Pharmacy Formulary - Tier 3 (Subsidized)

BECONASE AQ NASAL SPRAY 200 SPRAYS
BENICAR 5MG TABLET
BENICAR 20 MG TABLET
BENICAR 40 MG TABLET
BETAMETHASONE 0.05% (AUGMENT) CR
BETAMETHASONE 0.05% (AUGMENT) OINT
CETIRIZINE-D 24HR
CLARINEX 5MG TABLET
DESONIDE 0.05% CR
DESONIDE 0.05% OINT
DESONIDE 0.05% LOT
DESOXIMETASONE 0.25% CR
DESOXIMETASONE 0.25% OINT
DEXAMETHASONE 0.1% OPHTHALMIC SOLUTION
DILTIAZEM 120MG CD CAPSULE
DILTIAZEM 180MG CD CAPSULE
FEXOFENADINE 60MG TABLET
FEXOFENADINE 180MG TABLET
FEXOFENADINE-D 12 HOUR TABLET
FEXOFENADINE-D 24 HOUR TABLET
FLUNISOLIDE NASAL SOLUTION 0.025% 200 SPRAYS
FLUOCINONIDE 0.05% CR
FLUOCINONIDE 0.05% OINT
FLUOCINONIDE 0.05% SOLN
HYDROCORTISONE VAL 0.2% CR
HYDROCORTISONE VAL 0.2% OINT
NASACORT-AQ NASAL SPRAY 120 SPRAYS
NASONEX 17GM.NASAL SPRAY
NYSTATIN/TRIAMCINOLONE CREAM 15GM
PROPRANOLOL ER 60MG CAP
PROPRANOLOL ER 80MG CAP
PROPRANOLOL ER 120MG CAP
RHINOCORT AQUA NASAL SPRAY 120 SPRAY
TEST STRIPS (DIABETIC SUPPLIES* LIMITED BRANDS/MANUFACTURERS)
TEVETEN 400MG TABLET
TEVETEN 600MG TABLET
TRETINOIN 0.01% GEL
TRETINOIN 0.025% CREAM 20 GM
TRETINOIN 0.025% CREAM 45 GM
TRETINOIN 0.025% GEL
TRETINOIN 0.05% CREAM
TRETINOIN 0.1% CREAM