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					96th Medical Group-Eglin Air Force Base Hospital: Outpatient   Eglin Outpatient - Formulary (Generic List), Last Updated: 10/11/2010 8:38:49 AM   Page 1 of 10

                                                                release                                                                                           mg-0.0065 mg
                                                                  Akwa Tears (ocular lubricant)                                      Anusol-HC (hydrocortisone topical)
                                                                   ophthalmic, ointment     -                                         rectal, cream with          2.5%
                                                                   ophthalmic, solution     preserved                              applicator
                                                                  Aldactazide (hydrochlorothiazide-spironolactone)                    rectal, suppository         25 mg
                                                                   oral, tablet             25 mg-25 mg                              Apresoline (hydrALAZINE)
  Legend
                                                                  Aldactone (spironolactone)                                          oral, tablet                10 mg, 25 mg, 50 mg
 {P} Preferred
                                                                   oral, tablet             25 mg                                    Aralen Phosphate (chloroquine)
 {R} Restricted
                                                                  Aldara (imiquimod topical)                                          oral, tablet                500 mg
 {S} Status Pending
                                                                   topical, cream           5%                                       Aricept (donepezil)
 {TI} Therapeutic Interchange
                                                                  Aldomet (methyldopa)                                                oral, tablet                5 mg, 10 mg
 {High$} High Dollar Medication
                                                                   oral, tablet             250 mg                                   Arixtra (fondaparinux)
                                                                  Alkeran (melphalan)                                                 subcutaneous, solution 2.5 mg/0.5 mL
  Abilify (aripiprazole)                                           oral, tablet             2 mg                                     Artane (trihexyphenidyl)
   oral, tablet                2 mg, 5 mg, 10 mg, 15 mg,          Allegra (fexofenadine)                                              oral, tablet                2 mg
                               30 mg                               oral, tablet             60 mg, 180 mg                            Asacol (mesalamine)
  Accutane (isotretinoin)                                         Allegra-D 12 Hour (fexofenadine-pseudoephedrine)                    oral, enteric coated tablet 400 mg
   oral, capsule            20 mg, 40 mg                           oral, tablet, extended   60 mg-120 mg                             Asmanex Twisthaler 30 Dose (mometasone)
  Actifed (pseudoephedrine-triprolidine)                        release                                                               inhalation, aerosol         110 mcg/inh, 220 mcg/inh
   oral, tablet             60 mg-2.5 mg                          Allegra-D 24 Hour (fexofenadine-pseudoephedrine)                 powder
  Actigall (ursodiol)                                              oral, tablet, extended   180 mg-240 mg                            Astelin (azelastine nasal)
   oral, capsule            300 mg                              release                                                               nasal, spray                137 mcg/inh
  Actonel (risedronate)                                           Alora (estradiol)                                                  Atacand (candesartan)
   oral, tablet             35 mg, 150 mg                          transdermal, film,       0.05 mg/24 hours twice                    oral, tablet                4 mg, 8 mg, 16 mg, 32 mg
  Actos (pioglitazone)                                          extended release            weekly, 0.1 mg/24 hours                  Atacand HCT (candesartan-hydrochlorothiazide)
   oral, tablet             15 mg, 30 mg, 45 mg                                             twice weekly                              oral, tablet                16 mg-12.5 mg, 32 mg-12.5
  Acular (ketorolac ophthalmic)                                   Alphagan P (brimonidine ophthalmic)                                                             mg
   ophthalmic, solution     0.5%                                   ophthalmic, solution     0.15%                                    Atarax (hydrOXYzine)
  Adalat CC (NIFEdipine)                                          Alrex (loteprednol ophthalmic)                                      oral, syrup                 hydrochloride 10 mg/5 mL
   oral, tablet, extended   30 mg, 60 mg, 90 mg                    ophthalmic, suspension 0.2%                                        oral, tablet                hydrochloride 10 mg,
release                                                           Ambien (zolpidem)                                                                               hydrochloride 25 mg
  Adapin (doxepin)                                                 oral, tablet             5 mg, 10 mg                              Ativan (lorazepam)
   oral, capsule            10 mg, 25 mg, 50 mg, 100              Amlactin (ammonium lactate topical)                                 oral, tablet                0.5 mg, 1 mg
                            mg                                     topical, cream           12%                                      Atrovent (ipratropium)
  Adderall (amphetamine-dextroamphetamine)                         topical, lotion          12%                                       inhalation, solution        0.02%
   oral, tablet             5 mg, 10 mg, 20 mg                    Amoxil (amoxicillin)                                               Atrovent HFA (ipratropium)
  Adderall XR (amphetamine-dextroamphetamine)                      oral, capsule            250 mg, 500 mg                            inhalation, aerosol         CFC free 17 mcg/inh
   oral, capsule, extended 5 mg, 10 mg, 15 mg, 20 mg,              oral, powder for         250 mg/5 mL, 400 mg/5 mL                 Atrovent Nasal (ipratropium nasal)
release                     25 mg, 30 mg                        reconstitution                                                        nasal, spray                0.03%, 0.06%
  Advair Diskus (fluticasone-salmeterol)                           oral, tablet, chewable   250 mg                                   Augmentin (amoxicillin-clavulanate)
   inhalation, powder       100 mcg-50 mcg, 250                   Androderm (testosterone)                                            oral, powder for            400 mg-57 mg/5 mL
                            mcg-50 mcg, 500 mcg-50                 transdermal, film,       5 mg/24 hours                          reconstitution
                            mcg                                 extended release                                                      oral, tablet                500 mg-125 mg, 875
  Afrin (oxymetazoline nasal)                                     Antabuse (disulfiram)                                                                           mg-125 mg
   nasal, spray             0.05%                                  oral, tablet             250 mg                                   Augmentin ES-600 (amoxicillin-clavulanate)
  Aggrenox (aspirin-dipyridamole)                                 Antispas (atropine/hyoscyamine/PB/scopolamine)                      oral, powder for            600 mg-42.9 mg/5 mL
   oral, capsule, extended 25 mg-200 mg                            oral, tablet             0.0194 mg-0.1037 mg-16.2               reconstitution

For formulary questions please contact 96 MDOS/SGSD at 96MDG.Pharmacy@eglin.af.mil or call (850) 883-9006.Generated by Amplifi a service of Pharmacy OneSource, Inc.
96th Medical Group-Eglin Air Force Base Hospital: Outpatient   Eglin Outpatient - Formulary (Generic List), Last Updated: 10/11/2010 8:38:49 AM   Page 2 of 10
  Augmentin XR (amoxicillin-clavulanate)                          Betoptic S (betaxolol ophthalmic)                                extended release
   oral, tablet, extended     1000 mg-62.5 mg                      ophthalmic, suspension 0.25%                                      Catapres-TTS-3 (clonidine)
release                                                           Biaxin (clarithromycin)                                             transdermal, film,       0.3 mg/24 hr
  Auralgan (obsolete) (antipyrine-benzocaine otic)                 oral, powder for           250 mg/5 mL                          extended release
   otic, solution             54 mg-14 mg/mL                    reconstitution                                                       Ceftin (cefuroxime)
  Aurodex (antipyrine-benzocaine otic)                            Biaxin XL (clarithromycin)                                          oral, tablet             250 mg
   otic, solution             54 mg-14 mg/mL                       oral, tablet, extended     500 mg                                 Cefzil (cefprozil)
  AVC (sulfanilamide topical)                                   release                                                               oral, powder for         250 mg/5 mL
   vaginal, cream             15%                                 Blephamide (prednisoLONE-sulfacetamide sodium                    reconstitution
  Avelox (moxifloxacin)                                         ophthalmic)                                                          Celebrex (celecoxib)
   oral, tablet               400 mg                               ophthalmic, suspension 0.2%-10%                                    oral, capsule            100 mg, 200 mg
  Aventyl HCl (nortriptyline)                                     Boniva (ibandronate)                                               Celexa (citalopram)
   oral, capsule              25 mg                                oral, tablet               150 mg                                  oral, tablet             20 mg, 40 mg
  Aviane (ethinyl estradiol-levonorgestrel)                       Brethine (terbutaline)                                             Cephulac (lactulose)
   oral, tablet               20 mcg-100 mcg                       injectable, solution       1 mg/mL                                 oral, syrup              10 g/15 mL
  Avita (tretinoin topical)                                        oral, tablet               5 mg                                   Chlor-Trimeton (chlorpheniramine)
   topical, cream             0.025%                              BuSpar (busPIRone)                                                  oral, syrup              2 mg/5 mL
   topical, gel               0.025%                               oral, tablet               10 mg                                   oral, tablet             4 mg
  Aygestin (norethindrone)                                        Byetta Prefilled Pen (exenatide)                                   Cipro (ciprofloxacin)
   oral, tablet               5 mg                                 subcutaneous, solution 10 mcg/0.04 mL, 5                           oral, tablet             250 mg, 500 mg
  Azithromycin 3 Day Dose Pack (azithromycin)                                                 mcg/0.02 mL                            Ciprodex (ciprofloxacin-dexamethasone otic)
   oral, tablet               500 mg                              Calan SR (verapamil)                                                otic, suspension         0.3%-0.1%
  Azithromycin 5 Day Dose Pack (azithromycin)                      oral, tablet, extended     180 mg, 240 mg                         Citrate of Magnesia (magnesium citrate)
   oral, tablet               250 mg                            release                                                               oral, liquid             -
  Azulfidine (sulfasalazine)                                      Calciferol (ergocalciferol)                                        Claritin (loratadine)
   oral, tablet               500 mg                               oral, solution             8000 intl units/mL                      oral, syrup              5 mg/5 mL
  Bactrim (sulfamethoxazole-trimethoprim)                         Canasa (mesalamine)                                                 oral, tablet             10 mg
   oral, tablet               400 mg-80 mg                         rectal, suppository        1000 mg                                Cleocin HCl (clindamycin)
  Bactrim DS (sulfamethoxazole-trimethoprim)                      Capoten (captopril)                                                 oral, capsule            150 mg, 300 mg
   oral, tablet               800 mg-160 mg                        oral, tablet               25 mg, 50 mg                           Cleocin Pediatric (clindamycin)
  Bactrim Pediatric (sulfamethoxazole-trimethoprim)               Carac (fluorouracil topical)                                        oral, powder for         75 mg/5 mL
   oral, suspension           200 mg-40 mg/5 mL                    topical, cream             0.5%                                 reconstitution
  Bactroban (mupirocin topical)                                   Carafate (sucralfate)                                              Cleocin T (clindamycin topical)
   topical, ointment          2%                                   oral, tablet               1g                                      topical, solution        1%
   topical, cream             2%                                  Cardizem CD (diltiazem)                                            Cleocin Vaginal (clindamycin topical)
  Benadryl (diphenhydrAMINE)                                       oral, capsule, extended 120 mg/24 hours, 180                       vaginal, cream           2%
   oral, capsule              25 mg, 50 mg                      release                       mg/24 hours, 240 mg/24                 Climara (estradiol)
  Benadryl Children's Allergy (diphenhydrAMINE)                                               hours, 300 mg/24 hours,                 transdermal, film,       0.05 mg/24 hours weekly,
   oral, liquid               12.5 mg/5 mL                                                    360 mg/24 hours                      extended release            0.1 mg/24 hours weekly
  Benemid (probenecid)                                            Carmol-40 (urea topical)                                           Clinoril (sulindac)
   oral, tablet               500 mg                               topical, cream             40%                                     oral, tablet             150 mg, 200 mg
  Bentyl (dicyclomine)                                            Catapres (clonidine)                                               Clomid (clomiPHENE)
   oral, syrup                10 mg/5 mL                           oral, tablet               0.1 mg, 0.2 mg                          oral, tablet             50 mg
   oral, tablet               20 mg                               Catapres-TTS-1 (clonidine)                                         Colace (docusate)
  BenzaClin (benzoyl peroxide-clindamycin topical)                 transdermal, film,         0.1 mg/24 hr                            oral, capsule            sodium 100 mg
   topical, gel               5%-1%                             extended release                                                      oral, liquid             10 mg/mL
  Betapace (sotalol)                                              Catapres-TTS-2 (clonidine)                                         Colazal (balsalazide)
   oral, tablet               80 mg                                transdermal, film,         0.2 mg/24 hr                            oral, capsule            750 mg

For formulary questions please contact 96 MDOS/SGSD at 96MDG.Pharmacy@eglin.af.mil or call (850) 883-9006.Generated by Amplifi a service of Pharmacy OneSource, Inc.
96th Medical Group-Eglin Air Force Base Hospital: Outpatient   Eglin Outpatient - Formulary (Generic List), Last Updated: 10/11/2010 8:38:49 AM   Page 3 of 10
  Colestid (colestipol)                                           Crolom (cromolyn ophthalmic)                                        oral, capsule, extended 15 mg
   oral, tablet             1g                                     ophthalmic, solution        4%                                  release
  Coly-Mycin S (colistin/HC/neomycin/thonzonium otic)             Cyclocort (amcinonide topical)                                     DiaBeta (glyBURIDE)
   otic, suspension         0.3%-1%-0.33%-0.05%                    topical, cream              0.1% {15gm}                            oral, tablet                5 mg
  Combigan (brimonidine-timolol ophthalmic)                       Cyclogyl (cyclopentolate ophthalmic)                               Diamox (acetaZOLAMIDE)
   ophthalmic, solution     0.2%-0.5%                              ophthalmic, solution        1%                                     oral, tablet                250 mg
  Combipatch (estradiol-norethindrone)                            Cytomel (liothyronine)                                             Diamox Sequels (acetaZOLAMIDE)
   transdermal, film,       0.05 mg-0.14 mg/24 hours,              oral, tablet                25 mcg                                 oral, capsule, extended 500 mg
extended release            0.05 mg-0.25 mg/24 hours              Cytoxan (cyclophosphamide)                                       release
  Combivent (albuterol-ipratropium)                                oral, tablet                50 mg                                 Differin (adapalene topical)
   inhalation, aerosol with 90 mcg-18 mcg/inh                     Danocrine (danazol)                                                 topical, cream              0.1%
adapter                                                            oral, capsule               200 mg                                 topical, gel                0.1%
  Compazine (prochlorperazine)                                    Darvocet-N 100 (acetaminophen-propoxyphene)                        Diflucan (fluconazole)
   oral, tablet             10 mg                                  oral, tablet                napsylate 650 mg-100 mg                oral, powder for            40 mg/mL
   rectal, suppository      25 mg                                 Darvon-N (propoxyphene)                                          reconstitution
  Concerta (methylphenidate)                                       oral, tablet                napsylate 100 mg                       oral, tablet                150 mg, 200 mg
   oral, tablet, extended   18 mg/24 hr, 27 mg/24 hr,             DDAVP Nasal (desmopressin)                                         Dilantin (phenytoin)
release                     36 mg/24 hr, 54 mg/24 hr               nasal, spray                10 mcg/inh                             oral, capsule, extended 100 mg
  Condylox (podofilox topical)                                    Decadron (dexamethasone)                                         release
   topical, solution        0.5%                                   oral, elixir                0.5 mg/5 mL                           Dilaudid (hydromorphone)
  Cordarone (amiodarone)                                           oral, tablet                0.5 mg, 0.75 mg, 4 mg                  oral, tablet                2 mg
   oral, tablet             200 mg                                Delatestryl (testosterone)                                         Diltzac (diltiazem)
  Cordran Tape (flurandrenolide topical)                           intramuscular, solution enanthate 200 mg/mL                        oral, capsule, extended 120 mg/24 hours, 180
   topical, tape            4 mcg/cm2                             Demerol HCl (meperidine)                                         release                        mg/24 hours, 240 mg/24
  Coreg (carvedilol)                                               oral, tablet                50 mg                                                              hours, 300 mg/24 hours,
   oral, tablet             3.125 mg, 6.25 mg, 12.5               Demulen 1/35 (ethinyl estradiol-ethynodiol)                                                     360 mg/24 hours
                            mg, 25 mg                              oral, tablet                35 mcg-1 mg                           Disalcid (salsalate)
  Coreg CR (carvedilol)                                           Depakote (divalproex sodium)                                        oral, tablet                500 mg
   oral, capsule, extended 10 mg, 20 mg, 40 mg, 80                 oral, enteric coated tablet 125 mg {sprinkle}, 250 mg             Ditropan (oxybutynin)
release                     mg                                                                 {delayed release}, 500 mg              oral, syrup                 5 mg/5 mL
  Corgard (nadolol)                                               Depakote ER (divalproex sodium)                                     oral, tablet                5 mg
   oral, tablet             40 mg, 80 mg                           oral, tablet, extended      500 mg                                Ditropan XL (oxybutynin)
  Cortef (hydrocortisone)                                       release                                                               oral, tablet, extended      5 mg, 10 mg, 15 mg
   oral, tablet             10 mg                                 Depakote Sprinkles (divalproex sodium)                           release
  Cortenema (hydrocortisone)                                       oral, delayed release       125 mg {not ER}                       Diuril (chlorothiazide)
   rectal, suspension       100 mg/60 mL                        capsule                                                               oral, suspension            250 mg/5 mL
  Cortisporin Otic (hydrocortisone/neomycin/polymyxin             Derma-Smoothe/FS (fluocinolone topical)                            Docusil (docusate)
B otic)                                                            topical, oil                0.01%                                  oral, capsule               sodium 100 mg
   otic, suspension         1%-0.35%-10000 units/mL               Desyrel (traZODONE)                                                Dolophine (methadone)
   otic, solution           1%-0.35%-10000 units/mL                oral, tablet                50 mg                                  oral, tablet                10 mg
  Cortone Acetate (cortisone)                                     Detrol (tolterodine)                                               Domeboro Otic (acetic acid-aluminum acetate otic)
   oral, tablet             25 mg                                  oral, tablet                1 mg, 2 mg                             otic, solution              2%-0.79%
  Cosopt (dorzolamide-timolol ophthalmic)                         Detrol LA (tolterodine)                                            Dovonex (calcipotriene topical)
   ophthalmic, solution     2%-0.5% {dont stock 5ml}               oral, capsule, extended 2 mg, 4 mg                                 topical, cream              0.005%
  Coumadin (warfarin)                                           release                                                              Drysol (aluminum chloride hexahydrate topical)
   oral, tablet             1 mg, 2 mg, 2.5 mg, 5 mg              Dexedrine (dextroamphetamine)                                       topical, solution           20%
  Cozaar (losartan)                                                oral, tablet                5 mg                                  Ducodyl (bisacodyl)
   oral, tablet             25 mg, 50 mg, 100 mg                  Dexedrine Spansule (dextroamphetamine)                              oral, enteric coated tablet 5 mg

For formulary questions please contact 96 MDOS/SGSD at 96MDG.Pharmacy@eglin.af.mil or call (850) 883-9006.Generated by Amplifi a service of Pharmacy OneSource, Inc.
96th Medical Group-Eglin Air Force Base Hospital: Outpatient   Eglin Outpatient - Formulary (Generic List), Last Updated: 10/11/2010 8:38:49 AM   Page 4 of 10
  Dulcolax Laxative (bisacodyl)                                    oral, tablet               1 mg, 2 mg                               otic, solution           0.3%
   oral, enteric coated tablet 5 mg                               Estratest (esterified                                              FML Liquifilm (fluorometholone ophthalmic)
   rectal, suppository         10 mg                            estrogens-methylTESTOSTERone)                                          ophthalmic, suspension 0.1%
  Duragesic-100 (fentanyl)                                         oral, tablet               1.25 mg-2.5 mg                         Fosamax (alendronate)
   transdermal, film,          100 mcg/hr                         Estratest H.S. (esterified                                           oral, tablet             5 mg, 10 mg, 35 mg, 70 mg
extended release                                                estrogens-methylTESTOSTERone)                                        Fosamax Plus D (alendronate-cholecalciferol)
  Duragesic-25 (fentanyl)                                          oral, tablet               0.625 mg-1.25 mg                         oral, tablet             70 mg-2800 intl units, 70
   transdermal, film,          25 mcg/hr                          Eucerin (emollients, topical)                                                                 mg-5600 intl units
extended release                                                   topical, cream             -                                      Furadantin (nitrofurantoin)
  Duragesic-50 (fentanyl)                                         Eulexin (flutamide)                                                  oral, suspension         25 mg/5 mL
   transdermal, film,          50 mcg/hr                           oral, capsule              125 mg                                 Furoxone (furazolidone)
extended release                                                  Evista (raloxifene)                                                  oral, suspension         50 mg/15 mL
  Duragesic-75 (fentanyl)                                          oral, tablet               60 mg                                  Garamycin Ophthalmic (gentamicin ophthalmic)
   transdermal, film,          75 mcg/hr                          Evoxac (cevimeline)                                                  ophthalmic, ointment     0.3%
extended release                                                   oral, capsule              30 mg                                    ophthalmic, solution     0.3%
  Duricef (cefadroxil)                                            Feldene (piroxicam)                                                Geodon (ziprasidone)
   oral, capsule               500 mg                              oral, capsule              20 mg                                    oral, capsule            20 mg, 40 mg, 60 mg, 80
  E.E.S.-200 (erythromycin)                                       Femara (letrozole)                                                                            mg
   oral, suspension            ethylsuccinate 200 mg/5 mL          oral, tablet               2.5 mg                                 GlipiZIDE XL (glipiZIDE)
  Ecotrin (aspirin)                                               femhrt 1 mg/5 mcg (ethinyl estradiol-norethindrone)                  oral, tablet, extended   5 mg, 10 mg
   oral, enteric coated tablet 325 mg                              oral, tablet               5 mcg-1 mg                           release
  Effexor XR (venlafaxine)                                        Fenoglide (fenofibrate)                                            GlucaGen (glucagon)
   oral, capsule, extended 37.5 mg, 75 mg, 150 mg                  oral, tablet               40 mg, 120 mg                            injectable, powder for   recombinant 1 mg
release                                                           Feosol (ferrous sulfate)                                         injection
  Elavil (amitriptyline)                                           oral, tablet               325 mg                                 Glucagon Emergency Kit for Low Blood Sugar
   oral, tablet                10 mg, 25 mg, 50 mg                Finacea (azelaic acid topical)                                   (glucagon)
  Eldepryl (selegiline)                                            topical, gel               15%                                      injectable, powder for   recombinant 1 mg
   oral, tablet                5 mg                               Fioricet (APAP/butalbital/caffeine)                              injection
  Elidel (pimecrolimus topical)                                    oral, tablet               325 mg-50 mg-40 mg                     Glucophage (metformin)
   topical, cream              1%                                 Flagyl (metronidazole)                                               oral, tablet             500 mg, 850 mg, 1000 mg
  Elimite (permethrin topical)                                     oral, tablet               250 mg                                 Glucotrol (glipiZIDE)
   topical, cream              5%                                 Fleet Enema (sodium biphosphate-sodium phosphate)                    oral, tablet             5 mg, 10 mg
  Elixophyllin (theophylline)                                      rectal, enema              7 g-19 g                               Glucotrol XL (glipiZIDE)
   oral, elixir                80 mg/15 mL                        Fleet Mineral Oil Enema (mineral oil)                                oral, tablet, extended   5 mg, 10 mg
  Elmiron (pentosan polysulfate sodium)                            rectal, enema              100%                                 release
   oral, capsule               100 mg                             Flexeril (cyclobenzaprine)                                         Glucovance (glyBURIDE-metformin)
  Entocort EC (budesonide)                                         oral, tablet               10 mg                                    oral, tablet             1.25 mg-250 mg, 2.5
   oral, capsule, extended 3 mg                                   Flomax (tamsulosin)                                                                           mg-500 mg, 5 mg-500 mg
release                                                            oral, capsule              0.4 mg                                 Glynase PresTab (glyBURIDE)
  Enuclene (tyloxapol ophthalmic)                                 Flonase (fluticasone nasal)                                          oral, tablet             micronized 3 mg
   ophthalmic, solution        0.25%                               nasal, spray               0.05 mg/inh                            GoLYTELY (polyethylene glycol 3350 with
  EpiPen Auto-Injector (epinephrine)                              Florinef Acetate (fludrocortisone)                               electrolytes)
   injectable, kit             0.3 mg                              oral, tablet               0.1 mg                                   oral, powder for         -
  EpiPen JR Auto-Injector (epinephrine)                           Flovent HFA (fluticasone)                                        reconstitution
   injectable, kit             0.15 mg                             inhalation, aerosol with CFC free 44 mcg/inh, CFC                 Grifulvin V (griseofulvin)
  Epivir (lamivudine)                                           adapter                       free 110 mcg/inh, CFC free               oral, suspension         microcrystalline 125 mg/5
   oral, tablet                150 mg                                                         220 mcg/inh                                                       mL
  Estrace (estradiol)                                             Floxin Otic (ofloxacin otic)                                       Gris-PEG (griseofulvin)

For formulary questions please contact 96 MDOS/SGSD at 96MDG.Pharmacy@eglin.af.mil or call (850) 883-9006.Generated by Amplifi a service of Pharmacy OneSource, Inc.
96th Medical Group-Eglin Air Force Base Hospital: Outpatient   Eglin Outpatient - Formulary (Generic List), Last Updated: 10/11/2010 8:38:49 AM   Page 5 of 10
    oral, tablet            ultramicrocrystalline 250 mg          Isopto Atropine (atropine ophthalmic)                              Lamisil (terbinafine)
  Gynol II Jelly with Applicator (nonoxynol 9 topical)             ophthalmic, solution     1% {15ml}                                 oral, tablet               250 mg
    vaginal, gel            2%                                    Isopto Homatropine (homatropine ophthalmic)                        Lanoxin (digoxin)
  Haldol (haloperidol)                                             ophthalmic, solution     5%                                        oral, elixir               50 mcg/mL (0.05 mg/mL)
    oral, tablet            1 mg, 2 mg, 5 mg                      Janumet (metformin-sitagliptin)                                     oral, tablet               125 mcg (0.125 mg), 250
  Hemorrhoidal HC (hydrocortisone topical)                         oral, tablet             500 mg-50 mg, 1000 mg-50                                             mcg (0.25 mg)
    rectal, cream with      2.5%                                                            mg                                       Lantus (insulin glargine)
applicator                                                        Januvia (sitagliptin)                                               subcutaneous, solution 100 units/mL
    rectal, suppository     25 mg                                  oral, tablet             25 mg, 50 mg, 100 mg                     Lantus Solostar Pen (insulin glargine)
  Hydrea (hydroxyurea)                                            Keflex (cephalexin)                                                 subcutaneous, solution 100 units/mL
    oral, capsule           500 mg                                 oral, capsule            250 mg, 500 mg                           Lariam (mefloquine)
  HydroDIURIL (hydrochlorothiazide)                                oral, powder for         250 mg/5 mL                               oral, tablet                250 mg
    oral, tablet            25 mg, 50 mg                        reconstitution                                                       Lasix (furosemide)
  Hygroton (chlorthalidone)                                       Kenalog (triamcinolone topical)                                     oral, liquid                10 mg/mL
    oral, tablet            50 mg                                  topical, ointment        0.1%                                      oral, tablet                20 mg, 40 mg
  Hytone (hydrocortisone topical)                                  topical, cream           0.1%                                     Lessina (ethinyl estradiol-levonorgestrel)
    topical, cream          1%                                     topical, spray           0.147 mg/g                                oral, tablet                20 mcg-100 mcg
  Hytrin (terazosin)                                              Kenalog in Orabase (triamcinolone topical)                         Leukeran (chlorambucil)
    oral, capsule           1 mg, 2 mg, 5 mg, 10 mg                mucous membrane,         0.1%                                      oral, tablet                2 mg
  Hyzaar (hydrochlorothiazide-losartan)                         paste                                                                Levaquin (levofloxacin)
    oral, tablet            12.5 mg-100 mg, 12.5                  Keppra (levetiracetam)                                              oral, solution              25 mg/mL
                            mg-50 mg, 25 mg-100 mg                 oral, solution           100 mg/mL                                 oral, tablet                250 mg, 500 mg, 750 mg
  Ilotycin (erythromycin ophthalmic)                               oral, tablet             250 mg, 500 mg, 750 mg                   Levemir (insulin detemir)
    ophthalmic, ointment    0.5%                                  Keppra XR (levetiracetam)                                           subcutaneous, solution 100 units/mL
  Imdur (isosorbide mononitrate)                                   oral, tablet, extended   500 mg                                   Levitra (vardenafil)
    oral, tablet, extended  60 mg                               release                                                               oral, tablet                5 mg, 10 mg, 20 mg
release                                                           Klaron (sulfacetamide sodium topical)                              Levlen (ethinyl estradiol-levonorgestrel)
  Imitrex (sumatriptan)                                            topical, lotion          10%                                       oral, tablet                30 mcg-0.15 mg
    oral, tablet            50 mg, 100 mg                         Klonopin (clonazepam)                                              Levlite (ethinyl estradiol-levonorgestrel)
    subcutaneous, solution 6 mg/0.5 mL                             oral, tablet             0.5 mg, 1 mg, 2 mg                        oral, tablet                20 mcg-100 mcg
    subcutaneous, kit       6 mg/0.5 mL                           Klor-Con (potassium chloride)                                      Levsin (hyoscyamine)
  Imitrex Nasal (sumatriptan)                                      oral, powder for         20 mEq                                    oral, tablet                0.125 mg
    nasal, spray            5 mg, 20 mg/inh                     reconstitution                                                       Lialda (mesalamine)
  Imitrex Statdose (sumatriptan)                                  Klor-Con 10 (potassium chloride)                                    oral, enteric coated tablet 1.2 g
    subcutaneous, kit       6 mg/0.5 mL                            oral, tablet, extended   10 mEq                                   Lidex (fluocinonide topical)
  Imitrex Statdose Refill (sumatriptan)                         release                                                               topical, ointment           0.05%
    subcutaneous, kit       6 mg/0.5 mL                           Klor-Con 8 (potassium chloride)                                     topical, cream              0.05%
  Imodium (loperamide)                                             oral, tablet, extended   8 mEq                                     topical, gel                0.05%
    oral, capsule           2 mg                                release                                                              Lidex-E (fluocinonide topical)
  Imuran (azathioprine)                                           Klor-Con M20 (potassium chloride)                                   topical, cream              0.05%
    oral, tablet            50 mg                                  oral, tablet, extended   20 mEq                                   Lidocaine Viscous (lidocaine topical)
  Inderal LA (propranolol)                                      release                                                               mucous membrane,            2%
    oral, capsule, extended 60 mg, 80 mg                          Lac-Hydrin (ammonium lactate topical)                            solution
release                                                            topical, cream           12%                                      Lioresal (baclofen)
  Indocin (indomethacin)                                           topical, lotion          12%                                       oral, tablet                10 mg
    oral, capsule           25 mg                                 Lamictal (lamotrigine)                                             Lipitor (atorvastatin)
  Iopidine (apraclonidine ophthalmic)                              oral, tablet             25 mg, 100 mg, 150 mg,                    oral, tablet                10 mg, 20 mg, 40 mg, 80
    ophthalmic, solution    0.5%                                                            200 mg                                                                mg

For formulary questions please contact 96 MDOS/SGSD at 96MDG.Pharmacy@eglin.af.mil or call (850) 883-9006.Generated by Amplifi a service of Pharmacy OneSource, Inc.
96th Medical Group-Eglin Air Force Base Hospital: Outpatient   Eglin Outpatient - Formulary (Generic List), Last Updated: 10/11/2010 8:38:49 AM   Page 6 of 10
  Lithonate (lithium)                                             Medrol Dosepak (methylPREDNISolone)                                 oral, tablet              7.5 mg, 15 mg
   oral, capsule                300 mg                             oral, tablet            4 mg                                      Monistat 7 (miconazole topical)
  Lo/Ovral-28 (ethinyl estradiol-norgestrel)                      Megace (megestrol)                                                  vaginal, cream with       2%
   oral, tablet                 30 mcg-0.3 mg                      oral, suspension        40 mg/mL                                applicator
  Loestrin 21 1/20 (ethinyl estradiol-norethindrone)               oral, tablet            40 mg                                     Monistat Derm (miconazole topical)
   oral, tablet                 20 mcg-1 mg                       Mellaril (thioridazine)                                             topical, cream            2%
  Lomotil (atropine-diphenoxylate)                                 oral, tablet            10 mg, 25 mg, 100 mg                      Monopril (fosinopril)
   oral, tablet                 0.025 mg-2.5 mg                   Mephyton (phytonadione)                                             oral, tablet              10 mg, 20 mg, 40 mg
  Lopid (gemfibrozil)                                              oral, tablet            5 mg                                      Morphine IR (morphine)
   oral, tablet                 600 mg                            Mestinon (pyridostigmine)                                           oral, tablet              15 mg, 30 mg
  Lopressor (metoprolol)                                           oral, tablet            60 mg                                     Motrin (ibuprofen)
   oral, tablet                 50 mg, 100 mg                     Metadate CD (methylphenidate)                                       oral, tablet              400 mg, 600 mg, 800 mg
  Lopurin (allopurinol)                                            oral, capsule, extended 20 mg/24 hr                               MS Contin (morphine)
   oral, tablet                 100 mg, 300 mg                  release                                                               oral, tablet, extended    15 mg, 30 mg, 60 mg, 100
  Lortab 5/500 (acetaminophen-hydrocodone)                        Methergine (methylergonovine)                                    release                      mg
   oral, tablet                 500 mg-5 mg                        oral, tablet            0.2 mg                                    Mucinex (guaifenesin)
  Lortab 7.5/500 (acetaminophen-hydrocodone)                      Metoprolol Tartrate (metoprolol)                                    oral, tablet, extended    600 mg
   oral, tablet                 500 mg-7.5 mg                      oral, tablet            50 mg, 100 mg                           release
  Lortab Elixir (acetaminophen-hydrocodone)                       MetroCream (metronidazole topical)                                 Mucomyst-20 (acetylcysteine)
   oral, elixir                 500 mg-7.5 mg/15 mL                topical, cream          0.75%                                      inhalation, solution      20%
  Lotemax (loteprednol ophthalmic)                                MetroGel (metronidazole topical)                                   Multaq (dronedarone)
   ophthalmic, suspension 0.5%                                     topical, gel            1%                                         oral, tablet              400 mg
  Lotrel (amlodipine-benazepril)                                  MetroGel-Vaginal (metronidazole topical)                           Muro 128 (sodium chloride, hypertonic, ophthalmic)
   oral, capsule                2.5 mg-10 mg, 5 mg-10 mg,          vaginal, gel with       0.75%                                      ophthalmic, ointment      5%
                                5 mg-20 mg, 10 mg-20 mg         applicator                                                            ophthalmic, solution      5%
  Lovenox (enoxaparin)                                            Micardis (telmisartan)                                             Myambutol (ethambutol)
   subcutaneous, solution 30 mg/0.3 mL, 40 mg/0.4                  oral, tablet            20 mg, 40 mg, 80 mg                        oral, tablet              400 mg
                                mL, 60 mg/0.6 mL, 80              Micardis HCT (hydrochlorothiazide-telmisartan)                     Mycelex (clotrimazole topical)
                                mg/0.8 mL, 100 mg/mL, 120          oral, tablet            12.5 mg-40 mg, 12.5 mg-80                  topical, cream            1%
                                mg/0.8 mL                                                  mg, 25 mg-80 mg                            topical, solution         1%
  Lumigan (bimatoprost ophthalmic)                                Miconazole 7 (miconazole topical)                                  Mycolog-II (nystatin-triamcinolone topical)
   ophthalmic, solution         0.03%                              vaginal, cream with     2%                                         topical, ointment         100000 units/g-0.1%
  Lunesta (eszopiclone)                                         applicator                                                            topical, cream            100000 units/g-0.1%
   oral, tablet                 1 mg, 2 mg, 3 mg                  Micronase (glyBURIDE)                                              Mycostatin (nystatin)
  Luxiq (betamethasone topical)                                    oral, tablet            5 mg                                       oral, suspension          100000 units/mL
   topical, foam                0.12%                             Midrin (APAP/dichloralphenazone/isometheptene)                      oral, tablet              500000 units
  Macrodantin (nitrofurantoin)                                     oral, capsule           325 mg-100 mg-65 mg                       Mycostatin Topical (nystatin topical)
   oral, capsule                macrocrystals 25 mg,              Minipress (prazosin)                                                topical, cream            100000 units/g
                                macrocrystals 50 mg,               oral, capsule           1 mg, 2 mg, 5 mg                           topical, powder           100000 units/g
                                macrocrystals 100 mg              Minocin (minocycline)                                              Mydriacyl (tropicamide ophthalmic)
  Malarone (atovaquone-proguanil)                                  oral, capsule           50 mg                                      ophthalmic, solution      0.5%, 1%
   oral, tablet                 250 mg-100 mg                     MiraLax (polyethylene glycol 3350)                                 Myleran (busulfan)
  Maxalt (rizatriptan)                                             oral, powder for        -                                          oral, tablet              2 mg
   oral, tablet                 5 mg, 10 mg                     reconstitution                                                       Mylicon (simethicone)
  Maxalt-MLT (rizatriptan)                                        Mirapex (pramipexole)                                               oral, liquid              40 mg/0.6 mL
   oral, tablet, disintegrating 5 mg, 10 mg                        oral, tablet            0.125 mg, 0.25 mg, 0.5 mg,                Mysoline (primidone)
  Maxzide (hydrochlorothiazide-triamterene)                                                1 mg, 1.5 mg                               oral, tablet              50 mg, 250 mg
   oral, tablet                 50 mg-75 mg                       Mobic (meloxicam)                                                  Naftin (naftifine topical)

For formulary questions please contact 96 MDOS/SGSD at 96MDG.Pharmacy@eglin.af.mil or call (850) 883-9006.Generated by Amplifi a service of Pharmacy OneSource, Inc.
96th Medical Group-Eglin Air Force Base Hospital: Outpatient   Eglin Outpatient - Formulary (Generic List), Last Updated: 10/11/2010 8:38:49 AM   Page 7 of 10
   topical, cream             1%                                  Nolvadex (tamoxifen)                                                Ortho Tri-Cyclen Lo (ethinyl estradiol-norgestimate)
   topical, gel               1%                                   oral, tablet              10 mg                                     oral, tablet              triphasic 25 mcg
  Namenda (memantine)                                             Nordette (ethinyl estradiol-levonorgestrel)                         Ortho-Cyclen (ethinyl estradiol-norgestimate)
   oral, tablet               5 mg, 10 mg                          oral, tablet              30 mcg-0.15 mg                            oral, tablet              35 mcg-0.25 mg
  Naprosyn (naproxen)                                             Norgesic (ASA/caffeine/orphenadrine)                                Os-Cal 500 with D (calcium-vitamin D)
   oral, tablet               500 mg                               oral, tablet              385 mg-30 mg-25 mg                        oral, tablet              500 mg-200 intl units
  Nasalcrom (cromolyn nasal)                                      Normodyne (labetalol)                                               OxyContin (oxycodone)
   nasal, spray               5.2 mg/inh                           oral, tablet              100 mg                                    oral, tablet, extended    10 mg, 20 mg
  Nasalide (flunisolide nasal)                                    Norpramin (desipramine)                                          release
   nasal, spray               25 mcg/inh                           oral, tablet              25 mg, 50 mg                             OxyIR (oxycodone)
  Nasonex (mometasone nasal)                                      Nor-QD (norethindrone)                                               oral, capsule             5 mg
   nasal, spray               50 mcg/inh                           oral, tablet              0.35 mg                                  Pacerone (amiodarone)
  Navane (thiothixene)                                            Norvasc (amlodipine)                                                 oral, tablet              200 mg
   oral, capsule              2 mg, 5 mg                           oral, tablet              2.5 mg, 5 mg, 10 mg                      Pamelor (nortriptyline)
  Neosporin Ophthalmic                                            Novahistine Expectorant (codeine/guaifenesin/PSE)                    oral, capsule             25 mg
(gramicidin/neomycin/polymyxin B ophthalmic)                       oral, liquid              10 mg-100 mg-30 mg/5 mL                  Panoxyl 10 (benzoyl peroxide topical)
   ophthalmic, solution       0.025 mg-1.75 mg-10000              Novolin 70/30 (insulin isophane-insulin regular)                     topical, gel              10%
                              units/mL                             subcutaneous,             human recombinant 70                     Panoxyl 5 (benzoyl peroxide topical)
  Neosporin Ophthalmic Ointment                                 suspension                   units-30 units/mL                         topical, gel              5%
(bacitracin/neomycin/polymyxin B ophthalmic)                      Novolin N (insulin isophane)                                        Parlodel (bromocriptine)
   ophthalmic, ointment       400 units-3.5 mg-10000               subcutaneous,             human recombinant 100                     oral, tablet              2.5 mg
                              units/g                           suspension                   units/mL                                 Patanol (olopatadine ophthalmic)
  Neo-Synephrine Ophthalmic (phenylephrine                        Novolin R (insulin regular)                                          ophthalmic, solution      0.1%
ophthalmic)                                                        injectable, solution      human recombinant 100                    Paxil (paroxetine)
   ophthalmic, solution       2.5%                                                           units/mL                                  oral, tablet              20 mg, 40 mg
  Neptazane (methazolamide)                                       NovoLog (insulin aspart)                                            Pediaflor Drops (fluoride)
   oral, tablet               25 mg, 50 mg                         subcutaneous, solution 100 units/mL                                 oral, solution            0.5 mg/mL
  Neurontin (gabapentin)                                          NovoLog FlexPen (insulin aspart)                                    Pediazole (erythromycin-sulfiSOXAZOLE)
   oral, capsule              100 mg, 300 mg, 400 mg               subcutaneous, solution 100 units/mL                                 oral, granule for         200 mg-600 mg/5 mL
   oral, tablet               600 mg, 800 mg                      NuvaRing (ethinyl estradiol-etonogestrel)                        reconstitution
  Nexium (esomeprazole)                                            vaginal, ring             0.015 mg-0.120 mg                        Pen-Vee K (penicillin)
   oral, powder for           20 mg, 40 mg                        Ocufen (flurbiprofen ophthalmic)                                     oral, powder for          V potassium 250 mg/5 mL
reconstitution, delayed                                            ophthalmic, solution      0.03%                                 reconstitution
release                                                           Ocuflox (ofloxacin ophthalmic)                                       oral, tablet              V potassium 250 mg, V
   oral, delayed release      20 mg, 40 mg                         ophthalmic, solution      0.3%                                                                potassium 500 mg
capsule                                                           Olux (clobetasol topical)                                           Pepto-Bismol (bismuth subsalicylate)
  Niaspan ER (niacin)                                              topical, foam             0.05%                                     oral, tablet, chewable    262 mg
   oral, tablet, extended     500 mg, 1000 mg                     Omnicef (cefdinir)                                                  Percocet 5/325 (acetaminophen-oxycodone)
release                                                            oral, capsule             300 mg                                    oral, tablet              325 mg-5 mg
  Nitrolingual (nitroglycerin)                                     oral, powder for          125 mg/5 mL                              Periactin (cyproheptadine)
   sublingual, spray          0.4 mg                            reconstitution                                                         oral, tablet              4 mg
  Nitrostat (nitroglycerin)                                       Opticrom (cromolyn ophthalmic)                                      Peridex (chlorhexidine topical)
   sublingual, tablet         0.3 mg, 0.4 mg, 0.6 mg               ophthalmic, solution      4%                                        mucous membrane,          0.12%
  Nizoral (ketoconazole)                                          Oretic (hydrochlorothiazide)                                     liquid
   oral, tablet               200 mg                               oral, tablet              25 mg, 50 mg                             Periostat (doxycycline)
  Nizoral Topical (ketoconazole topical)                          Ortho Evra (ethinyl estradiol-norelgestromin)                        oral, capsule             20 mg
   topical, cream             2%                                   transdermal, film,        20 mcg-150 mcg/24 hr                     Persantine (dipyridamole)
   topical, shampoo           2%                                extended release                                                       oral, tablet              25 mg, 50 mg

For formulary questions please contact 96 MDOS/SGSD at 96MDG.Pharmacy@eglin.af.mil or call (850) 883-9006.Generated by Amplifi a service of Pharmacy OneSource, Inc.
96th Medical Group-Eglin Air Force Base Hospital: Outpatient   Eglin Outpatient - Formulary (Generic List), Last Updated: 10/11/2010 8:38:49 AM   Page 8 of 10
  Phenergan (promethazine)                                      capsule                                                               topical, gel               0.04%, 0.1%
   oral, syrup                6.25 mg/5 mL                        Prinivil (lisinopril)                                              Retin-A (tretinoin topical)
   oral, tablet               25 mg                                oral, tablet             5 mg, 10 mg, 20 mg, 40 mg                 topical, cream             0.025%, 0.05%, 0.1%
   rectal, suppository        12.5 mg, 25 mg                      Procardia (NIFEdipine)                                              topical, gel               0.025%
  Phisohex (hexachlorophene topical)                               oral, capsule            10 mg                                    Rimactane (rifampin)
   topical, liquid            3%                                  Procardia XL (NIFEdipine)                                           oral, capsule              300 mg
  Plaquenil Sulfate (hydroxychloroquine)                           oral, tablet, extended   30 mg, 60 mg, 90 mg                      Risperdal (risperidone)
   oral, tablet               200 mg                            release                                                               oral, tablet               0.5 mg, 1 mg, 2 mg
  Plavix (clopidogrel)                                            Proctofoam HC (hydrocortisone-pramoxine topical)                   Ritalin-SR (methylphenidate)
   oral, tablet               75 mg                                rectal, foam             1%-1%                                     oral, tablet, extended     20 mg
  Plendil (felodipine)                                            Proctozone HC (hydrocortisone topical)                           release
   oral, tablet, extended     2.5 mg, 5 mg, 10 mg                  rectal, cream with       2.5%                                     Robaxin (methocarbamol)
release                                                         applicator                                                            oral, tablet               500 mg
  Polytrim (polymyxin B-trimethoprim ophthalmic)                  Prolixin (fluphenazine)                                            Robinul (glycopyrrolate)
   ophthalmic, solution       10000 units-1 mg/mL                  oral, tablet             1 mg, 5 mg                                oral, tablet               1 mg
  Poly-Vi-Flor (multivitamin with fluoride)                       Proscar (finasteride)                                              Robitussin (guaifenesin)
   oral, liquid               Multiple Vitamins with               oral, tablet             5 mg                                      oral, liquid               100 mg/5 mL
                              Fluoride 0.25 mg/mL                 Protopic (tacrolimus topical)                                      Robitussin DM (dextromethorphan-guaifenesin)
  Poly-Vi-Sol Drops (multivitamin)                                 topical, ointment        0.1%                                      oral, liquid               10 mg-100 mg/5 mL
   oral, liquid               Pediatric Multiple Vitamins         Proventil HFA (albuterol)                                          Robitussin-AC (codeine-guaifenesin)
  Poly-Vi-Sol with Iron Drops (multivitamin with iron)             inhalation, aerosol with CFC free 90 mcg/inh                       oral, syrup                10 mg-100 mg/5 mL
   oral, liquid               Pediatric Multiple Vitamins       adapter                                                              Rocaltrol (calcitriol)
                              with Iron                           Provera (medroxyPROGESTERone)                                       oral, capsule              0.25 mcg
  Pravachol (pravastatin)                                          oral, tablet             2.5 mg, 10 mg                            Rondec Drops (chlorpheniramine-phenylephrine)
   oral, tablet               20 mg, 40 mg, 80 mg                 Prozac (fluoxetine)                                                 oral, liquid               1 mg-3.5 mg/mL
  Pred Forte (prednisoLONE ophthalmic)                             oral, capsule            20 mg                                    Santyl (collagenase topical)
   ophthalmic, suspension acetate 1%                               oral, tablet             10 mg                                     topical, ointment          250 units/g
  Pred Mild (prednisoLONE ophthalmic)                             Pulmicort Respules (budesonide)                                    Septra (sulfamethoxazole-trimethoprim)
   ophthalmic, suspension acetate 0.12%                            inhalation, suspension 0.25 mg/2 mL, 0.5 mg/2 mL                   oral, suspension           200 mg-40 mg/5 mL
  Premarin (conjugated estrogens)                                 Purinethol (mercaptopurine)                                         oral, tablet               400 mg-80 mg
   oral, tablet               0.3 mg, 0.45 mg, 0.625 mg,           oral, tablet             50 mg                                    Septra DS (sulfamethoxazole-trimethoprim)
                              0.9 mg, 1.25 mg                     Pyridium (phenazopyridine)                                          oral, tablet               800 mg-160 mg
  Premarin Vaginal (conjugated estrogens topical)                  oral, tablet             100 mg                                   Serevent Diskus (salmeterol)
   vaginal, cream with        0.625 mg/g                          Reglan (metoclopramide)                                             inhalation, powder         50 mcg
applicator                                                         oral, syrup              5 mg/5 mL                                Seroquel (quetiapine)
  Prempro (conjugated                                              oral, tablet             10 mg                                     oral, tablet               25 mg, 100 mg, 200 mg
estrogens-medroxyPROGESTERone)                                    Relenza (zanamivir)                                                Seroquel XR (quetiapine)
   oral, tablet               0.3 mg-1.5 mg, 0.625                 inhalation, powder       5 mg                                      oral, tablet, extended     200 mg, 300 mg, 400 mg
                              mg-2.5 mg, 0.625 mg-5 mg            Remeron (mirtazapine)                                            release
  Prenatal Multivitamins (multivitamin, prenatal)                  oral, tablet             15 mg, 30 mg                             Silvadene (silver sulfADIAZINE topical)
   oral, tablet               Prenatal Multivitamins with         Requip (ropinirole)                                                 topical, cream             1%
                              Folic Acid 1 mg                      oral, tablet             0.25 mg, 0.5 mg, 1 mg, 2                 Sinemet (carbidopa-levodopa)
  Prevident (fluoride topical)                                                              mg, 4 mg, 5 mg                            oral, tablet               25 mg-100 mg, 25 mg-250
   topical, gel               1.1%                                Restasis (cycloSPORINE ophthalmic)                                                             mg
  Prevident 5000 Plus (fluoride topical)                           ophthalmic, emulsion     0.05%                                    Sinemet CR (carbidopa-levodopa)
   topical, paste             1.1%                                Restoril (temazepam)                                                oral, tablet, extended     25 mg-100 mg, 50 mg-200
  Prilosec (omeprazole)                                            oral, capsule            15 mg, 30 mg                           release                       mg
   oral, delayed release      20 mg                               Retin A Micro Gel (tretinoin topical)                              Sinequan (doxepin)

For formulary questions please contact 96 MDOS/SGSD at 96MDG.Pharmacy@eglin.af.mil or call (850) 883-9006.Generated by Amplifi a service of Pharmacy OneSource, Inc.
96th Medical Group-Eglin Air Force Base Hospital: Outpatient   Eglin Outpatient - Formulary (Generic List), Last Updated: 10/11/2010 8:38:49 AM   Page 9 of 10
   oral, capsule               10 mg, 25 mg, 50 mg, 100            oral, powder for         12 mg/mL                                  oral, tablet, extended    25 mg, 50 mg, 100 mg, 200
                               mg                               reconstitution                                                     release                      mg
  Singulair (montelukast)                                         Tapazole (methimazole)                                             Transderm-Nitro (nitroglycerin)
   oral, tablet               10 mg                                oral, tablet             5 mg, 10 mg                               transdermal, film,        0.2 mg/hr, 0.4 mg/hr, 0.6
   oral, tablet, chewable     4 mg, 5 mg                          Tegretol (carbamazepine)                                         extended release             mg/hr
  SMZ-TMP DS (sulfamethoxazole-trimethoprim)                       oral, suspension         100 mg/5 mL                              Trental (pentoxifylline)
   oral, tablet               800 mg-160 mg                        oral, tablet             200 mg                                    oral, tablet, extended    400 mg
  Sodium Chloride, Inhalation (sodium chloride)                    oral, tablet, chewable   100 mg                                 release
   inhalation, solution       0.9%                                Tekturna (aliskiren)                                               Tridesilon (desonide topical)
  Sodium Sulamyd (sulfacetamide sodium ophthalmic)                 oral, tablet             150 mg, 300 mg                            topical, ointment         0.05%
   ophthalmic, solution       10%                                 Temovate (clobetasol topical)                                       topical, cream            0.05%
  Solaquin Forte (hydroquinone topical)                            topical, ointment        0.05%                                    Trileptal (oxcarbazepine)
   topical, gel               4%                                   topical, cream           0.05%                                     oral, tablet              150 mg, 300 mg, 600 mg
  Solaraze (diclofenac topical)                                    topical, solution        0.05%                                    Tri-Levlen (ethinyl estradiol-levonorgestrel)
   topical, gel               3%                                  Tenormin (atenolol)                                                 oral, tablet              triphasic
  Soriatane (acitretin)                                            oral, tablet             25 mg, 50 mg                             Trimpex (trimethoprim)
   oral, capsule              10 mg, 25 mg                        Terazol 7 (terconazole topical)                                     oral, tablet              100 mg
  Spiriva (tiotropium)                                             vaginal, cream           0.4%                                     TriNessa (ethinyl estradiol-norgestimate)
   inhalation, capsule        18 mcg                              Tessalon Perles (benzonatate)                                       oral, tablet              triphasic 35 mcg
  Stelazine (trifluoperazine)                                      oral, capsule            100 mg                                   Triphasil-28 (ethinyl estradiol-levonorgestrel)
   oral, tablet               2 mg                                Theo-Dur (theophylline)                                             oral, tablet              triphasic
  Strattera (atomoxetine)                                          oral, tablet, extended   200 mg, 300 mg                           Trivora-28 (ethinyl estradiol-levonorgestrel)
   oral, capsule              10 mg, 18 mg, 25 mg, 40           release                                                               oral, tablet              triphasic
                              mg, 60 mg                           Thorazine (chlorproMAZINE)                                         Trusopt (dorzolamide ophthalmic)
  Sudafed (pseudoephedrine)                                        oral, tablet             25 mg, 50 mg                              ophthalmic, solution      2%
   oral, tablet               30 mg                               Tiazac (diltiazem)                                                 T-Stat (erythromycin topical)
  Sulfatrim Suspension                                             oral, capsule, extended 120 mg/24 hours, 180                       topical, solution         2%
(sulfamethoxazole-trimethoprim)                                 release                     mg/24 hours, 240 mg/24                   Tylenol (acetaminophen)
   oral, suspension           200 mg-40 mg/5 mL                                             hours, 300 mg/24 hours,                   oral, tablet              325 mg, 500 mg
  Symbicort (budesonide-formoterol)                                                         360 mg/24 hours                          Tylenol Extra Strength (acetaminophen)
   inhalation, aerosol with 80 mcg-4.5 mcg/inh, 160               Tigan (trimethobenzamide)                                           oral, tablet              500 mg
adapter                       mcg-4.5 mcg/inh                      oral, capsule            300 mg                                   Tylenol Infant's Drops (acetaminophen)
  Symmetrel (amantadine)                                          Timoptic-XE (timolol ophthalmic)                                    oral, suspension          80 mg/0.8 mL
   oral, capsule              100 mg                               ophthalmic, gel forming 0.5%                                      Tylenol Regular Strength (acetaminophen)
  Synalar (fluocinolone topical)                                solution                                                              oral, tablet              325 mg
   topical, solution          0.01%                               Tobradex (dexamethasone-tobramycin ophthalmic)                     Tylenol with Codeine (acetaminophen-codeine)
  Synthroid (levothyroxine)                                        ophthalmic, suspension 0.1%-0.3%                                   oral, liquid              120 mg-12 mg/5 mL
   oral, tablet               100 mcg (0.1 mg), 112 mcg            ophthalmic, ointment     0.1%-0.3%                                Tylenol with Codeine #3 (acetaminophen-codeine)
                              (0.112 mg), 125 mcg (0.125          Tobrex (tobramycin ophthalmic)                                      oral, tablet              300 mg-30 mg
                              mg), 137 mcg (0.137 mg),             ophthalmic, ointment     0.3%                                     Ultram (traMADOL)
                              150 mcg (0.15 mg), 175               ophthalmic, solution     0.3%                                      oral, tablet              50 mg
                              mcg (0.175 mg), 25 mcg              Tofranil (imipramine)                                              Urecholine (bethanechol)
                              (0.025 mg), 50 mcg (0.05             oral, tablet             25 mg, 50 mg                              oral, tablet              25 mg
                              mg), 88 mcg (0.088 mg)              Topamax (topiramate)                                               Urispas (flavoxate)
  Tambocor (flecainide)                                            oral, tablet             25 mg, 100 mg, 200 mg                     oral, tablet              100 mg
   oral, tablet               100 mg                              Topicort (desoximetasone topical)                                  Urocit-K (potassium citrate)
  Tamiflu (oseltamivir)                                            topical, cream           0.25%                                     oral, tablet, extended    5 mEq
   oral, capsule              30 mg, 45 mg, 75 mg                 Toprol-XL (metoprolol)                                           release

For formulary questions please contact 96 MDOS/SGSD at 96MDG.Pharmacy@eglin.af.mil or call (850) 883-9006.Generated by Amplifi a service of Pharmacy OneSource, Inc.
96th Medical Group-Eglin Air Force Base Hospital: Outpatient   Eglin Outpatient - Formulary (Generic List), Last Updated: 10/11/2010 8:38:49 AM   Page 10 of 10
  Uroxatral (alfuzosin)                                           Wellbutrin (buPROPion)                                              oral, powder for          1 g, 100 mg/5 mL, 200 mg/5
   oral, tablet, extended      10 mg                               oral, tablet              75 mg, 100 mg                         reconstitution               mL
release                                                           Wellbutrin SR (buPROPion)                                           oral, tablet              250 mg, 500 mg
  Vagifem (estradiol topical)                                      oral, tablet, extended    100 mg/12 hours, 150                    Zithromax TRI-PAK (azithromycin)
   vaginal, tablet             10 mcg                           release                      mg/12 hours                              oral, tablet              500 mg
  Valium (diazepam)                                               Westcort (hydrocortisone topical)                                  Zithromax Z-Pak (azithromycin)
   oral, tablet                5 mg                                topical, ointment         valerate 0.2%                            oral, tablet              250 mg
  Valtrex (valacyclovir)                                           topical, cream            valerate 0.2%                           Zocor (simvastatin)
   oral, tablet                1g                                 Xalatan (latanoprost ophthalmic)                                    oral, tablet              5 mg, 10 mg, 20 mg, 40 mg,
  Ventolin HFA (albuterol)                                         ophthalmic, solution      0.005%                                                             80 mg
   inhalation, aerosol with CFC free 90 mcg/inh                   Xanax (alprazolam)                                                 Zofran (ondansetron)
adapter                                                            oral, tablet              0.5 mg                                   oral, tablet              4 mg, 8 mg
  Ventolin Nebules (albuterol)                                    Xifaxan (rifaximin)                                                Zoloft (sertraline)
   inhalation, solution        2.5 mg/3 mL (0.083%)                oral, tablet              200 mg                                   oral, tablet              50 mg, 100 mg
  VePesid (etoposide)                                             Xopenex HFA (levalbuterol)                                         Zomig (zolmitriptan)
   oral, capsule               50 mg                               inhalation, aerosol with CFC free 45 mcg/inh                       oral, tablet              2.5 mg, 5 mg
  Vermox (mebendazole)                                          adapter                                                              Zonegran (zonisamide)
   oral, tablet, chewable      100 mg                             Xylocaine Jelly (lidocaine topical)                                 oral, capsule             25 mg, 100 mg
  VFEND (voriconazole)                                             topical, gel with         2%                                      Zovia 1/35 (ethinyl estradiol-ethynodiol)
   oral, tablet                50 mg                            applicator                                                            oral, tablet              35 mcg-1 mg
  Vibra-Tabs (doxycycline)                                        Xylocaine Topical (lidocaine topical)                              Zovirax (acyclovir)
   oral, tablet                hyclate 100 mg                      topical, ointment         5%                                       oral, capsule             200 mg
  Vicodin (acetaminophen-hydrocodone)                             Xylocaine Viscous (lidocaine topical)                               oral, tablet              800 mg
   oral, tablet                500 mg-5 mg                         mucous membrane,          2%                                      Zyloprim (allopurinol)
  Vigamox (moxifloxacin ophthalmic)                             solution                                                              oral, tablet              100 mg, 300 mg
   ophthalmic, solution        0.5%                               Yasmin (drospirenone-ethinyl estradiol)                            Zyprexa (olanzapine)
  Viroptic (trifluridine ophthalmic)                               oral, tablet              3 mg-0.03 mg                             oral, tablet              5 mg, 10 mg, 15 mg
   ophthalmic, solution        1%                                 Yaz (drospirenone-ethinyl estradiol)                               Zyrtec (cetirizine)
  Vitamin B1 (thiamine)                                            oral, tablet              3 mg-0.02 mg                             oral, syrup               1 mg/mL
   oral, tablet                50 mg                              Zaditor (ketotifen ophthalmic)                                      oral, tablet              10 mg
  Vitamin B12 (cyanocobalamin)                                     ophthalmic, solution      0.025%                                  Zyrtec-D (cetirizine-pseudoephedrine)
   injectable, solution        1000 mcg/mL                        Zantac (ranitidine)                                                 oral, tablet, extended    5 mg-120 mg
   oral, tablet                1000 mcg                            oral, syrup               15 mg/mL                              release
  Vitamin B6 (pyridoxine)                                         Zantac 150 (ranitidine)
   oral, tablet                50 mg                               oral, tablet              150 mg
  Vitamin D2 (ergocalciferol)                                     Zarontin (ethosuximide)
   oral, solution              8000 intl units/mL                  oral, syrup               250 mg/5 mL
  Vivactil (protriptyline)                                         oral, capsule             250 mg
   oral, tablet                10 mg                              Zaroxolyn (metolazone)
  Voltaren Ophthalmic (diclofenac ophthalmic)                      oral, tablet              5 mg
   ophthalmic, solution        0.1%                               Zestoretic (hydrochlorothiazide-lisinopril)
  Voltaren Topical (diclofenac topical)                            oral, tablet              12.5 mg-10 mg, 12.5 mg-20
   topical, gel                1%                                                            mg, 25 mg-20 mg
  Vosol HC (acetic acid-hydrocortisone otic)                      Zestril (lisinopril)
   otic, solution              2%-1%                               oral, tablet              5 mg, 10 mg, 20 mg, 40 mg
  Vytorin (ezetimibe-simvastatin)                                 Zetia (ezetimibe)
   oral, tablet                10 mg-10 mg, 10 mg-20 mg,           oral, tablet              10 mg
                               10 mg-40 mg, 10 mg-80 mg           Zithromax (azithromycin)

For formulary questions please contact 96 MDOS/SGSD at 96MDG.Pharmacy@eglin.af.mil or call (850) 883-9006.Generated by Amplifi a service of Pharmacy OneSource, Inc.

				
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