Low-Cost Prescription Plans - Manatee Health Resource · Low-Cost Prescription Plans: Target...

Low-Cost

Prescription

Plans:Target

WalMart

Publix

KmartTake as needed

Nov 2009

FCCI does not guarantee the accuracy of the drug listing. It is recommended that you check

with the provider. The purpose of this brochure is for informational purposes only.

Target Pharmacy $4 Program

1

ACYCLOVIR 200MG CAPSULE 30

ALBUTEROL 0.5% NEBULES 20

ALBUTEROL 2MG* TABLET 90

ALBUTEROL 2MG/5ML SYRUP 120

ALBUTEROL 4MG* TABLET 60

ALLOPURINOL 100MG TABLET 30

ALLOPURINOL 300MG TABLET 30

AMILOR/HCTZ 550 TABLET 30

AMITRIPTYLINE 100MG TABLET 30





AMOXICILLIN 125/5ML SUSPENSION 80, 100, 150



AMOXICILLIN 250MG CAPSULE 30


AMOXICILLIN 500MG CAPSULE 30

AMOXIL 50MG/ML DROP 30

ANTIPYRINE/BENZOCAINE OTIC SOLUTION 10

ATENOLOL/CHLORTHALIDONE 50/25MG TABLET 30

ATENOLOL/CHLORTHALIDONE 100/25MG TABLET 30

ATENOLOL 100MG TABLET 30



ATROPINE SULFATE 1% OPHTHALMIC SOLUTION 5

BACITRACIN OPHTHALMIC OINTMENT 4

BACLOFEN 10MG TABLET 30

BELLADONNA ALKALOIDS/PB TABLET 60

BENAZEPRIL 10MG TABLET 30




BENZONATATE 100MG CAPSULE 14

BENZTROPINE 2MG TABLET 30

BETAMETHASONE DIPROPIONATE 0.05% CREAM 15, 45

BETAMETHASONE VALERATE 0.1% CREAM 15, 45

BETAMETHASONE VALERATE 0.1% OINTMENT 15, 45

BISOPROLOL/HCTZ 2.5/6.25 TABLET 30

BISOPROLOL/HCTZ 5/6.25MG TABLET 30

BISOPROLOL/HCTZ 10/6.25MG TABLET 30

BUMETANIDE 0.5MG TABLET 30

BUMETANIDE 1MG TABLET 30

BUSPIRONE 5MG TABLET 60

BUSPIRONE 10MG TABLET 60

CAPTOPRIL 100MG TABLET 60

CAPTOPRIL 12.5MG TABLET 60



CARBAMAZEPINE 200MG TABLET 60

CEPHALEXIN 250MG CAPSULE 28

CEPHALEXIN 500MG CAPSULE 30

CERON DM SYRUP 120

CERON DM DROPS 30

CHLORHEXIDINE GLUCONATE 0.12% SOLUTION 473

CHLORPROPAMIDE 100MG TABLET 30

CHLORTHALIDONE 25MG TABLET 30

CHLORTHALIDONE 50MG TABLET 30

CIMETIDINE 800MG TABLET 30

CIPROFLOXACN 250MG TABLET 14

CIPROFLOXACN 500MG TABLET 20

CITALOPRAM 20MG TABLET 30

CITALOPRAM 40MG TABLET 30

CLONIDINE 0.1MG TABLET 30

CLONIDINE 0.2MG TABLET 30

COLCHICINE 0.6MG TABLET 30

CYCLOBENZAPRINE 5MG TABLET 30

CYCLOBENZAPRINE 10MG TABLET 30

CYTRA-2 SOLUTION 180

DEXAMETHASONE 0.5MG TABLET 30

DEXAMETHASONE 0.75MG TABLET 12

DEXAMETHASONE 4MG TABLET 6

DICLOFENAC 75MG DR TABLET 60

DICYCLOMINE 10MG CAPSULE 90

DICYCLOMINE 20MG CAPSULE 60

DIGITEK 0.125MG TABLET 30

DIGITEK 0.25MG TABLET 30

DILTIAZEM 120MG TABLET 30




DOXAZOSIN 1MG TABLET 30




DOXEPIN HCL 100MG CAPSULE 30





DOXYCYCLINE HYC 100MG CAPSULE 20

DOXYCYCLINE HYC 100MG TABLET 20

DOXYCYCLINE HYC 50MG CAPSULE 30

ENALAPRIL/HCTZ 5/12.5MG TABLET 30

ENALAPRIL 10MG TABLET 30

ENALAPRIL 2.5MG TABLET 30



ERYTHROCIN 250MG TABLET 40

ERYTHROMYCIN 2% SOLUTION 60

ERYTHROMYCIN OPHTHALMIC OINTMENT 4

ERYTHROMYCIN 250MG EC CAPSULE 28

ESTRADIOL 0.5MG TABLET 30

ESTRADIOL 1MG TABLET 30

ESTRADIOL 2MG TABLET 30

ESTROPIPATE 0.75MG TABLET 30

ESTROPIPATE 1.5MG TABLET 30

ETHEDENT 0.25MG CHEWABLE TABLET 120

FAMOTIDINE 20MG TABLET 60

FLUCONAZOLE 150MG TABLET 1

FLUOCINONIDE 0.05% CREAM 15, 30

FLUOCINONIDE ACETIDE 0.01% SOLUTION 60

FLUOXETINE 10MG TABLET 30

FLUOXETINE 10MG CAPSULE 30

FLUOXETINE 20MG CAPSULE 30

FLUOXETINE 40MG* CAPSULE 30

FLUPHENAZINE 1MG TABLET 30

FOLIC ACID 1MG TABLET 30

FUROSEMIDE 20MG TABLET 30



GENTAMICIN 0.1% CREAM 15

GENTAMICIN 0.1% OINTMENT 15

GENTAMICIN 0.3% OPHTHALMIC SOLUTION 5

GLIMEPIRIDE 1MG TABLET 30



Medication Dosage Form Quantity Medication Dosage Form Quantity

*Due to state law in CA, CO, LA, MN, MT, PA, RI, TN, WI and WY, pricing on these drugs is higher than $4.

Please ask your Target Pharmacist for specific pricing.


2

GLIPIZIDE 10MG TABLET 60

GLIPIZIDE 5MG TABLET 30

GLYBURIDE MICRO 3MG TABLET 30

GLYBURIDE MICRO 6MG TABLET 30

GLYBURIDE 2.5MG TABLET 30

GLYBURIDE 5MG TABLET 30

GUAIFENESIN DM SYRUP 120

GUAIFENEX DM ER TABLET 60

GUANFACINE 1MG TABLET 30

HALOPERIDOL 0.5MG TABLET 30

HALOPERIDOL 1MG TABLET 30



HYDRALAZINE 10MG TABLET 30

HYDRALAZINE 25MG* TABLET 30

HYDROCHLOROTHIAZIDE 12.5MG CAPSULE 30

HYDROCHLOROTHIAZIDE 25MG TABLET 30

HYDROCHLOROTHIAZIDE 50MG TABLET 30

HYDROCORTISONE 1% CREAM 30

HYDROCORTISONE AC 25MG SUPPOSITORY 12

HYDROCORTISONE 2.5% CREAM 30

HYDROXYZINE HCL10MG/5ML SYRUP 120

HYOSCYAMINE 0.125/ML DROP 15

HYOSCYAMINE 0.125MG SUBLINGUAL TABLET 30

HYOSCYAMINE 0.125MG TABLET 60

HYOSCYAMINE 0.375 ER TABLET 30

IBUPROFEN 100/5ML SUSPENSION 120

IBUPROFEN 400MG TABLET 90



INDAPAMIDE 1.25MG TABLET 30

INDAPAMIDE 2.5MG TABLET 30

INDOMETHACIN 25MG CAPSULE 60

ISONIAZID 300MG TABLET 30

ISOSORBIDE MONO 30MG ER TABLET 30

ISOSORBIDE MONO 60MG ER TABLET 30

KLORCON-10 10MEQ ER TABLET 30

KLORCON-8 8MEQ ER TABLET 30

KLORCON M10 TABLET 30

LACTULOSE 10GM/15 SYRUP 237

LEVOTHYROXINE 100MCG TABLET 30








LEVOTHYROXINE 175MCG* TABLET 30


LIDOCAINE 2% VISCOUS SOLUTION 100

LISINOPRIL-HCTZ 10-12.5M TABLET 30

LISINOPRIL-HCTZ 20-25MG TABLET 30

LISINOPRIL-HCTZ 20-12.5 TABLET 30

LISINOPRIL 10MG TABLET 30

LISINOPRIL 2.5MG TABLET 30



LITHIUM CARB 300MG CAPSULE 90

LORATADINE 10MG* TABLET 30

LORATADINE 5MG/5ML SYRUP 120

LOVASTATIN 10MG* TABLET 30

LOVASTATIN 20MG* TABLET 30

MAG OXIDE 400MG TABLET 30

MAG64 64MG TABLET 60

MECLIZINE 12.5MG TABLET 90

MECLIZINE 25MG TABLET 90

MEDROXYPROGESTERONE 10MG TABLET 10

MEDROXYPROGESTERONE 2.5MG TABLET 30

MEDROXYPROGESTERONE 5MG TABLET 30

MEGESTROL 20MG TABLET 30

MELOXICAM 7.5 MG TABLET 30

MELOXICAM 15 MG TABLET 30

METFORMIN 1000MG TABLET 60


METFORMIN 500MG ER TABLET 60


METHYLDOPA 250MG* TABLET 60

METHYLDOPA 500MG* TABLET 30

METHYLPREDNISOLONE 4MG DOSE PAK 21

METHYLPREDNISOLONE 4MG TABLET 21

METOCLOPRAMIDE 10MG TABLET 60

METOCLOPRAMIDE 5MG/5ML SYRUP 60

METOPROLOL 100MG TABLET 60



METRONIDAZOLE 250MG TABLET 28

METRONIDAZOLE 500MG TABLET 14

MULTI-VITAMIN 0.25MG CHEWABLE TABLET 30

MULTI-VITAMIN/FL/FE CHEWABLE TABLET 30

MULTI-VITBET /FL 1MG CHEWABLE TABLET 30

MULTI-VITBET 0.5MGFL CHEWABLE TABLET 30

NADOLOL 20MG TABLET 30

NADOLOL 40MG TABLET 30

NAPROXEN 375MG TABLET 60

NAPROXEN 500MG TABLET 60

NATALCARE PIC TABLET 30

NATALCARE PLUS TABLET 30

NEOMYCIN/POLYMYXIN/DEXAMETHASONE 0.1% OPHTHALMIC OINTMENT 4

NEOMYCIN/POLYMYXIN/DEXAMETHASONE 0.1% OPHTHALMIC SUSPENSION 5

NORTRIPTYLINE 10MG CAPSULE 30

NORTRIPTYLINE 25MG CAPSULE 30

NYSTATIN/TRIAMCINOLONE CREAM 15, 30

NYSTATIN/TRIAMCINOLONE OINTMENT 15

NYSTATIN 100000U CREAM 15, 30

NYSTATIN 100000U OINTMENT 15, 30

OXYBUTYNIN 5MG TABLET 60

PAROXETINE 10MG* TABLET 30

PAROXETINE 20MG* TABLET 30

PENICILLN VK 125/5ML SOLUTION 200

PENICILLN VK 250/5ML SOLUTION 100

PENICILLN VK 250MG TABLET 28

PHENAZOPYRIDINE 100MG TABLET 6

PHENAZOPYRIDINE 200MG TABLET 30

PILOCARPINE 1% OPHTHALMIC SOLUTION 15

PILOCARPINE 2% OPHTHALMIC SOLUTION 15

PINDOLOL 10MG TABLET 30

PINDOLOL 5MG TABLET 30

PIROXICAM 20MG CAPSULE 30

POLYMIXIN SULFATE/TMP SOLUTION 10

POTASSIUM CHLORIDE 10% LIQUID 473

PRAVASTATIN 10MG* TABLET 30



PRAZOSIN HCL 1MG CAPSULE 30

PRAZOSIN HCL 2MG* CAPSULE 30

PRAZOSIN HCL 5MG* CAPSULE 30

PREDNISONE 10MG TABLET 30

Medication Dosage Form Quantity Medication Dosage Form Quantity




3

PREDNISONE 10MG* DOSEPACK 21, 48

PREDNISONE 2.5MG TABLET 30



PREDNISONE 5MG 6DAY PAK 21, 48

PRENATAL RX TABLET 30

PROCHLORPERAZINE 10MG TABLET 30

PROMETHAZINE 25MG TABLET 12

PROMETHAZINE DM SYRUP 120

PROMETHAZINE 6.25/5ML SYRUP 180

PROPRANOLOL 10MG TABLET 60




RANITIDINE 150MG* TABLET 60

RANITIDINE 300MG TABLET 30

SALSALATE 500MG TABLET 60

SELENIUM SUL 2.5% LOTION 120

SMZ/TMP DS 800/160 TABLET 20

SMZTMP 200/40/5ML SUSPENSION 120

SMZTMP 400/80MG TABLET 28

SOTALOL HCL 80MG TABLET 30

SPIRONOLACTONE 25MG TABLET 30

SULFACETAMIDE SODIUM 10% OPHTHALMIC SOLUTION 15

TERAZOSIN 10MG CAPSULE 30




TETRACYCLINE 250MG CAPSULE 60

TETRACYCLINE 500MG CAPSULE 60

THIORIDAZINE 25MG TABLET 30

THIORIDAZINE 50MG TABLET 30

THIOTHIXENE 2MG CAPSULE 30

TOBRAMYCIN 0.3% OPHTHALMIC SOLUTION 5

TRAMADOL HCL 50MG TABLET 60

TRAZODONE 100MG TABLET 30



TRIAMCINOLONE 0.025% CREAM 15, 80

TRIAMCINOLONE 0.1% CREAM 15, 80

TRIAMCINOLONE 0.1% OINTMENT 15, 80

TRIAMCINOLONE 0.5% CREAM 15

TRIAMTERENE/HCTZ 37.5/25 CAPSULE 30

TRIAMTERENE/HCTZ 37.5/25 TABLET 30

TRIAMTERENE/HCTZ 75/50MG TABLET 30

TRIHEXYPHENIDYL 2MG TABLET 60

TRIVENT DPC 6/2/15/5ML SYRUP 120

VERAPAMIL 120MG TABLET 30

VERAPAMIL 80MG TABLET 30

WARFARIN 5MG TABLET 30

Medication Dosage Form Quantity



©2009 Wal-Mart Stores, Inc. | Page 1 of 6

Prescription Program includes up to a 30-day supply for $4 and a 90-day supply for $10 of some covered generic drugs at commonly prescribed dosages. Higher dosages cost more. Prices for some drugs covered by the Prescription Program may be higher and may vary in some states. Restrictions apply. See Program Details or your Walmart Pharmacist for details. Free language assistance services available for prescription drug information at Walmart and Sam’s Club pharmacies in New York. Contact your Walmart or Sam’s Club pharmacy for details.

*Prices may be higher in CA, HI, MN, MT, PA, TN and WI.† Prepackaged drugs are covered only in unit sizes specified on Drug List. See Program Details or your Walmart Pharmacist for details.

$4 $1030-Day 90-Day

Allergies & Cold and FluBenzonatate 100mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . 14 . . . . . . . . 42

Ceron DM syrup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120ml . . . . 360ml

C-Phen drops* (30ml bottle)† . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . 3

Dex PC syrup* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120ml . . . . 360ml

Loratadine 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Promethazine DM syrup . . . . . . . . . . . . . . . . . . . . . . . . . 120ml . . . . 360ml

$4 $1030-Day 90-Day

Antibiotic TreatmentsAmoxicillin 125mg/5ml susp (80ml bottle)† . . . . . . . . . 1 . . . . . . . . 3

Amoxicillin 125mg/5ml susp (100ml bottle)† . . . . . . . . 1 . . . . . . . . 3


Amoxicillin 200mg/5ml susp (50ml bottle)† . . . . . . . . . 1 . . . . . . . . 3

Amoxicillin 200mg/5ml susp* (75ml bottle)† . . . . . . . . 1 . . . . . . . . 3

Amoxicillin 200mg/5ml susp* (100ml bottle)† . . . . . . . 1 . . . . . . . . 3





Amoxicillin 400mg/5ml susp* (75ml bottle)† . . . . . . . . 1 . . . . . . . . 3

Amoxicillin 400mg/5ml susp* (100ml bottle)† . . . . . . . 1 . . . . . . . . 3

Amoxicillin 250mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Amoxicillin 500mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Cephalexin 250mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 . . . . . . . . 84

Cephalexin 500mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Ciprofloxacin 250mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . 14 . . . . . . . . 42

Ciprofloxacin 500mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . 20 . . . . . . . . 60

Doxycycline Hyclate 50mg cap . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Doxycycline Hyclate 100mg cap . . . . . . . . . . . . . . . . . . . 20 . . . . . . . . 60

Doxycycline Hyclate 100mg tab . . . . . . . . . . . . . . . . . . . 20 . . . . . . . . 60

Erythromycin EC 250mg cap* . . . . . . . . . . . . . . . . . . . . . . 28 . . . . . . . . 84

Metronidazole 250mg tab . . . . . . . . . . . . . . . . . . . . . . . . . 28 . . . . . . . . 84

Metronidazole 500mg tab . . . . . . . . . . . . . . . . . . . . . . . . . 14 . . . . . . . . 42

Penicillin VK 250mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 . . . . . . . . 84

Penicillin VK 125mg/5ml susp (100ml bottle)† . . . . . . . 1 . . . . . . . . 3



SMZ-TMP 200mg-40mg/5ml susp. . . . . . . . . . . . . . . . 120ml . . . . 360ml

SMZ-TMP 400mg-80mg tab . . . . . . . . . . . . . . . . . . . . . . . 28 . . . . . . . . 84

SMZ-TMP DS 800mg-160mg tab . . . . . . . . . . . . . . . . . . . 20 . . . . . . . . 60

Tetracycline 250mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

Tetracycline 500mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

$4 $1030-Day 90-Day

Arthritis & PainAllopurinol 100mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Allopurinol 300mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Baclofen 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Colchicine 0.6mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Cyclobenzaprine 5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Cyclobenzaprine 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Dexamethasone 0.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Dexamethasone 0.75mg tab . . . . . . . . . . . . . . . . . . . . . . 12 . . . . . . . . 36

Dexamethasone 4mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . 6 . . . . . . . . 18

Retail Prescription Program Drug ListLow-cost prescriptions make a differenceAt Walmart, we don’t think you should have to choose between groceries and the medicines you need. Our $4 prescriptions save American families hundreds of millions of dollars a year.

More $4 prescriptions than everNow our $4 price covers hundreds of prescriptions. That includes medicines for a wide range of conditions and diagnosis groups. This list is a quick-reference tool that will help you find the specific medicines you’re looking for.

90-Day Prescriptions Taking a regular prescription? Ask your doctor if you can refill it 3 months at a time. At only $10, our 90-Day prescriptions save you even more than our regular low-cost prescriptions. You save trips to the pharmacy, too.

Revised 8/20/09




Revised 8/20/09

Arthritis & Pain (continued)Diclofenac DR 75mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

Ibuprofen 100mg/5ml susp* . . . . . . . . . . . . . . . . . . . . 120ml . . . . 360ml

Ibuprofen 400mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 . . . . . . . 270

Ibuprofen 600mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

Ibuprofen 800mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Indomethacin 25mg cap* . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

Meloxicam 7.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Meloxicam 15mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Naproxen 375mg tab*. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

Naproxen 500mg tab*. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

Piroxicam 20mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Salsalate 500mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

$4 $1030-Day 90-Day

AsthmaAlbuterol 2mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 . . . . . . . 270

Albuterol 4mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

Albuterol 2mg/5ml syrup . . . . . . . . . . . . . . . . . . . . . . . . 120ml . . . . 360ml

Albuterol 0.5% nebulizer soln (20ml bottle)† . . . . . . . . 1 . . . . . . . . 3

Albuterol 0.083% nebulizer soln* (25x3ml vials)† . . . . 1 . . . . . . . . 3

Ipratropium 0.02% nebulizer soln* (25x2.5ml vials)† . 1 . . . . . . . . 3

$4 $1030-Day 90-Day

CholesterolLovastatin 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Lovastatin 20mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Pravastatin 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Pravastatin 20mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Pravastatin 40mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

$4 $1030-Day 90-Day

DiabetesChlorpropamide 100mg tab* . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Glimepiride 1mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90



Glipizide 5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Glipizide 10mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

Glyburide 2.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Glyburide 5mg tab (blue) . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Glyburide 5mg tab (green) . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Glyburide, micronized 3mg tab . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Glyburide, micronized 6mg tab . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Metformin 500mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

Metformin 850mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

Metformin 1000mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

Metformin 500mg ER tab* . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

$4 $1030-Day 90-Day

Ear HealthAntipyrine/Benzocaine otic (10ml bottle)†. . . . . . . . . . . 1 . . . . . . . . 3

$4 $1030-Day 90-Day

Fungal InfectionsFluconazole 150mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . 3

Nystatin/Triamcin cream (15gm tube)† . . . . . . . . . . . . . . 1 . . . . . . . . 3

Nystatin/Triamcin cream (30gm tube)† . . . . . . . . . . . . . . 1 . . . . . . . . 3

Nystatin/Triamcin ointment (15gm tube)† . . . . . . . . . . . 1 . . . . . . . . 3

Nystatin cream (15gm tube)† . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . 3

Nystatin cream (30gm tube)† . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . 3

Nystatin ointment (15gm tube)† . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . 3

Nystatin ointment (30gm tube)† . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . 3

Terbinafine 250mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

$4 $1030-Day 90-Day

Gastrointestinal HealthBelladonna Alkaloid/PB tab . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

Cimetidine 800mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Cytra2 solution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180ml . . . . 540ml

Dicyclomine 10mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 . . . . . . . 270

Dicyclomine 20mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

Famotidine 20mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

Lactulose syrup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237ml . . . . 711ml

Metoclopramide 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180




Revised 8/20/09

Gastrointestinal Health (contined)Metoclopramide syrup . . . . . . . . . . . . . . . . . . . . . . . . . . . 60ml. . . . . 180ml

Promethazine 25mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . 12 . . . . . . . . 36

Promethazine plain syrup* . . . . . . . . . . . . . . . . . . . . . . 180ml . . . . 540ml

Ranitidine 150mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

Ranitidine 300mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

$4 $1030-Day 90-Day

Glaucoma & Eye CareAtropine Sulfate 1% op. soln (5ml bottle)† . . . . . . . . . . . 1 . . . . . . . . 3

Erythromycin op. ointment (3.5gm tube)†* . . . . . . . . . . 1 . . . . . . . . 3

Gentamicin 0.3% op. soln (5ml bottle)† . . . . . . . . . . . . . . 1 . . . . . . . . 3

Levobunolol 0.5% op soln (5ml bottle)† . . . . . . . . . . . . . 1 . . . . . . . . 3

Neomycin/Polymyxin/Dexamethasone

0.1% op. ointment (3.5gm tube)† . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . 3

Neomycin/Polymyxin/Dexamethasone

0.1% op. susp (5ml bottle)† . . . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . 3

Pilocarpine 1% op. soln (15ml bottle)† . . . . . . . . . . . . . . 1 . . . . . . . . 3

Pilocarpine 2% op. soln (15ml bottle)† . . . . . . . . . . . . . . 1 . . . . . . . . 3

Polymyxin Sulfate/TMP op. soln* (10ml bottle)† . . . . . 1 . . . . . . . . 3

Sulfacet Sodium 10% op. soln (15ml bottle)† . . . . . . . . 1 . . . . . . . . 3

Timolol Maleate 0.25% op. soln (5ml bottle)† . . . . . . . . 1 . . . . . . . . 3

Timolol Maleate 0.5% op soln (5ml bottle)† . . . . . . . . . . 1 . . . . . . . . 3

Tobramycin 0.3% op. soln (5ml bottle)† . . . . . . . . . . . . . 1 . . . . . . . . 3

$4 $1030-Day 90-Day

Heart Health & Blood PressureAmiloride-HCTZ 5mg-50mg tab . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Atenolol-Chlorthalidone 50mg-25mg tab . . . . . . . . . . 30 . . . . . . . . 90

Atenolol-Chlorthalidone 100mg-25mg tab . . . . . . . . 30 . . . . . . . . 90

Atenolol 25mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Atenolol 50mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Atenolol 100mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Benazepril 5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Benazepril 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90



Bisoprolol-HCTZ 2.5mg-6.25mg tab. . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Bisoprolol-HCTZ 5mg-6.25mg tab . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Bisoprolol-HCTZ 10mg-6.25mg tab . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Bumetanide 0.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Bumetanide 1mg tab. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Captopril 12.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

Captopril 25mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

Captopril 50mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

Captopril 100mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

Carvedilol 3.125mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

Carvedilol 6.25mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

Carvedilol 12.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

Carvedilol 25mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

Chlorthalidone 25mg tab . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Chlorthalidone 50mg tab . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Clonidine 0.1mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Clonidine 0.2mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Digoxin 0.125mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Digoxin 0.25mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Diltiazem 30mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

Diltiazem 60mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

Diltiazem 90mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

Diltiazem 120mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Doxazosin 1mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Doxazosin 2mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Doxazosin 4mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Doxazosin 8mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Enalapril-HCTZ 5mg-12.5mg tab . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Enalapril 2.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Enalapril 5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Enalapril 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Enalapril 20mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Furosemide 20mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90



Guanfacine 1mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Hydralazine 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Hydralazine 25mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Hydrochlorothiazide(HCTZ)12.5mg cap* . . . . . . . . . . . 30 . . . . . . . . 90

Hydrochlorothiazide (HCTZ) 25mg tab . . . . . . . . . . . . . 30 . . . . . . . . 90

Hydrochlorothiazide (HCTZ) 50mg tab . . . . . . . . . . . . . 30 . . . . . . . . 90




Revised 8/20/09

Heart Health & Blood Pressure (continued)Indapamide 1.25mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Indapamide 2.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Isosorbide Mononitrate 30mg ER tab . . . . . . . . . . . . . . 30 . . . . . . . . 90

Isosorbide Mononitrate 60mg ER tab . . . . . . . . . . . . . . 30 . . . . . . . . 90

Lisinopril-HCTZ 10mg-12.5mg tab . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Lisinopril-HCTZ 20mg-12.5mg tab* . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Lisinopril-HCTZ 20mg-25mg tab* . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Lisinopril 2.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Lisinopril 5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Lisinopril 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Lisinopril 20mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Methyldopa 250mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

Methyldopa 500mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Metoprolol Tartrate 25mg tab . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

Metoprolol Tartrate 50mg tab . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

Metoprolol Tartrate 100mg tab* . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

Nadolol 20mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Nadolol 40mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Pindolol 5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Pindolol 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Prazosin HCL 1mg cap. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90



Propranolol 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180




Sotalol HCL 80mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Spironolactone 25mg tab* . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Terazosin 1mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Terazosin 2mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Terazosin 5mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Terazosin 10mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Triamterene-HCTZ 37.5mg-25mg cap . . . . . . . . . . . . . . 30 . . . . . . . . 90

Triamterene-HCTZ 37.5mg-25mg tab . . . . . . . . . . . . . . 30 . . . . . . . . 90

Triamterene-HCTZ 75mg-50mg tab . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Verapamil 80mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Verapamil 120mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Warfarin 1mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Warfarin 2mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Warfarin 2.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Warfarin 3mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Warfarin 4mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Warfarin 5mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Warfarin 6mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Warfarin 7.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Warfarin 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

$4 $1030-Day 90-Day

Mental HealthAmitriptyline 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Amitriptyline 25mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90



Amitriptyline 100mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Benztropine 2mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Buspirone 5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

Buspirone 10mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

Carbamazepine 200mg tab* . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

Citalopram 20mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Citalopram 40mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Doxepin HCL 10mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90




Doxepin HCL 100mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Fluoxetine 10mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Fluoxetine 10mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90



Fluphenazine 1mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Haloperidol 0.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Haloperidol 1mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90



Lithium Carbonate 300mg cap* . . . . . . . . . . . . . . . . . . . 90 . . . . . . . 270

Nortriptyline 10mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90




Revised 8/20/09

Mental Health (continued)Nortriptyline 25mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Paroxetine 10mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Paroxetine 20mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Prochlorperazine 10mg tab. . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Thioridazine 25mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Thioridazine 50mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Thiothixene 2mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Trazodone 50mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Trazodone 100mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Trazodone 150mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Trihexyphenidyl 2mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

$4 $1030-Day 90-Day

Skin ConditionsBenzoyl Peroxide 4% creamy wash*

(170.1ml bottle)† . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . N/A

Betamethasone Dipropionate 0.05% cream

(15gm tube)† . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . 3

Betamethasone Dipropionate 0.05% cream

(45gm tube)† . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . 3

Betamethasone Valerate 0.1% cream

(15gm tube)† . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . 3

Betamethasone Val. 0.1% cream (45gm tube)†. . . . . . . 1 . . . . . . . . 3

Betamethasone Val. 0.1% ointment (15gm tube)† . . . 1 . . . . . . . . 3

Betamethasone Val. 0.1% ointment (45gm tube)† . . . 1 . . . . . . . . 3

Fluocinolone Acet. 0.01% soln (60ml bottle)† . . . . . . . . 1 . . . . . . . . 3

Fluocinonide 0.05% cream (15gm tube)† . . . . . . . . . . . . 1 . . . . . . . . 3

Fluocinonide 0.05% cream (30gm tube)† . . . . . . . . . . . . 1 . . . . . . . . 3

Gentamicin 0.1% cream (15gm tube)† . . . . . . . . . . . . . . . 1 . . . . . . . . 3

Gentamicin 0.1% ointment (15gm tube)† . . . . . . . . . . . 1 . . . . . . . . 3

Hydrocortisone 1% cream (28.35-30g tube)† . . . . . . . . 1 . . . . . . . . 3

Hydrocortisone 2.5% cream (30gm tube)† . . . . . . . . . . . 1 . . . . . . . . 3

Selenium Sulfide 2.5% lotion* (120ml bottle)† . . . . . . . 1 . . . . . . . . 3

Silver Sulfadiazine 1% cream* (50gm tube)† . . . . . . . . . 1 . . . . . . . . 3

Triamcinolone 0.025% cream (15gm tube)† . . . . . . . . . 1 . . . . . . . . 3

Triamcinolone 0.025% cream (80gm tube)† . . . . . . . . . 1 . . . . . . . . 3

Triamcinolone 0.1% cream (15gm tube)† . . . . . . . . . . . . 1 . . . . . . . . 3


Triamcinolone 0.1% ointment (15gm tube)† . . . . . . . . . 1 . . . . . . . . 3

Triamcinolone 0.1% ointment (80gm tube)† . . . . . . . . . 1 . . . . . . . . 3


$4 $1030-Day 90-Day

Thyroid ConditionsLevothyroxine 25mcg tab . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Levothyroxine 50mcg tab . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90



Levothyroxine 100mcg tab . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90





Levothyroxine 175mcg tab* . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Levothyroxine 200mcg tab* . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

$4 $1030-Day 90-Day

VirusesAcyclovir 200mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

$4 $1030-Day 90-Day

Vitamins & Nutritional HealthFolic Acid 1mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Klorcon 8 8mEq ER tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Klorcon 10 10mEq ER tab . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Klorcon M10 10mEq tab . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Mag 64 64mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

Magnesium Oxide 400mg tab . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Prenatal Plus qty 30* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Potassium Chloride 10% liquid . . . . . . . . . . . . . . . . . . 473ml . . . 1419ml

Sodium Fluoride .25mg chewable (120ct bottle) †* . . 1 . . . . . . . N/A

$4 $1030-Day 90-Day

Women’s HealthEstradiol 0.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Estradiol 1mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90




Revised 8/20/09

Estradiol 2mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Estropipate 0.75mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Estropipate 1.5mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

MedroxyprogesteroneAcetate 2.5mg tab . . . . . . . . . . 30 . . . . . . . . 90

Medroxyprogesterone Acetate 5mg tab . . . . . . . . . . . 30 . . . . . . . . 90

Medroxyprogesterone Acetate 10mg tab . . . . . . . . . . 10 . . . . . . . . 30

$9 $2430-Day 90-Day

Women’s HealthAlendronate SOD 35mg tab . . . . . . . . . . . . . . . . . . . . . . . . 4 . . . . . . . . 12

Alendronate SOD 70mg tab . . . . . . . . . . . . . . . . . . . . . . . . 4 . . . . . . . . 12

Clomiphene 50mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 . . . . . . . . 15

EST Estrogen/Methyl Testost HS tab. . . . . . . . . . . . . . . . 30 . . . . . . . . 90

EST Estrogen/Methyl Testost DS tab . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Sprintec 28-day tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 . . . . . . . N/A

Tri-Sprintec 28-day tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 . . . . . . . N/A

Tamoxifen 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

Tamoxifen 20mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

$4 $1030-Day 90-Day

Other Medical ConditionsChlorhexidine Gluconate 0.12% soln (473ml bottle)† . . . 1 . . . . . . . . 3

Hydrocortisone AC 25mg suppositories . . . . . . . . . . . . 12 . . . . . . . . 36

Isoniazid 300mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Lidocaine 2% viscous solution (100ml bottle)† . . . . . . 1 . . . . . . . . 3

Megestrol 20mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Methylpred 4mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 . . . . . . . . 63

Methylpred 4mg dose pak (21 tablets)† . . . . . . . . . . . . . 1 . . . . . . . . 3

Oxybutynin 5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180

Phenazopyridine 100mg tab . . . . . . . . . . . . . . . . . . . . . . . 6 . . . . . . . . 18

Phenazopyridine 200mg tab . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Prednisone 2.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Prednisone 5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Prednisone 5mg dose pak (21 tablets)† . . . . . . . . . . . . . . 1 . . . . . . . . 3

Prednisone 5mg dose pak* (48 tablets)† . . . . . . . . . . . . . 1 . . . . . . . . 3

Prednisone 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Prednisone 10mg dose pak (21 tablets)† . . . . . . . . . . . . 1 . . . . . . . . 3

Prednisone 10mg dose pak* (48 tablets)† . . . . . . . . . . . 1 . . . . . . . N/A

Prednisone 20mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90

Walmart’s Prescription Program DetailsWalmart’s Prescription Program (the “Program”) is available at all Walmart, Sam’s Club and Neighborhood Market 1. pharmacies in the United States (“Walmart Retail Pharmacies”), except in North Dakota, as set forth below in Sections 3 and 4. The Program is also available through Walmart Mail Service (“Walmart Mail Service”), as set forth below in Section 5.

The Program applies only to certain generic drugs at commonly prescribed dosages. Higher dosages cost more. You 2. may obtain a list of generic drugs and dosages covered under the Program at Walmart Retail Pharmacies (the “Retail Drug List”) and through Walmart Mail Service (the “Mail Service Drug List”) on Walmart.com or at Walmart Retail Pharmacies. The Retail Drug List and Mail Service Drug List may change and also may vary by state. Not all formulations of a drug (for example, enteric-coated, extended or timed release formulations) are covered under the Program. Program pricing not available when a covered drug is dispensed as part of a compound.

Under the Program at Walmart Retail Pharmacies, $4 is the price for up to a 30-day supply of certain covered generic 3. drugs at commonly prescribed dosages (the “$4 Retail Program”). $10 is the price of a 90-day supply of certain covered generic drugs at commonly prescribed dosages (the “$10 Retail Program”). Not all drugs covered by the $4 Retail Program are covered by the $10 Program. Prices for quantities between a 30-day supply and a 90-day supply of drugs covered by both the $4 Retail Program and $10 Retail Program are prorated based on the $4 Program price, but will not exceed $10. Prices for quantities greater than a 90-day supply of drugs covered by the $10 Retail Program are prorated based on the $10 Program price. Prorated pricing is not available under the Program for prepackaged drugs. For pricing policies relating to prepackaged drugs (such as tubes, vials or bottles), see Section 6.

Under the Program at Walmart Retail Pharmacies, $9 is the price for up to a 30-day supply of certain women’s health and 4. other covered generic drugs at commonly prescribed dosages (the “$9 Retail Program”). $24 is the price for a 90-day supply of certain women’s health and other covered generic drugs at commonly prescribed dosages (the “$24 Retail Program”). Not all drugs covered by the $9 Retail Program are covered by the $24 Retail Program. Prices for quantities between a 30-day supply and a 90-day supply of drugs covered by both the $9 Program and $24 Retail Program are prorated based on the $9 Program price, but will not exceed $24. Prices for quantities greater than a 90-day supply of drugs covered by the $24 Retail Program are prorated based on the $24 Program price. Prorated pricing is not available under the Program for prepackaged drugs. For pricing policies relating to prepackaged drugs, see Section 6.

Under the Program through Walmart Mail Service, $10 is the price for mail delivery of a 90-day supply of certain 5. generic drugs at commonly prescribed dosages (“$10 Mail Service Program”). $24 is the price for mail delivery of certain women’s health and certain other covered drugs at commonly prescribed dosages ($24 Mail Service Program”). Not all drugs covered by the $10 Retail Program are covered by the $10 Mail Service Program; not all drugs covered by the $24 Retail Program are covered by the $24 Mail Service Program. See Mail Service Drug List for a list of drugs covered by the $10 Mail Service Program and $24 Mail Service Program. Walmart Mail Service covers both initial fills and refills. Delivery of covered drugs is available only through Walmart Mail Service and is not available at Walmart, Sam’s Club, and Neighborhood Market retail pharmacies. Delivery under the Program through Walmart Mail Service is limited to U.S. addresses by First-Class Mail; expedited delivery is also available for an additional charge. Some health plans do not cover Walmart Mail Service or 90-day supplies. Prices for quantities greater than a 90-day supply of drugs covered by the $10 Mail Service Program and the $24 Mail Service Program are prorated based on the $10 and $24 Program price, respectively. Prices for quantities less than a 90-day supply are not prorated under either the $10 Mail Service Program or the $24 Mail Service Program. Prorated pricing is not available under the Program for prepackaged drugs. For pricing policies relating to prepackaged drugs, see Section 6.

Prepackaged drugs are covered under the Program only in the unit sizes specified on the Retail Drug List and Mail 6. Service Drug List. Prepackaged drugs are dispensed based on the quantities prescribed and unit sizes in stock at the dispensing pharmacy. Unit sizes not specified on the Retail Drug List or Mail Service Drug List are not covered under the Program. Multi-unit purchases are charged at a per unit price, based on the price per unit size dispensed, unless otherwise specified. Prepackaged drugs dispensed in unit sizes not specified on the Retail Drug List and Mail Service Drug List may be priced higher, even if equivalent quantities of the drug are available in specified unit sizes. Prorated pricing is not available under the Program for prepackaged drugs.

Prices of certain drugs covered by the Program may be higher in some states, as noted on the Retail Drug List and Mail 7. Service Drug List.

Program pricing may be limited to select manufacturers of a covered drug and is available as long as supplies from 8. such manufacturers are in stock at the dispensing pharmacy.

You may pay less or more than the Program price, depending on the terms of your health plan. Prescriber permission 9. may be required to change a 30-day prescription to a 90-day prescription. Certain plans, including government-funded programs, may not cover a 90-day supply.

For purchases made at Walmart Retail Pharmacies, prescriptions must initially be filled in person, and refills must be 10. picked up in store. There are no substitutions. Purchases made through Walmart Mail Service may be ordered at Walmart Retail Pharmacies, by phone or through walmart.com.

These Program Details are subject to change without advance notice. Changes to these Program Details may be 11. made only in writing.

New non program medication for asthma and smoking cessation.

Asthma ReliOn/Ventolin® HFA Inhaler 8g . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $9 Smoking Cessation Bupropion ER 150mg (17ct starter pack) . . . . . . . . . . . . . . . . . . . . . . $9

Not part of Prescription Program or subject to Walmart’s Prescription Program Details. Available at all Walmart, Sam’s Club and Neighborhood Markets pharmacies in the United States, except in North Dakota. These drugs are offered at the price specified only in the exact unit sizes and formulations specified above and are not subject to proration. You may pay more or less depending on the terms of your health plan. Specified price may be limited to select manufacturers of the drugs and is available as long as supplies are in stock at the pharmacy. There are no substitutions or mail orders. See your Walmart Pharmacist for details .

Good news.

Select oral antibiotics are free. At Publix, we’re always looking for ways to make your life easier. And helping you manage healthcare costs is no exception. That’s why we’re pleased to tell you that some commonly prescribed generic oral antibiotics are free at your neighborhood Publix Pharmacy. To take advantage of this great deal, all you have to do is bring in your prescription for any of the medications below, and we’ll give you up to a 14-day supply at no cost to you—regardless of your prescription insurance provider or the number of prescriptions you need filled.

Amoxicillin Ampicillin Cephalexin (capsules and suspension only) Sulfamethoxazole/Trimethoprim (SMZ-TMP) Ciprofloxacin (excluding Ciprofloxacin XR) Penicillin VK Doxycycline Hyclate (capsules only) Erythromycin Stearate and Ethylsuccinate

Page 1 of 1Publix Pharmacy Free Antibiotics

10/13/2009http://www.publix.com/freeantibiotics/

Version: 4/27/09

Alphabetical Formulary List

Drug Quantity Price Drug Quantity Price

Acetaminophen 120mg Suppositories 12 $5 Amoxicillin 400mg/5ml Suspension (100ml)

100 $5


50 $5


75 $5

Acetic Acid/Aluminum Acetate 2% Solution

60 $5 Amoxicillin 875mg Tablet 20 $5

Acyclovir 200mg Capsule 180 $15 Amoxil 125/5ml Suspension (150ml) 150 $5

Acyclovir 400mg Tablet 180 $15 Amoxil 250mg/5ml Suspension (100ml) 100 $5

Acyclovir 800mg Tablet 90 $15 Amoxil 500mg Capsule 30 $5

Advanced Natalcare Tablet 90 $15 Amoxil 50mg/ml Suspension (15ml) 30 $5

Albuterol 0.083% Solution Nebules 225 $10 Amoxil 50mg/ml Suspension (30ml) 60 $5

Albuterol 2mg Tablet 90 $5 Ampicillin 250mg Capsule 28 $5

Albuterol 2mg/5ml Syrup 360 $5 Ampicillin 500mg Capsule 28 $5

Albuterol 4mg Tablet 60 $5 Antipyrine and Benzocaine Otic Solution 10 $5

Albuterol 5mg/ml Solution 20 $5 Anucort-HC 25mg Suppositories 12 $5

Alendronate 35mg Tablet 4 $15 Apri 0.15-30 28 day Tablet 28 $25

Alendronate 70mg Tablet 4 $15 Aranelle 28 day Tablet 28 $25

Allopurinol 100mg Tablet 90 $10 Atenolol 100mg Tablet 90 $10

Allopurinol 300mg Tablet 90 $10 Atenolol 25mg Tablet 90 $10

Amiloride-HCTZ 5mg-50mg Tablet 90 $10 Atenolol 50mg Tablet 90 $10

Amitriptyline 100mg Tablet 90 $10 Atenolol-Chlorthalidone 100mg-25mg Tablet

90 $10

Amitriptyline 10mg Tablet 90 $10 Atenolol-Chlorthalidone 50mg-25mg Tablet

90 $10

Amitriptyline 150mg Tablet 180 $15 Atropine 1% Ophthalmic Solution 5 $5

Amitriptyline 25mg Tablet 90 $10 Aviane 28 day Tablet 28 $25

Amitriptyline 50mg Tablet 90 $10 Bacitracin Ophthalmic Ointment 4 $5

Amitriptyline 75mg Tablet 90 $10 Baclofen 10mg Tablet 270 $15

Amlodipine 10mg Tablet 90 $15 Baclofen 20mg Tablet 180 $15

Amlodipine 2.5mg Tablet 90 $15 Belladonna Alkaloid/Phenobarbital Tablet

180 $10

Amlodipine 5mg Tablet 90 $15 Benazepril 10mg Tablet 90 $10

Ammonium Lactate 12% Cream 144 $5 Benazepril 20mg Tablet 90 $10

Amoxicillin 125mg Chewable Tablet 20 $5 Benazepril 40mg Tablet 90 $10

Amoxicillin 125mg/5ml Suspension (100ml)

100 $5 Benazepril 5mg Tablet 90 $10


80 $5 Benazepril/HCTZ 10mg/12.5mg Tablet 90 $15

Amoxicillin 200mg Chewable Tablet 20 $5 Benazepril/HCTZ 20mg/12.5mg Tablet 90 $15


100 $5 Benazepril/HCTZ 20mg/25mg Tablet 90 $15


50 $5 Benazepril/HCTZ 5mg/6.25mg Tablet 90 $15


75 $5 Benzonatate 100mg Capsule 21 $5

Amoxicillin 250mg Capsule 30 $5 Benzonatate 200mg Capsule 14 $5

Amoxicillin 250mg Chewable Tablet 30 $5 Benzoyl Peroxide 10% Gel 60 $25

Amoxicillin 250mg Tablet 30 $5 Benzoyl Peroxide 10% Gel 90 $25


150 $5 Benztropine 0.5mg Tablet 180 $10

Version: 4/27/09



Benztropine 1mg Tablet 180 $10 Cetirizine 10mg Tablet 90 $15

Benztropine 2mg Tablet 90 $10 Chlorhexidine Gluconate 0.12% Solution

473 $5

Betamethasone Dip. 0.05% Cream (15gm)

15 $5 Chlorpropamide 100mg Tablet 90 $15

Betamethasone Dip. 0.05% Cream (45gm)

45 $5 Chlorthalidone 25mg Tablet 90 $10

Betamethasone Dip. 0.05% Lotion (60ml)

60 $5 Chlorthalidone 50mg Tablet 90 $10

Betamethasone Dip. 0.05% Ointment (15gm)

15 $5 Chlorzoxazone 500mg Tablet 90 $15

Betamethasone Dip. 0.05% Ointment (45gm)

45 $5 Cimetidine 200mg Tablet 180 $15

Betamethasone Valerate 0.1% Cream (15gm)


Betamethasone Valerate 0.1% Cream (45gm)


Betamethasone Valerate 0.1% Lotion (60ml)


Betamethasone Valerate 0.1% Ointment (15gm)

15 $5 Ciprofloxacin 250mg Tablet 20 $5

Betamethasone Valerate 0.1% Ointment (45gm)

45 $5 Ciprofloxacin 500mg Tablet 20 $5

Bisoprolol-HCTZ 10mg Tablet 90 $10 Ciprofloxacin 750mg Tablet 20 $5

Bisoprolol-HCTZ 2.5mg Tablet 90 $10 Citalopram 10mg Tablet 90 $10

Bisoprolol-HCTZ 5mg Tablet 90 $10 Citalopram 20mg Tablet 90 $10

Bumetanide 0.5mg Tablet 90 $10 Citalopram 40mg Tablet 90 $10

Bumetanide 1mg Tablet 90 $10 Clindamycin 1% Solution 30 $5

Bumetanide 2mg Tablet 90 $15 Clindamycin 150mg Capsule 28 $5

Buspirone 10mg Tablet 180 $10 Clobetasol 0.05% Cream 15 $5

Buspirone 15mg Tablet 90 $15 Clobetasol 0.05% Ointment 15 $5

Buspirone 5mg Tablet 180 $10 Clomiphene 50mg tablet 10 $25

Calcitriol 0.25mcg Capsule 30 $25 Clomipramine 25mg Capsule 90 $15

Calcium + Vitamin D 600mg/200mg Tab 60 $5 Clomipramine 50mg Capsule 90 $15

Calcium Carbonate 1250mg Tablet 60 $5 Clonidine 0.1mg Tablet 90 $10

Camila 0.35mg 28 day Tablet 28 $25 Clonidine 0.2mg Tablet 90 $10

Captopril 100mg Tablet 180 $10 Clonidine 0.3mg Tablet 90 $10

Captopril 12.5mg Tablet 180 $10 Clotrimazole and Betamethasone Cream

45 $5

Captopril 25mg Tablet 180 $10 Colchicine 0.6mg Tablet 90 $10

Captopril 50mg Tablet 180 $10 C-Phen DM Syrup 180 $5

Captopril/HCTZ 25-15mg Tablet 180 $15 Cryselle 28 day Tablet 28 $25

Captopril/HCTZ 25-25mg Tablet 180 $15 Cyclobenzaprine 10mg Tablet 90 $10

Carbamazepine 100mg Tablet 180 $10 Cyclobenzaprine 5mg Tablet 90 $10

Carbamazepine 200mg Tablet 180 $10 Cyproheptadine 4mg Tablet 30 $5

Carvedilol 12.5mg Tablet 180 $10 Cytra-2 Solution 540 $10

Carvedilol 25mg Tablet 180 $10 De-chlor DM Syrup 180 $5

Carvedilol 3.125mg Tablet 180 $10 Desonide 0.05% Cream 15 $5

Carvedilol 6.25mg Tablet 180 $10 Dex PC Syrup 180 $5

Cephalexin 250mg Capsule 40 $5 Dexamethasone 0.5mg Tablet 90 $5

Cephalexin 500mg Capsule 28 $5 Dexamethasone 0.75mg Tablet 36 $5

Ceron-DM Syrup 180 $5 Dexamethasone 4mg Tablet 18 $5

Version: 4/27/09



Dicyclomine 10mg Capsule 270 $10 Estropipate 0.75mg Tablet 90 $10

Dicyclomine 20mg Tablet 180 $10 Estropipate 1.5mg Tablet 90 $10

Digoxin 0.125mg Tablet 90 $10 Famotidine 20mg Tablet 180 $10

Digoxin 0.25mg Tablet 90 $10 Famotidine 40mg Tablet 90 $10

Diltiazem 120mg Tablet 90 $10 Ferrous Sulfate 325mg Tablet 180 $15

Diltiazem 30mg Tablet 180 $10 Fluconazole 150mg Tablet 1 $5

Diltiazem 60mg Tablet 180 $10 Fluocinolone 0.01% Solution 60 $5

Diltiazem 90mg Tablet 180 $10 Fluocinolone 0.01% Cream (15gm) 15 $5

Diphenhydramine 25mg Capsule 28 $5 Fluocinolone 0.01% Cream (60gm) 60 $5

Diphenhydramine 50mg Capsule 28 $5 Fluocinonide 0.05% Cream (15gm) 15 $5

Doxazosin 1mg Tablet 90 $10 Fluocinonide 0.05% Cream (30gm) 30 $5

Doxazosin 2mg Tablet 90 $10 Fluocinonide 0.05% Ointment (15gm) 15 $5

Doxazosin 4mg Tablet 90 $10 Fluocinonide 0.05% Ointment (30gm) 30 $5

Doxazosin 8mg Tablet 90 $10 Fluoxetine 10mg Capsule 90 $10

Doxepin 100mg Capsule 90 $10 Fluoxetine 10mg Tablet 90 $10

Doxepin 10mg Capsule 90 $10 Fluoxetine 20mg Capsule 180 $10

Doxepin 25mg Capsule 90 $10 Fluphenazine 1mg Tablet 90 $10

Doxepin 50mg Capsule 90 $10 Fluphenazine 5mg Tablet 90 $15

Doxepin 75mg Capsule 90 $10 Flurbiprofen 100mg Tablet 180 $15

Doxycycline Hyclate 100mg Capsule 20 $5 Folic Acid 1mg Tablet 90 $10

Doxycycline Hyclate 100mg Tablet 20 $5 Folic acid/ Vit B12/ Vit B6 Tablet 30 $25

Doxycycline Hyclate 50mg Capsule 20 $5 Fortical Nasal Spray 4 $25

Enalapril 10mg Tablet 180 $10 Furosemide 20mg Tablet 90 $10

Enalapril 2.5mg Tablet 180 $10 Furosemide 40mg Tablet 90 $10

Enalapril 20mg Tablet 180 $10 Furosemide 80mg Tablet 90 $10

Enalapril 5mg Tablet 180 $10 Gani-Tuss-DM 100mg-10mg/5ml Syrup 180 $5

Enalapril-HCTZ 10mg-25mg Tablet 90 $10 Gentamicin 0.1% Cream (15gm) 15 $5

Enalapril-HCTZ 5mg-12.5mg Tablet 90 $10 Gentamicin 0.1% Cream (30gm) 30 $5

Enpresse 28 day Tablet 28 $25 Gentamicin 0.1% Ointment (15gm) 15 $5

Errin 0.35mg 28 day Tablet 28 $25 Gentamicin 0.1% Ointment (30gm) 30 $5

Erythrocin Stearate 250mg Tablet 40 $5 Gentamicin 3mg/ml Ophthalmic Solution 5 $5

Erythrocin Stearate 500mg Tablet 28 $5 Glimepiride 1mg Tablet 90 $10

Erythromycin 2% Gel 60 $25 Glimepiride 2mg Tablet 90 $10

Erythromycin 2% Solution 60 $25 Glimepiride 4mg Tablet 90 $10

Erythromycin Benzoyl Peroxide Gel 23 $25 Glipizide 10mg Tablet 180 $10

Erythromycin Ethylsuccinate 400mg Tablet

28 $5 Glipizide 5mg Tablet 90 $10

Erythromycin Ophthalmic Ointment 4 $5 Glyburide 1.25mg Tablet 180 $10

Estradiol 0.025mg Patch 4 $25 Glyburide 2.5mg Tablet 180 $10

Estradiol 0.0375mg Patch 4 $25 Glyburide 5mg Tablet 180 $10

Estradiol 0.05mg Patch 4 $25 Glyburide Micronized 3mg Tablet 90 $10

Estradiol 0.06mg Patch 4 $25 Glyburide Micronized 6mg Tablet 90 $10

Estradiol 0.075mg Patch 4 $25 Guanfacine 1mg Tablet 90 $10

Estradiol 0.1mg Patch 4 $25 Guanfacine 2mg Tablet 90 $10

Estradiol 0.5mg Tablet 90 $10 Haloperidol 0.5mg Tablet 90 $10

Estradiol 1mg Tablet 90 $10 Haloperidol 1mg Tablet 90 $10

Estradiol 2mg Tablet 90 $10 Haloperidol 2mg Tablet 90 $10

Version: 4/27/09



Haloperidol 5mg Tablet 90 $10 Klor-con 10meq Tablet 90 $10

Hydralazine 10mg Tablet 90 $15 Klor-con 8meq Tablet 90 $10

Hydralazine 25mg Tablet 90 $15 Klor-con M 10meq Tablet 90 $10

Hydrochlorothiazide 12.5mg Capsule 90 $10 Lactulose 10g/15ml Syrup 711 $10

Hydrochlorothiazide 25mg Tablet 90 $10 Leflunomide 10mg Tablet 30 $25

Hydrochlorothiazide 50mg Tablet 90 $10 Leflunomide 20mg Tablet 30 $25

Hydrocortisone 2.5% Cream 30 $5 Lessina 0.1/0.02mg 28 day Tablet 28 $25

Hydrocortisone 2.5% Ointment 20 $5 Levobunolol 0.5% Ophthalmic Solution 15 $10

Hydroquinone 4% Sunscreen Cream 28 $25 Levothyroxine 100mcg Tablet 90 $15

Hydroxyzine Pamoate 25mg Capsule 180 $15 Levothyroxine 112mcg Tablet 90 $15

Hydroxyzine Pamoate 50mg Capsule 180 $15 Levothyroxine 125mcg Tablet 90 $15

Ibuprofen 100mg/5ml Suspension 240 $5 Levothyroxine 137mcg Tablet 90 $15

Ibuprofen 400mg Tablet 360 $10 Levothyroxine 150mcg Tablet 90 $15



Inatal Advance Tablet 90 $15 Levothyroxine 25mcg Tablet 90 $15

Inatal Ultra Tablet 90 $15 Levothyroxine 50mcg Tablet 90 $15

Indapamide 1.25mg Tablet 90 $10 Levothyroxine 75mcg Tablet 90 $15

Indapamide 2.5mg Tablet 90 $10 Levothyroxine 88mcg Tablet 90 $15

Indomethacin 25mg Capsule 180 $15 Lidocaine 2% Viscous Solution 100 $5

Ipratropium 0.02% Solution Nebules 225 $10 Lisinopril 10mg Tablet 90 $10

Isoniazid 300mg Tablet 90 $10 Lisinopril 2.5mg Tablet 90 $10

Isosorbide Dinitrate 10mg Tablet 270 $15 Lisinopril 20mg Tablet 90 $10




Isosorbide Mononitrate ER 120mg Tablet

90 $10 Lisinopril-HCTZ 10-12.5mg Tablet 90 $10

Isosorbide Mononitrate ER 30mg Tablet 90 $10 Lisinopril-HCTZ 20-12.5mg Tablet 90 $10

Isosorbide Mononitrate ER 60mg Tablet 90 $10 Lisinopril-HCTZ 20mg-25mg Tablet 90 $10

Jantoven 10mg Tablet 90 $10 Lithium Carbonate 300mg Capsule 270 $15

Jantoven 1mg Tablet 90 $10 Loperamide 2mg Capsule 270 $15

Jantoven 2.5mg Tablet 90 $10 Loratadine 10mg Tablet 90 $15

Jantoven 2mg Tablet 90 $10 Mag 64 Tablet 180 $10

Jantoven 3mg Tablet 90 $10 Mag Oxide 400mg Tablet 90 $10

Jantoven 4mg Tablet 90 $10 Medroxyprogesteron Acetate 150mg Inj 1 $25

Jantoven 5mg Tablet 90 $10 Medroxyprogesterone 10mg Tablet 90 $10

Jantoven 6mg Tablet 90 $10 Medroxyprogesterone 2.5mg Tablet 90 $10

Jantoven 7.5mg Tablet 90 $10 Medroxyprogesterone 5mg Tablet 90 $10

Junel 1.5/30 21 day Tablet 21 $25 Megestrol Acetate 20mg Tablet 90 $15

Junel 1/20 21 day Tablet 21 $25 Meloxicam 15mg Tablet 90 $10

Junel FE 1.5-30 28 day Tablet 28 $25 Meloxicam 7.5mg Tablet 90 $10

Junel FE 1/20 28 day Tablet 28 $25 Metformin 1000mg Tablet 180 $10

Kelnor 1/35 28 day Tablet 28 $25 Metformin 500mg ER Tablet 180 $10

Ketorolac 10mg Tablet 20 $5 Metformin 500mg Tablet 180 $10

Version: 4/27/09



Metformin 750mg ER Tablet 90 $10 Nitroglycerin 0.4mg Sublingual Tablet 100 $15

Metformin 850mg Tablet 180 $10 Nitroglycerin 0.6mg Sublingual Tablet 100 $15

Methocarbamol 500mg Tablet 180 $15 Nortrel 0.5/35 28 day Tablet 28 $25

Methocarbamol 750mg Tablet 180 $15 Nortrel 1/35 Tablet 28 $25

Methyldopa 250mg Tablet 180 $15 Nortrel 7/7/7 28 day Tablet 28 $25

Methyldopa 500mg Tablet 90 $15 Nortriptyline 10mg Capsule 180 $15

Methylprednisolone 4mg Pak 21 $5 Nortriptyline 25mg Capsule 180 $15

Methylprednisolone 4mg Tablet 21 $5 Nortriptyline 50mg Capsule 180 $15

Methyltestosterone Estrogen DS Tablet 30 $25 Nortriptyline 75mg Capsule 180 $15

Methyltestosterone Estrogen HS Tablet 30 $25 Nutrispire Tab 90 $15

Metoclopramide 10mg Tablet 270 $15 Nystatin 100000U Suspension 60 $5

Metoclopramide 5mg Tablet 360 $15 Nystatin 100MU/gm Cream (15gm) 15 $5

Metoclopramide 5mg/5ml Syrup 180 $10 Nystatin 100MU/gm Cream (30gm) 30 $5

Metoprolol Tartrate 100mg Tablet 180 $10 Nystatin 100MU/gm Ointment (15gm) 15 $5

Metoprolol Tartrate 25mg Tablet 180 $10 Nystatin 100MU/gm Ointment (30gm) 30 $5

Metoprolol Tartrate 50mg Tablet 180 $10 Nystatin/Triamcinolone 100MU-0.1 Cream (15gm)

15 $5

Metronidazole 0.75% Cream 45 $25 Nystatin/Triamcinolone 100MU-0.1 Cream (30gm)

30 $5

Metronidazole 0.75% Gel 45 $25 Nystatin/Triamcinolone 100MU-0.1 Cream (60gm)

60 $5

Metronidazole 0.75% Vaginal Gel 70 $25 Nystatin/Triamcinolone 100MU-0.1 Oint (15gm)

15 $5

Metronidazole 250mg Tablet 28 $5 Nystatin/Triamcinolone 100MU-0.1 Oint (30gm)

30 $5

Metronidazole 500mg Tablet 21 $5 Nystatin/Triamcinolone 100MU-0.1 Oint (60gm)

60 $5

Nadolol 20mg Tablet 90 $15 Ofloxacin 0.3% Ophthalmic Solution 5 $5

Nadolol 40mg Tablet 90 $15 Oxybutynin 5mg Tablet 180 $10

Naproxen 250mg Tablet 180 $10 Papaverine 150mg CR Capsule 180 $15

Naproxen 375mg Tablet 180 $10 Paroxetine 10mg Tablet 90 $15

Naproxen 500mg Tablet 180 $10 Paroxetine 20mg Tablet 90 $15

Naproxen Sodium 550mg Tablet 30 $5 Paroxetine 30mg Tablet 90 $15

NataCaps Capsule 90 $15 Paroxetine 40mg Tablet 90 $15

Natalcare Plus Tablet 90 $15 Penicillin VK 125mg/5ml Suspension (100ml)

100 $5

Natatab RX Tablet 90 $15 Penicillin VK 125mg/5ml Suspension (200ml)

200 $5

Necon 1/50 28 day Tablet 28 $25 Penicillin VK 250mg Tablet 28 $5

Neomycin/Poly B /Dex 0.1% Ophthalmic Oint

4 $5 Penicillin VK 250mg/5ml Suspension (100ml)

100 $5

Neomycin/Poly B /Dex 0.1% Ophthalmic Susp

5 $5 Penicillin VK 250mg/5ml Suspension (200ml)

200 $5

Nicardipine 20mg Capsule 180 $15 Penicillin VK 500mg Tablet 28 $5

Nicardipine 30mg Capsule 180 $15 Pentoxifylline 400mg Tablet 270 $15

Nitrofurantoin 100mg Capsule 42 $25 Phenazopyridine 100mg Tablet 20 $5

Nitrofurantoin Macrocrystals 50mg Cap 42 $25 Phenazopyridine 200mg Tablet 20 $5

Nitroglycerin 0.3mg Sublingual Tablet 100 $15 Pilocarpine 1% Ophthalmic Solution 45 $10

Version: 4/27/09



Pilocarpine 2% Ophthalmic Solution 45 $10 Salsalate 750mg Tablet 180 $15

Pindolol 10mg Tablet 90 $10 Sertraline 100mg Tablet 90 $15

Pindolol 5mg Tablet 90 $10 Sertraline 25mg Tablet 90 $15

Piroxicam 10mg Capsule 180 $10 Sertraline 50mg Tablet 90 $15

Piroxicam 20mg Capsule 90 $10 Silver Sulfadiazine 1% Cream (50gm) 50 $5

Portia 28 day Tablet 28 $25 Simvastatin 10mg Tablet 90 $15

Potassium Chloride 10% Liquid 1419 $10 Simvastatin 20mg Tablet 90 $15

Pravastatin 10mg Tablet 90 $15 Simvastatin 40mg Tablet 90 $15



Prazosin 1mg Capsule 90 $15 Sodium Fluoride 1.1% Gel (Freshmint) 56 $5

Prazosin 2mg Capsule 90 $15 Sodium Fluoride 5000 Plus 1.1% Gel (Spearmint)

51 $5

Prednisolone 15mg/5ml Syrup 120 $5 Sotalol 80mg Tablet 90 $10

Prednisolone 6.7mg/5ml Syrup 120 $5 Sotalol AF 80mg Tablet 90 $15

Prednisone 10mg Pak 63 $15 Spironolactone 25mg Tablet 90 $10

Prednisone 10mg Tablet 90 $10 Sprintec 28 day Tablet 28 $10

Prednisone 2.5mg Tablet 90 $10 Sulfacetamide Sodium 10% Ophthalmic Sol.

15 $5

Prednisone 20mg Tablet 90 $10 Sulfasalazine 500mg Tablet 180 $15

Prednisone 5mg Pak 144 $15 Tamoxifen 10mg Tablet 180 $25

Prednisone 5mg Tablet 90 $10 Tamoxifen 20mg Tablet 90 $25

PrenaTabs FA Tablet 90 $15 Terazosin 10mg Capsule 90 $10

PrenaTabs RX Tablet 90 $15 Terazosin 1mg Capsule 90 $10

Prenatal AD Tablet 90 $15 Terazosin 2mg Capsule 90 $10

Prenatal Plus 27-1mg Tablet 90 $15 Terazosin 5mg Capsule 90 $10

Prochloroperazine 5mg Tablet 40 $5 Terbinafine 250mg Tablet 90 $15

Prochlorperazine10mg Tablet 90 $10 Terconazole 0.8% Vaginal Cream 20 $25

Promethazine 25mg Tablet 36 $10 Tetracycline 250mg Capsule 60 $5

Promethazine DM Syrup 180 $5 Tetracycline 500mg Capsule 60 $5

Promethazine Plain Syrup 180 $5 Therobec Plus Tablet 90 $15

Propranolol 10mg Tablet 180 $10 Therobec Tablet 90 $15

Propranolol 20mg Tablet 180 $10 Thioridazine 25mg Tablet 90 $10

Propranolol 40mg Tablet 180 $10 Thioridazine 50mg Tablet 90 $10

Propranolol 80mg Tablet 180 $10 Thiothixene 2mg Capsule 90 $15

Propranolol/HCTZ 40mg/25mg Tablet 90 $15 Timolol Maleate 0.25% Ophthalmic Solution

15 $10

Propranolol/HCTZ 80mg/25mg Tablet 90 $15 Timolol Maleate 0.5% Ophthalmic Solution

15 $10

PSE Brom DM Syrup 150 $5 Tizanidine 2mg Tablet 180 $15

Quinapril 10mg Tablet 90 $15 Tizanidine 4mg Tablet 180 $15

Quinapril 20mg Tablet 90 $15 Tobramycin 0.3% Ophthalmic Solution 5 $5

Quinapril 40mg Tablet 90 $15 Trazodone 100mg Tablet 90 $10

Quinapril 5mg Tablet 90 $15 Trazodone 150mg Tablet 90 $10

Ranitidine 150mg Tablet 180 $10 Trazodone 50mg Tablet 90 $10

Ranitidine 300mg Tablet 90 $10 Triam/HCTZ 37.5mg/25mg Capsule 90 $10

Rena-vite RX Tablet 90 $15 Triam/HCTZ 37.5mg/25mg Tablet 90 $10

Rena-vite Tablet 90 $15 Triam/HCTZ 75mg/50mg Tablet 90 $10

Salsalate 500mg Tablet 180 $10 Triamcinolone Acetonide 0.025% Cream (15gm)

15 $5

Version: 4/27/09



Triamcinolone Acetonide 0.025% Cream (80gm)

80 $5 Velivet 28 day Tablet 28 $25

Triamcinolone Acetonide 0.025% Ointment (80gm)

80 $5 Verapamil 120mg Tablet 90 $10


15 $5 Verapamil 80mg Tablet 90 $10


80 $5 Vica-Forte Capsule 90 $10


15 $5 Vinate GT Tablet 90 $15


80 $5 Vinate M Tablet 90 $15


15 $5 Vinate Ultra Tablet 90 $15


15 $5 Vitamin D 50000IU Capsule 14 $25

Trihexyphenidyl 2mg Tablet 180 $10 Warfarin 10mg Tablet 90 $10

Trimethoprim and Poly B Ophthalmic Solution

10 $5 Warfarin 1mg Tablet 90 $10

Trimethoprim and SMZ 200mg-40mg/5ml Susp

240 $5 Warfarin 2.5mg Tablet 90 $10

Trimethoprim and SMZ 400mg-80mg Tablet


Trimethoprim and SMZ DS 800mg-160mg Tablet


Trinate Tablet 90 $15 Warfarin 4mg Tablet 90 $10

Tri-sprintec 28 day Tablet 28 $10 Warfarin 5mg Tablet 90 $10

Ultra Natalcare Tablet 90 $15 Warfarin 6mg Tablet 90 $10

Vandazole 0.75% Vaginal Gel 70 $25 Warfarin 7.5mg Tablet 90 $10

Low-Cost Prescription Plans - Manatee Health Resource · Low-Cost Prescription Plans: Target...

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Transcript of Low-Cost Prescription Plans - Manatee Health Resource · Low-Cost Prescription Plans: Target...