Marys Medicine

2016 him enhanced_formulary reference guide 10.9.15.pdf

2016 Essential Health Benefits Enhanced Effective 1/1/2016 Your formulary utilizes a Pharmacy and Therapeutics Committee (P & T Committee), made up of practicing physicians, pharmacists, and nurses to help ensure that our formulary is medically sound and that it supports patient health. This committee reviews and evaluates medications on the formulary based on safety and efficacy to help maintain clinical integrity in all therapeutic categories. FORMULARY DESIGN
Optum has chosen a closed formulary structure for our Essential Health Benefits Formulary. The formulary structure features low cost generics, generics, preferred and non-preferred brand-name drugs, specialty drugs (comprised of generic, preferred brand, and non-preferred brand specialty), and ACA (Affordable Care Act) preventive drugs. A closed formulary limits coverage to only those products listed in these levels. Products not listed on the formulary are generally not covered. Low cost generic drugs: Many generic drugs are listed under "LOW COST GENERIC". Drugs listed under "LOW COST GENERIC" have the same active ingredient as the brand-name versions but at a lower cost. Generic drugs: Most generic drugs are listed under "GENERIC". Drugs listed under "GENERIC" have the same active ingredient as the brand-name versions but at a lower cost. Preferred drugs: Drugs listed under "PREFERRED" include preferred brand name drugs that will generally have lower co-payments than non-preferred brand name drugs. Non-preferred drugs: Drugs listed under "NON PREFERRED" generally have higher co-payments than preferred brand name drugs. Specialty drugs: Drugs listed under "GENERIC SPECIALTY and PREFERRED BRAND SPECIALTY" have the same co-payment structure. NON-PREFERRED BRAND SPECIALTY drugs generally have the highest co-payment and cost. Specialty drugs are prescription medications that are sometimes used to treat complex and chronic conditions. They may require special monitoring or handling. ACA preventive drugs: Drugs listed under "PREVENTIVE" may have coverage and no co-payment when health care reform requirements are met for age, gender, and/or risk factors. REASONABLE MEDICAL MANAGEMENT
Optum's formulary also uses medical and utilization management functions to determine whether a prescription is medically necessary. These industry recognized and accepted management functions include but are not limited to quantity limits, step therapy, and prior authorization and help Optum and its clients determine whether the prescribed medication was prescribed in accordance with generally accepted medical practice standards, is clinically appropriate, and confirm that the prescribed medication is not more costly than an alternative product that is as likely to produce therapeutically equivalent results. As recommended by the United States Department of Labor, Optum's reasonable medical and utilization management functions apply to ACA preventive drugs. USING THIS FORMULARY REFERENCE GUIDE TO HELP
CONTAIN COSTS
Many health plans use the Optum formulary to help manage the overall cost of
providing prescription drug benefits. This formulary offers a wide range of medications
from which to choose. We realize that this formulary reference guide may not include
every drug from every manufacturer. However, choosing a generic or preferred drug
when it is appropriate can provide access to the necessary medications to stay
healthy, at a cost that is more affordable.
SAVING ON OUT-OF-POCKET COSTS
Your health plan sets the co-payments for each formulary drug status which include low cost generic, generic, preferred brand-name, non-preferred brand-name, and specialty medications. Co-payments and deductibles for preventive products follow health care reform rules. Health plans often design prescription drug plans to encourage the use of generic and preferred brand-name drugs. Choosing non-preferred drugs (or specialty drugs) may mean paying higher out-of-pocket expenses (such as coinsurance, co-payments, and deductible amounts) or not receiving coverage at all. Patients may also pay less for generic drugs. PLEASE NOTE: Brand-name drugs may become non-formulary if a generic
version becomes available.
CONSULTING THE PRESCRIBER'S OFFICE WHEN
APPROPRIATE
When employers and other health plans design their prescription drug plans, they may choose to provide coverage only for certain medications, time periods, doses, quantities, or for a specific indications (e.g. they may exclude coverage for medications for unapproved, unproven, or cosmetic indications). When coverage for medications is provided based on use or quantity, your pharmacy benefit may contact your prescriber's office for additional information to determine whether coverage is available under your plan. Patients who are unsure whether these coverage rules apply for a particular medication can consult their prescription drug benefit manual or contact a Member Services representative to determine specific coverage requirements. KNOWING HOW THE FORMULARY INFORMATION IS
ORGANIZED
The following formulary reference guide is designed in the following order: generics, generic preventive, preferred brand name, non-preferred brand name, brand name preventive, specialty drugs, low cost generics. In addition, immediately preceding the index is a section listing ACA preventive drugs by category. OptumRx specializes in the delivery, clinical management and affordability of prescription medications and consumer health products. We are an OptumTM company — a leading provider of integrated health services. Learn more at optum.com. trademarks and logos are owned by Optum, Inc. All other brand or product names are trademarks or registered marks of their respective owners. 2015 Optum, Inc. All rights reserved. Table of Contents
January 2016
amoxicillin/clavulanate potassium amoxicillin/clavulanate potassium ER clarithromycin ER ampicillin sodium ampicillin-sulbactam Erythromycin Base nafcillin sodium oxacillin sodium penicillin G potassium DificidQL
piperacillin sodium/ tazobactam sodium piperacillin sodium/tazobactam sodium Erythrocin Lactobionate piperacillin/tazobactam LOW COST GENERIC Bactocill IN Dextrose demeclocycline HCL LOW COST GENERIC dicloxacillin sodium penicillin v potassium doxycycline hyclate doxycycline hyclate DR doxycycline monohydrate minocycline HCL ER morgidox 1X100MG morgidox 2X100MG cefazolin sodium Tetracycline HCL LOW COST GENERIC cefoxitin sodium ciprofloxacin ER ciprofloxacin I.V.-IN D5W cefuroxime axetil cefuroxime sodium levofloxacin IN D5W moxifloxacin HCL Cefotetan/Dextrose Ciprofloxacin HCL LOW COST GENERIC cefotaxime sodium ciprofloxacin HCL cefpodoxime proxetil ceftriaxone sodium amikacin sulfate gentamicin sulfate Cefditoren Pivoxil gentamicin sulfate pediatric gentamicin sulfate/0.9% sodium chloride isotonic gentamicin paromomycin sulfate tobramycin sulfate Streptomycin Sulfate Effective January 1, 2016 v.1 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; GENERIC SPECIALTY PREFERRED BRAND SPECIALTY Tobi PodhalerQL,PA
LOW COST GENERIC valacyclovir HCLQL
neomycin sulfate AtriplaQL
CompleraQL
FuzeonQL,PA
Capastat Sulfate Relenza DiskhalerQL
Retrovir IV Infusion LOW COST GENERIC SelzentryPA
StribildQL
ANTIFUNGALS
TamifluQL
TruvadaPA
fluconazole IN dextrose griseofulvin microsize griseofulvin ultramicrosize GENERIC SPECIALTY adefovir dipivoxilQL,PA
SporanoxPA
PREFERRED BRAND SPECIALTY LOW COST GENERIC HarvoniPA
fluconazole IN NACL Moderiba 1200 Dose Pack Moderiba 800 Dose Pack terbinafine HCLQL
Peg-intron RedipenPA
Peg-intron Redipen PAK 4PA
PegasysPA
Pegasys ProclickPA
PegintronPA
acyclovir sodium Ribasphere Ribapak SovaldiPA
NON-PREFERRED BRAND SPECIALTY lamivudine/zidovudine Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; LOW COST GENERIC TyzekaQL,PA
VictrelisPA
metronidazole IN NACL 0.79% LOW COST GENERIC sulfamethoxazole/trimethoprim DS sulfatrim pediatric atovaquone/proguanil HCL quinine sulfatePA
Primaquine Phosphate GENERIC SPECIALTY cyclophosphamide LOW COST GENERIC chloroquine phosphate melphalan hydrochloride hydroxychloroquine sulfate PREFERRED BRAND SPECIALTY MISC. ANTI-INFECTIVES
clindamycin palmitate HCL ValchlorPA
clindamycin phosphate clindamycin phosphate add-vantage NON-PREFERRED BRAND SPECIALTY clindamycin phosphate pharmacy bulk package clindamycin phosphate IN D5W Cyclophosphamide colistimethate sodium imipenem/cilastatin bleomycin sulfate linezolidQL
GENERIC SPECIALTY polymyxin b sulfate daunorubicin HCL doxorubicin HCL liposome SivextroQL
mitoxantrone HCLQL,PA
XifaxanPA
PREFERRED BRAND SPECIALTY Azactam IN Iso-osmotic Dextrose NON-PREFERRED BRAND SPECIALTY PREFERRED BRAND SPECIALTY ErwinazePA
PREFERRED BRAND SPECIALTY CaystonPA
Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; GENERIC SPECIALTY methotrexate sodium leuprolide acetatePA
PREFERRED BRAND SPECIALTY GENERIC SPECIALTY Lupron DepotQL,PA
Trelstar MixjectQL,PA
cytarabine aqueous VantasQL,PA
XtandiPA
fludarabine phosphate ZytigaPA
PREFERRED BRAND SPECIALTY cyclosporine modified mycophenolate mofetil mycophenolic acid DR NON-PREFERRED BRAND SPECIALTY ANGIOGENESIS INHIBITORS
PREFERRED BRAND SPECIALTY Cellcept Intravenous NulojixPA
ANTIBODIES
ZortressPA
PREFERRED BRAND SPECIALTY PREFERRED BRAND SPECIALTY AdcetrisPA
PomalystPA
ArzerraPA
RevlimidPA
ThalomidPA
GazyvaPA
HerceptinPA
KadcylaPA
PerjetaPA
GENERIC SPECIALTY YervoyPA
NON-PREFERRED BRAND SPECIALTY BlincytoPA
OpdivoPA
vincristine sulfate vinorelbine tartrate PREFERRED BRAND SPECIALTY HalavenPA
megestrol acetate JevtanaPA
tamoxifen citrate NON-PREFERRED BRAND SPECIALTY Vinblastine Sulfate Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; Intron APA
Intron A W/DiluentPA
PREFERRED BRAND SPECIALTY Afinitor DisperzPA
BosulifPA
SylatronPA
SynriboPA
CometriqPA
TargretinPA
GleevecPA
IbrancePA
IclusigPA
NON-PREFERRED BRAND SPECIALTY ImbruvicaPA
InlytaPA
IstodaxPA
JakafiPA
CHEMOTHERAPY RESCUE
KyprolisPA
MekinistPA
leucovorin calcium NexavarPA
GENERIC SPECIALTY SprycelPA
StivargaPA
SutentPA
TafinlarPA
Levoleucovorin Calcium PREFERRED BRAND SPECIALTY TasignaPA
TykerbPA
VelcadePA
VotrientPA
XalkoriPA
CHEMOTHERAPY ADJUNCTS
PREFERRED BRAND SPECIALTY ZolinzaPA
ZydeligPA
NON-PREFERRED BRAND SPECIALTY Lenvima 10MG Daily DosePA
PHOSPHODIESTERASE INHBTR
Lenvima 14MG Daily DosePA
Lenvima 20MG Daily DosePA
milrinone lactate Lenvima 24MG Daily DosePA
milrinone IN dextrose LynparzaPA
TOPOISOMERASE I INHIBITOR
LOW COST GENERIC GENERIC SPECIALTY PREFERRED BRAND SPECIALTY NON-PREFERRED BRAND SPECIALTY isosorbide dinitrate isosorbide mononitrate nitroglycerin lingual nitroglycerin transdermal Bexxar 131 Iodine nitroglycerin ER nitroglycerin IN dextrose 5% nitroglycerin IN 5% dextrose Isosorbide Dinitrate Nitroglycerin Lingual GENERIC SPECIALTY RanexaPA
PREFERRED BRAND SPECIALTY LOW COST GENERIC isosorbide mononitrate ER ErivedgePA
Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; lidocaine HCL/dextrose propafenone HCL ER quinidine gluconate CR metoprolol succinate ER quinidine gluconate ER quinidine sulfate Quinidine Sulfate propranolol HCL ER sotalol HCL (AF) perindopril erbumine LOW COST GENERIC LOW COST GENERIC bisoprolol fumarate enalapril maleate fosinopril sodium metoprolol tartrate CALCIUM CHANNEL BLOCKERS
ANGIOTENSIN RCPTR BLOCKER
candesartan cilexetilST
diltiazem HCL CD diltiazem HCL ER Eprosartan Mesylate EdarbiST
LOW COST GENERIC losartan potassium DIRECT RENIN INHIBITORS
verapamil HCL ER ANTIHYPERTENSIVES MISC.
verapamil HCL SR fenoldopam mesylate LOW COST GENERIC phenoxybenzamine hydrochloride amlodipine besylate Methyldopate HCL doxazosin mesylate disopyramide phosphate flecainide acetate ibutilide fumarate lidocaine HCL IN D5W Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; ANTIHYPERTENSIVE COMBO
amlodipine besylate/benazepril hydrochloride amlodipine besylate/benazepril HCL dobutamine HCL/D5W amlodipine besylate/valsartan dobutamine/dextrose 5% benazepril HCL/hydrochlorothiazide dopamine HCL-dextrose 5% candesartan cilexetil/hydrochlorothiazide dopamine HCL/dextrose 5% fosinopril sodium/hydrochlorothiazide ephedrine sulfate norepinephrine bitartrate phenylephrine HCL telmisartan/amlodipine trandolapril/verapamil HCL trandolapril/verapamil HCL ER cholestyramine light colestipol HCL for oral suspension LOW COST GENERIC fenofibrate micronized atenolol/chlorthalidone fenofibric acid DR bisoprolol fumarate/hydrochlorothiazide enalapril maleate/hydrochlorothiazide fluvastatin sodium ER losartan potassium/hydrochlorothiazide micronized colestipol HCL DIURETICS
omega-3-acid ethyl esters pravastatin sodium acetazolamide sodium acetazolamide ER chlorothiazide sodium osmitrol viaflex Methyclothiazide PREFERRED BRAND SPECIALTY Ethacrynate Sodium LOW COST GENERIC LOW COST GENERIC atorvastatin calcium CARDIOVASCULAR - MISC.
hydrochlorothiazide amlodipine besylate/atorvastatin calcium CialisQL
ViagraQL
GENERIC SPECIALTY epoprostenol sodiumPA
Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; sildenafil citrateQL,PA
PREFERRED BRAND SPECIALTY RemodulinPA
TyvasoQL,PA
Tyvaso RefillQL,PA
Tyvaso StarterQL,PA
VeletriPA
ANTIBIOTICS - TOPICAL
avar-e emollient mupirocin calcium benzepro creamy wash benzepro foaming cloths benzepro SHORT contact benzoyl peroxide ANTIFUNGALS - TOPICAL
benzoyl peroxide SHORT contact ciclopirox nail lacquer ciclopirox olamine bpo 6% foaming cloths ciclopirox treatmentPA
clotrimazole/betamethasone dipropionate econazole nitrate claris clarifying wash clindacin etz pledgets naftifine HCLST
clindamycin phosphate nystatin/triamcinolone clindamycin/benzoyl peroxide erythromycin/benzoyl peroxide Cnl8 Nail KitPA
ErtaczoST
ExeldermST
MentaxST
pr benzoyl peroxide wash NaftinST
OxistatST
Pedipirox-4 NailPA
rosanil cleanser XolegelST
LOW COST GENERIC sodium sulfacetamide ANTIVIRALS - TOPICAL
sodium sulfacetamide/sulfur sodium sulfacetamide/sulfur cleanser sodium sulfacetamide/sulfur cleansing cloths sodium sulfacetamide/sulfur green sodium sulfacetamide/sulfur w/sunscreen sodium sulfacetamide/sulfur wash diclofenac sodiumQL,PA
sulfacetamide sodium sulfacetamide sodium/sulfur cleanser VoltarenQL
sulfacleanse 8/4 Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; LOW COST GENERIC triamcinolone acetonide IMMUNOMODULATING AGENTS
DERMATOLOGICALS - MISC.
ANTISEBORRHEIC AGENTS
selenium sulfide ammonium lactate sodium sulfacetamide sodium sulfacetamide wash CORTICOSTEROIDS - TOPICAL
diclofenac sodium alclometasone dipropionate grafco silver nitrate applicator augmented betamethasone dipropionate grafco silver nitrate applicator 12" betamethasone dipropionate betamethasone valerate k2k pain relieving patch clobetasol propionate clobetasol propionate e clobetasol propionate emollient lactic acid w/vitamin e cormax scalp application fluocinolone acetonide fluocinolone acetonide body lidocaine HCL jelly fluocinolone acetonide scalp lidocaine/prilocaine fluticasone propionate halobetasol propionate mafenide acetate hydrocortisone acetate/aloe hydrocortisone butyrate hydrocortisone butyrate (lipid) hydrocortisone butyrate (lipophilic) hydrocortisone valerate hydrocortisone IN absorbase premium lidocaine mometasone furoate relador PAK plus Diflorasone Diacetate salicylic acid cream salicylic acid lotion salicylic acid wart remover silver sulfadiazine sodium hyaluronate Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; Dexamethasone Sodium Phosphate urea IN zinc undecylenate/lactic acid vehicle urea 40% nail film testosterone cypionatePA
testosterone enanthatePA
Testosterone P.M.ST
CARB-o-philic 40 CARB-o-philic/40 RegranexPA
StriantST
estradiol valerate estradiol/norethindrone acetate GENERIC SPECIALTY norethindrone acetate/ethinyl estradiol PREFERRED BRAND SPECIALTY ValchlorPA
NON-PREFERRED BRAND SPECIALTY TargretinPA
ENDOCRINE AND METABOLIC
betamethasone sodium phosphate/betamethasone fludrocortisone acetate prednisolone sodium phosphate odt Dexamethasone Intensol Prednisone Intensol amethiaQL
LOW COST GENERIC amethia LOQL
ashlynaQL
dexamethasone sodium phosphate methylprednisolone methylprednisolone acetate methylprednisolone dose pack methylprednisolone sodiumsuccinate camreseQL
prednisolone sodium phosphate camrese LOQL
Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; next choice one dose dayseeQL
norethindrone & ethinyl estradiol ferrous fumarate norethindrone acetate/ethinyl estradiol desogestrel/ethinyl estradiol norethindrone acetate/ethinyl estradiol/ferrous fumarate drospirenone/ethinyl estradiol norgestimate/ethinyl estradiol nortrel 0.5/35 (28) opcicon one-step gildess FE 1.5/30 quasenseQL
setlakinQL
introvaleQL
jolessaQL
levonorgestrel and ethinyl estradiolQL
levonorgestrel/ethinyl estradiol levora 0.15/30-28 NuvaringQL
medroxyprogesterone acetateQL
Depo-subq Provera 104QL
microgestin FE 1.5/30 microgestin 1.5/30 microgestin 1/20 Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; Paragard Intrauterine Copper Contraceptive T380a glyburide micronized PROGESTINS
megestrol acetate norethindrone acetate metformin HCL ER GENERIC SPECIALTY PREFERRED BRAND SPECIALTY LOW COST GENERIC MakenaPA
LOW COST GENERIC medroxyprogesterone acetate ANTIDIABETIC AGENTS
Glucagen Hypokit Glucagon Emergency Kit InvokanaPA
Novolin N Relion Novolin R Relion ALPHA-GLUCOSIDASE INHIBIT
Novolin 70/30 Relion Novolog Mix 70/30 Novolog Mix 70/30 Prefilled Flexpen ApidraST
Apidra SolostarST
HumalogST
Humalog KwikpenST
INSULIN SENSITIZING AGENT
Humalog Mix 50/50ST
pioglitazone HCL Humalog Mix 50/50 KwikpenST
Humalog Mix 75/25ST
Humalog Mix 75/25 KwikpenST
Humulin NST
ANTIDIABETIC COMBINATIONS
Humulin N KwikpenST
glipizide/metformin HCL Humulin N U-100 PenST
glyburide/metformin HCL Humulin RST
pioglitazone HCL-glimepiride Humulin R U-500 (concentrated)ST
pioglitazone HCL/metformin HCL Humulin 70/30ST
Humulin 70/30 KwikpenST
Humulin 70/30 PenST
LevemirST
Levemir FlexpenST
Levemir FlextouchST
Symlinpen 120PA
Symlinpen 60PA
alendronate sodium INCRETIN MIMETIC AGENTS
ibandronate sodiumQL
risedronate sodiumQL,ST
risedronate sodium DRQL,ST
Etidronate Disodium Alendronate Sodium Fosamax Plus DQL
GENERIC SPECIALTY pamidronate disodium zoledronic acidPA
NON-PREFERRED BRAND SPECIALTY Pamidronate Disodium LOW COST GENERIC Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; Zoledronic AcidPA
GH RECEPTOR ANTAGONISTS
ZometaPA
PREFERRED BRAND SPECIALTY SomavertPA
calcitonin salmonQL
desmopressin acetate PREFERRED BRAND SPECIALTY PARATHYROID HORMONE
PREFERRED BRAND SPECIALTY ForteoQL
PREFERRED BRAND SPECIALTY H.p. ActharPA
RANK LIGAND INHIBITORS
PREFERRED BRAND SPECIALTY NON-PREFERRED BRAND SPECIALTY ProliaQL,PA
VASOPRESSIN ANTAGONISTS
HORMONE RECEPTOR MDLTR
PREFERRED BRAND SPECIALTY SamscaQL
raloxifene hydrochloride FERTILITY REGULATORS
GENERIC SPECIALTY chorionic gonadotropinQL
clomiphene citrate novarelQL
pregnyl w/diluent benzyl alcohol/NACLQL
SensiparPA
LHRH/GNRH AGONIST
PREFERRED BRAND SPECIALTY GENERIC SPECIALTY Lupron Depot-PEDQL,PA
sodium phenylbutyrate Supprelin LAQL,PA
PREFERRED BRAND SPECIALTY GROWTH HORMONES
CarbagluPA
PREFERRED BRAND SPECIALTY Norditropin CartridgeQL,PA
ElaprasePA
Norditropin FlexproQL,PA
FabrazymePA
Norditropin Nordiflex PenQL,PA
Nutropin AQ Nuspin 10QL,PA
LumizymePA
Nutropin AQ Nuspin 20QL,PA
MyaleptPA
Nutropin AQ Nuspin 5QL,PA
MyozymePA
Nutropin AQ PenQL,PA
NaglazymePA
NON-PREFERRED BRAND SPECIALTY RavictiPA
VimizimPA
NON-PREFERRED BRAND SPECIALTY liothyronine sodium propylthiouracil NON-PREFERRED BRAND SPECIALTY IncrelexPA
SOMATOSTATIC AGENTS
GENERIC SPECIALTY octreotide acetatePA
PREFERRED BRAND SPECIALTY Sandostatin Lar DepotPA
Somatuline DepotQL,PA
Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; LOW COST GENERIC levothyroxine sodium Esomeprazole Sodium unithroid direct Aciphex SprinkleQL
DexilantQL
Esomeprazole StrontiumQL
polyethylene glycol 3350 NexiumQL
gavilyte-n/flavor pack LOW COST GENERIC peg 3350/electrolytes peg-3350/electrolytes pantoprazole sodiumQL
peg-3350/NACL/NA bicarbonate/KCL Suprep Bowel Prep granisetron HCLQL
ondansetron odtQL
ondansetron HCLQL
LOW COST GENERIC trimethobenzamide HCL SancusoQL
diphenoxylate/atropine AkynzeoQL
AnzemetQL
GranisolQL
LOW COST GENERIC ULCER DRUGS
atropine sulfate esomeprazole magnesiumQL
ZenpepST
esomeprazole sodium PREFERRED BRAND SPECIALTY hyoscyamine sulfate GASTROINTESTINAL - MISC.
hyoscyamine sulfate odt alosetron hydrochloride hyoscyamine sulfate ER hyoscyamine sulfate SR balsalazide disodium methscopolamine bromide hydrocort ene 100MG omeprazole/sodium bicarbonateQL
hydrocortisone acetate/lidocaine HCL hydrocortisone acetate/pramoxine rabeprazole sodiumQL
lidocaine HCL/hydrocortisone acetate Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; metoclopramide odt bethanechol chloride oxybutynin chloride oxybutynin chloride ER tolterodine tartrate AmitizaQL
tolterodine tartrate ER trospium chloride trospium chloride ER OxytrolQL
LinzessQL
EnablexST
Sevelamer Carbonate clindamycin phosphate metronidazole vaginal PREFERRED BRAND SPECIALTY CimziaQL,PA
Cimzia Starter KitQL,PA
vcf vaginal contraceptivegel NON-PREFERRED BRAND SPECIALTY GattexPA
LOW COST GENERIC metoclopramide HCL URINARY ANTI-INFECTIVES
Options Gynol II Vaginal Contraceptive Vcf Vaginal Contraceptive Film Vcf Vaginal Contraceptive Foam methenamine hippurate PREFERRED BRAND SPECIALTY methenamine mandelate nitrofurantoin macrocrystals GENITOURINARY - MISC.
nitrofurantoin monohydrate nitrofurantoin monohydrate/macrocrystals acetic acid 0.25% alfuzosin HCL ER aminoacetic acid argyle sterile saline 100ML curity sterile saline cytra k crystals hydrochloric acid neomycin/polymyxin b sulfates potassium citrate ER potassium citrate-citric acid crystals potassium citrate/citric acid potassium citrate/sodium citrate/citric acid sodium chloride 0.9% Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; PREFERRED BRAND SPECIALTY ProcysbiPA
LOW COST GENERIC citric acid/sodium citrate ferrous fumarate 324 ferrous gluconate phenazopyridine HCL sodium citrate/citric acid gnp slow release iron high potency iron HEMATOPOIETIC AGENTS
iron slow release iron supplement childrens kp ferrous gluconate kp ferrous sulfate meijer ferrous sulfate folic acid/vitamin b-6/vitamin b-12 qc ferrous sulfate hematinic plus vitamins/minerals ra high potency iron hematinic/folic acid ra slow release iron slow release iron slow-release iron iferex 150 forte myferon 150 forte sm iron slow release poly-iron 150 forte polysaccharide iron forte th slow release iron purevit dualfe plus Iron Asp Gly/ Polysacch Compl/Ascorb CAL/B12/Fa/C Threon/Suc HM iron slow release bprotected pedia iron CVS Slow Release Iron eq slow-release iron eql iron supplement therapy eql slow release iron Ferretts Chewable Iron Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; Ferrous Fumarate Ferrous Gluconate aminocaproic acid High Potency Iron HEMATOLOGICAL - MISC.
Iron Chews Pediatric Novaferrum Pediatric Drops Slow Release Iron Sm Slow Release Iron GENERIC SPECIALTY anagrelide hydrochloride sodium ferric gluconate complex/sucrose PREFERRED BRAND SPECIALTY CerezymePA
ElelysoPA
LeukinePA
hetastarch 6%/NACL NeulastaPA
human albumin grifols Neulasta Delivery KitPA
NeumegaPA
pentoxifylline ER NeupogenPA
NplatePA
ProcritPA
PromactaPA
Aspirin/Dipyridamole NON-PREFERRED BRAND SPECIALTY Aranesp Albumin Free EpogenPA
ZavescaPA
PREFERRED BRAND SPECIALTY Alphanate/Von Willebrand Factor Complex/Human enoxaparin sodiumQL
fondaparinux sodiumQL
heparin lock flush heparin lock flush for flushing vascular access devices heparin lock flush/NACL for flushing vascular access heparin sodium dcu heparin sodium lock flush heparin sodium/sodium chloride 0.9% premix heparin sodium/D5W Kogenate FS Bio-set heparin sodium/NACL 0.9% monoject pharma grade flush syringe/heparin lock monoject prefill advanced heparin lock flush sash kit for flushing vascular access devices EliquisQL
PradaxaQL
XareltoQL
Xarelto Starter PackQL
SolirisPA
FragminQL
SavaysaQL
LOW COST GENERIC NON-PREFERRED BRAND SPECIALTY Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; LOW COST GENERIC hydroxyzine pamoate Hydroxyzine Pamoate Thrombate Iii W/10 ML Sterile Water Thrombate Iii W/20 ML Sterile Water budeprion SRQL
bupropion HCL ERQL
bupropion HCL SRQL
bupropion HCL XLQL
citalopram hydrobromide clomipramine HCL duloxetine HCLQL
escitalopram oxalate fluoxetine DRQL
fluvoxamine maleate fluvoxamine maleate ERQL
fluoridex daily defense imipramine pamoate fluoridex daily defense enhanced whitening fluoridex daily defense sensitivity relief paroxetine HCL ER phenelzine sulfate protriptyline HCL neutragard advanced neutral sodium fluoride tranylcypromine sulfate venlafaxine HCL ER pilocarpine hydrochloride stannous fluoride oral rinse Nortriptyline HCL topex topical anesthetic Venlafaxine HCL ER triamcinolone acetonide triamcinolone IN orabase PristiqQL
AplenzinQL
LOW COST GENERIC chlorhexidine gluconate ViibrydQL
chlorhexidine gluconate oral rinse Viibryd Starter PackQL
lidocaine viscous LOW COST GENERIC lidocaine HCL viscous amitriptyline HCL NEUROLOGY, CNS, PSYCH
nortriptyline HCL chlordiazepoxide HCL clorazepate dipotassium chlorpromazine HCL clozapineQL
diazepam intensol gene-xene TAB 15MG fluphenazine decanoate gene-xene TAB 3.75MG gene-xene TAB 7.5MG haloperidol decanoate haloperidol lactate lorazepam intensol loxapine succinate Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; metadate ERQL
olanzapine odtQL
methamphetamine HCLQL
paliperidone ERQL,ST
methylphenidate hydrochloride methylphenidate HCLQL
prochlorperazine methylphenidate HCL CDQL
prochlorperazine edisylate methylphenidate HCL ERQL
prochlorperazine maleate methylphenidate HCL SRQL
quetiapine fumarateQL
zenzediQL
risperidone odtQL
Methylphenidate HCL ER risperidone M-TABQL
ProcentraQL
thioridazine HCL DaytranaQL
trifluoperazine HCL ziprasidone HCLQL
Quillivant XRQL
Clozapine OdtQL
StratteraQL
VyvanseQL
AbilifyQL
Abilify DiscmeltQL
ConcertaQL
Abilify Maintena Focalin XRQL
LatudaQL
Kapvay Dose Pack Risperdal Consta Seroquel XRQL
carbamazepine ER FanaptQL,ST
Fanapt Titration PackQL,ST
FazacloQL
divalproex sodium divalproex sodium DR divalproex sodium ER LOW COST GENERIC fosphenytoin sodium fluphenazine HCL lithium carbonate lithium carbonate ER HYPNOTICS
levetiracetam ER dexmedetomidine HCL phenytoin infatabs phenytoin sodium phenytoin sodium extended tiagabine hydrochloride zaleplonQL
zolpidem tartrateQL
zolpidem tartrate ERQL
Phenobarbital Sodium RozeremQL
PREFERRED BRAND SPECIALTY LyricaQL
ADHD, NARCOLEPSY, ETC.
caffeine citrate clonidine HCL ER dexedrineQL
dexmethylphenidate HCLQL
NON-PREFERRED BRAND SPECIALTY dexmethylphenidate HCL ERQL
SabrilPA
dextroamphetamine sulfateQL
LOW COST GENERIC dextroamphetamine sulfate ERQL
Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; valproate sodium nicotine step 3QL
nicotine transdermal systemQL
px stop smoking aidQL
qc nicotine polacrilexQL
ra mini nicotineQL
ra nicotineQL
benztropine mesylate ra nicotine polacrilexQL
bromocriptine mesylate ra nicotine transdermal system step 3QL
sm nicotineQL
carbidopa/levodopa sm nicotine polacrilexQL
carbidopa/levodopa odt sm nicotine transdermal systemQL
carbidopa/levodopa ER sw nicotine polacrilexQL
tgt nicotine gumQL
pramipexole dihydrochloride tgt nicotine polacrilexQL
pramipexole dihydrochloride ER tgt nicotine step oneQL
tgt nicotine step threeQL
tgt nicotine step twoQL
thriveQL
CVS nicotineQL
trihexyphenidyl HCL CVS nicotine polacrilexQL
CVS nicotine polacrilex starterQL
CVS nicotine transdermal systemQL
CVS nts step 1QL
HM nicotine polacrilexQL
HM nicotine transdermal systemQL
NeuproST
HM nicotine transdermal system step 3QL
SR nicotine gumQL
PREFERRED BRAND SPECIALTY ApokynQL,PA
NEUROLOGY, PSYCH - MISC.
Gralise StarterQL,PA
acamprosate calcium DR Namenda XRQL
Namenda XR Titration PackQL
ergoloid mesylates SavellaQL
galantamine hydrobromide ChantixQL
Chantix Continuing Month PAKQL
memantine HCL titration PAK Chantix Starting Month PAKQL
Nicotine Transdermal SystemQL
rivastigmine tartrate rivastigmine transdermal system Galantamine Hydrobromide Nicotrol InhalerQL
Nicotrol NsQL
GENERIC SPECIALTY buprobanQL
bupropion HCL SRQL
eq nicotineQL
PREFERRED BRAND SPECIALTY eq nicotine gum refillQL
AmpyraQL,PA
eq nicotine gum starterQL
eq nicotine polacrilexQL
AvonexQL,PA
eq nicotine step 3QL
eql nicotineQL
eql nicotine polacrilexQL
eql nicotine polacrilex refillQL
eql nicotine polacrilex starterQL
gnp nicotine mini lozengeQL
gnp nicotine polacrilexQL
Rebif Rebidose Titration Pack gnp nicotine polacrilex miniQL
Rebif Titration Pack kls quit2QL
kls quit4QL
Tecfidera Starter PackQL,PA
nicotineQL
XyremQL,PA
nicotine polacrilexQL
NON-PREFERRED BRAND SPECIALTY nicotine polacrilex refillQL
LemtradaPA
nicotine polacrilex starter kitQL
nicotine step 1QL
nicotine step 2QL
Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; atracurium besylate sodium sulfacetamide cisatracurium besylate sulfacetamide sodium pancuronium bromide rocuronium bromide vecuronium bromide NON-PREFERRED BRAND SPECIALTY BotoxQL,PA
XeominQL,PA
LOW COST GENERIC polymyxin b sulfate/trimethoprim sulfate carisoprodol/aspirin tobramycin sulfate trimethoprim sulfate/polymyxin b sulfate dantrolene sodium ARTIFICIAL TEAR/LUBRICANT
orphenadrine citrate orphenadrine citrate ER Dantrolene Sodium dorzolamide HCL/timolol maleate PREFERRED BRAND SPECIALTY timolol maleate ophthalmic gel forming MonoviscPA
OrthoviscPA
SynviscPA
Synvisc OnePA
LOW COST GENERIC LOW COST GENERIC cyclobenzaprine HCL OPHTHALMIC STEROIDS
ANTIMYASTHENIC AGENTS
dexamethasone sodium phosphate neostigmine methylsulfate pyridostigmine bromide prednisolone acetate sulfacetamide sodium/prednisolone sodium phosphate OPHTHALMOLOGY AND OTIC
bacitracin/polymyxin b ciprofloxacin HCL LOW COST GENERIC gentamicin sulfate neomycin/polymyxin/bacitracin zinc Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; fluor-i-strips a.t. LumiganQL
fluorescein-benoxinate Travatan ZQL
flurbiprofen sodium cyclopentolate HCL green GLO lissamine greenophthalmic strips ketorolac tromethamine LOW COST GENERIC atropine sulfate IlevroQL
NevanacQL
phenylephrine HCL PREFERRED BRAND SPECIALTY Phospholine Iodide NON-PREFERRED BRAND SPECIALTY Isopto Carbachol ADRENERGIC AGENTS
OTIC AGENTS
brimonidine tartrate fluocinolone acetonide fluocinolone acetonide ear drops hydrocortisone/acetic acid neomycin/polymyxin/HC proparacaine HCL LOW COST GENERIC antipyrine/benzocaine OXYTOCICS
OPHTHALMICS - MISC.
methylergonovine maleate akorn balanced salt solution balanced salt solution ANALGESICS - NONNARCOTIC
diclofenac sodium Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; qc childrens aspirin choline magnesium trisalicylate ra aspirin adult low dose ra aspirin adult low strength ra aspirin childrens ra aspirin EC adult low strength ra childrens aspirin sm aspirin adult low strength sm aspirin enteric coated sm aspirin low dose sm aspirin EC low strength sm childrens aspirin st joseph aspirin tgt aspirin low dose adult aspirin EC low strength tgt childrens aspirin tgt enteric-coated aspirin th aspirin low dose aspirin adult low dose th enteric aspirin aspirin adult low strength aspirin childrens CVS aspirin adult low dose aspirin enteric coated adult low strength CVS aspirin adult low strength aspirin low dose CVS aspirin child aspirin low strength CVS aspirin low dose CVS aspirin low strength aspirin EC low dose aspirin EC LO-dose CVS childrens aspirin CVS enteric aspirin aspirin 81 low dose bayer advanced aspirin regular strength HM aspirin EC low dose bayer aspirin regimen bayer aspirin EC low dose bayer chewable low dose SB childrens aspirin childrens aspirin SB low dose asa EC childrens aspirin low strength Adult Aspirin Low Strength ecotrin low strength Aspirin Low Dose enteric coated aspirin NON-PREFERRED BRAND SPECIALTY eq adult aspirin low strength eq aspirin adult low dose ANALGESICS - OPIOID
eq aspirin low dose eq childrens aspirin acetaminophen/codeine eql adult aspirin low strength acetaminophen/codeine #2 acetaminophen/codeine #3 eql aspirin low dose acetaminophen/codeine #4 acetaminophen/codeine phosphate eql childrens aspirin gnp adult aspirin low strength buprenorphine HCLQL,PA
gnp aspirin low dose buprenorphine HCL/naloxone HCLQL,PA
goodsense aspirin low dose kls aspirin low dose butorphanol tartrate meijer aspirin EC miniprin low dose fentanylQL
px enteric aspirin fentanyl citrate oral transmucosalQL,PA
hydrocodone bitartrate/acetaminophen qc aspirin low dose Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; hydrocodone/ibuprofen hydromorphone HCL hydromorphone HCL dosette hydromorphone HCL ERQL
ketorolac tromethamineQL
naproxen sodium CR naproxen sodium ER methadone HCL intensol morphine sulfate morphine sulfate ERQL
Fenoprofen Calcium oxycodone/acetaminophen Meclofenamate Sodium oxycodone/aspirin oxycodone/ibuprofen oxymorphone hydrochloride oxymorphone hydrochloride ERQL
pentazocine/naloxone HCL PREFERRED BRAND SPECIALTY tramadol hydrochloride/acetaminophen ArcalystPA
HumiraPA
tramadol HCL ERQL
Humira Pediatric Crohns Disease Starter PackPA
Humira PenPA
Humira Pen-crohns DiseasestarterPA
Humira Pen-psoriasis StarterPA
NON-PREFERRED BRAND SPECIALTY EnbrelQL,PA
Enbrel SureclickQL,PA
IlarisQL,PA
FentanylQL
KineretPA
Hydrocodone Bitartrate/Acetaminophen SimponiPA
Hydromorphone HCL/Sodium Chloride Simponi AriaQL,PA
Levorphanol Tartrate LOW COST GENERIC Morphine Sulfate ERQL
Oxycodone HCL ERQL
Nucynta ERQL
almotriptan malateQL,ST
Opana ER (crush Resistant)QL
dihydroergotamine mesylate OxycontinQL
naratriptan HCLQL
rizatriptan benzoateQL
rizatriptan benzoate odtQL
EmbedaQL
sumatriptan succinateQL
ExalgoQL
sumatriptan succinate refillQL
zolmitriptan odtQL
Dihydroergotamine MesylateQL
Sumatriptan SuccinateQL
RelpaxQL
diclofenac potassium diclofenac sodium DR diclofenac sodium ER FrovaQL,ST
diclofenac sodium/misoprostol ZomigQL,ST
Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; Zomig Nasal SprayQL,ST
DymistaQL
GOUT AGENTS
NasonexQL
probenecid/colchicine LOW COST GENERIC ipratropium bromideQL
PREFERRED BRAND SPECIALTY KrystexxaPA
LOW COST GENERIC biotuss pediatric bromphen/pseudoephedrine HCL/dextromethorphan HBR giltuss pediatric bupivacaine spinal hydrocodone bitartrate/chlorpheniramine maleate/PSE hydrocodone bitartrate/homatropine methylbromide bupivacaine/epinephrine hydrocodone polistirex/chlorpheniramine polistirex chloroprocaine HCL hydrocodone/homatropine lidocaine/epinephrine promethazine VC plain promethazine VC/codeine promethazine/codeine sensorcaine-mpf spinal sensorcaine/epinephrine xylocaine dental LOW COST GENERIC RESPIRATORY, ALLERGY, ETC
albuterol sulfate carbinoxamine maleate albuterol sulfate ER albuterol TAB 4MG clemastine fumarate cyproheptadine HCL desloratadine odt diphenhydramine HCL ipratropium bromide/albuterol sulfateQL
levocetirizine dihydrochloride levalbuterol HCLQL
montelukast sodium terbutaline sulfate promethazine HCL Clemastine Fumarate Dexchlorpheniramine Maleate LOW COST GENERIC Metaproterenol Sulfate promethazine HCL plain Arcapta NeohalerQL
NASAL AGENTS
Asmanex HFAQL
Asmanex Twisthaler 120 Metered DosesQL
azelastine HCLQL
Asmanex Twisthaler 14 Metered DosesQL
Asmanex Twisthaler 30 Metered DosesQL
Asmanex Twisthaler 60 Metered DosesQL
fluticasone propionateQL
Asmanex Twisthaler 7 Metered DosesQL
olopatadine HCLQL
Atrovent HFAQL
triamcinolone acetonideQL
Combivent RespimatQL
Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; Afluria PF 2013-2014 DuleraQL
Afluria PF 2014-2015 Foradil AerolizerQL
Afluria PF 2015-2016 Afluria 2012-2013 Proair HFAQL
Afluria 2013-2014 Proair RespiclickQL
Afluria 2014-2015 Pulmicort FlexhalerQL
Afluria 2015-2016 Serevent DiskusQL
Spiriva HandihalerQL
Spiriva RespimatQL
SymbicortQL
Fluarix Quadrivalent 2013-2014 Tudorza PressairQL
Fluarix Quadrivalent 2014-2015 Fluarix Quadrivalent 2015-2016 BrovanaQL
Fluarix 2013-2014 Fluarix 2014-2015 Flublok 2013-2014 Maxair AutohalerQL
Flublok 2014-2015 Flublok 2015-2016 Zyflo CRPA
Flucelvax 2013-2014 NON-PREFERRED BRAND SPECIALTY Flucelvax 2014-2015 XolairPA
Flucelvax 2015-2016 LOW COST GENERIC Flulaval Quadrivalent 2013-2014 ipratropium bromideQL
Flulaval Quadrivalent 2014-2015 Flulaval Quadrivalent 2015-2016 RESPIRATORY AGENTS - MISC
Flulaval 2013-2014 Flulaval 2014-2015 PREFERRED BRAND SPECIALTY Aralast NPPA
Flumist Quadrivalent EsbrietPA
Fluvirin PF 2013-2014 KalydecoPA
Fluvirin PF 2014-2015 Fluvirin 2013-2014 PulmozymePA
Fluvirin 2014-2015 ZemairaPA
Fluvirin 2015-2016 Fluzone High-dose PF 2013-2014 NON-PREFERRED BRAND SPECIALTY GlassiaPA
Fluzone High-dose PF 2014-2015 Fluzone High-dose PF 2015-2016 Fluzone Intradermal Fluzone Intradermal Quadrivalent Fluzone Intradermal Quadrivalent 2015-2016 Fluzone Pediatric PF 2013-2014 Fluzone PF 2013-2014 Tetanus Toxoid Adsorbed Fluzone PF 2014-2015 Fluzone Quadrivalent 2013-2014 Fluzone Quadrivalent 2014-2015 Fluzone Quadrivalent 2015-2016 Fluzone Split 2013-2014 Diphtheria/Tetanus Toxoids Adsorbed Pediatric Fluzone Split 2014-2015 Fluzone Split 2015-2016 Ipol Inactivated IPV Tetanus/Diphtheria Toxoids-adsorbed Tetanus/Diphtheria Toxoids-adsorbed Adult Medical Provider EZ Flu Shot PF 2013-2014 Medical Provider EZ Flu Shot PF 2014-2015 VACCINES
Medical Provider EZ Flu Shot 2013-2014 Medical Provider EZ Flu Shot 2014-2015 Medical Provider EZ Flu Shot 2015-2016 Imovax Rabies (h.d.c.v.) Menomune-a/C/Y/W-135 Physicians EZ Use Flu Kit 2012-2013 Pneumovax 23/1 Dose Pneumovax 23/5 Dose Afluria PF 2012-2013 Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; thera-d rapid repletion vitajoy daily d gummies vitamin d high potency VITAMINS
vitamin d-1000 maximum strength vitamin d3 adult gummies vitamin d3 high potency vitamin d3 maximum strength vitamin d3 super strength CVS childrens vitamin d for bone health aqueous vitamin d infants CVS vitamin d infants CVS vitamin d 5000 high-potency bio-d-mulsion forte bprotected pedia d-vite PA vitamin d-3 gummy d-1000 extra strength d-2000 maximum strength Dialyvite Vitamin D3 Max d-5000 maximum strength Replesta Childrens Sm Vitamin D3 Maximum Strength dialyvite vitamin d 5000 d2000 ultra strength Vitamelts Vitamin D Wellesse Vitamin D3 d3 maximum strength d3 super strength d3 ultra strength eql childrens vitamin d gummies gnp vitamin d maximum strength gnp vitamin d super strength gnp vitamin d3 extra strength healthy kids vitamin d3 infuvite pediatric mult-vitamin/fluoride nat-rul vitamin d multi vitamin/fluoride multi-vit/fluoride multi-vit/iron/fluoride opurity vitamin d multi-vitamin/fluoride pronutrients vitamin d3 Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; multivitamin with fluoride Ultimatecare One multivitamin/fluoride Ultimatecare One NF multivitamins/fluoride niacinamide/azelaic ac/ turmer/fa/b6/zinc ox/copper tri-vit/fluoride tri-vitamin/fluoride sm prenatal vitamins triple-vitamin/fluoride Classic Prenatal Eql Prenatal Formula Gnp Prenatal Vitamins Mission Prenatal HP Pre-natal Formula Prenatal And Iron vitamax pediatric Prenatal Formula vitamin b-complex 100 vitamins a/c/d/fluoride Prenatal Vitamins Px Prenatal Multivitamins Bp Folinatal Plus B Sm Prenatal Vitamins Bp Multinatal Plus Cavan-EC Sod DHA Complete Natal DHA Brainstrong Prenatal Centrum Specialist Prenatal CVS Prenatal Gummy/DHA/Folic Acid Gnp Daily Prenatal Goodsense Prenatal Vitamins Healthy Mama Be Well Rounded HM One Daily Prenatal Combo Kp Prenatal Multivitamins Mynatal Ultracaplet Mission Prenatal Nat-rul Prenatal Vitamins One A Day Womens Prenatal/DHA One A Day Womens Prenatal1 One-a-day Womens Prenatal Prenatal Complete Prenatal Multi + DHA Prenatal Multi +dha Prenatal Multivitamin + DHA Prenatal One Daily Prenaissance Plus Prenatal Plus DHA Prenatal Vitamin Prenatal/Omega-3/Folic Acid/Iron PA Prenatal Formula Prenatal Plus Iron Ra Prenatal Formula/Folicacid Right Step Prenatal Similac Prenatal Early Shield Quflora Pediatric Sm One Daily Prenatal Th Prenatal Vitamins Your Life Multi Prenatal Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; LOW COST GENERIC BD Insulin Syringe Ultrafine/U-100/0.3ML/31G X 15/64"QL
BD Insulin Syringe Ultrafine/U-100/0.3ML/31G X 5/16"QL
BD Insulin Syringe Ultrafine/U-100/0.5ML/29G X 1/2"QL
Prenatal Low Iron BD Insulin Syringe Ultrafine/U-100/0.5ML/30G X 1/2"QL
BD Insulin Syringe Ultrafine/U-100/0.5ML/31G X 15/64"QL
BD Insulin Syringe Ultrafine/U-100/0.5ML/31G X 5/16"QL
BD Insulin Syringe Ultrafine/U-100/1ML/29G X 1/2"QL
MEDICAL DEVICES
BD Insulin Syringe Ultrafine/U-100/1ML/30G X 1/2"QL
BD Insulin Syringe Ultrafine/U-100/1ML/31G X 15/64"QL
BD Insulin Syringe Ultrafine/U-100/1ML/31G X 5/16"QL
BD Insulin Syringe Ultrafine/0.3ML/30G X 1/2"QL
Accu-chek Fastclix LancetsQL
BD Insulin Syringe Ultrafine/0.3ML/31G X 5/16"QL
Accu-chek Multiclix LancetsQL
BD Insulin Syringe Ultrafine/0.5ML/30G X 1/2"QL
Accu-chek Safe-t-pro LancetsQL
BD Insulin Syringe Ultrafine/0.5ML/31G X 5/16"QL
Accu-chek Safe-t-pro PluslancetsQL
BD Insulin Syringe Ultrafine/1ML/30G X 1/2"QL
Accu-chek Soft Touch LancetsQL
BD Insulin Syringe Ultrafine/1ML/31G X 5/16"QL
Accu-chek Softclix LancetsQL
BD Insulin Syringe/Detachable Needle/U-100/1ML/25G X Acti-lance Lancets 28GQL
1"QL
Acti-lance Lite Safety Lancets 28GQL
BD Insulin Syringe/Detachable Needle/U-100/1ML/25G X Acti-lance Special Safety Lancets 17GQL
5/8"QL
Acti-lance Special Safetylancets 17GQL
BD Insulin Syringe/Detachable Needle/U-100/1ML/26G X Acti-lance Universal Safety Lancets 23GQL
1/2"QL
Advocate LancetsQL
BD Insulin Syringe/U-100/0.5ML/30G X 1/2"QL
Advocate Lancets 30GQL
BD Insulin Syringe/U-100/1ML/27G X 1/2"QL
Advocate Safety LancetsQL
BD Insulin Syringe/U-100/1ML/28G X 1/2"QL
Advocate Safety Lancets 26GQL
BD Insulin Syringe/U-100/2ML/27.5G X 5/8"QL
Agamatrix Ultra-thin Lancets 33GQL
BD Insulin Syringe/U-100/2ML/29G X 1/2"QL
Assure Comfort Lancets Ultra Thin 28GQL
BD Integra Insulin Syringe/U-100/1ML/29G X 1/2"QL
Assure Comfort Lancets Ultra Thin 30GQL
BD Integra Syringe/Retracting Needle/1ML/25G X 1"QL
Assure Haemolance Plus High Flow 18GQL
BD Lancet Ultrafine 30GQL
Assure Haemolance Plus Low Flow 25GQL
BD Lancet Ultrafine 33GQL
Assure Haemolance Plus Micro Flow 28GQL
BD LO-dose Insulin Syringe Microfine IV/0.5ML/28G X Assure Haemolance Plus Normal Flow 21GQL
1/2"QL
Assure Haemolance Plus Pediatric BladeQL
BD Microtainer LancetsQL
Assure Lance LancetsQL
BD Pen Needle/Mini/Ultrafine/31G X 3/16"QL
Assure Lance Lancets 21GQL
BD Pen Needle/Nano/Ultra Fine/32G X 4MMQL
Assure Lance Plus Safety Lancets 25GQL
BD Pen Needle/SHORT/Ultrafine/31G X 5/16"QL
Assure Lance Plus Safety Lancets 30GQL
BD Pen Needle/Ultrafine/29G X 12.7MMQL
Assure LancetsQL
BD Pen Needle/Ultrafine/29GX1/2" 12.7MMQL
Aurora Lancet Super Thin 30GQL
BD Pen Needles SHORT/Ultrafine/31G X 5/16"QL
Aurora Lancet Thin 23GQL
BD Safety-lok Insulin Syringe/Perm Needle/UF/1ML/29G X 1/2"QL
AF Lancets Super ThinQL
BD Safetyglide Insulin Sysyringe/0.5ML/30G X 5/16"QL
AT Last LancetsQL
BD-insul SYR Mis LO DoseQL
Bayer Microlet LancetsQL
Careone Lancet ThinQL
Bullseye Mini Safety LancetsQL
Careone Lancet Ultra ThinQL
Bullseye Safety LancetsQL
Cleanlet Lancets 28GQL
BD Autoshield Duo 30G X 3/16"QL
Clever Chek Lancets UltrathinQL
BD Autoshield 29G X 3/16"QL
Clever Chek Lancets Ultrathin 30GQL
BD Autoshield 29G X 5/16"QL
Coaguchek LancetsQL
BD Insulin Syringe LUER-LOK/U-100/1MLQL
Comfort Assured Lancets Micro Thin 33GQL
BD Insulin Syringe Microfine IV/U-100/0.3ML/28G X 1/2"QL
Comfort Assured Lancets Super Thin 28GQL
BD Insulin Syringe Microfine IV/U-100/0.5ML/28G X 1/2"QL
Comfort LancetsQL
BD Insulin Syringe Microfine IV/U-100/1ML/27G X 5/8"QL
CVS Lancets Micro Thin 33GQL
BD Insulin Syringe Microfine IV/U-100/1ML/28G X 1/2"QL
CVS Lancets OriginalQL
BD Insulin Syringe Microfine/U-100/0.3ML/28G X 1/2"QL
CVS Lancets Thin 26GQL
BD Insulin Syringe Microfine/U-100/0.5ML/28G X 1/2"QL
CVS Lancets Ultra Thin 30GQL
BD Insulin Syringe Microfine/U-100/1ML/27G X 5/8"QL
CVS Lancets 21GQL
BD Insulin Syringe Microfine/U-100/1ML/28G X 1/2"QL
CVS Ultra Thin LancetsQL
BD Insulin Syringe Safetyglide/U-100/0.3ML/31G X
5/16"QL
Diastar Easy Test II Lancets 30GQL
BD Insulin Syringe Safetyglide/0.5ML/29G X 1/2"QL
Diastar Easy Test Lancets30GQL
BD Insulin Syringe Safetyglide/1ML/29G X 1/2"QL
Droplet Lancets Ultra Thin 30GQL
BD Insulin Syringe Slip Tip/U-100/1MLQL
Drug Mart Lancets ThinQL
BD Insulin Syringe U-40/1ML/25G X 5/8"QL
Drug Mart Lancets Ultra ThinQL
BD Insulin Syringe Ultrafine Half-unit/0.3ML/31G X 5/16"QL
Drug Mart On-the-go Lancets Gentle 30GQL
BD Insulin Syringe Ultrafine II/SHORT/0.5ML/31G X Drug Mart Unilet Lancets Super Thin 30GQL
5/16"QL
Drug Mart Unilet Lancets Ultra Thin 28GQL
BD Insulin Syringe Ultrafine II/SHORT/1ML/31G X 5/16"QL
Duane Reade Lancet Alternate Site 26GQL
BD Insulin Syringe Ultrafine/U-100/0.3ML/29G X 1/2"QL
Duane Reade Lancet Super Thin 30GQL
BD Insulin Syringe Ultrafine/U-100/0.3ML/30G X 1/2"QL
Duane Reade Lancet Ultra Thin 28GQL
E-z Ject LancetsQL
Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; E-z Ject Lancets ColorQL
Gnp LancetsQL
E-z Ject Lancets Super ThinQL
Gnp Lancets Micro Thin 33GQL
E-z Ject Lancets Super Thin 30GQL
Gnp Lancets Super Thin 30GQL
E-z Ject Lancets Thin 26GQL
Gnp Lancets ThinQL
E-z Ject Lancets 21GQL
Gnp Lancets Thin 26GQL
E-ZJECT Lancets Micro-thin 33GQL
Gnp Lancets 21GQL
Easy Comfort LancetsQL
Gnp Micro Thin Lancets 33GQL
Easy Comfort Lancets 30G/Pull TopQL
Gnp Super Thin Lancets/30GQL
Easy Comfort Lancets 30G/Thin TopQL
H&h Thinlet Lancets 26GQL
Easy Touch Lancets 21G/Pressure ActivatedQL
H&h Thinlet Super Thin Lancets 30GQL
Easy Touch Lancets 23G/Pressure ActivatedQL
H-e-b Incontrol Lancets Super Thin 30GQL
Easy Touch Lancets 26G/Pressure ActivatedQL
H-e-b Incontrol Lancets Ultra Thin 28GQL
Easy Touch Lancets 26G/Pull-topQL
Easy Touch Lancets 26G/TwistQL
Haemolance Low Flow LancetsQL
Easy Touch Lancets 28G/Pressure ActivatedQL
Haemolance PlusQL
Easy Touch Lancets 28G/Pull-topQL
Haemolance Plus High FlowQL
Easy Touch Lancets 28G/TwistQL
Haemolance Plus Low FlowQL
Easy Touch Lancets 30G/Button-activatedQL
Haemolance Plus Max FlowQL
Easy Touch Lancets 30G/Pressure ActivatedQL
Haemolance Plus Pediatric FlowQL
Easy Touch Lancets 30G/Pull-topQL
Healthwise Lancets 30GQL
Easy Touch Lancets 30G/TwistQL
Healthy Accents Unilet Lancets Super Thin 30GQL
Easy Touch Lancets 32G/Pressure ActivatedQL
Hy-vee LancetsQL
Easy Touch Lancets 32G/Pull-topQL
Hy-vee Thin LancetsQL
Easy Touch Lancets 32G/TwistQL
HM Lancets Micro Thin 33GQL
Easy Touch Lancets 33G/TwistQL
HM Lancets Ultra Thin 30GQL
Easy Touch Safety Lancets21G/Pressure ActivatedQL
IN Touch Diabetes Management Software Easy Touch Safety Lancets23G/Pressure ActivatedQL
IN Touch Sterile Lancets 30GQL
Easy Touch Safety Lancets26G/Button ActivatedQL
Kinney LancetsQL
Easy Touch Safety Lancets26G/Pressure ActivatedQL
Kinney Thin LancetsQL
Easy Touch Safety Lancets28G/Button ActivatedQL
Kroger LancetsQL
Easy Touch Safety Lancets28G/Pressure ActivatedQL
Kroger Lancets Micro Thin33GQL
Easy Twist & CAP LancetsQL
Kroger Lancets Super ThinQL
Easytest II LancetsQL
Kroger Lancets ThinQL
Easytest LancetsQL
Kroger Lancets Thin 26GQL
Embrace Lancets Ultra Thin 30GQL
Kroger Lancets Ultrathin 30GQL
Eql Color Lancets Micro Thin 33GQL
Kroger Lancets 21GQL
Eql Color Lancets 21GQL
LancetsQL
Eql Super Thin Lancets 30GQL
Lancets Bullseye SafetyQL
Eql Thin Lancets 26GQL
Lancets Micro Thin 33GQL
EZ Smart Blood Glucose LancetsQL
Lancets Safety Seal 21GQL
EZ-lets Lancets 21GQL
Lancets Safety Seal 26GQL
EZ-lets Lancets 23GQL
Lancets Safety Seal 28GQL
EZ-lets Lancets 26G Super-softQL
Lancets Safety Seal 30GQL
EZ-lets Lancets 28G Ultra-softQL
Lancets Super Thin 28GQL
EZ-lets Lancets 30GQL
Lancets ThinQL
Fasttake Compact Monitoring SystemQL
Lancets Twist TopQL
Fasttake Test StripsQL
Lancets Ultra FineQL
Fifty50 Safety Seal Lancets 30GQL
Lancets Ultra ThinQL
Fifty50 Safety Seal Lancets 32GQL
Lancets Ultra Thin 30GQL
Fine 30QL
Lancets 26G Twist TopQL
Fingerstix LancetsQL
Lancets 28GQL
Fora LancetsQL
Lancets 30GQL
Freds Pharmacy Unilet Lancets Super Thin 30GQL
Lancets 30G Twist TopQL
Freds Pharmacy Unilet Lancets Ultra Thin 28GQL
Lancets 30G/Twist TopQL
Freestyle LancetsQL
Lancets 31G Twist TopQL
Freestyle Unistick II LancetsQL
Lancets 33G Universal DesignQL
Gentle-let GP LancetsQL
Leader Lancets ColoredQL
Gentle-let Lancets General Purpose Style/Fine PointQL
Leader Super Thin LancetQL
Gentle-let Lancets General Purpose Style/Medium PointQL
Leader Thin LancetsQL
Gentle-let Lancets Safety Style/Fine PointQL
Liberty Blood Glucose MeterQL
Gentle-let Lancets Safety Style/Medium PointQL
Liberty Glucose Control Mid Global Inject Ease Lancets 28GQL
Liberty Glucose Control Normal Global Inject Ease Lancets 30GQL
Liberty Medical Lancets 30GQL
Glucocom Lancets 28GQL
Liberty Mini Lancing Device Glucocom Lancets 30GQL
Liberty Test StripsQL
Glucocom Lancets 33GQL
Lifescan Unistik II LancetsQL
Glucose Control Normal Lifescan Unistik 2 Deep PenetrationQL
Glucose Control Solution Lite Touch LancetsQL
Glucosource LancetsQL
Litetouch Lancets Micro Thin 33GQL
Gmate Lancets 30GQL
Live Better Lancet Super Thin 30GQL
Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; Live Better Lancet Ultra Thin 28GQL
Onetouch Verio Test StripsQL
Longs Lancets StandardQL
Penlet II Automatic Bloodsampler Longs Lancets ThinQL
Penlet II Replacement CAPS Longs Lancets Ultra ThinQL
Penlet II Replacement CAPS-deep Medichoice Pre-set Safety Lancet Dual UseQL
Penlet II Replacement CAPS-regular Medichoice Pre-set Safety Lancet Low FlowQL
Perfect Lancets 30GQL
Medichoice Pre-set Safety Lancet Medium FlowQL
Perfect Pressure Activated Safety Lancets 28GQL
Medichoice Pre-set Safety Lancet Moderate FlowQL
Pharmacist Choice Ultra Thin LancetsQL
Medichoice Safety Lancet ExtraQL
Pharmacist Choice Ultra Thin Lancets 28GQL
Medichoice Safety Lancet NormalQL
Pharmacist Choice Ultra Thin Lancets 30GQL
Medicine Shoppe LancetsQL
Pharmacist Choice Ultra Thin Lancets 31GQL
Medicine Shoppe Lancets ThinQL
Pharmacist Choice Ultra Thin Lancets 33GQL
Medisense Thin LancetsQL
Pharmacy Counter LancetsQL
Medlance Plus Extra Lancets 21GQL
Precision Thin LancetsQL
Medlance Plus LancetsQL
Precision Thins GP LancetQL
Medlance Plus Lancets Lite 25GQL
Precision Ultra LancetQL
Medlance Plus Lite Lancets 25GQL
Preferred Plus Lancets Colored 21GQL
Medlance Plus Special Lancets 0.8MMQL
Preferred Plus Lancets Super Thin 30GQL
Medlance Plus Superlite 30GQL
Preferred Plus Lancets Thin 26GQL
Medlance Plus Superlite 30G/Comfort MaxQL
Prodigy Pressure Activated Safety LancetsQL
Medlance Plus Universal Lancets 21GQL
Prodigy Twist Top LancetsQL
Medlance Plus/Lite 25GQL
Pss Select GP LancetsQL
Pss Select Safety LancetsQL
Px Lancets Ultra ThinQL
Qc LancetsQL
Meijer Color Lancets Universal 33GQL
Qc Lancets Super ThinQL
Meijer LancetsQL
Qc Lancets ThinQL
Meijer Lancets ThinQL
Qc Lancets Ultra ThinQL
Meijer Lancets Universal 33GQL
Ra E-ZJECT Color Lancets Micro-thin 33GQL
Meijer Super Thin LancetsQL
Ra E-ZJECT Lancets Thin 26GQL
Microlet LancetsQL
Ra E-ZJECT Lancets Thin 28GQL
Microtainer Safety Flow Lancet/Sterile/Single-useQL
Ra E-ZJECT Lancets Ultra Thin 30GQL
Monolet LancetsQL
Ra E-ZJECT Lancets 28GQL
Monolet Opd LancetsQL
Reality LancetsQL
Monolettor Safety LancetsQL
Reality Trigger LancetsQL
Myglucohealth Mgh Softlance Lancets 30GQL
Relion Lancets Micro-thin33GQL
Netgroup LancetsQL
Relion Lancets Standard 21GQL
Nova Safety Lancets 23GQL
Relion Lancets Thin 26GQL
Nova Safety Lancets 28GQL
Relion Lancets Ultra-thin30GQL
Nova Sureflex LancetsQL
Relion Thin LancetsQL
On Call LancetsQL
Relion Ultra Thin LancetsQL
On Call Plus LancetsQL
Relion Ultra Thin Lancets30GQL
Onetouch Basic SystemQL
Relion Ultra Thin Plus Lancets 32GQL
Onetouch Basic/Profile Test StripsQL
Relion Ultra Thin Plus Lancets 33GQL
Onetouch Club Lancets Fine PointQL
Renew Advanced Lancing Cartridge RefillsQL
Onetouch Combo PackQL
Rexall Lancets Ultra ThinQL
Onetouch Delica Lancets Extra Fine 33GQL
Rightest Gl300 LancetsQL
Onetouch Delica Lancets Fine 30GQL
Safe-t-lance Low Flow 25GQL
Onetouch Delica Lancing Device Safe-t-lance Normal Flow 21GQL
Onetouch Finepoint LancetsQL
Safe-t-lance Plus Safety Lancet High FlowQL
Onetouch LancetsQL
Safe-t-lance Plus Safety Lancet Low FlowQL
Onetouch Ping Meter Remote Safe-t-lance Plus Safety Lancet Normal FlowQL
Onetouch Profile SystemQL
Safety Lancet 21G/Pressure ActivatedQL
Onetouch Suresoft Lancing Device/18G Safety Lancet 28G/Pressure ActivatedQL
Onetouch Suresoft Lancing Device/21G Safety LancetsQL
Onetouch Suresoft Lancing Device/28G Safety Lancets 21GQL
Onetouch Ultra BlueQL
Safety Lancets 28GQL
Onetouch Ultra Control Safety Let LancetsQL
Onetouch Ultra MiniQL
Safety Seal Lancets 28GQL
Onetouch Ultra System KitQL
Safety Seal Lancets 30GQL
Onetouch Ultra 2QL
Safety-glide Insulin Syringe/0.3ML/29G X 1/2"QL
Onetouch Ultralink System (hex)QL
Sapscare Twist Top Lancets 30GQL
Onetouch Ultralink System (DEC)QL
Shopko On-the-go Comfort Lancets 30GQL
Onetouch UltrasmartQL
Shopko Unilet Lancets Super Thin 30GQL
Onetouch Ultrasoft LancetsQL
Shopko Unilet Lancets Ultra Thin 28GQL
Onetouch VerioQL
Onetouch Verio Control Solution High Sm Lancets 21GQL
Onetouch Verio IQ Blood Glucose Monitoring SystemQL
Sm Micro Thin Lancets 33GQL
Onetouch Verio Mid Control Solution Sm Super Thin LancetsQL
Onetouch Verio Sync Bloodglucose Monitoring SystemQL
Sm Super Thin Lancets 30GQL
Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; Sm Thin Lancets 26GQL
Unilet Lancets Micro-thin33GQL
Smart Diabetes Vantage Universal Lancets 30GQL
Unilet Lancets Super-thin30GQL
Smart Sense Color Lancets Universal 33GQL
Unilet Lancets Ultra-thin 28GQL
Smart Sense Standard Lancets Universal 21GQL
Unilet Superlite LancetQL
Smart Sense Super Thin Lancets Universal 30GQL
Unistik Safety Lancets 28GQL
Smart Sense Thin Lancets Universal 26GQL
Unistik Safety Lancets 30GQL
Smartest Lancets 28GQL
Unistik 3 GentleQL
Solus V2 Pressure Activated Safety Lancets 28GQL
Universal 1 Lancets Thin 26GQL
Solus V2 Twist Lancets 30GQL
Universal 1 Lancets Ultra Thin 30GQL
Sterilance TLQL
Super Thin LancetsQL
Sure Comfort Lancets 28GQL
Sure Comfort Lancets 30GQL
Value Plus Lancets Standard 21GQL
Sure-lance Flat LancetsQL
Value Plus Lancets Super Thin 30GQL
Sure-lance Lancets 26GQL
Value Plus Lancets Thin 26GQL
Sure-lance Thin Lancets 28GQL
Valumark Lancet Super Thin 30GQL
Sure-lance Ultra Thin LancetsQL
Valumark Lancet Ultra Thin 28GQL
Sure-touch Lancets UniversalQL
Vida Mia Unilet Lancets Super Thin 30GQL
Surelite LancetsQL
Vida Mia Unilet Lancets Ultra Thin 28GQL
Surestep Glucose Control Vitalet Pro LancetsQL
Surestep Glucose Control Solution Vitalet Pro Plus LancetsQL
Surestep Pro High Glucosecontrol W&f Lancets Colored 21GQL
Surestep Pro Linearity Kit W&f Lancets 26GQL
Surestep Pro Low Glucose Control Walgreens Advanced Travellancets 28GQL
Surestep Pro Normal Glucose Control Walgreens Comfort Assuredlancets Micro Thin/33GQL
Surestep Pro Test StripsQL
Walgreens Comfort Assuredlancets Super Thin/28GQL
Surestep Test StripsQL
Walgreens LancetsQL
SB Lancets ThinQL
Walgreens Thin LancetsQL
SB Lancets Ultra ThinQL
Walgreens Ultra Thin LancetsQL
Techlite AST LancetsQL
1ST Choice Lancets Super ThinQL
Techlite LancetsQL
1ST Choice Lancets ThinQL
Techlite Lancets 30GQL
1ST Choice Lancets Ultra ThinQL
Tgt Lancet Alternate SiteQL
1ST Tier Unilet Comfortouch Lancets 28GQL
Tgt Lancet Micro Thin 33GQL
1ST Tier Unilet Comfortouch Lancets 30GQL
Tgt Lancet Super Thin 30GQL
Tgt Lancet Thin 23GQL
Tgt Lancet Thin 26GQL
Accu-chek Fastclix Lancetdevice Kit Tgt Lancet Ultra Thin 28GQL
Accu-chek Multiclix Lanc Et Device Kit Tgt Lancet Ultra Thin 30GQL
Accu-chek Softclix Lancetdevice Thinlets GP LancetsQL
Accu-chek Softclix Lancetdevice Kit Thinlets LancetQL
Adjustable Lancing Device Todays Health Super Thin Lancets 30GQL
Advocate Insulin Pen Needles 29GX12.7MMQL
Todays Health Ultra Thin Lancets 28GQL
Advocate Insulin Pen Needles 31GX5MMQL
Travel Lancets 30GQL
Advocate Insulin Pen Needles 31GX8MMQL
Trueplus Lancets 26GQL
Advocate Insulin Syringe/U-100/0.3ML/29GX1/2"QL
Trueplus Lancets 28GQL
Advocate Insulin Syringe/U-100/0.3ML/30GX5/16"QL
Trueplus Lancets 28G Super ThinQL
Advocate Insulin Syringe/U-100/0.3ML/31GX5/16"QL
Trueplus Lancets 30GQL
Advocate Insulin Syringe/U-100/0.5ML/29GX1/2"QL
Trueplus Lancets 30G Ultra ThinQL
Advocate Insulin Syringe/U-100/0.5ML/30GX5/16"QL
Trueplus Lancets 33GQL
Advocate Insulin Syringe/U-100/0.5ML/31GX5/16"QL
Trueplus Lancets 33G Micro ThinQL
Advocate Insulin Syringe/U-100/1ML/29GX1/2"QL
Trueplus Safety Lancets 28GQL
Advocate Insulin Syringe/U-100/1ML/30GX5/16"QL
Ulticare Thin Lancets 30GQL
Advocate Insulin Syringe/U-100/1ML/31GX5/16"QL
Ultilet Classic LancetsQL
Advocate Lancing Device Ultilet LancetsQL
Advocate Rapid-safe Lancing Device Ultilet Lancets 33GQL
Alternate Site Lancing Device Ultilet Safety Lancets 23GQL
Anti-stick Insulin Syringe/U-100/0.5ML/28G X 1/2"QL
Ultra Thin Lancets 28GQL
Anti-stick Insulin Syringe/U-100/0.5ML/29G X 1/2"QL
Ultra Thin Lancets 30GQL
Anti-stick Insulin Syringe/U-100/1ML/29G X 1/2"QL
Ultra-thin II Auto LancetQL
Aqua Lance Adjustable Lancing Device Ultra-thin II Lancets 28GQL
Assure ID Insulin Safety Syringe/U-100/0.5ML/29G X Ultra-thin II Lancets 30GQL
1/2"QL
Assure ID Insulin Safety Syringe/U-100/1ML/29G X 1/2"QL
Ultra-thin II Safety Autolancets 26GQL
Aurora Pen Needles 29GX12MMQL
Unilet Comfortouch LancetQL
Aurora Pen Needles 31G X 6MMQL
Unilet ExceliteQL
Aurora Pen Needles 31G X 8MMQL
Unilet Excelite IIQL
Aurora Unifine Pentips/Mini/31GX3/16"QL
Unilet G.p. LancetQL
Aurora Unifine Pentips/32GX5/32"QL
Unilet G.p. Superlite LancetQL
Unilet GP 28 Ultra ThinQL
Auto-lancet Mini Unilet LancetQL
Autolet Impression Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; Autolet Impression Lancing Device Clever Choice Comfort EZ Pen Needles 33GX4MMQL
Autolet II Clinisafe Clever Choice Comfort EZ Pen Needles 33GX5MMQL
Autolet Lite Clinisafe Clever Choice Comfort EZ Pen Needles 33GX6MMQL
Autolet Lite Starter Pack Clever Choice Comfort EZ Pen Needles 33GX8MMQL
Clickfine Pen Needle Universal/31GX1/4"QL
Autolet Platforms Clickfine Pen Needle Universal/31GX5/16"QL
Bayer Microlet 2 Lancing Device Clickfine Pen Needle 32GX5/32"QL
BD Lancet Device Clickfine Pen Needles/31GX1/4"QL
BD Safety-glide Insulin Syringe/0.5ML/29G X 1/2"QL
Clickfine Pen Needles/31GX5/16"QL
Cardiocom Lancing Device Clickfine Universal Pen Needles 31GX1/4"QL
Carefine Pen Needle 32GX4MMQL
Clickfine Universal Pen Needles 31GX5/16"QL
Carefine Pen Needles 29GX1/2"QL
Carefine Pen Needles 30GX5/16"QL
Comfort Assist Insulin Syringe 0.3ML/29G X 1/2"QL
Carefine Pen Needles 31GX6MMQL
Comfort Assist Insulin Syringe/0.3ML/30G X 5/16"QL
Carefine Pen Needles 31GX8MMQL
Comfort Assist Insulin Syringe/0.3ML/31G X 5/16"QL
Carefine Pen Needles 32GX5MMQL
Comfort Assist Insulin Syringe/0.5ML/29G X 1/2"QL
Carefine Pen Needles 32GX6MMQL
Comfort Assist Insulin Syringe/0.5ML/30G X 5/16"QL
Careone Advanced Lancing Device Comfort Assist Insulin Syringe/0.5ML/31G X 5/16"QL
Careone Insulin Syringes/0.3ML/30G X 1/2"QL
Comfort Assist Insulin Syringe/1ML/29G X 1/2"QL
Careone Insulin Syringes/0.3ML/31G X 5/16"QL
Comfort Assist Insulin Syringe/1ML/30G X 5/16"QL
Careone Insulin Syringes/0.5ML/30G X 1/2"QL
Comfort Assist Insulin Syringe/1ML/31G X 5/16"QL
Careone Insulin Syringes/0.5ML/31G X 5/16"QL
CVS Insulin Syringe/0.3ML/29G X 1/2"QL
Careone Insulin Syringes/1ML/30G X 1/2"QL
CVS Insulin Syringe/0.3ML/30G X 1/2"QL
Careone Insulin Syringes/1ML/31GX5/16"QL
CVS Insulin Syringe/0.5ML/29G X 1/2"QL
Careone Unifine Pentips Pen Needles 32GX4MMQL
CVS Insulin Syringe/0.5ML/30G X 1/2"QL
Careone Unifine Pentips Plus Pen Needles 29GX12MMQL
CVS Insulin Syringe/1ML/29G X 1/2"QL
Careone Unifine Pentips Plus Pen Needles 31GX5MMQL
CVS Lancing Device Careone Unifine Pentips Plus Pen Needles 31GX6MMQL
Diascreen Liquid Urine Controls Careone Unifine Pentips Plus Pen Needles 31GX8MMQL
Careone Unifine Pentips Plus Pen Needles 32GX4MMQL
Careone Unifine Pentips 29GX12MMQL
Careone Unifine Pentips 31GX5MMQL
Careone Unifine Pentips 31GX6MMQL
Careone Unifine Pentips 31GX8MMQL
Chemstrip Bg Log Book Clever Choice Comfort EZ Insulin Pen Needles 31GX8MMQL
Clever Choice Comfort EZ Insulin Syringe/U- Clever Choice Comfort EZ Insulin Syringe/0.3ML/29G X 1/2"QL
Clever Choice Comfort EZ Insulin Syringe/0.3ML/30G X
1/2"QL
Clever Choice Comfort EZ Insulin Syringe/0.3ML/30G X
5/16"QL
Droplet Lancing Device Clever Choice Comfort EZ Insulin Syringe/0.3ML/31G X Drug Mart Adjustable Lancing Device 5/16"QL
Drug Mart Ultra Comfort Insulin Syringe/0.3ML/29G X Clever Choice Comfort EZ Insulin Syringe/0.5ML/28G X 1/2"QL
1/2"QL
Drug Mart Ultra Comfort Insulin Syringe/0.3ML/30G X Clever Choice Comfort EZ Insulin Syringe/0.5ML/29G X 5/16"QL
1/2"QL
Drug Mart Ultra Comfort Insulin Syringe/0.3ML/31G X Clever Choice Comfort EZ Insulin Syringe/0.5ML/30G X 5/16"QL
1/2"QL
Drug Mart Ultra Comfort Insulin Syringe/0.5ML/30G X Clever Choice Comfort EZ Insulin Syringe/0.5ML/30G X 5/16"QL
5/16"QL
Drug Mart Ultra Comfort Insulin Syringe/0.5ML/31G X Clever Choice Comfort EZ Insulin Syringe/0.5ML/31G X 5/16"QL
5/16"QL
Drug Mart Ultra Comfort Insulin Syringe/1ML/29G X 1/2"QL
Clever Choice Comfort EZ Insulin Syringe/1.0ML/30G X Drug Mart Ultra Comfort Insulin Syringe/1ML/30G X 1/2"QL
5/16"QL
Clever Choice Comfort EZ Insulin Syringe/1ML/28G X Drug Mart Unifine Pentips 31GX5MMQL
1/2"QL
Drug Mart Unifine Pentipsplus 32GX4MMQL
Clever Choice Comfort EZ Insulin Syringe/1ML/29G X Drug Mart Unifine Pentips29G X 12MMQL
1/2"QL
Drug Mart Unifine Pentips31GX6MMQL
Clever Choice Comfort EZ Insulin Syringe/1ML/30G X
5/16"QL
Drug Mart Unifine Pentips31GX8MMQL
Drug Mart Unifine Pentips32GX4MMQL
Clever Choice Comfort EZ Pen Needles 29GX12MMQL
Duane Reade Unifine Pentips 29G X 12MMQL
Clever Choice Comfort EZ Pen Needles 31GX5MMQL
Duane Reade Unifine Pentips 31G X 6MM Ultra SHORTQL
Clever Choice Comfort EZ Pen Needles 31GX6MMQL
Duane Reade Unifine Pentips 31G X 8MM SHORTQL
Clever Choice Comfort EZ Pen Needles 31GX8MMQL
Easy Comfort Insulin Syringe/U-100/0.5ML/30G X 1/2"QL
Clever Choice Comfort EZ Pen Needles 32GX4MMQL
Easy Comfort Insulin Syringe/U-100/1ML/30G X 1/2"QL
Clever Choice Comfort EZ Pen Needles 32GX5MMQL
Easy Comfort Insulin Syringe/0.3ML/30G X 5/16"QL
Clever Choice Comfort EZ Pen Needles 32GX6MMQL
Easy Comfort Insulin Syringe/0.5ML/30G X 5/16"QL
Clever Choice Comfort EZ Pen Needles 32GX8MMQL
Easy Comfort Insulin Syringe/1ML/30G X 5/16"QL
Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; Easy Comfort Pen Needles 31GX1/4"QL
Exel Comfort Point Insulin Syringe/0.3ML/29G X 1/2"QL
Easy Comfort Pen Needles 31GX3/16"QL
Exel Comfort Point Insulin Syringe/0.3ML/30G X 5/16"QL
Easy Comfort Pen Needles 31GX5/16"QL
Exel Comfort Point Insulin Syringe/0.5ML/28G X 1/2"QL
Easy Comfort Pen Needles 32GX5/32"QL
Exel Comfort Point Insulin Syringe/0.5ML/29G X 1/2"QL
Easy Mini Lancing Device Exel Comfort Point Insulin Syringe/0.5ML/30G X 5/16"QL
Easy Touch Insulin Syringe/Safety/U-100/0.5ML/29G X Exel Comfort Point Insulin Syringe/1ML/28G X 1/2"QL
1/2"QL
Exel Comfort Point Insulin Syringe/1ML/29G X 1/2"QL
Easy Touch Insulin Syringe/Safety/U-100/0.5ML/30G X Exel Comfort Point Insulin Syringe/1ML/30G X 5/16"QL
5/16"QL
Fifty50 Lancing Device Easy Touch Insulin Syringe/Safety/U-100/1ML/29G X Fifty50 Pen Needles 31G X3/16" (5MM)QL
1/2"QL
Fifty50 Pen Needles 31G X5/16" (8MM)QL
Easy Touch Insulin Syringe/Safety/U-100/1ML/30G X
1/2"QL
Fifty50 Superior Comfort Insulin Syringe/0.3ML/31G X
5/16"QL
Easy Touch Insulin Syringe/U-100/0.3ML/30G X 1/2"QL
Fifty50 Superior Comfort Insulin Syringe/0.5ML/31G X Easy Touch Insulin Syringe/U-100/0.5ML/27G X 1/2"QL
5/16"QL
Easy Touch Insulin Syringe/U-100/0.5ML/28G X 1/2"QL
Fifty50 Superior Comfort Insulin Syringe/1ML/31G X Easy Touch Insulin Syringe/U-100/0.5ML/30G X 1/2"QL
5/16"QL
Easy Touch Insulin Syringe/U-100/0.5ML/31G X 5/16"QL
Fora Lancing Device Easy Touch Insulin Syringe/U-100/1ML/27G X 1/2"QL
Freds Pharmacy Autolet Lancing Device Easy Touch Insulin Syringe/U-100/1ML/28G X 1/2"QL
Freds Pharmacy Unifine Pentips Pen Needles Easy Touch Insulin Syringe/U-100/1ML/29G X 1/2"QL
32GX4MMQL
Easy Touch Insulin Syringe/U-100/1ML/30G X 1/2"QL
Freds Pharmacy Unifine Pentips Plus 31GX5MMQL
Easy Touch Insulin Syringe/U-100/1ML/31G X 5/16"QL
Freds Pharmacy Unifine Pentips Plus 31GX8MMQL
Easy Touch Insulin Syringe/0.3ML/30G X 5/16"QL
Freestyle Precision Insulin Syringe/U-100/0.5ML/30G X Easy Touch Insulin Syringe/0.3ML/31G X 5/16"QL
5/16"QL
Freestyle Precision Insulin Syringe/U-100/0.5ML/31G X Easy Touch Insulin Syringe/0.5ML/29G X 1/2"QL
5/16"QL
Easy Touch Insulin Syringe/0.5ML/30G X 5/16"QL
Freestyle Precision Insulin Syringe/U-100/1ML/31G X Easy Touch Insulin Syringe/1ML/30G X 5/16"QL
5/16"QL
Easy Touch Lancing Device/Ejector Freestyle Precision Insulin Syringes/U-100/1ML/30G X Easy Touch Pen Needles 29GX1/2"QL
5/16"QL
Easy Touch Pen Needles 31GX1/4"QL
Gentle-let Platforms 2.4MM Easy Touch Pen Needles 31GX5/16"QL
Gentle-let Platforms 3.0MM Easy Touch Pen Needles 32GX1/4"QL
Global Ease Inject Pen Needles 29GX12MMQL
Easy Touch Pen Needles 32GX3/16"QL
Global Ease Inject Pen Needles 31GX8MMQL
Easy Touch Pen Needles 32GX5/32"QL
Global Ease Inject Pen Needles 32GX4MMQL
Easy Touch Pen Needles/31G X 3/16"QL
Global Ease Inject Pen Neeedles 31GX5MMQL
Easy Touch 32GX5MMQL
Global Inject Ease Insulin Syringe/U-100/0.3ML/29G X Easy Touch 32GX6MMQL
1/2"QL
Elite-thin Insulin Syringe/U-100/0.5ML/28G X 1/2"QL
Global Inject Ease Insulin Syringe/U-100/0.3ML/30G X Elite-thin Insulin Syringe/U-100/0.5ML/28G X 5/16"QL
1/2"QL
Global Inject Ease Insulin Syringe/U-100/0.3ML/30G X Elite-thin Insulin Syringe/U-100/0.5ML/29G X 5/16"QL
5/16"QL
Elite-thin Insulin Syringe/U-100/0.5ML/31G X 5/16"QL
Global Inject Ease Insulin Syringe/U-100/0.3ML/31G X Elite-thin Insulin Syringe/U-100/1ML/28G X 1/2"QL
5/16"QL
Elite-thin Insulin Syringe/U-100/1ML/28G X 5/16"QL
Global Inject Ease Insulin Syringe/U-100/0.5ML/28G X Elite-thin Insulin Syringe/U-100/1ML/29G X 1/2"QL
1/2"QL
Elite-thin Insulin Syringe/U-100/1ML/31G X 5/16"QL
Global Inject Ease Insulin Syringe/U-100/0.5ML/29G X Elite-thin Insulin Syringe/0.3ML/31G X 5/16"QL
1/2"QL
Elite-thin Insulin Syringe/0.5ML/29G X 1/2"QL
Global Inject Ease Insulin Syringe/U-100/0.5ML/30G X Elite-thin Insulin Syringe/0.5ML/30G X 5/16"QL
1/2"QL
Global Inject Ease Insulin Syringe/U-100/0.5ML/30G X Elite-thin Insulin Syringe/1ML/29G X 5/16"QL
5/16"QL
Elite-thin Insulin Syringe/1ML/30G X 5/16"QL
Global Inject Ease Insulin Syringe/U-100/0.5ML/31G X Eql Insulin Syringe/U-100/0.3ML/29G X 1/2"QL
5/16"QL
Eql Insulin Syringe/U-100/0.5ML/29G X 1/2"QL
Global Inject Ease Insulin Syringe/U-100/1ML/28G X Eql Insulin Syringe/U-100/1ML/29G X 1/2"QL
1/2"QL
Eql Insulin Syringe/0.3ML/29G X 1/2"QL
Global Inject Ease Insulin Syringe/U-100/1ML/29G X Eql Insulin Syringe/0.3ML/30G X 5/16"QL
1/2"QL
Eql Insulin Syringe/0.3ML/31G X 5/16"QL
Global Inject Ease Insulin Syringe/U-100/1ML/30G X Eql Insulin Syringe/0.5ML/29G X 1/2"QL
1/2"QL
Global Inject Ease Insulin Syringe/U-100/1ML/30G X Eql Insulin Syringe/0.5ML/30G X 5/16"QL
5/16"QL
Eql Insulin Syringe/0.5ML/31G X 5/16"QL
Global Inject Ease Insulin Syringe/U-100/1ML/31G X Eql Insulin Syringe/1ML/29G X 1/2"QL
5/16"QL
Eql Insulin Syringe/1ML/30G X 5/16"QL
Global Lancing Device Eql Insulin Syringe/1ML/31G X 5/16"QL
Glucocom Autolink Telemonitoring System Eql SHORT Pen Needles 31G X 8MMQL
Glucolet 2 Automatic Lancing Device Eql Ultra Comfort Insulinsyringe/0.3ML/31G X 5/16"QL
Glucopro Insulin Syringe/U-100/0.3ML/30G X 1/2"QL
Eql Ultra Comfort Insulinsyringe/1ML/30G X 5/16"QL
Glucopro Insulin Syringe/U-100/0.3ML/30G X 5/16"QL
Eql Ultra SHORT Pen Needles 31G X 6MMQL
Glucopro Insulin Syringe/U-100/0.3ML/31G X 5/16"QL
Excel Comfort Point Insulin Pen Needles 31G X 4MMQL
Glucopro Insulin Syringe/U-100/0.5ML/30G X 1/2"QL
Exel Comfort Point Insulin Pen Needles 29G X 12MMQL
Glucopro Insulin Syringe/U-100/0.5ML/30G X 5/16"QL
Exel Comfort Point Insulin Pen Needles 31G X 6MMQL
Glucopro Insulin Syringe/U-100/0.5ML/31G X 5/16"QL
Exel Comfort Point Insulin Pen Needles 31G X 8MMQL
Glucopro Insulin Syringe/U-100/1ML/30G X 1/2"QL
Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; Glucopro Insulin Syringe/U-100/1ML/30G X 5/16"QL
Insulin Syringe/0.5ML/30G X 1/2"QL
Glucopro Insulin Syringe/U-100/1ML/31G X 5/16"QL
Insulin Syringe/0.5ML/30G X 5/16"QL
Glucosource Lancet Device Insulin Syringe/0.5ML/31G X 5/16"QL
Gmate Lancing Device Insulin Syringe/1ML/28G X 1/2"QL
Gnp Clickfine Pen Needle Universal/31GX5/16"QL
Insulin Syringe/1ML/29G X 1/2"QL
Gnp Clickfine Universal Pen Needles 31GX1/4"QL
Insulin Syringe/1ML/30G X 5/16"QL
Gnp Clickfine Universal Pen Needles 31GX5/16"QL
Insulin Syringe/1ML/31G X 5/16"QL
Gnp Insulin Syringe/0.3ML/29G X 1/2"QL
Insupen Pen Needles 32G X4MMQL
Gnp Insulin Syringe/0.3ML/30G X 5/16"QL
Insupen Sensitive 32GX6MMQL
Gnp Insulin Syringe/0.3ML/31G X 5/16"QL
Insupen Sensitive 32GX8MMQL
Gnp Insulin Syringe/0.5ML/28G X 1/2"QL
Insupen Ultrafin 29GX12MMQL
Gnp Insulin Syringe/0.5ML/29G X 1/2"QL
Insupen Ultrafin 30GX8MMQL
Gnp Insulin Syringe/0.5ML/30G X 5/16"QL
Insupen Ultrafin 31GX6MMQL
Gnp Insulin Syringe/0.5ML/31G X 5/16"QL
Insupen Ultrafin 31GX8MMQL
Gnp Insulin Syringe/1ML/28G X 1/2"QL
Insupen 33GX4MMQL
Gnp Insulin Syringe/1ML/29G X 1/2"QL
IN Touch Lancing Device Gnp Insulin Syringe/1ML/30G X 5/16"QL
Kinray Insulin Syringe Preferred Plus/0.3ML/31G X 5/16"QL
Gnp Insulin Syringe/1ML/31G X 5/16"QL
Kinray Insulin Syringe Preferred Plus/0.5ML/31G X 5/16"QL
Gnp Ultra Comfort Insulin Syringe/0.3ML/29G X 1/2"QL
Kinray Insulin Syringe Preferred Plus/1ML/31G X 5/16"QL
Gnp Ultra Comfort Insulin Syringe/0.3ML/30G X 5/16" Kinray Insulin Syringe/0.5ML/29G X 1/2"QL
Kmart Valu Plus Insulin Syringe/0.3ML/30GQL
Gnp Ultra Comfort Insulin Syringe/0.3ML/31G X 5/16" Kmart Valu Plus Insulin Syringe/0.5ML/29GQL
Kmart Valu Plus Insulin Syringe/0.5ML/30GQL
Gnp Ultra Comfort Insulin Syringe/0.5ML/28G X 1/2"QL
Kmart Valu Plus Insulin Syringe/1ML/29GQL
Gnp Ultra Comfort Insulin Syringe/0.5ML/29G X 1/2"QL
Kmart Valu Plus Insulin Syringe/1ML/30GQL
Gnp Ultra Comfort Insulin Syringe/0.5ML/30G X 5/16" Kroger Insulin Syringe/0.3ML/29G X 1/2"QL
Kroger Insulin Syringe/0.3ML/30G X 5/16"QL
Gnp Ultra Comfort Insulin Syringe/0.5ML/31G X 5/16"
SHORTQL
Kroger Insulin Syringe/0.3ML/31G X 5/16"QL
Kroger Insulin Syringe/0.5ML/29G X 1/2"QL
Gnp Ultra Comfort Insulin Syringe/1ML/28G X 1/2"QL
Kroger Insulin Syringe/0.5ML/30G X 5/16"QL
Gnp Ultra Comfort Insulin Syringe/1ML/29G X 1/2"QL
Kroger Insulin Syringe/0.5ML/31G X 5/16"QL
Gnp Ultra Comfort Insulin Syringe/1ML/30G X 5/16"
SHORTQL
Kroger Insulin Syringe/1ML/29G X 1/2"QL
Gnp Ultra Comfort Insulin Syringe/1ML/31G X 5/16" Kroger Insulin Syringe/1ML/30G X 5/16"QL
Kroger Insulin Syringe/1ML/31G X 5/16"QL
H-e-b Incontrol Advanced Lancing Device Kroger Lancing Device H-e-b Incontrol Pen Needles 29GX12MMQL
Kroger Pen Needles 29G X 12MMQL
H-e-b IN Control Pen Needles 31GX5MMQL
Kroger Pen Needles 31G X 8MMQL
H-e-b IN Control Pen Needles 31GX6MMQL
Kroger Pen Needles 31GX1/4"QL
H-e-b IN Control Pen Needles 31GX8MMQL
Lancet Device Adjustable H-e-b IN Control Pen Needles/Nano/32GX4MMQL
Lancet Device With Ejector Health Care Lancing Device Lancet Transporter Case Healthwise Lancing Pen Healthwise Mini Pen Needles 31GX6MMQL
Lancing Device Adjustable Healthwise Pen Needles 29GX12MMQL
Healthwise SHORT Pen Needles 31GX8MMQL
Leader Advanced Lancing Device Healthwise Unifine Pentips Pen Needles 32GX4MMQL
Leader Insulin Syringe/0.3ML/29G X 1/2"QL
Healthy Accents Autolet Impression Lancing Device Leader Insulin Syringe/0.3ML/30G X 5/16"QL
Healthy Accents Unifine Pentips Pen Needles Leader Insulin Syringe/0.3ML/31G X 5/16"QL
29GX12MMQL
Leader Insulin Syringe/0.5ML/28G X 1/2"QL
Healthy Accents Unifine Pentips Pen Needles Leader Insulin Syringe/0.5ML/29G X 1/2"QL
31GX5MMQL
Leader Insulin Syringe/0.5ML/30G X 5/16"QL
Healthy Accents Unifine Pentips Pen Needles
31GX6MMQL
Leader Insulin Syringe/0.5ML/31G X 5/16"QL
Leader Insulin Syringe/1ML/28G X 1/2"QL
Healthy Accents Unifine Pentips Pen Needles
31GX8MMQL
Leader Insulin Syringe/1ML/29G X 1/2"QL
Healthy Accents Unifine Pentips Pen Needles Leader Insulin Syringe/1ML/30G X 5/16"QL
32GX4MMQL
Leader Insulin Syringe/1ML/31G X 5/16"QL
Hypolance AST Lancing Kit Leader Unifine Pentips Plus/Mini/31GX3/16"QL
Insulin Syringe/U-100/0.3ML/29G X 1/2"QL
Leader Unifine Pentips Plus/SHORT/31GX5/16"QL
Insulin Syringe/U-100/0.5ML/28G X 1/2"QL
Leader Unifine Pentips/Mini/31GX3/16"QL
Insulin Syringe/U-100/0.5ML/29G X 1/2"QL
Leader Unifine Pentips/Nano/32GX5/32"QL
Insulin Syringe/U-100/1ML/28G X 1/2"QL
Leader Unifine Pentips/Plus/32GX5/32"QL
Insulin Syringe/U-100/1ML/29G X 1/2"QL
Lite Touch Lancing Device Insulin Syringe/U-100/1ML/30G X 5/16"QL
Lite Touch Lancing Pen Insulin Syringe/U-100/1ML/31G X 5/16"QL
Lite Touch Pen Needles/31G X 3/16"QL
Insulin Syringe/0.3ML/29G X 1/2"QL
Litetouch Insulin Syringe/U-100/0.5ML/28G X 1/2"QL
Insulin Syringe/0.3ML/29G X 1"QL
Litetouch Insulin Syringe/U-100/0.5ML/29G X 1/2"QL
Insulin Syringe/0.3ML/30G X 5/16"QL
Litetouch Insulin Syringe/U-100/1ML/28G X 1/2"QL
Insulin Syringe/0.3ML/31G X 5/16"QL
Litetouch Insulin Syringe/U-100/1ML/29G X 1/2"QL
Insulin Syringe/0.5ML/27G X 1/2"QL
Litetouch Insulin Syringe/U-100/1ML/31G X 5/16"QL
Insulin Syringe/0.5ML/28G X 1/2"QL
Litetouch Insulin Syringe/0.3ML/29G X 1/2"QL
Insulin Syringe/0.5ML/29G X 1/2"QL
Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; Litetouch Insulin Syringe/0.3ML/30G X 5/16"QL
Monoject Ultra Comfort Insulin Syringe/1ML/29G X 1/2"QL
Litetouch Insulin Syringe/0.3ML/31G X 5/16"QL
Monoject Ultra Comfort Insulin Syringe/1ML/30G X 5/16"QL
Litetouch Insulin Syringe/0.5ML/30G X 5/16"QL
Monojector End CAPS Litetouch Insulin Syringe/0.5ML/31G X 5/16"QL
Monojector Opd End CAPS Litetouch Insulin Syringe/1ML/30G X 5/16"QL
Moore MED Monoject Insulin Syringe/U-100/0.5ML/28G X Litetouch Pen Needles 29GX12.7MMQL
1/2"QL
Moore MED Monoject Insulin Syringe/U-100/0.5ML/29G X Litetouch Pen Needles 31G X 6MMQL
1/2"QL
Litetouch Pen Needles 31GX8MM SHORTQL
Moore MED Monoject Insulin Syringe/U-100/1ML/28G X Live Better Advanced Lancing Device 1/2"QL
Live Better Pen Needles 29G X 12MMQL
Moore MED Monoject Insulin Syringe/U-100/1ML/29G X Live Better Pen Needles 31G X 12MMQL
1/2"QL
Live Better Pen Needles 31G X 6MMQL
Multi-lancet Device Longs Insulin Syringe/0.5ML/31G X 5/16"QL
Multi-lancet Device 2 Magellan Insulin Safety Syringe/U-100/0.3ML/29G X MS Insulin Syringe/0.3ML/29G X 1/2"QL
1/2"QL
MS Insulin Syringe/0.3ML/30G X 5/16"QL
Magellan Insulin Safety Syringe/U-100/0.3ML/30G X MS Insulin Syringe/0.3ML/31G X 5/16"QL
5/16"QL
MS Insulin Syringe/0.5ML/29G X 1/2"QL
Magellan Insulin Safety Syringe/U-100/0.5ML/29G X
1/2"QL
MS Insulin Syringe/0.5ML/30G X 5/16"QL
MS Insulin Syringe/0.5ML/31G X 5/16"QL
Magellan Insulin Safety Syringe/U-100/0.5ML/30G X
5/16"QL
MS Insulin Syringe/1ML/29G X 1/2"QL
Magellan Insulin Safety Syringe/U-100/1ML/29G X 1/2"QL
MS Insulin Syringe/1ML/30G X 5/16"QL
Magellan Insulin Safety Syringe/U-100/1ML/30G X 5/16"QL
MS Insulin Syringe/1ML/31G X 5/16"QL
Maxi-comfort Insulin Syringe/U-100/0.5ML/28GX1/2"QL
Nova Sureflex Lancing Device Maxi-comfort Insulin Syringe/U-100/1ML/28GX1/2"QL
Novofine Autocover 30GX8MMQL
Medic Insulin Syringe/0.3ML/30G X 5/16"QL
Novofine Plus 32GX4MMQL
Medic Insulin Syringe/0.5ML/30G X 5/16"QL
Novofine 30GX8MMQL
Medicine Shoppe Pen Needles 29G X 12MMQL
Novofine 32GX6MMQL
Medicine Shoppe Pen Needles 31G X 6MMQL
Novotwist 30GX8MMQL
Medicine Shoppe Pen Needles 31G X 8MMQL
Novotwist 32GX5MMQL
Meijer Pen Needles 29G X 12MMQL
On Call Lancing Device Meijer Pen Needles 31G X 6MMQL
On Call Plus Lancing Device Meijer Pen Needles 31G X 8MMQL
Pen Needles 29G X 12MMQL
Mini Lancing Device Pen Needles 29GX1/2"QL
Monoject Insulin Syringe Regular LUER Pen Needles 30GX5/16"QL
Pen Needles 31G X 1/4" SHORTQL
Monoject Insulin Syringe/Detach Needle/1ML/25G X 5/8"QL
Pen Needles 31G X 3/16"QL
Monoject Insulin Syringe/Detach Needle/1ML/27G X 1/2"QL
Pen Needles 31G X 6MMQL
Monoject Insulin Syringe/Perm Needle/U-100/0.5ML/28G X Pen Needles 31GX5/16"QL
1/2"QL
Pentips 31GX5MMQL
Monoject Insulin Syringe/Perm Needle/1ML/28G X 1/2"QL
Pentips 31GX8MMQL
Monoject Insulin Syringe/Safety/Perm Needle/0.3ML/29G X Pentips 32GX4MMQL
1/2"QL
Precision Sure-dose Insulin Syringe/0.3ML/30G X 5/16"QL
Monoject Insulin Syringe/Safety/Perm
Needle/0.3ML/29GX1/2"QL
Precision Sure-dose Insulin Syringe/0.5ML/28G X 1/2"QL
Precision Sure-dose Insulin Syringe/0.5ML/29G X 1/2"QL
Monoject Insulin Syringe/Safety/Perm Needle/0.5ML/29G X
1/2"QL
Precision Sure-dose Insulin Syringe/0.5ML/30G X 3/8"QL
Monoject Insulin Syringe/Safety/Perm Needle/1ML/29G X Precision Sure-dose Insulin Syringe/1ML/28G X 1/2"QL
1/2"QL
Precision Sure-dose Plus Insulin Syringe/0.3ML/29G X Monoject Insulin Syringe/Softpack/U-100/0.5ML/28G X 1/2"QL
1/2"QL
Precision Sure-dose Plus Insulin Syringe/1ML/29G X Monoject Insulin Syringe/Softpack/1ML/27G X 1/2"QL
1/2"QL
Monoject Insulin Syringe/U-100/0.3ML/30G X 5/16"QL
Preferred Plus Insulin Syringe/U-100/0.3ML/29G X 1/2"QL
Monoject Insulin Syringe/U-100/0.5ML/28G X 1/2"QL
Preferred Plus Insulin Syringe/U-100/0.3ML/30G X 5/16"QL
Monoject Insulin Syringe/U-100/0.5ML/30G X 5/16"QL
Preferred Plus Insulin Syringe/U-100/0.5ML/28G X 1/2"QL
Monoject Insulin Syringe/U-100/1ML/28G X 1/2"QL
Preferred Plus Insulin Syringe/U-100/0.5ML/29G X 1/2"QL
Monoject Insulin Syringe/U-100/1ML/30G X 5/16"QL
Preferred Plus Insulin Syringe/U-100/0.5ML/30G X 5/16"QL
Monoject Insulin Syringe/1MLQL
Preferred Plus Insulin Syringe/U-100/1ML/28G X 1/2"QL
Monoject Insulin Syringe/1ML/31G X 5/16"QL
Preferred Plus Insulin Syringe/U-100/1ML/29G X 1/2"QL
Monoject Ultra Comfort Insulin Syringe/0.3ML/29G X Preferred Plus Insulin Syringe/U-100/1ML/30G X 5/16"QL
1/2"QL
Preferred Plus Unifine Pentips 29G X 12MMQL
Monoject Ultra Comfort Insulin Syringe/0.3ML/30G X Preferred Plus Unifine Pentips 31G X 6MM Ultra SHORTQL
5/16"QL
Monoject Ultra Comfort Insulin Syringe/0.3ML/31G X Preferred Plus Unifine Pentips 31G X 8MM SHORTQL
5/16"QL
Preferred Plus Unifine Pentips 32GX4MMQL
Monoject Ultra Comfort Insulin Syringe/0.5ML/28G X Preferred Plus Unifine Pentips/Mini/31GX5MMQL
1/2"QL
Prodigy Insulin Mini Pen Needles/31G X 3/16"QL
Monoject Ultra Comfort Insulin Syringe/0.5ML/29G X
1/2"QL
Prodigy Insulin Pen Needles/29G X 1/2"QL
Prodigy Insulin Syring/U-100/0.3ML/31G X 5/16"QL
Monoject Ultra Comfort Insulin Syringe/0.5ML/30G X
5/16"QL
Prodigy Insulin Syringe/1/2ML/31G X 5/16"QL
Monoject Ultra Comfort Insulin Syringe/0.5ML/31G X Prodigy Insulin Syringe/1ML/28G X 1/2"QL
5/16"QL
Prodigy Insulin SHORT Penneedles/31G X 5/16"QL
Monoject Ultra Comfort Insulin Syringe/1ML/28G X 1/2"QL
Prodigy Lancing Device Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; Pss Select Platforms Safesnap Insulin Syringe/1ML/28G X 1/2"QL
Px Advanced Lancing Device Safesnap Insulin Syringe/1ML/29G X 1/2"QL
Px Extra SHORT Pen Needles 31GX6MMQL
Schnucks Insulin Syringe Ulti-fine/U-100/0.5ML/29G X Px Insulin Syringe/U-100/0.3ML/30G X 1/2"QL
1/2"QL
Schnucks Insulin Syringe Ulti-fine/U-100/0.5ML/30G X Px Insulin Syringe/U-100/0.3ML/31G X 5/16"QL
5/16"QL
Px Insulin Syringe/U-100/0.5ML/30G X 1/2"QL
Select-lite Device/Lancets Px Insulin Syringe/U-100/0.5ML/31G X 5/16"QL
Select-lite Lancing Device Px Insulin Syringe/U-100/1ML/30G X 1/2"QL
Shopko Autolet Lancing Device Px Insulin Syringe/U-100/1ML/31G X 5/16"QL
Shopko Unifine Pentips Pen Needles/Micro/32GX4MMQL
Px Lancet Auto Injector Shopko Unifine Pentips Pen Needles/Mini/31GX5MMQL
Px Mini Pen Needles 31GX5MMQL
Shopko Unifine Pentips Pen Px Pen Needle 29GX12MMQL
Px Pen Needle 31GX8MMQL
Shopko Unifine Pentips Pen Px Shortlength Pen Needles/31GX8MMQL
PC Unifine Pentips 29G X 1/2"QL
Simple Diagnostics Lancing Device PC Unifine Pentips 31G X 5MM MiniQL
Sm Insulin Syringe/U-100/0.3ML/29G X 1/2"QL
PC Unifine Pentips 31G X 6MM Ultra SHORTQL
Sm Insulin Syringe/U-100/0.3ML/30G X 5/16"QL
PC Unifine Pentips 31G X 8MM SHORTQL
Sm Insulin Syringe/U-100/0.5ML/28G X 1/2"QL
Qc Advanced Lancing Device Sm Insulin Syringe/U-100/0.5ML/29G X 1/2"QL
Qc Insulin Syringe 0.5ML/29GQL
Sm Insulin Syringe/U-100/0.5ML/30G X 5/16"QL
Qc Insulin Syringe 0.5ML/30GQL
Sm Insulin Syringe/U-100/1ML/28G X 1/2"QL
Qc Insulin Syringe 1ML/29GQL
Sm Insulin Syringe/U-100/1ML/29G X 1/2"QL
Qc Insulin Syringe/0.3ML/29GQL
Sm Insulin Syringe/U-100/1ML/30G X 5/16"QL
Qc Insulin Syringe/0.3ML/29G X 1/2"QL
Sm Insulin Syringe/0.3ML/31G X 5/16"QL
Qc Insulin Syringe/0.5ML/29G X 1/2"QL
Sm Insulin Syringe/0.5ML/31G X 5/16"QL
Qc Insulin Syringe/0.5ML/31G X 5/16"QL
Sm Insulin Syringe/1ML/31G X 5/16"QL
Qc Insulin Syringe/1ML/29G X 1/2"QL
Smart Diabetes Vantage Lancing Device Qc Insulin Syringe/1ML/30GQL
Solus V2 Lancing Device Qc Insulin Syringe/1ML/31G X 5/16"QL
Qc Pen Needles 29G X 12MMQL
Supreme II Confidence Paddles Qc Pen Needles 31G X 6MMQL
Sure Comfort Insulin Syringe/U-100/0.3ML/29G X 1/2"QL
Qc Pen Needles 31G X 8MMQL
Sure Comfort Insulin Syringe/U-100/0.3ML/30G X 1/2"QL
Qc Unifine Pentips 32GX4MMQL
Sure Comfort Insulin Syringe/U-100/0.3ML/30G X 5/16"QL
Ra Insulin Syringe/U-100/0.5ML/30G X 5/16"QL
Sure Comfort Insulin Syringe/U-100/0.3ML/31G X 5/16QL
Ra Insulin Syringe/U-100/1 ML/30G X 5/16"QL
Sure Comfort Insulin Syringe/U-100/0.3ML/31G X 5/16"QL
Ra Insulin Syringe/0.5ML/29G X 1/2"QL
Sure Comfort Insulin Syringe/U-100/0.5ML/28G X 1/2"QL
Ra Insulin Syringe/1ML/29G X 1/2"QL
Sure Comfort Insulin Syringe/U-100/0.5ML/29G X 1/2"QL
Ra Lancing Device Sure Comfort Insulin Syringe/U-100/0.5ML/30G X 1/2"QL
Ra Pen Needles 31G X 5MM 3/16"QL
Sure Comfort Insulin Syringe/U-100/0.5ML/30G X 5/16"QL
Ra Pen Needles 31G X 8MM 5/16"QL
Sure Comfort Insulin Syringe/U-100/0.5ML/31G X 5/16QL
Reality Insulin Syringe/U-100/0.5ML/28G X 1/2"QL
Sure Comfort Insulin Syringe/U-100/1ML/28G X 1/2"QL
Reality Insulin Syringe/U-100/0.5ML/29G X 1/2"QL
Sure Comfort Insulin Syringe/U-100/1ML/29G X 1/2"QL
Reality Insulin Syringe/U-100/1ML/28G X 1/2"QL
Sure Comfort Insulin Syringe/U-100/1ML/30G X 1/2"QL
Reality Insulin Syringe/U-100/1ML/29G X 1/2"QL
Sure Comfort Insulin Syringe/U-100/1ML/30G X 5/16"QL
Relion Insulin Syringe/U -100/0.5ML/29GQL
Sure Comfort Insulin Syringe/U-100/1ML/31G X 5/16"QL
Relion Insulin Syringe/U-00/1ML/29G X 1/2"QL
Sure Comfort Lancing Pen Relion Insulin Syringe/U-100/0.3ML/29GQL
Sure Comfort Pen Needles 29GX1/2" 12.7MMQL
Relion Insulin Syringe/U-100/0.3ML/29G X 1/2"QL
Sure Comfort Pen Needles 30GX5/16" SHORTQL
Relion Insulin Syringe/U-100/0.3ML/30GQL
Sure Comfort Pen Needles 31GX3/16" (5MM)QL
Relion Insulin Syringe/U-100/0.3ML/30G X 5/16"QL
Sure Comfort Pen Needles 31GX5/16" (8MM)QL
Relion Insulin Syringe/U-100/0.3ML/31G X 5/16"QL
Sure Comfort Pen Needles 32GX5/32"QL
Relion Insulin Syringe/U-100/0.5ML/29G X 1/2"QL
Sure Comfort Pen Needles 32GX6MMQL
Relion Insulin Syringe/U-100/0.5ML/30GQL
Sure-fine Pen Needles 29GX1/2" 12.7MMQL
Relion Insulin Syringe/U-100/0.5ML/30G X 5/16"QL
Sure-fine Pen Needles 31GX3/16" 5MMQL
Relion Insulin Syringe/U-100/0.5ML/31G X 5/16"QL
Sure-fine Pen Needles 31GX5/16" 8MMQL
Relion Insulin Syringe/U-100/1ML/30GQL
Sure-ject Insulin Syringe/U-100/0.3ML/29G X 1/2"QL
Relion Insulin Syringe/U-100/1ML/30G X 5/16"QL
Sure-ject Insulin Syringe/U-100/0.3ML/30G X 5/16"QL
Relion Insulin Syringe/U-100/1ML/31G X 5/16"QL
Sure-ject Insulin Syringe/U-100/0.3ML/31G X 5/16"QL
Relion Lancing Device Sure-ject Insulin Syringe/U-100/0.5ML/28G X 1/2"QL
Relion Mini Pen Needles 31GX6MMQL
Sure-ject Insulin Syringe/U-100/0.5ML/29G X 1/2"QL
Relion Pen Needles 29GX12MMQL
Sure-ject Insulin Syringe/U-100/0.5ML/30G X 5/16"QL
Relion Pen Needles 31GX8MMQL
Sure-ject Insulin Syringe/U-100/0.5ML/31G X 5/16"QL
Relion Pen Needles 32GX4MMQL
Sure-ject Insulin Syringe/U-100/1ML/28G X 1/2"QL
Relion SHORT Pen Needles 31GX8MMQL
Sure-ject Insulin Syringe/U-100/1ML/29G X 1/2"QL
Renew Advanced Lancing Device Sure-ject Insulin Syringe/U-100/1ML/30G X 5/16"QL
Rightest GD-L500 Alternate Site Adapter Sure-ject Insulin Syringe/U-100/1ML/31G X 5/16"QL
Rightest GD500 Lancing Device Safesnap Insulin Syringe/0.3ML/30G X 5/16"QL
SB Insulin Syringe/U-100/0.5ML/29G X 1/2"QL
Safesnap Insulin Syringe/0.5ML/29G X 1/2"QL
SB Insulin Syringe/U-100/0.5ML/30G X 5/16"QL
Safesnap Insulin Syringe/0.5ML/30G X 5/16"QL
SB Insulin Syringe/U-100/1ML/29G X 1/2"QL
Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; SB Insulin Syringe/U-100/1ML/30G X 5/16"QL
Ulticare Insulin Safety Syringe/1ML/29G X 1/2"QL
SB Insulin Syringe/U-100/1ML/31G X 5/16"QL
Ulticare Insulin Syringe Ultrafine U-100/0.3ML/31G X Terumo Insulin Syringe/U-100/0.3ML/29G X 1/2"QL
5/16"QL
Ulticare Insulin Syringe Ultrafine U-100/0.5ML/31G X Terumo Insulin Syringe/U-100/0.5ML/27G X 1/2"QL
5/16"QL
Terumo Insulin Syringe/U-100/0.5ML/28G X 1/2"QL
Ulticare Insulin Syringe Ultrafine U-100/1ML/31G X 5/16"QL
Terumo Insulin Syringe/U-100/1ML/28G X 1/2"QL
Ulticare Insulin Syringe 1CC/28G U-100 1/2"QL
Terumo Insulin Syringe/0.3ML/30G X 3/8"QL
Ulticare Insulin Syringe/SHORT/0.3ML/30G X 5/16"QL
Terumo Insulin Syringe/0.5ML/29G X 1/2"QL
Ulticare Insulin Syringe/SHORT/0.3ML/31G X 5/16"QL
Terumo Insulin Syringe/0.5ML/30G X 3/8"QL
Ulticare Insulin Syringe/SHORT/0.5ML/30G X 5/16"QL
Terumo Insulin Syringe/1ML/27G X 1/2"QL
Ulticare Insulin Syringe/SHORT/0.5ML/31G X 5/16"QL
Terumo Insulin Syringe/1ML/29G X 1/2"QL
Ulticare Insulin Syringe/SHORT/1ML/30G X 5/16"QL
Terumo Insulin Syringe/1ML/30G X 3/8"QL
Ulticare Insulin Syringe/SHORT/1ML/31G X 5/16"QL
Terumo Surguard Insulin Syringe/0.3ML/29G X 1/2"QL
Ulticare Insulin Syringe/U-100/0.3ML/29G X 1/2"QL
Terumo Surguard Insulin Syringe/0.5ML/28G X 1/2"QL
Ulticare Insulin Syringe/U-100/0.3ML/30G X 1/2"QL
Terumo Surguard Insulin Syringe/0.5ML/29G X 1/2"QL
Ulticare Insulin Syringe/U-100/0.3ML/30G X 5/16"QL
Terumo Surguard Insulin Syringe/1ML/28G X 1/2"QL
Ulticare Insulin Syringe/U-100/0.3ML/31G X 5/16"QL
Terumo Surguard Insulin Syringe/1ML/29G X 1/2"QL
Ulticare Insulin Syringe/U-100/0.5ML/29G X 1/2"QL
Tgt Advanced Lancing Device Ulticare Insulin Syringe/U-100/0.5ML/30G X 1/2"QL
Tgt Lancing Device Ulticare Insulin Syringe/U-100/0.5ML/30G X 5/16"QL
Thinpro Insulin Syringe/0.3ML/29G X 1/2"QL
Ulticare Insulin Syringe/U-100/0.5ML/31G X 5/16"QL
Thinpro Insulin Syringe/0.3ML/30G X 3/8"QL
Ulticare Insulin Syringe/U-100/1ML/29G X 1/2"QL
Thinpro Insulin Syringe/0.3ML/31G X 3/8"QL
Ulticare Insulin Syringe/U-100/1ML/30G X 1/2"QL
Thinpro Insulin Syringe/0.5ML/28G X 1/2"QL
Ulticare Insulin Syringe/U-100/1ML/30G X 5/16"QL
Thinpro Insulin Syringe/0.5ML/29G X 1/2"QL
Ulticare Insulin Syringe/U-100/1ML/31G X 5/16"QL
Thinpro Insulin Syringe/0.5ML/30G X 3/8"QL
Ulticare Insulin Syringe/0.3ML/29G X 1/2"QL
Thinpro Insulin Syringe/0.5ML/31G X 3/8"QL
Ulticare Insulin Syringe/0.3ML/30G X 1/2"QL
Thinpro Insulin Syringe/1ML/28G X 1/2"QL
Ulticare Insulin Syringe/0.3ML/30G X 5/16"QL
Thinpro Insulin Syringe/1ML/29G X 1/2"QL
Ulticare Insulin Syringe/0.5ML/28G X 1/2"QL
Thinpro Insulin Syringe/1ML/30G X 3/8"QL
Ulticare Insulin Syringe/0.5ML/29G X 1/2"QL
Thinpro Insulin Syringe/1ML/31G X 3/8"QL
Ulticare Insulin Syringe/0.5ML/30G X 1/2"QL
Todays Health Advanced Lancing Device Ulticare Insulin Syringe/0.5ML/30G X 5/16"QL
Todays Health Mini Pen Needles 31G X 1/4"QL
Ulticare Insulin Syringe/1ML/28G X 1/2"QL
Todays Health Original Pen Needles 29G X 1/2"QL
Ulticare Insulin Syringe/1ML/29G X 1/2"QL
Todays Health SHORT Pen Needles 31G X 5/16"QL
Ulticare Insulin Syringe/1ML/30G X 1/2"QL
Topcare Clickfine Universal Pen Eedles 31GX1/4"QL
Ulticare Insulin Syringe/1ML/30G X 5/16"QL
Topcare Clickfine Universal Pen Eedles 31GX5/16"QL
Ulticare Micro Pen Needles/32G X 4MMQL
Topcare Ultra Comfort Insulin Syringe/U-100/0.3ML/29G X
1/2"QL
Ulticare Mini Pen Needles Ulti-fine IVQL
Ulticare Mini Pen Needles 31GX6MMQL
Topcare Ultra Comfort Insulin Syringe/U-100/0.5ML/29G X
1/2"QL
Ulticare Mini Pen Needles/31G X 6MMQL
Topcare Ultra Comfort Insulin Syringe/U-100/1ML/29G X Ulticare Mini Pen Needles31GX6MMQL
1/2"QL
Ulticare Original Pen Needles Ulti-fineQL
Topcare Ultra Comfort Insulin Syringe/0.3ML/30G X Ulticare Pen Needles/29G X 12.7MMQL
5/16"QL
Ulticare SHORT Pen Needles Ulti-fine IVQL
Topcare Ultra Comfort Insulin Syringe/0.3ML/31G X Ulticare SHORT Pen Needles 31GX8MMQL
5/16"QL
Ulticare SHORT Pen Needles/31G X 8MMQL
Topcare Ultra Comfort Insulin Syringe/0.5ML/30G X
5/16"QL
Ultiguard Insulin Syringe/U-100/0.3ML/29G X 1/2"QL
Ultiguard Insulin Syringe/U-100/0.3ML/30G X 5/16"QL
Topcare Ultra Comfort Insulin Syringe/0.5ML/31G X
5/16"QL
Ultiguard Insulin Syringe/U-100/0.5ML/29G X 1/2"QL
Topcare Ultra Comfort Insulin Syringe/1ML/30G X 5/16"QL
Ultiguard Insulin Syringe/U-100/0.5ML/30G X 5/16"QL
Topcare Ultra Comfort Insulin Syringe/1ML/31G X 5/16"QL
Ultiguard Insulin Syringe/U-100/1ML/29G X 1/2"QL
Topco Insulin Syringe/U-100/0.3ML/29G X 1/2"QL
Ultiguard Insulin Syringe/U-100/1ML/30G X 5/16"QL
Topco Insulin Syringe/U-100/0.5ML/28G X 1/2"QL
Ultilet Insulin Syringe/SHORT/0.3ML/30G X 5/16"QL
Topco Insulin Syringe/U-100/0.5ML/29G X 1/2"QL
Ultilet Insulin Syringe/SHORT/0.3ML/31G X 5/16"QL
Topco Insulin Syringe/U-100/1ML/28G X 1/2"QL
Ultilet Insulin Syringe/SHORT/0.5ML/30G X 5/16"QL
Topco Insulin Syringe/U-100/1ML/29G X 1/2"QL
Ultilet Insulin Syringe/SHORT/0.5ML/31G X 5/16"QL
Tracer II 3 Volt Battery Ultilet Insulin Syringe/SHORT/1ML/30G X 5/16"QL
Truedraw Lancing Device Ultilet Insulin Syringe/SHORT/1ML/31G X 5/16"QL
Trueplus Insulin Syringe/U-100/0.3ML/29G X 1/2"QL
Ultilet Pen Needle 32GX4MM/SHORTQL
Trueplus Insulin Syringe/U-100/0.3ML/30G X 5/16"QL
Ultilet SHORT Pen Needles 31GX5/16"QL
Trueplus Insulin Syringe/U-100/0.3ML/31G X 5/16"QL
Ultilet SHORT Pen Needles31GX3/16"QL
Trueplus Insulin Syringe/U-100/0.5ML/28G X 1/2"QL
Ultra Comfort Insulin Syringe/U-100/0.3ML/30G X 5/16"QL
Trueplus Insulin Syringe/U-100/0.5ML/29G X 1/2"QL
Ultra Comfort Insulin Syringe/U-100/0.5ML/28G X 1/2"QL
Trueplus Insulin Syringe/U-100/0.5ML/30G X 5/16"QL
Ultra-comfort Insulin Syringe/U-100/0.3ML/29G X 1/2"QL
Trueplus Insulin Syringe/U-100/0.5ML/31G X 5/16"QL
Ultra-comfort Insulin Syringe/U-100/0.3ML/30G X 5/16"QL
Trueplus Insulin Syringe/U-100/1ML/28G X 1/2"QL
Ultra-comfort Insulin Syringe/U-100/0.3ML/31G X 5/16"QL
Trueplus Insulin Syringe/U-100/1ML/29G X 1/2"QL
Ultra-comfort Insulin Syringe/U-100/0.5ML/28G X 1/2"QL
Trueplus Insulin Syringe/U-100/1ML/30G X 5/16"QL
Ultra-comfort Insulin Syringe/U-100/0.5ML/29G X 1/2"QL
Trueplus Insulin Syringe/U-100/1ML/31G X 5/16"QL
Ultra-comfort Insulin Syringe/U-100/0.5ML/30G X 5/16"QL
Ulti-lance Automatic/ Clear Tip Ultra-comfort Insulin Syringe/U-100/0.5ML/31G X 5/16"QL
Ulticare Insulin Safety Syringe/0.5ML/29G X 1/2"QL
Ultra-comfort Insulin Syringe/U-100/1ML/28G X 1/2"QL
Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; Ultra-comfort Insulin Syringe/U-100/1ML/29G X 1/2"QL
Wd Medic Insulin Syringe/0.5ML/30G X 5/16"QL
Ultra-comfort Insulin Syringe/U-100/1ML/30G X 5/16"QL
Wd Medic Insulin Syringe/1ML/29G X 1/2"QL
Ultra-comfort Insulin Syringe/U-100/1ML/31G X 5/16"QL
Wd Medic Insulin Syringe/1ML/30G X 5/16"QL
Ultra-thin II Insulin Syringe SHORT/U- Wegmans Unifine Pentips Plus 32GX4MMQL
Wegmans Unifine Pentips Plus/Mini/31GX5MMQL
Ultra-thin II Insulin Syringe SHORT/U- Wegmans Unifine Pentips Plus/SHORT/31GX8MMQL
Wegmans Unifine Pentips Plus/Ultra SHORT/31GX6MMQL
Ultra-thin II Insulin Syringe SHORT/U- 1ST Tier Unifine Pentips /Mini/31GX5MMQL
1ST Tier Unifine Pentips Plus 31GX8MMQL
Ultra-thin II Insulin Syringe SHORT/U-
100/0.5ML/31GX5/16"QL
1ST Tier Unifine Pentips Plus 32GX4MMQL
1ST Tier Unifine Pentips Plus/Mini/31GX5MMQL
Ultra-thin II Insulin Syringe SHORT/U-
100/1ML/30GX5/16"QL
1ST Tier Unifine Pentips Plus/Original/29GX12MMQL
Ultra-thin II Insulin Syringe SHORT/U- 1ST Tier Unifine Pentips Plus/Ultra SHORT/31GX6MMQL
1ST Tier Unifine Pentips 29GX12MMQL
Ultra-thin II Insulin Syringe/U-100/0.3ML/29GX1/2"QL
1ST Tier Unifine Pentips 31GX6MMQL
Ultra-thin II Insulin Syringe/U-100/0.5ML/29GX1/2"QL
1ST Tier Unifine Pentips 31GX8MMQL
Ultra-thin II Insulin Syringe/U-100/1ML/29GX1/2"QL
1ST Tier Unifine Pentips 32GX4MMQL
Ultra-thin II Mini Pen Neeedles/31GX3/16"QL
Ultra-thin II Pen Needles 29GX1/2"QL
MEDICAL DEVICES - MISC
Ultra-thin II Pen Needles/SHORT/31GX5/16"QL
Aerochamber Mini Aerosol ChamberQL
Unifine Pentips Plus 29GX12MMQL
Aerochamber MVQL
Unifine Pentips Plus 31GX5MMQL
Aerochamber Plus Flow VUQL
Unifine Pentips Plus 31GX6MMQL
Aerochamber Plus Flow-VUQL
Unifine Pentips Plus 31GX8MMQL
Aerochamber Plus Flow-VU/Large MaskQL
Unifine Pentips Plus 32GX4MMQL
Aerochamber Plus Flow-VU/MaskQL
Unifine Pentips 29GX12MMQL
Aerochamber Plus Flow-VU/Medium MaskQL
Unifine Pentips 31G X 3/16"QL
Aerochamber Plus Flow-VU/Small MaskQL
Unifine Pentips 31G X 6MMQL
Aerochamber Z-stat Plus Valved Holding Chamber W/Flow Unifine Pentips 31G X 8MMQL
Unifine Pentips 31GX5MMQL
Aerochamber Z-stat Plus/FlowsignalQL
Unifine Pentips 31GX6MMQL
Aerochamber Z-stat Plus/Large MaskQL
Unifine Pentips 31GX8MMQL
Aerochamber Z-stat Plus/Medium MaskQL
Unifine Pentips 32GX4MMQL
Aerochamber Z-stat Plus/Small MaskQL
Unistik CZT Comfort Unistik CZT Normal Aerovent Plus Holding Chamber/CollapsibleQL
Alcoh-glove Contoured Wipe Alcoh-wipe 12" X 12" Unistik 2 Comfort Alcohol Prep Pads Unistik 2 Neonatal Unistik 2 Normal Arial ChamberQL
Unistik 3 Comfort Breatherite Collapsible Adult Spacer W/MaskQL
Unistik 3 Neonatal Breatherite Collapsible Child Spacer W/MaskQL
Unistik 3 Normal Breatherite Collapsible Infant Spacer W/MaskQL
Breatherite Collapsible Small Child Spacer W/MaskQL
V-r Monoject Insulin Syringe/U-100/0.3ML/29G X 1/2"QL
Breatherite Collapsible Spacer W/ Neonate MaskQL
V-r Monoject Insulin Syringe/U-100/0.5ML/28G X 1/2"QL
Breatherite Rigid Spacer W/MaskQL
V-r Monoject Insulin Syringe/U-100/0.5ML/29G X 1/2"QL
Breatherite W/Large MaskQL
V-r Monoject Insulin Syringe/U-100/1ML/28G X 1/2"QL
Breatherite W/Medium MaskQL
V-r Monoject Insulin Syringe/U-100/1ML/29G X 1/2"QL
Breatherite W/Small MaskQL
Value Health Insulin Syringe/U-100/0.5ML/29G X 1/2"QL
BD Swabs Single Use Value Health Insulin Syringe/U-100/1ML/29G X 1/2"QL
BD Swabs Single Use Butterfly Value Plus Lancing Device Curity Alcohol Preps/Medium 2 Ply Valumark Pen Needles 29GX12MMQL
Curity Alcohol Swabs Valumark Pen Needles 31G X 6MMQL
CVS Alcohol Prep Swabs Valumark Pen Needles 31G X 8MMQL
CVS Alcohol Swabs Vanishpoint Insulin Syringe/0.5ML/30G X 1/2"QL
Vanishpoint Insulin Syringe/1ML/29G X 1/2"QL
E-z SpacerQL
Vida Mia Autolet Lancing Device E-z Spacer The Body Guards PackQL
Vida Mia Unifine Pentips Mini 31GX6MMQL
EasiventQL
Vida Mia Unifine Pentips Original 29GX12MMQL
Vida Mia Unifine Pentips 32GX4MMQL
Vida Mia Unipfine Pentipsshort 31GX8MMQL
Vp Insulin Syringe/U-100/0.3ML/29G X 1/2"QL
Easy Touch Alcohol Prep Pads/Medium Wd Medic Insulin Syringe/0.3ML/29G X 1/2"QL
Fifty50 Alcohol Prep Pads Wd Medic Insulin Syringe/0.3ML/30G X 5/16"QL
Wd Medic Insulin Syringe/0.5ML/29G X 1/2"QL
Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; Global Alcohol Prep Ease Pads Gnp Alcohol Swabs deferoxamine mesylate Healthwise Alcohol Prep Pads dehydrated alcohol delflex-lm/1.5% dextrose delflex-LC/1.5% dextrose dextrose 10% flex container Inspirease Drug Delivery SystemQL
dextrose 2.5%/sodium chloride 0.45% Inspirease Mouthpiece dextrose 2.5%/NACL 0.45% Inspirease Reservoir Bags dextrose 30% partial fill LiteaireQL
Mask Vortex/Baby Whirl Duckling dextrose 5% viaflex Mask Vortex/Child/Frog dextrose 5%/lactated ringers Mask Vortex/Spinner The Duck dextrose 5%/potassium chloride 0.15% Mask Vortex/Toddler/Lady Bug dextrose 5%/ringers Meijer Alcohol Swabs Extra-thick dextrose 5%/sodium chloride 0.2% dextrose 5%/sodium chloride 0.33% dextrose 5%/sodium chloride 0.45% Nessi Spacer/Large MaskQL
dextrose 5%/sodium chloride 0.9% Nessi Spacer/MouthpieceQL
dextrose 5%/NACL 0.2% Nessi Spacer/Small/MED MaskQL
dextrose 5%/NACL 0.33% Optichamber AdvantageQL
dextrose 5%/NACL 0.45% Optichamber DiamondQL
dextrose 5%/NACL 0.9% Optichamber Diamond/Largeface MaskQL
Optichamber Diamond/Medium Face MaskQL
Optichamber Diamond/Smallface MaskQL
OptihalerQL
Optihaler MDI Drug Delivery SystemQL
effervescent pot chloride Panda Mask Large effervescent potassium Panda Mask Medium effervescent potassium/chloride Panda Mask Small Pediatric Panda Mask Pharmacist Choice Alcoholprep Pads Pocket ChamberQL
Pocket SpacerQL
Qc Alcohol Swabs Ra Alcohol Swabs indocyanine green Relion Alcohol Swabs isolyte-m/dextrose 5% RitefloQL
Saps Care Alcohol Prep Pads Shopko Alcohol Swabs Sm Alcohol Prep Pads Sure Comfort Alcohol Prep Pads kendall sodium chloride flush Sure-prep Alcohol Prep Pads SB Alcohol Prep Pads Tgt Alcohol Swabs Valved Holding ChamberQL
Vortex Valved Holding ChamberQL
klor-CON sprinkle Webcol Alcohol Prep Large 1 Ply Webcol Alcohol Prep Large 2 Ply Webcol Alcohol Prep Medium 2 Ply lactated ringers lactated ringers dextrose 5% viaflex lactated ringers irrigation lactated ringers viaflex magnesium chloride magnesium sulfate aminosyn II 8.5%/electrolytes aminosyn 8.5%/electrolytes monoject pharma grade flush syringe monoject sodium chloride flush argyle sterile water 100ML morrhuate sodium calcium chloride multitrace-4 concentrate calcium gluconate multitrace-5 concentrate n-acetyl-l-cysteine Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; normal saline flush Potassium Chloride ER normal saline flush for flushing vascular access devices normal saline i.v. flush phospha 250 neutral physiosol irrigation potassium acetate potassium chloride potassium chloride CR potassium chloride ER potassium chloride SR potassium chloride 0.15% /NACL 0.45% viaflex potassium chloride 0.15% w/NACL 0.9% viaflex potassium chloride 0.15% D5W/NACL 0.33% potassium chloride 0.15% D5W/NACL 0.45% potassium chloride 0.15% D5W/NACL 0.45% viaflex potassium chloride 0.15% NACL 0.9% Chek-stix Combo PAK Urinalysis Control potassium chloride 0.15%/D5W Chek-stix Control potassium chloride 0.22% D5W/NACL 0.45% potassium chloride 0.224%/D5W/NACL 0.45% potassium chloride 0.224%D5W/NACL 0.45% viaflex potassium chloride 0.3%/D5W potassium chloride 0.3%/NACL 0.9%/viaflex Ketone Test Strips potassium phosphate potassium phosphates ringers injection ringers irrigation Plasma-lyte-56/D5W saline flush zr/sterile field Relion Ketone Test Strips PREFERRED BRAND SPECIALTY sodium bicarbonate AdagenPA
sodium bicarbonate partial fill BivigamPA
Carimune NanofilteredPA
sodium chloride bacteriostatic ExjadePA
sodium chloride flush Flebogamma DifPA
sodium chloride pab Gamastan S/DPA
sodium chloride 0.45% Gammagard LiquidPA
sodium chloride 0.45% viaflex Gammagard S/DPA
sodium phosphate Gammagard S/D Iga Less Than 1mcg/MLPA
sodium polystyrene sulfonate GammakedPA
sodium thiosulfate GammaplexPA
Gamunex-cPA
sterile diluent for epoprostenol sodium HizentraPA
sterile water for injection sterile water irrigation sterile water irrigation plastic bottle Hyperrho S/D Mini-dose sterile water irrigation w/hanger JadenuPA
swabflush saline flush OctagamPA
tpn electrolytes PrivigenPA
virt-phos 250 neutral SynagisPA
XiaflexPA
Delflex-lm/2.5% Dextrose NON-PREFERRED BRAND SPECIALTY Delflex-lm/4.25% Dextrose BenlystaPA
Delflex-sm/1.5% Dextrose CytogamPA
Delflex-sm/2.5% Dextrose FerriproxPA
KCL 0.075%/D5W/NACL 0.45% KCL 0.15%/D5W/ NACL 0.3% Micrhogam Ultra-filtered Plus KCL 0.15%/D5W/NACL 0.2% Rhogam Ultra-filtered Plus KCL 0.15%/D5W/NACL 0.45% KCL 0.15%/D5W/NACL 0.9% KCL 0.3%/D5W/NACL 0.45% Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; sm aspirin EC low strength ACA PREVENTIVE DRUGS
sm childrens aspirin st joseph aspirin tgt aspirin low dose adult aspirin EC low strength tgt childrens aspirin tgt enteric-coated aspirin th aspirin low dose aspirin adult low dose th enteric aspirin aspirin adult low strength aspirin childrens CVS aspirin adult low dose aspirin enteric coated adult low strength CVS aspirin adult low strength aspirin low dose CVS aspirin child aspirin low strength CVS aspirin low dose CVS aspirin low strength aspirin EC low dose aspirin EC LO-dose CVS childrens aspirin CVS enteric aspirin aspirin 81 low dose bayer advanced aspirin regular strength HM aspirin EC low dose bayer aspirin regimen bayer aspirin EC low dose bayer chewable low dose SB childrens aspirin childrens aspirin SB low dose asa EC childrens aspirin low strength Adult Aspirin Low Strength ecotrin low strength Aspirin Low Dose enteric coated aspirin eq adult aspirin low strength eq aspirin adult low dose eq aspirin low dose eq childrens aspirin eql adult aspirin low strength amethiaQL
amethia LOQL
eql aspirin low dose eql childrens aspirin gnp adult aspirin low strength ashlynaQL
gnp aspirin low dose goodsense aspirin low dose kls aspirin low dose meijer aspirin EC camreseQL
miniprin low dose camrese LOQL
px enteric aspirin qc aspirin low dose qc childrens aspirin ra aspirin adult low dose ra aspirin adult low strength ra aspirin childrens dayseeQL
ra aspirin EC adult low strength ra childrens aspirin desogestrel/ethinyl estradiol drospirenone/ethinyl estradiol sm aspirin adult low strength sm aspirin enteric coated sm aspirin low dose Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; opcicon one-step gildess FE 1.5/30 quasenseQL
setlakinQL
introvaleQL
jolessaQL
vcf vaginal contraceptivegel levonorgestrel and ethinyl estradiolQL
levonorgestrel/ethinyl estradiol levora 0.15/30-28 medroxyprogesterone acetateQL
NuvaringQL
microgestin FE 1.5/30 Depo-subq Provera 104QL
microgestin 1.5/30 microgestin 1/20 Fc Female Condom Fc2 Female Condom Omniflex Diaphragm Options Gynol II Vaginal Contraceptive Ortho Diaphragm All-flex/65MM next choice one dose Ortho Diaphragm All-flex/70MM Ortho Diaphragm All-flex/75MM Ortho Diaphragm All-flex/80MM Ortho Diaphragm Coil Spring Kit 100 norethindrone & ethinyl estradiol ferrous fumarate Ortho Diaphragm Coil Spring Kit 105 norethindrone acetate/ethinyl estradiol Ortho Diaphragm Coil Spring Kit 50 norethindrone acetate/ethinyl estradiol/ferrous fumarate Ortho Diaphragm Flat Spring Kit 55 norgestimate/ethinyl estradiol Ortho Diaphragm Flat Spring Kit 60 Ortho Diaphragm Flat Spring Kit 65 nortrel 0.5/35 (28) Ortho Diaphragm Flat Spring Kit 70 Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; Ortho Diaphragm Flat Spring Kit 75 Ortho Diaphragm Flat Spring Kit 80 Ortho Diaphragm Flat Spring Kit 85 Ortho Diaphragm Flat Spring Kit 90 Ortho Diaphragm Flat Spring Kit 95 Gnp Daily Prenatal Prentif Cavity-rim Cervical CAP Prentif Fitting Set Goodsense Prenatal Vitamins HM One Daily Prenatal Combo Vcf Vaginal Contraceptive Film Vcf Vaginal Contraceptive Foam Kp Prenatal Multivitamins Wide-seal Silicone Diaphragm Kit 60 Mission Prenatal Wide-seal Silicone Diaphragm Kit 65 Nat-rul Prenatal Vitamins Wide-seal Silicone Diaphragm Kit 70 One-a-day Womens Prenatal Wide-seal Silicone Diaphragm Kit 75 Prenatal Complete Wide-seal Silicone Diaphragm Kit 80 Prenatal Multi +dha Wide-seal Silicone Diaphragm Kit 85 Prenatal One Daily Wide-seal Silicone Diaphragm Kit 90 Prenatal Vitamin Wide-seal Silicone Diaphragm Kit 95 PA Prenatal Formula Ra Prenatal Formula/Folicacid Right Step Prenatal Sm One Daily Prenatal Th Prenatal Vitamins LOW COST GENERIC Prenatal Low Iron Afluria PF 2012-2013 Afluria PF 2013-2014 Afluria PF 2014-2015 FOLIC ACID
Afluria PF 2015-2016 Afluria 2012-2013 Afluria 2013-2014 Afluria 2014-2015 Afluria 2015-2016 sm prenatal vitamins Diphtheria/Tetanus Toxoids Adsorbed Pediatric Fluarix Quadrivalent 2013-2014 Classic Prenatal Fluarix Quadrivalent 2014-2015 Fluarix Quadrivalent 2015-2016 Eql Prenatal Formula Fluarix 2013-2014 Gnp Prenatal Vitamins Fluarix 2014-2015 Flublok 2013-2014 Mission Prenatal HP Flublok 2014-2015 Flublok 2015-2016 Flucelvax 2013-2014 Pre-natal Formula Flucelvax 2014-2015 Flucelvax 2015-2016 Prenatal And Iron Flulaval Quadrivalent 2013-2014 Prenatal Formula Flulaval Quadrivalent 2014-2015 Flulaval Quadrivalent 2015-2016 Prenatal Vitamins Flulaval 2013-2014 Px Prenatal Multivitamins Flulaval 2014-2015 Flumist Quadrivalent Sm Prenatal Vitamins Fluvirin PF 2013-2014 Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; Fluvirin PF 2014-2015 Fluvirin 2013-2014 Fluvirin 2014-2015 Fluvirin 2015-2016 Fluzone High-dose PF 2013-2014 Fluzone High-dose PF 2014-2015 Fluzone High-dose PF 2015-2016 Fluzone Intradermal ferrous fumarate 324 Fluzone Intradermal Quadrivalent ferrous gluconate Fluzone Intradermal Quadrivalent 2015-2016 Fluzone Pediatric PF 2013-2014 Fluzone PF 2013-2014 Fluzone PF 2014-2015 Fluzone Quadrivalent 2013-2014 gnp slow release iron Fluzone Quadrivalent 2014-2015 high potency iron Fluzone Quadrivalent 2015-2016 Fluzone Split 2013-2014 Fluzone Split 2014-2015 iron slow release Fluzone Split 2015-2016 iron supplement childrens kp ferrous gluconate kp ferrous sulfate meijer ferrous sulfate Ipol Inactivated IPV Medical Provider EZ Flu Shot PF 2013-2014 qc ferrous sulfate Medical Provider EZ Flu Shot PF 2014-2015 ra high potency iron Medical Provider EZ Flu Shot 2013-2014 Medical Provider EZ Flu Shot 2014-2015 ra slow release iron Medical Provider EZ Flu Shot 2015-2016 slow release iron Menomune-a/C/Y/W-135 slow-release iron sm iron slow release th slow release iron Physicians EZ Use Flu Kit 2012-2013 Pneumovax 23/1 Dose Pneumovax 23/5 Dose HM iron slow release CVS Slow Release Iron Tetanus/Diphtheria Toxoids-adsorbed Tetanus/Diphtheria Toxoids-adsorbed Adult Ferrous Fumarate Ferrous Gluconate High Potency Iron Iron Chews Pediatric bprotected pedia iron eq slow-release iron eql iron supplement therapy Novaferrum Pediatric Drops eql slow release iron Slow Release Iron Sm Slow Release Iron Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; buprobanQL
bupropion HCL SRQL
eq nicotineQL
eq nicotine gum refillQL
d-1000 extra strength eq nicotine gum starterQL
d-2000 maximum strength eq nicotine polacrilexQL
eq nicotine step 3QL
eql nicotineQL
eql nicotine polacrilexQL
d-5000 maximum strength eql nicotine polacrilex refillQL
eql nicotine polacrilex starterQL
gnp nicotine mini lozengeQL
dialyvite vitamin d 5000 gnp nicotine polacrilexQL
d2000 ultra strength gnp nicotine polacrilex miniQL
kls quit2QL
kls quit4QL
nicotineQL
nicotine polacrilexQL
d3 maximum strength nicotine polacrilex refillQL
d3 super strength nicotine polacrilex starter kitQL
d3 ultra strength nicotine step 1QL
nicotine step 2QL
nicotine step 3QL
eql childrens vitamin d gummies nicotine transdermal systemQL
px stop smoking aidQL
qc nicotine polacrilexQL
ra mini nicotineQL
gnp vitamin d maximum strength ra nicotineQL
gnp vitamin d super strength ra nicotine polacrilexQL
gnp vitamin d3 extra strength ra nicotine transdermal system step 3QL
healthy kids vitamin d3 sm nicotineQL
sm nicotine polacrilexQL
sm nicotine transdermal systemQL
sw nicotine polacrilexQL
nat-rul vitamin d tgt nicotine gumQL
tgt nicotine polacrilexQL
tgt nicotine step oneQL
opurity vitamin d tgt nicotine step threeQL
pronutrients vitamin d3 tgt nicotine step twoQL
thriveQL
CVS nicotineQL
CVS nicotine polacrilexQL
CVS nicotine polacrilex starterQL
thera-d rapid repletion CVS nicotine transdermal systemQL
CVS nts step 1QL
HM nicotine polacrilexQL
vitajoy daily d gummies HM nicotine transdermal systemQL
HM nicotine transdermal system step 3QL
vitamin d high potency SR nicotine gumQL
ChantixQL
vitamin d-1000 maximum strength Chantix Continuing Month PAKQL
Chantix Starting Month PAKQL
Nicotine Transdermal SystemQL
vitamin d3 adult gummies Nicotrol InhalerQL
vitamin d3 high potency Nicotrol NsQL
vitamin d3 maximum strength vitamin d3 super strength VITAMIN D
CVS childrens vitamin d for bone health aqueous vitamin d infants CVS vitamin d infants bio-d-mulsion forte CVS vitamin d 5000 high-potency bprotected pedia d-vite Effective January 1, 2016 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; PA vitamin d-3 gummy Dialyvite Vitamin D3 Max Replesta Childrens Sm Vitamin D3 Maximum Strength Vitamelts Vitamin D Wellesse Vitamin D3 BOWEL PREPARATION AGENTS
gavilyte-n/flavor pack peg 3350/electrolytes peg-3350/electrolytes peg-3350/NACL/NA bicarbonate/KCL BREAST CANCER
tamoxifen citrate Effective January 1, 2016 v.1 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; A
Afluria PF 2013-2014, 26, 44 Afluria PF 2014-2015, 26, 44 adult aspirin EC low strength, 23, 42 Afluria PF 2015-2016, 26, 44 Adult Aspirin Low Strength, 23, 42 Agamatrix Ultra-thin Lancets 33G, 29 abacavir sulfate/lamivudine/zidovudine, 2 Advocate Insulin Pen Needles Advocate Insulin Pen Needles Abilify Discmelt, 19 Abilify Maintena, 19 Advocate Insulin Pen Needles akorn balanced salt solution, 22 acamprosate calcium DR, 20 Advocate Insulin Syringe/U- Accu-chek Fastclix Lancetdevice Kit, 32 Advocate Insulin Syringe/U- Accu-chek Fastclix Lancets, 29 Accu-chek Multiclix Lanc Et Device Kit, Advocate Insulin Syringe/U- Accu-chek Multiclix Lancets, 29 Advocate Insulin Syringe/U- albumin human, 17 Accu-chek Safe-t-pro Lancets, 29 Accu-chek Safe-t-pro Pluslancets, 29 Advocate Insulin Syringe/U- albuminar-25, 17 Accu-chek Soft Touch Lancets, 29 Accu-chek Softclix Lancetdevice, 32 Advocate Insulin Syringe/U- Accu-chek Softclix Lancetdevice Kit, 32 Accu-chek Softclix Lancets, 29 Advocate Insulin Syringe/U- albuterol sulfate, 25 acebutolol HCL, 6 100/1ML/29GX1/2", 32 albuterol sulfate ER, 25 Advocate Insulin Syringe/U- albuterol TAB 4MG, 25 alclometasone dipropionate, 9 acetaminophen/codeine, 23 Advocate Insulin Syringe/U- Alcoh-glove Contoured Wipe, 39 acetaminophen/codeine #2, 23 Alcoh-wipe 12" X 12", 39 acetaminophen/codeine #3, 23 Advocate Lancets, 29 Alcohol Pads, 39 acetaminophen/codeine #4, 23 Advocate Lancets 30G, 29 Alcohol Prep Pads, 39 acetaminophen/codeine phosphate, 23 Advocate Lancing Device, 32 Alcohol Preps, 39 Advocate Rapid-safe Lancing Device, 32 Alcohol Swabs, 39 acetazolamide, 7 Advocate Safety Lancets, 29 Alcohol Wipes, 39 Acetazolamide, 7 Advocate Safety Lancets 26G, 29 acetazolamide ER, 7 Aerochamber Mini Aerosol Chamber, 39 acetazolamide sodium, 7 Aerochamber MV, 39 alendronate sodium, 12 Aerochamber Plus Flow VU, 39 Alendronate Sodium, 12 Aerochamber Plus Flow-VU, 39 acetic acid 0.25%, 15 Aerochamber Plus Flow-VU/Large Mask, Alferon N, 5 acetylcysteine, 25, 40 alfuzosin HCL ER, 15 Aciphex Sprinkle, 14 Aerochamber Plus Flow-VU/Mask, 39 Aerochamber Plus Flow-VU/Medium Acti-lance Lancets 28G, 29 Aerochamber Plus Flow-VU/Small Mask, Alkeran, 3 Acti-lance Lite Safety Lancets 28G, 29 Acti-lance Special Safety Lancets 17G, Aerochamber Z-stat Plus Valved Holding almotriptan malate, 24 Chamber W/Flow VU, 39 Acti-lance Special Safetylancets 17G, 29 Aerochamber Z-stat Plus/Flowsignal, 39 Acti-lance Universal Safety Lancets 23G, Aerochamber Z-stat Plus/Large Mask, 39 alosetron hydrochloride, 14 Aerochamber Z-stat Plus/Medium Mask, Aerochamber Z-stat Plus/Small Mask, 39 Alphanate/Von Willebrand Factor Actoplus Met XR, 12 Complex/Human, 17 Aerovent Plus Holding Alphanine SD, 17 Chamber/Collapsible, 39 acyclovir sodium, 2 AF Lancets Super Thin, 29 alprazolam ER, 18 alprazolam odt, 18 Afinitor Disperz, 5 alprazolam XR, 18 Afluria 2012-2013, 26, 44 adefovir dipivoxil, 2 Afluria 2013-2014, 26, 44 Afluria 2014-2015, 26, 44 adenosine, 6, 40 Afluria 2015-2016, 26, 44 Adjustable Lancing Device, 32 Afluria PF 2012-2013, 26, 44 Assure ID Insulin Safety Syringe/U- altavera, 10, 42 100/0.5ML/29G X 1/2", 32 Alternate Site Lancing Device, 32 Aqua Lance Adjustable Lancing Device, Assure ID Insulin Safety Syringe/U- alyacen 1/35, 10, 42 100/1ML/29G X 1/2", 32 alyacen 7/7/7, 10, 42 aqueous vitamin d infants, 27, 46 Assure Lance Lancets, 29 amantadine HCL, 20 Assure Lance Lancets 21G, 29 Assure Lance Plus Safety Lancets 25G, Aranesp Albumin Free, 17 Assure Lance Plus Safety Lancets 30G, amethia LO, 10, 42 amethyst, 10, 42 Arcapta Neohaler, 25 Assure Lancets, 29 AT Last Lancets, 29 amikacin sulfate, 1 Atabex Prenatal, 28, 44 amiloride HCL, 7 argyle sterile saline 100ML, 15 amiloride/hydrochlorothiazide, 7 argyle sterile water 100ML, 40 aminoacetic acid, 15 Arial Chamber, 39 aminocaproic acid, 17 atorvastatin calcium, 7 aminophylline, 25 Armour Thyroid, 13 aminosyn 8.5%/electrolytes, 40 atovaquone/proguanil HCL, 3 aminosyn II 8.5%/electrolytes, 40 atracurium besylate, 21 amiodarone HCL, 6 ascomp/codeine, 23 ascorbic acid, 27 atropine sulfate, 14, 22 amitriptyline HCL, 18 atropine-care, 22 amlodipine besylate, 6 Atrovent HFA, 25 amlodipine besylate/atorvastatin calcium, Asmanex Twisthaler 120 Metered Doses, Aubagio, 20 amlodipine besylate/benazepril HCL, 7 Asmanex Twisthaler 14 Metered Doses, augmented betamethasone dipropionate, amlodipine besylate/benazepril hydrochloride, 7 Asmanex Twisthaler 30 Metered Doses, amlodipine besylate/valsartan, 7 amlodipine/valsartan/hctz, 7 Asmanex Twisthaler 60 Metered Doses, Aurora Lancet Super Thin 30G, 29 ammonium lactate, 9 Aurora Lancet Thin 23G, 29 Asmanex Twisthaler 7 Metered Doses, Aurora Pen Needles 29GX12MM, 32 Aurora Pen Needles 31G X 6MM, 32 Aurora Pen Needles 31G X 8MM, 32 amoxicillin/clavulanate potassium, 1 aspir-low, 23, 42 Aurora Unifine Pentips/32GX5/32", 32 amoxicillin/clavulanate potassium ER, 1 Aurora Unifine Pentips/Mini/31GX3/16", amphetamine/dextroamphetamine, 19 aspirin 81, 23, 42 aspirin 81 low dose, 23, 42 Amphotericin B, 2 aspirin adult low dose, 23, 42 Auto-lancet Mini, 32 aspirin adult low strength, 23, 42 Autolet II Clinisafe, 33 ampicillin sodium, 1 aspirin childrens, 23, 42 Autolet Impression, 32 ampicillin-sulbactam, 1 aspirin EC, 23, 42 Autolet Impression Lancing Device, 33 aspirin EC LO-dose, 23, 42 Autolet Lite Clinisafe, 33 aspirin EC low dose, 23, 42 Autolet Lite Starter Pack, 33 aspirin enteric coated adult low strength, Autolet Mini, 33 Autolet Platforms, 33 anagrelide hydrochloride, 17 aspirin low dose, 23, 42 Aspirin Low Dose, 23, 42 aspirin low strength, 23, 42 Androgel P.M., 10 avar cleanser, 8 Aspirin/Dipyridamole, 17 avar-e emollient, 8 Anti-stick Insulin Syringe/U- Assure Comfort Lancets Ultra Thin 28G, 100/0.5ML/28G X 1/2", 32 Anti-stick Insulin Syringe/U- Assure Comfort Lancets Ultra Thin 30G, 100/0.5ML/29G X 1/2", 32 Anti-stick Insulin Syringe/U-100/1ML/29G Assure Haemolance Plus High Flow 18G, avidoxy, 1 antipyrine/benzocaine, 22 Assure Haemolance Plus Low Flow 25G, Avonex, 20 Assure Haemolance Plus Micro Flow Apidra Solostar, 12 Assure Haemolance Plus Normal Flow Azactam IN Iso-osmotic Dextrose, 3 Assure Haemolance Plus Pediatric Blade, azathioprine, 4 apraclonidine, 22 azelastine HCL, 22, 25 BD Insulin Syringe Ultrafine Half- BD Pen Needle/Mini/Ultrafine/31G X unit/0.3ML/31G X 5/16", 29 BD Insulin Syringe Ultrafine BD Pen Needle/Nano/Ultra Fine/32G X II/SHORT/0.5ML/31G X 5/16", 29 BD Insulin Syringe Ultrafine BD Pen Needle/SHORT/Ultrafine/31G X II/SHORT/1ML/31G X 5/16", 29 BD Insulin Syringe Ultrafine/0.3ML/30G X BD Pen Needle/Ultrafine/29G X 12.7MM, azurette, 10, 42 BD Insulin Syringe Ultrafine/0.3ML/31G X BD Pen Needle/Ultrafine/29GX1/2" B
BD Insulin Syringe Ultrafine/0.5ML/30G X BD Pen Needles SHORT/Ultrafine/31G X b-complex 100, 27 BD Insulin Syringe Ultrafine/0.5ML/31G X BD posiflush, 41 BD Safety-glide Insulin BD Insulin Syringe Ultrafine/1ML/30G X Syringe/0.5ML/29G X 1/2", 33 BD Safety-lok Insulin Syringe/Perm BD Insulin Syringe Ultrafine/1ML/31G X Needle/UF/1ML/29G X 1/2", 29 bacitracin/polymyxin b, 21 BD Safetyglide Insulin BD Insulin Syringe Ultrafine/U- Sysyringe/0.5ML/30G X 5/16", 29 Bactocill IN Dextrose, 1 100/0.3ML/29G X 1/2", 29 BD Swabs Single Use, 39 Bactroban Nasal, 25 BD Insulin Syringe Ultrafine/U- BD Swabs Single Use Butterfly, 39 balanced salt, 22 100/0.3ML/30G X 1/2", 29 BD-insul SYR Mis LO Dose, 29 balanced salt solution, 22 BD Insulin Syringe Ultrafine/U- balsalazide disodium, 14 100/0.3ML/31G X 15/64", 29 benazepril HCL, 6 BD Insulin Syringe Ultrafine/U- benazepril HCL/hydrochlorothiazide, 7 100/0.3ML/31G X 5/16", 29 BD Insulin Syringe Ultrafine/U- 100/0.5ML/29G X 1/2", 29 bayer advanced aspirin regular strength, BD Insulin Syringe Ultrafine/U- 100/0.5ML/30G X 1/2", 29 bayer aspirin, 23, 42 BD Insulin Syringe Ultrafine/U- benzepro creamy wash, 8 bayer aspirin EC low dose, 23, 42 100/0.5ML/31G X 15/64", 29 benzepro foaming cloths, 8 bayer aspirin regimen, 23, 42 BD Insulin Syringe Ultrafine/U- benzepro SHORT contact, 8 bayer chewable low dose, 23, 42 100/0.5ML/31G X 5/16", 29 bayer low dose, 23, 42 BD Insulin Syringe Ultrafine/U- Bayer Microlet 2 Lancing Device, 33 100/1ML/29G X 1/2", 29 benzoyl peroxide, 8 Bayer Microlet Lancets, 29 BD Insulin Syringe Ultrafine/U- benzoyl peroxide SHORT contact, 8 100/1ML/30G X 1/2", 29 benztropine mesylate, 20 BD Autoshield 29G X 3/16", 29 BD Insulin Syringe Ultrafine/U- BD Autoshield 29G X 5/16", 29 100/1ML/31G X 15/64", 29 BD Autoshield Duo 30G X 3/16", 29 BD Insulin Syringe Ultrafine/U- BD Insulin Syringe LUER-LOK/U- 100/1ML/31G X 5/16", 29 betamethasone dipropionate, 9 BD Insulin Syringe/Detachable Needle/U- betamethasone sodium BD Insulin Syringe Microfine IV/U- 100/1ML/25G X 1", 29 phosphate/betamethasone acetate, 10 100/0.3ML/28G X 1/2", 29 BD Insulin Syringe/Detachable Needle/U- betamethasone valerate, 9 BD Insulin Syringe Microfine IV/U- 100/1ML/25G X 5/8", 29 100/0.5ML/28G X 1/2", 29 BD Insulin Syringe/Detachable Needle/U- betaxolol HCL, 6, 21 BD Insulin Syringe Microfine IV/U- 100/1ML/26G X 1/2", 29 bethanechol chloride, 15 100/1ML/27G X 5/8", 29 BD Insulin Syringe/U-100/0.5ML/30G X BD Insulin Syringe Microfine IV/U- 100/1ML/28G X 1/2", 29 BD Insulin Syringe/U-100/1ML/27G X BD Insulin Syringe Microfine/U- 100/0.3ML/28G X 1/2", 29 BD Insulin Syringe/U-100/1ML/28G X Bexxar 131 Iodine, 5 BD Insulin Syringe Microfine/U- 100/0.5ML/28G X 1/2", 29 BD Insulin Syringe/U-100/2ML/27.5G X BD Insulin Syringe Microfine/U- 100/1ML/27G X 5/8", 29 BD Insulin Syringe/U-100/2ML/29G X BD Insulin Syringe Microfine/U- 100/1ML/28G X 1/2", 29 BD Integra Insulin Syringe/U- BD Insulin Syringe 100/1ML/29G X 1/2", 29 Safetyglide/0.5ML/29G X 1/2", 29 BD Integra Syringe/Retracting BD Insulin Syringe Safetyglide/1ML/29G Needle/1ML/25G X 1", 29 bio-d-mulsion, 27, 46 BD Lancet Device, 33 bio-d-mulsion forte, 27, 46 BD Insulin Syringe Safetyglide/U- BD Lancet Ultrafine 30G, 29 100/0.3ML/31G X 5/16", 29 BD Lancet Ultrafine 33G, 29 BD Insulin Syringe Slip Tip/U-100/1ML, BD LO-dose Insulin Syringe Microfine IV/0.5ML/28G X 1/2", 29 BD Insulin Syringe U-40/1ML/25G X 5/8", BD Microtainer Lancets, 29 biotuss pediatric, 25 Careone Advanced Lancing Device, 33 bisoprolol fumarate, 6 Careone Insulin Syringes/0.3ML/30G X bisoprolol fumarate/hydrochlorothiazide, Careone Insulin Syringes/0.3ML/31G X Careone Insulin Syringes/0.5ML/30G X bleomycin sulfate, 3 butorphanol tartrate, 23 Careone Insulin Syringes/0.5ML/31G X Boostrix, 26, 44 Careone Insulin Syringes/1ML/30G X C
bp foaming wash, 8 Careone Lancet Thin, 29 Bp Folinatal Plus B, 28 Careone Lancet Ultra Thin, 29 Bp Multinatal Plus, 28 Careone Unifine Pentips 29GX12MM, 33 caffeine citrate, 19 Careone Unifine Pentips 31GX5MM, 33 Careone Unifine Pentips 31GX6MM, 33 Careone Unifine Pentips 31GX8MM, 33 Careone Unifine Pentips Pen Needles calcitonin salmon, 13 bpo 6% foaming cloths, 8 calcitonin-salmon, 13 bprotected pedia d-vite, 27, 46 Careone Unifine Pentips Plus Pen bprotected pedia iron, 16, 45 Needles 29GX12MM, 33 Brainstrong Prenatal, 28 Careone Unifine Pentips Plus Pen Needles 31GX5MM, 33 calcium acetate, 14 Breatherite Collapsible Adult Spacer Careone Unifine Pentips Plus Pen calcium chloride, 40 Needles 31GX6MM, 33 calcium gluconate, 40 Breatherite Collapsible Child Spacer Careone Unifine Pentips Plus Pen Needles 31GX8MM, 33 Breatherite Collapsible Infant Spacer Careone Unifine Pentips Plus Pen Needles 32GX4MM, 33 camrese LO, 10, 42 Breatherite Collapsible Small Child Carimune Nanofiltered, 41 Spacer W/Mask, 39 Carisoprodol, 21 Breatherite Collapsible Spacer W/ carisoprodol, 21 candesartan cilexetil, 6 Neonate Mask, 39 carisoprodol/aspirin, 21 candesartan cilexetil/hydrochlorothiazide, Breatherite Rigid Spacer W/Mask, 39 Breatherite W/Large Mask, 39 carteolol HCL, 21 Breatherite W/Medium Mask, 39 Breatherite W/Small Mask, 39 Capastat Sulfate, 2 briellyn, 10, 42 Cavan-EC Sod DHA, 28 brimonidine tartrate, 22 bromocriptine mesylate, 20 CARB-o-philic 40, 10 CARB-o-philic/40, 10 HCL/dextromethorphan HBR, 25 carbamazepine, 19 cefazolin sodium, 1 carbamazepine ER, 19 budeprion SR, 18 budesonide, 10, 25(2) Cefditoren Pivoxil, 1 carbidopa/levodopa, 20 Bullseye Mini Safety Lancets, 29 carbidopa/levodopa ER, 20 Bullseye Safety Lancets, 29 carbidopa/levodopa odt, 20 cefotaxime sodium, 1 carbinoxamine maleate, 25 Cefotetan/Dextrose, 1 bupivacaine HCL, 25 cefoxitin sodium, 1 bupivacaine spinal, 25 cefpodoxime proxetil, 1 Cardiocom Lancing Device, 33 bupivacaine/epinephrine, 25 buprenorphine HCL, 23 buprenorphine HCL/naloxone HCL, 23 buproban, 20, 46 ceftriaxone sodium, 1 Carefine Pen Needle 32GX4MM, 33 bupropion HCL, 18 cefuroxime axetil, 1 Carefine Pen Needles 29GX1/2", 33 bupropion HCL ER, 18 cefuroxime sodium, 1 Carefine Pen Needles 30GX5/16", 33 bupropion HCL SR, 18, 20, 46 Carefine Pen Needles 31GX6MM, 33 bupropion HCL XL, 18 Cellcept Intravenous, 4 Carefine Pen Needles 31GX8MM, 33 buspirone HCL, 18 Carefine Pen Needles 32GX5MM, 33 Carefine Pen Needles 32GX6MM, 33 citric acid/sodium citrate, 16 Clever Choice Comfort EZ Pen Needles Centrum Specialist Prenatal, 28 Clickfine Pen Needle 32GX5/32", 33 Clickfine Pen Needle Universal/31GX1/4", Clickfine Pen Needle claris clarifying wash, 8 clarithromycin, 1 Clickfine Pen Needles/31GX1/4", 33 Cervarix, 26, 44 clarithromycin ER, 1 Clickfine Pen Needles/31GX5/16", 33 Classic Prenatal, 28, 44 Clickfine Universal Pen Needles Cleanlet Lancets 28G, 29 31GX1/4", 33 cetirizine HCL, 25 Clickfine Universal Pen Needles cevimeline HCL, 18 clemastine fumarate, 25 31GX5/16", 33 Clemastine Fumarate, 25 clindacin etz pledgets, 8 Chantix Continuing Month PAK, 20, 46 Clever Chek Lancets Ultrathin, 29 Chantix Starting Month PAK, 20, 46 Clever Chek Lancets Ultrathin 30G, 29 Clever Choice Comfort EZ Insulin Pen clindamycin HCL, 3 Chek-stix Combo PAK Urinalysis Control, Needles 31GX8MM, 33 clindamycin palmitate HCL, 3 Clever Choice Comfort EZ Insulin clindamycin phosphate, 3, 8, 15 Chek-stix Control, 41 Syringe/0.3ML/29G X 1/2", 33 clindamycin phosphate add-vantage, 3 Clever Choice Comfort EZ Insulin clindamycin phosphate IN D5W, 3 Chemstrip Bg Log Book, 33 Syringe/0.3ML/30G X 1/2", 33 clindamycin phosphate pharmacy bulk Clever Choice Comfort EZ Insulin Syringe/0.3ML/30G X 5/16", 33 clindamycin/benzoyl peroxide, 8 childrens aspirin, 23, 42 Clever Choice Comfort EZ Insulin clinisol SF 15%, 40 childrens aspirin low strength, 23, 42 Syringe/0.3ML/31G X 5/16", 33 clinpro 5000, 18 chlordiazepoxide HCL, 18 Clever Choice Comfort EZ Insulin clobetasol propionate, 9 chlorhexidine gluconate, 18 Syringe/0.5ML/28G X 1/2", 33 clobetasol propionate e, 9 chlorhexidine gluconate oral rinse, 18 Clever Choice Comfort EZ Insulin clobetasol propionate emollient, 9 Syringe/0.5ML/29G X 1/2", 33 chloroprocaine HCL, 25 Clever Choice Comfort EZ Insulin chloroquine phosphate, 3 Syringe/0.5ML/30G X 1/2", 33 clomiphene citrate, 13 chlorothiazide, 7 Clever Choice Comfort EZ Insulin clomipramine HCL, 18 Chlorothiazide, 7 Syringe/0.5ML/30G X 5/16", 33 chlorothiazide sodium, 7 Clever Choice Comfort EZ Insulin clonazepam odt, 19 chlorpromazine HCL, 18 Syringe/0.5ML/31G X 5/16", 33 clonidine HCL, 6, 23 Chlorpropamide, 12 Clever Choice Comfort EZ Insulin clonidine HCL ER, 19 Chlorthalidone, 7 Syringe/1.0ML/30G X 1/2", 33 chlorzoxazone, 21 Clever Choice Comfort EZ Insulin clorazepate dipotassium, 18 Syringe/1ML/28G X 1/2", 33 cholestyramine, 7 Clever Choice Comfort EZ Insulin clotrimazole, 8, 18 cholestyramine light, 7 Syringe/1ML/29G X 1/2", 33 clotrimazole/betamethasone dipropionate, choline magnesium trisalicylate, 23 Clever Choice Comfort EZ Insulin chorionic gonadotropin, 13 Syringe/1ML/30G X 5/16", 33 Clever Choice Comfort EZ Insulin Clozapine Odt, 19 Cnl8 Nail Kit, 8 Clever Choice Comfort EZ Pen Needles ciclopirox nail lacquer, 8 Coaguchek Lancets, 29 ciclopirox olamine, 8 Clever Choice Comfort EZ Pen Needles ciclopirox treatment, 8 coated aspirin, 23, 42 Clever Choice Comfort EZ Pen Needles codeine sulfate, 23 Clever Choice Comfort EZ Pen Needles colestipol HCL, 7 cimetidine HCL, 14 Clever Choice Comfort EZ Pen Needles colestipol HCL for oral suspension, 7 colistimethate sodium, 3 Cimzia Starter Kit, 15 Clever Choice Comfort EZ Pen Needles Coly-mycin S, 22 Clever Choice Comfort EZ Pen Needles ciprofloxacin, 1 ciprofloxacin ER, 1 Clever Choice Comfort EZ Pen Needles Combivent Respimat, 25 Ciprofloxacin HCL, 1 ciprofloxacin HCL, 1, 21 Clever Choice Comfort EZ Pen Needles Comfort Assist Insulin Syringe 0.3ML/29G ciprofloxacin I.V.-IN D5W, 1 cisatracurium besylate, 21 Clever Choice Comfort EZ Pen Needles Comfort Assist Insulin Syringe/0.3ML/30G Clever Choice Comfort EZ Pen Needles Comfort Assist Insulin Syringe/0.3ML/31G citalopram hydrobromide, 18 Comfort Assist Insulin Syringe/0.5ML/29G CVS Insulin Syringe/0.3ML/29G X 1/2", d2000 ultra strength, 27, 46 Comfort Assist Insulin Syringe/0.5ML/30G CVS Insulin Syringe/0.3ML/30G X 1/2", d3 adult, 27, 46 d3 adult gummy, 27, 46 Comfort Assist Insulin Syringe/0.5ML/31G CVS Insulin Syringe/0.5ML/29G X 1/2", d3 high potency, 27, 46 Comfort Assist Insulin Syringe/1ML/29G CVS Insulin Syringe/0.5ML/30G X 1/2", d3 maximum strength, 27, 46 Comfort Assist Insulin Syringe/1ML/30G CVS Insulin Syringe/1ML/29G X 1/2", 33 d3 super strength, 27, 46 d3 ultra strength, 27, 46 Comfort Assist Insulin Syringe/1ML/31G CVS Lancets 21G, 29 CVS Lancets Micro Thin 33G, 29 Comfort Assured Lancets Micro Thin CVS Lancets Original, 29 CVS Lancets Thin 26G, 29 Comfort Assured Lancets Super Thin CVS Lancets Ultra Thin 30G, 29 CVS Lancing Device, 33 Comfort Lancets, 29 CVS nicotine, 20, 46 dantrolene sodium, 21 CVS nicotine polacrilex, 20, 46 Dantrolene Sodium, 21 CVS nicotine polacrilex starter, 20, 46 Complete Natal DHA, 28 CVS nicotine transdermal system, 20, 46 Daptacel, 26, 44 Completenate, 28 CVS nts step 1, 20, 46 CVS Prenatal, 28, 44 dasetta 1/35, 11, 42 CVS Prenatal Gummy/DHA/Folic Acid, dasetta 7/7/7, 11, 42 daunorubicin HCL, 3 CVS Prep Pads, 39 CVS Slow Release Iron, 16, 45 CVS Ultra Thin Lancets, 29 CVS vitamin d, 27, 46 CVS vitamin d 5000 high-potency, 27, 46 deblitane, 11, 42 CVS vitamin d infants, 27, 46 CVS vitamin d3, 27, 46 cyanocobalamin, 16 cormax scalp application, 9 cyclafem 1/35, 11, 42 deferoxamine mesylate, 40 cyclafem 7/7/7, 11, 42 dehydrated alcohol, 40 cyclobenzaprine HCL, 21 delflex-LC/1.5% dextrose, 40 Cortisporin-tc, 22 cyclopentolate HCL, 22 delflex-lm/1.5% dextrose, 40 cyclophosphamide, 3 Delflex-lm/2.5% Dextrose, 41 Cyclophosphamide, 3 Delflex-lm/4.25% Dextrose, 41 corvite free, 27 Delflex-sm/1.5% Dextrose, 41 Delflex-sm/2.5% Dextrose, 41 cyclosporine modified, 4 delta d3, 27, 46 cyproheptadine HCL, 25 cromolyn sodium, 14, 22 demeclocycline HCL, 1 Cromolyn Sodium, 25 cryselle-28, 11, 42 denta 5000 plus, 18 Curity Alcohol Preps/Medium 2 Ply, 39 cytarabine aqueous, 4 Depen Titratabs, 41 Curity Alcohol Swabs, 39 curity sterile saline, 15 cytra k crystals, 15 Depo-subq Provera 104, 11, 43 CVS Alcohol Prep Swabs, 39 CVS Alcohol Swabs, 39 D
desipramine HCL, 18 CVS aspirin, 23, 42 desloratadine, 25 CVS aspirin adult low dose, 23, 42 desloratadine odt, 25 CVS aspirin adult low strength, 23, 42 desmopressin acetate, 13 CVS aspirin child, 23, 42 desogestrel/ethinyl estradiol, 11, 42 CVS aspirin EC, 23, 42 CVS aspirin low dose, 23, 42 desoximetasone, 9 CVS aspirin low strength, 23, 42 Desoximetasone, 9 d-1000 extra strength, 27, 46 CVS childrens aspirin, 23, 42 dexamethasone, 10 d-2000 maximum strength, 27, 46 CVS childrens vitamin d for bone health, Dexamethasone, 10 Dexamethasone Intensol, 10 dexamethasone sodium phosphate, 10, CVS enteric aspirin, 23, 42 d-5000 maximum strength, 27, 46 CVS folic acid, 16, 44 Dexamethasone Sodium Phosphate, 10 Dexchlorpheniramine Maleate, 25 difil-G forte, 25 Drug Mart Lancets Ultra Thin, 29 Diflorasone Diacetate, 9 Drug Mart On-the-go Lancets Gentle Drug Mart Ultra Comfort Insulin dexmedetomidine HCL, 19 Syringe/0.3ML/29G X 1/2", 33 dexmethylphenidate HCL, 19 Drug Mart Ultra Comfort Insulin dexmethylphenidate HCL ER, 19 dihydroergotamine mesylate, 24 Syringe/0.3ML/30G X 5/16", 33 Dexpak 10 Day, 10 Dihydroergotamine Mesylate, 24 Drug Mart Ultra Comfort Insulin Dexpak 13 Day, 10 Syringe/0.3ML/31G X 5/16", 33 Dexpak 6 Day, 10 Drug Mart Ultra Comfort Insulin Syringe/0.5ML/30G X 5/16", 33 dextroamphetamine sulfate, 19 Drug Mart Ultra Comfort Insulin dextroamphetamine sulfate ER, 19 Syringe/0.5ML/31G X 5/16", 33 dextrose 10%, 40 Drug Mart Ultra Comfort Insulin dextrose 10% flex container, 40 diltiazem HCL CD, 6 Syringe/1ML/29G X 1/2", 33 dextrose 2.5%/NACL 0.45%, 40 diltiazem HCL ER, 6 Drug Mart Ultra Comfort Insulin dextrose 2.5%/sodium chloride 0.45%, Syringe/1ML/30G X 5/16", 33 Drug Mart Unifine Pentips 31GX5MM, 33 dextrose 30% partial fill, 40 diphenhydramine HCL, 25 Drug Mart Unifine Pentips29G X 12MM, dextrose 5% viaflex, 40 Diphtheria/Tetanus Toxoids Adsorbed Drug Mart Unifine Pentips31GX6MM, 33 dextrose 5%/lactated ringers, 40 Pediatric, 26, 44 Drug Mart Unifine Pentips31GX8MM, 33 dextrose 5%/NACL 0.2%, 40 dipyridamole, 17, 40 Drug Mart Unifine Pentips32GX4MM, 33 dextrose 5%/NACL 0.33%, 40 disopyramide phosphate, 6 Drug Mart Unifine Pentipsplus dextrose 5%/NACL 0.45%, 40 dextrose 5%/NACL 0.9%, 40 divalproex sodium, 19 Drug Mart Unilet Lancets Super Thin dextrose 5%/potassium chloride 0.15%, divalproex sodium DR, 19 divalproex sodium ER, 19 Drug Mart Unilet Lancets Ultra Thin 28G, dextrose 5%/ringers, 40 dobutamine HCL, 7 dextrose 5%/sodium chloride 0.2%, 40 dobutamine HCL/D5W, 7 Duane Reade Lancet Alternate Site 26G, dextrose 5%/sodium chloride 0.33%, 40 dobutamine/dextrose 5%, 7 dextrose 5%/sodium chloride 0.45%, 40 Duane Reade Lancet Super Thin 30G, dextrose 5%/sodium chloride 0.9%, 40 dextrose 50%, 40 Duane Reade Lancet Ultra Thin 28G, 29 dextrose 70%, 40 Duane Reade Unifine Pentips 29G X donepezil HCL, 20 Duane Reade Unifine Pentips 31G X dialyvite vitamin d 5000, 27, 46 6MM Ultra SHORT, 33 Dialyvite Vitamin D3 Max, 27, 47 Duane Reade Unifine Pentips 31G X Diascreen 10, 33 dopamine HCL-dextrose 5%, 7 Diascreen 1b, 33 dopamine HCL/dextrose 5%, 7 Diascreen 1G, 33 duloxetine HCL, 18 Diascreen 1k, 33 Diascreen 2GK, 33 dorzolamide HCL, 22 Diascreen 2GP, 33 dorzolamide HCL/timolol maleate, 21 Diascreen 4nl, 33 Diascreen 4obl, 33 doxazosin mesylate, 6 Diascreen 4PH, 33 E
E-z Ject Lancets, 29 doxercalciferol, 13 E-z Ject Lancets 21G, 30 doxorubicin HCL, 3 E-z Ject Lancets Color, 30 Doxorubicin HCL, 3 E-z Ject Lancets Super Thin, 30 doxorubicin HCL liposome, 3 E-z Ject Lancets Super Thin 30G, 30 Diascreen Liquid Urine Controls, 33 E-z Ject Lancets Thin 26G, 30 Diastar Easy Test II Lancets 30G, 29 Diastar Easy Test Lancets30G, 29 E-z Spacer The Body Guards Pack, 39 doxycycline hyclate, 1 E-ZJECT Lancets Micro-thin 33G, 30 diazepam intensol, 18 doxycycline hyclate DR, 1 diclofenac potassium, 24 doxycycline monohydrate, 1 diclofenac sodium, 8, 9, 22 Easivent/Mask-large, 39 diclofenac sodium DR, 24 Easivent/Mask-medium, 39 diclofenac sodium ER, 24 Droplet Lancets Ultra Thin 30G, 29 Easivent/Mask-small, 39 diclofenac sodium/misoprostol, 24 Droplet Lancing Device, 33 Easy Comfort Insulin Syringe/0.3ML/30G dicloxacillin sodium, 1 drospirenone/ethinyl estradiol, 11, 42 dicyclomine HCL, 14 Easy Comfort Insulin Syringe/0.5ML/30G Drug Mart Adjustable Lancing Device, 33 Drug Mart Lancets Thin, 29 Easy Comfort Insulin Syringe/1ML/30G X Easy Touch Lancets 28G/Pull-top, 30 Elite-thin Insulin Syringe/0.5ML/30G X Easy Comfort Insulin Syringe/U- Easy Touch Lancets 28G/Twist, 30 100/0.5ML/30G X 1/2", 33 Easy Touch Lancets 30G/Button- Elite-thin Insulin Syringe/1ML/29G X Easy Comfort Insulin Syringe/U- 100/1ML/30G X 1/2", 33 Easy Touch Lancets 30G/Pressure Elite-thin Insulin Syringe/1ML/30G X Easy Comfort Lancets, 30 Easy Comfort Lancets 30G/Pull Top, 30 Easy Touch Lancets 30G/Pull-top, 30 Elite-thin Insulin Syringe/U- Easy Comfort Lancets 30G/Thin Top, 30 Easy Touch Lancets 30G/Twist, 30 100/0.5ML/28G X 1/2", 34 Easy Comfort Pen Needles 31GX1/4", 34 Easy Touch Lancets 32G/Pressure Elite-thin Insulin Syringe/U- Easy Comfort Pen Needles 31GX3/16", 100/0.5ML/28G X 5/16", 34 Easy Touch Lancets 32G/Pull-top, 30 Elite-thin Insulin Syringe/U- Easy Comfort Pen Needles 31GX5/16", Easy Touch Lancets 32G/Twist, 30 100/0.5ML/29G X 5/16", 34 Easy Touch Lancets 33G/Twist, 30 Elite-thin Insulin Syringe/U- Easy Comfort Pen Needles 32GX5/32", Easy Touch Lancing Device/Ejector, 34 100/0.5ML/31G X 5/16", 34 Easy Touch Pen Needles 29GX1/2", 34 Elite-thin Insulin Syringe/U-100/1ML/28G Easy Mini Lancing Device, 34 Easy Touch Pen Needles 31GX1/4", 34 Easy Touch 32GX5MM, 34 Easy Touch Pen Needles 31GX5/16", 34 Elite-thin Insulin Syringe/U-100/1ML/28G Easy Touch 32GX6MM, 34 Easy Touch Pen Needles 32GX1/4", 34 Easy Touch Alcohol Prep Pads/Medium, Easy Touch Pen Needles 32GX3/16", 34 Elite-thin Insulin Syringe/U-100/1ML/29G Easy Touch Pen Needles 32GX5/32", 34 Easy Touch Insulin Syringe/0.3ML/30G X Easy Touch Pen Needles/31G X 3/16", Elite-thin Insulin Syringe/U-100/1ML/31G Easy Touch Insulin Syringe/0.3ML/31G X Easy Touch Safety Lancets21G/Pressure Elitek, 5 Elixophyllin, 26 Easy Touch Insulin Syringe/0.5ML/29G X Easy Touch Safety Lancets23G/Pressure Ella, 11 Easy Touch Insulin Syringe/0.5ML/30G X Easy Touch Safety Lancets26G/Button Easy Touch Insulin Syringe/1ML/30G X Easy Touch Safety Lancets26G/Pressure Embeda, 24 Embrace Lancets Ultra Thin 30G, 30 Easy Touch Insulin Syringe/Safety/U- Easy Touch Safety Lancets28G/Button 100/0.5ML/29G X 1/2", 34 Easy Touch Insulin Syringe/Safety/U- Easy Touch Safety Lancets28G/Pressure emoquette, 11, 43 100/0.5ML/30G X 5/16", 34 Easy Touch Insulin Syringe/Safety/U- Easy Twist & CAP Lancets, 30 100/1ML/29G X 1/2", 34 Easy Touch Insulin Syringe/Safety/U- Easytest II Lancets, 30 enalapril maleate, 6 100/1ML/30G X 1/2", 34 Easytest Lancets, 30 enalapril maleate/hydrochlorothiazide, 7 Easy Touch Insulin Syringe/U- EC-81 aspirin, 23, 42 100/0.3ML/30G X 1/2", 34 econazole nitrate, 8 Easy Touch Insulin Syringe/U- econtra EZ, 11, 42 Enbrel Sureclick, 24 100/0.5ML/27G X 1/2", 34 ecotrin low strength, 23, 42 Easy Touch Insulin Syringe/U- 100/0.5ML/28G X 1/2", 34 Easy Touch Insulin Syringe/U- Enfamil Expecta, 28 100/0.5ML/30G X 1/2", 34 Engerix-b, 26, 44 Easy Touch Insulin Syringe/U- 100/0.5ML/31G X 5/16", 34 enoxaparin sodium, 17 Easy Touch Insulin Syringe/U- enpresse-28, 11, 43 100/1ML/27G X 1/2", 34 Easy Touch Insulin Syringe/U- effervescent pot chloride, 40 100/1ML/28G X 1/2", 34 effervescent potassium, 40 Easy Touch Insulin Syringe/U- effervescent potassium/chloride, 40 enteric coated aspirin, 23, 42 100/1ML/29G X 1/2", 34 Easy Touch Insulin Syringe/U- ephedrine sulfate, 7 100/1ML/30G X 1/2", 34 epinastine HCL, 22 Easy Touch Insulin Syringe/U- 100/1ML/31G X 5/16", 34 epinephrine HCL, 25 Easy Touch Lancets 21G/Pressure Epipen-JR 2-PAK, 7 Easy Touch Lancets 23G/Pressure epirubicin HCL, 3 Epirubicin HCL, 3 Easy Touch Lancets 26G/Pressure Elite Iron, 16, 45 Easy Touch Lancets 26G/Pull-top, 30 Elite-thin Insulin Syringe/0.3ML/31G X Easy Touch Lancets 26G/Twist, 30 Easy Touch Lancets 28G/Pressure Elite-thin Insulin Syringe/0.5ML/29G X epoprostenol sodium, 7 Eprosartan Mesylate, 6 EZ Smart Blood Glucose Lancets, 30 EZ-lets Lancets 21G, 30 eq adult aspirin low strength, 23, 42 EZ-lets Lancets 23G, 30 eq aspirin, 23, 42 EZ-lets Lancets 26G Super-soft, 30 eq aspirin adult low dose, 23, 42 Erythrocin Lactobionate, 1 EZ-lets Lancets 28G Ultra-soft, 30 eq aspirin EC, 23, 42 erythromycin, 1, 8, 21 EZ-lets Lancets 30G, 30 eq aspirin low dose, 23, 42 Erythromycin Base, 1 ezfe 200, 16, 45 eq childrens aspirin, 23, 42 erythromycin/benzoyl peroxide, 8 F
eq nicotine, 20, 46 eq nicotine gum refill, 20, 46 eq nicotine gum starter, 20, 46 escitalopram oxalate, 18 eq nicotine polacrilex, 20, 46 eq nicotine step 3, 20, 46 eq slow-release iron, 16, 45 fallback solo, 11, 43 eql adult aspirin low strength, 23, 42 esomeprazole magnesium, 14 eql aspirin, 23, 42 esomeprazole sodium, 14 eql aspirin EC, 23, 42 Esomeprazole Sodium, 14 eql aspirin low dose, 23, 42 Esomeprazole Strontium, 14 eql childrens aspirin, 23, 42 estarylla, 11, 43 eql childrens vitamin d gummies, 27, 46 estazolam, 19 Fanapt Titration Pack, 19 Eql Color Lancets 21G, 30 Eql Color Lancets Micro Thin 33G, 30 eql folic acid, 16, 44 estradiol valerate, 10 Eql Insulin Syringe/0.3ML/29G X 1/2", 34 estradiol/norethindrone acetate, 10 Fasttake Compact Monitoring System, Eql Insulin Syringe/0.3ML/30G X 5/16", Fasttake Test Strips, 30 Eql Insulin Syringe/0.3ML/31G X 5/16", Ethacrynate Sodium, 7 ethambutol HCL, 2 Fc Female Condom, 43 Eql Insulin Syringe/0.5ML/29G X 1/2", 34 ethosuximide, 19 Fc2 Female Condom, 43 Eql Insulin Syringe/0.5ML/30G X 5/16", Etidronate Disodium, 12 FE Aspartate, 17, 45 Eql Insulin Syringe/0.5ML/31G X 5/16", etodolac ER, 24 FE gluconate, 16, 45 Eql Insulin Syringe/1ML/29G X 1/2", 34 etoposide, 4 Eql Insulin Syringe/1ML/30G X 5/16", 34 Etoposide, 4 Eql Insulin Syringe/1ML/31G X 5/16", 34 Eurax, 10 Eql Insulin Syringe/U-100/0.3ML/29G X Evamist, 10 felodipine ER, 6 Eql Insulin Syringe/U-100/0.5ML/29G X Exalgo, 24 Excel Comfort Point Insulin Pen Needles Eql Insulin Syringe/U-100/1ML/29G X Exel Comfort Point Insulin Pen Needles fenofibrate micronized, 7 eql iron supplement therapy, 16, 45 Fenofibric Acid, 7 eql nicotine, 20, 46 Exel Comfort Point Insulin Pen Needles fenofibric acid DR, 7 eql nicotine polacrilex, 20, 46 eql nicotine polacrilex refill, 20, 46 Exel Comfort Point Insulin Pen Needles fenoldopam mesylate, 6 eql nicotine polacrilex starter, 20, 46 Fenoprofen Calcium, 24 Eql Prenatal Formula, 28, 44 Exel Comfort Point Insulin Eql SHORT Pen Needles 31G X 8MM, Syringe/0.3ML/29G X 1/2", 34 Exel Comfort Point Insulin fentanyl citrate oral transmucosal, 23 eql slow release iron, 16, 45 Syringe/0.3ML/30G X 5/16", 34 Eql Super Thin Lancets 30G, 30 Exel Comfort Point Insulin Eql Thin Lancets 26G, 30 Syringe/0.5ML/28G X 1/2", 34 fer-iron, 16, 45 Eql Ultra Comfort Exel Comfort Point Insulin Insulinsyringe/0.3ML/31G X 5/16", 34 Syringe/0.5ML/29G X 1/2", 34 Eql Ultra Comfort Insulinsyringe/1ML/30G Exel Comfort Point Insulin Syringe/0.5ML/30G X 5/16", 34 Eql Ultra SHORT Pen Needles 31G X Exel Comfort Point Insulin Syringe/1ML/28G X 1/2", 34 ferretts, 16, 45 eql vitamin d-3, 27, 46 Exel Comfort Point Insulin Ferretts Chewable Iron, 16 eql vitamin d3, 27, 46 Syringe/1ML/29G X 1/2", 34 Ferretts IPS, 16, 45 Exel Comfort Point Insulin ferrex 150, 16, 45 Syringe/1ML/30G X 5/16", 34 ferric x-150, 16, 45 ergocalciferol, 27 Ferrimin 150, 17, 45 ergoloid mesylates, 20 ferro-bob, 16, 45 Ferro-sequels, 17, 45 ferrocite, 16, 45 ferrocite plus, 16 fluocinolone acetonide, 9, 22 folbee plus cz, 27 ferrogels forte, 16 fluocinolone acetonide body, 9 folic acid, 16, 44 ferrotabs, 16, 45 fluocinolone acetonide ear drops, 22 folic acid/vitamin b-6/vitamin b-12, 16 ferrous drops, 16, 45 fluocinolone acetonide scalp, 9 Ferrous Fumarate, 17, 45 ferrous fumarate 324, 16, 45 fluocinonide-e, 9 ferrous gluconate, 16, 45 fluor-a-day, 41, 44 Ferrous Gluconate, 17, 45 Fluor-a-day, 41, 44 fondaparinux sodium, 17 ferrous sulfate, 16, 45 fluor-i-strips a.t., 22 Fora Lancets, 30 Ferrous Sulfate, 17, 45 Fora Lancing Device, 34 ferrousul, 16, 45 Foradil Aerolizer, 26 formaldehyde, 40 Fifty50 Alcohol Prep Pads, 39 fluoridex daily defense, 18 Fifty50 Lancing Device, 34 fluoridex daily defense enhanced Fosamax Plus D, 12 Fifty50 Pen Needles 31G X3/16" (5MM), fosinopril sodium, 6 fluoridex daily defense sensitivity relief, fosinopril sodium/hydrochlorothiazide, 7 Fifty50 Pen Needles 31G X5/16" (8MM), fosphenytoin sodium, 19 fluoritab, 41, 44 Fifty50 Safety Seal Lancets 30G, 30 fluorometholone, 21 Fifty50 Safety Seal Lancets 32G, 30 Freds Pharmacy Autolet Lancing Device, Fifty50 Superior Comfort Insulin fluorouracil, 4, 10 Syringe/0.3ML/31G X 5/16", 34 Freds Pharmacy Unifine Pentips Pen Fifty50 Superior Comfort Insulin fluoxetine DR, 18 Needles 32GX4MM, 34 Syringe/0.5ML/31G X 5/16", 34 fluoxetine HCL, 18 Freds Pharmacy Unifine Pentips Plus Fifty50 Superior Comfort Insulin fluphenazine decanoate, 18 Syringe/1ML/31G X 5/16", 34 fluphenazine HCL, 19 Freds Pharmacy Unifine Pentips Plus flura-drops, 41, 44 flurazepam HCL, 19 Freds Pharmacy Unilet Lancets Super Flurazepam HCL, 19 Fingerstix Lancets, 30 Freds Pharmacy Unilet Lancets Ultra Thin flurbiprofen sodium, 22 Freestyle Lancets, 30 Freestyle Precision Insulin Syringe/U- fluticasone propionate, 9, 25 100/0.5ML/30G X 5/16", 34 flavoxate HCL, 15 Freestyle Precision Insulin Syringe/U- Flebogamma Dif, 41 fluvastatin sodium ER, 7 100/0.5ML/31G X 5/16", 34 flecainide acetate, 6 Fluvirin 2013-2014, 26, 45 Freestyle Precision Insulin Syringe/U- Fluvirin 2014-2015, 26, 45 100/1ML/31G X 5/16", 34 Flexichamber, 40 Fluvirin 2015-2016, 26, 45 Freestyle Precision Insulin Syringes/U- Fluvirin PF 2013-2014, 26, 44 100/1ML/30G X 5/16", 34 Fluvirin PF 2014-2015, 26, 45 Freestyle Unistick II Lancets, 30 Fluarix 2013-2014, 26, 44 fluvoxamine maleate, 18 Fluarix 2014-2015, 26, 44 fluvoxamine maleate ER, 18 Fluarix Quadrivalent 2013-2014, 26, 44 Fluzone High-dose PF 2013-2014, 26, Fluarix Quadrivalent 2014-2015, 26, 44 45 Fluarix Quadrivalent 2015-2016, 26, 44 Fluzone High-dose PF 2014-2015, 26, Flublok 2013-2014, 26, 44 Flublok 2014-2015, 26, 44 Fluzone High-dose PF 2015-2016, 26, G
Flublok 2015-2016, 26, 44 Fluzone Intradermal, 26, 45 Flucelvax 2013-2014, 26, 44 Fluzone Intradermal Quadrivalent, 26, 45 galantamine hydrobromide, 20 Flucelvax 2014-2015, 26, 44 Fluzone Intradermal Quadrivalent 2015- Galantamine Hydrobromide, 20 Flucelvax 2015-2016, 26, 44 Fluzone Pediatric PF 2013-2014, 26, 45 Gammagard Liquid, 41 fluconazole IN dextrose, 2 Fluzone PF 2013-2014, 26, 45 Gammagard S/D, 41 fluconazole IN NACL, 2 Fluzone PF 2014-2015, 26, 45 Gammagard S/D Iga Less Than Fluzone Quadrivalent 2013-2014, 26, 45 fludarabine phosphate, 4 Fluzone Quadrivalent 2014-2015, 26, 45 fludrocortisone acetate, 10 Fluzone Quadrivalent 2015-2016, 26, 45 Flulaval 2013-2014, 26, 44 Fluzone Split 2013-2014, 26, 45 Flulaval 2014-2015, 26, 44 Fluzone Split 2014-2015, 26, 45 Flulaval Quadrivalent 2013-2014, 26, 44 Fluzone Split 2015-2016, 26, 45 Flulaval Quadrivalent 2014-2015, 26, 44 FML, 21 Gardasil, 26, 45 Flulaval Quadrivalent 2015-2016, 26, 44 Focalin XR, 19 Gardasil 9, 26, 45 Gastrinex NF, 14 Flumist Quadrivalent, 26, 44 gatifloxacin, 21 gavilyte-c, 14, 47 Global Inject Ease Insulin Syringe/U- gavilyte-G, 14, 47 100/0.5ML/28G X 1/2", 34 Gnp Clickfine Universal Pen Needles Global Inject Ease Insulin Syringe/U- 31GX1/4", 35 gavilyte-n/flavor pack, 14, 47 100/0.5ML/29G X 1/2", 34 Gnp Clickfine Universal Pen Needles Global Inject Ease Insulin Syringe/U- 31GX5/16", 35 100/0.5ML/30G X 1/2", 34 Gnp Daily Prenatal, 28, 44 Global Inject Ease Insulin Syringe/U- gnp folic acid, 16, 44 gemcitabine HCL, 4 100/0.5ML/30G X 5/16", 34 Gnp Insulin Syringe/0.3ML/29G X 1/2", Global Inject Ease Insulin Syringe/U- gene-xene TAB 15MG, 18 100/0.5ML/31G X 5/16", 34 Gnp Insulin Syringe/0.3ML/30G X 5/16", gene-xene TAB 3.75MG, 18 Global Inject Ease Insulin Syringe/U- gene-xene TAB 7.5MG, 18 100/1ML/28G X 1/2", 34 Gnp Insulin Syringe/0.3ML/31G X 5/16", Global Inject Ease Insulin Syringe/U- 100/1ML/29G X 1/2", 34 Gnp Insulin Syringe/0.5ML/28G X 1/2", Global Inject Ease Insulin Syringe/U- gentamicin sulfate, 1, 21 100/1ML/30G X 1/2", 34 Gnp Insulin Syringe/0.5ML/29G X 1/2", gentamicin sulfate pediatric, 1 Global Inject Ease Insulin Syringe/U- gentamicin sulfate/0.9% sodium chloride, 100/1ML/30G X 5/16", 34 Gnp Insulin Syringe/0.5ML/30G X 5/16", Global Inject Ease Insulin Syringe/U- Gentle-let GP Lancets, 30 100/1ML/31G X 5/16", 34 Gnp Insulin Syringe/0.5ML/31G X 5/16", Gentle-let Lancets General Purpose Global Inject Ease Lancets 28G, 30 Style/Fine Point, 30 Global Inject Ease Lancets 30G, 30 Gnp Insulin Syringe/1ML/28G X 1/2", 35 Gentle-let Lancets General Purpose Global Lancing Device, 34 Gnp Insulin Syringe/1ML/29G X 1/2", 35 Style/Medium Point, 30 Glucagen Hypokit, 12 Gnp Insulin Syringe/1ML/30G X 5/16", 35 Gentle-let Lancets Safety Style/Fine Glucagon Emergency Kit, 12 Gnp Insulin Syringe/1ML/31G X 5/16", 35 Glucocom Autolink Telemonitoring gnp iron, 16, 45 Gentle-let Lancets Safety Style/Medium Glucocom Lancets 28G, 30 Gnp Lancets 21G, 30 Gentle-let Platforms 2.4MM, 34 Glucocom Lancets 30G, 30 Gnp Lancets Micro Thin 33G, 30 Gentle-let Platforms 3.0MM, 34 Glucocom Lancets 33G, 30 Gnp Lancets Super Thin 30G, 30 Glucolet 2 Automatic Lancing Device, 34 Gnp Lancets Thin, 30 Glucopro Insulin Syringe/U- Gnp Lancets Thin 26G, 30 gildagia, 11, 43 100/0.3ML/30G X 1/2", 34 Gnp Micro Thin Lancets 33G, 30 gildess 1.5/30, 11, 43 Glucopro Insulin Syringe/U- gnp nicotine mini lozenge, 20, 46 gildess 1/20, 11, 43 100/0.3ML/30G X 5/16", 34 gnp nicotine polacrilex, 20, 46 gildess 24 FE, 11, 43 Glucopro Insulin Syringe/U- gnp nicotine polacrilex mini, 20, 46 gildess FE 1.5/30, 11, 43 100/0.3ML/31G X 5/16", 34 Gnp Prenatal, 28, 44 gildess FE 1/20, 11, 43 Glucopro Insulin Syringe/U- Gnp Prenatal Vitamins, 28, 44 100/0.5ML/30G X 1/2", 34 gnp slow release iron, 16, 45 Glucopro Insulin Syringe/U- Gnp Super Thin Lancets/30G, 30 giltuss pediatric, 25 100/0.5ML/30G X 5/16", 34 Gnp Ultra Comfort Insulin Glucopro Insulin Syringe/U- Syringe/0.3ML/29G X 1/2", 35 100/0.5ML/31G X 5/16", 34 Gnp Ultra Comfort Insulin Glucopro Insulin Syringe/U-100/1ML/30G Syringe/0.3ML/30G X 5/16" SHORT, 35 Gnp Ultra Comfort Insulin Gliadel Wafer, 3 Glucopro Insulin Syringe/U-100/1ML/30G Syringe/0.3ML/31G X 5/16" SHORT, 35 Gnp Ultra Comfort Insulin Glucopro Insulin Syringe/U-100/1ML/31G Syringe/0.5ML/28G X 1/2", 35 glipizide ER, 12 Gnp Ultra Comfort Insulin glipizide XL, 12 Glucose Control Normal, 30 Syringe/0.5ML/29G X 1/2", 35 glipizide/metformin HCL, 12 Glucose Control Solution, 30 Gnp Ultra Comfort Insulin Global Alcohol Prep Ease Pads, 40 Glucosource Lancet Device, 35 Syringe/0.5ML/30G X 5/16" SHORT, 35 Global Ease Inject Pen Needles Glucosource Lancets, 30 Gnp Ultra Comfort Insulin Syringe/0.5ML/31G X 5/16" SHORT, 35 Global Ease Inject Pen Needles Gnp Ultra Comfort Insulin glyburide micronized, 12 Syringe/1ML/28G X 1/2", 35 Global Ease Inject Pen Needles glyburide/metformin HCL, 12 Gnp Ultra Comfort Insulin Syringe/1ML/29G X 1/2", 35 Global Ease Inject Pen Neeedles glycopyrrolate, 14 Gnp Ultra Comfort Insulin Syringe/1ML/30G X 5/16" SHORT, 35 Global Inject Ease Insulin Syringe/U- Gnp Ultra Comfort Insulin 100/0.3ML/29G X 1/2", 34 Gmate Lancets 30G, 30 Syringe/1ML/31G X 5/16" SHORT, 35 Global Inject Ease Insulin Syringe/U- Gmate Lancing Device, 35 gnp vitamin d, 27, 46 100/0.3ML/30G X 1/2", 34 gnp adult aspirin low strength, 23, 42 gnp vitamin d maximum strength, 27, 46 Global Inject Ease Insulin Syringe/U- Gnp Alcohol Swabs, 40 gnp vitamin d super strength, 27, 46 100/0.3ML/30G X 5/16", 34 gnp aspirin, 23, 42 gnp vitamin d3 extra strength, 27, 46 Global Inject Ease Insulin Syringe/U- gnp aspirin low dose, 23, 42 goodsense aspirin low dose, 23, 42 100/0.3ML/31G X 5/16", 34 Gnp Clickfine Pen Needle Goodsense Prenatal Vitamins, 28, 44 grafco silver nitrate applicator, 9 Needles 31GX6MM, 35 Humalog Mix 75/25, 12 grafco silver nitrate applicator 12", 9 Healthy Accents Unifine Pentips Pen Humalog Mix 75/25 Kwikpen, 12 Needles 31GX8MM, 35 human albumin grifols, 17 Gralise Starter, 20 Healthy Accents Unifine Pentips Pen granisetron HCL, 14 Needles 32GX4MM, 35 Healthy Accents Unilet Lancets Super Humira Pediatric Crohns Disease Starter green GLO lissamine greenophthalmic healthy kids vitamin d3, 27, 46 griseofulvin microsize, 2 Healthy Mama Be Well Rounded, 28 Humira Pen-crohns Diseasestarter, 24 griseofulvin ultramicrosize, 2 Humira Pen-psoriasis Starter, 24 guanfacine ER, 19 Humulin 70/30, 12 guanfacine HCL, 6 Humulin 70/30 Kwikpen, 12 Guanidine HCL, 21 Humulin 70/30 Pen, 12 hematinic plus vitamins/minerals, 16 H
hematinic/folic acid, 16 Humulin N Kwikpen, 12 Humulin N U-100 Pen, 12 H&h Thinlet Lancets 26G, 30 hematogen forte, 16 H&h Thinlet Super Thin Lancets 30G, 30 Humulin R U-500 (concentrated), 12 H-e-b IN Control Pen Needles hemocyte-plus, 16 Hy-vee Lancets, 30 Hy-vee Thin Lancets, 30 H-e-b IN Control Pen Needles hydralazine HCL, 6 H-e-b IN Control Pen Needles hydrochloric acid, 15 heparin lock flush, 17 hydrochlorothiazide, 7 H-e-b IN Control Pen heparin lock flush for flushing vascular hydrocodone bitartrate/acetaminophen, Needles/Nano/32GX4MM, 35 access devices, 17 H-e-b Incontrol Advanced Lancing heparin lock flush/NACL for flushing Hydrocodone Bitartrate/Acetaminophen, vascular access devices, 17 H-e-b Incontrol Lancets Super Thin 30G, heparin sodium, 17 hydrocodone bitartrate/chlorpheniramine heparin sodium dcu, 17 H-e-b Incontrol Lancets Ultra Thin 28G, heparin sodium lock flush, 17 hydrocodone bitartrate/homatropine heparin sodium/D5W, 17 methylbromide, 25 H-e-b Incontrol Pen Needles 29GX12MM, heparin sodium/NACL 0.9%, 17 hydrocodone polistirex/chlorpheniramine heparin sodium/sodium chloride 0.9% Haemolance Low Flow Lancets, 30 Haemolance Plus, 30 hetastarch 6%/NACL, 17 Haemolance Plus High Flow, 30 hydrocort ene 100MG, 14 Haemolance Plus Low Flow, 30 hydrocortisone, 9, 10, 14 Haemolance Plus Max Flow, 30 hydrocortisone acetate/aloe, 9 Haemolance Plus Pediatric Flow, 30 high potency iron, 16, 45 hydrocortisone acetate/lidocaine HCL, 14 High Potency Iron, 17, 45 hydrocortisone acetate/pramoxine, 14 halobetasol propionate, 9 hydrocortisone butyrate, 9 HM aspirin, 23, 42 hydrocortisone butyrate (lipid), 9 HM aspirin EC, 23, 42 hydrocortisone butyrate (lipophilic), 9 HM aspirin EC low dose, 23, 42 hydrocortisone IN absorbase, 9 haloperidol decanoate, 18 HM folic acid, 16, 44 hydrocortisone valerate, 9 haloperidol lactate, 18 hydrocortisone/acetic acid, 22 HM iron slow release, 16, 45 HM Lancets Micro Thin 33G, 30 Health Care Lancing Device, 35 HM Lancets Ultra Thin 30G, 30 hydromorphone HCL, 24 Healthwise Alcohol Prep Pads, 40 HM nicotine polacrilex, 20, 46 hydromorphone HCL dosette, 24 Healthwise Lancets 30G, 30 HM nicotine transdermal system, 20, 46 hydromorphone HCL ER, 24 Healthwise Lancing Pen, 35 HM nicotine transdermal system step 3, Hydromorphone HCL/Sodium Chloride, Healthwise Mini Pen Needles 31GX6MM, HM One Daily Prenatal Combo, 28, 44 hydroxychloroquine sulfate, 3 Healthwise Pen Needles 29GX12MM, 35 HM Prenatal, 28, 44 Healthwise SHORT Pen Needles HM vitamin d, 27, 46 hydroxyzine HCL, 18 HM vitamin d3, 27, 46 hydroxyzine pamoate, 18 Healthwise Unifine Pentips Pen Needles HM Vitamin D3, 27, 47 Hydroxyzine Pamoate, 18 Healthy Accents Autolet Impression homatropine HBR, 22 Lancing Device, 35 Healthy Accents Unifine Pentips Pen Needles 29GX12MM, 35 Humalog Kwikpen, 12 hyoscyamine sulfate, 14 Healthy Accents Unifine Pentips Pen Humalog Mix 50/50, 12 hyoscyamine sulfate ER, 14 Needles 31GX5MM, 35 Humalog Mix 50/50 Kwikpen, 12 hyoscyamine sulfate odt, 14 Healthy Accents Unifine Pentips Pen hyoscyamine sulfate SR, 14 Insulin Syringe/0.5ML/28G X 1/2", 35 Insulin Syringe/0.5ML/29G X 1/2", 35 Insulin Syringe/0.5ML/30G X 1/2", 35 Hyperhep B S/D, 41 Insulin Syringe/0.5ML/30G X 5/16", 35 Hyperrab S/D, 41 Insulin Syringe/0.5ML/31G X 5/16", 35 Hyperrho S/D, 41 Insulin Syringe/1ML/28G X 1/2", 35 Hyperrho S/D Mini-dose, 41 Insulin Syringe/1ML/29G X 1/2", 35 J
Hypolance AST Lancing Kit, 35 Insulin Syringe/1ML/30G X 5/16", 35 I
Insulin Syringe/1ML/31G X 5/16", 35 Insulin Syringe/U-100/0.3ML/29G X 1/2", ibandronate sodium, 12 Insulin Syringe/U-100/0.5ML/28G X 1/2", Insulin Syringe/U-100/0.5ML/29G X 1/2", ibutilide fumarate, 6 jencycla, 11, 43 Insulin Syringe/U-100/1ML/28G X 1/2", idarubicin HCL, 3 iferex 150, 16, 45 Insulin Syringe/U-100/1ML/29G X 1/2", iferex 150 forte, 16 jolivette, 11, 43 Insulin Syringe/U-100/1ML/30G X 5/16", junel 1.5/30, 11, 43 Insulin Syringe/U-100/1ML/31G X 5/16", junel 1/20, 11, 43 junel FE 1.5/30, 11, 43 Insupen 33GX4MM, 35 junel FE 1/20, 11, 43 Insupen Pen Needles 32G X4MM, 35 junel FE 24, 11, 43 Insupen Sensitive 32GX6MM, 35 imipenem/cilastatin, 3 Insupen Sensitive 32GX8MM, 35 imipramine HCL, 18 Insupen Ultrafin 29GX12MM, 35 imipramine pamoate, 18 K
Insupen Ultrafin 30GX8MM, 35 Insupen Ultrafin 31GX6MM, 35 k-effervescent, 40 Imovax Rabies (h.d.c.v.), 26 Insupen Ultrafin 31GX8MM, 35 Implanon, 11, 44 IN Touch Diabetes Management IN Touch Lancing Device, 35 Intron A W/Diluent, 5 IN Touch Sterile Lancets 30G, 30 introvale, 11, 43 k2k pain relieving patch, 9 Inatal Advance, 28 Invega Sustenna, 19 Inatal Ultra, 28 Kapvay Dose Pack, 19 Ipol Inactivated IPV, 26, 45 karidium, 41, 44 indigo carmine, 40 ipratropium bromide, 25, 26 ipratropium bromide/albuterol sulfate, 25 indocyanine green, 40 indomethacin, 24 KCL 0.075%/D5W/NACL 0.45%, 41 indomethacin ER, 24 KCL 0.15%/D5W/ NACL 0.3%, 41 Infanrix, 26, 45 KCL 0.15%/D5W/NACL 0.2%, 41 KCL 0.15%/D5W/NACL 0.45%, 41 KCL 0.15%/D5W/NACL 0.9%, 41 infuvite adult, 27 Iron Asp Gly/ Polysacch Compl/Ascorb KCL 0.3%/D5W/NACL 0.45%, 41 infuvite pediatric, 27 CAL/B12/Fa/C Threon/Suc, 16 Iron Chews Pediatric, 17, 45 kelnor 1/35, 11, 43 iron slow release, 16, 45 kendall sodium chloride flush, 40 iron supplement, 16, 45 Valved/Mouthpiece, 40 iron supplement childrens, 16, 45 Inspirachamber/Soothermask/Inspiramas Iron Up, 17, 45 ketoconazole, 2, 8 Inspirachamber/Soothermask/Inspiramas isolyte-m/dextrose 5%, 40 Ketone Test Strips, 41 Inspirease Bags, 40 Inspirease Drug Delivery System, 40 ketorolac tromethamine, 22, 24 Inspirease Mouthpiece, 40 Isopto Carbachol, 22 Inspirease Reservoir Bags, 40 isosorbide dinitrate, 5 kimidess, 11, 43 Insulin Syringe/0.3ML/29G X 1", 35 Isosorbide Dinitrate, 5 Insulin Syringe/0.3ML/29G X 1/2", 35 isosorbide mononitrate, 5 Kinney Lancets, 30 Insulin Syringe/0.3ML/30G X 5/16", 35 isosorbide mononitrate ER, 5 Kinney Thin Lancets, 30 Insulin Syringe/0.3ML/31G X 5/16", 35 isotonic gentamicin, 1 Kinray Insulin Syringe Preferred Plus/0.
Insulin Syringe/0.5ML/27G X 1/2", 35 3ML/31G X 5/16", 35 Kroger Pen Needles 31G X 8MM, 35 Kinray Insulin Syringe Preferred Kroger Pen Needles 31GX1/4", 35 Leader Advanced Lancing Device, 35 Plus/0.5ML/31G X 5/16", 35 Leader Insulin Syringe/0.3ML/29G X 1/2", Kinray Insulin Syringe Preferred Plus/1ML/31G X 5/16", 35 Leader Insulin Syringe/0.3ML/30G X Kinray Insulin Syringe/0.5ML/29G X 1/2", Kyprolis, 5 L
Leader Insulin Syringe/0.3ML/31G X l-cysteine HCL, 40 Leader Insulin Syringe/0.5ML/28G X 1/2", Leader Insulin Syringe/0.5ML/29G X 1/2", lactated ringers, 40 klor-CON m10, 40 Leader Insulin Syringe/0.5ML/30G X lactated ringers dextrose 5% viaflex, 40 Klor-CON M15, 41 lactated ringers irrigation, 40 klor-CON m20, 40 Leader Insulin Syringe/0.5ML/31G X lactated ringers viaflex, 40 klor-CON sprinkle, 40 Leader Insulin Syringe/1ML/28G X 1/2", kls aspirin EC, 23, 42 lactic acid w/vitamin e, 9 kls aspirin low dose, 23, 42 Leader Insulin Syringe/1ML/29G X 1/2", kls quit2, 20, 46 kls quit4, 20, 46 Leader Insulin Syringe/1ML/30G X 5/16", Kmart Valu Plus Insulin Syringe/0.3ML/30G, 35 Leader Insulin Syringe/1ML/31G X 5/16", lamivudine/zidovudine, 2 Kmart Valu Plus Insulin Syringe/0.5ML/29G, 35 Leader Lancets Colored, 30 lamotrigine ER, 19 Kmart Valu Plus Insulin Leader Super Thin Lancet, 30 lamotrigine odt, 19 Syringe/0.5ML/30G, 35 Leader Thin Lancets, 30 Lancet Device Adjustable, 35 Kmart Valu Plus Insulin Leader Unifine Pentips Lancet Device With Ejector, 35 Syringe/1ML/29G, 35 Lancet Transporter Case, 35 Kmart Valu Plus Insulin Leader Unifine Pentips Syringe/1ML/30G, 35 Lancets 26G Twist Top, 30 Leader Unifine Pentips/Mini/31GX3/16", Kogenate FS Bio-set, 17 Leader Unifine Pentips/Nano/32GX5/32", Lancets 30G Twist Top, 30 Kombiglyze XR, 12 Lancets 30G/Twist Top, 30 kp aspirin, 23, 42 Leader Unifine Pentips/Plus/32GX5/32", Lancets 31G Twist Top, 30 kp ferrous gluconate, 16, 45 Lancets 33G Universal Design, 30 kp ferrous sulfate, 16, 45 Lancets Bullseye Safety, 30 kp folic acid, 16, 44 Lancets Micro Thin 33G, 30 Kp Prenatal Multivitamins, 28, 44 Lancets Safety Seal 21G, 30 kp vitamin d, 27, 46 Lenvima 10MG Daily Dose, 5 Lancets Safety Seal 26G, 30 Kroger Insulin Syringe/0.3ML/29G X 1/2", Lenvima 14MG Daily Dose, 5 Lancets Safety Seal 28G, 30 Lenvima 20MG Daily Dose, 5 Lancets Safety Seal 30G, 30 Kroger Insulin Syringe/0.3ML/30G X Lenvima 24MG Daily Dose, 5 Lancets Super Thin 28G, 30 Kroger Insulin Syringe/0.3ML/31G X Lancets Twist Top, 30 Lancets Ultra Fine, 30 Kroger Insulin Syringe/0.5ML/29G X 1/2", leucovorin calcium, 5 Lancets Ultra Thin, 30 Lancets Ultra Thin 30G, 30 Kroger Insulin Syringe/0.5ML/30G X Lancing Device, 35 leuprolide acetate, 4 Lancing Device Adjustable, 35 Kroger Insulin Syringe/0.5ML/31G X levalbuterol, 25 levalbuterol HCL, 25 Kroger Insulin Syringe/1ML/29G X 1/2", Kroger Insulin Syringe/1ML/30G X 5/16", Levemir Flexpen, 12 Levemir Flextouch, 12 Lantus Solostar, 12 Kroger Insulin Syringe/1ML/31G X 5/16", levetiracetam, 19 levetiracetam ER, 19 larin 1.5/30, 11, 43 Kroger Lancets, 30 larin 1/20, 11, 43 Kroger Lancets 21G, 30 levobunolol HCL, 21 larin 24 FE, 11, 43 Kroger Lancets Micro Thin33G, 30 levocarnitine, 13 larin FE 1.5/30, 11, 43 Kroger Lancets Super Thin, 30 levocetirizine dihydrochloride, 25 larin FE 1/20, 11, 43 Kroger Lancets Thin, 30 levofloxacin, 1, 21 Kroger Lancets Thin 26G, 30 levofloxacin IN D5W, 1 Kroger Lancets Ultrathin 30G, 30 Levoleucovorin Calcium, 5 Kroger Lancing Device, 35 levonest, 11, 43 Kroger Pen Needles 29G X 12MM, 35 levonorgestrel, 11, 43 layolis FE, 11, 43 Levonorgestrel, 11, 43 M
levonorgestrel and ethinyl estradiol, 11, Litetouch Insulin Syringe/U-100/1ML/31G M-m-r II, 26, 45 levonorgestrel/ethinyl estradiol, 11, 43 Litetouch Lancets Micro Thin 33G, 30 Macnatal CN DHA, 28 levora 0.15/30-28, 11, 43 Litetouch Pen Needles 29GX12.7MM, 36 Levorphanol Tartrate, 24 Litetouch Pen Needles 31G X 6MM, 36 mafenide acetate, 9 levothyroxine sodium, 14 Litetouch Pen Needles 31GX8MM Magellan Insulin Safety Syringe/U- 100/0.3ML/29G X 1/2", 36 Magellan Insulin Safety Syringe/U- lithium carbonate, 19 100/0.3ML/30G X 5/16", 36 Liberty Blood Glucose Meter, 30 lithium carbonate ER, 19 Magellan Insulin Safety Syringe/U- Liberty Glucose Control Mid, 30 100/0.5ML/29G X 1/2", 36 Liberty Glucose Control Normal, 30 Live Better Advanced Lancing Device, 36 Magellan Insulin Safety Syringe/U- Liberty Medical Lancets 30G, 30 Live Better Lancet Super Thin 30G, 30 100/0.5ML/30G X 5/16", 36 Liberty Mini Lancing Device, 30 Live Better Lancet Ultra Thin 28G, 31 Magellan Insulin Safety Syringe/U- Liberty Test Strips, 30 Live Better Pen Needles 29G X 12MM, 100/1ML/29G X 1/2", 36 Magellan Insulin Safety Syringe/U- lidenza patch, 9 Live Better Pen Needles 31G X 12MM, 100/1ML/30G X 5/16", 36 magnesium chloride, 40 lidocaine HCL, 6, 9, 18, 25 Live Better Pen Needles 31G X 6MM, 36 magnesium sulfate, 40 lidocaine HCL IN D5W, 6 lidocaine HCL jelly, 9 LO Loestrin FE, 11, 43 lidocaine HCL viscous, 18 lidocaine HCL/dextrose, 6 Maprotiline HCL, 18 lidocaine HCL/hydrocortisone acetate, 14 lokara, 9 lidocaine viscous, 18 lomedia 24 FE, 11, 43 marlissa, 11, 43 lidocaine/epinephrine, 25 lidocaine/prilocaine, 9 Longs Insulin Syringe/0.5ML/31G X 5/16", lidodextrapine, 9 Longs Lancets Standard, 31 Mask Vortex/Baby Whirl Duckling, 40 Lifescan Unistik 2 Deep Penetration, 30 Longs Lancets Thin, 31 Mask Vortex/Child/Frog, 40 Lifescan Unistik II Lancets, 30 Longs Lancets Ultra Thin, 31 Mask Vortex/Spinner The Duck, 40 Mask Vortex/Toddler/Lady Bug, 40 loperamide HCL, 14 Maxair Autohaler, 26 lorazepam intensol, 18 Maxi-comfort Insulin Syringe/U- liothyronine sodium, 13 Maxi-comfort Insulin Syringe/U- 100/1ML/28GX1/2", 36 maximum d3, 27, 46 lisinopril/hydrochlorothiazide, 7 MD-gastroview, 41 lissamine green, 22 meclizine HCL, 14 Lite Touch Lancets, 30 losartan potassium, 6 Meclofenamate Sodium, 24 Lite Touch Lancing Device, 35 losartan potassium/hydrochlorothiazide, Medi-seltzer, 23, 42 Lite Touch Lancing Pen, 35 Medic Insulin Syringe/0.3ML/30G X 5/16", Lite Touch Pen Needles/31G X 3/16", 35 Medic Insulin Syringe/0.5ML/30G X 5/16", Litetouch Insulin Syringe/0.3ML/29G X low-ogestrel, 11, 43 Medical Provider EZ Flu Shot 2013-2014, Litetouch Insulin Syringe/0.3ML/30G X loxapine succinate, 18 Medical Provider EZ Flu Shot 2014-2015, Litetouch Insulin Syringe/0.3ML/31G X Medical Provider EZ Flu Shot 2015-2016, Litetouch Insulin Syringe/0.5ML/30G X Medical Provider EZ Flu Shot PF 2013- Litetouch Insulin Syringe/0.5ML/31G X Medical Provider EZ Flu Shot PF 2014- Litetouch Insulin Syringe/1ML/30G X Lupron Depot-PED, 13 Medichoice Pre-set Safety Lancet Dual Litetouch Insulin Syringe/U- 100/0.5ML/28G X 1/2", 35 Medichoice Pre-set Safety Lancet Low Litetouch Insulin Syringe/U- lysiplex plus, 27 100/0.5ML/29G X 1/2", 35 Medichoice Pre-set Safety Lancet Litetouch Insulin Syringe/U-100/1ML/28G Medichoice Pre-set Safety Lancet Litetouch Insulin Syringe/U-100/1ML/29G Moderate Flow, 31 Medichoice Safety Lancet Extra, 31 metformin HCL ER, 12 Medichoice Safety Lancet Normal, 31 methadone HCL, 24 mirtazapine odt, 18 Medicine Shoppe Lancets, 31 methadone HCL intensol, 24 Medicine Shoppe Lancets Thin, 31 Mission Prenatal, 28, 44 Medicine Shoppe Pen Needles 29G X methamphetamine HCL, 19 Mission Prenatal HP, 28, 44 Medicine Shoppe Pen Needles 31G X methenamine hippurate, 15 methenamine mandelate, 15 mitoxantrone HCL, 3 Medicine Shoppe Pen Needles 31G X MM aspirin, 23, 42 Medisense Thin Lancets, 31 methocarbamol, 21 Medlance Plus Extra Lancets 21G, 31 Medlance Plus Lancets, 31 methotrexate sodium, 4 Moderiba 1200 Dose Pack, 2 Medlance Plus Lancets Lite 25G, 31 Moderiba 800 Dose Pack, 2 Medlance Plus Lite Lancets 25G, 31 methscopolamine bromide, 14 moexipril HCL, 6 Medlance Plus Special Lancets 0.8MM, Methyclothiazide, 7 mometasone furoate, 9 Medlance Plus Superlite 30G, 31 Methyldopate HCL, 6 mono-linyah, 11, 43 Medlance Plus Superlite 30G/Comfort methylene blue, 40 methylergonovine maleate, 22 Monoject Insulin Syringe Regular LUER Medlance Plus Universal Lancets 21G, methylphenidate HCL, 19 Tip/Softpack/1ML, 36 methylphenidate HCL CD, 19 Monoject Insulin Syringe/1ML, 36 Medlance Plus/Lite 25G, 31 methylphenidate HCL ER, 19 Monoject Insulin Syringe/1ML/31G X Medlance/Extra, 31 Methylphenidate HCL ER, 19 Medlance/Lite, 31 methylphenidate HCL SR, 19 Monoject Insulin Syringe/Detach Medlance/Universal, 31 methylphenidate hydrochloride, 19 Needle/1ML/25G X 5/8", 36 medroxyprogesterone acetate, 11, 12, 43 methylprednisolone, 10 Monoject Insulin Syringe/Detach mefenamic acid, 24 methylprednisolone acetate, 10 Needle/1ML/27G X 1/2", 36 mefloquine HCL, 3 methylprednisolone dose pack, 10 Monoject Insulin Syringe/Perm methylprednisolone sodiumsuccinate, 10 Needle/1ML/28G X 1/2", 36 mega-c/a plus, 27 Monoject Insulin Syringe/Perm Needle/U- megestrol acetate, 4, 12 metoclopramide HCL, 15 100/0.5ML/28G X 1/2", 36 Meijer Alcohol Swabs Extra-thick, 40 metoclopramide odt, 15 Monoject Insulin Syringe/Safety/Perm meijer aspirin EC, 23, 42 Needle/0.3ML/29G X 1/2", 36 Meijer Color Lancets Universal 33G, 31 metoprolol succinate ER, 6 Monoject Insulin Syringe/Safety/Perm meijer ferrous sulfate, 16, 45 metoprolol tartrate, 6 Meijer Lancets, 31 Monoject Insulin Syringe/Safety/Perm Meijer Lancets Thin, 31 metronidazole, 3, 8 Needle/0.5ML/29G X 1/2", 36 Meijer Lancets Universal 33G, 31 metronidazole IN NACL 0.79%, 3 Monoject Insulin Syringe/Safety/Perm Meijer Pen Needles 29G X 12MM, 36 metronidazole vaginal, 15 Needle/1ML/29G X 1/2", 36 Meijer Pen Needles 31G X 6MM, 36 mexiletine HCL, 6 Monoject Insulin Meijer Pen Needles 31G X 8MM, 36 Syringe/Softpack/1ML/27G X 1/2", 36 Meijer Super Thin Lancets, 31 Micrhogam Ultra-filtered Plus, 41 Monoject Insulin Syringe/Softpack/U- 100/0.5ML/28G X 1/2", 36 microgestin 1.5/30, 11, 43 Monoject Insulin Syringe/U- melphalan hydrochloride, 3 microgestin 1/20, 11, 43 100/0.3ML/30G X 5/16", 36 memantine HCL, 20 microgestin FE, 11, 43 Monoject Insulin Syringe/U- memantine HCL titration PAK, 20 microgestin FE 1.5/30, 11, 43 100/0.5ML/28G X 1/2", 36 Menactra, 26, 45 Microlet Lancets, 31 Monoject Insulin Syringe/U- micronized colestipol HCL, 7 100/0.5ML/30G X 5/16", 36 Monoject Insulin Syringe/U-100/1ML/28G Menomune-a/C/Y/W-135, 26, 45 Microtainer Safety Flow Monoject Insulin Syringe/U-100/1ML/30G meperidine HCL, 24 monoject pharma grade flush syringe, 40 milrinone IN dextrose, 5 monoject pharma grade flush milrinone lactate, 5 syringe/heparin lock, 17 monoject prefill advanced heparin lock mercaptopurine, 4 Minastrin 24 FE, 11, 43 monoject sodium chloride flush, 40 Mini Lancing Device, 36 Monoject Ultra Comfort Insulin miniprin low dose, 23, 42 Syringe/0.3ML/29G X 1/2", 36 Monoject Ultra Comfort Insulin minocycline HCL, 1 Syringe/0.3ML/30G X 5/16", 36 minocycline HCL ER, 1 Monoject Ultra Comfort Insulin Metaproterenol Sulfate, 25 Syringe/0.3ML/31G X 5/16", 36 Monoject Ultra Comfort Insulin metformin HCL, 12 Syringe/0.5ML/28G X 1/2", 36 Monoject Ultra Comfort Insulin nefazodone HCL, 18 Syringe/0.5ML/29G X 1/2", 36 Nefazodone HCL, 18 Monoject Ultra Comfort Insulin mupirocin calcium, 8 Syringe/0.5ML/30G X 5/16", 36 neo-polycin HC, 21 Monoject Ultra Comfort Insulin Syringe/0.5ML/31G X 5/16", 36 Monoject Ultra Comfort Insulin neomycin sulfate, 2 Syringe/1ML/28G X 1/2", 36 Monoject Ultra Comfort Insulin mycophenolate mofetil, 4 neomycin/polymyxin b sulfates, 15 Syringe/1ML/29G X 1/2", 36 mycophenolic acid DR, 4 neomycin/polymyxin/bacitracin zinc, 21 Monoject Ultra Comfort Insulin Syringe/1ML/30G X 5/16", 36 myferon 150, 16, 45 Monojector End CAPS, 36 myferon 150 forte, 16 Monojector Opd End CAPS, 36 Myglucohealth Mgh Softlance Lancets Monolet Lancets, 31 Monolet Opd Lancets, 31 Mykidz Iron 10, 17, 45 Monolettor Safety Lancets, 31 neostigmine methylsulfate, 21 mononessa, 11, 43 Mynatal Advance, 28 Nessi Spacer/Large Mask, 40 Mynatal Ultracaplet, 28 Nessi Spacer/Mouthpiece, 40 montelukast sodium, 25 Nessi Spacer/Small/MED Mask, 40 Mynate 90 Plus, 28 Netgroup Lancets, 31 Moore MED Monoject Insulin Syringe/U- 100/0.5ML/28G X 1/2", 36 Moore MED Monoject Insulin Syringe/U- Neulasta Delivery Kit, 17 100/0.5ML/29G X 1/2", 36 Moore MED Monoject Insulin Syringe/U- 100/1ML/28G X 1/2", 36 Moore MED Monoject Insulin Syringe/U- N
neutragard advanced, 18 100/1ML/29G X 1/2", 36 neutral sodium fluoride, 18 n-acetyl-l-cysteine, 40 morgidox 1X100MG, 1 morgidox 2X100MG, 1 morphine sulfate, 24 morphine sulfate ER, 24 nevirapine ER, 2 Morphine Sulfate ER, 24 nafcillin sodium, 1 morrhuate sodium, 40 Nexplanon, 12, 44 nafrinse drops, 41, 44 next choice one dose, 11, 43 moxifloxacin HCL, 1 niacinamide/azelaic ac/ turmer/fa/b6/zinc nalbuphine HCL, 24 MS Insulin Syringe/0.3ML/29G X 1/2", 36 MS Insulin Syringe/0.3ML/30G X 5/16", nicardipine HCL, 6 nicorelief, 20, 46 MS Insulin Syringe/0.3ML/31G X 5/16", nicotine, 20, 46 naltrexone HCL, 41 nicotine polacrilex, 20, 46 MS Insulin Syringe/0.5ML/29G X 1/2", 36 nicotine polacrilex refill, 20, 46 MS Insulin Syringe/0.5ML/30G X 5/16", nicotine polacrilex starter kit, 20, 46 Namenda XR Titration Pack, 20 nicotine step 1, 20, 46 MS Insulin Syringe/0.5ML/31G X 5/16", nicotine step 2, 20, 46 nicotine step 3, 20, 46 MS Insulin Syringe/1ML/29G X 1/2", 36 nicotine transdermal system, 20, 46 MS Insulin Syringe/1ML/30G X 5/16", 36 Nicotine Transdermal System, 20, 46 naproxen sodium, 24 MS Insulin Syringe/1ML/31G X 5/16", 36 Nicotrol Inhaler, 20, 46 naproxen sodium CR, 24 mult-vitamin/fluoride, 27 Nicotrol Ns, 20, 46 naproxen sodium ER, 24 naratriptan HCL, 24 Multi Prenatal, 28, 44 multi vitamin/fluoride, 27 Multi-lancet Device, 36 nifedipine ER, 6 Nat-rul Prenatal Vitamins, 28, 44 Multi-lancet Device 2, 36 nat-rul vitamin d, 27, 46 multi-vit/fluoride, 27 multi-vit/iron/fluoride, 27 multi-vitamin/fluoride, 27 multi-vitamin/fluoride/iron, 28 multitrace-4 concentrate, 40 multitrace-5 concentrate, 40 necon 0.5/35-28, 11, 43 multivitamin with fluoride, 28 nitrofurantoin, 15 necon 1/35, 11, 43 multivitamin/fluoride, 28 nitrofurantoin macrocrystals, 15 necon 7/7/7, 11, 43 nitrofurantoin monohydrate, 15 NP thyroid 30, 13 NP thyroid 60, 13 Onetouch Suresoft Lancing Device/21G, monohydrate/macrocrystals, 15 NP thyroid 90, 13 nitroglycerin ER, 5 Onetouch Suresoft Lancing Device/28G, nitroglycerin IN 5% dextrose, 5 nu-iron 150, 16, 45 nitroglycerin IN dextrose 5%, 5 Onetouch Ultra 2, 31 nitroglycerin lingual, 5 Onetouch Ultra Blue, 31 Nitroglycerin Lingual, 5 Onetouch Ultra Control, 31 nitroglycerin transdermal, 5 Onetouch Ultra Mini, 31 Onetouch Ultra System Kit, 31 Onetouch Ultralink System (DEC), 31 Onetouch Ultralink System (hex), 31 Onetouch Ultrasmart, 31 Norditropin Cartridge, 13 Onetouch Ultrasoft Lancets, 31 Norditropin Flexpro, 13 Onetouch Verio, 31 Norditropin Nordiflex Pen, 13 Nutropin AQ Nuspin 10, 13 Onetouch Verio Control Solution High, norepinephrine bitartrate, 7 Nutropin AQ Nuspin 20, 13 norethindrone, 11, 43 Nutropin AQ Nuspin 5, 13 Onetouch Verio IQ Blood Glucose norethindrone & ethinyl estradiol ferrous Nutropin AQ Pen, 13 Monitoring System, 31 fumarate, 11, 43 Onetouch Verio Mid Control Solution, 31 norethindrone acetate, 12 Onetouch Verio Sync Bloodglucose norethindrone acetate/ethinyl estradiol, Monitoring System, 31 nystatin, 2, 8, 18 Onetouch Verio Test Strips, 31 norethindrone acetate/ethinyl estradiol/ferrous fumarate, 11, 43 norgestimate/ethinyl estradiol, 11, 43 O
Opana ER (crush Resistant), 24 norlyroc, 11, 43 opcicon one-step, 11, 43 normal saline flush, 41 normal saline flush for flushing vascular access devices, 41 opium tincture, 14 normal saline i.v. flush, 41 Optichamber Advantage, 40 octreotide acetate, 13 Optichamber Diamond, 40 nortrel 0.5/35 (28), 11, 43 Optichamber Diamond/Largeface Mask, ofloxacin, 1, 21, 22 nortrel 1/35, 11, 43 nortrel 7/7/7, 11, 43 Optichamber Diamond/Medium Face Nortriptyline HCL, 18 nortriptyline HCL, 18 Optichamber Diamond/Smallface Mask, olanzapine odt, 19 olopatadine HCL, 25 norwich aspirin, 23, 42 Optihaler MDI Drug Delivery System, 40 Omeclamox-PAK, 14 Nova Safety Lancets 23G, 31 optimal-d, 27, 46 omega-3-acid ethyl esters, 7 Nova Safety Lancets 28G, 31 optimal-d pack, 27, 46 Nova Sureflex Lancets, 31 Options Gynol II Vaginal Contraceptive, omeprazole/sodium bicarbonate, 14 Nova Sureflex Lancing Device, 36 Omniflex Diaphragm, 43 Novaferrum Pediatric Drops, 17, 45 opurity vitamin d, 27, 46 On Call Lancets, 31 On Call Lancing Device, 36 Novofine 30GX8MM, 36 On Call Plus Lancets, 31 Novofine 32GX6MM, 36 On Call Plus Lancing Device, 36 Novofine Autocover 30GX8MM, 36 Novofine Plus 32GX4MM, 36 ondansetron HCL, 14 Novolin 70/30, 12 orphenadrine citrate, 21 ondansetron odt, 14 Novolin 70/30 Relion, 12 orphenadrine citrate ER, 21 One A Day Womens Prenatal/DHA, 28 One A Day Womens Prenatal1, 28 Novolin N Relion, 12 orsythia, 11, 43 One-a-day Womens Prenatal, 28, 44 Ortho Diaphragm All-flex/65MM, 43 Onetouch Basic System, 31 Novolin R Relion, 12 Ortho Diaphragm All-flex/70MM, 43 Onetouch Basic/Profile Test Strips, 31 Ortho Diaphragm All-flex/75MM, 43 Onetouch Club Lancets Fine Point, 31 Novolog Flexpen, 12 Ortho Diaphragm All-flex/80MM, 43 Onetouch Combo Pack, 31 Novolog Mix 70/30, 12 Ortho Diaphragm Coil Spring Kit 100, 43 Onetouch Delica Lancets Extra Fine 33G, Novolog Mix 70/30 Prefilled Flexpen, 12 Ortho Diaphragm Coil Spring Kit 105, 43 Novolog Penfill, 12 Ortho Diaphragm Coil Spring Kit 50, 43 Onetouch Delica Lancets Fine 30G, 31 Ortho Diaphragm Flat Spring Kit 55, 43 Onetouch Delica Lancing Device, 31 Novoseven Rt, 17 Ortho Diaphragm Flat Spring Kit 60, 43 Onetouch Finepoint Lancets, 31 Novotwist 30GX8MM, 36 Ortho Diaphragm Flat Spring Kit 65, 43 Onetouch Lancets, 31 Novotwist 32GX5MM, 36 Ortho Diaphragm Flat Spring Kit 70, 43 Onetouch Ping Meter Remote, 31 Ortho Diaphragm Flat Spring Kit 75, 44 Onetouch Profile System, 31 Ortho Diaphragm Flat Spring Kit 80, 44 Onetouch Suresoft Lancing Device/18G, Ortho Diaphragm Flat Spring Kit 85, 44 PC Unifine Pentips 31G X 6MM Ultra Pharmacy Counter Lancets, 31 Ortho Diaphragm Flat Spring Kit 90, 44 SHORT, 37 Ortho Diaphragm Flat Spring Kit 95, 44 PC Unifine Pentips 31G X 8MM SHORT, phenazo, 16 ortho-CS 250, 27 phenazopyridine HCL, 16 phenelzine sulfate, 18 phenobarbital, 19 Pediatric Panda Mask, 40 Phenobarbital, 19 oscion cleanser, 8 Pedipirox-4 Nail, 8 Phenobarbital Sodium, 19 osmitrol viaflex, 7 Pedvax HIB, 26, 45 phenoxybenzamine hydrochloride, 6 peg 3350/electrolytes, 14, 47 phenylephrine HCL, 7, 22 peg-3350/electrolytes, 14, 47 peg-3350/NACL/NA bicarbonate/KCL, oxacillin sodium, 1 phenytoin infatabs, 19 phenytoin sodium, 19 Peg-intron Redipen, 2 phenytoin sodium extended, 19 Peg-intron Redipen PAK 4, 2 oxcarbazepine, 19 phospha 250 neutral, 41 Pegasys Proclick, 2 Phospholine Iodide, 22 oxybutynin chloride, 15 Pen Needles 29G X 12MM, 36 Physicians EZ Use Flu Kit 2012-2013, oxybutynin chloride ER, 15 Pen Needles 29GX1/2", 36 oxycodone HCL, 24 Pen Needles 30GX5/16", 36 Oxycodone HCL ER, 24 Pen Needles 31G X 1/4" SHORT, 36 physiosol irrigation, 41 oxycodone/acetaminophen, 24 Pen Needles 31G X 3/16", 36 phytonadione, 27 oxycodone/aspirin, 24 Pen Needles 31G X 6MM, 36 oxycodone/ibuprofen, 24 Pen Needles 31GX5/16", 36 pilocarpine HCL, 18, 22 penicillin G potassium, 1 pilocarpine hydrochloride, 18 oxymorphone hydrochloride, 24 penicillin v potassium, 1 oxymorphone hydrochloride ER, 24 Penlet II Automatic Bloodsampler, 31 Penlet II Replacement CAPS, 31 Penlet II Replacement CAPS-deep, 31 pioglitazone HCL, 12 Penlet II Replacement CAPS-regular, 31 pioglitazone HCL-glimepiride, 12 P
pioglitazone HCL/metformin HCL, 12 piperacillin sodium/ tazobactam sodium, PA Prenatal Formula, 28, 44 PA vitamin d-3, 27, 47 pentazocine/naloxone HCL, 24 piperacillin sodium/tazobactam sodium, 1 PA vitamin d-3 gummy, 27, 47 Pentips 31GX5MM, 36 Pentips 31GX8MM, 36 pirmella 1/35, 11, 43 Pentips 32GX4MM, 36 pirmella 7/7/7, 11, 43 pentoxifylline ER, 17 paliperidone ER, 19 Perfect Iron, 17, 45 plasbumin-25, 17 pamidronate disodium, 12 Perfect Lancets 30G, 31 Pamidronate Disodium, 12 Perfect Pressure Activated Safety Plasma-lyte A, 41 Pancrelipase, 14 Plasma-lyte-148, 41 pancuronium bromide, 21 Plasma-lyte-56/D5W, 41 Panda Mask Large, 40 perindopril erbumine, 6 Panda Mask Medium, 40 Pneumovax 23, 26, 45 Panda Mask Small, 40 Pneumovax 23/1 Dose, 26, 45 Pneumovax 23/5 Dose, 26, 45 pantoprazole sodium, 14 papaverine HCL, 7 Paragard Intrauterine Copper Perry Prenatal, 28, 44 Pocket Chamber, 40 Contraceptive T380a, 12 Pocket Spacer, 40 Pharmacist Choice Alcoholprep Pads, 40 paricalcitol, 13 Pharmacist Choice Ultra Thin Lancets, polocaine-mpf, 25 paromomycin sulfate, 1 Pharmacist Choice Ultra Thin Lancets paroxetine HCL, 18 poly-iron 150, 16, 45 paroxetine HCL ER, 18 Pharmacist Choice Ultra Thin Lancets poly-iron 150 forte, 16 Pharmacist Choice Ultra Thin Lancets polyethylene glycol 3350, 14 Pharmacist Choice Ultra Thin Lancets polymyxin b sulfate, 3 PC Unifine Pentips 29G X 1/2", 37 polymyxin b sulfate/trimethoprim sulfate, PC Unifine Pentips 31G X 5MM Mini, 37 Precision Sure-dose Plus Insulin Prenatal Plus DHA, 28 polysaccharide iron forte, 16 Syringe/1ML/29G X 1/2", 36 Prenatal Plus Iron, 28 Precision Thin Lancets, 31 Prenatal Vitamin, 28, 44 portia-28, 11, 43 Precision Thins GP Lancet, 31 Prenatal Vitamins, 28, 44 potassium acetate, 41 Precision Ultra Lancet, 31 potassium chloride, 41 Prenatal/Omega-3/Folic Acid/Iron, 28 potassium chloride 0.15% /NACL 0.45% Prentif Cavity-rim Cervical CAP, 44 Prentif Fitting Set, 44 potassium chloride 0.15% D5W/NACL prednisolone acetate, 21 prednisolone sodium phosphate, 10 potassium chloride 0.15% D5W/NACL prednisolone sodium phosphate odt, 10 previfem, 11, 43 Prevnar 13, 26, 45 potassium chloride 0.15% D5W/NACL 0.45% viaflex, 41 Prednisone Intensol, 10 potassium chloride 0.15% NACL 0.9%, Preferred Plus Insulin Syringe/U- 100/0.3ML/29G X 1/2", 36 potassium chloride 0.15% w/NACL 0.9% Preferred Plus Insulin Syringe/U- Primaquine Phosphate, 3 100/0.3ML/30G X 5/16", 36 potassium chloride 0.15%/D5W, 41 Preferred Plus Insulin Syringe/U- potassium chloride 0.22% D5W/NACL 100/0.5ML/28G X 1/2", 36 Preferred Plus Insulin Syringe/U- potassium chloride 0.224%/D5W/NACL 100/0.5ML/29G X 1/2", 36 Preferred Plus Insulin Syringe/U- Proair Respiclick, 26 potassium chloride 0.224%D5W/NACL 100/0.5ML/30G X 5/16", 36 0.45% viaflex, 41 Preferred Plus Insulin Syringe/U- potassium chloride 0.3%/D5W, 41 100/1ML/28G X 1/2", 36 potassium chloride 0.3%/NACL Preferred Plus Insulin Syringe/U- prochlorperazine, 19 0.9%/viaflex, 41 100/1ML/29G X 1/2", 36 prochlorperazine edisylate, 19 potassium chloride CR, 41 Preferred Plus Insulin Syringe/U- prochlorperazine maleate, 19 potassium chloride ER, 41 100/1ML/30G X 5/16", 36 Potassium Chloride ER, 41 Preferred Plus Lancets Colored 21G, 31 potassium chloride SR, 41 Preferred Plus Lancets Super Thin 30G, proctosol HC, 15 potassium citrate ER, 15 proctozone-HC, 9, 15 potassium citrate-citric acid crystals, 15 Preferred Plus Lancets Thin 26G, 31 potassium citrate/citric acid, 15 Preferred Plus Unifine Pentips 29G X Prodigy Insulin Mini Pen Needles/31G X potassium citrate/sodium citrate/citric Preferred Plus Unifine Pentips 31G X Prodigy Insulin Pen Needles/29G X 1/2", potassium phosphate, 41 6MM Ultra SHORT, 36 potassium phosphates, 41 Preferred Plus Unifine Pentips 31G X Prodigy Insulin SHORT Penneedles/31G pr benzoyl peroxide wash, 8 Preferred Plus Unifine Pentips Prodigy Insulin Syring/U-100/0.3ML/31G Pr Natal 400, 28 Pr Natal 400 EC, 28 Preferred Plus Unifine Prodigy Insulin Syringe/1/2ML/31G X Pr Natal 430, 28 Pentips/Mini/31GX5MM, 36 Pr Natal 430 EC, 28 pregnyl w/diluent benzyl alcohol/NACL, Prodigy Insulin Syringe/1ML/28G X 1/2", Prodigy Lancing Device, 36 pramipexole dihydrochloride, 20 Prodigy Pressure Activated Safety pramipexole dihydrochloride ER, 20 premium lidocaine, 9 Prodigy Twist Top Lancets, 31 Prenaissance Plus, 28 Proferrin ES, 17, 45 Prenaplus, 29, 44 pravastatin sodium, 7 Profilnine SD, 18 progesterone, 12 Pre-natal Formula, 28, 44 Precision Sure-dose Insulin Syringe/0.3ML/30G X 5/16", 36 Precision Sure-dose Insulin Prenatal And Iron, 28, 44 Syringe/0.5ML/28G X 1/2", 36 Prenatal Complete, 28, 44 Precision Sure-dose Insulin Prenatal Formula, 28, 44 Syringe/0.5ML/29G X 1/2", 36 Prenatal Forte, 28, 44 Precision Sure-dose Insulin Prenatal Low Iron, 29, 44 promethazine HCL, 25 Syringe/0.5ML/30G X 3/8", 36 Prenatal Multi + DHA, 28 promethazine HCL plain, 25 Precision Sure-dose Insulin Prenatal Multi +dha, 28, 44 promethazine VC plain, 25 Syringe/1ML/28G X 1/2", 36 Prenatal Multivitamin + DHA, 28 promethazine VC/codeine, 25 Precision Sure-dose Plus Insulin Prenatal One Daily, 28, 44 promethazine-DM, 25 Syringe/0.3ML/29G X 1/2", 36 Prenatal Plus, 29, 44 promethazine/codeine, 25 promethazine/dextromethorphan, 25 Qc Insulin Syringe/1ML/29G X 1/2", 37 ranitidine HCL, 14 promethazine/phenylephrine, 25 Qc Insulin Syringe/1ML/30G, 37 promethazine/phenylephrine/codeine, 25 Qc Insulin Syringe/1ML/31G X 5/16", 37 pronutrients vitamin d3, 27, 46 Qc Lancets Super Thin, 31 propafenone HCL, 6 Qc Lancets Thin, 31 propafenone HCL ER, 6 Qc Lancets Ultra Thin, 31 Reality Insulin Syringe/U-100/0.5ML/28G proparacaine HCL, 22 qc nicotine polacrilex, 20, 46 propranolol HCL, 6 Qc Pen Needles 29G X 12MM, 37 Reality Insulin Syringe/U-100/0.5ML/29G propranolol HCL ER, 6 Qc Pen Needles 31G X 6MM, 37 propylthiouracil, 13 Qc Pen Needles 31G X 8MM, 37 Reality Insulin Syringe/U-100/1ML/28G X Qc Prenatal, 28, 44 Qc Unifine Pentips 32GX4MM, 37 Reality Insulin Syringe/U-100/1ML/29G X protriptyline HCL, 18 Quadracel, 26, 45 Reality Lancets, 31 Pss Select GP Lancets, 31 quetiapine fumarate, 19 Reality Swabs, 40 Pss Select Platforms, 37 Quflora Pediatric, 28 Reality Trigger Lancets, 31 Pss Select Safety Lancets, 31 Quillivant XR, 19 Pulmicort Flexhaler, 26 Rebif Rebidose, 20 quinidine gluconate CR, 6 Rebif Rebidose Titration Pack, 20 purevit dualfe plus, 16 quinidine gluconate ER, 6 Rebif Titration Pack, 20 Px Advanced Lancing Device, 37 quinidine sulfate, 6 reciphexamine, 9 px aspirin, 23, 42 Quinidine Sulfate, 6 reclipsen, 11, 43 px enteric aspirin, 23, 42 quinine sulfate, 3 Px Extra SHORT Pen Needles Recombivax HB, 27, 45 R
px folic acid, 16, 44 Ra Alcohol Swabs, 40 Px Insulin Syringe/U-100/0.3ML/30G X ra aspirin, 23, 42 relador PAK plus, 9 ra aspirin adult low dose, 23, 42 Px Insulin Syringe/U-100/0.3ML/31G X ra aspirin adult low strength, 23, 42 Relenza Diskhaler, 2 ra aspirin childrens, 23, 42 Px Insulin Syringe/U-100/0.5ML/30G X Relion Alcohol Swabs, 40 ra aspirin EC, 23, 42 Relion Insulin Syringe/U -100/0.5ML/29G, ra aspirin EC adult low strength, 23, 42 Px Insulin Syringe/U-100/0.5ML/31G X ra childrens aspirin, 23, 42 Relion Insulin Syringe/U-00/1ML/29G X Ra E-ZJECT Color Lancets Micro-thin Px Insulin Syringe/U-100/1ML/30G X Relion Insulin Syringe/U-100/0.3ML/29G, Ra E-ZJECT Lancets 28G, 31 Px Insulin Syringe/U-100/1ML/31G X Ra E-ZJECT Lancets Thin 26G, 31 Relion Insulin Syringe/U-100/0.3ML/29G Ra E-ZJECT Lancets Thin 28G, 31 Ra E-ZJECT Lancets Ultra Thin 30G, 31 Px Lancet Auto Injector, 37 Relion Insulin Syringe/U-100/0.3ML/30G, ra folic acid, 16, 44 Px Lancets Ultra Thin, 31 ra high potency iron, 16, 45 Px Mini Pen Needles 31GX5MM, 37 Relion Insulin Syringe/U-100/0.3ML/30G Ra Insulin Syringe/0.5ML/29G X 1/2", 37 Px Pen Needle 29GX12MM, 37 Ra Insulin Syringe/1ML/29G X 1/2", 37 Px Pen Needle 31GX8MM, 37 Relion Insulin Syringe/U-100/0.3ML/31G Ra Insulin Syringe/U-100/0.5ML/30G X Px Prenatal Multivitamins, 28, 44 Px Shortlength Pen Needles/31GX8MM, Relion Insulin Syringe/U-100/0.5ML/29G Ra Insulin Syringe/U-100/1 ML/30G X px stop smoking aid, 20, 46 Relion Insulin Syringe/U-100/0.5ML/30G, Ra Lancing Device, 37 Relion Insulin Syringe/U-100/0.5ML/30G ra mini nicotine, 20, 46 pyridostigmine bromide, 21 ra nicotine, 20, 46 Q
Relion Insulin Syringe/U-100/0.5ML/31G ra nicotine polacrilex, 20, 46 Qc Advanced Lancing Device, 37 ra nicotine transdermal system step 3, Relion Insulin Syringe/U-100/1ML/30G, Qc Alcohol Swabs, 40 qc aspirin, 23, 42 Ra One Daily, 28, 44 Relion Insulin Syringe/U-100/1ML/30G X qc aspirin low dose, 23, 42 Ra Pen Needles 31G X 5MM 3/16", 37 qc childrens aspirin, 23, 42 Ra Pen Needles 31G X 8MM 5/16", 37 Relion Insulin Syringe/U-100/1ML/31G X qc ferrous sulfate, 16, 45 Ra Prenatal, 28, 44 Qc Insulin Syringe 0.5ML/29G, 37 Ra Prenatal Formula/Folicacid, 28, 44 Relion Ketone, 41 Qc Insulin Syringe 0.5ML/30G, 37 ra slow release iron, 16, 45 Relion Ketone Test Strips, 41 Qc Insulin Syringe 1ML/29G, 37 ra vitamin d-3, 27, 46 Relion Lancets Micro-thin33G, 31 Qc Insulin Syringe/0.3ML/29G, 37 Relion Lancets Standard 21G, 31 Qc Insulin Syringe/0.3ML/29G X 1/2", 37 rabeprazole sodium, 14 Relion Lancets Thin 26G, 31 Qc Insulin Syringe/0.5ML/29G X 1/2", 37 raloxifene hydrochloride, 13 Relion Lancets Ultra-thin30G, 31 Qc Insulin Syringe/0.5ML/31G X 5/16", Relion Lancing Device, 37 Relion Mini Pen Needles 31GX6MM, 37 Relion Pen Needles 29GX12MM, 37 rivastigmine tartrate, 20 Relion Pen Needles 31GX8MM, 37 rivastigmine transdermal system, 20 SB Alcohol Prep Pads, 40 Relion Pen Needles 32GX4MM, 37 SB aspirin, 23, 42 Relion SHORT Pen Needles 31GX8MM, rizatriptan benzoate, 24 SB aspirin EC, 23, 42 rizatriptan benzoate odt, 24 SB childrens aspirin, 23, 42 Relion Thin Lancets, 31 rocuronium bromide, 21 SB Insulin Syringe/U-100/0.5ML/29G X Relion Ultra Thin Lancets, 31 Relion Ultra Thin Lancets30G, 31 ropinirole ER, 20 SB Insulin Syringe/U-100/0.5ML/30G X Relion Ultra Thin Plus Lancets 32G, 31 ropinirole HCL, 20 Relion Ultra Thin Plus Lancets 33G, 31 SB Insulin Syringe/U-100/1ML/29G X ropivacaine HCL, 25 SB Insulin Syringe/U-100/1ML/30G X rosanil cleanser, 8 SB Insulin Syringe/U-100/1ML/31G X rena-vite RX, 28 SB Lancets Thin, 32 SB Lancets Ultra Thin, 32 SB low dose asa EC, 23, 42 S
Renew Advanced Lancing Cartridge Schnucks Insulin Syringe Ulti-fine/U- 100/0.5ML/29G X 1/2", 37 Safe-t-lance Low Flow 25G, 31 Renew Advanced Lancing Device, 37 Schnucks Insulin Syringe Ulti-fine/U- Safe-t-lance Normal Flow 21G, 31 100/0.5ML/30G X 5/16", 37 Safe-t-lance Plus Safety Lancet High Safe-t-lance Plus Safety Lancet Low Replesta, 27, 47 Replesta Childrens, 27, 47 Safe-t-lance Plus Safety Lancet Normal Replesta Nx, 27, 47 seb-prev wash, 9 Safesnap Insulin Syringe/0.3ML/30G X Select-lite Device/Lancets, 37 Select-lite Lancing Device, 37 Safesnap Insulin Syringe/0.5ML/29G X Retrovir IV Infusion, 2 selegiline HCL, 20 selenium sulfide, 9 Safesnap Insulin Syringe/0.5ML/30G X Rexall Lancets Ultra Thin, 31 Safesnap Insulin Syringe/1ML/28G X sensorcaine-mpf, 25 Safesnap Insulin Syringe/1ML/29G X Rhogam Ultra-filtered Plus, 41 sensorcaine-mpf spinal, 25 Safety Lancet 21G/Pressure Activated, Serevent Diskus, 26 Safety Lancet 28G/Pressure Activated, Ribasphere Ribapak, 2 Safety Lancets, 31 Safety Lancets 21G, 31 sertraline HCL, 18 Safety Lancets 28G, 31 setlakin, 11, 43 Safety Let Lancets, 31 Sevelamer Carbonate, 15 Safety Seal Lancets 28G, 31 Safety Seal Lancets 30G, 31 SF 5000 plus, 18 Safety-glide Insulin Syringe/0.3ML/29G X sharobel, 11, 43 Right Step Prenatal, 28, 44 Shopko Alcohol Swabs, 40 Rightest GD-L500 Alternate Site Adapter, Shopko Autolet Lancing Device, 37 salicylic acid, 9 Shopko On-the-go Comfort Lancets 30G, salicylic acid cream, 9 Rightest GD500 Lancing Device, 37 salicylic acid lotion, 9 Rightest Gl300 Lancets, 31 Shopko Unifine Pentips Pen salicylic acid wart remover, 9 rimantadine HCL, 2 Shopko Unifine Pentips Pen saline flush zr/sterile field, 41 ringers injection, 41 Needles/Mini/31GX5MM, 37 ringers irrigation, 41 Shopko Unifine Pentips Pen risedronate sodium, 12 Shopko Unifine Pentips Pen risedronate sodium DR, 12 Sandostatin Lar Depot, 13 Risperdal Consta, 19 Shopko Unilet Lancets Super Thin 30G, Saps Care Alcohol Prep Pads, 40 risperidone M-TAB, 19 Shopko Unilet Lancets Ultra Thin 28G, Sapscare Twist Top Lancets 30G, 31 risperidone odt, 19 sash kit for flushing vascular access Shur-seal, 15, 44 Smart Diabetes Vantage Universal sildenafil citrate, 8 silver sulfadiazine, 9 Smart Sense Color Lancets Universal st joseph aspirin, 23, 42 Similac Prenatal Early Shield, 28 Simple Diagnostics Lancing Device, 37 Smart Sense Standard Lancets Universal stannous fluoride oral rinse, 18 Simponi Aria, 24 Smart Sense Super Thin Lancets Universal 30G, 32 Sterilance PA, 37 Smart Sense Thin Lancets Universal Sterilance TL, 32 sterile diluent for epoprostenol sodium, Smartest Lancets 28G, 32 sodium acetate, 41 sterile water for injection, 41 sodium bicarbonate, 41 sterile water irrigation, 41 sodium bicarbonate partial fill, 41 sterile water irrigation plastic bottle, 41 sodium chloride, 15, 25, 41 sterile water irrigation w/hanger, 41 slow iron, 16, 45 sodium chloride 0.45%, 41 slow release iron, 16, 45 sodium chloride 0.45% viaflex, 41 Slow Release Iron, 17, 45 sodium chloride 0.9%, 15 slow-release iron, 16, 45 sodium chloride bacteriostatic, 41 Streptomycin Sulfate, 1 Sm Alcohol Prep Pads, 40 sodium chloride flush, 41 sm aspirin, 23, 42 sodium chloride pab, 41 sm aspirin adult low strength, 23, 42 sodium citrate/citric acid, 16 strovite plus, 28 sm aspirin EC low strength, 23, 42 Sodium Edecrin, 7 sm aspirin enteric coated, 23, 42 sodium ferric gluconate complex/sucrose, Stuart Prenatal, 28, 44 sm aspirin low dose, 23, 42 sm childrens aspirin, 23, 42 sodium fluoride, 41, 44 sm folic acid, 16, 44 sodium hyaluronate, 9 Sm Insulin Syringe/0.3ML/31G X 5/16", sodium phenylbutyrate, 13 sulfacetamide sodium, 8, 21 sodium phosphate, 41 sulfacetamide sodium/prednisolone Sm Insulin Syringe/0.5ML/31G X 5/16", sodium polystyrene sulfonate, 41 sodium phosphate, 21 sodium sulfacetamide, 8, 9, 21 sulfacetamide sodium/sulfur cleanser, 8 Sm Insulin Syringe/1ML/31G X 5/16", 37 sodium sulfacetamide wash, 9 sulfacleanse 8/4, 8 Sm Insulin Syringe/U-100/0.3ML/29G X sodium sulfacetamide/sulfur, 8 sodium sulfacetamide/sulfur cleanser, 8 Sm Insulin Syringe/U-100/0.3ML/30G X sodium sulfacetamide/sulfur cleansing sulfamethoxazole/trimethoprim DS, 3 Sm Insulin Syringe/U-100/0.5ML/28G X sodium sulfacetamide/sulfur green, 8 sulfasalazine, 15 sodium sulfacetamide/sulfur w/sunscreen, sulfatrim pediatric, 3 Sm Insulin Syringe/U-100/0.5ML/29G X sodium sulfacetamide/sulfur wash, 8 sulfazine EC, 15 Sm Insulin Syringe/U-100/0.5ML/30G X sodium thiosulfate, 41 sumatriptan succinate, 24 Sm Insulin Syringe/U-100/1ML/28G X Sumatriptan Succinate, 24 sumatriptan succinate refill, 24 Sm Insulin Syringe/U-100/1ML/29G X Super Daily D3, 27, 47 Solus V2 Lancing Device, 37 Super Thin Lancets, 32 Sm Insulin Syringe/U-100/1ML/30G X Solus V2 Pressure Activated Safety Supprelin LA, 13 Solus V2 Twist Lancets 30G, 32 Supreme II Confidence Paddles, 37 sm iron slow release, 16, 45 Somatuline Depot, 13 Suprep Bowel Prep, 14 Sm Lancets 21G, 31 Sure Comfort Alcohol Prep Pads, 40 Sm Micro Thin Lancets 33G, 31 Sure Comfort Insulin Syringe/U- sm nicotine, 20, 46 100/0.3ML/29G X 1/2", 37 sm nicotine polacrilex, 20, 46 sotalol HCL (AF), 6 Sure Comfort Insulin Syringe/U- sm nicotine transdermal system, 20, 46 100/0.3ML/30G X 1/2", 37 Sm One Daily Prenatal, 28, 44 Spiriva Handihaler, 26 Sure Comfort Insulin Syringe/U- sm prenatal vitamins, 28, 44 Spiriva Respimat, 26 100/0.3ML/30G X 5/16", 37 Sm Prenatal Vitamins, 28, 44 spironolactone, 7 Sure Comfort Insulin Syringe/U- Sm Slow Release Iron, 17, 45 100/0.3ML/31G X 5/16, 37 Sm Super Thin Lancets, 31 Sure Comfort Insulin Syringe/U- Sm Super Thin Lancets 30G, 31 sprintec 28, 11, 43 100/0.3ML/31G X 5/16", 37 Sm Thin Lancets 26G, 32 Sure Comfort Insulin Syringe/U- sm vitamin d, 27, 46 100/0.5ML/28G X 1/2", 37 sm vitamin d3, 27, 46 Sure Comfort Insulin Syringe/U- Sm Vitamin D3 Maximum Strength, 27, SR nicotine gum, 20, 46 100/0.5ML/29G X 1/2", 37 Sure Comfort Insulin Syringe/U- Smart Diabetes Vantage Lancing Device, ss 10-2, 8 100/0.5ML/30G X 1/2", 37 Sure Comfort Insulin Syringe/U- Surestep Pro Linearity Kit, 32 100/0.5ML/30G X 5/16", 37 Surestep Pro Low Glucose Control, 32 Terumo Insulin Syringe/0.3ML/30G X Sure Comfort Insulin Syringe/U- Surestep Pro Normal Glucose Control, 100/0.5ML/31G X 5/16, 37 Terumo Insulin Syringe/0.5ML/29G X Sure Comfort Insulin Syringe/U- Surestep Pro Test Strips, 32 100/1ML/28G X 1/2", 37 Surestep Test Strips, 32 Terumo Insulin Syringe/0.5ML/30G X Sure Comfort Insulin Syringe/U- 100/1ML/29G X 1/2", 37 Terumo Insulin Syringe/1ML/27G X 1/2", Sure Comfort Insulin Syringe/U- sw nicotine polacrilex, 20, 46 100/1ML/30G X 1/2", 37 swabflush saline flush, 41 Terumo Insulin Syringe/1ML/29G X 1/2", Sure Comfort Insulin Syringe/U- 100/1ML/30G X 5/16", 37 Terumo Insulin Syringe/1ML/30G X 3/8", Sure Comfort Insulin Syringe/U- symax fastabs, 14 100/1ML/31G X 5/16", 37 Terumo Insulin Syringe/U-100/0.3ML/29G Sure Comfort Lancets 28G, 32 Sure Comfort Lancets 30G, 32 Terumo Insulin Syringe/U-100/0.5ML/27G Sure Comfort Lancing Pen, 37 Symlinpen 120, 12 Sure Comfort Pen Needles 29GX1/2" Terumo Insulin Syringe/U-100/0.5ML/28G Sure Comfort Pen Needles 30GX5/16" Terumo Insulin Syringe/U-100/1ML/28G Sure Comfort Pen Needles 31GX3/16" Terumo Surguard Insulin Syringe/0.3ML/29G X 1/2", 38 Sure Comfort Pen Needles 31GX5/16" Terumo Surguard Insulin Syringe/0.5ML/28G X 1/2", 38 Sure Comfort Pen Needles 32GX5/32", T
Terumo Surguard Insulin Syringe/0.5ML/29G X 1/2", 38 Sure Comfort Pen Needles 32GX6MM, Terumo Surguard Insulin Syringe/1ML/28G X 1/2", 38 Sure-fine Pen Needles 29GX1/2" Terumo Surguard Insulin Syringe/1ML/29G X 1/2", 38 take action, 11, 43 Sure-fine Pen Needles 31GX3/16" 5MM, testosterone, 10 Testosterone, 10 Sure-fine Pen Needles 31GX5/16" 8MM, testosterone cypionate, 10 tamoxifen citrate, 4, 47 testosterone enanthate, 10 tamsulosin HCL, 16 Sure-ject Insulin Syringe/U- Testosterone P.M., 10 100/0.3ML/29G X 1/2", 37 Tetanus Toxoid Adsorbed, 26 Sure-ject Insulin Syringe/U- Tetanus/Diphtheria Toxoids-adsorbed, tarina FE 1/20, 11, 43 100/0.3ML/30G X 5/16", 37 taron-crystals, 15 Sure-ject Insulin Syringe/U- Tetanus/Diphtheria Toxoids-adsorbed 100/0.3ML/31G X 5/16", 37 Sure-ject Insulin Syringe/U- 100/0.5ML/28G X 1/2", 37 tetrabenazine, 20 Sure-ject Insulin Syringe/U- tetracaine HCL, 22 100/0.5ML/29G X 1/2", 37 Tetracaine HCL, 25 Sure-ject Insulin Syringe/U- Tetracycline HCL, 1 100/0.5ML/30G X 5/16", 37 Tecfidera Starter Pack, 20 Sure-ject Insulin Syringe/U- tetravisc forte, 22 Techlite AST Lancets, 32 100/0.5ML/31G X 5/16", 37 Techlite Lancets, 32 Sure-ject Insulin Syringe/U-100/1ML/28G Tgt Advanced Lancing Device, 38 Techlite Lancets 30G, 32 Tgt Alcohol Swabs, 40 Sure-ject Insulin Syringe/U-100/1ML/29G tgt aspirin, 23, 42 tgt aspirin low dose, 23, 42 Sure-ject Insulin Syringe/U-100/1ML/30G tgt childrens aspirin, 23, 42 tgt enteric-coated aspirin, 23, 42 Sure-ject Insulin Syringe/U-100/1ML/31G Tgt Lancet Alternate Site, 32 Tgt Lancet Micro Thin 33G, 32 Sure-lance Flat Lancets, 32 Tgt Lancet Super Thin 30G, 32 Sure-lance Lancets 26G, 32 Tgt Lancet Thin 23G, 32 Sure-lance Thin Lancets 28G, 32 Tgt Lancet Thin 26G, 32 Sure-lance Ultra Thin Lancets, 32 Tgt Lancet Ultra Thin 28G, 32 Tgt Lancet Ultra Thin 30G, 32 Sure-prep Alcohol Prep Pads, 40 Tgt Lancing Device, 38 Sure-touch Lancets Universal, 32 tgt nicotine gum, 20, 46 Surelite Lancets, 32 tgt nicotine polacrilex, 20, 46 Surestep Glucose Control, 32 tgt nicotine step one, 20, 46 Surestep Glucose Control Solution, 32 tgt nicotine step three, 20, 46 terbinafine HCL, 2 Surestep Pro High Glucosecontrol, 32 tgt nicotine step two, 20, 46 terbutaline sulfate, 25 th aspirin, 23, 42 th aspirin low dose, 23, 42 topotecan HCL, 5 th enteric aspirin, 23, 42 tizanidine HCL, 21 th folic acid, 16, 44 Th Prenatal Vitamins, 28, 44 th slow release iron, 16, 45 th vitamin d3, 27, 46 tpn electrolytes, 41 Tracer II 3 Volt Battery, 38 tobramycin sulfate, 1, 21 theophylline, 25 tramadol HCL, 24 theophylline CR, 25 tramadol HCL ER, 24 theophylline ER, 25 tramadol hydrochloride/acetaminophen, thera-d 2000, 27, 46 Todays Health Advanced Lancing Device, Thera-d 4000, 27, 47 thera-d rapid repletion, 27, 46 Todays Health Mini Pen Needles 31G X trandolapril/verapamil HCL, 7 thera-d sport, 27, 46 trandolapril/verapamil HCL ER, 7 Todays Health Original Pen Needles 29G tranexamic acid, 17 Transderm-scop, 14 thiamine HCL, 27 Todays Health SHORT Pen Needles 31G tranylcypromine sulfate, 18 Thinlets GP Lancets, 32 Thinlets Lancet, 32 Todays Health Super Thin Lancets 30G, Travel Lancets 30G, 32 Thinpro Insulin Syringe/0.3ML/29G X trazodone HCL, 18 Todays Health Ultra Thin Lancets 28G, Thinpro Insulin Syringe/0.3ML/30G X Thinpro Insulin Syringe/0.3ML/31G X Trelstar Mixject, 4 Thinpro Insulin Syringe/0.5ML/28G X tolmetin sodium, 24 Tolmetin Sodium, 24 Thinpro Insulin Syringe/0.5ML/29G X tolterodine tartrate, 15 tri-estarylla, 11, 43 tolterodine tartrate ER, 15 tri-legest FE, 11, 43 Thinpro Insulin Syringe/0.5ML/30G X Topcare Clickfine Universal Pen Eedles tri-linyah, 11, 43 tri-previfem, 11, 43 Thinpro Insulin Syringe/0.5ML/31G X Topcare Clickfine Universal Pen Eedles tri-sprintec, 11, 43 31GX5/16", 38 tri-vit/fluoride, 28 Thinpro Insulin Syringe/1ML/28G X 1/2", Topcare Ultra Comfort Insulin tri-vitamin/fluoride, 28 Syringe/0.3ML/30G X 5/16", 38 Thinpro Insulin Syringe/1ML/29G X 1/2", Topcare Ultra Comfort Insulin triamcinolone acetonide, 9, 18, 25 Syringe/0.3ML/31G X 5/16", 38 triamcinolone IN orabase, 18 Thinpro Insulin Syringe/1ML/30G X 3/8", Topcare Ultra Comfort Insulin Syringe/0.5ML/30G X 5/16", 38 Thinpro Insulin Syringe/1ML/31G X 3/8", Topcare Ultra Comfort Insulin Syringe/0.5ML/31G X 5/16", 38 thioridazine HCL, 19 Topcare Ultra Comfort Insulin Syringe/1ML/30G X 5/16", 38 Topcare Ultra Comfort Insulin Thrombate Iii W/10 ML Sterile Water, 18 Syringe/1ML/31G X 5/16", 38 Thrombate Iii W/20 ML Sterile Water, 18 Topcare Ultra Comfort Insulin Syringe/U- trifluoperazine HCL, 19 Thymoglobulin, 4 100/0.3ML/29G X 1/2", 38 trifluridine, 21 Topcare Ultra Comfort Insulin Syringe/U- trigels-f forte, 16 100/0.5ML/29G X 1/2", 38 Thyrolar-1/2, 13 Topcare Ultra Comfort Insulin Syringe/U- trihexyphenidyl HCL, 20 Thyrolar-1/4, 13 100/1ML/29G X 1/2", 38 Topco Insulin Syringe/U-100/0.3ML/29G trimethobenzamide HCL, 14 tiagabine hydrochloride, 19 Topco Insulin Syringe/U-100/0.5ML/28G trimethoprim sulfate/polymyxin b sulfate, ticlopidine HCL, 17 Topco Insulin Syringe/U-100/0.5ML/29G Trinatal RX 1, 28 tilia FE, 11, 43 Topco Insulin Syringe/U-100/1ML/28G X trinessa, 11, 43 Timolol Maleate, 6 Topco Insulin Syringe/U-100/1ML/29G X timolol maleate, 21 timolol maleate ophthalmic gel forming, topex topical anesthetic, 18 trivora-28, 11, 43 trospium chloride, 15 trospium chloride ER, 15 Ulticare Insulin Syringe/0.5ML/28G X Ulticare Thin Lancets 30G, 32 Truedraw Lancing Device, 38 Ultiguard Insulin Syringe/U- Trueplus Insulin Syringe/U- Ulticare Insulin Syringe/0.5ML/29G X 100/0.3ML/29G X 1/2", 38 100/0.3ML/29G X 1/2", 38 Ultiguard Insulin Syringe/U- Trueplus Insulin Syringe/U- Ulticare Insulin Syringe/0.5ML/30G X 100/0.3ML/30G X 5/16", 38 100/0.3ML/30G X 5/16", 38 Ultiguard Insulin Syringe/U- Trueplus Insulin Syringe/U- Ulticare Insulin Syringe/0.5ML/30G X 100/0.5ML/29G X 1/2", 38 100/0.3ML/31G X 5/16", 38 Ultiguard Insulin Syringe/U- Trueplus Insulin Syringe/U- Ulticare Insulin Syringe/1ML/28G X 1/2", 100/0.5ML/30G X 5/16", 38 100/0.5ML/28G X 1/2", 38 Ultiguard Insulin Syringe/U-100/1ML/29G Trueplus Insulin Syringe/U- Ulticare Insulin Syringe/1ML/29G X 1/2", 100/0.5ML/29G X 1/2", 38 Ultiguard Insulin Syringe/U-100/1ML/30G Trueplus Insulin Syringe/U- Ulticare Insulin Syringe/1ML/30G X 1/2", 100/0.5ML/30G X 5/16", 38 Ultilet Classic Lancets, 32 Trueplus Insulin Syringe/U- Ulticare Insulin Syringe/1ML/30G X 5/16", Ultilet Insulin Syringe/SHORT/0.3ML/30G 100/0.5ML/31G X 5/16", 38 Trueplus Insulin Syringe/U-100/1ML/28G Ulticare Insulin Ultilet Insulin Syringe/SHORT/0.3ML/31G Syringe/SHORT/0.3ML/30G X 5/16", 38 Trueplus Insulin Syringe/U-100/1ML/29G Ulticare Insulin Ultilet Insulin Syringe/SHORT/0.5ML/30G Syringe/SHORT/0.3ML/31G X 5/16", 38 Trueplus Insulin Syringe/U-100/1ML/30G Ulticare Insulin Ultilet Insulin Syringe/SHORT/0.5ML/31G Syringe/SHORT/0.5ML/30G X 5/16", 38 Trueplus Insulin Syringe/U-100/1ML/31G Ulticare Insulin Ultilet Insulin Syringe/SHORT/1ML/30G X Syringe/SHORT/0.5ML/31G X 5/16", 38 Trueplus Lancets 26G, 32 Ulticare Insulin Syringe/SHORT/1ML/30G Ultilet Insulin Syringe/SHORT/1ML/31G X Trueplus Lancets 28G, 32 Trueplus Lancets 28G Super Thin, 32 Ulticare Insulin Syringe/SHORT/1ML/31G Ultilet Lancets, 32 Trueplus Lancets 30G, 32 Ultilet Lancets 33G, 32 Trueplus Lancets 30G Ultra Thin, 32 Ulticare Insulin Syringe/U-100/0.3ML/29G Ultilet Pen Needle 32GX4MM/SHORT, Trueplus Lancets 33G, 32 Trueplus Lancets 33G Micro Thin, 32 Ulticare Insulin Syringe/U-100/0.3ML/30G Ultilet Safety Lancets 23G, 32 Trueplus Safety Lancets 28G, 32 Ultilet SHORT Pen Needles 31GX5/16", Trumenba, 27, 45 Ulticare Insulin Syringe/U-100/0.3ML/30G Ultilet SHORT Pen Needles31GX3/16", Tudorza Pressair, 26 Ulticare Insulin Syringe/U-100/0.3ML/31G Ultimatecare One, 28 Ulticare Insulin Syringe/U-100/0.5ML/29G Ultimatecare One NF, 28 Ultra Comfort Insulin Syringe/U- Ulticare Insulin Syringe/U-100/0.5ML/30G 100/0.3ML/30G X 5/16", 38 Ultra Comfort Insulin Syringe/U- Ulticare Insulin Syringe/U-100/0.5ML/30G 100/0.5ML/28G X 1/2", 38 Tyvaso Refill, 8 Ulticare Insulin Syringe/U-100/0.5ML/31G Ultra Thin Lancets 28G, 32 Tyvaso Starter, 8 Ultra Thin Lancets 30G, 32 Ulticare Insulin Syringe/U-100/1ML/29G X Ultra-comfort Insulin Syringe/U- U
100/0.3ML/29G X 1/2", 38 Ulticare Insulin Syringe/U-100/1ML/30G X Ultra-comfort Insulin Syringe/U- 100/0.3ML/30G X 5/16", 38 Ulticare Insulin Syringe/U-100/1ML/30G X Ultra-comfort Insulin Syringe/U- 100/0.3ML/31G X 5/16", 38 Ulti-lance Automatic/ Clear Tip, 38 Ulticare Insulin Syringe/U-100/1ML/31G X Ultra-comfort Insulin Syringe/U- Ulticare Insulin Safety Syringe/0.5ML/29G 100/0.5ML/28G X 1/2", 38 Ulticare Micro Pen Needles/32G X 4MM, Ultra-comfort Insulin Syringe/U- Ulticare Insulin Safety Syringe/1ML/29G 100/0.5ML/29G X 1/2", 38 Ulticare Mini Pen Needles 31GX6MM, 38 Ultra-comfort Insulin Syringe/U- Ulticare Insulin Syringe 1CC/28G U-100 Ulticare Mini Pen Needles Ulti-fine IV, 38 100/0.5ML/30G X 5/16", 38 Ulticare Mini Pen Needles/31G X 6MM, Ultra-comfort Insulin Syringe/U- Ulticare Insulin Syringe Ultrafine U- 100/0.5ML/31G X 5/16", 38 100/0.3ML/31G X 5/16", 38 Ulticare Mini Pen Needles31GX6MM, 38 Ultra-comfort Insulin Syringe/U- Ulticare Insulin Syringe Ultrafine U- Ulticare Original Pen Needles Ulti-fine, 100/1ML/28G X 1/2", 38 100/0.5ML/31G X 5/16", 38 Ultra-comfort Insulin Syringe/U- Ulticare Insulin Syringe Ultrafine U- Ulticare Pen Needles/29G X 12.7MM, 38 100/1ML/29G X 1/2", 39 100/1ML/31G X 5/16", 38 Ulticare SHORT Pen Needles 31GX8MM, Ultra-comfort Insulin Syringe/U- Ulticare Insulin Syringe/0.3ML/29G X 100/1ML/30G X 5/16", 39 Ulticare SHORT Pen Needles Ulti-fine IV, Ultra-comfort Insulin Syringe/U- Ulticare Insulin Syringe/0.3ML/30G X 100/1ML/31G X 5/16", 39 Ulticare SHORT Pen Needles/31G X Ultra-thin II Auto Lancet, 32 Ulticare Insulin Syringe/0.3ML/30G X Ultra-thin II Insulin Syringe SHORT/U- Unistik Safety Lancets 30G, 32 Valumark Lancet Ultra Thin 28G, 32 100/0.3ML/30GX5/16", 39 Valumark Pen Needles 29GX12MM, 39 Ultra-thin II Insulin Syringe SHORT/U- unithroid direct, 14 Valumark Pen Needles 31G X 6MM, 39 100/0.3ML/31GX5/16", 39 Universal 1 Lancets Thin 26G, 32 Valumark Pen Needles 31G X 8MM, 39 Ultra-thin II Insulin Syringe SHORT/U- Universal 1 Lancets Ultra Thin 30G, 32 Valved Holding Chamber, 40 100/0.5ML/30GX5/16", 39 vancomycin HCL, 3 Ultra-thin II Insulin Syringe SHORT/U- 100/0.5ML/31GX5/16", 39 Vanishpoint Insulin Syringe/0.5ML/30G X Ultra-thin II Insulin Syringe SHORT/U- urea 40% nail film, 10 100/1ML/30GX5/16", 39 urea hydrating, 10 Vanishpoint Insulin Syringe/1ML/29G X Ultra-thin II Insulin Syringe SHORT/U- urea IN zinc undecylenate/lactic acid 100/1ML/31GX5/16", 39 Ultra-thin II Insulin Syringe/U- 100/0.3ML/29GX1/2", 39 Ultra-thin II Insulin Syringe/U- 100/0.5ML/29GX1/2", 39 Ultra-thin II Insulin Syringe/U- Vcf Vaginal Contraceptive Film, 15, 44 100/1ML/29GX1/2", 39 Vcf Vaginal Contraceptive Foam, 15, 44 Ultra-thin II Lancets 28G, 32 vcf vaginal contraceptivegel, 15, 43 Ultra-thin II Lancets 30G, 32 Ultra-thin II Mini Pen Neeedles/31GX3/16", 39 vecuronium bromide, 21 Ultra-thin II Pen Needles 29GX1/2", 39 Ultra-thin II Pen Needles/SHORT/31GX5/16", 39 Ultra-thin II Safety Autolancets 26G, 32 venlafaxine HCL, 18 venlafaxine HCL ER, 18 umecta mousse, 10 Venlafaxine HCL ER, 18 Unifine Pentips 29GX12MM, 39 Unifine Pentips 31G X 3/16", 39 Verapamil HCL, 6 Unifine Pentips 31G X 6MM, 39 verapamil HCL, 6 Unifine Pentips 31G X 8MM, 39 verapamil HCL ER, 6 Unifine Pentips 31GX5MM, 39 verapamil HCL SR, 6 Unifine Pentips 31GX6MM, 39 Unifine Pentips 31GX8MM, 39 V
Unifine Pentips 32GX4MM, 39 Unifine Pentips Plus 29GX12MM, 39 Unifine Pentips Plus 31GX5MM, 39 Unifine Pentips Plus 31GX6MM, 39 Unifine Pentips Plus 31GX8MM, 39 V-r Monoject Insulin Syringe/U- Unifine Pentips Plus 32GX4MM, 39 100/0.3ML/29G X 1/2", 39 Unilet Comfortouch Lancet, 32 V-r Monoject Insulin Syringe/U- Unilet Excelite, 32 100/0.5ML/28G X 1/2", 39 Unilet Excelite II, 32 V-r Monoject Insulin Syringe/U- Unilet G.p. Lancet, 32 100/0.5ML/29G X 1/2", 39 Unilet G.p. Superlite Lancet, 32 V-r Monoject Insulin Syringe/U- Unilet GP 28 Ultra Thin, 32 Vida Mia Autolet Lancing Device, 39 100/1ML/28G X 1/2", 39 Unilet Lancet, 32 Vida Mia Unifine Pentips 32GX4MM, 39 V-r Monoject Insulin Syringe/U- Unilet Lancets Micro-thin33G, 32 Vida Mia Unifine Pentips Mini 31GX6MM, 100/1ML/29G X 1/2", 39 Unilet Lancets Super-thin30G, 32 Unilet Lancets Ultra-thin 28G, 32 Vida Mia Unifine Pentips Original valacyclovir HCL, 2 Unilet Superlite Lancet, 32 Vida Mia Unilet Lancets Super Thin 30G, valganciclovir, 2 Unistik 2 Comfort, 39 Vida Mia Unilet Lancets Ultra Thin 28G, valproate sodium, 20 Unistik 2 Extra, 39 valproic acid, 20 Unistik 2 Neonatal, 39 Vida Mia Unipfine Pentipsshort Unistik 2 Normal, 39 Unistik 2 Super, 39 Videx Pediatric, 2 Value Health Insulin Syringe/U- Unistik 3 Comfort, 39 100/0.5ML/29G X 1/2", 39 Unistik 3 Extra, 39 Viibryd Starter Pack, 18 Value Health Insulin Syringe/U- Unistik 3 Gentle, 32 100/1ML/29G X 1/2", 39 Unistik 3 Neonatal, 39 Value Plus Lancets Standard 21G, 32 Unistik 3 Normal, 39 Value Plus Lancets Super Thin 30G, 32 Unistik CZT Comfort, 39 Value Plus Lancets Thin 26G, 32 Unistik CZT Normal, 39 Value Plus Lancing Device, 39 Unistik Safety Lancets 28G, 32 Valumark Lancet Super Thin 30G, 32 W
Xyntha Solofuse, 17 Vinate Ultra, 28 W&f Lancets 26G, 32 Vinblastine Sulfate, 4 W&f Lancets Colored 21G, 32 Walgreens Advanced Travellancets 28G, Y
vincristine sulfate, 4 vinorelbine tartrate, 4 Walgreens Comfort Assuredlancets Micro yl folic acid, 16, 44 Walgreens Comfort Assuredlancets Super Thin/28G, 32 Your Life Multi Prenatal, 28 Z
Walgreens Lancets, 32 Walgreens Thin Lancets, 32 Walgreens Ultra Thin Lancets, 32 warfarin sodium, 17 virt-phos 250 neutral, 41 Wd Medic Insulin Syringe/0.3ML/29G X virt-vite plus, 28 Wd Medic Insulin Syringe/0.3ML/30G X Wd Medic Insulin Syringe/0.5ML/29G X Wd Medic Insulin Syringe/0.5ML/30G X vita s forte, 28 Wd Medic Insulin Syringe/1ML/29G X zenchent, 11, 43 Wd Medic Insulin Syringe/1ML/30G X zenchent FE, 11, 43 vitajoy daily d gummies, 27, 46 Webcol Alcohol Prep Large 1 Ply, 40 Vitalet Pro Lancets, 32 Webcol Alcohol Prep Large 2 Ply, 40 Vitalet Pro Plus Lancets, 32 Webcol Alcohol Prep Medium 2 Ply, 40 vitamax pediatric, 28 Vitamelts Vitamin D, 27, 47 Wegmans Unifine Pentips Plus vitamin b-complex 100, 28 vitamin c 222MG, 27 Wegmans Unifine Pentips vitamin d, 27, 46 Plus/Mini/31GX5MM, 39 vitamin d 400, 27, 46 Wegmans Unifine Pentips vitamin d high potency, 27, 46 Plus/SHORT/31GX8MM, 39 zinc sulfate, 41 vitamin d-1000, 27, 46 Wegmans Unifine Pentips Plus/Ultra ziprasidone HCL, 19 vitamin d-1000 maximum strength, 27, SHORT/31GX6MM, 39 vitamin d-3, 27, 46 Wellesse Vitamin D3, 27, 47 vitamin d-400, 27, 46 zoledronic acid, 12 vitamin d3, 27, 46 Wide-seal Silicone Diaphragm Kit 60, 44 Zoledronic Acid, 13 Vitamin D3, 27, 47 Wide-seal Silicone Diaphragm Kit 65, 44 vitamin d3 400, 27, 46 Wide-seal Silicone Diaphragm Kit 70, 44 zolmitriptan, 24 vitamin d3 adult gummies, 27, 46 Wide-seal Silicone Diaphragm Kit 75, 44 zolmitriptan odt, 24 vitamin d3 high potency, 27, 46 Wide-seal Silicone Diaphragm Kit 80, 44 zolpidem tartrate, 19 vitamin d3 maximum strength, 27, 46 Wide-seal Silicone Diaphragm Kit 85, 44 zolpidem tartrate ER, 19 vitamin d3 super strength, 27, 46 Wide-seal Silicone Diaphragm Kit 90, 44 Wide-seal Silicone Diaphragm Kit 95, 44 vitamins a/c/d/fluoride, 28 Zomig Nasal Spray, 25 wymzya FE, 11, 43 Vivotif Berna, 26 X
Zostavax, 27, 45 zovia 1/35e, 11, 43 Xarelto Starter Pack, 17 Vortex Valved Holding Chamber, 40 Vp Insulin Syringe/U-100/0.3ML/29G X 1
1ST Choice Lancets Super Thin, 32 1ST Choice Lancets Thin, 32 1ST Choice Lancets Ultra Thin, 32 xylocaine dental, 25 1ST Tier Unifine Pentips /Mini/31GX5MM, 1ST Tier Unifine Pentips 29GX12MM, 39 1ST Tier Unifine Pentips 31GX6MM, 39 1ST Tier Unifine Pentips 31GX8MM, 39 1ST Tier Unifine Pentips 32GX4MM, 39 1ST Tier Unifine Pentips Plus 31GX8MM, 1ST Tier Unifine Pentips Plus 32GX4MM, 1ST Tier Unifine Pentips Plus/Mini/31GX5MM, 39 1ST Tier Unifine Pentips Plus/Original/29GX12MM, 39 1ST Tier Unifine Pentips Plus/Ultra SHORT/31GX6MM, 39 1ST Tier Unilet Comfortouch Lancets 1ST Tier Unilet Comfortouch Lancets 8

Source: https://www.landoflincolnhealth.org/wp-content/uploads/2015/10/CF220_HIM_ENHANCED_COMPREHENSIVE_1.1.16_v.1.pdf