| Beta-Lactam Cephalosporins- First generation |
·
Cephalexin
Keflex
·
Cephradine Velosef
| Cephalosporins- Second generation |
·
Cefaclor
Ceclor
| Cephalosporins- Third Generation |
·
Cefdinir
Omnicef No
generic available
·
Cefixime Suprax No generic available
| Penicillins |
·
Amoxicillin Amoxil
·
Ampicillin
Principen
·
Amoxicillin/clavulanate Augementin
| Extended spectrum Penicillins |
·
Piperacillin
Pipracil
·
Cloxacillin Tegopen
·
Dicloxacillin Dynapen
| Other |
·
Loracarbef Lorabid
No generic available
| Macrolides- Erythromycins |
·
Erythromycin
ethylsuccinate EES
·
Erythromycin base E-Mycin
·
Erythromycin state
| Ketolides |
·
Telithromycin Ketek
No generic available
| Macrolides- non ketolides |
·
Azithromycin
Zithromax
no generic available
·
Clarithromycin Biaxen
| Quinolones |
·
Ofloxacin Floxin
·
Ciprofloxacin Cipro
·
Moxifloxin Avelox no generic available
| Non Fluorinated Quinolones |
·
Nalidixic acid NegGram
| Sulfonamides and combinations |
·
Sulfamethoxazole/trimethoprim Bactrim Septra
·
Erythromycin/sulfisoxazole
Pediazole
·
Sulfisoxazole Gantrisin
| Tetracyclines |
|
Doryx/Periostat not
covered |
·
Doxycycline
Vibramycin
·
Tetracycline Achromycin
| Other
Anti-folate |
·
Trimethoprim Trimpex
Proloprim no generic available
| Other glycopeptide |
|
Vancocin HCL 125mg
Quantity Limit 62 caps/30days |
|
b. Vancocin HCL 250mg Quantity Limit 62
caps/30days |
|
c. Vancocin HCL 250/5ml Quantity Limit
400ml/30 days |
·
Vancomycin
Vancocin
no generic available
| Other |
·
Clindamycin
Cleocin
| Nitrofurantoins |
·
Nitrofurantoin macro Macrodantin
| Oxazolidinones |
·
Linezolid
Zyvox no
generic available
| Miscellaneous |
·
Bacitracin
·
Metronidazole Flagyl
·
Neomycin
·
Furazolidone
· Triple sulfa cream
Cephalosporins Macrolides Fluoroquinolones
| ANCEF INJ 10GM | 25.5000 |
| ANCEF INJ 1GM | 1.3389 |
| ANCEF INJ 1GM | 3.3048 |
| ANCEF INJ 500MG | 1.8666 |
| CECLOR CAP 250MG | 1.9818 |
| CECLOR CAP 500MG | 3.9536 |
| CECLOR SUS 125/5ML | 0.1763 |
| CECLOR SUS 187/5ML | 0.2645 |
| CECLOR SUS 250/5ML | 0.3195 |
| CECLOR SUS 375/5ML | 0.4792 |
| CEDAX CAP 400MG | 8.3411 |
| CEDAX SUS 90MG/5ML | 0.6957 |
| CEFACLOR CAP 250MG | 0.6784 |
| CEFACLOR CAP 500MG | 0.7157 |
| CEFACLOR SUS 125/5ML | 0.0868 |
| CEFACLOR SUS 187/5ML | 0.1389 |
| CEFACLOR SUS 250/5ML | 0.1393 |
| CEFACLOR SUS 375/5ML | 0.1393 |
| CEFACLOR ER TAB | 2.8448 |
| CEFADROXIL CAP 500MG | 0.9602 |
| CEFADROXIL TAB 1GM | 4.2120 |
| CEFADYL INJ 1GM | 1.3974 |
| CEFAZOLIN INJ 10GM | 27.3975 |
| CEFAZOLIN INJ 1GM | 2.0625 |
| CEFAZOLIN INJ 1GM | 3.1137 |
| CEFAZOLIN INJ 1GM/50ML | 0.1190 |
| CEFAZOLIN INJ 20GM | 22.7348 |
| CEFAZOLIN INJ 300GM | 0.9563 |
| CEFAZOLIN INJ 500MG | 0.0893 |
| CEFAZOLIN INJ 500MG | 2.4195 |
| CEFAZOLIN INJ BULK | 1.0094 |
| CEFAZOLIN SO SOL DEXTROSE | 0.1122 |
| CEFIZOX INJ 10GM | 92.4766 |
| CEFIZOX INJ 1GM | 9.6815 |
| CEFIZOX INJ 1GM PB | 10.4550 |
| CEFIZOX INJ 2GM | 17.9690 |
| CEFIZOX INJ 2GM | 19.5925 |
| CEFIZOX/D5W INJ 1GM | 0.2377 |
| CEFIZOX/D5W INJ 2GM | 0.4036 |
| CEFOBID/DEX INJ 1GM | 0.2836 |
| CEFOBID/DEX INJ 2GM | 0.5228 |
| CEFOTAN INJ 10G/100M | 120.7425 |
| CEFOTAN INJ 1GM/10ML | 11.9323 |
| CEFOTAN INJ 1GM/15ML | 12.3889 |
| CEFOTAN INJ 1GM/50ML | 0.2846 |
| CEFOTAN INJ 2GM/15ML | 24.7880 |
| CEFOTAN INJ 2GM/20ML | 23.8748 |
| CEFOTAN INJ 2GM/50ML | 0.5692 |
| CEFOTAXIME INJ 10GM | 66.5160 |
| CEFOTAXIME INJ 1GM | 8.2500 |
| CEFOTAXIME INJ 20GM | 144.5000 |
| CEFOTAXIME INJ 2GM | 16.5000 |
| CEFOTAXIME INJ 500MG | 5.4375 |
| CEFOXITIN INJ 100GM | 4.5156 |
| CEFOXITIN INJ 10GM | 84.3750 |
| CEFOXITIN INJ 1GM | 8.4375 |
| CEFOXITIN INJ 2GM | 16.8750 |
| CEFPODOXIME TAB 100MG | 3.1526 |
| CEFPODOXIME TAB 200MG | 4.1284 |
| CEFTAZIDIME INJ 100GM | 7.3180 |
| CEFTIN SUS 125MG | 0.4815 |
| CEFTIN SUS 250MG | 0.8197 |
| CEFTIN TAB 250MG | 5.7133 |
| CEFTIN TAB 500MG | 10.4100 |
| CEFUROX/DEXT INJ 1.5GM | 0.2856 |
| CEFUROXIME INJ 1.5GM | 0.2766 |
| CEFUROXIME INJ 225GM | 3.7778 |
| CEFUROXIME INJ 7.5GM | 0.3281 |
| CEFUROXIME INJ 75 | 3.8958 |
| CEFUROXIME INJ 750MG | 0.2813 |
| CEFUROXIME TAB 250MG | 2.0417 |
| CEFUROXIME TAB 500MG | 3.7333 |
| CEFZIL SUS 125/5ML | 0.3953 |
| CEFZIL SUS 250/5ML | 0.7161 |
| CEFZIL TAB 250MG FC | 4.1358 |
| CEFZIL TAB 500MG FC | 8.5413 |
| CEPHALEXIN CAP 250MG | 0.2200 |
| CEPHALEXIN CAP 500MG | 0.2388 |
| CEPHALEXIN SUS 125/5ML | 0.0591 |
| CEPHALEXIN SUS 250/5ML | 0.1079 |
| CEPHALEXIN TAB 250MG | 0.3705 |
| CEPHALEXIN TAB 250MG | 0.9733 |
| CEPHALEXIN TAB 500MG | 1.9127 |
| CEPHRADINE CAP 250MG | 0.4875 |
| CLAFORAN INJ 10GM | 75.3780 |
| CLAFORAN INJ 1GM | 9.0100 |
| CLAFORAN INJ 1GM | 9.9555 |
| CLAFORAN INJ 2GM | 18.1580 |
| CLAFORAN INJ 2GM | 18.9023 |
| CLAFORAN INJ 500MG | 6.1200 |
| CLAFORAN/D5W INJ 1GM | 0.2169 |
| CLAFORAN/D5W INJ 2GM | 0.3642 |
| DURICEF CAP 500MG | 8.0585 |
| DURICEF SUS 125/5ML | 0.1454 |
| DURICEF SUS 250/5ML | 0.5742 |
| DURICEF SUS 500/5ML | 0.7949 |
| DURICEF TAB 1GM | 15.1625 |
| FORTAZ INJ 1GM | 0.2878 |
| FORTAZ INJ 1GM | 12.0928 |
| FORTAZ INJ 1GM | 12.5011 |
| FORTAZ INJ 2GM | 0.5296 |
| FORTAZ INJ 2GM | 24.1851 |
| FORTAZ INJ 2GM | 24.5939 |
| FORTAZ INJ 500MG | 6.0466 |
| FORTAZ INJ 6GM | 70.3800 |
| KEFLEX CAP 250MG | 1.5457 |
| KEFLEX CAP 500MG | 3.0382 |
| KEFLEX SUS 125/5ML | 0.2099 |
| KEFLEX SUS 250/5ML | 0.4196 |
| KEFUROX INJ 1.5GM | 10.4543 |
| KEFUROX INJ 7.5GM | 56.0547 |
| KEFUROX INJ 750MG | 5.4330 |
| MANDOL INJ 1GM | 7.7051 |
| MANDOL INJ 2GM | 15.4105 |
| MANDOL/D5W INJ 1GM | 0.1700 |
| MAXIPIME INJ 1GM | 16.1330 |
| MAXIPIME INJ 1GM | 16.7705 |
| MAXIPIME INJ 2GM | 32.0025 |
| MAXIPIME INJ 2GM | 32.6485 |
| MAXIPIME INJ 500MG | 8.1005 |
| MEFOXIN INJ 10GM | 101.4418 |
| MEFOXIN INJ 1GM | 10.1823 |
| MEFOXIN INJ 2GM | 20.2922 |
| MEFOXIN/DEX INJ 1GM | 0.2601 |
| MEFOXIN/DEX INJ 2GM | 0.4623 |
| OMNICEF CAP 300MG | 3.8115 |
| OMNICEF SUS 125MG/5 | 0.6021 |
| OMNICEF SUS 250MG/5 | 1.1742 |
| PANIXINE TAB 125MG | 0.3506 |
| PANIXINE TAB 250MG | 0.6885 |
| RANICLOR CHW 125MG | 0.9098 |
| RANICLOR CHW 187MG | 1.3647 |
| RANICLOR CHW 250MG | 1.6229 |
| RANICLOR CHW 375MG | 2.4344 |
| ROCEPHIN INJ 10GM | 423.5125 |
| ROCEPHIN INJ 1GM | 44.4890 |
| ROCEPHIN INJ 1GM | 44.8503 |
| ROCEPHIN INJ 250MG | 15.0705 |
| ROCEPHIN INJ 2GM | 86.3303 |
| ROCEPHIN INJ 2GM | 88.5777 |
| ROCEPHIN INJ 500MG | 26.4605 |
| ROCEPHIN/DEX INJ 1GM | 0.6831 |
| ROCEPHIN/DEX INJ 2GM | 1.1997 |
| SPECTRACEF TAB 200MG | 1.7649 |
| SUPRAX SUS 100/5ML | 0.7626 |
| TAZICEF INJ 1GM | 10.8282 |
| TAZICEF INJ 1GM PBK | 10.8285 |
| TAZICEF INJ 1GM/50ML | 0.2848 |
| TAZICEF INJ 2GM | 22.2285 |
| TAZICEF INJ 2GM | 22.5000 |
| TAZICEF INJ 2GM/50ML | 0.5241 |
| TAZICEF INJ 6GM | 62.1848 |
| VANTIN SUS 100/5ML | 0.8942 |
| VANTIN SUS 50MG/5ML | 0.4700 |
| VANTIN TAB 100MG | 4.1684 |
| VANTIN TAB 200MG | 5.5076 |
| VELOSEF CAP 250MG | 0.8399 |
| VELOSEF CAP 500MG | 1.6497 |
| VELOSEF SUS 250/5ML | 0.1711 |
| ZINACEF INJ 1.5GM | 11.4390 |
| ZINACEF INJ 1.5GM | 11.8482 |
| ZINACEF INJ 750MG | 5.7491 |
| ZINACEF INJ 750MG | 6.1574 |
| ZINACEF/D5W INJ 750MG PB | 0.1609 |
| ZINACEF/H20 INJ 1.5GM PB | 0.2747 |
| BIAXIN SUS 125/5ML | 0.3171 |
| BIAXIN SUS 250/5ML | 0.6044 |
| BIAXIN TAB 250MG | 3.6672 |
| BIAXIN TAB 500MG | 3.6672 |
| BIAXIN XL TAB 500MG | 3.8489 |
| CLARITHROMYC SUS 125/5ML | 0.2749 |
| CLARITHROMYC SUS 250/5ML | 0.5240 |
| CLARITHROMYC TAB 250MG | 3.1789 |
| CLARITHROMYC TAB 500MG | 3.1789 |
| DYNABAC TAB 250MG EC | 3.7069 |
| E.E.S. GRAN SUS 200/5ML | 0.0696 |
| ERYC CAP 250MG EC | 0.5434 |
| ERYPED DRO 100/2.5 | 0.1222 |
| ERYPED 400 SUS 400/5ML | 0.1199 |
| ERY-TAB TAB 250MG EC | 0.2245 |
| ERY-TAB TAB 333MG EC | 0.3305 |
| ERY-TAB TAB 500MG EC | 0.3789 |
| ERYTHROCIN INJ 1000MG | 6.5875 |
| ERYTHROCIN TAB 250MG | 0.0833 |
| ERYTHROCIN TAB 500MG | 0.1824 |
| ERYTHROM EST SUS 125/5ML | 0.0413 |
| ERYTHROM EST SUS 125/5ML | 0.0816 |
| ERYTHROM EST SUS 250/5ML | 0.1200 |
| ERYTHROM ETH SUS 200/5ML | 0.0283 |
| ERYTHROM ETH SUS 200/5ML | 0.0331 |
| ERYTHROM ETH SUS 400/5ML | 0.0520 |
| ERYTHROM ETH TAB 400MG | 0.1400 |
| ERYTHROM LAC INJ 500MG | 3.8301 |
| ERYTHROMYCIN CAP 250MG EC | 0.1774 |
| ERYTHROMYCIN TAB 250MG | 0.1318 |
| ERYTHROMYCIN TAB BS 500MG | 0.2421 |
| PCE TAB 333MG EC | 1.7120 |
| PCE TAB 500MG EC | 2.2580 |
| ZITHROMAX INJ 500MG | 24.8413 |
| ZITHROMAX POW 1GM PAK | 20.6848 |
| ZITHROMAX SUS 100/5ML | 1.8804 |
| ZITHROMAX SUS 200/5ML | 1.2536 |
| ZITHROMAX TAB 600MG | 15.9834 |
| ZITHROMAX TAB TRI-PAK | 13.3193 |
| ZITHROMAX TAB Z-PAK | 6.6597 |
| ZMAX SUS 2GM | 44.1065 |
| AVELOX INJ | 0.1488 |
| AVELOX TAB 400MG | 8.1763 |
| CIPRO SUS 10GM/100 | 1.1177 |
| CIPRO SUS 10GM/100 | 1.1623 |
| CIPRO SUS 5G/100ML | 0.9546 |
| CIPRO SUS 5G/100ML | 0.9928 |
| CIPRO TAB 250MG | 4.3388 |
| CIPRO TAB 500MG | 5.0788 |
| CIPRO TAB 750MG | 5.3266 |
| CIPRO CYSTIT TAB 100MG | 3.2952 |
| CIPRO I.V. INJ 1200/1% | 0.5506 |
| CIPRO I.V. SOL 400MG | 0.1276 |
| CIPRO XR TAB 1000MG | 8.3832 |
| CIPRO XR TAB 500MG | 7.3632 |
| CIPROFLOXACN TAB 100MG | 2.8645 |
| CIPROFLOXACN TAB 250MG | 0.4100 |
| CIPROFLOXACN TAB 500MG | 0.4500 |
| CIPROFLOXACN TAB 750MG | 1.0780 |
| FACTIVE TAB 320MG | 17.4573 |
| FLOXIN TAB 200MG | 4.7847 |
| FLOXIN TAB 300MG | 5.6942 |
| FLOXIN TAB 400MG | 6.0051 |
| LEVAQUIN INJ 25MG/ML | 1.7167 |
| LEVAQUIN SOL 25MG/ML | 0.6212 |
| LEVAQUIN TAB 250MG | 8.6838 |
| LEVAQUIN TAB 500MG | 9.9525 |
| LEVAQUIN TAB 750MG | 18.6401 |
| LEVAQUIN/D5W INJ 750/150 | 0.3433 |
| MAXAQUIN TAB 400MG | 6.4468 |
| NOROXIN TAB 400MG | 3.4446 |
| OFLOXACIN TAB 200MG | 3.2170 |
| OFLOXACIN TAB 300MG | 3.8860 |
| OFLOXACIN TAB 400MG | 3.5100 |
| TEQUIN INJ 10MG/ML | 0.8084 |
| TEQUIN INJ 2MG/ML | 0.1684 |
| TEQUIN TAB 200MG | 8.7176 |
| TEQUIN TAB 400MG | 8.7174 |
| ZAGAM TAB 200MG | 5.6814 |