FormWeb • Non-Formulary

Approved Hospital Formulary

Formulary Addition Requisition (Position 1)

Please review each of these drugs carefully.

felodipine	Non-Formulary
glyBURIDE	Non-Formulary
ketorolac	Nasal Spray is non-formulary
levonorgestrel	Norplant is Non-Formulary
omeprazole	Non-Formulary w/restrictions
rosuvastatin	Ezallor Sprinkle: Non-Formulary

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