Strength Form QTY Strength Form …

1 PHARMACY $4 and $10 Generic Medication List (sorted by disease state)Page 9 of 13 PHARMACY 2010 Marketing Style :11"T:17"Page 9 of 13 PHARMACY 2010 Marketing Style :11"T:17"Page 9 of 13 PHARMACY 2010 Marketing Style :11"T:17"Page 9 of 13 PHARMACY 2010 Marketing Style :11"T:17"Page 9 of 13 PHARMACY 2010 Marketing Style :11"T:17"$4 and $10 Generic Medication List (sorted by disease state)Medication Name/ StrengthForm$430-DayQTY$1090-DayQTYA llergy, Cough and ColdBenzonatate 100 MgCapsule1442 Ceron Mg/MlDrops*30 mL90 mLCeron Dm Mg/5 MlSyrup120 mL360 mLDec-Chlorphen Mg/MlDrops*30 mL90 mLDec-Chlorphen Dm Mg/5 MlSyrup*118 mL354 mLLoratadine 10 MgTablet3090 Promethazine Mg/5 MlSyrup*180 mL540 mLPromethazine Dm Syrup120 mL360 mLTrivent Dpc 6/2/15/5 MlSyrup*120 mL360 mLAnalgesicBaclofen 10 MgTablet3090 Cyclobenzaprine 5 MgTablet3090 Cyclobenzaprine 10 MgTablet3090 Diclofenac Er 75 MgTablet60180 Ibuprofen 100 Mg/5 MlSuspension*120 mL360 mLIbuprofen 400 MgTablet90270 Ibuprofen 600 MgTablet60180 Ibuprofen 800 MgTablet3090 Indomethacin 25 MgCapsule*60180 Meloxicam

2 MgTablet3090 Naproxen 375/500 MgTablet*60180 Anti-AnxietyBuspirone 5/10 MgTablet*60180 Doxepin Hcl 10/25/50/75/100 MgCapsule3090 Paroxetine 10/20 MgTablet*3090 AntibioticAmoxicillin 125 Mg/5 MlSuspension80 mL240 mLAmoxicillin 125 Mg/5 MlSuspension100 mL300 mLAmoxicillin 125 Mg/5 MlSuspension150 mL450 mLAmoxicillin 200 Mg/5 MlSuspension50 mL150 mLAmoxicillin 200 Mg/5 MlSuspension75 mL225 mLMedication Name/ StrengthForm$430-DayQTY$1090-DayQTYA moxicillin 200 Mg/5 MlSuspension*100 mL300 mLAmoxicillin 250 MgCapsule3090 Amoxicillin 250 Mg/5 MlSuspension80 mL240 mLAmoxicillin 250 Mg/5 MlSuspension100 mL300 mLAmoxicillin 250 Mg/5 MlSuspension150 mL450 mLAmoxicillin 400 Mg/5 MlSuspension50 mL150 mLAmoxicillin 400 Mg/5 MlSuspension*75 mL225 mLAmoxicillin 400 Mg/5 MlSuspension*100 mL300 mLAmoxicillin 500 MgCapsule3090 Cephalexin 250 MgCapsule2884 Cephalexin 500 MgCapsule3090 Ciprofloxacin 250 MgTablet1442 Ciprofloxacin 500 MgTablet2060 Doxycycline Hyclate 50 MgCapsule3090 Doxycycline Hyclate 100 MgCapsule/Tablet2060 Isoniazid 300 MgTablet3090 Metronidazole 250 MgTablet2884 Metronidazole 500 MgTablet1442 Penicillin Vk 125 Mg/5 MlSolution200 mL600 mLPenicillin Vk 250 Mg/5 MlSolution100 mL300 mLPenicillin Vk 250 MgTablet2884 Smz/Tmp 200/40/5

3 MlSuspension*120 mL360 mLSmz/Tmp 400/80 MgTablet2884 Smz/Tmp Ds 800/160 MgTablet2060 Tetracycline 250/500 MgCapsule60180 AntidepressantAmitriptyline 10/25/50/75/100 MgTablet3090 Citalopram 20/40 MgTablet3090 Doxepin Hcl 10/25/50/75/100 MgCapsule3090 Fluoxetine 10 MgTablet*3090 Fluoxetine 10/20/40* MgCapsule*3090 Medication Name/ StrengthForm$430-DayQTY$1090-DayQTYN ortriptyline 10/25 MgCapsule3090 Paroxetine 10/20 MgTablet*3090 Trazodone 50/100/150 MgTablet3090 AntifungalFluconazole 150 MgTablet13 Terbinafine 250 MgTablet*3090 Anti-InflammatoryDiclofenac Er 75 MgTablet60180 Ibuprofen 100 Mg/5 MlSuspension*120 mL360 mLIbuprofen 400 MgTablet90270 Ibuprofen 600 MgTablet60180 Ibuprofen 800 MgTablet3090 Indomethacin 25 MgCapsule*60180 Meloxicam MgTablet3090 Naproxen 375/500 MgTablet*60180 AntipsychoticFluphenazine 1 MgTablet3090 Haloperidol MgTablet3090 Lithium Carb 300 MgCapsule*90270 Thioridazine 25/50 MgTablet3090 Thiothixene 2 MgCapsule3090 AntiviralAcyclovir 200 MgCapsule3090 ArthritisDiclofenac Er 75 MgTablet60180 Ibuprofen 400 MgTablet90270 Ibuprofen 600 MgTablet60180 Ibuprofen 800 MgTablet3090 Indomethacin 25 MgCapsule*60180 Meloxicam MgTablet3090 Naproxen 375/500 MgTablet*60180 Medication Name/

4 StrengthForm$430-DayQTY$1090-DayQTYA sthmaAlbuterol 2 Mg/5 MlSyrup120 mL360 mLAlbuterol 2 MgTablet90270 Albuterol 4 MgTablet60180 Albuterol Neb *75 mL225 mLAlbuterol Neb mL60 mLIpratropium Neb Mg/MlSolution*75 mL225 mLCancer/OncologyMegestrol 20 MgTablet*3090 Cardiac/HypertensionAmiloride/Hctz 5-50 MgTablet3090 Atenolol 25/50/100 MgTablet3090 Atenolol/Chlorthal 50/25 MgTablet3090 Atenolol/Chlorthal 100/25 MgTablet3090 Benazepril 5/10/20/40 MgTablet3090 Bisoprolol/Hctz MgTablet3090 Bisoprolol/Hctz 5 MgTablet3090 Bisoprolol/Hctz 10 MgTablet3090 Bumetanide MgTablet3090 Captopril MgTablet60180 Carvedilol MgTablet60180 Carvedilol 25 MgTablet*60180 Clonidine MgTablet3090 Digoxin MgTablet3090 Diltiazem 30/60/90* MgTablet*60180 Diltiazem 120 MgTablet3090 Doxazosin 1/2/4/8 MgTablet3090 Enalapril MgTablet3090 Enalapril/Hctz 5 MgTablet3090 Furosemide 20/40/80 MgTablet3090 Guanfacine 1 MgTablet3090 Hydralazine 10/25 MgTablet3090 Hydrochlorothiazide */25/50 MgCapsule3090 Indapamide MgTablet3090 Isosorbide Mononitrate Er 30/60 MgTablet3090 Lisinopril MgTablet3090 Medication Name/ StrengthForm$430-DayQTY$1090-DayQTYL isinopril/Hctz MgTablet3090 Lisinopril/Hctz MgTablet*3090 Lisinopril/Hctz 20-25 MgTablet*3090

5 Methyldopa 250 MgTablet*60180 Methyldopa 500 MgTablet*3090 Metoprolol Tartrate 25/50/100* MgTablet*60180 Nadolol 20/40* MgTablet*3090 Prazosin Hcl 1/2*/5* MgCapsule*3090 Propranolol 10/20/40/80 MgTablet60180 Sotalol Hcl 80 MgTablet*3090 Spironolactone 25 MgTablet*3090 Terazosin 1/2/5/10 MgCapsule3090 Triamterene/Hctz MgCapsule/Tablet3090 Triamterene/Hctz 75/50 MgTablet3090 Verapamil 80/120 MgTablet3090 Warfarin 1/2 */6 MgTablet*3090 CholesterolLovastatin 10/20 MgTablet*3090 Pravastatin 10/20/40* MgTablet*3090 DiabetesChlorpropamide 100 MgTablet*3090 Glimepiride 1/2/4 MgTablet3090 Glipizide 5 MgTablet3090 Glipizide 10 MgTablet*60180 Glyburide MgTablet3090 Glyburide Micro 3/6 MgTablet3090 Metformin 500/850/1000* MgTablet*60180 Metformin Er 500 MgTablet*60180 Ear PreparationsAntipyrine/Benzocaine Otic Solution10 mL30 mLEye PreparationsAtropine Sulfate 1%Ophthalmic Solution5 mL15 mLErythromycin 5 Mg/GmOphthalmic Ointment*412 Gentamicin Solution5 mL15 mLMedication Name/ StrengthForm$430-DayQTY$1090-DayQTYL evobunolol Solution5 mL15 mLNeo/Polymx/Dexamethasone Ointment412 Neo/Polymx/Dexamethasone Suspension5 mL15 mLPilocarpine 1%/2%Ophthalmic Solution15 mL45 mLPolymyxin Sulfate/TmpOphthalmic Solution*10 mL30 mLSulfacetamide

6 Sodium 10%Ophthalmic Solution15 mL45 mLTimolol Maleate Solution5 mL15 mLTobramycin Solution5 mL15 mLHormonesEstradiol MgTablet3090 Estropipate * MgTablet*3090 Medroxyprogesterone MgTablet3090 Medroxyprogesterone 10 MgTablet1030 IncontinenceOxybutynin 5 MgTablet60180 Muscle RelaxantsBaclofen 10 MgTablet3090 Cyclobenzaprine 5/10 MgTablet3090 OtherAllopurinol 100/300 MgTablet3090 Carbamazepine 200 MgTablet*60180 Chlorhexidine Gluconate mL1419 mLCytra-2 Solution180 mL540 mLPhenazopyridine 100 MgTablet618 Phenazopyridine 200 MgTablet3090 Prochlorperazine 10 MgTablet3090 Medication Name/ StrengthForm$430-DayQTY$1090-DayQTYP arkinson s DiseaseBenztropine 2 MgTablet3090 Trihexyphenidyl 2 MgTablet60180 Prostate/BphDoxazosin 1/2/4/8 MgTablet3090 Megestrol 20 MgTablet3090 Prazosin Hcl 1/2*/5* MgCapsule*3090 Terazosin 1/2/5/10 MgCapsule3090 Seizure/EpilepsyCarbamazepine 200 MgTablet*60180 SteroidsDexamethasone MgTablet1236 Dexamethasone MgTablet3090 Dexamethasone 4 MgTablet618 Methylprednisolone 4 MgDose Pak/Tablet2163 Prednisone MgTablet3090 Prednisone 5/10 MgDose Pak2163 Prednisone 5 MgDose Pak*48144 Prednisone 10 MgDose Pak*48N/AStomach Disorders/GastrointestinalBelladonna Alkaloids/Pb Tablet60180

7 Cimetidine 800 MgTablet*3090 Dicyclomine 10 MgCapsule90270 Dicyclomine 20 MgTablet60180 Famotidine 20 MgTablet6090 Hydrocortisone Ac 25 MgSuppository1236 Lactulose 10 Gm/15 MlSyrup237 mL711 mLMetoclopramide 5 Mg/5 MlSyrup60 mL180 mLMetoclopramide 10 MgTablet60180 Prochlorperazine 10 MgTablet3090 Promethazine 25 MgTablet*1236 Ranitidine 150 MgTablet60180 Ranitidine 300 MgTablet3090 ThyroidLevothyroxine 25/50/75/ 55/100/112/125/137/150/175*/200* McgTablet*3090 Medication Name/ StrengthForm$430-DayQTY$1090-DayQTYT opical PreparationsBetamethasone DiproPionate g45 gBetamethasone Dipropionate g135 gBetamethasone Valerate g45 gBetamethasone Valerate g135 gBetamethasone Valerate g45 gBetamethasone Valerate g135 gFluocinonide g45 gFluocinonide g90 gFluocinolone Acetide mL180 mLGentamicin g45 gHydrocortisone 1%Cream3090 Hydrocortisone Viscous 2%Solution100 mL300 mLNystatin 100,000uCream/Ointment15 g45 gNystatin 100.

8 000uCream/Ointment30 g90 gNystatin/Triamcinolone Cream15 g45 gNystatin/Triamcinolone Cream30 g90 gNystatin/Triamcinolone Ointment15 g45 gSelenium Sulfide *120 mL360 mLSilver Sulfadiazine 1%Cream*50 g150 gTriamcinolone g45 gTriamcinolone g240 gTriamcinolone g45 gTriamcinolone g240 gTriamcinolone g45 gTuberculosisIsoniazid 300 MgTablet3090 Vitamins/SupplementsFolic Acid 1 MgTablet3090 Magnesium Oxide 400 MgTablet3090 Mag64 64 MgTablet*60180 Medication Name/ StrengthForm$430-DayQTY$1090-DayQTYP otassium Chloride 10%Liquid473 mL1419 mLPrenatal RxTablet*30N/ASodium Fluoride MgTablet*120N/A$9 and $24 Generic Medication ListMedication Name/ StrengthForm$930-DayQty$2490-DayQtyAsthm aVentolin Hfa Inhaler*8N/ASmoking CessationBupropion 150 Mg SrTablet*17N/AWomen s HealthAlendronate Sod 35/70 MgTablet412 Clomiphene 50 MgTablet515 Sprintec 28-DayTablet*28N/ATamoxifen 10 MgTablet60180 Tamoxifen 20 MgTablet3090 Tri-Sprintec 28-DayTablet*28N/AMen s HealthLevitra 20mgTablet1 (limit 10 per guest, per month)N/AFinasteride 5mg Tablet30N/A$4 prescriptions include up to a 30-day supply of covered drugs at commonly prescribed dosages.

9 $10 prescriptions include up to a