RxAnswer Prescr Guide 6/22.qxd

Transcription

E x c l u s i v e 4 Ti e r P r e s c r i p t i o n P r o g r a m
Doctor’s
Prescribing Guide
Take this booklet
to your doctor.
Printed June 2004.
Tier Drugs subject to change without notice based
on manufacturer pricing.
Dear Member:
Your prescription program is designed to educate you on the use of generic and other low cost brand name drugs.
The program is designed to help you and your doctor find drugs within the same therapeutic class as a drug you may
be currently taking. Most of all, your program is designed to save you money on your prescription drug costs. This
4 Tier Prescription Program card is recognized at 98% of pharmacies in the United States and Puerto Rico.
The formulary program has four tiers:
•
•
•
•
The first tier is generic drugs that will be available to you for up to a $10.00 payment.
The second tier is brand name drugs and select generic drugs that will be available to you for up to a $20.00 payment.
The third tier is brand name drugs and select generic drugs that will be available to you for up to a $50.00 payment.
The fourth tier is brand name drugs for which RxAnswer has negotiated a special network price.
Due to the volume of drugs under Tier 4 not all are printed in this guide. Please check the website for your specific drugs.
To get the most out of this program you should ask your doctor to prescribe a drug within the first two tiers if
possible. Often times drugs within the same therapeutic class can be prescribed in place of an expensive brand name
drug. Of course, if you choose the higher price brand name drug we have negotiated a substantial discount to you.
Please review this entire booklet. You may want to refer to the “frequently asked questions” section for more information.
Feel free to contact our customer service center if you have additional questions. Our knowledgeable Help Desk and Customer
Service department ensures that all physician, member and pharmacy calls are responded to swiftly and accurately. Call the
phone number on the back of your membership card for our prompt customer service help desk available toll free
Monday through Friday – 9 a.m. to 4 p.m. (Eastern time)
“I saved $45.22 on my four prescriptions! Talk about happy!”
Denver, CO
“I saved $168.33 on 5 prescriptions at Lowe’s Pharmacy.”
Amarillo, TX
“I saved $49.58 on 2 prescriptions at Walgreen’s.”
Lubbock, TX
Remember, don't leave the pharmacy without calling the
Pharmacy Help Desk number printed on the back of your
card if the pharmacy has any difficulty processing your
prescriptions.
Prices and Tier Position subject to change without notice.
Tier position and price only for quantities stated, additional
quantities may incur higher costs
This is not an insured product.
3
Frequently Asked Questions:
Where can I use the RxAnswer card?
The RxAnswer card is accepted at over 42,000 pharmacies throughout the United States. The network includes pharmacy chains as well as thousands of independent
pharmacies throughout the country. Pharmacy location information can be obtained by calling the number on the back of your card. We will send them information
about how they can participate in the network so that you can take advantage of the savings as soon as possible.
What if my pharmacy doesn’t recognize the card?
Pharmacies may not be familiar with every prescription program in which they participate. If the pharmacist does not recognize your RxAnswer card or if you encounter
a problem at the pharmacy, DO NOT leave without having the pharmacy call the toll-free number printed on the ID card.
How much will I pay for my prescriptions?
There are payments of up to $10.00 for drugs listed in Tier 1, up to $20.00 for brand name and select generic drugs listed in Tier 2 and up to $50.00 for brand name
and select generic drugs listed in Tier 3. For the drugs not listed in Tier 1, Tier 2 and Tier 3 members will pay the network contracted price that has been negotiated
by RxAnswer. Please pay close attention to the quantities listed by each drug in Tier 1, Tier 2 and Tier 3. Quantities in excess of those listed will result in higher prices.
What is my average savings on The Fourth Tier drugs?
There is no guaranteed percentage savings on every prescription purchase. The price paid depends upon the pharmacy and the type and quantity of drug purchased.
Pharmacies, just like other retail stores, compete against each other and may have special prices on some products. When this is the case, we cannot discount the pharmacy’s already low price, but a member will receive the advantage of the pharmacy’s special pricing. THE MEMBER ALWAYS RECEIVES THE LOWER OF THE
RxANSWER CONTRACT PRICE OR THE PHARMACY’S PRICE.
What is a generic drug?
Once a patent on a brand name drug expires, other drug companies may make a generic version of the drug, with the approval of the Food and Drug Administration
(FDA). The FDA’s standards for quality are the same for all manufacturers. This means the generic drug contains the same active ingredients as the brand name whose
patent has expired, and that its safe, potent and effective.
How can I keep my prescription drug costs down?
The use of generic prescription drugs, whenever available, is most cost effective. Don’t be shy – discuss your prescription options with your doctor. Ask whether an
alternative, less expensive option would work for your condition.
How will I know if there’s a generic equivalent available?
Simply ask your local pharmacist or call RxAnswer customer service department to find out about generic equivalents for your prescription. Also ask your doctor to prescribe generics whenever possible and appropriate. (Your new member packet will include helpful materials you can share with your doctor.)
What is the difference between brand name and generic drugs?
The brand name is the trade name under which the product is advertised and sold, and is protected by patents so that it can only be produced by one manufacturer for
a pre-determined number of years. Once a patent expires, other companies may manufacturer a generic equivalent, providing they follow stringent FDA regulations for
safety.
Generic drugs are drugs for which the patent has expired, allowing other manufacturers to produce and distribute the product under a generic name. Generics are essentially a chemical copy of their brand name equivalents. The color or shape may be different, but the active ingredients must be the same for both. The preferred drug
list contains only FDA-approved generic medications.
What is a preferred drug list?
A preferred drug list is a list of recommended prescription medications that is created, reviewed and continually updated by a team of physicians and pharmacists. The
preferred drug list contains a wide range of generic and brand name preferred products that have been approved by the Food and Drug Administration (FDA). Your
doctor can use this list to select medications for your health care needs, while helping you maximize your prescription drug benefit. A medication becomes a preferred
drug based on safety and efficacy, then on cost-effectiveness.
What is the difference between a preferred brand name drug vs. a non-preferred brand name drug?
A preferred brand name drug is a medication that has been reviewed and approved by a group of physicians and pharmacists, and has been selected for preferred status
based on its proven clinical and cost effectiveness.
A non-preferred brand name drug is a medication that has been reviewed by the same team of physicians and pharmacists who determined that an alternative drug that
is clinically equivalent and most cost effective is available. These designations may change as new clinical information becomes available.
What drugs are considered preferred (formulary) on Discount Plans?
The RxAnswer product guide contains certain brand drugs for which the member’s price is the scheduled amount listed. Drugs that are chemically or therapeutically
similar to drugs listed on the product guide are not discounted. Prices are subject to change due to manufacturer price changes to pharmacies. On these drugs, the participant enjoys the special network pricing.
What if the brand drug I am taking is not discounted?
If you are currently taking a medication that has similar active ingredients or is used to treat the same conditions as the preferred brand drugs on the RxAnswer product guide, it will still be discounted. You will pay the RxAnswer negotiated price for that drug. To take advantage of the potential program savings on listed preferred
drugs, you should ask your Pharmacist (where regulations permit) or a Doctor to change your medication, where medically appropriate, to a less expensive product listed in the product guide.
4
E x c l u s i v e 4 Ti e r P r e s c r i p t i o n P r o g r a m
Preferred Drug
List (PDL)
In the following pages the RxAnswer Prescription Drug Program has
conveniently listed the prescription drugs available in all four tiers.
These are listed in a variety of product categories. If you don’t find
what you need we encourage you to go to our website: www.rxanswer.net for the most up-to-date listing of drugs. Be sure to have the
proper spelling and dosage of the prescription handy.
Prices and tier position subject to change without notice. Tier position
and price only for quantities stated, additional quantities may incur
higher costs.
5
Preferred Generic Drugs*
Preferred Brand Name & Generic Drugs*
$20 or Less
$10 or Less
BENZAC AC & W 5 GEL - 60 GM
BENZAC AC & W 10 GEL - 60 GM
BENZAC AC 2.5 GEL - 60 GM
BENZAGEL WASH - 60 GM
BENZOYL PEROXIDE 10% GEL 60 GM
BENZOYL PEROXIDE 2.5% GEL 60 GM
BENZOYL PEROXIDE 5% GEL - 60 GM
DESQUAM E-GEL
“DESQUAM -X GEL, WASH , BAR”
ZERAC AC 6.25% SOLN - 60ML
PYRIDOSTIGIMINE BROMIDE 60MG
Analegesics - Narcotic
APAP/CODEINE 30-300
HYDROCODONE/APAP 10-650
HYDROCODONE/APAP 5-500
HYDROCODONE/APAP 7.5-500
OXYCODONE/APAP 5-325
PROPOXYPHENE NAPSYLATE/APAP 100/650
30
30
30
30
40
30
40
30
30
Analgesics - Non Narcotic
ACETAMINOPHEN
ASPIRIN
AKNE-MYCIN 2% OINT
AZELEX 20% CREAM
BENZACREAM-5
RETIN-A MICR GEL 0.04%
RETIN-A MICR GEL 0.1%
SULFACET-R LOT
SULFACET-R LOT TINT-FRE
TRIAZ
GEL 3%
TRIAZ
GEL 6%
TRIAZ
GEL 9%
60
60
60
60
60
60
60
42.5
1
60
100
100
ACCUTANE
AVITA
CONDYLOX
TRIAZ
RETIN A CREAM
RETIN A GEL
Alzheimer’s Disease
ARICEPT
EXELON
30
ASA/CODEINE 30 MG
30
ASA/CODEINE 60 MG
30
CODEINE SULFATE 30MG TABS
30
DARVON 65MG
60
40
30
40
30
PROPOXYPHENE NAPSYLATE/APAP 100/650 30
METHADONE 5MG TAB
30
MORPHINE SULFATE IR 15 MG
30
MORPHINE SULFATE IR 30 MG
120
MSIR 15 MG
120
OXYCODONE HCL 5MG TAB
90
OXYCODONE/ASA 4.88-325
60
PROPOXYPHENE HCL 65MG
60
PROPOXYPHENE W/APAP 65-650
60
APAP/CODEINE 60-300
CODEINE SULFATE 15MG TABLET
LEVORPHANOL 2MG TABLET
LORCET PLUS TABLET
LORTAB 5/500 TABLET
MAXIDONE 10/750MG TABLET
MORPHINE SUL TAB 10MG
MORPHINE SUL TAB 15MG
MS CONTIN 15MG TABLET SA
NORCO 10/325 TABLET
ORAMORPH SR 15MG TABLET SA
OXYCODONE/APAP 7.5/500 TAB
OXYCONTIN 10MG TABLET SA
PANLOR DC CAPSULE
PENTAZOCINE/NALOXONE TABLET
LOBAC
RELAGESIC 650-50
25
30
113.4
20
20
25
25
42.5
42.5
42.5
Acne
Acne
Acne
60 ML
60 ML
Special Negotiated Pricing**
Qty
Qty
Qty
Acne
CLINDAMYCIN 1% SOLUTION
ETHROMYCIN 1% SOLUTION
$50 or Less
PARAFON FORTE DSC 500MG CPT
ULTRACET TAB 37.5-325
ULTRAM 50MG TABLET
30
30
6
REMINYL
120
60
100
100
40
40
50
30
100
60
60
50
60
60
30
60
60
ANEXSIA
MEPERIDINE
AVINZA
PROMETHAZINE
BUPRENEX
MS CONTIN
BUTABITAL/W COD
NORCO
BUTORPHANOL TARTRATE ORAMORPH SR
CODEINE SULFATE 60MG
OXYCONTIN
DARVOCET-N 100 TAB
OXYIR
DARVON COMPOUND
PANLOR DC/SS
DARVON-N 100 TAB
PENTAZOCINE
DEMEROL
PERCOCET
DILAUDID
PERCODAN
DURAGESIC
SYNALGOS-DC
FIORICET W/COD
TALACEN
FIORINAL W/COD
TALWIN NX
KADIAN
TYLENOL W/CODEINE
LORCET
TYLOX
LORCET PLUS
ULTRACET
LORTAB
ULTRAM
MAXIDONE
VICODIN
MEPERIDINE 100MG
VICODIN ES/HP
VICOPROFEN
30
40
40
CHOLINE MAGNESIUM 750MG & 1000MG
DIFLUSINAL
FLEXTRA DS
EQUAGESIC
NOVASAL
ESGIC
PHRENILIN
ESGIC PLUS
PHRENILIN FORTE
FIORICET
ZORPRIN
FLEXTRA-650
$20 or Less
$10 or Less
Qty
Anorexiants
$50 or Less
Qty
Qty
Anorexiants
Anorexiants
DIDREX 50MG TABLET
PHENTERMINE 15MG CAPSULE
PHENTERMINE 30MG CAPSULE
PRELU-2 105MG CAPSULE SA
TENUATE DOSPAN 75MG TAB SA
Anti-Arrhythmics
Anti-Arrhythmics
IBUPROFEN 400MG
IBUPROFEN 600MG
IBUPROFEN 800MG
NAPROXEN 250MG
PIROXICAM 10 MG
PIROXICAM 20 MG
Antiarthritics
100
100
100
30
30
30
FENOPROFEN CALCIUM 600MG
INDOMETHACIN 25MG
INDOMETHACIN 50MG
KETOPROFEN 50MG
KETOPROFEN 75MG
NAPROXEN 375MG
NAPROXEN 500MG
100
150
100
150
30
30
40
AMOXICILLIN 250MG CHEWABLE
AMOXICILLIN 400MG TAB
AMOXICILLIN 875MG TAB
AMOXICILLIN 200 MG SUSP
AMOXICILLIN 400MG/5ML
AMPICILLIN 500MG
CEFACLOR 125MG5ML SUSP
Antibiotics
AMOXICILLIN 125 MG/5 ML SUSP
AMOXICILLIN 125 MG/5 ML SUSP
AMOXICILLIN 250 MG/5ML SUSP
AMOXICILLIN 250 MG/5ML SUSP
AMOXICILLIN 250MG
AMOXICILLIN 500 MG
AMPICILLIN 250 MG
Anorexiants
30
60
60
30
30
Anti-Arrhythmics
AMIODARONE HCL 200MG TABLET
DISOPYRAMIDE 100MG CAP SA
DISOPYRAMIDE 150MG CAP SA
ETHMOZINE TAB 200MG
ETHMOZINE TAB 250MG
ETHMOZINE TAB 300MG
FLECAINIDE ACETATE 50MG TAB
LANOXICAPS CAP 0.05MG
NORPACE
CAP 100MG CR
PROCAINAMIDE 750MG TAB SA
PROCANBID 500MG TABLET SA
PRONESTYL TAB 250MG
PRONESTYL TAB 375MG
PRONESTYL TAB 500MG
PROPAFENONE HCL 150MG TAB
PROPAFENONE HCL 225MG TAB
QUINIDINE SU TAB 300MG ER
SOTALOL 80MG TABLET
Antiarthritics
Anti-Arrhythmics
60
90
30
35
35
30
60
100
100
25
30
100
50
60
40
30
50
50
60
60
Antiarthritics
60
90
30
30
30
90
90
AZASAN 75MG TABLET
AZATHIOPRINE 50MG TABLET
BACLOFEN 20MG TABLET
BALCOFEN 10 MG
CELEBREX 100MG CAPSULE
DICLOFENAC POT 50MG TABLET
DIFLUNISAL 500MG TABLET
ETODOLAC 400MG SA
FLEXERIL TAB 5MG
INDOCIN
SUP 50MG
KETOROLAC 10MG TABLET
MECLOFENAMATE 25MG CAPSULE
MECLOFENAMATE 50MG CAPSULE
METHOTREXATE 2.5MG TABLET
MISOPROSTOL 200MCG TABLET
NABUMETONE 500MG TABLET
NABUMETONE 750MG TABLET
NAPRELAN 375 TABLET SA
OXAPROZIN 600MG TABLET
PONSTEL 250MG KAPSEALS
RELAFEN
TAB 500MG
RHEUMATREX TAB 2.5MG
TOLECTIN DS 400MG CAPSULE
TOLMETIN SODIUM 400MG CAP
TOLMETIN SODIUM 600MG CAP
VIOXX
TAB 12.5MG
VIOXX
TAB 25MG
VIOXX
TAB 50MG
ZORPRIN 800MG TABLET SA
Antibiotics
Antiarthritics
20
60
100
120
25
150
150
30
40
24
60
60
60
40
60
60
50
40
60
30
30
8
30
60
60
15
15
10
50
ANAPROX
MOTRIN
ANAPROX DS
NABUMETONE
ANSAID
NAPRELAN
ARAVA
NAPROSYN
ARTHROTEC NAPROXEN SODIUM 275 MG
BEXTRA NAPROXEN SODIUM 550 MG
CELEBREX
ORUDIS
DAYPRO
PONSTEL
DICLOFENAC SODIUM
PROBENECID
ENBREL
RELAFEN
ETODOLAC
RHEUMATREX
FLURBIPROFEN
SULINDAC
INDOCIN
TOLECTIN
KETOROLAC
TOLMETIN
LODINE
TORADOL
LODINE XL
VIOXX
MECLOFENAMATE
VOLTAREN
METHOTREXATE
VOLTAREN-XR
MOBIC
30
30
100
150
75
75
5
AMOXICILLIN/POTASSIUM CLAVULANATE KEFTAB
CECLOR
LEVAQUIN
CECLOR CD
LORABID
CEDAX
MACROBID
CEFACLOR CAPSULES MANDELAMINE
CEFADROXIL
MAXAQUIN
CEFTIN
MEBENDAZOLE
Antibiotics
30
20
20
100
100
30
75
AMOX TR-K CLV 200-28.5 TAB
AUGMENTIN CHW 125MG
AUGMENTIN SUS 125/5ML
AUGMENTIN SUS ES-600
AVELOX
TAB 400MG
7
AMIODARONE PROCAINAMIDE HCI 500 MG
CORDARONE
PROCANBID
DISOPYRAMIDE PHOS PROPAFENONE
ETHMOZINE
QUINIDEX
FLECAINIDE ACETATE
QUINIDINE GLUCONATE
MEXILETINE
RYTHMOL
MEXITIL
TAMBOCOR
NORPACE CR
TIKOSYN
PACERONE
TONOCARD
Antibiotics
$20 or Less
$10 or Less
Qty
Antibiotics
AMPICILLIN 500MG
DOXYCYCLINE HYCLATE 50MG
DOXYCYCLINE HYCLATE 100MG
ERYTHROMYCIN STEARATE 250MG
ERYTHROMYCIN STEARATE 500MG
ERYTHROMYCIN BASE 250MG
ERY-TAB 333
ERY-TAB 500
ISONIAZID 300MG
METRONIDAZOLE 500 MG
PENICILLIN VK 250 MG TABLET
PENICILLIN VK 500 MG TABLET
SULFISOXAZOLE
TRIMETHOPRIM-SULFAMETHOXAZOLE
TRIMETHOPRIM-SULFAMETHOXAZOLE DS
TETRACYCLINE 250MG
TETRACYCLINE 500MG
UROGESIC BLUE
PHENAZOPYRIDINE 200 MG
30
30
20
40
30
40
30
20
30
14
40
20
30
20
20
60
60
20
30
Antibiotics - Topical
BACITRACIN OINTMENT
15
GENTAMYCIN SULFATE 0.1% CREAM - 15GM
GENTAMYCIN SULFATE 0.1% OINT-15GM15
SSD CREAM - 50GM
50
PREFERRED GENERIC DRUGS*
$50 or Less
Qty
Qty
Antibiotics
Antibiotics
Antibiotics
CEFACLOR 187MG/5ML SUSP
75
CEPHALEXIN 125& 250MG/5ML SUSP 100
CEPHALEXIN 250 & 500MG CAPS
40
DICLOXACILLIN 250MG
30
ERYTHROMYCIN ETHYLSUCCINATE 30
ERYTHROMYCIN SULFISOXAZOLE 30
METHENAMINE MANDELATE 500MG 30
METHENAMINE MANDELATE 1G
30
TRIMETHOPRIM 100MG
30
AMOXIL 200 MG/5 ML
100
AMOXIL 400 MG/5ML
80
AMOCIL 200 MG AND 400 MG/5ML 200 ML
AMOXIL 875 MG TABLETS
20
AMOXIL DROPS
50
DAPSONE 25MG
60
DAPSONE 100MG
60
DYNAPEN 100ML
100
E.E.S. 200 SUSP
200
E.E.S. 400 SUSP
100
E.E.S. 400 TAB
40
ERY-TAB 250 MG
40
GANTRISIN 500MG/5ML - 180ML 180
LAMPRENE 50MG
30
MACRODANTIN 25MG
30
SUMYCIN 250
30
AVELOX ABC TAB 400MG
BIAXIN XL TAB 500MG PK
CEFACLOR 250MG CAPSULE
CEFACLOR 500MG CAPSULE
CEPHADROXIL 1000MG CAPSULE
CEPHADROXIL 500MG CAPSULE
CIPRO
TAB 250MG
CIPRO CYSTIT TAB 100MG
CIPROFLOXACI TAB 250MG
CLEOCIN
SUP 100MG
CLEOCIN HCL 75MG CAPSULE
CLEOCIN PED SOL 75MG/5ML
CEFUROXIME
MINOCIN
CEFZIL
MINOCYCLLINE
CIPRO
MONODOX
CIPRO CYSTITIS
MONUROL
CIPRO XR
NEGGRAM
CIPROFLOXACIN NEOMYCIN SULFATE
CLEOCIN
NITROFURANTOIN
CLINDAMYCIN
NOROXIN
DECLOMYCIN
OMNICEF
DICLOXACILLIN 500 MG
OXACILLIN
DORYX
PCE 500
DOXYCYCLINE MONOHYDRATE
PEDIAZOLE
DURICEF
PYRAZINAMIDE
DYNABEC
RIFAMATE
DYNACIN
RIFAMPIN
DYNACIN
ROCEPHIN
ETHAMBUTOL
SEPTRA DS
FLAGYL
SULFADIAZINE
FURADANTIN
SUPRAX
GEOCILLIN
TEQUIN
GLOXIN
TOTALCILLIN
HIPREX
URELLE
KANTREX
VANCOCIN
KEFLEX
VERMAX
VANCOMYCIN
VANTIN
VIBRAMYCIN
ZITHROMAX
ZYVOX
5
10
40
30
10
40
6
10
20
3
45
4
DOXYCYCLINE MONOHYDRATE 100MG CAP
30
DOXYCYCLINE MONOHYDRATE 50MG CAP 40
DURICEF
SUS 125/5ML
50
DURICEF
SUS 250/5ML
50
DURICEF
SUS 250/5ML
50
DURICEF
SUS 250/5ML
100
DURICEF
SUS 500/5ML
75
ERYC 250MG CAPSULE EC
60
ERYPED 400 SUS 400/5ML
100
ERYPED 400 SUS 400/5ML
200
ERY-TAB
TAB 250MG EC
100
ERY-TAB
TAB 333MG EC
120
ERY-TAB
TAB 500MG EC
100
GEOCILLIN TAB 382MG
20
LORABID
CAP 200MG
100
LORABID
SUS 100/5ML
75
LORABID
SUS 200/5ML
50
MACROBID CAP 100MG
20
MACRODANTIN CAP 25MG
50
MACRODANTIN 50MG CAPSULE
30
METHENAMINE HIPP 1GM TABLET 120
MONODOX 50MG CAPSULE
30
OMNICEF
SUS 125MG/5
60
PCE
TAB 333MG EC
20
PCE
TAB 500MG EC
20
PERIOSTAT 20MG TABLET
40
PYRAZINAMIDE 500MG TABLET
40
RIFADIN 150MG CAPSULE
150
RIFAMPIN CAP 100MG
60
RIFAMPIN CAP 300 MG
40
RIMANTADINE HCL 100MG TAB
25
SPECTRACEF 200MG TABLET
20
SULFISOXAZOLE 500MG TABLET
100
VANTIN
SUS 100/5ML
50
VANTIN
SUS 50MG/5ML
100
VANTIN
TAB 100MG
10
VELOSEF
CAP 250MG
40
VELOSEF
CAP 500MG
20
VELOSEF
SUS 250/5ML
200
VIBRAMYCIN SYP 50MG/5ML
90
YODOXIN
TAB 210MG
60
YODOXIN
TAB 650MG
50
ZITHROMAX SUS 100/5ML
15
22.5
30
ZITHROMAX TAB 250MG
6
ZITHROMAX TAB Z-PAK
6
ACTICIN
AKNE-MYCIN
AVAR
AZELEX
BACTROBAN
CORTISPORIN
15
PREFERRED BRAND NAME & GENERIC DRUGS* PREFERRED BRAND & GENERIC DRUGS*
8
IODOSORB
LINDANE
NICOSYN
OVIDE
PERMETHRIN
PLEXION
ELIMITE
$20 or Less
$10 or Less
Qty
Anticonvulsants
PHENOBARBITAL 15MG
PHENOBARBITAL 30MG
PHENOBARBITAL 60MG
PHENOBARBITAL 100 MG
Qty
120
120
120
120
CARBAMAZEPINE 100MG
CARBAMAZEPINE 200MG
CLONAZEPAM .5MG
CLONAZEPAM 1MG
CLONAZEPAM 2MG
PRIMIDONE 50MG
DILANTIN 30MG
DILANTIN 100MG
DILANTIN INFATABS 50MG
PHENYTEK 200MG
MYSOLINE 50MG
TEGRETOL 100MG
TEGRETOL XR 100MG
Anticonvulsants
30
60
30
30
30
30
30
30
30
30
30
30
30
CELONTIN CAP 300MG
COLESTID TAB 1GM
DEPAKOTE TAB 250MG EC
DEPAKOTE TAB 125MG EC
DEPAKOTE ER TAB 250 MG
DEPAKOTE ER TAB 250 MG
DEPAKOTE SPR CAP 125 MG
DEPAKOTE SPR CAP 125 MG
DILANTIN CAP 30MG
DILANTIN CHW 50MG
DILANTIN 100 MG
GABITRIL TAB 12MG
GABITRIL TAB 2MG
GABITRIL TAB 4MG
MYSOLINE 50MG TABLET
PEGANONE TAB 250MG
PEMOLINE 37.5MG TABLET
PEMOLINE 75 MG TABLET
PHENYTEK CAP 300MG
TEGRETOL XR TAB 100MG
TOPAMAX
CAP 15MG
TOPAMAX
TAB 25MG
TRILEPTAL TAB 150MG
ZONEGRAN CAP 100MG
ZONEGRAN CAP 25MG
ZONEGRAN CAP 50MG
Antidepressants
90
90
90
60
60
30
60
60
20
30
30
30
30
30
30
30
30
30
60
30
AMITRIPTYLINE W/PERPHENAZINE 10-4MG
CLOMIPRAMINE 25 MG
CLOMIPRAMINE 50 MG
CLOMIPRAMINE 75 MG
DESIPRAMINE 25MG
DOXEPIN 100MG
ELAVIL 10MG
FLUOXETINE 20 MG CAPSULES
IMIPRAMINE 25MG
IMIPRAMINE 50MG
MAPROTILINE 25MG
MAPROTILINE 50MG
TRAZODONE 150MG
SINEQUAN 10MG
SINEQUAN 25MG
Qty
Anticonvulsants
Antidepressants
AMITRIPTYLINE 10 MG
AMITRIPTYLINE 25 MG
AMITRIPTYLINE 50 MG
AMITRIPTYLINE 75 MG
AMITRIPTYLINE 100MG
AMITRIPTYLINE 150 MG
AMITRIPTYLINE W/PERPHENAZINE10-2MG
AMITRIPTYLINE W/PERPHENAZINE 25-2MG
AMOXAPINE 25MG
DOXEPIN 10 MG
DOXEPIN 25 MG
DOXEPIN 50 MG
DOXEPIN 75 MG
IMIPRAMINE 10 MG
NORTRIPTYLINE 10MG
NORTRIPTYLINE 25MG
NORTRIPTYLINE 50MG
NORTRIPTYLINE 75MG
TRAZODONE 50MG
TRAZODONE 100MG
$50 or Less
Anticonvulsants
50
30
40
80
30
40
80
90
150
120
120
20
30
30
100
60
100
60
30
120
80
40
30
20
40
20
80
40
Antidepressants
60
60
30
30
30
30
60
30
30
30
30
30
30
30
30
AMOXAPINE 50MG TABLET
BUPROPION HCL 100MG TABLET
BUPROPION HCL 75 MG TABLET
DESIPRAMINE 100MG TABLET
EFFEXOR
TAB 25MG
EFFEXOR
TAB 37.5MG
FLUVOXAMINE MALEATE 100MG TB
LEXAPRO
TAB 10MG
LEXAPRO
TAB 20MG
LEXAPRO
TAB 5MG
LITHOSTAT TAB 250MG
LOXAPINE SUCCINATE 10MG CAP
LOXAPINE SUCCINATE 25MG CAP
LOXAPINE SUCCINATE 50 MG CAP
LOXITANE 5MG CAPSULE
METAGLIP TAB 2.5-250M
MIRTAZAPINE 15MG SOLTAB
NEFAZODONE HCL 100MG TABLET
PARNATE 10MG TABLET
SERZONE 50MG TABLET
SINEQUAN CAP 100MG
SINEQUAN CAP 10MG
SINEQUAN CAP 25MG
SINEQUAN CAP 50MG
SINEQUAN CAP 75MG
SURMONTIL 25MG CAPSULE
VIVACTIL TAB 10MG
VIVACTIL TAB 5MG
9
BUTISOL SODIUM
LAMICTAL
CARBATROL
MESANTOIN
CEREBYX
MYSOLINE 250MG
DEPAKENE
NEURONTIN
DEPAKOTE
PEMOLINE
DEPAKOTE ER
PHENYTEK 300MG
DEPAKOTE SPRINKLE
PHENYTOIN SUSP
DIASTAT
PRIMIDONE 250MG
ETHOSUXIMIDE
TEGRETOL
FELBATOL
TEGRETOL XR
GABITRIL
TOPAMAX
DEPPRA
TRILEPTAL
KLONOPIN
VALPROIC ACID
Antidepressants
60
120
120
60
40
80
30
30
60
60
60
20
20
30
50
60
40
30
30
50
90
100
100
100
60
30
30
100
80
60
30
30
30
40
AMITRIPTYLINE
CHLORDIAZEPOXIDE
AMOXAPINE 50MG
ANAFRANIL
ASENDIN
AVENTYL
BUPROPION
CELEXA
DESYREL
EFFEXOR
EFFEXOR XR
ELAVIL
FLUOXETINE LIQUID
FLUOXETINE TABS
FLUVOXAMINE
LEXAPRO
LIMBITROL DS
MIRTAZAPINE
NARDIL
PAMELOR
PAROXETINE
PAXIL
PAXIL CR
PROZAC
REMERON
SARAFEM
SERZONE
SINEQUAN
SURMONTIL
TOFRANIL
TRIAVIL
TOFRANIL
VIVACTIL
WELLBUTRIN
WELLBUTRIN SR
ZOLOFT
$20 or Less
$10 or Less
Qty
Antidiarrheals
LOPERAMIDE 2 MG
PAREGORIC 2MG/5ML LIQ
DIPHENOXYLATE/ATROPINE
$50 or Less
Qty
Qty
Antidiarrheals
30
30
30
PAREGORIC 2MG/5 ML LIQ- 60ML
Antidiarrheals
ALINIA
IMODIUM
LOMOTIL
MOTOFEN
Antifungals - Topical
NYSTATIN CREAM 30GM
30
NYSTATIN OINTMENT 30GM
30
NYSTATIN/TRIAMCINOLONE CREAM 30GM 30
NYSTATIN/TRIAMCINOLONE OINTMENT 30GM30
ECONAZOLE NITRATE 15GM
15
SSD AF CREAM 50GM
50
PHISOHEX 3% LIQUID - 5OZ
150
SILVADENE - 50 GM
50
CLOTRIMAZOLE 1% CREAM - 30GM 30
ECONAZOLE 1% -15GM
15
KETOCONAZOLE 2% CREAM 15GM 15
EXELDERM 1% CREAM 15GM
15
COTRIMAZOLE/BETAMETHASONE 15 GM 15
TERAZOL 3
TERAZOL 3
TERAZOL 7
Antifungals/Antibacterials
DIFLUCAN 150MG
DIFLUCAN 200MG
NYSTATIN SUSPENSION - 60ML
Antimalarials
Antinauseants
MECLIZINE 25 MG
METOCLOPRAMIDE SYRUP
PROMETHAZINE HCL 25MG TAB
TEBAMIDE SUPP 200 MG
TEBAMIDE SUPP 100 MG
Antiparkinson Drugs
METOCLOPRAMIDE 5MG
METOCLOPRAMIDE 10MG
PROCHLORPERAZINE SUPP
PROCHLORPERAZINE TAB
COMPAZINE 2.5MG SUPP
COMPAZINE 5MG SUPP
TIGAN CAPSULES
TORECAN 10MG
30
30
30
PRIMAQUINE TAB 26.3MG
QUININE SULF CAP 200MG
QUININE SULF CAP 300MG
ANTIVERT TAB 50MG
PHENERGAN TAB 12.5MG
PHENERGAN 12.5 MG SUPP
PHENERGAN 25 MG TABLET
PHENERGAN 50MG TABLET
PROCHLORPERAZINE 2.5MG SUPP
PROCHLORPERAZINE 5MG SUPP
TRANSDERM-SC DIS 1.5MG
CHLORPROMAZINE 10MG
CHLORPROMAZINE 25MG
CHLORPROMAZINE 50MG
FLUPHENAZINE 1MG
FLUPHENAZINE 2.5MG
FLUPHENAZINE 5 MG
HALOPERIDOL 1MG
HALOPERIDOL 2MG
HALOPERIDOL LACTATE ORAL COND-120ML
LITHIUM CARBONATE 300MG
PERPHENAZINE 2MG
PERPHENAZINE 4MG
THIORIDAZINE 10 MG
AMPHOTEC
ANCOBON
BIO-STATIN
FULVICIN
FULVICIN U/F
GRIFULVIN
GRISACTIN
50
90
60
ANZEMAT
LARIAM
ARALEN PHOSPHATE
MALARONE
CHLOROQUINE PHOSPHATE
30
100
12
90
50
24
12
8
ANTIVERT
PLAQUENIL
COMPAZINE SYRUP
PROMETHAZINE SUPP
COMPAZINE TABLETS
PHENERGAN
DARAPRIM
REGLAN
HYDROXYCHLOROQUINE TRANSDERM - SCOP
KYTRIL
TIGAN SUPP
MARINOL
ZOFRAN
MEFLOQUINE
ZOFRAN ODT
Antinauseants
Antiparkinson Drugs
30
30
30
30
30
40
60
50
Antipsychotics
30
30
30
30
30
30
90
90
30
60
30
30
60
CLOZAPINE 25MG TABLET
HALOPERIDOL 10MG TABLET
MELLARIL 100MG TABLET
MOBAN
TAB 5MG
ORAP
TAB 1MG
ORAP
TAB 2MG
PERPHENAZINE 16MG TABLET
SEROQUEL TAB 25MG
THIORIDAZINE 200MG TABLET
10
GRIS-PEG
KETOCONAZOLE
LAMISIL
MYCEFEX
MYCOSTATIN
NIZORAL
SPORONAX
Antimalarials
Antiparkinson Drugs
Antipsychotics
30
30
30
30
30
30
2
3
8
20
50
30
30
60
Antinauseants
60
120
6
30
6
6
20
30
MIRAPEX 0.125MG TABLET
REQUIP
TAB 0.25MG
REQUIP
TAB 0.5MG
REQUIP
TAB 1MG
REQUIP
TAB 2MG
SELEGILINE HCL 5MG CAPSULE
SELEGILINE HCL 5MG TABLET
SINEMET CR 25/100 TABLET SA
HALOPERIDOL 0.5MG
HALOPERIDOL 1 MG
HALOPERIDOL 2MG
LITHIUM CARBONATE 150MG
THIOHIXENE 1MG
THIOHIXENE 2MG
GARAMYCIN
SULFACET-R
HYDROCORTISONE
VYTONE
W/LODOQUIN
CASTELLANI PAINT
MYCOLOG II
CLOTRIM/BETAMETH
MYCOSTATIN
CREAM
NAFTIN
FUNGIZONE
NIZORAL CREAM
FUNGOLD TINCTURE
NIZORAL SHAMPOO
LAMISIL
NYSTATIN POWDER
LOPROX
OXISTAT
LOTROMIN
PEDI-DRI POWDER
LOTRISONE
PENTAC
MENTAX
SPECTAZOLE
MONISTAT-DERM
Antimalarials
Antiparkinson Drugs
Antipsychotics
20
3
45
DIFLUCAN TAB 150MG
DIFLUCAN TAB 200MG
DIFLUCAN TAB 50MG
FULVICIN U/F TAB MICR 250
GRIS-PEG TAB 125MG
GRIS-PEG TAB 250MG
NITROFURANTOIN MCR 100MG CAP
NITROFURANTOIN MCR 50MG CAP
Antinauseants
30
240
20
10
10
CRE 0.8%
SUP 80MG
CRE 0.4%
1
1
60
Antimalarials
QUININE SULFATE 200MG
Antidiarrheals
60
Antipsychotics
60
30
60
30
60
45
120
120
120
120
30
90
ABILIFY
NAVANE
CLOZAPINE
ORAP
CLOZARIL
PERMITIL
DISULFRAM
PROLIXIN
GEODON
RISPERDAL
HALDOL
SERENTIL
HALOPERIDOL 5 & 10MG
SEROQUEL
LIMBITROL
STELAZINE
LITHOBID
THORAZINE
LOXAPINE
ZYPREXA
LOXITANE
ZYPREXA ZYDIS
MELLARIL
MOBAN
$20 or Less
$10 or Less
Qty
Antipsychotics
Qty
Antiperspirants
Antivirals
Asthma Therapy
Blood Modifiers
60
60
Antipsychotics
Antiperspirants
Antiperspirants
38
35
Antivirals
AVYCLOVIR 200MG/5 ML
AMANTADINE 100MG CAP
Antipsychotics
30
30
30
30
30
30
30
30
30
Antiperspirants
DRYSOL SOLUTION - 38ML
DRYSOL DAB-O MATIC - 35ML
Antivirals
120
30
ACYCLOVIR 200MG CAPSULES
FLUMADINE 100MG TABLET
FORTOVASE CAP 200MG
RETROVIR SYP 10MG/ML
ROFERON-A KIT 3MU/.5ML
SUSTIVA
CAP 50MG
SYMMETREL 100MG TABLET
VALTREX
TAB 500MG
VIDEX
SOL 2GM
VIDEX BUFFER CHW 25MG
ZOVIRAX
CRE 5%
Asthma Therapy
Asthma Therapy
ALBUTEROL 0.083%SOLN -120ML 120
ALBUTEROL SULFATE 0.5 MG
20
ALBUTEROL INHALER - 17GM17
ALBUTEROL SULF 2MG TAB
60
ALBUTEROL SULF 4MG TAB
60
ALBUTEROL SYRUP - 240ML
60
METAPROTERENOL 10MG TAB
60
METAPROTERENOL 20MG TAB
30
METAPROTERNOL SYRUP 240 ML 240
POTASSIUM IODIDE - 30ML
30
THEOPHYLLINE SR 100 MG TAB
60
60
60
THEO-24 300 MG
30
SSKI 1G/ML - 30ML
30
SLO-BID GYRO CAP 50MG CR
60
60
60
ACCOLATE TAB 10MG
ACCOLATE TAB 20MG
ELIXOPHYL GG SOL 100-100
ELIXOPHYL KI ELX 130-80
ELIXOPHYLLIN ELX 80/15ML
FLOVENT
AER 44MCG/AC
FLOVENT ROTA AER 50MCG
PROVENTIL AER 90MCG
PROVENTIL AER 90MCG RF
QUIBRON
CAP 150-90
QUIBRON-300 CAP
QUIBRON-T TAB 300MG
QUIBRON-T SR TAB 300MG
THEO-24
CAP 100MG CR
THEO-24
CAP 200MG CR
THEO-24
CAP 300MG CR
THEO-24
CAP 400MG ER
THEOBID
CAP 260MG CR
THEOLAIR TAB 125MG
UNIPHYL
TAB 400MG CR
UNIPHYL
TAB 600MG CR
VOSPIRE ER TAB 4MG
VOSPIRE ER TAB 8MG
Blood Modifiers
Blood Modifiers
DIPYRIDAMOLE 25MG
WARFARIN SODIUM 1MG
WARFARIN SODIUM 2MG
WARFARIN SODIUM 2.5MG
WARFARIN SODIUM 3MG
WARFARIN SODIUM 4MG
WARFARIN SODIUM 5MG
Qty
Antipsychotics
THIORIDAZINE 25MG
THIORIDAZINE 50 MG
THIOTHIXENE 5MG
THIOTHIXENE 10MG
TRIFLUOPERAZINE 1 MG
TRIFLUOPERAZINE 2MG
TRIFLUOPERAZINE 5MG
TRIFLUORPERAZINE 10MG
ESKALITH CR 450MG
ALBUTEROL 2 MG
ALBUTEROL 4 MG
$50 or Less
90
30
30
30
30
30
30
PERSANTINE 25MG TABLET
PERSANTINE 50MG TABLET
TICLOPIDINE 250MG TABLET
WARFARIN SODIUM 6MG TABLET
WARFARIN SODIUM 7.5MG TABLET
WARFARIN SODIUM 10MG TABLET
11
Antivirals
120
90
45
20
30
240
1
30
30
10
100
60
2
ACYCLOVIR 400 & 800MG RESCRIPTOR
COMBIVIR
RETROVIR
CRIXIVAN
RIMANTADINE
CYTOVENE
SUSTIVA
DENAVIR
TAMIFLU
EPIVIR
TRIZIVIR
FAMVIR
VALCYTE
FLUMADINE
VALTREX
FORTOVASE
VIDEX EC
GILEAD
VIRAMUNE
HIVID
ZERIT
INVIRASE
ZIAGEN
KALETRA
ZOVIRAX
NORVIR
ZOVIRAX 5% OINT
RELEZA
40
40
200
120
240
7.9
60
17
17
60
60
60
60
100
60
60
40
60
100
40
30
50
25
ACCOLATE
PROVENTIL HFA
ACCUNEB
PULMICORT
ADVAIR DISKUS PULMICORT RESPULES
AEROBID
PULMICORT TURBOHALER
AEROBID-M
QVAR
ALUPENT
SEREVENT
ATROVENT
SEREVENT DISKUS
AZMACORT
SINGULAIR
BRETHINE
TERBUTALINE
COMBIVENT
VENTOLIN
CROMOLYN SODIUM
VENTOLIN HFA
DUONEB
VOLMAX
FLOVENT
XOPENEX
FORADIL
INTAL
IPRATROPIUM BROMIDE
MAXAIR
90
60
60
60
60
60
AGGRENOX
LOVENOX
AGRYLIN
MIRADON
AMICAR
PENTOFORIFYLLINE
ARIXTRA
PLAVIX
COUMADIN
PLETAL
DIPYRIDAMOLE 50 & 75 MG
TICLID
FRAGMIN
HEPARIN
INNOGEP
Asthma Therapy
Blood Modifiers
$20 or Less
$10 or Less
Qty
Chemotherapeutic Agents
$50 or Less
Qty
Qty
HYDROXYUREA 500MG CAPSULE
TAMOXIFEN 10MG TABLET
TAMOXIFEN 20MG TABLET
TEMODAR
CAP 5MG
Cholesterol - Lowering Agents
GEMFIBROZIL 600 MG
Corticosteroids-Oral
PREDNISONE 1 MG
PREDNSIONE 2.5 MG
PREDNISONE 5 MG
PREDNISONE 10 MG
30
30
30
30
ALTOCOR
TAB 10MG CR
KRISTALOSE PAK 10GM
KRISTALOSE PAK 20GM
LESCOL
CAP 20MG
LESCOL
CAP 40MG
LOFIBRA
CAP 134MG
LOFIBRA
CAP 200MG
LOFIBRA 67MG CAPSULE
LOVASTATIN 10MG TABLET
TRICOR 54MG TABLET
WELCHOL
TAB 625MG
ARISTOCORT TAB 4MG
CORTEF
TAB 10MG
CORTEF
TAB 20MG
MEDROL
TAB 16MG
MEDROL
TAB 2MG
MEDROL 8MG TABLET
60
30
DEXAMETHASONE .5MG/ML ELIXIR- 240ML 240
METHYLPREDNISOLONE 15MG/5ML SYRUP - 60ML
60
PREDNISONE 15MG/5ML SYRUP - 60ML 60
PREDNISONE 20 MG
30
PREDNISONE 50MG
30
CORTEF 5MG
30
CORTEF 10MG
30
DELTASONE 5 MG
30
STERAPRED DS 10MG
21
Corticosteroids - Topical
45
BETAMETHASONE VALERATE .1% OINT - 45 GRAM 45
BETAMETHASONE VALERATE .1% LOT - 60 ML60
DESONIDE CREAM 15GM
15
DESONIDE OINT 15GM
15
FLUOCINOLONE ACETONIDE .01% CREAM - 60 GM 60
FLUOCINOLONE ACETONIDE .025 % CREAM - 60 GRAM 60
FLUOCINOLONE .05% CREAM - 30GM 30
HYDROCORTISONE 1% CREAM AND OINTMENT 30
HYDROCORTISONE 2.5% CREAM AND OINTMENT - 30GM 30
TRIAMCINOLONE ACETONIDE .025% CREAM - 80GM
80
TRIAMCINOLONE ACETONIDE .025% OINT - 80GM 80
TRIAMCINOLONE ACETONIDE .1% CREAM - 80GM 80
TRIAMCINOLONE ACETONIDE .5% CREAM-15GM
15
ACLOVATE .05% CREAM - 15GM
ACLOVATE .05% OINT- 15GM
ARISTOCORT A 1% CREAM - 15GM
ARISTOCORT A 1% OINT- 15GM
BETAMETHASONE VALERATE .1% CREAM - 45 GRAM
BETAMETHASONE DIPROP .05% CREAM 45GM
BETAMETHASONE DIPROP .05% OINT 45GM
CLOBETASOL PROPIONATE CREAM 15GM
DESONIDE CREAM 15GM
DESOXIMETASONE .05% 15GM
FLUOCINOLONE ACETONIDE .01% SOLN - 60 ML
FLUOCINOLONE ACETONIDE .025%OINT - 60 GM
FLUOCINONIDE .05% SOLN - 60ML
HYDROCORTISONE 2.5% OINT - 30 GM
HYDROCORTISONE VALERATE .2% -15GM
30
60
30
5
60
DEXAMETHASONE 0.5MG TAB
DEXAMETHASONE 0.75MG TAB
30
30
30
25
25
20
30
60
60
30
50
ACLOVATE 0.05% OINTMENT
ACLOVATE 0.05% CREAM
CORDRAN
OIN 0.05%
CORDRAN 24X3 TAP 4MCG/CM
CORDRAN SP CRE 0.05%
CORTISPORIN OIN
CUTIVATE CRE 0.05%
CUTIVATE OIN 0.005%
DENAVIR
CRE 1%
DERMA-SMOOTH OIL /FS
DERMATOP CRE 0.1%
DERMATOP OIN 0.1%
DIPROSONE AEROSOL 1%
ELIMITE CREAM
ELOCON
LOT 0.1%
EMLA
PAD
EPIFOAM
AER 1%
EXELDERM CRE 1%
EXELDERM SOL 1%
HALOG
CRE 0.1%
HALOG
OIN 0.1%
HALOG
SOL 0.1%
HALOG-E
CRE O.1%
LAC-HYDRIN LOT 12%
LOCOID
CRE 0.1%
LOCOID
CRE 0.1%
LOCOID
OIN 0.1%
LOCOID
OIN 0.1%
LOCOID
SOL 0.1%
LOCOID LIPO CRE 0.1%
LOPROX
CRE 0.77%
LOPROX
GEL TOPICAL
LOPROX TS SOL 0.77%
MANTADIL CRE
MENTAX
CRE 1%
12
ADVICOR
ALTOCOR
ATROMID-S
CHOLESTYRAMINE
COLESTID
CRESTOR
FENOFIBRATE
LESCOL
LESCOL XL
LIPITOR
LOVASTATIN
LOPID
MEVACOR
NIASPAN
PRAVACHOL
PREVALITE
QUESTRAN
TRICOR
WELCHOL
ZETIA
ZOCOR
30
100
60
20
80
30
15
15
15
15
45
45
15
15
15
60
60
60
30
15
ALL CHEMOTHERAPEUTIC AGENTS ARE COVERED
ARISTOCORT
CELESTONE
CORTISONE ACETATE
DECADRON
DEXAMETHASONE 4MG
DEXPAK
ENTOCORT EC
MEDROL
PRAMOXINE
PRELONE
45
45
60
1
60
15
30
30
1.5
118.1
15
15
85
60
30
10
10
60
30
30
30
20
30
225
45
15
45
20
15
30
30
30
12
15
30
CAPEX
KENALOG SPRAY
CLODERM
LIDEX
CORDRAN
MOMETASONE FUROATE
CUTIVATE
NUTRACORT
CYCLOCORT
OLUX
DERMATOP
PANDEL
DESOWEN
PRAMASONE
DIFLORASONE
PSORCON
DIPROLENE
SYNALAR
ELOCON
TEMOVATE
FS SHAMPOO
TOPICORT
HALOG
ULTRAVATE
HYTONE
VANOXIDE-HC
WESTCORT
$20 or Less
$10 or Less
Qty
$50 or Less
Qty
Qty
NAFTIN
CRE 1%
NAFTIN
GEL 1%
OVACE
AER 10%
OVACE
CRE 10%
OVACE
GEL 10%
OXISTAT
CRE 1%
OXISTAT
LOT 1%
PANDEL
CRE 0.1%
PANDEL
CRE 0.1%
PRAMASONE CRE 1%
PRAMASONE LOTION 1%
PRAMASONE LOTION 2.5%
PRAMOSONE CRE 2.5%
PRAMOSONE OIN 1%
PRAMOSONE OIN 2.5%
PSORCON E OIN 0.05%
PSORCON E CREAM 0.05%
SILVADENE CRE 1%
SOLAQUIN FOR CRE 4%
SOLAQUIN FOR GEL 4%
TOPICORT LP CRE 0.05%
ULTRAVATE CRE 0.05%
ULTRAVATE OIN 0.05%
Contraceptive Products
CYCLESSA
DESOGEN
LEVLEN
LEVLITE
MIRCETTE
TRILEVLEN
NUVARING
Cough/Cold/Allergy Products
CHLORPHENIRAMINE MALEATE 8MG 30
CHLORPHENIRAMINE TR 12MG
60
ACCUHIST DM SYRUP - 120 ML
120
ANAPLEX DM SYRUP - 180 ML
180
ANAPLEX HD SYRUP - 240ML
240
AQUABID DM TAB
30
AQUATAB C
20
AQUATAB D
20
ATUSS EX SYRUP - 120ML
120
ATUSS HC SYRUP - 120ML
120
ATUSS MS SYRUP - 120ML
120
BENZONATATE 100MG CAPS
30
BIDEX DM
20
BROMETANE DX SYRUP 180ML
180
BROMFENEX 120-12MG
30
CARBINOXAMINE SYRUP -120ML 120
CARBOFED DM SYRUP
120
CYPROHEPTADINE 4MG TAB
30
DALLERGY
20
DRITUSS HD ELIXIR-180ML
180
GUAIFENESIN DM SYRUP -120 ML 120
GUAIFENESIN DM TAB
20
GUAIFENESIN LA 600MG TAB
60
GUAIFENESIN W/COD SYRUP - 120ML120
GUAIFENESIN W/PSD 1200=120
120
GUAIFENESIN W/PSD 600-120
20
GUAIFENESIN/PHENYLEPHRINE
20
HISTENEX HC SYRUP - 240ML
240
HYDROXYZINE HCI 25MG TAB
30
IOPHEN-C NR LIQUID - 240ML
240
IOPHEN-DM NR LIQUID - 180ML
180
LEVALL SYRUP -120ML
120
LIQUIBID-D 1200
20
LIQUIBID-D 600
20
LODRANE 6MG TAB
20
LODRANE LIQUID -180ML
20
PALGIC D
20
ALBATUSSIN CAPLET SA
ALLEGRA
TAB 30MG
ALLEGRA
TAB 60MG
ALLEGRA
TAB 60MG
ALLEGRA
TAB 60MG
ALLEGRA-D TAB 60-120ER
BROMFED CAPSULE SA
BROMPHED-PD CAPSULE SA
CLARINEX TAB 5MG
ENTEX LA CAP 30-400MG
ENTEX PSE CAP 120-400
EXTENDRYL SR CAP
HUMIBID DM CAP CR
HUMIBID LA TAB 600-300
LEVALL G CAPSULE
MAXIFED DMX TABLET
MAXIPHEN DM CAPLET
MESCOLOR TABLET
NALEX-A TABLET
NUCOFED CAPSULE
NUMOBID 675MG TABLET SA
PALGIC
TAB 4MG
PHENABID TABLET CR
PHENABID TABLET DM
PROLEX D TABLET SA
P-V-TUSSIN TABLET
RESPA DM TAB 28-600MG
RESPI-TANN CHEW TABLET
RONDEC
TAB 4-60MG
RONDEC DM DRO
RONDEC DM SYP
RONDEC-TR TABLET SA
RU-TUSS DM TAB 60-800MG
13
MIS
15
20
50
30
30
30
15
45
10
28.4
60
60
28.4
28.4
28.4
15
200
400
28.4
28.4
15
15
15
1
YASMIN 3-0.03
30
60
30
30
30
30
30
30
100
30
20
30
30
100
50
50
50
60
60
60
60
30
50
100
30
40
60
60
100
30
60
30
180
30
60
ACCUHIST LA
ALDEX
ALLEGRA
ALLEGRA-D
ALLERX
ALFEN
AQUATAB DM
ATROVENT NASAL SPRAY
BROMFENEX PD
CLARINEX
CLEMASTINE FURMARATE
CODICLEAR
DECONAMINE
DURATUSS
ENTEX
FLONASE
GUAIFED
HISTEX HC
HUMIBID
HYCODAN
MUCO-FEN
NASACORT AQ
NASASLIDE
NASAREL
NASONEX
NOLAMINE
NUCOFED
OPTIMINE
PHENERGAN
RHINOCORT
RHINOCORT/AQUA
RONDEC
RONDEC-DM
RYNATAN
SEMPREX-D
$20 or Less
$10 or Less
Qty
$50 or Less
Qty
Qty
RYNA-12 TABLET
30
PANCOF HC SYRUP -120ML
120
PANCOF PD SYRUP 120ML
120
PANCOF SYRUP -120ML
120
PANCOF XP SYRUP -120ML
120
PANMIST DM
20
PANMIST JR
20
PANMIST LA
20
PANMIST S - 120ML
120
PANNAZ TAB
20
PROLEX D
20
PROLEX DH SYRUP - 120ML
120
PROLEX DM LIQUID - 120ML
120
PROLEX PD TAB
20
PROMETHAZINE TAB
30
PROMETHAZINE VC - 240 ML
240
PROMETHAZINE VC W/COD - 240 ML240
PROTUSS DM
20
PSEUDOPHEDRINE/CHLORPH 120-8 60
PSEUDOPHEDRINE/CHLORPH 800-30-420
PSEUDOVENT
20
QUINDAL-HD - 240ML
240
RESPA-DM
30
RESPAIRE -60
20
RU-TUSS JR
30
SUDAL DM
30
SU-TUSS DM/HD SYRUP - 240ML 240
TRI-VENT DM SYRUP - 240ML
240
TUSSI-BID 1200-60MG
20
SYN-RX
RYNA-12X SUS 5-30-100
RYNATAN
TAB 9-25MG
RYNATAN PED SUS
SEMPREX-D CAP 8-60MG
SINA-12X SUS
SINA-12X TAB 25-200MG
SINUTUSS DM TAB CR
SUDAL 12 SUS 6-30MG/5
SUDAL DM TAB 30-500MG
SUDAL SR TABLET
TESSALON PERLE 100MG CAP
TRINALIN REP TAB CR
TRI-NASAL SPR
TUSS-DA NR LIQ
TUSS-DM
SYP
TUSS-DM
TAB 10-200MG
TUSSEND
TAB
TUSSEND LIQ
TUSSI-12D TABLET
TUSSIONEX SUS EXT-REL
TYZINE
SOL 0.1%
VISTARIL SUS 25MG/5ML
VISTARIL 25MG CAPSULE
VISTARIL 50MG CAPSULE
Z-COF LA TAB 30-650MG
ZEPHREX-LA TABLET SA
ZOTEX
SYP
ZOTEX-LA TAB
ZTUSS
TAB
ZYRTEC
SYP 5MG/5ML
ZYRTEC
TAB 10MG
ZYRTEC
TAB 5MG
ZYRTEC-D TAB 5-120MG
Dental/Flouride Agents
480 ML
FLUOR-A-DAY
100
SF 1.1% GEL - 56 GM
56 GM
SF 5000 PLUS 1.1% CREAM - 51 GM 51 GM
SODIUM FLUORIDE DROPS - 50 ML 50 ML
SODIUM FLUORIDE TABS
100
STANNOUS FLOURIDE 0.4%
122
GEL-KAM SOLUTION
LURIDE TABLETS
PERIDEX LIQUID - 480ML
PHOS-FLUR GEL
PREVIDENT
PREVIDENT 5000 PLUS
Diabetic Oral Agents
PALGIC DS - 120ML
120
CHLORHEXIDINE GLUCONATE LIQUID- 480 ML
CHLORPROPAMIDE 100MG
CHLORPROPAMIDE 250MG
GLYBURIDE 1.25MG
GLYBURIDE 2.5MG
GLYBURIDE 5 MG
GLYBURIDE MICRONIZED 1MG
30
30
30
30
30
30
TOLAZAMIDE 250 MG
TOLAZAMIDE 100 MG
TOLAZAMIDE 500 MG
GLUCOTROL XL 2.5 MG
GLUCOTROL XL 5 MG
120
30
120
40
120
30
60
240
60
60
40
30
30
473
473
50
50
240
30
120
30
120
40
30
60
40
100
90
40
120
20
20
40
TRINALIN
TUSSIONEX
TUSSI-ORGANIDIN
ZYRTEC
ZYRTEC-D
30
30
480
PERIOSTAT
30
30
30
30
30
30
AMARYL
TAB 4MG
AVANDAMET TAB 1-500MG
GLUCOPHAGE TAB XR 750MG
GLUCOVANCE TAB 1.25/250
GLUCOVANCE TAB 2.5/500
GLUCOVANCE TAB 5/500MG
GLYCRON
TAB 4.5MG
GLYSET
TAB 100MG
GLYSET
TAB 25MG
GLYSET
TAB 50MG
METAGLIP TAB 2.5-500M
METAGLIP TAB 5-500MG
METAGLIP 2.5/500MG TABLET
METFORMIN 500 MG TABLET
METFORMIN HCL 1000MG TABLET
METFORMIN HCL 850MG TABLET
PRANDIN
TAB 0.5MG
PRANDIN
TAB 1MG
PRANDIN
TAB 2MG
14
40
30
30
20
30
40
50
45
45
50
50
60
60
50
30
50
120
120
120
40
40
40
ACTOS
GLUCOVANCE
AMARYL 4MG
AVANDAMET
GLYNASE
AVANDIA
GLYSET
DIABENESE
METAGLIP
DYMELOR
MICRONASE
GLUCOPHAGE
PRANDIN
GLUCOPHAGE XR
PRECOSE
GLUCOTROL 10MG
PROGLYCAM
GLUCOTROL XL 10MG
$20 or Less
$10 or Less
Qty
$50 or Less
Qty
Qty
PRECOSE
PRECOSE
PRECOSE
STARLIX
STARLIX
Digestants
Digestants
GASTRINEX
Diuretics
ACETAZOLAMIDE 250MG
AMILORIDE/HCTZ 5-50 MG
BUMETANIDE .5MG
CHLOROTHIAZIDE 250MG
CHLOROTHIAZIDE 500MG
CHLORTHALIDONE 25MG
CHLORTHALIDONE 50MG
FUROSEMIDE 20MG
FUROSEMIDE 40 MG
FUROSEMIDE 80 MG
HHYDROCHLORTHIAZIDE 25 MG
HYDROCHLOROTHIAZIDE 50 MG
INDAPAMIDE 1.25MG
INDAPAMIDE 2.5MG
TRIAMTERENE HCTZ 37.5-25MG TABS
TRIAMTERENE HCTZ 75-50MG TABS
Eczema/Psoriasis Medications
Electrolyte Depleters
ACETAZOLAMIDE 125 MG
AMILORIDE 5MG
BUMETANIDE 1 MG
BUMETANIDE 2 MG
CHLORTHALIDONE 100MG
FUROSEMIDE SOLN - 60ML
HCTZ 12.5MG
METHYLCLOTHIAZIDE 5MG
SPIRONOLACTONE 25MG
SPIRONOLACTONE/HCTZ 25-25
TORSEMIDE 5MG
TRIAMTERENE/HCTZ 37.5-25MG CAPS
TRIAMTERENE/HCTZ 75-50MG CAPS
BUMEX 0.5MG
BUMEX 1MG
DIURIL 250MG
DIURIL 500MG
DYAZIDE
LASIX 20MG
LASIX 40MG
MAXZIDE 25
Microzide 12.5 mg
TAB 100MG
TAB 25MG
TAB 50MG
TAB 120MG
TAB 60MG
50
60
60
30
40
Digestants
30
Digestants
KUTRASE
PANCREASE MT 4 CAPSULE EC
PANCRELIPASE CAP
ULTRASE MT 12 CAPSULE EC
Diuretics
30
30
30
30
30
30
30
30
30
30
30
30
30
30
30
30
60
100
100
50
CREON
ENCRON
DUTRASE
KU-ZYME
LIPRAM
Pancrease
120
90
30
30
40
50
30
30
ALDACTAZIDE
LOZOL
ALDACTONE
MAXZIDE 75/50
CAPOZIDE
METHAZOLAMIDE
CLORPRES
MIDAMOR
DEMADEX
MYKROX
DIAMOX SEQUELS
NATURETIN
DYRENIUM
RENESE
ENDURON
THALITONE
FLUMEZIDE“TORSEMIDE 10,20, 100MG”
HYGROTON
ZAROXOLYN
LASIX 80MG
110
ANTHRALIN
CAPITROL
CAMOL
DOVONEX
EXSEL
Micanol
Diuretics
30
30
30
30
30
30
30
30
30
30
30
30
30
30
30
30
30
30
30
30
30
30
KERALYT GEL- 30GM
SELENIUM SULFIDE SHAMPOO -120ML
SELSUN RX SHAMPOO -120ML
CAPITROL
SHA 2%
OVACE
OXSORALEN-ULTRA
SORIATANE
TAZORAC
VANAMIDE
Zetar
KIONEX
MARLEXATE
RENAGEL
Gastrointestinal Agents
BELLADONNA ALKALOIDS W/PHENOBARBITAL 16.2MG 30
ANASPAZ .125MG TAB
60
BELLADONNA W/PHENOBARB ELIX- 480ML 480
CIMETIDINE 300MG
60
CIMETIDINE 400MG
60
CIMETIDINE 800MG
30
CLIDINIUM/CHLORDIAZEPOXIDE
60
CYTOSPAZ
30
DONNATAL 16.2MG TABS
30
DONNATAL ELIXIR 120 ML
120
HYOSCYAMINE .15MG TAB
30
HYOSCYAMINE SULFATE .125 NG TAB 30
HYOSCYAMINE SULFATE .375MG ER CAP
30
HYOSCYAMINE SULFATE .375MG ER TAB
30
PROPANTHELINE BROMIDE 15MG 30
RANITIDINE 150MG TABS
30
RANITIDINE 300MG TABS
30
SUCRAFALATE 1GM
30
DONNATAL EXTENTABS
LEVBID 0.375MG TABLET SA
LEVSINEX 0.375MG CAPSULE SA
LOVASTATIN 20MG
LOVASTATIN 40MG
MOTOFEN
TAB
PAMINE 2.5MG TABLET
POTABA TABLETS 500 MG
RANITIDINE 300MG TABLET
REGLAN
TAB 5MG
REGLAN 10MG TABLET
ROBINUL
TAB 1MG
ROBINUL FORT TAB 2MG
SUCRALFATE 1 GM
ZANTAC
SYP 75MG/5ML
60
60
PANCRELIPASE
PANGESTYME
PANOKASE
ULTRASE
ULTRASE MT
Viokase
Diuretics
EDECRIN
TAB 25MG
EDECRIN
TAB 50MG
LOZOL 1.25MG TABLET
MAXZIDE 75/50 TABLET
SPIRONOLACTONE 100MG TABLET
THALITONE 15MG TABLET
ZAROXOLYN 2.5MG TABLET
ZAROXOLYN 5MG TABLET
SODIUM POLYSTYRENE SULFONATE SUSP- 120ML
PHOSLO 667MG TAB
100
DICYCLOMINE 10 MG
DICYCLOMINE 20 MG
15
50
40
30
30
30
20
60
100
100
70
50
60
30
120
90
ACIPHEX
AXID
BENTYL
CARAFATE
CYTOTEC
FAMOTIDINE
HELIDAC
LEVBID
LEVSIN/SL
LIBRAX
MISOPROSTOL
NEOSOL
NEXIUM
NIZATIDINE
OMEPRAZOLE
PAMINE
PEPCID
PREVACID
PREVPAC
PRILOSEC
PROTONIX
ROBINUL
ROBINUL FORTE
TAGAMET
URSO
URSODIOL
ZANTAC
ZELNORM
$20 or Less
$10 or Less
Qty
$50 or Less
Qty
Qty
Gout Medications
Gout Medications
Gout Medications
ALLOPURINOL 100MG TAB
60
ALLOPURINOL 300MG TAB
30
Heart High Blood Pressure Medications
ATENOLOL 25MG
30
ATENOLOL 50MG
30
ATENOLOL 100MG
30
ATENOLOL/CHLORTHALIDONE 50-25MG 30
ATENOLOL/CHLORTHALIDONE 100-25 MG 30
CAPTOPRIL 12.5MG
60
CAPTOPRIL 25MG
60
CAPTOPRIL 50MG
60
CLONIDINE 0.1MG
60
CLONIDINE 0.2MG
60
CLONIDINE 0.3MG
30
DIGOXIN 125MCG
30
DIGOXIN 250MCG
30
DITIAZEM 30MG
60
DILTIAZEM 60 MG
60
DILTIAZEM 90 MG
60
ENALAPRIL 2.5MG TABLETS
30
ENALAPRIL 5MG TABLETS
30
HYDRALAZINE 25 MG
60
HYDRALAZINE 50 MG
60
HYDRALAZINE 100 MG
30
METOPROLOL TARTRATE 50 MG
60
METOPROLOL TARTRATE 100 MG
60
PROPRANOLOL 10MG
60
PROPRANOLOL 20MG
60
PROPRANOLOL 40 MG
60
PROPRANOLOL/HCTZ 40/25
60
ZYLOPRIM 100 MG
30
ZYLOPRIM 300 MG
30
ACEBUTOLOL 200MG
30
ATENOLOL/CHLORTHALIDONE 100-25 MG
30
CAPTOPRIL/HCTZ 25-15MG
30
30
30
CLONIDINE 0.2MG
60
CLONIDINE 0.3MG
90
DIGOXIN 50MCG/ML ELIXIR- 60 ML 60
DILTIAZEM 60MG TABLETS
90
DILTIAZEM 90MG TABLETS
60
GUANFACINE HCI 1MG
30
HYDRALAZINE W/HCTZ
90
ISOXSUPRINE 10MG
90
LABETALOL 100MG
60
LANOXICAPS 100MCG
30
LANOXICAPS 200MCG
30
LANOXICAPS 50MCG
30
LANOXIN 125MCG
30
LANOXIN 250MCG
30
LISNOPRIL 2.5MG
30
LISNOPRIL 5MG
30
LISINOPRIL 10MG
30
LISINOPRIL 20 MG
30
METHYLDOPA 250MCG
60
METHYLDOPA 500MCG
60
METHYLDOPA /HCTZ
30
MINOXIDIL 2.5MG TAB
30
NADOLOL 20 MG
30
NALDOLOL 20MG
30
NALDOLOL 40MG
30
NICARDIPINE 30 POSES
30
NIFEDIPINE 10 MG
90
PAPVERINE HCL 150 MG
60
PINDOLOL 10MG
60
PINDOLOL 5MG
60
PRAZOSIN 1MG
30
PROPRANOLOL 60MG TAB
60
PROPRANOLOL 80MG TABS
60
PROPRANOLOL/HCTZ 80/25
60
RESPERINE .1MG
60
TIMOLOL MALEATE 5 MG
90
VERAPAMIL 120MG TAB
60
VERAPAMIL 40MG TAB
60
VERAPAMIL 80MG TAB
30
VERAPAMIL SR 180MG TAB
30
VERAPAMIL SR 240MG TAB
PROBENECID 500MG TABLET
Gout Medications
100
ACEON 2MG TABLET
30
ACEON 4 MG TABLET
30
ACCUPRIL TAB 10MG
30
ACCUPRIL TAB 20MG
30
ACCUPRIL TAB 40MG
30
ACCUPRIL TAB 5MG
30
ACCURETIC TAB 10/12.5
30
ACCURETIC TAB 20/12.5
30
ACCURETIC TAB 20/25
30
ACEBUTOLOL 200MG CAPSULE
90
ALDACTAZIDE 50/50
30
ALDOCLOR TAB 250/250
80
ALDORIL-D30 TAB 500/30
30
ALDORIL-D50 TAB 500/50
50
ALTACE
CAP 1.25MG
30
ALTACE
CAP 2.5MG
30
ALTACE
CAP 5MG
30
ALTACE
CAP 10MG
30
ATACAND
TAB 16MG
30
ATACAND
TAB 4MG
30
ATACAND
TAB 8MG
30
AVAPRO
TAB 150MG
30
AVAPRO
TAB 75MG
30
BENICAR
TAB 20MG
30
BENICAR
TAB 40MG
30
BENICAR
TAB 5MG
30
BENICAR HCT TAB 20-12.5
30
BENICAR HCT TAB 40-12.5
30
BENICAR HCT TAB 40-25MG
30
BISOPROLOL/HCTZ 2.5/6.25 TB
100
BLOCADREN 10MG
60
BLOCADREN 20 MG
30
BLOCADREN 5 MG
100
CARDENE SR CAP 30MG
50
CARDENE SR CAP 45MG
30
CARDENE SR CAP 60MG
25
CARDIZEM LA TAB 120MG
30
CARTROL
TAB 2.5MG
30
CARTROL
TAB 5MG
30
CLORPRES TAB 0.1-15MG
30
30
30
COZAAR
TAB 25MG
30
COZAAR
TAB 50MG
30
DIOVAN
TAB 40MG
30
DIOVAN
TAB 80MG
30
DYNACIRC CAP 2.5MG
30
HYZAAR
TAB 50-12.5
30
INDERAL LA CAP 60MG
30
INDERAL LA CAP 80MG
30
INNOPRAN XL CAP 120MG
40
40
40
40
KERLONE 10 MG
30
LABETOLOL 100 MG TABLET
120
100
60
16
ANTURANE PROBENECID/COLCHICINE
BENEMID
SULFINPYRAZONE
ADALAT
LABETALOL 200
ALTACE
LABETALOL 300 MG
ANTABUSE
LEVATOL
ATACAND
LEXXEL
ATACAND HCT
LISINOPRIL 40MG
AVALIDE
LISINOPRIL HCTZ
AVAPRO
LOPRESSOR
BENICAR
LOPRESSOR HCT
BETAPACE
LOTENSIN
BETAXOLOL
LOTENSIN HCT
BISOPROLOL FUMARATE
LOTREL
BISOPROLOL FUMARATE/HCTZ MAVIK
CALAN
MICARDIS
CALAN SR
MICARDIS HCT
CARDIZEM
MOXEXIPRIL
CARDIZEM CD
MONOPRIL
CARTIA XT
MONOPRIL HCT
CARTAPRES
NORVASC
CARTAPRES-TTS
PLENDIL
CLORPRES
PRINIVIL
COREG
PRINZIDE
CORGARD
PROCARDIA XL
CORZIDE
SECTRAL
COVERA-HS
SOTALOL
COZAAR
SULAR
DILACOR XR
TARKA
DILTIA XT
TAZTIA XT
DIOVAN
TENEX
DIOVAN HCT
TENORETIC
DISULFRAM
TENORMIN
DYNACIRC
TEVETEN
DYNACIRC CR
TIAZAC
ENALAPRIL 10 & 20 MG
TIMOLIDE
ENDURONYL
TOPROL XL
ENDURONYL FORTE
TRANDATE
ERGOLOID MESYLATES
UNIRETIC
GUANABEZ
VASCOR
HYTRIN
VASERETIC
INDERAL
VASOTEC
INDERAL LA
VERELAN
INDERIDE
VERELAN PM
ISOPTIN SR
ZEBETA
ZESTORETIC
ZESTRIL
ZIAC
$10 or Less
$20 or Less
$50 or Less
Qty
Qty
Qty
LEVATOL 20MG TABLET
30
LEXXEL
TAB 5-2.5MG
30
LEXXEL
TAB 5-5MG
30
LISINOPRIL 30MG TABLET
60
LISINOPRIL 40MG TABLET
60
LOPRESS HCT TAB 50/25MG
30
LOPRESSOR HCT 50/25 TABLET
30
LOTENSIN TAB 10MG
40
LOTENSIN TAB 20MG
40
LOTENSIN TAB 40MG
40
LOTENSIN TAB 5MG
40
LOTENSIN HCT TAB 10-12.5
40
LOTENSIN HCT TAB 20-12.5
40
LOTENSIN HCT TAB 20-25MG
40
LOTENSIN HCT TAB 5-6.25MG
40
MAVIK
TAB 1MG
50
MAVIK
TAB 2MG
50
MAVIK
TAB 4MG
50
MICARDIS TAB 20MG
30
MICARDIS TAB 40MG
30
MICARDIS TAB 80MG
30
MICARDIS HCT TAB 40/12.5
150
MINIPRESS 1MG CAPSULE
90
60
30
MINIZIDE 1 MG CAPSULE
60
MINIZIDE 2MG CAPSULE
50
MINIZIDE 3MG CAPSULE
30
MONOKET 10MG TABLET
50
MONOKET 20MG TABLET
40
MONOPRIL 10MG TABLET
30
MONOPRIL 20MG TABLET
30
MONOPRIL 40 MG TABLET
30
MONOPRIL HCT TAB 10/12.5
30
MONOPRIL HCT TAB 20/12.5
30
NORVASC
TAB 2.5MG
30
NORVASC
TAB 5MG
30
PLENDIL
TAB 2.5MG CR
30
PLENDIL
TAB 5MG CR
30
PLENDIL
TAB 5MG CR
30
RESERPINE TAB 0.1MG
100
RESERPINE TAB 0.25MG
100
SULAR
TAB 10MG CR
40
SULAR
TAB 40MG CR
30
TEVETEN
TAB 400MG
30
TEVETEN
TAB 600MG
30
TEVETEN HCT TAB 600-12.5
30
TEVETEN HCT TAB 600-25MG
30
TIAZAC 120MG CAPSULE SA
30
TIMOLIDE TAB 10/25
60
TOPROL XL TAB 100MG
40
TOPROL XL TAB 25MG
60
TOPROL XL TAB 50MG
60
UNIRETIC TAB 15/25MG
40
UNIRETIC TAB 15-12.5
40
UNIRETIC TAB 7.5/12.5
40
VERAPAMIL 120MG TABLET SA
90
ZEBETA 5MG TABLET
30
ZEBTA 10 MG TABLET
30
ZIAC 10-6.25MG TABLET
30
ZIAC 2.5-6.25MG TABLET
30
ZIAC 5-6.25MG TABLET
30
Hormones
ESTRADIOL .5MG
ESTRADIOL 1MG
ESTRADIOL 2 MG
Hormones
30
30
30
ESTRACE .5MG
ESTRACE 1MG
ESTROPIPATE .75MG
Hormones
30
30
30
ALORA
DIS 0.05MG
ALORA
DIS 0.1MG
CENESTIN TAB 0.625MG
17
Hormones
8
8
30
ACTIVELLA
ESTRING
AYGESTIN
ESTROPIPATE 2.5 MG
CLOMIPHENE CITRATE
NORETHINDRONE
$20 or Less
$10 or Less
Qty
Hormones
MEDROXYPROGESTERONE ACETATE 2.5MG
MEDROXYPROGESTERONE ACETATE 5 MG
MEDROXYPROGESTERONE ACETATE 10 MG
Qty
30
30
30
ESTROPIPATE 1.5MG
GYNDIOL 1.5MG
MEGESTROL 20MG
MENEST 0.3MG
MENEST 0.625MG
MENEST 1.25MG
PROVERA 2.5MG
Hormones
30
30
30
30
30
30
30
Laxatives
Local Anesthetics
Inflammatory Bowel Agents
LIDOCAINE 2% GEL- 30GM
LIDOCAINE 5% OINT-36GM
XYLOCAINE 5% OINT -34 GM
BUCALSEP SOLUTION - 30ML
DELESTROGEN
DEPO-ESTRADIOL
DEPO-PROVERA
DEPO-TESTADIOL
ESTRACE CREAM
ESTRATEST/HS
ORTHO-EST
ORTHO-PREFEST
PROCHIEVE
PROMETRIUM
PROVERA 10MG
SYNTEST
ASACOL
AZULFIDINE
CANASA
COLOZAL
Laxatives
4000
4000
4000
NULYTELY
NULYTELY
NULYTELY
NULYTELY
Local Anesthetics
100
30
12
4
4
4
4
4
8
30
8
8
8
8
8
8
8
30
30
60
50
30
30
30
40
30
30
30
30
30
28
28
28
28
28
60
60
50
60
40
30
8
8
8
8
8
8
8
8
50
480
480
60
60
Laxatives
GOLYTELY SOULTION
PEG 3350/ELECTROLYTE SOLUTION
COLYTE SOLUTION(REG)
Hormones
CENESTIN TAB 0.9MG
CENESTIN TAB 1.25MG
CLIMARA
DIS 0.025MG
CLIMARA
DIS 0.0375MG
CLIMARA
DIS 0.06MG
CLIMARA
DIS 0.075MG
CLIMARA PRO DIS WEEKLY
COMBIPATCH DIS .05/.25
CYTADREN 250MG TABLET
ESCLIM
DIS 0.025MG
ESCLIM
DIS 0.0375MG
ESCLIM
DIS 0.05MG
ESCLIM
DIS 0.075MG
ESCLIM
DIS 0.1MG
ESTRADERM DIS 0.05MG
ESTRADERM DIS 0.1MG
FEMHRT 1/5 TAB
MENEST 2.5 MG
METHERGINE 0.2MG TABLET
NORETHINDRONE 5MG TABLET
OGEN 0.625 TABLET
OGEN 1.25 TABLET
OGEN 2.5 TABLET
PREFEST TABLET
PREMARIN TAB 0.3MG
PREMARIN TAB 0.45MG
PREMARIN TAB 0.625MG
PREMARIN TAB 0.9MG
PREMARIN TAB 1.25MG
PREMPHASE TAB
PREMPRO
TAB .625-2.5
PREMPRO
TAB 0.3-1.5
PREMPRO
TAB 0.45-1.5
PREMPRO
TAB 0.625-5
PROGESTERONE CRE 10%
PROGESTERONE CRE 5%
PROMETRIUM CAP 100MG
PROVERA
TAB 2.5MG
PROVERA
TAB 5MG
PROVERA 10MG TABLET
VAGIFEM
TAB 25MCG
VIVELLE
DIS 0.05MG
VIVELLE
DIS 0.1MG
VIVELLE-DOT DIS 0.025MG
WINSTROL TAB 2MG
GENERLAC SYRUP 480ML
LACTULOSE SYRUP 480ML
SULFASALAZINE 500MG
SULFAZINE EC 500 MG
Qty
Hormones
LIDOCAINE VISCOUS - 100ML
$50 or Less
Laxatives
SOL
SOL CHERRY
SOL LMN/LIME
SOL ORANGE
Local Anesthetics
30
36
34
30
4000
4000
4000
4000
COLYTE FLAVORED SOL
KRISTALOSE
MIRALAX
Local Anesthetics
EMLA CREAM
EPIFOAM
LIDODERM
PRAMOSONE
18
DIPENTUM
PENTASA
ROWASA
$20 or Less
$10 or Less
Qty
Migraine Treatment
Muscle Relaxants
CHLORZOXAZONE 500MG
CYCLOBENZAPRINE 10 MG
CHOLINE SALICYLATE/
MAGNESIUM SALICYLATE 500 MG
MAGNESIUM SALICYLATE 750 MG
$50 or Less
Qty
Qty
Migraine Treatment
Migraine Treatment
ISOMETH/D-CHLORAPHENAZ/APAP 40
MIDRIN
30
BUTALBITAL/APAP/CAFFEINE CAP
BUTALBITAL/APAP/CAFFEINE TB
PHRENILIN FORTE TABLET
PHRENILIN TABLET
Muscle Relaxants
60
30
30
30
BACLOFEN 10MG
CARISOPRODOL 350MG
CARISOPRODOL CMPD 350MG
CHOLINE SALICYLATE/
METHOCARBAMOL 500MG
Nitrates
Nitrates
ISOSORBIDE DINITRATE 2.5MG S.L. 90
ISOSORBIDE DINITRATE 5MG S.L.
90
ISOSORBIDE DINITRATE 10MG
60
60
30
ISOSORBIDE MONO 30MG ER
60
NITROGYLCERIN SUBLINGUAL 0.3MG
100
NITROGYLCERIN SUBLINGUAL 0.4MG
100
NITROGLYCERIN 2%OINT 60 GM
NITROGLYCERIN 2.5MG CAPS
NITROGYLCERIN 6.5MG CAPS
NITROBID OINT 60GM
NITROSTAT 0.3MG
NITROSTAT 0.4MG
NITROSTAT 0.6MG
Migraine Treatment
100
200
70
120
Muscle Relaxants
30
30
30
DANTRIUM CAP 100MG
DANTRIUM CAP 25MG
DANTRIUM CAP 50MG
MESTINON 60MG TAB
MESTINON 180MG TIMESPAN
ROBAXIN-750 TAB 750MG
SKELAXIN TAB 400MG
SKELAXIN TAB 800MG
TIZANIDINE HCL 4MG TABLET
ZANAFLEX 2MG TABLET
ZANAFLEX 4 MG TABLET
NORGESIC TABLET
ORPHENADRINE COMP TABLET
60
60
60
60
60
100
100
100
60
60
Muscle Relaxants
Nitrates
Nitrates
NITROGLYCERIN TD PATCH 24HR 0.1 MG/HR 30
DILATRATE-SR
MONOKET
IMDUR
NITRO-DUR
ISMO
NITROGLYCERIN 9MG CAPS
ISORDIL
ISOSORBIDE MONONITRATE
MINITRAN
NITROLINGUAL SPR PUMPSPRA
NITROLINGUAL SPR PUMPSPRA
NITRONG
TAB 2.6MG CR
NITRONG
TAB 6.5MG CR
Ophthalmic Products
Ophthalmic Products
ATROPINE SULFATE - 5ML
ATROPINE SULFATE - 3.5GM
BACITRACIN OINT - 3/5GM
ERYTHROMYCIN 5MG/GM OINT - 3.5 GM
GENTAMICIN SULFATE 0.3% DROP - 15ML
LEVOBUNOLOL 0.25% DROP - 5ML
LEVOBUNOLOL 0.5% DROP - 5ML
NAPHAZOLINE 0.1% DROP 15 ML
BLEPH-10 DROP - 5ML
CYCLOPENTOLATE 1% - 15ML
ALBALON OPTHALMIC DROPS
ALPHAGAN P SOL 0.15%
ALREX
SUS 0.2%
AZOPT
SUS 1% OP
BETIMOL
SOL 0.25%
BETIMOL
SOL 0.5%
BLEPHAMIDE SUS OP
CILOXAN
SOL 0.3% OP
COSOPT
SOL
CROMYLYN OPHTH SOLN
CYCLOGYL SOL 0.5% OP
CYCLOGYL SOL 2% OP
DIAMOX SEQUELS 500MG CAP SA
ECONOPRED SUS 0.125%OP
EFLONE
SUS 0.1% OP
EPINAL
SOL 1% OP
EPINAL
SOL 1/2% OP
FLAREX
SUS 0.1% OP
FLOXIN OTIC SOL 0.3%
FML FORTE SUS 0.25% OP
FML S.O.P. OIN 0.1% OP
FML-S
SUS LIQUIFLM
HMS LIQUIFLM SUS 1% OP
INFLAM MILD SOL .125% OP
ISO ATROPINE SOL 0.5% OP
ISO CARBACHO SOL 0.75% OP
ISO CARPINE SOL 0.25% OP
ISO CARPINE SOL 10% OP
19
MAXALT
MAXALT MLT
RELPAX
WIGRAINE
ZOMIG
DANTRIUM
ROBAXISAL
FLEXERIL
SKELAXIN
METHOCARBAMOL 750MG
SOMA
ORPHENADRIVE CITRATE TIZANIDINE
5 ML
15 ML
DEXAMETHASONE SOD PHOS 0.1%- 5ML 5 ML
DIPIVEFRIN 0.1% DROP - 15ML 15 ML
EFLONE 0.1%DROP - 5ML
5 ML
FLUOROMETHOLONE 0.1% DROP - 5ML 5 ML
FLURBIPROFEN SOD 0.03%- 2.5ML 2.5 ML
GENTAMICIN SULFATE 0.3% OINT - 3.5 GM 3.5 GM
HOMATROPINE HYDROBROMIDE 5% 5ML 5 ML
NEOMYCIN/POLY-B/DEX OINT - 3.5 GM 3.5 GM
PILOCARPINE 2% DROP - 15 ML 15 ML
POLYMYXIN-B SULF/TRIMETHOPRIM-10 ML 10 ML
PREDNISOLONE ACETATE - 5ML 5 ML
PREDNISOLONE SOD PHOS - 5ML 5 ML
TIMOLOL MALEATE 0.5% DROP 15ML 15 ML
TIMOLOL MALEATE 0.25% DROP 15ML 15 ML
TRIPLE ANTIBIOTIC OINT 3.5GM
3.5 GM
TROPICAMIDE 1%DROP - 15ML 15 ML
CYCLOGEL 1% DROP - 5ML
5 ML
ISOPTO ATROPINE 1% - 5ML
5 ML
TIMOPTIC-XE 09.25% - 2.5 ML 2.5 ML
TIMOPTIC-XE 09.25% - 5 ML
5 ML
AMERGE
AXERT
CAFERGOT
DEPAKOTE ER
FROVA
IMITREX
20
30
30
60
30
40
30
20
60
40
30
40
60
Ophthalmic Products
5
3.5
3.5
3.5
15
5
5
15
NEO/POLYMYXIN/DEXAMETH 0.1% DROP -3.5ML
3.5
NEO/POLYMYXIN/DEXAMETH 0.1% DROP - 5ML
5
PILOCARPINE 0.5% DROP - 15 ML
15
PILOCARPINE 1% DROP - 15 ML
15
SULFACETAMIDE SODIUM 10% OINT 3.75GM 3.75
TIMOLOL MALEATE 0.25% DROP 10 ML 10
TIMOLOL MALEATE 0.5% DROP 10 ML 10
TOBRAMYCIN SULFATE 0.3% DROP - 5ML
5
12
4.9
100
100
Ophthalmic Products
15
5
5
5
15
10
5
10
5
10
15
15
30
10
10
7.5
7.5
5
5
10
3.5
10
10
10
5
15
30
15
15
15
ACULAR
ISOPTO HOMATRIPINE
ALAMAST
ALOCRIL
ALPHAGAN
ALREX
LUMIGAN
AZOPT
MAXITROL
BETAGAN
OCUPRESS
BETAXOLOL
OPTIVAR
BETOPTIC S
PATANOL
BLEPHAMIDE
PRED FORTE
BRIMONIDINE
PRED MILD
CARTEOLOL
PRED-G
CORTISPORIN
QUIXIN
CYCLOMYDRIL
RESCULA
DECADRON
TOBRADEX
DICLO SOD
TRAVATAN
DUOVISC
TRIFLURIDINE
EPIFRIN
TRUSOPT
FLUOESCITE
VASOCIDIN
INFLAMASE FORTE
VIROPTIC
ISOPTO CARBACHOL
ZADITOR
MYDFRIN
ZYMAR
$20 or Less
$10 or Less
Qty
Ophthalmic Products
$50 or Less
Qty
Qty
Ophthalmic Products
Ophthalmic Products
ISO CARPINE SOL 8% OP
ISO CETAMIDE SOL 15% OP
ISO HYOSCINE SOL 0.25% OP
LIVOSTIN SUS 0.05% OP
LOTEMAX
SUS 0.5%
MAXIDEX
SUS 0.1% OP
OCUFLOX
SOL 0.3% OP
OCUSERT
DIS PILO-20
OCUSERT
DIS PILO-40
OPTIVAR
DRO 0.05%
P3E1
SOL OP
PILOPINE HS GEL 4% OP
POLY-PRED SUS OP
PRED MILD SUS 0.12% OP
PRED MILD SUS 0.12% OP
PRED-G
SUS OP
PROPINE
SOL 0.1% OP
QUIXIN
SOL 0.5%
TIMOPTIC SOL 0.25% OP
TIMOPTIC SOL 0.5% OP
TIMOPTIC-XE SOL 0.25% OP
TIMOPTIC-XE SOL 0.5% OP
TOBREX
OIN 0.3% OP
TRUSOPT
SOL
VEXOL
SUS 1% OP
VIGAMOX
DRO 0.5%
VOLTAREN SOL 0.1% OP
XALATAN
SOL 0.005%
Osteoporosis Agents
Osteoporosis Agents
Ophthalmic Products
15
15
15
15
10
5
5
8
8
3
15
4
10
10
5
5
10
5
10
10
5
5
3.5
5
5
3
2.5
2.5
Osteoporosis Agents
Osteoporosis Agents
ACTONEL
EVISTA
FOSAMAX
MIACALCIN
Otic Products
Otic Products
Otic Products
ANTIPYRINE W/BENZOCAINE DROP - 15ML 15 ML
ACETIC ACID 2%SOLN - 15 ML 15 ML
OTOCAINE 20% DROP - 15 ML 15 ML
ZOLENE HC 10-10-1 DROP - 10ML10 ML
CERUMENEX SOL OTIC
COLY-MYCIN-S SUS OTIC
Pediatric Vitamins
Pediatric Vitamins
Pediatric Vitamins
Potassium Replacement Therapy
Pediatric Vitamins
MULTI-VITAMINS W/FLUORIDE 0.25MG
100
KLOR-CON 10
KLOR-CON 8
POTASSIUM CHLORIDE 10 MEQ CAPS
KLOR-CON 20 MEQ PACK
Prenatal Vitamins
ADVANCED NATAL CARE
NATALCARE 90
NATALCARE CFE
NATALCARE PIC
NATALCARE PIC FORTE
NATALCARE PLUS
ULTRA NATALCARE
KLOR-CON 20 MEQ
K-DUR 10MEQ
MICRO-K 10
MICRO-K 8
SLOW-K 8MEQ
30
30
30
30
30
Prenatal Vitamins
30
30
30
30
30
30
30
AMERICAINE
FLOXIN OTIC
CIPRO HC NEOMYCIN/POLYMYXIN/HC
CORTANE- B
PRAMXINE
CORTISPORIN
TYMPAGESIC
DOMEBORO
VOSOL
VOSOL HC
MULTI-VITAMINS W/FLUORIDE 0.5MG 100
MULTI-VITAMINS W/FLUORIDE 1MG
100
30
60
30
30
Otic Products
5
6
CENOGEN ULTRA
CITRACAL PRENATAL
DUET
EMBREX
ICAR-C PLUS
LACTOCAL-F
NATACHEW
NATAFORT
NESTABS
NUTRINATE
PRECARE CONCEIVE
PRECARE PRENATAL
PREMESIS RX
PRENATE ADVANCE
PRENATE GT
PRIMACARE
STUARTNATAL PLUS
Prenatal Vitamins
30
30
30
30
30
30
30
30
30
30
30
30
30
30
30
30
30
PRENATE
TAB ADVANCE
PRENATE GT TAB
STUARTNATAL 1/1 TABLET
20
Prenatal Vitamins
90
90
100
NIFEREX PN
$20 or Less
$10 or Less
Qty
Prostate Health
Qty
Colorectal Preparations
12
24
Sedatives, Hypnotics, & Antianxiety Drugs
ALPRAZOLAM 0.25MG
30
ALPRAZOLAM 0.5MG
30
ALPRAZOLAM 1MG
30
ALPRAZOLAM 2MG
30
DIAZEPAM 2MG
30
DIAZEPAM 5MG
30
DIAZEPAM 10MG
30
FLURAZEPAM 15MG
30
FLURAZEPAM 30MG
30
TEMAZEPAM 15MG
30
TEMAZEPAM 30MG
30
STIMULANTS
DEXTROAMPHETAMINE 5 MG
Prostate Health
Prostate Health
30
30
60
60
60
AVODART
HYTRIN
CARDURA
MINIPRESS
DIBENZYLINE
MINIZIDE
DOXAZOSIN MESYLATE 8MG PROSCAR
DOXAZOSIN MESYLATE 4MGTERAZOSIN
FLOMAX
HYDROCORTISONE ACETATE 2.5%CREAM 30
ANALPRAM-HC CRE 2.5%
ASACOL 400MG TABLET EC
CHLORDIAZEPOXIDE 5 MG
90
90
90
LORAZEPAM 0.5MG
30
LORAZEPAM 1MG
30
LORAZEPAM 2MG
30
TRIAZOLAM 0.125MG
30
TRIAZOLAM .25MG
30
AMBIEN
TAB 10MG
15
AMBIEN
TAB 5MG
20
BUSPIRONE HCL 7.5MG TABLET
60
CLOMIPRAMINE 75 MG CAPSULE
30
CLOMIPRAMINE 25MG CAPSULE
100
CLOMIPRAMINE 50MG CAPSULE
175
HALCION 0.125MG TABLET
30
HALCION 0.25MG TABLET
30
KLONOPIN 0.5 MG
40
KLONOPIN 1MG TABLET
30
KLONOPIN 2 MG TABLET
35
LIMBITROL DS TABLET
30
MEPROBAMATE 400MG TABLET
120
OXAZEPAM 30MG CAPSULE
60
PAXIPAM
TAB 20MG
90
PAXIPAM
TAB 40MG
60
PROSOM 1MG TABLET
30
PROSOM 2 MG TABLET
30
RESTORIL CAP 30MG
14
RESTORIL CAP 7.5MG
20
RESTORIL 15MG CAPSULE
14
SECONAL SODIUM 100MG PULVUL 30
SERAX
TAB 15MG
40
SERAX 10MG CAPSULE
50
XANAX XR TAB 0.5MG
20
XANAX XR TAB 1MG
15
XANAX XR TAB 2MG
10
XANAX XR TAB 3MG
28
STIMULANTS
30
DEXTROSTAT 10 MG
METHYLIN 5MG
METHYLPHENIDATE 5 MG
FOCALIN 2.5MG
Qty
Prostate Health
DOXAZOSIN MESYLATE 1MG
DOXAZOSIN MESYLATE 2MG
PRAZOSIN 1MG
PRAZOSIN 2 MG
PRAZOSIN 5 MG
HYDROCORTISONE ACETATE SUPPS
HYDROCORTISONE ACETATE SUPPS
$50 or Less
30
50
STIMULANTS
30
60
60
30
AMPHETAMINE SALTS 10MG TAB
CYLERT 18.75MG TABLET
D-AMPHETAMINE 10MG CAP SA
D-AMPHETAMINE 15MG CAP SA
DESOXYN 5MG TABLET
DEXTROSTAT 5MG TABLET
FOCALIN
TAB 10MG
FOCALIN
TAB 2.5MG
FOCALIN
TAB 5MG
METADATE ER 10MG TABLET SA
RITALIN
TAB 10MG
RITALIN
TAB 20MG
RITALIN
TAB 5MG
RITALIN SR TAB 20MG
21
ANALPRAM-HC
HEMRIL
ANUSOL-HC
PROCTOCORT
COLOCORT
PROCTOFOAM
CORTENEMA
PROCTO-KIT
CORTIFOAM
PROCTOSOL HC CREAM
AMBIEM
LIBRIUM
ATIVAN
MEPROBAMATE
BUSPAR
OXAZEPAM
BUSIPIRONE
PROSOM
CHLORAL HYDRATE
RESTORIL
CLORAZEPATE
SERAX
DIPOTASSIUM
SOMNOTE
DALMANE
SONATA
DORAL
TRANXENE
ESTAZOLAM
VALIUM
HALCION
XANAX
STIMULANTS
30
30
30
40
30
60
40
40
100
50
100
70
50
60
50
100
30
ADDERALL
ADDERALL XR
AMPHETAMINE SALT
COMBO
CONCERTA
DEXEDRINE
METADATE CD
METHYLIN ER
PROVIGIL
RITALIN
RITALIN-SR
STRATTERA
XYREM
$20 or Less
$10 or Less
Qty
Thyroid Medications
THYROID 15 MG
THYROID 30 MG
THYROID 60 MG
THYROID 65 MG
THYROID 90 MG
THYROID 120MG
THYROID 180 MG
THYROID 240 MG
THYROID 300 MG
$50 or Less
Qty
Qty
Thyroid Medications
30
30
30
30
30
30
30
30
30
Topical Enzymes
LEVOTHROID
LEVOTHYROXINE SODIUM
LEVOXYL(EXCEPT 300MG)
METHIMAZOLE 5 MG
PROPYLTHIOURACIL 50MG
UNITHROID
ARMOUR THYROID 15MG
ARMOUR THYROID 30MG
ARMOUR THYROID 60MG
ARMOUR THYROID 90 MG
CYTOMEL 5MG
SYNTHROID(EXCEPT 300MG)
THYROLAR-1/4
THYROLAR-1/2
Thyroid Medications
30
30
30
30
90
30
30
30
30
30
30
30
30
30
30
30
ARMOUR THYROID 300MG TABLET
CYTOMEL
TAB 25MCG
CYTOMEL
TAB 50MCG
CYTOMEL
TAB 5MCG
METHIMAZOLE 20MG TABLET
SYNTHROID 300MCG TABLET
TAPAZOLE 10MG TABLET
THYROLAR-1 TAB 60MG
THYROLAR-2 TAB 120MG
THYROLAR-3 TAB 180MG
Topical Enzymes
Thyroid Medications
60
60
40
80
90
30
50
30
30
30
Topical Enzymes
ACCUZYME
GRANULEX
PANAFIL
Urinary Tract Medications
30
30
CYTRA-2 480ML
CYTRA-3 480ML
OXYBUTYNIN 5MG
UROQID ACID
UNISED
URO BLUE
Vitamins & Minerals - Misc
CYANOCOBALAMIN 1000MCG/VIAL - 10ML 10
FERRAGEN
30
FE-TINIC 150 FORTE
30
FOLIC ACID 1MG
30
MAG-OXIDE 400 MG
100
ZINC SULFATE 220 MG
100
YOHIMBINE 5.4MG
30
ANEMAGEN
DIATX 5MG TAB
FOLGARD RX
FOLTX
HEMATINIC PLUS
HEMOCYTE PLUS
IROFOL
MEPHYTON 5MG
MULTI FERROUS FOLIC 500MG
NEPHPLEX RX
NEPHROCAPS
NEPHRON FA
NIFEREX- 150 FORTE
RENAL CAPS 1MG
RENAPHRO 1MG
TRICON CAPS
VICA-FORTE
VITAFOL TAB
Life Style
Life Style
CYTOMEL 50MCG
CYTOMEL 25 MCG
TAPAZOLE
Topical Enzymes
GRANUL-DERM SPRAY
TBC SPRAY
480
480
60
60
30
30
DITROPAN 5MG TABLET
FLOMAX
CAP 0.4MG
POLYCITRA-K SOLUTION
PROLOPRIM 100MG TABLET
PROSED/DS TABLET
SULFADIAZINE 500MG TABLET
TRIMPEX 100MG TABLET
URECHOLINE TAB 5MG
URECHOLINE 10 MG TABLET
UREX 1GM TABLET
URIMAX TABLET SA
URISPAS 100MG TABLET
URO-KP-NEUTR TAB
UROLENE BLUE TAB 65MG
UROQID #2 TAB
50
25
480
40
40
30
60
60
30
30
30
30
100
90
100
BICITRA
CYTRA-K
DETROL
DETROL LA
DITROPAN
DITROPAN XL
50
100
100
90
90
30
100
60
ALBAFORT
CHROMAGEN
FERO-FOLIC-500
FOLTRIN
FUMATINIC
GLUTOFAC MX
GLUTOFAC ZX TAB
NASCOBAL
TRINSICON
40
2
1
5
5
5
1
1
60
150
VIAGRA
PROPECIA
CELARIS
MUSE
LEVITRA
30
30
30
30
30
30
30
30
30
30
30
30
30
30
30
30
30
30
ALBAFORT
BEROCCA TABS
NIFEREX-150 CAP FORTE
PRENATE
TAB ADVANCE
PRENATE GT TAB
ROCALTROL 0.25MCG CAPSULE
STUARTNATAL 1/1 TABLET
VICON-FORTE CAPSULE
22
OXYTROL
POLYCITRA
PYRDIUM 200MG
URISPAS
UROCIT-K
Life Style
ANTABUSE TAB 250MG
CAVERJECT KIT 10MCG
CAVERJECT KIT 20MCG
CIALIS
TAB 10MG
CIALIS
TAB 20MG
CIALIS
TAB 5MG
EDEX
KIT 10MCG
EDEX
KIT 20MCG
YOCON 5.4MG TABLET
YOHIMBINE TAB 5.4MG
SANTYL
XENADERM
Life Style
$20 or Less
$10 or Less
Qty
Life Style
Qty
Qty
Life Style
Life Style
EDEX
KIT 40MCG
LEVITRA
TAB 10MG
LEVITRA
TAB 2.5MG
LEVITRA
TAB 20MG
LEVITRA
TAB 5MG
MUSE
SUP 1000MCG
MUSE
SUP 125MCG
MUSE
SUP 250MCG
MUSE
SUP 500MCG
NICOTROL CARTRIDGE INHALER
VIAGRA
TAB 100MG
VIAGRA
TAB 25MG
VIAGRA
TAB 50MG
ZYBAN
TAB 150MG SR
Miscellaneous
$50 or Less
Miscellaneous
Life Style
1
5
5
5
5
2
2
2
2
10
5
5
5
25
Miscellaneous
FLORINEF ACETATE 0.1MG TAB
LAMPRENE CAP 50MG
MINTEZOL CHW 500MG
MINTEZOL SUS 500/5ML
NEORAL 25MG GELATIN CAPSULE
PROAMATINE 2.5MG TABLET
QDALL CAPSULE
QUARZAN
CAP 2.5MG
QUARZAN
CAP 5MG
SALAGEN 5MG TABLET
SANDIMMUNE CAP 25MG
SULFINPYRAZONE 100MG TABLET
TICLOPIDINE 250MG TABLET
TRENTAL 400MG TABLET SA
VANIQA
CRE 13.9%
Miscellaneous
50
100
40
120
30
30
60
200
150
30
30
50
60
60
30
CARNITOR TAB
*Prices and Tier Position subject to change without notice
“*Tier positions and price only for quantities stated, additional quantities may incur higher costs”
**Special Network Pricing Tier (4) has no quantity limits
This is not an insured product.
Our Nationwide Pharmacy Network Includes 98% Of All Pharmacies.
Albertsons
Arbor Drug
BI-LO Pharmacy
Brooks Pharmacy
Bruno’s Pharmacy
Costco
Cub Pharmacy
CVS Pharmacy
Dillon Pharmacy
Dominick’s Pharmacy
Drug Emporium
Duane Reade
Eckerd Pharmacy
Fagen Pharmacy
Farmer Jack
More Information Contact:
© RxAnswer 06/04
Food Town Pharmacy
Fred Meyer
Fruth Pharmacy
Genovese Drug Store
Giant Eagle
Grand Union
Harris Teeter
Horizon Pharmacy
HY-Vee Pharmacy
Kerr Drug
K Mart Pharmacy
Kash N’ Karry
King Sooper’s
Kinney Drug
Kroger Pharmacy
Long’s
Marc’s
Medic Discount Drug
Medic Drug
Medicap Pharmacy
Medicine Shoppe, The
Meijer Drug
Osco Drug
Pamida Pharmacy
Pathmark Pharmacy
Price Chopper
Publix Pharmacy
Rite Aid Pharmacy
Safeway Pharmacy
Save-On
Schnuck’s Pharmacy
Shop ’N Save
Shopko Pharmacy
ShopRite Pharmacy
Stop & Shop
Target Pharmacy
TOPS Pharmacy
United Pharmacy
Von’s Pharmacy
Wal-Mart Pharmacy
Walgreens
Wegman Pharmacy
Weis Pharmacy
Winn Dixie Pharmacy
330MG

RxAnswer Prescr Guide 6/22.qxd

Transcription

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