FAMILY PHARMACY'S NEW $4.00 PRESCRIPTION CLUB
Generic Drug Name / Strength ____________________
30-day qty.
90-day qty.
30-day qty.
90-day qty.
Category Name ____________
Form _______
$4 ___
$11 _____
$9 ___
$26 ___
Viruses Asthma Asthma Asthma Asthma Asthma Womans Health Womans Health Arhritis,Gout & Pain Arhritis,Gout & Pain Heart Health & Blood Pressure Mental Health Mental Health Mental Health Mental Health Mental Health Antibiotic Antibiotic Antibiotic Antibiotic Antibiotic Antibiotic Antibiotic Antibiotic Antibiotic Antibiotic Antibiotic Antibiotic
Capsule Syrup Tablet Tablet Solution Solution Tablet Tablet
30 120
90 360
75 20 -
225 60 -
60 60 4 4
180 180 12 12
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet Tablet Tablet Tablet Tablet Tablet Suspension Suspension Suspension Suspension Suspension Suspension Capsule Suspension Suspension Suspension Suspension Suspension
30 30 30 30 30 30 80 100 150 50 75 100 30 80 100 150 50 75
90 90 90 90 90 90 240 300 450 150 225 300 90 240 300 450 150 225
-
-
A ACYCLOVIR 200 MG ALBUTEROL 2 MG/5 ML ALBUTEROL 2 MG ALBUTEROL 4 MG ALBUTEROL NEB 0.083% ALBUTEROL NEB 0.5% ALENDRONATE SOD 35 MG ALENDRONATE SOD 70 MG ALLOPURINOL 100 MG ALLOPURINOL 300 MG AMILORIDE/HCTZ 5-50 MG AMITRIPTYLINE 10 MG AMITRIPTYLINE 25 MG AMITRIPTYLINE 50 MG AMITRIPTYLINE 75 MG AMITRIPTYLINE 100 MG AMOXICILLIN 125 MG/5 ML AMOXICILLIN 125 MG/5 ML AMOXICILLIN 125 MG/5 ML AMOXICILLIN 200 MG/5 ML AMOXICILLIN 200 MG/5 ML* AMOXICILLIN 200 MG/5 ML* AMOXICILLIN 250 MG AMOXICILLIN 250 MG/5 ML AMOXICILLIN 250 MG/5 ML AMOXICILLIN 250 MG/5 ML AMOXICILLIN 400 MG/5 ML AMOXICILLIN 400 MG/5 ML*
1
FAMILY PHARMACY'S NEW $4.00 PRESCRIPTION CLUB
Generic Drug Name / Strength ____________________ AMOXICILLIN 400 MG/5 ML* AMOXICILLIN 500 MG
Category Name ____________ Antibiotic Antibiotic
ANTIPYRINE/BENZOCAINE
Ear Health Heart Health & ATENOLOL 25 MG Blood Pressure Heart Health & ATENOLOL 50 MG Blood Pressure Heart Health & ATENOLOL 100 MG Blood Pressure Heart Health & ATENOLOL/CHLORTHAL 50/25 MG Blood Pressure Heart Health & ATENOLOL/CHLORTHAL 100/25 MG Blood Pressure Glaucoma & Eye ATROPINE SULFATE 1% Care
30-day qty.
90-day qty.
30-day qty.
90-day qty.
$4 ___ 100 30
$11 _____ 300 90
$9 ___ -
$26 ___ -
Otic Solution 10
30
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet Ophthalmic Solution
30
90
-
-
5
15
-
-
Tablet
30
90
-
-
Tablet
60
180
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Capsule Tablet
14 30
42 90
-
-
Cream
15
45
-
-
Form _______ Suspension Capsule
B BACLOFEN 10 MG BELLADONNA ALKALOIDS/PB BENAZEPRIL 5 MG BENAZEPRIL 10 MG BENAZEPRIL 20 MG BENAZEPRIL 40 MG BENZONATATE 100 MG BENZTROPINE 2 MG BETAMETHASONE DIPROPIONATE
Arhritis,Gout & Pain Gastrointestinal Health Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Allergies, Cold and Flu Men's Health Skin Conditions
2
FAMILY PHARMACY'S NEW $4.00 PRESCRIPTION CLUB
Generic Drug Name / Strength ____________________ 0.05% BETAMETHASONE DIPROPIONATE 0.05% BETAMETHASONE VALERATE 0.10% BETAMETHASONE VALERATE 0.10% BETAMETHASONE VALERATE 0.10% BETAMETHASONE VALERATE 0.10% BISOPROLOL/HCTZ 2.5/6.25 MG BISOPROLOL/HCTZ 5/6.25 MG BISOPROLOL/HCTZ 10/6.25 MG BUPROPION 150 MG SR* BUMETANIDE 0.5 MG BUMETANIDE 1 MG BUSPIRONE 5 MG BUSPIRONE 10 MG*
30-day qty.
90-day qty.
30-day qty.
90-day qty.
Category Name ____________ Skin Conditions
Form _______ Cream
$4 ___ 15
$11 _____ 45
$9 ___ -
$26 ___ -
Skin Conditions
Cream
45
135
-
-
Skin Conditions
Cream
15
45
-
-
Skin Conditions
Cream
45
135
-
-
Skin Conditions
Ointment
15
45
-
-
Skin HeartConditions Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Mental Health Heart Health & Blood Pressure Heart Health & Blood Pressure Mental Health Mental Health
Ointment
45
135
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet Tablet
30 -
90 -
17
N/A
Tablet
30
90
-
-
Tablet Tablet Tablet
30 60 60
90 180 180
-
-
Tablet
60
180
-
-
Tablet
60
180
-
-
Tablet
60
180
-
-
C CAPTOPRIL 12.5 MG CAPTOPRIL 25 MG CAPTOPRIL 50 MG
Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure
3
FAMILY PHARMACY'S NEW $4.00 PRESCRIPTION CLUB
Generic Drug Name / Strength ____________________ CAPTOPRIL 100 MG CARBAMAZEPINE 200 MG* CARVEDILOL 3.125 MG CARVEDILOL 6.25 MG CARVEDILOL 12.5 MG CARVEDILOL 25 MG* CEPHALEXIN 250 MG CEPHALEXIN 500 MG CHLORHEXIDINE GLUCONATE 0.12% CHLORPROPAMIDE 100 MG* CIMETIDINE 800 MG* CIPROFLOXACIN 250 MG CIPROFLOXACIN 500 MG CITALOPRAM 20 MG CITALOPRAM 40 MG CLONIDINE 0.1 MG CLONIDINE 0.2 MG CYCLOBENZAPRINE 5 MG CYCLOBENZAPRINE 10 MG CYTRA-2
Category Name ____________ Heart Health & Blood Pressure Mental Health Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Antibiotic Antibiotic Miscellaneous Conditions Diabetes Gastrointestinal Health Antibiotic Antibiotic Mental Health Mental Health Heart Health & Blood Pressure Heart Health & Blood Pressure Arhritis,Gout & Pain Arhritis,Gout & Pain Gastrointestinal Health
30-day qty.
90-day qty.
30-day qty.
90-day qty.
Form _______
$4 ___
$11 _____
$9 ___
$26 ___
Tablet Tablet
60 60
180 180
-
-
Tablet
60
180
-
-
Tablet
60
180
-
-
Tablet
60
180
-
-
Tablet Capsule Capsule
60 28 30
180 84 90
-
-
Solution Tablet
473 30
1419 90
-
-
Tablet Tablet Tablet Tablet Tablet
30 14 20 30 30
90 42 60 90 90
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Solution
180
540
-
-
D 4
FAMILY PHARMACY'S NEW $4.00 PRESCRIPTION CLUB
Generic Drug Name / Strength ____________________ DEXAMETHASONE .75 MG DEXAMETHASONE 0.5 MG DEXAMETHASONE 4 MG DICLOFENAC ER 75 MG DICYCLOMINE 10 MG DICYCLOMINE 20 MG DIGOXIN 0.125 MG DIGOXIN 0.25 MG DILTIAZEM 30 MG DILTIAZEM 60 MG DILTIAZEM 90 MG* DILTIAZEM 120 MG DOXAZOSIN 1 MG DOXAZOSIN 2 MG DOXAZOSIN 4 MG DOXAZOSIN 8 MG DOXEPIN HCL 10 MG DOXEPIN HCL 25 MG
Category Name ____________ Oral Oral Oral Steroids Oral Oral Oral Steroids Oral Oral Steroids Arhritis,Gout & Pain Gastrointestinal Health Gastrointestinal Health Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Mental Health Mental Health
30-day qty.
90-day qty.
30-day qty.
90-day qty.
Form _______
$4 ___
$11 _____
$9 ___
$26 ___
Tablet
12
36
-
-
Tablet
30
90
-
-
Tablet
6
18
-
-
Tablet
60
180
-
-
Capsule
90
270
-
-
Tablet
60
180
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet
60
180
-
-
Tablet
60
180
-
-
Tablet
60
180
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet Capsule Capsule
30 30 30
90 90 90
-
-
5
FAMILY PHARMACY'S NEW $4.00 PRESCRIPTION CLUB
Generic Drug Name / Strength ____________________ DOXEPIN HCL 50 MG DOXEPIN HCL 75 MG DOXEPIN HCL 100 MG DOXYCYCLINE HYCLATE 50 MG
Category Name ____________ Mental Health Mental Health Mental Health Antibiotic
DOXYCYCLINE HYCLATE 100 MG
Antibiotic
30-day qty.
90-day qty.
30-day qty.
90-day qty.
Form _______ Capsule Capsule Capsule Capsule Capsule / Tablet
$4 ___ 30 30 30 30
$11 _____ 90 90 90 90
$9 ___ -
$26 ___ -
20
60
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet Ophthalmic Ointment Tablet Tablet Tablet Tablet Tablet
30
90
-
-
4 30 30 30 30 30
12 90 90 90 90 90
-
-
E ENALAPRIL 2.5 MG ENALAPRIL 5 MG ENALAPRIL 10 MG ENALAPRIL 20 MG ENALAPRIL/HCTZ 5/12.5 MG ERYTHROMYCIN 5 MG/GM* ESTRADIOL 0.5 MG ESTRADIOL 1 MG ESTRADIOL 2 MG ESTROPIPATE 0.75 MG ESTROPIPATE 1.5 MG* F
Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Glaucoma & Eye Care Womans Health Womans Health Womans Health Womans Health Womans Health
FAMOTIDINE 20 MG FINASTERIDE 5 MG
Gastrointestinal Health Men's Health
Tablet Tablet
60 -
90 -
30
N/A
FLUCONAZOLE 150 MG FLUOCINONIDE 0.05% FLUOCINONIDE 0.05% FLUOCINOLONE ACETIDE 0.01%
Fungal Infections Skin Conditions Skin Conditions Skin Conditions
Tablet Cream Cream Solution
1 15 30 60
3 45 90 180
-
-
6
FAMILY PHARMACY'S NEW $4.00 PRESCRIPTION CLUB
Generic Drug Name / Strength ____________________ FLUOXETINE 10 MG* FLUOXETINE 10 MG FLUOXETINE 20 MG FLUOXETINE 40 MG* FLUPHENAZINE 1 MG
FOLIC ACID 1 MG FUROSEMIDE 20 MG FUROSEMIDE 40 MG FUROSEMIDE 80 MG
Category Name ____________ Mental Health Mental Health Mental Health Mental Health Mental Health Vitamins & Nutritional Health Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure
30-day qty.
90-day qty.
30-day qty.
90-day qty.
Form _______ Tablet Capsule Capsule Capsule Tablet
$4 ___ 30 30 30 30 30
$11 _____ 90 90 90 90 90
$9 ___ -
$26 ___ -
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Liquid Cream / Ointment Ophthalmic Solution Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet
120
360
-
-
15
45
-
-
5 30 30 30 30 60 30 30 30 30
15 90 90 90 90 180 90 90 90 90
-
-
Tablet
30
90
-
-
G GANITUSS DM NR GENTAMICIN 0.1% GENTAMICIN 0.3% GLIMEPIRIDE 1 MG GLIMEPIRIDE 2 MG GLIMEPIRIDE 4 MG GLIPIZIDE 5 MG GLIPIZIDE 10 MG* GLYBURIDE 2.5 MG GLYBURIDE 5 MG GLYBURIDE MICRO 3 MG GLYBURIDE MICRO 6 MG GUANFACINE 1 MG
Allergies, Cold and Flu Skin Conditions Glaucoma & Eye Care Diabetes Diabetes Diabetes Diabetes Diabetes Diabetes Diabetes Diabetes Diabetes Heart Health & Blood Pressure
7
FAMILY PHARMACY'S NEW $4.00 PRESCRIPTION CLUB
Generic Drug Name / Strength ____________________
Category Name ____________
30-day qty.
90-day qty.
30-day qty.
90-day qty.
Form _______
$4 ___
$11 _____
$9 ___
$26 ___
Tablet Tablet Tablet Tablet
30 30 30 30
90 90 90 90
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Capsule
30
90
-
-
Tablet
30
90
-
-
Tablet Cream Cream
30 30 30
90 90 90
-
-
Suppository 12
36
-
-
Suspension
120
360
-
-
Tablet
90
270
-
-
Tablet
60
180
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
H HALOPERIDOL HALOPERIDOL HALOPERIDOL HALOPERIDOL
0.5 MG 1 MG 2 MG 5 MG
HYDRALAZINE 10 MG HYDRALAZINE 25 MG HYDROCHLOROTHIAZIDE HYDROCHLOROTHIAZIDE HYDROCHLOROTHIAZIDE HYDROCORTISONE 1% HYDROCORTISONE 2.5% HYDROCORTISONE AC 25
Mental Health Mental Health Mental Health Mental Health Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & 12.5 MG* Blood Pressure Heart Health & 25 MG Blood Pressure Heart Health & 50 MG Blood Pressure Skin Conditions Skin Conditions Miscellaneous MG Conditions
I IBUPROFEN 100 MG/5 ML* IBUPROFEN 400 MG IBUPROFEN 600 MG IBUPROFEN 800 MG INDAPAMIDE 1.25 MG INDAPAMIDE 2.5 MG
Arhritis,Gout & Pain Arhritis,Gout & Pain Arhritis,Gout & Pain Arhritis,Gout & Pain Heart Health & Blood Pressure Heart Health & Blood Pressure
8
FAMILY PHARMACY'S NEW $4.00 PRESCRIPTION CLUB
Generic Drug Name / Strength ____________________ INDOMETHACIN 25 MG* IPRATROPIUM NEB 0.2 MG/ML* ISONIAZID 300 MG ISOSORBIDE MONONITRATE ER 30 MG ISOSORBIDE MONONITRATE ER 60 MG
Category Name ____________ Arhritis,Gout & Pain Asthma Miscellaneous Conditions Heart Health & Blood Pressure Heart Health & Blood Pressure
30-day qty.
90-day qty.
30-day qty.
90-day qty.
Form _______
$4 ___
$11 _____
$9 ___
$26 ___
Capsule Solution
60 75
180 225
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Syrup
237
711
-
Tablet Ophthalmic Solution
-
-
1 (limit 10 per guest per month)
5
15
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet
30
90
Tablet
30
90
L LACTULOSE 10 GM/15 ML
LEVITRA® 20 MG LEVOBUNOLOL 0.5% LEVOTHYROXINE 25 MCG LEVOTHYROXINE 50 MCG LEVOTHYROXINE 75 MCG LEVOTHYROXINE 88 MCG LEVOTHYROXINE 100 MCG LEVOTHYROXINE 112 MCG LEVOTHYROXINE 125 MCG
Gastrointestinal Health
Men's Health Glaucoma & Eye Care Thyroid Conditions Thyroid Conditions Thyroid Conditions Thyroid Conditions Thyroid Conditions Thyroid Conditions Thyroid Conditions
9
N/A
FAMILY PHARMACY'S NEW $4.00 PRESCRIPTION CLUB
Generic Drug Name / Strength ____________________ LEVOTHYROXINE 137 MCG LEVOTHYROXINE 150 MCG LEVOTHYROXINE 175 MCG* LEVOTHYROXINE 200 MCG* LIDOCAINE VISCOUS 2% LISINOPRIL 2.5 MG LISINOPRIL 5 MG LISINOPRIL 10 MG LISINOPRIL 20 MG LISINOPRIL/HCTZ 10-12.5 MG LISINOPRIL/HCTZ 20-12.5 MG* LISINOPRIL/HCTZ 20-25 MG* LITHIUM CARB 300 MG* LORATADINE 10 MG LOVASTATIN 10 MG* LOVASTATIN 20 MG*
Category Name ____________ Thyroid Conditions Thyroid Conditions Thyroid Conditions Thyroid Conditions Miscellaneous Conditions Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Mental Health Allergies, Cold and Flu Cholesterol Cholesterol
30-day qty.
90-day qty.
30-day qty.
90-day qty.
$4 ___
$11 _____
$9 ___
$26 ___
Tablet
30
90
Tablet
30
90
Tablet
30
90
Form _______
Tablet
30
90
-
-
Solution
100
300
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet Capsule
30 90
90 270
-
-
Tablet Tablet Tablet
30 30 30
90 90 90
-
-
Tablet
30
90
-
-
M MAGNESIUM OXIDE 400 MG
Vitamins & Nutritional Health
10
FAMILY PHARMACY'S NEW $4.00 PRESCRIPTION CLUB
Generic Drug Name / Strength ____________________
MAG64 64 MG* MEDROXYPROGESTERONE 2.5 MG MEDROXYPROGESTERONE 5 MG MEDROXYPROGESTERONE 10 MG MEGESTROL 20 MG* MELOXICAM 7.5 MG MELOXICAM 15 MG METFORMIN 500 MG METFORMIN 850 MG METFORMIN 1000 MG* METFORMIN ER 500 MG* METHYLDOPA 250 MG* METHYLDOPA 500 MG* METHYLPREDNISOLONE 4 MG METOCLOPRAMIDE 5 MG/5 ML METOCLOPRAMIDE 10 MG METOPROLOL TARTRATE 25 MG METOPROLOL TARTRATE 50 MG METOPROLOL TARTRATE 100 MG* METRONIDAZOLE 250 MG METRONIDAZOLE 500 MG
Category Name ____________ Vitamins & Nutritional Health Womans Health Womans Health Womans Health Womans Health Arhritis,Gout & Pain Arhritis,Gout & Pain Diabetes Diabetes Diabetes Diabetes Heart Health & Blood Pressure Heart Health & Blood Pressure Oral Oral Steroids Gastrointestinal Health Gastrointestinal Health Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Antibiotic Antibiotic
30-day qty.
90-day qty.
30-day qty.
90-day qty.
Form _______
$4 ___
$11 _____
$9 ___
$26 ___
Tablet Tablet Tablet Tablet Tablet
60 30 30 10 30
180 90 90 30 90
-
-
Tablet
30
90
-
-
Tablet Tablet Tablet Tablet Tablet
30 60 60 60 60
90 180 180 180 180
-
-
Tablet
60
180
-
-
Tablet Dose Pak / Tablet
30
90
-
-
21
63
-
-
Syrup
60
180
-
-
Tablet
60
180
-
-
Tablet
60
180
-
-
Tablet
60
180
-
-
Tablet Tablet Tablet
60 28 14
180 84 42
-
-
11
FAMILY PHARMACY'S NEW $4.00 PRESCRIPTION CLUB
Generic Drug Name / Strength ____________________
Category Name ____________
30-day qty.
90-day qty.
30-day qty.
90-day qty.
Form _______
$4 ___
$11 _____
$9 ___
$26 ___
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet
60
180
-
-
Tablet
60
180
-
-
4
12
-
-
5 30 30
15 90 90
-
-
15
45
-
-
30
90
-
-
N
NAPROXEN 500 MG*
Heart Health & Blood Pressure Heart Health & Blood Pressure Arhritis,Gout & Pain Arhritis,Gout & Pain
NEO/POLYMX/DEXAMETHASONE 0.1% NEO/POLYMX/DEXAMETHASONE 0.1% NORTRIPTYLINE 10 MG NORTRIPTYLINE 25 MG
Glaucoma & Eye Care Glaucoma & Eye Care Mental Health Mental Health
NADOLOL 20 MG NADOLOL 40 MG* NAPROXEN 375 MG*
NYSTATIN 100,000U
Ophthalmic Ointment Ophthalmic Suspension Capsule Capsule Cream / Fungal Infections Ointment Cream / Fungal Infections Ointment
NYSTATIN/TRIAMCINOLONE
Fungal Infections Cream
15
45
-
-
NYSTATIN/TRIAMCINOLONE
Fungal Infections Cream
30
90
-
-
NYSTATIN/TRIAMCINOLONE
Fungal Infections Ointment
15
45
-
-
Miscellaneous Conditions
Tablet
60
180
-
-
Mental Health Mental Health
Tablet Tablet
30 30
90 90
-
-
NYSTATIN 100,000U
O OXYBUTYNIN 5 MG
P PAROXETINE 10 MG* PAROXETINE 20 MG*
12
FAMILY PHARMACY'S NEW $4.00 PRESCRIPTION CLUB
Generic Drug Name / Strength ____________________ PENICILLIN VK 125 MG/5 ML PENICILLIN VK 125 MG/5 ML PENICILLIN VK 250 MG/5 ML PENICILLIN VK 250 MG PHENAZOPYRIDINE 100 MG PHENAZOPYRIDINE 200 MG PILOCARPINE 1% PILOCARPINE 2% POLYMYXIN SULFATE/TMP *
POTASSIUM CHLORIDE 10% PRAVASTATIN 10 MG PRAVASTATIN 20 MG PRAVASTATIN 40 MG PRAZOSIN HCL 1 MG PRAZOSIN HCL 2 MG* PRAZOSIN HCL 5 MG* PREDNISONE 2.5 MG PREDNISONE 5 MG PREDNISONE 5 MG* PREDNISONE 5 MG
Category Name ____________ Antibiotic Antibiotic Antibiotic Antibiotic Miscellaneous Conditions Miscellaneous Conditions Glaucoma & Eye Care Glaucoma & Eye Care Glaucoma & Eye Care Vitamins & Nutritional Health Cholesterol Cholesterol Cholesterol Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Oral Oral Oral Steroids Oral Oral Oral Steroids Oral Oral Oral Steroids Oral Oral Oral Steroids
30-day qty.
90-day qty.
30-day qty.
90-day qty.
Form _______ Solution Solution Solution Tablet
$4 ___ 100 200 100 28
$11 _____ 300 600 300 84
$9 ___ -
$26 ___ -
Tablet
6
18
-
-
Tablet Ophthalmic Solution Ophthalmic Solution Ophthalmic Solution
30
90
-
-
15
45
-
-
15
45
-
-
10
30
-
-
Liquid Tablet Tablet Tablet
473 30 30 30
1419 90 90 90
-
-
Capsule
30
90
-
-
Capsule
30
90
-
-
Capsule
30
90
-
-
Tablet
30
90
-
-
Dose Pak
21
63
-
-
Dose Pak
48
144
-
-
Tablet
30
90
-
-
13
FAMILY PHARMACY'S NEW $4.00 PRESCRIPTION CLUB
Generic Drug Name / Strength ____________________ PREDNISONE 10 MG PREDNISONE 10 MG PREDNISONE 10 MG PREDNISONE 20 MG
PRENATAL PLUS* PROCHLORPERAZINE 10 MG PROMETHAZINE 6.25 MG/5 ML* PROMETHAZINE 25 MG* PROMETHAZINE DM PROPRANOLOL 10 MG PROPRANOLOL 20 MG PROPRANOLOL 40 MG PROPRANOLOL 80 MG
Category Name ____________ Oral Oral Oral Steroids Oral Oral Oral Steroids Oral Oral Oral Steroids Oral Oral Oral Steroids Vitamins & Nutritional Health Gastrointestinal Health Gastrointestinal Health Gastrointestinal Health Allergies, Cold and Flu Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure
30-day qty.
90-day qty.
30-day qty.
90-day qty.
Form _______
$4 ___
$11 _____
$9 ___
$26 ___
Dose Pak
21
63
-
-
Dose Pak
48
N/A
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet
30
N/A
-
-
Tablet
30
90
-
-
Syrup
180
540
-
-
Tablet
12
36
-
-
Syrup
120
360
-
-
Tablet
60
180
-
-
Tablet
60
180
-
-
Tablet
60
180
-
-
Tablet
60
180
-
-
Tablet
60
180
-
-
Tablet
30
90
-
-
R RANITIDINE 150 MG RANITIDINE 300 MG
Gastrointestinal Health Gastrointestinal Health
S 14
FAMILY PHARMACY'S NEW $4.00 PRESCRIPTION CLUB
Generic Drug Name / Strength ____________________ SILVER SULFADIAZINE 1%* SMZ/TMP 200/40/5 ML* SMZ/TMP 400/80 MG SMZ/TMP DS 800/160 MG SOTALOL HCL 80 MG* SPIRONOLACTONE 25 MG Previfem 28 Day SULFACETAMIDE SODIUM 10%
30-day qty.
90-day qty.
30-day qty.
90-day qty.
Category Name ____________ Skin Conditions Antibiotic Antibiotic Antibiotic Heart Health & Blood Pressure Heart Health & Blood Pressure Womans Health Glaucoma & Eye Care
Form _______ Cream Suspension Tablet Tablet
$4 ___ 50 120 28 20
$11 _____ 150 360 84 60
$9 ___ -
$26 ___ -
Tablet
30
90
-
-
Tablet Tablet Ophthalmic Solution
30 -
90 -
$24/28
N/A
15
45
-
-
Womans Health Womans Health Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure
Tablet Tablet
-
-
60 30
180 90
Capsule
30
90
-
-
Capsule
30
90
-
-
Capsule
30
90
-
-
Capsule
30
90
-
-
Fungal Infections Antibiotic Antibiotic Mental Health Mental Health Mental Health Glaucoma & Eye Care Glaucoma & Eye Care
Tablet Capsule Capsule Tablet Tablet Capsule Ophthalmic Solution Ophthalmic Solution
30 60 60 30 30 30
90 180 180 90 90 90
-
-
5
15
-
-
5
15
-
-
T TAMOXIFEN 10 MG TAMOXIFEN 20 MG TERAZOSIN 1 MG TERAZOSIN 2 MG TERAZOSIN 5 MG TERAZOSIN 10 MG TERBINAFINE 250 MG* TETRACYCLINE 250 MG TETRACYCLINE 500 MG THIORIDAZINE 25 MG THIORIDAZINE 50 MG THIOTHIXENE 2 MG TIMOLOL MALEATE 0.25% TIMOLOL MALEATE 0.5%
15
FAMILY PHARMACY'S NEW $4.00 PRESCRIPTION CLUB
Generic Drug Name / Strength ____________________ TOBRAMYCIN 0.3% TRAZODONE 50 MG TRAZODONE 100 MG TRAZODONE 150 MG TRIAMCINOLONE 0.025% TRIAMCINOLONE 0.025%
Category Name ____________ Glaucoma & Eye Care Mental Health Mental Health Mental Health Skin Conditions Skin Conditions
TRIAMCINOLONE 0.1%
Skin Conditions
TRIAMCINOLONE 0.1% TRIAMCINOLONE 0.5%
Skin Conditions Skin Conditions Heart Health & Blood Pressure Heart Health & Blood Pressure Mental Health Womans Health
TRIAMTERENE/HCTZ 37.5/25 MG TRIAMTERENE/HCTZ 75/50 MG TRIHEXYPHENIDYL 2 MG TRI-SPRINTEC 28-DAY*
30-day qty.
90-day qty.
30-day qty.
90-day qty.
Form _______ Ophthalmic Solution Tablet Tablet Tablet Cream Cream Cream / Ointment Cream / Ointment Cream Capsule / Tablet
$4 ___
$11 _____
$9 ___
$26 ___
5 30 30 30 15 80
15 90 90 90 45 240
-
-
15
45
-
-
80 15
240 45
-
-
30
90
-
-
Tablet Tablet Tablet
30 60 -
90 180 -
$24/28
N/A
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
V VERAPAMIL 80 MG VERAPAMIL 120 MG
Heart Health & Blood Pressure Heart Health & Blood Pressure
W WARFARIN 1 MG WARFARIN 2 MG WARFARIN 2.5 MG WARFARIN 3 MG
Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure
16
FAMILY PHARMACY'S NEW $4.00 PRESCRIPTION CLUB
Generic Drug Name / Strength ____________________ WARFARIN 4 MG WARFARIN 5 MG* WARFARIN 6 MG WARFARIN 7.5 MG WARFARIN 10 MG
Category Name ____________ Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure
30-day qty.
90-day qty.
30-day qty.
90-day qty.
Form _______
$4 ___
$11 _____
$9 ___
$26 ___
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
Tablet
30
90
-
-
$4 prescriptions include up to a 30-day supply of covered drugs at commonly prescribed dosages. $11 prescriptions include up to a 90-day supply of covered drugs at commonly prescribed dosages. Physician permission may be required to change a 30-day prescription to a 90-day prescription.
17
FAMILY PHARMACY'S NEW $4.00 PRESCRIPTION PROGRAM
Generic Drug Name / Strength
Category Name
Dosage Form
____________________
__________
30-day qty.
90-day 30-day 90-day qty. qty. qty.
$4
$11
$9
$26
_______
___
_____
___
___
Capsule Syrup Tablet Tablet Solution Solution Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Suspension Suspension Suspension Suspension Suspension Suspension Capsule Suspension Suspension Suspension Suspension
30 120 75 20 30 30 30 30 30 30 30 30 30 80 100 150 50 75 100 30 80 100 150 50
90 360 225 60 90 90 90 90 90 90 90 90 90 240 300 450 150 225 300 90 240 300 450 150
60 60 4 4 -
180 180 12 12 -
A ACYCLOVIR 200 MG ALBUTEROL 2 MG/5 ML ALBUTEROL 2 MG ALBUTEROL 4 MG ALBUTEROL NEB 0.083% ALBUTEROL NEB 0.5% ALENDRONATE SOD 35 MG ALENDRONATE SOD 70 MG ALLOPURINOL 100 MG ALLOPURINOL 300 MG AMILORIDE/HCTZ 5-50 MG AMITRIPTYLINE 10 MG AMITRIPTYLINE 25 MG AMITRIPTYLINE 50 MG AMITRIPTYLINE 75 MG AMITRIPTYLINE 100 MG AMLODIPINE 5MG AMOXICILLIN 125 MG/5 ML AMOXICILLIN 125 MG/5 ML AMOXICILLIN 125 MG/5 ML AMOXICILLIN 200 MG/5 ML AMOXICILLIN 200 MG/5 ML AMOXICILLIN 200 MG/5 ML AMOXICILLIN 250 MG AMOXICILLIN 250 MG/5 ML AMOXICILLIN 250 MG/5 ML AMOXICILLIN 250 MG/5 ML AMOXICILLIN 400 MG/5 ML
Viruses Asthma Asthma Asthma Asthma Asthma Womans Health Womans Health Arhritis,Gout & Pain Arhritis,Gout & Pain Heart Health & Blood Pressure Mental Health Mental Health Mental Health Mental Health Mental Health Heart Health & Blood Pressure Antibiotic Antibiotic Antibiotic Antibiotic Antibiotic Antibiotic Antibiotic Antibiotic Antibiotic Antibiotic Antibiotic
18
FAMILY PHARMACY'S NEW $4.00 PRESCRIPTION PROGRAM
Generic Drug Name / Strength
Category Name
____________________ AMOXICILLIN 400 MG/5 ML AMOXICILLIN 400 MG/5 ML AMOXICILLIN 500 MG ANTIPYRINE/BENZOCAINE
__________ Antibiotic Antibiotic Antibiotic Ear Health
90-day 30-day 90-day qty. qty. qty.
$4
$11
$9
$26
___
_____
___
75 100 30 10 $18.00/28 DAY 30 30 30 30
225 300 90 30
-
___ -
90 90 90 90
-
-
Tablet Ophthalmic Solution
30
90
-
-
5
15
-
-
Tablet Tablet Tablet Tablet Tablet Tablet Capsule Tablet
30 60 30 30 30 30 14 30
90 180 90 90 90 90 42 90
-
-
Skin Conditions
Cream
15
45
-
-
Skin Conditions
Cream
45
135
Skin Conditions
Cream
15
45
-
-
Skin Conditions
Cream
45
135
-
-
APRI BIRTH CONTROL Womans Health ATENOLOL 25 MG Heart Health & Blood ATENOLOL 50 MG Heart Health & Blood ATENOLOL 100 MG Heart Health & Blood ATENOLOL/CHLORTHAL 50/25 MG Heart Health & Blood ATENOLOL/CHLORTHAL 100/25 MG Heart Health & Blood ATROPINE SULFATE 1%
Dosage Form
30-day qty.
_______ Suspension Suspension Capsule Otic Solution
Pressure Pressure Pressure Pressure Pressure
Glaucoma & Eye Care
Tablet Tablet Tablet Tablet Tablet
B BACLOFEN 10 MG BELLADONNA ALKALOIDS/PB BENAZEPRIL 5 MG BENAZEPRIL 10 MG BENAZEPRIL 20 MG BENAZEPRIL 40 MG BENZONATATE 100 MG BENZTROPINE 2 MG BETAMETHASONE DIPROPIONATE 0.05% BETAMETHASONE DIPROPIONATE 0.05% BETAMETHASONE VALERATE 0.10% BETAMETHASONE VALERATE
Arhritis,Gout & Pain Gastrointestinal Health Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Allergies, Cold and Flu Men's Health
19
FAMILY PHARMACY'S NEW $4.00 PRESCRIPTION PROGRAM
Generic Drug Name / Strength
Category Name
Dosage Form
____________________ 0.10% BETAMETHASONE VALERATE 0.10% BETAMETHASONE VALERATE 0.10%
__________ Skin Conditions
BISOPROLOL/HCTZ 2.5/6.25 MG BISOPROLOL/HCTZ 5/6.25 MG BISOPROLOL/HCTZ 10/6.25 MG BUPROPION 150 MG SR BUMETANIDE 0.5 MG BUMETANIDE 1 MG BUSPIRONE 5 MG BUSPIRONE 10 MG
30-day qty.
90-day 30-day 90-day qty. qty. qty.
$4
$11
$9
$26
_______ Cream
___
_____
___
45
135
-
___ -
Skin Conditions
Ointment
15
45
-
-
Skin Conditions
Ointment
45
135
-
-
Heart Health & Heart Health & Heart Health & Mental Health Heart Health & Heart Health & Mental Health Mental Health
Blood Pressure Blood Pressure Blood Pressure
Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet
30 30 30 30 30 60 60
90 90 90 90 90 180 180
$19.00 -
$56.00 -
CAPTOPRIL 12.5 MG CAPTOPRIL 25 MG CAPTOPRIL 50 MG CAPTOPRIL 100 MG CARBAMAZEPINE 200 MG CARVEDILOL 3.125 MG CARVEDILOL 6.25 MG CARVEDILOL 12.5 MG
Heart Health & Heart Health & Heart Health & Heart Health & Mental Health Heart Health & Heart Health & Heart Health &
Blood Blood Blood Blood
Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet
60 60 60 60 60 60 60 60
180 180 180 180 180 180 180 180
-
-
CARVEDILOL 25 MG* CEPHALEXIN 250 MG CEPHALEXIN 500 MG
Heart Health & Blood Pressure Antibiotic Antibiotic
Tablet Capsule Capsule
60 28 30
180 84 90
-
-
Solution Tablet
473 30
1419 90
-
-
Blood Pressure Blood Pressure
C Pressure Pressure Pressure Pressure
Blood Pressure Blood Pressure Blood Pressure
CHLORHEXIDINE GLUCONATE 0.12% Miscellaneous Conditions
CHLORPROPAMIDE 100 MG
Diabetes
20
FAMILY PHARMACY'S NEW $4.00 PRESCRIPTION PROGRAM
Generic Drug Name / Strength
Category Name
Dosage Form
____________________ CIMETIDINE 800 MG CIPROFLOXACIN 250 MG CIPROFLOXACIN 500 MG CITALOPRAM 20 MG CITALOPRAM 40 MG CLOMIPHENE CITRATE 50MG CLONIDINE 0.1 MG
__________ Gastrointestinal Health Antibiotic Antibiotic Mental Health Mental Health Womans Health Heart Health & Blood Pressure
CLONIDINE 0.2 MG CYCLOBENZAPRINE 5 MG CYCLOBENZAPRINE 10 MG
30-day qty.
90-day 30-day 90-day qty. qty. qty.
$4
$11
$9
$26
_______ Tablet Tablet Tablet Tablet Tablet Tablet Tablet
___
_____
___
30 14 20 30 30
90 42 60 90 90
30
90
5 -
___ 15 -
Heart Health & Blood Pressure Arhritis,Gout & Pain Arhritis,Gout & Pain
Tablet Tablet Tablet
30 30 30
90 90 90
-
-
Oral Oral Oral Steroids Oral Oral Oral Steroids Oral Oral Steroids Gastrointestinal Health Gastrointestinal Health Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Mental Health Mental Health Mental Health Mental Health
Tablet Tablet Tablet Capsule Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Capsule Capsule Capsule Capsule
12 30 6 90 60 30
36 90 18 270 180 90
60 60 60 30 30 30 30 30 30 30 30
180 180 180 90 90 90 90 90 90 90 90
30 30 -
90 90 -
D DEXAMETHASONE .75 MG DEXAMETHASONE 0.5 MG DEXAMETHASONE 4 MG DICYCLOMINE 10 MG DICYCLOMINE 20 MG DIGOXIN 0.125 MG DIGOXIN 0.25 MG DILTIAZEM 30 MG DILTIAZEM 60 MG DILTIAZEM 90 MG DILTIAZEM 120 MG DOXAZOSIN 1 MG DOXAZOSIN 2 MG DOXAZOSIN 4 MG DOXAZOSIN 8 MG DOXEPIN HCL 10 MG DOXEPIN HCL 25 MG DOXEPIN HCL 50 MG DOXEPIN HCL 75 MG
21
FAMILY PHARMACY'S NEW $4.00 PRESCRIPTION PROGRAM
Generic Drug Name / Strength
Category Name
____________________ DOXEPIN HCL 100 MG DOXYCYCLINE HYCLATE 50 MG
__________ Mental Health Antibiotic
DOXYCYCLINE HYCLATE 100 MG
Antibiotic
ENALAPRIL 2.5 MG ENALAPRIL 5 MG ENALAPRIL 10 MG ENALAPRIL 20 MG ENALAPRIL/HCTZ 5/12.5 MG ESTRADIOL 0.5 MG ESTRADIOL 1 MG ESTRADIOL 2 MG ESTROPIPATE 0.75 MG ESTROPIPATE 1.5 MG
E
Dosage Form
30-day qty.
90-day 30-day 90-day qty. qty. qty.
$4
$11
$9
$26
_______ Capsule Capsule Capsule / Tablet
___
_____
___
30 30
90 90
-
___ -
20
60
-
-
Heart Health & Blood Pressure Heart Health & Blood Pressure
Tablet Tablet
30 30
90 90
-
-
Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Womans Health Womans Health Womans Health Womans Health Womans Health
Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet
30 30 30 30 30 30 30 30
90 90 90 90 90 90 90 90
-
-
Gastrointestinal Health Men's Health Fungal Infections Skin Conditions Skin Conditions Skin Conditions Mental Health Mental Health Mental Health Mental Health Vitamins & Nutritional Health Heart Health & Blood Pressure Heart Health & Blood Pressure
Tablet Tablet Tablet Cream Cream Solution Tablet Capsule Capsule Tablet Tablet Tablet Tablet
60 1 15 30 60 30 30 30 30 30 30 30
90 3 45 90 180 90 90 90 90 90 90 90
30 -
N/A -
F FAMOTIDINE 20 MG FINASTERIDE 5 MG FLUCONAZOLE 150 MG FLUOCINONIDE 0.05% FLUOCINONIDE 0.05% FLUOCINOLONE ACETIDE 0.01% FLUOXETINE 10 MG FLUOXETINE 10 MG FLUOXETINE 20 MG FLUPHENAZINE 1 MG FOLIC ACID 1 MG FUROSEMIDE 20 MG FUROSEMIDE 40 MG
22
FAMILY PHARMACY'S NEW $4.00 PRESCRIPTION PROGRAM
Generic Drug Name / Strength
Category Name
Dosage Form
____________________ FUROSEMIDE 80 MG
__________ Heart Health & Blood Pressure
_______ Tablet
Skin Conditions Diabetes Diabetes Diabetes Diabetes Diabetes Diabetes Diabetes Diabetes Diabetes Diabetes Heart Health & Blood Pressure
30-day qty.
90-day 30-day 90-day qty. qty. qty.
$4
$11
$9
$26
___
_____
___
30
90
-
___ -
Cream / Ointment Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet
15 30 30 30 30 60 30 30 30 30 30 30
45 90 90 90 90 180 90 90 90 90 90 90
-
-
Mental Health Mental Health Mental Health Mental Health Heart Health & Blood Pressure
Tablet Tablet Tablet Tablet Tablet
30 30 30 30 30
90 90 90 90 90
-
-
HYDROCHLOROTHIAZIDE 12.5 MG HYDROCHLOROTHIAZIDE 25 MG
Heart Health & Blood Pressure Heart Health & Blood Pressure
Capsule Tablet
30 30
90 90
-
-
HYDROCHLOROTHIAZIDE 50 MG
Heart Health & Blood Pressure Skin Conditions Skin Conditions Miscellaneous Conditions
Tablet Cream Cream Suppository
30 30 30 -
90 90 90 -
12
36
G GENTAMICIN 0.1% GLIMEPIRIDE 1 MG GLIMEPIRIDE 2 MG GLIMEPIRIDE 4 MG GLIPIZIDE 5 MG GLIPIZIDE 10 MG GLYBURIDE 1.25MG GLYBURIDE 2.5 MG GLYBURIDE 5 MG GLYBURIDE MICRO 3 MG GLYBURIDE MICRO 6 MG GUANFACINE 1 MG
H HALOPERIDOL HALOPERIDOL HALOPERIDOL HALOPERIDOL HYDRALAZINE
0.5 MG 1 MG 2 MG 5 MG 10 MG
HYDROCORTISONE 1% HYDROCORTISONE 2.5% HYDROCORTISONE AC 25 MG
I 23
FAMILY PHARMACY'S NEW $4.00 PRESCRIPTION PROGRAM
Generic Drug Name / Strength
Category Name
Dosage Form
____________________ IBUPROFEN 100 MG/5 ML IBUPROFEN 400 MG IBUPROFEN 600 MG IBUPROFEN 800 MG INDAPAMIDE 1.25 MG INDAPAMIDE 2.5 MG IPRATROPIUM NEB 0.2 MG/ML ISONIAZID 300 MG
__________ Arhritis,Gout & Pain Arhritis,Gout & Pain Arhritis,Gout & Pain Arhritis,Gout & Pain Heart Health & Blood Pressure Heart Health & Blood Pressure Asthma Miscellaneous Conditions
LACTULOSE 10 GM/15 ML
Gastrointestinal Health
LEVOBUNOLOL 0.5% LEVOTHYROXINE 25 MCG LEVOTHYROXINE 50 MCG LEVOTHYROXINE 75 MCG LEVOTHYROXINE 88 MCG LEVOTHYROXINE 100 MCG LEVOTHYROXINE 112 MCG LEVOTHYROXINE 125 MCG LEVOTHYROXINE 137 MCG LEVOTHYROXINE 150 MCG LEVOTHYROXINE 175 MCG LEVOTHYROXINE 200 MCG LIDOCAINE VISCOUS 2% LISINOPRIL 2.5 MG LISINOPRIL 5 MG LISINOPRIL 10 MG LISINOPRIL 20 MG LISINOPRIL/HCTZ 10-12.5 MG LISINOPRIL/HCTZ 20-12.5 MG
30-day qty.
90-day 30-day 90-day qty. qty. qty.
$4
$11
$9
$26
_______ Suspension Tablet Tablet Tablet Tablet Tablet Solution Tablet
___
_____
___
120 90 60 30 30 30 75 30
360 270 180 90 90 90 225 90
-
___ -
237
711
-
-
Glaucoma & Eye Care Thyroid Conditions Thyroid Conditions Thyroid Conditions Thyroid Conditions Thyroid Conditions Thyroid Conditions Thyroid Conditions Thyroid Conditions Thyroid Conditions Thyroid Conditions Thyroid Conditions Miscellaneous Conditions Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure
Syrup Ophthalmic Solution Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Solution Tablet Tablet Tablet Tablet Tablet
5 30 30 30 30 30 30 100 30 30 30 30 30
15 90 90 90 90 90 90 300 90 90 90 90 90
30 30 30 30 30 -
90 90 90 90 90 -
Heart Health & Blood Pressure
Tablet
30
90
-
-
L
24
FAMILY PHARMACY'S NEW $4.00 PRESCRIPTION PROGRAM
Generic Drug Name / Strength
Category Name
Dosage Form
____________________ LISINOPRIL/HCTZ 20-25 MG LITHIUM CARB 300 MG LORATADINE 10 MG LOVASTATIN 10 MG LOVASTATIN 20 MG
__________ Heart Health & Blood Pressure Mental Health Allergies, Cold and Flu Cholesterol Cholesterol
MAGNESIUM OXIDE 400 MG MEDROXYPROGESTERONE 2.5 MG
MEDROXYPROGESTERONE 5 MG
30-day qty.
90-day 30-day 90-day qty. qty. qty.
$4
$11
$9
$26
_______ Tablet Capsule Tablet Tablet Tablet
___
_____
___ -
___ -
Vitamins & Nutritional Health
Tablet
30
90
-
-
Womans Health
Tablet
30
90
-
-
Womans Health Womans Health Arhritis,Gout & Pain Arhritis,Gout & Pain Diabetes Diabetes Diabetes Diabetes Gastrointestinal Health Gastrointestinal Health Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure Antibiotic
Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Syrup Tablet Tablet Tablet Tablet Tablet
30 10 30 30 60 60 60 60 60 60 60 60 60 28
90 30 90 90 180 180 180 180 180 180 180 180 180 84
-
-
NADOLOL 20 MG NADOLOL 40 MG NAPROXEN 375 MG NAPROXEN 500 MG
Heart Health & Blood Pressure Heart Health & Blood Pressure Arhritis,Gout & Pain Arhritis,Gout & Pain
Tablet Tablet Tablet Tablet
90 90 180 180
-
-
NECON
Womans Health
Tablet
30 30 60 60 $28/28 Day
-
-
30 90 30 30 30
90 270 90 90 90
M
MEDROXYPROGESTERONE 10 MG
MELOXICAM 7.5 MG MELOXICAM 15 MG METFORMIN 500 MG METFORMIN 850 MG METFORMIN 1000 MG METFORMIN ER 500 MG METOCLOPRAMIDE 5 MG/5 ML METOCLOPRAMIDE 10 MG METOPROLOL TARTRATE 25 MG METOPROLOL TARTRATE 50 MG METOPROLOL TARTRATE 100MG
METRONIDAZOLE 250 MG
N
25
FAMILY PHARMACY'S NEW $4.00 PRESCRIPTION PROGRAM
Generic Drug Name / Strength
Category Name
____________________ NORTRIPTYLINE 10 MG NORTRIPTYLINE 25 MG
__________ Mental Health Mental Health
NYSTATIN 100,000U
Fungal Infections
NYSTATIN 100,000U NYSTATIN/TRIAMCINOLONE NYSTATIN/TRIAMCINOLONE NYSTATIN/TRIAMCINOLONE
Fungal Fungal Fungal Fungal
Dosage Form
30-day qty.
90-day 30-day 90-day qty. qty. qty.
$4
$11
$9
$26
___
_____
___
30 30
90 90
-
___ -
15
45
-
-
Infections Infections Infections Infections
_______ Capsule Capsule Cream / Ointment Cream / Ointment Cream Cream Ointment
30 15 30 15
90 45 90 45
-
-
Miscellaneous Conditions
Tablet
60
180
-
-
PAROXETINE 10 MG PAROXETINE 20 MG PENICILLIN VK 125 MG/5 ML PENICILLIN VK 250 MG/5 ML PENICILLIN VK 250 MG PENICILLIN VK 500MG PHENAZOPYRIDINE 100 MG PHENAZOPYRIDINE 200 MG
Mental Health Mental Health Antibiotic Antibiotic Antibiotic Antibiotic Miscellaneous Conditions Miscellaneous Conditions
30 30 100 100 28 28 6 30
90 90 300 300 84 84 18 90
-
-
PILOCARPINE 1%
Glaucoma & Eye Care
15
45
-
-
PILOCARPINE 2%
Glaucoma & Eye Care
15
45
-
-
POLYMYXIN SULFATE/TMP
Glaucoma & Eye Care
Tablet Tablet Solution Solution Tablet Tablet Tablet Tablet Ophthalmic Solution Ophthalmic Solution Ophthalmic Solution
10
30
-
-
POTASSIUM CHLORIDE 10% POTASSIUM CITRATE CITRIC ACID SOLUTION
Vitamins & Nutritional Health
Liquid
473
1419
-
-
Gastrointestinal Health
Liquid
180
540
-
-
O OXYBUTYNIN 5 MG
P
26
FAMILY PHARMACY'S NEW $4.00 PRESCRIPTION PROGRAM
Generic Drug Name / Strength
Category Name
Dosage Form
____________________ PRAVASTATIN 10 MG PRAVASTATIN 20 MG PRAVASTATIN 40 MG PRAZOSIN HCL 1 MG PREDNISONE 1MG PREDNISONE 2.5 MG PREDNISONE 5 MG PREDNISONE 5 MG PREDNISONE 10 MG PREDNISONE 20 MG PRENATAL PLUS WITH IRON Previfem 28 Day PROCHLORPERAZINE 10 MG PROMETHAZINE 6.25 MG/5 ML PROMETHAZINE 25 MG PROMETHAZINE DM SYRUP
__________ Cholesterol Cholesterol Cholesterol Heart Health & Blood Pressure Oral Steroids Oral Oral Oral Steroids Oral Oral Oral Steroids Oral Oral Oral Steroids Oral Oral Oral Steroids Oral Oral Oral Steroids Vitamins & Nutritional Health Womans Health Gastrointestinal Health Gastrointestinal Health Gastrointestinal Health Allergies, Cold and Flu
PROPRANOLOL 10 MG PROPRANOLOL 20 MG PROPRANOLOL 40 MG PROPRANOLOL 80 MG
30-day qty.
90-day 30-day 90-day qty. qty. qty.
$4
$11
$9
$26
_______ Tablet Tablet Tablet Capsule Tablet Tablet Dose Pak Tablet Tablet Tablet Tablet Tablet Tablet Syrup Tablet Syrup
___
_____
___
30 30 30 30 30 30 21 30 30 30 30 30 118 12 120
90 90 90 90 90 90 63 90 90 90 N/A 90 354 36 360
$24/28 -
___ N/A -
Heart Health & Blood Pressure Heart Health & Blood Pressure Heart Health & Blood Pressure
Tablet Tablet Tablet
60 60 60
180 180 180
-
-
Heart Health & Blood Pressure
Tablet
60
180
-
-
Gastrointestinal Health Gastrointestinal Health
Tablet Tablet
60 30
180 90
-
-
Cream Suspension Tablet Tablet
50 120 28 20
150 360 84 60
-
-
R RANITIDINE 150 MG RANITIDINE 300 MG
S SILVER SULFADIAZINE 1% SMZ/TMP 200/40/5 ML SMZ/TMP 400/80 MG SMZ/TMP DS 800/160 MG
Skin Conditions Antibiotic Antibiotic Antibiotic
27
FAMILY PHARMACY'S NEW $4.00 PRESCRIPTION PROGRAM
Generic Drug Name / Strength
Category Name
Dosage Form
____________________ SOTALOL HCL 80 MG SPIRONOLACTONE 25 MG
__________ Heart Health & Blood Pressure Heart Health & Blood Pressure
SULFACETAMIDE SODIUM 10%
Glaucoma & Eye Care
30-day qty.
90-day 30-day 90-day qty. qty. qty.
$4
$11
$9
$26
_______ Tablet Tablet Ophthalmic Solution
___
_____
___
30 30
90 90
-
___ -
15
45
-
-
T TAMOXIFEN 10 MG TAMOXIFEN 20 MG TERAZOSIN 1 MG TERAZOSIN 2 MG
Womans Health Womans Health Heart Health & Blood Pressure Heart Health & Blood Pressure
Tablet Tablet Capsule Capsule
30 30
90 90
30 30 -
90 90 -
TERAZOSIN 5 MG TERAZOSIN 10 MG TERBINAFINE 250 MG TETRACYCLINE 250 MG TETRACYCLINE 500 MG THIORIDAZINE 10MG THIORIDAZINE 25 MG THIOTHIXENE 2 MG
Heart Health & Blood Pressure Heart Health & Blood Pressure Fungal Infections Antibiotic Antibiotic Mental Health Mental Health Mental Health
30 30 60 60 30
90 90 180 180 90
30 30 -
90 90 -
TIMOLOL MALEATE 0.25% TRAZODONE 50 MG TRAZODONE 100 MG TRAZODONE 150 MG TRIAMCINOLONE 0.025% TRIAMCINOLONE 0.025%
Glaucoma & Eye Care Mental Health Mental Health Mental Health Skin Conditions Skin Conditions
5 30 30 30 15 80
15 90 90 90 45 240
-
-
TRIAMCINOLONE 0.1%
Skin Conditions
15
45
-
-
TRIAMCINOLONE 0.1%
Skin Conditions
80
240
-
-
TRIAMTERENE/HCTZ 37.5/25 MG
Heart Health & Blood Pressure
Capsule Capsule Tablet Capsule Capsule Tablet Tablet Capsule Ophthalmic Solution Tablet Tablet Tablet Cream Cream Cream / Ointment Cream / Ointment Capsule / Tablet
30
90
-
-
28
FAMILY PHARMACY'S NEW $4.00 PRESCRIPTION PROGRAM
Generic Drug Name / Strength
Category Name
Dosage Form
____________________
__________
TRIAMTERENE/HCTZ 75/50 MG TRIHEXYPHENIDYL 2 MG TRI-SPRINTEC 28-DAY
30-day qty.
90-day 30-day 90-day qty. qty. qty.
$4
$11
$9
$26
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Heart Health & Blood Pressure Mental Health Womans Health
Tablet Tablet Tablet
30 60 -
90 180 -
$24/28
N/A
Heart Health & Blood Pressure Heart Health & Blood Pressure
Tablet Tablet
30 30
90 90
-
-
Heart Heart Heart Heart Heart Heart Heart Heart Heart
Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet
30 30 30 30 30 30 30 30 30
90 90 90 90 90 90 90 90 90
-
-
V VERAPAMIL 80 MG VERAPAMIL 120 MG
W WARFARIN WARFARIN WARFARIN WARFARIN WARFARIN WARFARIN WARFARIN WARFARIN WARFARIN
1 MG 2 MG 2.5 MG 3 MG 4 MG 5 MG 6 MG 7.5 MG 10 MG
Health Health Health Health Health Health Health Health Health
& & & & & & & & &
Blood Blood Blood Blood Blood Blood Blood Blood Blood
Pressure Pressure Pressure Pressure Pressure Pressure Pressure Pressure Pressure
$4 prescriptions include up to a 30-day supply of covered drugs at commonly prescribed dosages. $11 prescriptions include up to a 90-day supply of covered drugs at commonly prescribed dosages. Physician permission may be required to change a 30-day prescription to a 90-day prescription. Prices are subject to change without notice.
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