Attachment Formulary 2500

Attachment n
Formulary for: HCHD Formulary Catalog - JEP

M&D #
User #
18325
Description
NDC #
Mfg
Generic Description
UDF 1
XYLOCAINE 20MG/ML *
145482 5285
A & D OINTMENT 2 OZ
00168-0035-01
FOU VITAMINS A AND D
561936 98137
ABELCET VL 100 MG 20ML
57665-0101-41
ENZ AMPHOTERICIN B LIPID COMPLEX
R-X
708677 98103
ABILIFY SDV 9.75MG/1.3ML
59148-0016-65
BRI
ARIPIPRAZOLE
R-X
504688 97792
ABILIFY TAB 5 MG 30
59148-0007-13
BRI
ARIPIPRAZOLE
R-X
504670 97793
ABILIFY TAB 5 MG 100UD
59148-0007-35
BRI
ARIPIPRAZOLE
R-X
446070 97436
ABILIFY TAB 10 MG 30
59148-0008-13
BRI
ARIPIPRAZOLE
R-X
446088 97437
59148-0008-35
BRI
ARIPIPRAZOLE
R-X
446096 97438
59148-0009-13
BRI
ARIPIPRAZOLE
R-X
446104 97439
59148-0009-35
BRI
ARIPIPRAZOLE
R-X
446112 97440
59148-0010-13
BRI
ARIPIPRAZOLE
R-X
446120 97441
59148-0010-35
BRI
ARIPIPRAZOLE
R-X
446138 97442
59148-0011-13
BRI
ARIPIPRAZOLE
R-X
446146 97443
59148-0011-35
BRI
ARIPIPRAZOLE
617548 98037
ABRAXANE VL 100 MG 50 ML
68817-0134-50
ABX PACLITAXEL PROTEIN-BOUND
105874 97223
ACCU-CHEK SAFE-T PRO LANCT 200
50924-0951-20
BM
798090 95825
ACEBUTOLOL CAP 200 MG 100
00378-1200-01
MYL ACEBUTOLOL HCL
798108 95826
ACEBUTOLOL CAP 400 MG 100
00378-1400-01
MYL ACEBUTOLOL HCL
R-X
534099 98088
ACETADOTE VL 200MG/ML 30ML CT4
66220-0107-30
CBL ACETYLCYSTEINE
R-X
454447 95219
ACETAMIN COD 12.5ML/100UD
00121-0504-12
PMA ACETAMINOPHEN WITH CODEINE
R-X
455022 22033
ACETAMIN COD 16 OZ
00121-0504-16
PMA ACETAMINOPHEN WITH CODEINE
R-X
504217 22568
ACETAMIN COD PHOS 300 MG 100UD
51079-0161-20
UDL ACETAMINOPHEN WITH CODEINE
R-X
425058 96192
ACETAMIN COD PHOS 300/30 100
00406-0484-01
MAL ACETAMINOPHEN WITH CODEINE
R-X
464206 98026
ACETAMIN SOL 160 MG 5ML/100
00121-0657-05
PMA ACETAMINOPHEN
R-X
581389 98173
ACETAMIN TAB 325 MG 100UD
00182-8447-89
TEV ACETAMINOPHEN
R-X
406447 91500
ACETAZOLAMIDE INJ 500 MG 10 ML
55390-0460-01
BED ACETAZOLAMIDE SODIUM
R-X
330415 23493
ACETAZOLAMIDE TAB 250 MG 100
51672-4023-01
TAR ACETAZOLAMIDE
R-X
843094 98326
ACETIC ACID 5% SOL 500ML A101
00010-1510-03
SCM
R-X
171876 97361
ACETIC ACID GLACL 500ML 250414
00406-2504-14
MBI
R-X
912675 5150
ACETIC ACID OTIC SOL 60ML
24208-0615-77
B&L ACETIC ACID/ALUMINUM ACETATE
R-X
456863 97537
ACETYLCYSTEINE VL 10% 4 ML/25
00517-7504-25
A-R
R-X
666016 5878
00409-3307-03
HOS ACETYLCYSTEINE
R-X
456871 97536
00517-7604-25
A-R
ACETYLCYSTEINE
R-X
LANCETS
ACETYLCYSTEINE
R-X
R-X
R-X
R-X
R-X
76927 97569
00517-7610-03
A-R
ACETYLCYSTEINE
R-X
459206 96064
00409-3308-03
HOS ACETYLCYSTEINE
R-X
273110 97812
ACT HIB ONE DOSE VL CT/5
49281-0545-05
AVE HAEMOPH B POLY CONJ-TET TOX/PF
R-X
198119 96556
ACTHREL SDV 100UG/VL
55566-0302-01
F-L
R-X
102772 97894
CORTICORELIN OVINE TRIFLUTATE
ACTIDOSE-AQUA 50 GM/240ML TUBE
00574-0121-76
PAD ACTIVATED CHARCOAL
R-X
51466 96323
ACTIVASE VL 50MG SNGL
50242-0044-13
GNT ALTEPLASE
R-X
51474 96324
ACTIVASE VL 100MG SNGL
50242-0085-27
GNT ALTEPLASE
R-X
422857 97704
ACTIVASE VL 2MG SNGL CTHFL
50242-0041-64
GNT ALTEPLASE
R-X
361931 98165
ACTIVELLA TAB 5X28 DIALPACK
00169-5174-01
NPH ESTRADIOL/NORETH AC
R-X
728915 98164
ACTIVELLA TAB 0.5MG/0.1MG 5X28
00169-5175-11
NPH ESTRADIOL/NORETH AC
R-X
346569 97092
ACTONEL TAB 5 MG 30
00149-0471-01
P&G RISEDRONATE SODIUM
R-X
134643 97697
ACTONEL TAB 35 MG 4/PK
00149-0472-01
P&G RISEDRONATE SODIUM
R-X
438267 97638
ACTOS TAB 15 MG 90
64764-0151-05
TPA PIOGLITAZONE HCL
R-X
358317 98016
ACULAR OPT SOL 5ML 2181
00023-2181-05
ALL
423541 95304
ACYCLOVIR CAP 200 MG 100
00093-8940-01
TEV ACYCLOVIR
R-X
733618 99126
ACYCLOVIR CAP 200 MG 100UD
00904-5789-61
MAJ ACYCLOVIR
R-X
647198 95801
ACYCLOVIR SUS 16 OZ
50383-0810-16
HTP ACYCLOVIR
R-X
393751 95958
ACYCLOVIR TAB 400 MG 100
00093-8943-01
TEV ACYCLOVIR
R-X
925800 96578
ACYCLOVIR TAB 400 MG 100UD
00093-8943-93
TEV ACYCLOVIR
R-X
401018 95750
ACYCLOVIR TAB 800 MG 100
00093-8947-01
TEV ACYCLOVIR
R-X
KETOROLAC TROMETHAMINE
R-X
Page 1 of 46
Attachment n
M&D #
User #
Description
NDC #
Mfg
Generic Description
UDF 1
882944 96579
ACYCLOVIR TAB 800 MG 100UD
51079-0878-20
UDL ACYCLOVIR
R-X
588822 95205
ACYCLOVIR VL 500MG 10ML/10
55390-0612-10
BED ACYCLOVIR SODIUM
R-X
847053 98033
ADACEL VACCINE 0.5ML CT/10
49281-0400-10
AVE DIPH,PERTUSS(ACELL),TET VAC/PF
R-X
143792 97777
ADDERALL XR CAP 5 MG 100
54092-0381-01
R-P
AMPHET ASP/AMPHET/D-AMPHET
CII
426809 97778
54092-0383-01
R-P
CII
143818 97779
54092-0385-01
R-P
CII
426817 97780
54092-0387-01
R-P
CII
143826 97781
54092-0389-01
R-P
CII
426825 97782
54092-0391-01
R-P
187476 96485
ADENOSCAN VL 3 MG/ML 30ML
00469-0871-30
ASE ADENOSINE
829861 97547
ADENOSINE SRN 6MG 2ML/10
25021-0301-72
S/P
946707 97815
ADVAIR DISKUS 100/50 INHAL 14
00173-0695-04
SKB FLUTICASONE/SALMETEROL
R-X
387456 97178
00173-0695-00
R-X
928986 97816
00173-0696-04
R-X
387464 97179
00173-0696-00
R-X
928994 97817
00173-0697-04
R-X
387472 97335
00173-0697-00
R-X
930917 98080
AGGRASTAT PREMIXD 5.0MG/100ML
25208-0002-01
MCU TIROFIBAN HCL M-HYDRATE/NS
R-X
859645 98081
AGGRASTAT PREMIXD 12.5MG/250ML
25208-0002-02
MCU TIROFIBAN HCL M-HYDRATE/NS
R-X
330373 97254
AGGRENOX CAP 200MG/25MG 60
00597-0001-60
BOE ASPIRIN/DIPYRIDAMOLE
R-X
684126 97632
AGRYLIN CAP .5 MG 100
54092-0063-01
ROB ANAGRELIDE HCL
R-X
84699 15336
AK-FLUOR SDV 10% 5ML/12 1795
17478-0253-10
AKR FLUORESCEIN SODIUM
R-X
84061 97705
AK-FLUOR SDV 25% 2ML/12 1815
17478-0250-20
R-X
861369 96474
ALBENZA TAB 200 MG 112
00007-5500-40
SKB ALBENDAZOLE
R-X
174094 95493
ALBUTEROL SULF .5% 20ML
24208-0347-20
B&L ALBUTEROL SULFATE
R-X
423194 97538
ALBUTEROL SULF AMP.5% .5ML/30
00487-9901-30
NPI
R-X
23283 95393
ADENOSINE
CII
R-X
ALBUTEROL SULFATE
R-X
ALBUTEROL SULF SYR 16 OZ
00093-0661-16
TEV ALBUTEROL SULFATE
R-X
796938 95186
ALBUTEROL SULF TAB 2 MG 100
00378-0255-01
MYL ALBUTEROL SULFATE
R-X
506543 97468
ALBUTEROL SULF TAB 2 MG 100UD
51079-0657-20
UDL ALBUTEROL SULFATE
R-X
796953 95187
ALBUTEROL SULF TAB 4 MG 100
00378-0572-01
MYL ALBUTEROL SULFATE
R-X
506550 97467
ALBUTEROL SULF TAB 4 MG 100UD
51079-0658-20
UDL ALBUTEROL SULFATE
R-X
743906 24270
ALCOHOL ISO 70% 16 OZ CS12
00574-0067-16
PAD ISOPROPYL ALCOHOL
R-X
846824 96932
ALDARA CREAM 5% 24 PACKETS/BOX
29336-0610-24
GWY IMIQUIMOD
R-X
917732 96572
ALENDRONATE SOD TAB 5MG 100
00378-3566-01
MYL ALENDRONATE SODIUM
R-X
999201 97420
ALENDRONATE SOD TAB 35MG PK/4
00093-5172-44
TEV ALENDRONATE SODIUM
R-X
999185 97157
ALENDRONATE SOD TAB 70MG PK/4
00093-5171-44
TEV ALENDRONATE SODIUM
R-X
597708 95718
ALFENTA AMP 2ML/10
11098-0060-02
AKR ALFENTANIL HCL
CII
597591 95481
ALFENTA AMP 10ML/5
11098-0060-10
AKR ALFENTANIL HCL
CII
827667 98185
ALIMTA SDV 100 MG
00002-7640-01
LIL
PEMETREXED DISODIUM
R-X
521617 98186
ALIMTA SDV 500 MG
00002-7623-01
LIL
PEMETREXED DISODIUM
R-X
499459 97582
ALINIA SUSP 100MG/5ML 60 ML
67546-0212-21
RMK NITAZOXANIDE
R-X
977298 22321
ALKERAN TAB 2 MG 50
00173-0045-35
SKB MELPHALAN
R-X
977959 96425
ALKERAN VL 50 MG
00173-0130-93
SKB MELPHALAN HCL
R-X
211144 96978
ALLCLENZ WOUND CLEANSER 12 OZ
08213-0200-12
HEA POLOXAMER 188/SORBITOL SOLN
R-X
361337 98091
ALLEGRA TAB 60 MG 100
00088-1107-47
AVE FEXOFENADINE HCL
R-X
297093 98092
ALLEGRA TAB 180 MG 100
00088-1109-47
AVE FEXOFENADINE HCL
R-X
796458 42421
ALLOPURINOL TAB 100 MG 100
00378-0137-01
MYL ALLOPURINOL
R-X
506808 27081
ALLOPURINOL TAB 100 MG 100UD
51079-0205-20
UDL ALLOPURINOL
R-X
796466 18146
ALLOPURINOL TAB 300 MG 100
00378-0181-01
MYL ALLOPURINOL
R-X
894535 27082
ALLOPURINOL TAB 300 MG 100UD
51079-0206-20
UDL ALLOPURINOL
R-X
977355 97919
ALOXI VL .25MG/5ML
62856-0797-01
EIS
PALONOSETRON HCL
R-X
418095 96519
ALPHAGAN P OPT SOL .15% 5 ML
00023-9177-05
ALL
BRIMONIDINE TARTRATE
R-X
418103 96520
00023-9177-10
ALL
R-X
418111 97905
00023-9177-15
ALL
R-X
798132 95190
ALPRAZOLAM TAB .25 MG 100
00378-4001-01
MYL ALPRAZOLAM
R-X
809806 99119
ALPRAZOLAM TAB .25 MG 100UD
51079-0788-20
UDL ALPRAZOLAM
R-X
Page 2 of 46
Attachment n
M&D #
User #
Description
NDC #
798157 95191
ALPRAZOLAM TAB .5 MG 100
00378-4003-01
809822 99120
ALPRAZOLAM TAB .5 MG 100UD
798199 95726
ALPRAZOLAM TAB 2 MG 100
295824 95422
Mfg
Generic Description
UDF 1
MYL ALPRAZOLAM
R-X
51079-0789-20
UDL ALPRAZOLAM
R-X
00378-4007-01
MYL ALPRAZOLAM
R-X
ALPROSTADIL VL 500 MCG 1ML/5
00703-1501-02
GES ALPROSTADIL
R-X
156356 2488
AMANTADINE CAP 100 MG 100
00781-2048-01
SNZ AMANTADINE HCL
R-X
503466 98300
AMANTADINE CAP 100 MG 100UD
51079-0481-20
UDL AMANTADINE HCL
R-X
746099 3281
AMANTADINE HCL SYR 16 OZ
00121-0646-16
PMA AMANTADINE HCL
R-X
104547 98301
AMANTADINE HCL SYR 10ML/100
00121-0646-10
PMA AMANTADINE HCL
R-X
511113 97914
AMARYL TAB 1 MG 100
00039-0221-10
AVE GLIMEPIRIDE
R-X
511154 97915
AMARYL TAB 2 MG 100
00039-0222-10
AVE GLIMEPIRIDE
R-X
511188 97916
AMARYL TAB 4 MG 100
00039-0223-10
AVE GLIMEPIRIDE
R-X
238147 97371
AMBISOME VL 50 MG
00469-3051-30
ASE AMPHOTERICIN B LIPOSOME
R-X
733436 95154
AMCINONIDE CR .1% 15 GM
00168-0278-15
FOU AMCINONIDE
R-X
977553 95155
AMCINONIDE CR .1% 60 GM
00168-0278-60
FOU AMCINONIDE
R-X
875377 95169
AMCINONIDE OIN .1% 60 GM
00168-0279-60
FOU AMCINONIDE
R-X
126151 95201
AMIDATE SRN 40MG 20ML/10 LSHD
00409-8060-29
HOS ETOMIDATE
R-X
637074 95199
AMIDATE VL 20MG 10ML/10 FTOP
00409-6695-01
HOS ETOMIDATE
R-X
134213 95200
AMIDATE VL 40MG 20ML/10 FTOP
00409-6695-02
HOS ETOMIDATE
R-X
847426 96518
AMIFOSTINE VL 10ML CT/3
55390-0308-03
BED AMIFOSTINE CRYSTALLINE
R-X
775684 25382
AMIKACIN SULF VL 100 MG 2ML/10
55390-0225-02
BED AMIKACIN SULFATE/PF
R-X
876516 22492
AMIKACIN VL 500 MG 2ML/10
00703-9032-03
GES AMIKACIN SULFATE/PF
R-X
797621 95183
AMILORIDE HCTZ TAB 5/50 100
00378-0577-01
MYL AMILORIDE/HYDROCHLOROTHIAZIDE
R-X
797639 95887
AMILORIDE HCTZ TAB 5/50 500
00378-0577-05
MYL AMILORIDE/HYDROCHLOROTHIAZIDE
R-X
127639 14196
AMINOCAPROIC ACID 250MG 20ML25
00409-4346-73
HOS AMINOCAPROIC ACID
R-X
314948 42640
AMINOCAPROIC ACID O/SOL 16OZ
61748-0044-16
V-I
AMINOCAPROIC ACID
R-X
417980 76950
AMINOCAPROIC ACID TB 500MG 100
61748-0045-01
V-I
AMINOCAPROIC ACID
R-X
127654 32409
AMINOPHYLN VL 250 MG 10ML/25
00409-5921-01
HOS AMINOPHYLLINE
R-X
442350 96390
AMIODARONE AMP 150MG/3ML CT10
00409-4348-35
HOS AMIODARONE HCL
R-X
356576 95242
AMIODARONE HCL TAB 200 MG 60
00093-9133-06
TEV AMIODARONE HCL
R-X
341289 98229
AMIODARONE HCL TAB 200 MG 100U
51079-0906-20
UDL AMIODARONE HCL
R-X
795047 21815
AMITRIPTYLINE TAB 10 MG 100
00378-2610-01
MYL AMITRIPTYLINE HCL
R-X
501791 97470
AMITRIPTYLINE TAB 10 MG 100U
51079-0131-20
UDL AMITRIPTYLINE HCL
R-X
501825 24719
51079-0107-20
R-X
880328 21819
00781-1487-10
SNZ AMITRIPTYLINE HCL
R-X
795104 21577
00378-2685-01
MYL AMITRIPTYLINE HCL
R-X
501809 21578
51079-0563-20
R-X
728147 96745
AMLODIPINE BESYLATE TB 10M100U
59762-1540-04
GRN AMLODIPINE BESYLATE
R-X
728139 95870
AMLODIPINE BESYLATE TB 10MG 90
59762-1540-01
R-X
729046 98070
AMLODIPINE BESYLATE TB 2.5100U
51079-0450-20
UDL AMLODIPINE BESYLATE
R-X
728097 95868
AMLODIPINE BESYLATE TB 2.5MG90
59762-1520-01
R-X
728105 95869
AMLODIPINE BESYLATE TB 5 MG 90
59762-1530-01
R-X
728113 96744
AMLODIPINE BESYLATE TB 5MG100U
59762-1530-05
R-X
127670 95166
AMMON CHL VL 100 MEQ 20ML/25
00074-6043-01
HOS
R-X
158873 95425
AMMONIUM LACT LOT 12% 225G RX
00574-2021-08
PAD AMMONIUM LACTATE
R-X
246363 96015
AMOXICILLIN CAP 250 MG 100
00093-3107-01
TEV AMOXICILLIN TRIHYDRATE
R-X
949784 96020
AMOXICILLIN CAP 250 MG 100UD
00093-3107-93
R-X
AMOXICILLIN CAP 500 MG 50
00093-3109-53
R-X
949792 96018
22590 96016
AMOXICILLIN CAP 500 MG 100UD
00093-3109-93
R-X
246157 95982
AMOXICILLIN CTB 125 MG 100
00093-2267-01
R-X
603548 95983
AMOXICILLIN CTB 250 MG 100
00093-2268-01
R-X
901900 97997
AMOXICILLIN SUS 125 MG 80ML
00093-4150-79
R-X
235713 18125
00093-4150-80
R-X
222166 18131
00093-4155-80
R-X
999383 97543
00093-4161-73
R-X
673616 97544
AMOXICLAV ES 600MG SUS 75ML
00093-8675-78
TEV AMOX TR/POTASSIUM CLAVULANATE
R-X
956474 96461
AMOXICLAV SUS 400 MG 100ML
66685-1012-02
SNZ AMOX TR/POTASSIUM CLAVULANATE
R-X
Page 3 of 46
Attachment n
M&D #
User #
Description
NDC #
00781-1831-20
Mfg
Generic Description
SNZ AMOX TR/POTASSIUM CLAVULANATE
UDF 1
14720 95298
AMOXICLAV TAB 500 MG 20
R-X
999169 96462
AMOXICLAV TAB 875 MG 20
00093-2275-34
TEV AMOX TR/POTASSIUM CLAVULANATE
R-X
444539 97278
AMPHETAMINE SALT COMB 5MG 100
00185-0084-01
SNZ AMPHET ASP/AMPHET/D-AMPHET
CII
370049 34940
AMPHOTERICIN-B 50 MG VL
39822-1055-05
PHT AMPHOTERICIN B
R-X
555995 3565
AMPICILLIN CAP 250 MG 100
00781-2144-01
SNZ AMPICILLIN TRIHYDRATE
R-X
556019 3324
00781-2145-01
SNZ AMPICILLIN TRIHYDRATE
R-X
669168 23228
67253-0181-50
DVA AMPICILLIN TRIHYDRATE
R-X
378083 27552
AMPICILLIN SOD VL 1 GM/10
63323-0389-10
APP AMPICILLIN SODIUM
R-X
378091 11480
AMPICILLIN SOD VL 2 GM/10
63323-0399-23
R-X
378067 9187
AMPICILLIN SOD VL 250 MG/10
63323-0387-10
R-X
378075 1582
AMPICILLIN SOD VL 500 MG/10
63323-0388-10
R-X
998765 23236
AMPICILLIN SUS 125 MG 100 ML
67253-0182-10
R-X
998773 23237
67253-0182-20
R-X
628941 10441
67253-0183-10
R-X
647172 15632
67253-0183-20
R-X
628974 97743
AMPICILLIN/SULBACTAM VL 3GM/10
63323-0369-20
APP AMPICILLIN SODIUM/SULBACTAM NA
R-X
628966 97742
AMPICILLIN/SULBACTAM VL1.5G/10
63323-0368-20
APP AMPICILLIN SODIUM/SULBACTAM NA
R-X
370031 34321
AMYL NITRITE INH 3ML/12
39822-9950-02
PHT AMYL NITRITE
R-X
393629 12977
ANCOBON 250 MG 100
00187-3554-10
ICN
FLUCYTOSINE
R-X
366385 12978
ANCOBON 500 MG 100
00187-3555-10
ICN
FLUCYTOSINE
R-X
389841 97212
ANDRODERM PATCH 2.5 MG 60
52544-0469-60
WAT TESTOSTERONE
R-X
ANDROID-10 100 CAP
00187-0902-01
ICN
R-X
605204 33434
ANDROXY TAB 10 MG 100
00832-0086-00
UPS FLUOXYMESTERONE
R-X
379602 97725
ANGIOMAX VL 250MG/VL CT/10
65293-0001-01
TMC BIVALIRUDIN
R-X
913194 22526
ANTIBIOTIC EAR SOL 10ML
24208-0631-10
B&L NEOMY SULF/POLYMYX B SULF/HC
R-X
911735 3251
ANTIBIOTIC EAR SUS 10ML
24208-0635-62
B&L NEOMY SULF/POLYMYX B SULF/HC
R-X
915157 86860
ANTIPYRINE & BENZ OTIC 10ML
24208-0561-62
B&L ANTIPYRINE/BENZOCAINE/GLYCERIN
R-X
287789 14980
ANTIVENIN-BLK WIDOW VL 2.5
00006-4084-00
MSD ANTIVENIN,LATRODECTUS MACTANS
R-X
847343 4569
APLISOL SOL 1CC VL
42023-0104-01
JHP TUBERCULIN,PURIF.PROT.DERIV.
R-X
627992 97947
APTIVUS CAPSULES 250 MG 120
00597-0003-02
BOE TIPRANAVIR
R-X
665166 98000
AQUASOL A 50MU 2ML/10
61703-0418-07
HOS VITAMIN A PALMITATE
R-X
928531 98028
AQUASOL E DROPS 12CC
61703-0419-77
HOS VITAMIN E
R-X
698084 97249
ARANESP SRN 25MCG/.4ML 4-PACK
55513-0057-04
AMG DARBEPOETIN ALFA IN POLYSORBAT
R-X
698092 97250
55513-0021-04
R-X
696849 97251
55513-0023-04
R-X
698381 97252
55513-0025-04
R-X
708743 97433
55513-0027-04
R-X
698100 97431
ARANESP SRN 200MCG/.4ML
55513-0028-01
R-X
698399 97432
ARANESP SRN 300MCG/.6ML
55513-0111-01
R-X
167486 96937
ARAVA TAB 10 MG 30
00088-2160-30
AVE LEFLUNOMIDE
R-X
167494 96938
ARAVA TAB 20 MG 30
00088-2161-30
AVE LEFLUNOMIDE
R-X
375196 97552
ARGATROBAN SDV 100MG/ML 2.5 ML
00007-4407-01
SKB ARGATROBAN
R-X
760876 96512
ARICEPT TAB 5 MG 30 7000
62856-0245-30
EIS
DONEPEZIL HCL
R-X
760611 96513
ARICEPT TAB 5 MG 100UD 7002
62856-0245-41
EIS
DONEPEZIL HCL
R-X
760900 96514
ARICEPT TAB 10 MG 30 7001
62856-0246-30
EIS
DONEPEZIL HCL
R-X
760348 96515
ARICEPT TAB 10 MG 100UD 7003
62856-0246-41
EIS
DONEPEZIL HCL
R-X
230441 96887
ARIMIDEX TAB 1 MG 30
00310-0201-30
A/Z
ANASTROZOLE
335711 97575
AROMASIN TAB 25 MG 30
00009-7663-04
PFZ EXEMESTANE
R-X
555805 97120
ASACOL TAB 400 MG 180
00149-0752-15
P&G MESALAMINE
R-X
869958 95351
ATENOLOL TAB 50 MG 100
00781-1506-01
SNZ ATENOLOL
R-X
705434 99161
ATENOLOL TAB 50 MG 100UD
51079-0684-20
UDL ATENOLOL
R-X
869941 95888
ATENOLOL TAB 50 MG 1000
00781-1506-10
SNZ ATENOLOL
R-X
550202 96119
ATGAM AMP 250 MG 5ML CT/5 P-F
00009-7224-02
PFZ LYMPHOCYTE IMMUNE GLOBULIN
R-X
885665 95243
ATRACURIUM VL 10MG/ML 5MLX10
55390-0102-05
BED ATRACURIUM BESYLATE
R-X
885715 98206
ATRACURIUM VL 10MG/ML 10MLX10
55390-0103-10
BED ATRACURIUM BESYLATE
R-X
675942 97976
ATRIPLA TAB 30
15584-0101-01
BGS EFAVIRENZ/EMTRICITAB/TENOFOVIR
R-X
32201 90179
METHYLTESTOSTERONE
R-X
Page 4 of 46
Attachment n
M&D #
User #
Description
132498 99156
ATROPINE SULF 1% 2ML/12
910513 31810
906073 89911
NDC #
Mfg
Generic Description
UDF 1
00065-0702-12
ALC ATROPINE SULFATE
R-X
ATROPINE SULF OPT OIN 3.5 GM
24208-0825-55
B&L ATROPINE SULFATE
R-X
ATROPINE SULF OPT SOL 1% 5ML
24208-0750-60
R-X
910539 89900
ATROPINE SULF OPT SOL 1% 15ML
24208-0750-06
R-X
125351 19432
ATROPINE SULF SRN 1MGLS10ML/10
00409-4911-34
HOS ATROPINE SULFATE
R-X
76695 5695
ATROPINE SULF VL .4MG 1ML/25
00517-0401-25
A-R
R-X
179192 5685
ATROPINE SULF VL .4MG 20ML/10
10019-0250-20
BAX ATROPINE SULFATE
R-X
619759 95489
ATROVENT HFA INH 200 SPY 8717
00597-0087-17
BOE IPRATROPIUM BROMIDE
R-X
750596 96403
ATROVENT NASAL SPY .03% 30ML
00597-0081-30
R-X
750315 96404
ATROVENT NASAL SPY .06% 15ML
00597-0086-76
R-X
413369 95299
AUGMENTIN SUS 125 MG 150ML
00029-6085-22
SKB AMOX TR/POTASSIUM CLAVULANATE
R-X
413385 95300
AUGMENTIN SUS 250 MG 150ML
00029-6090-22
R-X
413344 95297
AUGMENTIN TAB 250 MG 30
00029-6075-27
R-X
416289 99191
AUGMENTIN TAB 250 MG 100UD
00029-6075-31
R-X
416297 99192
AUGMENTIN TAB 500 MG 100UD
00029-6080-31
R-X
508911 97895
AUGMENTIN XR TAB 28 7-DAY PK
00029-6096-48
R-X
508929 97896
AUGMENTIN XR TAB 40 10-DAY PK
00029-6096-60
R-X
523266 97736
AVASTIN SDV 100 MG
50242-0060-01
GNT BEVACIZUMAB
R-X
597088 97968
AVELOX ABC PACK TAB 400 MG 5
00085-1733-03
SCH MOXIFLOXACIN HCL
R-X
639781 97969
AVELOX I.V. 250 ML CS/12
00085-1737-01
SCH MOXIFLOXACIN HCL/SOD CL
R-X
592881 97966
AVELOX TAB 400 MG 30
00085-1733-01
R-X
592899 97967
AVELOX TAB 400 MG 50UD
00085-1733-02
R-X
312157 25691
AVITENE 1 GM JAR CT/6 11-01
00001-0100-02
DAV
R-X
504720 97291
AVONEX PREFIL SRN 30MCG 4-WEEK
59627-0002-05
BIO
302661 3247
AZATHIOPRINE TAB 50 MG 100
00054-4084-25
ROX AZATHIOPRINE
676346 98041
AZILECT TAB .5 MG 30
68546-0142-56
TNE RASAGILINE MESYLATE
R-X
676387 98042
AZILECT TAB 1 MG 30
68546-0229-56
TNE RASAGILINE MESYLATE
R-X
641274 96325
AZITHROMYCIN OS 100MG/5ML 15ML
59762-3110-01
GRN AZITHROMYCIN
R-X
641282 96326
AZITHROMYCIN OS 200MG/5ML 15ML
59762-3120-01
GRN AZITHROMYCIN
R-X
641290 96327
AZITHROMYCIN OS200MG/5ML22.5ML
59762-3130-01
GRN AZITHROMYCIN
R-X
641316 95871
AZITHROMYCIN TAB 250 MG 30
59762-3060-02
GRN AZITHROMYCIN
R-X
847434 96746
AZITHROMYCIN TAB 250 MG 100UD
68084-0278-01
RPK AZITHROMYCIN
R-X
641357 97421
AZITHROMYCIN TAB 500 MG 30
59762-3070-02
GRN AZITHROMYCIN
R-X
661389 96571
AZITHROMYCIN VL 500MG/10MLCT10
63323-0398-10
APP AZITHROMYCIN
R-X
780171 96916
B-12 VL 1000 MCG 1ML/25
00517-0031-25
A-R
R-X
104752 96917
B-12 VL 1000 MCG 10ML/25
00517-0032-25
A-R
CYANOCOBALAMIN
R-X
476101 96918
B-12 VL 1000 MCG 30ML CT/5
00517-0130-05
A-R
CYANOCOBALAMIN
R-X
28167 31430
ATROPINE SULFATE
INTERFERON BETA-1A
CYANOCOBALAMIN
R-X
R-X
BACITRACIN OPT OIN 3.5 GM
48102-0007-35
FRA BACITRACIN
R-X
470393 16890
BACITRACIN POW STR 50KU VL
00009-0233-01
PFZ BACITRACIN
R-X
143719 95207
BACITRACIN ZINC/POLYMIX B 3.5G
24208-0555-55
B&L BACITRACIN/POLYMYXIN B SULFATE
R-X
589762 14621
BACITRACIN-NEO-POLY-HYDR 1/8OZ
24208-0785-55
B&L NEOMY SULF/BACITRAC ZN/POLY/HC
R-X
836007 32683
BACLOFEN TAB 10 MG 100
00172-4096-60
TEV BACLOFEN
R-X
873232 45264
BACLOFEN TAB 10 MG 100UD
00904-3365-61
MAJ BACLOFEN
R-X
405449 96885
BACTROBAN CR 15 GM TUBE
00029-1527-22
SKB MUPIROCIN CALCIUM
R-X
861237 96517
BACTROBAN NASAL OIN 10X1GM PKT
00029-1526-11
SKB MUPIROCIN CALCIUM
R-X
365346 95611
BACTROBAN OIN 22 GM TUBE
00029-1525-44
SKB MUPIROCIN
R-X
343715 41241
BAL-IN-OIL AMP 3CC/10
11098-0526-03
AKR DIMERCAPROL
R-X
998617 21212
BANOPHEN ELIXIR 118ML
00904-1228-20
MAJ DIPHENHYDRAMINE HCL
R-X
707018 98060
BARACLUDE O/SOL 0.05MG/ML210ML
00003-1614-12
BRI
ENTECAVIR
R-X
618538 98059
BARACLUDE TAB 1 MG 30
00003-1612-12
BRI
ENTECAVIR
R-X
618520 98058
BARACLUDE TAB 0.5 MG 30
00003-1611-12
BRI
ENTECAVIR
R-X
400614 98285
BAXA ORAL SRN 3 ML AM 500
00000-0085-03
B-C
R-X
405324 98286
BAXA ORAL SRN 10 ML AMB 500
00000-0085-10
B-C
R-X
18135 98204
BD POSIFLUSH SOD CHL 10ML/240
08290-0950-10
B-D
NORMAL SALINE
R-X
17954 98112
BD POSIFLUSH SOD CHL 10ML/480
08290-0940-10
B-D
NORMAL SALINE
R-X
BENZONATATE CAP 100 MG 100
00258-3654-01
INW BENZONATATE
995480 7452
R-X
Page 5 of 46
Attachment n
M&D #
User #
946194 98232
Description
BENZONATATE CAP 100 MG 100UD
NDC #
68084-0214-01
Mfg
Generic Description
RPK BENZONATATE
UDF 1
R-X
279174 817
BENZTROPINE TAB .5 MG 100
50111-0393-01
TEV BENZTROPINE MESYLATE
R-X
549543 99237
BENZTROPINE TAB .5 MG 100UD
00904-1055-61
MAJ BENZTROPINE MESYLATE
R-X
501569 19884
BENZTROPINE TAB 2 MG 100UD
51079-0222-20
UDL BENZTROPINE MESYLATE
R-X
436543 29860
BENZTROPINE TAB 2 MG 1000
50111-0395-03
TEV BENZTROPINE MESYLATE
R-X
112128 97985
BETAMETHASONE D OIN .05% 45 GM
00472-0381-45
APH BETAMETHASONE DIPROPIONATE
R-X
929497 97279
BETASERON SRN .3MG PRE-FILL/14
50419-0523-35
B/L
911024 34541
BETHANECHOL CHL TAB 25 MG 100
50111-0325-01
TEV BETHANECHOL CHLORIDE
R-X
133231 95760
BETOPTIC S .25% 10 ML
00065-0246-10
ALC BETAXOLOL HCL
R-X
BICALUTAMIDE TAB 50MG 30
00378-7017-93
MYL BICALUTAMIDE
R-X
755983 51150
BICILLIN CR 1.2MU CT10 TBX ADT
60793-0600-10
MNR PEN G BENZ/PEN G PROCAINE
R-X
704833 63471
BICILLIN LA .6MU 1ML/10 PED
60793-0700-10
MNR PENICILLIN G BENZATHINE
R-X
704841 64771
BICILLIN LA 1.2MU 2ML/10
60793-0701-10
R-X
704858 63571
BICILLIN LA 2.4MU 4ML/10
60793-0702-10
848978 30266
BICNU 100 MG VL
00015-3012-60
BRI
592923 95653
BILTRICIDE TAB 600 MG 6
00085-1747-01
SCH PRAZIQUANTEL
R-X
954537 16724
BLEOMYCIN SULF 15 UNIT SDV
63323-0136-10
APP BLEOMYCIN SULFATE
R-X
954545 97661
BLEOMYCIN SULF 30 UNIT SDV
63323-0137-20
APP BLEOMYCIN SULFATE
R-X
624254 97970
BOOSTRIX SRN .5ML CT/5
58160-0842-46
SKB DIPH,PERTUSS(ACELL),TET VAC/PF
R-X
358481 97277
BOTOX VL 100UNITS/VL 0504
00023-1145-01
ALL
R-X
389619 97663
BREVIBLOC BG 10MG/ML 250ML/10
10019-0055-61
BAX ESMOLOL HCL/SOD CL
R-X
479949 95572
BREVIBLOC VL 10MG/ML 10ML/25
10019-0115-01
BAX ESMOLOL HCL
R-X
878728 32721
BREVITAL SOD 500MG 50ML
42023-0105-01
JHP METHOHEXITAL SODIUM
R-X
130880 95038
BSS GLASS BOT 500ML/6
00065-0795-50
ALC BALANCED SALT IRRIG SOLN COMB2
R-X
130773 21281
BSS STERI-UNIT 15ML/36 (ALCON)
00065-0795-15
R-X
132712 95283
BSS-PLUS SOL 500ML/6
00065-0800-50
R-X
169631 95328
BUMETANIDE TAB 1 MG 100
00185-0129-01
EON BUMETANIDE
R-X
681213 99147
BUMETANIDE TAB 1 MG 100UD
51079-0892-20
UDL BUMETANIDE
R-X
406413 97328
BUMETANIDE VL.25MG/ML 2ML/10
55390-0500-02
BED BUMETANIDE
R-X
353557 97329
10019-0506-45
BAX BUMETANIDE
R-X
353375 97330
10019-0506-10
BAX BUMETANIDE
R-X
574152 15672
BUPIVACAINE MDV .25% 50ML/25
00409-1160-01
HOS BUPIVACAINE HCL
R-X
650481 95534
BUPRENEX AMP 1ML/5
12496-0757-01
RCP BUPRENORPHINE HCL
R-X
519041 96793
BUPROPION HCL SR TAB 100MG 60
00185-0410-60
EON BUPROPION HCL
R-X
535021 96794
BUPROPION HCL SR TAB 150MG 60
00185-0415-60
EON BUPROPION HCL
R-X
952689 98233
BUPROPION HCL XL TB 150MG 100U
68084-0251-01
RPK BUPROPION HCL
R-X
157123 95465
BUSPIRONE HCL TAB 5 MG 100
00591-0657-01
WAT BUSPIRONE HCL
R-X
106542 96153
BUSPIRONE HCL TAB 5 MG 100UD
51079-0985-20
UDL BUSPIRONE HCL
R-X
106823 95466
BUSPIRONE HCL TAB 10 MG 100
00591-0658-01
WAT BUSPIRONE HCL
R-X
106559 96154
BUSPIRONE HCL TAB 10 MG 100UD
51079-0986-20
UDL BUSPIRONE HCL
R-X
396648 97226
BUSPIRONE HCL TAB 7.5 MG 100
49884-0725-01
PAR BUSPIRONE HCL
R-X
219402 97286
BUTALBITAL/APAP TAB 100
00603-2540-21
QLT BUTALBITAL/ACETAMINOPHEN
R-X
321547 95367
BUTORPHANOL SDV 2MG 1ML/10
00409-1626-01
HOS BUTORPHANOL TARTRATE
R-X
669143 96677
CABERGOLINE TAB 0.5 MG 8
49884-0673-14
PAR CABERGOLINE
R-X
567826 97835
CADUET TAB 2.5/10MG 30
00069-2960-30
PFZ AMLODIPINE/ATORVAST CAL
R-X
567834 97836
00069-2970-30
R-X
567842 97837
00069-2980-30
R-X
524439 97838
CADUET TAB 5/10 MG 30
00069-2150-30
R-X
524447 97839
00069-2170-30
R-X
524454 97840
00069-2190-30
R-X
524462 97841
00069-2260-30
R-X
524470 97842
00069-2160-30
R-X
524488 97843
00069-2180-30
R-X
524496 97844
00069-2250-30
R-X
524504 97845
00069-2270-30
R-X
931857 97612
CAFCIT O/SOL 60MG 3 ML CT/10
55390-0358-03
BED CAFFEINE CITRATED
R-X
26286 98217
INTERFERON BETA-1B
CARMUSTINE
ONABOTULINUMTOXINA
R-X
R-X
R-X
Page 6 of 46
Attachment n
M&D #
User #
Description
NDC #
Mfg
Generic Description
UDF 1
931840 97048
CAFCIT SDV 60MG 3 ML
55390-0357-03
BED CAFFEINE CITRATED
918706 44179
CAFERGOT TAB 100
00781-5405-01
SNZ ERGOTAMINE TARTRATE/CAFFEINE
R-X
CAFFEINE SOD BENZ SDV 500MG/10
00517-2502-10
A-R
R-X
426932 37256
CALCITRIOL CAP .25 MCG 100
00093-0657-01
TEV CALCITRIOL
876896 97699
CALCITRIOL O/SOL 1MCG/ML 15 ML
00054-3120-41
ROX CALCITRIOL
R-X
CALCIUM CHL VL 1 GM 10ML/25
00517-2710-25
A-R
CALCIUM CHLORIDE
R-X
400515 95517
CALCIUM CHLSYR 10%10ML/10 ANSR
00409-1631-10
HOS CALCIUM CHLORIDE
R-X
16915 57411
CALCIUM DISOD VERSNT AMP2.5/10
29336-0400-10
GWY EDETATE CALCIUM DISODIUM
76513 96441
CALCIUM GLUC VL 10% 100ML/25
00517-3900-25
238063 12782
CALCIUM GLUC VL 10% 10ML/25 PF
567867 97874
CAMPRAL DR TAB 333MG 180
406959 97887
80119 96035
76240 5708
A-R
CAFFEINE/SODIUM BENZOATE
R-X
R-X
R-X
CALCIUM GLUCONATE
R-X
63323-0311-10
APP CALCIUM GLUCONATE
R-X
00456-3330-01
FOR ACAMPROSATE CALCIUM
R-X
CAMPTOSAR INJ 20MG/ML 2ML
00009-7529-02
PFZ IRINOTECAN HCL
R-X
474916 96492
CAMPTOSAR INJ 20MG/ML 5ML
00009-7529-01
PFZ IRINOTECAN HCL
R-X
617084 98199
CANASA SUPP 1000MG 30
58914-0501-56
813568 95042
CANDIN 1.0 ML 2000
49643-0138-01
AMD CANDIDA ALBICANS SKIN TEST
R-X
992735 12444
CAPASTAT SULF VL 1 GM 10ML
17478-0080-50
AKR CAPREOMYCIN SULFATE
R-X
S/I
MESALAMINE
R-X
531194 98283
CAPTOPRIL TAB 12.5 MG 100UD
00904-5045-61
MAJ CAPTOPRIL
R-X
529586 53113
CAPTOPRIL TAB 25 MG 100
00143-1172-01
W-W CAPTOPRIL
R-X
502575 99140
CAPTOPRIL TAB 25 MG 100UD
51079-0864-20
UDL CAPTOPRIL
R-X
534719 95820
00143-1172-10
W-W CAPTOPRIL
R-X
529578 53116
00143-1173-01
W-W CAPTOPRIL
R-X
565028 98281
CAPTOPRIL TAB 50 MG 100UD
00904-5047-61
MAJ CAPTOPRIL
R-X
529594 95821
00143-1173-10
W-W CAPTOPRIL
548628 95987
CARAFATE SUS 1G/10ML 14 OZ
58914-0170-14
797274 98302
CARBAMAZEPINE 100 MG 5ML/30UD
68094-0301-62
PRD CARBAMAZEPINE
389676 95540
CARBAMAZEPINE 100MG/5ML 450 ML
51672-4047-09
TAR CARBAMAZEPINE
R-X
529032 98303
CARBAMAZEPINE 200 MG 10ML/30UD
68094-0214-62
PRD CARBAMAZEPINE
R-X
23382 95162
S/I
SUCRALFATE
R-X
R-X
R-X
CARBAMAZEPINE CTB 100 MG 100
00093-0778-01
TEV CARBAMAZEPINE
R-X
916536 98304
CARBAMAZEPINE CTB 100 MG 100U
00182-1331-89
TEV CARBAMAZEPINE
R-X
500710 99144
CARBAMAZEPINE TAB 100 MG 100U
51079-0870-20
UDL CARBAMAZEPINE
R-X
CARBAMAZEPINE TAB 200 MG 100
00093-0109-01
TEV CARBAMAZEPINE
R-X
993840 98305
CARBAMAZEPINE TAB 200 MG 100U
00093-1233-93
TEV CARBAMAZEPINE
R-X
327353 95914
CARBIDOPA/LEVOD ER 50/200 100
00378-0094-01
MYL CARBIDOPA/LEVODOPA
R-X
23374 23477
CARBIDOPA/LEVODOPA 10/100 100
00093-0292-01
TEV CARBIDOPA/LEVODOPA
R-X
CARBIDOPA/LEVODOPA 10/100 100U
68084-0092-01
RPK CARBIDOPA/LEVODOPA
R-X
22335 95505
987602 47213
00093-0293-01
TEV CARBIDOPA/LEVODOPA
R-X
804096 99135
23390 46995
63739-0047-10
SKY CARBIDOPA/LEVODOPA
R-X
533364 23476
00228-2540-10
APH CARBIDOPA/LEVODOPA
R-X
809772 47214
51079-0783-20
UDL CARBIDOPA/LEVODOPA
R-X
340794 99301
51079-0923-20
UDL CARBIDOPA/LEVODOPA
R-X
647008 95636
CARBOPLATIN VL 50 MG POW
55390-0150-01
BED CARBOPLATIN
R-X
647016 95637
55390-0151-01
BED CARBOPLATIN
R-X
647024 95638
55390-0152-01
BED CARBOPLATIN
R-X
989632 98144
CARDENE IV 20MG 200ML/10 SOD
24477-0311-02
E/T
NICARDIPINE IN SALINE, ISO-OSM
R-X
994566 98323
CARDENE IV 40MG 200ML/10 DEX
24477-0324-02
E/T
NICARDIPINE IN DEXTROSE,ISO-OS
R-X
977876 98306
CARDENE IV 40MG 200ML/10 SOD
24477-0323-02
E/T
NICARDIPINE IN SALINE, ISO-OSM
R-X
949099 96132
CARDENE IV 2.5 MG/ML 10ML/10
24477-0030-25
E/T
NICARDIPINE HCL
R-X
598433 97860
CARN L/F CHOCOLATE CS/24 33890
00065-9050-71
NES NUTRITIONAL SUPPLEMENT
R-X
842526 97859
CARN L/F VANILLA CS/24 33888
00065-9050-70
R-X
842500 97862
CARN VHC VAN CS/24
00065-9050-76
R-X
369298 98002
CARNITOR VL 200MG/ML 5ML/5
54482-0147-01
SIG
691527 98148
CARPUJECT HOLDERS CT/50 CLO5
00074-2049-02
HOS
998864 96617
CARVEDILOL TAB 3.125 MG 100
00378-3631-01
MYL CARVEDILOL
R-X
798611 98236
CARVEDILOL TAB 3.125 MG 100UD
51079-0771-20
UDL CARVEDILOL
R-X
998872 96618
00378-3632-01
MYL CARVEDILOL
R-X
798629 98237
CARVEDILOL TAB 6.25 MG 100UD
51079-0930-20
UDL CARVEDILOL
R-X
LEVOCARNITINE
R-X
R-X
Page 7 of 46
Attachment n
M&D #
User #
Description
759480 96619
759498 96620
798645 98235
NDC #
Mfg
Generic Description
UDF 1
65862-0144-01
AUP CARVEDILOL
CARVEDILOL TAB 25 MG 100
65862-0145-01
AUP CARVEDILOL
R-X
CARVEDILOL TAB 25 MG 100UD
51079-0932-20
UDL CARVEDILOL
R-X
737973 95387
CATAPRES-TTS-1 1 PKGX4 3134
00597-0031-34
BOE CLONIDINE
R-X
811992 95388
00597-0032-34
BOE CLONIDINE
R-X
755025 95389
00597-0033-34
BOE CLONIDINE
R-X
290874 26395
CEENU CAP 10 MG 20
00015-3030-20
BRI
R-X
LOMUSTINE
R-X
290882 98130
CEENU CAP 40 MG 20
00015-3031-20
BRI
LOMUSTINE
R-X
290890 98131
CEENU CAP 100 MG 20
00015-3032-20
BRI
LOMUSTINE
R-X
665497 17156
CEFAZOLIN VL 1 GM 10ML/25
60505-0749-05
A-C
CEFAZOLIN SODIUM
R-X
198994 17155
CEFAZOLIN VL 500 MG 10ML/25 PF
63323-0236-10
APP CEFAZOLIN SODIUM
R-X
748996 98288
CEFDINIR OS 125 MG 60 ML
00781-6077-61
SNZ CEFDINIR
R-X
749002 98289
00781-6077-46
SNZ CEFDINIR
R-X
991604 98290
00093-4137-64
TEV CEFDINIR
R-X
989368 98291
00093-4137-73
TEV CEFDINIR
R-X
727255 96471
CEFEPIME VL 1 GM 20ML/10
60505-0834-04
A-C
CEFEPIME HCL
R-X
727271 96472
CEFEPIME VL 2 GM 20ML/10
60505-0681-04
A-C
CEFEPIME HCL
R-X
628024 53897
CEFOTAXIME SDV 1G CT/10
10019-0681-02
BAX CEFOTAXIME SODIUM
R-X
628016 96128
CEFOTAXIME SDV 500MG CT/10
10019-0680-01
BAX CEFOTAXIME SODIUM
R-X
955260 95942
CEFPODOXIME SUS 50MG/5ML 50ML
65862-0140-50
AUP CEFPODOXIME PROXETIL
R-X
955286 95943
CEFPODOXIME SUS 100MG/5ML 50ML
65862-0141-50
R-X
955245 95944
CEFPODOXIME TAB 100 MG 20
65862-0095-20
R-X
955252 95945
CEFPODOXIME TAB 200 MG 20
65862-0096-20
R-X
698316 96019
CEFPROZIL SUS 125MG/5ML 50 ML
63304-0960-03
R/P
CEFPROZIL
R-X
698324 96002
63304-0960-01
R/P
CEFPROZIL
R-X
698332 96003
63304-0960-04
R/P
CEFPROZIL
R-X
648279 96004
00781-6203-91
SNZ CEFPROZIL
R-X
648287 96005
00781-6203-57
SNZ CEFPROZIL
R-X
698365 96006
63304-0961-04
R/P
R-X
732446 95333
CEFTAZIDIME VL 1 GM CT/25
00781-3177-96
SNZ CEFTAZIDIME PENTAHYDRATE
732453 95334
CEFTAZIDIME VL 2 GM CT/10
00781-3178-95
SNZ CEFTAZIDIME PENTAHYDRATE
R-X
628149 95523
CEFTRIAXONE VL 1GM/10
00781-3208-95
SNZ CEFTRIAXONE SODIUM
R-X
628123 95316
CEFTRIAXONE VL 250MG/10
00781-3206-95
R-X
628156 96234
CEFTRIAXONE VL 2GM/10
00781-3209-95
R-X
628131 96233
CEFTRIAXONE VL 500MG/10
00781-3207-95
R-X
931790 95655
CEFUROXIME AXETIL 250MG 20
64679-0921-01
WCK CEFUROXIME AXETIL
R-X
931816 96240
CEFUROXIME AXETIL 500MG 20
64679-0922-01
WCK CEFUROXIME AXETIL
R-X
199448 96935
CELEBREX CAP 100 MG 100
00025-1520-31
PFZ CELECOXIB
R-X
R-X
CEFPROZIL
R-X
295717 97474
CELEBREX CAP 100 MG 100UD
00025-1520-34
PFZ CELECOXIB
199455 96936
CELEBREX CAP 200 MG 100
00025-1525-31
PFZ CELECOXIB
R-X
295725 97475
CELEBREX CAP 200 MG 100UD
00025-1525-34
PFZ CELECOXIB
R-X
230805 1434
CELESTONE SOLUSPAN VL 5CC
00085-0566-05
SCH BETAMET ACET/BETAMET NA PH
R-X
177535 97374
CELLCEPT IV VL 500 MG 20ML BX4
00004-0298-09
ROC MYCOPHENOLATE MOFETIL HCL
R-X
291419 97375
CELLCEPT O/SOL 200MG/ML 175 ML
00004-0261-29
ROC MYCOPHENOLATE MOFETIL
R-X
711549 45950
CELONTIN CAP 300 MG 100
00071-0525-24
PFZ METHSUXIMIDE
R-X
573873 67870
CENOLATE AMP 1 GM 2CC/50
00409-3397-32
HOS ASCORBATE SODIUM
R-X
491845 12127
CEPHALEXIN CAP 250 MG 100
00093-3145-01
TEV CEPHALEXIN MONOHYDRATE
R-X
604603 12831
CEPHALEXIN CAP 500 MG 100
00093-3147-01
R-X
374603 11646
CEPHALEXIN SUS 125 MG 100ML
00093-4175-73
R-X
603910 16719
00093-4177-73
R-X
701078 96456
00093-4177-74
R-X
999227 96610
CETIRIZINE HCL 1MG/ML SYR 4OZ
00093-6300-12
TEV CETIRIZINE HCL
R-X
828079 96611
CETIRIZINE HCL TAB 5MG 100
00378-3635-01
MYL CETIRIZINE HCL
R-X
828087 96361
CETIRIZINE HCL TAB 10MG 100
00378-3637-01
MYL CETIRIZINE HCL
R-X
517425 95787
CHEMET SUCCIMER CAP 100 MG 100
67386-0201-11
OVA SUCCIMER
R-X
528356 27400
CHLOR/HYD SYR 16 OZ
00121-0532-16
PMA CHLORAL HYDRATE
R-X
Page 8 of 46
Attachment n
M&D #
User #
Description
NDC #
Mfg
Generic Description
UDF 1
454595 95230
CHLOR/HYD SYR 500 MG 5ML/100UD
00121-0532-05
PMA CHLORAL HYDRATE
R-X
324533 23315
CHLORAMPHENCL VL 1 GM 10ML/10
63323-0011-15
APP CHLORAMPHENICOL NA SUCC
R-X
874560 26024
CHLORDIAZPX 25 MG 100
00555-0159-02
TEV CHLORDIAZEPOXIDE HCL
R-X
557587 45198
CHLORDIAZPX 25 MG 100UD
51079-0141-20
UDL CHLORDIAZEPOXIDE HCL
R-X
596270 95542
CHLORHEXIDINE GLUC O/R 16 OZ
50383-0720-16
HTP CHLORHEXIDINE GLUCONATE
R-X
127142 25440
CHLOROPROCAINE SDV 2% 30ML/25
00409-4169-01
HOS CHLOROPROCAINE HCL
R-X
127159 14143
CHLOROPROCAINE SDV 3% 30ML/25
00409-4170-01
HOS CHLOROPROCAINE HCL
R-X
344804 14219
CHLOROQUINE PHOS TAB 500 MG 25
00143-2125-22
W-W CHLOROQUINE PHOSPHATE
R-X
25411 97274
CHLOROTHIAZIDE SDV 500 MG 20ML
63323-0658-20
APP CHLOROTHIAZIDE SODIUM
R-X
967547 23402
CHLORPROMAZINE AMP 25MG 1ML/25
00641-1397-35
BAX CHLORPROMAZINE HCL
R-X
501213 96531
CHLORPROMAZINE TAB 10 MG 100
00781-1715-01
SNZ CHLORPROMAZINE HCL
R-X
502138 96532
CHLORPROMAZINE TAB 10 MG 100U
51079-0518-20
UDL CHLORPROMAZINE HCL
R-X
881318 28355
00781-1716-01
R-X
502146 30885
51079-0519-20
R-X
881250 28357
00781-1718-01
R-X
502385 30887
51079-0516-20
R-X
126581 95090
R-X
CHROMIUM TRACE METL VL 10ML/25
00409-4093-01
HOS CHROMIC CHLORIDE
14902 98030
CIPROFLOXACIN IV BG200M/100/24
00781-3239-09
SNZ CIPROFLOXACIN LACTATE/D5W
R-X
993873 98031
CIPROFLOXACIN IV BG400M/200/24
36000-0009-24
CLS CIPROFLOXACIN LACTATE/D5W
R-X
533836 95803
CIPROFLOXACIN OPT SOL 5 ML
61314-0656-05
FAL
CIPROFLOXACIN HCL
R-X
533828 95802
CIPROFLOXACIN OPT SOL 2.5 ML
61314-0656-25
FAL
CIPROFLOXACIN HCL
R-X
698431 95742
CIPROFLOXACIN SDV 200MG1%20M10
00703-0956-03
TEV CIPROFLOXACIN LACTATE
R-X
698449 95743
CIPROFLOXACIN SDV 400MG1%40M10
00703-0958-03
TEV CIPROFLOXACIN LACTATE
R-X
672295 96581
CIPROFLOXACIN TAB 100 MG 6
55111-0125-06
RED CIPROFLOXACIN HCL
R-X
998989 95529
00172-5311-60
TEV CIPROFLOXACIN HCL
R-X
557819 99214
CIPROFLOXACIN TAB 250 MG 100UD
00172-5311-10
R-X
548891 95530
00143-9928-01
W-W CIPROFLOXACIN HCL
R-X
557827 99216
00172-5312-10
R-X
999128 95531
00172-5313-60
R-X
761783 99217
68084-0071-01
RPK CIPROFLOXACIN HCL
R-X
369017 95682
CISPLATIN MDV 50 MG 50ML
00703-5747-11
GES CISPLATIN
R-X
369025 95683
CISPLATIN MDV 100 MG 100ML
00703-5748-11
GES CISPLATIN
R-X
733154 97786
CITALOPRAM O/SOL 10MG/5MG240ML
00054-0062-58
ROX CITALOPRAM HYDROBROMIDE
R-X
620484 97783
CITALOPRAM TAB 10 MG 100
55111-0342-01
RED CITALOPRAM HYDROBROMIDE
R-X
846956 98238
CITALOPRAM TAB 10 MG 100UD
00093-4740-93
TEV CITALOPRAM HYDROBROMIDE
R-X
999391 97784
00093-4741-01
R-X
846964 98239
00093-4741-93
R-X
858266 97785
13668-0011-01
TOR CITALOPRAM HYDROBROMIDE
R-X
846972 98240
00093-4742-93
R-X
619858 96328
CLARITHROMYCIN 125MG/5ML 100ML
68774-0302-35
DVA CLARITHROMYCIN
R-X
619874 96329
CLARITHROMYCIN 250MG/5ML 100ML
68774-0303-35
DVA CLARITHROMYCIN
R-X
999409 97242
CLARITHROMYCIN IR TAB 250MG 60
00093-7157-06
TEV CLARITHROMYCIN
R-X
623884 95770
CLARITHROMYCIN IR TAB 500MG 60
63304-0726-60
R/P
R-X
727339 97243
CLARITHROMYCIN IR TB 250MG100U
51079-0361-20
UDL CLARITHROMYCIN
R-X
28985 96371
CLARITHROMYCIN IR TB 500MG 50U
51079-0673-06
UDL CLARITHROMYCIN
R-X
CLARITHROMYCIN
999151 95562
CLEMASTINE FUM SYR 4 OZ
00093-0309-12
TEV CLEMASTINE FUMARATE
R-X
859124 95563
CLEMASTINE FUM TAB 2.68MG 100
00781-1359-01
SNZ CLEMASTINE FUMARATE
R-X
470849 17314
CLEOCIN PED SUS 100ML
00009-0760-04
PFZ CLINDAMYCIN PALMITATE
R-X
472696 95669
CLEOCIN PHOS BG 600 MG 50ML/24
00009-3375-02
PFZ CLINDAMYCIN PHOSPHATE/D5W
R-X
472720 97200
CLEOCIN PHOS BG 900 MG 50ML/24
00009-3382-02
PFZ CLINDAMYCIN PHOSPHATE/D5W
R-X
477265 96318
CLEOCIN T TOP LOT 1% 60ML
00009-3329-01
PFZ CLINDAMYCIN PHOSPHATE
R-X
476804 95861
CLEOCIN VAGINAL CR 40 GM
00009-3448-01
PFZ CLINDAMYCIN PHOSPHATE
R-X
643312 10464
CLINDAMYCIN CAP 150 MG 100
59762-3328-01
GRN CLINDAMYCIN HCL
R-X
504134 15865
CLINDAMYCIN CAP 150 MG 100UD
51079-0598-20
UDL CLINDAMYCIN HCL
R-X
469742 95565
CLINDAMYCIN CAP 300 MG 100
00591-3120-01
WAT CLINDAMYCIN HCL
R-X
848630 98162
CLINDAMYCIN CAP 300 MG 100UD
68084-0244-01
RPK CLINDAMYCIN HCL
R-X
Page 9 of 46
Attachment n
M&D #
User #
Description
NDC #
Mfg
Generic Description
UDF 1
643056 50818
CLINDAMYCIN TOP SOL 1% 60ML
59762-3728-02
GRN CLINDAMYCIN PHOSPHATE
R-X
573808 16175
CLINDAMYCIN VL 600MG 4ML/25
00409-4051-01
HOS CLINDAMYCIN PHOSPHATE
R-X
573816 95269
CLINDAMYCIN VL 900MG 6ML/25
00409-4052-01
HOS CLINDAMYCIN PHOSPHATE
R-X
775205 120259
CLINISOL 2L CS/6 2B6189
00338-0502-06
BXT PARENTERAL AMINO ACID 15% NO.1
R-X
339945 96333
CLOBETASOL PROP EMOL CRM 30 GM
00168-0301-30
FOU CLOBETASOL PROPIONATE/EMOLL
R-X
330506 96334
CLOBETASOL PROP GEL 30 GM
51672-1294-02
TAR CLOBETASOL PROPIONATE
R-X
144980 95918
CLOBETASOL PROP OIN 30 GM
00168-0162-30
FOU CLOBETASOL PROPIONATE
R-X
372912 95920
CLOBETASOL TOP SOL 50 ML
60432-0133-50
WCK CLOBETASOL PROPIONATE
R-X
882738 95676
CLOMIPRAMINE CAP 25 MG 100
00781-2027-01
SNZ CLOMIPRAMINE HCL
R-X
882746 95677
00781-2037-01
R-X
882753 95678
00781-2047-01
R-X
166728 21079
CLONAZEPAM TAB 1 MG 100
00185-0064-01
EON CLONAZEPAM
R-X
967562 99271
CLONAZEPAM TAB 1 MG 100UD
51079-0882-20
UDL CLONAZEPAM
R-X
258491 21081
CLONAZEPAM TAB .5 MG 100
00378-1910-01
MYL CLONAZEPAM
R-X
883249 96204
CLONAZEPAM TAB .5 MG 100UD
51079-0881-20
UDL CLONAZEPAM
R-X
796078 19499
CLONIDINE TAB .1 MG 100
00378-0152-01
MYL CLONIDINE HCL
R-X
557108 99127
CLONIDINE TAB .1 MG 100UD
00904-5656-61
MAJ CLONIDINE HCL
R-X
796094 19498
00378-0186-01
MYL CLONIDINE HCL
R-X
503052 99128
CLONIDINE TAB .2 MG 100UD
51079-0300-20
UDL CLONIDINE HCL
R-X
796102 95851
00378-0186-10
MYL CLONIDINE HCL
R-X
627943 95325
CLORAZEPATE TAB 7.5 MG 100
63304-0553-01
R/P
315481 23264
CLOTRIMAZOLE SOL 1% 30 ML
00093-0248-31
TEV CLOTRIMAZOLE
553719 95294
CLOTRIMAZOLE TROCHE 10MG 70
00054-4146-22
ROX CLOTRIMAZOLE
R-X
917781 96367
CLOTRIMAZOLE TROCHE 10MG 70UD
00574-0107-77
PAD CLOTRIMAZOLE
R-X
212548 97281
CLOZARIL TAB 25 MG 100
00078-0126-05
NVT CLOZAPINE
R-X
212522 97282
CLOZARIL TAB 25 MG 100UD
00078-0126-06
NVT CLOZAPINE
R-X
212555 97283
CLOZARIL TAB 100 MG 100
00078-0127-05
NVT CLOZAPINE
R-X
212530 97284
CLOZARIL TAB 100 MG 100UD
00078-0127-06
NVT CLOZAPINE
R-X
3822 97224
COAGUCHEK CONTROL KIT
50924-0745-01
BM
R-X
3830 95626
COAGUCHEK S SYSTEM CONTROLS
50924-0567-08
BM
R-X
227264 97225
COAGUCHEK STRIPS BX/48 3116247
50924-0247-48
BM
977231 98200
COARTEM TAB 20MG/120MG 24
00078-0568-45
NVT ARTEMETHER/LUMEFANTRINE
R-X
955518 95220
CII
CLORAZEPATE DIPOTASSIUM
R-X
R-X
PROTHROMBIN TIME TEST STRIPS
R-X
COCAINE- 4% 4ML SOLUTION
00527-1728-74
LAN COCAINE HCL
16782 24023
CODEINE SULF 30 MG 100
00054-0244-25
ROX CODEINE SULF
CII
17756 62621
CODEINE SULF 30 MG 4X25
00054-0244-24
ROX CODEINE SULF
CII
CII
CODEINE SULF 60 MG 100
00054-0245-25
ROX CODEINE SULF
652768 31890
17764 24024
COGENTIN AMP 1 MG 2CC/5
67386-0611-52
OVA BENZTROPINE MESYLATE
R-X
910810 39780
COLCHICINE TAB .6 MG 100
00143-1201-01
W-W COLCHICINE
R-X
472381 95541
COLESTID PKT 5 GM/30
00009-0260-01
PFZ COLESTIPOL HCL
R-X
476705 96356
COLESTID TAB 1 GM 120
00009-0450-03
PFZ COLESTIPOL HCL
R-X
673384 97667
COLISTIMETHATE SOD 150 MG VL
00574-0858-01
PAD COLISTIMETHATE SODIUM
R-X
848713 63800
COLY-MYCIN S OTIC 5CC
42023-0108-01
JHP NEOMY SULF/COLIST SUL/HC/THONZ
R-X
824912 98181
COMBIGAN OPT SOL 10ML 92112
00023-9211-10
ALL
751768 96704
COMBIVENT INH 200 SPY 1314
00597-0013-14
BOE IPRATROPIUM/ALBUTEROL SULFATE
185116 96654
COMBIVIR TAB 60
00173-0595-00
SKB LAMIVUDINE/ZIDOVUDINE
R-X
328484 97747
COMTAN TAB 200 MG 100
00078-0327-05
NVT ENTACAPONE
R-X
281725 97053
COMVAX SDV .5 ML/10
00006-4898-00
MSD HEP B VACCINE/HIB CONJ-MENG/PF
R-X
947333 97297
CONCERTA ER TAB 18 MG 100
50458-0585-01
JOM METHYLPHENIDATE HCL
CII
946889 97584
50458-0588-01
CII
947598 97298
50458-0586-01
CII
947606 97299
50458-0587-01
CII
848671 97280
COPAXONE PRE-FIL SRN 20MG 30
68546-0317-30
TNE GLATIRAMER ACETATE
R-X
472191 84011
CORTEF TAB 5 MG 50
00009-0012-01
PFZ HYDROCORTISONE
R-X
502989 9518
CORTROSYN VL .25MG 1ML/10
00548-5900-00
AMP COSYNTROPIN
R-X
470559 96546
CORVERT VL 10 ML
00009-3794-01
PFZ IBUTILIDE FUMARATE
R-X
652776 74771
COSMEGEN VL .5 MG 3ML
67386-0811-55
OVA DACTINOMYCIN
R-X
BRIMONIDINE TARTRATE/TIMOLOL
R-X
R-X
Page 10 of 46
Attachment n
M&D #
NDC #
Mfg
549907 96655
User #
COUMADIN TAB 1 MG 100
00056-0169-70
BRI
549915 96656
COUMADIN TAB 1 MG 100UD HSP
00056-0169-75
BRI
WARFARIN SODIUM
R-X
550103 16276
00056-0170-70
BRI
WARFARIN SODIUM
R-X
550780 16274
00056-0170-75
BRI
WARFARIN SODIUM
R-X
550020 16278
COUMADIN TAB 2.5 MG 100
00056-0176-70
BRI
WARFARIN SODIUM
R-X
550798 16277
COUMADIN TAB 2.5 MG 100UD HSP
00056-0176-75
BRI
WARFARIN SODIUM
R-X
550475 96657
00056-0188-70
BRI
WARFARIN SODIUM
R-X
550624 96658
COUMADIN TAB 3 MG 100UD HOSP
00056-0188-75
BRI
WARFARIN SODIUM
R-X
552984 96659
00056-0168-70
BRI
WARFARIN SODIUM
R-X
552950 98262
00056-0168-75
BRI
WARFARIN SODIUM
R-X
550012 16282
00056-0172-70
BRI
WARFARIN SODIUM
R-X
550160 16283
00056-0172-75
BRI
WARFARIN SODIUM
R-X
550889 96661
00056-0189-70
BRI
WARFARIN SODIUM
R-X
550863 96662
COUMADIN TAB 6 MG 100UD HOSP
00056-0189-75
BRI
WARFARIN SODIUM
R-X
550186 16285
COUMADIN TAB 7.5 MG 100
00056-0173-70
BRI
WARFARIN SODIUM
R-X
550038 16287
00056-0174-70
BRI
WARFARIN SODIUM
R-X
277533 97933
COZAAR TAB 25 MG 90
00006-0951-54
MSD LOSARTAN POTASSIUM
R-X
277558 98277
COZAAR TAB 25 MG 100UD
00006-0951-28
R-X
656009 97953
COZAAR TAB 25 MG 1000
00006-0951-82
R-X
989566 95957
CREON 12000 CAP 100
00032-1212-01
SLV LIPASE/PROTEASE/AMYLASE
R-X
505628 98076
CRESTOR TAB 5 MG 90
00310-0755-90
A/Z
ROSUVASTATIN CALCIUM
R-X
505644 98077
CRESTOR TAB 10 MG 90
00310-0751-90
A/Z
R-X
505636 98093
CRESTOR TAB 10 MG 100UD
00310-0751-39
ZNC ROSUVASTATIN CALCIUM
R-X
505669 98078
00310-0752-90
A/Z
R-X
505651 98094
CRESTOR TAB 20 MG 100UD
00310-0752-39
ZNC ROSUVASTATIN CALCIUM
R-X
505677 98079
00310-0754-30
377408 96867
CRIXIVAN CAP 200 MG 360
00006-0571-43
MSD INDINAVIR SULFATE
R-X
996207 96868
CRIXIVAN CAP 400 MG 180
00006-0573-62
MSD INDINAVIR SULFATE
R-X
377275 96122
CROFAB VL CT/2
00281-0330-10
SAV ANTIVENIN,CROTALIDAE FAB(OVIN)
R-X
681759 97867
CRUCIAL CAN 250ML CS/24
00065-9124-70
NES NUT.TX.COMP. IMMUNE SYSTM,SOY
R-X
513283 97634
CUBICIN INJ 500MG 10ML/10
67919-0011-01
CUB DAPTOMYCIN
R-X
R-X
80093 95086
Description
A/Z
Generic Description
UDF 1
WARFARIN SODIUM
R-X
R-X
CUPRIC SULF VL 4 MG 10ML/25
00517-6210-25
A-R
206920 96121
CYANIDE ANTIDOTE KIT
11098-0507-01
AKR SOD THIOSULF/SOD NIT/AMYL NIT
CUPRIC SULFATE
R-X
399808 98019
CYCLESSA CYCLE PK 6X28
00052-0283-06
SCH DESOGESTREL-ETHINYL ESTRADIOL
R-X
797456 95327
CYCLOBENZAPRINE TAB 10 MG 100
00378-0751-01
MYL CYCLOBENZAPRINE HCL
R-X
506444 99146
CYCLOBENZAPRINE TAB 10 MG 100U
51079-0644-20
UDL CYCLOBENZAPRINE HCL
R-X
132886 97190
CYCLOMYDRIL 2ML CT12
00065-0359-02
ALC CYCLOPENTOLATE/PHENYLEPHRINE
R-X
130427 97182
CYCLOMYDRIL PLASTIC 5ML
00065-0359-05
ALC CYCLOPENTOLATE/PHENYLEPHRINE
R-X
910869 99157
CYCLOPENTOLATE 1% 2ML
24208-0735-01
B&L CYCLOPENTOLATE HCL
R-X
910885 83150
CYCLOPENTOLATE 1% 15ML
24208-0735-06
B&L CYCLOPENTOLATE HCL
R-X
634998 95229
CYCLOPHOSPHAMIDE SDV 1GM 75ML
10019-0956-01
BAX CYCLOPHOSPHAMIDE
R-X
917849 5060
CYCLOPHOSPHAMIDE SDV 2GM 100ML
10019-0957-01
R-X
917823 98047
CYCLOPHOSPHAMIDE SDV 500MG 50M
10019-0955-01
R-X
345553 97746
CYCLOPHOSPHAMIDE TAB 25MG 100
00054-4129-25
ROX CYCLOPHOSPHAMIDE
R-X
865774 97710
CYCLOSPORINE O/SOL 100M/ML 50M
60505-0354-01
A-C
R-X
338848 97708
CYCLOSPORINE SG CAP 25 MG 30
00185-0932-30
EON CYCLOSPORINE, MODIFIED
R-X
338855 97709
CYCLOSPORINE SG CAP 100 MG 30
00185-0933-30
EON CYCLOSPORINE, MODIFIED
R-X
841684 97127
CYKLOKAPRON 100 MG/ML 10ML/10
00013-1114-10
PFZ TRANEXAMIC ACID
R-X
552380 97945
CYMBALTA CAP 30 MG 30
00002-3240-30
LIL
DULOXETINE HCL
R-X
28761 97946
CYMBALTA CAP 60 MG 30
00002-3270-30
LIL
DULOXETINE HCL
R-X
707190 82870
CYPROHEPTADINE TAB 4 MG 100
60258-0850-01
CYP CYPROHEPTADINE HCL
R-X
270793 27632
CYSTO-CONRAY II BOT 250ML/12
00019-0862-07
MAL IOTHALAMATE MEGLUMINE
R-X
335836 97198
CYTARABINE AQU 2GM P/F 20ML
61703-0319-22
HOS CYTARABINE/PF
R-X
146266 97197
CYTARABINE INJ 1 GM 20 ML
55390-0133-01
BED CYTARABINE/PF
R-X
406512 4055
CYTARABINE INJ 100MG CT/10
55390-0131-10
BED CYTARABINE/PF
R-X
146084 4482
CYTARABINE INJ 500MG CT/10
55390-0132-10
BED CYTARABINE/PF
R-X
CYCLOSPORINE, MODIFIED
Page 11 of 46
Attachment n
M&D #
User #
Description
NDC #
Mfg
Generic Description
UDF 1
635052 33531
CYTOMEL TAB 5 MCG 100
60793-0115-01
MNR LIOTHYRONINE SODIUM
R-X
653758 85140
60793-0116-01
R-X
654509 97337
60793-0117-01
R-X
254474 95745
CYTOTEC TAB 100 MCG 60
00025-1451-60
PFZ MISOPROSTOL
R-X
254490 99270
CYTOTEC TAB 100 MCG 100UD
00025-1451-34
PFZ MISOPROSTOL
R-X
967422 95908
CYTOVENE POW VL 500 MG 10ML/25
00004-6940-03
ROC GANCICLOVIR SODIUM
R-X
449561 13310
D.H.E. 45 AMP 1ML/10
66490-0041-01
ICN
417071 23775
DACARBAZINE 200 MG 20ML/10
55390-0090-10
BED DACARBAZINE
870634 25547
DANAZOL CAP 200 MG 100
00555-0635-02
TEV DANAZOL
R-X
645986 96045
DANTROLENE CAP 100 MG 100
00115-4433-01
GLO DANTROLENE SODIUM
R-X
757625 96042
DANTROLENE VL 20MG 65ML CT6
27505-0001-65
USW DANTROLENE SODIUM
R-X
878736 97808
DAPSONE TAB 25 MG 30UD
49938-0102-30
JAC DAPSONE
R-X
878744 95419
DAPSONE TAB 100 MG 30UD
49938-0101-30
JAC DAPSONE
R-X
246397 95755
DARAPRIM TAB 25 MG 100 201
00173-0201-55
SKB PYRIMETHAMINE
R-X
547349 95275
DAUNORUBICIN HCL 20MG/ 4ML X10
00703-5233-13
GES DAUNORUBICIN HCL
R-X
599456 96088
DDAVP RHINAL TUBE 2.5 ML
00075-2450-01
AVE DESMOPRESSIN ACETATE
R-X
617555 97813
DECAVAC SRN 0.5 ML CT/10
49281-0291-10
AVE TETANUS AND DIPHTHERIA TOX/PF
R-X
548073 3236
DEFEROXAMINE MESYL VL 500MG/4
00409-2336-10
HOS DEFEROXAMINE MESYLATE
R-X
76414 15490
DEHYDRATED ALCOHOL AMP 1ML/10
00517-8571-10
A-R
ETHYL ALCOHOL
R-X
76810 97701
DEHYDRATED ALCOHOL AMP 5ML/10
00517-8575-10
A-R
ETHYL ALCOHOL
R-X
645978 97364
DEMECLOCYCLINE TAB 300 MG 48
00115-2122-14
GLO DEMECLOCYCLINE HCL
R-X
829721 98276
DEMECLOCYCLINE TAB 300 MG 50U
62584-0163-65
RPK DEMECLOCYCLINE HCL
R-X
653766 97795
DEMEROL 100MG 20 ML
00409-1201-20
HOS MEPERIDINE HCL
CII
635714 17416
DEMEROL CPJ 25 MG/10 LL SLMPK
00409-1176-30
HOS MEPERIDINE HCL/PF
CII
639450 17417
00409-1178-30
CII
648709 17418
00409-1179-30
CII
636753 17419
00409-1180-69
CII
123323 33389
DEPAKENE SYR 250 MG 16 OZ 5682
00074-5682-16
ABB VALPROATE SODIUM
R-X
447649 97977
DEPAKOTE ER TAB 250 MG 100
00074-3826-13
ABB DIVALPROEX SODIUM
R-X
508499 97978
DEPAKOTE ER TAB 250 MG 100UD
00074-3826-11
R-X
369066 97156
DEPAKOTE ER TAB 500 MG 100
00074-7126-13
R-X
106641 97483
DEPAKOTE ER TAB 500 MG 100UD
00074-7126-11
R-X
123794 95311
DEPAKOTE TAB 125 MG 100
00074-6212-13
R-X
124669 97482
DEPAKOTE TAB 125 MG 100UD
00074-6212-11
R-X
123372 97907
00074-6214-13
R-X
124081 97908
00074-6214-11
R-X
123380 95226
00074-6215-13
R-X
124636 99190
00074-6215-11
R-X
DIHYDROERGOTAMINE MESYLATE
R-X
R-X
476937 316
DEPO-MEDROL VL 40 MG 1ML
00009-3073-01
PFZ METHYLPREDNISOLONE ACETATE
R-X
474791 95153
DEPO-MEDROL VL 80 MG 5ML
00009-0306-02
PFZ METHYLPREDNISOLONE ACETATE
R-X
473249 95873
DEPO-PROVERA VL 150 MG 1ML
00009-0746-30
PFZ MEDROXYPROGESTERONE ACET
R-X
472571 15565
DEPO-PROVERA VL 400 MG 2.5ML
00009-0626-01
PFZ MEDROXYPROGESTERONE ACET
R-X
477034 8851
DEPO-TESTOSTERNE 200 MG 10ML
00009-0417-02
PFZ TESTOSTERONE CYPIONATE
R-X
472597 41311
DEPO-TESTOSTERNE 200 MG/ML 1ML
00009-0417-01
PFZ TESTOSTERONE CYPIONATE
R-X
179838 95561
DERMA-SMOOTHE/FS SCALP OIL 4OZ
28105-0149-04
HIL
R-X
501288 18599
DESIPRAMINE TAB 25 MG 100
00781-1972-01
SNZ DESIPRAMINE HCL
R-X
501296 18603
DESIPRAMINE TAB 50 MG 100
00781-1973-01
SNZ DESIPRAMINE HCL
R-X
999276 97802
DESMOPRESSIN TAB .1 MG 100
00093-7316-01
TEV DESMOPRESSIN ACETATE
R-X
291807 97834
DESMOPRESSIN VL 4MCG/ML 10 ML
00703-5054-01
GES DESMOPRESSIN ACETATE
R-X
273144 95263
DESMOPRESSIN VL 4MCG/ML 1ML/10
00703-5051-03
GES DESMOPRESSIN ACETATE
R-X
946517 96612
DESQUAM-X WASH 5% 5 OZ
10631-0284-05
R/P
BENZOYL PEROXIDE
R-X
378372 97353
DETROL LA CAP 2 MG 90
00009-5190-02
PFZ TOLTERODINE TARTRATE
R-X
378398 97354
DETROL LA CAP 2 MG 100UD
00009-5190-04
R-X
377424 97355
DETROL LA CAP 4 MG 90
00009-5191-02
R-X
377440 97357
DETROL LA CAP 4 MG 100UD
00009-5191-04
R-X
50526 96991
DETROL TAB 1 MG 60 BOTTLE
00009-4541-02
R-X
FLUOCINOLONE/SHOWER CAP
Page 12 of 46
Attachment n
M&D #
User #
50567 96992
Description
DETROL TAB 2 MG 60 BOTTLE
NDC #
Mfg
Generic Description
UDF 1
00009-4544-02
R-X
205781 120060
DEX 5% BG 50ML/96 2B0081
00338-0017-11
BXT DEXTROSE 5%-WATER
R-X
844365 120192
DEX 5%BG 25ML CS/48 2B0080
00338-0017-10
R-X
205799 120061
DEX 5% BG 100ML/96 2B0082
00338-0017-18
R-X
844423 120270
DEX 70% 2000ML/6 PLAS 2B0296H
00338-0719-06
R-X
236463 120049
DEX 10% /SOD CHL .9% 1000ML/6
00409-1534-05
HOS DEXTROSE 10%-NORMAL SALINE
R-X
517466 95865
DEX 50% 50ML/10 ANYSRII/SRN
00409-7517-16
HOS DEXTROSE 50%-WATER
R-X
127019 18221
DEX 50% 50ML/25 VL
00409-6648-02
R-X
147074 120147
DEX 50% 2000ML/6 2B0256
00338-0031-06
R-X
125328 95400
DEX AMP 10% 5ML/25
00409-4089-02
R-X
599738 120186
DEX5/NACL.9/KCL20 LX14 2B2434X
00338-0803-04
BXT POTASSIUM CHLORIDE/D5-NS
R-X
592857 120057
DEX5/SD.45/KCL20 1LX14 2B1654X
00338-0671-04
BXT POTASSIUM CHLORIDE IN D5-1/2NS
R-X
621128 120055
DEX5/SOD.2/KCL20 1LX14 2B1614X
00338-0663-04
BXT POTASSIUM CHLORIDE/D5-0.25NS
R-X
DEXAMETHASONE ELX 8 OZ
60432-0466-08
WCK DEXAMETHASONE
R-X
910281 7070
24521 83060
DEXAMETHASONE OPT SOL .1% 5ML
24208-0720-02
B&L DEXAMETHASONE SOD PHOSPHATE
R-X
303685 98027
DEXAMETHASONE SOL 500ML
00054-3177-63
ROX DEXAMETHASONE
R-X
302935 82960
DEXAMETHASONE TAB .5 MG 100
00054-4179-25
ROX DEXAMETHASONE
R-X
302927 27791
DEXAMETHASONE TAB .5 MG 100U
00054-8179-25
ROX DEXAMETHASONE
R-X
302968 80661
DEXAMETHASONE TAB .75 MG 100
00054-4180-25
ROX DEXAMETHASONE
R-X
302950 26843
DEXAMETHASONE TAB .75 MG 100U
00054-8180-25
ROX DEXAMETHASONE
R-X
303404 98170
DEXAMETHASONE TAB 2 MG 100U
00054-8176-25
ROX DEXAMETHASONE
R-X
303438 26471
DEXAMETHASONE TAB 4 MG 100
00054-4184-25
ROX DEXAMETHASONE
R-X
303420 19752
DEXAMETHASONE TAB 4 MG 100U
00054-8175-25
ROX DEXAMETHASONE
R-X
226134 22074
DEXAMETHASONE VL 4 MG 1ML/25
63323-0165-01
APP DEXAMETHASONE SOD PHOSPHATE
R-X
226746 22072
63323-0165-05
R-X
218693 22073
DEXAMETHASONE VL 4 MG 30ML
63323-0165-30
R-X
636886 21014
63323-0516-10
R-X
844969 17627
DEXEDRINE SPN 5 90
00007-3512-59
SKB DEXTROAMPHETAMINE SULFATE
CII
827105 96498
DEXEDRINE SPN 10 90
00007-3513-59
CII
827113 97302
DEXEDRINE SPN 15 90
00007-3514-59
CII
618835 96378
DEXRAZOXANE VL 250 MG
55390-0014-02
BED DEXRAZOXANE
R-X
618843 96379
DEXRAZOXANE VL 500 MG
55390-0060-02
BED DEXRAZOXANE
R-X
386789 96497
DEXTROAMPHETAMINE TAB 5MG 100
00555-0952-02
TEV DEXTROAMPHETAMINE SULFATE
CII
480434 91510
DIAMOX SEQUEL 500 MG 100
51285-0754-02
DMD ACETAZOLAMIDE
R-X
636373 97892
DIASTAT ACUDIAL 10 MG TWIN
00187-0658-20
ICN
DIAZEPAM
R-X
636381 97893
DIASTAT ACUDIAL 20 MG TWIN
00187-0659-20
ICN
DIAZEPAM
R-X
449264 97321
DIASTAT GEL 2.5 MG PED TWIN
66490-0650-20
ICN
DIAZEPAM
R-X
DIASTIX 100 2803
00193-2802-21
BAY URINE GLUCOSE TEST,STRIP
R-X
305755 96500
DIAZEPAM SOL 5ML/40
00054-8207-16
ROX DIAZEPAM
R-X
304352 96499
DIAZEPAM SOL 500ML
00054-3188-63
ROX DIAZEPAM
R-X
636670 10627
DIAZEPAM SRN 5MG/ML 2ML/10LL
00409-1273-32
HOS DIAZEPAM
R-X
795161 95632
DIAZEPAM TAB 2 MG 100
00378-0271-01
MYL DIAZEPAM
R-X
502542 46531
DIAZEPAM TAB 2 MG 100UD
51079-0284-20
UDL DIAZEPAM
R-X
417279 96508
00591-5619-01
WAT DIAZEPAM
R-X
502559 96509
51079-0285-20
UDL DIAZEPAM
R-X
415745 1626
00591-5620-01
WAT DIAZEPAM
R-X
502567 46535
51079-0286-20
UDL DIAZEPAM
R-X
347823 80500
DIBENZYLINE 10 MG 100
65197-0001-01
W-S PHENOXYBENZAMINE HCL
R-X
10272 12984
603415 3338
DICLOXACILLIN CAP 250 MG 100
00093-3123-01
TEV DICLOXACILLIN SODIUM
R-X
603423 44635
DICLOXACILLIN CAP 500 MG 100
00093-3125-01
TEV DICLOXACILLIN SODIUM
R-X
428383 96962
DICYCLOMINE CAP 10 MG 100
00591-0794-01
WAT DICYCLOMINE HCL
R-X
500611 97478
DICYCLOMINE CAP 10 MG 100UD
51079-0118-20
UDL DICYCLOMINE HCL
R-X
255885 96963
DICYCLOMINE TAB 20 MG 100
00591-0795-01
WAT DICYCLOMINE HCL
R-X
357103 96964
DICYCLOMINE TAB 20 MG 100UD
51079-0119-20
UDL DICYCLOMINE HCL
R-X
619692 97139
DIDANOSINE DR CAP 200 MG 30
00555-0588-01
TEV DIDANOSINE
R-X
619700 97141
00555-0589-01
TEV DIDANOSINE
R-X
Page 13 of 46
Attachment n
M&D #
User #
Description
NDC #
619718 97143
00555-0590-01
763979 96188
DIFLUCAN ORAL SUS 40MG/ML 35ML
243444 95858
DIGIBIND INJ 38 MG VL
616243 90154
DIGOXIN ELX .05MG/ML 60ML
Mfg
Generic Description
UDF 1
TEV DIDANOSINE
R-X
00049-3450-19
PFZ FLUCONAZOLE
R-X
00173-0230-44
SKB DIGOXIN IMMUNE FAB
R-X
00054-0057-46
ROX DIGOXIN
R-X
R-X
710566 2370
DILANTIN 125 SUS 8 OZ
00071-2214-20
PFZ PHENYTOIN
994285 95784
DILANTIN CAP 30 MG 100
00071-3740-66
PFZ PHENYTOIN SODIUM EXTENDED
R-X
710558 43
DILANTIN INFATAB 50 MG 100
00071-0007-24
PFZ PHENYTOIN
R-X
711069 97513
DILANTIN INFATAB 50 MG 100UD
00071-0007-40
PFZ PHENYTOIN
R-X
842088 97492
DILAUDID HCL TAB 2 MG 4X25
59011-0452-01
P-F
CII
502831 97481
DILTIAZEM CAP ER 120 MG 80UD
51079-0947-08
UDL DILTIAZEM HCL
218347 97045
DILTIAZEM CAP ER 120 MG 100
00378-5220-01
MYL DILTIAZEM HCL
R-X
502849 97480
51079-0948-08
UDL DILTIAZEM HCL
R-X
218354 97046
00378-5280-01
MYL DILTIAZEM HCL
R-X
502856 97479
51079-0949-08
UDL DILTIAZEM HCL
R-X
218362 97047
00378-5340-01
MYL DILTIAZEM HCL
R-X
366930 95776
DILTIAZEM SDV 25MG/ 5ML CT/10
10019-0510-01
BAX DILTIAZEM HCL
R-X
366526 95777
DILTIAZEM SDV 50MG/10ML CT/10
10019-0510-02
BAX DILTIAZEM HCL
R-X
348003 96722
DILTIAZEM SDV 125MG/25ML CT/10
55390-0565-30
BED DILTIAZEM HCL
R-X
797712 95197
DILTIAZEM TAB 30 MG 100
00378-0023-01
MYL DILTIAZEM HCL
R-X
504407 99136
DILTIAZEM TAB 30 MG 100UD
51079-0745-20
UDL DILTIAZEM HCL
R-X
797720 95849
00378-0023-05
MYL DILTIAZEM HCL
R-X
797738 95198
00378-0045-01
MYL DILTIAZEM HCL
R-X
504415 99137
51079-0746-20
UDL DILTIAZEM HCL
R-X
797746 95850
00378-0045-05
MYL DILTIAZEM HCL
R-X
797753 95503
00378-0135-01
MYL DILTIAZEM HCL
R-X
504423 99248
51079-0747-20
UDL DILTIAZEM HCL
R-X
968081 37520
DIPHENHYDRAMINE 50 MG/ML CT25
00641-0376-25
BAX DIPHENHYDRAMINE HCL
R-X
136101 97396
DIPHENHYDRAMINE 12.5MG/5ML 100
00121-0489-05
PMA DIPHENHYDRAMINE HCL
R-X
733790 37420
DIPHENHYDRAMINE CAP 25 MG 1000
00904-5306-80
R-X
255703 27120
DIPHENHYDRAMINE CAP 50 MG 1000
00904-5307-80
R-X
502369 12194
DIPHENHYDRAMINE CAP 50 MG 100U
51079-0066-20
UDL DIPHENHYDRAMINE HCL
R-X
526616 17590
DIPHENHYDRAMINE ELX 4 OZ AF
00603-0823-94
QLT DIPHENHYDRAMINE HCL
R-X
421412 97395
DIPHENHYDRAMINE ELX 10ML 100UD
00121-0489-10
PMA DIPHENHYDRAMINE HCL
R-X
775288 96193
DIPHENOX/AT 100
00378-0415-01
MYL DIPHENOXYLATE HCL/ATROP SULF
R-X
502435 11658
DIPHENOX/AT 100UD
51079-0067-20
UDL DIPHENOXYLATE HCL/ATROP SULF
R-X
302679 91031
DIPHENOX/AT 2 OZ
00054-3194-46
ROX DIPHENOXYLATE HCL/ATROP SULF
R-X
618280 15821
DIPTH/TET/TOX ADSORB PED CT/10
49281-0278-10
AVE TETANUS,DIPHTHERIA TOXD PED/PF
R-X
693085 96406
DIPYRIDAMOLE SDV 50 MG 10ML/5
00641-2569-44
BAX DIPYRIDAMOLE
R-X
104836 40175
DIPYRIDAMOLE TAB 25 MG 100UD
00904-1086-61
MAJ DIPYRIDAMOLE
R-X
749598 45301
DIPYRIDAMOLE TAB 25 MG 1000
64980-0133-10
RIS
R-X
871582 47334
00555-0286-02
TEV DIPYRIDAMOLE
R-X
761890 99133
DIPYRIDAMOLE TAB 75 MG 100UD
00904-1088-61
MAJ DIPYRIDAMOLE
R-X
874990 95889
00555-0286-05
TEV DIPYRIDAMOLE
R-X
398297 96405
DIPYRIDAMOLE VL 5MG/ML 2ML/5
00703-1652-02
GES DIPYRIDAMOLE
R-X
417717 31716
DISOPYRAMIDE CAP 100 MG 100
00591-5560-01
WAT DISOPYRAMIDE PHOSPHATE
R-X
826685 18671
DIURIL ORAL SUS 8 OZ
65649-0311-12
SAL CHLOROTHIAZIDE
R-X
861013 95963
DOBUTAMIN 250MG/DEX5X18 2B0791
00338-1073-02
BXT DOBUTAMINE HCL/D5W
R-X
842658 97318
DOBUTAMIN 500MG/DEX5X18 2B0792
00338-1075-02
BXT DOBUTAMINE HCL/D5W
R-X
135244 37148
DOBUTAMINE/VL 250MG 20ML CT/10
00409-2344-02
HOS DOBUTAMINE HCL
R-X
415067 82911
DONNATAL TAB 100
66213-0425-10
PBM PHENOBARB/HYOSCY/ATROPINE/SCOP
R-X
414243 97653
DOPAMIN 400MG/DEX5%X12 2B0833
00338-1005-03
BXT DOPAMINE HCL/DEXTROSE 5%-WATER
R-X
861617 120177
DOPAMIN 800MG/DEX %X12 2B0843
00338-1007-03
BXT DOPAMINE HCL/DEXTROSE 5%-WATER
R-X
132407 18295
DOPAMINE VL 400 MG 10ML/25
00409-9104-20
HOS DOPAMINE HCL
R-X
994509 98166
DORIBAX VL 500MG 20ML/10
50458-0401-02
JOM DORIPENEM
R-X
665190 96320
DOVONEX CR 60 GM
00430-3020-15
W-C CALCIPOTRIENE
R-X
459701 31391
DOXAPRAM VL 400MG 20ML
55390-0035-01
BED DOXAPRAM HCL
R-X
HYDROMORPHONE HCL
R-X
DIPYRIDAMOLE
Page 14 of 46
Attachment n
M&D #
User #
Description
NDC #
Mfg
Generic Description
UDF 1
999417 96160
DOXAZOSIN MESYLATE TB 1MG 100
00093-8120-01
TEV DOXAZOSIN MESYLATE
R-X
553909 96161
DOXAZOSIN MESYLATE TB 1MG 100U
00904-5522-61
MAJ DOXAZOSIN MESYLATE
R-X
00093-8121-01
R-X
994426 96163
00093-8121-93
R-X
999425 96164
00093-8122-01
R-X
389031 96165
51079-0959-20
UDL DOXAZOSIN MESYLATE
R-X
999433 96166
00093-8123-01
R-X
795856 4075
DOXEPIN CAP 10 MG 100
00378-1049-01
MYL DOXEPIN HCL
R-X
502757 96908
DOXEPIN CAP 10 MG 100UD
51079-0436-20
UDL DOXEPIN HCL
R-X
795864 1672
00378-3125-01
MYL DOXEPIN HCL
R-X
502765 14165
51079-0437-20
UDL DOXEPIN HCL
R-X
795872 6174
00378-4250-01
MYL DOXEPIN HCL
R-X
502773 14166
51079-0438-20
UDL DOXEPIN HCL
R-X
795898 18257
00378-6410-01
MYL DOXEPIN HCL
R-X
506576 18259
51079-0651-20
UDL DOXEPIN HCL
R-X
419374 34492
49884-0222-01
PAR DOXEPIN HCL
R-X
336222 96355
DOXIL VL 2MG/ML 10 ML
17314-9600-01
JOM DOXORUBICIN HCL LIPOSOMAL
R-X
372797 98023
DOXIL VL 2MG/ML 25 ML
17314-9600-02
JOM DOXORUBICIN HCL LIPOSOMAL
R-X
146050 19478
DOXORUBICIN VL 10MG/10 PFS
55390-0235-10
BED DOXORUBICIN HCL
R-X
146019 98211
DOXORUBICIN VL 50MG LYP
55390-0233-01
BED DOXORUBICIN HCL
R-X
146068 23878
DOXORUBICIN VL 50MG PFS
55390-0237-01
BED DOXORUBICIN HCL
R-X
DOXYCYCLINE TAB 100 MG 50
53489-0120-02
MUT DOXYCYCLINE HYCLATE
R-X
18341 96162
30361 95533
612952 99250
DOXYCYCLINE TAB 100 MG 100UD
00904-0430-61
MAJ DOXYCYCLINE HYCLATE
R-X
423418 95716
DOXYCYCLINE VL 100 MG 15ML/10
55390-0110-10
BED DOXYCYCLINE HYCLATE
R-X
691477 85890
DRISDOL CAP 50 D530
00024-0392-02
AVE ERGOCALCIFEROL
R-X
225672 9593
DROPERIDOL AMP 5 MG 2ML/10
00409-1187-01
HOS DROPERIDOL
R-X
679969 97545
DURACLON VL 100MCG/ML 10 ML
66479-0520-01
BIN
R-X
530212 95356
DURAMORPH-PF .5MG/ML 10ML/10
60977-0016-02
BAX MORPHINE SULFATE/PF
CII
120972 21574
E.E.S. 400 TAB 100 5729
00074-5729-13
ABB ERYTHROMYCIN ETHYLSUCCINATE
R-X
825455 96103
E.S.P. SUS 200MG/600MG 100ML
51285-0445-22
DMD ERY E-SUCC/SULFISOXAZOLE
R-X
825471 96102
E.S.P. SUS 200MG/600MG 200ML
51285-0445-23
DMD ERY E-SUCC/SULFISOXAZOLE
R-X
646844 96699
EFFEXOR XR ERCAP 75 MG 30
00008-0833-21
WYE VENLAFAXINE HCL
R-X
775049 96700
EFFEXOR XR ERCAP 75 MG 100UD
00008-0833-03
WYE VENLAFAXINE HCL
R-X
646695 96701
EFFEXOR XR ERCAP 150 MG 30
00008-0836-21
WYE VENLAFAXINE HCL
R-X
255679 96702
EFFEXOR XR ERCAP 150 MG 100UD
00008-0836-03
WYE VENLAFAXINE HCL
R-X
646752 96697
EFFEXOR XR ERCAP 37.5 MG 30
00008-0837-21
WYE VENLAFAXINE HCL
R-X
775080 96698
EFFEXOR XR ERCAP 37.5 MG 100UD
00008-0837-03
WYE VENLAFAXINE HCL
R-X
989947 98266
EFFIENT TAB 5MG 30
00002-4760-30
LIL
PRASUGREL HYDROCHLORIDE
989962 98267
EFFIENT TAB 10MG 30
00002-4759-30
LIL
R-X
989970 98269
EFFIENT TAB 10MG 90ID
00002-4759-77
LIL
R-X
555649 10445
EFUDEX CR 5% 40 GM
00187-3204-47
VLT
FLUOROURACIL
R-X
436246 97994
ELIDEL CREAM 1% 30 GM
00078-0375-46
NVT PIMECROLIMUS
R-X
202150 97971
ELIXOPHYLLIN ELX 16 OZ
00456-0644-16
C-P
R-X
708040 95272
ELSPAR VL 10,000IU 10ML
67386-0411-51
OVA ASPARAGINASE
R-X
857706 95362
ELTA TAR 3.8 OZ JAR 3410
90205-0034-10
SAP
R-X
CLONIDINE HCL/PF
THEOPHYLLINE ANHYDROUS
R-X
674655 97625
EMEND CAP 80 MG 6UD HOSP
00006-0461-06
MSD APREPITANT
R-X
674663 97623
EMEND CAP 125 MG 6UD HOSP
00006-0462-06
MSD APREPITANT
R-X
499475 97630
EMTRIVA CAP 200 MG 30
61958-0601-01
NEX EMTRICITABINE
R-X
388785 97449
ENALAPRIL TAB 2.5 MG 100
00378-1051-01
MYL ENALAPRIL MALEATE
R-X
377069 97450
ENALAPRIL TAB 2.5 MG 100UD
51079-0950-20
UDL ENALAPRIL MALEATE
R-X
388793 95377
ENALAPRIL TAB 5 MG 100
00378-1052-01
R-X
377077 99174
ENALAPRIL TAB 5 MG 100UD
51079-0951-20
R-X
388801 95378
00378-1053-01
R-X
377085 99175
51079-0952-20
R-X
999375 95379
00093-0029-01
TEV ENALAPRIL MALEATE
R-X
377093 99176
51079-0953-20
R-X
Page 15 of 46
Attachment n
M&D #
User #
Description
NDC #
Generic Description
UDF 1
ENALAPRIL/HCTZ TAB 5/12.5 100
424820 98075
ENALAPRIL/HCTZ TAB 10/25 100
368969 95551
ENALAPRILAT VL 1.25MG/ML2ML/10
179168 96940
ENBREL 25 MG FOR INJ CT/4
58406-0425-34
AMG ETANERCEPT
R-X
559393 97749
ENBREL 50 MG PREFILL SRN CT/4
58406-0435-04
AMG ETANERCEPT
R-X
675843 98299
ENBREL 50 MG SURECLICK CT/4
58406-0445-04
AMG ETANERCEPT
R-X
935478 21469
ENDOCET TAB 5/325MG 100
60951-0602-70
END OXYCODONE HCL/ACETAMINOPHEN
CII
458950 97565
ENFACARE W/LIPUL POW 12.8OZ
00087-0019-44
M-J
388116 95969
ENFAMIL HUMAN MILK 100PKS/ 2CT
00087-2014-18
M-J
R-X
754176 98114
ENGERIX-B VL 10MCG/.5MLX10 PF
58160-0820-11
SKB HEPATITIS B VIRUS VACCINE-PF
R-X
754838 98115
ENGERIX-B VL 20MCG/ML CT10
58160-0821-11
SKB HEPATITIS B VIRUS VACCINE-PF
R-X
640326 98215
ENTOCORT EC CAP 3 MG 100
65483-0702-10
P/L
R-X
556993 23100
EPHE SULF VL 50 MG/ML 1ML/25
66758-0008-02
SNZ EPHEDRINE SULFATE
EPIDRIN CAPSULES 100
64125-0101-01
EXC ISOMETHEPT/ACETAMINOP/DICHLPHN
R-X
127712 23363
EPINEPHRINE AMP 1:1000 1ML/25
00409-7241-01
HOS EPINEPHRINE/PF
R-X
419572 24271
EPINEPHRINE MDV 1:1000 30ML
00548-9061-00
IMS
EPINEPHRINE
R-X
126607 17852
EPINEPHRINE SRN 1:10M 18GA X10
00409-4901-18
HOS EPINEPHRINE
R-X
820035 10620
EPINEPHRINE SRN 1:10M10ML/10LS
00409-4921-34
HOS EPINEPHRINE
R-X
212860 97356
EPIPEN AUTO-INJEC .3MG
49502-0500-01
DEY EPINEPHRINE
R-X
212894 97358
EPIPEN JR AUTO-INJEC .15MG
49502-0501-01
DEY EPINEPHRINE
R-X
630525 96354
EPIVIR O/SOL 10MG/ML 240 ML
00173-0471-00
SKB LAMIVUDINE
R-X
392225 96353
EPIVIR TAB 150 MG 60
00173-0470-01
SKB LAMIVUDINE
R-X
444414 97583
EPIVIR TAB 300 MG 30
00173-0714-00
SKB LAMIVUDINE
R-X
553867 97715
EPZICOM TAB 30
00173-0742-00
SKB ABACAVIR SULFATE/LAMIVUDINE
R-X
744995 33573
ERGOLOID MESYLAT 1 MG ORL 100
53489-0281-01
MUT ERGOLOID MESYLATES
R-X
123950 84290
ERY-TAB 250 MG 100
00074-6304-13
ABB ERYTHROMYCIN BASE
R-X
123505 98270
ERYPED 200 SUS 100ML
00074-6302-13
R-X
123356 98271
ERYPED 400 SUS 100ML
00074-6305-13
R-X
127290 97244
ERYTHROCIN LACT P/F VL500MG/10
00409-6482-01
HOS ERYTHROMYCIN LACTOBIONATE
R-X
227983 95566
ERYTHROMYCIN GEL 2% 30 GM
00168-0216-30
FOU ERYTHROMYCIN BASE/ETHANOL
R-X
104885 95567
ERYTHROMYCIN GEL 2% 60 GM
00168-0216-60
FOU ERYTHROMYCIN BASE/ETHANOL
R-X
143412 97231
ERYTHROMYCIN OPT OIN 1 GMX50
24208-0910-19
B&L ERYTHROMYCIN BASE
R-X
143420 30680
ERYTHROMYCIN OPT OIN 1/8 OZ
24208-0910-55
B&L ERYTHROMYCIN BASE
R-X
379248 95907
ESTRACE VAGINAL CR W/AP
00430-3754-14
W-C ESTRADIOL
R-X
704353 97748
ESTRADERM SYSTEM .05 MG 1X8
00078-0480-42
NVT ESTRADIOL
R-X
705905 97920
ESTRADERM SYSTEM .1 MG 1X8
00078-0481-42
NVT ESTRADIOL
R-X
144956 95903
ESTRADIOL TAB 1 MG 100
00591-0487-01
WAT ESTRADIOL
R-X
173542 95904
00591-0487-05
WAT ESTRADIOL
R-X
109041 95905
00591-0488-01
WAT ESTRADIOL
R-X
126276 95906
00591-0488-05
WAT ESTRADIOL
R-X
472126 98182
ESTRING VAGINAL RING 2 MG
00013-2150-36
PFZ ESTRADIOL
R-X
609412 95022
ETHYL CHL SPRAY 3.5OZ FINE
00386-0001-04
GEB ETHYL CHLORIDE
R-X
994129 96000
ETIDRONATE DISOD TB 200MG 60
00378-3286-91
MYL ETIDRONATE DISODIUM
R-X
637918 95684
ETOPOSIDE CAP 50 MG 20
00378-3266-94
MYL ETOPOSIDE
R-X
281600 95045
ETOPOSIDE MDV 20 MG/ML 5ML
00703-5653-01
GES ETOPOSIDE
R-X
951269 95526
EURAX CR 60 GM TUBE
10631-0091-60
R/P
CROTAMITON
R-X
392647 96994
EVISTA TAB 60 MG 100
00002-4165-02
LIL
RALOXIFENE HCL
R-X
342667 97707
EVOXAC CAP 30 MG 100
63395-0201-13
SKP CEVIMELINE HCL
R-X
513812 95485
FAMOTIDINE 20MG/2ML 2ML/25
10019-0045-02
BAX FAMOTIDINE/PF
R-X
396945 96286
FAMOTIDINE 20MG/2ML 4ML/10
55390-0028-10
BED FAMOTIDINE
R-X
505339 96144
FAMOTIDINE PRMX 50ML/48 2G3424
00338-5197-41
BXT FAMOTIDINE IN SALINE,ISO-OS/PF
R-X
398883 96282
FAMOTIDINE TAB 20MG 100
00378-3020-01
MYL FAMOTIDINE
R-X
398164 99215
FAMOTIDINE TAB 20MG 100UD
51079-0966-20
UDL FAMOTIDINE
R-X
400499 95965
00172-5728-80
TEV FAMOTIDINE
R-X
398867 98017
00378-3040-01
MYL FAMOTIDINE
R-X
397828 98018
FAMOTIDINE TAB 40MG 100UD
00172-5729-10
TEV FAMOTIDINE
R-X
25726 95947
00378-0712-01
Mfg
424812 98074
MYL ENALAPRIL/HYDROCHLOROTHIAZIDE
R-X
00378-0723-01
MYL ENALAPRIL/HYDROCHLOROTHIAZIDE
R-X
55390-0011-10
BED ENALAPRILAT DIHYDRATE
R-X
INFANT FORMULA W-IRON
R-X
BUDESONIDE
R-X
Page 16 of 46
Attachment n
M&D #
NDC #
Mfg
143974 97620
User #
FASLODEX 125MG/2.5ML SRN 2PK
00310-0720-25
A/Z
FULVESTRANT
R-X
143941 97621
FASLODEX 250MG/5ML SRN
00310-0720-50
A/Z
FULVESTRANT
R-X
412270 95953
FELBATOL 400 MG 100
00037-0430-01
WAL FELBAMATE
R-X
412288 95954
FELBATOL 600 MG 100
00037-0431-01
WAL FELBAMATE
R-X
412296 95955
FELBATOL SUS 600 MG/5ML 8 OZ
00037-0442-67
WAL FELBAMATE
R-X
212431 97754
FEMARA TAB 2.5 MG 30
00078-0249-15
NVT LETROZOLE
R-X
956631 98280
FENOFIBRATE CAP 160 MG 30UD
68084-0328-21
RPK FENOFIBRATE
R-X
954248 97270
FENOFIBRATE TAB 54 MG 90
00115-5511-10
GLO FENOFIBRATE
R-X
954255 97272
FENOFIBRATE TAB 160 MG 90
00115-5522-10
GLO FENOFIBRATE
R-X
FENTANYL AMP 2ML/10 P/F
10019-0038-67
BAX FENTANYL CITRATE/PF
CII
36244 462
36202 10305
Description
Generic Description
UDF 1
FENTANYL AMP 5ML/10 P/F
10019-0033-72
CII
645226 96344
FENTANYL AMP 10ML/5
00409-9093-36
HOS FENTANYL CITRATE/PF
CII
617506 95814
FENTANYL PATCH 25MCG 10CM 5
00781-7111-55
SNZ FENTANYL
CII
617514 95815
00781-7112-55
SNZ FENTANYL
CII
617522 95816
00781-7113-55
SNZ FENTANYL
CII
617530 95817
00781-7114-55
SNZ FENTANYL
CII
35683 96345
FENTANYL SDV 50MCG/ML 50ML P/F
10019-0037-83
CII
26278 97064
FERRLECIT AMP 62.5MG/5ML CT10
00024-2791-50
AVE SOD FERRIC GLUC COMPLX/SUCROSE
R-X
636944 98090
FEXOFENADINE HCL TAB 30MG 100
66993-0106-02
PRS FEXOFENADINE HCL
R-X
675710 98095
FEXOFENADINE HCL TAB 60MG100U
51079-0529-20
UDL FEXOFENADINE HCL
R-X
754135 98096
FEXOFENADINE HCL TAB 180MG100U
51079-0526-20
UDL FEXOFENADINE HCL
R-X
813097 98219
FINASTERIDE TAB 5 MG 100UD
51079-0520-20
UDL FINASTERIDE
R-X
645903 11933
FLAVOXATE HCL TAB 100 MG 100
00115-1811-01
GLO FLAVOXATE HCL
R-X
50393 98223
FLEET ENEMA 4.5OZ 201
00132-0201-40
CBF NA PHOS,M-B/NA PHOS,DI-BA
R-X
50419 98224
FLEET ENEMA W/MINERAL OIL 301
00132-0301-40
CBF MINERAL OIL
R-X
FLEET PEDIA-LAX ENEMA 202
00132-0202-20
CBF NA PHOS,M-B/NA PHOS,DI-BA
R-X
112581 97050
50401 98222
FLOMAX CAP 0.4 MG 100
00597-0058-01
BOE TAMSULOSIN HCL
R-X
638619 96171
FLONASE NASAL 120 DOSE
00173-0453-01
SKB FLUTICASONE PROPIONATE
R-X
735357 97196
FLOVENT HFA W/DOS COUNT 44MCG
00173-0718-20
R-X
726042 96469
00173-0719-20
R-X
727818 96470
00173-0720-20
R-X
618231 95630
FLUCONAZOLE BG 200MG 100ML/6
00703-1029-30
GES FLUCONAZOLE IN SALINE, ISO-OSM
R-X
549295 95631
FLUCONAZOLE BG 400MG 200ML/10
00338-6045-37
BXT FLUCONAZOLE IN SALINE, ISO-OSM
R-X
617993 96187
FLUCONAZOLE O/SUS 10MG/ML 35ML
00054-0002-85
ROX FLUCONAZOLE
R-X
745588 95373
FLUCONAZOLE TAB 50 MG 30
68462-0101-30
GPI
FLUCONAZOLE
R-X
956540 95629
68462-0102-30
GPI
FLUCONAZOLE
R-X
748053 99233
FLUCONAZOLE TAB 100 MG 100UD
00172-5411-10
TEV FLUCONAZOLE
R-X
746420 98073
FLUCONAZOLE TAB 150 MG 12X1UU
00172-5412-11
TEV FLUCONAZOLE
R-X
956557 95628
68462-0104-30
GPI
FLUCONAZOLE
R-X
748095 99234
FLUCONAZOLE TAB 200 MG 100UD
00172-5413-10
TEV FLUCONAZOLE
R-X
524702 95778
FLUDARABINE VL 50MG 6ML LYP
00703-5854-01
GES FLUDARABINE PHOSPHATE
R-X
533737 58640
FLUDROCORTISNE ACETATE.1MG 100
00555-0997-02
TEV FLUDROCORTISONE ACETATE
R-X
558841 95771
FLUMAZENIL VL 5 ML CT/10
63323-0424-05
APP FLUMAZENIL
R-X
558858 95772
FLUMAZENIL VL 10 ML
63323-0424-10
APP FLUMAZENIL
R-X
438994 97911
FLUNISOLIDE NAS SOL .025% 25ML
24208-0344-25
B&L FLUNISOLIDE
R-X
21709 18205
FLUOCINONIDE CR .05% 30 GM
00093-0262-30
TEV FLUOCINONIDE
R-X
23705 95259
FLUOCINONIDE E CR 30 GM
00093-0263-30
TEV FLUOCINONIDE/EMOLLIENT
R-X
988022 95260
FLUOCINONIDE E CR 60 GM
51672-1254-03
TAR FLUOCINONIDE/EMOLLIENT
R-X
23135 95261
FLUOCINONIDE GEL .05% 60 GM
00093-0265-92
TEV FLUOCINONIDE
R-X
22764 18204
FLUOCINONIDE OIN .05% 30 GM
00093-0264-30
TEV FLUOCINONIDE
R-X
22772 95270
FLUOCINONIDE OIN .05% 60 GM
00093-0264-92
TEV FLUOCINONIDE
R-X
23143 96613
FLUOCINONIDE SOL .05% 60ML
00093-0266-39
TEV FLUOCINONIDE
R-X
407775 27825
FLUOR-A-DAY CHW TAB .5MG 120
51817-0611-16
PSL SODIUM FLUORIDE
R-X
407783 97184
FLUOR-A-DAY CHW TAB 1.0MG 120
51817-0622-16
PSL SODIUM FLUORIDE
R-X
396531 13393
FLUOROMETHOLONE OPT SUS 5 ML
60758-0880-05
P-P
198861 98012
FLUOROURACL VL 5GM 100ML PB
63323-0117-61
APP FLUOROURACIL
FLUOROMETHOLONE
R-X
R-X
Page 17 of 46
Attachment n
M&D #
User #
Description
NDC #
Mfg
Generic Description
UDF 1
198853 96708
FLUOROURACL VL 2.5GM 50ML PB
63323-0117-51
APP FLUOROURACIL
R-X
198838 59070
FLUOROURACL SDV 500 MG 10ML/10
63323-0117-10
APP FLUOROURACIL
R-X
416800 96319
FLUOXETINE CAP 10 MG 100
00781-2823-01
SNZ FLUOXETINE HCL
R-X
665265 95574
FLUOXETINE CAP 20 MG 100
00781-2822-01
SNZ FLUOXETINE HCL
R-X
105437 96155
FLUOXETINE CAP 20 MG 100UD
51079-0971-20
UDL FLUOXETINE HCL
R-X
417139 97292
FLUOXETINE O/SOL20MG/5ML 120ML
00093-6108-12
TEV FLUOXETINE HCL
R-X
319491 52640
FLUPHENAZINE 2.5 MG/ML 10ML
63323-0281-10
APP FLUPHENAZINE HCL
R-X
326405 15508
FLUPHENAZINE DECA 25 MG/ML 5ML
63323-0272-05
APP FLUPHENAZINE DECANOATE
R-X
889162 88140
FLUPHENAZINE TAB 2.5 MG 100
00781-1437-01
SNZ FLUPHENAZINE HCL
R-X
809582 10693
FLUPHENAZINE TAB 2.5 MG 100UD
51079-0486-20
UDL FLUPHENAZINE HCL
R-X
889394 88040
FLUPHENAZINE TAB 5 MG 100
00781-1438-01
R-X
809590 99138
FLUPHENAZINE TAB 5 MG 100UD
51079-0487-20
R-X
889170 21186
FLUPHENAZINE TAB 10 MG 100
00781-1439-01
R-X
809608 99139
FLUPHENAZINE TAB 10 MG 100UD
51079-0488-20
R-X
589648 86800
FLURATE OPT SOL 5ML
24208-0732-05
B&L BENOXINATE HCL/FLUORESCEIN NA
R-X
795906 7535
FLURAZEPAM CAP 15 MG 100
00378-4415-01
MYL FLURAZEPAM HCL
R-X
143701 96945
FLURBIPROFEN SOD SOL 2.5ML
24208-0314-25
B&L FLURBIPROFEN SODIUM
R-X
533042 95640
FLUTAMIDE CAP 125 MG 180
00172-4960-58
TEV FLUTAMIDE
R-X
352989 16138
FML SUS 10ML DRP 212
11980-0211-10
ALL
R-X
761601 12715
FOLIC ACID TAB 1 MG 100
00143-1248-01
W-W FOLIC ACID
R-X
702126 15775
FOLIC ACID TAB 1 MG 100UD
51079-0041-20
UDL FOLIC ACID
R-X
910844 95724
FOLIC ACID TAB 1 MG 1000
00143-1248-10
W-W FOLIC ACID
R-X
332601 12746
FOLIC ACID VL 50 MG 10ML
63323-0184-10
APP FOLIC ACID
R-X
847921 96723
FOMEPIZOLE VL 1G/ML 1.5ML/4
00781-3182-84
SNZ FOMEPIZOLE
R-X
499376 98014
FORADIL AEROLIZER 12MCG CAP 60
00085-1401-01
SCH FORMOTEROL FUMARATE
R-X
503938 98015
FORADIL AEROLIZER 12MCG HOSP12
00085-1402-01
SCH FORMOTEROL FUMARATE
R-X
117473 95088
FORANE 100ML CT/6
10019-0360-40
BAX ISOFLURANE
R-X
631267 95415
FORTAZ FZN PRMXD 1 GM/50ML 24
00173-0412-00
SKB CEFTAZIDIME NA/DEXTROSE,ISO
R-X
631622 95416
FORTAZ FZN PRMXD 2 GM/50ML 24
00173-0413-00
SKB CEFTAZIDIME NA/DEXTROSE,ISO
R-X
590786 95332
FORTAZ VL 500 MG CT/10
00173-0377-10
SKB CEFTAZIDIME PENTAHYDRATE
R-X
522128 97791
FOSAMAX O/SOL 70 MG 4X75ML
00006-3833-34
MSD ALENDRONATE SODIUM
R-X
409045 96397
FOSAMAX TAB 10 MG 30
00006-0936-31
MSD ALENDRONATE SODIUM
R-X
646778 95756
FOSCARNET INJ 24MG/ML 250ML/12
00409-3863-02
HOS FOSCARNET SODIUM
R-X
646786 95757
FOSCARNET INJ 24MG/ML 500ML/12
00409-3863-05
HOS FOSCARNET SODIUM
R-X
755488 98124
FOSPHENYTOIN VL 50MG/ML 10M/10
00409-4857-10
HOS FOSPHENYTOIN SODIUM
R-X
755470 98122
FOSPHENYTOIN VL 50MG/ML 2ML/25
00409-4857-02
HOS FOSPHENYTOIN SODIUM
R-X
670398 97562
FUL-GLO 1 MG OPTH STRIPS BX100
17478-0404-01
R-X
925735 97671
FLUOROMETHOLONE
FURADANTIN SUS 230ML
59630-0450-08
HOR NITROFURANTOIN
R-X
24828 30272
FUROSEMIDE SOL 10 MG 60ML
60432-0613-60
WCK FUROSEMIDE
R-X
308874 30273
FUROSEMIDE SOL 10 MG 120ML
00054-3294-50
ROX FUROSEMIDE
R-X
304378 97488
FUROSEMIDE SOL 40 MG 5ML 40UD
00054-8298-16
ROX FUROSEMIDE
R-X
328591 44063
FUROSEMIDE SYR/A 40MG 4ML/10
00409-9631-04
HOS FUROSEMIDE
R-X
534479 18759
FUROSEMIDE TAB 20 MG 100
00603-3739-21
QLT FUROSEMIDE
R-X
501049 45315
FUROSEMIDE TAB 20 MG 100UD
51079-0072-20
UDL FUROSEMIDE
R-X
795310 27248
00378-0208-10
MYL FUROSEMIDE
R-X
795328 57641
00378-0216-01
MYL FUROSEMIDE
R-X
501056 10600
FUROSEMIDE TAB 40 MG 100UD
51079-0073-20
UDL FUROSEMIDE
R-X
795336 1952
00378-0216-10
MYL FUROSEMIDE
R-X
79871 1953
FUROSEMIDE VL 20 MG 2ML/25
00517-5702-25
A-R
R-X
127696 41183
00409-6102-04
HOS FUROSEMIDE
R-X
124909 18342
00409-6102-10
HOS FUROSEMIDE
R-X
514976 97669
FUZEON 90 MG 60 CONV KIT
00004-0380-39
ROC ENFUVIRTIDE
R-X
GABAPENTIN CAP 100 MG 100
59762-5026-01
GRN GABAPENTIN
R-X
GABAPENTIN CAP 100 MG 100UD
68084-0079-01
RPK GABAPENTIN
R-X
GABAPENTIN CAP 300 MG 100
59762-5027-01
GRN GABAPENTIN
R-X
00904-5632-61
MAJ GABAPENTIN
R-X
18531 97287
987784 97288
18549 96009
733824 99318
FUROSEMIDE
Page 18 of 46
Attachment n
M&D #
User #
Description
733832 97132
568519 97227
639799 3743
NDC #
Mfg
Generic Description
UDF 1
00904-5633-61
MAJ GABAPENTIN
R-X
GABAPENTIN TAB 600 MG 100
59762-5023-01
GRN GABAPENTIN
R-X
GAMASTAN 10ML SD VIAL
13533-0635-12
TAL
IMMUNE GLOBULIN,GAMMA (IGG)
R-X
514943 96151
GANCICLOVIR CAP 250 MG 180
63304-0636-28
R/P
GANCICLOVIR
R-X
514950 97091
GANCICLOVIR CAP 500 MG 180
63304-0637-28
R/P
GANCICLOVIR
R-X
996785 97902
GANITE 500MG/20ML 5
66657-0301-05
G/I
GALLIUM NITRATE
472878 77240
GELFILM STR FILM ENVELOPE OF 1
00009-0283-01
PFZ GELATIN
R-X
474833 76041
GELFOAM SPONGE 100 BX/6
00009-0342-01
PFZ GELATIN SPONGE,ABSORBABLE
R-X
655373 37841
GELFOAM SPONGE 12-7MM BX/12
00009-0315-08
PFZ GELATIN SPONGE,ABSORBABLE
R-X
GEMFIBROZIL TAB 600 MG 60
31722-0225-60
CBR GEMFIBROZIL
R-X
28654 95642
R-X
991794 99242
GEMFIBROZIL TAB 600 MG 100UD
00093-0670-93
TEV GEMFIBROZIL
R-X
393074 96496
GEMZAR VL 1 GM 50 ML 7502
00002-7502-01
LIL
GEMCITABINE HCL
R-X
393058 96495
GEMZAR VL 200 MG 10 ML 7501
00002-7501-01
LIL
GEMCITABINE HCL
R-X
456004 97823
GENOTROPIN .8MG M-QK 7PK/SRN
00013-2652-02
PFZ SOMATROPIN
R-X
105577 97824
GENOTROPIN 1.0MG M-QK 7PK/SRN
00013-2653-02
PFZ SOMATROPIN
R-X
509299 97826
GENOTROPIN 2.0MG M-QK 7PK/SRN
00013-2658-02
PFZ SOMATROPIN
R-X
155796 97828
GENOTROPIN 13.8MG CART. 1 S
00013-2646-81
PFZ SOMATROPIN
R-X
196220 98098
GENTAMICIN 40MG/ML 2ML/25
00409-1207-03
HOS GENTAMICIN SULFATE
R-X
R-X
306639 4522
GENTAMICIN 80MG/ 2ML CT/25
63323-0010-02
APP GENTAMICIN SULFATE
GENTAMICIN OPT OIN 3.5 GM
17478-0284-35
AKR GENTAMICIN SULFATE
R-X
910372 10882
GENTAMICIN OPT SOL 5ML
24208-0580-60
B&L GENTAMICIN SULFATE
R-X
296046 14198
GENTAMICIN PED MDV 2ML/25
63323-0513-02
APP GENTAMICIN SULFATE
R-X
325845 98097
GENTAMICIN VL P/F 20MG 2ML/25
63323-0173-02
APP GENTAMICIN SULFATE/PF
R-X
842641 95113
GENTAMYCN 80MG 50ML/24 2B0852
00338-0509-41
BXT GENTAMICIN IN SALINE, ISO-OSM
R-X
861518 97651
GENTAMYCN 100MG 50ML/24 2B0853
00338-0511-41
R-X
844191 97652
GENTAMYCN 120MG 100ML24 2B0864
00338-0507-48
R-X
387803 97167
GEODON CAP 20 MG 60 4200
00049-3960-60
PFZ ZIPRASIDONE HCL
R-X
408112 97532
GEODON CAP 20 MG 80UD 4205
00049-3960-41
PFZ ZIPRASIDONE HCL
R-X
387811 97168
00049-3970-60
PFZ ZIPRASIDONE HCL
R-X
408120 97533
00049-3970-41
PFZ ZIPRASIDONE HCL
R-X
387829 97176
00049-3980-60
PFZ ZIPRASIDONE HCL
R-X
408138 97534
00049-3980-41
PFZ ZIPRASIDONE HCL
R-X
387837 97169
00049-3990-60
PFZ ZIPRASIDONE HCL
R-X
408146 97535
00049-3990-41
PFZ ZIPRASIDONE HCL
R-X
845412 97567
GLEEVEC TAB 100 MG 90
00078-0401-34
NVT IMATINIB MESYLATE
R-X
506980 99172
GLIPIZIDE TAB 5 MG 100UD
51079-0810-20
UDL GLIPIZIDE
R-X
872770 95811
GLIPIZIDE TAB 5 MG 1000
00781-1452-10
SNZ GLIPIZIDE
R-X
506998 99173
GLIPIZIDE TAB 10 MG 100UD
51079-0811-20
UDL GLIPIZIDE
R-X
872804 95812
GLIPIZIDE TAB 10 MG 1000
00781-1453-10
SNZ GLIPIZIDE
R-X
326447 3780
GLUCAGEN DIAGNOSTIC KIT 1MG
55390-0004-01
BED GLUCAGON,HUMAN RECOMBINANT
R-X
624536 98184
GLUCAGEN HYPOKIT
00169-7065-15
NPH GLUCAGON,HUMAN RECOMBINANT
R-X
211169 34550
GLUTOL 180 ML
00574-1959-06
PAD DEXTROSE
R-X
770990 97879
GLYBURIDE MICRONIZD 1.5 MG 100
00378-1113-01
MYL GLYBURIDE,MICRONIZED
R-X
525576 97880
GLYBURIDE MICRONIZD 3 MG 100
00143-9919-01
W-W GLYBURIDE,MICRONIZED
R-X
525584 97881
GLYBURIDE MICRONIZD 6 MG 100
00143-9920-01
W-W GLYBURIDE,MICRONIZED
R-X
389528 95264
GLYBURIDE TAB 2.5 MG 100
00093-8343-01
TEV GLYBURIDE
R-X
673863 95809
GLYBURIDE TAB 2.5 MG 1000DIA
00093-8343-10
TEV GLYBURIDE
R-X
389486 95265
GLYBURIDE TAB 5 MG 100 MICR
00093-8344-01
TEV GLYBURIDE
R-X
502005 99170
GLYBURIDE TAB 5 MG 100UD
51079-0873-20
UDL GLYBURIDE
R-X
390369 95810
GLYBURIDE TAB 5 MG 1000 MICR
00093-8344-10
TEV GLYBURIDE
R-X
753632 97102
GLYBURIDE/METFORM 5/500 100
00093-5712-01
TEV GLYBURIDE/METFORMIN HCL
R-X
667097 97103
GLYBURIDE/METFORM 2.5/500 100
00228-2752-11
APH GLYBURIDE/METFORMIN HCL
R-X
667089 97104
GLYBURIDE/METFORM1.25/250 100
00228-2751-11
APH GLYBURIDE/METFORMIN HCL
R-X
616946 64951
GLYCOPYRROLATE TAB 1 MG 100
00677-1931-01
URL GLYCOPYRROLATE
R-X
829739 98242
GLYCOPYRROLATE TAB 1 MG 100UD
68084-0231-01
RPK GLYCOPYRROLATE
R-X
169045 92
GLYCOPYRROLATE VL .2 MG 1ML/25
10019-0016-81
BAX GLYCOPYRROLATE
R-X
84558 11734
Page 19 of 46
Attachment n
M&D #
User #
169052 95082
79921 102
Description
NDC #
10019-0016-17
Mfg
Generic Description
UDF 1
BAX GLYCOPYRROLATE
R-X
R-X
00517-4605-25
A-R
215509 97146
GLYSET TAB 25 MG 100
00009-5012-01
PFZ MIGLITOL
R-X
215517 97147
00009-5013-01
PFZ MIGLITOL
R-X
215525 97148
00009-5014-01
PFZ MIGLITOL
R-X
842450 97863
GLYTROL 250 ML CS/24
00065-9085-70
NES NUT.TX.GLUC.INTOLER,LAC-FR,SOY
R-X
719021 95430
GOLYTELY 4-LITER SINGLE
52268-0100-01
BRA PEG 3350/NA SULF,BICARB,CL/KCL
R-X
169425 55671
GONAK OPT SOL 2.5% 15ML
17478-0064-12
AKR HYPROMELLOSE
R-X
707687 95126
GRANULEX AEROSOL 2 OZ
51079-0621-81
UDL TRYPSIN/BALSAM PERU/CASTOR OIL
R-X
973669 95127
GRANULEX AEROSOL 4 OZ
51079-0621-82
UDL TRYPSIN/BALSAM PERU/CASTOR OIL
R-X
460881 46571
GRIS-PEG TAB 125 MG 100 763
00884-0763-04
PED GRISEOFULVIN ULTRAMICROSIZE
R-X
998922 14207
GRISEOFULVIN 125MG/5ML SUS 4OZ
10147-0810-04
PAT GRISEOFULVIN,MICROSIZE
R-X
705707 96191
GUAIF/COD SYR 10ML/100UD AF
00121-1775-10
PMA GUAIFENESIN/CODEINE PHOS
R-X
874214 95521
GUANFACINE HCL TAB 1 MG 100
00378-1160-01
MYL GUANFACINE HCL
R-X
604215 17587
GUIATUSS AC SYR 16 OZ
00603-1075-58
QLT GUAIFENESIN/CODEINE PHOS
R-X
295808 95624
HALOPERIDOL DEC100MG/ML 5ML
00703-7023-01
GES HALOPERIDOL DECANOATE
R-X
454892 87890
HALOPERIDOL ORAL SOL 120ML
00121-0581-04
PMA HALOPERIDOL LACTATE
R-X
795351 57710
HALOPERIDOL TAB 1 MG 100
00378-0257-01
MYL HALOPERIDOL
R-X
867366 24183
HALOPERIDOL TAB 1 MG 100UD
00781-1392-13
SNZ HALOPERIDOL
R-X
795369 87790
00378-0214-01
MYL HALOPERIDOL
R-X
867374 24184
00781-1393-13
SNZ HALOPERIDOL
R-X
795377 5116
00378-0327-01
MYL HALOPERIDOL
R-X
867382 24185
00781-1396-13
SNZ HALOPERIDOL
R-X
889865 18926
00781-1397-01
SNZ HALOPERIDOL
R-X
867390 24186
00781-1397-13
SNZ HALOPERIDOL
R-X
888958 95035
00781-1398-01
SNZ HALOPERIDOL
R-X
423673 12128
HALOPERIDOL VL5MG/ML 1ML/10
00703-7041-03
GES HALOPERIDOL LACTATE
R-X
736710 96147
HAVRIX 720 ELU.5MLX 10
58160-0825-11
SKB HEPATITIS A VIRUS VACCINE/PF
R-X
749077 96146
HAVRIX 1440 ELU/1ML W/O NDL 5
58160-0826-46
SKB HEPATITIS A VIRUS VACCINE/PF
R-X
841353 95189
HEALON SRN .85ML 31085
38544-5084-21
PHA
R-X
841460 97065
HEALON GV SRN .85ML 31985
38544-5085-41
PHA
707240 98051
HECTOROL CAP 0.5 MCG 50
58468-0120-01
G/C
DOXERCALCIFEROL
R-X
698282 98052
HECTOROL CAP 2.5 MCG 50
58468-0121-01
G/C
DOXERCALCIFEROL
R-X
953976 98024
HECTOROL VL 4 MCG CT/50
58468-0123-01
G/C
DOXERCALCIFEROL
R-X
345900 96516
HELIDAC THERAPY KIT 49514
65483-0495-14
P/L
BISMUTH SAL/METRONID/TETRACYC
R-X
472951 95295
HEMABATE SS 250MCG 10X1ML 1695
00009-0856-08
PFZ CARBOPROST TROMETHAMINE
295667 20400
HEMORRHOIDAL HC SUP 12
00574-7090-12
PAD HYDROCORTISONE ACETATE
R-X
666073 60671
HEP SOD 5MU/ML 1ML LLCJT SP/10
00409-1402-31
HOS HEPARIN SODIUM,PORCINE
R-X
17996 98127
HEP- 10U/ML 3ML/10ML SRN CS120
08290-0360-03
B-D
HEPARIN SODIUM,PORCINE/PF
R-X
18036 98111
HEP-100U/ML 3ML/ 3ML SRN CS120
08290-0370-03
B-D
HEPARIN SODIUM,PORCINE/PF
R-X
844209 120068
HEPARIN 1M /NACL 500X18 2B0953
00338-0431-03
BXT HEPARIN SODIUM,PORCINE/NS/PF
844241 97999
HEPARIN 2M /NACL1000X12 2B0944
00338-0433-04
BXT HEPARIN SODIUM,PORCINE/NS/PF
R-X
HEPARIN L/F NEW 100U 1ML/25
63323-0545-01
APP HEPARIN SODIUM,PORCINE
R-X
28795 97810
GLYCOPYRROLATE
R-X
R-X
R-X
331223 41377
HEPARIN P/F OLD 10U/ML 10ML/25
63323-0017-10
APP HEPARIN SODIUM,PORCINE/PF
R-X
29405 60871
HEPARIN SOD NEW 10000U 1ML/25
63323-0542-01
R-X
319061 60371
HEPARIN SOD OLD 1000U 1ML/25
63323-0540-01
R-X
363317 95514
63323-0540-31
R-X
362806 95512
63323-0542-07
R-X
363309 95513
HEPARIN SOD OLD1000U/M 10ML/25
63323-0540-11
R-X
319509 98038
HEPARIN SOD OLD1000U/ML 2ML/25
63323-0276-02
APP HEPARIN SODIUM,PORCINE/PF
R-X
703926 98287
HEPARIN SRN 1U 2ML/ 6ML 60
64253-0444-22
MFL HEPARIN SODIUM,PORCINE/PF
R-X
13722 98128
HEPARIN SRN 1U/ML 3ML 100
63807-0300-35
EMC HEPARIN SODIUM,PORCINE/PF
R-X
844225 120199
HEPARIN25M /DEX 500ML18 2B0808
00338-0550-03
BXT HEPARIN SODIUM,PORCINE/D5W
R-X
260018 95418
HEPATAMINE 8% 500ML/6 BOT
00264-9371-55
BBR AMINO ACIDS 8%
R-X
443051 97658
HEPSERA TAB 10 MG 30
61958-0501-01
NEX ADEFOVIR DIPIVOXIL
R-X
509430 97383
HERCEPTIN CARTON 440 MG
50242-0134-68
GNT TRASTUZUMAB
R-X
Page 20 of 46
Attachment n
M&D #
User #
326520 95083
Description
NDC #
Mfg
Generic Description
UDF 1
HESPAN BAG 500ML/12 L6511
00264-1965-10
BBR HETASTARCH/NORMAL SALINE
R-X
R-X
840033 99022
HUM COAL TAR SOL USP 16 OZ
00395-0617-16
HUM COAL TAR
841908 99117
HUM SIMPLE SYRUP N.F. 16 OZ
30395-2661-16
HUM
R-X
676619 97983
HUMIRA 40MG PREFILL PEN CT/2
00074-4339-02
ABB ADALIMUMAB
R-X
449660 97646
HUMIRA 40MG PREFILL SRN CT/2
00074-3799-02
ABB ADALIMUMAB
R-X
727594 98057
HUMIRA 40MG STARTER PK PEN CT6
00074-4339-06
ABB ADALIMUMAB
R-X
666412 96523
HYCAMTIN INJ 4MG VL
00007-4201-01
SKB TOPOTECAN HCL
R-X
602029 97713
HYDRALAZINE TAB 10 MG 100
49884-0029-01
PAR HYDRALAZINE HCL
R-X
826933 97714
HYDRALAZINE TAB 10 MG 100UD
51079-0074-20
UDL HYDRALAZINE HCL
R-X
605287 22992
HYDRALAZINE TAB 25 MG 100
49884-0027-01
PAR HYDRALAZINE HCL
R-X
909135 22640
HYDRALAZINE TAB 25 MG 100UD
00182-0554-89
TEV HYDRALAZINE HCL
R-X
244715 76720
HYDRALAZINE VL 20MG 1ML/25
00517-0901-25
A-R
HYDRALAZINE HCL
R-X
637942 98284
HYDROCHLOROTHIAZIDE 12.5MG100U
00172-4870-10
TEV HYDROCHLOROTHIAZIDE
R-X
345579 95315
HYDROCHLOROTHIAZIDE 25 MG 100
00172-2083-60
R-X
837112 95482
00172-2083-80
R-X
900142 99159
HYDROCHLOROTHIAZIDE 25MG 100UD
00182-0556-89
R-X
898809 22978
00172-2089-60
R-X
837120 54521
00172-2089-80
R-X
R-X
909077 1713
HYDROCHLOROTHIAZIDE 50 MG 100U
00182-0557-89
526285 96899
HYDROCODONE W/APAP 5/500 100
00406-0357-01
MAL HYDROCODONE BIT/ACETAMINOPHEN
R-X
438838 96900
HYDROCODONE W/APAP 5/500 100UD
00406-0357-62
MAL HYDROCODONE BIT/ACETAMINOPHEN
R-X
801936 96901
HYDROCODONE/HOMATROP SYR 16 OZ
00472-1030-16
APH HYDROCODONE BIT/HOMATROPINE
R-X
145201 70890
HYDROCORTISON CR 1% 1 OZ
00168-0015-31
FOU HYDROCORTISONE
R-X
144873 97489
HYDROCORTISON CR 1%-1.5G CT/48
00168-0154-08
FOU HYDROCORTISONE
R-X
703710 96614
HYDROCORTISON CR 2.5% 20 GM
00472-0337-20
APH HYDROCORTISONE
R-X
374942 96616
HYDROCORTISON LOT 2.5% 2 OZ
00168-0288-02
FOU HYDROCORTISONE
R-X
145177 23979
HYDROCORTISON OIN 1% 1 OZ
00168-0020-31
FOU HYDROCORTISONE
R-X
144824 96615
HYDROCORTISON OIN 2.5% 30 GM
00168-0146-30
FOU HYDROCORTISONE
R-X
910133 98001
HYDROCORTISON TAB 20 MG 100
00143-1254-01
W-W HYDROCORTISONE
R-X
336651 43831
HYDROCORTISONE ENEMA 60 ML/7
00574-2020-07
PAD HYDROCORTISONE
R-X
628818 98172
HYDROMORPHONE 2MG/10CPJ LL SPK
00409-1312-30
HOS HYDROMORPHONE HCL/PF
CII
994525 97491
HYDROMORPHONE 4MG 4X25
00054-0264-24
ROX HYDROMORPHONE HCL
CII
947135 96502
HYDROMORPHONE HCL TB 2MG 100
00406-3243-01
MAL HYDROMORPHONE HCL
CII
532770 96503
HYDROMORPHONE HCL TB 4MG 100
00406-3244-01
MAL HYDROMORPHONE HCL
CII
375782 54420
HYDROXYCHLOROQUINE 200 MG 100
00093-9774-01
TEV HYDROXYCHLOROQUINE SULFATE
R-X
315846 3089
HYDROXYUREA CAP 500 MG 100
00555-0882-02
TEV HYDROXYUREA
R-X
998849 59041
HYDROXYZINE SYR 4 OZ
60432-0150-04
WCK HYDROXYZINE HCL
R-X
81232 59341
HYDROXYZINE TAB 10 MG 100
50111-0307-01
TEV HYDROXYZINE HCL
R-X
531251 59241
50111-0308-01
TEV HYDROXYZINE HCL
R-X
80630 95893
50111-0308-03
TEV HYDROXYZINE HCL
R-X
HYDROXYZINE TAB 25 MG 100UD
68084-0254-01
RPK HYDROXYZINE HCL
R-X
954461 98234
531293 4818
50111-0309-01
TEV HYDROXYZINE HCL
R-X
76349 26890
HYDROXYZINE VL 25 MG 1ML/25
00517-4201-25
A-R
R-X
76406 36590
00517-5601-25
A-R
HYDROXYZINE HCL
R-X
76398 36490
00517-5602-25
A-R
HYDROXYZINE HCL
R-X
R-X
HYDROXYZINE HCL
424218 97853
HYPERHEP B IMM GLOBLN .5ML SRN
13533-0636-03
TAL
HEPATITIS B IMMUNE GLOBULIN
426130 37437
HYPERHEP B IMM GLOBLN 1ML SRN
13533-0636-02
TAL
HEPATITIS B IMMUNE GLOBULIN
886424 95697
IBUPROFEN SUS 16 OZ RX
00472-1270-16
APH IBUPROFEN
R-X
989996 26432
IBUPROFEN TAB 400 MG 100UD
63739-0442-10
SKY IBUPROFEN
R-X
109082 19552
IBUPROFEN TAB 400 MG 500
49884-0777-05
PAR IBUPROFEN
R-X
109140 95335
49884-0779-01
PAR IBUPROFEN
R-X
918276 99183
IBUPROFEN TAB 800 MG 100UD
00904-5855-61
MAJ IBUPROFEN
R-X
109157 95336
49884-0779-05
PAR IBUPROFEN
R-X
584219 97211
IC-GREEN 25 MG VL CT/6
17478-0701-02
AKR INDOCYANINE GREEN
R-X
442798 96894
IDARUBICIN HCL VL1MG/ML 5ML
00703-4154-11
GES IDARUBICIN HCL
R-X
442806 96895
00703-4155-11
GES IDARUBICIN HCL
R-X
R-X
Page 21 of 46
Attachment n
M&D #
User #
Description
442814 96896
158253 97751
641464 97922
NDC #
Mfg
Generic Description
UDF 1
00703-4156-11
GES IDARUBICIN HCL
R-X
IFOSFAMIDE SDV 1G LYP 30ML
63323-0142-10
APP IFOSFAMIDE
R-X
IFOSFAMIDE SDV 3G 75ML
10019-0926-02
BAX IFOSFAMIDE
R-X
107284 96424
IFOSFAMIDE/MESNA 3GM COMBO
00703-4100-68
GES IFOSFAMIDE/MESNA
R-X
883546 12872
IMIPRAMINE TAB 10 MG 100
00781-1762-01
SNZ IMIPRAMINE HCL
R-X
883579 12874
00781-1764-01
SNZ IMIPRAMINE HCL
R-X
883561 1368
IMIPRAMINE TAB 25 MG 100UD
00781-1764-13
SNZ IMIPRAMINE HCL
R-X
883595 26774
00781-1766-01
SNZ IMIPRAMINE HCL
R-X
919530 1362
IMIPRAMINE TAB 50 MG 100UD
00781-1766-13
SNZ IMIPRAMINE HCL
R-X
632422 95909
IMITREX 6 MG STATDOSE KIT
00173-0479-00
SKB SUMATRIPTAN SUCCINATE
R-X
631812 95910
IMITREX 6 MG STATDOSE REFILLS
00173-0478-00
R-X
184333 96741
IMITREX NASAL SPRAY 20 MG CT/6
00173-0523-00
SKB SUMATRIPTAN
R-X
518191 97943
IMITREX TAB 50 MG 9
00173-0736-01
R-X
518209 98292
IMITREX TAB 100 MG 9
00173-0737-01
R-X
638437 95911
IMITREX VL CT/5
00173-0449-02
R-X
929778 95240
R-X
INDERAL LA 80 MG 100
24090-0471-88
AKP PROPRANOLOL HCL
76372 72641
INDIGO CARMINE AMP .8% 5ML/10
00517-0375-10
A-R
501932 14377
INDOMETHACIN CAP 25 MG 100UD
51079-0190-20
UDL INDOMETHACIN
R-X
795435 6470
INDOMETHACIN CAP 25 MG 1000
00378-0143-10
MYL INDOMETHACIN
R-X
795443 97235
INDOMETHACIN CAP 50 MG 100
00378-0147-01
MYL INDOMETHACIN
R-X
INDOMETHACIN SDV 1MG
55390-0299-01
BED INDOMETHACIN SODIUM TRIHYDRATE
R-X
992537 98117
INFANRIX VL .5ML CT/10
58160-0810-11
SKB DIPH,PERTUSS(ACELL),TET PED/PF
R-X
441832 4391
INFED INJ 100 MG 2ML/10 VL
52544-0931-02
WAT IRON DEXTRAN COMPLEX
R-X
979419 96961
INFERGEN SDV 9MCG .3ML CT/6
66435-0201-99
TRP INTERFERON ALFACON-1
R-X
978056 96960
INFERGEN SDV 15MCG .5ML CT/6
66435-0201-15
TRP INTERFERON ALFACON-1
R-X
401133 95246
INFUVITE PED VIT VL CT5 2A9008
54643-5646-01
BXT MVI, PEDI NO.1 WITH VIT K
R-X
707356 98327
INS HUMALOG MIX 50/50 VIAL
00002-7512-01
LIL
INSULIN NPL/INSULIN LISPRO
R-X
400234 97217
INS HUMALOG VL 100U/ML 10ML
00002-7510-01
LIL
INSULIN LISPRO
119214 97703
INS NOVOFINE 30 NEEDLE BX/100
00169-1852-50
119123 95453
INS NOVOLIN HUM 70/30 U-100
286898 95396
INS NOVOLIN HUMAN N U-100
119099 95054
32185 95310
INDIGOTINDISULFONATE SODIUM
R-X
R-X
NPH NEEDLES, INSULIN DISPOSABLE
R-X
00169-1837-11
NPH HUM INSULIN NPH/REG INSULIN HM
R-X
00169-1834-11
NPH NPH, HUMAN INSULIN ISOPHANE
R-X
INS NOVOLIN HUMAN R U-100
00169-1833-11
NPH INSULIN REGULAR, HUMAN
R-X
442137 97674
INS NOVOLOG 70/30 FLXPEN 3ML/5
00169-3696-19
NPH INSULN ASP PRT/INSULIN ASPART
R-X
463075 97675
INS NOVOLOG FLEXPEN 3ML/5
00169-6339-10
NPH INSULIN ASPART
R-X
515957 97720
INSPRA TAB 25 MG 90
00025-1710-02
PFZ EPLERENONE
R-X
515965 97721
INSPRA TAB 25 MG 100UD
00025-1710-03
PFZ EPLERENONE
R-X
515973 97722
INSPRA TAB 50 MG 30
00025-1720-03
PFZ EPLERENONE
R-X
INSTA-GLUCOSE TUBE 31GM TRI/PK
00187-0746-33
ICN
R-X
185066 97551
INTEGRILIN VL 20 MG 10 ML
00085-1177-01
SCH EPTIFIBATIDE
R-X
185074 97550
INTEGRILIN VL 75 MG 100 ML
00085-1136-01
SCH EPTIFIBATIDE
R-X
828988 98138
INTELENCE TAB 100MG 120
59676-0570-01
JOM ETRAVIRINE
R-X
526368 96709
INTRALIPID 20% 100MLX10 2B6030
00338-0519-48
BXT FAT EMULSIONS
R-X
523134 95313
00338-0519-02
BXT FAT EMULSIONS
R-X
523159 95314
00338-0519-03
BXT FAT EMULSIONS
R-X
235317 95646
INTRON-A MDV 25MU HSA FREE
00085-1133-01
SCH INTERFERON ALFA-2B,RECOMB.
R-X
790535 95643
INTRON-A PEN 3MU .2ML 6 DOSE
00085-1242-01
R-X
235572 95645
INTRON-A VL 10MU 1ML
00085-0571-02
R-X
436980 97368
INVANZ 1G/20ML VL CT10
00006-3843-71
MSD ERTAPENEM SODIUM
R-X
712331 98043
INVEGA TAB 3 MG 30
50458-0550-01
JOM PALIPERIDONE
R-X
712349 98044
INVEGA TAB 6 MG 30
50458-0551-01
JOM PALIPERIDONE
R-X
712356 98045
INVEGA TAB 9 MG 30
50458-0552-01
JOM PALIPERIDONE
R-X
965459 96878
INVIRASE CAP 200 MG 270
00004-0245-15
ROC SAQUINAVIR MESYLATE
R-X
617365 97804
INVIRASE TAB 500 MG 120
00004-0244-51
ROC SAQUINAVIR MESYLATE
R-X
209544 17893
IPECAC SYR 1 OZ USP
00574-0012-01
PAD IPECAC
R-X
225797 95490
IPOL VL 10 DOSE
49281-0860-10
AVE POLIOMYELITIS VAC,KILLED
R-X
813089 98121
ISENTRESS TAB 400 MG 60
00006-0227-61
MSD RALTEGRAVIR POTASSIUM
R-X
11486 98187
DEXTROSE
Page 22 of 46
Attachment n
M&D #
User #
Description
564492 98324
ISOMETH/DICHLOR CAP 100UD
809400 97240
874446 95766
NDC #
Mfg
Generic Description
UDF 1
62584-0139-01
RPK ISOMETHEPT/ACETAMINOP/DICHLPHN
R-X
ISONIAZID SYR USP PT
46287-0009-01
CMP ISONIAZID
R-X
ISONIAZID TAB 100 MG 100
00555-0066-02
TEV ISONIAZID
R-X
978247 95767
ISONIAZID TAB 300 MG 30
00185-4350-30
SNZ ISONIAZID
R-X
502401 99240
ISONIAZID TAB 300 MG 100UD
51079-0083-20
UDL ISONIAZID
R-X
683896 21110
ISOPROTERENOL HCL AMP 1ML/25
00409-1410-01
HOS ISOPROTERENOL HCL
R-X
209072 23886
ISOPROTERENOL HCL AMP 5ML/10
00409-1410-05
HOS ISOPROTERENOL HCL
R-X
130310 80811
ISOPTO CARBACHOL 3% 15ML
00998-0225-15
ALC CARBACHOL
R-X
130237 33181
ISOPTO HOMATROPINE 2% 5ML
00998-0311-05
ALC HOMATROPINE HBR
R-X
130245 32181
ISOPTO HOMATROPINE 5% 5ML
00998-0315-05
ALC HOMATROPINE HBR
R-X
130047 7555
ISOPTO HYOSCINE 0.25% 5ML
00998-0331-05
ALC SCOPOLAMINE HYDROBROMIDE
R-X
ISOSORBIDE DIN ER 40 MG 100
64980-0144-01
RIS
ISOSORBIDE DINITRATE
R-X
ISOSORBIDE DIN ORL 5 MG 100U
00904-2150-61
MAJ ISOSORBIDE DINITRATE
R-X
15867 26977
105015 13512
527325 3149
ISOSORBIDE DIN ORL 10 MG 100
00143-1771-01
W-W ISOSORBIDE DINITRATE
R-X
18630 95807
00143-1771-10
R-X
613182 25277
00904-2151-61
R-X
530048 27166
00143-1772-01
R-X
883702 95808
00781-1695-10
SNZ ISOSORBIDE DINITRATE
R-X
613190 45282
00904-2154-61
R-X
404178 1737
ISOSORBIDE DIN SL 5 MG 100
00603-4123-21
QLT ISOSORBIDE DINITRATE
R-X
ISOSORBIDE MON ER 30 MG 100
62175-0128-37
K-U
ISOSORBIDE MONONITRATE
R-X
375980 98307
ISOSORBIDE MON ER 30 MG 100UD
58177-0222-11
ETH ISOSORBIDE MONONITRATE
R-X
179333 97555
62175-0119-37
K-U
R-X
375998 98308
ISOSORBIDE MON ER 60 MG 100UD
58177-0238-11
ETH ISOSORBIDE MONONITRATE
R-X
379214 97557
62175-0129-37
K-U
R-X
998971 95177
ISOTRETINOIN (CLARAVIS)40MG100
00555-1057-56
TEV ISOTRETINOIN
R-X
645739 95176
ISOTRETINOIN(AMNESTEEM)10MG 30
00378-6611-93
MYL ISOTRETINOIN
R-X
167999 3689
19992 97553
JJ SURGICEL HEMO 4X08 24 ABSB
38137-0019-52
J&J
R-X
24471 97937
KADIAN CAP 20 MG 100
46987-0322-11
ACK MORPHINE SULFATE
CII
24489 97938
46987-0325-11
CII
27623 97939
46987-0323-11
CII
24497 97941
46987-0326-11
CII
24836 97940
46987-0324-11
CII
371302 97145
KALETRA O/SOL 160 ML
00074-3956-46
ABB LOPINAVIR/RITONAVIR
R-X
641522 97899
KALETRA TAB 200/50MG 120
00074-6799-22
ABB LOPINAVIR/RITONAVIR
R-X
457960 83421
KANAMYCIN VL 1GM 3ML/10
63323-0359-03
APP KANAMYCIN SULFATE
R-X
283234 53400
KENALOG -10 VL 5ML
00003-0494-20
BRI
TRIAMCINOLONE ACETONIDE
R-X
288662 53300
KENALOG -40 VL 1ML
00003-0293-05
BRI
R-X
283135 31200
KENALOG -40 VL 5ML
00003-0293-20
BRI
R-X
989772 41827
KENALOG SPY 63 GM
10631-0093-62
R/P
R-X
698068 98004
KEPPRA SDV 5MLX10
50474-0002-63
UCB LEVETIRACETAM
R-X
146241 9078
KETAMINE HCL 50MG/ML 10ML/10
55390-0475-10
BED KETAMINE HCL
R-X
249755 12577
KETAMINE HCL 100MG/ML 5ML/10
00409-2051-05
HOS KETAMINE HCL
R-X
KETO DIASTIX 100 2882
00193-2882-21
BAY URINE GLUC-ACET COMB.TST,STRIP
R-X
360677 96881
KETOCONAZOLE CREAM 2% 30 GM
00093-0840-30
TEV KETOCONAZOLE
R-X
523332 96350
KETOCONAZOLE SHAMPOO 2% 4OZ
45802-0465-64
CPL KETOCONAZOLE
R-X
297481 95122
KETOCONAZOLE TAB 200 MG 100
00093-0900-01
TEV KETOCONAZOLE
R-X
930263 95846
KETOROLAC SDV 15MG 1ML/25
66860-0084-03
CUP KETOROLAC TROMETHAMINE
R-X
848044 95847
00517-0801-25
A-R
R-X
241125 95848
00409-3796-01
HOS KETOROLAC TROMETHAMINE
R-X
631556 26896
KLOR-CON 8 MEQ 100
00245-0040-11
UPS POTASSIUM CHLORIDE
R-X
214692 99211
KLOR-CON 8 MEQ 100UD
00245-0040-01
R-X
631564 23619
KLOR-CON 8 MEQ 500
00245-0040-15
R-X
631382 14406
KLOR-CON 20 MEQ POW PK/100
00245-0035-01
R-X
422535 95705
KLOR-CON M10 TAB 100
00245-0057-11
R-X
422485 95706
KLOR-CON M20 TAB 100
00245-0058-11
R-X
10017 10624
KETOROLAC TROMETHAMINE
Page 23 of 46
Attachment n
M&D #
User #
699967 97172
Description
KRISTALOSE POWDER 10 GM 30
NDC #
66220-0719-30
Mfg
Generic Description
UDF 1
CBL LACTULOSE
R-X
699975 97173
KRISTALOSE POWDER 20 GM 30
66220-0729-30
CBL LACTULOSE
R-X
104570 97345
L-ARGININE TAB 500 MG 50
00904-4215-51
MAJ ARGININE
R-X
876169 95690
L-CYSTEINE HCL VL 50MG 10ML/10
00703-5324-03
GES CYSTEINE HCL
R-X
249920 86041
L-THYROXINE VL 500 MCG 10ML PF
63323-0248-10
APP LEVOTHYROXINE SODIUM
R-X
330829 95381
LABETALOL MDV 5MG/ML 20ML
55390-0130-20
BED LABETALOL HCL
R-X
387985 95524
LABETALOL TAB 200 MG 100
00185-0117-01
EON LABETALOL HCL
R-X
340877 99249
LABETALOL TAB 200 MG 100UD
51079-0929-20
UDL LABETALOL HCL
R-X
421644 22525
LACTULOSE SOL 32 OZ (CHRON)
50383-0779-32
HTP LACTULOSE
R-X
616540 99265
LACTULOSE SOL 30ML 40UD CHRON
00121-4577-30
PMA LACTULOSE
R-X
249110 96200
LAMICTAL TAB 25 MG 100 633
00173-0633-02
SKB LAMOTRIGINE
R-X
249086 96201
00173-0642-55
SKB LAMOTRIGINE
R-X
249094 96202
00173-0643-60
SKB LAMOTRIGINE
R-X
249102 96203
00173-0644-60
SKB LAMOTRIGINE
R-X
243550 90269
LANOXIN AMP 2ML/50 237
00173-0260-35
SKB DIGOXIN
R-X
R-X
243436 1560
LANOXIN AMP PED .1 MG 10 263
00173-0262-10
SKB DIGOXIN
244012 14305
LANOXIN TAB .125 MG 100UD 245
00173-0242-56
SKB DIGOXIN
R-X
244210 1559
LANOXIN TAB .125 MG 1000 243
00173-0242-75
SKB DIGOXIN
R-X
243758 1346
LANOXIN TAB .25 MG 100UD 257
00173-0249-56
SKB DIGOXIN
R-X
242966 49321
LANOXIN TAB .25 MG 1000 251
00173-0249-75
SKB DIGOXIN
R-X
238501 97317
LANSINOH BREAST CR 1/4OZ BX/50
44677-0102-02
397935 97216
LANTUS VL U-100 10ML
00088-2220-33
983346 95454
LEUCOVORIN CALC 050MG CT10
876557 95731
LEUCOVORIN CALC 100MG 20ML
281576 95732
LEUCOVORIN CALC 350MG 30ML
00703-5145-01
GES LEUCOVORIN CALCIUM
R-X
324012 95011
LEUCOVORIN CALC TAB 5 MG 100
00054-4496-25
ROX LEUCOVORIN CALCIUM
R-X
504159 97496
LEUCOVORIN CALC TAB 5 MG 50UD
51079-0581-06
UDL LEUCOVORIN CALCIUM
R-X
875039 95012
LEUCOVORIN CALC TAB 25 MG 25
00555-0485-27
TEV LEUCOVORIN CALCIUM
R-X
243121 23121
LEUKERAN TAB 2 MG 50 635
00173-0635-35
SKB CHLORAMBUCIL
R-X
335604 98146
LEUPROLIDE ACETATE KIT
00185-7400-85
EON LEUPROLIDE ACETATE
R-X
450791 97900
LEVAQUIN INJ BG 500MG 100ML/24
00045-0068-01
JOM LEVOFLOXACIN/DEXTROSE 5%-WATER
R-X
372755 97724
LEVAQUIN INJ BG 750MG 150ML/24
00045-0066-01
JOM LEVOFLOXACIN/DEXTROSE 5%-WATER
R-X
647602 97676
LEVEMIR FLEXPEN 3ML/5
00169-6439-10
NPH INSULIN DETEMIR
R-X
977116 98175
LEVETIRACETAM O/SOL 100MG 16OZ
00054-0224-63
ROX LEVETIRACETAM
R-X
945972 98243
LEVETIRACETAM TB 250MG 100UD
51079-0820-20
UDL LEVETIRACETAM
R-X
945865 97164
LEVETIRACETAM TB 250MG 120
00378-5613-78
MYL LEVETIRACETAM
R-X
945956 98244
LEVETIRACETAM TB 500MG 100UD
51079-0821-20
UDL LEVETIRACETAM
R-X
945873 97165
00378-5615-78
MYL LEVETIRACETAM
R-X
945899 97166
00378-5617-78
MYL LEVETIRACETAM
R-X
949511 98174
13668-0017-60
TOR LEVETIRACETAM
R-X
395590 97723
LEVOCARNITINE 200MG/ML 5ML/5
00703-0404-02
GES LEVOCARNITINE
R-X
14761 78101
LEVOTHYROXINE SOD 25MCG 100
00781-5180-01
SNZ LEVOTHYROXINE SODIUM
R-X
14779 62551
00781-5181-01
R-X
14787 96924
00781-5182-01
R-X
14795 96926
00781-5183-01
R-X
14803 62651
00781-5184-01
R-X
14811 96928
00781-5185-01
R-X
14829 96976
00781-5186-01
R-X
14837 96930
00781-5191-01
R-X
14845 86091
00781-5187-01
R-X
14852 43431
00781-5188-01
R-X
14860 36951
00781-5189-01
R-X
14878 36851
00781-5190-01
R-X
LEVSIN/SL TAB .125 MG 100
68220-0113-10
ALA HYOSCYAMINE SULFATE
R-X
858589 97334
LLI
R-X
AVE INSULIN GLARGINE,HUM.REC.ANLOG
R-X
55390-0051-10
BED LEUCOVORIN CALCIUM
R-X
00703-5140-01
GES LEUCOVORIN CALCIUM
R-X
513986 97659
LEXIVA TAB 700 MG 60
00173-0721-00
SKB FOSAMPRENAVIR CALCIUM
R-X
844498 120069
LIDOCAIN.4% DEX 500X18 2B0973
00338-0409-03
BXT LIDOCAINE HCL/D5W/PF
R-X
Page 24 of 46
Attachment n
M&D #
User #
Description
NDC #
Mfg
Generic Description
UDF 1
126961 96342
LIDOCAINE AMP 1% 2ML/50
00409-4713-32
HOS LIDOCAINE HCL/PF
R-X
127860 96343
00409-4713-02
R-X
127886 31013
00409-4283-01
R-X
509901 31691
LIDOCAINE HCL JELLY 2% 30ML
17478-0711-30
AKR LIDOCAINE HCL
R-X
509893 97849
LIDOCAINE HCL JELLY 2% 5ML/10
17478-0711-10
AKR LIDOCAINE HCL
R-X
137026 97210
LIDOCAINE JELLY U/J 2% 5ML/25
00548-3012-00
IMS
LIDOCAINE HCL
R-X
136333 95497
LIDOCAINE JELLY U/J 2% 10ML/25
00548-3013-00
IMS
LIDOCAINE HCL
R-X
445874 96467
LIDOCAINE MDV 1% 10ML/25
63323-0201-10
APP LIDOCAINE HCL
R-X
505297 97846
LIDOCAINE MDV 1% 20ML 2X25
00409-4276-01
HOS LIDOCAINE HCL
R-X
505313 97847
LIDOCAINE MDV 2% 20ML/25 2X25
00409-4277-01
HOS LIDOCAINE HCL
R-X
573824 12800
LIDOCAINE MDV 2% 50ML/25
00409-4277-02
HOS LIDOCAINE HCL
R-X
328583 8863
LIDOCAINE SRN 1% 5ML/10 ANYSR
00409-9137-05
R-X
328534 17854
LIDOCAINE SRN/A 2% 5ML/10
00409-1323-05
R-X
303982 46651
LIDOCAINE TOP SOL BOT 4% 50ML
00054-3505-47
ROX LIDOCAINE HCL
R-X
304741 97388
LIDOCAINE VISCOUS 2% 20ML/40
00054-8500-16
ROX LIDOCAINE HCL
R-X
421271 90175
LIDOCAINE VISCOUS 2% 100ML
60432-0464-00
WCK LIDOCAINE HCL
R-X
124438 19409
LIDOCAINE VL 1% 30ML/25 STERL
00409-4270-01
R-X
24257 95020
LIDOCAINE/EP CPJ1:1 2% 1.8M/50
00409-0996-01
HOS LIDOCAINE HCL/EPINEPHRINE BIT
R-X
129676 32880
LIDOCAINE/EP MDV1:1 1% 30ML/25
00409-3178-02
HOS LIDOCAINE HCL/EPINEPHRINE
R-X
254896 32881
LIDOCAINE/EP MDV1:1 2% 20ML/25
00409-3182-01
HOS LIDOCAINE HCL/EPINEPHRINE
R-X
326603 97689
LIDODERM PATCH BX/30
63481-0687-06
END LIDOCAINE
R-X
749978 33940
LINDANE LOTION 1% 60 ML
60432-0833-60
MGP LINDANE
R-X
714113 96543
LIPITOR TAB 10 MG 90
00071-0155-23
PFZ ATORVASTATIN CALCIUM
R-X
336966 97643
LIPITOR TAB 10 MG 100UD
00071-0155-40
R-X
714121 96544
00071-0156-23
R-X
336974 97644
00071-0156-40
R-X
710954 96545
00071-0157-23
R-X
811976 98231
00071-0158-92
R-X
360651 97195
00071-0158-23
R-X
LIPOMUL LIQ CALORIE SUPPL 16OZ
23558-5604-06
LEE
R-X
975433 96996
LIPOSYN III 10% 250ML/12
00409-9790-02
HOS FAT EMULSIONS
R-X
416271 20516
LIPOSYN III 10% 500ML/12
00409-9790-03
HOS FAT EMULSIONS
R-X
998799 97929
LISINOPRIL TAB 5 MG 100
68180-0513-01
LUP LISINOPRIL
R-X
533000 98249
LISINOPRIL TAB 5 MG 100UD
00172-3758-10
TEV LISINOPRIL
R-X
00185-0101-01
SNZ LISINOPRIL
R-X
532416 98248
00172-3759-10
TEV LISINOPRIL
R-X
616011 97931
00172-3760-60
TEV LISINOPRIL
R-X
529263 98247
00172-3760-10
TEV LISINOPRIL
R-X
616052 97932
00172-3761-60
TEV LISINOPRIL
R-X
998781 97928
LISINOPRIL TAB 2.5 MG 100
68180-0512-01
LUP LISINOPRIL
R-X
18556 97925
LISINOPRIL/HCTZ TB 10/12.5 100
65862-0043-01
AUP LISINOPRIL/HYDROCHLOROTHIAZIDE
R-X
157990 97926
R-X
3889 80691
18986 97930
LISINOPRIL/HCTZ TB 20/12.5 100
00172-5034-60
TEV LISINOPRIL/HYDROCHLOROTHIAZIDE
18952 97927
LISINOPRIL/HCTZ TB 20/25 100
00591-0862-01
WAT LISINOPRIL/HYDROCHLOROTHIAZIDE
R-X
321372 10647
LITHIUM CARB CAP 300 MG 100
00054-2527-25
ROX LITHIUM CARBONATE
R-X
302638 21648
LITHIUM CARB CAP 300 MG 100UD
00054-8527-25
ROX LITHIUM CARBONATE
R-X
303040 97498
LITHIUM CITRATE SYR 5ML/100UD
00054-8529-04
ROX LITHIUM CITRATE
R-X
309922 95099
LITHIUM CITRATE SYR 500ML
00054-3527-63
ROX LITHIUM CITRATE
R-X
629030 97757
LITHOBID TAB 300 MG 100
68968-4492-01
JDS LITHIUM CARBONATE
R-X
137646 96024
LMD 10% W/5%DEX 500ML/12
00409-7418-03
HOS DEXTRAN 40/DEXTROSE 5%-WATER
R-X
144337 96023
LMD 10% .9NACL 500ML/12
00409-7419-03
HOS DEXTRAN 40/NORMAL SALINE
R-X
507889 97248
LMX4 PLUS 5GMX5 W/10 TEGADERM
00496-0882-07
FER LIDOCAINE/TRANSPARENT DRESSING
R-X
LOPERAMIDE CAP 2 MG 100
00093-0311-01
TEV LOPERAMIDE HCL
R-X
504258 97398
LOPERAMIDE CAP 2 MG 100UD
51079-0690-20
UDL LOPERAMIDE HCL
R-X
999359 97397
LOPERAMIDE SOL 1 MG/5ML 40UD
00054-8534-16
ROX LOPERAMIDE HCL
R-X
618983 97760
LORATADINE SYRUP 5MG/5ML 4 OZ
51672-2073-08
TAR LORATADINE
R-X
557082 97759
LORATADINE TAB 10 MG 30
00067-6070-30
NVT LORATADINE
R-X
23325 27268
Page 25 of 46
Attachment n
M&D #
User #
Description
NDC #
469825 98046
LORATADINE TAB 10 MG 100
00781-5077-01
949024 98250
LORATADINE TAB 10 MG 100UD
360644 95568
LORAZEPAM CPJ 2MG 1ML/10 LL
308734 97898
Mfg
Generic Description
UDF 1
SNZ LORATADINE
R-X
51079-0538-20
UDL LORATADINE
R-X
00409-1985-30
HOS LORAZEPAM
R-X
LORAZEPAM INTENSOL SOL 30ML
00054-3532-44
ROX LORAZEPAM
R-X
169003 95941
LORAZEPAM MDV 4MG/ML 10ML/10
10019-0103-10
BAX LORAZEPAM
R-X
168971 98169
LORAZEPAM SDV 2MG/ML 1ML/25
10019-0102-01
BAX LORAZEPAM
R-X
168997 49725
LORAZEPAM SDV 4MG/ML 1ML/25
10019-0103-01
BAX LORAZEPAM
R-X
719179 95450
LORAZEPAM TAB .5 MG 100
00378-2321-01
MYL LORAZEPAM
R-X
454496 99184
LORAZEPAM TAB .5 MG 100UD
51079-0417-20
UDL LORAZEPAM
R-X
719161 95451
LORAZEPAM TAB 1 MG 100
00378-2457-01
MYL LORAZEPAM
R-X
809715 99185
LORAZEPAM TAB 1 MG 100UD
51079-0386-20
UDL LORAZEPAM
R-X
910075 96943
LOTEMAX OPTH SUS .5% 5 ML
24208-0299-05
B&L LOTEPREDNOL ETABONATE
R-X
910091 96944
LOTEMAX OPTH SUS .5% 15 ML
24208-0299-15
B&L LOTEPREDNOL ETABONATE
R-X
420422 95973
LOVENOX SRN 30MG/.3ML BX/10
00075-0624-30
AVE ENOXAPARIN SODIUM
R-X
20412 96775
00075-0620-40
R-X
353334 96776
00075-0621-60
R-X
353359 96777
00075-0622-80
R-X
353367 96778
LOVENOX SRN 100MG/ 1ML BX/10
00075-0623-00
R-X
428698 95158
00075-2912-01
R-X
428706 95159
LOVENOX SRN 150MG/ 1ML BX/10
00075-2915-01
R-X
320739 97758
LOW-OGESTREL TAB 6X28
52544-0847-28
WAT NORGESTREL-ETHINYL ESTRADIOL
R-X
606715 96535
LOXAPINE CAP 5 MG 100
00378-7005-01
MYL LOXAPINE SUCCINATE
R-X
441618 95657
00591-0370-01
WAT LOXAPINE SUCCINATE
R-X
441626 25550
00591-0371-01
R-X
249979 38685
LOXAPINE CAP 25 MG 100UD
51079-0902-20
UDL LOXAPINE SUCCINATE
R-X
441634 25552
00591-0372-01
R-X
127381 97344
LTA PRE-ATTACHED KIT CS/25
00409-4698-01
HOS LIDOCAINE HCL
R-X
957837 97794
LUPRON DEPOT KIT 7.5 MG
00074-3642-03
ABB LEUPROLIDE ACETATE
R-X
977025 97755
00074-3346-03
R-X
977165 95744
00074-3641-03
R-X
978049 95925
LUPRON DEPOT PED KIT 15 MG
00074-2440-03
R-X
17087 95923
LUPRON DEPOT PED KIT 7.5 MG
00074-2108-03
R-X
958066 95924
LUPRON DEPOT PED KIT 11.25 MG
00074-2282-03
R-X
959932 96717
LUPRON-3-MONTH KIT 11.25 MG
00074-3663-03
R-X
977033 97756
LUPRON-4-MONTH KIT 30 MG
00074-3683-03
R-X
715565 96703
LUTERA TAB .1/20 6X28
52544-0949-28
WAT LEVONORGESTREL-ETH ESTRA
152066 97576
LYMPHAZURIN 10MG CT/6 LYM100
63261-0250-21
290767 95357
LYSODREN TAB 500 MG 100
289769 40328
M-M-R II 10X SINGL DOSE KITA&B
79905 95106
76547 97174
R-X
A-S
ISOSULFAN BLUE
R-X
00015-3080-60
BRI
MITOTANE
00006-4681-00
MSD MEASLES,MUMPS&RUBELLA VACC/PF
M.T.E.-4 VL 10ML/25
00517-7410-25
A-R
ZINC SULF/CUSO4 P-HYD/MANG/CR
R-X
M.T.E.-5 VL 10ML/25
00517-8510-25
A-R
ZINC SULF/CUSO4 P-HYD/MN/CR/SE
R-X
R-X
R-X
676171 50848
M.V.I. ADULT 2/ 5ML/10
61703-0422-82
HOS MVI, ADULT NO.1 WITH VIT K
561985 97811
M.V.I.-12(W/O-K) 2/50ML/10
61703-0423-83
HOS MVI, ADULT NO.2 WITHOUT VIT K
R-X
963322 20518
MAALOX SUS 5 OZ MINT
00067-6281-62
NVT MAG HYDROX/AL HYDROX/SIMETH
R-X
135392 98054
MAG SULF 40MG/ML 100ML/24
00409-6729-23
HOS MAGNESIUM SULFATE
R-X
254920 98139
MAG SULF 40MG/ML 500ML/24
00409-6729-03
R-X
707141 98053
MAG SULF BG 2G 50ML/24
00409-6729-24
R-X
147942 96152
MAG SULF BG 40G 1000ML/12
00409-6729-09
R-X
148551 18327
MAG SULF INJ 50% ANSYR 10ML/10
00409-1754-10
R-X
76539 96421
R-X
MAG SULF VL 50% 50ML/25
00517-2650-25
A-R
MAGNESIUM SULFATE
R-X
208637 4404
MAG SULF VL 1G 2ML/25 PF 96402
63323-0064-02
APP MAGNESIUM SULFATE
R-X
207985 98025
MAGNEVIST VL 10ML ***
50419-0188-01
B/L
GADOPENTETATE DIMEGLUMINE
R-X
203919 95725
MAGNEVIST VL 20ML ***
50419-0188-02
B/L
GADOPENTETATE DIMEGLUMINE
R-X
MANGANESE SDV 10ML/25
00517-6410-25
A-R
MANGANESE SULFATE
R-X
661520 97573
MANNITOL 20% 500ML/12
00409-7715-03
HOS MANNITOL
R-X
126441 4842
MANNITOL VL 25% 50ML/25
00409-4031-01
HOS MANNITOL
R-X
80192 95091
Page 26 of 46
Attachment n
M&D #
User #
21519 98036
Description
MARCAINE SPINL AMP 2ML/10 M661
NDC #
00409-1761-02
Mfg
Generic Description
HOS BUPIVACAINE HCL/DEX-WATER/PF
UDF 1
R-X
379768 97365
MARINOL CAP 2.5 MG 60
00051-0021-21
U-I
DRONABINOL
R-X
686907 97366
MARINOL CAP 5 MG 60
00051-0022-21
U-I
DRONABINOL
R-X
379776 97367
MARINOL CAP 10 MG 60
00051-0023-21
U-I
DRONABINOL
R-X
960021 7537
MATULANE CAP 50 MG 100
54482-0053-01
SIG
PROCARBAZINE HCL
R-X
754796 97642
MAXALT-MLT TAB 5 MG 3X4
00006-3800-12
MSD RIZATRIPTAN BENZOATE
R-X
754812 97641
MAXALT-MLT TAB 10 MG 3X4
00006-3801-12
MSD RIZATRIPTAN BENZOATE
R-X
451039 96676
MCT OIL QUART 365-13
41679-0365-13
NES MEDIUM CHAIN TRIGLYCERIDES
R-X
826073 55440
MD-GASTROVIEW BOT 120ML/12
00019-4816-05
MAL DIATR MEGLU/DIATRIZOATE SODIUM
R-X
365429 20167
MEBENDAZOLE TAB 100 MG 12 CHW
00093-9107-29
TEV MEBENDAZOLE
R-X
720896 95949
MECLIZINE TAB 25 MG 100
49884-0035-01
PAR MECLIZINE HCL
R-X
928960 98309
MECLIZINE TAB 25 MG 100UD
51079-0090-20
UDL MECLIZINE HCL
R-X
914861 95948
MECLIZINE TAB 12.5 MG 100 OTC
00536-3985-01
RUG MECLIZINE HCL
R-X
928796 98310
MECLIZINE TAB 12.5 MG 100UD
51079-0089-20
UDL MECLIZINE HCL
R-X
499483 98049
MEDISENSE H/L GLU/KET CONT SOL
57599-0139-01
MDS BLOOD-GLUCOSE CALIB. CONTROL
R-X
655852 96910
MEDISENSE H/L GLUC CONTR SOL
57599-0550-01
MDS BLOOD-GLUCOSE CALIB. CONTROL
R-X
470823 95927
MEDROL TAB 32 MG 25
00009-0176-01
PFZ METHYLPREDNISOLONE
R-X
643031 95445
MEDROXYPROGESTERONE 10MG 100
59762-3742-02
GRN MEDROXYPROGESTERONE ACET
R-X
828319 95710
MEDROXYPROGESTERONE 2.5MG 100
00555-0872-02
TEV MEDROXYPROGESTERONE ACET
R-X
134635 95753
MEFLOQUINE HCL TAB 250MG CT/25
00781-5076-86
SNZ MEFLOQUINE HCL
R-X
733089 12893
MEGESTROL ACETATE 20 MG 100
00054-4603-25
ROX MEGESTROL ACETATE
R-X
105023 98251
MEGESTROL ACETATE 20 MG 100UD
00054-8603-25
R-X
875070 97923
MEGESTROL ACETATE 40 MG 100
00555-0607-02
TEV MEGESTROL ACETATE
R-X
804617 98252
MEGESTROL ACETATE 40 MG 100UD
63739-0165-10
SKY MEGESTROL ACETATE
R-X
147777 98013
MEGESTROL O/S 40MG/ML 8OZ
00054-3542-58
R-X
529974 96145
MEGESTROL O/S 40MG/ML 16OZ
49884-0907-61
PAR MEGESTROL ACETATE
R-X
421529 95353
MELQUIN HP 4% CRM 1 OZ
58980-0472-10
STR HYDROQUINONE
R-X
729582 96148
MELQUIN-3 TOP SOL 1 OZ
58980-0476-10
STR HYDROQUINONE
R-X
672105 97965
MENACTRA SINGLE DOSE VL CT/5
49281-0589-05
AVE MENING VAC A,C,Y,W-135 DIP/PF
R-X
16683 97303
MENOMUNE ACYW135 1 DOSE
49281-0489-01
AVE MENINGOCOC VAC A,C,Y,W-135/PF
R-X
260927 19821
MEPERIDINE TAB 50 MG 25RN
00054-8595-11
ROX MEPERIDINE HCL
CII
304105 39820
MEPERIDINE TAB 50 MG 100
00054-4595-25
ROX MEPERIDINE HCL
CII
722736 95916
MEPERIDINE VL 300 MG/10 PCA
00409-6030-04
HOS MEPERIDINE HCL
CII
825679 23070
MEPHYTON TAB 5 MG 100
25010-0405-15
ATO PHYTONADIONE
R-X
575233 97472
MEPRON SUS 5 ML 42UD
00173-0547-00
SKB ATOVAQUONE
R-X
248963 96195
MEPRON SUS 750MG/5ML 210 ML
00173-0665-18
SKB ATOVAQUONE
R-X
523712 421
MERCAPTOPURINE TAB 50 MG 25
00054-4581-11
ROX MERCAPTOPURINE
R-X
236216 97776
MERREM IV 1 GM 30 ML/10
00310-0321-30
ZNC MEROPENEM
R-X
236240 97775
MERREM IV 500 MG 20 ML/10
00310-0325-20
ZNC MEROPENEM
R-X
999235 95679
MESALAMINE SUS ENEMA 4G 7/60ML
00093-6888-71
TEV MESALAMINE
R-X
424853 97752
MESNA MDV 1 GM 10ML
63323-0733-11
APP MESNA
R-X
965657 69711
MESTINON TIMESPAN 180 MG 30
00187-3013-30
ICN
658252 97647
METADATE CD CAP 10 MG 100
53014-0579-07
UCB METHYLPHENIDATE HCL
CII
658260 97648
53014-0580-07
CII
658278 97649
53014-0581-07
CII
873828 23959
METAPROTERENOL SYR 16 OZ
00603-1422-58
QLT METAPROTERENOL SULFATE
R-X
533257 18848
METAPROTERENOL TAB 20 MG 100
49884-0259-01
PAR METAPROTERENOL SULFATE
R-X
999268 97183
METFORMIN ER TAB 500MG 100
00093-7267-01
TEV METFORMIN HCL
R-X
METFORMIN HCL TAB 500MG 100
00781-5050-01
SNZ METFORMIN HCL
R-X
METFORMIN HCL TAB 500MG 100UD
62584-0259-01
RPK METFORMIN HCL
R-X
METFORMIN HCL TAB 850MG 100
00781-5051-01
SNZ METFORMIN HCL
R-X
671412 97351
METFORMIN HCL TAB 850MG 100UD
00904-5635-61
MAJ METFORMIN HCL
R-X
303651 16350
METHADONE 10 MG 100
00054-4571-25
ROX METHADONE HCL
CII
303487 99074
METHADONE 10 MG 4X25
00054-8554-24
ROX METHADONE HCL
CII
869735 16740
METHAZOLAMIDE TAB 50 MG 100
00781-1071-01
SNZ METHAZOLAMIDE
R-X
212084 20351
METHERGINE AMP 1ML/20
00078-0053-03
NVT METHYLERGONOVINE MALEATE
R-X
14886 96209
555979 97350
18820 96210
PYRIDOSTIGMINE BROMIDE
R-X
Page 27 of 46
Attachment n
M&D #
User #
Description
210518 4351
METHERGINE TAB 100
402230 32961
946319 98253
NDC #
Mfg
Generic Description
UDF 1
00078-0054-05
NVT METHYLERGONOVINE MALEATE
METHIMAZOLE TAB 10 MG 100
00185-0210-01
EON METHIMAZOLE
R-X
METHIMAZOLE TAB 10 MG 100UD
68084-0276-01
RPK METHIMAZOLE
R-X
463729 17391
METHOCARBAMOL 750 MG 100
00603-4486-21
QLT METHOCARBAMOL
R-X
797662 1941
METHOTREXATE TAB 2.5 MG 100
00378-0014-01
MYL METHOTREXATE SODIUM
R-X
978437 13007
METHOTREXATE VL 50MG 2ML/10PF
66758-0040-02
SNZ METHOTREXATE SODIUM/PF
R-X
146142 98048
METHOTREXATE VL 100 MG 4ML/10
55390-0032-10
BED METHOTREXATE SODIUM/PF
R-X
146027 95455
55390-0033-10
BED METHOTREXATE SODIUM/PF
R-X
978445 97662
66758-0040-08
SNZ METHOTREXATE SODIUM/PF
R-X
797704 91490
METHYCLOTHIAZIDE 5 MG 100
00378-0160-01
MYL METHYCLOTHIAZIDE
R-X
796334 95070
METHYLDOPA TAB 250 MG 100
00378-0611-01
MYL METHYLDOPA
R-X
502468 13589
METHYLDOPA TAB 250 MG 100UD
51079-0200-20
UDL METHYLDOPA
R-X
796342 52470
METHYLDOPA TAB 250 MG 1000
00378-0611-10
MYL METHYLDOPA
R-X
464388 52070
METHYLDOPATE VL 250 MG 5ML/10
00517-8905-10
A-R
R-X
15727 23414
R-X
METHYLDOPATE HCL
METHYLENE BLUE VL 1% 10ML/10
17478-0504-10
AKR METHYLENE BLUE
227603 76821
METHYLIN 5 MG 100
00406-1121-01
MAL METHYLPHENIDATE HCL
R-X
CII
227629 28721
METHYLIN 10 MG 100
00406-1122-01
MAL METHYLPHENIDATE HCL
CII
757245 96504
METHYLPHENIDATE 20 MG 100
00781-5753-01
SNZ METHYLPHENIDATE HCL
CII
478420 98207
METHYLPREDNISOLONE 4MG 21PK
00781-5022-07
SNZ METHYLPREDNISOLONE
R-X
617837 97392
METOCLOPRAMIDE SYR 10 ML 100UD
00121-1576-10
PMA METOCLOPRAMIDE HCL
R-X
526681 95247
METOCLOPRAMIDE SYR 16 OZ
00121-0576-16
PMA METOCLOPRAMIDE HCL
R-X
607614 95107
METOCLOPRAMIDE TAB 10 MG 100
00228-2269-10
APH METOCLOPRAMIDE HCL
R-X
502781 99145
METOCLOPRAMIDE TAB 10 MG 100U
51079-0283-20
UDL METOCLOPRAMIDE HCL
R-X
876458 46653
METOCLOPRAMIDE VL 5MG 2ML/25
00703-4502-04
GES METOCLOPRAMIDE HCL
R-X
614362 18138
METOLAZONE TAB 5 MG 100
00378-6173-01
MYL METOLAZONE
R-X
617340 98311
METOLAZONE TAB 5 MG 100UD
51079-0024-20
UDL METOLAZONE
R-X
744193 18136
METOLAZONE TAB 10 MG 100
00378-6174-01
MYL METOLAZONE
R-X
744201 18141
METOLAZONE TAB 2.5 MG 100
00378-6172-01
MYL METOLAZONE
R-X
636365 98312
METOLAZONE TAB 2.5 MG 100UD
51079-0023-20
UDL METOLAZONE
R-X
196279 95253
METOPROLOL TAR 5MG/5ML AMPCT12
00409-2285-05
HOS METOPROLOL TARTRATE
R-X
523738 98274
METOPROLOL TAR TAB 25 MG 100
00378-0018-01
MYL METOPROLOL TARTRATE
R-X
557850 98050
METOPROLOL TAR TAB 25 MG 100U
51079-0255-20
UDL METOPROLOL TARTRATE
R-X
797381 36864
00378-0032-01
R-X
797399 95895
00378-0032-10
R-X
506824 36868
51079-0801-20
R-X
797407 36869
00378-0047-01
R-X
506832 36872
51079-0802-20
R-X
987537 97906
METROCREAM .75% TOP CR 45 GM
00299-3836-45
G/L
R-X
846410 95913
METROGEL .75% VAGINAL GEL 70GM
29336-0200-25
GWY METRONIDAZOLE
R-X
844233 96098
METRONIDAZOL 500 100X24 2B3421
00338-1055-48
BXT METRONIDAZOLE/SODIUM CHLORIDE
R-X
761528 99132
METRONIDAZOLE TAB 250 MG 100UD
00904-1453-61
MAJ METRONIDAZOLE
R-X
279067 14027
METRONIDAZOLE TAB 250 MG 500
50111-0333-02
TEV METRONIDAZOLE
R-X
279075 95804
METRONIDAZOLE TAB 500 MG 100
50111-0334-01
TEV METRONIDAZOLE
R-X
501882 97505
METRONIDAZOLE TAB 500 MG 100UD
51079-0126-20
UDL METRONIDAZOLE
R-X
398370 95457
MEXILETINE HCL CAP 150 MG 100
00093-8739-01
TEV MEXILETINE HCL
R-X
412106 95458
MEXILETINE HCL CAP 200 MG 100
00093-8740-01
TEV MEXILETINE HCL
R-X
209809 23642
MIACALCIN 200I.U./ML 2ML MDV
00078-0149-23
NVT CALCITONIN,SALMON,SYNTHETIC
R-X
519272 96396
MIACALCIN NASAL SPRAY 3.7ML
00078-0311-54
NVT CALCITONIN,SALMON,SYNTHETIC
R-X
872135 97956
MICONAZOLE 7 VAG SUP 7
00713-0197-57
G&W MICONAZOLE NITRATE
R-X
453555 96669
MICROLIPID 89ML BOT CS48 8702
41679-0087-02
NES FAT EMULSIONS
R-X
439273 97888
MICRONOR DIALPAK 6X28
00062-1411-16
JOM NORETHINDRONE
R-X
107540 96999
MIDAZOLAM SYR 2MG/ML 118ML
00054-3566-99
ROX MIDAZOLAM HCL
R-X
361014 95719
MIDAZOLAM VL1MG/ML 2ML/10PF
55390-0137-02
BED MIDAZOLAM HCL
R-X
361162 95516
MIDAZOLAM VL1MG/ML 5ML/10
10019-0028-05
BAX MIDAZOLAM HCL
R-X
361212 96346
10019-0027-10
BAX MIDAZOLAM HCL
R-X
361048 95404
MIDAZOLAM VL5MG/ML 1ML/10PF
55390-0138-01
BED MIDAZOLAM HCL
R-X
METRONIDAZOLE
Page 28 of 46
Attachment n
M&D #
User #
Description
361063 95376
523696 97276
698555 98254
523688 97275
119867 96568
NDC #
Mfg
Generic Description
UDF 1
55390-0126-05
BED MIDAZOLAM HCL
MIDODRINE HCL TAB 5 MG 100
00378-1902-01
MYL MIDODRINE HCL
R-X
MIDODRINE HCL TAB 5 MG 100UD
51079-0453-20
UDL MIDODRINE HCL
R-X
MIDODRINE HCL TAB 2.5 MG 100
00378-1901-01
MYL MIDODRINE HCL
R-X
MILRINONE BG 20MG/100ML 2J0900
00338-6010-48
BXT MILRINONE LACTATE/D5W
R-X
109231 96567
MILRINONE VL 1MG/ML 10ML/10
10019-0070-01
BAX MILRINONE LACTATE
R-X
276998 98313
MINERAL OIL 30ML 100UD
00121-0462-30
PMA MINERAL OIL
R-X
303354 97311
MINOCYCLINE CAP 50 MG 100
00093-3165-01
TEV MINOCYCLINE HCL
R-X
875443 97312
MINOCYCLINE CAP 100 MG 50
00093-3167-53
TEV MINOCYCLINE HCL
R-X
711739 45955
MINOXIDIL TAB 2.5 MG 100
49884-0256-01
PAR MINOXIDIL
R-X
730572 45954
MINOXIDIL TAB 10 MG 100
49884-0257-01
PAR MINOXIDIL
R-X
677229 9530
MIOCHOL-E 20MG 2ML 1 VL& 1 AMP
00078-0474-61
NVT ACETYLCHOLINE CHLORIDE
R-X
339127 97830
MIOSTAT VL 1.5ML/12
00065-0023-15
ALC CARBACHOL
R-X
666461 96738
MIRAPEX TAB .5 MG 90
00597-0185-90
BOE PRAMIPEXOLE DI-HCL
R-X
666446 96737
00597-0184-90
R-X
666487 96739
MIRAPEX TAB 1.0 MG 90
00597-0190-90
R-X
666503 96740
MIRAPEX TAB 1.5 MG 90
00597-0191-90
R-X
666438 96736
00597-0183-90
R-X
532283 97410
MIRENA IUD SYSTEM
50419-0421-01
B/L
463174 96956
MIRTAZAPINE TAB 15 MG 30
00093-7206-56
TEV MIRTAZAPINE
R-X
503763 96957
MIRTAZAPINE TAB 15 MG 100UD
51079-0086-20
UDL MIRTAZAPINE
R-X
463182 96958
MIRTAZAPINE TAB 30 MG 30
00093-7207-56
TEV MIRTAZAPINE
R-X
503755 96959
MIRTAZAPINE TAB 30 MG 100UD
51079-0087-20
UDL MIRTAZAPINE
R-X
LEVONORGESTREL
R-X
R-X
146290 18817
MITOMYCIN VL 5 MG 15 ML
55390-0251-01
BED MITOMYCIN
R-X
666354 95666
MITOXANTRONE MDV 20MG 10ML
00703-4685-01
TEV MITOXANTRONE HCL
R-X
665653 95667
MITOXANTRONE MDV 25MG 12.5 ML
55390-0084-01
BED MITOXANTRONE HCL
R-X
723023 97819
MONO. S/NDL SRN 30G .5CC 100
08881-6097-00
CAN SYRING W-NDL,DISP,INSUL,0.5ML
R-X
723031 97820
MONO. S/NDL SRN 30G 1CC 100
08881-6096-00
CAN SYRINGE W-NDL, DISP,INSUL,1ML
R-X
MONSEL S PASTE 8 ML BX/12
48783-0112-08
GYX
R-X
621029 96347
MORPH CPJ 2MG/ML/10 LL SLMPAK
00409-1762-30
HOS MORPHINE SULFATE
CII
614131 96348
00409-1258-30
CII
654566 31871
MORPH CPJ 8MG/ML/10 LL SLMPK
00409-1260-69
CII
628925 85730
00409-1261-30
CII
649509 31030
MORPH CPJ 15MG/ML/10 LL SLMPK
00409-1264-31
CII
917898 96180
MORPH SULF IR TAB 15 MG 100
00054-0235-25
ROX MORPHINE SULFATE
CII
917393 96181
MORPH SULF IR TAB 15 MG 4X25
00054-0235-24
CII
917906 96182
MORPH SULF IR TAB 30 MG 100
00054-0236-25
CII
947499 96183
MORPH SULF IR TAB 30 MG 4X25
00054-0236-24
CII
12864 97406
MORPH SULF MDV 10MG/ML 10ML
10019-0178-62
BAX MORPHINE SULFATE
CII
988659 98105
35816 96349
MORPH SULF O/CNT 20MG/ML 15ML
00406-8003-15
MAL MORPHINE SULFATE
CII
988667 98106
00406-8003-30
MAL MORPHINE SULFATE
CII
978395 95041
00527-1425-62
LAN MORPHINE SULFATE
CII
705863 95711
MORPH SULF PCA 30MG/30ML/10 PF
00409-2029-02
HOS MORPHINE SULFATE/PF
CII
36335 95917
MORPH SULF SDV 10MG/ML 1ML/25
10019-0178-44
BAX MORPHINE SULFATE
CII
MORPH VL 5 MG/ML 30ML/10 PCA
00409-6028-04
HOS MORPHINE SULFATE/PF
CII
MORRHUATE SOD VL 50 MG/ML 30ML
00517-3065-01
A-R
R-X
726414 95582
76422 96049
989640 98264
SODIUM MORRHUATE
MULTAQ TAB 400MG 60
00024-4142-60
AVE DRONEDARONE HYDROCHLORIDE
R-X
16956 98265
MULTAQ TAB 400MG 100UD
00024-4142-10
AVE DRONEDARONE HYDROCHLORIDE
R-X
76869 97126
MULTI TRACE NEONATAL 2ML/25
00517-6202-25
A-R
R-X
76802 97154
MULTI TRACE-4 PED 3ML/25
00517-9203-25
A-R
R-X
105056 98005
MULTIVITAMIN SYR 480 ML
00904-0985-16
MAJ MULTIVITAMINS
R-X
319038 97852
MURI-LUBE LIGHT 10ML/25
63323-0254-10
APP MINERAL OIL
R-X
652792 790
MUSTARGEN VL 20CC/4
67386-0911-51
OVA MECHLORETHAMINE HCL
R-X
590679 95768
MYAMBUTOL TAB 100 MG 100
68850-0010-01
PHT ETHAMBUTOL HCL
R-X
590687 95769
MYAMBUTOL TAB 400 MG 100
68850-0012-01
PHT ETHAMBUTOL HCL
R-X
590695 98241
MYAMBUTOL TAB 400 MG 100UD
68850-0012-02
PHT ETHAMBUTOL HCL
R-X
Page 29 of 46
Attachment n
M&D #
User #
Description
NDC #
Mfg
Generic Description
UDF 1
620856 97875
MYCAMINE VL 50 MG
700625 98071
171694 96194
243311 3221
MYLERAN TAB 2 MG 25 713
427179 5070
MYOCHRYSINE MDV 50MG/ML 10 ML
459586 86261
MYSOLINE TAB 50 MG 100
66490-0690-10
459594 56261
MYSOLINE TAB 250 MG 100
529164 22506
NAFCILLIN SOD VL 1 GM/10
592170 24132
NAFCILLIN SOD VL 2 GM/10
00781-3125-95
SNZ NAFCILLIN SODIUM
R-X
399568 95560
NAFTIN 1% CR 30 GM
00259-4126-30
MRP NAFTIFINE HCL
R-X
129940 95143
NALBUPHINE AMP 10MG/ML 1ML/10
00409-1463-01
HOS NALBUPHINE HCL
R-X
637090 95142
NALBUPHINE VL 10MG/ML 10ML/25
00409-1464-01
HOS NALBUPHINE HCL
R-X
126045 12653
NALOXONE AMP .4 MG/ML 1ML/10
00409-1212-01
HOS NALOXONE HCL
R-X
555813 95330
NALOXONE L-J 1 MG/ML 2ML/10
00548-3369-00
IMS
NALOXONE HCL
R-X
181271 95252
NALOXONE VL .4 MG/ML 10ML/25
00409-1219-01
HOS NALOXONE HCL
R-X
516716 97690
NAMENDA TAB 5 MG 60
00456-3205-60
FOR MEMANTINE HCL
R-X
516732 97691
NAMENDA TAB 5 MG 100UD
00456-3205-63
FOR MEMANTINE HCL
R-X
516724 97692
NAMENDA TAB 10 MG 60
00456-3210-60
FOR MEMANTINE HCL
R-X
516740 97693
NAMENDA TAB 10 MG 100UD
00456-3210-63
FOR MEMANTINE HCL
R-X
84012 22915
00469-3250-10
ASE MICAFUNGIN SODIUM
R-X
MYCAMINE VL 100 MG
00469-3211-10
ASE MICAFUNGIN SODIUM
R-X
MYCOBUTIN CAP 150 MG 100
00013-5301-17
PFZ RIFABUTIN
R-X
00173-0713-25
SKB BUSULFAN
R-X
11098-0533-10
AKR GOLD SODIUM THIOMALATE
R-X
ICN
PRIMIDONE
R-X
66490-0691-10
ICN
PRIMIDONE
00781-3124-95
SNZ NAFCILLIN SODIUM
R-X
R-X
NAPHAZOLINE OPT SOL .1% 15ML
17478-0216-12
AKR NAPHAZOLINE HCL
R-X
605162 95502
NAPROXEN SUS 125 MG/5ML 500ML
00054-3630-63
ROX NAPROXEN
R-X
809863 95024
NAPROXEN TAB 250 MG 100UD
51079-0793-20
UDL NAPROXEN
R-X
999367 95823
NAPROXEN TAB 250 MG 500
00093-0147-05
TEV NAPROXEN
R-X
23507 96603
00093-0148-01
TEV NAPROXEN
R-X
00904-5536-61
MAJ NAPROXEN
R-X
554394 96604
00093-0149-01
TEV NAPROXEN
R-X
809889 96606
23531 96605
51079-0795-20
UDL NAPROXEN
R-X
706713 97290
NARDIL TAB 15 MG 60
00071-0350-60
PFZ PHENELZINE SULFATE
R-X
992610 96486
NAROPIN 2MG/ML 20ML/5 P/AMP
63323-0285-20
APP ROPIVACAINE HCL
R-X
NAROPIN 5MG/ML 30ML/5 P/SDV
63323-0286-31
APP ROPIVACAINE HCL
R-X
130955 38998
17061 96487
NATACYN OPT SOL 5% 15ML
00065-0645-15
ALC NATAMYCIN
R-X
418475 97271
NATRECOR VL 1.5 MG 5 ML
65847-0205-25
JOM NESIRITIDE
R-X
239541 95597
NEBUPENT INHAL SDV 300MG 15 ML
63323-0877-15
APP PENTAMIDINE ISETHIONATE
R-X
729822 34485
NECON 1/50 DIALPAK 3X28
52544-0245-31
WAT NORETHINDRONE-MESTRANOL
R-X
876979 96383
NEFAZODONE HCL TAB 100 MG 60
00093-1024-06
TEV NEFAZODONE HCL
R-X
876987 96385
00093-7113-06
TEV NEFAZODONE HCL
R-X
876995 96387
00093-1025-06
TEV NEFAZODONE HCL
R-X
877001 96389
00093-1026-06
TEV NEFAZODONE HCL
R-X
516328 59750
NEMBUTAL VL 50ML
67386-0501-55
OVA PENTOBARBITAL SODIUM
CII
830463 97993
NEOCATE 1 + POW 60GM/15 UNFL
49735-0110-48
SHS NUT.TX.IMPAIRED DIGEST FXN
R-X
813758 97992
NEOCATE INFANT FORMULA 400GM/4
49735-0108-04
SHS NUT.TX.IMPAIRED DIGEST FXN
R-X
875468 12651
NEOMYCIN SULF 500 MG 100
00093-1177-01
TEV NEOMYCIN SULFATE
R-X
502062 99130
NEOMYCIN SULF 500 MG 100UD
51079-0015-20
UDL NEOMYCIN SULFATE
R-X
967943 59181
NEOMYCIN-POLY-B/DEX OIN 1/8 OZ
61314-0631-36
FAL
NEO/POLYMYX B SULF/DEXAMETH
R-X
20370 21181
NEOMYCIN-POLY-B/DEX SUS 5 ML
61314-0630-06
FAL
NEO/POLYMYX B SULF/DEXAMETH
910414 23421
NEOMYCIN-POLY-B/GRAM SOL 10ML
24208-0790-62
B&L NEOMYCIN/POLYMYXN B/GRAMICIDIN
122614 90245
NEOSTIGMINE VL 1:1000 10ML/10
10019-0270-10
BAX NEOSTIGMINE METHYLSULFATE
R-X
491456 96001
NEPHRAMINE BOT 5.4% 250ML/12
00264-1909-55
BBR AMINO ACIDS 5.4%
R-X
946640 16554
NESACAINE-MPF SDV 2% 20ML AMBR
63323-0477-20
APP CHLOROPROCAINE HCL
R-X
104075 97378
NEULASTA 6 MG/0.6 ML W/SYRG
55513-0190-01
AMG PEGFILGRASTIM
R-X
22806 95956
NEUPOGEN 300 MCG 1ML/10 SDV
55513-0530-10
AMG FILGRASTIM
R-X
22798 95961
R-X
R-X
NEUPOGEN 480 MCG 1.6ML/10 SDV
55513-0546-10
AMG FILGRASTIM
R-X
387621 97123
NEURONTIN CAP 400 MG 100
00071-0806-24
PFZ GABAPENTIN
R-X
518498 97124
NEURONTIN TAB 800 MG 100
00071-0401-24
PFZ GABAPENTIN
R-X
619254 97917
NEXIUM IV 20 MG 10 X 5 ML VIAL
00186-6020-01
ZNC ESOMEPRAZOLE SODIUM
R-X
619262 97918
NEXIUM IV 40 MG 10 X 5 ML VIAL
00186-6040-01
A/Z
R-X
ESOMEPRAZOLE SODIUM
Page 30 of 46
Attachment n
M&D #
User #
Description
829366 97331
NIASPAN ER COATED TB 500MG 90
829374 97332
829382 97333
NDC #
Mfg
Generic Description
UDF 1
00074-3074-90
ABB NIACIN
R-X
NIASPAN ER COATED TB 750MG 90
00074-3079-90
ABB NIACIN
R-X
NIASPAN ER COATED TB1000MG 90
00074-3080-90
ABB NIACIN
R-X
795831 97376
NICARDIPINE CAP 20 MG 90
00378-1020-77
MYL NICARDIPINE HCL
R-X
795583 97377
NICARDIPINE CAP 30 MG 90
00378-1430-77
MYL NICARDIPINE HCL
R-X
677435 95792
NICOTINE PATCH STEP-1 21 MG 7
00067-5126-07
NVT NICOTINE
R-X
679050 95791
00067-5125-07
NVT NICOTINE
R-X
679068 95790
00067-5124-07
NVT NICOTINE
R-X
518795 95752
NICOTINE POLACRILX GUM 2MG 110
00536-3106-23
RUG NICOTINE POLACRILEX
R-X
606962 95136
NIFEDIPINE CAP 10 MG 100
00228-2497-10
APH NIFEDIPINE
R-X
344937 95661
NIFEDIPINE ER TAB 90 MG 100
00378-3495-01
MYL NIFEDIPINE
R-X
446781 98255
NIFEDIPINE ER TAB 90 MG 100U
51079-0969-20
UDL NIFEDIPINE
R-X
378299 96408
NIMBEX MDV 2MG/ML 10ML/10
00074-4380-10
ABB CISATRACURIUM BESYLATE
R-X
378273 96409
NIMBEX ICU SDV 10MG/ML 20ML
00074-4382-20
ABB CISATRACURIUM BESYLATE
R-X
813980 99231
NIMODIPINE CAP 30 MG 100UD
57664-0135-65
C-P
NIMODIPINE
R-X
286708 14800
NITRA TEST PAPER 5262
00003-0526-20
BRI
URINE PHENAPHTHAZINE-PH TEST
844043 97998
NITRO 25MG/DEX 250ML/12 1A0692
00338-1047-02
BXT NITROGLYCERIN/D5W
R-X
844050 120183
NITRO 50MG/DEX 250ML/12 1A0694
00338-1049-02
BXT NITROGLYCERIN/D5W
R-X
798488 95144
NITRO TRANSDERM .2 MG/HR 30
00378-9104-93
MYL NITROGLYCERIN
R-X
798496 95167
NITRO TRANSDERM .4 MG/HR 30
00378-9112-93
MYL NITROGLYCERIN
R-X
954727 19887
NITROBID OIN 30 GM
00281-0326-30
SAV NITROGLYCERIN
R-X
954743 97399
NITROBID OINTMENT 1GM CT/48
00281-0326-08
SAV NITROGLYCERIN
R-X
781153 3325
NITROFURANTOIN CAP 50 MG 100
00378-1650-01
MYL NITROFURANTOIN MACROCRYSTAL
R-X
R-X
520163 5639
NITROFURANTOIN CAP 50 MG 100U
51079-0584-20
UDL NITROFURANTOIN MACROCRYSTAL
R-X
747212 85151
NITROFURANTOIN CAP 100 MG 100
00378-1700-01
MYL NITROFURANTOIN MACROCRYSTAL
R-X
827097 3959
NITROFURANTOIN CAP 100MG 100UD
00093-2131-93
TEV NITROFURANTOIN MACROCRYSTAL
R-X
NITROGLYCERIN CAP TR 6.5 60
00185-1235-60
SNZ NITROGLYCERIN
R-X
464370 95125
NITROGLYCERIN VL 50 MG 10ML/25
00517-4810-25
A-R
R-X
471789 98282
NITROLINGUAL PUMPSPRAY 4.9 GM
59630-0300-65
HOR NITROGLYCERIN
R-X
339549 97125
NITROLINGUAL PUMPSPRAY 12.0 GM
59630-0300-20
HOR NITROGLYCERIN
R-X
129692 18975
NITROPRESS VL 50 MG 2ML FLIP
00409-3024-01
HOS NITROPRUSSIDE SODIUM
R-X
375394 12693
NITROSTAT TAB 0.4 MG 100 1/150
00071-0418-24
PFZ NITROGLYCERIN
R-X
375402 23324
NITROSTAT TAB 0.4MG 4X25 1/150
00071-0418-13
PFZ NITROGLYCERIN
R-X
464461 82621
NOREPINEPHRINE VL1MG/ML 4ML/10
00703-1153-03
GES NOREPINEPHRINE BITARTRATE
R-X
387860 98020
NORINYL 1+35 WALL 6X28
52544-0259-28
WAT NORETHINDRONE-ETHINYL ESTRAD
R-X
358903 120054
14894 26142
NITROGLYCERIN
NORMOSOL-R/DEX5 LC1000ML/12
00409-7968-09
HOS ELECTROLYTE-R SOLUTION/D5W
R-X
23879 31144
NORTRIPTYLINE CAP 10 MG 100
00093-0810-01
TEV NORTRIPTYLINE HCL
R-X
422790 31146
00591-5787-01
WAT NORTRIPTYLINE HCL
R-X
555987 31147
NORTRIPTYLINE CAP 25 MG 100UD
68084-0032-01
RPK NORTRIPTYLINE HCL
R-X
427104 44892
00591-5789-01
WAT NORTRIPTYLINE HCL
R-X
121160 96856
NORVIR O/SOL 80 MG/ML 240 ML
00074-1940-63
ABB RITONAVIR
R-X
617266 96855
NORVIR SOFT GELCAP 100 MG 30
00074-6633-30
ABB RITONAVIR
R-X
NOVASOURCE RENAL 27X8OZ 351100
00212-3511-62
R-X
450585 96671
NUTRAMIGEN POW LB 338-21
00087-0338-01
M-J
790733 98152
NUTREN JR W/O FB CS24
00065-9043-70
R-X
270918 97856
NUTREN 1.0 VAN CS/24
00065-9024-70
R-X
270942 97857
NUTREN 1.0 VN W/FB/24
00065-9025-70
NES NUTRITIONAL SUPPLEMENT/FIBER
R-X
270959 97873
NUTREN 2.0 VAN CS/24
00065-9040-70
R-X
270991 97866
NUTREN PULM VAN CS/24
00065-9141-70
NES NUT.TX.PULM.DISORD.REG,LAC-FR
R-X
271254 97865
NUTRI-HEP UNFL CS/24
00065-9078-70
NES NUT.TX.IMPAIRED HEPATIC FXN
R-X
707877 97963
NUVARING 3 PK
00052-0273-03
SCH ETONOGESTREL/ETHINYL ESTRADIOL
R-X
669069 20640
NYDRAZID INJ 100 MG 10ML
00781-3056-70
SNZ ISONIAZID
R-X
145268 22062
NYSTATIN CR 15 GM
00168-0054-15
FOU NYSTATIN
R-X
143164 22063
NYSTATIN CR 30 GM
00168-0054-30
FOU NYSTATIN
R-X
143172 2600
NYSTATIN OIN 15 GM
00168-0007-15
FOU NYSTATIN
R-X
144790 400
NYSTATIN OIN 30 GM
00168-0007-30
FOU NYSTATIN
R-X
71035 97864
INF FORMULA,SP.MET,LAC FR,IRON
R-X
Page 31 of 46
Attachment n
M&D #
User #
513275 97391
Description
NDC #
Mfg
Generic Description
UDF 1
NYSTATIN SUS 5ML 50UD
00472-5003-60
APH NYSTATIN
R-X
24679 98272
NYSTATIN SUS 60ML
60432-0537-60
WCK NYSTATIN
R-X
24661 19464
NYSTATIN SUS 16 OZ
60432-0537-16
WCK NYSTATIN
R-X
709089 98072
NYSTATIN VAG TAB 15
51285-0534-22
DMD NYSTATIN
R-X
295626 500
NYSTOP 100M U/GM 15GM
00574-2008-15
PAD NYSTATIN
R-X
646398 95989
OCTREOTIDE MDV 200MCG/ML 5ML
00703-3333-01
TEV OCTREOTIDE ACETATE
R-X
618470 95580
OCTREOTIDE SDV 50 MCG CT10
55390-0160-10
BED OCTREOTIDE ACETATE
R-X
618488 95988
55390-0161-10
R-X
618496 95990
55390-0162-10
R-X
848606 97052
OFLOXACIN OTIC SOL .3% 5ML
24208-0410-05
B&L OFLOXACIN
R-X
695759 95698
OMNIPAQUE BT350MG 200ML/10 416
00407-1414-04
GE
IOHEXOL
R-X
515809 95546
OMNIPAQUE PL300MG 100ML/10 532
00407-1413-63
GE
IOHEXOL
R-X
515817 95946
00407-1413-65
GE
IOHEXOL
R-X
514935 95494
00407-1414-91
GE
IOHEXOL
R-X
695619 95394
OMNIPAQUE VL 180MG 20ML/10 102
00407-1411-20
GE
IOHEXOL
R-X
695635 95461
00407-1413-10
GE
IOHEXOL
R-X
695999 95448
00407-1413-50
GE
IOHEXOL
R-X
695700 95449
00407-1414-50
GE
IOHEXOL
R-X
695080 95926
OMNISCAN VL 10ML/10 J100
00407-0690-10
GE
GADODIAMIDE
R-X
729319 95995
ONDANSETRON SDV 2ML CT/5
00143-9891-05
WWI ONDANSETRON HCL/PF
R-X
753905 97764
ONDANSETRON TAB 4MG 30
68462-0105-30
GPI
ONDANSETRON HCL
R-X
754143 97765
ONDANSETRON TAB 4MG 100UD
51079-0524-20
UDL ONDANSETRON HCL
R-X
858365 97766
ONDANSETRON TAB 8MG 30
00093-7236-56
TEV ONDANSETRON HCL
R-X
754150 97767
ONDANSETRON TAB 8MG 100UD
51079-0525-20
UDL ONDANSETRON HCL
R-X
859199 95738
ONDANSETRON VL 2MG/ML 20 ML
00143-9890-01
WWI ONDANSETRON HCL
R-X
525873 97744
OPTIVAR OPT SOL .05% 6ML
00037-7025-60
WAL AZELASTINE HCL
R-X
209585 98055
ORA-PLUS 16 OZ
00574-0303-16
PAD COMPOUNDING VEHICLE SUSP NO.7
R-X
209601 98056
ORA-SWEET 16 OZ
00574-0304-16
PAD COMPOUNDING VEHICLE NO.8
R-X
809442 99177
ORACIT SOL 15ML/10UD
46287-0014-15
CMP CITRIC ACID/SODIUM CITRATE
R-X
105791 98183
ORTHO EVRA PATCH 18
00062-1920-15
JOM NORELGESTROMIN/ETHIN.ESTRADIOL
R-X
OVCON-50 3X28
00430-0585-45
W-C NORETHINDRONE-ETHINYL ESTRAD
R-X
988857 97672
OXALIPLATIN SDV 5MG/ML 10ML
00703-3985-01
TEV OXALIPLATIN
R-X
988865 97673
OXALIPLATIN SDV 5MG/ML 20ML
00703-3986-01
TEV OXALIPLATIN
R-X
998682 97255
OXCARBAZEPINE TAB 150 MG 100
00054-0097-25
ROX OXCARBAZEPINE
R-X
825331 97256
OXCARBAZEPINE TAB 150 MG 100U
62584-0142-01
RPK OXCARBAZEPINE
R-X
998690 97257
00054-0098-25
ROX OXCARBAZEPINE
R-X
825349 97258
OXCARBAZEPINE TAB 300 MG 100U
62584-0143-01
RPK OXCARBAZEPINE
R-X
998757 97259
00054-0099-25
ROX OXCARBAZEPINE
R-X
773184 21465
OXYBUTYNIN TAB 5 MG 100
00603-4975-21
QLT OXYBUTYNIN CHLORIDE
R-X
872036 33044
OXYBUTYNIN TAB 5 MG 100UD
00904-2821-61
MAJ OXYBUTYNIN CHLORIDE
R-X
502930 21472
OXYCODONE/APAP TAB 5/325 100U
00406-0512-62
MAL OXYCODONE HCL/ACETAMINOPHEN
CII
558510 15355
OXYCODONE/ASA 4.88/325 TAB 100
00591-0820-01
WAT OXYCODONE HCL/OXYCODON TER/ASA
652909 96949
OXYCONTIN CR TAB 10 MG 20UD
59011-0100-20
P-F
OXYCODONE HCL
CII
740498 96948
OXYCONTIN CR TAB 10 MG 100
59011-0100-10
P-F
OXYCODONE HCL
CII
650424 96951
59011-0103-20
P-F
OXYCODONE HCL
CII
740795 96950
59011-0103-10
P-F
OXYCODONE HCL
CII
652917 96953
59011-0105-20
P-F
OXYCODONE HCL
CII
740811 96952
59011-0105-10
P-F
OXYCODONE HCL
CII
652925 96955
59011-0107-20
P-F
OXYCODONE HCL
CII
740209 96954
59011-0107-10
P-F
OXYCODONE HCL
CII
291690 56611
OXYTOCIN VL 10U 1ML/25
63323-0012-01
APP OXYTOCIN
R-X
474668 98032
OXYTROL TRANSDERMAL SYSTEM CT8
52544-0920-08
WAT OXYBUTYNIN
R-X
407429 96423
PACLITAXEL VL 30MG 5ML
55390-0114-05
BED PACLITAXEL,SEMI-SYNTHETIC
R-X
408435 96707
PACLITAXEL VL 100MG 16.7ML
55390-0114-20
BED PACLITAXEL,SEMI-SYNTHETIC
R-X
992594 97797
PACLITAXEL VL 300MG 50ML
63323-0763-50
APP PACLITAXEL,SEMI-SYNTHETIC
R-X
428730 95837
PAMIDRONATE LYP 30MG 10ML
55390-0127-01
BED PAMIDRONATE DISODIUM
R-X
17830 98220
CII
Page 32 of 46
Attachment n
M&D #
User #
Description
NDC #
Mfg
Generic Description
UDF 1
162891 95702
PANCREASE MT- 4 CAP 100
00045-0341-60
JOM LIPASE/PROTEASE/AMYLASE
162552 95703
PANCREASE MT-16 CAP 100
00045-0343-60
JOM LIPASE/PROTEASE/AMYLASE
R-X
876268 95662
PANCURONIUM VL 2 MG/ML 2ML/25
00703-2812-04
GES PANCURONIUM BROMIDE
R-X
876276 17523
PANCURONIUM VL 2 MG/ML 5ML/25
00703-2823-04
GES PANCURONIUM BROMIDE
R-X
PAPAVERINE HCL 30MG/ML 10ML
00517-4010-01
A-R
R-X
667220 23730
PAREGORIC USP PT
50383-0855-16
HTP PAREGORIC
211094 35928
PARLODEL TAB 2.5 MG 100
00078-0017-05
NVT BROMOCRIPTINE MESYLATE
R-X
240960 1018
PARNATE TAB 10 MG 100 447120
00007-4471-20
SKB TRANYLCYPROMINE SULFATE
R-X
76083 32890
27219 95754
PAPAVERINE HCL
R-X
PAROMOMYCIN SULF CAP 250MG 100
23155-0038-01
HPI
999474 97453
PAROXETINE HCL TAB 10 MG 30
65862-0154-30
AUP PAROXETINE HCL
R-X
529339 98256
PAROXETINE HCL TAB 10 MG 100UD
00904-5676-61
MAJ PAROXETINE HCL
R-X
13107-0155-30
AUP PAROXETINE HCL
R-X
529347 99288
PAROXETINE HCL TAB 20 MG 100UD
00904-5677-61
MAJ PAROXETINE HCL
R-X
999490 95877
65862-0156-30
AUP PAROXETINE HCL
R-X
14597 96477
65862-0157-30
AUP PAROXETINE HCL
R-X
37689 95876
PAROMOMYCIN SULFATE
R-X
R-X
130872 98136
PATANOL OPTH SOL .1% 5 ML
00065-0271-05
ALC OLOPATADINE HCL
R-X
193060 97454
PAXIL O/SUS 10 MG/5ML 250 ML
00029-3215-48
SKB PAROXETINE HCL
R-X
736702 97611
PEDIARIX SRN .5ML CT/ 5 PREFIL
58160-0811-46
SKB HEP B VACCINE/DP(A)T-POLIO/PF
R-X
972091 95612
PEDIASURE INST VAN CS24 51804
70074-0518-04
ROS
R-X
386540 97595
PEG-INTRON KIT 50MCG/.5ML
00085-1368-01
SCH PEGINTERFERON ALFA-2B
R-X
386557 97596
00085-1291-01
R-X
386565 97597
00085-1304-01
R-X
386573 97598
00085-1279-01
R-X
519322 97593
PEGASYS SRN 180MCG/.5ML CT/4
00004-0352-39
ROC PEGINTERFERON ALFA-2A
R-X
444968 97592
PEGASYS VL 180MCG/ML 1ML
00004-0350-09
ROC PEGINTERFERON ALFA-2A
R-X
798983 55670
PEN G PROCAINE .6MU 1ML/10
60793-0130-10
MNR PENICILLIN G PROCAINE
R-X
798991 43671
PEN G PROCAINE 1.2MU 2ML/10
60793-0131-10
MNR PENICILLIN G PROCAINE
R-X
511436 12454
PEN V POT O/PDR 125 MG 100ML
00093-4125-73
TEV PENICILLIN V POTASSIUM
R-X
302554 12455
00093-4125-74
R-X
246413 12456
00093-4127-73
R-X
598888 12457
PEN V POT O/S 250 MG 200ML
00093-4127-74
R-X
302307 4562
PEN V POT OV 250 MG 1000
00093-1172-10
R-X
885012 95805
PEN V POT OV 500 MG 100
00781-1655-01
SNZ PENICILLIN V POTASSIUM
R-X
376673 97362
PENLAC TOPICAL SOL 6.6 ML
00066-8008-02
AVE CICLOPIROX
R-X
949115 98132
PENTACEL VL .5ML CT/5
49281-0510-05
AVE DP(A)T-POLIO/HIB CONJ-TET/PF
R-X
335547 95288
PENTAM 300 15ML/10
63323-0113-10
APP PENTAMIDINE ISETHIONATE
R-X
179366 95986
PENTASA CAP 250 MG 240
54092-0189-81
ROB MESALAMINE
R-X
127365 97591
PENTOTHAL COMBO PAK 500 MG/25
00409-3329-01
HOS THIOPENTAL SODIUM
R-X
61754 95331
PENTOTHAL RTM SRN 500MG/25LIF
00409-3353-01
HOS THIOPENTAL SODIUM
R-X
776039 95281
PENTOXIFYLLINE ER 400 MG 100
00378-0357-01
MYL PENTOXIFYLLINE
R-X
902296 99171
PENTOXIFYLLINE ER 400 MG 100UD
51079-0889-20
UDL PENTOXIFYLLINE
R-X
826693 95785
PEPCID ORAL SUS 400 MG 50 ML
65649-0211-24
SAL FAMOTIDINE
R-X
655290 98150
PEPTAMEN AF 250ML/24
00065-9092-71
NES NS COMB1/FOS/INULIN
R-X
533935 95704
PERMETHRIN CR 5% 60GM
45802-0269-37
CPL PERMETHRIN
R-X
881359 83290
PERPHENAZINE TAB 2 MG 100
00781-1046-01
SNZ PERPHENAZINE
R-X
879767 97511
PERPHENAZINE TAB 2 MG 100UD
00781-1046-13
SNZ PERPHENAZINE
R-X
919621 83490
00781-1047-01
SNZ PERPHENAZINE
R-X
879775 97512
PERPHENAZINE TAB 4 MG 100UD
00781-1047-13
SNZ PERPHENAZINE
R-X
919571 93690
00781-1048-01
SNZ PERPHENAZINE
R-X
881375 13691
00781-1049-01
SNZ PERPHENAZINE
R-X
145375 99049
PETROLATUM WHITE 16 OZ
00168-0053-16
FOU PETROLATUM,WHITE
R-X
762435 64890
PFIZERPEN VL 5 MU 10 1635
00049-0520-83
PFZ PENICILLIN G POTASSIUM
R-X
763102 97814
PFIZERPEN VL 20 MU 7488
00049-0530-28
PFZ PENICILLIN G POTASSIUM
R-X
910125 33321
PHENOB 15 MG 1000
00143-1445-10
W-W PHENOBARBITAL
R-X
920454 64930
PHENOB 30 MG 1000
00143-1450-10
W-W PHENOBARBITAL
R-X
967760 23890
PHENOB 65 MG 1ML/25 VL
00641-0476-25
BAX PHENOBARBITAL SODIUM
R-X
Page 33 of 46
Attachment n
M&D #
User #
Description
NDC #
00121-0531-05
Mfg
Generic Description
PMA PHENOBARBITAL
UDF 1
136119 95223
PHENOB ELX 5ML/100UD
R-X
773424 33621
PHENOB ELX 16 OZ
00603-1508-58
QLT PHENOBARBITAL
R-X
982678 96510
PHENOB 100 MG 100
00143-1458-01
W-W PHENOBARBITAL
R-X
970848 1756
PHENOB 130 MG 1ML/25 VL
00641-0477-25
BAX PHENOBARBITAL SODIUM
R-X
350645 28868
PHENTOLAMINE MESYL VL 5 MG 2ML
55390-0113-01
BED PHENTOLAMINE MESYLATE
R-X
665893 97735
PHENYLEPHRINE HCL 10MG/ML5ML25
66758-0016-04
SNZ PHENYLEPHRINE HCL
R-X
84616 95032
PHENYLEPHRINE OPT/S 10% 5ML
17478-0205-10
AKR PHENYLEPHRINE HCL
R-X
372953 95349
PHENYLEPHRINE OPT/S 2.5% 3ML
61314-0342-01
FAL
PHENYLEPHRINE HCL
R-X
911313 12221
PHENYLEPHRINE OPT/S 2.5% 15ML
24208-0740-06
B&L PHENYLEPHRINE HCL
R-X
147801 2921
PHENYLEPHRINE VL 1% 1ML/25
10019-0163-12
BAX PHENYLEPHRINE HCL
R-X
199570 25770
PHENYTOIN ER CAP 100 MG 100
00378-1560-01
MYL PHENYTOIN SODIUM EXTENDED
R-X
296681 12198
PHENYTOIN ER CAP 100 MG 100U
51079-0905-20
UDL PHENYTOIN SODIUM EXTENDED
R-X
476457 99293
PHENYTOIN SUS 100 MG 4ML/50U
00472-5002-60
APH PHENYTOIN
R-X
967802 20075
PHENYTOIN VL 100 MG 2ML/25
00641-0493-25
BAX PHENYTOIN SODIUM
R-X
967810 97831
PHENYTOIN VL 250 MG 5ML/25
00641-2555-45
BAX PHENYTOIN SODIUM
R-X
695205 55471
PHISOHEX 5 OZ/48 HSP PK P315
00024-1535-48
AVE HEXACHLOROPHENE
R-X
691790 15920
PHISOHEX 16 OZ P316
00024-1535-06
AVE HEXACHLOROPHENE
R-X
358796 98157
PHOS-NAK POWDER CONC 100UD
60258-0006-01
CYP NAPH,MB-DB/K PH,MBDB
R-X
180646 76961
PHOSPHOLINE IOD .125% 6.25 MG
00046-1065-05
WYE ECHOTHIOPHATE IODIDE
R-X
444950 96031
PHYSOSTIGMINE 1MG/ML 2ML/10
11098-0510-02
AKR PHYSOSTIGMINE SALICYLATE
R-X
136358 95499
PHYTONADIONE M/J 1 MG .5ML/25
00548-1140-00
IMS
R-X
132878 99154
PILOCARPINE HCL 4% 2ML/12
00065-0756-12
ALC PILOCARPINE HCL
R-X
238766 19169
PILOCARPINE OPT SOL 1% 15ML
61314-0203-15
FAL
PILOCARPINE HCL
R-X
294298 19172
61314-0204-15
FAL
PILOCARPINE HCL
R-X
911701 19173
24208-0686-15
B&L PILOCARPINE HCL
R-X
133652 95312
PILOPINE HS OPT GEL 4% 4 GM
00065-0215-35
ALC PILOCARPINE HCL
R-X
606707 13024
PIN X PINWORM TREATMENT 1 OZ
13893-0691-45
PEN PYRANTEL PAMOATE
R-X
613976 96430
PIROXICAM CAP 10 MG 100
00093-0756-01
TEV PIROXICAM
R-X
674036 95224
PIROXICAM CAP 20 MG 100
00093-0757-01
TEV PIROXICAM
R-X
599746 120053
PLASMA LYTE A 1000X14 2B2544X
00338-0221-04
BXT ELECTROLYTE-A SOLUTION
R-X
255695 96721
PLAVIX TAB 75 MG 90
63653-1171-01
BRI
CLOPIDOGREL BISULFATE
R-X
790667 97204
PLAVIX TAB 75 MG 100UD
63653-1171-03
BRI
CLOPIDOGREL BISULFATE
R-X
133256 95322
PLEGISOL 1000ML/12
00409-7969-05
HOS CARDIOPLEGIC SOLUTION NO.1
R-X
409987 43512
PNEUMOVAX 23 SDV CT/10
00006-4943-00
MSD PNEUMOCOCCAL 23-VAL P-SAC VAC
R-X
287433 32931
PNEUMOVAX 23 VL 5 DOSE
00006-4739-00
MSD PNEUMOCOCCAL 23-VAL P-SAC VAC
R-X
209270 95397
PODOCON-25 15ML
00574-0601-15
PAD PODOPHYLLUM RESIN
R-X
667519 96330
PODOFILOX TOPICAL SOL.5% 3.5ML
00591-3204-13
WAT PODOFILOX
R-X
18747 11980
POLOCAINE VL 1% 50ML
63323-0283-50
APP MEPIVACAINE HCL
R-X
953364 88560
POLOCAINE VL 2% 50ML
63323-0296-50
APP MEPIVACAINE HCL
R-X
697888 97769
POLYETHYLENE GLYCOL 3350 255GM
51991-0457-58
BRK POLYETHYLENE GLYCOL 3350
R-X
697896 97770
POLYETHYLENE GLYCOL 3350 527GM
51991-0457-57
BRK POLYETHYLENE GLYCOL 3350
R-X
165316 69021
PONTOCAINE 1% 2ML/25 AMP
00409-1846-02
HOS TETRACAINE HCL
R-X
164756 95519
PONTOCAINE AMP 2ML/100
00409-1849-06
HOS TETRACAINE HCL
R-X
132456 95434
POT ACET VL 2 MEQ/ML 20ML/25
00409-8183-01
HOS POTASSIUM ACETATE
R-X
120931 98314
POT ACET VL 2 MEQ/VL 50ML/25
00409-3294-51
HOS POTASSIUM ACETATE
R-X
147090 120263
POT CHL 10MEQ 100ML/24 2B0826
00338-0709-48
BXT POTASSIUM CHLORIDE
R-X
774844 97734
POT CHL 20MEQ 100ML/24 2B0827
00338-0705-48
BXT POTASSIUM CHLORIDE
R-X
598938 97655
POT CHL 20MQ/.45% SOD 2B1357X
00338-0704-34
BXT POTASSIUM CHLORIDE IN 1/2 NS
R-X
POT CHL VL 250ML CS/12
00409-1513-02
HOS POTASSIUM CHLORIDE
R-X
126672 20259
POT CHL VL 10MEQ 5ML/25
00409-6635-01
HOS POTASSIUM CHLORIDE
R-X
225771 4852
POT CHL VL 20MEQ 10ML/25 PF
63323-0965-10
APP POTASSIUM CHLORIDE
R-X
61655 96417
PHYTONADIONE
225656 4853
POT CHL VL 40MEQ 20ML/25 PF
63323-0965-20
R-X
198978 19717
POT CHL VL 60MEQ/25
63323-0967-30
R-X
554147 24638
POT CHLOR 10% 16 OZ S/F
00904-1007-16
MAJ POTASSIUM CHLORIDE
R-X
422543 97514
POT CHLOR ER TAB 10MEQ 100UD
00245-0057-01
R-X
422527 99261
POT CHLOR ER TAB 20MEQ 100UD
00245-0058-01
R-X
Page 34 of 46
Attachment n
M&D #
User #
701946 99297
Description
POT CHLOR LIQ 40 MEQ 30ML/100
NDC #
00121-1465-30
Mfg
Generic Description
UDF 1
PMA POTASSIUM CHLORIDE
R-X
R-X
76943 20654
POT PHOS VL 15MM 5ML/25
00517-2305-25
A-R
POTASSIUM PHOS,M-BASIC-D-BASIC
76570 96420
POT PHOS VL 150MM 50ML/25
00517-2350-25
A-R
POTASSIUM PHOS,M-BASIC-D-BASIC
674150 96253
PRAVASTATIN SOD TAB 20 MG 90
00093-7201-98
TEV PRAVASTATIN SODIUM
674168 96482
00093-7202-98
TEV PRAVASTATIN SODIUM
R-X
813071 98278
PRAVASTATIN SOD TAB 40 MG 100U
51079-0782-20
UDL PRAVASTATIN SODIUM
R-X
847806 97273
55111-0274-90
RED PRAVASTATIN SODIUM
R-X
797373 25358
PRAZOSIN CAP 1 MG 100
00378-1101-01
MYL PRAZOSIN HCL
R-X
721142 28364
PRAZOSIN CAP 1 MG 100UD
51079-0630-20
UDL PRAZOSIN HCL
R-X
797365 41016
00378-2302-01
MYL PRAZOSIN HCL
R-X
721183 28365
51079-0631-20
UDL PRAZOSIN HCL
R-X
797357 25379
00378-3205-01
MYL PRAZOSIN HCL
R-X
721159 28366
51079-0632-20
UDL PRAZOSIN HCL
R-X
365320 98067
PRECEDEX DEXM VL 2ML/25
00409-1638-02
HOS DEXMEDETOMIDINE HCL
R-X
445346 97854
PRECISION XTRA STRIPS INST 50
57599-9695-04
MDS BLOOD SUGAR DIAGNOSTIC
R-X
352146 99178
PRED FORTE 1ML HSP 578
11980-0180-01
ALL
PREDNISOLONE ACETATE
R-X
352583 96084
PRED MILD 10ML 64
11980-0174-10
ALL
198564 95788
PREDNISOLONE O/SOL 240ML
00093-6118-87
TEV PREDNISOLONE
742502 15585
PREDNISOLONE OPT SUS 1% 5ML
61314-0637-05
FAL
309807 97515
PREDNISONE SOL 5 MG 5ML/40
00054-8722-16
ROX PREDNISONE
309799 95031
PREDNISONE SOL 500ML
00054-3722-63
ROX PREDNISONE
R-X
303933 97075
PREDNISONE SOL W/INTSL 30ML
00054-3721-44
ROX PREDNISONE
R-X
302356 14046
PREDNISONE TAB 1 MG 100
00054-4741-25
ROX PREDNISONE
R-X
302364 15859
PREDNISONE TAB 1 MG 100UD
00054-8739-25
ROX PREDNISONE
R-X
417196 14049
00591-5052-01
WAT PREDNISONE
R-X
302182 15862
00054-8724-25
ROX PREDNISONE
R-X
90936 95897
53489-0138-10
MUT PREDNISONE
R-X
90944 97234
53489-0139-01
MUT PREDNISONE
R-X
619635 97352
00054-0017-20
ROX PREDNISONE
R-X
417188 18554
00591-5443-01
WAT PREDNISONE
R-X
558528 14053
00054-0018-20
ROX PREDNISONE
R-X
558536 33415
00054-0019-20
ROX PREDNISONE
R-X
649806 12725
PREGESTIMIL LIPIL POW 16 OZ
00087-0367-01
M-J
646273 66791
PREMARIN .3 MG 100
00046-1100-81
647297 97626
PREMARIN .45 MG 100
649491 36591
PREMARIN .625 MG 100
646802 95822
PREMARIN .625 MG 1000
555789 56891
180851 97829
INFANT FORMULA W-IRON
R-X
R-X
R-X
R-X
R-X
R-X
R-X
WYE ESTROGENS,CONJUGATED
R-X
00046-1101-81
R-X
00046-1102-81
R-X
00046-1102-91
R-X
PREMARIN 1.25 MG 100
00046-1104-81
R-X
PREMARIN CREAM 1.5 OZ W/APP
00046-0872-93
R-X
180836 36191
PREMARIN IV 5CC 25 MG
00046-0749-05
R-X
736652 96337
PREMPHASE .625MG 1X28 BLISTER
00046-2579-11
WYE ESTROGEN,CON/M-PROGEST ACET
R-X
994855 97627
PREMPRO .3 /1.5 1X28 BLISTER
00046-1105-11
R-X
994947 97645
PREMPRO .45 /1.5 1X28 BLISTER
00046-1106-11
R-X
986216 96338
PREMPRO .625/2.5 1X28 BLISTER
00046-0875-11
R-X
986224 97952
PREMPRO .625/5 1X28 BLISTER
00046-0975-11
R-X
581249 98221
PRENATAL PLUS TAB 100
65162-0668-10
AKY PRENATAL VIT/FE FUMARATE/FA
R-X
PREPIDIL GEL 2.5MG/3G SRN CT5
00009-3359-02
PFZ DINOPROSTONE
R-X
22574 95860
367862 96933
PRESTIGE LITE TOUCH LANCET 100
56151-0142-60
732230 97131
PREVNAR SYR .5ML CT/10
00005-1970-50
WYE PNEUMOC 7-VAL CONJ-DIP CRM/PF
HDI
LANCETS
R-X
R-X
945592 97986
PREZISTA TAB 400 MG 60
59676-0561-01
JOM DARUNAVIR ETHANOLATE
R-X
849422 98123
PREZISTA TAB 600 MG 60
59676-0562-01
JOM DARUNAVIR ETHANOLATE
R-X
693549 55320
PRIMAQUINE PHOS TAB 100 P425
00024-1596-01
AVE PRIMAQUINE PHOSPHATE
R-X
799312 1849
PRIMIDONE TAB 250 MG 100UD
68084-0203-01
RPK PRIMIDONE
R-X
421768 57271
PROBENECID TAB .5 GM 100
00591-5347-01
WAT PROBENECID
R-X
126052 66640
PROCAINAMIDE VL 100 MG 10ML/25
00409-1902-01
HOS PROCAINAMIDE HCL
R-X
894543 18814
PROCAINAMIDE VL 500 MG 2ML/25
00409-1903-01
HOS PROCAINAMIDE HCL
R-X
Page 35 of 46
Attachment n
M&D #
User #
Description
NDC #
491738 95652
PROCALAMINE 3% 1000ML/6 S9150
00264-1915-00
549337 95592
PROCHLORPERAZINE 5MG/ML 2ML/10
206607 95598
PROCHLORPERAZINE SUP 25 MG 12
985267 96457
Mfg
Generic Description
UDF 1
BBR AA 3%/ELECTROLYTE-TPN SOLN/GLY
R-X
55390-0077-10
BED PROCHLORPERAZINE EDISYLATE
R-X
00713-0135-12
G&W PROCHLORPERAZINE MALEATE
R-X
PROCHLORPERAZINE TAB 10 MG 100
00378-5110-01
MYL PROCHLORPERAZINE MALEATE
R-X
500835 97516
PROCHLORPERAZINE TB 10MG 100UD
51079-0542-20
UDL PROCHLORPERAZINE MALEATE
R-X
977983 12496
PROCTOFOAM HC 10 GM
68220-0142-10
ALA HC ACETATE/PRAMOXINE HCL
R-X
454751 96117
PRODUCT 3232A 1 LB CAN 042521
00087-0425-41
M-J
R-X
406108 97666
PROGESTERONE/OIL 50MG/ML 10ML
63323-0261-10
APP PROGESTERONE
R-X
615906 33371
PROMETHAZINE SUP 25 MG 12
00574-7234-12
PAD PROMETHAZINE HCL
R-X
615922 95152
PROMETHAZINE SUP 12.5MG 12
00574-7236-12
PAD PROMETHAZINE HCL
R-X
PROMETHAZINE SYR 16 OZ
60432-0608-16
WCK PROMETHAZINE HCL
R-X
885723 32671
PROMETHAZINE TAB 25 MG 100
00781-1830-01
SNZ PROMETHAZINE HCL
R-X
715839 98257
PROMETHAZINE TAB 25 MG 100UD
51079-0895-20
UDL PROMETHAZINE HCL
R-X
446401 33971
PROMETHAZINE VL 25MG 1ML/25
00641-0928-25
BAX PROMETHAZINE HCL
R-X
949248 95827
PROPAFENONE HCL TAB 150MG 100
00603-5448-21
QLT PROPAFENONE HCL
R-X
458653 99274
PROPAFENONE HCL TAB 150MG 100U
51079-0996-20
UDL PROPAFENONE HCL
R-X
949271 95828
PROPAFENONE HCL TAB 300MG 100
00603-5450-21
QLT PROPAFENONE HCL
R-X
304246 34261
PROPANTHELINE BROMID 15MG 100
00054-4721-25
ROX PROPANTHELINE BROMIDE
R-X
911412 8200
PROPARACAINE OPT SOL .5% 15ML
24208-0730-06
B&L PROPARACAINE HCL
R-X
749499 95651
PROPOFOL SDV 10MG/ML 20ML/25
00703-2856-04
TEV PROPOFOL
R-X
749507 95921
00703-2858-09
TEV PROPOFOL
R-X
749515 95922
00703-2859-03
TEV PROPOFOL
R-X
602052 95504
PROPOXYPHN CAP 65 MG 100PINK
00093-0741-01
TEV PROPOXYPHENE HCL
R-X
870907 98325
PROPOXYPHN CAP 65 MG 100U WH
00904-7700-61
MAJ
R-X
804740 15574
PROPOXYPHN N-APAP 100MG 100UD
63739-0215-10
SKY PROPOXYPHENE/ACETAMINOPHEN
R-X
199240 18162
PROPOXYPHN N-APAP 100MG 100 WH
00093-0490-01
TEV PROPOXYPHENE/ACETAMINOPHEN
R-X
829762 98226
PROPRANOLOL HCL ER CP 80M100U
68084-0210-01
RPK PROPRANOLOL HCL
R-X
24729 97872
INFANT FORM,FE,LAC-FR,HYPOALR1
795484 2062
PROPRANOLOL TAB 10 MG 100
00378-0182-01
MYL PROPRANOLOL HCL
R-X
501411 22919
PROPRANOLOL TAB 10 MG 100UD
51079-0277-20
UDL PROPRANOLOL HCL
R-X
795526 95447
00378-0184-01
MYL PROPRANOLOL HCL
R-X
501437 22921
PROPRANOLOL TAB 40 MG 100UD
51079-0279-20
UDL PROPRANOLOL HCL
R-X
795534 2246
00378-0184-10
MYL PROPRANOLOL HCL
R-X
720243 95211
50111-0470-01
TEV PROPRANOLOL HCL
R-X
PROPRANOLOL VL 1MG/ML 1ML/10
00781-3777-95
SNZ PROPRANOLOL HCL
R-X
845305 86350
PROPYLTHIOURACIL 50 MG 1000
00143-1480-10
W-W PROPYLTHIOURACIL
R-X
637751 97990
PROQUAD 10 X 3 ML VIAL
00006-4999-00
MSD MEASLES,MUMPS,RUB,VARICELLA/PF
R-X
285981 95793
PROSCAR TAB 5 MG 30
00006-0072-31
MSD FINASTERIDE
R-X
227702 95133
PROSTIN E2 VAG SUP 20 MG 5PAK
00009-0827-03
PFZ DINOPROSTONE
R-X
319483 2947
PROTAMINE SULF 10M 5ML/25 PF
63323-0229-05
APP PROTAMINE SULFATE
R-X
469650 66560
PROTOPAM CHL 1G 20ML/6 VL
60977-0141-01
BAX PRALIDOXIME CHLORIDE
R-X
379453 97382
PROTOPIC OIN .1% 30 GM
00469-5202-30
ASE TACROLIMUS
R-X
379438 97381
PROTOPIC OIN .03% 30 GM
00469-5201-30
ASE TACROLIMUS
R-X
534628 98068
PROVIGIL TAB 100 MG 100NEWFORM
63459-0101-01
CEP MODAFINIL
R-X
534636 98069
PROVIGIL TAB 200 MG 100NEWFORM
63459-0201-01
CEP MODAFINIL
R-X
PSEU 120/CHLORP 8MG CAP 100
00185-1304-01
SNZ PSEUDOEPHEDRINE HCL/CHLOR-MAL
R-X
24240 3285
14753 18048
370320 97181
PULMICORT RESPULE .5MG/2MLX30
00186-1989-04
A/Z
BUDESONIDE
R-X
370312 97180
PULMICORT RESPULE .25MG/2MLX30
00186-1988-04
A/Z
BUDESONIDE
R-X
531442 95765
PYRAZINAMIDE TAB 500 MG 100
61748-0012-01
V-I
PYRAZINAMIDE
R-X
315069 97517
PYRAZINAMIDE TAB 500 MG 100UD
61748-0012-11
V-I
PYRAZINAMIDE
R-X
827428 79751
PYRIDOSTIGMINE BROM 60MG 100
00115-3511-01
GLO PYRIDOSTIGMINE BROMIDE
R-X
227876 5738
PYRIDOXINE 100MG/ML 1ML/25
63323-0180-01
APP PYRIDOXINE HCL
R-X
709030 4752
QUALAQUIN CAP 324 MG 30
13310-0153-07
ARS QUININE SULFATE
R-X
126615 12621
QUELICIN VL 20MG/ML 10ML/25
00409-6629-02
HOS SUCCINYLCHOLINE CHLORIDE
R-X
396119 83391
QUINIDINE GLUC AMP 10ML 530
00002-1407-01
LIL
349316 6490
QUINIDINE SULF ER TB 300MG 100
00093-9175-01
TEV QUINIDINE SULFATE
R-X
428508 3999
QUINIDINE SULF TAB 200 MG 100
00591-5438-01
WAT QUINIDINE SULFATE
R-X
QUINIDINE GLUCONATE
R-X
Page 36 of 46
Attachment n
M&D #
User #
Description
158204 97909
QVAR INHAL AERO 40MCG 100INHAL
442897 97910
843938 97359
NDC #
Mfg
Generic Description
UDF 1
59310-0175-40
WAK BECLOMETHASONE DIPROPIONATE
QVAR INHAL AERO 80MCG 100INHAL
59310-0177-80
WAK BECLOMETHASONE DIPROPIONATE
R-X
R-GENE 10 300ML
00009-0436-24
PFZ ARGININE HCL
R-X
978916 97698
RABAVERT VL 1 ML
63851-0501-01
C-T
R-X
858357 63691
RABIES VACCINE IMOVAX 1 DOSE
49281-0250-51
AVE RABIES VACC, HUMAN DIPLOID/PF
R-X
619510 97293
RAZADYNE ER CAPSULE 8 MG 30
50458-0387-30
JOM GALANTAMINE HYDROBROMIDE
R-X
619528 97294
50458-0388-30
R-X
619536 97295
50458-0389-30
R-X
642496 97455
RAZADYNE ORAL SOL 4MG/ML 100ML
50458-0490-10
R-X
620922 97228
RAZADYNE TAB 4 MG 60
50458-0396-60
R-X
621219 97229
50458-0397-60
R-X
615567 97230
50458-0398-60
R-X
964692 97871
RCF SOY FORM CONC 12X13 OZ 108
70074-0001-08
ROS
R-X
749143 98214
RECLAST INJ 5 MG 100 ML
00078-0435-61
NVT ZOLEDRONIC ACID/MANNITOL/WATER
R-X
315705 98134
RECOMBIVAX-HB 40 MCG/ML
00006-4992-00
MSD HEPATITIS B VIRUS VACCINE-PF
R-X
441071 95545
RECOMBIVAX-HB VL 1ML/10 ADULT
00006-4995-41
MSD HEPATITIS B VIRUS VACCINE-PF
R-X
439075 96942
REFLUDAN VL 50 MG CT/10
50419-0150-57
B/L
518399 95206
REGLAN VL 10ML/25
60977-0451-02
BAX METOCLOPRAMIDE HCL
619668 97664
REGONOL AMP 5MG/ML 2ML/10
00781-3040-95
SNZ PYRIDOSTIGMINE BROMIDE
R-X
224543 96934
REGRANEX GEL .01% 15 GM
00045-0810-15
JOM BECAPLERMIN
R-X
319699 97054
RELENZA DISKHALER INH 5 MG 5X4
00173-0681-01
SKB ZANAMIVIR
R-X
168427 97095
REMICADE VL 100 MG
57894-0030-01
JOM INFLIXIMAB
R-X
371021 97186
RENAGEL TAB 400 MG 360
58468-0020-01
G/C
R-X
790691 98149
REPLETE VAN 8.45OZ/24
00065-9022-70
R-X
993980 96884
RESCRIPTOR TAB 100 MG 360
63010-0020-36
SKB DELAVIRDINE MESYLATE
R-X
435677 97090
RESCRIPTOR TAB 200 MG 180
63010-0021-18
SKB DELAVIRDINE MESYLATE
R-X
508960 98151
RESOURCE BENECALORIE 1.5OZ/24
00212-2825-80
NES CALORIC SUPPLEMENT
R-X
374108 97870
RESOURCE BENEPROTEIN POW 8 OZ
00212-2841-07
NES PROTEIN SUPPLEMENT
R-X
859322 97962
RESTASIS .05% .4ML/30
00023-9163-30
ALL
CYCLOSPORINE
R-X
24364 96576
RETAVASE VL 10 ML FULL-KIT
24477-0041-02
E/T
RETEPLASE
R-X
693671 95579
RETIN A CREAM .025% 20 GM
00062-0165-01
JOM TRETINOIN
R-X
693697 95509
RETIN A CREAM 0.05% 20 GM
00062-0175-12
JOM TRETINOIN
R-X
693705 95510
00062-0175-13
JOM TRETINOIN
R-X
693713 19209
00062-0275-23
JOM TRETINOIN
R-X
693739 95507
RETIN A GEL 0.01% 15 GM
00062-0575-44
JOM TRETINOIN
R-X
693747 95508
00062-0575-46
JOM TRETINOIN
R-X
693770 21105
00062-0475-42
JOM TRETINOIN
R-X
246538 95981
RETROVIR I.V. VL 20ML/10 107
00173-0107-93
SKB ZIDOVUDINE
R-X
246496 95980
RETROVIR SYRUP 8 OZ 113
00173-0113-18
SKB ZIDOVUDINE
R-X
508903 97587
REYATAZ CAP 100 MG 60
00003-3623-12
BRI
ATAZANAVIR SULFATE
R-X
497917 97588
00003-3624-12
BRI
ATAZANAVIR SULFATE
R-X
497891 97589
00003-3631-12
BRI
ATAZANAVIR SULFATE
R-X
706994 98104
00003-3622-12
BRI
ATAZANAVIR SULFATE
976951 97599
RIBAVIRIN CAP 200 MG 56
68382-0260-07
ZYD RIBAVIRIN
R-X
142836 95323
RIDAURA CAP 3 MG 60
65483-0093-06
P/L
R-X
790675 95764
RIFAMATE CAP 60
00068-0509-60
AVE RIFAMPIN/ISONIAZID
528885 95762
RIFAMPIN CAP 150 MG 30
61748-0015-30
421966 95763
RIFAMPIN CAP 300 MG 100
61748-0018-01
RIFAMPIN CAP 300 MG 100UD
51079-0890-20
339176 97304
RIFAMPIN VL 600 MG 30 ML
55390-0123-01
BED RIFAMPIN
R-X
412056 96133
RIFATER TAB 60
00088-0576-41
AVE RIFAMPIN/INH/PYRAZINAMIDE
R-X
611632 97974
RILUTEK TAB 60
00075-7700-60
AVE RILUZOLE
R-X
759795 98135
RIMSO-50 BOT 50ML
67457-0177-50
BIN
R-X
515676 97799
RISPERDAL CONSTA 25 MG VL/KIT
50458-0306-11
JOM RISPERIDONE MICROSPHERES
R-X
515684 97800
RISPERDAL CONSTA 37.5MG VL/KIT
50458-0307-11
R-X
515692 97801
RISPERDAL CONSTA 50 MG VL/KIT
50458-0308-11
R-X
70755 97205
R-X
RABIES VACCINE (PCEC)/PF
LEPIRUDIN,RECOMBINANT
SEVELAMER HCL
AURANOFIN
R-X
R-X
R-X
R-X
V-I
RIFAMPIN
R-X
V-I
RIFAMPIN
R-X
UDL RIFAMPIN
R-X
DIMETHYL SULFOXIDE
Page 37 of 46
Attachment n
M&D #
User #
Description
NDC #
Mfg
Generic Description
UDF 1
476598 97608
RISPERDAL M-TAB 0.5 MG 28
50458-0395-28
JOM RISPERIDONE
R-X
479725 98315
RISPERDAL M-TAB 0.5 MG 30UD
50458-0395-30
JOM RISPERIDONE
R-X
476606 97609
RISPERDAL M-TAB 1.0 MG 28UD
50458-0315-28
JOM RISPERIDONE
R-X
476614 97610
RISPERDAL M-TAB 2.0 MG 28
50458-0325-28
JOM RISPERIDONE
R-X
689513 96549
RISPERDAL TAB 1 MG 100UD
50458-0300-01
JOM RISPERIDONE
R-X
689539 96551
50458-0320-01
JOM RISPERIDONE
R-X
689554 96553
50458-0330-01
JOM RISPERIDONE
R-X
689570 96555
50458-0350-01
JOM RISPERIDONE
R-X
917419 96547
RISPERIDONE O/SOL 1MG/ML 30ML
50458-0596-01
PAT RISPERIDONE
R-X
875914 98316
RISPERIDONE O/SOL 1MG/ML 30ML
00093-6169-31
TEV RISPERIDONE
R-X
917427 97035
RISPERIDONE TAB .25MG 60
50458-0590-60
PAT RISPERIDONE
R-X
RISPERIDONE TAB .25MG 100UD
00904-5973-61
MAJ RISPERIDONE
R-X
26138 98317
917450 97036
26146 98318
917484 96548
26153 98319
917518 96550
26161 98320
RISPERIDONE TAB .5MG 60
50458-0591-60
PAT RISPERIDONE
R-X
RISPERIDONE TAB .5MG 100UD
00904-5974-61
MAJ RISPERIDONE
R-X
R-X
RISPERIDONE TAB 1MG 60
50458-0592-60
PAT RISPERIDONE
RISPERIDONE TAB 1MG 100UD
00904-5975-61
MAJ RISPERIDONE
R-X
50458-0593-60
PAT RISPERIDONE
R-X
00904-5976-61
MAJ RISPERIDONE
R-X
917542 96552
50458-0594-60
PAT RISPERIDONE
R-X
988410 98321
68084-0274-01
RPK RISPERIDONE
R-X
917575 96554
50458-0595-60
PAT RISPERIDONE
R-X
00904-5978-61
MAJ RISPERIDONE
R-X
585158 97379
26187 98322
RITUXAN VL 100 MG 10 ML SNGL
50242-0051-21
GNT RITUXIMAB
R-X
585182 97380
RITUXAN VL 500 MG 50 ML SNGL
50242-0053-06
GNT RITUXIMAB
R-X
977058 96298
ROCURONIUM BRO 10MG/ML 10M/10
00781-3220-92
SNZ ROCURONIUM BROMIDE
R-X
977041 95966
ROCURONIUM BRO 10MG/ML 5ML/10
00781-3220-95
SNZ ROCURONIUM BROMIDE
R-X
929380 96728
ROPINIROLE HCL TAB 0.25MG 100
00378-5525-01
MYL ROPINIROLE HCL
R-X
929398 96730
ROPINIROLE HCL TAB 0.5MG 100
00378-5550-01
MYL ROPINIROLE HCL
R-X
929406 96731
ROPINIROLE HCL TAB 1MG 100
00378-5501-01
MYL ROPINIROLE HCL
R-X
927533 98279
ROPINIROLE HCL TAB 1MG 100UD
68084-0307-01
RPK ROPINIROLE HCL
R-X
929414 96733
00378-5502-01
MYL ROPINIROLE HCL
R-X
929422 97456
00378-5503-01
MYL ROPINIROLE HCL
R-X
929430 97457
00378-5504-01
MYL ROPINIROLE HCL
R-X
929448 96735
00378-5505-01
MYL ROPINIROLE HCL
R-X
660050 97991
ROTATEQ TUBE 2 ML CT/10
00006-4047-41
MSD ROTAVIRUS VAC,LIVE PENTAV
R-X
721407 96980
ROXICODONE TAB 5 MG 100
66479-0580-10
XAN OXYCODONE HCL
CII
721613 96981
ROXICODONE TAB 5 MG 4X25UD
66479-0580-25
XAN OXYCODONE HCL
CII
794040 97009
RX AMBER DRP BOT 1 OZ CT12 738
00000-0234-01
KER
R-X
794057 97010
RX AMBER DRP BOT 2 OZ CT24 739
00000-0234-02
KER
R-X
794065 97008
RX AMBER DRP BOT.5 OZ CT12 737
00000-0234-00
KER
R-X
794099 97011
RX OIN JAR 1 OZ CT/12 #901
00000-0209-01
KER
R-X
794107 97012
00000-0209-02
KER
R-X
794115 97013
00000-0209-04
KER
R-X
794958 97014
00000-0209-08
KER
R-X
794966 97015
00000-0209-16
KER
R-X
728741 97028
RX PRO PLUS VL- 75DR W/CAP 60
64015-4101-15
T-S
R-X
728774 97029
RX PRO PLUS VL-150DR W/CAP 35
64015-4173-70
T-S
R-X
728873 97002
RX PRO RND PLAS LIQ 4OZ CS96
64015-4197-60
T-S
R-X
728899 97004
64015-4197-70
T-S
R-X
728840 97005
64015-4197-80
T-S
R-X
728394 97023
RX PRO-1 VL-16 DR W/CAP CS/250
64015-4108-85
T-S
R-X
728485 97025
64015-4206-44
T-S
R-X
728501 97026
64015-4206-48
T-S
395269 97539
S2 RACEMIC INHL SOL .5ML/30
00487-5901-99
NPI
813881 99165
SALSALATE TAB 500 MG 100UD
00904-5628-61
MAJ SALSALATE
R-X
SALSALATE TAB 750 MG 100
65162-0513-10
AKY SALSALATE
R-X
29389 95307
R-X
RACEPINEPHRINE HCL
R-X
Page 38 of 46
Attachment n
M&D #
User #
Description
873091 99166
SALSALATE TAB 750 MG 100UD
813030 98113
785543 95089
NDC #
Mfg
Generic Description
UDF 1
00904-1251-61
MAJ SALSALATE
R-X
SANTYL OINTMENT 15 GM
00064-5010-15
HEA COLLAGENASE CLOSTRIDIUM HIST.
R-X
SCHIRMER TEAR TEST STRIPS 250
00065-0898-04
ALC TEAR TEST
R-X
R-X
335091 4237
SCOPOLAMINE VL .4 MG 1ML/25
63323-0268-01
APP SCOPOLAMINE HYDROBROMIDE
947853 30930
SECONAL SOD 100MG 100
42998-0679-01
MTH SECOBARBITAL SODIUM
CII
670091 95721
SELEGILINE HCL TAB 5 MG 60
60505-3438-03
A-C
R-X
184671 31940
SELENIUM SULF LOT 2.5% 4 OZ
45802-0040-64
CPL SELENIUM SULFIDE
R-X
79855 95237
SELENIUM VL 40 MCG 10ML/25
00517-6510-25
A-R
R-X
757450 98119
SELZENTRY TAB 150 MG 60
00069-0807-60
SKB MARAVIROC
757468 98120
SELZENTRY TAB 300 MG 60
00069-0808-60
SKB MARAVIROC
R-X
524637 97717
SENSIPAR TAB 30 MG 30
55513-0073-30
AMG CINACALCET HCL
R-X
524645 97718
55513-0074-30
AMG CINACALCET HCL
R-X
635508 97719
55513-0075-30
AMG CINACALCET HCL
R-X
992602 95515
SENSOR MPF SPNAL AMP .75%2M/10
63323-0473-02
APP BUPIVACAINE HCL/DEX-WATER/PF
R-X
122739 95319
SENSORCAINE AMP .75% 30ML/5
00186-1037-02
APP BUPIVACAINE HCL/PF
R-X
992545 95095
SENSORCAINE MPF SDV .25% 10M/5
63323-0464-10
R-X
998385 95320
SENSORCAINE SDV .25% 30ML/5
63323-0464-31
R-X
29132 95321
SENSORCAINE SDV .5% 30ML/5
63323-0466-31
R-X
183996 96892
SEREVENT DISKUS 28 HSP
00173-0520-00
SKB SALMETEROL XINAFOATE
R-X
184317 96893
SEREVENT DISKUS 60
00173-0521-00
SKB SALMETEROL XINAFOATE
R-X
989343 8630
SEROMYCIN PUL 250 MG 40
13845-1200-03
CHO CYCLOSERINE
R-X
233403 97096
SEROQUEL TAB 25 MG 100
00310-0275-10
A/Z
233411 97097
SEROQUEL TAB 25 MG 100UD
00310-0275-39
ZNC QUETIAPINE FUMARATE
R-X
647438 97979
00310-0278-10
A/Z
R-X
647446 97980
00310-0278-39
A/Z
QUETIAPINE FUMARATE
R-X
233429 97098
00310-0271-10
A/Z
QUETIAPINE FUMARATE
R-X
233437 97099
00310-0271-39
R-X
233445 97100
00310-0272-10
A/Z
R-X
233049 97101
00310-0272-39
A/Z
QUETIAPINE FUMARATE
R-X
374454 97451
00310-0274-60
A/Z
QUETIAPINE FUMARATE
R-X
374462 97452
00310-0274-39
R-X
647461 97981
00310-0279-10
A/Z
R-X
647479 97982
00310-0279-39
A/Z
QUETIAPINE FUMARATE
R-X
951053 98195
SEROQUEL XR TAB 50 MG 60
00310-0280-60
A/Z
QUETIAPINE FUMARATE
R-X
951079 98196
SEROQUEL XR TAB 50 MG 100UD
00310-0280-39
A/Z
QUETIAPINE FUMARATE
R-X
951061 98197
00310-0281-60
A/Z
QUETIAPINE FUMARATE
R-X
951087 98198
00310-0281-39
A/Z
QUETIAPINE FUMARATE
R-X
753723 98061
00310-0282-60
A/Z
QUETIAPINE FUMARATE
R-X
753731 98064
00310-0282-39
A/Z
QUETIAPINE FUMARATE
R-X
753756 98062
00310-0283-60
A/Z
QUETIAPINE FUMARATE
R-X
753764 98065
00310-0283-39
A/Z
QUETIAPINE FUMARATE
R-X
753780 98063
00310-0284-60
A/Z
QUETIAPINE FUMARATE
R-X
753798 98066
00310-0284-39
A/Z
QUETIAPINE FUMARATE
R-X
675025 97422
SERTRALINE O/CONC 60ML
59762-4940-01
GRN SERTRALINE HCL
R-X
675041 95797
SERTRALINE TAB 50 MG 30
59762-4900-01
GRN SERTRALINE HCL
R-X
799338 96158
SERTRALINE TAB 50 MG 100UD
68084-0181-01
RPK SERTRALINE HCL
R-X
675058 95798
SERTRALINE TAB 100 MG 30
59762-4910-01
GRN SERTRALINE HCL
R-X
674986 96159
SERTRALINE TAB 100 MG 100UD
59762-4910-03
GRN SERTRALINE HCL
R-X
SILVER NITRATE APP 100
12870-0001-01
ARZ SILVER NITRATE APPLICATOR
R-X
969915 20667
SILVERSULFADIAZINE 50 GM JAR
49884-0600-36
PAR SILVER SULFADIAZINE
R-X
967828 17608
SILVERSULFADIAZINE 400 GM JAR
49884-0600-40
PAR SILVER SULFADIAZINE
R-X
336610 97152
SIMILAC HUMAN MILK 50PK CS/3
70074-0545-98
ROS
R-X
964940 1126
SIMILAC POW PM 60/40 LB 850
70074-0608-50
ROS INFANT FORMULA,REGULAR
R-X
845388 97416
SIMVASTATIN TAB 5 MG 90
55111-0197-90
RED SIMVASTATIN
R-X
998815 97417
68180-0478-02
LUP SIMVASTATIN
R-X
675645 98258
SIMVASTATIN TAB 10 MG 100UD
51079-0454-20
UDL SIMVASTATIN
R-X
86207 95008
SELEGILINE HCL
SELENIUM
QUETIAPINE FUMARATE
QUETIAPINE FUMARATE
QUETIAPINE FUMARATE
QUETIAPINE FUMARATE
R-X
R-X
Page 39 of 46
Attachment n
M&D #
User #
Description
NDC #
68180-0479-01
Mfg
Generic Description
UDF 1
998831 97954
LUP SIMVASTATIN
R-X
998823 96259
68180-0479-02
LUP SIMVASTATIN
R-X
675652 98259
51079-0455-20
UDL SIMVASTATIN
R-X
999243 96260
00093-7155-98
TEV SIMVASTATIN
R-X
675660 98260
51079-0456-20
UDL SIMVASTATIN
R-X
999250 97044
00093-7156-98
TEV SIMVASTATIN
R-X
746057 98263
68084-0165-01
RPK SIMVASTATIN
R-X
342642 97067
SINGULAIR CHEW TAB 4 MG 90
00006-0711-54
MSD MONTELUKAST SODIUM
R-X
342659 97068
SINGULAIR CHEW TAB 4 MG 100UD
00006-0711-28
R-X
906347 96719
SINGULAIR CHEW TAB 5 MG 90
00006-0275-54
R-X
195883 96720
SINGULAIR CHEW TAB 5 MG 100UD
00006-0275-28
R-X
906313 96726
SINGULAIR TAB 10 MG 90
00006-0117-54
R-X
195891 96727
SINGULAIR TAB 10 MG 100UD
00006-0117-28
R-X
659243 96131
SITZMARKS CAP 10 8100
00000-0000-00
KON
R-X
76737 96418
SOD ACET VL 2MEQ 100ML/25
00517-2500-25
A-R
SODIUM ACETATE
76125 24255
SOD ACET VL 40MEQ 20ML/25
00517-2096-25
A-R
SODIUM ACETATE
R-X
144733 16036
SOD BICARB SRN 8.4% 50ML/10LS
00409-6637-34
HOS SODIUM BICARBONATE
R-X
137596 95535
00409-5534-34
R-X
573758 17855
00409-4900-34
R-X
919464 98039
SOD BICARB TAB 5 GR 1000
00536-4540-10
RUG SODIUM BICARBONATE
R-X
516757 98261
SOD BICARB TAB 10 GR 500UD
66553-0008-01
HSP SODIUM BICARBONATE
R-X
918813 98040
SOD BICARB TAB 10 GR 1000
00536-4544-10
RUG SODIUM BICARBONATE
R-X
125799 19434
SOD BICARB VL 4% 5ML/25
00409-6609-02
R-X
505321 97541
SOD BICARB VL 8.4% 50ML 2X25
00409-6625-02
R-X
173906 20283
SOD CHL .9% VL 10ML/25 PF
63323-0186-10
APP NORMAL SALINE
R-X
990770 120023
SOD CHL 3% 500ML/24 2B1353Q
00338-0054-03
BXT SODIUM CHLORIDE 3%
R-X
990424 120063
SOD CHL .9%BG 100ML/96 2B1302
00338-0049-18
BXT NORMAL SALINE
R-X
129403 96416
SOD CHL 250ML INJ BULK CS12
00409-4219-02
HOS SODIUM CHLORIDE
R-X
505503 2061
SOD CHL BACT.9% 30ML/100(4X25)
00409-1966-14
HOS BACTERIOSTATIC SODIUM CHLORIDE
R-X
24869 98273
SOD CHL INH SOL 3% 15ML CT/50
00378-6997-89
MYL SODIUM CL FOR INHALATION
R-X
18267 23005
SOD CHL INH SOL .9% VL 5ML/100
00378-6986-01
MYL SODIUM CL FOR INHALATION
R-X
R-X
132399 16037
SOD CHL VL--50 MEQ 20ML/25
00409-6657-73
HOS SODIUM CHLORIDE
R-X
990267 120062
SOD CHL.9% BG 50ML/96 2B1301
00338-0049-11
BXT NORMAL SALINE
R-X
565200 120144
SOD CHL.9/KCL1000ML/14 2B1764X
00338-0691-04
BXT POTASSIUM CHLORIDE/NS
R-X
370213 41411
SOD CIT W/CIT ACID 16 OZ
00121-0595-16
PMA CITRIC ACID/SODIUM CITRATE
R-X
14712 88200
SOD FLUORIDE DROP 50ML
50383-0656-50
HTP SODIUM FLUORIDE
R-X
122697 95147
SOD LACTATE VL 50 MEQ 10ML/25
00409-6664-02
HOS SODIUM LACTATE
R-X
516013 97996
SOD NITRITE VL 30MG/ML 10MLX2
60267-0079-02
HOP SODIUM NITRITE
R-X
76158 96050
SOD PHOS VL 45MM 15ML/25
00517-3415-25
A-R
SODIUM PHOS,M-BASIC-D-BASIC
R-X
76604 96422
SOD PHOS VL 150MM 50ML/25
00517-3450-25
A-R
SODIUM PHOS,M-BASIC-D-BASIC
R-X
80010 95528
SOD THIOSULFATE VL 25% 50ML
00517-5019-01
A-R
SODIUM THIOSULFATE
846865 97688
SODIUM EDECRIN VL 50CC
25010-0210-27
ATO ETHACRYNATE SODIUM
R-X
475210 30511
SOLU-CORTEF ACT-O-VL 100 MG/25
00009-0900-20
PFZ HYDROCORTISONE SOD SUCCINATE
R-X
474957 8898
SOLU-CORTEF ACT-O-VL 1000 MG
00009-0920-03
R-X
472969 90140
00009-0909-08
R-X
474759 2483
00009-0912-05
R-X
477364 12562
R-X
SOLU-MEDROL ACT-O-VL 1 GM 8ML
00009-3389-01
PFZ METHYLPREDNISOLONE SOD SUCC
R-X
37523 63141
SOLU-MEDROL VL 40 MG 1ML/25
00009-0039-28
PFZ METHYLPREDNISOLONE SOD SUCC/PF
R-X
37515 90138
SOLU-MEDROL VL 125 MG 2ML/25
00009-0047-22
PFZ METHYLPREDNISOLONE SOD SUCC/PF
R-X
475111 12559
SOLU-MEDROL VL 500 MG
00009-0758-01
PFZ METHYLPREDNISOLONE SOD SUCC
R-X
755496 96879
SORIATANE CK CONV KIT 10 MG
00145-3800-01
SKB ACITRETIN/EMOLLIENT COMB NO.26
R-X
755603 96880
SORIATANE CK CONV KIT 25 MG
00145-4300-01
SKB ACITRETIN/EMOLLIENT COMB NO.26
R-X
408468 97522
SORINE TAB 80 MG 100UD
00245-0012-01
UPS SOTALOL HCL
R-X
408542 97540
00245-0014-01
UPS SOTALOL HCL
R-X
408559 97521
00245-0015-01
UPS SOTALOL HCL
R-X
361113 95976
SOTALOL HCL TAB 80 MG 100
00185-0171-01
EON SOTALOL HCL
R-X
Page 40 of 46
Attachment n
M&D #
User #
Description
416933 95977
361147 95978
747253 97848
747261 97706
NDC #
Mfg
Generic Description
UDF 1
00093-1062-01
TEV SOTALOL HCL
R-X
00185-0174-01
EON SOTALOL HCL
R-X
SPIRIVA HANDIHALER 5 CAP INST
00597-0075-75
BOE TIOTROPIUM BROMIDE
R-X
SPIRIVA HANDIHALER 30
00597-0075-41
BOE TIOTROPIUM BROMIDE
R-X
889428 8173
SPIRONOLACTONE TAB 25 MG 1000
00781-1599-10
SNZ SPIRONOLACTONE
R-X
501668 11655
SPIRONOLACTONE TAB 25 MG 100U
51079-0103-20
UDL SPIRONOLACTONE
R-X
527499 97346
00228-2672-11
APH SPIRONOLACTONE
R-X
438663 97347
51079-0979-20
UDL SPIRONOLACTONE
R-X
108563 97348
59762-5013-01
GRN SPIRONOLACTONE
R-X
438671 97349
51079-0980-20
UDL SPIRONOLACTONE
R-X
432963 95886
SPORANOX CAP 100 MG 30
50458-0290-04
JOM ITRACONAZOLE
R-X
432955 99283
SPORANOX CAP 100 MG 30B/P
50458-0290-01
JOM ITRACONAZOLE
R-X
964023 97253
SPORANOX CAP 100 MG PULSEPAK28
50458-0290-28
JOM ITRACONAZOLE
R-X
416222 96559
SPORANOX O/SOL100MG/10ML 150ML
50458-0295-15
JOM ITRACONAZOLE
R-X
702480 95231
SPS SUS 16 OZ
46287-0006-01
CMP SODIUM POLYSTYRENE SULFONATE
R-X
702464 99298
SPS SUS 60ML/10
46287-0006-60
CMP SODIUM POLYSTYRENE SULFONATE
R-X
211391 99098
SSKI SOL 30ML
00245-0003-31
UPS POTASSIUM IODIDE
R-X
378950 97463
STARLIX TAB 60 MG 100
00078-0351-05
NVT NATEGLINIDE
R-X
378968 97215
STARLIX TAB 120 MG 100
00078-0352-05
NVT NATEGLINIDE
R-X
STERI-STRIP COMP BENZN TINC 40
70738-7022-83
3/M
R-X
257402 93610
STREPTOMYCIN SULF VL 1GM/10
39822-0706-02
PHT STREPTOMYCIN SULFATE
R-X
326199 97177
STROMECTOL TAB 3 MG 20
00006-0032-20
MSD IVERMECTIN
R-X
556092 97390
SUCRALFATE SUS 1G/10ML 50UD
66689-0790-50
KCC SUCRALFATE
R-X
105965 95151
SUCRALFATE TAB 1 GM 100
00591-0780-01
WAT SUCRALFATE
R-X
702100 99241
SUCRALFATE TAB 1 GM 100UD
51079-0871-20
UDL SUCRALFATE
R-X
431817 95184
SUFENTA AMP 2ML/10
11098-0050-02
AKR SUFENTANIL CITRATE
CII
431825 95185
SUFENTA AMP 5ML/10
11098-0050-05
AKR SUFENTANIL CITRATE
CII
819805 90580
SULFADIAZINE TAB 500 MG 100
00185-0757-01
EON SULFADIAZINE
R-X
813931 16777
SULFAMETHOXAZOLE/TR 400 100
53489-0145-01
MUT SULFAMETHOXAZOLE/TRIMETHOPRIM
R-X
14639 23916
00603-5781-21
QLT SULFAMETHOXAZOLE/TRIMETHOPRIM
R-X
491977 98022
SULFAMETHOXAZOLE/TR 800 100U
00904-2725-61
MAJ SULFAMETHOXAZOLE/TRIMETHOPRIM
R-X
998930 95901
53489-0146-05
MUT SULFAMETHOXAZOLE/TRIMETHOPRIM
R-X
999219 23623
SULFAMETHOXAZOLE/TR SUS 16 OZ
00093-5476-16
TEV SULFAMETHOXAZOLE/TRIMETHOPRIM
R-X
876383 96092
SULFAMETHOXAZOLE/TR VL 5ML/10
00703-9503-03
GES SULFAMETHOXAZOLE/TRIMETHOPRIM
R-X
256024 26280
SULFASALAZINE TAB 500 MG 100
00591-0796-01
WAT SULFASALAZINE
R-X
797845 38216
SULINDAC TAB 200 MG 100
00378-0531-01
MYL SULINDAC
R-X
702001 97523
SULINDAC TAB 200 MG 100UD
51079-0667-20
UDL SULINDAC
R-X
947168 97942
SUMATRIPTAN TAB 25MG 9
55111-0738-09
RED SUMATRIPTAN SUCCINATE
R-X
988584 95714
SUPLENA W/CARB VAN BTL 24X8OZ
70074-0536-36
ROS
R-X
311530 95813
SUPRANE 240 ML CT/6
10019-0641-24
BAX DESFLURANE
R-X
326975 98145
SURVANTA INTRATRACHEL SUS 4ML
00074-1040-04
ABB BERACTANT
R-X
124883 95902
SURVANTA INTRATRACHEL SUS 8ML
00074-1040-08
ABB BERACTANT
R-X
166280 96904
SUSTIVA CAP 50 MG 30
00056-0470-30
BRI
EFAVIRENZ
R-X
166272 96906
SUSTIVA CAP 200 MG 90
00056-0474-92
BRI
EFAVIRENZ
R-X
438259 97314
SUSTIVA TAB 600 MG 30
00056-0510-30
BRI
EFAVIRENZ
R-X
427716 97407
SWEET EASE CS/200 99044
00906-9904-41
CMV
757427 98107
SYMBICORT 80/4.5MCG INH 60DS
00186-0372-28
A/Z
BUDESONIDE/FORMOTEROL FUMARATE
R-X
748657 98108
00186-0372-20
A/Z
R-X
757435 98109
00186-0370-28
A/Z
R-X
748640 98110
00186-0370-20
A/Z
R-X
642777 97105
SYNAGIS LIQ SOL 50 MG
60574-4114-01
M-I
PALIVIZUMAB
R-X
642504 96886
SYNAGIS LIQ SOL 100 MG
60574-4113-01
M-I
PALIVIZUMAB
R-X
445924 98246
SYNTHROID 75MCG 100UD
00074-5182-11
ABB LEVOTHYROXINE SODIUM
446328 98245
SYNTHROID 125MCG 100UD
00074-7068-11
ABB LEVOTHYROXINE SODIUM
R-X
617902 98171
SYNVISC HYLAN G-F 20 KIT
58468-0090-01
G/B
R-X
946558 95829
TAMBOCOR TAB 50 MG 100
29336-0305-10
8573 97585
R-X
HYLAN G-F 20
GWY FLECAINIDE ACETATE
R-X
R-X
Page 41 of 46
Attachment n
M&D #
User #
Description
NDC #
Mfg
Generic Description
UDF 1
848184 95830
29336-0307-10
R-X
977967 95831
29336-0314-10
R-X
822437 98209
TAMIFLU CAP 30 MG 10 BLISTER
00004-0802-85
ROC OSELTAMIVIR PHOSPHATE
R-X
822445 98210
00004-0801-85
R-X
329540 97051
00004-0800-85
R-X
426775 97130
TAMIFLU O/PDR 12MG/ML 25ML
00004-0810-95
R-X
614370 33053
TAMOXIFEN CITR TAB 10 MG 60
00378-0144-91
MYL TAMOXIFEN CITRATE
R-X
565259 97987
TARCEVA TAB 25 MG 30
50242-0062-01
GNT ERLOTINIB HCL
R-X
565267 97988
50242-0063-01
GNT ERLOTINIB HCL
R-X
565275 97989
50242-0064-01
GNT ERLOTINIB HCL
R-X
TAXOTERE SDV W/DIL 20 MG VIAL
00075-8001-20
AVE DOCETAXEL
R-X
11197 96493
TAXOTERE SDV W/DIL 80 MG VIAL
00075-8001-80
AVE DOCETAXEL
R-X
875104 96622
11205 96494
TEGRETOL-XR TAB 100 MG 100
00078-0510-05
NVT CARBAMAZEPINE
R-X
875112 96624
00078-0511-05
NVT CARBAMAZEPINE
R-X
875120 96626
00078-0512-05
NVT CARBAMAZEPINE
R-X
727644 98099
TEKTURNA TAB 150 MG 30
00078-0485-15
NVT ALISKIREN HEMIFUMARATE
R-X
992891 98100
TEKTURNA TAB 150 MG 100UD
00078-0485-35
R-X
727651 98101
TEKTURNA TAB 300 MG 30
00078-0486-15
R-X
992909 98102
TEKTURNA TAB 300 MG 100UD
00078-0486-35
R-X
886655 95934
TEMAZEPAM CAP 15 MG 100
00781-2201-01
SNZ TEMAZEPAM
R-X
701953 99304
TEMAZEPAM CAP 15 MG 100UD
51079-0418-20
UDL TEMAZEPAM
R-X
886671 95935
TEMAZEPAM CAP 30 MG 100
00781-2202-01
SNZ TEMAZEPAM
R-X
159095 99305
TEMAZEPAM CAP 30 MG 100UD
51079-0419-20
UDL TEMAZEPAM
R-X
844977 97339
TEMODAR CAP 5 MG 5
00085-3004-02
SCH TEMOZOLOMIDE
R-X
732701 97340
TEMODAR CAP 20 MG 5
00085-1519-02
SCH TEMOZOLOMIDE
R-X
732735 97341
TEMODAR CAP 100 MG 14
00085-1366-01
SCH TEMOZOLOMIDE
R-X
732743 97342
TEMODAR CAP 250 MG 5
00085-1417-01
SCH TEMOZOLOMIDE
R-X
690198 98035
TERAZOL 3 VAGINAL SUP 3
00062-5351-01
JOM TERCONAZOLE
R-X
752618 96428
TERBINAFINE HCL TAB 250MG 30
67405-0543-03
HAR TERBINAFINE HCL
R-X
411629 23632
TERBUTALINE SULF TAB 5MG 100
00115-2622-01
GLO TERBUTALINE SULFATE
R-X
411595 23634
TERBUTALINE SULF TAB 2.5MG 100
00115-2611-01
GLO TERBUTALINE SULFATE
R-X
534370 18285
TERBUTALINE SULF VL 1MG 1ML/25
63323-0665-01
APP TERBUTALINE SULFATE
R-X
525790 97957
TERCONAZOLE 3 VAGINAL CR 20 GM
00591-3197-52
WAT TERCONAZOLE
R-X
525808 95680
TERCONAZOLE 7 VAGINAL CR 45 GM
00591-3196-89
WAT TERCONAZOLE
R-X
746651 77740
TETANUS TOX A SDV 0.5ML/10 VL
49281-0820-10
AVE TETANUS TOXOID,ADSORBED/PF
R-X
132753 19781
TETRACAINE HCL 0.5% 2ML/12
00065-0741-12
ALC TETRACAINE HCL
R-X
837302 13718
TETRACYCLINE CAP 250 MG 100
00172-2416-60
TEV TETRACYCLINE HCL
R-X
998328 13722
TETRACYCLINE CAP 250 MG 100UD
00172-2416-10
R-X
TETRACYCLINE CAP 500 MG 100UD
00172-2407-10
R-X
837336 95806
27896 97524
TETRACYCLINE CAP 500 MG 1000
00172-2407-80
R-X
479386 97448
THALOMID CAP 50 MG 10X28
59572-0205-94
C-C
R-X
129825 14037
THAM SOL 500ML/6
00409-1593-04
HOS TROMETHAMINE
R-X
977454 25133
THEOPH ER TAB 100 MG 100
50111-0483-01
TEV THEOPHYLLINE ANHYDROUS
R-X
977462 27143
50111-0482-01
R-X
925347 43594
THEOPH ER TAB 200 MG 100UD
00904-5888-61
MAJ THEOPHYLLINE ANHYDROUS
R-X
977470 95852
50111-0482-02
R-X
532218 25134
50111-0459-01
R-X
925354 43595
THEOPH ER TAB 300 MG 100UD
00904-5889-61
MAJ THEOPHYLLINE ANHYDROUS
R-X
977488 95853
50111-0459-02
R-X
861625 95491
THEOPH SR TAB 400 MG 100
29033-0001-01
NOS THEOPHYLLINE ANHYDROUS
R-X
871772 5932
THERA DERM LOT 240ML
00904-4299-09
MAJ LANOLIN/MINERAL OIL
R-X
315622 21167
THIAMINE VL 100 MG 2ML/25
63323-0013-02
APP THIAMINE HCL
R-X
243733 95291
THIOGUANINE TAB 40 MG 25 880
00173-0880-25
SKB THIOGUANINE
R-X
795658 12350
THIORIDAZINE TAB 25 MG 100
00378-0614-01
MYL THIORIDAZINE HCL
R-X
809749 11917
THIORIDAZINE TAB 25 MG 100UD
51079-0566-20
UDL THIORIDAZINE HCL
R-X
745141 47311
53489-0150-01
MUT THIORIDAZINE HCL
R-X
THALIDOMIDE
Page 42 of 46
Attachment n
M&D #
User #
Description
NDC #
502526 12824
795690 92311
502534 12825
399790 11740
THIOTEPA INJ 15 MG
795963 96533
THIOTHIXENE CAP 1 MG 100
795989 2306
00378-3005-01
504548 38687
THIOTHIXENE CAP 5 MG 100UD
795997 5236
504555 43589
THIOTHIXENE CAP 10 MG 100UD
859454 95663
859439 97586
Mfg
Generic Description
UDF 1
51079-0567-20
00378-0618-01
MYL THIORIDAZINE HCL
R-X
51079-0580-20
R-X
55390-0030-10
BED THIOTEPA
R-X
00378-1001-01
MYL THIOTHIXENE
R-X
MYL THIOTHIXENE
R-X
51079-0588-20
UDL THIOTHIXENE
R-X
00378-5010-01
MYL THIOTHIXENE
R-X
51079-0589-20
UDL THIOTHIXENE
R-X
THROMBIN JMI SPY KIT 20,000 UN
60793-0217-21
MNR THROMBIN (BOVINE)
R-X
THROMBIN JMI VL 5,000UN W/DIL
60793-0215-05
MNR THROMBIN (BOVINE)
R-X
336750 97833
THYROGEN INJECTION KIT 2/VIALS
58468-1849-04
155929 2993
TICE BCG VACCINE KIT 2ML VL
00052-0602-02
SCH BCG LIVE
R-X
199992 96149
TIMOLOL MAL OPT G/SOL .25% 5ML
61314-0224-05
FAL
TIMOLOL MALEATE
R-X
200063 96150
TIMOLOL MAL OPT G/SOL .5% 5ML
61314-0225-05
FAL
TIMOLOL MALEATE
R-X
742445 37147
TIMOLOL MAL OPT SOL .25% 5 ML
61314-0226-05
FAL
TIMOLOL MALEATE
R-X
742478 37146
TIMOLOL MAL OPT SOL .5 % 5 ML
61314-0227-05
FAL
TIMOLOL MALEATE
463687 97319
TIZANIDINE HCL TAB 2 MG 150
00185-0034-51
EON TIZANIDINE HCL
155697 97320
TIZANIDINE HCL TAB 4 MG 150
00185-4400-51
EON TIZANIDINE HCL
R-X
362376 98268
TNKASE KIT
50242-0038-61
GNT TENECTEPLASE
R-X
915140 95208
TOBRAMYCIN OPT SOL 5ML
24208-0290-05
B&L TOBRAMYCIN SULFATE
R-X
528430 23853
TOBRAMYCIN PED VL 20MG/2ML X25
63323-0305-02
APP TOBRAMYCIN SULFATE
R-X
255307 23849
TOBRAMYCIN SUL VL 80MG/2ML X25
00409-3578-01
HOS TOBRAMYCIN SULFATE
R-X
108373 96380
TOBRAMYCIN VL 1.2GM CT6
39822-0412-06
PHT TOBRAMYCIN SULFATE
R-X
406942 45961
TOLMETIN SOD CAP 400 MG 100
00093-8815-01
TEV TOLMETIN SODIUM
R-X
993154 96982
TOPAMAX SPRINKLE CAP 15 MG 60
50458-0647-65
JOM TOPIRAMATE
R-X
971085 96983
TOPAMAX SPRINKLE CAP 25 MG 60
50458-0645-65
JOM TOPIRAMATE
R-X
957043 98189
TOPIRAMATE TAB 25MG 100UD
51079-0726-20
UDL TOPIRAMATE
R-X
TOPIRAMATE TAB 25MG 60
00378-6101-91
MYL TOPIRAMATE
R-X
957050 98190
51079-0727-20
UDL TOPIRAMATE
R-X
955930 98188
13668-0032-60
TOR TOPIRAMATE
R-X
955898 98191
68084-0344-01
RPK TOPIRAMATE
R-X
00378-6103-91
MYL TOPIRAMATE
R-X
955906 98192
68084-0345-21
RPK TOPIRAMATE
R-X
955971 96986
13668-0034-60
TOR TOPIRAMATE
R-X
389700 97219
TOPROL XL TAB 25 MG 100
00186-1088-05
A/Z
METOPROLOL SUCCINATE
R-X
437640 97502
TOPROL XL TAB 25 MG 100UD
00186-1088-39
ZNC METOPROLOL SUCCINATE
R-X
125138 97220
00186-1090-05
A/Z
R-X
437657 97504
00186-1090-39
R-X
125146 97221
00186-1092-05
A/Z
R-X
437665 97503
00186-1092-39
R-X
125153 97222
00186-1094-05
A/Z
999144 96178
TRAMADOL HCL TAB 50 MG 100
00093-0058-01
TEV TRAMADOL HCL
R-X
19158 96984
19166 98985
T/I
THYROTROPIN ALFA
R-X
R-X
R-X
R-X
R-X
419945 96179
TRAMADOL HCL TAB 50 MG 100UD
51079-0991-20
UDL TRAMADOL HCL
R-X
382291 120166
TRAVASOL 10% 500ML/24 1B6623
00338-0644-03
BXT PARENTERAL AMINO ACID 10% NO.6
R-X
697797 97771
TRAVATAN Z OPTH SOL 2.5 ML
00065-0260-25
ALC TRAVOPROST
R-X
279141 95149
TRAZODONE TAB 50 MG 100
50111-0433-01
TEV TRAZODONE HCL
R-X
159111 96156
TRAZODONE TAB 50 MG 100UD
00904-3990-61
MAJ TRAZODONE HCL
R-X
279158 95150
TRAZODONE TAB 100 MG 100
50111-0434-01
TEV TRAZODONE HCL
R-X
159103 96157
TRAZODONE TAB 100 MG 100UD
00904-3991-61
MAJ TRAZODONE HCL
R-X
755611 97950
TRETINOIN CAP 10 MG 100
00555-0808-02
TEV TRETINOIN
R-X
145383 23079
TRIAMCINOLONE CR .025% 15 GM
00168-0003-15
FOU TRIAMCINOLONE ACETONIDE
R-X
145391 23078
00168-0003-80
R-X
703090 23081
00472-0301-15
APH TRIAMCINOLONE ACETONIDE
R-X
145433 23080
00168-0004-80
R-X
145417 19632
TRIAMCINOLONE OIN .025% 80 GM
00168-0005-80
R-X
Page 43 of 46
Attachment n
M&D #
User #
Description
NDC #
Generic Description
UDF 1
145458 11985
00168-0006-80
R-X
813402 97360
TRICHLOROACETIC ACID 15 ML
10481-3008-01
GOR TRICHLOROACETIC ACID
R-X
508838 95043
TRICHOPHYTON VL 1:200 2ML
00268-0432-02
ALK TRICHOPHYTON ALLERGENIC EXT
R-X
868653 98154
TRIESENCE VL 40MG 1ML INJ/SUS
00065-0543-01
ALC TRIAMCINOLONE ACETONIDE/PF
R-X
392910 95819
TRIFLUOPERAZINE TAB 1 MG 100
00378-2401-01
MYL TRIFLUOPERAZINE HCL
R-X
887364 87030
00781-1032-01
SNZ TRIFLUOPERAZINE HCL
R-X
398131 35561
00378-2405-01
MYL TRIFLUOPERAZINE HCL
R-X
887273 35591
00781-1036-01
SNZ TRIFLUOPERAZINE HCL
R-X
426627 91810
TRIHEXYPHENIDYL TAB 2 MG 1000
00591-5335-10
WAT TRIHEXYPHENIDYL HCL
R-X
282871 98118
TRIHIBIT SDV .5ML CT/5
49281-0597-05
AVE DP(A)T PED/HIB CONJ-TET/PF
R-X
405696 97261
TRILEPTAL O/SUS300MG/5ML 250ML
00078-0357-52
NVT OXCARBAZEPINE
R-X
511964 95179
TRIMETHOPRIM TAB 100 MG 100
00093-2158-01
TEV TRIMETHOPRIM
R-X
848325 97232
TRIPLE DYE APP .65ML/500
66689-0710-06
KCC GENT VIOLET/BRLNT GRN/PROFLAV
R-X
361915 97082
TRIZIVIR 300/150/300 60
00173-0691-00
SKB ABACAVIR/LAMIVUDINE/ZIDOVUDINE
R-X
491795 95799
TROPHAMINE BOT 10% 500ML/6
00264-9341-55
BBR AMINO ACIDS 10%
R-X
372987 70181
TROPICAMIDE OPT SOL 1% 15ML
61314-0355-02
FAL
TROPICAMIDE
R-X
372979 21381
TROPICAMIDE OPT SOL .5% 15ML
61314-0354-01
FAL
TROPICAMIDE
R-X
551333 97716
TRUVADA TAB 30
61958-0701-01
NEX EMTRICITABINE/TENOFOVIR
826453 97832
TWINRIX SDV 1 ML CT/10
58160-0815-11
SKB HEPATITIS A & B VACCINE/PF
R-X
753822 97890
TYGACIL VL 50 MG CT/10
00008-4990-02
WYE TIGECYCLINE
R-X
376178 96339
ULTANE 250ML PEN BOT
00074-4456-04
ABB SEVOFLURANE
R-X
986349 96479
ULTIVA INJ 1MG/ 3ML CT/10
67457-0198-03
BIN
REMIFENTANIL HCL
CII
986356 96480
ULTIVA INJ 2MG/ 5ML CT/10
67457-0198-05
BIN
REMIFENTANIL HCL
CII
986364 96481
ULTIVA INJ 5MG/10ML CT/10
67457-0198-10
BIN
REMIFENTANIL HCL
CII
736876 97062
UNISTIK-2 NORMAL 100 AT0702
08470-0702-01
OMI DIABETIC SUPPLIES,MISCELL
R-X
220251 96569
UROCIT-K TAB 5 MEQ 100
00178-0600-01
MIS
POTASSIUM CITRATE
R-X
219691 96570
UROCIT-K TAB 10 MEQ 100
00178-0610-01
MIS
POTASSIUM CITRATE
557967 95693
URSODIOL CAP 300 MG 100
00591-3159-01
WAT URSODIOL
417105 97188
VAGIFEM TAB CARTON OF 18 BLIST
00169-5173-04
NPH ESTRADIOL
R-X
404442 97214
VALCYTE TAB 450 MG 60
00004-0038-22
ROC VALGANCICLOVIR HYDROCHLORIDE
R-X
504795 96621
VALPROATE SOD SDV 500MG 5ML/10
63323-0494-05
APP VALPROATE SODIUM
R-X
647594 96558
VALTREX CPL 1 GM 30
00173-0565-04
SKB VALACYCLOVIR HCL
R-X
474510 96351
VALTREX CPL 500 MG 30
00173-0933-08
R-X
631648 96352
VALTREX CPL 500 MG 100UD
00173-0933-56
R-X
624437 97307
VANCOCIN PULV 125 MG 20ID
66593-3125-02
VPI
VANCOMYCIN HCL
R-X
628933 97308
VANCOCIN PULV 250 MG 20ID
66593-3126-02
VPI
VANCOMYCIN HCL
R-X
263178 95996
VANCOMYCIN VL 1 GM 20ML/10
63323-0284-20
APP VANCOMYCIN HCL
R-X
129718 90930
VANCOMYCIN VL 500MG/10 FLIPTP
00409-4332-01
HOS VANCOMYCIN HCL
R-X
426163 97193
VAQTA SDV 25U/.5ML CT/10
00006-4831-41
MSD HEPATITIS A VIRUS VACCINE/PF
R-X
280420 97194
VAQTA SDV 50U/ 1ML
00006-4841-00
MSD HEPATITIS A VIRUS VACCINE/PF
R-X
277657 96186
VARIVAX .5ML SDV CT/10
00006-4827-00
MSD VARICELLA VACC/PF
R-X
VASOPRESSIN VL 20U 1ML/25
00517-1020-25
A-R
837344 95708
VERAPAMIL ER TAB 180 MG 100
00172-4286-60
TEV VERAPAMIL HCL
R-X
187146 99262
VERAPAMIL ER TAB 180 MG 100UD
51079-0899-20
UDL VERAPAMIL HCL
R-X
837377 95709
00172-4280-60
TEV VERAPAMIL HCL
R-X
503201 99263
VERAPAMIL ER TAB 240 MG 100UD
51079-0869-20
UDL VERAPAMIL HCL
R-X
837369 95840
00172-4280-70
TEV VERAPAMIL HCL
R-X
796623 95170
VERAPAMIL TAB 80 MG 100
00378-0512-01
MYL VERAPAMIL HCL
R-X
873208 96368
VERAPAMIL TAB 80 MG 100UD
00904-2920-61
MAJ VERAPAMIL HCL
R-X
796631 95171
VERAPAMIL TAB 120 MG 100
00378-0772-01
MYL VERAPAMIL HCL
R-X
873190 96369
VERAPAMIL TAB 120 MG 100UD
00904-2924-61
MAJ VERAPAMIL HCL
R-X
254953 95118
VERAPAMIL VL 2.5 MG 2ML/5
00409-1144-01
HOS VERAPAMIL HCL
R-X
149351 97386
VFEND IV VL 200MG/20ML 1402
00049-3190-28
PFZ VORICONAZOLE
R-X
149369 97384
VFEND TAB 50 MG 30 1401
00049-3170-30
PFZ VORICONAZOLE
R-X
149377 97385
VFEND TAB 200 MG 30 1400
00049-3180-30
PFZ VORICONAZOLE
R-X
80036 54920
00168-0006-15
Mfg
145441 12158
VASOPRESSIN
R-X
R-X
R-X
R-X
R-X
Page 44 of 46
Attachment n
M&D #
User #
Description
NDC #
00069-4200-30
Mfg
Generic Description
UDF 1
205278 97958
VIAGRA TAB 25 MG 30 4000
PFZ SILDENAFIL CITRATE
R-X
205286 97959
205294 97960
00069-4210-30
R-X
00069-4220-30
375246 97137
VIDEX EC CAP 125 MG 30
00087-6671-17
R-X
BRI
R-X
476465 97670
VIGAMOX OPT SOL .5% 3 ML
00065-4013-03
ALC MOXIFLOXACIN HCL
R-X
146159 14330
VINBLASTINE SULF VL 10 MG/10
55390-0091-10
BED VINBLASTINE SULFATE
R-X
952143 13330
VINCRISTINE SULF SDV 1 ML
61703-0309-06
HOS VINCRISTINE SULFATE
R-X
952150 97798
VINCRISTINE SULF SDV 2 ML
61703-0309-16
HOS VINCRISTINE SULFATE
R-X
459487 96340
VINORELBINE VL 10MG/ML 1ML
00703-4182-01
GES VINORELBINE TARTRATE
R-X
848028 96341
VINORELBINE VL 10MG/ML 5ML
66758-0045-02
SNZ VINORELBINE TARTRATE
R-X
211334 96883
VIRACEPT PED ORAL POWDER 144G
63010-0011-90
SKB NELFINAVIR MESYLATE
R-X
332908 96882
VIRACEPT TAB 250 MG 300
63010-0010-30
R-X
527382 97665
VIRACEPT TAB 625 MG 120
63010-0027-70
R-X
418707 96869
VIRAMUNE TAB 200 MG 60
00597-0046-60
BOE NEVIRAPINE
R-X
427609 97310
VIREAD TAB 300 MG 30
61958-0401-01
NEX TENOFOVIR DISOPROXIL FUMARATE
R-X
345785 95037
VIROPTIC OPT SOL 7.5CC
61570-0037-75
MNR TRIFLURIDINE
R-X
130781 95723
VISCOAT SRN .5 ML
08065-1839-05
ALC CHONDR SU A NA/HYALUR SOD
R-X
356444 96436
VISIPAQUE BOT 270MG/ML/10 V026
00407-2222-03
GE
IODIXANOL
R-X
514448 98168
VISIPAQUE PL 320MG/ML/10 V562
00407-2223-17
GE
IODIXANOL
R-X
696641 96435
VISIPAQUE VL 270MG/ML/10 V020
00407-2222-01
GE
IODIXANOL
R-X
261255 96432
VISIPAQUE VL 320MG/ML/10 V040
00407-2223-01
GE
IODIXANOL
R-X
457903 96473
VISTIDE SDV 75MG/ML 5 ML
61958-0101-01
GSI
CIDOFOVIR
R-X
127308 47370
VIT K1 AMP 1 MG/25
00409-9157-01
HOS PHYTONADIONE
R-X
127316 95278
VIT K1 AMP 10 MG/25
00409-9158-01
HOS PHYTONADIONE
R-X
617274 98133
VITRASE 200 UNITS/ML VL CT/6
67425-0002-10
IST
R-X
511717 98153
VIVONEX PED 1.7 OZ PK/6 71310
00212-7131-76
NES LACTOSE-FREE FOOD
418954 96127
VIVONEX RTF 250ML/24 362500
00212-3625-51
NES NUT.TX.IMPAIRED DIGEST FXN,SOY
R-X
722082 98216
VOLUMEN BARIUM SUS 450ML CS/24
32909-0945-03
BDI
R-X
929679 98180
VOLUVEN BAG 500ML CS/15
00409-1029-01
HOS HETASTARCH/NORMAL SALINE
R-X
655910 97726
VYTORIN TAB 10/10 90
66582-0311-54
MKC EZETIMIBE/SIMVASTATIN
R-X
565150 97727
VYTORIN TAB 10/10 100UD
66582-0311-28
R-X
655928 97728
66582-0312-54
R-X
565168 97729
66582-0312-28
R-X
565176 97731
66582-0313-52
R-X
655936 97730
66582-0313-54
R-X
565184 97733
66582-0315-52
R-X
655944 97732
66582-0315-54
R-X
173724 97995
WATER DISTILLED 3 X 1 GAL
07093-1003-28
M-M
R-X
296889 1751
WATER INJ BACT VL 30ML/25
63323-0249-30
APP WATER/ME-PARABEN/PROPYLPARABEN
R-X
R-X
DIDANOSINE
HYALURONIDASE,OVINE
R-X
BARIUM SULFATE
223693 44880
WATER INJ STR VL 10ML/25 P/F
63323-0185-10
APP WATER FOR INJECTION,STERILE
599084 120027
WATER STR 1000ML/14 2B0304X
00338-0013-04
BXT WATER FOR INJECTION,STERILE
R-X
227736 97654
WATER STR 3000ML/4 INJ 2B0307
00338-0013-08
BXT WATER FOR INJECTION,STERILE
R-X
664979 97882
WIN RHO SDF 300MCG 1500IU
00944-2967-03
BAX RHO(D) IMMUNE GLOBULIN/MALTOSE
R-X
664995 97886
WIN RHO SDF 1000MCG 5000IU
00944-2967-05
BAX RHO(D) IMMUNE GLOBULIN/MALTOSE
R-X
472621 96524
XALATAN 2.5 ML
00013-8303-04
PFZ LATANOPROST
R-X
529826 96857
XELODA TAB 150 MG 60
00004-1100-20
ROC CAPECITABINE
R-X
529842 96858
XELODA TAB 500 MG 120
00004-1101-50
ROC CAPECITABINE
R-X
627182 97984
XENADERM 30 GM
00064-3900-30
HEA TRYPSIN/BALSAM PERU/CASTOR OIL
R-X
436105 97889
XENADERM 60 GM
00064-3900-60
HEA TRYPSIN/BALSAM PERU/CASTOR OIL
R-X
428748 97246
XIGRIS 5MG/5ML VL
00002-7559-01
LIL
DROTRECOGIN ALFA (ACTIVATED)
R-X
428755 97247
XIGRIS 20MG/20ML VL
00002-7561-01
LIL
DROTRECOGIN ALFA (ACTIVATED)
R-X
409599 97975
XOLAIR 150MG P/F LYPOH SDV
50242-0040-62
GNT OMALIZUMAB
R-X
XYLOCAINE MDV 1% 50ML
63323-0485-50
APP LIDOCAINE HCL
R-X
978759 95401
XYLOCAINE MPF AMP 2% 10ML/5
63323-0496-97
APP LIDOCAINE HCL/PF
R-X
978767 95173
XYLOCAINE MPF AMP 1.5% 20ML/5
63323-0493-91
APP LIDOCAINE HCL
R-X
XYLOCAINE SDV 2% 5ML/10
63323-0495-05
APP LIDOCAINE HCL/PF
R-X
26765 12798
17137 96468
Page 45 of 46
Attachment n
M&D #
User #
27847 98205
Description
XYLOCAINE/EPI SDV 2% 20ML
NDC #
Mfg
Generic Description
63323-0489-20
APP LIDOCAINE HCL/EPINEPHRINE/PF
UDF 1
R-X
731398 95232
YODOXIN TAB 650 MG 100
00516-0093-01
GLE IODOQUINOL
R-X
710392 956
ZARONTIN CAP 100
00071-0237-24
PFZ ETHOSUXIMIDE
R-X
710244 18322
ZARONTIN SYR 16 OZ
00071-2418-23
PFZ ETHOSUXIMIDE
R-X
449710 96126
ZERIT CAP 15 MG 60
00003-1964-01
BRI
STAVUDINE
R-X
449728 96011
ZERIT CAP 20 MG 60
00003-1965-01
BRI
STAVUDINE
R-X
449736 96012
ZERIT CAP 30 MG 60
00003-1966-01
BRI
STAVUDINE
R-X
449744 96013
ZERIT CAP 40 MG 60
00003-1967-01
BRI
STAVUDINE
R-X
282913 97237
ZERIT O/PDR 1MG/ML 200 ML
00003-1968-01
BRI
STAVUDINE
R-X
474056 97548
ZETIA 10 MG TAB 90
66582-0414-54
MKC EZETIMIBE
546580 97549
ZETIA 10 MG TAB 100UD
66582-0414-28
MKC EZETIMIBE
R-X
195818 97239
ZIAGEN O/SOL 20MG/ML 240 ML
00173-0664-00
SKB ABACAVIR SULFATE
R-X
195792 96907
ZIAGEN TAB 300 MG 60
00173-0661-01
SKB ABACAVIR SULFATE
R-X
827261 95484
ZIDOVUDINE CAP 100 MG 100
65862-0107-01
AUP ZIDOVUDINE
R-X
637314 96475
ZIDOVUDINE TAB 300 MG 60
00054-0052-21
ROX ZIDOVUDINE
R-X
76430 95087
ZINC SULF VL 10 MG 10ML/25
00517-6110-25
A-R
ZINC SULFATE
R-X
615781 96069
ZINC SULFATE CAP 220 MG 100
00245-0080-11
UPS ZINC SULFATE
R-X
237529 97030
ZIP LOC 3X5 2ML 1M A17
60338-2101-70
R/D
R-X
237537 97031
60338-2101-90
R/D
R-X
237545 97032
60338-2102-20
R/D
R-X
237552 97033
60338-2102-70
R/D
R-X
551291 97059
60338-2103-00
R/D
R-X
756031 99287
ZITHROMAX Z-PAK 250MGX6 CT3
00069-3060-75
PFZ AZITHROMYCIN
R-X
628446 97897
ZMAX EXT REL ORAL SUS 2 GM
00069-4170-21
PFZ AZITHROMYCIN
R-X
476333 96130
ZOLADEX SRN 3.6 MG SAFESYSTEM
00310-0950-36
ZNC GOSERELIN ACETATE
R-X
476341 96413
ZOLADEX SRN 10.8 MG SAFESYSTEM
00310-0951-30
A/Z
GOSERELIN ACETATE
R-X
ZOLPIDEM TAB 5 MG 100
13668-0007-01
TOR ZOLPIDEM TARTRATE
R-X
ZOLPIDEM TAB 5 MG 100UD
51079-0724-20
UDL ZOLPIDEM TARTRATE
R-X
ZOLPIDEM TAB 10 MG 100
13668-0008-01
TOR ZOLPIDEM TARTRATE
R-X
746875 99317
ZOLPIDEM TAB 10 MG 100UD
51079-0725-20
UDL ZOLPIDEM TARTRATE
R-X
479063 97600
ZOMETA VL 4 MG
00078-0387-25
NVT ZOLEDRONIC ACID
R-X
232744 97639
ZOMIG TAB 2.5 MG 6
00310-0210-20
ZNC ZOLMITRIPTAN
R-X
232736 97640
ZOMIG TAB 5 MG 3
00310-0211-25
A/Z
R-X
646562 97175
ZONISAMIDE CAP 100 MG 100
00378-6727-01
MYL ZONISAMIDE
R-X
673558 98116
ZOSTAVAX SDV
00006-4963-00
MSD VARICELLA VACC/PF
R-X
660159 95940
ZOSYN VL 4.5 GM CT/10
00206-8855-16
WYE PIPERACILLIN SODIUM/TAZOBACTAM
R-X
665695 98208
ZOSYN VL 2.25 GM CT/10
00206-8852-16
WYE PIPERACILLIN SODIUM/TAZOBACTAM
R-X
456434 95399
ZOVIRAX OIN 5% 15 GM
64455-0993-94
DJP ACYCLOVIR
R-X
636274 96710
ZYPREXA TAB 2.5 MG 30
00002-4112-30
LIL
OLANZAPINE
R-X
375147 97508
ZYPREXA TAB 2.5 MG 100ID
00002-4112-33
LIL
OLANZAPINE
R-X
636266 96711
ZYPREXA TAB 5 MG 30
00002-4115-30
LIL
OLANZAPINE
R-X
401265 96712
ZYPREXA TAB 5 MG 100ID
00002-4115-33
LIL
OLANZAPINE
R-X
636258 96713
ZYPREXA TAB 7.5 MG 30
00002-4116-30
LIL
OLANZAPINE
R-X
600866 96714
ZYPREXA TAB 7.5 MG 100ID
00002-4116-33
LIL
OLANZAPINE
R-X
636241 96715
ZYPREXA TAB 10 MG 30
00002-4117-30
LIL
OLANZAPINE
R-X
398073 96716
ZYPREXA TAB 10 MG 100ID
00002-4117-33
LIL
OLANZAPINE
R-X
525402 97696
ZYPREXA VL 10 MG
00002-7597-01
LIL
OLANZAPINE
R-X
367367 97128
ZYPREXA ZYDIS TAB 5 MG 30DSPK
00002-4453-85
LIL
OLANZAPINE
R-X
367375 97129
00002-4454-85
LIL
OLANZAPINE
R-X
423954 97570
00002-4455-85
LIL
OLANZAPINE
R-X
423962 97572
00002-4456-85
LIL
OLANZAPINE
R-X
366195 97079
ZYVOX IV BAG 200MG/100ML CS/10
00009-5137-01
PFZ LINEZOLID
R-X
347864 97083
ZYVOX IV BAG 600MG/300ML CS/10
00009-5140-01
PFZ LINEZOLID
R-X
347856 97078
ZYVOX O/PDR 100MG/5ML 150ML
00009-5136-01
PFZ LINEZOLID
R-X
347831 97076
ZYVOX TAB 600 MG 20
00009-5135-02
PFZ LINEZOLID
R-X
347849 97077
ZYVOX TAB 600 MG 3X10UD
00009-5135-03
PFZ LINEZOLID
R-X
20222 95971
746867 99316
20297 95972
R-X
ZOLMITRIPTAN
Page 46 of 46

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Attachment Formulary 2500

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Attachment n

Formulary for: HCHD Formulary Catalog - JEP

FOU VITAMINS A AND D

ABELCET VL 100 MG 20ML

ENZ AMPHOTERICIN B LIPID COMPLEX

ABILIFY SDV 9.75MG/1.3ML

ABILIFY TAB 5 MG 100UD

ABILIFY TAB 10 MG 100UD

ABILIFY TAB 15 MG 100UD

ABILIFY TAB 20 MG 100UD

ABILIFY TAB 30 MG 100UD

ABX PACLITAXEL PROTEIN-BOUND

ACCU-CHEK SAFE-T PRO LANCT 200

ACEBUTOLOL CAP 200 MG 100

MYL ACEBUTOLOL HCL

ACEBUTOLOL CAP 400 MG 100

MYL ACEBUTOLOL HCL

ACETADOTE VL 200MG/ML 30ML CT4

ACETAMIN COD 12.5ML/100UD

PMA ACETAMINOPHEN WITH CODEINE

PMA ACETAMINOPHEN WITH CODEINE

ACETAMIN COD PHOS 300 MG 100UD

UDL ACETAMINOPHEN WITH CODEINE

ACETAMIN COD PHOS 300/30 100

MAL ACETAMINOPHEN WITH CODEINE

ACETAMIN SOL 160 MG 5ML/100

ACETAMIN TAB 325 MG 100UD

ACETAZOLAMIDE INJ 500 MG 10 ML

BED ACETAZOLAMIDE SODIUM

ACETAZOLAMIDE TAB 250 MG 100

ACETIC ACID 5% SOL 500ML A101

ACETIC ACID GLACL 500ML 250414

ACETIC ACID OTIC SOL 60ML

B&L ACETIC ACID/ALUMINUM ACETATE

ACETYLCYSTEINE VL 10% 4 ML/25

ACETYLCYSTEINE VL 10% 30 ML/3

ACETYLCYSTEINE VL 20% 4 ML/25

ACETYLCYSTEINE VL 20% 10 ML/3

ACETYLCYSTEINE VL 20% 30 ML/3

ACT HIB ONE DOSE VL CT/5

AVE HAEMOPH B POLY CONJ-TET TOX/PF

ACTHREL SDV 100UG/VL

CORTICORELIN OVINE TRIFLUTATE

ACTIDOSE-AQUA 50 GM/240ML TUBE

PAD ACTIVATED CHARCOAL

ACTIVASE VL 50MG SNGL

ACTIVASE VL 100MG SNGL

ACTIVASE VL 2MG SNGL CTHFL

ACTIVELLA TAB 5X28 DIALPACK

ACTIVELLA TAB 0.5MG/0.1MG 5X28

P&G RISEDRONATE SODIUM

ACTONEL TAB 35 MG 4/PK

P&G RISEDRONATE SODIUM

TPA PIOGLITAZONE HCL

ACULAR OPT SOL 5ML 2181

ACYCLOVIR CAP 200 MG 100

ACYCLOVIR CAP 200 MG 100UD

ACYCLOVIR TAB 400 MG 100

ACYCLOVIR TAB 400 MG 100UD

ACYCLOVIR TAB 800 MG 100

ACYCLOVIR TAB 800 MG 100UD

ACYCLOVIR VL 500MG 10ML/10