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Edwards Air Force Base Pharmacy

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<strong>Edwards</strong> <strong>Air</strong> <strong>Force</strong> <strong>Base</strong><br />

<strong>Pharmacy</strong><br />

(Current as of 31 Oct 2013)


Table of Contents<br />

Welcome Letter from <strong>Pharmacy</strong> 3<br />

General <strong>Pharmacy</strong> Information 4<br />

How do I get my Refills 5<br />

<strong>Pharmacy</strong> Benefits 6<br />

Formulary Listing by alphabetical order (generic names) 8<br />

Listing by Common Use (not a complete listing) 20<br />

Quick Reference Phone Guide 21<br />

2


Welcome to <strong>Edwards</strong> AFB and the 412th Medical Group!<br />

We, the military and civilian pharmacy staff at the 412th Medical Group, are always striving to<br />

provide you and your family the best pharmaceutical care available. All of us are committed to<br />

providing quality services, and to ensure that the care you receive is and continues to be the best<br />

you’ve ever experienced.<br />

The pharmacy handbook/frequently asked questions has been created to hopefully make<br />

accessing pharmacy services easier and less confusing for beneficiaries. While it does not<br />

answer every question, it does provide guidance on most of our services.<br />

We would like to extend a special thank you to all of you in uniform who are defending our<br />

country and to all the veterans who have made major contributions to our nation. We also thank<br />

the families who have and continue to support all of you.<br />

<strong>Edwards</strong> <strong>Pharmacy</strong> Staff<br />

3


<strong>Pharmacy</strong> General Information<br />

What are the hours for the <strong>Pharmacy</strong><br />

<strong>Pharmacy</strong> hours are below.<br />

Monday 0730-1630<br />

Tuesday 0730-1630<br />

Wednesday 0730-1630<br />

Thursday 0730-1630<br />

Friday 0730-1630<br />

Closed the first Monday of each month, weekends, federal holidays, AFMC approved<br />

family days and Military down days.<br />

Where is the <strong>Pharmacy</strong><br />

The <strong>Pharmacy</strong> is located in the main clinic on 30 Nightingale Rd in building 5525.<br />

It is located in the south end of the first floor.<br />

Eligible beneficiaries include:<br />

<br />

<br />

<br />

<br />

<br />

<br />

<br />

Active duty service members and their families<br />

Activated National Guard and Reserve Members and their families (on Title 10 or Title<br />

32 [federal] orders)<br />

Retired service members and their families<br />

Survivors, widows/widowers and certain former spouses<br />

Medal of Honor recipients and their families<br />

Beneficiaries enrolled in TRICARE Reserve Select or the Continued Health Care Benefit<br />

Program<br />

Other beneficiaries listed in DEERS as eligible for TRICARE, including foreign force<br />

members and their families<br />

When updating DEERS with your personal information, be sure to update your address with a<br />

physical address.<br />

4


How do I get medication refills<br />

If you have an existing prescription that is still active with refills left, call the <strong>Pharmacy</strong> at<br />

661-277-9896. Prescriptions called into the refill line will be available for pickup within<br />

two duty days at the main pharmacy. If you present to the pharmacy window for a refill you<br />

may be asked to come back later or the next duty day. Please make every effort to call in<br />

prescription refills to avoid delays.<br />

Typically, if you’re running out of a medication (down to last refill or last set of doses), it<br />

means your provider is expecting you to follow-up for a re-evaluation. Please make a follow-up<br />

appointment prior to running out so your provider can see how you are doing.<br />

If your prescription has expired or you have no refills left and you see a provider on base,<br />

please call PCC at 661-277-7118 at least one week prior to running out of your medication.<br />

Ask to leave a telephone consult for your provider’s nurse. Please have the name and dosage of<br />

the medication ready to provide to the phone clerk, as it makes renewing your prescription<br />

easier. As long as the provider determines that you do not need a follow-up appointment prior<br />

to prescription renewal, your refill request will typically be taken care of within 72 business<br />

hours.<br />

If you see a civilian provider off base you will have to contact your provider for a new<br />

prescription. The pharmacy does accept faxed prescription orders.<br />

Any questions regarding your medications that can be handled by the pharmacy should be<br />

directed to their staff at 661-277-7118 (option 1 clinic pharmacy, option 3, option 2, speak to<br />

pharmacy personnel)<br />

5


YOUR PHARMACY Benefits<br />

All formulary medication at EDWARDS <strong>Pharmacy</strong>:<br />

$0 cost for up to a 90 day Supply<br />

Other Military Treatment Facility (MTF) Pharmacies<br />

An MTF pharmacy provides those medications listed on its local formulary (drug listing). Most<br />

MTF pharmacies accept prescriptions written by both civilian and military providers.<br />

To check the availability of a particular drug, contact you’re nearest MTF if not stationed at<br />

<strong>Edwards</strong> AFB in person or by phone.<br />

TRICARE Mail Order <strong>Pharmacy</strong> (TMOP)<br />

You can receive up to a 90-day supply* for most medications you take regularly (for instance,<br />

drugs for high blood-pressure, asthma or oral contraceptives) using TMOP.<br />

When you use the TMOP service you get:<br />

• Savings: You can save up to 66% of retail costs, because your<br />

Co-payment for a 90-day supply is the same as for a 30-day supply at a retail pharmacy.<br />

• Convenience and safety: Your medication is mailed to your home in a weather-resistant<br />

pouch for your privacy and protection and there is no charge for postage.<br />

You will pay a co-payment of:<br />

$0 for formulary generic for 90-day supply<br />

$13 for formulary brand-name for 90-day supply<br />

$43 for non-formulary drugs for 90-day supply.<br />

To use the TMOP service, just follow these steps:<br />

1) Ask your doctor for a prescription (for up to a 90-day supply*, plus refills for up to one year,<br />

if appropriate).<br />

2) Complete the TMOP registration/order form which can be downloaded from their website at:<br />

http://www.express-scripts.com/TRICARE/<br />

3) Insert your prescription, completed TMOP registration form, and co-payment, if needed, into<br />

the pre-addressed, postage paid envelope (attached to the registration form — use this envelope<br />

only for your TMOP registration) and mail them. Your prescriptions will be mailed to you<br />

within 14 days.<br />

6


• For more details on TMOP, please visit www.express-scripts.com/TRICARE or call 1-<br />

877-363-1303.<br />

DoD TRICARE Retail <strong>Pharmacy</strong> (TRRx) Network<br />

Another option for filling your prescription is to use a DoD TRRx network retail pharmacy.<br />

Simply give the network pharmacist your written prescription and your uniformed services<br />

identification (ID) card.<br />

You will pay a co-payment of:<br />

$5 for formulary generic for 30-day supply<br />

$17 for formulary brand-name for 30-day supply<br />

$44 for non-formulary drugs for 30-day supply.<br />

To find a DoD TRICARE Retail <strong>Pharmacy</strong> near you:<br />

• Visit www.express-scripts.com/TRICARE.<br />

The online pharmacy locator is updated on the first day of each month. If a pharmacy joined<br />

after the first day of the month, it might not appear on the locator until the following month.<br />

• Call 1.877.363.1303).<br />

Non-Network Retail <strong>Pharmacy</strong><br />

Your medications will cost the most at non-network retail pharmacies because they do not<br />

belong to the DoD TRRx network. At non-network pharmacies you will pay full price for your<br />

medication. To be reimbursed for non-network pharmacy claims, you must fill out the enclosed<br />

claim form (DD 2642), attach the required paperwork as described on the DD2642, and mail it<br />

to:<br />

Express Scripts<br />

P.O. Box 66518<br />

St. Louis, MO 63166-6518<br />

You can download additional claim forms (DD 2642) at www.express-scripts.com/TRICARE<br />

or www.tricare.osd.mil/ pharmacy/claims.cfm. Claim forms may also be obtained at<br />

TRICARE Service Centers and MTFs.<br />

7


<strong>Edwards</strong> AFB <strong>Pharmacy</strong> Formulary<br />

Alphabetically Listed by Generic Name<br />

Generic Name Brand Name How Supplied<br />

ACETAMINOPHEN Tylenol Tabs: 325 mg, 650mg<br />

Infant Drops: 80 mg/0.8 ml<br />

Soln: 160 mg/5 ml.<br />

Supps: 120mg, 650 mg<br />

ACETAMINOPHEN/BUTALBITAL/ Fioricet<br />

Tabs: 325mg/50mg/40mg<br />

CAFFEINE<br />

ACETAMINOPHEN/CODEINE<br />

PHOSPHATE<br />

Tylenol w/Codeine C-III Tabs: 30mg/300mg<br />

Elixir: 12mg/120 mg/5 ml<br />

ACETAZOLAMIDE Diamox Tabs: 250 mg, 500mg<br />

ACETIC ACID Domeboro Powder Packets<br />

ACYCLOVIR Zovirax Caps: 200mg Tabs: 400mg, 800mg<br />

Susp: 200mg/5ml<br />

Oint: 15 g<br />

ADAPALENE GEL Differin 0.1% Gel: 45g<br />

ALBUTEROL HFA Ventolin HFA Inhaler: 90mcg, 200 sprays/unit<br />

Neb Soln: 0.5%, 0.083%<br />

Oral Liq: 5mg/5ml.<br />

ALBUTEROL/ IPRATROPIUM Combivent<br />

Duoneb<br />

Inhaler: 200 sprays/unit<br />

Nebulizer: 0.5mg/2.5mg<br />

ALENDRONATE<br />

Fosamax<br />

Tabs: 5mg, 10 mg, 35 mg, 70 mg<br />

Soln: 70mg/75ml<br />

Tabs: 70mg/2800 IU, 70mg/5600 IU<br />

ALENDRONATE/VITAMIN D<br />

Fosamax Plus D<br />

ALFUZOSIN Uroxatral Tabs: 10mg<br />

ALLOPURINOL Zyloprim Tabs: 100mg, 300mg<br />

ALPRAZOLAM Xanax C-IV Tabs: 0.25mg, 0.5mg, 1mg, 2mg<br />

ALUMINUM CHLORIDE<br />

Drysol<br />

Liq: 37.5ml<br />

HEXAHYDRATE<br />

AMANTADINE Symmetrel Tabs: 100mg<br />

Syrup: 50mg/5 ml<br />

AMIODARONE Cordarone/Pacerone Tabs: 200mg, 400mg<br />

AMITRIPTYLINE Elavil Tabs: all strengths<br />

AMLODIPINE Norvasc Tabs: all strengths<br />

AMLODIPINE/BENAZEPRIL Lotrel Caps: all strengths<br />

AMMONIUM LACTATE Lac-Hydrin Lotion: 12%<br />

AMOXICILLIN Amoxil Susp:125mg/5ml, 250 mg/5ml, 400 mg/5 ml<br />

Caps: 250mg, 500mg<br />

AMOXICILLIN/ CLAVULANATE Augmentin Susp: 200mg/5ml, 250mg/5ml, 400mg/5ml<br />

ES Susp: 600 mg/5 ml<br />

Tabs: 250mg/125mg, 500mg/125mg,<br />

875mg/125mg<br />

Chew Tabs: 250/62.5mg<br />

XR: 1000 mg<br />

AMPHETAMINE/<br />

DEXTROAMPHETAMINE<br />

Adderall C-II<br />

Adderall XR C-II<br />

Tabs: 5, 10, 30 mg<br />

XR Caps: all strengths<br />

AMPICILLIN Ampicillin Caps: 500 mg<br />

ANTIPYRINE/<br />

Auralgan<br />

Otic soln: 15 ml<br />

BENZOCAINE/GLYCERIN<br />

ARIPIPRAZOLE Abilify Tabs: 5mg,10mg,15mg<br />

ARMOUR THYROID Thyroid Tabs: 15mg,30mg,60mg, & 90mg<br />

ASPIRIN ENTERIC COATED Ecotrin Tabs: 81mg, 325mg<br />

ATENOLOL Tenormin Tabs: all strengths<br />

8


ATOMOXETINE Strattera Caps: all strengths<br />

ATOPICLAIR<br />

Cream<br />

ATORVASTATIN Lipitor Tabs: all strengths<br />

AZATHIOPRINE Imuran Tabs: 50mg<br />

Prescription has to be written by Specialist<br />

AZELASTINE Astelin Nasal spray: 137mcg/spray<br />

**DoD Quantity limit 2 per 30 days**<br />

AZITHROMYCIN Zithromax Tabs: 250mg, 500mg Packet: 1g<br />

Susp: 100mg/5ml, 200mg/5ml<br />

BACITRACIN Bacitracin Oph oint<br />

Topical oint<br />

BACITRACIN/NEOMYCIN/<br />

Polysporin<br />

Oph oint<br />

POLYMYXIN<br />

BACLOFEN Lioresal Tabs: all strengths<br />

BELLADONNA ALKALOIDS Donnatal Tabs: 16.2mg<br />

Liq: 16.2mg/5ml<br />

BENAZEPRIL Lotensin Tabs: all strengths<br />

BENZONATATE Tessalon Perles Caps: all strengths<br />

BENZOYL PEROXIDE GEL,<br />

BENZOYL PEROXIDE WASH<br />

Benzac Gel: 42.5g (10%)<br />

Sol: 227g (10%)<br />

BENZOYL PEROXIDE/<br />

Benzaclin Gel: 25 g (1-5%)<br />

CLINDAMYCIN<br />

BENZTROPINE Cogentin Tabs: all strengths<br />

BETAMETHASONE<br />

DIPROPRIONATE<br />

Diprosone<br />

Cream: 0.05%, 45 g<br />

Oint: 0.05%, 15 g<br />

BETAMETHASONE VALERATE Valisone Cream: 0.1%, 15 g, 45 g<br />

BETAXOLOL Betoptic S Oph susp: 0.5%, 5 ml.<br />

BICALUTAMIDE Casodex Tabs: 50mg<br />

BISACODYL Dulcolax Tabs: 5 mg<br />

BLOOD GLUCOSE LANCETS Trueplus Boxes of 100<br />

BLOOD GLUCOSE MONITOR Trueresult/Precision Xtra<br />

BLOOD GLUCOSE STRIPS<br />

Precision Xtra<br />

Boxes of 100<br />

Trueresult<br />

BRIMONIDE Alphagan P Oph soln: 0.15%, 0.2%<br />

BROMOCRIPTINE Parlodel Tabs: all strengths<br />

BUDESONIDE Pulmicort Respules Neb Sol: all strengths<br />

BUDESONIDE/FORMOTEROL Symbicort Inhaler: 160/4.5, 80/4.5 mcg<br />

BUPROPRION Wellbutrin Tabs: 75, 100mg<br />

BUPROPRION Wellbutrin SR SR Tabs: 100mg, 150mg<br />

BUPROPRION Zyban SR Tabs: 150 mg<br />

BUPROPRION Wellbutrin XL Tabs: 150mg & 300mg<br />

BUSPIRONE HCL Buspar Tabs: all strengths<br />

CALCIUM CARB+VIT D OSCAL+D Tabs: 500mg<br />

CANDESARTAN Atacand Tabs: all strengths<br />

CANDESATAN/HCTZ Atacand HCT Tabs: 16/12.5, 32/12.5mg<br />

CAPTOPRIL Capoten Tabs: all strengths<br />

CARBAMAZEPINE<br />

Tegretol<br />

Tegretol XR<br />

Chewable tabs: 100mg Tabs: 200mg<br />

XR tabs: all strengths<br />

Liq: 100mg/5ml<br />

CARBAMIDE PEROXIDE Debrox Drops: 6.5%<br />

CARBIDOPA/LEVODOPA<br />

Sinemet<br />

Sinemet CR<br />

Tabs: 10/100, 25/100, 25/250 mg<br />

CR: 25/100 mg<br />

CARBOXYMETHYLCELLULOSE Celluvisc<br />

Refresh plus<br />

Boxes of 30<br />

Oph soln: 0.5%<br />

CARISOPRODOL Soma Tabs: 350 mg<br />

CARVEDILOL Coreg Tabs: all strengths<br />

CEFADROXIL Duricef Susp: 250 mg/5 ml<br />

CEFDINIR Omnicef Susp: 125 mg/5 ml & 250 mg/5 ml<br />

CEFPODOXIME Vantin Susp: 100 mg/5 ml<br />

9


CEFUROXIME Ceftin Susp: 250 mg/5 ml<br />

Tabs: 250, 500 mg<br />

CELECOXIB Celebrex Caps: all strengths<br />

CEPHALEXIN Keflex Caps: all strengths<br />

Susp: 250mg/5ml<br />

CETAPHIL Cetaphil Skin cleanser: 237ml<br />

CETIRIZINE Zyrtec Tabs: 10 mg Liquid: 5 mg/5 ml Chewable:<br />

5mg<br />

CETIRIZINE/PSEUDOEPHEDRINE Zyrtec-D Tabs: 5/120 mg<br />

CHLORAL HYDRATE Noctec Syrup: 500 mg/5 ml<br />

CHLORHEXIDINE RINSE Peridex Rinse: 0.12%<br />

CHLOROQUINE Aralen Tabs: 250, 500 mg<br />

CHLORTHALIDONE Hygroton Tabs: all strengths<br />

CIMETIDINE Tagamet Tabs: all strengths<br />

CIPROFLOXACIN Cipro Tabs: all strengths<br />

Susp: 5gm/100ml<br />

CIPROFLOXACIN Ciloxan Opth: 0.3%/2.5 ml<br />

CIPROFLOXACIN/DEXAMETHASONE CiproDex<br />

Soln: 7.5 ml<br />

CITALOPRAM Celexa Tabs: all strengths<br />

Soln: 10mg/5ml<br />

CLARITHROMYCIN Biaxin Tabs: 250, 500 mg<br />

CLINDAMYCIN Cleocin Caps: all strengths<br />

Susp: 75 mg/5 ml<br />

Top Soln: 1%, 60 ml<br />

Top Pads: 1%<br />

Vaginal Cream: 2%(40 gm)<br />

CLINDINIUM/<br />

Librax<br />

Caps: 2.5 mg/5 mg<br />

CHLORDIAZEPOXIDE<br />

CLOBETASOL PROPRIONATE Temovate 0.05% Cream: 15g, 45g<br />

0.05% Oint, 0.05% Soln<br />

CLOMIPHENE Clomid Tabs: 50 mg<br />

CLONAZEPAM Klonopin C-IV Tabs: all strengths<br />

CLONIDINE Catapres Tabs: all strengths<br />

CLOPIDOGREL Plavix Tabs: 75 mg<br />

CLOTRIMAZOLE Lotrimin 1% Cream: 30 g<br />

1% Topical soln<br />

CLOTRIMAZOLE / BETAMETHASONE Lotrisone<br />

Cream: 15, 45 g<br />

DIP<br />

CODEINE SULFATE Codeine C-III Tabs: 30 mg<br />

CODEINE/ GUAIFENESIN Robitussin AC C-V Liq: 10/100 mg per 5 ml (120 ml)<br />

**Qty must be in equivalents of 120 ml**<br />

COLESTIPOL Colestid Tabs: 1 g Powder Packets: Box of 90<br />

COLOCHICINE Colchicine Tabs: 0.6 mg<br />

CONJUGATED ESTROGENS Premarin Tabs: all strengths<br />

Vaginal cream 0.625mg/gm<br />

CONJUGATED ESTROGEN/<br />

Prempro<br />

Tabs: all strengths<br />

MEDROXYPROGESTERONE<br />

CROMOLYN SODIUM Crolom Oph Soln: 4%, 15 ml<br />

CYANOCOBALAMIN B-12 Injection 1ml vial<br />

CYCLOBENZAPRINE Flexeril Tabs: all strengths<br />

CYCLOPENTOLATE Cyclogel Oph Soln: 0.1%, 5 ml<br />

CYCLOSPORINE Restasis Oph Susp: 0.05%<br />

CYPROHEPTADINE Periactin Tabs: 4 mg<br />

Syrp: 2mg/5ml<br />

DESIPRAMINE Norpramin Tabs: all strengths<br />

DESMOPRESSIN DDAVP Tabs: 0.2 mg<br />

DESOGESTREL/ETHINYL<br />

Mircette<br />

28 day packs<br />

ESTRADIOL (Biphasic)<br />

DESOGESTREL/ETHINYL ESTRADIOL Desogen<br />

28 day packs<br />

10


DESONIDE Desowen Cream: 0.05% 60g<br />

Oint: 0.05% 60g<br />

DETEMIR Levemir Insulin vial<br />

DEXAMETHASONE Decadron Tabs: 0.5 mg, 4 mg<br />

Inj: 4mg/ml<br />

DEXTROAMPHETAMINE Dexedrine C-II Tabs: 5, 10 mg<br />

SR Caps: 5 mg, 15mg<br />

DIAZEPAM Valium C-IV Tabs: all strengths<br />

DICLOFENAC SODIUM Voltaren Tabs: 50, 75 mg<br />

Oph soln: 0.1%<br />

Top Gel: 1%<br />

DICLOXACILLIN Dynapen Caps: all strengths<br />

DICYCLOMINE Bentyl Tabs: all strengths<br />

Soln: 10mg/5ml<br />

DIGOXIN Lanoxin Tabs: all strengths<br />

Soln: 0.05mg/ml<br />

DILTIAZEM Tiazac Tabs: all strengths<br />

ER Caps: all strengths<br />

DIPHENOXYLATE W/ATROPINE Lomotil C-V Tabs: 2.5/0.025 mg<br />

DIPHENYDRAMINE Benadryl Caps: 25 mg, 50 mg Liq: 12.5 mg/5 ml<br />

DISOPYRAMINE Norpace Caps: 100 mg<br />

DIVALPROEX<br />

Depakote<br />

Depakote Sprinkles<br />

Depakote ER<br />

Tabs: all strengths<br />

Caps: 125 mg<br />

ER tabs: all strengths<br />

DOCUSATE SODIUM Colace Caps: 100 mg<br />

DONEPEZIL Aricept Tabs: all strengths<br />

DORZOLAMIDE Trusopt 2% Oph soln: 10 ml<br />

DORZOLAMIDE / TIMOLOL Cosopt Oph soln: 2%-0.05%<br />

DOXAZOSIN Cardura Tabs: all strengths<br />

DOXEPIN Adapin Caps: all strengths<br />

Soln: 10mg/ml<br />

DOXYCYCLINE HYCLATE Vibramycin Tabs: 100 mg<br />

Caps: 50, 100mg<br />

ENALAPRIL Vasotec Tabs: 2.5mg, 5mg &10mg<br />

ENOXAPARIN SODIUM Lovenox Inj: all strengths<br />

EPINEPHRINE<br />

Epi-Pen/Epi-Pen Jr<br />

Auto-injector 0.15mg/dose, 0.3mg/dose<br />

Twinject/Twinject Jr<br />

EPINEPHRINE Ephfrin 2% Oph soln: 15 ml<br />

ERGOTAMINE TARTRATE<br />

Cafergot<br />

Tabs: 100 mg/1 mg<br />

W/CAFFEINE<br />

ERYTHROMYCIN<br />

Erythrocin<br />

Romycin<br />

Tabs: all strengths<br />

Susp: 200 mg/5 ml<br />

Oph oint: 0.5% 5 mg/gm<br />

2% Topical soln: 60 ml<br />

2% gel<br />

ERGOCALCIFEROL Vitamin D Gel Caps: 50,000 units<br />

ESCITALOPRAM Lexapro Tabs: all strengths<br />

ESOMEPERZOLE Nexium Caps: all strengths<br />

ESTRADIOL<br />

Estrace<br />

Estraderm<br />

Vivelle Dot<br />

Esclim<br />

Tabs: all strengths<br />

Patch: all strengths<br />

ESTROGEN/<br />

Estratest HS<br />

Tabs: 0.625/1.25 mg<br />

METHYLTESTOSTERONE<br />

ETHAMBUTOL Myambutol Tabs: all strengths<br />

ETHINYL ESTRADIOL/<br />

DESOGESTREL<br />

Orthocept (Reclipsen) 0.03 mg EE/.015 mg D<br />

28 day packs<br />

ETHINYL ESTRADIOL/<br />

DROSPIRENONE<br />

Yasmin<br />

Yaz<br />

Tabs: 30 mcg/3 mg; 28 day packs<br />

Tabs: 20 mcg/3 mg; 28 day packs<br />

11


ETHINYL ESTRADIOL/<br />

ETONOGESTREL<br />

ETHINYL ESTRADIOL<br />

LEVONORGESTREL<br />

ETHINYL ESTRADIOL/<br />

LEVONORGESTREL<br />

ETHINYL ESTRADIOL/<br />

LEVONORGESTREL<br />

ETHINYL ESTRADIOL/<br />

NORELGESTROMIL<br />

ETHINYL ESTRADIOL/<br />

NORETHINDRONE<br />

ETHINYL ESTRADIOL/<br />

NORGESTIMATE<br />

Nuvaring<br />

TriLevlen, TriPhasil, Alesse,<br />

Lutera<br />

Nordette, Mircette<br />

Jollessa (brand only)<br />

Ortho Evra<br />

Ortho-Novum<br />

Loestrin 1/20 FE<br />

Necon 1/35<br />

Ortho-Cyclen<br />

Ortho Tri-cyclen<br />

Ortho Tri-cyclen LO<br />

ETHINYL ESTRADIOL/ NORGESTREL Ovral, LoOvral<br />

Vaginal ring<br />

Tabs:<br />

28 day packs<br />

28 day packs<br />

Tabs: extended cycles<br />

Transdermal patch<br />

28 day packs<br />

28 day packs<br />

28 day packs<br />

ETONORGESTREL Implanon IM device<br />

EZETMIBE Zetia Tabs: 10 mg<br />

FAMOTIDINE Pepcid Tabs: 20mg and 40mg<br />

FELODIPINE Plendil Tabs: all strengths<br />

FENOFIBRATE Lofibra, Tricor Tabs: 48mg, 54mg, 145mg, and 160 mg<br />

FERROUS SULFATE FeoSol Soln: 25 mg/ml, 50ml.<br />

Tabs: 325 mg<br />

FEXOFENADINE Allegra Tabs: 60, 180 mg<br />

FINASTERIDE Proscar Tabs: 5 mg<br />

FLUCONAZOLE Diflucan Tabs: all strengths<br />

FLUDROCORTISONE Florinef Tabs: 0.1 mg<br />

FLUNISOLIDE Nasarel Nasal spray: 25 mcg. 200 sprays/unit<br />

FLUOCINOLONE Synalar Soln: 1%, 60 ml<br />

FLUOCINONIDE Lidex *Cream: 0.05%, 15 g, 60 g<br />

Gel: 0.05%, 60 g<br />

Oint: 0.05%, 60 g<br />

FLUORIDE Prevident 5000+ 1 box<br />

FLUOROMETHOLONE Fluor-Op, FML Susp: 0.1%, 15 ml<br />

FLUOXETINE Prozac Caps: 10, 20, 40 mg<br />

Soln: 20mg/5ml<br />

FLUTICASONE Flonase Nasal spray: 50 mcg, 120 sprays/unit<br />

FLUTICASONE HFA Flovent HFA Inhaler: 44, 110, 220 mcg<br />

**Qty limit 2 per 30 days**<br />

FLUTICASONE Diskus Flovent Diskus Inhaler<br />

FLUTICASONE/ SALMETEROL Advair<br />

Advair HFA<br />

FOLIC ACID Folic Acid Tabs: 1 mg<br />

FUROSEMIDE Lasix Tabs: all strengths<br />

Soln: 10mg/ml<br />

GABAPENTIN Neurontin Caps: all strengths<br />

GEMFIBROZIL Lopid Tabs: 600 mg<br />

GENTAMICIN SULFATE Geramicin Oph soln: 0.3%, 5 ml<br />

Oph oint: 3.5 g<br />

GLIMEPIRIDE Amaryl Tabs: 1mg, 2mg, 4mg<br />

GLIPIZIDE<br />

Glucotrol<br />

Glucotrol XL<br />

Micronase<br />

Inhaler: 100/50 mcg, 250/50mcg, 500/50 mcg<br />

Inhaler: 45/21 mcg, 115/21 mcg, 230/21 mcg<br />

*Tabs: all strengths<br />

XL Tabs: all strengths<br />

Tabs: all strengths<br />

Micronized: all strengths<br />

GLYBURIDE<br />

GLYBURIDE MICRONIZED<br />

GLYBURIDE/ METFORMIN Glucovance Tabs: all strengths<br />

GOSERELIN Zoladex Implants: 3.6 mg, 10.8 mg<br />

12


GRAMICIDIN/NEOMYCIN/POLYMYXI<br />

Soln: 0.025mg/2.5mg/10000unit/ml<br />

N B<br />

GRISEOFULVIN Grispeg, Grifulvin V Tabs: 125, 250 mg Susp: 125 mg/5 ml<br />

GUAIFENESIN Mucinex Tabs: 600 mg<br />

GUAIFENESIN/PSE MucinexD Tabs: 600/60 mg,<br />

GUAIFENSIN/DEXTROMETHORPHAN Robitussin DM<br />

Liq: 100/10 mg per 5 ml<br />

HALOPERIDOL Haldol Caps: 1 mg, 10 mg<br />

HOMATROPINE Isopto Homatropine Liq: 5%, 5 ml<br />

HYALURONIC ACID Atopiclair Topical cream<br />

HYDRALAZINE Apresoline Tabs: 10, 25, 50 mg<br />

HYDROCHLOROTHIAZIDE HCTZ Caps 12.5 mg Tabs 25, 50 mg<br />

HYDROCODONE/<br />

ACETAMINOPHEN<br />

Vicodin<br />

Vicodin ES<br />

*Tabs: 5/500 mg<br />

ES Tabs: 7.5/750 mg<br />

HYDROCODONE/<br />

Norco<br />

Tabs: 5/325mg, 10/325mg<br />

ACETAMINOPHEN<br />

HYDROCORTISONE Anusol HC Cream: 2.5%<br />

Supps: 25 mg<br />

HYDROCORTISONE ACETATE/ Proctofoam<br />

Foam: 1%, 10 g<br />

PRAMOXINE<br />

HYDROCORTISONE VALERATE Westcort 0.2% Cream: 15 g, 60 g<br />

0.2% Oint: 45 g<br />

HYDROCORTISONE/<br />

Vosol HC<br />

Susp: 10 ml<br />

ACETIC ACID<br />

HYDROQUINONE w/ SUNSCREEN Solaquin Gel: 4%<br />

HYDROXYCHLOROQUINE Plaquenil Tabs: 200 mg<br />

HYDROXYPROPYL<br />

GenTeal Gel Opt Gel: 0.3%<br />

METHYLCELLULOSE<br />

HYDROXYZINE Atarax Tabs: all strengths Liq: 10 mg/5 ml<br />

IBANDRONATE Boniva Tabs: all strengths<br />

IBUPROFEN Motrin Tabs: all strengths<br />

Susp: 100 mg/5 ml<br />

IMIPRAMINE Tofranil Tabs: all strengths<br />

INDOMETHACIN Indocin *Caps: all strengths<br />

ER Cap: 75 mg<br />

INSULIN ASPART Novolog, Novolog Flexpen 100 units/ml, 10 ml vial<br />

INSULIN DETEMIR Levemir Vials 100 units/ml, 10ml vial<br />

INSULIN GLARGINE Lantus, Lantus SoloStar Pen 100 units/ml, 10 ml vial<br />

100 units/ml, pen<br />

INSULIN NPH/REGULAR 70/30 Novolin 70/30 100 units/ml, 10 ml vial<br />

INSULIN HUMAN NPH Novolin N 100 units/ml, 10 ml vial<br />

INSULIN HUMAN 70/30 Novolog Mix 70/30 100 units/ml, 10 ml vial<br />

INSULIN HUMAN REGULAR Novolin R 100 units/ml, 10 ml vial<br />

INSULIN SYRINGES<br />

Boxes of 100: 0.5 ml, 1 ml 29 G,½”<br />

INSULIN PEN NEEDLES<br />

IPATROPIUM BROMIDE<br />

**Limit 300 syringes/90 days**<br />

Neb Soln, Nasal spray<br />

Inhaler<br />

Atrovent<br />

Atrovent HFA<br />

ISONIAZID INH Tabs: all strengths Syrup: 50 mg/5 ml<br />

ISOSORBIDE DINITRATE Isordil SR Caps: 40 mg<br />

Tabs: all strengths<br />

ISOSORBIDE MONONITRATE Imdur Tabs: all strengths<br />

ISOTRETINOIN Accutane Caps: all strengths<br />

KETOCONAZOLE Nizoral Cream: 30 g<br />

Shampoo: 4 oz.<br />

KETOROLAC TROMETHAMINE Acular Oph soln: 0.5%, 5ml<br />

KETOTIFEN Zaditor Oph soln: 0.025 % 5 ml<br />

LACTULOSE Cepulac Syrup: 10 g/15 ml<br />

LAMOTRIGINE Lamictal Tabs: all strengths<br />

LANCETS Trueplus Boxes of 100<br />

13


LANCET DEVICE Soft-Touch Device<br />

LATANOPROST Xalatan Oph soln: 0.005%, 2.5 ml<br />

LEUCOVORIN Leucovorin Tabs: 5 mg<br />

LEVALBUTEROL Xopenex Inhaler: 200 sprays/unit<br />

LEVETIRACETAM Keppra Tabs: 500mg and 750mg<br />

LEVOFLOXACIN Levaquin Tabs: all strengths<br />

Soln: 25mg/ml<br />

LEVONORGESTREL Plan B One-Step Tabs: 1.5mg<br />

LEVONORGESTREL IUD Mirena IUD *Must have scheduled appt*<br />

LEVORA Nordette 28 day packs: 0.15/30<br />

LEVOTHYROXINE Synthroid Tabs: all strengths<br />

LIDOCAINE HCL<br />

Xylocaine<br />

Lidoderm<br />

Gel: 2%, 30 ml<br />

Soln: 2%, 100 ml<br />

Top Patch: 5%<br />

LISINOPRIL Zestril Tabs: all strengths<br />

LISINOPRIL/HCTZ Zestoretic Tabs: all strengths<br />

LITHIUM CARBONATE<br />

Lithium<br />

Lithium citrate<br />

Lithium carbonate XR<br />

Tabs: all strengths<br />

Caps: 600mg<br />

Syrp: 8mEq/5ml<br />

XR: 450mg<br />

LOPERAMIDE Imodium Caps: 2 mg<br />

LORATADINE Claritin Tabs: 10 mg<br />

Syrup: 1 mg/ml<br />

LORAZEPAM Ativan Tabs: all strengths<br />

LOSARTAN Cozaar Tabs: all strengths<br />

LOSARTAN/HCTZ Hyzaar Tabs: all strengths<br />

LOTEPREDNOL Alrex Susp: 0.2%, 5 ml<br />

LUBRICANT Lacrilube Opth oint: 3.5 g<br />

MAGNESIUM OXIDE Magnesium Oxide Tabs: 400mg<br />

MEBENDAZOLE Vermox Chew Tabs: 100 mg<br />

MECLIZINE Antivert Tabs: all strengths<br />

MEDROXYPROGESTERONE Depo Provera Injection: 150 mg<br />

**Must have appt for administration**<br />

MEDROXYPROGESTERONE Provera Tabs: all strengths<br />

MEGESTROL ACETATE Megace Tabs: 20mg & 40mg<br />

MEFLOQUINE Lariam Tabs: 250 mg<br />

MELOXICAM Mobic Tabs: 7.5, 15 mg<br />

MEMANTINE Namenda Tabs: 10mg<br />

MESALAMINE Asacol Tabs: 400mg<br />

MINERIN Eucerin Jar: 1 lb.<br />

METAXOLONE Skelaxin Tabs: 800 mg<br />

METFORMIN HCL<br />

Glucophage<br />

Glucophage XR<br />

Tabs: all strengths<br />

XR Tabs: all strengths<br />

METHIMAZOLE Tapazole Tabs: 10mg<br />

METHOCARBAMOL Robaxin Tabs: all strengths<br />

METHOTREXATE Rhemstrex Tabs: 2.5 mg<br />

METHYLDOPA Aldomet Tabs: all strengths<br />

METHYLPHENIDATE Ritalin C-II *Tabs: all strengths<br />

SR Tabs: 20 mg<br />

METHYLPHENIDATE XR Concerta C-II Tabs: all strengths<br />

METHYLPREDNISOLONE Medrol Tabs: 4 mg, dose pack<br />

METOCLOPRAMIDE HCL Reglan Tabs: all strengths Liq: 5 mg/5 ml<br />

METOPROLOL<br />

Lopressor<br />

Toprol XL<br />

Tabs: all strengths<br />

Tabs: all strengths<br />

METRONIDAZOLE Flagyl Tabs: all strengths<br />

METRONIDAZOLE Metro-Cream Cream: 0.075%<br />

METRONIDAZOLE Metro-Gel Gel: 1%<br />

METRONIDAZOLE Metrogel-Vaginal Gel: 0.75%, 70 g<br />

MICONAZOLE Nitrate Cream: 2%<br />

14


MINOCYCLINE Minocin Caps: all strengths<br />

MI PASTE PLUS MI Paste Dental paste<br />

MIRTAZAPINE Remeron Tabs: 15mg, 30mg, 45 mg<br />

MOISTURIZING CREAM Eucerin cream Cream<br />

MOMETASONE Elocon Cream: 15g, 30g<br />

Oint: 45g<br />

Solution: 60ml<br />

MOMETASONE<br />

Nasonex<br />

Asmanex<br />

Nasal spray<br />

Twisthaler<br />

MOMETASONE/FORMOTEROL Dulera Inhaler<br />

MONITOR, BLOODGLUCOSE Precision Xtra<br />

Kit<br />

True Result<br />

MONTELUKAST Singulair Tabs: all strengths<br />

Oral granules: 4 mg<br />

MORPHINE SULFATE IR Morphine C-II Tabs: all strengths<br />

MORPHINE SULFATE ER MS Contin C-II ER Tabs: all strengths<br />

MOXIFLOXACIN Vigamox Oph Soln: 0.5%, 5ml<br />

MULTIVITAMIN PEDIATRIC<br />

Poly Vi Sol w/Iron<br />

Soln: 50 ml<br />

SOLUTION W/IRON<br />

MULTIVITAMIN W/ FLUORIDE Poly Vi Flor Soln: 50 ml<br />

MUPIROCIN Bactroban Oint: 15 g<br />

NAPROXEN<br />

Naprosyn<br />

Naproxen sodium<br />

Tabs: all strengths<br />

Tabs: all strengths<br />

Susp: 125mg/ 5ml<br />

NEFAZODONE Serzone Tabs: 150 mg<br />

NEOMYCIN/POLYMYXIN/HC Cortisporin HC Soln, Susp: 10 ml<br />

NEOMYCIN/POLYMYXIN/<br />

Neosporin<br />

Ophth oint<br />

BACITRACIN<br />

NEOMYCIN/POLYMYXIN/<br />

Neosporin<br />

Oph soln 10 ml<br />

GRAMICIDIN<br />

NIACIN Niaspan *ER Tabs: all strengths<br />

NICOTINE Nicoderm Patches: all strengths<br />

NIFEDIPINE<br />

Adalat CC<br />

Procardia<br />

*SR Tabs: all strengths<br />

Caps: 10 mg<br />

NITROFURANTOIN Furadantin Susp: 25mg/5ml<br />

NITROFURANTOIN<br />

Macrobid<br />

Macrodantin<br />

Caps: 100 mg<br />

Caps: all strengths<br />

NITROGLYCERIN<br />

Nitrostat, Nitrobid, Nitro Dur SL Tabs: 0.4 mg<br />

SL Spray: 0.4 mg<br />

SR Caps: all strengths<br />

Patches: all strengths<br />

Ointment: 2%<br />

NORETHINDRONE Nor-QD 28 day packs<br />

NORETHINDRONE/ETHINYL Necon 7/7/7<br />

28 day packs<br />

ESTRADIOL<br />

NORETHINDRONE/ETHINYL Microgestin Fe 1.5/30 and 1/20 28 day packs<br />

ESTRADIOL/FERROUS FUMARATE<br />

NORGESTREL/ETHINYL ESTRADIOL Ogestrel 28 day packs Tabs: 0.5/0.05mg<br />

NORTRIPTYLINE Pamelor Caps: all strengths<br />

NYSTATIN Niastat Cream: 15 g<br />

Oint: 15 g<br />

Powder 100,000 unit<br />

Susp: 100,000 units/60 ml<br />

OFLOXACIN Ocuflox Oph Soln: 0.3% 5 ml<br />

OFLOXACIN Floxin Otic Soln: 5 mL<br />

OLANZAPINE Zyprexa Tabs: all strengths<br />

OLOPATADINE Patanol Oph soln: 0.1 % 5 ml<br />

OMEPRAZOLE Priolosec Caps: all strengths<br />

15


ONDANSETRON Zofran Tabs: all strengths<br />

ODT tabs: all strengths<br />

Liquid 4mg/5ml<br />

OXYBUTYNIN Ditropan Tabs: 5mg<br />

OXYBUTYNIN ER Ditropan XL Tabs: all strengths<br />

OXYCODONE/<br />

Percocet<br />

Tabs: 5/325 mg and 10/325mg<br />

ACETAMINOPHEN<br />

OXYMETAZOLINE Afrin nasal spray Soln: 0.05% (15 ml)<br />

PANTOPRAZOLE Protonix Tabs: 40mg<br />

PAROXETINE Paxil Tabs: all strengths<br />

PENICILLIN VK PenV K, Veetids Susp: 125mg/5ml, 250 mg/5 ml<br />

Tabs: all strengths<br />

PERMETHRIN Elimite, Nix Cream: 5%, 60 g Cream: 1%, twin pack 60 ml<br />

PHENAZOPYRIDINE Pyridium Tabs: all strengths<br />

PHENOBARBITAL Phenobarbital Tabs: 324mg<br />

PHENYLEPHRINE Mydfrin Oph soln: 2.5%, 5 ml<br />

PHENYTOIN Dilantin Caps: 100 mg Tabs Chew: 50 mg<br />

Susp: 125mg/5ml<br />

PILOCARPINE Pilocar Oph Soln: all strengths<br />

Oph Gel 4%<br />

PIMECROLIMUS Elidel Tube: 15 g, 30 g<br />

PIOGLITAZONE Actos Tabs: all strengths<br />

PIOGLITAZONE/<br />

Actoplus met<br />

Tabs: 15/850, 15/500 mg<br />

METFORMIN<br />

PIPERONYL BUTOXIDE/PYRETHRUM Rid Lice Shampoo: 4%/0.33%<br />

EXTRACT<br />

PODOFILOX Condylox Soln: 0.5%<br />

Gel: 0.5%<br />

POLYETHYLENE GLYCOL Trilyte Pwd for Reconst: 4 L<br />

POLYETHYLENE GLYCOL 3350 Miralax Powder: 527, 255 g<br />

POLYMYXIN B/TRIMETHOPRIM Polytrim Opth soln: 5 ml<br />

POLYVINYL ALCOHOL Artificial Tears Opth soln: 15ml<br />

Opth oint: 3.5g<br />

POTASSIUM BICARBONATE/POT Klorvess<br />

Packets: 20 mEq<br />

CHLORIDE<br />

POTASSIUM CHLORIDE<br />

Klor-con<br />

Box of 30<br />

ER Tabs: all strengths<br />

Powder packet: 20 mEq<br />

Soln: 20 mEq/15 ml<br />

CR Caps: 10 mEq<br />

Micro K<br />

PRAVASTATIN Pravachol Tabs: all strengths<br />

PRAZOSIN Minipress Caps: all strengths<br />

PREDNISOLONE Prelone/Orapred Liq: 15 mg/5 ml<br />

PREDNISOLONE ACETATE<br />

Pred Forte<br />

Pred Mild<br />

Oph Susp: 1%, 5 ml<br />

Oph Susp: 0.12%<br />

PREDNISONE Orasone, Deltasone Tabs: all strengths<br />

Syrup: 5mg/5ml<br />

PRENATAL VITAMINS + FOLIC ACID Natalins<br />

Tabs : PNV with 1mg folic acid<br />

**Limited to women age 45 and younger**<br />

PRIMAQUINE Primaquine Tabs: 23.6 mg<br />

PRIMIDONE Mysoline Tabs: all strengths<br />

PROBENECID Benemid Tabs: 500 mg<br />

PROCHLORPERAZINE Compazine Tabs: all strengths Supps: 25 mg<br />

PROGESTERONE Prometrium Caps: 100, 200 mg<br />

PROMETHAZINE Phenergan Tabs: all strengths Supps: all strengths<br />

Syrp: 6.25mg/5ml<br />

PROMETHAZINE/DEXTROMETHORP Phenergan DM<br />

Syrp: 120 ml<br />

HAN<br />

PROPARACAINE Ophthaine Soln: 0.5%, 15 ml<br />

16


PROPRANOLOL<br />

Inderal<br />

Inderal LA<br />

Tabs: 10, 40 mg<br />

LA Caps: 80 mg<br />

PROPYLTHIOURACIL PTU Tabs: 50 mg<br />

PSEUDOEPHEDRINE Sudafed Tabs: 30, 120 mg<br />

Liq: 30 mg/5 ml<br />

PYRAZINAMIDE PZA Tabs: 500 mg<br />

PYRIDOSTIGMINE Mestinon Tabs: 60 mg<br />

PYRIDOXINE Vitamin B6 Tabs: all strengths<br />

QUETIAPINE<br />

Seroquel<br />

Seroquel XR<br />

Tabs: all strengths<br />

XR: all strengths<br />

RALOXIFENE Evista Tabs: 60 mg<br />

RAMIPRIL Altace Caps: all strengths<br />

RANITIDINE Zantac Tabs: all strengths<br />

Syrup: 15 mg/ml<br />

RIFAMPIN Rifadin Caps: 300 mg<br />

RISPERIDONE Risperdal Tabs: all strengths<br />

Soln 1mg/ml<br />

RIZATRIPTAN<br />

Maxalt<br />

Maxalt MLT<br />

Tabs: all strengths<br />

MLT tabs: all strengths<br />

**DoD Quantity limit 36 tablets/90 days**<br />

ROPINIROLE Requip Tabs: 1mg, 2mg, 3mg, 4mg, 5mg<br />

SALICYLIC ACID Clear Away Plasters: 40%<br />

SALINE NASAL SPRAY Sea-mist Soln: 0.65%<br />

SALMETEROL<br />

Serevent Diskus<br />

Serevent<br />

*Inhaler: 18 mcg, 200 sprays/unit<br />

Neb Soln: 0.02%/2.5 ml, 30 unit<br />

SALISALATE Disalcid Tabs: 500, 750 mg<br />

SCOPOLAMINE Transderm Scop Patch: 1.5 mg<br />

SELENIUM SULFIDE Selsun Shampoo: 2.5% 120 ml<br />

SERTRALINE Zoloft Tabs: all strengths<br />

Liq: 20mg/ml<br />

SILDENAFIL Viagra Tabs: all strengths<br />

SILVER SULFADIAZINE Silvadene 1% cream<br />

SIMVASTATIN Zocor Tabs: all strengths<br />

SIMVASTATIN/EZETIMIBE Vytorin Tabs: all strengths<br />

SITAGLIPTIN Januvia Tabs: 25mg, 50mg, & 100mg<br />

SITAGLIPTIN/METFORMIN Janumet Tabs: 50/500 mg & 50/1000 mg<br />

SITAGLIPTIN/METFORMIN XR Janumet XR Tabs: all strengths<br />

SITAGLIPTIN/SIMVASTATIN Juvisync Tabs: 100/10mg, 100/20mg ,& 100/40mg<br />

SODIUM CHLORIDE Muro 128 Oint: 5%<br />

Soln: 5%<br />

SODIUM CHLORIDE/SODIUM Sinus Rinse Kit<br />

Adult/Pediatric<br />

BICARBONATE<br />

SODIUM CHLORIDE 0.9% Normal saline 3ml vials for Nebulization<br />

SPACER<br />

Optichamber<br />

Optichamber w/mask<br />

Aerochamber w/mask<br />

Device<br />

SPIRONOLACTONE Aldactone Tabs: all strengths<br />

SUCRALFATE Carafate Tabs: 1 g<br />

Liq: 1 g/10 ml<br />

SULFACETAMIDE Sulamyd, Bleph-10 Oph soln: 10%, 15 ml<br />

Opth oint: 3.5 g<br />

SULFACETAMIDE/<br />

Plexion<br />

Cleanser: 6oz<br />

SULFUR CLEANSER<br />

SULFAMETHOXAZOLE/<br />

Pediazole<br />

Susp:600/200 mg/5 ml<br />

ERYTHROMYCIN<br />

SULFAMETHOXISOLE/<br />

TRIMETHOPRIM<br />

Bactrim, Septra, Bactrim DS<br />

Sulfatrim<br />

Tabs: all strengths<br />

Susp:40/200 mg /5 ml<br />

SULFASALAZINE Azulfidine Tabs: 500 mg<br />

EC Tabs: 500mg<br />

17


SULINDAC Clinoril Tabs: 200mg<br />

SUMATRIPTAN Imitrex Tabs: 25, 50 mg<br />

**DoD Quantity limit 54 tablets/90 days**<br />

Tabs: 100 mg<br />

**DoD Quantity limit 27 tablets/90 days**<br />

SUMATRIPTAN Imitrex Nasal Spray: 20mg<br />

SUMATRIPTAN Imitrex Stat Dose Kit all strengths<br />

TAMOXIFEN Nolvadex Tabs: all strengths<br />

TAMSULOSIN Flomax Caps: 0.4mg<br />

TELMISARTAN<br />

TELMISARTAN/HCTZ<br />

Micardis,<br />

Micardis HCT<br />

Tabs: all strengths<br />

Tabs: all strengths<br />

TEMAZEPAM Restoril C-IV Caps: all strengths<br />

TERAZOSIN Hytrin Caps: all strengths<br />

TERBINAFINE HYROCHLORIDE Lamisil Tabs: 250mg<br />

TERBUTALINE Brethine Tabs: 5 mg<br />

TERCONAZOLE Terazol 7 Cream: 0.4%, 20 g<br />

TESTOSTERONE CYPIONATE Depo-Testosterone Inj: 200mg/ml<br />

THEOPHYLLINE<br />

Theo-24<br />

Theodur<br />

Uniphyl<br />

24 hr Caps: all strengths<br />

*12 hr Tabs: all strengths *Liq: 80 mg/15 ml<br />

*24 hr Tabs: 400mg<br />

THIAMINE Vitamin B1 Tabs: all strengths<br />

TIMOLOL MALEATE<br />

Timolol<br />

Timoptic XE<br />

Oph soln: all strengths<br />

Gel: all strengths<br />

TIOTROPIUM Spiriva Inh w/ device: 18 mcg<br />

TOBRAMYCIN Tobrex Soln: 0.3%, 5 ml<br />

TOBRAMYCIN/DEXAMETHASONE Tobradex Susp: 0.3%/0.1%, 5 ml<br />

Opth Oint: 3.5 g<br />

TOLNAFTATE Tinactin Soln: 1%, 10 ml<br />

*Cream: 1%<br />

TOLTERODINE Detrol LA SR Caps: all strengths<br />

TOPIRAMATE Topamax Tabs: all strengths<br />

TRAMADOL Ultram Tabs: all strengths<br />

**DoD Quantity Limit 240 tabs per 30 days**<br />

TRAZADONE Desyrel Tabs: 50, 100, 150, 300 mg<br />

TRETINOIN Retin A, Avita Cream: all strengths<br />

**Limited to persons


ZIPRASIDONE Geodon Caps: all strengths<br />

ZOLPIDEM Ambien C-IV Tabs: all strengths<br />

ZOMITRIPTAN Zomig/Zomig ZMT Tabs: all strengths/Oral disintegrating tabs<br />

**DoD Quantity limit 36 tablets/90 days**<br />

19


Quick List for Common Uses<br />

For Asthma/Allergies For Blood pressure For Cholesterol<br />

ACEs: benazepril (Lotensin), captopril<br />

(Capoten), lisinopril (Zestril)<br />

Inhalers: Albuterol (Ventolin/Proventil<br />

HFA), levalbuterol (Xopenex) MDI,<br />

salmeterol (Serevent Diskus)<br />

Nebulizer solutions: albuterol,<br />

budesonide (Pulmicort), ipratropium<br />

Other: montelukast (Singulair)<br />

Steroids: fluticasone (Flovent HFA)<br />

mometasone (Asmanex)<br />

Combo: albuterol/salmeterol (Advair &<br />

Advair HFA), budesonide/formoterol<br />

(Symbicort)<br />

ARBs: candesartan (Atacand), losartan<br />

(Cozaar), telmisartan (Micardis),<br />

valsartan (Diovan)<br />

BBs: atenolol (Tenormin), carvedilol<br />

(Coreg), metoprolol succinate (Toprol<br />

XL), metoprolol tartrate (Lopressor)<br />

CCBs: amlodipine (Norvasc), diltiazem<br />

ER (Tiazac), felodipine (Plendil),<br />

nifedipine SR (Adalat CC), verapamil<br />

(Calan SR)<br />

Statins: atorvastatin (Lipitor),<br />

pravastatin (Pravachol), simvastatin<br />

(Zocor)<br />

Other: Ezetimibe (Zetia), fenofibrate<br />

(Lofibra), niacin (Niaspan), gemfibrozil<br />

(Lopid)<br />

Combo: ezetimibe/simvastatin<br />

(Vytorin)<br />

Allergies: cetirizine (Zyrtec), loratadine<br />

(Claritin), fexofenadine (Allegra),<br />

cetirizine/pseudoephedrine (Zyrtec-D)<br />

Diuretics: furosemide (Lasix), HCTZ,<br />

spironolactone, triamterene/HCTZ<br />

(Maxzide)<br />

Nasal: azelastine (Astelin), fluticasone<br />

(Flonase), mometasone (Nasonex),<br />

fluocinonide (Nasarel)<br />

Insulin: Novolog (aspart), Novolin N<br />

(NPH), Novolin R (regular), Novolin<br />

70/30 (NPH/Reg), Novolog Mix 70/30<br />

(NPH/Reg), Lantus (glargine)<br />

Syringes: 0.5 ml, 1ml. BD Sharps<br />

container for disposal. Insulin Pen<br />

needles<br />

Blood glucose monitors/test strips:<br />

True Test and Precision Xtra (box of<br />

100 test strips)<br />

Lancets (box of 200): Trueplus lancet<br />

device for Precision True test and<br />

Precision Xtra.<br />

Combos: benazepril/amlodipine<br />

(Lotrel), lisinopril/HCTZ (Zestoretic)<br />

losartan/HCTZ (Hyzaar),<br />

telmisartan/HCTZ (Micardis HCT),<br />

valsartan/HCTZ (Diovan HCT)<br />

For Diabetes For Migraines Controlled Substances<br />

Oral Agents: Glipizide (Glucotrol &<br />

Glucotrol XL), Glyburide (Micronase),<br />

Metformin (Glucophage & Glucophage<br />

XR), pioglitazone (Actos),<br />

pioglitazone/metformin (Actoplusmet)<br />

Triptans: rizatriptan (Maxalt & Maxalt<br />

MLT), sumatriptan (Imitrex),<br />

zolmitriptan (Zomig & Zomig ZMT)<br />

[Please note DoD quantity limitations]<br />

The state of California requires<br />

that controlled substances MUST<br />

be written on a California Security<br />

Prescription pad.<br />

Acetaminophen/butalbital/caffeine<br />

(Fioricet)<br />

C-II: Adderall and Adderall XR, Ritalin,<br />

Concerta, Morphine IR, MS Contin,<br />

Percocet<br />

C-III: Tylenol w/ codeine #3, Codeine<br />

sulfate, Vicodin, and Vicodin ES<br />

C-IV: Alprazolam (Xanax), Clonazepam<br />

(Klonapin), diazepam (Valium),<br />

lorazepam (Ativan), temazepam<br />

(Restoril), zolpidem (Ambien).<br />

C-V: Robitussin AC (qty of 120ml),<br />

Lomotil<br />

NOTE: C-II: no refills allowed C-III-V:<br />

prescription only valid for 6 months.<br />

Refills are allowed but may not exceed<br />

6 months<br />

20


Quick Reference Telephone List<br />

Emergencies............................................................ 911<br />

Emergencies from cell phone on base................... 661- 277- 4541<br />

Poison Control ...................................................... 800-222-1222<br />

Appointments:<br />

Family practice ...................................................... 661-277-7118, option 1, then 1<br />

Pediatrics................................................................ 661-277-7118, option 1, then 2<br />

Flight Surgeon’s Office.......................................... 661-277-7118, option 1, then 3<br />

Optometry.............................................................. 661-277-7118, option 1, then 4<br />

Physical Therapy.................................................... 661-277-7118, option 1, then 5<br />

Dental Clinic.......................................................... 661-277-2872<br />

Family Advocacy................................................... 661-277-5292<br />

Flight Surgeon’s Office.......................................... 661-277-7118 option 3<br />

Health and Wellness Center.................................... 661-277-8480<br />

Immunizations.........................................................661-277-3427<br />

Laboratory............................................................... 661-277-2306<br />

Mental Health..........................................................661-277-5291<br />

Managed Care......................................................... 661-277-6969<br />

NurseLine................................................................ 661- 275-6877, or<br />

888-762-3842<br />

Patient Administration........................................... 661-275-2668<br />

<strong>Pharmacy</strong>................................................................ 661-277-9896<br />

Physical Therapy.................................................... 661-277-3891<br />

Primary Care Clinic............................................... 661-277-7118<br />

Public Health.......................................................... 661-275-2694<br />

Radiology................................................................ 661-277-2681<br />

TriWest/TRICARE................................................. 888-874-9378<br />

<strong>Base</strong> Exchange: Main Store 258-1078<br />

Commissary 277-4589<br />

Family Child Care Program<br />

Golf Course<br />

Information, Tickets and Travel (leisure)<br />

<strong>Base</strong> Schools Switchboard 258-4411<br />

Security <strong>Force</strong>s 277-3340<br />

275-4FCC/275-4322<br />

275-PUTT/275-7888<br />

275-TRIP/275-8747<br />

Retiree Activity Office 277-4931<br />

21

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