|
Medication Name |
30-Day |
90-Day |
|
|
Supply |
Supply |
|
|
|
|
|
A/B Otic Solution |
15 |
45 |
|
Acyclovir Cap 200 MG |
30 |
90 |
|
Albuterol Inh Solution 0.083% |
75 |
225 |
|
Albuterol Solution 0.5% |
20 |
60 |
|
Albuterol Syrp |
120 |
360 |
|
Albuterol Tab 2 MG |
90 |
270 |
|
Albuterol Tab 4 MG |
60 |
180 |
|
Allopurinol Tab 100 MG |
30 |
90 |
|
Amiloride/HCTZ Tab 5/50 |
30 |
90 |
|
Amitriptyline Tab 10 MG |
60 |
180 |
|
Amitriptyline Tab 100 MG |
30 |
90 |
|
Amitriptyline Tab 25 MG |
60 |
180 |
|
Amitriptyline Tab 50 MG |
60 |
180 |
|
Amitriptyline Tab 75 MG |
30 |
90 |
|
Amlodipine 2.5 MG |
30 |
90 |
|
Amlodipine 5 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 |
|
Anucort-HC Supp 25 MG |
12 |
36 |
|
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 |
|
Atropine Opth Solution 1% |
5 |
15 |
|
Bacitracin Opth Oint |
3.5 |
10.5 |
|
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 Tab 2 MG |
30 |
90 |
|
Betamethasone Dip Crm 0.05% |
15 |
45 |
|
Betamethasone Dip Crm 0.05% |
45 |
135 |
|
Betamethasone Val Crm 0.1% |
15 |
45 |
|
Betamethasone Val Crm 0.1% |
45 |
135 |
|
Betamethasone Val Oint 0.1% |
45 |
135 |
|
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 |
|
Chlorthalidone Tab 25 MG |
30 |
90 |
|
Chlorthalidone Tab 50 MG |
