Winn-Dixie Prescription Plan

‚Äč$4 & $10 GENERICS

Effective 05/01/2015

A
- Antibiotics, Antifungal, Antiviral, Arthritis/Pain, Asthma/Resp/Allergies

Antibiotics

QTY30 Day Qty 90 Day Qty
DRUG NAME$0.00 Copay$4.00 $10.00
AMOXICILLIN 125 MG/5 ML (150 ML BOTTLE)150  
AMOXICILLIN 125 MG/5 ML (100 ML BOTTLE) 100  
AMOXICILLIN 125 MG/5 ML (80 ML BOTTLE)80  
AMOXICILLIN 200 MG/5 ML (100 ML BOTTLE)100  
AMOXICILLIN 200 MG/5 ML (75 ML BOTTLE)75  
AMOXICILLIN 200 MG/5 ML (50 ML BOTTLE)50  
AMOXICILLIN 250 MG CAPSULES30  
AMOXICILLIN 250 MG/5 ML (150 ML BOTTLE) 150  
AMOXICILLIN 250 MG/5 ML (100 ML BOTTLE) 100  
AMOXICILLIN 250 MG/5 ML (80 ML BOTTLE)80  
AMOXICILLIN 400 MG/5 ML (100 ML BOTTLE) 100  
AMOXICILLIN 400 MG/5 ML (75 ML BOTTLE) 75  
AMOXICILLIN 400 MG/5 ML (50 ML BOTTLE)50  
AMOXICILLIN 500 MG CAPSULES30  
AMOXICILLIN 875 MG TABLETS20  
AMPICILLIN 250 MG CAPSULES28  
AMPICILLIN 500 MG CAPSULES28  
CEPHALEXIN 250 MG CAPSULES  30 
CEPHALEXIN 500 MG CAPSULES  30 
CIPROFLOXACIN 250 MG TABLETS20  
CIPROFLOXACIN 500 MG TABLETS20  
CIPROFLOXACIN 750 MG TABLETS14  
CLINDAMYCIN 150 MG CASULES 3090
ISONIAZID 300 MG TABLETS 3090
PENICILLIN V Pot 125/5 100 ML (100 ML BOTTLE)100  
PENICILLIN V Pot 125/5 200 ML (200 ML BOTTLE) 200  
PENICILLIN VK 250 MG TABLETS28  
PENICILLIN VK 250/5 ML (100 ML BOTTLE)100  
PENICILLIN VK 250/5 ML (200 ML BOTTLE)200  
PENICILLIN VK 500 MG TABLETS28  
SULFAMETH/TRIMETH 400/80 MG TABLETS28  
SULFAMETH/TRIMETH 800/160 MG TABLETS20  
SULFASALAZINE 500 MG TABLETS 3090
  30 Day Qty 90 Day Qty
  $8.00 $24.00
AMOX/K CLAV 500 MG TABLETS 20 
AMOX/K CLAV 875 MG TABLETS 20 
METRONIDAZOLE 250 MG TABLETS 2884
METRONIDAZOLE 500 MG TABLETS 1442
  30 Day Qty 90 Day Qty
  $15.00
AZITHROMYCIN 250 MG PAK (6 TABLETS) (NEW) 6N/A

Antifungal

 30 Day Qty 90 Day Qty
DRUG NAME $4.00 $10.00
FLUCONAZOLE 150 MG TABLETS 13
NYSTATIN 100 MU/ML ORAL SUSP DROP 60180
NYSTATIN 100 MU/ML ORAL SUSP 60180
TERBINAFINE 250 MG TABLETS 3090

Antiviral

 30 Day Qty 90 Day Qty
DRUG NAME $4.00 $10.00
AMANTADINE 50 MG/5 ML SYRUP 120360
ACYCLOVIR 200 MG CAPSULES 3090
ACYCLOVIR 400 MG TABLETS  3090
ACYCLOVIR 800 MG TABLETS  3090

Arthritis/ Pain

 30 Day Qty 90 Day Qty
DRUG NAME $4.00 $10.00
IBUPROFEN 400 MG TABLETS 90270
IBUPROFEN 600 MG TABLETS 60180
IBUPROFEN 800 MG TABLETS 3090
INDOMETHACIN 25 MG CAPSULES 60180
INDOMETHACIN 50 MG CAPSULES  3090
MELOXICAM 15 MG TABLETS 3090
MELOXICAM 7.5 MG TABLETS 3090
NAPROXEN 250 MG TABLETS 60180
NAPROXEN 375 MG TABLETS 60180
NAPROXEN 500 MG TABLETS 60180
  30 Day Qty 90 Day Qty
  $8.00 $24.00
BACLOFEN 10 MG TABLETS 3090
DICLOFENAC POT 50 MG TABLETS  60180
DICLOFENAC SOD DR 50 MG TABLETS  60180
DICLOFENAC SOD DR 75 MG TABLETS  60180

Asthma/ Resp/Allergies

 30 Day Qty 90 Day Qty
DRUG NAME $4.00 $10.00
ALBUTEROL 2 MG/5 ML SYRUP 120473
CETIRIZINE 10 MG TABLETS 3090
LORATADINE 10 MG TABLETS 3090
  30 Day Qty 90 Day Qty
  $4.00 $10.00
ALBUTEROL SULFATE 0.083 % NEB SOLN 75225
IPRATROPIUM BROMIDE 0.02% AMPULE 75225
  30 Day Qty 90 Day Qty
  $15.00
IPRATROPIUM BROM/ALBUTEROL SUL 0.5-2.5 90 
  30 Day Qty 90 Day Qty
  $15.00 $45.00
FLUTICASONE 50 MCG NASAL SPRAY 1648
MONTELUKAST 5 MG TABLETS 3090
MONTELUKAST 10 MG TABLETS 3090
B
C
- Cholesterol, CNS, Cough

Cholesterol

 30 Day Qty 90 Day Qty
DRUG NAME $4.00 $10.00
LOVASTATIN 10 MG TABLETS 3090
LOVASTATIN 20 MG TABLETS 3090
LOVASTATIN 40 MG TABLETS  3090
SIMVASTATIN 20 MG TABLETS 3090
SIMVASTATIN 40 MG TABLETS 3090
SIMVASTATIN 10 MG TABLETS 3090
SIMVASTATIN 5 MG TABLETS 3090
SIMVASTATIN 80 MG TABLETS 3090
  30 Day Qty 90 Day Qty
  $10.00 $30.00
GEMFIBROZIL 600 MG TABLETS 60180
  30 Day Qty 90 Day Qty
  $15.00 $45.00
PRAVASTATIN 10 MG TABLETS 3090
PRAVASTATIN 20 MG TABLETS 3090
PRAVASTATIN 40 MG TABLETS 3090

CNS

 30 Day Qty 90 Day Qty
DRUG NAME $4.00 $10.00
BENZTROPINE 0.5 MG TABLETS 3090
BENZTROPINE 1 MG TABLETS 3090
DIVALPROEX SODIUM DR 125 MG TABLETS 60180
DIVALPROEX SODIUM DR 250 MG TABLETS 60180
DIVALPROEX SODIUM DR 500 MG TABLETS  3090
HYDROXYZINE HCL 10 MG TABLETS 3090
HYDROXYZINE HCL 25 MG TABLETS 3090
HYDROXYZINE HCL 50 MG TABLETS  3090
HYDROXYZINE PAM 25 MG CAPSULES 3090
LAMOTRIGINE 100 MG TABLETS 3090
LAMOTRIGINE 150 MG TABLETS 3090
LAMOTRIGINE 200 MG TABLETS 3090
LAMOTRIGINE 25 MG TABLETS 3090
LAMOTRIGINE 25 MG CHEW TABS  3090
MIRTAZAPINE 15 MG TABLETS 3090
MIRTAZAPINE 30 MG TABLETS  3090
PRIMIDONE 50 MG TABLETS  3090
PRIMIDONE 250 MG TABLETS  3090
ROPINIROLE 0.25 MG TABLETS  3090
ROPINIROLE 0.5 MG TABLETS  3090
ROPINIROLE 1 MG TABLETS  3090
ROPINIROLE 2 MG TABLETS  3090
ROPINIROLE 3 MG TABLETS  3090
ROPINIROLE 4 MG TABLETS  3090
ROPINIROLE 5 MG TABLETS  3090
TOPIRAMATE 25 MG TABLETS 3090
TOPIRAMATE 50 MG TABLETS 3090
TOPIRAMATE 100 MG TABLETS 3090
TOPIRAMATE 200 MG TABLETS  3090
ZONISAMIDE 25 MG CAPSULES 3090
ZONISAMIDE 50 MG CAPSULES 3090
ZONISAMIDE 100 MG CAPSULES 3090
  30 Day Qty 90 Day Qty
DRUG NAME $8.00 $22.00
BENZTROPINE 2 MG TABLETS 3090
HYDROXYZINE PAM 50 MG CAPSULES 3090
MIRTAZAPINE 45 MG TABLETS  3090
OXCARBAZEPINE 150 MG TABLETS  60180
OXCARBAZEPINE 300 MG TABLETS 60 
OXCARBAZEPINE 600 MG TABLETS  3090
  30 Day Qty 90 Day Qty
  $24.00 N/A
SUMATRIPTAN 25 MG TABLETS 9 
SUMATRIPTAN 50 MG TABLETS 9 
SUMATRIPTAN 100 MG TABLETS 9 

Cough

 30 Day Qty 90 Day Qty
DRUG NAME $4.00 $10.00
BENZONATATE 100 MG CAPSULES 1442
BENZONATATE 100 MG CAPSULES  1442
PROMETHAZINE/DM 15-6.25 MG/5 ML SYRUP 120360
PROMETHAZINE 6.25/5 ML SYRUP* 120360
D
- Diabetes

Diabetes

 30 Day Qty 90 Day Qty
DRUG NAME $4.00 $10.00
BLOOD GLUCOSE KIT BY TOPCARE  1N/A
BLOOD GLUCOSE TEST STRIPS 25 CT BY TOPCARE  25N/A
BLOOD GLUCOSE LANCETS BY TOPCARE (NEW) 100N/A
GLIMEPIRIDE 1 MG TABLETS 3090
GLIMEPIRIDE 2 MG TABLETS 3090
GLIMEPIRIDE 4 MG TABLETS 3090
GLIPIZIDE 10 MG TABLETS 60180
GLIPIZIDE 5 MG TABLETS (DIABETA) 60180
GLYBURIDE 1.25 MG TABLETS 3090
GLYBURIDE 2.5 MG TABLETS 3090
GLYBURIDE 5 MG TABLETS 3090

Diabetes

QTY30 Day Qty 90 Day Qty
DRUG NAME$0.00 Copay$4.00 $10.00
GLYBURIDE/METFORMIN 1.25/250 MG TABLETS  60180
GLYBURIDE/METFORMIN 2.5/500 MG TABLETS 3090
GLYBURIDE/METFORMIN 5/500 MG TABLETS 3090
METFORMIN 1000 MG TABLETS90  
METFORMIN 500 MG TABLETS90  
METFORMIN 850 MG TABLETS90  
METFORMIN ER 500 MG TABLETS 60180
METFORMIN ER 750 MG TABLETS  60180
  30 Day Qty 90 Day Qty
  $8.00 $20.00
BLOOD GLUCOSE TEST STRIPS 50 CT BY TOPCARE 50n/a
GLYBURIDE MCR 5 MG TABLETS (MICRONASE) 3090
GLYBURIDE MCR 6 MG TABLETS 3090
E
- Ear/Eye

Ear/Eye

 30 Day Qty 90 Day Qty
DRUG NAME $4.00 $10.00
ANTIPYRINE/BENZO OTIC SOL  1030
CIPROFLOXACIN 0.3% OPTHALMIC SOL  515
GENTAMICIN SUL 0.3% OPTHALMIC SOL 515
TIMOLOL MAL 0.25% OPTHALMIC SOL (5 ML) 5N/A
TIMOLOL MAL 0.5% OPTHALMIC SOL (5 ML or 15ML) 515
TOBRAMYCIN 0.3% OPHTHALMIC SOLUTION 515
TRIMETHOPRIM-POLY B OPTHALMIC SOL 1030
  30 Day Qty 90 Day Qty
  $8.00 $24.00
TIMOLOL MAL 0.5% OPTHALMIC SOL (10 ML) 10N/A
F
G
- Gastrointestinal

Gastrointestinal

 30 Day Qty 90 Day Qty
DRUG NAME $4.00 $10.00
FAMOTIDINE 20 MG TABLETS 60180
FAMOTIDINE 40 MG TABLETS 60180
METOCLOPRAMIDE 10 MG TABLETS 60180
METOCLOPRAMIDE 5 MG 60180
METOCLOPRAMIDE 5 MG/5 ML SYRUP 240 
OMEPRAZOLE 20 MG CAPSULES 3090
ONDANSETRON 4 MG TABLETS 2060
ONDANSETRON 8 MG TABLETS 2060
ONDANSETRON ODT 4 MG TABLETS 1442
ONDANSETRON ODT 8 MG TABLETS 721
PROMETHAZINE 25 MG TABLETS 1236
RANITIDINE 150 MG TABLETS 60180
RANITIDINE 300 MG TABLETS 3090
RANITIDINE 15MG/ML SYRUP  150473
  30 Day Qty 90 Day Qty
DRUG NAME $4.00 $12.00
LACTULOSE 10 MG/15 ML SOLUTION 240960
  30 Day Qty 90 Day Qty
DRUG NAME $8.00 $24.00
DICYCLOMINE 10 MG CAPSULES 90270
DICYCLOMINE 20 MG TABLETS 60180
OMEPRAZOLE 40 MG CAPSULES 3090
H
- Heart and Blood Pressure

Heart and Blood Pressure

 30 Day Qty 90 Day Qty
DRUG NAME $4.00 $10.00
AMLODIPINE BES 10 MG TABLETS 3090
AMLODIPINE BES 2.5 MG TABLETS 3090
AMLODIPINE BES 5 MG TABLETS 3090
AMLODIPINE/BENZ 2.5/10 MG CAPSULES  3090
AMLODIPINE/BENZ 5/10 MG CAPSULES  3090
AMLODIPINE/BENZ 5/20 MG CAPSULES  3090
AMLODIPINE/BENZ 10/20 MG CAPSULES  3090
ATENOLOL 100 MG TABLETS 3090
ATENOLOL 25 MG TABLETS 3090
ATENOLOL 50 MG TABLETS 3090
BENAZEPRIL 10 MG TABLETS 3090
BENAZEPRIL 20 MG TABLETS 3090
BENAZEPRIL 40 MG TABLETS 3090
BENAZEPRIL 5 MG TABLETS 3090

Heart and Blood Pressure

QTY30 Day Qty 90 Day Qty
DRUG NAME$0.00 Copay$4.00 $10.00
BISOPROLOL 5 MG TABLETS 3090
BISOPROLOL 10 MG TABLETS 3090
BISOPROLOL/HCTZ 10/6.25 TABLETS 3090
BISOPROLOL/HCTZ 5/6.25 TABLETS 3090
BISOPROLOL/HCTZ 2.5/6.25 TABLETS 3090
CARVEDILOL 12.5 MG TABLETS 60180
CARVEDILOL 25 MG TABLETS 60180
CARVEDILOL 3.125 MG TABLETS 60180
CARVEDILOL 6.25 MG TABLETS 60180
CLONIDINE 0.1 MG TABLETS 60180
CLONIDINE 0.2 MG TABLETS 60180
CLONIDINE 0.3 MG TABLETS 60180
ENALAPRIL/HCTZ 5/12.5 MG  3090
ENALAPRIL/HCTZ 10-25 MG 3090
FUROSEMIDE 10 MG/ ML SOLUTION 60 
FUROSEMIDE 20 MG TABLETS 3090
FUROSEMIDE 40 MG TABLETS 3090
FUROSEMIDE 80 MG TABLETS 3090
GUANFACINE 1 MG TABLETS 3090
GUANFACINE 2 MG TABLETS 3090
HYDRALAZINE 10 MG TABLETS 60180
HYDRALAZINE 25 MG TABLETS 60180
HYDRALAZINE 50 MG TABLETS 60180
HYDRALAZINE 100 MG TABLETS 60180
HYDROCHLOROTHIAZIDE 12.5 MG CAPSULES  3090
HYDROCHLOROTHIAZIDE 12.5 MG TABLETS 3090
HYDROCHLOROTHIAZIDE 25 MG TABLETS 3090
HYDROCHLOROTHIAZIDE 50 MG TABLETS 3090
ISOSORBIDE MONONITRATE 20 MG TABLETS 3090
LISINOPRIL 10 MG TABLETS60  
LISINOPRIL 2.5 MG TABLETS60  
LISINOPRIL 20 MG TABLETS60  
LISINOPRIL 30 MG TABLETS60  
LISINOPRIL 40 MG TABLETS60  
LISINOPRIL 5 MG TABLETS60  
LISINOPRIL-HCTZ 10-12.5 MG TABLETS 3090
LISINOPRIL-HCTZ 20-12.5 MG TABLETS 3090
LISINOPRIL-HCTZ 20-25 MG TABLETS 3090
METHYLDOPA 250 MG TABLETS 60180
METHYLDOPA 500 MG TABLETS 3090
METOPROLOL 100 MG TABLETS 60180
METOPROLOL 25 MG TABLETS 60180
METOPROLOL 50 MG TABLETS 60180

Heart and Blood Pressure

 30 Day Qty 90 Day Qty
DRUG NAME $4.00 $10.00
PENTOXIFLYLINE 400 MG TABLETS 3090
SOTALOL HCL 80 MG TABLETS 3090
SOTALOL HCL 120 MG TABLETS  3090
SOTALOL HCL 160 MG TABLETS  3090
SPIRONOLACTONE 25 MG TABLETS 3090
SPIRONOLACTONE 50 MG TABLETS 3090
SPIRONOLACTONE 100 MG TABLETS  3090
TERAZOSIN 10 MG CAPSULES 3090
TERAZOSIN 1 MG CAPSULES 3090
TERAZOSIN 2 MG CAPSULES 3090
TERAZOSIN 5 MG CAPSULES 3090
TRIAMTERENE/HCTZ 37.5-25 TABLETS 3090
VERAPAMIL 120 MG TABLETS 3090
VERAPAMIL 80 MG TABLETS 3090
WARFARIN 10 MG TABLETS 3090
WARFARIN 1 MG TABLETS 3090
WARFARIN 2.5 MG TABLETS 3090
WARFARIN 2 MG TABLETS 3090
WARFARIN 3 MG TABLETS 3090
WARFARIN 4 MG TABLETS 3090
WARFARIN 5 MG TABLETS  3090
WARFARIN 6 MG TABLETS 3090
WARFARIN 7.5 MG TABLETS 3090
  30 Day Qty 90 Day Qty
DRUG NAME $8.00 $22.00
AMILORIDE/HCTZ 5 MG/50 MG TABLETS 3090
AMIODARONE 200 MG TABLETS  3090
AMLODIPINE/BENZ 5/40 MG CAPSULES  3090
AMLODIPINE/BENZ 10/40 MG CAPSULES  3090
CILOSTAZOL 50 MG TABLETS 60180
CILOSTAZOL 100 MG TABLETS 60180
DILTIAZEM 30 MG TABLETS 60180
DILTIAZEM 60 MG TABLETS 60180
DILTIAZEM 90 MG TABLETS 60180
DILTIAZEM 120 MG TABLETS 3090
FOSINOPRIL 10 MG TABLETS 3090
FOSINOPRIL 20 MG TABLETS 3090
FOSINOPRIL 40 MG TABLETS 3090
FOSINOPRIL/HCTZ 10-12.5 MG TABLETS 3090
FOSINOPRIL/HCTZ 20-12.5 MG TABLETS 3090
LABETALOL HCL 100 MG TABLETS 3090
LABETALOL HCL 200 MG TABLETS 3090
LABETALOL HCL 300 MG TABLETS 3090
TRIAMTERENE/HCTZ37.5-25 CAPSULES 3090
TRIAMTERENE/HCTZ 75-50 MG TABLETS 3090
  30 Day Qty 90 Day Qty
  $10.00$30.00
CLOPIDOGREL 75 MG TABLETS 3090
INDAPAMIDE 1.25 MG TABLETS 3090
INDAPAMIDE 2.5 MG TABLETS 3090
  30 Day Qty 90 Day Qty
DRUG NAME $12.00 $36.00
ATENOLOL/CHLOR 50/25 MG TABLETS 3090
ATENOLOL/CHLOR 100/25 MG TABLETS 3090
CHOLOROTHIAZIDE 250 MG TABLETS 60180
DILTIAZEM CD 120 MG CAPSULES 3090
DILTIAZEM CD 180 MG CAPSULES 3090
DILTIAZEM CD 240 MG CAPSULES 3090
LOSARTAN POT 25 MG 3090
LOSARTAN POT 50 MG 3090
LOSARTAN POT 100 MG 3090
LOSARTAN-HCTZ 50/12.5 MG TABLETS 3090
LOSARTAN-HCTZ 100/12.5 MG TABLETS 3090
LOSARTAN-HCTZ 100/25 MG TABLETS 3090
RAMIPRIL 1.25 MG CAPSULES 3090
RAMIPRIL 10 MG CAPSULES 3090
RAMIPRIL 2.5 MG CAPSULES 3090
RAMIPRIL 5 MG CAPSULES 3090
I, J, K, L
M
- Mental Health, Muscle Relaxants

Mental Health

 30 Day Qty 90 Day Qty
DRUG NAME $4.00 $10.00
BUSPIRONE 5 MG TABLETS 60180
BUSPIRONE 10 MG TABLETS 60180
CITALOPRAM 10 MG TABLETS 3090
CITALOPRAM 20 MG TABLETS 3090
CITALOPRAM 40 MG TABLETS 3090
FLUOXETINE 10 MG CAPSULES 3090
FLUOXETINE 20 MG CAPSULES 3090
FLUOXETINE 40 MG CAPSULES 3090
FLUPHENAZINE 1 MG TABLETS 3090
FLUPHENAZINE 5 MG TABLETS 3090
FLUPHENAZINE 10 MG TABLETS 3090
LITHIUM CARBONATE 300 MG CAPSULES 90270
NORTRIPTYLINE 10 MG CAPSULES 3090
NORTRIPTYLINE 25 MG CAPSULES 3090
PAROXETINE 10 MG TABLETS 3090
PAROXETINE 20 MG TABLETS 3090
PAROXETINE 30 MG TABLETS  3090
PAROXETINE 40 MG TABLETS 3090
PROCHLORPERAZINE 10 MG TABLETS 3090
PROCHLORPERAZINE 5 MG TABLETS 3090
  30 Day Qty 90 Day Qty
DRUG NAME $4.00 $10.00
RISPERIDONE 0.25 MG TABLETS 60180
RISPERIDONE 0.5 MG TABLETS 60180
RISPERIDONE 1 MG TABLETS 60180
RISPERIDONE 2 MG TABLETS 60180
RISPERIDONE 3 MG TABLETS 60180
SERTRALINE 25 MG TABLETS 3090
SERTRALINE 50 MG TABLETS 3090
SERTRALINE 100 MG TABLETS 3090
TRAZODONE 100 MG TABLETS 3090
TRAZODONE 150 MG TABLETS 3090
TRAZODONE 50 MG TABLETS 3090
  30 Day Qty 90 Day Qty
DRUG NAME $8.00 $22.00
AMITRIPTYLINE 10 MG TABLETS 3090
AMITRIPTYLINE 25 MG TABLETS 3090
BUSPIRONE 15 MG TABLETS 60180
NORTRIPTYLINE 50 MG CAPSULES  3090
NORTRIPTYLINE 75 MG CAPSULES 3090
RISPERIDONE 4 MG TABLETS 60180
THIOTHIXENE 1 MG 3090
THIORIDAZINE 10 MG TABLETS 3090
THIORIDAZINE 25 MG TABLETS 3090
  30 Day Qty 90 Day Qty
DRUG NAME $12.00 $36.00
AMITRIPTYLINE 50 MG TABLETS 3090
THIORIDAZINE 50 MG TABLETS 3090
  30 Day Qty 90 Day Qty
DRUG NAME $24.00 $65.00
AMITRIPTYLINE 75 MG TABLETS 3090
AMITRIPTYLINE 100 MG TABLETS 3090

Muscle Relaxants

 30 Day Qty 90 Day Qty
DRUG NAME $4.00 $10.00
CYCLOBENZAPRINE 10 MG TABLETS 3090
CYCLOBENZAPRINE 5 MG TABLETS 3090
METHOCARBAMOL 500 MG TABLETS 3090
METHOCARBAMOL 750 MG TABLETS 3090
N
O
- Other

Other

 30 Day Qty 90 Day Qty
DRUG NAME $4.00 $10.00
CHLORHEXADINE GLUCOSE 0.12% SOLN 480 
DEXAMETHASONE .5 MG TABLETS 1236
DEXAMETHASONE 0.75 MG TABLETS 1236
DEXAMETHASONE 4 MG TABLETS 618
LIDOCAINE 2% VISCOUS SOLUTION 100300
OXYBUTYNIN 5 MG/5 ML SYRUP 150N/A
PREDNISONE 1 MG TABLETS 90270
PREDNISONE 2.5 MG TABLETS 3090
PREDNISONE 20 MG TABLETS 3090
PREDNISONE 5 MG TABLETS 3090
PREDNISONE 10 MG TABLETS 3090
VITAMIN D 50,000 UNIT CAPSULES  824
P, Q, R
S
- Skin

Skin

 30 Day Qty 90 Day Qty
DRUG NAME $4.00 $10.00
HYDROCORTISONE 1% CREAM 30 GM 3090
HYDROCORTISONE 2.5% CREAM 30 GM 3090
MICONAZOLE 2% (OTC) 28 GM CREAM 2884
SILVER SULFADIAZINE 1% (25 GM) CREAM 2575
TRIAMCINOLONE 0.1% 15 GM (tube) CREAM 1545
  30 Day Qty 90 Day Qty
DRUG NAME $8.00 $18.00
SILVER SULFADIAZINE 1% (50 GM) CREAM 50 
TRIAMCINOLONE 0.025% 15 GM (tube) CREAM 1545
TRIAMCINOLONE 0.025% 15 GM (tube) OINTMENT 1545
TRIAMCINOLONE 0.025% 80 GM (tube) CREAM 80240
TRIAMCINOLONE 0.025% 80 GM (tube) OINTMENT 80240
TRIAMCINOLONE 0.1% 15 GM (tube) OINTMENT 1545
TRIAMCINOLONE 0.1% 80 GM (tube) CREAM 80240
TRIAMCINOLONE 0.1% 80 GM (tube) OINTMENT 80240
TRIAMCINOLONE 0.5% 15 GM (tube) CREAM 1545
TRIAMCINOLONE 0.5% 15 GM (tube) OINTMENT 1545
  30 Day Qty 90 Day Qty
  $24.00
MUPIROCIN 2% OINTMENT 22 
T
- Thyroid

Thyroid

 30 Day Qty 90 Day Qty
DRUG NAME $4.00$10.00
METHIMAZOLE 5 MG TABLETS  3090
METHIMAZOLE 10 MG TABLETS  3090
  30 Day Qty 90 Day Qty
  $8.00 $24.00
LEVOTHYROXINE 25 MCG TABLETS 3090
LEVOTHYROXINE 50 MCG TABLETS 3090
LEVOTHYROXINE 75 MCG TABLETS 3090
LEVOTHYROXINE 88 MCG TABLETS 3090
LEVOTHYROXINE 100 MCG TABLETS 3090
LEVOTHYROXINE 112 MCG TABLETS 3090
LEVOTHYROXINE 125 MCG TABLETS 3090
LEVOTHYROXINE 137 MCG TABLETS 3090
LEVOTHYROXINE 150 MCG TABLETS 3090
LEVOTHYROXINE 175 MCG TABLETS 3090
LEVOTHYROXINE 200 MCG TABLETS 3090
U
V
- Vaccines, Vitamins/Nutritional

Vaccines

   
DRUG NAMEPrice  
ADACEL $56.99  
DECAVAC $56.99  
ENERGIX-B $59.99  
GARDASIL $164.99  
HAVRIX $79.99  
MENACTRA $125.99  
MMR$63.99  
PNEUMOVAX $92.99  
SEASONAL INFLUENZA (INCLUDING INTRA-DERMAL) $24.99  
SEASONAL INFLUENZA HIGH DOSE $44.99  
SEASONAL INFLUENZA MIST $39.99  
SEASONAL INFLUENZA QUADRAVALENT $34.99  
TWINRIX $114.99  
TYPHIM $65.99  
VARIVAX $121.99  
VIVOTIF $51.99  
ZOSTAVAX $209.99  

Vitamins/ Nutritional

 30 Day Qty 90 Day Qty
DRUG NAME $4.00 $10.00
FOLIC ACID 1 MG TABLETS 3090
LUDENT CHEW FL 0.5 MG TABLETS 120360
LUDENT CHEW FL 1 MG TABLETS 120360
MAG 64 MG TABLETS 3090
MAG-OXIDE 400 MG TABLETS 60180
PRENATABS FA TABLETS 3090
PRENATAL 27 TABLETS 3090
PRENATAL PLUS 27 TABLETS 3090
W, X, Y, Z
Men's Health

Mens Health

 30 Day Qty 90 Day Qty
DRUG NAME $9.00 $27.00
FINASTERIDE 5 MG TABLETS 3090
Women's Health

Womens Health

 30 Day Qty 90 Day Qty
DRUG NAME $4.00 $10.00
ESTRADIOL 0.5 MG TABLETS 3090
ESTRADIOL 1 MG TABLETS 3090
ESTRADIOL 2 MG TABLETS 3090
MEDROXYPROGESTERONE AC 10 MG TABLETS 3090
MEDROXYPROGESTERONE AC 2.5 MG TABLETS 3090
MEDROXYPROGESTERONE AC 5 MG TABLETS 3090
  30 Day Qty 90 Day Qty
  $9.00 $24.00
ALENDRONATE SOD 35 MG TABLETS 412
ALENDRONATE SOD 70 MG TABLETS 412
CLOMIPHENE 50 MG TABLETS 515
  28 Day Qty 84 Day Qty
  $9.00 $27.00
ALTAVERA 0.15-30 MG-MCG TABLETS 2884
CAMILA 0.35 MG TABLETS 2884
CYCLAFEM 1/35 MG-MCG TABLETS 2884
CYCLAFEM 7/7/7 TABLETS 2884
EMOQUETTE 0.15-30 MG-MCG TABLETS 2884
ERRIN 0.35 MG TABLETS 2884
ORSYTHIA 0.1-20 MG-MCG TABLETS 2884
PREVIFEM 28 TABLETS 2884
TRI-PREVIFEM TABLETS 2884
Baby Club Benefits

Baby Club Benefits

Qty
DRUG NAME$0.00 Copay
MULTI-VIT/FLUORIDE 0.25 MG/ML DROPS (POLY-VI-FLOR)50
MULTI-VIT/FLUORIDE 0.5 MG CHEW (POLY-VI-FLOR)30
MULTI-VIT/FLUORIDE 0.5 MG/ML DROPS (POLY-VI-FLOR)50
MULTI-VIT/FLUORIDE 1 MG CHEW (POLY-VI-FLOR)30
MULTI-VIT/IRON/FLUORIDE 0.25 MG/ML DROPS (POLY-VI-FLOR/FE)50
MULTIVITAMIN/FLUORIDE 0.25 MG CHEW (POLY-VI-FLOR)30
MULTIVITAMIN/FLUORIDE 0.5 MG CHEW (POLY-VI-FLOR)30
MULTIVITAMIN/FLUORIDE 1 MG CHEW (POLY-VI-FLOR)30
MVC-FLUORIDE 0.25 MG CHEW (POLY-VI-FLOR)30
MVC CHEW W FL 0.25 MG TABLETS30
MVC CHEW W FL 0.5 MG TABLETS30
PNV FOLIC ACID PLUS MULTI 27-1 MG TAB (PRENATAL PLUS)30
POLY-VITAMIN/IRON/FLUORIDE 0.25 MG/ML DROPS (POLY-VI-FLOR/FE)50
PRENATABS FA 29-1 MG TAB (NATATAB FA)30
PRENATABS RX 29-1 MG TAB (PRENATAL PLUS IRON)30
PRENATAL 19, 29-1 MG CHEW30
PRENATAL 19, 29-1 MG TAB30
PRENATAL PLUS 27-1 MG TAB30
PRENATAL- U 106.5-1 MG CAP30
TRINATE 28-1 MG TAB (STUARTNATAL PLUS)30
TRI-VIT/FLUORIDE 0.25 MG/ML DROPS (TRI-VI-FLOR)50
TRI-VIT/FLUORIDE/IRON 0.25 MG/ML DROPS (TRI-VIT-FLOR/FE)50