UT Online OTC Order Form

UT Austin Online Over The Counter Medication Order Form

Please fill out the following confidential, HIPAA-secure form to order OTC products. If you have any questions, please feel free to call Tarrytown Pharmacy at 512-478-6419 and ask to speak with the pharmacy team. We look forward to taking care of your prescription and medication needs during your time in Austin! Hook 'em!

My Products*

In-Store Pick-Up (Tarrytown Pharmacy)Your order will be ready for you at the front counter at Tarrytown Pharmacy. 2727 Exposition Blvd Ste 105 Austin, TX 78703

$ Free

Delivery ($5)Delivery is available around the UT Campus, North and West Campus.

$5.00

Shipping ($8.50) (within 48 hours)Your order will be mailed to you within 48 hours.

$8.50

Women's Health & Hygiene

Plan B Generic - My Way (Levonorgestrel 1.5 mg Tablet) - 1 Tablet Product Image

Plan B Generic - My Way (Levonorgestrel 1.5 mg Tablet) - 1 TabletA tablet of the emergency contraceptive Levonorgestrel 1.5 mg Tablet

$25.00 Quantity

Opill Daily Oral Contraceptive - 1 Month Product Image

Opill Daily Oral Contraceptive - 1 MonthOpill® is a full prescription strength, progestin-only daily birth control pill that’s estrogen-free. You don't need a doctor's appointment or a prescription before you begin using it, so it's a great option for those without health insurance or frequent access to medical services.

$22.00 Quantity

Opill Daily Oral Contraceptive - 3 Month Product Image

Opill Daily Oral Contraceptive - 3 MonthOpill® is a full prescription strength, progestin-only daily birth control pill that’s estrogen-free. You don't need a doctor's appointment or a prescription before you begin using it, so it's a great option for those without health insurance or frequent access to medical services.

$58.00 Quantity

Pregnancy Test - (2-Pack)Twin-Pack. Two-Minute pregnancy test. Over 99% accurate from the day of your expected period. English and Spanish language instructions inside.

$12.00 Quantity

Monistat 3-Day Treatment Combination Pack Product Image

Monistat 3-Day Treatment Combination Pack Monistat 3-day treatment vaginal antifungal suppositories with 3 applicators + external cream for itch relief

$22.29 Quantity

Poise Panty Liners - 26 count Product Image

Poise Panty Liners - 26 countPoise daily panty liners light absorbency - 26 count

$6.59 Quantity

Poise Pads Moderate Absorbency - 20 count Product Image

Poise Pads Moderate Absorbency - 20 count Poise Pads moderate absorbency regular length - 20 count

$8.59 Quantity

Tampax Radiant Tampons Super - 14 count Product Image

Tampax Radiant Tampons Super - 14 countTampax Radiant tampons super absorbency - 14 count

$8.79 Quantity

Tampax Radiant Tampons Regular - 14 count Product Image

Tampax Radiant Tampons Regular - 14 count Tampax Radiant tampons regular absorbency - 14 count

$8.79 Quantity

Midol Complete - 24 gelcaps Product Image

Midol Complete - 24 gelcapsMidol Complete gelcaps - 24 count

$13.00 Quantity

Allergies

Benadryl Generic (Diphenhydramine) - 24 Tablets Product Image

Benadryl Generic (Diphenhydramine) - 24 TabletsDiphenhydramine 50 mg (Bendryl) - 24 count

$5.00 Quantity

Zyrtec Generic (Cetirizine) - 30 tablets Product Image

Zyrtec Generic (Cetirizine) - 30 tabletsCetirizine (Generic Zyrtec) used daily for allergy symptoms - 30 count

$9.99 Quantity

Flonase Allergy Relief Nasal Spray - 60 sprays Product Image

Flonase Allergy Relief Nasal Spray - 60 spraysFlonase 24 hour allergy symptom relief nasal spray (fluticasone propionate) - 60 sprays per bottle

$21.59 Quantity

Pataday Once Daily Relief - 2.5 mL Product Image

Pataday Once Daily Relief - 2.5 mLExtra strength once daily eye allergy itch relief

$25.79 Quantity

Cough and Cold

Nyquil Liquid Generic - 12 Ounces Product Image

Nyquil Liquid Generic - 12 OuncesGeneric Nyquil - Acetaminophen, Dextromethorphan, Doxylamine

$10.19 Quantity

Luden's Cough Drops Wild Berry Flavor - 30 count Product Image

Luden's Cough Drops Wild Berry Flavor - 30 count For temporary relief of sore throat

$3.49 Quantity

Eye Care

Visine Itchy Eye Relief - 15 mL Product Image

Visine Itchy Eye Relief - 15 mLTemporary relief of discomfort and redness of the eye

$8.19 Quantity

Opti-Free Replenish Contact Lens Solution - 120 mL Product Image

Opti-Free Replenish Contact Lens Solution - 120 mLOpti-Free enhanced comfort disinfecting contact lens solution

$8.79 Quantity

Pataday Once Daily Relief - 2.5 mLExtra strength once daily eye allergy itch relief

$25.79 Quantity

First Aid / Miscellaneous

Neosporin Generic (Antibiotic Ointment) Product Image

Neosporin Generic (Antibiotic Ointment)Neomycin, Polymyxin B, and Bacitracin Combination Triple Antibiotic Topical Ointment

$8.50 Quantity

Bandages (Band Aids)Generic Multi-Size Bandaids

$3.00 Quantity

Pedialyte Electrolyte Solution Product Image

Pedialyte Electrolyte SolutionPedialyte Electrolyte Solution - 33.8 oz

$7.29 Quantity

Dramamine Original Motion Sickness Relief - 36 tablets Product Image

Dramamine Original Motion Sickness Relief - 36 tablets Dramamine original formulat motion sickness relief - 36 tablets

$19.29 Quantity

Digital thermometer - 1 each

$9.89 Quantity

Abreva Generic (Docosanol) Cream - 2 grams Product Image

Abreva Generic (Docosanol) Cream - 2 gramsCold sore/fever blister treatment cream

$21.49 Quantity

Nexcare Waterproof Bandages for Blisters - 6 count Product Image

Nexcare Waterproof Bandages for Blisters - 6 countWaterproof cushioned blister protection

$7.39 Quantity

Hydrocortisone Cream 1% - 28.4 grams Product Image

Hydrocortisone Cream 1% - 28.4 gramsHydrocortisone maximum strength anti-itch and rash relief cream

$6.19 Quantity

Gastrointestinal

Pepto-Bismol - 12 liquicaps Product Image

Pepto-Bismol - 12 liquicaps Pepto-Bismol Liquicaps - 12 count

$9.49 Quantity

Imodium Generic (Loperamide HCL) - 24 soft gels Product Image

Imodium Generic (Loperamide HCL) - 24 soft gels Imodium (loperamide) anti-diarrheal softgels - 24 count

$11.99 Quantity

Tums Antacid Assorted Berries - 96 chewable tablets Product Image

Tums Antacid Assorted Berries - 96 chewable tablets Tums extra strength 750 mg antacid chewable tablets

$9.39 Quantity

Gas-X Extra Strength - 18 chewable tablets Product Image

Gas-X Extra Strength - 18 chewable tabletsRelieves gas, pressure, bloating, and discomfort. Chewable tablets are cherry creme flavor.

$8.79 Quantity

Pain Relief

Advil Generic (Ibuprofen) - 100 tablets Product Image

Advil Generic (Ibuprofen) - 100 tabletsIbuprofen Tablets - 100 count

$8.79 Quantity

Tylenol (Acetaminophen) - 20 liquid gels

$ Free Quantity

Sexual Health

Plan B Generic - My Way (Levonorgestrel 1.5 mg Tablet) - 1 TabletA tablet of the emergency contraceptive Levonorgestrel 1.5 mg Tablet

$25.00 Quantity

Durex Lubricated Latex Condoms - 3 count Product Image

Durex Lubricated Latex Condoms - 3 countDurex extra sensitive ultra thin lubricated latex condoms - 3 count

$9.79 Quantity

Vitamins/Supplements

Emergen-C Vitamin C Fizzy Drink Mix - 30 packets Product Image

Emergen-C Vitamin C Fizzy Drink Mix - 30 packetsEmergen-C 1,000 mg Vitamin C daily immune support tangerine - 30 packets

$17.99 Quantity

Nautre's Bounty Melatonin 3 mg - 120 Quick Dissolving Tablets Product Image

Nautre's Bounty Melatonin 3 mg - 120 Quick Dissolving Tablets Melatonin 3 mg promotes relaxation and sleep

$8.79 Quantity

Enter coupon

Total

$0.00

Check to see if you're in our delivery zone! Click HERE to see our delivery map.
OPill OTC Contraceptive Acknowledgement:
- I acknowledge that OPill is an Over The Counter Oral Contraceptive, which does not require a prescription.
- This is not a replacement for seeing a women's health provider.
- DAILY PILL: Effective at preventing pregnancy in just 48 hours after you begin taking it
- I understand that it must be taken within the same 3-hour window each day, otherwise there is a risk of pregnancy and back-up contraception (condom) should be used for 2 days.
- I will not hold Tarrytown Pharmacy liable for any adverse events that may occur while taking this medication.
OPill OTC Contraceptive Acknowledgement:*

I acknowledge that I have read and understood the items listed in the OPill OTC Contraceptive Acknowledgement above.
Student (Patient) Information/Demographics
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
UTEID:*
Please select a Pick-Up or Delivery Option on the first question. You will not be able to continue unless you do.
How would you like to get product? You must select this option at the top of the form as well.

In-Store Pick-Up (Tarrytown Pharmacy)Delivery ($5)Shipping ($8.50) (within 48 hours)
Select Date of Delivery:
Dorm/Apartment/Building Name*
Dorm Room Number or Apartment Number (Hardin House- please include Main, Green, Red, Grant, etc)*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number (you will be signed up to receive texts about prescriptions from the pharmacy)*
Please enter a valid phone number.
Email*
example@example.com
Please select a Pick-Up or Delivery Option on the first question. You will not be able to submit this form until you do.

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

UT Austin Online Over The Counter Medication Order Form

Student (Patient) Information/Demographics