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

All

A

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

	Trade Name (BrandName)	Form	Strength	Max. Qty	90 Day Price
Register Online Mail in form	ACEBUTOLOL( ACEBUTOLOL HCL )	CAPSULE	200MG	180	$30.00
Register Online Mail in form	ACYCLOVIR( ACYCLOVIR )	TABLET	400 MG	90	$30.00
Register Online Mail in form	ACYCLOVIR( ACYCLOVIR )	CAPSULES	200 MG	90	$30.00
Register Online Mail in form	ACYCLOVIR( ACYCLOVIR )	TABLET	800 MG	90	$30.00
Register Online Mail in form	AFEDITAB CR( NIFEDIPINE SA )	TABLET	30MG	90	$40.00
Register Online Mail in form	AFEDITAB CR( NIFEDIPINE SA )	TABLET	60MG	90	$75.00
Register Online Mail in form	ALBUTEROL INH( ALBUTEROL SULFATE INH )	AMPULE	0.83MG/ML	180/60	$20.00
Register Online Mail in form	ALBUTEROL INH( ALBUTEROL SULFATE INH )	SOLUTION	5 MG/ML	40	$20.00
Register Online Mail in form	ALENDRONATE( ALENDRONATE SODIUM )	TABLET	10MG	12	$20.00
Register Online Mail in form	ALENDRONATE( ALENDRONATE SODIUM )	TABLET	5MG	12	$20.00
Register Online Mail in form	ALENDRONATE( ALENDRONATE SODIUM )	TABLET	70MG	12	$20.00
Register Online Mail in form	ALFUZOSIN HCL ORAL TAB ER( ALFUZOSIN HCL )	TABLET	10 MG ER	90	$45.00
Register Online Mail in form	ALLOPURINOL( ALLOPURINOL )	TABLET	100MG	180	$20.00
Register Online Mail in form	ALLOPURINOL( ALLOPURINOL )	TABLET	300MG	180	$20.00
Register Online Mail in form	ALPRAZOLAM( ALPRAZOLAM )	TABLET	0.25MG	270	$30.00
Register Online Mail in form	ALPRAZOLAM( ALPRAZOLAM )	TABLET	0.5MG	270	$30.00
Register Online Mail in form	ALPRAZOLAM( ALPRAZOLAM )	TABLET	1MG	270	$30.00
Register Online Mail in form	ALPRAZOLAM( ALPRAZOLAM )	TABLET	2 MG	100	$20.00
Register Online Mail in form	AMILORIDE/HCT( AMILORIDE HCL/HCTZ )	TABLET	5MG-50MG	90	$20.00
Register Online Mail in form	AMIODARONE( AMIODARONE HCL )	TABLET	200MG	180	$30.00
Register Online Mail in form	AMITRIPT( AMITRIPTYLINE HCL )	TABLET	10MG	360	$20.00
Register Online Mail in form	AMITRIPT( AMITRIPTYLINE HCL )	TABLET	25MG	360	$20.00
Register Online Mail in form	AMITRIPT( AMITRIPTYLINE HCL )	TABLET	50MG	360	$20.00
Register Online Mail in form	AMITRIPT( AMITRIPTYLINE HCL )	TABLET	75MG	360	$20.00
Register Online Mail in form	AMITRIPT( AMITRIPTYLINE HCL ORAL TA )	TABLET	150 MG	90	$20.00
Register Online Mail in form	AMITRIPT( AMITRIPTYLINE HCL )	TABLET	100 MG	180	$20.00
Register Online Mail in form	AMLODIP/BENAZ( AMLODIPINE BESYLATE/BENAZ )	CAPSULES	10/ 20MG	90	$60.00
Register Online Mail in form	AMLODIP/BENAZ( AMLODIPINE BESYLATE/BENAZ )	CAPSULES	10/ 40MG	90	$60.00
Register Online Mail in form	AMLODIP/BENAZ( AMLODIPINE BESYLATE/BENAZ )	CAPSULES	2.5/10MG	90	$50.00
Register Online Mail in form	AMLODIP/BENAZ( AMLODIPINE BESYLATE/BENAZ )	CAPSULES	5/ 10MG	90	$50.00
Register Online Mail in form	AMLODIP/BENAZ( AMLODIPINE BESYLATE/BENAZ )	CAPSULES	5/ 40MG	90	$50.00
Register Online Mail in form	AMLODIP/BENAZ( AMLODIPINE BESYLATE/BENAZ )	CAPSULES	5/ 20MG	90	$50.00
Register Online Mail in form	AMLODIPINE( AMLODIPINE BESYLATE )	TABLET	10MG	180	$20.00
Register Online Mail in form	AMLODIPINE( AMLODIPINE BESYLATE )	TABLET	2.5MG	180	$20.00
Register Online Mail in form	AMLODIPINE( AMLODIPINE BESYLATE )	TABLET	5MG	180	$20.00
Register Online Mail in form	ANASTROZOLE( ANASTROZOLE )	TABLET	1 MG	90	$45.00
Register Online Mail in form	ANUCORT HC( HYDROCORTISONE ACETATE )	SUPPOSITORY	25MG	36	$20.00
Register Online Mail in form	ATENOLOL( ATENOLOL )	TABLET	100MG	270	$20.00
Register Online Mail in form	ATENOLOL( ATENOLOL )	TABLET	50MG	270	$20.00
Register Online Mail in form	ATENOLOL( ATENOLOL )	TABLET	25 MG	270	$20.00
Register Online Mail in form	ATENOLOL/CHLO( ATENOLOL/CHLORTHALIDONE )	TABLET	100-25MG	90	$20.00
Register Online Mail in form	ATENOLOL/CHLO( ATENOLOL/CHLORTHALIDONE )	TABLET	50-25MG	90	$20.00
Register Online Mail in form	ATORVASTATIN( ATORVASTATIN CALCIUM )	TABLET	10MG	90	$30.00
Register Online Mail in form	ATORVASTATIN( ATORVASTATIN CALCIUM )	TABLET	20MG	90	$30.00
Register Online Mail in form	ATORVASTATIN( ATORVASTATIN CALCIUM )	TABLET	40MG	90	$30.00
Register Online Mail in form	ATORVASTATIN( ATORVASTATIN CALCIUM )	TABLET	80MG	90	$30.00
Register Online Mail in form	AZATHIOPRINE( AZATHIOPRINE )	TABLET	50MG	180	$30.00

B

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

	Trade Name (BrandName)	Form	Strength	Max. Qty	90 Day Price
Register Online Mail in form	BACLOFEN( BACLOFEN )	TABLET	10MG	360	$30.00
Register Online Mail in form	BACLOFEN( BACLOFEN )	TABLET	20 MG	360	$30.00
Register Online Mail in form	BELLADONNA( BELLADONNA ALKDS/PB )	TABLET	16.2MG	270	$30.00
Register Online Mail in form	BENAZEPRIL( BENAZEPRIL )	TABLET	10MG	180	$20.00
Register Online Mail in form	BENAZEPRIL( BENAZEPRIL )	TABLET	20MG	180	$20.00
Register Online Mail in form	BENAZEPRIL( BENAZEPRIL )	TABLET	40MG	180	$20.00
Register Online Mail in form	BENAZEPRIL( BENAZEPRIL )	TABLET	5MG	180	$20.00
Register Online Mail in form	BENZTROPINE( BENZTROPINE MESYLATE )	TABLET	0.5MG	180	$20.00
Register Online Mail in form	BENZTROPINE( BENZTROPINE MESYLATE )	TABLET	1MG	180	$20.00
Register Online Mail in form	BENZTROPINE( BENZTROPINE MESYLATE )	TABLET	2MG	180	$20.00
Register Online Mail in form	BICALUTAMIDE( BICALUTAMIDE )	TABLET	50 MG	90	$65.00
Register Online Mail in form	BISOPROL/HCTZ( BISOPROLOL FUMARATE/HCTZ )	TABLET	10-6.25MG	180	$20.00
Register Online Mail in form	BISOPROL/HCTZ( BISOPROLOL FUMARATE/HCTZ )	TABLET	2.5-6.25MG	180	$20.00
Register Online Mail in form	BISOPROL/HCTZ( BISOPROLOL FUMARATE/HCTZ )	TABLET	5-6.25MG	180	$20.00
Register Online Mail in form	BRIMONID TART( BRIMONIDINE TARTRATE )	DROP	0.2%	15	$20.00
Register Online Mail in form	BUMETANIDE( BUMETANIDE )	TABLET	0.5MG	180	$30.00
Register Online Mail in form	BUMETANIDE( BUMETANIDE )	TABLET	1MG	180	$30.00
Register Online Mail in form	BUMETANIDE( BUMETANIDE )	TABLET	2MG	180	$30.00
Register Online Mail in form	BUPROPION( BUPROPION HCL )	TABLET	100MG	180	$45.00
Register Online Mail in form	BUPROPION( BUPROPION HCL )	TABLET	75MG	180	$45.00
Register Online Mail in form	BUPROPION XL( BUPROPION HCL SR 24H )	TABLET	150MG	90	$65.00
Register Online Mail in form	BUPROPION XL( BUPROPION HCL SR 24H )	TABLET	300 MG	90	$65.00
Register Online Mail in form	BUSPIRONE( BUSPIRONE HCL )	TABLET	10 MG	270	$30.00
Register Online Mail in form	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)	Form	Strength	Max. Qty	90 Day Price
Register Online Mail in form	CALCIUM ACE( CALCIUM ACETATE ORAL TABL )	TABLET	667 MG	200	$30.00
Register Online Mail in form	CALPHRON( CALCIUM ACETATE ORAL TABL )	TABLET		200	$30.00
Register Online Mail in form	CAPTOPRIL( CAPTOPRIL )	TABLET	100 MG	360	$20.00
Register Online Mail in form	CAPTOPRIL( CAPTOPRIL )	TABLET	12.5 MG	360	$20.00
Register Online Mail in form	CAPTOPRIL( CAPTOPRIL )	TABLET	50 MG	360	$20.00
Register Online Mail in form	CAPTOPRIL( CAPTOPRIL )	TABLET	25MG	360	$20.00
Register Online Mail in form	CARBAMAZEPINE( CARBAMAZEPINE CHEW )	CHEWABLE TABS	100MG	360	$20.00
Register Online Mail in form	CARBAMAZEPINE( CARBAMAZEPINE )	TABLET	200MG	360	$20.00
Register Online Mail in form	CARBIDOPA/LEV( CARBIDOPA/LEVODOPA )	TABLET	10-100MG	180	$45.00
Register Online Mail in form	CARBIDOPA/LEV( CARBIDOPA/LEVODOPA )	TABLET	25-100MG	180	$45.00
Register Online Mail in form	CARBIDOPA/LEV( CARBIDOPA/LEVODOPA SA )	TABLET	25-100MG	180	$45.00
Register Online Mail in form	CARBIDOPA/LEV( CARBIDOPA/LEVODOPA )	TABLET	25-250MG	180	$45.00
Register Online Mail in form	CARISOPRODOL( CARISOPRODOL )	TABLET	350 MG	270	$30.00
Register Online Mail in form	CARVEDILOL( CARVEDILOL )	TABLET	12.5MG	180	$20.00
Register Online Mail in form	CARVEDILOL( CARVEDILOL )	TABLET	25MG	180	$20.00
Register Online Mail in form	CARVEDILOL( CARVEDILOL )	TABLET	3.125MG	180	$20.00
Register Online Mail in form	CARVEDILOL( CARVEDILOL )	TABLET	6.25MG	180	$20.00
Register Online Mail in form	CETIRIZINE( CETIRIZINE HCL )	TABLET	10MG	90	$20.00
Register Online Mail in form	CETIRIZINE( CETIRIZINE HCL )	TABLET	5 MG	90	$20.00
Register Online Mail in form	CHLORDIAZ( CHLORDIAZEPOXIDE HCL )	CAPSULE	10MG	360	$30.00
Register Online Mail in form	CHLORDIAZ( CHLORDIAZEPOXIDE HCL )	CAPSULE	25MG	360	$30.00
Register Online Mail in form	CHLORDIAZ( CHLORDIAZEPOXIDE HCL )	GEL CAP	5MG	360	$30.00
Register Online Mail in form	CHLORPROP( CHLORPROPAMIDE )	TABLET	100MG	270	$30.00
Register Online Mail in form	CHLORZOXAZONE ORAL TABLET( CHLORZOXAZONE )	TABLET	500 MG	360	$20.00
Register Online Mail in form	CILOSTAZOL( CILOSTAZOL )	TABLET	100MG	180	$40.00
Register Online Mail in form	CILOSTAZOL ORAL TABLET 50( CILOSTAZOL )	TABLET	50 MG	180	$40.00
Register Online Mail in form	CIMETIDINE( CIMETIDINE )	TABLET	300 MG	360	$20.00
Register Online Mail in form	CIMETIDINE ORAL TABLET 40( CIMETIDINE )	TABLET	400 MG	360	$20.00
Register Online Mail in form	CIMETIDINE ORAL TABLET 80( CIMETIDINE )	TABLET	800 MG	360	$20.00
Register Online Mail in form	CITALOPRAM( CITALOPRAM HBR )	TABLET	10 MG	180	$20.00
Register Online Mail in form	CITALOPRAM( CITALOPRAM HBR )	TABLET	20 MG	180	$20.00
Register Online Mail in form	CITALOPRAM( CITALOPRAM HBR )	TABLET	40 MG	180	$20.00
Register Online Mail in form	CLOMIPRAMINE( CLOMIPRAMINE HCL ORAL CAP )	CAPSULES	25 MG	180	$45.00
Register Online Mail in form	CLONAZEPAM( CLONAZEPAM )	TABLET	0.5 MG	270	$30.00
Register Online Mail in form	CLONAZEPAM( CLONAZEPAM )	TABLET	1MG	270	$30.00
Register Online Mail in form	CLONAZEPAM( CLONAZEPAM )	TABLET	2MG	270	$30.00
Register Online Mail in form	CLONIDINE( CLONIDINE HCL )	TABLET	0.1MG	270	$20.00
Register Online Mail in form	CLONIDINE( CLONIDINE HCL )	TABLET	0.2MG	270	$20.00
Register Online Mail in form	CLONIDINE( CLONIDINE HCL )	TABLET	0.3MG	270	$20.00
Register Online Mail in form	CLOPIDOGREL( CLOPIDOGREL BISULFATE )	TABLET	75 MG	90	$20.00
Register Online Mail in form	COMBIVIR( ZIDOVUDINE/LAMIVUDINE )	TABLET	150-300MG		$15.05
Register Online Mail in form	CROMOLYN( CROMOLYN SODIUM OPHTH )	DROP	4%	30	$30.00
Register Online Mail in form	CYCLOBENZ( CYCLOBENZAPRINE HCL )	TABLET	10MG	360	$30.00
Register Online Mail in form	CYCLOBENZ( CYCLOBENZAPRINE HCL )	TABLET	5MG	360	$30.00
Register Online Mail in form	CYCLOSPOR MIC( CYCLOSPORINE MICROEMUL )	GEL CAP	25MG	60	$45.00

D

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

	Trade Name (BrandName)	Form	Strength	Max. Qty	90 Day Price
Register Online Mail in form	DEPO TESTOST( TESTOSTERONE CYPIONATE IN )	VIAL	200 MG	3	$45.00
Register Online Mail in form	DEXAMETH( DEXAMETHASONE )	TABLET	0.5MG	180	$30.00
Register Online Mail in form	DEXAMETH( DEXAMETHASONE )	TABLET	0.75MG	180	$30.00
Register Online Mail in form	DEXAMETH( DEXAMETHASONE )	TABLET	1.5MG	180	$30.00
Register Online Mail in form	DEXAMETH( DEXAMETHASONE )	TABLET	1MG	180	$30.00
Register Online Mail in form	DEXAMETH( DEXAMETHASONE )	TABLET	4MG	180	$30.00
Register Online Mail in form	DEXAMETH PHOS( DEXAMETHASONE SOD PHOS )	DROP	0.1%	10	$30.00
Register Online Mail in form	DIAZEPAM( DIAZEPAM )	TABLET	10 MG	360	$30.00
Register Online Mail in form	DIAZEPAM( DIAZEPAM )	TABLET	5 MG	360	$30.00
Register Online Mail in form	DIAZEPAM( DIAZEPAM )	TABLET	2 MG	360	$30.00
Register Online Mail in form	DICLOFEN POT( DICLOFENAC POTASSIUM )	TABLET	50 MG	180	$30.00
Register Online Mail in form	DICYCLOMINE( DICYCLOMINE HCL )	CAPSULE	10MG	360	$20.00
Register Online Mail in form	DICYCLOMINE( DICYCLOMINE HCL )	TABLET	20MG	360	$20.00
Register Online Mail in form	DIGOXIN( DIGOXIN )	TABLET	0.125MG	180	$20.00
Register Online Mail in form	DIGOXIN( DIGOXIN )	TABLET	0.25MG	180	$20.00
Register Online Mail in form	DILTIAZEM( DILTIAZEM HCL )	TABLET	120MG	180	$30.00
Register Online Mail in form	DILTIAZEM( DILTIAZEM HCL )	TABLET	30MG	360	$20.00
Register Online Mail in form	DILTIAZEM( DILTIAZEM HCL )	TABLET	60MG	360	$20.00
Register Online Mail in form	DILTIAZEM( DILTIAZEM HCL )	TABLET	90MG	180	$30.00
Register Online Mail in form	DILTIAZEM CD( DILTIAZEM HCL SA 24H )	CAPSULE	120MG	90	$40.00
Register Online Mail in form	DILTIAZEM XR( DILTIAZEM HCL CR )	CAPSULE	180MG	90	$40.00
Register Online Mail in form	DILTIAZEM XR( DILTIAZEM HCL CR )	CAPSULE	240MG	90	$60.00
Register Online Mail in form	DIPHENOXYL/AT( DIPHENOXYLATE/ATROP SULF )	TABLET	2.5-0.025MG	270	$30.00
Register Online Mail in form	DIVALPROEX DR( DIVALPROEX SODIUM EC )	TABLET	125 MG	180	$30.00
Register Online Mail in form	DIVALPROEX DR( DIVALPROEX SODIUM EC )	TABLET	250 MG	180	$30.00
Register Online Mail in form	DIVALPROEX DR( DIVALPROEX SODIUM EC )	TABLET	500 MG	180	$30.00
Register Online Mail in form	DIVALPROEX ER( DIVALPROEX SODIUM SR 24H )	TABLET	250MG	180	$65.00
Register Online Mail in form	DIVALPROEX ER( DIVALPROEX SODIUM SR 24H )	TABLET	500MG	180	$65.00
Register Online Mail in form	DONEPEZIL( DONEPEZIL HCL )	TABLET	10MG	90	$30.00
Register Online Mail in form	DONEPEZIL( DONEPEZIL HCL )	TABLET	5MG	90	$30.00
Register Online Mail in form	DOXAZOSIN( DOXAZOSIN MESYLATE )	TABLET	1MG	180	$20.00
Register Online Mail in form	DOXAZOSIN( DOXAZOSIN MESYLATE )	TABLET	2MG	180	$20.00
Register Online Mail in form	DOXAZOSIN( DOXAZOSIN MESYLATE )	TABLET	4MG	180	$20.00
Register Online Mail in form	DOXAZOSIN( DOXAZOSIN MESYLATE )	TABLET	8MG	180	$20.00
Register Online Mail in form	DOXEPIN( DOXEPIN HCL )	CAPSULE	10MG	180	$30.00
Register Online Mail in form	DOXEPIN( DOXEPIN HCL )	CAPSULE	25MG	180	$30.00
Register Online Mail in form	DOXEPIN( DOXEPIN HCL )	CAPSULES	50 MG	180	$30.00
Register Online Mail in form	DUTOPROL( METOPROLOL SUCC/HCTZ )	TABLET	100-12.5MG	90	$50.00
Register Online Mail in form	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)	Form	Strength	Max. Qty	90 Day Price
Register Online Mail in form	ENALAPRIL MAL( ENALAPRIL MALEATE )	TABLET	10 MG	270	$20.00
Register Online Mail in form	ENALAPRIL MAL( ENALAPRIL MALEATE )	TABLET	2.5 MG	270	$20.00
Register Online Mail in form	ENALAPRIL MAL( ENALAPRIL MALEATE )	TABLET	20 MG	270	$20.00
Register Online Mail in form	ENALAPRIL MAL( ENALAPRIL MALEATE )	TABLET	5 MG	270	$20.00
Register Online Mail in form	ENALAPRIL/HCT( ENALAPRIL MALEATE/HCTZ )	TABLET	10-25MG	180	$20.00
Register Online Mail in form	ENALAPRIL/HCT( ENALAPRIL MALEATE/HCTZ )	TABLET	5-12.5MG	180	$20.00
Register Online Mail in form	ESCITALOPRAM( ESCITALOPRAM OXALATE ORAL )	TABLET	10 MG	90	$30.00
Register Online Mail in form	ESCITALOPRAM( ESCITALOPRAM OXALATE ORAL )	TABLET	20 MG	90	$30.00
Register Online Mail in form	ESCITALOPRAM( ESCITALOPRAM OXALATE ORAL )	TABLET	5 MG	90	$30.00
Register Online Mail in form	ESTRADIOL( ESTRADIOL )	TABLET	0.5MG	180	$20.00
Register Online Mail in form	ESTRADIOL( ESTRADIOL )	TABLET	1MG	180	$20.00
Register Online Mail in form	ESTRADIOL( ESTRADIOL )	TABLET	2MG	180	$20.00
Register Online Mail in form	ESTROPIPATE( ESTROPIPATE (0.75 MG) )	TABLET	0.75MG	90	$30.00
Register Online Mail in form	ESTROPIPATE( ESTROPIPATE (1.5MG) )	TABLET	1.5MG	90	$30.00

F

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

	Trade Name (BrandName)	Form	Strength	Max. Qty	90 Day Price
Register Online Mail in form	FAMOTIDINE( FAMOTIDINE )	TABLET	20MG	180	$20.00
Register Online Mail in form	FAMOTIDINE( FAMOTIDINE )	TABLET	40MG	180	$20.00
Register Online Mail in form	FEXOFENADINE( FEXOFENADINE HCL )	TABLET	180MG	90	$45.00
Register Online Mail in form	FINASTERIDE( FINASTERIDE ORAL TABLET 5 )	TABLET	5 MG	90	$30.00
Register Online Mail in form	FLUCONAZOLE( FLUCONAZOLE )	TABLET	100MG	90	$30.00
Register Online Mail in form	FLUCONAZOLE( FLUCONAZOLE )	TABLET	150MG	90	$30.00
Register Online Mail in form	FLUCONAZOLE( FLUCONAZOLE )	TABLET	200MG	90	$30.00
Register Online Mail in form	FLUOXETINE( FLUOXETINE HCL )	CAPSULE	20MG	270	$20.00
Register Online Mail in form	FLUOXETINE( FLUOXETINE HCL )	CAPSULES	10 MG	270	$20.00
Register Online Mail in form	FLUOXETINE HC( FLUOXETINE HCL )	CAPSULE	40MG	90	$30.00
Register Online Mail in form	FLUPHENAZ( FLUPHENAZINE HCL )	TABLET	10MG	180	$30.00
Register Online Mail in form	FLUPHENAZ( FLUPHENAZINE HCL )	TABLET	1MG	180	$30.00
Register Online Mail in form	FLUPHENAZ( FLUPHENAZINE HCL )	TABLET	2.5MG	180	$30.00
Register Online Mail in form	FLUPHENAZ( FLUPHENAZINE HCL )	TABLET	5MG	180	$30.00
Register Online Mail in form	FLURAZEPAM( FLURAZEPAM HCL )	CAPSULE	15MG	90	$30.00
Register Online Mail in form	FLURAZEPAM( FLURAZEPAM HCL )	CAPSULE	30MG	90	$30.00
Register Online Mail in form	FOLIC ACID( FOLIC ACID )	TABLET	1MG	270	$20.00
Register Online Mail in form	FOSINOPRIL( FOSINOPRIL SODIUM )	TABLET	10MG	90	$30.00
Register Online Mail in form	FOSINOPRIL( FOSINOPRIL SODIUM )	TABLET	20MG	90	$30.00
Register Online Mail in form	FOSINOPRIL( FOSINOPRIL SODIUM )	TABLET	40MG	90	$30.00
Register Online Mail in form	FUROSEMIDE( FUROSEMIDE )	TABLET	20MG	360	$20.00
Register Online Mail in form	FUROSEMIDE( FUROSEMIDE )	TABLET	40MG	360	$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)	Form	Strength	Max. Qty	90 Day Price
Register Online Mail in form	GABAPENTIN( GABAPENTIN )	CAPSULE	100MG	270	$30.00
Register Online Mail in form	GABAPENTIN( GABAPENTIN )	CAPSULE	300MG	270	$30.00
Register Online Mail in form	GABAPENTIN( GABAPENTIN )	CAPSULE	400MG	270	$30.00
Register Online Mail in form	GEMFIBROZIL( GEMFIBROZIL )	TABLET	600MG	180	$30.00
Register Online Mail in form	GLIMEPIRIDE( GLIMEPIRIDE )	TABLET	1MG	180	$20.00
Register Online Mail in form	GLIMEPIRIDE( GLIMEPIRIDE )	TABLET	2MG	180	$20.00
Register Online Mail in form	GLIMEPIRIDE( GLIMEPIRIDE )	TABLET	4MG	180	$20.00
Register Online Mail in form	GLIPIZIDE( GLIPIZIDE )	TABLET	10MG	360	$20.00
Register Online Mail in form	GLIPIZIDE( GLIPIZIDE )	TABLET	5MG	360	$20.00
Register Online Mail in form	GLIPIZIDE XL( GLIPIZIDE ER 24H )	TABLET	10MG	180	$40.00
Register Online Mail in form	GLIPIZIDE XL( GLIPIZIDE ER 24H )	TABLET	2.5MG	180	$40.00
Register Online Mail in form	GLIPIZIDE XL( GLIPIZIDE ER 24H )	TABLET	5MG	180	$40.00
Register Online Mail in form	GLYBUR/METFOR( GLYBURIDE/METFORMIN HCL )	TABLET	1.25-250MG	180	$30.00
Register Online Mail in form	GLYBUR/METFOR( GLYBURIDE/METFORMIN HCL )	TABLET	2.5-500MG	180	$30.00
Register Online Mail in form	GLYBUR/METFOR( GLYBURIDE/METFORMIN HCL )	TABLET	5-500MG	180	$30.00
Register Online Mail in form	GLYBURIDE MCR( GLYBURIDE MICRONIZED )	TABLET	1.5 MG	360	$20.00
Register Online Mail in form	GLYBURIDE MCR( GLYBURIDE MICRONIZED )	TABLET	3MG	360	$20.00
Register Online Mail in form	GLYBURIDE MCR( GLYBURIDE MICRONIZED )	TABLET	6 MG	360	$20.00
Register Online Mail in form	GUANFACINE( GUANFACINE HCL )	TABLET	1MG	180	$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)	Form	Strength	Max. Qty	90 Day Price
Register Online Mail in form	HALOPERIDOL( HALOPERIDOL )	TABLET	0.5MG	180	$20.00
Register Online Mail in form	HALOPERIDOL( HALOPERIDOL )	TABLET	1MG	180	$20.00
Register Online Mail in form	HALOPERIDOL( HALOPERIDOL )	TABLET	2MG	180	$20.00
Register Online Mail in form	HALOPERIDOL( HALOPERIDOL )	TABLET	5MG	180	$20.00
Register Online Mail in form	HYDRALAZINE( HYDRALAZINE HCL )	TABLET	10MG	100	$20.00
Register Online Mail in form	HYDRALAZINE( HYDRALAZINE HCL )	TABLET	25MG	100	$20.00
Register Online Mail in form	HYDRALAZINE( HYDRALAZINE HCL )	TABLET	50MG	100	$20.00
Register Online Mail in form	HYDROCHLOR0( HCTZ(HYDROCHLOROTHIAZIDE) )	CAPSULE	12.5MG	180	$20.00
Register Online Mail in form	HYDROCHLORO( HCTZ(HYDROCHLOROTHIAZIDE) )	TABLET	25MG	180	$20.00
Register Online Mail in form	HYDROCHLORO( HCTZ(HYDROCHLOROTHIAZIDE) )	TABLET	50MG	180	$20.00
Register Online Mail in form	HYDROXYCHLORQ( HYDROXYCHLOROQUINE SULFAT )	TABLET	200 MG	180	$30.00
Register Online Mail in form	HYDROXYUREA( HYDROXYUREA )	CAPSULE	500MG	120	$50.00
Register Online Mail in form	HYDROXYZ PAM( HYDROXYZINE PAMOATE ORAL )	CAPSULES	50 MG	360	$20.00
Register Online Mail in form	HYDROXYZINE( HYDROXYZINE PAMOATE )	CAPSULES	25 MG	360	$20.00

I

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

	Trade Name (BrandName)	Form	Strength	Max. Qty	90 Day Price
Register Online Mail in form	IBUPROFEN( IBUPROFEN )	TABLET	400MG	360	$20.00
Register Online Mail in form	IBUPROFEN( IBUPROFEN )	TABLET	600MG	360	$20.00
Register Online Mail in form	IBUPROFEN( IBUPROFEN )	TABLET	800MG	360	$20.00
Register Online Mail in form	INDAPAMIDE( INDAPAMIDE )	TABLET	1.25MG	180	$20.00
Register Online Mail in form	INDAPAMIDE( INDAPAMIDE )	TABLET	2.5MG	180	$20.00
Register Online Mail in form	INTERMEZZO( ZOLPIDEM TARTRATE SUBLING )	TABLET	3.5 MG		$6.83
Register Online Mail in form	IPRAT/ALBUTER( ALBUTEROL SUL/IPRATROPIUM )	AMPULE	0.5-3MG/3	180ML or 60 Vials	$30.00
Register Online Mail in form	IPRATROP BROM( IPRATROPIUM BROMIDE )	SOLUTION	0.2 MG/ML	150ML or 60 Vials	$20.00
Register Online Mail in form	ISONIAZID( ISONIAZID )	TABLET	300MG	270	$20.00
Register Online Mail in form	ISOSORB MN( ISOSORBIDE MONONITRATE )	TABLET	20MG	90	$30.00
Register Online Mail in form	ISOSORB MN( ISOSORBIDE MONONIT SR 24H )	TABLET	30MG	90	$30.00
Register Online Mail in form	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.

	Trade Name (BrandName)	Form	Strength	Max. Qty	90 Day Price
Register Online Mail in form	JANTOVEN( WARFARIN SODIUM )	TABLET	10MG	180	$30.00
Register Online Mail in form	JANTOVEN( WARFARIN SODIUM )	TABLET	1MG	180	$30.00
Register Online Mail in form	JANTOVEN( WARFARIN SODIUM )	TABLET	2.5MG	180	$30.00
Register Online Mail in form	JANTOVEN( WARFARIN SODIUM )	TABLET	2MG	180	$30.00
Register Online Mail in form	JANTOVEN( WARFARIN SODIUM )	TABLET	3MG	180	$30.00
Register Online Mail in form	JANTOVEN( WARFARIN SODIUM )	TABLET	4MG	180	$30.00
Register Online Mail in form	JANTOVEN( WARFARIN SODIUM )	TABLET	5MG	180	$30.00
Register Online Mail in form	JANTOVEN( WARFARIN SODIUM )	TABLET	6MG	180	$30.00
Register Online Mail in form	JANTOVEN( WARFARIN SODIUM )	TABLET	7.5MG	180	$30.00

K

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

	Trade Name (BrandName)	Form	Strength	Max. Qty	90 Day Price
Register Online Mail in form	KETOCONAZOLE( KETOCONAZOLE )	CREAM	2%	120	$30.00
Register Online Mail in form	KETOCONAZOLE( KETOCONAZOLE )	TABLET	200MG	90	$30.00
Register Online Mail in form	KETOPROFEN( KETOPROFEN )	CAPSULES	50 MG	270	$30.00
Register Online Mail in form	KETOPROFEN( KETOPROFEN )	CAPSULE	75MG	270	$30.00

L

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

	Trade Name (BrandName)	Form	Strength	Max. Qty	90 Day Price
Register Online Mail in form	LAMOTRIGINE( LAMOTRIGINE )	TABLET	100MG	180	$30.00
Register Online Mail in form	LAMOTRIGINE( LAMOTRIGINE )	TABLET	150MG	180	$30.00
Register Online Mail in form	LAMOTRIGINE( LAMOTRIGINE )	CHEWABLE TABS	200MG	180	$30.00
Register Online Mail in form	LAMOTRIGINE( LAMOTRIGINE )	TABLET	25MG	180	$30.00
Register Online Mail in form	LATANOPROST( LATANOPROST )	DROP	0.005%	7.50	$30.00
Register Online Mail in form	LEFLUNOMIDE( LEFLUNOMIDE )	TABLET	10MG	90	$65.00
Register Online Mail in form	LEFLUNOMIDE( LEFLUNOMIDE )	TABLET	20MG	90	$65.00
Register Online Mail in form	LETROZOLE( LETROZOLE )	TABLET	2.5MG	90	$30.00
Register Online Mail in form	LEVETIRACETAM( LEVETIRACETAM )	TABLET	250MG	180	$60.00
Register Online Mail in form	LEVETIRACETAM( LEVETIRACETAM )	TABLET	500MG	180	$60.00
Register Online Mail in form	LEVETIRACETAM( LEVETIRACETAM )	TABLET	750MG	180	$60.00
Register Online Mail in form	LEVOBUNOL O/S( LEVOBUNOLOL HCL OPHTH )	DROP	0.5%	30	$20.00
Register Online Mail in form	LEVOBUNOLOL( LEVOBUNOLOL HCL )	DROPS	0.25 %	15	$20.00
Register Online Mail in form	LEVOCETIRIZIN( LEVOCETIRIZINE/DIHYDROCHL )	TABLET	5MG	90	$45.00
Register Online Mail in form	LEVOFLOXACIN( LEVOFLOXACIN )	TABLET	500MG	30	$30.00
Register Online Mail in form	LEVOFLOXACIN( LEVOFLOXACIN )	TABLET	750MG	30	$30.00
Register Online Mail in form	LEVOFLOXACIN( LEVOFLOXACIN )	TABLET	250 MG	30	$0.31
Register Online Mail in form	LEVOTHYROXINE( LEVOTHYROXINE SODIUM )	TABLET	100MCG	90	$20.00
Register Online Mail in form	LEVOTHYROXINE( LEVOTHYROXINE SODIUM )	TABLET	112MCG	90	$20.00
Register Online Mail in form	LEVOTHYROXINE( LEVOTHYROXINE SODIUM )	TABLET	125MCG	90	$20.00
Register Online Mail in form	LEVOTHYROXINE( LEVOTHYROXINE SODIUM )	TABLET	137MCG	90	$20.00
Register Online Mail in form	LEVOTHYROXINE( LEVOTHYROXINE SODIUM )	TABLET	150MCG	90	$20.00
Register Online Mail in form	LEVOTHYROXINE( LEVOTHYROXINE SODIUM )	TABLET	175MCG	90	$20.00
Register Online Mail in form	LEVOTHYROXINE( LEVOTHYROXINE SODIUM )	TABLET	200MCG	90	$20.00
Register Online Mail in form	LEVOTHYROXINE( LEVOTHYROXINE SODIUM )	TABLET	25MCG	90	$20.00
Register Online Mail in form	LEVOTHYROXINE( LEVOTHYROXINE SODIUM )	TABLET	300MCG	90	$20.00
Register Online Mail in form	LEVOTHYROXINE( LEVOTHYROXINE SODIUM )	TABLET	50MCG	90	$20.00
Register Online Mail in form	LEVOTHYROXINE( LEVOTHYROXINE SODIUM )	TABLET	75MCG	90	$20.00
Register Online Mail in form	LEVOTHYROXINE( LEVOTHYROXINE SODIUM )	TABLET	88MCG	90	$20.00
Register Online Mail in form	LISINOP/HCTZ( LISINOPRIL/HCTZ )	TABLET	10-12.5MG	270	$20.00
Register Online Mail in form	LISINOP/HCTZ( LISINOPRIL/HCTZ )	TABLET	20-12.5MG	270	$20.00
Register Online Mail in form	LISINOP/HCTZ( LISINOPRIL/HCTZ )	TABLET	20-25MG	270	$20.00
Register Online Mail in form	LISINOPRIL( LISINOPRIL )	TABLET	10 MG	270	$20.00
Register Online Mail in form	LISINOPRIL( LISINOPRIL )	TABLET	2.5 MG	270	$20.00
Register Online Mail in form	LISINOPRIL( LISINOPRIL )	TABLET	20MG	270	$20.00
Register Online Mail in form	LISINOPRIL( LISINOPRIL )	TABLET	30 MG	270	$20.00
Register Online Mail in form	LISINOPRIL( LISINOPRIL )	TABLET	5MG	270	$20.00
Register Online Mail in form	LISINOPRIL( LISINOPRIL )	TABLET	40MG	270	$20.00
Register Online Mail in form	LITHIUM CARB( LITHIUM CARBONATE )	CAPSULE	150MG	360	$30.00
Register Online Mail in form	LITHIUM CARB( LITHIUM CARBONATE )	CAPSULE	300MG	360	$30.00
Register Online Mail in form	LORATADINE( LORATADINE )	TABLET	10MG	100	$20.00
Register Online Mail in form	LORAZEPAM( LORAZEPAM )	TABLET	0.5MG	360	$30.00
Register Online Mail in form	LORAZEPAM( LORAZEPAM )	TABLET	1MG	360	$30.00
Register Online Mail in form	LORAZEPAM( LORAZEPAM )	TABLET	2MG	360	$30.00
Register Online Mail in form	LOSARTAN( LOSARTAN POTASSIUM )	TABLET	100 MG	90	$30.00
Register Online Mail in form	LOSARTAN( LOSARTAN POTASSIUM )	TABLET	25 MG	90	$30.00
Register Online Mail in form	LOSARTAN( LOSARTAN POTASSIUM )	TABLET	50 MG	90	$30.00
Register Online Mail in form	LOSARTAN/HCTZ( LOSARTAN POTASSIUM/HCTZ )	TABLET	50-12.5 MG	90	$30.00
Register Online Mail in form	LOSARTAN/HCTZ( LOSARTAN POTASSIUM/HCTZ )	TABLET	100-12.5MG	90	$30.00
Register Online Mail in form	LOSARTAN/HCTZ( LOSARTAN POTASSIUM/HCTZ )	TABLET	100-25MG	90	$30.00
Register Online Mail in form	LOVASTATIN( LOVASTATIN )	TABLET	10 MG	90	$30.00
Register Online Mail in form	LOVASTATIN( LOVASTATIN )	TABLET	20MG	90	$30.00
Register Online Mail in form	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)	Form	Strength	Max. Qty	90 Day Price
Register Online Mail in form	MECLIZINE( MECLIZINE HCL )	TABLET	12.5MG	270	$20.00
Register Online Mail in form	MECLIZINE HCL( MECLIZINE HCL CHEW )	TABLET	25 MG	270	$20.00
Register Online Mail in form	MEDROXYPROG( MEDROXYPROGESTERONE ACET )	TABLET	10MG	180	$20.00
Register Online Mail in form	MEDROXYPROG( MEDROXYPROGESTERONE ACET )	TABLET	2.5MG	180	$20.00
Register Online Mail in form	MEDROXYPROG( MEDROXYPROGESTERONE ACET )	TABLET	5MG	180	$20.00
Register Online Mail in form	MEGESTROL ACE( MEGESTROL ACETATE )	TABLET	20 MG	180	$40.00
Register Online Mail in form	MEGESTROL ACE( MEGESTROL ACETATE )	TABLET	40 MG	180	$40.00
Register Online Mail in form	MELOXICAM( MELOXICAM )	TABLET	15 MG	180	$20.00
Register Online Mail in form	MELOXICAM( MELOXICAM )	TABLET	7.5 MG	180	$20.00
Register Online Mail in form	MERCAPTOPURIN( MERCAPTOPURINE )	TABLET	50 MG	60	$75.00
Register Online Mail in form	METFORMIN( METFORMIN HCL )	TABLET	1000 MG	360	$30.00
Register Online Mail in form	METFORMIN( METFORMIN HCL )	TABLET	500 MG	360	$30.00
Register Online Mail in form	METFORMIN( METFORMIN HCL )	TABLET	850 MG	360	$30.00
Register Online Mail in form	METFORMIN( METFORMIN HCL SR 24H )	TABLET	500MG	180	$30.00
Register Online Mail in form	METFORMIN( METFORMIN HCL SR 24H )	TABLET	750MG	180	$30.00
Register Online Mail in form	METHOCARBAM( METHOCARBAMOL )	TABLET	500 MG	360	$30.00
Register Online Mail in form	METHOCARBAM( METHOCARBAMOL )	TABLET	750MG	360	$30.00
Register Online Mail in form	METHOTREXATE( METHOTREXATE SODIUM )	TABLET	2.5MG	96	$40.00
Register Online Mail in form	METHYLDOPA( METHYLDOPA )	TABLET	250MG	270	$30.00
Register Online Mail in form	METOCLOPRAM( METOCLOPRAMIDE HCL )	TABLET	10MG	360	$20.00
Register Online Mail in form	METOCLOPRAM( METOCLOPRAMIDE HCL )	TABLET	5MG	360	$20.00
Register Online Mail in form	METOPROLOL( METOPROLOL TARTRATE )	TABLET	100 MG	270	$20.00
Register Online Mail in form	METOPROLOL( METOPROLOL TARTRATE )	TABLET	25MG	270	$20.00
Register Online Mail in form	METOPROLOL( METOPROLOL TARTRATE )	TABLET	50MG	270	$20.00
Register Online Mail in form	METRONIDAZOLE( METRONIDAZOLE )	TABLET	500MG	180	$30.00
Register Online Mail in form	MINOCYCLINE( MINOCYCLINE HCL ORAL CAPS )	CAPSULES	100 MG	90	$30.00
Register Online Mail in form	MINOCYCLINE( MINOCYCLINE HCL ORAL CAPS )	CAPSULES	50 MG	90	$30.00
Register Online Mail in form	MIRTAZAPINE( MIRTAZAPINE )	TABLET	15 MG	90	$30.00
Register Online Mail in form	MIRTAZAPINE( MIRTAZAPINE )	TABLET	30 MG	90	$30.00
Register Online Mail in form	MIRTAZAPINE( MIRTAZAPINE )	TABLET	45MG	90	$30.00
Register Online Mail in form	MONTELUKAST( MONTELUKAST SODIUM CHEW )	CHEWABLE TABLET	4MG	90	$45.00
Register Online Mail in form	MONTELUKAST( MONTELUKAST SODIUM CHEW )	CHEWABLE TABLET	5MG	90	$45.00
Register Online Mail in form	MONTELUKAST( MONTELUKAST SODIUM )	TABLET	10MG	90	$45.00
Register Online Mail in form	MYCOPHENOLATE( MYCOPHENOLATE MOFETIL )	CAPSULE	250MG	120	$60.00
Register Online Mail in form	MYCOPHENOLATE( MYCOPHENOLATE MOFETIL )	TABLET	500MG	120	$60.00

N

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

	Trade Name (BrandName)	Form	Strength	Max. Qty	90 Day Price
Register Online Mail in form	NABUMETONE( NABUMETONE )	TABLET	500MG	180	$40.00
Register Online Mail in form	NABUMETONE( NABUMETONE )	TABLET	750MG	180	$40.00
Register Online Mail in form	NAPROXEN( NAPROXEN )	TABLET	250 MG	180	$20.00
Register Online Mail in form	NAPROXEN( NAPROXEN )	TABLET	375MG	180	$20.00
Register Online Mail in form	NAPROXEN( NAPROXEN )	TABLET	500 MG	180	$20.00
Register Online Mail in form	NAPROXEN SOD( NAPROXEN SODIUM )	TABLET	275MG	180	$20.00
Register Online Mail in form	NAPROXEN SOD( NAPROXEN SODIUM )	TABLET	550MG	180	$20.00
Register Online Mail in form	NEVIRAPINE( NEVIRAPINE ORAL TABLET 20 )	TABLET	200 MG	180	$40.00
Register Online Mail in form	NIACIN( VIT B3(NIACIN) )	TABLET	500MG	360	$20.00
Register Online Mail in form	NIFEDIPINE CC( NIFEDIPINE SA )	TABLET	60MG	90	$75.00
Register Online Mail in form	NIFEDIPINE CC( NIFEDIPINE SA )	TABLET	30MG	90	$40.00
Register Online Mail in form	NITROGLY TRAN( NITROGLYCERIN PATCH TD 24 )	AMPULE	0.2MG/HR	90	$50.00
Register Online Mail in form	NITROGLY TRAN( NITROGLYCERIN PATCH TD 24 )	AMPULE	0.4MG/HR	90	$50.00
Register Online Mail in form	NORTRIPTYLINE( NORTRIPTYLINE HCL )	CAPSULE	10MG	180	$30.00
Register Online Mail in form	NORTRIPTYLINE( NORTRIPTYLINE HCL )	CAPSULE	25MG	180	$30.00
Register Online Mail in form	NORTRIPTYLINE( NORTRIPTYLINE HCL )	CAPSULE	50MG	180	$30.00
Register Online Mail in form	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)	Form	Strength	Max. Qty	90 Day Price
Register Online Mail in form	OLANZAPINE( OLANZAPINE )	TABLET	10MG	90	$30.00
Register Online Mail in form	OLANZAPINE( OLANZAPINE )	TABLET	15MG	90	$65.00
Register Online Mail in form	OLANZAPINE( OLANZAPINE )	TABLET	2.5MG	90	$30.00
Register Online Mail in form	OLANZAPINE( OLANZAPINE )	TABLET	20MG	90	$65.00
Register Online Mail in form	OLANZAPINE( OLANZAPINE )	TABLET	5MG	90	$30.00
Register Online Mail in form	OLANZAPINE( OLANZAPINE )	TABLET	7.5MG	90	$30.00
Register Online Mail in form	OMEPRAZOLE DR( OMEPRAZOLE EC )	CAPSULE	10MG	90	$30.00
Register Online Mail in form	OMEPRAZOLE DR( OMEPRAZOLE EC )	CAPSULE	20MG	90	$30.00
Register Online Mail in form	OMEPRAZOLE DR( OMEPRAZOLE EC )	CAPSULE	40MG	90	$30.00
Register Online Mail in form	ONDANSETRON( ONDANSETRON HCL )	TABLET	4MG	60	$30.00
Register Online Mail in form	ONDANSETRON( ONDANSETRON HCL )	TABLET	8MG	60	$30.00
Register Online Mail in form	OXAPROZIN( OXAPROZIN )	TABLET	600 MG	30	$180.00
Register Online Mail in form	OXYBUTYNIN( OXYBUTYNIN CHL )	TABLET	5 MG	270	$20.00

P

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

	Trade Name (BrandName)	Form	Strength	Max. Qty	90 Day Price
Register Online Mail in form	PANTOPRAZOLE( PANTOPRAZOLE SOD SESQ DR )	TABLET	20 MG	90	$20.00
Register Online Mail in form	PANTOPRAZOLE( PANTOPRAZOLE SOD SESQ EC )	TABLET	40 MG	90	$20.00
Register Online Mail in form	PAROXETINE( PAROXETINE HCL )	TABLET	10MG	90	$30.00
Register Online Mail in form	PAROXETINE( PAROXETINE HCL )	TABLET	20 MG	90	$30.00
Register Online Mail in form	PAROXETINE( PAROXETINE HCL )	TABLET	30 MG	90	$30.00
Register Online Mail in form	PAROXETINE( PAROXETINE HCL )	TABLET	40MG	90	$30.00
Register Online Mail in form	PENTOXIFYLLIN( PENTOXIFYLLINE SA )	TABLET	400MG	270	$60.00
Register Online Mail in form	PERINDOPRIL( PERINDOPRIL ERBUMINE )	TABLET	2MG	90	$60.00
Register Online Mail in form	PERINDOPRIL( PERINDOPRIL ERBUMINE )	TABLET	4MG	90	$60.00
Register Online Mail in form	PERINDOPRIL( PERINDOPRIL ERBUMINE )	TABLET	8MG	90	$60.00
Register Online Mail in form	PHENYTOIN( PHENYTOIN SODIUM EXTENDED )	CAPSULES	100MG ER	180	$30.00
Register Online Mail in form	PIOGLITAZONE( PIOGLITAZONE HCL ORAL TAB )	TABLET	15 MG	90	$30.00
Register Online Mail in form	PIOGLITAZONE( PIOGLITAZONE HCL ORAL TAB )	TABLET	30 MG	90	$30.00
Register Online Mail in form	PIOGLITAZONE( PIOGLITAZONE HCL ORAL TAB )	TABLET	45 MG	90	$30.00
Register Online Mail in form	PRAMIPEXOLE( PRAMIPEXOLE DI-HCL )	TABLET	0.125MG	180	$30.00
Register Online Mail in form	PRAMIPEXOLE( PRAMIPEXOLE DI-HCL )	TABLET	0.25MG	180	$30.00
Register Online Mail in form	PRAMIPEXOLE( PRAMIPEXOLE DI-HCL )	TABLET	0.5MG	180	$30.00
Register Online Mail in form	PRAMIPEXOLE( PRAMIPEXOLE DI-HCL )	TABLET	1.5MG	180	$30.00
Register Online Mail in form	PRAMIPEXOLE( PRAMIPEXOLE DI-HCL )	TABLET	1MG	180	$30.00
Register Online Mail in form	PRAVASTATIN( PRAVASTATIN SODIUM )	TABLET	10MG	90	$20.00
Register Online Mail in form	PRAVASTATIN( PRAVASTATIN SODIUM )	TABLET	20MG	90	$20.00
Register Online Mail in form	PRAVASTATIN( PRAVASTATIN SODIUM )	TABLET	40MG	90	$20.00
Register Online Mail in form	PRAVASTATIN( PRAVASTATIN SODIUM )	TABLET	80 MG	90	$30.00
Register Online Mail in form	PRAZOSIN( PRAZOSIN HCL )	CAPSULES	5 MG	180	$30.00
Register Online Mail in form	PRAZOSIN( PRAZOSIN HCL )	CAPSULE	1MG	180	$30.00
Register Online Mail in form	PRAZOSIN( PRAZOSIN HCL )	CAPSULE	2MG	180	$30.00
Register Online Mail in form	PREDNISONE( PREDNISONE )	TABLET	10 MG	360	$20.00
Register Online Mail in form	PREDNISONE( PREDNISONE )	TABLET	20MG	360	$20.00
Register Online Mail in form	PREDNISONE( PREDNISONE )	TABLET	5MG	360	$20.00
Register Online Mail in form	PRIMIDONE( PRIMIDONE )	TABLET	250MG	180	$30.00
Register Online Mail in form	PRIMIDONE( PRIMIDONE )	TABLET	50MG	180	$30.00
Register Online Mail in form	PROCHLORPERAZ( PROCHLORPERAZINE MALEATE )	TABLET	5MG	270	$30.00
Register Online Mail in form	PROCHLORPERAZ( PROCHLORPERAZINE MALEATE )	TABLET	10MG	270	$30.00
Register Online Mail in form	PROPAFENONE( PROPAFENONE HCL )	TABLET	150 MG	180	$40.00
Register Online Mail in form	PROPRANOLOL( PROPRANOLOL HCL )	TABLET	10MG	360	$20.00
Register Online Mail in form	PROPRANOLOL( PROPRANOLOL HCL )	TABLET	20MG	360	$20.00
Register Online Mail in form	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)	Form	Strength	Max. Qty	90 Day Price
Register Online Mail in form	QUETIAPINE( QUETIAPINE FUMARATE )	TABLET	25 MG	90	$40.00
Register Online Mail in form	QUETIAPINE( QUETIAPINE FUMARATE )	TABLET	300 MG	90	$40.00
Register Online Mail in form	QUETIAPINE( QUETIAPINE FUMARATE )	TABLET	50 MG	90	$40.00
Register Online Mail in form	QUETIAPINE( QUETIAPINE FUMARATE )	TABLET	100 MG	90	$40.00
Register Online Mail in form	QUETIAPINE( QUETIAPINE FUMARATE )	TABLET	200 MG	90	$40.00
Register Online Mail in form	QUETIAPINE( QUETIAPINE FUMARATE )	TABLET	400 MG		$0.64
Register Online Mail in form	QUINAPRIL( QUINAPRIL HCL )	TABLET	10MG	90	$30.00
Register Online Mail in form	QUINAPRIL( QUINAPRIL HCL )	TABLET	20MG	90	$30.00
Register Online Mail in form	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)	Form	Strength	Max. Qty	90 Day Price
Register Online Mail in form	RAMIPRIL( RAMIPRIL )	CAPSULE	10MG	90	$20.00
Register Online Mail in form	RAMIPRIL( RAMIPRIL )	CAPSULE	2.5MG	90	$20.00
Register Online Mail in form	RAMIPRIL( RAMIPRIL )	CAPSULE	5MG	90	$20.00
Register Online Mail in form	RAMIPRIL( RAMIPRIL )	CAPSULES	1.25 MG	90	$20.00
Register Online Mail in form	RANITIDINE( RANITIDINE HCL )	TABLET	300 MG	180	$20.00
Register Online Mail in form	RANITIDINE( RANITIDINE HCL )	TABLET	150MG	180	$20.00
Register Online Mail in form	RESCRIPTOR( DELAVIRDINE MESYLATE )	TABLET	200MG		$1.90
Register Online Mail in form	REYATAZ( ATAZANAVIR SULFATE )	CAPSULE	100MG		$16.32
Register Online Mail in form	REYATAZ( ATAZANAVIR SULFATE )	CAPSULE	150MG		$16.32
Register Online Mail in form	REYATAZ( ATAZANAVIR SULFATE )	CAPSULE	200MG		$16.32
Register Online Mail in form	REYATAZ( ATAZANAVIR SULFATE )	CAPSULE	300MG		$32.34
Register Online Mail in form	RISPERIDONE( RISPERIDONE )	TABLET	0.25MG	180	$60.00
Register Online Mail in form	RISPERIDONE( RISPERIDONE )	TABLET	0.5MG	180	$60.00
Register Online Mail in form	RISPERIDONE( RISPERIDONE )	TABLET	1MG	180	$60.00
Register Online Mail in form	RISPERIDONE( RISPERIDONE )	TABLET	2MG	180	$60.00
Register Online Mail in form	RISPERIDONE( RISPERIDONE )	TABLET	3MG	180	$60.00
Register Online Mail in form	RISPERIDONE( RISPERIDONE )	TABLET	4MG	180	$60.00
Register Online Mail in form	RIZATRIPTAN( RIZATRIPTAN BENZOATE ORAL )	TABLET	10 MG	18	$40.00
Register Online Mail in form	RIZATRIPTAN( RIZATRIPTAN BENZOATE ORAL )	TABLET	5 MG	18	$40.00
Register Online Mail in form	ROPINIROLE( ROPINIROLE HCL )	TABLET	0.25MG	90	$40.00
Register Online Mail in form	ROPINIROLE( ROPINIROLE HCL )	TABLET	0.5MG	90	$40.00
Register Online Mail in form	ROPINIROLE( ROPINIROLE HCL )	TABLET	1MG	90	$40.00
Register Online Mail in form	ROPINIROLE( ROPINIROLE HCL )	TABLET	2MG	90	$40.00
Register Online Mail in form	ROPINIROLE( ROPINIROLE HCL )	TABLET	3 MG	90	$40.00
Register Online Mail in form	ROPINIROLE( ROPINIROLE HCL )	TABLET	4MG	90	$40.00
Register Online Mail in form	ROPINIROLE( ROPINIROLE HCL )	TABLET	5 MG	90	$40.00

S

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

	Trade Name (BrandName)	Form	Strength	Max. Qty	90 Day Price
Register Online Mail in form	SERTRALINE( SERTRALINE )	TABLET	100 MG	180	$30.00
Register Online Mail in form	SERTRALINE( SERTRALINE )	TABLET	25 MG	180	$30.00
Register Online Mail in form	SERTRALINE( SERTRALINE )	TABLET	50MG	180	$30.00
Register Online Mail in form	SIMVASTATIN( SIMVASTATIN )	TABLET	10MG	90	$20.00
Register Online Mail in form	SIMVASTATIN( SIMVASTATIN )	TABLET	40MG	90	$20.00
Register Online Mail in form	SIMVASTATIN( SIMVASTATIN )	TABLET	20 MG	90	$20.00
Register Online Mail in form	SIMVASTATIN( SIMVASTATIN )	TABLET	80 MG	90	$20.00
Register Online Mail in form	SIMVASTATIN( SIMVASTATIN )	TABLET	5 MG	90	$20.00
Register Online Mail in form	SOTALOL AF( SOTALOL HCL )	TABLET	120 MG	90	$40.00
Register Online Mail in form	SOTALOL AF( SOTALOL HCL )	TABLET	160MG	90	$40.00
Register Online Mail in form	SOTALOL AF( SOTALOL HCL )	TABLET	80MG	90	$40.00
Register Online Mail in form	SOTALOL HCL( SOTALOL HCL )	TABLET	120MG	90	$30.00
Register Online Mail in form	SOTALOL HCL( SOTALOL HCL )	TABLET	80MG	90	$30.00
Register Online Mail in form	SOTALOL HCL( SOTALOL HCL )	TABLET	160 MG	90	$30.00
Register Online Mail in form	SPIRONOLACT( SPIRONOLACTONE )	TABLET	25MG	180	$30.00
Register Online Mail in form	SPIRONOLACT( SPIRONOLACTONE )	TABLET	50MG	90	$30.00
Register Online Mail in form	SUCRALFATE( SUCRALFATE )	TABLET	1GM	270	$45.00
Register Online Mail in form	SULFAMETH/TMP( SULFAMETHOXAZOLE/TRIMETHO )	TABLET	400-80MG	180	$20.00
Register Online Mail in form	SULFAMETH/TMP( SULFAMETHOXAZOLE/TRIMETHO )	TABLET	800-160MG	180	$20.00
Register Online Mail in form	SULFASALAZINE( SULFASALAZINE )	TABLET	500MG	360	$45.00
Register Online Mail in form	SULFAZINE EC( SULFASALAZINE EC )	TABLET	500MG	180	$40.00
Register Online Mail in form	SULINDAC( SULINDAC )	TABLET	150 MG	180	$30.00
Register Online Mail in form	SULINDAC( SULINDAC )	TABLET	200MG	180	$30.00
Register Online Mail in form	SUMATRIPTAN( SUMATRIPTAN SUCCINATE )	TABLET	100MG	18	$35.00
Register Online Mail in form	SUMATRIPTAN( SUMATRIPTAN SUCCINATE )	TABLET	25MG	18	$35.00
Register Online Mail in form	SUMATRIPTAN( SUMATRIPTAN SUCCINATE )	TABLET	50MG	18	$35.00
Register Online Mail in form	SUSTIVA( EFAVIRENZ )	CAPSULE	200MG		$6.54
Register Online Mail in form	SUSTIVA( EFAVIRENZ )	TABLET	600MG		$19.61

T

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

	Trade Name (BrandName)	Form	Strength	Max. Qty	90 Day Price
Register Online Mail in form	TAMOXIFEN CIT( TAMOXIFEN CITRATE )	TABLET	20MG	90	$30.00
Register Online Mail in form	TAMOXIFEN CIT( TAMOXIFEN CITRATE )	TABLET	10 MG	90	$30.00
Register Online Mail in form	TAMSULOSIN( TAMSULOSIN HCL SR 24H )	CAPSULE	0.4MG	90	$30.00
Register Online Mail in form	TEMAZEPAM( TEMAZEPAM )	CAPSULE	15MG	90	$30.00
Register Online Mail in form	TEMAZEPAM( TEMAZEPAM )	CAPSULE	30MG	90	$30.00
Register Online Mail in form	TENOFOVIR DISOPROXIL FUMA( TENOFOVIR DISPROXIL FUM )	TABLET	300 MG		$0.00
Register Online Mail in form	TERAZOSIN( TERAZOSIN HCL )	CAPSULE	10MG	180	$20.00
Register Online Mail in form	TERAZOSIN( TERAZOSIN HCL )	CAPSULE	1MG	180	$20.00
Register Online Mail in form	TERAZOSIN( TERAZOSIN HCL )	CAPSULE	2MG	180	$20.00
Register Online Mail in form	TERAZOSIN( TERAZOSIN HCL )	CAPSULE	5MG	180	$20.00
Register Online Mail in form	TERBINAFINE( TERBINAFINE HCL )	TABLET	250 MG	90	$30.00
Register Online Mail in form	THEOPHY ANHYD( THEOPHYLLINE ANHY SR 12HR )	TABLET	100MG	180	$40.00
Register Online Mail in form	THEOPHY ANHYD( THEOPHYLLINE ANHY SR 12HR )	TABLET	200MG	180	$40.00
Register Online Mail in form	THEOPHY ANHYD( THEOPHYLLINE ANHY SR 12HR )	TABLET	300MG	180	$40.00
Register Online Mail in form	THYROID( THYROID PORK )	TABLET	15MG	90	$30.00
Register Online Mail in form	THYROID( THYROID PORK )	TABLET	30MG	90	$30.00
Register Online Mail in form	THYROID( THYROID PORK )	TABLET	60MG	90	$30.00
Register Online Mail in form	THYROID( THYROID PORK )	TABLET	90MG	90	$30.00
Register Online Mail in form	TIMOLOL O/S( TIMOLOL MALEATE )	DROP	0.25%	30	$20.00
Register Online Mail in form	TIMOLOL O/S( TIMOLOL MALEATE )	DROP	0.5%	30	$20.00
Register Online Mail in form	TIZANIDINE( TIZANIDINE HCL )	TABLET	2 MG	360	$30.00
Register Online Mail in form	TIZANIDINE( TIZANIDINE HCL )	TABLET	4 MG	360	$30.00
Register Online Mail in form	TOPIRAMATE( TOPIRAMATE )	TABLET	100MG	180	$30.00
Register Online Mail in form	TOPIRAMATE( TOPIRAMATE )	TABLET	200MG	180	$30.00
Register Online Mail in form	TOPIRAMATE( TOPIRAMATE )	TABLET	25MG	180	$30.00
Register Online Mail in form	TOPIRAMATE( TOPIRAMATE )	TABLET	50MG	180	$30.00
Register Online Mail in form	TORSEMIDE( TORSEMIDE )	TABLET	10MG	180	$30.00
Register Online Mail in form	TORSEMIDE( TORSEMIDE )	TABLET	20MG	180	$30.00
Register Online Mail in form	TORSEMIDE( TORSEMIDE )	TABLET	5 MG	180	$30.00
Register Online Mail in form	TRAMADOL( TRAMADOL HCL )	TABLET	50MG	360	$30.00
Register Online Mail in form	TRAMADOL ACET( TRAMADOL HCL/APAP )	TABLET	37.5-325MG		$0.31
Register Online Mail in form	TRANDOLAPRIL( TRANDOLAPRIL )	TABLET	1MG	90	$30.00
Register Online Mail in form	TRANDOLAPRIL( TRANDOLAPRIL )	TABLET	2MG	90	$30.00
Register Online Mail in form	TRANDOLAPRIL( TRANDOLAPRIL )	TABLET	4MG	90	$30.00
Register Online Mail in form	TRAZODONE( TRAZODONE HCL )	TABLET	100MG	360	$20.00
Register Online Mail in form	TRAZODONE( TRAZODONE HCL )	TABLET	50MG	360	$20.00
Register Online Mail in form	TRIAMTER/HCTZ( TRIAMTERENE/HCTZ )	TABLET	37.5-25 MG	90	$20.00
Register Online Mail in form	TRIAMTER/HCTZ( TRIAMTERENE/HCTZ )	TABLET	75-50MG	90	$20.00
Register Online Mail in form	TRIAZOLAM( TRIAZOLAM )	TABLET	0.25MG	90	$30.00
Register Online Mail in form	TRIAZOLAM( TRIAZOLAM )	TABLET	0.125 MG	90	$30.00
Register Online Mail in form	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)	Form	Strength	Max. Qty	90 Day Price
Register Online Mail in form	VENLAFAXINE( VENLAFAXINE HCL SA )	CAPSULES	150 MG	90	$40.00
Register Online Mail in form	VENLAFAXINE( VENLAFAXINE HCL SA )	CAPSULES	37.5 MG	90	$40.00
Register Online Mail in form	VENLAFAXINE( VENLAFAXINE HCL SA )	CAPSULES	75 MG	90	$40.00
Register Online Mail in form	VENTOLIN HFA( ALBUTEROL SULFATE CFE/FRE )	INHALANT	90 MCG	8	$18.00
Register Online Mail in form	VERAPAMIL( VERAPAMIL HCL SA )	TABLET	120 MG	90	$40.00
Register Online Mail in form	VERAPAMIL( VERAPAMIL HCL )	TABLET	120MG	360	$20.00
Register Online Mail in form	VERAPAMIL( VERAPAMIL HCL SA )	TABLET	180MG	90	$40.00
Register Online Mail in form	VERAPAMIL( VERAPAMIL HCL SA )	TABLET	240MG	90	$40.00
Register Online Mail in form	VERAPAMIL( VERAPAMIL HCL )	TABLET	80MG	360	$20.00
Register Online Mail in form	VIDEX EC( DIDANOSINE EC )	CAPSULE	125MG		$4.25
Register Online Mail in form	VIDEX EC( DIDANOSINE EC )	CAPSULE	250MG		$9.05
Register Online Mail in form	VIDEX EC( DIDANOSINE EC )	CAPSULE	400MG		$13.48
Register Online Mail in form	VIDEX PED( DIDANOSINE )	PASTE	10MG/ML		$57.13
Register Online Mail in form	VIRAMUNE( NEVIRAPINE )	TABLET	200MG		$10.26
Register Online Mail in form	VIRAMUNE XR( NEVIRAPINE )	TABLET	400 MG		$18.09
Register Online Mail in form	VIREAD( TENOFOVIR DISPROXIL FUM )	TABLET	300MG		$26.38

W

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

	Trade Name (BrandName)	Form	Strength	Max. Qty	90 Day Price
Register Online Mail in form	WARFARIN SOD( WARFARIN SODIUM )	TABLET	10MG	180	$30.00
Register Online Mail in form	WARFARIN SOD( WARFARIN SODIUM )	TABLET	1MG	180	$30.00
Register Online Mail in form	WARFARIN SOD( WARFARIN SODIUM )	TABLET	2.5MG	180	$30.00
Register Online Mail in form	WARFARIN SOD( WARFARIN SODIUM )	TABLET	2MG	180	$30.00
Register Online Mail in form	WARFARIN SOD( WARFARIN SODIUM )	TABLET	4MG	180	$30.00
Register Online Mail in form	WARFARIN SOD( WARFARIN SODIUM )	TABLET	5MG	180	$30.00
Register Online Mail in form	WARFARIN SOD( WARFARIN SODIUM )	TABLET	6MG	180	$30.00
Register Online Mail in form	WARFARIN SOD( WARFARIN SODIUM )	TABLET	7.5MG	180	$30.00

X

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

Y

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

Z

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

	Trade Name (BrandName)	Form	Strength	Max. Qty	90 Day Price
Register Online Mail in form	ZALEPLON ORAL CAPSULE 10( ZALEPLON )	CAPSULES	10 MG	90	$40.00
Register Online Mail in form	ZALEPLON ORAL CAPSULE 5 M( ZALEPLON )	CAPSULES	5 MG	90	$40.00
Register Online Mail in form	ZOLPIDEM TART( ZOLPIDEM TARTRATE )	TABLET	10MG	90	$30.00
Register Online Mail in form	ZOLPIDEM TART( ZOLPIDEM TARTRATE )	TABLET	5MG	90	$30.00
Register Online Mail in form	ZONISAMIDE( ZONISAMIDE )	CAPSULES	50 MG	180	$30.00
Register Online Mail in form	ZONISAMIDE( ZONISAMIDE )	CAPSULES	25 MG	180	$30.00

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.

Page was cache at: 5/22/2013 7:24:36 AM

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