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1

Search for medications or formulations to prescribe.

2

Click Order Medication and fill out order form.

3

Print and fax it to the pharmacy at 401-284-4506.

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Visit the Tutorials tab to learn more.

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1

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Patient Information

Last Name

First Name

MI

Address

Apt. #

City

State

ZIP

Phone #

Date of Birth

Sex

Male

Female

Email

Patient will pick up at pharmacy

Please ship to patient

Please ship to office

2

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Prescriber and Prescription Information

Prescriber's First Name

Prescriber's Last Name

Phone Number

Fax Number

Address

City

State

ZIP

NPI/DEA

Add

Adding

Radio 3

CheckboxBenzocaine 3%/Menthol 1%/Methyl Salicylate 25% Topical Emulsion

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Adding

Radio 3

CheckboxBenzocaine 2.3% Throat Spray

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Adding

Radio 3

CheckboxBenzalkonium Chloride 17% Topical Solution

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Adding

Radio 3

CheckboxBenazepril HCl 5 mg/ml Oral Suspension

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Adding

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CheckboxBenzalkonium Chloride 0.5% Topical Nail Gel

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Adding

Radio 3

CheckboxBenzocaine 2%/Menthol 0.2%/Thymol 0.2% Troche

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Adding

Radio 3

CheckboxBenzalkonium Chloride 0.15% Antiseptic Gel

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Adding

Radio 3

CheckboxBenzocaine 0.5%/Menthol/Phenol Compound Topical Lotion

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Adding

Radio 3

CheckboxBenzocaine 2%/Camphor 0.5%/Menthol 0.5% Compound Topical Gel (Vet-Equine)

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Adding

Radio 3

CheckboxBenzocaine 0.5%/Hydrocortisone 0.25% Rectal Ointment

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Adding

Radio 3

CheckboxBenzocaine 5%/Triamcinolone Acetonide 0.1%/Benzalkonium Chloride Topical Solution

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Adding

Radio 3

CheckboxBenzocaine 2%/Aluminum Chloride Hexahydrate 20%/Urea 10% Topical Solution

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Adding

Radio 3

CheckboxBenzocaine 6%/Chlorobutanol 5% Dental Gauze Solution

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Adding

Radio 3

CheckboxBenzalkonium Chloride 0.1% Gel

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Adding

Radio 3

CheckboxBenzocaine 2%/Hydroxyquinoline Sulfate 5% Rectal Ointment

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Adding

Radio 3

CheckboxBenazepril HCl 5 mg/ml Oral Suspension (Vet)

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Adding

Radio 3

CheckboxBenzocaine 6.3%/Menthol 0.5% Topical Cream

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Adding

Radio 3

CheckboxBenzalkonium Chloride 0.15% Antiseptic Solution

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Adding

Radio 3

CheckboxBaclofen 2% Topical Gel

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Adding

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CheckboxBaclofen 2%/Diazepam 1%/Ketamine HCl 0.5% Poloxamer Vaginal Gel

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Adding

Radio 3

CheckboxBacitracin 5,000 U/ml Mouthwash

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Adding

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CheckboxBaclofen 2%/Ketoprofen 10%/Lidocaine 5%/Gabapentin 5% Topical Gel

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Adding

Radio 3

CheckboxBaclofen 2%/Diazepam 1%/Ketamine HCl 0.5% Vaginal Gel

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Adding

Radio 3

CheckboxBelladonna Extract 16.2 mg/Morphine Sulfate 7.5 mg Suppository

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Adding

Radio 3

CheckboxBelladonna Extract 15 mg Compound Suppository

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Adding

Radio 3

CheckboxBaclofen 2%/Guaifenesin 5%/Cyclobenzaprine HCl 2% Rectal Gel

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Adding

Radio 3

CheckboxBaclofen 2%/Naltrexone HCl 1% Topical/Vaginal

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Adding

Radio 3

CheckboxBelladonna Extract 20 mg/Phenobarbital 50 mg Slow Release Capsules

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Adding

Radio 3

CheckboxBaclofen 2%/Gabapentin 6%/Amitriptyline HCl 2%/Lidocaine HCl 2% Topical Gel

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Adding

Radio 3

CheckboxBaclofen 2%/Gabapentin 2%/Diazepam 1 mg Suppository

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Adding

Radio 3

CheckboxBaclofen 20 mg/Guaifenesin 50 mg/Cyclobenzaprine HCl 20 mg Suppository

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Adding

Radio 3

CheckboxBaclofen 5 mg Troche

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Adding

Radio 3

CheckboxBelladonna Alkaloids/Phenobarbital 48.6 mg Slow Release Capsules

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Adding

Radio 3

CheckboxBelladonna Extract 16.2 mg/Morphine Sulfate 3.75 mg Suppository

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Adding

Radio 3

CheckboxBaclofen 2%/Ketoprofen 10%/Lidocaine 5%/Gabapentin 5% Topical Cream

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Adding

Radio 3

CheckboxBaclofen 20 mg/Amitriptyline HCl 20 mg Suppository

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Adding

Radio 3

CheckboxBaclofen 10 mg/ml Oral Suspension

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Adding

Radio 3

CheckboxBenazepril HCl 2 mg/0.1 ml Topical Gel (Vet)

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Adding

Radio 3

CheckboxBelladonna Extract 15 mg/Hydrocortisone 20 mg Suppository

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Adding

Radio 3

CheckboxBacitracin 500 U/Gm Topical Ointment

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Adding

Radio 3

CheckboxBaclofen 20 mg/Gm/Diazepam 10 mg/Gm Vaginal Gel

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Adding

Radio 3

CheckboxBeclomethasone Dipropionate 0.025%/Ipratropium Bromide 0.012% Nasal Suspension

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Adding

Radio 3

CheckboxBaclofen 2%/Ketoprofen 10%/Lidocaine 5%/Gabapentin 5% Topical Cream

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Adding

Radio 3

CheckboxAzelaic Acid 15%/Kojic Acid 4%/Phytic Acid 2% Topical Cream

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CheckboxAzithromycin 50 mg Capsules

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Adding

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CheckboxAzelastine HCl 0.15%/Brimonidine Tartrate 0.5% Topical Cream

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Adding

Radio 3

CheckboxAzithromycin 50 mg/Itraconazole 50 mg/Fluticasone Propionate 3 mg Capsules (For Nasal Irrigation/Nebulizer)

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Adding

Radio 3

CheckboxAzelastine HCl 500 Mcg Capsules (For Nasal Irrigation/Nebulizer)

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Adding

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CheckboxAzelaic Acid 15%/Kojic Acid 4% Topical Solution

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Adding

Radio 3

CheckboxAzelaic Acid 15% Topical Cream

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Adding

Radio 3

CheckboxAzithromycin 100 mg/5 ml Oral Suspension (Gluten Free)

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Adding

Radio 3

CheckboxAzelaic Acid 18%/Niacinamide 4%/Brimonidine Tartrate 0.4% Topical Cream

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Adding

Radio 3

CheckboxAzelaic Acid 20%/Hydrocortisone 1%/Cetyl Alcohol Topical Lotion

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Adding

Radio 3

CheckboxAzelastine Hydrochloride 0.175% Nasal Spray

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Radio 3

CheckboxAzelaic Acid 10%/Kojic Acid 4%/Ascorbic Acid 1% Topical Solution

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Adding

Radio 3

CheckboxAzithromycin 50 mg/Fluconazole 15 mg/Fluticasone Propionate 3 mg Capsules (For Nasal Irrigation/Nebulizer)

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Adding

Radio 3

CheckboxAzelaic Acid 20%/Kojic Acid 2% Topical Solution

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Adding

Radio 3

CheckboxAzelaic Acid 15%/Sulfacetamide 10%/Metronidazole 2%/Hydrocortisone 1% Topical Gel

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Adding

Radio 3

CheckboxAzithromycin 150 mg/ml Oral Suspension (Vet-Avian)

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Adding

Radio 3

CheckboxAzelaic Acid 15%/Ketotifen 0.05% Topical Gel

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Adding

Radio 3

CheckboxAzelaic Acid 15%/Oxymetazoline HCl 1%/Ketotifen 0.05% Topical Gel

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Adding

Radio 3

CheckboxAzelaic Acid 15% Topical Ointment

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Adding

Radio 3

CheckboxAzelaic Acid 15%/Niacinamide 4% Topical Solution

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Adding

Radio 3

CheckboxAzelastine Hydrochloride 0.175%/Ketotifen 0.05%/Mometasone Furoate 0.06% Nasal Spray

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Adding

Radio 3

CheckboxAzelastine HCl 350 mcg/Budesonide 0.6 mg Capsules (For Nasal Irrigation/Nebulizer)

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Adding

Radio 3

CheckboxAzithromycin 200 mg/5 ml Oral Suspension (Gluten Free)

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Adding

Radio 3

CheckboxAzelaic Acid 15%/Ketotifen 0.05% Topical Cream

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Adding

Radio 3

CheckboxAzelaic Acid 15%/Ivermectin 1%/Metronidazole 1% Topical Gel

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Adding

Radio 3

CheckboxAzithromycin 200 mg/ml Anhydrous Oral Paste (Vet-Equine)

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Adding

Radio 3

CheckboxAzelaic Acid 20%/Hydroquinone 8% Topical Cream

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Adding

Radio 3

CheckboxAzelastine Hydrochloride 0.175%/Budesonide 0.06% Nasal Spray

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Adding

Radio 3

CheckboxAzelaic Acid 15%/Niacinamide 4% Topical Cream

Add

Adding

Radio 3

CheckboxAzelaic Acid 15%/Metronidazole 1%/Oxymetazoline HCl 1% Topical Cream

Add

Adding

Radio 3

CheckboxAzelastine HCl 0.1%/Clobetasol Propionate 0.05% Topical Gel

Add

Adding

Radio 3

CheckboxAzelaic Acid 15%/Metronidazole 1.2% Topical Gel

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Adding

Radio 3

CheckboxAzelaic Acid 15%/Salicylic Acid 2%/Ascorbic Acid 1% Topical Cream

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Adding

Radio 3

CheckboxAtovaquone 250 mg/5 ml/Proguanil HCl 100 mg/5 ml Oral Suspension

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Adding

Radio 3

CheckboxAzelaic Acid 5%/Progesterone 2%/Minoxidil 5%/Liothyronine 2 Mcg/ml Shampoo

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Adding

Radio 3

CheckboxAzelaic Acid 5%/Minoxidil 5% Topical Foam

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Adding

Radio 3

CheckboxAtropine Sulfate 0.01%, 0.02% and 0.05% Ophthalmic Solution

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Adding

Radio 3

CheckboxAtomoxetine 6 mg/ml Oral Suspension

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Adding

Radio 3

CheckboxAzathioprine 50 mg Capsules (Gluten Free)

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Adding

Radio 3

CheckboxAtorvastatin 2%/Cholesterol 2% Topical Gel

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Adding

Radio 3

CheckboxAtomoxetine 4 mg/ml Oral Suspension

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Adding

Radio 3

CheckboxAtorvastatin 50 mg/ml Oral Suspension (Vet)

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Adding

Radio 3

CheckboxAtropine Sulfate 0.2% Vaginal Cream

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Adding

Radio 3

CheckboxAtropine Sulfate 1% Sublingual Oral Drops

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Adding

Radio 3

CheckboxAtropine Sulfate 0.54% Topical Cream

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Adding

Radio 3

CheckboxAtenolol 50 mg Capsules (Gluten Free)

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Adding

Radio 3

CheckboxAzelaic Acid 5%/Clindamycin 2% Topical Cream

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Adding

Radio 3

CheckboxAzelaic Acid 1%/Progesterone 1% Topical Cream

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Adding

Radio 3

CheckboxAttapulgite 40 mg/ml Oral Suspension

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Adding

Radio 3

CheckboxAzathioprine 50 mg/ml Oral Suspension

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Adding

Radio 3

CheckboxAtropine Sulfate 1 mg Troche

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Adding

Radio 3

CheckboxAzelaic Acid 5%/Ketoconazole 2% Topical Solution

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Adding

Radio 3

CheckboxAtorvastatin 1 mg/ml Oral Suspension

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Adding

Radio 3

CheckboxAzathioprine 0.5% Topical Gel

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Adding

Radio 3

CheckboxAtorvastatin 20 mg/ml Oral Suspension

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Adding

Radio 3

CheckboxAspirin 7.5% Topical Gel

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Adding

Radio 3

CheckboxAspirin 325 mg/5 ml Oral Suspension

Directions:

QTY:

Refills

1

2

3

4

5

6

7

8

9

10

xPrescriber's Signature:

Date

3

Circle for steps.

Fill out the Pharmacy Name and Fax Number, then fax it to the Pharmacy.

Pharmacy Name

Pharmacy Fax Number

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