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Program Name: 119



Overview
Program provides medications at a discounted rate to patients experiencing financial
hardship.


Medications covered
acyclovir tablet 400 mg (Zovirax)
allopurinol tablets 100 mg (Zyloprim)
allopurinol tablets 300 mg (Zyloprim)
alprazolam tablet 0.25 mg (Xanax)
alprazolam tablet 0.5 mg (Xanax)
alprazolam tablet 1 mg (Xanax)
alprazolam tablet 2 mg (Xanax)
amiodarone tablet 200 mg (Cordarone)
amitriptyline tablets 10 mg (Elavil)
amitriptyline tablets 25 mg (Elavil)
amitriptyline tablets 50 mg (Elavil)
amitriptyline tablets 75 mg (Elavil)
amitriptyline tablets 100 mg (Elavil)
amitriptyline tablets 150 mg (Elavil)
atenolol tablets 25 mg (Tenormin)
atenolol tablets 50 mg (Tenormin)
atenolol tablets 100 mg (Tenormin)
atenolol/chlorthalidone tablets 50/25 mg (Tenoretic)
atenolol/chlorthalidone tablets 100/25 mg (Tenoretic)
belladonna alkaloids/phenobarbital tablet (Donnatal)
benazepril tablets 5 mg (Lotensin)
benazepril tablets 10 mg (Lotensin)
benazepril tablets 20 mg (Lotensin)
benazepril tablets 40 mg (Lotensin)
benazepril HCTZ tablets 5/6.25 mg (Lotensin HCT)
benazepril HCTZ tablets 10/6.25 mg (Lotensin HCT)
benazepril HCTZ tablets 20/12.5mg (Lotensin HCT)
benazepril HCTZ tablets 20/25 mg (Lotensin HCT)
benztropine tablet 0.5 mg (Cogentin)
benztropine tablet 1 mg (Cogentin)
benztropine tablet 2 mg (Cogentin)
betamethasone dipropionate cream 0.05% (45 gm) (Diprolene AF)
betamethasone valerate cream 0.1% (40 gm) (Beta-val)
betamethasone valerate ointment .01% (45 gm) (Beta-val)
bicyclomine capsule 10 mg (Bentyl)
bicyclomine tablet 20 mg (Bentyl)
bisoprolol/HCTZ tablet 2.5/6.25 mg (Ziac)
bisoprolol/HCTZ tablet 5/6.25 mg (Ziac)
bisoprolol/HCTZ tablet 10/6.25 mg (Ziac)
bumetanide tablets 0.5 mg (Bumex)
bumetanide tablets 1 mg (Bumex)
bumetanide tablets 2 mg (Bumex)
buspirone tablets 30mg (BuSpar)
buspirone tablets 5 mg (BuSpar)
buspirone tablets 10 mg (BuSpar)
buspirone tablets 15 mg (BuSpar)
captopril tablets 12.5 mg (Capoten)
captopril tablets 25 mg (Capoten)
captopril tablets 50 mg (Capoten)
captopril tablets 100 mg (Capoten)
carbamazepine tablet 200 mg (Tegretol)
chlordiazepoxide/clidinium capsules (Librax)
citalopram tablets 10 mg (Celexa)
citalopram tablets 20 mg (Celexa)
citalopram tablets 40 mg (Celexa)
clonazepam tablet 0.5 mg (Klonopin)
clonazepam tablet 1 mg (Klonopin)
clonazepam tablet 2 mg (Klonopin)
clonidine tablets 0.1 mg (Catapres)
clonidine tablets 0.2 mg (Catapres)
clonidine tablets 0.2 mg (Catapres)
colchicine tablet 60 mg (Colchicine)
diazepam tablet 2 mg (Valium)
diazepam tablet 5 mg (Valium)
diazepam tablet 10 mg (Valium)
diclofenac EC tablet 255075 (Voltaren)
diclofenac EC tablet 255075 (Voltaren)
diclofenac EC tablet 25 mg (Voltaren)
diclofenac EC tablet 50 mg (Voltaren)
diclofenac EC tablet 75 mg (Voltaren)
digoxin tablets 0.125 mg (Lanoxin)
digoxin tablets 0.25 mg (Lanoxin)
diltiazem ER capsule 180 mg (Dilacor XR)
diltiazem ER capsule 240 mg (Dilacor XR)
diltiazem ER capsule 120 mg (Dilacor XR)
diphenoxylate/atropine tablet 2.5/0.025 mg (Lomotil)
doxazosin mesylate tablets 1 mg (Cardura)
doxazosin mesylate tablets 2 mg (Cardura)
doxazosin mesylate tablets 4 mg (Cardura)
doxazosin mesylate tablets 8 mg (Cardura)
enalapril maleate tablets 2.5 mg (Vasotec)
enalapril maleate tablets 5 mg (Vasotec)
enalapril maleate tablets 10 mg (Vasotec)
enalapril maleate tablets 20 mg (Vasotec)
enalapril/HCTZ tablet 5/12.5 mg (Vaseretic)
enalapril/HCTZ tablet 10/25 mg (Vaseretic)
estradiol tablets 0.5 mg (Estrace)
estradiol tablets 1 mg (Estrace)
estradiol tablets 2 mg (Estrace)
estropipate tablet 0.625 mg (Ogen)
estropipate tablet 1.25 mg (Ogen)
famotidine tablets 20 mg (Pepcid)
famotidine tablets 40 mg (Pepcid)
fluocinonide cream 0.05% (60 gm) (Lidex)
fluoxetine tablets 10 mg (Prozac)
fluoxetine tablets 20 mg (Prozac)
fluoxetine tablets 40 mg (Prozac)
folic acid tablets 1 mg (folic acid)
furosemide tablets 20 mg (Lasix)
furosemide tablets 40 mg (Lasix)
furosemide tablets 80 mg (Lasix)
gabapentin capsule 100 mg (Neurontin)
gabapentin capsule 300 mg (Neurontin)
gabapentin capsule 400 mg (Neurontin)
gemfibrozil tablets 1 mg (Lopid)
glipizide tablets 5 mg (Glucotrol)
glipizide tablets 10 mg (Glucotrol)
glipizide ER tablet 2.5 mg (Glucotrol XL)
glipizide ER tablets 5 mg (Glucotrol XL)
glipizide ER tablets 10 mg (Glucotrol XL)
glyburide tablets 1.25 mg (Micronase)
glyburide tablets 2.5 mg (Micronase)
glyburide tablets 5 mg (Micronase)
glyburide, micronized tablets 1.5 mg (Glynase PresTab)
glyburide, micronized tablets 3 mg (Glynase PresTab)
glyburide, micronized tablets 6 mg (Glynase PresTab)
glyburide/metformin tablets 1.25/250 mg (Glucovance)
glyburide/metformin tablets 2.5/500 mg (Glucovance)
glyburide/metformin tablets 5/500 mg (Glucovance)
haloperidol tablets 0.5 mg (Haldol)
haloperidol tablets 1 mg (Haldol)
haloperidol tablets 2 mg (Haldol)
haloperidol tablets 5 mg (Haldol)
hemorrhoidal HC suppository 25 mg (Anucort-HC)
hydrochlorothiazide capsules 12.5 mg (Microzide)
hydrochlorothiazide tablets 25 mg (Esidrix)
hydrochlorothiazide tablets 50 mg (Esidrix)
hydrocortisone cream 2.5% (30 gm) (Hytone)
ibuprofen tablets 400 mg (Motrin)
ibuprofen tablets 600 mg (Motrin)
ibuprofen tablets 800 mg (Motrin)
indapamide tablets 1.25 mg (Lozol)
indapamide tablets 2.5 mg (Lozol)
isosorbide mononitrate tablets 10 mg (Ismo)
isosorbide mononitrate tablets 20 mg (Ismo)
isosorbide mononitrate ER tablets 30 mg (Imdur)
isosorbide mononitrate ER tablets 60 mg (Imdur)
isosorbide mononitrate ER tablets 120 mg (Imdur)
labetalol HCl tablets 100 mg (Trandate)
labetalol HCl tablets 200 mg (Trandate)
labetalol HCl tablets 300 mg (Trandate)
levothyroxine tablets 25 mcg (Levoxyl)
levothyroxine tablets 50 mcg (Levoxyl)
levothyroxine tablets 75 mcg (Levoxyl)
levothyroxine tablets 88 mcg (Levoxyl)
levothyroxine tablets 100 mcg (Levoxyl)
levothyroxine tablets 112 mcg (Levoxyl)
levothyroxine tablets 137 mcg (Levoxyl)
levothyroxine tablets 150 mcg (Levoxyl)
levothyroxine tablets 175 mcg (Levoxyl)
levothyroxine tablets 200 mcg (Levoxyl)
levothyroxine tablets 300 mcg (Levoxyl)
levothyroxine tablets 300 mcg (Levoxyl)
lisinopril tablets 2.5 mg (Zestril)
lisinopril tablets 5 mg (Zestril)
lisinopril tablets 10 mg (Zestril)
lisinopril tablets 20 mg (Zestril)
lisinopril tablets 30 mg (Zestril)
lisinopril tablets 40 mg (Zestril)
lisinopril/HCTZ tablets 10/12.5 mg (Zestoretic)
lisinopril/HCTZ tablets 12.5/12.5 mg (Zestoretic)
lisinopril/HCTZ tablets 20/25 mg (Zestoretic)
lithium carbonate capsules 300 mg (Eskalith)
lorazepam tablet 0.5 mg (Ativan)
lorazepam tablet 1 mg (Ativan)
lorazepam tablet 2 mg (Ativan)
lovastatin tablets 10 mg (Mevacor)
lovastatin tablets 20 mg (Mevacor)
lovastatin tablets 40 mg (Mevacor)
meclizine tablet 12.5 mg (Antivert)
meclizine tablet 25 mg (Antivert)
medroxyprogesterone tablet 2.5 mg (Provera Acetate)
medroxyprogesterone acetate tablet 5 mg (Provera)
medroxyprogesterone acetate tablet 10 mg (Provera)
metformin HCl tablets 500 mg (Glucophage)
metformin HCl tablets 850 mg (Glucophage)
metformin HCl tablets 1000 mg (Glucophage)
metformin HCl ER tablets 500 mg (Glucophage XR)
methotrexate tablet 2.5 mg (methotrexate)
metoclopramide HCl tablets 5 mg (Reglan)
metoclopramide HCl tablets 10 mg (Reglan)
metolazone tablet 2.5 mg (Zaroxolyn)
metolazone tablet 5 mg (Zaroxolyn)
metoprolol tablets 50 mg (Lopressor)
metoprolol tablets 100 mg (Lopressor)
mirtazapine tablet 15 mg (Remeron)
mirtazapine tablet 45 mg (Remeron)
mirtazapine tablet 30 mg (Remeron)
nabumetone tablet 500 mg (Relafen)
nabumetone tablet 750 mg (Relafen)
nadolol tablets 20 mg (Corgard)
nadolol tablets 40 mg (Corgard)
nadolol tablets 80 mg (Corgard)
nadolol tablets 120 mg (Corgard)
nadolol tablets 160 mg (Corgard)
naproxen tablets 250 mg (Naprosyn)
naproxen tablets 375 mg (Naprosyn)
naproxen tablets 500 mg (Naprosyn)
naproxen sodium tablet 550 mg (Anaprox Ds)
nortriptyline HCl capsules 10 mg (Pamelor)
nortriptyline HCl capsules 25 mg (Pamelor)
nortriptyline HCl capsules 50 mg (Pamelor)
nortriptyline HCl capsules 75 mg (Pamelor)
nystatin cream 100,000 unit/gm (30 gm) (Mycostatin)
nystatin/triamcinolone cream 100,000 unit/gm-0.1% (60 gm) (Mycolog-ii)
omeprazole capsules 10 mg (Prilosec)
omeprazole capsules 20 mg (Prilosec)
oxybutynin tablets 5 mg (Ditropan)
paroxetine HCl tablet 10 mg (Paxil)
paroxetine HCl tablet 20 mg (Paxil)
paroxetine HCl tablet 30 mg (Paxil)
paroxetine HCl tablet 40 mg (Paxil)
pentoxifylline ER tablet 400 mg (Trental)
potassium tablets 750 mg (10 mEq) (potassium chloride ER)
potassium chloride tablet (K-Dur)
prednisone tablets 1 mg (Deltasone)
prednisone tablets 2.5 mg (Deltasone)
prednisone tablets 5 mg (Deltasone)
prednisone tablets 10 mg (Deltasone)
prednisone tablets 20 mg (Deltasone)
prednisone tablets 50 mg (Deltasone)
previfem tablet 28 days (Ortho-Cyclen)
prochlorperazine tablet 5 mg (Compazine)
prochlorperazine tablet 10 mg (Compazine)
Propylthiouracil tablet 50 mg
propranolol tablets 10 mg (Inderal)
propranolol tablets 20 mg (Inderal)
propranolol tablets 40 mg (Inderal)
propranolol tablets 60 mg (Inderal)
propranolol tablets 80 mg (Inderal)
quinapril tablet 5 mg (Accupril)
quinapril tablet 10 mg (Accupril)
quinapril tablet 20 mg (Accupril)
quinapril tablet 40 mg (Accupril)
ranitidine tablets 150 mg (Zantac)
ranitidine tablets 300 mg (Zantac)
spironolactone tablet 25 mg (Aldactone)
Sulfamethoxazole/Trimethoprim DS tablet
tamoxifen citrate tablets 10 mg (Nolvadex)
tamoxifen citrate tablets 20mg (Nolvadex)
temazepam capsule 15 mg (Restoril)
temazepam capsule 30 mg (Restoril)
terazosin capsules 1 mg (Hytrin)
terazosin capsules 2 mg (Hytrin)
terazosin capsules 5 mg (Hytrin)
terazosin capsules 10 mg (Hytrin)
theophylline ER tablet 100 mg (Theo-Dur)
theophylline ER tablet 200 mg (Theo-Dur)
theophylline ER tablet 300 mg (Theo-Dur)
timolol maleate ophthalmic solution 0.5% (Timoptic)
timolol maleate ophthalmic solution 0.25% (Timoptic)
tramadol tablet 50 mg (Ultram)
trazodone tablets 50 mg (Desyrel)
trazodone tablets 100 mg (Desyrel)
trazodone tablets 150 mg (Desyrel)
trazodone tablets 300 mg (Desyrel)
tri-previfem tablet 28 days (Ortho Tri-Cyclen)
triamterene/HCTZ capsules 37.5/25 mg (Maxzide)
triamterene/HCTZ capsules 50/25 mg (Maxzide)
triamcinolone cream 0.5% (15 gm) (Aristocort A)
triamcinolone cream 0.1% (80 gm) (Aristocort A)
verapamil tablets 40 mg (Calan)
verapamil tablets 80 mg (Calan)
verapamil tablets 120 mg (Calan)
verapamil SR tablets 12 mg (Calan SR)
verapamil SR tablets 18 mg (Calan SR)
verapamil SR tablets 24 mg (Calan SR)
warfarin tablet 1 mg (Coumadin)
warfarin tablet 2 mg (Coumadin)
warfarin tablet 3 mg (Coumadin)
warfarin tablet 2.5 mg (Coumadin)
warfarin tablet 4 mg (Coumadin)
warfarin tablet 5 mg (Coumadin)
warfarin tablet 6 mg (Coumadin)
warfarin tablet 7.5 mg (Coumadin)
warfarin tablet 10 mg (Coumadin)


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