<?xml version="1.0"?>
<formulary name="Prince Edward Island, June 16, 2000">
<category name="04:00 ANTIHISTAMINES">
<drug name="CETIRIZINE">
<form name="10MG TABLET" notinterchangeable="no">
<product din="01900986">
<brand>REACTINE</brand>
<company>PFI</company>
<drugprograms>W</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02231603">
<brand>APO-CETIRIZINE</brand>
<company>APX</company>
<drugprograms>W</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="DIPHENHYDRAMINE HCL">
<form name="25MG CAPSULE" notinterchangeable="no">
<product din="00757683">
<brand>PMS-DIPHENHYDRAMINE</brand>
<company>PMS</company>
<drugprograms>W</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="50MG CAPSULE" notinterchangeable="no">
<product din="00757691">
<brand>PMS-DIPHENHYDRAMINE</brand>
<company>PMS</company>
<drugprograms>W</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="12.5MG/5ML ELIXIR" notinterchangeable="no">
<product din="00792705">
<brand>PMS-DIPHENHYDRAMINE</brand>
<company>PMS</company>
<drugprograms>W</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="LORATIDINE">
<form name="10MG TABLET	" notinterchangeable="no">
<product din="00782696">
<brand>CLARITIN</brand>
<company>SCH</company>
<drugprograms>W</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
</category>
<category name="08:08.00 ANTHELMINTICS">
<drug name="MEBENDAZOLE">
<form name="100MG TABLET	" notinterchangeable="no">
<product din="00556734">
<brand>VERMOX</brand>
<company>JAN</company>
<drugprograms>FW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="PIPERAZINE ADIPATE">
<form name="2G/PACKAGE ORAL GRANULES	" notinterchangeable="no">
<product din="02100215">
<brand>ENTACYL</brand>
<company>RBP</company>
<drugprograms>W</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="120MG/ML ORAL SUSPENSION	" notinterchangeable="no">
<product din="02100223">
<brand>ENTACYL</brand>
<company>RBP</company>
<drugprograms>W</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
</category>
<category name="08:12.00 ANTIBIOTICS">
</category>
<category name="08:12.02 ANTIBIOTICS AMINOGLYCOSIDES">
<drug name="GENTAMICIN SULFATE">
<form name="80MG/2ML INJECTION SOLUTION (2ML)" notinterchangeable="no">
<product din="00223824">
<brand>GARAMYCIN</brand>
<company>SCH</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02145758">
<brand>GENTAMICIN SULFATE</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="TOBRAMYCIN">
<form name="80MG/2ML INJECTION SOLUTION (2ML)" notinterchangeable="no">
<product din="00325449">
<brand>NEBCIN</brand>
<company>LIL</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02230640">
<brand>SCHEINPHARM TOBRAMYCIN</brand>
<company>SCN</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02241210">
<brand>TOBRAMYCIN</brand>
<company>SAB</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
</category>
<category name="08:12.04 ANTIBIOTICS ANTIFUNGALS">
<drug name="GRISEOFULVIN">
<form name="250MG TABLET" notinterchangeable="no">
<product din="00028274">
<brand>FULVICIN U/F</brand>
<company>SCH</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="500MG TABLET" notinterchangeable="no">
<product din="00028282">
<brand>FULVICIN U/F</brand>
<company>SCH</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
</category>
<category name="08:12.04 ANTIBIOTICS ANTIFUNGALS">
<drug name="KETOCONAZOLE">
<notes>SEE APPENDIX A FOR EDS CRITERIA</notes>
<form name="200MG TABLET" notinterchangeable="no">
<product din="00633836">
<brand>NIZORAL </brand>
<company>JAN</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
<product din="02122197">
<brand>NU-KETOCON </brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
<product din="02231061">
<brand>NOVO-KETOCONAZOLE </brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
<product din="02237235">
<brand>APO-KETOCONAZOLE </brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
</drug>
<drug name="NYSTATIN">
<form name="100,000U/ML ORAL SUSPENSION" notinterchangeable="no">
<product din="00248169">
<brand>MYCOSTATIN</brand>
<company>BMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00779121">
<brand>NYADERM</brand>
<company>TAR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00792667">
<brand>NYSTATIN</brand>
<company>PMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02194201">
<brand>NILSTAT</brand>
<company>TCH</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="500,000U TABLET" notinterchangeable="no">
<product din="02194198">
<brand>NILSTAT</brand>
<company>TCH</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
</category>
<category name="08:12.06 ANTIBIOTICS CEPHALOSPORINS">
<drug name="CEFUROXIME AXETIL">
<notes>SEE APPENDIX A FOR EDS CRITERIA</notes>
<form name="25MG/ML ORAL SUSPENSION" notinterchangeable="no">
<product din="02212307">
<brand>CEFTIN </brand>
<company>GLA</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
<form name="50MG/ML ORAL SUSPENSION" notinterchangeable="no">
<product din="02212293">
<brand>CEFTIN </brand>
<company>GLA</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
<form name="250MG TABLET" notinterchangeable="no">
<product din="02212277">
<brand>CEFTIN </brand>
<company>GLA</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
<form name="500MG TABLET" notinterchangeable="no">
<product din="02212285">
<brand>CEFTIN </brand>
<company>GLA</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
</drug>
<drug name="CEPHALEXIN MONOHYDRATE">
<form name="25MG/ML ORAL SUSPENSION" notinterchangeable="no">
<product din="00015547">
<brand>KEFLEX</brand>
<company>LIL</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00342106">
<brand>NOVO-LEXIN</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02177811">
<brand>PMS-CEPHALEXIN</brand>
<company>PMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="50MG/ML ORAL SUSPENSION" notinterchangeable="no">
<product din="00035645">
<brand>KEFLEX</brand>
<company>LIL</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00342092">
<brand>NOVO-LEXIN</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02177838">
<brand>PMS-CEPHALEXIN</brand>
<company>PMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="250MG CAPSULE" notinterchangeable="no">
<product din="00342084">
<brand>NOVO-LEXIN</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="500MG CAPSULE" notinterchangeable="no">
<product din="00342114">
<brand>NOVO-LEXIN</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="250MG TABLET" notinterchangeable="no">
<product din="00403628">
<brand>KEFLEX</brand>
<company>LIL</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00583413">
<brand>NOVO-LEXIN</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00768723">
<brand>APO-CEPHALEX</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00865877">
<brand>NU-CEPHALEX</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02177781">
<brand>PMS-CEPHALEXIN</brand>
<company>PMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="500MG TABLET" notinterchangeable="no">
<product din="00244392">
<brand>KEFLEX</brand>
<company>LIL</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00583421">
<brand>NOVO-LEXIN</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00768715">
<brand>APO-CEPHALEX</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00865885">
<brand>NU-CEPHALEX</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02177803">
<brand>PMS-CEPHALEXIN</brand>
<company>PMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
</category>
<category name="08:12.12 ANTIBIOTICS ERYTHROMYCINS">
<drug name="CLARITHROMYCIN">
<notes>SEE APPENDIX A FOR EDS CRITERIA</notes>
<form name="25MG/ML ORAL SUSPENSION" notinterchangeable="no">
<product din="02146908">
<brand>BIAXIN </brand>
<company>ABB</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
<form name="250MG TABLET" notinterchangeable="no">
<product din="01984853">
<brand>BIAXIN </brand>
<company>ABB</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
<form name="500MG TABLET" notinterchangeable="no">
<product din="02126710">
<brand>BIAXIN </brand>
<company>ABB</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
</drug>
</category>
<category name="08:12.12 ANTIBIOTICS ERYTHROMYCINS">
<drug name="ERYTHROMYCIN BASE">
<form name="250MG CAPSULE (ENTERIC COATED PELLETS)" notinterchangeable="no">
<product din="00607142">
<brand>ERYC</brand>
<company>PDA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00726672">
<brand>APO-ERYTHRO E-C</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00878669">
<brand>NOVO-RYTHRO ENCAP</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="333MG CAPSULE (ENTERIC COATED PELLETS)" notinterchangeable="no">
<product din="00873454">
<brand>ERYC</brand>
<company>PDA </company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="01925938">
<brand>APO-ERYTHRO E-C</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="250MG TABLET" notinterchangeable="no">
<product din="00244635">
<brand>ERYTHROMID</brand>
<company>ABB</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00682020">
<brand>APO-ERYTHRO</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="ERYTHROMYCIN ESTOLATE">
<form name="25MG/ML ORAL SUSPENSION" notinterchangeable="no">
<product din="00021172">
<brand>NOVO-RYTHRO ESTOLATE</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="50MG/ML ORAL SUSPENSION" notinterchangeable="no">
<product din="00262595">
<brand>NOVO-RYTHRO ESTOLATE</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="ERYTHROMYCIN ETHYLSUCCINATE">
<form name="40MG/ML ORAL SUSPENSION" notinterchangeable="no">
<product din="00000299">
<brand>EES-200</brand>
<company>ABB</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00605859">
<brand>NOVO-RYTHRO-EES</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="80MG/ML ORAL SUSPENSION" notinterchangeable="no">
<product din="00453617">
<brand>EES-400</brand>
<company>ABB</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00652318">
<brand>NOVO-RYTHRO-EES</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="600MG TABLET" notinterchangeable="no">
<product din="00583782">
<brand>EES-600</brand>
<company>ABB</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00637416">
<brand>AP0-ERYTHRO-ES</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
</category>
<category name="08:12.16 ANTIBIOTICS PENICILLINS">
<drug name="AMOXICILLIN">
<form name="25MG/ML ORAL SUSPENSION" notinterchangeable="no">
<product din="00452149">
<brand>NOVAMOXIN</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00628131">
<brand>APO-AMOXI</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00865540">
<brand>NU-AMOXI</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="01934171">
<brand>NOVAMOXIN SUGAR REDUCED</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02041316">
<brand>AMOXIL</brand>
<company>WAY</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02181509">
<brand>LIN-AMOX</brand>
<company>LIN</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="50MG/ML ORAL SUSPENSION" notinterchangeable="no">
<product din="00452130">
<brand>NOVAMOXIN</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00628158">
<brand>APO-AMOXI</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00865559">
<brand>NU-AMOXI</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="01934163">
<brand>NOVAMOXIN SUGAR REDUCED</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02042592">
<brand>AMOXIL</brand>
<company>WAY</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02181517">
<brand>LIN-AMOX</brand>
<company>LIN</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="250MG CAPSULE" notinterchangeable="no">
<product din="00406724">
<brand>NOVAMOXIN</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00628115">
<brand>APO-AMOXI</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00865567">
<brand>NU-AMOXI</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02041294">
<brand>AMOXIL</brand>
<company>WAY</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02181487">
<brand>LIN-AMOX</brand>
<company>LIN</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02238171">
<brand>GEN-AMOXICILLIN</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="500MG CAPSULE" notinterchangeable="no">
<product din="00406716">
<brand>NOVAMOXIN</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00628123">
<brand>APO-AMOXI</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00865575">
<brand>NU-AMOXI</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02041308">
<brand>AMOXIL</brand>
<company>WAY</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02181495">
<brand>LIN-AMOX</brand>
<company>LIN</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02238172">
<brand>GEN-AMOXICILLIN</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="AMOXICILLIN &amp; CLAVULANIC ACID">
<form name="25MG &amp; 6.25MG/ML ORAL SUSPENSION" notinterchangeable="no">
<product din="01916882">
<brand>CLAVULIN</brand>
<company>SKB</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="50MG &amp; 12.5MG/ML ORAL SUSPENSION" notinterchangeable="no">
<product din="01916874">
<brand>CLAVULIN</brand>
<company>SKB</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="250MG &amp; 125MG TABLET" notinterchangeable="no">
<product din="01916866">
<brand>CLAVULIN</brand>
<company>SKB</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="500MG &amp; 125MG TABLET" notinterchangeable="no">
<product din="01916858">
<brand>CLAVULIN</brand>
<company>SKB</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="AMPICILLIN">
<form name="25MG/ML ORAL SUSPENSION" notinterchangeable="no">
<product din="00021121">
<brand>NOVO-AMPICILLIN</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00603260">
<brand>APO-AMPI</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00717495">
<brand>NU-AMPI</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="50MG/ML ORAL SUSPENSION" notinterchangeable="no">
<product din="00021148">
<brand>NOVO-AMPICILLIN</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00603287">
<brand>APO-AMPI</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00717649">
<brand>NU-AMPI</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="250MG CAPSULE" notinterchangeable="no">
<product din="00020877">
<brand>NOVO-AMPICILLIN</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00603279">
<brand>APO-AMPI</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00717657">
<brand>NU-AMPI</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="500MG CAPSULE" notinterchangeable="no">
<product din="00020885">
<brand>NOVO-AMPICILLIN</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00603295">
<brand>APO-AMPI</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00717673">
<brand>NU-AMPI</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="CLOXACILLIN">
<form name="25MG/ML ORAL LIQUID" notinterchangeable="no">
<product din="00337757">
<brand>NOVO-CLOXIN</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00644633">
<brand>APO-CLOXI</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00717630">
<brand>NU-CLOXI</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="250MG CAPSULE" notinterchangeable="no">
<product din="00337765">
<brand>NOVO-CLOXIN</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00618292">
<brand>APO-CLOXI</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00717584">
<brand>NU-CLOXI</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="500MG CAPSULE" notinterchangeable="no">
<product din="00337773">
<brand>NOVO-CLOXIN</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00618284">
<brand>APO-CLOXI</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00717592">
<brand>NU-CLOXI</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
</category>
<category name="08:12.16 ANTIBIOTICS PENICILLINS">
<drug name="PENICILLIN V (BENZATHINE)">
<form name="36MG/ML ORAL SUSPENSION" notinterchangeable="no">
<product din="02229618">
<brand>PEN-VEE</brand>
<company>LIH</company>
<drugprograms>FW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="60MG/ML ORAL SUSPENSION" notinterchangeable="no">
<product din="02229617">
<brand>PEN-VEE</brand>
<company>LIH</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="PENICILLIN V (POTASSIUM)">
<form name="300MG TABLET" notinterchangeable="no">
<product din="00021202">
<brand>NOVO-PEN-VK</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00642215">
<brand>APO-PEN VK</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00717568">
<brand>NU-PEN VK</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
</category>
<category name="08:12.24 ANTIBIOTICS TETRACYCLINES">
<drug name="DOXYCYCLINE">
<form name="100MG CAPSULE" notinterchangeable="no">
<product din="00024368">
<brand>VIBRAMYCIN</brand>
<company>PFI</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00725250">
<brand>NOVO-DOXYLIN</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00740713">
<brand>APO-DOXY</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00817120">
<brand>DOXYCIN</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02044668">
<brand>NU-DOXYCYCLINE</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02093103">
<brand>DOXYTEC</brand>
<company>TCH</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02140039">
<brand>ALTI-DOXYCYCLINE</brand>
<company>ALT</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="100 MG TABLET" notinterchangeable="no">
<product din="00578452">
<brand>VIBRA-TABS</brand>
<company>PFI</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00860751">
<brand>DOXYCIN</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00874256">
<brand>APO-DOXY</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02044676">
<brand>NU-DOXYCYCLINE</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02091232">
<brand>DOXYTEC</brand>
<company>TCH</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02142058">
<brand>ALTI-DOXYCYCLINE</brand>
<company>ALT</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02158574">
<brand>NOVO-DOXYLIN</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
</category>
<category name="08:12.24 ANTIBIOTICS TETRACYCLINES">
<drug name="MINOCYCLINE HCL">
<notes>SEE APPENDIX A FOR EDS CRITERIA</notes>
<form name="50MG CAPSULE" notinterchangeable="no">
<product din="01914138">
<brand>ALTI-MINOCYCLINE </brand>
<company>ALT</company>
<drugprograms>FW</drugprograms>
<exceptional>yes</exceptional>
</product>
<product din="02084090">
<brand>APO-MINOCYCLINE </brand>
<company>APX</company>
<drugprograms>FW</drugprograms>
<exceptional>yes</exceptional>
</product>
<product din="02108143">
<brand>NOVO-MINOCYCLINE </brand>
<company>NOP</company>
<drugprograms>FW</drugprograms>
<exceptional>yes</exceptional>
</product>
<product din="02173514">
<brand>MINOCIN </brand>
<company>WAY</company>
<drugprograms>FW</drugprograms>
<exceptional>yes</exceptional>
</product>
<product din="02230735">
<brand>GEN-MINOCYCLINE </brand>
<company>GPM</company>
<drugprograms>FW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
<form name="100MG CAPSULE" notinterchangeable="no">
<product din="01914146">
<brand>ALTI-MINOCYCLINE </brand>
<company>ALT</company>
<drugprograms>FW</drugprograms>
<exceptional>yes</exceptional>
</product>
<product din="02084104">
<brand>APO-MINOCYCLINE </brand>
<company>APX</company>
<drugprograms>FW</drugprograms>
<exceptional>yes</exceptional>
</product>
<product din="02108151">
<brand>NOVO-MINOCYCLINE </brand>
<company>NOP</company>
<drugprograms>FW</drugprograms>
<exceptional>yes</exceptional>
</product>
<product din="02173506">
<brand>MINOCIN </brand>
<company>WAY</company>
<drugprograms>FW</drugprograms>
<exceptional>yes</exceptional>
</product>
<product din="02230736">
<brand>GEN-MINOCYCLINE </brand>
<company>GPM</company>
<drugprograms>FW</drugprograms>
<exceptional>yes</exceptional>
</product>
<product din="02239982">
<brand>SCHEINPHARM MINOCYCLINE </brand>
<company>SCN</company>
<drugprograms>FW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
</drug>
<drug name="TETRACYCLINE">
<form name="25MG/ML ORAL LIQUID" notinterchangeable="no">
<product din="00151416">
<brand>NOVO-TETRA</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="250MG CAPSULE" notinterchangeable="no">
<product din="00021059">
<brand>NOVO-TETRA</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00580929">
<brand>APO-TETRA</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00717606">
<brand>NU-TETRA</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
</category>
<category name="08:12.28 ANTIBIOTICS OTHER ANTIBIOTICS">
<drug name="CLINDAMYCIN HCL">
<form name="150MG CAPSULE" notinterchangeable="no">
<product din="00030570">
<brand>DALACIN C</brand>
<company>PHU</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="300MG CAPSULE" notinterchangeable="no">
<product din="02182866">
<brand>DALACIN C</brand>
<company>PHU</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="CLINDAMYCIN PALMITATE HCL">
<form name="15MG/ML ORAL SOLUTION" notinterchangeable="no">
<product din="00225851">
<brand>DALACIN C</brand>
<company>PHU</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
</category>
<category name="08:12.28 ANTIBIOTICS OTHER ANTIBIOTICS">
<drug name="VANCOMYCIN HCL">
<notes>SEE APPENDIX A FOR EDS CRITERIA</notes>
<form name="125MG CAPSULE" notinterchangeable="no">
<product din="00800430">
<brand>VANCOCIN </brand>
<company>LIL</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
<form name="250MG CAPSULE" notinterchangeable="no">
<product din="00788716">
<brand>VANCOCIN </brand>
<company>LIL</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
</drug>
</category>
<category name="08:18.00 ANTIVIRALS">
<drug name="ACYCLOVIR">
<form name="200MG TABLET" notinterchangeable="no">
<product din="00634506">
<brand>ZOVIRAX</brand>
<company>GLA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02078627">
<brand>AVIRAX </brand>
<company>TCH</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02197405">
<brand>NU-ACYCLOVIR</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02207621">
<brand>APO-ACYCLOVIR</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02229707">
<brand>ALTI-ACYCLOVIR </brand>
<company>ALT </company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="400MG TABLET" notinterchangeable="no">
<product din="01911627">
<brand>ZOVIRAX</brand>
<company>GLA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02078635">
<brand>AVIRAX </brand>
<company>TCH</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02197413">
<brand>NU-ACYCLOVIR</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02207648">
<brand>APO-ACYCLOVIR</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02229708">
<brand>ALTI-ACYCLOVIR</brand>
<company>ALT</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="800MG TABLET" notinterchangeable="no">
<product din="01911635">
<brand>ZOVIRAX </brand>
<company>GLA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02078651">
<brand>AVIRAX </brand>
<company>TCH</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02197421">
<brand>NU-ACYCLOVIR</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02207656">
<brand>APO-ACYCLOVIR</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02229709">
<brand>ALTI-ACYCLOVIR</brand>
<company>ALT</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="FAMCICLOVIR">
<form name="500MG TABLET" notinterchangeable="no">
<product din="02177102">
<brand>FAMVIR</brand>
<company>SKB</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="VALACYCLOVIR">
<form name="500MG CAPLET" notinterchangeable="no">
<product din="02219492">
<brand>VALTREX</brand>
<company>GLA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
</category>
<category name="08:20.00 PLASMODICIDES (ANTIMALARIALS)">
<drug name="CHLOROQUINE PHOSPHATE">
<form name="250MG TABLET" notinterchangeable="no">
<product din="00021261">
<brand>NOVO-CHLOROQUINE</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02017539">
<brand>ARALEN</brand>
<company>SAW</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="HYDROXYCHLOROQUINE SULFATE">
<form name="200MG TABLET" notinterchangeable="no">
<product din="02017709">
<brand>PLAQUENIL</brand>
<company>SAW</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="QUININE SULFATE">
<form name="200MG CAPSULE" notinterchangeable="no">
<product din="00021008">
<brand>NOVO-QUININE</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00695440">
<brand>QUININE</brand>
<company>ODN</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="300MG CAPSULE" notinterchangeable="no">
<product din="00021016">
<brand>NOVO-QUININE</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00695459">
<brand>QUININE</brand>
<company>ODN</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
</category>
<category name="08:22.00 QUINOLONES">
<drug name="CIPROFLOXACIN">
<notes>SEE APPENDIX A FOR EDS CRITERIA</notes>
<form name="100MG/ML ORAL SUSPENSION" notinterchangeable="no">
<product din="02237514">
<brand>CIPRO </brand>
<company>BAY</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
<form name="250MG TABLET" notinterchangeable="no">
<product din="02155958">
<brand>CIPRO </brand>
<company>BAY</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
<form name="500MG TABLET" notinterchangeable="no">
<product din="02155966">
<brand>CIPRO </brand>
<company>BAY</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
<form name="750MG TABLET" notinterchangeable="no">
<product din="02155974">
<brand>CIPRO </brand>
<company>BAY</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
</drug>
</category>
<category name="08:22.00 QUINOLONES">
<drug name="LEVOFLOXACIN">
<notes>SEE APPENDIX A FOR EDS CRITERIA </notes>
<form name="250MG TABLET" notinterchangeable="no">
<product din="02236841">
<brand>LEVAQUIN </brand>
<company>JAN</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
<form name="500MG TABLET" notinterchangeable="no">
<product din="02236842">
<brand>LEVAQUIN </brand>
<company>JAN</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
</drug>
<drug name="NORFLOXACIN">
<notes>SEE APPENDIX A FOR EDS CRITERIA </notes>
<form name="400MG TABLET" notinterchangeable="no">
<product din="00643025">
<brand>NOROXIN </brand>
<company>MSD</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
<product din="02229524">
<brand>APO-NORFLOX </brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
<product din="02237682">
<brand>NOVO-NORFLOXACIN </brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
</drug>
<drug name="OFLOXACIN">
<notes>SEE APPENDIX A FOR EDS CRITERIA </notes>
<form name="200MG TABLET" notinterchangeable="no">
<product din="01968424">
<brand>FLOXIN </brand>
<company>JAN</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
<product din="02231529">
<brand>APO-OFLOX </brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
<form name="300MG TABLET" notinterchangeable="no">
<product din="01968416">
<brand>FLOXIN </brand>
<company>JAN</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
<product din="02231531">
<brand>APO-OFLOX </brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
<form name="400MG TABLET" notinterchangeable="no">
<product din="01968408">
<brand>FLOXIN </brand>
<company>JAN</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
<product din="02231532">
<brand>APO-OFLOX </brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
</drug>
</category>
<category name="08:26.00 SULFONES">
<drug name="DAPSONE">
<form name="100MG TABLET" notinterchangeable="no">
<product din="02041510">
<brand>AVLOSULFON</brand>
<company>WAY</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
</category>
<category name="08:36.00 URINARY ANTI-INFECTIVES">
<drug name="NITROFURANTOIN">
<form name="5MG/ML ORAL SUSPENSION" notinterchangeable="no">
<product din="00232971">
<brand>NOVO-FURAN</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="50MG CAPSULE (MACROCRYSTALS)" notinterchangeable="no">
<product din="01997637">
<brand>MACRODANTIN</brand>
<company>ALZ</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02231015">
<brand>NOVO-FURANTOIN</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="50MG TABLET" notinterchangeable="no">
<product din="00021563">
<brand>NOVO-FURAN</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00319511">
<brand>APO-NITROFURANTOIN</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="100MG TABLET" notinterchangeable="no">
<product din="00021571">
<brand>NOVO-FURAN</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00312738">
<brand>APO-NITROFURANTOIN</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="TRIMETHOPRIM">
<form name="100MG TABLET" notinterchangeable="no">
<product din="00675229">
<brand>PROLOPRIM</brand>
<company>GLA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="200MG TABLET" notinterchangeable="no">
<product din="00677590">
<brand>PROLOPRIM</brand>
<company>GLA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
</category>
<category name="08:40.00 MISCELLANEOUS ANTI-INFECTIVES">
<drug name="ERYTHROMYCIN ETHYLSUCCINATE &amp; SULFISOXAZOLE ACETATE">
<form name="40MG &amp; 120MG/ML ORAL SUSPENSION" notinterchangeable="no">
<product din="00583405">
<brand>PEDIAZOLE</brand>
<company>ABB</company>
<drugprograms>FW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="METRONIDAZOLE ">
<form name="250MG TABLET" notinterchangeable="no">
<product din="00021555">
<brand>NOVO-NIDAZOL</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00545066">
<brand>APO-METRONIDAZOLE</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
</category>
<category name="08:40.00 MISCELLANEOUS ANTI-INFECTIVES">
<drug name="SULFAMETHOXAZOLE &amp; TRIMETHOPRIM">
<form name="40MG &amp; 8MG/ML ORAL SUSPENSION" notinterchangeable="no">
<product din="00270644">
<brand>SEPTRA</brand>
<company>GLA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00272485">
<brand>BACTRIM</brand>
<company>HLR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00726540">
<brand>NOVO-TRIMEL</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00846465">
<brand>APO-SULFATRIM</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00865753">
<brand>NU-COTRIMOX</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="400MG &amp; 80MG TAB" notinterchangeable="no">
<product din="00270636">
<brand>SEPTRA</brand>
<company>GLA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00445274">
<brand>APO-SULFATRIM</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00510637">
<brand>NOVO-TRIMEL</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00865710">
<brand>NU-COTRIMOX</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="800MG &amp; 160MG TAB" notinterchangeable="no">
<product din="00368040">
<brand>SEPTRA DS</brand>
<company>GLA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00371823">
<brand>BACTRIM DS</brand>
<company>HLR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00445282">
<brand>APO-SULFATRIM DS</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00510645">
<brand>NOVO-TRIMEL DS</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00865729">
<brand>NU-COTRIMOX DS</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
</category>
<category name="10:00.00 ANTINEOPLASTIC AGENTS">
<drug name="ANASTROZOLE">
<notes>SEE APPENDIX A FOR EDS CRITERIA</notes>
<form name="1MG TABLET" notinterchangeable="no">
<product din="02224135">
<brand>ARIMIDEX </brand>
<company>AZE</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
</drug>
<drug name="BUSULFAN">
<form name="2MG TABLET" notinterchangeable="no">
<product din="00004618">
<brand>MYLERAN</brand>
<company>GLA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="CHLORAMBUCIL">
<form name="2MG TABLET" notinterchangeable="no">
<product din="00004626">
<brand>LEUKERAN</brand>
<company>GLA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="CYCLOPHOSPHAMIDE">
<form name="25MG TABLET" notinterchangeable="no">
<product din="00262676">
<brand>PROCYTOX</brand>
<company>HOR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00344877">
<brand>CYTOXAN</brand>
<company>BMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="50MG TABLET" notinterchangeable="no">
<product din="00013749">
<brand>PROCYTOX</brand>
<company>HOR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00344885">
<brand>CYTOXAN</brand>
<company>BMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="CYPROTERONE ACETATE">
<form name="50MG TABLET" notinterchangeable="no">
<product din="00704431">
<brand>ANDROCUR</brand>
<company>BEX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02229449">
<brand>ALTI-CPA</brand>
<company>ALT</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02229723">
<brand>GEN-CYPROTERONE</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02232872">
<brand>NOVO-CYPROTERONE</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="FLUTAMIDE">
<form name="250MG TABLET" notinterchangeable="no">
<product din="00637726">
<brand>EUFLEX</brand>
<company>SCH</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02230104">
<brand>PMS-FLUTAMIDE</brand>
<company>PMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02230089">
<brand>NOVO-FLUTAMIDE</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02238560">
<brand>APO-FLUTAMIDE</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
</category>
<category name="10:00.00 ANTINEOPLASTIC AGENTS">
<drug name="GOSERELIN ACETATE">
<form name="3.6MG DEPOT INJECTION" notinterchangeable="no">
<product din="02049325">
<brand>ZOLADEX</brand>
<company>AZE</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="10.8MG DEPORT INJECTION" notinterchangeable="no">
<product din="02225905">
<brand>ZOLADEX LA</brand>
<company>AZE</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="HYDROXYUREA">
<form name="500MG CAPSULE" notinterchangeable="no">
<product din="00465283">
<brand>HYDREA</brand>
<company>BMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="LEUPROLIDE ACETATE">
<form name="7.5MG/ML DEPOT INJECTION" notinterchangeable="no">
<product din="00836273">
<brand>LUPRON DEPOT</brand>
<company>ABB</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="22.5MG/ML DEPOT INJECTION" notinterchangeable="no">
<product din="02230248">
<brand>LUPRON DEPOT</brand>
<company>ABB</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="MEDROXYPROGESTERONE ACETATE">
<form name="100MG TABLET" notinterchangeable="no">
<product din="00030945">
<brand>PROVERA</brand>
<company>PHU</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="MEGESTROL ACETATE">
<notes>SEE APENDIX A FOR EDS CRITERIA</notes>
<form name="40MG TABLET" notinterchangeable="no">
<product din="00386391">
<brand>MEGACE </brand>
<company>BMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
<product din="02176092">
<brand>LIN-MEGESTROL </brand>
<company>LIN</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
<product din="02185415">
<brand>NU-MEGESTROL </brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
<product din="02195917">
<brand>APO-MEGESTROL </brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
<form name="160MG TABLET" notinterchangeable="no">
<product din="00731323">
<brand>MEGACE </brand>
<company>BMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
<product din="02176106">
<brand>LIN-MEGESTROL </brand>
<company>LIN</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
<product din="02185423">
<brand>NU-MEGESTROL </brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
<product din="02195925">
<brand>APO-MEGESTROL </brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
</drug>
<drug name="MELPHALAN">
<form name="2MG TABLET" notinterchangeable="no">
<product din="00004715">
<brand>ALKERAN</brand>
<company>GLA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
</category>
<category name="10:00.00 ANTINEOPLASTIC AGENTS">
<drug name="MERCAPTOPURINE">
<form name="50MG TABLET" notinterchangeable="no">
<product din="00004723">
<brand>PURINETHOL</brand>
<company>GLA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="METHOTREXATE">
<form name="2.5MG TABLET" notinterchangeable="no">
<product din="02170698">
<brand>METHOTREXATE</brand>
<company>WAY</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02182963">
<brand>METHOTREXATE</brand>
<company>FAU</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="TAMOXIFEN CITRATE ">
<form name="10MG TABLET" notinterchangeable="no">
<product din="00812404">
<brand>APO-TAMOX</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00851965">
<brand>NOVO-TAMOXIFEN</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="01926624">
<brand>TAMOFEN</brand>
<company>RPR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02048477">
<brand>NOLVADEX</brand>
<company>AZE</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02088428">
<brand>GEN-TAMOXIFEN</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="20MG TABLET" notinterchangeable="no">
<product din="00812390">
<brand>APO-TAMOX</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00851973">
<brand>NOVO-TAMOXIFEN</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="01926632">
<brand>TAMOFEN</brand>
<company>RPR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02048485">
<brand>NOLVADEX D</brand>
<company>AZE</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02089858">
<brand>GEN-TAMOXIFEN</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
</category>
<category name="12:04.00 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS">
<drug name="BETHANECHOL CHLORIDE">
<form name="10MG TABLET" notinterchangeable="no">
<product din="01947958">
<brand>DUVOID</brand>
<company>RBP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="25MG TABLET" notinterchangeable="no">
<product din="00349739">
<brand>URECHOLINE</brand>
<company>FRS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="01947931">
<brand>DUVOID</brand>
<company>RBP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="NEOSTIGMINE BROMIDE">
<form name="15MG TABLET" notinterchangeable="no">
<product din="00869945">
<brand>PROSTIGMIN</brand>
<company>ICN</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="PYRIDOSTIGMINE BROMIDE">
<form name="60MG TABLET" notinterchangeable="no">
<product din="00869961">
<brand>MESTINON</brand>
<company>ICN</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="180MG LONG ACTING TABLET" notinterchangeable="no">
<product din="00869953">
<brand>MESTINON</brand>
<company>ICN</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
</category>
<category name="12:08.04 ANTIPARKINSONIAN AGENTS">
<drug name="BENZTROPINE MESYLATE">
<form name="2MG TABLET" notinterchangeable="no">
<product din="00016357">
<brand>COGENTIN</brand>
<company>MSD</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00426857">
<brand>APO-BENZTROPINE</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00587265">
<brand>PMS-BENZTROPINE</brand>
<company>PMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="PROCYCLIDINE HCL">
<form name="0.5MG/ML ELIXIR" notinterchangeable="no">
<product din="00004405">
<brand>KEMADRIN</brand>
<company>GLA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00587362">
<brand>PMS-PROCYCLIDINE</brand>
<company>PMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="5MG TABLET" notinterchangeable="no">
<product din="00004758">
<brand>KEMADRIN</brand>
<company>GLA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00587354">
<brand>PMS-PROCYCLIDINE</brand>
<company>PMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
</category>
<category name="12:08.04 ANTIPARKINSONIAN AGENTS">
<drug name="TRIHEXYPHENIDYL HCL">
<form name="2MG TABLET" notinterchangeable="no">
<product din="00021911">
<brand>NOVO-HEXIDYL</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00545058">
<brand>APO-TRIHEX</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="5MG TABLET" notinterchangeable="no">
<product din="00021938">
<brand>NOVO-HEXIDYL</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00545074">
<brand>APO-TRIHEX</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
</category>
<category name="12:08.08 ANTIMUSCARINICS/ANTISPASMODICS">
<drug name="DICYCLOMINE HCL">
<form name="2MG/ML SYRUP" notinterchangeable="no">
<product din="02102978">
<brand>BENTYLOL</brand>
<company>HMR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="10MG TABLET" notinterchangeable="no">
<product din="02103087">
<brand>BENTYLOL</brand>
<company>HMR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="20MG TABLET" notinterchangeable="no">
<product din="02103095">
<brand>BENTYLOL</brand>
<company>HMR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="HYOSCINE BUTYLBROMIDE">
<form name="10MG TABLET" notinterchangeable="no">
<product din="00363812">
<brand>BUSCOPAN</brand>
<company>BOE</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="IPRATROPIUM BROMIDE">
<form name="200UG/DOSE INHALER AEROSOL (200 DOSE)" notinterchangeable="no">
<product din="00576158">
<brand>ATROVENT</brand>
<company>BOE</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="0.25MG/ML INHALATION SOLUTION (20ML)" notinterchangeable="no">
<product din="00731439">
<brand>ATROVENT</brand>
<company>BOE</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02097141">
<brand>ALTI-IPRATROPIUM</brand>
<company>ALT</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02126222">
<brand>APO-IPRAVENT</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02210479">
<brand>NOVO-IPRAMIDE</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02231136">
<brand>PMS-IPRATROPIUM</brand>
<company>PMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02239131">
<brand>GEN-IPRATROPIUM</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
</category>
<category name="12:08.08 ANTIMUSCARINICS/ANTISPASMODICS">
<drug name="PROPANTHELINE BROMIDE">
<form name="7.5MG TABLET" notinterchangeable="no">
<product din="02030829">
<brand>PRO-BANTHINE</brand>
<company>RBP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="15MG TABLET" notinterchangeable="no">
<product din="00294837">
<brand>PROPANTHEL</brand>
<company>ICN</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02030837">
<brand>PRO-BANTHINE</brand>
<company>RBP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
</category>
<category name="12:12.00 SYMPATHOMIMETIC (ADRENERGIC) AGENTS">
<drug name="EPINEPHRINE SUBCUTANEOUS INJECTION &amp; CHLORPHENIRAMINE MALEATE TABLET KIT">
<product din="02163950">
<brand>ANA-KIT</brand>
<company>BAY</company>
<drugprograms>W</drugprograms>
<exceptional>no</exceptional>
</product>
<notes>Note: Coverage is limited to one Ana-Kit at a time.</notes>
</drug>
<drug name="FENOTEROL HBR">
<form name="100UG/DOSE INHALER AEROSOL (200 DOSE)" notinterchangeable="no">
<product din="02006383">
<brand>BEROTEC</brand>
<company>BOE</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="0.1% INHALATION SOLUTION (20ML)" notinterchangeable="no">
<product din="00541389">
<brand>BEROTEC</brand>
<company>BOE</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="FORMOTEROL FUMARATE">
<notes>SEE APPENDIX A FOR EDS CRITERIA</notes>
<form name="12UG/DOSE AEROSOL POWDER CAPSULE" notinterchangeable="no">
<product din="02230898">
<brand>FORADIL </brand>
<company>NVR</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
<form name="12UG/DOSE INHALER POWDER" notinterchangeable="no">
<product din="02237224">
<brand>OXEZE TURBUHALER </brand>
<company>AZE</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
</drug>
<drug name="MIDODRINE HCL">
<notes>SEE APPENDIX A FOR EDS CRITERIA</notes>
<form name="2.5MG TABLET" notinterchangeable="no">
<product din="01934392">
<brand>AMATINE </brand>
<company>RBP</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
<form name="5MG TABLET" notinterchangeable="no">
<product din="01934406">
<brand>AMATINE </brand>
<company>RBP</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
</drug>
</category>
<category name="12:12.00 SYMPATHOMIMETIC (ADRENERGIC) AGENTS">
<drug name="ORCIPRENALINE SULFATE">
<form name="750UG/DOSE INHALER AEROSOL (300 DOSE)" notinterchangeable="no">
<product din="00254134">
<brand>ALUPENT</brand>
<company>BOE</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="2MG/ML SYRUP" notinterchangeable="no">
<product din="00249920">
<brand>ALUPENT</brand>
<company>BOE</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02152568">
<brand>ALTI-ORCIPRENALINE</brand>
<company>ALT</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02229862">
<brand>ORCIPREN</brand>
<company>TCH</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02236783">
<brand>APO-ORCIPRENALINE</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="SALBUTAMOL">
<form name="100UG/DOSE INHALER AEROSOL (200 DOSE)" notinterchangeable="no">
<product din="00790419">
<brand>APO-SALVENT</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00851841">
<brand>ALTI-SALBUTAMOL</brand>
<company>ALT</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00874086">
<brand>NOVO-SALMOL</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02213478">
<brand>VENTOLIN</brand>
<company>GLA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02232570">
<brand>AIROMIR (CFC-FREE)</brand>
<company>HMR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="200UG/DOSE AEROSOL POWDER DISK (120)" notinterchangeable="no">
<product din="02214997">
<brand>VENTODISK</brand>
<company>GLA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="400UG/DOSE AEROSOL POWDER DISK (120)" notinterchangeable="no">
<product din="02215004">
<brand>VENTODISK</brand>
<company>GLA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="200UG/DOSE AEROSOL POWDER CAPSULE" notinterchangeable="no">
<product din="02212315">
<brand>VENOTOLIN ROTACAPS</brand>
<company>GLA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="400UG/DOSE AEROSOL POWDER CAPSULE" notinterchangeable="no">
<product din="02212323">
<brand>VENTOLIN ROTACAPS</brand>
<company>GLA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="5MG/ML INHALATION SOLUTION (10ML)" notinterchangeable="no">
<product din="00860808">
<brand>SALBUTAMOL</brand>
<company>ALT</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02046741">
<brand>APO-SALVENT</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02048760">
<brand>ASMAVENT</brand>
<company>TCH</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02069571">
<brand>PMS-SALBUTAMOL</brand>
<company>PMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02154412">
<brand>RHO-SALBUTAMOL</brand>
<company>RHP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02213486">
<brand>VENTOLIN</brand>
<company>GLA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02232987">
<brand>GEN-SALBUTAMOL</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="0.4MG/ML ORAL LIQUID" notinterchangeable="no">
<product din="02212390">
<brand>VENTOLIN</brand>
<company>GLA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="2MG TABLET" notinterchangeable="no">
<product din="00620955">
<brand>NOVO-SALMOL</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02146843">
<brand>APO-SALVENT</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02165368">
<brand>NU-SALBUTAMOL</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="4MG TABLET" notinterchangeable="no">
<product din="00620963">
<brand>NOVO-SALMOL</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02146851">
<brand>APO-SALVENT</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02165376">
<brand>NU-SALBUTAMOL</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="SALMETEROL XINAFOATE">
<notes>SEE APPENDIX A FOR EDS CRITERIA </notes>
<form name="25UG/DOSE INHALER AEROSOL" notinterchangeable="no">
<product din="02211742">
<brand>SEREVENT </brand>
<company>GLA</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
<form name="50UG/DOSE INHALED POWDER DISK (60) " notinterchangeable="no">
<product din="02214261">
<brand>SEREVENT DISKHALER </brand>
<company>GLA</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
<form name="50UG/DOSE INHALED POWDER DISK (60)" notinterchangeable="no">
<product din="02231129">
<brand>SEREVENT DISKUS </brand>
<company>GLA</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
</drug>
<drug name="TERBUTALINE SULFATE">
<form name="0.5MG/DOSE INHALER POWDER" notinterchangeable="no">
<product din="00786616">
<brand>BRICANYL TURBUHALER</brand>
<company>AZE</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="2.5MG TABLET" notinterchangeable="no">
<product din="00335355">
<brand>BRICANYL</brand>
<company>AZE</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="5MG TABLET" notinterchangeable="no">
<product din="00335363">
<brand>BRICANYL</brand>
<company>AZE</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
</category>
<category name="12:16.00 SYMPATHOLYTIC (ADRENERGIC BLOCKING) AGENTS">
<drug name="DIHYDROERGOTAMINE MESYLATE">
<notes>SEE APPENDIX A FOR EDS CRITERIA</notes>
<form name="4MG/ML NASAL SPRAY" notinterchangeable="no">
<product din="02228947">
<brand>MIGRANAL </brand>
<company>NVR</company>
<drugprograms>FW</drugprograms>
<exceptional>yes</exceptional>
</product>
<notes>Note: Coverage is limited to 6 bottles per 30 day period.</notes>
</form>
</drug>
</category>
<category name="12:16.00 SYMPATHOLYTIC (ADRENERGIC BLOCKING) AGENTS">
<drug name="ERGOTAMINE TARTRATE">
<form name="2MG SUBLINGUAL TABLET" notinterchangeable="no">
<product din="00328952">
<brand>ERGOMAR</brand>
<company>RPR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="ERGOTAMINE &amp; PENTOBARBITAL COMPOUND">
<form name="RECTAL SUPPOSITORY" notinterchangeable="no">
<product din="00176214">
<brand>CAFERGOT-PB</brand>
<company>NVR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="FLUNARIZINE HCL">
<form name="5MG CAPSULE" notinterchangeable="no">
<product din="00846341">
<brand>SIBELIUM</brand>
<company>PMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="METHYSERGIDE MALEATE">
<notes>SEE APPENDIX A FOR EDS CRITERIA </notes>
<form name="2MG TABLET" notinterchangeable="no">
<product din="00027499">
<brand>SANSERT </brand>
<company>NVR</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
</drug>
<drug name="NARATRIPTAN HCL">
<notes>SEE APPENDIX A FOR EDS CRITERIA</notes>
<form name="1MG TABLET" notinterchangeable="no">
<product din="02237820">
<brand>AMERGE </brand>
<company>GLA</company>
<drugprograms>FW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
<form name="2.5MG TABLET" notinterchangeable="no">
<product din="02237821">
<brand>AMERGE </brand>
<company>GLA</company>
<drugprograms>FW</drugprograms>
<exceptional>yes</exceptional>
</product>
<notes>Note: Coverage is limited to 6 tablets per 30 day period.</notes>
</form>
</drug>
<drug name="SUMATRIPTAN">
<notes>SEE APPENDIX A FOR EDS CRITERIA </notes>
<form name="50MG TABLET" notinterchangeable="no">
<product din="02212153">
<brand>IMITREX </brand>
<company>GLA</company>
<drugprograms>FW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
<form name="100MG TABLET" notinterchangeable="no">
<product din="02212161">
<brand>IMITREX </brand>
<company>GLA</company>
<drugprograms>FW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
<form name="6MG/0.5ML INJECTION SOLUTION" notinterchangeable="no">
<product din="01950606">
<brand>IMITREX </brand>
<company>GLA</company>
<drugprograms>FW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
<form name="5MG NASAL SPRAY" notinterchangeable="no">
<product din="02230418">
<brand>IMITREX </brand>
<company>GLA</company>
<drugprograms>FW</drugprograms>
<exceptional>yes</exceptional>
</product>
<notes>SEE APPENDIX A FOR EDS CRITERIA </notes>
</form>
<form name="20MG NASAL SPRAY" notinterchangeable="no">
<product din="02230420">
<brand>IMITREX </brand>
<company>GLA</company>
<drugprograms>FW</drugprograms>
<exceptional>yes</exceptional>
</product>
<notes>Note: Coverage is limited to 6 tablets or 6 sprays or 6 syringes per 30 day period.</notes>
</form>
</drug>
<drug name="PIZOTYLINE">
<form name="0.5MG TABLET" notinterchangeable="no">
<product din="00329320">
<brand>SANDOMIGRAN</brand>
<company>NVR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="1MG TABLET" notinterchangeable="no">
<product din="00511552">
<brand>SANDOMIGRAN DS</brand>
<company>NVR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="ZOLMITRIPTAN">
<notes>SEE APPENDIX A FOR EDS CRITERIA</notes>
<form name="2.5MG TABLET" notinterchangeable="no">
<product din="02238660">
<brand>ZOMIG </brand>
<company>AZE</company>
<drugprograms>FW</drugprograms>
<exceptional>yes</exceptional>
</product>
<notes>Note: Coverage is limited to 6 tablets per 30 day period.</notes>
</form>
</drug>
</category>
<category name="12:20.00 SKELETAL MUSCLE RELAXANTS">
<drug name="BACLOFEN">
<form name="10MG TABLET" notinterchangeable="no">
<product din="00455881">
<brand>LIORESAL</brand>
<company>NVR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02063735">
<brand>PMS-BACLOFEN</brand>
<company>PMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02088398">
<brand>GEN-BACLOFEN</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02136090">
<brand>NU-BACLO</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02139332">
<brand>APO-BACLOFEN</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02229936">
<brand>NOVO-BACLOFEN</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02236507">
<brand>LIOTEC</brand>
<company>TCH</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="20MG TABLET" notinterchangeable="no">
<product din="00636576">
<brand>LIORESAL DS</brand>
<company>NVR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02063743">
<brand>PMS-BACLOFEN</brand>
<company>PMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02088401">
<brand>GEN-BACLOFEN</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02136104">
<brand>NU-BACLO</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02139391">
<brand>APO-BACLOFEN</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02229937">
<brand>NOVO-BACLOFEN</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02236508">
<brand>LIOTEC</brand>
<company>TCH</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
</category>
<category name="12:20.00 SKELETAL MUSCLE RELAXANTS">
<drug name="CYCLOBENZAPRINE HCL">
<notes>SEE APPENDIX A FOR EDS CRITERIA</notes>
<form name="10MG TABLET" notinterchangeable="no">
<product din="00782742">
<brand>FLEXERIL </brand>
<company>MSD</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
<product din="02080052">
<brand>NOVO-CYCLOPRINE </brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
<product din="02171848">
<brand>NU-CYLCOBENZAPRINE </brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
<product din="02174618">
<brand>ALTI-CYCLOBENZAPRINE </brand>
<company>ALT</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
<product din="02177145">
<brand>APO-CYCLOBENZAPRINE </brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
<product din="02212048">
<brand>PMS-CYCLOBENZAPRINE </brand>
<company>PMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
<product din="02231353">
<brand>GEN-CYCLOPRINE </brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
<product din="02236506">
<brand>FLEXITEC </brand>
<company>TCH</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
</drug>
<drug name="DANTROLENE SODIUM">
<form name="25MG CAPSULE" notinterchangeable="no">
<product din="01997602">
<brand>DANTRIUM</brand>
<company>PGA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="100MG CAPSULE" notinterchangeable="no">
<product din="01997653">
<brand>DANTRIUM</brand>
<company>PGA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="METHOCARBAMOL">
<form name="500MG TABLET" notinterchangeable="no">
<product din="01930990">
<brand>ROBAXIN</brand>
<company>WRI</company>
<drugprograms>W</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="METHOCARBAMOL &amp; ACETAMINOPHEN">
<form name="400MG &amp; 325MG TABLET" notinterchangeable="no">
<product din="01930974">
<brand>ROBAXACET</brand>
<company>WRI</company>
<drugprograms>W</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="400MG &amp; 325MG CAPLET" notinterchangeable="no">
<product din="02026805">
<brand>ROBAXACET</brand>
<company>WRI</company>
<drugprograms>W</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="METHOCARBAMOL &amp; ACETASALICYLIC ACID">
<form name="400MG &amp; 325MG TABLET" notinterchangeable="no">
<product din="01930982">
<brand>ROBAXISAL</brand>
<company>WRI</company>
<drugprograms>W</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="METHOCARBAMOL &amp; ACETASALICYLIC ACID &amp; CODEINE">
<form name="400MG &amp; 325MG &amp; 16.2MG TABLET" notinterchangeable="no">
<product din="01934783">
<brand>ROBAXISAL C-1/4</brand>
<company>WRI</company>
<drugprograms>FW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="400MG &amp; 325MG &amp; 32.4MG TABLET" notinterchangeable="no">
<product din="01934791">
<brand>ROBAXISAL C-1/2</brand>
<company>WRI</company>
<drugprograms>FW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
</category>
<category name="20:04.04 IRON PREPARATIONS">
<drug name="FERROUS GLUCONATE">
<form name="300MG TABLET" notinterchangeable="no">
<product din="00021458">
<brand>NOVO-FERROGLUC</brand>
<company>NOP</company>
<drugprograms>W</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00031097">
<brand>FERROUS GLUCONATE</brand>
<company>WAM</company>
<drugprograms>W</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00545031">
<brand>APO-FERROUS GLUCONATE</brand>
<company>APX</company>
<drugprograms>W</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="FERROUS SULFATE">
<form name="30MG/ML SYRUP" notinterchangeable="no">
<product din="00792675">
<brand>PMS-FERROUS SULFATE</brand>
<company>PMS</company>
<drugprograms>W</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="300MG TABLET" notinterchangeable="no">
<product din="00031100">
<brand>FERROUS SULFATE</brand>
<company>WAM</company>
<drugprograms>W</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00586323">
<brand>PMS-FERROUS SULFATE</brand>
<company>PMS</company>
<drugprograms>W</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="01912518">
<brand>APO-FERROUS SULFATE</brand>
<company>APX</company>
<drugprograms>W</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="160MG SUSTAINED-RELEASE TABLET" notinterchangeable="no">
<product din="00623520">
<brand>SLOW-FE</brand>
<company>NVR</company>
<drugprograms>W</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="75MG/ML ORAL DROPS" notinterchangeable="no">
<product din="02222574">
<brand>PMS-FERROUS SULFATE</brand>
<company>PMS</company>
<drugprograms>W</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="IRON-SORBITAL-CITRIC ACID COMPLEX">
<form name="50MG/ML INTRAMUSCULAR INJECTION" notinterchangeable="no">
<product din="00001910">
<brand>JECTOFER</brand>
<company>AZE</company>
<drugprograms>W</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
</category>
<category name="20:12.04 ANTI-COAGULANTS">
<drug name="WARFARIN">
<form name="1MG TABLET" notinterchangeable="no">
<product din="01918311">
<brand>COUMADIN</brand>
<company>DUP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="2MG TABLET" notinterchangeable="no">
<product din="01918338">
<brand>COUMADIN</brand>
<company>DUP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="2.5MG TABLET" notinterchangeable="no">
<product din="01918346">
<brand>COUMADIN</brand>
<company>DUP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="3MG TABLET" notinterchangeable="no">
<product din="02240205">
<brand>COUMADIN</brand>
<company>DUP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="4MG TABLET" notinterchangeable="no">
<product din="02007959">
<brand>COUMADIN</brand>
<company>DUP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="5MG TABLET" notinterchangeable="no">
<product din="01918354">
<brand>COUMADIN</brand>
<company>DUP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="10MG TABLET" notinterchangeable="no">
<product din="01918362">
<brand>COUMADIN</brand>
<company>DUP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
</category>
<category name="20:24.00 HEMORRHEOLOGIC AGENTS">
<drug name="CLOPIDOGREL BISULFATE">
<notes>SEE APPENDIX A FOR EDS CRITERIA</notes>
<form name="75MG TABLET" notinterchangeable="no">
<product din="02238682">
<brand>PLAVIX </brand>
<company>SAW</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
</drug>
<drug name="PENTOXIFYLLINE">
<form name="400MG SUSTAINED RELEASE TABLET" notinterchangeable="no">
<product din="01968432">
<brand>PENTOXIFYLLINE</brand>
<company>ALT</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02221977">
<brand>TRENTAL</brand>
<company>HMR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02230090">
<brand>APO-PENTOXIFYLLINE SR</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02230401">
<brand>NU-PENTOXIFYLLINE SR</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="TICLOPIDINE HCL">
<notes>SEE APPENDIX A FOR EDS CRITERIA</notes>
<form name="250MG TABLET" notinterchangeable="no">
<product din="02162776">
<brand>TICLID </brand>
<company>HLR</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
<product din="02194422">
<brand>SYN-TICLOPIDINE </brand>
<company>ALT</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
<product din="02237560">
<brand>NU-TICLOPIDINE </brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
<product din="02237701">
<brand>APO-TICLOPIDINE </brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
<product din="02239744">
<brand>GEN-TICLOPIDINE </brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
</drug>
</category>
<category name="24:04:00 CARDIAC DRUGS">
<drug name="ACEBUTOLOL HCL">
<form name="100MG TABLET" notinterchangeable="no">
<product din="01910140">
<brand>RHOTRAL</brand>
<company>RHP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="01926543">
<brand>SECTRAL</brand>
<company>RPR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02036290">
<brand>MONITAN</brand>
<company>WAY</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02147602">
<brand>APO-ACEBUTOLOL</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02165546">
<brand>NU-ACEBUTOLOL</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02204517">
<brand>NOVO-ACEBUTOLOL</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02237721">
<brand>GEN-ACEBUTOLOL</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02237885">
<brand>GEN-ACEBUTOLOL (TYPE S)</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="200MG TABLET" notinterchangeable="no">
<product din="01910159">
<brand>RHOTRAL</brand>
<company>RHP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="01926551">
<brand>SECTRAL</brand>
<company>RPR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02036436">
<brand>MONITAN</brand>
<company>WAY</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02147610">
<brand>APO-ACEBUTOLOL</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02165554">
<brand>NU-ACEBUTOLOL</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02204525">
<brand>NOVO-ACEBUTOLOL</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02237722">
<brand>GEN-ACEBUTOLOL</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02237886">
<brand>GEN-ACEBUTOLOL (TYPE S)</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="400MG TABLET" notinterchangeable="no">
<product din="01910167">
<brand>RHOTRAL</brand>
<company>RHP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="01926578">
<brand>SECTRAL</brand>
<company>RPR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02036444">
<brand>MONITAN</brand>
<company>WAY</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02147629">
<brand>APO-ACEBUTOLOL</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02165562">
<brand>NU-ACEBUTOLOL</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02204533">
<brand>NOVO-ACEBUTOLOL</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02237723">
<brand>GEN-ACEBUTOLOL</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02237887">
<brand>GEN-ACEBUTOLOL (TYPE S)</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="AMIODARONE">
<notes>SEE APPENDIX A FOR EDS CRITERIA</notes>
<form name="200MG TABLET" notinterchangeable="no">
<product din="02036282">
<brand>CORDARONE </brand>
<company>WAY</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
<product din="02240071">
<brand>ALTI-AMIODARONE </brand>
<company>ALT</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
</drug>
</category>
<category name="24:04.00 CARDIAC DRUGS">
<drug name="AMLODIPINE BESYLATE">
<form name="5MG TABLET" notinterchangeable="no">
<product din="00878928">
<brand>NORVASC</brand>
<company>PFI</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="10MG TABLET" notinterchangeable="no">
<product din="00878936">
<brand>NORVASC</brand>
<company>PFI</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="ATENOLOL">
<form name="50MG TABLET" notinterchangeable="no">
<product din="00773689">
<brand>APO-ATENOL</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00886114">
<brand>NU-ATENOL</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="01912062">
<brand>NOVO-ATENOL</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02039532">
<brand>TENORMIN</brand>
<company>AZE</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02146894">
<brand>GEN-ATENOLOL</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02171791">
<brand>TENOLIN</brand>
<company>TCH</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02220679">
<brand>SCHEIN-ATENOLOL</brand>
<company>SCN</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02231731">
<brand>RHO-ATENOLOL</brand>
<company>RHP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02237600">
<brand>PMS-ATENOLOL</brand>
<company>PMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="100MG TABLET" notinterchangeable="no">
<product din="00773697">
<brand>APO-ATENOL</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00886122">
<brand>NU-ATENOL</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="01912054">
<brand>NOVO-ATENOL</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02039540">
<brand>TENORMIN</brand>
<company>AZE</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02147432">
<brand>GEN-ATENOLOL</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02171805">
<brand>TENOLIN</brand>
<company>TCH</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02220687">
<brand>SCHEIN-ATENOLOL</brand>
<company>SCN</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02231733">
<brand>RHO-ATENOLOL</brand>
<company>RHP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02237601">
<brand>PMS-ATENOLOL</brand>
<company>PMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
</category>
<category name="24:04.00 CARDIAC DRUGS">
<drug name="CARVEDILOL">
<notes>SEE APPENDIX A FOR EDS CRITERIA</notes>
<form name="3.125MG TABLET" notinterchangeable="no">
<product din="02240808">
<brand>COREG </brand>
<company>HLR</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
<form name="6.25MG TABLET" notinterchangeable="no">
<product din="02240809">
<brand>COREG </brand>
<company>HLR</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
<form name="12.5MG TABLET" notinterchangeable="no">
<product din="02240810">
<brand>COREG </brand>
<company>HLR</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
<form name="25MG TABLET" notinterchangeable="no">
<product din="02240811">
<brand>COREG </brand>
<company>HLR</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
</drug>
<drug name="DIGOXIN">
<form name="0.05MG/ML ELIXIR" notinterchangeable="no">
<product din="00242713">
<brand>LANOXIN</brand>
<company>GLA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="0.0625MG TABLET" notinterchangeable="no">
<product din="00731269">
<brand>LANOXIN</brand>
<company>GLA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="0.125MG TABLET" notinterchangeable="no">
<product din="00035319">
<brand>LANOXIN</brand>
<company>GLA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="0.25MG TABLET" notinterchangeable="no">
<product din="00004685">
<brand>LANOXIN</brand>
<company>GLA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="DILTIAZEM HCL">
<form name="60MG SUSTAINED RELEASE CAPSULE" notinterchangeable="no">
<product din="02097214">
<brand>CARDIZEM-SR</brand>
<company>HMR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02222957">
<brand>APO-DILTIAZ SR</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02229406">
<brand>NOVO-DILTAZEM SR</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02231743">
<brand>GEN-DILTIAZEM SR</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="90MG SUSTAINED RELEASE CAPSULE" notinterchangeable="no">
<product din="02097222">
<brand>CARDIZEM-SR</brand>
<company>HMR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02222965">
<brand>APO-DILTIAZ SR</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02229407">
<brand>NOVO-DILTAZEM SR</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02231744">
<brand>GEN-DILTIAZEM SR</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="120MG SUSTAINED RELEASE CAPSULE" notinterchangeable="no">
<product din="02097230">
<brand>CARDIZEM-SR</brand>
<company>HMR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02222973">
<brand>APO-DILTIAZ SR</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02229408">
<brand>NOVO-DILTAZEM SR</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02231745">
<brand>GEN-DILTIAZEM SR</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="120MG CONTROLLED DELIVERY CAPSULE" notinterchangeable="no">
<product din="02097249">
<brand>CARDIZEM CD</brand>
<company>HMR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02229781">
<brand>ALTI-DILTIAZEM CD</brand>
<company>ALT</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02230997">
<brand>APO-DILTIAZEM CD</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02231052">
<brand>NU-DILTIAZ CD</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="180MG CONTROLLED DELIVERY CAPSULE" notinterchangeable="no">
<product din="02097257">
<brand>CARDIZEM CD</brand>
<company>HMR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02229782">
<brand>ALTI-DILTIAZEM CD</brand>
<company>ALT</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02230998">
<brand>APO-DILTIAZEM CD</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02231053">
<brand>NU-DILTIAZ CD</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="240MG CONTROLLED DELIVERY CAPSULE" notinterchangeable="no">
<product din="02097265">
<brand>CARDIZEM CD</brand>
<company>HMR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02229783">
<brand>ALTI-DILTIAZEM CD</brand>
<company>ALT</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02230999">
<brand>APO-DILTIAZEM CD</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02231054">
<brand>NU-DILTIAZ CD</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="300MG CONTROLLED DELIVERY CAPSULE" notinterchangeable="no">
<product din="02097273">
<brand>CARDIZEM CD</brand>
<company>HMR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02229526">
<brand>APO-DILTIAZEM CD</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02229784">
<brand>ALTI-DILTIAZEM CD</brand>
<company>ALT</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="30MG TABLET" notinterchangeable="no">
<product din="00771376">
<brand>APO-DILTIAZ</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00862924">
<brand>NOVO-DILTAZEM</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00886068">
<brand>NU-DILTIAZ</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00888524">
<brand>ALTI-DILTIAZEM</brand>
<company>ALT</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02097370">
<brand>CARDIZEM</brand>
<company>HMR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02146916">
<brand>GEN-DILTIAZEM</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="60MG TABLET" notinterchangeable="no">
<product din="00771384">
<brand>APO-DILTIAZ</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00862932">
<brand>NOVO-DILTAZEM</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00886076">
<brand>NU-DILTIAZ</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00888532">
<brand>ALTI-DILTIAZEM</brand>
<company>ALT</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02097389">
<brand>CARDIZEM</brand>
<company>HMR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02146924">
<brand>GEN-DILTIAZEM</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="DISOPYRAMIDE">
<form name="100MG CAPSULE" notinterchangeable="no">
<product din="01989553">
<brand>RYTHMODAN</brand>
<company>HMR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="150MG CAPSULE" notinterchangeable="no">
<product din="01989561">
<brand>RYTHMODAN</brand>
<company>HMR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="METOPROLOL TARTRATE">
<form name="100MG SUSTAINED RELEASE TABLET" notinterchangeable="no">
<product din="00658855">
<brand>LOPRESOR SR</brand>
<company>NVR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="200MG SUSTAINED RELEASE TABLET " notinterchangeable="yes">
<product din="00497827">
<brand>BETALOC DURULES</brand>
<company>AZE</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00534560">
<brand>LOPRESOR SR</brand>
<company>NVR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="50MG TABLET" notinterchangeable="no">
<product din="00397423">
<brand>LOPRESOR</brand>
<company>NVR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00402605">
<brand>BETALOC</brand>
<company>AZE</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00618632">
<brand>APO-METOPROLOL</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00648035">
<brand>NOVO-METOPROL</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00749354">
<brand>APO-METOPROLOL (TYPE L)</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00842648">
<brand>NOVO-METOPROL (UNCOATED)</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00865605">
<brand>NU-METOP</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02145413">
<brand>PMS-METOPROLOL-B</brand>
<company>PMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02174545">
<brand>GEN-METOPROLOL (TYPE L)</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02230448">
<brand>GEN-METOPROLOL</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02230803">
<brand>PMS-METOPROLOL-L</brand>
<company>PMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="100MG TABLET" notinterchangeable="no">
<product din="00397431">
<brand>LOPRESOR</brand>
<company>NVR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00402540">
<brand>BETALOC</brand>
<company>AZE</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00618640">
<brand>APO-METOPROLOL</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00648043">
<brand>NOVO-METOPROL</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00751170">
<brand>APO-METOPROLOL (TYPE L)</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00842656">
<brand>NOVO-METOPROL (UNCOATED)</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00865613">
<brand>NU-METOP</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02145421">
<brand>PMS-METOPROLOL-B</brand>
<company>PMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02174553">
<brand>GEN-METOPROLOL (TYPE L)</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02230449">
<brand>GEN-METOPROLOL</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02230804">
<brand>PMS-METOPROLOL-L</brand>
<company>PMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="MEXILETINE HCL">
<form name="100MG CAPSULE" notinterchangeable="no">
<product din="00599956">
<brand>MEXITIL</brand>
<company>BOE</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02230359">
<brand>NOVO-MEXILETINE</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02231690">
<brand>ALTI-MEXILETINE</brand>
<company>ALT</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="200MG CAPSULE" notinterchangeable="no">
<product din="00599964">
<brand>MEXITIL</brand>
<company>BOE</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02230360">
<brand>NOVO-MEXILETINE</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02231692">
<brand>ALTI-MEXILETINE</brand>
<company>ALT</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="NADOLOL">
<form name="40MG TABLET" notinterchangeable="no">
<product din="00607126">
<brand>CORGARD</brand>
<company>BMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00782505">
<brand>APO-NADOL</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00851663">
<brand>ALTI-NADOLOL</brand>
<company>ALT</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02126753">
<brand>NOVO-NADOLOL</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="80MG TABLET" notinterchangeable="no">
<product din="00463256">
<brand>CORGARD</brand>
<company>BMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00782467">
<brand>APO-NADOL</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00851671">
<brand>ALTI-NADOLOL</brand>
<company>ALT</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02126761">
<brand>NOVO-NADOLOL</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="160MG TABLET" notinterchangeable="no">
<product din="00523372">
<brand>CORGARD</brand>
<company>BMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00782475">
<brand>APO-NADOL</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00851698">
<brand>ALTI-NADOLOL</brand>
<company>ALT</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
</category>
<category name="24:04.00 CARDIAC DRUGS">
<drug name="NICARDIPINE HCL">
<notes>SEE APPENDIX A FOR EDS CRITERIA</notes>
<form name="20MG CAPSULE" notinterchangeable="no">
<product din="02162741">
<brand>CARDENE </brand>
<company>HLR</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
<form name="30MG CAPSULE" notinterchangeable="no">
<product din="02162733">
<brand>CARDENE </brand>
<company>HLR</company>
<drugprograms>FSW</drugprograms>
<exceptional>yes</exceptional>
</product>
</form>
</drug>
<drug name="NIFEDIPINE">
<form name="5MG CAPSULE" notinterchangeable="no">
<product din="00725110">
<brand>APO-NIFED</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02047462">
<brand>NOVO-NIFEDIN</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02235897">
<brand>PMS-NIFEDIPINE</brand>
<company>PMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="10MG CAPSULE" notinterchangeable="no">
<product din="00755907">
<brand>APO-NIFED</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00756830">
<brand>NOVO-NIFEDIN</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00865591">
<brand>NU-NIFED</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="01946307">
<brand>GEN-NIFEDIPINE</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02235898">
<brand>PMS-NIFEDIPINE</brand>
<company>PMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="10MG SUSTAINED RELEASE TABLET" notinterchangeable="no">
<product din="02154390">
<brand>NIFEDIPINE PA</brand>
<company>SCN</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02155885">
<brand>ADALAT PA</brand>
<company>BAY</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02197448">
<brand>APO-NIFED PA</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02212102">
<brand>NU-NIFEDIPINE PA</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="20MG SUSTAINED RELEASE TABLET" notinterchangeable="no">
<product din="02154404">
<brand>NIFEDIPINE PA</brand>
<company>SCN</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02155893">
<brand>ADALAT PA</brand>
<company>BAY</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02181525">
<brand>APO-NIFED PA</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02200937">
<brand>NU-NIFEDIPINE PA</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="20MG EXTENDED RELEASE TABLET" notinterchangeable="no">
<product din="02237618">
<brand>ADALAT XL</brand>
<company>BAY</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="30MG EXTENDED RELEASE TABLET" notinterchangeable="no">
<product din="02155907">
<brand>ADALAT XL</brand>
<company>BAY</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="60MG EXTENDED RELEASE TABLET" notinterchangeable="no">
<product din="02155990">
<brand>ADALAT XL</brand>
<company>BAY</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
</category>
<category name="24:04.00 CARDIAC DRUGS">
<drug name="PROCAINAMIDE HCL">
<form name="250MG CAPSULE" notinterchangeable="no">
<product din="00029076">
<brand>PRONESTYL</brand>
<company>BMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00713325">
<brand>APO-PROCAINAMIDE</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="375MG CAPSULE" notinterchangeable="no">
<product din="00296031">
<brand>PRONESTYL</brand>
<company>BMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00713333">
<brand>APO-PROCAINAMIDE</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="500MG CAPSULE" notinterchangeable="no">
<product din="00353523">
<brand>PRONESTYL</brand>
<company>BMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00713341">
<brand>APO-PROCAINAMIDE</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="250MG SUSTAINED RELEASE TABLET" notinterchangeable="no">
<product din="00638692">
<brand>PROCAN SR</brand>
<company>PDA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="500MG SUSTAINED RELEASE TABLET " notinterchangeable="yes">
<product din="00638676">
<brand>PROCAN SR</brand>
<company>PDA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00639885">
<brand>PRONESTYL SR</brand>
<company>BMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="750MG SUSTAINED RELEASE TABLET" notinterchangeable="no">
<product din="00638684">
<brand>PROCAN SR</brand>
<company>PDA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="PROPAFENONE HCL">
<form name="150MG TABLET" notinterchangeable="no">
<product din="00603708">
<brand>RYTHMOL</brand>
<company>KNL</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="300MG TABLET" notinterchangeable="no">
<product din="00603716">
<brand>RYTHMOL</brand>
<company>KNL</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="PROPRANOLOL	">
<form name="10MG TABLET" notinterchangeable="no">
<product din="00402788">
<brand>APO-PROPRANOLOL</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00496480">
<brand>NOVO-PRANOL</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00582255">
<brand>PMS-PROPRANOLOL</brand>
<company>PMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02042177">
<brand>INDERAL</brand>
<company>WAY</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="20MG TABLET" notinterchangeable="no">
<product din="00663719">
<brand>APO-PROPRANOLOL</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00740675">
<brand>NOVO-PRANOL</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02042193">
<brand>INDERAL</brand>
<company>WAY</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02044692">
<brand>NU-PROPRANOLOL</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="40MG TABLET" notinterchangeable="no">
<product din="00402753">
<brand>APO-PROPRANOLOL</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00496499">
<brand>NOVO-PRANOL</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00582263">
<brand>PMS-PROPRANOLOL</brand>
<company>PMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02042207">
<brand>INDERAL</brand>
<company>WAY</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02044706">
<brand>NU-PROPRANOLOL</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="80MG TABLET" notinterchangeable="no">
<product din="00402761">
<brand>APO-PROPRANOLOL</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00496502">
<brand>NOVO-PRANOL</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00582271">
<brand>PMS-PROPRANOLOL</brand>
<company>PMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02042215">
<brand>INDERAL</brand>
<company>WAY</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="120MG TABLET" notinterchangeable="no">
<product din="00504335">
<brand>APO-PROPRANOLOL</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00549657">
<brand>NOVO-PRANOL</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02042223">
<brand>INDERAL</brand>
<company>WAY</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="60MG LONG ACTING CAPSULE" notinterchangeable="no">
<product din="02042231">
<brand>INDERAL L.A.</brand>
<company>WAY</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="80MG LONG ACTING CAPSULE" notinterchangeable="no">
<product din="02042258">
<brand>INDERAL L.A.</brand>
<company>WAY</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="120MG LONG ACTING CAPSULE" notinterchangeable="no">
<product din="02042266">
<brand>INDERAL L.A.</brand>
<company>WAY</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="160MG LONG ACTING CAPSULE" notinterchangeable="no">
<product din="02042274">
<brand>INDERAL L.A.</brand>
<company>WAY</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="QUINIDINE BISULFATE">
<form name="250MG SUSTAINED RELEASE TABLET" notinterchangeable="no">
<product din="00249580">
<brand>BIQUIN DURULES</brand>
<company>AZE</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="QUINIDINE SULFATE">
<form name="200MG TABLET" notinterchangeable="no">
<product din="00021733">
<brand>NOVO-QUINIDIN</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00441740">
<brand>APO-QUINIDINE</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
</category>
<category name="24:04.00 CARDIAC DRUGS">
<drug name="SOTALOL HCL	">
<form name="80MG TABLET" notinterchangeable="no">
<product din="00897272">
<brand>SOTACOR</brand>
<company>BMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02084228">
<brand>ALTI-SOTALOL</brand>
<company>ALT</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02170833">
<brand>LIN-SOTALOL</brand>
<company>LIN</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02200996">
<brand>NU-SOTALOL</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02210428">
<brand>APO-SOTALOL</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02229778">
<brand>GEN-SOTALOL</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02231181">
<brand>NOVO-SOTALOL</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02234008">
<brand>RHO-SOTALOL</brand>
<company>RHP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02238326">
<brand>PMS-SOTALOL</brand>
<company>PMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02238417">
<brand>SOTAMOL</brand>
<company>TCH</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="160MG TABLET" notinterchangeable="no">
<product din="00483923">
<brand>SOTACOR</brand>
<company>BMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02084236">
<brand>ALTI-SOTALOL</brand>
<company>ALT</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02163772">
<brand>NU-SOTALOL</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02167794">
<brand>APO-SOTALOL</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02170841">
<brand>LIN-SOTALOL</brand>
<company>LIN</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02229779">
<brand>GEN-SOTALOL</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02231182">
<brand>NOVO-SOTALOL</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02234013">
<brand>RHO-SOTALOL</brand>
<company>RHP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02238327">
<brand>PMS-SOTALOL</brand>
<company>PMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02238415">
<brand>SOTAMOL</brand>
<company>TCH</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="TIMOLOL MALEATE">
<form name="5MG TABLET" notinterchangeable="no">
<product din="00755842">
<brand>APO-TIMOL</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="01947796">
<brand>NOVO-TIMOL</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02044609">
<brand>NU-TIMOLOL</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="10MG TABLET" notinterchangeable="no">
<product din="00755850">
<brand>APO-TIMOL</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="01947818">
<brand>NOVO-TIMOL</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02044617">
<brand>NU-TIMOLOL</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="20MG TABLET" notinterchangeable="no">
<product din="00755869">
<brand>APO-TIMOL</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="01947826">
<brand>NOVO-TIMOL</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
</category>
<category name="24:04.00 CARDIAC DRUGS">
<drug name="VERAPAMIL HCL">
<form name="80MG TABLET" notinterchangeable="no">
<product din="00554316">
<brand>ISOPTIN</brand>
<company>KNL</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00782483">
<brand>APO-VERAP</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00812331">
<brand>NOVO-VERAMIL</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00867365">
<brand>ALTI-VERAPAMIL</brand>
<company>ALT</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00886033">
<brand>NU-VERAP</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02237921">
<brand>GEN-VERAPAMIL</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="120MG TABLET" notinterchangeable="no">
<product din="00554324">
<brand>ISOPTIN</brand>
<company>KNL</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00782491">
<brand>APO-VERAP</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00812358">
<brand>NOVO-VERAMIL</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00867373">
<brand>ALTI-VERAPAMIL</brand>
<company>ALT</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00886041">
<brand>NU-VERAP</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02237922">
<brand>GEN-VERAPAMIL</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="120MG SUSTAINED RELEASE TABLET" notinterchangeable="no">
<product din="01907123">
<brand>ISOPTIN SR</brand>
<company>KNL</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02210347">
<brand>GEN-VERAPAMIL SR</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="180MG SUSTAINED RELEASE TABLET" notinterchangeable="no">
<product din="01934317">
<brand>ISOPTIN SR</brand>
<company>KNL</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02210355">
<brand>GEN-VERAPAMIL SR</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="240MG SUSTAINED RELEASE TABLET" notinterchangeable="no">
<product din="00742554">
<brand>ISOPTIN SR</brand>
<company>KNL</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02210363">
<brand>GEN-VERAPAMIL SR</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02211920">
<brand>NOVO-VERAMIL SR</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02237791">
<brand>PMS-VERAPAMIL SR</brand>
<company>PMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="180MG CONTROLLED-ONSET EXTENDED-RELEASE TABLET" notinterchangeable="no">
<product din="02231676">
<brand>CHRONOVERA</brand>
<company>SEA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="240MG CONTROLLED-ONSET EXTENDED-RELEASE TABLET" notinterchangeable="no">
<product din="02231677">
<brand>CHRONOVERA</brand>
<company>SEA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
</category>
<category name="24:06:00 ANTILIPEMIC DRUGS">
<drug name="ATORVASTATIN CALCIUM">
<form name="10MG TABLET" notinterchangeable="no">
<product din="02230711">
<brand>LIPITOR</brand>
<company>PDA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="20MG TABLET" notinterchangeable="no">
<product din="02230713">
<brand>LIPITOR</brand>
<company>PDA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="40MG TABLET" notinterchangeable="no">
<product din="02230714">
<brand>LIPITOR</brand>
<company>PDA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="CERIVASTATIN SODIUM">
<form name="0.2MG TABLET" notinterchangeable="no">
<product din="02237325">
<brand>BAYCOL</brand>
<company>BAY</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="0.3MG TABLET" notinterchangeable="no">
<product din="02237326">
<brand>BAYCOL</brand>
<company>BAY</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="0.4MG TABLET" notinterchangeable="no">
<product din="02241466">
<brand>BAYCOL</brand>
<company>BAY</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="CHOLESTYRAMINE">
<form name="REGULAR - 440MG/G ORAL POWDER (CAN)" notinterchangeable="no">
<product din="00634093">
<brand>QUESTRAN (42 DOSES)</brand>
<company>BMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02207745">
<brand>PMS-CHOLESTYRAMINE (42 DOSES)</brand>
<company>PMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="REGULAR - 440MG/G ORAL POWDER (POUCHES)" notinterchangeable="no">
<product din="00464880">
<brand>QUESTRAN</brand>
<company>BMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02139189">
<brand>NOVO-CHOLAMINE</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02210320">
<brand>PMS-CHOLESTYRAMINE</brand>
<company>PMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="LIGHT - 440MG/G ORAL POWDER (CAN)" notinterchangeable="no">
<product din="02125463">
<brand>PMS-CHOLESTYRAMINE (80 DOSES)</brand>
<company>PMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02141795">
<brand>PMS-CHOLESTYRAMINE (42 DOSES)</brand>
<company>PMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="LIGHT - 440MG/G ORAL POWDER (POUCHES)" notinterchangeable="no">
<product din="00890960">
<brand>PMS-CHOLESTYRAMINE LIGHT</brand>
<company>PMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="01918486">
<brand>QUESTRAN LIGHT</brand>
<company>BMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02139197">
<brand>NOVO-CHOLAMINE LIGHT</brand>
<company>NOP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="FENOFIBRATE">
<form name="100MG CAPSULE" notinterchangeable="no">
<product din="02223600">
<brand>NU-FENOFIBRATE</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02225980">
<brand>APO-FENOFIBRATE</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="200MG CAPSULE" notinterchangeable="no">
<product din="02146959">
<brand>LIPIDIL MICRO</brand>
<company>FRS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02231780">
<brand>PMS-FENOFIBRATE MICRO</brand>
<company>PMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02239864">
<brand>APO-FENO-MICRO</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02240210">
<brand>GEN-FENOFIBRATE MICRO</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="FLUVASTATIN SODIUM">
<form name="20MG CAPSULE" notinterchangeable="no">
<product din="02061562">
<brand>LESCOL</brand>
<company>NVR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="40MG CAPSULE" notinterchangeable="no">
<product din="02061570">
<brand>LESCOL</brand>
<company>NVR</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
</drug>
<drug name="GEMFIBROZIL">
<form name="300MG CAPSULE" notinterchangeable="no">
<product din="00599026">
<brand>LOPID</brand>
<company>PDA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00851922">
<brand>GEMFIBROZIL</brand>
<company>ALT</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="01979574">
<brand>APO-GEMFIBROZIL</brand>
<company>APX</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02058456">
<brand>NU-GEMFIBROZIL</brand>
<company>NXP</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02185407">
<brand>GEN-GEMFIBROZIL</brand>
<company>GPM</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="02239951">
<brand>PMS-GEMFIBROZIL</brand>
<company>PMS</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
</form>
<form name="600MG TABLET" notinterchangeable="no">
<product din="00659606">
<brand>LOPID</brand>
<company>PDA</company>
<drugprograms>FSW</drugprograms>
<exceptional>no</exceptional>
</product>
<product din="00851930">
<brand>GEMFIBROZIL </brand>
<company>A