Noblesville Booklet 8.5.22

95

NEW FORMULAS
ADDED!!

FORMULAS OF THE MONTH

Tofacitinb 2% cream
Cidofovir 1% adhesive gel
Monobenzone 20% cream
Dibutyl liq squarate 2% solution
Sirolimus 1% ointment
Glycopyrrolate topical spray 1%
Fluorouracil 5%/calcipotriene 0.005% 1:1 cream (AK)
Cholesterol 2%/Lovastatin 2% ointment (DSAP)

ABOUT US

Noblesville Low Cost Pharmacy is always coming up
with new ways to create customized medications to
meet your patient's needs. We now have access to
many different compounded products for skincare
that has precisely customized combinations,
strengths, and dosages to meet the unique needs of
every one of your patients.

SENDING RX
Prescriber can:
Call (317) 231-5252
Fax (317) 900-7458
E-scribes ID (0310207788)

CALLING PATIENT
Pharmacy team member calls
patient to verify demographics
and allergies.

SENDING RX
Order will be shipped within
24 hours

1

Acne Nail Fungus
Actinic Keratosis Oral Mucositis
Anesthetic Porokeratosis
Anti-Aging Radiation Burns
Dry, Cracking Skin Raynaud's Phenomenon
Eczema/Psoriasis Rosacea
Facial Peels Scars
Hair Loss Seborhheic Dermatitis
Hirsutism Shingles
Hyperhidrosis Skin Bleaching
Itching Stretch Marks
Keratosis Pilaris Vitiligo
Lamellar Ichythiosis Warts
LDN Wounds/Burns

2

Bases & Vehicles

Vanishing Cream | Propylene Glycol Free
Aqua / water / eau, glycerin, cetearyl alcohol, caprylic/capric Triglyceride, cetyl alcohol, ceteareth-20,
petrolatum, potassium Phosphate, ceramide np, ceramide ap, ceramide eop, carbomer, Dimethicone,
behentrimonium methosulfate, sodium lauroyl lactylate, Sodium hyaluronate, cholesterol,
phenoxyethanol, disodium edta, Dipotassium phosphate, tocopherol, phytosphingosine, xanthan gum,
Ethylhexylglycerin

Ointment | Propylene Glycol Free
Ceresin, Lanolin Alcohol,Microcrystalline Wax, Mineral Oil,Phenoxyethanol

Lotion | Propylene Glycol Free
Purified Water, Petrolatum, Glycerin, Methyl Glucose Sesquistearate, Methyl Gluceth-20 Sesquistearate,
Dimethicone, Cyclomethicone, Benzyl Alcohol, Glyceryl Stearate, Stearic Acid, Cetyl Alcohol, Xanthan
Gum, Magnesium Aluminum, Silicate, Soduim Carbomer 941

Transdermal Cream | Propylene Glycol Free
Fatty Acid Alcohols, Acids, and, Esters, Phospholipids, Antioxidants, Skin-feel Enhancer Natural
Humectant, Natural Preservatives, Nonionic an d Anionic Emulsifiers, Buffer shampoo base | Propylene
glycol free Purified Water, TEA-Lauryl Sulfate, Cocamidopropyl Betaine, PEG-8 Distearate, Benzyl Alcohol,
Cocamide MEA, Polyquaternium-22, Citric Acid. foam base | Propylene glycol free Alcohol-free and
propylene glycol-free foam vehicle, for water-soluble and some liposoluble actives, formulated with
gentle, non-irritating, and sensory-pleasing ingredients.

3

ID # COMMONLY REQUESTED FORMULAS FOR PATIENTS WITH ACNE SIZE COST SIG's (PER MD'S)
9240 AZELAIC ACID 15% / ALOE 0.1% SOLUTION 30ML $35 AAA QD
7806 AZELAIC ACID 15%/ ALOE 0.1% CREAM 30GM $35 AAA QD
7761 AZELAIC ACID 15%/ NIACINAMIDE 2% CREAM TOP MOVER 30GM $35 AAA QD
6927 AZELAIC ACID 15%/CLINDAMYCIN 1%/NIACINAMIDE 2% GEL 30GM $35 AAA QD
8313 AZELAIC ACID 20%/ ALOE 0.1% CREAM 30GM $35 AAA QD
7387 AZELAIC ACID 20%/ NIACINAMIDE 2% GEL 30GM $35 AAA QD
7866 AZELAIC ACID 5%/CLINDAMYCIN 2% CREAM TOP MOVER 30GM $35 AAA QD
7488 AZELAIC ACID 8%/NIACINAMIDE 2%/TRETINOIN 0.1% CREAM 30GM $35 AAA QD
8769 CLINDAMYCIN 1%/HYDROCORTISONE 750MG 2.5% LOTION 30ML $35 AAA QD
7367 CLINDAMYCIN 1%/TRETINOIN 0.03% CREAM TOP MOVER 30GM $35 AAA QD
8279 CLINDAMYCIN 1%/TRETINOIN 0.025%/ALO 0.1% TOPICAL GEL 30GM $35 AAA QD
9836 CLINDAMYCIN 1%/BENZOYL PEROXIDE 5%/ALOE 0.1% GEL 30GM $35 AAA QD
7440 IVERMECTIN 1%/OXYMETAZOLINE 1%/NIACINAMIDE 4% CREAM TOP MOVER 30GM $35 AAA QD
5153 MINOCYCLINE 3% FOAM 30ML $35 AAA QD
8098 SPIRONOLACTONE 5% CREAM TOP MOVER 30GM $35 AAA BID
7082 SPIRONOLACTONE 5% FOAM 30ML $35 AAA BID
SULFACETAMIDE 10%/SULFUR 5% CLEANSER NEW 60ML $35 AAA QD
7118 SULFACETAMIDE SULFUR 10%/ASCORB 5%1.67% TOPICAL CREAM 30GM $35 AAA QD
8582 TRETINOIN 0.025% ALOE 0.1% CREAM 30GM $35
9694 TRETINOIN 0.05% ASCORBIC ACID 1.67% CREAM 30GM $35 AAA QD HS
9761 TRETINOIN 0.05%/ERYTHROMY 3% CREAM 30GM $35 AAA QD HS
7877 TRETINOIN 0.1% ASCORBIC ACID 1.67% CREAM 30GM $35 AAA QD HS
9379 AAA QD HS
COMMONLY REQUESTED FORMULAS FOR PATIENTS WITH ACTINIC KERATOSIS
ID # DICLOFENAC SOD 3% CREAM SIZE COST SIG's (PER MD'S)
9133 FLUOROURACIL 5%/NIACINAMIDE 1% TOPICAL SOLUTION 60GM $35 AAA UD
9476 FLUOROURACIL 5%/NIACINAMIDE CREAM 30ML $35 AAA UD
9388 FLUOROURACIL 2.25%/CALCIPOTRIENE 0.0025% TOPICAL SOLUTION 30GM $35 AAA UD
6095 FLUOROURACIL 5%CALCIPOTRIENE 0.005% 1:1 CREAM TOP MOVER 30ML $35 AAA UD
9427 30GM $35 AAA UD
COMMONLY REQUESTED FORMULAS FOR PATIENTS NEEDING AN ANESTHETIC
ID # BENZOCAINE 20%/LIDOCAINE 8%/TETRACAINE 4% (PLASTICIZED OINT) TOP MOVER SIZE COST SIG's (PER MD'S)
9834 BENZOCAINE 20%/LIDOCAINE 10%/TETRACAINE 4% CREAM TOP MOVER 60GM $35 AAA 45 MIN PRIOR
2041 BENZOCAINE 20%/LIDOCAINE 8%/TETRACAINE 4% (SEPINO) CREAM TOP MOVER 60GM $35 AAA 45 MIN PRIOR
1897 60GM $35 AAA 45 MIN PRIOR

4

ID # COMMONLY REQUESTED FORMULAS FOR ANTI-AGING NEW SIZE COST SIG's (PER MD'S)
0381 ESTRIOL/ASCORBYL PALMITATE/TRETINOIN TOP MOVER 15GM $35 AAA QHS
0383 SODIUM HYALURONATE 0.5% TOPICAL BIOPEPTIDE CREAM 15GM 15GM $35 AAA QHS
0367 NIACINAMIDE 5%/ACETYL HEXAP/SODIUM HYALU GEL TOP MOVER 5GM $35 AAA QHS
0384 TRETINOIN 0.01% COLLAGEN ANTIWRINKLE LOT 15GM 15GM $35 AAA QHS
0373 PALMITOYL PENTAPEPTIDE/ACETYL HEXAPEPTIDE GEL ** FOR UNDER EYE** 5GM $35 AAA QHS
0370 ESTRIOL 0.1%/PALM PENT/ACETYL HEXAPEPTIDE GEL ** FOR UNDER EYE** TOP MOVER 5GM $35 AAA QHS
0368 PHENYLEPHRINE HCL 0.1%/CAFFEINE TOPICAL SERUM ** FOR UNDER EYE** 15ML $35 AAA QHS

ID # COMMONLY REQUESTED FORMULAS FOR PATIENTS WITH DRY, CRACKING SKIN SIZE COST SIG's (PER MD'S)
7078 CLOBETASOL 0.05%/S.A 4%/UREA 20% OINTMENT TOP MOVER 30GM $35 AAA BID
6966 LACTIC ACID 10%/GLYCERINE 10%/UREA 40% VANISHING CREAM TOP MOVER 60GM $35 AAA BID
7704 UREA 10% GEL 30GM $35
8924 UREA 10% LOTION 60GM $35 AAA QD-BID
7797 UREA 15% GEL 30GM $35 AAA QD-BID
7908 UREA 20%/VIT-E GEL 30GM $35 AAA QD-BID
AAA QD-BID
ID #
COMMONLY REQUESTED FORMULAS FOR PATIENTS WITH ECZEMA/PSORIASIS ** WITH CORTICOSTEROIDS ** SIZE COST SIG's (PER MD'S)
4340
5435 Super-high Potency Corticosteroid Group 30GM $35 AAA QD-BID
7466 CALCIPOTRIENE 0.005%/CLOBETASOL 0.05% OINTMENT TOP MOVER 30ML $35 AAA QD-BID
5890 CALCIPOTRIENE 0.005%/CLOBETASOL 0.05% SOLUTION TOP MOVER 30GM $35 AAA QD-BID
CALCIPOTRIENE 0.005%/CLOBETASOL 0.05% CREAM TOP MOVER 30ML $35 AAA QD-BID
8115 CLOBETASOL 0.05% /ZINC PYRITHIONE 0.25% SPRAY NEW 30GM $35 AAA QD-BID
9682 CLOBETASOL 0.05%/MENTHOL/CETA 90GM/5% Q.S 275GM NEW 30GM $35 AAA QD-BID
3657 CLOBETASOL 0.05%/ALOE 0.1% ANH BASE NEW 30ML $35 AAA QD-BID
2468 CLOBETASOL 0.05%/NIACINAMIDE 2% SOLUTION NEW 30GM $35 AAA QD-BID
3806 CLOBETASOL 0.05%/SALICYLIC ACID 6% CREAM NEW 30ML $35 AAA QD-BID
2893 CLOBETASOL 0.05% /MINOXIDIL 5% SOLUTION NEW 30ML $35 AAA QD-BID
0716 CLOBETASOL 0.05%/MINOXIDIL 5%/TACROLIMUS 0.03% CLEANSER NEW 30GM $35 AAA QD-BID
0715 CLOBETASOL 0.05%/CAMPH 0.5%/MENTH 0.5% /PRAMOX 1% OINTMENT NEW 30GM $35 AAA QD-BID
0714 CLOBETASOL 0.05%/CAMPH 0.5%/MENTH 0.5% /PRAMOX 1% CREAM NEW 30ML $35 AAA QD-BID
0713 CLOBETASOL 0.05%/CAMPH 0.5%/MENTH 0.5% /PRAMOX 1% SOLUTION NEW 30ML $35 AAA QD-BID
8759 CLOBETASOL 0.05%/CAMPH 0.5%/MENTH 0.5% /PRAMOX 1% FOAM NEW 60 GM $35 AAA QD-BID
CLOBETASOL 0.05% : CERAVETOPICAL CREAM (50ML:473GM) CREAM TOP MOVER
5

8296 CLOBETASOL 0.05%/ZINC PYRITH 0.2% SHAMPOO TOP MOVER TOP MOVER 60 GM $35 AAA QD-BID
7853 CLOBETASOL 0.05%/ZINC PYRITHIONE 0.2% CREAM 120ML $35 TIW UD
7830 CLOBETASOL 0.05%/SALIC ACID 6% SHAMPOO NEW 30GM $35
9497 CLOBETASOL 0.05% FOAM 120ML $35 AAA QD-BID
9534 COAL TAR 5%/SALICYLIC ACID 6%/ CLOBETASOL PROPIONATE 0.05% CREAM 30ML $35 AAA QD-BID
7860 COAL TAR 7.5GM/S.A. 4.8GM/CLOBETASOL 0.05% 90GM TOPICAL CREAM 60 GM $35
0680 FLUOCINONIDE 0.1%/CAMPH 0.5%/MENTH 0.5%/PRAMOX 1% CREAM NEW 60 GM $35 AAA UD
0679 FLUOCINONIDE 0.1%/CAMPH 0.5%/MENTH 0.5%/PRAMOX 1% OINTMENT NEW 30GM $35 AAA QD-BID
0678 FLUOCINONIDE 0.1%/CAMPH 0.5%/MENTH 0.5%/PRAMOX 1% SOLUTION NEW 30GM $35 AAA QD-BID
0677 FLUOCINONIDE 0.1%/CAMPH 0.5%/MENTH 0.5%/PRAMOX 1% FOAM NEW 30ML $35 AAA QD-BID
30ML $35 AAA QD-BID
0854 AAA QD-BID
5893 AAA QD-BID
3004
9548 High Potency Corticosteroid Group 30GM $35 AAA QD-BID
0719 BETAMETHASONE DIP 0.05%/CAMPHOR 0.5%/MENTHOL 0.5% /PRAMOXINE 1% OINTMENT NEW 30GM $35 AAA QD-BID
0671 CLOBETASOL 0.025% /CERAVE TOPICAL CREAM NEW 30GM $35 AAA QD-BID
0670 CALCIPOTRIENE 0.005%/FLUOCINONIDE 0.05% CREAM NEW 60GM $35 AAA QD-BID
0669 LIDEX 0.05% CREAM 60GM/MENTHOL 0.48GM/VANISHING CREAM Q.S 240GM 30GM $35 AAA QD-BID
0635 BETAMETHASONE DIP 0.05%/CAMPHOR 0.5%/MENTHOL 0.5% /PRAMOXINE 1% CREAM NEW 30GM $35 AAA QD-BID
0631 BETAMETHASONE VAL 0.1%/CAMPHOR 0.5%/MENTHOL 0.5%/PRAMOXINE 1% OINTMENT NEW 30ML $35 AAA QD-BID
BETAMETHASONE VAL 0.1%/CAMPHOR 0.5%/MENTHOL 0.5%/PRAMOXINE 1% FOAM NEW 30ML $35 AAA QD-BID
0718 BETAMETHASONE VAL 0.1%/CAMPHOR 0.5%/MENTHOL 0.5%/PRAMOXINE 1% SOLUTION NEW 30GM $35 AAA QD-BID
0717 FLUTICASONE 0.06%/CAMPH 0.5%/MENTH 0.5%/PRAMOX 1% OINTMENT NEW 30GM $35 AAA QD-BID
0637 MOMETASONE 0.12%/CAMPH 0.5%/MENTH 0.5%/PRAMOX 1%OINTMENT NEW
0632 30ML $35 AAA QD-BID
0630 Medium Potency Corticosteroid Group 30ML $35 AAA QD-BID
0629 BETAMETHASONE DIP 0.05%/CAMPHOR 0.5%/MENTHOL 0.5% /PRAMOXINE 1% SOLUTION NEW 30GM $35 AAA QD-BID
0625 BETAMETHASONE DIP 0.05%/CAMPHOR 0.5%/MENTHOL 0.5% /PRAMOXINE 1% FOAM NEW 30GM $35 AAA QD-BID
8419 FLUTICASONE 0.06%/CAMPH 0.5%/MENTH 0.5%/PRAMOX 1% CREAM NEW 30ML $35 AAA QD-BID
6569 MOMETASONE 0.12%/CAMPH 0.5%/MENTH 0.5%/PRAMOX 1% CREAM NEW 30ML $35 AAA QD-BID
0624 MOMETASONE 0.12%/CAMPH 0.5%/MENTH 0.5%/PRAMOX 1% FOAM NEW 30GM $35 AAA QD-BID
0623 MOMETASONE 0.12%/CAMPH 0.5%/MENTH 0.5%/PRAMOX 1% SOLUTION NEW 60GM $35 AAA QD-BID
0622 TRIAMCINOLONE 0.12%/CAMPH 0.5%/MENTH 0.5%/PRAMOX 1% CREAM NEW 60GM $35 AAA QD-BID
7238 TRIAMCINOLONE 0.1%/MENTHOL 0.48% CERAVE CREAM 30GM $35 AAA QD-BID
TRIAMCINOLONE 0.1%:SARNA (1:3) LOT 30GM $35 AAA QD-BID
TRIAMCINOLONE 0.12%/CAMPH 0.5%/MENTH 0.5%/PRAMOX 1% OINTMENT NEW 30GM $35 AAA QD-BID
TRIAMCINOLONE 0.12%/CAMPH 0.5%/MENTH 0.5%/PRAMOX 1% FOAM NEW 60GM $35 AAA QD-BID
TRIAMCINOLONE 0.12%/CAMPH 0.5%/MENTH 0.5%/PRAMOX 1% SOLUTION NEW
TRIAMCINOLONE 0.1%/COAL TAR 6% CREAM 6

0672 Lower-mid Potency Corticosteroid Group 30GM $35 AAA QD-BID
0676 BETAMETHASONE VAL 0.1%/CAMPHOR 0.5%/MENTHOL 0.5%/PRAMOXINE 1% CREAM NEW 30GM $35 AAA QD-BID
0675 DESOXIMETASONE 0.02% /CAMPH 0.5% /MENTH 0.5% /PRAMOX 1% CREAM NEW 30GM $35 AAA QD-BID
0510 DESOXIMETASONE 0.02% /CAMPH 0.5% /MENTH 0.5% /PRAMOX 1%OINTMENT NEW 30GM $35 AAA QD-BID
0673 DESONIDE 0.06%/CAMPH 0.5%/MENTH 0.5%/PRAMOX 1% OINTMENT NEW 30ML $35 AAA QD-BID
0674 DESOXIMETASONE 0.02% /CAMPH 0.5% /MENTH 0.5% /PRAMOX 1% FOAM NEW 30ML $35 AAA QD-BID
0634 DESOXIMETASONE 0.02% /CAMPH 0.5% /MENTH 0.5% /PRAMOX 1% SOLUTION NEW 30ML $35 AAA QD-BID
0633 FLUTICASONE 0.06%/CAMPH 0.5%/MENTH 0.5%/PRAMOX 1% FOAM NEW 30ML $35 AAA QD-BID
9272 FLUTICASONE 0.06%/CAMPH 0.5%/MENTH 0.5%/PRAMOX 1% SOLUTION NEW 60 GM $35 AAA QD-BID
COAL TAR 10%/ SALICYLIC ACID 3%/ TRIAMCINOLONE 0.1% LOTION
8193 Low Potency Corticosteroid Group 60 GM $35 AAA QD-BID
0511 DESONIDE 0.05%/ZINC PYRITHIONE 2% CREAM 30GM $35 AAA QD-BID
0509 DESONIDE 0.06%/CAMPH 0.5%/MENTH 0.5%/PRAMOX 1% CREAM NEW 30ML $35 AAA QD-BID
0508 DESONIDE 0.06%/CAMPH 0.5%/MENTH 0.5%/PRAMOX 1% FOAM NEW 30ML $35 AAA QD-BID
9444 DESONIDE 0.06%/CAMPH 0.5%/MENTH 0.5%/PRAMOX 1% SOLUTION NEW 60ML $35
7177 FLUOCINOLONE ACE 0.01% VIT-E 1% TOPICAL OIL (PEANUT OIL FREE) TOP MOVER 30 GM $35 AAA QD
TACROLIMUS 0.06%/TRIAMCINOLONE 0.025% CREAM AAA QD-BID
7870 Least Potent Corticosteroid Group 30GM $35
0514 IODOQUINOL 1%/HYDROCORTISONE 2.5%/ALOE 1% TOPICAL CREAM NEW 30GM $35 AAA QD-BID
0515 HYDROCORT 0.25%/CAMPH 0.5%/MENTH 0.5%/PRAMOX 1%OINTMENT NEW 30GM $35 AAA QD-BID
0513 HYDROCORT 0.25%/CAMPH 0.5%/MENTH 0.5%/PRAMOX 1% CREAM NEW 30ML $35 AAA QD-BID
0512 HYDROCORT 0.25%/CAMPH 0.5%/MENTH 0.5%/PRAMOX 1%FOAM NEW 30ML $35 AAA QD-BID
HYDROCORT 0.25%/CAMPH 0.5%/MENTH 0.5%/PRAMOX 1% SOLUTION NEW AAA QD-BID

ID # COMMONLY REQUESTED FORMULAS FOR PATIENTS WITH ECZEMA/PSORIASIS ** CORTICOSTEROIDS-FREE ** SIZE COST SIG's (PER MD'S)
7410 ANTHRALIN 1%/COAL TAR 1% TOPICAL CREAM 60 GM $35 AAA QD
8795 CALCIPOTRIENE 0.005% SOLUTION NEW 30ML $35
1187 CALCIPOTRIENE 0.005%/DAPSONE 5% SOLUTION NEW 30ML $35 AAA QD-BID
6424 CALCIPOTRIENE 0.005%/NIACINAMIDE CREAM NEW 30GM $35 AAA QD-BID
2978 CALCIPOTRIENE 0.005% /ALOE 0.1% FOAM NEW 30ML $35 AAA QD-BID
6868 METHOTREXATE 1% TOPICAL CREAM 30GM $35 AAA QD-BID
**** NALTREXONE 0.5-5MG LOW DOSE CAPSULE (ANY STRENGTH) 30 CAP $35
7592 NALTREXONE 0.2%/DIPHENHYDRAMINE 2% CREAM 30 GM $35 AAA QD
7765 NALTREXONE 0.2%/DIPHENHYDRAMINE 2% SCALP SOLUTION 30ML $35 1C PO HS
7592 NALTREXONE 0.2%/DIPHENHYDRAMINE 2% VANISHING CREAM 30GM $35 AAA QD
AAA QD-BID
7 AAA QD-BID

4415 ROFLUMILAST 0.3% CREAM 30GM $35 AAA QD-BID
9037 SALICYLIC ACID 6% SHAMPOO NEW 120ML $35 AAA QD
5443 TACROLIMUS 0.1%/CALCIPOTRIENE 0.005% 1:1 OINTMENT NEW 30GM $35
5939 TACROLIMUS 0.15%/MENTHOL 1% TOPICAL SOLUTION NEW 30ML $35 AAA QD-BID
9604 TACROLIMUS 0.1%/NIACINAMIDE 1% CREAM TOP MOVER 30 GM $35 AAA QD-BID
2988 TACROLIMUS 0.1%/NALTREXONE0.2% CREAM NEW 30GM $35 AAA QD-BID
TACROLIMUS 0.1% CLEANSER 30GM TOP MOVER 30GM $35 AAA QD-BID
6110 TACROLIMUS 0.15% CERAVE CREAM NEW 30GM $35 AAA QD-BID
6262 TACROLIMUS 0.1% TOPICAL SOLUTION TOP MOVER 30ML $35 AAA QD-BID
7657 AAA QD-BID

ID # COMMONLY REQUESTED FORMULAS FOR PATIENTS REQUIRING FACIAL PEELS SIZE COST SIG's (PER MD'S)
693* 30ML $35 UAD
9539 GLYCOLIC ACD 70% SOLUTION 15ML $35 UAD
9765 30ML $35 UAD
9540 JESSNER'S SOLUTION SALICY:RESORCINOL/LACTIC ACID TOP MOVER 15ML $35 UAD
9541 15ML $35 UAD
RESORCINOL 7%SALICYLIC AC 7%LACTIC ACID7%PANTH2% SOLUTION
ID #
7872 TRICHLOROACETIC ACID 25% (W/V)
7032
6969 TRICHLOROACETIC ACID 35% (W/V) TOPICAL SOLUTION
7884
7551 COMMONLY REQUESTED FORMULAS FOR PATIENTS WITH HAIR LOSS TOP MOVER SIZE COST SIG's (PER MD'S)
1742 FINASTERIDE 0.1%/MINOXIDIL 10% GEL TOP MOVER 60GM $35 AAA QD-BID
5262 FINASTERIDE 0.1%/MINOXIDIL 5% TOPICAL SOLUTION (DROPPER) TOP MOVER 30ML $35 AAA QD-BID
1608 FINASTERIDE 0.1%/MINOXIDIL 7%/TRETINOIN 0.025% FOAM TOP MOVER 30ML $35 AAA QD HS
5093 LATANOPROST 0.0025%/MINOXIDIL 2% ALCOHOL FREE SOLUTION (EYELASHES BRUSH) 5ML $35 AAA QD HS
3593 LATANOPROST 0.005%/MINOXIDIL 5%/ESTRON 0.05% SOLUTION (DROPPER) 5ML $35 AAA BID
5768 FINASTERIDE 0.1%/MINOXIDIL 7%/TRETINOIN 0.0125% TOPICAL SOLUTION TOP MOVER 30ML $35 AAA QD HS
7048 FINASTERIDE 0.1%/MINOXIDIL 7%/DUTASTERIDE 0.1% SOLUTION TOP MOVER 30ML $35 AAA QD HS
5272 FINASTERIDE 0.1%/MINOXIDIL 5% TOPICAL OIL LIQUID NEW 30ML $35 AAA QD HS
5582 FINASTERIDE 0.1% TOPICAL SOLUTION NEW 30ML $35 AAA QD HS
**** FINASTERIDE 0.1%/MINOXIDIL 5% TOPICAL SOLUTION TOP MOVER 30ML $35 AAA QD HS
5006 FINASTERIDE 0.1%/MINOXIDIL 5% TOPICAL FOAM NEW 30ML $35 AAA QD HS
2295 FINASTERIDE 0.1%/MINOXIDIL 7%/TRETINOIN 0.025% TOPICAL SOLUTION TOP MOVER 30ML $35 AAA QD HS
2038 FINASTERIDE 0.1%/MINOXIDIL 7% TOPICAL SOLUTION NEW 30ML $35 AAA QD HS
2559 FINASTERIDE 0.1%/MINOXIDIL 5%/DUTASTERIDE 0.01%/TRETINOIN LOTION 30ML $35 AAA QD HS
MINOXIDIL 0.25-1 MG CAPSULES (ANY STRENGTH) TOP MOVER 30CAPS $35 1C PO HS UD
MINOXIDIL 0.25MG/SPIRONOLACTONE 25MG CAPSULE NEW 30CAPS $35 1C PO HS UD
TOFACITINIB 2% SOLUTION NEW 10ML $35 UAD
TOFACITINIB 2% OINT NEW 10ML $35 UAD
TOFACITINIB 2% CREAM TOP MOVER 10ML $35 UAD

8

ID # COMMONLY REQUESTED FORMULAS FOR PATIENTS WITH HIRSUTISM SIZE COST SIG's (PER MD'S)
8124 METFORMIN 5%/PROGESTERONE 1%/AZELAIC 1%/SPIRONOLACTONE CREAM 30GM 35 AAA QD-BID

ID # COMMONLY REQUESTED FORMULAS FOR PATIENTS WITH HYPERHIDROSIS SIZE COST SIG's (PER MD'S)
5044 GLYCOPYRROLATE 1% TOPICAL GEL TOP MOVER 30GM $35 AAA QD-BID
6350 GLYCOPYRROLATE 1% TOPICAL SPRAY SOLUTION TOP MOVER 30ML $35 AAA QD-BID
6846 GLYCOPYRROLATE 1% TOPICAL CREAM TOP MOVER 30GM $35 AAA QD-BID
7055 ALUMINUM CHLORIDE HEXAHYDRATE 20% GEL 30GM $35 AAA QD-BID
7057 ALUMINUM CHLORIDE HEXAHYDRATE 20% SOLUTION 30ML $35 AAA QD-BID

ID # COMMONLY REQUESTED FORMULAS FOR PATIENTS WITH ITCHING SIZE COST SIG's (PER MD'S)
7848 AMITRIPTYLIN 2% CREAM 60GM $35 AAA QD-BID
7832 AMITRIPTYLIN 5%/LIDOCAINE 5% CREAM 60GM $35 AAA QD-BID
5739 AMITRIPTYLINE 5%/GABAPENTIN 15% TRANSDERMAL CREAM TOP MOVER 30GM $35 AAA QD-BID
8759 CLOBETASOL 0.05% : CERAVETOPICAL CREAM 1:10 (50ML:500GM) CREAM 60GM $35 AAA QD-BID
6517 GABAPENTIN 5%/AMITRIPTYLINE 5%/LIDOCAINE 5% VANISHING CREAM TOP MOVER 30GM $35 AAA QD-BID
5374 GABAPENTIN 5%/AMITRIPTYLINE 5%/LIDOCAINE 5% SCALP SOLUTION TOP MOVER 30ML $35 AAA QD-BID
6335 GABAPENTIN 5%/AMITRIPTYLINE 2%/LIDOCAINE 5% VANISHING CREAM 30GM $35 AAA QD-BID
7870 IODOQUINOL 1%/HYDROCORTISONE 2.5%/ALOE 1% TOPICAL CREAM TOP MOVER 30GM $35 AAA QD-BID
9548 LIDEX 0.05% CREAM 60GM/MENTHOL 0.48GM/VANISHING CREAM (1:4) Q.S 240GM TOP MOVER 60GM $35 AAA QD-BID
7765 NALTREXONE 0.2%/DIPHENHYDRAMINE 2% SCALP SOLUTION 30ML $35 AAA QD-BID
7592 NALTREXONE 0.2%/DIPHENHYDRAMINE 2% VANISHING CREAM TOP MOVER 30GM $35 AAA QD-BID
**** NALTREXONE 0.5-5MG LOW DOSE CAPSULE (ANY STRENGTH) TOP MOVER 30 CAP $35 1C PO HS
5939 TACROLIMUS 0.15%/MENTHOL 1% TOPICAL SOLUTION NEW 30ML $35 AAA QD-BID
8419 TRIAMCINOLONE 0.1%/MENTHOL 0.48% CERAVE CREAM 60GM $35 AAA QD-BID
2988 TACROLIMUS 0.1%/NALTREXONE 0.2% CREAM NEW 30GM $35 AAA QD-BID
6569 TRIAMCINOLONE 0.1%:SARNA (1:3) LOT 60GM $35 AAA QD-BID

ID # COMMONLY REQUESTED FORMULAS FOR PATIENTS WITH KERATOSIS PILARIS SIZE COST SIG's (PER MD'S)
5947 UREA 20%/SALICYLIC ACID 6%/AMMONIUM LACTATE 12% CREAM 60GM $35 AAA QD-BID
5915 UREA 40%/SALICYLIC ACID 6%/AMMONIUM LACTATE 12% CREAM 60GM $35 AAA QD-BID

ID # COMMONLY REQUESTED FORMULAS FOR PATIENTS WITH LAMELLAR ICHYTHIOSIS SIZE COST SIG's (PER MD'S)
6702 ACETYLCYSTEINE 10%/UREA 10%/ROSEMARY OIL 1.5% TOPICAL CREAM 30GM $35 UAD
6698 ACETYLCYSTEINE 10%/UREA 10%/ROSEMARY OIL TOPICAL GEL (PRACASIL PLUS) 30GM $35 UAD

9

ID # COMMONLY REQUESTED FORMULAS FOR LOW DOSE NALTREXONE (LDN) NEW SIZE COST SIG's (PER MD'S)
8074 NALTREXONE 0.5MG CAPSULE NEW 30 CAPS $35 1C PO HS
5755* NALTREXONE 1.5 MG CAPSULE NEW 30 CAPS $35 1C PO HS
5937 NALTREXONE 1MG CAPSULE NEW 30 CAPS $35 1C PO HS
7331 NALTREXONE 2.5MG CAPSULE NEW 30 CAPS $35 1C PO HS
1342 NALTREXONE 2MG CAPSULE NEW 30 CAPS $35 1C PO HS
5884 NALTREXONE 3.5MG CAPSULE NEW 30 CAPS $35 1C PO HS
9458 NALTREXONE 3MG CAPSULE TOP MOVER 30 CAPS $35 1C PO HS
6483 NALTREXONE 4 MG CAPSULE NEW 30 CAPS $35 1C PO HS
3483 NALTREXONE 7.5MG CAPSULE NEW 30 CAPS $35 1C PO HS
2170 NALTREXONE 9MG CAPSULE NEW 30 CAPS $35 1C PO HS
2050 NALTREXONE 5MG CAPSULE NEW 30 CAPS $35 1C PO HS
9632 NALTREXONE 4.5 MG CAPSULE TOP MOVER 30 CAPS $35 1C PO HS
7283 NALTREXONE 6MG CAPSULE NEW 30 CAPS $35 1C PO HS
2310 NALTREXONE 0.1% CREAM NEW $35
4303 NALTREXONE 0.2% CREAM NEW 30GM $35 AAA QD-BID
1596 NALTREXONE 0.4% CREAM NEW 30GM $35 AAA QD-BID
5366 NALTREXONE 1% VANISHING CREAM NEW 30GM $35 AAA QD-BID
7765 NALTREXONE 0.2%/DIPHENHYDRAMINE 2% SOLUTION NEW 30GM $35 AAA QD-BID
30ML AAA QD-BID
ID # COMMONLY REQUESTED FORMULAS FOR PATIENTS WITH NAIL FUNGUS
9201 (MILD TO MODERATE) ITRACONAZO 1%, IBUPROFEN 2%, UREA 10%,DMSO 10% NAIL SOLUTION SIZE COST SIG's (PER MD'S)
9202 (MODERATE TO SEVERE) ITRACON 1%, UNDECYLENIC ACID IN TEA TR OIL, UREA 10%, 15ML $35 AAA QD HS
DMSO 35% NAIL SOLUTION 15ML $35 AAA QD HS
8921 TERBINAFINE 1.7%/ITRACON 1%/KETOCON 1%/CLOTREM 1%/UNDECLYENIC IN TEA TREE OIL 10%
DMSO NAIL SOLUTION 15ML $35 AAA QD HS
6993 KETOCONAZOLE 2%/TEA TREE OIL/DMSO TOPICAL SOLUTION NEW
9304 THYMOL 4% SOLUTION TOP MOVER 15ML $35 AAA QD HS
9782 THYMOL 3% SOLUTION 15ML $35 AAA QD HS
5180 CIPROFLOXACIN 250MG/CLOTRIMAZOLE 10MG/DOXYCYCLINE 200MG FOOT BATH POWDER 15ML $35 AAA QD HS
** TINEA PEDIS ** TOP MOVER 30 DOSES $35 AAA QD UD
ID #
9871 COMMONLY REQUESTED FORMULAS FOR PATIENTS WITH ORAL MUCOSITIS SIZE COST SIG's (PER MD'S)
9759 MARY'S MAGIC MOUTH WASH SUS W/TETRACYCLIN W/O LIDOCAINE 120ML $35 SWISH/SPIT QID
8365 MARY'S MAGIC MOUTH WASH SUS W/TETRACYCLIN W/ LIDOCAINE TOP MOVER 120ML $35 SWISH/SPIT QID
MARY'S MAGIC MOUTH WASH SUS W/O TETRACYCLIN W/O LIDOCAINE 120ML $35 SWISH/SPIT QID

10

ID # COMMONLY REQUESTED FORMULAS FOR PATIENTS WITH POROKERATOSIS SIZE COST SIG's (PER MD'S)
5524 CHOLESTEROL 2%/LOVASTATIN 2% VANISHING CREAM NEW 30GM $35 AAA BID X 90 DAYS
6085 CHOLESTEROL 2%/LOVASTATIN 2% OINTMENT TOP MOVER 30GM $35 AAA BID X 90 DAYS

ID # COMMONLY REQUESTED FORMULAS FOR PATIENTS WITH RADIATION BURNS SIZE COST SIG's (PER MD'S)
9793 DICLOFENAC 1%/CYCLOBENZAPYRINE 0.2%/LIDOCAINE 5% TRANSDERMAL CREAM 60GM $35 AAA 3-4 TIMES/DAY
9789 DICLOFENAC SOD 1%/BACLOFEN 0.2%/LIDOCINE 5% TRANSDERMAL CREAM 60GM $35 AAA 3-4 TIMES/DAY
9791 GABAPENTIN 5%/AMITRIPTYLINE 2%/BACLOFEN 0.2/DICLOFENAC %1/LIDOCAINE 60GM $35 AAA 3-4 TIMES/DAY
5% TRANSDERMAL CREAM TOP MOVER
ID #
5051 COMMONLY REQUESTED FORMULAS FOR PATIENTS WITH RAYNAUD'S PHENOMENON SIZE COST SIG's (PER MD'S)
3896* SILDENAFIL 2% TOPICAL CREAM ~ 30GM $35 AAA BID
3776 NITROGLYCERIN OINTMENT 2% NEW 15GM $35 AAA BID
NIFEDIPINE 2% CREAM TOP MOVER 30GM $35 AAA BID
ID #
7823 COMMONLY REQUESTED FORMULAS FOR PATIENTS WITH ROSACEA TOP MOVER SIZE COST SIG's (PER MD'S)
7175 AZELAIC 15%/ IVERMECTIN 1%/ METRONIDA 1% (TRIPLE ROSACEA) CREAM 30 GM $35 AAA QD
6707 BRIMONIDINE 0.4%/NIACINAMID 4% GEL TOP MOVER 30 GM $35 AAA QD
7703 IVERMECTIN 1%/KETOTIFEN 0.05% TOPICAL CREAM 30 GM $35 AAA QD
7732 IVERMECTIN 1%/METRONIDAZOLE 0.75% CREAM TOP MOVER 30 GM $35 AAA QD
7658 IVERMECTIN 1%/METRONIDAZOLE 1% (DOUBLE ROSACEA) CREAM 30 GM $35 AAA QD
2166 IVERMECTIN 1%/METRONIDAZOLE1%/NIACINAMIDE 4% CREAM 30 GM $35 AAA QD
6707 IVERMECTIN 1%/NIACINAMIDE 4% (CLARIFYING™) TOP MOVER 30 GM $35 AAA QD
7676 KETOTIFEN 0.05% TOPICAL CREAM 30 GM $35 AAA QD
7589 METRONIDAZOL 0.75%/NIACINAMIDE 2% ULTRA LOTION 30 GM $35 AAA QD
7783 METRONIDAZOLE 0.75%/VITAMINE E 1% GEL 60 GM $35 AAA QD
9058 METRONIDAZOLE 1%/NIACINAMIDE 4% CREAM 60 GM $35 AAA QD
7660 OXYMETAZOLIN 1%/ALOE TOPICAL (CLARIFYING™) TOP MOVER 30 GM $35 AAA QD
7736 OXYMETAZOLIN0.06%/IVERMECTIN 1% CREAM TOP MOVER 30 GM $35 AAA QD
OXYMETAZOLINC0.06%/ASCORB 0.06% CREAM 30 GM $35 AAA QD

11

ID # COMMONLY REQUESTED FORMULAS FOR PATIENTS WITH SCARS SIZE COST SIG's (PER MD'S)
6705 ACNE SCARS: TOPIRAMATE 2.5% TOPICAL GEL (PRACASIL™-PLUS) 30GM $35 AAA BID
9598 BETAMETHASON VAL 0.1% SCAR GEL (KELOID SCAR) TOP MOVER 30 GM $35 AAA BID
9406* SODIUM HYALURONATE 0.5% SCAR CAR GEL TOP MOVER 30 GM $35 AAA BID

ID # COMMONLY REQUESTED FORMULAS FOR PATIENTS WITH SEBORHHEIC DERMATITIS NEW SIZE COST SIG's (PER MD'S)
4208 KETOCONAZOLE 2%/TACROLIMUS 0.1%/NIACINAMIDE CREAM 30GM $35 AAA QD-BID
9082 KETOCONAZOLE 2%/HYDROCORTISONE 2.5% TOPICAL CREAM TOP MOVER 30GM $35 AAA QD-BID
6193 KETOCONAZOLE 2%/SALICYLIC ACID 6% SHAMPOO 120ML $35 TIW UD
7696 KETOCOONAZOLE 2%/SAL ACID 6%/UREA 40% TOPICAL CREAM 30GM $35 AAA QD
3949 KETOCOONAZOLE 2%/TACROLIMUS 0.03% SHAMPOO 120ML $35 TIW UD
3645 KETOCONAZOLE 2%/TACROLIMUS 0.15% CERAVE CREAM 30GM $35 AAA QD-BID
9396 CICLOPIROX 0.77% CLOTRIMAZOLE 2% TOPICAL CREAM TOP MOVER 30GM $35 AAA QD-BID
2471 CICLOPIROX 1%/CLOBETASOLASOL 0.025% SHAMPOO TOP MOVER 120ML $35 TIW UD
5666 CICLOPIROX 0.77%/HYDROCORTISONE 2.5% 1:1 CREAM 30GM $35 AAA QD-BID
0725 CICLOPIROX 1%/ZINC2% SHAMPOO 120ML TOP MOVER 120ML $35 TIW UD
3813 CICLOPIROX 1%/SALICYLIC ACID 6% SHAMPOO 120ML 120ML $35 TIW UD

ID # COMMONLY REQUESTED FORMULAS FOR PATIENTS WITH SHINGLES SIZE COST SIG's (PER MD'S)
9529 ACYCLOVIR 5% LIDOCAINE 2% CREAM TOP MOVER 30GM $35 AAA 3-4 TIMES/DAY
6703 ACYCLOVIR 5% LIDOCAINE 2% SOLUTION 30ML $35 AAA 3-4 TIMES/DAY
9785 GABAPENTIN 5%/AMITRYPTILLINE 2%/BACLOFEN 0.2%/DICLOFENAC 1%/ACYCLOVIR 5%/LIDOCAINE 60GM $35 AAA 3-4 TIMES/DAY
5% CREAM TOP MOVER

12

ID # COMMONLY REQUESTED FORMULAS FOR PATIENTS REQUESTING SKIN BLEACHING (WITH HYDROQUINONE) SIZE COST SIG's (PER MD'S)
2017 $35 AAA QD HS
7320 HYDROQUINONE 10%/ASCORBIC ACID 20%/KOJIC ACID 5% CREAM TOP MOVER 30GM $35 AAA QD HS
7613 $35 AAA QD HS
8131 HYDROQUINONE 12%/KOJIC ACID 6%/ASCORBIC ACID 1%/NIACINAMIDE 2% CREAM TOP MOVER 30GM $35 AAA QD HS
8145 $35 AAA QD HS
8218 HYDROQUINONE 12%/KOJIC ACID 6%/ASCORBIC ACID 1%/NIACINAMIDE 2% CREAM TOP MOVER 30GM $35 AAA QD HS
8228 $35 AAA QD HS
8338 HYDROQUINONE 5%/TRETINOIN 0.05%/TRIAMCINOLONE 0.05% CREAM TOP MOVER 30GM $35 AAA QD HS
9089 $35 AAA QD HS
9152 TRETINOIN 0.05%/HYDROCORTISONE 0.05%/KOJIC ACID 0.05%/HYDROQUINONE 7% GEL 30GM $35 AAA QD HS
9229 $35 AAA QD HS
9473 KOJIC ACID 0.05%/HYDROQUINONE 7%/TRETINOIN 0.05% CREAM 30GM $35 AAA QD HS
7953 $35 AAA QD HS
KOJIC ACID 0.05%/HYDROQUINONE 7%/HYDROCORTISONE 0.05%/TRETINOIN 0.05% CREAM TOP MOVER 30GM
ID #
6222 HYDROQUINONE 6%/TRETINOIN 0.05%/HYDROCORTISONE 2.5% CREAM TOP MOVER 30GM
4250
6769 HYDROQUINONE 4%/ASCORBIC ACID 1.67% CREAM 30GM
7018
HYDROQUINONE 5% CREAM 30GM
ID #
6704 HYDROQUINONE 5%/TRETINOIN 0.1%/TRIAMCINOLONE 0.1% CREAM TOP MOVER 30GM
7773
HYDROQUINONE 6%/TRETINOIN 0.025%/DEXAMETHASONE 0.1% CREAM 30GM
ID #
6997 HYDROQUINONE 8% CREAM 30GM
3680
3679 COMMONLY REQUESTED FORMULAS FOR PATIENTS REQUESTING SKIN BLEACHING (HYDROQUINONE FREE) SIZE COST SIG's (PER MD'S)
8074 TRANEXAMIC ACID4.8%/AZELAIC ACID 15%/KOJIC ACID 6% CREAM TOP MOVER 30GM $35 AAA QD AM
9632 TRANEXAMIC ACID5%/NIACINAMIDE 4%/KOJIC ACID 2%/TRETINOIN 0.025% CREAM TOP MOVER 30GM $35 AAA QD HS
TRANEXAMIC ACID 3% CREAM 30GM $35 AAA QD AM
TRANEXAMIC ACID 5% CREAM 30GM $35 AAA QD AM

COMMONLY REQUESTED FORMULAS FOR PATIENTS WITH STRETCH MARKS SIZE COST SIG's (PER MD'S)
ALOE VERA 0.5% TOPICAL GEL (PRACASIL™-PLUS) 30GM $35 AAA BID
TRETINOIN 0.1% TOPICAL GEL (PRACASIL™-PLUS) (FORMULAPLUS™ BUD STUDY) 30GM $35
AAA QD HS
COMMONLY REQUESTED FORMULAS FOR PATIENTS WITH VITILIGO
PHENYLALANINE (L) 10% TOPICAL CREAM TOP MOVER SIZE COST SIG's (PER MD'S)
FLUOROURACIL 5%/TRIAMCINOLONE ACETONIDE 1% TOPICAL CREAM 30GM $35 AAA BID
FLUOROURACIL 5%/NALTREXONE HCL 0.025% TOPICAL CREAM 30GM $35 UAD
NALTREXONE HCL 0.5 MG CAPSULES 30GM $35 UAD
NALTREXONE HCL 4.5 MG CAPSULES 30CAP $35 1C PO HS
30CAP $35 1C PO HS

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ID # COMMONLY REQUESTED FORMULAS FOR PATIENTS WITH WARTS SIZE COST SIG's (PER MD'S)
7771 DPCP DIPHENYLCYCLOPROPENONE 0.01% TOPICAL SOLUTION TOP MOVER
1429 DPCP DIPHENYLCYCLOPROPENONE 0.009% TOPICAL SOLUTION 15ML $35 UAD
7869 DPCP DIPHENYLCYCLOPROPENONE 2% TOPICAL OINTMENT
6023 DPCP DIPHENYLCYCLOPROPENONE 2% SOLUTION TOP MOVER 15ML $35 UAD
4038 DIPHENYLCYCLOPROPENONE 0.5% TOPICAL OINTMENT
4488 DIPHENYLCYCLOPROPENONE 0.1% TOPICAL OINTMENT 30GM $35 UAD
6027 DIPHENYLCYCLOPROPENONE 0.1% TOPICAL SOLUTION
3081 DIPHENYLCYCLOPROPENONE 0.001% SOLUTION 5ML $35 UAD
7392 DIPHENYLCYCLOPROPENONE 0.005% SOLUTION
7381 DIPHENYLCYCLOPROPENONE 0.005% TOPICAL OINTMENT 30GM $35 UAD
1043 DIPHENYLCYCLOPROPENONE 0.01% OINTMENT
8917 DIPHENYLCYCLOPROPENONE 0.05% TOPICAL SOLUTION 30GM $35 UAD
9328 CANTHARIDIN 0.7% TOPICAL LIQUID TOP MOVER
9821 CANTHARIDIN PLUS TOPICAL LIQUID TOP MOVER 15ML $35 UAD
9570 CIMETIDINE 5%/DEOXY 0.2%/TEA TREE OILC 10%/IBUPROFEN 2% TOPICAL GEL
7816 CIMETIDINE 5%/SALICYLIC 30% ADHESIVE PEEL 15ML $35 UAD
7489 CIMETIDINE 5%/SALICYLIC ACID 15%/FLUOROURACIL 5% ADHESIVE PEEL TOP MOVER
1879 CIMETIDINE 5%/SALICYLIC ADHESIVE 20% ADHESIVE PEEL TOP MOVER 15ML $35 UAD
8552 DINITROCHLOROBENZENE 0.5% OINTMENT
7251 FLUOROURACIL 5%/SALACYLIC ACID 20% SOLUTION TOP MOVER 30GM $35 UAD
7792 FLUOROURACIL 5%/SALICYLIC 80% ADHESIVE PEEL
7893 FLUOROURACIL 5%/SALICYLIC 20% ADHESVIE PEEL TOP MOVER 30GM $35 UAD
6862* IMIQUIMOD 5% CREAM
7553 SALICYLIC ACID 40%/CIMETIDINE 5% TRANSDERMA SOLUTION 15ML $35 UAD
9041 SQUARIC ACID DIBUTYL ESTER 0.4% SOLUTION TOP MOVER
9806 SQUARIC ACID DIBUTYL ESTER 2% SOLUTION 2ML $35 OFFICE PROCEDURE
8999 SQUARIC ACID DIBUTYL ESTER 4% SOLUTION
8534 TRICHLOROACETIC ACID 20%/SALICYLIC ACID 60% TOPICAL PASTE 2ML $35 OFFICE PROCEDURE
3438 CIDOFOVIR 1% ADHESIVE GEL TOP MOVER
3117 CIDOFOVIR 2% ADHESIVE GEL NEW 15GM $35 AAA QD HS
3293 CIDOFOVIR 3% ADHESIVE GEL NEW
1 KIT $35 AAA QD HS

1 KIT $35 AAA QD HS

1 KIT $35 AAA QD HS

30 GM $35 UAD

30ML $35 AAA QD HS

1 KIT $35 AAA QD HS

1 KIT $35 AAA QD HS

12 PAK $35 UAD

15GM $35 AAA QD HS

15ML $35 UAD

15ML $35 UAD

15ML $35 UAD

1 KIT $35 AAA QD HS

1 KIT/5GM $65 AAA QD UD UNTIL CLEAR

1 KIT/5GM $125 AAA QD UD UNTIL CLEAR

1 KIT/5GM $165 AAA QD UD UNTIL CLEAR

14

ID # COMMONLY REQUESTED FORMULAS FOR PATIENTS WITH WOUNDS/BURNS * WITH INFECTION * SIZE COST SIG's (PER MD'S)
3615 DOXYCYCLINE 20 MG/PHENYTOIN 20 MG/MISOPROSTOL 0.024 MG/LIDOCAINE HCL 10 MG 60CAP $75 AAA BID
WOUND CARE CAPSULES
3614 INSULIN 3U/GM /METRONIDAZOLE 2%/HYDROCORTISONE 1%/ZINC SULFATE 2%/SILVER SULFADIAZINE 30GM $75 AAA TID
1% OINTMENT 30GM $75 AAA TID
3612 INSULIN 3U/GM /LEVOFLOXACIN 2%/MUPIROCIN 2%/ITRACONAZOLE 1% OINTMENT
3611 INSULIN 3U/GM /MISOPROSTOL 0.0024%/CIPROFLOXACIN HCL 2% OINTMENT 30GM $75 AAA TID
3610 INSULIN 3U/GM /VANCOMYCIN 2%/MUPIROCIN 2% OINTMENT 30GM $75 AAA TID

ID # COMMONLY REQUESTED FORMULAS FOR PATIENTS WITH WOUNDS/BURNS * WITHOUT INFECTION * SIZE COST SIG's (PER MD'S)
3609 $75 AAA TID
3608 INSULIN 3U/GM /PHENYTOIN 5%/MISOPROSTOL 0.0024%/ARGININE HCL 1% OINTMENT 30GM $75 AAA TID

INSULIN 3U/GM OINTMENT 30GM

15

FAQs

IF I DO NOT SEE A FORMULA I NEED, CAN YOU MAKE IT? ARE THERE PATIENT HANDOUTS AVAILABLE?
Indeed. We have over 3000 formulas and always Indeed. We can send to your office Tear-off patient
looking forward to adding more if what you’re handouts that will make the whole process simple
needing is not in our vast library! and easy to explain to new patients. Call us or
request our handouts Online through our portal:
www.3179007458.com

DO YOU SHIP/DELIVER TO PATIENTS? IS THERE A WAY I CAN KNOW WHAT NEW FORMULAS
Yes, we do! We ship for a flat fee of $8 (FREE shipping YOU HAVE?
with our $90 Discounted Program) Yes! Log in to our Online Portal, we will announce
any new/updated formula on there regularly.
Portal URL is: www.3179007458.com (Same as our fax
number to make it easy!)

HOW LONG DOES THE PATIENT HAS TO WAIT TO GET CAN I GET THIS FORMULA BOOKLET IN A DIGITAL COPY?
THEIR COMPOUND? Yes.
Once we get a hold of the patient regarding their Rx, All you need to do is scan this QR code to populate a
all orders are finished and shipped within 24-48 digital copy for you to save and keep on your smart
hours and takes approximately 3-5 business days phone.
for the patient to receive in the mail.

I WANT TO PRESCRIBE YOUR COMPOUND FOR IF A PATIENT IS TREATING A LARGE AREA, IS THERE A
FINASTERID E 0.1%/MINOXIDIL 5% SOLUTION BUT I DISCOUNT?
WANT TO SWITCH MINOXIDIL TO 7% INSTEAD, HOW Yes! We offer Triple the amount of our regularly
CAN I DO THAT? priced $35 Compounds for $90 and FREE shipping
That’s easy! Write in “Notes to pharmacy which means the patient gets one full container for
(escribe)/Other requested formulas (fax sheet)” the FREEfor the patient to receive in the mail.
formula you need, and we’ll make it!

16

The formulas and/or statements listed are provided for educational purposes only. They are compounding ideas that have
commonly been requested by physicians, and have not been evaluated by the Food and Drug Administration. Formulas and/or

material listed are not to be interpreted as a promise, guarantee or claim of therapeutic efficacy or safety. The information
contained herein is not intended to replace or substitute for conventional medical care, or encourage its abandonment. Every

patient is unique, and formulas should be adjusted to meet their individual needs.

Get in touch:

758 Westfield Rd . Noblesville . IN 46062
Tel (317) 231-5252
Fax (317) 900-7458

info@noblesvillelowcostpharmacy.com

17

18

NOBLESVILLE
LOW COST PHARMACY,LLC
PCAB ACCREDITED
COMPOUNDING PHARMACY

758 Westfield Rd .
Noblesville . IN 46062