Alphabetical Formulary List

Acetaminophen 120mg, 325mg, and 650mg Suppositories 12 $5.00 Antipyrine and Benzocaine Otic Solution 10 $5.00 Acetic Acid/Aluminum Acetate 2% Solution 60 $5.00 Anucort-HC 25mg Suppositories 12 $5.00 Acyclovir 200mg Capsule and 400mg Tablet 180 $15.00 Apri 0.15-30 28 day Tablet 28 $25.00 Acyclovir 800mg Tablet 90 $15.00 Aranelle 28 day Tablet 28 $25.00 Advanced Natalcare Tablet 90 $15.00 Atenolol 25mg, 50mg, and 100mg Advanced-RF Natalcare Tablet 90 $15.00 Atenolol-Chlorthalidone 50mg/25mg and 100mg/25mg Albuterol 0.083% Solution Nebules 225 $10.00 Atropine 1% Ophthalmic Solution 5 $5.00 Albuterol 2mg Tablet 90 $5.00 Aviane 28 day Tablet 28 $25.00 Albuterol 2mg/5ml Syrup 360 $5.00 Bacitracin Ophthalmic Ointment 4 $5.00 Albuterol 4mg Tablet 60 $5.00 Baclofen 10mg Tablet 270 $15.00 Albuterol 5mg/ml Solution 20 $5.00 Baclofen 20mg Tablet 180 $15.00 Alendronate 35mg and 70mg Tablet 4 $15.00 Belladonna Alkaloid/Phenobarbital Allopurinol 100mg and 300mg Benazepril 5mg, 10mg, 20mg, and 40mg Amiloride-HCTZ 5mg-50mg Benazepril/HCTZ 5mg/6.25mg, 10mg/12.5mg, 20mg/12.5mg, and 20mg/25mg Tablet 90 $15.00 Amitriptyline 10mg, 25mg, 50mg, 75mg and 100mg Benzonatate 100mg Capsule 21 $5.00 Amitriptyline 150mg Tablet 180 $15.00 Benzonatate 200mg Capsule 14 $5.00 Amlodipine 2.5mg, 5mg, and 10mg Tablet 90 $15.00 Benzoyl Peroxide 10% Gel 90 $25.00 Ammonium Lactate 12% Cream 144 $5.00 Benztropine 0.5mg and 1mg Amoxicillin (Amoxil) 125mg/5ml Suspension 150 $5.00 Benztropine 2mg Amoxicillin (Amoxil) 250mg/5ml Suspension 150 $5.00 Betamethasone Dip. 0.05% Cream 45 $5.00 Amoxicillin 125mg Chewable Tablet 20 $5.00 Betamethasone Dip. 0.05% Lotion 60 $5.00 Amoxicillin 200mg Chewable Tablet 20 $5.00 Betamethasone Dip. 0.05% Ointment 45 $5.00 Amoxicillin 200mg/5ml Suspension 100 $5.00 Betamethasone Valerate 0.1% Cream 45 $5.00 Amoxicillin 250mg Capsule and Chewable Tablets 30 $5.00 Betamethasone Valerate 0.1% Lotion 60 $5.00 Amoxicillin 400mg/5ml Suspension 100 $5.00 Betamethasone Valerate 0.1% Ointment 45 $5.00 Amoxicillin 875mg Tablet 20 $5.00 Bisoprolol-HCTZ 2.5mg, 5mg, and 10mg Amoxil 500mg Capsule 30 $5.00 Bumetanide 0.5mg and 1mg Amoxil 50mg/ml Suspension 60 $5.00 Bumetanide 2mg Tablet 90 $15.00 Ampicillin 250mg and 500mg Capsule 28 $5.00 Buspirone 15mg Tablet 90 $15.00

Clotrimazole and Betamethasone Buspirone 5mg and 10mg Cream 45 $5.00 Calcitriol 0.25mcg Capsule 30 $25.00 Colchicine 0.6mg Calcium + Vitamin D 600mg/200mg Tablet 60 $5.00 Cryselle 28 day Tablet 28 $25.00 Calcium Carbonate 1250mg Tablet 60 $5.00 Cyclobenzaprine 5mg and 10mg Camila 0.35mg 28 day Tablet 28 $25.00 Cyproheptadine 4mg Tablet 30 $5.00 Captopril 12.5mg, 25mg, 50mg, and 100mg Cytra-2 solution 540 $10.00 Captopril/HCTZ 25/15mg and 25/25mg Tablet 180 $15.00 De-chlor DM Syrup 180 $5.00 Carbamazepine 100mg and 200mg Desonide 0.05% Cream 15 $5.00 Carvedilol 3.125mg, 6.25mg, 12.5mg, and 25mg Dex PC Syrup 180 $5.00 Cephalexin 250mg Capsule 40 $5.00 Dexamethasone 0.5mg Tablet 90 $5.00 Cephalexin 500mg Capsule 28 $5.00 Dexamethasone 0.75mg Tablet 36 $5.00 Ceron-DM Syrup 180 $5.00 Dexamethasone 4mg Tablet 18 $5.00 Cetirizine 10mg Tablet 90 $15.00 Dicyclomine 10mg Capsule 270 $10.00 Chlorhexidine Gluconate 0.12% Solution 473 $5.00 Dicyclomine 20mg Chlorpropamide 100mg and 250mg Tablet 90 $15.00 Digoxin 0.125mg and 0.25mg Chlorthalidone 25mg and 50mg Diltiazem 120mg Chlorzoxazone 500mg Tablet 90 $15.00 Diltiazem 30mg, 60mg, and 90mg Cimetidine 200mg and 400mg Tablet 180 $15.00 Diphenhydramine 25mg and 50mg Capsule 28 $5.00 Cimetidine 300mg Tablet 360 $15.00 Doxazosin 1mg, 2mg, 4mg, and 8mg Cimetidine 800mg Tablet 90 $15.00 Doxepin 10mg, 25mg, 50mg, 75mg, and 100mg Capsule 90 $10.00 Ciprofloxacin 250mg, 500mg, and 750mg Tablet 20 $5.00 Doxycycline Hyclate 100mg Tablet and Capsule 20 $5.00 Citalopram 10mg, 20mg, and 40mg Doxycycline Hyclate 50mg Capsule 20 $5.00 Clindamycin 1% Solution 30 $5.00 Enalapril 2.5mg, 5mg, 10mg, and 20mg Clindamycin 150mg Capsule 28 $5.00 Enalapril-HCTZ 5/12.5mg and 10/25mg Clobetasol 0.05% Cream 15 $5.00 Enpresse 28 day Tablet 28 $25.00 Clobetasol 0.05% Ointment 15 $5.00 Errin 0.35mg 28 day Tablet 28 $25.00 Clomiphene 50mg tablet 10 $25.00 Erythrocin Stearate 250mg Tablet 40 $5.00 Clomipramine 25mg and 50mg Capsule 90 $15.00 Erythrocin Stearate 500mg Tablet 28 $5.00 Clonidine 0.1mg, 0.2mg, and 0.3mg Erythromycin 2% Gel 60 $25.00

Erythromycin 2% Solution 60 $25.00 Glimepiride 1mg, 2mg, and 4mg Erythromycin Benzoyl Peroxide Gel 23 $25.00 Glipizide 10mg Erythromycin Ethylsuccinate 200mg/5ml Susp 180 $5.00 Glipizide 5mg Erythromycin Ethylsuccinate 400mg Tablet 28 $5.00 Glyburide 1.25mg, 2.5mg, and 5mg Glyburide Micronized 3mg and 6mg Erythromycin Ophthalmic Ointment 4 $5.00 Estradiol 0.025, 0.0375, 0.05, 0.06, 0.075, and 0.1mg Patch 4 $25.00 Guanfacine 1mg and 2mg Estradiol 0.5mg, 1mg, and 2mg Haloperidol 0.5mg, 1mg, 2mg, and 5mg Estropipate 0.75mg and 1.5mg Hydralazine 10mg Famotidine 20mg Hydralazine 25mg Tablet 90 $15.00 Famotidine 40mg Hydrochlorothiazide 12.5mg Capsule, 12.5mg, 25mg, and 50mg Ferrous Sulfate 325mg Tablet 180 $15.00 Hydrocortisone 2.5% Cream 30 $5.00 Fluconazole 150mg Tablet 1 $5.00 Hydrocortisone 2.5% Ointment 20 $5.00 Fluocinolone 0.01% Solution 60 $5.00 Hydroquinone 4% Sunscreen Cream 28 $25.00 Hydroxyzine Pamoate 25mg and 50mg Fluocinolone 0.01% Cream 60 $5.00 Capsule 180 $15.00 Fluocinonide 0.05% Cream 30 $5.00 Ibuprofen 100mg/5ml Suspension 240 $5.00 Fluocinonide 0.05% Ointment 30 $5.00 Ibuprofen 400mg and 600mg Tablet 360 $10.00 Fluoxetine 10mg Capsule and Ibuprofen 800mg Tablet 270 $10.00 Fluoxetine 20mg Capsule 180 $10.00 Indapamide 1.25mg and 2.5mg Fluphenazine 1mg Indomethacin 25mg Capsule 180 $15.00 Fluphenazine 5mg Tablet 270 $15.00 Ipratropium 0.02% Solution Nebules 225 $10.00 Flurbiprofen 100mg Tablet 180 $15.00 Isoniazid 300mg Folic Acid 1mg Isosorbide Dinitrate 30mg Tablet 180 $15.00 Folic acid/ Vit B12/ Vit B6 Tablet 30 $25.00 Isosorbide Dinitrate 5mg, 10mg and 20mg Tablet 270 $15.00 Fortical Nasal Spray 4 $25.00 Isosorbide Mononitrate ER 30mg, 60mg, and 120mg Furosemide 20mg, 40mg, and 80mg Jantoven 1mg, 2mg, 2.5mg, 3mg, 4mg, 5mg, 6mg, 7.5mg, and 10mg Gani-Tuss-DM 100mg-10mg/5ml Syrup 180 $5.00 Junel 1.5/30 21 day Tablet 21 $25.00 Gentamicin 0.1% Cream 30 $5.00 Junel 1/20 21 day Tablet 21 $25.00 Gentamicin 0.1% Ointment 30 $5.00 Junel FE 1.5-30 28 day Tablet 28 $25.00 Gentamicin 3mg/ml Ophthalmic Solution 5 $5.00 Junel FE 1/20 28 day Tablet 28 $25.00

Kelnor 1/35 28 day Tablet 28 $25.00 Methylprednisolone 4mg Tablet 21 $5.00 Ketorolac 10mg Tablet 20 $5.00 Methyltestosterone Estrogen DS Tablet 30 $25.00 Klor-con 8meq and 10meq Methyltestosterone Estrogen HS Tablet 30 $25.00 Klor-con M 10meq Metoclopramide 10mg Tablet 270 $15.00 Lactulose 10g/15ml syrup 711 $10.00 Metoclopramide 5mg Tablet 360 $15.00 Leflunomide 10mg and 20mg Tablet 30 $25.00 Metoclopramide 5mg/5ml syrup 180 $10.00 Metoprolol Tartrate 25mg, 50mg, and Lessina 0.1/0.02mg 28 day Tablet 28 $25.00 100mg Levobunolol 0.5% Ophthalmic Solution 15 $10.00 Metronidazole 0.75% Cream 45 $25.00 Levothroid 50mcg, 75mcg, 100mcg, 112mcg, 125mcg, and 150mcg Tablet 90 $15.00 Metronidazole 0.75% Gel 45 $25.00 Levothyroxine 25, 50, 75, 88, 100, 112, 125, 137, 150, 175, and 200mcg Tablet 90 $15.00 Metronidazole 0.75% Vaginal Gel 70 $25.00 Lidocaine 2% Viscous Solution 100 $5.00 Metronidazole 250mg Tablet 28 $5.00 Lisinopril 2.5mg, 5mg, 10mg 20mg, 30mg, and 40mg Metronidazole 500mg Tablet 21 $5.00 Lisinopril-HCTZ 10/12.5mg, 20/12.5mg, and 20/25mg Nadolol 20mg and 40mg Tablet 90 $15.00 Lithium Carbonate 300mg Capsule 270 $15.00 Naproxen 250mg, 375mg, and 500mg Loperamide 2mg Capsule 270 $15.00 Naproxen Sodium 550mg Tablet 30 $5.00 Loratadine 10mg Tablet 90 $15.00 NataCaps Capsule 90 $15.00 Mag 64 Natalcare GlossTabs 90 $15.00 Mag Oxide 400mg Natalcare PIC Forte Tablet 90 $15.00 Medroxyprogesteron Acetate 150mg Inj. 1 $25.00 Natalcare PIC Tablet 90 $15.00 Medroxyprogesterone 2.5mg, 5mg, and 10mg Natalcare Plus Tablet 90 $15.00 Megestrol Acetate 20mg Tablet 90 $15.00 Natalcare RX Tablet 90 $15.00 Meloxicam 7.5mg and 15mg Natalcare Three Tablet 90 $15.00 Metformin 500mg ER Natatab CFE Tablet 90 $15.00 Metformin 500mg, 850mg, and 1000mg Natatab FA Tablet 90 $15.00 Metformin 750mg ER Natatab RX Tablet 90 $15.00 Methocarbamol 500mg and 750mg Tablet 180 $15.00 Necon 1/50 28 day Tablet 28 $25.00 Methyldopa 250mg Tablet 180 $15.00 Neomycin/Poly B /Dex 0.1% Ophthalmic Ointment 4 $5.00 Methyldopa 500mg Tablet 90 $15.00 Neomycin/Poly B /Dex 0.1% Ophthalmic Susp 5 $5.00 Methylprednisolone 4mg Pak 21 $5.00 Nicardipine 20mg and 30mg Capsule 180 $15.00

Nitrofurantoin 100mg Capsule 42 $25.00 Potassium Chloride 10% Liquid 1419 $10.00 Nitrofurantoin Macrocrystals 50mg Capsule 42 $25.00 Pravastatin 10mg, 20mg, and 40mg Tablet 90 $15.00 Nitroglycerin 0.3mg, 0.4mg, and 0.6mg Sublingual Tablet 200 $10.00 Prazosin 1mg and 2mg Capsule 90 $15.00 Nortrel 0.5/35 28 day Tablet 28 $25.00 Prednisolone 6.7mg/5ml and 15mg/5ml Syrup 120 $5.00 Nortrel 1/35 Tablet 28 $25.00 Prednisone 10mg Pak 63 $15.00 Nortrel 7/7/7 28 day Tablet 28 $25.00 Prednisone 2.5mg, 5mg, 10mg, and 20mg Nortriptyline 10mg, 25mg, 50mg, and 75mg Capsule 180 $15.00 Prednisone 5mg Pak 144 $15.00 Nutrispire Tab 90 $15.00 PrenaTabs RX Tablet 90 $15.00 Nystatin 100000U Suspension 60 $5.00 Prenatal MR 90 Fe Tablet 90 $15.00 Nystatin 100MU/gm Cream 30 $5.00 Prenatal MTR w/ Selenium Tablet 90 $15.00 Nystatin 100MU/gm Ointment 30 $5.00 Prenatal Rx 1 Tablet 90 $15.00 Nystatin/Triamcinolone 100MU-0.1 Cream 60 $5.00 Prenatal RX Tablet 90 $15.00 Nystatin/Triamcinolone 100MU-0.1 Oint 60 $5.00 Prenatal Z Tablet 90 $15.00 Ofloxacin 0.3% Ophthalmic Solution 5 $5.00 Prochloroperazine 5mg Tablet 40 $5.00 Oxybutynin 5mg Prochlorperazine10mg Papaverine 150mg CR Capsule 180 $15.00 Promethazine 25mg Tablet 36 $10.00 Paroxetine 10mg, 20mg, 30mg, and 40mg Tablet 90 $15.00 Promethazine DM and Plain Syrup 180 $5.00 Penicillin VK 125mg/5ml Suspension 200 $5.00 Propranolol 10mg, 20mg, 40mg, and 80mg Penicillin VK 250mg Tablet 28 $5.00 Propranolol/HCTZ 40/25mg and 80/25mg Tablet 90 $15.00 Penicillin VK 250mg/5ml Suspension 200 $5.00 PSE Brom DM Syrup 150 $5.00 Quinapril 5mg, 10mg, 20mg, and 40mg Penicillin VK 500mg Tablet 28 $5.00 Tablet 90 $15.00 Pentoxifylline 400mg Tablet 270 $15.00 Ranitidine 150mg Phenazopyridine 100mg Tablet 20 $5.00 Ranitidine 300mg Phenazopyridine 200mg Rena-vite RX Tablet 90 $15.00 Pilocarpine 1% and 2% Ophthalmic Solution 45 $10.00 Rena-vite Tablet 90 $15.00 Pindolol 5mg and 10mg Salsalate 500mg Piroxicam 10mg Capsule 180 $10.00 Salsalate 750mg Tablet 180 $15.00 Sertraline 25mg, 50mg, and 100mg Piroxicam 20mg Capsule 90 $10.00 Tablet 90 $15.00 Portia 28 day Tablet 28 $25.00 Silver Sulfadiazine 1% Cream 50 $5.00

Simvastatin 5mg, 10mg, 20mg, 40mg, Triam/HCTZ 37.5/25mg Capsule, and 80mg Tablet 90 $15.00 37.5/25mg, and 75/50mg Sodium Fluoride 1.1% Gel (Freshmint) 56 $5.00 Triamcinolone Acetonide 0.025% Cream 80 $5.00 Sodium Fluoride 5000 Plus 1.1% Gel (Spearmint) 51 $5.00 Triamcinolone Acetonide 0.025% Ointment 80 $5.00 Sotalol 80mg Triamcinolone Acetonide 0.1% Cream 80 $5.00 Triamcinolone Acetonide 0.1% Sotalol AF 80mg Tablet 90 $15.00 Ointment 80 $5.00 Spironolactone 25mg Triamcinolone Acetonide 0.5% Cream 15 $5.00 Sprintec 28 day Tablet 28 $10.00 Triamcinolone Acetonide 0.5% Ointment 15 $5.00 Sulfacetamide Sodium 10% Ophthalmic Solution 15 $5.00 Trihexyphenidyl 2mg Sulfasalazine 500mg Tablet 180 $15.00 Trimethoprim and Poly B Ophthalmic Solution 10 $5.00 Tamoxifen 10mg Tablet 180 $25.00 Trimethoprim and SMZ 200mg- 40mg/5ml Susp 240 $5.00 Tamoxifen 20mg Tablet 90 $25.00 Trimethoprim and SMZ 400mg-80mg Tablet 28 $5.00 Terazosin 1mg, 2mg, 5mg, and 10mg Capsule 90 $10.00 Trimethoprim and SMZ DS 800mg- 160mg Tablet 20 $5.00 Terbinafine 250mg Tablet 90 $15.00 Tri-sprintec 28 day Tablet 28 $10.00 Terconazole 0.8% Vaginal Cream 20 $25.00 Ultra Natalcare Tablet 90 $15.00 Tetracycline 250mg and 500mg Capsule 60 $5.00 Vandazole 0.75% Vaginal Gel 70 $25.00 Thioridazine 25mg and 50mg Velivet 28 day Tablet 28 $25.00 Thiothixene 2mg Capsule 90 $10.00 Verapamil 80mg and 120mg Timolol Maleate 0.25% and 0.5% Ophthalmic Solution 15 $10.00 Vita-con Forte Capsule 90 $15.00 Tizanidine 2mg and 4mg Tablet 180 $15.00 Vitamin D 50000IU Capsule 14 $25.00 Tobramycin 0.3% Ophthalmic Solution 5 $5.00 Vitaplex Plus Tablet 90 $15.00 Tramadol 50mg Tablet 180 $15.00 Vitaplex Tablet 90 $15.00 Trazodone 50mg, 100mg, and 150mg Warfarin 1mg, 2mg, 2.5mg, 3mg, 4mg, 5mg, 6mg, 7.5mg, and 10mg