Pharmacy Instructions & Formulary

This is the home page for all things pharmacy in EHHOP. This includes information on routine prescribing, EHHOP's formulary, as well as information about supplies and storage in clinic.

Quick Links

Below are a few quick links that are helpful while managing patients in and between clinic.

Medication Management on Epic

DOH enrollment instructions

Dispensary of Hope (DOH) information

Prescribing Urgent and In-Clinic Medications

Refill Instructions for Patients

Storage, Locker Codes, and Diabetes Supplies

PDAP Medications

PPI Prescribing Guide

Reimbursements

Using the Formulary

The formulary can be used to search for medications that are 'on-formulary', which means they are offered by the Mount Sinai pharmacy.

If a medication is marked 'Do Not Prescribe - Apply for PDAP', that means it is a specialty medication that we obtain for free through the use of PDAP (Patient Drug Assistance Programs) from pharmaceutical companies. To request a PDAP medication, please follow the instructions on this form.

If a medication is not on formulary and can't be obtained through PDAP, please see if there is a similar medication on formulary that can be prescribed.

If a medication is not on formulary, can't be obtained by PDAP, and can't be replaced, we can sometimes try to obtain it through purchasing with cash at a local pharmacy; however, please always check-in with the pharmacy team prior to pursuing this option.

If a medication is marked 'Available In-Clinic - See TS', it can be prescribed in clinic for urgent, single treatments.

If a medication is marked 'Available via DOH - Primary', this should be the preferred medication since it is free of charge. Please make sure the patient has completed a DOH form within the last 12 months (see Master List). If this is their first time receiving medications via DOH, tell the patient not to go to the pharmacy until Tuesday.

Please make sure patients do not pick up medications on Mondays before 12:00 p.m. so the pharmacy can be sure the medications are ready.

If you have any questions/difficulties please contact the pharmacy chair, Megan Paul.

• Formulary
• ANALGESICS
• Acetaminophen
  $0.01 (325mg) ANALGESICS
• Aspirin
  $0.02 (81mg), 325mg ANALGESICS
• Capsaicin 0.025% Cream
  $0.01 ANALGESICS
• Celecoxib
  100mg, $0.30 (200mg) ANALGESICS Available via DOH - Primary
• Codeine/Acetaminophen (Tylenol 3)
  $0.04 (30mg/300mg) ANALGESICS
• Diclofenac
  50mg tablet ANALGESICS Available via DOH - Primary
• Diclofenac
  $0.05 (1% topical gel) ANALGESICS NSAID
• Duloxetine
  $0.17, (20mg - delayed release), $0.45 (60mg) ANALGESICS
• Duloxetine
  30mg DR ANALGESICS Available via DOH - Primary
• Fentanyl Patches
  $2.88 (25mg, 50mg), $3.16 (75mg, 100mg) ANALGESICS Do Not Prescribe - Apply for PDAP
• Gabapentin (Neurontin)
  $0.13 (600mg), $0.07 (300mg), $0.06 (400mg), $0.05 (100mg) ANALGESICS
• Hydromorphone
  $0.09 (2mg), $0.11 (4mg) ANALGESICS
• Ibuprofen
  400mg, 600mg, 800mg (800mg not covered by DOH) ANALGESICS Available via DOH - Primary
• Liquid Morphine (Roxanol)
  $3.16 (75mg, 100mg), $2.88 (25mg, 50mg) ANALGESICS Do Not Prescribe
• Morphine Extended Release
  $0.21 (15mg), $0.54 (30mg) ANALGESICS
• Morphine Standard Release
  $0.42 (30mg), $2.42 (60mg) ANALGESICS
• Naproxen
  $0.07 (500mg), $0.04 (250mg) ANALGESICS
• Naproxen
  275mg, 375mg controlled release ANALGESICS Available via DOH - Primary <br>
• Oxycodone
  $0.10 (5mg) ANALGESICS
• Oxycodone/Acetaminophen (Percocet)
  $0.08 (5mg/325mg) ANALGESICS
• Pregabalin (Lyrica)
  $3.16 (75mg, 100mg), $2.88 (25mg, 50mg) ANALGESICS Do Not Prescribe - Apply for PDAP
• ANESTHETICS
• Lidocaine
  5% Transdermal patch ANESTHETICS Available via DOH - Primary
• Lidocaine
  4% Cream (15 gm/tube, 30gm/tube, 5gm/5tubes ANESTHETICS Available via DOH - Primary
• Lidocaine
  4% Patches ANESTHETICS
• Lidocaine
  2% Jelly ANESTHETICS
• ANTI-ADDICTION
• Buproprion (Wellbutrin)
  75mg ANTI-ADDICTION
• Naltrexone
  $0.79 (50mg tab) ANTI-ADDICTION
• Varenicline (Chantix)
  ANTI-ADDICTION Do Not Prescribe - Apply for PDAP
• Nicotine Patches
  $0.60 (70mg) ANTI-ADDICTION Call 1-866-NY-QUITS
• Topiramate
  25mg, 100mg ANTI-ADDICTION
• ANTICOAGULANTS/PROCOAGULANTS
• Aspirin
  $0.02 (81mg), 325mg ANTICOAGULANTS/PROCOAGULANTS
• Warfrin (Coumadin)
  $0.04 (2mg, 2.5mg, 3mg, 4mg, 5mg), $0.03 (1mg), $0.05 (5mg, 7.5mg, 10mg) ANTICOAGULANTS/PROCOAGULANTS
• Clopidogrel
  75mg ANTICOAGULANTS/PROCOAGULANTS Available via DOH - Primary
• Apixaban (Eliquis)
  $6.24 (2.5/5mg) ANTICOAGULANTS/PROCOAGULANTS Do Not Prescribe - Apply for PDAP
• Dabigatran (Pradaxa)
  $5.75 (110mg) ANTICOAGULANTS/PROCOAGULANTS
• Dabigatran (Pradaxa)
  $4.49 (75/150mg) ANTICOAGULANTS/PROCOAGULANTS
• Rivaroxaban (Xarelto)
  $11.62 (10/15/20mg) ANTICOAGULANTS/PROCOAGULANTS
• Prasugrel
  5mg ANTICOAGULANTS/PROCOAGULANTS Available via DOH - Primary
• Tranexamic Acid
  Do Not Prescribe - Apply for PDAP [#red] ANTICOAGULANTS/PROCOAGULANTS
• ANTICONVULSANTS
• Carbamazepine
  $0.67 (200mg) ANTICONVULSANTS Available via DOH - Primary
• Divalproex
  250mg ER, 500mg ER ANTICONVULSANTS
• Lamotrigine (Lamictal)
  25mg, 100mg, 150mg, 200mg ANTICONVULSANTS
• Levetiracetam
  100mg/ml solution, $0.28 (750mg) ANTICONVULSANTS
• Levetiracetam
  500mg, 1000mg ANTICONVULSANTS Available via DOH - Primary
• Phenytoin
  100mg ER ANTICONVULSANTS Available via DOH - Primary
• Topamax (Topiramate)
  $0.03 (25mg), $0.05 (100mg) ANTICONVULSANTS
• Valproate/Valproic Acid (Depakote)
  $0.07-$0.13 (125mg, 250mg, 500mg) ANTICONVULSANTS
• ANTIDEPRESSANTS
• Amitriptyline
  $0.22 (25mg), $0.02 (10mg), $0.47 (50mg) ANTIDEPRESSANTS <br>
• Buproprion (Wellbutrin)
  75mg ANTIDEPRESSANTS <br>
• Citalopram (Celexa)
  $0.02 (10mg), $0.03 (20mg - not covered by DOH), 40mg ANTIDEPRESSANTS Available via DOH - Primary
• Clomipramine
  50mg ANTIDEPRESSANTS Available via DOH - Primary
• Doxepin
  50mg ANTIDEPRESSANTS <br>
• Escitalopram
  5mg ANTIDEPRESSANTS
• Escitalopram
  $0.15 (10mg) ANTIDEPRESSANTS
• Fluoxetine (Prozac)
  10mg, 20mg, 60mg ANTIDEPRESSANTS Available via DOH - Primary
• Nortriptyline
  $0.11 (25mg), $0.07 (10mg) ANTIDEPRESSANTS
• Mirtazapine
  $1.93 (7.5mg - not covered by DOH), 15mg, 30mg, 45mg ANTIDEPRESSANTS Available via DOH - Primary
• Paroxetine (Paxil)
  20mg, 30mg, 37.5mg, 40mg ANTIDEPRESSANTS Available via DOH - Primary <br>
• Sertraline (Zoloft)
  $0.05 (25 mg), $0.05 (50 mg), $0.05 (100 mg) ANTIDEPRESSANTS Available via DOH - Primary
• Trazodone
  50mg, 100mg, 150mg, 300mg ANTIDEPRESSANTS Available via DOH - Primary <br>
• Venlafaxine
  37.5mg ER, 75 mg ER, 150mg ER ANTIDEPRESSANTS Available via DOH - Primary
• ANTIFUNGALS
• Clotrimazole Topical Cream, 1%
  $0.91 (15g) ANTIFUNGALS Topical
• Clotrimazole Topical Cream, 0.025%
  $0.1 (15g) ANTIFUNGALS Topical
• Clarithromycin
  250mg, 500mg, 50mg ER ANTIFUNGALS Available via DOH - Primary
• Clindamycin
  1% Solution, 150mg ANTIFUNGALS Check with TS Topical
• Clindamycin
  $0.23 (300mg) ANTIFUNGALS
• Bacitracin Ointment 0.5%
  $3.21 (1oz) ANTIFUNGALS Topical
• Econazole Nit Cream 1%
  $4.28 (15g) ANTIFUNGALS Topical
• Ketoconazole Cream 2%
  $30.04 (30g) ANTIFUNGALS Topical
• Ketoconazole Shampoo 2%
  $3.64 (30g) ANTIFUNGALS Topical
• Ketoconazole
  $0.16 (200mg) ANTIFUNGALS
• Econazole Nitrate (Spectrazole)
  $4.79 () ANTIFUNGALS Do Not Prescribe Topical
• Fluconazole
  50mg ANTIFUNGALS Available In Clinic - See TS <br>
• Itraconazole
  $0.53 (100mg), $0.06 (50mg), $0.20 (200mg), $0.37 (150mg) ANTIFUNGALS
• Terbinafine
  $0.9 (250mg) ANTIFUNGALS
• Metrogel
  ANTIFUNGALS Do Not Prescribe Topical
• Miconazole 2% Vaginal Cream
  $6.85 (1 tube) ANTIFUNGALS
• Nystatin
  100,000unit/g topical cream ANTIFUNGALS Available via DOH - Primary
• ANTIGOUT AGENTS
• Colchicine
  0.6mg ANTIGOUT AGENTS Available via DOH - Primary
• Febuxostat
  40mg, 80mg, ANTIGOUT AGENTS Available via DOH - Primary
• ANTIHYPERLIPIDEMICS
• Simvastatin (Zocor)
  10mg ANTIHYPERLIPIDEMICS Available via DOH - Primary
• Simvastatin (Zocor)
  20mg, 40mg ANTIHYPERLIPIDEMICS
• Rosuvastatin (Crestor)
  $0.06 (5 mg), $0.23 (10mg-not covered by DOH), 40mg ANTIHYPERLIPIDEMICS Available via DOH - Primary
• Pravastatin (Pravachol)
  20mg, 40mg ANTIHYPERLIPIDEMICS Available via DOH - Primary
• Atorvastatin (Lipitor)
  10mg, $0.07 (20mg), $0.22 (40mg), $0.21 (80mg - NOT covered by DOH) ANTIHYPERLIPIDEMICS Available via DOH - Primary
• Ezetimibe
  10mg ANTIHYPERLIPIDEMICS Available via DOH - Primary
• Ezetimibe/Simvastatin
  10mg-10mg, 10mg-20mg ANTIHYPERLIPIDEMICS Available via DOH - Primary
• Red yeast rice
  $0.16 (80mg), $0.07 (10mg), $0.18 (20mg), $0.07 (40mg) ANTIHYPERLIPIDEMICS Statins
• Niacin (Vit B6)
  $0.2 (500mg) ANTIHYPERLIPIDEMICS Statins
• Gemfibrozil (Lopid)
  $0.15 (600mg) ANTIHYPERLIPIDEMICS Statins
• Fenofibrate (Tricor, Triglide)
  54mg, 145mg ANTIHYPERLIPIDEMICS Available via DOH - Primary
• Fenofibrate (micronized)
  43mg ANTIHYPERLIPIDEMICS Available via DOH - Primary
• Fenofibric Acid
  45mg DR ANTIHYPERLIPIDEMICS Available via DOH - Primary
• Colesevelam
  625mg ANTIHYPERLIPIDEMICS Available via DOH - Primary
• ANTIMICROBIALS
• Penicillin V
  $0.07 (250mg), 875mg (dose not covered by DOH) ANTIMICROBIALS Available via DOH - Primary
• Amoxicillin
  500mg, 875mg ANTIMICROBIALS Available via DOH - Primary
• Amoxicillin
  400mg/5mL Powder for Suspension ANTIMICROBIALS Available via DOH - Primary
• Amoxicillin / Clavulanate Potassium
  875-125mg ANTIMICROBIALS Available via DOH - Primary
• Ampicillin
  1g powder for injection (10 vials/box) ANTIMICROBIALS Available via DOH - Primary
• Cephalexin
  $0.07 (250mg - dose not covered by DOH), $0.10 (500mg) ANTIMICROBIALS Available via DOH - Primary
• Ceftriaxone
  $0.71 ANTIMICROBIALS
• Ciprofloxacin
  250mg ANTIMICROBIALS
• Doxycycline
  $0.77 (100mg) ANTIMICROBIALS Available via DOH - Primary
• Doxycycline Hyclate
  50mg ANTIMICROBIALS Available via DOH - Primary
• Erythromycin
  $2.68 (250mg) ANTIMICROBIALS
• Azithromycin
  $0.64 (250mg), 500mg ANTIMICROBIALS Available via DOH - Primary
• Levaquin (Levofloxacin)
  250mg, $0.18 (500mg - not covered by DOH), 750mg ANTIMICROBIALS Available via DOH - Primary
• Linezolid
  600mg ANTIMICROBIALS Available via DOH - Primary
• Metronidazole
  $0.03 (250mg) ANTIMICROBIALS Available via DOH - Primary
• Moxifloxacin
  400mg ANTIMICROBIALS Quinolone
• Nitrofurantoin (Macrobid)
  50mg, 100mg ANTIMICROBIALS Available In Clinic - See TS
• TMP/SMX (Bactrim)
  400mg-80mg, 800mg-160mg ANTIMICROBIALS
• TMP/SMX (Bactrim)
  200mg-40mg/5mL Suspension ANTIMICROBIALS Available via DOH - Primary
• Vancomycin
  125mg, 250mg ANTIMICROBIALS Available via DOH - Primary
• Vancomycin
  250mg Powder for Injection ANTIMICROBIALS Antiviral
• ANTIMIGRAINE AGENTS
• Sumatriptan
  25mg ($9.60 for 9 days), 50mg ANTIMIGRAINE AGENTS
• Sumatriptan Injection
  6mg/0.5mL ANTIMIGRAINE AGENTS
• Sumatriptain
  5mg Nasal Spray, 20mg Nasal Spray ANTIMIGRAINE AGENTS Available via DOH - Primary
• Rizatriptan
  10mg ANTIMIGRAINE AGENTS
• Zolmitriptan
  2.5mg, 5mg ANTIMIGRAINE AGENTS Available via DOH - Primary
• ANTIMYCOBACTERIALS
• Isoniazid
  $0.14 (300mg) ANTIMYCOBACTERIALS
• Rifampin
  $0.54 (400mg) ANTIMYCOBACTERIALS
• RIPE Therapy
  $0.54 (400mg) ANTIMYCOBACTERIALS Check First With TS
• ANTIPARKINSON AGENTS
• Pramipexole
  0.25mg ANTIPARKINSON AGENTS
• Ropinirole
  0.25mg, 0.5mg, 1mg, 2mg ANTIPARKINSON AGENTS Available via DOH - Primary
• ANTIPSYCHOTICS
• Aripiprazole (Abilify)
  2mg, 5mg, 10mg, 15mg, 20mg, 30mg ANTIPSYCHOTICS Available via DOH - Primary
• Chlorpromazine
  50mg, 100 mg, 200 mg ANTIPSYCHOTICS <br>
• Fluphenazine
  10mg ANTIPSYCHOTICS <br>
• Haloperidol (Haldol)
  $0.40-$0.59 (0.5mg, 1mg, 2mg, 5mg, 10mg) ANTIPSYCHOTICS Available via DOH - Primary
• Haloperidol Decanoate
  50mg/mL, 100mg/mL ANTIPSYCHOTICS
• Lithium
  300mg, 300mg ER, 450mg ER ANTIPSYCHOTICS Available via DOH - Primary <br>
• Olanzapine
  2.5mg, 7.5mg, 10mg, 15mg, 20mg (15 and 20mg not covered by DOH) ANTIPSYCHOTICS Available via DOH - Primary
• Paliperidone
  3mg, 6mg ANTIPSYCHOTICS <br>
• Perphenazine
  2mg ANTIPSYCHOTICS
• Quetiapine (Seroquel)
  25mg, 200mg ER ANTIPSYCHOTICS Available via DOH - Primary
• Risperidone (Risperadol)
  $0.03 (0.5mg) ANTIPSYCHOTICS
• ANTISPASTICITY/MUSCLE RELAXERS
• Baclofen
  10mg, 20mg ANTISPASTICITY/MUSCLE RELAXERS Available via DOH - Primary
• Cyclobenzaprine (Flexeril)
  5mg, 7.5mg, 10mg ANTISPASTICITY/MUSCLE RELAXERS
• Methocarbamol
  750mg ANTISPASTICITY/MUSCLE RELAXERS Available via DOH - Primary
• Tizanidine
  2mg, 4mg ANTISPASTICITY/MUSCLE RELAXERS
• ANTIVIRALS
• Acyclovir
  5% Topical Ointment, 5grams/2 tubes, 15grams/1 tube ANTIVIRALS Available via DOH - Primary
• Famciclovir
  $1.76 (500mg) ANTIVIRALS
• Ganciclovir
  $0.05 (200mg) ANTIVIRALS Restricted Use - Check With TS
• Oseltamivir Phosphate
  75mg ANTIVIRALS
• Valacyclovir (Valtrex)
  $0.74 (500mg) ANTIVIRALS <br>
• PeP/PrEP
  $0.00 (0) ANTIVIRALS Do Not Prescribe - Apply for PDAP or Jack Martin Clinic
• Abacavir Sulfate/Lamivudine 600mg-300mg Tablet
  Available via DOH - Primary [#blue] ANTIVIRALS
• ANXIOLYTICS
• Alprazolam (Xanax)
  $0.03 (0.25mg, 0.5mg, 1mg) ANXIOLYTICS
• Buspirone
  5mg, 10mg, 15mg, 30mg ANXIOLYTICS Available via DOH - Primary
• Lorazepam (Ativan)
  $0.03 (1mg), $0.02 (0.5mg), $0.05 (2mg) ANXIOLYTICS
• Clonazepam (Klonopin)
  $0.01 (0.5mg), $0.03 (1mg), $0.04 (2mg) ANXIOLYTICS
• ASTHMA/COPD
• Prednisone
  5mg, 10mg ASTHMA/COPD Available In Clinic - See TS
• Albuterol HFA Inhaler
  0.08% 3mL ASTHMA/COPD Available In Clinic - See TS
• Levalbuterol Solution for Inhalation
  0.31mg/3mL, 0.63mg/3mL ASTHMA/COPD Available via DOH - Primary <br>
• Fluticasone Inhaler (Flovent)
  Do Not Prescribe - Apply for PDAP [#red] ASTHMA/COPD
• Montelukast (Singulair)
  4mg, 10mg (dose not covered by DOH) ASTHMA/COPD Available via DOH - Primary
• Fluticasone/Salmeterol (Advair)
  0.02% ASTHMA/COPD Do Not Prescribe - Apply for PDAP
• Fluticasone/Salmeterol Powder for Injalation
  100mcg-50mcg, 250mcg-50mcg ASTHMA/COPD Available via DOH - Primary
• Ipratroprium Bromide (Atrovent Inhaler)
  Do Not Prescribe - Apply for PDAP [#red] ASTHMA/COPD<br>
• Ipratropium Bromide Solution for Inhalation
  0.02% (30 vials or 60 vials) ASTHMA/COPD Available via DOH - Primary
• Budesonide/Formeterol (Symbicort)
  Do Not Prescribe - Apply for PDAP [#red] ASTHMA/COPD
• Budesonide Nebulizer Solution
  0.25mg/2mL, 0.5mg/2mL ASTHMA/COPD Available via DOH - Primary
• Asthma Medication Spacer
  ASTHMA/COPD Do Not Prescribe - Available in Clinic Other
• Albuterol Nebulizer Solution
  1.25mg/3mL (25 or 30 pouches) ASTHMA/COPD Available via DOH - Primary
• Albuterol Nebulizer Solution
  0.083% (30 vials) or 0.5% (30 pouches) ASTHMA/COPD Available via DOH - Primary
• Asthmanefrin refill solution for inhalation
  2.25% (30 vials) ASTHMA/COPD Available via DOH - Primary
• ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS
• Acetazolamide
  $1.96 (250mg) ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS
• Amlodipine
  5mg ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS <br>
• Amlodipine
  $0.02 (10mg) ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS
• Amlodipine Besylate/Atorvastatin Calcium 5mg-10mg Tablet
  Available via DOH - Primary [#blue]<br> ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS
• Amlodipine Besylate/Atorvastatin Calcium 5mg-20mg Tablet
  Available via DOH - Primary [#blue] ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS
• Amlodipine Besylate/Atorvastatin Calcium 5mg-40mg Tablet
  Available via DOH - Primary [#blue] ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS
• Amlodipine Besylate/Valsartan 5mg-320mg Tablet
  Available via DOH - Primary [#blue] ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS
• Amlodipine/Olmesartan Medoxomil 5mg-40mg Tablet
  Available via DOH - Primary [#blue] ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS
• Atenolol
  25mg, 50mg ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS Available via DOH - Primary <br>
• Benazepril
  10mg, 20mg ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS
• Captopril
  12.5mg, 25mg ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS
• Carvedilol
  3.125mg, 6.25mg, 12.5mg ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS <br>
• Chlorthalidone
  25mg ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS Available via DOH - Primary <br>
• Clonidine
  0.1mg, 0.1mg ER, 0.2mg, 0.3mg ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS Available via DOH - Primary
• Digoxin
  $0.26 (0.25mg), $0.26 (0.125mg) ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS
• Diltiazem
  120mg ER, 240mg ER ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS Available via DOH - Primary
• Enalapril
  $0.02 (20mg) ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS
• Felodipine
  10mg ER ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS Available via DOH - Primary
• Furosemide (Lasix)
  20mg (20mg dose not covered by DOH), 40mg, 80mg ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS Available via DOH - Primary <br>
• Hydralazine
  25mg ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS Available In Clinic - See TS Available via DOH - Primary
• Hydrochlorothiazide
  $0.07 (12.5mg), $0.04 (25mg) ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS
• Irbesartan/Hydrochlorothiazide
  300mg-12.5mg ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS Available via DOH - Primary
• Isosorbide Mononitrate
  $0.12 (60mg), $0.18 (30mg) ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS
• Isosorbide Dinitrate
  20mg ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS Available via DOH - Primary
• Labetalol
  100mg ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS Available In Clinic - See TS
• Lisinopril
  $0.03 (5mg), $0.04 (10mg), $0.06 (20mg), $0.11 (40mg) ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS Available In Clinic - See TS
• Losartan (Cozaar)
  $0.07 (100mg), $0.04 (50mg), $0.05 (25mg) ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS
• Losartan Potassium/Hydrochlorothiazide
  100mg-12.5mg ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS Available via DOH - Primary
• Methyldopa
  250mg ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS Available via DOH - Primary
• Metolazone
  2.5mg (this dose not covered by DOH), 5mg ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS Available via DOH - Primary
• Metoprolol Succinate
  25mg ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS
• Metoprolol Tartrate
  25mg, 50mg, 100mg ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS Available via DOH - Primary <br>
• Nifedipine
  10mg ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS Available via DOH - Primary
• Nifedipine (ER)
  30mg, $0.26 (60mg), 90mg ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS
• Nitroglycerin
  0.4mg/hr Transdermal Patch ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS Available via DOH - Primary
• Olmesartan
  5mg, $0.23 (20mg - dose not covered by DOH), 40mg ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS Available via DOH - Primary
• Prazosin
  $0.22 (1 mg), 2mg, 5mg ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS Available via DOH - Primary <br>
• Propranolol
  $0.15 (10mg), 20mg, 40mg, $0.31 (60mg ER) ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS
• Spironolactone
  25mg, 50mg, 100mg ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS <br>
• Telmisartan
  20mg, 40mg, 80mg ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS Available via DOH - Primary
• Terazosin
  $0.04 (1mg), $0.12 (5mg) ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS
• Triamterene
  37.5-25mg, 75-50mg (dose not covered by DOH) ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS Available via DOH - Primary
• Valsartan
  40mg, $0.81 (80mg), 160mg, 320mg ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS Available via DOH - Primary
• Valsartan - Hydrochlorothiazide
  160mg-12.5mg, 320mg-25mg ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTSAvailable via DOH - Primary
• Verapamil (SR)
  $0.05 (80mg), $0.56 (120mg), $0.17 (180mg), $0.16 (240mg) ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS
• Verapamil
  120mg ER ANTIHYPERTENSIVES/CARDIOVASCULAR AGENTS Available via DOH - Primary
• BLOOD GLUCOSE REGULATORS
• Metformin
  $0.01 (500mg), 500mg ER, 850mg, 850mg ER, $0.03 (1000mg) BLOOD GLUCOSE REGULATORS <br>
• Glimepiride
  4mg BLOOD GLUCOSE REGULATORS Preferred Sulfonylurea
• Glipizide
  5mg (5mg not covered by DOH), 10mg BLOOD GLUCOSE REGULATORS Available via DOH - Primary
• Glucometer Lancets
  Available in clinic [#green] BLOOD GLUCOSE REGULATORS
• Glucometer Test Strips
  Available in clinic [#green] BLOOD GLUCOSE REGULATORS
• Glucometers
  Available in clinic [#green] BLOOD GLUCOSE REGULATORS
• Gvoke (Glucagon)
  0.5mg/0.1mL pre-filled syringe BLOOD GLUCOSE REGULATORS Available via DOH - Primary
• Insulin NPH (Novolin)
  $128.16 (10 mL) BLOOD GLUCOSE REGULATORS Do Not Prescribe - See TS for Management
• Insulin Lantus (Basaglar)
  100unit/mL Kwikpen BLOOD GLUCOSE REGULATORS Available via DOH - Primary <br>
• Insulin Humalog
  100unit/mL Kwikpen, 75unit/25mL Kwikpen, 70/30 Vial, regular vials BLOOD GLUCOSE REGULATORS<br>
• Insulin Humulin N
  100 unit/mL suspension for injection BLOOD GLUCOSE REGULATORS Available via DOH - Primary
• Insulin Humulin R
  100 unit/mL solution for injection BLOOD GLUCOSE REGULATORS Available via DOH - Primary
• Insulin syringes
  Available in clinic [#green] BLOOD GLUCOSE REGULATORS
• Rosiglitazone (Avandia)
  Do Not Prescribe [#red] BLOOD GLUCOSE REGULATORS
• Januvia
  Do Not Prescribe - Apply for PDAP [#red] BLOOD GLUCOSE REGULATORS
• Dulaglutide (Trulicity)
  Do Not Prescribe - Apply for PDAP [#red], Consider as Substitute for Liraglutide (Victoza) BLOOD GLUCOSE REGULATORS
• ELECTROLYTES/MINERALS/METALS/VITAMINS
• Calcium Acetate (Phoslo)
  $0.42 (667 mg) ELECTROLYTES/MINERALS/METALS/VITAMINS
• Calcium Carbonate
  $0.01 (648mg), $0.02 (1250mg) ELECTROLYTES/MINERALS/METALS/VITAMINS
• Cyanocobalamin Injections (B12)
  10000mcg/10mL ELECTROLYTES/MINERALS/METALS/VITAMINS
• Cyanocobalamin Solution for Injection (B12)
  30000mcg/30mL ELECTROLYTES/MINERALS/METALS/VITAMINS Available via DOH - Primary
• Cyanocobalamin Tablets (B12)
  $0.02 (1000mcg) ELECTROLYTES/MINERALS/METALS/VITAMINS
• Calcium-Folic Acid Plus D Chewable
  Available via DOH - Primary [#blue] ELECTROLYTES/MINERALS/METALS/VITAMINS
• Iron Sulfate (Ferrous sulfate)
  $0.01 (325mg) ELECTROLYTES/MINERALS/METALS/VITAMINS
• Ferrous Gluconate 325mg
  $0.01 (325mg) ELECTROLYTES/MINERALS/METALS/VITAMINS
• Multivitamin
  $0.06/day ELECTROLYTES/MINERALS/METALS/VITAMINS
• Multigen Caplet
  Multivitamin ELECTROLYTES/MINERALS/METALS/VITAMINS
• Prena1
  Multivitamin ELECTROLYTES/MINERALS/METALS/VITAMINS
• Multivitamin High Potency
  $0.03 ELECTROLYTES/MINERALS/METALS/VITAMINS
• Potassium Chloride
  8mEq ER, 10mEq ER ELECTROLYTES/MINERALS/METALS/VITAMINS Available via DOH - Primary
• Potassium Citrate
  10mEq ER ELECTROLYTES/MINERALS/METALS/VITAMINS Available via DOH - Primary
• Pyridoxine B6
  $0.01 (50mg) ELECTROLYTES/MINERALS/METALS/VITAMINS
• Thiamine B1
  $0.01 (50mg) ELECTROLYTES/MINERALS/METALS/VITAMINS
• Vitamin C
  $0.02 (500mg) ELECTROLYTES/MINERALS/METALS/VITAMINS
• Vitamin D (Aqueous)
  4000u/mL ELECTROLYTES/MINERALS/METALS/VITAMINS
• Vitamin D
  $0.01 (400IU) ELECTROLYTES/MINERALS/METALS/VITAMINS
• Vitamin D2 Ergocalciferol
  $0.21 (50000IU) ELECTROLYTES/MINERALS/METALS/VITAMINS
• Vitamin D3 Cholecalciferol
  $0.01 (10mcg/400IU), $0.01 (25mg) ELECTROLYTES/MINERALS/METALS/VITAMINS
• Folbic (Folic Acid-B6-B12)
  2mg-2.5mg-25mg ELECTROLYTES/MINERALS/METALS/VITAMINS <br>
• VitaPearl Prenatal Multivitamin
  ELECTROLYTES/MINERALS/METALS/VITAMINS <br>
• Sodium Bicarbonate
  $0.01 (650 mg) ELECTROLYTES/MINERALS/METALS/VITAMINS
• GASTROINTESTINAL AGENTS
• Tums (Calcium Carbonate)
  $0.91 (4mg) GASTROINTESTINAL AGENTS Review PPI Guidelines Above
• Maalox (Calcium Carbonate)
  $0.91 (4mg) GASTROINTESTINAL AGENTS Review PPI Guidelines Above
• Esomeprazole (Nexium)
  20mg, 40mg GASTROINTESTINAL AGENTS Do Not Prescribe - Review PPI Guidelines Above Available via DOH - Primary <br>
• Omeprazole
  10mg, $0.04 20mg ER, $0.11 (40mg) GASTROINTESTINAL AGENTS Review PPI Guidelines Above
• Famotidine (Pepcid)
  $0.07 (20mg), $0.37 (40mg) GASTROINTESTINAL AGENTS Available via DOH - Primary
• Ranitidine (Zantac)
  $0.05 (150mg) GASTROINTESTINAL AGENTS Preferred H2RA
• Pantoprazole (Protonix)
  20mg DR, 40mg DR GASTROINTESTINAL AGENTS Preferred PPI - Review PPI Guidelines Above
• Lansoprazole
  15mg DR, 30mg DR GASTROINTESTINAL AGENTS Available via DOH - Primary
• Misoprostol
  $0.35 (100mg), $0.45 (50mg) GASTROINTESTINAL AGENTS
• Dicyclomine
  20mg GASTROINTESTINAL AGENTS
• Docusate sodium (Colace)
  $0.02 (100mg) GASTROINTESTINAL AGENTS
• Senna
  $0.01 (8.6mg) GASTROINTESTINAL AGENTS
• Bisacodyl (Dulcolax)
  $0.01 (5mg), $0.12 (10mg) GASTROINTESTINAL AGENTS
• Miralax (polyethylene glycol)
  $0.01 (5mg), $0.12 (10mg) GASTROINTESTINAL AGENTS
• MoviPrep (polyethylene glycol in 2L, colonoscopy prep)
  $0.12 (10mg), $0.01 (5mg) GASTROINTESTINAL AGENTS
• Erythromycin
  $2.68 (250mg) GASTROINTESTINAL AGENTS Pro-motility
• Meclizine
  $0.05 (12.5mg), 25mg GASTROINTESTINAL AGENTS Available via DOH - Primary
• Ondansetron (Zofran)
  4mg, 8 mg GASTROINTESTINAL AGENTS Available In Clinic - See TS
• Metoclopramide
  5mg, 10mg GASTROINTESTINAL AGENTS
• Simethicone
  $0.01 (80mg) GASTROINTESTINAL AGENTS
• Loperamide
  2mg GASTROINTESTINAL AGENTS
• Prochlorperazine
  5mg, 10mg, 20mg (dose not covered by DOH) GASTROINTESTINAL AGENTS Available via DOH - Primary
• Sucralfate
  1g GASTROINTESTINAL AGENTS Antiulcer
• OPHTHALMIC AGENTS (1mL ~ 20 Drops)
• Artificial Tears Ointment
  $1.61 (0.5oz) OPHTHALMIC AGENTS (1mL ~ 20 Drops) lubricant
• Artificial Tears Drops
  $0.10 (0.5oz) OPHTHALMIC AGENTS (1mL ~ 20 Drops) lubricant
• Artificial Tear (Night-time) Gel
  $1.90 OPHTHALMIC AGENTS (1mL ~ 20 Drops) lubricant
• Azelastine Hydrochloride Solution
  0.05% OPHTHALMIC AGENTS (1mL ~ 20 Drops) Available via DOH - Primary
• Bimatoprost Ophthalmic Solution
  0.03% (2.5mL or 5mL dropper) OPHTHALMIC AGENTS (1mL ~ 20 Drops) Available via DOH - Primary
• Travoprost
  0.004% Solution OPHTHALMIC AGENTS (1mL ~ 20 Drops) Available via DOH - Primary
• Erythromycin Ophthalmic Ointment 0.5%
  $6.39 (3.5 g) OPHTHALMIC AGENTS (1mL ~ 20 Drops) Topical
• Latanoprost 0.005%
  $1.98 (2.5mL) OPHTHALMIC AGENTS (1mL ~ 20 Drops) Preferred
• Olapatadine/Patanol
  $36 (5mL) OPHTHALMIC AGENTS (1mL ~ 20 Drops) Do Not Prescribe - Apply for PDAP Eye Drops
• Visine (Artificial) Tears
  $5.16 (0.5oz) OPHTHALMIC AGENTS (1mL ~ 20 Drops) lubricant
• Timolol maleate 0.5%
  $3.22 (5mL) OPHTHALMIC AGENTS (1mL ~ 20 Drops) pressure-lowering
• Dorzolamide 2%
  $8 (10mL) OPHTHALMIC AGENTS (1mL ~ 20 Drops) pressure-lowering
• Acetazolamide (Diamox) - oral
  $1.88 (250mg) OPHTHALMIC AGENTS (1mL ~ 20 Drops) pressure-lowering
• Prednisolone acetate 1% (Predforte)
  $33 (5mL) OPHTHALMIC AGENTS (1mL ~ 20 Drops) steroid
• Diclofenac 0.1%
  $6 (2.5mL) OPHTHALMIC AGENTS (1mL ~ 20 Drops) NSAID
• Gentamicin
  $4 (5mL) OPHTHALMIC AGENTS (1mL ~ 20 Drops) antibiotic
• Tobramycin
  0.3% solution OPHTHALMIC AGENTS (1mL ~ 20 Drops) Available via DOH - Primary
• Polytrim Ophthalmic Solution (Trimethoprim/Polymyxin B)
  $5 (10mL) OPHTHALMIC AGENTS (1mL ~ 20 Drops) antibiotic
• Neomycin-polymyxin B-gramicidin (Neosporin)
  $42 (10mL) OPHTHALMIC AGENTS (1mL ~ 20 Drops) Do Not Prescribe Without TS Approval antibiotic
• IMMUNOLOGICAL AGENTS
• Azathioprine
  $0.12 (50mg) IMMUNOLOGICAL AGENTS
• Methotrexate
  2.5mg IMMUNOLOGICAL AGENTS Available via DOH - Primary <br>
• Methylprednisolone
  $0.29 (4mg - dose not covered by DOH), 16mg IMMUNOLOGICAL AGENTS Available via DOH - Primary
• Prednisone
  $0.10 (1mg), $0.02 (5mg), $0.12 (10mg), $0.04 (20mg), $0.16 (50mg) IMMUNOLOGICAL AGENTS Available via DOH - Primary
• Hydroxychloroquine (Plaquenil)
  $0.21 (200mg) IMMUNOLOGICAL AGENTS Available via DOH - Primary
• Sulfasalazine
  $0.17 (500mg) IMMUNOLOGICAL AGENTS
• FEMALE GENITOURINARY AGENTS/CONTRACEPTION/
• Ethinyl estradiol w/ Norgestimate (Ortho-Tricyclen)
  $10.08 (28-day pack) FEMALE GENITOURINARY AGENTS/CONTRACEPTION/ Preferred
• Ethinyl estradiol w/ Norethidrone (Ortho-Novum) 1/35
  $16.52 (28-day pack) FEMALE GENITOURINARY AGENTS/CONTRACEPTION/
• Ethinyl estradiol w/ Desogestrel (Ortho-cept)
  $17.64 (28-day pack) FEMALE GENITOURINARY AGENTS/CONTRACEPTION/
• Ethinyl estradiol w/ Levonorgestrel triphasic (Tri-phasil)
  $17.64 (28-day pack) FEMALE GENITOURINARY AGENTS/CONTRACEPTION/
• Ethinyl estradiol w/ Levonorgestrel (Alesse)
  $19.04 (28-day pack) FEMALE GENITOURINARY AGENTS/CONTRACEPTION/
• Norelgestromin/ethinyl estradiol (Ortho-evra, Xulane)
  $99 (Box of 3 patches) FEMALE GENITOURINARY AGENTS/CONTRACEPTION/ Do Not Prescribe - Apply for PDAP
• Copper IUD
  $0 (1 device) FEMALE GENITOURINARY AGENTS/CONTRACEPTION/ Available Free at WHC
• Imvexxy
  4mcg vaginal insert (and starter pack) FEMALE GENITOURINARY AGENTS/CONTRACEPTION/ Available via DOH - Primary
• Liletta Hormonal IUD
  $0 (1 device) FEMALE GENITOURINARY AGENTS/CONTRACEPTION/ Available Free at WHC
• Nexplanon Progestin Implant
  $0 (1 device) FEMALE GENITOURINARY AGENTS/CONTRACEPTION/ Available Free at WHC
• Medroxyprogesterone IM injection (Depo Provera)
  $0 (dose) FEMALE GENITOURINARY AGENTS/CONTRACEPTION/ Available Free at WHC
• Levonorgestrel (Plan B)
  <br> FEMALE GENITOURINARY AGENTS/CONTRACEPTION/
• Estradiol Vaginal Cream
  $108.537 for 30-day supply 0.01% FEMALE GENITOURINARY AGENTS/CONTRACEPTION/ Estrogen
• Estradiol
  0.5mg/24 hr transdermal (twice-weekly) FEMALE GENITOURINARY AGENTS/CONTRACEPTION/ Available via DOH - Primary
• Misoprostol
  $0.35 (100mg), $0.45 (50mg) FEMALE GENITOURINARY AGENTS/CONTRACEPTION/
• Condoms
  $0.23 (5mg) FEMALE GENITOURINARY AGENTS/CONTRACEPTION/
• Medroxyprogesterone 2.5mg tab
  $0.04 (1 tab) FEMALE GENITOURINARY AGENTS/CONTRACEPTION/
• Conjugated Estrogens Vaginal Cream
  $45 () FEMALE GENITOURINARY AGENTS/CONTRACEPTION/ Do Not Prescribe - Apply for PDAP
• MALE GENITOURINARY AGENTS
• Doxazosin
  1mg, 2mg, 4mg (4mg not covered by DOH) MALE GENITOURINARY AGENTS Available via DOH - Primary
• Caverject (Alprostadil)
  $0.23 (5mg) MALE GENITOURINARY AGENTS Do Not Prescribe - Apply for PDAP
• Finasteride
  1 mg, 5mg (5mg not covered by DOH) MALE GENITOURINARY AGENTS Available via DOH - Primary <br>
• Sildenafil (Viagra)
  $0.23 (5mg) MALE GENITOURINARY AGENTS Not Available - Consider Cialis
• Tadalafil (Cialis)
  2.5mg MALE GENITOURINARY AGENTS Available via DOH - Primary
• Tadalafil (Cialis)
  20mg MALE GENITOURINARY AGENTS Do Not Prescribe - Apply for PDAP
• Tamsulosin (Flomax)
  0.4 mg MALE GENITOURINARY AGENTS
• Terazosin
  $0.07 (1mg, 2mg, 5mg) MALE GENITOURINARY AGENTS BPH
• METABOLIC/ENDOCRINE AGENTS
• Alendronate (Flosamax)
  35mg METABOLIC/ENDOCRINE AGENTS
• Risedronate
  150mg METABOLIC/ENDOCRINE AGENTS Available via DOH - Primary
• Allopurinol
  100mg, 300mg METABOLIC/ENDOCRINE AGENTS Available via DOH - Primary
• Ursodiol
  300mg METABOLIC/ENDOCRINE AGENTS Available via DOH - Primary
• SLEEP DISORDER AGENTS
• Doxepin
  10mg, 25mg, 50mg, 100mg SLEEP DISORDER AGENTSAvailable via DOH - Primary <br>
• Zolpidem (Ambien)
  $0.04 (10mg), $0.02 (5mg) SLEEP DISORDER AGENTS
• VACCINES: All Vaccines in IMA cabinet.
• Hepatitis A
  $0.03 (25mg) VACCINES: All Vaccines in IMA cabinet.
• Hepatitis B
  $0.03 (25mg) VACCINES: All Vaccines in IMA cabinet.
• Pneumovax
  $0.03 (25mg) VACCINES: All Vaccines in IMA cabinet.
• Tetanus toxoid
  $0.03 (25mg) VACCINES: All Vaccines in IMA cabinet.
• Diptheria and Tetanus
  $0.03 (25mg) VACCINES: All Vaccines in IMA cabinet.
• Diptheria, Pertussis and Tetanus
  $0.03 (25mg) VACCINES: All Vaccines in IMA cabinet.
• MMR
  $0.03 (25mg) VACCINES: All Vaccines in IMA cabinet.
• Polio
  $0.03 (25mg) VACCINES: All Vaccines in IMA cabinet.
• Meningococcal
  $0.03 (25mg) VACCINES: All Vaccines in IMA cabinet.
• Zoster Vax
  VACCINES: All Vaccines in IMA cabinet. Do Not Prescribe or Administer
• Gardasil
  $0.03 (25mg) VACCINES: All Vaccines in IMA cabinet. Not Available in WHC
• Meningococcal
  $0.03 (25mg) VACCINES: All Vaccines in IMA cabinet.
• Gardasil (HPV)
  $0.03 (25mg) VACCINES: All Vaccines in IMA cabinet.
• THYROIDAL AGENTS
• Levothyroxine
  25mcg, 50mcg, 75mcg, 88mcg, 100mcg, 112mcg, 125mcg, 137mcg, 150mcg, 175mcg, 200mcg THYROIDAL AGENTS Available via DOH - Primary <br>
• Methimazole
  $0.18 (10mg) THYROIDAL AGENTS
• Propylthiouracil
  $0.35 (50mg) THYROIDAL AGENTS
• ALLERGIES
• Diphenhydramine (Benadryl)
  $0.02 (50mg), $0.02 (25mg) ALLERGIES First generation anti-histamine
• Loratadine (Claritin)
  $0.05 (10mg) ALLERGIES Second generation anti-histamine
• Cetirizine (Zyrtec)
  10mg ALLERGIES Available via DOH - Primary
• Isotonic Saline Spray 0.65% 45mL
  $0.59 () ALLERGIES Sprays
• Beclomethasone Nasal (Beconase AQ)
  $0.59 () ALLERGIES Do Not Prescribe - Apply for PDAP Sprays
• Fluticasone Nasal Spray (Flonase)
  $3.55 () ALLERGIES Sprays
• Hydroxyzine
  $0.12 (10mg - dose not covered by DOH), $0.07 (25mg), $0.15 (50mg) ALLERGIES Available via DOH - Primary
• Epipen
  ALLERGIES Check First with TS Available In Clinic - See TS $150 (Dual Pack)
• Fexofenadine Hydrochloride
  180mg ALLERGIES Available via DOH - Primary
• Levocetirizine
  5mg ALLERGIES Available via DOH - Primary
• DERMATOLOGY
• Minocycline
  75mg DERMATOLOGY <br>
• Hydrocortisone 1% Cream
  $1.21 (30g) DERMATOLOGY Mild potency
• Hydrocortisone 2.5% Cream
  $2.89 (30g) DERMATOLOGY Mild potency
• Hydrocortisone 0.5% Ointment
  $2.76 (30g) DERMATOLOGY Mild potency
• Hydrocortisone 1% Ointment
  $0.76 (30g) DERMATOLOGY Mild potency
• Triamcinolone Acetonide (TAC)
  $0.10 (0.025% cream), 0.1% Topical Cream (cream covered by DOH) DERMATOLOGY Check First with TS Moderate potency
• Mometasone Furoate 0.1% cream 45gm
  $7.25 () DERMATOLOGY Moderate potency
• Betamethasone 0.1%
  $2.74 (15g) DERMATOLOGY Moderate potency
• Clobetasol Cream
  0.05% DERMATOLOGY Do Not Prescribe High potency Available via DOH - Primary
• Fluocinonide (Lidex)
  0.05% Topical Gel, Topical Ointment, Topical Solution DERMATOLOGY Check First with TS Available via DOH - Primary
• BenzaClin Gel
  $380 () DERMATOLOGY Do Not Prescribe
• Dovonex
  $204 DERMATOLOGY Do Not Prescribe Topical
• Metrogel
  $89 DERMATOLOGY Do Not Prescribe Topical
• Neomycin-polymyxin B-dexamethasone (Maxitrol)
  $13 (5mL) DERMATOLOGY antibiotic+steroid
• Acyclovir - oral
  $7 (200mg, 400mg tablets) DERMATOLOGY Available via DOH - Primary
• Atropine sulfate 1%
  $25 (15mL) DERMATOLOGY cycloplegic+mydriatic
• Olopatadine 0.1%
  <br> DERMATOLOGY
• Tretinoin
  0.05% Topical Gel, 0.1% Topical Cream DERMATOLOGY Available via DOH - Primary
• ANTITUSSIVES
• Benzonatate
  200mg Capsule ANTITUSSIVES Available via DOH - Primary
• Hormone Replacement Therapy
• Testosterone topical gel
• Testosterone topical solution
• Testosterone Enanthate
  5ml vial $60.66 Hormone Replacement Therapy Do not Prescribe Without Pharm Chair Approval
• Depo-Testosterone (testosterone cypionate injection)
  Hormone Replacement Therapy Do Not Prescribe - Apply for PDAP
• Spironolactone
  25mg, 50mg, 100mg Hormone Replacement Therapy Available via DOH - Primary