2015 Over-the-Counter (OTC) Catalog

Transcription


2015
Over-the-Counter (OTC) Catalog
�
Get the OTC items you need.
— Medicare Advantage Plans —
H5087_CA027266_WCM_OTC_ENG CMS Accepted 08302014
©WellCare 2014 CA_07_14_EC
EC5OTCCAT60343E
The Benefits of Easy Choice Health Plan Add Up.
What is Easy Choice’s OTC benefit? Simply put, we give you a monthly dollar
amount; you spend it on some of the over-the-counter (OTC) items you use every
day. It’s that easy.
The OTC benefit is part of your health plan. Every month you can get brand-name or
generic OTC medications and products like bandages, pain relievers, cold medicine,
toothpaste, vitamins and much more.
You can use this catalog, then order online or by phone, and we’ll ship your items
right to your door.
Each plan offers different OTC benefit amounts. Check your Evidence of Coverage
or Summary of Benefits for your specific benefit amount for your plan. Remember
that your benefit and items are only for your use. Use your benefit each month. It
does not roll over to the next month.
How Do I Use My OTC Benefit?
There are a couple of ways to get your items. No matter how you order them, we’ll
ship them right to your door. It’s that easy. Allow 7-10 days to receive your order.
Find the items you want in this catalog, then:
1.
Give us a call at 1-877-483-9563, TTY 711, Monday-Friday,
6:30 a.m.–8:00 p.m. Pacific.
2. Visit us at www.easychoicehealthplan.com. Log in using your member ID
number and date of birth. You can find your member ID number on your Easy
Choice member ID card.
Call Customer Service to order your OTC items
| 1
EC5OTCCAT60343E
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What Can I Order With My OTC Selection?
Eligible items
On the next few pages, you’ll find a list of products. These are the items that you
can order from us and have mailed to your home. Eligible items include but are
not limited to: fiber supplements, first aid supplies, medicines, ointments, sprays
with active medical ingredients that alleviate symptoms, topical sunscreen,
supportive items for comfort such as knee braces and adult incontinence
products, and mouth care such as dental floss and toothbrushes.
Dual-purpose items
What are dual-purpose items? They’re medicines and products that can be used
for either a medical condition or for general health and well-being. You can get
dual-purpose items as part of your OTC benefit if you use them to treat a
specific medical condition and your doctor recommends the product or medicine.
Talk with your doctor before buying dual-purpose items. For your convenience,
we’ve marked dual-purpose items with a (†).
Dual-purpose items include but are not limited to:
• Minerals and vitamins
• In-home testing and monitoring
• Hormone replacement
• Weight-loss items
Some items, under certain circumstances, may be covered under either Part B or
Part D. For example, gauze may be covered under Part B when it is being used, as
prescribed, to perform surgical wound dressing changes. For your convenience,
we’ve marked these items with a (**).
What’s not eligible?
The following categories and items listed are not eligible for the OTC benefit. You
cannot order them from us, and if you buy these items at a store, we can’t repay you
for them. Non-eligible items include but are not limited to:
• Alternative medicines such as botanicals, herbals, probiotics and nutraceuticals
• Baby items such as diapers and formula
• Contraceptives such as birth control pills and spermicides
• Convenience and comfort items such as scales, fans and magnifying glasses
• Cosmetic items such as mouthwash, bad breath remedies, deodorants and
teeth whitening
• Food products or supplements
• Replacement items such as hearing aid batteries and contact lens containers
2 | Call Customer Service to order your OTC items
�
Items You Can Order From Us
Do you prefer lower-cost generics or familiar brand-name products? Your OTC benefit lets
you make the choice! Look over the list of eligible items on the next few pages. You can order
online or by calling us and telling us the items you want. We’ll send them to your home and
deduct the amount from your monthly benefit.
OUR CATALOG ITEMS
ID#
GENERIC
DESCRIPTION
QTY
AMT
ID#
BRAND NAME
QTY
AMT
Benzoyl Peroxide Gel
10%
N/A
N/A
N/A
N/A
24ct
$6.50
ACNE TREATMENT
1241389
Benzoyl Peroxide Gel
45gm $3.50
10%
N/A
ALLERGY
Loratadine 10mg
Tablet
Loratadine 10mg
4257457
Tablets
Cold & Allergy PE
Tablets
Benadryl® Allergy
100ct $4.50 2118297
Softgels Dye Free
Afrin® Nasal Spray
1oz $6.50 1200021
Original
Loratadine 10mg
30ct $4.00
N/A
Tablet
Loratadine 10mg
100ct $12.00
N/A
Tablets
4264792 Saline Nasal Spray
1.5oz
Cetirizine 10mg
Tablets
Sinus & Allergy PE
7850068
Tablets
Afrin® Nasal Spray
N/A
Sinus
Allegra® OTC 180mg
N/A
Tablets 24-Hour
Allegra® OTC 60mg
N/A
Tablets 12-Hour
Zyrtec® OTC Adult
10mg 24-Hour Tab
Sinus & Allergy PE
24ct $3.50
N/A
Tablets
Afrin® Nasal Spray
0.5oz N/A 2155083
Sinus
Allegra® OTC 180mg
15ct
N/A 4330601
Tablets 24-Hour
Allegra® OTC 60Mg
12ct
N/A 4330668
Tablets 12-Hour
Cold & Allergy PE
Tablets
Diphenhydramine
2152874
25mg Capsules
1498302
3595196 Nasal Spray
4242327
4595054
24ct
30ct
$3.50
$3.50
$11.50
N/A
4764163 Ocean® Nasal Spray
4014296
* = Quantities and brands may vary depending upon availability.
† = Dual-purpose items
** = Covered under either Part B or Part D
| 3
�
0.5oz $7.50
N/A
N/A
N/A
N/A
1.5oz
$4.50
5ct
$9.00
N/A
N/A
0.5oz $7.50
15ct
$19.00
12ct
$13.50
ID#
GENERIC
DESCRIPTION
QTY
AMT
ID#
BRAND NAME
QTY
AMT
ANTACID / ACID REDUCERS
Antacid (Antigas)
N/A N/A
80mg Tablets
Tums® Tablets
150ct $6.50
1336700
Regular Assorted Fruit
Tums® Extra Strength
96ct $6.50
1469030
Tablets Assorted
Antacid (Antigas)
80mg Tablets
Antacid Assorted
2163913
Tablet
Antacid Chewable
2311934
Extra Strength
100ct $4.00
96ct
$3.50
2164309 Antacid Liquid DS
12oz
$4.50
N/A
Antacid Liquid DS
N/A
N/A
12oz
$4.50
N/A
Antacid Regular
Strength Liquid
N/A
N/A
36ct
$5.00
24ct
$5.00
70ct
$11.00
2804144
3203700
9900148
4288551
4305173
2967776
Antacid Regular
Strength Liquid
Effervescent Pain
Relief Tablets
Famotidine 10mg
Tablet
Famotidine Tablet
10mg
Gas Relief Softgel
Extra Strength
150ct $3.50
30ct
30ct
N/A
1189422 Alka-Seltzer® Original
Famotidine 10mg
Tablet
Pepcid® AC Tablets
$6.00 3434321
Original Strength
Gas-X Extra Strength
$6.00 2435568
Softgels
N/A
N/A
30ct
$13.50
10ct
$3.50
N/A
N/A
8oz
$5.50
40ct
$9.50
N/A
2164325 Milk of Magnesia
12oz
$4.00
N/A
1006741 Pink Bismuth Liquid
8oz
$3.50
1099829
30ct
$3.50
30ct
$5.00 2508752 Zantac® 75mg Tablets 30ct $13.00
12ct
N/A
1292697
36ct
N/A
1196120
18ct
N/A
1696657
14ct
N/A
4949434
14ct
N/A
4228979
14ct
N/A
3508264
Pink Bismuth Tablet Chewable
Ranitidine 75mg
4938775
Tablet
Alka-Seltzer® Tablets
N/A
Original
Gas-X® Chew Tab
N/A
Peppermint
Gas-X® Extra Strength
N/A
Cherry Crème
Nexium® 24-Hour
N/A Heartburn Relief
20mg
Prevacid® OTC
N/A
24-Hour Capsules
Prilosec® OTC 20mg
N/A
Tab
2236560
Milk of Magnesia
Pepto-Bismol® Liquid
Original
Pepto-Bismol®
2189959
Caplets Original
Alka-Seltzer® Tablets
Original
Gas-X® Chew Tab
Peppermint
Gas-X® Extra Strength
Cherry Crème
Nexium® 24-Hour
Heartburn Relief
20mg
Prevacid® OTC
24-Hour Capsules
Prilosec® OTC 20mg
Tab
�
12ct
$3.50
36ct
$7.50
18ct
$6.00
14ct
$15.00
14ct
$16.50
14ct
$17.00
ID#
GENERIC
DESCRIPTION
QTY
AMT
ID#
BRAND NAME
QTY
AMT
96ct
$6.00
ANTACID / ACID REDUCERS
N/A
N/A
N/A
N/A
Rolaids® Extra
Strength Chewable
Tablets Fruit
Rolaids® Regular
Strength Chewable
Tablets Mint
Tagamet® HB OTC
200mg Tablets
Smoothies Tab
Assorted Fruit
96ct
N/A
4864161
150ct
N/A
4864211
6ct
N/A
4810545
60ct
N/A
3710092
Rolaids® Extra
Strength Chewable
Tablets Fruit
Rolaids® Regular
Strength Chewable
Tablets Mint
Tagamet® HB OTC
200mg Tablets
Smoothies Tab
Assorted Fruit
150ct $6.00
6ct
$3.50
60ct
$6.50
N/A
Zantac® 75mg Tablets
10ct
N/A
2415958 Zantac® 75mg Tablets
10ct
$6.50
N/A
Zegerid OTC 20mg
14ct
N/A
4269395 Zegerid OTC 20mg
14ct
$15.00
ANTI-DIARRHEAL
4081907 Anti-Diarrheal Caplet
24ct
$5.50
N/A
Anti-Diarrheal Caplet
N/A
N/A
1363068 Anti-Diarrheal Caplet
12ct
$3.50
N/A
Anti-Diarrheal Caplet
N/A
N/A
4oz
N/A
3638244
4oz
$7.50
8oz
N/A
8oz
$6.00
N/A
N/A
Imodium® A-D Liquid
Cool Mint
Kaopectate® Liquid
Regular Flavor
Imodium® A-D Liquid
Cool Mint
Kaopectate® Liquid
4605168
Regular Flavor
ANTI-FUNGAL
Athletes Antifungal
Foot Cream
Clotrimazole 1%
3397718
Cream
Miconazole Nitrate
3508470
Cream 2%
4081683
2534121 Tolnaftate 1% Cream
1oz
N/A
N/A
Fungi Nail Tincture
Lamisil® Defense
Spray Powder
Lotrimin® AF Liquid
Spray
12gm $12.00
$4.50
1887819 Lotrimin® AF Cream
24gm $14.50
30gm $6.50
N/A
Miconazole Nitrate
Cream 2%
N/A
N/A
$5.50
N/A
Tolnaftate 1% Cream
N/A
N/A
$4.00
N/A
Tolnaftate 1% Powder
N/A
N/A
1oz
1026525 Tolnaftate 1% Powder 1.5oz
N/A
Lamisil® AT Athletes
Foot Cream
0.5oz $10.50 2856060
30ml
N/A
1147065 Fungi Nail Tincture
4.6oz
N/A
3704459
4.6oz
N/A
Lamisil® Defense
Spray Powder
Lotrimin® AF Liquid
4889614
Spray
| 5
�
30ml $14.50
4.6oz $8.50
4.6oz $9.00
ID#
GENERIC
DESCRIPTION
QTY
AMT
ID#
BRAND NAME
QTY
AMT
ANTI-FUNGAL
N/A
N/A
Lotrimin® AF Powder
Spray
Mycocide NS
Antimicrobial Sol
4.6oz
N/A
3636883
1oz
N/A
1119841
Lotrimin® AF Powder
Spray
Mycocide NS
Antimicrobial Sol
4.6oz $9.00
1oz
$16.00
6oz
$7.00
1oz
$6.00
1oz
$7.00
1oz
$5.50
1oz
$6.50
1oz
$5.00
4oz
$11.50
N/A
N/A
1oz
$10.00
4oz
$5.50
ANTI-ITCH
9900662 Calamine Lotion
6oz
Diphenhydramine
2372134
Cream 2%
1021872
N/A
N/A
N/A
N/A
Hydrocortisone 1%
Anti-Itch Cream
Benadryl® Regular
Strength Itch Relief
1% Cream
Cortizone-10
Intensive Healing
Formula Anti-Itch
Crème
Gold Bond®
Medicated Maximum
Strength Cream
Psoriasin Ointment
$4.00
4829941 Caladryl® Lotion
Benadryl® Extra
Strength Itch
Stopping 2% Cream
Cortaid® Anti-Itch
Maximum Strength
Cream 1%
Benadryl® Regular
Strength Itch Relief
1% Cream
Cortizone-10
Intensive Healing
Formula Anti-Itch
Crème
Gold Bond®
Medicated Maximum
Strength Cream
1oz
$4.50
1oz
$4.50 4995825
1oz
N/A
2529709
1oz
N/A
4029112
1oz
N/A
1984046
4oz
N/A
4424255 Psoriasin Ointment
2529717
ANTISEPTIC OINTMENTS / CREAMS
Bacitracin Zinc
Ointment
Triple Antibiotic
4762878
Ointment
2149250
N/A
N/A
N/A
Bactine® Liquid
Neosporin® Plus
Maximum Strength
Ointment
Neosporin® Plus
Maximum Strength
Ointment
1oz
$6.00
1oz
$7.50
4oz
N/A
0.5oz
N/A
1oz
N/A
Bacitracin Zinc
Ointment
Neosporin® Original
1026434
Antibiotic Ointment
N/A
1028760 Bactine® Liquid
Neosporin® Plus
4451555 Maximum Strength
Ointment
Neosporin® Plus
1203504 Maximum Strength
Ointment
�
0.5oz $7.00
1oz
$11.50
ID#
GENERIC
DESCRIPTION
QTY
AMT
ID#
BRAND NAME
QTY
AMT
COLD / COUGH / FLU REMEDIES
4807822
All Night Cold
Original Liquid
Effervescent Cold
9900163
Relief Tablets
9900000
Medicated Chest
Rub
8oz
20ct
4410890 Vicks NyQuil® Liquid
8oz
$10.00
$5.50
Alka-Seltzer® Plus
4235339 Cold Effervescent
Tablet Original
20ct
$6.50
3.53oz $4.00 2972362 Vicks® VapoRub
Mucus Relief DM
4371688
Tablet
30ct
4371647 Mucus Relief Tablets
60ct
3653219
Sudogest PE Tab
10mg
36ct
3695129
Tussin DM Sugar Free
Liquid Clear
4oz
3454915 Tussin Form
$5.50
8oz
Mucinex® DM
$4.00 3592367 Extended Release
Tablets
Mucinex® Extended
$5.00 3459377
Release Tablets
Sudogest PE Tab
$6.00
N/A
10mg
Robitussin® DM
$4.00 4485868 Sugar Free Peak Cold
Cough/Congestion
$5.00
N/A
3706827 Tussin Form CF
8oz
$5.00 4485769
1759349 Tussin Form DM
8oz
$5.00 4427639
36ct
N/A
4240206
6oz
N/A
1041318
28ct
N/A
4595310
20ct
N/A
3383619
N/A
N/A
N/A
N/A
Alka-Seltzer® Plus
Cold Formula
Effervescent Tablets
Original
Chloraseptic®
Sore Throat Spray
Menthol
Contac® Cold/Flu
Day/Night Caplet
Coricidin® HBP Chest
Congestion & Cough
Liqui-Gels
Tussin Form
Robitussin® Peak
Cold Max MultiSymptom Liquid
Robitussin® DM
Peak Cold Cough/
Congestion
Alka-Seltzer® Plus
Cold Formula
Effervescent Tablets
Original
Chloraseptic®
Sore Throat Spray
Menthol
Contac® Cold/Flu
Day/Night Caplet
Coricidin® HBP Chest
Congestion & Cough
Liqui-Gels
| 7
�
3.53oz $10.50
20ct $15.00
20ct $14.50
N/A
N/A
4oz
$7.00
N/A
N/A
4oz
$8.50
4oz
$7.00
36ct $10.00
6oz
$6.50
28ct
$8.50
20ct
$7.50
ID#
N/A
N/A
N/A
N/A
GENERIC
DESCRIPTION
QTY
AMT
ID#
BRAND NAME
COLD / COUGH / FLU REMEDIES
Coricidin® HBP
Coricidin® HBP
Maximum Strength
20ct N/A 2947067 Maximum Strength
Flu Tablets
Flu Tablets
Mucinex® DM
Mucinex® DM
Maximum Strength
14ct N/A 3989977 Maximum Strength
Tablets
Tablets
Vicks DayQuil®
Vicks DayQuil®
24ct N/A 4420766
Liquid Capsules
Liquid Capsules
Vicks NyQuil® Liquid
Vicks NyQuil® Liquid
24ct N/A 4410767
Capsules
Capsules
N/A
Vicks® VapoRub
1.76oz
N/A
2972354 Vicks® VapoRub
N/A
Vicks® VapoRub
6oz
N/A
1274505 Vicks® VapoRub
QTY
AMT
20ct
$7.50
14ct
$16.50
24ct
$11.50
24ct
$11.50
1.76oz $6.00
6oz
$15.50
EAR CARE
N/A
Debrox® Drops
Earwax Removal Aid
0.5oz
N/A
4811857
1287648 Artificial Tears
EYE CARE
0.5oz $8.00
N/A
2260040 Eye Drops
0.5oz $2.50
1133156
Debrox® Drops
Earwax Removal Aid
0.5oz $7.00
Artificial Tears
N/A N/A
Visine® Original Eye
0.5oz $6.00
Drops
Bausch & Lomb®
Soothe Hydration
15ml $12.00
Lubricant Eye Drops
Clear Eyes® Itchy Eye
0.5oz $5.00
Relief Drops
Refresh Liquigel®
0.5oz $12.50
Thera® Tears Sterilid
1.62oz $19.00
Lid Scrub
Visine® A Drops
0.5oz $7.50
Bausch & Lomb®
N/A Soothe Hydration
15ml N/A 4449708
Lubricant Eye Drops
Clear Eyes® Itchy Eye
N/A
0.5oz N/A 3599412
Relief Drops
N/A Refresh Liquigel®
0.5oz N/A 3286267
Thera® Tears Sterilid
N/A
1.62oz N/A 3804671
Lid Scrub
N/A Visine® A Drops
0.5oz N/A 3952991
FIBER SUPPLEMENTS
Fiber Laxative
Fiber Laxative
9900364
100ct $10.50
N/A
Caplets
Caplets
2566214 Fiberlax Tablets
90ct $7.00 1559285 FiberCon® Tablet
2567832 Natural Fiber Powder 13oz $9.50
N/A Natural Fiber Powder
N/A Metamucil® Capsules 100ct N/A 4590543 Metamucil® Capsules
Metamucil® Fiber
Metamucil® Fiber
N/A
24ct N/A 4408878
Wafers Cinnamon
Wafers Cinnamon
�
N/A
N/A
90ct $16.00
N/A N/A
100ct $19.50
24ct $9.00
ID#
GENERIC
DESCRIPTION
QTY
AMT
ID#
BRAND NAME
QTY
AMT
FIRST AID SUPPLIES
Adhesive Fabric
30ct
Strips Assorted
Adhesive Pads Non3342177
10ct
Stick Large 3in X 4in**
Adhesive Sheer
2256915
60ct
Strips Assorted
Adhesive Tape
9900077
1ea
1/2in X 5yd**
$3.50
1204890
$3.50
N/A
$2.50
1675024
$2.50
N/A
$3.00
1174028
100ct $3.00
300ct $4.00
300ct $4.50
1237551
N/A
N/A
1047281
2256865
Adhesive Waterproof
Tape 1/2in X 10yd**
4763371 Alcohol Prep Pads**
3260080 Cotton Balls
9280058 Cotton Swabs
Hydrogen Peroxide
1332113
3%
Sterile Pads
4756862
3in X 3in**
Thermometer Digital
4535811
Flexible Tip
ACE™ Bandage Velcro
N/A
2in
N/A
3in
ACE™ Cold Compress
N/A
Reusable
ACE™ Elastic Bandage
N/A
3in
BD Basic
N/A
Thermometer Digitial
N/A Ice Bag 9in
Lanacane®
Antibacterial First
N/A
Aid Spray Maximum
Strength
1ea
16oz
$3.50
N/A
25ct
$4.00
1134436
1ea
$8.00
N/A
1ea
N/A
1669886
1ea
N/A
1669878
1ea
N/A
1363159
1ea
N/A
1002054
1ea
N/A
4543138
1ea
N/A
1009349
3.5oz
N/A
4562286
BAND-AID® Flexible
30ct
Fabric Assorted Sizes
Adhesive Pads NonN/A
Stick Large 3in X 4in**
BAND-AID® Comfort60ct
Flex Sheer Assorted
Adhesive Tape
N/A
1/2in X 5yd**
Johnson & Johnson
Tape Waterproof
1ea
1/2in X 10yd**
BD Alcohol Swabs** 100ct
Cotton Balls
N/A
Cotton Swabs
N/A
Hydrogen Peroxide
N/A
3%
Johnson & Johnson
25ct
Gauze 4in X 4in Pad**
Thermometer Digital
N/A
Flexible Tip
1ea
2in
1ea
3in
ACE™ Cold Compress
1ea
Reusable
ACE™ Elastic Bandage
1ea
3in
BD Basic
1ea
Thermometer Digitial
Ice Bag 9in
1ea
Lanacane®
Antibacterial First
3.5oz
Aid Spray Maximum
Strength
| 9
�
$4.00
N/A
$3.50
N/A
$5.00
$3.50
N/A
N/A
N/A
$8.50
N/A
$5.00
$8.00
$7.00
$8.00
$5.00
$9.50
$7.50
ID#
GENERIC
DESCRIPTION
QTY
AMT
ID#
BRAND NAME
QTY
AMT
1ea
$13.50
1oz
$6.00
35ct
$3.00
8oz
$4.00
13oz
$6.00
1ea
$15.50
1ea
$5.50
1ea
$3.50
9ct
$3.50
FIRST AID SUPPLIES
N/A
N/A
N/A
N/A
N/A
N/A
Johnson & Johnson
First Aid Kit 140 Items
New-Skin® Liquid
Bandage
Nexcare™ Comfort
Strip 3/4in
Purell® Hand Sanitizer
Vaseline® Petroleum
Jelly
Vicks® Comfortflex
Thermometer
1ea
N/A
4476826
1oz
N/A
2167104
35ct
N/A
3483625
8oz
N/A
3659315
13oz
N/A
1217694
1ea
N/A
2867786
Johnson & Johnson
First Aid Kit 140 Items
New-Skin® Liquid
Bandage
Nexcare™ Comfort
Strip 3/4in
Purell® Hand Sanitizer
Vaseline® Petroleum
Jelly
Vicks® Comfortflex
Thermometer
FOOT CARE
N/A
N/A
N/A
ID#
999621
999244
999826
999027
999115
999053
Dr. Scholl’s® Callous
Remover One Step
Dr. Scholl’s® Corn
Remover Extra Thick
Pads
Cushion Regular
GENERIC DESCRIPTION
1ea
N/A
1ea
N/A
9ct
N/A
Dr. Scholl’s® Callous
Remover One Step
1085018 Remover Extra Thick
Pads
1038108
Cushion Regular
2314151
PACK CONTAINS
HOME CARE KITS
Cough Peak Max MultiPack Contains: Robitussin® Peak CF Max MultiSymptom Cold And
Symptom Cold 4oz, BD Basic Oral Thermometer,
Fever Combo
Acetaminophen 325mg Tablets 100ct
Pack Contains: Eye Drops 0.5oz, Mack’s® Wax Away
Ear Eye And Nose Combo
Removal System, Saline Nasal Spray 1.5oz
Pack Contains: Hydrogen Peroxide 16oz, Triple
First Aid Essentials
Antibiotic Ointment 1oz, BAND-AID® Flexible
Fabric Strips 30ct
Pack Contains: Tucks® Pads 40ct, Hemorrhoidal
Hemorrhoid Care Combo
Cream 1.8oz
Pack Contains: Crest® Toothpaste 3.6oz, Dental
Oral Care Combo
Floss 100yds, Toothbrush Full Head, Soft
Pack Contains: Arthritis Pain Reliever Caplets 50ct,
Pain Relief Combo
Icy Hot® Pain Relieving Cream 1.25oz
�
AMT
$18.00
$12.00
$15.00
$11.50
$7.50
$12.00
ID#
GENERIC
DESCRIPTION
QTY
AMT
ID#
BRAND NAME
QTY
AMT
HEMORRHOIDAL CARE
4362869
Antiseptic Cleansing
Pads
100ct $6.00
1101237 Tucks® Medicated Pads 100ct $10.00
Preparation H® Cream
0.9oz $9.50
Maximum Strength
Hemorrhoidal
Preparation H®
1633445
12ct $5.00 1156850
24ct $17.50
Suppositories
Suppositories
Preparation H®
Preparation H®
N/A
2oz
N/A 1156835
2oz $15.50
Ointment
Ointment
1101229 Tucks® Medicated Pads 40ct $6.50
N/A Tucks® Medicated Pads 40ct N/A
INCONTINENCE
N/A A&D® Ointment
4oz N/A 1219070 A&D® Ointment
4oz $6.00
Balmex Clear
Balmex Clear
N/A
3.5oz N/A 3545092
3.5oz $6.00
Protection Ointment
Protection Ointment
Balmex Diaper Rash
Balmex Diaper Rash
N/A Cream With Zinc
4oz N/A 2320794 Cream With Zinc
4oz $5.50
Oxide
Oxide
N/A Desitin® Ointment
2oz N/A
1171875 Desitin® Ointment
2oz $5.50
Fitted Briefs Extra
Fitted Briefs Extra
N/A
15ct N/A 4740585
15ct $15.00
Large (Diapers)
Large (Diapers)
Fitted Briefs Large
Fitted Briefs Large
N/A
18ct N/A 4740536
18ct $15.00
(Diapers)
(Diapers)
Fitted Briefs
Fitted Briefs
16ct $15.00
16ct N/A 4740551
N/A
Medium (Diapers)
Medium (Diapers)
Perfit Protective
Perfit Protective
N/A Underwear Extra
14ct N/A 4157053 Underwear Extra
14ct $15.00
Large
Large
Perfit Protective
Perfit Protective
18ct $15.00
N/A
18ct N/A 4157012
Underwear Large
Underwear Large
Perfit Protective
Perfit Protective
N/A Underwear
20ct N/A 4157004 Underwear
20ct $15.00
Medium
Medium
Prevail® Bladder
Prevail® Bladder
N/A Control Pads,
20ct N/A 3012762 Control Pads,
20ct $15.00
Moderate
Moderate
Prevail® Underpad
Prevail® Underpad
25ct N/A 4742458
25ct $25.00
N/A
(Bed Liners) 30in X 36in
(Bed Liners) 30in X 36in
9913268 Hemorrhoidal Cream
1.8oz
$5.50
3621521
| 11
�
ID#
GENERIC
DESCRIPTION
QTY
AMT
ID#
BRAND NAME
QTY
AMT
INCONTINENCE
N/A
N/A
N/A
N/A
N/A
2362390
2362408
4222527
4222535
1553338
1163260
3550779
3580743
1470475
N/A
N/A
N/A
N/A
Surecare Protective
Underwear Extra
Large
Surecare Protective
Underwear Large
Surecare Protective
Underwear
Medium
Lactaid® Caplets
Lactaid® Fast Act
Caplets
Bisacodyl 5mg Tablet
Bisacodyl 5mg Tablet
Clearlax Powder
Clearlax Powder
Magnesium Citrate
Cherry
Magnesium Citrate
Lemon
Natural Laxative
Plus Stool Softener
Tablets
Senna Tablet
Stool Softener
Softgels
Ex-Lax® Pieces
Regular Strength
Ex-Lax® Tablets
Regular Strength
Fleet Enema Adult
Fleet Glycerin
Suppository
Surecare Protective
14ct N/A 4494621 Underwear Extra
Large
Surecare Protective
18ct N/A 4438008
Underwear Large
Surecare Protective
18ct N/A 4763892 Underwear
Medium
LACTOSE INTOLERANT
120ct N/A 4418844 Lactaid® Caplets
Lactaid® Fast Act
32ct N/A 3637964
Caplets
LAXATIVES
100ct $7.00
N/A Bisacodyl 5mg Tablet
25ct $4.00 3323664 Dulcolax® Tablets 5mg
4.1oz $5.50 3919909 MiraLAX® Pwd 7 doses
8.3oz $13.50 3919917 MiraLAX® Powder
Magnesium Citrate
10oz $3.00
N/A
Cherry
Magnesium Citrate
10oz $3.00
N/A
Lemon
Natural Laxative
60ct $5.00
N/A Plus Stool Softener
Tablets
100ct $6.00 1003565 Senokot®-S Tablet
Stool Softener
100ct $4.50
N/A
Softgels
Ex-Lax® Pieces
24ct N/A 4064515
Regular Strength
Ex-Lax® Tablets
30ct N/A 2617033
Regular Strength
4.5oz N/A 1098011 Fleet Enema Adult
Fleet Glycerin
24ct N/A 1025972
Suppository
�
14ct $20.00
18ct $20.00
18ct $20.00
120ct $18.50
32ct
$11.00
N/A N/A
25ct $8.00
4.1oz $8.50
8.3oz $15.00
N/A
N/A
N/A
N/A
N/A
N/A
30ct $21.00
N/A
N/A
24ct
$6.00
30ct
$7.50
4.5oz $4.00
24ct
$3.50
ID#
GENERIC
DESCRIPTION
QTY
AMT
ID#
BRAND NAME
QTY
AMT
LICE TREATMENT
N/A
N/A
N/A
4562393
4348082
4348199
N/A
N/A
N/A
N/A
1200336
N/A
9900441
9900440
1123272
Nix® Control Spray
Pump
Nix® Lice Treatment
Creme Rinse Single
Creme Rinse
Nix® Control Spray
5oz
Pump
2oz
N/A 1827625
2oz
Creme Rinse Single
2oz x
Nix® Lice Treatment 2oz x
N/A 1827617
2oz
Creme Rinse
2oz
LOZENGES
Cough Drops Black
Cough Drops Black
25ct $2.00
N/A
N/A
Cherry Sugar Free
Cherry Sugar Free
Halls® Mentho-Lyptus
30ct
Cough Drops Cherry 30ct $2.00 2970994
Drops Cherry
Halls® Cough Drop
Cough Drops Honey
30ct
30ct $2.00 2971000
Honey Lemon
Lemon
Cepacol® Maximum
Cepacol® Maximum
Strength Lozenge
16ct N/A 4972725 Strength Lozenge
16ct
Honey Lemon
Honey Lemon
Halls® Defense
Halls® Defense
Vitamin C Drops
Vitamin C Drops
25ct N/A 3662343
25ct
Sugar Free Assorted
Sugar Free Assorted
Citrus
Citrus
Halls® Defense
Halls® Defense
Zinc Drops Harvest
25ct N/A 2971125 Zinc Drops Harvest
25ct
Cherry
Cherry
MISCELLANEOUS CARE**†
Lumiscope SelfLumiscope SelfTaking Blood
Taking Blood
1ea
N/A 2158566
1ea
Pressure Kit With
Pressure Kit With
Stethoscope
Stethoscope
MOTION SICKNESS
12ct
Motion Sickness Tab
12ct $2.50 4583258 Dramamine® 50mg
8ct
N/A 4489688 Bonine® Tablets
8ct
Bonine® Tablets
ORAL CARE
Dental Floss 100yd
1ea $2.50
N/A Dental Floss 100yd
N/A
Dental Floss Mint
Dental Floss Mint
1ea $2.50
N/A
N/A
Waxed 100yd
Waxed 100yd
Toothbrush Full Head
Toothbrush Full Head
1ea
$1.50
N/A
N/A
Soft
Soft
5oz
N/A
2879807
| 13
�
$8.00
$14.00
$23.00
N/A
$3.00
$3.00
$4.00
$3.00
$3.00
$17.50
$5.50
$4.50
N/A
N/A
N/A
ID#
GENERIC
DESCRIPTION
QTY
AMT
ID#
BRAND NAME
QTY
AMT
ORAL CARE
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Anbesol® Gel Regular
Strength Cool Mint
Anbesol® Liquid
Regular Strength
Cool Mint
Colgate® Toothpaste
Regular Super
Efferdent® Denture
Cleanser Tablets
Fixodent® Denture
Adhesive Cream
Original
Fixodent® Fresh
Orajel® Maximum
Strength Gel
Orajel® Mouth Sore
Gel
Polident® 3 Minute
Tablets
Polident® Overnight
Cleanser
Sea-Bond® Denture
Adhesive Lowers
Original
Sea-Bond® Denture
Adhesive Uppers
Original
Sensodyne®
Toothpaste Original
Flavor
Super Poligrip®
Denture Adhesive
Cream Zinc Free
Formula
Toothpaste Crest®
Large
0.33oz
N/A
3031879
0.41oz
N/A
3677994
8.2oz
N/A
1236058
40ct
N/A
1359454
2.5oz
N/A
1179100
2.5oz
N/A
1831072
0.25oz N/A
1033471
0.18oz
N/A
1529403
120ct
N/A
4575304
120ct
N/A
4575296
15ea
N/A
1138809
15ea
N/A
1138932
4oz
N/A
1089689
2.4oz
N/A
4300133
4.6oz
N/A
1185313
Anbesol® Gel Regular
Strength Cool Mint
Anbesol® Liquid
Regular Strength
Cool Mint
Colgate® Toothpaste
Regular Super
Efferdent® Denture
Cleanser Tablets
Fixodent® Denture
Adhesive Cream
Original
Fixodent® Fresh
Orajel® Maximum
Strength Gel
Orajel® Mouth Sore
Gel
Polident® 3 Minute
Tablets
Polident® Overnight
Cleanser
Sea-Bond® Denture
Adhesive Lowers
Original
Sea-Bond® Denture
Adhesive Uppers
Original
Sensodyne®
Toothpaste Original
Flavor
Super Poligrip®
Denture Adhesive
Cream Zinc Free
Formula
Toothpaste Crest®
Large
�
0.33oz $7.00
0.41oz $7.00
8.2oz $5.00
40ct
$4.00
2.5oz $7.00
2.5oz $7.00
0.25oz $7.00
0.18oz $6.50
120ct $10.00
120ct $10.00
15ea
$4.00
15ea
$4.00
4oz
$7.50
2.4oz $7.50
4.6oz $3.50
ID#
GENERIC
DESCRIPTION
QTY
AMT
ID#
BRAND NAME
QTY
AMT
PAIN RELIEVERS
2525855
2525871
3956810
2940625
2749588
Acetaminophen
325mg Tablet
Acetaminophen
Extra Strength 500mg
Tablet
Acetaminophen
Extra Strength Rapid
Release Gels 500mg
Arthritis Pain Relief
Caplet
Aspirin 325mg Tablet
100ct $4.50
1296250
100ct $5.00
1331958
100ct $7.50
N/A
$7.50
N/A
50ct
100ct $3.50
4212866
3998192
Aspirin Adult Enteric
Coated 81mg
120ct $3.50
4212809
1498807
Aspirin Child Chew
81mg
36ct
$2.00
1366830
3679529
Aspirin Enteric
Coated 325mg Tablet
125ct $4.00
4810636
100ct $5.50
N/A
2164226
2291243
1783547
3035771
4086849
9914581
4596680
2163442
Headache Relief
Added Strength
Tablet
Ibuprofen 200mg
Caplet
Ibuprofen 200mg
Caplet
Ibuprofen 200mg
Tablet
Ibuprofen Child Susp
Berry
Migraine Relief
Caplet
Naproxen Sodium
Caplet
Non-Aspirin Child
Chewable 80mg Fruit
100ct $6.00
50ct
$3.00
100ct $6.00
1110543 Advil® 200mg Caplet
1110568
$5.00 2488237
24ct
$4.00
30ct
$4.00
Advil® 200mg
Caplets
100ct $11.00
100ct $14.50
N/A
N/A
N/A
N/A
100ct $9.50
120ct $10.00
36ct
$3.50
125ct $9.00
N/A
N/A
100ct $14.50
50ct
$9.00
1330505 Advil® 200mg Tablets 100ct $14.50
4oz
100ct $9.00
Tylenol® 325mg
Tablets
Tylenol® Extra
Strength 500mg
Caplets
Acetaminophen
Extra Strength Rapid
Release Gels 500mg
Caplet
Bayer® 325mg Tablets
Bayer® Adult 81mg
Enteric Coated Low
Dose Aspirin
Bayer® Child Chew
Aspirin Low Dose
Ecotrin® 325mg
Regular Strength
Tablets
Headache Relief
Added Strength
Tablet
N/A
Advil® Child
Suspension Fruit
Migraine Relief
Caplet
4oz
$7.50
N/A
N/A
2190874 Aleve® 220mg Caplet 100ct $15.00
N/A
Non-Aspirin Child
Chewable 80mg Fruit
| 15
�
N/A
N/A
ID#
GENERIC
DESCRIPTION
QTY
AMT
ID#
BRAND NAME
QTY
AMT
N/A
N/A
N/A
N/A
24ct
$5.50
PAIN RELIEVERS
Pain Reliever PM
Extra Strength Caplet
7180078 Sleep Aid Tablets
Advil® 200mg Gel
N/A
Caplets
N/A Advil® 200mg Liqui-Gel
N/A Advil® 200mg Liqui-Gel
Advil® 200mg
N/A
Migraine Liqui-Gels
N/A Advil® 200mg Tablets
Advil® 200mg Tablets
N/A
EZ Open
N/A Advil® PM Caplet
Aleve® 220mg Arthritis
N/A
Gelcaps Easy Open
N/A Aleve® 220mg Caplets
N/A Aleve® 220mg Caplets
N/A Aleve® 220mg Liqu-Gels
N/A Aleve® 220mg Tablets
N/A Aleve® 220mg Tablets
N/A Anacin® Tablets
N/A Bayer® 325mg Tablets
N/A BC® Arthritis Powder
N/A BC® Headache Powder
Midol® Maximum
N/A Strength Menstrual
Form Caplet
Midol® Maximum
N/A Strength Menstrual
Form Gelcap
Motrin® IB 200mg
N/A
Caplet
Pamprin® Cramp Max
N/A
Relief Caplet
Pamprin® MultiN/A
Symptom Caplets
4760310
50ct
$4.00
N/A
16ct
$3.50
N/A
24ct
N/A
2384238
80ct
20ct
N/A
N/A
2764959
2764934
20ct
N/A
2947406
24ct
N/A
1330471
150ct
N/A
3779477
40ct
N/A
3725611
40ct
N/A
4212783
50ct
24ct
40ct
24ct
100ct
100ct
200ct
24ct
24ct
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
2190858
2190833
3807260
2190825
2190866
1156512
4212882
4849196
4849139
24ct
N/A
2612778
24ct
N/A
2715464
100ct
N/A
1752898
16ct
N/A
1027267
20ct
N/A
2364834
Pain Reliever PM
Extra Strength Caplet
Sleep Aid Tablets
Advil® 200mg Gel
Caplets
Advil® 200mg Liqui-Gel
Advil® 200mg Liqui-Gel
Advil® 200mg
Migraine Liqui-Gels
EZ Open
Advil® PM Caplet
Aleve® 220mg Arthritis
Gelcaps Easy Open
Aleve® 220mg Caplets
Aleve® 220mg Caplets
Aleve® 220mg Liqu-Gels
Aleve® 220mg Tablets
Aleve® 220mg Tablets
Anacin® Tablets
Bayer® 325mg Tablets
BC® Arthritis Powder
BC® Headache Powder
Midol® Maximum
Strength Menstrual
Form Caplet
Midol® Maximum
Strength Menstrual
Form Gelcap
Motrin® IB 200mg
Caplet
Pamprin® Cramp Max
Relief Caplet
Pamprin® MultiSymptom Caplets
�
80ct $16.00
20ct $6.00
20ct
$6.00
24ct
$5.50
150ct $19.00
40ct $10.50
40ct
$9.50
50ct
24ct
40ct
24ct
100ct
100ct
200ct
24ct
24ct
$9.50
$5.50
$12.00
$5.50
$15.00
$11.50
$14.00
$5.00
$5.00
24ct
$7.00
24ct
$7.00
100ct $13.50
16ct
$4.50
20ct
$5.00
ID#
GENERIC
DESCRIPTION
QTY
AMT
ID#
BRAND NAME
QTY
AMT
PAIN RELIEVERS
N/A
N/A
N/A
N/A
3666583
3593225
3733920
3734118
3734092
N/A
N/A
N/A
N/A
N/A
N/A
St. Joseph® Adult
Aspirin 81mg Chew
Tab
Tylenol® Extra
Strength 500mg
Caplets
St. Joseph® Adult
36ct N/A 4379871 Aspirin 81mg Chew
36ct $3.50
Tab
Tylenol® Extra
24ct N/A 2331908 Strength 500mg
24ct $5.00
Caplets
SKIN CARE / SUNSCREEN
Banana Boat® Sport
Banana Boat® Sport
8oz
N/A 4251906
8oz $10.50
Sunblock SPF 30
Sunblock SPF 30
Banana Boat®
Banana Boat®
Ultramist Sport Clear 6oz
N/A 4799995 Ultramist Sport Clear 6oz $12.00
SPF 50
SPF 50
SMOKING CESSATION
Nicotine Gum 2mg
50ct $25.00
N/A Nicotine Gum 2mg
N/A N/A
Nicotine Gum 4mg
50ct $25.00
N/A Nicotine Gum 4mg
N/A N/A
Nicotine Patch Step
Nicotine Patch Step
7ct $24.50
N/A
N/A N/A
1 21mg
1 21mg
Nicotine Patch Step
Nicotine Patch Step
7ct $24.50
N/A
N/A N/A
2 14mg
2 14mg
Nicotine Patch Step
Nicotine Patch Step
7ct $24.50
N/A
N/A N/A
3 7mg
3 7mg
SUPPORT
Futuro™ Ankle Support
1ea
N/A 3936366
1ea $10.50
Wrap Around Medium
Wrap Around Medium
1ea
N/A 3936374
1ea $10.50
Wrap Around Large
Wrap Around Large
Futuro™ Knee Support
1ea
N/A 3498516
1ea $15.50
Stabilizing Large
Stabilizing Large
1ea
N/A 3498508
1ea $15.50
Stabilizing Medium
Stabilizing Medium
Jobst® Women’s
Jobst® Women’s
Sheer Knee High
Sheer Knee High
1ea
N/A 2952414
1ea $13.00
8-15mmHg Medium
8-15mmHg Medium
Silky Beige
Silky Beige
Jobst® Women’s Sheer
Jobst® Women’s Sheer
Knee High 8-15mmHg
1ea
N/A 2952406 Knee High 8-15mmHg
1ea $13.00
Small Silky Beige
Small Silky Beige
| 17
�
ID#
GENERIC
DESCRIPTION
QTY
AMT
ID#
BRAND NAME
QTY
AMT
TOPICAL
2987865
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Muscle Rub Ultra
Bengay® Pain Relieving
2oz $4.00 2308583
2oz $7.00
Strength
Cream Ultra Strength
Abreva® Cold Sore
Abreva® Cold Sore
2gm N/A 2986651
2gm $24.50
Cream
Cream
Activon Ultra
Activon Ultra
Strength Arthritis
2oz
N/A 3878014 Strength Arthritis
2oz $11.50
Topical Analgesic
Topical Analgesic
Aspercreme® Heat
Aspercreme® Heat
2.5oz N/A 4020004
2.5oz $7.00
Pain Relieving Gel
Pain Relieving Gel
Aspercreme® Pain
Aspercreme® Pain
3oz
N/A 1241249
3oz $7.00
Relieving Rub
Relieving Rub
Bengay® Pain
Bengay® Pain
Relieving Cream Ultra 4oz
N/A 2308591 Relieving Cream Ultra 4oz $10.00
Strength
Strength
Bengay® Ultra
Bengay® Ultra
Strength Pain
Strength Pain
5ct
N/A 3577418
5ct $9.50
Relieving Patch Reg
Relieving Patch Reg
Size
Size
Bengay® Vanishing
Bengay® Vanishing
2oz
N/A 2308534
2oz $5.50
Scent Rub
Scent Rub
Capzasin Topical
Capzasin Topical
Analgesic Liquid No1oz
N/A 3934254 Analgesic Liquid No1oz $10.00
Mess Applicator
Mess Applicator
3.5oz N/A
1021112 Icy Hot® Balm
3.5oz $7.00
Icy Hot® Balm
1.25oz N/A
1141878 Icy Hot® Cream
1.25oz $5.00
Icy Hot® Cream
Icy Hot® Medicated
Icy Hot® Medicated
Patches Extra
5ct
N/A 3485984 Patches Extra
5ct $8.50
Strength Large (Back)
Strength Large (Back)
Icy Hot® Patches
Icy Hot® Patches
5ct
N/A 3011889
5ct $7.00
Arm/Neck/Leg
Arm/Neck/Leg
Icy Hot® Sleeve Large
Icy Hot® Sleeve Large
3ct
N/A 3549649
3ct $8.00
Knee/Ankle/Elbow
Knee/Ankle/Elbow
Stopain® (Now
Stopain® (Now
Cryoderm™) SX 10%
Cryoderm™) SX 10%
4oz
N/A 4878468
4oz $11.50
MSM Pain Relief
MSM Pain Relief
Spray
Spray
�
ID#
GENERIC
DESCRIPTION
QTY
AMT
ID#
BRAND NAME
QTY
AMT
2ct
$9.50
3ct
$9.50
3ct
$9.50
2oz
$22.00
2oz
$18.00
TOPICAL
N/A
N/A
N/A
N/A
N/A
ThermaCare®
Heatwraps 8HR
Lower Back & Hip
ThermaCare®
Heatwraps 8HR Neck/
Shoulder/Wrist
ThermaCare®
Heatwraps Menstrual
Zostrix High Potency
Cream
Zostrix Original
Strength Arthritis
Pain Relief Cream
2ct
N/A
3296340
3ct
N/A
3296365
3ct
N/A
4264628
2oz
N/A
2307304
2oz
N/A
3396918
ThermaCare®
Heatwraps 8HR
Lower Back & Hip
ThermaCare®
Heatwraps 8HR Neck/
Shoulder/Wrist
ThermaCare®
Heatwraps Menstrual
Zostrix High Potency
Cream
Zostrix Original
Strength Arthritis
Pain Relief Cream
VAGINAL
Miconazole 7 Vaginal
2470433
Cream
3379666
N/A
N/A
2200285
1121797
3671534
2461689
2204881
3662608
3070679
Suppositories
Monistat® 3 Cream
Prefilled Applicator
3ct
Vagistat-3
Combination Pack
Calcium Carbonate
600mg + D Tablet
Cerovite Senior
Tablet
Ferrous Sulfate
Tablets 325mg
Oyst-Cal + D 500mg
Prosight Tablet
Vitamin B-12 500mcg
Tablets
Vitamin C 500mg
45gm
7ct
3ct
1ea
60ct
60ct
100ct
60ct
60ct
100ct
250ct
Monistat® 7 Cream
$10.50 4725487 With Disposable
Applicator
$6.00
N/A
Suppositories
Monistat® 3 Cream
N/A 4738936 Prefilled Applicator
3ct
Vagistat-3
N/A 4008520
Combination Pack
VITAMINS†
Caltrate® 600mg + D
$5.00 4604971
Tablet
Cerovite Senior
$6.00
N/A
Tablet
Ferrous Sulfate
$6.00
N/A
Tablets 325mg
$3.50
N/A Oyst-Cal + D 500mg
$8.50
N/A Prosight Tablet
Vitamin B-12 500mcg
$5.50
N/A
Tablets
$11.00
N/A Vitamin C 500mg
| 19
�
1.59oz $13.50
N/A
N/A
3ct
$18.50
1ea
$13.00
60ct $10.50
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
ID#
GENERIC
DESCRIPTION
1715473 Vitamin D Tab 400IU
Vitamin E 400IU
2162998
Softgel
Windmill Vitamin A
3123247
10000IU Softgel
Windmill Vitamin
3108404 B Complex With
Vitamin C + Iron
Windmill Calcium
3123239
Chewable 500mg Tab
Windmill Folic Acid
3069549
400mcg Tabs
Centrum® Silver 50+
N/A
Ultra Men’s
Centrum® Silver
N/A
Chewable
N/A
Ultra Women’s
Ester-C 500mg
N/A
Tablets
N/A Ocuvite® Tablet
Viactiv® Calcium
N/A
Chew Carmel + D
Viactiv® Calcium
N/A Chew Milk Chocolate
+D
Vitafusion™ B
N/A Complex Chew
Energy
QTY
AMT
ID#
VITAMINS†
100ct $5.00
N/A
100ct $11.50
N/A
100ct $5.50
N/A
100ct $8.00
N/A
$6.50
N/A
180ct $6.50
N/A
60ct
100ct
N/A
4163507
60ct
N/A
3651502
100ct
N/A
4967014
60ct
N/A
3915196
60ct
N/A
1753490
60ct
N/A
4898375
60ct
N/A
4898383
70ct
N/A
4829388
BRAND NAME
QTY
AMT
Vitamin D Tab 400IU
Vitamin E 400IU
Softgel
Windmill Vitamin A
10000IU Softgel
Windmill Vitamin
B Complex With
Vitamin C + Iron
Windmill Calcium
Chewable 500mg Tab
Windmill Folic Acid
400mcg Tabs
Ultra Men’s
Centrum® Silver
Chewable
Ultra Women’s
Ester-C 500mg
Tablets
Ocuvite® Tablet
Viactiv® Calcium
Chew Carmel + D
Viactiv® Calcium
Chew Milk Chocolate
+D
Vitafusion™ B
Complex Chew
Energy
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
100ct $15.50
60ct $16.50
100ct $15.50
60ct
$8.50
60ct
$11.50
60ct $10.00
60ct $10.00
70ct
$5.00
WART REMOVAL
N/A
N/A
N/A
Compound W® Fast0.31oz N/A
Acting Liquid
Compound W® Gel 0.25oz N/A
Dr. Scholl’s® Clear
Away One Step Wart 1ea
N/A
Remover
Compound W® Fast0.31oz $9.50
Acting Liquid
1047471 Compound W® Gel 0.25oz $9.50
Dr. Scholl’s® Clear
1963636 Away One Step Wart 1ea $9.50
Remover
1156603
�
Easy Choice Health Plan
Easy Choice Health Plan allows for the submission of retail receipts for items
purchased that follow the Centers for Medicare & Medicaid Services (CMS)
guidelines. Our catalog is representative of these types of items. Please refer to the
catalog for the listings of items that are eligible for reimbursement and those that
are not.
Receipt totals will be deducted from the member’s monthly benefit allowance for
the month in which the purchase occurred. If the member’s monthly benefit
allowance has been exhausted, the request for reimbursement will be denied. To
have a receipt reimbursement form sent to you, call 1-877-483-9563, TTY 711,
Monday-Friday, 6:30 a.m.–8:00 p.m. Pacific. Or visit www.easychoicehealthplan.com
to print the form.
Completed forms should be mailed to:
Drug Source
PO.
. Box 1366
Elk Grove Village, IL 60009-9917
Please allow 30 days from the date the receipt and form were received for payment.
For a list of eligible items, please refer to this catalog.
| 21
�
We’re always just a phone call away!
If you’re ready to enroll or have enrollment questions, call 1-866-999-3945,
8 a.m. to 8 p.m., 7 days a week.
If you’re already a member, call the number for your state/plan listed below.
California:
All Plans .............................................................................................1-866-999-3945
Hours of operation are Monday–Friday, 8 a.m. to 8 p.m.
�
Between October 1 and February 14, representatives are available Monday–Sunday,
�
8 a.m. to 8 p.m., or visit us anytime at www.easychoicehealthplan.com.
�
Nurse Advice Line .............................................................. 1-800-581-9952 (24 hours, 7 days a week)
TTY for all of the above ........................................................................................................1-800-735-2929
�
Easy Choice Health Plan, a WellCare company, (HMO/HMO SNP) is a Medicare Advantage organization with a Medicare
contract and a contract with the California Medicaid program. Enrollment in Easy Choice (HMO/HMO SNP) depends
on contract renewal. The benefit information provided is a brief summary, not a complete description of benefits.
For more information, contact the plan. Limitations, co-payments and restrictions may apply. Benefits, premium and/
or co-payments/coinsurance may change on January 1 of each year. You must continue to pay your Medicare Part B
premium. Please contact Easy Choice for details.
62089
P.O. Box 31389 | Tampa, FL 33631-3389
�

2015 Over-the-Counter (OTC) Catalog

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