Holloman AFB Formulary

DISPENSING POLICIES/ PROCEDURES
Main Pharmacy
280 First St, Bldg. 15
Holloman AFB, NM 88330
Open: 0730 - 1630, M-F
Tel. No: (575) 572-7318
Refill Pharmacy Tel. No: (575) 572-7045 / 1-800-843-4682

The Pharmacy is closed: Saturday, Sunday, all federal holidays and specially designated 'down' days

The pharmacy must use generic medication whenever possible so please write all medications generically.

A prescription written as "Dispense as Written" may not be accepted.

Drugs with narrow therapeutic margins will not be generically substituted.

TELEPHONE PRESCRIPTIONS
Per Air Force directives, no pharmacy staff member may receive a prescription called in from a provider. This also includes prescription renewals. The pharmacy can, however, accept a change or substitution to a non-controlled prescription if the original prescription is located within the pharmacy.

Fax's: New prescriptions via FAX are NOT accepted.

NON-CONTROLLED PRESCRIPTIONS
Are honored up to 1 year from the date the prescription was written. Antibiotic prescriptions over 10 days old will be filled at the discretion of the pharmacy. Prescriptions for maintenance medications may be written for up to a 90 day supply with a maximum of 3 refills when requested by prescriber. All other non-controlled prescriptions may be written for up to 30 days supply with a maximum of 11 refills.

CONTROLLED PRESCRIPTIONS(**)
Prescriptions for Schedule 3, 4 or 5 medications will be honored for 6 months from the date they were written with up to 5 refills. Prescriptions for Schedule 2 medications will be honored for 7 days from the date they were written with no refills. Providers are reminded to include their DEA number on all controlled prescriptions.

REFILL POLICY
Refills MUST be called in through the automated refill system at 572-7045. They may be called in 7 days before the Rx should run out. Please allow for 2 duty days for refills to be ready.

Although medications are provided at no cost to our patients, this service is not free -- the American taxpayer pays the bill. Please consider less expensive alternatives whenever possible when prescribing.

TRICARE MAIL ORDER PHARMACY (EXPRESS SCRIPTS)
Contact 1-866-363-8667 or www.express-scripts.com/TRICARE for more information.
30 or 90 day supply:
Active duty: No cost
All Other Beneficiaries: Generic $0, Formulary Brand-Name: $9; Non-Formulary Brand-Name: $25
Copayments at retail pharmacies are $5 for generic drugs, $12 for brand name and $25 for non-formulary.

**The brand name in the listings are for reference only and do not signify the product dispensed**

I. Anti-Infective Agents

Cephalosporins

Cefdinir (Omnicef) Caps 300 mg
Cefdinir (Omnicef) Susp 125mg/5ml, 250mg/5ml
Cefpodoxime (Vantin) Tabs 100mg, 200 mg
Cefpodoxime (Vantin) Susp 100mg / 5mL
Cephalexin (Keflex) Caps 250mg, 500mg
Cephalexin (Keflex) Susp 250mg / 5mL

Fluoroquinolones

Ciprofloxacin (Cipro) Tabs 100mg, 250mg, 500 mg, Susp 250mg/5ml
Levofloxacin (Levaquin) Tabs 250mg, 500mg, 750mg, Sol 25mg/ml

Macrolides

Azithromycin (Zithromax) Susp 200mg / 5mL
Azithromycin (Zithromax) Susp 100 mg / 5 mL
Azithromycin (Zithromax) Z-pak Tabs 250mg, Tri-Pak 500mg, 1gm packets
Clarithromycin (Biaxin) Tabs 250mg, 500mg
Erythromycin (Ery-Tab) Tabs 250mg, 333mg, 400mg
Erythromycin (EryPed) Susp 200mg/5mL, 400mg / 5mL

Penicillins

Amoxicillin (Trimox) Susp 250mg/5ml; 400mg/5mL
Amoxicillin (Trimox) Caps 250, 500mg
Amox / Clav (Augmentin) Tabs 250mg, 500mg, 875mg
Amox / Clav (Augmentin) Susp 125mg/5ml, 400mg/5ml, 600mg/5ml
Dicloxacillin (Dynapen) Caps 250mg
Penicillin V Pot (Pen VK) Tabs 250mg, 500mg
Penicillin V Pot (Pen VK) Oral Susp 250mg /5mL

Sulfonamides

Sulfamethoxazole 800mg / Trimethoprim 160mg (Bactrim DS) Tabs
Sulfamethoxazole 200mg/ Trimethoprim 40mg (Bactrim Pediatric) Susp

Tetracyclines

Doxycycline (Vibramycin) Tabs 100mg
Tetracycline (Achromycin) Caps 250mg
Minocycline (Minocin) Caps 100mg

Other

Clindamycin (Cleocin) Caps 150mg, 300 mg
Clindamycin (Cleocin) Liquid 75mg/5ml
Nitrofurantoin (Macrodantin) Caps 50mg, 100mg
Nitrofurantoin (Macrobid) Caps 100mg

Antifungals

Fluconazole (Diflucan) Tabs 150mg, Susp 10mg/ml
Griseofulvin (Grifulvin-V) Oral Susp 125mg / 5 mL (microsized)
Griseofulvin Ultra (Gris-Peg) Tabs 125mg
Ketoconazole (Nizoral) Tabs 200mg
Ketoconazole (Nizoral) 2% Shampoo
Nystatin (Mycostatin) Tabs 500,000 units
Terbinafine (Lamisil) Tabs 250mg

Antiviral

Amantadine (Symmetrel) Caps 100mg
Acyclovir (Zovirax) Caps 200mg, Tabs 800mg, Sus 200mg/5ml
Hydroxychloroquine (Plaquenil) Tabs 200mg
Metronidazole (Flagyl) Tabs 250mg
Valcyclovir (Valtrex) Tabs 500mg

Antitubercular Agents

Ethambutol (Myambutol) Tabs 100mg, 400mg
Isoniazid (INH) Tabs 100mg, 300mg
Isoniazid (INH) Syrup 50mg / 5mL
Pyrazinamide Tabs 500 mg
Rifampin (Rifadin) Caps 300mg

Antihelmintic Agent

Mebendazole (Vermox) Chew Tab 100mg

II. Cardiovascular Agents

Antianginals/Vasodilator

Nitroglycerin sl Tabs 0.3mg, 0.4mg, Pump Spray, Oint 2%, Patches 0.1mg/hr, 0.2mg/hr, 0.3mg/hr, 0.4mg/hr, 0.6mg/hr, 0.8mg/hr
Isosorbide Dinitrate Tabs 5mg, 10mg, 40mg SR caps
Isosorbide Mononitrate (Imdur) Tabs 30mg, 60mg, and 120mg

Antihyperlipemics

BILE ACID SEQUESTRANT

Colestipol (Colestid) granules 300gm/box
Colestipol (Colestid) Tabs 1gram

FIBRIC ACID DERIVATIVES

Fenofibrate (TriCor) Tabs 48mg, 145mg
Gemfibrozil (Lopid) Tabs 600mg

HMG-CoA REDUCTASE INHIBITOR

Atorvastatin (Lipitor) Tabs 10mg, 20mg, 40mg, 80mg
Pravastatin (Pravachol) Tabs 10mg, 20mg, 40mg, and 80mg
Rosuvastatin(Crestor) Tabs 5mg, 10mg, 20mg, 40mg
Simvastatin (Zocor) Tabs 5mg, 10mg, 20mg, 40mg, and 80mg
Ezetimibe/Simvastatin (Vytorin) Tabs 10/10, 10/20, 10/40, 10/80 mg

MISC

Ezetimibe (Zetia) Tabs10mg
Niacin (Niaspan Extended-Release) Tabs 500mg, 750mg, and 1,000mg
Nicotinic Acid (Niacin) Tab 500mg

Antihypertensives

ACE INHIBITORS/COMBINATION PRODUCTS

Amlodipine/Benazepril (Lotrel) Caps 2.5/10, 5/10, 5/20, 10/20, 5/40, 10/40 mg
Captopril (Capoten) Tabs 25mg, 50mg, and 100mg
Lisinopril (Prinivil, Zestril) Tabs 2.5mg, 5mg, 10mg, 20mg, 30mg, and 40mg
Lisinopril-HCTZ (Zestoretic) Tabs 10-12.5mg, 20-25mg, 20-12.5mg
Ramipril (Altace) Caps 2.5mg, 5mg, 10mg

ANGIOTENSIN II BLOCKERS/COMBINATION DIURETIC

Losartan (Cozaar) Tabs 25mg, 50mg, and 100mg
Losartan/HCTZ (Hyzaar) Tabs 50/12.5mg, 100/25mg
Telmisartan (Micardis) Tabs 20mg, 40mg, and 80mg
Telmisartan/Hctz (Micardis HCT) 80mg/12.5mg, 80mg/25mg, 40mg/12.5MG
Valsartan (Diovan) Tabs 40mg, 80mg, 160mg, 320mg
Valsartan/HCTZ (Diovan HCT) Tabs 80mg/12.5mg, 160mg/12.5mg, 160mg/25mg, 320mg/12.5mg, 320mg/25mg

BETA BLOCKERS

Atenolol (Tenormin) Tabs 25mg, 50mg, 100mg
Carvedilol (Coreg) Tabs 3.125mg, 6.25mg, 12.5mg, and 25mg
Labetalol (Trandate) Tabs 200mg
Metoprolol (Lopressor) Tabs 25 mg, 50mg, and 100mg
Metoprolol XL (Toprol XL) Tabs 25mg, 50mg, 100mg, and 200mg
Propranolol (Inderal) Tabs 10mg, 40mg
Propranolol (Inderal LA) Caps 60mg, 80mg, and 120mg

CALCIUM CHANNEL BLOCKERS

Amlodipine (Norvasc) Tabs 2.5mg, 5mg, 10mg
Diltiazem (Tiazac) Tabs 60mg
Diltiazem (Tiazac SR) Caps 120mg, 180mg, 240mg, 300mg, 360mg, and 420mg
Felodipine (Plendil) Tabs 2.5mg, 5mg, 10mg
Nifedipine SR (Adalat CC) Tabs 30g, 60mg, and 90mg
Verapamil (Calan) Tabs 80mg
Verapamil (Calan SR) Tabs 120mg,180mg, 240mg

ALPHA-ADRENERGIC BLOCKERS

Doxazosin (Cardura) Tabs 2mg, 4mg, and 8mg
Prazosin (Minipress) Caps 1mg, 2mg, 5mg
Terazosin (Hytrin) Caps 1mg, 2mg, 5mg, 10mg

MISC. ANTIHYPERTENSIVES

Clonidine (Catapress TT Patches) 0.1 mg, 0.2 mg, 0.3 mg
Clonidine (Catapres) Tabs 0.1mg
Hydralazine (Apresoline) Tabs 10mg, 25mg
Methyldopa (Aldomet) Tabs 250mg

Antiplatelets/ Anticoagulants

Aspirin / Dipyridamole (Aggrenox) caps 5/200mg
Aspirin 81 mg Chewable Tabs, 325mg Tabs
Aspirin (Ecotrin) EC Tabs 325mg
Dipyridamole (Persantine) Tabs 25mg
Clopidogrel (Plavix) Tabs 75mg
Warfarin (Coumadin) Tabs 1mg, 2mg, 2.5mg, 3mg, 4mg, 5mg, 6mg, 7.5mg, and 10mg

Diuretics

CARBONIC ANHYDRASE INHIBITOR

Acetazolamide (Diamox) Tabs 250mg, 500mgCaps

LOOP

Furosemide (Lasix) Tabs 20mg, 40mg, sol 10mg/ml

THIAZIDE/COMBINATION POTASSIUM_SPARING

Chlorthalidone (Hygroton) Tabs 25mg, 50mg
Hydrochlorothiazide (HCTZ) Caps 12.5mg
Hydrochlorothiazide (HCTZ) Tabs 25mg, 50mg
Hydrochlorothiazide 25mg / Triamterene 37.5mg (Maxzide-25) Tabs
Indapamide (Lozol) Tabs 2.5mg
Metazolone (Zaroxolyn) Tabs 5mg

POTASSIUM-SPARING

Spironolactone (Aldactone) Tabs 25mg

Antiarrhythmics

Amiodarone (Pacerone) Tabs 200mg
Digoxin (Lanoxin) Tabs 0.125mg, 0.25mg, Sol 0.05/ml
Mexiletine (Mexitil) Caps 250mg

III. Central Nervous System Agents

Anticonvulsants

BARBITURATE

**Phenobarbital (Luminal) Tabs 30mg; Syrup 20mg/5ml
Primidone (Mysoline) Tabs 50mg, 250mg

BENZODIAZEPINE

**Clonazepam (Klonopin) Tabs 0.5mg
**Diazepam (Valium) Tabs 5mg

MISC

Carbamazepine (Tegretol) Chewtabs 100mg; Tabs 200mg, Sus 100mg/5ml
Carbamazepine Extended Release (Tegretol XR) Tabs 400mg
Divalproex Sodium (Depakote) Tabs 125mg, 250mg, Caps Sprk 125mg
Divalproex Sodium (Depakote ER) Tabs 250mg, 500mg
Gabapentin (Neurontin) Caps100mg 300mg, 400mg, 600mg, 800mg
Phenytoin (Dilantin) Caps 100mg
Phenytoin (Dilantin Infatabs) Chewtabs 50mg
Phenytoin (Dilantin) Oral susp 125mg / 5mL

Antidepressants

ALPHA-2 ANTAGONISTS

Mirtazapine (Remeron) Tabs 15mg

DOPAMINE-REUPTAKE INHIBITOR

Bupropion (Wellbutrin) Tabs SR 100mg, 150mg

SELECTIVE SEROTONIN REUPTAKE INHIBITOR (SSRI)

Citalopram (Celexa) Tabs 20mg, 40mg
Fluoxetine (Prozac) Caps 10mg, 20mg, Sol 20mg/5ml
Paroxetine (Paxil) Tabs 20mg, 40mg
Sertraline (Zoloft) Tabs 50mg, 100 mg, sol 20mg/ml

SEROTONIN/NOREPINEPHRINE INHIBITOR (SNRI)

Venlafaxine (Effexor) Tabs 75mg, 100mg;
XR Caps 37.5mg, 75mg, 150mg

SEROTONIN REUPTAKE INHIBITOR/ANTAGONIST (SNIA)

Trazodone (Desyrel) Tabs 50mg, 100mg

TRICYCLIC-(Limit of 30 day supply)

Amitriptyline (Elavil) Tabs 10mg, 25mg, 100mg
Doxepin (Sinequan) Caps 25mg, 100mg, 150mg, sol 10mg/ml
Imipramine (Tofranil) Tabs 10mg, 25mg
Nortriptyline (Pamelor) Caps 10mg, 25mg, sol 10mg/5ml
Mood Stabilizer / Antipyscotics

Lithium Carbonate Caps 150mg, Tabs 300 mg, syp 8meq/5ml
Olanzapine (Zyprexa) Tabs 2.5mg, 5 mg, and 10mg
Quetiapine (Seroquel) Tabs 25mg, 100mg, 200mg, and 300mg
Quetiapine Extended Release (Seroquel XR) Tabs 150mg, 200mg, and 50mg
Risperidone (Risperdal) Tabs 0.25mg, 0.5mg, 1mg, 2mg, 3mg, Sol 1mg/ml
Thioridazine (Mellaril) Tabs 25mg, 100mg

Anti- Parkinson's Agents

ANTICHOLINERGIC

Benztropine (Cogentin) Tabs 0.5mg, 2mg

DOPAMINE AGONIST

Amantadine (Symmetrel) Caps 100mg
Carbidopa / Levodopa (Sinemet) Tabs 25/250 mg, 25/100mg, 10/100mg
Trihexyphenidyl (Artane) Tabs 2mg, 5mg; Elixir 2mg/5ml

Anxiolytics / Sedatives / Hypnotics

BENZODIAZEPINE

Alprazolam (Xanax) Tabs 0.5mg
Clonazepam (Klonopin) Tabs 0.5mg
Diazepam (Valium) Tabs 5mg
Lorazepam (Ativan) Tabs 1mg
Temazepam (Restoril) Caps 15mg, 30mg

MISC

Buspirone (Buspar) Tabs 5mg, 10mg
Zolpidem (Ambien) Tabs 5mg, 10mg

Central Nervous System Stimulants/ADHD Medications

Atomoxetine (Strattera) 10mg, 18mg, 25mg, 40mg, 60mg Caps
**Dextroamphetamine (Dexedrine) Tabs 5mg; 10mg, 15mg SR Caps
**Methylphenidate (Ritalin) Tabs 5mg, 10mg
**Methylphenidate SR (Ritalin SR) Tabs SR 20mg
**Methylphenidate (Concerta) Tabs Ext. Release 18 mg, 27mg, 36mg, and 54mg
**D, L-amphetamine (Adderall) Tabs 5mg, 10mg, 20mg
**D, L-amphetamine (Adderall-XR) Caps 5mg, 10mg, 15mg, 20mg, 25mg, 30mg

Migraine Agents

SEROTONIN 5-HT1D AGONIST- (Limit Quantities)

Sumatriptan (Imitrex) Injection 6mg
Sumatriptan (Imitrex) Tabs 25mg, 50mg, and 100mg
Sumatriptan (Imitrex) Nasal spray 5mg, 20mg
Zolmitriptan (Zomig) Tabs 2.5mg, 5mg

MISC

**Acetaminophen 325 mg / Butalbital 50 mg / Caffeine 40mg (Fiorcet) Tabs
**Aspirin 325mg / Butalbital 50mg / Caffeine 40mg (Fiorinal) Tabs
Divalproex Sodium (Depakote ER) Tabs 250mg, 500mg

IV. Dermatologic Agents

Acne Products

Adapalene (Differin) Cream & Gel 0.1%
Benzoyl Peroxide Gel 2.5%
Clindamycin/Benzoyl Peroxide (Benzaclin) Gel
Tretinoin (Retin A) Cream 0.025%, 0.05%, 0.1%; Gel 0.01%, 0.025% (Age limit of 35 or younger)
Isotretinoin (Accutane) Caps 10mg, 20mg, 40mg

Antibiotics - Topicals

Bacitracin oint
Clindamycin (Cleocin) 1% Soln
Erythromycin 2% Soln, Gel
Metronidazole (Metrogel) 1% Gel
Mupiricin (Bactroban) 2% Oint
Silver sulfadiazine (Silvadene) Cream 1%

Antifungals - Topicals

Clotrimazole (Lotrimin) Topical sol 1%, Cream 1%
Ketoconazole (Nizoral) 2% Cream, 2%Shampoo
Miconazole (Monistat Derm) Cream 2%
Nystatin/Triamcinolone (Mycolog) Cream 100,000 units/0.1%
Nystatin (Mycostatin) 100,000 units/gm Cream, Oint. Powder
Terbinafine (Lamisil) Cream 1%

Antiparasitic - Topical

Permethrin (NIX) 1% Cream Rinse
Permethrin (Elimite) Cream 5%

Antiseborrheic Agent- Topical

Selenium sulfide (Selsun) Shampoo 2.5%

Corticosteroids-Topical

Betamethasone Valerate (Valisone) Cream 0.1%
Clobetasol Propionate (Temovate) Cream, Oint, Soln 0.05%
Fluocinonide (Lidex) Cream, Ointment 0.05%
Fluocinolone (Derma-Smooth/FS) Oil 0.01%
Flurandrenolide (Cordran) Tape
Hydrocortisone Cream 1%, 2.5%
Hydrocortisone Valerate (Westcort) Cream0.2%
Triamcinolone (Kenalog) 0.1%; Cream, Spray

ANESTHETIC/CORTICOSTEROID COMBINATION

Pramozine/Hydrocortisone (Proctofoam HC) Foam 1%/1%

Local Anesthetics-topical

Cepacol lozenges Reg
Lidocaine (Xylocaine) Oint 5%; Jelly 2%; Visc soln 2%

Misc-Topical

Aluminum chloride (Drysol) Soln 20%
Amlexanox (Aphthasol) Oral Paste 5%
Ammonium lactate (Lac-Hydrin) Lotion12%
Fluorouracil (Efudex) Cream 5%
Pimecrolimus (Elidel) Cream 1%
Podofilox (Condylox) Soln 0.5%
Salicylic acid (Duofilm) soln 17%
Zinc Oxide Oint. 20%

V. Gastrointestinal Agents

H2-ANTAGONIST

Cimetidine (Tagamet) Tabs 400mg; 300mg/5ml Syrup
Ranitidine (Zantac) Tabs 150mg; Syrup 15mg/mL

PROTON PUMP INHIBITORS

Esomeprazole (Nexium) Caps 20mg, 40mg
Omeprazole (Prilosec) Caps 10mg, 20mg

ANTISPASMODIC AGENTS
Hyoscyamine / Atropine / Phenobarbital/ Scopalamine (Donnatal) Tabs 0.1037 mg/0.0194 mg/16.2mg/0.0065mg, Elixir 16.2mg/5ml
Belladonna 0.2 mg/Phenobarbital 40 mg/Ergotamine 0.6mg (Bellergal-S) Tabs
Dicyclomine (Bentyl) Tabs 20mg, Caps 10mg sol 10mg/5ml
Chlordiazepoxide /Clindinium (Librax) Caps

LAXATIVE

Bisacodyl (Dulcolax) Tabs 5mg; Supps 10mg
Docusate sodium (Colace) Caps 100mg; 150mg/15ml Syrup
Fleets Enema
Fleets Oral Saline Laxative (PhosphaSoda)
GoLytely/CoLytely
Lactulose (Cephulac) Syrup 10mg / 15ml

ANTIDIARRHEALS

Bismuth subsalicylate (Pepto-Bismol) Chewtabs 262mg
**Diphenoxylate/Atropine (Lomotil) Tabs 2.5mg/0.025mg
Loperamide (Imodium) Caps 2mg

MISC

Pancreatic Enzymes (Pancreaze)
Simethicone (Mylicon) Tabs 80mg
Sucralfate (Carafate) Tabs 1gm
Sulfasalazine (Azulfidine) Tabs 500mg; Entabs 500mg
Mesalamine (Asacol) Tabs 400 mg

Antiemetics

Meclizine (Antivert) Tabs 25mg
Metoclopramide (Reglan) Tabs 10mg;
Syrup 5mg/5ml
Prochlorperazine (Compazine) Tabs 5mg
Prochlorperazine (Compazine) Supps 25mg
Promethazine (Phenergan) Tabs 25mg, Syp 6.25mg/5ml: Suppositories 12.5mg, 25mg
Ondansetron (Zofran ODT) 4mg, 8mg
Ondansetron (Zofran) 2 mg / mL liquid


VI. Genitourinary Agents

Urinary Tract Agents

OVERACTIVE BLADDER AGENTS

Oxybutynin (Ditropan) Tabs 5mg; 5mg/5ml Syrup
Oxybutynin ER (Ditropan XL) Tabs 5mg, 10mg,15mg
Tolterodine (Detrol LA) Caps 2mg, 4mg

URINARY ANALGESIC

Phenazopyridine (Pyridium) Tabs 100mg

BPH AGENTS

Alfuzosin (Uroxatral) Tabs 10mg
Doxazosin (Cardura) Tabs 2mg, 4mg, and 8mg
Terazosin (Hytrin) Caps 1mg, 2mg, 5mg, 10mg
Finasteride (Proscar) Tabs 5mg
Tamsulosin (Flomax) Cap 0.4mg

VII. Metabolic / Endocrine Agents

Androgens

**Testosterone Cypionate Inj 200mg /mL

Corticosteroids

Dexamethasone (Decadron) Tabs 1mg, 4mg
Fludrocortisone (Florinef) Tabs 0.1mg
Hydrocortisone (Cortef) Tabs 20mg
Methylprednisolone (Medrol-Dose Pak) Tabs 4mg 21'S
Prednisolone Oral (Prelone) liquid 15mg / 5mL
Prednisone (Deltasone) Tabs 1mg, 5mg, 20mg, sol 5mg/5ml

Diabetic Agents

INSULIN

Insulin NPH (Novolin N) 100units/ml 10ml
Insulin NPH / Regular 70/30 (Novolin 70/30) 100units/ml 10ml
Insulin Regular (Novolin R) 100units/ml 10ml
Insulin Glargine (Lantus) 100units/ml 10ml
Insulin Aspart (Novolog) 100units/ml 10ml
Insulin Glargine Pen (Lantus Solostar) 15ml per box
Insulin Aspart Pen (Novolog Flex Pen) 15ml per box
Inusulin Aspart 70/30 Pen (Novolog 70/30 Flex Pen)

SULFONYLUREA AGENTS

Glipizide (Glucotrol) Tabs 5mg
Glyburide (Diabeta, Micronase) Tabs 5mg
Glyburide micronized (Glynase) Tabs 1.5mg, 3mg, and 6mg
Glyburide Tabs 1.25mg, 2.5mg

BIGUANIDE

Metformin (Glucophage) Tabs 500mg, 850mg. 1000mg
Metformin XR (Glucophage XR) Tabs 500mg, 750mg

THIAZOLIDINEDIONE/COMBINATION

Pioglitazone (Actos) Tabs 15mg, 30mg, 45mg

MISC

Nateglinide (Starlix) Tabs 60mg, 120mg
Sitagliptin (Januvia) Tabs 50 mg, 100 mg
Sitagliptin / Metformin (Janumet) Tabs 50/500, 50/1000

Diabetic Supplies

Glucose Test Strips (Precision XTRA)
Lancets
Syringes, insulin 0.5mL (Lo-Dose) 100s; 1mL 100s
BD Pen Needles Original and Short

Gout Agents

Allopurinol (Zyloprim) Tabs 100mg, 300mg
Probenecid (Benemid) Tabs 500mg

Hormone Replacement Therapy

Estradiol (Estrace) Tabs 0.5mg, 1mg, 2mg
Estradiol Trans (Climara) 0.05mg/day, 0.1mg)/day
Estrogen Conj (Premarin) Tabs 0.3mg, 0.45mg, 0.625mg, 0.9mg, 1.25mg
Estrogen Conjugated (Premarin) vaginal cream 0.625mg/g
Estrogen Conj/Medroxyprogesterone (PremPro) Tabs 0.3mg/ 1.5mg
Estrogen Conj/Medroxyprogesterone (PremPro) Tabs 0.45mg/1.5mg
Estrogen Conj/Medroxyprogesterone (PremPro) Tabs 0.625mg /2.5mg
Estrogen Conj/Medroxyprogesterone (PremPro) Tabs 0.625mg/5mg
Estropipate (Ogen) Tabs 0.625mg, 1.25mg
Medroxyprogesterone (Provera) Tabs 2.5mg, 10mg
Raloxifene (Evista) Tabs 60mg

Contraceptives

Alesse
Depo-Provera 150mg/ml
Demulen 1/35-28
Jolessa (generic Seasonale)
Levlin
Loestrin Fe 1/20, 1.5/30
Lo-Ovral
Nor QD
Ortho Cyclen(Mononessa)
Ortho-Evra Transdermal patches
Ortho Tri-cyclen, Ortho Tri-cyclen LO
Ortho Novum 1/35, 1/50
Ortho Novum 7-7-7
Ovral
Triphasil / Trilevlen
Desogen/Apri/Ortho-Cept
Nuvaring
Yasmin
Yaz
Plan B/ Next Choice

Thyroid Agents

Levothyroxine (Synthroid) Tabs 0.025, 0.05, 0.075, 0.088, 0.1, 0.112, 0.125, 0.15, 0.175mg
Methimazole (Tapazole) Tabs 10 mg
Propylthiouracil (PTU) Tabs 50 mg

LHRH Agonists

Goserelin (Zoladex) 3.6mg, 10.8mg implants

VIII. Musculoskeletal Agents

Analgesics

Acetaminophen (Tylenol) Tabs 325mg
Acetaminophen (Tylenol) Elixir 160mg/5mL
**Tramadol (Ultram) Tabs 50mg


NSAIDS

Celecoxib (Celebrex) 100mg & 200mg
Ibuprofen (Motrin) Tabs 400mg, 600mg, 800mg
Ibuprofen (Motrin) Susp 100mg / 5mL
Indomethacin (Indocin) Caps 25mg
Ketorolac (Toradool) Tabs 10mg (max 20/month)
Meloxicam (Mobic) Tabs 7.5mg, 15mg
Naproxen (Naprosyn) Tabs 250mg, 275mg, 500mg, 550mg, 125/5mlsusp
Oxaprozin (Daypro) Tabs 600mg
Piroxicam (Feldene) Caps 20mg
Salsalate (Disalcid) Tabs 500mg, 750mg
Sulindac (Clinoril) Tabs 200mg

Analgesics Opioids

**Acetaminophen 300mg / Codeine 30mg
(Tylenol #3) Tabs
**Acetaminophen 120mg / Codeine 10mg / 5mL Elixir
**Acetaminophen 500mg / Hydrocodone 5mg (Lortab/Vicodin) Tabs
**Acetaminophen 325mg / Oxycodone 5mg (Percocet) Tabs
**Acetaminophen 500mg / Oxycodone 5mg (Tylox) Caps
**Codeine Tabs 30mg
**Meperidine (Demerol) Tabs 50mg, Inj. 50mg, 100mg
**Methadone Tabs 10mg- (For pain only)
**Morphine sulfate SR (MS Contin) Tabs 15mg, 30mg
**Morphine sulfate IR (MSIR) 15mg, 30mg

Antirheumatic Agents

Azathioprine (Imuran) Tabs 50mg
Hydroxychloroquine (Plaquenil) Tabs 200mg
Methotrexate (Rhematrex) Tabs 2.5mg
Sulfasalazine (Azulfidine) Tabs 500mg; ENtabs 500mg

Osteoporosis Agents/Bisphosphonate

Alendronate (Fosamax) Tabs 5mg, 10mg, 35mg, 70mg
Alendronate PlusD 70mg/2800IU
Ibandronate (Boniva) Tabs 2.5mg, 150mg
Raloxifene (Evista) Tabs 60mg
Risedronate (Actonel) Tabs 35mg

Skeletal Muscle Relaxant

Baclofen (Lioresal) Tabs 10mg
Cyclobenzaprine (Flexeril) Tabs 5mg, 10mg
Metaxalone (Skelaxin) Tabs 800mg (limit of 30 day supply)
Methocarbamol (Robaxin) Tabs 500mg
Orphenadrine (Norflex) Tabs 100mg

Misc

Pyridostigmine (Mestinon) Tabs 60mg

IX. Ophthalmic Agents

Anti-Infectives

Bacitracin oint
Ciprofloxacin (Ciloxin) 0.3% Soln; Oint 0.3%
Erythromycin Oint 5mg/gm
Gentamicin (Garamycin) Soln 0.3%; Oint 0.3%
Moxifloxacin (Vigamox) 0.5% Soln
Neomycin / Polymyxin B / Gramicidin (Neosporin) Soln
Neomycin / Polymyxin B / Bacitracin (Neosporin) Oint
Polymyxin B / Trimethoprim (Polytrim) Soln
Sulfacetamide (Bleph-10) 10% Soln, Oint
Tobramycin/Dexamethasone (TobraDex) Susp, Oint
Tobramycin (Tobrex) 0.03% soln

Anti-Inflammatory / Allergy

Fluorometholone(FML) Susp 0.1%
Flurbiprofen (Ocufen) Soln
Lodoxamide (Alomide) Soln 0.1%
Loteprednol (Lotemax) Susp 0.5%
Olopatadine(Patanol) Soln 0.1%
Prednisolone (Pred-Forte) Soln 1%
Prednisolone (Pred Mild) Soln 0.125%

Glaucoma

BETA_BLOCKERS

Betaxolol S (Betoptic S) Susp 0.25%
Carteolol (Ocupress) Soln 1%
Timolol (Timoptic) Soln 0.25%, 0.5%
Timolol (Timocptic-XE) Gel 0.25% 0.5%

ALPHA2-ADRENERGIC AGONIST

Brimonidine (Alphagan-P) Drops 0.15%
Brimonidine (Alphagan) Drops 0.2%
Dipivefrin (Propine) Soln 0.1%

PROSTAGLANDIN

Latanoprost (Xalatan) Soln 0.05%

CHOLINERGIC AGENT

Pilocarpine (Isoptocarpine) Soln 0.5%, 1%, 2%, 4%
Pilocarpine (Pilopine HS) Gel 4%

NSAID

Ketorolac (Acular LS) 0.4% Soln

Misc

Artificial Tears
Celluvisc Drops
GenTeal 0.3% Soln
Sodium Chloride 5% (Muro) Ointment

X. Otic Agents

Acetic Acid (Domeboro) Soln 2%
Antipyrine/Benzocaine (Auralgan) Soln
Bacitracin / Neomycin/ Polymyxin B/Hydrocortisone (Cortisporin) Susp
Carbamide(Debrox) Soln 6.5%
Ciprofloxacin / Dexamethazone (Ciprodex)

XI. Respiratory Agents

Antihistamines / Decongestants / Cough / Cold / Allergy

ANTIHISTAMINES/ANTIHISTAMINE & DECONGESTANT COMBO

Brompheniramine/Pseudoephedrine (Dimetapp) & (Dimetapp DM) Elixir
Cetirizine (Zyrtec) Tabs 10 mg; Syrup 5mg/5mL
Chlorpheniramine (CTM) Tabs 4mg
Cyproheptadine (Periactin) Tabs 4mg
Diphenhydramine (Benadryl) Caps 25mg, Tabs 25mg
Diphenhydramine (Benadryl) Elixir 12.5mg / 5mL
Fexofenadine (Allegra) Tabs 60mg, 180mg
Hydroxyzine HCl (Atarax) Tabs 10mg, 25mg, Syrup 10mg/5ml
Loratadine (Claritin) Tabs 10mg, Syrup 5mg/5ml
Meclizine (Antivert) Tabs 25mg
**Pseudoephedrine / Triprolidine tabs (Actifed) Tabs

ANTITUSSIVE

Benzonatate (Tessalon) Perles 100mg

EXPECTORANT/COMBINATION

**Guaifenesin / Codeine 30mg (Robitussin AC) Syrup
Guaifenesin / Dextromethorphan (Robitussin DM) Syrup

DECONGESTANT

**Pseudoephedrine (Sudafed) Tabs 30mg; Syrup 30mg / 5mL

Asthma Medications

ANTICHOLINERGIC AGENTS

Ipratropium Bromide (Atrovent HFA) Inhaler 17 mcg / puff
Ipratropium Bromide (Atrovent) Neb Soln for inhalation 0.03%
Tiotropium Bromide (Spiriva) HandiHaler

BETA2-AGONISTS/COMBINATION PRODUCTS

Albuterol HFA (Ventolin) Inhaler
Albuterol (Proventil) Soln 0.5%
Albuterol (Proventil) Soln 0.083%
Albuterol (Proventil) Syrup 2mg /5ml
Ipratropium / Albuterol (Combivent) Inhaler
Salmeterol Xinafoate(Serevent Diskus)

CORTICOSTEROID, INHALED/COMBINATION PRODUCTS

Budesonide (Pulmicort Respules) inhalation Susp 0.25mg/2ml, 0.5mg/2ml
Flunisolide (Aerobid) Inhaler 250mcg / puff
Fluticasone (Flovent HFA) Inhaler 44, 110, 220 mcg / puff
Fluticasone/Salmeterol (Advair Diskus) 100/50, 250/50, 500/50mcg
Mometasone Furoate (Asmanex Twisthaler) 110mcg, 220mcg
Budesonide/Formoterol (Symbicort) Inhaler 80/4.5, 160/4.5

MAST CELL STABILIZER

Cromolyn Sodium (Intal) Inhalant Soln 10 mg/ mL

LEUKOTRIENE RECEPTOR ANTAGONIST

Montelukast (Singulair) Tabs 4mg, 5mg, 10mg; Granules 4mg

MISC

Inspirase (drug delivery system for MDI's)
Aerochamber (drug delivery system for MDI's)
Sodium Chloride 5ml Neb Soln
Theophylline (Theodur) Tabs 200mg, 300mg
Theophylline Anhydrous (Theo-24) Caps 300mg,
Theophylline Anhydrous (Theophylline ER) Tabs 400mg
Theophylline (Elixophyllin 80mg/15mL

Nasal Preparations

ANTICHOLINERGIC AGENT

Ipratropium (Atrovent) Spray 0.3%, 0.6%

ANTIHISTAMINE

Azelastine (Astelin Nasal) Spray 137mcg/spray

CORTICOSTEROID, INTRANASAL

Flunisolide (Nasarel) Spray 25mcg
Fluticasone (Flonase) Spray

SEROTONIN 5-HT1D AGONIST

Sumatriptan (Imitrex) Spray 5mg, 20mg

VASOCONSTRICTOR

Oxymetazoline (Afrin) Spray 0.05%

MISC

Desmopressin (DDAVP) Spray 0.1%
Sodium chloride (Ocean) Drops / Spray 0.65%

XII. Vaginal Preparations

Clotrimazole (Gyne-Lotrimin) Cream 1%
Clindamycin (Cleocin) Cream 2%
Estrogen Conjugated (Premarin) Cream 0.625 mg / gm
Metronidazole (Metrogel) Gel 0.75%
Terconazole (Terazol 3) Supps

XIII. Vitamin / Mineral / Electrolyte Agents

Calcium 500mg with Vit D (OsCal) Tabs
Cyanocobalamin (Vit B 12) 1,000mcg Tabs and 1mg/ml injection
Ergocalciferol (Vitamin D2) caps 50,000IU
Ferrous Sulfate Tabs 325mg
Ferrous Sulfate Oral sol 15mg /0.6mL
Folic Acid Tabs 1mg
Folic Acid, Cyanocobalamin, Pyridoxine (Foltx) 2.5mg/1mg/25mg
Magnesium Gluconate Tabs 500mg
Poly-Vi Sol Fe (multi-vitamin for breastfed babies)
Potassium Chloride Tabs 10mEq, 20mEq; 20mEq packets, Liq 10%
Prenatal Vitamins / Minerals Tabs (Age limit of 45 or younger.)
Pyridoxine (Vitamin B6) Tabs 50mg
Thiamine (Vitamin B1) Tabs 50mg

I. Misc Agents

Antineoplastic Agents

Azathioprine (Imuran) Tabs 50mg
Fluorouracil (Efudex) Cream 5%
Methotrexate (Rheumatrex) Tabs 2.5mg
Tamoxifen (Nolvadex) Tabs 10mg

Dental Preparations

Chlorhexidine (Peridex / Periogard) Oral soln 0.12%
Sodium Fluoride (Luride) Tabs 1.1mg (0.5mg Fl)
Sodium Fluoride Oral soln 0.5mg /mL
Sodium Fluoride (PreviDent) 1.1% gel
Sodium Flouride (PreviDent Plus) 1.1% paste
Stannous Fluoride (GelKam) 0.4% gel
Triamcinolone (Kenalog) Dental Paste 0.1%

Hemorrhoid Agents

Hemorrhoidal HC Supps (Anusol HC)
Hemorrhoidal Supps (Anusol)
Hydrocortisone Cream 2.5%
Pramozine/Hydrocortisone (Proctofoam HC) Foam 1%/1%

Smoking Deterrents

Bupropion SR 150 mg
Nicotine Patch (Nicoderm) 7mg / day, 14mg/day, 21mg / day

Other

Clomiphene (Clomid) Tabs 50mg
Donepezil (Aricept) Tabs 5 mg, 10mg
Disulfiram (Antabuse) Tabs 250mg
Epinephrine (Epipen Jr, Epipen) Autoinjector 0.15mg, 0.3mg
Methylergonovine (Methergine) Tabs 0.2mg
Sodium citrate with citric acid 480ml (Bicitra)
Vardenafil HCL (Levitra) Tabs 2.5mg, 5mg, 10mg, 20mg
Vitamin D Caps 50,000 IU