kirtland afb pharmacy formulary by generic 9/17/2012 846-3131
kirtland afb pharmacy formulary by generic 9/17/2012 846-3131
kirtland afb pharmacy formulary by generic 9/17/2012 846-3131
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KIRTLAND AFB PHARMACY<br />
FORMULARY BY BRAND<br />
3/7/2014<br />
(505) <strong>846</strong>-<strong>3131</strong><br />
BRAND NAME GENERIC NAME DOSAGE FORM STRENGTH<br />
Abilify Aripiprazole Tab 2mg, 5mg, 10mg, 15mg, 20mg, 30mg<br />
Accu Chek Aviva Blood Glucose Meter Meter<br />
Accu Chek Aviva Blood Glucose Monitoring Strip Strip Max of 200 strips/30days<br />
Acetasol HC, VoSol HC<br />
Acetic Acid/Propylene<br />
Glycol/Hydrocortisone<br />
Otic Sol'n 2%/3%/1%<br />
Actigall Ursodiol Cap 300mg<br />
Actonel Risendronate Tab 35mg, 150mg<br />
Actos Pioglitazone Tab 15mg, 30mg, 45mg<br />
Acular LS Ketorolac Ophth Sol'n 0.4%<br />
Adalat CC Nifedipine Tab 30mg, 60mg, 90mg<br />
Adapin Doxepin Sol'n 10mg/ml<br />
Adapin Doxepin Cap 10mg, 25mg, 50mg, 75mg<br />
Adderall Amphetamine Salts Tab 10mg, 15mg , 20mg, 30mg<br />
Adderall XR Amphetamine Salts Cap 5mg, 10mg, 15mg, 20mg, 25mg, 30mg<br />
Advair Diskus Salmeterol/Fluticasone Diskus<br />
Advair HFA Salmeterol/Fluticasone MDI<br />
Aerochamber Aerochamber<br />
Afrin Oxymetazoline Nasal Spr 0.05%<br />
Aggrenox Aspirin/Dypyridamole Cap 25mg/200mg<br />
Albenza Albendazole Tab 200mg<br />
Alcohol Pads Alcohol Pads Pads<br />
100/50mcg, 250/50mcg, 500/50mcg<br />
Max of 1 diskus/30 days<br />
45/21mcg, 115/21mcg, 230/21mcg<br />
Max of 2 inh/30 days<br />
Aldactone Spironalactone Tab 25mg, 50mg, 100mg<br />
Aldara Imiquimod Cr 5%<br />
Allegra Fexofenadine Tab 60mg, 180mg<br />
Alphagan Bimonidine Ophth Sol'n 0.2%<br />
Alphagan P Brimonidine Ophth Sol'n 0.15%<br />
Altace Ramipril Cap 1.25mg, 2.5mg, 5mg, 10mg<br />
Amaryl Glimepiride Tab 2mg, 4mg<br />
Ambien Zolpidem Tab 5mg, 10mg<br />
Amoxil Amoxicillin Cap 250mg, 500mg<br />
Amoxil Amoxicillin Tab 875mg<br />
Amoxil Amoxicillin Susp 125mg/5ml , 250mg/5ml, 400mg/5ml<br />
Antabuse Disulfiram Tab 250mg<br />
Antivert Meclizine Tab 25mg<br />
Anusol HC Hydrocortisone Supp 25mg<br />
Apresoline Hydralazine Tab 10mg, 25mg, 50mg<br />
Aquaphor Petrolatum Oint 41%<br />
Aralen Chloroquine Tab 500mg<br />
Arava Leflunomide Tab 10mg, 20mg<br />
Aricept Donepezil Tab 5mg, 10mg<br />
Arimidex Anastrozole Tab 1mg<br />
Aristocort A Triamcinolone Oint 0.5%<br />
Armour Thyroid Thyroid Tab<br />
Artane Trihexyphenidyl Elixir 2mg/5ml<br />
Artane Trihexyphenidyl Tab 2mg<br />
Arzol Applicators Silver Nitrate/Potassium Nitrate 75%/25%<br />
15mg, 30mg, 60mg, 90mg, 120mg, 180mg, 240mg,<br />
300mg<br />
Asacol Mesalamine Tab 400mg<br />
Asmanex Mometasone Inh<br />
110mcg (30 doses), 220mcg (60 doses)<br />
Max 120 doses/30 days<br />
Aspirin Aspirin EC Tab 81mg, 325mg<br />
Astelin Azelastine Nasal Spray 0.1% (137mcg/spray)<br />
Atacand Candesartan Tab 4mg, 8mg, 16mg, 32mg<br />
Atarax Hydroxyzine Hydrochloride Tab 10mg, 25mg, 50mg<br />
Bold items are Basic Core Formulary 1
KIRTLAND AFB PHARMACY<br />
Atarax Hydroxyzine Hydrochloride Syrp, Soln 10mg/5ml<br />
Ativan Lorazepam Tab 0.5mg, 1mg, 2mg<br />
FORMULARY BY BRAND<br />
3/7/2014<br />
(505) <strong>846</strong>-<strong>3131</strong><br />
Atripla Emtricitabine/Tenofovir/Efavirenz Tab 200/300/600mg<br />
Atrovent Ipatropium Sol'n for Neb<br />
0.5mg/2.5ml (0.02%)<br />
Max of 450 amps/30days<br />
Atrovent Ipatropium Nasal Spray 0.03%, 0.06%<br />
Atrovent HFA Ipatropium Inh<br />
<strong>17</strong>mcg/Actuation<br />
Max 2 inh/30days<br />
Augmentin Amoxicillin/Clavulanate Susp<br />
125-31.25mg/5ml, 200-28.5mg/5ml, 250-62.5/5ml,<br />
400-57.5mg/5ml, ES 600-42mg/5ml<br />
Augmentin Amoxicillin/Clavulanate Tab 250/125mg, 500/125mg, 875/125mg<br />
Auralgan Antipyrine/Benzocaine Sol'n 5.4%/1.4%<br />
Avelox Moxifloxacin Tab 400mg, ABC pack 400mg<br />
Avonex Interferon Beta 1A Inj 30mg<br />
Aygestin Norethindrone Tab 5mg<br />
Azulfidine Sulfasalazine ENTab 500mg<br />
Azulfidine Sulfasalazine Tab 500mg<br />
Bacitracin Bacitracin Oint<br />
Bacitracin Bacitracin Ophth Oint<br />
Bactroban Mupirocin Crm/Oint 2%<br />
Benadryl Diphenhydramine Cap 25mg<br />
Benadryl Diphenhydramine Syrp 12.5mg/5ml<br />
Benemid Probenecid Tab 500mg<br />
Bentyl Dicyclomine Sol'n 10mg/5ml<br />
Bentyl Dicyclomine Cap 10mg<br />
Bentyl Dicyclomine Tab 20mg<br />
Benzaclin Clindamycin/Benzoyl Peroxide Gel 1%/5%<br />
Benzamycin Benzoyl Peroxide/Erythromycin Gel 50/30mg-gm<br />
Betaseron Interferon Beta 1B Inj 0.3mg<br />
Betoptic S Betaxolol Ophth Susp 0.25%<br />
Biaxin Clarithromycin Tab 500mg<br />
Biaxin XL Clarithromycin Tab 500mg, 500mg Pak (14 day)<br />
Biogaia Lactobacillus Reuteri Drop Susp 100 million cell/5 drops<br />
Bleph-10 Sulfacetamide Ophth Sol'n 10%<br />
Blephamide Sulfacetamide/Prednisolone Ophth Susp & Oint 10%/0.2%<br />
Boniva Ibandronate Tab 150mg<br />
Boudreauxs Butt Paste Zinc Oxide Paste Oint<br />
Bromday Bromfenac Ophth Sol'n 0.09%<br />
Buspar Buspirone Tab 5mg, 10mg, 15mg<br />
Byetta Exenatide Prefilled Syringe 5mcg, 10mcg<br />
Calan Verapamil Tab 80mg<br />
Calan SR Verapamil Tab 120mg, 180mg, 240mg<br />
Capoten Captopril Tab 12.5mg, 25mg, 50mg, 100mg<br />
Carafate Sucralfate Tab & Susp 1gm, 1g/10ml<br />
Cardec DM DM-Phenylephrine-Chlorpheniramine Drops 3mg-3.5mg-1mg/mL<br />
Cardec DM DM-Phenylephrine-Chlorpheniramine Syrp 15mg-12.5mg-4mg/5mL<br />
Cardizem Diltiazem Tab 60mg<br />
Cardura Doxazosin Tab 2mg, 4mg, 8mg<br />
Catapres Clonidine Tab 0.1mg, 0.2mg, 0.3mg<br />
Ceftin Cefuroxime Tab 250mg, 500mg<br />
Cefzil Cefprozil Tab 250mg<br />
Cefzil Cefprozil Susp 125mg/5ml, 250mg/5ml<br />
Celebrex Celecoxib Cap 100mg, 200mg<br />
Celexa Citalopram Sol'n 10mg/5ml<br />
Celexa Citalopram Tab 10mg, 20mg, 40mg<br />
CellCept Mycophenolate Mofetil Tab 250mg, 500mg<br />
Bold items are Basic Core Formulary 2
KIRTLAND AFB PHARMACY<br />
Cephulac Lactulose Syrp 10gm/15ml<br />
FORMULARY BY BRAND<br />
3/7/2014<br />
(505) <strong>846</strong>-<strong>3131</strong><br />
Chantix Verenicline Tab<br />
Starter pack and maintenance therapy<br />
Must take HAWC Smoking Cessation class<br />
Age restriction >18yo<br />
Max of 2 quit attempts per year<br />
Chlortrimeton Chlorpheniramine Tab 4mg<br />
Chlortrimeton Chlorpheniramine Syrp 2mg/5ml<br />
Ciloxan Ciprofloxacin Ophth Oint/Sol'n 0.3%<br />
Cipro Ciprofloxacin Tab 100mg, 250mg, 500mg, 750mg<br />
Cipro Ciprofloxacin Sol'n 250mg/5ml<br />
Ciprodex Ciprofloxacin/Dexamethasone Otic Susp 0.3%/0.1%<br />
Claritin Loratadine Tab 10mg<br />
Claritin Loratadine Syrp 5mg/5ml<br />
Claritin-D Loratadine & Pseudoephedrine Tab 10/240mg 24-hr tab<br />
Claritin-D Loratadine & Pseudoephedrine Tab 5/120mg 12-hr tab<br />
Cleocin Clindamycin Cap 150mg, 300mg<br />
Cleocin Clindamycin Susp 75mg/5ml<br />
Cleocin Clindamycin Vag Cr 2%<br />
Cleocin-T Clindamycin Sol'n/Gel 1%<br />
Climara Estradiol Patch<br />
0.025mg, 0.0375mg, 0.05mg, 0.06mg, 0.075mg,<br />
0.1mg,<br />
Clinpro 5000 Sodium Fluoride Paste 1.1%<br />
Clomid Clomiphene Tab 50mg<br />
Codeine Sulfate Codeine Sulfate Tab 30mg<br />
Cogentin Benztropine Tab 0.5mg, 1mg, 2mg<br />
Colace Docusate Sodium Cap 100mg<br />
Colchicine Colchicine Tab 0.6mg<br />
Colestid Colestipol Tab 1gm<br />
Co-lyte PEG 3350 & Electrolytes Sol'n<br />
Combigan Brimonidine/Timolol Ophth Sol'n 0.2/0.5%<br />
Combivent Respimat Albuterol/Ipatropium Inh<br />
100mcg/20mcg<br />
Max 2 Aer w/adap (8gm)/30 days<br />
Combivir Lamivudine/Zidovudine Tab 150/300mg<br />
Compazine Prochlorperazine Tab 10mg<br />
Compazine Prochlorperazine Supp 25mg<br />
Concerta Methylphenidate Tab 18mg, 27mg, 36mg, 54mg<br />
Copaxone Glatiramer Acetate Inj 20mg/ml<br />
Cordarone Amiodarone Tab 200mg<br />
Coreg Carvedilol Tab 3.125mg, 6.25mg, 12.5mg, 25mg<br />
Cortisone Hydrocortisone Cr 1%, 2.5%<br />
Cortisporin Neomycin/Polymyxin/Hydrocortisone Otic Soln & Susp<br />
Cosopt Dorzolamide/Timolol Ophth Sol'n 2%/0.5%<br />
Coumadin Warfarin Tab<br />
1mg, 2mg, 2.5mg, 3mg, 4mg, 5mg, 6mg, 7.5mg,<br />
10mg<br />
Cozaar Losartan Tab 25mg, 50mg, 100mg<br />
Crestor Rosuvastatin Tab 5mg, 10mg, 20mg, 40mg<br />
Cyclessa/Caziant/Velivet Ethinyl Estradiol/Desogestrel Tab 25mcg/0.1mg-0.125mg-0.15mg<br />
Cyclogyl Cyclopentolate Ophth Sol'n 1%, 2%<br />
Cytomel Liothyronine Tab 5mcg<br />
DDAVP Desmopressin Nasal Sol'n/Tab 0.1mg/spray, 0.1mg<br />
Debrox Carbamide Peroxide Otic Sol'n<br />
Decadron Dexamethasone Tab 0.5mg, 0.75mg, 4mg<br />
Deltasone Prednisone Tab 1mg, 5mg, 10mg, 20mg, 50mg<br />
Demerol Meperidine Tab 50mg<br />
Demulen, Kelnor, Zovia Ethinyl Estradiol/Ethylnodiol Tab 35mcg/1mg<br />
Depade Naltrexone Tab 50mg<br />
Depakene Valproic Acid Sol'n 250mg/5ml<br />
Bold items are Basic Core Formulary 3
KIRTLAND AFB PHARMACY<br />
Depakote Divalproex Sodium Tab 125mg, 250mg, 500mg<br />
Depakote ER Divalproex Sodium Tab 250mg, 500mg<br />
Depakote Sprinkles Divalproex Sodium Sprinkles Cap 125mg<br />
Depo-Testosterone Testosterone Cypionate Inj 200mg/ml<br />
DermaCerin Mineral Oil/Lanolin Cr<br />
Desquam-X Benzoyl Peroxide Gel & Cleanser 5%, 10%<br />
Bold items are Basic Core Formulary 4<br />
FORMULARY BY BRAND<br />
3/7/2014<br />
(505) <strong>846</strong>-<strong>3131</strong><br />
Desyrel Trazadone Tab 50mg, 100mg, 150mg, 300mg<br />
Detrol LA Tolterodine Cap 2mg, 4mg<br />
Dexedrine Dextroamphetamine Tab 5mg<br />
Dibucaine Dibucaine Oint 1%<br />
Differin Adapalene Cr 0.1%<br />
Diflucan Fluconzole Tab 100mg, 150mg, 200mg<br />
Diflucan Fluconzole Susp 10mg/ml<br />
Dilantin Phenytoin Susp 125mg/5ml<br />
Dilantin Phenytoin Tab 50mg<br />
Dilantin Phenytoin Cap 100mg<br />
Dilaudid Hydromorphone Tab 2mg<br />
Dimetapp for Children-Cold & Cough<br />
Brompheniramine-Dextromethrophan-<br />
Phenylephrine<br />
Syrp<br />
1mg-5mg-2.5mg/5mL<br />
Diovan Valsartan Tab 40mg, 80mg, 160mg, 320mg<br />
Diovan HCT Valsartan/hydrochlorothiazide Tab<br />
80/12.5mg, 160/12.5mg, 160/25mg, 320/12.5mg,<br />
320/25mg<br />
Diprosone Betamethasone Dipropionate Cr 0.05%<br />
Disalcid Salsalate Tab 500mg, 750mg<br />
Ditropan Oxybutynin Tab 5mg<br />
Ditropan XL Oxybutynin ER Tab 5mg,10mg,15mg<br />
Donnatal Atrop/Scop/Hyos/Phenobarb. Tab 0.0194/0.0065/0.137/16.2mg<br />
Dovonex Calcipotriene Cr 0.005%<br />
Drysol Aluminum Chloride Sol'n 20%<br />
Dulcolax Bisacodyl Tab/Supp 5mg (Tab), 10mg (Supp)<br />
Dulera Mometasone / Formoterol Inh 100-5mcg , 200-5mcg<br />
DuoNeb Albuterol/Ipatropium Sol'n for Neb 0.5mg-2.5mg/3ml<br />
D-Vi-Sol Ergocalciferol Liq 400IU/ml<br />
Dyazide Triamterene/HCTZ Cap 37.5/25mg<br />
Dycill Dicloxacillin Cap 250mg, 500mg<br />
E.E.S. Erythromycin Ethylsuccinate Susp 200mg/5ml<br />
Effexor Venlafaxine Tab 25mg,37.5mg, 50mg, 75mg, 100mg<br />
Effexor XR Venlafaxine Cap 37.5mg, 75mg, 150mg, 225mg,<br />
Efudex Fluorouracil Cr 5%<br />
Elavil Amitriptyline Tab 10mg, 25mg, 50mg, 75mg<br />
Elidel Pimecrolimus Cr 1%<br />
Elimite/Acticin Permethrin Cr 5%<br />
Emla Lidocaine/Prilocaine Cr 2.5%/2.5%<br />
Entocort EC Budesonide Cap 3mg<br />
Epi Pen/Epi Pen Jr Epinephrine Inj 0.3mg/Injection, 0.15mg/Injection<br />
Epogen Epoetin Alfa Inj<br />
Erystat/Emgel Erythromycin/Ethyl Alcohol Gel & Sol'n 2%<br />
Ery-Tab Erythromycin Base Tab 250mg, 333mg<br />
Erythrocin Erythromycin Stearate Tab 250mg<br />
Eskalith Lithium Carbonate Cap 150mg, 300mg<br />
Eskalith Lithium Citrate Sol'n 8mEq/5ml<br />
Estrace Estradiol Cr 0.1mg/1gm<br />
Estrace Estradiol Tab 1mg, 2mg<br />
2000U/ml, 3000U/ml, 4000U/ml, 10000U/ml,<br />
20000U/ml<br />
Estratest, Estratest HS Estrogen Esterified/Methyltestosterone Tab 0.625mg/1.25mg, 1.25mg/2.5mg<br />
Eulexin Flutamide Cap 125mg
KIRTLAND AFB PHARMACY<br />
Evista Raloxifene Tab 60mg<br />
Famvir Famciclovir Tab 500mg<br />
Feldene Piroxicam Cap 20mg<br />
Femara Letrozole Tab 2.5mg<br />
Ferrous Sulfate Ferrous Sulfate Tab 325mg<br />
Ferrous Sulfate Ferrous Sulfate Drops 15mg/ml<br />
Fioricet Butalbital/Acetaminophen/Caffeine Tab 50mg/325mg/40mg<br />
Fiorinal Butalbital/Aspirin/Caffeine Tab 50mg/325mg/40mg<br />
Flagyl Metronidazole Tab 250mg, 500mg<br />
Flagyl Metronidazole Vag Gel 0.75%<br />
Fleet Fleet Enema Adult & Pediatric<br />
Flexeril Cyclobenzaprine Tab 5mg, 10mg<br />
Flomax Tamulosin Cap 0.4mg<br />
Bold items are Basic Core Formulary 5<br />
FORMULARY BY BRAND<br />
3/7/2014<br />
(505) <strong>846</strong>-<strong>3131</strong><br />
Flonase Fluticasone Nasal Inh 50mcg Max of 1 bottle (16gm)/30 days<br />
Flovent Diskus Fluticasone Diskus 100mcg, 250mcg Max of 2 inh/30 days<br />
Flovent HFA Fluticasone Oral Inh<br />
44mcg, 110mcg, 220mcg<br />
Max of 2 inh/30 days<br />
Floxin otic Ofloxacin Otic Susp 0.3%<br />
FML Fluorometholone Ophth Susp 0.1%<br />
Folic Acid Folic Acid Tab 1mg<br />
Fortesta Testosterone Gel Pump 1%<br />
Fosamax Alendronate Tab 5mg, 10mg, 35mg, 70mg<br />
Fosamax Plus D Alendronate/Cholecalciferol Tab 70mg/2800IU, 70mg/5600IU<br />
Furadantin Nitrofurantoin Susp 25mg/5ml<br />
Gengraf Cyclosporine, modified Cap 25mg, 100mg<br />
Genoptic/Gentak Gentamicin Ophth Sol'n/Oint 0.3%<br />
Gentian Violet Gentian Violet Sol'n 1%<br />
Gleevec Imatinib Tab 100mg, 400mg<br />
Glucagon Emergency Kit Glucagon, Human Recombinant Inj 1mg/ml<br />
Glucophage Metformin Tab 500mg, 850mg, 1000mg<br />
Glucophage XR Metformin ER Tab 500mg, 750mg<br />
Glucotrol Glipizide Tab 5mg, 10mg<br />
Glucotrol XL Glipizide Tab 2.5mg, 5mg, 10mg<br />
Glucovance Glyburide/Metformin Tab 1.25/250mg, 2.5/500mg, 5/500mg<br />
Glynase Glyburide, Micronized Tab 1.5mg, 3mg, 6mg<br />
GrisPeg Griseofulvin, Ultramicrosize Tab 125mg, 250mg<br />
GrisPeg Griseofulvin, Microsize Susp 125mg/5ml<br />
Halcion Triazolam Tab 0.125mg, 0.25mg<br />
Humira Adalimumab Inj 20mg/0.4ml (Syringe), 40mg/0.8ml (Pen & Syringe)<br />
Hydrocerin Petrolatum/Mineral Oil Cr<br />
Hydrodiuril Hydrochlorothiazide Tab 12.5mg, 25mg, 50mg<br />
Hygrotron Chlorthalidone Tab 25mg, 50mg<br />
Hytrin Terazosin Cap 1mg, 2mg, 5mg, 10mg<br />
Hyzaar Losartan/Hydrochlorothiazide Tab 50/12.5mg, 100/12.5mg, 100/25mg<br />
Ilotycin Erythromycin Ophth Oint 0.5%<br />
Imdur Isosorbide Mononitrate Tab 30mg, 60mg, 120mg<br />
Imitrex Sumatriptan Succinate Inj<br />
Imitrex Sumatriptan Succinate Tab<br />
Imodium Loperamide Cap 2mg<br />
Imuran Azathioprine Tab 50mg<br />
Incivek Telaprevir Tab 375mg<br />
6mg/cartridge<br />
Max 16 devices (8ml)/30 days<br />
25mg, 50mg Max of 18 tabs/30 days<br />
100mg Max of 9 tabs/30 days<br />
Inderal Propranolol Tab 10mg, 20mg, 40mg, 60mg, 80mg<br />
Inderal LA Propranolol Cap 60mg, 80mg, 120mg, 160mg
KIRTLAND AFB PHARMACY<br />
Indocin Indomethacin Cap 25mg, 50mg<br />
Indocin-SR Indomethacin SR Cap 75mg<br />
Isopto Atropine Atropine Ophth Sol'n/Oint 1%<br />
Isopto Homatropine Homatropine Ophth Sol'n 5%<br />
FORMULARY BY BRAND<br />
3/7/2014<br />
(505) <strong>846</strong>-<strong>3131</strong><br />
Isordil Isosorbide Dinitrate Tab 5mg, 10mg, 20mg, 30mg, 40mg SR<br />
Janumet Sitagliptin/Metformin Tab 50/500mg, 50/1000mg<br />
Janumet XR Sitagliptin/Metformin XR Tab 50/500mg, 50/1000mg, 100/1000mg<br />
Januvia Sitagliptin Tab 25mg, 50mg, 100mg<br />
Keflex Cephalexin Cap 250mg, 500mg<br />
Keflex Cephalexin Susp 250mg/5ml<br />
Kenalog<br />
Triamcinolone<br />
Cr<br />
Cr, Oint, Oral Paste<br />
Top Spray<br />
0.5%<br />
0.1%<br />
0.147mg/gm<br />
Keppra Levetiracetam Tab 500mg, 750mg<br />
Klonopin Clonazepam Tab 0.5mg, 1mg, 2mg<br />
Klor-Con Potassium Chloride Packet 20mEq<br />
Klor-Con Potassium Chloride Sol'n 20mE1/15ml<br />
Klor-Con Potassium Chloride Tab 10mEq, 20mEq<br />
Kuvan Sapropterin Tab 100mg<br />
LacHydrin Ammonium Lactate Lotion 12%<br />
Lacrilube Mineral Oil/White Petrolatum Ophth Oint 15%/83%<br />
Lamictal Lamotrigine Tab 5mg, 25mg, 100mg, 150mg, 200mg<br />
Lamictal XR Lamotrigine XR Tab 50mg, 100mg, 200mg, 300mg<br />
Lamisil Terbinafine Tab, Cr 250mg, 1%<br />
Lancets (Precision Xtra, Accu Chek) Lancets (Precision Xtra & AccuChek) Lancets<br />
Lanoxin Digoxin Tab 0.125mg, 0.25mg<br />
Lantus Insulin Glargine Sol'n<br />
Lariam Mefloquine Tab 250mg<br />
Lasix Furosemide Sol'n 10mg/ml<br />
100U/ml 10ml Vials<br />
100U/ml 3ml Solostar<br />
Lasix Furosemide Tab 20mg, 40mg<br />
Levaquin Levofloxacin Sol'n 250mg/10ml<br />
Levaquin Levofloxacin Tab 250mg, 500mg, 750mg<br />
Levemir Insulin Detemir Sol 100U/ml 10ml Vials<br />
Levsinex Hyoscyamine Cap 0.125mg, 0.375mg<br />
Lexapro Escitalopram Tab 10mg, 20mg<br />
Lidex Fluocinonide Cr, Oint, Gel, Sol 0.05%<br />
Lidoderm Lidocaine Patches Patch 5%<br />
Lindane Lindane Shampoo 1%<br />
Liorisal Baclofen Tab 10mg, 20mg<br />
Lipitor Atorvastatin Tab 10mg, 20mg, 40mg, 80mg<br />
LiquiTears/Artificial Tears Polyvinyl Alcohol Sol'n 1.4%<br />
Lithobid Lithium Carbonate Tab 300mg ER<br />
Lodine Etodolac Tab 400mg<br />
LoEstrin Fe, Microgestin Fe, Junel Fe Ethinyl Estradiol/Norethindrone Tab 20mcg/1mg, 30mcg/1.5mg<br />
Lomotil Diphenoxylate/Atropine Tab 2.5/0.025mg<br />
Lo-Ovral, Low-Ogestrel, Cryselle Ethinyl Estradiol/Norgestrel Tab 30mcg/0.3mg<br />
Lopid Gemfibrozil Tab 600mg<br />
Lopressor Metoprolol Tartrate Tab 25mg, 50mg, 100mg<br />
Lotemax Loteprednol Ophth Susp 0.5%<br />
Lotensin Benazepril Tab 5mg, 10mg, 20mg, 40mg<br />
Lotrel Amlodipine/Benazepril Cap<br />
2.5/10mg, 5/10mg, 5/20mg, 5/40mg, 10/20mg,<br />
10/40mg<br />
Lotrimin Clotrimazole Cr/Sol'n 1%<br />
Lotrisone Clotrimazole/Betamethasone Dip Cr<br />
Bold items are Basic Core Formulary 6
KIRTLAND AFB PHARMACY<br />
FORMULARY BY BRAND<br />
3/7/2014<br />
(505) <strong>846</strong>-<strong>3131</strong><br />
Lovenox Enoxaparin Sol'n 30mg, 40mg, 60mg, 80mg, 100mg, 120mg, 150mg<br />
Lumigan Bimatoprost Ophth Sol'n 0.01%, 0.03%<br />
Luminal Phenobarbital Tab 16.2mg, 32.4mg, 64.8mg, 100mg<br />
Luminal Phenobarbital Elix 20mg/5ml<br />
Lunesta Eszopiclone Tab 1mg, 2mg, 3mg<br />
Lupron Depot Leuprolide Acetate Inj 3.75mg<br />
Luride Fluoride Sol'n 0.5mg/ml<br />
Maalox, Antacid<br />
Aluminum Hydroxide/Magnesium<br />
Hydroxide/Simethicone<br />
Macrobid Nitrofurantoin Monohydrate/Macro Cap 100mg<br />
Macrodantin Nitrofurantoin Macrocrystal Cap 50mg<br />
Magic Mouthwash<br />
Diphenhydramine/Maalox/Viscous<br />
Lidocaine<br />
Bold items are Basic Core Formulary 7<br />
Susp<br />
Susp<br />
Magnesium Citrate Magnesium Citrate Sol'n<br />
200mg/200mg/20mg<br />
1:1:1<br />
Must specify exact quantities of each drug<br />
Maxalt Rizatriptan Tab 5mg, 10mg Max of 12 tabs/30 days<br />
Maxalt MLT Rizatriptan Dis. Tab 5mg, 10mg Max of 12 tabs/30 days<br />
Maxitrol Neomycin/Polymixin B Sulf/Dexameth Ophth Oint 3.5mg/gm-10,000U/gm-0.1%<br />
Maxzide Triamterene/HCTZ Tab 75/50mg<br />
Maxzide-25 Triamterene/HCTZ Tab 37.5/25mg<br />
Medrol Methylprednisolone Tab 4mg, 4mg dosepack<br />
Megace Megestrol Acetate Tab 40mg<br />
Mephyton Phytonadione Tab 5mg<br />
Methadose Methadone Tab 10mg<br />
Methergine Methylergonovine Maleate Tab 0.2mg<br />
Metrogel Metronidazole Gel 1%<br />
Mevacor Lovastatin Tab 10mg, 20mg, 40mg<br />
Micardis Telmisartan Tab 20mg, 40mg, 80mg<br />
Micardis HCT Telmisartan/HCTZ Tab 40/12.5mg, 80/12.5mg, 80/25mg<br />
Miconazole Miconazole Top Cr 2%<br />
MicroK Potassium Chloride Cap 10mEq<br />
Micronase Glyburide Tab 1.25mg, 1.5mg, 2.5mg, 5mg, 6mg<br />
Microzide Hydrochlorothiazide Cap 12.5mg<br />
Mineral Oil Mineral Oil Sol'n<br />
Minipress Prazosin Cap 1mg, 2mg, 5mg<br />
Minocin Minocycline Cap 50mg, 100mg<br />
Miralax Polyethylene Glycol 3350 Powder 527g bottle (<strong>17</strong>gm/dose)<br />
Mirapex Pramipexole Tab 0.125mg, 0.25mg, 0.5mg, 1mg, 1.5mg<br />
Mircette/Kariva/Azurette/Viorele Ethinyl Estradiol/Desogestrel Tab 20mcg-0mcg-10mcg/0.15mg<br />
Mobic Meloxicam Tab 7.5mg, 15mg<br />
Monistat/Miconazole 7 Miconazole Vag Cr 2% (7-day)<br />
MonoNessa, Ortho Cyclen, Previfem,<br />
Sprintec<br />
Ethinyl Estradiol/Norgestimate Tab 35mcg/0.25mg<br />
Monopril Fosinopril Tab 10mg, 20mg, 40mg<br />
Morphine Sulfate Morphine Sulfate Tab 15mg<br />
Motrin Ibuprofen Tab 400mg, 600mg, 800mg<br />
Motrin Ibuprofen Susp 100mg/5ml<br />
MS Contin Morphine Sulfate Tab 15mg, 30mg, 60mg, 100mg, 200mg<br />
Mucinex Guaifenesin Tab 200mg<br />
Muro 128 Sodium Chloride Sol'n/Oint 5%<br />
Myambutol Ethambutol Tab 100mg, 400mg<br />
Mycolog II Nystatin/Triamcinolone Crm 100,000U-1mg/g<br />
Myfortic Mycophenolate Sodium Tab 180mg, 360mg<br />
Mylicon Simethicone Tab 80mg<br />
Mylicon Simethicone Sol'n 40mg/0.6ml<br />
Mysoline Primidone Tab 50mg<br />
Namenda Memantine Tab 5mg, 10mg & Starter Pak
KIRTLAND AFB PHARMACY<br />
Naphcon A Naphazoline/Pheniramine Ophth Sol'n 0.025%/0.3%<br />
Naprosyn Naproxen Susp 125mg/5ml<br />
Naprosyn Naproxen Tab 250mg, 375mg, 500mg<br />
Nasalide Flunisolide Nasal Spr 0.025%<br />
Bold items are Basic Core Formulary 8<br />
FORMULARY BY BRAND<br />
3/7/2014<br />
(505) <strong>846</strong>-<strong>3131</strong><br />
Nasonex Mometasone Nasal Spr 50mcg Max of 2 bottles/30 days<br />
Necon 1/35, Norinyl 1+35. Nortrel<br />
1/35, Ortho-Novum 1/35<br />
Ethinyl Estradiol/Norethindrone Tab 35mcg/1mg<br />
Neo-Fradin Neomycin Sulfate Tab 500mg<br />
Neoral Cyclosporine, Modified Cap 25mg, 100mg<br />
Neosporin Neomycin/Polymyxin/Bacitracin Ophth Oint<br />
Neosporin Neomycin/Polymyxin/Gramicidin Ophth Sol'n<br />
Neo-Synephrine Phenylephrine Ophth Sol'n 2.5%<br />
Neptazane Methazolamide Tab 50mg<br />
Neupogen Filgrastim Inj<br />
300mcg/0.5ml, 300mcg/ml, 480mcg/0.8ml,<br />
480mcg/1.6ml<br />
Neurontin Gabapentin Cap 100mg, 300mg, 400mg<br />
Neurontin Gabapentin Tab 600mg, 800mg<br />
Nevanac Nepafenac Ophth Susp 0.1%<br />
Nexium Esomeprazole Magnesium Cap 20mg, 40mg<br />
Niacin (immediate release) Niacin Tab ER 500mg<br />
Niaspan Niacin E.R. Tab 500mg, 750mg, 1000mg ER<br />
Niazid Isoniazid Sol'n 50mg/5ml<br />
Nicoderm Nicotine Patch<br />
7mg, 14mg, 21mg<br />
Must take HAWC Smoking Cessation class<br />
Age restriction >18yo<br />
Max of 2 quit attempts per year<br />
Nicorette Nicotine Gum<br />
2mg<br />
Must take HAWC Smoking Cessation class<br />
Age restriction >18yo<br />
Max of 2 quit attempts per year<br />
Nitro-Dur II Nitroglycerin Patch<br />
0.1mg/hr, 0.2mg/hr, 0.3mg/hr, 0.4mg/hr,<br />
0.6mg/hr, 0.8mg/hr<br />
Nitroglycerin Nitroglycerin SL Tab/Oint 400mcg/2%<br />
Nitrolingual Nitroglycerin SL Spray 400mcg<br />
Nizoral Ketoconazole Crm 2%<br />
Nizoral Ketoconazole Tab 200mg<br />
Nolvadex Tamoxifen Citrate Tab 10mg, 20mg<br />
Nor QD, Camila, Errin, Jolivette,<br />
Micronor, Nora-BE<br />
Norethindrone Tab 0.35mg<br />
Norco,Vicodin Hydrocodone/Acetaminophen Tab 5/325mg, 7.5/325mg, 10/325mg<br />
Nordette-28, Levlen-28, Levora,<br />
Portia<br />
Ethinyl Estradiol/Levonorgestrel Tab 30mcg/0.15mg<br />
Norditropin, Nordiflex Somatropin Inj 30mg/3ml<br />
Norflex Orphenadrine Citrate Tab ER 100mg<br />
Norinyl 1+50 Norethindrone/Mestranol Tab 1mg/50mcg<br />
Normodyne Labetalol Tab 200mg, 300mg<br />
Norvasc Amlodipine Besylate Tab 2.5mg, 5mg, 10mg<br />
Norvir Ritonavir Tab 100mg<br />
NovoFine Pen Needles Short Pen Needles Needle 30 guage<br />
Novolin Human Insulin Sol'n/Susp R, N and 70/30 10ml Vials<br />
Novolog Insulin Aspart Sol'n Plain, 70/30 10ml Vials<br />
Novolog Flexpen Insulin Aspart Flexpen Sol'n Plain, 70/30 3ml<br />
Nutropin Somatropin Inj 5mg/ml<br />
Nutropin AQ Somatropin Inj 10mg/2ml<br />
Nuvaring Ethinyl Estradiol/Etonogestrel Vag Ring 15mcg/0.12mg per 24h<br />
Nydrazid Isoniazid Tab 100mg, 300mg<br />
Nystatin Nystatin Cr/Oint/Pwd 100,000U/gm<br />
Nystatin Nystatin Tab 500,000U<br />
Nystatin Nystatin Susp 100,000U/ml
KIRTLAND AFB PHARMACY<br />
Ocean Sodium Chloride Sol'n 0.65%<br />
Ocuflox Ofloxacin Ophth Sol'n 0.3%<br />
Omnicef Cefdinir Susp 125mg/5mL<br />
Optivar Azelastine Ophth Sol'n 0.05%<br />
Oracea Doxycycline Monohydrate Cap 40mg<br />
Orapred ODT Prednisolone Sod Phosphate Tab Rap Dis 15mg<br />
Ortho Evra Ethinyl Estradiol/Norelgestromin Patch 20mcg/150mcg per 24h<br />
Ortho Novum, Necon 777 Ethinyl Estradiol/Norethindrone Tab 35mcg/0.5-0.75-1mg<br />
Ortho TriCyclen Lo Ethinyl Estradiol/Norgestimate Tab 25mcg/0.18-0.215-0.25mg<br />
Ortho-Cept/Reclipsen/Desogen/Apri Ethinyl Estradiol/Desogestrel Tab 30mcg/0.15mg<br />
Os-Cal + D Calcium/Vitamin D Tab 500mg/200IU<br />
Oxycontin Oxycodone ER Tab 10mg, 20mg, 40mg<br />
Pamelor Nortriptyline Cap 10mg, 25mg, 50mg<br />
Pataday Olopatadine Ophth Sol'n 0.2%<br />
Patanol Olopatadine Ophth Sol'n 0.10%<br />
Paxil Paroxetine Tab 10mg, 20mg, 30mg, 40mg<br />
Pediapred Prednisolone Sodium Phosphate Syrp 5mg/5ml<br />
Pediazole Erythromycin/Sulfasoxazole Susp 200mg-600mg/5mL<br />
Bold items are Basic Core Formulary 9<br />
FORMULARY BY BRAND<br />
3/7/2014<br />
(505) <strong>846</strong>-<strong>3131</strong><br />
Pegasys Peginterferon Alfa 2A Inj 180mcg/0.5ml (kit & syringe), 180mcg/ml<br />
Peg-Intron Peginterferon Alfa 2B Inj<br />
Penlac Ciclopirox Nail Lacquer Sol'n 8%<br />
Pentasa Mesalamine Cap 250mg<br />
Pepcid Famotidine Tab 20mg, 40mg<br />
Pepto Bismol Bismuth Subsalicylate Tab 262mg<br />
50mcg/0.5ml, 80mcg/0.5ml, 120mcg/0.5ml,<br />
150mcg/0.5ml<br />
Percocet Oxycodone/Acetaminophen Tab 5/325mg, 7.5/325mg, 10/325mg, 7.5/500mg<br />
Periactin Cyproheptadine Tab 4mg<br />
Periactin Cyproheptadine Syrp 2mg/5ml<br />
Peridex Chlorhexidine Gluconate Sol'n 12%<br />
Phenergan Promethazine Tab 12.5mg, 25mg<br />
Phenergan Promethazine Syrp 6.25mg/5ml<br />
Phenergan/Codeine Promethazine/Codeine Syrp 6.25mg-10mg/5mL<br />
Pilocarpine Pilocarpine Ophth Sol'n 1%, 2%, 4%<br />
Pilopine HS Pilocarpine Ophth Gel 4%<br />
Plan B One-Step Levonorgestrel Tab 1.5mg No refills<br />
Plaquenil Hydroxychloroquine Tab 200mg<br />
Plavix Clopidogrel Tab 75mg<br />
Plendil Felodipine Tab ER 2.5mg, 5mg, 10mg<br />
Polytrim Polymyxin/Trimethoprim Ophth Sol'n 10,000U/ml-0.1%<br />
Poly-vi-sol MVI Dropper<br />
Poly-vi-sol with Fluoride MVI with Fluoride Dropper<br />
Poly-vi-sol with Iron MVI with Iron Dropper<br />
Pradaxa Dabigatran Cap 75mg, 150mg<br />
Pravachol Pravastatin Tab 10mg, 20mg, 40mg, 80mg<br />
Precision Xtra<br />
Blood Glucose Meter<br />
Precision Xtra Blood Glucose Monitoring Strip Strip Max of 200 strips/30days<br />
Pred Forte Prednisolone Acetate Ophth Susp 1%<br />
Pred Mild Prednisolone Acetate Ophth Susp 0.12%<br />
Prelone Prednisolone Syrp 15mg/5mL<br />
Premarin Estrogen, Conjugated Vag Cr 0.625mg/gm<br />
Premarin Estrogen, Conjugated Tab 0.3mg, 0.45mg, 0.625mg, 0.9mg, 1.25mg<br />
Prempro Estrogen/Medroxyprogesterone Tab 0.3/1.5mg, 0.45/1.5mg, 0.625/2.5mg, 0.625/5mg<br />
Prenatal Vitamins Prenatal Vitamins Tab<br />
Folic Acid 1mg Limited to women age 45 and<br />
younger per DoD guidelines<br />
Prevacid SoluTabs Lanzoprazole ODT 15mg, 30mg Limited to pts
KIRTLAND AFB PHARMACY<br />
Prevident Sodium Fluoride Gel 1.1%<br />
Prevident 5000 Sodium Fluoride Gel 1.1%<br />
Prezista Darunavir Tab 400mg<br />
Prilosec Omeprazole Cap 10mg, 20mg, 40mg<br />
Primaquine Primaquine Tab 26.3mg (15mg)<br />
Bold items are Basic Core Formulary 10<br />
FORMULARY BY BRAND<br />
3/7/2014<br />
(505) <strong>846</strong>-<strong>3131</strong><br />
Prinivil/Zestril Lisinopril Tab 2.5mg, 5mg, 10mg, 20mg, 30mg, 40mg<br />
Prinzide/Zestoretic Lisinopril/HCTZ Tab 10/12.5mg, 20/12.5mg, 20/25mg<br />
Procardia Nifedipine Cap 10mg<br />
Procrit Epoetin Alfa Inj<br />
Prograf Tacrolimus Cap 0.5mg, 1mg, 5mg<br />
Prometrium Progesterone, Micronized Cap 100mg, 200mg<br />
Proscar Finasteride Tab 5mg<br />
Protopic Tacrolimus Oint 0.1%<br />
2000U/ml, 3000U/ml, 4000U/ml, 10000U/ml,<br />
20000U/ml, 40000U/ml<br />
Proventil Albuterol Sol'n for Neb 0.5% (5mg/ml) 20ml bottle<br />
Proventil Albuterol Unit dose vials<br />
0.083% (2.5ml/3ml)<br />
Max 200 amps (600ml)/30 days<br />
Proventil HFA Albuterol MDI 90mcg per inhalation Max 2 inh/30 days<br />
Provera Medroxyprogesterone Tab 2.5mg, 5mg, 10mg<br />
Provigil Modafinil Tab 100mg, 200mg<br />
Prozac Fluoxetine Sol'n 20mg/5ml<br />
Prozac Fluoxetine Cap 10mg, 20mg, 40mg<br />
Prozac Fluoxetine Tab 60mg<br />
PTU Propylthiouracil Tab 50mg<br />
Pulmicort Respule Budesonide Sol'n for Neb 0.25mg/2ml, 0.5mg/2ml<br />
Pyridium Phenazopyridine Tab 100mg, 200mg<br />
Questran Cholestyramine Packet 4gm/packet<br />
Rapamune Sirolimus Tab 1mg, 2mg<br />
Rebetol Ribavirin Tab 200mg<br />
Rebif Interferon Beta 1A/Albumin Inj 22mcg/0.5ml, 44mcg/0.5ml<br />
Rectiv Nitroglycerin Oint 0.4% (w/w)<br />
Reglan Metoclopramide Tab 10mg<br />
Reglan Metoclopramide Syrp 5mg/5ml<br />
Relafen Nabumetone Tab 500mg, 750mg<br />
Relpax Eletriptan Tab 20mg, 40mg<br />
Remeron Mirtazapine Tab 15mg, 30mg<br />
Requip Ropinirole Tab 0.25mg, 0.5mg, 1mg, 2mg, 3mg, 4mg, 5mg<br />
Restasis Cyclosporine Ophth Emulsion 0.05%<br />
Restoril Temazepam Cap 7.5mg, 15mg, 30mg<br />
Retin-A Tretinoin Cr 0.025%, 0.05%<br />
Retin-A Tretinoin Gel 0.01%<br />
Rheumatrex Methotrexate Tab 2.5mg<br />
Rifadin Rifampin Cap 300mg<br />
Rilutek Riluzole Tab 50mg<br />
Risperdal Risperidone Sol'n 1mg/ml<br />
Risperdal Risperidone Tab 0.25mg, 0.5mg, 1mg, 2mg, 3mg, 4mg<br />
Ritalin Methylphenidate Tab 5mg, 10mg, 20mg<br />
Ritalin LA Methylphenidate Cap 10mg, 20mg, 30mg, 40mg<br />
Robaxin Methocarbamol Tab 500mg, 750mg<br />
Robitussin AC Guaifenesin/Codeine Syrp 100mg-10mg/5mL<br />
Robitussin DM Guaifenesin/Dextromethorphan Syrp 100mg-10mg/5mL<br />
Rocatrol Calcitriol Cap 0.25mcg<br />
Romycin Erythromycin Ophth Oint 0.50%<br />
Rondec Phenylephrine/Carbinoxamine Drops 3.5-1mg/mL<br />
Rondec Phenylephrine/Carbinoxamine Syrp 12.5-4mg/5mL<br />
Rowasa Mesalamine Enema 4gm
KIRTLAND AFB PHARMACY<br />
Roxicodone Oxycodone Tab 5mg, 10mg, 15mg<br />
Sandimmune Cyclosporine, Non-modified Cap 25mg, 100mg<br />
Selsun Selenium Sulfide Lotion 2.5%<br />
Septra Sulfamethoxazole/Trimethoprim Tab 400mg/80mg<br />
Septra Sulfamethoxazole/Trimethoprim DS Tab 800mg/160mg<br />
Septra Sulfamethoxazole/Trimethoprim Susp 200mg-40mg/5mL<br />
FORMULARY BY BRAND<br />
3/7/2014<br />
(505) <strong>846</strong>-<strong>3131</strong><br />
Serevent Salmeterol Diskus 50mcg Max of 60 blisters/30 days<br />
Seroquel Quetiapine Tab 25mg, 50mg, 100mg, 200mg, 300mg, 400mg<br />
Seroquel XR Quetiapine XR Tab 50mg, 150mg, 200mg, 300mg, 400mg<br />
Serzone Nefazodone Tab 150mg<br />
Silvadene Silver Sulfadiazine Crm 1%<br />
Sinemet Carbidopa/Levodopa Tab 10/100mg, 25/100mg, 25/250mg<br />
Sinemet CR Carbidopa/Levodopa Tab 25/100mg, 50/200mg<br />
Singulair Montelukast Chew Tab 4mg, 5mg<br />
Singulair Montelukast Granules 4mg<br />
Singulair Montelukast Tab 10mg<br />
Skelaxin Metaxalone Tab 800mg<br />
Sodium Chloride Sodium Chloride Inh Sol'n 0.9%<br />
Spiriva Tiotropium Bromide Inh Powder 18mcg Max of 30 blisters/30 days<br />
Sronyx, Levlite, Lessina-28, Lutera,<br />
Alesse-28, Aviane<br />
Ethinyl Estradiol/Levonorgestrel Tab 20mcg/0.1mg<br />
Strattera Atomoxetine Cap 18mg, 25mg, 40mg, 60mg<br />
Sudafed Pseudoephedrine Tab 30mg<br />
Sudafed Pseudoephedrine Syrp 30mg/5ml<br />
Sumycin Tetracycline Cap 250mg<br />
Surgilube Surgical Lubricant Topical Lube<br />
Sustiva Efavirenz Tab 50mg, 200mg, 600mg<br />
Symadine Amantadine Sol'n 50mg/5ml<br />
Symbicort Budesonide/Formoterol Inh 80/4.5mcg, 160/4.5mcg Max of 1 inh/30 days<br />
Symmetrel Amantadine Cap 100mg<br />
Synthroid Levothyroxine Tab<br />
25mcg, 50mcg, 75mcg, 88mcg, 100mcg, 112mcg,<br />
125mcg, 137mcg, 150mcg, <strong>17</strong>5mcg, 200mcg,<br />
300mcg<br />
Syringe (Insulin) Syringe (Insulin) 30G 0.3cc, 0.5cc, 1cc<br />
Tagamet Cimetidine Liq 300mg/5ml<br />
Tambocor Flecanide Tab 50mg, 100mg<br />
Tapazole Methimazole Tab 5mg, 10mg<br />
Tarceva Erlotinib Tab 25mg, 100mg, 150mg<br />
Tears Naturale Free Sodium Chloride Sol'n 0.1% -0.3% Preservative Free<br />
Tebrazid Pyrazinamide Tab 500mg<br />
Tegretol Carbamazepine Susp 100mg/5ml<br />
Tegretol Carbamazepine Chew Tab 100mg<br />
Tegretol Carbamazepine Tab 200mg<br />
Tegretol XR Carbamazepine Tab ER 100mg, 200mg, 400mg<br />
Temovate Clobetasol Propionate Cr/Gel/Oint 0.05%<br />
Tenex Guanfacine Tab 1mg<br />
Tenormin Atenolol Tab 25mg, 50mg, 100mg<br />
Terazol-7 Terconazole Cr 0.4%<br />
Tessalon Perle Benzonatate Cap 100mg, 200mg<br />
Thalomid Thalidomide Clone Cap 50mg, 100mg, 150mg, 200mg<br />
Thalomid Thalidomide Cap 50mg, 200mg, 400mg<br />
Theo-24 Theophylline Extended Release Cap 100mg, 200mg, 300mg, 400mg (24-hr)<br />
Theochron Theophylline Controlled Release Tab 200mg, 300mg (12-hr)<br />
Theophylline Theophylline Elixir 80mg/15ml<br />
Theophylline Theophylline Extended Release Tab 400mg (24-hr)<br />
Bold items are Basic Core Formulary 11
KIRTLAND AFB PHARMACY<br />
FORMULARY BY BRAND<br />
3/7/2014<br />
(505) <strong>846</strong>-<strong>3131</strong><br />
Tiazac/Taztia XT/Diltzac Diltiazem ER Cap 120mg, 180mg, 240mg, 300mg, 360mg, 420mg<br />
Timoptic Timolol Sol'n 0.25%, 0.5%<br />
Timoptic XE Timolol Gel Form. Sol'n 0.25%, 0.5%<br />
Tobradex Tobramycin/Dexamethasone Ophth Susp/Oint 0.3%/0.1%<br />
Tobrex Tobramycin Ophth Sol'n/Oint 0.3%<br />
Tofranil Imipramine Tab 10mg, 25mg, 50mg<br />
Tofranil-PM Imipramine Pamoate Cap 75mg<br />
Topamax Topiramate Tab 25mg, 50mg, 100mg, 200mg<br />
Toprol XL Metoprolol Succinate Tab 25mg, 50mg, 100mg, 200mg<br />
Tracleer Bosentan Tab 62.5mg, 125mg<br />
Transderm Scop Scopolamine Patch 1.5mg/72 hr<br />
Tricor Fenofibrate Tab 48mg, 145mg<br />
Triglide Fenofibrate Tab 50mg, 160mg<br />
Trileptal Oxcarbazepine Tab 150mg, 300mg, 600mg<br />
Trinessa, Ortho Tri-cyclen, Triprevifem,<br />
Tri-Sprintec<br />
Norgestimate/Ethinyl Estradiol Tab 0.18-0.215-0.25mg/35mcg<br />
Trivora, Tri Levlin & Triphasil 28 Ethinyl Estradiol/Levonorgestrel Tab 30-40-30mcg/0.05-0.075-0.125mg<br />
Trizivir Abacavir/Lamivudine/Zidovudine Tab 300/150/300mg<br />
Trusopt Dorzolamide Ophth Sol'n 2%<br />
Truvada Tenofovir/Emtricitabine Tab 300mg/200mg<br />
Tykerb Lapatinib Ditosylate Tab 250mg<br />
Tylenol Acetaminophen Sol'n 160mg/5ml<br />
Tylenol Acetaminophen Tab 325mg, 500mg<br />
Tylenol Acetaminophen Supp 120mg, 650mg<br />
Tylenol with Codeine Acetaminophen with Codeine Tab 300/30mg, 300/60mg<br />
Tylenol with Codeine Acetaminophen with Codeine Liquid 120mg-12mg/5ml<br />
Ultram Tramadol Tab 50mg Max 240 tabs/30 days<br />
Urocit-K Potassium Citrate Tab 10mEq<br />
Uroxatral Alfuzosin Tab 10mg<br />
Vagifem Estradiol Hemihydrate Vag Tab 10mcg<br />
Valium Diazepam Tab 2mg, 5mg, 10mg<br />
Valtrex Valacyclovir Tab 500mg, 1g<br />
Vanicream Emollient Cr<br />
Vantin Cefpodoxime Tab 100mg<br />
Vasotec Enalapril Tab 2.5, 10mg, 20mg<br />
Veetids Penicillin VK Tab 250mg, 500mg<br />
Veetids Penicillin VK Susp 125mg/5ml, 250mg/5ml<br />
Ventolin HFA Albuterol MDI 90mcg per inhalation<br />
Vesicare Solifenacin Tab 5mg<br />
Viagra Sildenafil Tab 25mg, 50mg, 100mg Max 6 tabs/30 days<br />
VibraTab Doxycycline Hyclate Tab 100mg<br />
Vigamox Moxifloxacin Sol'n 0.5%<br />
Vistaril Hydroxyzine Pamoate Cap 25mg , 50mg<br />
Vitamin B12 Cyanocobalamin Sol'n 1000mcg/vial<br />
Vitamin B6 Pyridoxine Tab 50mg<br />
Vitamin D Ergocalciferol Cap 50,000 units<br />
Voltaren Diclofenac Ophth Sol 0.1%<br />
Voltaren Diclofenac Tab 50mg, 75mg<br />
Voltaren Diclofenac Top Gel 1%<br />
Vytorin Ezetimibe/Simvastatin Tab 10/10mg, 10/20mg, 10/40mg, 10/80mg<br />
Wellbutrin Bupropion Tab 75mg, 100mg<br />
Wellbutrin SR Bupropion Sustained Release Tab 100mg, 150mg, 200mg<br />
Wellbutrin XL Bupropion Extended Release Tab 150mg, 300mg<br />
Westcort Hydrocortisone Valerate Cr/Oint 0.2%<br />
Xalatan Latanoprost Sol 0.005%<br />
Bold items are Basic Core Formulary 12
KIRTLAND AFB PHARMACY<br />
Xanax Alprazolam Tab 0.25mg, 0.5mg, 1mg<br />
Xarelto Rivaroxaban Tab 10mg , 15mg, 20mg<br />
Xeloda Capecitabine Tab 150mg, 500mg<br />
Xopenex HFA Levalbuterol Tartrate Inh 45mcg<br />
Xylocaine Lidocaine Visc Jel & Top Jel 2%<br />
Xylocaine Lidocaine Top Oint 5%<br />
Yasmin 28 Ethinyl Estradiol/Drosperinone Tab 30mcg/3.0mg<br />
Yaz Ethinyl Estradiol/Drosperinone Tab 20mcg/3.0mg<br />
Zanaflex Tizanidine Cap 4mg<br />
Zantac Ranitidine Syrp 15mg/mL<br />
Zantac Ranitidine Tab 150mg, 300mg<br />
Zaroxolyn Metolazone Tab 2.5mg, 5mg<br />
Zetia Ezetimibe Tab 10mg<br />
Ziac Bisoprolol/Hydrochlorothiazide Tab 2.5/6.25mg, 5/6.25mg<br />
FORMULARY BY BRAND<br />
3/7/2014<br />
(505) <strong>846</strong>-<strong>3131</strong><br />
Zithromax Azithromycin Tab 250mg (Z-pak), 500mg (Tri-Pak)<br />
Zithromax Azithromycin Susp 100mg/5ml, 200mg/5ml & 1gm Powder Packets<br />
Zocor Simvastatin Tab 5mg, 10mg, 20mg, 40mg, 80mg<br />
Zofran Ondansetron Tab 4mg, 8mg<br />
Zofran ODT Ondansetron ODT Orally Dis Tabs 4mg, 8mg<br />
Zoladex Goserelin Acetate Inj 3.6mg, 10.8mg<br />
Zoloft Sertraline Tab 25mg, 50mg, 100mg<br />
Zoloft Sertraline Sol'n 20mg/ml<br />
Zomig Zolmitriptan Tab 2.5mg, 5mg Max of 12 tabs/30 days<br />
Zomig ZMT Zolmitriptan Orally Dis Tabs 2.5mg, 5mg Max of 12 tabs/30 days<br />
Zovirax Acyclovir Susp 200mg/5ml<br />
Zovirax Acyclovir Cap 200mg, 400mg<br />
Zovirax Acyclovir Tab 800mg<br />
Zyloprim Allopurinol Tab 100mg, 300mg<br />
Zymaxid Gatifloxacin Ophth Sol'n 0.5%<br />
Zyprexa Olanzapine Tab 2.5mg, 5mg, 10mg<br />
Zyrtec Cetirizine Tab 5mg, 10mg<br />
Zyrtec Cetirizine Syrp 5mg/5ml<br />
Zyrtec-D Cetirizine/Pseudoephedrine Tab 5/120mg 12-hr tab<br />
TRICARE Online (TOL) Pharmacy Refill is a new capability that allows authorized beneficiaries to securely request prescription refills from the TOL website (www.tricare.mil). TOL<br />
Pharmacy Refill serves as a secure portal to the MHS prescription refill system, AudioCARE, and is compliant with Health Insurance Portability and Accountability Act (HIPAA) and<br />
Joint Commission (JC) standards.<br />
Authorized beneficiaries will have the ability to request refills of those prescriptions that are refillable, check the status of their refill requests, and<br />
link to the TRICARE Mail Order Pharmacy<br />
Mon –Fri 0730-<strong>17</strong>00 (505) <strong>846</strong>-3130<br />
Automated Refill line (505) <strong>846</strong>-5770<br />
Main/Satellite Pharmacy<br />
The Pharmacy is closed all federal holidays, family days, and training days.<br />
New Prescriptions<br />
New prescriptions are dropped off at Window #4.<br />
New prescription must contain patient name, address, phone number, date of birth, sponsor's social security number, and allergies to medications.<br />
Completed prescriptions are picked up at Windows #1 and #2.<br />
Patient names are displayed on the lob<strong>by</strong> TV Screen for 90 minutes after completion of script.<br />
Patients 18 years and older, the patient ID card or a black and white copy of the ID card, front and back, must be presented to pick up prescriptions.<br />
Current Yellow Cards must be presented for drop off and pick up of prescriptions.<br />
Controlled Prescriptions<br />
Prescriptions for Schedule 3, 4 or 5 medications will be honored for 6 months from the date they were written with up to 5 refills.<br />
Providers are reminded to include their DEA number on all controlled prescriptions.<br />
Bold items are Basic Core Formulary 13
KIRTLAND AFB PHARMACY<br />
FORMULARY BY BRAND<br />
3/7/2014<br />
(505) <strong>846</strong>-<strong>3131</strong><br />
Non-Controlled Prescriptions<br />
Are honored up to 365 days from the date the prescription was written.<br />
Antibiotic prescriptions over 10 days old will be filled at the discretion of the <strong>pharmacy</strong>.<br />
Prescriptions for maintenance medications may be written for up to a 90 day supply with a maximum of 3 refills when requested <strong>by</strong> prescriber.<br />
State and Federal laws maintain that all prescriptions be originally signed <strong>by</strong> the provider; stamped/copied signatures are NOT acceptable.<br />
‘Indications’ are highly encouraged to prevent prescription errors.<br />
The <strong>pharmacy</strong> must use <strong>generic</strong> medication whenever possible so please write all medications <strong>generic</strong>ally.<br />
WE ACCEPT FAXED PRESCRIPTIONS FROM YOUR DOCTORS OFFICE ONLY. OUR FAX NUMBER IS (505) <strong>846</strong>-3137.<br />
TELEPHONE PRESCRIPTIONS ARE NOT ACCEPTED.<br />
Website: This <strong>formulary</strong> and other information about the <strong>pharmacy</strong> is available at: http://www.<strong>kirtland</strong>.af.mil, select 'Medical Clinic' icon and then select<br />
Kirtland Formulary'.<br />
Training Day & Closure Schedule for 2013<br />
1 Jan – Federal Holiday<br />
20 Jan – Federal Holiday<br />
29 Jan – Training Day<br />
<strong>17</strong> Feb – Federal Holiday<br />
26 Feb – Training Day<br />
26 Mar – Training Day<br />
30 Apr – Training Day<br />
23 May – Family Day<br />
26 May – Federal Holiday<br />
28 May – Training Day<br />
25 Jun – Training Day<br />
04 Jul – Federal Holiday<br />
30 Jul – Training Day<br />
27 Aug – Training Day<br />
29 Aug – Family Day<br />
1 Sep – Federal Holiday<br />
24 Sep – Training Day<br />
13 Oct – Federal Holiday<br />
29 Oct – Training Day<br />
11 Nov – Federal Holiday<br />
27 Nov – Federal Holiday<br />
28 Nov – Family Day<br />
25 Dec – Federal Holiday<br />
26 Dec -- Family Day<br />
Bold items are Basic Core Formulary 14
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