|
A |
|
|
|
|
|
|
Generic Drug Name/Strength |
|
Form |
30 Day Qty |
|
90 Day Qty |
|
Albuterol 2mg/5ml |
|
Syrup |
120 |
|
360 |
|
Albuterol Neb 0.083% |
|
Solution |
75 |
|
225 |
|
Albuterol Neb 0.5% |
|
Solution |
20 |
|
60 |
|
Alendronate Sodium 35mg |
|
Tablet |
4 |
|
12 |
|
Alendronate Sodium 70mg |
|
Tablet |
4 |
|
12 |
|
Allopurinol 100mg |
|
Tablet |
30 |
|
90 |
|
Allopurinol 300mg |
|
Tablet |
30 |
|
90 |
|
Amiloride/HCTZ 5-50mg |
|
Tablet |
30 |
|
90 |
|
Amitriptyline 10mg |
|
Tablet |
30 |
|
90 |
|
Amitriptyline 25mg |
|
Tablet |
30 |
|
90 |
|
Amitriptyline 50mg |
|
Tablet |
30 |
|
90 |
|
Amitriptyline 75mg |
|
Tablet |
30 |
|
90 |
|
Amitriptyline 100mg |
|
Tablet |
30 |
|
90 |
|
Amoxicillin 125mg/5ml |
|
Suspension |
80 |
|
240 |
|
Amoxicillin 125mg/5ml |
|
Suspension |
100 |
|
300 |
|
Amoxicillin 125mg/5ml |
|
Suspension |
150 |
|
450 |
|
Amoxicillin 200mg/5ml |
|
Suspension |
50 |
|
150 |
|
Amoxicillin 200mg/5ml |
|
Suspension |
75 |
|
225 |
|
Amoxicillin 200mg/5ml |
|
Suspension |
100 |
|
300 |
|
Amoxicillin 250mg |
|
Capsule |
30 |
|
90 |
|
Amoxicillin 250mg/5ml |
|
Suspension |
80 |
|
240 |
|
Amoxicillin 250mg/5ml |
|
Suspension |
100 |
|
300 |
|
Amoxicillin 400mg/5ml |
|
Suspension |
50 |
|
150 |
|
Amoxicillin 400mg/5ml |
|
Suspension |
75 |
|
225 |
|
Amoxicillin 400mg/5ml |
|
Suspension |
100 |
|
300 |
|
Amoxil 50mg/ml |
|
Drops |
30 |
|
90 |
|
Amoxicillin 500mg |
|
Capsule |
30 |
|
90 |
|
Anucort HC 25mg |
|
Suppository |
12 |
|
36 |
|
Atenolol 25mg |
|
Tablet |
30 |
|
90 |
|
Atenolol 50mg |
|
Tablet |
30 |
|
90 |
|
Atenolol 100mg |
|
Tablet |
30 |
|
90 |
|
Atenolol/Chlorthal 50/25mg |
|
Tablet |
30 |
|
90 |
|
Atenolol/Chlorthal 100/25mg |
|
Tablet |
30 |
|
90 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
B |
|
|
|
|
|
|
Generic Drug Name/Strength |
|
Form |
30 Day Qty |
|
90 Day Qty |
|
Bacitracin |
|
Opthalmic Ointment |
4 |
|
12 |
|
Baclofen 10mg |
|
Tablet |
30 |
|
90 |
|
Benazepril 5mg |
|
Tablet |
30 |
|
90 |
|
Benazepril 10mg |
|
Tablet |
30 |
|
90 |
|
Benazepril 20mg |
|
Tablet |
30 |
|
90 |
|
Benazepril 40mg |
|
Tablet |
30 |
|
90 |
|
Benzonatate 100mg |
|
Capsule |
14 |
|
42 |
|
Benztropine 2mg |
|
Tablet |
30 |
|
90 |
|
Betamethasone Dipropionate 0.05% |
Cream |
15 |
|
45 |
|
Betamethasone Dipropionate 0.05% |
Cream |
45 |
|
135 |
|
Betamethasone Valerate 0.1% |
|
Cream |
15 |
|
45 |
|
Betamethasone Valerate 0.1% |
|
Cream |
45 |
|
135 |
|
Betamethasone Valerate 0.1% |
|
Ointment |
15 |
|
45 |
|
Betamethasone Valerate 0.1% |
|
Ointment |
45 |
|
135 |
|
Bisoprolol/HCTZ 2.5/6.25mg |
|
Tablet |
30 |
|
90 |
|
Bisoprolol/HCTZ 5/6.25mg |
|
Tablet |
30 |
|
90 |
|
Bisoprolol/HCTZ 10/6.25mg |
|
Tablet |
30 |
|
90 |
|
Bumetanide 0.5mg |
|
Tablet |
30 |
|
90 |
|
Bumetanide 1mg |
|
Tablet |
30 |
|
90 |
|
Buspirone 5mg |
|
Tablet |
60 |
|
180 |
|
Buspirone 15mg |
|
Tablet |
60 |
|
180 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
C |
|
|
|
|
|
|
Generic Drug Name/Strength |
|
Form |
30 Day Qty |
|
90 Day Qty |
|
C-Phen DM 12.5/4/15mg/5ml |
|
Syrup |
120 |
|
360 |
|
Captopril 12.5mg |
|
Tablet |
60 |
|
180 |
|
Captopril 25mg |
|
Tablet |
60 |
|
180 |
|
Captopril 50mg |
|
Tablet |
60 |
|
180 |
|
Captopril 100mg |
|
Tablet |
60 |
|
180 |
|
Carbamazepine 200mg |
|
Tablet |
60 |
|
180 |
|
Carvedilol 3.125mg |
|
Tablet |
60 |
|
180 |
|
Carvedilol 6.25mg |
|
Tablet |
60 |
|
180 |
|
Carvedilol 12.5mg |
|
Tablet |
60 |
|
180 |
|
Carvedilol 25mg |
|
Tablet |
60 |
|
180 |
|
Cephalexin 250mg |
|
Capsule |
28 |
|
84 |
|
Chlorhexidine Gluconate 0.12% |
|
Solution |
473 |
|
1419 |
|
Chlorpropamide 100mg |
|
Tablet |
30 |
|
90 |
|
Chlorthalidone 25mg |
|
Tablet |
30 |
|
90 |
|
Chlorthalidone 50mg |
|
Tablet |
30 |
|
90 |
|
Cimetidine 300mg |
|
Tablet |
60 |
|
180 |
|
Cimetidine 400mg |
|
Tablet |
60 |
|
180 |
|
Cimedtidine 800mg |
|
Tablet |
30 |
|
90 |
|
Citalopram 20mg |
|
Tablet |
30 |
|
90 |
|
Citalopram 40mg |
|
Tablet |
30 |
|
90 |
|
Clonidine 0.1mg |
|
Tablet |
30 |
|
90 |
|
Clonidine 0.2mg |
|
Tablet |
30 |
|
90 |
|
Colchicine 0.6mg |
|
Tablet |
30 |
|
90 |
|
Cyclobenzaprine 5mg |
|
Tablet |
30 |
|
90 |
|
Cyclobenzaprine 10mg |
|
Tablet |
30 |
|
90 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
D |
|
|
|
|
|
|
Generic Drug Name/Strength |
|
Form |
30 Day Qty |
|
90 Day Qty |
|
Dexamethasone 0.075mg |
|
Tablet |
12 |
|
36 |
|
Dexamethasone 0.5mg |
|
Tablet |
30 |
|
90 |
|
Dexamethasone 4mg |
|
Tablet |
6 |
|
18 |
|
Dicyclomine 10mg |
|
Capsule |
90 |
|
270 |
|
Dicyclomine 20mg |
|
Tablet |
60 |
|
180 |
|
Digoxin 0.125mg |
|
Tablet |
30 |
|
90 |
|
Digoxin 0.25mg |
|
Tablet |
30 |
|
90 |
|
Diltiazem 30mg |
|
Tablet |
60 |
|
180 |
|
Diltiazem 60mg |
|
Tablet |
60 |
|
180 |
|
Diltiazem 90mg |
|
Tablet |
60 |
|
180 |
|
Diltiazem 120mg |
|
Tablet |
30 |
|
90 |
|
Doxazosin 1mg |
|
Tablet |
30 |
|
90 |
|
Doxazosin 2mg |
|
Tablet |
30 |
|
90 |
|
Doxazosin 4mg |
|
Tablet |
30 |
|
90 |
|
Doxazosin 8mg |
|
Tablet |
30 |
|
90 |
|
Doxepin 10mg |
|
Capsule |
30 |
|
90 |
|
Doxepin 25mg |
|
Capsule |
30 |
|
90 |
|
Doxepin 50mg |
|
Capsule |
30 |
|
90 |
|
Doxepin 75mg |
|
Capsule |
30 |
|
90 |
|
Doxepin 100mg |
|
Capsule |
30 |
|
90 |
|
Doxycycline Hyclate 50mg |
|
Capsule |
30 |
|
90 |
|
Doxycycline Hyclate 100mg |
|
Capsule/Tablet |
20 |
|
60 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
E |
|
|
|
|
|
|
Generic Drug Name/Strength |
|
Form |
30 Day Qty |
|
90 Day Qty |
|
Enalapril 2.5mg |
|
Tablet |
30 |
|
90 |
|
Enalapril 5mg |
|
Tablet |
30 |
|
90 |
|
Enalapril 10mg |
|
Tablet |
30 |
|
90 |
|
Enalapril 20mg |
|
Tablet |
30 |
|
90 |
|
Enalapril/HCTZ 5/12.5mg |
|
Tablet |
30 |
|
90 |
|
Erythromycin 5mg/gm |
|
Opthalmic Ointment |
4 |
|
12 |
|
Estradiolol 0.5mg |
|
Tablet |
30 |
|
90 |
|
Estradiolol 1mg |
|
Tablet |
30 |
|
90 |
|
Estradiolol 2mg |
|
Tablet |
30 |
|
90 |
|
Estropipate 0.75mg |
|
Tablet |
30 |
|
90 |
|
Estropipate 1.5mg |
|
Tablet |
30 |
|
90 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
F |
|
|
|
|
|
|
Generic Drug Name/Strength |
|
Form |
30 Day Qty |
|
90 Day Qty |
|
Famotadine 20mg |
|
Tablet |
60 |
|
90 |
|
Fluconazole 150mg |
|
Tablet |
1 |
|
3 |
|
Fluocinonide 0.05% |
|
Cream |
15 |
|
45 |
|
Fluocinonide 0.05% |
|
Cream |
30 |
|
90 |
|
Fluocinolone Acetide 0.01% |
|
Solution |
60 |
|
180 |
|
Fluoxetine 10mg |
|
Capsule/Tablet |
30 |
|
90 |
|
Fluoxetine 20mg |
|
Capsule |
60 |
|
180 |
|
Fluphenazine 1mg |
|
Tablet |
30 |
|
90 |
|
Folic Acid 1mg |
|
Tablet |
30 |
|
90 |
|
Furosemide 20mg |
|
Tablet |
30 |
|
90 |
|
Furosemide 40mg |
|
Tablet |
30 |
|
90 |
|
Furosemide 80mg |
|
Tablet |
30 |
|
90 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
G |
|
|
|
|
|
|
Generic Drug Name/Strength |
|
Form |
30 Day Qty |
|
90 Day Qty |
|
Gentamicin 0.1% |
|
Cream/Ointment |
15 |
|
45 |
|
Gentamicin 0.3% |
|
Opthalmic Solution |
5 |
|
15 |
|
Glimeperide 1mg |
|
Tablet |
30 |
|
90 |
|
Glimeperide 2mg |
|
Tablet |
30 |
|
90 |
|
Glimeperide 4mg |
|
Tablet |
30 |
|
90 |
|
Glipizide 5mg |
|
Tablet |
30 |
|
90 |
|
Glipizide 10mg |
|
Tablet |
60 |
|
180 |
|
Glyburide 1.25mg |
|
Tablet |
30 |
|
90 |
|
Glyburide 2.5mg |
|
Tablet |
30 |
|
90 |
|
Glyburide 5mg |
|
Tablet |
30 |
|
90 |
|
Glyburide Micro 3mg |
|
Tablet |
30 |
|
90 |
|
Glyburide Micro 6mg |
|
Tablet |
30 |
|
90 |
|
Guanfacine 1mg |
|
Tablet |
30 |
|
90 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
H |
|
|
|
|
|
|
Generic Drug Name/Strength |
|
Form |
30 Day Qty |
|
90 Day Qty |
|
Haloperidol 0.5mg |
|
Tablet |
30 |
|
90 |
|
Haloperidol 1mg |
|
Tablet |
30 |
|
90 |
|
Haloperidol 2mg |
|
Tablet |
30 |
|
90 |
|
Haloperidol 5mg |
|
Tablet |
30 |
|
90 |
|
Hydrochlorothiazide 12.5mg |
|
Capsule |
30 |
|
90 |
|
Hydrochlorothiazide 25mg |
|
Tablet |
30 |
|
90 |
|
Hydrochlorothiazide 50mg |
|
Tablet |
30 |
|
90 |
|
Hydrocortisone 1% |
|
Cream |
30 |
|
90 |
|
Hydrocortisone 2.5% |
|
Cream |
30 |
|
90 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
I |
|
|
|
|
|
|
Generic Drug Name/Strength |
|
Form |
30 Day Qty |
|
90 Day Qty |
|
Ibuprofen 100mg/5ml |
|
Suspension |
120 |
|
360 |
|
Ibuprofen 400mg |
|
Tablet |
90 |
|
270 |
|
Ibuprofen 600mg |
|
Tablet |
60 |
|
180 |
|
Ibuprofen 800mg |
|
Tablet |
30 |
|
90 |
|
Indapamide 1.25mg |
|
Tablet |
30 |
|
90 |
|
Indapamide 2.5mg |
|
Tablet |
30 |
|
90 |
|
Ipratropium Neb 0.2mg/ml |
|
Solution |
75 |
|
225 |
|
Isoniazid 300mg |
|
Tablet |
30 |
|
90 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
L |
|
|
|
|
|
|
Generic Drug Name/Strength |
|
Form |
30 Day Qty |
|
90 Day Qty |
|
Labetalol 100mg |
|
Tablet |
60 |
|
180 |
|
Lactulose 10gm/15ml |
|
Syrup |
237 |
|
711 |
|
Levobunolol 0.5% |
|
Opthalmic Solution |
5 |
|
15 |
|
Levothyroxine 25mcg |
|
Tablet |
30 |
|
90 |
|
Levothyroxine 50mcg |
|
Tablet |
30 |
|
90 |
|
Levothyroxine 75mcg |
|
Tablet |
30 |
|
90 |
|
Levothyroxine 88mcg |
|
Tablet |
30 |
|
90 |
|
Levothyroxine 100mcg |
|
Tablet |
30 |
|
90 |
|
Levothyroxine 112mcg |
|
Tablet |
30 |
|
90 |
|
Levothyroxine 125mcg |
|
Tablet |
30 |
|
90 |
|
Levothyroxine 137mcg |
|
Tablet |
30 |
|
90 |
|
Levothyroxine 150mcg |
|
Tablet |
30 |
|
90 |
|
Levothyroxine 175mcg |
|
Tablet |
30 |
|
90 |
|
Levothyroxine 200mcg |
|
Tablet |
30 |
|
90 |
|
Lidocaine Viscous 2% |
|
Solution |
100 |
|
300 |
|
Lisinopril 2.5mg |
|
Tablet |
30 |
|
90 |
|
Lisinopril 5mg |
|
Tablet |
30 |
|
90 |
|
Lisinopril 10mg |
|
Tablet |
30 |
|
90 |
|
Lisinopril 20mg |
|
Tablet |
30 |
|
90 |
|
Lisinopril 30mg |
|
Tablet |
30 |
|
90 |
|
Lisinopril 40mg |
|
Tablet |
30 |
|
90 |
|
Lisinopril/HCTZ 10/12.5mg |
|
Tablet |
|