Focus on counseling on proper drug regimens for diabetes patients

Patricia Lurye Dempster, R.Ph., M.S., one of Apple Valley Pharmacy’s own pharmacists, has earned the American Pharmacists Association (APhA) National Certificate, “The Pharmacist and Patient Centered Diabetes Care.” Upon completion of the training program, Patti holds an additional 23 pharmacy continuing education (CE) credits which focus on current standards of care for patients with diabetes.




Apple_Valley_Pharmacy_Patti_Studying_DiabetesThe certificate program is an intense educational experience designed to equip Pharmacists with the knowledge, skills and confidence to provide effective evidence based diabetes care. Patti completed five self-study modules and the NYC based live seminar incorporating case studies and hands-on skill training. This course focused on the situations that most likely will be encountered as well as services most needed in Community and Ambulatory care practice settings.

Through the “Diabetes Care” course,  Patti has gained valuable training and experience in evaluating and adjusting drug therapy regimens for patients with Type 1 and type 2 diabetes, counseling patients about lifestyle interventions, analyzing and interpreting self-monitoring of blood glucose results and assessing the overall health status to identify needed monitoring and interventions.


Vote for Apple Valley Pharmacy as Readers’ Choice

It’s that time of year again, when your favorite local businesses can achieve the Readers’ Choice Award! It’s up to YOU TO DECIDE WHO WINS the Times Herald Record’s Readers’ Choice Award, with a simple vote for your community’s locally owned, operated & loved Full Service Pharmacy! What other pharmacy can you call on for over the counter medications, compounded medications made specifically for you or your pet, vitamins & supplements, homeopathic remedies, pill packaging & synchronization services, consultation services, FREE front door parking and FREE local delivery?!?!

To vote for Apple Valley Pharmacy, go to:

Under the Merchants and Retailers category, scroll down to PHARMACY, where you can VOTE for Apple Valley Pharmacy.
Your vote automatically enters you to win two Lawn Passes for Chicago and Earth, Wind & Fire at Bethel Woods!!

Thank you so much for your support!!!

Readers Choice Vote_Apple_Valley_Pharmacy

Apple Valley Pharmacy’s “Mobile” Pharmacy saves you time & money.

Apple Valley Pharmacy offers many unique services that will make filling and receiving prescriptions easy and personal.

  • Text Notifications — Receive text notifications when your prescription is available for pick-up.
  • Local Delivery & Direct-To-You-Shipping* — Apple Valley Pharmacy is the family friendly pharmacy that delivers & ships medication.
  • Refill Prescriptions — Request refills on the go using the Rx2Go app on your mobile device.
  • Transfer Prescriptions — Move your prescriptions from another pharmacy to Apple Valley Pharmacy.Delivery Logo

Try our pharmacy — drop off your prescriptions or have your doctor call them in.


A Multi-Faceted Approach To Patient Health

AnnMarie_America's Pharmacist article photo













When AnnMarie Cloutier, PharmD, says, “I want to be more of a clinical wellness center, instead of a standard pharmacy,” it’s not because of the various challenges facing independents, such as low reimbursement rates, tightening margins, deep discounting big box stores, and mail order, to name just a few. “No,” she says. “I just truly believe in the model.”


As owner of Apple Valley Pharmacy ( Warwick, N.Y., Cloutier is looking to get away from the mindset of simply dispensing a prescription medication for every ailment or malady. Wellness Naturally“I know it’s counterintuitive from a business perspective to say that I think you should take care of your health instead of popping a pill,” she says. “But I truly believe that. I see alternative measures for a lot of the prescribed medications. Patients take a medication or a combination of medications that cause harmful or even incapacitating side effects. Then they’re prescribed an additional drug to treat the side effect. The symptoms of their original condition are then multiplied.” Cloutier, who in June celebrated her third anniversary as Apple Valley Pharmacy owner, is focused on a multi-faceted approach to patient health, with prescriptions being a part and not the primary focus. She freely admits that if it’s a choice between having patients taking an alternative product or a commercial prescription medication, she prefers the former. “Oh, absolutely,” she says. But at the same time, Cloutier says it’s not always so simple. “It’s usually a lot more complicated than telling them to take a certain herb or supplement. That’s why I look at a person as a whole. It’s not like I can say, ‘Okay, instead of taking a drug you can take an herb.’ Either way, whatever you are taking isn’t going to work if you eat fast food all the time,” she says with a laugh. “So I try to educate them. I also realize that changing all of those habits that are detrimental is never going to happen all at once. So you try to do a little bit at a time.” But that’s the benefit of being their pharmacist, Cloutier points out. “Customers are able to come into the pharmacy routinely to ask questions. They can always walk in and receive counseling from one of the pharmacists unlike having to schedule yearly or biannual appointments with a physician. I run into them at the grocery store, and once or twice a month here.”

AVP Store #1

SIGNATURE PRODUCTS Cloutier was born and raised in Warwick, a town of nearly 7,000 residents in southern New York near the New Jersey state line. She received herBachelor of Science in pharmacy at Northeastern University in Boston, and her PharmD at the University of Rhode Island. She stayed in the Northeast for about a dozen years, and gained a variety of clinical experience, most notably with stints at Northeastern Medical Center, Massachusetts General Hospital, and Solvay Pharmaceuticals, before

AVP Group

The pharmacy itself is about 1,800 square feet, conveniently located behind a row of physicians’ offices. Cloutier describes Warwick and the surrounding area as something of a bedroom community for New York City, about 50 miles to the southeast. As for Apple Valley Pharmacy, she considers it a hybrid store. Among its services are free local delivery, medication compounding, pill packaging for better adherence, breastfeeding product rental and sales (it is a Medela–authorized retailer), immunizations, bioidentical hormone replacement therapy, and nutrition consultations. Of course, alternative therapies are becoming the pharmacy’s signature.

Apple Valley has a full line of homeopathic products, nutraceuticals, teas, and dietary supplements. Cloutier says that Bach flower remedies are hot sellers at the moment. (The remedies are extreme dilutions of flower material developed by Edward Bach, an English homeopath, in the 1930s. Bach believed that dew found on flower petals retain healing properties of that plant. The remedies are intended primarily for emotional and spiritual conditions, including but not limited to depression, anxiety, insomnia, and stress.)

Cloutier says that the pharmacy recently worked with Professional Compounding Centers of America’s Wellness Works division to develop and sell a nutraceutical private label brand with the Apple Valley logo. The pharmacy also carries a full line of Boron mineral products. Looking for ways to pair up a supplement or other natural product with a prescription is part of Apple Valley’s strategy. “We market vitamins and supplements through patient education. Our pharmacy staff is trained to recognize when somebody is on a prescription that will deplete them of a certain nutrient. Then we recommend the proper vitamin protocol to accompany the medication.”

EDUCATION ESSENTIAL Anyone can offer a product. But if you can’t articulate what it does and how it works, it’s less likely to sell. Cloutier understands that completely, saying, “Education is critical.” To soak up as much insight as possible about alternative medicine, therapies, and wellness, she has been a frequent attendee at trade shows and conferences in recent years. When not on the road, she participates in webinars and does a lot of reading and research. Cloutier is also in the process of getting her board certification in wellness from the American Academy of Anti-Aging Medicine, another aspect of what she describes as “an ongoing learning process.”

Through PCCA, Cloutier participates in a network call with other pharmacy owners. “We talk once each month to discuss business and clinical topics, which is quite helpful,” she says. And through contacts she has made from trade shows and meetings, she has become part of a networking group with other pharmacists. “A lot of times we’ll just call each other, which is very helpful, because as a sole owner you are kind of in a vacuum if you don’t reach out to others,” Cloutier says.

“I would say that’s the biggest challenge of owning a pharmacy on your own. Making sure you know what’s hot, what’s trending, what product mix you should have in the store, even down to billing. It’s more advantageous for me to call a colleague than it is to wait for the next conference.” With wellness, Cloutier seeks to learn as much as possible about items she is carrying in her store. “I contact the company of any product I may be interested in carrying,” she says. “I ask if the product is GMP [good manufacturing practice] certified, where the ingredients are sourced from, and how they verify quality. Some manufacturers do get inspected by the FDA [Food and Drug Administration] and I ask how often. I strive to carry products that go through rigorous testing and source their ingredients as locally as possible. And also, owners can be as savvy as possible, but they can’t be available 24/7, so if you don’t educate your staff and they don’t have that buy in, it’s never going to work.” Cloutier says that customers will sometimes mention a product that she doesn’t have. “They’ll say, ‘It’s half the price of what you carry.’ And I’ll assure them that I have no idea where it came from. It could claim to have a certain amount of a specific property, but you don’t know how much is really in there. Nobody is validating it. So I look for companies that do their own internal validation.”

Obviously, customer attitudes must be taken into account when deciding what products to carry. “You have to look at where you are located, and your demographic, because that will dictate if people will spend for that or not,” Cloutier says. “Then you kind of go from there. You have to keep in mind people’s cultural influences. You would have to know what products to offer or not offer to make sure you don’t insult or offend anyone. Keeping all of that in mind is important.” AVP Store #2

LOCAL GIFT SOURCES Like many independent retail pharmacies, Apple Valley carries an assortment of gift items, but with a bit of a twist. Cloutier explains that there are a lot of local crafters and artistic people in the community, so she buys a lot of handmade, artisan items that are locally made. She even has a family flavor to her offerings. “My mother makes quilts and place mats and things like that for each season,” Cloutier says. “She does a lot of knitting. For example, she makes winter hats for infants and children, which complement our Medela breastfeeding selection.

We try to focus gifts on things that someone will pick up for someone who’s sick. It might be a tea cup or a coffee cup with natural honey that’s made locally. If they are here to pick up a prescription for someone who’s sick, we try to think what could go with it.”

Cloutier also points out that with locally made products, she can often take them on consignment. “We only pay for what we sell, which is nice, because your overhead isn’t huge if the product line doesn’t sell as well as you thought it would. For someone who is interested in getting into this, that might be the way to go.” With any new product, Cloutier generally gives it three months to sell. If it doesn’t move, it’s not for lack of effort. “We usually give initiatives to the staff for the number of units we want sold, that kind of thing,” she says. “We have one item where the company that offers the product will give my staff commission for each product they sell, and then I match it. I don’t do that on every product, but there are some that have a higher price point, so I can still sustain that commission.”

A surprisingly popular item, Cloutier says, were Dr. Comfort slippers. “I wasn’t certain of how the line was going to be received, but they were popular,” she says. “I was really excited about them. I came back from [the NCPA Convention and Trade Exposition] last year and had ordered a whole shipment of them. My staff initially had doubts. They turned out to be a better seller than they thought, because we normally don’t sell footwear. It’s kind of a strange offering, but people loved them. We started selling them in the fall before the holidays with great success.”

TRANSITIONING TO TOTAL WELLNESS Part of Cloutier’s goal to move her pharmacy toward a total wellness destination includes receiving more referrals from physicians for patients who might be benefit from a medication therapy management type of consultation. “With a lot of them, we can help them lower the number of medications that they are on, and change their supplement routine,” Cloutier says. “It also helps that we compound, because we can consolidate some of their supplements into one dosage form, instead of having them taking five or 10 pills.”

In an ideal world, Cloutier would have practitioners coming into the pharmacy to work collaboratively. It might be a nutritionist, or a naturopath – basically anyone who shares her goals for patient care. She would like to have enough office space for those professionals to bring patients into her business, and ideally those patients would eventually become pharmacy customers. “I have a specific vision I’m looking to create – but I’m still not there yet,” she says with laugh. “I’m not big enough in this location to do that.” Cloutier hopes that will change in a few years, when her lease will be up and she will be, in her words, “a free agent.” At that point, if all goes well, she will be in a larger building with greater visibility and more foot traffic.

In the meantime, she has made the best of her existing space. After buying the store, she did a number of renovations. This included putting all of her retail products on cubes, set on casters that can be moved. “Our retail floor can be completely wide open and can accommodate lectures,” Cloutier says. “Space can be opened, and we let providers use it for free. Say that a podiatrist wants to talk about heels spurs Thursday at 7 p.m. They can come in and use the space. We are scheduled to have an acupuncturist come in for three hours to demonstrate stress relief techniques. We have a small lounge area with a coffee table, and she’ll perform that service on people for free. They get an idea of what she does, and it brings people into the store.”

Cloutier also had a flat screen television mounted on a wall to show pharmacy photos, display Power Point presentations during meetings, and provide general information about the business. “So many of our customers come for a retail prescription and don’t know what other services we offer. Somebody came in the other day and said, ‘Oh, you make medication for animals? We have been going to a pharmacy 30 minutes away.’ I’m like, ‘What!?’ So even with brochures and flyers, it can still be difficult to spread the word.” But Apple Valley does get its name out by being a good local citizen, being active in various community and charity events.

It also has a presence on social media with a Facebook page that is updated daily. For a while Cloutier says the staff was generating all the content internally, but as that became time-consuming, Apple Valley has since signed up for the NCPA Digital Pharmacist™ Solution powered by RxWiki (www.ncpanet. org/digitalpharmacist), which is free to NCPA members. (The pharmacy will still contribute its own content on occasion.) Apple Valley also sends out a monthly newsletter, and is moving toward creating more online sales opportunities.

For Cloutier, the most satisfying aspect of her job is simply helping people feel better. “We get a lot of patients who come here who may have gone to a chain and to five or six doctors and pharmacists,” she says. “And when they get to us, we have the time, and the desire to speak to them, and look them in the eye and spend that time with them, and not look at them as a number and rush them through. Some people cry with joy and relief and a thank you—it makes a huge difference.” ■

Published August 2014 in NCPA’s pharmacy journal, America’s Pharmacist. Chris Linville is managing editor of America’s Pharmacist.

Compounding To Solve Life’s Problems

In every field of medicine, there are some patients who don’t respond to traditional methods of treatment. Sometimes they need medicine at strengths that are not manufactured at drug companies. Sometimes they simply need a different method of ingesting a medication. With a written prescription, the compounding pharmacist can and often does address many patient dosing problems by customizing a medication to meet a specific need.


compounding devices


Lactose Intolerance – Lactose is often used as a filler or excipient for capsules. Potential Solution: Compound the required medication using an excipient other than lactose.


Allergic to Dyes or Preservatives Potential Solution: Compound the prescribed medication dye- or preservative-free.


Alcohol-free Medications Potential Solution: Customize the medication without the addition of alcohol.


Discontinued Medications Potential Solution: When the USP grade chemical and applicable formula are available, it can be compounded.


Medications in Short Supply Potential Solution: Same as discontinued medication above.  


Required Strength Not Available Potential Solution: Customize the medication to the required potency.  


Required Dosage Form Not Available Potential Solution: A wide variety of dosage forms are available, and others might possibly be created to meet a unique patient need.  


Medication Taste Potential Solution: Many medications can be flavored to enhance palatability.  


Side Effect Intolerance Potential Solution: Customize the medication to alleviate or reduce the side effect(s).


Economic Hardship Potential Solution: Drug combinations in a single dosage form, e.g., NSAIDS and analgesics or analgesics and anti-nauseates, can be customized. Such combinations can reduce the cost of some medications.


Patients Not Responding To Conventional Medication

Drug Therapy – Medication is not working or bringing about the desired therapeutic outcome. Potential Solution: Compound the required medication based upon a written prescription to improve therapeutic outcome. ©


© Compounding For Life’s Problems, Professional Compounding Center of America (PCCA)

Your Medication Coverage May Be At Risk


Unbeknownst to members, insurance companies often change which prescriptions are covered and which are not. This is not always shared with the insured members prior to the changes. In addition to being expensive and inconvenient, these modifications make the medicine that you depend on virtually inaccessible and have real consequences for your quality of life.

Although you’re not always made privy to these changes directly from your insurance provider, you do have the power to get informed and take action to make sure that the medication that you depend on, including your compounds, remain accessible to you.

Here’s what you can do:

Thyroid 1 Go to and get informed about recent changes to certain insurance and benefit plans.

Thyroid 2 Take action: Learn how to talk to your HR or benefits manager to keep your coverage and get other tools designed to protect your access to compounds.

Thyroid 3 Click here to receive email alerts about new developments.


Compounding is the Art and Science of Creating Personalized Medications

Pharmacy compounding is the art and science of preparing personalized medications for patients. Compounded medications are “made from scratch” – individual ingredients are mixed together in the exact strength and dosage form required by the patient. This method allows the compounding pharmacist to work with the patient and the prescriber to customize a medication to meet the patient’s specific needs.

A Brief History of Compounding

At one time, nearly all prescriptions were compounded. With the advent of mass drug manufacturing in the 1950s and ‘60s, compounding rapidly declined. The pharmacist’s role as a preparer of medications quickly changed to that of a dispenser of manufactured dosage forms, and most pharmacists no longer were trained to compound medications. However, the “one-size-fits-all” nature of many mass-produced medications meant that some patients’ needs were not being met

Will My Insurance Company Cover My Compounds?

Because compounded medications are exempt by law from having the National Drug Code ID numbers that manufactured products carry, some insurance companies will not directly reimburse the compounding pharmacy. However, almost every insurance plan allows for the patient to be reimbursed by sending in claims forms. While you may be paying a pharmacy directly for a compounded prescription, most insurance plans should cover the final cost.



Keep personalized medicine accessible and affordable.

What Can My Pharmacist Do For Me?

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Pharmacists are a critical part of your healthcare team. Many supervise pharmacy technicians, who prepare medicine to fill your prescriptions. Today’s pharmacists do much more. They counsel you on how to use your medicine correctly and they can help prevent overdoses and dangerous drug interactions by tracking the amounts and combinations of the drugs you take.

The pharmacist is a drug expert. He or she can help you get the most out of your medication by sharing important information on how to use it. Should you take your prescription before or after meals? Is it necessary to stay out of the sun or avoid particular foods while taking your prescription? What over-the-counter drugs, herbal products, or other remedies should you avoid while taking a medication or if you have a particular medical condition? The next time you have questions about your prescription or non-prescription medication, chat with your pharmacist.*



Specialty Services at Apple Valley Pharmacy Include:

  • Custom Medication Compounding: For People & Pets
  • Medication Therapy Management (MTM)
  • Pill Packagine Service
  • Hormone Therapy Consultations
  • Immunizations
  • FREE Local Delivery & Shipping

*Source: University of Rochester Medical Center

Acupuncture: Treating the Body Through the Ears

Maintaining optimum health is best to keep the body in balance. If you continue to live your life while out of balance, further illness can occur. Acupuncture, a form of holistic medicine, can bring the body back into balance. Ear treatments are an easy way to introduce someone into acupuncture and bring the body into balance. Heather Botjer LAc, one of several thousand National Acupuncture Detoxification Association (i.e. the NADA Protocol)-trained practitioners worldwide, is an acupuncturist. She will be giving ear treatments Monday June 30th, 2014 from 2:30 pm – 4:30 pm at the Apple Valley Pharmacy located at 44 Ronald Reagan Blvd, Warwick, NY. The NADA Protocol focuses solely on relaxation and detoxification to help the patient improve their overall health, all through the ear. It does this by a type of medicine called acupuncture. Acupuncture is beneficial for treating chronic illnesses, pain, stress etc. It can benefit people with low back pain, joint pain, headaches, menopause, as well as relieving PMS symptoms. It is even a great treatment for women who are pregnant and nursing. In addition, acupuncture is also beneficial as a preventative care. Once the body is back in balance acupuncture can help the body maintain a sense of equilibrium. It is great for relieving stress, boosting energy, and helping one sleep better. As it exists today, the NADA protocol consists of inserting small, stainless steel, sterile disposable needles into five points on the outer surface of a person’s ear. Acupuncture needles are thinner then regular needles and usually don’t hurt. In a typical session, both ears of the patient are needled, and needles usually stay in for 15 to 40 minutes. Patients often claim to feel energized, lighter or even more relaxed after undergoing one of these treatments. Usually this type of treatment is done in a group setting and particularly for people just trying out acupuncture. The reason that this protocol is done in a group setting is to help build support among those being treated and eliminate any feelings of isolation. Many patients and health care providers have reported that they noticed an improvement in: retention in drug treatment programs, optimistic attitudes about detoxification and recovery, reductions in cravings and anxiety, fewer episodes of sleep disturbance, and reduced need for pharmaceuticals. Ear treatments are a safe, and comfortable introduction into acupuncture. Everyone can definitely benefit from the healing powers of acupuncture. heatherbio


Heather Botjer LAc has two locations, one in Florida New York off of 17A. The other is in Rockland County – Piermont New York. On Monday June 30th, 2014 from 2:30 pm – 4:30 pm, Heather will be at the Apple Valley Pharmacy offering a complimentary stress relief detoxification treatment for people who are interested in acupuncture.

Saw Palmetto Benefits a Healthy Prostate


Saw Palmetto Extract may be a useful dietary supplement for men who wish to support and maintain the healthy structure and function of their prostate gland.

  • Saw palmetto is used mainly for urinary symptoms associated with an enlarged prostate gland (also called benign prostatic hyperplasia, or BPH).
  • Saw palmetto is also used for other conditions, including chronic pelvic pain, bladder disorders, decreased sex drive, hair loss, and hormone imbalances.



Saw Palmetto Extract, one of Apple Valley Pharmacy’s recommended supplements supporting healthy prostate function, contains a number of beneficial compounds including fatty acids that may support the healthy structure and function of a man’s prostate.


Common Names–saw palmetto, American dwarf palm tree, cabbage palm

Latin NamesSerenoa repens, Sabal serrulata



The active ingredients of Saw Palmetto Extract, a NOW brand dietary supplement, include Pumpkin Seed Oil (a nutritional oil rich in essential fatty acids, EFAs, known for its high phytosterol content) and Zinc (a mineral with a strong role in maintaining prostate health, testosterone levels and overall sexual health).


The only treatment for Celiac disease is the lifelong gluten-free diet. A gluten-free diet means eliminating all foods, beverages, vitamins, supplements – and medications (prescription and over-the-counter) – that contain wheat, rye or barley.

If you have been diagnosed with Celiac disease or need to follow a gluten-free diet you must be aware of potential sources of gluten. In the area of pharmaceuticals, potential sources of gluten contamination come primarily from the addition of the excipient (filler) ingredients added to the active drug in order to make a particular dosage form.¹

Gluten can be used in many medications as an excipient, so it is important for you to check that each medication you take is gluten-free. If you have Celiac disease and are filling a prescription, ask the pharmacist to verify the ingredients to ensure that it is gluten-free. You can ask their help in reading and understanding the list of ingredients or contact the manufacturer. IF IT IS DISCOVERED THAT YOUR PRESCRIBED MEDICATION CONTAINS GLUTEN, ASK THE PHARMACIST TO CONSULT WITH YOUR PHYSICIAN TO DETERMINE AN APPROPRIATE COMPOUNDED DRUG. If you need a drug made without gluten Apple Valley Pharmacy in Warwick, NY can compound it for you.

It is important for pharmacists and physicians to be aware that medications may not work as expected in people with undiagnosed or newly diagnosed Celiac disease due to problems with malabsorption. IF YOU DO NOT FEEL WELL OR THE MEDICATION DOES NOT SEEM TO BE WORKING, IT IS IMPORTANT TO CHECK WITH YOUR PRESCRIBING PHYSICIAN RIGHT AWAY.

Some Excipients to look for:

  • Dextrins – Result from the hydrolysis of starch by heat or hydrochloric acid (from corn). It can also be obtained from wheat, rice or tapioca. Dextrates (when source is not specified)
  • Dextri-maltose (when barley malt is used)
  • Maltodextrin – A startch hydolysate that is usually obtained from corn but can be extracted from wheat, potato or rice
  • Modified Starch (when source is not specified)
  • Pregelantinized Starch – a starch that has been chemically or mechanically processed. The starch can come from corn, wheat, potato or tapioca
  • Sodium starch glycolate – a starch that is usually obtained from potato but many come from any starch source

Questions to ask:

What are the inactive ingredients or excipients? What is the source of the ingredient or excipient? Answers can be found on the package insert and the key word to look for is starch. If the starch is listed as “cornstarch” or starch (corn) it can be assumed to be gluten-free. However, if starch is listed by itself the only way to confirm the source is to call the manufacturer.

Important Information:

> Generic drugs do not have to contain the same excipients as brand name drugs or another generic equivalent

> Botanical sources of a starch may not be specified and need to be investigated

> There are currently NO requirements for labeling gluten found in prescription drug ingredients



¹ Medications and celiac disease: Tips from a pharmacist. Parrish, C. R. (2007). Practical Gastroenterology

January, 2007, pages 58-64. For a complete copy of the article above go to: Maintained by Steven Plogsted, PharmD., pharmacist at Nationwide Children’s Hospital, Columbus, Ohio


Celiac Disease Foundation; Citing Blog Source []