36C24418Q9323-002.xlsx

XLSX spreadsheet 21 KB Posted

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Pharmacy Services Phila VAMC CBOCs and after hours support Federal contract opportunity
Solicitation number
36C24418Q9323
Issued by
Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 4

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36C24418Q9323 FIRST FILL FORMULARY BY DRUG CLASS CMC VAMC.xlsx

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Sheet1

ANTIBIOTICSQTY LIMITBLOOD PRESSURE/HEARTQTY LIMIT
AMOXICILLIN CAP (250MG,500MG)AMLODIPINE TAB (2.5MG, 5MG, 10MG)
AMOXICILLIN/CLAVULANATE K TAB (500MG, 875MG)ASPIRIN 81MG (EC OR CHEW)
AZITHROMYCIN TAB (250MG)6 tabletsATENOLOL TAB (25MG, 50MG, 100MG)
CEPHALEXIN CAP (250MG, 500MG)ATENOLOL/CHLORTHALIDONE TAB (50-25MG, 100-25MG)
CIPROFLOXACIN HCL TAB (250MG, 500MG, 750MG)CAPTOPRIL TAB (12.5MG, 25MG, 50MG, 100MG)
CLINDAMYCIN CAP (150MG, 300MG)CARVEDILOL TAB (3.125MG, 6.25MG, 12.5MG, 25MG)
DOXYCYCLINE CAP OR TAB (100MG)CHLORTHALIDONE TAB (25MG, 50MG)
LEVOFLOXACIN TAB (250MG, 500MG, 750MG)CLONIDINE HCL TAB (0.1MG, 0.2MG, 0.3MG)
METRONIDAZOLE TAB (250MG, 500MG)DIGOXIN TAB (0.125MG, 0.25MG)
NITROFURANTOIN MONOHYDRATE CAP (100MG)(12HR)DILTIAZEM HCL TAB OR (24HR SA) CAP
PENICILLIN TAB (250MG, 500MG)DOXAZOSIN MESYLATE TAB (1MG, 2MG, 4MG, 8MG)
PHENAZOPYRIDINE HCL TAB (100MG, 200MG)3 daysENALAPRIL TAB (2.5MG, 5MG, 10MG)
SULFAMETHOXAZOLE/TMP TAB OR SUSP (SS, DS)FOSINOPRIL TAB (10MG, 20MG, 40MG)
ANTIFUNGAL/ANTIVIRALQTY LIMITFUROSEMIDE TAB (20MG, 40MG, 80MG)
ACYCLOVIR CAP/TAB (200MG, 400MG, 800MG)HYDRALAZINE HCL TAB (10MG, 25MG, 50MG, 100MG)
FLUCONAZOLE TAB (50MG, 100MG, 150MG, 200MG)HYDROCHLOROTHIAZIDE CAP/TAB (12.5MG, 25MG, 50MG)
NYSTATIN ORAL SUSP (100,000UNIT/ML)480mlHCTZ/LISINOPRIL (10-12.5MG, 20-12.5MG, 20-25MG)
OSELTAMIVIR CAP (75MG)10 capsHCTZ/TRIAMTERENE CAP/TAB (25-37.5MG)
COUGH/COLD/ALLERGYQTY LIMITISOSORBIDE MONONITRATE SA TAB (30MG, 60MG)
CHLORPHENIRAMINE MALEATE TAB (4MG)LISINOPRIL TAB (2.5MG, 5MG, 10MG, 20MG, 40MG)
CODEINE/GUAIFENESIN SYRUP (10-100/5ML)120 mlMETOPROLOL TARTRATE TAB (25MG, 50MG, 100MG)
DEXTROMETHORPHAN/GUAIFENESIN SYRUP (10-100/5ML)120 mlPRAZOSIN HCL CAP (1MG, 2MG, 5MG)
DIPHENHYDRAMINE HCL CAP (25MG,50MG)PROPRANOLOL HCL TAB/SA CAP
EPINEPHRINE 0.3ML AUTO-INJECTOR1 twin packNITROGLYCERIN SL TAB (0.4MG)25 COUNT
GUAIFENESIN 100MG/5MLSYRUP120mlSPIRONOLACTONE TAB (25MG, 50MG, 100MG)
LORATADINE TAB (10MG)TERAZOSIN HCL CAP (1MG, 2MG, 5MG, 10MG)
HYDROXYZINE HCL TAB (10MG,25MG, 50MG)VERAPAMIL HCL TAB/SA TAB
PSEUDOEPHEDRINE HCL TAB (30MG)30 tabletsOPHTHALMIC/OTICQTY LIMIT
INHALERS/INHALATION SOLUTIONQTY LIMITANTIPYRINE/BENZOCAINE/GLYCERIN OTIC SOLN1 BOTTLE
ALBUTEROL 90MCG ORAL INHALER1 INHALERHC/NEOMYCIN/POLYMYXIN OTIC (SOLN OR SUSP)10ml
ALBUTEROL 0.083% INHALATION SOLN1 BOX OF 30OFLOXACIN 0.3% OPHTH or OTIC SOLN5 ml
MOMETASONE FUROATE ORAL INHALER30 doseSULFACETAMIDE NA 10% OPHTH SOLN15 ml
TRIFLURIDINE 1% OPHTH SOLN1 BOTTLE
DIABETESQTY LIMITPAIN/INFLAMMATIONQTY LIMIT
DEXTROSE SQUEEZE TUBE1 PACKAGEACETAMINOPHEN SUPP (650MG)/TAB(325MG, 500MG)12 SUPPOSITORIES
GLIPIZIDE TAB (2.5MG, 5MG, 10MG)BUTALBITAL/APAP/CAFFEINE TAB (50-325-40MG)15 tablets
GLUCAGON EMERGENCY KIT1 KITBACLOFEN TAB (10MG, 20MG)
GLUCOSE TAB50CTCODEINE 30/ACETAMINOPHEN 300MG TAB15 tablets
INSULIN SYRINGE (1/2ML, 1ML)10 daysCYCLOBENZAPRINE TAB (10MG)
INSULIN ASPART (Novolog)1 vialDICLOFENAC NA EC TAB (25MG, 50MG, 75MG)
INSULIN DETEMIR (Levemir)1 vialHYDROCODONE/APAP 5/325 TAB15 tablets
INSULIN HUMAN 70/30 (NPH/REG) (Novolin 70/30)1 vialIBUPROFEN TAB (200MG, 400MG, 600MG, 800MG)
INSULIN HUMAN NPH 100U/ML (Novolin N)1 vialINDOMETHACIN CAP (25MG, 50MG)
INSULIN HUMAN REGULAR 100U/ML (Novolin R)1 vialMETHOCARBAMOL TAB (500MG, 750MG)
METFORMIN HCL TAB (500MG, 850MG, 1000MG)METHYLPREDNISOLONE 4MG DOSE PAK1 DOSE PAK
GIQTY LIMITNAPROXEN TAB (250MG, 375MG, 500MG)
ALOH/MGOH/SIMTH EXTRA STRENGTH SUSP1 bottleOXYCODONE/APAP 5/325 TAB15 tablets
DOCUSATE CAP (100MG)PREDNISONE TAB (1MG, 2.5MG, 5MG, 10MG, 20MG)
LOPERAMIDE HCL CAP (2MG)TRAMADOL HCL TAB (50MG)15 tablets
FAMOTIDINE TAB (20MG, 40MG)MISCELLANEOUSQTY LIMIT
METOCLOPRAMIDE HCL TAB (5MG, 10MG)CARBAMAZEPINE TAB (100MG, 200MG)
MILK OF MAGNESIA SUSP1 BOTTLECLONAZEPAM TAB (0.5MG. 1MG, 2MG)
OMEPRAZOLE CAP (20MG)COLCHICINE CAP (0.6MG)3 TABLETS
PROCHLORPERAZINE SUPP (25MG) /TAB (5MG, 10MG)5 DAYSDIAZEPAM TAB (2MG, 5MG, 10MG)
RANITIDINE TAB (150MG)LACTULOSE 10GM/15ML SOLN480 ml
SENNOSIDES TAB (8.6MG)LEVOTHYROXINE NA (SYNTHROID BRAND ONLY) TAB
TOPICAL/VAGINALQTY LIMITLORAZEPAM ORAL TAB (0.5MG. 1MG, 2MG)
BACITRACIN 500 UNITS OINTMENT30GMMECLIZINE HCL TAB (12.5MG, 25MG)
BACITRACIN 500/POLYMYXIN 10000U/GM OINT30GMMEDROXYPROGESTERONE TAB (2.5MG, 5MG, 10MG)
CLOTRIMAZOLE 1% TOPICAL CRM/VAGINAL CRM30GMPHENYTOIN CAP (100MG)
HYDROCORTISONE CREAM (0.5%, 1%, 2.5%)30GMPOTASSIUM CHLORIDE CAP/TAB (8MEQ, 10MEQ, 20MEQ)
NITROGLYCERIN 2% OINT60gmSODIUM POLYSTYRENE SULFONATE SUSP (15GM/60ML)480ml
NYSTATIN CREAM (100,000 UNITS/GM)30GMTAMSULOSIN CAP (0.4MG)
PERMETHRIN 5% CREAM60GMVALPROIC ACID CAP (250MG)
WARFARIN NA TAB (1MG, 2MG, 2.5MG, 5MG)EXELAN BRAND PREFERRED

FIRST FILL PHARMACY FORMULARY eff 120114 &8(Updated 7/14/15)

&"-,Bold"14 DAY LIMIT UNLESS OTHERWISE NOTED Please see other side

Sheet2

Sheet3

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