Attachement J - Durham Formulary.pdf

GPI DRUG NAME MESSAGING/NOTES

65991002050315 ACETAMINOPHEN W/ CODEINE TAB 300-30 MG

12405010000110 ACYCLOVIR CAP 200 MG

124050100003** ACYCLOVIR TABS

44201010103410 ALBUTEROL SULFATE INHAL AERO 108 MCG/ACT (90MCG BASE EQUIV)

35400005000305 AMIODARONE HCL TAB 200 MG

582000101003** AMITRIPTYLINE HCL TABS

3400000308**** AMLODIPINE BENZOATE

01200010****** AMOXICILLIN

0199000220**** AMOXICILLIN & POT CLAVULANATE

83370010000330 APIXABAN TAB 5 MG 5 DAY SUPPLY

332000200003** ATENOLOL TABS

03400010****** AZITHROMYCIN

43102010000105 BENZONATATE CAP 100 MG

73100010100310 BENZTROPINE MESYLATE TAB 1 MG

73100010100315 BENZTROPINE MESYLATE TAB 2 MG

652000102082** BUPRENORPHINE HCL-NALOXONE HCL DIHYDRATE FILM

65200010200720 BUPRENORPHINE HCL-NALOXONE HCL SL TAB 2-0.5 MG (BASE EQUIV)

65200010200740 BUPRENORPHINE HCL-NALOXONE HCL SL TAB 8-2 MG (BASE EQUIV)

58300040100310 BUPROPION HCL TAB 100 MG

58300040100305 BUPROPION HCL TAB 75 MG

583000401074** BUPROPION HCL TB12

7260002000**** CARBAMAZEPINE

333000070003** CARVEDILOL TABS

02100020****** CEPHALEXIN

57100020100110 CHLORDIAZEPOXIDE HCL CAP 10 MG

57100020100115 CHLORDIAZEPOXIDE HCL CAP 25 MG

37600025000305 CHLORTHALIDONE TAB 25 MG

37600025000310 CHLORTHALIDONE TAB 50 MG

05000020****** CIPROFLOXACIN

581600201003** CITALOPRAM HYDROBROMIDE TABS

3500010000320 CLARITHROMYCIN TAB 500 MG

16220020100110 CLINDAMYCIN HCL CAP 150 MG

16220020100120 CLINDAMYCIN HCL CAP 300 MG

7210001000**** CLONAZEPAM

362010101003** CLONIDINE HCL TABS

85158020100320 CLOPIDOGREL BISULFATE TAB 75 MG (BASE EQUIV) 14 DAY SUPPLY

90154020003705 CLOTRIMAZOLE CREAM 1%

55104020003705 CLOTRIMAZOLE VAGINAL CREAM 1%

68000020000310 COLCHICINE TAB 0.6 MG 3 TABS MAX

751000501003** CYCLOBENZAPRINE HCL TABS

5710004000**** DIAZEPAM

66100007200620 DICLOFENAC SODIUM TAB DELAYED RELEASE 50 MG

66100007200630 DICLOFENAC SODIUM TAB DELAYED RELEASE 75 MG

31200010****** DIGOXIN

62802040000325 DISULFIRAM TAB 250 MG

725000101075** DIVALPROEX SODIUM TB24

725000101006** DIVALPROEX SODIUM TBEC

0400002000**** DOXYCYCLINE (MONOHYDRATE)

8310102010**** ENOXAPARIN SODIUM

86101025004210 ERYTHROMYCIN OPHTH OINT 5 MG/GM

031000******** ERYTHROMYCINS***

581600341003** ESCITALOPRAM OXALATE TAB

661000080001** ETODOLAC CAPS

66100008000310 ETODOLAC TAB 400 MG

661000080075** ETODOLAC TB24

11407015000325 FLUCONAZOLE TAB 150 MG

58160040000310 FLUOXETINE HCL TAB 10 MG

58160040000320 FLUOXETINE HCL TAB 20 MG

3720003000**** FUROSEMIDE

72600030000110 GABAPENTIN CAP 100 MG

72600030000130 GABAPENTIN CAP 300 MG

72600030000140 GABAPENTIN CAP 400 MG

VISN 6 DURHAM VAHCS FORMULARY

272000300003** GLIPIZIDE TABS

272000401003** GLYBURIDE MICRONIZED TABS

27200040000315 GLYBURIDE TAB 5 MG

43997002282020 GUAIFENESIN-CODEINE SOLN 100-10 MG/5ML

364000101003** HYDRALAZINE HCL TABS

376000400003** HYDROCHLOROTHIAZIDE TABS

65991702100305 HYDROCODONE-ACETAMINOPHEN TAB 10-325 MG

65991702100356 HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG

90550075003725 HYDROCORTISONE CREAM 2.5%

572000401003** HYDROXYZINE HCL TABS

572000402001** HYDROXYZINE PAMOATE CAPS

661000200003** IBUPROFEN TABS

661000300001** INDOMETHACIN CAPS

661000300002** INDOMETHACIN CPCR

27104006002020 INSULIN DETEMIR INJ 100 UNIT/ML

44100030123420 IPRATROPIUM BROMIDE HFA INHAL AEROSOL 17 MCG/ACT

44209902013420 IPRATROPIUM-ALBUTEROL INHAL AEROSOL SOLN 20-100 MCG/ACT

32100020****** ISOSORBIDE DINITRATE

5000034000330 LEVOFLOXACIN TAB 500 MG

5000034000340 LEVOFLOXACIN TAB 750 MG

25400040000340 LEVONORGESTREL TAB 1.5 MG

28100010****** LEVOTHYROXINE SODIUM

36991802550305 LISINOPRIL & HYDROCHLOROTHIAZIDE TAB 10-12.5 MG

36991802550310 LISINOPRIL & HYDROCHLOROTHIAZIDE TAB 20-12.5 MG

36991802550320 LISINOPRIL & HYDROCHLOROTHIAZIDE TAB 20-25 MG

361000300003** LISINOPRIL TABS

595000101001** LITHIUM CARBONATE CAPS

571000600003** LORAZEPAM TABS

361500402003** LOSARTAN POTASSIUM TABS

50200050000310 MECLIZINE HCL TAB 25 MG

661000520003** MELOXICAM TABS

27250050007520 METFORMIN HCL TAB ER 24HR 500 MG

272500500003** METFORMIN HCL TABS

651000501003** METHADONE HCL TABS

751000700003** METHOCARBAMOL TABS

22100030000310 METHYLPREDNISOLONE TAB 4 MG

2210003000B705 METHYLPREDNISOLONE TAB THERAPY PACK 4 MG (21)

376000600003** METOLAZONE TABS

332000300575** METOPROLOL SUCCINATE TB24

332000301003** METOPROLOL TARTRATE TABS

16000035000305 METRONIDAZOLE TAB 250 MG

16000035000310 METRONIDAZOLE TAB 500 MG

55100035004020 METRONIDAZOLE VAGINAL GEL 0.75%

58030050000315 MIRTAZAPINE TAB 15 MG

44400036208020 MOMETASONE FUROATE INHAL POWD 220 MCG/INH (BREATH ACTIVATED)

6510005510A7** MORPHINE SULFATE T12A

651000551003** MORPHINE SULFATE TABS

651000551004** MORPHINE SULFATE TBCR

6510005510A6** MORPHINE SULFATE TBEA

05000037****** MOXIFLOXACIN HCL

86101038102025 MOXIFLOXACIN HCL OPHTH SOLN 0.5% (BASE EQ) (2 TIMES DAILY)

86101038102020 MOXIFLOXACIN HCL OPHTH SOLN 0.5% (BASE EQUIV)

93400030100305 NALTREXONE HCL TAB 50 MG

661000601003** NAPROXEN SODIUM TABS

661000600003** NAPROXEN TABS

86109903054220 NEOMYCIN-BACITRACIN-POLYMYXIN 3.5MG-500U-10000U OPTH OINT

86109903202000 NEOMYCIN-POLYMY-GRAMICID OP SOL 1.75-10000-0.025MG-UNT-MG/

87991003102010 NEOMYCIN-POLYMYXIN-HC OTIC SOLN 1%

87991003101807 NEOMYCIN-POLYMYXIN-HC OTIC SUSP 3.5 MG/ML-10000 UNIT/ML-1%

16800050100120 NITROFURANTOIN MACROCRYSTALLINE CAP 100 MG

16800050150120 NITROFURANTOIN MONOHYDRATE MACROCRYSTALLINE CAP 100 MG

321000300085** NITROGLYCERIN PT24

32100030000715 NITROGLYCERIN SL TAB 0.4 MG

591570600003** OLANZAPINE TABS

12504060200110 OSELTAMIVIR PHOSPHATE CAP 30 MG (BASE EQUIV)

12504060200120 OSELTAMIVIR PHOSPHATE CAP 75 MG (BASE EQUIV)

12504060201910 OSELTAMIVIR PHOSPHATE FOR SUSP 6 MG/ML (BASE EQUIV)

65100075100310 OXYCODONE HCL TAB 5 MG

65990002200310 OXYCODONE W/ ACETAMINOPHEN TAB 5-325 MG

581600600003** PAROXETINE HCL TABS

01100040****** PENICILLIN V

909000350037** PERMETHRIN CREAM

72200030000505 PHENYTOIN CHEW TAB 50 MG

7220003020**** PHENYTOIN SODIUM EXTENDED

86109902602020 POLYMYXIN B-TRIMETHOPRIM OPHTH SOLN 10000 UNIT/ML-0.1% 14 DAY SUPPLY

79700030100440 POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 20 MEQ

362020301001** PRAZOSIN HCL CAPS

221000450003** PREDNISONE TABS

86300050101815 PREDNISOLONE ACETATE OPHTH SUSP 1%

592000551003** PROCHLORPERAZINE MALEATE TABS

592000550052** PROCHLORPERAZINE SUPP

414000201052** PROMETHAZINE HCL SUPP

414000201003** PROMETHAZINE HCL TABS

591530701003** QUETIAPINE FUMARATE TABS

590700700003** RISPERIDONE TABS

83370060000330 RIVAROXABAN TAB 15 MG 5 DAY SUPPLY

5816007010**** SERTRALINE HCL

99450010001840 SODIUM POLYSTYRENE SULFONATE ORAL SUSP 15 GM/60ML

37500020000305 SPIRONOLACTONE TAB 25 MG

1699000230**** SULFAMETHOXAZOLE-TRIMETHOPRIM

568520701001** TAMSULOSIN HCL CAPS

602010300001** TEMAZEPAM CAPS

3620204010**** TERAZOSIN HCL

86101070002005 TOBRAMYCIN OPHTH SOLN 0.3% 14 DAY SUPPLY

65100095100320 TRAMADOL HCL TAB 50 MG

581200801003** TRAZODONE HCL TABS

90550085103705 TRIAMCINOLONE ACETONIDE CREAM 0.025%

90550085103710 TRIAMCINOLONE ACETONIDE CREAM 0.1%

90550085104210 TRIAMCINOLONE ACETONIDE OINT 0.1%

379900023003** TRIAMTERENE & HYDROCHLOROTHIAZIDE TAB

12405085100320 VALACYCLOVIR HCL TAB 1 GM

12405085100310 VALACYCLOVIR HCL TAB 500 MG

361500800003** VALSARTAN TAB

581800901070** VENLAFAXINE HCL CP24

83200030200303 WARFARIN SODIUM TAB 1 MG

83200030200310 WARFARIN SODIUM TAB 2.5 MG

83200030200315 WARFARIN SODIUM TAB 5 MG

NDC DRUG NAME MESSAGING/NOTES

49502-0393-80 INSULIN GLARGINE-YFGN INJ 100 UNIT/ML GENERIC ONLY

00169-18-3302 NOVOLIN R

00169-18-3311 NOVOLIN R

00169-18-3402 NOVOLIN N

00169-18-3411 NOVOLIN N

00169-18-3702 NOVOLIN 70-30

00169-18-3711 NOVOLIN 70-30

00169-30-0701 NOVOLIN 70-30 FLEXPEN

00169-30-0712 NOVOLIN 70-30 FLEXPEN

00169-30-0715 NOVOLIN 70-30 FLEXPEN

00169-30-0725 NOVOLIN 70-30 FLEXPEN

00378-93-2032 WIXELA INHUB MYLAN

00378-93-2132 WIXELA INHUB MYLAN

00378-93-2232 WIXELA INHUB MYLAN