Upload
nguyentuong
View
213
Download
0
Embed Size (px)
Citation preview
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
2
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*
4
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
5
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
6
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
7
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.