2009 Table of Drugs

IA - Intra-arterial administration 

IV - Intravenous administration 

IM - Intramuscular administration 

IT - Intrathecal 

SC - Subcutaneous administration 

INH - Administration by inhaled solution 

VAR - Various routes of administration 

OTH - Other routes of administration 

ORAL - Administered orally 

Intravenous administration includes all methods, such as gravity infusion, injections, and timed 

pushes. The ‘VAR’ posting denotes various routes of administration and is used for drugs that are 

commonly administered into joints, cavities, tissues, or topical applications, in addition to other 

parenteral administrations. Listings posted with ‘OTH’ indicate other administration methods, such 

as suppositories or catheter injections. 

A

Abarelix 10 mg J0128 

Abatacept 10 mg J0129 

Abbokinase, see Urokinase 

Abbokinase, Open Cath, see Urokinase 

Abciximab 10 mg IV J0130 

Abelcet, see Amphotericin B Lipid Complex 

ABLC, see Amphotericin B 

Acetazolamide sodium up to 500 mg IM, IV J1120 

Acetylcysteine, injection 100 mg J0132 

Acetylcysteine, unit dose form per gram INH J7604,J7608 

Achromycin, see Tetracycline 

ACTH, see Corticotropin 

Acthar, see Corticotropin 

Actimmune, see Interferon gamma 1-B 

Activase, see Alteplase recombinant 

Acyclovir 5 mg J0133 

Adalimumab 20 mg J0135 

Adenocard, see Adenosine 

Adenoscan, see Adenosine 

Adenosine 6 mg IV J0150 

Adenosine 30 mg IV J0152 
Adrenalin Chloride, see Adrenalin, epinephrine 

Adrenalin, epinephrine up to 1 ml ampule SC, IM J0170 

Adriamycin PFS, see Doxorubicin HCl 

Adriamycin RDF, see Doxorubicin HCl 

Adrucil, see Fluorouracil 

Agalsidase beta 1 mg J0180 

Aggrastat, see Tirofiban hydrochloride 

A-hydroCort, see Hydrocortisone sodium phosphate 

Akineton, see Biperiden 

Alatrofloxacin mesylate, injection 100 mg IV J0200 

Albuterol 0.5 mg INH J7620 

Albuterol, concentrated form 1 mg INH J7610, J7611 

Albuterol, unit dose form 1 mg INH J7609, J7613 

Aldesleukin per single use vial IM, IV J9015 

Aldomet, see Methyldopate HCl 

Alefacept 0.5 mg J0215 

Alemtuzumab 10 mg J9010 

Alferon N, see Interferon alfa-n3 

Alglucerase per 10 units IV J0205 

Alglucosidase 10 mg J0220 

Alkaban-AQ, see Vinblastine sulfate 

Alkeran, see Melphalan, oral 

Alpha 1-proteinase inhibitor, human 10 mg IV J0256 

Alphanate J7186 

Alprostadil, injection 1.25 mcg OTH J0270 

 injection 

Alprostadil, urethral suppository OTH J0275 

Alteplase recombinant 1 mg IV J2997 

Alupent, see Metaproterenol sulfate or Metaproterenol, compounded 

Amcort, see Triamcinolone diacetate 

A-methaPred, see Methylprednisolone sodium succinate 

Amgen, see Interferon alphacon-1 

Amifostine 500 mg IV J0207 

Amikacin sulfate 100 mg J0278 

Aminolevalinic acid Hcl unit dose (354 mg) OTH J7308 

Aminophylline/Aminophyllin up to 250 mg IV J0280 

Amiodarone HCl 30 mg IV J0282 

Amitriptyline HCl up to 20 mg IM J1320 

Amobarbital up to 125 mg IM, IV J0300 

Amphocin, see Amphotericin B 

Amphotericin B 50 mg IV J0285 

Amphotericin B, lipid complex 10 mg IV J0287-J0289 

Ampicillin sodium up to 500 mg IM, IV J0290 

Ampicillin sodium/sulbactam sodium per 1.5 gm IM, IV J0295 

Amygdalin, see Laetrile, Amygdalin, vitamin B-17 

Amytal, see Amobarbital 

Anabolin LA 100, see Nandrolone decanoate 
3

Anadulafungin 1 mg J0348 

Ancef, see Cefazolin sodium 

Andrest 90-4, see Testosterone enanthate and estradiol valerate 

Andro-Cyp, see Testosterone cypionate 

Andro-Cyp 200, see Testosterone cypionate 

Andro L.A. 200, see Testosterone enanthate 

Andro-Estro 90-4, see Testosterone enanthate and estradiol valerate 

Andro/Fem, see Testosterone cypionate and estradiol cypionate 

Androgyn L.A., see Testosterone enanthate and estradiol valerate 

Androlone-50, see Nandrolone phenpropionate 

Androlone-D 100, see Nandrolone decanoate 

Andronaq-50, see Testosterone suspension 

Andronaq-LA, see Testosterone cypionate 

Andronate-200, see Testosterone cypionate 

Andronate-100, see Testosterone cypionate 

Andropository 100, see Testosterone enanthate 

Andryl 200, see Testosterone enanthate 

Anectine, see Succinylcholine chloride 

Anergan 25, see Promethazine HCl 

Anergan 50, see Promethazine HCl 

Anistreplase 30 units IV J0350 

Anti-Inhibitor per IU IV J7198 

Antispas, see Dicyclomine HCl 

Antithrombin III (human) per IU IV J7197 

Anzemet, see Dolasetron mesylate injection 

A.P.L., see Chorionic gonadotropin 

Apomorphine Hydrochloride 1 mg J0364 

Apresoline, see Hydralazine HCl 

Aprotinin 10,000 kiu J0365 

AquaMEPHYTON, see Vitamin K 

Aralen, see Chloroquine HCl 

Aramine, see Metaraminol 

Aranesp, see Darbepoetin Alfa 

Arbutamine 1 mg IV J0395 

Aredia, see Pamidronate disodium 

Arfonad, see Trimethaphan camsylate 

Arformoterol tartrate 15 mcg J7605 

Aripiprazole 0.25 mg J0400 

Aristocort Forte, see Triamcinolone diacetate 

Aristocort Intralesional, see Triamcinolone diacetate 

Aristospan Intra-Articular, see Triamcinolone hexacetonide 

Aristospan Intralesional, see Triamcinolone hexacetonide 

Arrestin, see Trimethobenzamide HCl 

Arsenic trioxide 1 mg IV J9017 

Asparaginase 10,000 units IV, IM J9020 
4

Astramorph PF, see Morphine sulfate 

Atgam, see Lymphocyte immune globulin 

Ativan, see Lorazepam 

Atropine, concentrated form per mg INH J7635 

Atropine, unit dose form per mg INH J7636 

Atropine sulfate up to 0.3 mg IV, IM, SC J0460 

Atrovent, see Ipratropium bromide 

Aurothioglucose up to 50 mg IM J2910 

Autologous cultured chondrocytes implant J7330 

Autoplex T, see Hemophilia clotting factors 

Avonex, see Interferon beta-1a 

Azacitidine 1 mg J9025 

Azathioprine 50 mg ORAL J7500 

Azathioprine, parenteral 100 mg IV J7501 

Azithromycin, dihydrate 1 gm ORAL Q0144 

Azithromycin, injection 500 mg IV J0456 

B

Baclofen 10 mg IT J0475 

Baclofen for intrathecal trial 50 mcg OTH J0476 

Bactocill, see Oxacillin sodium 

BAL in oil, see Dimercaprol 

Banflex, see Orphenadrine citrate 

Basiliximab 20 mg J0480 

BCG (Bacillus Calmette and Guérin), live per vial IV J9031 

 instillation 

Beclomethasone inhalation solution, unit dose form per mg INH J7622 

Bena-D 10, see Diphenhydramine HCl 

Bena-D 50, see Diphenhydramine HCl 

Benadryl, see Diphenhydramine HCl 

Benahist 10, see Diphenhydramine HCl 

Benahist 50, see Diphenhydramine HCl 

Ben-Allergin-50, see Diphenhydramine HCl 

Bendamustine HCl 1 mg J9033 

Benefix, see Factor IX, recombinant 

Benoject-10, see Diphenhydramine HCl 

Benoject-50, see Diphenhydramine HCl 

Bentyl, see Dicyclomine 

Benztropine mesylate per 1 mg IM, IV J0515 

Berubigen, see Vitamin B-12 cyanocobalamin 

Betalin 12, see Vitamin B-12 cyanocobalamin 

Betameth, see Betamethasone sodium phosphate 

Betamethasone acetate 

 & betamethasone sodium phosphate per 3 mg IM J0702 
5

Betamethasone inhalation solution, unit dose form per mg INH J7624 

Betamethasone sodium phosphate per 4 mg IM, IV J0704 

Betaseron, see Interferon beta-1b 

Bethanechol chloride up to 5 mg SC J0520 

Bevacizumab 10 mg J9035 

Bicillin L-A, see Penicillin G benzathine 

Bicillin C-R 900/300, see Penicillin G procaine and penicillin G 

 benzathine 

Bicillin C-R, see Penicillin G benzathine and penicillin G procaine 

BiCNU, see Carmustine 

Biperiden lactate per 5 mg IM, IV J0190 

Bitolterol mesylate,concentrated form per mg INH J7628 

Bitolterol mesylate,unit dose form per mg INH J7629 

Bivalirudin 1 mg J0583 

Blenoxane, see Bleomycin sulfate 

Bleomycin sulfate 15 units IM, IV, SC J9040 

Bortezomib 0.1 mg J9041 

Botulinum toxin type A per unit IM J0585 

Botulinum toxin type B per 100 units IM J0587 

Brethine, see Terbutaline sulfate or Terbutaline, compounded 

Bricanyl Subcutaneous, see Terbutaline sulfate 

Brompheniramine maleate per 10 mg IM, SC, IV J0945 

Bronkephrine, see Ethylnorepinephrine HCl 

Bronkosol, see Isoetharine HCl 

Budesonide inhalation solution, concentrated form 0.25 mg INH J7633, J7634 

Budesonide inhalation solution, unit dose form 0.5 mg INH J7626, J7627 

Buprenorphine Hydrochloride 0.1 mg J0592 

Busulfan 1 mg J0594 

Busulfan 2 mg ORAL J8510 

Butorphanol tartrate 1 mg J0595 

C

Cabergoline .25 mg ORAL J8515 

Cafcit, see Caffeine citrate 

Caffeine citrate 5 mg IV J0706 

Caine-1, see Lidocaine Hcl 

Caine-2, see Lidocaine HCl 

Calcijex, see Calcitriol 

Calcimar, see Calcitonin-salmon 

Calcitonin-salmon up to 400 units SC, IM J0630 

Calcitriol 0.1 mcg IM J0636 

Calcium Disodium Versenate, see Edetate calcium disodium 

Calcium gluconate per 10 ml IV J0610 

Calcium glycerophosphate & calcium lactate per 10 ml IM, SC J0620 
6

Calphosan, see Calcium glycerophosphate and calcium lactate 

Camptosar, see Irinotecan 

Capecitabine 150 mg ORAL J8520 

Capecitabine 500 mg ORAL J8521 

Carbocaine with Neo-Cobefrin, see Mepivacaine 

Carbocaine, see Mepivacaine 

Carboplatin 50 mg IV J9045 

Carmustine 100 mg IV J9050 

Carnitor, see Levocarnitine 

Carticel, see Autologous cultured chondrocytes 

Caspofungin acetate 5 mg IV J0637 

Cefadyl, see Cephapirin Sodium 

Cefazolin sodium 500 mg IV, IM J0690 

Cefepime hydrochloride 500 mg IV J0692 

Cefizox, see Ceftizoxime sodium 

Cefotaxime sodium per 1 g IV, IM J0698 

Cefoxitin sodium 1 g IV, IM J0694 

Ceftazidime per 500 mg IM, IV J0713 

Ceftizoxime sodium per 500 mg IV, IM J0715 

Ceftriaxone sodium per 250 mg IV, IM J0696 

Cefuroxime sodium, sterile per 750 mg IM, IV J0697 

Celestone Phosphate, see Betamethasone sodium phosphate 

Celestone Soluspan, see Betamethasone acetate 

 and betamethasone sodium phosphate 

CellCept, see Mycophenolate mofetil 

Cel-U-Jec, see Betamethasone sodium phosphate 

Cenacort Forte, see Triamcinolone diacetate 

Cenacort A-40, see Triamcinolone acetonide 

Cephalothin sodium up to 1 g IM, IV J1890 

Cephapirin sodium up to 1 g IV, IM J0710 

Ceredase, see Alglucerase 

Cerezyme, see Imiglucerase 

Cerubidine, see Daunorubicin HCl 

Cetuximab 10 mg J9055 

Chealamide, see Endrate ethylenediamine-tetra-acetic acid 

Chloramphenicol sodium succinate up to 1 g IV J0720 

Chlordiazepoxide HCl up to 100 mg IM, IV J1990 

Chloromycetin Sodium Succinate, see Chloramphenicol sodium succinate 

Chloroprocaine HCl per 30 ml VAR J2400 

Chlorpromazine HCl, oral 10 mg ORAL Q0171 

 25 mg ORAL Q0172 

Chloroquine HCl up to 250 mg IM J0390 

Chlorothiazide sodium per 500 mg IV J1205 

Chlorpromazine HCl up to 50 mg IM, IV J3230 

Chorex-5, see Chorionic gonadotropin 
7

Chorex-10, see Chorionic gonadotropin 

Chorignon, see Chorionic gonadotropin 

Chorionic gonadotropin per 1,000 USP units IM J0725 

Choron 10, see Chorionic gonadotropin 

Cidofovir 375 mg IV J0740 

Cilastatin sodium, imipenem per 250 mg IV, IM J0743 

Cipro IV, see Ciprofloxacin 

Ciprofloxacin 200 mg IV J0706 

Cisplatin, powder or solution per 10 mg IV J9060 

Cisplatin 50 mg IV J9062 

Cladribine per mg IV J9065 

Claforan, see Cefotaxime sodium 

Clofarabine 1 mg J9027 

Clonidine Hydrochloride 1 mg epidural J0735 

Cobex, see Vitamin B-12 cyanocobalamin 

Codeine phosphate per 30 mg IM, IV, SC J0745 

Codimal-A, see Brompheniramine maleate 

Cogentin, see Benztropine mesylate 

Colchicine per 1 mg IV J0760 

Colistimethate sodium up to 150 mg IM, IV J0770 

Coly-Mycin M, see Colistimethate sodium 

Compa-Z, see Prochlorperazine 

Compazine, see Prochlorperazine 

Cophene-B, see Brompheniramine maleate 

Copper contraceptive, intrauterine OTH J7300 

Cordarone, see Amiodarone HCl 

Corgonject-5, see Chorionic gonadotropin 

Corticorelin ovine triflutate 1 mcg J0795 

Corticotropin up to 40 units IV, IM, SC J0800 

Cortrosyn, see Cosyntropin 

Cosmegen, see Dactinomycin 

Cosyntropin per 0.25 mg IM, IV J0835 

Cotranzine, see Prochlorperazine 

Cromolyn sodium, unit dose form per 10 mg INH J7631,J7632 

Crysticillin 300 A.S., see Penicillin G procaine 

Crysticillin 600 A.S., see Penicillin G procaine 

Cyclophosphamide 100 mg IV J9070 

 200 mg IV J9080 

 500 mg IV J9090 

 1 g IV J9091 

 2 g IV J9092 

Cyclophosphamide, lyophilized 100 mg IV J9093 

 200 mg IV J9094 

 500 mg IV J9095 

 1 g IV J9096 
8

 2 g IV J9097 

Cyclophosphamide, oral 25 mg ORAL J8530 

Cyclosporine, oral 25 mg ORAL J7515 

 100 mg ORAL J7502 

Cyclosporine, parenteral 250 mg IV J7516 

Cytarabine 100 mg SC, IV J9100 

Cytarabine 500 mg SC, IV J9110 

Cytarabine liposome 10 mg J9098 

Cytomegalovirus immune globulin intravenous(human)per vial IV J0850 

Cytosar-U, see Cytarabine 

Cytovene, see Ganciclovir sodium 

Cytoxan, see Cyclophosphamide; cyclophosphamide, lyophilized; and 

 cyclophosphamide, oral 

D

D-5-W, infusion 1000 cc IV J7070 

Dacarbazine 100 mg IV J9130 

 200 mg IV J9140 

Daclizumab 25 mg IV J7513 

Dactinomycin 0.5 mg IV J9120 

Dalalone, see Dexamethasone sodium phosphate 

Dalalone L.A., see Dexamethasone acetate 

Dalteparin sodium per 2500 IU SC J1645 

Daptomycin 1 mg J0878 

Darbepoetin Alfa 1 mcg J0881, J0882 

Daunorubicin citrate, liposomal 10 mg IV J9151 

 formulation 

Daunorubicin HCl 10 mg IV J9150 

Daunoxome, see Daunorubicin citrate 

DDAVP, see Desmopressin acetate 

Decadron Phosphate, see Dexamethasone sodium phosphate 

Decadron, see Dexamethasone sodium phosphate 

Decadron-LA, see Dexamethasone acetate 

Deca-Durabolin, see Nandrolone decanoate 

Decaject, see Dexamethasone sodium phosphate 

Decaject-L.A., see Dexamethasone acetate 

Decitabine 1 mg J0894 

Decolone-50, see Nandrolone decanoate 

Decolone-100, see Nandrolone decanoate 

De-Comberol, see Testosterone cypionate and estradiol cypionate 

Deferoxamine mesylate 500 mg IM, SC, IV J0895 

Dehist, see Brompheniramine maleate 

Deladumone OB, see Testosterone enanthate and estradiol valerate 

Deladumone, see Testosterone enanthate and estradiol valerate 
9

Delatest, see Testosterone enanthate 

Delatestadiol, see Testosterone enanthate and estradiol valerate 

Delatestryl, see Testosterone enanthate 

Delta-Cortef, see Prednisolone, oral 

Delestrogen, see Estradiol valerate 

Demadex, see Torsemide 

Demerol HCl, see Meperidine HCl 

Denileukin diftitox 300 mcg J9160 

DepAndro 100, see Testosterone cypionate 

DepAndro 200, see Testosterone cypionate 

DepAndrogyn, see Testosterone cypionate and estradiol cypionate 

DepGynogen, see Depo-estradiol cypionate 

DepMedalone 40, see Methylprednisolone acetate 

DepMedalone 80, see Methylprednisolone acetate 

Depo-estradiol cypionate up to 5 mg IM J1000 

Depogen, see Depo-estradiol cypionate 

Depoject, see Methyprednisolone acetate 

Depo-Medrol, see Methylprednisolone acetate 

Depopred-40, see Methylprednisolone acetate 

Depopred-80, see Methylprednisolone acetate 

Depo-Provera, see Medroxyprogesterone acetate 

Depotest, see Testosterone cypionate 

Depo-Testadiol, see Testosterone cypionate and estradiol cypionate 

Depotestogen, see Testosterone cypionate and estradiol cypionate 

Depo-Testosterone, see Testosterone cypionate 

Desferal Mesylate, see Deferoxamine mesylate 

Desmopressin acetate 1 mcg IV, SC J2597 

Dexacen LA-8, see Dexamethasone acetate 

Dexacen-4, see Dexamethasone sodium phosphate 

Dexamethasone, concentrated form per mg INH J7637 

Dexamethasone,unit form per mg INH J7638 

Dexamethasone, oral 0.25 mg J8540 

Dexamethasone acetate 1 mg IM J1094 

Dexamethasone sodium phosphate 1 mg IM, IV, OTH J1100 

Dexasone, see Dexamethasone sodium phosphate 

Dexasone L.A., see Dexamethasone acetate 

Dexferrum, see Iron Dextran 

Dexone, see Dexamethasone sodium phosphate 

Dexone LA, see Dexamethasone acetate 

Dexrazoxane hydrochloride 250 mg IV J1190 

Dextran 40 500 ml IV J7100 

Dextran 75 500 ml IV J7110 

Dextrose 5%/normal saline solution, 500 ml = 1 unit IV J7042 

Dextrose/water (5%) 500 ml = 1 unit IV J7060 

D.H.E. 45, see Dihydroergotamine 
10

Diamox, see Acetazolamide sodium 

Diazepam up to 5 mg IM, IV J3360 

Diazoxide up to 300 mg IV J1730 

Dibent, see Dicyclomine HCl 

Dicyclomine HCl up to 20 mg IM J0500 

Didronel, see Etidronate disodium 

Diethylstilbestrol diphosphate 250 mg IV J9165 

Diflucan, see Fluconazole 

Digoxin up to 0.5 mg IM, IV J1160 

Digoxin immune fab (ovine) per vial J1162 

Dihydrex, see Diphenhydramine Hcl 

Dihydroergotamine mesylate per 1 mg IM, IV J1110 

Dilantin, see Phenytoin sodium 

Dilaudid, see Hydromorphone HCl 

Dilocaine, see Lidocaine HCl 

Dilomine, see Dicyclomine HCl 

Dilor, see Dyphylline 

Dimenhydrinate up to 50 mg IM, IV J1240 

Dimercaprol per 100 mg IM J0470 

Dimethyl sulfoxide, see DMSO, Dimethylsulfoxide 

Dinate, see Dimenhydrinate 

Dioval, see Estradiol valerate 

Dioval 40, see Estradiol valerate 

Dioval XX, see Estradiol valerate 

Diphenacen-50, see Diphenhydramine HCl 

Diphenhydramine HCl, injection up to 50 mg IV, IM J1200 

Diphenhydramine HCl, oral 50 mg ORAL Q0163 

Dipyridamole per 10 mg IV J1245 

Disotate, see Endrate ethylenediamine-tetra-acetic acid 

Di-Spaz, see Dicyclomine HCl 

Ditate-DS, see Testosterone enanthate and estradiol valerate 

Diuril Sodium, see Chlorothiazide sodium 

D-Med 80, see Methylprednisolone acetate 

DMSO, Dimethyl sulfoxide 50%, 50 ml OTH J1212 

Dobutamine HCl per 250 mg IV J1250 

Dobutrex, see Dobutamine Hcl 

Docetaxel 20 mg IV J9170 

Dolasetron mesylate, injection 10 mg IV J1260 

Dolasetron mesylate, tablets 100 mg ORAL Q0180 

Dolophine HCl, see Methadone Hcl 

Dommanate, see Dimenhydrinate 

Donbax, see Doripenem 

Dopamine HCl 40 mg J1265 

Doribax, see Doripenem 

Doripenem 10 mg J1267 
11

Dornase alpha, unit dose form per mg INH J7639 

Doxercalciferol 1 mcg IV J1270 

Doxil, see Doxorubicin HCL, lipid 

Doxorubicin HCL 10 mg IV J9000 

Doxorubicin HCL, all lipid 10 mg IV J9001 

Dramamine, see Dimenhydrinate 

Dramanate, see Dimenhydrinate 

Dramilin, see Dimenhydrinate 

Dramocen, see Dimenhydrinate 

Dramoject, see Dimenhydrinate 

Dronabinol, oral 2.5 mg ORAL Q0167 

Dronabinol, oral 5 mg ORAL Q0168 

Droperidol up to 5 mg IM, IV J1790 

Drug administered through a metered dose inhaler INH J3535 

Droperidol and fentanyl citrate up to 2 ml ampule IM, IV J1810 

DTIC-Dome, see Dacarbazine 

Dua-Gen L.A., see Testosterone enanthate and estradiol valerate cypionate 

Duoval P.A., see Testosterone enanthate and estradiol valerate 

Durabolin, see Nandrolone phenpropionate 

Duraclon, see Clonidine Hydrochloride 

Dura-Estrin, see Depo-estradiol cypionate 

Duracillin A.S., see Penicillin G procaine 

Duragen-10, see Estradiol valerate 

Duragen-20, see Estradiol valerate 

Duragen-40, see Estradiol valerate 

Duralone-40, see Methylprednisolone acetate 

Duralone-80, see Methylprednisolone acetate 

Duralutin, see Hydroxyprogesterone Caproate 

Duramorph, see Morphine sulfate 

Duratest-100, see Testosterone cypionate 

Duratest-200, see Testosterone cypionate 

Duratestrin, see Testosterone cypionate and estradiol cypionate 

Durathate-200, see Testosterone enanthate 

Dymenate, see Dimenhydrinate 

Dyphylline up to 500 mg IM J1180 

E

Eculizumab 10 mg J1300 

Edetate calcium disodium up to 1000 mg IV, SC, IM J0600 

Edetate disodium per 150 mg IV J3520

Elavil, see Amitriptyline HCl 

Ellence, see Epirubicin HCl 

Elliotts b solution 1 ml OTH J9175 

Elspar, see Asparaginase 
12

Emend, see Fosaprepitant 

Emete-Con, see Benzquinamide 

Eminase, see Anistreplase 

Enbrel, see Etanercept 

Endrate ethylenediamine-tetra-acetic acid, see Edetate disodium

Enfuvirtide 1 mg J1324 

Enovil, see Amitriptyline HCl 

Enoxaparin sodium 10 mg SC J1650 

Epinephrine, adrenalin up to 1 ml amp SC, IM J0170 

Epirubicin hydrochloride 2 mg J9178 

Epoetin alfa 1000 units Q4055 

Epoprostenol 0.5 mg IV J1325 

Eptifibatide, injection 5 mg IM, IV J1327 

Ergonovine maleate up to 0.2 mg IM, IV J1330 

Ertapenem sodium 500 mg J1335 

Erythromycin lactobionate 500 mg IV J1364 

Estra-D, see Depo-estradiol cypionate 

Estra-L 20, see Estradiol valerate 

Estra-L 40, see Estradiol valerate 

Estra-Testrin, see Testosterone enanthate and estradiol valerate 

Estradiol Cypionate, see Depo-estradiol cypionate 

Estradiol L.A., see Estradiol valerate 

Estradiol L.A. 20, see Estradiol valerate 

Estradiol L.A. 40, see Estradiol valerate 

Estradiol valerate up to 10 mg IM J1380 

up to 20 mg IM J1390 

up to 40 mg IM J0970 

Estro-Cyp, see Depo-estradiol cypionate 

Estrogen, conjugated per 25 mg IV, IM J1410 

Estroject L.A., see Depo-estradiol cypionate 

Estrone per 1 mg IM J1435 

Estrone 5, see Estrone 

Estrone Aqueous, see Estrone 

Estronol, see Estrone 

Estronol-L.A., see Depo-estradiol cypionate 

Etanercept, injection 25 mg IM, IV J1438 

Ethanolamine 100 mg J1430 

Ethyol, see Amifostine 

Etidronate disodium per 300 mg IV J1436 

Etonogestrel implant J7307 

Etopophos, see Etoposide 

Etoposide 10 mg IV J9181 

Etoposide, oral 50 mg ORAL J8560 

Euflexxa J7323 

Everone, see Testosterone Enanthate 
13

F

Factor VIIa (coagulation factor, recombinant) 1 mcg IV J7189 

Factor VIII (anti-hemophilic factor, human) per IU IV J7190 

Factor VIII (anti-hemophilic factor, porcine) per IU IV J7191 

Factor VIII (anti-hemophilic factor, recombinant) per IU IV J7192 

Factor IX (anti-hemophilic factor, purified, per IU IV J7193 

 non-recombinant) 

Factor IX (anti-hemophilic factor, recombinant) per IU IV J7195 

Factor IX, complex per IU IV J7194 

Factors, other hemophilia clotting per IU IV J7196 

Factrel, see Gonadorelin HCl 

Feiba VH Immuno, see Factors, other hemophilia clotting 

Fentanyl citrate 0.1 mg IM, IV J3010 

Ferrlecit, see Sodium ferricgluconate complex in sucrose injection 

Filgrastim (G-CSF) 300 mcg SC, IV J1440 

480 mcg SC, IV J1441 

Flebogamma 500 mg IV J1572 

Flexoject, see Orphenadrine citrate 

Flexon, see Orphenadrine citrate 

Flolan, see Epoprostenol 

Floxuridine 500 mg IV J9200 

Fluconazole 200 mg IV J1450 

Fludara, see Fludarabine phosphate 

Fludarabine phosphate 50 mg IV J9185 

Flunisolide inhalation solution, unit dose form per mg INH J7641 

Fluocinolone J7311 

Fluorouracil 500 mg IV J9190 

Folex, see Methotrexate sodium 

Folex PFS, see Methotrexate sodium 

Follutein, see Chorionic gonadotropin 

Fomepizole 15 mg J1451 

Fomivirsen sodium 1.65 mg Intraocular J1452 

Fondaparinux sodium 0.5 mg J1652 

Formoterol 12 mcg INH J7640 

Formoterol fumarate 20 mcg J7606 

Fortaz, see Ceftazidime 

Fosaprepitant 1 mg J1453 

Foscarnet sodium per 1,000 mg IV J1455 

Foscavir, see Foscarnet sodium 

Fosphenytoin 50 mg Q2009 

FUDR, see Floxuridine 

Fulvestrant 25 mg J9395 

Fungizone Intravenous, see Amphotericin B 

Furomide M.D., see Furosemide 
14

Furosemide up to 20 mg IM, IV J1940 

G

Gallium nitrate 1 mg J1457 

Galsulfase 1 mg J1458 

Gamastan, see Gamma globulin and Immune globulin 

Gammagard Liquid 500 mg J1569 

Gamma globulin 1 cc IM J1460 

 2 cc IM J1470 

 3 cc IM J1480 

 4 cc IM J1490 

 5 cc IM J1500 

 6 cc IM J1510 

 7 cc IM J1520 

 8 cc IM J1530 

 9 cc IM J1540 

 10 cc IM J1550 

over 10 cc IM J1560 

Gammar, see Gamma globulin and Immune globulin 

Gammar-IV, see Immune globulin intravenous (human) 

Gamulin RH, see Rho(D) immune globulin 

Gamunex 500 mg J1561 

Ganciclovir, implant 4.5 mg OTH J7310 

Ganciclovir sodium 500 mg IV J1570 

Garamycin, gentamicin up to 80 mg IM, IV J1580 

Gatifloxacin 10 mg IV J1590 

Gefitinib 250 mg J8565 

Gemcitabine HCl 200 mg IV J9201 

Gemsar, see Gemcitabine Hcl 

Gemtuzumab ozogamicin 5 mg IV J9300 

Gentamicin Sulfate, see Garamycin, gentamicin 

Gentran, see Dextran 40 

Gentran 75, see Dextran 75 

Gesterol 50, see Progesterone 

Glatiramer Acetate 20 mg J1595 

Glucagon Hcl per 1 mg SC, IM, IV J1610 

Glukor, see Chorionic gonadotropin 

Glycopyrrolate, concentrated form per 1 mg INH J7642 

Glycopyrrolate, unit dose form per 1 mg INH J7643 

Gold sodium thiomalate up to 50 mg IM J1600 

Gonadorelin HCl per 100 mcg SC, IV J1620 
15

Gonic, see Chorionic gonadotropin 

Goserelin acetate implant per 3.6 mg SC J9202 

Granisetron HCl, injection 100 mcg IV J1626 

Granisetron HCl, oral 1 mg ORAL Q0166 

Gynogen L.A. A10,@ see Estradiol valerate 

Gynogen L.A. A20,@ see Estradiol valerate 

Gynogen L.A. A40,@ see Estradiol valerate 

H

Haldol, see Haloperidol 

Haloperidol up to 5 mg IM, IV J1630 

Haloperidol decanoate per 50 mg IM J1631 

Hectoral, see Doxercalciferol 

Hemin 1 mg J1640 

Hemofil M, see Factor VIII 

Hemophilia clotting factors(e.g., anti-inhibitors) per IU IV J7198 

Hemophilia clotting factors, NOC per IU IV J7199 

Hepagam B 0.5 ml IM J1571 

 0.5 ml IV J1573 

Hep-Lock, see Heparin sodium (heparin lock flush) 

Hep-Lock U/P, see Heparin sodium (heparin lock flush) 

Heparin sodium 1,000 units IV, SC J1644 

Heparin sodium (heparin lock flush) 10 units IV J1642 

Herceptin, see Trastuzumab 

Hexadrol Phosphate, see Dexamethasone sodium phosphate 

Histaject, see Brompheniramine maleate 

Histerone 50, see Testosterone suspension 

Histerone 100, see Testosterone suspension 

Histrelin acetate 10 mcg J1675 

Histrelin implant 50 mg J9225 

Hyalgan J7321 

Hyaluronidase up to 150 units SC, IV J3470 

Hyaluronidase, ovine up to 999 units J3471 

Hyaluronidase, ovine per 1000 units J3472 

Hyaluronidase recombinant 1 usp J3473 

Hyate:C, see Factor VIII (anti-hemophilic factor (porcine)) 

Hybolin Improved, see Nandrolone phenpropionate 

Hybolin Decanoate, see Nandrolone decanoate 

Hycamtin, see Topotecan 

Hydralazine HCl up to 20 mg IV, IM J0360 

Hydrate, see Dimenhydrinate 

Hydrocortisone acetate up to 25 mg IV, IM, SC J1700 

Hydrocortisone sodium phosphate up to 50 mg IV, IM, SC J1710 

Hydrocortisone succinate sodium up to 100 mg IV, IM, SC J1720 
16

Hydrocortone Acetate, see Hydrocortisone acetate 

Hydrocortone Phosphate, see Hydrocortisone sodium phosphate 

Hydromorphone HCl up to 4 mg SC, IM, IV J1170 

Hydroxyzine HCl up to 25 mg IM J3410 

Hydroxyzine Pamoate 25 mg ORAL Q0177 

 50 mg ORAL Q0178 

Hylan G-F 20 J7322 

Hyoscyamine sulfate up to 0.25 mg SC, IM, IV J1980 

Hyperstat IV, see Diazoxide 

Hyper-Tet, see Tetanus immune globulin, human 

HypRho-D, see Rho(D) immune globulin 

Hyrexin-50, see Diphenhydramine HCl 

Hyzine-50, see Hydroxyzine HCl 

I

Ibandronate sodium 1 mg J1740 

Ibutilide fumarate 1 mg IV J1742 

Idamycin, see Idarubicin HCl 

Idarubicin HCl 5 mg IV J9211 

Idursulfase 1 mg J1743 

Ifex, see Ifosfamide 

Ifosfamide 1 g IV J9208 

Ilotycin, see Erythromycin gluceptate 

Imferon, see Iron dextran 

Imiglucerase per unit IV J1785 

Imitrex, see Sumatriptan succinate 

Immune globulin 

 Flebogamma 500 mg IV J1572 

 Gammagard Liquid 500 mg IV J1569 

 Gamunex 500 mg IV J1561 

 HepaGam B 0.5 ml IM J1571 

 HepaGam B 0.5 ml IV J1573 

 NOS 500 mg IV J1566 

 Octagam 500 mg IV J1568 

 Privigen 500 mg IV J1459 

 Rhophylac 100 IU IM J2791 

 Subcutaneous 100 mg J1562 

Immunosuppressive drug, not otherwise classified J7599 

Imuran, see Azathioprine 

Inapsine, see Droperidol 

Inderal, see Propranolol HCl 

Infed, see Iron Dextran 

Infergen, see Interferon alfa-1 

Infliximab, injection 10 mg IM, IV J1745 

Innohep, see Tinzarparin 
17

Innovar, see Droperidol with fentanyl citrate 

Insulin 5 units SC J1815 

Insulin lispro 50 units SC J1817 

Intal, see Cromolyn sodium or Cromolyn sodium, compounded 

Integrilin, injection, see Eptifibatide 

Interferon alphacon-1, recombinant 1 mcg SC J9212 

Interferon alfa-2a, recombinant 3 million units SC, IM J9213 

Interferon alfa-2b, recombinant 1 million units SC, IM J9214 

Interferon alfa-n3 (human leukocyte derived) 250,000 IU IM J9215 

Interferon beta-1a 33 mcg IM J1825 

Interferon beta-1a 11 mcg IM Q3025 

Interferon beta-1a 11 mcg SC Q3026 

Interferon beta-1b 0.25 mg SC J1830 

Interferon gamma-1b 3 million units SC J9216 

Intrauterine copper contraceptive, see Copper contraceptive, intrauterine 

Ipratropium bromide, unit dose form per mg INH J7644, J7645 

Irinotecan 20 mg IV J9206 

Iron dextran 50 mg J1750 

Iron sucrose 1 mg IV J1756 

Irrigation solution for Tx of bladder calculi per 50 ml OTH Q2004 

Isocaine HCl, see Mepivacaine 

Isoetharine HCl, concentrated form per mg INH J7647, J7648 

Isoetharine Hcl, unit dose form per mg INH J7649, J7650 

Isoproterenol HCl, concentrated form per mg INH J7657, J7658 

Isoproterenol Hcl, unit dose form per mg INH J7659, J7660 

Isuprel, see Isoproterenol HCl 

Itraconazole 50 mg IV J1835 

Ixabepilone 1 mg J9207 

Ixempra, see Ixabepilone 

J

Jenamicin, see Garamycin, gentamicin 

K

Kabikinase, see Streptokinase 

Kaleinate, see Calcium gluconate 

Kanamycin sulfate up to 75 mg IM, IV J1850 

Kanamycin sulfate up to 500 mg IM, IV J1840 

Kantrex, see Kanamycin sulfate 

Keflin, see Cephalothin sodium 

Kefurox, see Cufuroxime sodium 

Kefzol, see Cefazolin sodium 

Kenaject-40, see Triamcinolone acetonide 
18

Kenalog-10, see Triamcinolone acetonide 

Kenalog-40, see Triamcinolone acetonide 

Keppra, see Levetiracetam 

Kestrone 5, see Estrone 

Ketorolac tromethamine per 15 mg IM, IV J1885 

Key-Pred 25, see Prednisolone acetate 

Key-Pred 50, see Prednisolone acetate 

Key-Pred-SP, see Prednisolone sodium phosphate 

K-Flex, see Orphenadrine citrate 

Klebcil, see Kanamycin sulfate 

Koate-HP, see Factor VIII 

Kogenate, see Factor VIII 

Konakion, see Vitamin K, phytonadione, etc. 

Konyne-80, see Factor IX, complex 

Kytril, see Granisetron HCl 

L

L.A.E. 20, see Estradiol valerate 

Laetrile, Amygdalin, vitamin B-17 J3570 

Lanoxin, see Digoxin 

Lanreotide 1 mg J1930 

Largon, see Propiomazine HCl 

Laronidase 0.1 mg J1931 

Lasix, see Furosemide 

L-Caine, see Lidocaine HCl 

Lepirudin 50 mg J1945 

Leucovorin calcium per 50 mg IM, IV J0640 

Leukine, see Sargramostim (GM-CSF) 

Leuprolide acetate (for depot suspension) per 3.75 mg IM J1950 

 7.5 mg IM J9217 

Leuprolide acetate per 1 mg IM J9218 

Leuprolide acetate implant 65 mg J9219 

Leustatin, see Cladribine 

Levalbuterol HCl, concentrated form 0.5 mg INH J7607, J7612 

Levalbuterol HCl, unit dose form 0.5 mg INH J7614, J7615 

Levaquin I.U., see Levofloxacin 

Levetiracetam 10 mg J1953 

Levocarnitine per 1 gm IV J1955 

Levo-Dromoran, see Levorphanol tartrate 

Levofloxacin 250 mg IV J1956 

Levoleucovorin calcium 0.5 mg J0641 

Levonorgestrel implant J7306 

Levonorgestrel releasing intrauterin contraceptive 52 mg OTH J7302 

Levorphanol tartrate up to 2 mg SC, IV J1960 
19

Levsin, see Hyoscyamine sulfate 

Levulan Kerastick, see Aminolevulinic acid HCl 

Lexiscan, see Regadenoson 

Librium, see Chlordiazepoxide HCl 

Lidocaine HCl 10 mg IV J2001 

Lidoject-1, see Lidocaine HCl 

Lidoject-2, see Lidocaine HCl 

Lincocin, see Lincomycin HCl 

Lincomycin HCl up to 300 mg IV J2010 

Linezolid 200 mg IV J2020 

Liquaemin Sodium, see Heparin sodium 

Lioresal, see Baclofen 

LMD (10%), see Dextran 40 

Lovenox, see Enoxaparin sodium 

Lorazepam 2 mg IM, IV J2060 

Lufyllin, see Dyphylline 

Luminal Sodium, see Phenobarbitol sodium 

Lunelle, see Medroxyprogesterone acetate/estradiol cypionate 

Lupron, see Leuprolide acetate 

Lymphocyte immune globulin, 

 anti-thymocyte globulin, equine 250 mg IV J7504 

 anti-thymocyte globulin, rabbit 25 mg IV J7511 

Lyophilized, see Cyclophosphamide, lyophilized 

M

Magnesium sulfate 500 mg J3475 

Mannitol 25% in 50 ml IV J2150 

Marmine, see Dimenhydrinate 

Maxipime, see Cefepime hydrochloride 

Mecasermin 1 mg J2170 

Mechlorethamine HCl (nitrogen mustard), HN2 10 mg IV J9230 

Medralone 40, see Methylprednisolone acetate 

Medralone 80, see Methylprednisolone acetate 

Medrol, see Methylprednisolone 

Medroxyprogesterone acetate 50 mg IM J1051 

 150 mg IM J1055 

Medroxyprogesterone acetate/estradiol cypionate 5 mg/25 mg IM J1056 

Mefoxin, see Cefoxitin sodium 

Melphalan HCl 50 mg IV J9245 

Melphalan, oral 2 mg ORAL J8600 

Menoject LA, see Testosterone cypionate and estradiol cypionate 

Mepergan Injection, see Meperdine and promethazine HCl 

Meperidine HCl per 100 mg IM, IV, SC J2175 

Meperidine and promethazine HCl up to 50 mg IM, IV J2180 
20

Mepivacaine HCL per 10 ml VAR J0670 

Meropenem 100 mg J2185 

Mesna 200 mg IV J9209 

Mesnex, see Mesna 

Metaprel, see Metaproterenol sulfate 

Metaproterenol sulfate, concentrated form per 10 mg INH J7667, J7668 

Metaproterenol sulfate, unit dose form per 10 mg INH J7669, J7670 

Metaraminol bitartrate per 10 mg IV, IM, SC J0380 

Metastron, see Strontium-89 chloride 

Methacholine chloride 1 mg J7674 

Methadone HCl up to 10 mg IM, SC J1230 

Methergine, see Methylergonovine maleate 

Methocarbamol up to 10 ml IV, IM J2800 

Methotrexate, oral 2.5 mg ORAL J8610 

Methotrexate sodium 5 mg IV, IM, IT, IA J9250 

50 mg IV, IM, IT, IA J9260 

Methotrexate LPF, see Methotrexate sodium 

Methyldopate HCl up to 250 mg IV J0210 

Methylene blue 1 ml A9535 

Methylprednisolone, oral per 4 mg ORAL J7509 

Methylprednisolone acetate 20 mg IM J1020 

 40 mg IM J1030 

 80 mg IM J1040 

Methylprednisolone sodium succinate up to 40 mg IM, IV J2920 

up to 125 mg IM, IV J2930 

Metoclopramide HCl up to 10 mg IV J2765 

Miacalcin, see Calcitonin-salmon 

Micafungin sodium 1 mg J2248 

Midazolam HCl per 1 mg IM, IV J2250 

Milrinone lactate 5 mg IV J2260 

Mirena, see Levonorgestrel releasing intrauterine contraceptive 

Mithracin, see Plicamycin 

Mitomycin 5 mg IV J9280 

 20 mg IV J9290 

 40 mg IV J9291 

Mitoxantrone HCl per 5 mg IV J9293 

Monocid, see Cefonicic sodium 

Monoclate-P, see Factor VIII 

Monoclonal antibodies, parenteral 5 mg IV J7505 

Mononine, see Factor IX, purified, non-recombinant 

Morphine sulfate up to 10 mg IM, IV, SC J2270 

100 mg IM, IV, SC J2271 

Morphine sulfate, preservative-free per 10 mg SC, IM, IV J2275 

Moxifloxacin 100 mg J2280 

M-Prednisol-40, see Methylprednisolone acetate 
21

M-Prednisol-80, see Methylprednisolone acetate 

Mucomyst, see Acetylcysteine or Acetylcysteine, compounded 

Mucosol, see Acetylcysteine 

Muromonab-CD3 5 mg IV J7505 

Muse, see Alprostadil 

Mustargen, see Mechlorethamine HCl 

Mutamycin, see Mitomycin 

Mycophenolic acid 180 mg J7518 

Mycophenolate Mofetil 250 mg ORAL J7517 

Myleran, see Busulfan 

Mylotarg, see Gemtuzumab ozogamicin 

Myobloc, see Botulinum toxin type B 

Myochrysine, see Gold sodium thiomalate 

Myolin, see Orphenadrine citrate 

N

Nabilone 1 mg ORAL J8650 

Nalbuphine HCl per 10 mg IM, IV, SC J2300 

Naloxone HCl per 1 mg IM, IV, SC J2310 

Naltrexone, depot form 1 mg J2315 

Nandrobolic L.A., see Nandrolone decanoate 

Nandrolone decanoate up to 50 mg IM J2320 

up to 100 mg IM J2321 

up to 200 mg IM J2322 

Narcan, see Naloxone HCl 

Naropin, see Ropivacaine HCl 

Nasahist B, see Brompheniramine maleate 

Nasal vaccine inhalation INH J3530 

Natalizumab 1 mg J2323 

Navane, see Thiothixene 

Navelbine, see Vinorelbine tartrate 

ND Stat, see Brompheniramine maleate 

Nebcin, see Tobramycin sulfate 

NebuPent, see Pentamidine isethionate 

Nelarabine 50 mg J9261 

Nembutal Sodium Solution, see Pentobarbital sodium 

Neocyten, see Orphenadrine citrate 

Neo-Durabolic, see Nandrolone decanoate 

Neoquess, see Dicyclomine HCl 

Neosar, see Cyclophosphamide 

Neostigmine methylsulfate up to 0.5 mg IM, IV, SC J2710 

Neo-Synephrine, see Phenylephrine HCl 

Nervocaine 1%, see Lidocaine HCl 

Nervocaine 2%, see Lidocaine HCl 
22

Nesacaine, see Chloroprocaine HCL 

Nesacaine-MPF, see Chloroprocaine HCl 

Nesiritide 0.1 mg J2325 

Neumega, see Oprelvekin 

Neupogen, see Filgrastim (G-CSF) 

Neutrexin, see Trimetrexate glucuronate 

Nipent, see Pentostatin 

Nordryl, see Diphenhydramine HCl 

Norflex, see Orphenadrine citrate 

Norzine, see Thiethylperazine maleate 

Not otherwise classified drugs J3490 

Not otherwise classified drugs other than INH J7799 

 administered thru DME 

Not otherwise classified drugs INH J7699 

 administered thru DME 

Not otherwise classified drugs, anti-neoplastic J9999 

Not otherwise classified drugs, chemotherapeutic ORAL J8999 

Not otherwise classified drugs, immunosuppressive J7599 

Not otherwise classified drugs, nonchemotherapeutic ORAL J8499 

Novantrone, see Mitoxantrone HCl 

Novo Seven, see Factor VIIa 

NPH, see Insulin 

Nubain, see Nalbuphine HCl 

Nulicaine, see Lidocaine HCl 

Numorphan, see Oxymorphone HCl 

Numorphan H.P., see Oxymorphone HCl 

O

Octagam 500 mg J1568 

Octreotide Acetate, injection 1 mg IM J2353 

 25 mcg IV,SQ J2354 

Oculinum, see Botulinum toxin type A 

O-Flex, see Orphenadrine citrate 

Omalizumab 5 mg J2357 

Omnipen-N, see Ampicillin 

Oncaspar, see Pegaspargase 

Oncovin, see Vincristine sulfate 

Ondansetron HCI 1 mg IV J2405 

Ondansetron HCl, oral 8 mg ORAL Q0179 

Oprelvekin 5 mg SC J2355 

Oraminic II, see Brompheniramine maleate 

Ormazine, see Chlorpromazine HCl 

Orphenadrine citrate up to 60 mg IV, IM J2360 

Orphenate, see Orphenadrine citrate 

Orthovisc J7324 
23

Or-Tyl, see Dicyclomine 

Oxacillin sodium up to 250 mg IM, IV J2700 

Oxaliplatin 0.5 mg J9263 

Oxymorphone HCl up to 1 mg IV, SC, IM J2410 

Oxytetracycline HCl up to 50 mg IM J2460 

Oxytocin up to 10 units IV, IM J2590 

P

Paclitaxel 30 mg IV J9265 

Paclitaxel protein-bound particles 1 mg J9264 

Palifermin 50 mcg J2425 

Palonosetron HCl 25 mcg J2469 

Pamidronate disodium per 30 mg IV J2430 

Panitumumab 10 mg J9303 

Papaverine HCl up to 60 mg IV, IM J2440 

Paragard T 380 A, see Copper contraceptive, intrauterine 

Paraplatin, see Carboplatin 

Paricalcitol, injection 1 mcg IV, IM J2501 

Pegademase bovine 25 iu J2504 

Pegaptinib 0.3 mg J2503 

Pegaspargase per single dose vial IM, IV J9266 

Pegfilgrastim 6 mg J2505 

Pemetrexed 10 mg J9305 

Penicillin G benzathine up to 600,000 units IM J0560 

up to 1,200,000 units IM J0570 

up to 2,400,000 units IM J0580 

Penicillin G benzathine and penicillin G procaine 

 up to 600,000 units IM J0530 

up to 1,200,000 units IM J0540 

up to 2,400,000 units IM J0550 

Penicillin G potassium up to 600,000 units IM, IV J2540 

Penicillin G procaine, aqueous up to 600,000 units IM, IV J2510 

Pentamidine isethionate per 300 mg INH J2545,J7676 

Pentastarch, 10% 100 ml J2513 

Pentazocine HCl 30 mg IM, SC, IV J3070 

Pentobarbital sodium per 50 mg IM, IV, OTH J2515 

Pentostatin per 10 mg IV J9268 

Peforomist, see Formoterol fumarate 

Permapen, see Penicillin G benzathine 

Perphenazine, injection up to 5 mg IM, IV J3310 

Perphenazine, tablets 4 mg ORAL Q0175 

 8 mg ORAL Q0176 

Persantine IV, see Dipyridamole 

Pfizerpen, see Penicillin G potassium 
24

Pfizerpen A.S., see Penicillin G procaine 

Phenazine 25, see Promethazine HCl 

Phenazine 50, see Promethazine HCl 

Phenergan, see Promethazine HCl 

Phenobarbital sodium up to 120 mg IM, IV J2560 

Phentolamine mesylate up to 5 mg IM, IV J2760 

Phenylephrine HCl up to 1 ml SC, IM, IV J2370 

Phenytoin sodium per 50 mg IM, IV J1165 

Photofrin, see Porfimer sodium 

Phytonadione (Vitamin K) per 1 mg IM, SC, IV J3430 

Piperacillin/Tazobactam Sodium, injection 1.125 g IV J2543 

Pitocin, see Oxytocin 

Plantinol AQ, see Cisplatin 

Plas+SD, see Plasma, pooled multiple donor 

Plasma, cryoprecipitate reduced each unit P9044 

Plasma, pooled multiple donor, frozen, each unit IV P9023 

Platinol, see Cisplatin 

Plicamycin 2,500 mcg IV J9270 

Polocaine, see Mepivacaine 

Polycillin-N, see Ampicillin 

Porfimer Sodium 75 mg IV J9600 

Potassium chloride per 2 mEq IV J3480 

Pralidoxime chloride up to 1 g IV, IM, SC J2730 

Predalone-50, see Prednisolone acetate 

Predcor-25, see Prednisolone acetate 

Predcor-50, see Prednisolone acetate 

Predicort-50, see Prednisolone acetate 

Prednisone per 5 mg ORAL J7506 

Prednisolone, oral 5 mg ORAL J7510 

Prednisolone acetate up to 1 ml IM J2650 

Predoject-50, see Prednisolone acetate 

Pregnyl, see Chorionic gonadotropin 

Premarin Intravenous, see Estrogen, conjugated 

Prescription,chemotherapeutic,not otherwise specified ORAL J8999 

Prescription,nonchemotherapeutic,not otherwise specified ORAL J8499 

Primacor, see Milrinone lactate 

Primaxin I.M., see Cilastatin sodium, imipenem 

Primaxin I.V., see Cilastatin sodium, imipenem 

Priscoline HCl, see Tolazoline HCl 

Privigen 500 mg J1459 

Pro-Depo, see Hydroxyprogesterone Caproate 

Procainamide HCl up to 1 g IM, IV J2690 

Prochlorperazine up to 10 mg IM, IV J0780 

Prochlorperazine maleate, oral 5 mg ORAL Q0164 

 10 mg ORAL Q0165 
25

Profasi HP, see Chorionic gonadotropin 

Profilnine Heat-Treated, see Factor IX 

Progestaject, see Progesterone 

Progesterone per 50 mg J2675 

Prograf, see Tacrolimus, oral or parenteral 

Prokine, see Sargramostim (GM-CSF) 

Prolastin, see Alpha 1-proteinase inhibitor, human 

Proleukin, see Aldesleukin 

Prolixin Decanoate, see Fluphenazine decanoate 

Promazine HCl up to 25 mg IM J2950 

Promethazine HCl, injection up to 50 mg IM, IV J2550 

Promethazine HCl, oral 12.5 mg ORAL Q0169 

 25 mg ORAL Q0170 

Pronestyl, see Procainamide HCl 

Proplex T, see Factor IX 

Proplex SX-T, see Factor IX 

Propranolol HCl up to 1 mg IV J1800 

Prorex-25, see Promethazine HCl 

Prorex-50, see Promethazine HCl 

Prostaphlin, see Procainamide HCl 

Prostigmin, see Neostigmine methylsulfate 

Protamine sulfate per 10 mg IV J2720 

Protein C Concentrate 10 IU J2724 

Protirelin per 250 mcg IV J2725 

Prothazine, see Promethazine HCl 

Protopam Chloride, see Pralidoxime chloride 

Proventil, see Albuterol sulfate, compounded 

Prozine-50, see Promazine HCl 

Pulmicort Respules, see Budesonide 

Pyridoxine HCl 100 mg J3415 

Q

Quelicin, see Succinylcholine chloride 

Quinupristin/dalfopristin 500 mg(150/350) IV J2770 

R

Ranibizumab 0.1 mg J2778 

Ranitidine HCL, injection 25 mg IV, IM J2780 

Rapamune, see Sirolimus 

Rasburicase 0.5 mg J2783 

Reclast 1 mg J3488 

Recombinate, see Factor VIII 

Redisol, see Vitamin B-12 cyanocobalamin 
26

Regadenoson 0.1 mg J2785 

Regitine, see Phentolamine mesylate 

Reglan, see Metoclopramide HCl 

Regular, see Insulin 

Relefact TRH, see Protirelin 

Remicade, see Infliximab, injection 

Reo Pro, see Abciximab 

Rep-Pred 40, see Methylprednisolone acetate 

Rep-Pred 80, see Methylprednisolone acetate 

RespiGam, see Respiratory Syncytial Virus 

Respiratory Syncytial Virus Immuneglobulin 50 mg IV J1565 

Retavase, see Reteplase 

Reteplase 18.8 mg IV J2993 

Retrovir, see Zidovudine 

Rheomacrodex, see Dextran 40 

Rhesonativ, see Rho(D) immune globulin, human 

Rheumatrex Dose Pack, see Methotrexate, oral 

Rho(D) immune globulin J2791 

Rho(D) immune globulin, human 1 dose package, 300 mcg IM J2790 

 50 mg J2788 

Rho(D)immune globulin, human,solvent detergent 100 IU IV J2792 

RhoGAM, see Rho(D) immune globulin, human 

Rhophylac 100 IU J2791 

Ringers lactate infusion up to 1,000 cc IV J7120 

Risperidone 0.5 mg J2794 

Rituxan, see Rituximab 

Rituximab 100 mg IV J9310 

Robaxin, see Methocarbamol 

Rocephin, see Ceftriaxone sodium 

Roferon-A, see Interferon alfa-2A, recombinant 

Ropivacaine Hydrochloride 1 mg J2795 

Rubex, see Doxorubicin HCl 

Rubramin PC, see Vitamin B-12 cyanocobalamin 

S

Saline solution 5% dextrose, 500 ml IV J7042 

infusion, 250 cc IV J7050 

infusion, 1,000 cc IV J7030 

Saline solution, sterile 500 ml = 1 unit IV, OTH J7040 

Sandimmune, see Cyclosporine 

Sandoglobulin, see Immune globulin intravenous (human) 

Sandostatin Lar Depot, see Octreotide 

Sargramostim (GM-CSF) 50 mcg IV J2820 

Selestoject, see Betamethasone sodium phosphate 

Sermorelin acetate 1 mcg Q0515 
27

Sincalide 5 mcg J2805 

Sinusol-B, see Brompheniramine maleate 

Sirolimus 1 mg Oral J7520 

Sodium ferricgluconate in sucrose 12.5 mg J2916 

Sodium Hyaluronate 

 Euflexxa J7323 

 Hyalgan J7321 

 Orthovisc J7324 

 Supartz J7321 

Solganal, see Aurothioglucose 

Solu-Cortef, see Hydrocortisone sodium phosphate (J1710) 

Solu-Medrol, see Methylprednisolone sodium succinate 

Solurex, see Dexamethasone sodium phosphate 

Solurex LA, see Dexamethasone acetate 

Somatrem 1 mg J2940 

Somatropin 1 mg J2941 

Somatulin Depot, see Lanreotide 

Sparine, see Promazine HCl 

Spasmoject, see Dicyclomine HCl 

Spectinomycin HCl up to 2 g IM J3320 

Sporanox, see Itraconazole 

Staphcillin, see Methicillin sodium 

Stilphostrol, see Diethylstilbestrol diphosphate 

Streptase, see Streptokinase 

Streptokinase per 250,000 IU IV J2995 

Streptomycin Sulfate, see Streptomycin 

Streptomycin up to 1 g IM J3000 

Streptozocin 1 gm IV J9320 

Strontium-89 chloride per millicurie A9600 

Sublimaze, see Fentanyl citrate 

Succinylcholine chloride up to 20 mg IV, IM J0330 

Sumatriptan succinate 6 mg SC J3030 

Supartz J7321 

Surostrin, see Succinycholine chloride 

Sus-Phrine, see Adrenalin, epinephrine 

Synercid, see Quinupristin/dalfopristin 

Synkavite, see Vitamin K, phytonadione, etc. 

Syntocionon, see Oxytocin 

Synvisc J7322 

Sytobex, see Vitamin B-12 cyanocobalamin 

T

Tacrolimus, oral per 1 mg ORAL J7507 

Tacrolimus, parenteral 5 mg J7525 

Talwin, see Pentazocine Hcl 
28

Taractan, see Chlorprothixene 

Taxol, see Paclitaxel 

Taxotere, see Docetaxel 

Tazidime, see Ceftazidime Technetium TC Sestambi per dose A9500 

TEEV, see Testosterone enanthate and estradiol valerate 

Temozolmide 5 mg ORAL J8700 

Temsirolimus 1 mg J9330 

Tenecteplase 1 mg J3101 

Teniposide 50 mg Q2017 

Tequin, see Gatifloxacin 

Terbutaline sulfate up to 1 mg SC, IV J3105 

Terbutaline sulfate, concentrated form per 1 mg INH J7680 

Terbutaline sulfate, unit dose form per 1 mg INH J7681 

Teriparatide 10 mcg J3110 

Terramycin IM, see Oxytetracycline HCl 

Testa-C, see Testosterone cypionate 

Testadiate, see Testosterone enanthate and estradiol valerate 

Testadiate-Depo, see Testosterone cypionate 

Testaject-LA, see Testosterone cypionate 

Testaqua, see Testosterone suspension 

Test-Estro Cypionates, see Testosterone cypionate and estradiol cypionate 

Test-Estro-C, see Testosterone cypionate and estradiol cypionate 

Testex, see Testosterone propionate 

Testoject-50, see Testosterone suspension 

Testoject-LA, see Testosterone cypionate 

Testone LA 200, see Testosterone enanthate 

Testone LA 100, see Testosterone enanthate 

Testosterone Aqueous, see Testosterone suspension 

Testosterone enanthate and estradiol valerate up to 1 cc IM J0900 

Testosterone enanthate up to 100 mg IM J3120 

up to 200 mg IM J3130 

Testosterone cypionate up to 100 mg IM J1070 

1 cc, 200 mg IM J1080 

Testosterone cypionate and estradiol cypionate up to 1 ml IM J1060 

Testosterone propionate up to 100 mg IM J3150 

Testosterone suspension up to 50 mg IM J3140 

Testradiol 90/4, see Testosterone enanthate and estradiol valerate 

Testrin PA, see Testosterone enanthate 

Tetanus immune globulin, human up to 250 units IM J1670 

Tetracycline up to 250 mg IM, IV J0120 

Thallous Chloride TL 201 per MCI A9505 

Theelin Aqueous, see Estrone 

Theophylline per 40 mg IV J2810 

TheraCys, see BCG live 

Thiamine HCl 100 mg J3411 
29

Thiethylperazine maleate, injection up to 10 mg IM J3280 

Thiethylperazine maleate, oral 10 mg ORAL Q0174 

Thiotepa 15 mg IV J9340 

Thorazine, see Chlorpromazine HCl 

Thymoglobulin, see Immune globulin, anti-thymocyte 

Thypinone, see Protirelin 

Thyrogen, see Thyrotropin Alfa 

Thyrotropin Alfa, injection 0.9 mg IM, SC J3240 

Tice BCG, see BCG live 

Ticon, see Trimethobenzamide HCl 

Tigan, see Trimethobenzamide HCl 

Tigecycline 1 mg J3243 

Tiject-20, see Trimethobenzamide HCl 

Tinzaparin 1000 IU SC J1655 

Tirofiban Hydrochloride, injection 0.25 mg IM, IV J3246 

TNKase, see Tenecteplase 

Tobi, see Tobramycin, inhalation solution 

Tobramycin, inhalation solution 300 mg INH J7682, J7685 

Tobramycin sulfate up to 80 mg IM, IV J3260 

Tofranil, see Imipramine HCl 

Tolazoline HCl up to 25 mg IV J2670 

Topotecan 0.25 mg Oral J8705 

4 mg IV J9350 

Toradol, see Ketorolac tromethamine 

Torecan, see Thiethylperazine maleate 

Torisel, see Temsirolimus 

Tornalate, see Bitolterol mesylate 

Torsemide 10 mg/ml IV J3265 

Totacillin-N, see Ampicillin 

Trastuzumab 10 mg IV J9355 

Treanda, see Bendamustine HCl 

Treprostinil 1 mg J3285 

Tri-Kort, see Triamcinolone acetonide 

Triam-A, see Triamcinolone acetonide 

Triamcinolone, concentrated form per 1 mg INH J7683 

Triamcinolone, unit dose per 1 mg INH J7684 

Triamcinolone acetonide 1 mg J3300 

 per 10 mg IM J3301 

Triamcinolone diacetate per 5 mg IM J3302 

Triamcinolone hexacetonide per 5 mg VAR J3303 

Triesence, see Triamcinolone acetonide 

Triflupromazine HCl up to 20 mg IM, IV J3400 

Trilafon, see Perphenazine 

Trilog, see Triamcinolone acetonide 

Trilone, see Triamcinolone diacetate 
30

Trimethobenzamide HCl, injection up to 200 mg IM J3250 

Trimethobenzamide HCl, oral 250 mg ORAL Q0173 

Trimetrexate glucuronate per 25 mg IV J3305 

Triptorelin Pamoate 3.75 mg J3315 

Trisenox, see Arsenic trioxide 

Trobicin, see Spectinomycin HCl 

Trovan, see Alatrofloxacin mesylate 

Tysabri, see Natalizumab 

U

Ultrazine-10, see Prochlorperazine 

Unasyn, see Ampicillin sodium/sulbactam sodium 

Unclassified drugs (see also Not elsewhere classified) J3490 

Unspecified oral antiemetic Q0181 

Urea up to 40 g IV J3350 

Ureaphil, see Urea 

Urecholine, see Bethanechol chloride 

Urofollitropin 75 iu J3355 

Urokinase 5,000 IU vial IV J3364 

250,000 IU vial IV J3365 

V

V-Gan 25, see Promethazine HCl 

V-Gan 50, see Promethazine HCl 

Valergen 10, see Estradiol valerate 

Valergen 20, see Estradiol valerate 

Valergen 40, see Estradiol valerate 

Valertest No. 1, see Testosterone enanthate and estradiol valerate 

Valertest No. 2, see Testosterone enanthate and estradiol valerate 

Valium, see Diazepam 

Valrubicin, intravesical 200 mg OTH J9357 

Valstar, see Valrubicin 

Vancocin, see Vancomycin HCl 

Vancoled, see Vancomycin HCl 

Vancomycin HCl 500 mg IV, IM J3370 

Vasoxyl, see Methoxamine HCl 

Velban, see Vinblastine sulfate 

Velsar, see Vinblastine sulfate 

Venofer, see Iron sucrose 

Ventolin, see Albuterol sulfate 

VePesid, see Etoposide and Etoposide, oral 
31

Versed, see Midazolam HCl 

Verteporfin 0.1 mg IV J3396 

Vesprin, see Triflupromazine HCl 

Viadur, see Leuprolide acetate implant 

Vinblastine sulfate 1 mg IV J9360 

Vincasar PFS, see Vincristine sulfate 

Vincristine sulfate 1 mg IV J9370 

 2 mg IV J9375 

 5 mg IV J9380 

Vinorelbine tartrate per 10 mg IV J9390 

Vistaject-25, see Hydroxyzine HCl 

Vistaril, see Hydroxyzine HCl 

Vistide, see cidofovir 

Visudyne, see Verteporfin 

Vitamin K, phytonadione, menadione, 

 menadiol sodium diphosphate per 1 mg IM, SC, IV J3430 

Vitamin B-12 cyanocobalamin up to 1,000 mcg IM, SC J3420 

Von Willebrand Factor Complex, human per IU VWF:RCo IV J7187 

Voriconazole 10 mg J3465 

W

Wehamine, see Dimenhydrinate 

Wehdryl, see Diphenhydramine HCl 

Wellcovorin, see Leucovorin calcium 

Win Rho SD, see Rho(D)immuglobulin, human, solvent detergent 

Wyamine Sulfate, see Mephentermine sulfate 

Wycillin, see Penicillin G procaine 

Wydase, see Hyaluronidase 

X

Xeloda, see Capecitabine 

Xopenex, see Albuterol 

Xylocaine HCl, see Lidocaine HCl 

Z

Zanosar, see Streptozocin 

Zantac, see Ranitidine HCL 

Zemplar, see Paricalcitol 

Zenapax, see Daclizumab 

Zetran, see Diazepam 

Ziconotide 1 mcg J2278 
32

Zidovudine 10 mg IV J3485 

Zinacef, see Cefuroxime sodium 

Ziprasidone Mesylate 10 mg J3486 

Zithromax, see Azithromycin dihydrate 

Zithromax I.V., see Azithromycin, injection 

Zofran, see Ondansetron HCl 

Zoladex, see Goserelin acetate implant 

Zoledronic Acid 1 mg J3487 

Zolicef, see Cefazolin sodium 

Zometa 1 mg J3487 

Zosyn, see Piperacillin 

Zyvox, see Linezolid 

Last Updated November 3, 2008