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Pharmacy Instructions & Formulary
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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