Formulary #5Formulary #4Formulary #3Formulary 2Medications Available For Patients who need to pay by cash. Home Page
  Formulary pg 6  
 
 
  

Hormones

  
P0092090   Estradiol (Estrace) 1mg Tablets #90  $Call
P0093090   Estradiol (Estrace) 2mg Tablets #90  $Call
P0094030   Estropipate (Ogen) 0.75mg Tablets #30            $Call
P0234030   Levothyroxine (Synthroid) 0.025mg Tablets #30  $Call
P0129030   Levothyroxine  (Synthroid) 0.05mg Tablets #30  $Call
P0131030   Levothyroxine  (Synthroid) 0.1mg Tablets #30  $Call
P0239030   Levothyroxine (Synthroid) 0.2mg Tablets #30  $Call
P0141030   Medroxyprogesterone (Provera) 2.5mg Tablets #30  $Call
P0140010   Medroxyprogesterone (Provera) 10mg Tablets #10  $Call

Muscle Relaxants

  
P0617015   Baclofen (Lioresal) 10mg Tablets #15  $Call
P0043020   Carisoprodol (Soma) 350mg Tablets #20  $Call
P0055014   Chlorzoxazone (Parafon) 500mg Tablets #14  $Call
P0064020   Cyclobenzaprine (Flexeril) 10mg Tablets #20            $Call
P0064030   Cyclobenzaprine (Flexeril) 10mg Tablets #30  $Call
P0145020   Methocarbamol 500mg (Robaxin) Tablets #20  $Call
P0146020   Methocarbamol 750mg  (Robaxin) Tablets #20  $Call
P0158020   Orphenadrine Citrate (Norflex) 100mg Tablets #20  $Call
P0168030   Piroxicam (Feldene) 20mg Capsules #30  $Call

Respiratory Medications

  
R0224017   Albuterol (Ventolin) Aerosol Inhaler 17gm  $Call
P0010030   Albuterol (Ventolin) 2mg Tablets #30  $Call
P0250060   Theophylline CR (Theo-Dur) 200mg Tablets #60  $Call
P0202060   Theophylline CR (Theo-Dur) 300mg Tablets #60  $Call

Scabies and Lice Medications

  
R0389002   Acticin (Elimite, Permethrin) 5% Cream 2oz  $Call
R0511004   Lice Treatment Shampoo 4oz  $Call

Vitamins and Supplements

  
R0265100   Ferrous Sulfate (Fer-In-Sol) 325mg UD Tablets #100            $  Call
R0264050   Ferrous Sulfate 125mg Drops 50ml  $  Call
P0217030   Folic Acid (Folvite) 1mg Tablets #30  $  Call
P0217090   Folic Acid (Folvite) 1mg Tablets #90  $Call
P0150030   Multi-Day Vitamin Tablets #30            $  Call
P0150090   Multi-Day Vitamin Tablets #90  $Call
R0757060   Oyst-Cal 500mg plus D Tablets #60  $ Call
O0000162   Pediatric Electrolyte (Pedialyte) Solution 33.8oz  $Call
R0318050   Polyvitamin/Fluor  0.25mg Drops 50ml  $ Call
R0319100   Polyvitamin/Fluor  0.5mg Chew Tabs #100  $  Call
R0638050   Polyvite drops no iron or Fl Drops 50ml  $ Call
P0259030   Potassium Chl. (Micro-K, K-Tab) 10mEq Tablets #30  $  Call
R0324100   Prenatal W/Folic Acid 0.8Mg Tablets #100  $  Call
P0274090   Thiamine 100mg Tablets #90  $  Call
P0650090   Vitamin E 400mg Capsules #90  $  Call

Weight Control

  
P0036014   Bontril SR 105mg Capsules #14 C3  $Call
P0036030   Bontril SR 105mg Capsules #30 C3  $Call
P0076030   Diethylpropion 25mg Tablets #30 C4  $Call
P0077014   Diethylpropion 75mg Tablets #14 C4  $Call
P0077028   Diethylpropion 75mg Tablets #28 C4  $Call
P0394028   Phendimetrazine 35mg (Yellow) Tablets #28 C4  $Call
P0394060   Phendimetrazine 35mg (Yellow) Tablets #60 C4  $Call
P0394084   Phendimetrazine 35mg (Yellow) Tablets #84 C4  $Call
P0165014   Phentermine 15mg Capsules #14 C3 Call
P0165030   Phentermine 15mg Capsules #30 C4  $Call
P0357030   Phentermine 30mg (Yellow) Capsules #30 C4