Drug Benefit List 2012

40:00 ELECTROLYTIC, CALORIC, AND WATER BALANCE

40:08.00 ALKALINIZING AGENTS

CITRIC ACID, SODIUM CITRATE

66.8mg & 100mg/mL Solution

00721344 DICITRATE PMS

SODIUM BICARBONATE

325mg Tablet

00481912 SODIUM BICARBONATE XEN

40:10.00 AMMONIA DETOXICANTS

LACTULOSE

ST 667mg/mL Oral Liquid

02331551 TEVA-LACTULOSE TEV

40:12.00 REPLACEMENT PREPARATIONS

CALCIUM CARBONATE

ST 500mg Tablet

00682039 APO-CAL 500 APX

02240240 CALCIUM PMT

80003773 CALCIUM TRI

80017732 CALCIUM PRO

02246040 CALCIUM CARBONATE JMP

02237352 EURO-CAL EUR

00618098 NU-CAL ODN

00622443 O-CALCIUM 500 VTH

80001408 OYSTER SHELL CALCIUM NUR

80001122 PMS-CALCIUM PMS

CALCIUM LACTOGLUCONATE

20mg/mL Oral Liquid

80002626 SOLUCAL JMP

80006877 WAMPOLE MINERAL CALCIUM JMP

CALCIUM, VITAMIN D

ST 500mg & 400IU Chewable Tablet

80009628 CALODAN D ODN

80002901 CARBOCAL D EUR

80009412 M-CAL D MAN

ST Tablet

80017196 CALCIUM WITH VIT D PRO

80017190 CAL-D PDL

ST 500mg & 125IU Tablet

80004966 CALCITE D 500 RIV

02246041 CALCIUM CARBONATE WITH JMP

00730599 CALCIUM CARBONATE WITH VIT D PMT

02237351 EURO-CAL D EUR

00720798 NEO CAL-D-500 NEO

80004281 PMS-CALCIUM/VITAMIN D PMS

80004968 CALCIUM D TRI

ST 500mg & 400IU Tablet

80003919 BIOCAL-D FORTE BMI

80004963 CALCITE 500 + D 400 RIV

80004969 CALCIUM 500 + D 400 TRI

80002623 CALCIUM 500MG WITH VIT D JMP

02245511 CARBOCAL D EUR

80002122 JAMP-CALCIUM+VITAM D JMP

80013329 M-CAL D MAN

80002703 NU-CAL D ODN

80015351 PRIVA CAL D FORTE PHA

ST 500mg & 1000IU Tablet

80019536 M-CAL D MAN

ST 500mg & 800IU Tablet

80019533 M-CAL D MAN

ELECTROLYTE & DEXTROSE

3.56g & 300mg & 470mg & 530mg Powder

01931563 GASTROLYTE REG SAC

25mg & 2.2mg & 2.2mg & 0.9mg/mL Solution

00630365 PEDIALYTE ABB

02219883 PEDIATRIC ELECTROLYTE PMS

MAGNESIUM

25mg Oral Liquid

80009357 JAMP-MAGNESIUM JMP

28mg Tablet

80009539 JAMP-MAGNESIUM JMP

100mg Tablet

02068400 MAGNESIUM JAM

MAGNESIUM CITRATE

5.40% Oral Liquid

00262609 CITRO MAG 15GM/300ML RPH

MAGNESIUM GLUCONATE

100mg/mL Oral Liquid

00026697 RATIO-MAGNESIUM RPH

POTASSIUM CHLORIDE

ST 25MEQ Effervescent Tablet

02085992 K LYTE WPC

ST 8mmol Long Acting Capsule

02244068 RIVA-K RIV

ST 600mg Long Acting Capsule

02042304 MICRO K EXTENCAPS WAY

ST 8mmol Long Acting Tablet

00602884 APO-K APX

02246734 EURO-K 600 EUR

80008214 ODAN K-8 ODN

00613274 PRO-600K PDL

00074225 SLOW K NVR

ST 20mmol Long Acting Tablet

02242261 EURO-K 20 EUR

00713376 K-DUR KEY

80004415 ODAN K-20 ODN

02243975 RIVA-K 20 RIV

ST 1.33MEQ/mL Oral Liquid

01918303 K 10 GSK

02238604 PMS-POTASSIUM PMS

SODIUM CHLORIDE

0.9% Inhalation Diluent

02094657 BACTERIOSTATIC NACL BIO

00801267 SODIUM CHLORIDE *

02058235 SODIUM CHLORIDE BDH

0.9% Injection

00060208 SODIUM CHLORIDE BAT

00402249 SODIUM CHLORIDE ABB

02150204 SODIUM CHLORIDE OMG

99002329 SODIUM CHLORIDE *

40:17.00 CALCIUM-REMOVING RESINS

CALCIUM POLYSTYRENE SULFONATE

1g binds with approx 1.6mmol K Powder

02017741 RESONIUM CALCIUM SAC

40:18.00 ION-REMOVING AGENTS

SODIUM POLYSTYRENE SULFONATE

1g binds with approx 1mmol K Powder

02026961 KAYEXALATE SAC

00765252 K-EXIT OMG

00755338 PMS-SOD POLYSTYRENE SULFONA PMS

250mg/mL Oral Suspension

00769541 PMS-SOD POLYSTYRENE SULF PMS

250mg/mL Retention Enema

00769533 PMS-SOD POLYSTYRENE SULF PMS

40:20.00 CALORIC AGENTS

LEVOCARNITINE

100mg/mL Oral Liquid

02144336 CARNITOR SIG

200mg/mL Solution

02144344 CARNITOR IV SIG

330mg Tablet

02144328 CARNITOR SIG

40:28.08 LOOP DIURETICS

ETHACRYNIC ACID

ST 25mg Tablet

02258528 EDECRIN FRS

FUROSEMIDE

ST 10mg/mL Solution

02224720 LASIX SAC

ST 20mg Tablet

00396788 APO-FUROSEMIDE APX

02247371 BIO-FUROSEMIDE BMI

02248124 DOM-FUROSEMIDE BMI

00496723 FUROSEMIDE PDL

02351420 FUROSEMIDE SAN

02224690 LASIX SAC

00337730 NOVO-SEMIDE TEV

02239224 NU-FUROSEMIDE NXP

02247493 PMS-FUROSEMIDE PMS

ST 40mg Tablet

00362166 APO-FUROSEMIDE APX

02247372 BIO-FUROSEMIDE BMI

02248125 DOM-FUROSEMIDE BMI

00397792 FUROSEMIDE PDL

02351439 FUROSEMIDE SAN

02224704 LASIX SAC

00337749 NOVO-SEMIDE TEV

02239225 NU-FUROSEMIDE NXP

02247494 PMS-FUROSEMIDE PMS

ST 80mg Tablet

00707570 APO-FUROSEMIDE APX

00667080 FUROSEMIDE PDL

02351447 FUROSEMIDE SAN

00765953 NOVO-SEMIDE TEV

ST 500mg Tablet

02224755 LASIX SPECIAL SAC

40:28.16 POTASSIUM SPARING DIURETICS

AMILORIDE HCL

ST 5mg Tablet

02249510 MIDAMOR AAP

AMILORIDE HCL, HYDROCHLOROTHIAZIDE

ST 5mg & 50mg Tablet

00870943 AMI-HYDRO PDL

00784400 APO-AMILZIDE APX

02257378 MYLAN-AMILAZIDE MYL

01937219 NOVAMILOR TEV

00886106 NU-AMILZIDE NXP

TRIAMTERENE, HYDROCHLOROTHIAZIDE

ST 50mg & 25mg Tablet

00441775 APO-TRIAZIDE APX

00532657 NOVO-TRIAMZIDE TEV

00865532 NU-TRIAZIDE NXP

00519367 PRO-TRIAZIDE PRO

02240846 RIVA-ZIDE RIV

40:28.20 TIAZIDE DIURETICS

HYDROCHLOROTHIAZIDE

12.5mg Tablet

02327856 APO-HYDRO APX

02274086 PMS-HYDROCHLOROTHIAZIDE BMI

ST 25mg Tablet

00326844 APO-HYDROCLOROTHIAZIDE APX

02247170 BIO-HYDROCHLOROTHIAZIDE BMI

02248134 DOM-HYDROCHLOROTHIAZIDE DPC

00341975 HYDROCHLOROTHIAZIDE PDL

02360594 HYDROCHLOROTHIAZIDE SAN

00021474 NOVO-HYDRAZIDE TEV

02250659 NU-HYDRO NXP

02247386 PMS-HYDROCHLOROTHIAZIDE PMS

ST 50mg Tablet

00312800 APO-HYDRO APX

02247171 BIO-HYDROCHLOROTHIAZIDE BMI

02248135 DOM-HYDROCHLOROTHIAZIDE DPC

02360608 HYDROCHLOROTHIAZIDE SAN

00021482 NOVO-HYDRAZIDE TEV

02250667 NU-HYDRO NXP

02247387 PMS-HYDROCHLOROTHIAZIDE PMS

ST 100mg Tablet

00644552 APO-HYDRO APX

00532088 HYDROCHLOROTHIAZIDE PDL

40:28.24 THIAZIDE LIKE DIURETICS

CHLORTHALIDONE

ST 50mg Tablet

00360279 CHLORTHALIDONE AAP

ST 100mg Tablet

00360287 APO-CHLORTHALIDONE APX

INDAPAMIDE

ST 1.25mg Tablet

02245246 APO-INDAPAMIDE APX

02239913 DOM-INDAPAMIDE DPC

02227339 INDAPAMIDE PRO

02179709 LOZIDE SEV

02240067 MYLAN-INDAPAMIDE MYL

02240349 PHL-INDAPAMIDE PHH

02239619 PMS-INDAPAMIDE PMS

02312530 PRO-INDAPAMIDE PDL

02247245 RIVA-INDAPAMIDE RIV

ST 2.5mg Tablet

02223678 APO-INDAPAMIDE APX

02239917 DOM-INDAPAMIDE DPC

02049341 INDAPAMIDE PRO

00564966 LOZIDE SEV

02153483 MYLAN-INDAPAMIDE MYL

02231184 NOVO-INDAPAMIDE TEV

02223597 NU-INDAPAMIDE NXP

02239620 PMS-INDAPAMIDE PMS

02312549 PRO-INDAPAMIDE PDL

02242125 RIVA-INDAPAMIDE RIV

METOLAZONE

ST 2.5mg Tablet

00888400 ZAROXOLYN SAC

40:36.00 IRRIGATING SOLUTIONS

WATER

Injection

00038202 STERILE WATER ABB *

99002264 STERILE WATER (QC) *

00402257 STERILE WATER FOR INJ OMG

02142546 STERILE WATER FOR INJ HOS

00905178 WATER FOR INJECTION (QC) *

40:40.00 URICOSURIC AGENTS

PROBENECID

500mg Tablet

00294926 BENURYL VAE

SULFINPYRAZONE

200mg Tablet

02045699 NU-SULFINPYRAZONE NXP

00441767 SULFINPYRAZONE AAP