BISOPROLOL/HCTZ 10-6.25MG *†BUMETANIDE 0.5MG BUSPIRONE 5MG *†BUSPIRONE 10MG ZIAC® BUMEX® BUSPAR® BUSPAR® C CARBAMAZAPINE 200MG CARVEDILOL 3.125MG CARVEDILOL 6.25MG CARVEDILOL 12.5MG CARVEDILOL 25MG † CEPHALEXIN 250MG *†CEPHALEXIN 500MG Hundreds of Prescriptions for $4 30-day supply just 4 $ 90-day supply just 10 $ Pharmacy Available at Hy-Vee Food and Drugstores A GENERIC NAME ACYCLOVIR 200MG ALBUTEROL 2MG/5ML *†ALBUTEROL SULFATE NEBULIZER 0.08% ALLOPURINOL 100MG ALLOPURINOL 300MG AMITRIPTYLINE 10MG AMITRIPTYLINE 25MG AMITRIPTYLINE 50MG AMITRIPTYLINE 75MG AMITRIPTYLINE 100MG AMOXICILLIN 125MG/5ML AMOXICILLIN 125MG/5ML AMOXICILLIN 125MG/5ML AMOXICILLIN 200MG/5ML AMOXICILLIN 250MG AMOXICILLIN 250MG/5ML AMOXICILLIN 250MG/5ML *†AMOXICILLIN 400MG/5ML AMOXICILLIN 400MG/5ML *†AMOXICILLIN 400MG/5ML *†AMOXICILLIN 500MG ATENOLOL 25MG ATENOLOL 50MG ATENOLOL 100MG B BACLOFEN 10MG BENAZEPRIL 5MG BENAZEPRIL 10MG BENAZEPRIL 20MG BENAZEPRIL 40MG BENZTROPINE 2MG BENZONATATE 100MG BISOPROLOL/HCTZ 5-6.25MG PROVENTIL® 75SOLUTION (25 VIALS) 30TABLET 30TABLET 30TABLET 30TABLET 30TABLET 30TABLET 30TABLET 80SUSPENSION 100SUSPENSION 150SUSPENSION 50SUSPENSION 30CAPSULE 80SUSPENSION 100SUSPENSION 100SUSPENSION 50SUSPENSION 75SUSPENSION 30CAPSULE 30TABLET TENORMIN® 30TABLET TENORMIN® 30TABLET LIORESAL® LOTENSIN® LOTENSIN® LOTENSIN® LOTENSIN® COGENTIN® TESSALON® ZIAC® D DEXAMETHASONE 0.5MG DEXAMETHASONE 0.75MG DEXAMETHASONE 4MG DICYCLOMINE 10MG DICYCLOMINE 20MG E 30TABLET 30TABLET 30TABLET 30TABLET 30TABLET 30TABLET 14CAPSULE 30TABLET VASOTEC® VASOTEC® VASOTEC® ENALAPRIL MALEATE/HCTZ 5-12.5MGVASERETIC® ESTRADIOL 0.5MG ESTRACE® ESTRADIOL 1MG ESTRACE® ESTRADIOL 2MG ESTRACE® F FAMOTIDINE 20MG FLUCONAZOLE 150MG FLUOXETINE 10MG FLUOXETINE 10MG FLUOXETINE 20MG *†FLUOXETINE 40MG FOLIC ACID 1MG FUROSEMIDE 20MG FUROSEMIDE 40MG FUROSEMIDE 80MG G GLIMEPIRIDE 1MG GLIMEPIRIDE 2MG GLIMEPIRIDE 4MG GLIPIZIDE 5MG GLIPIZIDE 10MG *†GLYBURIDE 5MG GLYBURIDE MCR 3MG GUANFACINE 1MG H HALOPERIDOL 0.5MG HALOPERIDOL 1MG HALOPERIDOL 2MG *†HYDRALAZINE 25MG 60TABLET 60TABLET 60TABLET 60TABLET 60TABLET 28CAPSULE 30CAPSULE 473 SOLUTION 14TABLET 20TABLET 30TABLET 30TABLET 30TABLET 30TABLET 30TABLET 30TABLET DECADRON® 30TABLET DECADRON® 12TABLET DECADRON®6 TABLET BENTYL® 90CAPSULE BENTYL® 60TABLET ENALAPRIL 2.5MG †ENALAPRIL 5MG †ENALAPRIL 10MG BRAND NAME QTY FORM ZOVIRAX® 30CAPSULE PROVENTIL® 120SYRUP ZYLOPRIM® ZYLOPRIM® ELAVIL® ELAVIL® ELAVIL® ELAVIL® ELAVIL® AMOXIL® AMOXIL® AMOXIL® AMOXIL® AMOXIL® AMOXIL® AMOXIL® AMOXIL® AMOXIL® AMOXIL® AMOXIL® TENORMIN® TEGRETOL® COREG® COREG® COREG® COREG® KEFLEX® KEFLEX® CHLORHEXIDINE GLUCONATE 0.12%PERIDEX® CIPRO® CIPROFLOXACN 250MG *†CIPROFLOXACIN 500MG CIPRO® CELEXA® CITALOPRAM 20MG CITALOPRAM 40MG CELEXA® CLONIDINE 0.1MG CATAPRES® CLONIDINE 0.2MG CATAPRES® CYCLOBENZAPRINE 5MG FLEXERIL® FLEXERIL® CYCLOBENZAPRINE 10MG 30TABLET 30TABLET 60TABLET 60TABLET PEPCID® DIFLUCAN® PROZAC® PROZAC® PROZAC® PROZAC® FOLVITE® LASIX® LASIX® LASIX® 30TABLET 30TABLET 30TABLET 30 TABLET 30TABLET 30TABLET 30TABLET 60TABLET 1TABLET 30TABLET 30CAPSULE 30CAPSULE 30CAPSULE 30TABLET 30TABLET 30TABLET 30TABLET AMARYL® 30TABLET AMARYL® 30TABLET AMARYL® 30TABLET GLUCOTROL® 30TABLET GLUCOTROL® 60TABLET DIABETA® 30TABLET GLYNASE PRESTAB®30 TABLET TENEX® 30TABLET HALDOL® 30TABLET HALDOL® 30TABLET HALDOL® 30TABLET APRESOLINE®30TABLET †HYDROCHLOROTHIAZIDE 12.5MGMICROZIDE® 30 CAPSULE HYDROCHLOROTHIAZIDE 25MG HYDRODIURIL®30 TABLET HYDROCHLOROTHIAZIDE 50MG HYDRODIURIL®30 TABLET HYDROCORTISONE 1%HYTONE® 30CREAM I †IBUPROFEN 400MG IBUPROFEN 600MG IBUPROFEN 800MG INDAPAMIDE 1.25MG INDAPAMIDE 2.5MG MOTRIN® MOTRIN® MOTRIN® LOZOL® LOZOL® 90TABLET 60TABLET 30TABLET 30TABLET 30TABLET L LACTULOSE 10GM/15ML CHRONULAC® 240SYRUP LIDOCAINE VISCOUS 2% XYLOCAINE® 100SOLUTION PRINIVIL®/ZESTRIL®30 TABLET LISINOPRIL 2.5MG LISINOPRIL 5MG PRINIVIL®/ZESTRIL®30 TABLET LISINOPRIL 10MG PRINIVIL®/ZESTRIL®30 TABLET PRINIVIL®/ZESTRIL®30 TABLET LISINOPRIL 20MG LISINOPRIL/HCTZ 10-12.5MG PRINZIDE®/ 30TABLET ZESTORETIC® TABLET LISINOPRIL/HCTZ 20-12.5MG PRINZIDE®/30 ZESTORETIC® LISINOPRIL/HCTZ 20-25MG PRINZIDE®/30 TABLET ZESTORETIC® LITHIUM CARBONATE 300MG ESKALITH® 90CAPSULE LORATADINE 10MG CLARITIN® 30TABLET MEVACOR® 30TABLET *†LOVASTATIN 10MG *†LOVASTATIN 20MG MEVACOR® 30TABLET M MAGNESIUM OXIDE 400MG MAG-OX® 30TABLET MEDROXYPROGESTERONE 2.5MGPROVERA® 30 TABLET 30 TABLET MEDROXYPROGESTERONE 5MGPROVERA® MEDROXYPROGESTERONE 10MGPROVERA® 10 TABLET MELOXICAM 7.5MG MOBIC® 30TABLET MELOXICAM 15MG MOBIC® 30TABLET GLUCOPHAGE®60 TABLET METFORMIN 500MG METFORMIN 850MG GLUCOPHAGE®60 TABLET †METFORMIN 1000MG GLUCOPHAGE®60 TABLET GLUCOPHAGE XR®60 TABLET METFORMIN ER 500MG METOCLOPRAMIDE 5MG/5ML REGLAN® 60SYRUP REGLAN® 60TABLET METOCLOPRAMIDE 10MG METOPROLOL TARTRATE 25MGLOPRESSOR® 60TABLET METOPROLOL TARTRATE 50MGLOPRESSOR® 60TABLET METOPROLOL TARTRATE 100MGLOPRESSOR® 60 TABLET N *NAPROXEN 375MG NAPROXEN 500MG NATALCARE PLUS NORTRIPTYLIN 10MG P *†PAROXETINE 10MG *†PAROXETINE 20MG PENICILLIN VK 125MG/5ML PENICILLIN VK 250MG/5ML *†PENICILLIN VK 250MG PHENAZOPYRIDINE 100MG PREDNISONE 2.5MG PREDNISONE 5MG PROCHLORPERAZINE 10MG PROMETHAZINE 25MG PROMETHAZINE 6.25MG/5ML PROMETHAZINE DM PROPRANOLOL 10MG PROPRANOLOL 20MG PROPRANOLOL 40MG PROPRANOLOL 80MG NAPROSYN® 60TABLET NAPROSYN® 60TABLET STUARTNATAL®30 TABLET PAMELOR® 30CAPSULE PAXIL® 30TABLET PAXIL® 30TABLET V-CILLIN K® 100 SUSPENSION V-CILLIN K® 100 SUSPENSION VEETIDS® 28TABLET PYRIDIUM® 6TABLET DELTASONE® 30TABLET DELTASONE® 30TABLET COMPAZINE® 30TABLET PHENERGAN®12TABLET PHENERGAN® 120SYRUP PHENERGAN DM® 120SYRUP INDERAL® 60TABLET INDERAL® 60TABLET INDERAL® 60TABLET INDERAL® 60TABLET S SMZ/TMP 400-80MG BACTRIM® 28TABLET SMZ/TMP DS 800-160MG BACTRIM DS® 20 TABLET SODIUM CITRATE/CITRIC ACID BICITRA® 180 SOLUTION 30 TABLET SODIUM FLUORIDE CHEWABLE 0.25MGLURIDE® SOTALOL HCL 80MG BETAPACE® 30TABLET SPIRONOLACTONE 25MG ALDACTONE®30TABLET T TERAZOSIN 1MG TERAZOSIN 2MG TERAZOSIN 5MG TERAZOSIN 10MG *†TERBINAFINE 250MG HYTRIN® HYTRIN® HYTRIN® HYTRIN® LAMISIL® 30CAPSULE 30CAPSULE 30CAPSULE 30CAPSULE 30TABLET TIMOLOL MALEATE 0.25%TIMOPTIC® 5OPHTHALMIC DROP TRAZODONE 50MG TRAZODONE 100MG TRAZODONE 150MG †TRIAMCINOLONE 0.025% †TRIAMCINOLONE 0.10% TRIHEXYPHENIDYL 2MG V VERAPAMIL 80MG VERAPAMIL 120MG W WARFARIN 1MG WARFARIN 2.5MG WARFARIN 2MG WARFARIN 3MG WARFARIN 4MG WARFARIN 5MG †WARFARIN 6MG †WARFARIN 7.5MG †WARFARIN 10MG DESYREL® 30TABLET DESYREL® 30TABLET DESYREL® 30TABLET ARISTOCORT®15CREAM ARISTOCORT®15OINTMENT ARTANE® 60TABLET CALAN® CALAN® 30TABLET 30TABLET COUMADIN® COUMADIN® COUMADIN® COUMADIN® COUMADIN® COUMADIN® COUMADIN® COUMADIN® COUMADIN® 30TABLET 30TABLET 30TABLET 30TABLET 30TABLET 30TABLET 30TABLET 30TABLET 30TABLET *Due to state laws, these drugs are not covered under the 30-day program in MN and WI; however, they have been competitively priced. †Due to state laws, these drugs are not covered under the 90-day program in MN and WI; however, they have been competitively priced. Please ask your pharmacist for specific pricing in these states. $4 prescriptions are for up to a 30-day supply at commonly prescribed dosages. Drug list subject to change. This list was created on 2-28-14. Please visit our website at www.hy-vee.com for a current list of affected drugs and states.
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