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

A tablet of the emergency contraceptive Levonorgestrel 1.5 mg Tablet

$25.00 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

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

$22.29 Quantity

Poise Panty Liners - 26 count

Poise daily panty liners light absorbency - 26 count

$6.59 Quantity

Poise Pads Moderate Absorbency - 20 count

Poise Pads moderate absorbency regular length - 20 count

$8.59 Quantity

Tampax Radiant Tampons Super - 14 count

Tampax Radiant tampons super absorbency - 14 count

$8.79 Quantity

Tampax Radiant Tampons Regular - 14 count

Tampax Radiant tampons regular absorbency - 14 count

$8.79 Quantity

Midol Complete - 24 gelcaps

Midol Complete gelcaps - 24 count

$13.00 Quantity

Allergies

Benadryl Generic (Diphenhydramine) - 24 Tablets

Diphenhydramine 50 mg (Bendryl) - 24 count

$5.00 Quantity

Zyrtec Generic (Cetirizine) - 30 tablets

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

$9.99 Quantity

Flonase Allergy Relief Nasal Spray - 60 sprays

Flonase 24 hour allergy symptom relief nasal spray (fluticasone propionate) - 60 sprays per bottle

$21.59 Quantity

Pataday Once Daily Relief - 2.5 mL

Extra strength once daily eye allergy itch relief

$25.79 Quantity

Cough and Cold

Nyquil Liquid Generic - 12 Ounces

Generic Nyquil - Acetaminophen, Dextromethorphan, Doxylamine

$10.19 Quantity

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

Temporary relief of discomfort and redness of the eye

$8.19 Quantity

Opti-Free Replenish Contact Lens Solution - 120 mL

Opti-Free enhanced comfort disinfecting contact lens solution

$8.79 Quantity

Pataday Once Daily Relief - 2.5 mL

Extra strength once daily eye allergy itch relief

$25.79 Quantity

First Aid / Miscellaneous

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

Pedialyte Electrolyte Solution - 33.8 oz

$7.29 Quantity

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

Cold sore/fever blister treatment cream

$21.49 Quantity

Nexcare Waterproof Bandages for Blisters - 6 count

Waterproof cushioned blister protection

$7.39 Quantity

Hydrocortisone Cream 1% - 28.4 grams

Hydrocortisone maximum strength anti-itch and rash relief cream

$6.19 Quantity

Gastrointestinal

Pepto-Bismol - 12 liquicaps

Pepto-Bismol Liquicaps - 12 count

$9.49 Quantity

Imodium Generic (Loperamide HCL) - 24 soft gels

Imodium (loperamide) anti-diarrheal softgels - 24 count

$11.99 Quantity

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

Relieves gas, pressure, bloating, and discomfort. Chewable tablets are cherry creme flavor.

$8.79 Quantity

Pain Relief

Advil Generic (Ibuprofen) - 100 tablets

Ibuprofen Tablets - 100 count

$8.79 Quantity

Sexual Health

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

A tablet of the emergency contraceptive Levonorgestrel 1.5 mg Tablet

$25.00 Quantity

Durex Lubricated Latex Condoms - 3 count

Durex extra sensitive ultra thin lubricated latex condoms - 3 count

$9.79 Quantity

Vitamins/Supplements

Emergen-C Vitamin C Fizzy Drink Mix - 30 packets

Emergen-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

Melatonin 3 mg promotes relaxation and sleep

$8.79 Quantity

Enter coupon

Total

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:
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.
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.Format: (000) 000-0000.
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

My Products*

Student (Patient) Information/Demographics

Payment Methods

My Products