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Retail Prescription Program Drug List
Low-cost prescriptions make a difference
90-Day Prescriptions
At Walmart, we don’t think you should have to choose between Taking a regular prescription? Ask your doctor if you can refil it groceries and the medicines you need. Our $4 prescriptions save 3 months at a time. At only $10, our 90-Day prescriptions save you American families hundreds of mil ions of dol ars a year. even more than our regular low-cost prescriptions. You save trips More $4 prescriptions than ever
Now our $4 price covers hundreds of prescriptions. That includes medicines for a wide range of conditions and diagnosis groups. This list is a quick-reference tool that will help you find the specific Ciprofloxacin 500mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . 20 . . . . . . . . 60 30-Day 90-Day
Doxycycline Hyclate 50mg cap . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Allergies & Cold and Flu
Doxycycline Hyclate 100mg cap . . . . . . . . . . . . . . . . . . . 20 . . . . . . . . 60 Benzonatate 100mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . 14 . . . . . . . . 42 Doxycycline Hyclate 100mg tab . . . . . . . . . . . . . . . . . . . 20 . . . . . . . . 60 Ceron DM syrup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120ml . . . . 360ml Erythromycin EC 250mg cap* . . . . . . . . . . . . . . . . . . . . . . 28 . . . . . . . . 84 C-Phen drops* (30ml bottle)† . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . 3 Metronidazole 250mg tab . . . . . . . . . . . . . . . . . . . . . . . . . 28 . . . . . . . . 84 Dex PC syrup* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120ml . . . . 360ml Metronidazole 500mg tab . . . . . . . . . . . . . . . . . . . . . . . . . 14 . . . . . . . . 42 Loratadine 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Penicillin VK 250mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 . . . . . . . . 84 Promethazine DM syrup . . . . . . . . . . . . . . . . . . . . . . . . . 120ml . . . . 360ml Penicillin VK 125mg/5ml susp (100ml bottle)† . . . . . . . 1 . . . . . . . . 3Penicillin VK 125mg/5ml susp (200ml bottle)† . . . . . . . 1 . . . . . . . . 3 Penicillin VK 250mg/5ml susp (100ml bottle)† . . . . . . . 1 . . . . . . . . 3 30-Day 90-Day
Antibiotic Treatments
SMZ-TMP 200mg-40mg/5ml susp*. . . . . . . . . . . . . . . 120ml . . . . 360mlSMZ-TMP 400mg-80mg tab . . . . . . . . . . . . . . . . . . . . . . . 28 . . . . . . . . 84 Amoxicillin 125mg/5ml susp (80ml bottle)† . . . . . . . . . 1 . . . . . . . . 3 SMZ-TMP DS 800mg-160mg tab . . . . . . . . . . . . . . . . . . . 20 . . . . . . . . 60 Amoxicillin 125mg/5ml susp (100ml bottle)† . . . . . . . . 1 . . . . . . . . 3 Tetracycline 250mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Amoxicillin 125mg/5ml susp (150ml bottle)† . . . . . . . . 1 . . . . . . . . 3 Tetracycline 500mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Amoxicillin 200mg/5ml susp (50ml bottle)† . . . . . . . . . 1 . . . . . . . . 3Amoxicillin 200mg/5ml susp* (75ml bottle)† . . . . . . . . 1 . . . . . . . . 3 Amoxicillin 200mg/5ml susp* (100ml bottle)† . . . . . . . 1 . . . . . . . . 3 30-Day 90-Day
Amoxicillin 250mg/5ml susp (80ml bottle)† . . . . . . . . . 1 . . . . . . . . 3 Arthritis & Pain
Amoxicillin 250mg/5ml susp (100ml bottle)† . . . . . . . . 1 . . . . . . . . 3 Allopurinol 100mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Amoxicillin 250mg/5ml susp (150ml bottle)† . . . . . . . . 1 . . . . . . . . 3 Allopurinol 300mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Amoxicillin 400mg/5ml susp (50ml bottle)† . . . . . . . . . 1 . . . . . . . . 3 Baclofen 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Amoxicillin 400mg/5ml susp* (75ml bottle)† . . . . . . . . 1 . . . . . . . . 3 Colchicine 0.6mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Amoxicillin 400mg/5ml susp* (100ml bottle)† . . . . . . . 1 . . . . . . . . 3 Cyclobenzaprine 5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Amoxicillin 250mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Cyclobenzaprine 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Amoxicillin 500mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Dexamethasone 0.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Cephalexin 250mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 . . . . . . . . 84 Dexamethasone 0.75mg tab . . . . . . . . . . . . . . . . . . . . . . 12 . . . . . . . . 36 Cephalexin 500mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Dexamethasone 4mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . 6 . . . . . . . . 18 Ciprofloxacin 250mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . 14 . . . . . . . . 42Prescription Program includes up to a 30-day supply for $4 and a 90-day supply for $10 of some covered generic drugs at commonly prescribed dosages. Higher dosages cost more. Prices for some drugs covered by the Prescription Program may be higher and may vary in some states. Restrictions apply. See Program Details or your Walmart Pharmacist for details. Free language assistance services available for prescription drug information at Walmart and Sam’s Club pharmacies in New York. Contact your Walmart or Sam’s Club pharmacy for details.
*Prices may be higher in CA, HI, MN, MT, PA, TN and WI.
† Prepackaged drugs are covered only in unit sizes specified on Drug List. See Program Details or your Walmart Pharmacist for details.
2009 Wal-Mart Stores, Inc. | Page 1 of 6 Arthritis & Pain (continued)
Glipizide 10mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Diclofenac DR 75mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Glyburide 2.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Ibuprofen 100mg/5ml susp* . . . . . . . . . . . . . . . . . . . . 120ml . . . . 360ml Glyburide 5mg tab (blue) . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Ibuprofen 400mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 . . . . . . . 270 Glyburide 5mg tab (green) . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Ibuprofen 600mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Glyburide, micronized 3mg tab . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Ibuprofen 800mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Glyburide, micronized 6mg tab . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Indomethacin 25mg cap* . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Metformin 500mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Meloxicam 7.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Metformin 850mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Meloxicam 15mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Metformin 1000mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Naproxen 375mg tab*. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Metformin 500mg ER tab* . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Naproxen 500mg tab*. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180Piroxicam 20mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 30-Day 90-Day
Ear Health
30-Day 90-Day
Antipyrine/Benzocaine otic (10ml bottle)†. . . . . . . . . . . 1 . . . . . . . . 3 Asthma
Albuterol 2mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 . . . . . . . 270
30-Day 90-Day
Albuterol 4mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Fungal Infections
Albuterol 2mg/5ml syrup . . . . . . . . . . . . . . . . . . . . . . . . 120ml . . . . 360ml Fluconazole 150mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . 3 Albuterol 0.5% nebulizer soln (20ml bottle)† . . . . . . . . 1 . . . . . . . . 3 Nystatin/Triamcin cream (15gm tube)† . . . . . . . . . . . . . . 1 . . . . . . . . 3 Albuterol 0.083% nebulizer soln* (25x3ml vials)† . . . . 1 . . . . . . . . 3 Nystatin/Triamcin cream (30gm tube)† . . . . . . . . . . . . . . 1 . . . . . . . . 3 Ipratropium 0.02% nebulizer soln* (25x2.5ml vials)† . 1 . . . . . . . . 3 Nystatin/Triamcin ointment (15gm tube)† . . . . . . . . . . . 1 . . . . . . . . 3Nystatin cream (15gm tube)† . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . 3 30-Day 90-Day
Nystatin cream (30gm tube)† . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . 3 Cholesterol
Nystatin ointment (15gm tube)† . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . 3 Lovastatin 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Nystatin ointment (30gm tube)† . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . 3 Lovastatin 20mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Terbinafine 250mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Pravastatin 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90Pravastatin 20mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 30-Day 90-Day
Pravastatin 40mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Gastrointestinal Health
Belladonna Alkaloid/PB tab . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180
30-Day 90-Day
Cimetidine 800mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Diabetes
Cytra2 solution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180ml . . . . 540ml Chlorpropamide 100mg tab* . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Dicyclomine 10mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 . . . . . . . 270 Glimepiride 1mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Dicyclomine 20mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Glimepiride 2mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Famotidine 20mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Glimepiride 4mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Lactulose syrup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237ml . . . . 711ml Glipizide 5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Metoclopramide 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Prescription Program includes up to a 30-day supply for $4 and a 90-day supply for $10 of some covered generic drugs at commonly prescribed dosages. Higher dosages cost more. Prices for some drugs covered by the Prescription Program may be higher and may vary in some states. Restrictions apply. See Program Details or your Walmart Pharmacist for details. Free language assistance services available for prescription drug information at Walmart and Sam’s Club pharmacies in New York. Contact your Walmart or Sam’s Club pharmacy for details.
*Prices may be higher in CA, HI, MN, MT, PA, TN and WI.
† Prepackaged drugs are covered only in unit sizes specified on Drug List. See Program Details or your Walmart Pharmacist for details.
2009 Wal-Mart Stores, Inc. | Page 2 of 6 Gastrointestinal Health (contined)
Bisoprolol-HCTZ 5mg-6.25mg tab . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Metoclopramide syrup . . . . . . . . . . . . . . . . . . . . . . . . . . . 60ml. . . . . 180ml Bisoprolol-HCTZ 10mg-6.25mg tab . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Promethazine 25mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . 12 . . . . . . . . 36 Bumetanide 0.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Promethazine plain syrup* . . . . . . . . . . . . . . . . . . . . . . 180ml . . . . 540ml Bumetanide 1mg tab. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Ranitidine 150mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Captopril 12.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Ranitidine 300mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Captopril 25mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180Captopril 50mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Captopril 100mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 30-Day 90-Day
Carvedilol 3.125mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Glaucoma & Eye Care
Carvedilol 6.25mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Atropine Sulfate 1% op. soln (5ml bottle)† . . . . . . . . . . . 1 . . . . . . . . 3 Carvedilol 12.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Erythromycin op. ointment (3.5gm tube)†* . . . . . . . . . . 1 . . . . . . . . 3 Carvedilol 25mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Gentamicin 0.3% op. soln (5ml bottle)† . . . . . . . . . . . . . . 1 . . . . . . . . 3 Chlorthalidone 25mg tab . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Levobunolol 0.5% op soln (5ml bottle)† . . . . . . . . . . . . . 1 . . . . . . . . 3 Chlorthalidone 50mg tab . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Clonidine 0.1mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 0.1% op. ointment (3.5gm tube)† . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . 3 Clonidine 0.2mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Digoxin 0.125mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 0.1% op. susp (5ml bottle)† . . . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . 3 Digoxin 0.25mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Pilocarpine 1% op. soln (15ml bottle)† . . . . . . . . . . . . . . 1 . . . . . . . . 3 Diltiazem 30mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Pilocarpine 2% op. soln (15ml bottle)† . . . . . . . . . . . . . . 1 . . . . . . . . 3 Diltiazem 60mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Polymyxin Sulfate/TMP op. soln* (10ml bottle)† . . . . . 1 . . . . . . . . 3 Diltiazem 90mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Sulfacet Sodium 10% op. soln (15ml bottle)† . . . . . . . . 1 . . . . . . . . 3 Diltiazem 120mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Timolol Maleate 0.25% op. soln (5ml bottle)† . . . . . . . . 1 . . . . . . . . 3 Doxazosin 1mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Timolol Maleate 0.5% op soln (5ml bottle)† . . . . . . . . . . 1 . . . . . . . . 3 Doxazosin 2mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Tobramycin 0.3% op. soln (5ml bottle)† . . . . . . . . . . . . . 1 . . . . . . . . 3 Doxazosin 4mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90Doxazosin 8mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Enalapril-HCTZ 5mg-12.5mg tab . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 30-Day 90-Day
Heart Health & Blood Pressure
Enalapril 2.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90Enalapril 5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Amiloride-HCTZ 5mg-50mg tab . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Enalapril 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Atenolol-Chlorthalidone 50mg-25mg tab . . . . . . . . . . 30 . . . . . . . . 90 Enalapril 20mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Atenolol-Chlorthalidone 100mg-25mg tab . . . . . . . . 30 . . . . . . . . 90 Furosemide 20mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Atenolol 25mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Furosemide 40mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Atenolol 50mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Furosemide 80mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Atenolol 100mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Guanfacine 1mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Benazepril 5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Hydralazine 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Benazepril 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Hydralazine 25mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Benazepril 20mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Hydrochlorothiazide(HCTZ)12.5mg cap* . . . . . . . . . . . 30 . . . . . . . . 90 Benazepril 40mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Hydrochlorothiazide (HCTZ) 25mg tab . . . . . . . . . . . . . 30 . . . . . . . . 90 Bisoprolol-HCTZ 2.5mg-6.25mg tab. . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Hydrochlorothiazide (HCTZ) 50mg tab . . . . . . . . . . . . . 30 . . . . . . . . 90 Prescription Program includes up to a 30-day supply for $4 and a 90-day supply for $10 of some covered generic drugs at commonly prescribed dosages. Higher dosages cost more. Prices for some drugs covered by the Prescription Program may be higher and may vary in some states. Restrictions apply. See Program Details or your Walmart Pharmacist for details. Free language assistance services available for prescription drug information at Walmart and Sam’s Club pharmacies in New York. Contact your Walmart or Sam’s Club pharmacy for details.
*Prices may be higher in CA, HI, MN, MT, PA, TN and WI.
† Prepackaged drugs are covered only in unit sizes specified on Drug List. See Program Details or your Walmart Pharmacist for details.
2009 Wal-Mart Stores, Inc. | Page 3 of 6 Heart Health & Blood Pressure (continued)
Warfarin 1mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Indapamide 1.25mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Warfarin 2mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Indapamide 2.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Warfarin 2.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Isosorbide Mononitrate 30mg ER tab . . . . . . . . . . . . . . 30 . . . . . . . . 90 Warfarin 3mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Isosorbide Mononitrate 60mg ER tab . . . . . . . . . . . . . . 30 . . . . . . . . 90 Warfarin 4mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Lisinopril-HCTZ 10mg-12.5mg tab . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Warfarin 5mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Lisinopril-HCTZ 20mg-12.5mg tab* . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Warfarin 6mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Lisinopril-HCTZ 20mg-25mg tab* . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Warfarin 7.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Lisinopril 2.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Warfarin 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Lisinopril 5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90Lisinopril 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 30-Day 90-Day
Lisinopril 20mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Mental Health
Methyldopa 250mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Amitriptyline 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Methyldopa 500mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Amitriptyline 25mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Metoprolol Tartrate 25mg tab . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Amitriptyline 50mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Metoprolol Tartrate 50mg tab . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Amitriptyline 75mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Metoprolol Tartrate 100mg tab* . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Amitriptyline 100mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Nadolol 20mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Benztropine 2mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Nadolol 40mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Buspirone 5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Pindolol 5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Buspirone 10mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Pindolol 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Carbamazepine 200mg tab* . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Prazosin HCL 1mg cap. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Citalopram 20mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Prazosin HCL 2mg cap. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Citalopram 40mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Prazosin HCL 5mg cap. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Doxepin HCL 10mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Propranolol 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Doxepin HCL 25mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Propranolol 20mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Doxepin HCL 50mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Propranolol 40mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Doxepin HCL 75mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Propranolol 80mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Doxepin HCL 100mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Sotalol HCL 80mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Fluoxetine 10mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Spironolactone 25mg tab* . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Fluoxetine 10mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Terazosin 1mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Fluoxetine 20mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Terazosin 2mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Fluoxetine 40mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Terazosin 5mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Fluphenazine 1mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Terazosin 10mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Haloperidol 0.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Triamterene-HCTZ 37.5mg-25mg cap . . . . . . . . . . . . . . 30 . . . . . . . . 90 Haloperidol 1mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Triamterene-HCTZ 37.5mg-25mg tab . . . . . . . . . . . . . . 30 . . . . . . . . 90 Haloperidol 2mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Triamterene-HCTZ 75mg-50mg tab . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Haloperidol 5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Verapamil 80mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Lithium Carbonate 300mg cap* . . . . . . . . . . . . . . . . . . . 90 . . . . . . . 270 Verapamil 120mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Nortriptyline 10mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Prescription Program includes up to a 30-day supply for $4 and a 90-day supply for $10 of some covered generic drugs at commonly prescribed dosages. Higher dosages cost more. Prices for some drugs covered by the Prescription Program may be higher and may vary in some states. Restrictions apply. See Program Details or your Walmart Pharmacist for details. Free language assistance services available for prescription drug information at Walmart and Sam’s Club pharmacies in New York. Contact your Walmart or Sam’s Club pharmacy for details.
*Prices may be higher in CA, HI, MN, MT, PA, TN and WI.
† Prepackaged drugs are covered only in unit sizes specified on Drug List. See Program Details or your Walmart Pharmacist for details.
2009 Wal-Mart Stores, Inc. | Page 4 of 6 Mental Health (continued)
Triamcinolone 0.1% ointment (15gm tube)† . . . . . . . . . 1 . . . . . . . . 3 Nortriptyline 25mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Triamcinolone 0.1% ointment (80gm tube)† . . . . . . . . . 1 . . . . . . . . 3 Paroxetine 10mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Triamcinolone 0.5% cream (15gm tube)† . . . . . . . . . . . . 1 . . . . . . . . 3 Paroxetine 20mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Prochlorperazine 10mg tab. . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 30-Day 90-Day
Thioridazine 25mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Thyroid Conditions
Thioridazine 50mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Levothyroxine 25mcg tab . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Thiothixene 2mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Levothyroxine 50mcg tab . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Trazodone 50mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Levothyroxine 75mcg tab . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Trazodone 100mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Levothyroxine 88mcg tab . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Trazodone 150mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Levothyroxine 100mcg tab . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Trihexyphenidyl 2mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Levothyroxine 112mcg tab . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90Levothyroxine 125mcg tab . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Levothyroxine 137mcg tab . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 30-Day 90-Day
Levothyroxine 150mcg tab . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Skin Conditions
Levothyroxine 175mcg tab* . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Levothyroxine 200mcg tab* . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 (170.1ml bottle)† . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . N/ABetamethasone Dipropionate 0.05% cream 30-Day 90-Day
(15gm tube)† . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . 3 Acyclovir 200mg cap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 (45gm tube)† . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . 3Betamethasone Valerate 0.1% cream (15gm tube)† . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . 3 30-Day 90-Day
Betamethasone Val. 0.1% cream (45gm tube)†. . . . . . . 1 . . . . . . . . 3 Vitamins & Nutritional Health
Betamethasone Val. 0.1% ointment (15gm tube)† . . . 1 . . . . . . . . 3 Folic Acid 1mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Betamethasone Val. 0.1% ointment (45gm tube)† . . . 1 . . . . . . . . 3 Klorcon 8 8mEq ER tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Fluocinolone Acet. 0.01% soln (60ml bottle)† . . . . . . . . 1 . . . . . . . . 3 Klorcon 10 10mEq ER tab . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Fluocinonide 0.05% cream (15gm tube)† . . . . . . . . . . . . 1 . . . . . . . . 3 Klorcon M10 10mEq tab . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Fluocinonide 0.05% cream (30gm tube)† . . . . . . . . . . . . 1 . . . . . . . . 3 Mag 64 64mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 Gentamicin 0.1% cream (15gm tube)† . . . . . . . . . . . . . . . 1 . . . . . . . . 3 Magnesium Oxide 400mg tab . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Gentamicin 0.1% ointment (15gm tube)† . . . . . . . . . . . 1 . . . . . . . . 3 Prenatal Plus qty 30* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Hydrocortisone 1% cream (28.35-30g tube)† . . . . . . . . 1 . . . . . . . . 3 Potassium Chloride 10% liquid . . . . . . . . . . . . . . . . . . 473ml . . . 1419ml Hydrocortisone 2.5% cream (30gm tube)† . . . . . . . . . . . 1 . . . . . . . . 3 Sodium Fluoride .25mg chewable (120ct bottle) †* . . 1 . . . . . . . N/A Selenium Sulfide 2.5% lotion* (120ml bottle)† . . . . . . . 1 . . . . . . . . 3Silver Sulfadiazine 1% cream* (50gm tube)† . . . . . . . . . 1 . . . . . . . . 3 30-Day 90-Day
Triamcinolone 0.025% cream (15gm tube)† . . . . . . . . . 1 . . . . . . . . 3 Women’s Health
Triamcinolone 0.025% cream (80gm tube)† . . . . . . . . . 1 . . . . . . . . 3 Estradiol 0.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Triamcinolone 0.1% cream (15gm tube)† . . . . . . . . . . . . 1 . . . . . . . . 3 Estradiol 1mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Triamcinolone 0.1% cream (80gm tube)† . . . . . . . . . . . . 1 . . . . . . . . 3 Prescription Program includes up to a 30-day supply for $4 and a 90-day supply for $10 of some covered generic drugs at commonly prescribed dosages. Higher dosages cost more. Prices for some drugs covered by the Prescription Program may be higher and may vary in some states. Restrictions apply. See Program Details or your Walmart Pharmacist for details. Free language assistance services available for prescription drug information at Walmart and Sam’s Club pharmacies in New York. Contact your Walmart or Sam’s Club pharmacy for details.
*Prices may be higher in CA, HI, MN, MT, PA, TN and WI.
† Prepackaged drugs are covered only in unit sizes specified on Drug List. See Program Details or your Walmart Pharmacist for details.
2009 Wal-Mart Stores, Inc. | Page 5 of 6 Estradiol 2mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 New non program medication for asthma and smoking cessation.
Estropipate 0.75mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Estropipate 1.5mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 ReliOn/Ventolin® HFA Inhaler 8g . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $9 MedroxyprogesteroneAcetate 2.5mg tab . . . . . . . . . . 30 . . . . . . . . 90
Smoking Cessation
Medroxyprogesterone Acetate 5mg tab . . . . . . . . . . . 30 . . . . . . . . 90 Bupropion ER 150mg (17ct starter pack) . . . . . . . . . . . . . . . . . . . . . . $9 Medroxyprogesterone Acetate 10mg tab . . . . . . . . . . 10 . . . . . . . . 30 Not part of Prescription Program or subject to Walmart’s Prescription Program Details. Available at all Walmart, Sam’s Club and Neighborhood Markets pharmacies in the United 30-Day 90-Day
States, except in North Dakota. These drugs are offered at the price Women’s Health
specified only in the exact unit sizes and formulations specified above and are not subject to proration. You may pay more or less Alendronate SOD 35mg tab . . . . . . . . . . . . . . . . . . . . . . . . 4 . . . . . . . . 12 depending on the terms of your health plan. Specified price may be limited to select manufacturers of the drugs and is available Alendronate SOD 70mg tab . . . . . . . . . . . . . . . . . . . . . . . . 4 . . . . . . . . 12 as long as supplies are in stock at the pharmacy. There are no Clomiphene 50mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 . . . . . . . . 15 substitutions or mail orders. See your Walmart Pharmacist Sprintec 28-day tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 . . . . . . . N/A Walmart’s Prescription Program Details
Tri-Sprintec 28-day tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 . . . . . . . N/A 1. Walmart’s Prescription Program (the “Program”) is available at al Walmart, Sam’s Club and Neighborhood Market Tamoxifen 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 pharmacies in the United States (“Walmart Retail Pharmacies”), except in North Dakota, as set forth below in Sections 3 and 4. The Program is also available through Walmart Mail Service (“Walmart Mail Service”), as set forth below in Section 5.
Tamoxifen 20mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 2. The Program applies only to certain generic drugs at commonly prescribed dosages. Higher dosages cost more. You may obtain a list of generic drugs and dosages covered under the Program at Walmart Retail Pharmacies (the “Retail Drug List”) and through Walmart Mail Service (the “Mail Service Drug List”) on Walmart.com or at Walmart Retail Pharmacies. The Retail Drug List and Mail Service Drug List may change and also may vary by state. Not all formulations of a drug (for example, enteric-coated, extended or timed release formulations) are covered under the Program. Program pricing not available when a covered drug is dispensed as part of a compound. 30-Day 90-Day
3. Under the Program at Walmart Retail Pharmacies, $4 is the price for up to a 30-day supply of certain covered generic Other Medical Conditions
drugs at commonly prescribed dosages (the “$4 Retail Program”). $10 is the price of a 90-day supply of certain covered generic drugs at commonly prescribed dosages (the “$10 Retail Program”). Not al drugs covered by the $4 Retail Program are covered by the $10 Program. Prices for quantities between a 30-day supply and a 90-day supply of drugs Chlorhexidine Gluconate 0.12% soln (473ml bottle)† . . . 1 . . . . . . . . 3 covered by both the $4 Retail Program and $10 Retail Program are prorated based on the $4 Program price, but will not exceed $10. Prices for quantities greater than a 90-day supply of drugs covered by the $10 Retail Program are prorated based on the $10 Program price. Prorated pricing is not available under the Program for prepackaged drugs. Hydrocortisone AC 25mg suppositories . . . . . . . . . . . . 12 . . . . . . . . 36 For pricing policies relating to prepackaged drugs (such as tubes, vials or bottles), see Section 6.
4. Under the Program at Walmart Retail Pharmacies, $9 is the price for up to a 30-day supply of certain women’s health and Isoniazid 300mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 other covered generic drugs at commonly prescribed dosages (the “$9 Retail Program”). $24 is the price for a 90-day supply of certain women’s health and other covered generic drugs at commonly prescribed dosages (the “$24 Retail Lidocaine 2% viscous solution (100ml bottle)† . . . . . . 1 . . . . . . . . 3 Program”). Not al drugs covered by the $9 Retail Program are covered by the $24 Retail Program. Prices for quantities between a 30-day supply and a 90-day supply of drugs covered by both the $9 Program and $24 Retail Program are prorated based on the $9 Program price, but will not exceed $24. Prices for quantities greater than a 90-day supply of Megestrol 20mg tab* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 drugs covered by the $24 Retail Program are prorated based on the $24 Program price. Prorated pricing is not available under the Program for prepackaged drugs. For pricing policies relating to prepackaged drugs, see Section 6.
Methylpred 4mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 . . . . . . . . 63 5. Under the Program through Walmart Mail Service, $10 is the price for mail delivery of a 90-day supply of certain generic drugs at commonly prescribed dosages (“$10 Mail Service Program”). $24 is the price for mail delivery of Methylpred 4mg dose pak (21 tablets)† . . . . . . . . . . . . . 1 . . . . . . . . 3 certain women’s health and certain other covered drugs at commonly prescribed dosages ($24 Mail Service Program”). Not al drugs covered by the $10 Retail Program are covered by the $10 Mail Service Program; not al drugs covered by the $24 Retail Program are covered by the $24 Mail Service Program. See Mail Service Drug List for a list of drugs Oxybutynin 5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 . . . . . . . 180 covered by the $10 Mail Service Program and $24 Mail Service Program. Walmart Mail Service covers both initial fil s and refil s. Delivery of covered drugs is available only through Walmart Mail Service and is not available at Walmart, Phenazopyridine 100mg tab . . . . . . . . . . . . . . . . . . . . . . . 6 . . . . . . . . 18 Sam’s Club, and Neighborhood Market retail pharmacies. Delivery under the Program through Walmart Mail Service is limited to U.S. addresses by First-Class Mail; expedited delivery is also available for an additional charge. Some health Phenazopyridine 200mg tab . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 plans do not cover Walmart Mail Service or 90-day supplies. Prices for quantities greater than a 90-day supply of drugs covered by the $10 Mail Service Program and the $24 Mail Service Program are prorated based on the $10 and $24 Program price, respectively. Prices for quantities less than a 90-day supply are not prorated under either the $10 Mail Prednisone 2.5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 Service Program or the $24 Mail Service Program. Prorated pricing is not available under the Program for prepackaged drugs. For pricing policies relating to prepackaged drugs, see Section 6. Prednisone 5mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 6. Prepackaged drugs are covered under the Program only in the unit sizes specified on the Retail Drug List and Mail Service Drug List. Prepackaged drugs are dispensed based on the quantities prescribed and unit sizes in stock at the Prednisone 5mg dose pak (21 tablets)† . . . . . . . . . . . . . . 1 . . . . . . . . 3 dispensing pharmacy. Unit sizes not specified on the Retail Drug List or Mail Service Drug List are not covered under the Program. Multi-unit purchases are charged at a per unit price, based on the price per unit size dispensed, unless otherwise specified. Prepackaged drugs dispensed in unit sizes not specified on the Retail Drug List and Mail Service Prednisone 5mg dose pak* (48 tablets)† . . . . . . . . . . . . . 1 . . . . . . . . 3 Drug List may be priced higher, even if equivalent quantities of the drug are available in specified unit sizes. Prorated pricing is not available under the Program for prepackaged drugs.
Prednisone 10mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 7. Prices of certain drugs covered by the Program may be higher in some states, as noted on the Retail Drug List and Mail Prednisone 10mg dose pak (21 tablets)† . . . . . . . . . . . . 1 . . . . . . . . 3 8. Program pricing may be limited to select manufacturers of a covered drug and is available as long as supplies from such manufacturers are in stock at the dispensing pharmacy.
Prednisone 10mg dose pak* (48 tablets)† . . . . . . . . . . . 1 . . . . . . . N/A 9. You may pay less or more than the Program price, depending on the terms of your health plan. Prescriber permission may be required to change a 30-day prescription to a 90-day prescription. Certain plans, including government- Prednisone 20mg tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . 90 funded programs, may not cover a 90-day supply. 10. For purchases made at Walmart Retail Pharmacies, prescriptions must initially be filled in person, and refills must be picked up in store. There are no substitutions. Purchases made through Walmart Mail Service may be ordered at Walmart Retail Pharmacies, by phone or through walmart.com.
11. These Program Details are subject to change without advance notice. Changes to these Program Details may be Prescription Program includes up to a 30-day supply for $4 and a 90-day supply for $10 of some covered generic drugs at commonly prescribed dosages. Higher dosages cost more. Prices for some drugs covered by the Prescription Program may be higher and may vary in some states. Restrictions apply. See Program Details or your Walmart Pharmacist for details. Free language assistance services available for prescription drug information at Walmart and Sam’s Club pharmacies in New York. Contact your Walmart or Sam’s Club pharmacy for details.
*Prices may be higher in CA, HI, MN, MT, PA, TN and WI.
† Prepackaged drugs are covered only in unit sizes specified on Drug List. See Program Details or your Walmart Pharmacist for details.
2009 Wal-Mart Stores, Inc. | Page 6 of 6

Source: http://www.gracefsa.com/WalmartRxBenefits.pdf