ANTIVIRAL Generic Name Brand Name Qty Form ACYCLOVIR 200MG ZOVIRAX® 30 CAPSULE ARTHRITIS & PAIN Generic Name Brand Name Qty Form ALLOPURINOL 100MG ZYLOPRIM® 30 TABLET ALLOPURINOL 300MG ZYLOPRIM® 30 TABLET BACLOFEN 10MG LIORESAL® 30 TABLET CYCLOBENZAPRINE 5MG FLEXERIL® 30 TABLET CYCLOBENZAPRINE 10MG FLEXERIL® 30 TABLET DEXAMETHASONE 0.5MG DECADRON® 30 TABLET DEXAMETHASONE 0.75MG DECADRON® 12 TABLET DEXAMETHASONE 4MG DECADRON® 6 TABLET † IBUPROFEN 400MG MOTRIN® 90 TABLET IBUPROFEN 600MG MOTRIN® 60 TABLET IBUPROFEN 800MG MOTRIN® 30 TABLET MELOXICAM 7.5MG MOBIC® 30 TABLET MELOXICAM 15MG MOBIC® 30 TABLET * NAPROXEN 375MG NAPROSYN® 60 TABLET NAPROXEN 500MG NAPROSYN® 60 TABLET Hundreds of Prescriptions for $4 CHOLESTEROL 30-day supply just 90-day supply just Generic Name Brand Name Qty Form $ $ *† LOVASTATIN 10MG MEVACOR® 30 TABLET 4 10 *† LOVASTATIN 20MG MEVACOR® 30 TABLET COUGH & COLD Pharmacy Generic Name Brand Name Qty Form 100MG Available at Hy-Vee Food and Drugstores BENZONATATE TESSALON® 14 CAPSULE PROMETHAZINE DM PHENERGAN DM® 120 SYRUP DIABETES ALLERGY & ASTHMA Generic Name Brand Name Qty Form Generic Name Brand Name Qty Form GLIMEPIRIDE 1MG AMARYL® 30 TABLET ALBUTEROL 2MG/5ML PROVENTIL® 120 SYRUP GLIMEPIRIDE 2MG AMARYL® 30 TABLET *† ALBUTEROL GLIMEPIRIDE 4MG AMARYL® 30 TABLET SULFATE NEBULIZER 0.08% PROVENTIL® 75 SOLUTION GLIPIZIDE 5MG GLUCOTROL® 30 TABLET (25 vials) GLIPIZIDE 10MG GLUCOTROL® 60 TABLET LORATADINE 10MG CLARITIN® 30 TABLET *† GLYBURIDE 5MG DIABETA® 30 TABLET PROMETHAZINE 6.25MG/5ML PHENERGAN® 120 SYRUP GLYBURIDE MCR 3MG GLYNASE PRESTAB® 30 TABLET METFORMIN 500MG GLUCOPHAGE® 60 TABLET ANTIBIOTICS METFORMIN 850MG GLUCOPHAGE® 60 TABLET Generic Name Brand Name Qty Form † METFORMIN 1000MG GLUCOPHAGE® 60 TABLET AMOXICILLIN 125MG/5ML AMOXIL® 80 SUSPENSION METFORMIN ER 500MG GLUCOPHAGE XR® 60 TABLET AMOXICILLIN 125MG/5ML AMOXIL® 100 SUSPENSION AMOXICILLIN 125MG/5ML AMOXIL® 150 SUSPENSION AMOXICILLIN 200MG/5ML AMOXIL® 50 SUSPENSION EYE & EAR Generic Name Brand Name Qty Form AMOXICILLIN 250MG/5ML AMOXIL® 80 SUSPENSION AMOXICILLIN 250MG/5ML AMOXIL® 100 SUSPENSION TIMOLOL MALEATE 0.25% TIMOPTIC® 5 OPHTHALMIC DROP AMOXICILLIN 250MG AMOXIL® 30 CAPSULE AMOXICILLIN 400MG/5ML AMOXIL® 50 SUSPENSION *† AMOXICILLIN 400MG/5ML AMOXIL® 75 SUSPENSION GASTROINTESTINAL HEALTH *† AMOXICILLIN 400MG/5ML AMOXIL® 100 SUSPENSION Generic Name Brand Name Qty Form *† AMOXICILLIN 500MG AMOXIL® 30 CAPSULE DICYCLOMINE 10MG BENTYL® 90 CAPSULE † CEPHALEXIN 250MG KEFLEX® 28 CAPSULE DICYCLOMINE 20MG BENTYL® 60 TABLET *† CEPHALEXIN 500MG KEFLEX® 30 CAPSULE FAMOTIDINE 20MG PEPCID® 60 TABLET CIPROFLOXACN 250MG CIPRO® 14 TABLET LACTULOSE 10GM/15ML CHRONULAC® 240 SYRUP *† CIPROFLOXACIN 500MG CIPRO® 20 TABLET METOCLOPRAMIDE 5MG/5ML REGLAN® 60 SYRUP PENICILLIN VK 125MG/5ML V-CILLIN K® 100 SUSPENSION METOCLOPRAMIDE 10MG REGLAN® 60 TABLET PENICILLIN VK 250MG/5ML V-CILLIN K® 100 SUSPENSION PHENAZOPYRIDINE 100MG PYRIDIUM® 6 TABLET *† PENICILLIN VK 250MG VEETIDS® 28 TABLET PROMETHAZINE 25MG PHENERGAN® 12 TABLET SMZ/TMP 400-80MG BACTRIM® 28 TABLET SODIUM CITRATE/CITRIC ACID BICITRA® 180 SOLUTION SMZ/TMP DS 800-160MG BACTRIM DS® 20 TABLET ANTIFUNGAL Generic Name Brand Name Qty Form FLUCONAZOLE 150MG DIFLUCAN® 1 TABLET *† TERBINAFINE 250MG LAMISIL® 30 TABLET HEART HEALTH MENTAL HEALTH Generic Name Brand Name Qty Form Generic Name Brand Name Qty Form ATENOLOL 25MG TENORMIN® 30 TABLET BUSPIRONE 5MG BUSPAR® 60 TABLET ATENOLOL 50MG TENORMIN® 30 TABLET *† BUSPIRONE 10MG BUSPAR® 60 TABLET ATENOLOL 100MG TENORMIN® 30 TABLET CITALOPRAM 20MG CELEXA® 30 TABLET CITALOPRAM 40MG CELEXA® 30 TABLET BENAZEPRIL 5MG LOTENSIN® 30 TABLET FLUOXETINE 10MG PROZAC® 30 TABLET BENAZEPRIL 10MG LOTENSIN® 30 TABLET FLUOXETINE 10MG PROZAC® 30 CAPSULE BENAZEPRIL 20MG LOTENSIN® 30 TABLET FLUOXETINE 20MG PROZAC® 30 CAPSULE BENAZEPRIL 40MG LOTENSIN® 30 TABLET *† FLUOXETINE 40MG PROZAC® 30 CAPSULE BISOPROLOL/HCTZ 5-6.25MG ZIAC® 30 TABLET LITHIUM CARBONATE 300MG ESKALITH® 90 CAPSULE BISOPROLOL/HCTZ 10-6.25MG ZIAC® 30 TABLET NORTRIPTYLIN 10MG PAMELOR® 30 CAPSULE *† BUMETANIDE 0.5MG BUMEX® 30 TABLET *† PAROXETINE 10MG PAXIL® 30 TABLET CARVEDILOL 3.125MG COREG® 60 TABLET *† PAROXETINE 20MG PAXIL® 30 TABLET CARVEDILOL 6.25MG COREG® 60 TABLET PROCHLORPERAZINE 10MG COMPAZINE® 30 TABLET CARVEDILOL 12.5MG COREG® 60 TABLET TRAZODONE 50MG DESYREL® 30 TABLET CARVEDILOL 25MG COREG® 60 TABLET TRAZODONE 100MG DESYREL® 30 TABLET CLONIDINE 0.1MG CATAPRES® 30 TABLET TRAZODONE 150MG DESYREL® 30 TABLET CLONIDINE 0.2MG CATAPRES® 30 TABLET TRIHEXYPHENIDYL 2MG ARTANE® 60 TABLET ENALAPRIL 2.5MG VASOTEC® 30 TABLET † ENALAPRIL 5MG VASOTEC® 30 TABLET † ENALAPRIL 10MG VASOTEC® 30 TABLET OTHER ENALAPRIL MALEATE/HCTZ 5-12.5MG VASERETIC® 30 TABLET Generic Name Brand Name Qty Form FUROSEMIDE 20MG LASIX® 30 TABLET CHLORHEXIDINE GLUCONATE 0.12% PERIDEX® 473 SOLUTION FUROSEMIDE 40MG LASIX® 30 TABLET LIDOCAINE VISCOUS 2% XYLOCAINE® 100 SOLUTION FUROSEMIDE 80MG LASIX® 30 TABLET PREDNISONE 2.5MG DELTASONE® 30 TABLET GUANFACINE 1MG TENEX® 30 TABLET PREDNISONE 5MG DELTASONE® 30 TABLET *† HYDRALAZINE 25MG APRESOLINE® 30 TABLET † HYDROCHLOROTHIAZIDE 12.5MG MICROZIDE® 30 CAPSULE HYDROCHLOROTHIAZIDE 25MG HYDRODIURIL® 30 TABLET SKIN CONDITIONS HYDROCHLOROTHIAZIDE 50MG HYDRODIURIL® 30 TABLET Generic Name Brand Name Qty Form LISINOPRIL 2.5MG PRINIVIL®/ZESTRIL® 30 TABLET HYDROCORTISONE 1% HYTONE® 30 CREAM LISINOPRIL 5MG PRINIVIL®/ZESTRIL® 30 TABLET † TRIAMCINOLONE 0.025% ARISTOCORT® 15 CREAM LISINOPRIL 10MG PRINIVIL®/ZESTRIL® 30 TABLET † TRIAMCINOLONE 0.10% ARISTOCORT® 15 OINTMENT LISINOPRIL 20MG PRINIVIL®/ZESTRIL® 30 TABLET LISINOPRIL/HCTZ 10-12.5MG PRINZIDE®/ 30 TABLET VITAMINS & SUPPLEMENTS ZESTORETIC® Generic Name Brand Name Qty Form LISINOPRIL/HCTZ 20-12.5MG PRINZIDE®/ 30 TABLET FOLIC ACID 1MG FOLVITE® 30 TABLET ZESTORETIC® MAGNESIUM OXIDE 400MG MAG-OX® 30 TABLET LISINOPRIL/HCTZ 20-25MG PRINZIDE®/ 30 TABLET SODIUM FLUORIDE CHEWABLE 0.25MG LURIDE® 30 TABLET ZESTORETIC® METOPROLOL TARTRATE 25MG LOPRESSOR® 60 TABLET WOMEN’S HEALTH METOPROLOL TARTRATE 50MG LOPRESSOR® 60 TABLET Generic Name Brand Name Qty Form METOPROLOL TARTRATE 100MG LOPRESSOR® 60 TABLET ESTRADIOL 0.5MG ESTRACE® 30 TABLET PROPRANOLOL 10MG INDERAL® 60 TABLET ESTRADIOL 1MG ESTRACE® 30 TABLET PROPRANOLOL 20MG INDERAL® 60 TABLET ESTRADIOL 2MG ESTRACE® 30 TABLET PROPRANOLOL 40MG INDERAL® 60 TABLET MEDROXYPROGESTERONE 10MG PROVERA® 10 TABLET PROPRANOLOL 80MG INDERAL® 60 TABLET SOTALOL HCL 80MG BETAPACE® 30 TABLET *Due to state laws, these drugs are not covered under the 30-day program in MN SPIRONOLACTONE 25MG ALDACTONE® 30 TABLET and WI; however, they have been competitively priced. TERAZOSIN 1MG HYTRIN® 30 CAPSULE †Due to state laws, these drugs are not covered under the 90-day program in MN TERAZOSIN 2MG HYTRIN® 30 CAPSULE and WI; however, they have been competitively priced. TERAZOSIN 5MG HYTRIN® 30 CAPSULE Please ask your pharmacist for specific pricing in these states. TERAZOSIN 10MG HYTRIN® 30 CAPSULE VERAPAMIL 80MG CALAN® 30 TABLET $4 prescriptions are for up to a 30-day supply at commonly prescribed dosages. Drug list subject to change. This list was created on7-15-14. Please visit our website VERAPAMIL 120MG CALAN® 30 TABLET at www.hy-vee.com for a current list of affected drugs and states. WARFARIN 1MG COUMADIN® 30 TABLET WARFARIN 2MG COUMADIN® 30 TABLET WARFARIN 2.5MG COUMADIN® 30 TABLET WARFARIN 3MG COUMADIN® 30 TABLET WARFARIN 4MG COUMADIN® 30 TABLET WARFARIN 5MG COUMADIN® 30 TABLET † WARFARIN 6MG COUMADIN® 30 TABLET † WARFARIN 7.5MG COUMADIN® 30 TABLET *† WARFARIN 10MG COUMADIN® 30 TABLET