AvMed Medicare Choice

Transcripción

1 AvMed Medicare Choice Formulario 2018 (Lista de medicamentos cubiertos) POR FAVOR LEA: ESTE DOCUMENTO CONTIENE INFORMACIÓN SOBRE LOS MEDICAMENTOS QUE CUBRIMOS EN ESTE PLAN Nota para los miembros actuales: este Formulario ha cambiado con respecto al año pasado. Revise este documento para asegurarse de que aún contiene los medicamentos que toma. Este formulario ha sido actualizado para el 5/01/2018. Para obtener información más reciente o respuestas a sus preguntas, por favor llame al Departamento de Servicios a los Afiliados de AvMed Choice al desde el 1ro de octubre al 14 de febrero: 8:00 am a 8:00 pm, los 7 días de la semana. Y del 15 de febrero al 30 de septiembre: 8:00 am a 8:00 pm, de lunes a viernes, y 9:00 am a 1:00 pm los sábados (para los usuarios de TTY, 711 o el , los 7 días a la semana y las 24 horas del día) o visite Este documento incluye una lista de los medicamentos (el formulario) de nuestro plan cuya actualización parte del 1 de mayo de Para un formulario actualizado, por favor póngase en contacto con nosotros. La información para comunicarse con nosotros, junto con la fecha de la última vez que actualizamos el formulario, aparece aquí en la portada y la contraportada. Generalmente, debe concurrir a las farmacias de la red para usar el beneficio de medicamentos con receta. Los beneficios, el formulario, la red de farmacias o los copagos/el coseguro pueden cambiar el 1 de enero de 2019 y periódicamente durante el año. HPMS Approved Formulary File Submission ID Version 9 H1016_PH213SP accepted_final1 AvMed Medicare Choice es un plan de HMO con contrato de Medicare. Inscripción en AvMed depende de la renovación del contrato. i

2 Qué es el Formulario completo de AvMed Medicare Choice? Un Formulario es una lista de medicamentos cubiertos seleccionados por AvMed con la colaboración de un equipo de proveedores de atención médica, que representa los tratamientos con receta que se considera que son parte necesaria de un programa de tratamiento de calidad. Normalmente, AvMed cubrirá los medicamentos incluidos en el formulario, siempre que el medicamento sea médicamente necesario, el medicamento con receta se obtenga en una farmacia de la red de AvMed y se cumpla con otras normas del plan. Para obtener más información sobre cómo obtener sus medicamentos con receta, consulte la Evidencia de cobertura. Puede cambiar el Formulario (lista de medicamentos)? En general, si usted está tomando un medicamento que aparece en nuestro formulario del 2018 y que estaba cubierto a principios de año, no vamos a interrumpir o reducir la cobertura del medicamento durante el año de cobertura 2018, excepto cuando un medicamento genérico nuevo y menos costoso esté disponible o cuando nueva información adversa sobre la seguridad o eficacia de un fármaco se dé a conocer. Otros tipos de cambios en el Formulario, por ejemplo, la eliminación de un medicamento, no afectarán a los miembros que estén actualmente tomando el medicamento. Por el resto del año de cobertura, continuará disponible al mismo costo compartido para aquellos miembros que estén tomándolo. Consideramos que es importante que tenga acceso continuo a los medicamentos del Formulario que estaban disponibles cuando eligió nuestro plan durante el resto del año de cobertura, salvo en los casos en los que usted podría ahorrar más dinero o que nosotros podríamos garantizarle su seguridad. Si retiramos medicamentos de nuestro Formulario, o agregamos autorizaciones previas, restricciones de límite de cantidad o de tratamiento escalonado en un medicamento, debemos notificarles a los miembros afectados por el cambio al menos 60 días antes de que entre en vigencia dicho cambio, o cuando el miembro solicite un resurtido del medicamento, momento en el cual el miembro recibirá un suministro del medicamento para 60 días. Si la Administración de Drogas y Alimentos considera que un medicamento de nuestro Formulario es inseguro o el fabricante del medicamento lo retira del mercado, eliminaremos de inmediato dicho medicamento de nuestro Formulario y les notificaremos a los miembros que toman el medicamento en cuestión. El Formulario adjunto está vigente a partir del 1 de mayo de Para recibir información actualizada sobre los medicamentos cubiertos por AvMed, comuníquese con nosotros. Nuestra información de contacto aparece en las páginas de la portada y la portada posterior. Cómo utilizo el Formulario? Hay dos formas para encontrar su medicamento dentro del Formulario: Afección médica El Formulario comienza en la página 2. Los medicamentos de este Formulario están agrupados en categorías según el tipo de afección médica para cuyo tratamiento se los emplea. Por ejemplo, los medicamentos utilizados para tratar una afección cardíaca se enumeran dentro de la categoría Cardiovascular, Hipertensión/Lípidos. Si sabe para qué se utiliza su medicamento, busque el nombre de la categoría en la lista que empieza en la página 2. Luego, busque su medicamento debajo del nombre de la categoría. ii

3 Listado alfabético Si no está seguro de qué categoría consultar, debe buscar su medicamento en el Índice que comienza en la página 69. El Índice proporciona una lista alfabética de todos los medicamentos incluidos en este documento. En el Índice, están tanto los medicamentos de marca como los genéricos. Busque en el Índice y encuentre su medicamento. Junto a su medicamento, verá el número de página donde puede encontrar información acerca de la cobertura. Vaya a la página que figura en el Índice y encuentre el nombre de su medicamento en la primera columna de la lista. Qué son los medicamentos genéricos? AvMed cubre tanto los medicamentos de marca como los genéricos. Un medicamento genérico está aprobado por la Administración de Drogas y Alimentos (FDA) dado que se considera que tiene el mismo ingrediente activo que el medicamento de marca. Normalmente, los medicamentos genéricos cuestan menos que los de marca. Hay alguna restricción en mi cobertura? Algunos medicamentos cubiertos pueden tener requisitos o límites adicionales de cobertura. Estos requisitos y límites pueden incluir: Autorización previa: AvMed exige que usted [o su médico] obtenga una autorización previa para determinados medicamentos. Esto significa que necesitará contar con la aprobación de AvMed antes de obtener sus medicamentos con receta. Si no consigue la autorización, es posible que AvMed no cubra el medicamento. Límites de cantidad: para ciertos medicamentos, AvMed limita la cantidad del medicamento que cubrirá. Por ejemplo, AvMed proporciona 30 tabletas por receta para Januvia 50MG. Esto puede ser complementario a un suministro estándar para un mes o tres meses. Tratamiento escalonado: en algunos casos, AvMed requiere que usted primero pruebe ciertos medicamentos para tratar su afección médica antes de que cubramos otro medicamento para esa enfermedad. Por ejemplo, si el medicamento A y el medicamento B tratan su afección médica, es posible que AvMed no cubra el medicamento B a menos que usted pruebe primero el medicamento A. Si el medicamento A no funciona para usted, entonces AvMed cubrirá el medicamento B. Para averiguar si su medicamento tiene requisitos o límites adicionales, consulte el Formulario que empieza en la página 2. También puede obtener más información sobre las restricciones que se aplican a medicamentos cubiertos específicos en nuestro sitio web. Hemos publicado documentos en línea que explican nuestras restricciones de autorización previa y tratamiento escalonado. También puede pedirnos que le enviemos una copia. Nuestra información de contacto, junto con la fecha de la última actualización del Formulario, aparece en las páginas de la portada y la portada posterior. Puede pedirle a AvMed que haga una excepción a estas restricciones o límites, o puede solicitarle una lista de otros medicamentos similares que puedan tratar su afección médica. Consulte la sección Cómo solicito una excepción al Formulario de AvMed? en la página iv para obtener información acerca de cómo solicitar una excepción. iii

4 Qué pasa si mi medicamento no está en el Formulario? Si el medicamento que toma no está incluido en este Formulario (lista de medicamentos cubiertos), primero debe comunicarse con Servicios para los miembros y preguntar si su medicamento está cubierto. Si resulta que AvMed no cubre el medicamento que toma, tiene dos alternativas: Puede pedir a Servicios para los miembros una lista de medicamentos similares que estén cubiertos por AvMed. Cuando reciba la lista, muéstresela a su médico y pídale que le recete un medicamento similar que esté cubierto por AvMed. Puede solicitar que AvMed haga una excepción y cubra su medicamento. Consulte a continuación para obtener información sobre cómo solicitar una excepción. Cómo puedo solicitar que se haga una excepción al Formulario de AvMed Medicare Choice? Puede solicitarle a AvMed que haga una excepción a nuestras normas de cobertura. Hay varios tipos de excepciones que puede solicitarnos. Puede pedirnos que cubramos un medicamento, incluso si no está en nuestro Formulario. Si se aprueba, este medicamento estará cubierto a un nivel de costo compartido predeterminado, y usted no podrá pedirnos que le brindemos el medicamento a un nivel de costo compartido menor. Puede pedirnos que cubramos un medicamento del Formulario a un nivel de costo compartido menor si este medicamento no está incluido en el nivel de medicamentos especializados. Si se aprueba, esto reduciría el monto que usted debe pagar por su medicamento. Puede pedirnos que no apliquemos restricciones o límites de cobertura para su medicamento. Por ejemplo, para ciertos medicamentos, AvMed limita la cantidad del medicamento que cubriremos. Si su medicamento tiene un límite de cantidad, puede pedirnos que hagamos una excepción al límite y cubramos una cantidad mayor. Por lo general, AvMed Medicare Choice solo aprobará su pedido de excepción si los medicamentos alternativos incluidos en el Formulario del plan, el medicamento de menor costo compartido o las restricciones de uso adicionales no fueran tan efectivos para tratar su afección o pudieran causarle efectos médicos adversos. Debe comunicarse con nosotros para solicitarnos una decisión inicial de cobertura para una excepción al Formulario, o a la restricción de uso. Cuando solicita una excepción al Formulario, o a la restricción de uso, debe presentar una declaración de su médico o de la persona autorizada a dar recetas que respalde su solicitud. Por lo general, debemos tomar una decisión dentro de las 72 horas a partir de la fecha de haber recibido la declaración que respalda su solicitud por parte de la persona autorizada a dar recetas. Puede solicitar una excepción acelerada (rápida) si usted o su médico consideran que esperar 72 horas para la toma de la decisión podría perjudicar gravemente su salud. Si se le concede el trámite rápido de la excepción, debemos comunicarle nuestra decisión a más tardar dentro de las 24 horas después de haber recibido la declaración de respaldo de su médico o de otra persona autorizada a dar recetas. iv

5 Qué debo hacer antes de hablar con mi médico sobre el cambio de los medicamentos que tomo o la solicitud de una excepción? Como miembro nuevo o permanente de nuestro plan, es posible que esté tomando medicamentos que no están incluidos en el Formulario. También es posible que esté tomando un medicamento incluido en el Formulario pero su capacidad de conseguirlo sea limitada. Por ejemplo, puede necesitar nuestra autorización previa antes de poder obtener su medicamento con receta. Debe consultar con su médico para decidir si debe cambiar su medicamento por uno apropiado que nosotros cubramos o solicitar una excepción al formulario para que le cubramos el medicamento que toma. Mientras evalúa con su médico el procedimiento adecuado para seguir en su caso, podemos cubrir su medicamento, en ciertos casos, durante los primeros 90 días en que usted sea miembro de nuestro plan. Para cada uno de los medicamentos que no están incluidos en el Formulario o si su capacidad para conseguir los medicamentos es limitada, cubriremos un suministro temporal para 30 días (a menos que tenga una receta para menos días) cuando acuda a una farmacia de la red. Después del primer suministro para 30 días, no seguiremos pagando estos medicamentos, incluso si ha sido miembro del plan durante menos de 90 días. Si reside en un centro de atención a largo plazo, le permitiremos resurtir su receta hasta que le hayamos brindado un suministro de transición de entre 98 días como máximo, de manera consistente con el incremento de provisión (a menos que tenga una receta para menos días). Cubriremos más de un resurtido de estos medicamentos durante los primeros 90 días en que usted sea miembro del plan. Si necesita un medicamento que no está en el Formulario o si su capacidad para conseguir los medicamentos es limitada, pero ya pasaron los primeros 90 días de membresía en nuestro plan, cubriremos un suministro de emergencia del medicamento para 31 días (a menos que tenga una receta para menos días) mientras solicita la excepción al formulario. Para obtener más información Para obtener información más detallada sobre la cobertura para medicamentos con receta de AvMed, consulte la Evidencia de cobertura y otra documentación del plan. Si tiene alguna pregunta sobre AvMed, comuníquese con nosotros. Nuestra información de contacto, junto con la fecha de la última actualización del Formulario, aparece en las páginas de la portada y la portada posterior. Si tiene preguntas generales sobre su cobertura para medicamentos con receta de Medicare, llame a Medicare al MEDICARE ( ), las 24 horas, los 7 días de la semana. Los usuarios de TTY deben llamar al O visite Formulario de AvMed Medicare Choice El formulario do a continuación/que comienza en la siguiente página proporciona información acerca de la cobertura de los medicamentos cubiertos por AvMed. Si tiene alguna dificultad para encontrar el medicamento que toma en la lista, consulte el Índice que comienza en la página 69. v

6 La primera columna de la tabla menciona el nombre del medicamento. Los medicamentos de marca están en letra mayúscula (por ejemplo, JANUVIA), y los medicamentos genéricos están en letra minúscula y cursiva (por ejemplo, metformin hcl). La información incluida en la columna de Requisitos/límites indica si AvMed tiene algún requisito especial para la cobertura del medicamento. Lista de Abreviaturas y Su Significado B/D : Este medicamento por receta puede estar cubierto bajo la Parte B o la D del Medicare, dependiendo de las circunstancias. Para tomar una determinación, puede ser que se necesite presentar información quedescriba el uso y las circunstancias del medicamento EX : s Realzado. Este medicamento por receta normalmente no está cubierto por ningún plan de Medicare para recetas médicas. La cantidad que usted paga cuando le despachan la receta de este medicamento no cuenta para sus costos totales de medicamentos (es decir, la cantidad que usted paga no le ayuda a calificar para la cobertura catastrófica). Además, si está recibiendo ayuda adicional para pagar sus medicamentos por receta, usted no conseguirá ningún tipo de ayuda adicional para costear este medicamento. GC : Cobertura de Brecha. Proporcionamos cobertura para este medicamento por receta en la Etapa de Falta Por favor consulte su Constancia de Cobertura para detalles sobre esta cobertura. LA : Disponibilidad Limitada. Este medicamento por receta puede estar disponible sólo en ciertas farmacias. Para obtener más información, por favor llame al Departamento de Servicios a los Afiliados. MO : Encargo por Correo. Este medicamento por receta está disponible a través de nuestro servicio de pedidos por correo, así como a través de nuestra red de farmacias. Considere usar esta opción de envíos por correo para sus medicamentos a largo plazo (de mantenimiento, como las medicinas para la presión arterial). Las farmacias de la red pueden ser más apropiadas para las recetas sin varias repeticiones (como los antibióticos). PA : Autorización Previa. El Plan requiere que usted o su médico obtenga autorización previa para ciertos medicamentos. Esto significa que usted tendrá que obtener la aprobación antes de que le despachen sus recetas. Si no obtiene la aprobación, es posible que el plan no cubra el medicamento. QL : Límite de Cantidad. Para ciertos medicamentos, el Plan limita la cantidad del medicamento que cubrimos. ST : Terapia Escalonada. En algunos casos, el Plan requiere que usted pruebe primero ciertos medicamentos para su problema médico antes de cubrir otro medicamento. Por ejemplo, si el medicamento A y el medicamento B son indicados para su problema médico, es posible que no cubramos el medicamento B a menos que usted primero pruebe el medicamento A. Si el medicamento A no le funciona, entonces le cubriremos el medicamento B. PA - Autorización Previa QL - Cantidad Limitada ST - Terapia Escalonada B/D - Autorización Previa, Parte D vs. Parte B solamente LA - Disponibilidad Limitada de Cobertura 1

7 AvMed 05/01/2018 Analgésicos Gota allopurinol tab GC allopurinol tab GC colchicine w/ probenecid tab COLCRYS TAB 0.6MG 3 QL QL (120 tabs / 30 MITIGARE CAP 0.6MG 3 QL QL (60 caps / 30 probenecid tab ULORIC TAB 40MG 3 ST ULORIC TAB 80MG 3 ST Antiinflamatorios no esteroideos celecoxib cap 50 QL (240 caps / 30 celecoxib cap 100 QL (120 caps / 30 celecoxib cap 200 QL (60 caps / 30 celecoxib cap 400 QL (30 caps / 30 diclofenac potassium tab 50 3 QL QL (120 tabs / 30 diclofenac sodium tab delayed 2 GC release 25 diclofenac sodium tab delayed 2 GC release 50 diclofenac sodium tab delayed 2 GC release 75 diclofenac sodium tab er 24hr 2 GC 100 diflunisal tab etodolac cap etodolac cap etodolac tab etodolac tab etodolac tab er 24hr etodolac tab er 24hr etodolac tab er 24hr flurbiprofen tab 50 3 flurbiprofen tab ibuprofen susp 100 /5ml 3 ibuprofen tab 400 ibuprofen tab 600 ibuprofen tab 800 ketoprofen cap 50 3 ketoprofen cap 75 3 meloxicam tab 7.5 meloxicam tab 15 nabumetone tab GC nabumetone tab GC naproxen dr tab GC naproxen dr tab GC naproxen sodium tab naproxen sodium tab naproxen susp 125 /5ml 4 naproxen tab 250 naproxen tab 375 naproxen tab 500 piroxicam cap 10 3 piroxicam cap 20 3 sulindac tab GC sulindac tab GC Analgésicos opiáceos acetaminophen w/ codeine soln /5ml QL (5000 ml / 30 acetaminophen w/ codeine tab QL (400 tabs / 30 acetaminophen w/ codeine tab QL (400 tabs / 30 acetaminophen w/ codeine tab QL (400 tabs / 30 2 GC QL 2 GC QL 2 GC QL 2 GC QL butorphanol tartrate inj 1 4 /ml butorphanol tartrate inj 2 4 /ml nalbuphine hcl inj 10 /ml 4 nalbuphine hcl inj 20 /ml 4 tramadol hcl tab 50 QL (240 tabs / 30 2 GC QL 2

8 tramadol-acetaminophen tab 3 QL QL (240 tabs / 30 Analgésicos opiáceos, CII endocet tab QL QL (360 tabs / 30 endocet tab QL QL (360 tabs / 30 endocet tab QL QL (360 tabs / 30 endocet tab QL QL (360 tabs / 30 fentanyl citrate lozenge on a 5 QL PA handle 200 mcg QL (120 lozenges / 30 fentanyl citrate lozenge on a 5 QL PA handle 400 mcg QL (120 lozenges / 30 fentanyl citrate lozenge on a 5 QL PA handle 600 mcg QL (120 lozenges / 30 fentanyl citrate lozenge on a 5 QL PA handle 800 mcg QL (120 lozenges / 30 fentanyl citrate lozenge on a 5 QL PA handle 1200 mcg QL (120 lozenges / 30 fentanyl citrate lozenge on a 5 QL PA handle 1600 mcg QL (120 lozenges / 30 fentanyl td patch 72hr 12 mcg/hr QL (10 patches / 30 fentanyl td patch 72hr 25 mcg/hr QL (10 patches / 30 fentanyl td patch 72hr 50 mcg/hr QL (10 patches / 30 fentanyl td patch 72hr 75 mcg/hr QL (10 patches / 30 fentanyl td patch 72hr 100 mcg/hr QL (10 patches / 30 FENTORA TAB 100MCG QL (120 tabs / 30 FENTORA TAB 200MCG QL (120 tabs / 30 FENTORA TAB 400MCG QL (120 tabs / 30 FENTORA TAB 600MCG QL (120 tabs / 30 FENTORA TAB 800MCG QL (120 tabs / 30 hydrocodone-acetaminophen soln /15ml QL (5400 ml / 30 hydrocodone-acetaminophen tab QL (360 tabs / 30 hydrocodone-acetaminophen tab QL (360 tabs / 30 hydrocodone-acetaminophen tab QL (360 tabs / 30 hydrocodone-ibuprofen tab QL (150 tabs / 30 hydromorphone hcl liqd 1 /ml hydromorphone hcl preservative free (pf) inj 10 /ml hydromorphone hcl tab 2 QL (270 tabs / 30 hydromorphone hcl tab 4 QL (270 tabs / 30 PA PA PA 5 QL PA 5 QL PA 5 QL PA 5 QL PA 5 QL PA 2 GC QL 2 GC QL 2 GC QL 3 QL 4 4 B/D 3 QL 3 QL 3

9 hydromorphone hcl tab 8 3 QL QL (270 tabs / 30 HYSINGLA ER TAB 20 MG 3 QL HYSINGLA ER TAB 30 MG 3 QL HYSINGLA ER TAB 40 MG 3 QL HYSINGLA ER TAB 60 MG 3 QL HYSINGLA ER TAB 80 MG 3 QL HYSINGLA ER TAB 100 MG 3 QL HYSINGLA ER TAB 120 MG 3 QL methadone con 10/ml 3 QL QL (120 ml / 30 methadone hcl soln 5 /5ml 3 QL QL (450 ml / 30 methadone hcl soln 10 3 QL /5ml QL (450 ml / 30 methadone hcl tab 5 3 QL QL (180 tabs / 30 methadone hcl tab 10 3 QL QL (180 tabs / 30 MORPHINE SUL INJ 4 B/D 2MG/ML MORPHINE SUL INJ 4 B/D 4MG/ML MORPHINE SUL INJ 4 B/D 5MG/ML MORPHINE SUL INJ 4 B/D 8MG/ML MORPHINE SUL INJ 4 B/D 10MG/ML MORPHINE SUL INJ 4 B/D 150/30ML morphine sulfate inj 8 /ml 4 B/D morphine sulfate inj 10 /ml 4 B/D morphine sulfate iv soln 1 4 B/D /ml morphine sulfate iv soln pf 4 /ml 4 B/D morphine sulfate iv soln pf 8 4 B/D /ml morphine sulfate iv soln pf 10 4 B/D /ml morphine sulfate oral soln 10 3 /5ml morphine sulfate oral soln 20 3 /5ml morphine sulfate oral soln /5ml (20 /ml) morphine sulfate tab 15 3 QL QL (180 tabs / 30 morphine sulfate tab 30 3 QL QL (180 tabs / 30 morphine sulfate tab er 15 3 QL QL (90 tabs / 30 morphine sulfate tab er 30 3 QL QL (90 tabs / 30 morphine sulfate tab er 60 3 QL QL (90 tabs / 30 morphine sulfate tab er QL QL (90 tabs / 30 morphine sulfate tab er QL NUCYNTA ER TAB 50MG 3 QL QL (120 tabs / 30 NUCYNTA ER TAB 100MG 3 QL QL (120 tabs / 30 NUCYNTA ER TAB 150MG 3 QL NUCYNTA ER TAB 200MG 3 QL NUCYNTA ER TAB 250MG 3 QL oxycodone hcl cap 5 QL (180 caps / 30 oxycodone hcl conc /5ml (20 /ml) oxycodone hcl soln 5 /5ml 4 oxycodone hcl tab 5 3 QL QL (180 tabs / 30 oxycodone hcl tab 10 QL (180 tabs / 30 3 QL 4

10 oxycodone hcl tab 15 3 QL gentamicin in saline inj 2 2 GC QL (180 tabs / 30 /ml oxycodone hcl tab 20 3 QL gentamicin sulfate inj 10 2 GC QL (180 tabs / 30 /ml oxycodone hcl tab 30 3 QL gentamicin sulfate inj 40 2 GC QL (180 tabs / 30 /ml oxycodone w/ acetaminophen 3 QL neomycin sulfate tab soln /5ml paromomycin sulfate cap QL (1800 ml / 30 oxycodone w/ acetaminophen 3 QL streptomycin sulfate for inj 1 4 tab gm QL (360 tabs / 30 SULFADIAZINE TAB 500MG 4 oxycodone w/ acetaminophen 3 QL tobramycin nebu soln PA tab /5ml QL (360 tabs / 30 tobramycin sulfate for inj oxycodone w/ acetaminophen 3 QL gm tab tobramycin sulfate inj QL (360 tabs / 30 gm/30ml (40 /ml) (base oxycodone w/ acetaminophen 3 QL equiv) tab tobramycin sulfate inj 2 3 QL (360 tabs / 30 gm/50ml (40 /ml) (base Anestésicos equiv) Anestésicos locales tobramycin sulfate inj 10 3 lidocaine hcl local inj 0.5% 2 GC B/D /ml (base equivalent) lidocaine hcl local inj 1% 2 GC B/D tobramycin sulfate inj 80 3 lidocaine hcl local inj 2% 2 GC B/D /2ml (40 /ml) (base lidocaine hcl local 2 GC B/D equiv) preservative free (pf) inj 0.5% Contra infecciones, misceláneos lidocaine hcl local 2 GC B/D ALBENZA TAB 200MG 5 preservative free (pf) inj 1% ALINIA SUS 100/5ML 5 lidocaine hcl local 2 GC B/D ALINIA TAB 500MG 5 preservative free (pf) inj 1.5% atovaquone susp 750 /5ml 5 Contra infecciones AZACTAM INJ 1GM 4 Antibacterianos, misceláneos AZACTAM INJ 2GM 4 amikacin sulfate inj 1 gm/4ml 3 (250 /ml) AZACTAM/DEX INJ 1GM 4 amikacin sulfate inj AZACTAM/DEX INJ 2GM 4 /2ml (250 /ml) aztreonam for inj 1 gm 4 gentamicin in saline inj GC aztreonam for inj 2 gm 4 /ml BILTRICIDE TAB 600MG 3 gentamicin in saline inj 1 2 GC CAYSTON INH 75MG 5 LA PA /ml clindamycin hcl cap 75 gentamicin in saline inj GC clindamycin hcl cap 150 /ml clindamycin hcl cap 300 gentamicin in saline inj GC clindamycin palmitate hcl for 4 /ml soln 75 /5ml (base equiv) 5

11 clindamycin phosphate in d5w 4 iv soln 300 /50ml clindamycin phosphate in d5w 4 iv soln 600 /50ml clindamycin phosphate in d5w 4 iv soln 900 /50ml clindamycin phosphate inj 9 3 gm/60ml clindamycin phosphate inj /2ml clindamycin phosphate inj /4ml clindamycin phosphate inj /6ml clindamycin phosphate iv soln /2ml clindamycin phosphate iv soln /6ml CLINDMYC/NAC INJ 4 300/50ML CLINDMYC/NAC INJ 4 600/50ML CLINDMYC/NAC INJ 4 900/50ML colistimethate sod for inj (colistin base activity) dapsone tab 25 3 dapsone tab daptomycin for iv soln EMVERM CHW 100MG 5 imipenem-cilastatin 3 intravenous for soln 250 imipenem-cilastatin 3 intravenous for soln 500 INVANZ INJ 1GM 4 ivermectin tab 3 3 linezolid for susp 100 /5ml 5 linezolid in sodium chloride iv 5 soln 600 /300ml-0.9% linezolid iv soln 600 /300ml 5 (2 /ml) linezolid tab meropenem iv for soln 1 gm 4 meropenem iv for soln methenamine hippurate tab 1 3 gm metronidazole in nacl 0.79% 2 GC iv soln 500 /100ml metronidazole tab GC metronidazole tab GC NEBUPENT INH 300MG 4 B/D nitrofurantoin macrocrystalline 3 cap 50 nitrofurantoin macrocrystalline 2 GC cap 100 nitrofurantoin monohydrate 2 GC macrocrystalline cap 100 PENTAM 300 INJ 300MG 4 SIVEXTRO INJ 200MG 5 SIVEXTRO TAB 200MG 5 sulfamethoxazoletrimethoprim 4 iv soln /5ml sulfamethoxazoletrimethoprim 4 susp /5ml sulfamethoxazoletrimethoprim tab sulfamethoxazoletrimethoprim tab SYNERCID INJ 500MG 5 tigecycline for iv soln 50 5 TIGECYCLINE INJ 50MG 5 trimethoprim tab GC vancomycin hcl cap vancomycin hcl cap vancomycin hcl for inj 10 gm 4 vancomycin hcl for inj vancomycin hcl for inj vancomycin hcl for inj vancomycin hcl for inj VANCOMYCIN INJ 1 GM 4 VANCOMYCIN INJ 500MG 4 VANCOMYCIN INJ 750MG 4 Fungicidas ABELCET INJ 5MG/ML 5 B/D 6

12 AMBISOME INJ 50MG 5 B/D amphotericin b for inj 50 4 B/D CANCIDAS INJ 50MG 5 CANCIDAS INJ 70MG 5 caspofungin acetate for iv 5 soln 50 caspofungin acetate for iv 5 soln 70 CASPOFUNGIN INJ 50MG 5 CASPOFUNGIN INJ 70MG 5 fluconazole for susp 10 /ml 3 fluconazole for susp 40 /ml 3 fluconazole in dextrose inj /100ml fluconazole in dextrose inj /200ml fluconazole in nacl 0.9% inj /100ml fluconazole in nacl 0.9% inj /200ml fluconazole tab 50 2 GC fluconazole tab GC fluconazole tab GC fluconazole tab GC FLUCONAZOLE/ INJ NACL flucytosine cap flucytosine cap griseofulvin microsize susp /5ml griseofulvin microsize tab griseofulvin ultramicrosize tab griseofulvin ultramicrosize tab itraconazole cap PA ketoconazole tab PA MYCAMINE INJ 50MG 5 MYCAMINE INJ 100MG 5 NOXAFIL SUS 40MG/ML 5 QL QL (630 ml / 30 NOXAFIL TAB 100MG 5 QL QL (93 tabs / 30 nystatin tab unit 3 terbinafine hcl tab GC QL QL (90 tabs / 365 voriconazole for inj voriconazole for susp 40 5 /ml voriconazole tab 50 5 voriconazole tab Antipalúdicos atovaquone-proguanil hcl tab atovaquone-proguanil hcl tab chloroquine phosphate tab chloroquine phosphate tab COARTEM TAB MG 4 mefloquine hcl tab PRIMAQUINE TAB 26.3MG 3 quinine sulfate cap PA Agentes antirretrovirales abacavir sulfate soln 20 3 /ml (base equiv) abacavir sulfate tab (base equiv) APTIVUS CAP 250MG 5 APTIVUS SOL 5 atazanavir sulfate cap (base equiv) atazanavir sulfate cap (base equiv) atazanavir sulfate cap (base equiv) CRIXIVAN CAP 200MG 4 CRIXIVAN CAP 400MG 4 didanosine delayed release 4 capsule 200 didanosine delayed release 4 capsule 250 didanosine delayed release 4 capsule 400 EDURANT TAB 25MG 5 efavirenz cap 50 4 efavirenz cap

13 efavirenz tab EMTRIVA CAP 200MG 3 EMTRIVA SOL 10MG/ML 3 fosamprenavir calcium tab (base equiv) FUZEON INJ 90MG 5 INTELENCE TAB 25MG 4 INTELENCE TAB 100MG 5 INTELENCE TAB 200MG 5 INVIRASE CAP 200MG 5 INVIRASE TAB 500MG 5 ISENTRESS CHW 25MG 3 ISENTRESS CHW 100MG 5 ISENTRESS HD TAB 600MG 5 ISENTRESS POW 100MG 5 ISENTRESS TAB 400MG 5 lamivudine oral soln 10 /ml 3 lamivudine tab lamivudine tab LEXIVA SUS 50MG/ML 4 LEXIVA TAB 700MG 5 nevirapine susp 50 /5ml 4 nevirapine tab nevirapine tab er 24hr nevirapine tab er 24hr NORVIR CAP 100MG 3 NORVIR SOL 80MG/ML 3 NORVIR TAB 100MG 3 PREZISTA SUS 100MG/ML 5 QL QL (400 ml / 30 PREZISTA TAB 75MG 3 QL QL (480 tabs / 30 PREZISTA TAB 150MG 5 QL QL (240 tabs / 30 PREZISTA TAB 600MG 5 QL PREZISTA TAB 800MG 5 QL RESCRIPTOR TAB 100 MG 4 RESCRIPTOR TAB 200MG 4 RETROVIR INJ 10MG/ML 4 REYATAZ CAP 150MG 5 REYATAZ CAP 200MG 5 REYATAZ CAP 300MG 5 REYATAZ POW 50MG 5 ritonavir tab SELZENTRY SOL 20MG/ML 5 SELZENTRY TAB 25MG 4 SELZENTRY TAB 75MG 5 SELZENTRY TAB 150MG 5 SELZENTRY TAB 300MG 5 stavudine cap 15 3 stavudine cap 20 3 stavudine cap 30 3 stavudine cap 40 3 SUSTIVA CAP 50MG 4 SUSTIVA CAP 200MG 5 SUSTIVA TAB 600MG 5 tenofovir disoproxil fumarate 5 tab 300 TIVICAY TAB 10MG 3 TIVICAY TAB 25MG 5 TIVICAY TAB 50MG 5 TYBOST TAB 150MG 3 VIDEX EC CAP 125MG 4 VIDEX SOL 2GM 4 VIDEX SOL 4GM 4 VIRACEPT TAB 250MG 5 VIRACEPT TAB 625MG 5 VIRAMUNE SUS 50MG/5ML 4 VIREAD POW 40MG/GM 5 VIREAD TAB 150MG 5 VIREAD TAB 200MG 5 VIREAD TAB 250MG 5 VIREAD TAB 300MG 5 ZERIT SOL 1MG/ML 5 ZIAGEN SOL 20MG/ML 3 zidovudine cap zidovudine syrup 10 /ml 4 zidovudine tab Agentes antirretrovirales mixtos abacavir sulfate-lamivudine 5 tab

14 abacavir sulfate-lamivudinezidovudine 5 tab ATRIPLA TAB 5 BIKTARVY TAB 5 COMPLERA TAB 5 DESCOVY TAB 200/25 5 EVOTAZ TAB GENVOYA TAB 5 JULUCA TAB 50-25MG 5 KALETRA TAB MG 4 KALETRA TAB MG 5 lamivudine-zidovudine tab lopinavir-ritonavir soln /5ml (80-20 /ml) ODEFSEY TAB 5 PREZCOBIX TAB STRIBILD TAB 5 TRIUMEQ TAB 5 TRUVADA TAB QL TRUVADA TAB QL TRUVADA TAB QL TRUVADA TAB QL Agentes antituberculosos CAPASTAT SUL INJ 1GM 4 cycloserine cap ethambutol hcl tab ethambutol hcl tab isoniazid inj 100 /ml 3 isoniazid syrup 50 /5ml 4 isoniazid tab 100 isoniazid tab 300 PASER GRA 4GM 4 PRIFTIN TAB 150MG 4 pyrazinamide tab rifabutin cap rifampin cap rifampin cap rifampin for inj RIFATER TAB 4 SIRTURO TAB 100MG 5 LA PA TRECATOR TAB 250MG 4 Antivirales acyclovir cap GC acyclovir sodium for inj B/D acyclovir sodium iv soln 50 4 B/D /ml acyclovir susp 200 /5ml 4 acyclovir tab GC acyclovir tab GC adefovir dipivoxil tab 10 5 BARACLUDE SOL.05MG/ML 5 DAKLINZA TAB 30MG 5 PA DAKLINZA TAB 60MG 5 PA DAKLINZA TAB 90MG 5 PA entecavir tab entecavir tab 1 5 EPCLUSA TAB PA EPIVIR HBV SOL 5MG/ML 4 famciclovir tab famciclovir tab famciclovir tab ganciclovir sodium for inj B/D HARVONI TAB MG 5 PA lamivudine tab 100 (hbv) 4 MAVYRET TAB MG 5 PA oseltamivir phosphate cap 30 3 QL (base equiv) QL (168 caps / year) oseltamivir phosphate cap 45 3 QL (base equiv) QL (84 caps / year) oseltamivir phosphate cap 75 3 QL (base equiv) QL (84 caps / year) oseltamivir phosphate for 3 QL susp 6 /ml (base equiv) QL (1080 ml / year) PEGASYS INJ 5 PA PEGASYS INJ 180MCG/M 5 PA 9

15 PEGASYS INJ PROCLICK 5 PA REBETOL SOL 40MG/ML 5 RELENZA MIS DISKHALE 3 QL QL (6 inhalers / year) ribasphere cap ribasphere tab ribasphere tab ribasphere tab ribavirin cap ribavirin tab rimantadine hydrochloride tab SOVALDI TAB 400MG 5 PA TAMIFLU SUS 6MG/ML 3 QL QL (1080 ml / year) valacyclovir hcl tab 1 gm 3 valacyclovir hcl tab valganciclovir hcl for soln 50 5 /ml (base equiv) valganciclovir hcl tab (base equivalent) VEMLIDY TAB 25MG 5 VOSEVI TAB 5 PA ZEPATIER TAB MG 5 PA Cefalosporinas cefaclor cap cefaclor cap CEFACLOR ER TAB 500MG 4 cefaclor for susp 125 /5ml 4 cefaclor for susp 250 /5ml 4 cefaclor for susp 375 /5ml 4 cefadroxil cap GC cefadroxil for susp /5ml cefadroxil for susp /5ml cefadroxil tab 1 gm 3 CEFAZOLIN INJ 1GM/50ML 3 cefazolin sodium for inj 1 gm 3 cefazolin sodium for inj 10 gm 3 cefazolin sodium for inj 20 gm 3 cefazolin sodium for inj cefazolin sodium for iv soln 1 3 gm CEFAZOLIN SOL 3 cefdinir cap cefdinir for susp 125 /5ml 4 cefdinir for susp 250 /5ml 4 cefepime hcl for inj 1 gm 4 cefepime hcl for inj 2 gm 4 cefixime for susp 100 /5ml 4 cefixime for susp 200 /5ml 4 cefotaxime sodium for inj 1 4 gm cefotaxime sodium for inj 2 4 gm cefotaxime sodium for inj cefoxitin sodium for inj 10 gm 4 cefoxitin sodium for iv soln 1 4 gm cefoxitin sodium for iv soln 2 4 gm cefpodoxime proxetil for susp 4 50 /5ml cefpodoxime proxetil for susp /5ml cefpodoxime proxetil tab cefpodoxime proxetil tab cefprozil for susp 125 /5ml 3 cefprozil for susp 250 /5ml 3 cefprozil tab cefprozil tab ceftazidime for inj 1 gm 4 ceftazidime for inj 2 gm 4 ceftazidime for inj 6 gm 4 CEFTAZIDIME/ SOL D5W 4 1GM CEFTAZIDIME/ SOL D5W 4 2GM ceftriaxone sodium for inj 1 3 gm ceftriaxone sodium for inj 2 3 gm 10

16 ceftriaxone sodium for inj 10 3 gm ceftriaxone sodium for inj ceftriaxone sodium for inj ceftriaxone sodium for iv soln 3 1 gm ceftriaxone sodium for iv soln 3 2 gm cefuroxime axetil tab cefuroxime axetil tab cefuroxime sodium for inj gm cefuroxime sodium for inj gm cefuroxime sodium for inj cefuroxime sodium for iv soln gm cephalexin cap 250 cephalexin cap 500 cephalexin for susp /5ml cephalexin for susp /5ml SUPRAX CAP 400MG 3 SUPRAX CHW 100MG 4 SUPRAX CHW 200MG 4 SUPRAX SUS 500/5ML 3 tazicef inj 1gm 4 tazicef inj 2gm 4 tazicef inj 6gm 4 TEFLARO INJ 400MG 5 TEFLARO INJ 600MG 5 Eritromicinas/macrólidos azithromycin for susp /5ml azithromycin for susp /5ml azithromycin iv for soln azithromycin powd pack for 3 susp 1 gm azithromycin tab 250 azithromycin tab 500 azithromycin tab 600 clarithromycin for susp /5ml clarithromycin for susp /5ml clarithromycin tab clarithromycin tab clarithromycin tab er 24hr DIFICID TAB 200MG 5 ery-tab tab 250 ec 4 ery-tab tab 333 ec 4 ery-tab tab 500 ec 4 ERYTHROCIN INJ 500MG 4 erythrocin tab erythromycin ethylsuccinate 4 tab 400 erythromycin tab erythromycin tab erythromycin w/ delayed 4 release particles cap 250 Fluoroquinolonas ciprofloxacin 200 /100ml in 3 d5w ciprofloxacin 400 /200ml in 3 d5w ciprofloxacin for oral susp /5ml (5%) (5 gm/100ml) ciprofloxacin for oral susp /5ml (10%) (10 gm/100ml) ciprofloxacin hcl tab (base equiv) ciprofloxacin hcl tab 250 (base equiv) ciprofloxacin hcl tab 500 (base equiv) ciprofloxacin hcl tab 750 (base equiv) ciprofloxacin iv soln /20ml (1%) ciprofloxacin iv soln /40ml (1%) levofloxacin in d5w iv soln 250 /50ml 3 11

17 levofloxacin in d5w iv soln /100ml levofloxacin in d5w iv soln /150ml levofloxacin iv soln 25 /ml 4 levofloxacin oral soln 25 4 /ml levofloxacin tab 250 levofloxacin tab 500 levofloxacin tab 750 Penicilinas amoxicillin & k clavulanate 4 chew tab amoxicillin & k clavulanate 4 chew tab amoxicillin & k clavulanate for 3 susp /5ml amoxicillin & k clavulanate for 3 susp /5ml amoxicillin & k clavulanate for 3 susp /5ml amoxicillin & k clavulanate for 3 susp /5ml amoxicillin & k clavulanate tab 2 GC amoxicillin & k clavulanate tab 2 GC amoxicillin & k clavulanate tab 2 GC amoxicillin & k clavulanate tab 4 er 12hr amoxicillin (trihydrate) cap 250 amoxicillin (trihydrate) cap 500 amoxicillin (trihydrate) chew 2 GC tab 125 amoxicillin (trihydrate) chew 2 GC tab 250 amoxicillin (trihydrate) for susp 125 /5ml amoxicillin (trihydrate) for susp 200 /5ml amoxicillin (trihydrate) for susp 250 /5ml amoxicillin (trihydrate) for susp 400 /5ml amoxicillin (trihydrate) tab 500 amoxicillin (trihydrate) tab 875 ampicillin & sulbactam sodium 4 for inj 1.5 (1-0.5) gm ampicillin & sulbactam sodium 4 for inj 3 (2-1) gm ampicillin & sulbactam sodium 4 for inj 15 (10-5) gm ampicillin & sulbactam sodium 4 for iv soln 15 (10-5) gm ampicillin cap 250 ampicillin cap 500 ampicillin for susp 125 /5ml 3 ampicillin for susp 250 /5ml 3 ampicillin sodium for inj 1 gm 4 ampicillin sodium for inj 2 gm 4 ampicillin sodium for inj 10 gm 4 ampicillin sodium for inj ampicillin sodium for inj ampicillin sodium for inj ampicillin sodium for iv soln 1 4 gm ampicillin sodium for iv soln 2 4 gm ampicillin sodium for iv soln 4 10 gm AUGMENTIN SUS 125/5ML 4 BICILLIN L-A INJ BICILLIN L-A INJ BICILLIN L-A INJ dicloxacillin sodium cap dicloxacillin sodium cap nafcillin sodium for inj 1 gm 4 nafcillin sodium for inj 2 gm 4 nafcillin sodium for iv soln 1 4 gm 12

18 nafcillin sodium for iv soln 2 4 gm nafcillin sodium for iv soln 10 5 gm oxacillin sodium for inj 1 gm 4 (base equivalent) oxacillin sodium for inj 2 gm 4 (base equivalent) oxacillin sodium for inj 10 gm 5 (base equivalent) PEN G PROC INJ PENICILL GK/ INJ DEX 2MU 4 PENICILL GK/ INJ DEX 3MU 4 penicillin g potassium for inj unit penicillin g potassium for inj unit penicillin g sodium for inj unit penicillin v potassium for soln 2 GC 125 /5ml penicillin v potassium for soln 2 GC 250 /5ml penicillin v potassium tab 250 penicillin v potassium tab 500 PIPER/TAZOBA INJ GM piperacillin sod-tazobactam 4 na for inj gm ( gm) piperacillin sod-tazobactam 4 sod for inj 2.25 gm ( gm) piperacillin sod-tazobactam 4 sod for inj 4.5 gm (4-0.5 gm) piperacillin sod-tazobactam 4 sod for inj 40.5 gm ( gm) Tetraciclinas doxy 100 inj doxycycline hyclate cap 50 3 doxycycline hyclate cap doxycycline hyclate for inj doxycycline hyclate tab 20 3 doxycycline hyclate tab doxycycline monohydrate cap 2 GC 50 doxycycline monohydrate cap 2 GC 100 doxycycline monohydrate tab 3 50 doxycycline monohydrate tab 3 75 doxycycline monohydrate tab doxycycline monohydrate tab minocycline hcl cap 50 3 minocycline hcl cap 75 3 minocycline hcl cap Agentes antineoplásicos Agentes alquilantes BENDEKA INJ 100/4ML 5 B/D busulfan inj 6 /ml 5 B/D CYCLOPHOSPH CAP 25MG 4 B/D CYCLOPHOSPH CAP 50MG 4 B/D cyclophosphamide for inj 1 5 B/D gm cyclophosphamide for inj 2 5 B/D gm cyclophosphamide for inj B/D dacarbazine for inj B/D dacarbazine for inj B/D EMCYT CAP 140MG 4 GLEOSTINE CAP 5MG 4 GLEOSTINE CAP 10MG 4 GLEOSTINE CAP 40MG 4 GLEOSTINE CAP 100MG 4 HEXALEN CAP 50MG 5 IFEX INJ 3GM 4 B/D ifosfamide for inj 1 gm 4 B/D IFOSFAMIDE INJ 3GM 4 B/D ifosfamide iv inj 1 gm/20ml 3 B/D (50 /ml) 13

19 ifosfamide iv inj 3 gm/60ml 3 B/D (50 /ml) LEUKERAN TAB 2MG 4 melphalan hcl for inj 50 5 B/D (base equiv) MUSTARGEN INJ 10MG 5 B/D Antraciclinas adriamycin inj 20 4 B/D doxorubicin hcl for inj 10 4 B/D doxorubicin hcl for inj 50 4 B/D doxorubicin hcl inj 2 /ml 4 B/D doxorubicin hcl liposomal inj 5 B/D (for iv infusion) 2 /ml epirubicin hcl iv soln 50 4 B/D /25ml (2 /ml) epirubicin hcl iv soln B/D /100ml (2 /ml) Antibióticos bleomycin sulfate for inj 15 3 B/D unit bleomycin sulfate for inj 30 3 B/D unit mitomycin for iv soln 5 5 B/D mitomycin for iv soln 20 5 B/D mitomycin for iv soln 40 5 B/D Antimetabolitos adrucil inj 500/10ml 3 B/D ALIMTA INJ 100MG 5 B/D ALIMTA INJ 500MG 5 B/D azacitidine for inj B/D cladribine iv soln 10 /10ml 5 B/D (1 /ml) cytarabine inj 20 /ml 3 B/D fludarabine phosphate for inj 4 B/D 50 fludarabine phosphate inj 25 4 B/D /ml fluorouracil iv soln 1 gm/20ml 3 B/D (50 /ml) fluorouracil iv soln B/D gm/50ml (50 /ml) fluorouracil iv soln 5 3 B/D gm/100ml (50 /ml) fluorouracil iv soln 500 /10ml (50 /ml) 3 B/D gemcitabine hcl for inj 1 gm 5 B/D gemcitabine hcl for inj 2 gm 5 B/D gemcitabine hcl for inj B/D gemcitabine hcl inj 1 4 B/D gm/26.3ml (38 /ml) (base equiv) gemcitabine hcl inj 2 4 B/D gm/52.6ml (38 /ml) (base equiv) gemcitabine hcl inj B/D /5.26ml (38 /ml) (base equiv) mercaptopurine tab 50 4 methotrexate sodium for inj 1 2 GC B/D gm methotrexate sodium inj 50 2 GC B/D /2ml (25 /ml) methotrexate sodium inj GC B/D /10ml (25 /ml) methotrexate sodium inj pf 50 2 GC B/D /2ml (25 /ml) methotrexate sodium inj pf 2 GC B/D 100 /4ml (25 /ml) methotrexate sodium inj pf 2 GC B/D 200 /8ml (25 /ml) methotrexate sodium inj pf 2 GC B/D 250 /10ml (25 /ml) methotrexate sodium inj pf 2 GC B/D 1000 /40ml (25 /ml) NIPENT INJ 10MG 5 B/D PURIXAN SUS 20MG/ML 5 TABLOID TAB 40MG 4 Antimitótico, taxoides ABRAXANE INJ 100MG 5 B/D docetaxel for inj conc 20 5 B/D /ml docetaxel for inj conc 80 5 B/D /4ml (20 /ml) DOCETAXEL INJ 20MG/2ML 5 B/D DOCETAXEL INJ 80MG/4ML 5 B/D DOCETAXEL INJ 80MG/8ML 5 B/D DOCETAXEL INJ 160/8ML 5 B/D DOCETAXEL INJ 160/16ML 5 B/D DOCETAXEL INJ 200/10 5 B/D 14

20 paclitaxel iv conc 30 /5ml 4 B/D (6 /ml) paclitaxel iv conc B/D /16.7ml (6 /ml) paclitaxel iv conc B/D /25ml (6 /ml) paclitaxel iv conc 300 /50ml (6 /ml) 4 B/D TAXOTERE INJ 80MG/4ML 5 B/D Antimitóticos, alcaloides de la vinca vinblastine sulfate inj 1 /ml 2 GC B/D vincasar pfs inj 1/ml 2 GC B/D vincristine sulfate iv soln 1 /ml vinorelbine tartrate inj 10 /ml (base equiv) vinorelbine tartrate inj 50 /5ml (10 /ml) (base equiv) 2 GC B/D 3 B/D 3 B/D Modificadores de la reacción biológica AVASTIN INJ 5 LA PA AVASTIN INJ 400/16ML 5 LA PA BELEODAQ INJ 500MG 5 PA BORTEZOMIB INJ 3.5MG 5 PA ERIVEDGE CAP 150MG 5 LA PA FARYDAK CAP 10MG 5 LA PA FARYDAK CAP 15MG 5 LA PA FARYDAK CAP 20MG 5 LA PA HERCEPTIN INJ 150MG 5 PA HERCEPTIN INJ 440MG 5 PA IBRANCE CAP 75MG 5 LA PA IBRANCE CAP 100MG 5 LA PA IBRANCE CAP 125MG 5 LA PA IDHIFA TAB 50MG 5 LA PA IDHIFA TAB 100MG 5 LA PA KADCYLA INJ 100MG 5 B/D KADCYLA INJ 160MG 5 B/D KEYTRUDA INJ 100MG/4M 5 PA KEYTRUDA SOL 50MG 5 PA KISQALI 200 PAK FEMARA 5 PA KISQALI 400 PAK FEMARA 5 PA KISQALI 600 PAK FEMARA 5 PA KISQALI TAB 200DOSE 5 PA KISQALI TAB 400DOSE 5 PA KISQALI TAB 600DOSE 5 PA LYNPARZA CAP 50MG 5 LA PA LYNPARZA TAB 100MG 5 LA PA LYNPARZA TAB 150MG 5 LA PA MYLOTARG INJ 4.5MG 5 LA PA NINLARO CAP 2.3MG 5 PA NINLARO CAP 3MG 5 PA NINLARO CAP 4MG 5 PA ODOMZO CAP 200MG 5 LA PA RITUXAN INJ 100MG 5 LA PA RITUXAN INJ 500MG 5 LA PA RITUXAN INJ HYCELA 5 LA PA RUBRACA TAB 200MG 5 LA PA RUBRACA TAB 250MG 5 LA PA RUBRACA TAB 300MG 5 LA PA TECENTRIQ INJ 1200/20 5 LA PA VELCADE INJ 3.5MG 5 PA VENCLEXTA TAB 10MG 4 LA PA VENCLEXTA TAB 50MG 4 LA PA VENCLEXTA TAB 100MG 5 LA PA VENCLEXTA TAB START PK 5 LA PA VERZENIO TAB 50MG 5 LA PA VERZENIO TAB 100MG 5 LA PA VERZENIO TAB 150MG 5 LA PA VERZENIO TAB 200MG 5 LA PA YERVOY INJ 50MG 5 PA YERVOY INJ 200MG 5 PA ZEJULA CAP 100MG 5 LA PA ZOLINZA CAP 100MG 5 PA Agentes antineoplásicos hormonales anastrozole tab 1 2 GC bicalutamide tab 50 3 DEPO-PROVERA INJ 400/ML 4 B/D ERLEADA TAB 60MG 5 LA PA exemestane tab 25 4 FARESTON TAB 60MG 5 FASLODEX INJ 250/5ML 5 B/D flutamide cap hydroxyprogesterone 5 B/D caproate im in oil 1.25 gm/5ml letrozole tab GC leuprolide acetate inj kit 5 3 PA /ml LUPRON DEPOT INJ 3.75MG 5 PA 15

21 LUPRON DEPOT INJ 5 PA 11.25MG LYSODREN TAB 500MG 3 megestrol acetate susp 40 2 GC /ml megestrol acetate susp PA /5ml megestrol acetate tab 20 2 GC megestrol acetate tab 40 2 GC nilutamide tab SOLTAMOX SOL 10MG/5ML 4 tamoxifen citrate tab 10 (base equivalent) tamoxifen citrate tab 20 (base equivalent) TRELSTAR MIX INJ 3.75MG 5 PA TRELSTAR MIX INJ 11.25MG 5 PA XTANDI CAP 40MG 5 LA PA ZYTIGA TAB 250MG 5 LA PA ZYTIGA TAB 500MG 5 LA PA Inmunomoduladores POMALYST CAP 1MG 5 LA PA POMALYST CAP 2MG 5 LA PA POMALYST CAP 3MG 5 LA PA POMALYST CAP 4MG 5 LA PA REVLIMID CAP 2.5MG 5 QL LA PA QL (28 caps / 28 REVLIMID CAP 5MG 5 QL LA PA QL (28 caps / 28 REVLIMID CAP 10MG 5 QL LA PA QL (28 caps / 28 REVLIMID CAP 15MG 5 QL LA PA QL (28 caps / 28 REVLIMID CAP 20MG 5 QL LA PA QL (28 caps / 28 REVLIMID CAP 25MG 5 QL LA PA QL (28 caps / 28 THALOMID CAP 50MG 5 QL PA QL (30 caps / 30 THALOMID CAP 100MG 5 QL PA QL (30 caps / 30 THALOMID CAP 150MG 5 QL PA QL (60 caps / 30 THALOMID CAP 200MG QL (60 caps / 30 5 QL PA Inhibidores de la cinasa AFINITOR DIS TAB 2MG 5 QL PA QL (150 tabs / 30 AFINITOR DIS TAB 3MG 5 QL PA QL (90 tabs / 30 AFINITOR DIS TAB 5MG 5 QL PA AFINITOR TAB 2.5MG 5 QL PA AFINITOR TAB 5MG 5 QL PA AFINITOR TAB 7.5MG 5 QL PA AFINITOR TAB 10MG 5 QL PA ALECENSA CAP 150MG 5 LA PA ALUNBRIG PAK 5 LA PA ALUNBRIG TAB 30MG 5 LA PA ALUNBRIG TAB 90MG 5 LA PA ALUNBRIG TAB 180MG 5 LA PA BOSULIF TAB 100MG 5 PA BOSULIF TAB 400MG 5 PA BOSULIF TAB 500MG 5 PA CABOMETYX TAB 20MG 5 QL LA PA CABOMETYX TAB 40MG 5 QL LA PA CABOMETYX TAB 60MG 5 QL LA PA CALQUENCE CAP 100MG 5 LA PA CAPRELSA TAB 100MG 5 LA PA CAPRELSA TAB 300MG 5 LA PA COMETRIQ KIT 60MG 5 LA PA COMETRIQ KIT 100MG 5 LA PA COMETRIQ KIT 140MG 5 LA PA COTELLIC TAB 20MG 5 LA PA GILOTRIF TAB 20MG 5 LA PA GILOTRIF TAB 30MG 5 LA PA GILOTRIF TAB 40MG 5 LA PA ICLUSIG TAB 15MG 5 LA PA ICLUSIG TAB 45MG 5 LA PA imatinib mesylate tab 100 (base equivalent) QL (90 tabs / 30 5 QL PA 16

22 imatinib mesylate tab QL PA (base equivalent) IMBRUVICA CAP 70MG 5 LA PA IMBRUVICA CAP 140MG 5 LA PA IMBRUVICA TAB 140MG 5 LA PA IMBRUVICA TAB 280MG 5 LA PA IMBRUVICA TAB 420MG 5 LA PA IMBRUVICA TAB 560MG 5 LA PA INLYTA TAB 1MG 5 QL LA PA QL (180 tabs / 30 INLYTA TAB 5MG 5 QL LA PA QL (120 tabs / 30 IRESSA TAB 250MG 5 LA PA JAKAFI TAB 5MG 5 QL LA PA JAKAFI TAB 10MG 5 QL LA PA JAKAFI TAB 15MG 5 QL LA PA JAKAFI TAB 20MG 5 QL LA PA JAKAFI TAB 25MG 5 QL LA PA LENVIMA CAP 8 MG 5 LA PA LENVIMA CAP 10 MG 5 LA PA LENVIMA CAP 14 MG 5 LA PA LENVIMA CAP 18 MG 5 LA PA LENVIMA CAP 20 MG 5 LA PA LENVIMA CAP 24 MG 5 LA PA MEKINIST TAB 0.5MG 5 LA PA MEKINIST TAB 2MG 5 LA PA NERLYNX TAB 40MG 5 LA PA NEXAVAR TAB 200MG 5 LA PA RYDAPT CAP 25MG 5 PA SPRYCEL TAB 20MG 5 PA SPRYCEL TAB 50MG 5 PA SPRYCEL TAB 70MG 5 PA SPRYCEL TAB 80MG 5 PA SPRYCEL TAB 100MG 5 PA SPRYCEL TAB 140MG 5 PA STIVARGA TAB 40MG 5 LA PA SUTENT CAP 12.5MG 5 PA SUTENT CAP 25MG 5 PA SUTENT CAP 37.5MG 5 PA SUTENT CAP 50MG 5 PA TAFINLAR CAP 50MG 5 LA PA TAFINLAR CAP 75MG 5 LA PA TAGRISSO TAB 40MG 5 LA PA TAGRISSO TAB 80MG 5 LA PA TARCEVA TAB 25MG 5 QL LA PA QL (90 tabs / 30 TARCEVA TAB 100MG 5 QL LA PA TARCEVA TAB 150MG 5 QL LA PA TASIGNA CAP 150MG 5 PA TASIGNA CAP 200MG 5 PA TYKERB TAB 250MG 5 LA PA VOTRIENT TAB 200MG 5 LA PA XALKORI CAP 200MG 5 LA PA XALKORI CAP 250MG 5 LA PA ZELBORAF TAB 240MG 5 LA PA ZYDELIG TAB 100MG 5 LA PA ZYDELIG TAB 150MG 5 LA PA ZYKADIA CAP 150MG 5 LA PA Misceláneos bexarotene cap 75 5 PA DROXIA CAP 200MG 3 DROXIA CAP 300MG 3 DROXIA CAP 400MG 3 hydroxyurea cap LONSURF TAB PA LONSURF TAB PA MATULANE CAP 50MG 5 LA mitoxantrone hcl inj conc 20 3 B/D /10ml (2 /ml) mitoxantrone hcl inj conc 25 3 B/D /12.5ml (2 /ml) mitoxantrone hcl inj conc 30 3 B/D /15ml (2 /ml) SYLATRON KIT 200MCG 5 PA SYLATRON KIT 300MCG 5 PA SYLATRON KIT 600MCG 5 PA SYNRIBO INJ 3.5MG 5 PA tretinoin cap 10 5 TRISENOX INJ 12MG/6ML 5 B/D Agentes a base de platino carboplatin iv soln 50 /5ml 3 B/D 17

23 carboplatin iv soln B/D /15ml carboplatin iv soln B/D /45ml carboplatin iv soln B/D /60ml cisplatin inj 50 /50ml (1 3 B/D /ml) cisplatin inj 100 /100ml (1 3 B/D /ml) cisplatin inj 200 /200ml (1 3 B/D /ml) oxaliplatin for iv inj 50 5 B/D oxaliplatin for iv inj B/D oxaliplatin iv soln 50 /10ml 4 B/D oxaliplatin iv soln B/D /20ml Agentes protectores dexrazoxane for inj B/D dexrazoxane for inj B/D ELITEK INJ 1.5MG 5 B/D ELITEK INJ 7.5MG 5 B/D leucovorin calcium for inj 50 4 B/D leucovorin calcium for inj B/D leucovorin calcium for inj B/D leucovorin calcium for inj B/D leucovorin calcium for inj B/D leucovorin calcium tab 5 3 leucovorin calcium tab 10 3 leucovorin calcium tab 15 3 leucovorin calcium tab 25 3 LEVOLEUCOVOR INJ 5 B/D 175MG LEVOLEUCOVOR SOL 5 B/D 250MG/25 levoleucovorin calcium for iv 5 B/D inj 50 (base equiv) levoleucovorin calcium inj B/D /17.5ml (base equiv) mesna inj 100 /ml 4 B/D MESNEX TAB 400MG 5 Inhibidores de la topoisomerasa etoposide inj 100 /5ml (20 3 B/D /ml) etoposide inj 500 /25ml (20 3 B/D /ml) irinotecan hcl inj 40 /2ml 4 B/D (20 /ml) irinotecan hcl inj 100 /5ml 4 B/D (20 /ml) irinotecan hcl inj 500 /25ml 4 B/D (20 /ml) toposar inj 1gm/50ml 3 B/D toposar inj 100/5ml 3 B/D topotecan hcl for inj 4 5 B/D TOPOTECAN INJ 4MG/4ML 5 B/D Cardiovascular Combinaciones del inhibidor de la ECA amlodipine besylatebenazepril hcl cap amlodipine besylatebenazepril hcl cap 5-10 amlodipine besylatebenazepril hcl cap 5-20 amlodipine besylatebenazepril hcl cap 5-40 amlodipine besylatebenazepril hcl cap amlodipine besylatebenazepril hcl cap benazepril & hydrochlorothiazide tab benazepril & hydrochlorothiazide tab benazepril & hydrochlorothiazide tab benazepril & hydrochlorothiazide tab captopril & hydrochlorothiazide tab

24 captopril & hydrochlorothiazide tab captopril & hydrochlorothiazide tab captopril & hydrochlorothiazide tab enalapril maleate & hydrochlorothiazide tab enalapril maleate & hydrochlorothiazide tab fosinopril sodium & hydrochlorothiazide tab fosinopril sodium & hydrochlorothiazide tab lisinopril & hydrochlorothiazide tab lisinopril & hydrochlorothiazide tab lisinopril & hydrochlorothiazide tab moexipril-hydrochlorothiazide tab moexipril-hydrochlorothiazide tab moexipril-hydrochlorothiazide tab quinapril-hydrochlorothiazide tab quinapril-hydrochlorothiazide tab quinapril-hydrochlorothiazide tab Inhibidores de la ECA benazepril hcl tab 5 benazepril hcl tab 10 benazepril hcl tab 20 benazepril hcl tab 40 captopril tab 12.5 captopril tab 25 captopril tab 50 captopril tab 100 enalapril maleate tab 2.5 enalapril maleate tab 5 enalapril maleate tab 10 enalapril maleate tab 20 fosinopril sodium tab 10 fosinopril sodium tab 20 fosinopril sodium tab 40 lisinopril tab 2.5 lisinopril tab 5 lisinopril tab 10 lisinopril tab 20 lisinopril tab 30 lisinopril tab 40 moexipril hcl tab 7.5 moexipril hcl tab 15 perindopril erbumine tab 2 perindopril erbumine tab 4 perindopril erbumine tab 8 quinapril hcl tab 5 quinapril hcl tab 10 quinapril hcl tab 20 quinapril hcl tab 40 ramipril cap 1.25 ramipril cap 2.5 ramipril cap 5 ramipril cap 10 trandolapril tab 1 trandolapril tab 2 trandolapril tab 4 Antagonistas del receptor de aldosterona eplerenone tab 25 4 eplerenone tab 50 4 spironolactone tab 25 spironolactone tab 50 spironolactone tab 100 Alfa bloqueadores doxazosin mesylate tab 1 doxazosin mesylate tab 2 3 QL 3 QL 19

25 doxazosin mesylate tab 4 3 QL doxazosin mesylate tab 8 3 prazosin hcl cap 1 3 prazosin hcl cap 2 3 prazosin hcl cap 5 3 terazosin hcl cap 1 (base equivalent) terazosin hcl cap 2 (base equivalent) terazosin hcl cap 5 (base equivalent) terazosin hcl cap 10 (base equivalent) Combinaciones de antagonista del receptor de la angiotensina II amlodipine besylateolmesartan medoxomil tab 5-20 amlodipine besylateolmesartan medoxomil tab 5-40 amlodipine besylateolmesartan medoxomil tab amlodipine besylateolmesartan medoxomil tab amlodipine besylate-valsartan tab amlodipine besylate-valsartan tab amlodipine besylate-valsartan tab amlodipine besylate-valsartan tab amlodipine-valsartanhydrochlorothiazide tab amlodipine-valsartanhydrochlorothiazide tab amlodipine-valsartanhydrochlorothiazide tab amlodipine-valsartanhydrochlorothiazide tab amlodipine-valsartanhydrochlorothiazide tab ENTRESTO TAB 24-26MG 3 ENTRESTO TAB 49-51MG 3 ENTRESTO TAB MG 3 irbesartan-hydrochlorothiazide tab irbesartan-hydrochlorothiazide tab losartan potassium & hydrochlorothiazide tab losartan potassium & hydrochlorothiazide tab losartan potassium & hydrochlorothiazide tab olmesartan medoxomilhydrochlorothiazide tab olmesartan medoxomilhydrochlorothiazide tab olmesartan medoxomilhydrochlorothiazide tab olmesartan-amlodipinehydrochlorothiazide tab olmesartan-amlodipinehydrochlorothiazide tab olmesartan-amlodipinehydrochlorothiazide tab olmesartan-amlodipinehydrochlorothiazide tab olmesartan-amlodipinehydrochlorothiazide tab

26 valsartan-hydrochlorothiazide tab valsartan-hydrochlorothiazide tab valsartan-hydrochlorothiazide tab valsartan-hydrochlorothiazide tab valsartan-hydrochlorothiazide tab Antagonistas del receptor de la angiotensina irbesartan tab 75 irbesartan tab 150 irbesartan tab 300 losartan potassium tab 25 losartan potassium tab 50 losartan potassium tab 100 olmesartan medoxomil tab 5 olmesartan medoxomil tab 20 olmesartan medoxomil tab 40 valsartan tab 40 valsartan tab 80 valsartan tab 160 valsartan tab 320 Antiarrítmicos amiodarone hcl inj GC /3ml (50 /ml) amiodarone hcl inj GC /9ml (50 /ml) amiodarone hcl inj GC /18ml (50 /ml) amiodarone hcl tab amiodarone hcl tab 200 amiodarone hcl tab disopyramide phosphate cap 2 GC 100 disopyramide phosphate cap 2 GC 150 dofetilide cap 125 mcg (0.125 ) 4 dofetilide cap 250 mcg ( ) dofetilide cap 500 mcg (0.5 4 ) flecainide acetate tab 50 3 flecainide acetate tab flecainide acetate tab mexiletine hcl cap mexiletine hcl cap mexiletine hcl cap MULTAQ TAB 400MG 4 NORPACE CAP 100MG CR 4 NORPACE CAP 150MG CR 4 pacerone tab pacerone tab 200 pacerone tab propafenone hcl cap er 12hr propafenone hcl cap er 12hr propafenone hcl cap er 12hr propafenone hcl tab propafenone hcl tab propafenone hcl tab quinidine gluconate tab er quinidine sulfate tab GC quinidine sulfate tab GC sorine tab 80 2 GC sorine tab GC sorine tab GC sorine tab GC sotalol hcl (afib/afl) tab 80 3 sotalol hcl (afib/afl) tab sotalol hcl (afib/afl) tab sotalol hcl tab 80 2 GC sotalol hcl tab GC sotalol hcl tab GC sotalol hcl tab GC Antilipémicos, los inhibidores de la HMG- CoA reductasa 21

27 atorvastatin calcium tab 10 (base equivalent) atorvastatin calcium tab 20 (base equivalent) atorvastatin calcium tab 40 (base equivalent) atorvastatin calcium tab 80 (base equivalent) lovastatin tab 10 lovastatin tab 20 lovastatin tab 40 pravastatin sodium tab 10 pravastatin sodium tab 20 pravastatin sodium tab 40 pravastatin sodium tab 80 rosuvastatin calcium tab 5 QL rosuvastatin calcium tab 10 QL rosuvastatin calcium tab 20 QL rosuvastatin calcium tab 40 QL simvastatin tab 5 simvastatin tab 10 simvastatin tab 20 simvastatin tab 40 simvastatin tab 80 QL Antilipémicos, misceláneos cholestyramine light powder 4 4 gm/dose cholestyramine light powder 4 packets 4 gm cholestyramine powder 4 4 gm/dose cholestyramine powder 4 packets 4 gm colestipol hcl granule packets 4 5 gm colestipol hcl granules 5 gm 4 colestipol hcl tab 1 gm 3 ezetimibe tab 10 4 ezetimibe-simvastatin tab ezetimibe-simvastatin tab ezetimibe-simvastatin tab ezetimibe-simvastatin tab fenofibrate micronized cap 67 3 fenofibrate micronized cap fenofibrate micronized cap fenofibrate tab 48 3 fenofibrate tab 54 3 fenofibrate tab fenofibrate tab gemfibrozil tab GC JUXTAPID CAP 5MG 5 LA PA JUXTAPID CAP 10MG 5 LA PA JUXTAPID CAP 20MG 5 LA PA JUXTAPID CAP 30MG 5 LA PA JUXTAPID CAP 40MG 5 LA PA JUXTAPID CAP 60MG 5 LA PA KYNAMRO INJ 200MG/ML 5 PA niacin tab er 500 (antihyperlipidemic) QL (90 tabs / 30 niacin tab er (antihyperlipidemic) niacin tab er (antihyperlipidemic) niacor tab omega-3-acid ethyl esters cap 4 1 gm PRALUENT INJ 75MG/ML 5 PA PRALUENT INJ 150MG/ML 5 PA prevalite pow 4gm 4 prevalite pow 4gm pk 4 VASCEPA CAP 0.5GM 4 VASCEPA CAP 1GM 4 WELCHOL PAK 3.75GM 3 WELCHOL TAB 625MG 3 22

28 Betabloqueante / Diurético Cominaciones atenolol & chlorthalidone tab atenolol & chlorthalidone tab bisoprolol & hydrochlorothiazide tab bisoprolol & hydrochlorothiazide tab bisoprolol & hydrochlorothiazide tab metoprolol & 3 hydrochlorothiazide tab metoprolol & 3 hydrochlorothiazide tab metoprolol & 3 hydrochlorothiazide tab propranolol & 3 hydrochlorothiazide tab propranolol & 3 hydrochlorothiazide tab Betabloqueante acebutolol hcl cap GC acebutolol hcl cap GC atenolol tab 25 atenolol tab 50 atenolol tab 100 bisoprolol fumarate tab 5 2 GC bisoprolol fumarate tab 10 2 GC BYSTOLIC TAB 2.5MG BYSTOLIC TAB 5MG BYSTOLIC TAB 10MG BYSTOLIC TAB 20MG carvedilol tab carvedilol tab 6.25 carvedilol tab 12.5 carvedilol tab 25 COREG CR CAP 10MG 4 COREG CR CAP 20MG 4 COREG CR CAP 40MG 4 COREG CR CAP 80MG 4 labetalol hcl tab labetalol hcl tab labetalol hcl tab metoprolol succinate tab er 3 24hr 25 (tartrate equiv) metoprolol succinate tab er 3 24hr 50 (tartrate equiv) metoprolol succinate tab er 3 24hr 100 (tartrate equiv) metoprolol succinate tab er 3 24hr 200 (tartrate equiv) metoprolol tartrate iv soln 5 3 /5ml metoprolol tartrate iv soln cart 3 inj 5 /5ml (1 /ml) metoprolol tartrate tab 25 metoprolol tartrate tab 50 metoprolol tartrate tab 100 nadolol tab 20 4 nadolol tab 40 4 nadolol tab 80 4 pindolol tab 5 3 pindolol tab 10 3 propranolol hcl cap er 24hr 60 3 propranolol hcl cap er 24hr 80 3 propranolol hcl cap er 24hr propranolol hcl cap er 24hr propranolol hcl inj 1 /ml 3 propranolol hcl oral soln 20 3 /5ml propranolol hcl oral soln 40 3 /5ml propranolol hcl tab

29 propranolol hcl tab 20 3 propranolol hcl tab 40 3 propranolol hcl tab 60 3 propranolol hcl tab 80 3 timolol maleate tab 5 3 timolol maleate tab 10 3 timolol maleate tab 20 3 Bloqueantes de los Canales de Calcio afeditab tab 30 cr 3 afeditab tab 60 cr 3 amlodipine besylate tab 2.5 (base equivalent) amlodipine besylate tab 5 (base equivalent) amlodipine besylate tab 10 (base equivalent) diltiazem hcl cap er 12hr 60 diltiazem hcl cap er 12hr 90 diltiazem hcl cap er 12hr 120 diltiazem hcl cap er 24hr 120 diltiazem hcl cap er 24hr 180 diltiazem hcl cap er 24hr 240 diltiazem hcl coated beads cap er 24hr 120 diltiazem hcl coated beads cap er 24hr 180 diltiazem hcl coated beads cap er 24hr 240 diltiazem hcl coated beads cap er 24hr 300 diltiazem hcl coated beads cap er 24hr 360 diltiazem hcl extended release beads cap er 24hr 120 diltiazem hcl extended release beads cap er 24hr 180 diltiazem hcl extended release beads cap er 24hr diltiazem hcl extended release 3 beads cap er 24hr 300 diltiazem hcl extended release 3 beads cap er 24hr 360 diltiazem hcl extended release 3 beads cap er 24hr 420 diltiazem hcl iv soln 25 2 GC /5ml (5 /ml) diltiazem hcl iv soln 50 2 GC /10ml (5 /ml) diltiazem hcl iv soln GC /25ml (5 /ml) diltiazem hcl tab 30 2 GC diltiazem hcl tab 60 2 GC diltiazem hcl tab 90 2 GC diltiazem hcl tab GC felodipine tab er 24hr felodipine tab er 24hr 5 3 felodipine tab er 24hr 10 3 isradipine cap isradipine cap 5 4 nicardipine hcl cap 20 4 nicardipine hcl cap 30 4 nifedipine tab er 24hr 30 3 nifedipine tab er 24hr 60 3 nifedipine tab er 24hr 90 3 nifedipine tab er 24hr osmotic 3 release 30 nifedipine tab er 24hr osmotic 3 release 60 nifedipine tab er 24hr osmotic 3 release 90 nimodipine cap 30 5 NYMALIZE SOL 30/10ML 5 verapamil hcl cap er 24hr verapamil hcl cap er 24hr verapamil hcl cap er 24hr verapamil hcl cap er 24hr verapamil hcl cap er 24hr

30 verapamil hcl cap er 24hr verapamil hcl cap er 24hr verapamil hcl iv soln /ml verapamil hcl tab 40 verapamil hcl tab 80 verapamil hcl tab 120 verapamil hcl tab er GC verapamil hcl tab er GC verapamil hcl tab er GC Glucósidos digitálicos digitek tab GC digitek tab QL digoxin inj 0.25 /ml 3 digoxin oral soln 0.05 /ml 2 GC digoxin tab 125 mcg (0.125 ) 3 QL digoxin tab 250 mcg ( GC ) DIRECT RENIN INHIBITORS/COMBINATIONS TEKTURNA HCT TAB TEKTURNA HCT TAB MG TEKTURNA HCT TAB TEKTURNA HCT TAB MG TEKTURNA TAB 150MG 4 TEKTURNA TAB 300MG 4 Diuréticos acetazolamide cap er 12hr acetazolamide tab acetazolamide tab amiloride & 2 GC hydrochlorothiazide tab 5-50 amiloride hcl tab 5 3 bumetanide inj 0.25 /ml 3 bumetanide tab bumetanide tab 1 3 bumetanide tab 2 3 chlorothiazide tab chlorothiazide tab chlorthalidone tab 25 3 chlorthalidone tab 50 3 furosemide inj 10 /ml 2 GC furosemide oral soln 8 /ml 2 GC furosemide oral soln 10 /ml 2 GC furosemide tab 20 furosemide tab 40 furosemide tab 80 hydrochlorothiazide cap 12.5 hydrochlorothiazide tab 12.5 hydrochlorothiazide tab 25 hydrochlorothiazide tab 50 indapamide tab GC indapamide tab GC methazolamide tab 25 4 methazolamide tab 50 4 methyclothiazide tab 5 3 metolazone tab metolazone tab 5 3 metolazone tab 10 3 spironolactone & 3 hydrochlorothiazide tab torsemide tab 5 2 GC torsemide tab 10 2 GC torsemide tab 20 2 GC torsemide tab GC triamterene & hydrochlorothiazide cap triamterene & hydrochlorothiazide tab triamterene & hydrochlorothiazide tab Misceláneos 25

31 clonidine hcl tab 0.1 clonidine hcl tab 0.2 clonidine hcl tab 0.3 clonidine hcl td patch weekly /24hr clonidine hcl td patch weekly /24hr clonidine hcl td patch weekly /24hr CORLANOR TAB 5MG 4 CORLANOR TAB 7.5MG 4 DEMSER CAP 250MG 5 hydralazine hcl inj 20 /ml 4 hydralazine hcl tab 10 2 GC hydralazine hcl tab 25 2 GC hydralazine hcl tab 50 2 GC hydralazine hcl tab GC midodrine hcl tab midodrine hcl tab 5 3 midodrine hcl tab 10 3 minoxidil tab GC minoxidil tab 10 2 GC NORTHERA CAP 100MG 5 LA PA NORTHERA CAP 200MG 5 LA PA NORTHERA CAP 300MG 5 LA PA RANEXA TAB 500MG 3 RANEXA TAB 1000MG 3 Nitratos isosorbide dinitrate tab 5 3 isosorbide dinitrate tab 10 3 isosorbide dinitrate tab 20 3 isosorbide dinitrate tab 30 3 isosorbide dinitrate tab er 40 4 isosorbide mononitrate tab 10 2 GC isosorbide mononitrate tab 20 2 GC isosorbide mononitrate tab er 2 GC 24hr 30 isosorbide mononitrate tab er 2 GC 24hr 60 isosorbide mononitrate tab er 24hr GC minitran dis 0.1/hr 3 minitran dis 0.2/hr 3 minitran dis 0.4/hr 3 minitran dis 0.6/hr 3 NITRO-BID OIN 2% 3 NITRO-DUR DIS 0.3MG/HR 4 NITRO-DUR DIS 0.8MG/HR 4 nitroglycerin sl tab nitroglycerin sl tab nitroglycerin sl tab nitroglycerin td patch 24hr /hr nitroglycerin td patch 24hr /hr nitroglycerin td patch 24hr /hr nitroglycerin td patch 24hr /hr Hipertensión Arterial Pulmonar ADCIRCA TAB 20MG 5 QL PA ADEMPAS TAB 0.5MG 5 QL LA PA QL (90 tabs / 30 ADEMPAS TAB 1.5MG 5 QL LA PA QL (90 tabs / 30 ADEMPAS TAB 1MG 5 QL LA PA QL (90 tabs / 30 ADEMPAS TAB 2.5MG 5 QL LA PA QL (90 tabs / 30 ADEMPAS TAB 2MG 5 QL LA PA QL (90 tabs / 30 LETAIRIS TAB 5MG 5 QL LA PA LETAIRIS TAB 10MG 5 QL LA PA OPSUMIT TAB 10MG 5 QL LA PA REMODULIN INJ 1MG/ML 5 LA PA REMODULIN INJ 2.5MG/ML 5 LA PA REMODULIN INJ 5MG/ML 5 LA PA REMODULIN INJ 10MG/ML 5 LA PA sildenafil citrate tab 20 3 QL PA QL (90 tabs / 30 TRACLEER TAB 62.5MG QL (120 tabs / 30 5 QL LA PA 26

32 TRACLEER TAB 125MG 5 QL LA PA VENTAVIS SOL 10MCG/ML 5 PA VENTAVIS SOL 20MCG/ML 5 PA Sistema nervioso central Contra la ansiedad alprazolam tab 0.5 QL QL (240 tabs / 30 alprazolam tab 0.25 QL QL (480 tabs / 30 alprazolam tab 1 QL QL (120 tabs / 30 alprazolam tab 2 QL QL (150 tabs / 30 buspirone hcl tab 5 2 GC buspirone hcl tab GC buspirone hcl tab 10 2 GC buspirone hcl tab 15 2 GC buspirone hcl tab 30 4 fluvoxamine maleate tab 25 2 GC QL QL (45 tabs / 30 fluvoxamine maleate tab 50 2 GC QL QL (45 tabs / 30 fluvoxamine maleate tab GC lorazepam conc 2 /ml 3 QL QL (150 ml / 30 lorazepam inj 2 /ml 2 GC lorazepam inj 4 /ml 2 GC lorazepam tab 0.5 QL QL (150 tabs / 30 lorazepam tab 1 QL QL (150 tabs / 30 lorazepam tab 2 QL QL (150 tabs / 30 Anticonvulsivos APTIOM TAB 200MG QL (180 tabs / 30 APTIOM TAB 400MG QL (90 tabs / 30 APTIOM TAB 600MG 5 QL 5 QL 5 QL BANZEL SUS 40MG/ML 5 PA BANZEL TAB 200MG 5 PA BANZEL TAB 400MG 5 PA BRIVIACT INJ 50MG/5ML 4 PA BRIVIACT SOL 10MG/ML 5 PA BRIVIACT TAB 10MG 5 PA BRIVIACT TAB 25MG 5 PA BRIVIACT TAB 50MG 5 PA BRIVIACT TAB 75MG 5 PA BRIVIACT TAB 100MG 5 PA carbamazepine cap er 12hr carbamazepine cap er 12hr carbamazepine cap er 12hr carbamazepine chew tab carbamazepine susp /5ml carbamazepine tab carbamazepine tab er 12hr carbamazepine tab er 12hr carbamazepine tab er 12hr CELONTIN CAP 300MG 4 clonazepam orally 3 QL disintegrating tab 0.5 QL (240 tabs / 30 clonazepam orally 3 QL disintegrating tab 0.25 QL (480 tabs / 30 clonazepam orally disintegrating tab QL QL (960 tabs / 30 clonazepam orally disintegrating tab 1 QL (120 tabs / 30 clonazepam orally disintegrating tab 2 QL (300 tabs / 30 3 QL 3 QL clonazepam tab 0.5 APTIOM TAB 800MG 5 QL QL (240 tabs / 30 QL 27

33 clonazepam tab 1 QL QL (120 tabs / 30 clonazepam tab 2 QL QL (300 tabs / 30 clorazepate dipotassium tab 3 QL 3.75 QL (120 tabs / 30 clorazepate dipotassium tab 3 QL 7.5 QL (120 tabs / 30 clorazepate dipotassium tab 3 QL 15 QL (180 tabs / 30 DIASTAT ACDL GEL 5-10MG 4 DIASTAT ACDL GEL DIASTAT PED GEL 2.5M 4 GEL diazepam con 5/ml 3 QL QL (240 ml / 30 diazepam inj 5 /ml 3 diazepam oral soln 1 /ml 3 QL QL (1200 ml / 30 diazepam rectal gel delivery 4 system 2.5 diazepam rectal gel delivery 4 system 10 diazepam rectal gel delivery 4 system 20 diazepam tab 2 QL QL (120 tabs / 30 diazepam tab 5 QL QL (120 tabs / 30 diazepam tab 10 QL QL (120 tabs / 30 DILANTIN CAP 30MG 3 DILANTIN CAP 100MG 3 DILANTIN CHW 50MG 3 DILANTIN-125 SUS 125/5ML 4 divalproex sodium cap 4 delayed release sprinkle 125 divalproex sodium tab 3 delayed release 125 divalproex sodium tab delayed release divalproex sodium tab 3 delayed release 500 divalproex sodium tab er 24 hr divalproex sodium tab er 24 hr epitol tab ethosuximide cap ethosuximide soln /5ml felbamate susp 600 /5ml 5 felbamate tab felbamate tab FYCOMPA SUS 0.5MG/ML 5 QL PA QL (720 ml / 30 FYCOMPA TAB 2MG PA QL (180 tabs / 30 FYCOMPA TAB 4MG 5 QL PA QL (90 tabs / 30 FYCOMPA TAB 6MG 5 QL PA FYCOMPA TAB 8MG 5 QL PA FYCOMPA TAB 10MG 5 QL PA FYCOMPA TAB 12MG 5 QL PA gabapentin cap GC QL QL (1080 caps / 30 gabapentin cap GC QL QL (360 caps / 30 gabapentin cap GC QL QL (270 caps / 30 gabapentin oral soln QL /5ml QL (2160 ml / 30 gabapentin tab QL QL (180 tabs / 30 gabapentin tab QL QL (120 tabs / 30 GABITRIL TAB 12MG 4 GABITRIL TAB 16MG 4 lamotrigine tab 25 2 GC lamotrigine tab GC 28

34 lamotrigine tab GC lamotrigine tab GC lamotrigine tab chewable 3 dispersible 5 lamotrigine tab chewable 3 dispersible 25 lamotrigine tab er 24hr 25 4 lamotrigine tab er 24hr 50 4 lamotrigine tab er 24hr lamotrigine tab er 24hr lamotrigine tab er 24hr lamotrigine tab er 24hr levetiracetam in sodium 4 chloride iv soln 500 /100ml levetiracetam in sodium 4 chloride iv soln 1000 /100ml levetiracetam in sodium 4 chloride iv soln 1500 /100ml levetiracetam inj 500 /5ml 4 (100 /ml) levetiracetam oral soln /ml levetiracetam tab levetiracetam tab levetiracetam tab levetiracetam tab levetiracetam tab er 24hr levetiracetam tab er 24hr LYRICA CAP 25MG 3 QL QL (120 caps / 30 LYRICA CAP 50MG 3 QL QL (120 caps / 30 LYRICA CAP 75MG 3 QL QL (120 caps / 30 LYRICA CAP 100MG QL (120 caps / 30 3 QL LYRICA CAP 150MG 3 QL QL (120 caps / 30 LYRICA CAP 200MG 3 QL QL (90 caps / 30 LYRICA CAP 225MG 3 QL QL (60 caps / 30 LYRICA CAP 300MG 3 QL QL (60 caps / 30 LYRICA SOL 20MG/ML 3 QL QL (946 ml / 30 ONFI SUS 2.5MG/ML 5 PA ONFI TAB 10MG 5 PA ONFI TAB 20MG 5 PA oxcarbazepine susp /5ml (60 /ml) oxcarbazepine tab oxcarbazepine tab oxcarbazepine tab PEGANONE TAB 250MG 4 PHENOBARB INJ 65MG/ML 2 GC phenobarbital elixir 20 /5ml 2 GC phenobarbital sodium inj GC /ml phenobarbital tab 15 2 GC phenobarbital tab GC phenobarbital tab 30 2 GC phenobarbital tab GC phenobarbital tab 60 2 GC phenobarbital tab GC phenobarbital tab GC phenobarbital tab GC PHENYTEK CAP 200MG 3 PHENYTEK CAP 300MG 3 phenytoin chew tab 50 3 phenytoin sodium extended 3 cap 100 phenytoin sodium extended 3 cap 200 phenytoin sodium extended 3 cap 300 phenytoin sodium inj 50 3 /ml phenytoin susp 125 /5ml 3 primidone tab 50 2 GC primidone tab GC 29

35 roweepra tab roweepra tab roweepra tab roweepra xr tab 500 xr 3 roweepra xr tab 750 xr 3 SABRIL POW 500MG 5 QL LA PA QL (180 packets / 30 SABRIL TAB 500MG 5 QL LA PA VIMPAT TAB 150MG 5 QL VIMPAT TAB 200MG 5 QL zonisamide cap 25 3 zonisamide cap 50 3 zonisamide cap Contra la demencia donepezil hydrochloride orally disintegrating tab 5 2 GC QL QL (180 tabs / 30 SPRITAM TAB 250MG 4 SPRITAM TAB 500MG 4 donepezil hydrochloride orally 2 GC SPRITAM TAB 750MG 4 disintegrating tab 10 donepezil hydrochloride tab 5 2 GC QL SPRITAM TAB 1000MG 4 TEGRETOL SUS 100/5ML 4 TEGRETOL TAB 200MG 4 donepezil hydrochloride tab 2 GC TEGRETOL-XR TAB 100MG 4 10 TEGRETOL-XR TAB 200MG 4 donepezil hydrochloride tab 4 TEGRETOL-XR TAB 400MG 4 23 tiagabine hcl tab 2 4 galantamine hydrobromide tiagabine hcl tab 4 4 cap er 24hr 8 QL (30 caps / 30 tiagabine hcl tab 12 4 galantamine hydrobromide tiagabine hcl tab 16 4 cap er 24hr 16 topiramate sprinkle cap 15 4 QL (30 caps / 30 topiramate sprinkle cap 25 4 galantamine hydrobromide 4 topiramate tab 25 2 GC cap er 24hr 24 topiramate tab 50 2 GC galantamine hydrobromide 4 topiramate tab GC oral soln 4 /ml topiramate tab GC galantamine hydrobromide valproate sodium inj tab 4 /ml QL (180 tabs / 30 valproate sodium oral soln 3 galantamine hydrobromide 250 /5ml (base equiv) tab 8 valproic acid cap QL (90 tabs / 30 vigabatrin powd pack QL LA PA galantamine hydrobromide 4 QL (180 packets / 30 tab 12 memantine hcl cap er 24hr 7 4 PA VIMPAT INJ 200MG/20 5 VIMPAT SOL 10MG/ML 5 QL PA if < 30 yrs QL (1200 ml / 30 memantine hcl cap er 24hr 14 4 PA VIMPAT TAB 50MG QL (180 tabs / 30 PA if < 30 yrs VIMPAT TAB 100MG 5 QL 30

36 memantine hcl cap er 24hr 21 4 PA PA if < 30 yrs memantine hcl cap er 24hr 28 4 PA PA if < 30 yrs memantine hcl oral solution 2 4 PA /ml PA if < 30 yrs memantine hcl tab 5 3 PA PA if < 30 yrs memantine hcl tab 10 3 PA PA if < 30 yrs NAMENDA XR CAP 7MG 4 PA PA if < 30 yrs NAMENDA XR CAP 14MG 4 PA PA if < 30 yrs NAMENDA XR CAP 21MG 4 PA PA if < 30 yrs NAMENDA XR CAP 28MG 4 PA PA if < 30 yrs NAMENDA XR CAP 4 PA TITRATIO PA if < 30 yrs NAMZARIC CAP 4 NAMZARIC CAP 7-10MG 4 NAMZARIC CAP 14-10MG 4 NAMZARIC CAP 21-10MG 4 NAMZARIC CAP 28-10MG 4 rivastigmine tartrate cap rivastigmine tartrate cap 3 4 rivastigmine tartrate cap rivastigmine tartrate cap 6 4 rivastigmine td patch 24hr 4.6 /24hr QL (30 patches / 30 rivastigmine td patch 24hr 9.5 /24hr QL (30 patches / 30 rivastigmine td patch 24hr 13.3 /24hr QL (30 patches / 30 Antidepresivos amitriptyline hcl tab 10 2 GC amitriptyline hcl tab 25 2 GC amitriptyline hcl tab 50 2 GC amitriptyline hcl tab 75 2 GC amitriptyline hcl tab GC amitriptyline hcl tab GC amoxapine tab 25 3 amoxapine tab 50 3 amoxapine tab amoxapine tab bupropion hcl tab 75 3 bupropion hcl tab bupropion hcl tab er 12hr GC bupropion hcl tab er 12hr GC bupropion hcl tab er 12hr GC bupropion hcl tab er 24hr QL QL (90 tabs / 30 bupropion hcl tab er 24hr QL citalopram hydrobromide oral 3 soln 10 /5ml citalopram hydrobromide tab QL 10 (base equiv) QL (45 tabs / 30 citalopram hydrobromide tab QL 20 (base equiv) QL (45 tabs / 30 citalopram hydrobromide tab QL 40 (base equiv) clomipramine hcl cap 25 2 GC clomipramine hcl cap 50 2 GC clomipramine hcl cap 75 2 GC desipramine hcl tab 10 4 desipramine hcl tab

37 desipramine hcl tab 50 4 desipramine hcl tab 75 4 desipramine hcl tab desipramine hcl tab desvenlafaxine succinate tab er 24hr 25 (base equiv) desvenlafaxine succinate tab er 24hr 50 (base equiv) desvenlafaxine succinate tab er 24hr 100 (base equiv) doxepin hcl cap 10 2 GC doxepin hcl cap 25 2 GC doxepin hcl cap 50 2 GC doxepin hcl cap 75 2 GC doxepin hcl cap GC doxepin hcl cap GC doxepin hcl conc 10 /ml 2 GC duloxetine hcl enteric coated 3 QL pellets cap 20 (base eq) QL (180 caps / 30 duloxetine hcl enteric coated 3 QL pellets cap 30 (base eq) QL (120 caps / 30 duloxetine hcl enteric coated 3 QL pellets cap 60 (base eq) QL (60 caps / 30 EMSAM DIS 6MG/24HR 5 QL PA QL (30 patches / 30 EMSAM DIS 9MG/24HR 5 QL PA QL (30 patches / 30 EMSAM DIS 12MG/24H 5 QL PA QL (30 patches / 30 escitalopram oxalate soln 5 /5ml (base equiv) QL (600 ml / 30 escitalopram oxalate tab 5 (base equiv) QL (45 tabs / 30 2 GC QL escitalopram oxalate tab 10 (base equiv) QL (45 tabs / 30 escitalopram oxalate tab 20 (base equiv) 2 GC QL 2 GC QL FETZIMA CAP 20MG QL (180 caps / 30 FETZIMA CAP 40MG QL (90 caps / 30 FETZIMA CAP 80MG QL (30 caps / 30 FETZIMA CAP 120MG QL (30 caps / 30 FETZIMA CAP TITRATIO 4 fluoxetine hcl cap 10 QL QL (30 caps / 30 fluoxetine hcl cap 20 QL QL (120 caps / 30 fluoxetine hcl cap 40 fluoxetine hcl solution 20 2 GC /5ml imipramine hcl tab 10 2 GC imipramine hcl tab 25 2 GC imipramine hcl tab 50 2 GC maprotiline hcl tab 25 4 maprotiline hcl tab 50 4 maprotiline hcl tab 75 4 MARPLAN TAB 10MG QL (180 tabs / 30 mirtazapine orally 3 QL disintegrating tab 15 mirtazapine orally 3 disintegrating tab 30 mirtazapine orally 3 disintegrating tab 45 mirtazapine tab GC QL QL (45 tabs / 30 mirtazapine tab 15 2 GC QL QL (45 tabs / 30 mirtazapine tab 30 2 GC mirtazapine tab 45 2 GC nefazodone hcl tab 50 4 nefazodone hcl tab

38 nefazodone hcl tab nefazodone hcl tab nefazodone hcl tab nortriptyline hcl cap 10 nortriptyline hcl cap 25 nortriptyline hcl cap 50 nortriptyline hcl cap 75 nortriptyline hcl soln 10 4 /5ml paroxetine hcl tab 10 QL QL (45 tabs / 30 paroxetine hcl tab 20 QL QL (45 tabs / 30 paroxetine hcl tab 30 QL paroxetine hcl tab 40 QL QL (45 tabs / 30 PAXIL SUS 10MG/5ML QL (900 ml / 30 phenelzine sulfate tab 15 3 PRISTIQ TAB 25MG PRISTIQ TAB 50MG PRISTIQ TAB 100MG protriptyline hcl tab 5 4 protriptyline hcl tab 10 4 sertraline hcl oral concentrate 3 for solution 20 /ml sertraline hcl tab 25 QL QL (45 tabs / 30 sertraline hcl tab 50 QL QL (45 tabs / 30 sertraline hcl tab 100 tranylcypromine sulfate tab 10 4 trazodone hcl tab 50 trazodone hcl tab 100 trazodone hcl tab 150 trimipramine maleate cap 25 QL (240 caps / 30 2 GC QL trimipramine maleate cap 50 2 GC QL QL (120 caps / 30 trimipramine maleate cap GC QL QL (60 caps / 30 TRINTELLIX TAB 5MG QL (120 tabs / 30 TRINTELLIX TAB 10MG TRINTELLIX TAB 20MG venlafaxine hcl cap er 24hr 2 GC QL 37.5 (base equivalent) QL (30 caps / 30 venlafaxine hcl cap er 24hr 75 2 GC QL (base equivalent) QL (30 caps / 30 venlafaxine hcl cap er 24hr 2 GC QL 150 (base equivalent) QL (60 caps / 30 venlafaxine hcl tab 25 3 venlafaxine hcl tab venlafaxine hcl tab 50 3 venlafaxine hcl tab 75 3 venlafaxine hcl tab VIIBRYD KIT STARTER 4 VIIBRYD TAB 10MG VIIBRYD TAB 20MG VIIBRYD TAB 40MG Antiparkinsonianos amantadine hcl cap QL QL (120 caps / 30 amantadine hcl syrup 50 2 GC /5ml amantadine hcl tab APOKYN INJ 10MG/ML 5 LA PA AZILECT TAB 0.5MG 4 AZILECT TAB 1MG 4 benztropine mesylate inj 1 /ml 3 33

39 benztropine mesylate tab GC benztropine mesylate tab 1 2 GC benztropine mesylate tab 2 2 GC bromocriptine mesylate cap 5 4 (base equivalent) bromocriptine mesylate tab (base equivalent) carbidopa & levodopa orally 4 disintegrating tab carbidopa & levodopa orally 4 disintegrating tab carbidopa & levodopa orally 4 disintegrating tab carbidopa & levodopa tab 10-2 GC 100 carbidopa & levodopa tab 25-2 GC 100 carbidopa & levodopa tab 25-2 GC 250 carbidopa & levodopa tab er carbidopa & levodopa tab er carbidopa-levodopaentacapone 4 tabs carbidopa-levodopaentacapone 4 tabs carbidopa-levodopaentacapone 4 tabs carbidopa-levodopaentacapone 4 tabs carbidopa-levodopaentacapone 4 tabs carbidopa-levodopaentacapone 4 tabs entacapone tab NEUPRO DIS 1MG/24HR 4 NEUPRO DIS 2MG/24HR 4 NEUPRO DIS 3MG/24HR 4 NEUPRO DIS 4MG/24HR 4 NEUPRO DIS 6MG/24HR 4 NEUPRO DIS 8MG/24HR 4 pramipexole dihydrochloride 2 GC tab 0.5 pramipexole dihydrochloride 2 GC tab 0.25 pramipexole dihydrochloride 2 GC tab 0.75 pramipexole dihydrochloride 2 GC tab pramipexole dihydrochloride 2 GC tab 1 pramipexole dihydrochloride 2 GC tab 1.5 rasagiline mesylate tab (base equiv) rasagiline mesylate tab 1 4 (base equiv) ropinirole hydrochloride tab 2 GC 0.5 ropinirole hydrochloride tab 2 GC 0.25 ropinirole hydrochloride tab 1 2 GC ropinirole hydrochloride tab 2 2 GC ropinirole hydrochloride tab 3 2 GC ropinirole hydrochloride tab 4 2 GC ropinirole hydrochloride tab 5 2 GC selegiline hcl cap 5 4 selegiline hcl tab 5 3 STALEVO 50 TAB 4 STALEVO 75 TAB 5 STALEVO 100 TAB 5 STALEVO 125 TAB 5 STALEVO 150 TAB 5 STALEVO 200 TAB 5 trihexyphenidyl hcl elixir 0.4 /ml 2 GC 34

40 trihexyphenidyl hcl tab 2 2 GC trihexyphenidyl hcl tab 5 2 GC Antipsicóticos ABILIFY MAIN INJ 300MG QL (1 injection / 28 ABILIFY MAIN INJ 400MG QL (1 injection / 28 aripiprazole oral solution 1 /ml QL (900 ml / 30 aripiprazole orally disintegrating tab 10 aripiprazole orally disintegrating tab 15 aripiprazole tab 2 aripiprazole tab 5 aripiprazole tab 10 aripiprazole tab 15 aripiprazole tab 20 aripiprazole tab 30 ARISTADA INJ 441MG/1. QL (1 injection / 28 ARISTADA INJ 662MG/2 QL (1 injection / 28 ARISTADA INJ 882MG/3 QL (1 injection / 28 ARISTADA INJ 1064MG QL (1 injection / 56 CHLORPROMAZ INJ 25MG/ML CHLORPROMAZ INJ 50MG/2ML 5 QL 5 QL 5 QL 5 QL 5 QL 5 QL 5 QL 5 QL 5 QL 5 QL 5 QL 4 4 chlorpromazine hcl tab 10 4 chlorpromazine hcl tab 25 4 chlorpromazine hcl tab 50 4 chlorpromazine hcl tab chlorpromazine hcl tab clozapine orally disintegrating 4 PA tab 12.5 clozapine orally disintegrating 4 PA tab 25 clozapine orally disintegrating PA tab 100 QL (270 tabs / 30 clozapine orally disintegrating PA tab 150 QL (180 tabs / 30 clozapine orally disintegrating 5 QL PA tab 200 QL (135 tabs / 30 clozapine tab 25 3 clozapine tab 50 3 clozapine tab 100 QL (270 tabs / 30 clozapine tab 200 QL (135 tabs / 30 FANAPT PAK 4 FANAPT TAB 1MG FANAPT TAB 2MG FANAPT TAB 4MG FANAPT TAB 6MG FANAPT TAB 8MG FANAPT TAB 10MG FANAPT TAB 12MG fluphenazine decanoate inj 25 4 /ml fluphenazine hcl elixir 2.5 /5ml 4 35

41 fluphenazine hcl inj 2.5 /ml 4 fluphenazine hcl oral conc 5 4 /ml fluphenazine hcl tab 1 4 fluphenazine hcl tab fluphenazine hcl tab 5 4 fluphenazine hcl tab 10 4 GEODON INJ 20MG QL (6 ml / 3 haloperidol decanoate im soln 4 50 /ml haloperidol decanoate im soln /ml haloperidol lactate inj 5 /ml 3 haloperidol lactate oral conc 2 2 GC /ml haloperidol tab haloperidol tab 1 3 haloperidol tab 2 3 haloperidol tab 5 3 haloperidol tab 10 3 haloperidol tab 20 3 INVEGA SUST INJ 39/0.25 QL (1 injection / 28 INVEGA SUST INJ 78/0.5ML 5 QL QL (1 injection / 28 INVEGA SUST INJ 117/ QL QL (1 injection / 28 INVEGA SUST INJ 5 QL 156MG/ML QL (1 injection / 28 INVEGA SUST INJ 234/1.5 5 QL QL (1 injection / 28 INVEGA TRINZ INJ 273MG 5 QL QL (1 injection / 90 INVEGA TRINZ INJ 410MG QL (1 injection / 90 5 QL INVEGA TRINZ INJ 546MG QL (1 injection / 90 INVEGA TRINZ INJ 819MG QL (1 injection / 90 LATUDA TAB 20MG QL (240 tabs / 30 LATUDA TAB 40MG LATUDA TAB 60MG LATUDA TAB 80MG LATUDA TAB 120MG loxapine succinate cap 5 3 loxapine succinate cap 10 3 loxapine succinate cap 25 3 loxapine succinate cap 50 3 NUPLAZID TAB 17MG olanzapine for im inj 10 QL (3 vials / 1 day) olanzapine orally disintegrating tab 5 olanzapine orally disintegrating tab 10 olanzapine orally disintegrating tab 15 olanzapine orally disintegrating tab 20 olanzapine tab 2.5 QL (240 tabs / 30 olanzapine tab 5 QL (120 tabs / 30 olanzapine tab 7.5 olanzapine tab 10 olanzapine tab 15 5 QL 5 QL 5 QL LA PA 3 QL 3 QL 3 QL 3 QL 3 QL 36

42 olanzapine tab 20 3 QL paliperidone tab er 24hr QL paliperidone tab er 24hr 3 5 QL paliperidone tab er 24hr 6 5 QL paliperidone tab er 24hr 9 5 QL perphenazine tab 2 4 perphenazine tab 4 4 perphenazine tab 8 4 perphenazine tab 16 4 pimozide tab 1 4 pimozide tab 2 4 quetiapine fumarate tab 25 2 GC QL QL (90 tabs / 30 quetiapine fumarate tab 50 2 GC QL QL (90 tabs / 30 quetiapine fumarate tab GC QL QL (90 tabs / 30 quetiapine fumarate tab GC QL QL (90 tabs / 30 quetiapine fumarate tab GC QL QL (90 tabs / 30 quetiapine fumarate tab GC QL QL (90 tabs / 30 quetiapine fumarate tab er 24hr 50 QL (120 tabs / 30 quetiapine fumarate tab er 24hr 150 quetiapine fumarate tab er 24hr 200 quetiapine fumarate tab er 24hr 300 quetiapine fumarate tab er 24hr 400 REXULTI TAB 0.5MG QL (180 tabs / 30 REXULTI TAB 0.25MG QL (360 tabs / 30 REXULTI TAB 1MG QL (90 tabs / 30 REXULTI TAB 2MG REXULTI TAB 3MG REXULTI TAB 4MG RISPERDAL INJ 12.5MG QL (2 injections / 28 RISPERDAL INJ 25MG QL (2 injections / 28 RISPERDAL INJ 37.5MG QL (2 injections / 28 RISPERDAL INJ 50MG QL (2 injections / 28 risperidone orally disintegrating tab 0.5 QL (90 tabs / 30 risperidone orally disintegrating tab 0.25 QL (90 tabs / 30 risperidone orally disintegrating tab 1 risperidone orally disintegrating tab 2 risperidone orally disintegrating tab 3 5 QL 5 QL 5 QL 5 QL 5 QL 5 QL 5 QL 5 QL 37

43 risperidone orally disintegrating tab 4 VRAYLAR CAP 4.5MG QL (30 caps / 30 5 QL PA QL (120 tabs / 30 VRAYLAR CAP 6MG 5 QL PA risperidone soln 1 /ml 3 QL QL (30 caps / 30 QL (240 ml / 30 ziprasidone hcl cap 20 risperidone tab GC QL QL (60 caps / 30 QL (90 tabs / 30 ziprasidone hcl cap 40 risperidone tab GC QL QL (60 caps / 30 QL (90 tabs / 30 ziprasidone hcl cap 60 risperidone tab 1 2 GC QL QL (60 caps / 30 ziprasidone hcl cap 80 risperidone tab 2 2 GC QL QL (60 caps / 30 ZYPREXA RELP INJ 210MG PA risperidone tab 3 2 GC QL QL (2 vials / 28 ZYPREXA RELP INJ 300MG 5 QL PA risperidone tab 4 2 GC QL QL (2 vials / 28 QL (120 tabs / 30 ZYPREXA RELP INJ 405MG 5 QL PA SAPHRIS SUB 2.5MG QL (1 vial / 28 QL (240 tabs / 30 Trastorno por déficit de atención e SAPHRIS SUB 5MG hiperactividad QL (120 tabs / 30 amphetaminedextroamphetamine cap er SAPHRIS SUB 10MG 24hr 5 thioridazine hcl tab 10 2 GC QL (90 caps / 30 thioridazine hcl tab 25 2 GC amphetaminedextroamphetamine thioridazine hcl tab 50 2 GC cap er thioridazine hcl tab GC 24hr 10 thiothixene cap 1 4 QL (90 caps / 30 thiothixene cap 2 4 amphetaminedextroamphetamine cap er thiothixene cap hr 15 thiothixene cap 10 4 QL (30 caps / 30 trifluoperazine hcl tab 1 3 amphetaminedextroamphetamine cap er (base equivalent) trifluoperazine hcl tab hr 20 (base equivalent) QL (30 caps / 30 trifluoperazine hcl tab 5 3 amphetaminedextroamphetamine cap er (base equivalent) trifluoperazine hcl tab hr 25 (base equivalent) QL (30 caps / 30 VERSACLOZ SUS 50MG/ML 5 QL PA amphetaminedextroamphetamine cap er QL (600 ml / 30 VRAYLAR CAP 1.5-3MG 4 PA 24hr 30 VRAYLAR CAP 1.5MG 5 QL PA QL (30 caps / 30 QL (120 caps / 30 VRAYLAR CAP 3MG 5 QL PA QL (60 caps / 30 38

44 amphetaminedextroamphetamine 3 QL tab 5 QL (360 tabs / 30 amphetaminedextroamphetamine 3 QL tab 7.5 QL (240 tabs / 30 amphetaminedextroamphetamine 3 QL tab 10 QL (180 tabs / 30 amphetaminedextroamphetamine 3 QL tab 12.5 QL (144 tabs / 30 amphetaminedextroamphetamine 3 QL tab 15 QL (120 tabs / 30 amphetaminedextroamphetamine 3 QL tab 20 QL (90 tabs / 30 amphetaminedextroamphetamine 3 QL tab 30 atomoxetine hcl cap 10 (base equiv) QL (120 caps / 30 atomoxetine hcl cap 18 (base equiv) QL (120 caps / 30 atomoxetine hcl cap 25 (base equiv) QL (120 caps / 30 atomoxetine hcl cap 40 (base equiv) QL (60 caps / 30 atomoxetine hcl cap 60 (base equiv) QL (30 caps / 30 atomoxetine hcl cap 80 (base equiv) QL (30 caps / 30 atomoxetine hcl cap 100 (base equiv) QL (30 caps / 30 dextroamphetamine sulfate 4 cap er 24hr 5 dextroamphetamine sulfate 4 cap er 24hr 10 dextroamphetamine sulfate 4 cap er 24hr 15 dextroamphetamine sulfate 4 tab 5 dextroamphetamine sulfate 4 tab 10 guanfacine hcl tab er 24hr 1 2 GC (base equiv) guanfacine hcl tab er 24hr 2 2 GC (base equiv) guanfacine hcl tab er 24hr 3 2 GC (base equiv) guanfacine hcl tab er 24hr 4 2 GC (base equiv) methylphenidate hcl soln 5 /5ml QL (1800 ml / 30 methylphenidate hcl soln 10 /5ml QL (900 ml / 30 methylphenidate hcl tab 5 3 QL QL (180 tabs / 30 methylphenidate hcl tab 10 3 QL QL (180 tabs / 30 methylphenidate hcl tab 20 3 QL QL (90 tabs / 30 methylphenidate hcl tab er 10 QL (90 tabs / 30 methylphenidate hcl tab er 20 QL (90 tabs / 30 Hipnóticos eszopiclone tab 1 eszopiclone tab 2 2 GC QL 2 GC QL 39

45 eszopiclone tab 3 2 GC QL HETLIOZ CAP 20MG 5 LA PA SILENOR TAB 3MG 3 QL SILENOR TAB 6MG 3 QL temazepam cap GC QL QL (30 caps / 30 temazepam cap 15 2 GC QL QL (60 caps / 30 zolpidem tartrate tab 5 2 GC QL zolpidem tartrate tab 10 2 GC QL Migraña dihydroergotamine mesylate 5 inj 1 /ml dihydroergotamine mesylate 5 QL nasal spray 4 /ml QL (8 ml / 30 eletriptan hydrobromide tab 20 (base equivalent) QL (12 tabs / 30 eletriptan hydrobromide tab 40 (base equivalent) QL (12 tabs / 30 ergotamine w/ caffeine tab migergot sup 2/100 5 naratriptan hcl tab 1 (base 3 QL equiv) QL (12 tabs / 30 naratriptan hcl tab QL (base equiv) QL (12 tabs / 30 RELPAX TAB 20MG QL (12 tabs / 30 RELPAX TAB 40MG QL (12 tabs / 30 rizatriptan benzoate oral disintegrating tab 5 (base eq) QL (18 tabs / 30 3 QL rizatriptan benzoate oral 3 QL disintegrating tab 10 (base eq) QL (18 tabs / 30 rizatriptan benzoate tab 5 3 QL (base equivalent) QL (18 tabs / 30 rizatriptan benzoate tab 10 3 QL (base equivalent) QL (18 tabs / 30 sumatriptan nasal spray 5 /act QL (24 inhalers / 30 sumatriptan nasal spray 20 /act QL (12 inhalers / 30 sumatriptan succinate inj 6 /0.5ml QL (12 injections / 30 sumatriptan succinate solution auto-injector 4 /0.5ml QL (18 injections / 30 sumatriptan succinate solution auto-injector 6 /0.5ml QL (12 injections / 30 sumatriptan succinate solution cartridge 4 /0.5ml QL (18 injections / 30 sumatriptan succinate solution cartridge 6 /0.5ml QL (12 injections / 30 sumatriptan succinate solution prefilled syringe 6 /0.5ml QL (12 injections / 30 sumatriptan succinate tab 25 QL (12 tabs / 30 2 GC QL 40

46 sumatriptan succinate tab 50 2 GC QL QL (12 tabs / 30 sumatriptan succinate tab GC QL QL (12 tabs / 30 zolmitriptan orally disintegrating tab 2.5 QL (12 tabs / 30 zolmitriptan orally disintegrating tab 5 QL (12 tabs / 30 zolmitriptan tab 2.5 QL (12 tabs / 30 zolmitriptan tab 5 QL (12 tabs / 30 Misceláneos AUSTEDO TAB 6MG 5 QL LA PA AUSTEDO TAB 9MG 5 QL LA PA QL (120 tabs / 30 AUSTEDO TAB 12MG 5 QL LA PA QL (120 tabs / 30 lithium carbonate cap 150 lithium carbonate cap 300 lithium carbonate cap 600 lithium carbonate tab GC lithium carbonate tab er GC lithium carbonate tab er GC LITHIUM SOL 8MEQ/5ML 3 NUEDEXTA CAP 20-10MG 4 PA pyridostigmine bromide tab 60 3 riluzole tab 50 3 tetrabenazine tab QL PA QL (240 tabs / 30 tetrabenazine tab 25 QL (120 tabs / 30 5 QL PA Agentes para la esclerosis múltiple AMPYRA TAB 10MG 5 LA PA AVONEX KIT 30MCG 5 PA AVONEX PEN KIT 30MCG 5 PA AVONEX PREFL KIT 30MCG 5 PA BETASERON INJ 0.3MG QL (14 syringes / 28 COPAXONE INJ 40MG/ML QL (12 syringes / 28 GILENYA CAP 0.5MG QL (28 caps / 28 glatiramer acetate soln prefilled syringe 20 /ml QL (30 syringes / 30 glatiramer acetate soln prefilled syringe 40 /ml QL (12 syringes / 28 glatopa inj 20/ml QL (30 syringes / 30 glatopa inj 40/ml QL (12 syringes / 28 5 QL PA 5 QL PA 5 QL PA 5 QL PA 5 QL PA 5 QL PA 5 QL PA REBIF INJ 22/0.5 5 PA REBIF INJ 44/0.5 5 PA REBIF REBIDO INJ 22/0.5 5 PA REBIF REBIDO INJ 44/0.5 5 PA REBIF REBIDO INJ TITRATN 5 PA REBIF TITRTN INJ PACK 5 PA TYSABRI INJ 300/15ML 5 LA PA Agentes para la terapia musculoesqueletal baclofen tab 10 2 GC baclofen tab 20 2 GC cyclobenzaprine hcl tab 5 2 GC cyclobenzaprine hcl tab 10 2 GC dantrolene sodium cap 25 4 dantrolene sodium cap 50 4 dantrolene sodium cap tizanidine hcl tab 2 (base 2 GC equivalent) tizanidine hcl tab 4 (base equivalent) 2 GC Narcolepsia/cataplejía 41

47 armodafinil tab 50 PA QL (150 tabs / 30 armodafinil tab 150 PA armodafinil tab 200 PA armodafinil tab 250 PA XYREM SOL 500MG/ML QL (540 ml / 30 5 QL LA PA Psicoterapéuticos / Misceláneos acamprosate calcium tab 4 delayed release 333 buprenorphine hcl sl tab 2 3 PA (base equiv) buprenorphine hcl sl tab 8 3 PA (base equiv) buprenorphine hcl-naloxone 3 QL PA hcl sl tab (base equiv) QL (120 tabs / 30 buprenorphine hcl-naloxone 3 QL PA hcl sl tab 8-2 (base equiv) QL (120 tabs / 30 bupropion hcl (smoking 3 deterrent) tab er 12hr 150 CHANTIX PAK 0.5& 1MG 4 PA CHANTIX PAK 1MG 4 PA CHANTIX TAB 0.5MG 4 PA CHANTIX TAB 1MG 4 PA disulfiram tab disulfiram tab naloxone hcl inj 0.4 /ml 3 naloxone hcl inj 4 /10ml 3 naloxone hcl soln cartridge /ml naloxone hcl soln prefilled 3 syringe 2 /2ml naltrexone hcl tab 50 3 NICOTROL INH 4 NICOTROL NS SPR 4 10MG/ML SUBOXONE MIS 2-0.5MG QL (120 SL films / 30 PA SUBOXONE MIS 4-1MG QL (120 SL films / 30 SUBOXONE MIS 8-2MG QL (120 SL films / 30 SUBOXONE MIS 12-3MG QL (60 SL films / 30 VIVITROL INJ 380MG 5 PA PA PA Endocrino y metabólico Andrógenos ANADROL-50 TAB 50MG 5 PA ANDRODERM DIS PA 2MG/24HR QL (30 patches / 30 ANDRODERM DIS PA 4MG/24HR QL (30 patches / 30 ANDROGEL GEL 1.62% 3 QL PA QL (150 grams / 30 oxandrolone tab PA oxandrolone tab 10 4 PA testosterone cypionate im inj 3 PA in oil 100 /ml testosterone cypionate im inj 3 PA in oil 200 /ml testosterone enanthate im inj 3 PA in oil 200 /ml testosterone td gel 12.5 PA /act (1%) QL (300 gm / 30 testosterone td gel 25 /2.5gm (1%) PA QL (300 gm / 30 testosterone td gel 50 PA /5gm (1%) QL (300 gm / 30 Antidiabéticos, inyectables ALCOHOL SWABS 3 BASAGLAR INJ 100UNIT 3 42

48 BYDUREON INJ 2MG 3 QL QL (4 vials / 28 BYDUREON INJ BCISE 3 QL QL (4 pens / 28 BYDUREON PEN INJ 2MG 3 QL QL (4 pens / 28 BYETTA INJ 5MCG QL (1 pen / 30 BYETTA INJ 10MCG QL (1 pen / 30 FIASP FLEX INJ TOUCH 3 FIASP INJ 100/ML 3 GAUZE PADS 2" X 2" 3 HUMULIN R INJ U HUMULIN R INJ U B/D INSULIN PEN NEEDLE 3 INSULIN SAFETY NEEDLES 3 INSULIN SYRINGE 3 LEVEMIR INJ 3 LEVEMIR INJ FLEXTOUC 3 NOVOLIN INJ 70/30 3 (brand RELION not covered) NOVOLIN N INJ U (brand RELION not covered) NOVOLIN R INJ U (brand RELION not covered) NOVOLOG INJ 100/ML 3 NOVOLOG INJ FLEXPEN 3 NOVOLOG INJ PENFILL 3 NOVOLOG MIX INJ 70/30 3 NOVOLOG MIX INJ 3 FLEXPEN OZEMPIC INJ 2/1.5ML 3 QL QL (1 pen / 28 OZEMPIC INJ 2/1.5ML 3 QL QL (2 pens / 28 SOLIQUA INJ 100/33 3 QL QL (10 pens / 30 SYMLINPEN 60 INJ 5 PA 1000MCG SYMLNPEN 120 INJ 1000MCG 5 PA TRESIBA FLEX INJ 100UNIT 3 TRESIBA FLEX INJ 200UNIT 3 TRULICITY INJ 0.75/0.5 3 QL QL (4 pens / 28 TRULICITY INJ 1.5/0.5 3 QL QL (4 pens / 28 VICTOZA INJ 18MG/3ML 3 QL QL (3 pens / 30 XULTOPHY INJ 100/3.6 QL (5 pens / 30 3 QL Antidiabéticos, orales acarbose tab 25 3 acarbose tab 50 3 acarbose tab FARXIGA TAB 5MG 3 QL FARXIGA TAB 10MG 3 QL glimepiride tab 1 QL QL (240 tabs / 30 glimepiride tab 2 QL QL (120 tabs / 30 glimepiride tab 4 QL glipizide tab 5 QL QL (240 tabs / 30 glipizide tab 10 QL QL (120 tabs / 30 glipizide tab er 24hr 2.5 QL QL (240 tabs / 30 glipizide tab er 24hr 5 QL QL (120 tabs / 30 glipizide tab er 24hr 10 QL glipizide xl tab 2.5 QL QL (240 tabs / 30 glipizide xl tab 5 QL QL (120 tabs / 30 glipizide-metformin hcl tab QL QL (240 tabs / 30 glipizide-metformin hcl tab QL (120 tabs / 30 QL 43

49 glipizide-metformin hcl tab 5- QL 500 QL (120 tabs / 30 glyburide micronized tab GC QL QL (240 tabs / 30 glyburide micronized tab 3 2 GC QL QL (120 tabs / 30 glyburide micronized tab 6 2 GC QL glyburide tab GC QL QL (480 tabs / 30 glyburide tab GC QL QL (240 tabs / 30 glyburide tab 5 2 GC QL QL (120 tabs / 30 glyburide-metformin tab GC QL 250 QL (240 tabs / 30 glyburide-metformin tab GC QL 500 QL (120 tabs / 30 glyburide-metformin tab GC QL QL (120 tabs / 30 INVOKAMET TAB MG 3 QL QL (120 tabs / 30 INVOKAMET TAB QL INVOKAMET TAB QL INVOKAMET TAB QL INVOKAMET XR TAB 50-3 QL 500MG QL (120 tabs / 30 INVOKAMET XR TAB 50-3 QL 1000 INVOKAMET XR TAB QL 500 INVOKAMET XR TAB QL INVOKANA TAB 100MG 3 QL QL (90 tabs / 30 INVOKANA TAB 300MG 3 QL JANUMET TAB MG 3 QL JANUMET TAB QL JANUMET XR TAB 50-3 QL 500MG JANUMET XR TAB QL JANUMET XR TAB QL JANUVIA TAB 25MG 3 QL JANUVIA TAB 50MG 3 QL JANUVIA TAB 100MG 3 QL JENTADUETO TAB QL JENTADUETO TAB QL JENTADUETO TAB QL JENTADUETO TAB XR 3 QL JENTADUETO TAB XR 3 QL metformin hcl tab 500 QL QL (150 tabs / 30 metformin hcl tab 850 QL QL (90 tabs / 30 metformin hcl tab 1000 QL QL (75 tabs / 30 metformin hcl tab er 24hr 500 QL (120 tabs / 30 (generic of GLUCOPHAGE XR) QL 44

50 metformin hcl tab er 24hr 750 QL (generic of GLUCOPHAGE XR) nateglinide tab 60 QL QL (90 tabs / 30 nateglinide tab 120 QL QL (90 tabs / 30 pioglitazone hcl tab 15 QL (base equiv) pioglitazone hcl tab 30 QL (base equiv) pioglitazone hcl tab 45 QL (base equiv) repaglinide tab 0.5 QL QL (120 tabs / 30 repaglinide tab 1 QL QL (120 tabs / 30 repaglinide tab 2 QL QL (240 tabs / 30 TRADJENTA TAB 5MG 3 QL XIGDUO XR TAB QL XIGDUO XR TAB 5-500MG 3 QL XIGDUO XR TAB MG 3 QL XIGDUO XR TAB MG 3 QL XIGDUO XR TAB QL Bifosfonatos ACTONEL TAB 5MG 4 ACTONEL TAB 30MG 4 ACTONEL TAB 35MG 4 ACTONEL TAB 150MG 4 alendronate sodium tab 5 alendronate sodium tab 10 alendronate sodium tab 35 QL (4 tabs / 28 alendronate sodium tab 40 alendronate sodium tab 70 QL (4 tabs / 28 QL QL ibandronate sodium iv soln 3 2 GC /3ml (base equivalent) ibandronate sodium tab GC (base equivalent) pamidronate disodium for inj 3 B/D 30 pamidronate disodium for inj 3 B/D 90 pamidronate disodium iv soln 3 B/D 3 /ml pamidronate disodium iv soln 3 B/D 9 /ml PAMIDRONATE INJ 6MG/ML 3 B/D zoledronic acid inj conc for iv 4 B/D infusion 4 /5ml zoledronic acid iv soln 5 /100ml 4 B/D Agonistas de los receptores de calcio SENSIPAR TAB 30MG 5 B/D QL QL (120 tabs / 30 SENSIPAR TAB 60MG 5 B/D QL SENSIPAR TAB 90MG 5 B/D QL QL (120 tabs / 30 Agentes quelantes CHEMET CAP 100MG 4 DEPEN TITRA TAB 250MG 5 EXJADE TAB 125MG 5 LA PA EXJADE TAB 250MG 5 LA PA EXJADE TAB 500MG 5 LA PA JADENU SPRKL GRA 90MG 5 LA PA JADENU SPRKL GRA 5 LA PA 180MG JADENU SPRKL GRA 5 LA PA 360MG JADENU TAB 90MG 5 LA PA JADENU TAB 180MG 5 LA PA JADENU TAB 360MG 5 LA PA 45

51 sodium polystyrene sulfonate 3 oral susp 15 gm/60ml sodium polystyrene sulfonate 4 oral susp 15 gm/60ml sodium polystyrene sulfonate 3 powder SYPRINE CAP 250MG 5 trientine hcl cap Anticonceptivos alyacen tab 1/35 2 GC apri tab 2 GC aranelle tab 3 aubra tab GC aviane tab 2 GC balziva tab 3 bekyree tab 3 blisovi fe tab 1.5/30 2 GC blisovi fe tab 1/20 2 GC briellyn tab 3 camila tab GC cryselle-28 tab 28 tabs 2 GC cyclafem tab 1/35 2 GC cyclafem tab 7/7/7 2 GC dasetta tab 1/35 2 GC dasetta tab 7/7/7 2 GC deblitane tab GC delyla tab GC desogest-eth estrad & eth estrad tab /0.01 (21/5) desogest-ethin est tab / / desogestrel & ethinyl estradiol 2 GC tab mcg drospirenone-ethinyl estradiol 3 tab drospirenone-ethinyl estradiol 3 tab ELLA TAB 30MG 4 emoquette tab 2 GC enpresse-28 tab 2 GC enskyce tab 2 GC errin tab GC 3 3 ethynodiol diacetate & ethinyl 3 estradiol tab 1-35 mcg ethynodiol diacetate & ethinyl 3 estradiol tab 1-50 mcg falmina tab 2 GC femynor tab GC gildagia tab introvale tab 3 isibloom tab GC jolivette tab GC juleber tab 2 GC junel 1.5/30 tab 2 GC junel 1/20 tab 2 GC junel fe tab 1.5/30 2 GC junel fe tab 1/20 2 GC kariva tab 28 day 3 kelnor tab 1/35 3 kimidess tab 3 kurvelo tab 0.15/30 2 GC larin fe tab 1.5/30 2 GC larin fe tab 1/20 2 GC larin tab 1.5/30 2 GC larin tab 1/20 2 GC lessina tab 2 GC levonest tab 2 GC levonorgestrel & ethinyl 3 estradiol (91-day) tab levonorgestrel & ethinyl 2 GC estradiol tab mcg levonorgestrel & ethinyl 2 GC estradiol tab mcg levonorgestrel-eth estra tab 2 GC / / mcg levora-28 tab 0.15/30 2 GC loryna tab lutera tab 2 GC lyza tab GC marlissa tab 0.15/30 2 GC medroxyprogesterone acetate 2 GC im susp 150 /ml medroxyprogesterone acetate im susp prefilled syr 150 /ml 2 GC 46

52 mononessa tab 2 GC myzilra tab 2 GC necon tab 0.5/35 3 necon tab 7/7/7 2 GC nikki tab norelgestromin-ethinyl 4 estradiol td ptwk mcg/24hr norethindrone & mestranol tab mcg norethindrone ac-ethinyl 3 estrad-fe tab 1-20/1-30/1-35 -mcg norethindrone ace & ethinyl 2 GC estradiol tab 1-20 mcg norethindrone ace & ethinyl 2 GC estradiol tab mcg norethindrone ace & ethinyl 2 GC estradiol-fe tab 1-20 mcg norethindrone ace & ethinyl 2 GC estradiol-fe tab mcg norethindrone tab GC norethindrone-eth estradiol 3 tab /1-35/ mcg norgestimate & ethinyl 2 GC estradiol tab mcg norgestimate-eth estrad tab / / mcg norgestimate-eth estrad tab 2 GC / / mcg norgestrel & ethinyl estradiol 2 GC tab mcg norlyroc tab GC nortrel tab 0.5/35 3 nortrel tab 1/35 2 GC nortrel tab 7/7/7 2 GC NUVARING MIS 4 orsythia tab 2 GC philith tab pimtrea tab 3 pirmella tab 1/35 2 GC portia-28 tab 2 GC previfem tab 2 GC quasense tab 3 reclipsen tab 2 GC sharobel tab GC sprintec 28 tab 28 day 2 GC tarina fe tab 1/20 2 GC tri-legest tab fe 3 tri-lo- tab sprintec 3 tri-previfem tab 2 GC tri-sprintec tab 2 GC trinessa lo tab 3 trinessa tab 2 GC trivora-28 tab 2 GC velivet pak 3 vienva tab GC viorele tab 3 vyfemla tab zenchent tab 3 zovia 1/35e tab 3 zovia 1/50e tab 3 Endometriosis danazol cap 50 4 danazol cap danazol cap SYNAREL SOL 2MG/ML 5 Reemplazo enzimático ADAGEN INJ 250/ML 5 LA PA ALDURAZYME INJ 5 LA PA 2.9MG/5M BUPHENYL TAB 500MG 5 LA PA CARBAGLU TAB 200MG 5 LA PA CERDELGA CAP 84MG 5 PA CEREZYME INJ 400UNIT 5 LA PA CYSTADANE POW 5 LA CYSTAGON CAP 50MG 4 LA PA CYSTAGON CAP 150MG 4 LA PA FABRAZYME INJ 5MG 5 LA PA FABRAZYME INJ 35MG 5 LA PA KUVAN POW 100MG 5 LA PA KUVAN POW 500MG 5 LA PA KUVAN TAB 100MG 5 LA PA levocarnitine inj 200 /ml 4 B/D 47

53 levocarnitine oral soln 1 4 B/D gm/10ml (10%) levocarnitine tab B/D LUMIZYME INJ 50MG 5 LA PA NAGLAZYME INJ 1MG/ML 5 LA PA ORFADIN CAP 2MG 5 LA PA ORFADIN CAP 5MG 5 LA PA ORFADIN CAP 10MG 5 LA PA ORFADIN CAP 20MG 5 LA PA ORFADIN SUS 4MG/ML 5 LA PA sodium phenylbutyrate oral 5 PA powder 3 gm/teaspoonful sodium phenylbutyrate tab 5 PA 500 ZAVESCA CAP 100MG 5 LA PA Estrógenos DELESTROGEN INJ 4 10MG/ML ESTRACE VAG CRE 0.01% 4 estradiol tab GC estradiol tab 1 2 GC estradiol tab 2 2 GC estradiol td patch weekly GC /24hr estradiol td patch weekly GC /24hr estradiol td patch weekly GC /24hr estradiol td patch weekly 2 GC /24hr estradiol td patch weekly 2 GC /24hr estradiol td patch weekly 2 GC /24hr (37.5 mcg/24hr) estradiol vaginal cream /gm estradiol vaginal tab 10 mcg 3 estradiol valerate im in oil 20 3 /ml estradiol valerate im in oil 40 3 /ml jinteli tab 1-5mcg 2 GC norethindrone acetate-ethinyl estradiol tab 1-5 mcg 2 GC PREMARIN TAB 0.3MG 3 PREMARIN TAB 0.9MG 3 PREMARIN TAB 0.45MG 3 PREMARIN TAB 0.625MG 3 PREMARIN TAB 1.25MG 3 PREMPHASE TAB 3 PREMPRO TAB PREMPRO TAB PREMPRO TAB PREMPRO TAB Glucocorticoides cortisone acetate tab 25 4 DEXAMETHASON CON 4 1MG/ML dexamethasone elixir /5ml dexamethasone sod 2 GC phosphate preservative free inj 10 /ml dexamethasone sodium 2 GC phosphate inj 4 /ml dexamethasone sodium 2 GC phosphate inj 10 /ml dexamethasone sodium 2 GC phosphate inj 20 /5ml dexamethasone sodium 2 GC phosphate inj 100 /10ml dexamethasone sodium 2 GC phosphate inj 120 /30ml dexamethasone soln /5ml dexamethasone tab GC dexamethasone tab GC dexamethasone tab 1 2 GC dexamethasone tab GC dexamethasone tab 2 2 GC dexamethasone tab 4 2 GC dexamethasone tab 6 2 GC fludrocortisone acetate tab GC hydrocortisone tab 5 3 hydrocortisone tab 10 3 hydrocortisone tab

54 methylprednisolone acetate 2 GC B/D inj susp 40 /ml methylprednisolone acetate 2 GC B/D inj susp 80 /ml methylprednisolone sod succ 3 B/D for inj 40 (base equiv) methylprednisolone sod succ 3 B/D for inj 125 (base equiv) methylprednisolone sod succ 3 B/D for inj 1000 (base equiv) methylprednisolone tab 4 3 B/D methylprednisolone tab 8 3 B/D methylprednisolone tab 16 3 B/D methylprednisolone tab 32 3 B/D methylprednisolone tab 2 GC therapy pack 4 (21) prednisolone sod phosph oral 3 B/D soln 6.7 /5ml (5 /5ml base) prednisolone sod phosphate 2 GC B/D oral soln 15 /5ml (base equiv) prednisolone sodium 3 B/D phosphate oral soln 25 /5ml (base eq) prednisolone syrup 15 /5ml 2 GC B/D (usp solution equivalent) PREDNISONE CON 5MG/ML 4 B/D prednisone oral soln 5 /5ml 3 B/D prednisone tab 1 B/D prednisone tab 2.5 B/D prednisone tab 5 B/D prednisone tab 10 B/D prednisone tab 20 B/D prednisone tab 50 B/D prednisone tab therapy pack 5 2 GC (21) prednisone tab therapy pack 5 2 GC (48) prednisone tab therapy pack 2 GC 10 (21) prednisone tab therapy pack 10 (48) 2 GC SOLU-CORTEF INJ 250MG 4 Agentes para elevar los niveles de glucosa GLUCAGEN INJ HYPOKIT 3 GLUCAGON KIT 1MG 3 PROGLYCEM SUS 50MG/ML 4 Hormonas de crecimiento humano NORDITROPIN INJ 5/1.5ML 5 PA NORDITROPIN INJ 10/1.5ML 5 PA NORDITROPIN INJ 15/1.5ML 5 PA NORDITROPIN INJ 30/3ML 5 PA Misceláneos cabergoline tab calcitonin (salmon) nasal soln 3 B/D 200 unit/act FORTEO SOL 600/2.4 5 PA INCRELEX INJ 40MG/4ML 5 LA PA KORLYM TAB 300MG 5 LA PA LUPR DEP-PED INJ 3M 5 PA 30MG LUPR DEP-PED INJ 7.5MG 5 PA LUPR DEP-PED INJ 5 PA 11.25MG LUPR DEP-PED INJ 15MG 5 PA MIACALCIN INJ 200/ML 5 B/D NATPARA INJ 25MCG 5 PA NATPARA INJ 50MCG 5 PA NATPARA INJ 75MCG 5 PA NATPARA INJ 100MCG 5 PA octreotide acetate inj 50 4 PA mcg/ml (0.05 /ml) octreotide acetate inj PA mcg/ml (0.1 /ml) octreotide acetate inj PA mcg/ml (0.2 /ml) octreotide acetate inj PA mcg/ml (0.5 /ml) octreotide acetate inj PA mcg/ml (1 /ml) PROLIA SOL 60MG/ML QL (1 injection / 180 raloxifene hcl tab 60 3 SANDOSTATIN KIT LAR 5 PA 10MG SANDOSTATIN KIT LAR 20MG 5 PA 49

55 SANDOSTATIN KIT LAR 5 PA 30MG SIGNIFOR INJ 0.3MG/ML 5 LA PA SIGNIFOR INJ 0.6MG/ML 5 LA PA SIGNIFOR INJ 0.9MG/ML 5 LA PA SOMATULINE INJ 60/0.2ML 5 PA SOMATULINE INJ 90/0.3ML 5 PA SOMATULINE INJ 120/.5ML 5 PA SOMAVERT INJ 10MG 5 LA PA SOMAVERT INJ 15MG 5 LA PA SOMAVERT INJ 20MG 5 LA PA SOMAVERT INJ 25MG 5 LA PA SOMAVERT INJ 30MG 5 LA PA XGEVA INJ 5 PA Agentes aglutinantes de fosfato AURYXIA TAB 210MG 5 QL QL (360 tabs / 30 calcium acetate (phosphate 3 QL binder) cap 667 (169 ca) QL (360 caps / 30 calcium acetate (phosphate 3 QL binder) tab 667 QL (360 tabs / 30 RENVELA PAK 0.8GM 3 QL QL (540 paks / 30 RENVELA PAK 2.4GM 3 QL QL (180 paks / 30 RENVELA TAB 800MG 3 QL QL (540 tabs / 30 sevelamer carbonate packet 3 QL 0.8 gm QL (540 packs / 30 sevelamer carbonate packet 3 QL 2.4 gm QL (180 packs / 30 sevelamer carbonate tab QL QL (540 tabs / 30 Progestinas medroxyprogesterone acetate tab 2.5 medroxyprogesterone acetate tab 5 medroxyprogesterone acetate tab 10 norethindrone acetate tab 5 3 Agentes tiroideos levo-t tab 25mcg 2 GC levo-t tab 50mcg 2 GC levo-t tab 75mcg 2 GC levo-t tab 88mcg 2 GC levo-t tab 100mcg 2 GC levo-t tab 112mcg 2 GC levo-t tab 125mcg 2 GC levo-t tab 137mcg 2 GC levo-t tab 150mcg 2 GC levo-t tab 175mcg 2 GC levo-t tab 200 mcg 2 GC levo-t tab 300 mcg 2 GC levothyroxine sodium tab 25 2 GC mcg levothyroxine sodium tab 50 2 GC mcg levothyroxine sodium tab 75 2 GC mcg levothyroxine sodium tab 88 2 GC mcg levothyroxine sodium tab GC mcg levothyroxine sodium tab GC mcg levothyroxine sodium tab GC mcg levothyroxine sodium tab GC mcg levothyroxine sodium tab GC mcg levothyroxine sodium tab GC mcg levothyroxine sodium tab GC mcg levothyroxine sodium tab GC mcg levoxyl tab 25mcg 2 GC levoxyl tab 50mcg 2 GC levoxyl tab 75mcg 2 GC levoxyl tab 88mcg 2 GC levoxyl tab 100mcg 2 GC 50

56 levoxyl tab 112mcg 2 GC levoxyl tab 125mcg 2 GC levoxyl tab 137mcg 2 GC levoxyl tab 150mcg 2 GC levoxyl tab 175mcg 2 GC levoxyl tab 200mcg 2 GC liothyronine sodium tab 5 mcg 3 liothyronine sodium tab 25 3 mcg liothyronine sodium tab 50 3 mcg methimazole tab 5 2 GC methimazole tab 10 2 GC propylthiouracil tab 50 3 SYNTHROID TAB 25MCG 4 SYNTHROID TAB 50MCG 4 SYNTHROID TAB 75MCG 4 SYNTHROID TAB 88MCG 4 SYNTHROID TAB 100MCG 4 SYNTHROID TAB 112MCG 4 SYNTHROID TAB 125MCG 4 SYNTHROID TAB 137MCG 4 SYNTHROID TAB 150MCG 4 SYNTHROID TAB 175MCG 4 SYNTHROID TAB 200MCG 4 SYNTHROID TAB 300MCG 4 unithroid tab 25mcg 2 GC unithroid tab 50mcg 2 GC unithroid tab 75mcg 2 GC unithroid tab 88mcg 2 GC unithroid tab 100mcg 2 GC unithroid tab 112mcg 2 GC unithroid tab 125mcg 2 GC unithroid tab 150mcg 2 GC unithroid tab 175mcg 2 GC unithroid tab 200mcg 2 GC unithroid tab 300mcg 2 GC Vasopresinas desmopressin acetate inj 4 mcg/ml desmopressin acetate nasal soln 0.01% (refrigerated) desmopressin acetate nasal spray soln 0.01% desmopressin acetate nasal spray soln 0.01% (refrigerated) 4 desmopressin acetate tab desmopressin acetate tab STIMATE SOL 1.5MG/ML 5 Gastrointestinal Antieméticos aprepitant capsule 40 4 B/D aprepitant capsule 80 4 B/D aprepitant capsule B/D aprepitant capsule therapy 4 B/D pack 80 & 125 dronabinol cap B/D QL QL (60 caps / 30 dronabinol cap 5 4 B/D QL QL (60 caps / 30 dronabinol cap 10 4 B/D QL QL (60 caps / 30 EMEND SUS 125MG 4 B/D granisetron hcl inj 0.1 /ml 3 granisetron hcl inj 1 /ml 3 granisetron hcl inj 4 /4ml (1 3 /ml) granisetron hcl tab 1 4 B/D meclizine hcl tab GC meclizine hcl tab 25 2 GC metoclopramide hcl inj 5 2 GC /ml (base equivalent) metoclopramide hcl soln 5 2 GC /5ml (10 /10ml) (base equiv) metoclopramide hcl tab 5 (base equivalent) metoclopramide hcl tab 10 (base equivalent) ondansetron hcl inj 4 /2ml 2 GC (2 /ml) ondansetron hcl inj 40 2 GC /20ml (2 /ml) ondansetron hcl oral soln 4 4 B/D /5ml ondansetron hcl tab 4 3 B/D 51

57 ondansetron hcl tab 8 3 B/D ondansetron hcl tab 24 3 B/D ondansetron orally 2 GC B/D disintegrating tab 4 ondansetron orally 2 GC B/D disintegrating tab 8 prochlorperazine edisylate inj 4 5 /ml prochlorperazine maleate tab 2 GC 5 (base equivalent) prochlorperazine maleate tab 2 GC 10 (base equivalent) prochlorperazine suppos 25 4 promethazine hcl inj 25 /ml 2 GC promethazine hcl inj 50 /ml 2 GC promethazine hcl syrup GC /5ml promethazine hcl tab GC promethazine hcl tab 25 2 GC promethazine hcl tab 50 2 GC scopolamine td patch 72hr 1 /3days QL (10 patches / 30 TRANSDERM-SC DIS 1.5MG QL (10 patches / 30 Antiespasmódicos dicyclomine hcl cap 10 dicyclomine hcl oral soln 10 4 /5ml dicyclomine hcl tab 20 glycopyrrolate inj 4 /20ml 4 (0.2 /ml) glycopyrrolate tab 1 3 glycopyrrolate tab 2 3 Antagonista de los receptores de la H2 famotidine for susp 40 /5ml 4 famotidine in nacl 0.9% iv soln 2 GC 20 /50ml famotidine inj 20 /2ml 2 GC famotidine inj 40 /4ml 2 GC famotidine inj 200 /20ml 2 GC famotidine tab 20 famotidine tab 40 ranitidine hcl inj 50 /2ml 3 (25 /ml) ranitidine hcl inj 150 /6ml 3 (25 /ml) ranitidine hcl syrup 15 /ml 3 (75 /5ml) ranitidine hcl tab 150 ranitidine hcl tab 300 Enfermedad inflamatoria intestinal APRISO CAP 0.375GM 3 ASACOL HD TAB 800MG 4 balsalazide disodium cap budesonide delayed release 5 particles cap 3 CANASA SUP 1000MG 4 DELZICOL CAP 400MG 4 hydrocortisone enema /60ml mesalamine enema 4 gm 4 mesalamine rectal enema 4 4 gm & cleanser wipe kit mesalamine tab delayed 4 release 800 sulfasalazine tab sulfasalazine tab delayed 3 release 500 Lasantes constulose sol 10gm/15 2 GC enulose sol 10gm/15 2 GC gavilyte-c sol 2 GC gavilyte-g sol 2 GC gavilyte-n sol flav pk 2 GC generlac sol 10gm/15 2 GC GOLYTELY SOL 3 lactulose (encephalopathy) 2 GC solution 10 gm/15ml lactulose solution 10 gm/15ml 2 GC MOVIPREP SOL 4 NULYTELY SOL FLAV PKS 3 peg 3350-kcl-na bicarb-naclna 2 GC sulfate for soln 236 gm peg 3350-kcl-na bicarb-naclna 2 GC sulfate for soln 240 gm 52

58 peg 3350-kcl-sod bicarb-nacl 2 GC for soln 420 gm polyethylene glycol 3350 oral 3 packet polyethylene glycol 3350 oral 2 GC powder SUPREP BOWEL SOL PREP 4 KIT trilyte sol 2 GC Misceláneos alosetron hcl tab 0.5 (base 5 PA equiv) alosetron hcl tab 1 (base 5 PA equiv) AMITIZA CAP 8MCG 3 QL QL (120 caps / 30 AMITIZA CAP 24MCG 3 QL QL (60 caps / 30 cromolyn sodium oral conc /5ml diphenoxylate w/ atropine liq /5ml diphenoxylate w/ atropine tab GATTEX KIT 5MG 5 LA PA LINZESS CAP 72MCG 3 QL QL (30 caps / 30 LINZESS CAP 145MCG 3 QL QL (60 caps / 30 LINZESS CAP 290MCG 3 QL QL (30 caps / 30 loperamide hcl cap 2 2 GC misoprostol tab 100 mcg 3 misoprostol tab 200 mcg 3 MOVANTIK TAB 12.5MG 3 QL MOVANTIK TAB 25MG 3 QL RELISTOR INJ 8/0.4ML 5 PA RELISTOR INJ 12/0.6ML 5 PA sucralfate tab 1 gm 3 ursodiol cap ursodiol tab ursodiol tab XIFAXAN TAB 550MG 5 PA Enzimas pancreáticas CREON CAP 3000UNIT 3 CREON CAP 6000UNIT 3 CREON CAP 12000UNT 3 CREON CAP 24000UNT 3 CREON CAP 36000UNT 3 ZENPEP CAP 4 ZENPEP CAP 3000UNIT 4 ZENPEP CAP 5000UNIT 4 ZENPEP CAP 10000UNT 4 ZENPEP CAP 15000UNT 4 ZENPEP CAP 20000UNT 4 ZENPEP CAP 25000UNT 4 ZENPEP CAP 40000UNT 4 Inhipidores de la Bomba de Protones DEXILANT CAP 30MG DR QL (30 caps / 30 DEXILANT CAP 60MG DR QL (30 caps / 30 esomeprazole magnesium cap delayed release 20 (base eq) QL (30 caps / 30 esomeprazole magnesium cap delayed release 40 (base eq) QL (30 caps / 30 esomeprazole sodium for 4 intravenous soln 20 (base equiv) esomeprazole sodium for 4 intravenous soln 40 (base equiv) lansoprazole cap delayed 2 GC release 15 lansoprazole cap delayed 2 GC release 30 omeprazole cap delayed QL release 10 QL (30 caps / 30 omeprazole cap delayed release 20 QL (60 caps / 30 QL 53

59 omeprazole cap delayed release 40 QL (30 caps / 30 pantoprazole sodium ec tab 20 (base equiv) pantoprazole sodium ec tab 40 (base equiv) QL 2 GC QL 2 GC QL oxybutynin chloride tab er 24hr 10 oxybutynin chloride tab er 24hr 15 tolterodine tartrate cap er 24hr 2 QL (30 caps / 30 3 QL 3 QL Genitourinarias tolterodine tartrate cap er 24hr Hiperplasia Prostática Benigna 4 alfuzosin hcl tab er 24hr 10 2 GC QL QL (30 caps / 30 tolterodine tartrate tab 1 4 tolterodine tartrate tab 2 4 dutasteride cap QL TOVIAZ TAB 4MG 3 QL QL (30 caps / 30 dutasteride-tamsulosin hcl TOVIAZ TAB 8MG 3 QL cap QL (30 caps / 30 trospium chloride tab 20 finasteride tab 5 2 GC tamsulosin hcl cap VESICARE TAB 5MG Misceláneos bethanechol chloride tab 5 3 VESICARE TAB 10MG bethanechol chloride tab 10 3 Antiinfecciosos vaginales bethanechol chloride tab 25 3 clindamycin phosphate 3 vaginal cream 2% bethanechol chloride tab 50 3 metronidazole vaginal gel % potassium citrate tab er 5 meq 4 terconazole vaginal cream 3 (540 ) 0.4% potassium citrate tab er 10 4 terconazole vaginal cream 3 meq (1080 ) 0.8% potassium citrate tab er 15 4 terconazole vaginal suppos 3 meq (1620 ) 80 Antiespansmódicos Urinario vandazole gel 0.75% 4 MYRBETRIQ TAB 25MG Hematológicos Anticoagulantes MYRBETRIQ TAB 50MG COUMADIN TAB 1MG 4 COUMADIN TAB 2.5MG 4 oxybutynin chloride syrup 5 COUMADIN TAB 2MG 4 /5ml COUMADIN TAB 3MG 4 oxybutynin chloride tab 5 3 COUMADIN TAB 4MG 4 oxybutynin chloride tab er 3 QL COUMADIN TAB 5MG 4 24hr 5 COUMADIN TAB 6MG 4 54

60 COUMADIN TAB 7.5MG 4 COUMADIN TAB 10MG 4 ELIQUIS ST P TAB 5MG 3 ELIQUIS TAB 2.5MG 3 ELIQUIS TAB 5MG 3 enoxaparin sodium inj 30 4 /0.3ml enoxaparin sodium inj 40 4 /0.4ml enoxaparin sodium inj 60 4 /0.6ml enoxaparin sodium inj 80 4 /0.8ml enoxaparin sodium inj /ml enoxaparin sodium inj /0.8ml enoxaparin sodium inj /ml enoxaparin sodium inj /3ml fondaparinux sodium 4 subcutaneous inj 2.5 /0.5ml fondaparinux sodium 5 subcutaneous inj 5 /0.4ml fondaparinux sodium 5 subcutaneous inj 7.5 /0.6ml fondaparinux sodium 5 subcutaneous inj 10 /0.8ml HEP SOD/NACL INJ UNT heparin sodium (porcine) 40 3 unit/ml in d5w heparin sodium (porcine) 50 3 unit/ml in d5w heparin sodium (porcine) unit/ml in d5w heparin sodium (porcine) inj 3 B/D 1000 unit/ml heparin sodium (porcine) inj 3 B/D 5000 unit/ml heparin sodium (porcine) inj unit/ml 3 B/D heparin sodium (porcine) inj 3 B/D unit/ml jantoven tab 1 jantoven tab 2.5 jantoven tab 2 jantoven tab 3 jantoven tab 4 jantoven tab 5 jantoven tab 6 jantoven tab 7.5 jantoven tab 10 PRADAXA CAP 75MG 4 PRADAXA CAP 110MG 4 PRADAXA CAP 150MG 4 warfarin sodium tab 1 warfarin sodium tab 2 warfarin sodium tab 2.5 warfarin sodium tab 3 warfarin sodium tab 4 warfarin sodium tab 5 warfarin sodium tab 6 warfarin sodium tab 7.5 warfarin sodium tab 10 XARELTO STAR TAB 15/20MG 3 XARELTO TAB 10MG 3 XARELTO TAB 15MG 3 XARELTO TAB 20MG 3 Factores de crecimiento hematopoyéticos GRANIX INJ 300/0.5 5 PA GRANIX INJ 480/0.8 5 PA MOZOBIL INJ 5 PA NEUPOGEN INJ 300/0.5 5 PA NEUPOGEN INJ 300MCG 5 PA NEUPOGEN INJ 480/0.8 5 PA NEUPOGEN INJ 480MCG 5 PA PROCRIT INJ 2000/ML 3 PA PROCRIT INJ 3000/ML 3 PA PROCRIT INJ 4000/ML 3 PA PROCRIT INJ 10000/ML 3 PA PROCRIT INJ 20000/ML 5 PA PROCRIT INJ 40000/ML 5 PA Misceláneos 55

61 anagrelide hcl cap HUMIRA INJ 10MG/0.2 5 QL PA anagrelide hcl cap 1 4 QL (2 syringes / 28 cilostazol tab 50 2 GC cilostazol tab GC HUMIRA KIT 20MG/0.4 5 QL PA CINRYZE SOL 500 UNIT 5 QL LA PA QL (2 syringes / 28 QL (20 vials / 30 ENDARI POW 5GM 5 LA PA HUMIRA KIT 40MG/0.8 5 QL PA FIRAZYR INJ 30MG/3ML 5 QL PA QL (6 syringes / 28 QL (9 syringes / 30 HUMIRA PEDIA INJ 5 PA HAEGARDA INJ 2000UNIT 5 QL LA PA CROHNS QL (30 vials / 30 HUMIRA PEN INJ 40MG/0.8 5 QL PA HAEGARDA INJ 3000UNIT 5 QL LA PA QL (6 pens / 28 QL (20 vials / 30 HUMIRA PEN INJ CROHNS 5 PA pentoxifylline tab er GC HUMIRA PEN INJ PSORIASI 5 PA PROMACTA TAB 12.5MG 5 QL LA PA hydroxychloroquine sulfate 3 QL (360 tabs / 30 tab 200 PROMACTA TAB 25MG 5 QL LA PA leflunomide tab 10 3 QL (180 tabs / 30 leflunomide tab 20 3 PROMACTA TAB 50MG 5 QL LA PA methotrexate sodium tab QL (90 tabs / 30 (base equiv) PROMACTA TAB 75MG 5 QL LA PA REMICADE INJ 100MG 5 PA XATMEP SOL 2.5MG/ML 4 B/D tranexamic acid iv soln XELJANZ TAB 5MG 5 QL PA /10ml (100 /ml) tranexamic acid tab XELJANZ XR TAB 11MG 5 QL PA Inhibidores de la agregación plaquetaria aspirin-dipyridamole cap er 4 Inmunoglobulinas 12hr BIVIGAM INJ 10% 5 PA BRILINTA TAB 60MG 3 CARIMUNE NF INJ 6GM 5 PA BRILINTA TAB 90MG 3 CARIMUNE NF INJ 12GM 5 PA clopidogrel bisulfate tab 75 FLEBOGAMMA INJ 5 PA (base equiv) 5GM/50ML EFFIENT TAB 5MG 4 FLEBOGAMMA INJ 5 PA 10/100ML EFFIENT TAB 10MG 4 FLEBOGAMMA INJ 5 PA prasugrel hcl tab 5 (base 4 10/200ML equiv) FLEBOGAMMA INJ 5 PA prasugrel hcl tab 10 (base 4 20/200ML equiv) FLEBOGAMMA INJ 5 PA ZONTIVITY TAB 2.08MG 4 20/400ML Agentes inmunológicos FLEBOGAMMA INJ DIF 5% 5 PA Fármacos antirreumáticos modificadores GAMASTAN S/D INJ 3 B/D de la enfermedad (DMARD) GAMMAGARD INJ 5 PA 1GM/10ML GAMMAGARD INJ 2.5GM/25 5 PA 56

62 GAMMAGARD INJ 5GM/50ML 5 PA GAMMAGARD INJ 10GM/100 5 PA GAMMAGARD INJ 20GM/200 5 PA GAMMAGARD INJ 30GM/300 5 PA GAMMAGARD SD INJ 5GM 5 PA HU GAMMAGARD SD INJ 10GM 5 PA HU GAMMAKED INJ 1GM/10ML 5 PA GAMMAKED INJ 2.5GM/25 5 PA GAMMAKED INJ 5GM/50ML 5 PA GAMMAKED INJ 10GM/100 5 PA GAMMAKED INJ 20GM/200 5 PA GAMMAPLEX INJ 5% 5 PA GAMMAPLEX INJ 10% 5 PA GAMUNEX-C INJ 1GM/10ML 5 PA GAMUNEX-C INJ 2.5GM/25 5 PA GAMUNEX-C INJ 5GM/50ML 5 PA GAMUNEX-C INJ 10GM/100 5 PA GAMUNEX-C INJ 20GM/200 5 PA GAMUNEX-C INJ 40/400ML 5 PA OCTAGAM INJ 1GM 5 PA OCTAGAM INJ 2.5GM 5 PA OCTAGAM INJ 2GM/20ML 5 PA OCTAGAM INJ 5GM 5 PA OCTAGAM INJ 5GM/50ML 5 PA OCTAGAM INJ 10/100ML 5 PA OCTAGAM INJ 10GM 5 PA OCTAGAM INJ 20/200ML 5 PA OCTAGAM INJ 25GM 5 PA PRIVIGEN INJ 5 GRAMS 5 PA PRIVIGEN INJ 10GRAMS 5 PA PRIVIGEN INJ 20GRAMS 5 PA PRIVIGEN INJ 40GRAMS 5 PA Inmunomoduladores ACTIMMUNE INJ 2MU/0.5 5 LA PA ARCALYST INJ 220MG 5 PA INTRON A INJ 10MU 5 B/D INTRON A INJ 18MU 5 B/D INTRON A INJ 25MU 5 B/D INTRON A INJ 50MU 5 B/D Inmunosupresores AZATHIOPRINE INJ 100MG 4 B/D azathioprine tab 50 3 B/D BENLYSTA INJ 120MG 5 PA BENLYSTA INJ 200MG/ML 5 PA BENLYSTA INJ 400MG 5 PA cyclosporine cap 25 4 B/D cyclosporine cap B/D cyclosporine iv soln 50 /ml 4 B/D cyclosporine modified cap 25 4 B/D cyclosporine modified cap 50 4 B/D cyclosporine modified cap B/D cyclosporine modified oral 4 B/D soln 100 /ml gengraf cap 25 4 B/D gengraf cap 50 4 B/D gengraf cap B/D gengraf sol 100/ml 4 B/D mycophenolate mofetil cap 4 B/D 250 mycophenolate mofetil for oral 5 B/D susp 200 /ml mycophenolate mofetil tab 4 B/D 500 mycophenolate sodium tab dr 4 B/D 180 (mycophenolic acid equiv) mycophenolate sodium tab dr 4 B/D 360 (mycophenolic acid equiv) NULOJIX INJ 250MG 5 B/D RAPAMUNE SOL 1MG/ML 5 B/D SANDIMMUNE SOL 3 B/D 100MG/ML sirolimus tab B/D sirolimus tab 1 4 B/D sirolimus tab 2 5 B/D tacrolimus cap B/D tacrolimus cap 1 4 B/D tacrolimus cap 5 4 B/D ZORTRESS TAB 0.5MG 5 B/D ZORTRESS TAB 0.25MG 5 B/D ZORTRESS TAB 0.75MG 5 B/D Vacunas ACTHIB INJ 3 57

63 ADACEL INJ 3 BCG VACCINE INJ 3 BEXSERO INJ 3 BOOSTRIX INJ 3 DAPTACEL INJ 3 DIP/TET PED INJ 25-5LFU 3 B/D ENGERIX-B INJ 10/0.5ML 3 B/D ENGERIX-B INJ 20MCG/ML 3 B/D GARDASIL 9 INJ 3 HAVRIX INJ 720UNIT 3 HAVRIX INJ 1440UNIT 3 HIBERIX SOL 10MCG 3 IMOVAX RABIE INJ 2.5/ML 3 INFANRIX INJ 3 IPOL INJ INACTIVE 3 IXIARO INJ 3 KINRIX INJ 3 M-M-R II INJ 3 MENACTRA INJ 3 MENVEO INJ 3 PEDIARIX INJ 0.5ML 3 PEDVAX HIB INJ 3 PENTACEL INJ 3 PROQUAD INJ 3 QUADRACEL INJ 3 RABAVERT INJ 3 RECOMBIVA HB INJ 3 B/D 5MCG/0.5 RECOMBIVA HB INJ 3 B/D 10MCG/ML RECOMBIVA-HB INJ 3 B/D 40MCG/ML ROTARIX SUS 3 ROTATEQ SOL 3 SHINGRIX INJ 50MCG 3 QL VAQTA INJ 25/0.5ML 3 VAQTA INJ 50UNT/ML 3 VARIVAX INJ 3 YF-VAX INJ 3 ZOSTAVAX INJ 3 QL QL (1 vial per lifetime) Suplementos alimenticios Electrolitos klor-con 8 tab 8meq er 2 GC klor-con 10 tab 10meq er 2 GC KLOR-CON M15 TAB 15MEQ 3 ER MAGNESIUM SU INJ 3 2GM/50ML MAGNESIUM SU INJ 3 4G/100ML MAGNESIUM SU INJ 3 20/500ML MAGNESIUM SU INJ 3 40G/1000 MAGNESIUM SU INJ 3 80MG/ML magnesium sulfate in 3 dextrose 5% iv soln 1 gm/100ml magnesium sulfate inj 50% 3 magnesium sulfate iv soln 2 3 gm/50ml (40 /ml) magnesium sulfate iv soln 4 3 gm/50ml (80 /ml) magnesium sulfate iv soln 4 3 gm/100ml (40 /ml) magnesium sulfate iv soln 20 3 gm/500ml (40 /ml) magnesium sulfate iv soln 40 3 gm/1000ml (40 /ml) MG SO4/D5W INJ 10MG/ML 3 QL (2 vials per lifetime) MG SO4/D5W INJ 20MG/ML 3 SYNAGIS INJ 50MG 5 potassium chloride cap er 8 3 SYNAGIS INJ 100MG/ML 5 meq TENIVAC INJ 5-2LF 3 B/D potassium chloride cap er 10 3 TET/DIP TOX INJ 2-2 LF 3 B/D meq TRUMENBA INJ 3 potassium chloride 2 microencapsulated crys er tab TWINRIX INJ 3 10 meq TYPHIM VI INJ 3 GC 58

64 potassium chloride 2 GC microencapsulated crys er tab 20 meq potassium chloride oral soln 4 10% (20 meq/15ml) potassium chloride oral soln 4 20% (40 meq/15ml) potassium chloride powder 4 packet 20 meq potassium chloride tab er 8 2 GC meq (600 ) potassium chloride tab er 10 2 GC meq potassium chloride tab er 20 2 GC meq (1500 ) sodium chloride inj GC meq/ml (14.6%) sodium fluoride chew; tab; 1.1 (0.5 f) /ml soln 2 GC tpn electrol inj 4 B/D Nutrición IV amino acid infusion 6% 2 GC B/D AMINOSYN 7% INJ /LYTES 4 B/D AMINOSYN II INJ 8.5% 4 B/D aminosyn ii inj 8.5/lyte 4 B/D AMINOSYN II INJ 10% 4 B/D AMINOSYN INJ 8.5% 4 B/D aminosyn inj 8.5/lyte 4 B/D AMINOSYN INJ 10% 4 B/D AMINOSYN M INJ 3.5% 4 B/D AMINOSYN-HBC INJ 7% 4 B/D AMINOSYN-PF INJ 7% 4 B/D AMINOSYN-PF INJ 10% 4 B/D AMINOSYN-RF INJ 5.2% 4 B/D CLINIMIX INJ 2.75/D5W 4 B/D CLINIMIX INJ 4.25/D5W 4 B/D CLINIMIX INJ 4.25/D10 4 B/D CLINIMIX INJ 4.25/D20 4 B/D CLINIMIX INJ 4.25/D25 4 B/D CLINIMIX INJ 5%/D15W 4 B/D CLINIMIX INJ 5%/D20W 4 B/D CLINIMIX INJ 5%/D25W 4 B/D fat emulsion iv soln 20% 4 B/D FREAMINE HBC INJ 6.9% 4 B/D FREAMINE III INJ 10% 4 B/D hepatamine sol 8% 4 B/D INTRALIPID INJ 30% 4 B/D NEPHRAMINE INJ 5.4% 4 B/D PREMASOL SOL 10% 4 B/D PROCALAMINE INJ 3% 4 B/D PROSOL INJ 20% 4 B/D TRAVASOL INJ 10% 4 B/D TROPHAMINE INJ 10% 4 B/D Soluciones de reemplazo IV D5W/LYTES INJ #48 3 D5W/NACL INJ 0.3% 4 D10W/NACL INJ 0.2% 3 dextrose 2.5% w/ sodium 2 GC chloride 0.45% dextrose 5% in lactated 2 GC ringers dextrose 5% w/ sodium 2 GC chloride 0.2% dextrose 5% w/ sodium 2 GC chloride 0.9% dextrose 5% w/ sodium 2 GC chloride 0.33% dextrose 5% w/ sodium 2 GC chloride 0.45% dextrose 5% w/ sodium 2 GC chloride 0.225% dextrose 10% w/ sodium 2 GC chloride 0.45% dextrose inj 5% 2 GC dextrose inj 10% 2 GC dextrose inj 50% 2 GC dextrose inj 70% 2 GC IONOSOL-MB INJ /D5W 4 ISOLYTE-P INJ /D5W 4 ISOLYTE-S INJ 4 kcl 10 meq/l (0.075%) in 2 GC dextrose 5% & nacl 0.45% inj kcl 20 meq/l (0.15%) in 2 GC dextrose 5% & nacl 0.2% inj kcl 20 meq/l (0.15%) in 2 GC dextrose 5% & nacl 0.9% inj kcl 20 meq/l (0.15%) in 2 GC dextrose 5% & nacl 0.33% inj kcl 20 meq/l (0.15%) in dextrose 5% & nacl 0.45% inj 2 GC 59

65 kcl 20 meq/l (0.15%) in nacl 2 GC 0.9% inj kcl 20 meq/l (0.15%) in nacl 2 GC 0.45% inj kcl 30 meq/l (0.224%) in 2 GC dextrose 5% & nacl 0.45% inj kcl 40 meq/l (0.3%) in 2 GC dextrose 5% & nacl 0.45% inj kcl 40 meq/l (0.3%) in nacl 0.9% inj 2 GC KCL/D5W/NACL INJ 0.3/0.9% 4 KCL/D5W/NACL INJ 0.15/0.2 3 lactated ringer's solution 2 GC NORMOSOL -M INJ /D5W 4 NORMOSOL -R INJ /D5W 4 NORMOSOL-R INJ PH PLASMA-LYTE INJ PLASMA-LYTE INJ -A 4 potassium chloride 20 meq/l 2 GC (0.15%) in dextrose 5% inj potassium chloride 40 meq/l 2 GC (0.3%) in dextrose 5% inj potassium chloride inj 2 2 GC meq/ml potassium chloride inj 10 2 GC meq/50ml potassium chloride inj 10 2 GC meq/100ml potassium chloride inj 20 2 GC meq/50ml potassium chloride inj 20 2 GC meq/100ml potassium chloride inj 40 meq/100ml 2 GC ringer's solution 2 GC sodium chloride inj 0.45% 2 GC sodium chloride inj 3% 2 GC sodium chloride inj 5% 2 GC sodium chloride iv soln 0.9% 2 GC Vitaminas calcitriol cap 0.5 mcg 3 B/D calcitriol cap 0.25 mcg 3 B/D calcitriol inj 1 mcg/ml 4 B/D calcitriol oral soln 1 mcg/ml 4 B/D paricalcitol cap 1 mcg 4 B/D paricalcitol cap 2 mcg 4 B/D paricalcitol cap 4 mcg 4 B/D prenatal vitamin/folic acid > 2 GC 0.8 (generic) RAYALDEE CAP 30MCG 5 Oftálmico Contra infecciones/ antiinflamatorios bacitracin-polymyxinneomycin-hc 3 ophth oint 1% BLEPHAMIDE OIN S.O.P. 4 neomycin-polymyxindexamethasone 2 GC ophth oint 0.1% neomycin-polymyxindexamethasone 2 GC ophth susp 0.1% neomycin-polymyxin-hc ophth 4 susp sulfacetamide sodiumprednisolone 2 GC ophth soln (0.25)% TOBRADEX OIN % 3 TOBRADEX ST SUS tobramycin-dexamethasone 4 ophth susp % ZYLET SUS % 3 Contra infecciones bacitracin ophth oint unit/gm bacitracin-polymyxin b ophth 2 GC oint BESIVANCE SUS 0.6% 3 CILOXAN OIN 0.3% OP 3 ciprofloxacin hcl ophth soln 2 GC 0.3% erythromycin ophth oint 5 2 GC /gm gatifloxacin ophth soln 0.5% 4 gentak oin 0.3% op 2 GC gentamicin sulfate ophth soln 2 GC 0.3% MOXEZA SOL 0.5% 3 moxifloxacin hcl ophth soln 0.5% (base equiv) 3 60

66 NATACYN SUS 5% OP 4 neomycin-bacitrac zn-polymyx 3 5(3.5)-400unt-10000unt op oin neomycin-polymy-gramicid op 3 sol unt/ml ofloxacin ophth soln 0.3% 2 GC polymyxin b-trimethoprim 2 GC ophth soln unit/ml- 0.1% sulfacetamide sodium ophth 3 oint 10% sulfacetamide sodium ophth 3 soln 10% tobramycin ophth soln 0.3% 2 GC trifluridine ophth soln 1% 3 VIGAMOX DRO 0.5% 3 ZIRGAN GEL 0.15% 4 Antiinflamatorios ALREX SUS 0.2% 3 bromfenac sodium ophth soln % (base equiv) (oncedaily) BROMSITE DRO 0.075% 4 dexamethasone sodium 3 phosphate ophth soln 0.1% diclofenac sodium ophth soln 2 GC 0.1% DUREZOL EMU 0.05% 3 fluorometholone ophth susp 3 0.1% flurbiprofen sodium ophth soln 2 GC 0.03% ILEVRO DRO 0.3% OP 3 ketorolac tromethamine ophth 3 soln 0.4% ketorolac tromethamine ophth 3 soln 0.5% LOTEMAX GEL 0.5% 3 LOTEMAX OIN 0.5% 3 LOTEMAX SUS 0.5% 3 PRED SOD PHO SOL 1% OP 3 prednisolone acetate ophth 3 susp 1% PROLENSA SOL 0.07% 3 Antialérgicos azelastine hcl ophth soln % BEPREVE DRO 1.5% 3 cromolyn sodium ophth soln 4% LASTACAFT SOL 0.25% 4 olopatadine hcl ophth soln 3 0.2% (base equivalent) PAZEO DRO 0.7% 3 Contra el glaucoma ALPHAGAN P SOL 0.1% 3 AZOPT SUS 1% OP 3 betaxolol hcl ophth soln 0.5% 3 BETOPTIC-S SUS 0.25% OP 3 brimonidine tartrate ophth 2 GC soln 0.2% brimonidine tartrate ophth 4 soln 0.15% carteolol hcl ophth soln 1% 2 GC COMBIGAN SOL 0.2/0.5% 3 dorzolamide hcl ophth soln 3 2% dorzolamide hcl-timolol 3 maleate ophth soln /ml ISTALOL SOL 0.5% OP 3 latanoprost ophth soln 2 GC 0.005% levobunolol hcl ophth soln 2 GC 0.5% LUMIGAN SOL 0.01% 3 metipranolol ophth soln 0.3% 3 PHOSPHOLINE SOL %OP pilocarpine hcl ophth soln 1% 3 pilocarpine hcl ophth soln 2% 3 pilocarpine hcl ophth soln 4% 3 SIMBRINZA SUS 1-0.2% 3 timolol maleate ophth gel 4 forming soln 0.5% timolol maleate ophth gel forming soln 0.25% 4 61

67 timolol maleate ophth soln 0.5% timolol maleate ophth soln 3 0.5% (once-daily) timolol maleate ophth soln 0.25% TRAVATAN Z DRO 0.004% 3 Misceláneos CYSTARAN SOL 0.44% 5 LA PA proparacaine hcl ophth soln 3 0.5% RESTASIS EMU 0.05% 3 QL QL (64 single use vials / 30 RESTASIS MUL EMU 0.05% QL (1 bottle / 30 3 QL Inhibidores de la fosfodiesterasa tipo 5 Inhibidores de la fosfodiesterasa tipo 5 CIALIS TAB 10MG 3 ED QL QL (4 tabs / 30 CIALIS TAB 20MG 3 ED QL QL (4 tabs / 30 sildenafil citrate tab 25 3 ED QL QL (4 tabs / 30 sildenafil citrate tab 50 3 ED QL QL (4 tabs / 30 sildenafil citrate tab ED QL QL (4 tabs / 30 VIAGRA TAB 25MG 4 ED QL QL (4 tabs / 30 VIAGRA TAB 50MG 4 ED QL QL (4 tabs / 30 VIAGRA TAB 100MG 4 ED QL QL (4 tabs / 30 Respiratorio Combinaciones de anticolinérgico/beta agonista ANORO ELLIPT AER QL (60 blisters / 30 3 QL TRELEGY AER ELLIPTA QL (60 blisters / 30 Anticolinérgicos ATROVENT HFA AER 17MCG QL (2 inhalers / 30 3 QL INCRUSE ELPT INH 3 QL 62.5MCG QL (30 blisters / 30 ipratropium bromide inhal soln 2 GC B/D 0.02% ipratropium bromide nasal 3 soln 0.03% (21 mcg/spray) ipratropium bromide nasal 3 soln 0.06% (42 mcg/spray) Antihistamínicos azelastine hcl nasal spray 3 0.1% (137 mcg/spray) azelastine hcl nasal spray % (205.5 mcg/spray) cetirizine hcl oral soln 1 /ml 2 GC (5 /5ml) cyproheptadine hcl syrup 2 2 GC /5ml cyproheptadine hcl tab 4 2 GC diphenhydramine hcl inj 50 2 GC /ml hydroxyzine hcl im soln 25 2 GC /ml hydroxyzine hcl im soln 50 2 GC /ml hydroxyzine hcl syrup 10 2 GC /5ml hydroxyzine hcl tab 10 2 GC hydroxyzine hcl tab 25 2 GC hydroxyzine hcl tab 50 2 GC hydroxyzine pamoate cap 25 2 GC hydroxyzine pamoate cap 50 2 GC BEVESPI AER 9-4.8MCG 3 QL QL (1 inhaler / 30 COMBIVENT AER levocetirizine dihydrochloride 4 QL (2 inhalers / 30 soln 2.5 /5ml (0.5 /ml) ipratropium-albuterol nebu 3 B/D levocetirizine dihydrochloride 2 GC soln (3) /3ml tab 5 62

68 Beta agonistas albuterol sulfate soln nebu 0.5% (5 /ml) albuterol sulfate soln nebu 0.63 /3ml (base equiv) albuterol sulfate soln nebu 0.083% (2.5 /3ml) albuterol sulfate soln nebu 1.25 /3ml (base equiv) albuterol sulfate syrup 2 /5ml 2 GC B/D 2 GC B/D 2 GC B/D 2 GC B/D albuterol sulfate tab 2 4 albuterol sulfate tab 4 4 albuterol sulfate tab er 12hr 4 4 albuterol sulfate tab er 12hr 8 4 levalbuterol hcl soln nebu 4 B/D 1.25 /3ml (base equiv) levalbuterol hcl soln nebu conc 1.25 /0.5ml (base equiv) 4 B/D levalbuterol tartrate inhal aerosol 45 mcg/act (base equiv) QL (2 inhalers / 30 3 QL PERFOROMIST NEB 20MCG 5 B/D SEREVENT DIS AER 50MCG QL (60 inhalations / 30 3 QL terbutaline sulfate tab terbutaline sulfate tab 5 4 VENTOLIN HFA AER 3 QL QL (2 inhalers / 30 XOPENEX HFA AER QL (2 inhalers / 30 Moduladores de los leucotrienos montelukast sodium chew tab 3 4 (base equiv) montelukast sodium chew tab 3 5 (base equiv) montelukast sodium oral 4 granules packet 4 (base equiv) zafirlukast tab 10 4 zafirlukast tab 20 4 Estabilizadores de los mastocitos cromolyn sodium soln nebu 3 B/D 20 /2ml Misceláneos acetylcysteine inhal soln 10% 3 B/D acetylcysteine inhal soln 20% 3 B/D ARALAST NP INJ 500MG 5 LA PA ARALAST NP INJ 1000MG 5 LA PA DALIRESP TAB 250MCG 4 DALIRESP TAB 500MCG 4 epinephrine solution autoinjector /0.3ml (1:1000) (generic of Adrenaclick) epinephrine solution autoinjector /0.15ml (1:1000) (generic of Adrenaclick) ESBRIET CAP 267MG 5 PA ESBRIET TAB 267MG 5 PA ESBRIET TAB 801MG 5 PA KALYDECO PAK 50MG 5 PA KALYDECO PAK 75MG 5 PA KALYDECO TAB 150MG 5 PA OFEV CAP 100MG 5 PA OFEV CAP 150MG 5 PA ORKAMBI TAB PA ORKAMBI TAB PA PROLASTIN-C INJ 1000MG 5 LA PA PULMOZYME SOL 1MG/ML 5 PA XOLAIR SOL 150MG 5 LA PA ZEMAIRA INJ 1000MG 5 LA PA Esteroides nasales flunisolide nasal soln 25 3 QL mcg/act (0.025%) QL (3 bottles / 30 fluticasone propionate nasal 2 GC QL susp 50 mcg/act QL (1 bottle / 30 mometasone furoate nasal susp 50 mcg/act 2 GC QL QL (2 inhalers / 30 montelukast sodium tab 10 2 GC NASONEX SPR 50MCG/AC (base equiv) QL (2 inhalers / 30 63

69 Esteroides inhalados ARNUITY ELPT INH 100MCG 3 QL QL (30 inhalations / 30 ARNUITY ELPT INH 200MCG 3 QL QL (30 inhalations / 30 budesonide inhalation susp 4 B/D 0.5 /2ml budesonide inhalation susp 4 B/D 0.25 /2ml FLOVENT DISK AER 50MCG 3 QL QL (120 inhalations / 30 FLOVENT DISK AER 3 QL 100MCG QL (120 inhalations / 30 FLOVENT DISK AER 3 QL 250MCG QL (240 inhalations / 30 FLOVENT HFA AER 44MCG 3 QL QL (2 inhalers / 30 FLOVENT HFA AER 110MCG QL (2 inhalers / 30 3 QL FLOVENT HFA AER 3 QL 220MCG QL (2 inhalers / 30 PULMICORT INH 90MCG 3 QL QL (2 inhalers / 30 PULMICORT INH 180MCG QL (2 inhalers / 30 3 QL Combinaciones de esteroides/beta agonista ADVAIR DISKU AER 100/50 3 QL QL (60 inhalations / 30 ADVAIR DISKU AER 250/50 3 QL QL (60 inhalations / 30 ADVAIR DISKU AER 500/50 QL (60 inhalations / 30 3 QL ADVAIR HFA AER 45/21 3 QL QL (1 inhaler / 30 ADVAIR HFA AER 115/21 3 QL QL (1 inhaler / 30 ADVAIR HFA AER 230/21 3 QL QL (1 inhaler / 30 BREO ELLIPTA INH QL QL (60 blisters / 30 BREO ELLIPTA INH QL QL (60 blisters / 30 SYMBICORT AER QL QL (1 inhaler / 30 SYMBICORT AER QL QL (1 inhaler / 30 Xantinas aminophylline inj 25 /ml 3 THEO-24 CAP 100MG CR 4 THEO-24 CAP 200MG CR 4 THEO-24 CAP 300MG CR 4 THEO-24 CAP 400MG ER 4 theophylline soln 80 /15ml 4 theophylline tab er 12hr theophylline tab er 12hr theophylline tab er 12hr theophylline tab er 12hr theophylline tab er 24hr theophylline tab er 24hr De uso tópico Dermatología, Acné amnesteem cap 10 4 PA amnesteem cap 20 4 PA amnesteem cap 40 4 PA avita cre 0.025% 4 PA avita gel 0.025% 4 PA benzoyl peroxideerythromycin 4 gel 5-3% claravis cap 10 4 PA 64

70 claravis cap 20 4 PA ciclopirox olamine cream 3 claravis cap 30 4 PA 0.77% (base equiv) claravis cap 40 4 PA ciclopirox olamine susp 0.77% 3 clindacin-p pad 1% 3 (base equiv) clindamycin phosphate gel 3 ciclopirox shampoo 1% 4 1% clotrimazole cream 1% 3 clindamycin phosphate lotion 4 clotrimazole soln 1% 3 1% ketoconazole cream 2% 3 clindamycin phosphate soln 3 naftifine hcl cream 2% 2 GC 1% nyamyc pow clindamycin phosphate swab 3 nystatin cream % unit/gm erythromycin gel 2% 4 nystatin oint unit/gm 3 erythromycin pads 2% 3 nystatin topical powder 3 erythromycin soln 2% unit/gm isotretinoin cap 10 4 PA nystop pow isotretinoin cap 20 4 PA Dermatología, antipsoriásicos isotretinoin cap 30 4 PA acitretin cap 10 5 PA isotretinoin cap 40 4 PA acitretin cap PA myorisan cap 10 4 PA acitretin cap 25 5 PA myorisan cap 20 4 PA calcipotriene cream 0.005% 4 myorisan cap 30 4 PA calcipotriene soln 0.005% (50 4 myorisan cap 40 4 PA mcg/ml) sulfacetamide sodium lotion 4 tazarotene cream 0.1% 4 PA 10% (acne) TAZORAC CRE 0.05% 4 PA tretinoin cream 0.1% 4 PA Dermatología, contra la seborreica tretinoin cream 0.05% 4 PA ketoconazole shampoo 2% 2 GC tretinoin cream 0.025% 4 PA selenium sulfide lotion 2.5% 2 GC tretinoin gel 0.01% 4 PA Dermatología, corticosteroides tretinoin gel 0.025% 4 PA zenatane cap 30 4 PA ala-cort cre 1% ala-cort cre 2.5% Dermatología, antibióticos alclometasone dipropionate 3 gentamicin sulfate cream 3 cream 0.05% 0.1% alclometasone dipropionate 3 gentamicin sulfate oint 0.1% 3 oint 0.05% mafenide acetate packet for 4 betamethasone dipropionate 3 topical soln 5% (50 gm) augmented cream 0.05% mupirocin oint 2% 2 GC betamethasone dipropionate 4 silver sulfadiazine cream 1% 2 GC augmented gel 0.05% ssd cre 1% 2 GC betamethasone dipropionate 4 SULFAMYLON CRE 4 augmented lotion 0.05% 85MG/GM betamethasone dipropionate 4 SULFAMYLON PAK 5% 5 augmented oint 0.05% Dermatología, fungicidas betamethasone dipropionate 3 ciclopirox gel 0.77% 4 cream 0.05% 65

71 betamethasone dipropionate 3 lotion 0.05% betamethasone dipropionate 3 oint 0.05% betamethasone valerate 3 cream 0.1% (base equivalent) betamethasone valerate lotion 3 0.1% (base equivalent) betamethasone valerate oint 3 0.1% (base equivalent) clobetasol e cre 0.05% QL (60 gm / 30 clobetasol propionate lotion 0.05% QL (60 ml / 30 desonide cream 0.05% 2 GC desoximetasone cream 0.05% 4 desoximetasone cream 0.25% 4 desoximetasone gel 0.05% 4 desoximetasone oint 0.05% 4 desoximetasone oint 0.25% 4 fluocinolone acetonide cream % fluocinolone acetonide cream % fluocinolone acetonide oil % (body oil) fluocinolone acetonide oil % (scalp oil) fluocinolone acetonide oint % fluocinolone acetonide soln % fluocinonide cream 0.05% 4 fluocinonide emulsified base 4 cream 0.05% fluocinonide gel 0.05% 4 fluocinonide soln 0.05% 3 fluticasone propionate cream % fluticasone propionate oint % halobetasol propionate cream % halobetasol propionate oint % hydrocortisone butyrate 4 cream 0.1% hydrocortisone butyrate oint 4 0.1% hydrocortisone butyrate soln 4 0.1% hydrocortisone cream 1% hydrocortisone cream 2.5% hydrocortisone lotion 2.5% 3 hydrocortisone oint 1% 2 GC hydrocortisone oint 2.5% 2 GC hydrocortisone valerate cream 4 0.2% hydrocortisone valerate oint 4 0.2% mometasone furoate cream 2 GC 0.1% mometasone furoate oint 3 0.1% mometasone furoate solution 3 0.1% (lotion) TEXACORT SOL 2.5% 4 triamcinolone acetonide 2 GC cream 0.1% triamcinolone acetonide 2 GC cream 0.5% triamcinolone acetonide 2 GC cream 0.025% triamcinolone acetonide lotion 3 0.1% triamcinolone acetonide lotion % triamcinolone acetonide oint 2 GC 0.1% triamcinolone acetonide oint 2 GC 0.5% triamcinolone acetonide oint 0.025% 2 GC Dermatología, anestésicos locales glydo gel 2% 3 QL PA QL (30 ml / 30 lidocaine hcl gel 2% QL (30 ml / 30 3 QL PA 66

72 lidocaine hcl soln 4% 2 GC QL PA QL (50 ml / 30 lidocaine oint 5% PA QL (50 gm / 30 lidocaine patch 5% PA QL (3 patches / 1 day) lidocaine-prilocaine cream % QL (30 gm / 30 PA Dermatología, misceláneos de la piel y las membranas mucosas CARAC CRE 0.5% 5 diclofenac sodium gel 1% 3 PA diclofenac sodium soln 1.5% 4 doxepin hcl cream 5% 4 fluorouracil cream 0.5% 5 fluorouracil cream 5% 4 fluorouracil soln 2% 4 fluorouracil soln 5% 4 hydrocortisone rectal cream 3 2.5% imiquimod cream 5% 4 lactic acid (ammonium 3 lactate) cream 12% lactic acid (ammonium 3 lactate) lotion 12% metronidazole cream 0.75% 4 metronidazole gel 0.75% 4 metronidazole lotion 0.75% 4 ORACEA CAP 40MG 4 PANRETIN GEL 0.1% 5 PENNSAID SOL 2% 5 PICATO GEL 0.05% 3 PICATO GEL 0.015% 3 podofilox soln 0.5% 3 procto-med cre hc 2.5% 3 procto-pak cre 1% 3 proctozone cre -hc 2.5% 3 tacrolimus oint 0.1% 4 tacrolimus oint 0.03% 4 TARGRETIN GEL 1% 5 PA VALCHLOR GEL 0.016% 5 LA PA Dermatología, Escabicidas y contra la pediculosis malathion lotion 0.5% 4 permethrin cream 5% 3 Dermatología, agentes para el cuidad de heridas acetic acid irrigation soln 0.25% 2 GC REGRANEX GEL 0.01% 5 PA SANTYL OIN 250/GM 4 sodium chloride irrigation soln 2 GC 0.9% water for irrigation, sterile irrigation soln 2 GC Agentes para la boca/garganta/dentales cevimeline hcl cap 30 4 chlorhexidine gluconate soln 0.12% clotrimazole troche 10 4 lidocaine hcl viscous soln 2% 2 GC nystatin susp unit/ml 3 periogard sol 0.12% pilocarpine hcl tab 5 4 pilocarpine hcl tab triamcinolone acetonide 3 dental paste 0.1% Ótico acetic acid 2% in aluminum 3 acetate otic soln acetic acid otic soln 2% 3 CIPRODEX SUS % 3 fluocinolone acetonide (otic) 4 oil 0.01% neomycin-polymyxin-hc otic 3 soln 1% neomycin-polymyxin-hc otic 3 susp 3.5 /ml unit/ml- 1% ofloxacin otic soln 0.3% 4 Vitaminas Complejo de vitamina B cyanocobalamin inj 1000 mcg/ml 2 ED GC 67

73 folic acid tab 1 1 ED GC QL Vitamina D ergocalciferol cap unit 2 ED GC QL QL (4 caps / 28 Actividad de la vitamina K MEPHYTON TAB 5MG 4 ED QL 68

74 Index A abacavir sulfate soln 20 /ml (base equiv)...7 abacavir sulfate tab 300 (base equiv)...7 abacavir sulfate-lamivudine tab abacavir sulfate-lamivudinezidovudine tab ABELCET INJ 5MG/ML...6 ABILIFY MAIN INJ 300MG 35 ABILIFY MAIN INJ 400MG 35 ABRAXANE INJ 100MG acamprosate calcium tab delayed release acarbose tab acarbose tab acarbose tab acebutolol hcl cap acebutolol hcl cap acetaminophen w/ codeine soln /5ml...2 acetaminophen w/ codeine tab acetaminophen w/ codeine tab acetaminophen w/ codeine tab acetazolamide cap er 12hr acetazolamide tab acetazolamide tab acetic acid 2% in aluminum acetate otic soln acetic acid irrigation soln 0.25% acetic acid otic soln 2% acetylcysteine inhal soln 10% acetylcysteine inhal soln 20% acitretin cap acitretin cap acitretin cap ACTHIB INJ ACTIMMUNE INJ 2MU/ ACTONEL TAB 150MG ACTONEL TAB 30MG ACTONEL TAB 35MG ACTONEL TAB 5MG acyclovir cap acyclovir sodium for inj acyclovir sodium iv soln 50 /ml... 9 acyclovir susp 200 /5ml.. 9 acyclovir tab acyclovir tab ADACEL INJ ADAGEN INJ 250/ML ADCIRCA TAB 20MG adefovir dipivoxil tab 10 9 ADEMPAS TAB 0.5MG ADEMPAS TAB 1.5MG ADEMPAS TAB 1MG ADEMPAS TAB 2.5MG ADEMPAS TAB 2MG adriamycin inj adrucil inj 500/10ml ADVAIR DISKU AER 100/ ADVAIR DISKU AER 250/ ADVAIR DISKU AER 500/ ADVAIR HFA AER 115/21 64 ADVAIR HFA AER 230/21 64 ADVAIR HFA AER 45/ afeditab tab 30 cr afeditab tab 60 cr AFINITOR DIS TAB 2MG. 16 AFINITOR DIS TAB 3MG. 16 AFINITOR DIS TAB 5MG. 16 AFINITOR TAB 10MG AFINITOR TAB 2.5MG AFINITOR TAB 5MG AFINITOR TAB 7.5MG ala-cort cre 1% ala-cort cre 2.5% ALBENZA TAB 200MG... 5 albuterol sulfate soln nebu 0.083% (2.5 /3ml) albuterol sulfate soln nebu 0.5% (5 /ml) albuterol sulfate soln nebu 0.63 /3ml (base equiv). 63 albuterol sulfate soln nebu 1.25 /3ml (base equiv). 63 albuterol sulfate syrup 2 /5ml albuterol sulfate tab albuterol sulfate tab albuterol sulfate tab er 12hr albuterol sulfate tab er 12hr alclometasone dipropionate cream 0.05% alclometasone dipropionate oint 0.05% ALCOHOL SWABS ALDURAZYME INJ 2.9MG/5M ALECENSA CAP 150MG. 16 alendronate sodium tab alendronate sodium tab alendronate sodium tab alendronate sodium tab alendronate sodium tab alfuzosin hcl tab er 24hr ALIMTA INJ 100MG ALIMTA INJ 500MG ALINIA SUS 100/5ML... 5 ALINIA TAB 500MG... 5 allopurinol tab allopurinol tab alosetron hcl tab 0.5 (base equiv) alosetron hcl tab 1 (base equiv) ALPHAGAN P SOL 0.1%. 61 alprazolam tab alprazolam tab alprazolam tab alprazolam tab ALREX SUS 0.2%

75 ALUNBRIG PAK ALUNBRIG TAB 180MG ALUNBRIG TAB 30MG ALUNBRIG TAB 90MG alyacen tab 1/ amantadine hcl cap amantadine hcl syrup 50 /5ml amantadine hcl tab AMBISOME INJ 50MG...7 amikacin sulfate inj 1 gm/4ml (250 /ml)...5 amikacin sulfate inj 500 /2ml (250 /ml)...5 amiloride & hydrochlorothiazide tab amiloride hcl tab amino acid infusion 6% aminophylline inj 25 /ml 64 AMINOSYN 7% INJ /LYTES AMINOSYN II INJ 10% AMINOSYN II INJ 8.5% aminosyn ii inj 8.5/lyte AMINOSYN INJ 10% AMINOSYN INJ 8.5% aminosyn inj 8.5/lyte AMINOSYN M INJ 3.5% AMINOSYN-HBC INJ 7%.. 59 AMINOSYN-PF INJ 10% AMINOSYN-PF INJ 7% AMINOSYN-RF INJ 5.2%. 59 amiodarone hcl inj 150 /3ml (50 /ml) amiodarone hcl inj 450 /9ml (50 /ml) amiodarone hcl inj 900 /18ml (50 /ml) amiodarone hcl tab amiodarone hcl tab amiodarone hcl tab AMITIZA CAP 24MCG AMITIZA CAP 8MCG amitriptyline hcl tab amitriptyline hcl tab amitriptyline hcl tab amitriptyline hcl tab amitriptyline hcl tab amitriptyline hcl tab amlodipine besylate tab 10 (base equivalent) amlodipine besylate tab 2.5 (base equivalent) amlodipine besylate tab 5 (base equivalent) amlodipine besylatebenazepril hcl cap amlodipine besylatebenazepril hcl cap amlodipine besylatebenazepril hcl cap amlodipine besylatebenazepril hcl cap amlodipine besylatebenazepril hcl cap amlodipine besylatebenazepril hcl cap amlodipine besylateolmesartan medoxomil tab amlodipine besylateolmesartan medoxomil tab amlodipine besylateolmesartan medoxomil tab amlodipine besylateolmesartan medoxomil tab amlodipine besylatevalsartan tab amlodipine besylatevalsartan tab amlodipine besylatevalsartan tab amlodipine besylatevalsartan tab amlodipine-valsartanhydrochlorothiazide tab amlodipine-valsartanhydrochlorothiazide tab amlodipine-valsartanhydrochlorothiazide tab amlodipine-valsartanhydrochlorothiazide tab amlodipine-valsartanhydrochlorothiazide tab amnesteem cap amnesteem cap amnesteem cap amoxapine tab amoxapine tab amoxapine tab amoxapine tab amoxicillin & k clavulanate chew tab amoxicillin & k clavulanate chew tab amoxicillin & k clavulanate for susp /5ml. 12 amoxicillin & k clavulanate for susp /5ml. 12 amoxicillin & k clavulanate for susp /5ml amoxicillin & k clavulanate for susp /5ml. 12 amoxicillin & k clavulanate tab amoxicillin & k clavulanate tab amoxicillin & k clavulanate tab amoxicillin & k clavulanate tab er 12hr amoxicillin (trihydrate) cap amoxicillin (trihydrate) cap amoxicillin (trihydrate) chew tab amoxicillin (trihydrate) chew 70

76 tab amoxicillin (trihydrate) for susp 125 /5ml amoxicillin (trihydrate) for susp 200 /5ml amoxicillin (trihydrate) for susp 250 /5ml amoxicillin (trihydrate) for susp 400 /5ml amoxicillin (trihydrate) tab amoxicillin (trihydrate) tab amphetaminedextroamphetamine cap er 24hr amphetaminedextroamphetamine cap er 24hr amphetaminedextroamphetamine cap er 24hr amphetaminedextroamphetamine cap er 24hr amphetaminedextroamphetamine cap er 24hr amphetaminedextroamphetamine cap er 24hr amphetaminedextroamphetamine tab amphetaminedextroamphetamine tab amphetaminedextroamphetamine tab amphetaminedextroamphetamine tab amphetaminedextroamphetamine tab amphetaminedextroamphetamine tab amphetaminedextroamphetamine tab amphotericin b for inj 50 7 ampicillin & sulbactam sodium for inj 1.5 (1-0.5) gm ampicillin & sulbactam sodium for inj 15 (10-5) gm ampicillin & sulbactam sodium for inj 3 (2-1) gm ampicillin & sulbactam sodium for iv soln 15 (10-5) gm ampicillin cap ampicillin cap ampicillin for susp 125 /5ml ampicillin for susp 250 /5ml ampicillin sodium for inj 1 gm ampicillin sodium for inj 10 gm ampicillin sodium for inj ampicillin sodium for inj 2 gm ampicillin sodium for inj ampicillin sodium for inj ampicillin sodium for iv soln 1 gm ampicillin sodium for iv soln 10 gm ampicillin sodium for iv soln 2 gm AMPYRA TAB 10MG ANADROL-50 TAB 50MG. 42 anagrelide hcl cap anagrelide hcl cap anastrozole tab ANDRODERM DIS 2MG/24HR ANDRODERM DIS 4MG/24HR ANDROGEL GEL 1.62%.. 42 ANORO ELLIPT AER APOKYN INJ 10MG/ML aprepitant capsule aprepitant capsule aprepitant capsule aprepitant capsule therapy pack 80 & apri tab APRISO CAP 0.375GM APTIOM TAB 200MG APTIOM TAB 400MG APTIOM TAB 600MG APTIOM TAB 800MG APTIVUS CAP 250MG... 7 APTIVUS SOL... 7 ARALAST NP INJ 1000MG ARALAST NP INJ 500MG 63 aranelle tab ARCALYST INJ 220MG aripiprazole oral solution 1 /ml aripiprazole orally disintegrating tab aripiprazole orally disintegrating tab aripiprazole tab aripiprazole tab aripiprazole tab aripiprazole tab aripiprazole tab aripiprazole tab ARISTADA INJ 1064MG ARISTADA INJ 441MG/ ARISTADA INJ 662MG/ ARISTADA INJ 882MG/ armodafinil tab armodafinil tab armodafinil tab armodafinil tab ARNUITY ELPT INH 100MCG ARNUITY ELPT INH 200MCG ASACOL HD TAB 800MG 52 aspirin-dipyridamole cap er 12hr atazanavir sulfate cap 150 (base equiv)... 7 atazanavir sulfate cap 200 (base equiv)

77 atazanavir sulfate cap 300 (base equiv)...7 atenolol & chlorthalidone tab atenolol & chlorthalidone tab atenolol tab atenolol tab atenolol tab atomoxetine hcl cap 10 (base equiv) atomoxetine hcl cap 100 (base equiv) atomoxetine hcl cap 18 (base equiv) atomoxetine hcl cap 25 (base equiv) atomoxetine hcl cap 40 (base equiv) atomoxetine hcl cap 60 (base equiv) atomoxetine hcl cap 80 (base equiv) atorvastatin calcium tab 10 (base equivalent) atorvastatin calcium tab 20 (base equivalent) atorvastatin calcium tab 40 (base equivalent) atorvastatin calcium tab 80 (base equivalent) atovaquone susp 750 /5ml...5 atovaquone-proguanil hcl tab atovaquone-proguanil hcl tab ATRIPLA TAB...9 ATROVENT HFA AER 17MCG aubra tab AUGMENTIN SUS 125/5ML AURYXIA TAB 210MG AUSTEDO TAB 12MG AUSTEDO TAB 6MG AUSTEDO TAB 9MG AVASTIN INJ AVASTIN INJ 400/16ML aviane tab avita cre 0.025% avita gel 0.025% AVONEX KIT 30MCG AVONEX PEN KIT 30MCG AVONEX PREFL KIT 30MCG azacitidine for inj AZACTAM INJ 1GM... 5 AZACTAM INJ 2GM... 5 AZACTAM/DEX INJ 1GM... 5 AZACTAM/DEX INJ 2GM... 5 AZATHIOPRINE INJ 100MG azathioprine tab azelastine hcl nasal spray 0.1% (137 mcg/spray) azelastine hcl nasal spray 0.15% (205.5 mcg/spray).. 62 azelastine hcl ophth soln 0.05% AZILECT TAB 0.5MG AZILECT TAB 1MG azithromycin for susp 100 /5ml azithromycin for susp 200 /5ml azithromycin iv for soln azithromycin powd pack for susp 1 gm azithromycin tab azithromycin tab azithromycin tab AZOPT SUS 1% OP aztreonam for inj 1 gm... 5 aztreonam for inj 2 gm... 5 B bacitracin ophth oint 500 unit/gm bacitracin-polymyxin b ophth oint bacitracin-polymyxinneomycin-hc ophth oint 1% baclofen tab baclofen tab balsalazide disodium cap balziva tab BANZEL SUS 40MG/ML BANZEL TAB 200MG BANZEL TAB 400MG BARACLUDE SOL.05MG/ML... 9 BASAGLAR INJ 100UNIT. 42 BCG VACCINE INJ bekyree tab BELEODAQ INJ 500MG benazepril & hydrochlorothiazide tab benazepril & hydrochlorothiazide tab benazepril & hydrochlorothiazide tab benazepril & hydrochlorothiazide tab benazepril hcl tab benazepril hcl tab benazepril hcl tab benazepril hcl tab BENDEKA INJ 100/4ML BENLYSTA INJ 120MG BENLYSTA INJ 200MG/ML BENLYSTA INJ 400MG benzoyl peroxideerythromycin gel 5-3% benztropine mesylate inj 1 /ml benztropine mesylate tab benztropine mesylate tab benztropine mesylate tab BEPREVE DRO 1.5% BESIVANCE SUS 0.6% betamethasone dipropionate augmented cream 0.05%.. 65 betamethasone dipropionate augmented gel 0.05% betamethasone dipropionate augmented lotion 0.05% betamethasone dipropionate augmented oint 0.05%

78 betamethasone dipropionate cream 0.05% betamethasone dipropionate lotion 0.05% betamethasone dipropionate oint 0.05% betamethasone valerate cream 0.1% (base equivalent) betamethasone valerate lotion 0.1% (base equivalent) betamethasone valerate oint 0.1% (base equivalent) BETASERON INJ 0.3MG.. 41 betaxolol hcl ophth soln 0.5% bethanechol chloride tab bethanechol chloride tab bethanechol chloride tab bethanechol chloride tab BETOPTIC-S SUS 0.25% OP BEVESPI AER 9-4.8MCG. 62 bexarotene cap BEXSERO INJ bicalutamide tab BICILLIN L-A INJ BICILLIN L-A INJ BICILLIN L-A INJ BIKTARVY TAB...9 BILTRICIDE TAB 600MG...5 bisoprolol & hydrochlorothiazide tab bisoprolol & hydrochlorothiazide tab bisoprolol & hydrochlorothiazide tab bisoprolol fumarate tab bisoprolol fumarate tab BIVIGAM INJ 10% bleomycin sulfate for inj 15 unit bleomycin sulfate for inj 30 unit BLEPHAMIDE OIN S.O.P. 60 blisovi fe tab 1.5/ blisovi fe tab 1/ BOOSTRIX INJ BORTEZOMIB INJ 3.5MG 15 BOSULIF TAB 100MG BOSULIF TAB 400MG BOSULIF TAB 500MG BREO ELLIPTA INH BREO ELLIPTA INH briellyn tab BRILINTA TAB 60MG BRILINTA TAB 90MG brimonidine tartrate ophth soln 0.15% brimonidine tartrate ophth soln 0.2% BRIVIACT INJ 50MG/5ML 27 BRIVIACT SOL 10MG/ML 27 BRIVIACT TAB 100MG BRIVIACT TAB 10MG BRIVIACT TAB 25MG BRIVIACT TAB 50MG BRIVIACT TAB 75MG bromfenac sodium ophth soln 0.09% (base equiv) (once-daily) bromocriptine mesylate cap 5 (base equivalent) bromocriptine mesylate tab 2.5 (base equivalent).. 34 BROMSITE DRO 0.075%. 61 budesonide delayed release particles cap budesonide inhalation susp 0.25 /2ml budesonide inhalation susp 0.5 /2ml bumetanide inj 0.25 /ml 25 bumetanide tab bumetanide tab bumetanide tab BUPHENYL TAB 500MG.. 47 buprenorphine hcl sl tab 2 (base equiv) buprenorphine hcl sl tab 8 (base equiv) buprenorphine hcl-naloxone hcl sl tab (base equiv) buprenorphine hcl-naloxone hcl sl tab 8-2 (base equiv) bupropion hcl (smoking deterrent) tab er 12hr bupropion hcl tab bupropion hcl tab bupropion hcl tab er 12hr bupropion hcl tab er 12hr bupropion hcl tab er 12hr bupropion hcl tab er 24hr bupropion hcl tab er 24hr buspirone hcl tab buspirone hcl tab buspirone hcl tab buspirone hcl tab buspirone hcl tab busulfan inj 6 /ml butorphanol tartrate inj 1 /ml... 2 butorphanol tartrate inj 2 /ml... 2 BYDUREON INJ 2MG BYDUREON INJ BCISE BYDUREON PEN INJ 2MG BYETTA INJ 10MCG BYETTA INJ 5MCG BYSTOLIC TAB 10MG BYSTOLIC TAB 2.5MG BYSTOLIC TAB 20MG BYSTOLIC TAB 5MG C cabergoline tab CABOMETYX TAB 20MG 16 CABOMETYX TAB 40MG 16 CABOMETYX TAB 60MG 16 calcipotriene cream 0.005% 73

79 calcipotriene soln 0.005% (50 mcg/ml) calcitonin (salmon) nasal soln 200 unit/act calcitriol cap 0.25 mcg calcitriol cap 0.5 mcg calcitriol inj 1 mcg/ml calcitriol oral soln 1 mcg/ml calcium acetate (phosphate binder) cap 667 (169 ca) calcium acetate (phosphate binder) tab CALQUENCE CAP 100MG camila tab CANASA SUP 1000MG CANCIDAS INJ 50MG...7 CANCIDAS INJ 70MG...7 CAPASTAT SUL INJ 1GM..9 CAPRELSA TAB 100MG.. 16 CAPRELSA TAB 300MG.. 16 captopril & hydrochlorothiazide tab captopril & hydrochlorothiazide tab captopril & hydrochlorothiazide tab captopril & hydrochlorothiazide tab captopril tab captopril tab captopril tab captopril tab CARAC CRE 0.5% CARBAGLU TAB 200MG.. 47 carbamazepine cap er 12hr carbamazepine cap er 12hr carbamazepine cap er 12hr carbamazepine chew tab carbamazepine susp 100 /5ml carbamazepine tab carbamazepine tab er 12hr carbamazepine tab er 12hr carbamazepine tab er 12hr carbidopa & levodopa orally disintegrating tab carbidopa & levodopa orally disintegrating tab carbidopa & levodopa orally disintegrating tab carbidopa & levodopa tab carbidopa & levodopa tab carbidopa & levodopa tab carbidopa & levodopa tab er carbidopa & levodopa tab er carbidopa-levodopaentacapone tabs carbidopa-levodopaentacapone tabs carbidopa-levodopaentacapone tabs carbidopa-levodopaentacapone tabs carbidopa-levodopaentacapone tabs carbidopa-levodopaentacapone tabs carboplatin iv soln 150 /15ml carboplatin iv soln 450 /45ml carboplatin iv soln 50 /5ml carboplatin iv soln 600 /60ml CARIMUNE NF INJ 12GM 56 CARIMUNE NF INJ 6GM.. 56 carteolol hcl ophth soln 1% carvedilol tab carvedilol tab carvedilol tab carvedilol tab caspofungin acetate for iv soln caspofungin acetate for iv soln CASPOFUNGIN INJ 50MG 7 CASPOFUNGIN INJ 70MG 7 CAYSTON INH 75MG... 5 cefaclor cap cefaclor cap CEFACLOR ER TAB 500MG cefaclor for susp 125 /5ml cefaclor for susp 250 /5ml cefaclor for susp 375 /5ml cefadroxil cap cefadroxil for susp 250 /5ml cefadroxil for susp 500 /5ml cefadroxil tab 1 gm CEFAZOLIN INJ 1GM/50ML cefazolin sodium for inj 1 gm cefazolin sodium for inj 10 gm cefazolin sodium for inj 20 gm cefazolin sodium for inj cefazolin sodium for iv soln 1 gm CEFAZOLIN SOL cefdinir cap

80 cefdinir for susp 125 /5ml cefdinir for susp 250 /5ml cefepime hcl for inj 1 gm cefepime hcl for inj 2 gm cefixime for susp 100 /5ml cefixime for susp 200 /5ml cefotaxime sodium for inj 1 gm cefotaxime sodium for inj 2 gm cefotaxime sodium for inj cefoxitin sodium for inj 10 gm cefoxitin sodium for iv soln 1 gm cefoxitin sodium for iv soln 2 gm cefpodoxime proxetil for susp 100 /5ml cefpodoxime proxetil for susp 50 /5ml cefpodoxime proxetil tab cefpodoxime proxetil tab cefprozil for susp 125 /5ml cefprozil for susp 250 /5ml cefprozil tab cefprozil tab ceftazidime for inj 1 gm ceftazidime for inj 2 gm ceftazidime for inj 6 gm CEFTAZIDIME/ SOL D5W 1GM CEFTAZIDIME/ SOL D5W 2GM ceftriaxone sodium for inj 1 gm ceftriaxone sodium for inj 10 gm ceftriaxone sodium for inj 2 gm ceftriaxone sodium for inj ceftriaxone sodium for inj ceftriaxone sodium for iv soln 1 gm ceftriaxone sodium for iv soln 2 gm cefuroxime axetil tab cefuroxime axetil tab cefuroxime sodium for inj 1.5 gm cefuroxime sodium for inj 7.5 gm cefuroxime sodium for inj cefuroxime sodium for iv soln 1.5 gm celecoxib cap celecoxib cap celecoxib cap celecoxib cap CELONTIN CAP 300MG cephalexin cap cephalexin cap cephalexin for susp 125 /5ml cephalexin for susp 250 /5ml CERDELGA CAP 84MG CEREZYME INJ 400UNIT 47 cetirizine hcl oral soln 1 /ml (5 /5ml) cevimeline hcl cap CHANTIX PAK 0.5& 1MG. 42 CHANTIX PAK 1MG CHANTIX TAB 0.5MG CHANTIX TAB 1MG CHEMET CAP 100MG chlorhexidine gluconate soln 0.12% chloroquine phosphate tab chloroquine phosphate tab chlorothiazide tab chlorothiazide tab CHLORPROMAZ INJ 25MG/ML CHLORPROMAZ INJ 50MG/2ML chlorpromazine hcl tab chlorpromazine hcl tab chlorpromazine hcl tab chlorpromazine hcl tab chlorpromazine hcl tab chlorthalidone tab chlorthalidone tab cholestyramine light powder 4 gm/dose cholestyramine light powder packets 4 gm cholestyramine powder 4 gm/dose cholestyramine powder packets 4 gm CIALIS TAB 10MG CIALIS TAB 20MG ciclopirox gel 0.77% ciclopirox olamine cream 0.77% (base equiv) ciclopirox olamine susp 0.77% (base equiv) ciclopirox shampoo 1% cilostazol tab cilostazol tab CILOXAN OIN 0.3% OP CINRYZE SOL 500 UNIT. 56 CIPRODEX SUS % 67 ciprofloxacin 200 /100ml in d5w ciprofloxacin 400 /200ml in d5w ciprofloxacin for oral susp 250 /5ml (5%) (5 gm/100ml) ciprofloxacin for oral susp 500 /5ml (10%) (10 gm/100ml) ciprofloxacin hcl ophth soln 0.3% ciprofloxacin hcl tab 100 (base equiv) ciprofloxacin hcl tab

81 (base equiv) ciprofloxacin hcl tab 500 (base equiv) ciprofloxacin hcl tab 750 (base equiv) ciprofloxacin iv soln 200 /20ml (1%) ciprofloxacin iv soln 400 /40ml (1%) cisplatin inj 100 /100ml (1 /ml) cisplatin inj 200 /200ml (1 /ml) cisplatin inj 50 /50ml (1 /ml) citalopram hydrobromide oral soln 10 /5ml citalopram hydrobromide tab 10 (base equiv) citalopram hydrobromide tab 20 (base equiv) citalopram hydrobromide tab 40 (base equiv) cladribine iv soln 10 /10ml (1 /ml) claravis cap claravis cap claravis cap claravis cap clarithromycin for susp 125 /5ml clarithromycin for susp 250 /5ml clarithromycin tab clarithromycin tab clarithromycin tab er 24hr clindacin-p pad 1% clindamycin hcl cap clindamycin hcl cap clindamycin hcl cap clindamycin palmitate hcl for soln 75 /5ml (base equiv)...5 clindamycin phosphate gel 1% clindamycin phosphate in d5w iv soln 300 /50ml...6 clindamycin phosphate in d5w iv soln 600 /50ml...6 clindamycin phosphate in d5w iv soln 900 /50ml... 6 clindamycin phosphate inj 300 /2ml... 6 clindamycin phosphate inj 600 /4ml... 6 clindamycin phosphate inj 9 gm/60ml... 6 clindamycin phosphate inj 900 /6ml... 6 clindamycin phosphate iv soln 300 /2ml... 6 clindamycin phosphate iv soln 900 /6ml... 6 clindamycin phosphate lotion 1% clindamycin phosphate soln 1% clindamycin phosphate swab 1% clindamycin phosphate vaginal cream 2% CLINDMYC/NAC INJ 300/50ML... 6 CLINDMYC/NAC INJ 600/50ML... 6 CLINDMYC/NAC INJ 900/50ML... 6 CLINIMIX INJ 2.75/D5W CLINIMIX INJ 4.25/D CLINIMIX INJ 4.25/D CLINIMIX INJ 4.25/D CLINIMIX INJ 4.25/D5W CLINIMIX INJ 5%/D15W CLINIMIX INJ 5%/D20W CLINIMIX INJ 5%/D25W clobetasol e cre 0.05% clobetasol propionate lotion 0.05% clomipramine hcl cap clomipramine hcl cap clomipramine hcl cap clonazepam orally disintegrating tab clonazepam orally disintegrating tab clonazepam orally disintegrating tab clonazepam orally disintegrating tab clonazepam orally disintegrating tab clonazepam tab clonazepam tab clonazepam tab clonidine hcl tab clonidine hcl tab clonidine hcl tab clonidine hcl td patch weekly 0.1 /24hr clonidine hcl td patch weekly 0.2 /24hr clonidine hcl td patch weekly 0.3 /24hr clopidogrel bisulfate tab 75 (base equiv) clorazepate dipotassium tab clorazepate dipotassium tab clorazepate dipotassium tab clotrimazole cream 1% clotrimazole soln 1% clotrimazole troche clozapine orally disintegrating tab clozapine orally disintegrating tab clozapine orally disintegrating tab clozapine orally disintegrating tab clozapine orally disintegrating tab clozapine tab clozapine tab clozapine tab clozapine tab COARTEM TAB MG 7 colchicine w/ probenecid tab COLCRYS TAB 0.6MG... 2 colestipol hcl granule packets 5 gm colestipol hcl granules 5 gm 76

82 colestipol hcl tab 1 gm colistimethate sod for inj 150 (colistin base activity)...6 COMBIGAN SOL 0.2/0.5% COMBIVENT AER COMETRIQ KIT 100MG COMETRIQ KIT 140MG COMETRIQ KIT 60MG COMPLERA TAB...9 constulose sol 10gm/ COPAXONE INJ 40MG/ML COREG CR CAP 10MG COREG CR CAP 20MG COREG CR CAP 40MG COREG CR CAP 80MG CORLANOR TAB 5MG CORLANOR TAB 7.5MG.. 26 cortisone acetate tab COTELLIC TAB 20MG COUMADIN TAB 10MG COUMADIN TAB 1MG COUMADIN TAB 2.5MG COUMADIN TAB 2MG COUMADIN TAB 3MG COUMADIN TAB 4MG COUMADIN TAB 5MG COUMADIN TAB 6MG COUMADIN TAB 7.5MG CREON CAP 12000UNT.. 53 CREON CAP 24000UNT.. 53 CREON CAP 3000UNIT CREON CAP 36000UNT.. 53 CREON CAP 6000UNIT CRIXIVAN CAP 200MG...7 CRIXIVAN CAP 400MG...7 cromolyn sodium ophth soln 4% cromolyn sodium oral conc 100 /5ml cromolyn sodium soln nebu 20 /2ml cryselle-28 tab 28 tabs cyanocobalamin inj 1000 mcg/ml cyclafem tab 1/ cyclafem tab 7/7/ cyclobenzaprine hcl tab cyclobenzaprine hcl tab CYCLOPHOSPH CAP 25MG CYCLOPHOSPH CAP 50MG cyclophosphamide for inj 1 gm cyclophosphamide for inj 2 gm cyclophosphamide for inj cycloserine cap cyclosporine cap cyclosporine cap cyclosporine iv soln 50 /ml cyclosporine modified cap cyclosporine modified cap cyclosporine modified cap cyclosporine modified oral soln 100 /ml cyproheptadine hcl syrup 2 /5ml cyproheptadine hcl tab CYSTADANE POW CYSTAGON CAP 150MG. 47 CYSTAGON CAP 50MG CYSTARAN SOL 0.44% cytarabine inj 20 /ml D D10W/NACL INJ 0.2% D5W/LYTES INJ # D5W/NACL INJ 0.3% dacarbazine for inj dacarbazine for inj DAKLINZA TAB 30MG... 9 DAKLINZA TAB 60MG... 9 DAKLINZA TAB 90MG... 9 DALIRESP TAB 250MCG. 63 DALIRESP TAB 500MCG. 63 danazol cap danazol cap danazol cap dantrolene sodium cap dantrolene sodium cap dantrolene sodium cap dapsone tab dapsone tab DAPTACEL INJ daptomycin for iv soln dasetta tab 1/ dasetta tab 7/7/ deblitane tab DELESTROGEN INJ 10MG/ML delyla tab DELZICOL CAP 400MG DEMSER CAP 250MG DEPEN TITRA TAB 250MG DEPO-PROVERA INJ 400/ML DESCOVY TAB 200/ desipramine hcl tab desipramine hcl tab desipramine hcl tab desipramine hcl tab desipramine hcl tab desipramine hcl tab desmopressin acetate inj 4 mcg/ml desmopressin acetate nasal soln 0.01% (refrigerated).. 51 desmopressin acetate nasal spray soln 0.01% desmopressin acetate nasal spray soln 0.01% (refrigerated) desmopressin acetate tab desmopressin acetate tab desogest-eth estrad & eth estrad tab /0.01 (21/5) desogest-ethin est tab / /

83 desogestrel & ethinyl estradiol tab mcg desonide cream 0.05% desoximetasone cream 0.05% desoximetasone cream 0.25% desoximetasone gel 0.05% desoximetasone oint 0.05% desoximetasone oint 0.25% desvenlafaxine succinate tab er 24hr 100 (base equiv) desvenlafaxine succinate tab er 24hr 25 (base equiv) desvenlafaxine succinate tab er 24hr 50 (base equiv) DEXAMETHASON CON 1MG/ML dexamethasone elixir 0.5 /5ml dexamethasone sod phosphate preservative free inj 10 /ml dexamethasone sodium phosphate inj 10 /ml dexamethasone sodium phosphate inj 100 /10ml dexamethasone sodium phosphate inj 120 /30ml dexamethasone sodium phosphate inj 20 /5ml dexamethasone sodium phosphate inj 4 /ml dexamethasone sodium phosphate ophth soln 0.1% dexamethasone soln 0.5 /5ml dexamethasone tab dexamethasone tab dexamethasone tab dexamethasone tab dexamethasone tab dexamethasone tab dexamethasone tab DEXILANT CAP 30MG DR DEXILANT CAP 60MG DR dexrazoxane for inj dexrazoxane for inj dextroamphetamine sulfate cap er 24hr dextroamphetamine sulfate cap er 24hr dextroamphetamine sulfate cap er 24hr dextroamphetamine sulfate tab dextroamphetamine sulfate tab dextrose 10% w/ sodium chloride 0.45% dextrose 2.5% w/ sodium chloride 0.45% dextrose 5% in lactated ringers dextrose 5% w/ sodium chloride 0.2% dextrose 5% w/ sodium chloride 0.225% dextrose 5% w/ sodium chloride 0.33% dextrose 5% w/ sodium chloride 0.45% dextrose 5% w/ sodium chloride 0.9% dextrose inj 10% dextrose inj 5% dextrose inj 50% dextrose inj 70% DIASTAT ACDL GEL DIASTAT ACDL GEL 5-10MG DIASTAT PED GEL 2.5M GEL diazepam con 5/ml diazepam inj 5 /ml diazepam oral soln 1 /ml diazepam rectal gel delivery system diazepam rectal gel delivery system diazepam rectal gel delivery system diazepam tab diazepam tab diazepam tab diclofenac potassium tab diclofenac sodium gel 1%. 67 diclofenac sodium ophth soln 0.1% diclofenac sodium soln 1.5% diclofenac sodium tab delayed release diclofenac sodium tab delayed release diclofenac sodium tab delayed release diclofenac sodium tab er 24hr dicloxacillin sodium cap dicloxacillin sodium cap dicyclomine hcl cap dicyclomine hcl oral soln 10 /5ml dicyclomine hcl tab didanosine delayed release capsule didanosine delayed release capsule didanosine delayed release capsule DIFICID TAB 200MG diflunisal tab digitek tab digitek tab digoxin inj 0.25 /ml digoxin oral soln 0.05 /ml 78

84 digoxin tab 125 mcg (0.125 ) digoxin tab 250 mcg (0.25 ) dihydroergotamine mesylate inj 1 /ml dihydroergotamine mesylate nasal spray 4 /ml DILANTIN CAP 100MG DILANTIN CAP 30MG DILANTIN CHW 50MG DILANTIN-125 SUS 125/5ML diltiazem hcl cap er 12hr diltiazem hcl cap er 12hr diltiazem hcl cap er 12hr diltiazem hcl cap er 24hr diltiazem hcl cap er 24hr diltiazem hcl cap er 24hr diltiazem hcl coated beads cap er 24hr diltiazem hcl coated beads cap er 24hr diltiazem hcl coated beads cap er 24hr diltiazem hcl coated beads cap er 24hr diltiazem hcl coated beads cap er 24hr diltiazem hcl extended release beads cap er 24hr diltiazem hcl extended release beads cap er 24hr diltiazem hcl extended release beads cap er 24hr diltiazem hcl extended release beads cap er 24hr diltiazem hcl extended release beads cap er 24hr diltiazem hcl extended release beads cap er 24hr diltiazem hcl iv soln 125 /25ml (5 /ml) diltiazem hcl iv soln 25 /5ml (5 /ml) diltiazem hcl iv soln 50 /10ml (5 /ml) diltiazem hcl tab diltiazem hcl tab diltiazem hcl tab diltiazem hcl tab DIP/TET PED INJ 25-5LFU diphenhydramine hcl inj 50 /ml diphenoxylate w/ atropine liq /5ml diphenoxylate w/ atropine tab disopyramide phosphate cap disopyramide phosphate cap disulfiram tab disulfiram tab divalproex sodium cap delayed release sprinkle divalproex sodium tab delayed release divalproex sodium tab delayed release divalproex sodium tab delayed release divalproex sodium tab er 24 hr divalproex sodium tab er 24 hr docetaxel for inj conc 20 /ml docetaxel for inj conc 80 /4ml (20 /ml) DOCETAXEL INJ 160/16ML DOCETAXEL INJ 160/8ML DOCETAXEL INJ 200/ DOCETAXEL INJ 20MG/2ML DOCETAXEL INJ 80MG/4ML DOCETAXEL INJ 80MG/8ML dofetilide cap 125 mcg (0.125 ) dofetilide cap 250 mcg (0.25 ) dofetilide cap 500 mcg (0.5 ) donepezil hydrochloride orally disintegrating tab donepezil hydrochloride orally disintegrating tab donepezil hydrochloride tab donepezil hydrochloride tab donepezil hydrochloride tab dorzolamide hcl ophth soln 2% dorzolamide hcl-timolol maleate ophth soln /ml doxazosin mesylate tab doxazosin mesylate tab doxazosin mesylate tab doxazosin mesylate tab doxepin hcl cap doxepin hcl cap doxepin hcl cap doxepin hcl cap doxepin hcl cap doxepin hcl cap doxepin hcl conc 10 /ml 32 doxepin hcl cream 5% doxorubicin hcl for inj doxorubicin hcl for inj doxorubicin hcl inj 2 /ml 14 79

85 doxorubicin hcl liposomal inj (for iv infusion) 2 /ml doxy 100 inj doxycycline hyclate cap doxycycline hyclate cap doxycycline hyclate for inj doxycycline hyclate tab doxycycline hyclate tab doxycycline monohydrate cap doxycycline monohydrate cap doxycycline monohydrate tab doxycycline monohydrate tab doxycycline monohydrate tab doxycycline monohydrate tab dronabinol cap dronabinol cap dronabinol cap drospirenone-ethinyl estradiol tab drospirenone-ethinyl estradiol tab DROXIA CAP 200MG DROXIA CAP 300MG DROXIA CAP 400MG duloxetine hcl enteric coated pellets cap 20 (base eq) duloxetine hcl enteric coated pellets cap 30 (base eq) duloxetine hcl enteric coated pellets cap 60 (base eq) DUREZOL EMU 0.05% dutasteride cap dutasteride-tamsulosin hcl cap E EDURANT TAB 25MG...7 efavirenz cap efavirenz cap efavirenz tab EFFIENT TAB 10MG EFFIENT TAB 5MG eletriptan hydrobromide tab 20 (base equivalent) eletriptan hydrobromide tab 40 (base equivalent) ELIQUIS ST P TAB 5MG.. 55 ELIQUIS TAB 2.5MG ELIQUIS TAB 5MG ELITEK INJ 1.5MG ELITEK INJ 7.5MG ELLA TAB 30MG EMCYT CAP 140MG EMEND SUS 125MG emoquette tab EMSAM DIS 12MG/24H EMSAM DIS 6MG/24HR EMSAM DIS 9MG/24HR EMTRIVA CAP 200MG... 8 EMTRIVA SOL 10MG/ML... 8 EMVERM CHW 100MG... 6 enalapril maleate & hydrochlorothiazide tab enalapril maleate & hydrochlorothiazide tab enalapril maleate tab enalapril maleate tab enalapril maleate tab enalapril maleate tab 5 19 ENDARI POW 5GM endocet tab endocet tab endocet tab endocet tab ENGERIX-B INJ 10/0.5ML 58 ENGERIX-B INJ 20MCG/ML enoxaparin sodium inj 100 /ml enoxaparin sodium inj 120 /0.8ml enoxaparin sodium inj 150 /ml enoxaparin sodium inj 30 /0.3ml enoxaparin sodium inj 300 /3ml enoxaparin sodium inj 40 /0.4ml enoxaparin sodium inj 60 /0.6ml enoxaparin sodium inj 80 /0.8ml enpresse-28 tab enskyce tab entacapone tab entecavir tab entecavir tab ENTRESTO TAB 24-26MG ENTRESTO TAB 49-51MG ENTRESTO TAB MG enulose sol 10gm/ EPCLUSA TAB epinephrine solution autoinjector 0.15 /0.15ml (1:1000) epinephrine solution autoinjector 0.3 /0.3ml (1:1000) epirubicin hcl iv soln 200 /100ml (2 /ml) epirubicin hcl iv soln 50 /25ml (2 /ml) epitol tab EPIVIR HBV SOL 5MG/ML. 9 eplerenone tab eplerenone tab ergocalciferol cap unit ergotamine w/ caffeine tab ERIVEDGE CAP 150MG.. 15 ERLEADA TAB 60MG errin tab ery-tab tab 250 ec ery-tab tab 333 ec ery-tab tab 500 ec ERYTHROCIN INJ 500MG

86 erythrocin tab erythromycin ethylsuccinate tab erythromycin gel 2% erythromycin ophth oint 5 /gm erythromycin pads 2% erythromycin soln 2% erythromycin tab erythromycin tab erythromycin w/ delayed release particles cap ESBRIET CAP 267MG ESBRIET TAB 267MG ESBRIET TAB 801MG escitalopram oxalate soln 5 /5ml (base equiv) escitalopram oxalate tab 10 (base equiv) escitalopram oxalate tab 20 (base equiv) escitalopram oxalate tab 5 (base equiv) esomeprazole magnesium cap delayed release 20 (base eq) esomeprazole magnesium cap delayed release 40 (base eq) esomeprazole sodium for intravenous soln 20 (base equiv) esomeprazole sodium for intravenous soln 40 (base equiv) ESTRACE VAG CRE 0.01% estradiol tab estradiol tab estradiol tab estradiol td patch weekly /24hr estradiol td patch weekly /24hr (37.5 mcg/24hr) estradiol td patch weekly 0.05 /24hr estradiol td patch weekly 0.06 /24hr estradiol td patch weekly /24hr estradiol td patch weekly 0.1 /24hr estradiol vaginal cream 0.1 /gm estradiol vaginal tab 10 mcg estradiol valerate im in oil 20 /ml estradiol valerate im in oil 40 /ml eszopiclone tab eszopiclone tab eszopiclone tab ethambutol hcl tab ethambutol hcl tab ethosuximide cap ethosuximide soln 250 /5ml ethynodiol diacetate & ethinyl estradiol tab 1-35 mcg ethynodiol diacetate & ethinyl estradiol tab 1-50 mcg etodolac cap etodolac cap etodolac tab etodolac tab etodolac tab er 24hr etodolac tab er 24hr etodolac tab er 24hr etoposide inj 100 /5ml (20 /ml) etoposide inj 500 /25ml (20 /ml) EVOTAZ TAB exemestane tab EXJADE TAB 125MG EXJADE TAB 250MG EXJADE TAB 500MG ezetimibe tab ezetimibe-simvastatin tab ezetimibe-simvastatin tab ezetimibe-simvastatin tab ezetimibe-simvastatin tab F FABRAZYME INJ 35MG FABRAZYME INJ 5MG falmina tab famciclovir tab famciclovir tab famciclovir tab famotidine for susp 40 /5ml famotidine in nacl 0.9% iv soln 20 /50ml famotidine inj 20 /2ml famotidine inj 200 /20ml famotidine inj 40 /4ml famotidine tab famotidine tab FANAPT PAK FANAPT TAB 10MG FANAPT TAB 12MG FANAPT TAB 1MG FANAPT TAB 2MG FANAPT TAB 4MG FANAPT TAB 6MG FANAPT TAB 8MG FARESTON TAB 60MG FARXIGA TAB 10MG FARXIGA TAB 5MG FARYDAK CAP 10MG FARYDAK CAP 15MG FARYDAK CAP 20MG FASLODEX INJ 250/5ML. 15 fat emulsion iv soln 20% felbamate susp 600 /5ml felbamate tab felbamate tab felodipine tab er 24hr felodipine tab er 24hr felodipine tab er 24hr femynor tab fenofibrate micronized cap

87 fenofibrate micronized cap fenofibrate micronized cap fenofibrate tab fenofibrate tab fenofibrate tab fenofibrate tab fentanyl citrate lozenge on a handle 1200 mcg...3 fentanyl citrate lozenge on a handle 1600 mcg...3 fentanyl citrate lozenge on a handle 200 mcg...3 fentanyl citrate lozenge on a handle 400 mcg...3 fentanyl citrate lozenge on a handle 600 mcg...3 fentanyl citrate lozenge on a handle 800 mcg...3 fentanyl td patch 72hr 100 mcg/hr...3 fentanyl td patch 72hr 12 mcg/hr...3 fentanyl td patch 72hr 25 mcg/hr...3 fentanyl td patch 72hr 50 mcg/hr...3 fentanyl td patch 72hr 75 mcg/hr...3 FENTORA TAB 100MCG...3 FENTORA TAB 200MCG...3 FENTORA TAB 400MCG...3 FENTORA TAB 600MCG...3 FENTORA TAB 800MCG...3 FETZIMA CAP 120MG FETZIMA CAP 20MG FETZIMA CAP 40MG FETZIMA CAP 80MG FETZIMA CAP TITRATIO. 32 FIASP FLEX INJ TOUCH.. 43 FIASP INJ 100/ML finasteride tab FIRAZYR INJ 30MG/3ML.. 56 FLEBOGAMMA INJ 10/100ML FLEBOGAMMA INJ 10/200ML FLEBOGAMMA INJ 20/200ML FLEBOGAMMA INJ 20/400ML FLEBOGAMMA INJ 5GM/50ML FLEBOGAMMA INJ DIF 5% flecainide acetate tab flecainide acetate tab flecainide acetate tab FLOVENT DISK AER 100MCG FLOVENT DISK AER 250MCG FLOVENT DISK AER 50MCG FLOVENT HFA AER 110MCG FLOVENT HFA AER 220MCG FLOVENT HFA AER 44MCG fluconazole for susp 10 /ml... 7 fluconazole for susp 40 /ml... 7 fluconazole in dextrose inj 200 /100ml... 7 fluconazole in dextrose inj 400 /200ml... 7 fluconazole in nacl 0.9% inj 200 /100ml... 7 fluconazole in nacl 0.9% inj 400 /200ml... 7 fluconazole tab fluconazole tab fluconazole tab fluconazole tab FLUCONAZOLE/ INJ NACL flucytosine cap flucytosine cap fludarabine phosphate for inj fludarabine phosphate inj 25 /ml fludrocortisone acetate tab flunisolide nasal soln 25 mcg/act (0.025%) fluocinolone acetonide (otic) oil 0.01% fluocinolone acetonide cream 0.01% fluocinolone acetonide cream 0.025% fluocinolone acetonide oil 0.01% (body oil) fluocinolone acetonide oil 0.01% (scalp oil) fluocinolone acetonide oint 0.025% fluocinolone acetonide soln 0.01% fluocinonide cream 0.05% 66 fluocinonide emulsified base cream 0.05% fluocinonide gel 0.05% fluocinonide soln 0.05% fluorometholone ophth susp 0.1% fluorouracil cream 0.5% fluorouracil cream 5% fluorouracil iv soln 1 gm/20ml (50 /ml) fluorouracil iv soln 2.5 gm/50ml (50 /ml) fluorouracil iv soln 5 gm/100ml (50 /ml) fluorouracil iv soln 500 /10ml (50 /ml) fluorouracil soln 2% fluorouracil soln 5% fluoxetine hcl cap fluoxetine hcl cap fluoxetine hcl cap fluoxetine hcl solution 20 /5ml fluphenazine decanoate inj 25 /ml fluphenazine hcl elixir 2.5 /5ml fluphenazine hcl inj 2.5 /ml fluphenazine hcl oral conc 5 /ml fluphenazine hcl tab fluphenazine hcl tab 10 82

88 fluphenazine hcl tab fluphenazine hcl tab flurbiprofen sodium ophth soln 0.03% flurbiprofen tab flurbiprofen tab flutamide cap fluticasone propionate cream 0.05% fluticasone propionate nasal susp 50 mcg/act fluticasone propionate oint 0.005% fluvoxamine maleate tab fluvoxamine maleate tab fluvoxamine maleate tab folic acid tab fondaparinux sodium subcutaneous inj 10 /0.8ml fondaparinux sodium subcutaneous inj 2.5 /0.5ml fondaparinux sodium subcutaneous inj 5 /0.4ml fondaparinux sodium subcutaneous inj 7.5 /0.6ml FORTEO SOL 600/ fosamprenavir calcium tab 700 (base equiv)...8 fosinopril sodium & hydrochlorothiazide tab fosinopril sodium & hydrochlorothiazide tab fosinopril sodium tab fosinopril sodium tab fosinopril sodium tab FREAMINE HBC INJ 6.9% FREAMINE III INJ 10% furosemide inj 10 /ml furosemide oral soln 10 /ml furosemide oral soln 8 /ml furosemide tab furosemide tab furosemide tab FUZEON INJ 90MG... 8 FYCOMPA SUS 0.5MG/ML FYCOMPA TAB 10MG FYCOMPA TAB 12MG FYCOMPA TAB 2MG FYCOMPA TAB 4MG FYCOMPA TAB 6MG FYCOMPA TAB 8MG G gabapentin cap gabapentin cap gabapentin cap gabapentin oral soln 250 /5ml gabapentin tab gabapentin tab GABITRIL TAB 12MG GABITRIL TAB 16MG galantamine hydrobromide cap er 24hr galantamine hydrobromide cap er 24hr galantamine hydrobromide cap er 24hr galantamine hydrobromide oral soln 4 /ml galantamine hydrobromide tab galantamine hydrobromide tab galantamine hydrobromide tab GAMASTAN S/D INJ GAMMAGARD INJ 10GM/ GAMMAGARD INJ 1GM/10ML GAMMAGARD INJ 2.5GM/ GAMMAGARD INJ 20GM/ GAMMAGARD INJ 30GM/ GAMMAGARD INJ 5GM/50ML GAMMAGARD SD INJ 10GM HU GAMMAGARD SD INJ 5GM HU GAMMAKED INJ 10GM/ GAMMAKED INJ 1GM/10ML GAMMAKED INJ 2.5GM/ GAMMAKED INJ 20GM/ GAMMAKED INJ 5GM/50ML GAMMAPLEX INJ 10% GAMMAPLEX INJ 5% GAMUNEX-C INJ 10GM/ GAMUNEX-C INJ 1GM/10ML GAMUNEX-C INJ 2.5GM/ GAMUNEX-C INJ 20GM/ GAMUNEX-C INJ 40/400ML GAMUNEX-C INJ 5GM/50ML ganciclovir sodium for inj GARDASIL 9 INJ gatifloxacin ophth soln 0.5% GATTEX KIT 5MG GAUZE PADS gavilyte-c sol gavilyte-g sol gavilyte-n sol flav pk gemcitabine hcl for inj 1 gm gemcitabine hcl for inj 2 gm gemcitabine hcl for inj

89 gemcitabine hcl inj 1 gm/26.3ml (38 /ml) (base equiv) gemcitabine hcl inj 2 gm/52.6ml (38 /ml) (base equiv) gemcitabine hcl inj 200 /5.26ml (38 /ml) (base equiv) gemfibrozil tab generlac sol 10gm/ gengraf cap gengraf cap gengraf cap gengraf sol 100/ml gentak oin 0.3% op gentamicin in saline inj 0.8 /ml...5 gentamicin in saline inj 1 /ml...5 gentamicin in saline inj 1.2 /ml...5 gentamicin in saline inj 1.6 /ml...5 gentamicin in saline inj 2 /ml...5 gentamicin sulfate cream 0.1% gentamicin sulfate inj 10 /ml...5 gentamicin sulfate inj 40 /ml...5 gentamicin sulfate oint 0.1% gentamicin sulfate ophth soln 0.3% GENVOYA TAB...9 GEODON INJ 20MG gildagia tab GILENYA CAP 0.5MG GILOTRIF TAB 20MG GILOTRIF TAB 30MG GILOTRIF TAB 40MG glatiramer acetate soln prefilled syringe 20 /ml. 41 glatiramer acetate soln prefilled syringe 40 /ml. 41 glatopa inj 20/ml glatopa inj 40/ml GLEOSTINE CAP 100MG 13 GLEOSTINE CAP 10MG.. 13 GLEOSTINE CAP 40MG.. 13 GLEOSTINE CAP 5MG glimepiride tab glimepiride tab glimepiride tab glipizide tab glipizide tab glipizide tab er 24hr glipizide tab er 24hr glipizide tab er 24hr glipizide xl tab glipizide xl tab glipizide-metformin hcl tab glipizide-metformin hcl tab glipizide-metformin hcl tab GLUCAGEN INJ HYPOKIT GLUCAGON KIT 1MG glyburide micronized tab glyburide micronized tab glyburide micronized tab glyburide tab glyburide tab glyburide tab glyburide-metformin tab glyburide-metformin tab glyburide-metformin tab glycopyrrolate inj 4 /20ml (0.2 /ml) glycopyrrolate tab glycopyrrolate tab glydo gel 2% GOLYTELY SOL granisetron hcl inj 0.1 /ml granisetron hcl inj 1 /ml 51 granisetron hcl inj 4 /4ml (1 /ml) granisetron hcl tab GRANIX INJ 300/ GRANIX INJ 480/ griseofulvin microsize susp 125 /5ml... 7 griseofulvin microsize tab griseofulvin ultramicrosize tab griseofulvin ultramicrosize tab guanfacine hcl tab er 24hr 1 (base equiv) guanfacine hcl tab er 24hr 2 (base equiv) guanfacine hcl tab er 24hr 3 (base equiv) guanfacine hcl tab er 24hr 4 (base equiv) H HAEGARDA INJ 2000UNIT HAEGARDA INJ 3000UNIT halobetasol propionate cream 0.05% halobetasol propionate oint 0.05% haloperidol decanoate im soln 100 /ml haloperidol decanoate im soln 50 /ml haloperidol lactate inj 5 /ml haloperidol lactate oral conc 2 /ml haloperidol tab haloperidol tab haloperidol tab haloperidol tab haloperidol tab haloperidol tab HARVONI TAB MG. 9 HAVRIX INJ 1440UNIT HAVRIX INJ 720UNIT HEP SOD/NACL INJ 25000UNT heparin sodium (porcine) 100 unit/ml in d5w heparin sodium (porcine) 40 unit/ml in d5w

90 heparin sodium (porcine) 50 unit/ml in d5w heparin sodium (porcine) inj 1000 unit/ml heparin sodium (porcine) inj unit/ml heparin sodium (porcine) inj unit/ml heparin sodium (porcine) inj 5000 unit/ml hepatamine sol 8% HERCEPTIN INJ 150MG.. 15 HERCEPTIN INJ 440MG.. 15 HETLIOZ CAP 20MG HEXALEN CAP 50MG HIBERIX SOL 10MCG HUMIRA INJ 10MG/ HUMIRA KIT 20MG/ HUMIRA KIT 40MG/ HUMIRA PEDIA INJ CROHNS HUMIRA PEN INJ 40MG/ HUMIRA PEN INJ CROHNS HUMIRA PEN INJ PSORIASI HUMULIN R INJ U hydralazine hcl inj 20 /ml hydralazine hcl tab hydralazine hcl tab hydralazine hcl tab hydralazine hcl tab hydrochlorothiazide cap hydrochlorothiazide tab hydrochlorothiazide tab hydrochlorothiazide tab hydrocodone-acetaminophen soln /15ml...3 hydrocodone-acetaminophen tab hydrocodone-acetaminophen tab hydrocodone-acetaminophen tab hydrocodone-ibuprofen tab hydrocortisone butyrate cream 0.1% hydrocortisone butyrate oint 0.1% hydrocortisone butyrate soln 0.1% hydrocortisone cream 1%. 66 hydrocortisone cream 2.5% hydrocortisone enema 100 /60ml hydrocortisone lotion 2.5% 66 hydrocortisone oint 1% hydrocortisone oint 2.5%.. 66 hydrocortisone rectal cream 2.5% hydrocortisone tab hydrocortisone tab hydrocortisone tab hydrocortisone valerate cream 0.2% hydrocortisone valerate oint 0.2% hydromorphone hcl liqd 1 /ml... 3 hydromorphone hcl preservative free (pf) inj 10 /ml... 3 hydromorphone hcl tab hydromorphone hcl tab hydromorphone hcl tab hydroxychloroquine sulfate tab hydroxyprogesterone caproate im in oil 1.25 gm/5ml hydroxyurea cap hydroxyzine hcl im soln 25 /ml hydroxyzine hcl im soln 50 /ml hydroxyzine hcl syrup 10 /5ml hydroxyzine hcl tab hydroxyzine hcl tab hydroxyzine hcl tab hydroxyzine pamoate cap hydroxyzine pamoate cap HYSINGLA ER TAB 100 MG... 4 HYSINGLA ER TAB 120 MG... 4 HYSINGLA ER TAB 20 MG 4 HYSINGLA ER TAB 30 MG 4 HYSINGLA ER TAB 40 MG 4 HYSINGLA ER TAB 60 MG 4 HYSINGLA ER TAB 80 MG 4 I ibandronate sodium iv soln 3 /3ml (base equivalent). 45 ibandronate sodium tab 150 (base equivalent) IBRANCE CAP 100MG IBRANCE CAP 125MG IBRANCE CAP 75MG ibuprofen susp 100 /5ml 2 ibuprofen tab ibuprofen tab ibuprofen tab ICLUSIG TAB 15MG ICLUSIG TAB 45MG IDHIFA TAB 100MG IDHIFA TAB 50MG IFEX INJ 3GM ifosfamide for inj 1 gm IFOSFAMIDE INJ 3GM ifosfamide iv inj 1 gm/20ml (50 /ml) ifosfamide iv inj 3 gm/60ml (50 /ml) ILEVRO DRO 0.3% OP imatinib mesylate tab 100 (base equivalent) imatinib mesylate tab 400 (base equivalent) IMBRUVICA CAP 140MG. 17 IMBRUVICA CAP 70MG IMBRUVICA TAB 140MG. 17 IMBRUVICA TAB 280MG. 17 IMBRUVICA TAB 420MG. 17 IMBRUVICA TAB 560MG. 17 imipenem-cilastatin 85

91 intravenous for soln imipenem-cilastatin intravenous for soln imipramine hcl tab imipramine hcl tab imipramine hcl tab imiquimod cream 5% IMOVAX RABIE INJ 2.5/ML INCRELEX INJ 40MG/4ML INCRUSE ELPT INH 62.5MCG indapamide tab indapamide tab INFANRIX INJ INLYTA TAB 1MG INLYTA TAB 5MG INSULIN PEN NEEDLE INSULIN SAFETY NEEDLES INSULIN SYRINGE INTELENCE TAB 100MG...8 INTELENCE TAB 200MG...8 INTELENCE TAB 25MG...8 INTRALIPID INJ 30% INTRON A INJ 10MU INTRON A INJ 18MU INTRON A INJ 25MU INTRON A INJ 50MU introvale tab INVANZ INJ 1GM...6 INVEGA SUST INJ 117/ INVEGA SUST INJ 156MG/ML INVEGA SUST INJ 234/ INVEGA SUST INJ 39/ INVEGA SUST INJ 78/0.5ML INVEGA TRINZ INJ 273MG INVEGA TRINZ INJ 410MG INVEGA TRINZ INJ 546MG INVEGA TRINZ INJ 819MG INVIRASE CAP 200MG... 8 INVIRASE TAB 500MG... 8 INVOKAMET TAB INVOKAMET TAB INVOKAMET TAB INVOKAMET TAB MG INVOKAMET XR TAB INVOKAMET XR TAB INVOKAMET XR TAB INVOKAMET XR TAB MG INVOKANA TAB 100MG INVOKANA TAB 300MG IONOSOL-MB INJ /D5W IPOL INJ INACTIVE ipratropium bromide inhal soln 0.02% ipratropium bromide nasal soln 0.03% (21 mcg/spray) ipratropium bromide nasal soln 0.06% (42 mcg/spray) ipratropium-albuterol nebu soln (3) /3ml irbesartan tab irbesartan tab irbesartan tab irbesartanhydrochlorothiazide tab irbesartanhydrochlorothiazide tab IRESSA TAB 250MG irinotecan hcl inj 100 /5ml (20 /ml) irinotecan hcl inj 40 /2ml (20 /ml) irinotecan hcl inj 500 /25ml (20 /ml) ISENTRESS CHW 100MG. 8 ISENTRESS CHW 25MG... 8 ISENTRESS HD TAB 600MG... 8 ISENTRESS POW 100MG. 8 ISENTRESS TAB 400MG... 8 isibloom tab ISOLYTE-P INJ /D5W ISOLYTE-S INJ isoniazid inj 100 /ml... 9 isoniazid syrup 50 /5ml.. 9 isoniazid tab isoniazid tab isosorbide dinitrate tab isosorbide dinitrate tab isosorbide dinitrate tab isosorbide dinitrate tab isosorbide dinitrate tab er isosorbide mononitrate tab isosorbide mononitrate tab isosorbide mononitrate tab er 24hr isosorbide mononitrate tab er 24hr isosorbide mononitrate tab er 24hr isotretinoin cap isotretinoin cap isotretinoin cap isotretinoin cap isradipine cap isradipine cap ISTALOL SOL 0.5% OP itraconazole cap ivermectin tab IXIARO INJ J JADENU SPRKL GRA 180MG JADENU SPRKL GRA 360MG JADENU SPRKL GRA 90MG JADENU TAB 180MG JADENU TAB 360MG

92 JADENU TAB 90MG JAKAFI TAB 10MG JAKAFI TAB 15MG JAKAFI TAB 20MG JAKAFI TAB 25MG JAKAFI TAB 5MG jantoven tab jantoven tab jantoven tab jantoven tab jantoven tab jantoven tab jantoven tab jantoven tab jantoven tab JANUMET TAB JANUMET TAB MG JANUMET XR TAB JANUMET XR TAB JANUMET XR TAB MG JANUVIA TAB 100MG JANUVIA TAB 25MG JANUVIA TAB 50MG JENTADUETO TAB JENTADUETO TAB JENTADUETO TAB JENTADUETO TAB XR jinteli tab 1-5mcg jolivette tab juleber tab JULUCA TAB 50-25MG...9 junel 1.5/30 tab junel 1/20 tab junel fe tab 1.5/ junel fe tab 1/ JUXTAPID CAP 10MG JUXTAPID CAP 20MG JUXTAPID CAP 30MG JUXTAPID CAP 40MG JUXTAPID CAP 5MG JUXTAPID CAP 60MG K KADCYLA INJ 100MG KADCYLA INJ 160MG KALETRA TAB MG.. 9 KALETRA TAB MG.. 9 KALYDECO PAK 50MG KALYDECO PAK 75MG KALYDECO TAB 150MG.. 63 kariva tab 28 day kcl 10 meq/l (0.075%) in dextrose 5% & nacl 0.45% inj kcl 20 meq/l (0.15%) in dextrose 5% & nacl 0.2% inj kcl 20 meq/l (0.15%) in dextrose 5% & nacl 0.33% inj kcl 20 meq/l (0.15%) in dextrose 5% & nacl 0.45% inj kcl 20 meq/l (0.15%) in dextrose 5% & nacl 0.9% inj kcl 20 meq/l (0.15%) in nacl 0.45% inj kcl 20 meq/l (0.15%) in nacl 0.9% inj kcl 30 meq/l (0.224%) in dextrose 5% & nacl 0.45% inj kcl 40 meq/l (0.3%) in dextrose 5% & nacl 0.45% inj kcl 40 meq/l (0.3%) in nacl 0.9% inj KCL/D5W/NACL INJ 0.15/ KCL/D5W/NACL INJ 0.3/0.9% kelnor tab 1/ ketoconazole cream 2% ketoconazole shampoo 2% ketoconazole tab ketoprofen cap ketoprofen cap ketorolac tromethamine ophth soln 0.4% ketorolac tromethamine ophth soln 0.5% KEYTRUDA INJ 100MG/4M KEYTRUDA SOL 50MG kimidess tab KINRIX INJ KISQALI 200 PAK FEMARA KISQALI 400 PAK FEMARA KISQALI 600 PAK FEMARA KISQALI TAB 200DOSE KISQALI TAB 400DOSE KISQALI TAB 600DOSE klor-con 10 tab 10meq er.. 58 klor-con 8 tab 8meq er KLOR-CON M15 TAB 15MEQ ER KORLYM TAB 300MG kurvelo tab 0.15/ KUVAN POW 100MG KUVAN POW 500MG KUVAN TAB 100MG KYNAMRO INJ 200MG/ML L labetalol hcl tab labetalol hcl tab labetalol hcl tab lactated ringer's solution lactic acid (ammonium lactate) cream 12% lactic acid (ammonium lactate) lotion 12% lactulose (encephalopathy) solution 10 gm/15ml lactulose solution 10 gm/15ml lamivudine oral soln 10 /ml... 8 lamivudine tab 100 (hbv)... 9 lamivudine tab lamivudine tab lamivudine-zidovudine tab lamotrigine tab lamotrigine tab lamotrigine tab lamotrigine tab lamotrigine tab chewable 87

93 dispersible lamotrigine tab chewable dispersible lamotrigine tab er 24hr lamotrigine tab er 24hr lamotrigine tab er 24hr lamotrigine tab er 24hr lamotrigine tab er 24hr lamotrigine tab er 24hr lansoprazole cap delayed release lansoprazole cap delayed release larin fe tab 1.5/ larin fe tab 1/ larin tab 1.5/ larin tab 1/ LASTACAFT SOL 0.25%.. 61 latanoprost ophth soln 0.005% LATUDA TAB 120MG LATUDA TAB 20MG LATUDA TAB 40MG LATUDA TAB 60MG LATUDA TAB 80MG leflunomide tab leflunomide tab LENVIMA CAP 10 MG LENVIMA CAP 14 MG LENVIMA CAP 18 MG LENVIMA CAP 20 MG LENVIMA CAP 24 MG LENVIMA CAP 8 MG lessina tab LETAIRIS TAB 10MG LETAIRIS TAB 5MG letrozole tab leucovorin calcium for inj leucovorin calcium for inj leucovorin calcium for inj leucovorin calcium for inj leucovorin calcium for inj leucovorin calcium tab leucovorin calcium tab leucovorin calcium tab leucovorin calcium tab LEUKERAN TAB 2MG leuprolide acetate inj kit 5 /ml levalbuterol hcl soln nebu 1.25 /3ml (base equiv). 63 levalbuterol hcl soln nebu conc 1.25 /0.5ml (base equiv) levalbuterol tartrate inhal aerosol 45 mcg/act (base equiv) LEVEMIR INJ LEVEMIR INJ FLEXTOUC 43 levetiracetam in sodium chloride iv soln 1000 /100ml levetiracetam in sodium chloride iv soln 1500 /100ml levetiracetam in sodium chloride iv soln 500 /100ml levetiracetam inj 500 /5ml (100 /ml) levetiracetam oral soln 100 /ml levetiracetam tab levetiracetam tab levetiracetam tab levetiracetam tab levetiracetam tab er 24hr levetiracetam tab er 24hr levobunolol hcl ophth soln 0.5% levocarnitine inj 200 /ml 47 levocarnitine oral soln 1 gm/10ml (10%) levocarnitine tab levocetirizine dihydrochloride soln 2.5 /5ml (0.5 /ml) levocetirizine dihydrochloride tab levofloxacin in d5w iv soln 250 /50ml levofloxacin in d5w iv soln 500 /100ml levofloxacin in d5w iv soln 750 /150ml levofloxacin iv soln 25 /ml levofloxacin oral soln 25 /ml levofloxacin tab levofloxacin tab levofloxacin tab LEVOLEUCOVOR INJ 175MG LEVOLEUCOVOR SOL 250MG/ levoleucovorin calcium for iv inj 50 (base equiv) levoleucovorin calcium inj 175 /17.5ml (base equiv) levonest tab levonorgestrel & ethinyl estradiol (91-day) tab levonorgestrel & ethinyl estradiol tab mcg levonorgestrel & ethinyl estradiol tab mcg levonorgestrel-eth estra tab / / mcg levora-28 tab 0.15/ levo-t tab 100mcg levo-t tab 112mcg levo-t tab 125mcg levo-t tab 137mcg levo-t tab 150mcg levo-t tab 175mcg levo-t tab 200 mcg levo-t tab 25mcg

94 levo-t tab 300 mcg levo-t tab 50mcg levo-t tab 75mcg levo-t tab 88mcg levothyroxine sodium tab 100 mcg levothyroxine sodium tab 112 mcg levothyroxine sodium tab 125 mcg levothyroxine sodium tab 137 mcg levothyroxine sodium tab 150 mcg levothyroxine sodium tab 175 mcg levothyroxine sodium tab 200 mcg levothyroxine sodium tab 25 mcg levothyroxine sodium tab 300 mcg levothyroxine sodium tab 50 mcg levothyroxine sodium tab 75 mcg levothyroxine sodium tab 88 mcg levoxyl tab 100mcg levoxyl tab 112mcg levoxyl tab 125mcg levoxyl tab 137mcg levoxyl tab 150mcg levoxyl tab 175mcg levoxyl tab 200mcg levoxyl tab 25mcg levoxyl tab 50mcg levoxyl tab 75mcg levoxyl tab 88mcg LEXIVA SUS 50MG/ML...8 LEXIVA TAB 700MG...8 lidocaine hcl gel 2% lidocaine hcl local inj 0.5%..5 lidocaine hcl local inj 1%...5 lidocaine hcl local inj 2%...5 lidocaine hcl local preservative free (pf) inj 0.5%...5 lidocaine hcl local preservative free (pf) inj 1% 5 lidocaine hcl local preservative free (pf) inj 1.5%... 5 lidocaine hcl soln 4% lidocaine hcl viscous soln 2% lidocaine oint 5% lidocaine patch 5% lidocaine-prilocaine cream % linezolid for susp 100 /5ml... 6 linezolid in sodium chloride iv soln 600 /300ml-0.9%... 6 linezolid iv soln 600 /300ml (2 /ml)... 6 linezolid tab LINZESS CAP 145MCG LINZESS CAP 290MCG LINZESS CAP 72MCG liothyronine sodium tab 25 mcg liothyronine sodium tab 5 mcg liothyronine sodium tab 50 mcg lisinopril & hydrochlorothiazide tab lisinopril & hydrochlorothiazide tab lisinopril & hydrochlorothiazide tab lisinopril tab lisinopril tab lisinopril tab lisinopril tab lisinopril tab lisinopril tab lithium carbonate cap lithium carbonate cap lithium carbonate cap lithium carbonate tab lithium carbonate tab er lithium carbonate tab er LITHIUM SOL 8MEQ/5ML 41 LONSURF TAB LONSURF TAB loperamide hcl cap lopinavir-ritonavir soln /5ml (80-20 /ml).. 9 lorazepam conc 2 /ml lorazepam inj 2 /ml lorazepam inj 4 /ml lorazepam tab lorazepam tab lorazepam tab loryna tab losartan potassium & hydrochlorothiazide tab losartan potassium & hydrochlorothiazide tab losartan potassium & hydrochlorothiazide tab losartan potassium tab losartan potassium tab losartan potassium tab LOTEMAX GEL 0.5% LOTEMAX OIN 0.5% LOTEMAX SUS 0.5% lovastatin tab lovastatin tab lovastatin tab loxapine succinate cap loxapine succinate cap loxapine succinate cap loxapine succinate cap LUMIGAN SOL 0.01% LUMIZYME INJ 50MG LUPR DEP-PED INJ 11.25MG LUPR DEP-PED INJ 15MG 89

95 LUPR DEP-PED INJ 3M 30MG LUPR DEP-PED INJ 7.5MG LUPRON DEPOT INJ 11.25MG LUPRON DEPOT INJ 3.75MG lutera tab LYNPARZA CAP 50MG LYNPARZA TAB 100MG.. 15 LYNPARZA TAB 150MG.. 15 LYRICA CAP 100MG LYRICA CAP 150MG LYRICA CAP 200MG LYRICA CAP 225MG LYRICA CAP 25MG LYRICA CAP 300MG LYRICA CAP 50MG LYRICA CAP 75MG LYRICA SOL 20MG/ML LYSODREN TAB 500MG.. 16 lyza tab M mafenide acetate packet for topical soln 5% (50 gm) MAGNESIUM SU INJ 20/500ML MAGNESIUM SU INJ 2GM/50ML MAGNESIUM SU INJ 40G/ MAGNESIUM SU INJ 4G/100ML MAGNESIUM SU INJ 80MG/ML magnesium sulfate in dextrose 5% iv soln 1 gm/100ml magnesium sulfate inj 50% magnesium sulfate iv soln 2 gm/50ml (40 /ml) magnesium sulfate iv soln 20 gm/500ml (40 /ml) magnesium sulfate iv soln 4 gm/100ml (40 /ml) magnesium sulfate iv soln 4 gm/50ml (80 /ml) magnesium sulfate iv soln 40 gm/1000ml (40 /ml) malathion lotion 0.5% maprotiline hcl tab maprotiline hcl tab maprotiline hcl tab marlissa tab 0.15/ MARPLAN TAB 10MG MATULANE CAP 50MG MAVYRET TAB MG. 9 meclizine hcl tab meclizine hcl tab medroxyprogesterone acetate im susp 150 /ml medroxyprogesterone acetate im susp prefilled syr 150 /ml medroxyprogesterone acetate tab medroxyprogesterone acetate tab medroxyprogesterone acetate tab mefloquine hcl tab megestrol acetate susp 40 /ml megestrol acetate susp 625 /5ml megestrol acetate tab megestrol acetate tab MEKINIST TAB 0.5MG MEKINIST TAB 2MG meloxicam tab meloxicam tab melphalan hcl for inj 50 (base equiv) memantine hcl cap er 24hr memantine hcl cap er 24hr memantine hcl cap er 24hr memantine hcl cap er 24hr memantine hcl oral solution 2 /ml memantine hcl tab memantine hcl tab MENACTRA INJ MENVEO INJ MEPHYTON TAB 5MG mercaptopurine tab meropenem iv for soln 1 gm 6 meropenem iv for soln mesalamine enema 4 gm. 52 mesalamine rectal enema 4 gm & cleanser wipe kit mesalamine tab delayed release mesna inj 100 /ml MESNEX TAB 400MG metformin hcl tab metformin hcl tab metformin hcl tab metformin hcl tab er 24hr metformin hcl tab er 24hr methadone con 10/ml... 4 methadone hcl soln 10 /5ml... 4 methadone hcl soln 5 /5ml... 4 methadone hcl tab methadone hcl tab methazolamide tab methazolamide tab methenamine hippurate tab 1 gm... 6 methimazole tab methimazole tab methotrexate sodium for inj 1 gm methotrexate sodium inj 250 /10ml (25 /ml) methotrexate sodium inj 50 /2ml (25 /ml) methotrexate sodium inj pf 100 /4ml (25 /ml) methotrexate sodium inj pf 1000 /40ml (25 /ml). 14 methotrexate sodium inj pf 200 /8ml (25 /ml) methotrexate sodium inj pf 250 /10ml (25 /ml) methotrexate sodium inj pf 90

96 50 /2ml (25 /ml) methotrexate sodium tab 2.5 (base equiv) methyclothiazide tab 5 25 methylphenidate hcl soln 10 /5ml methylphenidate hcl soln 5 /5ml methylphenidate hcl tab methylphenidate hcl tab methylphenidate hcl tab methylphenidate hcl tab er methylphenidate hcl tab er methylprednisolone acetate inj susp 40 /ml methylprednisolone acetate inj susp 80 /ml methylprednisolone sod succ for inj 1000 (base equiv) methylprednisolone sod succ for inj 125 (base equiv) 49 methylprednisolone sod succ for inj 40 (base equiv). 49 methylprednisolone tab methylprednisolone tab methylprednisolone tab methylprednisolone tab methylprednisolone tab therapy pack 4 (21) metipranolol ophth soln 0.3% metoclopramide hcl inj 5 /ml (base equivalent) metoclopramide hcl soln 5 /5ml (10 /10ml) (base equiv) metoclopramide hcl tab 10 (base equivalent) metoclopramide hcl tab 5 (base equivalent) metolazone tab metolazone tab metolazone tab metoprolol & hydrochlorothiazide tab metoprolol & hydrochlorothiazide tab metoprolol & hydrochlorothiazide tab metoprolol succinate tab er 24hr 100 (tartrate equiv) metoprolol succinate tab er 24hr 200 (tartrate equiv) metoprolol succinate tab er 24hr 25 (tartrate equiv) 23 metoprolol succinate tab er 24hr 50 (tartrate equiv) 23 metoprolol tartrate iv soln 5 /5ml metoprolol tartrate iv soln cart inj 5 /5ml (1 /ml) 23 metoprolol tartrate tab metoprolol tartrate tab metoprolol tartrate tab metronidazole cream 0.75% metronidazole gel 0.75%.. 67 metronidazole in nacl 0.79% iv soln 500 /100ml... 6 metronidazole lotion 0.75% metronidazole tab metronidazole tab metronidazole vaginal gel 0.75% mexiletine hcl cap mexiletine hcl cap mexiletine hcl cap MG SO4/D5W INJ 10MG/ML MG SO4/D5W INJ 20MG/ML MIACALCIN INJ 200/ML midodrine hcl tab midodrine hcl tab midodrine hcl tab migergot sup 2/ minitran dis 0.1/hr minitran dis 0.2/hr minitran dis 0.4/hr minitran dis 0.6/hr minocycline hcl cap minocycline hcl cap minocycline hcl cap minoxidil tab minoxidil tab mirtazapine orally disintegrating tab mirtazapine orally disintegrating tab mirtazapine orally disintegrating tab mirtazapine tab mirtazapine tab mirtazapine tab mirtazapine tab misoprostol tab 100 mcg misoprostol tab 200 mcg MITIGARE CAP 0.6MG... 2 mitomycin for iv soln mitomycin for iv soln mitomycin for iv soln 5 14 mitoxantrone hcl inj conc 20 /10ml (2 /ml) mitoxantrone hcl inj conc 25 /12.5ml (2 /ml) mitoxantrone hcl inj conc 30 /15ml (2 /ml) M-M-R II INJ moexipril hcl tab moexipril hcl tab moexiprilhydrochlorothiazide tab moexiprilhydrochlorothiazide tab moexiprilhydrochlorothiazide tab

97 mometasone furoate cream 0.1% mometasone furoate nasal susp 50 mcg/act mometasone furoate oint 0.1% mometasone furoate solution 0.1% (lotion) mononessa tab montelukast sodium chew tab 4 (base equiv) montelukast sodium chew tab 5 (base equiv) montelukast sodium oral granules packet 4 (base equiv) montelukast sodium tab 10 (base equiv) MORPHINE SUL INJ 10MG/ML...4 MORPHINE SUL INJ 150/30ML...4 MORPHINE SUL INJ 2MG/ML...4 MORPHINE SUL INJ 4MG/ML...4 MORPHINE SUL INJ 5MG/ML...4 MORPHINE SUL INJ 8MG/ML...4 morphine sulfate inj 10 /ml...4 morphine sulfate inj 8 /ml...4 morphine sulfate iv soln 1 /ml...4 morphine sulfate iv soln pf 10 /ml...4 morphine sulfate iv soln pf 4 /ml...4 morphine sulfate iv soln pf 8 /ml...4 morphine sulfate oral soln 10 /5ml...4 morphine sulfate oral soln 100 /5ml (20 /ml)...4 morphine sulfate oral soln 20 /5ml...4 morphine sulfate tab 15.4 morphine sulfate tab 30 4 morphine sulfate tab er morphine sulfate tab er morphine sulfate tab er morphine sulfate tab er morphine sulfate tab er MOVANTIK TAB 12.5MG. 53 MOVANTIK TAB 25MG MOVIPREP SOL MOXEZA SOL 0.5% moxifloxacin hcl ophth soln 0.5% (base equiv) MOZOBIL INJ MULTAQ TAB 400MG mupirocin oint 2% MUSTARGEN INJ 10MG.. 14 MYCAMINE INJ 100MG... 7 MYCAMINE INJ 50MG... 7 mycophenolate mofetil cap mycophenolate mofetil for oral susp 200 /ml mycophenolate mofetil tab mycophenolate sodium tab dr 180 (mycophenolic acid equiv) mycophenolate sodium tab dr 360 (mycophenolic acid equiv) MYLOTARG INJ 4.5MG myorisan cap myorisan cap myorisan cap myorisan cap MYRBETRIQ TAB 25MG.. 54 MYRBETRIQ TAB 50MG.. 54 myzilra tab N nabumetone tab nabumetone tab nadolol tab nadolol tab nadolol tab nafcillin sodium for inj 1 gm nafcillin sodium for inj 2 gm nafcillin sodium for iv soln 1 gm nafcillin sodium for iv soln 10 gm nafcillin sodium for iv soln 2 gm naftifine hcl cream 2% NAGLAZYME INJ 1MG/ML nalbuphine hcl inj 10 /ml 2 nalbuphine hcl inj 20 /ml 2 naloxone hcl inj 0.4 /ml 42 naloxone hcl inj 4 /10ml 42 naloxone hcl soln cartridge 0.4 /ml naloxone hcl soln prefilled syringe 2 /2ml naltrexone hcl tab NAMENDA XR CAP 14MG NAMENDA XR CAP 21MG NAMENDA XR CAP 28MG NAMENDA XR CAP 7MG. 31 NAMENDA XR CAP TITRATIO NAMZARIC CAP NAMZARIC CAP 14-10MG NAMZARIC CAP 21-10MG NAMZARIC CAP 28-10MG NAMZARIC CAP 7-10MG. 31 naproxen dr tab naproxen dr tab naproxen sodium tab naproxen sodium tab naproxen susp 125 /5ml 2 naproxen tab naproxen tab naproxen tab naratriptan hcl tab 1 (base equiv)

98 naratriptan hcl tab 2.5 (base equiv) NASONEX SPR 50MCG/AC NATACYN SUS 5% OP nateglinide tab nateglinide tab NATPARA INJ 100MCG NATPARA INJ 25MCG NATPARA INJ 50MCG NATPARA INJ 75MCG NEBUPENT INH 300MG...6 necon tab 0.5/ necon tab 7/7/ nefazodone hcl tab nefazodone hcl tab nefazodone hcl tab nefazodone hcl tab nefazodone hcl tab neomycin sulfate tab neomycin-bacitrac znpolymyx 5(3.5)-400unt unt op oin neomycin-polymy-gramicid op sol unt-/ml neomycin-polymyxindexamethasone ophth oint 0.1% neomycin-polymyxindexamethasone ophth susp 0.1% neomycin-polymyxin-hc ophth susp neomycin-polymyxin-hc otic soln 1% neomycin-polymyxin-hc otic susp 3.5 /ml unit/ml-1% NEPHRAMINE INJ 5.4% NERLYNX TAB 40MG NEUPOGEN INJ 300/ NEUPOGEN INJ 300MCG 55 NEUPOGEN INJ 480/ NEUPOGEN INJ 480MCG 55 NEUPRO DIS 1MG/24HR. 34 NEUPRO DIS 2MG/24HR. 34 NEUPRO DIS 3MG/24HR. 34 NEUPRO DIS 4MG/24HR. 34 NEUPRO DIS 6MG/24HR. 34 NEUPRO DIS 8MG/24HR. 34 nevirapine susp 50 /5ml. 8 nevirapine tab nevirapine tab er 24hr nevirapine tab er 24hr NEXAVAR TAB 200MG niacin tab er 1000 (antihyperlipidemic) niacin tab er 500 (antihyperlipidemic) niacin tab er 750 (antihyperlipidemic) niacor tab nicardipine hcl cap nicardipine hcl cap NICOTROL INH NICOTROL NS SPR 10MG/ML nifedipine tab er 24hr nifedipine tab er 24hr nifedipine tab er 24hr nifedipine tab er 24hr osmotic release nifedipine tab er 24hr osmotic release nifedipine tab er 24hr osmotic release nikki tab nilutamide tab nimodipine cap NINLARO CAP 2.3MG NINLARO CAP 3MG NINLARO CAP 4MG NIPENT INJ 10MG NITRO-BID OIN 2% NITRO-DUR DIS 0.3MG/HR NITRO-DUR DIS 0.8MG/HR nitrofurantoin macrocrystalline cap nitrofurantoin macrocrystalline cap 50 6 nitrofurantoin monohydrate macrocrystalline cap nitroglycerin sl tab nitroglycerin sl tab nitroglycerin sl tab nitroglycerin td patch 24hr 0.1 /hr nitroglycerin td patch 24hr 0.2 /hr nitroglycerin td patch 24hr 0.4 /hr nitroglycerin td patch 24hr 0.6 /hr NORDITROPIN INJ 10/1.5ML NORDITROPIN INJ 15/1.5ML NORDITROPIN INJ 30/3ML NORDITROPIN INJ 5/1.5ML norelgestromin-ethinyl estradiol td ptwk mcg/24hr norethindrone & mestranol tab 1-50 mcg norethindrone ace & ethinyl estradiol tab 1-20 mcg 47 norethindrone ace & ethinyl estradiol tab mcg norethindrone ace & ethinyl estradiol-fe tab 1-20 mcg norethindrone ace & ethinyl estradiol-fe tab mcg norethindrone acetate tab norethindrone acetate-ethinyl estradiol tab 1-5 mcg.. 48 norethindrone ac-ethinyl estrad-fe tab 1-20/1-30/1-35 -mcg norethindrone tab

99 norethindrone-eth estradiol tab /1-35/ mcg norgestimate & ethinyl estradiol tab mcg norgestimate-eth estrad tab / / mcg norgestimate-eth estrad tab / / mcg norgestrel & ethinyl estradiol tab mcg norlyroc tab NORMOSOL -M INJ /D5W 60 NORMOSOL -R INJ /D5W 60 NORMOSOL-R INJ PH NORPACE CAP 100MG CR NORPACE CAP 150MG CR NORTHERA CAP 100MG. 26 NORTHERA CAP 200MG. 26 NORTHERA CAP 300MG. 26 nortrel tab 0.5/ nortrel tab 1/ nortrel tab 7/7/ nortriptyline hcl cap nortriptyline hcl cap nortriptyline hcl cap nortriptyline hcl cap nortriptyline hcl soln 10 /5ml NORVIR CAP 100MG...8 NORVIR SOL 80MG/ML...8 NORVIR TAB 100MG...8 NOVOLIN INJ 70/ NOVOLIN N INJ U NOVOLIN R INJ U NOVOLOG INJ 100/ML NOVOLOG INJ FLEXPEN 43 NOVOLOG INJ PENFILL.. 43 NOVOLOG MIX INJ 70/30 43 NOVOLOG MIX INJ FLEXPEN NOXAFIL SUS 40MG/ML...7 NOXAFIL TAB 100MG...7 NUCYNTA ER TAB 100MG 4 NUCYNTA ER TAB 150MG 4 NUCYNTA ER TAB 200MG 4 NUCYNTA ER TAB 250MG 4 NUCYNTA ER TAB 50MG.. 4 NUEDEXTA CAP 20-10MG NULOJIX INJ 250MG NULYTELY SOL FLAV PKS NUPLAZID TAB 17MG NUVARING MIS nyamyc pow NYMALIZE SOL 30/10ML. 24 nystatin cream unit/gm nystatin oint unit/gm nystatin susp unit/ml nystatin tab unit... 7 nystatin topical powder unit/gm nystop pow O OCTAGAM INJ 10/100ML 57 OCTAGAM INJ 10GM OCTAGAM INJ 1GM OCTAGAM INJ 2.5GM OCTAGAM INJ 20/200ML 57 OCTAGAM INJ 25GM OCTAGAM INJ 2GM/20ML OCTAGAM INJ 5GM OCTAGAM INJ 5GM/50ML octreotide acetate inj 100 mcg/ml (0.1 /ml) octreotide acetate inj 1000 mcg/ml (1 /ml) octreotide acetate inj 200 mcg/ml (0.2 /ml) octreotide acetate inj 50 mcg/ml (0.05 /ml) octreotide acetate inj 500 mcg/ml (0.5 /ml) ODEFSEY TAB... 9 ODOMZO CAP 200MG OFEV CAP 100MG OFEV CAP 150MG ofloxacin ophth soln 0.3%. 61 ofloxacin otic soln 0.3% olanzapine for im inj olanzapine orally disintegrating tab olanzapine orally disintegrating tab olanzapine orally disintegrating tab olanzapine orally disintegrating tab olanzapine tab olanzapine tab olanzapine tab olanzapine tab olanzapine tab olanzapine tab olmesartan medoxomil tab olmesartan medoxomil tab olmesartan medoxomil tab olmesartan medoxomilhydrochlorothiazide tab olmesartan medoxomilhydrochlorothiazide tab olmesartan medoxomilhydrochlorothiazide tab olmesartan-amlodipinehydrochlorothiazide tab olmesartan-amlodipinehydrochlorothiazide tab olmesartan-amlodipinehydrochlorothiazide tab olmesartan-amlodipinehydrochlorothiazide tab olmesartan-amlodipinehydrochlorothiazide tab olopatadine hcl ophth soln 0.2% (base equivalent) omega-3-acid ethyl esters 94

100 cap 1 gm omeprazole cap delayed release omeprazole cap delayed release omeprazole cap delayed release ondansetron hcl inj 4 /2ml (2 /ml) ondansetron hcl inj 40 /20ml (2 /ml) ondansetron hcl oral soln 4 /5ml ondansetron hcl tab ondansetron hcl tab ondansetron hcl tab ondansetron orally disintegrating tab ondansetron orally disintegrating tab ONFI SUS 2.5MG/ML ONFI TAB 10MG ONFI TAB 20MG OPSUMIT TAB 10MG ORACEA CAP 40MG ORFADIN CAP 10MG ORFADIN CAP 20MG ORFADIN CAP 2MG ORFADIN CAP 5MG ORFADIN SUS 4MG/ML ORKAMBI TAB ORKAMBI TAB orsythia tab oseltamivir phosphate cap 30 (base equiv)...9 oseltamivir phosphate cap 45 (base equiv)...9 oseltamivir phosphate cap 75 (base equiv)...9 oseltamivir phosphate for susp 6 /ml (base equiv)..9 oxacillin sodium for inj 1 gm (base equivalent) oxacillin sodium for inj 10 gm (base equivalent) oxacillin sodium for inj 2 gm (base equivalent) oxaliplatin for iv inj oxaliplatin for iv inj oxaliplatin iv soln 100 /20ml oxaliplatin iv soln 50 /10ml oxandrolone tab oxandrolone tab oxcarbazepine susp 300 /5ml (60 /ml) oxcarbazepine tab oxcarbazepine tab oxcarbazepine tab oxybutynin chloride syrup 5 /5ml oxybutynin chloride tab oxybutynin chloride tab er 24hr oxybutynin chloride tab er 24hr oxybutynin chloride tab er 24hr oxycodone hcl cap oxycodone hcl conc 100 /5ml (20 /ml)... 4 oxycodone hcl soln 5 /5ml... 4 oxycodone hcl tab oxycodone hcl tab oxycodone hcl tab oxycodone hcl tab oxycodone hcl tab oxycodone w/ acetaminophen soln /5ml... 5 oxycodone w/ acetaminophen tab oxycodone w/ acetaminophen tab oxycodone w/ acetaminophen tab oxycodone w/ acetaminophen tab OZEMPIC INJ 2/1.5ML P pacerone tab pacerone tab pacerone tab paclitaxel iv conc 100 /16.7ml (6 /ml) paclitaxel iv conc 150 /25ml (6 /ml) paclitaxel iv conc 30 /5ml (6 /ml) paclitaxel iv conc 300 /50ml (6 /ml) paliperidone tab er 24hr paliperidone tab er 24hr paliperidone tab er 24hr paliperidone tab er 24hr pamidronate disodium for inj pamidronate disodium for inj pamidronate disodium iv soln 3 /ml pamidronate disodium iv soln 9 /ml PAMIDRONATE INJ 6MG/ML PANRETIN GEL 0.1% pantoprazole sodium ec tab 20 (base equiv) pantoprazole sodium ec tab 40 (base equiv) paricalcitol cap 1 mcg paricalcitol cap 2 mcg paricalcitol cap 4 mcg paromomycin sulfate cap paroxetine hcl tab paroxetine hcl tab paroxetine hcl tab paroxetine hcl tab PASER GRA 4GM... 9 PAXIL SUS 10MG/5ML PAZEO DRO 0.7% PEDIARIX INJ 0.5ML PEDVAX HIB INJ peg 3350-kcl-na bicarb-naclna sulfate for soln 236 gm 52 peg 3350-kcl-na bicarb-naclna sulfate for soln 240 gm 52 peg 3350-kcl-sod bicarb-nacl 95

101 for soln 420 gm PEGANONE TAB 250MG. 29 PEGASYS INJ...9 PEGASYS INJ 180MCG/M.9 PEGASYS INJ PROCLICK PEN G PROC INJ PENICILL GK/ INJ DEX 2MU PENICILL GK/ INJ DEX 3MU penicillin g potassium for inj unit penicillin g potassium for inj unit penicillin g sodium for inj unit penicillin v potassium for soln 125 /5ml penicillin v potassium for soln 250 /5ml penicillin v potassium tab penicillin v potassium tab PENNSAID SOL 2% PENTACEL INJ PENTAM 300 INJ 300MG...6 pentoxifylline tab er PERFOROMIST NEB 20MCG perindopril erbumine tab perindopril erbumine tab perindopril erbumine tab periogard sol 0.12% permethrin cream 5% perphenazine tab perphenazine tab perphenazine tab perphenazine tab phenelzine sulfate tab PHENOBARB INJ 65MG/ML phenobarbital elixir 20 /5ml phenobarbital sodium inj 130 /ml phenobarbital tab phenobarbital tab phenobarbital tab phenobarbital tab phenobarbital tab phenobarbital tab phenobarbital tab phenobarbital tab PHENYTEK CAP 200MG. 29 PHENYTEK CAP 300MG. 29 phenytoin chew tab phenytoin sodium extended cap phenytoin sodium extended cap phenytoin sodium extended cap phenytoin sodium inj 50 /ml phenytoin susp 125 /5ml philith tab PHOSPHOLINE SOL 0.125%OP PICATO GEL 0.015% PICATO GEL 0.05% pilocarpine hcl ophth soln 1% pilocarpine hcl ophth soln 2% pilocarpine hcl ophth soln 4% pilocarpine hcl tab pilocarpine hcl tab pimozide tab pimozide tab pimtrea tab pindolol tab pindolol tab pioglitazone hcl tab 15 (base equiv) pioglitazone hcl tab 30 (base equiv) pioglitazone hcl tab 45 (base equiv) PIPER/TAZOBA INJ GM piperacillin sod-tazobactam na for inj gm ( gm) piperacillin sod-tazobactam sod for inj 2.25 gm ( gm) piperacillin sod-tazobactam sod for inj 4.5 gm (4-0.5 gm) piperacillin sod-tazobactam sod for inj 40.5 gm ( gm) pirmella tab 1/ piroxicam cap piroxicam cap PLASMA-LYTE INJ PLASMA-LYTE INJ -A podofilox soln 0.5% polyethylene glycol 3350 oral packet polyethylene glycol 3350 oral powder polymyxin b-trimethoprim ophth soln unit/ml- 0.1% POMALYST CAP 1MG POMALYST CAP 2MG POMALYST CAP 3MG POMALYST CAP 4MG portia-28 tab potassium chloride 20 meq/l (0.15%) in dextrose 5% inj 60 potassium chloride 40 meq/l (0.3%) in dextrose 5% inj.. 60 potassium chloride cap er 10 meq potassium chloride cap er 8 meq potassium chloride inj 10 meq/100ml potassium chloride inj 10 meq/50ml potassium chloride inj 2 meq/ml potassium chloride inj 20 meq/100ml potassium chloride inj 20 meq/50ml potassium chloride inj 40 meq/100ml potassium chloride 96

102 microencapsulated crys er tab 10 meq potassium chloride microencapsulated crys er tab 20 meq potassium chloride oral soln 10% (20 meq/15ml) potassium chloride oral soln 20% (40 meq/15ml) potassium chloride powder packet 20 meq potassium chloride tab er 10 meq potassium chloride tab er 20 meq (1500 ) potassium chloride tab er 8 meq (600 ) potassium citrate tab er 10 meq (1080 ) potassium citrate tab er 15 meq (1620 ) potassium citrate tab er 5 meq (540 ) PRADAXA CAP 110MG PRADAXA CAP 150MG PRADAXA CAP 75MG PRALUENT INJ 150MG/ML PRALUENT INJ 75MG/ML 22 pramipexole dihydrochloride tab pramipexole dihydrochloride tab pramipexole dihydrochloride tab pramipexole dihydrochloride tab pramipexole dihydrochloride tab pramipexole dihydrochloride tab prasugrel hcl tab 10 (base equiv) prasugrel hcl tab 5 (base equiv) pravastatin sodium tab pravastatin sodium tab pravastatin sodium tab pravastatin sodium tab prazosin hcl cap prazosin hcl cap prazosin hcl cap PRED SOD PHO SOL 1% OP prednisolone acetate ophth susp 1% prednisolone sod phosph oral soln 6.7 /5ml (5 /5ml base) prednisolone sod phosphate oral soln 15 /5ml (base equiv) prednisolone sodium phosphate oral soln 25 /5ml (base eq) prednisolone syrup 15 /5ml (usp solution equivalent) PREDNISONE CON 5MG/ML prednisone oral soln 5 /5ml prednisone tab prednisone tab prednisone tab prednisone tab prednisone tab prednisone tab prednisone tab therapy pack 10 (21) prednisone tab therapy pack 10 (48) prednisone tab therapy pack 5 (21) prednisone tab therapy pack 5 (48) PREMARIN TAB 0.3MG PREMARIN TAB 0.45MG. 48 PREMARIN TAB 0.625MG PREMARIN TAB 0.9MG PREMARIN TAB 1.25MG. 48 PREMASOL SOL 10% PREMPHASE TAB PREMPRO TAB PREMPRO TAB PREMPRO TAB PREMPRO TAB prenatal vitamin/folic acid > 0.8 (generic) prevalite pow 4gm prevalite pow 4gm pk previfem tab PREZCOBIX TAB PREZISTA SUS 100MG/ML... 8 PREZISTA TAB 150MG... 8 PREZISTA TAB 600MG... 8 PREZISTA TAB 75MG... 8 PREZISTA TAB 800MG... 8 PRIFTIN TAB 150MG... 9 PRIMAQUINE TAB 26.3MG7 primidone tab primidone tab PRISTIQ TAB 100MG PRISTIQ TAB 25MG PRISTIQ TAB 50MG PRIVIGEN INJ 10GRAMS 57 PRIVIGEN INJ 20GRAMS 57 PRIVIGEN INJ 40GRAMS 57 PRIVIGEN INJ 5 GRAMS. 57 probenecid tab PROCALAMINE INJ 3% prochlorperazine edisylate inj 5 /ml prochlorperazine maleate tab 10 (base equivalent) prochlorperazine maleate tab 5 (base equivalent) prochlorperazine suppos PROCRIT INJ 10000/ML.. 55 PROCRIT INJ 2000/ML PROCRIT INJ 20000/ML.. 55 PROCRIT INJ 3000/ML PROCRIT INJ 4000/ML PROCRIT INJ 40000/ML.. 55 procto-med cre hc 2.5% procto-pak cre 1% proctozone cre -hc 2.5% PROGLYCEM SUS 50MG/ML PROLASTIN-C INJ 1000MG PROLENSA SOL 0.07% PROLIA SOL 60MG/ML

103 PROMACTA TAB 12.5MG 56 PROMACTA TAB 25MG PROMACTA TAB 50MG PROMACTA TAB 75MG promethazine hcl inj 25 /ml promethazine hcl inj 50 /ml promethazine hcl syrup 6.25 /5ml promethazine hcl tab promethazine hcl tab promethazine hcl tab propafenone hcl cap er 12hr propafenone hcl cap er 12hr propafenone hcl cap er 12hr propafenone hcl tab propafenone hcl tab propafenone hcl tab proparacaine hcl ophth soln 0.5% propranolol & hydrochlorothiazide tab propranolol & hydrochlorothiazide tab propranolol hcl cap er 24hr propranolol hcl cap er 24hr propranolol hcl cap er 24hr propranolol hcl cap er 24hr propranolol hcl inj 1 /ml 23 propranolol hcl oral soln 20 /5ml propranolol hcl oral soln 40 /5ml propranolol hcl tab propranolol hcl tab propranolol hcl tab propranolol hcl tab propranolol hcl tab propylthiouracil tab PROQUAD INJ PROSOL INJ 20% protriptyline hcl tab protriptyline hcl tab PULMICORT INH 180MCG PULMICORT INH 90MCG 64 PULMOZYME SOL 1MG/ML PURIXAN SUS 20MG/ML. 14 pyrazinamide tab pyridostigmine bromide tab Q QUADRACEL INJ quasense tab quetiapine fumarate tab quetiapine fumarate tab quetiapine fumarate tab quetiapine fumarate tab quetiapine fumarate tab quetiapine fumarate tab quetiapine fumarate tab er 24hr quetiapine fumarate tab er 24hr quetiapine fumarate tab er 24hr quetiapine fumarate tab er 24hr quetiapine fumarate tab er 24hr quinapril hcl tab quinapril hcl tab quinapril hcl tab quinapril hcl tab quinapril-hydrochlorothiazide tab quinapril-hydrochlorothiazide tab quinapril-hydrochlorothiazide tab quinidine gluconate tab er quinidine sulfate tab quinidine sulfate tab quinine sulfate cap R RABAVERT INJ raloxifene hcl tab ramipril cap ramipril cap ramipril cap ramipril cap RANEXA TAB 1000MG RANEXA TAB 500MG ranitidine hcl inj 150 /6ml (25 /ml) ranitidine hcl inj 50 /2ml (25 /ml) ranitidine hcl syrup 15 /ml (75 /5ml) ranitidine hcl tab ranitidine hcl tab RAPAMUNE SOL 1MG/ML rasagiline mesylate tab 0.5 (base equiv) rasagiline mesylate tab 1 (base equiv) RAYALDEE CAP 30MCG. 60 REBETOL SOL 40MG/ML 10 REBIF INJ 22/ REBIF INJ 44/ REBIF REBIDO INJ 22/ REBIF REBIDO INJ 44/ REBIF REBIDO INJ TITRATN REBIF TITRTN INJ PACK 41 reclipsen tab RECOMBIVA HB INJ 10MCG/ML RECOMBIVA HB INJ 5MCG/ RECOMBIVA-HB INJ 98

104 40MCG/ML REGRANEX GEL 0.01%.. 67 RELENZA MIS DISKHALE RELISTOR INJ 12/0.6ML.. 53 RELISTOR INJ 8/0.4ML RELPAX TAB 20MG RELPAX TAB 40MG REMICADE INJ 100MG REMODULIN INJ 10MG/ML REMODULIN INJ 1MG/ML REMODULIN INJ 2.5MG/ML REMODULIN INJ 5MG/ML RENVELA PAK 0.8GM RENVELA PAK 2.4GM RENVELA TAB 800MG repaglinide tab repaglinide tab repaglinide tab RESCRIPTOR TAB 100 MG...8 RESCRIPTOR TAB 200MG 8 RESTASIS EMU 0.05% RESTASIS MUL EMU 0.05% RETROVIR INJ 10MG/ML..8 REVLIMID CAP 10MG REVLIMID CAP 15MG REVLIMID CAP 2.5MG REVLIMID CAP 20MG REVLIMID CAP 25MG REVLIMID CAP 5MG REXULTI TAB 0.25MG REXULTI TAB 0.5MG REXULTI TAB 1MG REXULTI TAB 2MG REXULTI TAB 3MG REXULTI TAB 4MG REYATAZ CAP 150MG...8 REYATAZ CAP 200MG...8 REYATAZ CAP 300MG...8 REYATAZ POW 50MG...8 ribasphere cap ribasphere tab ribasphere tab ribasphere tab ribavirin cap ribavirin tab rifabutin cap rifampin cap rifampin cap rifampin for inj RIFATER TAB... 9 riluzole tab rimantadine hydrochloride tab ringer's solution RISPERDAL INJ 12.5MG. 37 RISPERDAL INJ 25MG RISPERDAL INJ 37.5MG. 37 RISPERDAL INJ 50MG risperidone orally disintegrating tab risperidone orally disintegrating tab risperidone orally disintegrating tab risperidone orally disintegrating tab risperidone orally disintegrating tab risperidone orally disintegrating tab risperidone soln 1 /ml risperidone tab risperidone tab risperidone tab risperidone tab risperidone tab risperidone tab ritonavir tab RITUXAN INJ 100MG RITUXAN INJ 500MG RITUXAN INJ HYCELA rivastigmine tartrate cap rivastigmine tartrate cap rivastigmine tartrate cap rivastigmine tartrate cap rivastigmine td patch 24hr 13.3 /24hr rivastigmine td patch 24hr 4.6 /24hr rivastigmine td patch 24hr 9.5 /24hr rizatriptan benzoate oral disintegrating tab 10 (base eq) rizatriptan benzoate oral disintegrating tab 5 (base eq) rizatriptan benzoate tab 10 (base equivalent) rizatriptan benzoate tab 5 (base equivalent) ropinirole hydrochloride tab ropinirole hydrochloride tab ropinirole hydrochloride tab ropinirole hydrochloride tab ropinirole hydrochloride tab ropinirole hydrochloride tab ropinirole hydrochloride tab rosuvastatin calcium tab rosuvastatin calcium tab rosuvastatin calcium tab rosuvastatin calcium tab ROTARIX SUS ROTATEQ SOL roweepra tab roweepra tab roweepra tab roweepra xr tab 500 xr. 30 roweepra xr tab 750 xr. 30 RUBRACA TAB 200MG RUBRACA TAB 250MG RUBRACA TAB 300MG RYDAPT CAP 25MG S SABRIL POW 500MG SABRIL TAB 500MG SANDIMMUNE SOL 100MG/ML

105 SANDOSTATIN KIT LAR 10MG SANDOSTATIN KIT LAR 20MG SANDOSTATIN KIT LAR 30MG SANTYL OIN 250/GM SAPHRIS SUB 10MG SAPHRIS SUB 2.5MG SAPHRIS SUB 5MG scopolamine td patch 72hr 1 /3days selegiline hcl cap selegiline hcl tab selenium sulfide lotion 2.5% SELZENTRY SOL 20MG/ML...8 SELZENTRY TAB 150MG..8 SELZENTRY TAB 25MG...8 SELZENTRY TAB 300MG..8 SELZENTRY TAB 75MG...8 SENSIPAR TAB 30MG SENSIPAR TAB 60MG SENSIPAR TAB 90MG SEREVENT DIS AER 50MCG sertraline hcl oral concentrate for solution 20 /ml sertraline hcl tab sertraline hcl tab sertraline hcl tab sevelamer carbonate packet 0.8 gm sevelamer carbonate packet 2.4 gm sevelamer carbonate tab sharobel tab SHINGRIX INJ 50MCG SIGNIFOR INJ 0.3MG/ML. 50 SIGNIFOR INJ 0.6MG/ML. 50 SIGNIFOR INJ 0.9MG/ML. 50 sildenafil citrate tab sildenafil citrate tab sildenafil citrate tab sildenafil citrate tab SILENOR TAB 3MG SILENOR TAB 6MG silver sulfadiazine cream 1% SIMBRINZA SUS 1-0.2%.. 61 simvastatin tab simvastatin tab simvastatin tab simvastatin tab simvastatin tab sirolimus tab sirolimus tab sirolimus tab SIRTURO TAB 100MG... 9 SIVEXTRO INJ 200MG... 6 SIVEXTRO TAB 200MG... 6 sodium chloride inj 0.45%. 60 sodium chloride inj 2.5 meq/ml (14.6%) sodium chloride inj 3% sodium chloride inj 5% sodium chloride irrigation soln 0.9% sodium chloride iv soln 0.9% sodium fluoride chew; tab; 1.1 (0.5 f) /ml soln sodium phenylbutyrate oral powder 3 gm/teaspoonful.. 48 sodium phenylbutyrate tab sodium polystyrene sulfonate oral susp 15 gm/60ml sodium polystyrene sulfonate powder SOLIQUA INJ 100/ SOLTAMOX SOL 10MG/5ML SOLU-CORTEF INJ 250MG SOMATULINE INJ 120/.5ML SOMATULINE INJ 60/0.2ML SOMATULINE INJ 90/0.3ML SOMAVERT INJ 10MG SOMAVERT INJ 15MG SOMAVERT INJ 20MG SOMAVERT INJ 25MG SOMAVERT INJ 30MG sorine tab sorine tab sorine tab sorine tab sotalol hcl (afib/afl) tab sotalol hcl (afib/afl) tab sotalol hcl (afib/afl) tab sotalol hcl tab sotalol hcl tab sotalol hcl tab sotalol hcl tab SOVALDI TAB 400MG spironolactone & hydrochlorothiazide tab spironolactone tab spironolactone tab spironolactone tab sprintec 28 tab 28 day SPRITAM TAB 1000MG SPRITAM TAB 250MG SPRITAM TAB 500MG SPRITAM TAB 750MG SPRYCEL TAB 100MG SPRYCEL TAB 140MG SPRYCEL TAB 20MG SPRYCEL TAB 50MG SPRYCEL TAB 70MG SPRYCEL TAB 80MG ssd cre 1% STALEVO 100 TAB STALEVO 125 TAB STALEVO 150 TAB STALEVO 200 TAB STALEVO 50 TAB STALEVO 75 TAB stavudine cap stavudine cap stavudine cap stavudine cap STIMATE SOL 1.5MG/ML 51 STIVARGA TAB 40MG streptomycin sulfate for inj 1 gm... 5 STRIBILD TAB... 9 SUBOXONE MIS 12-3MG 42 SUBOXONE MIS 2-0.5MG 100

106 SUBOXONE MIS 4-1MG.. 42 SUBOXONE MIS 8-2MG.. 42 sucralfate tab 1 gm sulfacetamide sodium lotion 10% (acne) sulfacetamide sodium ophth oint 10% sulfacetamide sodium ophth soln 10% sulfacetamide sodiumprednisolone ophth soln (0.25)% SULFADIAZINE TAB 500MG...5 sulfamethoxazoletrimethoprim iv soln /5ml...6 sulfamethoxazoletrimethoprim susp /5ml...6 sulfamethoxazoletrimethoprim tab sulfamethoxazoletrimethoprim tab SULFAMYLON CRE 85MG/GM SULFAMYLON PAK 5% sulfasalazine tab sulfasalazine tab delayed release sulindac tab sulindac tab sumatriptan nasal spray 20 /act sumatriptan nasal spray 5 /act sumatriptan succinate inj 6 /0.5ml sumatriptan succinate solution auto-injector 4 /0.5ml sumatriptan succinate solution auto-injector 6 /0.5ml sumatriptan succinate solution cartridge 4 /0.5ml sumatriptan succinate solution cartridge 6 /0.5ml sumatriptan succinate solution prefilled syringe 6 /0.5ml sumatriptan succinate tab sumatriptan succinate tab sumatriptan succinate tab SUPRAX CAP 400MG SUPRAX CHW 100MG SUPRAX CHW 200MG SUPRAX SUS 500/5ML SUPREP BOWEL SOL PREP KIT SUSTIVA CAP 200MG... 8 SUSTIVA CAP 50MG... 8 SUSTIVA TAB 600MG... 8 SUTENT CAP 12.5MG SUTENT CAP 25MG SUTENT CAP 37.5MG SUTENT CAP 50MG SYLATRON KIT 200MCG. 17 SYLATRON KIT 300MCG. 17 SYLATRON KIT 600MCG. 17 SYMBICORT AER SYMBICORT AER SYMLINPEN 60 INJ 1000MCG SYMLNPEN 120 INJ 1000MCG SYNAGIS INJ 100MG/ML. 58 SYNAGIS INJ 50MG SYNAREL SOL 2MG/ML.. 47 SYNERCID INJ 500MG... 6 SYNRIBO INJ 3.5MG SYNTHROID TAB 100MCG SYNTHROID TAB 112MCG SYNTHROID TAB 125MCG SYNTHROID TAB 137MCG SYNTHROID TAB 150MCG SYNTHROID TAB 175MCG SYNTHROID TAB 200MCG SYNTHROID TAB 25MCG 51 SYNTHROID TAB 300MCG SYNTHROID TAB 50MCG 51 SYNTHROID TAB 75MCG 51 SYNTHROID TAB 88MCG 51 SYPRINE CAP 250MG T TABLOID TAB 40MG tacrolimus cap tacrolimus cap tacrolimus cap tacrolimus oint 0.03% tacrolimus oint 0.1% TAFINLAR CAP 50MG TAFINLAR CAP 75MG TAGRISSO TAB 40MG TAGRISSO TAB 80MG TAMIFLU SUS 6MG/ML tamoxifen citrate tab 10 (base equivalent) tamoxifen citrate tab 20 (base equivalent) tamsulosin hcl cap TARCEVA TAB 100MG TARCEVA TAB 150MG TARCEVA TAB 25MG TARGRETIN GEL 1% tarina fe tab 1/ TASIGNA CAP 150MG TASIGNA CAP 200MG TAXOTERE INJ 80MG/4ML tazarotene cream 0.1% tazicef inj 1gm tazicef inj 2gm tazicef inj 6gm TAZORAC CRE 0.05% TECENTRIQ INJ 1200/ TEFLARO INJ 400MG TEFLARO INJ 600MG TEGRETOL SUS 100/5ML TEGRETOL TAB 200MG.. 30 TEGRETOL-XR TAB 100MG TEGRETOL-XR TAB 200MG 101

107 TEGRETOL-XR TAB 400MG TEKTURNA HCT TAB TEKTURNA HCT TAB MG TEKTURNA HCT TAB TEKTURNA HCT TAB MG TEKTURNA TAB 150MG.. 25 TEKTURNA TAB 300MG.. 25 temazepam cap temazepam cap TENIVAC INJ 5-2LF tenofovir disoproxil fumarate tab terazosin hcl cap 1 (base equivalent) terazosin hcl cap 10 (base equivalent) terazosin hcl cap 2 (base equivalent) terazosin hcl cap 5 (base equivalent) terbinafine hcl tab terbutaline sulfate tab terbutaline sulfate tab terconazole vaginal cream 0.4% terconazole vaginal cream 0.8% terconazole vaginal suppos testosterone cypionate im inj in oil 100 /ml testosterone cypionate im inj in oil 200 /ml testosterone enanthate im inj in oil 200 /ml testosterone td gel 12.5 /act (1%) testosterone td gel 25 /2.5gm (1%) testosterone td gel 50 /5gm (1%) TET/DIP TOX INJ 2-2 LF.. 58 tetrabenazine tab tetrabenazine tab TEXACORT SOL 2.5% THALOMID CAP 100MG.. 16 THALOMID CAP 150MG.. 16 THALOMID CAP 200MG.. 16 THALOMID CAP 50MG THEO-24 CAP 100MG CR 64 THEO-24 CAP 200MG CR 64 THEO-24 CAP 300MG CR 64 THEO-24 CAP 400MG ER 64 theophylline soln 80 /15ml theophylline tab er 12hr theophylline tab er 12hr theophylline tab er 12hr theophylline tab er 12hr theophylline tab er 24hr theophylline tab er 24hr thioridazine hcl tab thioridazine hcl tab thioridazine hcl tab thioridazine hcl tab thiothixene cap thiothixene cap thiothixene cap thiothixene cap tiagabine hcl tab tiagabine hcl tab tiagabine hcl tab tiagabine hcl tab tigecycline for iv soln 50 6 TIGECYCLINE INJ 50MG... 6 timolol maleate ophth gel forming soln 0.25% timolol maleate ophth gel forming soln 0.5% timolol maleate ophth soln 0.25% timolol maleate ophth soln 0.5% timolol maleate ophth soln 0.5% (once-daily) timolol maleate tab timolol maleate tab timolol maleate tab TIVICAY TAB 10MG... 8 TIVICAY TAB 25MG... 8 TIVICAY TAB 50MG... 8 tizanidine hcl tab 2 (base equivalent) tizanidine hcl tab 4 (base equivalent) TOBRADEX OIN % 60 TOBRADEX ST SUS tobramycin nebu soln 300 /5ml... 5 tobramycin ophth soln 0.3% tobramycin sulfate for inj 1.2 gm... 5 tobramycin sulfate inj 1.2 gm/30ml (40 /ml) (base equiv)... 5 tobramycin sulfate inj 10 /ml (base equivalent)... 5 tobramycin sulfate inj 2 gm/50ml (40 /ml) (base equiv)... 5 tobramycin sulfate inj 80 /2ml (40 /ml) (base equiv)... 5 tobramycin-dexamethasone ophth susp % tolterodine tartrate cap er 24hr tolterodine tartrate cap er 24hr tolterodine tartrate tab tolterodine tartrate tab topiramate sprinkle cap topiramate sprinkle cap topiramate tab topiramate tab topiramate tab topiramate tab toposar inj 100/5ml toposar inj 1gm/50ml

108 topotecan hcl for inj TOPOTECAN INJ 4MG/4ML torsemide tab torsemide tab torsemide tab torsemide tab TOVIAZ TAB 4MG TOVIAZ TAB 8MG tpn electrol inj TRACLEER TAB 125MG.. 27 TRACLEER TAB 62.5MG. 26 TRADJENTA TAB 5MG tramadol hcl tab tramadol-acetaminophen tab trandolapril tab trandolapril tab trandolapril tab tranexamic acid iv soln 1000 /10ml (100 /ml) tranexamic acid tab TRANSDERM-SC DIS 1.5MG tranylcypromine sulfate tab TRAVASOL INJ 10% TRAVATAN Z DRO 0.004% trazodone hcl tab trazodone hcl tab trazodone hcl tab TRECATOR TAB 250MG...9 TRELEGY AER ELLIPTA.. 62 TRELSTAR MIX INJ 11.25MG TRELSTAR MIX INJ 3.75MG TRESIBA FLEX INJ 100UNIT TRESIBA FLEX INJ 200UNIT tretinoin cap tretinoin cream 0.025% tretinoin cream 0.05% tretinoin cream 0.1% tretinoin gel 0.01% tretinoin gel 0.025% triamcinolone acetonide cream 0.025% triamcinolone acetonide cream 0.1% triamcinolone acetonide cream 0.5% triamcinolone acetonide dental paste 0.1% triamcinolone acetonide lotion 0.025% triamcinolone acetonide lotion 0.1% triamcinolone acetonide oint 0.025% triamcinolone acetonide oint 0.1% triamcinolone acetonide oint 0.5% triamterene & hydrochlorothiazide cap triamterene & hydrochlorothiazide tab triamterene & hydrochlorothiazide tab trientine hcl cap trifluoperazine hcl tab 1 (base equivalent) trifluoperazine hcl tab 10 (base equivalent) trifluoperazine hcl tab 2 (base equivalent) trifluoperazine hcl tab 5 (base equivalent) trifluridine ophth soln 1% trihexyphenidyl hcl elixir 0.4 /ml trihexyphenidyl hcl tab trihexyphenidyl hcl tab tri-legest tab fe tri-lo- tab sprintec trilyte sol trimethoprim tab trimipramine maleate cap trimipramine maleate cap trimipramine maleate cap trinessa lo tab trinessa tab TRINTELLIX TAB 10MG TRINTELLIX TAB 20MG TRINTELLIX TAB 5MG tri-previfem tab TRISENOX INJ 12MG/6ML tri-sprintec tab TRIUMEQ TAB... 9 trivora-28 tab TROPHAMINE INJ 10% trospium chloride tab TRULICITY INJ 0.75/ TRULICITY INJ 1.5/ TRUMENBA INJ TRUVADA TAB TRUVADA TAB TRUVADA TAB TRUVADA TAB TWINRIX INJ TYBOST TAB 150MG... 8 TYKERB TAB 250MG TYPHIM VI INJ TYSABRI INJ 300/15ML U ULORIC TAB 40MG... 2 ULORIC TAB 80MG... 2 unithroid tab 100mcg unithroid tab 112mcg unithroid tab 125mcg unithroid tab 150mcg unithroid tab 175mcg unithroid tab 200mcg unithroid tab 25mcg unithroid tab 300mcg unithroid tab 50mcg unithroid tab 75mcg unithroid tab 88mcg ursodiol cap ursodiol tab ursodiol tab V valacyclovir hcl tab 1 gm valacyclovir hcl tab VALCHLOR GEL 0.016%

109 valganciclovir hcl for soln 50 /ml (base equiv) valganciclovir hcl tab 450 (base equivalent) valproate sodium inj 100 /ml valproate sodium oral soln 250 /5ml (base equiv) valproic acid cap valsartan tab valsartan tab valsartan tab valsartan tab valsartanhydrochlorothiazide tab valsartanhydrochlorothiazide tab valsartanhydrochlorothiazide tab valsartanhydrochlorothiazide tab valsartanhydrochlorothiazide tab vancomycin hcl cap vancomycin hcl cap vancomycin hcl for inj 10 gm...6 vancomycin hcl for inj vancomycin hcl for inj vancomycin hcl for inj vancomycin hcl for inj VANCOMYCIN INJ 1 GM...6 VANCOMYCIN INJ 500MG.6 VANCOMYCIN INJ 750MG.6 vandazole gel 0.75% VAQTA INJ 25/0.5ML VAQTA INJ 50UNT/ML VARIVAX INJ VASCEPA CAP 0.5GM VASCEPA CAP 1GM VELCADE INJ 3.5MG velivet pak VEMLIDY TAB 25MG VENCLEXTA TAB 100MG 15 VENCLEXTA TAB 10MG.. 15 VENCLEXTA TAB 50MG.. 15 VENCLEXTA TAB START PK venlafaxine hcl cap er 24hr 150 (base equivalent). 33 venlafaxine hcl cap er 24hr 37.5 (base equivalent) 33 venlafaxine hcl cap er 24hr 75 (base equivalent) venlafaxine hcl tab venlafaxine hcl tab venlafaxine hcl tab venlafaxine hcl tab venlafaxine hcl tab VENTAVIS SOL 10MCG/ML VENTAVIS SOL 20MCG/ML VENTOLIN HFA AER verapamil hcl cap er 24hr verapamil hcl cap er 24hr verapamil hcl cap er 24hr verapamil hcl cap er 24hr verapamil hcl cap er 24hr verapamil hcl cap er 24hr verapamil hcl cap er 24hr verapamil hcl iv soln 2.5 /ml verapamil hcl tab verapamil hcl tab verapamil hcl tab verapamil hcl tab er verapamil hcl tab er verapamil hcl tab er VERSACLOZ SUS 50MG/ML VERZENIO TAB 100MG VERZENIO TAB 150MG VERZENIO TAB 200MG VERZENIO TAB 50MG VESICARE TAB 10MG VESICARE TAB 5MG VIAGRA TAB 100MG VIAGRA TAB 25MG VIAGRA TAB 50MG VICTOZA INJ 18MG/3ML. 43 VIDEX EC CAP 125MG... 8 VIDEX SOL 2GM... 8 VIDEX SOL 4GM... 8 vienva tab vigabatrin powd pack VIGAMOX DRO 0.5% VIIBRYD KIT STARTER VIIBRYD TAB 10MG VIIBRYD TAB 20MG VIIBRYD TAB 40MG VIMPAT INJ 200MG/ VIMPAT SOL 10MG/ML VIMPAT TAB 100MG VIMPAT TAB 150MG VIMPAT TAB 200MG VIMPAT TAB 50MG vinblastine sulfate inj 1 /ml vincasar pfs inj 1/ml vincristine sulfate iv soln 1 /ml vinorelbine tartrate inj 10 /ml (base equiv) vinorelbine tartrate inj 50 /5ml (10 /ml) (base equiv) viorele tab VIRACEPT TAB 250MG... 8 VIRACEPT TAB 625MG... 8 VIRAMUNE SUS 50MG/5ML... 8 VIREAD POW 40MG/GM... 8 VIREAD TAB 150MG... 8 VIREAD TAB 200MG... 8 VIREAD TAB 250MG... 8 VIREAD TAB 300MG... 8 VIVITROL INJ 380MG

110 voriconazole for inj voriconazole for susp 40 /ml...7 voriconazole tab voriconazole tab VOSEVI TAB VOTRIENT TAB 200MG VRAYLAR CAP 1.5-3MG.. 38 VRAYLAR CAP 1.5MG VRAYLAR CAP 3MG VRAYLAR CAP 4.5MG VRAYLAR CAP 6MG vyfemla tab W warfarin sodium tab warfarin sodium tab warfarin sodium tab warfarin sodium tab warfarin sodium tab warfarin sodium tab warfarin sodium tab warfarin sodium tab warfarin sodium tab water for irrigation, sterile irrigation soln WELCHOL PAK 3.75GM.. 22 WELCHOL TAB 625MG X XALKORI CAP 200MG XALKORI CAP 250MG XARELTO STAR TAB 15/20MG XARELTO TAB 10MG XARELTO TAB 15MG XARELTO TAB 20MG XATMEP SOL 2.5MG/ML. 56 XELJANZ TAB 5MG XELJANZ XR TAB 11MG.. 56 XGEVA INJ XIFAXAN TAB 550MG XIGDUO XR TAB XIGDUO XR TAB MG XIGDUO XR TAB XIGDUO XR TAB MG XIGDUO XR TAB 5-500MG XOLAIR SOL 150MG XOPENEX HFA AER XTANDI CAP 40MG XULTOPHY INJ 100/ XYREM SOL 500MG/ML.. 42 Y YERVOY INJ 200MG YERVOY INJ 50MG YF-VAX INJ Z zafirlukast tab zafirlukast tab ZAVESCA CAP 100MG ZEJULA CAP 100MG ZELBORAF TAB 240MG.. 17 ZEMAIRA INJ 1000MG zenatane cap zenchent tab ZENPEP CAP ZENPEP CAP 10000UNT. 53 ZENPEP CAP 15000UNT. 53 ZENPEP CAP 20000UNT. 53 ZENPEP CAP 25000UNT. 53 ZENPEP CAP 3000UNIT.. 53 ZENPEP CAP 40000UNT. 53 ZENPEP CAP 5000UNIT.. 53 ZEPATIER TAB MG ZERIT SOL 1MG/ML... 8 ZIAGEN SOL 20MG/ML... 8 zidovudine cap zidovudine syrup 10 /ml. 8 zidovudine tab ziprasidone hcl cap ziprasidone hcl cap ziprasidone hcl cap ziprasidone hcl cap ZIRGAN GEL 0.15% zoledronic acid inj conc for iv infusion 4 /5ml zoledronic acid iv soln 5 /100ml ZOLINZA CAP 100MG zolmitriptan orally disintegrating tab zolmitriptan orally disintegrating tab zolmitriptan tab zolmitriptan tab zolpidem tartrate tab zolpidem tartrate tab 5 40 zonisamide cap zonisamide cap zonisamide cap ZONTIVITY TAB 2.08MG. 56 ZORTRESS TAB 0.25MG 57 ZORTRESS TAB 0.5MG.. 57 ZORTRESS TAB 0.75MG 57 ZOSTAVAX INJ zovia 1/35e tab zovia 1/50e tab ZYDELIG TAB 100MG ZYDELIG TAB 150MG ZYKADIA CAP 150MG ZYLET SUS % ZYPREXA RELP INJ 210MG ZYPREXA RELP INJ 300MG ZYPREXA RELP INJ 405MG ZYTIGA TAB 250MG ZYTIGA TAB 500MG

111 Este formulario ha sido actualizado para el 5/01/2018. Para obtener información más reciente o respuestas a sus preguntas, por favor llame al Departamento de Servicios a los Afiliados de AvMed Choice al desde el 1ro de octubre al 14 de febrero: 8:00 am a 8:00 pm, los 7 días de la semana. Y del 15 de febrero al 30 de septiembre: 8:00 am a 8:00 pm, de lunes a viernes, y 9:00 am a 1:00 pm los sábados (para los usuarios de TTY, 711 o el , los 7 días a la semana y las 24 horas del día) o visite 105