(318) 456-8348 For Refills and Questions

The Barksdale Main Pharmacy fills prescriptions ordered by providers assigned to the 2nd Medical Group. The Main Pharmacy is located in the 2nd MDG Clinic and is open 7:30 a.m. - 5 p.m. Monday through Friday.  We are closed the third Friday of every month from 0730-1330 for training, and closed on Federal Holidays/Wing Down Days.  You may contact the clinic at (318) 456-6555.

 

The Bx Satellite Pharmacy fills prescriptions from off-base providers and all prescription refills. All refill requests must be called into the automated refill line at (318) 456-8348 or toll-free at 1-877-576-1539.  In addition, if your doctor would like to send in an Electronic Prescription (eRx) to the Satellite Pharmacy, please have your doctor send eRx to:  DoD BARKSDALE ePharmacy    The prescription will be filled once you or your representative check in at the Intake Window in the Bx Satellite Pharmacy Lobby.  Faxed prescriptions are not accepted. 

 

The Bx Satellite Pharmacy is located at the Base Exchange and is open 7:30 a.m. - 5 p.m. Monday through Friday.  We are closed the third Friday of every month from 0730-1330 for training, and closed on Federal Holidays/Wing Down Days.  Our Satellite Pharmacy also has a drive thru for your convenience to pick up your already filled prescription.

  

Please note that if you or a representative are checking in or picking up for yourself, or are checking in or picking up a prescription for someone else over the age of 18, please know the patient's date of birth, and have in your possession and show the Resource Management Third Party Collections Card (updated annually) and a signed permission slip or note, authorizing you to pick up the other patient's medication. 

 

Our formulary list of available medications is listed below.  Please Scroll down below for full formulary list.

 

Thank you for your continued patronage. You are a valued customer and we also thank you for the opportunity to serve you!

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Tricare Prescription Home Delivery Information:  1-877-363-1433

http://www.tricare.mil/homedelivery 

 

 
 

Please Go to the below Link to Sign into Barksdale AFB MiCare Secure Messaging:

https://sites.google.com/site/barksdalepharmacymicare/

 

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Barksdale AFB Pharmacy Formulary as of 29 February 2016:



                 

Abilify 2, 5, 10, 15, 20, 30 mg tab

Albendazole (Albenza)

Albenza 200 mg tab

Acamprosate 333mg tab

Accutane 10, 20, 40mg cap

Acetaminophen (APAP) 325mg tab; 160/5mL soln; 120mg, 650mg suppository

Acetaminophen/Codeine 300/30 tab,120-12mg/5ml Elixir@

Acetaminophen/Hydrocodone 5, 7.5, 10/325mg tab;              2.5-108mg/5mL elixir@

Acetaminophen/Oxycodone 5/325, 10/325 (C-II)*

Acetasol HC Otic Soln

Acetic Acid/Alum Acetate Otic

Acetic Acid/HC Otic Soln

Actos 15, 30, 45 mg tabs

Acyclovir 200 cap; 400, 800 tab, 200/5mL susp; 5% ointment

Adalat CC 30, 60, 90mg tab

Adapalene/benzoyl peroxide 0.1/2.5% gel

Adderall IR 5, 10, 20 mg (C-II)*

Adderall XR 5, 10, 15, 20, 25, 30mg(C-II)*

Advair Diskus 100/50, 250/50, 500mcg/50mcg; HFA 45/21, 115/21, 230mcg/21mcg

AeroChamber

AeroChamber w/mask (s, m, l)

Afrin 0.05% 12-HR nasal spray

Aggrenox 25mg/200mg cap

Albuterol 1.25mg/3mL, 2.5mg/3mL (0.083%) neb; 4mg tabs; 2mg/5ml syrup; 108 mcg/inh HFA

Albuterol/Ipratropium 20/100mcg MDI, 0.5-2.5mg/3ml neb

Aldactone 25, 50, 100mg tab

Alendronate 5, 10, 35, 70mg tabs

Alfuzosin ER 10 mg tab

Aliskiren 150mg, 300mg tab

Aliskiren/HCT 150/12.5mg, 150/25, 300/12.5mg, 300/25mg tab

Allegra 180 mg tab, 6mg/mL susp

Allegra-D 180-240 mg (24hr) tab#

Allopurinol 100, 300mg tab

Alora 0.025, 0.05, 0.06, 0.075, 0.1mg/24hr patch

Alphagan-P 0.1, 0.15, 0.2% Opht

Altace 1.25, 2.5, 5, 10 mg cap

Aluminum Chloride Hexahydrate 20% top soln

Amantadine 100mg cap, 50mg/5mL

Amaryl 1, 2, 4mg tabs

Ambien 5,10mg tab@

Amiodarone 200 mg tab

Amitriptyline 10, 25, 50, 75mg tab

AmLactin 12% lotion

Amlodipine 2.5, 5, 10mg tab

Amlodipine/Benazepril 2.5/10, 5/10, 5/20, 5/40, 10/20, 10/40mg cap

Ammonium lactate 12% lotion

Amoxicillin 250, 500mg cap; 875mg tab; 250mg chew tab; 125/5, 250/5, 400mg/5mL susp

Amoxil 250, 500mg cap; 875mg tab; 250mg chew tab; 125/5, 250/5, 400mg/5mL susp

Amox/Clav 250,500, 875 mg tab; 125/5, 200/5, 250/5, 400/5, 600mg/5mL susp

Androderm 2mg, 4mg patch@

Antivert 25mg tab

Anusol-HC 2.5% rectal crm, 25 mg suppository

Apixaban (Eliquis) 2.5, 5 mg tabs

Apresoline 10, 25, 50, 100 mg tab

Apri -28

Aquaphor oint 1lb jar#

Aralen 500 mg tab

Aricept 5, 10mg tab

Armour Thyroid 15, 30, 60mg tab

Aripipazole 2, 5, 10, 15, 20, 30mg

Artane 2mg tab

Aspirin (Enteric Coated) 81,325mg

Aspirin/Dipyridamole 25/200mg

Astelin 0.1% nasal spray

Atacand 16, 32mg tab

Atacand HCT 16/12.5, 32/12.5mg

Atarax 10, 25, 50mg tab; 10mg/5ml syrup

Atenolol 25, 50, 100mg tab

Ativan 1mg tab@

Atomoxetine 10, 18, 25, 40, 60, 80, 100mg cap

Atorvastatin 10, 20, 40, 80 mg tab

Atrovent 17 mcg/act HFA; 0.02% neb soln

Augmentin 125/5, 200/5, 250/5, 400/5mL susp

Augmentin ES 600mg/5ml susp

Augmentin 250, 500, 875mg tab

Aurodex 5.4/1.4% otic soln

Avelox 400mg tab

Azathioprine 50 mg tab

Azithromycin 250, 500mg tab, 1gm packet; 100/5, 200/5mL susp

Azulfidine 500mg tab

Azurette tab

B-1 Vitamin 50 mg tab

B-3 Vitamin 100, 500mg tab

B-6 Vitamin 50 mg tab

B-12 Vitamin 1000 mcg/ml inj; 500mcg tab

B-12 Vitamin syringe/needle for injection 25G x 5/8” 3ml

Bacitracin 500U/gm opht oint; topical oint

Baclofen 10mg tab

Bactrim SS 400/80mg, DS 800/160mg tab; 200/40/5mL susp

Bactroban 2% topical oint

Benadryl 25mg cap; 12.5mg/5mL

Benemid 500mg tab

Bentyl 10,20mg tab; 10/5mL soln

Benzonatate 100mg Perles

Benzoyl peroxide 5, 10% gel

Benztropine 0.5, 1, 2mg tab

Betamethasone/Clotrimazole 0.05%/1% cream

Betaseron

Betaxolol 0.25% opht susp

Betoptic-S 0.25% opht susp

Biaxin 125,250mg/5ml susp; 500mg tab

Bisacodyl 5mg tab

Bisoprolol/HCTZ 2.5/6.25, 5/6.25, 10/6.25mg tab

Blood Glucose Monitors:

        FreeStyle Lite

        Precision Xtra

 Boniva 150mg tab

Brimonidine 0.1, 0.15, 0.2% opht

Bromfed DM

Budesonide 0.25/2, 0.5mg/2ml neb

Bumentanide 0.5mg tab

Bumex 0.5mg tab

Bupropion IR 75, 100mg tab

Bupropion SR 100, 150, 300mg tab

Bupropion XL 150, 300mg tab

Buspar 5, 10, 15mg tab

Buspirone 5, 10, 15mg tab

Bydureon

Byetta 5, 10mcg pen

Calan IR 80mg tab

Calan SR 120, 180, 240mg tab

Calcitriol 0.25, 0.5 mcg cap

Calcium (oyster shell) + Vit D3 500mg/200IU tab

Camila tab

Campral 333mg tab

Candesartan 16, 32mg tab

Candesartan/HCTZ 16/12.5; 32/12.5mg tab

Capoten 12.5, 25, 50, 100 mg tab

Capsaicin 0.025% cream

Captopril 12.5, 25, 50, 100 mg tab

Carbamazepine 100 (chew), 200mg tab; 100/5mL susp

Carbamazepine ER 400mg tab

Carbamide peroxide 6.5% otic soln

Carbidopa/Levodopa 10/100, 25/100, 25/250 mg tab

Carbidopa/Levodopa XR 50/200mg

Carboxymethylcellulose 0.5% opht

Cardura 2, 4, 8mg tab

Carisoprodol 350 mg tab@

Carvedilol 3.125,6.25, 12.5, 25mg

Casodex

Catapres 0.1, 0.2, 0.3mg tab

Cefadroxil 250/5, 500mg/5ml susp; 500mg cap

Cefdinir 125/5, 250/5mL susp; 300mg cap

Cefpodoxime 50/5,100mg/5mL susp

Cefprozil 125/5, 250/5mL susp; 250, 500mg tab

Ceftin 250, 500mg tab

Cefuroxime 250, 500mg tab

Cefzil 250, 500mg tab; 125/5, 250mg/5ml susp

Celebrex 100, 200mg cap

Celecoxib 100, 200mg cap

Celexa 10, 20, 40mg tab; 10mg/5mL soln

Cellcept 250mg cap, 500mg tab

Cephalexin 250, 500mg cap; 125/5, 250mg/5mL susp

Cetaphil (cream, wash)

Cetirizine 1mg/ml soln, 5, 10mg tab

Cetirizine-D 5/120 mg (12hr) tab#

Chantix 1mg tab**Must be enrolled in Smoking Cessation Program 456-8046**

Cheratussin AC syrup@

Cheratussin DAC syrup@

Cholestyramine Resin 4 gm/scoop Regular, Lite(sugarfree)

Chlorhexidine 0.12% oral rinse

Chloroquine Phosphate 500mg tab

Chlorthalidone 25, 50mg tab

        Ciloxan 0.3% opht soln

Cipro 100, 250,500, 750mg tab; 250mg/5mL susp

Ciprodex 0.3/0.1% otic susp

Ciprofloxacin 100, 250, 500, 750mg tabs; 250mg/5mL susp; 0.3% opht soln

Citalopram 10, 20, 40mg tabs; 10mg/5mL soln

Clarithromycin 125/5, 250mg/5ml; 500mg tab

Claritin 10mg tab; 5mg/5ml soln

Claritin-D 10mg/240mg (24hr)tab#

Cleocin 2% vag cream

Cleocin 150, 300mg cap

Cleocin-T 1% topical solution

Clidinium/Chlordiazepoxide 2.5/5mg cap

Clindamycin 150, 300mg cap; 1% top solnl; 2% vag crm

Clobetasol 0.05% crm, oint

Clomid 50mg tab

Clomiphene 50mg tab

Clonazepam 0.5, 1mg tab@

Clonidine 0.1, 0.2, 0.3mg tab

Clopidogrel 75, 300mg tab

Clotrimazole 1% top crm, vag crm, top soln

Clotrimazole/Betamethasone 1%/0.05% cream

Codeine sulfate 30mg tab (C-II)*

Codeine/Acetaminophen #3 tabs, 12-120mg/5ml elixir@

Codeine/Guaifenesin 10-100mg/5mL (118mL)@

Cogentin 0.5, 1, 2mg tab

Colchicine 0.6mg tab

Colcrys 0.6mg tab

Colestid 1gm tab

Colestipol 1gm tab

CoLyte powder mix to 4000ml

CombiPatch 0.14/0.05, 0.25mg/0.05mg patch

        Combivent Respimat 20/100mcg

Concerta 18, 27, 36, 54mg (C-II)*

Condylox 0.5% topical solution

Cordarone 200 mg tab

Coreg 3.125, 6.25, 12.5, 25mg tab

Cortisporin otic susp

Cosopt opht soln

Coumadin 1, 2, 2.5, 3, 4, 5, 6, 7.5, 10mg tab

Cozaar 25, 50, 100mg tab

Creon 3000U,6000U, 1200U, 2400U, 3600U tab

Crestor 5, 10, 20, 40mg tab

Crolom 4% opht soln

Cromolyn 4% opht soln

Cyanocobalamin (B-12) 500 mcg tab; 1000 mcg/ml inj

Cyclobenzaprine 5, 10mg tab

Cymbalta

Cyclosporine 0.05% opht; 25, 100mg caps (Gengraf equiv)

Cyproheptadine 4mg tab, 2mg/5mL

Cytomel 25mcg tab

Cytotec 200mcg tab

Dabigatran 75mg, 150mg cap

Daily Multivitamin

Debrox 6.5% 15mL

Decadron 0.5, 4mg tab

Demerol 50mg tab (C-II)*

Demulen 1/35 tab

Depakene 250mg/5ml soln

Depakote sprinkle 125 mg cap

Depakote DR 125, 250, 500 mg tab

Depakote ER 250,500mg tab

Depo-Testosterone 200mg/mL@

Desmopressin Tablets

Desogen tab

Desonide 0.05% Lotion, Cream

Desyrel 50, 100, 150, 300mg tab

Detrol LA 2, 4 mg cap

Dexamethasone 0.5, 4mg tab

DexPak 6 day, 10 day, 13 day

Dextromethorphan/Guaifenesin  10-100mg/5ml syrup

Diabeta 1.25, 2.5, 5mg tab

Diazepam 5mg tab@

Diclofenac 0.1% opht soln; 1% top gel

Dicloxacillin 250, 500mg cap

Dicyclomine 10,20mg tab; 10mg/5mL soln

Diflucan 150, 200mg tab

Digoxin 0.125, 0.25mg tab

Dilantin Infatabs 50mg chew tab, 125/5mL  susp, 100mg ER cap

Diltiazem IR 60mg tab

Diltiazem ER 120, 180, 240, 300, 360, 420mg cap

Diovan 40, 80, 160, 320 mg tab

Diovan HCT 80/12.5, 160/12.5, 160/25, 320/12.5, 320/25 mg

Diphenhydramine 25mg cap; 12.5mg/5ml liq

Diphenoxylate/Atropine 0.025/2.5mg tab

Dipyridamole 25mg tab

Disalcid 500mg tab

Ditropan 5mg tab; 1mg/ml soln

Ditropan XL 5, 10, 15mg tab

Divalproex sprinkle 125mg cap

Divalproex DR 125, 250, 500mg

Divalproex ER 250, 500mg tab

Docusate calcium 240 mg cap

Domeboro otic soln

Donepezil 5, 10mg tab

Donnatal tab

Dorzolamide/Timolol 2/0.5% opht

Doxazosin 2, 4, 8mg tab

Doxepin 10, 25, 50, 75, 100mg cap; 10mg/mL soln

Doxycycline 100mg cap, 100mg tab

Drysol 20% top soln

Dulcolax 5mg tab

Duloxetine

DuoNeb 0.5-2.5mg/3ml neb

Duricef 250mg/5ml, 500mg/5ml susp, 500mg cap

Dynapen 250mg cap

Ecotrin 325mg tab

Effexor IR 25, 37.5, 50, 75, 100mg

Effexor XR 37.5,75,150, 225mg cap

Efudex 5% top cream

Elavil 10, 25, 50, 75mg tab

Elidel 1% top cream

Elimite 5% top crm, 60gm

Eliquis 2.5, 5 mg tab

Empagliflozin (Jardiance) - (Must try Januvia, Janumet or Janumet XR prior)

Enema Fleet, Fleet Pedialax

Enoxaparin 30/0.3, 40/0.4, 60/0.6, 80/0.8, 100mg/1mL inj

Epiduo 0.1/2.5% gel

Epinephrine 0.15, 0.3mg inj

Epipen; Epipen Jr autoinj

Ergocalciferol 1.25mg (50,000units) cap

Ery-Tab DR 250mg (as Base)

Erythrocin 250mg (as Stearate)

Erythromycin (EES) 200mg/5ml

Erythromycin Base DR 250mg tab

Erythromycin Stearate 250mg tab

Erythromycin 0.5% opht oint

Erythromycin 2% top soln, top gel

Escitalopram 5, 10, 20mg tab

Esomeprazole 20,40mg cap

E.S.P. 200-600/5mL susp

Estrace 1mg tab

Estradiol 1mg tab, 10mcg vag tab

Estradiol patch 0.0375, 0.025, 0.05, 0.06, 0.075, 0.1mg

Estradiol/Norethindrone 0.14, 0.25mg/0.05mg patch

Estrogen Conj 0.3, 0.45, 0.625, 0.9, 1.25mg tab

Estrogen Conj/Medroxy-progesterone 0.3/1.5, 0.45/1.5, 0.625/2.5, 0.625/5 mg tab

Estrogen vag crm 0.625mg/gm

Ethambutol 100, 400mg tab

Evista 60mg tab

Exenatidine 5, 10mcg inj

Ezetimibe 10mg tab

Felodipine 2.5, 5, 10mg tab

Fenofibrate 48, 54, 67, 134, 145, 160, 200mg tab

Fer-iron 15 mg/1 mL drops

Ferrous Sulfate 325mg tab, 15mg/ml drops

Fexofenadine 180 mg tabs, 6mg/mL soln

Fexofenadine-D 180/240mg (24hr) tab#

        Finasteride 5mg tab

Fioricet tab

Fish Oil 1000mg cap

Flagyl 250, 500mg tab

Flavoxate 100 mg tab

Fleet Enema, Fleet Pedialax Enema

Flexeril 5, 10mg tab

Flomax 0.4 mg cap

Flonase 50 mcg nasal spray

Florinef 0.1mg tab

Flovent HFA 44, 110, 220mcg; Diskus 50, 100, 250mcg

Fluconazole 150, 200mg tab

Fludrocortisone 0.1 mg tab

Fluocinolone 0.01% top soln

Fluocinonide 0.05% crm, oint

Fluoride 1.1 mg/ml drops

Fluoride 1.1% toothpaste, gel

Fluorometholone 0.1% opht susp

Fluorouracil 5% cream

Fluoxetine 10, 20, 40mg cap; 20mg/5mL soln

Fluticasone 50 mcg nasal spray; HFA 44, 110, 220 mcg;

 Diskus 50, 100, 250 mcg

Fluticasone/Salmeterol Diskus 100/50, 250/50, 500/50; HFA 45/21, 115/21, 230/21

FML 0.1% opht susp

Folic Acid 1mg tab

Fortesta 2% gel pump@

Fosamax 5, 10, 35, 70mg tabs

Fosinopril 10, 20, 40mg tab

FreeStyle Lite Blood Glucose Monitor; test strips

Furosemide 20,40mg tab; 10mg/mL

Gabapentin 100, 300, 400, 600, 800mg

Gemfibrozil 600mg tab

        Gengraf 25, 100mg cap

Gentak 0.3% opth oint, soln

Gentamycin 0.3% opth oint, soln

Gildess Fe 1/20; 1.5/30 tab

Glimepiride 1, 2, 4 mg tab

Glipizide 5, 10mg tab

Glipizide XL 5mg, 10mg tabs

Glucagon 1mg inj 

Glucophage 500, 850, 1000mg tab

Glucophage XR 500, 750mg tabs

Glucotrol 5, 10 mg tab

Glucotrol XL 5, 10mg tab

Glucovance 1.25/250, 2.5/500, 5mg/500mg tab

Glyburide 1.25, 1.5, 2.5, 3, 5, 6mg

Glyburide/Metformin 1.25/250, 2.5/250, 5mg/500mg tab

Glycerin 1.2gm  pediatric supp

Glynase 3, 6 mg tab

Golytely powder mix to 4000ml

Goserelin 3.6, 10.8mg implant

Granisetron 1mg tab

Griseofulvin 500mg, 125/5 susp (microsize); 125, 250, 500mg tab (ultramicrosize);

GrisPeg (ultramicrosize) 125, 250, 500mg tab; 125/5mL susp

Guaifenesin 600mg tab

Guaifenesin/Codeine syrup 100-10mg/5mL (4 oz)@

Guaifenesin/Dextromethorphan 100-10mg/5ml syrup

Guaifenesin/Pseudoephedrine 600/60mg tab

Guaifenesin/Pseudoephedrine/ Codeine syrup (4 oz) @

Guanfacine ER 1, 2, 3, 4 mg tab

Haldol 0.5, 2, 5mg tab

Half-lytely bowel prep kit

Haloperidol 0.5, 2, 5mg tab

HCTZ 12.5, 25, 50mg

Hemorrhoidal HC 25 mg supp

Humalog Insulin Lispro vial, Kwikpen

        Hycet 7.5-325mg/15ml soln (4oz)*

Hydralazine 10, 25, 50, 100mg tab

Hydrochlorothiazide 12.5, 25,50mg

Hydrochlorothiazide/Triamterene 25/37.5, 50/75mg tab

Hydrocodone/APAP 5/325, 7.5/325, 10/325mg tab;       7.5-325mg/15mL soln (4 oz)*

Hydrocortisone 1%, 2.5% top crm, 2.5% rectal crm, 25mg sup

Hydrocortisone valerate 0.2% crm

Hydrodiuril 25, 50 mg tab

Hydroxychloroquine 200mg tab

Hydroxyzine 10, 25, 50mg tab, 10mg/5ml syrup

Hygroton 25mg tab

Hyoscyamine 0.125mg tab, SL tab

Hydrophor ointment 1 lb

Hytrin 1,2,5,10mg cap

Hyzaar 100/12.5, 50/12.5, 100mg/25mg tab

Ibandronate Sodium 150mg tab

Ibuprofen 400, 600, 800mg tab

Ibuprofen Childrens 100mg/5ml liq

Imdur 30, 60, 120 mg tab

Imipramine HCl 10, 25, 50 mg tab

Imipramine Pamoate 75 mg cap

Imitrex 25,50, 100mg tab; 6 mg Autoinjector (2/kit); 20 mg nasal spray#

Imodium 2mg cap

Imuran 50mg tab

Inderal 10, 40mg tab

Inderal LA 60, 80, 120, 160mg cap

Indocin 25, 50mg cap

Indocin SR 75mg cap

Indomethacin 25, 50mg cap

Indomethacin SR 75 mg cap

Inspirease inhaler device

Insulins:

Humalog (Insulin Lispro)

Humalog Kwikpen 

        Lantus (Insulin Glargine)

Lantus Solostar Pen

Linagliptin (Tradjenta) - (Must try Januvia, Janumet or Janumet XR prior)

Linagliptin/Metformin (Jentadueto) - (Must try Januvia, Janumet or Janumet XR prior)

Liraglutide (Victoza)

Novolin 70/30

Novolin N (NPH)

Novolin R (Regular)

Novolog (Insulin Aspart)

Novolog Flexpen

Novolog Mix 70/30

Novolog Mix 70/30 Flexpen

Intuniv 1, 2, 3, 4 mg tab

Ipratropium 17 mcg/act HFA; 0.02% neb soln

Ipratropium/Albuterol MDI, neb

Iron Sulfate 325mg tab, 15 mg/1 ml infant drops

        IsoDitrate ER 40 mg tab

Isoniazid 50/5ml susp; 100, 300mg tab

Isordil 5, 10, 20, 30 mg tab

Isordil Titradose 40 mg tab

Isosorbide Dinitrate 5,10, 20, 30, 40mg tab

Isosorbide Dinitrate ER 40mg tab

Isosorbide Mononitrate SR 30, 60, 120mg tab

Isotretinoin 10, 20, 40mg caps

Janumet 50/500mg, 50/1000mg tab

Janumet XR 50/500, 50/1000, 100/1000mg tab

Januvia 25, 50, 100mg tab

Jentadueto 5/1000 mg tab  (Linagliptin/Metformin) - (Must try Januvia, Janumet or Janumet XR prior)

Junel Fe 1/20;1.5/30 tab

Kariva tab

KCl ER 8, 10, 20 mEq tab; 10 mEq cap; 20 mEq packet; 10% soln

Keflex 250, 500mg cap

Keflex 125,250mg/5ml susp

Kelnor 1/35 tab

Kenalog 0.1% in Orabase 5gm

        Keppra 250,500,750,1000mg tab

Ketoconazole 200mg tab

Ketoconazole 2% cream

Ketorolac 10 mg tabs#

Klonopin 0.5, 1mg tab@

Klor-Con ER 8, 10, 20 mEq tab; 20 mEq packet;

Kytril 1mg tab#

l-methylfolate/pyridoxal 5’-phosphate/methylcobalamin caps

Lac-Hydrin 12% lotion

Lactinex granules

Lactobacillus granules, caps

Lactulose 10gm/15ml oral soln

        Lamictal 25,100,150,200mg tab

Lamisil 250mg tab

Lamotrigine 25,100,150,200mg tab

Lancets Thin (200 count)

Lanoxin 0.125, 0.25mg tab

Lantus Insulin 100U/mL vial

Lantus Solostar pens (1500U/pack)

Lariam 250 mg tab

Lasix 20, 40mg tab; 10mg/mLsoln

Latanoprost 0.005% Opht Soln

Lessina tab

Levalbuterol 0.63, 1.25 mg/3 ml neb

Levaquin 250, 500, 750mg tab; 125mg/5mL susp

Levetiracetam 250,500,750, 1000mg tab

Levofloxacin 250, 500, 750mg tabs; 125mg/5mL susp

Levonorgestrel 0.75, 1.5mg tab

Levora tab

Levothyroxine 25, 50, 75, 88, 100, 112, 125, 137, 150, 175, 200, 300 mcg tab

Lexapro 5, 10, 20mg tab

Lialda 1.2 gram tab

Librax 2.5mg/5mg cap

Lidex 0.05% top cream, oint

Lidocaine 5% top oint, patches

Lidocaine viscous 2% soln

Lidoderm 5% patches#

Linagliptin 5mg tab#

Liothyronine 25 mcg tab

Lipitor 10, 20, 40, 80 mg tab

Lisinopril 2.5, 5,10,20,30,40mg tab

Lisinopril/HCTZ 10/12.5, 20/12.5, 20/25 mg tab

Lithium 150, 300mg cap

Lithium Citrate 8mEq/5mL soln

Loestrin Fe 1/20; 1.5/30 tab

Lofibra 48, 54, 67, 134, 145, 160, 200mg tab

Lomotil 2.5/0.025mg tab@

Lo-Ovral tab

Loperamide 2mg cap

Lopid 600mg tab

Lopressor 25, 50, 100mg tab

Loratadine 10mg tab; 5mg/5ml sol

Loratadine-D 10mg/240mg (24hr)#

Lorazepam 1mg tab@

Losartan 25, 50,100mg tab

Losartan/HCT 100/12.5; 50/12.5; 100/25mg tab

Lotrel 2.5/10, 5/10, 5/20, 5/40, 10/20, 10/40mg cap

Lotrimin 1% top crm, vag crm

Lotrisone 0.05/1% cream

Lovenox 30mg/0.3ml, 40mg/0.4ml, 60mg/0.6ml, 80mg/0.8mL, 100mg/1ml inj

Low-Ogestrel tab

Lutera tab

Lysteda 650mg tab

Macrobid 100mg cap

Macrodantin 50,100mg cap; 25mg/5ml susp

Magnesium Oxide 400mg tab

Maxalt 5, 10mg#

Maxalt-MLT 5, 10mg#

Maxzide 25/37.5, 50/75 mg tab

Meclizine 25mg tab

Medrol 4mg Dose-Pack

Medroxyprogesterone 2.5, 5, 10mg

Mefloquine 250 mg tab

Meloxicam 7.5, 15mg tab

Memantine XR starter pack, 14, 28mg tab

Meperidine 50mg tab (C-II)*

Mephyton 5mg tab

Mesalamine 1.2gram tab

Metadate CD 10,20,30,40mg (C-II)*

Metanx capsules

Metaxalone 800mg tab

Metformin 500, 850, 1,000mg tab

Metformin ER 500,750 mg tab

Metformin/Sitagliptin 50/500mg, 50/1000mg tab

Metformin/Sitagliptin XR 50/500, 50/1000, 100/1000mg tab

Methocarbamol 500, 750 mg tab

Methotrexate 2.5mg tab; 25mg/mL inj

Methylin 2.5, 5mg chew tab(C-II)*

Methylphenidate 5,10,20mg (C-II)*

Methylphenidate CD 10, 20, 30, 40mg (C-II)*

Methylphenidate 20mg SR (C-II)*

Methylphenidate XR 18, 27, 36, 54mg tabs (C-II)*

Methylprednisolone 4mg dose-pack

Metoclopramide 10mg tab; 5mg/5mL liq

Metoprolol succinate XL 25, 50, 100, 200mg tab

Metoprolol tartrate 25,50,100mg

Metrogel 1% topical gel; 0.75% vaginal gel

Metronidazole 1% topical gel; 0.75% vaginal gel

Metronidazole 250, 500mg tab

Micardis 20, 40, 80 mg tab

Micardis HCT 12.5/40, 12.5/80, 25mg/80mg tab

Microgestin Fe 1/20; 1.5/30 tab

Micro-K 10 mEq cap

Micronase tab

Micronor tab

Minipress 1, 2, 5mg cap

Minocin 50, 100mg cap

Minocycline 50, 100mg cap

Mirapex 0.125, 0.25, 0.75, 1, 1.5mg

Miralax 255gm, 510gm btl

Mircette tab

Mirtazapine 15, 30, 45mg tab

Misoprostol 200mcg tab

Mobic 7.5, 15mg tab

Modafinil 100, 200 mg tab@

Mononessa tab

Monopril 10, 20, 40mg tab

Montelukast 4, 5mg chew tab;      10 mg tab; 4mg granules

Morphine IR 15, 30mg (C-II)*

Morphine SR 15, 30, 60, 100, 200mg (C-II)*

Motrin 400, 600, 800mg tab

Motrin Children’s 100mg/5ml liq

Moxifloxacin 400mg tabs; 0.5% opht soln

MS Contin 15, 30, 60, 100, 200 mg (C-II)*

Mucinex 600 mg tab

Mucinex-D 600/60mg tab

Multivitamin Daily (generic only)

Mupirocin 2% top ointment

Muro 128 opht oint, soln

Myambutol 100, 400mg tab

Mycophenolate 250, 500mg

Mycolog II top crm, oint 15gm

Mylanta Max Strength liq

Mysoline 250mg tab

Mytussin DAC (4 oz)@

NaCl for Inhal 0.9% 3ml Amps

Namenda XR starter pack, 14, 28mg tab

Naproxen 250, 500mg, 550mg DS tab; 125mg/5mL

Naprosyn 250, 500mg, 550mg DS tab; 125mg/5mL

Necon 1/35, 1/50, 777 tab

Needles, Pen 31G x 5/16th”(8mm)

Needles, B-12 Luer-Lok 25G x 5/8” (16mm) with 3ml syringe

Neosporin 400/5/10K, 400/3.5/10K top oint

Neosporin 1.75/10K opht

Neurontin 100, 300, 400, 600, 800mg

Nexium 20,40mg cap

Next Choice tab

Niacin (B-3) 100, 500mg tab

Niacin ER 500, 750, 1000 mg tab

Niaspan 500, 750, 1000 mg tab

Nicotine gum 2, 4 mg**Must be enrolled in Smoking Cessation Program 456-8046**

Nicotine patch 7, 14, 21mg**Must be enrolled in Smoking Cessation Program 456-8046**

Nifedipine ER 30, 60, 90mg tab

Nitro-Dur 0.1, 0.2, 0.3, 0.4, 0.6, 0.8mg/hr patch

Nitrofurantoin 25mg/5ml susp

Nitrofurantoin 50, 100mg cap

Nitrofurantoin SR 100 mg cap

Nitroglycerin 0.1, 0.2, 0.3, 0.4, 0.6, 0.8mg/hr patch

Nitroglycerin 1/150 subling tab

Nitroglycerin 400 mcg SL spray

Nitrolingual 400 mcg spray

Nitro-Stat 1/150 subling tab

Nizoral 200 mg tab; 2% crm, shampoo

Nolvadex 10, 20mg tab

        Norco 5/325, 7.5/325, 10/325mg*

Nordette 28 tab

Norethindrone 0.35 mg tab

Norinyl 1/35 tab

Nortrel 1/35 tab

Nortriptyline 10, 25, 50 mg cap; 10mg/5mL soln

Nor-QD tab

Norvasc 2.5, 5, 10mg tab

Novolin 70/30 100U/mL vial

Novolin N, (NPH) 100U/mL vial

Novolin R, (Regular) 100U/mL vial

Novolog 100U/mL vial, FlexPen

Novolog Mix 70/30 100U/mL vial, FlexPen

NuLytely bowel prep kit

NuvaRing 0.0.15-0.12mg/day ring

Nystatin 100,000 U/ml oral susp, 100,000U/gm crm, oint, pwdr

Nystatin/triamcinolone 100,000U-0.1%/gm crm, oint

Ocuflox 0.3% opht soln

Ofloxacin 0.3% opht soln

Ogestrel

Olopatadine 0.01%, 0.02% opht sol

Omeprazole 10, 20, 40 mg cap

Omnicef 125/5, 250/5 susp,    300mg cap

Ondansetron 4mg, 8mg tabs#

Ondansetron ODT 4mg, 8mg tabs#

        Optichamber spacing device

Oralone 0.1% oral paste

Orapred 15mg/5mL soln

Ortho-Cept tab

Ortho-Cyclen tab

Ortho Evra patch

Ortho-Novum 1/35;1/50; 777 tab

Ortho-Tri-Cyclen tab

Ortho-Tri-Cyclen Lo tab

Oscal+D3 500mg/200 IU tab

Oseltamivir 75 mg caps, 60mg/mL susp

Ovral tab

Oxybutynin 5mg tab;1mg/ml soln

Oxybutynin XL 5, 10, 15mg tab

Oxycodone/Acetaminophen 5/325, 10/325mg (C-II)*

Oxymetazoline 0.05% nasal spray

Pacerone 200mg tab

Pamelor 10,25mg cap; 10mg/5mL

Pancrelipase 3000U,6000U, 1200U, 2400U, 3600U tab

Pancrelipase 5/17/27K units cap

Pantoprazole 20, 40mg tab

Pataday 0.2% ophth soln

Patanol 0.1% ophth soln

Paroxetine 20mg tab

Paxil 20mg tab

Pradaxa 75 mg, 150mg cap

Pediaflor 1.1mg/ml drops

Pediazole 200-600/5mL susp

Pen needles 31G x 5/16th”(8mm)

Penicillin VK 250, 500 mg tabs; 125/5mL, 250/5mL susp

Percocet 5/325, 10/325mg (C-II)*

Periactin 4mg tab

Peridex 0.12% dental soln, 473mL

Periogard 0.12% dental soln

Permethrin 1% lotion, 5% crm

Persantine 25mg tab

Phenazopyridine 100,200mg tab

Phenergan 12.5, 25 mg supp

Phenergan 25mg tab; 6.25mg/5mL

Phenobarbital 20mg/5ml elixir@

Phenobarbital 15, 30, 60, 100mg@

Phenytoin 50mg chew tab, 100mg ER cap, 125mg/5ml susp

Phytonadione 5mg tab

Pilocarpine 1, 2, 4% ophth soln, 4% ophth gel

Pilopine HS 4% opht gel

Pimecrolimus 1% cream

Pimtrea tab

Pioglitazone 15, 30, 45 mg tab

Plan B One-Step tab

Plaquenil 200mg tab

Plavix 75, 300mg tab

Plendil 2.5, 5, 10mg tab

Podofilox 0.5% top soln

Polyethylene Glycol (PEG)255gm, 510gm powder btl

Polytrim ophth soln  

PolyVitamin infant drops

Portia 28 tab

Potassium Chloride ER 8, 10, 20 mEq tab; 10 mEq cap; 20 mEq packet; 10% soln

Pradaxa 75mg, 150mg cap

Pramipexole 0.125, 0.25, 0.05, 0.75, 1, 1.5mg tab

Pravachol 10, 20, 40, 80mg tab

Pravastatin 10, 20, 40, 80mg tab

Prazosin 1, 2, 5mg cap

Precision XTRA Monitor, strips#

Pred Forte 0.12%, 1%  opht susp

Prednisolone 0.12%, 1% opht susp

Prednisolone 15mg/5ml soln

Prednisolone Sodium Phosphate 15mg/5ml soln

Prednisone 1, 5, 10, 20mg tab

Prelone 15mg/5ml soln

Premarin 0.3, 0.45, 0.625, 0.9, 1.25mg tab

Premarin 0.625mg/gm vag cream

Prempro 0.3/1.5, 0.45/1.5, 0.625/2.5, 0.625/5 mg tab

Prenatal Vitamin w/minerals#

Prevalite 4g/dose powder

Prevident 5000 Plus toothpaste

Prevident 1.1% gel toothpaste

Prilosec 10, 20, 40 mg cap

Primaquine 26.3mg tab

Primidone 250mg tab

Prinivil 2.5, 5,10,20,30,40mg tab

Prinzide 10/12.5, 20/12.5, 20/25mg

ProAir HFA 90mcg/inh Inhaler

Probenecid 500mg tab

Probiotics Formula cap

Proctozone-HC 2.5% cream

Promethazine 25mg tab; 12.5, 25mg supp; 6.25mg/5mL soln

Prometrium

Propranolol 10, 40mg tab

Propranolol LA 60, 80, 120, 160mg cap

Propylthiouracil 50mg tab

Proscar 5mg tab

Protonix 20, 40mg tab

Proventil 1.25mg/3mL, 2.5mg/3mL (0.083%) neb; 4mg tabs; 2mg/5ml syrup

Provera 2.5, 5, 10mg tab

Provigil 100, 200 mg tab@

Prozac 10,20,40mg cap; 20mg/5mL

Pseudoephedrine 30mg tab#

Pulmicort Respules 0.25/2,0.5/2ml

Pyrazinamide 500mg tab

Pyridium 100, 200mg tab

Pyridoxine (B-6) 50 mg tab

Questran 4gm/dose powder

Questran Light 4gm/dose powder

Quetiapine 25, 50, 100, 200, 300, 400mg tab

Quetiapine ER 50, 150, 200, 300, 400mg tab

Quinidine gluconate 324 mg tab

Raloxifene 60mg tab

Ramipril 1.25, 2.5, 5, 10mg cap

Ranitidine 150 mg tab, 15mg/ml

Reclipsen tab

Refresh artificial tears

Refresh(preservative free) opht sol

Refresh Celluvisc

        Reglan 10mg tab, 5mg/5ml liq

Remeron 15, 30, 45mg tab

Requip 0.25, 0.5, 1, 2, 3, 4, 5mg tab

Restasis 0.05% opht soln

Restoril 15, 30mg cap@

Retin–A 0.025 %, 0.05% cream

Rheumatrex 2.5mg tab

Rifampin 300mg cap

Risperdal 0.25, 0.5, 1, 2, 3, 4 mg tab; 1mg/mL soln

Risperidone 0.25, 0.5, 1, 2, 3, 4mg tab; 1mg/mL soln

Ritalin 5, 10, 20mg (C-II)*

Rivaroxaban (Xarelto)

Rizatriptan 5, 10mg;MLT 5, 10mg#

Robaxin 500, 750mg tab

Robitussin AC syrup@

Robitusssin DAC syrup@

Robitussin DM syrup

Rocaltrol 0.25, 0.5 mcg cap

Ropinirole 0.25, 0.5, 1, 2, 3, 4, 5mg

Rosuvastatin 5, 10, 20, 40mg tab

Salmeterol 50 mcg/inh diskus

Salsalate 500, 750mg tab

Scopolamine 1.5mg/72hr patch

Selenium sulfide 2.5% lotion (suspension)

Septra DS 800/160mg tab; 200-40/5ml susp

Serevent 50mcg/inh Diskus

Seroquel 25,50,100,200,300,400mg

Seroquel XR 50, 150, 200, 300, 400mg tab

Sertraline 25, 50, 100mg tab; 20mg/mL liq

Sildenafil 25, 50, 100mg tab

Silvadene 1% cream

Silver sulfadiazine 1% cream

Simvastatin 5, 10, 20, 40 mg tab

Sinemet 10/100, 25/100, 25/250mg

Sinemet CR 50/200mg tab

Sinequan 10mg, 25, 50, 75mg cap; 10mg/mL liq

Singulair 4, 5, 10mg tab; 4mg granules

Sitagliptin 25, 50, 100mg tab

Sitagliptin/Metformin 50/500mg, 50/1000mg tba

Skelaxin 800 mg tab

Sodium Chloride 0.9% inh amps

Sodium Chloride 5% opht oint/sol

Sodium Fluoride 1.1 mg/ml drops

Sodium Phosphates Enema, pediatric enema

Solifenacin 5,10mg tab

Soma 350mg tab@

Sonata 5, 10 mg@

Sotalol

Spacer, inhalation device

Spiriva 18mcg inh Handihaler

Spironolactone 25, 50, 100mg tab

Sprintec tab

Sronyx tab

Strattera 10,18,25,40,60,80,100mg 

Sudafed 30mg tab#

Sulfacetamide 10% opht soln

Sulfamethoxazole/Trimethoprim SS tabs (400/80mg); DS tabs (800/160mg); 200/40/5mL susp

Sulfamide 10% ophth soln

Sulfasalazine 500mg tab

Sulfasalazine XR 500mg tab

Sulfazine EC 500 mg tab

Sumatriptan 25,50, 100mg tab; 6mg Autoinjector (2/kit); 20mg nasal spray#

Sumatriptan/Naproxen 85/500mg#

Surfak 240mg cap

Synalar 0.01% top soln

Synthroid 25, 50,75,88,100,112, 125,137,150,175,200,300 mcg

Syringes/needles insulin 31G, 5/16th”(8mm); 0.3, 0.5, 1 cc#

Syringe, 3ml syringe with Luer-Lok needle 25G x 5/8” (16mm)

Syringes/needles insulin 18G,        1 1/2”

Syringes/needles insulin 22G,        1 1/2”

Tamiflu 75 mg cap, 6mg/mL susp

Tamoxifen 10, 20mg tab  

Tamsulosin 0.4 mg cap

Tegretol 100mg (chew) 200mg tab; 100mg/5mL

Tegretol XR 400 mg tab         

Tekturna 150mg, 300mg tab

Tekturna/HCT 150/12.5mg, 150/25mg, 300/25mg tab

Telmisartan 20, 40, 80 mg tab

Telmisartan HCT 12.5/40, 12.5/80, 25/80mg tab

Temazepam 15, 30mg cap@

Temovate 0.05% cream, oint

Tenormin 25, 50, 100mg tab

Terazole-7 0.4% vag cream

Terazosin 1,2,5,10mg cap

Terbinafine 250mg tab

Terconazole 0.4% vag cream

Tessalon 100mg perles

Test Strips:

        FreeStyle Lite

        Precision Xtra

Testosterone 2% gel pump; 200mg/mL injection; 2mg, 4mg patches@

Tetracycline 250, 500mg cap

Theo-24 (24h) 300, 400mg cap

Theo-Dur (12h) 200, 300mg tab

Theophylline (12hr) 200, 300 mg tabs; 80mg/15mL soln

Theophylline XR (24hr) 300, 400mg cap

Thiamine (B-1) 50mg tab

Thyroid 15, 30, 60mg tab

Tiazac 120, 180, 240, 300, 360, 420mg cap

Timolol 0.25%, 0.5% opht soln

Timolol 0.25%,0.5% opht GFS

Timoptic-XE 0.25%,0.5% opht

Tiotropium 18 mcg/inh inhaler

Tizanidine 4mg tab

Tobradex 0.3/0.1% opht soln,oint

Tobramycin 0.3% opht soln, oint

Tobramycin/Dexamethasone 0.3/0.1% opht soln, oint

Tobrex 0.3% opht soln, oint

Tofranil 10, 25, 50mg tab

Tofranil-PM 75mg cap

Tolterodine ER 2, 4 mg cap

Topamax 25, 50, 100, 200mg tab

Topiramate 25, 50, 100, 200mg tab

Toprol XL 25, 50, 100, 200 mg tab

Toradol 10 mg tab#

Tramadol 50mg tab@

Tranexamic Acid 650mg tab

Transderm Scop 1.5mg/72hr patch

Trazodone 50,100,150,300mg tab

Tretinoin 0.025%, 0.05% cream

Treximet 85/500mg tab#

Triamcinolone 0.1% top crm, oint, oral paste

Triamcinolone/Nystatin top cream

Triamterene/HCTZ 25/37.5, 50/75mg tab

Tricor 48, 145mg tab

Trifluridine 1% opht soln

Trihexyphenidyl 2mg tab, 0.4mg/mL elixir

Tri-levlin tab

TriLyte bowel prep kit

TriNessa tab

Triphasil tab

Trivora tab

Trixaicin 0.025% cream

Tylenol 325mg tab;160mg/5ml childrens liq; 120, 650 mg suppository

Tylenol #3 (300/30mg) tab@

Tylenol w/codeine 120-12mg/5ml elixir@

Ultram 50mg tab

Urispas 100mg tab

Uroxatral ER 10mg tab

Vagifem 10mcg vag tab

Valacyclovir 500mg, 1gm tab

Valium 5mg tab@

Valproic acid 250/5mL soln

Valsartan 40, 80, 160, 320 mg tab

Valsartan/HCTZ 80/12.5,160/12.5, 160/25, 320/12.5, 320/25 mg

Valtrex 500mg, 1gm tab

Vantin 50/5, 100mg/5mL susp

Varenicline 1mg tab**Must be enrolled in Smoking Cessation Program 456-8046**

Venlafaxine IR 25, 37.5, 50, 75, 100mg tabs

Venlafaxine SR 37.5, 75, 150, 225mg cap

Verapamil 80 mg tab

Verapamil SR 120, 180, 240 mg tab

Vermox 100 mg tab

Vesicare 5,10mg tab

Viagra 25, 50, 100mg tab #

Vibramycin 100 mg cap, 100mg tab

Victoza pen-injector

Viroptic 1% opht soln

Viscous Lidocaine 2% oral soln

Vistaril 25, 50 mg tabs

Vitamin B-1 50 mg tab

Vitamin B-3 100,500mg tab

Vitamin B-6 50mg tab

Vitamin B-12 500 mcg tab;      1000 mcg inj

Vitamin D2 1.25mg (50,000IU) cap

Vitamin K 5mg tab

Vivelle Dot 0.0375, 0.25, 0.05, 0.06, 0.075, 0.1 mg patch

Voltaren 1% gel#

Voltaren Ophtha  0.1% opht soln

VoSol-HC otic soln

Warfarin 1, 2, 2.5, 3, 4, 5, 6, 7.5, 10mg tab

Wellbutrin 75, 100mg tab

Wellbutrin SR 100,150 300mg tab#

Wellbutrin XL 150, 300 mg tab

Westcort 0.2% cream

Xalatan 0.005% ophth soln

Xopenex 0.63, 1.25 mg/ 3ml neb soln

Xylocaine 2% viscous soln

Yasmin tab

Yaz tab

Yocon 5.4 mg tab

Zaleplon 5, 10 mg@

Zanaflex 4mg tab

Zantac 150 mg tab, 15mg/ml syrup

Xarelto (Rivaroxaban)

Zenpep 5/17/27K units cap

Zestoretic 10/12.5, 20/12.5, 20/25mg tab

Zestril 2.5,5,10,20,30,40 mg tab

Zetia 10 mg tab

Ziac 2.5/6.25, 5/6.25, 10/6.25mg

Zinc Oxide ointment 1 lb#

Zithromax 250, 500 mg tab; 1gm packet, 100/5, 200/5mL susp

Zocor 5, 10, 20, 40mg tab

Zofran 4mg, 8mg tabs#

Zofran ODT 4mg, 8mg tabs#

Zoladex 3.6, 10.8 mg implants

Zolmitriptan 2.5, 5mg; ZMT 2.5, 5mg tab#

Zoloft 25,50,100mg tab; 20mg/mL

Zolpidem 5, 10 mg tab@

Zomig 2.5,5mg;ZMT 2.5,5mg tab#

Zovia 1/35 tab

Zovirax 200mg cap; 400, 800mg tab; 200/5mL susp; 5% oint

Z-Pak 250 mg tab

Zyban 150mg tab**Must be enrolled in Smoking Cessation Program 456-8046**

Zyloprim 100, 300mg tab

Zyrtec 5, 10mg tab, 1mg/ml liq

Zyrtec-D 5/120 mg (12hr) tab#


 

RESTRICTIONS:

 

Blood Glucose Test Strips/Syringes

Limit 150 strips/syringes per 30 days

 

Bupropion:  Wellbutrin SR is not to be used for tobacco cessation.

 

Cetirizine-D (Zyrtec-D):

Qty limit to 60 tabs per 30 days

with up to 5 refills

 

Diclofenac (Voltaren) Gel

Qty limit 2 tubes per 90 days

 

Fexofenadine-D (Allegra-D):

Qty limit up to 30 tabs per 30 days with up to 5 refills. Limit 30 day supply at a time.

 

Granisetron (Kytril)

Restricted to chemotherapy.

Max of 8 tablets per 28 days

 

Guaifenesin-D (Mucinex D):

Qty limit to 36 tablets per 30 days with up to 5 refills

 

Jardiance (empaglflozin)

Must try metformin, januvia, janumet first

 

Jentadueto (linagliptan & metformin)

Must try metformin, januvia, janumet first

 

Ketorolac (Toradol)

Qty limit 20 tabs per 30 days

 

Lidocaine (Lidoderm) patches

Limit 30 day supply at a time.

 

Loratadine-D (Claritin-D):

Qty limit to 30 tablets per 30 days with up to 5 refills. Limit 30 day supply at a time.

 

Nicotine Gum:

Qty limit up to 150 pieces per 30 days.

 

**Must be enrolled in Smoking Cessation Program for meds. Call 456-8046 for more information**

 

Odansetron (Zofran/Zofran ODT)

Qty limit 60 tabs per 30 days

 

Prenatal Vitamins

Limited to women of child-bearing age up to and including 45 years old.

 

Pseudoephedrine 30 mg         

Qty limit to 72 tablets per 30 days with up to 5 refills. Limit 30 day supply at a time.

 

Rizatriptan (Maxalt/Maxalt MLT)

Used as 2nd line after Zomig failed.

Limit 12 tabs per 30 days

 

Sildenafil (Viagra)

Qty limit 6 doses per 30 days

 

Sumatriptan (Imitrex)

Autoinjector (2/kit)

Qty limit to 8 syringes per 30 days

 

Nasal Spray

Qty limit 6 doses per 30 days

 

Tablets

50 mg Qty limit 18 tabs per 30 days

100 mg Qty limit 9 tabs per 30 days

 

 

Sumatriptan/Naproxen (Treximet)

Qty limit 9 tablets per 30 days

 

Tradjenta (linaglptin)

Must try metformin, januvia, janumet first

 

    Zinc Oxide Ointment

Qty limit 1 lb jar with zero refills per prescription

 

Zolmitriptan (Zomig)

Qty limit to 12 tabs per 30 days