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Cms formulary id: «cms_formulary_id»

Alliance CompleteCare
Future Formulary Change File
CMS FORMULARY ID: 13348
EFFECTIVE DATE: 6/1/2013

DRUG NAME
DILANTIN 50 MG ORAL

CHANGE DESCRIPTION
BRAND DELETION, ADD FRF GENERIC

REASON DESCRIPTION
REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW
GENERIC EQUIVALENT.

OTHER POSSIBLE DRUGS
Alliance CompleteCare
Future Formulary Change File
CMS FORMULARY ID: 13348
EFFECTIVE DATE: 6/1/2013

DRUG NAME
DUETACT 30 MG-2 MG ORAL

CHANGE DESCRIPTION
BRAND DELETION, ADD FRF GENERIC

REASON DESCRIPTION
REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW
GENERIC EQUIVALENT.

OTHER POSSIBLE DRUGS
Alliance CompleteCare
Future Formulary Change File
CMS FORMULARY ID: 13348
EFFECTIVE DATE: 6/1/2013

DRUG NAME
DUETACT 30 MG-4 MG ORAL

CHANGE DESCRIPTION
BRAND DELETION, ADD FRF GENERIC

REASON DESCRIPTION
REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW
GENERIC EQUIVALENT.

OTHER POSSIBLE DRUGS
Alliance CompleteCare
Future Formulary Change File
CMS FORMULARY ID: 13348
EFFECTIVE DATE: 6/1/2013

DRUG NAME
GRIS-PEG 250 MG ORAL

CHANGE DESCRIPTION
BRAND DELETION, ADD FRF GENERIC

REASON DESCRIPTION
REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW
GENERIC EQUIVALENT.

OTHER POSSIBLE DRUGS
Alliance CompleteCare
Future Formulary Change File
CMS FORMULARY ID: 13348
EFFECTIVE DATE: 6/1/2013

DRUG NAME
PROTONIX IV 40 MG INTRAVEN.

CHANGE DESCRIPTION
BRAND DELETION, ADD FRF GENERIC

REASON DESCRIPTION
REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW
GENERIC EQUIVALENT.

OTHER POSSIBLE DRUGS
Alliance CompleteCare
Future Formulary Change File
CMS FORMULARY ID: 13348
EFFECTIVE DATE: 6/1/2013

DRUG NAME
TRICOR 145MG ORAL

CHANGE DESCRIPTION
BRAND DELETION, ADD FRF GENERIC

REASON DESCRIPTION
REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW
GENERIC EQUIVALENT.

OTHER POSSIBLE DRUGS
Alliance CompleteCare
Future Formulary Change File
CMS FORMULARY ID: 13348
EFFECTIVE DATE: 6/1/2013

DRUG NAME
TRICOR 48 MG ORAL

CHANGE DESCRIPTION
BRAND DELETION, ADD FRF GENERIC

REASON DESCRIPTION
REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW
GENERIC EQUIVALENT.

OTHER POSSIBLE DRUGS
Alliance CompleteCare
Future Formulary Change File
CMS FORMULARY ID: 13348
EFFECTIVE DATE: 6/1/2013

DRUG NAME
ZERIT 1 MG/ML ORAL

CHANGE DESCRIPTION
BRAND DELETION, ADD FRF GENERIC

REASON DESCRIPTION
REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW
GENERIC EQUIVALENT.

OTHER POSSIBLE DRUGS

Source: https://www.alamedaalliance.org/~/media/files/modules/publications/pharmacy/2013%20acc%20pharmacy%20documents/future%20formulary%20change_june%202013.pdf

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