Hormone Replacement Therapy List
800.622.4510 | www.wellsrx.com
Hormone Replacement Therapy Medication
Form
Strength
Package Size
0.25mg
Per Mini-Tab
0.5mg
Per Mini-Tab
1.2mg
Per Mini-Tab
1.5mg
Per Mini-Tab
Oral/Sublingual Preparations
Anastrozole
Rapid Dissolve Mini-Tab
Anastrozole (Commercial Product)
Tablet
1mg
Per Tablet
Clomiphene Citrate (Commercial Product)
Tablet
50mg
Per Tablet
Capsule
200mg
Per Capsule
Sermorelin Acetate
Rapid Dissolve Mini-Tab
400mcg
Per Tablet
Sermorelin Acetate/GHRP(2)/GHRP(6)
Rapid Dissolve Mini-Tab
300mcg/300mcg/300mcg
Per Tablet
10mg
Per Tablet
20mg
Per Tablet
N-Dim (Commercial Product)
Tamoxifen Citrate (Commercial Product)
Tablet
Oral Thyroid Preparations N-Adrenal Complex (Commercial Product)
Capsule
Supplement
Per Capsule
N-Adrenotone (Commercial Product)
Capsule
Supplement
Per Capsule
Tablet
¼ grain - 5 grain
Per Tablet
Biotin/Finasteride
Capsule
5mg/1mg
Per Capsule
Finasteride
Capsule
1.25mg
Per Capsule
1mg
Per Tablet
5mg
Per Tablet
1.5mg
Per Capsule
3.0mg
Per Capsule
4.5mg
Per Capsule
Armour Thyroid® (Commercial Product)
Finasteride (Commercial Product)
Naltrexone
Published 5/17/2016. Prices subject to change
Tablet
Capsule
WPN-4800-05172016
Hormone Replacement Therapy List
800.622.4510 | www.wellsrx.com
Medication
Form
Strength
Package Size
Nature-Throid® (Commercial Product)
Tablet
¼ grain - 4 grain
Per Tablet
up to and including 59mcg*
#30 / #60 / #90
60-90mcg*
#30 / #60 / #90
91mcg-120mcg*
#30 / #60 / #90
121mcg and higher*
#30 / #60 / #90
T3 SR (Slow Release) or T3/T4 SR (Slow Release)
Capsule
*Price is based on the total amount of mcgs of either T3 by iteslf or T3/T4 combined
Thyroid USP, Porcine SR (Slow Release)
WP-Thyroid® (Commercial Product)
Capsule
Tablet
30mg
Per Capsule
60mg
Per Capsule
90mg
Per Capsule
120mg
Per Capsule
¼ grain - 2 grain
Per Tablet
For a complete list of topical & oral preparations, please see (Non-Sterile BHRT Formulary)
Injectable Preparations
Sermorelin Acetate, Lyophilized Vial
Injectable
9mg
Per Kit*
15mg
Per Kit*
28mg
Per Kit*
Sermorelin Acetate/GHRP(6) Lyophilized Vial
Injectable
6mg/3mg
Per Kit*
Sermorelin Acetate/GHRP(2) Lyophilized Vial
Injectable
9mg/3mg
Per Kit*
Sermorelin Acetate/GHRP(2)/GHRP(6) Lyophilized Vial
Injectable
9mg/3.15mg/3.15mg
Per Kit*
9mg/9mg/9mg
Per Kit*
Sermorelin Acetate/GHRP(2)/Theanine Lyophilized Vial
Injectable
15mg/5.4mg/75mg
Per Kit*
*Kit Includes: Vial of Medication, Diluent, Mixing Syringe/Needle (Injection supplies sold separately)
Published 5/17/2016. Prices subject to change
WPN-4800-05172016
Hormone Replacement Therapy List
800.622.4510 | www.wellsrx.com
Medication
Testosterone Cypionate in Grapeseed Oil
Form
Injectable
Strength
Package Size
20mg/mL
5mL Vial
50mg/mL
1mL Vial
100mg/mL
1mL Vial 5mL Vial 1mL Vial
200mg/mL
5mL Vial 10mL Vial 1mL Vial
Testosterone Cypionate in Sesame Oil
Injectable
200mg/mL
Testosterone Cypionate/Anastrozole
Injectable
200mg/1mg/mL
10mL Vial
Testosterone Enanthate In Grapeseed Oil
Injectable
200mg/mL
10mL Vial
Testosterone Propionate
Injectable
100mg/mL
10mL Vial
Injectable
200mg/mL
10mL Vial
Injectable
250mg/mL
10mL Vial
Tri-Test (50% Cyp/37.5% Enan/12.5% Prop)
Injectable
200mg/mL
10mL Vial
Depo® Testosterone (Commercial Product)
Injectable
200mg/mL
10mL Vial
Ultra-Test (80% Cypionate/20% Propionate)
Published 5/17/2016. Prices subject to change
10mL Vial
WPN-4800-05172016
BHRT Sterile Implantable Pellets List
800.622.4510 | www.wellsrx.com
BHRT Sterile Implantable Pellets Medication
Form
Strength
Pellet Size (mm)
DHEA
Pellet
25mg
(3mm)
3mg
(3mm)
6mg
(3mm)
10mg
(3mm)
12.5mg
(3mm)
15mg
(3mm)
18mg
(3mm)
20mg
(3mm)
22mg
(3mm)
25mg
(3mm)
37.5mg
(3mm)
50mg
(3mm)
10mg
(3mm)
15mg
(3mm)
20mg
(3mm)
50mg
(3mm)
100mg
(3mm)
12.5mg
(3mm)
18mg
(3mm)
25mg
(3mm)
37.5mg
(3mm)
50mg
(3mm)
62.5mg
(3mm)
80mg
(3mm)
87.5mg
(3mm)
100mg
(3mm)
100mg
(4.5mm)
200mg
(4.5mm)
Estradiol
Estradiol/Estriol 50%/50%
Progesterone
Testosterone
Published 05/24/16. Prices subject to change.
Pellet
Pellet
Pellet
Pellet
WPN-4600-05242016
BHRT Sterile Implantable Pellets List
800.622.4510 | www.wellsrx.com
Medication
Testosterone/Anastrozole
Testosterone/Finasteride
Trocar Kit for Pellet Insertion
Published 05/24/16. Prices subject to change.
Form
Pellet
Pellet
Trocar
Strength
Pellet Size (mm)
60mg/4mg
(3mm)
200mg/9mg
(4.5mm)
200mg/20mg
(4.5mm)
60mg/6mg
(3mm)
Disposable Plastic Tip (3mm)
Each
Disposable Plastic Tip (4.5mm)
Each
Disposable Stainless Steel Tip (3mm & 4.5mm)
Each
Reusable - Titanium (3mm & 4.5mm)
Each
WPN-4600-05242016
Non-Sterile BHRT List
800.622.4510 | www.wellsrx.com
Non-Sterile BHRT (Bio-Identical Hormone Replacement Therapy) Medication & Form
Progesterone Capsules Please specify one of the following: - Progesterone in Olive Oil - Progesterone SR (Powder)
Progesterone (Retail Product) 1 Ingredient Capsule: Estriol (E3)/ Estradiol (E2)/DHEA/Testosterone/ Pregnenolone 2 Ingredient Capsule: Estriol (E3)/Estradiol (E2)/DHEA/ Testosterone/Pregnenolone
3 Ingredient Capsule: Estriol (E3)/ Estradiol (E2) / Progesterone/DHEA/ Testosterone/Pregnenolone 4 Ingredient Capsule: Estriol (E3)/Estradiol (E2)/ Estrone (E1)/Progesterone/DHEA/ Testosterone/Pregnenolone Topical / Vaginal Female Cream/Gel (Tier 1) -up to and including: Estriol(E3)/ Estradiol(E2)/Estrone(E1) 1.5mg/mL ea / Progesterone 40mg/mL / Testosterone 5mg/mL / DHEA 5mg/mL / Pregnenolone 20mg/mL (Includes Vaginal Applicator)
Published 5/24/2016. Prices subject to change
Strength
#30 QTY
#60 QTY
#90 QTY
#180 QTY
Min Price
25mg
3
3
3
3
3
50mg
3
3
3
3
3
75mg
3
3
3
3
3
100mg
3
3
3
3
3
125mg
3
3
3
3
3
150mg
3
3
3
3
3
175mg
3
3
3
3
3
200mg
3
3
3
3
3
100mg & 200mg
Call For Pricing
1 Ingredient (≤20mg)
3
3
3
3
3
1 Ingredient (>20mg)
3
3
3
3
3
2 Ingredients (≤20mg)
3
3
3
3
3
2 Ingredients (>20mg)
3
3
3
3
3
3 Ingredients (≤2.5mg/100mg/25mg)
3
3
3
3
3
3 Ingredients (>2.5mg/100mg/25mg)
3
3
3
3
3
4 Ingredients (≤1.25/100/5mg)
3
3
3
3
3
4 Ingredients (>1.25/100/5mg)
3
3
3
3
3
1 Ingredient
3
3
3
3
2 Ingredients
3
3
3
3
3 Ingredients
3
3
3
3
4 Ingredients
3
3
3
3
5 Ingredients
3
3
3
3
WPN-5000-05242016
Non-Sterile BHRT List
800.622.4510 | www.wellsrx.com
Medication & Form Topical/Vaginal Female Cream/Gel (Tier 2) - greater than and including: Estriol(E3)/Estradiol(E2)/Estrone(E1) 1.6mg/mL ea/ Progesterone 41mg/mL/ Testosterone 25mg/mL/ DHEA 6mg/ mL/ Pregnenolone 21mg/mL (Includes Vaginal Applicator)
Mini-Inserts (Vaginal) Estriol/Estradiol ≤1.5mg /Progesterone ≤40mg/ Testosterone ≤20mg / DHEA ≤10mg / Pregnenolone ≤20mg
Mini-Troches (Oral): Estriol/Estradiol ≤1.5mg/Progesterone ≤40mg/Testosterone ≤20mg/ DHEA ≤10mg/Pregnenolone ≤20mg
Testosterone Cream/Gel
Testosterone Troches (Oral)
Strength
#30 QTY
#60 QTY
#90 QTY
#180 QTY
Min Price
1 Ingredient
3
3
3
3
2 Ingredients
3
3
3
3
3 Ingredients
3
3
3
3
4 Ingredients
3
3
3
3
5 Ingredients
3
3
3
3
MINI - 1 Ingredient
3
3
3
3
3
MINI - 2 Ingredients
3
3
3
3
3
MINI - 3 Ingredients
3
3
3
3
3
MINI - 4 Ingredients
3
3
3
3
3
MINI - 1 Ingredient
3
3
3
3
3
MINI - 2 Ingredients
3
3
3
3
3
MINI - 3 Ingredients
3
3
3
3
3
MINI - 4 Ingredients
3
3
3
3
3
26-50mg/mL (2.6%-5%)
3
3
3
3
51-100mg/mL (5.1%-10%)
3
3
3
3
101-200mg/mL (10.1%-20%)
3
3
3
3
20mg-100mg
3
3
3
3
101mg-200mg
3
3
3
3
Troches are scored, Mini-Troches are single dose
BHRT Topical Creams are Dispensed in Topi-Clicks. Pumps or syringes are available upon request
Published 5/24/2016. Prices subject to change
WPN-5000-05242016
Male & Female Sexual Health List
800.622.4510 | www.wellsrx.com
Sexual Health - Male & Female Medication
Form
Strength
Package Size
Troche
6mg
Per Troche
50iu/100mg
Per Tablet
125iu/100mg
Per Tablet
50iu/100mg
Per Troche
125iu/100mg
Per Troche
125iu/25mg
Per Tablet
125iu/20mg
Per Troche
125iu/25mg
Per Troche
100mg/10mg
Per Troche
5mg/10mg
Per Mini-Troche
10mg/10mg
Per Mini-Troche
Male - Oral/Sublingual Preparations Apomorphine *Must Ship Cold* Oxytocin/Sildenafil
Chewable Tablet
Oxytocin/Sildenafil *Must Ship Cold*
Troche
Oxytocin/Tadalafil
Chewable Tablet
Oxytocin/Tadalafil *Must Ship Cold*
Troche
Sildenafil/Testosterone *Must Ship Cold*
Troche
Tadalafil/Testosterone *Must Ship Cold*
Mini-Troche
Male Sexual Wellness Kit
Call for Availability and Pricing Troches are scored, Mini-Troches are single dose
Male - Injectable Preparations Alprostadil (Prostaglandin, PGE1) *Must Ship Cold*
Injectable
Arginine/Carnitine/Citrulline/Lidocaine
Injectable
Bimix (Papaverine/Phentolamine)
Injectable
Published 05/16/16. Prices subject to change.
20mcg/mL
10mL Vial
40mcg/mL
10mL Vial
100mg/100mg/100mg/10mg/mL
10mL Vial
30mg/1mg/mL
5mL Vial
30mg/1mg/mL
10mL Vial
WPN-5200-05162016
Male & Female Sexual Health List
800.622.4510 | www.wellsrx.com
Medication
Form
Strength
Package Size 2mL Vial
Injectable
17.65mg/0.59mg/5.9mcg
5mL Vial 10mL Vial 2mL Vial
Trimix (Papaverine/Phentolamine/Alprostadil) *Must Ship Cold*
Injectable
30mg/1mg/10mcg/mL
5mL Vial 10mL Vial 2mL Vial
Injectable
30mg/3mg/60mcg/mL
5mL Vial 10mL Vial
Phenylephrine (Rescue Vial) (Commercial Product)
Injectable
Male Sexual Wellness Kit
10mg/mL
1mL Vial
Call for Availability and Pricing
Female - Vaginal/Oral/Nasal Spray Preparations Aminophylline/Arginine
Gel
Oxytocin *Must Ship Cold*
Mini-Troche
Oxytocin *Must Ship Cold*
Nasal Spray
3%/6%
15mL
50iu
Per Mini-Troche
250iu
Per Mini-Troche
10iu/Spray 60iu/Spray
15mL Bottle (#180 Sprays)
Sildenafil/Aminophylline/Arginine
Cream
2%/3%/6%
15mL
Sildenafil/Aminophylline/Arginine/Testosterone
Cream
2%/3%/6%/0.1%
15mL
Vitamin E
Cream
200iu/mL
15mL
Female Sexual Wellness Kit
Call for Availability and Pricing
For additional female preparations, please see (Non-Sterile BHRT Formulary)
Published 05/16/16. Prices subject to change.
WPN-5200-05162016
Weight Management, Lipotropics, Vitamin List
800.622.4510 | www.wellsrx.com
Weight Management/Lipotropics/Vitamin Therapies Medication
Form
Strength
Package Size
Capsule
75mg/75mg/75mg/75mg
Per Capsule
200iu
Per Tablet
300iu
Per Tablet
500iu
Per Tablet
Rapid Dissolve Mini-Tablet
500iu/300mcg
Per Tablet
Sublingual Drops
11,562.5iu
Per Vial
MIC + Chromium
Tablet
50mg/100mg/5mg/50mcg
Per Tablet
Methylcobalamin/Pyridoxine/Folic Acid
Tablet
2mg/25mg/2.5mg
Per Tablet
Phendimetrazine (Commercial Product)
Tablet
35mg
Per Tablet
Phentermine HCL (Commercial Product)
Tablet
37.5mg
Per Tablet
Arginine-L
Injectable
100mg/mL
30mL Vial
Carnitine-L
Injectable
250mg/mL
30mL Vial
B-Complex (B2, B3, B6, B12(C)) + Vitamin C
Injectable
2mg/20mg/2mg/ 300mcg + 20mg/mL
30mL Vial
Cyanocobalamin (B12) (Commercial Product)
Injectable
1,000mcg/mL
10mL Vial
Injectable
1,000mcg/mL
30mL Vial
GAC (Glutamine/Arginine/Carnitine)
Injectable
25mg/100mg/200mg/mL
30mL Vial
GOAL (Glutamine/Ornithine/Arginine/Lysine) + Lidocaine
Injectable
75mg/75mg/150mg/ 150mg/mL + 10mg/mL
30mL Vial
Glutathione-L *Must Ship Cold*
Injectable
200mg/mL
30mL Vial
Oral/Sublingual Preparations GOAL (Glutamine/Ornithine/Arginine/Lysine)
hCG
hCG + B12(M) hCG (Diluent/Dropper included)
Rapid Dissolve Mini-Tablet
Injectable Preparations
Published 5/17/2016. Prices subject to change
WPN-4100-05172016
Weight Management, Lipotropics, Vitamin List
800.622.4510 | www.wellsrx.com
Medication
hCG Lyophilized Vial
hCG + B12(C), Lyophilized Vial
Form
Strength
Package Size
Injectable
3,500iu
Per Kit*
Injectable
5,000iu
Per Kit*
Injectable
6,000iu
Per Kit*
Injectable
7,500iu
Per Kit*
Injectable
11,000iu
Per Kit*
Injectable
20,000iu
Per Kit*
Injectable
10,000iu + 40mcg
Per Kit*
*Kit Includes: Vial of Medication, Diluent, Mixing Syringe/Needle (Injection supplies sold separately) Injectable
1,000mcg/mL
10mL Vial
Injectable
1,000mcg/mL
30mL Vial
Injectable
5,000mcg/mL
10mL Vial
MIC Combo Standard
Injectable
15mg/50mg/100mg/mL
30mL Vial
MIC/B12(M)
Injectable
15mg/50mg/100mg/mL + 1000mcg/mL
30mL Vial
MIC/Chromium/B12(M)
Injectable
25mg/50mg/50mg/ 25mcg/1mg/mL
10mL Vial
MIC/B-Complex (B2, B3, B6, B12(M))
Injectable
15mg/50mg/100mg/2.5mg/ 0.4mg/2.5mg/0.25mg/mL
30mL Vial
MIC/B12(M) + Carnitine
Injectable
12.5mg/50mg/100mg/ 1mg/mL+ 50mg/mL
30mL Vial
MIC/B-Complex (B2, B3, B6, B12(M)) + Carnitine + Lidocaine
Injectable
15mg/30mg/30mg/0.5mg/ 20mg/20mg/0.5mg/mL + 85mg/mL + 20mg/mL
30mL Vial
MIC/B-Complex (B1, B2, B6) + Carnitine + Arginine + Chromium + Lidocaine
Injectable
12.5mg/25mg/25mg/30mg/ 2mg/2mg/25mg/12.5mg/ 0.2mg/20mg/mL
MIC/B-Complex (B2, B3, B5, B12(M)) + Chromium + Carnitine
Injectable
20mg/40mg/50mg/5mg/33mg/ 2mg/1mg/25mcg/25mg/mL
Methylcobalamin (B12)
Published 5/17/2016. Prices subject to change
10mL Vial 30mL Vial 30mL Vial
WPN-4100-05172016
Weight Management, Lipotropics, Vitamin List
800.622.4510 | www.wellsrx.com
Medication IC/B-Complex (B1, B2, B3, B5, B6, B12(C)) + Leucine + Carnitine + Chromium + Lidocaine Vitamin D3 in Sesame Oil
Form
Strength
Package Size
Injectable
25mg/25mg/5mg/2.5mg/ 25mg/5mg/5mg/0.1mg/ 1.5mg/25mg/25mcg/10mg/mL
30mL Vial
Injectable
50,000iu/mL
5mL Vial
Injectable
100,000iu/mL
5mL Vial
B12 Abbreviations - (C)=Cyanocobalamin (M)=Methylcobalamin, (H)=Hydroxocobalamin
Published 5/17/2016. Prices subject to change
WPN-4100-05172016
Syringes, Needles, Misc. List
800.622.4510 | www.wellsrx.com
Syringes/Needles/Miscellaneous Device
Form
Size
Package Size
Syringe w/Needle
28g x 1/2” 0.5mL
Pack of 10
Syringe w/Needle
29g x 1/2” 0.5mL
Pack of 10
Syringe w/Needle
29g x 1/2” 1mL
Pack of 10
Syringe w/Needle
30g x 1/2” 1mL
Pack of 10
Syringe w/Needle
30g x 5/16” 0.5mL
Pack of 10
Syringe w/Needle
30g x 5/16” 0.3mL
Pack of 10
Syringe w/Needle
30g x 5/16” 1mL
Pack of 10
Syringe w/Needle
31g x 5/16” 0.5mL
Pack of 10
Syringe w/Needle
31g x 5/16” 1mL
Pack of 10
Syringe w/Needle
Special Request
Pack of 10
Syringe w/Needle
18g x 1.5” 3mL
Each
Syringe w/Needle
20g x 1” 3mL
Each
Syringe w/Needle
20g x 1.5” 3mL
Each
Syringe w/Needle
21g x 1” 3mL
Each
Syringe w/Needle
22g x 1” 3mL
Each
Syringe w/Needle
22g x 1.5” 3mL
Each
Syringe w/Needle
23g x 1” 3mL
Each
Syringe w/Needle
23g x 1.5” 3mL
Each
Syringe w/Needle
25g x 1” 3mL
Each
Insulin / Subcutaneous Syringes
Insulin Syringe (SureComfort or UltiCare)
BD Brand Insulin Syringes
Intramuscular Syringes
BD IM Syringes
Published 05/13/16. Prices subject to change.
WPN-5400-05132016
Syringes, Needles, Misc. List
800.622.4510 | www.wellsrx.com
Device
Form
Size
Package Size
Needle
16g x 1”
Each
Needle
18g x 1”
Each
Needle
18g x 1.5”
Each
Needle
20g x 1”
Each
Needle
20g x 1.5”
Each
Needle
21g x 1”
Each
Needle
21g x 1.5”
Each
Needle
22g x 1”
Each
Needle
22g x 1.5”
Each
Needle
23g x 1”
Each
Needle
23g x 1.5”
Each
Needle
25g x 5/8”
Each
Needle
25g x 1”
Each
Needle
25g x 1.5”
Each
Needle
27g x 0.5”
Each
Needle
27g x 1.25”
Each
Syringe w/o Needle
1mL
Each
Syringe w/o Needle
3mL
Each
Syringe w/o Needle
5mL
Each
Syringe w/o Needle
10mL
Each
Prep Pads
Prep Pads
#100 Pads
1.4qt
Sharps
Each
Needles
BD Needle
Miscellaneous
BD Luer-Lok™
Alcohol Prep Pads BD - Sharps Container
Published 05/13/16. Prices subject to change.
WPN-5400-05132016