1. NAVSTA Pharmacy HM2 Julian Gourley NAVSTA Pharmacy
(619)

2. NAVSTA Pharmacy - Overview
Please utilize NMCSD Formulary for any formulary inquiries on the NMCSD Intranet homepage.
IDC Formulary is also located on the NMCSD Intranet homepage.
CHCS Clinic site/AHLTA Dispensing Location: NAVSTA ACTIVE DUTY BMC 32ND ST
Hours of Operation: Monday-Friday (Closed Federal Holidays)

3. NMCSD Formulary Look-Up

4. NMCSD IDC Formulary Look-Up

5. IDC Formulary - Overview
These rules apply to Naval Medical Center San Diego and associated Branch Medical Clinics.
Prescribing must be in accordance with MANMED Ch. 21 and OPNAVINST C.
Medications prescribed by IDCs must be filled at NMCSD pharmacy or associated Branch Medical Clinic satellite pharmacies.
Unless specifically indicated, IDCs are not permitted to prescribe non-formulary or specialist- restricted medications, controlled substances, psychotropic medications (including antidepressants, anxiolytics, hypnotics, mood stabilizers, and antipsychotics), anticonvulsants, intravenous antibiotics.
IDCs are restricted to oral, vaginal, rectal, or topical medications unless specifically included in this formulary.
IDC's will not prescribe to any patients known to be or suspected of being pregnant.

6. IDC Formulary – Prescription Policies
1. Quantities will be filled up to a maximum of 90-day supply with 3 refills for maintenance medications. Prescriptions will be valid for one year.

7. IDC Formulary – Prescription Policies
2. Deployment prescriptions may be written and filled locally for up to a 180 day supply. Arrangements should be made to have follow-on refill prescriptions entered into the mail order pharmacy IAW DoD Deployment Prescription Program ( The only exception to this policy is malaria prophylaxis, for which a quantity sufficient for an entire deployment may be prescribed, even if greater than 180 days.

8. IDC Formulary – Prescription Policies
3. Restricted items (*) and non-restricted items may be initiated, refilled, and modified by IDCs. However, prescription of restricted items (*) must be under the guidance of a supervising physician who must co-sign the clinical encounter, and the IDC must annotate physician approval in the prescription comment box. IDCs may renew prescriptions without direct physician concurrence if the patient’s condition is stable.

9. Annotate approval into comments section and include contact number

10. IDC Formulary Restricted Medications
Medication Authorization List for Independent Duty Corpsmen (IDC) Restricted Medications Naval Medical Center San Diego and Branch Clinics
Generic Name
Brand Name
Formulation
Route
Category
Notes
*alfuzosin
Uroxatral®
10mg tab PO
Alpha Blockers
*allopurinol
100mg, 300mg
Gout Agents
*amlodipine
2.5mg, 5mg, 10mg tabs
Calcium Channel Blocker
*atenolol
Tenormin®
25mg, 50mg, 100mg tabs
Beta Blockers
*atorvastatin
Lipitor®
10, 20, 40, 80mg
Statin
*bupropion SR
Zyban®
150mg
Tobacco Cessation
For Tobacco cessation only; Ensure consult for smoking cessation
*captopril
Capoten®
ACE Inhibitors/ARBs
*Chlorthalidone
25mg, 50mg, 100 mg tab
Diuretics
*ciprofloxacin
Cipro®
250, 500, 750mg tabs
Antibiotic
Not restricted when prescribed under existing protocol, i.e. pneumonia protocol for MCRD Recruits
*clobetasol
Temovate®
0.05% crm, oint
topical
Steroid
Super-high potency steroid
*clonidine
Catapres®
0.1 mg, 0.2mg tabs
Antihypertensive
*colchicine
Colcrys®
0.6mg tab
*diltiazem extended-release
Tiazac®
120mg, 180mg, 240mg, 300mg, 360mg caps
*fluocinonide
Lidex®
0.05% cream & oint
*fosinopril
Monopril®
10mg, 20mg, 40mg tabs
*furosemide
Lasix®
20mg, 40mg tab
*glipizide
Glucotrol®
5mg, 10mg tabs
Antidiabetic Agents
*glyburide
Micronase®
2.5mg, 5mg tabs
*hydralazine
Apresoline®
25mg tabs
*hydrochlorothiazide
12.5mg, 25 mg tab
*insulin aspart
Novolog®
100U/ml SQ
*ipatropium
Atrovent®
HFA
Asthma/COPD
Short acting anticholinergics (COPD/Emphysema)
*ipatropium and albuterol
Combivent®
ipratropium 20mcg and albuterol 100mcg
Short acting Beta agonist/ anticholinergic (COPD/ Emphysema)
*isoniazid
300mg tabs
*levofloxicin
500mg, 750mg tabs
IDC Formulary
Restricted
Medications

11. IDC Formulary Restricted Medications (continued) *levothyroxine
Synthroid®
All Formulations PO
Thyroid replacement
*lisinopril
Zestril®
2.5mg, 5mg, 10mg, 20mg, 30mg, 40mg tabs
ACE Inhibitors/ARBs
*losartan
25mg, 50mg, 100mg tabs
*losartan-HCTZ
Hyzaar®
50/12.5mg, 100/12.5mg, 100/25mg tabs
(May continue these drugs in combination with hydrochlorothiazide)
*metformin
Glucophage®
500mg, 850mg, 1000mg tabs
Antidiabetic Agents
*metoprolol
Lopressor®
Beta Blockers
*metoprolol XL
Toprol XL®
25mg, 50mg,100mg tabs
*moxifloxacin
400mg tabs
Antibiotic
Not restricted when prescribed under existing protocol, i.e. pneumonia protocol for MCRD Recruits
*nifedipine
Adalat CC®
30mg, 60mg & 90mg ER tabs
Calcium Channel Blocker
*nitroglycerin
Nitrostat®
0.3mg, 0.4mg, 0.6mg SL tabs
Vasodilators/Angina Agents
*oxybutynin CL
Ditropan XL®
5mg, 10mg tabs
Urinary Tract/Prostate Agents
*pioglitazone
Actos®
15mg, 30mg tabs
*potassium chloride
8meq, 10meq, 20meq SR tabs
Electrolyte Replacement
*potassium citrate
Urocit-k®
5meq, 10meq tab
*pramoxine
Proctofoam HC® aerosol foam
topical
Anorectal Treatment
*pravastatin
Pravachol®
10mg, 20mg, 40mg tabs
Statin
*probenecid
500mg tab
Gout Agents
*propranolol
Inderal®
10mg, 20mg, 40mg & 80mg tabs
*rifampin
300mg caps
*rosuvastatin
Crestor®
5mg, 10mg, 20mg, 40 mg
*simvastatin
Zocor®
10mg, 20mg, 40mg
*tamsulosin
Flomax®
0.4mg caps
*telmisartan
Micardis®
20mg, 40mg, 80mg tabs
*varenicline
Chantix
0.5 mg
Tobacco Cessation
Ensure consult for smoking cessation
*verapamil
80, 120 mg tab
*verapamil extended-release
Calan SR®
180mg, 240mg SR tabs
IDC Formulary
Restricted
Medications
(continued)

12. IDC Formulary – Prescription Policies
If a medication is not listed as restricted or non-restricted on the IDC formulary, it cannot be prescribed/modified/renewed by IDC.
This applies even to prescriptions for continuing therapy (sertraline, gabapentin, Adderall, etc.)
Prescriptions not adhering to IDC formulary will be rejected and an attempt will be made to contact IDC to correct discrepancies.
Please leave your most current phone number in prescription comments to resolve any possible prescriptions discrepancies.

13. IDC Formulary – Prescription Policies
4. Physician guidance is strongly encouraged, particularly when ordering new medications or making adjustments to existing prescriptions for chronic conditions.

14. IDC Formulary – Prescription Policies
5. "IDC" and a contact phone # must be entered in the comment section for all prescriptions

15. IDC Formulary – Prescription Policies
6. Restricted items (*) must be approved by supervising physician and the MD/DO name entered in the comment section

16. DD 1289 Example

17. Poly-Prescription Example

18. Misc. Information We do not have an OTC/cold pack program
We accept hard copy prescriptions.
Please verify formulary status of medications before writing if unsure with applicable resources.

19. Questions?
HM2 Julian Gourley NAVSTA Pharmacy (619)