Generic Medication List

Generic Medications

$3.00 / 30 Days

Allergies, Cough and Cold

Name	Dosage Form	30-day QTY
Cetrizine 1 Mg/Ml	Syrup	120
Promethazine DM	Syrup	120
Promethazine 6.25 Mg/5Ml*	Syrup	180
Loratadine 10 Mg	Tablet	30
Benzonatate 100 Mg	Capsule	14

Antibiotic

Name	Dosage Form	30-day QTY
Amoxicillin 125 Mg/5 Ml	Suspension	100
Amoxicillin 125 Mg/5 Ml	Suspension	150
Amoxicillin 200 Mg/5 Ml	Suspension	50
Amoxicillin 200 Mg/5 Ml*	Suspension	75
Amoxicillin 200 Mg/5 Ml*	Suspension	100
Amoxicillin 250 Mg	Capsule	30
Amoxicillin 250 Mg/5Ml	Suspension	80
Amoxicillin 250 Mg/5Ml	Suspension	100
Amoxicillin 250 Mg/5Ml	Suspension	150
Amoxicillin 400 Mg/5Ml	Suspension	50
Amoxicillin 400 Mg/5Ml*	Suspension	75
Amoxicillin 400 Mg/5Ml*	Suspension	100
Amoxicillin 500 Mg	Capsule	30
Cephalexin 250 Mg	Capsule	28
Cephalexin 500 Mg	Capsule	30
Ciprofloxacin 250 Mg	Tablet	14
Ciprofloxacin 500 Mg	Tablet	20
Penicillin Vk 125 Mg/5 Ml	Solution	100
Penicillin Vk 125 Mg/5 Ml	Solution	200
Penicillin Vk 250 Mg/5 Ml	Solution	100
Penicillin Vk 250 Mg	Tablet	28
Smz/Tmp 400/80 Mg	Tablet	28
Smz/Tmp Ds 800/160 Mg	Tablet	20
Amoxicillin 125 Mg/5 Ml	Suspension	80

Antipsychotic

Name	Dosage Form	30-day QTY
Lithium Carb 300 Mg*	Capsule	90
Fluphenazine 1 Mg	Tablet	30

Antiviral

Name	Dosage Form	30-day QTY
Acyclovir 400 Mg	Tablet	30
Acyclovir 200 Mg	Capsule	30

Arthritis / Pain

Name	Dosage Form	30-day QTY
Ibuprofen 600 Mg	Tablet	60
Ibuprofen 800 Mg	Tablet	30
Ibuprofen 100 Mg/5 Ml	Suspension	120
Indomethacin 25 Mg	Capsule	60
Meloxicam 7.5 / 15 Mg	Tablet	30
Naproxen 375 / 500 Mg*	Tablet	60
Ibuprofen 400 Mg	Tablet	60

Asthma

Name	Dosage Form	30-day QTY
Albuterol Neb 0.083%*	Solution	75
Ipratropium Neb 0.2 Mg/Ml*	Solution	62.5
Albuterol 2 MG/5 Ml	Syrup	120

Cardiology / Hypertension

Name	Dosage Form	30-day QTY
Benazepril 5/10/20/140 Mg	Tablet	30
Bisoprolol / Hctz 5 / 6.25 Mg	Tablet	30
Bisoprolol / Hctz 10 / 6.25 Mg	Tablet	30
Carvedilol 3.125 / 6.25 / 12.5 Mg	Tablet	60
Carvedilol 25 Mg*	Tablet	60
Clonidine 0.1/0.2 Mg	Tablet	30
Enalapril / Hctz 5/12.5 Mg	Tablet	30
Furosemide 20/40/80 Mg	Tablet	30
Guanfacine 1 Mg	Tablet	30
Hydralazine 10/25 Mg	Syrup	30
Hydrochlorothiazide 12.5*/25/50 Mg	Capsule	30
Indapamide 1.25 / 2.5 Mg	Tablet	30
Propranolol 10/20/40 Mg	Tablet	30
Lisinopril 2.5/5/10/20 Mg	Tablet	30
Verapamil 80/120 Mg	Tablet	30
Atenolol 25/50/100	Tablet	30

Cholesterol

Name	Dosage Form	30-day QTY
Simvastatin 20/40 Mg	Tablet	30
Lovastatin 10/20 Mg *	Tablet	30

Diabetes

Name	Dosage Form	30-day QTY
Glipizide 5 Mg	Tablet	30
Glipizide 10 Mg*	Tablet	30
Glyburide 2.5/5 Mg	Tablet	30
Metformin 500/850/1000* Mg	Tablet	60
Metformin ER 500 Mg*	Tablet	60
Glimepiride 1/2/4 Mg	Tablet	30

Eye Preparations

Name	Dosage Form	30-day QTY
Timolol 0.25%	Ophthalmic Solution	5

Gout

Name	Dosage Form	30-day QTY
Allopurinol 100 Mg	Tablet	30

Hormones Maleate

Name	Dosage Form	30-day QTY
Medroxyprogesterone 2.5/5 Mg	Tablet	30
Medroxyprogesterone 10 Mg	Tablet	10
Estradiol 0.5/2 Mg	Tablet	30

Parkinson’s Disease

Name	Dosage Form	30-day QTY
Trihexyphenidyl	Tablet	60
Benztropine 2 Mg	Tablet	30

Prostate / Bph

Name	Dosage Form	30-day QTY
Terazosin	Capsule	30

Steroids

Name	Dosage Form	30-day QTY
Dexamethasone 0.5 Mg	Tablet	30
Dexamethasone 4 Mg	Tablet	5
Prednisone 2.5/5 Mg	Tablet	30
Dexamethasone 0.75 Mg	Tablet	10

Stomach Disorders / Gastrointestinal

Name	Dosage Form	30-day QTY
Dicyclomine 20 Mg	Tablet	60
Lactulose 10 Gm/15 Ml	Syrup	237
Mectoclopramide 5 Mg / 5 Ml	Syrup	60
Mectoclopramide 10 Mg	Tablet	30
Prochlorperazine 10 Mg	Tablet	30
Promethazine 25 Mg*	Tablet	10
Ranitidine 150 Mg	Tablet	30
Ranitidine 300 Mg	Tablet	30
Dicyclomine 10 Mg	Capsule	60

Topical Preparations

Name	Dosage Form	30-day QTY
Triamcinolone 0.025%	Cream	15
Triamcinolone 0.1%	Cream/Ointment	15
Triamcinolone 0.5%	Cream	15
Hydrocortisone 2.5%	Cream	30

Vitamins / Supplements

Name	Dosage Form	30-day QTY
Magnesium Oxide 400 Mg	Magnesium Oxide 400 Mg	30
Prenatal Plus*	Tablet	30
Sodium Flouride 0.5 Mg*	Tablet	30
Folic Acid 1 Mg	Tablet	30

Women’s Health

Name	Dosage Form	30-day QTY
Sprintec 28-Day*	Tablet	28
Tri-Sprintec 28-Day*	Tablet	28
Alendronate Sod 35/70 Mg	Tablet	4

The Low Cost Generics Drug List represents a summary of products included in our MemorialRx program. This is not an all-inclusive list. Products that are not represented on this list may be subject to plan-specific copayment. Void where prohibited by law. Your prescription benefit plan design may apply restrictions, regardless of the drugs, appearance in this document. Log into www.MemorialRX.com to check coverage and copay information for a specific medicine. For more details call Customer Care using the toll-free number on the back of your prescription benefit ID card. Copay means that the amount a plan member is required to pay for a prescription in accordance with a Plan.

Certain drugs or dosages may be subject to additional costs or copays. The Low Cost Generics Drug List is based on commonly prescribed doses. This list is subject to change without prior notice. MemorialRx Pharmacy may receive rebates, discounts and service fees from pharmaceutical manufacturers for certain listed products. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with Memorial Rx Pharmacy. Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.

Copyright 2015 MemorialRx Pharmacy. All rights reserved. This document contains confidential and proprietary information of MemorialRx Pharmacy and cannot be reproduced, distributed or printed without written permission from MemorialRx Pharmacy.

* These drugs may be priced higher upon cost increase by MemorialRx Pharmacy‘s Drug Suppliers.