COBORN’S PHARMACY Coborn’s Pharmacy $4 GENERIC MEDICATION FORMULARY
COBORN’S PHARMACY Coborn’s Pharmacy $4 GENERIC MEDICATION FORMULARY Coborn’s Pharmacy’s $4 generic medication formulary is sorted by medical condition. Generic Drug Name / Strength Form 30-day quantity $4.00 90-day quantity $10.00 30-day quantity $9.00 90-day quantity $24.00 Allergy, Cough, and Cold Albuterol 2mg/5ml Albuterol Sulfate Nebulizer 0.083% Syrup Solution 120 - 360 - Ipratropium Bromide Nebulizer 0.02% Solution - - Loratadine 10mg Promethazine 6.25mg/5ml Antibiotics Amoxicillin 400mg/5ml Cephalexin 250mg Cephalexin 500mg Ciprofloxacin 250mg Ciprofloxacin 500mg Isoniazid 300mg Penicillin VK 125mg/5ml Penicillin VK 125mg/5ml Penicillin VK 250mg/5ml Penicillin VK 250mg SMZ/TMP 400-80mg SMZ/TMP DS 800-160mg Antifungal Fluconazole 150mg Terbinafine 250mg Antiviral Acyclovir 200mg Arthritis and Pain Allopurinol 100mg Allopurinol 300mg Baclofen 10mg Cyclobenzaprine 5mg Cyclobenzaprine 10mg Dexamethasone 0.5mg Dexamethasone 0.75mg Dexamethasone 4mg Ibuprofen 100mg/5ml Ibuprofen 400mg Ibuprofen 600mg Ibuprofen 800mg Indomethacin 25mg Meloxicam 7.5mg Meloxicam 15mg Naproxen 375mg Naproxen 500mg Cholesterol Lovastatin 10mg Lovastatin 20mg Tablet Syrup 30 120 90 360 75 (25 vials) 75 (30 vials) - 225 (75 vials) 225 (90 vials) - Suspension Capsule Capsule Tablet Tablet Tablet Suspension Suspension Suspension Tablet Tablet Tablet 28 30 14 20 30 100 200 100 28 28 20 84 90 42 60 90 300 600 300 84 84 60 100 - 300 - Tablet Tablet 1 - 3 - 30 90 Capsule 30 90 - - Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Suspension Tablet Tablet Tablet Capsule Tablet Tablet Tablet Tablet 30 30 30 12 6 90 60 30 30 30 - 90 90 90 36 18 270 180 90 90 90 - 30 30 30 120 60 60 60 90 90 90 360 180 180 180 Tablet Tablet - - 30 30 90 90 The Coborn’s Pharmacy $4 and $10 Generic Medication Program covers up to the quantity specified for each eligible drug. Most quantities are based on a course of therapy at commonly prescribed dosages. Prices for greater than the specified quantity are prorated based on the $4 and $10 prescription program price. List may change and vary at any given time. Coborn’s Pharmacy Program reserves the right to modify or discontinue this program and its terms and conditions at any time without notice. See your Coborn’s Pharmacist for details. 11.07.2014 COBORN’S PHARMACY Diabetes Chlorpropamide 100mg Glimepiride 1mg Glimepiride 2mg Glimepiride 4mg Glipizide 5mg Glipizide 10mg Glyburide 2.5mg Glyburide 5mg Glyburide MCR 3mg Glyburide MCR 6mg Metformin 500mg ER Metformin 500mg Metformin 850mg Metformin 1000mg Eye and Ear Polymixin/TMP Timolol Maleate 0.25% Timolol Maleate 0.5% Gastrointestinal Health Belladonna ALK/PG 16.2mg Cimetidine 800mg Metoclopramide 5mg/5ml Metoclopramide 10mg Oxybutynin 5mg Phenazopyridine 100mg Promethazine 25mg Ranitidine 150mg Ranitidine 300mg Heart Health Amiloride/HCTZ 5-50mg Atenolol 25 mg Atenolol 50mg Atenolol 100mg Atenolol/Chlorthalidone 50-25mg Atenolol/Chlorthalidone 100-25mg Benazepril 5mg Benazepril 10mg Benazepril 20mg Benazepril 40mg Bisoprolol/HCTZ 2.5-6.25mg Bisoprolol/HCTZ 5-6.25mg Bisoprolol/HCTZ 10-6.25mg Carvedilol 3.125mg Carvedilol 6.25mg Carvedilol 12.5mg Carvedilol 25mg Clonidine 0.1mg Clonidine 0.2mg Diltiazem 30mg Diltiazem 60mg Diltiazem 90mg Diltiazem 120mg Enalapril 2.5mg Enalapril 5mg Enalapril 10mg Enalapril 20mg Enalapril/HCTZ 5-12.5mg Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet 30 30 30 30 30 30 60 60 - 90 90 90 90 90 60 180 180 - 30 60 30 30 60 60 90 180 90 90 180 180 Solution Opthalmic Drop Opthalmic Drop 5 - 15 - 10 5 30 15 Tablet Tablet Syrup Tablet Tablet Tablet Tablet Tablet Tablet 60 60 6 60 30 180 180 18 180 90 60 30 30 12 - 180 90 90 36 - Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet 30 30 30 30 30 30 30 30 30 30 60 60 60 60 30 30 60 60 30 30 30 30 90 90 90 90 90 90 90 90 90 90 180 180 180 180 90 90 180 180 90 90 90 90 30 30 30 60 30 30 - 90 90 90 180 90 90 - The Coborn’s Pharmacy $4 and $10 Generic Medication Program covers up to the quantity specified for each eligible drug. Most quantities are based on a course of therapy at commonly prescribed dosages. Prices for greater than the specified quantity are prorated based on the $4 and $10 prescription program price. List may change and vary at any given time. Coborn’s Pharmacy Program reserves the right to modify or discontinue this program and its terms and conditions at any time without notice. See your Coborn’s Pharmacist for details. 11.07.2014 COBORN’S PHARMACY Heart Health…..continued Furosemide 20mg Furosemide 40mg Furosemide 80mg Guanfacine 1mg Hydralazine 10mg Hydralazine 25mg Hydrochlorothiazide 12.5mg Hydrochlorothiazide 25mg Hydrochlorothiazide 50mg Indapamide 1.25mg Indapamide 2.5mg Isosorbide Mono ER 30mg Isosorbide Mono ER 60mg Lisinopril 2.5mg Lisinopril 5mg Lisinopril 10mg Lisinopril 20mg Lisinopril/HCTZ 10-12.5mg Lisinopril/HCTZ 20-12.5mg Lisinopril/HCTZ 20-25mg Methyldopa 250mg Metoprolol Tartrate 25mg Metoprolol Tartrate 50mg Metoprolol Tartrate 100mg Propranolol 10mg Propranolol 20mg Propranolol 40mg Propranolol 80mg Sotalol HCL 80mg Spironolactone 25mg Terozosin 1mg Terazosin 2mg Terazosin 5mg Terazosin 10mg Triamterene/HCTZ 37.5-25mg Triamterene/HCTZ 75-50mg Verapamil 80mg Verapamil 120mg Warfarin 1mg Warfarin 2mg Warfarin 2.5mg Warfarin 3mg Warfarin 4mg Warfarin 5mg Warfarin 6mg Warfarin 7.5mg Warfarin 10mg Mental Health Amitriptyline 10mg Amitriptyline 25mg Benztropine 2mg Buspirone 5mg Buspirone 10mg Citalopram 20mg Citalopram 40mg Fluoxetine 10mg Fluoxetine 10mg Fluoxetine 20mg Tablet Tablet Tablet Tablet Tablet Tablet Capsule Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Capsule Capsule Capsule Capsule Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet 30 30 30 30 30 30 30 30 30 30 30 30 30 60 60 60 60 60 60 30 30 30 30 30 30 30 30 30 30 30 30 30 30 90 90 90 90 90 90 90 90 90 90 90 90 90 180 180 180 180 180 180 90 90 90 90 90 90 90 90 90 90 90 90 90 90 30 30 30 30 30 30 30 60 60 30 30 30 30 30 - 90 90 90 90 90 90 90 180 180 90 90 90 90 90 - Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Capsule Capsule 30 60 30 30 30 30 90 180 90 90 90 90 30 30 60 30 - 90 90 180 90 - The Coborn’s Pharmacy $4 and $10 Generic Medication Program covers up to the quantity specified for each eligible drug. Most quantities are based on a course of therapy at commonly prescribed dosages. Prices for greater than the specified quantity are prorated based on the $4 and $10 prescription program price. List may change and vary at any given time. Coborn’s Pharmacy Program reserves the right to modify or discontinue this program and its terms and conditions at any time without notice. See your Coborn’s Pharmacist for details. 11.07.2014 COBORN’S PHARMACY Mental Health…..continued Fluphenazine 1mg Haloperidal 0.5mg Haloperidal 1mg Lithium Carbonate 300mg Nortriptylin 10mg Nortriptylin 25mg Paroxetine 10mg Paroxetine 20mg Prochlorperazine 10mg Trazodone 50mg Trazodone 100mg Trazodone 150mg Trihexyphenidyl 2mg Other Chlorhexidine Gluconate 0.12% Lidocaine Viscous 2% Prednisone 2.5mg Prednisone 5mg Prednisone 10mg Skin Conditions Gentamicin 0.1% Gentamicin 0.1% Hydrocortisone 1% Hydrocortisone 2.5% Triamcinolone 0.025% Triamcinolone 0.025% Triamcinolone 0.1% Vitamins and Supplements Folic Acid 1mg Mag 64 64mg Magnesium Oxide 400mg Prenatal RX Sodium Fluoride Chewable 0.25mg Sodium Fluoride Chewable 0.5mg Women’s Health Estradiol 0.5mg Estradiol 1mg Estradiol 2mg Medroxyprogesterone 2.5mg Medroxyprogesterone 5mg Medroxyprogesterone 10mg Megesterol 20mg Tablet Tablet Tablet Capsule Capsule Capsule Tablet Tablet Tablet Tablet Tablet Tablet Tablet 30 30 30 30 30 30 30 60 90 90 90 90 90 90 90 180 90 30 30 30 30 - 270 90 90 90 90 - Solution Solution Tablet Tablet Tablet 473 100 30 30 - 1419 300 90 90 - 30 90 Cream Ointment Cream Cream Cream Cream Ointment 15 15 - 45 45 - 30 30 15 80 15 90 90 45 240 45 Tablet Tablet Tablet Tablet Tablet Tablet 30 30 - 90 N/A - 60 30 120 120 180 90 N/A N/A Tablet Tablet Tablet Tablet Tablet Tablet Tablet 30 30 30 30 30 10 - 90 90 90 90 90 30 - 30 90 The Coborn’s Pharmacy $4 and $10 Generic Medication Program covers up to the quantity specified for each eligible drug. Most quantities are based on a course of therapy at commonly prescribed dosages. Prices for greater than the specified quantity are prorated based on the $4 and $10 prescription program price. List may change and vary at any given time. Coborn’s Pharmacy Program reserves the right to modify or discontinue this program and its terms and conditions at any time without notice. See your Coborn’s Pharmacist for details. 11.07.2014
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