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Retail Prescription Program Drug List
Low-cost prescriptions make a difference
90-Day Prescriptions
At Walmart, we don’t think you should have to choose between Taking a regular prescription? Ask your doctor if you can refil it groceries and the medicines you need. Our $4 prescriptions save 3 months at a time. At only $10, our 90-Day prescriptions save you American families hundreds of mil ions of dol ars a year. even more than our regular low-cost prescriptions. You save trips More $4 prescriptions than ever
Now our $4 price covers hundreds of prescriptions. That includes medicines for a wide range of conditions and diagnosis groups. This list is a quick-reference tool that wil help you find the specific Ciprofloxacin 250mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . 14 . . . . . . . . 42 30-Day 90-Day
Ciprofloxacin 500mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . 20 . . . . . . . . 60 Allergies & Cold and Flu
Doxycycline Hyclate 50mg cap . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Benzonatate 100mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . 14 . . . . . . . . 42 Doxycycline Hyclate 100mg cap . . . . . . . . . . . . . . . . . . . 20 . . . . . . . . 60 Ceron DM syrup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120ml . . . . 360ml Doxycycline Hyclate 100mg tab . . . . . . . . . . . . . . . . . . . 20 . . . . . . . . 60 C-Phen drops* (30ml bottle)† . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . 3 Erythromycin EC 250mg cap* . . . . . . . . . . . . . . . . . . . . . . 28 . . . . . . . . 84 Dex PC syrup* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120ml . . . . 360ml Metronidazole 250mg tab . . . . . . . . . . . . . . . . . . . . . . . . . 28 . . . . . . . . 84 Loratadine 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Metronidazole 500mg tab . . . . . . . . . . . . . . . . . . . . . . . . . 14 . . . . . . . . 42 Promethazine DM syrup . . . . . . . . . . . . . . . . . . . . . . . . . 120ml . . . . 360ml Penicillin VK 250mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 . . . . . . . . 84Penicillin VK 125mg/5ml susp (100ml bottle)† . . . . . . . 1 . . . . . . . . 3 Penicillin VK 125mg/5ml susp (200ml bottle)† . . . . . . . 1 . . . . . . . . 3 30-Day 90-Day
Antibiotic Treatments
Penicillin VK 250mg/5ml susp (100ml bottle)† . . . . . . . 1 . . . . . . . . 3SMZ-TMP 200mg-40mg/5ml susp*. . . . . . . . . . . . . . . 120ml . . . . 360ml Amoxicillin 125mg/5ml susp (80ml bottle)† . . . . . . . . . 1 . . . . . . . . 3 SMZ-TMP 400mg-80mg tab . . . . . . . . . . . . . . . . . . . . . . . 28 . . . . . . . . 84 Amoxicillin 125mg/5ml susp (100ml bottle)† . . . . . . . . 1 . . . . . . . . 3 SMZ-TMP DS 800mg-160mg tab . . . . . . . . . . . . . . . . . . . 20 . . . . . . . . 60 Amoxicillin 125mg/5ml susp (150ml bottle)† . . . . . . . . 1 . . . . . . . . 3 Tetracycline 250mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Amoxicillin 200mg/5ml susp (50ml bottle)† . . . . . . . . . 1 . . . . . . . . 3 Tetracycline 500mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Amoxicillin 200mg/5ml susp* (75ml bottle)† . . . . . . . . 1 . . . . . . . . 3Amoxicillin 200mg/5ml susp* (100ml bottle)† . . . . . . . 1 . . . . . . . . 3 Amoxicillin 250mg/5ml susp (80ml bottle)† . . . . . . . . . 1 . . . . . . . . 3 30-Day 90-Day
Amoxicillin 250mg/5ml susp (100ml bottle)† . . . . . . . . 1 . . . . . . . . 3 Arthritis & Pain
Amoxicillin 250mg/5ml susp (150ml bottle)† . . . . . . . . 1 . . . . . . . . 3 Allopurinol 100mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Amoxicillin 400mg/5ml susp (50ml bottle)† . . . . . . . . . 1 . . . . . . . . 3 Allopurinol 300mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Amoxicillin 400mg/5ml susp* (75ml bottle)† . . . . . . . . 1 . . . . . . . . 3 Baclofen 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Amoxicillin 400mg/5ml susp* (100ml bottle)† . . . . . . . 1 . . . . . . . . 3 Cyclobenzaprine 5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Amoxicillin 250mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Cyclobenzaprine 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Amoxicillin 500mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Dexamethasone 0.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Cephalexin 250mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 . . . . . . . . 84 Dexamethasone 0.75mg tab . . . . . . . . . . . . . . . . . . . . . . 12 . . . . . . . . 36 Cephalexin 500mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Dexamethasone 4mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . 6 . . . . . . . . 18 Prescription Program includes up to a 30-day supply for $4 and a 90-day supply for $10 of some covered generic drugs at commonly prescribed dosages. Higher dosages cost more. Prices for some drugs covered by the Prescription Program may be higher and may vary in some states. Restrictions apply. See Program Details or your Walmart Pharmacist for details. Free language assistance services available for prescription drug information at Walmart and Sam’s Club pharmacies in New York. Contact your Walmart or Sam’s Club pharmacy for details.
*Prices may be higher in CA, HI, MN, MT, PA, TN and WI.
† Prepackaged drugs are covered only in unit sizes specified on Drug List.  See Program Details or your Walmart Pharmacist for details.
2010 Wal-Mart Stores, Inc. | Page 1 of 6 Arthritis & Pain (continued)
Glyburide 2.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Diclofenac DR 75mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Glyburide 5mg tab (blue) . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Ibuprofen 100mg/5ml susp* . . . . . . . . . . . . . . . . . . . . 120ml . . . . 360ml Glyburide 5mg tab (green) . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Ibuprofen 400mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 . . . . . . . 270 Glyburide, micronized 3mg tab . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Ibuprofen 600mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Glyburide, micronized 6mg tab . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Ibuprofen 800mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Metformin 500mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Indomethacin 25mg cap* . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Metformin 850mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Meloxicam 7.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Metformin 1000mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Meloxicam 15mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Metformin 500mg ER tab* . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Naproxen 375mg tab*. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180Naproxen 500mg tab*. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 30-Day 90-Day
Ear Health
30-Day 90-Day
Antipyrine/Benzocaine otic (15ml bottle)†. . . . . . . . . . . 1 . . . . . . . . 3 Asthma
Albuterol 2mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 . . . . . . . 270
30-Day 90-Day
Albuterol 4mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Fungal Infections
Albuterol 2mg/5ml syrup . . . . . . . . . . . . . . . . . . . . . . . . 120ml . . . . 360ml Fluconazole 150mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . 3 Albuterol 0.5% nebulizer soln (20ml bottle)† . . . . . . . . 1 . . . . . . . . 3 Nystatin/Triamcin cream (15gm tube)† . . . . . . . . . . . . . . 1 . . . . . . . . 3 Albuterol 0.083% nebulizer soln* (25x3ml vials)† . . . . 1 . . . . . . . . 3 Nystatin/Triamcin cream (30gm tube)† . . . . . . . . . . . . . . 1 . . . . . . . . 3 Ipratropium 0.02% nebulizer soln* (25x2.5ml vials)† . 1 . . . . . . . . 3 Nystatin/Triamcin ointment (15gm tube)† . . . . . . . . . . . 1 . . . . . . . . 3Nystatin cream (15gm tube)† . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . 3 30-Day 90-Day
Nystatin cream (30gm tube)† . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . 3 Cholesterol
Nystatin ointment (15gm tube)† . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . 3 Lovastatin 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Nystatin ointment (30gm tube)† . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . 3 Lovastatin 20mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Terbinafine 250mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Pravastatin 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90Pravastatin 20mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 30-Day 90-Day
Pravastatin 40mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Gastrointestinal Health
Belladonna Alkaloid/PB tab . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180
30-Day 90-Day
Cimetidine 800mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Diabetes
Cytra2 solution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180ml . . . . 540ml Chlorpropamide 100mg tab* . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Dicyclomine 10mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 . . . . . . . 270 Glimepiride 1mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Dicyclomine 20mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Glimepiride 2mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Famotidine 20mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Glimepiride 4mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Lactulose syrup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237ml . . . . 711ml Glipizide 5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Metoclopramide 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Glipizide 10mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Prescription Program includes up to a 30-day supply for $4 and a 90-day supply for $10 of some covered generic drugs at commonly prescribed dosages. Higher dosages cost more. Prices for some drugs covered by the Prescription Program may be higher and may vary in some states. Restrictions apply. See Program Details or your Walmart Pharmacist for details. Free language assistance services available for prescription drug information at Walmart and Sam’s Club pharmacies in New York. Contact your Walmart or Sam’s Club pharmacy for details.
*Prices may be higher in CA, HI, MN, MT, PA, TN and WI.
† Prepackaged drugs are covered only in unit sizes specified on Drug List.  See Program Details or your Walmart Pharmacist for details.
2010 Wal-Mart Stores, Inc. | Page 2 of 6 Gastrointestinal Health (contined)
Bisoprolol-HCTZ 5mg-6.25mg tab . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Metoclopramide syrup . . . . . . . . . . . . . . . . . . . . . . . . . . . 60ml. . . . . 180ml Bisoprolol-HCTZ 10mg-6.25mg tab . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Promethazine 25mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . 12 . . . . . . . . 36 Bumetanide 0.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Promethazine plain syrup* . . . . . . . . . . . . . . . . . . . . . . 180ml . . . . 540ml Bumetanide 1mg tab. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Ranitidine 150mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Captopril 12.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Ranitidine 300mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Captopril 25mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180Captopril 50mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Captopril 100mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 30-Day 90-Day
Carvedilol 3.125mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Glaucoma & Eye Care
Carvedilol 6.25mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Atropine Sulfate 1% op. soln (5ml bottle)† . . . . . . . . . . . 1 . . . . . . . . 3 Carvedilol 12.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Erythromycin op. ointment (3.5gm tube)†* . . . . . . . . . . 1 . . . . . . . . 3 Carvedilol 25mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Gentamicin 0.3% op. soln (5ml bottle)† . . . . . . . . . . . . . . 1 . . . . . . . . 3 Chlorthalidone 25mg tab . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Levobunolol 0.5% op soln (5ml bottle)† . . . . . . . . . . . . . 1 . . . . . . . . 3 Chlorthalidone 50mg tab . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Clonidine 0.1mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 0.1% op. ointment (3.5gm tube)† . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . 3 Clonidine 0.2mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Digoxin 0.125mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 0.1% op. susp (5ml bottle)† . . . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . 3 Digoxin 0.25mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Pilocarpine 1% op. soln (15ml bottle)† . . . . . . . . . . . . . . 1 . . . . . . . . 3 Diltiazem 30mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Pilocarpine 2% op. soln (15ml bottle)† . . . . . . . . . . . . . . 1 . . . . . . . . 3 Diltiazem 60mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Polymyxin Sulfate/TMP op. soln* (10ml bottle)† . . . . . 1 . . . . . . . . 3 Diltiazem 90mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Sulfacet Sodium 10% op. soln (15ml bottle)† . . . . . . . . 1 . . . . . . . . 3 Diltiazem 120mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Timolol Maleate 0.25% op. soln (5ml bottle)† . . . . . . . . 1 . . . . . . . . 3 Doxazosin 1mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Timolol Maleate 0.5% op soln (5ml bottle)† . . . . . . . . . . 1 . . . . . . . . 3 Doxazosin 2mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Tobramycin 0.3% op. soln (5ml bottle)† . . . . . . . . . . . . . 1 . . . . . . . . 3 Doxazosin 4mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90Doxazosin 8mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Enalapril-HCTZ 5mg-12.5mg tab . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 30-Day 90-Day
Heart Health & Blood Pressure
Enalapril 2.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90Enalapril 5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Amiloride-HCTZ 5mg-50mg tab . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Enalapril 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Atenolol-Chlorthalidone 50mg-25mg tab . . . . . . . . . . 30 . . . . . . . . 90 Enalapril 20mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Atenolol-Chlorthalidone 100mg-25mg tab . . . . . . . . 30 . . . . . . . . 90 Furosemide 20mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Atenolol 25mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Furosemide 40mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Atenolol 50mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Furosemide 80mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Atenolol 100mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Guanfacine 1mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Benazepril 5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Hydralazine 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Benazepril 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Hydralazine 25mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Benazepril 20mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Hydrochlorothiazide(HCTZ)12.5mg cap* . . . . . . . . . . . 30 . . . . . . . . 90 Benazepril 40mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Hydrochlorothiazide (HCTZ) 25mg tab . . . . . . . . . . . . . 30 . . . . . . . . 90 Bisoprolol-HCTZ 2.5mg-6.25mg tab. . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Hydrochlorothiazide (HCTZ) 50mg tab . . . . . . . . . . . . . 30 . . . . . . . . 90 Prescription Program includes up to a 30-day supply for $4 and a 90-day supply for $10 of some covered generic drugs at commonly prescribed dosages. Higher dosages cost more. Prices for some drugs covered by the Prescription Program may be higher and may vary in some states. Restrictions apply. See Program Details or your Walmart Pharmacist for details. Free language assistance services available for prescription drug information at Walmart and Sam’s Club pharmacies in New York. Contact your Walmart or Sam’s Club pharmacy for details.
*Prices may be higher in CA, HI, MN, MT, PA, TN and WI.
† Prepackaged drugs are covered only in unit sizes specified on Drug List.  See Program Details or your Walmart Pharmacist for details.
2010 Wal-Mart Stores, Inc. | Page 3 of 6 Heart Health & Blood Pressure (continued)
Warfarin 1mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Indapamide 1.25mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Warfarin 2mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Indapamide 2.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Warfarin 2.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Isosorbide Mononitrate 30mg ER tab . . . . . . . . . . . . . . 30 . . . . . . . . 90 Warfarin 3mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Isosorbide Mononitrate 60mg ER tab . . . . . . . . . . . . . . 30 . . . . . . . . 90 Warfarin 4mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Lisinopril-HCTZ 10mg-12.5mg tab . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Warfarin 5mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Lisinopril-HCTZ 20mg-12.5mg tab* . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Warfarin 6mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Lisinopril-HCTZ 20mg-25mg tab* . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Warfarin 7.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Lisinopril 2.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Warfarin 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Lisinopril 5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90Lisinopril 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 30-Day 90-Day
Lisinopril 20mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Mental Health
Methyldopa 250mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Amitriptyline 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Methyldopa 500mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Amitriptyline 25mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Metoprolol Tartrate 25mg tab . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Amitriptyline 50mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Metoprolol Tartrate 50mg tab . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Amitriptyline 75mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Metoprolol Tartrate 100mg tab* . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Amitriptyline 100mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Nadolol 20mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Benztropine 2mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Nadolol 40mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Buspirone 5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Pindolol 5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Buspirone 10mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Pindolol 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Carbamazepine 200mg tab* . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Prazosin HCL 1mg cap. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Citalopram 20mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Prazosin HCL 2mg cap. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Citalopram 40mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Prazosin HCL 5mg cap. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Doxepin HCL 10mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Propranolol 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Doxepin HCL 25mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Propranolol 20mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Doxepin HCL 50mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Propranolol 40mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Doxepin HCL 75mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Propranolol 80mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Doxepin HCL 100mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Sotalol HCL 80mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Fluoxetine 10mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Spironolactone 25mg tab* . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Fluoxetine 10mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Terazosin 1mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Fluoxetine 20mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Terazosin 2mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Fluoxetine 40mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Terazosin 5mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Fluphenazine 1mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Terazosin 10mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Haloperidol 0.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Triamterene-HCTZ 37.5mg-25mg cap . . . . . . . . . . . . . . 30 . . . . . . . . 90 Haloperidol 1mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Triamterene-HCTZ 37.5mg-25mg tab . . . . . . . . . . . . . . 30 . . . . . . . . 90 Haloperidol 2mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Triamterene-HCTZ 75mg-50mg tab . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Haloperidol 5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Verapamil 80mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Lithium Carbonate 300mg cap* . . . . . . . . . . . . . . . . . . . 90 . . . . . . . 270 Verapamil 120mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Nortriptyline 10mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Prescription Program includes up to a 30-day supply for $4 and a 90-day supply for $10 of some covered generic drugs at commonly prescribed dosages. Higher dosages cost more. Prices for some drugs covered by the Prescription Program may be higher and may vary in some states. Restrictions apply. See Program Details or your Walmart Pharmacist for details. Free language assistance services available for prescription drug information at Walmart and Sam’s Club pharmacies in New York. Contact your Walmart or Sam’s Club pharmacy for details.
*Prices may be higher in CA, HI, MN, MT, PA, TN and WI.
† Prepackaged drugs are covered only in unit sizes specified on Drug List.  See Program Details or your Walmart Pharmacist for details.
2010 Wal-Mart Stores, Inc. | Page 4 of 6 Mental Health (continued)
Nortriptyline 25mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 30-Day 90-Day
Paroxetine 10mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Thyroid Conditions
Paroxetine 20mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Levothyroxine 25mcg tab . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Prochlorperazine 10mg tab. . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Levothyroxine 50mcg tab . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Thioridazine 25mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Levothyroxine 75mcg tab . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Thioridazine 50mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Levothyroxine 88mcg tab . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Thiothixene 2mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Levothyroxine 100mcg tab . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Trazodone 50mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Levothyroxine 112mcg tab . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Trazodone 100mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Levothyroxine 125mcg tab . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Trazodone 150mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Levothyroxine 137mcg tab . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Trihexyphenidyl 2mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Levothyroxine 150mcg tab . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90Levothyroxine 175mcg tab* . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Levothyroxine 200mcg tab* . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 30-Day 90-Day
Skin Conditions
30-Day 90-Day
(15gm tube)† . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . 3 Acyclovir 200mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 (45gm tube)† . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . 3 Betamethasone Valerate 0.1% cream (15gm tube)† . . 1 . . . . . . . . 3 30-Day 90-Day
Betamethasone Val. 0.1% cream (45gm tube)†. . . . . . . 1 . . . . . . . . 3 Vitamins & Nutritional Health
Betamethasone Val. 0.1% ointment (15gm tube)† . . . 1 . . . . . . . . 3 Folic Acid 1mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Betamethasone Val. 0.1% ointment (45gm tube)† . . . 1 . . . . . . . . 3 Klorcon 8 8mEq ER tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Fluocinolone Acet. 0.01% soln (60ml bottle)† . . . . . . . . 1 . . . . . . . . 3 Klorcon 10 10mEq ER tab . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Fluocinonide 0.05% cream (15gm tube)† . . . . . . . . . . . . 1 . . . . . . . . 3 Klorcon M10 10mEq tab . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Fluocinonide 0.05% cream (30gm tube)† . . . . . . . . . . . . 1 . . . . . . . . 3 Mag 64 64mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Gentamicin 0.1% cream (15gm tube)† . . . . . . . . . . . . . . . 1 . . . . . . . . 3 Magnesium Oxide 400mg tab . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Gentamicin 0.1% ointment (15gm tube)† . . . . . . . . . . . 1 . . . . . . . . 3 Prenatal Plus qty 30* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Hydrocortisone 1% cream (28.35-30g tube)† . . . . . . . . 1 . . . . . . . . 3 Potassium Chloride 10% liquid . . . . . . . . . . . . . . . . . . 473ml . . . 1419ml Hydrocortisone 2.5% cream (30gm tube)† . . . . . . . . . . . 1 . . . . . . . . 3 Sodium Fluoride .25mg chewable (120ct bottle) †* . . 1 . . . . . . . N/A Selenium Sulfide 2.5% lotion* (120ml bottle)† . . . . . . . 1 . . . . . . . . 3Silver Sulfadiazine 1% cream* (50gm tube)† . . . . . . . . . 1 . . . . . . . . 3 Triamcinolone 0.025% cream (15gm tube)† . . . . . . . . . 1 . . . . . . . . 3 30-Day 90-Day
Triamcinolone 0.025% cream (80gm tube)† . . . . . . . . . 1 . . . . . . . . 3 Women’s Health
Triamcinolone 0.1% cream (15gm tube)† . . . . . . . . . . . . 1 . . . . . . . . 3 Estradiol 0.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Triamcinolone 0.1% cream (80gm tube)† . . . . . . . . . . . . 1 . . . . . . . . 3 Estradiol 1mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Triamcinolone 0.1% ointment (15gm tube)† . . . . . . . . . 1 . . . . . . . . 3 Estradiol 2mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Triamcinolone 0.1% ointment (80gm tube)† . . . . . . . . . 1 . . . . . . . . 3 Estropipate 0.75mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Triamcinolone 0.5% cream (15gm tube)† . . . . . . . . . . . . 1 . . . . . . . . 3 Estropipate 1.5mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Prescription Program includes up to a 30-day supply for $4 and a 90-day supply for $10 of some covered generic drugs at commonly prescribed dosages. Higher dosages cost more. Prices for some drugs covered by the Prescription Program may be higher and may vary in some states. Restrictions apply. See Program Details or your Walmart Pharmacist for details. Free language assistance services available for prescription drug information at Walmart and Sam’s Club pharmacies in New York. Contact your Walmart or Sam’s Club pharmacy for details.
*Prices may be higher in CA, HI, MN, MT, PA, TN and WI.
† Prepackaged drugs are covered only in unit sizes specified on Drug List.  See Program Details or your Walmart Pharmacist for details.
2010 Wal-Mart Stores, Inc. | Page 5 of 6 MedroxyprogesteroneAcetate 2.5mg tab . . . . . . . . . . 30 . . . . . . . . 90 New non program medication for asthma and smoking cessation.
Medroxyprogesterone Acetate 5mg tab . . . . . . . . . . . 30 . . . . . . . . 90 Medroxyprogesterone Acetate 10mg tab . . . . . . . . . . 10 . . . . . . . . 30 ReliOn/Ventolin® HFA Inhaler 8g . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $9 Smoking Cessation
30-Day 90-Day
Bupropion ER 150mg (17ct starter pack) . . . . . . . . . . . . . . . . . . . . . . $9 Women’s Health
Not part of Prescription Program or subject to Walmart’s Alendronate SOD 35mg tab . . . . . . . . . . . . . . . . . . . . . . . . 4 . . . . . . . . 12 Prescription Program Details. Available at all Walmart, Sam’s Club and Neighborhood Markets pharmacies in the United Alendronate SOD 70mg tab . . . . . . . . . . . . . . . . . . . . . . . . 4 . . . . . . . . 12 States, except in North Dakota. These drugs are offered at the price specified only in the exact unit sizes and formulations specified Clomiphene 50mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 . . . . . . . . 15 above and are not subject to proration. You may pay more or less Sprintec 28-day tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 . . . . . . . N/A depending on the terms of your health plan. Specified price may be limited to select manufacturers of the drugs and is available Tri-Sprintec 28-day tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 . . . . . . . N/A as long as supplies are in stock at the pharmacy. There are no Tamoxifen 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 substitutions or mail orders. See your Walmart Pharmacist Tamoxifen 20mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Walmart’s Prescription Program Details
1. Walmart’s Prescription Program (the “Program”) is available at al Walmart, Sam’s Club and Neighborhood Market pharmacies in the United States (“Walmart Retail Pharmacies”), except in North Dakota, as set forth below in Sections 3 30-Day 90-Day
and 4. The Program is also available through Walmart Mail Service (“Walmart Mail Service”), as set forth below in Section 5.
Other Medical Conditions
2. The Program applies only to certain generic drugs at commonly prescribed dosages. Higher dosages cost more. You may obtain a list of generic drugs and dosages covered under the Program at Walmart Retail Pharmacies (the “Retail Drug List”) and through Walmart Mail Service (the “Mail Service Drug List”) on Walmart.com or at Walmart Retail Chlorhexidine Gluconate 0.12% soln (473ml bottle)† . . . 1 . . . . . . . . 3 Pharmacies. The Retail Drug List and Mail Service Drug List may change and also may vary by state. Not all formulations of a drug (for example, enteric-coated, extended or timed release formulations) are covered under the Program. Program pricing not available when a covered drug is dispensed as part of a compound. Hydrocortisone AC 25mg suppositories* . . . . . . . . . . . 12 . . . . . . . . 36 3. Under the Program at Walmart Retail Pharmacies, $4 is the price for up to a 30-day supply of certain covered generic drugs at commonly prescribed dosages (the “$4 Retail Program”). $10 is the price of a 90-day supply of certain covered Isoniazid 300mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 generic drugs at commonly prescribed dosages (the “$10 Retail Program”). Not al drugs covered by the $4 Retail Program are covered by the $10 Program. Prices for quantities between a 30-day supply and a 90-day supply of drugs Lidocaine 2% viscous solution (100ml bottle)† . . . . . . . 1 . . . . . . . . 3 covered by both the $4 Retail Program and $10 Retail Program are prorated based on the $4 Program price, but will not exceed $10. Prices for quantities greater than a 90-day supply of drugs covered by the $10 Retail Program are prorated based on the $10 Program price. Prorated pricing is not available under the Program for prepackaged drugs.  Megestrol 20mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 For pricing policies relating to prepackaged drugs (such as tubes, vials or bottles), see Section 6.
4. Under the Program at Walmart Retail Pharmacies, $9 is the price for up to a 30-day supply of certain women’s health and Methylpred 4mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 . . . . . . . . 63 other covered generic drugs at commonly prescribed dosages (the “$9 Retail Program”). $24 is the price for a 90-day supply of certain women’s health and other covered generic drugs at commonly prescribed dosages (the “$24 Retail Methylpred 4mg dose pak (21 tablets)† . . . . . . . . . . . . . 1 . . . . . . . . 3 Program”). Not al drugs covered by the $9 Retail Program are covered by the $24 Retail Program. Prices for quantities between a 30-day supply and a 90-day supply of drugs covered by both the $9 Program and $24 Retail Program are prorated based on the $9 Program price, but wil not exceed $24. Prices for quantities greater than a 90-day supply of Oxybutynin 5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 drugs covered by the $24 Retail Program are prorated based on the $24 Program price. Prorated pricing is not available under the Program for prepackaged drugs.  For pricing policies relating to prepackaged drugs, see Section 6.
Phenazopyridine 100mg tab . . . . . . . . . . . . . . . . . . . . . . . 6 . . . . . . . . 18 5. Under the Program through Walmart Mail Service, $10 is the price for mail delivery of a 90-day supply of certain generic drugs at commonly prescribed dosages (“$10 Mail Service Program”). $24 is the price for mail delivery of Phenazopyridine 200mg tab . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 certain women’s health and certain other covered drugs at commonly prescribed dosages ($24 Mail Service Program”). Not al drugs covered by the $10 Retail Program are covered by the $10 Mail Service Program; not al drugs covered by the $24 Retail Program are covered by the $24 Mail Service Program. See Mail Service Drug List for a list of drugs Prednisone 2.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 covered by the $10 Mail Service Program and $24 Mail Service Program. Walmart Mail Service covers both initial fil s and refil s. Delivery of covered drugs is available only through Walmart Mail Service and is not available at Walmart, Prednisone 5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Sam’s Club, and Neighborhood Market retail pharmacies. Delivery under the Program through Walmart Mail Service is limited to U.S. addresses by First-Class Mail; expedited delivery is also available for an additional charge. Some health plans do not cover Walmart Mail Service or 90-day supplies. Prices for quantities greater than a 90-day supply of drugs † . . . . . . . . . . . . . . 1 . . . . . . . . 3 covered by the $10 Mail Service Program and the $24 Mail Service Program are prorated based on the $10 and $24 Program price, respectively. Prices for quantities less than a 90-day supply are not prorated under either the $10 Mail Prednisone 5mg dose pak* (48 tablets)† . . . . . . . . . . . . . 1 . . . . . . . . 3 Service Program or the $24 Mail Service Program. Prorated pricing is not available under the Program for prepackaged drugs.  For pricing policies relating to prepackaged drugs, see Section 6. Prednisone 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 6. Prepackaged drugs are covered under the Program only in the unit sizes specified on the Retail Drug List and Mail Service Drug List. Prepackaged drugs are dispensed based on the quantities prescribed and unit sizes in stock at the Prednisone 10mg dose pak (21 tablets)† . . . . . . . . . . . . 1 . . . . . . . . 3 dispensing pharmacy. Unit sizes not specified on the Retail Drug List or Mail Service Drug List are not covered under the Program. Multi-unit purchases are charged at a per unit price, based on the price per unit size dispensed, unless otherwise specified. Prepackaged drugs dispensed in unit sizes not specified on the Retail Drug List and Mail Service Prednisone 10mg dose pak* (48 tablets)† . . . . . . . . . . . 1 . . . . . . . N/A Drug List may be priced higher, even if equivalent quantities of the drug are available in specified unit sizes. Prorated pricing is not available under the Program for prepackaged drugs.
Prednisone 20mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 7. Prices of certain drugs covered by the Program may be higher in some states, as noted on the Retail Drug List and Mail 8. Program pricing may be limited to select manufacturers of a covered drug and is available as long as supplies from such manufacturers are in stock at the dispensing pharmacy.
9. You may pay less or more than the Program price, depending on the terms of your health plan.  Prescriber permission may be required to change a 30-day prescription to a 90-day prescription. Certain plans, including government- funded programs, may not cover a 90-day supply. 10. For purchases made at Walmart Retail Pharmacies, prescriptions must initial y be fil ed in person, and refil s must be picked up in store. There are no substitutions. Purchases made through Walmart Mail Service may be ordered at Walmart Retail Pharmacies, by phone or through walmart.com.
11. These Program Details are subject to change without advance notice. Changes to these Program Details may be Prescription Program includes up to a 30-day supply for $4 and a 90-day supply for $10 of some covered generic drugs at commonly prescribed dosages. Higher dosages cost more. Prices for some drugs covered by the Prescription Program may be higher and may vary in some states. Restrictions apply. See Program Details or your Walmart Pharmacist for details. Free language assistance services available for prescription drug information at Walmart and Sam’s Club pharmacies in New York. Contact your Walmart or Sam’s Club pharmacy for details.
*Prices may be higher in CA, HI, MN, MT, PA, TN and WI.
† Prepackaged drugs are covered only in unit sizes specified on Drug List.  See Program Details or your Walmart Pharmacist for details.
2010 Wal-Mart Stores, Inc. | Page 6 of 6

Source: http://pharmacycheckerblog.com/wp-content/uploads/2010/08/Retail-Prescription-Program-Drug-List.pdf

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