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PROPOSED FORMULARY FOR PRIMARY C, 3/17/2004 <br />Name <br />Strength <br />Size <br />Price /Unit <br />Price /Dose <br />Stock 1 yr. <br />Total Price <br />Infection <br />Infection <br />Amoxicillin f Cap <br />250 mg <br />1 DO <br />$5.00 <br />$0.05 <br />12 <br />$60.00 <br />Amoxicillin Cap <br />500 mg <br />100 <br />$7.00 <br />$0.07 <br />25 <br />$175.00 <br />Amoxicillin <br />250/5 ml <br />100 ml <br />$2.27 <br />20 <br />$45.40 <br />Azithromycin tab <br />250 mg <br />30 <br />$172.41 <br />$5.70 <br />12 <br />$2,068.92 <br />Azithromycin Susp <br />100 mg /5 ml <br />15 ml <br />$18.86 <br />10 <br />$188.60 <br />Azithromycin Susp <br />200mg /5 ml <br />30 ml <br />$24.32 <br />10 <br />$243.20 <br />Cephalexin Monohydrate (Keflex) caps <br />500 mg <br />100 <br />$7.65 <br />$0.07 <br />10 <br />$76.50 <br />Ceftriaxone <br />500mg /vial <br />10 vials <br />$72.37 <br />3 <br />$217.11 <br />Dicloxacillin cap <br />500 mg <br />100 <br />$12.00 <br />$0.12 <br />5 <br />$60.00 <br />Doxycycline tab <br />100 mg <br />100 <br />$7.00 <br />$0.07 <br />20 <br />$140.00 <br />Metronidazole tab <br />500 mg <br />100 <br />$3.00 <br />$0.03 <br />20 <br />$60.00 <br />Nitrofurantoin cap <br />100 mg <br />100 <br />$24.00 <br />$0.24 <br />12 <br />$288.00 <br />TMP /SMX DS tab <br />800 & 60 <br />100 <br />$7.00 <br />$0.07 <br />12 <br />$84.00 <br />TMP /SMX susp <br />200 & 40/5ml <br />473 <br />$22.15 <br />15 <br />$332.25 <br />Ery-tab <br />333 mg <br />100 <br />$8.06 <br />$0.08 <br />6 <br />$48.36 <br />Pen VK tab <br />500 mg <br />100 <br />$10.00 <br />$0.10 <br />10 <br />$100.00 <br />Acyclovir tab <br />200 mg <br />100 <br />$6.00 <br />$0.06 <br />12 <br />$72.00 <br />Cardiovascular <br />° <br />Atenolol <br />50 mg <br />100 <br />$7.00 <br />$0.07 <br />20 <br />$140.00 <br />Clondidine <br />0.1 mg <br />100 <br />$2.00 <br />$0.02 <br />40 <br />$80.00 <br />Cozaar <br />50 mg <br />100 <br />$82.00 <br />$0.82 <br />4 <br />$328.00 <br />Enalapril tab <br />10 mg <br />100 <br />$11.00 <br />$0.11 <br />15 <br />$165.00 <br />Furosemide <br />40 mg <br />10D <br />$2.00 <br />$0.02 <br />40 <br />$80.00 <br />Hydrochlorthiazide <br />25 mg <br />100 <br />$3.00 <br />$0.03 <br />200 <br />$6DO.00 <br />Lovastatin <br />20 mg <br />60 <br />$24.00 <br />$0.40 <br />30 <br />$720.00 <br />Metoprolol <br />50 mg <br />100 <br />$6.00 <br />$0.06 <br />20 <br />$120.00 <br />Potassium Chloride <br />10 mEq <br />100 <br />$4.00 <br />$0.04 <br />10 <br />$40.00 <br />Tdamterene /HCTZ <br />375 mg /25 mg <br />100 <br />$4.00 <br />$0.04 <br />40 <br />$160.00 <br />Diabetes <br />Actos <br />15 mg <br />90 <br />$62.10 <br />- <br />$0.69 <br />15 <br />$931.50 <br />Glipizide ( glucotrol) <br />5 mg <br />10D <br />$4.00 <br />$0.04 <br />20 <br />$80.00 <br />Glipizide (glucotrol) <br />10 mg <br />100 <br />$6.00 <br />$0.06 <br />20 <br />$120.00 <br />Metformin Hcl (Glucophage) <br />500 mg <br />100 <br />$15.79 <br />$0.15 <br />12 <br />$189.48 <br />CNS /Psych <br />Buproprion <br />75 mg <br />100 <br />$32.00 <br />$0.32 <br />62 <br />$1,984.00 <br />Fluoxitene <br />10 mg <br />100 <br />$13.00 <br />$0.13 <br />36 <br />$468.00 <br />Fluoxitene <br />20 mg <br />100 <br />$14.00 <br />$0.14 <br />146 <br />$2,044.00 <br />Gastrointestinal <br />Dicyclomine tab <br />10 mg <br />100 <br />$3.00 <br />$0.03 <br />100 <br />$300.00 <br />Respiratory <br />Albuterol inhaler <br />17 gms <br />il <br />$2.73 <br />180 <br />$491.40 <br />Cromolyn inhaler <br />26 ml <br />$12.90 <br />60 <br />$774.00 <br />Albuterol liquid <br />2mg /5ml <br />473 ml <br />$31.00 <br />9 <br />$279.00 <br />Acne <br />Adapalene (Differen) <br />0.10% <br />15 gm <br />- <br />$37.19 <br />5 <br />$185.95 <br />Azeloic acid (Azelex) <br />201%/. <br />30 gm <br />$48.52 <br />1 5 <br />$242.60 <br />