your personal health and wellness shop

YOUR PERSONAL HEALTH AND WELLNESS SHOP
NAME (NOMBRE) ______________________________________________________________
ADDRESS (DIRECCIÓN) ________________________________________________________
_____________________________________________________________________________
MEMBER ID ( NUMERO DE MEMBRESIA) __________________________________________
PHONE (TELEFONO) ___________________________________________________________
Item Antacids / Digestion / Laxatives Qty
A4
A7
A8
A13
A14
A15
L1
L11
L13
L2
L4
L6
L7
Q1
Q3
Q4
(Antiácidos / Digestión / Laxantes)
Similar to
Similar a
ANTACID CALCIUM ES TABLETS 96CT
TUMS
RANITIDINE 75 MG
30CT ZANTAC
ANTACID TABS
100CT MYLANTA
ANTACID/ANTI GAS CHEWABLE TABS 90 CT MAALOX
HEARTBURN RELIEF TABS 30 CT PEPCID ACID
DRAMAMINE TABLETS
20 CT DRAMAMINE
LAXATIVE TABS (BISACODYL) 100CT DULCOLAX
COLON CLEANSER
120 CT
ENEMA SINGLE
1CT
FLEET
STOOL SOFTENER
60CT COLACE
LAXATIVE (NATURAL VEGETABLE)
100CT SENOKOT
GLYCERIN SUPPOSITORIES 25CT FLEET
FIBER CAPSULES
160CT METAMUCIL
ANTI -DIARRHEAL TABS
18CT IMODIUM
PINK BISMUTH CHEWABLE TABS 30CT PEPTOBISMOL
GAS RELIEF TABS E/S
30CT GAS X
Pain Relief (Analgésicos)
A1 EFFERVESCENT PAIN RELIEF 36CT ALKA-SELTZER
F2
MUSCLE RUB
4OZ BENGAY
F34 HOT/COLD PATCHES (REUSABLE) 1CT ICY HOT
M46
AZO URINARY RELIEF
12TABS AZO STANDARD
M6
SLEEP AID
16CT SOMINEX
P1 IBUPROFEN PAIN RELIEF 200 MG 50CT
ADVIL
P2
ASPIRIN 325 MG
100CT ECOTRIN
P3
ASPRIN (ENTERIC) 325 MG 100CT ECOTRIN
P4 ASPIRIN LOW DOSE (COATED ) 120CT BAYER
P6
ACETAMINOPHEN 500 MG 100CT TYLENOL
P8 ASPIRIN 81 MG (CHEWABLE ) 36CT BAYER
P9
ASPRIN (COATED)
100CT BAYER
P11
NON-ASPIRIN (CHEWABLE) 80MG
30CT TYLENOL
P13 NON-ASPIRIN SUSPENSION
4OZ TYLENOL
P14
HOT/COLD PATCHES
5CT ICY HOT
P17
MIGRAINE RELIEF
100CT EXEDRIN
P19
NAPROXEN 220MG
100CT ALEVE
P44 MUSCLE THERAPEUTIC BLUE GEL 4OZ MINERAL ICE
P45 ACETAMINOPHIN PAIN RELIEVER 24 CT TYLENOL PM
Cough / Cold / Allergy (Tos / Catarros / Alergia)
C1
NASAL SPRAY REGULAR
1OZ
AFRIN
C2 ALLERGY DIPHENHYDRAMINE CAPSULES 24CT BENADRYL
C7
CHEST RUB-MEDICATED
3.5OZ VICK'S VAPORUB
C10 ALLERGY LORATIDINE 10 MG 10CT CLARITIN
C11 SORE THROAT LOZENGES
18CT CHLORASEPTIC
C12 TUSSIN EXPECTORANT-LIQUID 4OZ ROBITUSSEN
C13 TUSSIN DM COUGH-LIQUID
4OZ ROBITUSSEN DM
C14 COLD MULTI -SYMPTOM MAPAP 24CT TYLENOL COLD
C16 NASAL DECONGESTANT TABS 18CT SUDAFED PE
C19 CHEST DECONGESTANT 400 MG 50CT MUCINEX
C24
COLD GELS PE DAYTIME
12CT VICK'S DAYQUIL
C35 COUGH SYRUP (SUGAR FREE) 4OZ SUGER FREE TUSSIN
C52
NASAL SALINE SPRAY
1.5OZ
OCEAN
C53 ALLERGY CETIRIZINE 10 MG TABS 14CT
ZYRTEC
C54 SINUS CONGESTION NIGHTTIME 12CT VICK'S NYQUIL
C55 ALLERGY DIPHENHYDRAMINE (LIQUID) 4 OZ BENADRYL
C56
SINUS ACETAMENOPHIN
24 CT TYLENOL SINUS
C57
SORE THROAT SPRAY
6 OZ CHLORASEPTIC
Price
Precio
$3.99
$7.99
$6.49
$4.99
$6.99
$3.99
$8.99
$7.99
$1.99
$6.99
$10.99
$3.49
$10.99
$5.49
$3.99
$4.49
$4.49
$5.49
$4.99
$4.99
$3.99
$4.49
$2.49
$5.49
$5.49
$6.99
$3.99
$1.99
$4.49
$3.49
$6.99
$7.49
$7.99
$3.99
$3.99
$4.49
$3.49
$4.99
$7.99
$3.49
$4.49
$4.49
$3.99
$4.49
$9.49
$4.49
$4.49
$3.49
$9.99
$4.49
$4.49
$4.99
$3.99
YOU WILL RECEIVE THE GENERIC EQUIVALENT OF ALL ITEMS.
Item
F4
First Aid
Primeros Auxilios
Qty
Precio
CORTAID
$4.99
6OZ CALADRYL $2.49
ANTI -ITCH CREAM
1OZ BENADRYL $3.49
F10
SKIN RASH OINTMENT
F1
SELF-ADHERENT BANDAGES
F21
IODINE
F29
Similar a
CALAMINE LOTION
F5 HYDROCORTISONE CREAM 1% 1OZ
F11
Similar to Price
ANTI- ITCH GEL
2OZ
DESITIN
$3.99
4OZ BENADRYL $4.99
3”
ACE
$3.49
F7 TRIPLE ANTIBIOTIC OINTMENT 0.5OZ NEOSPORIN $4.49
F9
F24
F61
F62
M45
CLEAR PLASTIC BANDAGE
30CT BAND AID $2.49
TRIPLE ANTIBIOTIC OINTMENT PLUS
1OZ NEOSPORIN PLUS $6.99
FIRST AID KIT
FIRST AID TAPE
1OZ
1CT
5YD
DR. SANA $1.99
J&J
J&J
ALCOHOL PREP PADS
100CT
P20
GLUCOSE CHEWABLE TABS
10CT
DEX 4
X2
DENTURE TABS
40CT
EFFERDENT
$6.99
$1.99
$3.99
M52 BENZOCAINE TOPICAL (COLD SORES) 1 OZ ANBESOL GEL $5.99
M53
M35
GAUZE
2"
Dental Teeth Related (Dental)
DENTAL FLOSS WAXED
100 YD
TOOTHBRUSH
1CT
J&J
J&J
$1.89
$2.49
$1.99
$5.49
X6 DENTURE ADHESIVE REGULAR 2.5OZ FIXODENT $4.99
M2
H2
E3
X16
E1
Anti-Hemorrhoidals (Contra Hemorroides)
HEMORRHOIDAL SUPPOSITORIES
$0.99
12 CT PREPARATION $4.99
Ear and Eye Care (Cuidado de la vista y Oido)
EAR DROPS
EAR WAX DROPS
ARTIFICIAL TEARS
0.4OZ SIMILISAN $7.99
0.5OZ
EYE DROPS ORIGINAL
0.5OZ
M12
BABY WIPES
20CT
M43
SQUARE TWEEZERS
1CT
M51
7 DAY PILL BOX
Miscellaneous (Misceláneo)
SKIN POWDER
MURINE
$4.49
J&J
$1.99
0.5OZ TEARS NATURALE $4.49
E2
M11
ORAL-B
4OZ
VISINE
J&J
$3.49
$1.99
F35 MEDICATED CALLUS REMOVER 1CT DR. SCHOLLS $3.49
M23
M44
M50
M30
X80
X82
HAND SANITIZER
NAIL CLIPPER
LUBRICATING JELLY
MICONAZOLE NITRATE
MAXI REGULAR
TAMPON PLASTIC
X71 *BLOOD PRESURE MONITOR SEMI DIGITAL
X72 *BLOOD PRESSURE MONITOR
C8
THERMOMETER DIGITAL
2OZ
PUREL
4OZ
K-Y
1CT
EACH
APEX
$0.99
$1.99
$4.49
$1.99
1 APL MONISTAT 7 $6.99
24CT
ALWAYS
1CT
OMRON
$3.49
20CT TAMPAX PEARL $3.99
1CT
1CT
APEX
USTED RECIBIRA EL GENERICO DE TODOS LOS PRODUCTOS.
*Please limit to one per order. / *Por favor, limite a uno por orden.
$1.49
$24.99
$17.99
$4.99
Vitamins / Minerals (Vitaminas / Minerales)
V1
VITAMIN B-COMPLEX 100%
100CT B-COMPLEX $4.49
V17
FOLIC ACID 800 MCG
V3
CALCIUM CARBONATE 600 MG +D
60CT
V19
OMEGA 3 FISH OIL 1000 MG
V6
MULTIVITAMINS (TABLET)
V26
VITAMIN D 400 MG IU
100CT NATURE MADE $2.99
VITAMIN B 12
100CT NATURE MADE $8.49
V2
V5
VITAMIN C 500 MG
CO- Q10 10 MG
100CT NATURE MADE $5.99
CALTRATE
$4.49
100CT ONE A DAY
$4.99
30CT NATURE'S BOUNTY $5.49
V7 VITAMINS (COMPLETE SENIOR) 100CT CENTRUM SILVER $9.99
V10 GLUCOSAMINE/CHONDROITIN (TABLETS) 50CT NATURE'S BOUNTY $10.99
V11 CALCIUM 500 MG + VITAMIN D 75CT
CITRACAL
$5.49
V14 VITAMIN A 10,000 IU NATURAL 100CT NATURE'S BOUNTY $4.49
V15 MULTIVITAMINS (CHEWABLE ) 100CT FLINTSTONES $6.99
V16
VITAMIN E 400 MG IU
100CT NATURE MADE $11.99
V18
V21
IRON SUPPLEMENT
URINOZINC
V32
VITAMIN D 1000 MG IU
V35
MAGNESIUM 500 MG
V38
CO- Q10 30 MG
V33
100CT FOLIC ACID $2.99
100CT
100CT
60CT
PURITAN
$5.49
$7.49
$14.99
100CT NATURE MADE $3.49
100CT NATURE'S BOUNTY $3.99
V36 ZINC GLUCONATE 50 MG CHELATED 100CT
FDC
$4.49
V40
FDC
$4.49
SELENIUM 50 MG
V44
PROSIGHT VITAMIN
90CT NATURE'S BOUNTY $9.99
100CT
60 CT
Must consult with Primary Care Physician prior to ordering a dual-purpose item.
Debe consultar con su médico de cabecera antes de ordenar un producto de doble propósito.
OCUVITE
$6.99
Over-the-Counter Drug Catalog Program
$75 Quarterly Benefit
MERCY MARICOPA ADVANTAGE
Programa de Catálogo de Medicamentos sin Receta
Beneficio de $75 Trimestral
MERCY MARICOPA ADVANTAGE
MERCY MARICOPA ADVANTAGE is pleased to provide its members the Your
Personal Health and Wellness Shop. This is a convenient way to get generic
non-prescription medicine and personal health and wellness products by
mail through you MERCY MARICOPA ADVANTAGE OTC Benefit.
MERCY MARICOPA ADVANTAGE se complace en proveer a sus miembros el
Catálogo de Medicamentos Sin Receta. Esta es una forma conveniente de recibir
por correo sus medicamentos y suministros sin receta medica a través de su
beneficio de MERCY MARICOPA ADVANTAGE
HOW TO ORDER BY MAIL:
1. Clearly write your name, address, telephone number and member
ID in the space at the top of the form. Your shipping address must be
the same as the address in your member record. We cannot fill your
order if your address is not the same.
COMO ORDENAR POR CORREO:
1. Escriba claramente su nombre, dirección, numero de teléfono y numero
de socio en el espacio indicado. Su dirección de envio debe coincidir
con la dirección que tenemos en su archivo de afiliación. No se
completarán las solicitudes en los casos en que no coincidan las
direcciónes.
2. Check (√) items you want on the order form that add up to $75
or less. Your benefit limit is $75 every quarter. If you order more than
$75, you will receive the first $75 of items on your order.
2 Seleccione artículos que sumen hasta $75 o menos. Su beneficio tiene
un limite de $75 cada trimestre. Si excede este limite, recibirá
automáticamente sólo los primeros artículos que sumen un total de $75.
3. Fold and seal the form with tape.
3. Doble y selle el formulario con cinta adhesiva.
4. Place a first class postage stamp on the address side (out-side) of
the form and mail.
4. Coloque una estampilla de Primera Clase en la parte de afuera de este
formulario.
ORDER BY PHONE:
To place your order by phone, call 1-888-628-2770 from 9 a.m. to 5 p.m.
E.S.T. Monday through Friday.
POR TELEFONO:
Para colocar su orden llame al 1-888-628-2770 de 9 a.m. a 5 p.m.,
Hora del Este Lunes a Viernes.
ORDER BY FAX:
Fax the completed order form to 1-866-682-6733 any time.
POR FAX:
Envie su forma por fax al 1-866-682-6733 a cualquier hora.
POR INTERNET: mercymaricopamma.otchs.com
ORDER ONLINE: mercymaricopamma.otchs.com
OTC Health Solutions
9400 NW 104 Street
Medley, FL 33178
City: _____________________ State: __________ Zip: ________
Address: _____________________________________________
Name: _______________________________________________
Place
Stamp
Here