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Hydrochlorothiazide (HCTZ) 50mg tab

30

90

Amitriptyline 10mg tab

30

90

Indapamide 1.25mg tab

30

90

Amitriptyline 25mg tab

30

90

Indapamide 2.5mg tab

30

90

Amitriptyline 50mg tab

30

90

Isosorbide MononitrateER 30mg ertab

30

90

Amitriptyline 75mg tab

30

90

Isosorbide MononitrateER 60mg ertab

30

90

Amitriptyline 100mg tab

30

90

Lisinopril-HCTZ 10mg-12.5mg tab

30

90

Benztropine 2mg tab

30

90

Lisinopril-HCTZ 20mg-12.5mg tab*

30

90

Buspirone 5mg tab

60

180

Lisinopril-HCTZ 20mg-25mg tab*

30

90

Buspirone 10mg tab*

60

180

Lisinopril 2.5mg tab

30

90

Carbamazepine 200mg tab*

60

180

Lisinopril 5mg tab

30

90

Citalopram 20mg tab

30

90

Lisinopril 10mg tab

30

90

Citalopram 40mg tab

30

90

Lisinopril 20mg tab

30

90

Doxepin HCL 10mg cap

30

90

Methyldopa 250mg tab*

60

180

Doxepin HCL 25mg cap

30

90

Methyldopa 500mg tab*

30

90

Doxepin HCL 50mg cap

30

90

Metoprolol Tartrate 25mg tab

60

180

Doxepin HCL 75mg cap

30

90

Metoprolol Tartrate 50mg tab

60

180

Doxepin HCL 100mg cap

30

90

Metoprolol Tartrate 100mg tab*

60

180

Fluoxetine 10mg tab*

30

90

Nadolol 20mg tab

30

90

Fluoxetine 10mg cap

30

90

Nadolol 40mg tab

30

90

Fluoxetine 20mg cap

30

90

Nitroquick 0.3mg sublingual tab*

100

300

Fluoxetine 40mg cap

30

90

Nitroquick 0.4mg sublingual tab*

100

300

Fluphenazine 1mg tab

30

90

Pindolol 5mg tab

30

90

Haloperidol 0.5mg tab

30

90

Pindolol 10mg tab

30

90

Haloperidol 1mg tab

30

90

Prazosin HCL 1mg cap

30

90

Haloperidol 2mg tab

30

90

Prazosin HCL 2mg cap

30

90

Haloperidol 5mg tab

30

90

Prazosin HCL 5mg cap

30

90

Lithium Carbonate 300mg cap*

90

270

Propranolol 10mg tab

60

180

Nortriptyline 10mg cap

30

90

Propranolol 20mg tab

60

180

Nortriptyline 25mg cap

30

90

Propranolol 40mg tab

60

180

Paroxetine 10mg tab*

30

90

Propranolol 80mg tab

60

180

Paroxetine 20mg tab*

30

90

Sotalol HCL 80mg tab*

30

90

Prochlorperazine 10mg tab

30

90

Spironolactone 25mg tab*

30

90

Thioridazine 25mg tab

30

90

Terazosin 1mg cap

30

90

Thioridazine 50mg tab

30

90

Terazosin 2mg cap

30

90

Thiothixene 2mg cap

30

90

Terazosin 5mg cap

30

90

Trazodone 50mg tab

30

90

Terazosin 10mg cap

30

90

Trazodone 100mg tab

30

90

Triamterene-HCTZ 37.5mg-25mg cap & tab

30

90

Trazodone 150mg tab

30

90

Triamterene-HCTZ 75mg-50mg tab

30

90

Trihexyphenidyl 2mg tab

60

180

30

90

30

90

30

90

30

90

Verapamil 80mg tab Verapamil 120mg tab Warfarin 1mg tab Warfarin 2mg tab

30

90

30

90

30

90

30

90

30

90

30

90

30

90

Furosemide 20mg tab Furosemide 40mg tab Furosemide 80mg tab Guanfacine 1mg tab Hydralazine 10mg tab Hydralazine 25mg tab Hydrochlorothiazide(HCTZ)12.5mg cap* Hydrochlorothiazide (HCTZ) 25mg tab

30

90

Warfarin 5mg tab*

30

90

Warfarin 6mg tab

30

90

Warfarin 7.5mg tab

30

90

Warfarin 10mg tab

30

90

June 5, 2008

Warfarin 2.5mg tab Warfarin 3mg tab Warfarin 4mg tab

30

90

30

90

30

90

$4 Program covers up to a 30day supply of eligible drugs at commonly prescribed dosages. $10 Program covers a 90day supply of eligible drugs at commonly prescribed dosages. Prices for less than a 90day supply are prorated based on $4 Program price, not to exceed $10. Prices for more than a 90day supply are prorated based on $10 Program price. Physician permission may be required to change 30day prescription to 90day prescription. Not all drugs eligible for $4 Program are eligible for $10 Program. Certain plans, including governmentfunded programs, may not cover a 90day supply.

Prescription Program available at all WalMart, Samʹs Club & Neighborhood Markets except in ND. Only eligible drugs are covered. List may change and vary by state. Prescriptions must initially be filled in person. Refills must be picked up in store. No substitutions or mail orders. Prices may be higher in some states. Certain plans may entitle you to pay less. See Walmart.com or pharmacist for details.

  • *

    These drugs may be priced higher in CA, HI, MN, MT, PA, TN, WI, WY.

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