List. * Brand Diabetes Levemir 100 units/ml Vial 10mL $122.29 Levemir FlexPen 100 units/ml 15mL $203.03 NovoLog 100 units/ml Vial 10mL $116.84 NovoLog FlexPen Syringe 15mL $222.41 NovoLog 100 units/ml Cartridge 15mL $214.04 NovoLog Mix 70-30 Vial 10mL $121.07 NovoLog Mix 70-30 FlexPen Syringe 15mL $222.41 Victoza 2 pk., 18mg/3mL ea. Pen 6mL $311.44 Victoza 3 pk., 18mg/3mL ea. Pen 9mL $465.42 Generic Diabetes Glipizide ER 2.5mg Tablet 30 $11.87 Metformin ER 750mg Tablet 60 $11.87 Glipizide/Metformin 2.5-250mg Tablet 60 $11.87 Glipizide/Metformin 5-500mg Tablet 60 $11.87 Glipizide/Metformin 1.25-250mg Tablet 60 $11.87 Glipizide/Metformin 2.5-500mg Tablet 60 $11.87 Brand Heart Health CRESTOR 10mg Tablet 30 $115.03 CRESTOR 20mg Tablet 30 $115.03 CRESTOR 40mg Tablet 30 $115.03 CRESTOR 5mg Tablet 30 $115.03 Generic Heart Health Losartan 25mg Tablet 30 $11.87 Losartan 50mg Tablet 30 $11.87 Losartan 100mg Tablet 30 $11.87 Losartan/HCT 50/12.5mg Tablet 30 $11.87 Losartan/HCT 100/12.5mg Tablet 30 $11.87 Losartan/HCT 100/25mg Tablet 30 $11.87 Atorvastatin 10mg Tablet 30 $11.87 Atorvastatin 20mg Tablet 30 $11.87 Atorvastatin 40mg Tablet 30 $11.87 s valid as of 6/22/2013 Atorvastatin 80mg Tablet 30 $11.87 Clopidogrel 75mg Tablet 30 $11.87 Brand Devices and Supplies TRUEresult Blood Glucose System 1 ct. Free TRUEtest Glucose Test Strips 50 ct. $19.33 TRUEtest Glucose Test Strips 100 ct. $35.19 OptiChamber Advantage Small Mask OptiChamber Advantage Medium Mask 1 ct. $14.90 1 ct. $14.90 OptiChamber Advantage 1 ct. $8.53 Brand OTC Mucinex D Extended Relief Tablet 18 $11.46 Mucinex D Extended Relief Tablet 24 $20.11 Delsym 30mg/5mL 5 oz. $9.76 Brand Gastrointestinal Nexium 10mg Packet 30 $152.86 Nexium 20mg Packet 30 $152.86 Nexium 2.5mg Packet 30 $152.86 Nexium 40mg Packet 30 $152.86 Nexium 5mg Packet 30 $152.86 Nexium 20mg Capsule 30 $152.86 Nexium 40mg Capsule 30 $152.86 Vimovo 375-20mg Tablet 60 $89.56 Vimovo 500-20mg Tablet 60 $89.56 Generic Gastrointestinal Polyeth Glycol 3350 Powder 255 $11.87 Polyeth Glycol 3350 Powder 527 $11.87 * program discount also applies to cash purchases of select over-the-counter items ** program discounts apply only to listed prescriptions. Discounts available only state/federal government health care program. s on List include discounts
List. * Generic Gastrointestinal (continued) Diphenoxylate/Atropine 2.5-.025mg Tablet 30 $11.87 Loperamide 2mg Capsule 60 $11.87 Hyoscyamine 0.125mg Tablet 30 $11.87 Hyoscyamine Sublingal 0.125mg Tablet 30 $11.87 Hyoscyamine ER 0.375mg Tablet 30 $11.87 Glycopyrrolate 1mg Tablet 60 $11.87 Glycopyrrol 2mg Tablet 60 $11.87 Chlordiazepoxide/Clidinium 5-2.5mg Capsule 30 $11.87 Ranitidine 75mg/5mL Syrup 120 $11.87 Lansoprazole 15mg Capsule 30 $11.87 Lansoprazole 30mg Capsule 30 $11.87 Omeprazole 10mg Capsule 30 $11.87 Omeprazole 20mg Capsule 30 $11.87 Omeprazole 40mg Capsule 30 $11.87 Pantoprazole 20mg Tablet 30 $11.87 Pantoprazole 40mg Tablet 30 $11.87 Sucralfate 1mg Tablet 60 $11.87 Meclizine 12.5mg Tablet 30 $11.87 Meclizine 25mg Tablet 30 $11.87 Ursodiol 300mg Capsule 60 $11.87 Generic Allergy Products Montelukast 4mg Chew 30 $11.87 Montelukast 5mg Tablet 30 $11.87 Montelukast 10mg Tablet 30 $11.87 Brand Asthma-COPD Symbicort 160-4.5mcg Inhaler 1 ct. $227.25 Symbicort 80-4.5mcg Inhaler 1 ct. $199.26 Pulmicort 180mcg FLEXHALER 1 ct. $156.01 Pulmicort 90mcg FLEXHALER 1 ct. $117.40 Generic Cough-Cold-Allergy Amoxicillin 875mg Tablet 20 $11.87 500-125mg Tablet 20 $11.87 s valid as of 6/22/2013 875-125mg Tablet 20 $11.87 200mg/5mL 200mg/5mL 100 $11.87 50 $11.87 100 $11.87 125 $11.87 200 $11.87 Cephalexin 125mg/5mL 100 $11.87 Cephalexin 125mg/5mL 200 $11.87 Cephalexin 250mg/5mL 100 $11.87 Cephalexin 250mg/5mL 200 $11.87 Azithromycin 250mg Tablet 6 $11.87 Azithromycin 500mg Tablet 3 $11.87 Azithromycin 100mg/5mL 15 $11.87 Azithromycin 200mg/5mL 15 $11.87 Azithromycin 200mg/5mL 23 $11.87 Azithromycin 200mg/5mL 30 $11.87 * program discount also applies to cash purchases of select over-the-counter items ** program discounts apply only to listed prescriptions. Discounts available only state/federal government health care program. s on List include discounts
List. * Generic Cough-Cold-Allergy (continued) Clarithromycin 250mg Tablet 20 $11.87 Clarithromycin 500mg Tablet 20 $11.87 Minocycline 50mg Capsule 30 $11.87 Minocycline 100mg Capsule 30 $11.87 Levofloxacin 250mg Tablet 10 $11.87 Levofloxacin 500mg Tablet 10 $11.87 Levofloxacin 750mg Tablet 10 $11.87 Cetirizine 1mg/mL Syrup 120 $11.87 Levocetirizine 5mg Tablet 30 $11.87 Loratadine 5mg/5mL Syrup 120 $11.87 Hydroxyzine HCL 10mg Tablet 60 $11.87 Hydroxyzine HCL 25mg Tablet 60 $11.87 Hydroxyzine HCL 50mg Tablet 60 $11.87 Hydroxyzine HCL 10mg/5mL Solution 120 $11.87 Hydroxyzine PAM 25mg Capsule 60 $11.87 Hydroxyzine PAM 50mg Capsule 60 $11.87 Ciprofloxacn Opthalmic 0.3% Solution 5 $11.87 Gentak Opthalmic 0.3% Ointment 4 $11.87 Ofloxacin Opthalmic 0.3% Solution 5 $11.87 Neo/Poly/Hc Otic 1% 10 $11.87 Neo/Poly/Hc Otic 1% Solution 10 $11.87 Prednisolone 15mg/5mL Syrup 30 $11.87 Prednisolone 15mg/5mL Solution 30 $11.87 Prednisolone 6.7mg/5mL Liquid 30 $11.87 Brand Other CAMBIA 50mg Powder Packet 9 pk. $156.05 Natroba 0.9% Topical 120mL $137.09 Eye Care Alphagan P 0.1% Eye Drops 5mL $81.76 Alphagan P 0.1% Eye Drops 10mL $159.94 Alphagan P 0.1% Eye Drops 15mL $238.19 Combigan Eye Drops 5mL $87.88 Combigan Eye Drops 10mL $172.28 s valid as of 6/22/2013 LUMIGAN 0.03% Eye Drops 2.5mL $90.78 LUMIGAN 0.03% Eye Drops 5mL $177.99 LUMIGAN 0.03% Eye Drops 7.5mL $265.23 LUMIGAN 0.01% Eye Drops 2.5mL $97.77 LUMIGAN 0.01% Eye Drops 5mL $191.95 LUMIGAN 0.01% Eye Drops 7.5mL $286.16 RESTASIS 0.05% Eye Emulsion 30 udv 144.00 RESTASIS 0.05% Eye Emulsion 60 udv $288.00 Generic Mental Wellness Bupropion SR 100mg Tablet 60 $11.87 Bupropion SR 150mg Tablet 60 $11.87 Bupropion SR 200mg Tablet 60 $11.87 Bupropion XL 150mg Tablet 30 $11.87 Bupropion XL 300mg Tablet 30 $11.87 Carbidopa-Levodopa 25-100mg Tablet 90 $11.87 Carbidopa-Levodopa 25-250mg Tablet 90 $11.87 Carbamazepine 100mg Chew 90 $11.87 Divalproex 125mg Capsule 90 $11.87 Divalproex EC 125mg Tablet 90 $11.87 Divalproex EC 250mg Tablet 90 $11.87 Divalproex EC 500mg Tablet 90 $11.87 Divalproex ER 250mg Tablet 30 $11.87 Divalproex ER 500mg Tablet 30 $11.87 Donepezil HCL 5mg Tablet 30 $11.87 Donepezil HCL 10mg Tablet 30 $11.87 Escitalopram 5mg Tablet 30 $11.87 Escitalopram 10mg Tablet 30 $11.87 Escitalopram 20mg Tablet 30 $11.87 Gabapentin 100mg Capsule 90 $11.87 * program discount also applies to cash purchases of select over-the-counter items ** program discounts apply only to listed prescriptions. Discounts available only state/federal government health care program. s on List include discounts
List. * Generic Mental Wellness (continued) Gabapentin 300mg Capsule 90 $11.87 Gabapentin 400mg Capsule 90 $11.87 Lamotrigine 25mg Tablet 60 $11.87 Lamotrigine 100mg Tablet 60 $11.87 Lamotrigine 150mg Tablet 60 $11.87 Lamotrigine 200mg Tablet 60 $11.87 Levetiracetam 250mg Tablet 60 $11.87 Levetiracetam 500mg Tablet 60 $11.87 Levetiracetam 750mg Tablet 60 $11.87 Levetiracetam 1000mg Tablet 60 $11.87 Levetiracetam 100mg/mL Solution 240 $11.87 Olanzapine 2.5mg Tablet 30 $11.87 Olanzapine 5mg Tablet 30 $11.87 Olanzapine 7.5mg Tablet 30 $11.87 Olanzapine 10mg Tablet 30 $11.87 Olanzapine 15mg Tablet 30 $11.87 Olanzapine 20mg Tablet 30 $11.87 Pramipexole 0.125mg Tablet 60 $11.87 Pramipexole 0.25mg Tablet 60 $11.87 Pramipexole 0.5mg Tablet 60 $11.87 Pramipexole 1mg Tablet 60 $11.87 Pramipexole 1.5mg Tablet 60 $11.87 Quetiapine 25mg Tablet 30 $11.87 Quetiapine 50mg Tablet 30 $11.87 Quetiapine 100mg Tablet 30 $11.87 Quetiapine 200mg Tablet 30 $11.87 Quetiapine 300mg Tablet 30 $11.87 Risperidone 0.25mg Tablet 60 $11.87 Risperidone 0.5mg Tablet 60 $11.87 Risperidone 1mg Tablet 60 $11.87 Risperidone 2mg Tablet 60 $11.87 Risperidone 3mg Tablet 60 $11.87 Risperidone 4mg Tablet 60 $11.87 Risperidone 0.5mg ODT 60 $11.87 Risperidone 1mg ODT 60 $11.87 s valid as of 6/22/2013 Risperidone 2mg ODT 60 $11.87 Risperidone 1mg/mL Solution 30 $11.87 Topiramate 25mg Tablet 60 $11.87 Topiramate 50mg Tablet 60 $11.87 Topiramate 100mg Tablet 60 $11.87 Topiramate 200mg Tablet 60 $11.87 Venlafaxine 37.5mg Tablet 60 $11.87 Venlafaxine 75mg Tablet 60 $11.87 Venlafaxine 100mg Tablet 60 $11.87 Venlafaxine HCL ER 37.5mg Capsule 30 $11.87 Venlafaxine HCL ER 75mg Capsule 30 $11.87 Venlafaxine HCL ER 150mg Capsule 30 $11.87 Generic Oncology & Oncology Support Levofloxacin 250mg Tablet 10 $11.87 Levofloxacin 500mg Tablet 10 $11.87 Levofloxacin 750mg Tablet 10 $11.87 Ketoconazole 200mg Tablet 20 $11.87 Fluconazole 100mg Tablet 10 $11.87 Fluconazole 200mg Tablet 10 $11.87 Fluconazole 10mg/mL 35mL $11.87 Acyclovir 400mg Tablet 30 $11.87 Acyclovir 800mg Tablet 30 $11.87 Valacyclovir 500mg Tablet 20 $11.87 Valacyclovir 1gm Tablet 10 $11.87 Mercaptopurine 50mg Tablet 25 $11.87 Bicalutamide 50mg Tablet 30 $11.87 Anastrozole 1mg Tablet 30 $11.87 Letrozole 2.5mg Tablet 30 $11.87 Megestrol 40mg Tablet 60 $11.87 * program discount also applies to cash purchases of select over-the-counter items ** program discounts apply only to listed prescriptions. Discounts available only state/federal government health care program. s on List include discounts
List. * Generic Oncology & Oncology Support (cont.) Megestrol 40mg/mL 240mL $11.87 Ondansetron 4mg ODT 30 $11.87 Ondansetron 8mg ODT 10 $11.87 Ondansetron 4mg Tablet 30 $11.87 Ondansetron 8mg Tablet 30 $11.87 Generic Women s Health Estropipate 0.75mg Tablet 30 $11.87 Norethindrone 5mg Tablet 30 $11.87 Liothyronine 5mcg Tablet 30 $11.87 Liothyronine 25mcg Tablet 30 $11.87 Methimazole 5mg Tablet 30 $11.87 Methimazole 10mg Tablet 30 $11.87 Ibandronate 150mg Tablet 1 $11.87 Metronidazole Vaginal Gel 0.75% 70 $11.87 Terconazole Vaginal Cream 0.40% 45 $11.87 Terconazole Vaginal Cream 0.80% 20 $11.87 Oral Contraceptives Camila Tablet 28 $11.87 Errin Tablet 28 $11.87 Reclipsen Tablet 28 $11.87 Syeda Tablet 28 $11.87 Kelnor Tablet 28 $11.87 Aviane Tablet 28 $11.87 Altavera Tablet 28 $11.87 Nortrel Tablet 0.5 / 35 28 $11.87 Nortrel Tablet 1 / 35 28 $11.87 Microgestin Tablet 1 / 20 21 $11.87 Microgestin Tablet 1.5 / 30 21 $11.87 Cryselle-28 Tablet 1 / 20 28 $11.87 Microgestin FE Tablet 1.5 / 30 28 $11.87 Microgestin FE Tablet 28 $11.87 Enpresse-28 Tablet 28 $11.87 Nortrel 7/7/7 Tablet 28 $11.87 Generic Skin Care Myorisan (isotretinoin) 10mg 30 $96.90 Myorisan (isotretinoin) 20mg 30 $114.90 Myorisan (isotretinoin) 40mg 30 $135.00 * program discount also applies to cash purchases of select over-the-counter items ** program discounts apply only to listed prescriptions. Discounts available only state/federal government health care program. s on List include discounts s valid as of 6/22/2013