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V3. Calcium Carbonate +d 600mg. 60 ct. 4.49. V5. Coenzyme Q-10 50mg. 30 ct. 5.49. V6. Adult daily Spectravite Multivitam

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Name (nombre)________________________________ Member ID (número de membresía)__________________________________________



Item

Drug Name (Nombre Del Medicamento)

Brand (Marca)

Qty

Price (Precio)

Vitamins / Minerals (Vitaminas / Minerales) V2 V3 V5 V6 V7 V10 V16 V17 V18 V19 V26 V32 V35 V36 V41 V46 V48 V49 V51 V54 V56 V57

Vitamin C 500mg Calcium Carbonate +D 600mg Coenzyme Q-10 50mg Adult Daily Spectravite Multivitamin Adult Senior Spectravite Multivitamin Glucosamine/Chondroitin Vitamin E 400 IU Soft Gel Folic Acid 800mcg Tablet Iron 65mg Omega 3 Fish Oil 1000mg Vitamin D 400 IU Vitamin D 1000 IU Magnesium 500mg Zinc Gluconate 50mg Chewable Multivitamins Adult Daily Multivitamin Gummy Biotin 10000mcg Soft Gel Melatonin Gummy 5mg Tumeric 400mg Calcium Supplement Gummy Vitamin A 8000 IU NAT Vitamin B12 500mcg

100 ct 60 ct 30 ct 130 ct 125 ct 80 ct 100 ct 100 ct 90 ct 120 ct 100 ct 100 ct 100 ct 100 ct 60 ct 50 ct 60 ct 60 ct 100 ct 50 ct 100 ct 100 ct

Centrum Centrum Silver Osteo Bi-Flex

Puritan

Caltrate Gummy Bites

6.99 4.49 5.49 6.99 9.99 13.99 11.99 3.49 5.49 8.99 2.99 3.49 4.49 4.49 6.99 7.99 12.49 9.49 10.49 9.99 4.99 8.99

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.

Name (nombre)________________________________ Member ID (número de membresía)__________________________________________ Over-the-Counter Drug Catalog Program $30 Monthly Benefit Medica HealthCare Plans MedicareMax (HMO) Medica HealthCare Plans MedicareMax (HMO) is pleased to provide its members with the Over‑the‑Counter (OTC) Drug Catalog. This is a convenient way to get OTC drugs and supplies by mail through your Medica HealthCare Plans MedicareMax (HMO) benefit. How to order by mail: 1. C  learly 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. 2. Check (✔) items you want on the order form that add up to $30 or less. Your benefit limit is $30 every month. If you order more than $30, you will receive the first $30 of items on your order. 3. Fold and seal the form with tape. 4. Place a first class postage stamp on the address side (outside) of the form and mail. 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. Order by fax: Fax the completed order form to 1-866-682-6733 any time. Order online: Medica.otchs.com Pick up at any Navarro Discount Pharmacy or CVS/pharmacy y más™ stores.

Programa de Catálogo de Medicamentos sin Receta Beneficio de $30 Mensual Medica HealthCare Plans MedicareMax (HMO) Medica HealthCare Plans MedicareMax (HMO) 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 médica a través de su beneficio de Medica HealthCare Plans MedicareMax (HMO). Como ordenar por correo: 1. E  scriba claramente su nombre, dirección, número de teléfono y número de miembro en el espacio indicado. Su dirección de envío 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. Seleccione artículos que sumen hasta $30 o menos. Su beneficio tiene un límite de $30 cada mes. Si excede este límite, recibirá automáticamente sólo los primeros artículos que sumen un total de $30. 3. Doble y selle el formulario con cinta adhesiva. 4. Coloque una estampilla de Primera Clase en la parte de afuera de este formulario. Por teléfono: Para colocar su orden llame al 1-888‑628-2770 de 9 a.m. a 5 p.m., hora del este, lunes a viernes. Por fax: Envíe su forma por fax al 1-866‑682‑6733 a cualquier hora. Por internet: Medica.otchs.com Recoja en cualquiera de las farmacias Navarro o CVS/pharmacy y más.™

Name:____________________________________________________ Address:__________________________________________________ City:_____________________________ State:______ ZIP:__________

OTC Health Solutions 9675 NW 117th Ave Suite 202 Miami, FL 33178

Place stamp here

Name (nombre)_________________________________________________________________ Address (dirección)______________________________________________________________ ______________________________________________________________________________ Member id (número de membresía)________________ Phone (teléfono)__________________



Item

Drug Name (Nombre Del Medicamento)

Qty

Brand (Marca)

Price (Precio)

Antacids / Digestion / Laxatives (Antiácidos / Digestión / Laxantes) A1 A2 A4 A7 A8 A13 A14 A15 L1 L2 L4 L6 L7 P20 Q1 Q3 Q4

Effervescent Pain Relief Dairy Relief Chewable Antacid Calcium E/S Tab Mixed Fruit Ranitidine 75mg Heartburn Relief Tablets Antacid Calcium E/S Smooth Mixed Fruit Acid Controller Tabs Motion Sickness Tabs Bisacodyl Laxatives Tabs Stool Softener Laxative Natural Vegetable Glycerin Suppositories Adult Fiber Capsules Glucose Chewable Tab Orange Anti-Diarrheal Caplets Pink Bismuth Chewable Tabs Gas Relief E/S Soft Gels

36 ct 60 ct 96 ct 30 ct 100 ct 60 ct

Alka Seltzer Lactaid Fast Act Tums E-X Zantac 75 Gaviscon Tums Smoothies E-X

4.49 12.49 3.99 7.99 6.49 3.99

30 ct 12 ct 25 ct 100 ct 50 ct 25 ct 160 ct 10 ct 12 ct 30 ct 30 ct

Pepcid AC Dramamine Dulcolax Colace Senokot Fleet Glycerin Metamucil

6.99 3.99 4.49 9.99 7.99 3.49 10.99 1.99 5.49 3.99 4.49

Imodium A-D Pepto Bismol Gas X Extra Strength

Cough / Cold / Allergy (Tos / Catarros / Alergia) C1 C2 C3 C7 C8 C10 C11 C12 C13 C16

Nasal Spray Regular Allergy Relief-Tablets Cold Flu & Sore Throat Max Medicated Chest Rub Digital Thermometer Loratidine 10mg Sore Throat Lozenges Tussin CF Tussin DM Nasal Decongestant Pseudo Free Tabs

1 oz 24 ct 6 oz 3.5 oz 1 ct 10 ct 18 ct 4 oz 4 oz 18 ct

Afrin Sinus Benadryl Mucinex Fast Max Vicks Vaporub Claritin Cepacol Robitussin CF Robitussin DM Sudafed PE Nasal Decongestant

5.49 3.99 9.99 5.99 4.99 7.99 3.99 4.99 4.99 4.49

Medicines, ointments and sprays with active medical ingredients that cure, diminish or remove symptoms. Medicamentos, ungüentos y aerosoles con ingredientes medicinales activos que curan o eliminan los síntomas. You will receive the generic equivalent of all items. Usted recibirá el genérico equivalente de todos los productos. MDFL17HM3884403_000

Name (nombre)________________________________ Member ID (número de membresía)__________________________________________



Item C19 C24

Drug Name (Nombre Del Medicamento)

C52 C53 C54 C56

Chest Congestion Relief 400mg Daytime Cold/Flu Pseudo Free Softgels Nasal Spray Saline Allergy Cetirizine 10mg Tabs Nighttime Cold & Flu Sinus Acetaminophen

C57 C60

Sore Throat Spray Cough Cold (HBP)

Brand (Marca)

Qty 60 ct 16 ct 1.5 oz 14 ct 16 ct 24 ct 6 oz 16 ct

Price (Precio)

Humibid E Vicks Dayquil

9.49 4.49

Ocean Zyrtec Vicks Nyquil Tylenol Sinus Congestion Pain Daytime Vicks Chloraseptic Coricidin HBP Cough

3.49 9.99 4.49 4.99 4.49 5.99

Dental / Teeth Related (Dentales / Dientes Relacionados) M2 M4 M35 M52 M70

Toothbrush Sens Toothpaste Wht Dental Floss Waxed Oral Pain Relief Nighttime Mouth Guard

X2

Denture Cleanser Tab Anti‑Bacteria Mint Denture Cleanser Tab Anti-Bacteria Denture Adhesive Regular

X5 X6

Each 4 oz 100 yd 0.33 oz 2 ct 84 ct 40 ct 2.4 oz

Basics Toothbrush Sensodyne J & J Dental Floss Anbesol Gel The Doctor’s NightGuard Advanced Comfort Polident Efferdent Super Poligrip Free

0.99 4.99 2.49 5.99 24.99 5.49 2.99 4.49

Eye and Ear Care (Cuidado de la Vista y Oido) E1 E2 E4 X16

Dry Eye Relief Eye Drops Redness Relief Eye Itch Relief Ear Wax Removal

0.5 oz 0.5 oz 0.17 oz Kit

Visine Tears Visine Red Eye Relief Zaditor Murine Ear Wax Removal System

4.49 3.49 10.99 5.99

First Aid (Primeros Auxilios) F1 F2 F3 F4 F5 F7 F9 F11 F12 F21

Bandage Self Adherant 4” x 1.8 Yds Muscle Rub Bandage Antbtc HD Fab One Size Calamine Lotion Plus Hydrocortisone Cream Triple Antibiotic Ointment Bandage Clear Plastic Asst Sizes Anti-Itch Cream Sheer Bandages Iodine

1 ct 3 oz 20 ct 6 oz 1 oz 0.5 oz 45 ct 1 oz 40 ct 1 oz

Futuro Elastic Bandages Bengay Caladryl Cortizone Neosporin Benadryl Anti-Itch Cream

3.99 5.99 3.49 4.99 4.99 4.49 3.99 4.99 2.49 2.49

Name (nombre)________________________________ Member ID (número de membresía)__________________________________________



Item F22 F25 F26 F29 F34 F36 F61 F62 F65 F66 F68 M45 M53

Drug Name (Nombre Del Medicamento) First Aid Antiseptic Merthiolate Lice Treatment Ringworm Treatment Anti-Itch Gel Hot/Cold Multi-Compress Reusable Ice Pack Bacitracin Ointment First Aid Tape Gauze Pad 2X2 Bndg Liquid Petroleum Jelly Alcohol Prep Pads Gauze Roll 2” x 2 Yds

Brand (Marca)

Qty 2 oz 8 oz 0.5 oz 4 oz 1 ct 1 ct 1 oz 1 ct 25 ct 0.3 oz 2.5 oz 100 ct 1 ct

RID Lice Killing Shampoo Lotrimin AF Benadryl Anti-Itch Gel

Vaseline

Price (Precio) 3.99 15.99 7.99 4.99 9.99 4.99 5.99 1.99 3.49 4.99 3.99 3.99 1.99

Foot Care (Cuidado de los Pies) F35

Liquid Corn & Callus Remover

0.5 oz

O1 O2 O3

Clotrimazole Cream Tolnaftate Athlete’s Foot Cream Wart Removal

1 oz 1 oz 0.5 oz

Dr. Scholl’s Liquid Corn/ Callus Remover Lotrimin AF Tinactin Cream Compound W

3.99 9.99 6.99 7.99

Incontinence (Incontinencia) X74 X75 X76 X77 X78

Pads-Bladder Control Moderate* Underwear Women S/M Underwear Men L Underwear Men S/M Underwear Women L

20 ct 20 ct 18 ct 18 ct 18 ct

Poise Depends Depends Depends Depends

5.99 13.99 13.99 13.99 13.99

Miscellaneous (Misceláneos) M23 M43 M44 M49 M51 M75 X71 X72 X81

Hand Sanitizer Tweezers Deluxe Nail Clippers Tablet Cutter 7 Day Pill Box Mosquito Repellant w/ 30% Deet BP Monitor Semi-Auto 8.7” x 16.5”* BP Monitor Manual 8.7” x 12.6”* Maxi Reg

*LIMIT (1) PER ORDER • *LÍMITE DE (1) POR ORDEN

2 oz 1 ct 1 ct Each Each 6 oz Each Each 24 ct

Automatic Inflate BP monitor Always Maxi

1.49 1.99 2.49 6.49 2.49 6.49 24.99 17.99 3.49

Name (nombre)________________________________ Member ID (número de membresía)__________________________________________



Item

Drug Name (Nombre Del Medicamento)

Brand (Marca)

Qty

Price (Precio)

Nicotine Replacement Therapy (Terapia para reemplazar la nicotina) M60 M61 M62 M63 M64 M65 M66

Nicotine Gum 4mg Nicotine Gum 4mg Sugar Free Nicotine Gum 2mg Nicotine Gum 2mg Sugar Free Nicotine Mint 4mg Lozenges Nicotine Mint 2mg Lozenges Nicotine Transdermal 21mg Patch

20 ct 20 ct 20 ct 20 ct 20 ct 20 ct 7 ct

Nicorette Nicorette Nicorette Nicorette Nicorette Nicorette

10.99 10.99 10.99 10.99 10.99 10.99 19.99

Pain Relievers (Analgésicos) H2 H3 M6 M46 P1 P2 P3 P4 P6 P8 P9 P14 P17 P19 P44 P45 P50

Hemorrhoidal Suppositories Hemorrhoidal Ointment Sleep Aid Urinary Relief Max Strength Ibuprofen Tabs 200mg Aspirin 325mg Coated Tablets Low Dose Enteric Aspirin 81mg Low Dose Enteric Aspirin 81mg Acetaminophen 500mg Aspirin Chewable 81mg Orange Headache Pain Relief Hot/Cold Patches Headache Pain Relief Naproxen 220mg Therapeutic Blue Gel Acetaminophen Pain Reliever PM Menstrual Pain Relief Max

12 ct 2 oz 24 ct 12 ct 50 ct 100 ct 32 ct 120 ct 100 ct 36 ct 24 ct 5 ct 100 ct 24 ct 8 oz 24 ct 24 ct

Preparation H Suppositories Preparation H Ointment Simply Sleep Azo Standard Advil Bayer 325mg Ecotrin Ecotrin Tylenol Bayer Chewable Excedrin Extra Strength Icy Hot Medicated Patch Excedrin Extra Strength Aleve Mineral Ice Tylenol PM Midol Complete

4.99 7.49 3.99 4.99 4.49 2.49 2.49 5.49 6.99 2.49 1.99 6.99 7.49 3.99 7.49 3.99 4.99

Personal Care (Cuidado Personal) F10 F64 M1

Diaper Rash Ointment Acne Treatment 10% Sunblock SPF 45

M9 M11 M20 M30

Cotton Swab Baby Powder Unscented Wipe Miconazole 7 Day Vaginal Cream

2 oz 1 oz 3 oz 375 ct 4 oz 20 ct 7 ct

Desitin Clearasil Daily Clear Neutrogena Ultra Sheer Dry‑Touch

Monistat 7

3.99 4.99 6.99 2.49 1.99 1.49 7.99

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