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Mag 64 64mg tab* Magnesium Oxide 400mg tab Natalcare Pic tab* Natalcare Plus tab* Potassium Chloride 10% liquid Prenatal Rx tab*

60 30 30 30 473ml 30

180 90 90 90 1419ml N/A

Estradiol 0.5mg tab Estradiol 1mg tab Estradiol 2mg tab Estropipate 0.75mg tab Estropipate 1.5mg tab* MedroxyprogesteroneAcetate 2.5mg tab Medroxyprogesterone Acetate 5mg tab Medroxyprogesterone Acetate 10mg tab

30 30 30 30 30 30 30 10

90 90 90 90 90 90 90 30

Alendronate SOD 35mg tab Alendronate SOD 70mg tab Clomiphene 50mg tab EST Estrogen/Methyl Testost DS tab EST Estrogen/Methyl Testost HS tab Sprintec 28-day tab* Tri-Sprintec 28-day tab* Tamoxifen 10mg tab Tamoxifen 20mg tab

4 4 5 30 30 28 28 60 30

12 12 15 90 90 N/A N/A 180 90

Chlorhexidine Gluconate 0.12% solution Hydrocortisone AC 25mg suppositories Isoniazid 300mg tab Lidocaine 2% viscous solution Megestrol 20mg tab* Methylpred 4mg dose pak Methylpred 4mg tab Oxybutynin 5mg tab Phenazopyridine 100mg tab Phenazopyridine 200mg tab Prednisone 2.5mg tab Prednisone 5mg tab Prednisone 5mg dose pak Prednisone 5mg dose pak* Prednisone 10mg tab Prednisone 10mg dose pak Prednisone 10mg dose pak* Prednisone 20mg tab

473ml 12 30 100ml 30 21 21 60 6 30 30 30 21 48 30 21 48 30

1419ml 36 90 300ml 90 63 63 180 18 90 90 90 63 144 90 63 N/A 90

June 5, 2008

Acyclovir 200mg cap

30

90

Benzoyl Peroxide 4% creamy wash*

171ml

N/A

Betamethasone Dipropionate 0.05% cream

15gm

45gm

Betamethasone Dipropionate 0.05% cream

45gm

135gm

Betamethasone Valerate 0.1% cream

15gm

45gm

Betamethasone Val. 0.1% cream

45gm

135gm

Betamethasone Val. 0.1% ointment

15gm

45gm

Betamethasone Val. 0.1% ointment

45gm

135gm

Fluocinolone Acet. 0.01% solution

60ml

180ml

Fluocinonide 0.05% cream

15gm

45gm

Fluocinonide 0.05% cream

30gm

90gm

Gentamicin 0.1% cream

15gm

45gm

Gentamicin 0.1% ointment

15gm

45gm

Hydrocortisone 1% cream

30gm

90gm

Hydrocortisone 2.5% cream

30gm

90gm

Selenium Sulfide 2.5% lotion*

120ml

360ml

Silver Sulfadiazine 1% cream*

50gm

150gm

Triamcinolone 0.025% cream

15gm

45gm

Triamcinolone 0.025% cream

80gm

240gm

Triamcinolone 0.1% cream

15gm

45gm

Triamcinolone 0.1% cream

80gm

240gm

Triamcinolone 0.1% ointment

15gm

45gm

Triamcinolone 0.1% ointment

80gm

240gm

Triamcinolone 0.5% cream

15gm

45gm

30

90

30

90

30

90

30

90

30

90

30

90

30

90

30

90

30

90

30

90

30

90

120

N/A

30

90

30

90

30

90

30

90

Levothyroxine 25mcg tab Levothyroxine 50mcg tab Levothyroxine 75mcg tab Levothyroxine 88mcg tab Levothyroxine 100mcg tab Levothyroxine 112mcg tab Levothyroxine 125mcg tab Levothyroxine 137mcg tab Levothyroxine 150mcg tab Levothyroxine 175mcg tab* Levothyroxine 200mcg tab*

Ethedent 0.25mg chewable* Folic Acid 1mg tab Klorcon 8 8mEq ER tab Klorcon 10 10mEq ER tab Klorcon M10 10mEq tab

$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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