$4 Generic Drug List*
nity is pleased to announce that Saint John Pharmacy is now off ering $4 generic drugs! You can take advantage of this off er for the medications listed below by either coming into the Saint John Pharmacy with your prescriptions
and refi lls or by requesting your prescriptions be sent to you by mail order. Prescriptions for the medications
listed below are FREE for Vantage Members if they are fi lled through the Saint John Pharmacy.

Allergies, Cough & Cold and Flu
Cholesterol Medications
Diabetes Medications
Amoxicillin 125mg/5ml susp .80,100, or 150 mL Amoxicillin 200mg/5ml susp .50, 75, or 100 mL Amoxicillin 250mg/5ml susp .80,100, or 150 mL Amoxicillin 400mg/5ml susp .50, 75, or 100 mL Penicillin VK 125mg/5ml susp .100 or 200mL Penicillin VK 250mg/5ml susp .100mL Ear Preparations
SMZ-TMP 400mg-80mg .28 tabs SMZ-TMP DS 800mg-160mg .20 tabs Fungal Infection
Fluconazole 150mg .1 tab Terbinafi ne 250mg .30 tabs Arthritis Treatments and Analgesics
Allopurinol 100 or 300mg .30 tabs
Gastrointestinal and Stomach Disorders
Asthma Treatments
Albuterol 2mg .90 tabs
Glaucoma and Eye Care Products
Atropine Sulfate 1% oph. soln (5 ml bottle) .1 Gentamicin 0.3% oph. soln (5ml bottle) .1 Albuterol 0.5% nebulizer soln .20mL bottle Levobunolol 0.5% oph. soln (5ml bottle) .1 Polymyxin Sulfate/TMP oph. soln (10ml bottle) .1Timolol Maleate 0.25% oph. soln (5ml bottle) .1Timolol Maleate 0.5% oph. soln (5ml bottle) .1 Heart and Blood Pressure Treatments
Men’s Health
Atenolol-Chlorthalidone 100mg-25mg .30 tabs Atenolol-Chlorthalidone 50mg-25mg .30 tabs Mental Health
Amitriptyline 10, 25, 50, 75 or 100mg .30 tabs Bisoprolol-HCTZ 5mg-6.25mg .30 tabsBumetanide 0.5 or 1mg .30 tabs Carvedilol 3.125, 6.25, 12.5 or 25mg .60 tabs Furosemide 20, 40 or 80mg .30 tabsGuanfacine 1mg .30 tabs Virus Treatment
Hydrochlorothiazide(HCTZ)12.5mg .30 caps Hydrochlorothiazide (HCTZ) 25 or 50mg 30 tabsIndapamide 1.25 pr 2.5mg .30 tabs Women’s Health
Isosorbide Mononitrate 30 or 60mg ER .30 tabs Medroxyprogesterone Acetate 2.5 or 5mg .30 tabs Medroxyprogesterone Acetate 10mg .10 tabs Metoprolol Tartrate 25, 50 or 100mg .60 tabs Nadolol 20 or 40mg .30 tabsPrazosin HCL 1 or 2mg.30 tabs Other Medical Conditions
Propranolol 10, 20, 40 or 80mg .60 tabs Sotalol HCL 80mg .30 tabs Chlorhexidine Gluconate 0.12% soln .473ml bottle Lidocaine 2% viscous solution .100ml bottle Triamterene-HCTZ 37.5mg-25mg .30 caps or tabs Warfarin 1, 2, 2.5, 3, 4, 5, 6, 7.5 or 10mg .30 tabs *Medications on this list are subject to modifi cation or discontinuation at any time without notice. Please visit
nitypharmacy.com/forms to view a complete and updated list.
Also available on our website is the Mail Order Form. Fax or mail your completed Mail Order Form to have your prescriptions
delivered right to your home. You can also call Saint John Pharmacy at (888) 316-4354 with your prescription
information to transfer your medications. We can charge your debit or credit card for the applicable copay and shipping
charges. Shipping is free for Vantage Members. Please allow 48 hours to transfer and process the prescription(s) and
an additional 2-3 days for the U.S. Postal Service to deliver. Prescription auto-fi ll is available upon request.
(888) 316 -4354
110 Saint John Street, Monroe, LA 71201

Source: http://www.myaffinitypharmacy.com/doc/ProviderDrugList.pdf


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