Pharmacy Formulary - Tier 1 (Preferred)

ACETAMINOPHEN 325 MG TABLET
ACETAMINOPHEN 650 MG SUPPOSITORY
ACETAMINOPHEN EXTRA STRENGTH LIQUID 8OZ
ACETAMINOPHEN/CODEINE 120MG/12MG PER 5ML
ACETAMINOPHEN/CODEINE 300MG/30MG TABLET
ACYCLOVIR 200MG CAPSULE
ACYCLOVIR 400MG TABLET
ACYCLOVIR 800MG TABLET
ALBUTEROL .083% PREMIX SOLUTION 3ML VIAL
ALBUTEROL 0.5% SOLUTION 20ML VIAL
ALBUTEROL HFA METERED DOSE INHALER
ALLOPURINOL 100MG TABLET
ALLOPURINOL 300MG TABLET
ALPRAZOLAM 0.25MG TABLET
ALPRAZOLAM 0.5MG TABLET
ALPRAZOLAM 1MG TABLET
ALUMINUM HYDROXIDE GEL
AMITRIPTYLINE HCL 10MG TABLET
AMITRIPTYLINE HCL 25MG TABLET
AMITRIPTYLINE HCL 50MG TABLET
AMLODIPINE 2.5MG TABLET
AMLODIPINE 5MG TABLET
AMLODIPINE 10MG TABLET
AMOXICILLIN 250MG CAPSULE
AMOXICILLIN 500MG CAPSULE
AMOXICILLIN 875MG TABLET
AMOXICILLIN/CLAVULANATE 500/125 TABLET
AMOXICILLIN/CLAVULANATE 875/125TABLET
AMPICILLIN 250MG CAPSULE
AMPICILLIN 500MG CAPSULE
ANTACID/ANTI-GAS SUSP
ARTIFICAL TEARS SOLN
ASPIRIN 81MG ENTERIC COATED
ATENOLOL 25MG TABLET
ATENOLOL 50MG TABLET
ATORVASTIN 10MG TABLET
ATORVASTIN 20MG TABLET
ATORVASTIN 40MG TABLET
AZITHROMYCIN 250MG TABLET
AZITHROMYCIN PAK 250MG
AZITHROMYCIN PAK 500MG
AZITHROMYCIN 1GM PACKAGE
AZTHIOPRINE 50MG TABLET
BACITRACIN OINTMENT
BACITRACIN/POLYMYXIN OPHTHALMIC OINTMENT 3.5GM(POLYSPORIN)
BACLOFEN 10MG TABLET
BACLOFEN 20MG TABLET
BENZONATATE 100 MG CAPSULES
BENZOYL PEROXIDE WB 10%
BENZOYL PEROXIDE WB 5%
BENZTROPINE 0.5MG TABLET
BENZTROPINE 1MG TABLET
BENZTROPINE 2MG TABLET
BETAMETHASONE DIPROPIONATE 0.05% OINTMENT
BETAMETHASONE DIPROPIONATE 0.05% CREAM
BETAMETHASONE DIPROPIONATE 0.05% LOTION
BETAMETHASONE VALERATE 0.1% CREAM
BETAMETHASONE VALERATE 0.1% LOTION
BETAMETHASONE VALERATE 0.1% OINTMENT
BISACODYL 10MG SUPPOSITORY
BISACODYL 5MG TABLET ENTERIC COATED
BISMUTH SUBSALICYLATE LIQUID
BISMUTH SUBSALICYLATE TABLET
BUPROPION 75 MG TABLET
BUPROPION 100 MG TABLET
BUPROPION SR 100MG TABLET
BUPROPION SR 150MG TABLET
BUPROPION SR 150MG (GENERIC ZYBAN)
BURPOPION SR 200MG TABLET
BUPROPION XL(ER) 150MG TABLET
BUPROPION XL(ER) 300MG TABLET
BUSPIRONE 10MG TABLET
BUSPIRONE 15MG TABLET
BUSPIRONE 5MG TABLET
BUTALBITAL/APAP/CAFFEINE TABLET
BUTALBITAL/ASA/CAFFEINE COMPOUND TABLET
CALCIUM CARBONATE 500MG TABLET
CALCIUM 500MG WITH VITAMIN D3 400 IU TABLET
CAPTOPRIL 25MG TABLET
CAPTOPRIL 50MG TABLET
CARBAMAZEPINE 100MG CHEWABLE TABLET
CARBAMAZEPINE 200 MG TABLET
CEFACLOR 500MG CAPSULE
CEFPODOXIME 200 MG TABLET
CEFUROXIME 250MG TABLET
CEPHALEXIN 250MG CAPSULE
CEPHALEXIN 500MG CAPSULE
CETIRIZINE 10MG TABLET
CHLORPHENIRAMINE 4MG TABLET
CHOLESTYRAMINE LIGHT 239.4GM
CHOLESTYRAMINE USP POWDER
CIMETIDINE 300MG TABLET
CIMETIDINE 400MG TABLET
CIPROFLOXACIN OPHTH.SOL. 0.3% 5ML
CIPROFLOXACIN HCL 250MG TABLET
CIPROFLOXACIN HCL 500MG TABLET
CIPROFLOXACIN HCL 750MG TABLET
CITALOPRAM 10MG TABLET
CITALOPRAM 20MG TABLET
CITALOPRAM 40MG TABLET
CLARITHROMYCIN 250MG TABLET
CLARITHROMYCIN 500MG TABLET
CLINDAMYCIN 150MG CAPSULE
CLINDAMYCIN PHOSPHATE VAGINAL CREAM
CLOBETASOL 0.05% CREAM**
CLOBETASOL 0.05% OINTMENT**
CLOBETASOL 0.05% SOLUTION**
CLONAZEPAM 0.5MG TABLET
CLONAZEPAM 1MG TABLET
CLONAZEPAM 2MG TABLET
CLONIDINE HCL 0.1MG TABLET
CLOTRIMAZOLE 1% CREAM
CLOTRIMAZOLE/BETAMETHASONE CREAM
COUGH DROPS
CYCLOBENZAPRINE 5MG TABLET
CYCLOBENZAPRINE 10MG TABLET
CYPROHEPTADINE 4MG TABLET
DESIPRAMINE 10MG TABLET
DESIPRAMINE 25MG TABLET
DESIPRAMINE 50MG TABLET
DEXAMETHASONE 0.1% OPHTHALMIC SOLUTION
DEXAMETHASONE 0.5MG TABLET
DEXAMETHASONE 0.75MG TABLET
DEXAMETHASONE 4MG TABLET
DIABETIC TUSSIN MAX-STR LIQUID 4OZ
DIAZEPAM 10MG TABLET
DIAZEPAM 2MG TABLET
DIAZEPAM 5MG TABLET
DICLOXACILLIN 250 MG CAPSULE
DICLOXACILLIN 500MG CAPSULE
DICYCLOMINE 10MG CAPSULE
DICYCLOMINE 20MG TABLET
DIGOXIN 0.25MG TABLET
DIGOXIN 0.125MG TABLET
DILANTIN 100MG KAPSEAL
DILTIAZEM 30MG TABLET
DILTIAZEM 60MG TABLET
DIPHENHYDRAMINE 25MG CAPSULE
DIPHENHYDRAMINE ELIXIR
DIVALPROEX SODIUM DR 125MG TABLET(DEPAKOTE)
DIVALPROEX SODIUM DR 250MG TABLET(DEPAKOTE)
DIVALPROEX SODIUM DR 500MG TABLET(DEPAKOTE)
DIVALPROEX SODIUM ER 250MG TABLET(DEPAKOTE ER)
DIVALPROEX SODIUM ER 500MG TABLET(DEPAKOTE ER)
DIVALPROEX SODIUM SPRINKLE 125MG (DEPAKOTE SPRINKLE)
DOCUSATE SODIUM 100MG CAPSULE
DOMEBORO PACKETS
DOXEPIN 10MG CAPSULE
DOXEPIN 25MG CAPSULE
EAR DROP 15ML(DEBROX GENERIC EQ)
ENALAPRIL MALEATE 10MG TABLET
ENALAPRIL MALEATE 20MG TABLET
ERY-TAB 250MG TABLET ENTERIC COATED
ERY-TAB 333MG TABLET ENTERIC COATED
ERYTHROMYCIN OPHTHALMIC OINTMENT
ESCITALOPRAM 10MG TAB (LEXAPRO GENERIC EQ)
ESCITALOPRAM 20MG TAB (LEXAPRO GENERIC EQ)
ESTROPIPATE 0.75MG TABLET
ESTROPIPATE 1.5MG TABLET
ETHAMBUTOL 400MG TABLET
FAMOTIDINE 20MG TABLET
FAMOTIDINE 40 MG TABLET
FERROUS SULFATE 325MG TABLET
FIBER THERAPY POWDER 16OZ
FLUCONAZOLE 100MG TABLET
FLUCONAZOLE 150 MG TABLET
FLUOCINOLONE 0.01%CREAM
FLUOCINOLONE 0.025% CREAM
FLUOCINOLONE 0.025% OINTMENT
FLUOXETINE 10MG TABLET
FLUOXETINE 20MG CAPSULE
FLURAZEPAM 15MG CAPSULE
FLURAZEPAM 30MG CAPSULE
FLUTICASONE 0.05% NASAL SPRAY 120SPRAYS
FLUVOXAMINE 100MG TABLET
FLUVOXAMINE 50MG TABLET
FOLIC ACID 1MG TABLET
FUROSEMIDE 20MG TABLET
FUROSEMIDE 40MG TABLET
GABAPENTIN 100MG CAPSULE
GABAPENTIN 300MG CAPSULE
GABAPENTIN 400MG CAPSULE
GEMFIBROZIL 600MG TABLET
GENTAMICIN 3MG/ML OPHTHALMIC SOLUTION
GLIPIZIDE 10MG TABLET
GLIPIZIDE 5MG TABLET
GLUCAGON EMERGENCY KIT**
GLYBURIDE 2.5MG TABLET
GUAIFENESIN 200MG TABLET
GUAIFENESIN SYRUP 4 OZ
GUAIFENESIN WITH CODEINE SYRUP 100/10 4 OZ
GUAIFENESIN WITH DEXTROMETHORPHAN SYRUP 4 OZ
HYDROCHLOROTHIAZIDE 25MG TABLET
HYDROCORTISONE 0.5% CREAM
HYDROCORTISONE 1.0% CREAM
HYDROCORTISONE 1.0% OINT
HYDROGEN PEROXIDE 3% USP
HYDROXYCHLOROQUINE 200MG TABLET
HYDROXYZINE HCL 10MG TABLET
HYDROXYZINE HCL 25MG TABLET
HYDROXYZINE PAMOATE 25MG CAPSULE
HYDROXYZINE PAMOATE 50MG CAPSULE
HYOSCYAMINE 0.375 EXTENDED RELEASE TABLET
HYOSCYAMINE SL 0.125MG TABLET
IBUPROFEN 100MG/5ML 4OZ
IBUPROFEN 200MG TABLET
IBUPROFEN 400MG TABLET
IBUPROFEN 600MG TABLET
IBUPROFEN 800MG TABLET
IMIPRAMINE HCL 10MG TABLET
IMIPRAMINE HCL 25MG TABLET
IMIPRAMINE HCL 50MG TABLET
IMIQUIMOD 5% CR 0.25GM PACKET**
INDOMETHACIN 25MG CAPSULE
INDOMETHACIN 50MG CAPSULE
INSULINS (*except Novolin/Novolog)
Apidra 10ml vial
Humalog 100 units/ml vial
Humulin N (NPH) 100 units/ml vial
Humulin R 100 units/ml vial
Lantus 100 units/ml vial
Levemir 100 units/ml vial
INSULIN PENS* (*except Novolog Flexpens)
Humalog Kwik Pens 3ml 5/box
Lantus Solostar Pens 3ml 5/box
Levemir Flextouch 3ml 5/box
IPRATROPIUM BROMIDE 0.02% INHALATION SOLUTION (0.5MG/VIAL)
IPRATROPIUM 0.5MG/ALBUTEROL 3MG PREMIX INHALATION SOL. 3ML VIAL
ISONIAZID 300MG TABLET
KETOROLAC OPHTHALMIC SOLUTION 0.5% 5 ML
KETOROLAC 10MG TABLET
LAMOTRIGINE 25MG TABLET
LAMOTRIGINE 100MG TABLET
LAMOTRIGINE 150MG TABLET
LAMOTRIGINE 200MG TABLET
LANTUS 100 UNITS/ML 10ML VIAL
LEVOFLOXACIN 250MG TABLET
LEVOFLOXACIN 500MG TABLET
LEVOFLOXACIN 750MG TABLET
LEVOTHYROXINE (SYNTHROID) 25MCG TABLET
LEVOTHYROXINE (SYNTHROID) 50MCG TABLET
LEVOTHYROXINE (SYNTHROID) 75MCG TABLET
LEVOTHYROXINE (SYNTHROID) 88MCG TABLET
LEVOTHYROXINE (SYNTHROID) 100MCG TABLET
LEVOTHYROXINE (SYNTHROID) 112MCG TABLET
LEVOTHYROXINE (SYNTHROID) 125MCG TABLET
LEVOTHYROXINE (SYNTHROID) 137MCG TABLET
LEVOTHYROXINE (SYNTHROID) 150MCG TABLET
LEVOTHYROXINE (SYNTHROID) 175 MCG TABLET
LEVOTHYROXINE (SYNTHROID) 200MCG TABLET
LIDOCAINE 2% JELLY 30ML
LIDOCAINE 2% VISCOUS SOLUTION
LISINOPRIL 5MG TABLET
LISINOPRIL 10MG TABLET
LISINOPRIL 20MG TABLET
LISINOPRIL 30MG TABLET
LISINOPRIL 40MG TABLET
LITHIUM 150MG TABLET
LITHIUM 300MG TABLET
LITHIUM ER 300MG TABLET
LITHIUM ER 450MG TABLET
LOPERAMIDE 2MG CAPSULE
LORATADINE 10MG 30/BOX
LORAZEPAM 0.5MG TABLET
LORAZEPAM 1MG TABLET
LOSARTAN 25MG Tablet
LOSARTAN 50MG Tablet
LOSARTAN 100MG Tablet
LOVASTATIN 10MG TABLET
LOVASTATIN 20MG TABLET
LOVASTATIN 40MG TABLET
MECLIZINE 12.5MG TABLET
MEDROXYPROGESTERONE 10MG TABLET
MEDROXYPROGESTERONE 2.5MG TABLET
METFORMIN 500MG EXTENDED RELEASE TABLET
METFORMIN 750MG EXTENDED RELEASE TABLET
METFORMIN HCL 500 MGTABLET
METFORMIN HCL 850 MG TABLET
METFORMIN HCL 1000MG TABLET
METHIMAZOLE 5MG TABLET
METHIMAZOLE 10MG TABLET
METHYLCELLULOSE POWDER
METHYLPREDNISOLONE 4MG DOSPAK 21 TABLETS
METHYLPREDNISOLONE 4MG TABLET
METOCLOPRAMIDE 10MG TABLET
METOPROLOL 25MG TABLET
METOPROLOL 50MG TABLET
METRONIDAZOLE 0.75% VAGINAL GEL
METRONIDAZOLE 250MG TABLET
METRONIDAZOLE 500 MG TABLET
MICONAZOLE 2% CREAM
MICONAZOLE 2% VAGINAL CREAM
MICONAZOLE 3 COMBINATION PACK
MILK OF MAGNESIA 12OZ
MIRTAZAPINE 15MG TABLET
MIRTAZAPINE 30MG TABLET
MIRTAZAPINE 45MG TABLET
MOMETASONE FUROATE 0.1% CREAM
MOMETASONE FUROATE 0.1% OINTMENT
MOMETASONE FUROATE 0.1% SOLUTION/LOTION
MUPIROCIN OINTMENT 2% 22GM
NADOLOL 20MG TABLET
NADOLOL 40MG TABLET
NAPHAZOLINE 0.025%/PHENIRAMINE 0.3% OPHTH DROPS
NAPROXEN 250MG TABLET
NAPROXEN 500MG TABLET
NEEDLES (PEN NEEDLES)
(DIABETIC SUPPLIES* LIMITED BRANDS/MANUFACTURER/SIZES)
NEOMYCIN/POLYMYXIN/HYDROCORTISONE OTIC SUSPENSION(CORTISPORIN)
NIACIN 500MG SR TABLET
NITROFURANTOIN 100MG MACROCRYSTAL 
NITROFURANTOIN 50 MG MACROCRYSTAL 
NITROSTAT 0.4MG TABLET SL
NORFLOXACIN 400MG TABLET
NORTRIPTYLINE 10MG CAPSULE
NORTRIPTYLINE 25MG CAPSULE
NYSTATIN 500000UNITS ORAL TABLET
NYSTATIN SUSPENSION 60 ML
OMEPRAZOLE 20MG CAPSULE
OMNIFLEX (LATEX FREE) 55 DIAPHRAGM
OMNIFLEX (LATEX FREE) 60 DIAPHRAGM
OMNIFLEX (LATEX FREE) 65 DIAPHRAGM
OMNIFLEX (LATEX FREE) 70 DIAPHRAGM
OMNIFLEX (LATEX FREE) 75 DIAPHRAGM
OMNIFLEX (LATEX FREE) 80 DIAPHRAGM
OMNIFLEX (LATEX FREE) 85 DIAPHRAGM
OMNIFLEX (LATEX FREE) 90 DIAPHRAGM
OPTICHAMBER SPACER
OXCARBAZEPINE 150MG TABLET
OXCARBAZEPINE 300MG TABLET
OXCARBAZEPINE 600MG TABLET
OXYBUTYNIN 5MG TABLET
OXYMETAZOLINE 0.05% NASAL SPRAY
PANTOPRAZOLE DR 20MG TABLET
PANTOPRAZOLE DR 40MG TABLET
PAROXETINE HCL 10MG TABLET
PAROXETINE HCL 20MG TABLET
PAROXETINE HCL 30MG TABLET
PAROXETINE HCL 40MG TABLET
PENICILLIN VK 250MG TABLET
PENICILLIN VK 500MG TABLET
PERMETHRIN 1% CREAM RINSE 60CC
PERMETHRIN 5% CREAM 60GM
PHENAZOPYRIDINE 97.5MG TABLET 12/BOX
PHISOHEX 3% CLEANSER 5OZ
PILL SPLITTER
POLYMYXIN B/TRIMETHOPRIM OPHTHALMIC SOLUTION
POVIDONE-IODINE 10% SOLUTION
PREDNISONE 1MG TABLET
PREDNISONE 5MG TABLET
PREDNISONE 10MG TABLET
PREDNISONE 20MG TABLET
PROCHLORPERAZINE 5MG TABLET
PROCHLORPERAZINE 10MG TABLET
PROCHLORPERAZINE 25MG SUPPOSITORY
PROMETHAZINE 25MG SUPPOSITORY
PROMETHAZINE 25MG TABLET
PROPRANOLOL 10MG TABLET
PROPRANOLOL 20MG TABLET
PROPRANOLOL 40MG TABLET
PROPRANOLOL 60MG TABLET
PROPRANOLOL 80MG TABLET
PROPYLTHIOURACIL 50MG TABLET
PSEUDOEPHEDRINE 30MG TABLET 24/BOX**
PSEUDOEPHEDRINE 60MG TABLET**
PSYLLIUM FIBER (REGULAR)
PYRAZINAMIDE 500MG TABLET
PYRIDOXINE 50MG TABLET
QUETIAPINE 25MG TABLET
QUETIAPINE 50MG TABLET
QUETIAPINE 100MG TABLET
QUETIAPINE 200MG TABLET
QUETIAPINE 300MG TABLET
QUETIAPINE 400MG TABLET
RANITIDINE 150MG TABLET
RANITIDINE 300MG TABLET
RIFAMPIN 150MG CAPSULE
RIFAMPIN 300MG CAPSULE
RISPERIDONE 4MG TABLET
RISPERIDONE 3MG TABLET
RISPERIDONE 2MG TABLET
RISPERIDONE 1MG TABLET
RISPERIDONE 0.5MG TABLET
RISPERIDONE 0.25MG TABLET
SALICYLIC ACID 17%(W/W)
SALONPAS EXTERNAL PAIN PATCHES
SELENIUM SULFIDE 2.5% SHAMPOO 
SEREVENT DISKUS
SERTRALINE 25MG TABLET
SERTRALINE 50MG TABLET
SERTRALINE 100MG TABLET
SILVER SULFADIAZINE 1% CREAM
SIMETHICONE 80MG TABLET
SIMVASTATIN 10 MG TABLET
SIMVASTATIN 20 MG TABLET
SIMVASTATIN 40 MG TABLET
SINGULAIR 10MG TABLET**
SINUS RINSE(LARGE VOLUME NASAL IRRIGATION KIT)
SODIUM CHLORIDE 0.65% NASAL SPRAY
SORE THROAT SPRAY
SPERMICIDAL JELLY
SPIRONOLACTONE 25MG TABLET
SPIRONOLACTONE 50MG TABLET
SUCRALFATE TABLET 1 GRAM
SULFACETAMIDE /PREDNISOLONE OPHTHALMIC SOLUTION
SULFACETAMIDE 10% OPHTHALMIC SOLUTION
SULFAMETHOXAZOLE/TRIMETHOPRIM DOUBLE STRENGTH
SULFAMETHOXAZOLE/TRIMETHOPRIM SINGLE STRENGTH 400-80
SULFASALAZINE 500MG TABLET
SULINDAC 150MG TABLET
SULINDAC 200MG TABLET
SUMATRIPTAN 25MG TABLET**
SUMATRIPTAN 50MG TABLET**
SUMATRIPTAN 100MG TABLET**
SYRINGES WITH NEEDLE 100/BOX
(DIABETIC SUPPLIES* LIMITED BRANDS/MANUFACTURER/SIZES)
TEMAZEPAM 15MG CAPSULE
TEMAZEPAM 30MG CAPSULE
TERCONAZOLE .40% VAGINAL CREAM 45G
TERCONAZOLE .80% VAGINAL CREAM 20G
TERCONAZOLE 3 80MG VAGINAL SUPPOSITORY
THEOPHYLLINE 200MG ER CAPSULE
THEOPHYLLINE 300MG ER CAPSULE
THROAT LOZENGES
THYROID 1/4GR (15MG) ARMOUR TABLET
THYROID 1/2GR (30MG) ARMOUR TABLET
THYROID 1GR (60MG) ARMOUR TABLET
THYROID 1.5GR (90MG) ARMOUR TABLET
THYROID 2GR (120MG) ARMOUR TABLET
TOBRAMYCIN OPHTHALMIC SOLUTION
TOLNAFTATE 1% CREAM
TOLNAFTATE 1% SOLUTION
TOPIRAMATE 25MG TAB
TOPIRAMATE 50MG TAB
TOPIRAMATE 100MG TAB
TRAZODONE 100MG TABLET
TRAZODONE 50MG TABLET
TRIAMCINOLONE 0.1% CREAM
TRIAMCINOLONE 0.1% DENTAL PASTE
TRIAMCINOLONE 0.1% OINTMENT
TRIAMTERENE/HYDROCHLOROTHIAZIDE 37.5/25 TABLET
TRIMETHOBENZAMIDE 200MG SUPPOSITORY
TRIMETHOBENZAMIDE 300MG CAPSULE
TRIMETHOPRIM 100MG TABLET
VENLAFAXINE 75 MG TABLET
VENLAFAXIN ER 150MG CAPSULE
VENLAFAXIN ER 75MG CAPSULE
VENLAFAXIN ER 37.5MG CAPSULE
VERAPAMIL 120MG ER TABLET
VERAPAMIL 80MG TABLET
VERAPAMIL ER 180MG TABLET
VERAPAMIL ER 240 TABLET
VITAMIN D3 50,000 INTERNATIONAL UNIT CAPSULE
ZOLPIDEM 5MG TABLET
ZOLPIDEM 10MG TABLET

**QUANTITY LIMITS