Pharmacy Formulary - Tier 4 (Market Price)

ACETAZOLAMIDE 125MG TABLET
ADAPALENE 0.1% CREAM
ADAPALENE 0.1% GEL
AMMONIUM LACTATE 12% CREAM
AMMONIUM LACTATE 12% LOTION
AMOXICILLIN 250MG/5ML SUSP 150ML
BACITRACIN OPHTHALMIC OINTMENT 500UNITS/GM 3.5GM 
BENAZEPRIL 10MG TABLET
BENAZEPRIL 40MG TABLET
CARBAMAZEPINE XR 200MG TABLET
CEFIXIME 400MG TABLET (SUPRAX)
CELEBREX 200MG CAPSULE
CHLORHEXIDINE ORAL RINSE
CHLOROQUINE 500MG TABLET
CLINDAMYCIN PH 1% GEL
CLINDAMYCIN PH 1% LOTION
CLOMIPRAMINE 25MG CAP
CLOMIPRAMINE 50MG CAP
CLOTRIMAZOLE 10MG TROCHE
COLCHICINE 0.6MG TAB
COMBIVIR 150MG/300MG TAB
CORTEF 10MG TAB
CYANOCOBALAMINE 1MG/ML VIAL
DICLOFENAC SOD EC 75MG TAB
DOXAZOSIN MESYLATE 2MG TAB
DOXAZOSIN MESYLATE 8MG TAB
DRYSOL 20% 60ML
ESTRADIOL 2MG TAB
ETODOLAC 400MG TAB
FERROUS GLUCONATE 324MG TAB
FINASTERIDE 1MG TAB
FINASTERIDE 5MG TAB
FLUDROCORTISONE 0.1MG TAB
GABAPENTIN 600MG TAB
ISOTRETINOIN 20MG CAPSULE
GUANFACINE 1MG TABLET
ISOTRETINOIN 30MG CAPSULE
ISOTRETINOIN 40MG CAPSULE
KALETRA 50MG/200MG TAB
KETOCONAZOLE 2% SHAMPOO
LEVETIRACETAM 500MG TAB
LEVETIRACETAM 750MG TAB
LEVETIRACETAM 1000MG TAB
LIDOCAINE 5% OINTMENT
LIOTHYRONINE SOD 25MG TAB
MALARONE TAB
MEFLOQUINE HCL 250MG TAB
MELOXICAM 7.5MG TAB
MELOXICAM 15MG TAB
MESALAMINE 4GM/60ML RECTAL SUSP 7/BOX
MESALAMINE 1000MG SUPPOSITORIES
METHOTREXATE 2.5MG TAB
METRONIDAZOLE 0.75% CR
METRONIDAZOLE 0.75% TOPICAL GEL
MINOCYCLINE 50MG CAPSULE
MINOCYCLINE 75MG CAPSULE
MINOCYCLINE 100MG CAPSULE
NABUMETONE 500MG TAB
NABUMETONE 750MG TAB
NEOMYCIN/BACITRACIN/POLYMYXIN/HYDROCORTISONE OPHTHALMIC OINTMENT(CORTISPORIN)
NEOMYCIN/POLYMYXIN /HYDROSORTISONE OPHTHALMIC SOLUTION(CORTISPORIN)
NEOMYCIN/POLYMYXIN/GRAMICIDIN OPHTHALMIC SOLUTION(NEOSPORIN)
NEOMYCIN/POLYMYXIN/BACITRACIN OPHTHALMIC OINTMENT(NEOSPORIN)
NICOTINAMIDE ZCF 750MG TAB
NICOTINE 7MG TRANSDERMAL PATCH
NICOTINE 14MG TRANSDERMAL PATCH
NICOTINE 21MG TRANSDERMAL PATCH
OFLOXACIN 0.3% OPHTH SOL 5ML
OFLOXACIN OTIC DROPS
OXYBUTYNIN 10MG ER TAB
OXYBUTYNIN 15MG ER TAB
PEAK FLOW METER(MINI-WRIGHT)
PENICILLIN VK 250MG/5ML SUSP 100ML
POLYETHYLENE GLYCOL 3350 PWD(MIRALAX EQIVALENT)
POTASSIUM CIT 10MEQ TAB
PRED MILD 0.12% OPHTH SUSP
PRENATAL PLUS VITAMINS
PROMETHAZINE WITH CODEINE SYRUP
PULMOAIDE NEBULIZER MACHINE
RETIN-A MICRO 0.04% GEL 45GM
RETIN-A MICRO 0.04% PUMP 50GM
RETIN-A MICRO 0.1% GEL 20GM
RETIN-A MICRO 0.1% GEL 45GM
RETIN-A MICRO 0.1% PUMP 50GM
ROPINIROLE 0.25MG TAB
SODIUM FLUORIDE 5000 1.1% PRESCRIPTION DENTAL CREAM
STROMECTROL (IVERMECTIN) 3MG TAB
TAMIFLU 75MG CAPSULE
TAMSULOSIN HCL 0.4MG CAPSULE
TERBINAFINE 1% CREAM
TERBINAFINE 250MG TAB
TOBRAMYCIN/DEXAMETHASONE OPHTH SUSP
TRAMADOL HCL 50MG TAB
TRANSDERM SCOP 1.5MG/72 HR PATCH
TYPHOID ORAL VACCINE
VALACYCLOVIR HCL 500MG TAB
VALACYCLOVIR HCL 1000MG TAB
VIAGRA 50MG TAB
VIAGRA 100MG TAB
VITAMIN D3 1000 INTERNATIONAL UNIT TAB
VOLTAREN 1% GEL 100GM
WARFARIN SOD 1MG TAB
WARFARIN SOD 2MG TAB
WARFARIN SOD 3MG TAB
WARFARIN SOD 4MG TAB
WARFARIN SOD 5MG TAB
WARFARIN SOD 7.5MG TAB
WARFARIN SOD 10MG TAB
ZADITOR (KETOTIFEN FUMARATE) OPHTH SOLN
ZALEPLON 10MG CAPSULE