Appendix_C-Sample_DME.Formulary.pdf

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Emergency Prescription Assistance Program (EPAP) - Long Term
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HHS-ASPR-16-100-SOL-00006
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Appendix C - Sample of Prescription Drug Formulary Medical Supplies Vaccines and DME Listing

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Amend_3_-_RFQ__16-100-SOL-00006_-_EPAP_Long_Term.pdf PDF
proposal_intent_response_sheet_form1.doc DOC document
Amendment_2_-_RFQ__16-100-SOL-00006_-_EPAP_Long_Term.pdf PDF
ATTACHMENT__3_PRICING_TABLE_.xlsx XLSX spreadsheet
ATTACHMENT__2_CLIN_STRUCTURE_TABLE.docx DOCX document
Amendment_1_-_RFQ__16-100-SOL-00006_-_EPAP_Requirement.pdf PDF
ATTACHMENT__2_CLIN_STRUCTURE_TABLE.pdf PDF
ATTACHMENT__1_PAST_PERFORMANCE.pdf PDF
ATTACHMENT__3_PRICING_TABLE_.pdf PDF
Appendix_A-HISTORICAL_DATA.pdf PDF
Appendix_D-Sample_Eligibility.pdf PDF
Appendix_E-Sample_Claim_Report.pdf PDF
Appendix_F-Pharmacy_Notification.pdf PDF
FINAL_RFP_16-100-SOL-00006.pdf PDF
Appendix_B-Sample_Work_Flow.pdf PDF
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APPENDIX C - RFP #HHS-ASPR-16-100-SOL-00006

EPAP - Long Term Requirement

Generic Name Brand Name Dosage Form

ABACAVIR 20 MG/ML ORAL

SOLUTION [ZIAGEN] ZIAGEN ORAL SOLUTION

ABACAVIR 300 MG ORAL

TABLET ORAL TABLET

ABACAVIR 300 MG ORAL

TABLET [ZIAGEN] ZIAGEN ORAL TABLET

ABACAVIR 300 MG /

LAMIVUDINE 150 MG /

ZIDOVUDINE 300 MG ORAL

TABLET ORAL TABLET

ABACAVIR 300 MG /

LAMIVUDINE 150 MG /

ZIDOVUDINE 300 MG ORAL

TABLET [TRIZIVIR] TRIZIVIR ORAL TABLET

ABACAVIR 600 MG /

DOLUTEGRAVIR 50 MG /

LAMIVUDINE 300 MG ORAL

TABLET [TRIUMEQ] TRIUMEQ ORAL TABLET

ABACAVIR 600 MG /

LAMIVUDINE 300 MG ORAL

TABLET [EPZICOM] EPZICOM ORAL TABLET

1 ML ABATACEPT 125 MG/ML

PREFILLED SYRINGE

[ORENCIA] ORENCIA PREFILLED SYRINGE

ABATACEPT 25 MG/ML

INJECTABLE SOLUTION

[ORENCIA] ORENCIA INJECTABLE SOLUTION

ABIRATERONE ACETATE 250

MG ORAL TABLET [ZYTIGA] ZYTIGA ORAL TABLET

ABOBOTULINUMTOXINA 500

UNT/ML INJECTABLE

SOLUTION [DYSPORT] DYSPORT INJECTABLE SOLUTION

ACAMPROSATE CALCIUM 333

MG DELAYED RELEASE ORAL

TABLET

DELAYED RELEASE ORAL

TABLET

ACARBOSE 100 MG ORAL

TABLET ORAL TABLET

ACARBOSE 100 MG ORAL

TABLET [PRECOSE] PRECOSE ORAL TABLET

ACARBOSE 25 MG ORAL

TABLET ORAL TABLET

ACARBOSE 25 MG ORAL

TABLET [PRECOSE] PRECOSE ORAL TABLET

ACARBOSE 50 MG ORAL

TABLET ORAL TABLET

ACARBOSE 50 MG ORAL

TABLET [PRECOSE] PRECOSE ORAL TABLET

ACEBUTOLOL

HYDROCHLORIDE 200 MG

ORAL CAPSULE ORAL CAPSULE

ACEBUTOLOL

HYDROCHLORIDE 200 MG

ORAL CAPSULE [SECTRAL] SECTRAL ORAL CAPSULE

ACEBUTOLOL

HYDROCHLORIDE 400 MG

ORAL CAPSULE ORAL CAPSULE

SAMPLE - Formulary

SAMPLE - Formulary

ACEBUTOLOL

HYDROCHLORIDE 400 MG

ORAL CAPSULE [SECTRAL] SECTRAL ORAL CAPSULE

ACETAMINOPHEN 21.7 MG/ML

/ BUTALBITAL 3.33 MG/ML /

CAFFEINE 2.67 MG/ML ORAL

SOLUTION [VANATOL] VANATOL ORAL SOLUTION

ACETAMINOPHEN 21.7 MG/ML

/ HYDROCODONE

BITARTRATE 0.5 MG/ML ORAL ORAL SOLUTION

ACETAMINOPHEN 21.7 MG/ML

/ HYDROCODONE

BITARTRATE 0.5 MG/ML ORAL

SOLUTION [HYCET] HYCET ORAL SOLUTION

ACETAMINOPHEN 21.7 MG/ML

/ HYDROCODONE

BITARTRATE 0.67 MG/ML ORAL

SOLUTION [ZAMICET] ZAMICET ORAL SOLUTION

ACETAMINOPHEN 24 MG/ML /

CODEINE PHOSPHATE 2.4

MG/ML ORAL SOLUTION ORAL SOLUTION

ACETAMINOPHEN 24 MG/ML /

CODEINE PHOSPHATE 2.4

MG/ML ORAL SUSPENSION

[CAPITAL AND CODEINE] CAPITAL AND CODEINE ORAL SUSPENSION

ACETAMINOPHEN 300 MG /

BUTALBITAL 50 MG ORAL

TABLET [BUPAP] BUPAP ORAL TABLET

ACETAMINOPHEN 300 MG /

BUTALBITAL 50 MG /

CAFFEINE 40 MG ORAL ORAL CAPSULE

ACETAMINOPHEN 300 MG /

BUTALBITAL 50 MG /

CAFFEINE 40 MG ORAL

CAPSULE [FIORICET] FIORICET ORAL CAPSULE

ACETAMINOPHEN 300 MG /

BUTALBITAL 50 MG /

CAFFEINE 40 MG / CODEINE

PHOSPHATE 30 MG ORAL ORAL CAPSULE

ACETAMINOPHEN 300 MG /

BUTALBITAL 50 MG /

CAFFEINE 40 MG / CODEINE

PHOSPHATE 30 MG ORAL

CAPSULE [FIORICET WITH FIORICET WITH CODEINE ORAL CAPSULE

ACETAMINOPHEN 300 MG /

CODEINE PHOSPHATE 15 MG

ORAL TABLET ORAL TABLET

ACETAMINOPHEN 300 MG /

CODEINE PHOSPHATE 30 MG

ORAL TABLET ORAL TABLET

ACETAMINOPHEN 300 MG /

CODEINE PHOSPHATE 30 MG

ORAL TABLET [TYLENOL WITH

CODEINE] TYLENOL WITH CODEINE ORAL TABLET

ACETAMINOPHEN 300 MG /

CODEINE PHOSPHATE 60 MG

ORAL TABLET ORAL TABLET

SAMPLE - Formulary

ACETAMINOPHEN 300 MG /

CODEINE PHOSPHATE 60 MG

ORAL TABLET [TYLENOL WITH

CODEINE] TYLENOL WITH CODEINE ORAL TABLET

ACETAMINOPHEN 300 MG /

HYDROCODONE BITARTRATE

10 MG ORAL TABLET ORAL TABLET

ACETAMINOPHEN 300 MG /

HYDROCODONE BITARTRATE

10 MG ORAL TABLET

[VICODIN] VICODIN ORAL TABLET

ACETAMINOPHEN 300 MG /

HYDROCODONE BITARTRATE

10 MG ORAL TABLET [XODOL] XODOL ORAL TABLET

ACETAMINOPHEN 300 MG /

HYDROCODONE BITARTRATE

5 MG ORAL TABLET ORAL TABLET

ACETAMINOPHEN 300 MG /

HYDROCODONE BITARTRATE

5 MG ORAL TABLET [VICODIN] VICODIN ORAL TABLET

ACETAMINOPHEN 300 MG /

HYDROCODONE BITARTRATE

5 MG ORAL TABLET [XODOL] XODOL ORAL TABLET

ACETAMINOPHEN 300 MG /

HYDROCODONE BITARTRATE

7.5 MG ORAL TABLET ORAL TABLET

ACETAMINOPHEN 300 MG /

HYDROCODONE BITARTRATE

7.5 MG ORAL TABLET

[VICODIN] VICODIN ORAL TABLET

ACETAMINOPHEN 300 MG /

HYDROCODONE BITARTRATE

7.5 MG ORAL TABLET [XODOL] XODOL ORAL TABLET

ACETAMINOPHEN 300 MG /

OXYCODONE

HYDROCHLORIDE 10 MG

ORAL TABLET [PRIMLEV] PRIMLEV ORAL TABLET

ACETAMINOPHEN 300 MG /

OXYCODONE

HYDROCHLORIDE 5 MG ORAL

TABLET [PRIMLEV] PRIMLEV ORAL TABLET

ACETAMINOPHEN 300 MG /

OXYCODONE

HYDROCHLORIDE 7.5 MG

ORAL TABLET [PRIMLEV] PRIMLEV ORAL TABLET

ACETAMINOPHEN 320.5 MG /

CAFFEINE 30 MG /

DIHYDROCODEINE

BITARTRATE 16 MG ORAL

CAPSULE [TREZIX] TREZIX ORAL CAPSULE

ACETAMINOPHEN 325 MG /

BUTALBITAL 50 MG ORAL

TABLET ORAL TABLET

ACETAMINOPHEN 325 MG /

BUTALBITAL 50 MG /

CAFFEINE 40 MG ORAL ORAL CAPSULE

SAMPLE - Formulary

ACETAMINOPHEN 325 MG /

BUTALBITAL 50 MG /

CAFFEINE 40 MG ORAL ORAL TABLET

ACETAMINOPHEN 325 MG /

BUTALBITAL 50 MG /

CAFFEINE 40 MG ORAL ESGIC ORAL TABLET

ACETAMINOPHEN 325 MG /

BUTALBITAL 50 MG /

CAFFEINE 40 MG / CODEINE

PHOSPHATE 30 MG ORAL ORAL CAPSULE

ACETAMINOPHEN 325 MG /

HYDROCODONE BITARTRATE

10 MG ORAL TABLET ORAL TABLET

ACETAMINOPHEN 325 MG /

HYDROCODONE BITARTRATE

10 MG ORAL TABLET [LORCET] LORCET ORAL TABLET

ACETAMINOPHEN 325 MG /

HYDROCODONE BITARTRATE

10 MG ORAL TABLET [LORTAB] LORTAB ORAL TABLET

ACETAMINOPHEN 325 MG /

HYDROCODONE BITARTRATE

10 MG ORAL TABLET [NORCO] NORCO ORAL TABLET

ACETAMINOPHEN 325 MG /

HYDROCODONE BITARTRATE

2.5 MG ORAL TABLET ORAL TABLET

ACETAMINOPHEN 325 MG /

HYDROCODONE BITARTRATE

5 MG ORAL TABLET ORAL TABLET

ACETAMINOPHEN 325 MG /

HYDROCODONE BITARTRATE

5 MG ORAL TABLET [LORCET] LORCET ORAL TABLET

ACETAMINOPHEN 325 MG /

HYDROCODONE BITARTRATE

5 MG ORAL TABLET [LORTAB] LORTAB ORAL TABLET

ACETAMINOPHEN 325 MG /

HYDROCODONE BITARTRATE

5 MG ORAL TABLET [NORCO] NORCO ORAL TABLET

ACETAMINOPHEN 325 MG /

HYDROCODONE BITARTRATE

7.5 MG ORAL TABLET ORAL TABLET

ACETAMINOPHEN 325 MG /

HYDROCODONE BITARTRATE

7.5 MG ORAL TABLET

[LORCET] LORCET ORAL TABLET

ACETAMINOPHEN 325 MG /

HYDROCODONE BITARTRATE

7.5 MG ORAL TABLET

[LORTAB] LORTAB ORAL TABLET

ACETAMINOPHEN 325 MG /

HYDROCODONE BITARTRATE

7.5 MG ORAL TABLET [NORCO] NORCO ORAL TABLET

ACETAMINOPHEN 325 MG /

OXYCODONE

HYDROCHLORIDE 10 MG

SAMPLE - Formulary

ACETAMINOPHEN 325 MG /

OXYCODONE

HYDROCHLORIDE 10 MG

ORAL TABLET [ENDOCET] ENDOCET ORAL TABLET

ACETAMINOPHEN 325 MG /

OXYCODONE

HYDROCHLORIDE 10 MG

ORAL TABLET [PERCOCET] PERCOCET ORAL TABLET

ACETAMINOPHEN 325 MG /

OXYCODONE

HYDROCHLORIDE 2.5 MG

ORAL TABLET ORAL TABLET

ACETAMINOPHEN 325 MG /

OXYCODONE

HYDROCHLORIDE 2.5 MG

ORAL TABLET [PERCOCET] PERCOCET ORAL TABLET

ACETAMINOPHEN 325 MG /

OXYCODONE

HYDROCHLORIDE 5 MG ORAL

TABLET ORAL TABLET

ACETAMINOPHEN 325 MG /

OXYCODONE

HYDROCHLORIDE 5 MG ORAL

TABLET [ENDOCET] ENDOCET ORAL TABLET

ACETAMINOPHEN 325 MG /

OXYCODONE

HYDROCHLORIDE 5 MG ORAL

TABLET [PERCOCET] PERCOCET ORAL TABLET

ACETAMINOPHEN 325 MG /

OXYCODONE

HYDROCHLORIDE 7.5 MG

ORAL TABLET ORAL TABLET

ACETAMINOPHEN 325 MG /

OXYCODONE

HYDROCHLORIDE 7.5 MG

ORAL TABLET [ENDOCET] ENDOCET ORAL TABLET

ACETAMINOPHEN 325 MG /

OXYCODONE

HYDROCHLORIDE 7.5 MG

ORAL TABLET [PERCOCET] PERCOCET ORAL TABLET

12 HR ACETAMINOPHEN 325

MG / OXYCODONE

HYDROCHLORIDE 7.5 MG

EXTENDED RELEASE ORAL

TABLET [XARTEMIS] XARTEMIS

EXTENDED RELEASE ORAL

TABLET

ACETAMINOPHEN 325 MG /

TRAMADOL HYDROCHLORIDE

37.5 MG ORAL TABLET ORAL TABLET

ACETAMINOPHEN 325 MG /

TRAMADOL HYDROCHLORIDE

37.5 MG ORAL TABLET

[ULTRACET] ULTRACET ORAL TABLET

ACETAMINOPHEN 65 MG/ML /

OXYCODONE

HYDROCHLORIDE 1 MG/ML

ORAL SOLUTION [ROXICET] ROXICET ORAL SOLUTION

SAMPLE - FormularyACETATE 0.044 MEQ/ML /

CYSTEINE 0.2 MG/ML /

HISTIDINE 2.5 MG/ML /

ISOLEUCINE 5.6 MG/ML /

LEUCINE 8.8 MG/ML / LYSINE 9

MG/ML / METHIONINE 8.8

MG/ML / PHENYLALANINE 8.8

MG/ML / SODIUM BISULFITE

0.5 MG/ML / SODIUM

CHLORIDE 0.005 MEQ/ML /

THREONINE 4 MG/ML /

TRYPTOPHAN 2 MG/ML /

VALINE 6.4 MG/ML

INJECTABLE SOLUTION NEPHRAMINE INJECTABLE SOLUTION

ACETAZOLAMIDE 100 MG/ML

INJECTABLE SOLUTION INJECTABLE SOLUTION

ACETAZOLAMIDE 125 MG

ORAL TABLET ORAL TABLET

ACETAZOLAMIDE 250 MG

ORAL TABLET ORAL TABLET

12 HR ACETAZOLAMIDE 500

MG EXTENDED RELEASE

ORAL CAPSULE

EXTENDED RELEASE ORAL

CAPSULE

12 HR ACETAZOLAMIDE 500

MG EXTENDED RELEASE

ORAL CAPSULE [DIAMOX] DIAMOX

EXTENDED RELEASE ORAL

CAPSULE

ACETIC ACID 20 MG/ML OTIC

SOLUTION OTIC SOLUTION

ACETIC ACID 20 MG/ML /

HYDROCORTISONE 10 MG/ML

OTIC SOLUTION OTIC SOLUTION

ACETIC ACID 20 MG/ML /

HYDROCORTISONE 10 MG/ML

OTIC SOLUTION [ACETASOL

HC] ACETASOL HC OTIC SOLUTION

ACETOHYDROXAMIC ACID 250

MG ORAL TABLET [LITHOSTAT] LITHOSTAT ORAL TABLET

ACETYLCYSTEINE 100 MG/ML

INHALANT SOLUTION INHALANT SOLUTION

ACETYLCYSTEINE 200 MG/ML

INHALANT SOLUTION INHALANT SOLUTION

ACITRETIN 10 MG ORAL

CAPSULE ORAL CAPSULE

ACITRETIN 10 MG ORAL

CAPSULE [SORIATANE] SORIATANE ORAL CAPSULE

ACITRETIN 17.5 MG ORAL

CAPSULE ORAL CAPSULE

ACITRETIN 17.5 MG ORAL

CAPSULE [SORIATANE] SORIATANE ORAL CAPSULE

ACITRETIN 25 MG ORAL

CAPSULE ORAL CAPSULE

ACITRETIN 25 MG ORAL

CAPSULE [SORIATANE] SORIATANE ORAL CAPSULE

30 ACTUAT ACLIDINIUM

BROMIDE 0.4 MG/ACTUAT DRY

POWDER INHALER [TUDORZA] TUDORZA DRY POWDER INHALER

SAMPLE - Formulary

60 ACTUAT ACLIDINIUM

BROMIDE 0.4 MG/ACTUAT DRY

POWDER INHALER [TUDORZA] TUDORZA DRY POWDER INHALER

ACRIVASTINE 8 MG /

PSEUDOEPHEDRINE

HYDROCHLORIDE 60 MG

ORAL CAPSULE [SEMPREX-D] SEMPREX-D ORAL CAPSULE

ACYCLOVIR 0.05 MG/MG

TOPICAL OINTMENT TOPICAL OINTMENT

ACYCLOVIR 0.05 MG/MG

TOPICAL OINTMENT [ZOVIRAX] ZOVIRAX TOPICAL OINTMENT

ACYCLOVIR 200 MG ORAL

CAPSULE ORAL CAPSULE

ACYCLOVIR 200 MG ORAL

CAPSULE [ZOVIRAX] ZOVIRAX ORAL CAPSULE

ACYCLOVIR 40 MG/ML ORAL

SUSPENSION ORAL SUSPENSION

ACYCLOVIR 40 MG/ML ORAL

SUSPENSION [ZOVIRAX] ZOVIRAX ORAL SUSPENSION

ACYCLOVIR 400 MG ORAL

TABLET ORAL TABLET

ACYCLOVIR 50 MG/ML

INJECTABLE SOLUTION INJECTABLE SOLUTION

ACYCLOVIR 50 MG/ML

TOPICAL CREAM [ZOVIRAX] ZOVIRAX TOPICAL CREAM

ACYCLOVIR 50 MG/ML /

HYDROCORTISONE 10 MG/ML

TOPICAL CREAM [XERESE] XERESE TOPICAL CREAM

ACYCLOVIR 800 MG ORAL

TABLET ORAL TABLET

0.8 ML ADALIMUMAB 50 MG/ML

PREFILLED SYRINGE [HUMIRA] HUMIRA PREFILLED SYRINGE

0.2 ML ADALIMUMAB 50 MG/ML

PREFILLED SYRINGE [HUMIRA] HUMIRA PREFILLED SYRINGE

0.4 ML ADALIMUMAB 50 MG/ML

PREFILLED SYRINGE [HUMIRA] HUMIRA PREFILLED SYRINGE

{6 (0.8 ML ADALIMUMAB 50

MG/ML PREFILLED SYRINGE

[HUMIRA]) } PACK [HUMIRA

PEN - CROHN'S DISEASE

STARTER PACK]

HUMIRA PEN - CROHN'S

DISEASE STARTER PACK PACK

ADAPALENE 0.001 MG/MG

TOPICAL GEL TOPICAL GEL

ADAPALENE 0.001 MG/MG

TOPICAL GEL [DIFFERIN] DIFFERIN TOPICAL GEL

ADAPALENE 0.001 MG/MG /

BENZOYL PEROXIDE 0.025

MG/MG TOPICAL GEL [EPIDUO] EPIDUO TOPICAL GEL

ADAPALENE 0.003 MG/MG

TOPICAL GEL TOPICAL GEL

ADAPALENE 0.003 MG/MG

TOPICAL GEL [DIFFERIN] DIFFERIN TOPICAL GEL

ADAPALENE 1 MG/ML TOPICAL

CREAM TOPICAL CREAM

ADAPALENE 1 MG/ML TOPICAL

CREAM [DIFFERIN] DIFFERIN TOPICAL CREAM

SAMPLE - Formulary

ADAPALENE 1 MG/ML TOPICAL

LOTION [DIFFERIN] DIFFERIN TOPICAL LOTION

ADEFOVIR DIPIVOXIL 10 MG

ORAL TABLET ORAL TABLET

ADEFOVIR DIPIVOXIL 10 MG

ORAL TABLET [HEPSERA] HEPSERA ORAL TABLET

ADO-TRASTUZUMAB

EMTANSINE 20 MG/ML

INJECTABLE SOLUTION

[KADCYLA] KADCYLA INJECTABLE SOLUTION

AFATINIB 20 MG ORAL TABLET

[GILOTRIF] GILOTRIF ORAL TABLET

AFATINIB 30 MG ORAL TABLET

[GILOTRIF] GILOTRIF ORAL TABLET

AFATINIB 40 MG ORAL TABLET

[GILOTRIF] GILOTRIF ORAL TABLET

AGALSIDASE BETA 5 MG/ML

INJECTABLE SOLUTION

[FABRAZYME] FABRAZYME INJECTABLE SOLUTION

ARGININE 5.75 MG/ML /

CALCIUM CHLORIDE 0.004

MEQ/ML / DIBASIC POTASSIUM

PHOSPHATE 2.61 MG/ML /

GLUCOSE 150 MG/ML /

GLYCINE 5.15 MG/ML /

HISTIDINE 2.4 MG/ML /

ISOLEUCINE 3 MG/ML /

LEUCINE 3.65 MG/ML / LYSINE

2.9 MG/ML / MAGNESIUM

CHLORIDE 0.01 MEQ/ML /

METHIONINE 2 MG/ML /

PHENYLALANINE 2.8 MG/ML /

PROLINE 3.4 MG/ML / SERINE

2.5 MG/ML / SODIUM ACETATE

TRIHYDRATE 3.4 MG/ML /

SODIUM CHLORIDE 0.01

MEQ/ML / THREONINE 2.1

MG/ML / TRYPTOPHAN 0.9

MG/ML / TYROSINE 0.2 MG/ML /

VALINE 2.9 MG/ML

INJECTABLE SOLUTION CLINIMIX E 5/15 INJECTABLE SOLUTION

SAMPLE - Formulary

ARGININE 5.75 MG/ML /

CALCIUM CHLORIDE 0.004

MEQ/ML / DIBASIC POTASSIUM

PHOSPHATE 2.61 MG/ML /

GLUCOSE 200 MG/ML /

GLYCINE 5.15 MG/ML /

HISTIDINE 2.4 MG/ML /

ISOLEUCINE 3 MG/ML /

LEUCINE 3.65 MG/ML / LYSINE

2.9 MG/ML / MAGNESIUM

CHLORIDE 0.01 MEQ/ML /

METHIONINE 2 MG/ML /

PHENYLALANINE 2.8 MG/ML /

PROLINE 3.4 MG/ML / SERINE

2.5 MG/ML / SODIUM ACETATE

TRIHYDRATE 3.4 MG/ML /

SODIUM CHLORIDE 0.01

MEQ/ML / THREONINE 2.1

MG/ML / TRYPTOPHAN 0.9

MG/ML / TYROSINE 0.2 MG/ML /

VALINE 2.9 MG/ML

INJECTABLE SOLUTION CLINIMIX E 5/20 INJECTABLE SOLUTION

ARGININE 5.75 MG/ML /

CALCIUM CHLORIDE 0.004

MEQ/ML / DIBASIC POTASSIUM

PHOSPHATE 2.61 MG/ML /

GLUCOSE 250 MG/ML /

GLYCINE 5.15 MG/ML /

HISTIDINE 2.4 MG/ML /

ISOLEUCINE 3 MG/ML /

LEUCINE 3.65 MG/ML / LYSINE

2.9 MG/ML / MAGNESIUM

CHLORIDE 0.01 MEQ/ML /

METHIONINE 2 MG/ML /

PHENYLALANINE 2.8 MG/ML /

PROLINE 3.4 MG/ML / SERINE

2.5 MG/ML / SODIUM ACETATE

TRIHYDRATE 3.4 MG/ML /

SODIUM CHLORIDE 0.01

MEQ/ML / THREONINE 2.1

MG/ML / TRYPTOPHAN 0.9

MG/ML / TYROSINE 0.2 MG/ML /

VALINE 2.9 MG/ML

INJECTABLE SOLUTION CLINIMIX E 5/25 INJECTABLE SOLUTION

SAMPLE - Formulary

ARGININE 5.75 MG/ML /

GLUCOSE 150 MG/ML /

GLYCINE 5.15 MG/ML /

HISTIDINE 2.4 MG/ML /

ISOLEUCINE 3 MG/ML /

LEUCINE 3.65 MG/ML / LYSINE

2.9 MG/ML / METHIONINE 2

MG/ML / PHENYLALANINE 2.8

MG/ML / PROLINE 3.4 MG/ML /

SERINE 2.5 MG/ML /

THREONINE 2.1 MG/ML /

TRYPTOPHAN 0.9 MG/ML /

TYROSINE 0.2 MG/ML / VALINE

290 MG/ML INJECTABLE

SOLUTION [CLINIMIX 5/15] CLINIMIX 5/15 INJECTABLE SOLUTION

ARGININE 5.75 MG/ML /

GLUCOSE 200 MG/ML /

GLYCINE 5.15 MG/ML /

HISTIDINE 2.4 MG/ML /

ISOLEUCINE 3 MG/ML /

LEUCINE 3.65 MG/ML / LYSINE

2.9 MG/ML / METHIONINE 2

MG/ML / PHENYLALANINE 2.8

MG/ML / PROLINE 3.4 MG/ML /

SERINE 2.5 MG/ML /

THREONINE 2.1 MG/ML /

TRYPTOPHAN 0.9 MG/ML /

TYROSINE 0.2 MG/ML / VALINE

2.9 MG/ML INJECTABLE

SOLUTION [CLINIMIX 5/20] CLINIMIX 5/20 INJECTABLE SOLUTION

ARGININE 5.75 MG/ML /

GLUCOSE 250 MG/ML /

GLYCINE 5.15 MG/ML /

HISTIDINE 2.4 MG/ML /

ISOLEUCINE 3 MG/ML /

LEUCINE 3.65 MG/ML / LYSINE

2.9 MG/ML / METHIONINE 2

MG/ML / PHENYLALANINE 2.8

MG/ML / PROLINE 3.4 MG/ML /

SERINE 2.5 MG/ML /

THREONINE 2.1 MG/ML /

TRYPTOPHAN 0.9 MG/ML /

TYROSINE 0.2 MG/ML / VALINE

2.9 MG/ML INJECTABLE

SOLUTION [CLINIMIX 5/25] CLINIMIX 5/25 INJECTABLE SOLUTION

SAMPLE - Formulary

8.5 MG/ML / GLYCINE 11

MG/ML / HISTIDINE 2.6 MG/ML /

ISOLEUCINE 6.2 MG/ML /

LEUCINE 8.1 MG/ML / LYSINE

6.24 MG/ML / MAGNESIUM

CHLORIDE 0.00502 MEQ/ML /

METHIONINE 3.4 MG/ML /

PHENYLALANINE 3.8 MG/ML /

POTASSIUM CHLORIDE 0.0654

MEQ/ML / PROLINE 7.5 MG/ML /

SERINE 3.7 MG/ML / SODIUM

CHLORIDE 0.00479 MEQ/ML /

SODIUM PHOSPHATE 0.0299

MEQ/ML / THREONINE 4.6

MG/ML / TRYPTOPHAN 1.5

MG/ML / TYROSINE 0.44 MG/ML

/ VALINE 6.8 MG/ML

INJECTABLE SOLUTION

[AMINOSYN 8.5 % WITH

ELECTROLYTES, SULFITE-

FREE]

AMINOSYN 8.5 % WITH

ELECTROLYTES, SULFITE-

FREE INJECTABLE SOLUTION

ARGININE 15.3 MG/ML /

ASPARTATE 10.5 MG/ML /

GLUTAMATE 11.1 MG/ML /

GLYCINE 7.5 MG/ML /

HISTIDINE 4.5 MG/ML /

ISOLEUCINE 9.9 MG/ML /

LEUCINE 15 MG/ML / LYSINE

15.8 MG/ML / METHIONINE 2.58

MG/ML / PHENYLALANINE 4.47

MG/ML / PROLINE 10.8 MG/ML /

SERINE 7.95 MG/ML /

THREONINE 6 MG/ML /

TRYPTOPHAN 3 MG/ML /

TYROSINE 4.05 MG/ML /

VALINE 7.5 MG/ML

INJECTABLE SOLUTION AMINOSYN II 15% INJECTABLE SOLUTION

SAMPLE - Formulary

ARGININE 2.9 MG/ML /

CALCIUM ACETATE 0.003

MEQ/ML / CYSTEINE 0.2 MG/ML

/ GLYCERIN 30 MG/ML /

GLYCINE 4.2 MG/ML /

HISTIDINE 0.85 MG/ML /

ISOLEUCINE 2.1 MG/ML /

LEUCINE 2.7 MG/ML / LYSINE

3.1 MG/ML / MAGNESIUM

ACETATE 0.008 MEQ/ML /

METHIONINE 1.6 MG/ML /

PHENYLALANINE 1.7 MG/ML /

PHOSPHORIC ACID 0.41

MG/ML / POTASSIUM

CHLORIDE 0.02 MEQ/ML /

PROLINE 3.4 MG/ML / SERINE

1.8 MG/ML / SODIUM ACETATE

0.025 MEQ/ML / SODIUM

CHLORIDE 0.014 MEQ/ML /

THREONINE 1.2 MG/ML /

TRYPTOPHAN 0.46 MG/ML /

VALINE 2 MG/ML INJECTABLE PROCALAMINE 3 INJECTABLE SOLUTIONALANINE 20.7 MG/ML /

ARGININE 11.5 MG/ML /

GLYCINE 10.3 MG/ML /

HISTIDINE 4.8 MG/ML /

ISOLEUCINE 6 MG/ML /

LEUCINE 7.3 MG/ML / LYSINE

5.8 MG/ML / METHIONINE 4

MG/ML / PHENYLALANINE 5.6

MG/ML / PROLINE 6.8 MG/ML /

SERINE 5 MG/ML / THREONINE

4.2 MG/ML / TRYPTOPHAN 1.8

MG/ML / TYROSINE 0.4 MG/ML /

VALINE 5.8 MG/ML

INJECTABLE SOLUTION TRAVASOL 10 INJECTABLE SOLUTION

ARGININE 14.7 MG/ML /

ASPARTATE 4.34 MG/ML /

GLUTAMATE 7.49 MG/ML /

GLYCINE 10.4 MG/ML /

HISTIDINE 8.94 MG/ML /

ISOLEUCINE 7.49 MG/ML /

LEUCINE 10.4 MG/ML / LYSINE

11.8 MG/ML / METHIONINE 7.49

MG/ML / PHENYLALANINE 10.4

MG/ML / PROLINE 8.94 MG/ML /

SERINE 5.92 MG/ML /

THREONINE 7.49 MG/ML /

TRYPTOPHAN 2.5 MG/ML /

TYROSINE 0.39 MG/ML /

VALINE 9.6 MG/ML

INJECTABLE SOLUTION CLINISOL 15 INJECTABLE SOLUTION

SAMPLE - Formulary

ARGININE 19.6 MG/ML /

ASPARTATE 6 MG/ML /

GLUTAMATE 10.2 MG/ML /

GLYCINE 20.6 MG/ML /

HISTIDINE 11.8 MG/ML /

ISOLEUCINE 10.8 MG/ML /

LEUCINE 10.8 MG/ML / LYSINE

13.5 MG/ML / METHIONINE 7.6

MG/ML / PHENYLALANINE 10

MG/ML / PROLINE 13.4 MG/ML /

SERINE 10.2 MG/ML /

THREONINE 9.8 MG/ML /

TRYPTOPHAN 3.2 MG/ML /

TYROSINE 0.5 MG/ML / VALINE

14.4 MG/ML INJECTABLE

SOLUTION [PROSOL] PROSOL INJECTABLE SOLUTION

ARGININE 7.3 MG/ML /

ASPARTATE 1.9 MG/ML /

CYSTEINE 0.14 MG/ML /

GLUTAMATE 3 MG/ML /

GLYCINE 2.2 MG/ML /

HISTIDINE 2.9 MG/ML /

ISOLEUCINE 4.9 MG/ML /

LEUCINE 8.4 MG/ML / LYSINE

4.9 MG/ML / METHIONINE 2

MG/ML / PHENYLALANINE 2.9

MG/ML / PROLINE 4.1 MG/ML /

SERINE 2.3 MG/ML / TAURINE

0.15 MG/ML / THREONINE 2.5

MG/ML / TRYPTOPHAN 1.2

MG/ML / TYROSINE 1.4 MG/ML /

VALINE 4.7 MG/ML PREMASOL INJECTABLE SOLUTION

ARGININE 7.3 MG/ML /

ASPARTATE 1.9 MG/ML /

CYSTEINE 0.2 MG/ML /

GLUTAMATE 3 MG/ML /

GLYCINE 2.2 MG/ML /

HISTIDINE 2.9 MG/ML /

ISOLEUCINE 4.9 MG/ML /

LEUCINE 8.4 MG/ML / LYSINE

6.9 MG/ML / METHIONINE 2

MG/ML / PHENYLALANINE 2.9

MG/ML / PROLINE 4.1 MG/ML /

SERINE 2.3 MG/ML / SODIUM

ACETATE 0.0544 MEQ/ML /

SODIUM CHLORIDE 0.003

MEQ/ML / SODIUM

METABISULFITE 0.5 MG/ML /

TAURINE 0.15 MG/ML /

THREONINE 2.5 MG/ML /

TRYPTOPHAN 1.2 MG/ML /

TYROSINE 1.64 MG/ML /

VALINE 4.7 MG/ML TROPHAMINE 6 % INJECTABLE SOLUTION

SAMPLE - FormularyALANINE 4 MG/ML / ARGININE

5.8 MG/ML / CYSTEINE 0.2

MG/ML / GLYCINE 3.3 MG/ML /

HISTIDINE 1.6 MG/ML /

ISOLEUCINE 7.6 MG/ML /

LEUCINE 13.7 MG/ML / LYSINE

5.8 MG/ML / METHIONINE 2.5

MG/ML / PHENYLALANINE 3.2

MG/ML / PROLINE 6.3 MG/ML /

SERINE 3.3 MG/ML /

THREONINE 2 MG/ML /

TRYPTOPHAN 0.9 MG/ML /

VALINE 8.8 MG/ML

INJECTABLE SOLUTION FREAMINE 6.9 INJECTABLE SOLUTION

ARGININE 3.43 MG/ML /

GLYCINE 4.48 MG/ML /

HISTIDINE 1.05 MG/ML /

ISOLEUCINE 2.52 MG/ML /

LEUCINE 3.29 MG/ML / LYSINE

2.52 MG/ML / MAGNESIUM

ACETATE 0.003 MEQ/ML /

METHIONINE 1.4 MG/ML /

PHENYLALANINE 1.54 MG/ML /

PHOSPHORIC ACID 0.4 MG/ML

/ POTASSIUM ACETATE 0.01

MEQ/ML / PROLINE 3 MG/ML /

SERINE 1.47 MG/ML / SODIUM

CHLORIDE 0.04 MEQ/ML /

THREONINE 1.82 MG/ML /

TRYPTOPHAN 0.56 MG/ML /

TYROSINE 0.31 MG/ML /

VALINE 2.8 MG/ML

INJECTABLE SOLUTION

[AMINOSYN 3.5 % M, SULFITE

AMINOSYN 3.5 % M, SULFITE

FREE INJECTABLE SOLUTION

ARGININE 8.61 MG/ML /

ASPARTATE 3.7 MG/ML /

GLUTAMATE 5.76 MG/ML /

GLYCINE 2.7 MG/ML /

HISTIDINE 2.2 MG/ML /

ISOLEUCINE 5.34 MG/ML /

LEUCINE 8.31 MG/ML / LYSINE

4.75 MG/ML / METHIONINE 1.25

MG/ML / PHENYLALANINE 3

MG/ML / PROLINE 5.7 MG/ML /

SERINE 3.47 MG/ML / TAURINE

0.5 MG/ML / THREONINE 3.6

MG/ML / TRYPTOPHAN 1.25

MG/ML / TYROSINE 0.44 MG/ML

/ VALINE 4.52 MG/ML

INJECTABLE SOLUTION AMINOSYN-PF 7% INJECTABLE SOLUTION

SAMPLE - Formulary

ARGININE 12 MG/ML /

ASPARTATE 3.2 MG/ML /

CYSTEINE 0.16 MG/ML /

GLUTAMATE 5 MG/ML /

GLYCINE 3.6 MG/ML /

HISTIDINE 4.8 MG/ML /

ISOLEUCINE 8.2 MG/ML /

LEUCINE 14 MG/ML / LYSINE

8.2 MG/ML / METHIONINE 3.4

MG/ML / PHENYLALANINE 4.8

MG/ML / PROLINE 6.8 MG/ML /

SERINE 3.8 MG/ML / TAURINE

0.25 MG/ML / THREONINE 4.2

MG/ML / TRYPTOPHAN 2

MG/ML / TYROSINE 2.4 MG/ML /

VALINE 7.8 MG/ML PREMASOL INJECTABLE SOLUTION

ARGININE 12 MG/ML /

ASPARTATE 3.2 MG/ML /

CYSTEINE 0.24 MG/ML /

GLUTAMATE 5 MG/ML /

GLYCINE 3.6 MG/ML /

HISTIDINE 4.8 MG/ML /

ISOLEUCINE 8.2 MG/ML /

LEUCINE 1.4 MG/ML / LYSINE

1.2 MG/ML / METHIONINE 3.4

MG/ML / PHENYLALANINE 4.8

MG/ML / PROLINE 6.8 MG/ML /

SERINE 3.8 MG/ML / SODIUM

ACETATE 0.097 MEQ/ML /

SODIUM CHLORIDE 0.003

MEQ/ML / SODIUM

METABISULFITE 0.5 MG/ML /

TAURINE 0.25 MG/ML /

THREONINE 4.2 MG/ML /

TRYPTOPHAN 2 MG/ML /

TYROSINE 2.84 MG/ML /

VALINE 7.8 MG/ML

INJECTABLE SOLUTION TROPHAMINE 10 % INJECTABLE SOLUTION

SAMPLE - Formulary

ALANINE 5.7 MG/ML /

ARGININE 3.16 MG/ML /

CALCIUM CHLORIDE 0.004

MEQ/ML / DIBASIC POTASSIUM

PHOSPHATE 2.61 MG/ML /

GLUCOSE 100 MG/ML /

GLYCINE 2.83 MG/ML /

HISTIDINE 1.32 MG/ML /

ISOLEUCINE 1.65 MG/ML /

LEUCINE 2.01 MG/ML / LYSINE

1.59 MG/ML / MAGNESIUM

CHLORIDE 0.01 MEQ/ML /

METHIONINE 1.1 MG/ML /

PHENYLALANINE 1.54 MG/ML /

PROLINE 1.87 MG/ML / SERINE

1.38 MG/ML / SODIUM

ACETATE TRIHYDRATE 2.17

MG/ML / SODIUM CHLORIDE

0.02 MEQ/ML / THREONINE

1.16 MG/ML / TRYPTOPHAN 0.5

MG/ML / TYROSINE 0.11 MG/ML

/ VALINE 1.6 MG/ML

INJECTABLE SOLUTION CLINIMIX E 2.75/10 INJECTABLE SOLUTION

ARGININE 3.16 MG/ML /

CALCIUM CHLORIDE 0.004

MEQ/ML / DIBASIC POTASSIUM

PHOSPHATE 2.61 MG/ML /

GLUCOSE 50 MG/ML /

GLYCINE 2.83 MG/ML /

HISTIDINE 1.32 MG/ML /

ISOLEUCINE 1.65 MG/ML /

LEUCINE 2.01 MG/ML / LYSINE

1.59 MG/ML / MAGNESIUM

CHLORIDE 0.01 MEQ/ML /

METHIONINE 1.1 MG/ML /

PHENYLALANINE 1.54 MG/ML /

PROLINE 1.87 MG/ML / SERINE

1.38 MG/ML / SODIUM

ACETATE TRIHYDRATE 2.17

MG/ML / SODIUM CHLORIDE

0.02 MEQ/ML / THREONINE

1.16 MG/ML / TRYPTOPHAN 0.5

MG/ML / TYROSINE 0.11 MG/ML

/ VALINE 1.6 MG/ML

INJECTABLE SOLUTION CLINIMIX E 2.75/5 INJECTABLE SOLUTION

SAMPLE - FormularyALANINE 5.7 MG/ML /

ARGININE 3.16 MG/ML /

GLUCOSE 50 MG/ML /

GLYCINE 2.83 MG/ML /

HISTIDINE 1.32 MG/ML /

ISOLEUCINE 1.65 MG/ML /

LEUCINE 2.01 MG/ML / LYSINE

1.59 MG/ML / METHIONINE 1.1

MG/ML / PHENYLALANINE 1.54

MG/ML / PROLINE 1.87 MG/ML /

SERINE 1.38 MG/ML /

THREONINE 1.16 MG/ML /

TRYPTOPHAN 0.5 MG/ML /

TYROSINE 0.11 MG/ML /

VALINE 1.6 MG/ML CLINIMIX 2.75/5 INJECTABLE SOLUTION

ARGININE 5.07 MG/ML /

GLYCINE 6.6 MG/ML /

HISTIDINE 1.54 MG/ML /

ISOLEUCINE 7.89 MG/ML /

LEUCINE 15.8 MG/ML / LYSINE

2.65 MG/ML / METHIONINE 2.06

MG/ML / PHENYLALANINE 2.28

MG/ML / PROLINE 4.48 MG/ML /

SERINE 2.21 MG/ML /

THREONINE 2.72 MG/ML /

TRYPTOPHAN 0.88 MG/ML /

TYROSINE 0.33 MG/ML /

VALINE 7.89 MG/ML

INJECTABLE SOLUTION

[AMINOSYN-HBC 7 %, SULFITE-

AMINOSYN-HBC 7 %,

SULFITE-FREE INJECTABLE SOLUTION

ARGININE 7.13 MG/ML /

ASPARTATE 4.9 MG/ML /

GLUTAMATE 5.17 MG/ML /

GLYCINE 3.5 MG/ML /

HISTIDINE 2.1 MG/ML /

ISOLEUCINE 4.62 MG/ML /

LEUCINE 7 MG/ML / LYSINE

7.35 MG/ML / METHIONINE 1.2

MG/ML / PHENYLALANINE 2.09

MG/ML / PROLINE 5.05 MG/ML /

SERINE 3.71 MG/ML /

THREONINE 2.8 MG/ML /

TRYPTOPHAN 1.4 MG/ML /

TYROSINE 1.89 MG/ML /

VALINE 3.5 MG/ML

INJECTABLE SOLUTION

[AMINOSYN II 7 %, SULFITE-

AMINOSYN II 7 %, SULFITE-

FREE INJECTABLE SOLUTION

SAMPLE - Formulary

ARGININE 12.3 MG/ML /

ASPARTATE 5.27 MG/ML /

GLUTAMATE 8.2 MG/ML /

GLYCINE 3.85 MG/ML /

HISTIDINE 3.12 MG/ML /

ISOLEUCINE 7.6 MG/ML /

LEUCINE 12 MG/ML / LYSINE

6.77 MG/ML / METHIONINE 1.8

MG/ML / PHENYLALANINE 4.27

MG/ML / PROLINE 8.12 MG/ML /

SERINE 4.95 MG/ML / TAURINE

0.7 MG/ML / THREONINE 5.12

MG/ML / TRYPTOPHAN 1.8

MG/ML / TYROSINE 0.44 MG/ML

/ VALINE 6.73 MG/ML

INJECTABLE SOLUTION

[AMINOSYN-PF 10 %, SULFITE-

FREE]

AMINOSYN-PF 10 %,

SULFITE-FREE INJECTABLE SOLUTIONALANINE 7.7 MG/ML /

ARGININE 6 MG/ML /

CYSTEINE 0.2 MG/ML /

GLYCINE 9 MG/ML / HISTIDINE

2.4 MG/ML / ISOLEUCINE 9

MG/ML / LEUCINE 11 MG/ML /

LYSINE 6.1 MG/ML /

METHIONINE 1 MG/ML /

PHENYLALANINE 1 MG/ML /

PHOSPHORIC ACID 1.15

MG/ML / PROLINE 8 MG/ML /

SERINE 5 MG/ML / THREONINE

4.5 MG/ML / TRYPTOPHAN 0.66

MG/ML / VALINE 8.4 MG/ML

INJECTABLE SOLUTION HEPATAMINE 8 INJECTABLE SOLUTION

SAMPLE - Formulary

ALANINE 8.44 MG/ML /

ARGININE 8.65 MG/ML /

ASPARTATE 5.95 MG/ML /

GLUTAMATE 6.27 MG/ML /

GLYCINE 4.25 MG/ML /

HISTIDINE 2.55 MG/ML /

ISOLEUCINE 5.61 MG/ML /

LEUCINE 8.5 MG/ML / LYSINE

8.93 MG/ML / MAGNESIUM

CHLORIDE 0.005 MEQ/ML /

METHIONINE 1.46 MG/ML /

PHENYLALANINE 2.53 MG/ML /

POTASSIUM CHLORIDE 0.066

MEQ/ML / PROLINE 6.14 MG/ML

/ SERINE 4.5 MG/ML / SODIUM

CHLORIDE 0.01 MEQ/ML /

SODIUM PHOSPHATE, DIBASIC

0.0299 MEQ/ML / THREONINE

3.4 MG/ML / TRYPTOPHAN 1.7

MG/ML / TYROSINE 2.3 MG/ML /

VALINE 4.25 MG/ML

INJECTABLE SOLUTION

[AMINOSYN II 8.5 % WITH

ELECTROLYTES, SULFITE-

AMINOSYN II 8.5 % WITH

ELECTROLYTES, SULFITE-

FREE INJECTABLE SOLUTION

ARGININE 8.65 MG/ML /

ASPARTATE 5.95 MG/ML /

GLUTAMATE 6.27 MG/ML /

GLYCINE 4.25 MG/ML /

HISTIDINE 2.55 MG/ML /

ISOLEUCINE 5.61 MG/ML /

LEUCINE 8.5 MG/ML / LYSINE

8.93 MG/ML / METHIONINE 1.46

MG/ML / PHENYLALANINE 2.53

MG/ML / PROLINE 6.14 MG/ML /

SERINE 4.5 MG/ML /

THREONINE 3.4 MG/ML /

TRYPTOPHAN 1.7 MG/ML /

TYROSINE 2.3 MG/ML / VALINE

4.25 MG/ML INJECTABLE

SOLUTION [AMINOSYN II 8.5 %,

SULFITE-FREE]

AMINOSYN II 8.5 %, SULFITE-

SAMPLE - Formulary

ALANINE 8.8 MG/ML /

ARGININE 4.89 MG/ML /

CALCIUM CHLORIDE 0.004

MEQ/ML / DIBASIC POTASSIUM

PHOSPHATE 2.61 MG/ML /

GLUCOSE 100 MG/ML /

GLYCINE 4.38 MG/ML /

HISTIDINE 2.04 MG/ML /

ISOLEUCINE 2.55 MG/ML /

LEUCINE 3.11 MG/ML / LYSINE

2.47 MG/ML / MAGNESIUM

CHLORIDE 0.01 MEQ/ML /

METHIONINE 1.7 MG/ML /

PHENYLALANINE 2.38 MG/ML /

PROLINE 2.89 MG/ML / SERINE

2.13 MG/ML / SODIUM

ACETATE TRIHYDRATE 2.97

MG/ML / SODIUM CHLORIDE

0.013 MEQ/ML / THREONINE

1.79 MG/ML / TRYPTOPHAN

0.77 MG/ML / TYROSINE 0.17

MG/ML / VALINE 2.47 MG/ML

INJECTABLE SOLUTION CLINIMIX E 4.25/10 INJECTABLE SOLUTION

ALANINE 8.8 MG/ML /

ARGININE 4.89 MG/ML /

CALCIUM CHLORIDE 0.004

MEQ/ML / DIBASIC POTASSIUM

PHOSPHATE 2.61 MG/ML /

GLUCOSE 250 MG/ML /

GLYCINE 4.38 MG/ML /

HISTIDINE 2.04 MG/ML /

ISOLEUCINE 2.55 MG/ML /

LEUCINE 3.11 MG/ML / LYSINE

2.47 MG/ML / MAGNESIUM

CHLORIDE 0.01 MEQ/ML /

METHIONINE 1.7 MG/ML /

PHENYLALANINE 2.38 MG/ML /

PROLINE 2.89 MG/ML / SERINE

2.13 MG/ML / SODIUM

ACETATE TRIHYDRATE 2.97

MG/ML / SODIUM CHLORIDE

0.013 MEQ/ML / THREONINE

1.79 MG/ML / TRYPTOPHAN

0.77 MG/ML / TYROSINE 0.17

MG/ML / VALINE 2.47 MG/ML

INJECTABLE SOLUTION CLINIMIX E 4.25/25 INJECTABLE SOLUTION

SAMPLE - Formulary

ARGININE 4.89 MG/ML /

CALCIUM CHLORIDE 0.004

MEQ/ML / DIBASIC POTASSIUM

PHOSPHATE 2.61 MG/ML /

GLUCOSE 50 MG/ML /

GLYCINE 4.38 MG/ML /

HISTIDINE 2.04 MG/ML /

ISOLEUCINE 2.55 MG/ML /

LEUCINE 3.11 MG/ML / LYSINE

2.47 MG/ML / MAGNESIUM

CHLORIDE 0.01 MEQ/ML /

METHIONINE 1.7 MG/ML /

PHENYLALANINE 2.38 MG/ML /

PROLINE 2.89 MG/ML / SERINE

2.13 MG/ML / SODIUM

ACETATE TRIHYDRATE 2.97

MG/ML / SODIUM CHLORIDE

0.013 MEQ/ML / THREONINE

1.79 MG/ML / TRYPTOPHAN

0.77 MG/ML / TYROSINE 0.17

MG/ML / VALINE 2.47 MG/ML

INJECTABLE SOLUTION CLINIMIX E 4.25/5 INJECTABLE SOLUTION

ARGININE 4.89 MG/ML /

GLUCOSE 100 MG/ML /

GLYCINE 4.38 MG/ML /

HISTIDINE 2.04 MG/ML /

ISOLEUCINE 2.55 MG/ML /

LEUCINE 3.11 MG/ML / LYSINE

2.47 MG/ML / METHIONINE 1.7

MG/ML / PHENYLALANINE 2.38

MG/ML / PROLINE 2.89 MG/ML /

SERINE 2.13 MG/ML /

THREONINE 1.79 MG/ML /

TRYPTOPHAN 0.77 MG/ML /

TYROSINE 0.17 MG/ML /

VALINE 2.47 MG/ML

INJECTABLE SOLUTION CLINIMIX 4.25/10 INJECTABLE SOLUTION

ARGININE 4.89 MG/ML /

GLUCOSE 200 MG/ML /

GLYCINE 4.38 MG/ML /

HISTIDINE 2.04 MG/ML /

ISOLEUCINE 2.55 MG/ML /

LEUCINE 3.11 MG/ML / LYSINE

2.47 MG/ML / METHIONINE 1.7

MG/ML / PHENYLALANINE 2.38

MG/ML / PROLINE 2.89 MG/ML /

SERINE 2.13 MG/ML /

THREONINE 1.79 MG/ML /

TRYPTOPHAN 0.77 MG/ML /

TYROSINE 0.17 MG/ML /

VALINE 2.47 MG/ML

INJECTABLE SOLUTION CLINIMIX 4.25/20 INJECTABLE SOLUTION

SAMPLE - Formulary

ARGININE 4.89 MG/ML /

GLUCOSE 250 MG/ML /

GLYCINE 4.38 MG/ML /

HISTIDINE 2.04 MG/ML /

ISOLEUCINE 2.55 MG/ML /

LEUCINE 3.11 MG/ML / LYSINE

2.47 MG/ML / METHIONINE 1.7

MG/ML / PHENYLALANINE 2.38

MG/ML / PROLINE 2.89 MG/ML /

SERINE 2.13 MG/ML /

THREONINE 1.79 MG/ML /

TRYPTOPHAN 0.77 MG/ML /

TYROSINE 0.17 MG/ML /

VALINE 2.47 MG/ML

INJECTABLE SOLUTION CLINIMIX 4.25/25 INJECTABLE SOLUTION

ARGININE 4.89 MG/ML /

GLUCOSE 50 MG/ML /

GLYCINE 4.38 MG/ML /

HISTIDINE 2.04 MG/ML /

ISOLEUCINE 2.55 MG/ML /

LEUCINE 3.11 MG/ML / LYSINE

2.47 MG/ML / METHIONINE 1.7

MG/ML / PHENYLALANINE 2.38

MG/ML / PROLINE 2.89 MG/ML /

SERINE 2.13 MG/ML /

THREONINE 1.79 MG/ML /

TRYPTOPHAN 0.77 MG/ML /

TYROSINE 0.17 MG/ML /

VALINE 2.47 MG/ML

INJECTABLE SOLUTION CLINIMIX 4.25/5 INJECTABLE SOLUTION

6.9 MG/ML / GLYCINE 9 MG/ML

/ HISTIDINE 2.1 MG/ML /

ISOLEUCINE 5.1 MG/ML /

LEUCINE 6.6 MG/ML / LYSINE

5.1 MG/ML / MAGNESIUM

CHLORIDE 0.005 MEQ/ML /

METHIONINE 2.8 MG/ML /

PHENYLALANINE 3.1 MG/ML /

POTASSIUM CHLORIDE 0.065

MEQ/ML / PROLINE 6.1 MG/ML /

SERINE 3 MG/ML / SODIUM

CHLORIDE 0.00479 MEQ/ML /

SODIUM PHOSPHATE, DIBASIC

0.0299 MEQ/ML / THREONINE

3.7 MG/ML / TRYPTOPHAN 1.2

MG/ML / TYROSINE 0.44 MG/ML

/ VALINE 5.6 MG/ML

INJECTABLE SOLUTION

[AMINOSYN 7 % WITH

ELECTROLYTES, SULFITE-

FREE]

AMINOSYN 7 % WITH

ELECTROLYTES, SULFITE-

SAMPLE - Formulary

ARGININE 10.2 MG/ML /

ASPARTATE 7 MG/ML /

GLUTAMATE 7.38 MG/ML /

GLYCINE 5 MG/ML / HISTIDINE

3 MG/ML / ISOLEUCINE 6.6

MG/ML / LEUCINE 10 MG/ML /

LYSINE 10.5 MG/ML /

METHIONINE 1.72 MG/ML /

PHENYLALANINE 2.98 MG/ML /

PROLINE 7.22 MG/ML / SERINE

5.3 MG/ML / THREONINE 4

MG/ML / TRYPTOPHAN 2

MG/ML / TYROSINE 2.7 MG/ML /

VALINE 5 MG/ML INJECTABLE

SOLUTION [AMINOSYN II 10 %] AMINOSYN II 10 % INJECTABLE SOLUTION

ALBENDAZOLE 200 MG ORAL

TABLET [ALBENZA] ALBENZA ORAL TABLET

0.5 ML ALBIGLUTIDE 100

MG/ML PREFILLED SYRINGE

[TANZEUM] TANZEUM PREFILLED SYRINGE

0.5 ML ALBIGLUTIDE 60 MG/ML

PREFILLED SYRINGE

[TANZEUM] TANZEUM PREFILLED SYRINGE

200 ACTUAT ALBUTEROL 0.09

MG/ACTUAT DRY POWDER

INHALER [PROAIR] PROAIR DRY POWDER INHALER

200 ACTUAT ALBUTEROL 0.09

MG/ACTUAT METERED DOSE

INHALER [PROAIR HFA] PROAIR HFA METERED DOSE INHALER

200 ACTUAT ALBUTEROL 0.09

MG/ACTUAT METERED DOSE

INHALER [PROVENTIL] PROVENTIL METERED DOSE INHALER

200 ACTUAT ALBUTEROL 0.09

MG/ACTUAT METERED DOSE

INHALER [VENTOLIN] VENTOLIN METERED DOSE INHALER

120 ACTUAT ALBUTEROL 0.1

MG/ACTUAT / IPRATROPIUM

BROMIDE 0.02 MG/ACTUAT

METERED DOSE INHALER

[COMBIVENT] COMBIVENT METERED DOSE INHALER

ALBUTEROL 0.21 MG/ML

INHALANT SOLUTION INHALANT SOLUTION

ALBUTEROL 0.4 MG/ML ORAL

SOLUTION ORAL SOLUTION

ALBUTEROL 0.417 MG/ML

INHALANT SOLUTION INHALANT SOLUTION

ALBUTEROL 0.83 MG/ML

INHALANT SOLUTION INHALANT SOLUTION

ALBUTEROL 0.833 MG/ML /

IPRATROPIUM BROMIDE 0.167

MG/ML INHALANT SOLUTION INHALANT SOLUTION

ALBUTEROL 1 MG/ML

INHALANT SOLUTION INHALANT SOLUTION

ALBUTEROL 2 MG ORAL

TABLET ORAL TABLET

SAMPLE - Formulary

12 HR ALBUTEROL 4 MG

EXTENDED RELEASE ORAL

TABLET

EXTENDED RELEASE ORAL

TABLET

ALBUTEROL 4 MG ORAL

TABLET ORAL TABLET

12 HR ALBUTEROL 4 MG

EXTENDED RELEASE ORAL

TABLET [VOSPIRE] VOSPIRE

EXTENDED RELEASE ORAL

TABLET

12 HR ALBUTEROL 8 MG

EXTENDED RELEASE ORAL

TABLET

EXTENDED RELEASE ORAL

TABLET

12 HR ALBUTEROL 8 MG

EXTENDED RELEASE ORAL

TABLET [VOSPIRE] VOSPIRE

EXTENDED RELEASE ORAL

TABLET

ALCAFTADINE 2.5 MG/ML

OPHTHALMIC SOLUTION

[LASTACAFT] LASTACAFT OPHTHALMIC SOLUTION

ALCLOMETASONE

DIPROPIONATE 0.0005 MG/MG

TOPICAL OINTMENT TOPICAL OINTMENT

ALCLOMETASONE

DIPROPIONATE 0.5 MG/ML

TOPICAL CREAM TOPICAL CREAM

ALDESLEUKIN 1.1 MG/ML

INJECTABLE SOLUTION

[PROLEUKIN] PROLEUKIN INJECTABLE SOLUTION

ALENDRONIC ACID 0.933

MG/ML ORAL SOLUTION ORAL SOLUTION

ALENDRONIC ACID 10 MG

ORAL TABLET ORAL TABLET

ALENDRONIC ACID 35 MG

ORAL TABLET ORAL TABLET

ALENDRONIC ACID 40 MG

ORAL TABLET ORAL TABLET

ALENDRONIC ACID 5 MG ORAL

TABLET ORAL TABLET

ALENDRONIC ACID 70 MG

ORAL TABLET ORAL TABLET

ALENDRONIC ACID 70 MG

EFFERVESCENT ORAL

TABLET [BINOSTO] BINOSTO

EFFERVESCENT ORAL

TABLET

ALENDRONIC ACID 70 MG

ORAL TABLET [FOSAMAX] FOSAMAX ORAL TABLET

ALENDRONIC ACID 70 MG /

CHOLECALCIFEROL 2800 UNT

ORAL TABLET [FOSAMAX

PLUS D] FOSAMAX PLUS D ORAL TABLET

ALENDRONIC ACID 70 MG /

CHOLECALCIFEROL 5600 UNT

ORAL TABLET [FOSAMAX

PLUS D] FOSAMAX PLUS D ORAL TABLET

24 HR ALFUZOSIN

HYDROCHLORIDE 10 MG

EXTENDED RELEASE ORAL

TABLET

EXTENDED RELEASE ORAL

TABLET

SAMPLE - Formulary

24 HR ALFUZOSIN

HYDROCHLORIDE 10 MG

EXTENDED RELEASE ORAL

TABLET [UROXATRAL] UROXATRAL

EXTENDED RELEASE ORAL

TABLET

ALGLUCOSIDASE ALFA 5

MG/ML INJECTABLE SOLUTION

[LUMIZYME] LUMIZYME INJECTABLE SOLUTION

ALGLUCOSIDASE ALFA 5

MG/ML INJECTABLE SOLUTION

[MYOZYME] MYOZYME INJECTABLE SOLUTION

ALISKIREN 150 MG ORAL

TABLET [TEKTURNA] TEKTURNA ORAL TABLET

ALISKIREN 150 MG /

HYDROCHLOROTHIAZIDE 12.5

MG ORAL TABLET [TEKTURNA

HCT] TEKTURNA HCT ORAL TABLET

ALISKIREN 150 MG /

HYDROCHLOROTHIAZIDE 25

MG ORAL TABLET [TEKTURNA

HCT] TEKTURNA HCT ORAL TABLET

ALISKIREN 300 MG ORAL

TABLET [TEKTURNA] TEKTURNA ORAL TABLET

ALISKIREN 300 MG /

HYDROCHLOROTHIAZIDE 12.5

MG ORAL TABLET [TEKTURNA

HCT] TEKTURNA HCT ORAL TABLET

ALISKIREN 300 MG /

HYDROCHLOROTHIAZIDE 25

MG ORAL TABLET [TEKTURNA

HCT] TEKTURNA HCT ORAL TABLET

ALITRETINOIN 0.001 MG/MG

TOPICAL GEL [PANRETIN] PANRETIN TOPICAL GEL

ALLOPURINOL 100 MG ORAL

TABLET ORAL TABLET

ALLOPURINOL 100 MG ORAL

TABLET [ZYLOPRIM] ZYLOPRIM ORAL TABLET

ALLOPURINOL 20 MG/ML

INJECTABLE SOLUTION

[ALOPRIM] ALOPRIM INJECTABLE SOLUTION

ALLOPURINOL 300 MG ORAL

TABLET ORAL TABLET

ALLOPURINOL 300 MG ORAL

TABLET [ZYLOPRIM] ZYLOPRIM ORAL TABLET

ALMOTRIPTAN 12.5 MG ORAL

TABLET [AXERT] AXERT ORAL TABLET

ALMOTRIPTAN 6.25 MG ORAL

TABLET [AXERT] AXERT ORAL TABLET

ALOGLIPTIN 12.5 MG ORAL

TABLET [NESINA] NESINA ORAL TABLET

ALOGLIPTIN 12.5 MG /

METFORMIN

HYDROCHLORIDE 1000 MG

ORAL TABLET [KAZANO] KAZANO ORAL TABLET

ALOGLIPTIN 12.5 MG /

METFORMIN

HYDROCHLORIDE 500 MG

ORAL TABLET [KAZANO] KAZANO ORAL TABLET

SAMPLE - Formulary

ALOGLIPTIN 12.5 MG /

PIOGLITAZONE 15 MG ORAL

TABLET [OSENI] OSENI ORAL TABLET

ALOGLIPTIN 12.5 MG /

PIOGLITAZONE 30 MG ORAL

TABLET [OSENI] OSENI ORAL TABLET

ALOGLIPTIN 12.5 MG /

PIOGLITAZONE 45 MG ORAL

TABLET [OSENI] OSENI ORAL TABLET

ALOGLIPTIN 25 MG ORAL

TABLET [NESINA] NESINA ORAL TABLET

ALOGLIPTIN 25 MG /

PIOGLITAZONE 15 MG ORAL

TABLET [OSENI] OSENI ORAL TABLET

ALOGLIPTIN 25 MG /

PIOGLITAZONE 30 MG ORAL

TABLET [OSENI] OSENI ORAL TABLET

ALOGLIPTIN 25 MG /

PIOGLITAZONE 45 MG ORAL

TABLET [OSENI] OSENI ORAL TABLET

ALOGLIPTIN 6.25 MG ORAL

TABLET [NESINA] NESINA ORAL TABLET

ALOSETRON 0.5 MG ORAL

TABLET ORAL TABLET

ALOSETRON 0.5 MG ORAL

TABLET [LOTRONEX] LOTRONEX ORAL TABLET

ALOSETRON 1 MG ORAL

TABLET ORAL TABLET

ALOSETRON 1 MG ORAL

TABLET [LOTRONEX] LOTRONEX ORAL TABLET

ALPHA 1-PROTEINASE

INHIBITOR, HUMAN 20 MG/ML

INJECTABLE SOLUTION

[ARALAST] ARALAST INJECTABLE SOLUTION

ALPHA 1-PROTEINASE

INHIBITOR, HUMAN 20 MG/ML

INJECTABLE SOLUTION

[GLASSIA] GLASSIA INJECTABLE SOLUTION

ALPHA 1-PROTEINASE

INHIBITOR, HUMAN 50 MG/ML

INJECTABLE SOLUTION

[PROLASTIN] PROLASTIN INJECTABLE SOLUTION

ALPHA 1-PROTEINASE

INHIBITOR, HUMAN 50 MG/ML

INJECTABLE SOLUTION

[ZEMAIRA] ZEMAIRA INJECTABLE SOLUTION

ALPRAZOLAM 0.25 MG

DISINTEGRATING ORAL

TABLET

DISINTEGRATING ORAL

TABLET

ALPRAZOLAM 0.25 MG ORAL

TABLET ORAL TABLET

ALPRAZOLAM 0.25 MG ORAL

TABLET [XANAX] XANAX ORAL TABLET

ALPRAZOLAM 0.5 MG

DISINTEGRATING ORAL

TABLET

DISINTEGRATING ORAL

SAMPLE - Formulary

24 HR ALPRAZOLAM 0.5 MG

EXTENDED RELEASE ORAL

TABLET

EXTENDED RELEASE ORAL

TABLET

ALPRAZOLAM 0.5 MG ORAL

TABLET ORAL TABLET

24 HR ALPRAZOLAM 0.5 MG

EXTENDED RELEASE ORAL

TABLET [XANAX] XANAX

EXTENDED RELEASE ORAL

TABLET

ALPRAZOLAM 0.5 MG ORAL

TABLET [XANAX] XANAX ORAL TABLET

ALPRAZOLAM 1 MG

DISINTEGRATING ORAL

TABLET

DISINTEGRATING ORAL

TABLET

24 HR ALPRAZOLAM 1 MG

EXTENDED RELEASE ORAL

TABLET

EXTENDED RELEASE ORAL

TABLET

ALPRAZOLAM 1 MG ORAL

TABLET ORAL TABLET

24 HR ALPRAZOLAM 1 MG

EXTENDED RELEASE ORAL

TABLET [XANAX] XANAX

EXTENDED RELEASE ORAL

TABLET

ALPRAZOLAM 1 MG ORAL

TABLET [XANAX] XANAX ORAL TABLET

ALPRAZOLAM 1 MG/ML ORAL

SOLUTION ORAL SOLUTION

ALPRAZOLAM 2 MG

DISINTEGRATING ORAL

TABLET

DISINTEGRATING ORAL

TABLET

24 HR ALPRAZOLAM 2 MG

EXTENDED RELEASE ORAL

TABLET

EXTENDED RELEASE ORAL

TABLET

ALPRAZOLAM 2 MG ORAL

TABLET ORAL TABLET

24 HR ALPRAZOLAM 2 MG

EXTENDED RELEASE ORAL

TABLET [XANAX] XANAX

EXTENDED RELEASE ORAL

TABLET

ALPRAZOLAM 2 MG ORAL

TABLET [XANAX] XANAX ORAL TABLET

24 HR ALPRAZOLAM 3 MG

EXTENDED RELEASE ORAL

TABLET

EXTENDED RELEASE ORAL

TABLET

24 HR ALPRAZOLAM 3 MG

EXTENDED RELEASE ORAL

TABLET [XANAX] XANAX

EXTENDED RELEASE ORAL

TABLET

ALTRETAMINE 50 MG ORAL

CAPSULE [HEXALEN] HEXALEN ORAL CAPSULE

AMANTADINE

HYDROCHLORIDE 10 MG/ML

ORAL SOLUTION ORAL SOLUTION

AMANTADINE

HYDROCHLORIDE 100 MG

ORAL CAPSULE ORAL CAPSULE

AMANTADINE

HYDROCHLORIDE 100 MG

ORAL TABLET ORAL TABLET

AMBRISENTAN 10 MG ORAL

TABLET [LETAIRIS] LETAIRIS ORAL TABLET

SAMPLE - Formulary

AMBRISENTAN 5 MG ORAL

TABLET [LETAIRIS] LETAIRIS ORAL TABLET

AMCINONIDE 0.001 MG/MG

TOPICAL OINTMENT TOPICAL OINTMENT

AMCINONIDE 1 MG/ML

TOPICAL CREAM TOPICAL CREAM

AMCINONIDE 1 MG/ML

TOPICAL LOTION TOPICAL LOTION

AMIFOSTINE 50 MG/ML

INJECTABLE SOLUTION INJECTABLE SOLUTION

AMIKACIN SULFATE 250

MG/ML INJECTABLE SOLUTION INJECTABLE SOLUTION

AMILORIDE HYDROCHLORIDE

5 MG ORAL TABLET ORAL TABLET

AMILORIDE HYDROCHLORIDE

5 MG /

HYDROCHLOROTHIAZIDE 50

MG ORAL TABLET ORAL TABLET

AMINOPHYLLINE 25 MG/ML

INJECTABLE SOLUTION INJECTABLE SOLUTION

AMINOSALICYLIC ACID 4000

MG ORAL GRANULES [PASER

D/R] PASER D/R ORAL GRANULES

AMIODARONE

HYDROCHLORIDE 1.5 MG/ML

INJECTABLE SOLUTION

[NEXTERONE] NEXTERONE INJECTABLE SOLUTION

AMIODARONE

HYDROCHLORIDE 1.8 MG/ML

INJECTABLE SOLUTION

[NEXTERONE] NEXTERONE INJECTABLE SOLUTION

AMIODARONE

HYDROCHLORIDE 100 MG

ORAL TABLET [PACERONE] PACERONE ORAL TABLET

AMIODARONE

HYDROCHLORIDE 200 MG

ORAL TABLET ORAL TABLET

AMIODARONE

HYDROCHLORIDE 200 MG

ORAL TABLET [PACERONE] PACERONE ORAL TABLET

AMIODARONE

HYDROCHLORIDE 400 MG

ORAL TABLET ORAL TABLET

AMIODARONE

HYDROCHLORIDE 400 MG

ORAL TABLET [PACERONE] PACERONE ORAL TABLET

AMIODARONE

HYDROCHLORIDE 50 MG/ML

INJECTABLE SOLUTION INJECTABLE SOLUTION

AMITRIPTYLINE

HYDROCHLORIDE 10 MG

ORAL TABLET ORAL TABLET

AMITRIPTYLINE

HYDROCHLORIDE 10 MG /

PERPHENAZINE 2 MG ORAL

SAMPLE - Formulary

AMITRIPTYLINE

HYDROCHLORIDE 10 MG /

PERPHENAZINE 4 MG ORAL

TABLET ORAL TABLET

AMITRIPTYLINE

HYDROCHLORIDE 100 MG

ORAL TABLET ORAL TABLET

AMITRIPTYLINE

HYDROCHLORIDE 12.5 MG /

CHLORDIAZEPOXIDE 5 MG

ORAL TABLET ORAL TABLET

AMITRIPTYLINE

HYDROCHLORIDE 150 MG

ORAL TABLET ORAL TABLET

AMITRIPTYLINE

HYDROCHLORIDE 25 MG

ORAL TABLET ORAL TABLET

AMITRIPTYLINE

HYDROCHLORIDE 25 MG /

CHLORDIAZEPOXIDE 10 MG

ORAL TABLET ORAL TABLET

AMITRIPTYLINE

HYDROCHLORIDE 25 MG /

PERPHENAZINE 2 MG ORAL

TABLET ORAL TABLET

AMITRIPTYLINE

HYDROCHLORIDE 25 MG /

PERPHENAZINE 4 MG ORAL

TABLET ORAL TABLET

AMITRIPTYLINE

HYDROCHLORIDE 50 MG

ORAL TABLET ORAL TABLET

AMITRIPTYLINE

HYDROCHLORIDE 50 MG /

PERPHENAZINE 4 MG ORAL

TABLET ORAL TABLET

AMITRIPTYLINE

HYDROCHLORIDE 75 MG

ORAL TABLET ORAL TABLET

AMLODIPINE 10 MG ORAL

TABLET ORAL TABLET

AMLODIPINE 10 MG ORAL

TABLET [NORVASC] NORVASC ORAL TABLET

AMLODIPINE 10 MG /

ATORVASTATIN 10 MG ORAL

TABLET ORAL TABLET

AMLODIPINE 10 MG /

ATORVASTATIN 10 MG ORAL

TABLET [CADUET] CADUET ORAL TABLET

AMLODIPINE 10 MG /

ATORVASTATIN 20 MG ORAL

TABLET ORAL TABLET

AMLODIPINE 10 MG /

ATORVASTATIN 20 MG ORAL

TABLET [CADUET] CADUET ORAL TABLET

AMLODIPINE 10 MG /

ATORVASTATIN 40 MG ORAL

SAMPLE - Formulary

AMLODIPINE 10 MG /

ATORVASTATIN 40 MG ORAL

TABLET [CADUET] CADUET ORAL TABLET

AMLODIPINE 10 MG /

ATORVASTATIN 80 MG ORAL

TABLET ORAL TABLET

AMLODIPINE 10 MG /

ATORVASTATIN 80 MG ORAL

TABLET [CADUET] CADUET ORAL TABLET

AMLODIPINE 10 MG /

BENAZEPRIL

HYDROCHLORIDE 20 MG

ORAL CAPSULE ORAL CAPSULE

AMLODIPINE 10 MG /

BENAZEPRIL

HYDROCHLORIDE 20 MG

ORAL CAPSULE [LOTREL] LOTREL ORAL CAPSULE

AMLODIPINE 10 MG /

BENAZEPRIL

HYDROCHLORIDE 40 MG

ORAL CAPSULE ORAL CAPSULE

AMLODIPINE 10 MG /

BENAZEPRIL

HYDROCHLORIDE 40 MG

ORAL CAPSULE [LOTREL] LOTREL ORAL CAPSULE

AMLODIPINE 10 MG /

HYDROCHLOROTHIAZIDE 12.5

MG / OLMESARTAN

MEDOXOMIL 40 MG ORAL

TABLET [TRIBENZOR] TRIBENZOR ORAL TABLET

AMLODIPINE 10 MG /

HYDROCHLOROTHIAZIDE 12.5

MG / VALSARTAN 160 MG

ORAL TABLET ORAL TABLET

AMLODIPINE 10 MG /

HYDROCHLOROTHIAZIDE 12.5

MG / VALSARTAN 160 MG

ORAL TABLET [EXFORGE HCT] EXFORGE HCT ORAL TABLET

AMLODIPINE 10 MG /

HYDROCHLOROTHIAZIDE 25

MG / OLMESARTAN

MEDOXOMIL 40 MG ORAL

TABLET [TRIBENZOR] TRIBENZOR ORAL TABLET

AMLODIPINE 10 MG /

HYDROCHLOROTHIAZIDE 25

MG / VALSARTAN 160 MG

ORAL TABLET ORAL TABLET

AMLODIPINE 10 MG /

HYDROCHLOROTHIAZIDE 25

MG / VALSARTAN 160 MG

ORAL TABLET [EXFORGE HCT] EXFORGE HCT ORAL TABLET

AMLODIPINE 10 MG /

HYDROCHLOROTHIAZIDE 25

MG / VALSARTAN 320 MG

SAMPLE - Formulary

AMLODIPINE 10 MG /

HYDROCHLOROTHIAZIDE 25

MG / VALSARTAN 320 MG

ORAL TABLET [EXFORGE HCT] EXFORGE HCT ORAL TABLET

AMLODIPINE 10 MG /

OLMESARTAN MEDOXOMIL 20

MG ORAL TABLET [AZOR] AZOR ORAL TABLET

AMLODIPINE 10 MG /

OLMESARTAN MEDOXOMIL 40

MG ORAL TABLET [AZOR] AZOR ORAL TABLET

AMLODIPINE 10 MG /

TELMISARTAN 40 MG ORAL

TABLET ORAL TABLET

AMLODIPINE 10 MG /

TELMISARTAN 40 MG ORAL

TABLET [TWYNSTA] TWYNSTA ORAL TABLET

AMLODIPINE 10 MG /

TELMISARTAN 80 MG ORAL

TABLET ORAL TABLET

AMLODIPINE 10 MG /

TELMISARTAN 80 MG ORAL

TABLET [TWYNSTA] TWYNSTA ORAL TABLET

AMLODIPINE 10 MG /

VALSARTAN 160 MG ORAL

TABLET ORAL TABLET

AMLODIPINE 10 MG /

VALSARTAN 160 MG ORAL

TABLET [EXFORGE] EXFORGE ORAL TABLET

AMLODIPINE 10 MG /

VALSARTAN 320 MG ORAL

TABLET ORAL TABLET

AMLODIPINE 10 MG /

VALSARTAN 320 MG ORAL

TABLET [EXFORGE] EXFORGE ORAL TABLET

AMLODIPINE 2.5 MG ORAL

TABLET ORAL TABLET

AMLODIPINE 2.5 MG ORAL

TABLET [NORVASC] NORVASC ORAL TABLET

AMLODIPINE 2.5 MG /

ATORVASTATIN 10 MG ORAL

TABLET ORAL TABLET

AMLODIPINE 2.5 MG /

ATORVASTATIN 10 MG ORAL

TABLET [CADUET] CADUET ORAL TABLET

AMLODIPINE 2.5 MG /

ATORVASTATIN 20 MG ORAL

TABLET ORAL TABLET

AMLODIPINE 2.5 MG /

ATORVASTATIN 20 MG ORAL

TABLET [CADUET] CADUET ORAL TABLET

AMLODIPINE 2.5 MG /

ATORVASTATIN 40 MG ORAL

TABLET ORAL TABLET

AMLODIPINE 2.5 MG /

ATORVASTATIN 40 MG ORAL

TABLET [CADUET] CADUET ORAL TABLET

SAMPLE - Formulary

AMLODIPINE 2.5 MG /

BENAZEPRIL

HYDROCHLORIDE 10 MG

ORAL CAPSULE ORAL CAPSULE

AMLODIPINE 2.5 MG /

BENAZEPRIL

HYDROCHLORIDE 10 MG

ORAL CAPSULE [LOTREL] LOTREL ORAL CAPSULE

AMLODIPINE 5 MG ORAL

TABLET ORAL TABLET

AMLODIPINE 5 MG ORAL

TABLET [NORVASC] NORVASC ORAL TABLET

AMLODIPINE 5 MG /

ATORVASTATIN 10 MG ORAL

TABLET ORAL TABLET

AMLODIPINE 5 MG /

ATORVASTATIN 10 MG ORAL

TABLET [CADUET] CADUET ORAL TABLET

AMLODIPINE 5 MG /

ATORVASTATIN 20 MG ORAL

TABLET ORAL TABLET

AMLODIPINE 5 MG /

ATORVASTATIN 20 MG ORAL

TABLET [CADUET] CADUET ORAL TABLET

AMLODIPINE 5 MG /

ATORVASTATIN 40 MG ORAL

TABLET ORAL TABLET

AMLODIPINE 5 MG /

ATORVASTATIN 40 MG ORAL

TABLET [CADUET] CADUET ORAL TABLET

AMLODIPINE 5 MG /

ATORVASTATIN 80 MG ORAL

TABLET ORAL TABLET

AMLODIPINE 5 MG /

ATORVASTATIN 80 MG ORAL

TABLET [CADUET] CADUET ORAL TABLET

AMLODIPINE 5 MG /

BENAZEPRIL

HYDROCHLORIDE 10 MG

ORAL CAPSULE ORAL CAPSULE

AMLODIPINE 5 MG /

BENAZEPRIL

HYDROCHLORIDE 10 MG

ORAL CAPSULE [LOTREL] LOTREL ORAL CAPSULE

AMLODIPINE 5 MG /

BENAZEPRIL

HYDROCHLORIDE 20 MG

ORAL CAPSULE ORAL CAPSULE

AMLODIPINE 5 MG /

BENAZEPRIL

HYDROCHLORIDE 20 MG

ORAL CAPSULE [LOTREL] LOTREL ORAL CAPSULE

AMLODIPINE 5 MG /

BENAZEPRIL

HYDROCHLORIDE 40 MG

ORAL CAPSULE ORAL CAPSULE

SAMPLE - Formulary

AMLODIPINE 5 MG /

BENAZEPRIL

HYDROCHLORIDE 40 MG

ORAL CAPSULE [LOTREL] LOTREL ORAL CAPSULE

AMLODIPINE 5 MG /

HYDROCHLOROTHIAZIDE 12.5

MG / OLMESARTAN

MEDOXOMIL 20 MG ORAL

TABLET [TRIBENZOR] TRIBENZOR ORAL TABLET

AMLODIPINE 5 MG /

HYDROCHLOROTHIAZIDE 12.5

MG / OLMESARTAN

MEDOXOMIL 40 MG ORAL

TABLET [TRIBENZOR] TRIBENZOR ORAL TABLET

AMLODIPINE 5 MG /

HYDROCHLOROTHIAZIDE 12.5

MG / VALSARTAN 160 MG

ORAL TABLET ORAL TABLET

AMLODIPINE 5 MG /

HYDROCHLOROTHIAZIDE 12.5

MG / VALSARTAN 160 MG

ORAL TABLET [EXFORGE HCT] EXFORGE HCT ORAL TABLET

AMLODIPINE 5 MG /

HYDROCHLOROTHIAZIDE 25

MG / OLMESARTAN

MEDOXOMIL 40 MG ORAL

TABLET [TRIBENZOR] TRIBENZOR ORAL TABLET

AMLODIPINE 5 MG /

HYDROCHLOROTHIAZIDE 25

MG / VALSARTAN 160 MG

ORAL TABLET ORAL TABLET

AMLODIPINE 5 MG /

HYDROCHLOROTHIAZIDE 25

MG / VALSARTAN 160 MG

ORAL TABLET [EXFORGE HCT] EXFORGE HCT ORAL TABLET

AMLODIPINE 5 MG /

OLMESARTAN MEDOXOMIL 20

MG ORAL TABLET [AZOR] AZOR ORAL TABLET

AMLODIPINE 5 MG /

OLMESARTAN MEDOXOMIL 40

MG ORAL TABLET [AZOR] AZOR ORAL TABLET

AMLODIPINE 5 MG /

TELMISARTAN 40 MG ORAL

TABLET ORAL TABLET

AMLODIPINE 5 MG /

TELMISARTAN 40 MG ORAL

TABLET [TWYNSTA] TWYNSTA ORAL TABLET

AMLODIPINE 5 MG /

TELMISARTAN 80 MG ORAL

TABLET ORAL TABLET

AMLODIPINE 5 MG /

TELMISARTAN 80 MG ORAL

TABLET [TWYNSTA] TWYNSTA ORAL TABLET

AMLODIPINE 5 MG /

VALSARTAN 160 MG ORAL

SAMPLE - Formulary

AMLODIPINE 5 MG /

VALSARTAN 160 MG ORAL

TABLET [EXFORGE] EXFORGE ORAL TABLET

AMLODIPINE 5 MG /

VALSARTAN 320 MG ORAL

TABLET ORAL TABLET

AMLODIPINE 5 MG /

VALSARTAN 320 MG ORAL

TABLET [EXFORGE] EXFORGE ORAL TABLET

AMMONIUM CHLORIDE 5

MEQ/ML INJECTABLE

SOLUTION INJECTABLE SOLUTION

AMMONIUM LACTATE 120

MG/ML TOPICAL CREAM TOPICAL CREAM

AMMONIUM LACTATE 120

MG/ML TOPICAL LOTION TOPICAL LOTION

AMOXAPINE 100 MG ORAL

TABLET ORAL TABLET

AMOXAPINE 150 MG ORAL

TABLET ORAL TABLET

AMOXAPINE 25 MG ORAL

TABLET ORAL TABLET

AMOXAPINE 50 MG ORAL

TABLET ORAL TABLET

12 HR AMOXICILLIN 1000 MG /

CLAVULANATE 62.5 MG

EXTENDED RELEASE ORAL

TABLET

EXTENDED RELEASE ORAL

TABLET

AMOXICILLIN 120 MG/ML /

CLAVULANATE 8.58 MG/ML

ORAL SUSPENSION ORAL SUSPENSION

AMOXICILLIN 125 MG

CHEWABLE TABLET CHEWABLE TABLET

AMOXICILLIN 200 MG /

CLAVULANATE 28.5 MG

CHEWABLE TABLET CHEWABLE TABLET

AMOXICILLIN 25 MG/ML ORAL

SUSPENSION ORAL SUSPENSION

AMOXICILLIN 25 MG/ML /

CLAVULANATE 6.25 MG/ML

ORAL SUSPENSION

[AUGMENTIN] AUGMENTIN ORAL SUSPENSION

AMOXICILLIN 250 MG

CHEWABLE TABLET CHEWABLE TABLET

AMOXICILLIN 250 MG ORAL

CAPSULE ORAL CAPSULE

AMOXICILLIN 250 MG /

CLAVULANATE 125 MG ORAL

TABLET ORAL TABLET

AMOXICILLIN 40 MG/ML ORAL

SUSPENSION ORAL SUSPENSION

AMOXICILLIN 40 MG/ML /

CLAVULANATE 5.7 MG/ML

ORAL SUSPENSION ORAL SUSPENSION

AMOXICILLIN 400 MG /

CLAVULANATE 57 MG

CHEWABLE TABLET CHEWABLE TABLET

SAMPLE - Formulary

AMOXICILLIN 50 MG/ML ORAL

SUSPENSION ORAL SUSPENSION

AMOXICILLIN 50 MG/ML /

CLAVULANATE 12.5 MG/ML

ORAL SUSPENSION ORAL SUSPENSION

AMOXICILLIN 500 MG ORAL

CAPSULE ORAL CAPSULE

AMOXICILLIN 500 MG ORAL

TABLET ORAL TABLET

{4 (AMOXICILLIN 500 MG ORAL

CAPSULE) / 2

(CLARITHROMYCIN 500 MG

ORAL TABLET) / 2

(LANSOPRAZOLE 30 MG

DELAYED RELEASE ORAL

CAPSULE) } PACK PACK

{4 (AMOXICILLIN 500 MG ORAL

CAPSULE [TRIMOX]) / 2

(CLARITHROMYCIN 500 MG

ORAL TABLET [BIAXIN]) / 2

(LANSOPRAZOLE 30 MG

DELAYED RELEASE ORAL

CAPSULE [PREVACID]) } PACK

[PREVPAC] PREVPAC PACK

{4 (AMOXICILLIN 500 MG ORAL

CAPSULE) / 2

(CLARITHROMYCIN 500 MG

ORAL TABLET) / 2

(OMEPRAZOLE 20 MG

DELAYED RELEASE ORAL

CAPSULE) } PACK

[OMECLAMOX] OMECLAMOX PACK

AMOXICILLIN 500 MG /

CLAVULANATE 125 MG ORAL

TABLET ORAL TABLET

AMOXICILLIN 80 MG/ML ORAL

SUSPENSION ORAL SUSPENSION

AMOXICILLIN 80 MG/ML /

CLAVULANATE 11.4 MG/ML

ORAL SUSPENSION ORAL SUSPENSION

AMOXICILLIN 875 MG ORAL

TABLET ORAL TABLET

AMOXICILLIN 875 MG /

CLAVULANATE 125 MG ORAL

TABLET ORAL TABLET

24 HR AMPHETAMINE

ASPARTATE 1.25 MG /

AMPHETAMINE SULFATE 1.25

MG / DEXTROAMPHETAMINE

SACCHARATE 1.25 MG /

DEXTROAMPHETAMINE

SULFATE 1.25 MG EXTENDED

RELEASE ORAL CAPSULE

CAPSULE

SAMPLE - Formulary

AMPHETAMINE ASPARTATE

1.25 MG / AMPHETAMINE

SULFATE 1.25 MG /

DEXTROAMPHETAMINE

SACCHARATE 1.25 MG /

DEXTROAMPHETAMINE

SULFATE 1.25 MG ORAL

TABLET ORAL TABLET

24 HR AMPHETAMINE

ASPARTATE 1.25 MG /

AMPHETAMINE SULFATE 1.25

MG / DEXTROAMPHETAMINE

SACCHARATE 1.25 MG /

DEXTROAMPHETAMINE

SULFATE 1.25 MG EXTENDED

RELEASE ORAL CAPSULE

[ADDERALL] ADDERALL

EXTENDED RELEASE ORAL

CAPSULE

AMPHETAMINE ASPARTATE

1.25 MG / AMPHETAMINE

SULFATE 1.25 MG /

DEXTROAMPHETAMINE

SACCHARATE 1.25 MG /

DEXTROAMPHETAMINE

SULFATE 1.25 MG ORAL

TABLET [ADDERALL] ADDERALL ORAL TABLET

AMPHETAMINE ASPARTATE

1.875 MG / AMPHETAMINE

SULFATE 1.875 MG /

DEXTROAMPHETAMINE

SACCHARATE 1.875 MG /

DEXTROAMPHETAMINE

SULFATE 1.875 MG ORAL

TABLET ORAL TABLET

AMPHETAMINE ASPARTATE

1.875 MG / AMPHETAMINE

SULFATE 1.875 MG /

DEXTROAMPHETAMINE

SACCHARATE 1.875 MG /

DEXTROAMPHETAMINE

SULFATE 1.875 MG ORAL

TABLET [ADDERALL] ADDERALL ORAL TABLET

24 HR AMPHETAMINE

ASPARTATE 2.5 MG /

AMPHETAMINE SULFATE 2.5

MG / DEXTROAMPHETAMINE

SACCHARATE 2.5 MG /

DEXTROAMPHETAMINE

SULFATE 2.5 MG EXTENDED

RELEASE ORAL CAPSULE

EXTENDED RELEASE ORAL

CAPSULE

AMPHETAMINE ASPARTATE

2.5 MG / AMPHETAMINE

SULFATE 2.5 MG /

DEXTROAMPHETAMINE

SACCHARATE 2.5 MG /

DEXTROAMPHETAMINE

SULFATE 2.5 MG ORAL

SAMPLE - Formulary

24 HR AMPHETAMINE

ASPARTATE 2.5 MG /

AMPHETAMINE SULFATE 2.5

MG / DEXTROAMPHETAMINE

SACCHARATE 2.5 MG /

DEXTROAMPHETAMINE

SULFATE 2.5 MG EXTENDED

RELEASE ORAL CAPSULE

[ADDERALL] ADDERALL

EXTENDED RELEASE ORAL

CAPSULE

AMPHETAMINE ASPARTATE

3.125 MG / AMPHETAMINE

SULFATE 3.125 MG /

DEXTROAMPHETAMINE

SACCHARATE 3.125 MG /

DEXTROAMPHETAMINE

SULFATE 3.125 MG ORAL

TABLET ORAL TABLET

24 HR AMPHETAMINE

ASPARTATE 3.75 MG /

AMPHETAMINE SULFATE 3.75

MG / DEXTROAMPHETAMINE

SACCHARATE 3.75 MG /

DEXTROAMPHETAMINE

SULFATE 3.75 MG EXTENDED

RELEASE ORAL CAPSULE

EXTENDED RELEASE ORAL

CAPSULE

AMPHETAMINE ASPARTATE

3.75 MG / AMPHETAMINE

SULFATE 3.75 MG /

DEXTROAMPHETAMINE

SACCHARATE 3.75 MG /

DEXTROAMPHETAMINE

SULFATE 3.75 MG ORAL

TABLET ORAL TABLET

24 HR AMPHETAMINE

ASPARTATE 3.75 MG /

AMPHETAMINE SULFATE 3.75

MG / DEXTROAMPHETAMINE

SACCHARATE 3.75 MG /

DEXTROAMPHETAMINE

SULFATE 3.75 MG EXTENDED

RELEASE ORAL CAPSULE

[ADDERALL] ADDERALL

EXTENDED RELEASE ORAL

CAPSULE

24 HR AMPHETAMINE

ASPARTATE 5 MG /

AMPHETAMINE SULFATE 5 MG

/ DEXTROAMPHETAMINE

SACCHARATE 5 MG /

DEXTROAMPHETAMINE

SULFATE 5 MG EXTENDED

RELEASE ORAL CAPSULE

EXTENDED RELEASE ORAL

CAPSULE

AMPHETAMINE ASPARTATE 5

MG / AMPHETAMINE SULFATE

5 MG / DEXTROAMPHETAMINE

SACCHARATE 5 MG /

DEXTROAMPHETAMINE

SULFATE 5 MG ORAL TABLET ORAL TABLET

SAMPLE - Formulary

24 HR AMPHETAMINE

ASPARTATE 5 MG /

AMPHETAMINE SULFATE 5 MG

/ DEXTROAMPHETAMINE

SACCHARATE 5 MG /

DEXTROAMPHETAMINE

SULFATE 5 MG EXTENDED

RELEASE ORAL CAPSULE

[ADDERALL] ADDERALL

EXTENDED RELEASE ORAL

CAPSULE

AMPHETAMINE ASPARTATE 5

MG / AMPHETAMINE SULFATE

5 MG / DEXTROAMPHETAMINE

SACCHARATE 5 MG /

DEXTROAMPHETAMINE

SULFATE 5 MG ORAL TABLET

[ADDERALL] ADDERALL ORAL TABLET

24 HR AMPHETAMINE

ASPARTATE 6.25 MG /

AMPHETAMINE SULFATE 6.25

MG / DEXTROAMPHETAMINE

SACCHARATE 6.25 MG /

DEXTROAMPHETAMINE

SULFATE 6.25 MG EXTENDED

RELEASE ORAL CAPSULE

EXTENDED RELEASE ORAL

CAPSULE

24 HR AMPHETAMINE

ASPARTATE 6.25 MG /

AMPHETAMINE SULFATE 6.25

MG / DEXTROAMPHETAMINE

SACCHARATE 6.25 MG /

DEXTROAMPHETAMINE

SULFATE 6.25 MG EXTENDED

RELEASE ORAL CAPSULE

[ADDERALL] ADDERALL

EXTENDED RELEASE ORAL

CAPSULE

24 HR AMPHETAMINE

ASPARTATE 7.5 MG /

AMPHETAMINE SULFATE 7.5

MG / DEXTROAMPHETAMINE

SACCHARATE 7.5 MG /

DEXTROAMPHETAMINE

SULFATE 7.5 MG EXTENDED

RELEASE ORAL CAPSULE

EXTENDED RELEASE ORAL

CAPSULE

AMPHETAMINE ASPARTATE

7.5 MG / AMPHETAMINE

SULFATE 7.5 MG /

DEXTROAMPHETAMINE

SACCHARATE 7.5 MG /

DEXTROAMPHETAMINE

SULFATE 7.5 MG ORAL

TABLET ORAL TABLET

24 HR AMPHETAMINE

ASPARTATE 7.5 MG /

AMPHETAMINE SULFATE 7.5

MG / DEXTROAMPHETAMINE

SACCHARATE 7.5 MG /

DEXTROAMPHETAMINE

SULFATE 7.5 MG EXTENDED

RELEASE ORAL CAPSULE

[ADDERALL] ADDERALL

SAMPLE - Formulary

AMPHETAMINE SULFATE 10

MG ORAL TABLET [EVEKEO] EVEKEO ORAL TABLET

AMPHETAMINE SULFATE 5 MG

ORAL TABLET [EVEKEO] EVEKEO ORAL TABLET

AMPHOTERICIN B 5 MG/ML

INJECTABLE SOLUTION INJECTABLE SOLUTION

AMPHOTERICIN B LIPOSOMAL

4 MG/ML INJECTABLE

SOLUTION [AMBISOME] AMBISOME INJECTABLE SOLUTION

AMPHOTERICIN B LIPOSOMAL

5 MG/ML INJECTABLE

SUSPENSION [ABELCET] ABELCET INJECTABLE SUSPENSION

AMPICILLIN 100 MG/ML

INJECTABLE SOLUTION INJECTABLE SOLUTION

AMPICILLIN 100 MG/ML /

SULBACTAM 50 MG/ML

INJECTABLE SOLUTION INJECTABLE SOLUTION

AMPICILLIN 100 MG/ML /

SULBACTAM 50 MG/ML

INJECTABLE SOLUTION

[UNASYN] UNASYN INJECTABLE SOLUTION

AMPICILLIN 125 MG/ML

INJECTABLE SOLUTION INJECTABLE SOLUTION

AMPICILLIN 20 MG/ML /

SULBACTAM 10 MG/ML

INJECTABLE SOLUTION INJECTABLE SOLUTION

AMPICILLIN 25 MG/ML ORAL

SUSPENSION ORAL SUSPENSION

AMPICILLIN 250 MG ORAL

CAPSULE ORAL CAPSULE

AMPICILLIN 250 MG/ML

INJECTABLE SOLUTION INJECTABLE SOLUTION

AMPICILLIN 250 MG/ML /

SULBACTAM 125 MG/ML

INJECTABLE SOLUTION INJECTABLE SOLUTION

AMPICILLIN 250 MG/ML /

SULBACTAM 125 MG/ML

INJECTABLE SOLUTION

[UNASYN] UNASYN INJECTABLE SOLUTION

AMPICILLIN 50 MG/ML ORAL

SUSPENSION ORAL SUSPENSION

AMPICILLIN 500 MG ORAL

CAPSULE ORAL CAPSULE

AMYLASES 109000 UNT /

ENDOPEPTIDASES 68000 UNT

/ LIPASE 20000 UNT DELAYED

RELEASE ORAL CAPSULE

[ZENPEP] ZENPEP

DELAYED RELEASE ORAL

CAPSULE

AMYLASES 120000 UNT /

ENDOPEPTIDASES 76000 UNT

/ LIPASE 24000 UNT DELAYED

RELEASE ORAL CAPSULE

[CREON] CREON

DELAYED RELEASE ORAL

CAPSULE

AMYLASES 136000 UNT /

ENDOPEPTIDASES 85000 UNT

/ LIPASE 25000 UNT DELAYED

RELEASE ORAL CAPSULE

[ZENPEP] ZENPEP

DELAYED RELEASE ORAL

SAMPLE - Formulary

AMYLASES 15000 UNT /

ENDOPEPTIDASES 9500 UNT /

LIPASE 3000 UNT DELAYED

RELEASE ORAL CAPSULE

[CREON] CREON

DELAYED RELEASE ORAL

CAPSULE

AMYLASES 16000 UNT /

ENDOPEPTIDASES 10000 UNT

/ LIPASE 3000 UNT DELAYED

RELEASE ORAL CAPSULE

[ZENPEP] ZENPEP

DELAYED RELEASE ORAL

CAPSULE

AMYLASES 17500 UNT /

ENDOPEPTIDASES 10000 UNT

/ LIPASE 4200 UNT DELAYED

RELEASE ORAL CAPSULE

[PANCREAZE] PANCREAZE

DELAYED RELEASE ORAL

CAPSULE

AMYLASES 180000 UNT /

ENDOPEPTIDASES 114000

UNT / LIPASE 36000…

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