Medication Ordered 

Dosage form 

ERX

Dose and Frequency 

Formulary Medication 

Dosage Form 

ERX

Dose and Frequency 

Ciprofloxacin 0.3%

Ophthalmic solution

9610

Any dose/frequency

Ofloxacin

0.3%

Ophthalmic solution

19746

Same Dose and frequency

1687

Ciprofloxacin 0.3%

Ophthalmic ointment

23234

Any dose/frequency

Erythromycin 0.5%

Ophthalmic ointment

2888

Gatifloxacin 0.5%

Ophthalmic solution

105011

Any dose/frequency

Ofloxacin 0.3%

Ophthalmic solution

19746

Same dose and frequency

Levofloxacin 0.5%

Ophthalmic solution

28872

Any dose/frequency

Ofloxacin 0.3%

Ophthalmic solution

19746

Levofloxacin 1.5%

Ophthalmic solution

87836

Any dose/frequency

Ofloxacin 0.3%

Ophthalmic solution

19746

Moxifloxacin 0.5%*

Ophthalmic solution

151152

1 drop BID-TID

Ofloxacin 0.3%

Ophthalmic solution

19746

1-2 drops QID

35699

35697