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! ! ! ! ! ! !

Treating)Patients)Special)

) ) American Specialty Pharmacy has 4 Pharmacists on site to help ensure quality of compounded products.

American Specialty Pharmacy has Two “State of the Art” ISO-5 Class-100 clean rooms. One for compounding all sterile preparations & one negative pressure chemo room for compounding Chemotherapy medications.

American Specialty Pharmacy is fully compliant with USP797

E-Prescribing capability with real time order entry and tracking system

Specialized Customer Service

One stop for all your Pharmaceutical needs

For all questions or concerns please feel free to call us any time at (877) 868-4110

Pharmacy Locations Plano 2743 W. 15th Street Plano, TX 75075 Ph: (214) 919-2090 Fax: (214) 919-2091

Denton 2436 S. Interstate 35E Suite 360 Denton, TX 76205 Ph: (940) 383-1222 Fax: (940) 383-1444

San Antonio 2414 Babcock Rd. Suite 111 San Antonio, TX 78229 Ph: (210) 615-7400 Fax: (210) 615-7401

Tyler 1109 E. 5th Street Tyler, TX 75701 Ph: (903) 533-9100 Fax: (903) 533-9101

El Paso 1015 N. Zaragoza St. El Paso, TX 79907 Ph: (915) 860-7225 Fax: (915) 860-7320

Miami 2389 SW 22nd Street (Coral Way) Miami, FL 33145 Ph: (305) 856-0070 Fax: (305) 856-0072


2743 W. 15th St., Plano, TX 75075 Ph: 877-868-4110 Fax: 877-868-4144

INJECTABLE LIST Betamethasone Acetate/Phospate (Soluspan) 6mg/ml P/F

Methylprednisolone Suspension 40mg/ml and 80mg/ml P/F

Size

Size

2ml vial 5ml vial 10ml vial

2ml vial (min 20 vials) 5ml vial (min 6 vials) 10ml vial (min 6 vials)

Betamethasone Sodium Phospate 12mg/ml P/F

Ondansetron 2mg/ml

Size

Size

2ml vial (min 20 vials) 5ml vial (min 6 vials)

2ml vial (min 50 vials)

Chondroitin / Glucosamine / DMSO

Midazolam* 1-5mg/ml

Size

Size

2ml vial (min 3 vials)

1-2ml vial (min 50 vials)

Hyaluronidase 150u/ml P/F

Fentanyl* 50mcg/ml

Size

Size

10ml vial preservative free

2ml vial (min 50 vials)

Dexamethasone (Decadron equiv.) P/F same price as Triamcinolone (same min. quantities apply Triamcinolone Acetonide P/F 40mg/ml P/F

Sodium Bicarbonate 4.2% - 8.4%

Size 1ml vial (min 20 vials) 2ml vial (min 20 vials)

Size 50ml vial (min 12 vials) Lidocaine 1-2% Size 50ml vial (min 12 vials)

PLANO - DENTON - TYLER - SAN ANTONIO - EL PASO - MIAMI


We look forward to serving you and meeting all of your pharmacy needs. OUR PRODUCTS & SERVICES

We are a full service pharmacy that specializes in: Compounded & Specialty Medications Durable Medical Equipment (DME) Nutritional Supplementation Workers’ Compensation Prescriptions Everyday Prescriptions

WE TAKE THE BURDEN OFF OF YOU

Our customer service is second to none; provided by highly trained sta . We assist each patient throughout the entire process. From contacting your insurance carrier to automatic re lls and overnight delivery.

www.AMERICANSPECIALTYPHARMACY.com


At American Specialty Pharmacy, we use the latest technology with top quality ingredients to compound safe and e ective customized medications. Our pharmacists are experts at compounding new, discontinued, back-ordered, or unavailable medications to meet speci c patient needs. We o er a full line of Professional Quality Vitamins,

Nutritional Supplements, OTC Medications, Everyday Prescriptions, Medical Equipment & Specialty Medications.

COMPLIMENTARY DELIVERY All deliveries are delivered straight to your door within 24 hours at no out-of-pocket cost to you.

AUTOMATIC REFILLS

Your re lls are lled automatically based on your prescription or physician’s approval. It is not necessary to reorder!

PLANO LOCATION

2743 West 15th Street Plano, TX 75075 P: 877-868-4110 . F: 877-868-4144

EMAIL

info@americanspecialtyrx.com

HOURS OF OPERATION Mon - Fri 9am until 7pm Sat & Sun 9am until 3pm

www.AMERICANSPECIALTYPHARMACY.com


NEUROLOGY & PAIN REFERRAL FORM

PRESCRIPTION

PLEASE ATTACH COPIES OF PATIENT’S INSURANCE CARDS

FIBROMYALGIA (TOPICAL): *A

Cream Size (Pump): 75gm (Seventy-Five Grams)

FORMULAS FOR TOPICAL PAIN/ARTHRITIS/SPASM/NEUROPATHY:

SHINGLES & TRIGEMINAL NEURALGIA (TOPICAL):

NEUROPATHIC PAIN & ANTI - INFLAMMATORY SPRAY:

MIGRAINE HEADACHE:

Prescriber’s Signature

Today’s Date

Spray Size:


COMPOUNDED NON-STERILE REFERRAL FORM

PRESCRIPTION

Today’s Date

PLEASE ATTACH COPIES OF PATIENT’S INSURANCE CARDS

Cream Size (Pump)

Prescriber’s Signature

at 888-966-0188


FEMALE HRT REFERRAL FORM

PRESCRIPTION

PLEASE ATTACH COPIES OF PATIENT’S INSURANCE CARDS C- PERIMENOPAUSAL:

C- PMS:

Progesterone Topical *Apply Cyclically Days 12 – 25 once a day. *Apply BID or TID week prior to period.

Progesterone Topical

C- BI–ESTROGEN TOPICAL:

*Apply Cyclically Days 1 – 25 once a day.

C- PREMENOPAUSAL:

Progesterone Topical *Apply Cyclically Days 12 – 25 once a day. *Apply BID or TID week prior to period.

QTY:

30gm (Thirty Grams)

60gm (Sixty Grams)

C- DHEA ORAL: QTY:

30gm (Thirty Grams)

C- MENO – POSTMENOPAUSAL SURGERY: Progesterone Topical

C- BI–ESTROGEN TOPICAL: *Apply Cyclically Days 1 – 25 once a day. QTY:

30gm (Thirty Grams)

60gm (Sixty Grams)

C- BI – ESTROGEN TOPICAL:

C- TESTOSTERONE TOPICAL QTY: QTY:

30gm (Thirty Grams)

30gm (Thirty Grams)

60gm (Sixty Grams)

C- TESTOSTERONE TOPICAL: QTY:

30gm (Thirty Grams)

60gm (Sixty Grams)

SEXUAL DYSFUNCTION ENHANCEMENT:

QTY:

30gm (Thirty Grams)

LIBIDO BOOST CREAM:

N.O.C. AROUSAL CREAM QTY:

30gm (Thirty Grams)

Today’s Date

QTY:

30gm (Thirty Grams)

Prescriber’s Signature

at 888-966-0188


hCG REFERRAL FORM

PRESCRIPTION

PLEASE ATTACH COPIES OF PATIENT’S INSURANCE CARDS

Injectable: *Administer daily or bi-weekly

30

Slim Shots: *Inject as directed

40

Sublingual Drops: *Administer sublingually 4 drops a day 30

40

Nasal Spray (not available for hypogonadism) *Administer one spray per nostril daily 30

Today’s Date

ADDITIONAL NOTES:

40

Prescriber’s Signature IMPORTANCE NOTICE:

at 888-966-0188


MALE HRT REFERRAL FORM

PRESCRIPTION

Today’s Date

PLEASE ATTACH COPIES OF PATIENT’S INSURANCE CARDS

▢ ▢

Viagra

DESIGNED SUPPLEMENTS & SUPPLIES ▢

TROCHES/TABLETS ▢

CREAM, GEL & ETC - QTY: 30gm (Thrity Grams) ▢

▢ ▢

CREAM, GEL & ETC - QTY: 60ml (Sixty Milliliters) ▢

INJECTABLE - QTY: 10ml (Ten Milliliters) ▢

COMPOUNDED INTRACAVERNOSAL - QTY: 10ml (Ten Milliliters) ▢ ▢ ▢ ▢

ADDITIONAL NOTES:

Prescriber’s Signature at 888-966-0188


COMPOUNDED INTRACAVERNOSAL

PRESCRIPTION

Today’s Date

PLEASE ATTACH COPIES OF PATIENT’S INSURANCE CARDS

MIX: -

BI-MIX:

TRI-MIX:

QUATRO-MIX:

ADDITIONAL NOTES:

Prescriber’s Signature

at 888-966-0188


www.AMERICANSPECIALTYRX.com Plano | Denton | El Paso | San Antonio | Miami | Tyler | Houston

Internal / Family Medicine  

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