available medications
available medications
available medications
Chronic Formulary
Maintenance Medications
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Acute Formulary
Immediate Need Medications
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The most utilized chronic and acute medications can be filled at no additional cost beyond the monthly membership fee!
* seach by brand name, generic name, or treatment condition.
Chronic Formulary
Maintenance Medications
Acute Formulary
Immediate Need Medications
The most utilized chronic and acute medications can be filled at no additional cost beyond the monthly membership fee!
* seach by brand name, generic name, or treatment condition.
to view the complete list of available medications, please turn your device horizontally, or visit this page on a tablet or computer.
Chronic Formulary
Maintenance Medications
click to view all
Acute Formulary
Immediate Need Medications
click to view all
The most utilized chronic and acute medications can be filled at no additional cost beyond the monthly membership fee!
Chronic Formulary
Maintenance Medications
The top most utilized chronic medications in our formulary can be purchased in a 90-Day supply at no additional cost!
Access your prescribed medications directly from American Producers and Suppliers cutting out the middle-man and passing the savings on to you. To get them at no additional cost, these chronic medications must be ordered from our home delivery pharmacy partner.
ADhd
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Atomoxetine 100mg Capsule | 90 | EA | ORAL | STRATTERA |
| Atomoxetine 10mg Capsule | 90 | EA | ORAL | STRATTERA |
| Atomoxetine 18mg Capsule | 90 | EA | ORAL | STRATTERA |
| Atomoxetine 25mg Capsule | 90 | EA | ORAL | STRATTERA |
| Atomoxetine 40mg Capsule | 90 | EA | ORAL | STRATTERA |
| Atomoxetine 60mg Capsule | 90 | EA | ORAL | STRATTERA |
| Atomoxetine 80mg Capsule | 90 | EA | ORAL | STRATTERA |
| Guanfacine ER 24HR 1mg Tablet | 90 | EA | ORAL | INTUNIV |
| Guanfacine ER 24HR 2mg Tablet | 90 | EA | ORAL | INTUNIV |
| Guanfacine ER 24HR 3mg Tablet | 90 | EA | ORAL | INTUNIV |
| Guanfacine ER 24HR 4mg Tablet | 90 | EA | ORAL | INTUNIV |
Allergy / Antihistamines
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Azelastine 0.1% (137mcg/spray) Nasal Spray 30ml | 90 | ML | NASAL | ASTELIN |
| Fluticasone Propionate (50mcg/spray) Nasal Spray 16gm | 48 | GM | SPRAY | FLONASE ALLERGY RELIEF |
| Ipratropium Bromide 0.06% (42mcg/Spray) Nasal Spray 15mL | 45 | ML | SPRAY | ATROVENT |
| Ketorolac 0.5% Opthalmic Solution | 15 | ML | OPHTHAL SOLUTION | ACULAR |
| Olopatadine 0.2% Ophthalmic Solution | 7.5 | ML | OPHTHAL SOLUTION | PATADAY |
Alzheimer’s / Dementia
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Donepezil 10mg Tablet | 90 | EA | ORAL | ARICEPT |
| Donepezil 23mg Tablet | 90 | EA | ORAL | ARICEPT |
| Donepezil 5mg Tablet | 90 | EA | ORAL | ARICEPT |
| Memantine 10mg Tablet | 90 | EA | ORAL | NAMENDA |
| Memantine 5mg Tablet | 180 | EA | ORAL | NAMENDA |
Anti-anxiety
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Buspirone 10mg Tablet | 270 | EA | ORAL | BUSPAR |
| Buspirone 15mg Tablet | 180 | EA | ORAL | BUSPAR |
| Buspirone 30mg Tablet | 180 | EA | ORAL | BUSPAR |
| Buspirone 5mg Tablet | 270 | EA | ORAL | BUSPAR |
| Buspirone 7.5mg Tablet | 270 | EA | ORAL | BUSPAR |
Antibiotics
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Clindamycin 300mg Capsule | 90 | EA | ORAL | CLEOCIN |
| Doxycycline Hyclate 100mg Capsule | 180 | EA | ORAL | VIBRAMYCIN |
| Doxycycline Hyclate 100mg Tablet | 180 | EA | ORAL | VIBRA-TABS |
| Doxycycline Hyclate 20mg Tablet | 180 | EA | ORAL | PERIOSTAT |
| Doxycycline Hyclate 50mg Capsule | 180 | EA | ORAL | VIBRAMYCIN |
| Doxycycline Monohydrate 100mg Capsule | 90 | EA | ORAL | MONODOX |
| Doxycycline Monohydrate 100mg Tablet | 90 | EA | ORAL | VARIOUS |
| Minocycline 50mg Capsule | 180 | EA | ORAL | MINOCIN |
Anticoagulants
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Warfarin 10mg Tablet | 126 | EA | ORAL | COUMADIN |
| Warfarin 1mg Tablet | 126 | EA | ORAL | COUMADIN |
| Warfarin 2.5mg Tablet | 126 | EA | ORAL | COUMADIN |
| Warfarin 2mg Tablet | 126 | EA | ORAL | COUMADIN |
| Warfarin 3mg Tablet | 126 | EA | ORAL | COUMADIN |
| Warfarin 4mg Tablet | 126 | EA | ORAL | COUMADIN |
| Warfarin 5mg Tablet | 126 | EA | ORAL | COUMADIN |
| Warfarin 6mg Tablet | 126 | EA | ORAL | COUMADIN |
| Warfarin 7.5mg Tablet | 126 | EA | ORAL | COUMADIN |
Anticonvulsants
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Carbamazepine 200mg Tablet | 180 | EA | ORAL | TEGRETOL |
| Divalproex Sodium DR 125mg Tablet | 270 | EA | ORAL | DEPAKOTE |
| Divalproex Sodium DR 250mg Tablet | 270 | EA | ORAL | DEPAKOTE |
| Divalproex Sodium DR 500mg Tablet | 180 | EA | ORAL | DEPAKOTE |
| Divalproex Sodium ER 24HR 250mg Tablet | 90 | EA | ORAL | DEPAKOTE ER |
| Divalproex Sodium ER 24HR 500mg Tablet | 90 | EA | ORAL | DEPAKOTE ER |
| Lamotrigine 100mg Tablet | 180 | EA | ORAL | LAMICTAL |
| Lamotrigine 150mg Tablet | 180 | EA | ORAL | LAMICTAL |
| Lamotrigine 200mg Tablet | 180 | EA | ORAL | LAMICTAL |
| Lamotrigine 25mg Tablet | 180 | EA | ORAL | LAMICTAL |
| Lamotrigine ER 24HR 100mg Tablet | 90 | EA | ORAL | LAMICTAL SR |
| Lamotrigine ER 24HR 200mg Tablet | 90 | EA | ORAL | LAMICTAL SR |
| Lamotrigine ER 24HR 250mg Tablet | 90 | EA | ORAL | LAMICTAL SR |
| Lamotrigine ER 24HR 25mg Tablet | 90 | EA | ORAL | LAMICTAL SR |
| Lamotrigine ER 24HR 300mg Tablet | 90 | EA | ORAL | LAMICTAL SR |
| Lamotrigine ER 24HR 50mg Tablet | 90 | EA | ORAL | LAMICTAL SR |
| Levetiracetam 1000mg Tablet | 180 | EA | ORAL | KEPPRA |
| Levetiracetam 250mg Tablet | 180 | EA | ORAL | KEPPRA |
| Levetiracetam 500mg Tablet | 180 | EA | ORAL | KEPPRA |
| Levetiracetam 750mg Tablet | 180 | EA | ORAL | KEPPRA |
| Levetiracetam ER 24HR 500mg Tablet | 90 | EA | ORAL | KEPPRA XR |
| Levetiracetam ER 24HR 750mg Tablet | 90 | EA | ORAL | KEPPRA XR |
| Oxcarbazepine 150mg Tablet | 180 | EA | ORAL | TRILEPTAL |
| Oxcarbazepine 300mg Tablet | 180 | EA | ORAL | TRILEPTAL |
| Phenytoin 50mg Chewable Tablet | 90 | EA | ORAL | DILANTIN |
| Phenytoin ER 100mg Capsule | 180 | EA | ORAL | DILANTIN |
| Primidone 250mg Tablet | 90 | EA | ORAL | MYSOLINE |
| Primidone 50mg Tablet | 360 | EA | ORAL | MYSOLINE |
| Topiramate 100mg Tablet | 180 | EA | ORAL | TOPAMAX |
| Topiramate 200mg Tablet | 90 | EA | ORAL | TOPAMAX |
| Topiramate 25mg Tablet | 180 | EA | ORAL | TOPAMAX |
| Topiramate 50mg Tablet | 180 | EA | ORAL | TOPAMAX |
| Zonisamide 100mg Capsule | 90 | EA | ORAL | ZONEGRAN |
| Zonisamide 25mg Capsule | 270 | EA | ORAL | ZONEGRAN |
| Zonisamide 50mg Capsule | 270 | EA | ORAL | ZONEGRAN |
Antidepressants
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Amitriptyline 100mg Tablet | 90 | EA | ORAL | ELAVIL |
| Amitriptyline 10mg Tablet | 270 | EA | ORAL | ELAVIL |
| Amitriptyline 25mg Tablet | 270 | EA | ORAL | ELAVIL |
| Amitriptyline 50mg Tablet | 180 | EA | ORAL | ELAVIL |
| Amitriptyline 75mg Tablet | 90 | EA | ORAL | ELAVIL |
| Bupropion 100mg Tablet | 90 | EA | ORAL | WELLBUTRIN |
| Bupropion 75mg Tablet | 90 | EA | ORAL | WELLBUTRIN |
| Bupropion SR 12HR 100mg Tablet | 180 | EA | ORAL | WELLBUTRIN SR |
| Bupropion SR 12HR 150mg Tablet | 180 | EA | ORAL | WELLBUTRIN SR |
| Bupropion SR 12HR 200mg Tablet | 180 | EA | ORAL | WELLBUTRIN SR |
| Bupropion XL 24HR 150mg Tablet | 90 | EA | ORAL | WELLBUTRIN XL |
| Bupropion XL 24hr 300mg Tablet | 90 | EA | ORAL | WELLBUTRIN XL |
| Citalopram 10mg Tablet | 180 | EA | ORAL | CELEXA |
| Citalopram 20mg Tablet | 180 | EA | ORAL | CELEXA |
| Citalopram 40mg Tablet | 90 | EA | ORAL | CELEXA |
| Desvenlafaxine ER 24HR 100mg Tablet | 90 | EA | ORAL | PRISTIQ |
| Desvenlafaxine ER 24HR 25mg Tablet | 90 | EA | ORAL | PRISTIQ |
| Desvenlafaxine ER 24HR 50mg Tablet | 90 | EA | ORAL | PRISTIQ |
| Doxepin 100mg Capsule | 90 | EA | ORAL | SINEQUAN |
| Doxepin 10mg Capsule | 90 | EA | ORAL | SINEQUAN |
| Doxepin 150mg Capsule | 90 | EA | ORAL | SINEQUAN |
| Doxepin 25mg Capsule | 90 | EA | ORAL | SINEQUAN |
| Doxepin 50mg Capsule | 90 | EA | ORAL | SINEQUAN |
| Doxepin 75mg Capsule | 90 | EA | ORAL | SINEQUAN |
| Duloxetine DR 20mg Capsule | 180 | EA | ORAL | CYMBALTA |
| Duloxetine DR 30mg Capsule | 90 | EA | ORAL | CYMBALTA |
| Duloxetine DR 60mg Capsule | 90 | EA | ORAL | CYMBALTA |
| Escitalopram 10mg Tablet | 180 | EA | ORAL | LEXAPRO |
| Escitalopram 20mg Tablet | 90 | EA | ORAL | LEXAPRO |
| Escitalopram 5mg Tablet | 180 | EA | ORAL | LEXAPRO |
| Fluoxetine 10mg Capsule | 180 | EA | ORAL | PROZAC |
| Fluoxetine 10mg Tablet | 180 | EA | ORAL | PROZAC |
| Fluoxetine 20mg Capsule | 180 | EA | ORAL | PROZAC |
| Fluoxetine 20mg Tablet | 90 | EA | ORAL | PROZAC |
| Fluoxetine 40mg Capsule | 90 | EA | ORAL | PROZAC |
| Fluoxetine 60mg Tablet | 90 | EA | ORAL | PROZAC |
| Fluvoxamine 100mg Tablet | 90 | EA | ORAL | LUVOX |
| Fluvoxamine 25mg Tablet | 90 | EA | ORAL | LUVOX |
| Fluvoxamine 50mg Tablet | 90 | EA | ORAL | LUVOX |
| Imipramine 10mg Tablet | 270 | EA | ORAL | TOFRANIL |
| Imipramine 25mg Tablet | 180 | EA | ORAL | TOFRANIL |
| Imipramine 50mg Tablet | 180 | EA | ORAL | TOFRANIL |
| Lithium Carbonate 150mg Capsule | 180 | EA | ORAL | LITHIUM CARBONATE |
| Lithium Carbonate 300mg Capsule | 180 | EA | ORAL | ESKALITH |
| Lithium Carbonate ER 300mg Tablet | 180 | EA | ORAL | LITHOBID |
| Lithium Carbonate ER 450mg Tablet | 180 | EA | ORAL | ESKALITH |
| Mirtazapine 15mg Tablet | 90 | EA | ORAL | REMERON |
| Mirtazapine 30mg Tablet | 90 | EA | ORAL | REMERON |
| Mirtazapine 45mg Tablet | 90 | EA | ORAL | REMERON |
| Mirtazipine 7.5mg Tablet | 90 | EA | ORAL | REMERON |
| Nortriptyline 10mg Capsule | 90 | EA | ORAL | PAMELOR |
| Nortriptyline 25mg Capsule | 90 | EA | ORAL | PAMELOR |
| Nortriptyline 50mg Capsule | 180 | EA | ORAL | PAMELOR |
| Nortriptyline 75mg Capsule | 360 | EA | ORAL | PAMELOR |
| Paroxetine 10mg Tablet | 180 | EA | ORAL | PAXIL |
| Paroxetine 20mg Tablet | 180 | EA | ORAL | PAXIL |
| Paroxetine 30mg Tablet | 90 | EA | ORAL | PAXIL |
| Paroxetine 40mg Tablet | 90 | EA | ORAL | PAXIL |
| Sertraline 100mg Tablet | 90 | EA | ORAL | ZOLOFT |
| Sertraline 25mg Tablet | 90 | EA | ORAL | ZOLOFT |
| Sertraline 50mg Tablet | 180 | EA | ORAL | ZOLOFT |
| Trazodone 100mg Tablet | 90 | EA | ORAL | DESYREL |
| Trazodone 150mg Tablet | 90 | EA | ORAL | DESYREL |
| Trazodone 50mg Tablet | 180 | EA | ORAL | DESYREL |
| Venlafaxine 100mg Tablet | 180 | EA | ORAL | EFFEXOR |
| Venlafaxine 25mg Tablet | 180 | EA | ORAL | EFFEXOR |
| Venlafaxine 37.5mg Tablet | 180 | EA | ORAL | EFFEXOR |
| Venlafaxine 50mg Tablet | 180 | EA | ORAL | EFFEXOR |
| Venlafaxine 75mg Tablet | 180 | EA | ORAL | EFFEXOR |
| Venlafaxine ER 150mg Capsule | 90 | EA | ORAL | EFFEXOR XR |
| Venlafaxine ER 24HR 150mg Tablet | 90 | EA | ORAL | EFFEXOR ER TABLET |
| Venlafaxine ER 24HR 225mg Tablet | 90 | EA | ORAL | EFFEXOR ER TABLET |
| Venlafaxine ER 24HR 37.5mg Tablet | 90 | EA | ORAL | EFFEXOR ER TABLET |
| Venlafaxine ER 24HR 75mg Tablet | 90 | EA | ORAL | EFFEXOR ER TABLET |
| Venlafaxine ER 37.5mg Capsule | 90 | EA | ORAL | EFFEXOR XR |
| Venlafaxine ER 75mg Capsule | 90 | EA | ORAL | EFFEXOR XR |
Antigout
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Fluconazole 100mg Tablet | 90 | EA | ORAL | DIFLUCAN |
| Fluconazole 200mg Tablet | 12 | EA | ORAL | DIFLUCAN |
| Fluconazole 50mg Tablet | 90 | EA | ORAL | DIFLUCAN |
Antihistamines
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Hydroxyzine HCl 25mg Tablet | 180 | EA | ORAL | HYDROXYZINE HCL |
| Hydroxyzine HCl 10mg Tablet | 270 | EA | ORAL | HYDROXYZINE HCL |
| Hydroxyzine HCl 50mg Tablet | 90 | EA | ORAL | HYDROXYZINE HCL |
| Hydroxyzine Pamoate 25mg Capsule | 180 | EA | ORAL | VISTARIL |
| Hydroxyzine Pamoate 50mg Capsule | 180 | EA | ORAL | VISTARIL |
Anti-inflammatory / NSAID
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Diclofenac Sodium DR 75mg Tablet | 180 | EA | ORAL | VOLTAREN |
| Ibuprofen 400mg Tablet | 180 | EA | ORAL | MOTRIN |
| Ibuprofen 600mg Tablet | 180 | EA | ORAL | MOTRIN |
| Ibuprofen 800mg Tablet | 180 | EA | ORAL | MOTRIN |
| Indomethacin 25mg Capsule | 90 | EA | ORAL | INDOCIN |
| Meloxicam 7.5mg Tablet | 90 | EA | ORAL | MOBIC |
| Naproxen 375mg Tablet | 180 | EA | ORAL | NAPROSYN |
| Naproxen 500mg Tablet | 180 | EA | ORAL | NAPROSYN |
| Celecoxib 100mg Capsule | 90 | EA | ORAL | CELEBREX |
| Celecoxib 200mg Capsule | 90 | EA | ORAL | CELEBREX |
| Celecoxib 400mg Capsule | 90 | EA | ORAL | CELEBREX |
| Celecoxib 50mg Capsule | 180 | EA | ORAL | CELEBREX |
| Indomethacin 50mg Capsule | 180 | EA | ORAL | INDOCIN |
| Meloxicam 15mg Tablet | 90 | EA | ORAL | MOBIC |
| Nabumetone 500mg Tablet | 180 | EA | ORAL | RELAFEN |
| Nabumetone 750mg Tablet | 90 | EA | ORAL | RELAFEN |
| Naproxen 250mg Tablet | 180 | EA | ORAL | NAPROSYN |
| Piroxicam 10mg Capsule | 90 | EA | ORAL | FELDENE |
| Piroxicam 20mg Capsule | 90 | EA | ORAL | FELDENE |
Anti-inflammatory / Steroid
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Prednisone 5mg Tablet | 180 | EA | ORAL | PREDNISONE |
| Prednisone 1mg Tablet | 360 | EA | ORAL | PREDNISONE |
| Prednisone 2.5mg Tablet | 180 | EA | ORAL | PREDNISONE |
Antinausea
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Meclizine 12.5mg Tablet | 270 | EA | ORAL | ANTIVERT |
| Ondansetron 4mg Tablet | 90 | EA | ORAL | ZOFRAN |
| Ondansetron 8mg Tablet | 90 | EA | ORAL | ZOFRAN |
| Ondansetron ODT 4mg Tablet | 54 | EA | ORAL | ZOFRAN ODT |
| Ondansetron ODT 8mg Tablet | 54 | EA | ORAL | ZOFRAN ODT |
Antiparkinson
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Amantadine 100mg Tablet | 180 | EA | ORAL | AMANTADINE |
| Benztropine 0.5mg Tablet | 270 | EA | ORAL | COGENTIN |
| Benztropine 1mg Tablet | 270 | EA | ORAL | COGENTIN |
| Benztropine 2mg Tablet | 270 | EA | ORAL | COGENTIN |
| Carbidopa/Levodopa 10/100mg Tablet | 360 | EA | ORAL | SINEMET |
| Carbidopa/Levodopa 25/100mg Tablet | 270 | EA | ORAL | SINEMET |
| Carbidopa/Levodopa 25/250mg Tablet | 270 | EA | ORAL | SINEMET |
| Carbidopa/Levodopa ER 25/100mg Tablet | 270 | EA | ORAL | SINEMET CR |
| Carbidopa/Levodopa ER 50/200mg Tablet | 270 | EA | ORAL | SINEMET CR |
| Pramipexole 0.125mg Tablet | 270 | EA | ORAL | MIRAPEX |
| Pramipexole 0.25mg Tablet | 270 | EA | ORAL | MIRAPEX |
| Pramipexole 0.5mg Tablet | 270 | EA | ORAL | MIRAPEX |
| Pramipexole 0.75mg Tablet | 270 | EA | ORAL | MIRAPEX |
| Pramipexole 1.5mg Tablet | 270 | EA | ORAL | MIRAPEX |
| Pramipexole 1mg Tablet | 270 | EA | ORAL | MIRAPEX |
Antipsychotic
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Aripiprazole 10mg Tablet | 90 | EA | ORAL | ABILIFY |
| Aripiprazole 15mg Tablet | 90 | EA | ORAL | ABILIFY |
| Aripiprazole 20mg Tablet | 90 | EA | ORAL | ABILIFY |
| Aripiprazole 2mg Tablet | 180 | EA | ORAL | ABILIFY |
| Aripiprazole 30mg Tablet | 90 | EA | ORAL | ABILIFY |
| Aripiprazole 5mg Tablet | 90 | EA | ORAL | ABILIFY |
| Fluphenazine 10mg Tablet | 90 | EA | ORAL | PROLIXIN |
| Fluphenazine 1mg Tablet | 90 | EA | ORAL | PROLIXIN |
| Fluphenazine 2.5mg Tablet | 90 | EA | ORAL | PROLIXIN |
| Fluphenazine 5mg Tablet | 90 | EA | ORAL | PROLIXIN |
| Lithium Carbonate 300mg Tablet | 180 | EA | ORAL | LITHIUM CARBONATE |
| Lurasidone 120mg Tablet | 90 | EA | ORAL | LATUDA |
| Lurasidone 20mg Tablet | 90 | EA | ORAL | LATUDA |
| Lurasidone 40mg Tablet | 90 | EA | ORAL | LATUDA |
| Lurasidone 60mg Tablet | 90 | EA | ORAL | LATUDA |
| Lurasidone 80mg Tablet | 90 | EA | ORAL | LATUDA |
| Olanzapine 10mg Tablet | 90 | EA | ORAL | ZYPREXA |
| Olanzapine 15mg Tablet | 90 | EA | ORAL | ZYPREXA |
| Olanzapine 2.5mg Tablet | 90 | EA | ORAL | ZYPREXA |
| Olanzapine 20mg Tablet | 90 | EA | ORAL | ZYPREXA |
| Olanzapine 5mg Tablet | 90 | EA | ORAL | ZYPREXA |
| Olanzapine 7.5mg Tablet | 90 | EA | ORAL | ZYPREXA |
| Perphenazine 2mg Tablet | 90 | EA | ORAL | PERPHENAZINE |
| Perphenazine 4mg Tablet | 90 | EA | ORAL | PERPHENAZINE |
| Perphenazine 8mg Tablet | 90 | EA | ORAL | PERPHENAZINE |
| Quetiapine ER 150mg Tablet | 90 | EA | ORAL | SEROQUEL XR |
| Quetiapine ER 200mg Tablet | 90 | EA | ORAL | SEROQUEL XR |
| Quetiapine ER 300mg Tablet | 90 | EA | ORAL | SEROQUEL XR |
| Quetiapine ER 400mg Tablet | 90 | EA | ORAL | SEROQUEL XR |
| Quetiapine ER 50mg Tablet | 90 | EA | ORAL | SEROQUEL XR |
| Quetiapine Fumarate IR 100mg Tablet | 180 | EA | ORAL | SEROQUEL |
| Quetiapine Fumarate IR 200mg Tablet | 180 | EA | ORAL | SEROQUEL |
| Quetiapine Fumarate IR 25mg Tablet | 270 | EA | ORAL | SEROQUEL |
| Quetiapine Fumarate IR 300mg Tablet | 90 | EA | ORAL | SEROQUEL |
| Quetiapine Fumarate IR 400mg Tablet | 90 | EA | ORAL | SEROQUEL |
| Quetiapine Fumarate IR 50mg Tablet | 270 | EA | ORAL | SEROQUEL |
| Risperidone 0.25mg Tablet | 270 | EA | ORAL | RISPERDAL |
| Risperidone 0.5mg Tablet | 270 | EA | ORAL | RISPERDAL |
| Risperidone 1mg Tablet | 270 | EA | ORAL | RISPERDAL |
| Risperidone 2mg Tablet | 180 | EA | ORAL | RISPERDAL |
| Risperidone 3mg Tablet | 180 | EA | ORAL | RISPERDAL |
| Risperidone 4mg Tablet | 90 | EA | ORAL | RISPERDAL |
Antirheumatic
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Hydroxychloroquine Sulfate 200mg Tablet | 180 | EA | ORAL | PLAQUENIL |
| Methotrexate 2.5mg Tablet | 84 | EA | ORAL | TREXALL |
Antivirals
| Medicine Name | Max Qty | Units | Route | Reference Brand | |
|---|---|---|---|---|---|
| Antivirals | Acyclovir 400mg Tablet | 180 | EA | ORAL | ZOVIRAX |
| Antivirals | Acyclovir 800mg Tablet | 90 | EA | ORAL | ZOVIRAX |
| Antivirals | Valacyclovir 500mg Tablet | 90 | EA | ORAL | VALTREX |
| Antivirals | Valacyclovir 1gm Tablet | 90 | EA | ORAL | VALTREX |
Asthma / Bronchodilators
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Albuterol Sulfate (UD 30x3ml) 0.083% (2.5mg/3ml) Inhalation Solution | 270 | ML | NEB | PROVENTIL/VENTOLIN |
| Albuterol Sulfate/Ipratropium Bromide (UD 30x3ml) (3mg/0.5mg/3ml) Inhalation Solution | 270 | ML | NEB | DUONEB |
| Montelukast 10mg Tablet | 90 | EA | ORAL | SINGULAIR |
| Montelukast 5mg Chewable Tablet | 90 | EA | ORAL | SINGULAIR |
| Albuterol Inhaler (Only Sandoz NDC = 00781729685) | 6.7 | GM | INHALATION | PROAIR |
| Levalbuterol (UD 25x3ml) 0.63mg/3ml Inhalation Solution | 225 | ML | NEB | XOPENEX |
| Levalbuterol (UD 25x3ml) 1.25mg/3ml Inhalation Solution | 225 | ML | NEB | XOPENEX |
Cardiac / Hypertension
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Amiloride/Hydrochlorothiazide 5/50mg Tablet | 90 | EA | ORAL | MODURETIC |
| Amiodarone 200mg Tablet | 180 | EA | ORAL | CORDARONE |
| Amlodipine 10mg Tablet | 180 | EA | ORAL | NORVASC |
| Amlodipine 2.5mg Tablet | 180 | EA | ORAL | NORVASC |
| Amlodipine 5mg Tablet | 180 | EA | ORAL | NORVASC |
| Amlodipine/Benazepril 10/20mg Capsule | 90 | EA | ORAL | LOTREL |
| Amlodipine/Benazepril 10/40mg Capsule | 90 | EA | ORAL | LOTREL |
| Amlodipine/Benazepril 2.5/10mg Capsule | 90 | EA | ORAL | LOTREL |
| Amlodipine/Benazepril 5/10mg Capsule | 90 | EA | ORAL | LOTREL |
| Amlodipine/Benazepril 5/20mg Capsule | 90 | EA | ORAL | LOTREL |
| Amlodipine/Benazepril 5/40mg Capsule | 90 | EA | ORAL | LOTREL |
| Amlodipine/Olmesartan 10/20mg Tablet | 90 | EA | ORAL | AZOR |
| Amlodipine/Olmesartan 10/40mg Tablet | 90 | EA | ORAL | AZOR |
| Amlodipine/Olmesartan 5/20mg Tablet | 90 | EA | ORAL | AZOR |
| Amlodipine/Olmesartan 5/40mg Tablet | 90 | EA | ORAL | AZOR |
| Atenolol 100mg Tablet | 90 | EA | ORAL | TENORMIN |
| Atenolol 25mg Tablet | 180 | EA | ORAL | TENORMIN |
| Atenolol 50mg Tablet | 90 | EA | ORAL | TENORMIN |
| Atenolol/Chlorthalidone 100/25mg Tablet | 90 | EA | ORAL | TENORETIC |
| Atenolol/Chlorthalidone 50/25mg Tablet | 90 | EA | ORAL | TENORETIC 50 |
| Benazepril 10mg Tablet | 90 | EA | ORAL | LOTENSIN |
| Benazepril 20mg Tablet | 90 | EA | ORAL | LOTENSIN |
| Benazepril 40mg Tablet | 90 | EA | ORAL | LOTENSIN |
| Benazepril 5mg Tablet | 180 | EA | ORAL | LOTENSIN |
| Bisoprolol 10mg Tablet | 90 | EA | ORAL | ZEBETA |
| Bisoprolol 5mg Tablet | 90 | EA | ORAL | ZEBETA |
| Bisoprolol/HCTZ 10/6.25mg Tablet | 90 | EA | ORAL | ZIAC |
| Bisoprolol/HCTZ 2.5/6.25mg Tablet | 90 | EA | ORAL | ZIAC |
| Bisoprolol/HCTZ 5/6.25mg Tablet | 90 | EA | ORAL | ZIAC |
| Bumetanide 0.5 mg Tablet | 90 | EA | ORAL | BUMEX |
| Bumetanide 1mg Tablet | 90 | EA | ORAL | BUMEX |
| Bumetanide 2mg Tablet | 180 | EA | ORAL | BUMEX |
| Carvedilol 12.5mg Tablet | 180 | EA | ORAL | COREG |
| Carvedilol 25mg Tablet | 180 | EA | ORAL | COREG |
| Carvedilol 3.125mg Tablet | 180 | EA | ORAL | COREG |
| Carvedilol 6.25mg Tablet | 180 | EA | ORAL | COREG |
| Chlorthalidone 25mg Tablet | 90 | EA | ORAL | HYGROTON |
| Chlorthalidone 50mg Tablet | 90 | EA | ORAL | HYGROTON |
| Cilostazol 100mg Tablet | 90 | EA | ORAL | PLETAL |
| Cilostazol 50mg Tablet | 180 | EA | ORAL | PLETAL |
| Clonidine 0.1mg Tablet | 180 | EA | ORAL | CATAPRES |
| Clonidine 0.2mg Tablet | 180 | EA | ORAL | CATAPRES |
| Clonidine 0.3mg Tablet | 180 | EA | ORAL | CATAPRES |
| Clopidogrel 75mg Tablet | 90 | EA | ORAL | PLAVIX |
| Digoxin 0.125mg Tablet | 90 | EA | ORAL | LANOXIN |
| Digoxin 0.25mg Tablet | 90 | EA | ORAL | LANOXIN |
| Diltiazem 120mg Tablet | 90 | EA | ORAL | CARDIZEM |
| Diltiazem 24HR CR 120mg Capsule (AB3 CARDIZEM CD) | 90 | EA | ORAL | CARDIZEM CD |
| Diltiazem 24HR CR 180mg Capsule (AB3 CARDIZEM CD) | 90 | EA | ORAL | CARDIZEM CD |
| Diltiazem 24HR CR 240mg Capsule (AB3 CARDIZEM CD) | 90 | EA | ORAL | CARDIZEM CD |
| Diltiazem 24HR CR 360mg Capsule (AB3 CARDIZEM CD) | 90 | EA | ORAL | CARDIZEM CD |
| Diltiazem 24HR ER Coated Beads 120mg Capsule (AB4 TIAZAC) | 90 | EA | ORAL | TIAZAC |
| Diltiazem 24HR ER Coated Beads 180mg Capsule (AB4 TIAZAC) | 90 | EA | ORAL | TIAZAC |
| Diltiazem 24HR ER Coated Beads 240mg Capsule (AB4 TIAZAC) | 90 | EA | ORAL | TIAZAC |
| Diltiazem 24HR ER Coated Beads 300mg Capsule (AB4 TIAZAC) | 90 | EA | ORAL | TIAZAC |
| Diltiazem 24HR ER Coated Beads 360mg Capsule (AB4 TIAZAC) | 90 | EA | ORAL | TIAZAC |
| Diltiazem 24HR ER Coated Beads 420mg Capsule (AB4 TIAZAC) | 90 | EA | ORAL | TIAZAC |
| Doxazosin 1mg Tablet | 90 | EA | ORAL | CARDURA |
| Doxazosin 2mg Tablet | 90 | EA | ORAL | CARDURA |
| Doxazosin 4mg Tablet | 90 | EA | ORAL | CARDURA |
| Doxazosin 8mg Tablet | 90 | EA | ORAL | CARDURA |
| Enalapril 10mg Tablet | 180 | EA | ORAL | VASOTEC |
| Enalapril 2.5mg Tablet | 180 | EA | ORAL | VASOTEC |
| Enalapril 20mg Tablet | 180 | EA | ORAL | VASOTEC |
| Enalapril 5mg Tablet | 180 | EA | ORAL | VASOTEC |
| Enalapril/Hydrochlorothiazide 10/25mg Tablet | 90 | EA | ORAL | VASERETIC |
| Enalapril/Hydrochlorothiazide 5/12.5mg Tablet | 90 | EA | ORAL | VASERETIC |
| Felodipine ER 24HR 2.5mg Tablet | 90 | EA | ORAL | PLENDIL |
| Felodipine ER 24HR 5mg Tablet | 90 | EA | ORAL | PLENDIL |
| Flecainide Acetate 100mg Tablet | 180 | EA | ORAL | TAMBOCOR |
| Flecainide Acetate 50mg Tablet | 180 | EA | ORAL | TAMBOCOR |
| Fosinopril Sodium 10mg Tablet | 90 | EA | ORAL | MONOPRIL |
| Fosinopril Sodium 20mg Tablet | 90 | EA | ORAL | MONOPRIL |
| Fosinopril Sodium 40mg Tablet | 90 | EA | ORAL | MONOPRIL |
| Furosemide 20mg Tablet | 180 | EA | ORAL | LASIX |
| Furosemide 40mg Tablet | 180 | EA | ORAL | LASIX |
| Furosemide 80mg Tablet | 90 | EA | ORAL | LASIX |
| Guanfacine 1mg Tablet | 90 | EA | ORAL | TENEX |
| Guanfacine 2mg Tablet | 90 | EA | ORAL | TENEX |
| Hydralazine 100mg Tablet | 180 | EA | ORAL | APRESOLINE |
| Hydralazine 10mg Tablet | 270 | EA | ORAL | APRESOLINE |
| Hydralazine 25mg Tablet | 180 | EA | ORAL | APRESOLINE |
| Hydralazine 50mg Tablet | 180 | EA | ORAL | APRESOLINE |
| Hydrochlorothiazide 12.5mg Capsule | 90 | EA | ORAL | MICROZIDE |
| Hydrochlorothiazide 12.5mg Tablet | 90 | EA | ORAL | HYDRODIURIL |
| Hydrochlorothiazide 25mg Tablet | 90 | EA | ORAL | HYDRODIURIL |
| Hydrochlorothiazide 50mg Tablet | 90 | EA | ORAL | HYDRODIURIL |
| Indapamide 1.25mg Tablet | 90 | EA | ORAL | LOZOL |
| Indapamide 2.5mg Tablet | 90 | EA | ORAL | LOZOL |
| Irbesartan 150mg Tablet | 90 | EA | ORAL | AVAPRO |
| Irbesartan 300mg Tablet | 90 | EA | ORAL | AVAPRO |
| Irbesartan 75mg Tablet | 90 | EA | ORAL | AVAPRO |
| Irbesartan/HCTZ 150/12.5mg Tablet | 90 | EA | ORAL | AVALIDE |
| Irbesartan/HCTZ 300/12.5mg Tablet | 90 | EA | ORAL | AVALIDE |
| Isosorbide Mononitrate ER 24HR 120mg Tablet | 90 | EA | ORAL | IMDUR |
| Isosorbide Mononitrate ER 30mg Tablet | 90 | EA | ORAL | IMDUR |
| Isosorbide Mononitrate ER 60mg Tablet | 90 | EA | ORAL | IMDUR |
| Labetalol 100mg Tablet | 180 | EA | ORAL | TRANDATE |
| Labetalol 200mg Tablet | 180 | EA | ORAL | TRANDATE |
| Labetalol 300mg Tablet | 180 | EA | ORAL | TRANDATE |
| Lisinopril 10mg Tablet | 180 | EA | ORAL | PRINIVIL/ZESTRIL |
| Lisinopril 2.5mg Tablet | 180 | EA | ORAL | PRINIVIL/ZESTRIL |
| Lisinopril 20mg Tablet | 180 | EA | ORAL | PRINIVIL/ZESTRIL |
| Lisinopril 30mg Tablet | 180 | EA | ORAL | PRINIVIL/ZESTRIL |
| Lisinopril 40mg Tablet | 180 | EA | ORAL | PRINIVIL/ZESTRIL |
| Lisinopril 5mg Tablet | 180 | EA | ORAL | PRINIVIL/ZESTRIL |
| Lisinopril/HCTZ 10/12.5mg Tablet | 90 | EA | ORAL | ZESTORETIC |
| Lisinopril/HCTZ 20/12.5mg Tablet | 90 | EA | ORAL | ZESTORETIC |
| Lisinopril/HCTZ 20/25mg Tablet | 90 | EA | ORAL | ZESTORETIC |
| Losartan 100mg Tablet | 90 | EA | ORAL | COZAAR |
| Losartan 25mg Tablet | 90 | EA | ORAL | COZAAR |
| Losartan 50mg Tablet | 90 | EA | ORAL | COZAAR |
| Losartan/HCTZ 100/12.5mg Tablet | 90 | EA | ORAL | HYZAAR |
| Losartan/HCTZ 100/25mg Tablet | 90 | EA | ORAL | HYZAAR |
| Losartan/HCTZ 50/12.5mg Tablet | 90 | EA | ORAL | HYZAAR |
| Metolazone 2.5mg Tablet | 90 | EA | ORAL | ZAROXOLIN |
| Metolazone 5mg Tablet | 90 | EA | ORAL | ZAROXOLIN |
| Metoprolol Succinate ER 100mg Tablet | 90 | EA | ORAL | TOPROL XL |
| Metoprolol Succinate ER 200mg Tablet | 90 | EA | ORAL | TOPROL XL |
| Metoprolol Succinate ER 25mg Tablet | 90 | EA | ORAL | TOPROL XL |
| Metoprolol Succinate ER 50mg Tablet | 90 | EA | ORAL | TOPROL XL |
| Metoprolol Tartrate 100mg Tablet | 180 | EA | ORAL | LOPRESSOR |
| Metoprolol Tartrate 25mg Tablet | 180 | EA | ORAL | LOPRESSOR |
| Metoprolol Tartrate 37.5mg Tablet | 180 | EA | ORAL | LOPRESSOR |
| Metoprolol Tartrate 50mg Tablet | 180 | EA | ORAL | LOPRESSOR |
| Metoprolol Tartrate 75mg Tablet | 180 | EA | ORAL | LOPRESSOR |
| Minoxidil 10mg Tablet | 90 | EA | ORAL | MINOXIDIL |
| Minoxidil 2.5mg Tablet | 360 | EA | ORAL | MINOXIDIL |
| Nadolol 20mg Tablet | 90 | EA | ORAL | CORGARD |
| Nadolol 40mg Tablet | 90 | EA | ORAL | CORGARD |
| Nebivolol 10mg Tablet | 90 | EA | ORAL | BYSTOLIC |
| Nebivolol 2.5mg Tablet | 90 | EA | ORAL | BYSTOLIC |
| Nebivolol 20mg Tablet | 90 | EA | ORAL | BYSTOLIC |
| Nebivolol 5mg Tablet | 90 | EA | ORAL | BYSTOLIC |
| Nifedipine ER 24HR 30mg Tablet (AB1 ADALAT CC) | 90 | EA | ORAL | ADALAT CC |
| Nifedipine ER 24HR 60mg Tablet (AB1 ADALAT CC) | 90 | EA | ORAL | ADALAT CC |
| Nifedipine ER 24HR 90mg Tablet (AB1 ADALAT CC) | 90 | EA | ORAL | ADALAT CC |
| Nifedipine ER 24HR Osmotic Release 30mg Tablet (AB2 PROCARDIA XL) | 90 | EA | ORAL | PROCARDIA XL |
| Nifedipine ER 24HR Osmotic Release 60mg Tablet (AB2 PROCARDIA XL) | 90 | EA | ORAL | PROCARDIA XL |
| Nifedipine ER 24HR Osmotic Release 90mg Tablet (AB2 PROCARDIA XL) | 90 | EA | ORAL | PROCARDIA XL |
| Olmesartan 20mg Tablet | 90 | EA | ORAL | BENICAR |
| Olmesartan 40mg Tablet | 90 | EA | ORAL | BENICAR |
| Olmesartan 5mg Tablet | 180 | EA | ORAL | BENICAR |
| Olmesartan/HCTZ 20/12.5mg Tablet | 90 | EA | ORAL | BENICAR HCT |
| Olmesartan/HCTZ 40/12.5mg Tablet | 90 | EA | ORAL | BENICAR HCT |
| Olmesartan/HCTZ 40/25mg Tablet | 90 | EA | ORAL | BENICAR HCT |
| Potassium Chloride ER 10meq Capsule (MICRO-K 10) | 180 | EA | ORAL | MICRO-K |
| Potassium Chloride ER 10meq Tablet (AB2 KLOR-CON 10/AB3 K-TAB) | 90 | EA | ORAL | KLOR-CON/K-TAB |
| Potassium Chloride ER 20meq Tablet (AB1 K-TAB) | 90 | EA | ORAL | KLOR-CON M20 |
| Potassium Chloride ER 20mEq Tablet (AB3 CLOR-CON) | 90 | EA | ORAL | KLOR-CON |
| Potassium Chloride ER 8meq (600mg) Tablet | 180 | EA | ORAL | KLOR-CON/K-TAB |
| Potassium Chloride ER 8meq Capsule | 180 | EA | ORAL | MICRO-K |
| Potassium Chloride Microencapsulated ER 10meq Tablet (AB1 KLOR-CON M-10) | 90 | EA | ORAL | KLOR_CON 10 |
| Prasugrel 10mg Tablet | 90 | EA | ORAL | EFFIENT |
| Prasugrel 5mg Tablet | 90 | EA | ORAL | EFFIENT |
| Prazosin 1mg Capsule | 180 | EA | ORAL | MINIPRESS |
| Prazosin 2mg Capsule | 90 | EA | ORAL | MINIPRESS |
| Prazosin 5mg Capsule | 90 | EA | ORAL | MINIPRESS |
| Propafenone 150mg Tablet | 180 | EA | ORAL | RYTHMOL |
| Propafenone 300mg Tablet | 90 | EA | ORAL | RYTHMOL |
| Propranolol 10mg Tablet | 270 | EA | ORAL | INDERAL |
| Propranolol 20mg Tablet | 270 | EA | ORAL | INDERAL |
| Propranolol 40mg Tablet | 180 | EA | ORAL | INDERAL |
| Propranolol 60mg Tablet | 180 | EA | ORAL | INDERAL |
| Propranolol 80mg Tablet | 180 | EA | ORAL | INDERAL |
| Propranolol ER 24HR 120mg Capsule | 90 | EA | ORAL | INDERAL LA |
| Propranolol ER 24HR 160mg Capsule | 90 | EA | ORAL | INDERAL LA |
| Propranolol ER 24HR 60mg Capsule | 90 | EA | ORAL | INDERAL LA |
| Propranolol ER 24HR 80mg Capsule | 90 | EA | ORAL | INDERAL LA |
| Quinapril 20mg Tablet | 90 | EA | ORAL | ACCUPRIL |
| Quinapril 40mg Tablet | 90 | EA | ORAL | ACCUPRIL |
| Ramipril 1.25mg Capsule | 180 | EA | ORAL | ALTACE |
| Ramipril 10mg Capsule | 180 | EA | ORAL | ALTACE |
| Ramipril 2.5mg Capsule | 180 | EA | ORAL | ALTACE |
| Ramipril 5mg Capsule | 180 | EA | ORAL | ALTACE |
| Sildenafil 20mg Tablet | 90 | EA | ORAL | REVATIO |
| Sotalol 120mg Tablet | 180 | EA | ORAL | BETAPACE |
| Sotalol 160mg Tablet | 180 | EA | ORAL | BETAPACE |
| Sotalol 240mg Tablet | 90 | EA | ORAL | BETAPACE |
| Sotalol 80mg Tablet | 180 | EA | ORAL | BETAPACE |
| Spironolactone 100mg Tablet | 90 | EA | ORAL | ALDACTONE |
| Spironolactone 25mg Tablet | 180 | EA | ORAL | ALDACTONE |
| Spironolactone 50mg Tablet | 90 | EA | ORAL | ALDACTONE |
| Telmisartan 20mg Tablet | 90 | EA | ORAL | MICARDIS |
| Telmisartan 40mg Tablet | 90 | EA | ORAL | MICARDIS |
| Telmisartan 80mg Tablet | 90 | EA | ORAL | MICARDIS |
| Telmisartan/Hydrochlorothiazide 40/12.5mg Tablet | 90 | EA | ORAL | MICARDIS HCT |
| Telmisartan/Hydrochlorothiazide 80/12.5mg Tablet | 90 | EA | ORAL | MICARDIS HCT |
| Telmisartan/Hydrochlorothiazide 80/25mg Tablet | 90 | EA | ORAL | MICARDIS HCT |
| Terazosin 10mg Capsule | 90 | EA | ORAL | HYTRIN |
| Terazosin 1mg Capsule | 90 | EA | ORAL | HYTRIN |
| Terazosin 2mg Capsule | 90 | EA | ORAL | HYTRIN |
| Terazosin 5mg Capsule | 90 | EA | ORAL | HYTRIN |
| Torsemide 100mg Tablet | 90 | EA | ORAL | DEMADEX |
| Torsemide 10mg Tablet | 90 | EA | ORAL | DEMADEX |
| Torsemide 20mg Tablet | 90 | EA | ORAL | DEMADEX |
| Torsemide 5mg Tablet | 90 | EA | ORAL | DEMADEX |
| Trandolapril 1mg Tablet | 180 | EA | ORAL | MAVIK |
| Trandolapril 2mg Tablet | 180 | EA | ORAL | MAVIK |
| Trandolapril 4mg Tablet | 180 | EA | ORAL | MAVIK |
| Triamterene/HCTZ 37.5/25mg Capsule | 90 | EA | ORAL | DYAZIDE |
| Triamterene/HCTZ 37.5/25mg Tablet | 90 | EA | ORAL | MAXZIDE-25 |
| Triamterene/HCTZ 75/50mg Tablet | 90 | EA | ORAL | MAXZIDE |
| Valsartan 160mg Tablet | 90 | EA | ORAL | DIOVAN |
| Valsartan 320mg Tablet | 90 | EA | ORAL | DIOVAN |
| Valsartan 40mg Tablet | 90 | EA | ORAL | DIOVAN |
| Valsartan 80mg Tablet | 90 | EA | ORAL | DIOVAN |
| Valsartan/HCTZ 160/12.5mg Tablet | 90 | EA | ORAL | DIOVAN HCT |
| Valsartan/HCTZ 160/25mg Tablet | 90 | EA | ORAL | DIOVAN HCT |
| Valsartan/HCTZ 320/12.5mg Tablet | 90 | EA | ORAL | DIOVAN HCT |
| Valsartan/HCTZ 320/25mg Tablet | 90 | EA | ORAL | DIOVAN HCT |
| Valsartan/HCTZ 80/12.5mg Tablet | 90 | EA | ORAL | DIOVAN HCT |
| Verapamil 120mg Tablet | 90 | EA | ORAL | CALAN |
| Verapamil 80mg Tablet | 270 | EA | ORAL | CALAN |
| Verapamil ER 120mg Tablet | 90 | EA | ORAL | CALAN SR |
| Verapamil ER 180mg Tablet | 90 | EA | ORAL | CALAN SR |
| Verapamil ER 240mg Tablet | 90 | EA | ORAL | CALAN SR |
Cholesterol / Triglycerides
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Atorvastatin 10mg Tablet | 90 | EA | ORAL | LIPITOR |
| Atorvastatin 20mg Tablet | 90 | EA | ORAL | LIPITOR |
| Atorvastatin 40mg Tablet | 90 | EA | ORAL | LIPITOR |
| Atorvastatin 80mg Tablet | 90 | EA | ORAL | LIPITOR |
| Choline Fenofibrate DR 135mg Capsule | 90 | EA | ORAL | TRILIPIX |
| Choline Fenofibrate DR 45mg Capsule | 90 | EA | ORAL | TRILIPIX |
| Ezetimibe 10mg Tablet | 90 | EA | ORAL | ZETIA |
| Ezetimibe/Simvastatin 10/10mg Tablet | 90 | EA | ORAL | VYTORIN |
| Ezetimibe/Simvastatin 10/20mg Tablet | 90 | EA | ORAL | VYTORIN |
| Ezetimibe/Simvastatin 10/40mg Tablet | 90 | EA | ORAL | VYTORIN |
| Ezetimibe/Simvastatin 10/80mg Tablet | 90 | EA | ORAL | VYTORIN |
| Fenofibrate 145mg Tablet | 90 | EA | ORAL | TRICOR |
| Fenofibrate 160mg Tablet | 90 | EA | ORAL | TRICOR |
| Fenofibrate 200mg Capsule | 90 | EA | ORAL | TRICOR |
| Fenofibrate 48mg Tablet | 90 | EA | ORAL | TRICOR |
| Fenofibrate 54mg Tablet | 90 | EA | ORAL | TRICOR |
| Fenofibrate Micronized 134mg Capsule | 90 | EA | ORAL | TRICOR |
| Fenofibrate Micronized 67mg Capsule | 90 | EA | ORAL | TRICOR |
| Gemfibrozil 600mg Tablet | 180 | EA | ORAL | LOPID |
| Lovastatin 10mg Tablet | 90 | EA | ORAL | MEVACOR |
| Lovastatin 20mg Tablet | 90 | EA | ORAL | MEVACOR |
| Lovastatin 40mg Tablet | 90 | EA | ORAL | MEVACOR |
| Niacin ER 1000mg Tablet | 90 | EA | ORAL | NIASPAN |
| Niacin ER 500mg Tablet | 180 | EA | ORAL | NIASPAN |
| Omega-3-acid Ethyl Esters 1gm Capsule | 360 | EA | ORAL | LOVAZA |
| Pravastatin 10mg Tablet | 90 | EA | ORAL | PRAVACHOL |
| Pravastatin 20mg Tablet | 90 | EA | ORAL | PRAVACHOL |
| Pravastatin 40mg Tablet | 90 | EA | ORAL | PRAVACHOL |
| Pravastatin 80mg Tablet | 90 | EA | ORAL | PRAVACHOL |
| Rosuvastatin 10mg Tablet | 90 | EA | ORAL | CRESTOR |
| Rosuvastatin 20mg Tablet | 90 | EA | ORAL | CRESTOR |
| Rosuvastatin 40mg Tablet | 90 | EA | ORAL | CRESTOR |
| Rosuvastatin 5mg Tablet | 90 | EA | ORAL | CRESTOR |
| Simvastatin 10mg Tablet | 90 | EA | ORAL | ZOCOR |
| Simvastatin 20mg Tablet | 90 | EA | ORAL | ZOCOR |
| Simvastatin 40mg Tablet | 90 | EA | ORAL | ZOCOR |
| Simvastatin 5mg Tablet | 180 | EA | ORAL | ZOCOR |
| Simvastatin 80mg Tablet | 90 | EA | ORAL | ZOCOR |
Diabetes
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Acarbose 100mg Tablet | 270 | EA | ORAL | PRECOSE |
| Acarbose 25mg Tablet | 270 | EA | ORAL | PRECOSE |
| Acarbose 50mg Tablet | 270 | EA | ORAL | PRECOSE |
| Glimepiride 1mg Tablet | 180 | EA | ORAL | AMARYL |
| Glimepiride 2mg Tablet | 180 | EA | ORAL | AMARYL |
| Glimepiride 4mg Tablet | 180 | EA | ORAL | AMARYL |
| Glipizide 10mg Tablet | 180 | EA | ORAL | GLUCOTROL |
| Glipizide 5mg Tablet | 180 | EA | ORAL | GLUCOTROL |
| Glipizide ER 10mg Tablet | 180 | EA | ORAL | GLUCOTROL XL |
| Glipizide ER 2.5mg Tablet | 180 | EA | ORAL | GLUCOTROL XL |
| Glipizide ER 5mg Tablet | 180 | EA | ORAL | GLUCOTROL XL |
| Glipizide/Metformin 2.5/500mg Tablet | 180 | EA | ORAL | METAGLIP |
| Glipizide/Metformin 5/500mg Tablet | 180 | EA | ORAL | METAGLIP |
| Glyburide 1.25mg Tablet | 180 | EA | ORAL | DIABETA |
| Glyburide 2.5mg Tablet | 180 | EA | ORAL | DIABETA |
| Glyburide 5mg Tablet | 360 | EA | ORAL | DIABETA |
| Glyburide/Metformin 1.25/250mg Tablet | 360 | EA | ORAL | GLUCOVANCE |
| Glyburide/Metformin 2.5/500mg Tablet | 360 | EA | ORAL | GLUCOVANCE |
| Glyburide/Metformin 5/500mg Tablet | 360 | EA | ORAL | GLUCOVANCE |
| Metformin 1000mg Tablet | 180 | EA | ORAL | GLUCOPHAGE |
| Metformin 500mg Tablet | 360 | EA | ORAL | GLUCOPHAGE |
| Metformin 850mg Tablet | 270 | EA | ORAL | GLUCOPHAGE |
| Metformin ER 24HR 500mg Tablet | 180 | EA | ORAL | GLUCOPHAGE XR |
| Metformin ER 24HR 750mg Tablet | 180 | EA | ORAL | GLUCOPHAGE XR |
| Pioglitazone 15mg Tablet | 180 | EA | ORAL | ACTOS |
| Pioglitazone 30mg Tablet | 90 | EA | ORAL | ACTOS |
| Pioglitazone 45mg Tablet | 90 | EA | ORAL | ACTOS |
| Pioglitazone/Metformin 15/500mg Tablet | 180 | EA | ORAL | ACTOPLUS MET |
| Pioglitazone/Metformin 15/850mg Tablet | 180 | EA | ORAL | ACTOPLUS MET |
Endoctrine System
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Clomiphone citrate 50mg Tablets | 30 | EA | ORAL | CLOMID |
Gastrointestinal
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Dicyclomine 10mg Capsule | 180 | EA | ORAL | BENTYL |
| Dicyclomine 20mg Tablet | 180 | EA | ORAL | BENTYL |
| Famotidine 20mg Tablet | 180 | EA | ORAL | PEPCID |
| Omeprazole DR 20mg Capsule | 180 | EA | ORAL | PRILOSEC |
| Omeprazole DR 40mg Capsule | 90 | EA | ORAL | PRILOSEC |
| Pantoprazole EC 40mg Tablet | 90 | EA | ORAL | PROTONIX |
| Cyproheptadine 4mg Tablet | 270 | EA | ORAL | PERIACTIN |
| Esomeprazole DR 20mg Capsule | 90 | EA | ORAL | NEXIUM |
| Esomeprazole DR 40mg Capsule | 90 | EA | ORAL | NEXIUM |
| Famotidine 10mg Tablet | 180 | EA | ORAL | PEPCID |
| Famotidine 40mg Tablet | 90 | EA | ORAL | PEPCID |
| Glycopyrrolate 1mg Tablet | 180 | EA | ORAL | ROBINUL |
| Glycopyrrolate 2mg Tablet | 180 | EA | ORAL | ROBINUL FORTE |
| Hyoscyamine 0.125mg Tablet | 90 | EA | ORAL | LEVSIN |
| Lansoprazole DR 15mg Capsule | 90 | EA | ORAL | PREVACID 24HR |
| Lansoprazole DR 30mg Capsule | 90 | EA | ORAL | PREVACID |
| Omeprazole DR 10mg Capsule | 90 | EA | ORAL | PRILOSEC |
| Pantoprazole EC 20mg Tablet | 90 | EA | ORAL | PROTONIX |
| Rabeprazole EC 20mg Tablet | 90 | EA | ORAL | ACIPHEX |
| Sucralfate 1gm Tablet | 270 | EA | ORAL | CARAFATE |
Glaucoma
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Brimonidine 15ml .02% Ophthalmic Solution | 45 | ML | OPHTHAL LIQUID | ALPHAGAN |
| Dorzolamide/Timolol 22.3/6.8mg/ml Ophthalmic Solution | 30 | ML | OPHTHAL SOLUTION | COSOPT |
| Latanoprost 0.005% Ophthalmic Solution 2.5mL | 7.5 | ML | OPHTHAL LIQUID | XALATAN |
| Timolol Maleate 0.25% Ophthalmic Solution | 15 | ML | OPHTHAL SOLUTION | TIMOPTIC |
| Timolol Maleate 0.5% Ophthalmic Solution | 15 | ML | OPHTHAL SOLUTION | TIMOPTIC |
Hormone Replacement
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Estradiol 0.5mg Tablet | 90 | EA | ORAL | ESTRACE |
| Estradiol 1mg Tablet | 90 | EA | ORAL | ESTRACE |
| Estradiol 2mg Tablet | 90 | EA | ORAL | ESTRACE |
| Medroxyprogesterone Acetate 10mg Tablet | 90 | EA | ORAL | PROVERA |
| Medroxyprogesterone Acetate 2.5mg Tablet | 90 | EA | ORAL | PROVERA |
| Medroxyprogesterone Acetate 5mg Tablet | 90 | EA | ORAL | PROVERA |
| Progesterone 100mg Capsule | 90 | EA | ORAL | PROMETRIUM |
| Progesterone 200mg Capsule | 90 | EA | ORAL | PROMETRIUM |
Hormone-Based Chemo (Breast Cancer)
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Anastrozole 1mg Tablet | 90 | EA | ORAL | ARIMIDEX |
| Letrozole 2.5mg Tablet | 90 | EA | ORAL | FEMARA |
| Tamoxifen Citrate 10mg Tablet | 90 | EA | ORAL | NOLVADEX |
| Tamoxifen Citrate 20mg Tablet | 90 | EA | ORAL | NOLVADEX |
Men’s Health
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Alfuzosin ER 24HR 10mg Tablet | 90 | EA | ORAL | UROXATRAL |
| Dutasteride 0.5mg Capsule | 90 | EA | ORAL | AVODART |
| Finasteride 1mg Tablet | 90 | EA | ORAL | PROPECIA |
| Finasteride 5mg Tablet | 90 | EA | ORAL | PROSCAR |
| Sildenafil 100mg Tablet | 30 | EA | ORAL | VIAGRA |
| Sildenafil 25mg Tablet | 30 | EA | ORAL | VIAGRA |
| Sildenafil 50mg Tablet | 30 | EA | ORAL | VIAGRA |
| Silodosin 4mg Capsule | 90 | EA | ORAL | RAPAFLO |
| Silodosin 8mg Capsule | 90 | EA | ORAL | RAPAFLO |
| Tadalafil 10mg Tablet | 30 | EA | ORAL | CIALIS |
| Tadalafil 2.5mg Tablet | 90 | EA | ORAL | CIALIS |
| Tadalafil 20mg Tablet | 30 | EA | ORAL | CIALIS |
| Tadalafil 5mg Tablet | 90 | EA | ORAL | CIALIS |
| Tamsulosin 0.4mg Capsule | 90 | EA | ORAL | FLOMAX |
Migraine
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Naratriptan 2.5mg Tablet | 27 | EA | ORAL | AMERGE |
| Rizatriptan 10mg Tablet | 27 | EA | ORAL | MAXALT |
| Rizatriptan 5mg Tablet | 27 | EA | ORAL | MAXALT |
| Rizatriptan ODT 10mg Disintegrating Tablet | 27 | EA | ORAL | MAXALT-MLT |
| Sumatriptan 100mg Tablet | 27 | EA | ORAL | IMITREX |
| Sumatriptan 50mg Tablet | 27 | EA | ORAL | IMITREX |
| Eletriptan 20mg Tablet | 18 | EA | ORAL | RELPAX |
| Eletriptan 40mg Tablet | 18 | EA | ORAL | RELPAX |
| Rizatriptan 5mg ODT Orally Disintegrating Tablet | 27 | EA | ORAL | MAXALT-MLT |
| Sumatriptan 25mg Tablet | 27 | EA | ORAL | IMITREX |
| Zolmitriptan 2.5mg Tablet | 18 | EA | ORAL | ZOMIG |
| Zolmitriptan 5mg Tablet | 18 | EA | ORAL | ZOMIG |
Muscle Relaxants / Restless Leg Syndrome
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Tizanidine 2mg Tablet | 180 | EA | ORAL | ZANAFLEX |
| Tizanidine 4mg Tablet | 180 | EA | ORAL | ZANAFLEX |
| Baclofen 10mg Tablet | 180 | EA | ORAL | LIORESAL |
| Ropinirole 0.25mg Tablet | 180 | EA | ORAL | REQUIP |
| Ropinirole 0.5mg Tablet | 180 | EA | ORAL | REQUIP |
| Ropinirole 1mg Tablet | 180 | EA | ORAL | REQUIP |
| Ropinirole 2mg Tablet | 180 | EA | ORAL | REQUIP |
| Ropinirole 3mg Tablet | 180 | EA | ORAL | REQUIP |
| Ropinirole 4mg Tablet | 180 | EA | ORAL | REQUIP |
| Ropinirole 5mg Tablet | 180 | EA | ORAL | REQUIP |
| Tizanidine 2mg Capsule | 180 | EA | ORAL | ZANAFLEX |
| Tizanidine 4mg Capsule | 180 | EA | ORAL | ZANAFLEX |
| Tizanidine 6mg Capsule | 180 | EA | ORAL | ZANAFLEX |
Oral Contraceptives
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Desogestrel/Ethinyl Estradiol 0.15/0.03mg Tablet | 84 | EA | ORAL | ORTHOCEPT/DESOGEN |
| Desogestrol-Ethinyl Estradiol/Ethinyl Estradiol (21/5) 0.150-0.02/0.01mg Tablet | 84 | EA | ORAL | MIRCETTE |
| Drospirenone/Ethinyl Estradiol 3/0.02mg Tablet | 84 | EA | ORAL | YAZ |
| Drospirenone/Ethinyl Estradiol 3/0.03mg Tablet | 84 | EA | ORAL | YASMIN |
| Kelnor 1/35 (Ethynodiol Diacetate/Ethinyl Estradiol) Tablet | 84 | EA | ORAL | ZOVIA 1/35 |
| Kelnor 1/50 (Ethynodiol Diacetate/Ethinyl Estradiol) Tablet | 84 | EA | ORAL | KELNOR |
| Levonorgestrel/Ethinyl Estradiol 0.150/0.03mg Tablet | 84 | EA | ORAL | LEVORA 0.15/30-28 |
| Levonorgestrel/Ethinyl Estradiol 0.1mg/20mcg Tablet | 84 | EA | ORAL | ALESSE |
| Levonorgestrel-EthIinyl Estradiol 0.05-30/0.075-40/0.125-30mg/mcg Tablet | 84 | EA | ORAL | TRIVORA |
| Levonorgestrel-EthIinyl Estradiol 0.15/0.03-0.01mg Tablet 91 Pack | 91 | EA | ORAL | JAIMIESS |
| Levonorgestrel-Ethinyl Estradiol 0.1-0.02mg (84)/Ethinyl Estradiol 0.01mg (7) Tablet | 91 | EA | ORAL | CAMRESE LO |
| Norethindrone 0.35mg Tablet (AB1 NOR-QD/AB2 ORTHO-MICRONOR) | 84 | EA | ORAL | NOR-QD/ORTHO-MICRONOR |
| Norethindrone Acetate 5mg Tablet | 90 | EA | ORAL | AYGESTIN |
| Norethindrone/Ethinyl Estradiol (No Iron) 1.5/0.03mg Tablet | 63 | EA | ORAL | LOESTRIN 1.5/30-21 |
| Norethindrone/Ethinyl Estradiol (No Iron) 1/0.02mg Tablet | 63 | EA | ORAL | LOESTRIN 1/20 |
| Norethindrone/Ethinyl Estradiol 0.4mg/35mcg Tablet | 84 | EA | ORAL | NORTREL 1/35 |
| Norethindrone/Ethinyl Estradiol 0.5/.035mg;0.75/.035mg; 1/.035mg Tablet | 84 | EA | ORAL | ORTHO-NOVUM 7/7/7-28 |
| Norethindrone/Ethinyl Estradiol 1mg/0.035mcg Tablet | 84 | EA | ORAL | NORTREL 1/35 |
| Norethindrone/Ethinyl Estradiol 35mcg/0.5mg Tablet | 84 | EA | ORAL | NORTREL 0.5/35 (28) |
| Norethindrone/Ethinyl Estradiol/Fe 1mg/0.02mg Tablet | 84 | EA | ORAL | LOESTRIN 24 FE |
| Norethindrone/Ethinyl Estradiol/Iron 1.5/.03mg Tablet | 84 | EA | ORAL | LOESTRIN FE 1.5/30 |
| Norethindrone/Ethinyl Estradiol/Iron 1mg/20mcg Tablet | 84 | EA | ORAL | LOESTRIN FE 1/20 |
| Norgestimate/Ethinyl Estradiol 0.18/0.025mg; 0.215/0.025mg and 0.25/0.025mg Tablet | 84 | EA | ORAL | ORTHO TRI-CYCLEN LO |
| Norgestimate/Ethinyl Estradiol 0.18/0.035; 0.215/0.035 and 0.25/0.035mg Tablet | 84 | EA | ORAL | ORTHO TRI-CYCLEN |
| Norgestimate/Ethinyl Estradiol 0.25mg/35mcg Tablet | 84 | EA | ORAL | ORTHO CYCLEN |
| Norgestrel/Ethinyl Estradiol 0.3/0.03mg Tablet | 84 | EA | ORAL | CRYSELLE-28 |
Osteoporosis
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Alendronate 10mg Tablet | 90 | EA | ORAL | FOSAMAX |
| Alendronate 35mg Tablet | 12 | EA | ORAL | FOSAMAX |
| Alendronate 70mg Tablet | 12 | EA | ORAL | FOSAMAX |
| Ibandronate 150mg Tablet | 3 | EA | ORAL | BONIVA |
| Raloxifene 60mg Tablet | 90 | EA | ORAL | EVISTA |
| Risedronate 150mg Tablet (Monthly) | 3 | EA | ORAL | ACTONEL |
| Risedronate 35mg Tablet (Weekly) | 12 | EA | ORAL | ACTONEL |
Smoking Cessation
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Bupropion ER 12HR 150mg Tablet (Smoking Deterrent) | 180 | EA | ORAL | ZYBAN |
Thyroid
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Levothyroxine Sodium 100mcg Tablet | 120 | EA | ORAL | SYNTHROID |
| Levothyroxine Sodium 112mcg Tablet | 120 | EA | ORAL | SYNTHROID |
| Levothyroxine Sodium 125mcg Tablet | 120 | EA | ORAL | SYNTHROID |
| Levothyroxine Sodium 137mcg Tablet | 120 | EA | ORAL | SYNTHROID |
| Levothyroxine Sodium 150mcg Tablet | 120 | EA | ORAL | SYNTHROID |
| Levothyroxine Sodium 175mcg Tablet | 120 | EA | ORAL | SYNTHROID |
| Levothyroxine Sodium 200mcg Tablet | 120 | EA | ORAL | SYNTHROID |
| Levothyroxine Sodium 25mcg Tablet | 120 | EA | ORAL | SYNTHROID |
| Levothyroxine Sodium 300mcg Tablet | 120 | EA | ORAL | SYNTHROID |
| Levothyroxine Sodium 50mcg Tablet | 120 | EA | ORAL | SYNTHROID |
| Levothyroxine Sodium 75mcg Tablet | 120 | EA | ORAL | SYNTHROID |
| Levothyroxine Sodium 88mcg Tablet | 120 | EA | ORAL | SYNTHROID |
| Liothyronine 25mcg Tablet | 90 | EA | ORAL | CYTOMEL |
| Liothyronine 50mcg Tablet | 90 | EA | ORAL | CYTOMEL |
| Liothyronine 5mcg Tablet | 90 | EA | ORAL | CYTOMEL |
| Methimazole 10mg Tablet | 180 | EA | ORAL | TAPAZOLE |
| Methimazole 5mg Tablet | 180 | EA | ORAL | TAPAZOLE |
| Propylthiouracil 50mg Tablet | 270 | EA | ORAL | PROPYLTHIOURACIL |
Urinary Incontinence
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Oxybutynin 5mg Tablet | 180 | EA | ORAL | DITROPAN |
| Oxybutynin ER 24HR 10mg Tablet | 90 | EA | ORAL | DITROPAN XL |
| Oxybutynin ER 24HR 15mg Tablet | 90 | EA | ORAL | DITROPAN XL |
| Oxybutynin ER 24HR 5mg Tablet | 90 | EA | ORAL | DITROPAN XL |
| Solifenacin 10mg Tablet | 180 | EA | ORAL | VESICARE |
| Solifenacin 5mg Tablet | 180 | EA | ORAL | VESICARE |
| Tolterodine ER 24HR 2mg Capsule | 90 | EA | ORAL | DETROL LA |
| Tolterodine ER 24HR 4mg Capsule | 90 | EA | ORAL | DETROL LA |
| Tolterodine Tartrate 1mg Tablet | 180 | EA | ORAL | DETROL |
| Tolterodine Tartrate 2mg Tablet | 180 | EA | ORAL | DETROL |
Vitamins
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Ergocalciferol 50000IU (1.25mg) Capsule | 12 | EA | ORAL | DRISDOL |
| Folic Acid 1mg Tablet | 90 | EA | ORAL | VARIOUS |
Acute Formulary
Immediate Need Medications
The most utilized acute medications in our formulary can be purchased up to a 21-Day supply at no additional cost beyond the monthly membership fee!
If there is an emergency, sickness, or injury and you need your medications fast, our membership card will allow you to fill your prescription at any of 64,000 pharmacies nationwide!
Each medication may only be filled (2) times within a 180-day period. Fills after the first two will be standard contractual pharmacy rates. For Chronic Medications, please call or refer to the Chronic Formulary
Allergy
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Diphenhydramine 50mg Capsule | 21 | EA | ORAL | BENADRYL |
Anesthetics
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Lidocaine Vicious HCl 100ml 20mg/ml Solution | 100 | ML | ORAL LIQUID | XYLOCAINE VISCOUS |
Antibiotics
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Amoxicillin & K Clavulanate For Susp 600mg/42.9mg/5ml Suspension | 200 | ML | ORAL LIQUID | AUGMENTIN ES-600 |
| Amoxicillin (Trihydrate) 500 Tablet | 63 | EA | ORAL | AMOXIL |
| Amoxicillin 250mg Capsule | 63 | EA | ORAL | AMOXIL |
| Amoxicillin 250mg/5ml Suspension | 300 | ML | ORAL LIQUID | AMOXIL |
| Amoxicillin 400mg/5ml Suspension | 200 | ML | ORAL LIQUID | AMOXIL |
| Amoxicillin 500mg Capsule | 63 | EA | ORAL | AMOXIL |
| Amoxicillin 875mg Tablet | 42 | EA | ORAL | AMOXIL |
| Amoxicillin/Potassium Clav 400/57mg/5ml Suspension | 200 | ML | ORAL LIQUID | AUGMENTIN |
| Amoxicillin/Potassium Clav 500/125mg Tablet | 63 | EA | ORAL | AUGMENTIN |
| Amoxicillin/Potassium Clav 875/125mg Tablet | 42 | EA | ORAL | AUGMENTIN |
| Azithromycin 200mg/5ml (30ml) Suspension | 30 | ML | ORAL LIQUID | ZITHROMAX |
| Azithromycin 250mg (#6) Tablet | 1 | EA | ORAL | ZITHROMAX |
| Azithromycin 500mg (#3) Tablet | 1 | EA | ORAL | ZITHROMAX |
| Cefuroxime Axetil Tab 500mg Tablet | 42 | EA | ORAL | CEFTIN |
| Cephalexin 200ml 250mg/5ml Suspension | 400 | ML | ORAL LIQUID | KEFLEX |
| Cephalexin 250mg Capsule | 84 | EA | ORAL | KEFLEX |
| Cephalexin 500mg Capsule | 42 | EA | ORAL | KEFLEX |
| Ciprofloxacin HCl 250mg Tablet | 42 | EA | ORAL | CIPRO |
| Ciprofloxacin HCl 500mg Tablet | 42 | EA | ORAL | CIPRO |
| Clindamycin HCl 150mg Capsule | 84 | EA | ORAL | CLEOCIN |
| Doxycycline Hyclate 20mg Tablet | 42 | EA | ORAL | PERIOSTAT |
| Levofloxacin 250mg Tablet | 20 | EA | ORAL | LEVAQUIN |
| Levofloxacin 500mg Tablet | 20 | EA | ORAL | LEVAQUIN |
| Metronidazole 500mg Tablet | 60 | EA | ORAL | FLAGYL |
| Nitrofurantoin monohydrate/macrocrystals 100mg Capsule | 42 | EA | ORAL | MACROBID |
| Penicillin V Potassium 250mg/5ml Solution | 400 | ML | ORAL LIQUID | VEETIDS |
| Penicillin V Potassium 500mg Tablet | 60 | EA | ORAL | VEETIDS |
| Sulfamethoxazole/Trimethoprim 200mg-40mg/5ml Suspension | 120 | ML | ORAL LIQUID | SULFATRIM PEDIATRIC |
| Sulfamethoxazole/Trimethoprim 800mg/160mg Tablet | 42 | EA | ORAL | BACTRIM DS |
Antibiotics (Ear)
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Neomycin/Polymyxin/HC 10ml 1% Otic Solution | 10 | ML | OTIC LIQUID | CORTISPORIN |
| Neomycin/Polymyxin/HC 10ml 3.5mg-10000 Unit-1%/ml Otic Suspension | 10 | ML | OTIC LIQUID | CORTISPORIN |
Antibiotics (Eye)
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Ciprofloxacin HCl 5ml 0.3% Ophthalmic Solution | 5 | ML | OPHTHAL LIQUID | CILOXAN |
| Erythromycin 3.5gm 5mg/gm Ophthalmic Ointment | 3.5 | GM | OPHTHAL SOLID | ILOTYCIN |
| Ofloxacin 0.3% Ophthalmic Solution | 5 | ML | OPHTHAL LIQUID | OCUFLOX |
| Polymyxin B Sulf/Trimethoprim 10ml 10,000u/0.1%/ml Drops | 10 | ML | OPHTHAL LIQUID | POLYTRIM |
| Tobramycin 5ml 0.3% Ophthalmic Drop | 5 | ML | OPHTHAL LIQUID | TOBREX |
Antibiotics (Topical)
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Clindamycin Phosphate Soln 60ml 1% Solution | 60 | ML | TOPICAL LIQUID | CLEOCIN-T |
| Mupirocin 22gm 2% Ointment | 22 | GM | TOPICAL SOLID | BACTROBAN |
Antiburn (Topical)
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Silver Sulfadiazine 50gm 1% Cream | 50 | GM | TOPICAL SOLID | SSD |
Antifungal / Anti-inflammatory (Topicals)
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Clotrimazole/Betamethasone 15gm 1/0.05% Cream | 15 | GM | TOPICAL SOLID | LOTRISONE |
Antifungals
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Fluconazole 150mg Tablet | 1 | EA | ORAL | DIFLUCAN |
| Nystatin 100mu/ml Suspension | 60 | ML | ORAL LIQUID | MYCOSTATIN |
| Terbinafine 250mg Tablet | 21 | EA | ORAL | LAMISIL |
| Metronidazole 500mg Tablet | 60 | EA | ORAL | FLAGYL |
Antifungals (Topical)
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Clotrimazole 45gm 1% Cream | 45 | GM | TOPICAL SOLID | DESENEX |
| Ketoconazole Shampoo 120ml 2% Shampoo | 120 | ML | TOPICAL LIQUID | NIZORAL |
| Metronidazole Vaginal Gel 70gm 0.75% Gel | 70 | GM | TOPICAL GEL | METROGEL-VAGINAL |
| Nystatin Cream 100,000units/gm Cream | 30 | GM | TOPICAL SOLID | MYCOSTATIN |
Antigout
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Allopurinol 100mg Tablet | 21 | EA | ORAL | ZYLOPRIM |
| Allopurinol 300mg Tablet | 21 | EA | ORAL | ZYLOPRIM |
Antihistamines
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Hydroxyzine HCl 25mg Tablet | 60 | EA | ORAL | HYDROXYZINE HCL |
Anti-inflammatory (Eye)
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Neomycin/Polymyxin/Dexamethasone 5ml 0.1% Ophthalmic Suspension | 5 | ML | OPHTHAL LIQUID | MAXITROL |
| Prednisolone Acetate 5ml 1% Ophthalmic Suspension | 5 | ML | OPHTHAL LIQUID | OMNIPRED |
Anti-inflammatory / NSAIDS
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Diclofenac Sodium DR 75mg Tablet | 42 | EA | ORAL | VOLTAREN |
| Ibuprofen 400mg Tablet | 60 | EA | ORAL | MOTRIN |
| Ibuprofen 600mg Tablet | 60 | EA | ORAL | MOTRIN |
| Ibuprofen 800mg Tablet | 60 | EA | ORAL | MOTRIN |
| Indomethacin 25mg Capsule | 15 | EA | ORAL | INDOCIN |
| Meloxicam 7.5mg Tablet | 21 | EA | ORAL | MOBIC |
| Naproxen 375mg Tablet | 42 | EA | ORAL | NAPROSYN |
| Naproxen 500mg Tablet | 42 | EA | ORAL | NAPROSYN |
| Diclofenac Potassium 50mg Tablet | 42 | EA | ORAL | CATAFLAM |
| Diclofenac Sodium DR 50mg Tablet | 42 | EA | ORAL | VOLTAREN |
| Ketorolac 10mg Tablet | 15 | EA | ORAL | TORADOL |
Anti-inflammatory / Steroid (Oral)
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Prednisone 5mg Tablet | 30 | EA | ORAL | PREDNISONE |
| Dexamethasone 4mg Tablet | 63 | EA | ORAL | DECADRON |
| Fludrocortisone Acetate 0.1mg Tablet | 21 | EA | ORAL | FLORINEF |
| Methylprednisolone Pack (1x21) 4mg Tablet | 21 | EA | ORAL | MEDROL DOSEPAK |
| Prednisone 10mg Tablet | 30 | EA | ORAL | DELTASONE |
| Prednisone 20mg Tablet | 30 | EA | ORAL | DELTASONE |
| Prednisone 50mg Tablet | 42 | EA | ORAL | DELTASONE |
Anti-inflammatory / Steroid (Topical)
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Betamethasone Valerate Oint 1% Ointment 45gm | 45 | GM | TOPICAL SOLID | VALISONE |
| Clobetasol 0.05% Cream 15g | 15 | GM | TOPICAL SOLID | TEMOVATE |
| Clobetasol Propionate 0.05% Ointment15gm | 15 | GM | TOPICAL SOLID | TEMOVATE |
| Hydrocortisone 2.5% Cream | 30 | GM | TOPICAL SOLID | HYTONE |
| Hydrocortisone 2.5% Ointment | 30 | GM | TOPICAL SOLID | HYTONE |
| Mometasone Furoate 0.1% Cream 15gm | 15 | GM | TOPICAL SOLID | ELOCON |
| Triamcinolone Acetonide 0.1% Cream 15gm | 15 | GM | TOPICAL SOLID | KENALOG |
| Triamcinolone Acetonide 0.1% Ointment 80gm | 80 | GM | TOPICAL SOLID | KENALOG |
Antinausea
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Meclizine HCl 25mg Tablet | 63 | EA | ORAL | ANTIVERT |
| Prochlorperazine Maleate 10mg Tablet | 21 | EA | ORAL | COMPAZINE |
| Promethazine HCl 25mg Tablet | 84 | EA | ORAL | PHENERGAN |
Antivirals
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Acyclovir 400mg Tablet | 30 | EA | ORAL | ZOVIRAX |
| Acyclovir 800mg Tablet | 30 | EA | ORAL | ZOVIRAX |
| Valacyclovir 500mg Tablet | 42 | EA | ORAL | VALTREX |
| Acyclovir 200mg Capsule | 50 | EA | ORAL | ZOVIRAX |
Asthma / Bronchodilators
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Albuterol Sulfate (UD 30x3ml) 0.083% (2.5mg/3ml) Inhalation Solution | 90 | ML | NEB | PROVENTIL/VENTOLIN |
| Albuterol Sulfate/Ipratropium Bromide (UD 30x3ml) (3mg/0.5mg/3ml) Inhalation Solution | 90 | ML | NEB | DUONEB |
| Montelukast 10mg Tablet | 21 | EA | ORAL | SINGULAIR |
| Montelukast 5mg Chewable Tablet | 21 | EA | ORAL | SINGULAIR |
| Montelukast Sodium 4mg Chew Tab | 21 | EA | ORAL | SINGULAIR |
| Prednisolone Sod Phosphate 15mg/5mL Oral Solution | 120 | ML | ORAL LIQUID | PRELONE |
Cardiac / Hypertension
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Nitroglycerin 0.4mg Disintegrating Tablet (#25) | 1 | EA | ORAL | NITROSTAT |
Cough and Cold
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Benzonatate 100mg Capsule | 30 | EA | ORAL | TESSALON PERLES |
| Benzonatate 200mg Capsule | 30 | EA | ORAL | TESSALON PERLES |
| Promethazine-DM 6.25-15mg/5mL Syrup | 240 | ML | ORAL LIQUID | PHERAZINE DM |
Gastrointestinal
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Dicyclomine 10mg Capsule | 60 | EA | ORAL | BENTYL |
| Dicyclomine 20mg Tablet | 63 | EA | ORAL | BENTYL |
| Famotidine 20mg Tablet | 42 | EA | ORAL | PEPCID |
| Omeprazole DR 20mg Capsule | 21 | EA | ORAL | PRILOSEC |
| Omeprazole DR 40mg Capsule | 21 | EA | ORAL | PRILOSEC |
| Pantoprazole EC 40mg Tablet | 21 | EA | ORAL | PROTONIX |
| Diphenox/Atropine 2.5/.025mg Tablet | 30 | EA | ORAL | LOMOTIL |
| Polyethylene Glycol 3350 236gm NA Solution | 4000 | ML | ORAL LIQUID | GO-LYTELY |
Migraine
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Naratriptan 2.5mg Tablet | 9 | EA | ORAL | AMERGE |
| Rizatriptan 10mg Tablet | 6 | EA | ORAL | MAXALT |
| Rizatriptan 5mg Tablet | 6 | EA | ORAL | MAXALT |
| Rizatriptan ODT 10mg Disintegrating Tablet | 3 | EA | ORAL | MAXALT-MLT |
| Sumatriptan 100mg Tablet | 9 | EA | ORAL | IMITREX |
| Sumatriptan 50mg Tablet | 9 | EA | ORAL | IMITREX |
| Butalbital/Acetaminophen/Caffeine 50/325/40mg Tablet | 42 | EA | ORAL | ESGIC |
Muscle Relaxants
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Tizanidine 2mg Tablet | 30 | EA | ORAL | ZANAFLEX |
| Tizanidine 4mg Tablet | 42 | EA | ORAL | ZANAFLEX |
| Cyclobenzaprine HCl 5mg Tablet | 30 | EA | ORAL | FLEXERIL |
| Cycylobenzaprine HCl 10mg Tablet | 63 | EA | ORAL | FLEXERIL |
| Methocarbamol 500mg Tablet | 60 | EA | ORAL | ROBAXIN |
| Methocarbamol 750mg Tablet | 60 | EA | ORAL | ROBAXIN-750 |
Oral Health
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Chlorhexidine Gluconate 473ml 0.12% Oral Solution | 473 | ML | ORAL LIQUID | PERIOGARD |
| Sodium Fluoride 51gm 1.1% Gel | 51 | GM | ORAL GEL | PREVIDENT 5000 DRY MOUTH |
| Triamcinolone 5gm 0.1% Dental Paste | 5 | GM | ORAL PASTE | ORALONE DENTAL PASTE |
Pain Relievers
| Medicine Name | Max Qty | Units | Route | Reference Brand |
|---|---|---|---|---|
| Acetaminophen/Tramadol HCl 325/37.5mg Tablet | 63 | EA | ORAL | ULTRACET |
| Gabapentin 300mg Capsule | 60 | EA | ORAL | NEURONTIN |
| Gabapentin 400mg Capsule | 60 | EA | ORAL | NEURONTIN |
| Gabapentin 600mg Tablet | 60 | EA | ORAL | NEURONTIN |
| Gabapentin 800mg Tablet | 60 | EA | ORAL | NEURONTIN |
| Tramadol 50mg Tablet | 63 | EA | ORAL | ULTRAM |