More Related Content Similar to Formulary (updated jul 11) (20) Formulary (updated jul 11)2. Table of Contents
Welcome Letter from Flight Commander 4
General Pharmacy Information 5
How do I get my Refills? 6
Pharmacy Benefits 7
New to our Formulary 9
Formulary Listing by alphabetical order (generic names) 10
Listing by Common Use (not a complete listing) 21
Quick Reference Phone Guide 22
2
3. Welcome to Edwards AFB and the 95th Medical Group!
We, the military and civilian pharmacy staff at the 95th Medical Group, are always striving to
provide you and your family the best pharmaceutical care available. All of us are committed to
providing quality services, and to ensure that the care you receive is and continues to be the best
you’ve ever experienced.
The pharmacy handbook/frequently asked questions has been created to hopefully make
accessing pharmacy services easier and less confusing for beneficiaries. While it does not
answer every question, it does provide guidance on most of our services.
I would like to extend on behalf of my staff and self, a special thank you to all of you in
uniform who are defending our country and to all the veterans who have made major
contributions to our nation. We also thank the families who have and continue to support all of
you.
Vanthy Pham
Vanthy B. Pham, Maj, USAF, BSC, PharmD
Diagnostics and Therapeutics Flight Commander
3
4. Pharmacy General Information
What are the hours for the Pharmacy?
Pharmacy hours are below.
Monday 0730-1630
Tuesday 0730-1630
Wednesday 0730-1630
Thursday 0730-1630
Friday 0730-1630
Closed the first Monday of each month, weekends, federal holidays, AFMC approved
family days and Military down days.
Where is the Pharmacy?
The Pharmacy is located in the main clinic on 30 Nightingale Rd in building 5525.
It is located in the south end of the first floor.
Eligible beneficiaries include:
Active duty service members and their families
Activated National Guard and Reserve Members and their families (on Title 10 or Title
32 [federal] orders)
Retired service members and their families
Survivors, widows/widowers and certain former spouses
Medal of Honor recipients and their families
Beneficiaries enrolled in TRICARE Reserve Select or the Continued Health Care Benefit
Program
Other beneficiaries listed in DEERS as eligible for TRICARE, including foreign force
members and their families
When updating DEERS with your personal information, be sure to update your address with a
physical address.
4
5. How do I get medication refills?
If you have an existing prescription that is still active with refills left, call the Pharmacy
at 661-277-9896. Prescriptions called into the refill line will be available for pickup within
two duty days at the main pharmacy or at the APM located in BX lobby (*certain medications
only*). If you present to the pharmacy window for a refill you may be asked to come back later
or the next duty day. Please make every effort to call in prescription refills to avoid delays.
Typically, if you’re running out of a medication (down to last refill or last set of doses), it
means your provider is expecting you to follow-up for a re-evaluation. Please make a follow-up
appointment prior to running out so your provider can see how you are doing.
If your prescription has expired or you have no refills left and you see a provider on base,
please call PCC at 661-277-7118 at least one week prior to running out of your medication.
Ask to leave a telephone consult for your provider’s nurse. Please have the name and dosage of
the medication ready to provide to the phone clerk, as it makes renewing your prescription
easier. As long as the provider determines that you do not need a follow-up appointment prior
to prescription renewal, your refill request will typically be taken care of within 72 business
hours.
If you see a civilian provider off base you will have to contact your provider for a new
prescription. The pharmacy does NOT accept fax or phone-in prescription orders or refills.
Any questions regarding your medications that can be handled by the pharmacy should be
directed to their staff at 661-277-9896 (option 1 clinic pharmacy, option 5 speak to pharmacy
personnel)
Can’t make it to the pharmacy during normal duty hours? Sign up today to use our
Automated Prescription Machine (APM) located in the BX food lobby to pick up your
prescription refills. The APM is available during BX hours including weekends.
5
6. YOUR PHARMACY Benefits
All formulary medication at EDWARDS Pharmacy:
$0 cost for up to a 90 day Supply
Other Military Treatment Facility (MTF) Pharmacies
An MTF pharmacy provides those medications listed on its local formulary (drug listing). Most
MTF pharmacies accept prescriptions written by both civilian and military providers.
To check the availability of a particular drug, contact you’re nearest MTF if not stationed at
Edwards AFB in person or by phone.
TRICARE Mail Order Pharmacy (TMOP)
You can receive up to a 90-day supply* for most medications you take regularly (for instance,
drugs for high blood-pressure, asthma or oral contraceptives) using TMOP.
When you use the TMOP service you get:
• Savings: You can save up to 66% of retail costs, because your
co-payment for a 90-day supply is the same as for a 30-day supply at a retail pharmacy.
• Convenience and safety: Your medication is mailed to your home in a weather-resistant
pouch for your privacy and protection and there is no charge for postage.
To use the TMOP service, just follow these steps:
1) Ask your doctor for a prescription (for up to a 90-day supply*,plus refills for up to one year,
if appropriate).
2) Complete the TMOP registration/order form which can be downloaded from their website at:
http://www.express-scripts.com/TRICARE/
3) Insert your prescription, completed TMOP registration form, and co-payment, if needed, into
the pre-addressed, postage paid envelope (attached to the registration form — use this envelope
only for your TMOP registration) and mail them. Your prescriptions will be mailed to you
within 14 days.
• For more details on TMOP, please visit www.express-scripts.com/TRICARE or call 1-
877-363-1303.
6
7. DoD TRICARE Retail Pharmacy (TRRx) Network
Another option for filling your prescription is to use a DoD TRRx network retail pharmacy.
Simply give the network pharmacist your written prescription and your uniformed services
identification (ID) card.
You will pay a co-payment of:
$0 for formulary generic for 30-day supply
$9 for formulary brand-name for 30-day supply
$25 for non-formulary drugs for 30-day supply.
To find a DoD TRICARE Retail Pharmacy near you:
• Visit www.express-scripts.com/TRICARE.
The online pharmacy locator is updated on the first day of each month. If a pharmacy joined
after the first day of the month, it might not appear on the locator until the following month.
• Call 1.877.363.1303).
Non-Network Retail Pharmacy
Your medications will cost the most at non-network retail pharmacies because they do not
belong to the DoD TRRx network. At non-network pharmacies you will pay full price for your
medication. To be reimbursed for non-network pharmacy claims, you must fill out the enclosed
claim form (DD 2642),attach the required paperwork as described on the DD2642,and mail it
to:
Express Scripts
P.O. Box 66518
St. Louis, MO 63166-6518
You can download additional claim forms (DD 2642) at www.express-scripts.com/TRICARE
or www.tricare.osd.mil/ pharmacy/claims.cfm. Claim forms may also be obtained at
TRICARE Service Centers and MTFs.
7
8. New to our formulary!
Budesonide/formoterol (Symbicort) for Asthma or COPD
Cetirizine (Zyrtec) chewable tablets for allergies
Cetirizine/pseudoephedrine (Zyrtec-D) for allergies
Insulin glargine pen (Lantus SoloStar Pen) for diabetes mellitus
Scopalamine patches (Transderm Scop) for motion sickness
Tamsulosin (Flomax) for enlarged prostate or BPH
Valsartan (Diovan) for hypertension
Valsartan/HCTZ (DiovanHCT) for hypertension
Ciprofloxacin/Dexamethasone (Ciprodex) for ear infection
Famotidine (Pepcid) for heartburn, GERD
Fenofibrate 54mg and 160mg for hyperlipidemia (replacing Fenoglide)
Fenofibrate (Tricor) 48mg and 145mg for hyperlipidemia
Rovustatin (Crestor) for hyperlipidemia *DoD requires Prior Authorization
Mometasone/Formoterol (Dulera) Inhaler for asthma or COPD
Ergocalciferol (Vitamin D) 50,000 units for Vit D supplements
Calcium Carbonate + Vit D 500mg (Oscal+D) for calcium supplements
8
9. Diclofenac (Voltaren) 1% topical gel for pain
Lidocaine (Lidoderm) 5% patch-for pain
Detemir (Levemir) Insulin-for diabetes
Pantoprazole (Protonix)-for GERD
Clindamycin (Cleocin T) 1% Pads-for acne
Aspart (Novolog FlexPen) Insulin Pen-for diabetes
No longer on formulary!
Rosiglitazone (Avandia) for diabetes
Rosiglitazone/Metformin (Avandamet) for diabetes
Ciprofloxacin/Hydrocortisone (CiproHC) for ear infection
9
10. Edwards AFB Pharmacy Formulary
Alphabetically Listed by Generic Name
Generic Name Brand Name How Supplied
ACETAMINOPHEN Tylenol Tabs: 325 mg, 650mg
Infant Drops: 80 mg/0.8 ml
Soln: 160 mg/5 ml.
Supps: 120mg, 650 mg
ACETAMINOPHEN/BUTALBITAL/ Fioricet Tabs: 325mg/50mg/40mg
CAFFEINE
ACETAMINOPHEN/CODEINE Tylenol w/Codeine C-III Tabs: 30mg/300mg
PHOSPHATE Elixir: 12mg/120 mg/5 ml
ACETAZOLAMIDE Diamox Tabs: 250 mg, 500mg
ACETIC ACID Domeboro Powder Packets
ACYCLOVIR Zovirax Caps: 200mg Tabs: 400mg, 800mg
Susp: 200mg/5ml
Oint: 15 g
ADAPALENE GEL Differin 0.1% Gel: 45g
ALBUTEROL HFA Ventolin HFA Inhaler: 90mcg, 200 sprays/unit
Neb Soln: 0.5%, 0.083%
Oral Liq: 5mg/5ml.
ALBUTEROL/ IPRATROPIUM Combivent Inhaler: 200 sprays/unit
ALENDRONATE Fosamax Tabs: 5mg, 10 mg, 35 mg, 70 mg
Soln: 70mg/75ml
ALENDRONATE/VITAMIN D Fosamax Plus D Tabs: 70mg/2800 IU, 70mg/5600 IU
ALFUZOSIN Uroxatral Tabs: 10mg
ALLOPURINOL Zyloprim Tabs: 100mg, 300mg
ALPRAZOLAM Xanax C-IV Tabs: 0.25mg, 0.5mg, 1mg, 2mg
ALUMINUM CHLORIDE Drysol Liq: 37.5ml
HEXAHYDRATE
AMANTADINE Symmetrel Tabs: 100mg
Syrup: 50mg/5 ml
AMIODARONE Cordarone/Pacerone Tabs: 200mg, 400mg
AMITRIPTYLINE Elavil Tabs: all strengths
AMLODIPINE Norvasc Tabs: all strengths
AMLODIPINE/BENAZEPRIL Lotrel Caps: all strengths
AMMONIUM LACTATE Lac-Hydrin Lotion: 12%
AMOXICILLIN Amoxil Susp:125mg/5ml, 250 mg/5ml, 400 mg/5 ml
Caps: 250mg, 500mg
AMOXICILLIN/ CLAVULANATE Augmentin Susp: 200mg/5ml, 250mg/5ml, 400mg/5ml
ES Susp: 600 mg/5 ml
Tabs: 250mg/125mg, 500mg/125mg,
875mg/125mg
Chew Tabs: 250/62.5mg
XR: 1000 mg
AMPHETAMINE/ Adderall C-II Tabs: 5, 10, 30 mg
DEXTROAMPHETAMINE Adderall XR C-II XR Caps: all strengths
AMPICILLIN Ampicillin Caps: 500 mg
ANTIPYRINE/ Auralgan Otic soln: 15 ml
BENZOCAINE/GLYCERIN
ASPIRIN ENTERIC COATED Ecotrin Tabs: 81mg, 325mg
ATENOLOL Tenormin Tabs: all strengths
ATOMOXETINE Strattera Caps: all strengths
ATORVASTATIN Lipitor Tabs: all strengths
AZELASTINE Astelin Nasal spray: 137mcg/spray
**DoD Quantity limit 2 per 30 days**
AZITHROMYCIN Zithromax Tabs: 250mg, 500mg Packet: 1g
Susp: 100mg/5ml, 200mg/5ml
10
11. BACITRACIN Bacitracin Oph oint
Topical oint
BACITRACIN/NEOMYCIN/ Polysporin Oph oint
POLYMYXIN
BACLOFEN Lioresal Tabs: all strenghts
BELLADONNA ALKALOIDS Donnatal Tabs: 16.2mg
Liq: 16.2mg/5ml
BENAZEPRIL Lotensin Tabs: all strengths
BENZONATATE Tessalon Perles Caps: all strengths
BENZOYL PEROXIDE GEL, Benzac Gel: 42.5g (10%)
BENZOYL PEROXIDE WASH Sol: 227g (10%)
BENZOYL PEROXIDE/ Benzaclin Gel: 25 g (1-5%)
CLINDAMYCIN
BENZTROPINE Cogentin Tabs: all strengths
BETAMETHASONE Diprosone Cream: 0.05%, 45 g
DIPROPRIONATE Oint: 0.05%, 15 g
BETAMETHASONE VALERATE Valisone Cream: 0.1%, 15 g, 45 g
BETAXOLOL Betoptic S Oph susp: 0.5%, 5 ml.
BISACODYL Dulcolax Tabs: 5 mg
BRIMONIDE Alphagan P Oph soln: 0.15%, 0.2%
BROMOCRIPTINE Parlodel Tabs: all strengths
BUDESONIDE Pulmicort Respules Neb Sol: all strengths
BUDESONIDE/FORMOTEROL Symbicort Inhaler: 160/4.5, 80/4.5 mcg
BUPROPRION Wellbutrin Tabs: 75, 100mg
BUPROPRION Wellbutrin SR SR Tabs: 100mg, 150mg
BUPROPRION Zyban SR Tabs: 150 mg
BUSPIRONE HCL Buspar Tabs: all strengths
CALCIUM CARB+VIT D OSCAL+D Tabs: 500mg
CANDESARTAN Atacand Tabs: all strenghts
CANDESATAN/HCTZ Atacand HCT Tabs: 16/12.5, 32/12.5mg
CAPTOPRIL Capoten Tabs: all strengths
CARBAMAZEPINE Tegretol Chewable tabs: 100mg Tabs: 200mg
Tegretol XR XR tabs: all strengths
Liq: 100mg/5ml
CARBIDOPA/LEVODOPA Sinemet Tabs: 10/100, 25/100, 25/250 mg
Sinemet CR CR: 25/100 mg
CARBOXYMETHYLCELLULOSE Celluvisc Boxes of 30
CARISOPRODOL Soma Tabs: 350 mg
CARVEDILOL Coreg Tabs: all strengths
CEFADROXIL Duricef Susp: 250 mg/5 ml
CEFDINIR Omnicef Susp: 125 mg/5 ml & 250 mg/5 ml
CEFPODOXIME Vantin Susp: 100 mg/5 ml
CEFUROXIME Ceftin Susp: 250 mg/5 ml
Tabs: 250, 500 mg
CELECOXIB Celebrex Caps: all strengths
CEPHALEXIN Keflex Caps: all strengths
Susp: 250mg/5ml
CETIRIZINE Zyrtec Tabs: 10 mg Liquid: 5 mg/5 ml Chewable: 5mg
CETIRIZINE/PSEUDOEPHEDRINE Zyrtec-D Tabs: 5/120 mg
CHLORAL HYDRATE Noctec Syrup: 500 mg/5 ml
CHLORHEXIDINE RINSE Peridex Rinse: 0.12%
CHLOROQUINE Aralen Tabs: 250, 500 mg
CHLORTHALIDONE Hygroton Tabs: all strengths
CIMETIDINE Tagamet Tabs: all strengths
CIPROFLOXACIN Cipro Tabs: all strengths
Susp: 5gm/100ml
CIPROFLOXACIN Ciloxan Opth: 0.3%/2.5 ml
CIPROFLOXACIN/DEXAMETHASONE CiproDex Soln: 7.5 ml
11
12. CITALOPRAM Celexa Tabs: all strengths
Soln: 10mg/5ml
CLARITHROMYCIN Biaxin Tabs: 250, 500 mg
CLINDAMYCIN Cleocin Caps: all strengths
Susp: 75 mg/5 ml
Top Soln: 1%, 60 ml
Top Pads: 1%
Vaginal Cream: 2%(40 gm)
CLINDINIUM/ Librax Caps: 2.5 mg/5 mg
CHLORDIAZEPOXIDE
CLOBETASOL PROPRIONATE Temovate 0.05% Cream: 15g, 45g
0.05% Oint, 0.05% Soln
CLOMIPHENE Clomid Tabs: 50 mg
CLONAZEPAM Klonopin C-IV Tabs: all strengths
CLONIDINE Catapres Tabs: all strengths
CLOPIDOGREL Plavix Tabs: 75 mg
CLOTRIMAZOLE Lotrimin 1% Cream: 30 g
1% Topical soln
CLOTRIMAZOLE / BETAMETHASONE Lotrisone Cream: 15, 45 g
DIP
CODEINE SULFATE Codeine C-III Tabs: 30 mg
CODEINE/ GUAIFENESIN Robitussin AC C-V Liq: 10/100 mg per 5 ml (120 ml)
**Qty must be in equivalents of 120 ml**
COLESTIPOL Colestid Tabs: 1 g Powder Packets: Box of 90
COLOCHICINE Colchicine Tabs: 0.6 mg
CONJUGATED ESTROGENS Premarin Tabs: all strengths
Vaginal cream 0.625mg/gm
CONJUGATED ESTROGEN/ Prempro Tabs: all strengths
MEDROXYPROGESTERONE
CROMOLYN SODIUM Crolom Oph Soln: 4%, 15 ml
CYCLOBENZAPRINE Flexeril Tabs: all strengths
CYCLOPENTOLATE Cyclogel Oph Soln: 0.1%, 5 ml
CYPROHEPTADINE Periactin Tabs: 4 mg
Syrp: 2mg/5ml
DESIPRAMINE Norpramin Tabs: all strengths
DESMOPRESSIN DDAVP Tabs: 0.2 mg
DESOGESTREL/ETHINYL Mircette 28 day packs
ESTRADIOL (Biphasic)
DESOGESTREL/ETHINYL ESTRADIOL Desogen 28 day packs
DETEMIR Levemir Insulin vial
DEXAMETHASONE Decadron Tabs: 0.5 mg, 4 mg
DEXTROAMPHETAMINE Dexedrine C-II Tabs: 5, 10 mg
SR Caps: 5 mg, 15mg
DIAGNOSTIC STRIPS Precision Xtra Boxes of 50
AccuChek Aviva
DIAZEPAM Valium C-IV Tabs: all strengths
DICLOFENAC SODIUM Voltaren Tabs: 50, 75 mg
Oph soln: 0.1%
Top Gel: 1%
DICLOXACILLIN Dynapen Caps: all strengths
DICYCLOMINE Bentyl Tabs: all strengths
Soln: 10mg/5ml
DIGOXIN Lanoxin Tabs: all strengths
Soln: 0.05mg/ml
DILTIAZEM Tiazac Tabs: 60 mg
ER Caps: all strengths
DIPHENOXYLATE W/ATROPINE Lomotil C-V Tabs: 2.5/0.025 mg
DIPHENYDRAMINE Benadryl Caps: 25 mg, 50 mg Liq: 12.5 mg/5 ml
DISOPYRAMINE Norpace Caps: 100 mg
12
13. DIVALPROEX Depakote Tabs: all strengths
Depakote Sprinkles Caps: 125 mg
Depakote ER ER tabs: all strengths
DOCUSATE SODIUM Colace Caps: 100 mg
DONEPEZIL Aricept Tabs: all strengths
DORZOLAMIDE Trusopt 2% Oph soln: 10 ml
DORZOLAMIDE / TIMOLOL Cosopt Oph soln: 2%-0.05%
DOXAZOSIN Cardura Tabs: all strengths
DOXEPIN Adapin Caps: all strengths
Soln: 10mg/ml
DOXYCYCLINE HYCLATE Vibramycin Tabs: 100 mg
Caps: 50, 100mg
EPINEPHRINE Epi-Pen/Epi-Pen Jr Auto-injector 0.15mg/dose, 0.3mg/dose
Twinject
EPINEPHRINE Ephfrin 2% Oph soln: 15 ml
ERGOTAMINE TARTRATE Cafergot Tabs: 100 mg/1 mg
W/CAFFEINE
ERYTHROMYCIN Erythrocin Tabs: all strengths
Susp: 200 mg/5 ml
Romycin Oph oint: 0.5% 5 mg/gm
2% Topical soln: 60 ml
2% gel
ERGOCALCIFEROL Vitamin D Gel Caps: 50,000 units
ESOMEPERZOLE Nexium Caps: all strengths
ESTRADIOL Estrace Tabs: all strengths
Estraderm Patch: all strengths
Vivelle Dot
Esclim
ESTROGEN/ Estratest HS Tabs: 0.625/1.25 mg
METHYLTESTOSTERONE
ETHAMBUTOL Myambutol Tabs: all strengths
ETHINYL ESTRADIOL/ DESOGESTREL Orthocept (Reclipsen) 0.03 mg EE/.015 mg D
28 day packs
ETHINYL ESTRADIOL/ Yasmin Tabs: 30 mcg/3 mg; 28 day packs
DROSPIRENONE Yaz Tabs: 20 mcg/3 mg; 28 day packs
ETHINYL ESTRADIOL/ Nuvaring Vaginal ring
ETONOGESTREL
ETHINYL ESTRADIOL TriLevlen, TriPhasil, Alesse, Tabs:
LEVONORGESTREL Lutera 28 day packs
ETHINYL ESTRADIOL/ Nordette, Mircette 28 day packs
LEVONORGESTREL
ETHINYL ESTRADIOL/ Ortho Evra Transdermal patch
NORELGESTROMIL
ETHINYL ESTRADIOL/ Ortho-Novum 28 day packs
NORETHINDRONE Loestrin 1/20 FE
Necon 1/35
ETHINYL ESTRADIOL/ Ortho-Cyclen 28 day packs
NORGESTIMATE Ortho Tri-cyclen
Ortho Tri-cyclen LO
ETHINYL ESTRADIOL/ NORGESTREL Ovral, LoOvral 28 day packs
ETONORGESTREL Implanon IM device
EZETMIBE Zetia Tabs: 10 mg
FAMOTIDINE Pepcid Tabs: 20mg and 40mg
FELODIPINE Plendil Tabs: all strengths
FENOFIBRATE Lofibra, Tricor Tabs: 48mg, 54mg, 145mg, and 160 mg
FERROUS SULFATE FeoSol Soln: 25 mg/ml, 50ml.
Tabs: 325 mg
FEXOFENADINE Allegra Tabs: 60, 180 mg
FINASTERIDE Proscar Tabs: 5 mg
13
14. FLUCONAZOLE Diflucan Tabs: all strengths
FLUDROCORTISONE Florinef Tabs: 0.1 mg
FLUNISOLIDE Nasarel Nasal spray: 25 mcg. 200 sprays/unit
FLUOCINOLONE Synalar Soln: 1%, 60 ml
FLUOCINONIDE Lidex *Cream: 0.05%, 15 g, 60 g
Gel: 0.05%, 60 g
Oint: 0.05%, 60 g
FLUORIDE Prevident 5000+, Luride Gel: 1.1%, 2oz
Drops: 1.1 mg/ml
Tabs: 1.1 mg
FLUOROMETHOLONE Fluor-Op, FML Susp: 0.1%, 15 ml
FLUOXETINE Prozac Caps: 10, 20, 40 mg
Soln: 20mg/5ml
FLUTICASONE Flonase Nasal spray: 50 mcg, 120 sprays/unit
FLUTICASONE HFA Flovent HFA Inhaler: 44, 110, 220 mcg
**Qty limit 2 per 30 days**
FLUTICASONE Diskus Flovent Diskus Inhaler
FLUTICASONE/ SALMETEROL Advair Inhaler: 100/50 mcg, 250/50mcg, 500/50 mcg
Advair HFA Inhaler: 45/21 mcg, 115/21 mcg, 230/21 mcg
FOLIC ACID Folic Acid Tabs: 1 mg
FUROSEMIDE Lasix Tabs: all strengths
Soln: 10mg/ml
GABAPENTIN Neurontin Caps: all strengths
GEMFIBROZIL Lopid Tabs: 600 mg
GENTAMICIN SULFATE Geramicin Oph soln: 0.3%, 5 ml
Oph oint: 3.5 g
GLIPIZIDE Glucotrol *Tabs: all strengths
Glucotrol XL XL Tabs: all strengths
GLYBURIDE Micronase Tabs: all strengths
GLYBURIDE MICRONIZED Micronized: all strengths
GLYBURIDE/ METFORMIN Glucovance Tabs: all strengths
GLYCOPYRROLATE Robinul Tabs: 1 mg
GOSERELIN Zoladex Implants: 3.6 mg, 10.8 mg
GRAMICIDIN/NEOMYCIN/POLYMYXIN Soln: 0.025mg/2.5mg/10000unit/ml
B
GRISEOFULVIN Grispeg, Grifulvin V Tabs: 125, 250 mg Susp: 125 mg/5 ml
GUAIFENESIN Mucinex Tabs: 600 mg
GUAIFENESIN/PSE MucinexD Tabs: 600/60 mg,
GUAIFENSIN/DEXTROMETHORPHAN Robitussin DM Liq: 100/10 mg per 5 ml
HALOPERIDOL Haldol Caps: 1 mg, 10 mg
HOMATROPINE Isopto Homatropine Liq: 5%, 5 ml
HYALURONIC ACID Atopiclair Topical cream
HYDRALAZINE Apresoline Tabs: 10, 25, 50 mg
HYDROCHLOROTHIAZIDE HCTZ Caps 12.5 mg Tabs 25, 50 mg
HYDROCODONE/ Vicodin *Tabs: 5/500 mg
ACETAMINOPHEN Vicodin ES ES Tabs: 7.5/750 mg
HYDROCORTISONE Anusol HC Cream: 2.5%
Supps: 25 mg
HYDROCORTISONE ACETATE/ Proctofoam Foam: 1%, 10 g
PRAMOXINE Cream: 30 g
HYDROCORTISONE VALERATE Westcort 0.2% Cream: 15 g, 60 g
0.2% Oint: 45 g
HYDROCORTISONE/ Vosol HC Susp: 10 ml
ACETIC ACID
HYDROXYAMPHETAMINE/ Paremyd Soln: 1%/0.25%
TROPICAMIDE
HYDROXYCHLOROQUINE Plaquenil Tabs: 200 mg
HYDROXYZINE Atarax Tabs: all strengths Liq: 10 mg/5 ml
IBANDRONATE Boniva Tabs: all strengths
14
15. IBUPROFEN Motrin Tabs: all strengths
Susp: 100 mg/5 ml
IMIPRAMINE Tofranil Tabs: all strengths
INDOMETHACIN Indocin *Caps: all strengths
ER Cap: 75 mg
INSULIN ASPART Novolog, Novolog Flexpen 100 units/ml, 10 ml vial
INSULIN GLARGINE Lantus, Lantus SoloStar Pen 100 units/ml, 10 ml vial
100 units/ml, pen
INSULIN NPH/REGULAR 70/30 Novolin 70/30 100 units/ml, 10 ml vial
INSULIN HUMAN NPH Novolin N 100 units/ml, 10 ml vial
INSULIN HUMAN 70/30 Novolog Mix 70/30 100 units/ml, 10 ml vial
INSULIN HUMAN REGULAR Novolin R 100 units/ml, 10 ml vial
INSULIN SYRINGES Boxes of 100: 0.5 ml, 1 ml 29 G,½”
INSULIN PEN NEEDLES **Limit 300 syringes/90 days**
IPATROPIUM BROMIDE Atrovent Neb Soln, Nasal spray
Atrovent HFA Inhaler
ISONIAZID INH Tabs: all strengths Syrup: 50 mg/5 ml
ISOSORBIDE DINITRATE Isordil SR Caps: 40 mg
Tabs: all strengths
ISOSORBIDE MONONITRATE Imdur Tabs: all strengths
ISOTRETINOIN Accutane Caps: all strengths
KETOCONAZOLE Nizoral Cream: 30 g
Shampoo: 4 oz
KETOROLAC TROMETHAMINE Acular Oph soln: 0.5%, 5ml
KETOTIFEN Zaditor Oph soln: 0.025 % 5 ml
LACTULOSE Cepulac Syrup: 10 g/15 ml
LAMOTRIGINE Lamictal Tabs: all strengths
LANCETS Soft-Touch Boxes of 200
Accu-chek Soft Clix
LANCET DEVICE Soft-Touch Device
LATANOPROST Xalatan Oph soln: 0.005%, 2.5 ml
LEUCOVORIN Leucovorin Tabs: 5 mg
LEVALBUTEROL Xopenex Inhaler: 200 sprays/unit
LEVOBUNOLOL Betagan Oph Soln: 0.5%, 5ml
LEVOCABASTINE Livostin Oph soln: 0.025%, 5 ml
LEVOFLOXACIN Levaquin Tabs: all strengths
Soln: 25mg/ml
LEVONORGESTREL Plan B One-Step Tabs: 1.5mg
Next Choice Tabs: 0.75mg
LEVONORGESTREL IUD Mirena IUD *Must have scheduled appt*
LEVOTHYROXINE Synthroid Tabs: all strengths
LIDOCAINE HCL Xylocaine Gel: 2%, 30 ml
Soln: 2%, 100 ml
Lidoderm Top Patch: 5%
LISINOPRIL Zestril Tabs: all strengths
LISINOPRIL/HCTZ Zestoretic Tabs: all strengths
LITHIUM CARBONATE Lithium Tabs: all strengths
Lithium citrate Syrp: 8mEq/5ml
LOPERAMIDE Imodium Caps: 2 mg
LORATADINE Claritin Tabs: 10 mg
Syrup: 1 mg/ml
LORAZEPAM Ativan Tabs: all strengths
LOSARTAN Cozaar Tabs: all strengths
LOSARTAN/HCTZ Hyzaar Tabs: all strengths
LOTEPREDNOL Alrex Susp: 0.2%, 5 ml
LUBRICANT Lacrilube Opth oint: 3.5 g
LUVOXAMINE Luvox Tabs: 100 mg
MEBENDAZOLE Vermox Chew Tabs: 100 mg
MECLIZINE Antivert Tabs: all strengths
15
16. MEDROXYPROGESTERONE Depo Provera Injection: 150 mg
**Must have appt for administration**
MEDROXYPROGESTERONE Provera Tabs: all strengths
MEFLOQUINE Lariam Tabs: 250 mg
MELOXICAM Mobic Tabs: 7.5, 15 mg
METAXOLONE Skelaxin Tabs: 800 mg
METFORMIN HCL Glucophage Tabs: all strengths
Glucophage XR XR Tabs: all strengths
METHOCARBAMOL Robaxin Tabs: all strengths
METHOTREXATE Rhemstrex Tabs: 2.5 mg
METHYLDOPA Aldomet Tabs: all strengths
METHYLPHENIDATE Ritalin C-II *Tabs: all strengths
SR Tabs: 20 mg
METHYLPHENIDATE XR Concerta C-II Tabs: all strengths
METHYLPREDNISOLONE Medrol Tabs: 4 mg, dosepack
METOCLOPRAMIDE HCL Reglan Tabs: all strengths Liq: 5 mg/5 ml
METOPROLOL Lopressor Tabs: all strengths
Toprol XL Tabs: all strengths
METRONIDAZOLE Flagyl Tabs: all strengths
METRONIDAZOLE Metrogel-Vaginal Gel: 0.75%, 70 g
MINOCYCLINE Minocin Caps: all strengths
MI PASTE PLUS MI Paste Dental paste
MOISTURIZING CREAM Eucerin cream Cream
MOMETASONE Elocon Cream: 15g, 30g
MOMETASONE Nasonex Nasal spray
Asmanex Twisthaler
MOMETASONE/FORMOTEROL Dulera Inhaler
MONITOR, BLOODGLUCOSE Precision Xtra Kit
AccuCheck Aviva
MONTELUKAST Singulair Tabs: all strengths
Oral granules: 4 mg
MORPHINE SULFATE IR Morphine C-II Tabs: all strengths
MORPHINE SULFATE ER MS Contin C-II ER Tabs: all strengths
MOXIFLOXACIN Vigamox Oph Soln: 0.5%, 5ml
MULTIVITAMIN PEDIATRIC Poly Vi Sol w/Iron Soln: 50 ml
SOLUTION W/IRON
MULTIVITAMIN W/ FLUORIDE Poly Vi Flor Soln: 50 ml
Chew Tab: 0.25mg, 0.5 mg
MUPIROCIN Bactroban Oint: 15 g
NAPROXEN Naprosyn Tabs: all strengths
Naproxen sodium Tabs: all strengths
Susp: 125mg/ 5ml
NEFAZODONE Serzone Tabs: 150 mg
NEOMYCIN/POLYMYXIN/HC Cortisporin HC Soln, Susp: 10 ml
NEOMYCIN/POLYMYXIN/ Neosporin Ophth oint
BACITRACIN
NEOMYCIN/POLYMYXIN/ Neosporin Oph soln 10 ml
GRAMICIDIN
NIACIN Niaspan *CR Tabs: all strengths
NICOTINE Nicoderm Patches: all strengths
NIFEDIPINE Adalat CC *SR Tabs: all strengths
Procardia Caps: 10 mg
NITROFURANTOIN Macrobid Caps: 100 mg
Macrodantin Caps: all strengths
NITROGLYCERIN Nitrostat, Nitrobid, Nitro SL Tabs: 0.4 mg
Dur SL Spray: 0.4 mg
SR Caps: all strengths
Patches: all strengths
NORETHINDRONE Micronor 28 day packs
16
17. NORTRIPTYLINE Pamelor Caps: all strengths
Soln: 10mg/5ml
NYSTATIN Niastat Cream: 15 g
Oint: 15 g
Powder 100,000 unit
Susp: 100,000 units/60 ml
OFLOXACIN Ocuflox Oph Soln: 0.3% 5 ml
OFLOXACIN Floxin Otic Soln: 5 mL
OLANZAPINE Zyprexa Tabs: all strengths
OLOPATADINE Patanol Oph soln: 0.1 % 5 ml
OMEPRAZOLE Priolosec Caps: all strengths
OXYBUTYNIN Ditropan Tabs: 5mg
OXYBUTYNIN ER Ditropan XL Tabs: all strengths
OXYCODONE/ Percocet Tabs: 5/325 mg
ACETAMINOPHEN
OXYMETAZOLINE Afrin nasal spray Soln: 0.05% (15 ml)
PANTOPRAZOLE Protonix Tabs: 40mg
PAROXETINE Paxil Tabs: all strengths
PENICILLIN VK PenV K, Veetids Susp: 125mg/5ml, 250 mg/5 ml
Tabs: all strengths
PERMETHRIN Elimite, Nix Cream: 5%, 60 g Cream: 1%, twinpack 60 ml
PHENAZOPYRIDINE Pyridium Tabs: all strengths
PHENOBARBITAL Phenobarbital Tabs: 15, 30, 60, 100 mg Liq: 20 mg/5 ml
PHENYLEPHRINE Mycifrin Oph soln: 2.5%, 15 ml
PHENYTOIN Dilantin Caps: 100 mg Tabs Chew: 50 mg
Susp: 125mg/5ml
PILOCARPINE Pilocar Oph Soln: all strengths
Oph Gel 4%
PIMECROLIMUS Elidel Tube: 15 g, 30 g
PIOGLITAZONE Actos Tabs: all strengths
PIOGLITAZONE/ Actoplus met Tabs: 15/850, 15/500 mg
METFORMIN
POLYETHYLENE GLYCOL Trilyte Pwd for Reconst: 4 L
POLYETHYLENE GLYCOL 3350 Miralax Powder: 527, 255 g
POLYMYXIN B/TRIMETHOPRIM Polytrim Oph soln: 5 ml
POTASSIUM BICARBONATE/POT Klorvess Packets: 20 mEq
CHLORIDE Box of 30
POTASSIUM CHLORIDE Klor-con ER Tabs: all strengths
Powder packet: 20 mEq
Soln: 20 mEq/15 ml
Micro K CR Caps: 10 mEq
PRAVASTATIN Pravachol Tabs: all strengths
PRAZOSIN Minipress Caps: all strengths
PREDNISOLONE Prelone/Orapred Liq: 15 mg/5 ml
PREDNISOLONE ACETATE Pred Forte Oph Susp: 1%, 5 ml
Pred Mild Oph Susp: 0.12%
PREDNISOLONE ACETATE/ AKCide Oph oint
SULFACETAMIDE
PREDNISONE Orasone, Deltasone Tabs: all strengths
Syrup: 5mg/5ml
PRENATAL VITAMINS + FOLIC ACID Natalins Tabs : PNV with 1mg folic acid
**Limited to women age 45 and younger**
PRENISOLONE SODIUM PHOSPHATE Inflamase Susp: 1/8%, 1%, 5 ml
PRIMAQUINE Primaquine Tabs: 23.6 mg
PRIMIDONE Mysoline Tabs: all strengths
PROBENECID Benemid Tabs: 500 mg
PROCHLORPERAZINE Compazine Tabs: all strengths Supps: 25 mg
PROGESTERONE Prometrium Caps: 100, 200 mg
17
18. PROMETHAZINE Phenergan Tabs: all strengths Supps: all strengths
Syrp: 6.25mg/5ml
PROMETHAZINE/DEXTROMETHORPH Phenergan DM Syrp: 120 ml
AN
PROPARACAINE Ophthaine Soln: 0.5%, 15 ml
PROPOXYPHENE/ Darvocet-N 100 Tabs: 100/650 mg
ACETAMINOPHEN
PROPRANOLOL Inderal Tabs: 10, 40 mg
Inderal LA LA Caps: 80 mg
PROPYLTHIOURACIL PTU Tabs: 50 mg
PSEUDOEPHEDRINE Sudafed Tabs: 30, 120 mg
Liq: 30 mg/5 ml
PYRAZINAMIDE PZA Tabs: 500 mg
PYRIDOSTIGMINE Mestinon Tabs: 60 mg
PYRIDOXINE Vitamin B6 Tabs: all strengths
QUETIAPINE Seroquel Tabs: all strengths
Seroquel XR XR: all strengths
RALOXIFENE Evista Tabs: 90 mg
RANITIDINE Zantac Tabs: all strengths
Syrup: 15 mg/ml
RIFAMPIN Rifadin Caps: 300 mg
RIMEXOLONE Vexol Oph Susp: 1%
RISPERIDONE Risperdal Tabs: all strengths
Soln 1mg/ml
RIZATRIPTAN Maxalt Tabs: all strengths
Maxalt MLT MLT tabs: all strengths
**DoD Quantity limit 36 tablets/90 days**
ROVUSTATIN Crestor Tabs: all strengths
**DoD requires Prior Authorization from MD
SALICYLIC ACID Clear Away Plasters: 40%
SALINE NASAL SPRAY Sea-mist Soln: 0.65%
SALMETEROL Serevent Diskus *Inhaler: 18 mcg, 200 sprays/unit
Serevent Neb Soln: 0.02%/2.5 ml, 30 unit
SALISALATE Disalcid Tabs: 500, 750 mg
SCOPOLAMINE Transderm Scop Patch: 1.5 mg
SELENIUM SULFIDE Selsun Shampoo: 2.5% 120 ml
SERTRALINE Zoloft Tabs: all strengths
Liq: 20mg/ml
SILVER SULFADIAZINE Silvadene 1% cream
SIMVASTATIN Zocor Tabs: all strengths
SIMVASTATIN/EZETIMIBE Vytorin Tabs: all strengths
SODIUM CHLORIDE 0.9% Normal saline 3ml vials for Nebulization
SPACER Optichamber Device
Optichamber w/mask
Aerochamber w/mask
SPIRONOLACTONE Aldactone Tabs: all strengths
SUCRALFATE Carafate Tabs: 1 g
Liq: 1 g/10 ml
SULFACETAMIDE Sulamyd, Bleph-10 Oph soln: 10%, 15 ml
Opth oint: 3.5 g
SULFACETAMIDE SODIUM/ Vasocine Opth oint: 10%/0.5%
PREDNISOLONE ACETATE
SULFACETAMIDE SODIUM/ Isopto Catapred Susp: 10%/0.25%, 15ml.
PREDNISOLONE ACETATE
SULFACETAMIDE/ Plexion Cleanser: 6oz
SULFUR CLEANSER
SULFAMETHOXAZOLE/ Pediazole Susp:600/200 mg/5 ml
ERYTHROMYCIN
18
19. SULFAMETHOXISOLE/ Bactrim, Septra, Bactrim DS Tabs: all strengths
TRIMETHOPRIM Sulfatrim Susp:40/200 mg /5 ml
SULFASALAZINE Azulfidine Tabs: 500 mg
EC Tabs: 500mg
SUMATRIPTAN Imitrex Tabs: 25, 50 mg
**DoD Quantity limit 54 tablets/90 days**
Tabs: 100 mg
**DoD Quantity limit 27 tablets/90 days**
SUMATRIPTAN Imitrex Stat Dose Kit all strengths
TAMOXIFEN Nolvadex Tabs: all strengths
TAMSULOSIN Flomax Caps: 0.4mg
TELMISARTAN Micardis, Tabs: all strengths
TELMISARTAN/HCTZ Micardis HCT Tabs: all strengths
TEMAZEPAM Restoril C-IV Caps: all strengths
TERAZOSIN Hytrin Caps: all strengths
TERBUTALINE Brethine Tabs: 5 mg
TERCONAZOLE Terazol 7 Cream: 0.4%, 20 g
TETRACYCLINE Achromycin Caps: all strengths
THEOPHYLLINE Theo-24 24 hr Caps: all strengths
Theodur *12 hr Tabs: all strengths *Liq: 80 mg/15 ml
Uniphyl *24 hr Tabs: 400mg
THIAMINE Vitamin B1 Tabs: all strengths
TIMOLOL MALEATE Timolol Oph soln: all strengths
Timoptic XE Gel: all strengths
TIOTROPIUM Spiriva Inh w/ device: 18 mcg
TOBRAMYCIN Tobrex Soln: 0.3%, 5 ml
TOBRAMYCIN/DEXAMETHASONE Tobradex Susp: 0.3%/0.1%, 2.5 ml
Opth Oint: 3.5 g
TOLNAFTATE Tinactin Soln: 1%, 10 ml
TOLTERODINE Detrol LA SR Caps: all strengths
TOPIRAMATE Topamax Tabs: all strengths
TRAMADOL Ultram Tabs: all strengths
**DoD Quantity Limit 240 tabs per 30 days**
TRAZADONE Desyrel Tabs: 50, 100, 150, 300 mg
TRETINOIN Retin A, Avita Cream: all strengths
**Limited to persons <36 yrs of age**
TRIAMCINOLONE Kenalog in Orabase Paste: 0.1% 5 g
T TRIAMCINOLONE Kenalog *Cream: 1%, 5%
Spray: 15 mcg/spray. 63g
Ointment: 1%
TRIAMTERENE/HCTZ Maxzide Tabs: 37.5/25, 75/50 mg
TRIHEXYPHENIDYL Artane Tabs: all strengths *Elixir: 0.4mg/ml
TRIMETHOBENZAMIDE Tigan Caps: 300 mg
TRIMETHOPRIM/POLYMYXIN B Polytrim Soln: 10 ml
TROPICAMIDE Mydriacyl Soln: 1%, 15 ml
VALACYCLOVIR Valtrex Tabs: all strengths
VALPROIC ACID Depakene Liq: 250 mg/5ml
VALSARTAN Diovan Tabs: all strengths
VALSARTAN/HCTZ DiovanHCT Tabs: all strengths
VARDENAFIL Levitra Tabs: all strengths
Under 40? Need prior authorization form
**DoD Quantity limit 18 tablets/90 days**
VARENECLINE Chantix Tabs: Starter pack, continuing treatment pack
(0.5, 1 mg tabs)
**Must be enrolled in Smoking Cessation
class**
VENLAFAXINE Effexor, Effexor XR XR Caps: all strengths
VERAPAMIL Calan Tabs: 80 mg
SR Tabs: all strengths
19
20. WARFARIN Coumadin Tabs: all strengths
XYLITOL Spry Gum Dental chewing gum
ZIPRASIDONE Geodon Caps: all strengths
ZOLPIDEM Ambien C-IV Tabs: all strengths
ZOMITRIPTAN Zomig/Zomig ZMT Tabs: all strengths/Oral disintegrating tabs
**DoD Quantity limit 36 tablets/90 days**
20
21. Quick List for Common Uses
For Asthma/Allergies For Blood pressure For Cholesterol
Inhalers: Albuterol (Ventolin/Proventil ACEs: benazepril (Lotensin), captopril Statins: atorvastatin (Lipitor),
HFA), levalbuterol (Xopenex) MDI, (Capoten), lisinopril (Zestril) pravastatin (Pravachol), simvastatin
salmeterol (Serevent Diskus) (Zocor)
ARBs: candesartan (Atacand), losartan
Nebulizer solutions: albuterol, (Cozaar), telmisartan (Micardis), Other: Ezetimibe (Zetia), fenofibrate
budesonide (Pulmicort), ipratropium valsartan (Diovan) (Lofibra), niacin (Niaspan), gemfibrozil
(Lopid)
Other: montelukast (Singulair) BBs: atenolol (Tenormin), carvedilol
(Coreg), metoprolol succinate (Toprol Combo: ezetimibe/simvastatin
Steroids: fluticasone (Flovent HFA) XL), metoprolol tartrate (Lopressor) (Vytorin)
mometasone (Asmanex)
CCBs: amlodipine (Norvasc), diltiazem
Combo: albuterol/salmeterol (Advair & ER (Tiazac), felodipine (Plendil),
Advair HFA), budesonide/formoterol nifedipine SR (Adalat CC), verapamil
(Symbicort) (Calan SR)
Allergies: cetirizine (Zyrtec), loratadine Diuretics: furosemide (Lasix), HCTZ,
(Claritin), fexofenadine (Allegra), spironolactone, triamterene/HCTZ
cetirizine/pseudoephedrine (Zyrtec-D) (Maxzide)
Nasal: azelastine (Astelin), fluticasone Combos: benazepril/amlodipine
(Flonase), mometasone (Nasonex), (Lotrel), lisinopril/HCTZ (Zestoretic)
fluocinonide (Nasarel) losartan/HCTZ (Hyzaar),
telmisartan/HCTZ (Micardis HCT),
valsartan/HCTZ (Diovan HCT)
For Diabetes For Migraines Controlled Substances
Oral Agents: Glipizide (Glucotrol & Triptans: rizatriptan (Maxalt & Maxalt The state of California requires
Glucotrol XL), Glyburide (Micronase), MLT), sumatriptan (Imitrex), that controlled substances MUST
Metformin (Glucophage & Glucophage zolmitriptan (Zomig & Zomig ZMT) be written on a California Security
XR), pioglitazone (Actos), [Please note DoD quantity limitations] Prescription pad.
pioglitazone/metformin (Actoplusmet)
Acetaminophen/butalbital/caffeine C-II: Adderall and Adderall XR, Ritalin,
Insulin: Novolog (aspart), Novolin N (Fioricet) Concerta, Morphine IR, MS Contin,
(NPH), Novolin R (regular), Novolin Percocet
70/30 (NPH/Reg), Novolog Mix 70/30
(NPH/Reg), Lantus (glargine) C-III: Tylenol w/ codeine #3, Codeine
sulfate, Vicodin, and Vicodin ES
Syringes: 0.5 ml, 1ml. BD Sharps
container for disposal. Insulin Pen C-IV: Alprazolam (Xanax), Clonazepam
needles (Klonapin), diazepam (Valium),
lorazepam (Ativan), temazepam
Blood glucose monitors/test strips: (Restoril), zolpidem (Ambien).
Accu-chek Aviva, Precision Xtra (box of
50 test strips) C-V: Robitussin AC (qty of 120ml),
Lomotil
Lancets (box of 200): Accu-chek
Softclix for Aviva Accu-check Soft NOTE: C-II: no refills allowed C-III-V:
touch plus lancet device for Precision prescription only valid for 6 months.
Xtra. Refills are allowed but may not exceed
6 months
21
22. Quick Reference Telephone List
Emergencies............................................................ 911
Emergencies from cell phone on base................... 661- 277- 4541
Poison Control ...................................................... 800-222-1222
Appointments:
Family practice ...................................................... 661-277-7118, option 1, then 1
Pediatrics................................................................ 661-277-7118, option 1, then 2
Flight Surgeon’s Office.......................................... 661-277-7118, option 1, then 3
Optometry.............................................................. 661-277-7118, option 1, then 4
Physical Therapy.................................................... 661-277-7118, option 1, then 5
Dental Clinic.......................................................... 661-277-2872
Family Advocacy................................................... 661-277-5292
Flight Surgeon’s Office.......................................... 661-277-7118 option 3
Health and Wellness Center.................................... 661-277-8480
Immunizations.........................................................661-277-3427
Laboratory............................................................... 661-277-2306
Mental Health..........................................................661-277-5291
Managed Care......................................................... 661-277-6969
NurseLine................................................................ 661- 275-6877, or
888-762-3842
Patient Administration........................................... 661-275-2668
Pharmacy................................................................ 661-277-9896
Physical Therapy.................................................... 661-277-3891
Primary Care Clinic............................................... 661-277-7118
Public Health.......................................................... 661-275-2694
Radiology................................................................ 661-277-2681
TriWest/TRICARE................................................. 888-874-9378
Base Exchange: Main Store 258-1078
Commissary 277-4589
Family Child Care Program 275-4FCC/275-4322
Golf Course 275-PUTT/275-7888
Information, Tickets and Travel (leisure) 275-TRIP/275-8747
Base Schools Switchboard 258-4411
Security Forces 277-3340
Retiree Activity Office 277-4931
22