| $4 and $10 Generic Prescriptions |
| Medication Name |
30 Day Quantity |
90 Day Quantity |
| Acyclovir Cap 200 MG |
30 |
90 |
| Albuterol Inh Solution 0.083% |
75 |
225 |
| Albuterol Syrup |
120 |
360 |
| Albuterol Tab 2 MG |
90 |
270 |
| Albuterol Tab 4 MG |
60 |
180 |
| Alendronate Sodium Tab 10 MG |
4 |
12 |
| Allopurinol Tab 100 MG |
30 |
90 |
| Allopurinol Tab 300 MG |
30 |
90 |
| Amiloride/HCTZ Tab 5/50 |
30 |
90 |
| Amitriptyline Tab 10 MG |
60 |
180 |
| Amitriptyline Tab 25 MG |
60 |
180 |
| Amitriptyline Tab 50 MG |
60 |
180 |
| Amitriptyline Tab 75 MG |
30 |
90 |
| Amitriptyline Tab 100 MG |
30 |
90 |
| Amitriptyline Tab 150 MG |
30 |
90 |
| Amlodipine 2.5 MG |
30 |
90 |
| Amlodipine 5 MG |
30 |
90 |
| Amlodipine 10 MG |
30 |
90 |
| Amoxicillin 125mg/5mL suspension |
80 |
240 |
| Amoxicillin 125mg/5mL suspension |
100 |
300 |
| Amoxicillin 125mg/5mL suspension |
150 |
450 |
| Amoxicillin 200mg chewable tab |
30 |
90 |
| Amoxicillin 200mg/5mL suspension |
50 |
150 |
| Amoxicillin 200mg/5mL suspension |
75 |
225 |
| Amoxicillin 200mg/5mL suspension |
100 |
300 |
| Amoxicillin 250mg cap |
30 |
90 |
| Amoxicillin 250mg chewable tab |
30 |
90 |
| Amoxicillin 250mg tab |
30 |
90 |
| Amoxicillin 250mg/5mL suspension |
80 |
240 |
| Amoxicillin 250mg/5mL suspension |
100 |
300 |
| Amoxicillin 250mg/5mL suspension |
150 |
450 |
| Amoxicillin 400mg chewable tab |
30 |
90 |
| Amoxicillin 400mg/5mL suspension |
50 |
150 |
| Amoxicillin 400mg/5mL suspension |
75 |
225 |
| Amoxicillin 400mg/5mL suspension |
100 |
300 |
| Amoxicillin 500mg cap |
30 |
90 |
| Amoxicillin 50mg/5mL drops |
30 |
90 |
| Amoxicillin 875mg tab |
30 |
90 |
| Ampicillin 125mg/5mL suspension |
100 |
300 |
| Ampicillin 125mg/5mL suspension |
200 |
600 |
| Ampicillin 250mg cap |
30 |
90 |
| Ampicillin 250mg/5mL suspension |
100 |
300 |
| Ampicillin 250mg/5mL suspension |
200 |
600 |
| Ampicillin 500mg cap |
30 |
90 |
| Atenolol Tab 100 MG |
30 |
90 |
| Atenolol Tab 25 MG |
30 |
90 |
| Atenolol Tab 50 MG |
30 |
90 |
| Atenolol/Chlrthal Tab 100/25 |
30 |
90 |
| Atenolol/Chlrthal Tab 50/25 |
30 |
90 |
| Baclofen Tab 10 MG |
60 |
180 |
| Belladonna Alk w/Pb Tab |
60 |
180 |
| Benazepril Tab 10 MG |
30 |
90 |
| Benazepril Tab 20 MG |
30 |
90 |
| Benazepril Tab 40 MG |
30 |
90 |
| Benazepril Tab 5 MG |
30 |
90 |
| Benzonatate Cap 100 MG |
14 |
42 |
| Benztropine Mes Cap 0.5 MG |
30 |
90 |
| Benztropine Mes Cap 1 MG |
30 |
90 |
| Benztropine Mes Tab 2 MG |
30 |
90 |
| Bisoprolol/HCTZ Tab 10 MG |
30 |
90 |
| Bisoprolol/HCTZ Tab 2.5 MG |
30 |
90 |
| Bisoprolol/HCTZ Tab 5 MG |
30 |
90 |
| Bumetanide Tab 0.5 MG |
30 |
90 |
| Bumetanide Tab 1 MG |
30 |
90 |
| Buspirone Tab 10 mg |
60 |
180 |
| Buspirone Tab 5 mg |
60 |
180 |
| Captopril Tab 100 MG |
90 |
270 |
| Captopril Tab 12.5 MG |
90 |
270 |
| Captopril Tab 25 MG |
90 |
270 |
| Captopril Tab 50 MG |
90 |
270 |
| Carbamazepine Tab 200 MG |
100 |
300 |
| Carvedilol Tab 12.5 MG |
60 |
180 |
| Carvedilol Tab 25 MG |
60 |
180 |
| Carvedilol Tab 3.125 MG |
60 |
180 |
| Carvedilol Tab 6.25 MG |
60 |
180 |
| Cephalexin Cap 250 MG |
40 |
120 |
| Cephalexin Cap 500 MG |
40 |
120 |
| Ceron Drp |
30 |
90 |
| Ceron-Dm Syrp |
120 |
360 |
| Chlorhexidine Rinse 0.12% |
473 |
1419 |
| Chlorpropamide Tab 100 MG |
30 |
90 |
| Ciprofloxacin 250mg tab |
14 |
42 |
| Ciprofloxacin 750mg tab |
20 |
60 |
| Citalopram Tab 10 MG |
30 |
90 |
| Citalopram Tab 20 MG |
30 |
90 |
| Citalopram Tab 40 MG |
30 |
90 |
| Clonidine Tab 0.1 MG |
30 |
90 |
| Clonidine Tab 0.2 MG |
30 |
90 |
| Cyclobenzaprine Tab 10 MG |
30 |
90 |
| Cyclobenzaprine Tab 5 MG |
30 |
90 |
| Cytra-2 Sol |
473 |
1419 |
| Dexamethasone Tab 0.5 MG |
30 |
90 |
| Dexamethasone Tab 0.75 MG |
18 |
54 |
| Dexamethasone Tab 4 MG |
12 |
36 |
| Dicyclomine Cap 10 MG |
90 |
270 |
| Dicyclomine Cap 20 MG |
60 |
180 |
| Digitek Tab 0.125 MG |
30 |
90 |
| Digitek Tab 0.25 MG |
30 |
90 |
| Diltiazem Tab 120 MG |
30 |
90 |
| Diltiazem Tab 30 MG |
60 |
180 |
| Diltiazem Tab 60 MG |
60 |
180 |
| Diltiazem Tab 90 MG |
60 |
180 |
| Doxazosin Tab 1 MG |
30 |
90 |
| Doxazosin Tab 2 MG |
30 |
90 |
| Doxazosin Tab 4 MG |
30 |
90 |
| Doxazosin Tab 8 MG |
30 |
90 |
| Doxepin Cap 100 MG |
30 |
90 |
| Doxepin Cap 25 MG |
30 |
90 |
| Doxepin Cap 50 MG |
30 |
90 |
| Doxepin Cap 75 MG |
30 |
90 |
| Enalapril Mal Tab 10 MG |
30 |
90 |
| Enalapril Mal Tab 2.5 MG |
30 |
90 |
| Enalapril Mal Tab 20 MG |
30 |
90 |
| Enalapril Mal Tab 5 MG |
30 |
90 |
| Enalapril/HCTZ Tab 5/12.5 MG |
30 |
90 |
| Enulose Sol 10G/15ML |
473 |
1419 |
| Estradiol Tab 0.5 MG |
30 |
90 |
| Estradiol Tab 1 MG |
30 |
90 |
| Estradiol Tab 2 MG |
30 |
90 |
| Estropipate Tab 0.75 MG |
30 |
90 |
| Estropipate Tab 1.5 MG |
30 |
90 |
| Ethedent Chw Tab 0.25 MG |
30 |
90 |
| Famotidine Tab 20 MG |
30 |
90 |
| Fluconazole Tab 150 MG U/U |
1 |
3 |
| Fluoxetine Cap 10 MG |
30 |
90 |
| Fluoxetine Cap 20 MG |
30 |
90 |
| Fluphenazine Tab 1 MG |
60 |
180 |
| Folic Acid 1 MG |
30 |
90 |
| Fosinopril 10 MG |
30 |
90 |
| Furosemide Tab 20 MG |
30 |
90 |
| Furosemide Tab 40 MG |
30 |
90 |
| Furosemide Tab 80 MG |
30 |
90 |
| Gentamicin Opth Solution 0.3% |
5 |
15 |
| Gentamicin Sulf Crm 0.1% |
15 |
45 |
| Gentamicin Sulf Oint 0.1% |
15 |
45 |
| Glimepiride Tab 1 MG |
30 |
90 |
| Glimepiride Tab 2 MG |
30 |
90 |
| Glimepiride Tab 4 MG |
30 |
90 |
| Glipizide Tab 10 MG |
60 |
180 |
| Glipizide Tab 5 MG |
30 |
90 |
| Glyburide Micro Tab 3 MG |
30 |
90 |
| Glyburide Micro Tab 6 MG |
30 |
90 |
| Glyburide Tab 2.5 MG |
30 |
90 |
| Guaifenesin Dm Syrup |
120 |
360 |
| Guanfacine Tab 1 MG |
30 |
90 |
| Haloperidol Tab 0.5 MG |
60 |
180 |
| Haloperidol Tab 1 MG |
60 |
180 |
| Haloperidol Tab 2 MG |
60 |
180 |
| Haloperidol Tab 5 MG |
60 |
180 |
| HCTZ Cap 12.5 MG |
30 |
90 |
| HCTZ Tab 25 MG |
30 |
90 |
| HCTZ Tab 50 MG |
30 |
90 |
| Hydralazine Tab 10 MG |
30 |
90 |
| Hydralazine Tab 25 MG |
30 |
90 |
| Hydrocortisone Crm 1% |
30 |
90 |
| Hydrocortisone Crm 2.5% |
30 |
90 |
| Hydroxyzine Syrp |
120 |
360 |
| Ibuprofen susp 100 MG/ 5 ML |
120 |
360 |
| Ibuprofen Tab 400 MG |
90 |
270 |
| Ibuprofen Tab 600 MG |
60 |
180 |
| Ibuprofen Tab 800 MG |
60 |
180 |
| Indapamide Tab 1.25 MG |
30 |
90 |
| Indapamide Tab 2.5 MG |
30 |
90 |
| Indomethacin Cap 25 MG |
60 |
180 |
| Ipratropium Solution 0.02% Udv |
75 |
225 |
| Isoniazid Tab 300 MG |
30 |
90 |
| Lactulose 10gm/15mL solution |
473 |
1419 |
| Levobunolol Opth 0.5% |
5 |
15 |
| Levothyroxine Tab 100 MCG |
30 |
90 |
| Levothyroxine Tab 112 MCG |
30 |
90 |
| Levothyroxine Tab 125 MCG |
30 |
90 |
| Levothyroxine Tab 137 MCG |
30 |
90 |
| Levothyroxine Tab 150 MCG |
30 |
90 |
| Levothyroxine Tab 175 MCG |
30 |
90 |
| Levothyroxine Tab 200 MCG |
30 |
90 |
| Levothyroxine Tab 25 MCG |
30 |
90 |
| Levothyroxine Tab 50 MCG |
30 |
90 |
| Levothyroxine Tab 75 MCG |
30 |
90 |
| Levothyroxine Tab 88 MCG |
30 |
90 |
| Lidocaine Viscous Sol 2% |
100 |
300 |
| Lisinopril Tab 10 MG |
30 |
90 |
| Lisinopril Tab 2.5 MG |
30 |
90 |
| Lisinopril Tab 20 MG |
30 |
90 |
| Lisinopril Tab 5 MG |
30 |
90 |
| Lisinopril/HCTZ Tab 10/12.5 |
30 |
90 |
| Lisinopril/HCTZ Tab 20/12.5 |
30 |
90 |
| Lisinopril/HCTZ Tab 20/25 |
30 |
90 |
| Lithium Carb Cap 300 MG |
90 |
270 |
| Loratadine 10 MG |
30 |
90 |
| Lovastatin Tab 10 MG |
30 |
90 |
| Lovastatin Tab 20 MG |
30 |
90 |
| Lovastatin Tab 40 MG |
30 |
90 |
| Magnesium Oxide Tab 400 MG |
60 |
180 |
| Mag-SR Tab 64 MG |
30 |
90 |
| Medroxyprogst Ace Tab 10 MG |
30 |
90 |
| Medroxyprogst Ace Tab 2.5 MG |
30 |
90 |
| Medroxyprogst Ace Tab 5 MG |
30 |
90 |
| Megestrol Tab 20 MG |
30 |
90 |
| Meloxicam Tab 15 MG |
30 |
90 |
| Meloxicam Tab 7.5 MG |
30 |
90 |
| Metformin ER Tab 500 MG |
60 |
180 |
| Metformin Tab 1000 MG |
60 |
180 |
| Metformin Tab 500 MG |
60 |
180 |
| Metformin Tab 850 MG |
60 |
180 |
| Methyldopa Tab 250 MG |
60 |
180 |
| Methyldopa Tab 500 MG |
30 |
90 |
| Methylprednisolne Tab 4 MG |
21 |
63 |
| Metoclopramide Syrp 5 MG |
120 |
360 |
| Metoclopramide Tab 10 MG |
60 |
180 |
| Metoprolol Tab 100 MG |
60 |
180 |
| Metoprolol Tab 25 MG |
60 |
180 |
| Metoprolol Tab 50 MG |
60 |
180 |
| Metronidazole Tab 250 MG |
28 |
84 |
| Metronidazole Tab 500 MG |
14 |
42 |
| Naproxen Tab 375 MG |
60 |
180 |
| Naproxen Tab 500 MG |
60 |
180 |
| Natalcare Pic Tab |
30 |
90 |
| Natalcare Plus Tab |
30 |
90 |
| Neomyc/Polyb/Dex Opth Susp |
5 |
15 |
| Nitroquick SL Tab 0.3 MG |
100 |
300 |
| Nitroquick SL Tab 0.4 MG |
100 |
300 |
| Nortriptyline Cap 10 MG |
30 |
90 |
| Nortriptyline Cap 25 MG |
30 |
90 |
| Oxybutynin Tab 5 MG |
60 |
180 |
| Paroxetine Tab 10 MG |
30 |
90 |
| Paroxetine Tab 20 MG |
30 |
90 |
| Paroxetine Tab 30 MG |
30 |
90 |
| Penicillin VK 125mg/5mL suspension |
100 |
300 |
| Penicillin VK 125mg/5mL suspension |
200 |
600 |
| Penicillin VK 250mg tab |
28 |
84 |
| Penicillin VK 250mg/5mL suspension |
100 |
300 |
| Penicillin VK 250mg/5mL suspension |
200 |
600 |
| Penicillin VK 500mg tab |
28 |
84 |
| Phenazopyridine Tab 100 MG |
30 |
90 |
| Phenazopyridine Tab 200 MG |
30 |
90 |
| Pilocarpine Opth Solution 2% |
15 |
45 |
| Potassium CL Oral Solution 10% |
473 |
1419 |
| Pravastatin 10 MG |
30 |
90 |
| Pravastatin 20 MG |
30 |
90 |
| Pravastatin 40 MG |
30 |
90 |
| Prazosin Cap 1 MG |
30 |
90 |
| Prazosin Cap 2 MG |
30 |
90 |
| Prazosin Cap 4 MG |
30 |
90 |
| Prednisone Tab 10 MG |
30 |
90 |
| Prednisone Tab 2.5 MG |
30 |
90 |
| Prednisone Tab 20 MG |
30 |
90 |
| Prednisone Tab 5 MG |
30 |
90 |
| Prednisone Tab 5 MG DosePack |
21 |
63 |
| Prochlorperazine Tab 10 MG |
30 |
90 |
| Prometh Dm Syrup |
120 |
360 |
| Prometh Plain Syrp |
120 |
360 |
| Promethazine Tab 25 MG |
30 |
90 |
| Propranolol Tab 10 MG |
60 |
180 |
| Propranolol Tab 20 MG |
60 |
180 |
| Propranolol Tab 40 MG |
60 |
180 |
| Propranolol Tab 80 MG |
60 |
180 |
| Quinapril 5 MG |
30 |
90 |
| Quinapril 10 MG |
30 |
90 |
| Quinapril 20 MG |
30 |
90 |
| Quinapril 40 MG |
30 |
90 |
| Ramipril 2.5 MG |
30 |
90 |
| Ramipril 5 MG |
30 |
90 |
| Ranitidine Tab 150 MG |
60 |
180 |
| Ranitidine Tab 300 MG |
30 |
90 |
| Selenium Sulfide Lotion 2.5% |
120 |
360 |
| Sertraline 25 MG |
30 |
90 |
| Sertraline 50 MG |
30 |
90 |
| Sertraline 100 MG |
30 |
90 |
| Simvastatin 5 MG |
30 |
90 |
| Simvastatin 10 MG |
30 |
90 |
| Simvastatin 20 MG |
30 |
90 |
| Simvastatin 40 MG |
30 |
90 |
| Simvastatin 80 MG |
30 |
90 |
| SMZ-TMP 200mg/40mg suspension |
120 |
360 |
| SMZ-TMP 400mg/80mg tab |
28 |
84 |
| SMZ-TMP DS 800mg/160mg tab |
20 |
60 |
| Sotalol Tab 80 MG |
30 |
90 |
| Spironolactone 25mg |
30 |
90 |
| Spironolactone 50mg |
30 |
90 |
| Spironolactone Tab 25 MG |
30 |
90 |
| Terazosin Cap 1 MG |
30 |
90 |
| Terazosin Cap 10 MG |
30 |
90 |
| Terazosin Cap 2 MG |
30 |
90 |
| Terazosin Cap 5 MG |
30 |
90 |
| Terbinafine Tab 250 MG |
30 |
90 |
| Tetracycline Cap 250 MG |
60 |
180 |
| Tetracycline Cap 500 MG |
60 |
180 |
| Thioridazine Tab 25 MG |
30 |
90 |
| Thioridazine Tab 50 MG |
30 |
90 |
| Thiothixene Tab 25 MG |
30 |
90 |
| Timolol Mal Opth Solution 0.25 |
5 |
15 |
| Timolol Mal Opth Solution 0.5 |
5 |
15 |
| Trazodone Tab 100 MG |
30 |
90 |
| Trazodone Tab 150 MG |
30 |
90 |
| Trazodone Tab 50 MG |
30 |
90 |
| Triamterene/HCTZ Tab 37.5/25 |
30 |
90 |
| Triamterene/HCTZ Tab 75/50 |
30 |
90 |
| Trihexyphenidyl Tab 2 MG |
60 |
180 |
| Trimeth/Polymyxin Opth Solution |
10 |
30 |
| Verapamil Tab 120 MG |
60 |
180 |
| Verapamil Tab 80 MG |
60 |
180 |
| Warfarin Sodium 1 MG |
30 |
90 |
| Warfarin Sodium 2 MG |
30 |
90 |
| Warfarin Sodium Tab 10 MG |
30 |
90 |
| Warfarin Sodium Tab 2.5 MG |
30 |
90 |
| Warfarin Sodium Tab 3 MG |
30 |
90 |
| Warfarin Sodium Tab 4 MG |
30 |
90 |
| Warfarin Sodium Tab 5 MG |
30 |
90 |
| Warfarin Sodium Tab 6 MG |
30 |
90 |
| Warfarin Sodium Tab 7.5 MG |
30 |
90 |
| |
| $9 and $24 Generic Prescriptions |
| Medication Name |
30 Day Quantity |
90 Day Quantity |
| Alendronate Sodium 35 MG |
4 |
12 |
| Alendronate Sodium 70 MG |
4 |
12 |
| Clomiphene 50 MG |
5 |
15 |
| Mononessa Tablets |
28 |
84 |
| Tamoxifen 10 MG |
60 |
180 |
| Tamoxifen 20 MG |
30 |
90 |
| Trinessa Tablets |
28 |
84 |