FOX ARMY HEALTH CENTER

PHARMACY FORMULARY REFERENCE

HOURS OF OPERATION:

Monday thru Friday 7:30am – 4:30pm

CLOSED VARYING FIRST Thursdays of the month at 11:30 for training

Please check website for Live Wait-Time Tracker:

www.redstone.amedd.army.mil

FY17 Holiday and Training Closure Schedule on last page

ORDER REFILLS AHEAD OF TIME BY:

Phone: 256-955-8888 ext. 1023 or 256-842-7337

or 800-223-9531 or

Online: www.redstone.amedd.army.mil

This FORMULARY can also be found on line at

www.redstone.amedd.army.mil

Medications or their equivalent removed from the FAHC formulary

Cyclosporine Ophthalmic (Restasis); Azelaic acid 15% (Finacea) GEL;

Esomeprazole (Nexium)

Over 100 New Items ADDED this year!

Suzette Baker, RPh, BS, Pharm

CHIEF, PHARMACY SERVICE

REDSTONE ARSENAL, AL 35809-7000

JULY 2017

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FOREWARD This guide is published for the use of the customers of Fox Army Health Center. It is intended as an

aid to understanding the services available at Fox Army Health Center’s Pharmacy and is not an official publication of this organization of the Department of the Army. While we have attempted

to provide information representative of the questions most often asked by our customers, this guide does not pretend to be all inclusive or exclusive to services offered. Specific questions should

be directed to the pharmacy staff.

GENERAL INFORMATION

AR 40-3 requires that medical care and services be provided only to eligible beneficiaries. The

military I.D. card is a tool that helps us meet this requirement. Medication will not be issued for a patient who is over the age of 10 years unless a valid military I.D. card (or a

paper photocopy of the front and back of the ID Card) for that patient is presented to pharmacy services. (Electronic devices with pictures of ID Card are not accepted.)

TELEPHONE NUMBERS:

Outpatient pharmacy: (256) 955-8888 ext. # 1701

Automated phone-in refill system: (256) 842-7337 or 1-800-223-9531 or (256) 955-8888 ext 1023 On-line refill requests: www.redstone.amedd.army.mil

GENERAL DISPENSING POLICIES

Maintenance medications: A 90 day supply may be dispensed at one time of maintenance medications. The prescription with refills can be filled up to a 12 month period for NON-controlled drugs. For Narcotics and Scheduled III-V Controlled Substances: a maximum of a 30 day supply may be prescribed with 5 refills for a total of six months. Schedule II drugs may be written for a maximum of a one month supply and are NOT refillable. Narcotic prescription refills may be filled no sooner than two (2) days prior to actual due date of refill prescription (28 days from the date it was last picked up). Exception: Ritalin, Adderall, & Concerta (or equivalents) may be given up to a 90-day supply for Attention Deficit Disorder and No Refills.

Electronically transmitted prescriptions from providers are not filled until the patient presents to pharmacy, pulls appropriate category service ticket and requests the new prescription. Narcotic prescriptions must be hand-carried with original signature of prescriber (electronic submission not accepted). Prescriptions expire after ONE year from the original date it was written for most medications; controlled substances prescriptions expire SIX months from the original date written. Please properly dispose of all unused medications using these timelines. FAHC follows dispensing policy outlined by ASD (HA) policies and Tri-Care and will substitute generics whenever available.

FORMULARY INDEX Therapeutic Category – page # Therapeutic Category – page#

Alzheimers/Dementia - 4

Analgesics/NSAIDS/Opioids - 4

Anti-Anxiety - 4

Anti-Coagulants/Blood Thinner (Circulation) - 4

Anti-Convulsants (Epilepsy,Parkinsons) – 5

Anti-Depressants / Bipolar - 5

Anti-Histamine/Decongestant/Cough- 5,6

Nasal Sprays and Rinses - 6

Anti-Microbials(Antibiotics/Bacteria/ Fungal/ Parasitic/Viral)-6,7

Asthma/Bronchodilators/COPD (Respiratory)-7

Attention Deficit/Narcolepsy–7

Attention Deficit/Non-Stimulants-7

Cholesterol/Lipid Lowering - 8

Contraceptives (Birth Control)- 8,9 Corticosteroids – Oral - 9

Dental Agents - 9

Diabetic Agents & Supplies – 9,10

Diuretic (Fluid Retension) - 10

Electrolyte Replacement - 10 Emergency Meds(Insect Sting/Contraception/Substance Abuse)10

Erectile Dysfunction - 10

Ear Care (Otic Preparations) - 10

Eye Care (Antibiotics/Antivirals) - 10

Eye Care – Other 11

Fertility - 11

Gastro-IntestinalAgents(Acid Reflux/Heartburn) - 11 G-I Agents Other (GI Prep kits/IBS/Gall Bladder/etc) -11,12 Genito-Urinary Agents (Bladder/Prostate) -12

Gout Agents - 12

Hormones (Estrogen/Progestin/Testosterone) – 12

Hypertensive/Cardiac (Blood Pressure/Heart)-13,14

Immunologic/Biologic(RA/Psoriasis/Crohn’s) – 14

Migraine Agents – 14

Multiple Sclerosis Agent- 14

Muscle Relaxants - 14

Myesthenia Gravis - 14

Nausea/Vomiting - 14 Neurological Agent (Nerve Pain/Restless Leg) - 14

Oncology/Cancer - 15

Osteoporosis/Bone Loss - 15

Prostate Medication - 15

Psychiatrics - 15

Sedative Hypnotics (Sleep Aids) - 15

Substance Abuse - 15

Thyroid/Antithyroid Agents - 16

Topical Agents - 16,17

Vaginal Preparations - 17

Vitamins and Minerals - 17

FAHC follows dispensing policy outlined by ASD (HA) policies and Tri-Care and

will substitute generics whenever available.

*Dye-free products are not stocked and are not available for order at this pharmacy*

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Alzheimers / Dementia

Donepezil (Aricept equiv) 5mg;10mg tablets

Memantine (Namenda equiv) immediate release tablets only – 5mg & 10mg (excludes Namenda XR)

Rivastigmine patch (Exelon equiv) 4.6mg/24 hrs; 9.5mg/24 hrs; 13.3mg/24 hrs

ANALGESICS / ANTI-INFLAMMATORY / OPIOIDS

Acetaminophen 325mg tabs (Tylenol equiv)

Acetaminophen elixir for Children (Tylenol Elixir equiv) 160mg/5ml

Acetaminophen w/Codeine elixir (Tylenol w/Codeine Elixir equiv) 120mg/12mg per 5mls *controlled substance**

Acetaminophen w/codeine #3 (Tylenol#3 equiv) 300mg/30mg tablet *controlled substance*

Analpram HC (pramoxine/ 1%/HC 2.5%) cream

Arthrotec equiv (diclofenac/misoprostol) 75/200mg tablet

Aspirin (enteric coated and chewable) 81mg tabs; 325mg enteric-coated tabs

Celecoxib (Celebrex equiv) 100mg; 200mg caps

Diclofenac (Voltaren, Voltaren DR equiv) 75mg delayed-release tabs, 50mg immediate release tabs

Etodolac (Lodine, Lodine XL equiv) 400mg; 500mg;500mg XL tabs

Fentanyl transdermal system ( Duragesic equiv ) 25; 50; 75; 100 mcg/hour *controlled substance*

Ibuprofen (Motrin equiv) 400; 600; 800mg tabs

Indomethacin (Indocin, Indocin SR equiv) 25mg; 50mg; 75mg SRcaps

Ketorolac Tromethamine (Toradol equiv) 10mg tab *maximum qty of #24 tabs*

Lidocaine (Lidoderm) Adhesive Patch 5% (700mg/patch) maximum 3 boxes/30 days

Meloxicam (Mobic equiv) 7.5mg; 15mg tabs

Mefenamic acid (Ponstel equiv) 250mg caps

Meperidine (Demerol equiv) – 50mg tabs only *controlled substance*

Morphine immediate release oral (MSIR equiv) 15mg; 30mg tabs *controlled substance*

Morphine sustained-release (Ms Contin equiv) 15mg; 30mg; 60mg; 100mg; 200mg tabs *controlled substance*

Nabumetone (Relafen equiv) 500mg; 750mg tabs

Naproxen immediate-release (Naprosyn; Anaprox DS equiv) 250mg; 375mg; 500mg ; 550mg tablets

Norco tabs (equiv) Hydrocodone/Acetaminophen – 5/325; 7.5/325; 10/325 tablets *controlled substance*

Norco liquid (equiv) Hydrocodone /Acetaminophen 7.5/325mg per 15ml (tablespoonful) *controlled substance*

Oxycodone immediate-release (Roxicodone, Oxy IR equiv) 5mg; 10mg; 15mg;, 20mg; 30mg *controlled substance*

Oxycodone sustained-release (Oxycontin equiv) 10mg; 15mg; 20mg; 30mg; 40mg; 60mg; 80mg tabs *controlled substance*

Oxycodone/acetaminophen (Percocet equiv) 5/325; 7.5/325; 10/325 tabs *controlled substance*

Piroxicam (Feldene equiv) 10mg; 20mg caps

Salsalate (Disalcid equiv) 500mg tabs

Tramadol (Ultram equiv) Immediate-Release only 50mg; QTY LIMIT: 30 day limit for controlled substances; Excludes Tramadol ER

Ultracet equiv (Tramadol/Acetaminophen) 37.5mg/325mg; QTY LIMIT: 30 day limit/controlled substance; maximum of 240 tabs/30 days

Anti-Anxiety

Buspirone (Buspar equiv) 5mg; 10mg 15mg tabs

Clonazepam oral (Klonopin) 0.5mg; 1mg; 2mg tabs *controlled substance*

Clorazepate oral (Tranxene) 7.5mg tabs only *controlled substance*

Diazepam oral tabs (Valium) 2mg; 5mg tabs *controlled substance*

Hydroxyzine HCL oral (Atarax) 10mg; 25mg tabs

Hydroxyzine Pamoate (Vistaril equiv) 25mg caps

Chlordiazepoxide/clidinium (Librax equiv) 5mg/2.5mg caps

Lorazepam (Ativan) 0.5mg, 1mg, 2mg tabs *controlled substance*

Anti-Coagulants - (Circulation/Blood Thinners)

Apixaban (Eliquis) 2.5mg; 5mg tabs

Cilostazole (Pletal equiv) 50mg; 100mg tabs Clopidogrel (Plavix) 75mg tabs

Dipyridamole (Persantine equiv) 25mg tabs Enoxaparin (Lovenox equiv) 30mg; 40mg; 60mg; 80mg;100mg; 120mg; 150mg injection

Prasugrel (Effient) 10mg tabs Rivaroxaban (Xarelto) 10mg; 15mg; 20mg tabs

Warfarin sodium (GENERIC only) all strengths

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Anti-Convulsants/ Epilepsy/Parkinson

Amantadine (Symmetrel equiv) 100mg caps

Benztropine (Cogentin equiv) 0.5mg 2mg tabs

Carbamazepine (Tegretol equiv) 100mg 200mg tabs

Carbamezapine XR (Tegretol XR equiv) 100mg; 200mg; 400mg tabs

Carbamezapine Suspension (Tegretol Suspension equiv) 100mg/5ml

Clonazepam (Klonopin equiv) 0.5mg; 1mg; 2mg tabs *controlled substance*

Clorazepate (Tranxene equiv) 7.5mg tabs only *controlled substance*

Diazepam (Valium equiv) 2mg; 5mg tabs *controlled substance*

Divalproex (Depakote, Depakote ER, Depakote Sprinkles equiv) 250mg SR; 250mg ER and 500mg ER; 125mg sprinkles

Lacosamide (Vimpat) tablets all strengths – QTY limit – controlled substance

Lamotrigine (Lamictal equiv) 25mg; 50mg; 150mg; 200mg tabs; and 5mg Chewtabs & 25mg Chewtabs

Leviteracetam (Keppra equiv) 250mg; 500mg; 750mg; 1000mg; 500mg XR; 750mg XR tabs

Oxcarbazepine (Trileptal) 150mg; 300mg; 600mg tabs

Phenobarbital 32.4 mg tablets *controlled substance*

Phenytoin (Dilantin brand only) 30mg; 100mg caps; 50mg chew tabs; 125mg/5ml suspension

Primidone (Mysoline) 50mg; 250mg tabs

Sinemet equiv (Carbidopa/Levodopa) – Immediate-release 10/100, 25/100, 25/250mg tabs

Sinemet ER equiv (Carbidopa/Levodopa ER) 25/100mg tablet & 50/200mg tablet

Stalevo equiv (Carbidopa-Levodopa-Entacapone) tablets all strengths

Topiramate (Topamax equiv) 25mg; 50mg; 100mg; 200mg tabs; and 15mg & 25mg sprinkle capsules

Trihexyphenidyl (Artane equiv) 2mg tablets

Zonisamide (Zonegran equiv) 25mg; 100mg caps **allergy alert - this is a SULFA drug**

Anti-Depressants / Bipolar

Amitriptyline (Elavil) 10mg; 25mg; 50mg; 100mg tabs Bupropion SR (Wellbutrin SR equiv) 100mg; 150mg tabs

Bupropion XL (Wellbutrin XL equiv) 150mg; 300mg tabs

Citalopram (Celexa equiv) 10mg; 20mg; 40mg tabs

Doxepin (Sinequan equiv) 10mg; 25mg; 50mg caps

Duloxetine (Cymbalta equiv) 20mg; 30mg; 60mg caps

Escitalopram (Lexapro equiv) 10mg; 20mg tabs

Fluoxetine (Prozac equiv) 10mg; 20mg caps

Fluvoxamine (Luvox equiv) 50mg; 100mg caps (Excludes Luvox CR)

Imipramine (Tofranil equiv) 10mg; 25mg tablets

Lurasidone (Latuda) 20mg; 40mg; 60mg; 80mg tabs

Mirtazapine (Remeron equiv ) 15mg, 30mg tabs

Nefazodone (Serzone equiv) 150mg; 200mg; 250mg

Nortriptyline (Pamelor equiv) 10mg; 25mg capsules

Paroxetine (Paxil equiv) 10mg, 20mg; 30mg tabs

Paroxetine CR (Paxil CR equiv) 25mg caps

Sertraline (Zoloft equiv) 25mg; 50mg; 100mg tabs

Trazodone (Desyrel equiv) 50mg; 100mg tabs

Venlafaxine Immediate-release (Effexor equiv) 25mg; 75mg tabs

Venlafaxine XR (Effexor XR equiv) 37.5mg; 75mg; 150mg caps

Anti-Emetics (Nausea/Vomiting)

Ondansetron liquid (Zofran equiv) 4mg/5ml

Ondansetron tablets (Zofran equiv) – 8mg oral tabs; 4mg ODT and 8mg ODT (Oral Disintegrating Tabs)

Prochlorperazine (Compazine equiv) – 5mg; 10mg tabs

Promethazine (Phenergan equiv) 25mg tabs

Promethazine (Phenergan equiv) 6.25mg/5ml liquid

Promethazine (Phenergan equiv) 12.5mg; 25mg suppositories

Scopolamine Base (Transderm Scop patch) 1.5mg/72hr (Motion sickness prevention only) **limit: 4 patches/30 days per patient**

Anti-Histamines / Decongestants / Cough Suppressants / Allergy

Benzonatate perles (Tessalon equiv) 100mg

Bromfed DM liquid equiv (Brompheniramine/pseudoephedrin 2mg/30mg/10mg per 5mls) **Limit 1 mo. w/refills**

Cetirizine liquid (Zyrtec liquid for Children) 5mg/5ml

Cetirizine (Zyrtec equiv) 10mg tablets only

Cetirizine-D (Zyrtec-D equiv) 12-hour *Available only in 12 count boxes*Limit 1 mo. w/refills**

Chlorpheniramine (Chlortrimeton equiv) 4mg tabs

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Anti-Histamines / Decongestants / Cough Suppressants / Allergy cont.

Cyproheptadine (Periactin equiv) 4mg tabs and 2mg/5ml oral solution

Diphenhydramine (Benadryl equiv) – 25mg caps and 12.5ml/5ml liquid

Fexofenadine (Allegra equiv) 60mg 180mg tabs

Fexofenadine liquid (Children’s Allegra equiv) 30mg/5ml suspension

Allegra-D 12-hr equiv (fexofenadine 60mg/pseudoephedrine 120mg) **Only available in 30 count boxes**Limit 1 mo. w/refills**

Hydroxyzine (Atarax) 10mg,25mg tabs and 10mg/5ml liquid

Guaifenesin sustained release (Mucinex equiv) 600mg tabs only

Mucinex-D 12 hour equiv (guaifenesin 600mg/60mg pse tabs **Only available in 36 count boxes***Limit 1 mo. w/refills*

Guaifenesin (Robitussin-generic) 100mg/5ml syrup

Guaifenesin/dextromethorphan (Robitussin DM-generic) 100mg/5mg per 5ml syrup

Guaifenesin/Codeine (Cheratussin AC) syrup *controlled substance*

Guaifenesin/Codeine/pseudoephedrine (Cheratussin DAC) syrup *controlled substance*

Lodrane –D equiv (brompheniramine/pseudephedrine 12mg/120mg) tablets **Only available in 60 count btl***Limit 1 mo. w/refills**

Loratadine (Claritin equiv) 10mg Swallow tablets and Children’s Oral solution 5mg/5ml

Claritin-D equiv (Loratadine 10mg/pseudoephedrine 240mg) 24-hr **Only available in 15 count boxes** Limit 1 mo. w/refills**

Meclizine (Antivert) 25mg tabs

Montelukast (Singular equiv) – 4mg granules; 4mg & 5mg chewtabs; 10mg tabs

Norel AD equiv (acetaminophen 325mg/chlorpheniramine 4mg/phenylephrine10mg) tabs

Promethazine w/DM syrup ( Phenergan DM Syrup generic)

Pseudoephedrine (Sudafed) 60mg tablets only (by prescription only)

Tussionex equiv suspension (hydrocodone/chlorpheniramine) 10mg/8mg –**Max qty of 4 ounces (115ml) dispensed**controlled substance

Anti-Microbials (Antibiotics, Anti-Virals, Antifungals, Antiparasitic)

Acyclovir (Zovirax equiv) 200mg, 400mg

Albendazole (Albenza eqiuv) 200mg

Amantadine (Symmetrel equiv) 100mg caps

Amoxicillin tabs/caps (Amoxil) 250mg, 500mg , 875mg

Amoxicillin suspension (Amoxil) 250mg/5ml; 400mg/5ml

Amoxicillin/clavulanate (Augmentin equiv) 250mg, 500mg, 875mg, and XR 1000mg tab

Amoxicillin/clavulanate (Augmentin equiv) suspension 200mg/5ml; 250mg/5ml; 400mg/5ml; 600mg/5ml

Cefprozil (Cefzil) 250mg tabs or 250mg/5ml susp.

Cephadroxil (Duricef equiv) 500mg caps

Cephalexin (Keflex equiv) – 250mg, 500mg caps

Cephalexin (Keflex equiv) 250mg/5ml suspension

Cefdinir (Omnicef equiv) 300mg caps only

Cefdinir (Omnicef equiv) 125mg/5ml; 250mg/5ml suspension

Ciprofloxan (Cipro equiv) 250mg; 500mg tablets

Clarithromycin (Biaxin & Biaxin XL equiv) – 500mg tabs or 250mg/5ml suspension.

Clindamycin oral (Cleocin equib) 150mg; 300mg caps and 75mg/5ml oral suspension

Dicloxacillin oral (Dynapen equiv) 250mg

Doxycycline Hyclate (Vibramycin equib) 20mg; 100mg oral tabs/cap (excludes Doryx extended release)

Doxycycline Monohydrate (Monodox equiv) 50mg; 100mg caps

Doxycycline, USP (ORACEA equiv) 40mg caps for ACNE

Erythromycin (Erythrocin equiv) and ERYC delayed release 250mg oral

Famcyclovir (Famvir equiv) 250mg; 500mg tabs

Fluconazole (Diflucan equiv) 100mg; 150mg; 200mg tabs

Griseofulvin oral (Gris-peg equiv ) Ultramicrosize 250mg tabs; microsize oral susp. 125mg/5ml

Isoniazid oral (INH) 100mg; 300mg

Ivermectin 3mg tabs

Ivermectin 0.5% Lotion (Sklice equiv)

Itraconazole (Sporonox eqiuv) 200mg caps

Levofloxacin (Levaquin equiv) 250mg; 500mg; 750mg tabs

Methenamine (Hiprex, Urex) 1gm tabs

Metronidazole (Flagyl) 250mg, 500mg tabs

Minocycline (Minocin) 50mg, 100mg caps

Naftifine (Naftin equiv) 2% cream

Nitrofurantoin USP (Macrodantin equiv) 50mg cap and Nitrofurantoin monohydrate/macrocyrstals (Macrobid equiv) 100mg caps

Nystatin 500,000u oral tabs (does not include Mycostatin Pastilles)

Penicillin VK (Pen VK) 250mg, 500mg tabs and Penicillin VK 250mg/5ml suspension

Rifampin (Rifadin equiv) 300mg caps

Sulfamethoxazole/trimethoprim (Bactrim DS/Septra DS equiv) 160mg/800mg tabs and 200mg/40mg per 5ml pediatric suspension

Terbinafine (Lamisil equiv) 250mg tabs and cream

Valacyclovir (Valtrex equiv) – 500mg, 1gm tablets

Zithromycin (Zithromax, Zpack equiv) 250mg tabs and 100mg/5ml; 200mg/5ml

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ANTI-NEOPLASTIC AGENTS (Oncology/Cancer)

Antiandrogen

Bicalutamide (Casodex equiv) 50mg tab

Antiestrogen

Anastrazole (Arimidex equiv) 1mg tabs

Exemestane (Aromasin equiv) 25mg tabs

Letrozole (Femara equiv) 2.5mg tabs

Tamoxifen (Nolvadex equiv) 10mg, 20mg tabs

Antimetabolite/Folic Acid Antagonist

Methotrexate 2.5mg tablets only (excludes injectable)

Antipsychotics (Psychiatrics)

Chlorpromazine (Thorazine equiv) 25mg, 50mg tabs

Lithium 300mg tab/cap and Lithium extended-release (Lithobid equiv) 300mg XR, 450mg XR tabs

Lurasidone (Latuda equiv) 40mg, 60mg tablets

Olanzapine (Zyprexa equiv) 2.5mg; 5mg; 10mg tabs

Quetiapine and Quietiapine XR (Seroquel and Seroquel XR equiv) all strengths for both

Risperidone (Risperdal equiv) 0.25mg, 0.5mg, 1mg, 2mg, 4mg tabs

Ziprasidone (Geodon equiv) 20mg, 40mg, 60mg, 80mg tabs

Antirheumatics (Arthritis/Rheumatoid Arthritis)

Azathioprine (Imuran equiv) 50mg tablets

Hydroxychloroquine (Plaquenil equiv) 200mg tablets

Humira (Adalimumab) injection 40mg/injection (2 injections per box)

Leflunomide (Arava equiv) 20mg tablets

Asthma / COPD / Respiratory (oral inhalers provided in HFA form when available)

Advair (Salmeterol/fluticasone) oral discus

Albuterol oral MDI (ProAir HFA inhaler)

Albuterol oral liquid

Albuterol nebulizer solution for inhalation (1.25mg/3ml and 2.5mg/3ml) – 30 per box

Anora Ellipta inhaler (umeclidinium/vilanterol) MDI 62.5mcg/25mcg

Budesonide nebulizer solution for inhalation (Pulmicort Respules) 0.25mg & 0.5mg & 1mg vials **30 per box

Combivent Respimat (Albuterol/Ipratropium) inhaler *dosed 1 puff four times daily*

Duoneb equiv (Albuterol 3mg and Ipratropium) nebulizer solution for inhalation – 30 per box

Fluticasone oral inhaler (Flovent HFA & Diskus)

Fluticasone/salmeterol (Advair HFA & Diskus)

Ipatropium oral inhaler (Atrovent MDI)

Ipatropium nebulizer solution for inhalation (Atrovent) **30 per box**

Levalbuterol MDI (Xopenex equiv) oral inhaler

Levalbuterol nebulizer solution (Xopenex equiv) 0.31mg/3ml, 0.63mg/3ml, 1.25mg/3ml

Montelukast (Singulair) 10mg oral tablets, 4mg & 5mg chewable tablets, and 4mg oral granules

Spacer (Aerochamber) and also Aerochamber w/mask (S,M,L)

Salmeterol (Serevent Discus)

Terbutaline (Brethine) 2.5mg, 5mg tabs

Theophylline sustained release (TheoDur equiv) – 400mg & 600mg (200mg & 300mg unavailable)

Tiotropium (Spiriva HandiHaler)

Tiotropium (Spirivia RESPIMAT) *ONE inhaler per 30 DAYS* 1.25mg/actuation and 2.5mcg/actuation

Incruse Ellipta inhaler (umeclidinium inhalation) MDI 62/5mg

8

Attention Deficit/Narcolepsy

Adderall (mixed amphetamine salts equiv) 5mg; 10mg; 20mg; 30mg tabs *controlled substance*

Adderall XR (mixed amphetamine equiv) 5mg; 10mg; 20mg; 25mg; 30mg tabs *controlled substance*

Methylphenidate (Ritalin, Concerta equiv) 5mg; 10mg; 20mg tabs *controlled substance*

Methylphenidate LA (Ritalin LA equiv) GENERIC ONLY 20mg; 30mg; 40mg caps *controlled substance*

Methylphenidate XR suspension (Quillivent XR Reconstitute equiv) 5mg/ml *ordered upon request only-requires 3 business days)

Dextroamphetamine (Dexedrine equiv) 5mg and Dexedrine equiv Spansules 5mg; 10mg; 15mg *controlled substance*

Attention Deficit/Non-Stimulant Guanfacine ER (Intuniv equiv) 1mg; 2mg; 3mg 4mg tabs

Atomoxetine (Strattera equiv) capsules – all strengths

Cholesterol / Lipid Lowering

Atorvastatin (Lipitor) 10mg, 20mg, 40mg, 80mg tabs

Cholestyramine powder cans (Questran equiv)

Colestipol (Colestid equiv) 1gm tablets

Ezetimibe (Zetia equiv) 10mg tablets

Fenofibrate (Triglide equiv) 160mg (only)

Fenofibrate Nanocrystallized (Tricor equiv) 48mg, 54mg, 145mg, (excludes Trilipix delayed release)

Gemfibozil (Lopid equiv) 600mg tabs

Niacin SR (Niaspan equiv) extended-release 500mg; 750mg; 1000mg tabs

Pravastatin (Pravachol equiv) 10mg; 20mg; 40mg; 80mg tabs

Rosuvastatin (Crestor equiv) 10mg; 20mg; 40mg tabs

Simvastatin (Zocor equiv) 5mg; 10mg; 20mg; 40mg; 80mg tabs

Contraceptives (Birth control)

Caziant (desogrestrel 0.1-0.125-0.15/EE25mcg) Triphasic

Demulan 1/50E, 1/35E equiv

Jolessa (levonorgestrel/ethinyl estradiol) 3pk (91day) equiv

Loestrin FE 1.5/30, 1/20 equiv

Lo/Ovral 28day equiv

Nordette 28 equiv

NOR-QD (norinthindrone) or equiv

Nuvaring (estonogestrel/Ethinyl Estradiol) vaginal ring

Ortho Cyclen or equiv

Ortho-Novum 1/35 28day or equiv

Ortho-Novum 1/50 28day or equiv

Ortho-Novum 777 28day or equiv

Ortho-TriCyclen 28day and Othro-TriCyclen LO (or equiv)

Ovral or equiv

Tri-Norinyl 28day or equiv

Triphasil 28day or equiv

Yasmin equiv

Yaz equiv

Xulane Patch (equiv to Ortho Evra)

Corticosteroids – Oral

Budesonide (Entocort equiv) 3mg caps (Crohn’s Disease) Dexamethasone (Decadron equiv) 0.5mg, 0.75mg; 1.5mg, 4mg tabs and DexPak 1.5mg tabs (6-day, 10-day, 13-day pack)

Fludrocortisone (Florinef equiv) 0.1mg tabs

Methylprednisolone (Medrol, Medrol Dose Pack equiv) 4mg tabs

Prednisone (Deltasone equiv) 5, 10, 20mg tabs

Prednisolone (Pediapred, Prelone equiv) 5mg/5ml and 15mg/5ml liquid

Dental Agents

Chlorhexidine oral rinse (Peridex, PerioGard)

Sodium Fluoride 1.1% past (PreviDent 5000 Plus) Spearmint

Triamcinolone paste (Kenalog-in-Orabase)

Viscous Lidocaine (Xylocaine) 2% oral gel 100ml

9

Diabetic Agents/Supplies

Alcohol pads Box of 100

Exenatide (Bydureon) 2mg SQ pen (4 injections per box)

Empagliflozin (Jardiance) 10mg; 25mg tab

Glucometer Free Style Lite (only one type of meter on formulary)

Glucometer Strips Free Style Lite test strips

Lancets (generic)

Glimepiride (Amaryl equiv) 2mg, 4mg tabs

Glipizide IR (Glucotrol immediate-release equiv) 5mg; 10mg tabs

Glipizide XL (Glucotrol XL equiv) 5mg; 10mg XL tabs

Glucogon Emergency Injectable Kit #1

Glyburide (Micronase) 0.25mg; 5mg tabs

Glyburide, Micronized (Glynase equiv) 3mg; 6mg tabs

Glucovance (metformin/glyburide) 1.25mg/250mg; 2.5mg/500mg; 5mg/500mg tabs

Insulin aspart (Novolog & Novolog mix) - vials and Flexpens

Insulin detemir (rDNA origin) (Levemir) –vials only

Insulin glargine (rDNA origin) Lantus Vials and Solostar pens

Insulin human - 70/30 vials, NPH vial, Regular vials

Insulin Lispro (HUMALOG) vials, Kwikpen,

Insulin Lispro MIX 75/25 (Humalog Mix Kwikpen)

Insulin PEN Needles Short – 1/4” (6mm) length, 32 gauge

Metformin (Glucophage equiv) 500mg; 850mg; 1000mg tabs

Metformin XR (Glucophage XR equiv) 500mgXR and 750mgXR tabs (Excludes 1000mg XR)

Nateglinide (Starlix) 60mg; 120mg tabs

Pioglitazone (Actos equiv) 15mg; 30mg; 45mg

Sitagliptin (Januvia) 25mg; 50mg; 100mg tabs

Sitagliptin/Metformin oral (Janumet) tablets 50/500mg & 50/1000mg

Sitagliptin/Metformin XR (Janumet XR) 50/500mg; 50/1000mg; 100/1000mg (once daily dosing)

Syringes, Insulin - Available in 1/2cc and 1cc, ½” 30G

Diuretics (Fluid Retention)

Chlorthalidone 25mg; 50mg tabs

Furosemide (Lasix equiv) 20mg; 40mg tabs

Hydrochlorothiazide (HCTZ) 12.5mg caps; 25mg; 50mg tabs

Hydrochlorothiazide/triamterene (Maxzide equiv) 25mg/37.5mg; 50mg/75mg tabs

Indapamide (Lozol equiv) tablets

Metolazone (Zaroxolyn equiv) 2.5mg, 5mg tabs

Spironolactone (Aldactone equiv) 25mg; 50mg tabs

Torsemide (Demadex equiv) 5mg; 20mg tabs

Electolyte Replacement

Magnesium Oxide (MagOx) 400mg tabs

Potassium chloride (KDur, Klor) 8 mEq, 10mEq, 20mEq tabs

Potassium chloride powder for solution (KLor 20mEq packets) 100 packets/box

Emergency Kit (Insect Sting / Substance Abuse)

Insect sting kit (Epi-Pen and Epi-pen Jr.) **Pharmacy needs to annotate allergy on file**

Naloxone (Narcan equiv) Nasal Spray

Naltrexone (Naltrexone) 50mg tabs

Erectile Dysfunction

Sildenafil (Viagra equiv) 25mg; 50mg; 100mg (Limit 6 tabs/month –Maximum 3 months/18 tabs)

Fertility Drugs

Clomiphene (Clomid equiv) 50mg tabs

10

Gastrointestinal Reflux Disease (GERD) Agents/Acid Reflux/Heartburn Cimetidine (Tagamet equiv) 300mg; 400mg tabs

Famotidine (Pepcid equiv) 20mg; 40mg tabs

Omeprazole (Prilosec equiv) 20mg; 40mg caps

Omeprazole (FIRST-Omeprazole) KIT for oral suspension 2mg/ml

Pantoprazole (Protonix equiv) 20mg; 40mg tabs

Rabeprazole (Aciphex equiv) 20mg tabs

Gastrointestinal Agents (GI Prep Kits/ Diarrhea/Constipation/IBS/Crohn’s/Gallbladder)

Budesonide (Entocort equiv) 3mg caps (for Crohn’s disease)

Chlordiazepoxide/clidinium (Librax equiv)

Colyte / Golytely Bowel Prep **See other Bowel Prep kits below*

Dicyclomine (Bentyl equiv) 10mg caps; 20mg tabs

Docusate sodium (Colace equiv) 100mg caps

Flavoxate (Urispas equiv) 100mg tabs

Hyoscyamine (Levsin, LevBid equiv) 0.125mg SL; 0.375 tabs

Lactulose (Cephulac equiv) Syrup 10gm/15ml

Linaclotide (Linzess equiv) 145mcg; 290mcg tabs

Lomotil (diphenoxylate/atropine) 2.5mg/0.025mg tabs *controlled substance*

Loperamide (Imodium equiv) 2mg caps

Lubiprostone (Amitiza equiv) 8mcg, 24mcg tabs

Mesalamine (Lialda equiv) 1.2G delayed release

Miralax equiv (propylene glycol 3350) powder for suspension (Max Qty Limit = 1 x 527gm bottle per 30 days) 17gm/dose

Metoclopramide (Reglan equiv) 10mg tablets

Misoprostol (Cytotec equiv) 200mg tabs

Moviprep Bowel Prep kit

Pancrelipase (Creon equiv) delayed release capsules 3000mg; 6000mg; 12,000mg; 24,000mg; 36,000mg caps

Prochlorperazine (Compazine equiv) – 5mg tabs

Prepopik Bowel Prep kit

Ranitidine (Zantac equiv) 300mg; 400mg – (Excludes EFFERdos or GELdose

SuPrep Bowel Prep Kit

Sucralfate (Carafate equiv) 1 gram tabs and 1gm/10ml Suspension

Ursodiol (Actigal equiv) 300mg; 500mg caps

Genitourinary Agents (Bladder/Prostate)

Alfuzosin (Uroxatral equiv) 10mg tabs

Doxazosin (Cardura equiv) 2mg; 4mg; 8mg tabs

Desmopressin (DDAVP equiv) Nasal spray

Desmopressin (DDAVP equiv) 0.1mg; 0.2mg tabs

Oxybutynin (Ditropan equiv) 5mg Immediate-Release tabs

Oxybutynin XL (Ditropan XL equiv) 5mg XL; 10mg XL tabs

Prazosin (Minipres equiv) 1mg; 2mg; 5mg caps

Phenazopyridine (Pyridium equiv) 100mg; 200mg tablets

Solifenacin (Vesicare equiv) 5mg; 10mg tabs

Tamsulosin (Flomax equiv) 0.4mg caps

Terazosin (Hytrin equiv) 1mg; 2mg; 5mg; 10mg caps

Tolterodine LA (Detrol LA equiv) (Excludes immediate-release tabs)

Urogesic Blue equiv (hyoscyamine/methenamine/methylene blue/NaPhosphate) tablets

Ustell equiv (methanamine/NaPhosphate/phenylsalicylate/methylene blue/hyoscyamine) caps

Gout Agents

Allopurinol (Zyloprim equiv) 100mg; 300mg tabs

Colbenemid equiv (colchicine/probenecid) 0.5mg/500mg tabs

Colchicine 0.6mg only

Probenecid (Benemid equiv) 500mg tabs

11

Hormones – Estrogen/ Progestin/Testosterone

Activella equiv (estradiol & norethindrone) 0.5mg/0.1mg and 1mg/0.5mg) tabs

Prempro equiv (0.3/1.5 and 0.45/1.5 and 0.625/2.5 and 0.625/5mg) tabs

Combipatch equiv (estradiol/norenthindrone) 50/140mcg (0.05/0.14mg) and 50/250mcg (0.05/0.25mg)

Conjugated estrogens (Premarin equiv) 0.3mg, 0.45mg, 0.625mg, 0.9mg, 1.25mg tabs

Conjugated estrogens vaginal cream (Premarin Vaginal Cream equiv)

Estradiol vaginal cream (Estrace Vaginal Cream equiv)

Estradiol (Vagifem equiv) 10mcg vaginal tab

Estradiol 2mg Ring (ESTRING equiv)

Estradiol patch equiv (Alora Patch: 0.05mg & 0.1mg) Twice-a-week dosing

Estradiol patch equiv (Climara Patch) Once-a-week dosing

Estradiol (Estrace equiv) 0.5mg, 1mg, 2mg tabs

Estradiol transdermal patch equiv 0.1mg/24hr (Minivelle; Vivelle Dot- transdermal)

Estratest equiv (Estradiol/Methyltestosterone) tablets (controlled substance)

Medroxyprogesterone (Provera equiv) 5mg; 10mg tablets

Progesterone (Prometrium equiv) 100mg; 200mg caps

Testosterone Enanthate 200mg/ml 5ml injectable (cypionate is EXCLUDED) (controlled substance)

Testosterone Gel (Fortesta equiv) 60gm canister (controlled substance) 120 pumps/can

HYPERTENSIVE/CARDIAC MEDICATIONS (Blood Pressure/Heart)

Ace Inhibitors/Angiotensin II Blocker – all generic only

Benazepril (Lotensin equiv) 5mg, 10mg, 20mg & 40mg tabs

Captopril (Capoten) 25mg tablets

Enalapril (Vasotec equiv) 5mg, 10mg tabs

Fosinopril (Monopril equiv) 10mg, 20mg tablets

Lisinopril (Zestril, Prinivil equiv) 2.5mg, 5mg, 10mg, 20mg tabs

Lisinopril-HCTZ (Zestoretic equiv) 10/12.5, 20/12.5, and 20/25mg tabs

Losartan (Cozaar equiv) 25mg; 50mg; 100mg tabs

Losartin-HCTZ (Hyzaar equiv) 50/12.5, 100/12.5, and 100/25mg tabs

Ramipril (Altace equiv) 1.25mg; 2.5mg; 5mg; 10mg caps

Telmisartan (Micardis equiv) 20mg; 40mg & 80mg tabs

Telmisartan-HCT ( Micardis/HCT equiv) 40/12.5, 80/12.5, and 80/25mg tabs

Valsartan (Diovan equiv) 40mg, 80mg, 160mg, 320mg tabs

Valsartan- HCT (Diovan/HCT equiv) 160mg/12.5mg, 160mg/25mg and 320/12.5mg, 320/25mg tabs

Alpha-1-Adrenergic Blocker

Doxazosin oral (Cardura equiv) 2mg, 4mg, 8mg tabs

Prazosin (Minipres equiv) 1mg, 2mg, 5mg caps

Terazosin (Hytrin equiv) 1mg, 2mg, 5mg, 10mg caps

Alpha/Beta-Adrenergic Blocker

Carvedilol (Coreg equiv) 3.125mg; 6.25mg; 12.5mg; 25mg tabs

Carvedilol CR (Coreg equiv) 10mg; 20mg; 40mg; 80mg caps

Antiadrenergic – Centrally Acting

Clonidine (Catapres) 0.1mg; 0.2mg; 0.3mg tabs

Beta-Adrenergic Blockers – all generic only

Atenolol (Tenormin equiv) 25mg; 50mg tabs

Bisoprolol (Zebeta equiv) 5mg; 10mg tabs

Metoprolol (Lopressor equiv) 25mg; 50mg; 100mg tabs

Metoprolol Succinate ( Toprol XL equiv) 25mg; 50mg; 100mg tabs

Nadolol (Corgard equiv) 40mg; 80mg tabs

Propranolol (Inderal, Inderal LA equiv) 10mg; 20mg; 40mg; 80mg tabs also 60mg LA; 80mg LA;, 120mg LA; 160mg LA caps

Ziac equiv (bisoprolol 5mg/ hydrochlorothiazide 6.25mg) tabs

12

Calcium Channel Blockers

Amlodipine (Norvasc equiv) tablets 2.5mg; 5mg; 10mg tabs

Amlodipine/benazepril (Lotrel equiv) 2.5/10mg; 5/10mg; 5/20mg; 10/20mg, 5/40mg; 10/40mg caps

Diltiazem (Cardizem equiv) 30mg; 60mg; 90mg tabs

Diltiazem Sustained Release (Tiazac equiv) 120mg;180mg; 240mg; 300mg; 360mg; 420mg caps

Felodipine (Plendil equiv) 2.5mg; 5mg; 10mg tabs

Nifedipine Sustained Release (Adalat CC equiv) 30mg; 60mg; 90mg tabs

Verapamil (Calan, Calan SR) 80mg SR; 180mg SR; 240 SR tabs (Excludes Verelan extended-release)

Cardiac Agents

Amiodarone (Pacerone equiv) 200mg tab

Digoxin (Lanoxin equiv) 0.125mg, 0.25 tab

Dipyridamole (Persantine equiv) 0.25 tab

Flecainide (Tambocor equiv) 50mg; 100mg; 150mg tab

Magnesium Oxide (MagOx) 400mg tab

Ranolazine (Ranexa equiv) 500mg; 1,000mg tabs

Sotalol (Betapace equiv) oral tab 80mg; 120mg; 160mg; 240mg

Combination

Exforge equiv (Amlodipine/Valsartan) tablets

Exforge HCT equiv (Amlodipine/Valsartan/Hydrochlorothiazide)

Vasodilators

Hydralazine oral (Apresoline equiv) oral tab

Isosorbide dinitrate oral (Isordil equiv) oral tab

Isosorbide mononitrate (Imdur,Ismo equiv) oral tab

Nitroglycerin patches (Nitro-Dur equiv)

Nitroglycerin sublingual (Nitrostat equiv tabs and sublingual spray)

Immunologics / Biologic Agent (Rheumatoid Arthritis/Psoriasis/Crohn’s)

Adalimumab (Humira) 40mg/0.8ml Pen Inj Kit & 40mg/0.8ml Syringe Kit *(limited to these two only)

Levflunomide (Arava equiv)

Mycophenolate (Cellcept equiv) oral 250mg; 500mg

Migraine Agents

Eletriptan (Relpax equiv) – Quantity limit: 12 tabs per 30 days

Fioricet oral (or equiv) 325mg/50mg/40mg (only) *controlled substance*

Fiorinal oral (or equiv) *controlled substance*

Imitrex oral tabs – generic only Quantity limits : 25mg & 50mg tabs limited to 18 tabs/30 days ; 100mg tabs limited to 9 tabs/30 days

Imitrex Stat Dose equiv syringes Quantity limits : 8 syringes/30 days

Maxalt equiv oral tabs and Maxalt MLT equiv oral tabs Quantity limits: 12 tabs/30 days

Topiramate (Topamax equiv) tabs all strengths (excludes extended release tables)

Zomig equiv oral tabs 5mg only Quantity limits: 12 tabs/30days

Zomig-ZMT equiv orally disintegrating tablets 2.5mg & 5mg Quantity limit: 12 tabs/30 days

Multiple Sclerosis Agent Interferon Beta-1b (Betaseron) 0.3mg *(vial or kit only on BCF)*

Muscle Relaxants

Baclofen (Lioresal equiv) oral tab 10mg

Cyclobenzaprine (Flexeril equiv) oral tab 5mg; 10mg

Metaxalone (Skelaxin equiv) oral tabs 400mg; 800mg

Methocarbamol (Robaxin equiv) oral tabs 500mg; 750mg

Tizanidine (Zanaflex equiv) oral tabs 4mg only

13

Myesthenia Gravis Pyridostigmine (Mestinon equiv) 60mg caps

Neurological Agents (Nerve Pain/Restless Leg Syndrome)

Gabapentin (Neurontin equiv) 100mg; 300mg; 400mg 600mg; 800mg

Pramipexole (Mirapex equiv) 0.125mg; 0.25mg & 0.5mg tablets (immediate release) only (for Restless Legs Syndrome)

Ropinirole (Requip equiv) (immediate release only) 0.25mg; 0.5mg; 1mg; 2mg; 3mg; 4mg & 5mg tabs

Nasal Sprays And Rinses

Atrovent Nasal Spray equiv (Ipratropium Bromide) 0.03% and 0.06% Azelastine (Astelin equiv) Nasal Spray (Excludes Astepro)

Flunisolide nasal spray (Nasalide equiv)

Fluticasone (Flonase equiv) Nasal Spray

Saline Nasal Spray (Ocean spray equiv)

Eye Care:Ophthalmics – Antibiotics/Antivirals Azasite (azithromycin equiv) Ophthalmic Sol 1%

Bacitracin ophth oint

Ciprofloxacin (Ciloxan equiv) - ophth drops and ointment

Cortisporin equiv drops and ointment

Erythromycin ophth oint (Ilotycin equiv)

Ganciclovir (Zirgan equiv) 0.15% GEL

Gentamycin (Garamycin equiv) drops and ointment

Moxifloxacin (Vigamox equiv) drops 0.5%

Neosporin Ophth soln (or equiv)

Ofloxacin ophth (Ocuflox equiv) 0.3% soln

Sulfacetamide ophth soln (Sulamyd equiv)

Tobramycin (Tobrex equiv) – drops and ointment

Tobramycin/dexamethasone (Tobradex equiv) drops and ointment

Trimethoprim/polymixin-b (Polytrim equiv) drops

Eye Care: Ophthalmics – other (glaucoma, moisturizing, allergy, anti-inflammatory, other)

Acular (Ketorolac Tromethamine) 0.5% drops; no refills

Alphagan-P (brimonidine) 0.1% & 0.15% drops

Atropine 1% ophth sol 5ml bottle

Betagan equiv (levobunolol) 0.5% ONLY

Betoptic-S equiv (betaxolol) 0.25%; 0.5% drops

Bimatoprost (Lumigan equiv) 0.01% soln

Combigan equiv (Brimonidine/Timolol) drops 0.2%/0.5%

Cosopt Plus equiv (Timolol/Dorzolamide)

Diclofenac (Voltaren equiv) drops

Difluprednate (Durezol equiv) 0.05% drops

Dorzolamide (Trusopt equiv) drops

Fluorometholone (FML equiv) 0.1% suspension

Isopto Hyoscine (scopolamine) drops

Latanoprost (generic only) Xalatan <must be refrigerated>

Loteprednol etabonate (Alrex equiv)

Loteprednol etabonate 0.5% (Lotemax equiv) gel only

LiquifilmTears equiv (1.4% polyvinyl alcohol / 0.5% chlorobutanol, NaCl) with preservatives only (drops)

Nepafenac Opth (Nevanac equiv) 0.1% suspension

Nepafenac (Ilevro equiv) 0.3% susp (once daily dosage)

Olopatadine HCL 0.1% ( Patanol equiv)

Olopatadine HCL 0.2% (Pataday equiv)

Pilocarpine 1% ; 2% and 4% SOLUTION only

Pred-Forte equiv (prednisolone) 1% solution 5ml bottle

Pred-Mild equiv (prednisolone) 0.25% solution 5ml bottle

Celluvisc PF equiv (Preservative Free – carboxymethylcellullose) 30ct/box

Refresh Celluvisc PF equiv (Preservative Free) carboxymethylcellullose 30ct/box

Simbrinza equiv (Brinzolamide/Brimonidine) drops 1%/0.2%

Sodium Chloride (Muro-128 equiv) 5% drops and 5% ophth ointment

Timolol, Timolol GFS (Timoptic, Timoptic XE equiv) 0.25%; 0.5% ophthalmic solution

Zaditor equiv (ketotifen) 0.025% ophth sol 5ml bottle

14

Osteoporosis / Bone Loss

Alendronate (Fosamax equiv) 10mg; 35mg and 70mg tablets (Excludes Fosamax-D)

Calcitrol (Rocaltrol equiv) 0.25mcg; 0.5mcg caps

Ibandronate (Boniva equiv) 150mg tab (once monthly)

Miacalcin Nasal spray equiv (Calcitonin-salmon) - Store unopened bottle in fridge; open bottles at room temp & discard after 30 days

Raloxifene (Evista equiv) 60mg tablet

Ear Care: Otic Preparations

Ciprodex equiv (Ciprofloxacin/Dexamethasone) drops

Cortisporin equiv (hydrocortisone/neomycin/polyB) solution and suspension

Debrox equiv (carbamide peroxide) drops

Domeboro equiv Otic Solution

Prostate Medication

Alfuzosin (Uroxatral equiv) 10mg tab

Bicalutamide (Casodex equiv) 50mg tab

Doxazosin oral (Cardura equiv) 2mg; 4mg; 8mg

Finasteride (Proscar equiv) 5mg Tablets

Tamsulosin (Flomax- equiv) 0.4mg

Terazosin (Hytrin equiv) 1mg; 2mg; 5mg; 10mg caps

Sedative Hypnotic Agents / Insomnia (Sleep Aids)

Eszopiclone (Lunesta equiv) 1mg; 2mg; 3mg (30 day qty limit) *controlled substance*

Temazepam (Restoril equiv) 7.5mg; 15mg; 30mg caps (30 day qty limit) *controlled substance*

Trazodone (Desyrel equiv) 50mg; 100mg tabs

Zolpidem (Ambien equiv) – *controlled substance** (Excludes Ambien C) maximum of 5mg dose for all females *MAX of 30 days

supply w/refills*

Thyroid/Antithyroid Agents Armour Thyroid – 15mg; 30mg; 60mg; 90mg; 120mg or (1/4gr, 1/2gr, 1gr, 1.5gr, 2 grain) tabs

Levothyroxine (Synthroid brand only) all strengths (25, 50, 75, 88, 100, 112, 125, 137, 150, 175, 200 mcg) tablets

Liothyronine (Cytomel equiv) 5mcg; 25mcg; 50mcg tabs

Methimazole (Tapazole equiv) 5mg; 10mg tabs – for Hyperthyroidism

Propylthiouracil (PTU) 50mg tablets

Topical Agents

Acyclovir (Zovirax) 5% ointment

Adapalene (Differin) 0.1% GEL

Analpram HC equiv (Pramoxine 1%/ Hydrocortisone 2.5%) cream

Aluminum chloride hexahydrate (Drysol equiv)

Augmented Betamethasone Dipropionate (Diprolene AF equiv) topical cream 15 gram and 50 gram

Bacitracin topical ointment 30 gram

Betamethasone Valerate 0.1% (Valisone equiv) cream 15gm tube

Ciclopirox 8% (Penlac equiv) Solution only

Clindamycin (Cleocin-T equiv) topical solution only 60 ml

Clindamycin gel, cream, lotion

Clobetasol cream (Temovate equiv) 0.05% cream/ointment 15 gram

Clobetasol Foam (Olux equiv)

Clotrimazole/Betamethasone dipropionate cream (Lotrisone equiv)

Desonide (DesOwen equiv) cream

Diclofenac 1% TOPICAL GEL (only) – (Voltaren GEL equiv) 100gram

Diclofenac 1.5% topical SOLUTION (PENNSAID equiv) (**excluding 2% solution)

Diflorasone (Psorcon equiv) cream

Duac gel equiv (Clindamycin 1.2% / Benzoyl Peroxide 5%)

Epiduo gel equiv (Adapalene 0.1%/Benzoyl Peroxide 2.5%)

Erythromycin 1.5% topical, (solution) *excludes pads*

Fluocinolone (Synalar equiv) 0.025% cream and ointment

Fluocinolone (Synalar equiv) 0.01% cream and solution

Fluocinonide (Lidex equiv) 0.05% cream; ointment; solution

15

Topical Agents continued

Fluocinonide (Lidex equiv) 0.1% cream

Fluorouracil (Efudex equiv) 5% cream

Gentamycin 0.1% (Garamycin equiv) cream

Halobetasol (Ultravate equiv) cream/ointment

Hydrocortisone 0.5% ; 1%; 2.5% cream

Hydrocortisone Valerate (Westcort equiv) cream

Hydrocortisone rectal cream and suppositories (Anusol-HC equiv)

Hydroquinone 4% (Eldoquin equiv) cream

Imiquimond 5% cream (Aldara equiv) Box of 24 single use packets

Ivermectin 0.5% Lotion (Sklice equiv)

Ketaconazole (Nizoral equiv) Shampoo

Lidocaine 2% JELLY 30gram

Lidocaine 4% CREAM 30gram

Lidocaine 5% OINT 35gram

Metronidazole (Metrocream equiv) 0.75% topical cream

Metronidazole (Metrogel equiv) topical gel

Mometasone (Elocon equiv) 0.1% cream

Mupirocin (Bactroban equiv) ointment and cream

Nystatin ointment & powder

Permethrin (Elimite equiv) cream

Pimecrolimus (Elidel equiv) cream

Prilocaine 2.5%/Lidocaine 2.5% cream (EMLA equiv) 30gram

Proctofoam HC equiv (Hydrocortisone/Pramoxine)

Retapamulin 1% ointment (Altabax equiv)

Sebex equiv (colloidal sulfur/salicylic acid) 2% Shampoo

Selenium sulfide 2.5% (Selsun equiv) lotion (**excludes 1% Selsun Blue which is OTC)

Silver sulfadiazine cream (Silvadene equiv)

Sulfacetamide 10% lotion (Klaron equiv)

Tacrolimus (Protoptic equiv) ointment 0.3% (<16yrs) and 0.1% (>15yrs)

Tazarotene (Tazorac equiv) gel 0.1%

Terbinafine (Lamisil Equiv) 1% cream

Tretinoin CREAM only (Retin-A equiv) *NOT FOR COSMETIC USE* (excludes gel, ointment, and 0.1% MICRO)

Triamcinolone acetonide 0.1% (Kenalog equiv) cream, ointment, spray

Triamcinolone/Nystatin cream (Mycolog equiv)

Urea 20%, 40% cream

Vaginal Preparations

Clindamycin phosphate vaginal (Cleocin equiv)

Clotrimazole vaginal cream (Gyne-Lotrimin-7 equiv)

Estradiol (Vagifem equiv) 10mcg vaginal tab

Estradiol (Estrace equiv) Vaginal Cream

Metronidazole (Metrogel equiv) Vaginal Cream

Miconazole 2% vaginal cream (Monistat-7 equiv)

Premarin Vaginal Cream equiv

Vitamins and Minerals

B12 1000mcg tablet

B12 injection (cyanocobalamine) - 1000mcg/ml (note: prescription is needed for syringes)

Cardiotek Rx (Bioperine 5mg; Folic acid 2mg; B12 500mcg; B6 50mg; L-Arginine 500mg)

Cerefolin NAC (methylfolate 6mg; N-acetyl-L-cysteine 600mg; methylcobalamine 2mg; algae-S powder 90.314mg) tablets

Ferrous sulfate (Iron) 325mg immediate-release tabs

Folic acid 1mg tabs

Foltx (cyanocobalamine 2mg; pyridoxine 25mg; L-methylfolate 1.13mg)

ICAR-C equiv (carbonyl iron 100mg, Vit C 250mg) tabs

ICAR-C Plus equiv (folic acid 1mg; cyanocobalamine 25mcg; Vit C 250mg; carbonyl iron 100mg)

Magnesium Oxide (MagOx) 400mg tabs

Prenatal vitamins with folic acid tabs *Limited to women of child bearing age

Calcitrol (Rocaltrol equiv) 0.25mcg; 0.5mcg caps

Vitamin D2 only - 50,000 IU caps

16

Fox has no emergency room or emergency

medical services (EMS).

Dial 911 to activate EMS.

Advice Nurses are available 24 hours a day, at (256) 955-8888 or 1-

800-223-9531, to provide care advice.

Pharmacy business hours: 07:30am – 4:30pm MON-FRI

CLOSURES

**Varying First Thursdays of each Month at 11:30 for training

**Saturdays and Sundays

**All noted Federal and Training Holidays – See schedule next page

Check out the Live Wait-Time Tracker on the website:

www.redstone.amedd.army.mil

17

Fox Army Health Center

Holiday Schedule Fiscal Year 2017 (Subject to mission requirement changes)

FEDERAL HOLIDAY and TRAINING HOLIDAY FULL-DAY CLOSURES:

04 JUL 17 TUESDAY INDEPENDENCE DAY

04 SEP 17 MONDAY LABOR DAY

DESIGNATED FULL-DAY CLOSURES FOR QUARTERLY TRAINING:

14 APR 17 FRIDAY QUARTERLY TRAINING DAY

01 SEP 17 FRIDAY QUARTERLY TRAINING DAY

DESIGNATED HALF-DAY CLOSURES FOR TRAINING ( OPEN 07:30 – 11:30) and/or

ORGANIZATIONAL ACTIVITY: (OPEN 07:30 – 11:30)

Please NOTE: The last pharmacy service ticket will be available a minimum of 15 minutes prior to

closing OR EARLIER if the number of customers to be served exceeds the operating hours.

03 JUL 17 MONDAY TRAINING AFTERNOON

03 AUG 17 THURSDAY TRAINING AFTERNOON

Nurse Advice Lines (NALs) are available during non-duty hours at (256) 955-8888 or 1-800-223-

9531 to provide care advice. Fox Army Health Center is an ambulatory care clinic, and does not

have an emergency room. In case of emergency, dial 911.