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SCRIPTS FORMULARIES SHAREDHEALTHALLIANCE.COM (314) 594-0600

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Page 1: SCRIPTS FORMULARIES...Acetaminophen/Tramadol HCl 37.5/ 325 mg Tablets Gabapentin 300 mg Capsules Gabapentin 600 mg Tablets Phenazopyridine HCl 95mg Tablets Tramadol 50 mg Tablets Anesthetics

(314) 594-0600 [email protected]

SCRIPTSFORMULARIES

SHAREDHEALTHALLIANCE.COM(314) 594-0600

Page 2: SCRIPTS FORMULARIES...Acetaminophen/Tramadol HCl 37.5/ 325 mg Tablets Gabapentin 300 mg Capsules Gabapentin 600 mg Tablets Phenazopyridine HCl 95mg Tablets Tramadol 50 mg Tablets Anesthetics

SHARED HEALTH ALLIANCE2

ACUTE FORMULARY (Immediate Need)

The most utilized acute medications in our formulary can be purchased up to a 21-Day supply for a $5.00 payment! If there is an emergency, sickness or injury and you need your medications fast, our

membership card will allow you to fill your prescription at any of 64,000 pharmacies nationwide for only $5.00. We have relationships with most major pharmacies to save you money when you can’t wait 3-5

days for home-delivery. We are changing the way you think about prescription drug pricing!

$5Guaranteed

All Medications on this

Formulary

only

Anti-BurnSilver Sulfadiazine 1% Cream (50 grams)

AntiDiarrhealDiphenox w/Atropine 2.5/.025mg TabletsLoperamide 2 mg Capsules

Anti FungalClotrimazole 0.01% (45gm) Vag CreamFluconazole 150mg (#1) TabletMetronidazole 500mg TabletsNystatin 100000/ml(60ml) SuspensionTerbinafine 250mg Tablets

Anti Gout AgentsAllopurinol 100 mg TabletsAllopurinol 300 mg Tablets

AntihistamineDiphenhydramine 50mg CapsulesHydroxyzine HCl 25mg Tablets

Anti InflammatoryDiclofenac Potassium 50 mg TabletsDiclofenac Sodium ER 75 mg TabletsIndomethacin 25 mg CapsulesIbuprofen 600mg TabletsIbuprofen 800mg TabletsMeloxicam 7.5 mg TabletsNaproxen 375 mg TabletsNaproxen 500 mg TabletsMethylprednisolone (Dose pack) 4mg (#21) TabletsPrednisone 5 mg TabletsPrednisone 20 mg Tablets

Topical Anti-InflammatoryTriamcinolone Acetonide 0.1% (15gm) CreamMometasone Furoate 0.1% (15gm) Cream

Anti NauseaOndansetron ODT 4 mg TabletsOndansetron 8 mg TabletsPromethazine HCl 25 mg Tablets

AntiviralAcyclovir 400 mg TabletsAcyclovir 800 mg TabletsValacyclovir 500 mg Tablets

AsthmaAlbuterol Sulfate 24 30 X 3ml UD 0.08% (for nebulizer)Albuterol Sulfate/ Ipratropium Bromide 2430X3ml UD NEB 3mg/0.5mgMontelukast 4mg Chewable TabletsMontelukast 5mg Chewable TabletsMontelukast 10 mg Tablets

Cough SuppressantsBenzonatate 100mg Capsules

Gastro-IntestinalDicyclomine HCl 20 mg TabletsFamotidine 20mg TabletsPantoprazole Sodium DR 40mg Tablets

MigraineSumatriptan Succinate 50 mg TabletsSumatriptan Succinate 100mg Tablets

Muscle RelaxersCyclobenzaprine HCl 10mg TabletsMethocarbamol 500 mg TabletsMethocarbamol 750 mg TabletsTizanidine HCl 4mg Tablets

Nasal SprayFluticasone Propionate 16gm 50mcg NasalSpray

Pain RelieversAcetaminophen/Tramadol HCl 37.5/ 325 mg TabletsGabapentin 300 mg CapsulesGabapentin 600 mg TabletsPhenazopyridine HCl 95mg TabletsTramadol 50 mg Tablets

Anesthetics (Topical)Lidocaine Vicious HCl 20mg/ml (100ml)Solution

AntibioticsAmoxicillin 250 mg CapsulesAmoxicillin 500 mg CapsulesAmoxicillin 875 mg TabletsAmoxicillin 250mg/5ml (150ml) SuspensionAmoxicillin 400mg/5ml (100ml) SuspensionAmoxicillin/Potassium Clav 500/125 mg TabletsAmoxicillin/Potassium Clav 875/125 mg TabletsAmoxicillin/Potassium Clav 400-57mg/5ml(100ml) SuspensionAzithromycin 250 mg (card#6) TabletsAzithromycin 500mg (card#3) TabletsAzithromycin 20mg/ml (30ml) SuspensionCephalexin 250 mg CapsulesCephalexin 500 mg CapsulesCephalexin 250mgmg/5ml (200ml) SuspensionCiprofloxacin HCI 250mg TabletsCiprofloxacin HCl 500mg TabletsClindamycin HCl 150mg CapsulesClindamycin HCl 300mg CapsulesDoxycycline Hyclate 100mg CapsulesLevofloxacin 250 mg TabletsLevofloxacin 500 mg TabletsPenicillin V Potassium 500 mg TabletsPenicillin V Potassium 250 mg/5ml (200ml) SolutionSulfamethoxazole-Trimethoprim 800/160mg TabletsSulfamethoxazole-Trimethoprim 200mg/40mg SuspensionNitrofurantoin monohydrate/ macrocrystals 100mg Capsules

Antibiotics (Topical)Erythromycin OPTH (3.5mg) OintmentMupirocin 2% (22gm) OintmentPolymyxin B Sulf/Trimethoprim 10K/ml-0.1 (10ml) DropsTobramycin 0.3%(5ml) Opth. Drops

Page 3: SCRIPTS FORMULARIES...Acetaminophen/Tramadol HCl 37.5/ 325 mg Tablets Gabapentin 300 mg Capsules Gabapentin 600 mg Tablets Phenazopyridine HCl 95mg Tablets Tramadol 50 mg Tablets Anesthetics

(314) 594-0600 [email protected] 3

CHRONIC FORMULARY (Maintenance Medications)

The top 75 most utilized chronic medications in our formulary can be purchased in a 90-Day supply for the lowest prices around! We purchase our medications direct from American Producers and Suppliers cutting out the middle-man and passing the savings on to you. To get the pricing below, these chronic

medications can only be ordered from our Akron, Ohio home delivery pharmacy.

Allergy/AntihistaminesCetirizine 10 mg tabletsLoratadine 10 mg tabletsLevocetirizine 5mg tabletsFexofenadine 180mg tabletsFluticasone Nasal 50mcg

Alzheimer’s/DementiaDonepezil 5mg oral tabletsDonepezil 10mg oral tablets

AnticoagulantWarfarin 1mg tabletsWarfarin 2.5mg tabletsWarfarin 5mg tabletsWarfarin 7.5mg tablets

AnticonvulsantsLevetiracetam 500mg tabletsPhenytoin Sodium 100mg

AntidepressantsBupropion SR 150mg tabletsBupropion XL 150mg tabletsBupropion XL 300mg tabletsCitalopram 10mg tabletsCitalopram 20mg tabletsCitalopram 40mg tabletsDuloxetine 30mg capsulesDuloxetine 60mg capsulesEscitalopram 5mg tabletsEscitalopram 10mg tabletsEscitalopram 20mg tabletsFluoxetine 10mg capsulesFluoxetine 20mg capsulesParoxetine 20mg tabletsSertraline 50mg tabletsSertraline 100mg tabletsTrazodone 50mg tabletsTrazodone 100mg tabletsVenlafaxine ER 37.5mg capsulesVenlafaxine ER 75mg capsulesVenlafaxine ER 150mg capsules

AntiGout AgentAllopurinol 100mg tabletsAllopurinol 300mg tablets

Anti-Inflammatory/NSAIDSCelecoxib 200mg capsulesDiclofenac 75mg tabletsDiclofenac Sodium 1% GelIbuprofen 400mg tabletsIbuprofen 600mg tabletsIbuprofen 800mg tabletsMeloxicam 7.5mg oral tabletsMeloxicam 15mg oral tabletsNaproxen 375mg tabletsNaproxen 500mg tablets

Digoxin 0.125mg tabletsDigoxin 0.25mg tabletsDiltiazem ER 120mg capsulesDiltiazem ER 180mg capsules Diltiazem ER 240mg capsulesDoxazosin 2mg tablets tabletsDoxazosin 4mg tablets tabletsEnalapril 5mg tablets tabletsEnalapril 10mg tablets tabletsEnalapril 20mg tablets tabletsEzetimbe 10mg tabletsFurosemide 20mg tabletsFurosemide 40mg tabletsHydrochlorothiazide (HCTZ) 12.5mg capsulesHydrochlorothiazide (HCTZ) 25mg tabletsHydralazine 25mg tabletsIrbesartan 150mg tabletsIrbesartan 300mg tabletsIsosorbide mononitrate ER 30mg tabletsIsosorbide mononitrate ER 60mg tabletsLabetalol 100mg tabletsLabetalol 200mg tabletsLisinopril 5mg tabletsLisinopril 10mg tabletsLisinopril 20mg tabletsLisinopril 40mg tabletsLisinopril/HCTZ 10-12.5mg tabletsLisinopril/HCTZ 20-12.5mg tabletsLisinopril/HCTZ 20-25mg tabletsLosartan 25mg tabletsLosartan 50mg tabletsLosartan 100mg tabletsLosartan/HCTZ 50-12.5mg tabletsLosartan/HCTZ 100-12.5mg tabletsLosartan/HCTZ 100-25 mg tabletsMetoprolol Succinate ER 25mg tabletsMetoprolol Succinate ER 50mg tabletsMetoprolol Succinate ER 100mg tabletsMetoprolol Tartrate 25mg tabletsMetoprolol Tartrate 50mg tabletsMetoprolol Tartrate 100mg tabletsNifedipine ER 30mg tabletsNifedipine ER 60mg tabletsOlmesartan 20mg tabletsOlmesartan 40mg tabletsOlmesartan/HCTZ 20-12.5mg tabletsOlmesartan/HCTZ 40-12.5mg tabletsOlmesartan/HCTZ 40-25mg tabletsPotassium Chloride 10 mEq tabletsPotassium Chloride 20 mEq tabletsRamipril 5mg capsulesRamipril 10mg capsulesSpironolactone 25mg tabletsTriamterene/HCTZ 37.5-25mg capsulesValsartan 80mg tabletsValsartan 160mg tabletsValsartan 320mg tabletsValsartan/HCTZ 80-12.5mg tabletsValsartan/HCTZ 160-12.5mg tabletsValsartan/HCTZ 160-25mg tabletsValsartan/HCTZ 320-25mg tabletsVerapamil SR 180mg tabletsVerapamil SR 240mg tablets

Anti-PsychoticsAripiprazole 2mg oral tabletsAripiprazole 5mg oral tabletsAripiprazole 10mg oral tabletsAripiprazole 15mg oral tabletsAripiprazole 20mg oral tabletsAripiprazole 30mg oral tabletsOlanzapine 2.5mg oral tabletsOlanzapine 5mg oral tabletsOlanzapine 7.5mg oral tabletsOlanzapine 10mg oral tabletsQuetiapine 25mg oral tabletsQuetiapine 50mg oral tabletsQuetiapine 100mg oral tabletsQuetiapine 200mg oral tabletsRisperidone 0.25mg oral tabletsRisperidone 0.5mg oral tabletsRisperidone 1mg oral tabletsRisperidone 2mg oral tabletsRisperidone 3mg oral tabletsRisperidone 4mg oral tablets

AntiviralAcyclovir 400mg tablets

AnxiolyticsBuspirone 10mg tabletsBuspirone 15mg tabletsMirtazapine 15mg oral tabletsMirtazapine 30mg oral tabletsMirtazapine 45mg oral tablets

Anti-RejectionTacrolimus 0.5mg capsulesTacrolimus 1mg capsules

Bronchodilator/AsthmaAlbuterol Sulfate InhalationAlbuterol Sulfate (HFA) 1 UnitAlbuterol & Ipratropium Inhalation Solution 3mLMontelukast Sodium 5mg chewable tabletsMontelukast Sodium 10mg oral tablets

Cardiac/HypertensionAmiodarone 200mg tabletsAmlodipine 2.5mg tabletsAmlodipine 5mg tabletsAmlodipine 10mg tablets Amlodipine/Benazepril 5-10mg capsules Amlodipine/Benazepril 5-20mg capsulesAmlodipine/Benazepril 10-20mg capsulesAmlodipine/Benazepril 10-40mg capsulesAtenolol 25mg tabletsAtenolol 50mg tabletsAtenolol 100mg tabletsBenazepril 20mg tabletsBenazepril 40mg tabletsCarvedilol 3.125mg tabletsCarvedilol 6.25mg tabletsCarvedilol 12.5mg tabletsCarvedilol 25mg tabletsChlorthalidone 25mg tabletsClonidine 0.1mg tabletsClonidine 0.2mg tabletsClopidogrel 75mg tablets

Page 4: SCRIPTS FORMULARIES...Acetaminophen/Tramadol HCl 37.5/ 325 mg Tablets Gabapentin 300 mg Capsules Gabapentin 600 mg Tablets Phenazopyridine HCl 95mg Tablets Tramadol 50 mg Tablets Anesthetics

SHARED HEALTH ALLIANCE4

CHRONIC FORMULARY (Maintenance Medications)

The top 75 most utilized chronic medications in our formulary can be purchased in a 90-Day supply for the lowest prices around! We purchase our medications direct from American Producers and Suppliers cutting out the middle-man and passing the savings on to you. To get the pricing below, these chronic

medications can only be ordered from our Akron, Ohio home delivery pharmacy.

Oral ContraceptivesAll cycles sold in 28 countEE 30mcg/Desogestrel 0.15mg(Ortho-Cept/Desogen/Reclipsen) -$15.00 (1) $45.00 (3)

EE 20mcg/Drospirenone 3mg X 24 days (Yaz/ Loryna/Gianvi) - $10.00 (1) $30.00 (3)

EE 30mcg/Drospirenone 3mg(Yasmin/Ocella/Zarah) - $10.00 (1) $30.00 (3)

EE 30mcg/Levonorgestrel 0.15mg(Nordette 28/Levora) - $10.00 (1) $30.00 (3)

EE 20mcg/Northindrone1mg/Iron(Junel Fe 1/20/ Loestrin Fe 1/20/Microgestin 1/20) - $10.00 (1) $30.00 (3)

EE 30mcg/Northindrone 0.15mg/IronLoestrin Fe 1.5/30/Larin Fe 1.5/30 $10.00 (1) $30.00 (3)

EE 35mcg/Norethindrone 1mg(Norinyl 1/35/ Ortho-Novum 1/35) $10.00 (1) $30.00 (3)

EE35mcg/Norethindrone-Total of 15.75mg/cycle(Alyacen 7/7/7/Necon 7/7/7) $10.00 (1) $30.00 (3)

EE 35mcg/Norgestimate 0.25mgOrtho-cyclen 28/Sprintec/Mono-Nessa $10.00 (1) $30.00 (3)

EE35mcg/Norgestimate0.18mg/0.215mg/0.25mg x 7 days(Tri-Nessa/ Tri-Sprintec/Ortho-Tri-Cyclen) $10.00 (1) $30.00 (3)

EE 25mcg/Norgestimate0.18mg/0.215mg/0.25mg X 7 daysOrtho-Tri-Cyclen Lo/Trinessa Lo/ Tri-Lo-Sprintec $10.00 (1) $30.00 (3)

EE 35mg/Norethridrone 0.5mg (total of 10, 5mg/cycle) (Modicon-28/Brevicon-28) $15.00 (1) $45.00 (3)

Norethindrone 0.35mg (progesterone only) (Errin/ Aygestin) $10.00 (1) $30.00 (3)

Mens HealthFinasteride 5mg tabletsSildenafil 50mg tablets (10 tablets/30 days)Sildenafil 50mg tablets (30 tablets/90 days)Sildenafil 100mg tablets (10 tablets/30 days)Sildenafil 100mg tablets (30 tablets/90 days)Tadalafil 2.5mg tablets (10 tablets/30 days)Tadalafil 2.5mg tablets (30 tablets/90 days)Tamsulosin 0.4mg capsules

OsteoporosisAlendronate 35mgAlendronate 70mgHydroxychloroquine 200mg tabletsRaloxifene HCl 60mg tablets

ThyroidLevothyroxine Sodium 25mcg tabletsLevothyroxine Sodium 50mcg tabletsLevothyroxine Sodium 75mcg tabletsLevothyroxine Sodium 88mcg tabletsLevothyroxine Sodium 100mcg tabletsLevothyroxine Sodium 112mcg tabletsLevothyroxine Sodium 125mcg tabletsLevothyroxine Sodium 137mcg tabletsLevothyroxine Sodium 150mcg tabletsLevothyroxine Sodium 175mcg tabletsLevothyroxine Sodium 200mcg tabletsLiothyronine Sodium 5mcg tablets

Cholesterol/TriglyceridesAtorvastatin 10mg tabletsAtorvastatin 20mg tabletsAtorvastatin 40mg tabletsAtorvastatin 80mg tabletsGemfibrozil 600mg tabletsFenofibrate 145mg capsulesFenofibrate 160mg capsulesLovastatin 20mg tabletsLovastatin 40mg tabletsPravastatin 20mg tabletsPravastatin 40mg tabletsRosuvastatin 5mg tabletsRosuvastatin 10mg tabletsRosuvastatin 20mg tabletsRosuvastatin 40mg tabletsSimvastatin 10mg tabletsSimvastatin 20mg tabletsSimvastatin 40mg tabletsSimvastatin 80mg tablets

DiabetesGlimepride 2mg tabletsGlimepride 4mg tabletsGlipizide 5mg tabletsGlipizide 10mg tabletsGlipizide ER 5mg tabletsGlipizide ER 10mg tabletsGlyburide 5mg tabletsGlyburide/Metformin 2.5-500mg tabletsGlyburide/Metformin 5-500mg tabletsMetformin 500mg tabletsMetformin 850mg tabletsMetformin 1000mg tabletsPioglitazone 15mg tabletsPioglitazone 30mg tabletsPioglitazone 45mg tablets

EstrogenEstradiol oral 0.5mg tabletsEstradiol oral 1mg tabletsEstradiol oral 2mg tablets

GastrointestinalEsomeprazole 40mg capsulesFamotidine 20mg tabletsLansoprazole 30mg capsulesOmeprazole 20mg capsulesOmeprazole 40mg capsulesPantoprazole 40mg tabletsRantidine 150mg tablets

GlaucomaBrimonidine 0.2% (15 ml Bottle)Timolol 0.5% Solution (15 ml Bottle)

Hormone-Based Chemo (Breast Cancer)Anastrozole 1mgLetrozole 2.5mg

Formulary Pricing Key

$15 / 90-Day

$30 / 90-Day

$45 / 90-Day