D.38 Voucher Formulary.pdf
PDF 37 KB Posted
- Attached to
- Q201--Ada CBOC
- Solicitation number
- 36C25923R0047
About this file
This document contains a voucher formulary for the Department of Veterans Affairs solicitation number 36C25923R0047 for the Q201 Ada CBOC opportunity. The formulary lists over 200 generic and brand name pharmaceutical products including albuterol, amoxicillin, atorvastatin, cephalexin, ciprofloxacin, digoxin, diltiazem, doxycycline, enalapril, furosemide, glipizide, hydrochlorothiazide, ibuprofen, lisinopril, metoprolol, metformin, morphine sulfate, naproxen, omeprazole, penicillin, prednisone, ranitidine, and warfarin that are approved for dispensing under the contract. The solicitation is for an outpatient community based outpatient clinic opportunity through the Department of Veterans Affairs Veterans Health Administration VISN 19. The formulary provides details on product strengths and dosage forms that are in scope for the requirement.
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Text version
D.38 VOUCHER FORMULARY
36C25923R0047
Albuterol oral inhaler
ACYCLOVIR 200MG CAPS
ACYCLOVIR 800MG TAB
Albuterol/Ipratropium inhaler
Allopurinol 100mg
Allopurinol 300mg
Amlodipine
Amoxicillin 250mg Caps
Amoxicillin 500mg Caps
Amoxicillin/clavulanate 500mg/125mg
Amoxicillin/clavulanate 875mg/125mg
Atenolol 25mg
Atenolol 50mg
Atenolol 100mg
ATROPINE/DIPHENOXYLATE
Azithromycin 250mg
Azithromycin 500mg
Butalbital 50mg/apap 5gr/caffeine
Captopril 12.5mg
Captopril 25mg
Captopril 50mg
Cephalexin 250mg Caps
Cephalexin 500mg Caps
CIPROFLOXACIN 500MG
CODEINE 30/APAP325
Chlorpheniramine 4mg
Clindamycin 150mg Caps
Clonidine 0.1mg
Clonidine 0.2mg
Clonidine 0.3mg
Clotrimazole 1% cream cyclobenzaprine 10mg
Dicyclomine 10mg Caps
Digoxin .125mg
Digoxin .25mg
Diltiazem) 120mg
Diltiazem) 180mg
Diltiazem 240mg
Diltiazem 300mg
Diltiazem 360mg
Diphenhydramine 25mg
Doxycycline 100mg Caps
Erythromycin eye oint
Erythromycin stearate 250mg
Erythromycin stearate 500mg
Flunisolide nasal inhaler
Flunisolide oral inhaler
Fluocinonide 0.05% cream
Fluocinonide 0.05% oint
Fosinopril 10mg tabs
Fosinopril 20mg tabs
Fosinopril 40mg tabs
Furosemide 20mg
Furosemide 40mg
Glipizide 10mg tabs
Glipizide 5mg tabs
Glyburide 2.5mg tabs
Glyburide 5mg tabs
Guaifenesin with codeine oral liquid
Hydrochlorthiazide 25mg
Hydrochlorthiazide 50mg
Hydrocortisone 1% cream
Ibuprofen 400mg tablets
Ibuprofen 800mg tablets
Indomethacin 25mg caps
Indomethacin 50mg caps
Insulin NPH
Insulin NPH/Regular 70/30
Insulin Regular
Ipratropium oral inhaler
Isosorbide mononitrate 30mg
Isosorbide mononitrate 60mg
NA. POLY STYRENE suspension 15g/60ml
LevoFloxacin
Levonrgestril (Next Choice) Morning after pill.
Levothyroxine (all strengths)
Lisinopril 10mg
Lisinopril 20mg
Lisinopril 40mg
Meclizine
Metronidazole
Methocarbamol 500mg tablets
Methyl prednisone dosepak 4mg
Metoprolol 100mg tabs
Metoprolol 50mg tabs
Mometasone oral inhaler
Morphine Sulfate SR 100mg
Morphine Sulfate SR 15mg
Morphine Sulfate SR 30mg
Morphine Sulfate SR 60mg moxifloxicin 400mg
Naproxen 250mg tablets
Naproxen 375mg tablets
Next Choice Levonorgestril
Nitroglycerin patch .1mg/hr
Nitroglycerin patch .2mg/hr
Nitroglycerin patch .4mg/hr
Nitroglycerin patch .6mg/hr
Nitroglycerin sublingual .3mg
Nitroglycerin sublingual .4mg
Nitroglycerin sublingual .6mg
Novolin 70/30 insulin
Novolin N insulin
Novolin R insulin oseltamivir phaohate 75mg capsules #10
Penicillin VK 125mg
Penicillin VK 250mg
Penicillin VK 500mg
Permethrin 5% cream
Phenytoin 30mg,50mg,100mg
Phytonadione (vit K) 5mg tablet
Piroxicam 10mg caps
Piroxicam 20mg caps
Polym/Neo/HC otic susp
Polymyx/Trimet opth soln
Potassium 10meq SR tab
Prednisone 10mg
Prednisone 20mg
Prednisone 40mg
Prednisone 5mg promethazine 25mg tablets
Pseudoephedrine 60mg/tripolidine 2.5mg
Ranitidine 150mg tabs
Ranitidine 300mg tabs
Silvadene Cream
Sodium polystyrene suspension
Sulfamethoxazole 800mg/trimethoprim 160mg
Sulindac 150mg tablets
Sulindac 200mg tablets
Terazosin
Tobramycin 0.3% opth oint
Tobramycin 0.3% opth soln
Triam/HCTZ 37.5/25mg tablets
Triamcinolone 0.1% cream
Triamcinolone 0.1% oint
Tylenol with Codeine #3 tablets
Warfarin 1mg tab
Warfarin 2.5mg tab
Warfarin 2mg,3mg, 4mg tab
Warfarin 5mg, 6mg 7.5 mg tab
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