Department of Human Services Proposed PDL for IOWA Medicaid Program Listing Covered OTC Drugs: Effective Date: 10/13/2015 Note: Not all s may be represented and the status of those listed are subject to change without notification. DRUG CATEGORY Drug Description PA: "" denotes ANALGESICS - MISC. Aspirin Tab 325 24385-0416 - 78 Aspirin Tab 325 24385-0416 - 87 Aspirin Tab 325 63868-0352 - 03 Aspirin Tab 325 63868-0352 - 10 Aspirin Tab 325 00113-0416 - 78 Aspirin Tab 325 00113-0416 - 87 Aspirin Tab 325 00113-0416 - 90 Aspirin Tab 325 00904-2009 - 40 Aspirin Tab 325 00904-2009 - 60 Aspirin Tab 325 00904-2019 - 59 Aspirin Tab 325 62011-0020 - 01 Aspirin Tab 325 49348-0001 - 10 Aspirin Tab 325 49348-0001 - 14 Aspirin Tab 325 49348-0001 - 23 Aspirin Tab 325 PHARBEST PHARMACEUTICALS, 16103-0365 - 08 Aspirin Tab 325 PHARBEST PHARMACEUTICALS, 16103-0365 - 11 Aspirin Tab 325 00536-1053 - 01 Aspirin Tab 325 00536-1053 - 05 Aspirin Tab 325 00536-1054 - 29 Aspirin Tab 325 00536-3305 - 01 Aspirin Tab 325 00536-3305 - 10 Aspirin Tab 325 15127-0738 - 01 Aspirin Tab 325 15127-0738 - 05 Aspirin Tab 325 15127-0738 - 10 Aspirin Tab 325 15127-0738 - 21 Aspirin Tab 325 TIME-CAP LABS, 49483-0011 - 10 Aspirin Tab 325 Aspirin Chew Tab 81 24385-0028 - 68 Aspirin Chew Tab 81 24385-0278 - 68 Aspirin Chew Tab 81 24385-0364 - 68 Aspirin Chew Tab 81 63868-0241 - 36 Aspirin Chew Tab 81 00113-0274 - 68 Aspirin Chew Tab 81 00113-0467 - 68 Aspirin Chew Tab 81 37205-0369 - 68 Aspirin Chew Tab 81 37205-0467 - 68 Aspirin Chew Tab 81 Page 1 of 28
Drug Description PA: "" denotes ANALGESICS - MISC. Aspirin Chew Tab 81 37205-0708 - 68 Aspirin Chew Tab 81 00904-4040 - 73 Aspirin Chew Tab 81 00904-6288 - 89 Aspirin Chew Tab 81 62011-0021 - 01 Aspirin Chew Tab 81 62011-0028 - 01 Aspirin Chew Tab 81 62011-0212 - 01 Aspirin Chew Tab 81 49348-0191 - 07 Aspirin Chew Tab 81 49348-0498 - 07 Aspirin Chew Tab 81 49348-0757 - 07 Aspirin Chew Tab 81 PHARBEST PHARMACEUTICALS, 16103-0366 - 05 Aspirin Chew Tab 81 PHARBEST PHARMACEUTICALS, 16103-0366 - 11 Aspirin Chew Tab 81 PRIME MARKETING LLC 62107-0026 - 36 Aspirin Chew Tab 81 QUALITEST PHARMACEUTICALS, 00603-0024 - 36 Aspirin Chew Tab 81 00536-1008 - 36 Aspirin Chew Tab 81 00536-3297 - 36 Aspirin Chew Tab 81 15127-0241 - 36 Aspirin Chew Tab 81 TIME-CAP LABS, 49483-0334 - 63 Aspirin Chew Tab 81 36800-0259 - 68 Aspirin Chew Tab 81 36800-0274 - 68 Aspirin Chew Tab 81 36800-0467 - 68 Aspirin Chew Tab 81 24385-0535 - 87 24385-0541 - 87 DRUG COMPANY 46122-0180 - 76 DRUG COMPANY 46122-0180 - 87 DRUG COMPANY 46122-0182 - 48 00904-7704 - 18 00904-7704 - 70 00904-7704 - 80 62011-0003 - 01 62011-0019 - 01 49348-0980 - 15 49348-0980 - 23 49348-0980 - 53 49348-0981 - 15 MCKESSON PACKAGING SERVICE, A DIVISION 63739-0522 - 01 MCKESSON PACKAGING SERVICE, A DIVISION 63739-0522 - 10 PHARBEST PHARMACEUTICALS, 16103-0356 - 09 PHARBEST PHARMACEUTICALS, 16103-0356 - 11 PRIME MARKETING LLC 62107-0027 - 26 PRIME MARKETING LLC 62107-0027 - 32 QUALITEST PHARMACEUTICALS, 00603-0026 - 22 QUALITEST PHARMACEUTICALS, 00603-0026 - 32 00536-1004 - 10 00536-1004 - 41 00536-3086 - 10 Page 2 of 28
Drug Description PA: "" denotes ANALGESICS - MISC. 00536-3086 - 41 15127-0228 - 65 15127-0228 - 94 TIME-CAP LABS, 49483-0330 - 10 TIME-CAP LABS, 49483-0330 - 12 36800-0277 - 48 Aspirin Tab Delayed Release 325 24385-0429 - 02 Aspirin Tab Delayed Release 325 24385-0429 - 90 Aspirin Tab Delayed Release 325 37205-0429 - 87 Aspirin Tab Delayed Release 325 37205-0429 - 96 Aspirin Tab Delayed Release 325 LNK INTERNATIONAL, 50844-0227 - 12 Aspirin Tab Delayed Release 325 00904-2011 - 59 Aspirin Tab Delayed Release 325 00904-2013 - 60 Aspirin Tab Delayed Release 325 00904-2013 - 72 Aspirin Tab Delayed Release 325 00904-2013 - 80 Aspirin Tab Delayed Release 325 62011-0040 - 01 Aspirin Tab Delayed Release 325 49348-0937 - 14 Aspirin Tab Delayed Release 325 49348-0937 - 82 Aspirin Tab Delayed Release 325 MCKESSON PACKAGING SERVICE, A DIVISION 63739-0523 - 01 Aspirin Tab Delayed Release 325 PHARBEST PHARMACEUTICALS, 16103-0357 - 08 Aspirin Tab Delayed Release 325 PHARBEST PHARMACEUTICALS, 16103-0357 - 11 Aspirin Tab Delayed Release 325 PRIME MARKETING LLC 62107-0028 - 01 Aspirin Tab Delayed Release 325 PRIME MARKETING LLC 62107-0028 - 32 Aspirin Tab Delayed Release 325 QUALITEST PHARMACEUTICALS, 00603-0168 - 21 Aspirin Tab Delayed Release 325 QUALITEST PHARMACEUTICALS, 00603-0169 - 21 Aspirin Tab Delayed Release 325 QUALITEST PHARMACEUTICALS, 00603-0169 - 32 Aspirin Tab Delayed Release 325 00536-3313 - 01 Aspirin Tab Delayed Release 325 00536-3313 - 10 Aspirin Tab Delayed Release 325 36800-0429 - 02 Aspirin Tab Delayed Release 325 Acetaminophen Tab 325 24385-0403 - 78 Acetaminophen Tab 325 00904-1982 - 51 Acetaminophen Tab 325 00904-1982 - 59 Acetaminophen Tab 325 00904-1982 - 60 Acetaminophen Tab 325 00904-1982 - 61 Acetaminophen Tab 325 00904-1982 - 80 Acetaminophen Tab 325 62011-0032 - 01 Acetaminophen Tab 325 49348-0973 - 10 Acetaminophen Tab 325 MCKESSON PACKAGING SERVICE, A DIVISION 63739-0440 - 01 Acetaminophen Tab 325 PHARBEST PHARMACEUTICALS, 16103-0353 - 07 Acetaminophen Tab 325 PHARBEST PHARMACEUTICALS, 16103-0353 - 08 Acetaminophen Tab 325 PHARBEST PHARMACEUTICALS, 16103-0353 - 11 Acetaminophen Tab 325 PRIME MARKETING LLC 62107-0052 - 01 Acetaminophen Tab 325 PRIME MARKETING LLC 62107-0052 - 10 Acetaminophen Tab 325 QUALITEST PHARMACEUTICALS, 00603-0263 - 29 Acetaminophen Tab 325 Page 3 of 28
Drug Description PA: "" denotes ANALGESICS - MISC. Acetaminophen Tab 325 QUALITEST PHARMACEUTICALS, 00603-0263 - 32 Acetaminophen Tab 325 00536-3222 - 01 Acetaminophen Tab 325 00536-3222 - 10 Acetaminophen Tab 325 15127-0072 - 08 Acetaminophen Tab 325 15127-0072 - 24 Acetaminophen Tab 325 36800-0403 - 78 Acetaminophen Tab 325 24385-0145 - 71 24385-0484 - 47 24385-0484 - 71 24385-0484 - 78 24385-0484 - 90 DRUG COMPANY 46122-0003 - 62 DRUG COMPANY 46122-0003 - 71 DRUG COMPANY 46122-0003 - 76 DRUG COMPANY 46122-0003 - 78 DRUG COMPANY 46122-0178 - 78 63868-0503 - 50 63868-0507 - 01 63868-0987 - 50 00113-0227 - 71 00113-0484 - 62 00113-0484 - 71 00113-0484 - 78 00113-0484 - 90 37205-0593 - 71 37205-0593 - 78 37205-0594 - 71 37205-0594 - 78 37205-0594 - 90 37205-0980 - 71 37205-0980 - 78 00904-1983 - 24 00904-1983 - 40 00904-1983 - 51 00904-1983 - 59 00904-1983 - 60 00904-1983 - 80 00904-1983 - 94 00904-1988 - 59 00904-1988 - 60 00904-1988 - 61 00904-1988 - 80 00904-5816 - 60 62011-0023 - 01 62011-0023 - 03 Page 4 of 28
Drug Description PA: "" denotes ANALGESICS - MISC. 62011-0027 - 01 62011-0049 - 01 49348-0042 - 09 49348-0042 - 10 49348-0042 - 14 49348-0730 - 09 49348-0730 - 10 49348-0998 - 10 45802-0484 - 78 45802-0484 - 90 PHARBEST PHARMACEUTICALS, 16103-0376 - 06 PHARBEST PHARMACEUTICALS, 16103-0376 - 08 PHARBEST PHARMACEUTICALS, 16103-0376 - 11 PRIME MARKETING LLC 62107-0050 - 01 PRIME MARKETING LLC 62107-0050 - 10 PRIME MARKETING LLC 62107-0051 - 01 PRIME MARKETING LLC 62107-0051 - 10 QUALITEST PHARMACEUTICALS, 00603-0268 - 29 QUALITEST PHARMACEUTICALS, 00603-0268 - 32 00536-3218 - 01 00536-3218 - 10 00536-3231 - 01 00536-3231 - 10 15127-0730 - 06 15127-0730 - 21 15127-0735 - 05 15127-0735 - 08 15127-0735 - 09 15127-0735 - 16 36800-0010 - 71 36800-0010 - 78 36800-0046 - 62 36800-0046 - 71 36800-0046 - 78 36800-0046 - 83 36800-0227 - 71 36800-0227 - 78 36800-0405 - 72 36800-0405 - 78 36800-0484 - 62 36800-0484 - 71 36800-0484 - 78 36800-0484 - 90 Acetaminophen Soln 100 /ML QUALITEST PHARMACEUTICALS, 00603-0838 - 73 Acetaminophen Soln 100 /ML SILAR PHARMACEUTICALS, 54838-0145 - 15 Acetaminophen Soln 100 /ML SILAR PHARMACEUTICALS, 54838-0145 - 30 Acetaminophen Soln 100 /ML Page 5 of 28
Drug Description PA: "" denotes ANALGESICS - MISC. Acetaminophen Suppos 120 00472-1201 - 06 Acetaminophen Suppos 120 G&W LABORATORIES, INC 00713-0118 - 01 Acetaminophen Suppos 120 G&W LABORATORIES, INC 00713-0118 - 12 Acetaminophen Suppos 120 G&W LABORATORIES, INC 00713-0118 - 50 Acetaminophen Suppos 120 45802-0732 - 30 Acetaminophen Suppos 120 45802-0732 - 33 Acetaminophen Suppos 120 TARO PHARMACEUTICALS USA, 51672-2115 - 02 Acetaminophen Suppos 120 TARO PHARMACEUTICALS USA, 51672-2115 - 04 Acetaminophen Suppos 120 ANTIEMETIC - ANTICHOLINERGIC / DOPAMINERGIC Meclizine HCl Tab 12.5 00536-1017 - 01 Meclizine HCl Tab 12.5 00536-1017 - 10 Meclizine HCl Tab 12.5 00536-3985 - 01 Meclizine HCl Tab 12.5 00536-3985 - 10 Meclizine HCl Tab 12.5 Meclizine HCl Tab 25 24385-0388 - 51 Meclizine HCl Tab 25 62011-0035 - 01 Meclizine HCl Tab 25 49348-0363 - 67 Meclizine HCl Tab 25 Meclizine HCl Chew Tab 25 00536-1018 - 01 Meclizine HCl Chew Tab 25 00536-1018 - 10 Meclizine HCl Chew Tab 25 00536-3990 - 01 Meclizine HCl Chew Tab 25 00536-3990 - 10 Meclizine HCl Chew Tab 25 TRIGEN LABORATORIES, LLC 13811-0648 - 01 Meclizine HCl Chew Tab 25 TRIGEN LABORATORIES, LLC 13811-0648 - 10 Meclizine HCl Chew Tab 25 ANTIHISTAMINES - NON-SEDATING Cetirizine HCl Tab 5 MYLAN PHARMACEUTICALS, 00378-3635 - 01 Cetirizine HCl Tab 5 RISING PHARMACEUTICALS, INC 16571-0401 - 10 Cetirizine HCl Tab 5 SANDOZ 00781-1683 - 01 Cetirizine HCl Tab 5 AMERICAN HEALTH PACKAGING 60687-0165 - 01 AMERICAN HEALTH PACKAGING 60687-0165 - 11 24385-0998 - 65 24385-0998 - 74 24385-0998 - 75 APOTE CORP. 60505-2633 - 01 APOTE CORP. 60505-2633 - 08 63868-0132 - 14 63868-0132 - 30 63868-0132 - 90 DR. REDDY'S LABORATORIES, 55111-0699 - 90 00113-9458 - 39 00113-9458 - 66 Page 6 of 28
Drug Description PA: "" denotes ANTIHISTAMINES - NON-SEDATING 37205-0820 - 76 00904-5852 - 41 00904-5852 - 43 00904-5852 - 46 00904-5852 - 60 00904-5852 - 61 00904-5852 - 89 62011-0052 - 01 62011-0052 - 02 62011-0205 - 02 49348-0847 - 13 49348-0939 - 12 49348-0939 - 44 49348-0984 - 46 MYLAN INSTITUTIONAL, INC 51079-0597 - 01 MYLAN INSTITUTIONAL, INC 51079-0597 - 20 MYLAN PHARMACEUTICALS, 00378-3637 - 01 MYLAN PHARMACEUTICALS, 00378-3637 - 05 NORTHSTAR R LLC 16714-0271 - 02 NORTHSTAR R LLC 16714-0271 - 03 OHM PHARMACEUTICALS, 51660-0939 - 54 45802-0919 - 39 45802-0919 - 87 RISING PHARMACEUTICALS, INC 16571-0402 - 10 RISING PHARMACEUTICALS, INC 16571-0402 - 50 00536-1041 - 05 00536-4088 - 07 00536-4088 - 11 00536-4088 - 88 SANDOZ 00781-1684 - 01 15127-0909 - 14 15127-0909 - 30 36800-0458 - 13 36800-0458 - 39 36800-0458 - 47 36800-0458 - 66 36800-0458 - 72 36800-0458 - 87 36800-0458 - 95 Cetirizine HCl Oral Soln 1 /ML (5 /5ML) DRUG COMPANY DRUG COMPANY 24385-0188 - 26 46122-0020 - 26 46122-0101 - 26 00113-0974 - 26 37205-0591 - 26 Cetirizine HCl Oral Soln 1 /ML (5 /5ML) Cetirizine HCl Oral Soln 1 /ML (5 /5ML) Cetirizine HCl Oral Soln 1 /ML (5 /5ML) Cetirizine HCl Oral Soln 1 /ML (5 /5ML) Cetirizine HCl Oral Soln 1 /ML (5 /5ML) Page 7 of 28
Drug Description PA: "" denotes ANTIHISTAMINES - NON-SEDATING Cetirizine HCl Oral Soln 1 /ML (5 /5ML) PRECISION DOSE, PRECISION DOSE, SILAR PHARMACEUTICALS, TARO PHARMACEUTICALS USA, TARO PHARMACEUTICALS USA, 37205-0826 - 26 37205-0855 - 26 00904-5828 - 20 00904-6372 - 20 62011-0051 - 01 62011-0054 - 01 62011-0093 - 01 62011-0180 - 01 49348-0078 - 34 49348-0326 - 34 49348-0934 - 34 45802-0974 - 26 68094-0720 - 59 68094-0720 - 62 54838-0552 - 40 51672-2088 - 08 51672-2102 - 08 36800-0974 - 26 Cetirizine HCl Oral Soln 1 /ML (5 /5ML) Cetirizine HCl Oral Soln 1 /ML (5 /5ML) Cetirizine HCl Oral Soln 1 /ML (5 /5ML) Cetirizine HCl Oral Soln 1 /ML (5 /5ML) Cetirizine HCl Oral Soln 1 /ML (5 /5ML) Cetirizine HCl Oral Soln 1 /ML (5 /5ML) Cetirizine HCl Oral Soln 1 /ML (5 /5ML) Cetirizine HCl Oral Soln 1 /ML (5 /5ML) Cetirizine HCl Oral Soln 1 /ML (5 /5ML) Cetirizine HCl Oral Soln 1 /ML (5 /5ML) Cetirizine HCl Oral Soln 1 /ML (5 /5ML) Cetirizine HCl Oral Soln 1 /ML (5 /5ML) Cetirizine HCl Oral Soln 1 /ML (5 /5ML) Cetirizine HCl Oral Soln 1 /ML (5 /5ML) Cetirizine HCl Oral Soln 1 /ML (5 /5ML) Cetirizine HCl Oral Soln 1 /ML (5 /5ML) Cetirizine HCl Oral Soln 1 /ML (5 /5ML) Cetirizine HCl Oral Soln 1 /ML (5 /5ML) AMERICAN HEALTH PACKAGING 68084-0248 - 01 AMERICAN HEALTH PACKAGING 68084-0248 - 11 24385-0471 - 52 24385-0471 - 65 24385-0471 - 76 24385-0471 - 78 24385-0471 - 99 DRUG COMPANY 46122-0158 - 65 APOTE CORP. 60505-0147 - 01 APOTE CORP. 60505-0147 - 08 63868-0151 - 01 63868-0151 - 10 63868-0151 - 30 00113-0612 - 39 00113-0612 - 46 00113-0612 - 60 00113-0612 - 65 Page 8 of 28
Drug Description PA: "" denotes ANTIHISTAMINES - NON-SEDATING 37205-0346 - 72 00904-5728 - 15 00904-5728 - 87 00904-5728 - 89 00904-6074 - 46 00904-6074 - 60 00904-6074 - 61 00904-6074 - 89 62011-0074 - 01 62011-0074 - 02 62011-0074 - 03 62011-0248 - 02 49348-0818 - 01 49348-0818 - 12 49348-0818 - 13 49348-0818 - 44 MYLAN INSTITUTIONAL, INC 51079-0246 - 01 MYLAN INSTITUTIONAL, INC 51079-0246 - 20 OHM PHARMACEUTICALS, 51660-0526 - 01 OHM PHARMACEUTICALS, 51660-0526 - 05 OHM PHARMACEUTICALS, 51660-0526 - 31 45802-0650 - 65 45802-0650 - 78 45802-0650 - 87 SANDOZ 00781-5077 - 01 15127-0715 - 10 15127-0715 - 30 36800-0612 - 46 36800-0612 - 65 36800-0612 - 72 36800-0612 - 76 36800-0612 - 87 Loratadine Syrup 10 /10ML 24385-0531 - 26 Loratadine Syrup 10 /10ML DRUG COMPANY 46122-0164 - 26 Loratadine Syrup 10 /10ML 37205-0378 - 26 Loratadine Syrup 10 /10ML 00904-6234 - 20 Loratadine Syrup 10 /10ML 62011-0072 - 01 Loratadine Syrup 10 /10ML 62011-0181 - 01 Loratadine Syrup 10 /10ML 49348-0333 - 34 Loratadine Syrup 10 /10ML 49348-0636 - 34 Loratadine Syrup 10 /10ML SILAR PHARMACEUTICALS, 54838-0554 - 40 Loratadine Syrup 10 /10ML SILAR PHARMACEUTICALS, 54838-0558 - 40 Loratadine Syrup 10 /10ML TARO PHARMACEUTICALS USA, 51672-2073 - 08 Loratadine Syrup 10 /10ML TARO PHARMACEUTICALS USA, 51672-2085 - 08 Loratadine Syrup 10 /10ML TARO PHARMACEUTICALS USA, 51672-2092 - 08 Loratadine Syrup 10 /10ML ANTIHISTAMINES - OTHER Page 9 of 28
Drug Description PA: "" denotes ANTIHISTAMINES - OTHER Chlorpheniramine Maleate Tab 4 24385-0463 - 62 Chlorpheniramine Maleate Tab 4 24385-0463 - 78 Chlorpheniramine Maleate Tab 4 EDWARDS PHARMACEUTICALS, 00485-0085 - 01 Chlorpheniramine Maleate Tab 4 00113-0463 - 78 Chlorpheniramine Maleate Tab 4 37205-0215 - 62 Chlorpheniramine Maleate Tab 4 37205-0215 - 78 Chlorpheniramine Maleate Tab 4 00904-0012 - 24 Chlorpheniramine Maleate Tab 4 00904-0012 - 59 Chlorpheniramine Maleate Tab 4 00904-0012 - 61 Chlorpheniramine Maleate Tab 4 00904-0012 - 80 Chlorpheniramine Maleate Tab 4 62011-0059 - 01 Chlorpheniramine Maleate Tab 4 49348-0025 - 04 Chlorpheniramine Maleate Tab 4 49348-0025 - 10 Chlorpheniramine Maleate Tab 4 00536-1006 - 01 Chlorpheniramine Maleate Tab 4 00536-1006 - 10 Chlorpheniramine Maleate Tab 4 00536-1006 - 35 Chlorpheniramine Maleate Tab 4 00536-3467 - 01 Chlorpheniramine Maleate Tab 4 00536-3467 - 10 Chlorpheniramine Maleate Tab 4 00536-3467 - 35 Chlorpheniramine Maleate Tab 4 15127-0821 - 09 Chlorpheniramine Maleate Tab 4 36800-0463 - 62 Chlorpheniramine Maleate Tab 4 24385-0462 - 62 24385-0462 - 78 63868-0087 - 01 63868-0087 - 24 CONTRACT PHARMACAL CORP 10267-0835 - 01 CONTRACT PHARMACAL CORP 10267-0835 - 04 EON LABS, 00185-0648 - 01 EON LABS, 00185-0648 - 10 00113-0462 - 62 00904-2035 - 24 00904-2035 - 59 00904-5306 - 60 00904-5306 - 61 00904-5306 - 80 62011-0056 - 01 62011-0056 - 03 49348-0971 - 10 PHARBEST PHARMACEUTICALS, 16103-0348 - 03 PHARBEST PHARMACEUTICALS, 16103-0348 - 08 PHARBEST PHARMACEUTICALS, 16103-0348 - 11 QUALITEST PHARMACEUTICALS, 00603-0241 - 18 QUALITEST PHARMACEUTICALS, 00603-3339 - 21 QUALITEST PHARMACEUTICALS, 00603-3339 - 32 00536-1010 - 01 00536-3594 - 01 Page 10 of 28
Drug Description PA: "" denotes ANTIHISTAMINES - OTHER SDA LABORATORIES 66424-0020 - 01 SDA LABORATORIES 66424-0020 - 10 15127-0283 - 24 15127-0283 - 48 36800-0462 - 62 36800-0462 - 67 36800-0462 - 78 Diphenhydramine HCl Liquid 12.5 /5ML 24385-0379 - 26 Diphenhydramine HCl Liquid 12.5 /5ML 63868-0823 - 54 Diphenhydramine HCl Liquid 12.5 /5ML 00113-0379 - 26 Diphenhydramine HCl Liquid 12.5 /5ML 37205-0565 - 26 Diphenhydramine HCl Liquid 12.5 /5ML 37205-0565 - 34 Diphenhydramine HCl Liquid 12.5 /5ML 00904-1228 - 00 Diphenhydramine HCl Liquid 12.5 /5ML 00904-1228 - 20 Diphenhydramine HCl Liquid 12.5 /5ML 00904-5174 - 16 Diphenhydramine HCl Liquid 12.5 /5ML 62011-0057 - 01 Diphenhydramine HCl Liquid 12.5 /5ML 62011-0228 - 01 Diphenhydramine HCl Liquid 12.5 /5ML 49348-0045 - 34 Diphenhydramine HCl Liquid 12.5 /5ML 49348-0045 - 37 Diphenhydramine HCl Liquid 12.5 /5ML 49348-0056 - 34 Diphenhydramine HCl Liquid 12.5 /5ML QUALITEST PHARMACEUTICALS, 00603-0823 - 54 Diphenhydramine HCl Liquid 12.5 /5ML QUALITEST PHARMACEUTICALS, 00603-0823 - 58 Diphenhydramine HCl Liquid 12.5 /5ML QUALITEST PHARMACEUTICALS, 00603-0823 - 81 Diphenhydramine HCl Liquid 12.5 /5ML QUALITEST PHARMACEUTICALS, 00603-0823 - 94 Diphenhydramine HCl Liquid 12.5 /5ML 00536-0770 - 85 Diphenhydramine HCl Liquid 12.5 /5ML 00536-0770 - 97 Diphenhydramine HCl Liquid 12.5 /5ML SILAR PHARMACEUTICALS, 54838-0135 - 40 Diphenhydramine HCl Liquid 12.5 /5ML SILAR PHARMACEUTICALS, 54838-0135 - 70 Diphenhydramine HCl Liquid 12.5 /5ML SILAR PHARMACEUTICALS, 54838-0135 - 80 Diphenhydramine HCl Liquid 12.5 /5ML 36800-0379 - 26 Diphenhydramine HCl Liquid 12.5 /5ML 36800-0379 - 34 Diphenhydramine HCl Liquid 12.5 /5ML Diphenhydramine HCl Syrup 12.5 /5ML QUALITEST PHARMACEUTICALS, 00603-0860 - 54 Diphenhydramine HCl Syrup 12.5 /5ML SILAR PHARMACEUTICALS, 54838-0154 - 40 Diphenhydramine HCl Syrup 12.5 /5ML SILAR PHARMACEUTICALS, 54838-0154 - 70 Diphenhydramine HCl Syrup 12.5 /5ML SILAR PHARMACEUTICALS, 54838-0154 - 80 Diphenhydramine HCl Syrup 12.5 /5ML COUGH/COLD 10-100 /5ML 00113-0359 - 26 00113-0359 - 34 37205-0970 - 26 37205-0970 - 34 10-100 /5ML 10-100 /5ML 10-100 /5ML 10-100 /5ML Page 11 of 28
Drug Description PA: "" denotes COUGH/COLD 10-100 /5ML 00904-0053 - 00 00904-0053 - 09 00904-0053 - 16 00904-0053 - 20 00904-6306 - 20 49348-0017 - 34 49348-0017 - 37 49348-0017 - 39 49348-0861 - 34 49348-0861 - 37 PHARMACEUTICAL ASSOCIATES, 00121-0638 - 05 PHARMACEUTICAL ASSOCIATES, 00121-0638 - 10 QUALITEST PHARMACEUTICALS, 00603-0855 - 58 QUALITEST PHARMACEUTICALS, 00603-0855 - 81 QUALITEST PHARMACEUTICALS, 00603-0855 - 94 00536-0970 - 85 00536-0970 - 97 SILAR PHARMACEUTICALS, 54838-0209 - 40 SILAR PHARMACEUTICALS, 54838-0209 - 70 SILAR PHARMACEUTICALS, 54838-0209 - 80 COUGH/COLD - SYSTEMIC DECONGESTANTS Pseudoephedrine HCl Tab 30 10-100 /5ML 10-100 /5ML 10-100 /5ML 10-100 /5ML 10-100 /5ML 10-100 /5ML 10-100 /5ML 10-100 /5ML 10-100 /5ML 10-100 /5ML 10-100 /5ML 10-100 /5ML 10-100 /5ML 10-100 /5ML 10-100 /5ML 10-100 /5ML 10-100 /5ML 10-100 /5ML 10-100 /5ML 10-100 /5ML 24385-0432 - 62 Pseudoephedrine HCl Tab 30 24385-0432 - 80 Pseudoephedrine HCl Tab 30 63868-0146 - 24 Pseudoephedrine HCl Tab 30 63868-0146 - 48 Pseudoephedrine HCl Tab 30 00113-0432 - 62 Pseudoephedrine HCl Tab 30 00113-2432 - 62 Pseudoephedrine HCl Tab 30 00113-2432 - 67 Pseudoephedrine HCl Tab 30 00113-2432 - 80 Pseudoephedrine HCl Tab 30 37205-0445 - 62 Pseudoephedrine HCl Tab 30 37205-0445 - 80 Pseudoephedrine HCl Tab 30 00904-5053 - 24 Pseudoephedrine HCl Tab 30 00904-5053 - 59 Pseudoephedrine HCl Tab 30 00904-5053 - 60 Pseudoephedrine HCl Tab 30 Page 12 of 28
Drug Description PA: "" denotes COUGH/COLD - SYSTEMIC DECONGESTANTS Pseudoephedrine HCl Tab 30 00904-6338 - 60 Pseudoephedrine HCl Tab 30 62011-0078 - 01 Pseudoephedrine HCl Tab 30 62011-0078 - 02 Pseudoephedrine HCl Tab 30 49348-0024 - 04 Pseudoephedrine HCl Tab 30 49348-0024 - 08 Pseudoephedrine HCl Tab 30 49348-0024 - 34 Pseudoephedrine HCl Tab 30 45802-0432 - 62 Pseudoephedrine HCl Tab 30 00536-3607 - 35 Pseudoephedrine HCl Tab 30 36800-0432 - 62 Pseudoephedrine HCl Tab 30 36800-0432 - 67 Pseudoephedrine HCl Tab 30 Pseudoephedrine HCl Tab 60 00904-5125 - 46 Pseudoephedrine HCl Tab 60 00904-5125 - 59 Pseudoephedrine HCl Tab 60 Pseudoephedrine HCl Syrup 30 /5ML 00536-1850 - 85 NASAL DECON SYP 30/5ML DIABETIC - INSULIN Insulin Regular (Human) Inj 100 Unit/ML ELI LILLY AND COMPANY 00002-8215 - 01 HUMULIN R INJ U-100 ELI LILLY AND COMPANY 00002-8215 - 17 HUMULIN R INJ U-100 NOVO NORDISK, 00169-1833 - 02 NOVOLIN R INJ RELION NOVO NORDISK, 00169-1833 - 11 NOVOLIN R INJ U-100 Insulin Isophane (Human) Inj 100 Unit/ML ELI LILLY AND COMPANY 00002-8315 - 01 HUMULIN N INJ U-100 ELI LILLY AND COMPANY 00002-8315 - 17 HUMULIN N INJ U-100 NOVO NORDISK, 00169-1834 - 02 NOVOLIN N INJ RELION NOVO NORDISK, 00169-1834 - 11 NOVOLIN N INJ U-100 Insulin Isophane & Regular (Human) Inj 100 Unit/ML (70-30) ELI LILLY AND COMPANY 00002-8715 - 01 HUMULIN INJ 70/30 ELI LILLY AND COMPANY 00002-8715 - 17 HUMULIN INJ 70/30 NOVO NORDISK, 00169-1837 - 02 NOVOLIN70/30 INJ RELION NOVO NORDISK, 00169-1837 - 11 NOVOLIN INJ 70/30 GI - ANTI - FLATULENTS / GI STIMULANTS Sennosides Tab 8.6 24385-0404 - 78 Sennosides Tab 8.6 63868-0257 - 10 Sennosides Tab 8.6 CYPRESS PHARMACEUTICAL, LLC 60258-0950 - 01 Sennosides Tab 8.6 GOLDLINE LABORATORIES, 00182-1093 - 01 Sennosides Tab 8.6 GOLDLINE LABORATORIES, 00182-1093 - 10 Sennosides Tab 8.6 37205-0241 - 78 Sennosides Tab 8.6 00904-5165 - 59 Sennosides Tab 8.6 00904-5165 - 61 Sennosides Tab 8.6 00904-5165 - 80 Sennosides Tab 8.6 00904-6434 - 59 Sennosides Tab 8.6 00904-6434 - 80 Sennosides Tab 8.6 Page 13 of 28
Drug Description PA: "" denotes GI - ANTI - FLATULENTS / GI STIMULANTS Sennosides Tab 8.6 PHARBEST PHARMACEUTICALS, PHARBEST PHARMACEUTICALS, PRIME MARKETING LLC PURDUE PRODUCTS, L.P. PURDUE PRODUCTS, L.P. PURDUE PRODUCTS, L.P. PURDUE PRODUCTS, L.P. QUALITEST PHARMACEUTICALS, QUALITEST PHARMACEUTICALS, TIME-CAP LABS, TIME-CAP LABS, 62011-0192 - 01 16103-0363 - 08 16103-0363 - 11 62107-0031 - 01 67618-0300 - 10 67618-0300 - 11 67618-0300 - 20 67618-0300 - 50 00603-0282 - 21 00603-0282 - 32 00536-5904 - 01 00536-5904 - 10 15127-0105 - 01 49483-0080 - 01 49483-0080 - 10 Sennosides Tab 8.6 Sennosides Tab 8.6 Sennosides Tab 8.6 Sennosides Tab 8.6 SENOKOT TAB 8.6 SENOKOT TAB 8.6 SENOKOT TAB 8.6 SENOKOT TAB 8.6 Sennosides Tab 8.6 Sennosides Tab 8.6 Sennosides Tab 8.6 Sennosides Tab 8.6 Sennosides Tab 8.6 Sennosides Tab 8.6 Sennosides Tab 8.6 DRUG COMPANY 46122-0014 - 31 DRUG COMPANY 46122-0014 - 33 DRUG COMPANY 46122-0014 - 71 63868-0002 - 14 GAVIS PHARMACEUTICALS, LLC 43386-0312 - 08 GAVIS PHARMACEUTICALS, LLC 43386-0312 - 14 KREMERS URBAN, 62175-0190 - 07 KREMERS URBAN, 62175-0190 - 15 KREMERS URBAN, 62175-0190 - 31 KREMERS URBAN, 62175-0195 - 07 KREMERS URBAN, 62175-0195 - 15 KREMERS URBAN, 62175-0195 - 31 00113-0306 - 01 00113-0306 - 02 00113-0306 - 03 37205-0612 - 71 37205-0612 - 72 37205-0612 - 73 00904-6025 - 76 00904-6025 - 77 00904-6025 - 84 62011-0153 - 01 62011-0153 - 02 49348-0893 - 50 49348-0893 - 70 49348-0893 - 92 45802-0868 - 01 45802-0868 - 02 45802-0868 - 03 00536-1052 - 24 00536-1052 - 27 Page 14 of 28
Drug Description PA: "" denotes GI - ANTI - FLATULENTS / GI STIMULANTS 00536-1052 - 84 36800-0181 - 04 36800-0306 - 01 36800-0306 - 02 36800-0306 - 03 GI - ANTIPERISTALTIC AGENTS 24385-0386 - 89 24385-0554 - 53 24385-0554 - 62 24385-0554 - 67 DRUG COMPANY 46122-0169 - 08 63868-0338 - 12 63868-0338 - 24 63868-0338 - 60 00113-0224 - 53 00113-0224 - 62 00113-0224 - 89 00113-0224 - 91 37205-0370 - 53 37205-0370 - 67 37205-0370 - 89 00904-7725 - 12 00904-7725 - 24 62011-0150 - 01 62011-0150 - 02 62011-0150 - 03 49348-0529 - 02 49348-0529 - 04 49348-0529 - 08 49348-0529 - 34 OHM PHARMACEUTICALS, 51660-0123 - 12 15127-0338 - 12 15127-0338 - 66 36800-0224 - 53 36800-0224 - 62 36800-0224 - 80 36800-0224 - 91 Loperamide HCl Liq 1 /5ML (0.2 /ML) 24385-0377 - 26 Loperamide HCl Liq 1 /5ML (0.2 /ML) HI-TECH PHARMACAL CO. 50383-0618 - 04 Loperamide HCl Liq 1 /5ML (0.2 /ML) HI-TECH PHARMACAL CO. 50383-0618 - 05 Loperamide HCl Liq 1 /5ML (0.2 /ML) HI-TECH PHARMACAL CO. 50383-0618 - 06 Loperamide HCl Liq 1 /5ML (0.2 /ML) HI-TECH PHARMACAL CO. 50383-0618 - 10 Loperamide HCl Liq 1 /5ML (0.2 /ML) HI-TECH PHARMACAL CO. 50383-0618 - 11 Loperamide HCl Liq 1 /5ML (0.2 /ML) Page 15 of 28
Drug Description PA: "" denotes GI - MISC. Magnesium Hydroxide Susp 400 /5ML 24385-0332 - 40 Magnesium Hydroxide Susp 400 /5ML 24385-0396 - 40 Magnesium Hydroxide Susp 400 /5ML 24385-0608 - 40 Magnesium Hydroxide Susp 400 /5ML 63868-0310 - 12 Magnesium Hydroxide Susp 400 /5ML 63868-0787 - 57 Magnesium Hydroxide Susp 400 /5ML 63868-0788 - 57 Magnesium Hydroxide Susp 400 /5ML 00113-0332 - 40 Magnesium Hydroxide Susp 400 /5ML 00113-0396 - 40 Magnesium Hydroxide Susp 400 /5ML 37205-0833 - 40 Magnesium Hydroxide Susp 400 /5ML 37205-0834 - 40 Magnesium Hydroxide Susp 400 /5ML 00904-0788 - 14 Magnesium Hydroxide Susp 400 /5ML 00904-0788 - 16 Magnesium Hydroxide Susp 400 /5ML 00904-0789 - 14 Magnesium Hydroxide Susp 400 /5ML 62011-0123 - 01 Magnesium Hydroxide Susp 400 /5ML 62011-0124 - 01 Magnesium Hydroxide Susp 400 /5ML 49348-0307 - 39 Magnesium Hydroxide Susp 400 /5ML PHARMACEUTICAL ASSOCIATES, 00121-0431 - 30 Magnesium Hydroxide Susp 400 /5ML 00536-2470 - 83 Magnesium Hydroxide Susp 400 /5ML 00536-2470 - 85 Magnesium Hydroxide Susp 400 /5ML 15127-0833 - 73 Magnesium Hydroxide Susp 400 /5ML 15127-0835 - 73 Magnesium Hydroxide Susp 400 /5ML 36800-0332 - 40 Magnesium Hydroxide Susp 400 /5ML 36800-0396 - 40 Magnesium Hydroxide Susp 400 /5ML 36800-0949 - 40 Magnesium Hydroxide Susp 400 /5ML Sennosides Syrup 8.8 /5ML 00904-6289 - 09 Sennosides Syrup 8.8 /5ML 00536-1000 - 59 Sennosides Syrup 8.8 /5ML Sennosides-Docusate Sodium Tab 8.6-50 AMERICAN HEALTH PACKAGING CYPRESS PHARMACEUTICAL, LLC GOLDLINE LABORATORIES, GOLDLINE LABORATORIES, 68084-0050 - 11 24385-0495 - 72 24385-0495 - 78 24385-0505 - 72 63868-0131 - 01 60258-0951 - 06 00182-1113 - 01 00182-1113 - 10 37205-0251 - 72 00904-5643 - 60 00904-5643 - 61 Sennosides-Docusate Sodium Tab 8.6-50 Sennosides-Docusate Sodium Tab 8.6-50 Sennosides-Docusate Sodium Tab 8.6-50 Sennosides-Docusate Sodium Tab 8.6-50 Sennosides-Docusate Sodium Tab 8.6-50 Sennosides-Docusate Sodium Tab 8.6-50 Sennosides-Docusate Sodium Tab 8.6-50 Sennosides-Docusate Sodium Tab 8.6-50 Sennosides-Docusate Sodium Tab 8.6-50 Sennosides-Docusate Sodium Tab 8.6-50 Sennosides-Docusate Sodium Tab 8.6-50 Page 16 of 28
Drug Description PA: "" denotes GI - MISC. Sennosides-Docusate Sodium Tab 8.6-50 MCKESSON PACKAGING SERVICE, A DIVISION MCKESSON PACKAGING SERVICE, A DIVISION PURDUE PRODUCTS, L.P. PURDUE PRODUCTS, L.P. PURDUE PRODUCTS, L.P. PURDUE PRODUCTS, L.P. PURDUE PRODUCTS, L.P. PURDUE PRODUCTS, L.P. PURDUE PRODUCTS, L.P. QUALITEST PHARMACEUTICALS, QUALITEST PHARMACEUTICALS, QUALITEST PHARMACEUTICALS, QUALITEST PHARMACEUTICALS, TIME-CAP LABS, TIME-CAP LABS, NICOTINE PATCHES / TABLETS Nicotine TD Patch 24HR 7 /24HR 00904-6339 - 61 62011-0161 - 01 62011-0165 - 01 49348-0532 - 12 49348-0544 - 10 49348-0544 - 19 63739-0432 - 01 63739-0432 - 10 67618-0106 - 10 67618-0106 - 30 67618-0106 - 60 67618-0310 - 01 67618-0310 - 11 67618-0310 - 30 67618-0310 - 60 00603-0149 - 21 00603-0149 - 32 00603-0283 - 21 00603-0283 - 32 00536-0355 - 01 00536-0355 - 10 00536-4086 - 01 00536-4086 - 10 49483-0081 - 01 49483-0081 - 10 Sennosides-Docusate Sodium Tab 8.6-50 Sennosides-Docusate Sodium Tab 8.6-50 Sennosides-Docusate Sodium Tab 8.6-50 Sennosides-Docusate Sodium Tab 8.6-50 Sennosides-Docusate Sodium Tab 8.6-50 Sennosides-Docusate Sodium Tab 8.6-50 Sennosides-Docusate Sodium Tab 8.6-50 Sennosides-Docusate Sodium Tab 8.6-50 Sennosides-Docusate Sodium Tab 8.6-50 Sennosides-Docusate Sodium Tab 8.6-50 Sennosides-Docusate Sodium Tab 8.6-50 SENOKOT S TAB 8.6-50 SENOKOT S TAB 8.6-50 SENOKOT S TAB 8.6-50 SENOKOT S TAB 8.6-50 Sennosides-Docusate Sodium Tab 8.6-50 Sennosides-Docusate Sodium Tab 8.6-50 Sennosides-Docusate Sodium Tab 8.6-50 Sennosides-Docusate Sodium Tab 8.6-50 Sennosides-Docusate Sodium Tab 8.6-50 Sennosides-Docusate Sodium Tab 8.6-50 Sennosides-Docusate Sodium Tab 8.6-50 Sennosides-Docusate Sodium Tab 8.6-50 Sennosides-Docusate Sodium Tab 8.6-50 Sennosides-Docusate Sodium Tab 8.6-50 DR. REDDY'S LABORATORIES, 43598-0446 - 70 Nicotine TD Patch 24HR 7 /24HR DR. REDDY'S LABORATORIES, 43598-0446 - 74 Nicotine TD Patch 24HR 7 /24HR GLAOSMITHKLINE 00135-0196 - 02 NICODERM CQ DIS 7/24HR GLAOSMITHKLINE 00135-0196 - 05 NICODERM CQ DIS 7/24HR 37205-0363 - 74 Nicotine TD Patch 24HR 7 /24HR 62011-0050 - 01 Nicotine TD Patch 24HR 7 /24HR NOVARTIS CONSUMER HEALTH, 00067-5124 - 07 Nicotine TD Patch 24HR 7 /24HR NOVARTIS CONSUMER HEALTH, 00067-5124 - 14 Nicotine TD Patch 24HR 7 /24HR NOVARTIS CONSUMER HEALTH, 00067-6128 - 14 Nicotine TD Patch 24HR 7 /24HR Page 17 of 28
Drug Description PA: "" denotes NICOTINE PATCHES / TABLETS Nicotine TD Patch 24HR 7 /24HR 00536-5894 - 88 Nicotine TD Patch 24HR 7 /24HR Nicotine TD Patch 24HR 14 /24HR DR. REDDY'S LABORATORIES, 43598-0447 - 70 Nicotine TD Patch 24HR 14 /24HR DR. REDDY'S LABORATORIES, 43598-0447 - 74 Nicotine TD Patch 24HR 14 /24HR GLAOSMITHKLINE 00135-0195 - 02 NICODERM CQ DIS 14/24H GLAOSMITHKLINE 00135-0195 - 03 NICODERM CQ DIS 14/24H GLAOSMITHKLINE 00135-0195 - 05 NICODERM CQ DIS 14/24H 37205-0361 - 74 Nicotine TD Patch 24HR 14 /24HR 62011-0172 - 01 Nicotine TD Patch 24HR 14 /24HR NOVARTIS CONSUMER HEALTH, 00067-5125 - 07 Nicotine TD Patch 24HR 14 /24HR NOVARTIS CONSUMER HEALTH, 00067-5125 - 14 Nicotine TD Patch 24HR 14 /24HR NOVARTIS CONSUMER HEALTH, 00067-6129 - 14 Nicotine TD Patch 24HR 14 /24HR 00536-5895 - 88 Nicotine TD Patch 24HR 14 /24HR Nicotine TD Patch 24HR 21 /24HR DR. REDDY'S LABORATORIES, 43598-0448 - 28 Nicotine TD Patch 24HR 21 /24HR DR. REDDY'S LABORATORIES, 43598-0448 - 70 Nicotine TD Patch 24HR 21 /24HR DR. REDDY'S LABORATORIES, 43598-0448 - 74 Nicotine TD Patch 24HR 21 /24HR GLAOSMITHKLINE 00135-0145 - 02 NICODERM CQ DIS 21/24H GLAOSMITHKLINE 00135-0194 - 01 NICODERM CQ DIS 21/24H GLAOSMITHKLINE 00135-0194 - 02 NICODERM CQ DIS 21/24H GLAOSMITHKLINE 00135-0194 - 03 NICODERM CQ DIS 21/24H GLAOSMITHKLINE 00135-0194 - 05 NICODERM CQ DIS 21/24H 37205-0358 - 74 Nicotine TD Patch 24HR 21 /24HR 62011-0173 - 01 Nicotine TD Patch 24HR 21 /24HR 49348-0144 - 46 Nicotine TD Patch 24HR 21 /24HR NOVARTIS CONSUMER HEALTH, 00067-5126 - 07 Nicotine TD Patch 24HR 21 /24HR NOVARTIS CONSUMER HEALTH, 00067-5126 - 14 Nicotine TD Patch 24HR 21 /24HR NOVARTIS CONSUMER HEALTH, 00067-5126 - 28 Nicotine TD Patch 24HR 21 /24HR NOVARTIS CONSUMER HEALTH, 00067-6130 - 14 Nicotine TD Patch 24HR 21 /24HR 00536-5896 - 88 Nicotine TD Patch 24HR 21 /24HR NICOTINE REPLACEMENT - OTHER Nicotine Polacrilex Gum 2 24385-0170 - 58 Nicotine Polacrilex Gum 2 24385-0594 - 71 Nicotine Polacrilex Gum 2 GLAOSMITHKLINE 00135-0157 - 07 NICORETTE ST GUM 2 ORIG GLAOSMITHKLINE 00135-0157 - 10 NICORETTE GUM 2 ORIG GLAOSMITHKLINE 00135-0157 - 11 NICORETTE GUM 2 ORIG GLAOSMITHKLINE 00135-0225 - 02 NICORETTE ST GUM 2 MINT GLAOSMITHKLINE 00135-0225 - 03 NICORETTE GUM 2 MINT GLAOSMITHKLINE 00135-0229 - 04 NICORETTE GUM 2 MINT GLAOSMITHKLINE 00135-0229 - 05 NICORETTE GUM 2 MINT GLAOSMITHKLINE 00135-0241 - 02 NICORETTE GUM 2FRUIT GLAOSMITHKLINE 00135-0241 - 03 NICORETTE GUM 2FRUIT GLAOSMITHKLINE 00135-0241 - 05 NICORETTE GUM 2FRUIT GLAOSMITHKLINE 00135-0241 - 06 NICORETTE GUM 2FRUIT GLAOSMITHKLINE 00135-0241 - 08 NICORETTE GUM 2FRUIT Page 18 of 28
Drug Description PA: "" denotes NICOTINE REPLACEMENT - OTHER Nicotine Polacrilex Gum 2 GLAOSMITHKLINE 00135-0466 - 01 NICORETTE GUM 2 CINN GLAOSMITHKLINE 00135-0466 - 02 NICORETTE GUM 2 CINN GLAOSMITHKLINE 00135-0466 - 03 NICORETTE GUM 2 CINN GLAOSMITHKLINE 00135-0466 - 05 NICORETTE GUM 2 CINN GLAOSMITHKLINE 00135-0474 - 01 NICORETTE GUM 2 MINT GLAOSMITHKLINE 00135-0474 - 02 NICORETTE GUM 2 MINT GLAOSMITHKLINE 00135-0474 - 03 NICORETTE GUM 2 MINT GLAOSMITHKLINE 00135-0474 - 05 NICORETTE GUM 2 MINT GLAOSMITHKLINE 00135-0474 - 08 NICORETTE GUM 2 MINT 00113-0206 - 25 Nicotine Polacrilex Gum 2 37205-0203 - 71 Nicotine Polacrilex Gum 2 37205-0967 - 58 Nicotine Polacrilex Gum 2 37205-0967 - 78 Nicotine Polacrilex Gum 2 00904-5734 - 11 Nicotine Polacrilex Gum 2 00904-5734 - 51 Nicotine Polacrilex Gum 2 00904-5736 - 11 Nicotine Polacrilex Gum 2 00904-5736 - 51 Nicotine Polacrilex Gum 2 62011-0047 - 02 Nicotine Polacrilex Gum 2 49348-0573 - 08 Nicotine Polacrilex Gum 2 49348-0573 - 36 Nicotine Polacrilex Gum 2 49348-0691 - 36 Nicotine Polacrilex Gum 2 49348-0787 - 10 Nicotine Polacrilex Gum 2 45802-0206 - 25 Nicotine Polacrilex Gum 2 00536-1362 - 06 Nicotine Polacrilex Gum 2 00536-1362 - 23 Nicotine Polacrilex Gum 2 00536-1362 - 34 Nicotine Polacrilex Gum 2 00536-3029 - 06 Nicotine Polacrilex Gum 2 00536-3029 - 23 Nicotine Polacrilex Gum 2 00536-3029 - 34 Nicotine Polacrilex Gum 2 00536-3112 - 01 Nicotine Polacrilex Gum 2 00536-3112 - 37 Nicotine Polacrilex Gum 2 00536-3386 - 01 Nicotine Polacrilex Gum 2 00536-3386 - 37 Nicotine Polacrilex Gum 2 00536-3404 - 01 Nicotine Polacrilex Gum 2 36800-0029 - 25 Nicotine Polacrilex Gum 2 36800-0206 - 25 Nicotine Polacrilex Gum 2 36800-0352 - 78 Nicotine Polacrilex Gum 2 36800-0456 - 78 Nicotine Polacrilex Gum 2 Nicotine Polacrilex Gum 4 24385-0598 - 71 Nicotine Polacrilex Gum 4 63868-0195 - 11 Nicotine Polacrilex Gum 4 GLAOSMITHKLINE 00135-0158 - 07 NICORETTE ST GUM 4 ORIG GLAOSMITHKLINE 00135-0158 - 10 NICORETTE GUM 4 ORIG GLAOSMITHKLINE 00135-0158 - 11 NICORETTE GUM 4 ORIG GLAOSMITHKLINE 00135-0226 - 02 NICORETTE GUM 4 MINT GLAOSMITHKLINE 00135-0226 - 03 NICORETTE GUM 4 MINT GLAOSMITHKLINE 00135-0230 - 04 NICORETTE GUM 4 MINT Page 19 of 28
Drug Description PA: "" denotes NICOTINE REPLACEMENT - OTHER Nicotine Polacrilex Gum 4 GLAOSMITHKLINE 00135-0230 - 05 NICORETTE GUM 4 MINT GLAOSMITHKLINE 00135-0242 - 01 NICORETTE GUM 4FRUIT GLAOSMITHKLINE 00135-0242 - 02 NICORETTE GUM 4FRUIT GLAOSMITHKLINE 00135-0242 - 03 NICORETTE GUM 4FRUIT GLAOSMITHKLINE 00135-0242 - 05 NICORETTE GUM 4FRUIT GLAOSMITHKLINE 00135-0242 - 06 NICORETTE GUM 4FRUIT GLAOSMITHKLINE 00135-0242 - 08 NICORETTE GUM 4FRUIT GLAOSMITHKLINE 00135-0467 - 02 NICORETTE GUM 4 CINN GLAOSMITHKLINE 00135-0467 - 03 NICORETTE GUM 4 CINN GLAOSMITHKLINE 00135-0467 - 05 NICORETTE GUM 4 CINN GLAOSMITHKLINE 00135-0475 - 01 NICORETTE GUM 4 MINT GLAOSMITHKLINE 00135-0475 - 02 NICORETTE GUM 4 MINT GLAOSMITHKLINE 00135-0475 - 03 NICORETTE GUM 4 MINT GLAOSMITHKLINE 00135-0475 - 05 NICORETTE GUM 4 MINT GLAOSMITHKLINE 00135-0475 - 08 NICORETTE GUM 4 MINT 00113-0422 - 25 Nicotine Polacrilex Gum 4 00113-0532 - 78 Nicotine Polacrilex Gum 4 37205-0204 - 71 Nicotine Polacrilex Gum 4 37205-0968 - 58 Nicotine Polacrilex Gum 4 37205-0968 - 78 Nicotine Polacrilex Gum 4 00904-5735 - 11 Nicotine Polacrilex Gum 4 00904-5735 - 51 Nicotine Polacrilex Gum 4 00904-5737 - 11 Nicotine Polacrilex Gum 4 00904-5737 - 51 Nicotine Polacrilex Gum 4 62011-0170 - 01 Nicotine Polacrilex Gum 4 49348-0572 - 08 Nicotine Polacrilex Gum 4 49348-0572 - 36 Nicotine Polacrilex Gum 4 49348-0692 - 36 Nicotine Polacrilex Gum 4 49348-0788 - 10 Nicotine Polacrilex Gum 4 45802-0001 - 25 Nicotine Polacrilex Gum 4 45802-0110 - 78 Nicotine Polacrilex Gum 4 00536-1372 - 06 Nicotine Polacrilex Gum 4 00536-1372 - 23 Nicotine Polacrilex Gum 4 00536-1372 - 34 Nicotine Polacrilex Gum 4 00536-3030 - 06 Nicotine Polacrilex Gum 4 00536-3030 - 23 Nicotine Polacrilex Gum 4 00536-3113 - 01 Nicotine Polacrilex Gum 4 00536-3113 - 37 Nicotine Polacrilex Gum 4 00536-3387 - 01 Nicotine Polacrilex Gum 4 00536-3405 - 01 Nicotine Polacrilex Gum 4 36800-0170 - 25 Nicotine Polacrilex Gum 4 36800-0170 - 71 Nicotine Polacrilex Gum 4 36800-0422 - 71 Nicotine Polacrilex Gum 4 36800-0532 - 78 Nicotine Polacrilex Gum 4 36800-0854 - 78 Nicotine Polacrilex Gum 4 Nicotine Polacrilex Lozenge 2 24385-0975 - 67 Nicotine Polacrilex Lozenge 2 Page 20 of 28
Drug Description PA: "" denotes NICOTINE REPLACEMENT - OTHER Nicotine Polacrilex Lozenge 2 DRUG COMPANY 46122-0176 - 08 Nicotine Polacrilex Lozenge 2 GLAOSMITHKLINE 00135-0508 - 02 NICORETTE LOZ 2 MINT GLAOSMITHKLINE 00135-0508 - 03 NICORETTE LOZ 2 MINT GLAOSMITHKLINE 00135-0510 - 01 NICORETTE LOZ 2 MINT GLAOSMITHKLINE 00135-0510 - 02 NICORETTE LOZ 2 MINT GLAOSMITHKLINE 00135-0510 - 03 NICORETTE LOZ 2 MINT GLAOSMITHKLINE 00135-0510 - 05 NICORETTE LOZ 2 MINT GLAOSMITHKLINE 00135-0512 - 01 NICORETTE LOZ 2 CHRY GLAOSMITHKLINE 00135-0512 - 05 NICORETTE LOZ 2 CHRY GLAOSMITHKLINE 00135-0514 - 03 NICORETTE LOZ 2 ORIG 00113-0344 - 05 Nicotine Polacrilex Lozenge 2 37205-0987 - 69 Nicotine Polacrilex Lozenge 2 62011-0048 - 01 Nicotine Polacrilex Lozenge 2 62011-0199 - 01 Nicotine Polacrilex Lozenge 2 49348-0852 - 16 Nicotine Polacrilex Lozenge 2 45802-0344 - 05 Nicotine Polacrilex Lozenge 2 00536-1038 - 81 Nicotine Polacrilex Lozenge 2 36800-0344 - 05 Nicotine Polacrilex Lozenge 2 Nicotine Polacrilex Lozenge 4 24385-0976 - 67 Nicotine Polacrilex Lozenge 4 GLAOSMITHKLINE 00135-0509 - 02 NICORETTE LOZ 4 MINT GLAOSMITHKLINE 00135-0509 - 03 NICORETTE LOZ 4 MINT GLAOSMITHKLINE 00135-0511 - 01 NICORETTE LOZ 4 MINT GLAOSMITHKLINE 00135-0511 - 02 NICORETTE LOZ 4 MINT GLAOSMITHKLINE 00135-0511 - 05 NICORETTE LOZ 4 MINT GLAOSMITHKLINE 00135-0513 - 01 NICORETTE LOZ 4 CHRY GLAOSMITHKLINE 00135-0513 - 05 NICORETTE LOZ 4 CHRY GLAOSMITHKLINE 00135-0515 - 03 NICORETTE LOZ 4 ORIG 00113-0873 - 05 Nicotine Polacrilex Lozenge 4 37205-0988 - 69 Nicotine Polacrilex Lozenge 4 62011-0171 - 01 Nicotine Polacrilex Lozenge 4 62011-0171 - 02 Nicotine Polacrilex Lozenge 4 62011-0200 - 01 Nicotine Polacrilex Lozenge 4 49348-0853 - 16 Nicotine Polacrilex Lozenge 4 45802-0873 - 05 Nicotine Polacrilex Lozenge 4 00536-1039 - 81 Nicotine Polacrilex Lozenge 4 36800-0873 - 05 Nicotine Polacrilex Lozenge 4 NSAIDS 24385-0058 - 78 24385-0058 - 82 24385-0059 - 78 24385-0604 - 71 24385-0604 - 76 24385-0604 - 78 24385-0604 - 85 24385-0604 - 90 Page 21 of 28
Drug Description PA: "" denotes NSAIDS 24385-0647 - 71 24385-0647 - 76 24385-0647 - 78 AMNEAL PHARMACEUTICALS 53746-0140 - 01 AMNEAL PHARMACEUTICALS 53746-0140 - 10 00113-0074 - 71 00113-0074 - 78 00113-0517 - 71 00113-0604 - 62 00113-0604 - 71 00113-0604 - 78 00113-0604 - 90 00113-0647 - 62 00113-0647 - 71 00113-0647 - 78 37205-0341 - 71 37205-0341 - 78 37205-0345 - 71 37205-0345 - 78 37205-0350 - 78 37205-0605 - 71 00904-7912 - 24 00904-7912 - 51 00904-7912 - 59 00904-7914 - 51 00904-7914 - 59 00904-7914 - 61 00904-7915 - 24 00904-7915 - 40 00904-7915 - 51 00904-7915 - 59 00904-7915 - 70 00904-7915 - 80 62011-0013 - 01 62011-0014 - 01 62011-0014 - 02 62011-0014 - 03 62011-0015 - 01 62011-0015 - 02 62011-0213 - 01 62011-0222 - 01 62011-0222 - 02 49348-0196 - 09 49348-0196 - 10 49348-0196 - 35 49348-0706 - 04 49348-0706 - 09 49348-0706 - 10 Page 22 of 28
Drug Description PA: "" denotes NSAIDS 49348-0706 - 14 49348-0727 - 09 49348-0727 - 10 MCKESSON PACKAGING SERVICE, A DIVISION 63739-0134 - 01 PHARBEST PHARMACEUTICALS, 16103-0393 - 06 PHARBEST PHARMACEUTICALS, 16103-0393 - 08 PRIME MARKETING LLC 62107-0002 - 01 PRIME MARKETING LLC 62107-0002 - 50 00536-3587 - 01 00536-3587 - 06 15127-0312 - 01 15127-0312 - 24 15127-0312 - 25 15127-0312 - 50 15127-0335 - 01 15127-0335 - 24 15127-0335 - 50 15127-0905 - 50 15127-0907 - 24 15127-0907 - 50 36800-0074 - 71 36800-0074 - 78 36800-0183 - 83 36800-0517 - 71 36800-0517 - 78 36800-0604 - 62 36800-0604 - 71 36800-0604 - 78 36800-0604 - 85 36800-0604 - 90 36800-0604 - 93 36800-0647 - 62 36800-0647 - 71 36800-0647 - 78 36800-0647 - 90 00472-1255 - 94 00472-1261 - 94 00472-1263 - 94 24385-0009 - 26 24385-0009 - 34 24385-0361 - 26 24385-0361 - 34 24385-0372 - 26 24385-0905 - 26 24385-0905 - 34 DRUG COMPANY 46122-0110 - 26 Page 23 of 28
Drug Description PA: "" denotes NSAIDS 63868-0756 - 18 63868-0758 - 18 00113-0166 - 26 00113-0660 - 26 00113-0897 - 26 00113-0897 - 34 37205-0282 - 26 37205-0283 - 26 37205-0643 - 26 37205-0660 - 26 37205-0848 - 26 00904-5309 - 09 00904-5309 - 20 00904-5577 - 20 62011-0010 - 01 62011-0011 - 01 62011-0030 - 01 62011-0030 - 02 62011-0214 - 01 49348-0229 - 34 49348-0229 - 37 49348-0499 - 34 49348-0500 - 34 49348-0876 - 34 45802-0133 - 26 45802-0140 - 26 45802-0897 - 26 45802-0897 - 34 PHARMACEUTICAL ASSOCIATES, 00121-1836 - 05 PHARMACEUTICAL ASSOCIATES, 00121-4774 - 05 PRECISION DOSE, 68094-0494 - 58 PRECISION DOSE, 68094-0494 - 59 PRECISION DOSE, 68094-0494 - 61 PRECISION DOSE, 68094-0494 - 62 PRECISION DOSE, 68094-0503 - 59 PRECISION DOSE, 68094-0503 - 61 PRECISION DOSE, 68094-0503 - 62 15127-0900 - 04 15127-0978 - 04 36800-0166 - 26 36800-0660 - 26 36800-0897 - 26 OP. ARTIFICIAL TEARS AND LUBRICANTS *Artificial Tear Ophth Solution*** ALCON LABORATORIES, 00065-0416 - 25 *Artificial Tear Ophth Solution*** ALCON LABORATORIES, 00065-0416 - 36 *Artificial Tear Ophth Solution*** Page 24 of 28
Drug Description PA: "" denotes OP. ARTIFICIAL TEARS AND LUBRICANTS *Artificial Tear Ophth Solution*** ALCON LABORATORIES, 00065-0418 - 15 *Artificial Tear Ophth Solution*** ALCON LABORATORIES, 00065-0418 - 30 *Artificial Tear Ophth Solution*** ALCON LABORATORIES, 00065-0419 - 28 *Artificial Tear Ophth Solution*** ALCON LABORATORIES, 00065-0426 - 22 *Artificial Tear Ophth Solution*** ALCON LABORATORIES, 00065-0426 - 23 *Artificial Tear Ophth Solution*** 37205-0603 - 05 *Artificial Tear Ophth Solution*** *Artificial Tear Ophth Ointment*** AKORN INC 17478-0062 - 35 *Artificial Tear Ophth Ointment*** ALLERGAN INC 00023-0240 - 04 *Artificial Tear Ophth Ointment*** ALLERGAN INC 00023-0312 - 04 *Artificial Tear Ophth Ointment*** ALLERGAN INC 00023-0312 - 07 *Artificial Tear Ophth Ointment*** DRUG COMPANY 46122-0202 - 04 *Artificial Tear Ophth Ointment*** Sodium Chloride Hypertonic Ophth Soln 5% AKORN INC BAUSCH & LOMB BAUSCH & LOMB Sodium Chloride Hypertonic Ophth Oint 5% AKORN INC BAUSCH & LOMB BAUSCH & LOMB TOPICAL - ACNE PREPARATIONS Benzoyl Peroxide Gel 5% Benzoyl Peroxide Gel 10% Benzoyl Peroxide Lotion 5% Benzoyl Peroxide Lotion 10% TOPICAL - ANTIBIOTIC Bacitracin Oint 500 Unit/GM G&W LABORATORIES, INC 17478-0623 - 12 24208-0277 - 15 24208-0277 - 30 00904-5314 - 35 17478-0622 - 35 24208-0385 - 55 24208-0385 - 56 00904-5315 - 38 45802-0216 - 01 45802-0216 - 96 00536-1055 - 56 00536-4089 - 56 45802-0308 - 01 45802-0308 - 96 00536-1056 - 56 00536-4092 - 56 00536-0810 - 95 00536-1057 - 75 00536-0815 - 95 00536-1058 - 75 00713-0280 - 31 37205-0275 - 10 62011-0094 - 01 Sodium Chloride Hypertonic Ophth Soln 5% MURO 128 SOL 5% OP MURO 128 SOL 5% OP Sodium Chloride Hypertonic Ophth Soln 5% Sodium Chloride Hypertonic Ophth Oint 5% MURO 128 OIN 5% OP MURO 128 OIN 5% OP Sodium Chloride Hypertonic Ophth Oint 5% Benzoyl Peroxide Gel 5% Benzoyl Peroxide Gel 5% Benzoyl Peroxide Gel 5% Benzoyl Peroxide Gel 5% Benzoyl Peroxide Gel 10% Benzoyl Peroxide Gel 10% Benzoyl Peroxide Gel 10% Benzoyl Peroxide Gel 10% ACNE MEDICAT LOT 5% ACNE MEDICAT LOT 5% ACNE MEDICAT LOT 10% ACNE MEDICAT LOT 10% Bacitracin Oint 500 Unit/GM Bacitracin Oint 500 Unit/GM Bacitracin Oint 500 Unit/GM Page 25 of 28
Drug Description PA: "" denotes TOPICAL - ANTIBIOTIC Bacitracin Oint 500 Unit/GM 49348-0154 - 72 Bacitracin Oint 500 Unit/GM 45802-0060 - 01 Bacitracin Oint 500 Unit/GM 45802-0060 - 03 Bacitracin Oint 500 Unit/GM 45802-0060 - 70 Bacitracin Oint 500 Unit/GM 00472-0179 - 34 00472-0179 - 56 24385-0061 - 01 24385-0061 - 03 E FOUGERA AND CO. 00168-0012 - 09 E FOUGERA AND CO. 00168-0012 - 31 E FOUGERA AND CO. 00168-0012 - 35 G&W LABORATORIES, INC 00713-0268 - 31 00113-0067 - 64 37205-0273 - 10 00904-0734 - 31 00904-0734 - 36 62011-0098 - 01 49348-0029 - 72 45802-0061 - 01 45802-0061 - 03 45802-0061 - 70 45802-0143 - 01 45802-0143 - 03 45802-0143 - 70 QUALITEST PHARMACEUTICALS, 00603-0644 - 50 TARO PHARMACEUTICALS USA, 51672-2016 - 01 TARO PHARMACEUTICALS USA, 51672-2016 - 02 TOPICAL - ANTIFUNGALS Tolnaftate Soln 1% Tolnaftate Powder 1% Tolnaftate Cream 1% TARO PHARMACEUTICALS USA, TARO PHARMACEUTICALS USA, 45802-0033 - 85 45802-0701 - 11 00904-0726 - 45 00536-5150 - 26 24385-0032 - 03 63868-0104 - 46 37205-0197 - 10 00904-0722 - 36 49348-0155 - 29 45802-0032 - 01 45802-0032 - 03 51672-2020 - 01 51672-2020 - 02 Tolnaftate Soln 1% Tolnaftate Soln 1% Tolnaftate Powder 1% Tolnaftate Powder 1% Tolnaftate Cream 1% Tolnaftate Cream 1% Tolnaftate Cream 1% Tolnaftate Cream 1% Tolnaftate Cream 1% Tolnaftate Cream 1% Tolnaftate Cream 1% Tolnaftate Cream 1% Tolnaftate Cream 1% Page 26 of 28
Drug Description PA: "" denotes TOPICAL - ANTIFUNGALS Miconazole Nitrate Cream 2% 00472-0735 - 14 Miconazole Nitrate Cream 2% 00472-0735 - 42 Miconazole Nitrate Cream 2% 00472-0735 - 56 Miconazole Nitrate Cream 2% COLOPLAST CORPORATION 11701-0045 - 14 Miconazole Nitrate Cream 2% COLOPLAST CORPORATION 11701-0045 - 22 Miconazole Nitrate Cream 2% COLOPLAST CORPORATION 11701-0045 - 23 Miconazole Nitrate Cream 2% 49348-0689 - 72 Miconazole Nitrate Cream 2% MEDLINE INDUSTRIES, 53329-0079 - 64 Miconazole Nitrate Cream 2% MEDLINE INDUSTRIES, 53329-0080 - 57 Miconazole Nitrate Cream 2% MEDLINE INDUSTRIES, 53329-0080 - 58 Miconazole Nitrate Cream 2% MEDLINE INDUSTRIES, 53329-0162 - 04 Miconazole Nitrate Cream 2% QUALITEST PHARMACEUTICALS, 00603-7805 - 50 Miconazole Nitrate Cream 2% SMITH & NEPHEW, 50484-0328 - 00 Miconazole Nitrate Cream 2% SMITH & NEPHEW, 50484-0329 - 00 Miconazole Nitrate Cream 2% TARO PHARMACEUTICALS USA, 51672-2001 - 01 Miconazole Nitrate Cream 2% TARO PHARMACEUTICALS USA, 51672-2001 - 02 Miconazole Nitrate Cream 2% TOPICAL - SCABICIDES AND PEDICULICIDES Permethrin Lotion 1% 00472-5242 - 67 Permethrin Lotion 1% 00472-5242 - 69 Permethrin Lotion 1% 62011-0112 - 01 Permethrin Lotion 1% 49348-0460 - 30 Permethrin Lotion 1% 49348-0460 - 34 Permethrin Lotion 1% Pyrethrins-Piperonyl Butoxide Liq 0.33-4% 37205-0285 - 16 Pyrethrins-Piperonyl Butoxide Liq 0.33-4% Pyrethrins-Piperonyl Butoxide Shampoo 0.33-4% 24385-0116 - 03 00113-0866 - 26 37205-0165 - 26 00904-2528 - 20 62011-0119 - 02 49348-0443 - 34 Pyrethrins-Piperonyl Butoxide Shampoo 0.33-4% Pyrethrins-Piperonyl Butoxide Shampoo 0.33-4% Pyrethrins-Piperonyl Butoxide Shampoo 0.33-4% Pyrethrins-Piperonyl Butoxide Shampoo 0.33-4% Pyrethrins-Piperonyl Butoxide Shampoo 0.33-4% Pyrethrins-Piperonyl Butoxide Shampoo 0.33-4% VAGINAL - ANTI FUNGALS Clotrimazole Vaginal Cream 1% TARO PHARMACEUTICALS USA, Miconazole Nitrate Vaginal Cream 2% 00472-0220 - 41 00472-0220 - 63 49348-0793 - 76 51672-2003 - 06 00472-0730 - 41 00472-0730 - 63 24385-0590 - 29 Clotrimazole Vaginal Cream 1% Clotrimazole Vaginal Cream 1% Clotrimazole Vaginal Cream 1% Clotrimazole Vaginal Cream 1% Miconazole Nitrate Vaginal Cream 2% Miconazole Nitrate Vaginal Cream 2% Miconazole Nitrate Vaginal Cream 2% Page 27 of 28
Drug Description PA: "" denotes VAGINAL - ANTI FUNGALS Miconazole Nitrate Vaginal Cream 2% G&W LABORATORIES, INC TARO PHARMACEUTICALS USA, Miconazole Nitrate Vaginal Suppos 100 00713-0252 - 37 00113-0214 - 29 00113-0825 - 29 00904-7734 - 45 00904-7734 - 57 49348-0530 - 77 49348-0872 - 77 51672-2035 - 06 36800-0825 - 29 Miconazole Nitrate Vaginal Cream 2% Miconazole Nitrate Vaginal Cream 2% Miconazole Nitrate Vaginal Cream 2% Miconazole Nitrate Vaginal Cream 2% Miconazole Nitrate Vaginal Cream 2% Miconazole Nitrate Vaginal Cream 2% Miconazole Nitrate Vaginal Cream 2% Miconazole Nitrate Vaginal Cream 2% Miconazole Nitrate Vaginal Cream 2% 00472-1736 - 07 Miconazole Nitrate Vaginal Suppos 100 G&W LABORATORIES, INC 00713-0197 - 57 Miconazole Nitrate Vaginal Suppos 100 49348-0833 - 61 Miconazole Nitrate Vaginal Suppos 100 Page 28 of 28