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Patient Assistance Program


Patient Assistance Program (PAP) is one program which helps patients who can’t afford their high cost medications. These programs are typically offered by pharmaceutical companies aimed mainly to help patients get the medication they desperately need. It helps qualifying patients who do not have prescription drug coverage to get free or low-cost medicines through the public or private programs that's suited for them. Doctors, health care providers, patient advocacy organizations and community groups come together to create a network of patient support system for the needy patients.



You can apply online using the short entry form or download a pdf copy of the application.The pharmacy can accept only original prescription drug orders from patients, and that faxed prescriptions can be accepted only from the prescribing practitioners. You can also have us contact your current pharmacy for a prescription transfer.


Click Here For a Complete Medication List

PAP From Xubex

Xubex’s Patient Assistance Program is one of the most innovative, best and patient friendly PAPs available. Generic medications have not always been available through Patient Assistance Programs. Xubex offers assistance to individuals for generic medications. With Xubex’s PAP, a licensed pharmacist in the United States fills all prescriptions with the same medications available from your local pharmacy. Xubex offers PAP to patients who qualify access to prescriptions and it ensures low-cost, predictable pharmaceutical services. Enrolling for Xubex’s Patient Assistance Program requires neither any enrollment fee nor any monthly subscription. In compliance with HIPAA confidentiality regulations, Xubex ships all medications discreetly to the patient’s home, office or trusted family member. Xubex prides itself for providing a dynamic and easy to use program for those who need assistance. Xubex can be reached by phone at 866-699-8239 or visit online at www.xubex.com.

Following are a list of generic medications available through our Patient Assistance Program.Click on medication name for medication monographs.All of the prices listed are based on a 90 day supply of medication

Please Note: Prices and availabilities are subject to change without prior notice

Please Note: This service is not currently available in Montana. Xubex Patient Assistance Program is not insurance.
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A

You can apply online or you may choose to print an registration form to take to your physician.

 Trade Name (BrandName)FormStrengthMax. Qty90 Day Price
Register Online
Mail in form
ACEBUTOLOL( ACEBUTOLOL HCL )
CAPSULE 200MG 180 $30.00
Register Online
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ACYCLOVIR( ACYCLOVIR )
TABLET 400 MG 90 $30.00
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ACYCLOVIR( ACYCLOVIR )
CAPSULES 200 MG 90 $30.00
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ACYCLOVIR( ACYCLOVIR )
TABLET 800 MG 90 $30.00
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ADIPEX P( PHENTERMINE HCL ORAL CAPS )
CAPSULES 37.5 MG 30 $49.99
Register Online
Mail in form
AFEDITAB CR( NIFEDIPINE SA )
TABLET 30MG 60 $40.00
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AFEDITAB CR( NIFEDIPINE SA )
TABLET 60MG 60 $60.00
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ALBUTEROL INH( ALBUTEROL SULFATE INH )
AMPULE 0.83MG/ML 180/60 $20.00
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ALBUTEROL INH( ALBUTEROL SULFATE INH )
SOLUTION 5 MG/ML 40 $20.00
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ALENDRONATE( ALENDRONATE SODIUM )
TABLET 10MG 90 $20.00
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ALENDRONATE( ALENDRONATE SODIUM )
TABLET 5MG 90 $20.00
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ALENDRONATE( ALENDRONATE SODIUM )
TABLET 70MG 12 $20.00
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ALFUZOSIN HCL ORAL TAB ER( ALFUZOSIN HCL )
TABLET 10 MG ER 90 $45.00
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ALLOPURINOL( ALLOPURINOL )
TABLET 100MG 180 $20.00
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ALLOPURINOL( ALLOPURINOL )
TABLET 300MG 180 $20.00
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ALPRAZOLAM( ALPRAZOLAM )
TABLET 0.25MG 270 $30.00
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ALPRAZOLAM( ALPRAZOLAM )
TABLET 0.5MG 270 $30.00
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ALPRAZOLAM( ALPRAZOLAM )
TABLET 1MG 270 $30.00
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ALPRAZOLAM( ALPRAZOLAM )
TABLET 2 MG 100 $20.00
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AMILORIDE/HCT( AMILORIDE HCL/HCTZ )
TABLET 5MG-50MG 90 $40.00
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AMIODARONE( AMIODARONE HCL )
TABLET 200MG 180 $30.00
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AMITRIPT( AMITRIPTYLINE HCL )
TABLET 10MG 90 $20.00
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AMITRIPT( AMITRIPTYLINE HCL )
TABLET 25MG 90 $30.00
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AMITRIPT( AMITRIPTYLINE HCL )
TABLET 50MG 90 $50.00
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AMITRIPT( AMITRIPTYLINE HCL )
TABLET 75MG 90 $75.00
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AMLODIP/BENAZ( AMLODIPINE BESYLATE/BENAZ )
CAPSULES 10/ 20MG 60 $60.00
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AMLODIP/BENAZ( AMLODIPINE BESYLATE/BENAZ )
CAPSULES 2.5/10MG 60 $50.00
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AMLODIP/BENAZ( AMLODIPINE BESYLATE/BENAZ )
CAPSULES 5/ 10MG 90 $50.00
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AMLODIP/BENAZ( AMLODIPINE BESYLATE/BENAZ )
CAPSULES 5/ 20MG 90 $50.00
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AMLODIP/BENAZ( AMLODIPINE BESYLATE/BENAZ )
CAPSULES 10/ 40MG 50 $60.00
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AMLODIPINE( AMLODIPINE BESYLATE )
TABLET 10MG 180 $20.00
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AMLODIPINE( AMLODIPINE BESYLATE )
TABLET 2.5MG 180 $20.00
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AMLODIPINE( AMLODIPINE BESYLATE )
TABLET 5MG 180 $20.00
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ANASTROZOLE( ANASTROZOLE )
TABLET 1 MG 90 $45.00
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ATENOLOL( ATENOLOL )
TABLET 50MG 270 $20.00
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ATENOLOL( ATENOLOL )
TABLET 25 MG 270 $20.00
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ATENOLOL ORAL TABLET 100( ATENOLOL )
TABLET 100 MG 270 $20.00
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ATENOLOL/CHLO( ATENOLOL/CHLORTHALIDONE )
TABLET 100-25MG 90 $20.00
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ATENOLOL/CHLO( ATENOLOL/CHLORTHALIDONE )
TABLET 50-25MG 90 $20.00
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ATORVASTATIN( ATORVASTATIN CALCIUM ORAL )
TABLET 40 MG 90 $30.00
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ATORVASTATIN( ATORVASTATIN CALCIUM ORAL )
TABLET 20 MG 90 $30.00
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ATORVASTATIN CALCIUM ORAL( ATORVASTATIN CALCIUM )
TABLET 10 MG 90 $30.00
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ATORVASTATIN CALCIUM ORAL( ATORVASTATIN CALCIUM )
TABLET 80 MG 90 $30.00
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AZATHIOPRINE( AZATHIOPRINE )
TABLET 50MG 90 $30.00


B

You can apply online or you may choose to print an registration form to take to your physician.

 Trade Name (BrandName)FormStrengthMax. Qty90 Day Price
Register Online
Mail in form
BACLOFEN( BACLOFEN )
TABLET 10MG 180 $40.00
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BACLOFEN( BACLOFEN )
TABLET 20 MG 180 $50.00
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BENAZEPRIL( BENAZEPRIL )
TABLET 10MG 180 $20.00
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BENAZEPRIL( BENAZEPRIL )
TABLET 20MG 180 $20.00
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BENAZEPRIL( BENAZEPRIL )
TABLET 40MG 180 $20.00
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BENAZEPRIL( BENAZEPRIL )
TABLET 5MG 180 $20.00
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BENZTROPINE( BENZTROPINE MESYLATE )
TABLET 0.5MG 180 $40.00
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BENZTROPINE( BENZTROPINE MESYLATE )
TABLET 1MG 180 $40.00
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BENZTROPINE( BENZTROPINE MESYLATE )
TABLET 2MG 180 $40.00
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BICALUTAMIDE( BICALUTAMIDE )
TABLET 50 MG 90 $65.00
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BISOPROL/HCTZ( BISOPROLOL FUMARATE/HCTZ )
TABLET 5-6.25MG 180 $20.00
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BISOPROLOL FUMARATE ORAL( BISOPROLOL FUMARATE/HCTZ )
TABLET 10 MG 90 $60.00
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BISOPROLOL FUMARATE/HCTZ( BISOPROLOL FUMARATE/HCTZ )
TABLET 2.5/6.25MG 180 $20.00
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BRIMONID TART( BRIMONIDINE TARTRATE )
DROP 0.2% 15 $20.00
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BUPROPION( BUPROPION HCL ORAL TABLET )
TABLET 100 MG 90 $50.00
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BUPROPION( BUPROPION HCL ORAL TABLET )
TABLET 75 MG 90 $65.00
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BUPROPION XL( BUPROPION HCL SR 24H )
TABLET 300 MG 90 $65.00
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BUPROPION XL( BUPROPION HCL SR 24H )
TABLET 150MG 90 $65.00
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BUSPIRONE( BUSPIRONE HCL )
TABLET 10 MG 270 $30.00
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BUSPIRONE( BUSPIRONE HCL )
TABLET 5MG 270 $30.00
Register Online
Mail in form
BUSPIRONE( BUSPIRONE HCL )
TABLET 15MG 270 $30.00


C

You can apply online or you may choose to print an registration form to take to your physician.

 Trade Name (BrandName)FormStrengthMax. Qty90 Day Price
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Mail in form
CALCIUM ACE( CALCIUM ACETATE ORAL TABL )
TABLET 667 MG 90 $45.00
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CALPHRON( CALCIUM ACETATE ORAL TABL )
TABLET 200 $30.00
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CARBIDOPA/LEV( CARBIDOPA/LEVODOPA )
TABLET 10-100MG 180 $45.00
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CARBIDOPA/LEV( CARBIDOPA/LEVODOPA )
TABLET 25-100MG 180 $45.00
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CARBIDOPA/LEV( CARBIDOPA/LEVODOPA SA )
TABLET 25-100MG 90 $60.00
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CARBIDOPA/LEV( CARBIDOPA/LEVODOPA )
TABLET 25-250MG 180 $45.00
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CARISOPRODOL( CARISOPRODOL )
TABLET 350 MG 270 $30.00
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CARVEDILOL( CARVEDILOL )
TABLET 12.5MG 180 $20.00
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CARVEDILOL( CARVEDILOL )
TABLET 25MG 180 $20.00
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CARVEDILOL( CARVEDILOL )
TABLET 3.125MG 180 $20.00
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CARVEDILOL( CARVEDILOL )
TABLET 6.25MG 180 $20.00
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CETIRIZINE( CETIRIZINE HCL )
TABLET 10MG 90 $20.00
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CETIRIZINE( CETIRIZINE HCL )
TABLET 5 MG 90 $20.00
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CHLORDIAZ( CHLORDIAZEPOXIDE HCL )
CAPSULE 10MG 360 $30.00
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CHLORDIAZ( CHLORDIAZEPOXIDE HCL )
CAPSULE 25MG 360 $30.00
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CHLORDIAZ( CHLORDIAZEPOXIDE HCL )
GEL CAP 5MG 360 $30.00
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CHLORZOXAZONE ORAL TABLET( CHLORZOXAZONE )
TABLET 500 MG 120 $40.00
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CILOSTAZOL( CILOSTAZOL )
TABLET 100MG 180 $40.00
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CILOSTAZOL ORAL TABLET 50( CILOSTAZOL )
TABLET 50 MG 180 $40.00
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CIMETIDINE( CIMETIDINE )
TABLET 300 MG 90 $30.00
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CIMETIDINE ORAL TABLET 40( CIMETIDINE )
TABLET 400 MG 90 $30.00
Register Online
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CIMETIDINE ORAL TABLET 80( CIMETIDINE )
TABLET 800 MG 90 $60.00
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CITALOPRAM( CITALOPRAM HBR )
TABLET 10 MG 180 $20.00
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CITALOPRAM( CITALOPRAM HBR )
TABLET 20 MG 180 $20.00
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CITALOPRAM( CITALOPRAM HBR )
TABLET 40 MG 180 $20.00
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CLONAZEPAM( CLONAZEPAM )
TABLET 1MG 270 $30.00
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CLONAZEPAM( CLONAZEPAM )
TABLET 2MG 270 $30.00
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CLONAZEPAM( CLONAZEPAM )
TABLET 0.5 MG 270 $30.00
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CLONIDINE( CLONIDINE HCL )
TABLET 0.1MG 270 $20.00
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CLONIDINE( CLONIDINE HCL )
TABLET 0.2MG 180 $30.00
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CLONIDINE( CLONIDINE HCL )
TABLET 0.3MG 180 $30.00
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CLOPIDOGREL( CLOPIDOGREL BISULFATE )
TABLET 75 MG 90 $20.00
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CROMOLYN( CROMOLYN SODIUM OPHTH )
DROP 4% 30 $30.00
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CYCLOBENZ( CYCLOBENZAPRINE HCL )
TABLET 10MG 360 $30.00
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CYCLOBENZ HCL( CYCLOBENZAPRINE HCL ORAL )
TABLET 5 MG 360 $30.00
Register Online
Mail in form
CYCLOSPOR MIC( CYCLOSPORINE MICROEMUL )
GEL CAP 25MG 60 $55.00


D

You can apply online or you may choose to print an registration form to take to your physician.

 Trade Name (BrandName)FormStrengthMax. Qty90 Day Price
Register Online
Mail in form
DEPO TESTOST( TESTOSTERONE CYPIONATE IN )
VIAL 200 MG 3 $45.00
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DEXAMETH( DEXAMETHASONE )
TABLET 0.5MG 180 $30.00
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DEXAMETH( DEXAMETHASONE )
TABLET 0.75MG 180 $30.00
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DEXAMETH( DEXAMETHASONE )
TABLET 1.5MG 180 $30.00
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DEXAMETH( DEXAMETHASONE )
TABLET 1MG 120 $40.00
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DEXAMETH( DEXAMETHASONE )
TABLET 4MG 180 $30.00
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DEXAMETH PHOS( DEXAMETHASONE SOD PHOS )
DROP 0.1% 10 $30.00
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DIAZEPAM( DIAZEPAM )
TABLET 10 MG 360 $30.00
Register Online
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DIAZEPAM( DIAZEPAM )
TABLET 5 MG 360 $30.00
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DIAZEPAM( DIAZEPAM )
TABLET 2 MG 360 $30.00
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DICLOFEN POT( DICLOFENAC POTASSIUM )
TABLET 50 MG 90 $80.00
Register Online
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DICYCLOMINE( DICYCLOMINE HCL )
CAPSULE 10MG 360 $20.00
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DICYCLOMINE( DICYCLOMINE HCL )
TABLET 20MG 180 $30.00
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DILTIAZEM( DILTIAZEM HCL )
TABLET 120MG 180 $40.00
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DILTIAZEM( DILTIAZEM HCL )
TABLET 30MG 180 $20.00
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DILTIAZEM( DILTIAZEM HCL )
TABLET 60MG 180 $20.00
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DILTIAZEM( DILTIAZEM HCL )
TABLET 90MG 180 $30.00
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DILTIAZEM CD( DILTIAZEM HCL SA 24H )
CAPSULE 120MG 90 $40.00
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DILTIAZEM XR( DILTIAZEM HCL CR )
CAPSULE 180MG 90 $40.00
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DILTIAZEM XR( DILTIAZEM HCL CR )
CAPSULE 240MG 90 $60.00
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DIVALPROEX DR( DIVALPROEX SODIUM EC )
TABLET 125 MG 180 $30.00
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DIVALPROEX DR( DIVALPROEX SODIUM EC )
TABLET 250 MG 180 $30.00
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DIVALPROEX DR( DIVALPROEX SODIUM EC )
TABLET 500 MG 120 $30.00
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DONEPEZIL( DONEPEZIL HCL )
TABLET 10MG 90 $20.00
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DONEPEZIL( DONEPEZIL HCL )
TABLET 5MG 90 $20.00
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DOXAZOSIN( DOXAZOSIN MESYLATE )
TABLET 2MG 90 $60.00
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DOXAZOSIN( DOXAZOSIN MESYLATE )
TABLET 4MG 90 $70.00
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DOXAZOSIN( DOXAZOSIN MESYLATE )
TABLET 8MG 90 $70.00
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DOXAZOSIN( DOXAZOSIN MESYLATE ORAL T )
TABLET 1 MG 90 $65.00
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DOXEPIN( DOXEPIN HCL ORAL CAPSULE )
CAPSULES 25 MG 90 $35.00
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DOXEPIN( DOXEPIN HCL ORAL CAPSULE )
CAPSULES 10 MG 90 $25.00
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DOXEPIN( DOXEPIN HCL ORAL CAPSULE )
CAPSULES 50 MG 90 $50.00
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DUTOPROL( METOPROLOL SUCC/HCTZ )
TABLET 100-12.5MG 90 $50.00
Register Online
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DUTOPROL( METOPROLOL SUCC/HCTZ )
TABLET 25-12.5 MG 90 $50.00
Register Online
Mail in form
DUTOPROL( METOPROLOL SUCC/HCTZ )
TABLET 50-12.5 MG 90 $50.00


E

You can apply online or you may choose to print an registration form to take to your physician.

 Trade Name (BrandName)FormStrengthMax. Qty90 Day Price
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Mail in form
ELIQUIS( APIXABAN ORAL TABLET 2.5 )
TABLET 2.5 MG $5.24
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ENALAPRIL MAL( ENALAPRIL MALEATE ORAL TA )
TABLET 10 MG 180 $60.00
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ENALAPRIL MAL( ENALAPRIL MALEATE ORAL TA )
TABLET 20 MG 180 $40.00
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ENALAPRIL MAL( ENALAPRIL MALEATE )
TABLET 2.5 MG 90 $50.00
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ENALAPRIL MAL( ENALAPRIL MALEATE )
TABLET 5 MG 90 $40.00
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ENALAPRIL/HCT( ENALAPRIL MALEATE/HCTZ )
TABLET 10-25MG 90 $20.00
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ENALAPRIL/HCT( ENALAPRIL MALEATE/HCTZ )
TABLET 5-12.5MG 90 $20.00
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ESCITALOPRAM( ESCITALOPRAM OXALATE ORAL )
TABLET 10 MG 90 $30.00
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ESCITALOPRAM( ESCITALOPRAM OXALATE ORAL )
TABLET 20 MG 90 $30.00
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ESCITALOPRAM( ESCITALOPRAM OXALATE ORAL )
TABLET 5 MG 90 $30.00
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ESTRADIOL( ESTRADIOL )
TABLET 0.5MG 90 $20.00
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ESTRADIOL( ESTRADIOL )
TABLET 1MG 90 $20.00
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ESTRADIOL( ESTRADIOL )
TABLET 2MG 90 $20.00
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ESTROPIPATE( ESTROPIPATE (0.75 MG) )
TABLET 0.75MG 90 $45.00
Register Online
Mail in form
ESTROPIPATE( ESTROPIPATE (1.5MG) )
TABLET 1.5MG 90 $55.00


F

You can apply online or you may choose to print an registration form to take to your physician.

 Trade Name (BrandName)FormStrengthMax. Qty90 Day Price
Register Online
Mail in form
FAMOTIDINE( FAMOTIDINE )
TABLET 20MG 180 $20.00
Register Online
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FAMOTIDINE( FAMOTIDINE )
TABLET 40MG 180 $20.00
Register Online
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FEXOFENADINE( FEXOFENADINE HCL )
TABLET 180MG 90 $30.00
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FINASTERIDE( FINASTERIDE ORAL TABLET 5 )
TABLET 5 MG 90 $30.00
Register Online
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FLUOXETINE( FLUOXETINE HCL )
CAPSULES 10 MG 270 $20.00
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FLUOXETINE( FLUOXETINE HCL )
CAPSULE 20MG 270 $20.00
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FLUOXETINE HC( FLUOXETINE HCL )
CAPSULE 40MG 90 $30.00
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FLUPHENAZ( FLUPHENAZINE HCL )
TABLET 10MG 90 $30.00
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FLUPHENAZ( FLUPHENAZINE HCL )
TABLET 1MG 180 $30.00
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FLUPHENAZ( FLUPHENAZINE HCL )
TABLET 2.5MG 90 $30.00
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FLURAZEPAM( FLURAZEPAM HCL )
CAPSULE 15MG 90 $30.00
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FLURAZEPAM( FLURAZEPAM HCL )
CAPSULE 30MG 90 $30.00
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FOLIC ACID( FOLIC ACID )
TABLET 1MG 270 $20.00
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FOSINOPRIL( FOSINOPRIL SODIUM )
TABLET 10MG 90 $20.00
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FOSINOPRIL( FOSINOPRIL SODIUM )
TABLET 20MG 90 $20.00
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FOSINOPRIL( FOSINOPRIL SODIUM )
TABLET 40MG 90 $20.00
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FUROSEMIDE( FUROSEMIDE )
TABLET 20MG 270 $20.00
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FUROSEMIDE( FUROSEMIDE )
TABLET 40MG 270 $20.00
Register Online
Mail in form
FUROSEMIDE( FUROSEMIDE )
TABLET 80 MG 360 $20.00


G

You can apply online or you may choose to print an registration form to take to your physician.

 Trade Name (BrandName)FormStrengthMax. Qty90 Day Price
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GABAPENTIN( GABAPENTIN )
CAPSULE 100MG 270 $30.00
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GABAPENTIN( GABAPENTIN )
CAPSULE 300MG 270 $30.00
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GABAPENTIN( GABAPENTIN )
CAPSULE 400MG 270 $30.00
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GEMFIBROZIL( GEMFIBROZIL )
TABLET 600MG 180 $30.00
Register Online
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GLIMEPIRIDE( GLIMEPIRIDE )
TABLET 1MG 180 $20.00
Register Online
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GLIMEPIRIDE( GLIMEPIRIDE )
TABLET 2MG 180 $20.00
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GLIMEPIRIDE( GLIMEPIRIDE )
TABLET 4MG 180 $20.00
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GLIPIZIDE( GLIPIZIDE )
TABLET 10MG 180 $20.00
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GLIPIZIDE( GLIPIZIDE )
TABLET 5MG 360 $20.00
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GLIPIZIDE XL( GLIPIZIDE ER 24H )
TABLET 10MG 90 $30.00
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GLIPIZIDE XL( GLIPIZIDE ER 24H )
TABLET 2.5MG 90 $20.00
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GLIPIZIDE XL( GLIPIZIDE ER 24H )
TABLET 5MG 90 $20.00
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GLYBUR/METFOR( GLYBURIDE/METFORMIN HCL )
TABLET 2.5-500MG 180 $30.00
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GLYBUR/METFOR( GLYBURIDE/METFORMIN HCL )
TABLET 5-500MG 90 $30.00
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GLYBURIDE MCR( GLYBURIDE MICRONIZED )
TABLET 1.5 MG 180 $30.00
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GLYBURIDE MCR( GLYBURIDE MICRONIZED )
TABLET 3MG 90 $30.00
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GLYBURIDE MCR( GLYBURIDE MICRONIZED )
TABLET 6 MG 90 $40.00
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GLYBURIDE/METFORMIN HCL O( GLYBURIDE/METFORMIN HCL )
TABLET 1.25/250MG 180 $30.00
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GUANFACINE( GUANFACINE HCL )
TABLET 1MG 90 $30.00
Register Online
Mail in form
GUANFACINE( GUANFACINE HCL )
TABLET 2 MG 180 $30.00


H

You can apply online or you may choose to print an registration form to take to your physician.

 Trade Name (BrandName)FormStrengthMax. Qty90 Day Price
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HALOPERIDOL( HALOPERIDOL ORAL TABLET 1 )
TABLET 1 MG $0.52
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HALOPERIDOL( HALOPERIDOL ORAL TABLET 2 )
TABLET 2 MG $0.71
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HALOPERIDOL( HALOPERIDOL ORAL TABLET 5 )
TABLET 5 MG $1.09
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HALOPERIDOL( HALOPERIDOL ORAL TABLET 1 )
TABLET 10 MG $1.38
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HUMALOG KWIK( INSULIN NPL/INSULIN LISPR )
MIX 75/25 $376.18
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HUMALOG KWIK( INSULIN NPL/INSULIN LISPR )
MIX 50/50 $376.18
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HYDRALAZINE( HYDRALAZINE HCL )
TABLET 10MG 100 $20.00
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HYDRALAZINE( HYDRALAZINE HCL )
TABLET 25MG 100 $20.00
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HYDRALAZINE( HYDRALAZINE HCL )
TABLET 50MG 100 $20.00
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HYDROCHLOR0( HCTZ(HYDROCHLOROTHIAZIDE) )
CAPSULE 12.5MG 180 $20.00
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HYDROCHLORO( HCTZ(HYDROCHLOROTHIAZIDE) )
TABLET 25MG 180 $20.00
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HYDROCHLORO( HCTZ(HYDROCHLOROTHIAZIDE) )
TABLET 50MG 180 $20.00
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HYDROXYCHLORQ( HYDROXYCHLOROQUINE SULFAT )
TABLET 200 MG 180 $30.00
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HYDROXYUREA( HYDROXYUREA )
CAPSULE 500MG 120 $50.00
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HYDROXYZ PAM( HYDROXYZINE PAMOATE ORAL )
CAPSULES 50 MG 180 $30.00
Register Online
Mail in form
HYDROXYZINE( HYDROXYZINE PAMOATE ORAL )
CAPSULES 25 MG 180 $30.00


I

You can apply online or you may choose to print an registration form to take to your physician.

 Trade Name (BrandName)FormStrengthMax. Qty90 Day Price
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IBUPROFEN( IBUPROFEN )
TABLET 400MG 180 $20.00
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IBUPROFEN( IBUPROFEN )
TABLET 600MG 180 $20.00
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IBUPROFEN( IBUPROFEN )
TABLET 800MG 180 $20.00
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INDAPAMIDE( INDAPAMIDE )
TABLET 1.25MG 90 $30.00
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INDAPAMIDE( INDAPAMIDE )
TABLET 2.5MG 90 $30.00
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IPRAT/ALBUTER( ALBUTEROL SUL/IPRATROPIUM )
AMPULE 0.5-3MG/3 180ML or 60 Vials $30.00
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IPRATROP BROM( IPRATROPIUM BROMIDE )
SOLUTION 0.2 MG/ML 180ML or 60 Vials $20.00
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ISONIAZID( ISONIAZID )
TABLET 300MG 180 $40.00
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ISOSORB MN( ISOSORBIDE MONONITRATE )
TABLET 20MG 90 $40.00
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ISOSORB MN( ISOSORBIDE MONONIT SR 24H )
TABLET 30MG 90 $30.00
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ISOSORB MN( ISOSORBIDE MONONIT SR 24H )
TABLET 60MG 90 $30.00


J

You can apply online or you may choose to print an registration form to take to your physician.



K

You can apply online or you may choose to print an registration form to take to your physician.



L

You can apply online or you may choose to print an registration form to take to your physician.

 Trade Name (BrandName)FormStrengthMax. Qty90 Day Price
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LAMOTRIGINE( LAMOTRIGINE )
TABLET 100MG 180 $30.00
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LAMOTRIGINE( LAMOTRIGINE )
TABLET 150MG 180 $30.00
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LAMOTRIGINE( LAMOTRIGINE )
CHEWABLE TABS 200MG 180 $30.00
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LAMOTRIGINE( LAMOTRIGINE )
TABLET 25MG 180 $30.00
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LATANOPROST( LATANOPROST )
DROP 0.005% 7.50 $30.00
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LEFLUNOMIDE( LEFLUNOMIDE )
TABLET 10MG 90 $65.00
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LEFLUNOMIDE( LEFLUNOMIDE )
TABLET 20MG 90 $65.00
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LETROZOLE( LETROZOLE )
TABLET 2.5MG 90 $30.00
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LEVETIRACETAM( LEVETIRACETAM )
TABLET 250MG 180 $60.00
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LEVETIRACETAM( LEVETIRACETAM )
TABLET 500MG 180 $60.00
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LEVETIRACETAM( LEVETIRACETAM )
TABLET 750MG 180 $60.00
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LEVOBUNOL O/S( LEVOBUNOLOL HCL OPHTHALMI )
DROPS 0.5 % $41.78
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LEVOBUNOLOL HCL OPHTHALMI( LEVOBUNOLOL HCL )
DROPS 0.5 % 10 $20.00
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LEVOCETIRIZIN( LEVOCETIRIZINE/DIHYDROCHL )
TABLET 5MG 90 $45.00
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LEVOFLOXACIN( LEVOFLOXACIN )
TABLET 500MG 30 $30.00
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LEVOFLOXACIN( LEVOFLOXACIN )
TABLET 750MG 30 $30.00
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LEVOFLOXACIN( LEVOFLOXACIN )
TABLET 250 MG 30 $30.00
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LEVOTHYROXINE( LEVOTHYROXINE SODIUM )
TABLET 100MCG 90 $45.00
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LEVOTHYROXINE( LEVOTHYROXINE SODIUM )
TABLET 112MCG 90 $55.00
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LEVOTHYROXINE( LEVOTHYROXINE SODIUM )
TABLET 125MCG 90 $55.00
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LEVOTHYROXINE( LEVOTHYROXINE SODIUM )
TABLET 137MCG 90 $55.00
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LEVOTHYROXINE( LEVOTHYROXINE SODIUM )
TABLET 150MCG 90 $55.00
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LEVOTHYROXINE( LEVOTHYROXINE SODIUM )
TABLET 175MCG 90 $65.00
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LEVOTHYROXINE( LEVOTHYROXINE SODIUM )
TABLET 200MCG 90 $65.00
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LEVOTHYROXINE( LEVOTHYROXINE SODIUM )
TABLET 25MCG 90 $35.00
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LEVOTHYROXINE( LEVOTHYROXINE SODIUM )
TABLET 300MCG 90 $89.00
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LEVOTHYROXINE( LEVOTHYROXINE SODIUM )
TABLET 50MCG 90 $45.00
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LEVOTHYROXINE( LEVOTHYROXINE SODIUM )
TABLET 75MCG 90 $45.00
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LEVOTHYROXINE( LEVOTHYROXINE SODIUM )
TABLET 88MCG 90 $45.00
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LISINOP/HCTZ( LISINOPRIL/HCTZ )
TABLET 10-12.5MG 270 $20.00
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LISINOP/HCTZ( LISINOPRIL/HCTZ )
TABLET 20-12.5MG 270 $20.00
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LISINOP/HCTZ( LISINOPRIL/HCTZ )
TABLET 20-25MG 180 $20.00
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LISINOPRIL( LISINOPRIL )
TABLET 5MG 180 $20.00
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LISINOPRIL( LISINOPRIL )
TABLET 40MG 180 $20.00
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LISINOPRIL( LISINOPRIL )
TABLET 10 MG 180 $20.00
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LISINOPRIL( LISINOPRIL )
TABLET 2.5 MG 180 $20.00
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LISINOPRIL( LISINOPRIL )
TABLET 20MG 180 $20.00
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LISINOPRIL( LISINOPRIL )
TABLET 30 MG 180 $20.00
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LITHIUM CARB( LITHIUM CARBONATE )
CAPSULE 150MG 360 $30.00
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LITHIUM CARB( LITHIUM CARBONATE )
CAPSULE 300MG 360 $30.00
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LORATADINE( LORATADINE )
TABLET 10MG 100 $20.00
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LORAZEPAM( LORAZEPAM )
TABLET 0.5MG 270 $30.00
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LORAZEPAM( LORAZEPAM )
TABLET 1MG 270 $30.00
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LORAZEPAM( LORAZEPAM )
TABLET 2MG 270 $30.00
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LOSARTAN( LOSARTAN POTASSIUM )
TABLET 100 MG 90 $20.00
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LOSARTAN( LOSARTAN POTASSIUM )
TABLET 25 MG 90 $20.00
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LOSARTAN( LOSARTAN POTASSIUM )
TABLET 50 MG 90 $20.00
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LOSARTAN/HCTZ( LOSARTAN POTASSIUM/HCTZ )
TABLET 50-12.5 MG 90 $20.00
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LOSARTAN/HCTZ( LOSARTAN POTASSIUM/HCTZ )
TABLET 100-12.5MG 90 $20.00
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LOSARTAN/HCTZ( LOSARTAN POTASSIUM/HCTZ )
TABLET 100-25MG 90 $20.00
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LOVASTATIN( LOVASTATIN )
TABLET 10 MG 90 $30.00
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LOVASTATIN( LOVASTATIN )
TABLET 20MG 90 $30.00
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LOVASTATIN( LOVASTATIN )
TABLET 40 MG 90 $30.00


M

You can apply online or you may choose to print an registration form to take to your physician.

 Trade Name (BrandName)FormStrengthMax. Qty90 Day Price
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MECLIZINE( MECLIZINE HCL )
TABLET 12.5MG 270 $20.00
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MECLIZINE HCL( MECLIZINE HCL CHEW )
TABLET 25 MG 270 $20.00
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MEDROXYPROG( MEDROXYPROGESTERONE ACET )
TABLET 10MG 90 $20.00
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MEDROXYPROG( MEDROXYPROGESTERONE ACET )
TABLET 2.5MG 90 $20.00
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MEDROXYPROG( MEDROXYPROGESTERONE ACET )
TABLET 5MG 90 $20.00
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MEGESTROL ACE( MEGESTROL ACETATE )
TABLET 20 MG 180 $40.00
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MEGESTROL ACE( MEGESTROL ACETATE )
TABLET 40 MG 180 $40.00
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MELOXICAM( MELOXICAM )
TABLET 15 MG 180 $20.00
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MELOXICAM( MELOXICAM )
TABLET 7.5 MG 180 $20.00
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MERCAPTOPURIN( MERCAPTOPURINE )
TABLET 50 MG 60 $75.00
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METFORMIN( METFORMIN HCL )
TABLET 1000 MG 360 $30.00
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METFORMIN( METFORMIN HCL )
TABLET 500 MG 360 $30.00
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METFORMIN( METFORMIN HCL )
TABLET 850 MG 360 $30.00
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METFORMIN( METFORMIN HCL SR 24H )
TABLET 500MG 180 $30.00
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METFORMIN( METFORMIN HCL SR 24H )
TABLET 750MG 90 $20.00
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METHOCARBAM( METHOCARBAMOL )
TABLET 500 MG 270 $30.00
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METHOCARBAM( METHOCARBAMOL )
TABLET 750MG 270 $30.00
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METHYLDOPA( METHYLDOPA )
TABLET 250MG 180 $30.00
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METOCLOPRAM( METOCLOPRAMIDE HCL )
TABLET 10MG 360 $30.00
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METOCLOPRAM( METOCLOPRAMIDE HCL )
TABLET 5MG 360 $30.00
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METOPROLOL( METOPROLOL TARTRATE )
TABLET 100 MG 270 $20.00
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METOPROLOL( METOPROLOL TARTRATE )
TABLET 25MG 270 $20.00
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METOPROLOL( METOPROLOL TARTRATE )
TABLET 50MG 270 $20.00
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METRONIDAZOLE( METRONIDAZOLE )
TABLET 500MG 90 $50.00
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MINOCYCLINE( MINOCYCLINE HCL ORAL CAPS )
CAPSULES 100 MG 90 $30.00
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MINOCYCLINE( MINOCYCLINE HCL ORAL CAPS )
CAPSULES 50 MG 90 $30.00
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MIRTAZAPINE( MIRTAZAPINE )
TABLET 15 MG 90 $30.00
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MIRTAZAPINE( MIRTAZAPINE )
TABLET 30 MG 90 $30.00
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MIRTAZAPINE( MIRTAZAPINE )
TABLET 45MG 90 $30.00
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MONTELUKAST( MONTELUKAST SODIUM CHEW )
CHEWABLE TABLET 4MG 90 $45.00
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MONTELUKAST( MONTELUKAST SODIUM CHEW )
CHEWABLE TABLET 5MG 90 $45.00
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MONTELUKAST( MONTELUKAST SODIUM )
TABLET 10MG 90 $45.00
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MYCOPHENOLATE( MYCOPHENOLATE MOFETIL )
CAPSULE 250MG 120 $60.00
Register Online
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MYCOPHENOLATE( MYCOPHENOLATE MOFETIL )
TABLET 500MG 90 $60.00


N

You can apply online or you may choose to print an registration form to take to your physician.

 Trade Name (BrandName)FormStrengthMax. Qty90 Day Price
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NABUMETONE( NABUMETONE )
TABLET 500MG 90 $40.00
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NABUMETONE( NABUMETONE )
TABLET 750MG 90 $40.00
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NAPROXEN( NAPROXEN )
TABLET 250 MG 180 $20.00
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NAPROXEN( NAPROXEN )
TABLET 375MG 180 $20.00
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NAPROXEN( NAPROXEN )
TABLET 500 MG 180 $20.00
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NAPROXEN SOD( NAPROXEN SODIUM )
TABLET 275MG 120 $30.00
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NAPROXEN SOD( NAPROXEN SODIUM )
TABLET 550MG 120 $30.00
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NEVIRAPINE( NEVIRAPINE ORAL TABLET 20 )
TABLET 200 MG 180 $45.00
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NIACIN ORAL TABLET 500 MG( VIT B3(NIACIN) )
TABLET 500 MG 360 $20.00
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NITROGLY TRAN( NITROGLYCERIN TRANSDERM P )
PATCH 0.2MG/HR 90 $65.00
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NITROGLY TRAN( NITROGLYCERIN TRANSDERM P )
PATCH 0.4MG/HR 90 $65.00
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NORTRIPTYLINE( NORTRIPTYLINE HCL )
CAPSULE 10MG 180 $30.00
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NORTRIPTYLINE( NORTRIPTYLINE HCL )
CAPSULE 25MG 180 $30.00
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NORTRIPTYLINE( NORTRIPTYLINE HCL )
CAPSULE 50MG 180 $30.00
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NORTRIPTYLINE( NORTRIPTYLINE HCL )
CAPSULE 75MG 180 $30.00


O

You can apply online or you may choose to print an registration form to take to your physician.

 Trade Name (BrandName)FormStrengthMax. Qty90 Day Price
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OLANZAPINE( OLANZAPINE )
TABLET 15MG 90 $65.00
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OLANZAPINE( OLANZAPINE )
TABLET 2.5MG 90 $40.00
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OLANZAPINE( OLANZAPINE )
TABLET 20MG 90 $65.00
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OLANZAPINE( OLANZAPINE )
TABLET 5MG 90 $30.00
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OLANZAPINE( OLANZAPINE )
TABLET 7.5MG 90 $30.00
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OLANZAPINE( OLANZAPINE ORAL TABLET 10 )
TABLET 10 MG 90 $30.00
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OMEPRAZOLE DR( OMEPRAZOLE EC )
CAPSULE 10MG 90 $30.00
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OMEPRAZOLE DR( OMEPRAZOLE EC )
CAPSULE 20MG 90 $30.00
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OMEPRAZOLE DR( OMEPRAZOLE EC )
CAPSULE 40MG 90 $30.00
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ONDANSETRON( ONDANSETRON HCL )
TABLET 4MG 30 $30.00
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ONDANSETRON( ONDANSETRON HCL )
TABLET 8MG 30 $30.00
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ONDANSETRON( ONDANSETRON HCL ODT )
TABLET 4 MG 30 $30.00
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ONDANSETRON( ONDANSETRON HCL ODT )
TABLET 8 MG 30 $30.00
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OXYBUTYNIN( OXYBUTYNIN CHL )
TABLET 5 MG 90 $50.00


P

You can apply online or you may choose to print an registration form to take to your physician.

 Trade Name (BrandName)FormStrengthMax. Qty90 Day Price
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PANTOPRAZOLE( PANTOPRAZOLE SOD SESQ DR )
TABLET 20 MG 90 $20.00
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PANTOPRAZOLE( PANTOPRAZOLE SOD SESQ EC )
TABLET 40 MG 90 $20.00
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PAROXETINE( PAROXETINE HCL )
TABLET 10MG 90 $30.00
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PAROXETINE( PAROXETINE HCL )
TABLET 20 MG 90 $30.00
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PAROXETINE( PAROXETINE HCL )
TABLET 30 MG 90 $30.00
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PAROXETINE( PAROXETINE HCL )
TABLET 40MG 90 $30.00
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PENTOXIFYLLIN( PENTOXIFYLLINE SA )
TABLET 400MG 180 $45.00
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PERINDOPRIL( PERINDOPRIL ERBUMINE )
TABLET 2MG 90 $60.00
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PERINDOPRIL( PERINDOPRIL ERBUMINE )
TABLET 4MG 60 $60.00
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PERINDOPRIL( PERINDOPRIL ERBUMINE )
TABLET 8MG 90 $60.00
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PHENYTOIN( PHENYTOIN SODIUM EXTENDED )
CAPSULES 100MG ER 180 $30.00
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PIOGLITAZONE( PIOGLITAZONE HCL ORAL TAB )
TABLET 15 MG 90 $30.00
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PIOGLITAZONE( PIOGLITAZONE HCL ORAL TAB )
TABLET 30 MG 90 $30.00
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PIOGLITAZONE( PIOGLITAZONE HCL ORAL TAB )
TABLET 45 MG 90 $30.00
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PRAMIPEXOLE( PRAMIPEXOLE DI-HCL )
TABLET 0.25MG 180 $30.00
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PRAMIPEXOLE( PRAMIPEXOLE DI-HCL )
TABLET 0.5MG 180 $30.00
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PRAMIPEXOLE( PRAMIPEXOLE DI-HCL )
TABLET 1.5MG 180 $30.00
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PRAMIPEXOLE( PRAMIPEXOLE DI-HCL )
TABLET 1MG 180 $30.00
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PRAMIPEXOLE DI-HCL ORAL T( PRAMIPEXOLE DI-HCL )
TABLET .125 MG 180 $30.00
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PRASUGREL HCL ORAL TABLET( EFFIENT )
TABLET 10 MG $9.79
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PRASUGREL HCL ORAL TABLET( EFFIENT )
TABLET 5 MG $9.79
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PRAVASTATIN( PRAVASTATIN SODIUM )
TABLET 10MG 90 $45.00
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PRAVASTATIN( PRAVASTATIN SODIUM )
TABLET 20MG 90 $45.00
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PRAVASTATIN( PRAVASTATIN SODIUM )
TABLET 40MG 90 $55.00
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PRAZOSIN( PRAZOSIN HCL )
CAPSULE 1MG 90 $30.00
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PRAZOSIN( PRAZOSIN HCL )
CAPSULE 2MG 90 $30.00
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PRAZOSIN( PRAZOSIN HCL )
CAPSULES 5 MG 90 $45.00
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PREDNISONE( PREDNISONE )
TABLET 10 MG 180 $30.00
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PREDNISONE( PREDNISONE )
TABLET 20MG 180 $30.00
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PREDNISONE( PREDNISONE )
TABLET 5MG 180 $30.00
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PRIMIDONE( PRIMIDONE )
TABLET 250MG 180 $30.00
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PRIMIDONE( PRIMIDONE ORAL TABLET 50 )
TABLET 50 MG 360 $40.00
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PROCHLORPERAZ( PROCHLORPERAZINE MALEATE )
TABLET 5MG 270 $30.00
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PROCHLORPERAZ( PROCHLORPERAZINE MALEATE )
TABLET 10MG 270 $30.00
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PROPAFENONE( PROPAFENONE HCL )
TABLET 150 MG 120 $40.00
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PROPRANOLOL( PROPRANOLOL HCL )
TABLET 10MG 360 $20.00
Register Online
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PROPRANOLOL( PROPRANOLOL HCL )
TABLET 20MG 360 $20.00
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PROPRANOLOL( PROPRANOLOL HCL )
TABLET 40MG 360 $20.00
Register Online
Mail in form
PROPRANOLOL( PROPRANOLOL HCL )
TABLET 80MG 360 $20.00


Q

You can apply online or you may choose to print an registration form to take to your physician.

 Trade Name (BrandName)FormStrengthMax. Qty90 Day Price
Register Online
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QUETIAPINE( QUETIAPINE FUMARATE )
TABLET 25 MG 180 $40.00
Register Online
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QUETIAPINE( QUETIAPINE FUMARATE )
TABLET 300 MG 90 $40.00
Register Online
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QUETIAPINE( QUETIAPINE FUMARATE )
TABLET 50 MG 90 $40.00
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QUETIAPINE( QUETIAPINE FUMARATE )
TABLET 100 MG 90 $40.00
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QUETIAPINE( QUETIAPINE FUMARATE )
TABLET 200 MG 90 $40.00
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QUETIAPINE( QUETIAPINE FUMARATE )
TABLET 400 MG $0.64
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QUINAPRIL( QUINAPRIL HCL )
TABLET 10MG 90 $30.00
Register Online
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QUINAPRIL( QUINAPRIL HCL )
TABLET 20MG 90 $30.00
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QUINAPRIL( QUINAPRIL HCL )
TABLET 40MG 90 $30.00
Register Online
Mail in form
QUINAPRIL( QUINAPRIL HCL )
TABLET 5MG 90 $30.00


R

You can apply online or you may choose to print an registration form to take to your physician.

 Trade Name (BrandName)FormStrengthMax. Qty90 Day Price
Register Online
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RABEPRAZOLE( )
TABLET 20 MG DR 90 $90.00
Register Online
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RAMIPRIL( RAMIPRIL )
CAPSULES 1.25 MG 90 $20.00
Register Online
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RAMIPRIL( RAMIPRIL )
CAPSULE 10MG 90 $20.00
Register Online
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RAMIPRIL( RAMIPRIL )
CAPSULE 2.5MG 90 $20.00
Register Online
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RAMIPRIL( RAMIPRIL )
CAPSULE 5MG 90 $20.00
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RANITIDINE( RANITIDINE HCL )
TABLET 150MG 180 $20.00
Register Online
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RANITIDINE( RANITIDINE HCL )
TABLET 300 MG 180 $30.00
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RESCRIPTOR( DELAVIRDINE MESYLATE )
TABLET 200MG $1.90
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REYATAZ( ATAZANAVIR SULFATE )
CAPSULE 150MG $16.32
Register Online
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REYATAZ( ATAZANAVIR SULFATE )
CAPSULE 200MG $16.32
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REYATAZ( ATAZANAVIR SULFATE )
CAPSULE 300MG $32.34
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RISPERIDONE( RISPERIDONE )
TABLET 0.25MG 180 $60.00
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RISPERIDONE( RISPERIDONE )
TABLET 0.5MG 180 $60.00
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RISPERIDONE( RISPERIDONE )
TABLET 1MG 180 $60.00
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RISPERIDONE( RISPERIDONE )
TABLET 2MG 180 $60.00
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RISPERIDONE( RISPERIDONE )
TABLET 3MG 180 $60.00
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RISPERIDONE( RISPERIDONE )
TABLET 4MG 180 $60.00
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RIZATRIPTAN( RIZATRIPTAN BENZOATE ORAL )
TABLET 10 MG 18 $40.00
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RIZATRIPTAN( RIZATRIPTAN BENZOATE ORAL )
TABLET 5 MG 18 $40.00
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ROPINIROLE( ROPINIROLE HCL )
TABLET 0.25MG 90 $40.00
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ROPINIROLE( ROPINIROLE HCL )
TABLET 0.5MG 90 $40.00
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ROPINIROLE( ROPINIROLE HCL )
TABLET 1MG 90 $40.00
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ROPINIROLE( ROPINIROLE HCL )
TABLET 2MG 90 $40.00
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ROPINIROLE( ROPINIROLE HCL )
TABLET 3 MG 90 $30.00
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ROPINIROLE( ROPINIROLE HCL )
TABLET 4MG 90 $40.00
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ROPINIROLE( ROPINIROLE HCL )
TABLET 5 MG 90 $40.00


S

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 Trade Name (BrandName)FormStrengthMax. Qty90 Day Price
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SERTRALINE( SERTRALINE )
TABLET 100 MG 180 $30.00
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SERTRALINE( SERTRALINE )
TABLET 25 MG 180 $30.00
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SERTRALINE( SERTRALINE )
TABLET 50MG 180 $30.00
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SILDENAFIL( SILDENAFIL CITRATE ORAL T )
TABLET 20 MG 30 $30.00
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SIMVASTATIN( SIMVASTATIN )
TABLET 20 MG 90 $20.00
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SIMVASTATIN( SIMVASTATIN )
TABLET 80 MG 90 $20.00
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SIMVASTATIN( SIMVASTATIN )
TABLET 5 MG 90 $20.00
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SIMVASTATIN( SIMVASTATIN )
TABLET 10MG 90 $20.00
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SIMVASTATIN( SIMVASTATIN )
TABLET 40MG 90 $20.00
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SOTALOL AF( SOTALOL HCL )
TABLET 160MG 90 $20.00
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SOTALOL AF( SOTALOL HCL )
TABLET 80MG 180 $40.00
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SOTALOL AF( SOTALOL HCL )
TABLET 120 MG 90 $30.00
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SOTALOL HCL( SOTALOL HCL )
TABLET 160 MG 180 $40.00
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SOTALOL HCL( SOTALOL HCL )
TABLET 120MG 180 $40.00
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SOTALOL HCL( SOTALOL HCL )
TABLET 80MG 180 $40.00
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SPIRONOLACT( SPIRONOLACTONE )
TABLET 25MG 90 $30.00
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SPIRONOLACT( SPIRONOLACTONE )
TABLET 50MG 60 $40.00
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STAVUDINE( STAVUDINE ORAL CAPSULE 15 )
CAPSULES 15 MG 60 $90.00
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STAVUDINE( STAVUDINE ORAL CAPSULE 20 )
CAPSULES 20 MG 60 $90.00
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STAVUDINE( STAVUDINE ORAL CAPSULE 30 )
CAPSULES 30 MG 60 $90.00
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STAVUDINE( STAVUDINE ORAL CAPSULE 40 )
CAPSULES 40 MG 60 $90.00
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STAVUDINE( STAVUDINE ORAL SOLN RECON )
SOLUTION 1 MG/ML 200 $90.00
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SUCRALFATE( SUCRALFATE ORAL TABLET 1 )
TABLET 1 GM 180 $55.00
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SULFAMETH/TMP( SULFAMETHOXAZOLE/TRIMETHO )
TABLET 400-80MG 180 $30.00
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SULFAMETH/TMP( SULFAMETHOXAZOLE/TRIMETHO )
TABLET 800-160MG 180 $20.00
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SULFASALAZINE( SULFASALAZINE )
TABLET 500MG 180 $45.00
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SULFAZINE EC( SULFASALAZINE EC )
TABLET 500MG 90 $40.00
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SULINDAC( SULINDAC )
TABLET 150 MG 180 $40.00
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SULINDAC( SULINDAC )
TABLET 200MG 180 $65.00
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SUMATRIPTAN( SUMATRIPTAN SUCCINATE )
TABLET 100MG 18 $35.00
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SUMATRIPTAN( SUMATRIPTAN SUCCINATE )
TABLET 25MG 18 $35.00
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SUMATRIPTAN( SUMATRIPTAN SUCCINATE )
TABLET 50MG 18 $35.00
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SUSTIVA( EFAVIRENZ )
CAPSULE 200MG $6.54
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SUSTIVA( EFAVIRENZ )
TABLET 600MG $19.61


T

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 Trade Name (BrandName)FormStrengthMax. Qty90 Day Price
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TAMOXIFEN CIT( TAMOXIFEN CITRATE )
TABLET 20MG 90 $65.00
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TAMOXIFEN CIT( TAMOXIFEN CITRATE )
TABLET 10 MG 90 $45.00
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TAMSULOSIN( TAMSULOSIN HCL SR 24H )
CAPSULE 0.4MG 90 $30.00
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TEMAZEPAM( TEMAZEPAM )
CAPSULE 15MG 90 $30.00
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TEMAZEPAM( TEMAZEPAM )
CAPSULE 30MG 90 $30.00
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TERAZOSIN( TERAZOSIN HCL )
CAPSULE 10MG 180 $20.00
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TERAZOSIN( TERAZOSIN HCL )
CAPSULE 1MG 180 $20.00
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TERAZOSIN( TERAZOSIN HCL )
CAPSULE 2MG 180 $20.00
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TERAZOSIN( TERAZOSIN HCL )
CAPSULE 5MG 180 $20.00
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TERBINAFINE( TERBINAFINE HCL )
TABLET 250 MG 90 $30.00
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THYROID( THYROID PORK )
TABLET 15MG 90 $30.00
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THYROID( THYROID PORK )
TABLET 30MG 90 $30.00
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THYROID( THYROID PORK )
TABLET 60MG 90 $30.00
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THYROID( THYROID PORK )
TABLET 90MG 90 $40.00
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TIMOLOL O/S( TIMOLOL MALEATE )
DROP 0.25% 30 $20.00
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TIMOLOL O/S( TIMOLOL MALEATE )
DROP 0.5% 30 $20.00
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TIZANIDINE( TIZANIDINE HCL ORAL TABLE )
TABLET 2 MG 90 $65.00
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TOPIRAMATE( TOPIRAMATE )
TABLET 100MG 180 $30.00
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TOPIRAMATE( TOPIRAMATE )
TABLET 200MG 180 $30.00
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TOPIRAMATE( TOPIRAMATE )
TABLET 25MG 180 $30.00
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TOPIRAMATE( TOPIRAMATE )
TABLET 50MG 180 $30.00
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TORSEMIDE( TORSEMIDE )
TABLET 10MG 180 $30.00
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TORSEMIDE( TORSEMIDE )
TABLET 20MG 180 $30.00
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TORSEMIDE( TORSEMIDE )
TABLET 5 MG 180 $30.00
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TRAMADOL( TRAMADOL HCL )
TABLET 50MG 360 $30.00
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TRAMADOL ACET( TRAMADOL HCL/APAP )
TABLET 37.5-325MG $0.31
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TRANDOLAPRIL( TRANDOLAPRIL )
TABLET 1MG 90 $30.00
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TRANDOLAPRIL( TRANDOLAPRIL )
TABLET 2MG 90 $30.00
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TRANDOLAPRIL( TRANDOLAPRIL )
TABLET 4MG 90 $30.00
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TRAZODONE( TRAZODONE HCL )
TABLET 100MG 360 $20.00
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TRAZODONE( TRAZODONE HCL )
TABLET 50MG 360 $20.00
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TRIAMTER/HCTZ( TRIAMTERENE/HCTZ )
TABLET 37.5-25 MG 90 $20.00
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TRIAMTER/HCTZ( TRIAMTERENE/HCTZ )
TABLET 75-50MG 90 $20.00
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TRIAZOLAM( TRIAZOLAM )
TABLET 0.25MG 90 $65.00
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TRIAZOLAM( TRIAZOLAM )
TABLET 0.125 MG 90 $65.00
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TRIHEXYPHENID( TRIHEXYPHENIDYL HCL )
TABLET 2MG 180 $20.00


U

You can apply online or you may choose to print an registration form to take to your physician.



V

You can apply online or you may choose to print an registration form to take to your physician.

 Trade Name (BrandName)FormStrengthMax. Qty90 Day Price
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VALACYCLOVIR( VALACYCLOVIR HCL ORAL TAB )
TABLET 500 MG 30 $30.00
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VALACYCLOVIR( VALACYCLOVIR HCL ORAL TAB )
TABLET 1000 MG 30 $40.00
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VALSART/HCTZ( VALSARTAN/HYDROCHLOROTHIA )
TABLET 80/12.5MG 90 $45.00
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VALSART/HCTZ( VALSARTAN/HYDROCHLOROTHIA )
TABLET 320/12.5MG 90 $45.00
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VALSART/HCTZ( VALSARTAN/HYDROCHLOROTHIA )
TABLET 320/25MG 90 $45.00
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VALSARTAN( VALSARTAN/HYDROCHLOROTHIA )
TABLET 160 12.5MG 90 $45.00
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VALSARTAN( VALSARTAN/HYDROCHLOROTHIA )
TABLET 160 25 MG 90 $45.00
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VENLAFAXINE( VENLAFAXINE HCL SA )
CAPSULES 150 MG 90 $40.00
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VENLAFAXINE( VENLAFAXINE HCL SA )
CAPSULES 37.5 MG 90 $40.00
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VENLAFAXINE( VENLAFAXINE HCL SA )
CAPSULES 75 MG 90 $40.00
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VENTOLIN HFA( ALBUTEROL SULFATE CFE/FRE )
INHALANT 90 MCG 8 $18.00
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VERAPAMIL( VERAPAMIL HCL SA )
TABLET 120 MG 90 $40.00
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VERAPAMIL( VERAPAMIL HCL )
TABLET 120MG 180 $30.00
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VERAPAMIL( VERAPAMIL HCL SA )
TABLET 180MG 90 $40.00
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VERAPAMIL( VERAPAMIL HCL SA )
TABLET 240MG 90 $40.00
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VERAPAMIL( VERAPAMIL HCL )
TABLET 80MG 180 $30.00
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VIDEX EC( DIDANOSINE EC )
CAPSULE 125MG $4.25
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VIDEX EC( DIDANOSINE EC )
CAPSULE 250MG $9.05
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VIDEX EC( DIDANOSINE EC )
CAPSULE 400MG $13.48
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VIDEX PED( DIDANOSINE )
PASTE 10MG/ML $57.13
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VIRAMUNE( NEVIRAPINE )
TABLET 200MG $10.26
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VIRAMUNE XR( NEVIRAPINE )
TABLET 400 MG $18.09


W

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X

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 Trade Name (BrandName)FormStrengthMax. Qty90 Day Price
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XARELTO( RIVAROXABAN )
TABLET 10 MG $10.52
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XARELTO( RIVAROXABAN )
TABLET 15 MG $9.74
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XARELTO( RIVAROXABAN )
TABLET 20 MG $9.74


Y

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Z

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All quantities are for Maximum 90 day supply
* Quantity Limitation Applies.
**** All creams have quantity limitation
! Medicare eligibility required. Administrative fee applies.
Medications beyond therapeutic dosages according to the manufacturer will be dispensed based on established therapeutic guidelines.

This service is not currently available in Montana.
 
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