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'-.Retail Prescription Program Drug ListLow-cost prescriptions make a difference90-Day PrescriptionsAt Walmart, we don't think you should have to choose betweengroceries and the medicines you need. Our 4 prescriptions saveAmerican families hundreds of millions of dollars a year.Taking a regular prescription? Ask your doctor if you can refill it3 months at a time. At only 10.our 90-Day prescriptions save youeven more than our regular low-cost prescriptions. You save tripsto the pharmacy, too.More 4 prescriptions than everNow our 4 price covers hundreds of prescriptions. That includesmedicines for a wide range of conditions and diagnosis groups.This list is a quick-reference tool that will help you find the specificmedicines you're looking for.Allergies& Cold and FluBenzonatate1OOmg capCeron OM syrup . .C-Phen drops* (30ml bottle)'Dex PC syrup*Loratadine1Omg tabPromethazineAntibioticOM syrup . .Revised 3/3/10 4 60mlMetronidazole3090Penicillin VK 2s0mg tab120ml360mlPenicillin VK 12smg/sml 4 1030-Day90-DayCiprofloxacinsOOmg tab2060Doxycycline Hyclate SOmg cap3090Doxycycline Hyclate 1OOmg cap2060Doxycycline Hyclate 1OOmg tab2060Erythromycin28842s0mg tab2884sOOmg tab14422884susp (1OOml bottle)!13Penicillin VK 12smg/smlsusp (200ml bottle)!13Penicillin VK 2s0mg/smlsusp (1OOml bottle)!13120ml360ml2884SMZ-TMP OS 800mg- 160mg tab2060Tetracycline 2s0mg cap60180Tetracycline sOOmg cap60180EC 2s0mg cap*SMZ-TMP 200mg-40mg/smlTreatmentsSMZ-TMP 400mg-80mgsusp*tabAmoxicillin12smg/smlsusp (80ml bottle)'13Amoxicillin12smg/smlsusp (1OOml bottle)!13Amoxicillin12smg/smlsusp (1sOml bottle)!13Amoxicillin200mg/smlsusp (sOml bottle)!13Amoxicillin200mg/smlsusp* (7sml bottle)'13Amoxicillin200mg/smlsusp* (1OOml bottle)!13Amoxicillin2s0mg/smlsusp (80ml bottle)'13Arthritis & PainAmoxicillin2s0mg/smlsusp (1OOml bottle)'13Allopurinol100mg tab3090Amoxicillin2s0mg/smlsusp (1sOml bottle)'13Allopurinol300mg tab3090Amoxicillin400mg/smlsusp (sOml bottle)'13Baclofen 1Omg tab3090Amoxicillin400mg/smlsusp* (7sml bottle)'13Colchicine 0.6mg tab3090Amoxicillin400mg/smlsusp* (1OOml bottle)'13Cyclobenzaprinesmg tab3090Amoxicillin2S0mg cap3090Cyclobenzaprine1Omg tab3090AmoxicillinsOOmg cap3090Dexamethasone O.smg tab3090Cephalexin2s0mg cap2884Dexamethasone O.7smg tab1236CephalexinsOOmg cap3090Dexamethasone 4mg tab618 4 ip' I?x. :i. ,. ? . ;;:::::::::::::::::.1. ::: :::::. 1090-Day . . . . . . . . . . . . . . . . . . . . . . Prescr.pt.on Drognm ;ncludes up to a 30 day sucoly for S4 and a ')0 day supply for S 10 of so ne covererr 'lene',e drugs 3t commonly prescnbed dosages HIgher dosiqes costmo-e, Pr'ces for some drugs cove-eo by the P'eser pnon Dmgram may be ·'.grer Ind 'n"y ,ary ., some ':., s. ilestrctonslppl/See : '09'am DE" '5 or 10'" Wa:rnar,Pharrn ic st for dela Is. Free la"gudge ass.stance services available for preset ution oJrug r.formation at ',val mar dnd Sarn s Clubpharrnac.es ,n 'Jew 'lark. Contact your Walmar t or Sam s Club pharmacy for .jAl »ts."Pr.ce s may be higher .n CA. HI. MN. MT. PA. fN and WI'Prepackageddruqs are covered only In unit s.zes ',peCtfied on Drug L,st. ee Program Detaolsor your Walrnarr Pharmacist for derails.
Arthritis & Pain (continued)DiclofenacDR 75mg tabIbuprofen100mg/5mlIbuprofenGlyburide 2.5mg tab3090Glyburide 5mg tab (blue)3090Glyburide 5mg tab (green)309060180120ml360ml400mg tab90270Glyburide, micronized3mg tab3090Ibuprofen600mg tab60180Glyburide, micronized 6mg tab3090Ibuprofen800mg tab3090Metformin500mg tab6018060180Metformin850mg tab60180Indomethacinsusp*25mg cap*Meloxicam7.5mg tab3090Metformin1000mg tab"60180Meloxicam15mg tab3090Metformin500mg ERtab*60180Naproxen375mg tab*60180Naproxen500mg tab"6018030-0ay 1090-0ay90270 4 430-0ay 1090-0ay13 43Q-Oay 109Q-OayFluconazole 150mg tab13NystatinlTriamcincream (15gm tube)!13NystatinlTriamcincream (30gm tuber13NystatinlTriamcinointment13Nystatin cream (15gm tube)'13Nystatin cream (30gm tuber13Nystatin ointment(15gm tuber13(30gm tube)!133090 4N:Qu 1090-0ayBelladonna Alkaloid/PB tab60180Cimetidine 800mg tab*3090180ml540mlEar HealthAntipyrine/Benzocaineotic (1Oml 20ml360mlAlbuterol2mg/5ml syrupAlbuterol0.5% nebulizer soln (20ml bottle)!13Albuterol0.083% nebulizer soln* (25x3ml vials)!130.02% nebulizer soln* (25x2.5ml vials)' . 13Ipratropium 4 1090-0ay CholesterolFungal Infections3090Nystatin ointmentLovastatin 20mg tab*3090Terbinafine 250mg tab*Pravastatin 1Omg tab3090Pravastatin 20mg tab3090Lovastatin1Omg tabPravastatin 40mg tab"3090 4 1090-0ay30-0ayGastrointestinal HealthCytra2 solutionDiabetesChlorpropamide1OOmg tab*(15gm tube)'3090Dicyclomine10mg cap90270Glimepiride1mg tab3090Dicyclomine 20mg tab60180Glimepiride2mg tab3090Famotidine 20mg tab60180Glimepiride4mg tab3090Lactulose syrup237ml711 mlGlipizide 5mg tab3090Metoclopramide60180Glipizide601801Omg tab*10mg tabPre scr-puon"rogI1 11 'nctuces up ',0 a 30 day supply for S4 nd a Xl clay supply for 510 ,jf some (')yerecl 'Jener'c drugs at conlll'onilpreler,bedrjOldyes;llghel dos.iqe'I 'It', 1" ',t' fl)r s. ne drugs covered by tht' Prescriptionpro ]ram may be Iligrer dnd nldY vary .n some states. gesuct'olll.lPply ) e i'r(l'JrJfll Details or your .VdilllJI[,Ik .i 'H(· · f)' !. .lj!C;.F'ee lanqudge dssistance services dval1dble for preset ptoo druq i"forn'dtiorl at ',Valmart !ld Sam's C'ubfj"d"1l1leI .n 'Jew York Contactyour '''Jaln1drt or S,J",'s Club oharrnacy Ior'Prices may be higher .n CA, HI. MN, .'AT, PA, TN and WI.prepdrkag d drugs dre covered only In unit Sizes peclflJ:ld on Drug List.or yOIJl 'Ndlrnart Pharrllacist for details.Re'/Ised 3/ 3/ 0details.:;;.le Programs c, 'ItCp 3ds
GastrointestinalMetoclopramideBisoprolol-HCTZ 5mg-6.25mgHealth (contined)syrup60ml.180mlPromethazine25mg tab*1236Promethazineplain syrup*180ml540ml30903090Bumetanide 0.5mg tab3090Bumetanide1mg tab3090Bisoprolol-HCTZtab1Omg-6.25mg tabRanitidine150mg tab60180Captopril 12.5mg tab60180Ranitidine300mg tab3090Captopril 25mg tab60180Captopril 50mg tab60Captopril 1OOmg tab60180Carvedilol 3.125mg tab60180Carvedilol6.25mgtab60180Carvedilol 12.5mg tab60180Carvedilol 25mg tab*60180Chlorthalidone25mg tab3090Chlorthalidone50mg tab3090Clonidine 0.1 mg tab3090Clonidine 0.2mg tab3090Digoxin 0.125mg tab3090Digoxin 0.25mg tab3090Diltiazem 30mg tab60180Diltiazem 60mg tab60180Diltiazem 90mg tab*60180Diltiazem 120mg tab3090Doxazosin 1mg tab3090Doxazosin 2mg tab3090Doxazosin 4mg tab3090Doxazosin 8mg tab3090Enalapril-HCTZ 5mg- 12.5mg tab3090Enalapril2.5mg3090Enalapril 5mg tab3090Enalapril 10mg tab3090Enalapril 20mg tab3090Furosemide 20mg tab3090Furosemide 40mg tab3090Furosemide 80mg tab . .3090Guanfacine 1mg tab3090Hydralazine 10mg tab3090Hydralazine 25mg tab30903090 10 4 GlaucomaAtropine & Eye CareSulfate 1% op. soln (5ml bottle)'13130.3% op. soln (5ml bottle)'130.5% op soln (5ml bottle)'13130.1% op. susp (5ml bottle)'13Pilocarpine1% op. soln (15ml bottle)'13Pilocarpine2% op. soln (15ml bottle)'13Polymyxin SulfatefTMP op. soln* (1Oml bottle)'13Sulfacet Sodium 10% op. soln (15ml bottle}'13Timolol Maleate 0.25% op. soln (5ml bottle)'13Timolol1313 4 10ErythromycinGentamicinLevobunololop. ointment(3.5gm tube)'*Neomycin/Polymyxin/Dexamethasone0.1% op. ointment(3.5gm tube)'Neomycin/Polymyxin/DexamethasoneMaleate 0.5% op soln (5ml bottle)'Tobramycin0.3% op. soln (5ml bottle)' Heart Health & Blood PressureAmiloride-HCTZ5mg-50mg halidone100mg-25mgtabtab309030903090Atenolol25mg tab3090Atenolol50mg tab3090Atenolol1OOmg tab30908enazepril5mg tab3090Benazepril1Omg tab3090Benazepril 20mg tab3090Benazepril 40mg tab3090Bisoprolol-HCTZ30902.5mg-6.25mg tabPrescrpnon' 'ogram · clu .les up '0 a 30 -jay suopty formore. Pnces for some drugs covered by the PrescflptionPharmacist for details. 'ee language asvrstance servicespharmac.es In 'Iew York Contact your Walman Or Sam's0(I Page30f6Hydrochlorothiazide(HCTZ)12.5mg cap"180Hydrochlorothiazide(HCTZ) 25mg tab3090Hydrochlorothiazide(HCTZ) SOmg tab3090S4 and a JO day supply for S 10 of orne covered qener c drugs H commonly oresc-bec uosaqes. H'gher dosages costProgram mal be n.gher and 'nay ,ary n some states. qeslflC! ens applv c ee Program ':let.,ds or lour Walmartava table for prescrpt.on drug .nforrnanon at Walmart and Som s ClubClub pharmacy'Prices may be higher ·n CA, HI, MN, MT, PA. rN and WI.Prepackaged drugs Me covered only in unit sizes vpec.fledor your Walmar Pharmacist for details.2010',\Ial ''''Jr' .tores,tab'"for detailson Drug L SI. See Program DetailsRevised 3/3/ \ 0
Heart Health & Blood Pressure (continued)Warfarin 1mg tab3090Indapamide1.2Smg tab3090Warfarin 2mg tab3090Indapamide2.5mg tab3090Warfarin 2.Smg tab309030903090Isosorbide Mononitrate30mg ERtab3090Warfarin 3mg tabIsosorbide Mononitrate60mg ERtab3090Warfarin 4mg tab,Lisinopril-HCTZ10mg-12.Smg tab3090Warfarin Smg tab"3090Lisinopril-HCTZ20mg-12.Smg tab*3090Warfarin 6mg tab3090Lisinopril-HCTZ20mg-2Smg tab*3090Warfarin 7.5mg tab3090Lisinopril 2.Smg tab3090Warfarin 10mgtab3090Lisinopril Smg tab3090Lisinopril30901Omg tabLisinopril 20mg tab3090Methyldopa2S0mg tab*60180MethyldopaSOOmgtab*3090MetoprololTartrate 2Smg tab60180MetoprololTartrate SOmg tab60180MetoprololTartrate 1OOmg tab*60180Nadolol 20mg tab3090Nadolol 40mg tab3090Pindolol Smg tab3090Pindolol 1Omg tab3090Prazosin HCL 1mg cap3090Prazosin HCL 2mg cap3090Prazosi n HCL 5mg 018080mg tab60180Sotalol HCL 80mg tab"3090Spironolactone3090Terazosin 1mg cap3090Terazosin 2mg cap3090Terazosin Smg cap3090Terazosin 1Omg cap3090 4lO-DayMental HealthAmitriptyline1Omg tab3090Amitriptyline2Smg tab3090AmitriptylineSOmg tab3090Amitriptyline7Smg tab3090Amitriptyline100mg tab30903090Buspirone Smg tab60180Buspirone 1Omg tab*60180Carbamazepine60180Citalopram 20mg tab3090Citalopram 40mg tab3090Doxepin HCL 10mg cap3090Doxepin HCL2Smg cap3090Doxepin HCL SOmg cap3090Doxepin HCL 7Smg cap3090Doxepin HCL 1OOmg cap3090Fluoxetine 1Omg tab*3090Fluoxetine 1Omg cap3090Fluoxetine 20mg cap3090Fluoxetine 40mg cap3090Fluphenazine 1mg tab3090Haloperidol O.Smg tab3090Haloperidol3090Benztropine 2mg tab20mg tabPropranolol40mgPropranolol2Smg tab*Triamterene-HCTZ37.Smg-2Smg cap, . 3090Triamterene-HCTZ37.Smg-2Smg tab3090Triamterene-HCTZ7Smg-SOmg tab3090Verapamil 80mg tab3090Verapamil 120mg tab3090 10 ,200mg tab*1mg um Carbonate 300mg cap"90270Nortriptyline309010mg capD'esu'pt'onP'oC;'Jn1 ;nciudes up to J 30 ,jay supply for S4 )nd d JO (lly .uuply fa,S lOaf some covered qenerc drugs at cornrnor 'y presc bed dosages "j'c;her ,Iose ; . · cost-nore PfI(eS for SO'11edrugs covered by rne Prese' pton Program mdY be '1'91'er ino may '/drY ,n some st,ltPS. DestflC{,ons 'pply See P'oqram Ot:{dils or your ',',a'ma' (Pharmacist for l!etarls. Free 'anquaqe dsslstance servce s wa,'able for prescription drug .nforrnation J{ Walmdrt and Sam s ClubonarrnacesIn 'Iew York. Coruact your Nalmart 0r Sam's Club pharmdcy for ojetailsPevseo 313/'"Prrces may he higher In CA. HI, \/IN, MT, PA, TN Jnd WIPrepackaged drugs are covered only .n unit sizes spt'r.f"dor four 'Nalmdft l'hdfl1lacisl for details.20!f)WJI M.,., S'o'es. I.". I P1ge .j of 6on Drug L"1.S"e ProqrimDetailsWalmart ' J5 . mol'Ml' lI". ben.,.8
Mental Health (continued) 4Nortriptyline2Smg cap 1090-Day3090Paroxetine 1Omg tab*3090Thyroid ConditionsParoxetine 20mg tab"3090Levothyroxine2Smcg tab3090 '3090Prochlorperazine1Omg tab,30-DayLevothyroxineSOmcg tab3090Thioridazine2Smg tab3090Levothyroxine7Smcg tab3090ThioridazineSOmg tab3090Levothyroxine88mcg tab3090Thiothixene2mg cap3090Levothyroxine1OOmcg tab3090Trazodone SOmg tab3090Levothyroxine112mcg tab3090Trazodone1OOmg tab3090Levothyroxine12Smcg tab3090Trazodone 1SOmg tab3090Levothyroxine137mcg tab3090Trihexyphenidyl60180Levothyroxine1SOmcg tab3090Levothyroxine17Smcg tab"3090Levothyroxine200mcg tab"3090 4 10,2mg tab 430-Day 1090-DaySkin m(1Sgm tube)'1BetamethasoneDipropionate3Acyclovir 200mg capO.OS%cream(4Sgm tube)' Viruses309013BetamethasoneValerate 0.1% cream (1Sgm tube)' . 13BetamethasoneVal. 0.1% cream (4Sgm tube)'13Vitamins & Nutritional lic Acid 1mg tab3090Betamethasone13Klorcon 8 8mEq ERtab3090 4Val. 0.1% ointment(4Sgm tube)'3.O:O.iy 10 FluocinoloneAcet. 0.01% soln (60ml bottle)'13Klorcon 10 1OmEq ERtab3090FluocinonideO.OS%cream (1Sgm tube)'13Klorcon M10 10mEq tab3090FluocinonideO.OS%cream (30gm tube)'13Mag 64 64mg tab"60180Gentamicin0.1% cream (1Sgm tube)'13Magnesium Oxide 400mg tab3090Gentamicin0.1% ointment13Prenatal Plus qty 30*3090473ml141 9ml(1Sgm tube)'Hydrocortisone1% cream (28.3S-30g tube)'13Potassium Chloride 10% liquidHydrocortisone2.S% cream (30gm tube)'13Sodium Fluoride .2Smg chewable (120ct bottle) t* . 1Selenium Sulfide 2.5% lotion* (120ml bottle)'13Silver Sulfadiazine 1% cream* (SOgm tube)'13 4Triamcinolone0.02S% cream (1Sgm tube)'1330-Day 1090-DayTriamcinolone0.02S% cream (80gm tube)'13Women's HealthTriamcinolone0.1% cream (1Sgm tube)'13Estradiol O.Smg tab3090Triamcinolone0.1% cream (80gm tube)'13Estradiol 1mg tab3090Triamcinolone0.1% ointment(1Sgm tube)'13Estradiol 2mg tab3090Triamcinolone0.1% ointment(80gm tube)'13Estropipate 0.7Smg tab3090TriamcinoloneO.S%cream (1Sgm tube)'13Estropipate 1.Smg tab"3090Prescr.puon D·og.am nctudes up to a 30-day supply formore. P, ces for some drugs covered by the P'escflptionPhar maost for dera.ts. ,ree language aSSIStance servcespharmacies III 'Jew Yor Contact lour Walmart Or Sam's54 Jnd J 90 clay supply for 5 10 of some covered generic druqs st commonly oresc-rbed cosaces Y'gher dos.iqes (OSrProgram may be "'gher and may '/ary in vome states. Mest.-c ions apply S- eProqrarn 'Jetails or lour Warnartava.lable for pre scr.pt.on drug Informationat 'Naiman and Sam's ClubClub pharmact for details.Pev·)ed 3/31'"Pnce s may be h'gher In CA. HI. MN. MT. ?A, TN and WIP'epackageddrolgS are covered only In unit s,zes speCified on Drug t.st.or your .vJI art Pharmacist for details.2010 Wal 'v1art Stores. 'nc.] Paqe S r)f 6N/Alee Program Details)
MedroxyprogesteroneAcetate2.5mg tab3090MedroxyprogesteroneAcetate 5mg tab . .3090MedroxyprogesteroneAcetate 10mg tab1030 930-Day 2490-DayWomen's HealthAlendronateSOD 35mg tab412AlendronateSOD 70mg tab412Clomiphene50mg tab515Sprintec 28-day tab"28N/ ATri-Sprintec28N/A601803090 4 1028-day tab"Tamoxifen1Omg tabTamoxifen20mg tab,,I.Wolmart's Presaipdon Program (tho'Program1 is "" lablo at.U W.1mdrt, Sam's Club and Neighborhood Marketpharmades in the United States ("Walmart Ret Pharmadesi. except in North 0ak0Ia. as set forth bekJw in Sections 3and 4. Ibe l'Iogram oIso ""aoIabIo clYough waImart Mail SeMc. ('Walmart Mail SeMce1. as set btI1 below in Section S.2.rbe Program .ppIies only to certain generic: drugs at coovnonly proscribed dosages Higher dosag cost mor . Yoomay obtain. IisI01 generic: drugs and dosages c undo the Program.t Walm.ort R UPharmacies (the ·Ret. Drug Usn and through WaImart Mail5e voc. (the 'M Servke Drug usn on Walmart.com or at Walmart RetaiPIlarmades. The Re Drug Ust and Mail SeMc. Drug Lst may change ""d also may vary by stere. No formuiatior1S 01. drug (for example, eoteoc-eceeed extended or timed release formulations) are c edundef theProgtam. Program pricing not ""adab/e when. covered drug is dispensed as part 01. c 90-Day Other Medical ConditionsChlorhexidine Gluconate 0.12% soln (473ml bottle)'HydrocortisoneAC 25mg suppositoriesIsoniazid 300mg tab'"Lidocaine 2% viscous solution (1OOml bottle)t131236309013Megestrol20mg tab"3090Methylpred4mg tab2163Methylpred4mg dose pak (21 tablets)'13Oxybutynin5mg tab601803. Under the Program Wolmart RetM Pharmades, 54 is the poce for up to. supply 01 cert.in covered genericdrug !CommonIy ribeddosages (th.' 4 Retad Progtam1. 1 to." the price 01. 9 Hl.Jy supply 01 certain coveredgeneric drugs at coovnonly pr nbeddosages (the'l I0.Reta Progfaml. No all drugs covered by the 4 RetailProgram. covered by the 110. Program Prkes for quanmies between a 3(} jay suppIy.nd.9 Hl.Jy supply 01 drugscovered by both the 14 Ret Progfam and I I0.Retail Program are prorated based on the 14 Program prke. but WIllnot exceed I' 0. Prices for quant ies gre.ter thdfl. 9().day supply 01 drug. covered by the I I0.Ret Program arepeoeetedbased on the 110. Progtam prk . Prorated prkiog i. not ev 1abIo undo th.Program for prepackaged drug.for pricing poIioes relating 10 prepackaged drugs (such a.1\Jbes, vials or I,see Section 6.4.Phenazopyridine1OOmg tab618Phenazopyridine200mg tab30903090309013133090Prednisone 2.5mg tabPrednisone 5mg tab,Prednisone 5mg dose pak (21 tablets)'Prednisone 5mg dose pak" (48 tablets)',Prednisone1Omg tabPrednisone1Omg dose pak (21 tablets)'13Prednisone1Omg dose pak" (48 tablets)'1N/A3090Prednisone 20mg tabUnder the Program at WaImart PI1armades. 19 the prke for up 10 a supply 01certain women'. health ando hercovered generic drug. at commonly dosages (the'19 Programj. 1241. the pm for a 9().daysupply 01 certainhealth and o her c"""ed generic drugs at commonly prescnbed dosages (the'124 RetailProgramj. No all drugs covered by the 19 Reta Program covered by the 124 R Program Prices for quantities-.a JO.day supply and a 9 Hl.Jy supply 01 drug. covered by bo h the 19 Program and 124 Program eprorated based on the 19 Program prk e, but wiU not e",eed 124. Ptkes for quantities .t .thdfla 9 Hl.Jy .upply 01drug. covered by the 124 Ret Program are prorated based on the S24 Program prk . Prorated prking Is no! "".iablounder the Program for prepackaged drug. for prking poIides relating to prepackaged drug. see Sectiofl6."",""",'sS.Under the Program through W.lmart Mail Servke, S 10.is the peke for mail delr-y 01. 9().day supply 01 c,"aingeneric drugs at COJTVT OJlIyprescnbed dosage. i'S I 0.Ma SeMc. Program,. 124 Is the peke for ma delMfy 0(certain women's health and certam other covered drugs It commonty prescribed dosages (S24 Mail Service Programj.Not all drug. covered by the I I0 R", Program . coveted by tbe S 10.Mail Service Program; not .N drug. covered byrbe 124 Ret.il Progt.m are o» edby the 124 Mail Servke Progfam See Ma Servce Drug Ust for a list 01 drugscovet'ed by the S 10 Mail Servke Program and S24 Mau Servk:e Program. WalCNtt Matt Service covers both initial fillsand refids. DeUvery of covered drugs is available only through Wa'mart Mall Servk:e and ts not availabte at W mart.Sam'. Oul: . and Neighbothood Market retail ph. rmac DeIi'Iery undo the Progtam through waimart Mad Service islimited to U5. addreues by Fint-(Ia.u M.UI; ellpeditrd de4ivery is also avaital* for an addit charge. Some healthptans do not eOYet' Wa'mart Mail Sefvice OI90-day suppl Prkes lOt quantit gteater than a 9O-day suppty of drugscovered by1 10.Ma Service Programorld the 124 Ma seevce Program ere proeated based on the I Io.nd 124Program poce, respectMly. Ptk es for quantities less than a 9 Hl.Jy supply are not prorated undo either the 5 I 0.Ma Servke Program or the 124 Mail5e voc. Program. Proreted pr1Ofl9 is not available undo the Program for prepackageddrug. for pnOng poIides relating 10 prepad aged drug see Section 6.I"".u.s6.Prepackaged drug r. covered undo the Program only onthe uMspecified on the Retail Drug list and Ma Service Drug llit. Prepac:kqddrugs are dispensed based on me qtJdI1t1t pre libed and unit siH-s In stock at t dispensing pharmacy. Un sees not speofied on the Retail Drug Ust OfM'" sevce Drug List are not covered undefthe Program. MultHJnit purchases are charg at a pet' untt IYKe ba on the poce per untt slze dispensed. vniesso herwose scecfed. Prepackaged drug. dispensed In un sees not speofied on the Reta Drug US! and Mail SeevsceDrug list may be prked higher, even equrvalenl quanOties 0( me drug are avaHable onspec.1ed un" '1ZeS. ProratedprICing" roe avarlable under the Program for prepackaged drugs.7.?nees 01 certain drugscoveredSeMce Drug Ust.by the Program may be hogher on some51 noted on the Re Drug Ust and Mail8. Program priong may be limrIed to seecr manufactur ees 01. covered drug and av abIe Iong as supplies humwch manufacturers are in ock a( tM dtsprnSM'19 ph.wmacy.(au may pcry less Or rrcee than ttw Prexyam poce, depeonding on lhe tertrrs of)'QUI he.Yth P'an Pfescnber perrrvss;onmay be req .«ed 10 change a 3(} jay prescnptionlO a 9 Hl.Jy pre.r:ripoon Ceft." plans. .ndU ing ".,.,.fvnded progrom may not cover a 9 Hl.Jy supply.10 For putch.J rrede at Walmart RetM PhMmac.ie'i. ptl!SUlptlOf'l\ must Ifllbaily be fiRed '" per'iOn, and refiS\ must beptd.ed up an ucee Ibere ace no s.ubst1f\Jhons. Putc:has.es mclde rhrt:lO Jl1Walmart Mall Seooce may be- ordered ittRetail PI1armades. by phone or cIYoogh wolmartLom.W,"""",11 tbese Program Details are sotaect 10 change wrthoulrn.:tdronty 1(1wrltlng.xNCII'laroeceO· !Othese Progf am Oetads may be'Prescr.pnonProqrarn '1cludes Up to a 30'day upply for 54 J'ld a 90 day upply for 5 10 of some covered generic druqs at commonly orescr.bed dosages Higher dos .qe s costnor e. Prlcel for some drugs covered by the Prescription Iogrdm may be 11;g'1er lnd may Ydry in some states. 8estri({lons apply Set Program Details or your wa.mart?'lal rr-ac.st for ;iptails. r'ee 'anquaqe ass.stance serv ces ava.labte for prescrptiondrug Information at Walmart and Sam's Clubp'lMm"c'el.n 'Jew York. Contact your Walmart or Sam's Club phalrnJcy for -::etdils.Pev.sed 3/3/'"Pnces may be higher In CA. HI, MN, MT, PA. rN and WI'Prepackageddrl.gs are covered only ,n unit sizes spec.fiedor your Walman Pharmacist for cietails.2010 WliMart Slorps.ncI Page 6 of6on Drug L st. Jee Proqrarn DerartsC)
At Walmart, we don't think you should have to choose between groceries and the medicines you need. Our 4 prescriptions save American families hundreds of millions of dollars a year. More 4 prescriptions than ever Now our 4 price covers hundreds of prescriptions. That includes medi
