\n\n\t| Amiloride\/Hydrochlorothiazide 5\/50mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | MODURETIC<\/td>\n<\/tr>\n |
\n\t| Amiodarone 200mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | CORDARONE<\/td>\n<\/tr>\n |
\n\t| Amlodipine 10mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | NORVASC<\/td>\n<\/tr>\n |
\n\t| Amlodipine 2.5mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | NORVASC<\/td>\n<\/tr>\n |
\n\t| Amlodipine 5mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | NORVASC<\/td>\n<\/tr>\n |
\n\t| Amlodipine\/Benazepril 10\/20mg Capsule<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | LOTREL<\/td>\n<\/tr>\n |
\n\t| Amlodipine\/Benazepril 10\/40mg Capsule<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | LOTREL<\/td>\n<\/tr>\n |
\n\t| Amlodipine\/Benazepril 2.5\/10mg Capsule<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | LOTREL<\/td>\n<\/tr>\n |
\n\t| Amlodipine\/Benazepril 5\/10mg Capsule<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | LOTREL<\/td>\n<\/tr>\n |
\n\t| Amlodipine\/Benazepril 5\/20mg Capsule<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | LOTREL<\/td>\n<\/tr>\n |
\n\t| Amlodipine\/Benazepril 5\/40mg Capsule<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | LOTREL<\/td>\n<\/tr>\n |
\n\t| Amlodipine\/Olmesartan 10\/20mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | AZOR<\/td>\n<\/tr>\n |
\n\t| Amlodipine\/Olmesartan 10\/40mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | AZOR<\/td>\n<\/tr>\n |
\n\t| Amlodipine\/Olmesartan 5\/20mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | AZOR<\/td>\n<\/tr>\n |
\n\t| Amlodipine\/Olmesartan 5\/40mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | AZOR<\/td>\n<\/tr>\n |
\n\t| Atenolol 100mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | TENORMIN<\/td>\n<\/tr>\n |
\n\t| Atenolol 25mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | TENORMIN<\/td>\n<\/tr>\n |
\n\t| Atenolol 50mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | TENORMIN<\/td>\n<\/tr>\n |
\n\t| Atenolol\/Chlorthalidone 100\/25mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | TENORETIC<\/td>\n<\/tr>\n |
\n\t| Atenolol\/Chlorthalidone 50\/25mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | TENORETIC 50<\/td>\n<\/tr>\n |
\n\t| Benazepril 10mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | LOTENSIN<\/td>\n<\/tr>\n |
\n\t| Benazepril 20mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | LOTENSIN<\/td>\n<\/tr>\n |
\n\t| Benazepril 40mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | LOTENSIN<\/td>\n<\/tr>\n |
\n\t| Benazepril 5mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | LOTENSIN<\/td>\n<\/tr>\n |
\n\t| Bisoprolol 10mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | ZEBETA<\/td>\n<\/tr>\n |
\n\t| Bisoprolol 5mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | ZEBETA<\/td>\n<\/tr>\n |
\n\t| Bisoprolol\/HCTZ 10\/6.25mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | ZIAC<\/td>\n<\/tr>\n |
\n\t| Bisoprolol\/HCTZ 2.5\/6.25mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | ZIAC<\/td>\n<\/tr>\n |
\n\t| Bisoprolol\/HCTZ 5\/6.25mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | ZIAC<\/td>\n<\/tr>\n |
\n\t| Bumetanide 0.5 mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | BUMEX<\/td>\n<\/tr>\n |
\n\t| Bumetanide 1mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | BUMEX<\/td>\n<\/tr>\n |
\n\t| Bumetanide 2mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | BUMEX<\/td>\n<\/tr>\n |
\n\t| Carvedilol 12.5mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | COREG<\/td>\n<\/tr>\n |
\n\t| Carvedilol 25mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | COREG<\/td>\n<\/tr>\n |
\n\t| Carvedilol 3.125mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | COREG<\/td>\n<\/tr>\n |
\n\t| Carvedilol 6.25mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | COREG<\/td>\n<\/tr>\n |
\n\t| Chlorthalidone 25mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | HYGROTON<\/td>\n<\/tr>\n |
\n\t| Chlorthalidone 50mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | HYGROTON<\/td>\n<\/tr>\n |
\n\t| Cilostazol 100mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | PLETAL<\/td>\n<\/tr>\n |
\n\t| Cilostazol 50mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | PLETAL<\/td>\n<\/tr>\n |
\n\t| Clonidine 0.1mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | CATAPRES<\/td>\n<\/tr>\n |
\n\t| Clonidine 0.2mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | CATAPRES<\/td>\n<\/tr>\n |
\n\t| Clonidine 0.3mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | CATAPRES<\/td>\n<\/tr>\n |
\n\t| Clopidogrel 75mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | PLAVIX<\/td>\n<\/tr>\n |
\n\t| Digoxin 0.125mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | LANOXIN<\/td>\n<\/tr>\n |
\n\t| Digoxin 0.25mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | LANOXIN<\/td>\n<\/tr>\n |
\n\t| Diltiazem 120mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | CARDIZEM<\/td>\n<\/tr>\n |
\n\t| Diltiazem 24HR CR 120mg Capsule (AB3 CARDIZEM CD)<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | CARDIZEM CD<\/td>\n<\/tr>\n |
\n\t| Diltiazem 24HR CR 180mg Capsule (AB3 CARDIZEM CD)<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | CARDIZEM CD<\/td>\n<\/tr>\n |
\n\t| Diltiazem 24HR CR 240mg Capsule (AB3 CARDIZEM CD)<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | CARDIZEM CD<\/td>\n<\/tr>\n |
\n\t| Diltiazem 24HR CR 360mg Capsule (AB3 CARDIZEM CD)<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | CARDIZEM CD<\/td>\n<\/tr>\n |
\n\t| Diltiazem 24HR ER Coated Beads 120mg Capsule (AB4 TIAZAC)<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | TIAZAC<\/td>\n<\/tr>\n |
\n\t| Diltiazem 24HR ER Coated Beads 180mg Capsule (AB4 TIAZAC)<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | TIAZAC<\/td>\n<\/tr>\n |
\n\t| Diltiazem 24HR ER Coated Beads 240mg Capsule (AB4 TIAZAC)<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | TIAZAC<\/td>\n<\/tr>\n |
\n\t| Diltiazem 24HR ER Coated Beads 300mg Capsule (AB4 TIAZAC)<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | TIAZAC<\/td>\n<\/tr>\n |
\n\t| Diltiazem 24HR ER Coated Beads 360mg Capsule (AB4 TIAZAC)<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | TIAZAC<\/td>\n<\/tr>\n |
\n\t| Diltiazem 24HR ER Coated Beads 420mg Capsule (AB4 TIAZAC)<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | TIAZAC<\/td>\n<\/tr>\n |
\n\t| Doxazosin 1mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | CARDURA<\/td>\n<\/tr>\n |
\n\t| Doxazosin 2mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | CARDURA<\/td>\n<\/tr>\n |
\n\t| Doxazosin 4mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | CARDURA<\/td>\n<\/tr>\n |
\n\t| Doxazosin 8mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | CARDURA<\/td>\n<\/tr>\n |
\n\t| Enalapril 10mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | VASOTEC<\/td>\n<\/tr>\n |
\n\t| Enalapril 2.5mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | VASOTEC<\/td>\n<\/tr>\n |
\n\t| Enalapril 20mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | VASOTEC<\/td>\n<\/tr>\n |
\n\t| Enalapril 5mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | VASOTEC<\/td>\n<\/tr>\n |
\n\t| Enalapril\/Hydrochlorothiazide 10\/25mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | VASERETIC<\/td>\n<\/tr>\n |
\n\t| Enalapril\/Hydrochlorothiazide 5\/12.5mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | VASERETIC<\/td>\n<\/tr>\n |
\n\t| Felodipine ER 24HR 2.5mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | PLENDIL<\/td>\n<\/tr>\n |
\n\t| Felodipine ER 24HR 5mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | PLENDIL<\/td>\n<\/tr>\n |
\n\t| Flecainide Acetate 100mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | TAMBOCOR<\/td>\n<\/tr>\n |
\n\t| Flecainide Acetate 50mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | TAMBOCOR<\/td>\n<\/tr>\n |
\n\t| Fosinopril Sodium 10mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | MONOPRIL<\/td>\n<\/tr>\n |
\n\t| Fosinopril Sodium 20mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | MONOPRIL<\/td>\n<\/tr>\n |
\n\t| Fosinopril Sodium 40mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | MONOPRIL<\/td>\n<\/tr>\n |
\n\t| Furosemide 20mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | LASIX<\/td>\n<\/tr>\n |
\n\t| Furosemide 40mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | LASIX<\/td>\n<\/tr>\n |
\n\t| Furosemide 80mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | LASIX<\/td>\n<\/tr>\n |
\n\t| Guanfacine 1mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | TENEX<\/td>\n<\/tr>\n |
\n\t| Guanfacine 2mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | TENEX<\/td>\n<\/tr>\n |
\n\t| Hydralazine 100mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | APRESOLINE<\/td>\n<\/tr>\n |
\n\t| Hydralazine 10mg Tablet<\/td> | 270<\/td> | EA<\/td> | ORAL<\/td> | APRESOLINE<\/td>\n<\/tr>\n |
\n\t| Hydralazine 25mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | APRESOLINE<\/td>\n<\/tr>\n |
\n\t| Hydralazine 50mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | APRESOLINE<\/td>\n<\/tr>\n |
\n\t| Hydrochlorothiazide 12.5mg Capsule<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | MICROZIDE<\/td>\n<\/tr>\n |
\n\t| Hydrochlorothiazide 12.5mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | HYDRODIURIL<\/td>\n<\/tr>\n |
\n\t| Hydrochlorothiazide 25mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | HYDRODIURIL<\/td>\n<\/tr>\n |
\n\t| Hydrochlorothiazide 50mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | HYDRODIURIL<\/td>\n<\/tr>\n |
\n\t| Indapamide 1.25mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | LOZOL<\/td>\n<\/tr>\n |
\n\t| Indapamide 2.5mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | LOZOL<\/td>\n<\/tr>\n |
\n\t| Irbesartan 150mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | AVAPRO<\/td>\n<\/tr>\n |
\n\t| Irbesartan 300mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | AVAPRO<\/td>\n<\/tr>\n |
\n\t| Irbesartan 75mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | AVAPRO<\/td>\n<\/tr>\n |
\n\t| Irbesartan\/HCTZ 150\/12.5mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | AVALIDE<\/td>\n<\/tr>\n |
\n\t| Irbesartan\/HCTZ 300\/12.5mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | AVALIDE<\/td>\n<\/tr>\n |
\n\t| Isosorbide Mononitrate ER 24HR 120mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | IMDUR<\/td>\n<\/tr>\n |
\n\t| Isosorbide Mononitrate ER 30mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | IMDUR<\/td>\n<\/tr>\n |
\n\t| Isosorbide Mononitrate ER 60mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | IMDUR<\/td>\n<\/tr>\n |
\n\t| Labetalol 100mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | TRANDATE<\/td>\n<\/tr>\n |
\n\t| Labetalol 200mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | TRANDATE<\/td>\n<\/tr>\n |
\n\t| Labetalol 300mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | TRANDATE<\/td>\n<\/tr>\n |
\n\t| Lisinopril 10mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | PRINIVIL\/ZESTRIL<\/td>\n<\/tr>\n |
\n\t| Lisinopril 2.5mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | PRINIVIL\/ZESTRIL<\/td>\n<\/tr>\n |
\n\t| Lisinopril 20mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | PRINIVIL\/ZESTRIL<\/td>\n<\/tr>\n |
\n\t| Lisinopril 30mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | PRINIVIL\/ZESTRIL<\/td>\n<\/tr>\n |
\n\t| Lisinopril 40mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | PRINIVIL\/ZESTRIL<\/td>\n<\/tr>\n |
\n\t| Lisinopril 5mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | PRINIVIL\/ZESTRIL<\/td>\n<\/tr>\n |
\n\t| Lisinopril\/HCTZ 10\/12.5mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | ZESTORETIC<\/td>\n<\/tr>\n |
\n\t| Lisinopril\/HCTZ 20\/12.5mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | ZESTORETIC<\/td>\n<\/tr>\n |
\n\t| Lisinopril\/HCTZ 20\/25mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | ZESTORETIC<\/td>\n<\/tr>\n |
\n\t| Losartan 100mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | COZAAR<\/td>\n<\/tr>\n |
\n\t| Losartan 25mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | COZAAR<\/td>\n<\/tr>\n |
\n\t| Losartan 50mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | COZAAR<\/td>\n<\/tr>\n |
\n\t| Losartan\/HCTZ 100\/12.5mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | HYZAAR<\/td>\n<\/tr>\n |
\n\t| Losartan\/HCTZ 100\/25mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | HYZAAR<\/td>\n<\/tr>\n |
\n\t| Losartan\/HCTZ 50\/12.5mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | HYZAAR<\/td>\n<\/tr>\n |
\n\t| Metolazone 2.5mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | ZAROXOLIN<\/td>\n<\/tr>\n |
\n\t| Metolazone 5mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | ZAROXOLIN<\/td>\n<\/tr>\n |
\n\t| Metoprolol Succinate ER 100mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | TOPROL XL<\/td>\n<\/tr>\n |
\n\t| Metoprolol Succinate ER 200mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | TOPROL XL<\/td>\n<\/tr>\n |
\n\t| Metoprolol Succinate ER 25mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | TOPROL XL<\/td>\n<\/tr>\n |
\n\t| Metoprolol Succinate ER 50mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | TOPROL XL<\/td>\n<\/tr>\n |
\n\t| Metoprolol Tartrate 100mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | LOPRESSOR<\/td>\n<\/tr>\n |
\n\t| Metoprolol Tartrate 25mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | LOPRESSOR<\/td>\n<\/tr>\n |
\n\t| Metoprolol Tartrate 37.5mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | LOPRESSOR<\/td>\n<\/tr>\n |
\n\t| Metoprolol Tartrate 50mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | LOPRESSOR<\/td>\n<\/tr>\n |
\n\t| Metoprolol Tartrate 75mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | LOPRESSOR<\/td>\n<\/tr>\n |
\n\t| Minoxidil 10mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | MINOXIDIL<\/td>\n<\/tr>\n |
\n\t| Minoxidil 2.5mg Tablet<\/td> | 360<\/td> | EA<\/td> | ORAL<\/td> | MINOXIDIL<\/td>\n<\/tr>\n |
\n\t| Nadolol 20mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | CORGARD<\/td>\n<\/tr>\n |
\n\t| Nadolol 40mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | CORGARD<\/td>\n<\/tr>\n |
\n\t| Nebivolol 10mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | BYSTOLIC<\/td>\n<\/tr>\n |
\n\t| Nebivolol 2.5mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | BYSTOLIC<\/td>\n<\/tr>\n |
\n\t| Nebivolol 20mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | BYSTOLIC<\/td>\n<\/tr>\n |
\n\t| Nebivolol 5mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | BYSTOLIC<\/td>\n<\/tr>\n |
\n\t| Nifedipine ER 24HR 30mg Tablet (AB1 ADALAT CC)<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | ADALAT CC<\/td>\n<\/tr>\n |
\n\t| Nifedipine ER 24HR 60mg Tablet (AB1 ADALAT CC)<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | ADALAT CC<\/td>\n<\/tr>\n |
\n\t| Nifedipine ER 24HR 90mg Tablet (AB1 ADALAT CC)<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | ADALAT CC<\/td>\n<\/tr>\n |
\n\t| Nifedipine ER 24HR Osmotic Release 30mg Tablet (AB2 PROCARDIA XL)<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | PROCARDIA XL<\/td>\n<\/tr>\n |
\n\t| Nifedipine ER 24HR Osmotic Release 60mg Tablet (AB2 PROCARDIA XL)<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | PROCARDIA XL<\/td>\n<\/tr>\n |
\n\t| Nifedipine ER 24HR Osmotic Release 90mg Tablet (AB2 PROCARDIA XL)<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | PROCARDIA XL<\/td>\n<\/tr>\n |
\n\t| Olmesartan 20mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | BENICAR<\/td>\n<\/tr>\n |
\n\t| Olmesartan 40mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | BENICAR<\/td>\n<\/tr>\n |
\n\t| Olmesartan 5mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | BENICAR<\/td>\n<\/tr>\n |
\n\t| Olmesartan\/HCTZ 20\/12.5mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | BENICAR HCT<\/td>\n<\/tr>\n |
\n\t| Olmesartan\/HCTZ 40\/12.5mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | BENICAR HCT<\/td>\n<\/tr>\n |
\n\t| Olmesartan\/HCTZ 40\/25mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | BENICAR HCT<\/td>\n<\/tr>\n |
\n\t| Potassium Chloride ER 10meq Capsule (MICRO-K 10)<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | MICRO-K<\/td>\n<\/tr>\n |
\n\t| Potassium Chloride ER 10meq Tablet (AB2 KLOR-CON 10\/AB3 K-TAB)<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | KLOR-CON\/K-TAB<\/td>\n<\/tr>\n |
\n\t| Potassium Chloride ER 20meq Tablet (AB1 K-TAB)<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | KLOR-CON M20<\/td>\n<\/tr>\n |
\n\t| Potassium Chloride ER 20mEq Tablet (AB3 CLOR-CON)<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | KLOR-CON<\/td>\n<\/tr>\n |
\n\t| Potassium Chloride ER 8meq (600mg) Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | KLOR-CON\/K-TAB<\/td>\n<\/tr>\n |
\n\t| Potassium Chloride ER 8meq Capsule<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | MICRO-K<\/td>\n<\/tr>\n |
\n\t| Potassium Chloride Microencapsulated ER 10meq Tablet (AB1 KLOR-CON M-10)<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | KLOR_CON 10<\/td>\n<\/tr>\n |
\n\t| Prasugrel 10mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | EFFIENT<\/td>\n<\/tr>\n |
\n\t| Prasugrel 5mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | EFFIENT<\/td>\n<\/tr>\n |
\n\t| Prazosin 1mg Capsule<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | MINIPRESS<\/td>\n<\/tr>\n |
\n\t| Prazosin 2mg Capsule<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | MINIPRESS<\/td>\n<\/tr>\n |
\n\t| Prazosin 5mg Capsule<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | MINIPRESS<\/td>\n<\/tr>\n |
\n\t| Propafenone 150mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | RYTHMOL<\/td>\n<\/tr>\n |
\n\t| Propafenone 300mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | RYTHMOL<\/td>\n<\/tr>\n |
\n\t| Propranolol 10mg Tablet<\/td> | 270<\/td> | EA<\/td> | ORAL<\/td> | INDERAL<\/td>\n<\/tr>\n |
\n\t| Propranolol 20mg Tablet<\/td> | 270<\/td> | EA<\/td> | ORAL<\/td> | INDERAL<\/td>\n<\/tr>\n |
\n\t| Propranolol 40mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | INDERAL<\/td>\n<\/tr>\n |
\n\t| Propranolol 60mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | INDERAL<\/td>\n<\/tr>\n |
\n\t| Propranolol 80mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | INDERAL<\/td>\n<\/tr>\n |
\n\t| Propranolol ER 24HR 120mg Capsule<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | INDERAL LA<\/td>\n<\/tr>\n |
\n\t| Propranolol ER 24HR 160mg Capsule<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | INDERAL LA<\/td>\n<\/tr>\n |
\n\t| Propranolol ER 24HR 60mg Capsule<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | INDERAL LA<\/td>\n<\/tr>\n |
\n\t| Propranolol ER 24HR 80mg Capsule<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | INDERAL LA<\/td>\n<\/tr>\n |
\n\t| Quinapril 20mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | ACCUPRIL<\/td>\n<\/tr>\n |
\n\t| Quinapril 40mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | ACCUPRIL<\/td>\n<\/tr>\n |
\n\t| Ramipril 1.25mg Capsule<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | ALTACE<\/td>\n<\/tr>\n |
\n\t| Ramipril 10mg Capsule<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | ALTACE<\/td>\n<\/tr>\n |
\n\t| Ramipril 2.5mg Capsule<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | ALTACE<\/td>\n<\/tr>\n |
\n\t| Ramipril 5mg Capsule<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | ALTACE<\/td>\n<\/tr>\n |
\n\t| Sildenafil 20mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | REVATIO<\/td>\n<\/tr>\n |
\n\t| Sotalol 120mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | BETAPACE<\/td>\n<\/tr>\n |
\n\t| Sotalol 160mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | BETAPACE<\/td>\n<\/tr>\n |
\n\t| Sotalol 240mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | BETAPACE<\/td>\n<\/tr>\n |
\n\t| Sotalol 80mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | BETAPACE<\/td>\n<\/tr>\n |
\n\t| Spironolactone 100mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | ALDACTONE<\/td>\n<\/tr>\n |
\n\t| Spironolactone 25mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | ALDACTONE<\/td>\n<\/tr>\n |
\n\t| Spironolactone 50mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | ALDACTONE<\/td>\n<\/tr>\n |
\n\t| Telmisartan 20mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | MICARDIS<\/td>\n<\/tr>\n |
\n\t| Telmisartan 40mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | MICARDIS<\/td>\n<\/tr>\n |
\n\t| Telmisartan 80mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | MICARDIS<\/td>\n<\/tr>\n |
\n\t| Telmisartan\/Hydrochlorothiazide 40\/12.5mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | MICARDIS HCT<\/td>\n<\/tr>\n |
\n\t| Telmisartan\/Hydrochlorothiazide 80\/12.5mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | MICARDIS HCT<\/td>\n<\/tr>\n |
\n\t| Telmisartan\/Hydrochlorothiazide 80\/25mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | MICARDIS HCT<\/td>\n<\/tr>\n |
\n\t| Terazosin 10mg Capsule<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | HYTRIN<\/td>\n<\/tr>\n |
\n\t| Terazosin 1mg Capsule<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | HYTRIN<\/td>\n<\/tr>\n |
\n\t| Terazosin 2mg Capsule<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | HYTRIN<\/td>\n<\/tr>\n |
\n\t| Terazosin 5mg Capsule<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | HYTRIN<\/td>\n<\/tr>\n |
\n\t| Torsemide 100mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | DEMADEX<\/td>\n<\/tr>\n |
\n\t| Torsemide 10mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | DEMADEX<\/td>\n<\/tr>\n |
\n\t| Torsemide 20mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | DEMADEX<\/td>\n<\/tr>\n |
\n\t| Torsemide 5mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | DEMADEX<\/td>\n<\/tr>\n |
\n\t| Trandolapril 1mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | MAVIK<\/td>\n<\/tr>\n |
\n\t| Trandolapril 2mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | MAVIK<\/td>\n<\/tr>\n |
\n\t| Trandolapril 4mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | MAVIK<\/td>\n<\/tr>\n |
\n\t| Triamterene\/HCTZ 37.5\/25mg Capsule<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | DYAZIDE<\/td>\n<\/tr>\n |
\n\t| Triamterene\/HCTZ 37.5\/25mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | MAXZIDE-25<\/td>\n<\/tr>\n |
\n\t| Triamterene\/HCTZ 75\/50mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | MAXZIDE<\/td>\n<\/tr>\n |
\n\t| Valsartan 160mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | DIOVAN<\/td>\n<\/tr>\n |
\n\t| Valsartan 320mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | DIOVAN<\/td>\n<\/tr>\n |
\n\t| Valsartan 40mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | DIOVAN<\/td>\n<\/tr>\n |
\n\t| Valsartan 80mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | DIOVAN<\/td>\n<\/tr>\n |
\n\t| Valsartan\/HCTZ 160\/12.5mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | DIOVAN HCT<\/td>\n<\/tr>\n |
\n\t| Valsartan\/HCTZ 160\/25mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | DIOVAN HCT<\/td>\n<\/tr>\n |
\n\t| Valsartan\/HCTZ 320\/12.5mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | DIOVAN HCT<\/td>\n<\/tr>\n |
\n\t| Valsartan\/HCTZ 320\/25mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | DIOVAN HCT<\/td>\n<\/tr>\n |
\n\t| Valsartan\/HCTZ 80\/12.5mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | DIOVAN HCT<\/td>\n<\/tr>\n |
\n\t| Verapamil 120mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | CALAN<\/td>\n<\/tr>\n |
\n\t| Verapamil 80mg Tablet<\/td> | 270<\/td> | EA<\/td> | ORAL<\/td> | CALAN<\/td>\n<\/tr>\n |
\n\t| Verapamil ER 120mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | CALAN SR<\/td>\n<\/tr>\n |
\n\t| Verapamil ER 180mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | CALAN SR<\/td>\n<\/tr>\n |
\n\t| Verapamil ER 240mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | CALAN SR<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Cholesterol \/ Triglycerides” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Atorvastatin 10mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | LIPITOR<\/td>\n<\/tr>\n | \n\t| Atorvastatin 20mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | LIPITOR<\/td>\n<\/tr>\n | \n\t| Atorvastatin 40mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | LIPITOR<\/td>\n<\/tr>\n | \n\t| Atorvastatin 80mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | LIPITOR<\/td>\n<\/tr>\n | \n\t| Choline Fenofibrate DR 135mg Capsule<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | TRILIPIX<\/td>\n<\/tr>\n | \n\t| Choline Fenofibrate DR 45mg Capsule<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | TRILIPIX<\/td>\n<\/tr>\n | \n\t| Ezetimibe 10mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | ZETIA<\/td>\n<\/tr>\n | \n\t| Ezetimibe\/Simvastatin 10\/10mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | VYTORIN<\/td>\n<\/tr>\n | \n\t| Ezetimibe\/Simvastatin 10\/20mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | VYTORIN<\/td>\n<\/tr>\n | \n\t| Ezetimibe\/Simvastatin 10\/40mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | VYTORIN<\/td>\n<\/tr>\n | \n\t| Ezetimibe\/Simvastatin 10\/80mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | VYTORIN<\/td>\n<\/tr>\n | \n\t| Fenofibrate 145mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | TRICOR<\/td>\n<\/tr>\n | \n\t| Fenofibrate 160mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | TRICOR<\/td>\n<\/tr>\n | \n\t| Fenofibrate 200mg Capsule<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | TRICOR<\/td>\n<\/tr>\n | \n\t| Fenofibrate 48mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | TRICOR<\/td>\n<\/tr>\n | \n\t| Fenofibrate 54mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | TRICOR<\/td>\n<\/tr>\n | \n\t| Fenofibrate Micronized 134mg Capsule<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | TRICOR<\/td>\n<\/tr>\n | \n\t| Fenofibrate Micronized 67mg Capsule<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | TRICOR<\/td>\n<\/tr>\n | \n\t| Gemfibrozil 600mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | LOPID<\/td>\n<\/tr>\n | \n\t| Lovastatin 10mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | MEVACOR<\/td>\n<\/tr>\n | \n\t| Lovastatin 20mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | MEVACOR<\/td>\n<\/tr>\n | \n\t| Lovastatin 40mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | MEVACOR<\/td>\n<\/tr>\n | \n\t| Niacin ER 1000mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | NIASPAN<\/td>\n<\/tr>\n | \n\t| Niacin ER 500mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | NIASPAN<\/td>\n<\/tr>\n | \n\t| Omega-3-acid Ethyl Esters 1gm Capsule<\/td> | 360<\/td> | EA<\/td> | ORAL<\/td> | LOVAZA<\/td>\n<\/tr>\n | \n\t| Pravastatin 10mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | PRAVACHOL<\/td>\n<\/tr>\n | \n\t| Pravastatin 20mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | PRAVACHOL<\/td>\n<\/tr>\n | \n\t| Pravastatin 40mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | PRAVACHOL<\/td>\n<\/tr>\n | \n\t| Pravastatin 80mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | PRAVACHOL<\/td>\n<\/tr>\n | \n\t| Rosuvastatin 10mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | CRESTOR<\/td>\n<\/tr>\n | \n\t| Rosuvastatin 20mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | CRESTOR<\/td>\n<\/tr>\n | \n\t| Rosuvastatin 40mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | CRESTOR<\/td>\n<\/tr>\n | \n\t| Rosuvastatin 5mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | CRESTOR<\/td>\n<\/tr>\n | \n\t| Simvastatin 10mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | ZOCOR<\/td>\n<\/tr>\n | \n\t| Simvastatin 20mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | ZOCOR<\/td>\n<\/tr>\n | \n\t| Simvastatin 40mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | ZOCOR<\/td>\n<\/tr>\n | \n\t| Simvastatin 5mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | ZOCOR<\/td>\n<\/tr>\n | \n\t| Simvastatin 80mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | ZOCOR<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Diabetes” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Acarbose 100mg Tablet<\/td> | 270<\/td> | EA<\/td> | ORAL<\/td> | PRECOSE<\/td>\n<\/tr>\n | \n\t| Acarbose 25mg Tablet<\/td> | 270<\/td> | EA<\/td> | ORAL<\/td> | PRECOSE<\/td>\n<\/tr>\n | \n\t| Acarbose 50mg Tablet<\/td> | 270<\/td> | EA<\/td> | ORAL<\/td> | PRECOSE<\/td>\n<\/tr>\n | \n\t| Glimepiride 1mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | AMARYL<\/td>\n<\/tr>\n | \n\t| Glimepiride 2mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | AMARYL<\/td>\n<\/tr>\n | \n\t| Glimepiride 4mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | AMARYL<\/td>\n<\/tr>\n | \n\t| Glipizide 10mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | GLUCOTROL<\/td>\n<\/tr>\n | \n\t| Glipizide 5mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | GLUCOTROL<\/td>\n<\/tr>\n | \n\t| Glipizide ER 10mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | GLUCOTROL XL<\/td>\n<\/tr>\n | \n\t| Glipizide ER 2.5mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | GLUCOTROL XL<\/td>\n<\/tr>\n | \n\t| Glipizide ER 5mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | GLUCOTROL XL<\/td>\n<\/tr>\n | \n\t| Glipizide\/Metformin 2.5\/500mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | METAGLIP<\/td>\n<\/tr>\n | \n\t| Glipizide\/Metformin 5\/500mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | METAGLIP<\/td>\n<\/tr>\n | \n\t| Glyburide 1.25mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | DIABETA<\/td>\n<\/tr>\n | \n\t| Glyburide 2.5mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | DIABETA<\/td>\n<\/tr>\n | \n\t| Glyburide 5mg Tablet<\/td> | 360<\/td> | EA<\/td> | ORAL<\/td> | DIABETA<\/td>\n<\/tr>\n | \n\t| Glyburide\/Metformin 1.25\/250mg Tablet<\/td> | 360<\/td> | EA<\/td> | ORAL<\/td> | GLUCOVANCE<\/td>\n<\/tr>\n | \n\t| Glyburide\/Metformin 2.5\/500mg Tablet<\/td> | 360<\/td> | EA<\/td> | ORAL<\/td> | GLUCOVANCE<\/td>\n<\/tr>\n | \n\t| Glyburide\/Metformin 5\/500mg Tablet<\/td> | 360<\/td> | EA<\/td> | ORAL<\/td> | GLUCOVANCE<\/td>\n<\/tr>\n | \n\t| Metformin 1000mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | GLUCOPHAGE<\/td>\n<\/tr>\n | \n\t| Metformin 500mg Tablet<\/td> | 360<\/td> | EA<\/td> | ORAL<\/td> | GLUCOPHAGE<\/td>\n<\/tr>\n | \n\t| Metformin 850mg Tablet<\/td> | 270<\/td> | EA<\/td> | ORAL<\/td> | GLUCOPHAGE<\/td>\n<\/tr>\n | \n\t| Metformin ER 24HR 500mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | GLUCOPHAGE XR<\/td>\n<\/tr>\n | \n\t| Metformin ER 24HR 750mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | GLUCOPHAGE XR<\/td>\n<\/tr>\n | \n\t| Pioglitazone 15mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | ACTOS<\/td>\n<\/tr>\n | \n\t| Pioglitazone 30mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | ACTOS<\/td>\n<\/tr>\n | \n\t| Pioglitazone 45mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | ACTOS<\/td>\n<\/tr>\n | \n\t| Pioglitazone\/Metformin 15\/500mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | ACTOPLUS MET<\/td>\n<\/tr>\n | \n\t| Pioglitazone\/Metformin 15\/850mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | ACTOPLUS MET<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Endoctrine System” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Clomiphone citrate 50mg Tablets<\/td> | 30<\/td> | EA<\/td> | ORAL<\/td> | CLOMID<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Gastrointestinal” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Dicyclomine 10mg Capsule<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | BENTYL<\/td>\n<\/tr>\n | \n\t| Dicyclomine 20mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | BENTYL<\/td>\n<\/tr>\n | \n\t| Famotidine 20mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | PEPCID<\/td>\n<\/tr>\n | \n\t| Omeprazole DR 20mg Capsule<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | PRILOSEC<\/td>\n<\/tr>\n | \n\t| Omeprazole DR 40mg Capsule<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | PRILOSEC<\/td>\n<\/tr>\n | \n\t| Pantoprazole EC 40mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | PROTONIX<\/td>\n<\/tr>\n | \n\t| Cyproheptadine 4mg Tablet<\/td> | 270<\/td> | EA<\/td> | ORAL<\/td> | PERIACTIN<\/td>\n<\/tr>\n | \n\t| Esomeprazole DR 20mg Capsule<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | NEXIUM<\/td>\n<\/tr>\n | \n\t| Esomeprazole DR 40mg Capsule<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | NEXIUM<\/td>\n<\/tr>\n | \n\t| Famotidine 10mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | PEPCID<\/td>\n<\/tr>\n | \n\t| Famotidine 40mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | PEPCID<\/td>\n<\/tr>\n | \n\t| Glycopyrrolate 1mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | ROBINUL<\/td>\n<\/tr>\n | \n\t| Glycopyrrolate 2mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | ROBINUL FORTE<\/td>\n<\/tr>\n | \n\t| Hyoscyamine 0.125mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | LEVSIN<\/td>\n<\/tr>\n | \n\t| Lansoprazole DR 15mg Capsule<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | PREVACID 24HR<\/td>\n<\/tr>\n | \n\t| Lansoprazole DR 30mg Capsule<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | PREVACID<\/td>\n<\/tr>\n | \n\t| Omeprazole DR 10mg Capsule<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | PRILOSEC<\/td>\n<\/tr>\n | \n\t| Pantoprazole EC 20mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | PROTONIX<\/td>\n<\/tr>\n | \n\t| Rabeprazole EC 20mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | ACIPHEX<\/td>\n<\/tr>\n | \n\t| Sucralfate 1gm Tablet<\/td> | 270<\/td> | EA<\/td> | ORAL<\/td> | CARAFATE<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Glaucoma” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Brimonidine 15ml .02% Ophthalmic Solution<\/td> | 45<\/td> | ML<\/td> | OPHTHAL LIQUID<\/td> | ALPHAGAN<\/td>\n<\/tr>\n | \n\t| Dorzolamide\/Timolol 22.3\/6.8mg\/ml Ophthalmic Solution<\/td> | 30<\/td> | ML<\/td> | OPHTHAL SOLUTION<\/td> | COSOPT<\/td>\n<\/tr>\n | \n\t| Latanoprost 0.005% Ophthalmic Solution 2.5mL<\/td> | 7.5<\/td> | ML<\/td> | OPHTHAL LIQUID<\/td> | XALATAN<\/td>\n<\/tr>\n | \n\t| Timolol Maleate 0.25% Ophthalmic Solution<\/td> | 15<\/td> | ML<\/td> | OPHTHAL SOLUTION<\/td> | TIMOPTIC<\/td>\n<\/tr>\n | \n\t| Timolol Maleate 0.5% Ophthalmic Solution<\/td> | 15<\/td> | ML<\/td> | OPHTHAL SOLUTION<\/td> | TIMOPTIC<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Hormone Replacement” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Estradiol 0.5mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | ESTRACE<\/td>\n<\/tr>\n | \n\t| Estradiol 1mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | ESTRACE<\/td>\n<\/tr>\n | \n\t| Estradiol 2mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | ESTRACE<\/td>\n<\/tr>\n | \n\t| Medroxyprogesterone Acetate 10mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | PROVERA<\/td>\n<\/tr>\n | \n\t| Medroxyprogesterone Acetate 2.5mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | PROVERA<\/td>\n<\/tr>\n | \n\t| Medroxyprogesterone Acetate 5mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | PROVERA<\/td>\n<\/tr>\n | \n\t| Progesterone 100mg Capsule<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | PROMETRIUM<\/td>\n<\/tr>\n | \n\t| Progesterone 200mg Capsule<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | PROMETRIUM<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Hormone-Based Chemo (Breast Cancer)” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Anastrozole 1mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | ARIMIDEX<\/td>\n<\/tr>\n | \n\t| Letrozole 2.5mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | FEMARA<\/td>\n<\/tr>\n | \n\t| Tamoxifen Citrate 10mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | NOLVADEX<\/td>\n<\/tr>\n | \n\t| Tamoxifen Citrate 20mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | NOLVADEX<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Men\u2019s Health” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Alfuzosin ER 24HR 10mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | UROXATRAL<\/td>\n<\/tr>\n | \n\t| Dutasteride 0.5mg Capsule<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | AVODART<\/td>\n<\/tr>\n | \n\t| Finasteride 1mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | PROPECIA<\/td>\n<\/tr>\n | \n\t| Finasteride 5mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | PROSCAR<\/td>\n<\/tr>\n | \n\t| Sildenafil 100mg Tablet<\/td> | 30<\/td> | EA<\/td> | ORAL<\/td> | VIAGRA<\/td>\n<\/tr>\n | \n\t| Sildenafil 25mg Tablet<\/td> | 30<\/td> | EA<\/td> | ORAL<\/td> | VIAGRA<\/td>\n<\/tr>\n | \n\t| Sildenafil 50mg Tablet<\/td> | 30<\/td> | EA<\/td> | ORAL<\/td> | VIAGRA<\/td>\n<\/tr>\n | \n\t| Silodosin 4mg Capsule<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | RAPAFLO<\/td>\n<\/tr>\n | \n\t| Silodosin 8mg Capsule<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | RAPAFLO<\/td>\n<\/tr>\n | \n\t| Tadalafil 10mg Tablet<\/td> | 30<\/td> | EA<\/td> | ORAL<\/td> | CIALIS<\/td>\n<\/tr>\n | \n\t| Tadalafil 2.5mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | CIALIS<\/td>\n<\/tr>\n | \n\t| Tadalafil 20mg Tablet<\/td> | 30<\/td> | EA<\/td> | ORAL<\/td> | CIALIS<\/td>\n<\/tr>\n | \n\t| Tadalafil 5mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | CIALIS<\/td>\n<\/tr>\n | \n\t| Tamsulosin 0.4mg Capsule<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | FLOMAX<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Migraine” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Naratriptan 2.5mg Tablet<\/td> | 27<\/td> | EA<\/td> | ORAL<\/td> | AMERGE<\/td>\n<\/tr>\n | \n\t| Rizatriptan 10mg Tablet<\/td> | 27<\/td> | EA<\/td> | ORAL<\/td> | MAXALT<\/td>\n<\/tr>\n | \n\t| Rizatriptan 5mg Tablet<\/td> | 27<\/td> | EA<\/td> | ORAL<\/td> | MAXALT<\/td>\n<\/tr>\n | \n\t| Rizatriptan ODT 10mg Disintegrating Tablet<\/td> | 27<\/td> | EA<\/td> | ORAL<\/td> | MAXALT-MLT<\/td>\n<\/tr>\n | \n\t| Sumatriptan 100mg Tablet<\/td> | 27<\/td> | EA<\/td> | ORAL<\/td> | IMITREX<\/td>\n<\/tr>\n | \n\t| Sumatriptan 50mg Tablet<\/td> | 27<\/td> | EA<\/td> | ORAL<\/td> | IMITREX<\/td>\n<\/tr>\n | \n\t| Eletriptan 20mg Tablet<\/td> | 18<\/td> | EA<\/td> | ORAL<\/td> | RELPAX<\/td>\n<\/tr>\n | \n\t| Eletriptan 40mg Tablet<\/td> | 18<\/td> | EA<\/td> | ORAL<\/td> | RELPAX<\/td>\n<\/tr>\n | \n\t| Rizatriptan 5mg ODT Orally Disintegrating Tablet<\/td> | 27<\/td> | EA<\/td> | ORAL<\/td> | MAXALT-MLT<\/td>\n<\/tr>\n | \n\t| Sumatriptan 25mg Tablet<\/td> | 27<\/td> | EA<\/td> | ORAL<\/td> | IMITREX<\/td>\n<\/tr>\n | \n\t| Zolmitriptan 2.5mg Tablet<\/td> | 18<\/td> | EA<\/td> | ORAL<\/td> | ZOMIG<\/td>\n<\/tr>\n | \n\t| Zolmitriptan 5mg Tablet<\/td> | 18<\/td> | EA<\/td> | ORAL<\/td> | ZOMIG<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Muscle Relaxants \/ Restless Leg Syndrome” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Tizanidine 2mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | ZANAFLEX<\/td>\n<\/tr>\n | \n\t| Tizanidine 4mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | ZANAFLEX<\/td>\n<\/tr>\n | \n\t| Baclofen 10mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | LIORESAL<\/td>\n<\/tr>\n | \n\t| Ropinirole 0.25mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | REQUIP<\/td>\n<\/tr>\n | \n\t| Ropinirole 0.5mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | REQUIP<\/td>\n<\/tr>\n | \n\t| Ropinirole 1mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | REQUIP<\/td>\n<\/tr>\n | \n\t| Ropinirole 2mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | REQUIP<\/td>\n<\/tr>\n | \n\t| Ropinirole 3mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | REQUIP<\/td>\n<\/tr>\n | \n\t| Ropinirole 4mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | REQUIP<\/td>\n<\/tr>\n | \n\t| Ropinirole 5mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | REQUIP<\/td>\n<\/tr>\n | \n\t| Tizanidine 2mg Capsule<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | ZANAFLEX<\/td>\n<\/tr>\n | \n\t| Tizanidine 4mg Capsule<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | ZANAFLEX<\/td>\n<\/tr>\n | \n\t| Tizanidine 6mg Capsule<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | ZANAFLEX<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Oral Contraceptives” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Desogestrel\/Ethinyl Estradiol 0.15\/0.03mg Tablet<\/td> | 84<\/td> | EA<\/td> | ORAL<\/td> | ORTHOCEPT\/DESOGEN<\/td>\n<\/tr>\n | \n\t| Desogestrol-Ethinyl Estradiol\/Ethinyl Estradiol (21\/5) 0.150-0.02\/0.01mg Tablet<\/td> | 84<\/td> | EA<\/td> | ORAL<\/td> | MIRCETTE<\/td>\n<\/tr>\n | \n\t| Drospirenone\/Ethinyl Estradiol 3\/0.02mg Tablet<\/td> | 84<\/td> | EA<\/td> | ORAL<\/td> | YAZ<\/td>\n<\/tr>\n | \n\t| Drospirenone\/Ethinyl Estradiol 3\/0.03mg Tablet<\/td> | 84<\/td> | EA<\/td> | ORAL<\/td> | YASMIN<\/td>\n<\/tr>\n | \n\t| Kelnor 1\/35 (Ethynodiol Diacetate\/Ethinyl Estradiol) Tablet<\/td> | 84<\/td> | EA<\/td> | ORAL<\/td> | ZOVIA 1\/35<\/td>\n<\/tr>\n | \n\t| Kelnor 1\/50 (Ethynodiol Diacetate\/Ethinyl Estradiol) Tablet<\/td> | 84<\/td> | EA<\/td> | ORAL<\/td> | KELNOR<\/td>\n<\/tr>\n | \n\t| Levonorgestrel\/Ethinyl Estradiol 0.150\/0.03mg Tablet<\/td> | 84<\/td> | EA<\/td> | ORAL<\/td> | LEVORA 0.15\/30-28<\/td>\n<\/tr>\n | \n\t| Levonorgestrel\/Ethinyl Estradiol 0.1mg\/20mcg Tablet<\/td> | 84<\/td> | EA<\/td> | ORAL<\/td> | ALESSE<\/td>\n<\/tr>\n | \n\t| Levonorgestrel-EthIinyl Estradiol 0.05-30\/0.075-40\/0.125-30mg\/mcg Tablet<\/td> | 84<\/td> | EA<\/td> | ORAL<\/td> | TRIVORA<\/td>\n<\/tr>\n | \n\t| Levonorgestrel-EthIinyl Estradiol 0.15\/0.03-0.01mg Tablet 91 Pack<\/td> | 91<\/td> | EA<\/td> | ORAL<\/td> | JAIMIESS<\/td>\n<\/tr>\n | \n\t| Levonorgestrel-Ethinyl Estradiol 0.1-0.02mg (84)\/Ethinyl Estradiol 0.01mg (7) Tablet<\/td> | 91<\/td> | EA<\/td> | ORAL<\/td> | CAMRESE LO<\/td>\n<\/tr>\n | \n\t| Norethindrone 0.35mg Tablet (AB1 NOR-QD\/AB2 ORTHO-MICRONOR)<\/td> | 84<\/td> | EA<\/td> | ORAL<\/td> | NOR-QD\/ORTHO-MICRONOR<\/td>\n<\/tr>\n | \n\t| Norethindrone Acetate 5mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | AYGESTIN<\/td>\n<\/tr>\n | \n\t| Norethindrone\/Ethinyl Estradiol (No Iron) 1.5\/0.03mg Tablet<\/td> | 63<\/td> | EA<\/td> | ORAL<\/td> | LOESTRIN 1.5\/30-21<\/td>\n<\/tr>\n | \n\t| Norethindrone\/Ethinyl Estradiol (No Iron) 1\/0.02mg Tablet<\/td> | 63<\/td> | EA<\/td> | ORAL<\/td> | LOESTRIN 1\/20<\/td>\n<\/tr>\n | \n\t| Norethindrone\/Ethinyl Estradiol 0.4mg\/35mcg Tablet<\/td> | 84<\/td> | EA<\/td> | ORAL<\/td> | NORTREL 1\/35<\/td>\n<\/tr>\n | \n\t| Norethindrone\/Ethinyl Estradiol 0.5\/.035mg;0.75\/.035mg; 1\/.035mg Tablet<\/td> | 84<\/td> | EA<\/td> | ORAL<\/td> | ORTHO-NOVUM 7\/7\/7-28<\/td>\n<\/tr>\n | \n\t| Norethindrone\/Ethinyl Estradiol 1mg\/0.035mcg Tablet<\/td> | 84<\/td> | EA<\/td> | ORAL<\/td> | NORTREL 1\/35<\/td>\n<\/tr>\n | \n\t| Norethindrone\/Ethinyl Estradiol 35mcg\/0.5mg Tablet<\/td> | 84<\/td> | EA<\/td> | ORAL<\/td> | NORTREL 0.5\/35 (28)<\/td>\n<\/tr>\n | \n\t| Norethindrone\/Ethinyl Estradiol\/Fe 1mg\/0.02mg Tablet<\/td> | 84<\/td> | EA<\/td> | ORAL<\/td> | LOESTRIN 24 FE<\/td>\n<\/tr>\n | \n\t| Norethindrone\/Ethinyl Estradiol\/Iron 1.5\/.03mg Tablet<\/td> | 84<\/td> | EA<\/td> | ORAL<\/td> | LOESTRIN FE 1.5\/30<\/td>\n<\/tr>\n | \n\t| Norethindrone\/Ethinyl Estradiol\/Iron 1mg\/20mcg Tablet<\/td> | 84<\/td> | EA<\/td> | ORAL<\/td> | LOESTRIN FE 1\/20<\/td>\n<\/tr>\n | \n\t| Norgestimate\/Ethinyl Estradiol 0.18\/0.025mg; 0.215\/0.025mg and 0.25\/0.025mg Tablet<\/td> | 84<\/td> | EA<\/td> | ORAL<\/td> | ORTHO TRI-CYCLEN LO<\/td>\n<\/tr>\n | \n\t| Norgestimate\/Ethinyl Estradiol 0.18\/0.035; 0.215\/0.035 and 0.25\/0.035mg Tablet<\/td> | 84<\/td> | EA<\/td> | ORAL<\/td> | ORTHO TRI-CYCLEN<\/td>\n<\/tr>\n | \n\t| Norgestimate\/Ethinyl Estradiol 0.25mg\/35mcg Tablet<\/td> | 84<\/td> | EA<\/td> | ORAL<\/td> | ORTHO CYCLEN<\/td>\n<\/tr>\n | \n\t| Norgestrel\/Ethinyl Estradiol 0.3\/0.03mg Tablet<\/td> | 84<\/td> | EA<\/td> | ORAL<\/td> | CRYSELLE-28<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Osteoporosis” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Alendronate 10mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | FOSAMAX<\/td>\n<\/tr>\n | \n\t| Alendronate 35mg Tablet<\/td> | 12<\/td> | EA<\/td> | ORAL<\/td> | FOSAMAX<\/td>\n<\/tr>\n | \n\t| Alendronate 70mg Tablet<\/td> | 12<\/td> | EA<\/td> | ORAL<\/td> | FOSAMAX<\/td>\n<\/tr>\n | \n\t| Ibandronate 150mg Tablet<\/td> | 3<\/td> | EA<\/td> | ORAL<\/td> | BONIVA<\/td>\n<\/tr>\n | \n\t| Raloxifene 60mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | EVISTA<\/td>\n<\/tr>\n | \n\t| Risedronate 150mg Tablet (Monthly)<\/td> | 3<\/td> | EA<\/td> | ORAL<\/td> | ACTONEL<\/td>\n<\/tr>\n | \n\t| Risedronate 35mg Tablet (Weekly)<\/td> | 12<\/td> | EA<\/td> | ORAL<\/td> | ACTONEL<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Smoking Cessation” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Bupropion ER 12HR 150mg Tablet (Smoking Deterrent)<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | ZYBAN<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Thyroid” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Levothyroxine Sodium 100mcg Tablet<\/td> | 120<\/td> | EA<\/td> | ORAL<\/td> | SYNTHROID<\/td>\n<\/tr>\n | \n\t| Levothyroxine Sodium 112mcg Tablet<\/td> | 120<\/td> | EA<\/td> | ORAL<\/td> | SYNTHROID<\/td>\n<\/tr>\n | \n\t| Levothyroxine Sodium 125mcg Tablet<\/td> | 120<\/td> | EA<\/td> | ORAL<\/td> | SYNTHROID<\/td>\n<\/tr>\n | \n\t| Levothyroxine Sodium 137mcg Tablet<\/td> | 120<\/td> | EA<\/td> | ORAL<\/td> | SYNTHROID<\/td>\n<\/tr>\n | \n\t| Levothyroxine Sodium 150mcg Tablet<\/td> | 120<\/td> | EA<\/td> | ORAL<\/td> | SYNTHROID<\/td>\n<\/tr>\n | \n\t| Levothyroxine Sodium 175mcg Tablet<\/td> | 120<\/td> | EA<\/td> | ORAL<\/td> | SYNTHROID<\/td>\n<\/tr>\n | \n\t| Levothyroxine Sodium 200mcg Tablet<\/td> | 120<\/td> | EA<\/td> | ORAL<\/td> | SYNTHROID<\/td>\n<\/tr>\n | \n\t| Levothyroxine Sodium 25mcg Tablet<\/td> | 120<\/td> | EA<\/td> | ORAL<\/td> | SYNTHROID<\/td>\n<\/tr>\n | \n\t| Levothyroxine Sodium 300mcg Tablet<\/td> | 120<\/td> | EA<\/td> | ORAL<\/td> | SYNTHROID<\/td>\n<\/tr>\n | \n\t| Levothyroxine Sodium 50mcg Tablet<\/td> | 120<\/td> | EA<\/td> | ORAL<\/td> | SYNTHROID<\/td>\n<\/tr>\n | \n\t| Levothyroxine Sodium 75mcg Tablet<\/td> | 120<\/td> | EA<\/td> | ORAL<\/td> | SYNTHROID<\/td>\n<\/tr>\n | \n\t| Levothyroxine Sodium 88mcg Tablet<\/td> | 120<\/td> | EA<\/td> | ORAL<\/td> | SYNTHROID<\/td>\n<\/tr>\n | \n\t| Liothyronine 25mcg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | CYTOMEL<\/td>\n<\/tr>\n | \n\t| Liothyronine 50mcg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | CYTOMEL<\/td>\n<\/tr>\n | \n\t| Liothyronine 5mcg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | CYTOMEL<\/td>\n<\/tr>\n | \n\t| Methimazole 10mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | TAPAZOLE<\/td>\n<\/tr>\n | \n\t| Methimazole 5mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | TAPAZOLE<\/td>\n<\/tr>\n | \n\t| Propylthiouracil 50mg Tablet<\/td> | 270<\/td> | EA<\/td> | ORAL<\/td> | PROPYLTHIOURACIL<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Urinary Incontinence” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Oxybutynin 5mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | DITROPAN<\/td>\n<\/tr>\n | \n\t| Oxybutynin ER 24HR 10mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | DITROPAN XL<\/td>\n<\/tr>\n | \n\t| Oxybutynin ER 24HR 15mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | DITROPAN XL<\/td>\n<\/tr>\n | \n\t| Oxybutynin ER 24HR 5mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | DITROPAN XL<\/td>\n<\/tr>\n | \n\t| Solifenacin 10mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | VESICARE<\/td>\n<\/tr>\n | \n\t| Solifenacin 5mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | VESICARE<\/td>\n<\/tr>\n | \n\t| Tolterodine ER 24HR 2mg Capsule<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | DETROL LA<\/td>\n<\/tr>\n | \n\t| Tolterodine ER 24HR 4mg Capsule<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | DETROL LA<\/td>\n<\/tr>\n | \n\t| Tolterodine Tartrate 1mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | DETROL<\/td>\n<\/tr>\n | \n\t| Tolterodine Tartrate 2mg Tablet<\/td> | 180<\/td> | EA<\/td> | ORAL<\/td> | DETROL<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Vitamins” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Ergocalciferol 50000IU (1.25mg) Capsule<\/td> | 12<\/td> | EA<\/td> | ORAL<\/td> | DRISDOL<\/td>\n<\/tr>\n | \n\t| Folic Acid 1mg Tablet<\/td> | 90<\/td> | EA<\/td> | ORAL<\/td> | VARIOUS<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ disabled_on=”on|off|off” module_id=”acute” _builder_version=”4.27.0″ _module_preset=”default” custom_padding=”||86px|||” global_colors_info=”{}”][et_pb_row column_structure=”1_3,2_3″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_column type=”1_3″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Acute Formulary” _builder_version=”4.27.2″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”right” title_font_size=”37px” custom_margin=”||-9px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” text_font=”|300||on|||||” text_font_size=”25px” text_orientation=”right” global_colors_info=”{}”]<\/p>\n Immediate Need Medications<\/p>\n [\/et_pb_text][\/et_pb_column][et_pb_column type=”2_3″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_text _builder_version=”4.27.2″ _module_preset=”default” text_font=”|600|||||||” text_font_size=”20px” custom_margin=”14px||0px||false|false” global_colors_info=”{}”]<\/p>\n The most utilized acute medications in our formulary can be purchased up to a 21-Day supply at no additional cost beyond the monthly membership fee!<\/p>\n [\/et_pb_text][et_pb_text _builder_version=”4.27.2″ _module_preset=”default” text_font_size=”15px” text_line_height=”1.3em” text_orientation=”justified” custom_margin=”16px|||||” custom_padding=”||0px|||” global_colors_info=”{}”]<\/p>\n If there is an emergency, sickness, or injury and you need your medications fast, our membership card will allow you to fill your prescription at any of 64,000 pharmacies nationwide!<\/p>\n Each medication may only be filled (2) times within a 180-day period. Fills after the first two will be standard contractual pharmacy rates. For Chronic Medications, please call or refer to the Chronic Formulary<\/p>\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Allergy” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Diphenhydramine 50mg Capsule<\/td> | 21<\/td> | EA<\/td> | ORAL<\/td> | BENADRYL<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Anesthetics” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Lidocaine Vicious HCl 100ml 20mg\/ml Solution<\/td> | 100<\/td> | ML<\/td> | ORAL LIQUID<\/td> | XYLOCAINE VISCOUS<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Antibiotics” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Amoxicillin & K Clavulanate For Susp 600mg\/42.9mg\/5ml Suspension<\/td> | 200<\/td> | ML<\/td> | ORAL LIQUID<\/td> | AUGMENTIN ES-600<\/td>\n<\/tr>\n | \n\t| Amoxicillin (Trihydrate) 500 Tablet<\/td> | 63<\/td> | EA<\/td> | ORAL<\/td> | AMOXIL<\/td>\n<\/tr>\n | \n\t| Amoxicillin 250mg Capsule<\/td> | 63<\/td> | EA<\/td> | ORAL<\/td> | AMOXIL<\/td>\n<\/tr>\n | \n\t| Amoxicillin 250mg\/5ml Suspension<\/td> | 300<\/td> | ML<\/td> | ORAL LIQUID<\/td> | AMOXIL<\/td>\n<\/tr>\n | \n\t| Amoxicillin 400mg\/5ml Suspension<\/td> | 200<\/td> | ML<\/td> | ORAL LIQUID<\/td> | AMOXIL<\/td>\n<\/tr>\n | \n\t| Amoxicillin 500mg Capsule<\/td> | 63<\/td> | EA<\/td> | ORAL<\/td> | AMOXIL<\/td>\n<\/tr>\n | \n\t| Amoxicillin 875mg Tablet<\/td> | 42<\/td> | EA<\/td> | ORAL<\/td> | AMOXIL<\/td>\n<\/tr>\n | \n\t| Amoxicillin\/Potassium Clav 400\/57mg\/5ml Suspension<\/td> | 200<\/td> | ML<\/td> | ORAL LIQUID<\/td> | AUGMENTIN<\/td>\n<\/tr>\n | \n\t| Amoxicillin\/Potassium Clav 500\/125mg Tablet<\/td> | 63<\/td> | EA<\/td> | ORAL<\/td> | AUGMENTIN<\/td>\n<\/tr>\n | \n\t| Amoxicillin\/Potassium Clav 875\/125mg Tablet<\/td> | 42<\/td> | EA<\/td> | ORAL<\/td> | AUGMENTIN<\/td>\n<\/tr>\n | \n\t| Azithromycin 200mg\/5ml (30ml) Suspension<\/td> | 30<\/td> | ML<\/td> | ORAL LIQUID<\/td> | ZITHROMAX<\/td>\n<\/tr>\n | \n\t| Azithromycin 250mg (#6) Tablet<\/td> | 1<\/td> | EA<\/td> | ORAL<\/td> | ZITHROMAX<\/td>\n<\/tr>\n | \n\t| Azithromycin 500mg (#3) Tablet<\/td> | 1<\/td> | EA<\/td> | ORAL<\/td> | ZITHROMAX<\/td>\n<\/tr>\n | \n\t| Cefuroxime Axetil Tab 500mg Tablet<\/td> | 42<\/td> | EA<\/td> | ORAL<\/td> | CEFTIN<\/td>\n<\/tr>\n | \n\t| Cephalexin 200ml 250mg\/5ml Suspension<\/td> | 400<\/td> | ML<\/td> | ORAL LIQUID<\/td> | KEFLEX<\/td>\n<\/tr>\n | \n\t| Cephalexin 250mg Capsule<\/td> | 84<\/td> | EA<\/td> | ORAL<\/td> | KEFLEX<\/td>\n<\/tr>\n | \n\t| Cephalexin 500mg Capsule<\/td> | 42<\/td> | EA<\/td> | ORAL<\/td> | KEFLEX<\/td>\n<\/tr>\n | \n\t| Ciprofloxacin HCl 250mg Tablet<\/td> | 42<\/td> | EA<\/td> | ORAL<\/td> | CIPRO<\/td>\n<\/tr>\n | \n\t| Ciprofloxacin HCl 500mg Tablet<\/td> | 42<\/td> | EA<\/td> | ORAL<\/td> | CIPRO<\/td>\n<\/tr>\n | \n\t| Clindamycin HCl 150mg Capsule<\/td> | 84<\/td> | EA<\/td> | ORAL<\/td> | CLEOCIN<\/td>\n<\/tr>\n | \n\t| Doxycycline Hyclate 20mg Tablet<\/td> | 42<\/td> | EA<\/td> | ORAL<\/td> | PERIOSTAT<\/td>\n<\/tr>\n | \n\t| Levofloxacin 250mg Tablet<\/td> | 20<\/td> | EA<\/td> | ORAL<\/td> | LEVAQUIN<\/td>\n<\/tr>\n | \n\t| Levofloxacin 500mg Tablet<\/td> | 20<\/td> | EA<\/td> | ORAL<\/td> | LEVAQUIN<\/td>\n<\/tr>\n | \n\t| Metronidazole 500mg Tablet<\/td> | 60<\/td> | EA<\/td> | ORAL<\/td> | FLAGYL<\/td>\n<\/tr>\n | \n\t| Nitrofurantoin monohydrate\/macrocrystals 100mg Capsule<\/td> | 42<\/td> | EA<\/td> | ORAL<\/td> | MACROBID<\/td>\n<\/tr>\n | \n\t| Penicillin V Potassium 250mg\/5ml Solution<\/td> | 400<\/td> | ML<\/td> | ORAL LIQUID<\/td> | VEETIDS<\/td>\n<\/tr>\n | \n\t| Penicillin V Potassium 500mg Tablet<\/td> | 60<\/td> | EA<\/td> | ORAL<\/td> | VEETIDS<\/td>\n<\/tr>\n | \n\t| Sulfamethoxazole\/Trimethoprim 200mg-40mg\/5ml Suspension<\/td> | 120<\/td> | ML<\/td> | ORAL LIQUID<\/td> | SULFATRIM PEDIATRIC<\/td>\n<\/tr>\n | \n\t| Sulfamethoxazole\/Trimethoprim 800mg\/160mg Tablet<\/td> | 42<\/td> | EA<\/td> | ORAL<\/td> | BACTRIM DS<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Antibiotics (Ear)” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Neomycin\/Polymyxin\/HC 10ml 1% Otic Solution<\/td> | 10<\/td> | ML<\/td> | OTIC LIQUID<\/td> | CORTISPORIN<\/td>\n<\/tr>\n | \n\t| Neomycin\/Polymyxin\/HC 10ml 3.5mg-10000 Unit-1%\/ml Otic Suspension<\/td> | 10<\/td> | ML<\/td> | OTIC LIQUID<\/td> | CORTISPORIN<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Antibiotics (Eye)” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Ciprofloxacin HCl 5ml 0.3% Ophthalmic Solution<\/td> | 5<\/td> | ML<\/td> | OPHTHAL LIQUID<\/td> | CILOXAN<\/td>\n<\/tr>\n | \n\t| Erythromycin 3.5gm 5mg\/gm Ophthalmic Ointment<\/td> | 3.5<\/td> | GM<\/td> | OPHTHAL SOLID<\/td> | ILOTYCIN<\/td>\n<\/tr>\n | \n\t| Ofloxacin 0.3% Ophthalmic Solution<\/td> | 5<\/td> | ML<\/td> | OPHTHAL LIQUID<\/td> | OCUFLOX<\/td>\n<\/tr>\n | \n\t| Polymyxin B Sulf\/Trimethoprim 10ml 10,000u\/0.1%\/ml Drops<\/td> | 10<\/td> | ML<\/td> | OPHTHAL LIQUID<\/td> | POLYTRIM<\/td>\n<\/tr>\n | \n\t| Tobramycin 5ml 0.3% Ophthalmic Drop<\/td> | 5<\/td> | ML<\/td> | OPHTHAL LIQUID<\/td> | TOBREX<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Antibiotics (Topical)” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Clindamycin Phosphate Soln 60ml 1% Solution<\/td> | 60<\/td> | ML<\/td> | TOPICAL LIQUID<\/td> | CLEOCIN-T<\/td>\n<\/tr>\n | \n\t| Mupirocin 22gm 2% Ointment<\/td> | 22<\/td> | GM<\/td> | TOPICAL SOLID<\/td> | BACTROBAN<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Antiburn (Topical)” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Silver Sulfadiazine 50gm 1% Cream<\/td> | 50<\/td> | GM<\/td> | TOPICAL SOLID<\/td> | SSD<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Antifungal \/ Anti-inflammatory (Topicals)” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Clotrimazole\/Betamethasone 15gm 1\/0.05% Cream<\/td> | 15<\/td> | GM<\/td> | TOPICAL SOLID<\/td> | LOTRISONE<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Antifungals” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Fluconazole 150mg Tablet<\/td> | 1<\/td> | EA<\/td> | ORAL<\/td> | DIFLUCAN<\/td>\n<\/tr>\n | \n\t| Nystatin 100mu\/ml Suspension<\/td> | 60<\/td> | ML<\/td> | ORAL LIQUID<\/td> | MYCOSTATIN<\/td>\n<\/tr>\n | \n\t| Terbinafine 250mg Tablet<\/td> | 21<\/td> | EA<\/td> | ORAL<\/td> | LAMISIL<\/td>\n<\/tr>\n | \n\t| Metronidazole 500mg Tablet<\/td> | 60<\/td> | EA<\/td> | ORAL<\/td> | FLAGYL<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Antifungals (Topical)” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Clotrimazole 45gm 1% Cream<\/td> | 45<\/td> | GM<\/td> | TOPICAL SOLID<\/td> | DESENEX<\/td>\n<\/tr>\n | \n\t| Ketoconazole Shampoo 120ml 2% Shampoo<\/td> | 120<\/td> | ML<\/td> | TOPICAL LIQUID<\/td> | NIZORAL<\/td>\n<\/tr>\n | \n\t| Metronidazole Vaginal Gel 70gm 0.75% Gel<\/td> | 70<\/td> | GM<\/td> | TOPICAL GEL<\/td> | METROGEL-VAGINAL<\/td>\n<\/tr>\n | \n\t| Nystatin Cream 100,000units\/gm Cream<\/td> | 30<\/td> | GM<\/td> | TOPICAL SOLID<\/td> | MYCOSTATIN<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Antigout” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Allopurinol 100mg Tablet<\/td> | 21<\/td> | EA<\/td> | ORAL<\/td> | ZYLOPRIM<\/td>\n<\/tr>\n | \n\t| Allopurinol 300mg Tablet<\/td> | 21<\/td> | EA<\/td> | ORAL<\/td> | ZYLOPRIM<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Antihistamines” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Hydroxyzine HCl 25mg Tablet<\/td> | 60<\/td> | EA<\/td> | ORAL<\/td> | HYDROXYZINE HCL<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Anti-inflammatory (Eye)” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Neomycin\/Polymyxin\/Dexamethasone 5ml 0.1% Ophthalmic Suspension<\/td> | 5<\/td> | ML<\/td> | OPHTHAL LIQUID<\/td> | MAXITROL<\/td>\n<\/tr>\n | \n\t| Prednisolone Acetate 5ml 1% Ophthalmic Suspension<\/td> | 5<\/td> | ML<\/td> | OPHTHAL LIQUID<\/td> | OMNIPRED<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Anti-inflammatory \/ NSAIDS” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Diclofenac Sodium DR 75mg Tablet<\/td> | 42<\/td> | EA<\/td> | ORAL<\/td> | VOLTAREN<\/td>\n<\/tr>\n | \n\t| Ibuprofen 400mg Tablet<\/td> | 60<\/td> | EA<\/td> | ORAL<\/td> | MOTRIN<\/td>\n<\/tr>\n | \n\t| Ibuprofen 600mg Tablet<\/td> | 60<\/td> | EA<\/td> | ORAL<\/td> | MOTRIN<\/td>\n<\/tr>\n | \n\t| Ibuprofen 800mg Tablet<\/td> | 60<\/td> | EA<\/td> | ORAL<\/td> | MOTRIN<\/td>\n<\/tr>\n | \n\t| Indomethacin 25mg Capsule<\/td> | 15<\/td> | EA<\/td> | ORAL<\/td> | INDOCIN<\/td>\n<\/tr>\n | \n\t| Meloxicam 7.5mg Tablet<\/td> | 21<\/td> | EA<\/td> | ORAL<\/td> | MOBIC<\/td>\n<\/tr>\n | \n\t| Naproxen 375mg Tablet<\/td> | 42<\/td> | EA<\/td> | ORAL<\/td> | NAPROSYN<\/td>\n<\/tr>\n | \n\t| Naproxen 500mg Tablet<\/td> | 42<\/td> | EA<\/td> | ORAL<\/td> | NAPROSYN<\/td>\n<\/tr>\n | \n\t| Diclofenac Potassium 50mg Tablet<\/td> | 42<\/td> | EA<\/td> | ORAL<\/td> | CATAFLAM<\/td>\n<\/tr>\n | \n\t| Diclofenac Sodium DR 50mg Tablet<\/td> | 42<\/td> | EA<\/td> | ORAL<\/td> | VOLTAREN<\/td>\n<\/tr>\n | \n\t| Ketorolac 10mg Tablet<\/td> | 15<\/td> | EA<\/td> | ORAL<\/td> | TORADOL<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Anti-inflammatory \/ Steroid (Oral)” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Prednisone 5mg Tablet<\/td> | 30<\/td> | EA<\/td> | ORAL<\/td> | PREDNISONE<\/td>\n<\/tr>\n | \n\t| Dexamethasone 4mg Tablet<\/td> | 63<\/td> | EA<\/td> | ORAL<\/td> | DECADRON<\/td>\n<\/tr>\n | \n\t| Fludrocortisone Acetate 0.1mg Tablet<\/td> | 21<\/td> | EA<\/td> | ORAL<\/td> | FLORINEF<\/td>\n<\/tr>\n | \n\t| Methylprednisolone Pack (1x21) 4mg Tablet<\/td> | 21<\/td> | EA<\/td> | ORAL<\/td> | MEDROL DOSEPAK<\/td>\n<\/tr>\n | \n\t| Prednisone 10mg Tablet<\/td> | 30<\/td> | EA<\/td> | ORAL<\/td> | DELTASONE<\/td>\n<\/tr>\n | \n\t| Prednisone 20mg Tablet<\/td> | 30<\/td> | EA<\/td> | ORAL<\/td> | DELTASONE<\/td>\n<\/tr>\n | \n\t| Prednisone 50mg Tablet<\/td> | 42<\/td> | EA<\/td> | ORAL<\/td> | DELTASONE<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Anti-inflammatory \/ Steroid (Topical)” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Betamethasone Valerate Oint 1% Ointment 45gm<\/td> | 45<\/td> | GM<\/td> | TOPICAL SOLID<\/td> | VALISONE<\/td>\n<\/tr>\n | \n\t| Clobetasol 0.05% Cream 15g<\/td> | 15<\/td> | GM<\/td> | TOPICAL SOLID<\/td> | TEMOVATE<\/td>\n<\/tr>\n | \n\t| Clobetasol Propionate 0.05% Ointment15gm<\/td> | 15<\/td> | GM<\/td> | TOPICAL SOLID<\/td> | TEMOVATE<\/td>\n<\/tr>\n | \n\t| Hydrocortisone 2.5% Cream<\/td> | 30<\/td> | GM<\/td> | TOPICAL SOLID<\/td> | HYTONE<\/td>\n<\/tr>\n | \n\t| Hydrocortisone 2.5% Ointment<\/td> | 30<\/td> | GM<\/td> | TOPICAL SOLID<\/td> | HYTONE<\/td>\n<\/tr>\n | \n\t| Mometasone Furoate 0.1% Cream 15gm<\/td> | 15<\/td> | GM<\/td> | TOPICAL SOLID<\/td> | ELOCON<\/td>\n<\/tr>\n | \n\t| Triamcinolone Acetonide 0.1% Cream 15gm<\/td> | 15<\/td> | GM<\/td> | TOPICAL SOLID<\/td> | KENALOG<\/td>\n<\/tr>\n | \n\t| Triamcinolone Acetonide 0.1% Ointment 80gm<\/td> | 80<\/td> | GM<\/td> | TOPICAL SOLID<\/td> | KENALOG<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Antinausea” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Meclizine HCl 25mg Tablet<\/td> | 63<\/td> | EA<\/td> | ORAL<\/td> | ANTIVERT<\/td>\n<\/tr>\n | \n\t| Prochlorperazine Maleate 10mg Tablet<\/td> | 21<\/td> | EA<\/td> | ORAL<\/td> | COMPAZINE<\/td>\n<\/tr>\n | \n\t| Promethazine HCl 25mg Tablet<\/td> | 84<\/td> | EA<\/td> | ORAL<\/td> | PHENERGAN<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Antivirals” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Acyclovir 400mg Tablet<\/td> | 30<\/td> | EA<\/td> | ORAL<\/td> | ZOVIRAX<\/td>\n<\/tr>\n | \n\t| Acyclovir 800mg Tablet<\/td> | 30<\/td> | EA<\/td> | ORAL<\/td> | ZOVIRAX<\/td>\n<\/tr>\n | \n\t| Valacyclovir 500mg Tablet<\/td> | 42<\/td> | EA<\/td> | ORAL<\/td> | VALTREX<\/td>\n<\/tr>\n | \n\t| Acyclovir 200mg Capsule<\/td> | 50<\/td> | EA<\/td> | ORAL<\/td> | ZOVIRAX<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Asthma \/ Bronchodilators” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Albuterol Sulfate (UD 30x3ml) 0.083% (2.5mg\/3ml) Inhalation Solution<\/td> | 90<\/td> | ML<\/td> | NEB<\/td> | PROVENTIL\/VENTOLIN<\/td>\n<\/tr>\n | \n\t| Albuterol Sulfate\/Ipratropium Bromide (UD 30x3ml) (3mg\/0.5mg\/3ml) Inhalation Solution<\/td> | 90<\/td> | ML<\/td> | NEB<\/td> | DUONEB<\/td>\n<\/tr>\n | \n\t| Montelukast 10mg Tablet<\/td> | 21<\/td> | EA<\/td> | ORAL<\/td> | SINGULAIR<\/td>\n<\/tr>\n | \n\t| Montelukast 5mg Chewable Tablet<\/td> | 21<\/td> | EA<\/td> | ORAL<\/td> | SINGULAIR<\/td>\n<\/tr>\n | \n\t| Montelukast Sodium 4mg Chew Tab<\/td> | 21<\/td> | EA<\/td> | ORAL<\/td> | SINGULAIR<\/td>\n<\/tr>\n | \n\t| Prednisolone Sod Phosphate 15mg\/5mL Oral Solution<\/td> | 120<\/td> | ML<\/td> | ORAL LIQUID<\/td> | PRELONE<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Cardiac \/ Hypertension” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Nitroglycerin 0.4mg Disintegrating Tablet (#25)<\/td> | 1<\/td> | EA<\/td> | ORAL<\/td> | NITROSTAT<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Cough and Cold” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Benzonatate 100mg Capsule<\/td> | 30<\/td> | EA<\/td> | ORAL<\/td> | TESSALON PERLES<\/td>\n<\/tr>\n | \n\t| Benzonatate 200mg Capsule<\/td> | 30<\/td> | EA<\/td> | ORAL<\/td> | TESSALON PERLES<\/td>\n<\/tr>\n | \n\t| Promethazine-DM 6.25-15mg\/5mL Syrup<\/td> | 240<\/td> | ML<\/td> | ORAL LIQUID<\/td> | PHERAZINE DM<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Gastrointestinal” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Dicyclomine 10mg Capsule<\/td> | 60<\/td> | EA<\/td> | ORAL<\/td> | BENTYL<\/td>\n<\/tr>\n | \n\t| Dicyclomine 20mg Tablet<\/td> | 63<\/td> | EA<\/td> | ORAL<\/td> | BENTYL<\/td>\n<\/tr>\n | \n\t| Famotidine 20mg Tablet<\/td> | 42<\/td> | EA<\/td> | ORAL<\/td> | PEPCID<\/td>\n<\/tr>\n | \n\t| Omeprazole DR 20mg Capsule<\/td> | 21<\/td> | EA<\/td> | ORAL<\/td> | PRILOSEC<\/td>\n<\/tr>\n | \n\t| Omeprazole DR 40mg Capsule<\/td> | 21<\/td> | EA<\/td> | ORAL<\/td> | PRILOSEC<\/td>\n<\/tr>\n | \n\t| Pantoprazole EC 40mg Tablet<\/td> | 21<\/td> | EA<\/td> | ORAL<\/td> | PROTONIX<\/td>\n<\/tr>\n | \n\t| Diphenox\/Atropine 2.5\/.025mg Tablet<\/td> | 30<\/td> | EA<\/td> | ORAL<\/td> | LOMOTIL<\/td>\n<\/tr>\n | \n\t| Polyethylene Glycol 3350 236gm NA Solution<\/td> | 4000<\/td> | ML<\/td> | ORAL LIQUID<\/td> | GO-LYTELY<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Migraine” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Naratriptan 2.5mg Tablet<\/td> | 9<\/td> | EA<\/td> | ORAL<\/td> | AMERGE<\/td>\n<\/tr>\n | \n\t| Rizatriptan 10mg Tablet<\/td> | 6<\/td> | EA<\/td> | ORAL<\/td> | MAXALT<\/td>\n<\/tr>\n | \n\t| Rizatriptan 5mg Tablet<\/td> | 6<\/td> | EA<\/td> | ORAL<\/td> | MAXALT<\/td>\n<\/tr>\n | \n\t| Rizatriptan ODT 10mg Disintegrating Tablet<\/td> | 3<\/td> | EA<\/td> | ORAL<\/td> | MAXALT-MLT<\/td>\n<\/tr>\n | \n\t| Sumatriptan 100mg Tablet<\/td> | 9<\/td> | EA<\/td> | ORAL<\/td> | IMITREX<\/td>\n<\/tr>\n | \n\t| Sumatriptan 50mg Tablet<\/td> | 9<\/td> | EA<\/td> | ORAL<\/td> | IMITREX<\/td>\n<\/tr>\n | \n\t| Butalbital\/Acetaminophen\/Caffeine 50\/325\/40mg Tablet<\/td> | 42<\/td> | EA<\/td> | ORAL<\/td> | ESGIC<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Muscle Relaxants” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Tizanidine 2mg Tablet<\/td> | 30<\/td> | EA<\/td> | ORAL<\/td> | ZANAFLEX<\/td>\n<\/tr>\n | \n\t| Tizanidine 4mg Tablet<\/td> | 42<\/td> | EA<\/td> | ORAL<\/td> | ZANAFLEX<\/td>\n<\/tr>\n | \n\t| Cyclobenzaprine HCl 5mg Tablet<\/td> | 30<\/td> | EA<\/td> | ORAL<\/td> | FLEXERIL<\/td>\n<\/tr>\n | \n\t| Cycylobenzaprine HCl 10mg Tablet<\/td> | 63<\/td> | EA<\/td> | ORAL<\/td> | FLEXERIL<\/td>\n<\/tr>\n | \n\t| Methocarbamol 500mg Tablet<\/td> | 60<\/td> | EA<\/td> | ORAL<\/td> | ROBAXIN<\/td>\n<\/tr>\n | \n\t| Methocarbamol 750mg Tablet<\/td> | 60<\/td> | EA<\/td> | ORAL<\/td> | ROBAXIN-750<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Oral Health” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Chlorhexidine Gluconate 473ml 0.12% Oral Solution<\/td> | 473<\/td> | ML<\/td> | ORAL LIQUID<\/td> | PERIOGARD<\/td>\n<\/tr>\n | \n\t| Sodium Fluoride 51gm 1.1% Gel<\/td> | 51<\/td> | GM<\/td> | ORAL GEL<\/td> | PREVIDENT 5000 DRY MOUTH<\/td>\n<\/tr>\n | \n\t| Triamcinolone 5gm 0.1% Dental Paste<\/td> | 5<\/td> | GM<\/td> | ORAL PASTE<\/td> | ORALONE DENTAL PASTE<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.0″ _module_preset=”default” module_alignment=”center” custom_margin=”||||false|false” custom_padding=”1px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Pain Relievers” _builder_version=”4.27.0″ _module_preset=”default” title_font=”|600||on|||||” title_text_align=”left” custom_margin=”||-15px||false|false” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.0″ _module_preset=”default” custom_margin=”15px|||15px|false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n\n \n\n\n\t| Medicine Name<\/th> | Max Qty<\/th> | Units<\/th> | Route<\/th> | Reference Brand<\/th>\n<\/tr>\n<\/thead>\n | \n\n\t| Acetaminophen\/Tramadol HCl 325\/37.5mg Tablet<\/td> | 63<\/td> | EA<\/td> | ORAL<\/td> | ULTRACET<\/td>\n<\/tr>\n | \n\t| Gabapentin 300mg Capsule<\/td> | 60<\/td> | EA<\/td> | ORAL<\/td> | NEURONTIN<\/td>\n<\/tr>\n | \n\t| Gabapentin 400mg Capsule<\/td> | 60<\/td> | EA<\/td> | ORAL<\/td> | NEURONTIN<\/td>\n<\/tr>\n | \n\t| Gabapentin 600mg Tablet<\/td> | 60<\/td> | EA<\/td> | ORAL<\/td> | NEURONTIN<\/td>\n<\/tr>\n | \n\t| Gabapentin 800mg Tablet<\/td> | 60<\/td> | EA<\/td> | ORAL<\/td> | NEURONTIN<\/td>\n<\/tr>\n | \n\t| Tramadol 50mg Tablet<\/td> | 63<\/td> | EA<\/td> | ORAL<\/td> | ULTRAM<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":" Maintenance Medicationsclick to view allImmediate Need Medicationsclick to view allThe most utilized chronic and acute medications can be filled at no additional cost beyond the monthly membership fee!* seach by brand name, generic name, or treatment condition.Maintenance MedicationsImmediate Need MedicationsThe most utilized chronic and acute medications can be filled at no additional cost beyond the 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