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INDIAN RIVER COUNTY HEALTH DEPARTMENT FORMULARY PRICE LIST Cost Cost Unit per Unit per Product Name Issue UI Product Name Issue UI Acetaminophen suppositories 120 mg Each $0.14 Havrix Adult Hep-A prefilled Each Actifed tabs Box $2.45 Havrix Pediatrics He -A prefilled Each Albuterol inhaler Kit $2.78 Hepatitis A Immune globulin 2ml Each Albuterol.083% Each $0.10 Hepatitis B Immune globulin 5ml Each Aldactone 50 mg(Spironolactone) Each '$0.68 Hydrochlorothiazide 25 mg Each $0.02 Amitriptyline HCL 25 mg Each $0.02 Hydrocortisone 1%cream Tube $0.82 Amoxicillin 250 mg susp Bottle $2.03 lbu rofen 400 mg Each $0.02 Aspirin EC 325 mg Each 0.01,Kenalog 40,in' 1 cc in' $5.77 Aspirin EC 81 mg Each $0.02 Lisinopril 20 mg Each $0.07 Atenolol 50 mg Each $0.03 Lisino ril 5 mg Each $0.05 Atenolol 100 mg Each $0.06 Medrox pro esterone Acetate(Depo-Provera)tabs 10 mg. Each $0.10 Aurodex ear drops Bottle $0.89 Metformin hcl 500 m (Glucophage) Each $0.05 Bacitracin Tube $1.11 Metformin hcl 1000 m (Glucophage) Each $0.08 Benzoin Comp Tincture Bottle $17.65 Motrin,childrens berry Bottle $4.21 Captopril 50 mg Each $0.02 MMR Vacine Each Captopril 100 mg Each $0.06 Naproxin 500 mg Each $0.07 Cephalexin 250 mg Each $0.05 Neomvcin/Polymyxin Gramicidin opthalmic solution Bottle $16.02 Cephalexin 500 mg Each $0.09 Neomycin/Polymyxin HC opthalmic solution Bottle $8.89 Cephaiexin suspension 125 mg Bottle $6.78 Nitrotab sub lingual 3mg Each $0.03 Cephalexin suspension 250 mg Bottle $9.69 Nix Bottle $7.76 Ciprofloxin hcl 500 mg Each $0.09 Pen VK suspension 250 mg Bottle $2.74 Clonidine.1 mg Each $0.05 Pen VK tabs 500 mg Each $0.15 Clonidine.2 mg Each $0.07 Phen le hrin 2.5%optic solution Bottle $1.49 Clotrimazole cream 1% Tube $1.20 Phene ran suppositories 12.5 mg Each $3.46 Coreg 3.12 mg(Carvedilol) Each $1.51 Pneumovax 1 cc in' Coreg 6.25 m (Carvedilol) Each $1.51 Pink bismuth Each $0.06 Cyanocobalamin 1000mcg 1 cc in' $0.54 Prednisone 10 mg Each $0.02 Depo-Medrol 80 mg 1 cc in' $8.24 Proparacaine.5 O/S Bottle $1.88 Dexamethone Sod Phos 4 mg 1 cc in' $0.31 Q-Tussin Bottle $0.76 Diabetic tussin Bottle $4.20 Ranitidine 150 m (Zantac) Each $0.03 Digoxin.25 mg Each $0.07 Silvadene cream 1% Tube $5.34 Elimite Tube $32.77 Sodium Chloride.9% Bottle $7.67 Engerix-B adult 20mcg Each Triam/HCTZ 37.5/25 Each $0.05 Engerix-B pediatric 10 mcg .5 cc in' Triamcinolone 0.1%Cream Tube $1.23 Erythromycin e e ointment 5m / m Tube $0.59 Triple anitbiotic ointment Tube $1.96 Erythromycin Stearate 500 mg Each $0.13 Tropicamide I%optic solution Bottle $2.43 Ethyl Chloride Fine 103.05 ml Each $14.64 TwinRix 1 cc in' Fluor-I-Strips Each $0.16 T phim VI prefilled syringe .5 cc in' Furosemide 20 m (Lasix) Each $0.19 Vera amil 240 mg Each $0.19 Furosemide 40 m (Lasix) Each $0.21 Warfarin 2 m (Coumadin) Each $0.12 Genahist allergy 25 mg Box $0.90 Warfarin 5 m Coumadin Each $0.12 Genapap caplet 500 mg Each $1.67 Xylocaine 1% Vile $2.58 Genapap infant drops Bottle $1.13 X locaine 2% Vile $3.57 Glyburide 5 mg Each $0.07 Note:A$1.50 per bottle repack fee will be added to all dipensed medications under the repackaging program. Blank fees are covered under the fee schedule. CLFEE2005-06 10:00 AM 9/9/2005