| AHFS Therapeutic Class |
Generic Name |
Strength |
Form |
Quantity Limits (per day supply) |
| 5-alpha-Reductase Inhibitors | FINASTERIDE | 5MG | Tablet | - |
| Adamantanes | AMANTADINE HYDROCHLORIDE | 100MG | Capsule | - |
| Adamantanes | AMANTADINE HYDROCHLORIDE | 50MG/5ML | Syrup | - |
| Adrenals | FLUTICASONE PROPIONATE | 100MCG/BLIST | Aerosol Powder Breath Activated | 60.00 per 30 days |
| Adrenals | FLUTICASONE PROPIONATE | 110MCG/ACT | Aerosol | 2.00 per 30 days |
| Adrenals | FLUTICASONE PROPIONATE | 220MCG/ACT | Aerosol | 2.00 per 30 days |
| Adrenals | FLUTICASONE PROPIONATE | 250MCG/BLIST | Aerosol Powder Breath Activated | 60.00 per 30 days |
| Adrenals | FLUTICASONE PROPIONATE | 44MCG/ACT | Aerosol | 2.00 per 30 days |
| Adrenals | FLUTICASONE PROPIONATE | 50MCG/BLIST | Aerosol Powder Breath Activated | 60.00 per 30 days |
| Adrenals | MOMETASONE FUROATE | 110MCG/INH | Aerosol Powder Breath Activated | 120.00 per 30 days |
| Adrenals | MOMETASONE FUROATE | 220MCG/INH | Aerosol Powder Breath Activated | 120.00 per 30 days |
| Adrenals | PREDNISOLONE SODIUM PHOSPHATE | 15MG/5ML | Solution | - |
| Adrenals | PREDNISONE | 10MG | Tablet | - |
| Adrenals | PREDNISONE | 1MG | Tablet | - |
| Adrenals | PREDNISONE | 20MG | Tablet | - |
| Adrenals | PREDNISONE | 5MG | Tablet | - |
| alpha-Adrenergic Agonists | BRIMONIDINE TARTRATE | 0.15% | Solution | - |
| alpha-Adrenergic Agonists | BRIMONIDINE TARTRATE | 0.2% | Solution | - |
| alpha-Adrenergic Blocking Agents | TERAZOSIN HCL | 10MG | Capsule | - |
| alpha-Adrenergic Blocking Agents | TERAZOSIN HCL | 1MG | Capsule | - |
| alpha-Adrenergic Blocking Agents | TERAZOSIN HCL | 2MG | Capsule | - |
| alpha-Adrenergic Blocking Agents | TERAZOSIN HCL | 5MG | Capsule | - |
| Aminopenicillins | AMOXICILLIN | 250MG | Capsule | - |
| Aminopenicillins | AMOXICILLIN | 250MG/5ML | Suspension Reconstituted | - |
| Aminopenicillins | AMOXICILLIN | 400MG/5ML | Suspension Reconstituted | - |
| Aminopenicillins | AMOXICILLIN | 500MG | Capsule | - |
| Aminopenicillins | AMOXICILLIN; CLAVULANIC ACID | 125MG/5ML; 31.25MG/5ML | Suspension Reconstituted | - |
| Aminopenicillins | AMOXICILLIN; CLAVULANIC ACID | 200MG/5ML; 28.5MG/5ML | Suspension Reconstituted | - |
| Aminopenicillins | AMOXICILLIN; CLAVULANIC ACID | 250MG/5ML; 62.5MG/5ML | Suspension Reconstituted | - |
| Aminopenicillins | AMOXICILLIN; CLAVULANIC ACID | 250MG; 125MG | Tablet | - |
| Aminopenicillins | AMOXICILLIN; CLAVULANIC ACID | 400MG/5ML; 57MG/5ML | Suspension Reconstituted | - |
| Aminopenicillins | AMOXICILLIN; CLAVULANIC ACID | 500MG; 125MG | Tablet | - |
| Aminopenicillins | AMOXICILLIN; CLAVULANIC ACID | 875MG; 125MG | Tablet | - |
| Aminopenicillins | AMOXICILLIN; POTASSIUM CLAVULANATE | 400MG/5ML; 57MG/5ML | Suspension Reconstituted | - |
| Aminopenicillins | AMOXICILLIN; POTASSIUM CLAVULANATE | 600MG/5ML; 42.9MG/5ML | Suspension Reconstituted | - |
| Ammonia Detoxicants | LACTULOSE | 10GM/15ML | Solution | - |
| Ammonia Detoxicants | LACTULOSE | 10GM/15ML | Solution | - |
| Amphetamines | AMPHETAMINE ASPARTATE; AMPHETAMINE SULFATE; DEXTROAMPHETAMINE SACCHARATE; DEXTROAMPHETAMINE SULFATE | 1.25MG; 1.25MG; 1.25MG; 1.25MG | Capsule Extended Release 24 Hour | - |
| Amphetamines | AMPHETAMINE ASPARTATE; AMPHETAMINE SULFATE; DEXTROAMPHETAMINE SACCHARATE; DEXTROAMPHETAMINE SULFATE | 2.5MG; 2.5MG; 2.5MG; 2.5MG | Capsule Extended Release 24 Hour | - |
| Amphetamines | AMPHETAMINE ASPARTATE; AMPHETAMINE SULFATE; DEXTROAMPHETAMINE SACCHARATE; DEXTROAMPHETAMINE SULFATE | 3.75MG; 3.75MG; 3.75MG; 3.75MG | Capsule Extended Release 24 Hour | - |
| Amphetamines | AMPHETAMINE ASPARTATE; AMPHETAMINE SULFATE; DEXTROAMPHETAMINE SACCHARATE; DEXTROAMPHETAMINE SULFATE | 5MG; 5MG; 5MG; 5MG | Capsule Extended Release 24 Hour | - |
| Amphetamines | AMPHETAMINE ASPARTATE; AMPHETAMINE SULFATE; DEXTROAMPHETAMINE SACCHARATE; DEXTROAMPHETAMINE SULFATE | 6.25MG; 6.25MG; 6.25MG; 6.25MG | Capsule Extended Release 24 Hour | - |
| Amphetamines | AMPHETAMINE ASPARTATE; AMPHETAMINE SULFATE; DEXTROAMPHETAMINE SACCHARATE; DEXTROAMPHETAMINE SULFATE | 7.5MG; 7.5MG; 7.5MG; 7.5MG | Capsule Extended Release 24 Hour | - |
| Analgesics and Antipyretics, Misc | ACETAMINOPHEN; BUTALBITAL; CAFFEINE | 325MG; 50MG; 40MG | Tablet | - |
| Angiotensin II Receptor Antagonists | HYDROCHLOROTHIAZIDE; LOSARTAN POTASSIUM | 12.5MG; 100MG | Tablet | - |
| Angiotensin II Receptor Antagonists | HYDROCHLOROTHIAZIDE; LOSARTAN POTASSIUM | 12.5MG; 50MG | Tablet | - |
| Angiotensin II Receptor Antagonists | HYDROCHLOROTHIAZIDE; LOSARTAN POTASSIUM | 25MG; 100MG | Tablet | - |
| Angiotensin II Receptor Antagonists | HYDROCHLOROTHIAZIDE; TELMISARTAN | 12.5MG; 40MG | Tablet | - |
| Angiotensin II Receptor Antagonists | HYDROCHLOROTHIAZIDE; TELMISARTAN | 12.5MG; 80MG | Tablet | - |
| Angiotensin II Receptor Antagonists | HYDROCHLOROTHIAZIDE; TELMISARTAN | 25MG; 80MG | Tablet | - |
| Angiotensin II Receptor Antagonists | HYDROCHLOROTHIAZIDE; VALSARTAN | 12.5MG; 160MG | Tablet | - |
| Angiotensin II Receptor Antagonists | HYDROCHLOROTHIAZIDE; VALSARTAN | 12.5MG; 320MG | Tablet | - |
| Angiotensin II Receptor Antagonists | HYDROCHLOROTHIAZIDE; VALSARTAN | 12.5MG; 80MG | Tablet | - |
| Angiotensin II Receptor Antagonists | HYDROCHLOROTHIAZIDE; VALSARTAN | 25MG; 160MG | Tablet | - |
| Angiotensin II Receptor Antagonists | HYDROCHLOROTHIAZIDE; VALSARTAN | 25MG; 320MG | Tablet | - |
| Angiotensin II Receptor Antagonists | LOSARTAN POTASSIUM | 100MG | Tablet | - |
| Angiotensin II Receptor Antagonists | LOSARTAN POTASSIUM | 25MG | Tablet | - |
| Angiotensin II Receptor Antagonists | LOSARTAN POTASSIUM | 50MG | Tablet | - |
| Angiotensin II Receptor Antagonists | TELMISARTAN | 20MG | Tablet | - |
| Angiotensin II Receptor Antagonists | TELMISARTAN | 40MG | Tablet | - |
| Angiotensin II Receptor Antagonists | TELMISARTAN | 80MG | Tablet | - |
| Angiotensin II Receptor Antagonists | VALSARTAN | 160MG | Tablet | - |
| Angiotensin II Receptor Antagonists | VALSARTAN | 320MG | Tablet | - |
| Angiotensin II Receptor Antagonists | VALSARTAN | 40MG | Tablet | - |
| Angiotensin II Receptor Antagonists | VALSARTAN | 80MG | Tablet | - |
| Angiotensin-Converting Enzyme Inhibitors | CAPTOPRIL | 100MG | Tablet | - |
| Angiotensin-Converting Enzyme Inhibitors | CAPTOPRIL | 12.5MG | Tablet | - |
| Angiotensin-Converting Enzyme Inhibitors | CAPTOPRIL | 25MG | Tablet | - |
| Angiotensin-Converting Enzyme Inhibitors | CAPTOPRIL | 50MG | Tablet | - |
| Angiotensin-Converting Enzyme Inhibitors | HYDROCHLOROTHIAZIDE; LISINOPRIL | 12.5MG; 10MG | Tablet | - |
| Angiotensin-Converting Enzyme Inhibitors | HYDROCHLOROTHIAZIDE; LISINOPRIL | 12.5MG; 20MG | Tablet | - |
| Angiotensin-Converting Enzyme Inhibitors | HYDROCHLOROTHIAZIDE; LISINOPRIL | 25MG; 20MG | Tablet | - |
| Angiotensin-Converting Enzyme Inhibitors | LISINOPRIL | 10MG | Tablet | - |
| Angiotensin-Converting Enzyme Inhibitors | LISINOPRIL | 2.5MG | Tablet | - |
| Angiotensin-Converting Enzyme Inhibitors | LISINOPRIL | 20MG | Tablet | - |
| Angiotensin-Converting Enzyme Inhibitors | LISINOPRIL | 30MG | Tablet | - |
| Angiotensin-Converting Enzyme Inhibitors | LISINOPRIL | 40MG | Tablet | - |
| Angiotensin-Converting Enzyme Inhibitors | LISINOPRIL | 5MG | Tablet | - |
| Angiotensin-Converting Enzyme Inhibitors | RAMIPRIL | 1.25MG | Capsule | - |
| Angiotensin-Converting Enzyme Inhibitors | RAMIPRIL | 10MG | Capsule | - |
| Angiotensin-Converting Enzyme Inhibitors | RAMIPRIL | 2.5MG | Capsule | - |
| Angiotensin-Converting Enzyme Inhibitors | RAMIPRIL | 5MG | Capsule | - |
| Anorexigenics & Resp & Cereb Stim, Misc | METHYLPHENIDATE HYDROCHLORIDE | 10MG | Capsule Extended Release 24 Hour | - |
| Anorexigenics & Resp & Cereb Stim, Misc | METHYLPHENIDATE HYDROCHLORIDE | 10MG | Tablet | - |
| Anorexigenics & Resp & Cereb Stim, Misc | METHYLPHENIDATE HYDROCHLORIDE | 18MG | Tablet Extended Release | - |
| Anorexigenics & Resp & Cereb Stim, Misc | METHYLPHENIDATE HYDROCHLORIDE | 20MG | Capsule Extended Release 24 Hour | - |
| Anorexigenics & Resp & Cereb Stim, Misc | METHYLPHENIDATE HYDROCHLORIDE | 20MG | Tablet | - |
| Anorexigenics & Resp & Cereb Stim, Misc | METHYLPHENIDATE HYDROCHLORIDE | 27MG | Tablet Extended Release | - |
| Anorexigenics & Resp & Cereb Stim, Misc | METHYLPHENIDATE HYDROCHLORIDE | 30MG | Capsule Extended Release 24 Hour | - |
| Anorexigenics & Resp & Cereb Stim, Misc | METHYLPHENIDATE HYDROCHLORIDE | 36MG | Tablet Extended Release | - |
| Anorexigenics & Resp & Cereb Stim, Misc | METHYLPHENIDATE HYDROCHLORIDE | 40MG | Capsule Extended Release 24 Hour | - |
| Anorexigenics & Resp & Cereb Stim, Misc | METHYLPHENIDATE HYDROCHLORIDE | 54MG | Tablet Extended Release | - |
| Anorexigenics & Resp & Cereb Stim, Misc | METHYLPHENIDATE HYDROCHLORIDE | 5MG | Tablet | - |
| Antiallergic Agents | OLOPATADINE HYDROCHLORIDE | 0.1% | Solution | - |
| Antibacterials | BACITRACIN ZINC; NEOMYCIN SULFATE; POLYMYXIN B SULFATE | 400UNIT/GM; 3.5MG/GM; 10000UNIT/GM | Ointment | - |
| Antibacterials | BACITRACIN ZINC; NEOMYCIN SULFATE; POLYMYXIN B SULFATE | 400UNIT/GM; 5MG/GM; 10000UNIT/GM | Ointment | - |
| Antibacterials | CLINDAMYCIN PHOSPHATE | 1% | Solution | - |
| Antibacterials | CLINDAMYCIN PHOSPHATE | 2% | Cream | - |
| Antibacterials | ERYTHROMYCIN | 2% | Gel | - |
| Antibacterials | ERYTHROMYCIN | 2% | Solution | - |
| Antibacterials | ERYTHROMYCIN | 5MG/GM | Ointment | - |
| Antibacterials | GENTAMICIN SULFATE | 0.3% | Ointment | - |
| Antibacterials | GENTAMICIN SULFATE | 0.3% | Solution | - |
| Antibacterials | GRAMICIDIN; NEOMYCIN SULFATE; POLYMYXIN B SULFATE | 0.025MG/ML; 1.75MG/ML; 10000UNIT/ML | Solution | - |
| Antibacterials | METRONIDAZOLE | 0.75% | Gel | - |
| Antibacterials | MUPIROCIN | 2% | Ointment | - |
| Antibacterials | POLYMYXIN B SULFATE; TRIMETHOPRIM SULFATE | 10000UNIT/ML; 0.1% | Solution | - |
| Antibacterials | SULFACETAMIDE SODIUM | 10% | Solution | - |
| Anticholinergic Agents | BENZTROPINE MESYLATE | 0.5MG | Tablet | - |
| Anticholinergic Agents | BENZTROPINE MESYLATE | 1MG | Tablet | - |
| Anticholinergic Agents | BENZTROPINE MESYLATE | 2MG | Tablet | - |
| Anticholinergic Agents | TRIHEXYPHENIDYL HYDROCHLORIDE | 0.4MG/ML | Elixir | - |
| Anticholinergic Agents | TRIHEXYPHENIDYL HYDROCHLORIDE | 2MG | Tablet | - |
| Anticonvulsants, Miscellaneous | CARBAMAZEPINE | 100MG | Tablet Chewable | - |
| Anticonvulsants, Miscellaneous | CARBAMAZEPINE | 100MG/5ML | Suspension | - |
| Anticonvulsants, Miscellaneous | CARBAMAZEPINE | 200MG | Tablet | - |
| Anticonvulsants, Miscellaneous | CARBAMAZEPINE | 400MG | Tablet Extended Release 12 Hour | - |
| Anticonvulsants, Miscellaneous | DIVALPROEX SODIUM | 125MG | Capsule Sprinkle | - |
| Anticonvulsants, Miscellaneous | DIVALPROEX SODIUM | 125MG | Tablet Delayed Release | - |
| Anticonvulsants, Miscellaneous | DIVALPROEX SODIUM | 250MG | Tablet Delayed Release | - |
| Anticonvulsants, Miscellaneous | DIVALPROEX SODIUM | 250MG | Tablet Extended Release 24 Hour | - |
| Anticonvulsants, Miscellaneous | DIVALPROEX SODIUM | 500MG | Tablet Delayed Release | - |
| Anticonvulsants, Miscellaneous | DIVALPROEX SODIUM | 500MG | Tablet Extended Release 24 Hour | - |
| Anticonvulsants, Miscellaneous | GABAPENTIN | 100MG | Capsule | - |
| Anticonvulsants, Miscellaneous | GABAPENTIN | 300MG | Capsule | - |
| Anticonvulsants, Miscellaneous | GABAPENTIN | 400MG | Capsule | - |
| Anticonvulsants, Miscellaneous | GABAPENTIN | 600MG | Tablet | - |
| Anticonvulsants, Miscellaneous | GABAPENTIN | 800MG | Tablet | - |
| Antidiarrhea Agents | LOPERAMIDE HYDROCHLORIDE | 2MG | Capsule | - |
| Antifungals, Miscellaneous | GRISEOFULVIN | 125MG/5ML | Suspension | - |
| Antifungals, Miscellaneous | GRISEOFULVIN ULTRAMICROSIZE | 125MG | Tablet | - |
| Antifungals, Miscellaneous | GRISEOFULVIN ULTRAMICROSIZE | 250MG | Tablet | - |
| Antigout Agents | ALLOPURINOL | 100MG | Tablet | - |
| Antigout Agents | ALLOPURINOL | 300MG | Tablet | - |
| Anti-inflammatory Agents | FLUOCINONIDE | 0.05% | Cream | - |
| Anti-inflammatory Agents | HYDROCORTISONE | 2.5% | Cream | - |
| Anti-inflammatory Agents | HYDROCORTISONE ACETATE | 25MG | Suppository | - |
| Anti-inflammatory Agents | MESALAMINE (5-ASA) | 400MG | Tablet Delayed Release | - |
| Anti-inflammatory Agents | TRIAMCINOLONE ACETONIDE | 0.1% | Cream | - |
| Antilipemic Agents, Miscellaneous | NIACIN | 1000MG | Tablet Extended Release | - |
| Antilipemic Agents, Miscellaneous | NIACIN | 500MG | Tablet Extended Release | - |
| Antilipemic Agents, Miscellaneous | NIACIN | 750MG | Tablet Extended Release | - |
| Antimanic Agents | LITHIUM CARBONATE | 150MG | Capsule | - |
| Antimanic Agents | LITHIUM CARBONATE | 300MG | Capsule | - |
| Antimanic Agents | LITHIUM CITRATE | 8MEQ/5ML | Solution | - |
| Antimuscarinics/Antispasmodics | DICYCLOMINE HYDROCHLORIDE | 10MG | Capsule | - |
| Antimuscarinics/Antispasmodics | DICYCLOMINE HYDROCHLORIDE | 10MG/5ML | Solution | - |
| Antimuscarinics/Antispasmodics | DICYCLOMINE HYDROCHLORIDE | 10MG/5ML | Syrup | - |
| Antimuscarinics/Antispasmodics | DICYCLOMINE HYDROCHLORIDE | 20MG | Tablet | - |
| Antimuscarinics/Antispasmodics | IPRATROPIUM BROMIDE | 0.02% | Solution | 450.00 per 30 days |
| Antimuscarinics/Antispasmodics | IPRATROPIUM BROMIDE | 17MCG/ACT | Aerosol Solution | 2.00 per 30 days |
| Antineoplastic Agents | GOSERELIN ACETATE | 10.8MG | Implant | - |
| Antineoplastic Agents | GOSERELIN ACETATE | 3.6MG | Implant | - |
| Antineoplastic Agents | METHOTREXATE | 2.5MG | Tablet | - |
| Antineoplastic Agents | TAMOXIFEN CITRATE | 10MG | Tablet | - |
| Antineoplastic Agents | TAMOXIFEN CITRATE | 20MG | Tablet | - |
| Antiprotozoals, Miscellaneous | METRONIDAZOLE | 250MG | Tablet | - |
| Antiprotozoals, Miscellaneous | METRONIDAZOLE | 500MG | Tablet | - |
| Antipruritics and Local Anesthetics | PHENAZOPYRIDINE HYDROCHLORIDE | 100MG | Tablet | - |
| Antipruritics and Local Anesthetics | PHENAZOPYRIDINE HYDROCHLORIDE | 200MG | Tablet | - |
| Antithyroid Agents | PROPYLTHIOURACIL | 50MG | Tablet | - |
| Antituberculosis Agents | ETHAMBUTOL HYDROCHLORIDE | 100MG | Tablet | - |
| Antituberculosis Agents | ETHAMBUTOL HYDROCHLORIDE | 400MG | Tablet | - |
| Antituberculosis Agents | ISONIAZID | 100MG | Tablet | - |
| Antituberculosis Agents | ISONIAZID | 300MG | Tablet | - |
| Antituberculosis Agents | PYRAZINAMIDE | 500MG | Tablet | - |
| Antituberculosis Agents | RIFAMPIN | 300MG | Capsule | - |
| Anxiolytics, Sedatives, & Hypnotics Misc | BUSPIRONE HYDROCHLORIDE | 10MG | Tablet | - |
| Anxiolytics, Sedatives, & Hypnotics Misc | BUSPIRONE HYDROCHLORIDE | 15MG | Tablet | - |
| Anxiolytics, Sedatives, & Hypnotics Misc | BUSPIRONE HYDROCHLORIDE | 5MG | Tablet | - |
| Anxiolytics, Sedatives, & Hypnotics Misc | HYDROXYZINE HYDROCHLORIDE | 10MG | Tablet | - |
| Anxiolytics, Sedatives, & Hypnotics Misc | HYDROXYZINE HYDROCHLORIDE | 10MG/5ML | Solution | - |
| Anxiolytics, Sedatives, & Hypnotics Misc | HYDROXYZINE HYDROCHLORIDE | 10MG/5ML | Syrup | - |
| Anxiolytics, Sedatives, & Hypnotics Misc | HYDROXYZINE HYDROCHLORIDE | 25MG | Tablet | - |
| Anxiolytics, Sedatives, & Hypnotics Misc | HYDROXYZINE HYDROCHLORIDE | 50MG | Tablet | - |
| Anxiolytics, Sedatives, & Hypnotics Misc | ZOLPIDEM TARTRATE | 10MG | Tablet | - |
| Anxiolytics, Sedatives, & Hypnotics Misc | ZOLPIDEM TARTRATE | 5MG | Tablet | - |
| Atypical Antipsychotics | QUETIAPINE FUMARATE | 100MG | Tablet | - |
| Atypical Antipsychotics | QUETIAPINE FUMARATE | 150MG | Tablet Extended Release 24 Hour | - |
| Atypical Antipsychotics | QUETIAPINE FUMARATE | 200MG | Tablet | - |
| Atypical Antipsychotics | QUETIAPINE FUMARATE | 200MG | Tablet Extended Release 24 Hour | - |
| Atypical Antipsychotics | QUETIAPINE FUMARATE | 25MG | Tablet | - |
| Atypical Antipsychotics | QUETIAPINE FUMARATE | 300MG | Tablet | - |
| Atypical Antipsychotics | QUETIAPINE FUMARATE | 300MG | Tablet Extended Release 24 Hour | - |
| Atypical Antipsychotics | QUETIAPINE FUMARATE | 400MG | Tablet | - |
| Atypical Antipsychotics | QUETIAPINE FUMARATE | 400MG | Tablet Extended Release 24 Hour | - |
| Atypical Antipsychotics | QUETIAPINE FUMARATE | 50MG | Tablet | - |
| Atypical Antipsychotics | QUETIAPINE FUMARATE | 50MG | Tablet Extended Release 24 Hour | - |
| Atypical Antipsychotics | RISPERIDONE | 0.25MG | Tablet | - |
| Atypical Antipsychotics | RISPERIDONE | 0.5MG | Tablet | - |
| Atypical Antipsychotics | RISPERIDONE | 1MG | Tablet | - |
| Atypical Antipsychotics | RISPERIDONE | 1MG/ML | Solution | - |
| Atypical Antipsychotics | RISPERIDONE | 2MG | Tablet | - |
| Atypical Antipsychotics | RISPERIDONE | 3MG | Tablet | - |
| Atypical Antipsychotics | RISPERIDONE | 4MG | Tablet | - |
| Azoles | CLOTRIMAZOLE | 1% | Solution | - |
| Azoles | FLUCONAZOLE | 150MG | Tablet | - |
| Barbiturates | PHENOBARBITAL | 100MG | Tablet | - |
| Barbiturates | PHENOBARBITAL | 15MG | Tablet | - |
| Barbiturates | PHENOBARBITAL | 20MG/5ML | Elixir | - |
| Barbiturates | PHENOBARBITAL | 20MG/5ML | Solution | - |
| Barbiturates | PHENOBARBITAL | 30MG | Tablet | - |
| Barbiturates | PHENOBARBITAL | 60MG | Tablet | - |
| Benzodiazepines | CLONAZEPAM | 0.5MG | Tablet | - |
| Benzodiazepines | DIAZEPAM | 5MG | Tablet | - |
| Benzodiazepines | TEMAZEPAM | 15MG | Capsule | - |
| Benzodiazepines | TEMAZEPAM | 30MG | Capsule | - |
| beta-Adrenergic Blocking Agents | ATENOLOL | 100MG | Tablet | - |
| beta-Adrenergic Blocking Agents | ATENOLOL | 25MG | Tablet | - |
| beta-Adrenergic Blocking Agents | ATENOLOL | 50MG | Tablet | - |
| beta-Adrenergic Blocking Agents | CARVEDILOL | 12.5MG | Tablet | - |
| beta-Adrenergic Blocking Agents | CARVEDILOL | 25MG | Tablet | - |
| beta-Adrenergic Blocking Agents | CARVEDILOL | 3.125MG | Tablet | - |
| beta-Adrenergic Blocking Agents | CARVEDILOL | 6.25MG | Tablet | - |
| beta-Adrenergic Blocking Agents | METOPROLOL SUCCINATE | 100MG | Tablet Extended Release 24 Hour | - |
| beta-Adrenergic Blocking Agents | METOPROLOL SUCCINATE | 200MG | Tablet Extended Release 24 Hour | - |
| beta-Adrenergic Blocking Agents | METOPROLOL SUCCINATE | 25MG | Tablet Extended Release 24 Hour | - |
| beta-Adrenergic Blocking Agents | METOPROLOL SUCCINATE | 50MG | Tablet Extended Release 24 Hour | - |
| beta-Adrenergic Blocking Agents | METOPROLOL TARTRATE | 100MG | Tablet | - |
| beta-Adrenergic Blocking Agents | METOPROLOL TARTRATE | 25MG | Tablet | - |
| beta-Adrenergic Blocking Agents | METOPROLOL TARTRATE | 50MG | Tablet | - |
| beta-Adrenergic Blocking Agents | TIMOLOL MALEATE | 0.25% | Gel Forming Solution | - |
| beta-Adrenergic Blocking Agents | TIMOLOL MALEATE | 0.25% | Solution | - |
| beta-Adrenergic Blocking Agents | TIMOLOL MALEATE | 0.5% | Gel Forming Solution | - |
| beta-Adrenergic Blocking Agents | TIMOLOL MALEATE | 0.5% | Solution | - |
| Biguanides | METFORMIN HYDROCHLORIDE | 1000MG | Tablet | - |
| Biguanides | METFORMIN HYDROCHLORIDE | 500MG | Tablet | - |
| Biguanides | METFORMIN HYDROCHLORIDE | 500MG | Tablet Extended Release 24 Hour | - |
| Biguanides | METFORMIN HYDROCHLORIDE | 750MG | Tablet Extended Release 24 Hour | - |
| Biguanides | METFORMIN HYDROCHLORIDE | 850MG | Tablet | - |
| Bone Resorption Inhibitors | ALENDRONATE SODIUM | 10MG | Tablet | - |
| Bone Resorption Inhibitors | ALENDRONATE SODIUM | 35MG | Tablet | - |
| Bone Resorption Inhibitors | ALENDRONATE SODIUM | 5MG | Tablet | - |
| Bone Resorption Inhibitors | ALENDRONATE SODIUM | 70MG | Tablet | - |
| Bone Resorption Inhibitors | ALENDRONATE SODIUM; CHOLECALCIFEROL | 70MG; 5600UNIT | Tablet | - |
| Bone Resorption Inhibitors | IBANDRONATE SODIUM | 150MG | Tablet | - |
| Calcium-Channel Blocking Agents, Misc | DILTIAZEM HYDROCHLORIDE | 120MG | Capsule Extended Release 24 Hour | - |
| Calcium-Channel Blocking Agents, Misc | DILTIAZEM HYDROCHLORIDE | 180MG | Capsule Extended Release 24 Hour | - |
| Calcium-Channel Blocking Agents, Misc | DILTIAZEM HYDROCHLORIDE | 240MG | Capsule Extended Release 24 Hour | - |
| Calcium-Channel Blocking Agents, Misc | DILTIAZEM HYDROCHLORIDE | 300MG | Capsule Extended Release 24 Hour | - |
| Calcium-Channel Blocking Agents, Misc | DILTIAZEM HYDROCHLORIDE | 360MG | Capsule Extended Release 24 Hour | - |
| Calcium-Channel Blocking Agents, Misc | DILTIAZEM HYDROCHLORIDE | 420MG | Capsule Extended Release 24 Hour | - |
| Calcium-Channel Blocking Agents, Misc | VERAPAMIL HYDROCHLORIDE | 120MG | Tablet Extended Release | - |
| Calcium-Channel Blocking Agents, Misc | VERAPAMIL HYDROCHLORIDE | 180MG | Tablet Extended Release | - |
| Calcium-Channel Blocking Agents, Misc | VERAPAMIL HYDROCHLORIDE | 240MG | Tablet Extended Release | - |
| Cardiotonic Agents | DIGOXIN | 0.125MG | Tablet | - |
| Cardiotonic Agents | DIGOXIN | 0.25MG | Tablet | - |
| Cell Stimulants and Proliferants | TRETINOIN | 0.025% | Cream | - |
| Cell Stimulants and Proliferants | TRETINOIN | 0.05% | Cream | - |
| Central Alpha-Agonists | CLONIDINE HYDROCHLORIDE | 0.1MG | Tablet | - |
| Central Alpha-Agonists | CLONIDINE HYDROCHLORIDE | 0.2MG | Tablet | - |
| Central Alpha-Agonists | CLONIDINE HYDROCHLORIDE | 0.3MG | Tablet | - |
| Centrally Acting Skeletal Muscle Relaxants | CYCLOBENZAPRINE HYDROCHLORIDE | 10MG | Tablet | - |
| Centrally Acting Skeletal Muscle Relaxants | METHOCARBAMOL | 500MG | Tablet | - |
| Class III Antiarrhythmics | AMIODARONE HCL | 200MG | Tablet | - |
| Contraceptives | DROSPIRENONE; ETHINYL ESTRADIOL | 3MG; 0.02MG | Tablet | - |
| Contraceptives | DROSPIRENONE; ETHINYL ESTRADIOL | 3MG; 0.03MG | Tablet | - |
| Contraceptives | ETHINYL ESTRADIOL; LEVONORGESTREL | 0.03MG; 0.15MG | Tablet | - |
| Contraceptives | ETHINYL ESTRADIOL; LEVONORGESTREL | 0.03MG; 0.15MG | Tablet | - |
| Contraceptives | ETHINYL ESTRADIOL; LEVONORGESTREL | 20MCG; 0.1MG | Tablet | - |
| Contraceptives | ETHINYL ESTRADIOL; LEVONORGESTREL | 30MCG; 0.15MG | Tablet | - |
| Contraceptives | ETHINYL ESTRADIOL; NORETHINDRONE | 35MCG; 1MG | Tablet | - |
| Contraceptives | ETHINYL ESTRADIOL; NORGESTIMATE | 0; 0 | Tablet | - |
| Contraceptives | ETHINYL ESTRADIOL; NORGESTIMATE | 0; 0 | Tablet | - |
| Contraceptives | ETHINYL ESTRADIOL; NORGESTIMATE | 35MCG; 0.25MG | Tablet | - |
| Contraceptives | LEVONORGESTREL | 0.75MG | Tablet | 2.00 per days |
| Contraceptives | NORETHINDRONE | 0.35MG | Tablet | - |
| Corticosteroids | FLUTICASONE PROPIONATE | 50MCG/ACT | Suspension | 16.00 per 30 days |
| Corticosteroids | HYDROCORTISONE; NEOMYCIN SULFATE; POLYMYXIN B SULFATE | 1%; 3.5MG/ML; 10000UNIT/ML | Suspension | - |
| Corticosteroids | PREDNISOLONE ACETATE | 0.12% | Suspension | - |
| Corticosteroids | PREDNISOLONE ACETATE | 1% | Suspension | - |
| Coumarin Derivatives | WARFARIN SODIUM | 10MG | Tablet | - |
| Coumarin Derivatives | WARFARIN SODIUM | 1MG | Tablet | - |
| Coumarin Derivatives | WARFARIN SODIUM | 2.5MG | Tablet | - |
| Coumarin Derivatives | WARFARIN SODIUM | 2MG | Tablet | - |
| Coumarin Derivatives | WARFARIN SODIUM | 3MG | Tablet | - |
| Coumarin Derivatives | WARFARIN SODIUM | 4MG | Tablet | - |
| Coumarin Derivatives | WARFARIN SODIUM | 5MG | Tablet | - |
| Coumarin Derivatives | WARFARIN SODIUM | 6MG | Tablet | - |
| Coumarin Derivatives | WARFARIN SODIUM | 7.5MG | Tablet | - |
| Derivatives, Miscellaneous | CYPROHEPTADINE HYDROCHLORIDE | 2MG/5ML | Syrup | - |
| Derivatives, Miscellaneous | CYPROHEPTADINE HYDROCHLORIDE | 4MG | Tablet | - |
| Devices | INHALER SPACER (MTF CHOICE) | | Miscellaneous | - |
| Devices | INSULIN SYRINGE | U-100/1ML/31G X 5/16" | Miscellaneous | - |
| Diabetes Mellitus | GLUCOSE TEST STRIPS | 0 | Strip | 204.00 per 30 days |
| Dihydropyridines | AMLODIPINE BESYLATE | 10MG | Tablet | - |
| Dihydropyridines | AMLODIPINE BESYLATE | 2.5MG | Tablet | - |
| Dihydropyridines | AMLODIPINE BESYLATE | 5MG | Tablet | - |
| Dihydropyridines | AMLODIPINE BESYLATE; BENAZEPRIL HCL | 10MG; 20MG | Capsule | - |
| Dihydropyridines | AMLODIPINE BESYLATE; BENAZEPRIL HCL | 10MG; 40MG | Capsule | - |
| Dihydropyridines | AMLODIPINE BESYLATE; BENAZEPRIL HCL | 2.5MG; 10MG | Capsule | - |
| Dihydropyridines | AMLODIPINE BESYLATE; BENAZEPRIL HCL | 5MG; 10MG | Capsule | - |
| Dihydropyridines | AMLODIPINE BESYLATE; BENAZEPRIL HCL | 5MG; 20MG | Capsule | - |
| Dihydropyridines | AMLODIPINE BESYLATE; BENAZEPRIL HCL | 5MG; 40MG | Capsule | - |
| Dihydropyridines | NIFEDIPINE | 30MG | Tablet Extended Release 24 Hour | - |
| Dihydropyridines | NIFEDIPINE | 60MG | Tablet Extended Release 24 Hour | - |
| Dihydropyridines | NIFEDIPINE | 90MG | Tablet Extended Release 24 Hour | - |
| Dipeptidyl Peptidase-4 (DPP-4) Inhibitors | METFORMIN HYDROCHLORIDE; SITAGLIPTIN PHOSPHATE | 1000MG; 50MG | Tablet | - |
| Dipeptidyl Peptidase-4 (DPP-4) Inhibitors | METFORMIN HYDROCHLORIDE; SITAGLIPTIN PHOSPHATE | 500MG; 50MG | Tablet | - |
| Dipeptidyl Peptidase-4 (DPP-4) Inhibitors | SITAGLIPTIN PHOSPHATE | 100MG | Tablet | - |
| Dipeptidyl Peptidase-4 (DPP-4) Inhibitors | SITAGLIPTIN PHOSPHATE | 25MG | Tablet | - |
| Dipeptidyl Peptidase-4 (DPP-4) Inhibitors | SITAGLIPTIN PHOSPHATE | 50MG | Tablet | - |
| Direct Vasodilators | HYDRALAZINE HYDROCHLORIDE | 10MG | Tablet | - |
| Direct Vasodilators | HYDRALAZINE HYDROCHLORIDE | 25MG | Tablet | - |
| Direct Vasodilators | HYDRALAZINE HYDROCHLORIDE | 50MG | Tablet | - |
| Dopamine Precursors | CARBIDOPA ANHYDROUS; LEVODOPA | 10MG; 100MG | Tablet | - |
| Dopamine Precursors | CARBIDOPA ANHYDROUS; LEVODOPA | 25MG; 100MG | Tablet | - |
| Dopamine Precursors | CARBIDOPA ANHYDROUS; LEVODOPA | 25MG; 250MG | Tablet | - |
| EENT Anti-infectives, Miscellaneous | CHLORHEXIDINE GLUCONATE | 0.12% | Solution | - |
| Erythromycins | ERYTHROMYCIN | 250MG | Tablet Delayed Release | - |
| Erythromycins | ERYTHROMYCIN ETHYLSUCCINATE | 200MG/5ML | Suspension Reconstituted | - |
| Erythromycins | ERYTHROMYCIN STEARATE | 250MG | Tablet | - |
| Estrogen Agonist-Antagonists | RALOXIFENE HYDROCHLORIDE | 60MG | Tablet | - |
| Estrogens | ESTRADIOL | 0.025MG/24HR | Patch Weekly | - |
| Estrogens | ESTRADIOL | 0.05MG/24HR | Patch Weekly | - |
| Estrogens | ESTRADIOL | 0.06MG/24HR | Patch Weekly | - |
| Estrogens | ESTRADIOL | 0.075MG/24HR | Patch Weekly | - |
| Estrogens | ESTRADIOL | 0.1MG/24HR | Patch Weekly | - |
| Estrogens | ESTRADIOL | 37.5MCG/24HR | Patch Weekly | - |
| Estrogens | ESTROGENS, CONJUGATED | 0.3MG | Tablet | - |
| Estrogens | ESTROGENS, CONJUGATED | 0.45MG | Tablet | - |
| Estrogens | ESTROGENS, CONJUGATED | 0.625MG | Tablet | - |
| Estrogens | ESTROGENS, CONJUGATED | 0.625MG/GM | Cream | - |
| Estrogens | ESTROGENS, CONJUGATED | 1.25MG | Tablet | - |
| Estrogens | ESTROGENS, CONJUGATED; MEDROXYPROGESTERONE ACETATE | 0.3MG; 1.5MG | Tablet | - |
| Estrogens | ESTROGENS, CONJUGATED; MEDROXYPROGESTERONE ACETATE | 0.45MG; 1.5MG | Tablet | - |
| Estrogens | ESTROGENS, CONJUGATED; MEDROXYPROGESTERONE ACETATE | 0.625MG; 2.5MG | Tablet | - |
| Estrogens | ESTROGENS, CONJUGATED; MEDROXYPROGESTERONE ACETATE | 0.625MG; 5MG | Tablet | - |
| Fibric Acid Derivatives | FENOFIBRATE | 145MG | Tablet | - |
| Fibric Acid Derivatives | FENOFIBRATE | 48MG | Tablet | - |
| Fibric Acid Derivatives | GEMFIBROZIL | 600MG | Tablet | - |
| First Generation Cephalosporins | CEPHALEXIN | 250MG | Capsule | - |
| First Generation Cephalosporins | CEPHALEXIN | 250MG/5ML | Suspension Reconstituted | - |
| First Generation Cephalosporins | CEPHALEXIN | 500MG | Capsule | - |
| First Generation Cephalosporins | CEPHALEXIN MONOHYDRATE | 250MG | Capsule | - |
| First Generation Cephalosporins | CEPHALEXIN MONOHYDRATE | 250MG/5ML | Suspension Reconstituted | - |
| First Generation Cephalosporins | CEPHALEXIN MONOHYDRATE | 500MG | Capsule | - |
| Genitourinary Smooth Muscle Relaxants | OXYBUTYNIN CHLORIDE | 10MG | Tablet Extended Release 24 Hour | - |
| Genitourinary Smooth Muscle Relaxants | OXYBUTYNIN CHLORIDE | 15MG | Tablet Extended Release 24 Hour | - |
| Genitourinary Smooth Muscle Relaxants | OXYBUTYNIN CHLORIDE | 5MG | Tablet Extended Release 24 Hour | - |
| Genitourinary Smooth Muscle Relaxants | TOLTERODINE TARTRATE | 2MG | Capsule Extended Release 24 Hour | - |
| Genitourinary Smooth Muscle Relaxants | TOLTERODINE TARTRATE | 4MG | Capsule Extended Release 24 Hour | - |
| Histamine H2-Antagonists | RANITIDINE HYDROCHLORIDE | 150MG | Tablet | - |
| Histamine H2-Antagonists | RANITIDINE HYDROCHLORIDE | 150MG/10ML | Syrup | - |
| Histamine H2-Antagonists | RANITIDINE HYDROCHLORIDE | 15MG/ML | Syrup | - |
| Histamine H2-Antagonists | RANITIDINE HYDROCHLORIDE | 75MG/5ML | Syrup | - |
| HMG-CoA Reductase Inhibitors | ATORVASTATIN CALCIUM | 10MG | Tablet | - |
| HMG-CoA Reductase Inhibitors | ATORVASTATIN CALCIUM | 20MG | Tablet | - |
| HMG-CoA Reductase Inhibitors | ATORVASTATIN CALCIUM | 40MG | Tablet | - |
| HMG-CoA Reductase Inhibitors | ATORVASTATIN CALCIUM | 80MG | Tablet | - |
| HMG-CoA Reductase Inhibitors | PRAVASTATIN SODIUM | 10MG | Tablet | - |
| HMG-CoA Reductase Inhibitors | PRAVASTATIN SODIUM | 20MG | Tablet | - |
| HMG-CoA Reductase Inhibitors | PRAVASTATIN SODIUM | 40MG | Tablet | - |
| HMG-CoA Reductase Inhibitors | PRAVASTATIN SODIUM | 80MG | Tablet | - |
| HMG-CoA Reductase Inhibitors | SIMVASTATIN | 10MG | Tablet | - |
| HMG-CoA Reductase Inhibitors | SIMVASTATIN | 20MG | Tablet | - |
| HMG-CoA Reductase Inhibitors | SIMVASTATIN | 5MG | Tablet | - |
| HMG-CoA Reductase Inhibitors | SIMVASTATIN - HIGH DOSE (40 MG and HIGHER) | 40MG | Tablet | - |
| Hydantoins | PHENYTOIN | 125MG/5ML | Suspension | - |
| Hydantoins | PHENYTOIN | 50MG | Tablet Chewable | - |
| Hydantoins | PHENYTOIN SODIUM | 100MG | Capsule | - |
| Insulins | INSULIN ASPART (HUMAN ANALOG) | 100UNIT/ML | Solution | - |
| Insulins | INSULIN ASPART (HUMAN ANALOG); INSULIN ASPART PROTAMINE | 30UNIT/ML; 70UNIT/ML | Suspension | - |
| Insulins | INSULIN GLARGINE | 100UNIT/ML | Solution | - |
| Insulins | INSULIN HUMAN (REGULAR) | 100UNIT/ML | Solution | - |
| Insulins | INSULIN HUMAN (REGULAR); INSULIN HUMAN, ISOPHANE (NPH) | 30UNIT/ML; 70UNIT/ML | Suspension | - |
| Insulins | INSULIN HUMAN, ISOPHANE (NPH) | 100UNIT/ML | Suspension | - |
| Leukotriene Modifiers | MONTELUKAST SODIUM | 10MG | Tablet | - |
| Leukotriene Modifiers | MONTELUKAST SODIUM | 4MG | Packet | - |
| Leukotriene Modifiers | MONTELUKAST SODIUM | 4MG | Tablet Chewable | - |
| Leukotriene Modifiers | MONTELUKAST SODIUM | 5MG | Tablet Chewable | - |
| Lincomycins | CLINDAMYCIN HYDROCHLORIDE | 150MG | Capsule | - |
| Local Anesthetics | ANTIPYRINE; BENZOCAINE | 5.4%; 1.4% | Solution | - |
| Local Anesthetics | ANTIPYRINE; BENZOCAINE | 54MG/ML; 14MG/ML | Solution | - |
| Local Anti-infectives, Miscellaneous | SELENIUM SULFIDE | 2.5% | Lotion | - |
| Local Anti-infectives, Miscellaneous | SILVER SULFADIAZINE | 1% | Cream | - |
| Loop Diuretics | FUROSEMIDE | 10MG/ML | Solution | - |
| Loop Diuretics | FUROSEMIDE | 20MG | Tablet | - |
| Loop Diuretics | FUROSEMIDE | 40MG | Tablet | - |
| Mineralocorticoid (Aldost) Recept Antag | SPIRONOLACTONE | 25MG | Tablet | - |
| Miotics | PILOCARPINE HYDROCHLORIDE | 1% | Solution | - |
| Miotics | PILOCARPINE HYDROCHLORIDE | 2% | Solution | - |
| Miotics | PILOCARPINE HYDROCHLORIDE | 4% | Gel | - |
| Miotics | PILOCARPINE HYDROCHLORIDE | 4% | Solution | - |
| Miscellaneous Antidepressants | BUPROPION HCL | 100MG | Tablet | - |
| Miscellaneous Antidepressants | BUPROPION HCL | 100MG | Tablet Extended Release 12 Hour | - |
| Miscellaneous Antidepressants | BUPROPION HCL | 150MG | Tablet Extended Release 12 Hour | - |
| Miscellaneous Antidepressants | BUPROPION HCL | 150MG | Tablet Extended Release 24 Hour | - |
| Miscellaneous Antidepressants | BUPROPION HCL | 300MG | Tablet Extended Release 24 Hour | - |
| Miscellaneous Antidepressants | BUPROPION HCL | 75MG | Tablet | - |
| Multivitamin Preparations | ASCORBIC ACID; BIOTIN; CALCIUM; CHOLINE; COPPER; CYANOCOBALAMIN; ERGOCALCIFEROL; FERROUS FUMARATE; FOLIC ACID; INOSITOL; MAGNESIUM; NIACINAMIDE; PANTOTHENIC ACID; PHOSPHORUS; PYRIDOXINE HYDROCHLORIDE; RIBOFLAVIN; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN | 120MG; 10MCG; 200MG; 30MG; 2MG; 12MCG; 400UNIT; 75MG; 1MG; 25MG; 50MG; 20MG; 5MG; 50MG; 15MG; 3.5MG; 2MG; 4000UNIT; 15UNIT; 25MG | Tablet | - |
| Natural Penicillins | PENICILLIN V POTASSIUM | 125MG/5ML | Solution Reconstituted | - |
| Natural Penicillins | PENICILLIN V POTASSIUM | 250MG | Tablet | - |
| Natural Penicillins | PENICILLIN V POTASSIUM | 250MG/5ML | Solution Reconstituted | - |
| Natural Penicillins | PENICILLIN V POTASSIUM | 500MG | Tablet | - |
| Nitrates and Nitrites | ISOSORBIDE DINITRATE | 10MG | Tablet | - |
| Nitrates and Nitrites | ISOSORBIDE DINITRATE | 20MG | Tablet | - |
| Nitrates and Nitrites | ISOSORBIDE DINITRATE | 30MG | Tablet | - |
| Nitrates and Nitrites | ISOSORBIDE DINITRATE | 40MG | Tablet Extended Release | - |
| Nitrates and Nitrites | ISOSORBIDE DINITRATE | 5MG | Tablet | - |
| Nitrates and Nitrites | ISOSORBIDE MONONITRATE | 120MG | Tablet Extended Release 24 Hour | - |
| Nitrates and Nitrites | ISOSORBIDE MONONITRATE | 30MG | Tablet Extended Release 24 Hour | - |
| Nitrates and Nitrites | ISOSORBIDE MONONITRATE | 60MG | Tablet Extended Release 24 Hour | - |
| Nitrates and Nitrites | NITROGLYCERIN | 0.1MG/HR | Patch 24 Hour | - |
| Nitrates and Nitrites | NITROGLYCERIN | 0.2MG/HR | Patch 24 Hour | - |
| Nitrates and Nitrites | NITROGLYCERIN | 0.3MG/HR | Patch 24 Hour | - |
| Nitrates and Nitrites | NITROGLYCERIN | 0.4MG | Tablet Sublingual | - |
| Nitrates and Nitrites | NITROGLYCERIN | 0.4MG/HR | Patch 24 Hour | - |
| Nitrates and Nitrites | NITROGLYCERIN | 0.4MG/SPRAY | Solution | - |
| Nitrates and Nitrites | NITROGLYCERIN | 0.6MG/HR | Patch 24 Hour | - |
| Nitrates and Nitrites | NITROGLYCERIN | 0.8MG/HR | Patch 24 Hour | - |
| Nucleosides and Nucleotides | ACYCLOVIR | 200MG | Capsule | - |
| Nucleosides and Nucleotides | ACYCLOVIR | 200MG/5ML | Suspension | - |
| Nucleosides and Nucleotides | ACYCLOVIR | 400MG | Tablet | - |
| Nucleosides and Nucleotides | ACYCLOVIR | 800MG | Tablet | - |
| Opiate Agonists | ACETAMINOPHEN; CODEINE PHOSPHATE | 120MG/5ML; 12MG/5ML | Solution | - |
| Opiate Agonists | ACETAMINOPHEN; CODEINE PHOSPHATE | 300MG; 30MG | Tablet | - |
| Opiate Agonists | ACETAMINOPHEN; OXYCODONE HYDROCHLORIDE | 325MG; 5MG | Tablet | - |
| Opiate Agonists | MORPHINE SULFATE | 100MG | Tablet Extended Release 12 Hour | - |
| Opiate Agonists | MORPHINE SULFATE | 15MG | Tablet Extended Release 12 Hour | - |
| Opiate Agonists | MORPHINE SULFATE | 200MG | Tablet Extended Release 12 Hour | - |
| Opiate Agonists | MORPHINE SULFATE | 30MG | Tablet Extended Release 12 Hour | - |
| Opiate Agonists | MORPHINE SULFATE | 60MG | Tablet Extended Release 12 Hour | - |
| Opiate Agonists | TRAMADOL HCL | 50MG | Tablet | 240.00 per 30 days |
| Other Macrolides | AZITHROMYCIN | 100MG/5ML | Suspension Reconstituted | - |
| Other Macrolides | AZITHROMYCIN | 1GM | Packet | - |
| Other Macrolides | AZITHROMYCIN | 250MG | Tablet | - |
| Other Macrolides | AZITHROMYCIN | 500MG | Tablet | - |
| Other Nonsteroidal Anti-inflammatory Agents | IBUPROFEN | 400MG | Tablet | - |
| Other Nonsteroidal Anti-inflammatory Agents | IBUPROFEN | 600MG | Tablet | - |
| Other Nonsteroidal Anti-inflammatory Agents | IBUPROFEN | 800MG | Tablet | - |
| Other Nonsteroidal Anti-inflammatory Agents | INDOMETHACIN | 25MG | Capsule | - |
| Other Nonsteroidal Anti-inflammatory Agents | INDOMETHACIN | 50MG | Capsule | - |
| Other Nonsteroidal Anti-inflammatory Agents | MELOXICAM | 15MG | Tablet | - |
| Other Nonsteroidal Anti-inflammatory Agents | MELOXICAM | 7.5MG | Tablet | - |
| Other Nonsteroidal Anti-inflammatory Agents | NAPROXEN | 125MG/5ML | Suspension | - |
| Other Nonsteroidal Anti-inflammatory Agents | NAPROXEN | 250MG | Tablet | - |
| Other Nonsteroidal Anti-inflammatory Agents | NAPROXEN | 500MG | Tablet | - |
| Penicillinase-resistant Penicillins | DICLOXACILLIN SODIUM | 250MG | Capsule | - |
| Penicillinase-resistant Penicillins | DICLOXACILLIN SODIUM | 500MG | Capsule | - |
| Phenothiazine Derivatives | PROMETHAZINE HYDROCHLORIDE | 12.5MG | Suppository | - |
| Phenothiazine Derivatives | PROMETHAZINE HYDROCHLORIDE | 25MG | Suppository | - |
| Phenothiazine Derivatives | PROMETHAZINE HYDROCHLORIDE | 25MG | Tablet | - |
| Phenothiazine Derivatives | PROMETHAZINE HYDROCHLORIDE | 6.25MG/5ML | Solution | - |
| Phenothiazine Derivatives | PROMETHAZINE HYDROCHLORIDE | 6.25MG/5ML | Syrup | - |
| Phosphodiesterase Type 5 Inhibitors | SILDENAFIL CITRATE | 100MG | Tablet | 6.00 per 30 days |
| Phosphodiesterase Type 5 Inhibitors | SILDENAFIL CITRATE | 25MG | Tablet | 6.00 per 30 days |
| Phosphodiesterase Type 5 Inhibitors | SILDENAFIL CITRATE | 50MG | Tablet | 6.00 per 30 days |
| Platelet-Aggregation Inhibitors | CLOPIDOGREL BISULFATE | 300MG | Tablet | - |
| Platelet-Aggregation Inhibitors | CLOPIDOGREL BISULFATE | 75MG | Tablet | - |
| Polyenes | NYSTATIN | 100000UNIT/GM | Cream | - |
| Polyenes | NYSTATIN | 100000UNIT/GM | Ointment | - |
| Polyenes | NYSTATIN | 100000UNIT/ML | Suspension | - |
| Potassium-sparing Diuretics | HYDROCHLOROTHIAZIDE; TRIAMTERENE | 25MG; 37.5MG | Tablet | - |
| Potassium-sparing Diuretics | HYDROCHLOROTHIAZIDE; TRIAMTERENE | 50MG; 75MG | Tablet | - |
| Progestins | MEDROXYPROGESTERONE ACETATE | 10MG | Tablet | - |
| Progestins | MEDROXYPROGESTERONE ACETATE | 2.5MG | Tablet | - |
| Progestins | MEDROXYPROGESTERONE ACETATE | 5MG | Tablet | - |
| Prokinetic Agents | METOCLOPRAMIDE HYDROCHLORIDE | 10MG | Tablet | - |
| Prokinetic Agents | METOCLOPRAMIDE HYDROCHLORIDE | 10MG/10ML | Solution | - |
| Prokinetic Agents | METOCLOPRAMIDE HYDROCHLORIDE | 5MG/5ML | Solution | - |
| Prostaglandin Analogs | LATANOPROST | 0.005% | Solution | - |
| Proton-pump Inhibitors | ESOMEPRAZOLE MAGNESIUM TRIHYDRATE | 20MG | Capsule Delayed Release | - |
| Proton-pump Inhibitors | ESOMEPRAZOLE MAGNESIUM TRIHYDRATE | 40MG | Capsule Delayed Release | - |
| Proton-pump Inhibitors | OMEPRAZOLE | 10MG | Capsule Delayed Release | - |
| Proton-pump Inhibitors | OMEPRAZOLE | 20MG | Capsule Delayed Release | - |
| Quinolones | CIPROFLOXACIN | 5GM/100ML | Suspension Reconstituted | - |
| Quinolones | CIPROFLOXACIN HCL | 100MG | Tablet | - |
| Quinolones | CIPROFLOXACIN HCL | 250MG | Tablet | - |
| Quinolones | CIPROFLOXACIN HCL | 500MG | Tablet | - |
| Quinolones | CIPROFLOXACIN HCL | 750MG | Tablet | - |
| Quinolones | LEVOFLOXACIN HEMIHYDRATE | 250MG | Tablet | - |
| Quinolones | LEVOFLOXACIN HEMIHYDRATE | 25MG/ML | Solution | - |
| Quinolones | LEVOFLOXACIN HEMIHYDRATE | 500MG | Tablet | - |
| Quinolones | LEVOFLOXACIN HEMIHYDRATE | 750MG | Tablet | - |
| Replacement Preparations | POTASSIUM CHLORIDE | 10% | Liquid | - |
| Replacement Preparations | POTASSIUM CHLORIDE | 10% | Solution | - |
| Replacement Preparations | POTASSIUM CHLORIDE | 10MEQ | Capsule Extended Release | - |
| Replacement Preparations | POTASSIUM CHLORIDE | 10MEQ | Tablet Extended Release | - |
| Replacement Preparations | POTASSIUM CHLORIDE | 20MEQ | Packet | - |
| Replacement Preparations | POTASSIUM CHLORIDE | 20MEQ | Tablet Extended Release | - |
| Respiratory Smooth Muscle Relaxants | THEOPHYLLINE | 200MG | Tablet Extended Release 12 Hour | - |
| Respiratory Smooth Muscle Relaxants | THEOPHYLLINE | 300MG | Capsule Extended Release 24 Hour | - |
| Respiratory Smooth Muscle Relaxants | THEOPHYLLINE | 300MG | Tablet Extended Release 12 Hour | - |
| Respiratory Smooth Muscle Relaxants | THEOPHYLLINE | 400MG | Capsule Extended Release 24 Hour | - |
| Respiratory Smooth Muscle Relaxants | THEOPHYLLINE | 400MG | Tablet Extended Release 24 Hour | - |
| Respiratory Smooth Muscle Relaxants | THEOPHYLLINE | 80MG/15ML | Elixir | - |
| Salicylates | SALSALATE | 500MG | Tablet | - |
| Salicylates | SALSALATE | 750MG | Tablet | - |
| Scabicides and Pediculicides | PERMETHRIN | 5% | Cream | - |
| Selective alpha-1-Adrenergic Blocking Agents | ALFUZOSIN HYDROCHLORIDE | 10MG | Tablet Extended Release 24 Hour | - |
| Selective alpha-1-Adrenergic Blocking Agents | TAMSULOSIN HYDROCHLORIDE | 0.4MG | Capsule | - |
| Selective beta-2-Adrenergic Agonists | ALBUTEROL SULFATE | 0.083% | Nebulization Solution | 600.00 per 30 days |
| Selective beta-2-Adrenergic Agonists | ALBUTEROL SULFATE | 108MCG/ACT | Aerosol Solution | 2.00 per 30 days |
| Selective beta-2-Adrenergic Agonists | ALBUTEROL SULFATE; IPRATROPIUM BROMIDE | 103MCG/ACT; 18MCG/ACT | Aerosol | - |
| Selective beta-2-Adrenergic Agonists | FLUTICASONE PROPIONATE; SALMETEROL XINAFOATE | 100MCG/DOSE; 50MCG/DOSE | Aerosol Powder Breath Activated | - |
| Selective beta-2-Adrenergic Agonists | FLUTICASONE PROPIONATE; SALMETEROL XINAFOATE | 115MCG/ACT; 21MCG/ACT | Aerosol | 24.00 per 30 days |
| Selective beta-2-Adrenergic Agonists | FLUTICASONE PROPIONATE; SALMETEROL XINAFOATE | 230MCG/ACT; 21MCG/ACT | Aerosol | 24.00 per 30 days |
| Selective beta-2-Adrenergic Agonists | FLUTICASONE PROPIONATE; SALMETEROL XINAFOATE | 250MCG/DOSE; 50MCG/DOSE | Aerosol Powder Breath Activated | - |
| Selective beta-2-Adrenergic Agonists | FLUTICASONE PROPIONATE; SALMETEROL XINAFOATE | 45MCG/ACT; 21MCG/ACT | Aerosol | 24.00 per 30 days |
| Selective beta-2-Adrenergic Agonists | FLUTICASONE PROPIONATE; SALMETEROL XINAFOATE | 500MCG/DOSE; 50MCG/DOSE | Aerosol Powder Breath Activated | - |
| Selective beta-2-Adrenergic Agonists | SALMETEROL XINAFOATE | 50MCG/DOSE | Aerosol Powder Breath Activated | 60.00 per 30 days |
| Selective Serotonin Agonists | RIZATRIPTAN BENZOATE | 10MG | Tablet | 12.00 per 30 days |
| Selective Serotonin Agonists | RIZATRIPTAN BENZOATE | 10MG | Tablet Dispersible | 12.00 per 30 days |
| Selective Serotonin Agonists | RIZATRIPTAN BENZOATE | 5MG | Tablet | 12.00 per 30 days |
| Selective Serotonin Agonists | RIZATRIPTAN BENZOATE | 5MG | Tablet Dispersible | 12.00 per 30 days |
| Selective Serotonin Agonists | SUMATRIPTAN SUCCINATE | 100MG | Tablet | 9.00 per 30 days |
| Selective Serotonin Agonists | SUMATRIPTAN SUCCINATE | 25MG | Tablet | 18.00 per 30 days |
| Selective Serotonin Agonists | SUMATRIPTAN SUCCINATE | 50MG | Tablet | 18.00 per 30 days |
| Selective Serotonin Agonists | SUMATRIPTAN SUCCINATE | 6MG/0.5ML | Syringe(s) | 8.00 per 30 days |
| Selective Serotonin- and Norepinephrine-reuptake Inhibitors | VENLAFAXINE HCL | 100MG | Tablet | - |
| Selective Serotonin- and Norepinephrine-reuptake Inhibitors | VENLAFAXINE HCL | 150MG | Capsule Extended Release 24 Hour | - |
| Selective Serotonin- and Norepinephrine-reuptake Inhibitors | VENLAFAXINE HCL | 225MG | Tablet Extended Release 24 Hour | - |
| Selective Serotonin- and Norepinephrine-reuptake Inhibitors | VENLAFAXINE HCL | 25MG | Tablet | - |
| Selective Serotonin- and Norepinephrine-reuptake Inhibitors | VENLAFAXINE HCL | 37.5MG | Capsule Extended Release 24 Hour | - |
| Selective Serotonin- and Norepinephrine-reuptake Inhibitors | VENLAFAXINE HCL | 37.5MG | Tablet | - |
| Selective Serotonin- and Norepinephrine-reuptake Inhibitors | VENLAFAXINE HCL | 50MG | Tablet | - |
| Selective Serotonin- and Norepinephrine-reuptake Inhibitors | VENLAFAXINE HCL | 75MG | Capsule Extended Release 24 Hour | - |
| Selective Serotonin- and Norepinephrine-reuptake Inhibitors | VENLAFAXINE HCL | 75MG | Tablet | - |
| Selective Serotonin-reuptake Inhibitors | CITALOPRAM HYDROBROMIDE | 10MG | Tablet | - |
| Selective Serotonin-reuptake Inhibitors | CITALOPRAM HYDROBROMIDE | 10MG/5ML | Solution | - |
| Selective Serotonin-reuptake Inhibitors | CITALOPRAM HYDROBROMIDE | 20MG | Tablet | - |
| Selective Serotonin-reuptake Inhibitors | CITALOPRAM HYDROBROMIDE | 40MG | Tablet | - |
| Selective Serotonin-reuptake Inhibitors | FLUOXETINE HCL | 10MG | Capsule | - |
| Selective Serotonin-reuptake Inhibitors | FLUOXETINE HCL | 10MG | Capsule | - |
| Selective Serotonin-reuptake Inhibitors | FLUOXETINE HCL | 20MG | Capsule | - |
| Selective Serotonin-reuptake Inhibitors | FLUOXETINE HCL | 20MG | Capsule | - |
| Selective Serotonin-reuptake Inhibitors | FLUOXETINE HCL | 20MG/5ML | Solution | - |
| Selective Serotonin-reuptake Inhibitors | FLUOXETINE HCL | 40MG | Capsule | - |
| Selective Serotonin-reuptake Inhibitors | SERTRALINE HYDROCHLORIDE | 100MG | Tablet | - |
| Selective Serotonin-reuptake Inhibitors | SERTRALINE HYDROCHLORIDE | 20MG/ML | Concentrate | - |
| Selective Serotonin-reuptake Inhibitors | SERTRALINE HYDROCHLORIDE | 25MG | Tablet | - |
| Selective Serotonin-reuptake Inhibitors | SERTRALINE HYDROCHLORIDE | 50MG | Tablet | - |
| Serotonin Modulators | TRAZODONE HYDROCHLORIDE | 100MG | Tablet | - |
| Serotonin Modulators | TRAZODONE HYDROCHLORIDE | 150MG | Tablet | - |
| Serotonin Modulators | TRAZODONE HYDROCHLORIDE | 300MG | Tablet | - |
| Serotonin Modulators | TRAZODONE HYDROCHLORIDE | 50MG | Tablet | - |
| Skin and Mucous Membrane Agents, Misc | PIMECROLIMUS | 1% | Cream | - |
| Sulfonamides | SULFAMETHOXAZOLE; TRIMETHOPRIM | 200MG/5ML; 40MG/5ML | Suspension | - |
| Sulfonamides | SULFAMETHOXAZOLE; TRIMETHOPRIM | 400MG; 80MG | Tablet | - |
| Sulfonamides | SULFAMETHOXAZOLE; TRIMETHOPRIM | 800MG/20ML; 160MG/20ML | Suspension | - |
| Sulfonamides | SULFAMETHOXAZOLE; TRIMETHOPRIM | 800MG; 160MG | Tablet | - |
| Sulfonamides | SULFASALAZINE | 500MG | Tablet | - |
| Sulfonamides | SULFASALAZINE | 500MG | Tablet Delayed Release | - |
| Sulfonylureas | GLIPIZIDE | 10MG | Tablet | - |
| Sulfonylureas | GLIPIZIDE | 5MG | Tablet | - |
| Sulfonylureas | GLYBURIDE | 1.25MG | Tablet | - |
| Sulfonylureas | GLYBURIDE | 1.5MG | Tablet | - |
| Sulfonylureas | GLYBURIDE | 2.5MG | Tablet | - |
| Sulfonylureas | GLYBURIDE | 3MG | Tablet | - |
| Sulfonylureas | GLYBURIDE | 5MG | Tablet | - |
| Sulfonylureas | GLYBURIDE | 6MG | Tablet | - |
| Tetracyclines | DOXYCYCLINE HYCLATE | 100MG | Capsule | - |
| Tetracyclines | DOXYCYCLINE HYCLATE | 100MG | Tablet | - |
| Tetracyclines | TETRACYCLINE HYDROCHLORIDE | 250MG | Capsule | - |
| Tetracyclines | TETRACYCLINE HYDROCHLORIDE | 500MG | Capsule | - |
| Thiazide Diuretics | HYDROCHLOROTHIAZIDE | 12.5MG | Capsule | - |
| Thiazide Diuretics | HYDROCHLOROTHIAZIDE | 25MG | Tablet | - |
| Thiazide Diuretics | HYDROCHLOROTHIAZIDE | 50MG | Tablet | - |
| Thiazide-like Diuretics | CHLORTHALIDONE | 25MG | Tablet | - |
| Thiazide-like Diuretics | CHLORTHALIDONE | 50MG | Tablet | - |
| Thyroid Agents | LEVOTHYROXINE SODIUM | 100MCG | Tablet | - |
| Thyroid Agents | LEVOTHYROXINE SODIUM | 112MCG | Tablet | - |
| Thyroid Agents | LEVOTHYROXINE SODIUM | 125MCG | Tablet | - |
| Thyroid Agents | LEVOTHYROXINE SODIUM | 137MCG | Tablet | - |
| Thyroid Agents | LEVOTHYROXINE SODIUM | 150MCG | Tablet | - |
| Thyroid Agents | LEVOTHYROXINE SODIUM | 175MCG | Tablet | - |
| Thyroid Agents | LEVOTHYROXINE SODIUM | 200MCG | Tablet | - |
| Thyroid Agents | LEVOTHYROXINE SODIUM | 25MCG | Tablet | - |
| Thyroid Agents | LEVOTHYROXINE SODIUM | 300MCG | Tablet | - |
| Thyroid Agents | LEVOTHYROXINE SODIUM | 50MCG | Tablet | - |
| Thyroid Agents | LEVOTHYROXINE SODIUM | 75MCG | Tablet | - |
| Thyroid Agents | LEVOTHYROXINE SODIUM | 88MCG | Tablet | - |
| Tricyclics and Other Norepinephrine-reuptake Inhibitors | AMITRIPTYLINE HYDROCHLORIDE | 10MG | Tablet | - |
| Tricyclics and Other Norepinephrine-reuptake Inhibitors | AMITRIPTYLINE HYDROCHLORIDE | 25MG | Tablet | - |
| Tricyclics and Other Norepinephrine-reuptake Inhibitors | AMITRIPTYLINE HYDROCHLORIDE | 50MG | Tablet | - |
| Tricyclics and Other Norepinephrine-reuptake Inhibitors | AMITRIPTYLINE HYDROCHLORIDE | 75MG | Tablet | - |
| Tricyclics and Other Norepinephrine-reuptake Inhibitors | DOXEPIN HYDROCHLORIDE | 10MG | Capsule | - |
| Tricyclics and Other Norepinephrine-reuptake Inhibitors | DOXEPIN HYDROCHLORIDE | 10MG/ML | Concentrate | - |
| Tricyclics and Other Norepinephrine-reuptake Inhibitors | DOXEPIN HYDROCHLORIDE | 25MG | Capsule | - |
| Tricyclics and Other Norepinephrine-reuptake Inhibitors | DOXEPIN HYDROCHLORIDE | 50MG | Capsule | - |
| Tricyclics and Other Norepinephrine-reuptake Inhibitors | DOXEPIN HYDROCHLORIDE | 75MG | Capsule | - |
| Tricyclics and Other Norepinephrine-reuptake Inhibitors | IMIPRAMINE HYDROCHLORIDE | 10MG | Tablet | - |
| Tricyclics and Other Norepinephrine-reuptake Inhibitors | IMIPRAMINE HYDROCHLORIDE | 25MG | Tablet | - |
| Tricyclics and Other Norepinephrine-reuptake Inhibitors | IMIPRAMINE HYDROCHLORIDE | 50MG | Tablet | - |
| Tricyclics and Other Norepinephrine-reuptake Inhibitors | IMIPRAMINE PAMOATE | 75MG | Capsule | - |
| Tricyclics and Other Norepinephrine-reuptake Inhibitors | NORTRIPTYLINE HYDROCHLORIDE | 10MG | Capsule | - |
| Tricyclics and Other Norepinephrine-reuptake Inhibitors | NORTRIPTYLINE HYDROCHLORIDE | 25MG | Capsule | - |
| Tricyclics and Other Norepinephrine-reuptake Inhibitors | NORTRIPTYLINE HYDROCHLORIDE | 50MG | Capsule | - |
| Uricosuric Agents | PROBENECID | 500MG | Tablet | - |
| Urinary Anti-infectives | NITROFURANTOIN MACROCRYSTALLINE | 50MG | Capsule | - |
| Urinary Anti-infectives | NITROFURANTOIN MONOHYDRATE MACROCRYSTALS | 100MG | Capsule | - |
| Vitamin B Complex | FOLIC ACID | 1MG | Tablet | - |