluticasone propionate nasal susp 50 mcg/act
.................................................... 116
fluticasone propionate oint 0.005%.......... 121
fluvoxamine maleate tab 100 mg ..............47
fluvoxamine maleate tab 25 mg................47
fluvoxamine maleate tab 50 mg................47
foam antacid chw 80-20mg .....................75
FOLGARD TAB...................................86
FOLIC ACID CAP 20MG ........................99
FOLIC ACID CAP 5MG .........................99
folic acid inj 5 mg/ml .............................99
folic acid tab 1 mg ................................99
FOLIC ACID TAB 1 MG .........................99
folic acid tab 400 mcg ...........................99
folic acid tab 800 mcg ...........................99
folic acid tab 800mcg ............................99
FOLITAB 500 TAB ...............................86
foltabs 800 tab ....................................86
fondaparinux sodium inj 10 mg/0.8ml .........84
fondaparinux sodium inj 2.5 mg/0.5ml ........84
fondaparinux sodium inj 5 mg/0.4ml ..........84
fondaparinux sodium inj 7.5 mg/0.6ml ........84
FORADIL CAP AEROLIZE ................... 108
FORTEO SOL 600/2.4 ..........................73
FORTICAL SPR 200/ACT ......................73
foscarnet sodium inj 24 mg/ml .................23
10-12.5 mg ........................................35
20-12.5 mg ........................................35
fosinopril sodium tab 10 mg ....................36
FOSRENOL CHW 1000MG ....................73
FOSRENOL CHW 500MG ......................73
FOSRENOL CHW 750MG ......................73
FREAMINE HBC INJ 6.9% .....................92
FREAMINE III INJ 10% .........................92
FRESHKOTE SOL 2.7-2% ................... 105
fruit c-100 chw .................................. 100
fungicure spr intens ............................ 118
FUNGOID TINC KIT ........................... 119
?
FUNGOID TINC SOL 2% .................... 119
furosemide inj 10 mg/ml ........................ 44
furosemide oral soln 10 mg/ml ................ 44
furosemide sol 8mg/ml.......................... 44
furosemide tab 20 mg ........................... 44
FUZEON INJ 90MG ............................. 20
FYCOMPA TAB 10MG ......................... 49
FYCOMPA TAB 12MG ......................... 49
FYCOMPA TAB 2MG ........................... 49
FYCOMPA TAB 4MG ........................... 49
FYCOMPA TAB 6MG ........................... 49
FYCOMPA TAB 8MG ........................... 49
G
gabapentin cap 100 mg ........................ 49
gabapentin oral soln 250 mg/5ml ............. 49
gabapentin tab 600 mg ......................... 49
gabapentin tab 800 mg ......................... 49
GABITRIL TAB 12MG .......................... 49
GABITRIL TAB 16MG .......................... 49
...................................................... 52
...................................................... 52
galantamine hydrobromide cap sr 24hr 8 mg 52
galantamine hydrobromide oral soln 4 mg/ml52
galantamine hydrobromide tab 12 mg........ 52
galantamine hydrobromide tab 4 mg ......... 52
galantamine hydrobromide tab 8 mg ......... 52
GAMASTAN S/D INJ............................ 88
GAMMAGARD INJ 10GM/100 ................ 88
GAMMAGARD INJ 1GM/10ML................ 88
GAMMAGARD INJ 2.5GM/25 ................. 88
GAMMAGARD INJ 20GM/200 ................ 88
GAMMAGARD INJ 30GM/300 ................ 88
GAMMAGARD INJ 5GM/50ML................ 88
GAMMAGARD SD INJ 10GM HU ............ 88
GAMMAGARD SD INJ 2.5GM HU............ 88
GAMMAGARD SD INJ 5GM HU .............. 88
GAMMAKED INJ 10GM/100 ................... 88
GAMMAKED INJ 1GM/10ML .................. 88
GAMMAKED INJ 2.5GM/25 ................... 88
GAMMAKED INJ 20GM/200 ................... 88
145
GAMMAKED INJ 5GM/50ML...................88
GAMMAPLEX INJ 10GM .......................88
GAMMAPLEX INJ 2.5GM.......................88
GAMMAPLEX INJ 5GM .........................88
GAMUNEX-C INJ 10GM/100...................88
GAMUNEX-C INJ 1GM/10ML ..................88
GAMUNEX-C INJ 2.5GM/25 ...................88
GAMUNEX-C INJ 20GM/200...................88
GAMUNEX-C INJ 5GM/50ML ..................88
ganciclovir sodium for inj 500 mg ..............23
GARDASIL INJ ...................................90
gatifloxacin ophth soln 0.5% .................. 103
GAUZE PADS 2" X 2" ...........................65
gavilyte-c sol ......................................79
gavilyte-g sol ......................................79
gavilyte-n sol flav pk .............................79
GAVISCON CHW ................................75
GAVISCON SUS .................................75
gemcitabine hcl for inj 1 gm ....................30
gemcitabine hcl for inj 2 gm ....................30
gemcitabine hcl for inj 200 mg .................30
GEMCITABINE INJ 1GM .......................30
GEMCITABINE INJ 200MG ....................30
GEMCITABINE INJ 2GM .......................30
gemfibrozil tab 600 mg ..........................40
generlac sol 10gm/15 ............................79
gengraf cap 100mg ..............................89
gengraf cap 25mg ................................89
gengraf sol 100mg/ml ...........................89
gentak oin 0.3% op ............................ 103
gentam/nacl inj 0.9mg/ml .......................17
gentam/nacl inj 1.4mg/ml .......................17
gentamicin in saline inj 0.8 mg/ml .............17
gentamicin in saline inj 1 mg/ml ................17
gentamicin in saline inj 2 mg/ml ................17
gentamicin sulfate cream 0.1% .............. 118
gentamicin sulfate inj 10 mg/ml ................17
gentamicin sulfate inj 40 mg/ml ................17
gentamicin sulfate iv soln 10 mg/ml ...........17
gentamicin sulfate oint 0.1% ................. 118
gentamicin sulfate ophth oint 0.3% .......... 103
gentamicin sulfate ophth soln 0.3% ......... 103
GENTEAL GEL ................................. 105
GENTEAL MILD DRO 0.2% .................. 105
?
GENTIAN VIOL SOL 1% ..................... 119
GENTIAN VIOL SOL 2% ..................... 119
gentle laxat sup 10mg .......................... 79
GEODON INJ 20MG ............................ 58
geravim liq ...................................... 100
GERIATRIC LIQ VITAMIN ................... 100
gildagia tab 0.4-35 ............................... 68
gildess tab 1.5/30 ................................ 68
GILENYA CAP 0.5MG .......................... 63
GILOTRIF TAB 20MG .......................... 32
GILOTRIF TAB 30MG .......................... 32
GILOTRIF TAB 40MG .......................... 32
GLEEVEC TAB 100MG ........................ 32
GLEEVEC TAB 400MG ........................ 32
glimepiride tab 1 mg ............................ 66
glipizide tab 10 mg .............................. 66
glipizide tab 5 mg ................................ 66
glipizide tab sr 24hr 10 mg ..................... 66
glipizide tab sr 24hr 2.5 mg .................... 66
glipizide tab sr 24hr 5 mg ...................... 66
glipizide-metformin hcl tab 2.5-250 mg ...... 66
glipizide-metformin hcl tab 2.5-500 mg ...... 66
glipizide-metformin hcl tab 5-500 mg ......... 66
GLUCAGEN INJ HYPOKIT .................... 72
GLUCAGON KIT 1MG .......................... 72
glycopyrrolate inj 4 mg/20ml (0.2 mg/ml) .... 77
glycopyrrolate tab 1 mg ......................... 77
glycopyrrolate tab 2 mg ......................... 77
GNP DAILY MIS PRENATAL................ 100
gnp day time liq cold/flu ...................... 111
gnp ibuprofn tab cold/sin ..................... 111
gnp iron tab 45mg ............................... 86
gnp tussin liq nighttim ......................... 111
GOLYTELY SOL................................. 79
goniotaire sol 2.5% op ........................ 105
GONIOVISC SOL 2% ......................... 106
granisetron hcl inj 0.1 mg/ml ................... 76
granisetron hcl inj 1 mg/ml ..................... 76
granisetron hcl inj 4 mg/4ml (1 mg/ml) ....... 77
granisetron hcl tab 1 mg ........................ 77
GRANIX INJ 300/0.5 ............................ 85
GRANIX INJ 480/0.8 ............................ 85
griseofulvin microsize susp 125 mg/5ml ..... 19
griseofulvin microsize tab 500 mg ............ 19
146
griseofulvin ultramicrosize tab 125 mg........20
griseofulvin ultramicrosize tab 250 mg........20
guaifenesin syrup 100 mg/5ml ............... 111
guaifenesin-codeine soln 100-10 mg/5ml .. 111
gummi bear chw multivit ...................... 100
H
halobetasol propionate cream 0.05% ....... 121
halobetasol propionate oint 0.05% .......... 121
haloperidol decanoate im soln 100 mg/ml....58
haloperidol decanoate im soln 50 mg/ml .....58
haloperidol lactate inj 5 mg/ml .................58
haloperidol lactate oral conc 2 mg/ml .........58
haloperidol tab 0.5 mg ...........................58
haloperidol tab 1 mg .............................58
haloperidol tab 10 mg ...........................58
haloperidol tab 20 mg ...........................58
HAVRIX INJ 1440UNIT .........................90
HAVRIX INJ 720UNIT ...........................90
hc-1% hemorr oin 1% ......................... 121
headache tab 25-500mg ........................64
heather tab 0.35mg ..............................68
HEP SOD/D5W INJ 25000UNT ................84
HEP SOD/NACL INJ 25000UNT ..............84
HEPARIN SOD INJ 2000/ML...................84
HEPARIN SOD INJ 2500/ML...................84
HEPARIN SODIUM (PORCINE) 2 UNIT/ML IN
SODIUM CHLORIDE 0.9% .....................84
IN D5W ............................................84
heparin sodium (porcine) inj 1000 unit/ml ....84
heparin sodium (porcine) inj 10000 unit/ml ..84
heparin sodium (porcine) inj 20000 unit/ml ..84
heparin sodium (porcine) inj 5000 unit/ml ....84
HEPATAMINE SOL 8% .........................92
HERCEPTIN INJ 440MG .......................31
HEXALEN CAP 50MG ..........................29
HIBERIX SOL 10MCG ..........................90
HONEY BEARS CHW ......................... 100
HONEY BEARS CHW IRON-ZIN ............ 100
HUMIRA KIT 20MG/0.4 .........................87
HUMIRA KIT 40MG/0.8 .........................87
HUMIRA PEN KIT 40MG/0.8 ...................87
HUMIRA PEN KIT CROHNS ...................87
HUMIRA PEN KIT PSORIASI ..................87
?
HUMULIN R INJ U-500 ......................... 65
hydralazine hcl inj 20 mg/ml ................... 45
hydralazine hcl tab 10 mg ...................... 45
hydralazine hcl tab 100 mg .................... 45
hydrochlorothiazide cap 12.5 mg ............. 45
hydrochlorothiazide tab 12.5 mg .............. 45
hydrochlorothiazide tab 25 mg ................ 45
hydrochlorothiazide tab 50 mg ................ 45
HYDROCIL INS POW 95% .................... 79
hydrocodone-acetaminophen soln 7.5-325
mg/15ml ........................................... 14
hydrocodone-acetaminophen tab 10-325 mg14
hydrocodone-acetaminophen tab 5-325 mg 14
hydrocodone-acetaminophen tab 7.5-325 mg
...................................................... 14
hydrocodone-ibuprofen tab 7.5-200 mg ..... 14
HYDROCORT AC CRE 0.5% ............... 121
HYDROCORT/ OIN ALOE 1% .............. 121
hydrocortisone butyrate cream 0.1% ....... 121
hydrocortisone butyrate oint 0.1% .......... 121
hydrocortisone butyrate soln 0.1%.......... 121
hydrocortisone cream 0.5% .................. 121
hydrocortisone cream 1% .................... 121
hydrocortisone cream 2.5% .................. 121
hydrocortisone enema 100 mg/60ml ......... 78
HYDROCORTISONE ENEMA 100 MG/60ML
...................................................... 78
hydrocortisone lotion 2.5% ................... 121
hydrocortisone oint 0.5% ..................... 121
hydrocortisone oint 1% ....................... 121
hydrocortisone oint 2.5% ..................... 121
hydrocortisone tab 10 mg ...................... 71
hydrocortisone tab 20 mg ...................... 72
hydrocortisone tab 5 mg ........................ 71
hydrocortisone valerate cream 0.2% ....... 121
hydrocortisone valerate oint 0.2% .......... 121
hydrocortisone-aloe vera cream 0.5% ..... 121
hydrocortisone-aloe vera cream 1% ........ 121
hydromorphone hcl liqd 1 mg/ml .............. 15
hydromorphone hcl preservative free (pf) inj 10
mg/ml .............................................. 15
hydromorphone hcl tab 2 mg .................. 15
147
hydroxocobalamin inj 1000 mcg/ml ......... 100
hydroxychloroquine sulfate tab 200 mg ......87
hydroxyurea cap 500 mg ........................33
hydroxyzine hcl im soln 25 mg/ml ........... 108
hydroxyzine hcl im soln 50 mg/ml ........... 108
HYPOTEARS SOL 1-1% ..................... 106
I
ibandronate sodium tab 150 mg (base
equivalent) .........................................67
ibuprofen cap 200 mg ...........................13
ibuprofen dro 50/1.25 ............................13
ibuprofen jr chw 100mg .........................13
ibuprofen pm tab 200-38mg ....................64
ibuprofen sus 100/5ml ...........................13
ibuprofen susp 100 mg/5ml .....................14
ibuprofen tab 400 mg ............................14
ibuprofen tab 600 mg ............................14
ibuprofen tab 800 mg ............................14
icaps cap ........................................ 100
ICAPS LUTEIN TAB ZEAXANTH ........... 100
icaps mv tab..................................... 100
ICLUSIG TAB 15MG.............................32
ICLUSIG TAB 45MG.............................32
idarubicin hcl iv inj 10 mg/10ml (1 mg/ml) ....30
idarubicin hcl iv inj 20 mg/20ml (1 mg/ml) ....30
idarubicin hcl iv inj 5 mg/5ml (1 mg/ml) .......30
IFEX INJ 3GM ....................................29
ifosfamide for inj 1 gm ...........................29
IFOSFAMIDE INJ 3GM .........................29
ifosfamide iv inj 1 gm/20ml (50 mg/ml) .......29
ifosfamide iv inj 3 gm/60ml (50 mg/ml) .......29
ILEVRO DRO 0.3% OP ....................... 104
IMBRUVICA CAP 140MG ......................32
imipenem-cilastatin intravenous for soln 250
mg ..................................................18
imipenem-cilastatin intravenous for soln 500
mg ..................................................18
imipramine hcl tab 10 mg .......................54
imiquimod cream 5% .......................... 122
IMOVAX RABIE INJ 2.5/ML ....................90
INCRELEX INJ 40MG/4ML .....................73
indapamide tab 1.25 mg ........................45
indapamide tab 2.5 mg ..........................45
INFANRIX INJ ....................................90
?
INLYTA TAB 1MG ............................... 32
INLYTA TAB 5MG ............................... 32
INSULIN PEN NEEDLE ........................ 65
INSULIN SAFETY NEEDLES ................. 65
INSULIN SYRINGE ............................. 65
INTEGRA CAP ................................... 86
INTELENCE TAB 100MG ...................... 20
INTELENCE TAB 200MG ...................... 20
INTELENCE TAB 25MG ....................... 20
intense cold tab /flu med ..................... 111
intense coug liq reliever ...................... 111
INTRALIPID INJ 20% ........................... 92
INTRALIPID INJ 30% ........................... 92
INTRON-A INJ 10MU ........................... 89
INTRON-A INJ 18MU ........................... 89
INTRON-A INJ 25MU ........................... 89
INTRON-A INJ 50MU ........................... 89
introvale tab ...................................... 68
INTUNIV TAB 1MG ............................. 61
INTUNIV TAB 2MG ............................. 61
INTUNIV TAB 3MG ............................. 61
INTUNIV TAB 4MG ............................. 61
INVANZ INJ 1GM................................ 18
INVEGA SUST INJ 117/0.75 .................. 58
INVEGA SUST INJ 156MG/ML ............... 58
INVEGA SUST INJ 234/1.5 .................... 58
INVEGA SUST INJ 39/0.25 .................... 58
INVEGA SUST INJ 78/0.5ML.................. 58
INVEGA TAB 1.5MG ............................ 58
INVEGA TAB 3MG .............................. 58
INVEGA TAB 6MG .............................. 58
INVEGA TAB 9MG .............................. 58
INVIRASE CAP 200MG ........................ 20
INVIRASE TAB 500MG ........................ 20
INVOKAMET TAB 150-1000 .................. 66
INVOKAMET TAB 150-500 .................... 66
INVOKAMET TAB 50-1000 .................... 66
INVOKAMET TAB 50-500MG ................. 66
INVOKANA TAB 100MG ....................... 66
INVOKANA TAB 300MG ....................... 66
IONOSOL-B/ INJ D5W ......................... 93
IONOSOL-MB INJ /D5W ....................... 93
IPOL INJ INACTIVE ............................. 90
ipratropium bromide inhal soln 0.02% ...... 107
ipratropium bromide nasal soln 0.03% (21
mcg/spray) ...................................... 107
148
ipratropium bromide nasal soln 0.06% (42
mcg/spray) ...................................... 107
ipratropium-albuterol nebu soln 0.5-2.5(3)
mg/3ml ........................................... 106
irinotecan hcl inj 100 mg/5ml (20 mg/ml) .....35
irinotecan hcl inj 40 mg/2ml (20 mg/ml) ......35
irinotecan hcl inj 500 mg/25ml (20 mg/ml) ...35
iromin-g tab...................................... 100
iron 100 tab plus ..................................86
iron 100/c tab 100-250 ..........................86
iron chews chw pediatri .........................86
IRON TAB 18MG .................................86
IRON TAB 18MG CR ............................86
iron tab 28mg .....................................86
IRON TAB 28MG .................................86
iron therapy tab 200mg ..........................86
IRON UP LIQ .....................................86
ISENTRESS CHW 100MG .....................21
ISENTRESS CHW 25MG .......................21
ISENTRESS POW 100MG .....................21
ISENTRESS TAB 400MG ......................21
ISOLYTE-P INJ /D5W ...........................93
isolyte-s inj ........................................93
isoniazid inj 100 mg/ml ..........................22
isoniazid syrup 50 mg/5ml ......................22
isoniazid tab 100 mg .............................22
isoniazid tab 300 mg .............................22
ISOPTO TEARS SOL 0.5% OP ............. 106
isosorbide dinitrate tab 10 mg ..................46
isosorbide dinitrate tab 5 mg ...................46
isosorbide dinitrate tab cr 40 mg ...............46
isosorbide mononitrate tab 10 mg .............46
isosorbide mononitrate tab 20 mg .............46
isosorbide mononitrate tab sr 24hr 120 mg ..46
isosorbide mononitrate tab sr 24hr 30 mg....46
isosorbide mononitrate tab sr 24hr 60 mg....46
isradipine cap 2.5 mg ............................43
isradipine cap 5 mg ..............................43
ISTALOL SOL 0.5% OP....................... 105
ISTODAX INJ 10MG .............................31
itraconazole cap 100 mg ........................20
IXIARO INJ ........................................90
J
JAKAFI TAB 10MG ..............................32
?
JAKAFI TAB 15MG.............................. 32
JAKAFI TAB 20MG.............................. 32
JAKAFI TAB 25MG.............................. 33
JAKAFI TAB 5MG ............................... 32
JALYN CAP ...................................... 82
jantoven tab 10mg ............................... 84
jantoven tab 1mg ................................ 84
jantoven tab 2.5mg .............................. 84
jantoven tab 2mg ................................ 84
jantoven tab 3mg ................................ 84
jantoven tab 4mg ................................ 84
jantoven tab 5mg ................................ 84
jantoven tab 6mg ................................ 84
jantoven tab 7.5mg .............................. 84
JANUMET TAB 50-1000 ....................... 66
JANUMET TAB 50-500MG .................... 66
JANUMET XR TAB 100-1000 ................. 66
JANUMET XR TAB 50-1000 ................... 66
JANUMET XR TAB 50-500MG ................ 66
JANUVIA TAB 100MG .......................... 66
JANUVIA TAB 25MG ........................... 66
JANUVIA TAB 50MG ........................... 66
JENTADUETO TAB 2.5-1000 ................. 66
JENTADUETO TAB 2.5-500 ................... 66
JENTADUETO TAB 2.5-850 ................... 66
J-MAX SYP 5-200MG ........................ 111
JOLIVETTE TAB 0.35MG ...................... 68
J-TAN D PD DRO 1-7.5MG .................. 111
J-TAN PD DRO 1MG/ML ..................... 108
junel 1.5/30 tab................................... 68
junel 1/20 tab ..................................... 68
junel fe tab 1.5/30 ............................... 68
junel fe tab 1/20 .................................. 68
K
KADCYLA INJ 100MG .......................... 31
KADCYLA INJ 160MG .......................... 31
KALETRA SOL................................... 22
KALETRA TAB 100-25MG ..................... 22
KALETRA TAB 200-50MG ..................... 22
kaopectate sus 262/15ml ....................... 76
kariva tab 28 day ................................ 68
NACL 0.45% INJ................................. 93
NACL 0.2% INJ .................................. 93
149
NACL 0.33% INJ .................................93
NACL 0.45% INJ .................................93
NACL 0.9% INJ ...................................93
kcl 20 meq/l (0.15%) in nacl 0.45% inj ........93
KCL 20 MEQ/L (0.15%) IN NACL 0.45% INJ 93
KCL 20 MEQ/L (0.15%) IN NACL 0.9% INJ .93
NACL 0.45% INJ .................................93
NACL 0.45% INJ .................................93
KCL 40 MEQ/L (0.3%) IN NACL 0.9% INJ ...93
KCL/D5W/NACL INJ 0.15/0.2 ..................93
KCL/D5W/NACL INJ 0.3/0.9% .................93
ketoconazole cream 2%....................... 119
ketoconazole shampoo 2% ................... 119
ketoconazole tab 200 mg .......................20
ketoprofen cap 50 mg ...........................14
ketoprofen cap 75 mg ...........................14
ketorolac tromethamine ophth soln 0.4% .. 104
ketorolac tromethamine ophth soln 0.5% .. 104
ketotif fum dro 0.025%op ..................... 104
kidkare liq cgh/cold............................. 111
kionex pow ........................................67
kionex sus 15gm/60 .............................67
KLOR-CON 10 TAB 10MEQ ER ...............91
KLOR-CON 8 TAB 8MEQ ER ..................91
klor-con m15 tab .................................91
klor-con pow 20meq .............................91
konsyl cap 520mg ................................79
KONSYL POW 100% ............................79
konsyl pow 28.3% ................................79
KONSYL POW 28.3% ...........................79
konsyl pow 30.9% ................................79
KONSYL POW 60.3% ...........................79
KONSYL POW 71.67% .........................79
KONSYL-D POW 52.3% ........................79
kp ca/mg/zn tab...................................96
kp calcium cap 600+d ...........................96
kp calcium tab 600+d ............................96
kp vitamin e cap 100unit ...................... 100
KPN PRENATAL TAB ......................... 100
KUVAN POW 100MG ...........................70
KUVAN TAB 100MG.............................70
?
L
labetalol hcl tab 100 mg ........................ 41
laclotion lot 12% ............................... 122
LACTATED RINGER'S SOLUTION .......... 93
lactic acid (ammonium lactate) cream 12% 122
lactic acid (ammonium lactate) lotion 12% 122
lactobacillus tab .................................. 76
lactulose (encephalopathy) solution 10
gm/15ml ........................................... 79
lactulose solution 10 gm/15ml ................. 79
LAMISIL ADV GEL 1% ....................... 119
lamisil af aer 1% ............................... 119
lamisil af pow defense ........................ 119
LAMISIL AT SPR 1% ......................... 119
lamivudine tab 100 mg.......................... 23
lamivudine-zidovudine tab 150-300 mg ...... 22
lamotrigine tab 100 mg ......................... 49
lamotrigine tab 25 mg ........................... 49
lamotrigine tab chewable dispersible 25 mg 50
lamotrigine tab chewable dispersible 5 mg .. 50
lamotrigine tab sr 24hr 100 mg ................ 50
lamotrigine tab sr 24hr 25 mg ................. 50
lamotrigine tab sr 24hr 50 mg ................. 50
LANOXIN TAB 0.125MG ....................... 44
LANOXIN TAB 0.25MG ........................ 44
lansoprazole cap 15mg dr...................... 82
LANTUS INJ 100/ML............................ 65
LANTUS INJ SOLOSTAR ...................... 65
larin fe tab 1.5/30 ................................ 68
larin fe tab 1/20 .................................. 68
larin tab 1.5/30 ................................... 68
larin tab 1/20 ..................................... 68
LASTACAFT SOL 0.25% .................... 104
latanoprost ophth soln 0.005% .............. 105
LATUDA TAB 120MG .......................... 59
LATUDA TAB 20MG ............................ 58
LATUDA TAB 40MG ............................ 58
150
LATUDA TAB 60MG .............................58
LATUDA TAB 80MG .............................59
lax diet sup tab 500mg ..........................79
laxative chw 15mg ...............................79
LAZANDA SPR 100MCG .......................15
LAZANDA SPR 400MCG .......................15
leflunomide tab 10 mg ...........................87
leflunomide tab 20 mg ...........................87
lessina tab .........................................68
LETAIRIS TAB 10MG ...........................47
LETAIRIS TAB 5MG .............................47
letrozole tab 2.5 mg ..............................31
leucovorin calcium for inj 100 mg ..............34
leucovorin calcium for inj 50 mg ...............34
leucovorin calcium tab 10 mg ..................34
leucovorin calcium tab 5 mg ....................34
leucovorin inj calcium ............................34
LEUKERAN TAB 2MG ..........................29
LEUKINE INJ 250MCG .........................85
leuprolide acetate inj kit 5 mg/ml...............31
levalbuterol hcl soln nebu conc 1.25 mg/0.5ml
(base equiv) ..................................... 108
LEVEMIR INJ .....................................65
LEVEMIR INJ FLEXPEN ........................65
LEVEMIR INJ FLEXTOUC .....................65
levetiracetam inj 500 mg/5ml (100 mg/ml) ...50
levetiracetam oral soln 100 mg/ml .............50
levetiracetam tab 1000 mg .....................50
levetiracetam tab 250 mg .......................50
levetiracetam tab sr 24hr 500 mg..............50
levetiracetam tab sr 24hr 750 mg..............50
LEVOBUNOLOL HCL OPHTH SOLN 0.25%
.................................................... 105
levobunolol hcl ophth soln 0.5% ............. 105
levocarnitine inj 200 mg/ml .....................70
levocarnitine oral soln 1 gm/10ml (10%) .....70
levocarnitine tab 330 mg ........................70
levocetirizine dihydrochloride soln 2.5 mg/5ml
(0.5 mg/ml) ...................................... 108
levocetirizine dihydrochloride tab 5 mg ..... 108
?
levofloxacin in d5w iv soln 250 mg/50ml ..... 26
levofloxacin in d5w iv soln 500 mg/100ml ... 26
levofloxacin in d5w iv soln 750 mg/150ml ... 26
levofloxacin iv soln 25 mg/ml .................. 26
levofloxacin oral soln 25 mg/ml................ 27
levofloxacin tab 250 mg ........................ 27
levonest tab....................................... 68
levonorgestrel & ethinyl estradiol (91-day) tab
0.15-0.03 mg ..................................... 68
levonorgestrel & ethinyl estradiol tab 0.1 mg-20
mcg ................................................ 68
levonorgestrel tab 0.75 mg ..................... 68
levonorgestrel tab 1.5 mg ...................... 68
levora-28 tab 0.15/30 ........................... 68
levothyroxine sodium tab 100 mcg ........... 74
levothyroxine sodium tab 25 mcg ............. 74
LEVOXYL TAB 100MCG ....................... 74
LEVOXYL TAB 112MCG ....................... 74
LEVOXYL TAB 125MCG ....................... 74
LEVOXYL TAB 137MCG ....................... 74
LEVOXYL TAB 150MCG ....................... 74
LEVOXYL TAB 175MCG ....................... 74
LEVOXYL TAB 200MCG ....................... 74
LEVOXYL TAB 25MCG ........................ 74
LEVOXYL TAB 50MCG ........................ 74
LEVOXYL TAB 75MCG ........................ 74
LEVOXYL TAB 88MCG ........................ 74
LEXIVA SUS 50MG/ML ........................ 21
LEXIVA TAB 700MG ............................ 21
LIALDA TAB 1.2GM ............................. 78
lice killing liq max st ........................... 123
lice killing sha 0.33-4% ....................... 123
lice trtmnt liq .................................... 123
lice trtmnt liq 1% ............................... 123
151
licide aer 0.5% .................................. 123
LICIDE TREAT KIT ............................ 123
lidocaine hcl gel 2% ............................ 122
lidocaine hcl local inj 0.5% ......................17
lidocaine hcl local inj 1% ........................17
lidocaine hcl local inj 1.5% ......................17
lidocaine hcl local inj 2% ........................17
lidocaine hcl local preservative free (pf) inj 0.5%
......................................................17
lidocaine hcl local preservative free (pf) inj 1%
......................................................17
lidocaine hcl soln 4% .......................... 122
lidocaine hcl viscous soln 2% ................ 123
lidocaine oint 5% ............................... 122
lidocaine patch 5% ............................. 122
lidocaine-prilocaine cream 2.5-2.5% ........ 122
LINZESS CAP 145MCG ........................81
LINZESS CAP 290MCG ........................81
liothyronine sodium tab 25 mcg ................74
liothyronine sodium tab 5 mcg .................74
liothyronine sodium tab 50 mcg ................74
liq ca/vit d cap 600mg ...........................96
LIQUID CALCI CAP WITH D3 .................96
liquituss gg liq 200/5ml ........................ 111
......................................................35
......................................................35
lisinopril & hydrochlorothiazide tab 20-25 mg35
lisinopril tab 10 mg ...............................36
lisinopril tab 2.5 mg ..............................36
lisinopril tab 5 mg.................................36
lithium carbonate cap 150 mg ..................62
lithium carbonate tab 300 mg ..................62
lithium carbonate tab cr 300 mg ...............62
lithium carbonate tab cr 450 mg ...............62
LITHIUM SOL 8MEQ/5ML ......................62
LITTLE NOSES DRO 0.125% ............... 111
LOCALNESIUM TAB ............................96
LOCALNESIUM TAB -C ........................96
LODRANE D CAP 4-60MG ................... 111
?
LOHIST-D LIQ ................................. 111
lohist-dm syp 5-2-10mg ...................... 111
lohist-peb liq 4-10/5ml ........................ 111
LOKARA LOT 0.05% ......................... 121
LOMUSTINE CAP 10 MG ...................... 29
LOMUSTINE CAP 100 MG .................... 29
LOMUSTINE CAP 40 MG ...................... 29
loperamide hcl cap 2 mg ....................... 81
loperamide hcl liq 1 mg/7.5ml ................. 76
loratadine & pseudoephedrine tab sr 24hr
10-240 mg ...................................... 111
loratadine tab 10 mg .......................... 108
lorazepam con 2mg/ml ......................... 47
lorazepam inj 2 mg/ml .......................... 47
lorazepam inj 4 mg/ml .......................... 47
lorazepam tab 0.5 mg ........................... 47
lorazepam tab 1 mg ............................. 47
lorazepam tab 2 mg ............................. 47
LORTUSS DM LIQ ............................ 111
LORTUSS EX LIQ ............................. 111
LORTUSS LQ LIQ ............................. 111
loryna tab 3-0.02mg ............................. 68
100-12.5 mg ...................................... 37
100-25 mg ........................................ 37
50-12.5 mg ....................................... 37
losartan potassium tab 100 mg................ 38
losartan potassium tab 25 mg ................. 38
losartan potassium tab 50 mg ................. 38
LOTEMAX GEL 0.5% ......................... 104
LOTEMAX OIN 0.5% ......................... 104
LOTEMAX SUS 0.5% ......................... 104
LOTRIMIN ULT CRE 1% ..................... 119
LOTRONEX TAB 0.5MG ....................... 81
LOTRONEX TAB 1MG ......................... 81
lovastatin tab 10 mg ............................. 39
low-ogestrel tab .................................. 68
loxapine succinate cap 10 mg ................. 59
loxapine succinate cap 5 mg .................. 59
lubr/dry eye dro 0.5-0.9% .................... 106
152
lubricnt eye dro 0.5% op ...................... 106
lubricnt gel dro 1% ............................. 106
LUMIGAN SOL 0.01%......................... 105
LUMITENE CAP 30MG ....................... 100
LUMIZYME INJ 50MG...........................70
LUPR DEP-PED INJ 11.25MG.................31
LUPR DEP-PED INJ 15MG ....................31
LUPR DEP-PED INJ 30MG ....................31
LUPR DEP-PED INJ 7.5MG ....................31
LUPRON DEPOT INJ 11.25MG ...............32
LUPRON DEPOT INJ 3.75MG .................31
LUSAIR LIQ ..................................... 111
lutera tab...........................................69
LYRICA CAP 100MG ............................50
LYRICA CAP 150MG ............................50
LYRICA CAP 200MG ............................50
LYRICA CAP 225MG ............................50
LYRICA CAP 25MG .............................50
LYRICA CAP 300MG ............................50
LYRICA CAP 50MG .............................50
LYRICA CAP 75MG .............................50
LYRICA SOL 20MG/ML .........................50
LYSODREN TAB 500MG .......................32
lyza tab 0.35mg...................................69
M
maalox child chw .................................75
maalox multi sus symp max ....................75
maalox sus reg st ................................75
MAALOX TC SUS ................................75
mafenide acetate packet for topical soln 5% (50
gm) ............................................... 118
MAG CITRATE TAB 100MG ...................96
MAG OXIDE CAP 400MG ......................76
MAG-200 TAB ....................................96
MAG-AL LIQ ......................................76
mag-delay tab.....................................96
MAGINEX TAB 615 MG.........................96
MAGN SULFATE CAP 70MG ..................96
magnacaps cap 100mg .........................96
MAGNEBIND TAB 200 ..........................96
MAGNEBIND TAB 300 ..........................96
MAGNESIUM CAP 300MG .....................96
MAGNESIUM CAP 400MG .....................96
magnesium citrate soln ..........................79
MAGNESIUM GL TAB 550MG.................96
magnesium oxide tab 250 mg ..................76
?
magnesium oxide tab 400 mg ................. 76
magnesium oxide tab 400 mg (240 mg
elemental mg) .................................... 96
magnesium oxide tab 400 mg (241.3 mg
elemental mg) .................................... 97
magnesium oxide tab 420 mg ................. 76
magnesium oxide tab 500 mg (mg supplement)
...................................................... 97
MAGNESIUM SU INJ 40MG/ML .............. 91
MAGNESIUM SU INJ 80MG/ML .............. 91
magnesium sulfate inj 50% .................... 91
MAGNESIUM SULFATE INJ 50% ............ 91
magnesium tab 200 mg ........................ 97
magnesium tab 250 mg ........................ 97
MAGNESIUM TAB 30MG ...................... 97
MAG-TAB SR TAB 84MG ...................... 96
malathion lotion 0.5% ......................... 123
mapap cold tab 10-5-325 ..................... 111
maprotiline hcl tab 25 mg ...................... 54
MAR-COF BP LIQ ............................. 111
marlissa tab 0.15/30 ............................ 69
MARPLAN TAB 10MG.......................... 54
MATULANE CAP 50MG........................ 33
MAXIDEX SUS 0.1% OP ..................... 104
m-clear wc liq................................... 111
meclizine hcl tab 12.5 mg ...................... 77
meclizine hcl tab 25 mg ........................ 77
MEDI-GRAINE TAB ........................... 111
medroxyprogesterone acetate im susp 150
mg/ml .............................................. 69
medroxyprogesterone acetate tab 10 mg ... 74
medroxyprogesterone acetate tab 2.5 mg ... 73
medroxyprogesterone acetate tab 5 mg ..... 74
mefloquine hcl tab 250 mg ..................... 20
MEGACE ES SUS 625/5ML ................... 32
mega-maratho tab 100 tr ..................... 100
megestrol acetate susp 40 mg/ml ............. 32
megestrol acetate tab 20 mg .................. 32
megestrol acetate tab 40 mg .................. 32
MEKINIST TAB 0.5MG ......................... 33
MEKINIST TAB 2MG ........................... 33
MELOXICAM SUSP 7.5 MG/5ML ............ 14
meloxicam tab 15 mg ........................... 14
meloxicam tab 7.5 mg .......................... 14
153
melphalan hcl for inj 50 mg (base equiv) .....29
MENACTRA INJ ..................................90
m-end dm liq .................................... 111
M-END DMX LIQ ............................... 111
M-END MAX D LIQ ............................ 111
M-END PE LIQ ................................. 111
m-end wc liq ..................................... 111
MENOMUNE INJ A/C/Y/W .....................90
MENVEO INJ .....................................90
MEPHYTON TAB 5MG ....................... 100
mercaptopurine tab 50 mg ......................30
meribin cap 5mg ................................ 100
meropenem iv for soln 1 gm ....................18
meropenem iv for soln 500 mg .................18
mesalamine enema 4 gm .......................78
mesalamine rectal enema 4 gm & cleanser
wipe kit .............................................78
mesna inj 100 mg/ml.............................34
MESNEX TAB 400MG ..........................34
METAMUCIL POW 28% ........................79
METAMUCIL POW 63% ........................79
METAMUCIL WAF ...............................79
metformin hcl tab 1000 mg .....................66
metformin hcl tab 500 mg .......................66
metformin hcl tab 850 mg .......................66
metformin hcl tab sr 24hr 500 mg .............66
metformin hcl tab sr 24hr 750 mg .............66
methadone con 10mg/ml ........................15
methadone hcl soln 10 mg/5ml ................15
methadone hcl soln 5 mg/5ml ..................15
methadone hcl tab 10 mg .......................15
methadone hcl tab 5 mg ........................15
methazolamide tab 25 mg ......................45
methazolamide tab 50 mg ......................45
methenamine hippurate tab 1 gm .............18
methimazole tab 10 mg .........................74
methimazole tab 5 mg ...........................74
methotrexate sodium for inj 1 gm ..............30
methotrexate sodium inj 25 mg/ml ............30
methotrexate sodium inj pf 25 mg/ml .........30
methotrexate sodium tab 2.5 mg (base equiv)
......................................................87
methyclothiazide tab 5 mg ......................45
methylergonovine maleate tab 0.2 mg ........73
methylphenidate hcl soln 10 mg/5ml ..........61
methylphenidate hcl soln 5 mg/5ml ...........61
?
methylphenidate hcl tab 10 mg ................ 61
methylphenidate hcl tab 20 mg ................ 61
methylphenidate hcl tab 5 mg ................. 61
methylphenidate hcl tab cr 10 mg ............. 61
methylphenidate hcl tab cr 20 mg ............. 61
...................................................... 72
...................................................... 72
1000 mg ........................................... 72
125 mg ............................................ 72
methylprednisolone sodium succinate for inj 40
mg .................................................. 72
methylprednisolone tab 16 mg ................ 72
methylprednisolone tab 32 mg ................ 72
methylprednisolone tab 4 mg .................. 72
methylprednisolone tab 4 mg dose pack .... 72
methylprednisolone tab 8 mg .................. 72
metipranolol ophth soln 0.3% ................ 105
metoclopramide hcl inj 5 mg/ml ............... 77
metoclopramide hcl soln 5 mg/5ml (10
mg/10ml) .......................................... 77
metoclopramide hcl tab 10 mg ................ 77
metoclopramide hcl tab 5 mg .................. 77
metolazone tab 10 mg .......................... 45
metolazone tab 2.5 mg ......................... 45
metolazone tab 5 mg............................ 45
metoprolol & hydrochlorothiazide tab 100-25
mg .................................................. 40
metoprolol & hydrochlorothiazide tab 100-50
mg .................................................. 41
metoprolol & hydrochlorothiazide tab 50-25 mg
...................................................... 40
metoprolol succinate tab sr 24hr 100 mg .... 41
metoprolol succinate tab sr 24hr 200 mg .... 41
metoprolol succinate tab sr 24hr 25 mg ..... 41
metoprolol succinate tab sr 24hr 50 mg ..... 41
metoprolol tartrate inj 1 mg/ml ................. 41
metoprolol tartrate tab 100 mg ................ 41
metoprolol tartrate tab 25 mg .................. 41
metoprolol tartrate tab 50 mg .................. 41
metronidazole cream 0.75% ................. 122
metronidazole gel 0.75% ..................... 122
metronidazole in nacl 0.79% iv soln 500
mg/100ml ......................................... 18
154
metronidazole lotion 0.75% ................... 122
metronidazole tab 250 mg ......................18
metronidazole tab 500 mg ......................18
metronidazole vaginal gel 0.75% ..............83
mexiletine hcl cap 150 mg ......................38
MEXSANA POW ............................... 122
MG GLUCONATE TAB 250MG ................97
MG SO4/D5W INJ 10MG/ML...................91
MG SO4/D5W INJ 20MG/ML...................91
MIACALCIN INJ 200/ML ........................73
mi-acid chw........................................76
miconazole 3 cre 4% ............................83
miconazole 3 kit combinat ......................83
miconazole 3 kit combo pk .....................83
miconazole 7 cre tube/kit .......................83
miconazole 7 sup 100mg .......................83
miconazole nitrate vaginal supp 1200 mg & 2%
cream kit ...........................................83
microgestin tab 1.5/30 ...........................69
microgestin tab 1/20 .............................69
microgestin tab fe 1/20 ..........................69
microgestin tab fe1.5/30.........................69
midodrine hcl tab 10 mg.........................45
midodrine hcl tab 2.5 mg ........................45
midodrine hcl tab 5 mg ..........................45
MILK OF MAGN SUS 2400MG ................79
MILK OF MAGN SUS 800/5ML ................79
milk of magn sus frsh mnt.......................79
MINERAL OIL.....................................80
mineral oil enema ................................80
minitran dis 0.1mg/hr ............................46
minocycline hcl cap 100 mg ....................29
minocycline hcl cap 50 mg ......................29
minocycline hcl cap 75 mg ......................29
minoxidil tab 10 mg ..............................46
minoxidil tab 2.5 mg .............................45
mintox plus chw ..................................76
mirtazapine orally disintegrating tab 15 mg ..54
mirtazapine tab 15 mg ...........................54
?
mirtazapine tab 30 mg .......................... 54
mirtazapine tab 45 mg .......................... 54
mirtazapine tab 7.5 mg ......................... 54
misoprostol tab 100 mcg ....................... 81
misoprostol tab 200 mcg ....................... 81
MISSION PREN TAB ......................... 100
MISSION PREN TAB HP .................... 100
mitomycin for inj 20 mg ......................... 30
mitomycin for inj 40 mg ......................... 30
mitomycin for inj 5 mg .......................... 30
...................................................... 33
mitoxantrone hcl inj conc 25 mg/12.5ml (2
mg/ml) ............................................. 33
...................................................... 33
mitrazol pow 2% ............................... 119
M-M-R II INJ LIVE ............................... 90
moderiba pak 1000/day ........................ 23
moderiba pak 1200/day ........................ 23
moderiba pak 600/day .......................... 23
moderiba pak 800/day .......................... 23
moexipril hcl tab 15 mg ......................... 36
moexipril hcl tab 7.5 mg ........................ 36
moexipril-hydrochlorothiazide tab 15-12.5 mg
...................................................... 35
moexipril-hydrochlorothiazide tab 15-25 mg 35
moexipril-hydrochlorothiazide tab 7.5-12.5 mg
...................................................... 35
mometasone furoate cream 0.1% .......... 121
mometasone furoate oint 0.1% .............. 121
mometasone furoate solution 0.1% (lotion) 121
MONONESSA TAB ............................. 69
montelukast sodium chew tab 4 mg (base
equiv) ............................................ 115
montelukast sodium chew tab 5 mg (base
equiv) ............................................ 115
montelukast sodium oral granules packet 4 mg
(base equiv) .................................... 115
montelukast sodium tab 10 mg (base equiv)
.................................................... 115
MORPHINE SUL INJ 2MG/ML ................ 15
MORPHINE SULFATE (CONCENTRATE)
ORAL SOLN 20 MG/ML ........................ 15
morphine sulfate beads cap sr 24hr 120 mg 16
155
morphine sulfate beads cap sr 24hr 30 mg ..16
morphine sulfate cap sr 24hr 10 mg ..........16
morphine sulfate cap sr 24hr 100 mg .........16
morphine sulfate inj pf 0.5 mg/ml ..............16
morphine sulfate inj pf 1 mg/ml ................16
MORPHINE SULFATE IV SOLN 1 MG/ML ..16
......................................................16
......................................................16
MORPHINE SULFATE ORAL SOLN 10
MG/5ML............................................16
MORPHINE SULFATE ORAL SOLN 20
MG/5ML............................................16
MORPHINE SULFATE TAB 15 MG ...........16
MORPHINE SULFATE TAB 30 MG ...........16
morphine sulfate tab cr 100 mg ................16
morphine sulfate tab cr 15 mg .................16
morphine sulfate tab cr 200 mg ................16
motion sick chw 25mg ...........................77
motion sick tab 50mg ............................77
motrin ib tab 200mg ..............................13
MOVIPREP SOL .................................80
MOXEZA SOL 0.5% ........................... 103
MOZOBIL INJ .....................................85
mucaphed tab 10-400mg ..................... 111
MUCINEX CGH GRA 5-100MG ............. 111
mucinex cold tab sinus ........................ 111
MUCINEX D TAB 120-1200 .................. 111
MUCINEX D TAB 60-600MG................. 111
MUCINEX TAB 1200MG ...................... 112
MUCINEX/KIDS GRA 100MG ............... 112
MUCINEX/KIDS GRA 50MG ................. 112
mucus relief liq 5-100mg ...................... 112
mucus relief liq cold/sin ....................... 112
?
mucus relief tab 400mg ....................... 112
mucus+chst liq 100/5ml ...................... 112
mucus-dm max tab 60-1200 ................. 112
mucus-dm tab 30-600mg ..................... 112
mucus-er tab 600mg .......................... 112
MULTAQ TAB 400MG .......................... 38
multi-delyn liq................................... 100
MULTI-DELYN LIQ /IRON ................... 100
multi-sympt liq cld nght ....................... 112
multi-sympt pak day/nght ..................... 112
multi-vit tab ..................................... 100
multsym cold liq childrns ..................... 112
mupirocin oint 2% ............................. 118
MURO 128 SOL 2% OP ...................... 106
MUSTARGEN INJ 10MG ...................... 29
my way tab 1.5mg ............................... 69
MYCAMINE INJ 100MG ........................ 20
MYCAMINE INJ 50MG ......................... 20
mycophenolate mofetil cap 250 mg .......... 89
mycophenolate mofetil tab 500 mg ........... 89
(mycophenolic acid equiv) ..................... 89
(mycophenolic acid equiv) ..................... 89
MYKIDZ IRON SUS 10MG/2ML ............ 100
MYKIDZ IRON SUS 15/1.5ML ................ 86
myorisan cap 10mg ........................... 117
myorisan cap 20mg ........................... 117
myorisan cap 40mg ........................... 117
MYOZYME INJ 50MG .......................... 70
MYRBETRIQ TAB 25MG ...................... 82
MYRBETRIQ TAB 50MG ...................... 82
myzilra tab ........................................ 69
N
nabumetone tab 500 mg ....................... 14
nabumetone tab 750 mg ....................... 14
nadolol tab 20 mg ............................... 41
nadolol tab 40 mg ............................... 41
nadolol tab 80 mg ............................... 41
nafcillin sodium for inj 1 gm .................... 28
nafcillin sodium for inj 10 gm .................. 28
nafcillin sodium for inj 2 gm .................... 28
nafcillin sodium for iv soln 1 gm ............... 28
nafcillin sodium for iv soln 2 gm ............... 28
NAGLAZYME INJ 1MG/ML .................... 70
nail-ex tab 2.5mg .............................. 100
156
naloxone hcl inj 0.4 mg/ml ......................64
naloxone hcl inj 1 mg/ml ........................64
naltrexone hcl tab 50 mg ........................64
NAMENDA SOL 10MG/5ML ...................52
NAMENDA TAB 10MG ..........................52
NAMENDA TAB 5MG ...........................52
NAMENDA XR CAP 14MG .....................52
NAMENDA XR CAP 21MG .....................52
NAMENDA XR CAP 28MG .....................52
NAMENDA XR CAP 7MG ......................52
NAMENDA XR CAP TITRATIO ................52
naphazoline hcl ophth soln 0.1% ............ 106
naproxen dr tab 375mg .........................14
naproxen dr tab 500mg .........................14
NAPROXEN SODIUM CAP 220 MG..........13
naproxen sodium tab 275 mg ..................14
naproxen sodium tab 550 mg ..................14
naproxen susp 125 mg/5ml .....................14
naproxen tab 250 mg ............................14
naproxen tab 375 mg ............................14
naproxen tab 500 mg ............................14
naratriptan hcl tab 1 mg (base equiv) .........62
naratriptan hcl tab 2.5 mg (base equiv) .......62
nasal decon liq 15mg/5ml ..................... 112
nasal decon syp 30mg/5ml ................... 112
NASAL DECONG LIQ 30MG/5ML .......... 112
nasal decong tab 10mg ....................... 112
nasal decong tab 30mg ....................... 112
nasal relief tab 5-325mg ...................... 112
nasal relief tab night ........................... 112
nasal spr 0.05% ................................ 112
NASCOBAL SPR 500MCG ................... 100
NASOHIST DM DRO .......................... 112
nasohist dro 1-2mg/ml ......................... 112
NASONEX SPR 50MCG/AC ................. 116
NASOPEN PE LIQ ............................. 112
nat fiber pow therapy ............................80
NATACYN SUS 5% OP ....................... 103
nateglinide tab 120 mg ..........................66
nateglinide tab 60 mg ............................66
natures tear sol 0.4% .......................... 106
naturl fiber pow 68% .............................80
NEBUPENT INH 300MG ........................18
necon tab 0.5/35 .................................69
necon tab 1/35 ....................................69
NECON TAB 1/50-28 ............................69
?
necon tab 10/11-28.............................. 69
NECON TAB 7/7/7 .............................. 69
nefazodone hcl tab 100 mg .................... 54
nefazodone hcl tab 50 mg...................... 54
neomycin sulfate tab 500 mg .................. 17
neomycin-bacitrac zn-polymyx
5(3.5)mg-400unt-10000unt op oin .......... 103
neomycin-polymy-gramicid op sol
1.75-10000-0.025mg-unt-mg/ml ............ 103
oint 0.1% ........................................ 103
susp 0.1%....................................... 103
neomycin-polymyxin-hc ophth susp ........ 103
neomycin-polymyxin-hc otic soln 1% ....... 124
neomycin-polymyxin-hc otic susp 3.5
mg/ml-10000 unit/ml-1% ..................... 124
NEORAL CAP 100MG .......................... 89
NEORAL CAP 25MG ........................... 89
NEORAL SOL 100MG/ML ..................... 90
neosporin+pn oin relf max ................... 118
NEO-SYNEPHRI SPR 0.5% ................. 112
neotuss liq ...................................... 112
NEPHRAMINE INJ 5.4% ....................... 92
NEPHRONEX LIQ ............................. 100
NEUMEGA INJ 5MG ............................ 85
NEUPOGEN INJ 300/0.5 ....................... 85
NEUPOGEN INJ 300MCG ..................... 85
NEUPOGEN INJ 480/0.8 ....................... 85
NEUPOGEN INJ 480MCG ..................... 85
NEUPRO DIS 1MG/24HR...................... 56
NEUPRO DIS 2MG/24HR...................... 56
NEUPRO DIS 3MG/24HR...................... 56
NEUPRO DIS 4MG/24HR...................... 56
NEUPRO DIS 6MG/24HR...................... 56
NEUPRO DIS 8MG/24HR...................... 56
neuro-k-250 tab 250mg ....................... 100
neuro-k-500 tab ................................ 100
neutrahist dro 0.8-9mg........................ 112
NEVANAC SUS 0.1% ........................ 104
NEVIRAPINE SUSP 50 MG/5ML ............. 21
nevirapine tab 200 mg .......................... 21
nevirapine tab sr 24hr 400 mg ................. 21
157
nexafed tab 30mg .............................. 112
NEXAVAR TAB 200MG .........................33
NEXIUM CAP 20MG.............................82
NEXIUM CAP 40MG.............................82
NEXIUM GRA 10MG DR .......................82
NEXIUM GRA 2.5MG DR .......................82
NEXIUM GRA 20MG DR .......................82
NEXIUM GRA 40MG DR .......................82
NEXIUM GRA 5MG DR .........................82
next choice tab 1.5mg ...........................69
niacin cap cr 250 mg........................... 100
niacin cap cr 500 mg........................... 100
niacin tab 100 mg .............................. 100
niacin tab 250 mg .............................. 100
niacin tab 50 mg ................................ 100
niacin tab 500 mg .............................. 100
niacin tab cr 1000 mg (antihyperlipidemic) ...40
niacin tab cr 500 mg ........................... 100
niacin tab cr 500 mg (antihyperlipidemic) ....40
niacin tab cr 750 mg ........................... 100
niacin tab cr 750 mg (antihyperlipidemic) ....40
NIACIN TR TAB 1000MG ..................... 100
niacinamide tab 100 mg ....................... 100
niacinamide tab 500 mg ....................... 100
niacor tab 500mg .................................40
nicardipine hcl cap 20 mg .......................43
nicardipine hcl cap 30 mg .......................43
nicotine polacrilex gum 4 mg ...................64
nicotine polacrilex lozenge 2 mg ...............64
NICOTINE POLACRILEX LOZENGE 2 MG .64
nicotine polacrilex lozenge 4 mg ...............64
NICOTINE POLACRILEX LOZENGE 4 MG .64
NICOTINE SYS KIT TRANSDER .............64
nicotine td patch 24hr 14 mg/24hr .............64
nicotine td patch 24hr 21 mg/24hr .............64
nicotine td patch 24hr 7 mg/24hr ..............64
NICOTROL INH ..................................64
NICOTROL NS SPR 10MG/ML ................64
nifedical xl tab 30mg .............................43
nifedical xl tab 60mg .............................43
nifedipine tab sr 24hr 30 mg ....................43
nifedipine tab sr 24hr osmotic 30 mg .........43
?
night time liq cold/flu .......................... 112
night time liq cough ............................ 112
night-time cap sinus ........................... 112
nikki tab 3-0.02mg ............................... 69
NILANDRON TAB 150MG ..................... 32
nimodipine cap 30 mg .......................... 43
NIPENT INJ 10MG .............................. 30
nitro-bid oin 2% .................................. 46
NITRO-DUR DIS 0.3MG/HR ................... 46
NITRO-DUR DIS 0.8MG/HR ................... 46
nitrofurantoin macrocrystalline cap 100 mg . 18
nitrofurantoin macrocrystalline cap 50 mg ... 18
nitrofurantoin monohydrate macrocrystalline
cap 100 mg ....................................... 18
nitroglycerin td patch 24hr 0.1 mg/hr ......... 46
NITROLINGUAL SPR PUMPSPRA .......... 46
NITROSTAT SUB 0.3MG ...................... 46
NITROSTAT SUB 0.4MG ...................... 46
NITROSTAT SUB 0.6MG ...................... 46
NIZORAL A-D SHA 1% ....................... 119
nohist-lq liq 4-10/5ml .......................... 112
non-asa jr tab 160mg ........................... 13
non-aspirin chw 160mg jr ...................... 13
non-aspirin chw 80mg .......................... 13
NON-ASPIRIN TAB 500MG QM .............. 13
NORDITROPIN INJ 10/1.5ML ................. 72
NORDITROPIN INJ 15/1.5ML ................. 72
NORDITROPIN INJ 30/3ML ................... 72
NORDITROPIN INJ 5/1.5ML .................. 72
NOREL AD TAB 4-10-325 ................... 112
NOREL CS LIQ ................................ 112
norelgestromin-ethinyl estradiol td ptwk 150-35
mcg/24hr .......................................... 69
norethindrone acetate tab 5 mg ............... 74
norethindrone tab 0.35 mg ..................... 69
NORETHINDRONE TAB 0.35 MG ........... 69
NORETHINDRONE-ETH ESTRADIOL TAB
0.5-35/1-35/0.5-35 MG-MCG .................. 69
norgestimate-eth estrad tab
0.18-35/0.215-35/0.25-35 mg-mcg ........... 69
norlyroc tab 0.35mg ............................. 69
normosol -m inj /d5w ............................ 93
NORMOSOL -R INJ /D5W ..................... 93
158
NORMOSOL-R INJ PH 7.4 .....................93
NORPACE CAP 100MG CR ...................38
NORPACE CAP 150MG CR ...................38
nortrel tab 0.5/35 .................................69
nortrel tab 1/35 ...................................69
nortrel tab 7/7/7 ...................................69
nortriptyline hcl cap 10 mg ......................54
nortriptyline hcl soln 10 mg/5ml ................54
NORVIR CAP 100MG ...........................21
NORVIR SOL 80MG/ML ........................21
NORVIR TAB 100MG ...........................21
NOVAFERRUM DRO 15MG/ML...............86
NOVAFERRUM LIQ 125 ........................86
NOVOLIN INJ 70/30 .............................65
NOVOLIN N INJ U-100 ..........................65
NOVOLIN R INJ U-100 ..........................65
NOVOLOG INJ 100/ML .........................65
NOVOLOG INJ FLEXPEN ......................65
NOVOLOG INJ PENFILL .......................65
NOVOLOG MIX INJ 70/30 ......................65
NOVOLOG MIX INJ FLEXPEN ................65
NOXAFIL SUS 40MG/ML .......................20
NOXAFIL TAB 100MG ..........................20
NUEDEXTA CAP 20-10MG ....................62
nu-iron 150 cap 150mg ..........................86
NULOJIX INJ 250MG ............................90
NULYTELY SOL FLAV PKS ...................80
NUTRATEAR SOL 0.6% ...................... 106
nutr-e-sol liq 400/15ml ......................... 100
NUTRICION TAB PORVIDA ................. 100
NUTRISOURCE PAK FIBER...................80
NUVARING MIS ..................................69
NUVIGIL TAB 150MG ...........................63
NUVIGIL TAB 200MG ...........................63
NUVIGIL TAB 250MG ...........................63
NUVIGIL TAB 50MG.............................63
nyamyc pow 100000 ........................... 119
NYMALIZE SOL 60/20ML ......................43
nystatin cream 100000 unit/gm .............. 119
nystatin oint 100000 unit/gm ................. 119
nystatin susp 100000 unit/ml ................. 123
nystatin tab 500000 unit .........................20
nystatin topical powder ........................ 119
?
nystop pow 100000 ........................... 119
O
OCTAGAM INJ 10GM .......................... 88
OCTAGAM INJ 1GM ............................ 88
OCTAGAM INJ 2.5GM ......................... 88
OCTAGAM INJ 25GM .......................... 88
OCTAGAM INJ 5GM ............................ 88
...................................................... 73
octreotide acetate inj 1000 mcg/ml (1 mg/ml)73
...................................................... 73
...................................................... 73
...................................................... 73
ofloxacin ophth soln 0.3% .................... 103
ofloxacin otic soln 0.3% ...................... 124
olanzapine for im inj 10 mg .................... 59
olanzapine orally disintegrating tab 10 mg .. 59
olanzapine orally disintegrating tab 5 mg .... 59
olanzapine tab 10 mg ........................... 59
olanzapine tab 2.5 mg .......................... 59
olanzapine tab 5 mg ............................ 59
olanzapine tab 7.5 mg .......................... 59
OLYSIO CAP 150MG ........................... 23
omega-3-acid ethyl esters cap 1 gm ......... 40
omeprazole cap 20.6mgdr ..................... 82
omeprazole cap delayed release 10 mg ..... 82
OMEPRAZOLE TAB 20MG .................... 82
omeprazole-sodium bicarbonate cap 20-1100
mg .................................................. 82
ondansetron hcl inj 4 mg/2ml (2 mg/ml) ..... 77
ondansetron hcl inj 40 mg/20ml (2 mg/ml) .. 77
ondansetron hcl oral soln 4 mg/5ml .......... 77
ondansetron hcl tab 24 mg ..................... 77
ondansetron hcl tab 4 mg ...................... 77
ondansetron hcl tab 8 mg ...................... 77
ondansetron orally disintegrating tab 4 mg .. 77
ondansetron orally disintegrating tab 8 mg .. 77
159
ONFI SUS 2.5MG/ML ...........................50
ONFI TAB 10MG .................................50
ONFI TAB 20MG .................................50
ONSET FORTE TAB .......................... 112
optics mini dro .................................. 106
oral saline sol laxative ...........................80
ORAP TAB 1MG .................................59
ORAP TAB 2MG .................................59
ORFADIN CAP 10MG ...........................70
ORFADIN CAP 2MG ............................70
ORFADIN CAP 5MG ............................70
organ-i nr tab 200mg .......................... 112
orsythia tab ........................................69
os-cal + d3 tab 500-200 .........................97
OSTEO-PORETI TAB ...........................97
oxacillin sodium for inj 1 gm ....................28
oxacillin sodium for inj 10 gm...................28
oxacillin sodium for inj 2 gm ....................28
oxaliplatin for iv inj 100 mg .....................34
oxaliplatin for iv inj 50 mg .......................34
oxaliplatin iv soln 100 mg/20ml ................34
oxaliplatin iv soln 50 mg/10ml ..................34
oxandrolone tab 10 mg ..........................65
oxandrolone tab 2.5 mg .........................65
oxcarbazepine susp 300 mg/5ml (60 mg/ml) 50
oxcarbazepine tab 150 mg .....................50
oxybutynin chloride syrup 5 mg/5ml ...........83
oxybutynin chloride tab 5 mg ...................83
oxybutynin chloride tab sr 24hr 10 mg ........83
oxybutynin chloride tab sr 24hr 15 mg ........83
oxybutynin chloride tab sr 24hr 5 mg .........83
oxycodone hcl cap 5 mg ........................16
OXYCODONE HCL CONC 100 MG/5ML (20
MG/ML) ............................................16
oxycodone hcl soln 5 mg/5ml ..................16
oxycodone hcl tab 10 mg .......................16
oxycodone hcl tab 5 mg .........................16
......................................................16
......................................................16
?
oxycodone w/ acetaminophen tab 5-325 mg 16
...................................................... 16
oys shell+d tab 250-125 ........................ 97
oysco 500 tab 500mg ........................... 97
OYSCO 500+D CHW ........................... 97
oyst shell/d tab 500-200 ........................ 97
oyst shell/d tab 500mg .......................... 97
oyst-cal d tab 250mg ............................ 97
P
pacerone tab 100mg ............................ 38
pacerone tab 200mg ............................ 39
pacerone tab 400mg ............................ 39
paclitaxel iv conc 100 mg/16.7ml (6 mg/ml) . 31
paclitaxel iv conc 150 mg/25ml (6 mg/ml) ... 31
paclitaxel iv conc 30 mg/5ml (6 mg/ml) ...... 31
paclitaxel iv conc 300 mg/50ml (6 mg/ml) ... 31
pain relief dro 80/0.8ml ......................... 13
pain relief liq 500/15ml .......................... 13
pain relief sus 160/5ml .......................... 13
pain relief sus pls cold ........................ 112
pain relief tab 325mg............................ 13
pain relief tab 500mg............................ 13
pain relieve tab pm ............................ 112
pain relievr tab 325mg .......................... 13
pamidronate disodium iv soln 3 mg/ml ....... 67
pamidronate disodium iv soln 9 mg/ml ....... 67
pamidronate inj 6mg/ml ......................... 67
PANOXYL BAR 10%.......................... 118
panoxyl wash liq 10% ......................... 118
PANOXYL-4 LIQ CREM WSH .............. 118
PANOXYL-8 LIQ CREM WSH .............. 118
PANRETIN GEL 0.1% ........................ 122
pantoprazole sodium ec tab 20 mg (base equiv)
...................................................... 82
pantoprazole sodium ec tab 40 mg (base equiv)
...................................................... 82
pantothenic acid tab 100 mg ................. 100
pantothenic acid tab 500 mg ................. 101
paricalcitol cap 1 mcg ......................... 101
paromomycin sulfate cap 250 mg ............. 17
paroxetine hcl tab 10 mg ....................... 54
160
paroxetine hcl tab 40 mg ........................54
PARVA-CAL TAB 250-100 .....................97
PARVA-CAL TAB 500MG ......................97
paser gra 4gm ....................................22
PATADAY SOL 0.2% .......................... 104
PATANASE SPR 0.6% ........................ 108
PATANOL SOL 0.1% OP ..................... 104
PAXIL SUS 10MG/5ML .........................54
ped formula liq 100-10/5 ...................... 112
pediacare liq long-act .......................... 112
PEDIA-LAX LIQ 50MG ..........................80
pedi-atric liq niterest ........................... 112
pedi-dri pow 100000 ........................... 119
PEDVAX HIB INJ.................................90
peg 3350-kcl-na bicarb-nacl-na sulfate for soln
236 gm .............................................80
PEG 3350-KCL-NA BICARB-NACL-NA
SULFATE FOR SOLN 240 GM ................80
peg 3350-kcl-sod bicarb-nacl for soln 420 gm
......................................................80
PEGANONE TAB 250MG ......................50
PEG-INTRON KIT 120 RP ......................89
PEG-INTRON KIT 120MCG ....................89
PEG-INTRON KIT 150 RP ......................89
PEG-INTRON KIT 150MCG ....................89
PEG-INTRON KIT 50MCG .....................89
PEG-INTRON KIT 50MCG RP .................89
PEG-INTRON KIT 80MCG .....................89
PEG-INTRON KIT 80MCG RP .................89
pen g proc inj 600000 ...........................28
PENICILL GK/ INJ DEX 2MU ..................28
PENICILL GK/ INJ DEX 3MU ..................28
penicillin g potassium for inj 20000000 unit ..28
penicillin g potassium for inj 5000000 unit ...28
penicillin g sodium for inj 5000000 unit .......28
penicillin v potassium for soln 125 mg/5ml ...28
penicillin v potassium for soln 250 mg/5ml ...28
penicillin v potassium tab 250 mg .............28
penicillin v potassium tab 500 mg .............28
PENTAM 300 INJ 300MG ......................18
PENTASA CAP 250MG CR ....................78
PENTASA CAP 500MG CR ....................78
pentoxifylline tab cr 400 mg ....................87
PEPCID AC CHW 10MG .......................78
peptic relf chw 262mg ...........................76
perdiem over tab 15mg ..........................80
?
PERFOROMIST NEB 20MCG .............. 108
perindopril erbumine tab 2 mg ................. 36
periogard sol 0.12% ........................... 123
permethrin cream 5% ......................... 123
permethrin lotion 1% .......................... 123
perphenazine tab 16 mg........................ 59
perphenazine tab 2 mg ......................... 59
PERRY PRENAT CAP ....................... 101
PHENAGIL TAB 3.5-10MG .................. 113
phenelzine sulfate tab 15 mg .................. 54
PHENOBARB INJ 65MG/ML .................. 50
phenobarbital elixir 20 mg/5ml ................ 50
phenobarbital sodium inj 130 mg/ml .......... 50
phenobarbital tab 100 mg ...................... 51
phenobarbital tab 15 mg........................ 50
phenobarbital tab 16.2 mg ..................... 50
phenylephrine-brompheniramine-dm liquid
10-4-20 mg/5ml ................................ 113
PHENYLHIST LIQ DH ........................ 113
phenytek cap 200mg ............................ 51
phenytek cap 300mg ............................ 51
phenytoin chew tab 50 mg ..................... 51
phenytoin sodium extended cap 100 mg .... 51
phenytoin sodium inj 50 mg/ml ................ 51
phenytoin susp 125 mg/5ml.................... 51
philith tab 0.4-35 ................................. 69
PHOSLYRA SOL ................................ 73
PHOS-NAK POW CONCENTR ............... 97
PHOSPHOLINE SOL 0.125%OP ........... 105
phytonadione inj 1 mg/0.5ml (2 mg/ml) .... 101
phytonadione inj 10 mg/ml ................... 101
phytonadione tab 100 mcg ................... 101
PILOCARPINE HCL OPHTH SOLN 1% ... 105
161
pilocarpine hcl tab 5 mg ....................... 123
pilocarpine hcl tab 7.5 mg..................... 123
pimtrea tab ........................................69
pindolol tab 10 mg ...............................41
pindolol tab 5 mg .................................41
pioglitazone hcl tab 15 mg (base equiv) ......66
2-0.25 gm ..........................................28
3-0.375 gm ........................................28
36-4.5 gm ..........................................28
4-0.5 gm ...........................................28
pirmella tab 1/35 ..................................69
piroxicam cap 10 mg.............................14
piroxicam cap 20 mg.............................14
PLASMA-LYTE INJ -148 ........................94
PLASMA-LYTE INJ 56/D5W ...................93
PLASMA-LYTE INJ -A...........................94
podofilox soln 0.5% ............................ 122
polyethylene glycol 3350 oral packet .........80
polyethylene glycol 3350 oral powder ........80
polymyxin b-trimethoprim ophth soln 10000
unit/ml-0.1% ..................................... 103
POLY-TUSSIN LIQ 10-9.375 ................. 113
POLY-TUSSIN LIQ AC ........................ 113
POLY-TUSSIND LIQ 10-9.375 ............... 113
polyvitamin dro ................................. 101
polyvitamin dro /iron ........................... 101
POMALYST CAP 1MG ..........................33
POMALYST CAP 2MG ..........................33
POMALYST CAP 3MG ..........................33
POMALYST CAP 4MG ..........................34
portia-28 tab.......................................69
POTASSIUM CHLORIDE 20 MEQ/L (0.15%)
IN DEXTROSE 5% INJ ..........................94
DEXTROSE 5% INJ .............................94
potassium chloride cap cr 10 meq .............91
potassium chloride cap cr 8 meq ..............91
......................................................94
potassium chloride inj 10 meq/50 ml ..........94
potassium chloride inj 2 meq/ml ...............94
?
...................................................... 94
potassium chloride inj 20 meq/50 ml ......... 94
potassium chloride inj 40 meq/100 ml ........ 94
tab 10 meq ........................................ 91
tab 20 meq ........................................ 91
...................................................... 91
...................................................... 91
POTASSIUM CHLORIDE TAB CR 10 MEQ 91
(1500 MG) ........................................ 91
POTASSIUM CHLORIDE TAB CR 8 MEQ (600
MG) ................................................ 91
(1080 MG) ........................................ 82
POTASSIUM CITRATE TAB CR 5 MEQ (540
MG) ................................................ 82
POTIGA TAB 200MG ........................... 51
POTIGA TAB 300MG ........................... 51
POTIGA TAB 400MG ........................... 51
POTIGA TAB 50MG............................. 51
povidone/iod sol 10% ........................... 83
PRADAXA CAP 150MG ........................ 85
PRADAXA CAP 75MG ......................... 84
pramipexole dihydrochloride tab 0.125 mg .. 56
pramipexole dihydrochloride tab 0.25 mg ... 56
pramipexole dihydrochloride tab 0.5 mg ..... 56
pramipexole dihydrochloride tab 0.75 mg ... 56
pramipexole dihydrochloride tab 1 mg ....... 56
pramipexole dihydrochloride tab 1.5 mg ..... 56
pravastatin sodium tab 10 mg ................. 39
prazosin hcl cap 1 mg .......................... 37
pred sod pho sol 1% op ...................... 104
PREDNISOLONE ACETATE OPHTH SUSP
1% ............................................... 104
prednisolone sod phosph oral soln 6.7 mg/5ml
(5 mg/5ml base) ................................. 72
prednisolone sod phosphate oral soln 15
162
mg/5ml (base equiv) .............................72
prednisolone sodium phosphate oral soln 25
mg/5ml (base eq).................................72
prednisolone syrup 15 mg/5ml (usp solution
equivalent) .........................................72
prednisone con 5mg/ml .........................72
prednisone oral soln 5 mg/5ml .................72
prednisone tab 1 mg .............................72
prednisone tab 10 mg ...........................72
prednisone tab 10 mg dose pack ..............72
prednisone tab 2.5 mg...........................72
prednisone tab 5 mg .............................72
prednisone tab 5 mg dose pack ...............72
PREMARIN VAG CRE 0.625MG ..............71
premasol sol 10% ................................92
PRENATAL TAB ............................... 101
PRENATAL TAB 27-0.8MG .................. 101
PRENATAL VITAMIN/FOLIC ACID > 0.8 MG
(GENERIC) ...................................... 101
PRETZ SOL ..................................... 113
prevalite pow 4gm ................................40
previfem tab .......................................69
PREZISTA SUS 100MG/ML ....................21
PREZISTA TAB 150MG.........................21
PREZISTA TAB 600MG.........................21
PREZISTA TAB 75MG ..........................21
PREZISTA TAB 800MG.........................21
PRIFTIN TAB 150MG ...........................22
PRILOSEC OTC TAB 20MG ...................82
PRIMAQUINE TAB 26.3MG ....................20
primidone tab 250 mg ...........................51
primidone tab 50 mg .............................51
PRISTIQ TAB 100MG ...........................54
PRISTIQ TAB 50MG.............................54
PRIVIGEN INJ 10GRAMS ......................88
PRIVIGEN INJ 5 GRAMS .......................88
PROAIR HFA AER ............................. 108
probenecid tab 500 mg ..........................12
probiotic cap ......................................76
PROBIOTIC CAP FORMULA ..................76
PROCALAMINE INJ 3% ........................92
PRO-CHLO LIQ ................................ 113
?
prochlorperazine edisylate inj 5 mg/ml ....... 77
prochlorperazine maleate tab 10 mg (base
equivalent) ........................................ 77
prochlorperazine maleate tab 5 mg (base
equivalent) ........................................ 77
prochlorperazine suppos 25 mg............... 77
PRO-CLEAR AC SYP ........................ 113
PROCRIT INJ 10000/ML ....................... 85
PROCRIT INJ 2000/ML ........................ 85
PROCRIT INJ 20000/ML ....................... 85
PROCRIT INJ 3000/ML ........................ 85
PROCRIT INJ 4000/ML ........................ 85
PROCRIT INJ 40000/ML ....................... 85
procto-pak cre 1% ............................. 119
proctosol hc cre 2.5% ......................... 119
proctozone cre -hc 2.5% ..................... 119
PROFE CAP 180MG............................ 86
PROGLYCEM SUS 50MG/ML ................ 72
PROGRAF CAP 0.5MG ........................ 90
PROGRAF CAP 1MG........................... 90
PROGRAF CAP 5MG........................... 90
PROLASTIN-C INJ 1000MG ................ 115
PROLENSA SOL 0.07% ..................... 106
PROLEUKIN INJ 22MU ........................ 31
PROLIA SOL 60MG/ML ........................ 73
PROMACTA TAB 12.5MG ..................... 87
PROMACTA TAB 25MG ....................... 87
PROMACTA TAB 50MG ....................... 87
PROMACTA TAB 75MG ....................... 87
promethazine hcl inj 25 mg/ml ................. 77
promethazine hcl inj 50 mg/ml ................. 77
PRONTO AER 0.4% .......................... 123
propafenone hcl cap sr 12hr 225 mg ......... 39
propafenone hcl tab 150 mg ................... 39
proparacaine hcl ophth soln 0.5% .......... 106
propranolol & hydrochlorothiazide tab 40-25 mg
...................................................... 41
propranolol & hydrochlorothiazide tab 80-25 mg
...................................................... 41
propranolol hcl cap sr 24hr 120 mg ........... 41
propranolol hcl cap sr 24hr 160 mg ........... 41
propranolol hcl cap sr 24hr 60 mg ............ 41
163
propranolol hcl cap sr 24hr 80 mg .............41
propranolol hcl inj 1 mg/ml ......................41
propranolol hcl oral soln 20 mg/5ml ...........41
propranolol hcl oral soln 40 mg/5ml ...........41
propranolol hcl tab 10 mg .......................41
propylthiouracil tab 50 mg ......................74
PROQUAD INJ ...................................90
PROSOL INJ 20% ...............................92
PROTEXIN SYP ................................ 101
protriptyline hcl tab 10 mg ......................55
protriptyline hcl tab 5 mg ........................54
PRUDOXIN CRE 5% .......................... 119
pseudoephed-bromphen-dm liquid 20-4-20
mg/5ml ........................................... 113
pseudoephedr tab 60mg ...................... 113
psyldex pow 30%.................................80
psyllium powder 100% ..........................80
PULMOZYME SOL 1MG/ML ................. 115
pure & gentl dro 0.3% ......................... 106
pyrazinamide tab 500 mg .......................22
PYRE/PIPERON LIQ .......................... 123
pyridostigmine bromide tab 60 mg ............63
pyridoxine hcl inj 100 mg/ml .................. 101
pyridoxine hcl tab 100 mg..................... 101
pyridoxine hcl tab 25 mg ...................... 101
pyridoxine hcl tab 50 mg ...................... 101
pyridoxine hcl tab cr 200 mg ................. 101
PYRIL DM SUS................................. 113
pyrilamine mal-phenylephrine hcl tann susp
16-5 mg/5ml ..................................... 113
Q
qc natural pow vegetabl .........................80
q-pap infant dro 80/0.8ml .......................13
q-tapp dm elx ................................... 113
quasense tab .....................................69
quetiapine fumarate tab 100 mg ...............59
quetiapine fumarate tab 25 mg.................59
quetiapine fumarate tab 50 mg.................59
quinapril hcl tab 10 mg ..........................36
?
quinapril hcl tab 20 mg.......................... 36
quinapril hcl tab 40 mg.......................... 36
quinapril hcl tab 5 mg ........................... 36
...................................................... 35
...................................................... 36
quinapril-hydrochlorothiazide tab 20-25 mg . 36
quinidine gluconate tab cr 324 mg ............ 39
quinidine sulfate tab 200 mg ................... 39
quinidine sulfate tab 300 mg ................... 39
quinine sulfate cap 324 mg .................... 20
QVAR AER 40MCG ........................... 116
QVAR AER 80MCG ........................... 116
R
ra anti-itch oin 1% ............................. 121
ra aspirin tab 500mg ............................ 13
ra b-complex tab vit c tr ....................... 101
ra beta caro cap 15mg ........................ 101
RA CA/BORON TAB ............................ 97
RA CALAMINE LOT........................... 122
ra col-rite cap 50mg ............................. 80
ra coral cap calcium ............................. 97
ra fiber tab 500mg ............................... 80
ra hydrocort cre 0.5% ......................... 121
ra iron tab 27mg ................................. 86
ra lubricant dro 0.4-0.3% ..................... 106
ra magnesium cap 500mg ..................... 97
RA OYS SHL/D TAB 250MG .................. 97
ra oys shl/d tab 500mg ......................... 97
ra vit c loz 60mg ............................... 101
ra vitamin c tab 1000mg ...................... 101
RABAVERT INJ.................................. 91
raloxifene hcl tab 60 mg ........................ 73
ramipril cap 1.25 mg ............................ 36
ramipril cap 10 mg ............................... 36
ramipril cap 2.5 mg .............................. 36
ramipril cap 5 mg ................................ 36
RANEXA TAB 1000MG ........................ 46
RANEXA TAB 500MG .......................... 46
ranitidine hcl inj 150 mg/6ml (25 mg/ml) ..... 78
ranitidine hcl inj 50 mg/2ml (25 mg/ml) ....... 78
ranitidine hcl syrup 15 mg/ml (75 mg/5ml)... 78
ranitidine hcl tab 150 mg ....................... 78
ranitidine hcl tab 300 mg ....................... 78
ranitidine hcl tab 75 mg ......................... 78
164
ranitidine tab 75mg...............................78
RAPAMUNE SOL 1MG/ML .....................90
RAPAMUNE TAB 1MG .........................90
RAPAMUNE TAB 2MG .........................90
REBETOL SOL 40MG/ML ......................23
reclipsen tab ......................................69
RECOMBIVA HB INJ 10MCG/ML .............91
RECOMBIVA HB INJ 5MCG/0.5...............91
RECOMBIVA-HB INJ 40MCG/ML .............91
refenesen tab chst cng ........................ 113
REFRESH CELL DRO 1% OP ............... 106
refresh p.m. oin op ............................. 106
REFRESH SOL OPTIVE ...................... 106
REGRANEX GEL 0.01% ...................... 123
reguloid pow 48.57% ............................80
reguloid pow 58.6% ..............................80
rehydralyte sol ....................................92
RELENZA MIS DISKHALE .....................23
RELISTOR INJ 12/0.6ML .......................80
RELISTOR INJ 8/0.4ML.........................80
RELISTOR KIT 12/0.6ML .......................80
RELPAX TAB 20MG .............................62
RELPAX TAB 40MG .............................62
REMICADE INJ 100MG .........................87
REMODULIN INJ 10MG/ML ....................47
REMODULIN INJ 1MG/ML .....................47
REMODULIN INJ 2.5MG/ML ...................47
REMODULIN INJ 5MG/ML .....................47
RENVELA PAK 0.8GM ..........................73
RENVELA PAK 2.4GM ..........................73
RENVELA TAB 800MG .........................73
repaglinide tab 0.5 mg ...........................66
repaglinide tab 1 mg .............................67
repaglinide tab 2 mg .............................67
RESCON TAB 2-60MG ....................... 113
RESCON-DM SYP ............................. 113
RESCRIPTOR TAB 100 MG ...................21
RESCRIPTOR TAB 200MG ....................21
RESPAIRE-30 CAP ............................ 113
RESTASIS EMU 0.05% ....................... 106
RETAINE MGD EMU 0.5-0.5% .............. 106
RETROVIR INJ 10MG/ML ......................21
REVATIO SUS 10MG/ML.......................47
REVLIMID CAP 10MG ..........................89
REVLIMID CAP 15MG ..........................89
REVLIMID CAP 2.5MG .........................89
?
REVLIMID CAP 20MG.......................... 89
REVLIMID CAP 25MG.......................... 89
REVLIMID CAP 5MG ........................... 89
REYATAZ CAP 150MG ........................ 21
REYATAZ CAP 200MG ........................ 21
REYATAZ CAP 300MG ........................ 21
RHINARIS GEL 0.2% ......................... 113
RHINARIS SPR 0.2% ......................... 113
ribapak pak 1000/day ........................... 23
ribapak pak 1200/day ........................... 23
ribapak pak 600/day ............................ 23
ribapak pak 800/day ............................ 23
ribasphere cap 200mg .......................... 23
ribasphere tab 200mg .......................... 23
ribavirin cap 200 mg ............................ 23
ribavirin tab 200 mg ............................. 23
riboflavin tab 100 mg .......................... 101
riboflavin tab 25 mg ........................... 101
riboflavin tab 50 mg ........................... 101
rid ess lice kit 0.33-4% ........................ 123
rifabutin cap 150 mg ............................ 22
rifampin cap 150 mg ............................ 22
rifampin cap 300 mg ............................ 22
rifampin for inj 600 mg .......................... 22
RIFATER TAB ................................... 22
riluzole tab 50 mg................................ 63
rimantadine hydrochloride tab 100 mg ....... 23
ri-mox plus sus ................................... 76
RINGER'S SOLUTION ......................... 94
RIOMET SOL .................................... 67
RISA-BID TAB PROBIO ........................ 76
risamine oin..................................... 122
RISPERDAL INJ 12.5MG ...................... 59
RISPERDAL INJ 25MG ........................ 59
RISPERDAL INJ 37.5MG ...................... 59
RISPERDAL INJ 50MG ........................ 59
risperidone orally disintegrating tab 0.25 mg 59
risperidone orally disintegrating tab 0.5 mg . 59
risperidone orally disintegrating tab 1 mg ... 59
risperidone soln 1 mg/ml ....................... 60
risperidone tab 0.25 mg ........................ 60
165
risperidone tab 0.5 mg...........................60
risperidone tab 1 mg .............................60
ritifed syp 1.25-30 .............................. 113
RITUXAN INJ 500MG ...........................31
rivastigmine tartrate cap 1.5 mg ...............52
rivastigmine tartrate cap 3 mg..................52
rivastigmine tartrate cap 4.5 mg ...............52
rivastigmine tartrate cap 6 mg..................52
rizatriptan benzoate orally disintegrating tab 10
mg ..................................................62
rizatriptan benzoate orally disintegrating tab 5
mg ..................................................62
rizatriptan benzoate tab 10 mg .................62
rizatriptan benzoate tab 5 mg ..................62
robafen cf syp cgh/cld ......................... 113
robafen cgh cap 15mg......................... 113
robitussin cap cold+flu ......................... 113
robitussin liq 15mg/5ml ........................ 113
ROBITUSSIN LIQ CF ......................... 113
ROBITUSSIN LIQ CGH/COLD............... 113
robitussin liq ms max .......................... 113
ROBITUSSIN LIQ NIGHT TM ................ 113
robitussin liq to go dm ......................... 113
robitussin syp 15mg/5ml ...................... 113
robitussin syp 7.5/5ml ......................... 113
ROCALTROL CAP 0.25MCG ................ 101
ROCALTROL CAP 0.5MCG .................. 101
ROCALTROL SOL 1MCG/ML ............... 101
ropinirole hydrochloride tab 0.25 mg ..........56
ropinirole hydrochloride tab 0.5 mg ...........56
ropinirole hydrochloride tab 1 mg ..............56
rosadan cre 0.75% ............................. 122
ROTARIX SUS ...................................91
ROTATEQ SOL ..................................91
roxicet sol 5-325/5 ...............................17
roxicet tab 5-325mg ..............................17
ROZEREM TAB 8MG ...........................61
RU-HIST-D LIQ 30-10/5....................... 113
RU-HIST-D TAB 30-10MG ................... 113
?
RYMED TAB 2-10MG......................... 113
rynex dm liq..................................... 113
rynex pse liq .................................... 113
S
SABRIL POW 500MG .......................... 51
SABRIL TAB 500MG............................ 51
SANDIMMUNE CAP 100MG .................. 90
SANDIMMUNE CAP 25MG .................... 90
SANDIMMUNE SOL 100MG/ML .............. 90
SANDOSTATIN KIT LAR 10MG .............. 73
SANTYL OIN 250/GM ........................ 123
SAPHRIS SUB 10MG .......................... 60
SAPHRIS SUB 5MG ............................ 60
sb fib lax pow 33% .............................. 80
SB NAT FIBER POW 49% ..................... 80
sb triple oin antibiot............................ 118
SCHOOLTIME SHA ........................... 123
SCOOBY-DOO CHW ......................... 101
scot-tussin liq dm sf ........................... 113
SCOT-TUSSIN LIQ ORIGINAL ............. 114
SCOT-TUSSIN LIQ SENIOR ................ 114
SECURA CRE 30.6% ......................... 122
secura prote cre 10% ......................... 122
selegiline hcl cap 5 mg ......................... 57
selegiline hcl tab 5 mg .......................... 57
selenium sulfide lotion 2.5% ................. 119
selenium tab 100 mcg .......................... 97
SELENIUM TAB 200MCG ..................... 97
SELZENTRY TAB 150MG ..................... 21
SELZENTRY TAB 300MG ..................... 21
SENNA PROMPT CAP 9-500MG ............ 80
SENNA SYP ...................................... 80
SENNA TAB 187MG ............................ 80
senna tab 25mg.................................. 80
senna-extra tab 17.2mg ........................ 80
sennosides cap 8.6 mg ......................... 80
sennosides syrup 8.8 mg/5ml ................. 80
sennosides tab 8.6 mg.......................... 80
sennosides-docusate sodium tab 8.6-50 mg 80
sen-o-tabs tab 187mg .......................... 80
SENSI-CARE OIN 49-15% .................. 122
SENSIPAR TAB 30MG ......................... 67
SENSIPAR TAB 60MG ......................... 67
SENSIPAR TAB 90MG ......................... 67
166
SEREVENT DIS AER 50MCG ............... 108
SEROQUEL XR TAB 150MG ..................60
SEROQUEL XR TAB 50MG ....................60
sertraline hcl oral conc 20 mg/ml ..............55
sertraline hcl tab 100 mg ........................55
sertraline hcl tab 25 mg .........................55
sertraline hcl tab 50 mg .........................55
sharobel tab 0.35mg .............................69
sildenafil citrate tab 20 mg ......................47
SILENOR TAB 3MG .............................61
SILENOR TAB 6MG .............................61
SILVER SULFADIAZINE CREAM 1% ...... 118
SIMBRINZA SUS 1-0.2% ..................... 105
simply sleep tab 25mg...........................64
simvastatin tab 10 mg ...........................39
simvastatin tab 5 mg .............................39
sinus max st tab 30-500mg ................... 114
sinus pain/ tab pressure ....................... 114
sirolimus tab 0.5 mg .............................90
SIRTURO TAB 100MG ..........................22
SIVEXTRO INJ 200MG .........................19
SIVEXTRO TAB 200MG ........................19
sleep aid tab 25mg ...............................64
sleep aid tab 50mg ...............................64
slo-niacin tab 250mg cr ....................... 101
slow iron tab 50mg ...............................86
slow magnes/ tab calcium ......................97
SLOW REL FE TAB 140MG CR ...............86
SLOW REL FE TAB 143MG CR ...............86
SLOW RELEASE TAB 143MG ................86
slow release tab 45mg ..........................86
slow release tab 47.5mg ........................86
SLOW-MAG TAB.................................97
sm ca/mg/zn tab ..................................97
SM CORAL CAL TAB 1000MG ................97
sm iron slow tab 160mg cr ......................86
sm magnesium tab 250mg .....................97
sm tussin cf liq .................................. 114
sodium bicarbonate tab 325 mg ...............76
sodium bicarbonate tab 650 mg ...............76
?
SODIUM CHLOR NEB 0.45% ............... 115
sodium chloride hypertonic ophth oint 5% . 106
sodium chloride hypertonic ophth soln 5% 106
SODIUM CHLORIDE INJ 0.45% .............. 94
SODIUM CHLORIDE INJ 2.5 MEQ/ML (14.6%)
...................................................... 92
SODIUM CHLORIDE INJ 3%.................. 94
SODIUM CHLORIDE INJ 5%.................. 94
SODIUM CHLORIDE IRRIGATION SOLN 0.9%
.................................................... 123
SODIUM CHLORIDE IV SOLN 0.9% ........ 94
SODIUM FLUORIDE CHEW; TAB; 1.1 (0.5 F)
MG/ML SOLN .................................... 92
sodium phenylbutyrate oral powder 3
gm/teaspoonful................................... 70
sodium phosphates - enema .................. 80
sodium polystyrene sulfonate oral susp 15
gm/60ml ........................................... 67
SODIUM POW BICARBON .................... 76
SOLIA TAB ....................................... 69
SOLTAMOX SOL 10MG/5ML ................. 32
soluble fib pow therapy ......................... 80
SOLU-CORTEF INJ 250MG ................... 72
SOMATULINE INJ 120/.5ML .................. 73
SOMATULINE INJ 60/0.2ML .................. 73
SOMATULINE INJ 90/0.3ML .................. 73
SOMAVERT INJ 10MG ......................... 73
SOMAVERT INJ 15MG ......................... 73
SOMAVERT INJ 20MG ......................... 73
SOMAVERT INJ 25MG ......................... 73
SOMAVERT INJ 30MG ......................... 73
SOOTHE DRO 0.6-0.6% ..................... 106
soothe tab 262mg ............................... 76
sorbulax pow 100% ............................. 80
sorine tab 120mg ................................ 39
sorine tab 160mg ................................ 39
sorine tab 240mg ................................ 39
sorine tab 80mg.................................. 39
sotalol hcl (afib/afl) tab 120 mg ................ 39
sotalol hcl (afib/afl) tab 160 mg ................ 39
sotalol hcl (afib/afl) tab 80 mg ................. 39
sotalol hcl tab 120 mg .......................... 39
sotalol hcl tab 80 mg ............................ 39
SOVALDI TAB 400MG ......................... 23
167
SPIRIVA CAP HANDIHLR .................... 107
spironolactone & hydrochlorothiazide tab 25-25
mg ..................................................45
spironolactone tab 100 mg .....................37
spironolactone tab 25 mg .......................37
spironolactone tab 50 mg .......................37
sprintec 28 tab 28 day ...........................70
SPRYCEL TAB 100MG .........................33
SPRYCEL TAB 140MG .........................33
SPRYCEL TAB 20MG ...........................33
SPRYCEL TAB 50MG ...........................33
SPRYCEL TAB 70MG ...........................33
SPRYCEL TAB 80MG ...........................33
sps sus 15gm/60 .................................67
SSD CRE 1% ................................... 118
st joseph as chw 81mg ..........................13
ST JOSEPH CHW 75MG ADU ................13
STAHIST AD LIQ............................... 114
STAHIST AD TAB 25-60MG ................. 114
STANBACK AF POW 950MG..................13
STATUSS LIQ GREEN ....................... 114
stavudine cap 15 mg.............................21
stavudine cap 20 mg.............................21
stavudine cap 30 mg.............................21
stavudine cap 40 mg.............................21
stavudine for oral soln 1 mg/ml ................21
STERILE LUBR DRO 0.7% .................. 106
STIVARGA TAB 40MG ..........................33
stomach relf sus 525/15ml ......................76
stool softnr cap 100mg ..........................81
stool softnr cap 240mg ..........................81
stool softnr cap 50mg ............................80
stool softnr syp 60/15ml .........................81
stool softnr tab 8.6-50mg .......................81
STRATTERA CAP 100MG .....................61
STRATTERA CAP 10MG .......................61
STRATTERA CAP 18MG .......................61
STRATTERA CAP 25MG .......................61
STRATTERA CAP 40MG .......................61
STRATTERA CAP 60MG .......................61
STRATTERA CAP 80MG .......................61
streptomycin sulfate for inj 1 gm ...............17
STRIBILD TAB....................................22
STUART PRENA PAK + DHA ............... 101
SUBOXONE MIS 12-3MG ......................64
SUBOXONE MIS 2-0.5MG .....................64
?
SUBOXONE MIS 4-1MG ....................... 64
SUBOXONE MIS 8-2MG ....................... 64
SUCRAID SOL 8500/ML ....................... 81
sucralfate tab 1 gm .............................. 81
sudafed 12hr tab 120mg cr .................. 114
SUDAFED 24HR TAB 240MG .............. 114
sulfacetamide sodium lotion 10% (acne) .. 117
sulfacetamide sodium ophth oint 10% ..... 104
sulfacetamide sodium ophth soln 10% ..... 104
sulfacetamide sodium-prednisolone ophth soln
10-0.23(0.25)% ................................ 103
sulfadiazine tab 500mg ......................... 17
sulfamethoxazole-trimethoprim iv soln 400-80
mg/5ml ............................................ 19
sulfamethoxazole-trimethoprim susp 200-40
mg/5ml ............................................ 19
...................................................... 19
...................................................... 19
SULFAMYLON CRE 85MG/GM ............ 118
sulfasalazine tab 500 mg ....................... 78
sulfazine ec tab 500mg ......................... 78
sulindac tab 150 mg ............................. 14
sulindac tab 200 mg ............................. 14
...................................................... 62
SUMATRIPTAN NASAL SPRAY 5 MG/ACT 62
sumatriptan succinate inj 6 mg/0.5ml ........ 62
AUTO-INJECTOR 4 MG/0.5ML ............... 62
sumatriptan succinate solution auto-injector 6
mg/0.5ml .......................................... 62
CARTRIDGE 4 MG/0.5ML ..................... 62
CARTRIDGE 6 MG/0.5ML ..................... 62
sumatriptan succinate solution prefilled syringe
6 mg/0.5ml ........................................ 62
sumatriptan succinate tab 100 mg ............ 62
sumatriptan succinate tab 25 mg ............. 62
sumatriptan succinate tab 50 mg ............. 62
summers eve sol 0.3% ......................... 83
super b-100 tab ................................ 101
SUPER POW NU-THERA ................... 101
SUPRAX CAP 400MG .......................... 25
suprax chw 100mg .............................. 25
168
suprax chw 200mg ...............................25
suprax sus 100/5ml ..............................25
suprax sus 200/5ml ..............................25
SUPRAX SUS 500/5ML .........................25
suprax tab 400mg ................................25
SUPREP BOWEL SOL PREP .................81
SURMONTIL CAP 100MG .....................55
SURMONTIL CAP 25MG .......................55
SURMONTIL CAP 50MG .......................55
SUSTIVA CAP 200MG ..........................21
SUSTIVA CAP 50MG ...........................21
SUSTIVA TAB 600MG ..........................21
SUTENT CAP 12.5MG ..........................33
SUTENT CAP 25MG ............................33
SUTENT CAP 37.5MG ..........................33
SUTENT CAP 50MG ............................33
syeda tab 3-0.03mg ..............................70
SYLATRON KIT 296MCG ......................34
SYLATRON KIT 444MCG ......................34
SYLATRON KIT 888MCG ......................34
SYMBICORT AER 160-4.5 ................... 116
SYMBICORT AER 80-4.5..................... 116
SYMLINPEN 60 INJ 1000MCG ................65
SYMLNPEN 120 INJ 1000MCG ...............65
SYNAGIS INJ 100MG/ML ......................91
SYNAGIS INJ 50MG.............................91
SYNAREL SOL 2MG/ML .......................70
SYNERCID INJ 500MG .........................19
SYNTHROID TAB 100MCG ....................74
SYNTHROID TAB 25MCG .....................74
SYPRINE CAP 250MG ..........................67
SYSTANE BAL SOL RESTOR .............. 106
systane dro contacts ........................... 106
SYSTANE GEL 0.3% .......................... 106
SYSTANE LIQ DRO 0.4-0.3% ............... 106
systane oin ...................................... 106
?
T
TAB-A-VITE TAB WOMENS ................ 101
TABLOID TAB 40MG ........................... 30
tacrolimus cap 0.5 mg .......................... 90
tacrolimus cap 1 mg ............................. 90
tacrolimus cap 5 mg ............................. 90
TAFINLAR CAP 50MG ......................... 33
TAFINLAR CAP 75MG ......................... 33
TAMIFLU CAP 30MG ........................... 23
TAMIFLU CAP 45MG ........................... 23
TAMIFLU CAP 75MG ........................... 23
TAMIFLU SUS 6MG/ML ........................ 23
...................................................... 32
...................................................... 32
tamsulosin hcl cap 0.4 mg ..................... 82
TARCEVA TAB 100MG ........................ 33
TARCEVA TAB 150MG ........................ 33
TARCEVA TAB 25MG .......................... 33
TARGRETIN CAP 75MG ....................... 34
TARGRETIN GEL 1% ........................ 122
TASIGNA CAP 150MG ......................... 33
TASIGNA CAP 200MG ......................... 33
tazicef inj 1gm .................................... 25
tazicef inj 2gm .................................... 25
tazicef inj 6gm .................................... 25
TAZORAC CRE 0.05% ....................... 119
TAZORAC CRE 0.1%......................... 119
taztia xt cap 120mg/24.......................... 43
taztia xt cap 180mg/24.......................... 43
taztia xt cap 240mg/24.......................... 43
taztia xt cap 300mg/24.......................... 43
taztia xt cap 360mg/24.......................... 43
TEARS AGAIN GEL NGHT/DAY ........... 106
TEFLARO INJ 400MG .......................... 25
TEFLARO INJ 600MG .......................... 25
TEGRETOL SUS 100/5ML .................... 51
TEGRETOL TAB 200MG ...................... 51
TEGRETOL-XR TAB 100MG .................. 51
TEKAMLO TAB 150-10MG .................... 44
TEKAMLO TAB 150-5MG ...................... 44
TEKAMLO TAB 300-10MG .................... 44
TEKAMLO TAB 300-5MG ...................... 44
169
TEKTURNA HCT TAB 150-12.5 ...............44
TEKTURNA HCT TAB 150-25MG .............44
TEKTURNA HCT TAB 300-12.5 ...............44
TEKTURNA HCT TAB 300-25MG .............44
TEKTURNA TAB 150MG .......................44
TEKTURNA TAB 300MG .......................44
temazepam cap 15 mg ..........................61
temazepam cap 7.5 mg .........................61
TENIVAC INJ 5-2LF .............................91
terazosin hcl cap 1 mg ..........................37
terazosin hcl cap 10 mg .........................37
terbinafine cre 1% .............................. 119
terbinafine hcl tab 250 mg ......................20
terbutaline sulfate inj 1 mg/ml ................ 108
terbutaline sulfate tab 2.5 mg ................ 108
terbutaline sulfate tab 5 mg ................... 108
terconazole vaginal cream 0.4% ...............83
terconazole vaginal cream 0.8% ...............83
terconazole vaginal suppos 80 mg ............83
TESTIM GEL 1%(50MG) .......................65
......................................................65
......................................................65
testosterone enanthate im inj in oil 200 mg/ml
......................................................65
TET/DIP TOX INJ 2-2 LF .......................91
TETANUS TOX INJ 5LF ADS ..................91
TEV-TROPIN INJ 5MG ..........................72
texacort sol 2.5% ............................... 121
tgt lubricnt dro eye ............................. 106
th eye tears dro ................................. 106
THALOMID CAP 100MG .......................89
THALOMID CAP 150MG .......................89
THALOMID CAP 200MG .......................89
THALOMID CAP 50MG .........................89
theo-24 cap 100mg cr ......................... 116
theo-24 cap 200mg cr ......................... 116
theo-24 cap 300mg cr ......................... 116
theo-24 cap 400mg er ......................... 116
theophylline soln 80 mg/15ml ................ 116
theophylline tab sr 12hr 100 mg ............. 117
?
theophylline tab sr 24hr 400 mg............. 117
THERA BETA- TAB CAROTENE ........... 101
THERA-D TAB 4000UNIT.................... 101
THERAFLU FLU PAK SORE THR ......... 114
theraflu nt liq warm rlf ......................... 114
THERAFLU POW ............................. 114
THERAFLU POW MAX-D .................... 114
THERANATAL TAB 27-1 ..................... 101
THERATEARS SOL OP ...................... 106
thiamine hcl inj 100 mg/ml ................... 101
thiamine hcl tab 100 mg ...................... 101
thiamine hcl tab 250 mg ...................... 101
thiamine hcl tab 50 mg........................ 101
thiamine mononitrate tab 100 mg ........... 102
thioridazine hcl tab 10 mg ...................... 60
thioridazine hcl tab 100 mg .................... 60
thiothixene cap 1 mg ............................ 60
thiothixene cap 10 mg .......................... 60
thrive gum 2mg mint ............................ 64
thrive gum 4mg mint ............................ 64
tiagabine hcl tab 2 mg .......................... 51
tiagabine hcl tab 4 mg .......................... 51
TIKOSYN CAP 125MCG ....................... 39
TIKOSYN CAP 250MCG ....................... 39
TIKOSYN CAP 500MCG ....................... 39
TIMENTIN INJ 3.1GM .......................... 28
TIMENTIN INJ 31GM ........................... 28
SOLN 0.25% ................................... 105
SOLN 0.5% ..................................... 105
timolol maleate ophth soln 0.25% ........... 105
timolol maleate ophth soln 0.5% ............ 105
timolol maleate tab 10 mg ...................... 42
timolol maleate tab 20 mg ...................... 42
timolol maleate tab 5 mg ....................... 42
tioconazole oin 6.5% vag ....................... 83
titralac chw 420mg .............................. 76
TIVICAY TAB 50MG ............................ 21
tizanidine hcl tab 2 mg .......................... 63
170
tizanidine hcl tab 4 mg...........................63
tobra/nacl inj 80/0.9 ..............................17
TOBRADEX OIN 0.3-0.1% ................... 103
TOBRADEX ST SUS 0.3-0.05 ............... 103
tobramycin nebu soln 300 mg/5ml ............17
tobramycin ophth soln 0.3% .................. 104
tobramycin sulfate for inj 1.2 gm ...............17
tobramycin sulfate inj 1.2 gm/30ml (40 mg/ml)
......................................................17
tobramycin sulfate inj 10 mg/ml ................17
tobramycin sulfate inj 2 gm/50ml (40 mg/ml) 17
tobramycin sulfate inj 80 mg/2ml (40 mg/ml) 17
tobramycin-dexamethasone ophth susp
0.3-0.1% ......................................... 103
TOBREX OIN 0.3% OP ....................... 104
tolnaftate cream 1% ........................... 119
tolnaftate soln 1% .............................. 119
TOLTERODINE TARTRATE CAP SR 24HR 2
MG ..................................................83
TOLTERODINE TARTRATE CAP SR 24HR 4
MG ..................................................83
tolterodine tartrate tab 1 mg ....................83
tolterodine tartrate tab 2 mg ....................83
topiramate sprinkle cap 15 mg .................51
topiramate sprinkle cap 25 mg .................51
topiramate tab 100 mg ..........................51
topiramate tab 200 mg ..........................51
topiramate tab 25 mg ............................51
topiramate tab 50 mg ............................51
toposar inj 1gm/50ml ............................35
topotecan hcl for inj 4 mg .......................35
torsemide inj 20mg/2ml .........................45
torsemide inj 50mg/5ml .........................45
torsemide tab 10 mg .............................45
torsemide tab 100 mg ...........................45
torsemide tab 20 mg .............................45
torsemide tab 5 mg ..............................45
total b/c tab ...................................... 102
total fiber pow .....................................81
TOVIAZ TAB 4MG ...............................83
TOVIAZ TAB 8MG ...............................83
TPN ELECTROL INJ ............................92
TRACLEER TAB 125MG .......................47
TRACLEER TAB 62.5MG.......................47
TRADJENTA TAB 5MG .........................67
tramadol hcl tab 50 mg ..........................14
?
tramadol-acetaminophen tab 37.5-325 mg .. 14
trandolapril tab 1 mg ............................ 36
tranexamic acid inj 100 mg/ml ................. 87
tranexamic acid tab 650 mg ................... 87
TRANSDERM-SC DIS 1.5MG ................. 77
tranylcypromine sulfate tab 10 mg ............ 55
travasol inj 10% .................................. 92
TRAVATAN Z DRO 0.004% ................. 105
trazodone hcl tab 100 mg ...................... 55
trazodone hcl tab 150 mg ...................... 55
trazodone hcl tab 50 mg ........................ 55
TREANDA INJ 100MG ......................... 29
TREANDA INJ 25MG ........................... 29
TRECATOR TAB 250MG ...................... 22
TRELSTAR DEP INJ 3.75MG ................. 32
TRELSTAR LA INJ 11.25MG .................. 32
tretinoin cap 10 mg .............................. 34
tretinoin cream 0.025% ....................... 117
tretinoin cream 0.05% ........................ 117
tretinoin cream 0.1% .......................... 117
tretinoin gel 0.01%............................. 117
tretinoin gel 0.025% ........................... 117
triacting dt liq cold/cgh ........................ 114
triamcinolone acetonide cream 0.025% ... 121
triamcinolone acetonide cream 0.1%....... 121
triamcinolone acetonide cream 0.5%....... 121
triamcinolone acetonide dental paste 0.1% 123
triamcinolone acetonide lotion 0.025%..... 122
triamcinolone acetonide lotion 0.1% ........ 121
triamcinolone acetonide oint 0.025% ....... 122
triamcinolone acetonide oint 0.1% .......... 122
triamcinolone acetonide oint 0.5% .......... 122
triaminic liq ...................................... 114
TRIAMINIC MIS GRAPE ..................... 108
TRIAMINIC NT MIS COLD/CGH ............ 114
TRIAMINIC SOL COLD/CGH................ 114
TRIAMINIC SYP CHST/NSL ................ 114
TRIAMINIC SYP COLD/ALL ................. 114
TRIAMINIC SYP COLD/CGH................ 114
TRIAMINIC SYP FEVER ..................... 114
TRIAMINIC SYP INFANT ...................... 13
triaminic tab 10mg ............................. 108
triamterene & hydrochlorothiazide cap 37.5-25
mg .................................................. 45
171
triamterene & hydrochlorothiazide tab 37.5-25
mg ..................................................45
triamterene & hydrochlorothiazide tab 75-50 mg
......................................................45
TRIBENZOR20- TAB 5-12.5MG ...............37
TRIBENZOR40- TAB 10-12.5 ..................38
TRIBENZOR40- TAB 10-25MG................38
TRIBENZOR40- TAB 5-12.5MG ...............38
TRIBENZOR40- TAB 5-25MG .................38
tri-buff asa tab 325mg ...........................13
TRICODE AR LIQ .............................. 114
TRICODE GF LIQ .............................. 114
triderm cre 0.1% ................................ 122
trifluoperazine hcl tab 1 mg .....................60
trifluoperazine hcl tab 10 mg ...................60
trifluridine ophth soln 1% ...................... 104
tri-legest tab fe ....................................70
trilyte sol ...........................................81
trimethoprim tab 100 mg ........................19
TRINESSA TAB ..................................70
triple antib oin ................................... 118
TRIPLE PASTE OIN 12.8% .................. 122
triple paste oin af 2% .......................... 119
tri-previfem tab ....................................70
TRISENOX SOL 10MG/10M ...................34
tri-sprintec tab.....................................70
TRIUMEQ TAB ...................................22
TRI-VI-SOL DRO /IRON ...................... 102
TRI-VI-SOL SOL ............................... 102
tri-vita sol ........................................ 102
tri-vitamin dro ................................... 102
trivora-28 tab ......................................70
TROPHAMINE INJ 10% ........................92
trospium chloride tab 20 mg ....................83
TRUVADA TAB 200-300 ........................22
trymine cg liq 225-7.5 .......................... 114
TUCKS OIN 1% ................................ 122
TUDORZA PRES AER 400/ACT ............ 107
tusnel c syp...................................... 114
TUSNEL LIQ .................................... 114
TUSNEL PED DRO 7.5-50 ................... 114
TUSNEL PEDI LIQ 15-5-50 .................. 114
TUSNEL-DM DRO PEDIATRC .............. 114
tussin cf liq cgh/cold ........................... 114
?
tussin dm syp 100-10/5 ....................... 114
tussi-pres liq pe ped ........................... 114
TWINRIX INJ ..................................... 91
TYBOST TAB 150MG .......................... 21
TYGACIL INJ 50MG ............................ 19
TYKERB TAB 250MG .......................... 33
tylenol chld tab 80mg ........................... 13
TYPHIM VI INJ ................................... 91
TYSABRI INJ 300/15ML........................ 63
TYZEKA TAB 600MG ........................... 24
U
UCERIS TAB 9MG .............................. 78
ULORIC TAB 40MG............................. 12
ULORIC TAB 80MG............................. 12
UNITHROID TAB 100MCG .................... 75
UNITHROID TAB 25MCG ...................... 75
UPCAL D POW .................................. 97
URO-MAG CAP 140MG ........................ 76
ursodiol cap 300 mg ............................ 81
ursodiol tab 250 mg ............................. 81
ursodiol tab 500 mg ............................. 81
V
VAGIFEM TAB 10MCG ........................ 71
vagistat-3 kit combo pk ......................... 83
valacyclovir hcl tab 1 gm ....................... 24
valacyclovir hcl tab 500 mg .................... 24
VALCHLOR GEL 0.016% .................... 122
VALCYTE SOL 50MG/ML...................... 24
VALCYTE TAB 450MG ......................... 24
valproate sodium inj 100 mg/ml ............... 51
valproate sodium syrup 250 mg/5ml (base
equiv) .............................................. 51
valproic acid cap 250 mg ....................... 51
valsartan tab 160 mg............................ 38
valsartan tab 320 mg............................ 38
valsartan tab 40 mg ............................. 38
valsartan tab 80 mg ............................. 38
172
......................................................38
......................................................38
......................................................38
......................................................38
......................................................38
vancomycin hcl cap 125 mg ....................19
vancomycin hcl cap 250 mg ....................19
vancomycin hcl for inj 10 gm ...................19
vancomycin hcl for inj 1000 mg ................19
vancomycin hcl for inj 500 mg..................19
vancomycin hcl for inj 5000 mg ................19
vancomycin inj 750mg ...........................19
VANDAZOLE GEL 0.75% ......................83
VAQTA INJ 25/0.5ML ...........................91
VAQTA INJ 50UNT/ML ..........................91
VARIVAX INJ .....................................91
VASCEPA CAP 1GM ............................40
VASOCLEAR A SOL OP ..................... 104
vcks dayquil liq mucus dm .................... 114
VELCADE INJ 3.5MG ...........................31
velivet pak .........................................70
venlafaxine hcl cap sr 24hr 150 mg (base
equivalent) .........................................55
venlafaxine hcl cap sr 24hr 37.5 mg (base
equivalent) .........................................55
venlafaxine hcl cap sr 24hr 75 mg (base
equivalent) .........................................55
venlafaxine hcl tab 100 mg .....................55
venlafaxine hcl tab 25 mg .......................55
venlafaxine hcl tab 37.5 mg ....................55
verapamil hcl cap sr 24hr 100 mg .............43
VERAPAMIL HCL CAP SR 24HR 360 MG ..43
verapamil hcl iv soln 2.5 mg/ml ................43
verapamil hcl tab 120 mg .......................43
verapamil hcl tab 40 mg .........................43
?
verapamil hcl tab 80 mg ........................ 43
verapamil hcl tab cr 120 mg ................... 43
VERSACLOZ SUS 50MG/ML ................. 60
vertin-32 tab ...................................... 77
VESICARE TAB 10MG ......................... 83
VESICARE TAB 5MG .......................... 83
VIBRAMYCIN SYP 50MG/5ML ............... 29
VICK VAPORUB OIN ......................... 114
VICTOZA INJ 18MG/3ML ...................... 65
VICTRELIS CAP 200MG ....................... 24
VIDEX SOL 2GM ................................ 21
VIDEX SOL 4GM ................................ 21
VIGAMOX DRO 0.5% ........................ 104
VIIBRYD KIT ..................................... 55
VIIBRYD TAB 10MG ............................ 55
VIIBRYD TAB 20MG ............................ 55
VIIBRYD TAB 40MG ............................ 55
VIMPAT INJ 200MG/20 ........................ 51
VIMPAT SOL 10MG/ML ........................ 51
VIMPAT TAB 100MG ........................... 51
VIMPAT TAB 150MG ........................... 51
VIMPAT TAB 200MG ........................... 51
VIMPAT TAB 50MG ............................. 51
vinblastine inj 1mg/ml ........................... 31
vincasar pfs inj 1mg/ml ......................... 31
vincristine sulfate iv soln 1 mg/ml ............. 31
vinorelbine tartrate inj 10 mg/ml ............... 31
vinorelbine tartrate inj 50 mg/5ml (10 mg/ml) 31
viorele tab ......................................... 70
VIRACEPT TAB 250MG ........................ 21
VIRACEPT TAB 625MG ........................ 21
VIRAMUNE XR TAB 100MG .................. 21
VIREAD POW 40MG/GM ...................... 21
VIREAD TAB 150MG ........................... 22
VIREAD TAB 200MG ........................... 22
VIREAD TAB 250MG ........................... 22
VIREAD TAB 300MG ........................... 22
visine-a sol op .................................. 104
VISINE-LR SOL 0.025% ..................... 104
VIT B12/FA TAB ................................. 86
vit c & e cap combo ........................... 102
vita-bee/c tab ................................... 102
VITALETS CHW ............................... 102
vitalize liq ginseng ............................. 102
173
VITA-MAG TAB................................. 102
vitamin a cap 10000 unit ...................... 102
vitamin a cap 8000unit ........................ 102
VITAMIN A TAB ................................ 102
vitamin a tab 10000 unit ....................... 102
VITAMIN A TAB 15000UNT .................. 102
vitamin b12 tab 2000mcg ..................... 102
VITAMIN C CHW 1000MG ................... 102
VITAMIN C SOL ................................ 102
vitamin d cap 1000unit ........................ 102
vitamin d chw 1000unit ........................ 102
vitamin d chw 400unit ......................... 102
VITAMIN D2 TAB 2000UNIT ................. 102
VITAMIN D2 TAB 400UNIT................... 102
vitamin d3 cap 10000unt ...................... 102
VITAMIN D3 CAP 4000UNIT ................. 102
VITAMIN D3 CAP 400UNIT .................. 102
vitamin d3 cap 50000unt ...................... 102
VITAMIN D3 LIQ 1200UNIT .................. 102
VITAMIN D3 TAB 3000UNIT ................. 102
VITAMIN D3 TAB 50000UNT ................ 102
vitamin d3 tab 5000unit ....................... 102
vitamin e cap 1000 unit ........................ 102
vitamin e cap 200 unit ......................... 102
vitamin e cap 600 unit ......................... 102
VITAMIN E CHW 400UNIT ................... 102
vitamin e soln 15 unit/0.3ml (50 unit/ml) .... 102
VITAMIN E TAB 100UNIT .................... 102
VITAMIN E TAB 200UNIT .................... 102
vitamin e tab 400 unit .......................... 102
VITAMIN K TAB 100MCG .................... 102
vitamin mixture cap ............................ 102
vitamins a & d cap ............................. 103
vita-plus e cap 400unit ........................ 102
vitatrum chw..................................... 103
vite/iron chw children .......................... 103
VIVA DROPS DRO 1% ....................... 106
VOLTAREN GEL 1% .......................... 122
voriconazole for inj 200 mg .....................20
voriconazole for susp 40 mg/ml ................20
voriconazole tab 200 mg ........................20
voriconazole tab 50 mg .........................20
VOTRIENT TAB 200MG ........................33
vyfemla tab 0.4-35 ...............................70
W
wal-act tab 2.5-60mg .......................... 114
?
wal-dryl all tab sinus........................... 114
wal-dryl-d tab alrg/sin ......................... 114
wal-fex d tab 12 hour.......................... 114
wal-flu cold pak daytime ...................... 114
wal-itin d tab 5-120mg ........................ 114
wal-itin syp 5mg/5ml .......................... 108
wal-phed pe tab 4-10mg...................... 114
wal-phed tab 4-60mg ......................... 114
wal-som cap 50mg .............................. 64
warfarin sodium tab 1 mg ...................... 85
warfarin sodium tab 10 mg ..................... 85
warfarin sodium tab 2.5 mg .................... 85
warfarin sodium tab 7.5 mg .................... 85
WATER FOR IRRIGATION, STERILE
IRRIGATION SOLN ........................... 123
wee care sus 15/1.25 ........................... 86
WELCHOL PAK 3.75GM ....................... 40
WELCHOL TAB 625MG ........................ 40
X
XALKORI CAP 200MG ......................... 33
XALKORI CAP 250MG ......................... 33
XARELTO STAR TAB 15/20MG .............. 85
XARELTO TAB 10MG .......................... 85
XARELTO TAB 15MG .......................... 85
XARELTO TAB 20MG .......................... 85
XENAZINE TAB 12.5MG ....................... 63
XENAZINE TAB 25MG ......................... 63
XGEVA INJ ....................................... 73
XIFAXAN TAB 550MG.......................... 81
XOLAIR SOL 150MG ......................... 116
XOPENEX HFA AER ......................... 108
XTANDI CAP 40MG............................. 32
XYREM SOL 500MG/ML ....................... 63
Y
YF-VAX INJ....................................... 91
yl folic aci tab 400mcg ........................ 103
Z
zafirlukast tab 10 mg .......................... 115
zafirlukast tab 20 mg .......................... 115
zarah tab 3-0.03mg ............................. 70
ZAVESCA CAP 100MG ........................ 70
174
zazole cre 0.4% ..................................83
ZAZOLE CRE 0.8% ..............................83
z-cof 12dm liq ................................... 115
ZELBORAF TAB 240MG .......................33
ZEMAIRA INJ 1000MG ....................... 116
zenatane cap 10mg ............................ 117
zenatane cap 20mg ............................ 117
zenatane cap 40mg ............................ 117
zenchent tab ......................................70
ZENPEP CAP 10000UNT ......................81
ZENPEP CAP 15000UNT ......................81
ZENPEP CAP 20000UNT ......................81
ZENPEP CAP 25000UNT ......................81
ZENPEP CAP 3000UNIT .......................81
ZENPEP CAP 5000UNIT .......................81
ZETIA TAB 10MG ................................40
ZIAGEN SOL 20MG/ML.........................22
zidovudine cap 100 mg ..........................22
zidovudine syrup 10 mg/ml .....................22
zidovudine tab 300 mg ..........................22
zinc oxide oint 20% ............................ 122
ZINC OXIDE PST 25% ........................ 123
ziprasidone hcl cap 20 mg ......................60
ZMAX SUS 2GM .................................26
ZODRYL AC 25 SUS .......................... 115
ZODRYL AC 30 SUS .......................... 115
ZODRYL AC 35 SUS .......................... 115
ZODRYL AC 40 SUS .......................... 115
ZODRYL DAC SUS 25 ........................ 115
ZODRYL DAC SUS 30 ........................ 115
ZODRYL DAC SUS 35 ........................ 115
ZODRYL DAC SUS 40 ........................ 115
?
ZODRYL DEC25 SUS ........................ 115
ZODRYL DEC30 SUS ........................ 115
ZODRYL DEC35 SUS ........................ 115
ZODRYL DEC40 SUS ........................ 115
zoledronic acid inj conc for iv infusion 4 mg/5ml
...................................................... 67
ZOLINZA CAP 100MG ......................... 31
zolmitriptan orally disintegrating tab 2.5 mg . 62
zolmitriptan orally disintegrating tab 5 mg ... 62
zolmitriptan tab 2.5 mg ......................... 62
zolmitriptan tab 5 mg ............................ 62
zolpidem tartrate tab 10 mg .................... 61
zolpidem tartrate tab 5 mg ..................... 61
ZOMETA INJ 4MG/100 ......................... 67
zonatuss cap 150mg .......................... 115
zonisamide cap 100 mg ........................ 52
zonisamide cap 25 mg .......................... 51
zonisamide cap 50 mg .......................... 51
ZONTIVITY TAB 2.08MG ...................... 87
ZOO FRIENDS CHW COMPLETE ......... 103
ZORTRESS TAB 0.25MG ...................... 90
ZORTRESS TAB 0.5MG ....................... 90
ZORTRESS TAB 0.75MG ...................... 90
ZOSTAVAX INJ .................................. 91
Z-TUSS AC LIQ 2-9/5ML ..................... 115
Z-TUSS E LIQ.................................. 115
ZYDELIG TAB 100MG.......................... 33
ZYDELIG TAB 150MG.......................... 33
ZYKADIA CAP 150MG ......................... 33
ZYLET SUS 0.5-0.3% ........................ 103
ZYTIGA TAB 250MG ........................... 32
ZYVOX SOL 2MG/ML .......................... 19
ZYVOX SUS 100MG/5M ....................... 19
ZYVOX TAB 600MG ............................ 19
175
Pou Jwenn Plis Enfòmasyon:
Rele Sèvis Patisipan:
(855) 776-7545
Oswa ale sou sitwèb:
North Shore-LIJ
FIDA LiveWell
(Medicare-Medicaid Plan)
Lis Medikaman ki Garanti yo
(Fòmilè)
2015
Nou fè bon kalite swen sante
vin fasil pou jwenn.
TANPRI LI:
DOKIMAN SA A GEN ENFÒMASYON SOU MEDIKAMAN NOU GARANTI NAN PLAN SA A
Sèvis Patisipan: (855) 776-7545

North Shore-LIJ FIDA LiveWell - North Shore

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