GHCCM Pharmacy, Drug Formulary Old | Greater Hickory Cooperative Christian Ministry (GHCCM)

CLASS	MEDICATION	BRAND/GENERIC NAME	CCM $3 ADMIN FEE PER RX/ GENERICS READILY AVAIL W/A CCM CARD	PAP $3 ADMIN FEE PER RX (MAY TAKE FROM 3-4 WEEKS)	340B (1) KINTEGRA FAMILY MEDICINE PATIENTS ($3 ADMIN FEE)	DIRECT RELIEF REPLENISHMENT (FREE TO PT W/ CCM CARD)	DHOPE (FREE TO PT W/ CCM CARD)	WAL-MART $4 GENERIC AVAILABLE AT MOST PHARM.	PUBLIX (FREE TO PATIENT)	Key for classes
1	ACETAMINOPHEN	TYLENOL	X							1. Analgesics/Pain
2	ACYCLOVIR	ZOVIRAX	X		X					2. Anti-infectives
10	ADVAIR	FLUTICASONE/SALMETEROL		X	X					3. Topicals
10	ALBUTEROL SOLN	PROAIR, VENTOLIN, PROVENTIL			X					4. Eye/Nose/Ear
6	ALDACTONE	SPIRONOLACTONE			X					5. Anti-Platelets
13	ALENDRONATE	FOSAMAX	X		X					6. Cardiovascular
1	ALLOPURINOL	ZYLOPRIM	X		X		X			7. Gastrointestinal
11	AMANTADINE	SYMMETREL			X					8. Gynecological
6	AMIODARONE	CORDARON	X		X					9. Urological
7	AMITIZA	LUBIPROSTONE		X						10. Asthma/Allergy
11	AMITRIPTYLINE	ELAVIL	X		X		X	x		11. Central Nervous Sys
6	AMLODIPINE	NORVASC	X		X		X		x	12. Endocrine
2	AMOX-CLV	AUGMENTIN	X		X					13. Osteoporosis
2	AMOXICILLIN	AMOXIL	X		X				x	14. Supplements
2	AMPICILLIN	OMNIPEN							x	15. Miscellaneous
10	ANORO ELIPTA	UMECLIDINIUM		X
12	APIDRA	INSULIN GLULISINE		X
11	ARIPIPRAZOLE	ABILIFY			X		X
12	ARMOUR THYROID	DESSICATED THYROID		X
10	ASMANEX TWISTHALER	MOMETASONE		X
6	ASPIRIN	ECOTRIN	X		X		X
6	ATENOLOL*	TENORMIN	X		X		X	x
11	ATOMOXETINE	STRATTERA			X
6	ATORVASTATIN	LIPITOR	X		X		X
10	ATROVENT HFA (IPRATROPIUM SOLN)	IPRATROPIUM		X	X
7, 15	AZASAN	AZATHIOPRINE		X
2	AZITHROMYCIN	ZITHROMAX	X		X
4	AZOPT	BRINZOLAMIDE		X
1	BACLOFEN	LIORESAL	X		X		X
6	BENAZEPRIL	LOTENSIN	X		X			x
6	BENICAR	OLMESARTAN			X
6	BENICAR/HCTZ	OLMESARTAN/HCTZ			X
10,15	BENZONATATE	TESSALON PERLES	X		X
2,3	BENZOYL PEROXIDE 10%	ACETOXYL			X
11	BENZTROPINE	COGENTIN	X		X
6	BETAPACE	SOTALOL			X
10	BEVESPI	GLYCOPYRROLATE/FORMOTEROL		X
6	BISOPROLOL-HCTZ	ZIAC			X
12	BLOOD GLUCOSE METERS N/C		X (ZERO FEE)		$3.00
12	BLOOD GLUCOSE TEST STRIPS		$5.75 PER BOX OF 50 (PRICE MAY VARY)		$9.08 PER BOX OF 50 (PRICE MAY VARY)
10	BREO ELIPTA	FLUTICASONE/VILANTEROL		X
5	BRILINTA	TICAGRELOR		X
10	BUDESONIDE SOLN	PULMICORT			X
11	BUPROPION	WELLBUTRIN			X		X
11	BUPROPION XL	WELLBUTRIN XL	X		X
11	BUPROPION SR	WELLBUTRIN SR	X		X
11	BUSPIRONE	BUSPAR	X		X		X	x
1	BUTALBITAL/APAP	FIORICET			X
1	BUTALBITAL/APAP/CAFFEINE	FIORICET			X
12	BYDUREON	EXENATIDE		X
12	BYETTA	EXENATIDE		X
6	BYSTOLIC	NEBIVOLOL		X	X
6	CADUET	ATORVASTATIN/AMLODIPINE		X
6	CALAN SR	VERAPAMIL			X
7	CARAFATE	SUCRALFATE			X
11	CARBAMAZEPINE	TEGRETOL			X
6	CARDIZEM CD	DILTIAZEM			X
6	CARDIZEM LA	DILTIAZEM		X	X
6	CARVEDILOL	COREG	X		X		X	x
2	CEFDINIR	OMNICEF			X
2	CEFUROXIME	CEFTIN/ZINACEF			X
1	CELEBREX	CELECOXIB		X	X
1	CELECOXIB	CELEBREX			X		X
2	CEPHALEXIN	KEFLEX	X		X
10	CETIRIZINE	ZYRTEC			X
15	CHANTIX	VARENICLINE		X
2	CHLORHEXIDINE	PERIDEX			X
6	CHLORTHALIDONE	HYGROTON			X		X
9, 15	CIALIS	TADALAFIL		X
5	CILOSTAZOL	PLETAL	X		X
2	CIPROFLOXACIN	CIPRO	X		X
11	CITALOPRAM*	CELEXA	X		X		X	X
10	CLARINEX	DESLORATADINE		X
2	CLARITHROMYCIN	BIAXIN			X
8	CLIMARA	ESTRIDIOL (PATCH)		X
2	CLINDAMYCIN (ORAL)	CLEOCIN	X		X
2,3	CLINDAMYCIN PHOS. TOP SOL	CLINDACIN/CLINDAGEL			X
2, 3	CLINDAMYCIN + BENZOYL PEROXIDE	BENZACLIN			X
10	CLOBETASOL PROPIONATE	CLOBEX			X
6	CLONIDINE (ORAL)	CATAPRES	X		X		X	X
5	CLOPIDOGREL	PLAVIX	X		X
2,3	CLOTRIMAZOLE/BETAMETH 0.05% CRM (LIMIT 15 GRAMS PER MONTH)	LOTRISONE			X
4	CROMOLYN OPHLAMIC SOLUTION				X
12	CYANCOBALMIN INJECTION				X
1	CYCLOBENZAPRINE*	FLEXERIL	X		X
11	CYMBALTA	DULOXETINE		X		X
10	CYPROHEPTADINE	PERIACTIN			X
12	CYTOMEL	LIOTHYRONINE			X
11	DEPAKOTE ER	VALPROATE ER		X	X
10	DESLORATADINE	CLARINEX			X
9	DETROL LA	TOLTERIDONE ER		X	X
7	DEXILANT	LANSOPRAZOLE		X	X
1	DICLOFENAC (ORAL)	CATAFLAM/ZORVOLEX	X		X		X
1,3	DICLOFENAC GEL	VOLTAREN GEL/FLECTOR PATCH			X
7	DICYCLOMINE	BENTYL	X		X		X
6	DIGOXIN	DIGITEK/LANOXIN			X		X
11	DILANTIN	PHENYTOIN		X
6	DILTIAZEM ER CAPS	CARDIZEM LA, CARTIA XT			X		X
6	DILTIAZEM TABS (CARDIZEM)	CARDIZEM			X
6	DIOVAN	VALSARTAN			X
10	DIPHENHYDRAMINE	BENADRYL	X		X
11	DIVALPROEX EC/DR	DEPAKOTE EC/DR	X		X		X
11	DIVALPROEX SODIUM	DEPAKOTE			X
11	DONEPEZIL	ARICEPT	X
6,9	DOXAZOSIN	CARDURA			X
11	DOXEPIN	SILENOR	X		X		X
2	DOXYCYCLINE	VIBRAMYCIN/MONODOX	X		X		X
10	DULERA	MOMETASONE/FORMOTEROL		X
11	DULOXETINE	CYMBALTA	X		X		X
4	DUREZOL OPTH	DIFLUPREDNATE		X
6	EDARBI	AZILSARTAN		X
11	EFFEXOR XR	VENLAFAXINE ER			X
1	ELETRIPTAN	RELPAX			X
5	ELIQUIS	APIXABAN		X
1, 9	ELMIRON	PENTOSAN		X
7	EMEND	APREPITANT		X
6	ENALAPRIL	VASOTEC			X
6	ENTRESTO	SACUBITRIL/VALSARTAN		X
2	EPCLUSA	SOFOSBUVIR/VELPATASVIR		X
10	EPINEPHRINE	EPI-PEN 2 PAK		X	X
2,4	ERYTHROMYCIN OPTH OINT	ROMYCIN			X
11	ESCITALOPRAM	LEXAPRO	X		X		X
7	ESOMEPRAZOLE	NEXIUM			X		X
3, 8	ESTRACE VAG CREAM	ESTRIDIOL		X
8	ESTRADIOL (ORAL)	ALORA	X		X		X
13	EVISTA	RALOXIFENE		X
7	FAMOTIDINE	PEPCID			X
12	FARXIGA	DAPAGLIFLOZIN		X
6	FENOFIBRATE	TRICOR			X		X
14	FERROUS SULFATE	FER-IN-SOL	X
9	FINASTERIDE	PROPECIA/PROSCAR	X		X
1, 4	FLAREX	FLUOROMETHOLONE		X
6	FLECAINIDE	TAMBOCOR			X
1, 3	FLECTOR PATCH	DICLOFENAC		X
10	FLOVENT HFA	FLUTICASONE		X
2	FLUCONAZOLE	DIFLUCAN	X		X		X
11	FLUOXETINE	PROZAC	X		X		X	x
11	FLUPHENAZINE HYDROCHLORIDE	MODECATE			X
4,10	FLUTICASONE NASAL INH	FLONASE			X
14	FOLIC ACID	FOLVITE	X		X			x
6	FUROSEMIDE*	LASIX	X		X		X	x
1,11	GABAPENTIN	NEURONTIN	X		X
6	GEMFIBROZIL	LOPID	X		X
12	GLIMEPIRIDE	AMARYL	X		X			x
12	GLIPIZIDE	GLUCOTROL	X		X		X	x
12	GLIPIZIDE XL	GLUCOTROL XL			X
12	GLUCAGON ER KIT	GLUCAGON		X
12	GLYBURIDE	DIABETA/GLYNASE	X		X
6,11	GUANFACINE ER	INTUNIV	X
11	HALOPERIDOL	HALDOL			X
2	HARVONI	LEDIPASVIR/SOFOSBUVIR		X
12	HUMALOG	INSULIN LISPRO		X	X		X
1	HUMIRA	ADALIMUMAB		X
12	HUMULIN N, R, 70/30 U-500	INSULIN LISPRO		X			X
6	HYDRALAZINE	APRESOLINE	X		X			x
6	HYDROCHLOROTHIAZIDE*	MICROZIDE	X		X		X	x
1,3	HYDROCORTISONE CREAM 2.5% (LIMIT 20 GRAMS PER MONTH)				X
12	HYDROXYCHLOROQUINE	PLAQUENIL			X
11	HYDROXYZINE PAM	VISTARIL	X		X
11	HYDROXYZINE HCL	ATARAX	X		X
7	HYOSCYAMINE SULF	LEVBID/LEVSIN	X		X
1	IBUPROFEN*	MOTRIN	X		X		X
1, 4	ILEVRO	NEPAFENAC		X
6	INDAPAMIDE	LOZIDE						x
1	INDOMETHACIN	TIVORBEX	X		X
11	INTUNIV	GUANFACINE		X
11	INVEGA ER	PALIPERIDONE			X
12	INVOKAMET	CANAGLIFLOZIN				X
12	INVOKANA	CANAGLIFLOZIN			X	X
10	IPRATROPIUM SOLN	ATROVENT HFA			X		X
10	IPRATROPIUM NASAL SOLN	ATROVENT			X
10	IPRATROPIUM/ALBUT INH SOLN	DUONEB			X
6	IRBESARTAN	AVAPRO	X		X
6	ISOSORBIDE DN	ISORDIL			X
6	ISOSORBIDE MN	IMDUR	X		X			x
12	JANUMET	SITAGLIPTIN/METFORMIN		X
12	JANUMET XR	SITAGLIPTIN/METFORMIN		X	X
12	JANUVIA	SITAGLIPTIN		X	X
14	K-TAB	POTASSIUM CHLORIDE			X
11	KEPPRA	LEVETIRACETAM		X
11	KEPPRA XR	LEVETIRACETAM XR		X
2,3	KETOCONAZOLE SHAMPOO				X
12	KOMBIGLYZE	SAXAGLIPTIN/METFORMIN		X
6	LABETALOL	TRANDATE			X
7	LACTULOSE SOLN	KRISTALOSE			X
11	LAMICTAL	LAMOTRIGINE		X	X
11	LAMOTRIGINE	LAMICTAL	X		X
12	LANTUS	INSULIN GLARGINE		X
11	LATUDA	LURASIDONE		X
8	LARISSIA	ETHINYLESTRIDIOL/LEVONORGESTREL	X
4	LATANOPROST	XALATAN		X
12	LEVEMIR	INSULIN DETEMIR		X	X
11	LEVETIRACETAM	KEPPRA	X		X		X
10	LEVOCETIRIZINE	XYZAL			X
2	LEVOFLOXACIN	LEVAQUIN	X		X
12	LEVOTHYROXINE	SYNTHROID/TIROSINT/LEVOXYL	X		X			x
12	LEVOXYL	LEVOTHYROXINE		X
7	LIALDA	MESALAMINE		X
7	LINZESS	LINACLOTIDE		X	X
6	LISINOPRIL*	PRINIVIL	X		X			x	x
6	LISINOPRIL-HCTZ	PRINZIDE	X		X			x
11	LITHIUM	LITHOBID/ESKALITH	X		X		X	x
6	LOSARTAN	COZAAR	X		X
6	LOSARTAN/HCTZ	HYZAAR	X		X			x
6	LOVASTATIN	MEVACOR	X		X
5	LOVENOX	ENOXAPARIN		X
4	LUMIGAN	BIMATOPROST			X
2	MACROBID	NITROFURANTOIN			X
1	MAXALT	RIZATRIPTAN		X
7	MECLIZINE	BONINE/DRAMAMINE	X		X		X
1, 10	MEDROL DOSEPAK	METHYLPREDNISOLONE			X
8	MEDROXYPROGESTERONE	DEPOPROVERA	X		X
7,12	MEGESTROL	MEGACE			X
7,12	MEGESTROL	MEGACE ES ORAL SUSP		X
1	MELOXICAM*	MOBIC	X		X
12	METFORMIN*	GLUCOPHAGE