S02. Attachment D - Needed Prescriptions.pdf

Generic Name Dosage Form

ACETAMINOPHEN LIQUID,ORAL

ACETAMINOPHEN SUPP,RTL

ACETAMINOPHEN TAB

ACETAMINOPHEN W/ CODEINE TAB/CAP

ACETAMINOPHEN/ASPIRIN/CAFFEINE TAB TAB

ACETAMINOPHEN/CAFFEINE TAB TAB

ACETAMINOPHEN/HYDROCODONE LIQUID,ORAL

ACETAMINOPHEN/OXYCODONE HCL LIQUID,ORAL

ACETAMINOPHEN/OXYCODONE HCL TAB

ACETAZOLAMIDE TAB

ACETAZOLAMIDE CAP,SA

ACETIC ACID OTIC

ACETYLCYSTEINE SOLN,INHL/ORAL

ACYCLOVIR CAP,ORAL

ACYCLOVIR TAB

ALBENDAZOLE TAB

ALBUTEROL SULFATE INHALATION INHALER,NEBULES

ALBUTEROL/IPRATROPIUM INHL,ORAL

ALBUTEROL/IPRATROPIUM INHL,SOLN

ALLOPURINOL TAB

ALPRAZOLAM TAB

AMIODARONE TAB

AMITRIPTYLINE HCL TAB

AMLODIPINE TAB

AMOXICILLIN CAP,ORAL

AMOXICILLIN PWDR,RENST-ORAL

AMOXICILLIN TAB

AMOXICILLIN & K CLAVULANATE CHEW TAB

AMOXICILLIN & K CLAVULANATE TAB/CAP/SUSPENSION

AMOXICILLIN & K CLAVULANATE TAB, SA (12 HR)

APIXABAN TAB

ARIPIPRAZOLE TAB

ARTIFICIAL TEARS METHYLCELLULOSE (OTC) SOLN,OPH

ARTIFICIAL TEARS POLYVINYL ALCOHOL (PF) (OTC) SOLN,OPH

ARTIFICIAL TEARS SOLN (OTC) SOLN,OPH

ASPIRIN (OTC) CHEW,TAB

ASPIRIN (OTC) TAB,EC

ATENOLOL TAB

ATORVASTATIN TAB

ATROPINE SO4 /DIPHENOXYLATE HCL ORAL TAB

AZITHROMYCIN TAB/CAP/SUSPENSION

BACITRACIN OINT,TOP

BACITRACIN/HC /NEO/POLYMYX OINT,OPH

BACITRACIN/NEOMYCIN/POLYMYXIN OINT,OPH

BACITRACIN/NEOMYCIN/POLYMYXIN B OINT,TOP

BACITRACIN/POLYMYXIN OINT,OPH

BACITRACIN/POLYMYXIN OINT, TOP

BACLOFEN TAB

BENZONATATE CAP,ORAL

BENZTROPINE MESYLATE TAB

BETAMETHASONE DIPROPIONATE CREAM,TOP

BETAMETHASONE DIPROPIONATE OINT,TOP

BETAMETHASONE VALERATE CREAM,TOP

BETAMETHASONE VALERATE LOTION,TOP

Attachment D - Needed Prescriptions

BETAMETHASONE VALERATE OINT,TOP

BISACODYL ENEMA,RTL

BISACODYL (OTC) TAB,EC

BISACODYL (OTC) SUPP,RTL

BISMUTH SUBSALICYLATE SUSP,ORAL

BISMUTH SUBSALICYLATE TAB,CHEWABLE

BUPRENORPHINE SL TAB

BUPRENORPHINE/NALOXONE SL TAB

BUPROPION HCL TAB/TAB,SA (12HR-SR)/TAB,SA

(24HR-SR)

CARBAMAZEPINE CAP,SA/TAB,SA

CARBAMAZEPINE TAB

CARBAMIDE PEROXIDE/GLYERCIN SOLN, OTIC

CARVEDILOL TAB

CEFACLOR CAP,ORAL

CEFADROXIL CAP,ORAL

CEFDINIR CAP,ORAL

CEFIXIME TAB

CEFPODOXIME PROXETIL TAB

CEFUROXIME TAB/CAP

CELECOXIB CAP,ORAL

CEPHALEXIN TAB/CAP/SUSPENSION

CETIRIZINE TAB

CETRORELIX ACETATE INJ

CHLORDIAZEPOXIDE HCL CAP,ORAL

CHLORHEXADINE GLUCONATE MOUTHWASH

CHLORPHENIRAMINE MALEATE (OTC) TAB

CHLORPROMAZINE TAB

CHLORTHALIDONE TAB

CHORIOGONADOTROPIN ALFA INJ

CIPROFLOXACIN HCL TAB

CIPROFLOXACIN HCL SOLN,OPH

CIPROFLOXACIN/DEXAMETHASONE SUSP, OTIC

CITALOPRAM HYDROBROMIDE TAB

CLARITHROMYCIN TAB

CLINDAMYCIN TAB/CAP/SOLN

CLOBETASOL CREAM,TOP

CLOBETASOL OINT,TOP

CLOBETASOL SOLN,TOP

CLOMIPHENE CITRATE TAB

CLONAZEPAM TAB

CLONIDINE TAB/CAP

CLOPIDOGREL BISULFATE TAB

CLOTRIMAZOLE CREAM, VAG

CLOTRIMAZOLE CREAM, TOP

CLOTRIMAZOLE TOP, SOLN

CLOTRIMAZOLE TROCHE TAB/CAP

CODEINE TAB

CODEINE/ACETAMINOPHEN ELIXIR

CODEINE/GUAIFENESIN LIQUID,ORAL

COLCHICINE TAB/CAP

COVID-19 VACCINE (COMIRNATY) INJ

COVID-19 VACCINE (SPIKEVAX) INJ

COVID-19 VACCINE (NOVAVAX) INJ

CYCLOBENZAPRINE HCL TAB/CAP

CYCLOSERINE CAP,ORAL

CYPROHEPTADINE TAB

DABIGATRAN CAP,ORAL

DAPSONE TAB

DEMECLOCYCLINE HCL TAB

DESOGESTREL0.15MG/ETHINYL ESTRADIOL 30MCG,28 (MONO) (EQV-RECLIPSEN) TAB

DESONIDE CREAM,TOP

DEXAMETHASONE TAB

DEXAMETHASONE NA PHOSPHATE SOLN,OPH

DEXAMETHASONE/NEO/POLYMX OINT,OPH

DEXAMETHASONE/TOBRAMYCIN SUSP,OPH

DEXAMETHASONE/TOBRAMYCIN OINT,OPH

DEXTROMETHORPHAN/GUAIFENESIN (OTC) LIQUID,ORAL

DEXTROMETHORPHAN/GUAIFENESIN (SF) (OTC) LIQUID,ORAL

DEXTROSE SQUEEZE TUBE (OTC) LIQUID,ORAL

DIAZEPAM TAB

DICLOFENAC 1% GEL, TOP

DICLOFENAC NA SOLN,OPH

DICLOFENAC NA TAB,EC

DICLOFENAC POTASSIUM TAB

DICLOXACILLIN NA CAP,ORAL

DICYCLOMINE HCL TAB/CAP

DIGOXIN TAB

DILTIAZEM HCL TAB

DILTIAZEM HCL CAP,SA (12HR AND 24HR)

DIPHENHYDRAMINE HCL (OTC) CAP,ORAL

DIPHENHYDRAMINE HCL (OTC) LIQUID,ORAL

DIPHENHYDRAMINE HCL (OTC) TAB

DIVALPROEX SODIUM TAB/CAP

DOCUSATE (OTC) CAP,ORAL

DOCUSATE (OTC) LIQUID,ORAL

DOCUSATE (OTC) ENEMA,RTL

DOCUSATE/SENNOSIDES TAB

DONEPEZIL TAB

DOXAZOSIN TAB

DOXEPIN TAB

DOXYCYCLINE SUSP

DOXYCYCLINE TAB/CAP

DROSPIRENONE 3MG/ETHINYL ESTRADIOL 20MCG (EQV-YAZ) TAB

DROSPIRENONE 3MG/ETHINYL ESTRADIOL 30MCG (EQV-YASMIN) TAB

DULOXETINE CAP,EC

EDOXABAN TAB

ENOXAPARIN SODIUM INJECTION

EPINEPHRINE AUTOINJECTOR INJ, SOLN

ERYTHROMYCIN SUSP

ERYTHROMYCIN TAB

ERYTHROMYCIN TAB,EC

ERYTHROMYCIN OPHTH OINTMENT

ESCITALOPRAM TAB

ETHAMBUTOL HCL TAB

ETHINYL ESTRADIOL 0.12MG/ETONOGESTREL 0.015MG (EQV-NUVARING) RING,VAGINAL

ETHINYL ESTRADIOL 20MCG/LEVONORGESTREL 0.1MG,28 (MONO) (EQV-LUTERA) TAB

ETHINYL ESTRADIOL 20MCG/NORETHINDRONE 1MG,21 (EQV-LOESTRIN 1/20) TAB

ETHINYL ESTRADIOL 30MCG/LEVONORGESTREL 0.15MG,28 (MONO) (EQV-LEVLEN) TAB

ETHINYL ESTRADIOL 30/40/30MCG/LEVONORGESTREL .05/.075/.125,28 (TRI) (EQV-

ENPRESSE)

TAB

ETHINYL ESTRADIOL 30MCG/NORETHINDRONE 1.5MG,21 (EQV-LOESTRIN 1.5/30) TAB

ETHINYL ESTRADIOL 35MCG/NORELGESTROMIN 150MCG (EQV-XULANE) TAB

ETHINYL ESTRADIOL 35MCG/NORETHINDRONE 1MG,28 (MONO) (EQV-NORINYL 1 +35) TAB

ETHINYL ESTRADIOL 35MCG/NORETHINDRONE,28 (TRI) (EQV-DASETTA 7/7/7) TAB

ETHINYL ESTRADIOL 35MCG/NORGESTIMATE 0.25MG,28 (MONO) (EQV-MONONESSA) TAB

ETHINYL ESTRADIOL 35MCG/NORGESTIMATE,28 (TRI) (EQV-TRI-ESTARYLLA) TAB

ETHIONAMIDE TAB

ETODOLAC CAP/TAB

EYE RINSE (OTC) SOLN,OPH IRRG

FAMCICLOVIR TAB

FAMOTIDINE TAB

FLECAINIDE TAB

FLUCONAZOLE PWDR,RENST-ORAL

FLUCONAZOLE TAB/CAP

FLUCYTOSINE CAP,ORAL

FLUOCINOLONE ACETONIDE 0.01% SOLN,TOP

FLUOCINONIDE CREAM,TOP

FLUOCINONIDE OINT,TOP

FLUOCINONIDE SOLN,TOP

FLUOROMETHOLONE SUSP,OPH

FLUOXETINE CAP/TAB

FLUPHENAZINE TAB

FLUTICASONE (PROPRIONATE ONLY) INHL,NASAL

FLUTICASONE/SALMETEROL INHL,ORAL

FLUVOXAMINE TAB

FOLLITROPIN BETA INJ

FOLLITROPIN ALFA INJ

FOLLITROPIN BETA (FOLLISTIM) PEN DEVICE

FUROSEMIDE TAB/CAP

GABAPENTIN CAP/TAB

GANCICLOVIR GEL,OPH

GANIRELIX ACETATE SYR INJ

GENTAMICIN SO4 CREAM,TOP

GENTAMICIN SULFATE OPHTHALMIC OINT/SOLN

GENTAMICIN/PREDNISOLONE SUSP,OPH

GLIPIZIDE TAB/CAP

GLUCAGON RECOMBINANT INJ

GLUCOSE (OTC) TAB,CHEWABLE

GLYCERIN (ADULT) (OTC) SUPP,RTL

GONADOTROPIN,CHORIONIC INJ

GRAMICIDIN/NEOMYCIN/POLYMYXIN SOLN,OPH

GUAIFENESIN TAB

GUAIFENESIN TAB,SA

GUAIFENESIN LIQUID,ORAL

HALOBETASOL CREAM,TOP

HALOBETASOL OINT,TOP

HALOPERIDOL ORAL TAB/CAP/SOLUTION

HEMORRHOIDAL (OTC) OINT,RTL

HEMORRHOIDAL (OTC) SUPP,RTL

HYDRALAZINE HCL TAB

HYDROCHLOROTHIAZIDE CAP OR TAB

HYDROCHLOROTHIAZIDE/LISINOPRIL TAB

HYDROCHLOROTHIAZIDE/TRIAMTERENE TAB/CAP

HYDROCODONE-ACETAMINOPHEN TAB/CAP

HYDROCORTISONE TAB

HYDROCORTISONE CREAM,RTL

HYDROCORTISONE AEROSOL,TOP

HYDROCORTISONE (PLAIN OR ACETATE) OINT,TOP

HYDROCORTISONE (PLAIN OR ACETATE) LOTION,TOP

HYDROCORTISONE TOPICAL CREAM

HYDROCORTISONE/PRAMOXINE AEROSOL,RTL

HYDROCORTISONE/PRAMOXINE OINT,RTL

HYDROMORPHONE HCL TAB

HYDROXYCHLOROQUINE SULFATE TAB

HYDROXYZINE CAP OR TAB

HYDROXYZINE INJ,SOLN

HYDROXYZINE LIQUID,ORAL

IBUPROFEN TAB

INDOMETHACIN CAP

INDOMETHACIN SA CAP, SA

INFLUENZA (SEASONAL) VACCINE INJ

INSULIN SYRINGE

INSULIN ASPART INJECTION

INSULIN ASPART PROTAMINE/INSULIN ASPART (70/30) INJ,SUSP

INSULIN DETEMIR INJECTION

INSULIN GLARGINE INJECTION

INSULIN GLARGINE-YFGN 100 UNIT/ML INJECTION

INSULIN HUMAN 70/30 (NPH/REG) (OTC) INJ,SUSP

INSULIN ISOPHANE (HUMAN) INJ 100 UNIT/ML (NOVOLIN) INJECTION

INSULIN LOW DOSE SYRINGE

INSULIN NPH INJECTION

INSULIN PEN NEEDLE NEEDLE

INSULIN REGULAR (HUMAN) INJ 100 UNIT/ML (NOVOLIN) INJECTION

INSULIN REGULAR (HUMAN) INJ 500 UNIT/ML INJECTION

IPRATROPIUM BROMIDE INHALANT

IPRATROPIUM BROMIDE SOLN,INHL

ISONIAZID TAB

ISOSORBIDE DINITRATE TAB

ISOSORBIDE MONONITRATE SR 24HR TAB/CAP

ITRACONAZOLE ORAL CAP,ORAL

KETOCONAZOLE TAB

KETOCONAZOLE SHAMPOO

KETOCONAZOLE 2% CREAM,TOP

KETOROLAC TROMETHAMINE SOLN,OPH

KETOTIFEN 0.025% SOLN

LABETALOL TAB

LACTULOSE SYRUP

LAMOTRIGINE TAB

LETROZOLE TAB

LEUCOVORIN TAB

LEUPROLIDE ACETATE INJ

LEVETIRACETAM TAB

LEVOFLOXACIN TAB/CAP

LEVONORGESTREL (Plan B) TAB/CAP

LEVOTHYROXINE TAB

LIDOCAINE (4%) PATCH

LIDOCAINE 2% VISCOUS LIQUID,ORAL

LIDOCAINE 2.5%/PRILOCAINE 2.5% CREAM, TOP

LINEZOLID PWDR,RENST-ORAL

LINEZOLID TAB

LISINOPRIL TAB

LITHIUM CAP,ORAL/TAB/TAB,SA

LOPERAMIDE HCL CAP/TAB

LOPERAMIDE HCL LIQUID,ORAL

LORATADINE TAB

LORAZEPAM TAB/CAP

LOSARTAN TAB

LOXAPINE CAP,ORAL

LUBRICATING (PF) (OTC) OINT,OPH

MAGNESIUM CITRATE (OTC) LIQUID,ORAL

MAGNESIUM HYDROXIDE (OTC) SUSP,ORAL

MECLIZINE HCL (OTC) CHEW TAB/TAB

MEDROXYPROGESTERONE ACETATE INJ (Depo-SubQ Provera 104 EQV) SUSP,INJ MEDROXYPROGESTERONE ACETATE INJ (Depo-Provera EQV) SUSP,INJ

MELOXICAM TAB

MEMANTINE HCL TAB

METFORMIN HCL TAB/CAP/TAB,SA

METHENAMINE TAB

METHOCARBAMOL TAB

METHYLPREDNISOLONE 4 MG DOSE PACK TAB/CAP

METOCLOPRAMIDE TAB

METOCLOPRAMIDE HCL LIQUID,ORAL

METOLAZONE TAB

METOPROLOL TARTRATE TAB

METOPROLOL SUCCINATE SUSTAINED ACTION TAB,SA

METRONIDAZOLE GEL,TOP

METRONIDAZOLE TAB/CAP

METRONIDAZOLE VAGINAL GEL

MICONAZOLE CREAM,TOP

MICONAZOLE NITRATE 2% TINCTURE,TOP

MINERAL OIL (OTC) ENEMA

MINOCYCLINE HCL CAP/TAB

MIRTAZAPINE TAB

MISOPROSTOL TAB

MOLNUPIRAVIR CAP,ORAL

MOMETASONE FUROATE INHL,ORAL

MONTELUKAST TAB

MORPHINE CAP,SA

MORPHINE LIQUID,ORAL

MORPHINE SOLN,CONC

MORPHINE TAB,IR

MORPHINE TAB,SA

MOXIFLOXACIN TAB

MOXIFLOXACIN OPH

MUPIROCIN OINT,TOP

NABUMETONE TAB

NALOXONE NASAL SPRAY

NAPROXEN TAB

NATAMYCIN SUSP,OPH

NEOMYCIN SULFATE TAB

NEOMYCIN-POLYMYXIN-HC OTIC SOLUTION/SUSPENSION

NIFEDIPINE TAB,SA

NIRMATRELVIR/RITONAVIR TAB

NITROFURANTOIN MONOHYDRATE/MACROCRYSTALLINE TAB/CAP

NITROGLYCERIN PATCH

NITROGLYCERIN SL TAB

NORETHINDRONE 0.35MG (EQV-NOR QD),28 TAB

NORTRIPTYLINE CAP,ORAL

NYSTATIN SUSP,ORAL

NYSTATIN TAB,ORAL

NYSTATIN CREAM,TOP

NYSTATIN 100000UNT/GM OINT,TOP

OFLOXACIN SOLN,OPH

OLANZAPINE TAB

OLODATEROL/TIOTROPIUM INHL,ORAL

OMEPRAZOLE CAP,EC

ONDANSETRON TAB/CAP

OPHTH LUBRICATING OINTMENT (PF) (OTC) OINT,OPH

OSELTAMIVIR PHOSPHATE TAB/CAP

OXCARBAZEPINE TAB

OXYBUTYNIN TAB, SA

OXYBUTYNIN CHLORIDE TAB

OXYCODONE HCL LIQUID,ORAL

OXYCODONE HCL TAB

PANTOPRAZOLE TAB,EC

PAROXETINE TAB

PENICILLIN PWDR,RENST-ORAL

PENICILLIN VK TAB/CAP

PERMETHRIN 1% LIQUID, TOPICAL

PERMETHRIN (OTC) LOTION,TOP

PERMETHRIN 5% TOPICAL CREAM

PERPHENAZINE TAB

PHENAZOPYRIDINE HCL TAB/CAP

PHENOL LIQUID,ORAL

PHENYLEPHRINE TAB

PHENYTOIN SODIUM TAB/CAP/SUSPENSION

PHYTONADIONE (VITAMIN K) 5mg TAB/CAP

PNEUMOCOCCAL CONJUGATE (21-VALENT) VACCINE INJ/SYR

POLY/NEO/HC OTIC SOLUTION/SUSPENSION

POLYETHYLENE GLYCOL 3350 (PEG-3350) PWDR,RENST-ORAL

POLYETHYLENE GLYCOL 3350 (PEG-3350)/ELECTROLYTES PWDR,RENST-ORAL

POLYMYXIN/TRIMETHOPRIM OPHTHALMIC SOLUTION

POTASSIUM CHLORIDE TAB/TAB,ER/CAP/SOLUTION

PRAZOSIN TAB/CAP

PRAZOSIN HCL CAP,ORAL

PREDNISOLONE ACETATE OPHTHALMIC SUSPENSION

PREDNISOLONE NA PHOSPHATE/SULFACETAMIDE SOLN,OPH

PREDNISONE TAB

PRIMIDONE TAB

PROCHLORPERAZINE SUPP,RTL

PROCHLORPERAZINE MALEATE TAB

PROGESTERONE GEL,VAGINAL

PROGESTERONE INJ (IN OIL)

PROGESTERONE TAB

PROMETHAZINE HCL SUPP,RTL

PROMETHAZINE HCL TAB

PROMETHAZINE HCL SYRUP

PROPRANOLOL TAB

PROPRANOLOL CAP,SA

PSEUDOEPHEDRINE HCL (OTC) TAB

PSEUDOEPHEDRINE/TRIPROLIDINE TAB

PYRAZINAMIDE TAB

QUETIAPINE TAB

RIBAVIRIN CAP,ORAL

RIBAVIRIN TAB

RIFABUTIN CAP,ORAL

RIFAMPIN CAP,ORAL

RIFAPENTINE TAB

RIMANTADINE HCL TAB

RISPERIDONE TAB

RIVAROXABAN TAB

RSV VACCINE (RECOMBINANT)-Abrysvo INJ RSV VACCINE (RECOMBINANT, ADJUVANTED)-Arexvy INJ

SALSALATE TAB

SCOPALAMINE PATCH

SENNOSIDES (OTC) TAB

SERTRALINE TAB

SILVADENE TOPICAL CREAM

SITAGLIPTIN (EQV-ZITUVIO) TAB

SODIUM BIPHOSPHATE/SODIUM PHOSPHATE (OTC) ENEMA

SODIUM CHLORIDE (NEBULIZER) SOLN,INHL

SODIUM POLYSTYRENE SULFONATE SUSP

SODIUM POLYSTYRENE SULFONATE SUSP,RTL

SODIUM POLYSTYRENE SULFONATE PWDR

SPACER, INHALER DEVICE

SPIRONOLACTONE TAB

SUCRALFATE TAB

SULFACETAMIDE SODIUM OPHTHALMIC SOLN/OINT

SULFADIAZINE TAB

SULFAMETHOXAZOLE/TRIMETHOPRIM SUSP

SULFAMETHOXAZOLE-TRIMETHOPRIM TAB/CAP

SULINDAC TAB

SUMATRIPTAN TAB, INJ, NASAL SPRAY

TACROLIMUS OINT,TOP

TAMSULOSIN CAP.ORAL

TEMAZEPAM CAP,ORAL

TERAZOSIN HCL CAP,ORAL

TERBINAFINE HCL TAB

TERBINAFINE HCL 1% CREAM,TOP

TETRACYCLINE HCL CAP,ORAL

TIOTROPIUM INHL,ORAL/CAP,INHL

TIZANIDINE TAB

TOBRAMYCIN OPHTHALMIC SOLUTION

TOLNAFTATE POWDER,TOP

TOPIRAMATE TAB

TRAMADOL HCL TAB

TRAZODONE TAB/CAP

TRIAMCINOLONE CREAM,TOP

TRIAMCINOLONE OINT,TOP

TRIFLURIDINE SOLN,OPH

TRIMETHOBENZAMIDE CAP,ORAL

TRIMETHOPRIM TAB

ULIPRISTAL TAB

VALACYCLOVIR TAB/CAP

VALGANCICLOVIR HCL TAB

VALPROIC ACID CAP,ORAL

VANCOMYCIN HCL CAP,ORAL

VENLAFAXINE CAP,SA/TAB,SA/TAB

VERAPAMIL HCL TAB,SA

WARFARIN TAB

ZANAMIVIR INHL,ORAL

ZIPRASIDONE CAP,ORAL

ZOLPIDEM TAB/CAP

ZOSTER VACCINE (SHINGRIX) INJ, LYPHL

Comments

OTC Only (81MG) OTC Only

2mg and 8mg only 2mg/0.5mg and 8mg/2mg only

0.25mg/VL

25mg, 50mg 250 mcg/0.5mL SYR

50mg

3 TABS

NDC: 00069236201/NDC: 00069239201

NDC: 80777010295/NDC: 80777010296/NDC: 80777010293

NDC: 8063110710/8063110701

5mg and 10mg only

300 UNIT; 600 UNIT; 900 UNIT

450 UNIT/VL; 1050 UNIT/VL; 300 UNIT/0.5ML PEN; 450 UNIT/0.75ML PEN; 900 UNIT/1.5ML PEN

250mcg/0.5mL

10000 UNIT/VL

Specific gauges Pen and Vial

Pen and Vial Pen and Vial Pen and Vial

Specific gauges Pen and Vial

Pen

2.5mg

1MG/0.2ML

104MG/0.65ML

150MG/ML

(DILANTIN)

NO 8MEQ; TAB ER=20MEQ (RX ONLY)

4%, 8% (with applicator) 50mg/mL

100mg

NDC: 00069034401/NDC: 00069034405 (Note: Referral Required) NDC: 58160084811 (Note: Referral Required)

Limit 4 patches

5 TABS/14 DAYS

Sheet1