kirtland afb pharmacy formulary by brand 6/14/2013 846-3131

KIRTLAND AFB PHARMACYFORMULARY BY BRAND3/19/2014(505) 846-3131Depakote ER Divalproex Sodium Tab 250mg, 500mgDepakote Sprinkles Divalproex Sodium Sprinkles Cap 125mgDepo-Testosterone Testosterone Cypionate Inj 200mg/mlDermaCerin Mineral Oil/Lanolin CrDesowen Desonide Cr 0.05%Desquam-X Benzoyl Peroxide Gel & Cleanser 5%, 10%Desyrel Trazadone Tab 50mg, 100mg, 150mg, 300mgDetrol LA Tolterodine Cap 2mg, 4mgDexedrine Dextroamphetamine Tab 5mgDibucaine Dibucaine Oint 1%Differin Adapalene Cr 0.1%Diflucan Fluconzole Tab 100mg, 150mg, 200mgDiflucan Fluconzole Susp 10mg/mlDilantin Phenytoin Susp 125mg/5mlDilantin Phenytoin Tab 50mgDilantin Phenytoin Cap 100mgDilaudid Hydromorphone Tab 2mgDimetapp for Children-Cold & CoughBrompheniramine-Dextromethrophan-PhenylephrineSyrp1mg-5mg-2.5mg/5mLDiovan Valsartan Tab 40mg, 80mg, 160mg, 320mgDiovan HCT Valsartan/hydrochlorothiazide Tab80/12.5mg, 160/12.5mg, 160/25mg, 320/12.5mg,320/25mgDiprosone Betamethasone Dipropionate Cr 0.05%Disalcid Salsalate Tab 500mg, 750mgDitropan Oxybutynin Tab 5mgDitropan XL Oxybutynin ER Tab 5mg,10mg,15mgDonnatal Atrop/Scop/Hyos/Phenobarb. Tab 0.0194/0.0065/0.137/16.2mgDovonex Calcipotriene Cr 0.005%Drysol Aluminum Chloride Sol'n 20%Dulcolax Bisacodyl Tab/Supp 5mg (Tab), 10mg (Supp)Dulera Mometasone / Formoterol Inh 100-5mcg , 200-5mcgDuoNeb Albuterol/Ipatropium Sol'n for Neb 0.5mg-2.5mg/3mlD-Vi-Sol Cholecalciferol Liq 400IU/mlDyazide Triamterene/HCTZ Cap 37.5/25mgDycill Dicloxacillin Cap 250mg, 500mgE.E.S. Erythromycin Ethylsuccinate Susp 200mg/5mlEffexor Venlafaxine Tab 25mg,37.5mg, 50mg, 75mg, 100mgEffexor XR Venlafaxine Cap 37.5mg, 75mg, 150mg, 225mg,Efudex Fluorouracil Cr 5%Elavil Amitriptyline Tab 10mg, 25mg, 50mg, 75mgElidel Pimecrolimus Cr 1%Elimite/Acticin Permethrin Cr 5%Emla Lidocaine/Prilocaine Cr 2.5%/2.5%Entocort EC Budesonide Cap 3mgEpi Pen/Epi Pen Jr Epinephrine Inj 0.3mg/Injection, 0.15mg/InjectionEpogen Epoetin Alfa Inj2000U/ml, 3000U/ml, 4000U/ml, 10000U/ml,20000U/mlErystat/Emgel Erythromycin/Ethyl Alcohol Gel & Sol'n 2%Ery-Tab Erythromycin Base Tab 250mg, 333mgErythrocin Erythromycin Stearate Tab 250mgEskalith Lithium Carbonate Cap 150mg, 300mgEskalith Lithium Citrate Sol'n 8mEq/5mlEstrace Estradiol Cr 0.1mg/1gmEstrace Estradiol Tab 1mg, 2mgEstratest, Estratest HS Estrogen Esterified/Methyltestosterone Tab 0.625mg/1.25mg, 1.25mg/2.5mgBold items are Basic Core Formulary 4

KIRTLAND AFB PHARMACYFORMULARY BY BRAND3/19/2014(505) 846-3131Eulexin Flutamide Cap 125mgEvista Raloxifene Tab 60mgFamvir Famciclovir Tab 500mgFeldene Piroxicam Cap 20mgFemara Letrozole Tab 2.5mgFerrous Sulfate Ferrous Sulfate Tab 325mgFerrous Sulfate Ferrous Sulfate Drops 15mg/mlFioricet Butalbital/Acetaminophen/Caffeine Tab 50mg/325mg/40mgFiorinal Butalbital/Aspirin/Caffeine Tab 50mg/325mg/40mgFlagyl Metronidazole Tab 250mg, 500mgFlagyl Metronidazole Vag Gel 0.75%Fleet Fleet Enema Adult & PediatricFlexeril Cyclobenzaprine Tab 5mg, 10mgFlomax Tamulosin Cap 0.4mgFlonase Fluticasone Nasal Inh 50mcg Max of 1 bottle (16gm)/30 daysFlovent Diskus Fluticasone Diskus 100mcg, 250mcg Max of 2 inh/30 daysFlovent HFA Fluticasone Oral Inh44mcg, 110mcg, 220mcgMax of 2 inh/30 daysFloxin otic Ofloxacin Otic Susp 0.3%FML Fluorometholone Ophth Susp 0.1%Folic Acid Folic Acid Tab 1mgFortesta Testosterone Gel Pump 1%Fosamax Alendronate Tab 5mg, 10mg, 35mg, 70mgFosamax Plus D Alendronate/Cholecalciferol Tab 70mg/2800IU, 70mg/5600IUFuradantin Nitrofurantoin Susp 25mg/5mlGengraf Cyclosporine, modified Cap 25mg, 100mgGenoptic/Gentak Gentamicin Ophth Sol'n/Oint 0.3%Gentian Violet Gentian Violet Sol'n 1%Gleevec Imatinib Tab 100mg, 400mgGlucagon Emergency Kit Glucagon, Human Recombinant Inj 1mg/mlGlucophage Metformin Tab 500mg, 850mg, 1000mgGlucophage XR Metformin ER Tab 500mg, 750mgGlucotrol Glipizide Tab 5mg, 10mgGlucotrol XL Glipizide Tab 2.5mg, 5mg, 10mgGlucovance Glyburide/Metformin Tab 1.25/250mg, 2.5/500mg, 5/500mgGlynase Glyburide, Micronized Tab 1.5mg, 3mg, 6mgGrisPeg Griseofulvin, Ultramicrosize Tab 125mg, 250mgGrisPeg Griseofulvin, Microsize Susp 125mg/5mlHalcion Triazolam Tab 0.125mg, 0.25mgHumira Adalimumab Inj 20mg/0.4ml (Syringe), 40mg/0.8ml (Pen & Syringe)Hydrocerin Petrolatum/Mineral Oil CrHydrodiuril Hydrochlorothiazide Tab 12.5mg, 25mg, 50mgHygrotron Chlorthalidone Tab 25mg, 50mgHytrin Terazosin Cap 1mg, 2mg, 5mg, 10mgHyzaar Losartan/Hydrochlorothiazide Tab 50/12.5mg, 100/12.5mg, 100/25mgIlotycin Erythromycin Ophth Oint 0.5%Imdur Isosorbide Mononitrate Tab 30mg, 60mg, 120mgImitrex Sumatriptan Succinate Inj6mg/cartridgeMax 16 devices (8ml)/30 daysImitrex Sumatriptan Succinate Tab25mg, 50mg Max of 18 tabs/30 days100mg Max of 9 tabs/30 daysImodium Loperamide Cap 2mgImuran Azathioprine Tab 50mgIncivek Telaprevir Tab 375mgBold items are Basic Core Formulary 5

KIRTLAND AFB PHARMACYFORMULARY BY BRAND3/19/2014(505) 846-3131Inderal Propranolol Tab 10mg, 20mg, 40mg, 60mg, 80mgInderal LA Propranolol Cap 60mg, 80mg, 120mg, 160mgIndocin Indomethacin Cap 25mg, 50mgIndocin-SR Indomethacin SR Cap 75mgIsopto Atropine Atropine Ophth Sol'n/Oint 1%Isopto Homatropine Homatropine Ophth Sol'n 5%Isordil Isosorbide Dinitrate Tab 5mg, 10mg, 20mg, 30mg, 40mg SRJanumet Sitagliptin/Metformin Tab 50/500mg, 50/1000mgJanumet XR Sitagliptin/Metformin XR Tab 50/500mg, 50/1000mg, 100/1000mgJanuvia Sitagliptin Tab 25mg, 50mg, 100mgKeflex Cephalexin Cap 250mg, 500mgKeflex Cephalexin Susp 250mg/5mlKenalogTriamcinoloneCrCr, Oint, Oral PasteTop Spray0.5%0.1%0.147mg/gmKeppra Levetiracetam Tab 500mg, 750mgKlonopin Clonazepam Tab 0.5mg, 1mg, 2mgKlor-Con Potassium Chloride Packet 20mEqKlor-Con Potassium Chloride Sol'n 20mE1/15mlKlor-Con Potassium Chloride Tab 10mEq, 20mEqKuvan Sapropterin Tab 100mgLacHydrin Ammonium Lactate Lotion 12%Lacrilube/Artificial Tears Mineral Oil/White Petrolatum Ophth Oint 15%/83%Lamictal Lamotrigine Tab 5mg, 25mg, 100mg, 150mg, 200mgLamictal XR Lamotrigine XR Tab 50mg, 100mg, 200mg, 300mgLamisil Terbinafine Tab, Cr 250mg, 1%Lancets (Precision Xtra) Lancets (Precision Xtra) LancetsLanoxin Digoxin Tab 0.125mg, 0.25mgLantus Insulin Glargine Sol'n100U/ml 10ml Vials100U/ml 3ml SolostarLariam Mefloquine Tab 250mgLasix Furosemide Sol'n 10mg/mlLasix Furosemide Tab 20mg, 40mgLevaquin Levofloxacin Sol'n 250mg/10mlLevaquin Levofloxacin Tab 250mg, 500mg, 750mgLevemir Insulin Detemir Sol 100U/ml 10ml VialsLevsinex Hyoscyamine Cap 0.125mg, 0.375mgLexapro Escitalopram Tab 10mg, 20mgLidex Fluocinonide Cr, Oint, Gel, Sol 0.05%Lidoderm Lidocaine Patches Patch 5%Lindane Lindane Shampoo 1%Liorisal Baclofen Tab 10mg, 20mgLipitor Atorvastatin Tab 10mg, 20mg, 40mg, 80mgLiquiTears/Artificial Tears Polyvinyl Alcohol Sol'n 1.4%Lithobid Lithium Carbonate Tab 300mg ERLodine Etodolac Tab 400mgLoEstrin Fe, Microgestin Fe, Junel Fe Ethinyl Estradiol/Norethindrone Tab 20mcg/1mg, 30mcg/1.5mgLomotil Diphenoxylate/Atropine Tab 2.5/0.025mgLo-Ovral, Low-Ogestrel, Cryselle Ethinyl Estradiol/Norgestrel Tab 30mcg/0.3mgLopid Gemfibrozil Tab 600mgLopressor Metoprolol Tartrate Tab 25mg, 50mg, 100mgLotemax Loteprednol Ophth Susp 0.5%Lotensin Benazepril Tab 5mg, 10mg, 20mg, 40mgLotrel Amlodipine/Benazepril Cap2.5/10mg, 5/10mg, 5/20mg, 5/40mg, 10/20mg,10/40mgLotrimin Clotrimazole Cr/Sol'n 1%Bold items are Basic Core Formulary 6

KIRTLAND AFB PHARMACYLotrisone Clotrimazole/Betamethasone Dip CrFORMULARY BY BRAND3/19/2014(505) 846-3131Lovenox Enoxaparin Sol'n 30mg, 40mg, 60mg, 80mg, 100mg, 120mg, 150mgLumigan Bimatoprost Ophth Sol'n 0.01%, 0.03%Luminal Phenobarbital Tab 16.2mg, 32.4mg, 64.8mg, 100mgLuminal Phenobarbital Elix 20mg/5mlLunesta Eszopiclone Tab 1mg, 2mg, 3mgLupron Depot Leuprolide Acetate Inj 3.75mgLuride Fluoride Sol'n 0.5mg/mlMaalox, AntacidAluminum Hydroxide/MagnesiumHydroxide/SimethiconeSusp200mg/200mg/20mgMacrobid Nitrofurantoin Monohydrate/Macro Cap 100mgMacrodantin Nitrofurantoin Macrocrystal Cap 50mgMagic MouthwashDiphenhydramine/Maalox/ViscousLidocaineSuspMagnesium Citrate Magnesium Citrate Sol'n1:1:1Must specify exact quantities of each drugMaxalt Rizatriptan Tab 5mg, 10mg Max of 12 tabs/30 daysMaxalt MLT Rizatriptan Dis. Tab 5mg, 10mg Max of 12 tabs/30 daysMaxitrol Neomycin/Polymixin B Sulf/Dexameth Ophth Oint 3.5mg/gm-10,000U/gm-0.1%Maxzide Triamterene/HCTZ Tab 75/50mgMaxzide-25 Triamterene/HCTZ Tab 37.5/25mgMedrol Methylprednisolone Tab 4mg, 4mg dosepackMegace Megestrol Acetate Tab 40mgMephyton Phytonadione Tab 5mgMethadose Methadone Tab 10mgMethergine Methylergonovine Maleate Tab 0.2mgMetrogel Metronidazole Gel 1%Mevacor Lovastatin Tab 10mg, 20mg, 40mgMicardis Telmisartan Tab 20mg, 40mg, 80mgMicardis HCT Telmisartan/HCTZ Tab 40/12.5mg, 80/12.5mg, 80/25mgMiconazole Miconazole Top Cr 2%MicroK Potassium Chloride Cap 10mEqMicronase Glyburide Tab 1.25mg, 1.5mg, 2.5mg, 5mg, 6mgMicrozide Hydrochlorothiazide Cap 12.5mgMineral Oil Mineral Oil Sol'nMinipress Prazosin Cap 1mg, 2mg, 5mgMinocin Minocycline Cap 50mg, 100mgMiralax Polyethylene Glycol 3350 Powder 527g bottle (17gm/dose)Mirapex Pramipexole Tab 0.125mg, 0.25mg, 0.5mg, 1mg, 1.5mgMircette/Kariva/Azurette/Viorele Ethinyl Estradiol/Desogestrel Tab 20mcg-0mcg-10mcg/0.15mgMobic Meloxicam Tab 7.5mg, 15mgMonistat/Miconazole 7 Miconazole Vag Cr 2% (7-day)MonoNessa, Ortho Cyclen, Previfem,Ethinyl Estradiol/NorgestimateSprintecTab 35mcg/0.25mgMonopril Fosinopril Tab 10mg, 20mg, 40mgMorphine Sulfate Morphine Sulfate Tab 15mgMotrin Ibuprofen Tab 400mg, 600mg, 800mgMotrin Ibuprofen Susp 100mg/5mlMS Contin Morphine Sulfate Tab 15mg, 30mg, 60mg, 100mg, 200mgMucinex Guaifenesin Tab 200mgMuro 128 Sodium Chloride Sol'n/Oint 5%Myambutol Ethambutol Tab 100mg, 400mgMycolog II Nystatin/Triamcinolone Crm 100,000U-1mg/gMyfortic Mycophenolate Sodium Tab 180mg, 360mgMylicon Simethicone Tab 80mgMylicon Simethicone Sol'n 40mg/0.6mlBold items are Basic Core Formulary 7

KIRTLAND AFB PHARMACYFORMULARY BY BRAND3/19/2014(505) 846-3131Mysoline Primidone Tab 50mgNamenda Memantine Tab 5mg, 10mg & Starter PakNaphcon A Naphazoline/Pheniramine Ophth Sol'n 0.025%/0.3%Naprosyn Naproxen Susp 125mg/5mlNaprosyn Naproxen Tab 250mg, 375mg, 500mgNasalide Flunisolide Nasal Spr 0.025%Nasonex Mometasone Nasal Spr 50mcg Max of 2 bottles/30 daysNecon 1/35, Norinyl 1+35. Nortrel1/35, Ortho-Novum 1/35Ethinyl Estradiol/Norethindrone Tab 35mcg/1mgNeo-Fradin Neomycin Sulfate Tab 500mgNeoral Cyclosporine, Modified Cap 25mg, 100mgNeosporin Neomycin/Polymyxin/Bacitracin Ophth OintNeosporin Neomycin/Polymyxin/Gramicidin Ophth Sol'nNeo-Synephrine Phenylephrine Ophth Sol'n 2.5%Neptazane Methazolamide Tab 50mgNeupogen Filgrastim Inj300mcg/0.5ml, 300mcg/ml, 480mcg/0.8ml,480mcg/1.6mlNeurontin Gabapentin Cap 100mg, 300mg, 400mgNeurontin Gabapentin Tab 600mg, 800mgNevanac Nepafenac Ophth Susp 0.1%Nexium Esomeprazole Magnesium Cap 20mg, 40mgNiacin (immediate release) Niacin Tab ER 500mgNiaspan Niacin E.R. Tab 500mg, 750mg, 1000mg ERNiazid Isoniazid Sol'n 50mg/5mlNicoderm Nicotine Patch7mg, 14mg, 21mgMust take HAWC Smoking Cessation classAge restriction >18yoMax of 2 quit attempts per yearNicorette Nicotine Gum2mgMust take HAWC Smoking Cessation classAge restriction >18yoMax of 2 quit attempts per yearNitro-Dur II Nitroglycerin Patch0.1mg/hr, 0.2mg/hr, 0.3mg/hr, 0.4mg/hr, 0.6mg/hr,0.8mg/hrNitroglycerin Nitroglycerin SL Tab/Oint 400mcg/2%Nitrolingual Nitroglycerin SL Spray 400mcgNizoral Ketoconazole Crm 2%Nizoral Ketoconazole Tab 200mgNolvadex Tamoxifen Citrate Tab 10mg, 20mgNor QD, Camila, Errin, Jolivette,Micronor, Nora-BENorethindrone Tab 0.35mgNorco,Vicodin Hydrocodone/Acetaminophen Tab 5/325mg, 7.5/325mg, 10/325mgNordette-28, Levlen-28, Levora,PortiaEthinyl Estradiol/Levonorgestrel Tab 30mcg/0.15mgNorditropin, Nordiflex Somatropin Inj 30mg/3mlNorflex Orphenadrine Citrate Tab ER 100mgNorinyl 1+50 Norethindrone/Mestranol Tab 1mg/50mcgNormodyne Labetalol Tab 200mg, 300mgNorvasc Amlodipine Besylate Tab 2.5mg, 5mg, 10mgNorvir Ritonavir Tab 100mgNovoFine Pen Needles Short Pen Needles Needle 30 guageNovolin Human Insulin Sol'n/Susp R, N and 70/30 10ml VialsNovolog Insulin Aspart Sol'n Plain, 70/30 10ml VialsNovolog Flexpen Insulin Aspart Flexpen Sol'n Plain, 70/30 3mlNutropin Somatropin Inj 5mg/mlNutropin AQ Somatropin Inj 10mg/2mlNuvaring Ethinyl Estradiol/Etonogestrel Vag Ring 15mcg/0.12mg per 24hNydrazid Isoniazid Tab 100mg, 300mgBold items are Basic Core Formulary 8

KIRTLAND AFB PHARMACYFORMULARY BY BRAND3/19/2014(505) 846-3131Nystatin Nystatin Cr/Oint/Pwd 100,000U/gmNystatin Nystatin Tab 500,000UNystatin Nystatin Susp 100,000U/mlOcean Sodium Chloride Sol'n 0.65%Ocuflox Ofloxacin Ophth Sol'n 0.3%Omnicef Cefdinir Susp 125mg/5mLOptivar Azelastine Ophth Sol'n 0.05%Oracea Doxycycline Monohydrate Cap 40mgOrapred ODT Prednisolone Sod Phosphate Tab Rap Dis 15mgOrtho Evra Ethinyl Estradiol/Norelgestromin Patch 20mcg/150mcg per 24hOrtho Novum, Necon 777 Ethinyl Estradiol/Norethindrone Tab 35mcg/0.5-0.75-1mgOrtho TriCyclen Lo Ethinyl Estradiol/Norgestimate Tab 25mcg/0.18-0.215-0.25mgOrtho-Cept/Reclipsen/Desogen/Apri Ethinyl Estradiol/Desogestrel Tab 30mcg/0.15mgOs-Cal + D Calcium/Vitamin D Tab 500mg/200IUOxycontin Oxycodone ER Tab 10mg, 20mg, 40mgPamelor Nortriptyline Cap 10mg, 25mg, 50mgPataday Olopatadine Ophth Sol'n 0.2%Patanol Olopatadine Ophth Sol'n 0.10%Paxil Paroxetine Tab 10mg, 20mg, 30mg, 40mgPediapred Prednisolone Sodium Phosphate Syrp 5mg/5mlPediazole Erythromycin/Sulfasoxazole Susp 200mg-600mg/5mLPegasys Peginterferon Alfa 2A Inj 180mcg/0.5ml (kit & syringe), 180mcg/mlPeg-Intron Peginterferon Alfa 2B Inj50mcg/0.5ml, 80mcg/0.5ml, 120mcg/0.5ml,150mcg/0.5mlPenlac Ciclopirox Nail Lacquer Sol'n 8%Pentasa Mesalamine Cap 250mgPepcid Famotidine Tab 20mg, 40mgPepto Bismol Bismuth Subsalicylate Tab 262mgPercocet Oxycodone/Acetaminophen Tab 5/325mg, 7.5/325mg, 10/325mg, 7.5/500mgPeriactin Cyproheptadine Tab 4mgPeriactin Cyproheptadine Syrp 2mg/5mlPeridex Chlorhexidine Gluconate Sol'n 12%Phenergan Promethazine Tab 12.5mg, 25mgPhenergan Promethazine Syrp 6.25mg/5mlPhenergan/Codeine Promethazine/Codeine Syrp 6.25mg-10mg/5mLPilocarpine Pilocarpine Ophth Sol'n 1%, 2%, 4%Pilopine HS Pilocarpine Ophth Gel 4%Plan B One-Step Levonorgestrel Tab 1.5mg No refillsPlaquenil Hydroxychloroquine Tab 200mgPlavix Clopidogrel Tab 75mgPlendil Felodipine Tab ER 2.5mg, 5mg, 10mgPolytrim Polymyxin/Trimethoprim Ophth Sol'n 10,000U/ml-0.1%Poly-vi-sol MVI DropperPoly-vi-sol with Fluoride MVI with Fluoride DropperPoly-vi-sol with Iron MVI with Iron DropperPradaxa Dabigatran Cap 75mg, 150mgPravachol Pravastatin Tab 10mg, 20mg, 40mg, 80mgPrecision XtraBlood Glucose MeterPrecision Xtra Blood Glucose Monitoring Strip Strip Max of 200 strips/30daysPred Forte Prednisolone Acetate Ophth Susp 1%Pred Mild Prednisolone Acetate Ophth Susp 0.12%Prelone Prednisolone Syrp 15mg/5mLPremarin Estrogen, Conjugated Vag Cr 0.625mg/gmPremarin Estrogen, Conjugated Tab 0.3mg, 0.45mg, 0.625mg, 0.9mg, 1.25mgBold items are Basic Core Formulary 9

KIRTLAND AFB PHARMACYFORMULARY BY BRAND3/19/2014(505) 846-3131Prempro Estrogen/Medroxyprogesterone Tab 0.3/1.5mg, 0.45/1.5mg, 0.625/2.5mg, 0.625/5mgPrenatal Vitamins Prenatal Vitamins TabFolic Acid 1mg Limited to women age 45 andyounger per DoD guidelinesPrevacid SoluTabs Lanzoprazole ODT 15mg, 30mg Limited to pts

KIRTLAND AFB PHARMACYFORMULARY BY BRAND3/19/2014(505) 846-3131Romycin Erythromycin Ophth Oint 0.50%Rondec Phenylephrine/Carbinoxamine Drops 3.5-1mg/mLRowasa Mesalamine Enema 4gmRoxicodone Oxycodone Tab 5mg, 10mg, 15mgSandimmune Cyclosporine, Non-modified Cap 25mg, 100mgSelsun Selenium Sulfide Lotion 2.5%Septra Sulfamethoxazole/Trimethoprim Tab 400mg/80mgSeptra Sulfamethoxazole/Trimethoprim DS Tab 800mg/160mgSeptra Sulfamethoxazole/Trimethoprim Susp 200mg-40mg/5mLSerevent Salmeterol Diskus 50mcg Max of 60 blisters/30 daysSeroquel Quetiapine Tab 25mg, 50mg, 100mg, 200mg, 300mg, 400mgSeroquel XR Quetiapine XR Tab 50mg, 150mg, 200mg, 300mg, 400mgSerzone Nefazodone Tab 150mgSilvadene Silver Sulfadiazine Crm 1%Sinemet Carbidopa/Levodopa Tab 10/100mg, 25/100mg, 25/250mgSinemet CR Carbidopa/Levodopa Tab 25/100mg, 50/200mgSingulair Montelukast Chew Tab 4mg, 5mgSingulair Montelukast Granules 4mgSingulair Montelukast Tab 10mgSkelaxin Metaxalone Tab 800mgSodium Chloride Sodium Chloride Inh Sol'n 0.9%Spiriva Tiotropium Bromide Inh Powder 18mcg Max of 30 blisters/30 daysSronyx, Levlite, Lessina-28, Lutera,Alesse-28, AvianeEthinyl Estradiol/Levonorgestrel Tab 20mcg/0.1mgStrattera Atomoxetine Cap 10mg, 18mg, 25mg, 40mg, 60mgSudafed Pseudoephedrine Tab 30mgSudafed Pseudoephedrine Syrp 30mg/5mlSumycin Tetracycline Cap 250mgSurgilube Surgical Lubricant Topical LubeSustiva Efavirenz Tab 50mg, 200mg, 600mgSymadine Amantadine Sol'n 50mg/5mlSymbicort Budesonide/Formoterol Inh 80/4.5mcg, 160/4.5mcg Max of 1 inh/30 daysSymmetrel Amantadine Cap 100mgSynthroid Levothyroxine Tab25mcg, 50mcg, 75mcg, 88mcg, 100mcg, 112mcg,125mcg, 137mcg, 150mcg, 175mcg, 200mcg,300mcgSyringe (Insulin) Syringe (Insulin) 30G 0.3cc, 0.5cc, 1ccTagamet Cimetidine Liq 300mg/5mlTambocor Flecanide Tab 50mg, 100mgTapazole Methimazole Tab 5mg, 10mgTarceva Erlotinib Tab 25mg, 100mg, 150mgTears Naturale Free Sodium Chloride Sol'n 0.1% -0.3% Preservative FreeTebrazid Pyrazinamide Tab 500mgTegretol Carbamazepine Susp 100mg/5mlTegretol Carbamazepine Chew Tab 100mgTegretol Carbamazepine Tab 200mgTegretol XR Carbamazepine Tab ER 100mg, 200mg, 400mgTemovate Clobetasol Propionate Cr/Gel/Oint 0.05%Tenex Guanfacine Tab 1mgTenormin Atenolol Tab 25mg, 50mg, 100mgTerazol-7 Terconazole Cr 0.4%Tessalon Perle Benzonatate Cap 100mg, 200mgThalomid Thalidomide Clone Cap 50mg, 100mg, 150mg, 200mgThalomid Thalidomide Cap 50mg, 200mg, 400mgTheo-24 Theophylline Extended Release Cap 100mg, 200mg, 300mg, 400mg (24-hr)Bold items are Basic Core Formulary 11

KIRTLAND AFB PHARMACYFORMULARY BY BRAND3/19/2014(505) 846-3131Theochron Theophylline Controlled Release Tab 200mg, 300mg (12-hr)Theophylline Theophylline Elixir 80mg/15mlTheophylline Theophylline Extended Release Tab 400mg (24-hr)Tiazac/Taztia XT/Diltzac Diltiazem ER Cap 120mg, 180mg, 240mg, 300mg, 360mg, 420mgTimoptic Timolol Sol'n 0.25%, 0.5%Timoptic XE Timolol Gel Form. Sol'n 0.25%, 0.5%Tobradex Tobramycin/Dexamethasone Ophth Susp/Oint 0.3%/0.1%Tobrex Tobramycin Ophth Sol'n/Oint 0.3%Tofranil Imipramine Tab 10mg, 25mg, 50mgTofranil-PM Imipramine Pamoate Cap 75mgTopamax Topiramate Tab 25mg, 50mg, 100mg, 200mgToprol XL Metoprolol Succinate Tab 25mg, 50mg, 100mg, 200mgTracleer Bosentan Tab 62.5mg, 125mgTransderm Scop Scopolamine Patch 1.5mg/72 hrTricor Fenofibrate Tab 48mg, 145mgTriglide Fenofibrate Tab 50mg, 160mgTrileptal Oxcarbazepine Tab 150mg, 300mg, 600mgTrinessa, Ortho Tri-cyclen, Triprevifem,Tri-SprintecNorgestimate/Ethinyl Estradiol Tab 0.18-0.215-0.25mg/35mcgTrivora, Tri Levlin & Triphasil 28 Ethinyl Estradiol/Levonorgestrel Tab 30-40-30mcg/0.05-0.075-0.125mgTrizivir Abacavir/Lamivudine/Zidovudine Tab 300/150/300mgTrusopt Dorzolamide Ophth Sol'n 2%Truvada Tenofovir/Emtricitabine Tab 300mg/200mgTykerb Lapatinib Ditosylate Tab 250mgTylenol Acetaminophen Sol'n 160mg/5mlTylenol Acetaminophen Tab 325mg, 500mgTylenol Acetaminophen Supp 120mg, 650mgTylenol with Codeine Acetaminophen with Codeine Tab 300/30mg, 300/60mgTylenol with Codeine Acetaminophen with Codeine Liquid 120mg-12mg/5mlUltram Tramadol Tab 50mg Max 240 tabs/30 daysUrocit-K Potassium Citrate Tab 10mEqUroxatral Alfuzosin Tab 10mgVagifem Estradiol Hemihydrate Vag Tab 10mcgValium Diazepam Tab 2mg, 5mg, 10mgValtrex Valacyclovir Tab 500mg, 1gVanicream Emollient CrVantin Cefpodoxime Tab 100mgVasotec Enalapril Tab 2.5, 10mg, 20mgVeetids Penicillin VK Tab 250mg, 500mgVeetids Penicillin VK Susp 125mg/5ml, 250mg/5mlVesicare Solifenacin Tab 5mgViagra Sildenafil Tab 25mg, 50mg, 100mg Max 6 tabs/30 daysVibraTab Doxycycline Hyclate Tab 100mgVigamox Moxifloxacin Sol'n 0.5%Vistaril Hydroxyzine Pamoate Cap 25mg , 50mgVitamin B12 Cyanocobalamin Sol'n 1000mcg/vialVitamin B6 Pyridoxine Tab 50mgVitamin D Ergocalciferol Cap 50,000 unitsVoltaren Diclofenac Ophth Sol 0.1%Voltaren Diclofenac Tab 50mg, 75mgVoltaren Diclofenac Top Gel 1%Wellbutrin Bupropion Tab 75mg, 100mgWellbutrin SR Bupropion Sustained Release Tab 100mg, 150mg, 200mgWellbutrin XL Bupropion Extended Release Tab 150mg, 300mgWestcort Hydrocortisone Valerate Cr/Oint 0.2%Bold items are Basic Core Formulary 12

KIRTLAND AFB PHARMACYFORMULARY BY BRAND3/19/2014(505) 846-3131Xalatan Latanoprost Sol 0.005%Xanax Alprazolam Tab 0.25mg, 0.5mg, 1mg, 2mgXarelto Rivaroxaban Tab 10mg , 15mg, 20mgXeloda Capecitabine Tab 150mg, 500mgXylocaine Lidocaine Visc Jel & Top Jel 2%Xylocaine Lidocaine Top Oint 5%Yasmin 28 Ethinyl Estradiol/Drosperinone Tab 30mcg/3.0mgYaz Ethinyl Estradiol/Drosperinone Tab 20mcg/3.0mgZanaflex Tizanidine Cap 4mgZantac Ranitidine Syrp 15mg/mLZantac Ranitidine Tab 150mg, 300mgZaroxolyn Metolazone Tab 2.5mg, 5mgZetia Ezetimibe Tab 10mgZiac Bisoprolol/Hydrochlorothiazide Tab 2.5/6.25mg, 5/6.25mgZithromax Azithromycin Tab 250mg (Z-pak), 500mg (Tri-Pak)Zithromax Azithromycin Susp 100mg/5ml, 200mg/5ml & 1gm Powder PacketsZocor Simvastatin Tab 5mg, 10mg, 20mg, 40mg, 80mgZofran Ondansetron Tab 4mg, 8mgZofran ODT Ondansetron ODT Orally Dis Tabs 4mg, 8mgZoladex Goserelin Acetate Inj 3.6mg, 10.8mgZoloft Sertraline Tab 25mg, 50mg, 100mgZoloft Sertraline Sol'n 20mg/mlZomig Zolmitriptan Tab 2.5mg, 5mg Max of 12 tabs/30 daysZomig ZMT Zolmitriptan Orally Dis Tabs 2.5mg, 5mg Max of 12 tabs/30 daysZovirax Acyclovir Susp 200mg/5mlZovirax Acyclovir Cap 200mg, 400mgZovirax Acyclovir Cr & Oint 5%Zovirax Acyclovir Tab 800mgZyloprim Allopurinol Tab 100mg, 300mgZymaxid Gatifloxacin Ophth Sol'n 0.5%Zyprexa Olanzapine Tab 2.5mg, 5mg, 10mgZyrtec Cetirizine Tab 5mg, 10mgZyrtec Cetirizine Syrp 5mg/5mlZyrtec-D Cetirizine/Pseudoephedrine Tab 5/120mg 12-hr tabTRICARE Online (TOL) Pharmacy Refill is a new capability that allows authorized beneficiaries to securely request prescription refills from the TOL website (www.tricare.mil). TOLPharmacy Refill serves as a secure portal to the MHS prescription refill system, AudioCARE, and is compliant with Health Insurance Portability and Accountability Act (HIPAA) andJoint Commission (JC) standards.Authorized beneficiaries will have the ability to request refills of those prescriptions that are refillable, check the status of their refill requests, andlink to the TRICARE Mail Order PharmacyMon –Fri 0730-1700 (505) 846-3130Automated Refill line (505) 846-5770Main/Satellite PharmacyThe Pharmacy is closed all federal holidays, family days, and training days.New PrescriptionsNew prescriptions are dropped off at Window #4.New prescription must contain patient name, address, phone number, date of birth, sponsor's social security number, and allergies to medications.Completed prescriptions are picked up at Windows #1 and #2.Patient names are displayed on the lobby TV Screen for 90 minutes after completion of script.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.Current Yellow Cards must be presented for drop off and pick up of prescriptions.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.Providers are reminded to include their DEA number on all controlled prescriptions.Bold items are Basic Core Formulary 13

KIRTLAND AFB PHARMACYFORMULARY BY BRAND3/19/2014(505) 846-3131Non-Controlled PrescriptionsAre honored up to 365 days from the date the prescription was written.Antibiotic prescriptions over 10 days old will be filled at the discretion of the pharmacy.Prescriptions for maintenance medications may be written for up to a 90 day supply with a maximum of 3 refills when requested by prescriber.State and Federal laws maintain that all prescriptions be originally signed by the provider; stamped/copied signatures are NOT acceptable.‘Indications’ are highly encouraged to prevent prescription errors.The pharmacy must use generic medication whenever possible so please write all medications generically.WE ACCEPT FAXED PRESCRIPTIONS FROM YOUR DOCTORS OFFICE ONLY. OUR FAX NUMBER IS (505) 846-3137.TELEPHONE PRESCRIPTIONS ARE NOT ACCEPTED.Website: This formulary and other information about the pharmacy is available at: http://www.kirtland.af.mil, select 'Medical Clinic' icon and then selectKirtland Formulary'.Training Day & Closure Schedule for 20131 Jan – Federal Holiday20 Jan – Federal Holiday29 Jan – Training Day17 Feb – Federal Holiday26 Feb – Training Day26 Mar – Training Day30 Apr – Training Day23 May – Family Day26 May – Federal Holiday28 May – Training Day25 Jun – Training Day04 Jul – Federal Holiday30 Jul – Training Day27 Aug – Training Day29 Aug – Family Day1 Sep – Federal Holiday24 Sep – Training Day13 Oct – Federal Holiday29 Oct – Training Day11 Nov – Federal Holiday27 Nov – Federal Holiday28 Nov – Family Day25 Dec – Federal Holiday26 Dec -- Family DayBold items are Basic Core Formulary 14