Attachment L-9.8 PA_ST_QL List.XLSX

XLSX spreadsheet 2 MB Posted

Attached to
DRAFT RFP TRICARE Pharmacy Services, 5th Generation (TPharm5) Federal contract opportunity
Solicitation number
HT940220R0002
Issued by
Defense Health Agency

About this file

Written by GovTribe AI ·

This draft request for proposals from the Defense Health Agency concerns pharmacy services under the TRICARE program for the fifth generation of the TRICARE Pharmacy contract, known as TPharm5. The potential contract would have an 18-month transition period and seven 1-year option periods for healthcare delivery, with a potential total period of performance of 9 years. The draft RFP includes sections on the contract structure, specialty pharmacy services, retail pharmacy networks, compounded medications, care coordination, patient safety notifications, and quality control. Comments from industry on the draft RFP are requested by 17 January 2020 to help the agency refine its approach for providing high quality pharmacy services within statutory and regulatory requirements. An information session on the draft RFP will be held on 11 December 2019.

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Other files for this federal contract opportunity

Other files attached to DRAFT RFP TRICARE Pharmacy Services, 5th Generation (TPharm5), newest first.
File Type Posted
QA CAS Applicability Specific Clauses (May 15 2020).pdf PDF
Responses to Industry on Revised Draft Section C 20200504.pdf PDF
TPharm5 - Overview of Changes to Draft Section C.DOCX DOCX document
DHA Responses to Industry on Draft RFP 20200318.pdf PDF
Data Pkg 7 Specialty Drug Utilization, Retail and Mail.xlsx XLSX spreadsheet
Data Pkg 14 Retail Claims with COB.xlsx XLSX spreadsheet
Attachment J-5 TPharm5 Award Fee Plan 20191122.docx DOCX document
Data Pkg 5 MOP Utilization by Drug.xlsx XLSX spreadsheet
Data Pkg 23 - Paid Claims and Rejects - MHS GENESIS.xlsx XLSX spreadsheet
Data Pkg 22 - Paid Claims and Rejects - Retail.xlsx XLSX spreadsheet
Data Pkg 24 - CHCBP Volume.xlsx XLSX spreadsheet
Attachment L-9.6 Self-Admin Injectables List.xlsx XLSX spreadsheet
Attachment L-9.7 Expanded Use of MTF and TMOP List.xlsx XLSX spreadsheet
Attachment L-18 CDRL Supplemental Bid Schedule.xlsx XLSX spreadsheet
Attachment L-1 Ordering Instructions for Data Files not on SAM.gov.docx DOCX document
TPharm5 Draft Section L 20191202.docx DOCX document
Data Pkg 25 - OHI Development.xlsx XLSX spreadsheet
Attachment L-9.5 Non-Formulary List.xlsx XLSX spreadsheet
Data Pkg 9 Customer_Service_Volume.xlsx XLSX spreadsheet
Data Pkg 16 VA_VA CHDR Volume.xlsx XLSX spreadsheet
Data Pkg 13 - MTF Claims Volumes by Site.xlsx XLSX spreadsheet
Attachment L-3 Specialty Reimbursement for Use in Determining Incentiv....docx DOCX document
Attachment L-9 Benefit Design Document_TPharm5.xlsx XLSX spreadsheet
Attachment L-2 Retail Network Reimbursement Table.docx DOCX document
TPharm5 Draft RFP READ FIRST 20191202.docx DOCX document
Tpharm5 Draft Section G 20191202.docx DOCX document
Attachment L-8 MMC Sample File.xlsx XLSX spreadsheet
Attachment L-4 Negotiated Specialty Retail Replenished Dispensing Fees.docx DOCX document
Attachment L-9.9 Fluoride Products List.xlsx XLSX spreadsheet
Attachment L-12 IHS_Pharmacy_Listing_2019.xlsx XLSX spreadsheet
Data Pkg 15 IHS_Pharmacy_Claims_Volume_2017_&_2018.xlsx XLSX spreadsheet
TPharm5 Draft Section E 20191120.docx DOCX document
TPharm5 Draft Section D 20191120.docx DOCX document
Attachment L-1.1 List of Data Packages.docx DOCX document
Attachment L-19 Past Performance Questionnaire Template Tab F 20191120.docx DOCX document
Attachment J-2 Acronym List.docx DOCX document
Attachment J-3 Website Links.docx DOCX document
Attachment L-5 Guaranty_Agreement.pdf PDF
Attachment L-7 Teaming Subcontractor Consent Ltr.docx DOCX document
Attachment L-9.3 Covered OTCs - Purchased Care.xlsx XLSX spreadsheet
Attachment L-19.1 PPI Tool Instructions.docx DOCX document
Data Pkg 3 TRICARE Retail Pharmacy Claim Volume.xlsx XLSX spreadsheet
TPharm5 Draft Section C 20191202.docx DOCX document
Data Pkg 6 - MOP Utilization.xlsx XLSX spreadsheet
Attachment L-13 VA_Pharmacy_Listing_2019.xlsx XLSX spreadsheet
Attachment L-1.2 Non-Disclosure Agreement.docx DOCX document
Data Pkg 21 Enrolled Beneficiary Population.xlsx XLSX spreadsheet
TPharm5 Draft Section H 20191121.docx DOCX document
Data Pkg 10 - Compound Utilizers.xlsx XLSX spreadsheet
TPharm5 Draft Section I 20191120.docx DOCX document
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Manual PA FDB GCN NDC11 TRADE NAME STRENGTH DESC GCDF DESC ROUTE DESC FORMULARY STATUS F=LEGEND

I=INSULIN

O=OTCSUBCODEPACK SIZEMANUFACTURER NAMERule Name
0057500002814801HUMATROPE12 MGCARTRIDGE (EA)INJECTIONNFBrand1ELI LILLY & CO.PA DRUGS, DOD PA REQUIRED
0567966733077301INSULIN LISPRO100/MLVIAL (ML)SUBCUTANEOUSYIBrand10ELI LILLY & CO.TPA - INSULIN LISPRO, INSULIN LISPRO KWIKPEN U-100 REQUIRES PRIOR AUTHORIZATION
0705500456140511BYSTOLIC5 MGTABLETORALNFBrand1FOREST/ALLERGANPA DRUGS, DOD PA REQUIRED
0705500456140530BYSTOLIC5 MGTABLETORALNFBrand30FOREST/ALLERGANPA DRUGS, DOD PA REQUIRED
0705500456140563BYSTOLIC5 MGTABLETORALNFBrand100FOREST/ALLERGANPA DRUGS, DOD PA REQUIRED
0705500456140590BYSTOLIC5 MGTABLETORALNFBrand90FOREST/ALLERGANPA DRUGS, DOD PA REQUIRED
1049542227008105CINRYZE500 (5 ML)VIAL (EA)INTRAVENOUSYFBrand1VIROPHARMA/SHIRPA DRUGS, DOD PA REQUIRED
1055400013264681GENOTROPIN12 MG/MLCARTRIDGE (EA)SUBCUTANEOUSNFBrand1PHARMACI/PFIZERPA DRUGS, DOD PA REQUIRED
1056154396011111OXANDRIN2.5 MGTABLETORALNFMulti-Source Brand100SAVIENT PHARMACNON-FCP MSL6274 RTL/MDP <> COB PA REQUIRED
1116258607010565MYNATAL-Z65 MG-1 MGTABLETORALNFGeneric100ME PHARMEBD: LEG PRENATAL VIT, AGE >45 PA REQUIRED
1116258607081120MYNATAL PLUS65 MG-1 MGTABLETORALNFGeneric100ME PHARMEBD: LEG PRENATAL VIT, AGE >45 PA REQUIRED
1116858607010359MYNATAL65 MG-1 MGCAPSULEORALNFGeneric100ME PHARMEBD: LEG PRENATAL VIT, AGE >45 PA REQUIRED
1117858607010390MYNATE 90 PLUS90-50-1MGTABLET, EXTENDED RELEASEORALNFGeneric100ME PHARMEBD: LEG PRENATAL VIT, AGE >45 PA REQUIRED
1276342546081230PR NATAL 43029-1-430MGCOMBINATION PACKAGE (EA)ORALNFGeneric60PRUGEN PHARMACEEBD: LEG PRENATAL VIT, AGE >45 PA REQUIRED
1276744087108801SAIZEN8.8 MGVIAL (EA)SUBCUTANEOUSNFBrand1EMD SERONO, INCPA DRUGS, DOD PA REQUIRED
1276744087338807ZORBTIVE8.8 MGVIAL (EA)SUBCUTANEOUSNFBrand1EMD SERONO, INCPA DRUGS, DOD PA REQUIRED
1292100052031301FOLLISTIM AQ300/0.36MLCARTRIDGE (ML)SUBCUTANEOUSYFBrand0.42ORGANON PHARM.PA DRUGS, DOD PA REQUIRED
1292200052031601FOLLISTIM AQ600/0.72MLCARTRIDGE (ML)SUBCUTANEOUSYFBrand0.78ORGANON PHARM.PA DRUGS, DOD PA REQUIRED
1415823359010530C-NATE DHA28-1-200MGCAPSULEORALNFGeneric30CENTURION LABSEBD: LEG PRENATAL VIT, AGE >45 PA REQUIRED
1415835573020030RELNATE DHA28-1-200MGCAPSULEORALNFGeneric30BUREL PHARMACEUEBD: LEG PRENATAL VIT, AGE >45 PA REQUIRED
1415869543037030VIRT-NATE DHA28-1-200MGCAPSULEORALNFGeneric30VIRTUS PHARMACEEBD: LEG PRENATAL VIT, AGE >45 PA REQUIRED
1431513811005030ULTIMATECARE ONE NF27-1-50 MGCAPSULEORALNFGeneric30TRIGEN LABORATOEBD: LEG PRENATAL VIT, AGE >45 PA REQUIRED
1440400002840001FORTEO20MCG/DOSEPEN INJECTOR (ML)SUBCUTANEOUSYFBrand2.4ELI LILLY & CO.PA DRUGS, DOD PA REQUIRED
1440513811004930ULTIMATECARE ONE27-1-330MGCAPSULEORALNFGeneric30TRIGEN LABORATOEBD: LEG PRENATAL VIT, AGE >45 PA REQUIRED
1448542546051830PR NATAL 430 EC29-1-430MGCOMBINATION PACKAGE, TABLET AND DR CAPORALNFGeneric60PRUGEN PHARMACEEBD: LEG PRENATAL VIT, AGE >45 PA REQUIRED
1471111026262903OBSTETRIX DHA29-1-50 MGCOMBINATION PACKAGE, TABLET AND DR CAPORALNFGeneric60SEYER INC.EBD: LEG PRENATAL VIT, AGE >45 PA REQUIRED
1471167555014830OBTREX DHA29-1-50 MGCOMBINATION PACKAGE, TABLET AND DR CAPORALNFBrand60PRONOVA CORPEBD: LEG PRENATAL VIT, AGE >45 PA REQUIRED
1471198826011069OBSTETRIX DHA29-1-50 MGCOMBINATION PACKAGE, TABLET AND DR CAPORALNFGeneric60SEYER INC.EBD: LEG PRENATAL VIT, AGE >45 PA REQUIRED
1497800054052121BOSENTAN125 MGTABLETORALYFGeneric60WEST-WARD/HIKMAPA DRUGS, DOD PA REQUIRED
1497800591251260BOSENTAN125 MGTABLETORALYFGeneric60ACTAVIS/TEVAPA DRUGS, DOD PA REQUIRED
1497810148012560BOSENTAN125 MGTABLETORALYFGeneric60COTHERIX, INC.PA DRUGS, DOD PA REQUIRED
1497847335003986BOSENTAN125 MGTABLETORALYFGeneric60SUN PHARMA GLOBPA DRUGS, DOD PA REQUIRED
1497849884005902BOSENTAN125 MGTABLETORALYFGeneric60PAR PHARM.PA DRUGS, DOD PA REQUIRED
1497865162087406BOSENTAN125 MGTABLETORALYFGeneric60AMNEAL PHARMACEPA DRUGS, DOD PA REQUIRED
1497866215010203TRACLEER125 MGTABLETORALYFMulti-Source Brand30ACTELION PHARMAPA DRUGS, DOD PA REQUIRED
1497866215010206TRACLEER125 MGTABLETORALYFMulti-Source Brand60ACTELION PHARMAPA DRUGS, DOD PA REQUIRED
1497868382044714BOSENTAN125 MGTABLETORALYFGeneric60ZYDUS PHARMACEUPA DRUGS, DOD PA REQUIRED
1497900054052021BOSENTAN62.5 MGTABLETORALYFGeneric60WEST-WARD/HIKMAPA DRUGS, DOD PA REQUIRED
1497900591251160BOSENTAN62.5 MGTABLETORALYFGeneric60ACTAVIS/TEVAPA DRUGS, DOD PA REQUIRED
1497910148062560BOSENTAN62.5 MGTABLETORALYFGeneric60COTHERIX, INC.PA DRUGS, DOD PA REQUIRED
1497947335003886BOSENTAN62.5 MGTABLETORALYFGeneric60SUN PHARMA GLOBPA DRUGS, DOD PA REQUIRED
1497949884005802BOSENTAN62.5 MGTABLETORALYFGeneric60PAR PHARM.PA DRUGS, DOD PA REQUIRED
1497965162087306BOSENTAN62.5 MGTABLETORALYFGeneric60AMNEAL PHARMACEPA DRUGS, DOD PA REQUIRED
1497966215010103TRACLEER62.5 MGTABLETORALYFMulti-Source Brand30ACTELION PHARMAPA DRUGS, DOD PA REQUIRED
1497966215010106TRACLEER62.5 MGTABLETORALYFMulti-Source Brand60ACTELION PHARMAPA DRUGS, DOD PA REQUIRED
1497968382044614BOSENTAN62.5 MGTABLETORALYFGeneric60ZYDUS PHARMACEUPA DRUGS, DOD PA REQUIRED
1538127505009060ZELNORM6 MGTABLETORALNFBrand60US WORLDMEDS/ALPA DRUGS, DOD PA REQUIRED
1559646287002001CAROSPIR25 MG/5 MLSUSPENSION, ORAL (FINAL DOSE FORM)ORALNFBrand473CMP PHARMA, INCTPA - CAROSPIR ORAL SUSPENSION FOR PTS >12 YEARS OF AGE REQUIRES PRIOR AUTHORIZATION
1559646287002004CAROSPIR25 MG/5 MLSUSPENSION, ORAL (FINAL DOSE FORM)ORALNFBrand118CMP PHARMA, INCTPA - CAROSPIR ORAL SUSPENSION FOR PTS >12 YEARS OF AGE REQUIRES PRIOR AUTHORIZATION
1575142546014516BENZOYL PEROXIDE7 %CLEANSER (ML)TOPICALYFGeneric473PRUGEN PHARMACEPA DRUGS, DOD PA REQUIRED
1575143538011016PACNEX7 %CLEANSER (ML)TOPICALYFMulti-Source Brand480MEDIMETRIKS PHAPA DRUGS, DOD PA REQUIRED
1598513811054330TARON PRENATAL30-1.2-55CAPSULEORALNFGeneric30TRIGEN LABORATOEBD: LEG PRENATAL VIT, AGE >45 PA REQUIRED
1613452427027430NAPRELAN750 MGTABLET,EXTENDED RELEASE MULTIPHASE 24 HRORALNFBrand30ALMATICA PHARMAPA DRUGS, DOD PA REQUIRED
1615342192032030PNV-SELECT27 MG-1 MGTABLETORALNFGeneric30ACELLA PHARMACEEBD: LEG PRENATAL VIT, AGE >45 PA REQUIRED
1615342192032090PNV-SELECT27 MG-1 MGTABLETORALNFGeneric90ACELLA PHARMACEEBD: LEG PRENATAL VIT, AGE >45 PA REQUIRED
1615369543024190VIRT-PN27 MG-1 MGTABLETORALNFGeneric90VIRTUS PHARMACEEBD: LEG PRENATAL VIT, AGE >45 PA REQUIRED
1616842546001718BENZEPRO7 %CLEANSER (GRAM)TOPICALYFMulti-Source Brand180PRUGEN PHARMACEPA DRUGS, DOD PA REQUIRED
1616842546014518PR BENZOYL PEROXIDE7 %CLEANSER (GRAM)TOPICALYFMulti-Source Brand180PRUGEN PHARMACEPA DRUGS, DOD PA REQUIRED
1619200682005110CROTAN10 %LOTION (GRAM)TOPICALYFGeneric227MARNEL PHARM.PA DRUGS, DOD PA REQUIRED
1619200682005120CROTAN10 %LOTION (GRAM)TOPICALYFGeneric60MARNEL PHARM.PA DRUGS, DOD PA REQUIRED
1619200682005130CROTAN10 %LOTION (GRAM)TOPICALYFGeneric454MARNEL PHARM.PA DRUGS, DOD PA REQUIRED
1619210631009216EURAX10 %LOTION (GRAM)TOPICALYFBrand454RANBAXY/SUN PHAPA DRUGS, DOD PA REQUIRED
1619210631009260EURAX10 %LOTION (GRAM)TOPICALYFBrand60RANBAXY/SUN PHAPA DRUGS, DOD PA REQUIRED
1649811086003201VANOXIDE-HC5 %-0.5 %SUSPENSION, TOPICAL (GRAM)TOPICALYFBrand25SUMMERS LABS/MAPA DRUGS, DOD PA REQUIRED
1676655495011101ATABEX EC29-1-50 MGTABLET, ENTERIC COATEDORALNFBrand100ADVANCED MEDEBD: LEG PRENATAL VIT, AGE >45 PA REQUIRED
1693868712002301INOVA8%-5%COMBINATION PACKAGE (EA)TOPICALYFBrand58INNOCUTIS/EPI HPA DRUGS, DOD PA REQUIRED
1693968712001301INOVA4 %-5 %COMBINATION PACKAGE (EA)TOPICALYFBrand58INNOCUTIS/EPI HPA DRUGS, DOD PA REQUIRED
1699600187581130APLENZIN348MGTABLET, EXTENDED RELEASE 24 HRORALNFBrand30VALEANT/BAUSCHPA DRUGS, DOD PA REQUIRED
1705000187581230APLENZIN522MGTABLET, EXTENDED RELEASE 24 HRORALNFBrand30VALEANT/BAUSCHPA DRUGS, DOD PA REQUIRED
1733242192012560BPO6 %TOWELETTE (EA)TOPICALYFGeneric60ACELLA PHARMACEPA DRUGS, DOD PA REQUIRED
1733242546001660BENZEPRO6 %TOWELETTE (EA)TOPICALYFGeneric60PRUGEN PHARMACEPA DRUGS, DOD PA REQUIRED
1747550242004314NUTROPIN AQ10 MG/2 MLCARTRIDGE (ML)SUBCUTANEOUSNFBrand2GENENTECH, INC.PA DRUGS, DOD PA REQUIRED
1790046672086046CHLORZOXAZONE250 MGTABLETORALYFGeneric60MIKART, INCPA DRUGS, DOD PA REQUIRED
1790069499033060CHLORZOXAZONE250 MGTABLETORALYFGeneric60SOLUBIOMIX, LLCPA DRUGS, DOD PA REQUIRED
1790069597033060CHLORZOXAZONE250 MGTABLETORALYFGeneric60BASIEMPA DRUGS, DOD PA REQUIRED
1798858487000101DURLAZA162.5 MGCAPSULE, EXT RELEASE 24 HRORALNFBrand30NEW HAVEN PHARMNON-FCP MSL6274 RTL/MDP <> COB PA REQUIRED
1810468727010001XYREM500 MG/MLSOLUTION, ORALORALYFBrand180JAZZ PHARMACEUTXYREM (DG=MSL6277), DOD PA REQUIRED
1816000067434504TRANSDERM-SCOP1 MG/3 DAYPATCH,TRANSDERMAL 3 DAYTRANSDERMALNFMulti-Source Brand4NOVARTIS CONSUMNON-FCP MSL6274 RTL/MDP <> COB PA REQUIRED
1816000067434604TRANSDERM-SCOP1 MG/3 DAYPATCH,TRANSDERMAL 3 DAYTRANSDERMALYFMulti-Source Brand4GSK CONSUMER HENON-FCP MSL6274 RTL/MDP <> COB PA REQUIRED
1826554396011060OXANDRIN10 MGTABLETORALNFMulti-Source Brand60SAVIENT PHARMACNON-FCP MSL6274 RTL/MDP <> COB PA REQUIRED
1870300456142030BYSTOLIC20 MGTABLETORALNFBrand30FOREST/ALLERGANPA DRUGS, DOD PA REQUIRED
1870300456142090BYSTOLIC20 MGTABLETORALNFBrand90FOREST/ALLERGANPA DRUGS, DOD PA REQUIRED
1892400074379902HUMIRA40MG/0.8MLSYRINGE KIT (EA)SUBCUTANEOUSYFBrand2ABBVIE US LLCPA DRUGS, DOD PA REQUIRED
1892400074379903HUMIRA PEDIATRIC40MG/0.8MLSYRINGE KIT (EA)SUBCUTANEOUSYFBrand3ABBVIE US LLCPA DRUGS, DOD PA REQUIRED
1892400074379906HUMIRA PEDIATRIC40MG/0.8MLSYRINGE KIT (EA)SUBCUTANEOUSYFBrand6ABBVIE US LLCPA DRUGS, DOD PA REQUIRED
1899500002446330CIALIS10 MGTABLETORALNFMulti-Source Brand30ELI LILLY & CO.EBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1899500093301856TADALAFIL10 MGTABLETORALNFGeneric30TEVA USAEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1899500378697293TADALAFIL10 MGTABLETORALNFGeneric30MYLANEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1899513668056730TADALAFIL10 MGTABLETORALNFGeneric30TORRENT PHARMACEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1899527241011303TADALAFIL10 MGTABLETORALNFGeneric30AJANTA PHARMA LEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1899529300028813TADALAFIL10 MGTABLETORALNFGeneric30UNICHEM PHARMACEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1899531722064530TADALAFIL10 MGTABLETORALNFGeneric30CAMBER PHARMACEEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1899535573041130TADALAFIL10 MGTABLETORALNFGeneric30BUREL PHARMACEUEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1899543598057430TADALAFIL10 MGTABLETORALNFGeneric30DR. REDDY'S LABEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1899547335001183TADALAFIL10 MGTABLETORALNFGeneric30SUN PHARMA GLOBEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1899560505468503TADALAFIL10 MGTABLETORALNFGeneric30APOTEX CORPEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1899562332017930TADALAFIL10 MGTABLETORALNFGeneric30ALEMBIC PHARMACEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1899566993070230TADALAFIL10 MGTABLETORALNFGeneric30PRASCO LABSEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1899568180092106TADALAFIL10 MGTABLETORALNFGeneric30LUPIN PHARMACEUEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1899568382089806TADALAFIL10 MGTABLETORALNFGeneric30ZYDUS PHARMACEUEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1899569097037502TADALAFIL10 MGTABLETORALNFGeneric30CIPLA USA, INC.EBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1899569097037505TADALAFIL10 MGTABLETORALNFGeneric90CIPLA USA, INC.EBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1899569238134803TADALAFIL10 MGTABLETORALNFGeneric30AMNEAL PHARMACEEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1899600002446430CIALIS20 MGTABLETORALNFMulti-Source Brand30ELI LILLY & CO.EBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1899600093301956TADALAFIL20 MGTABLETORALNFGeneric30TEVA USAEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1899600378697393TADALAFIL20 MGTABLETORALNFGeneric30MYLANEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1899613668056830TADALAFIL20 MGTABLETORALNFGeneric30TORRENT PHARMACEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1899616729037210TADALAFIL20 MGTABLETORALNFGeneric30ACCORD HEALTHCAEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1899627241011403TADALAFIL20 MGTABLETORALNFGeneric30AJANTA PHARMA LEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1899629300028913TADALAFIL20 MGTABLETORALNFGeneric30UNICHEM PHARMACEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1899631722064630TADALAFIL20 MGTABLETORALNFGeneric30CAMBER PHARMACEEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1899635573041230TADALAFIL20 MGTABLETORALNFGeneric30BUREL PHARMACEUEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1899643598057330TADALAFIL20 MGTABLETORALNFGeneric30DR. REDDY'S LABEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1899647335001283TADALAFIL20 MGTABLETORALNFGeneric30SUN PHARMA GLOBEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1899660505468603TADALAFIL20 MGTABLETORALNFGeneric30APOTEX CORPEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1899662332018030TADALAFIL20 MGTABLETORALNFGeneric30ALEMBIC PHARMACEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1899666993070330TADALAFIL20 MGTABLETORALNFGeneric30PRASCO LABSEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1899668180092206TADALAFIL20 MGTABLETORALNFGeneric30LUPIN PHARMACEUEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1899668382089906TADALAFIL20 MGTABLETORALNFGeneric30ZYDUS PHARMACEUEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1899669097037602TADALAFIL20 MGTABLETORALNFGeneric30CIPLA USA, INC.EBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1899669097037605TADALAFIL20 MGTABLETORALNFGeneric90CIPLA USA, INC.EBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1899669238134903TADALAFIL20 MGTABLETORALNFGeneric30AMNEAL PHARMACEEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1921600023916330RESTASIS0.05 %DROPPERETTE, SINGLE-USE DROP DISPENSEROPHTHALMIC (EYE)YFBrand30ALLERGAN INC.TPA - OPHTHALMIC RESTASIS/MULTIDOSE,CEQUA,XIIDRA W/O USE IN LAST 120 DAYS REQUIRES PRIOR AUTH
1921600023916360RESTASIS0.05 %DROPPERETTE, SINGLE-USE DROP DISPENSEROPHTHALMIC (EYE)YFBrand60ALLERGAN INC.TPA - OPHTHALMIC RESTASIS/MULTIDOSE,CEQUA,XIIDRA W/O USE IN LAST 120 DAYS REQUIRES PRIOR AUTH
1932600093765356VARDENAFIL HCL5 MGTABLETORALNFGeneric30TEVA USAEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1932600173082913LEVITRA5 MGTABLETORALNFMulti-Source Brand30GLAXOSMITHKLINEEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1932600527280132VARDENAFIL HCL5 MGTABLETORALNFGeneric30LANNETT CO. INCEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1932670710106903VARDENAFIL HCL5 MGTABLETORALNFGeneric30ZYDUS PHARMACEUEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1932700093765456VARDENAFIL HCL10 MGTABLETORALNFGeneric30TEVA USAEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1932700173083013LEVITRA10 MGTABLETORALNFMulti-Source Brand30GLAXOSMITHKLINEEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1932700527280232VARDENAFIL HCL10 MGTABLETORALNFGeneric30LANNETT CO. INCEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1932770710107003VARDENAFIL HCL10 MGTABLETORALNFGeneric30ZYDUS PHARMACEUEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1932800093765556VARDENAFIL HCL20 MGTABLETORALNFGeneric30TEVA USAEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1932800173083113LEVITRA20 MGTABLETORALNFMulti-Source Brand30GLAXOSMITHKLINEEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1932800527280332VARDENAFIL HCL20 MGTABLETORALNFGeneric30LANNETT CO. INCEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1932870710107103VARDENAFIL HCL20 MGTABLETORALNFGeneric30ZYDUS PHARMACEUEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
1952358809035930VANATOL S50-325/15SOLUTION, ORALORALYFBrand30G.M. PHARMPA DRUGS, DOD PA REQUIRED
1952358809082016VANATOL LQ50-325/15SOLUTION, ORALORALYFBrand473G.M. PHARMPA DRUGS, DOD PA REQUIRED
1994852244003060STRIANT30 MGMUCOADHESIVE SYSTEM,EXTEND.RELEASE 12 HRBUCCALYFBrand60AUXILIUM/ENDO PPA DRUGS, DOD PA REQUIRED
1998066992039910REGIMEX25 MGTABLETORALYFMulti-Source Brand100WRASER PHARMATPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
1998075834010001BENZPHETAMINE HCL25 MGTABLETORALYFGeneric100NIVAGEN PHARMACTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
1998110702004001BENZPHETAMINE HCL50 MGTABLETORALYFGeneric100KVK-TECH, INC.TPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
1998110702004003BENZPHETAMINE HCL50 MGTABLETORALYFGeneric30KVK-TECH, INC.TPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
1998110702004050BENZPHETAMINE HCL50 MGTABLETORALYFGeneric500KVK-TECH, INC.TPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
1998123155017401BENZPHETAMINE HCL50 MGTABLETORALYFGeneric100HERITAGE PHARMATPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
1998123155017403BENZPHETAMINE HCL50 MGTABLETORALYFGeneric30HERITAGE PHARMATPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
1998142806008101BENZPHETAMINE HCL50 MGTABLETORALYFGeneric100EPIC PHARMA LLCTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
1998142806008130BENZPHETAMINE HCL50 MGTABLETORALYFGeneric30EPIC PHARMA LLCTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
1998175834010201BENZPHETAMINE HCL50 MGTABLETORALYFGeneric100NIVAGEN PHARMACTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
1998175834010205BENZPHETAMINE HCL50 MGTABLETORALYFGeneric500NIVAGEN PHARMACTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
1998175834010230BENZPHETAMINE HCL50 MGTABLETORALYFGeneric30NIVAGEN PHARMACTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2025800093765256VARDENAFIL HCL2.5 MGTABLETORALNFGeneric30TEVA USAEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
2025800173082813LEVITRA2.5 MGTABLETORALNFMulti-Source Brand30GLAXOSMITHKLINEEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
2025800527280032VARDENAFIL HCL2.5 MGTABLETORALNFGeneric30LANNETT CO. INCEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
2025870710106803VARDENAFIL HCL2.5 MGTABLETORALNFGeneric30ZYDUS PHARMACEUEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
2038310631011731ABSORICA30 MGCAPSULEORALNFBrand30RANBAXY/SUN PHAPA DRUGS, DOD PA REQUIRED
2038310631011769ABSORICA30 MGCAPSULEORALNFBrand10RANBAXY/SUN PHAPA DRUGS, DOD PA REQUIRED
2058944087907001GONAL-F1050 UNITVIAL (EA)SUBCUTANEOUSYFBrand1EMD SERONO, INCPA DRUGS, DOD PA REQUIRED
2059044087903001GONAL-F450 UNITVIAL (EA)SUBCUTANEOUSYFBrand1EMD SERONO, INCPA DRUGS, DOD PA REQUIRED
2059344087900501GONAL-F RFF75 UNITVIAL (EA)SUBCUTANEOUSYFBrand1EMD SERONO, INCPA DRUGS, DOD PA REQUIRED
2059344087900506GONAL-F RFF75 UNITVIAL (EA)SUBCUTANEOUSYFBrand1EMD SERONO, INCPA DRUGS, DOD PA REQUIRED
2069100093211001PHENTERMINE HCL15 MGCAPSULEORALYFGeneric100TEVA USATPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069100185064401PHENTERMINE HCL15 MGCAPSULEORALYFGeneric100SANDOZTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069100185064410PHENTERMINE HCL15 MGCAPSULEORALYFGeneric1000SANDOZTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069100527174201PHENTERMINE HCL15 MGCAPSULEORALYFGeneric100LANNETT CO. INCTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069100527174210PHENTERMINE HCL15 MGCAPSULEORALYFGeneric1000LANNETT CO. INCTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069110702002601PHENTERMINE HCL15 MGCAPSULEORALYFGeneric100KVK-TECH, INC.TPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069110702002610PHENTERMINE HCL15 MGCAPSULEORALYFGeneric1000KVK-TECH, INC.TPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069111534015701PHENTERMINE HCL15 MGCAPSULEORALYFGeneric100SUNRISE PHARMACTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069111534015703PHENTERMINE HCL15 MGCAPSULEORALYFGeneric1000SUNRISE PHARMACTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069113107010501PHENTERMINE HCL15 MGCAPSULEORALYFGeneric100AUROBINDO PHARMTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069151224020350PHENTERMINE HCL15 MGCAPSULEORALYFGeneric100TAGI PHARMATPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069151224020370PHENTERMINE HCL15 MGCAPSULEORALYFGeneric1000TAGI PHARMATPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069169315020201PHENTERMINE HCL15 MGCAPSULEORALYFGeneric100LEADING PHARMATPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069169315020210PHENTERMINE HCL15 MGCAPSULEORALYFGeneric1000LEADING PHARMATPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069200093210901PHENTERMINE HCL30 MGCAPSULEORALYFGeneric100TEVA USATPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069200185064701PHENTERMINE HCL30 MGCAPSULEORALYFGeneric100SANDOZTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069200185064710PHENTERMINE HCL30 MGCAPSULEORALYFGeneric1000SANDOZTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069200185500001PHENTERMINE HCL30 MGCAPSULEORALYFGeneric100SANDOZTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069200185500010PHENTERMINE HCL30 MGCAPSULEORALYFGeneric1000SANDOZTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069200527059701PHENTERMINE HCL30 MGCAPSULEORALYFGeneric100LANNETT CO. INCTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069200527059710PHENTERMINE HCL30 MGCAPSULEORALYFGeneric1000LANNETT CO. INCTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069200527130801PHENTERMINE HCL30 MGCAPSULEORALYFGeneric100LANNETT CO. INCTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069200527130810PHENTERMINE HCL30 MGCAPSULEORALYFGeneric1000LANNETT CO. INCTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069200527131001PHENTERMINE HCL30 MGCAPSULEORALYFGeneric100LANNETT CO. INCTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069200527131010PHENTERMINE HCL30 MGCAPSULEORALYFGeneric1000LANNETT CO. INCTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069200527143801PHENTERMINE HCL30 MGCAPSULEORALYFGeneric100LANNETT CO. INCTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069200527143810PHENTERMINE HCL30 MGCAPSULEORALYFGeneric1000LANNETT CO. INCTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069210702002701PHENTERMINE HCL30 MGCAPSULEORALYFGeneric100KVK-TECH, INC.TPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069210702002710PHENTERMINE HCL30 MGCAPSULEORALYFGeneric1000KVK-TECH, INC.TPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069210702002801PHENTERMINE HCL30 MGCAPSULEORALYFGeneric100KVK-TECH, INC.TPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069210702002810PHENTERMINE HCL30 MGCAPSULEORALYFGeneric1000KVK-TECH, INC.TPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069211534017601PHENTERMINE HCL30 MGCAPSULEORALYFGeneric100SUNRISE PHARMACTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069211534017603PHENTERMINE HCL30 MGCAPSULEORALYFGeneric1000SUNRISE PHARMACTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069213107010601PHENTERMINE HCL30 MGCAPSULEORALYFGeneric100AUROBINDO PHARMTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069251224020250PHENTERMINE HCL30 MGCAPSULEORALYFGeneric100TAGI PHARMATPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069251224020270PHENTERMINE HCL30 MGCAPSULEORALYFGeneric1000TAGI PHARMATPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069253489043301PHENTERMINE HCL30 MGCAPSULEORALYFGeneric100MUTUAL PHARM COTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069253489043310PHENTERMINE HCL30 MGCAPSULEORALYFGeneric1000MUTUAL PHARM COTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069269315020301PHENTERMINE HCL30 MGCAPSULEORALYFGeneric100LEADING PHARMATPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069269315020310PHENTERMINE HCL30 MGCAPSULEORALYFGeneric1000LEADING PHARMATPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069300527174301PHENTERMINE HCL37.5 MGCAPSULEORALYFGeneric100LANNETT CO. INCTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069300527174310PHENTERMINE HCL37.5 MGCAPSULEORALYFGeneric1000LANNETT CO. INCTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069300527174330PHENTERMINE HCL37.5 MGCAPSULEORALYFGeneric30LANNETT CO. INCTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069310702002901PHENTERMINE HCL37.5 MGCAPSULEORALYFGeneric100KVK-TECH, INC.TPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069310702002910PHENTERMINE HCL37.5 MGCAPSULEORALYFGeneric1000KVK-TECH, INC.TPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069311534015901PHENTERMINE HCL37.5 MGCAPSULEORALYFGeneric100SUNRISE PHARMACTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069311534015903PHENTERMINE HCL37.5 MGCAPSULEORALYFGeneric1000SUNRISE PHARMACTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069311534015930PHENTERMINE HCL37.5 MGCAPSULEORALYFGeneric30SUNRISE PHARMACTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069342806052401PHENTERMINE HCL37.5 MGCAPSULEORALYFGeneric100EPIC PHARMA LLCTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069357844001901ADIPEX-P37.5 MGCAPSULEORALYFMulti-Source Brand100TEVA SELECT BRATPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069369315020401PHENTERMINE HCL37.5 MGCAPSULEORALYFGeneric100LEADING PHARMATPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069369315020403PHENTERMINE HCL37.5 MGCAPSULEORALYFGeneric30LEADING PHARMATPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2069369315020410PHENTERMINE HCL37.5 MGCAPSULEORALYFGeneric1000LEADING PHARMATPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2071300527144501PHENTERMINE HCL37.5 MGTABLETORALYFGeneric100LANNETT CO. INCTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2071300527144510PHENTERMINE HCL37.5 MGTABLETORALYFGeneric1000LANNETT CO. INCTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2071300603519216PHENTERMINE HCL37.5 MGTABLETORALYFGeneric30QUALITEST/PAR PTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2071300603519221PHENTERMINE HCL37.5 MGTABLETORALYFGeneric100QUALITEST/PAR PTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2071300603519232PHENTERMINE HCL37.5 MGTABLETORALYFGeneric1000QUALITEST/PAR PTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2071310702002501PHENTERMINE HCL37.5 MGTABLETORALYFGeneric100KVK-TECH, INC.TPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2071310702002503PHENTERMINE HCL37.5 MGTABLETORALYFGeneric30KVK-TECH, INC.TPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2071310702002510PHENTERMINE HCL37.5 MGTABLETORALYFGeneric1000KVK-TECH, INC.TPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2071311534016001PHENTERMINE HCL37.5 MGTABLETORALYFGeneric100SUNRISE PHARMACTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2071311534016003PHENTERMINE HCL37.5 MGTABLETORALYFGeneric1000SUNRISE PHARMACTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2071311534016030PHENTERMINE HCL37.5 MGTABLETORALYFGeneric30SUNRISE PHARMACTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2071313107006101PHENTERMINE HCL37.5 MGTABLETORALYFGeneric100AUROBINDO PHARMTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2071313107006199PHENTERMINE HCL37.5 MGTABLETORALYFGeneric1000AUROBINDO PHARMTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2071343547040410PHENTERMINE HCL37.5 MGTABLETORALYFGeneric100SOLCO HEALTHCARTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2071343547040411PHENTERMINE HCL37.5 MGTABLETORALYFGeneric1000SOLCO HEALTHCARTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2071351224010150PHENTERMINE HCL37.5 MGTABLETORALYFGeneric100TAGI PHARMATPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2071351224010170PHENTERMINE HCL37.5 MGTABLETORALYFGeneric1000TAGI PHARMATPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2071353489067601PHENTERMINE HCL37.5 MGTABLETORALYFGeneric100MUTUAL PHARM COTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2071353489067610PHENTERMINE HCL37.5 MGTABLETORALYFGeneric1000MUTUAL PHARM COTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2071357844000901ADIPEX-P37.5 MGTABLETORALYFMulti-Source Brand100TEVA SELECT BRATPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2071357844000956ADIPEX-P37.5 MGTABLETORALYFMulti-Source Brand30TEVA SELECT BRATPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2071364980019001PHENTERMINE HCL37.5 MGTABLETORALYFGeneric100RISING PHARMTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2071364980019003PHENTERMINE HCL37.5 MGTABLETORALYFGeneric30RISING PHARMTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2071364980019010PHENTERMINE HCL37.5 MGTABLETORALYFGeneric1000RISING PHARMTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2071368645048554PHENTERMINE HCL37.5 MGTABLETORALYFGeneric30LEGACY PHARMACETPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2071369315020101PHENTERMINE HCL37.5 MGTABLETORALYFGeneric100LEADING PHARMATPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2071369315020103PHENTERMINE HCL37.5 MGTABLETORALYFGeneric30LEADING PHARMATPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2071369315020110PHENTERMINE HCL37.5 MGTABLETORALYFGeneric1000LEADING PHARMATPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2071510702000109LOMAIRA8 MGTABLETORALNFBrand90KVK-TECH, INC.TPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2073600002446230CIALIS5 MGTABLETORALNFMulti-Source Brand30ELI LILLY & CO.EBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
2073600002446234CIALIS5 MGTABLETORALNFMulti-Source Brand30ELI LILLY & CO.EBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
2073600002446279CIALIS5 MGTABLETORALNFMulti-Source Brand15ELI LILLY & CO.EBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
2073600093301730TADALAFIL5 MGTABLETORALNFGeneric15TEVA USAEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
2073600093301756TADALAFIL5 MGTABLETORALNFGeneric30TEVA USAEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
2073600093301765TADALAFIL5 MGTABLETORALNFGeneric30TEVA USAEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
2073600378697193TADALAFIL5 MGTABLETORALNFGeneric30MYLANEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
2073613668056630TADALAFIL5 MGTABLETORALNFGeneric30TORRENT PHARMACEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
2073616729037010TADALAFIL5 MGTABLETORALNFGeneric30ACCORD HEALTHCAEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
2073627241011203TADALAFIL5 MGTABLETORALNFGeneric30AJANTA PHARMA LEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
2073629300028713TADALAFIL5 MGTABLETORALNFGeneric30UNICHEM PHARMACEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
2073629300028782TADALAFIL5 MGTABLETORALNFGeneric30UNICHEM PHARMACEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
2073631722064430TADALAFIL5 MGTABLETORALNFGeneric30CAMBER PHARMACEEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
2073635573041030TADALAFIL5 MGTABLETORALNFGeneric30BUREL PHARMACEUEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
2073643598057530TADALAFIL5 MGTABLETORALNFGeneric30DR. REDDY'S LABEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
2073647335001083TADALAFIL5 MGTABLETORALNFGeneric30SUN PHARMA GLOBEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
2073660505468403TADALAFIL5 MGTABLETORALNFGeneric30APOTEX CORPEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
2073662332017815TADALAFIL5 MGTABLETORALNFGeneric30ALEMBIC PHARMACEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
2073662332017830TADALAFIL5 MGTABLETORALNFGeneric30ALEMBIC PHARMACEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
2073666993070130TADALAFIL5 MGTABLETORALNFGeneric30PRASCO LABSEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
2073666993070138TADALAFIL5 MGTABLETORALNFGeneric30PRASCO LABSEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
2073666993070156TADALAFIL5 MGTABLETORALNFGeneric15PRASCO LABSEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
2073668180092006TADALAFIL5 MGTABLETORALNFGeneric30LUPIN PHARMACEUEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
2073668382089706TADALAFIL5 MGTABLETORALNFGeneric30ZYDUS PHARMACEUEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
2073669097037402TADALAFIL5 MGTABLETORALNFGeneric30CIPLA USA, INC.EBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
2073669097037405TADALAFIL5 MGTABLETORALNFGeneric90CIPLA USA, INC.EBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
2073669238134703TADALAFIL5 MGTABLETORALNFGeneric30AMNEAL PHARMACEEBD: IMPOTENCE - ORAL, FEMALES PA REQUIRED
2077100527147501DIETHYLPROPION HCL25 MGTABLETORALYFGeneric100LANNETT CO. INCTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2077100591078301DIETHYLPROPION HCL25 MGTABLETORALYFGeneric100ACTAVIS/TEVATPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2077110702004401DIETHYLPROPION HCL25 MGTABLETORALYFGeneric100KVK-TECH, INC.TPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2077110702004406DIETHYLPROPION HCL25 MGTABLETORALYFGeneric60KVK-TECH, INC.TPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2078000527147701DIETHYLPROPION HCL ER75 MGTABLET, EXTENDED RELEASEORALYFGeneric100LANNETT CO. INCTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2078000591078201DIETHYLPROPION HCL ER75 MGTABLET, EXTENDED RELEASEORALYFGeneric100ACTAVIS/TEVATPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2084000185525401PHENDIMETRAZINE TARTRATE ER105 MGCAPSULE, EXTENDED RELEASEORALYFGeneric100SANDOZTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2084000185525410PHENDIMETRAZINE TARTRATE ER105 MGCAPSULE, EXTENDED RELEASEORALYFGeneric1000SANDOZTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2084069543040910PHENDIMETRAZINE TARTRATE ER105 MGCAPSULE, EXTENDED RELEASEORALYFGeneric100VIRTUS PHARMACETPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2085200185405701PHENDIMETRAZINE TARTRATE35 MGTABLETORALYFGeneric100SANDOZTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2085200185405710PHENDIMETRAZINE TARTRATE35 MGTABLETORALYFGeneric1000SANDOZTPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2085210702004501PHENDIMETRAZINE TARTRATE35 MGTABLETORALYFGeneric100KVK-TECH, INC.TPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2085210702004503PHENDIMETRAZINE TARTRATE35 MGTABLETORALYFGeneric30KVK-TECH, INC.TPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2085210702004510PHENDIMETRAZINE TARTRATE35 MGTABLETORALYFGeneric1000KVK-TECH, INC.TPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2085210702007701PHENDIMETRAZINE TARTRATE35 MGTABLETORALYFGeneric100KVK-TECH, INC.TPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2085210702007703PHENDIMETRAZINE TARTRATE35 MGTABLETORALYFGeneric30KVK-TECH, INC.TPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2085210702007710PHENDIMETRAZINE TARTRATE35 MGTABLETORALYFGeneric1000KVK-TECH, INC.TPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2085210702007801PHENDIMETRAZINE TARTRATE35 MGTABLETORALYFGeneric100KVK-TECH, INC.TPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2085210702007803PHENDIMETRAZINE TARTRATE35 MGTABLETORALYFGeneric30KVK-TECH, INC.TPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2085210702007810PHENDIMETRAZINE TARTRATE35 MGTABLETORALYFGeneric1000KVK-TECH, INC.TPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2085268462056101PHENDIMETRAZINE TARTRATE35 MGTABLETORALYFGeneric100GLENMARK PHARMATPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2085268462056110PHENDIMETRAZINE TARTRATE35 MGTABLETORALYFGeneric1000GLENMARK PHARMATPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2085269543041010PHENDIMETRAZINE TARTRATE35 MGTABLETORALYFGeneric100VIRTUS PHARMACETPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2085269543041011PHENDIMETRAZINE TARTRATE35 MGTABLETORALYFGeneric1000VIRTUS PHARMACETPA - LEGEND ANTI-OBESITY DRUGS REQUIRES PRIOR AUTHORIZATION
2136844087111501GONAL-F RFF REDI-JECT300/0.5MLPEN INJECTOR (ML)SUBCUTANEOUSYFBrand0.5EMD SERONO, INCPA DRUGS, DOD PA REQUIRED
2137544087111601GONAL-F RFF REDI-JECT450/0.75MLPEN INJECTOR (ML)SUBCUTANEOUSYFBrand0.75EMD SERONO, INCPA DRUGS, DOD PA REQUIRED
2137644087111701GONAL-F RFF REDI-JECT900/1.5 MLPEN INJECTOR (ML)SUBCUTANEOUSYFBrand1.5EMD SERONO, INCPA DRUGS, DOD PA REQUIRED
2145000013265402GENOTROPIN1.2MG/0.25SYRINGE (EA)SUBCUTANEOUSNFBrand7PHARMACI/PFIZERPA DRUGS, DOD PA REQUIRED
2145100013265502GENOTROPIN1.4MG/0.25SYRINGE (EA)SUBCUTANEOUSNFBrand7PHARMACI/PFIZERPA DRUGS, DOD PA REQUIRED
2145200013265602GENOTROPIN1.6MG/0.25SYRINGE (EA)SUBCUTANEOUSNFBrand7PHARMACI/PFIZERPA DRUGS, DOD PA REQUIRED
2145300013265702GENOTROPIN1.8MG/0.25SYRINGE (EA)SUBCUTANEOUSNFBrand7PHARMACI/PFIZERPA DRUGS, DOD PA REQUIRED
2145400013265802GENOTROPIN2MG/0.25MLSYRINGE (EA)SUBCUTANEOUSNFBrand7PHARMACI/PFIZERPA DRUGS, DOD PA REQUIRED
2157313811053530FOLIVANE-OB85 MG-1 MGCAPSULEORALNFGeneric30TRIGEN LABORATOEBD: LEG PRENATAL VIT, AGE >45 PA REQUIRED
2157352747062030CONCEPT OB85 MG-1 MGCAPSULEORALNFMulti-Source Brand30US PHARMACEUTICEBD: LEG PRENATAL VIT, AGE >45 PA REQUIRED
2157413811053630TARON-C DHA35-1-200MGCAPSULEORALNFGeneric30TRIGEN LABORATOEBD: LEG PRENATAL VIT, AGE >45 PA REQUIRED
2157452747062130CONCEPT DHA35-1-200MGCAPSULEORALNFMulti-Source Brand30US PHARMACEUTICEBD: LEG PRENATAL VIT, AGE >45 PA REQUIRED
2157458657012130DOTHELLE DHA35-1-200MGCAPSULEORALNFGeneric30METHOD PHARMACEBD: LEG PRENATAL VIT, AGE >45 PA REQUIRED
2157476439033130VIRT-C DHA35-1-200MGCAPSULEORALNFGeneric30VIRTUS PHARMACEEBD: LEG PRENATAL VIT, AGE >45 PA REQUIRED
2158500813020201O-CAL PRENATAL15 MG-1 MGTABLETORALNFBrand100PHARMICSEBD: LEG PRENATAL VIT, AGE >45 PA REQUIRED
2159766215030300VENTAVIS20 MCG/MLAMPUL FOR NEBULIZATION (ML)INHALATIONYFBrand1ACTELION PHARMAPA DRUGS, DOD PA REQUIRED
2159766215030330VENTAVIS20 MCG/MLAMPUL FOR NEBULIZATION (ML)INHALATIONYFBrand1ACTELION PHARMAPA DRUGS, DOD PA REQUIRED
2172851991017801VINATE II29 MG-1 MGTABLETORALNFGeneric100BRECKENRIDGEEBD: LEG PRENATAL VIT, AGE >45 PA REQUIRED
2183100378600191METFORMIN HCL ER1000 MGTABLET, EXTENDED RELEASE 24 HRORALNFGeneric60MYLANPA DRUGS, DOD PA REQUIRED
2183100591272060METFORMIN HCL ER1000 MGTABLET, EXTENDED RELEASE 24 HRORALNFGeneric60ACTAVIS/TEVAPA DRUGS, DOD PA REQUIRED
2183129033003206METFORMIN HCL ER1000 MGTABLET, EXTENDED RELEASE 24 HRORALNFGeneric60NOSTRUM LABORATPA DRUGS, DOD PA REQUIRED
2183142806040660METFORMIN HCL ER1000 MGTABLET, EXTENDED RELEASE 24 HRORALNFGeneric60EPIC PHARMA LLCPA DRUGS, DOD PA REQUIRED
2183150742063460METFORMIN HCL ER1000 MGTABLET, EXTENDED RELEASE 24 HRORALNFGeneric60INGENUS PHARMACPA DRUGS, DOD PA REQUIRED
2183159630057560FORTAMET1000 MGTABLET, EXTENDED RELEASE 24 HRORALNFMulti-Source Brand60SHIONOGI PHARMAPA DRUGS, DOD PA REQUIRED
2183168084081932METFORMIN HCL ER1000 MGTABLET, EXTENDED RELEASE 24 HRORALNFGeneric20AHPPA DRUGS, DOD PA REQUIRED
2183168084081933METFORMIN HCL ER1000 MGTABLET, EXTENDED RELEASE 24 HRORALNFGeneric1AHPPA DRUGS, DOD PA REQUIRED
2183168180033707METFORMIN HCL ER1000 MGTABLET, EXTENDED RELEASE 24 HRORALNFGeneric60LUPIN PHARMACEUPA DRUGS, DOD PA REQUIRED
2183200378600291METFORMIN HCL ER500 MGTABLET, EXTENDED RELEASE 24 HRORALNFGeneric60MYLANPA DRUGS, DOD PA REQUIRED
2183200591271960METFORMIN HCL ER500 MGTABLET, EXTENDED RELEASE 24 HRORALNFGeneric60ACTAVIS/TEVAPA DRUGS, DOD PA REQUIRED
2183229033003106METFORMIN HCL ER500 MGTABLET, EXTENDED RELEASE 24 HRORALNFGeneric60NOSTRUM LABORATPA DRUGS, DOD PA REQUIRED
2183242806040560METFORMIN HCL ER500 MGTABLET, EXTENDED RELEASE 24 HRORALNFGeneric60EPIC PHARMA LLCPA DRUGS, DOD PA REQUIRED
2183250742063360METFORMIN HCL ER500 MGTABLET, EXTENDED RELEASE 24 HRORALNFGeneric60INGENUS PHARMACPA DRUGS, DOD PA REQUIRED
2183259630057460FORTAMET500 MGTABLET, EXTENDED RELEASE 24 HRORALNFMulti-Source Brand60SHIONOGI PHARMAPA DRUGS, DOD PA REQUIRED
2183268180033607METFORMIN HCL ER500 MGTABLET, EXTENDED RELEASE 24 HRORALNFGeneric60LUPIN PHARMACEUPA DRUGS, DOD PA REQUIRED
2264524987011114NILANDRON150 MGTABLETORALYFMulti-Source Brand30COVIS/CONCORDIAPA DRUGS, DOD PA REQUIRED
2264559212011114NILANDRON150 MGTABLETORALYFMulti-Source Brand30CONCORDIA PHARMPA DRUGS, DOD PA REQUIRED
2264562559017331NILUTAMIDE150 MGTABLETORALYFGeneric30ANI PHARMACEUTIPA DRUGS, DOD PA REQUIRED
2283600169643810LEVEMIR FLEXTOUCH100/ML (3)INSULIN PEN (ML)SUBCUTANEOUSNIBrand3NOVO NORDISKPA DRUGS, DOD PA REQUIRED
2293542192010515BPO4 %GEL (GRAM)TOPICALYFGeneric42.5ACELLA PHARMACEPA DRUGS, DOD PA REQUIRED
2293642192010615BPO8 %GEL (GRAM)TOPICALYFGeneric42.5ACELLA PHARMACEPA DRUGS, DOD PA REQUIRED
2314100051848888ANDROGEL12.5/1.25GGEL IN METERED-DOSE PUMPTRANSDERMALNFMulti-Source Brand75ABBVIE US LLCPA DRUGS, DOD PA REQUIRED
2314100245087240VOGELXO12.5/1.25GGEL IN METERED-DOSE PUMPTRANSDERMALYFBrand75UPSHER-SMITH LAPA DRUGS, DOD PA REQUIRED
2314100245087242VOGELXO12.5/1.25GGEL IN METERED-DOSE PUMPTRANSDERMALYFBrand75UPSHER-SMITH LAPA DRUGS, DOD PA REQUIRED
2314100591292102TESTOSTERONE12.5/1.25GGEL IN METERED-DOSE PUMPTRANSDERMALYFGeneric75ACTAVIS/TEVAPA DRUGS, DOD PA REQUIRED
2314100591292118TESTOSTERONE12.5/1.25GGEL IN METERED-DOSE PUMPTRANSDERMALYFGeneric75ACTAVIS/TEVAPA DRUGS, DOD PA REQUIRED
2314100832112140TESTOSTERONE12.5/1.25GGEL IN METERED-DOSE PUMPTRANSDERMALYFBrand75UPSHER-SMITH LAPA DRUGS, DOD PA REQUIRED
2314100832112142TESTOSTERONE12.5/1.25GGEL IN METERED-DOSE PUMPTRANSDERMALYFBrand75UPSHER-SMITH LAPA DRUGS, DOD PA REQUIRED
2314145802011602TESTOSTERONE12.5/1.25GGEL IN METERED-DOSE PUMPTRANSDERMALYFGeneric75PERRIGO CO.PA DRUGS, DOD PA REQUIRED
2349513811058030ZATEAN-PN DHA27-1-300MGCAPSULEORALNFGeneric30TRIGEN LABORATOEBD: LEG PRENATAL VIT, AGE >45 PA REQUIRED
2349542192032130PNV-DHA27-1-300MGCAPSULEORALNFGeneric30ACELLA PHARMACEEBD: LEG PRENATAL VIT, AGE >45 PA REQUIRED
2349558657012230RULAVITE DHA27-1-300MGCAPSULEORALNFGeneric30METHOD PHARMACEBD: LEG PRENATAL VIT, AGE >45 PA REQUIRED
2349569543034030VIRT-PN DHA27-1-300MGCAPSULEORALNFGeneric30VIRTUS PHARMACEEBD: LEG PRENATAL VIT, AGE >45 PA REQUIRED
2369544087001601SAIZENPREP8.8MG/1.51CARTRIDGE (EA)SUBCUTANEOUSNFBrand1EMD SERONO, INCPA DRUGS, DOD PA REQUIRED
2369544087108001SAIZEN8.8MG/1.51CARTRIDGE (EA)SUBCUTANEOUSNFBrand1EMD SERONO, INCPA DRUGS, DOD PA REQUIRED
2376142998050101EMFLAZA6 MGTABLETORALYFBrand100MARATHON/PTC THPA DRUGS, DOD PA REQUIRED
2376152856050101EMFLAZA6 MGTABLETORALYFBrand100PTC THERAPEUTICPA DRUGS, DOD PA REQUIRED
2376242998050303EMFLAZA30 MGTABLETORALYFBrand30MARATHON/PTC THPA DRUGS, DOD PA REQUIRED
2376252856050303EMFLAZA30 MGTABLETORALYFBrand30PTC THERAPEUTICPA DRUGS, DOD PA REQUIRED
2392900093540189OMEGA-3 ACID ETHYL ESTERS1 GCAPSULEORALYFGeneric120TEVA USAPA DRUGS, DOD PA REQUIRED
2392900173088408LOVAZA1 GCAPSULEORALYFMulti-Source Brand120GLAXOSMITHKLINEPA DRUGS, DOD PA REQUIRED
2392900254301008OMEGA-3 ACID ETHYL ESTERS1 GCAPSULEORALYFGeneric120PAR PHARM.PA DRUGS, DOD PA REQUIRED
2392916714066001OMEGA-3 ACID ETHYL ESTERS1 GCAPSULEORALYFGeneric120NORTHSTAR RX LLPA DRUGS, DOD PA REQUIRED
2392931722093612OMEGA-3 ACID ETHYL ESTERS1 GCAPSULEORALYFGeneric120CAMBER PHARMACEPA DRUGS, DOD PA REQUIRED
2392942291065712OMEGA-3 ACID ETHYL ESTERS1 GCAPSULEORALYFGeneric120AVKAREPA DRUGS, DOD PA REQUIRED
2392949884001908OMEGA-3 ACID ETHYL ESTERS1 GCAPSULEORALYFGeneric120PAR PHARM.PA DRUGS, DOD PA REQUIRED
2392960505317007OMEGA-3 ACID ETHYL ESTERS1 GCAPSULEORALYFGeneric120APOTEX CORPPA DRUGS, DOD PA REQUIRED
2392964380076111OMEGA-3 ACID ETHYL ESTERS1 GCAPSULEORALYFGeneric120STRIDES PHARMAPA DRUGS, DOD PA REQUIRED
2392965162003416OMEGA-3 ACID ETHYL ESTERS1 GCAPSULEORALYFGeneric120AMNEAL PHARMACEPA DRUGS, DOD PA REQUIRED
2392966993072632OMEGA-3 ACID ETHYL ESTERS1 GCAPSULEORALYFGeneric120PRASCO LABSPA DRUGS, DOD PA REQUIRED
2392966993083932OMEGA-3 ACID ETHYL ESTERS1 GCAPSULEORALYFGeneric120PRASCO LABSPA DRUGS, DOD PA REQUIRED
2392970868015060TRIKLO1 GCAPSULEORALYFGeneric60KEY THERAPEUTICPA DRUGS, DOD PA REQUIRED
2414500169770421NORDITROPIN FLEXPRO5 MG/1.5MLPEN INJECTOR (ML)SUBCUTANEOUSYFBrand1.5NOVO NORDISKPA DRUGS, DOD PA REQUIRED
2414600169770521NORDITROPIN FLEXPRO10MG/1.5MLPEN INJECTOR (ML)SUBCUTANEOUSYFBrand1.5NOVO NORDISKPA DRUGS, DOD PA REQUIRED
2414700169770821NORDITROPIN FLEXPRO15MG/1.5MLPEN INJECTOR (ML)SUBCUTANEOUSYFBrand1.5NOVO NORDISKPA DRUGS, DOD PA REQUIRED
2420300395808262SILDENAFIL CITRATE100 %POWDER (GRAM)MISCELLANEOUSYFBrand100HUMCO LAB.AGE<40, VIAGRA (GC) PA REQUIRED
2420310695001717SILDENAFIL CITRATE100 %POWDER (GRAM)MISCELLANEOUSYFBrand500WILLOW BIRCH PHAGE<40, VIAGRA (GC) PA REQUIRED
2420337803190803SILDENAFIL CITRATE100 %POWDER (GRAM)MISCELLANEOUSYFBrand5APOTHECA SUPPLYAGE<40, VIAGRA (GC) PA REQUIRED
2420337803190804SILDENAFIL CITRATE100 %POWDER (GRAM)MISCELLANEOUSYFBrand25APOTHECA SUPPLYAGE<40, VIAGRA (GC) PA REQUIRED
2420337803190805SILDENAFIL CITRATE100 %POWDER (GRAM)MISCELLANEOUSYFBrand100APOTHECA SUPPLYAGE<40, VIAGRA (GC) PA REQUIRED
2420337803190807SILDENAFIL CITRATE100 %POWDER (GRAM)MISCELLANEOUSYFBrand500APOTHECA SUPPLYAGE<40, VIAGRA (GC) PA REQUIRED
2420346144032010SILDENAFIL CITRATE100 %POWDER (GRAM)MISCELLANEOUSYFBrand100A.P.I. SOLUTIONAGE<40, VIAGRA (GC) PA REQUIRED
2420346144032025SILDENAFIL CITRATE100 %POWDER (GRAM)MISCELLANEOUSYFBrand25A.P.I. SOLUTIONAGE<40, VIAGRA (GC) PA REQUIRED
2420358597808802SILDENAFIL CITRATE100 %POWDER (GRAM)MISCELLANEOUSYFBrand5AMERICAN PHARMAAGE<40, VIAGRA (GC) PA REQUIRED
2420358597808803SILDENAFIL CITRATE100 %POWDER (GRAM)MISCELLANEOUSYFBrand10AMERICAN PHARMAAGE<40, VIAGRA (GC) PA REQUIRED
2420358597808804SILDENAFIL CITRATE100 %POWDER (GRAM)MISCELLANEOUSYFBrand25AMERICAN PHARMAAGE<40, VIAGRA (GC) PA REQUIRED
2420358597808805SILDENAFIL CITRATE100 %POWDER (GRAM)MISCELLANEOUSYFBrand50AMERICAN PHARMAAGE<40, VIAGRA (GC) PA REQUIRED
2420358597808806SILDENAFIL CITRATE100 %POWDER (GRAM)MISCELLANEOUSYFBrand100AMERICAN PHARMAAGE<40, VIAGRA (GC) PA REQUIRED
2420358597808807SILDENAFIL CITRATE100 %POWDER (GRAM)MISCELLANEOUSYFBrand500AMERICAN PHARMAAGE<40, VIAGRA (GC) PA REQUIRED

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