Antibiotics
*Due to state laws, these drugs are not covered under the 30-day program in MN and WI; however, they have been competitively priced. Please ask your pharmacist for specific pricing in these states.
†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. List subject to change.
| GENERIC NAME | BRAND NAME | QTY | FORM |
| AMOXICILLIN 125MG/5ML | AMOXIL® | 80 | SUSPENSION |
| AMOXICILLIN 125MG/5ML | AMOXIL® | 100 | SUSPENSION |
| AMOXICILLIN 125MG/5ML | AMOXIL® | 150 | SUSPENSION |
| AMOXICILLIN 200MG/5ML | AMOXIL® | 50 | SUSPENSION |
| *† AMOXICILLIN 200MG/5ML | AMOXIL® | 75 | SUSPENSION |
| *† AMOXICILLIN 200MG/5ML | AMOXIL® | 100 | SUSPENSION |
| AMOXICILLIN 250MG/5ML | AMOXIL® | 80 | SUSPENSION |
| AMOXICILLIN 250MG/5ML | AMOXIL® | 100 | SUSPENSION |
| AMOXICILLIN 250MG/5ML | AMOXIL® | 150 | SUSPENSION |
| AMOXICILLIN 250MG | AMOXIL® | 30 | CAPSULE |
| AMOXICILLIN 400MG/5ML | AMOXIL® | 50 | SUSPENSION |
| *† AMOXICILLIN 400MG/5ML | AMOXIL® | 75 | SUSPENSION |
| *† AMOXICILLIN 400MG/5ML | AMOXIL® | 100 | SUSPENSION |
| *† AMOXICILLIN 500MG | AMOXIL® | 30 | CAPSULE |
| AMOXICILLIN PEDIATRIC 50MG/ML | AMOXIL® | 30 | DROP |
| *† AMOXICILLIN CHEW 125MG | AMOXIL® | 42 | TABLET |
| AMOXICILLIN CHEW 250MG | AMOXIL® | 30 | TABLET |
| CEPHALEXIN 250MG | KEFLEX® | 28 | CAPSULE |
| † CEPHALEXIN 500MG | KEFLEX® | 30 | CAPSULE |
| CIPROFLOXACN 250MG | CIPRO® | 14 | TABLET |
| CIPROFLOXACIN 500MG | CIPRO® | 20 | TABLET |
| CIPROFLOXACN 750MG | CIPRO® | 14 | TABLET |
| CLINDAMYCIN 150MG | CLEOCIN® | 28 | CAPSULE |
| DOXYCYCLINE HYC 50MG | VIBRAMYCIN® | 30 | CAPSULE |
| DOXYCYCLINE HYC 100MG | VIBRA-TABS® | 20 | TABLET |
| DOXYCYCLINE HYC 100MG | VIBRAMYCIN® | 20 | CAPSULE |
| ERYTHROMYCIN OPTHALMIC | ILOTYCIN® | 4 | OINTMENT |
| ERYTHROMYCIN 2% | T-STAT® | 60 | SOLUTION |
| *† ERYTHROMYCIN BASE 250MG | | 56 | TABLET |
| ERYTHROMYCIN EC 250MG | ERYC® | 28 | CAPSULE |
| *† ERYTHROMYCIN ST 250MG | ERYTHROCIN® | 40 | TABLET |
| *† ERYTHROMYCIN ST 500MG | ERYTHROCIN® | 40 | TABLET |
| ISONIAZID 300MG | NYDRAZID® | 30 | TABLET |
| METRONIDAZOLE 250MG | FLAGYL® | 28 | TABLET |
| METRONIDAZOLE 500MG | FLAGYL® | 14 | TABLET |
| PENICILLIN VK 125MG/5ML | V-CILLIN K® | 100 | SUSPENSION |
| PENICILLIN VK 125MG/5ML | V-CILLIN K® | 200 | SUSPENSION |
| PENICILLIN VK 250MG/5ML | V-CILLIN K® | 100 | SUSPENSION |
| PENICILLIN VK 250MG/5ML | V-CILLIN K® | 200 | SUSPENSION |
| PENICILLIN VK 250MG | VEETIDS® | 28 | TABLET |
| *† PENICILLIN VK 500MG | V-CILLIN K® | 40 | TABLET |
| SMZ/TMP 400-80MG | BACTRIM® | 28 | TABLET |
| SMZ/TMP DS 800-160MG | BACTRIM DS® | 20 | TABLET |
| *† SMZ/TMP PEDIATRIC 200-40MG/5ML | BACTRIM PED® | 120 | SUSPENSION |
| TETRACYCLINE 250MG | ACHROMYCIN® | 60 | CAPSULE |
| TETRACYCLINE 500MG | ACHROMYCIN® | 60 | CAPSULE |
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