

URGENT/ACUTE MEDICATION FORMULARY
The Most Common Urgent Care/Acute Medications, Available at Over 70,000 Pharmacies
ANTIBIOTIC
AMOXICILLIN. 250 MG CAP. Max Qty: 60 (Amoxil)
AMOXICILLIN. 500 MG CAP. Max Qty: 30 (Amoxil)
AMOXICILLIN, 875 MG TAB. Max Qty: 28 (Amoxil)
AMOXICILLIN. 250 MG/5ML SUSP. Max Qty: 200 (Amoxil)
AMOXICILLIN. 400 MG/5ML SUSP. Max Qty: 200 (Amoxil)
AMOXICILLIN/CLAVULANIC ACID. 500-125 MG TAB. Max Qty: 28 (Augmentin)
AMOXICILLIN/CLAVULANIC ACID. 875-125 MG TAB. Max Qty: 28 (Augmentin)
AMOXICILLIN/CLAVULANIC ACID.4 00-57 MG/5ML SUSP. Max Qty: 200 (Augmentin)
AMOXICILLIN/CLAVULANIC ACID. 600-42.9 MG/5ML SUSP. Max Qty: 200 (Augmentin)
AZITHROMYCIN. 250 MG TAB. Max Qty: 6 (Zithromax)
AZITHROMYCIN, 500 MG TAB. Max Qty: 3 (Zithromax)
AZITHROMYCIN.100 MG/5ML SUSP. Max Qty: 15 (Zithromax)
AZITHROMYCIN. 200 MG/5ML SUSP. Max Qty: 30 (Zithromax)
CEFDINI R. 300 MG CAP.Max Qty: 14 (Omnicef)
CEPHALEXIN. 250 MG CAP. Max Qty: 56 (Keflex)
CEPHALEXIN. 500 MG CAP. Max Qty: 40 (Keflex)
CEPHALEXI N. 250 MG/5ML SUSP. Max Qty: 200 (Keflex)
CIPROFLOXACIN, 250 MG TAB. Max Qty: 28 (Cipro)
CIPROFLOXACIN. 500 MG TAB. Max Qty: 28 (Cipro)
CLINDAMYCIN. 150 MG CAP. Max Qty: 28 (Cleocin)
CLINDAMYCIN, 300MG CAP. Max Qty: 28 (Cleocin)
DOXYCYCLINE HYCLATE. 100 MG TAB. Max Qty: 28(Vibramycin)
LEVOFLOXACIN. 250 MG TAB. Max Qty: 21 (Levaquin)
LEVOFLOXACIN, 500 MG TAB. Max Qty: 21 (Levaquin)
METRONIDAZOLE. 500 MG TAB. Max Qty: 28 (Flagyl)
NITROFURANTOIN.100 MG CAP. Max Qty: 28 (Macrobid)
PENICILLIN VK. 500MG TAB. Max Qty: 28 (Veetids)
PENICILLIN VK. 250 MG/5ML SUSP. Max Qty: 200 (Veetids)
SM Z/TM P OS. 800-160 MG TAB. Max Qty: 28 (Bactrim)
SM Z/TM P. 200-40 MG/5ML SUSP. Max Qty: 120 (Bactrim)
CARDIOVASCULAR
NITROGLYCERIN, 0.4 MG SL TAB, Max Qty: 25 (Nitrostat)
PROPRANOLOL. 10 MG TAB. Max Qty: 15 (lnderal)
CORTICOSTEROID
METHYLPREDNISOLONE. 4 MG PACK. Max Qty: 21 (Medrol Dosepak)
PREDNISONE.10 MG TAB. Max Qty: 20 (Deltasone)
PREDNISONE. 20 MG TAB. Max Qty: 20 (Deltasone)
PREDNISOLONE.15 MG/5ML SOLN. Max Qty: 120 (Orapred)
CORTICOSTEROID TOPICAL
HYDROCORTISONE. 2.5% CREAM. Max Qty: 30(Hytone)
PREDNISOLONE.1% OPTH SUSP. Max Qty: 5 (Pred Forte)
TRIAMCINOLONE. 0.1% CREAM. Max Qty: 30 (Kenalog)
TRIAMCINOLONE. 0.1% OINT. Max Qty: 30 (Kenalog)
COUGH & COLD
BENZONATATE, 100 MG CAP. Max Qty: 30 (Tessalon Perles)
BENZONATATE. 200 MG CAP. Max Qty: 30 (Tessalon Perles)
BROMPH/PSE/DM SYR. 30 MG SOLN. Max Qty: 120 (Bromfed OM)
DIABETES
INSULIN LISPRO. 100U/ML INJ. Max Qty: 2 Vials / 90 Days (Humalog)*
ANTIBIOTIC TOPICAL
ERYTHROMYCIN. 0.5% OPTH OINT. Max Qty: 3.5 (lllotycin)
MUPIROCIN. 2% OINT. Max Qty: 22 (Bactroban)
NEO/POLY /HC. OTIC SOLN. Max Qty: 10 (Cortisporin)
POLYMYXIN B/TR IM ETH. OPTH SOLN. Max Qty: 10 (Polytrim)
SILVER SULFADIAZINE.1% CREAM. Max Qty: 50(Silvadene)
TOBRAMYCIN, 0.3% OPTH SOLN. Max Qty: 5 (Tobrex)
GASTROINTESTINAL
DICYCLOMINE. 20 MG TAB. Max Qty: 60 (Benty!)
DIPHENOX-ATROPINE. 2.5-0.025 MG TAB, Max Qty: 30 (Lomotil)
ONDANSETRON ODT. 4 MG TAB, Max Qty: 6 (Zofran DDT)
ONDANSETRON ODT. 8 MG TAB. Max Qty: 6 (Zofran ODT)
PANTOPROZOLE. 40 MG TAB. Max Qty: 21 (Protonix)
PROMETHAZINE. 25 MG TAB. Max Qty: 30 (Phenergan)
GOUT
ALLOPURINOL. 100 MG TAB. Max Qty: 21 (Zyloprim)
ALLOPURINOL. 300MG TAB, Max Qty: 21 (Zyloprim)

ANTIGISTAMINE
CETIR IZINE. 10 MG TAB. Max Qty: 30 (Zyrtec)
HYDROXYZINE. 25 MG TAB. Max Qty: 30 (Atarax)
ANTIFUNGAL
FLUCONAZOLE. 150 MG TAB. Max Qty: 2 (Diflucan)
NYSTATIN.100.000 USP CREAM. Max Qty: 30 (M ycostatin)
NYSTATIN.1 00,000 USP OINT. Max Qty: 30 (M ycostatin)
$0 PRESCRIPTIONS
FOR THE MOST COMMON URGENT CARE CONDITIONS
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Asthma/Allergic Reactions
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Ear & Eye Infections
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Fungal Infections
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Migraines
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Pain & Injuries
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Skin Infections
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Stomach Viruses
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Upper Respiratory Infection (URI)
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Urinary Tract Infections (UTI)
MIGRAINE
SUMATRIPTAN. 50 MG TAB. Max Qty: 9 (lmitrex)
SUMATRIPTAN.100 MG TAB. Max Qty: 9(Imitrex)
MUSCLE RELAXANT
CYCLOBENZAPRINE.10 MG TAB. Max Qty: 30 (Flexeril)
PAIN MANAGEMENT
IBUPROFEN. 800 MG TAB. Max Qty: 60 (Motrin)
NAPROXEN. 500 MG TAB. Max Qty: 30 (Naprosyn)
PHENAZOPYRIDINE. 200 MG TAB. Max Qty: 10 (Pyridium)
TRAMADOL. 50 MG TAB. Max Qty: 30 (Ultram)
RESPIRATORY
ALBUTEROL MDI. 90 MCG INH. Max Qty: 1 (6.7g) / 1 Year (Proventil)