REPORT NO : HMHRP970 COUNTY OF LOS ANGELES PAGE 1 RUN DATE : 08/31/14 DEPARTMENT OF MENTAL HEALTH REPORTING PERIOD: AUGUST 2014 PATS DRUG FORMULARY BY GENERIC NAME GENERIC DRUG NAME TRADE DRUG NAME DRUG CODE STRENGTH PREPACK SIZE MEDI-CAL BILLABLE ------------------------------------------------------------------------------------------------------------------------ ACAMPROSATE CAMPRAL ACS333 333 MG 180 TABLETS Y ACETAMINOPHEN TYLENOL APC300 325 MG 100 TABLETS Y ADDERALL XR ADDERALL XR AEA5XR 5 MG 100 CAPSULE Y ADDERALL XR ADDERALL XR AEA10XR 10 MG 100 CAPSULE Y ADDERALL XR ADDERALL XR AEA15XR 15 MG 100 CAPSULE Y ADDERALL XR ADDERALL XR AEA20XR 20 MG 100 CAPSULE Y ADDERALL XR ADDERALL XR AEA25XR 25 MG 100 CAPSULE Y ADDERALL XR ADDERALL XR AEA30XR 30 MG 100 CAPSULE Y AMANTADINE SYMMETREL AMD100 100 MG 100 CAPSULES Y AMITRIPTYLINE ELAVIL AML10 10 MG 100 TABLETS Y AMITRIPTYLINE ELAVIL AML25 25 MG 100 TABLETS Y AMITRIPTYLINE ELAVIL AML50 50 MG 100 TABLETS Y AMITRIPTYLINE ELAVIL AML75 75 MG 100 TABLETS Y AMITRIPTYLINE ELAVIL AML100 100 MG 100 TABLETS Y AMPHETAMINE ADDERALL AEA5 5 MG 100 TABLET Y AMPHETAMINE ADDERALL AEA7.5 7.5 MG 100 TABLET Y AMPHETAMINE ADDERALL AEA10 10 MG 100 TABLET Y AMPHETAMINE ADDERALL AEA12.5 12.5MG 100 TABLET Y AMPHETAMINE ADDERALL AEA15 15 MG 100 TABLET Y AMPHETAMINE ADDERALL AEA20 20 MG 100 TABLET Y AMPHETAMINE ADDERALL AEA30 30 MG 100 TABLET Y ARIPIPRAZOLE ABILIFY APZ1L 1 MG/ML 150 ML Y ARIPIPRAZOLE ABILIFY APZ2 2 MG 30 TABLETS Y ARIPIPRAZOLE ABILIFY APZ5 5 MG 100 TABLET Y ARIPIPRAZOLE ABILIFY APZ10 10 MG 100 TABLET Y ARIPIPRAZOLE ABILIFY APZ10SL 10 MG 30 TABLETS Y ARIPIPRAZOLE ABILIFY APZ15 15 MG 100 TABLET Y ARIPIPRAZOLE ABILIFY APZ15SL 15 MG 30 TABLETS Y ARIPIPRAZOLE ABILIFY APZ20 20 MG 30 TABLET Y ARIPIPRAZOLE ABILIFY APZ30 30 MG 30 TABLET Y ASENAPINE SAPHRIS ASP5SL 5 MG 100 TABLETS Y ASENAPINE SAPHRIS ASP10SL 10 MG 100 TABLETS Y ASPIRIN ASPIRIN ASA300 325 MG 100 TABLETS Y BENZTROPINE COGENTIN BTP.5 0.5 MG 100 TABLETS Y BENZTROPINE COGENTIN BTP1A 1 MG/ML 2 CC/AMP Y BENZTROPINE COGENTIN BTP1 1 MG 100 TABLETS Y BENZTROPINE COGENTIN BTP2 2 MG 100 TABLETS Y BETHANECHOL URECHOLINE BTC5 5 MG 100 TABLETS Y BETHANECHOL URECHOLINE BTC10 10 MG 100 TABLETS Y BETHANECHOL URECHOLINE BTC25 25 MG 100 TABLETS Y BETHANECHOL URECHOLINE BTC50 50 MG 100 TABLETS Y BUPRENORPHINE N SUBOXONE SBX8 8 MG 30 FILMTAB Y BUPRENORPHINEN SUBOXONE SBX2 2 MG 30 FILMTAB Y BUPROPION WELLBUTRIN BPP75 75 MG 100 TABLET Y BUPROPION WELLBUTRIN BPP100 100 MG 100 TABLET Y BUPROPION WELLBUTRIN SR BPPSR200 200 MG 60 TABLET Y REPORT NO : HMHRP970 COUNTY OF LOS ANGELES PAGE 2 RUN DATE : 08/31/14 DEPARTMENT OF MENTAL HEALTH REPORTING PERIOD: AUGUST 2014 PATS DRUG FORMULARY BY GENERIC NAME GENERIC DRUG NAME TRADE DRUG NAME DRUG CODE STRENGTH PREPACK SIZE MEDI-CAL BILLABLE ------------------------------------------------------------------------------------------------------------------------ BUPROPION SR WELLBUTRIN SR BPPSR100 100 MG 60 TABLET Y BUPROPION SR WELLBUTRIN SR BPPSR150 150 MG 60 TABLET Y BUPROPION XL WELLBUTRIN XL BPP150XL 150 MG 30 TABLET Y BUPROPION XL WELLBUTRIN XL BPP300XL 300 MG 30 TABLET Y BUSPIRONE BUSPAR BPR5 5 MG 100 TABLETS Y BUSPIRONE BUSPAR BPR10 10 MG 100 TABLETS Y BUSPIRONE BUSPAR BPR15 15 MG 60 TABLET Y BUSPIRONE BUSPAR BPR30 30 MG 60 TABLET Y CARBAMAZEPINE TEGRETOL CBP200-1 200 MG 100 TABLETS Y CHLORAL HYDRATE NOCTEC CH500L 500 MG/5ML 480 ML Y CHLORAL HYDRATE NOCTEC CH500 500 MG 100 CAPSULES Y CHLORPROMAZINE THORAZINE CPZ10 10 MG 100 TABLETS Y CHLORPROMAZINE THORAZINE CPZ251A 25 MG/ML 1 AMP Y CHLORPROMAZINE THORAZINE CPZ25 25 MG 100 TABLETS Y CHLORPROMAZINE THORAZINE CPZ50 50 MG 100 TABLETS Y CHLORPROMAZINE THORAZINE CPZ100 100 MG 100 TABLETS Y CHLORPROMAZINE THORAZINE CPZ200 200 MG 100 TABLETS Y CITALOPRAM CELEXA CTP20 20 MG 100 TABLET Y CITALOPRAM CELEXA CTP40 40 MG 100 TABLET Y CLOMIPRAMINE ANAFRANIL CPM25 25 MG 100 CAPSULE Y CLOMIPRAMINE ANAFRANIL CPM50 50 MG 100 CAPSULE Y CLOMIPRAMINE ANAFRANIL CPM75 75 MG 100 CAPSULE Y CLONIDINE CATAPRES CD1 0.1 MG 100 TABLETS Y CLONIDINE CATAPRES CD2 0.2 MG 100 TABLETS Y CLONIDINE CATAPRES CD3 0.3 MG 100 TABLETS Y CLOZAPINE CLOZARIL CZP25 25 MG 100 TABLET Y CLOZAPINE CLOZARIL CZP100 100 MG 100 TABLET Y CLOZAPINE CLOZAPINE CZP200 200 MG 100 TABLETS Y CLOZARIL CLOZARIL CZR25 25 MG 100 TABLET Y CLOZARIL CLOZARIL CZR100 100 MG 100 TABLET Y CONCERTA CONCERTA CCT18 18 MG 100 TABLET Y CONCERTA CONCERTA CCT27 27 MG 100 CAPSULE Y CONCERTA CONCERTA CCT36 36 MG 100 TABLET Y CONCERTA CONCERTA CCT54 54 MG 100 TABLET Y D-METHYLPHEN FOCALIN XR FOC35 35 MG 100 CAPSULES Y D-METHYLPHEN XR FOCALIN XR FOC5 5 100 CAPSULES Y D-METHYLPHEN XR FOCALIN XR FOC10 10 MG 100 CAPSULES Y D-METHYLPHEN XR FOCALIN XR FOC15 15 MG 100 CAPSULES Y D-METHYLPHEN XR FOCALIN XR FOC20 20 MG 100 CAPSULES Y D-METHYLPHEN XR FOCALIN XR FOC25 25 MG 100 CAPSULES Y D-METHYLPHEN XR FOCALIN XR FOC30 30 MG 100 CAPSULES Y D-METHYLPHEN XR FOCALIN XR FOC40 40 MG 100 CAPSULES Y DESIPRAMINE NORPRAMINE DSM10 10 MG 100 TABLETS Y DESIPRAMINE NORPRAMINE DSM25 25 MG 100 TABLETS Y DESIPRAMINE NORPRAMINE DSM50 50 MG 100 TABLETS Y DESIPRAMINE NORPRAMINE DSM75 75 MG 100 TABLETS Y REPORT NO : HMHRP970 COUNTY OF LOS ANGELES PAGE 3 RUN DATE : 08/31/14 DEPARTMENT OF MENTAL HEALTH REPORTING PERIOD: AUGUST 2014 PATS DRUG FORMULARY BY GENERIC NAME GENERIC DRUG NAME TRADE DRUG NAME DRUG CODE STRENGTH PREPACK SIZE MEDI-CAL BILLABLE ------------------------------------------------------------------------------------------------------------------------ DESIPRAMINE NORPRAMINE DSM100 100 MG 100 TABLETS Y DEXTROAMPHETAMI DEXEDRINE DAM5T 5 MG 100 TABLET Y DIPHENHYDRAMINE BENADRYL DPM12L 12.5 MG/4 ML 480 ML Y DIPHENHYDRAMINE BENADRYL DPM50 50 MG 100 CAPSULES Y DIPHENHYDRAMINE BENADRYL DPM50A 50 MG/ML 10 ML Y DISULFIRAM ANTABUSE DSR250 250 MG 100 TABLETS Y DIVALPROEX DEPAKOTE DVP125E 125 MG 100 TABLET Y DIVALPROEX DEPAKOTE DVP250E 250 MG 100 TABLET Y DIVALPROEX DEPAKOTE DVP500E 500 MG 100 TABLET Y DIVALPROEX ER DEPAKOTE ER DVP250ER 250 MG 100 TABLET Y DIVALPROEX ER DEPAKOTE ER DVP500ER 500 MG 100 TABLET Y DOXEPIN SINEQUAN DXP10L 10 MG/ML 120 ML Y DOXEPIN SINEQUAN DXP10 10 MG 100 CAPSULES Y DOXEPIN SINEQUAN DXP25 25 MG 100 CAPSULES Y DOXEPIN SINEQUAN DXP50 50 MG 100 CAPSULES Y DOXEPIN SINEQUAN DXP75 75 MG 100 CAPSULES Y DOXEPIN SINEQUAN DXP100 100 MG 100 CAPSULES Y DOXEPIN SINEQUAN DXP150 150 MG 50 CAPSULES Y DSS COLASE DSS111 100 MG 100 CAPSULES Y DSS COLASE DSS240 250 MG 100 CAPSULES Y DULOXETINE CYMBALTA DLT20 20 MG 60 CAPSULE Y DULOXETINE CYMBALTA DLT30 30 MG 30 CAPSULE Y DULOXETINE CYMBALTA DLT60 60 MG 30 CAPSULE Y ESCITALOPRAM LEXAPRO ETP10 10 MG 100 TABLET Y ESCITALOPRAM LEXAPRO ETP20 20 MG 100 TABLET Y FAZACLO FAZACLO FZC25 25 MG 100 TABLET Y FAZACLO FAZACLO FZC100 100 MG 100 TABLET Y FAZACLO FAZACLO FZC150 150 MG 100 TABLETS Y FAZACLO FAZACLO FZC200 200 MG 100 TABLETS Y FLUOXETINE PROZAC FOT10 10 MG 100 CAPSULE Y FLUOXETINE PROZAC FOT10T 10 MG 100 TABLET Y FLUOXETINE PROZAC FOT20 20 MG 100 CAPSULES Y FLUOXETINE PROZAC FOT20L 20 MG/5 ML 120 ML Y FLUOXETINE WEEK PROZAC WEEKLY FOT90 90 MG 4 CAPSULE Y FLUPHENAZINE PROLIXIN FPZ.5L 0.5 MG/ML 480 ML Y FLUPHENAZINE PROLIXIN FPZ1 1 MG 100 TABLETS Y FLUPHENAZINE PROLIXIN DEC FPZ26J 25 MG/ML DEC 5 ML VIAL Y FLUPHENAZINE PROLIXIN FPZ2.5J 2.5 MG/ML 10 ML VIAL Y FLUPHENAZINE PROLIXIN FPZ2.5 2.5 MG 100 TABLETS Y FLUPHENAZINE PROLIXIN FPZ5L 5 MG/ML 120 ML Y FLUPHENAZINE PROLIXIN FPZ5 5 MG 100 TABLETS Y FLUPHENAZINE PROLIXIN FPZ10 10 MG 100 TABLETS Y FLURAZAPAM DALMANE FAP15 15 MG 100 CAPSULES Y FLURAZAPAM DALMANE FAP30 30 MG 100 CAPSULES Y FLUVOXAMINE LUVOX FVM100 100 MG 100 TABLET Y FLUVOXAMINE CR LUVOX CR FVM100CR 100 MG 30 CAPSULES Y REPORT NO : HMHRP970 COUNTY OF LOS ANGELES PAGE 4 RUN DATE : 08/31/14 DEPARTMENT OF MENTAL HEALTH REPORTING PERIOD: AUGUST 2014 PATS DRUG FORMULARY BY GENERIC NAME GENERIC DRUG NAME TRADE DRUG NAME DRUG CODE STRENGTH PREPACK SIZE MEDI-CAL BILLABLE ------------------------------------------------------------------------------------------------------------------------ FLUVOXAMINE CR LUVOX CR FVM150CR 150 MG 30 CAPSULES Y GUANFACINE TENEX GFC1 1 MG 100 TABLET Y GUANFACINE TENEX GFC2 2 MG 100 TABLET Y HALOPERIDOL HALDOL HLD.5 0.5 MG 100 TABLETS Y HALOPERIDOL HALDOL HLD1 1 MG 100 TABLETS Y HALOPERIDOL HALDOL DEC HLD105J 100MG/ML 5 ML Y HALOPERIDOL HALDOL DEC HLD100J 100 MG/ML 5 ML Y HALOPERIDOL HALDOL HLD2L 2 MG/ML 120 ML Y HALOPERIDOL HALDOL HLD2 2 MG 100 TABLETS Y HALOPERIDOL HALDOL HLD21L 2 MG/ML 15 ML Y HALOPERIDOL HALDOL HLD5 5 MG 100 TABLETS Y HALOPERIDOL HALDOL HLD5J 5 MG/ML 10 ML Y HALOPERIDOL HALDOL HLD10 10 MG 100 TABLETS Y HALOPERIDOL HALDOL DEC HLD50J 50 MG/ML 5 ML Y HYDROXYZINE ATARAX HDY10 10 MG 100 TABLETS Y HYDROXYZINE ATARAX HDY10L 10 MG/5ML 480 ML Y HYDROXYZINE ATARAX HDY25 25 MG 100 TABLETS Y HYDROXYZINE ATARAX HDY50 50 MG 100 TABLETS Y HYDROXYZINE PAM VISTARIL HDY251 25 MG 100 CAPSULES Y HYDROXYZINE PAM VISTARIL HDY501 50 MG 100 CAPSULES Y ILOPERIDONE FANAPT ILD1 1 MG 60 TABLETS Y ILOPERIDONE FANAPT ILD2 2 MG 60 TABLETS Y ILOPERIDONE FANAPT ILD4 4 MG 60 TABLETS Y ILOPERIDONE FANAPT ILD6 6 MG 60 TABLETS Y ILOPERIDONE FANAPT TPAK ILDTP 6 MG 8 TABLETS Y ILOPERIDONE FANAPT ILD8 8 MG 60 TABLETS Y ILOPERIDONE FANAPT ILD10 10 MG 60 TABLETS Y ILOPERIDONE FANAPT ILD12 12 MG 60 TABLETS Y IMIPRAMINE TOFRANIL IMM10 10 MG 100 TABLETS Y IMIPRAMINE TOFRANIL IMM25 25 MG 100 TABLETS Y IMIPRAMINE TOFRANIL IMM50 50 MG 100 TABLETS Y L-DEXAMFETAMINE VYVANSE LDM20 20 MG 100 CAPSULE Y L-DEXAMFETAMINE VYVANSE LDM30 30 MG 100 CAPSULES Y L-DEXAMFETAMINE VYVANSE LDM40 40 MG 100 CAPSULES Y L-DEXAMFETAMINE VYVANSE LDM50 50 MG 100 CAPSULES Y L-DEXAMFETAMINE VYVANSE LDM60 60 MG 100 CAPSULES Y L-DEXAMFETAMINE VYVANSE LDM70 70 MG 100 CAPSULES Y LAMOTRIGINE LAMICTAL LTG25 25 MG 100 TABLET Y LAMOTRIGINE LAMICTAL LTG100 100 MG 100 TABLET Y LAMOTRIGINE LAMICTAL LTG150 150 MG 60 TABLET Y LAMOTRIGINE LAMICTAL LTG200 200 MG 60 TABLET Y LEVOTHYROXINE SYNTHROID LVI0.025 0.025 MG 100 TABLET Y LEVOTHYROXINE SYNTHROID LVI0.05 0.05 MG 100 TABLET Y LEVOTHYROXINE SYNTHROID LVI0.075 0.075 MG 100 TABLET Y LEVOTHYROXINE SYNTHROID LVI0.1 0.1 MG 100 TABLET Y LEVOTHYROXINE SYNTHROID LVI0.125 0.125 MG 100 TABLET Y REPORT NO : HMHRP970 COUNTY OF LOS ANGELES PAGE 5 RUN DATE : 08/31/14 DEPARTMENT OF MENTAL HEALTH REPORTING PERIOD: AUGUST 2014 PATS DRUG FORMULARY BY GENERIC NAME GENERIC DRUG NAME TRADE DRUG NAME DRUG CODE STRENGTH PREPACK SIZE MEDI-CAL BILLABLE ------------------------------------------------------------------------------------------------------------------------ LEVOTHYROXINE SYNTHROID LVI0.15 0.15 MG 100 TABLET Y LEVOTHYROXINE SYNTHROID LVI0.2 0.2 MG 100 TABLET Y LEVOTHYROXINE SYNTHROID LVI0.3 0.3 MG 100 TABLET Y LITHIUM ESKALITH LTC301 300 MG 100 CAPSULES Y LITHIUM LITHIUM LTC300T 300MG 100 TABLET Y LITHIUM CITRATE CIBALITH-S LTC300L 300 MG/5 ML 480 ML Y LITHOBID LITHOBID LTC300C 300 MG 100 TABLETS Y LORAZEPAM ATIVAN LAP.5 0.5 MG 100 TABLETS Y LORAZEPAM ATIVAN LAP1 1 MG 100 TABLETS Y LORAZEPAM ATIVAN LAP2 2 MG 100 TABLETS Y LOXAPINE LOXITANE LOX5 5 MG 100 CAPSULES Y LOXAPINE LOXITANE LOX10 10 MG 100 CAPSULES Y LOXAPINE LOXITANE LOX25 25 MG 100 CAPSULES Y LOXAPINE LOXITANE LOX50 50 MG 100 CAPSULES Y LURASIDONE LATUDA LAD20 20 MG 30 TABLETS Y LURASIDONE LATUDA LAD40 40 MG 30 TABLETS Y LURASIDONE LATUDA LAD60 60 MG 30 TABLETS Y LURASIDONE LATUDA LAD80 80 MG 30 TABLETS Y LURASIDONE LATUDA LAD120 120 MG 30 TABLETS Y METFORMIN METFORMIN MFN1000 1000 MG 100 TABLETS Y METFORMIN METFORMIN MFN500 500 MG 100 TABLETS Y METHYLPHENIDATE RITALIN MTD5 5 MG 100 TABLETS Y METHYLPHENIDATE RITALIN MTD10 10 MG 100 TABLETS Y METHYLPHENIDATE RITALIN MTD20 20 MG 100 TABLETS Y METOPROLOL LOPRESSOR MTL50 50 MG 100 TABLET Y METOPROLOL LOPRESSOR MTL100 100 MG 100 TABLET Y MIRTAZAPINE REMERON MTP15 15 MG 30 TABLET Y MIRTAZAPINE REMERON MTP30 30 MG 30 TABLET Y MIRTAZAPINE REMERON MTP45 45 MG 30 TABLET Y MIRTAZAPINE SOL REMERON SOLTAB MTP15-1 15 MG 30 TABLET Y MIRTAZAPINE SOL REMERON SOLTAB MTP30-1 30 MG 30 TABLET Y MIRTAZAPINE SOL REMERON SOLTAB MTP45-1 45 MG 30 TABLET Y NALTREXONE REVIA NTO50 50 MG 30 TABLET Y NEFAZODONE SERZONE NFD50 50 MG 60 TABLET Y NEFAZODONE SERZONE NFD100 100 MG 60 TABLET Y NEFAZODONE SERZONE NFD150 150 MG 60 TABLET Y NEFAZODONE SERZONE NFD200 200 MG 60 TABLET Y NEFAZODONE SERZONE NFD250 250 MG 60 TABLET Y NORTRIPTYLINE PAMELOR NTL10L 10 MG/5ML 480 ML Y NORTRIPTYLINE PAMELOR NTL10 10 MG 100 CAPSULES Y NORTRIPTYLINE PAMELOR NTL25 25 MG 100 CAPSULES Y NORTRIPTYLINE PAMELOR NTL50 50 MG 100 CAPSULES Y NORTRIPTYLINE PAMELOR NTL75 75 MG 100 CAPSULES Y OLANZAPINE ZYPREXA OLP2.5 2.5 MG 60 TABLET Y OLANZAPINE ZYPREXA OLP5 5 MG 60 TABLET Y OLANZAPINE ZYPREXA OLP7.5 7.5 MG 60 TABLET Y REPORT NO : HMHRP970 COUNTY OF LOS ANGELES PAGE 6 RUN DATE : 08/31/14 DEPARTMENT OF MENTAL HEALTH REPORTING PERIOD: AUGUST 2014 PATS DRUG FORMULARY BY GENERIC NAME GENERIC DRUG NAME TRADE DRUG NAME DRUG CODE STRENGTH PREPACK SIZE MEDI-CAL BILLABLE ------------------------------------------------------------------------------------------------------------------------ OLANZAPINE ZYPREXA OLP10 10 MG 60 TABLET Y OLANZAPINE ZYPREXA OLP15 15 MG 60 TABLET Y OLANZAPINE ZYPREXA OLP20 20 MG 60 TABLET Y OLANZAPINE ZYDI ZYPREXA ZYDIS OLP5Z 5 MG 30 TABLET Y OLANZAPINE ZYDI ZYPREXA ZYDIS OLP10Z 10 MG 30 TABLET Y OLANZAPINE ZYDI ZYPREXA ZYDIS OLP15Z 15 MG 30 TABLET Y OLANZAPINE ZYDI ZYPREXA ZYDIS OLP20Z 20 MG 30 TABLET Y OXCARBAZEPINE TRILEPTAL OBP150 150 MG 100 TABLET Y OXCARBAZEPINE TRILEPTAL OBP300 300 MG 100 TABLET Y OXCARBAZEPINE TRILEPTAL OBP600 600 MG 100 TABLET Y PAROXETINE PAXIL PXT10 10 MG 30 TABLET Y PAROXETINE PAXIL CR PXT12.5CR 12.5 MG 30 TABLET Y PAROXETINE PAXIL PXT20 20 MG 100 TABLET Y PAROXETINE PAXIL CR PXT25CR 25 MG 30 TABLET Y PAROXETINE PAXIL PXT30 30 MG 30 TABLET Y PAROXETINE PAXIL CR PXT37.5CR 37.5 MG 30 TABLET Y PAROXETINE PAXIL PXT40 40 MG 30 TABLET Y PERPHEN/AMITRIP TRIAVIL TAV225 2-25 MG 100 TABLETS Y PERPHEN/AMITRIP TRIAVIL TAV210 2-10 MG 100 TABLETS Y PERPHEN/AMITRIP TRIAVIL TAV410 4-10 MG 100 TABLETS Y PERPHEN/AMITRIP TRIAVIL TAV425 4-25 MG 100 TABLETS Y PERPHENAZINE TRILAFON PRZ2 2 MG 100 TABLETS Y PERPHENAZINE TRILAFON PRZ4 4 MG 100 TABLETS Y PERPHENAZINE TRILAFON PRZ8 8 MG 100 TABLETS Y PERPHENAZINE TRILAFON PRZ16 16 MG 100 TABLETS Y PHENOBARBITAL PHENOBARBITAL PB30 30 MG 100 TABLETS Y PHENOBARBITAL PHENOBARBITAL PB60 60 MG 100 TABLETS Y PHENYTOIN DILANTIN DPD50 50 MG 100 TABLETS Y PHENYTOIN LA DILANTIN DPD100 100 MG 100 CAPSULES Y PROPRANOLOL INDERAL PPO10 10 MG 100 TABLETS Y PROPRANOLOL INDERAL PPO20 20 MG 100 TABLETS Y PROPRANOLOL INDERAL PPO40 40 MG 100 TABLETS Y PROPRANOLOL INDERAL PPO80 80 MG 100 TABLETS Y PROTRIPTYLINE VIVACTIL PTL5 5 MG 100 TABLETS Y PROTRIPTYLINE VIVACTIL PTL10 10 MG 100 TABLETS Y QUETIAPINE SEROQUEL QTP25 25 MG 100 TABLET Y QUETIAPINE SEROQUEL QTP100 100 MG 100 TABLET Y QUETIAPINE SEROQUEL QTP200 200 MG 100 TABLET Y QUETIAPINE SEROQUEL QTP300 300 MG 60 TABLET Y QUETIAPINE SEROQUEL QTP400 400 MG 100 TABLETS Y QUETIAPINE XR SEROQUEL XR QTP50XR 50 MG 100 TABLETS Y QUETIAPINE XR SEROQUEL XR QTP150XR 150 MG 100 TABLETS Y QUETIAPINE XR SEROQUEL XR QTP200XR 200 MG 60 TABLETS Y QUETIAPINE XR SEROQUEL XR QTP300XR 300 MG 60 TABLETS Y QUETIAPINE XR SEROQUEL XR QTP400XR 400 MG 60 TABLETS Y RISPERIDONE RISPERDAL RPD.25 0.25 MG 60 TABLET Y REPORT NO : HMHRP970 COUNTY OF LOS ANGELES PAGE 7 RUN DATE : 08/31/14 DEPARTMENT OF MENTAL HEALTH REPORTING PERIOD: AUGUST 2014 PATS DRUG FORMULARY BY GENERIC NAME GENERIC DRUG NAME TRADE DRUG NAME DRUG CODE STRENGTH PREPACK SIZE MEDI-CAL BILLABLE ------------------------------------------------------------------------------------------------------------------------ RISPERIDONE RISPERDAL RPD.5 0.5 MG 60 TABLET Y RISPERIDONE RISPERDAL RPD1L 1 MG/ML 30 ML Y RISPERIDONE RISPERDAL RPD1 1 MG 60 TABLET Y RISPERIDONE RISPERDAL RPD2 2 MG 60 TABLET Y RISPERIDONE RISPERDAL RPD3 3 MG 60 TABLET Y RISPERIDONE RISPERDAL RPD4 4 MG 60 TABLET Y SERTRALINE ZOLOFT STL50 50 MG 100 TABLET Y SERTRALINE ZOLOFT STL100 100 MG 100 TABLET Y TEGRETOL TEGRETOL CBP100 100 MG 100 TABLETS Y TEMAZEPAM RESTORIL TMP15 15 MG 100 CAPSULES Y TEMAZEPAM RESTORIL TMP30 30 MG 100 CAPSULES Y THIORIDAZINE MELLARIL T10-1 10 MG 100 TABLETS Y THIORIDAZINE MELLARIL T15 15 MG 100 TABLETS Y THIORIDAZINE MELLARIL T25 25 MG 100 TABLETS Y THIORIDAZINE MELLARIL T50 50 MG 100 TABLETS Y THIORIDAZINE MELLARIL T100 100 MG 100 TABLETS Y THIORIDAZINE MELLARIL T150 150 MG 100 TABLETS Y THIOTHIXENE NAVANE TOX1 1 MG 100 CAPSULES Y THIOTHIXENE NAVANE TOX2 2 MG 100 CAPSULES Y THIOTHIXENE NAVANE TOX5 5 MG 100 CAPSULES Y THIOTHIXENE NAVANE TOX5L 5 MG/ML 120 ML Y THIOTHIXENE NAVANE TOX10 10 MG 100 CAPSULES Y TOPIRAMATE TOPAMAX TPM25 25 MG 60 TABLET Y TOPIRAMATE TOPAMAX TPM50 50 MG 60 TABLET Y TOPIRAMATE TOPAMAX TPM100 100 MG 60 TABLET Y TOPIRAMATE TOPAMAX TPM200 200 MG 60 TABLET Y TOPIRAMATE SPK TOPAMAX SPRINK TPM25S 25 MG 60 CAPSULE Y TRAZODON DESYREL TAD50 50 MG 100 TABLETS Y TRAZODON DESYREL TAD100 100 MG 100 TABLETS Y TRAZODON DESYREL TAD150 150 MG 100 TABLETS Y TRIAZOLAN HALCION TIL125 0.125 MG 100 TABLETS Y TRIAZOLAN HALCION TIL25 0.25 MG 100 TABLETS Y TRIFLUOPERAZINE STELAZINE TFZ1 1 MG 100 TABLETS Y TRIFLUOPERAZINE STELAZINE TFZ2-1 2 MG 100 TABLETS Y TRIFLUOPERAZINE STELAZINE TFZ5-1 5 MG 100 TABLETS Y TRIFLUOPERAZINE STELAZINE TFZ10 10 MG 100 TABLETS Y TRIHEXYPHENIDYL ARTANE THD2-1 2 MG 100 TABLETS Y TRIHEXYPHENIDYL ARTANE THD5-1 5 MG 100 TABLETS Y VALPROIC ACID DEPAKENE VPA250L 250 MG/5 ML 480 ML Y VALPROIC ACID DEPAKENE VPA250 250 MG 100 CAPSULES Y VENLAFAXINE ER VENLAFAXINE ER VNX375ER 37.5 MG 90 TABLETS Y VENLAFAXINE ER VENLAFAXINE ER VNX75ER 75 MG 90 TABLETS Y VENLAFAXINE ER VENLAFAXINE ER VNX150ER 150 MG 90 TABLETS Y VENLAFAXINE ER VENLAFAXINE ER VNX225ER 225 MG 90 TABLETS Y VENLAFAXINE XR EFFEXOR XR VNX37.5 37.5 MG 100 CAPSULE Y VENLAFAXINE XR EFFEXOR XR VNX375XR 37.5 MG 100 CAPSULE Y REPORT NO : HMHRP970 COUNTY OF LOS ANGELES PAGE 8 RUN DATE : 08/31/14 DEPARTMENT OF MENTAL HEALTH REPORTING PERIOD: AUGUST 2014 PATS DRUG FORMULARY BY GENERIC NAME GENERIC DRUG NAME TRADE DRUG NAME DRUG CODE STRENGTH PREPACK SIZE MEDI-CAL BILLABLE ------------------------------------------------------------------------------------------------------------------------ VENLAFAXINE XR EFFEXOR XR VNX75XR 75 MG 100 CAPSULE Y VENLAFAXINE XR EFFEXOR XR VNX150XR 150 MG 100 CAPSULE Y ZIPRASIDONE GEODON ZPD20 20 MG 60 CAPSULE Y ZIPRASIDONE GEODON ZPD40 40 MG 60 CAPSULE Y ZIPRASIDONE GEODON ZPD60 60 MG 60 CAPSULE Y ZIPRASIDONE GEODON ZPD80 80 MG 60 CAPSULE Y ** END OF REPORT **