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 250MG/5ML | AMOXIL® | 80 | SUSPENSION |
| AMOXICILLIN 250MG/5ML | AMOXIL® | 100 | 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 |
| † CEPHALEXIN 250MG | KEFLEX® | 28 | CAPSULE |
| † CEPHALEXIN 500MG | KEFLEX® | 30 | CAPSULE |
| CIPROFLOXACN 250MG | CIPRO® | 14 | TABLET |
| *† CIPROFLOXACIN 500MG | CIPRO® | 20 | TABLET |
| DOXYCYCLINE HYC 50MG | VIBRAMYCIN® | 30 | CAPSULE |
| DOXYCYCLINE HYC 100MG | VIBRA-TABS® | 20 | TABLET |
| DOXYCYCLINE HYC 100MG | VIBRAMYCIN® | 20 | CAPSULE |
| ISONIAZID 300MG | NYDRAZID® | 30 | TABLET |
| PENICILLIN VK 125MG/5ML | V-CILLIN K® | 100 | SUSPENSION |
| PENICILLIN VK 250MG/5ML | V-CILLIN K® | 100 | SUSPENSION |
| *† PENICILLIN VK 250MG | VEETIDS® | 28 | TABLET |
| SMZ/TMP 400-80MG | BACTRIM® | 28 | TABLET |
| SMZ/TMP DS 800-160MG | BACTRIM DS® | 20 | TABLET |
| TETRACYCLINE 250MG | ACHROMYCIN® | 60 | CAPSULE |
| † TETRACYCLINE 500MG | ACHROMYCIN® | 60 | CAPSULE |
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