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INDIAN RIVER COUNTY HEALTH DEPARTMENT FORMULARY PRICE LIST Efffective Nov. 01, 2006 Cost Cost Unit per Unit per Product Name Issue UI Product Name Issue UI Acetaminophen suppositories 120 mg Each $0.23 Hydrocortisone 1% cream Tube $1.49 Acetasol HC Bottle $13.00 Ibuprofen 400 mg Each $0.02 Actifed tabs Box $2.50 Kenaloq 40, in' 1 cc in' $6.00 Albuterol .083% Each $0.12 Labetalol 100mg Each $0.10 Aldactone 50 m (Spironolactone) Each $0.29 Labetalol 2TOmg Each $0.13 Amitriptyline HCL 25 mg Each $0.03 Lisinopril 20 mg Each $0.06 Amitriptyline HCL 100 mg Each $0.11 Lisinopril 5 mg Each $0.03 Amoxicillin/Pot C lavulanate Strawberry Bottle $22.83 Medroxyprogesterone Acetate(Depo-Provera)tabs 10 Mg. Each $0.13 Amoxicillin 250 mg susp Bottle $1.82 Metformin hcl 500 mg (Glucophage) Each $0.04 Aspirin EC 325 mg Each $0.02 Metformin hcl 1000 mg (Glucophage) Each $0.07 Aspirin EC 81 mg Each $0.01 Motrin, childrens berry Bottle $4.86 Atenolol 50 mg Each $0.03 Mupirocin Ointment 2% Tube $9.78 Atenolol 100 mg Each $0.06 Nadolol 20mg Each $0.18 Aurodex ear drops Bottle $1.09 Nadolol 40mg Each $0.21 Bacitracin Tube $1.47 Na roxin 500 mg Each $0.06 Benzoin Comp Tincture Bottle 1 $3.22 Neomycin/Polymyxin Gramicidin o thalmic solution Bottle $16.01 Captopril 50 mg Each $0.02 Neomycin/Polymyxin HC otic solution Bottle $13.99 Captopril 100 mg Each $0.05 Nifedi in ER 60mg Each $0.58 Cephalexin 250 mg Each $0.07 Nitrotab sub lingual 3mg Each 1 $0.03 Cephalexin 500 m Each $0.12 Nix Bottle $5.78 Cephalexin suspension 250 mg Bottle $14.41 Norvasc 5mg Each $1.41 Ci rofloxin hcl 500 mg Each $0.09 Pen VK suspension 250 mg Bottle $2.74 Cleocin Palmitate 75m /5ml Bottle $24.20 Pen VK tabs 500 mg Each $0.14 Clindamycin HCL 150mg Each $0.16 Phen le hrin 2.5% optic solution Bottle $1.21 Clonidine .1 mg Each $0.07 Phene ran suppositories 12.5 mg Each $0.87 Clonidine .2 mg Each $0.09 Pink bismuth Each $0.04 Clotrimazole cream 1% Tube $2.18 Polymyxin B/Trimetho rim 10 mU-.1% Pol rim Bottle $1.24 Coreg 3.12 m Carvedilol Each $1.58 Prednisone 10 mg Each $0.02 Coreg 6.25 m Carvedilol Each $1.58 Prednisolone 15 mg/5 ml Bottle $8.74 Cyanocobalamin 1000mcg 1 cc in' $1.44 Pro aracaine .5 O/S Bottle $1.93 Depo-Medrol 80 mg 1 cc in' $8.71 Proventil syrup 2 mg/5 cc Albuterol sulfate Bottle $15.64 Dexamethone Sod Phos 4 mg 1-2c in' $0.30 Q-Tussin Bottle $0.82 Diabetic tussin Bottle $4.87 Ranitidine 150 m Zantac Each $0.02 Di oxin .25 mg Each $0.11 Silvadene cream 1% Tube $5.29 Elimite Tube $17.77 Sodium Chloride .9% Bottle $0.93 Erythromycin e e ointment 5m / m Tube $1.21 Sodium Soulam d Sulfacetamide Sodium 10% Bottle $2.05 Erythromycin Stearate 500 mg Each $0.15 Sulfamethoxazole/Trimetho rim Cher 200-40m /5ml Bottle $17.22 E hrom cin/sulfisoxazole(berry) Pedia;Bottle $4.94 Triam/HCTZ 37.5/25 Each $0.05 Ethyl Chloride Fine 103.05 ml Each $15.81 Triamcinolone 0.1% Cream Tube $2.23 Fluor-I-Strips Each $0.16 Triple anitbiotic ointment Tube $2.82 Furosemide 20 m Lasix Each $0.23 Tropicamide 1%optic solution Bottle $3.56 Furosemide 40 m Lasix Each $0.28 Tylenol Infant 80 mg/.8 ml Bottle $26.98 3enahist allergy 25 Mg Box $0.90 Tylenol Liquid Susp 160 mg/5 ml cherry Bottle $5.69 :;enapap caplet 500 Mg Each $2.86 Verapamil 240 mg Each $0.19 3enapap infant drops Bottle $1.55 Warfarin 2 m Coumadin Each $0.13 31 buride 5 mg Each $0.10 Warfarin 5 m Coumadin Each $0.13 3riseofulvin 125 mg/ml Bottle $34.77 Xylocaine 1% Vile $2.66 3rifulvin tabs 250 mg Each $2.22 Xylocaine 2% Vile $3.68 -1drochlorothiazide 25 mg Each $0.03 Jote:A$1.50 per bottle repack fee will be added to all dipensed medications under the repackaging pro ram. 'harmac ems received from the State Pharmacy are in-kind donation at no cost to IRCHD will not be charged to the patient. CLFEE2006-07 3:38 PM 10/23/2006