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