ATTACH 2 COMPREHENSIVE DRUG LIST 6 18 2020.xlsx updated.xlsx no embeda.pdf

FDASOL1222072 ATTACHMENT 2 COMPREHENSIVE DRUG LIST

Product name Strength Size NDC number Notes estimated annual requirement

Availability (Yes/No)

Drug Price

ABRAXANE (paclitaxel albumin-bound injectable suspension)

100mg/vial 1 in 1 CARTON 68817-134-50

ADASUVE (loxapine inhalation aerosol powder)

10mg 5 in 1 CARTON 10885-003-05

ADRENACLICK (epinephrine injection)

EQ 0.15MG/DELIVERY

ADVAIR DISKUS (fluticasone propionate and salmeterol powder)

0.5MG/INH; EQ

0.05MG BASE/INH

60 in 1 INHALER 0173-0695-00 provide quotes for brand and all available generics 5

AMBISOME (amphotericin B injection, powder, lyophilized, for solution)

50mg/vial 1 vial 0469-3051-30

AZILECT (Rasagiline Mesylate) Tablet

1mg bottle of 30 provide quotes for brand and all available generics 10

BECONASE AQ

(beclomethasone dipropionate monohydrate spray, suspension)

EQ 0.042MG

DIPROP/SPRAY

1 bottle 0173-0388-79

BYDUREON BCISE (exenatide injection, suspension, extended release)

2 MG 1 in 1 carton and 4 in 1 carton

0310-6540-85 and 0310-6540-04

CARAFATE (sucralfate suspension)

1GM/10ML

CONCERTA (methylphenidate hydrochloride tablet, extended release)

54mg bottle of 100 50458-587-01 provide quotes for brand and all available generics 5

CORGARD (nadolol tablet)

80mg bottle of 100 provide quotes for brand and all available generics 5

CUPRIMINE (penicillamine capsule)

250mg bottle of 100 provide quotes for brand and all available generics 5

DEFINITY (perflutren injection, suspension)

6.52mg/mL Box containing 16 vials (2mL)

11994-011-16

DEPEN (penicillamine tablet) 250mg bottle of 100 0037-4401-01 5

DEXILANT (dexlansoprazole capsule, delayed release)

30mg provide quotes for brand and all available generics 5

DIPRIVAN (propofol injection, emulsion)

10mg/mL provide quotes for brand and all available generics 5

DOXIL (doxorubicin liposomal injection)

20mg/10mL provide quotes for brand and all available generics 5

Effexor XR (venlafaxine hydrochloride capsule, extended release)

150mg provide quotes for brand and all available generics 5

EPIPEN JR (epinephrine injection)

0.15MG/DELIVERY

EVZIO (naloxone hydrochloride injection, solution)

2mg/0.4mL Carton containing 2 auto-injectors and 1 trainer

60842-051-01

EXONDYS 51(eteplirsen injection)

100mg/2mL 60923-363-02

EXPAREL (bupivacaine injection, suspension, liposomal)

266MG/20ML

(13.3MG/ML)

Box containing 10 vials, each vial containing 20 mL

Need 1 box containing 10 vials, each containing 20mL of Exparel

FIRMAGON (degarelix) 120mg/vial 5 FORTEO (teriparatide injection, solution)

0.6MG/2.4ML

(0.25MG/ML) 3

HYSINGLA ER (hydrocodone bitartrate tablet, extended release)

120mg

INJECTAFER (ferric carboxymaltose injection injection, solution)

750MG IRON/15ML

(50MG IRON/ML)

KADIAN (morphine sulfate capsule, extended release)

100mg provide quotes for brand and all available generics 5

LOTEMAX (loteprednol etabonate suspension/drops)

0.50% provide quotes for brand and all

LUMASON (sulfur hexaflouride)

60.7MG/25MG 0270-7099-16 Need 2 boxes/1 box from 2 different lots 2

MIACALCIN (calcitonin salmon injection, solution)

200IU/ml 1 in 1 carton 67457-675-02

MIRENA (levonorgestrel intrauterine device)

52mg

NARCAN (naloxone hydrochloride Spray)

4MG/SPRAY

NASONEX (mometasone furoate monohydrate spray, metered)

EQ 0.05MG

BASE/SPRAY

provide quotes for brand and all available generics 5

NEXIUM (esomeprazole magnesium granule, delayed release)

EQ 40MG

BASE/PACKET

NITROMIST (nitroglycerin aerosol, metered)

0.4MG/SPRAY

NOCTIVA (desmopressin acetate spray, metered)

0.00083MG/SPRAY

Ozurdex (dexamethasone implant)

0.7mg

PARAGARD T 380A (copper intrauterine device)

309MG/COPPER

PENTASA (mesalamine capsule)

500mg

PREMARIN (conjugated estrogens vaginal cream)

0.625MG/GM

PREVACID (lansoprazole tablet, orally disintegrating, delayed release)

30mg provide quotes for brand and all available generics 5

PROAIR RESPICLICK (albuterol sulfate powder, metered)

EQ 0.090MG BASE/INH

PROTONIX DELAYED-

RELEASE(pantoprazole sodium granule, delayed release)

40mg

PROVENTIL HFA (albuterol sulfate aerosol, metered)

EQ 0.09MG BASE/INH

QVAR REDIHALER

(beclomethasone dipropionate hfa aerosol, metered)

0.04MG/INH

RASUVO (methotrexate injection, solution)

7.5MG/0.15ML

(7.5MG/0.15ML) 5

RESTASIS (cyclosporine emulsion)

0.05%

RISPERDAL CONSTA

(risperidone injection)

50MG/VIAL

SANDOSTATIN LAR DEPOT

(octreotide acetate)

30mg

SCLEROSOL (talc aerosol, powder)

4GM/SPRAY 63256-100-30

SKYLA (levonorgestrel intrauterine device)

13.5mg

SPINRAZA (nusinersen injection, solution)

12mg/5mL 64406-058-01

SPIRIVA RESPIMAT

(tiotropium bromide inhalation spray spray, metered)

EQ 0.0025MG

BASE/INH

0597-0100-61

STRIVERDI RESPIMAT

(olodaterol respimat inhalation spray spray, metered)

EQ 0.0025MG

BASE/INH

0597-0192-61

SYMJEPI (epinephrine injection)

0.3MG/0.3ML

(0.3MG/0.3ML) 5

TAMIFLU (oseltamivir phosphate capsule)

EQ 75MG BASE provide quotes for brand and all available generics 5

TENORMIN (atenolol tablet)

100mg bottle of 100 provide quotes for brand and all available generics 5

TESTOPEL (testosterone pellet)

75mg

TIMOPTIC-XE (timolol maleate solution)

0.25%

TOBI PODHALER (tobramycin capsule)

28MG

TOBREX (tobramycin ophthalmic suspension)

0.30%

TOBRADEX

(tobramycin/dexamethasone ophthalmic suspension)

0.3%/0.1% provide quotes for brand and all available generics 10

TOBRADEX ST

(tobramycin/dexamethasone ophthalmic suspension)

0.3%/0.05%

TRELEGY ELLIPTA (fluticasone furoate, umeclidinium bromide and vilanterol trifenatate powder)

0.1MG/INH;EQ

0.0625MG

BASE/INH;EQ 0.025MG

BASE/INH

0173-0887-10 or 0173-0887-14

TRELSTAR (triptorelin pamoate)

22.5mg

TYMLOS (abaloparatide injection, solution)

3.12MG/1.56ML

(2MG/ML) 3

TYVASO (treprostinil inhalant) 0.6MG/ML

UCERIS (budesonide aerosol, rectal foam)

2MG/ACTUATION

VELPHORO (sucroferric oxyhydroxide tablet, chewable)

500mg 49230-645-51

VELTASSA (patiromer powder, for suspensionr)

EQ 8.4GM

BASE/PACKET 3

VICTOZA (liraglutide injection)

18MG/3ML (6MG/ML)

VIDAZA (azacitidine injection, powder, lyophilized, for solution)

100mg/vial provide quotes for brand and all available generics 5

VIVITROL (naltrexone injection)

380mg

VYXEOS (daunorubicin and cytarabine liposome injection, powder, lyophilized, for suspension)

44mg/100mg

XERESE (acyclovir and hydrocortisone cream)

5%; 1% 1 in 1 CARTON 0187-5104-01

XERESE (acyclovir and hydrocortisone cream)

5%; 1% 20 in 1 CARTON 0187-5104-02

XHANCE (fluticasone propionate spray, metered)

0.093MG

XOPENEX HFA (levalbuterol tartrate aerosol, metered)

EQ 0.045 MG

BASE/INH 5

XTAMPZA ER (oxycodone capsule, extended release)

36mg

XULTOPHY 100/3.6 (insulin degludec and liraglutide injection, solution)

UNITS/ML;3.6MG/ML

ZIAGEN (abacavir sulfate tablet, film coated)

EQ 300MG BASE provide quotes for brand and all

ZOVIRAX (acyclovir capsule) 200mg provide quotes for brand and all available generics 5

ZOVIRAX (acyclovir tablet) 400mg provide quotes for brand and all

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