Item F1 BANDAGE SELF-ADHERANT 3" ACE 3.49 F10 DIAPER

NAME (NOMBRE)
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ADDRESS (DIRECCIÓN)
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MEMBER ID ( NUMERO DE MEMBRESIA)
Antacids / Digestion / Laxatives
Item (Antiácidos
/ Digestión / Laxantes)
Qty
Brand
Marca
A1 EFFERVESCENT PAIN RELIEF 36 ct ALKA-SELTZER
A4 CALCIUM ANTACID ES TABLETS (MIXED FRUIT) 96 ct TUMS
A7
RANITIDINE 75MG
30 ct ZANTAC
A8
ANTIACID TABS
100 ct MYLANTA
A13 ANTACID/ANTI GAS CHEWABLE TABS 90 CT MAALOX
A14 HEARTBURN RELIEF TABS 30 CT PEPCID ACID
A15
DRAMAMINE TABLETS
20 CT DRAMAMINE
L1
BISACODYL TABS
100 ct DULCOLAX
L2
STOOL SOFTENER
60 ct COLACE
L11
COLON CLEANSER
120 CT
L4 NATURAL VEGETABLE LAXATIVE 100 ct SENOKOT
L5
CASCARA SAGRADA
90 ct
L6 GLYCERIN SUPPOSITORIES ADULT 25 ct FLEET
L7
FIBER CAPSULES
160 ct METAMUCIL
L13
ENEMA SINGLE
1 ct
Q1 ANTI-DIARRHEAL TABLETS 18 ct IMODIUM
Q3 PINK BISMUTH TABLETS CHEWABLE 30 ct PEPTO-BISMOL
Q4
GAS RELIEF E/S
30 ct GAS X
Q8 LITTLE TUMMY GAS RELIEF
1OZ
Pain Relievers (Analgésicos)
P1 IBUPROFEN TABS 200MG 50 ct ADVIL
P11 NON-ASPIRIN CHEW 80MG 30 ct TYLENOL
P12 CHILDREN'S IBUPROFEN SUSPENSION
4OZ MOTRIN
P13 NON-ASPIRIN SUSPENSION CHERRY 4 oz TYLENOL
P14 HOT AND COLD PATCHES
5 ct ICY HOT
P17 MIGRAINE RELIEF CAPLETS 100 ct EXCEDRIN MGRN
P19
NAPROXEN 220MG
100 ct ALEVE
P20 GLUCOSE CHEWABLE TABLETS ORANGE 10 ct DEX 4
P2
ASPIRIN 325MG
100 ct BAYER
100 ct BAYER
P9
ASPIRIN COATED
P3 ENTERIC ASPIRIN 325MG 100 ct ECOTRIN
P4 LOW-DOSE ASPIRIN ENTERIC COATED 120 ct ECOTRIN
P44 THERAPEUTIC BLUE GEL
4 oz MINERAL ICE
P45 ACETAMINOPHIN PAIN RELIEVER 24 CT TYLENOL PM
P6 ACETAMINOPHEN 500MG TABLETS 100 ct TYLENOL
P8 CHEWABLE ASPIRIN 81MG 36 ct BAYER
Cough / Cold / Allergy (Tos / Catarros / Alergia)
C1
NASAL SPRAY REGULAR
1 oz
AFRIN
C10
LORATIDINE 10MG
10 ct CLARITIN
C11 SORE THROAT LOZENGES 18 ct CHLORASEPTIC
C12
TUSSIN EXPECTORANT
4 oz ROBITUSSIN
C13
TUSSIN DM
4 oz ROBITUSSIN DM
C14 MAPAP COLD MULTI SYMPTOM MAJOR 24 ct TYLENOL COLD
C16 NASAL DECONGESTANT PSEUDO FREE 18 ct SUDAFED PE
C19 CHEST CONGESTANT RELIEF 400MG 50 ct MUCINEX
C20 CHILLDREN’S ALLERGY ELIXIR NON PSEUDO 4oz BENADRYL
C2
ALLERGY CAPSULES
24 ct BENADRYL
C24 DAYTIME PE SOFTGELS
12 ct VICK'S DAYQUIL
4 oz ROBITUSSIN
C35
TUSSIN SUGAR FREE
C52 SALINE NASAL SPRAY 1.5 + 33% 1.5 oz OCEAN
C53 CETIRIZINE 10MG TABLETS 14 ct ZYERTC
C54 SINUS CONGESTION & PAIN NIGHTTIME (PE) 12 ct VICK'S NYQUIL
C55 ALLERGY DIPHENHYDRAMINE (LIQUID) 4 OZ BENADRYL
C56 SINUS ACETAMENOPHIN 24 CT TYLENOL SINUS
C57
SORE THROAT SPRAY
6 OZ CHLORASEPTIC
C7
MEDICATED CHEST RUB 3.5 oz VICK'S VAPORUB
Ear and Eye Care (Cuidado de la vista y Oido)
E1
E2
E3
X16
ARTIFICIAL TEARS
EYE DROPS
EARACHE DROPS
EAR WAX DROP
1/2 oz TEARS NATURALE
.5 oz
VISINE
.4 oz SIMILISAN
.5 oz MURINE
Price
Precio
4.49
3.99
7.99
6.49
4.99
6.99
3.99
8.99
6.99
7.99
10.99
5.99
3.49
10.99
1.99
5.49
3.99
4.49
$8.99
4.49
4.49
$6.99
3.49
6.99
7.49
7.99
2.49
2.49
1.99
5.49
5.49
3.99
$3.99
6.99
3.99
4.49
7.99
3.49
4.49
4.49
3.99
4.49
9.49
4.49
3.49
4.49
4.49
3.49
9.99
4.49
4.49
4.99
3.99
4.99
4.49
3.49
7.99
4.49
PHONE (TELEFONO)
First Aid / Personal Care
Brand
Price
Qty
Item Primeros
Auxilios / Cuidado Personal
Marca
Precio
F1 BANDAGE SELF-ADHERANT 3"
ACE
3.49
F10 DIAPER RASH OINTMENT
2 oz DESITIN 3.99
F11
ANTI-ITCH CREAM
1 oz BENADRYL 3.49
F2
MUSCLE RUB
4 oz BEN-GAY 5.49
F21
IODINE
1 oz
1.99
F22
MERCUROCHROME
1 oz
2.49
F24
FIRST-AID KIT
Each
J&J
6.99
F29
ANTI-ITCH GEL
4 oz BENADRYL 4.99
F34 HOT/COLD MULTI-COMPRESS 1 ct
4.99
F4
CALAMINE LOTION
6 oz CALADRYL 2.49
F5 HYDROCORTISONE CREAM 1% 1 oz CORTAID 4.99
5 yd
F62
FIRST AID TAPE
J&J
1.99
F64
BENZOYL PEROXIDE 10%
1 oz OXY BALANCE 3.99
F7 TRIPLE ANTIBIOTIC OINTMENT .5 oz NEOSPORIN 4.49
F61 TRIPLE ANTIBIOTIC OINTMENT PLUS 1 oz NEOSPORIN PLUS 6.99
F9 CLEAR PLASTIC BANDAGES 30 ct BAND AID 2.49
X71 *BLOOD PRESURE MONITOR SEMI DIGITAL 1 ct
24.99
X72 *BLOOD PRESSURE MONITOR 1 ct
17.99
X18
VITAMIN E CREAM
4 oz
4.49
M45
ALCOHOL PREP PADS
100CT
$3.99
M52 BENZOCAINE TOPICAL (COLD SORES)
1 OZ ANBESOL GEL $5.99
GAUZE
2”
J&J
1.89
M53
Dental (Dental)
X2
DENTURE TABS
40 ct EFFERDENT 5.49
X6 DENTURE ADHESIVE REGULAR 2.5 oz FIXODENT 4.99
M2
TOOTHBRUSH
1 pk
0.99
J&J
M35 DENTAL FLOSS WAXED 100 yd
1.99
Anti-Hemorrhoidals (Contra Hemorroides)
H2 HEMORRHOIDAL SUPPOSITORIES 12 CT PREPARATION H $4.99
H3 HEMORROIDAL OINTMENT 2 oz PREPARATION H 6.49
Anti-Fungals (Antimicóticos)
O1
CLOTRIMAZOLE
1 oz LOTRIMIN 9.99
O2
TOLNAFTATE
1 oz TINACTIN 5.99
Miscellaneous / Sunscreen Lotion (Misceláneo / Loción Protectora Del Sol)
M11
SKIN POWDER
4OZ
J&J
$1.99
M12
BABY WIPES
20CT
J&J
$1.99
F35 MEDICATED CALLUS REMOVER 1CT DR. SCHOLLS $3.49
M23
HAND SANITIZER
2OZ
PUREL $1.49
M43
SQUARE TWEEZERS
1CT
$0.99
M44
NAIL CLIPPER
1CT
$1.99
M48
OIL OF BEAUTY
6OZ
OLAY
$5.99
M50
LUBRICATING JELLY
4OZ
K-Y
$4.49
M51
7 DAY PILL BOX
EACH
APEX
$1.99
M30
MICONAZOLE NITRATE
1 APL MONISTAT 7 $6.99
M37 PREGNANCY STICK SINGLE
1CT
E.P.T
$7.99
X54 RIBBED LUBRICATED CONDOM 12CT TROJAN $8.99
X74 BLADDER CONTROL PADS SUPER 20CT
POISE
$5.99
X75 ADULT UNDERWEAR SMALL/MEDIUM 20CT
POISE $12.99
X76 ADULT UNDERWEAR LARGE 18CT
POISE $12.99
X77 ADULT UNDERWEAR X-LARGE 16CT
POISE $12.99
M1
SUNSCREEN SPF 30
4OZ COPPERTONE $3.99
M46
AZO URINARY RELIEF
12TABS AZO STANDARD $4.99
M6
SLEEP AID
16CT SOMINEX $3.99
M3
LIP BALM
.35 oz CHAP STICK 1.19
M39 INSOLES AIR FOAM MENS
1 PR DR. SCHOLL'S $1.99
M40 INSOLES AIR FOAM WOMENS 1 PR DR. SCHOLL'S $1.99
M41 STANDARD EMERY BOARDS 10CT
$0.99
M42
NAIL CARE STICKS
1CT
$0.99
X80
MAXI REGULAR
24CT ALWAYS $3.49
X82
TAMPON PLASTIC
20CT TAMPAX PEARL $3.99
X71 *BLOOD PRESURE MONITOR SEMI DIGITAL 1CT
$24.99
X72 *BLOOD PRESSURE MONITOR 1CT OMRON $17.99
C8
THERMOMETER DIGITAL
1CT
APEX
$4.99
(1) PER ORDER • *L
DE (1) POR ORDEN
1OÍ MZI TE LOTRIMIN
O1 ANTI-FUNGAL *L
CRIEAMIMT(CLOTRIMAZOLE)
$9.99
Medicines, ointments and sprays with active medical ingredients that cure, diminish or remove symptoms
Medicamentos, ungüentos y aerosol con ingredientes medicinales activos que curan o eliminan los síntomas
YOU WILL RECEIVE THE GENERIC EQUIVALENT OF ALL ITEMS.
USTED RECIBIRÁ EL GENÉRICO DE TODOS LOS PRODUCTOS.
__
Vitamins / Minerals (Vitamins / Minerales)
V1 B-COMPLEX VITAMIN 100% RDA
V10 GLUCOSAMIN/CHONDROITIN
V11
CALCIUM 500 MG +D
V14
A 10,000 IU NATURAL
100 ct
50 ct
75 ct CITRACAL
100 ct NATURE'S BOUNTY
V15 CHEWABLE MULTIVITAMINS
V16
VITAMIN E 400 IU
V17
FOLIC ACID 800MCG
V18
IRON SUPPLEMENT
V19 OMEGA-3 FISH OIL 1000MG
V2
VITAMIN C 500MG
V21
URINOZINC CAPSULES
V22
COLLAGEN 500MG
V20 SOYA LECITHIN 1200MG
100 ct FLINSTONES 6.99
100 ct
11.99
100 ct
2.99
100 ct
5.49
100 ct PURITAN 7.49
100 ct
5.99
60 ct
14.99
100 ct BOTANIC CHOICE 8.49
100 ct
6.99
V26
VITAMIN D 400 IU
V3 CALCIUM CARBONATE + D
V4
CAT'S CLAW 350MG
V5
COENZYME Q-10 10MG
V6
DAILY MULTI VITAMIN
V7 COMPLETE SENIOR VITAMINS
V8
ECHINACEA 400 MG
V9
GINGKO BILOBA 400MG
V32
VITAMIN D 1,000 IU
V33 VITAMIN B-12 1000 MCG
V34 RESVERATOL XTRA FORMULA 30 CAPS
MAGNESIUM 500 MG
V35
V36 ZINC GLUCONATE 50 MG CHELATED
V38
CO-Q10 30MG 90 CT
V40
SELENIUM 50MCG
V44
PROSIGHT VITAMIN
4.49
10.99
5.49
4.49
100 ct
60 ct CALTRATE
60 ct
30 ct NATURE'S BOUNTY
100 ct ONE A DAY
100 ct CENTRUM SLVR
60 ct
50 ct
100 CT
100 CT
30 CT
100 CT
100 CT
90 CT
100 CT NATURE'S BOUNTY
60 CT OCUVITE
2.99
4.49
5.49
5.49
4.99
9.99
7.49
6.49
3.49
8.49
4.99
3.99
4.49
9.99
4.49
$6.99
Must consult with Primary Care Physician prior to ordering a dual-purpose item.
Debe consultar con su médico de cabecera antes de ordenar un producto de doble propósito.
Over-the-Counter Drug Catalog Program $25 Benefit
Over-the-Counter Catálogo de Beneficios de $25 Mensual
UNITED HEALTHCARE. is pleased to provide its members with the Over-theCounter (OTC) Drug Catalog Program. This is a convenient way to get OTC
drugs and supplies by mail through your UNITED HEALTHCARE OTC benefit.
UNITED HEALTHCARE se complace en proveer a sus miembros el Programa de
Catálogo de Medicinas Sin Receta. Esta es una forma conveniente de recibir por
correo sus medicamentos y suministros sin receta medica a través de su
beneficio de UNITED HEALTHCARE
Your Case Manager is happy to assist you in ordering any Over-the-Counter
items on this list you need. Please contact your Case Manager at:
HOW TO ORDER BY MAIL:
1. Clearly write your name, address, telephone number and member ID in
the space at the top of the form. Your shipping address must be the same
as the address in your member record. We cannot fill your order if your
address is not the same.
2. Check (√) items you want on the order form that add up to $25 or less.
Your benefit limit is $25 every month. If you order more than $25, you
will receive the first $25 of items on your order.
3. Fold and seal the form with tape.
Su Administrador de Casos con mucho gusto le ayudará a pedir cualquiera de los
artículos de venta libre que usted necesita en esta lista.
Por favor, póngase en contacto con su Administrador de Casos designado.
COMO ORDENAR POR CORREO:
1. Escriba claramente su nombre, dirección, numero de teléfono y numero de
socio en el espacio indicado. Su dirección de envio debe coincidir con la di
rección que tenemos en su archivo de afiliación. No se completarán las
solicitudes en los casos en que no coincidan las direcciónes.
2 Seleccione artículos que sumen hasta $25 o menos. Su beneficio tiene un
limite de $25 cada mes. Si excede este limite, recibirá automáticamente sólo
aquellos artículos que sumen un total de $25 o menos.
3. Doble y selle el formulario con cinta adhesiva.
4. Place a first class postage stamp on the address side (out-side) of
the form and mail.
4. Coloque una estampilla de Primera Clase en la parte de afuera de este
formulario.
ORDER BY PHONE:
To place your order by phone, call 1-888-628-2770 from 9 a.m. to 5 p.m. E.S.T.
Monday through Friday.
POR TELEFONO:
Para colocar su orden llame al 1-888-628-2770 de 9 a.m. a 5 p.m., Hora del Este
Lunes a Viernes.
ORDER BY FAX:
Fax the completed order form to 1-866-682-6733 any time.
ORDER ONLINE: uhc.otchs.com
POR FAX:
Envie su forma por fax al 1-866-682-6733 a cualquier hora.
POR INTERNET: uhc.otchs.com
PICK UP AT ANY OF THE NAVARRO DISCOUNT PHARMACIES STORES
RECOJA EN CUALQUIERA DE LAS FARMACIAS NAVARRO.
Name:
Address:
City:
State:
Zip:
OTC Health Solutions
9400 NW 104 Street
Medley, FL 33178
AHCA-B-N-1/15-8/18-300

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