VALUE PREFERRED MEDICATIONS

Transcription

1 ANALGESICS AND ANESTHETICS ANALGESICS - ANTI-INFLAMMATORY celecoxib cap 100 (Celebrex) celecoxib cap 200 (Celebrex) celecoxib cap 400 (Celebrex) celecoxib cap 50 (Celebrex) diclofenac potassium tab 50 (Cataflam) diclofenac sodium tab delayed release 25 diclofenac sodium tab delayed release 50 diclofenac sodium tab delayed release 75 diclofenac sodium tab sr 24hr 100 (Voltaren-xr) etodolac cap 200 etodolac cap 300 etodolac tab 400 etodolac tab 500 etodolac tab sr 24hr 400 etodolac tab sr 24hr 500 etodolac tab sr 24hr 600 flurbiprofen tab 100 flurbiprofen tab 50 ibuprofen susp 100 /5ml ibuprofen tab 400 ibuprofen tab 600 ibuprofen tab 800 indomethacin cap 25 indomethacin cap 50 ketoprofen cap 50 ketoprofen cap 75 leflunomide tab 10 (Arava) leflunomide tab 20 (Arava) meloxicam tab 15 (Mobic) meloxicam tab 7.5 (Mobic) nabumetone tab 500 nabumetone tab 750 naproxen sodium tab 275 (Anaprox) naproxen sodium tab 550 (Anaprox ds) naproxen susp 125 /5ml (Naprosyn) naproxen tab 250 (Naprosyn) naproxen tab 375 (Naprosyn) naproxen tab 500 (Naprosyn) naproxen tab ec 375 (Ec-naprosyn) naproxen tab ec 500 (Ec-naprosyn) oxaprozin tab 600 (Daypro) piroxicam cap 10 (Feldene) piroxicam cap 20 (Feldene) sulindac tab 150 sulindac tab 200 ENBREL etanercept for subcutaneous inj 25 ENBREL etanercept subcutaneous soln prefilled syringe 25 /0.5ml ENBREL etanercept subcutaneous soln prefilled syringe 50 /ml ENBREL SURECLICK etanercept subcutaneous solution auto-injector 50 /ml HUMIRA adalimumab prefilled syringe kit 10 /0.2ml HUMIRA adalimumab prefilled syringe kit 20 /0.4ml HUMIRA adalimumab prefilled syringe kit 40 /0.8ml HUMIRA PEDIATRIC CROHNS D adalimumab prefilled syringe kit 40 /0.8ml HUMIRA PEN adalimumab pen-injector kit 40 /0.8ml HUMIRA PEN-CROHNS DISEASE adalimumab pen-injector kit 40 /0.8ml HUMIRA PEN-PSORIASIS STAR adalimumab pen-injector kit 40 /0.8ml ILARIS canakinumab for inj 180 OTEZLA apremilast tab 30 OTEZLA apremilast tab starter therapy pack 10 & 20 & 30 SIMPONI golimumab subcutaneous soln autoinjector 100 /ml SIMPONI golimumab subcutaneous soln autoinjector 50 /0.5ml SIMPONI golimumab subcutaneous soln prefilled syringe 100 /ml SIMPONI golimumab subcutaneous soln prefilled syringe 50 /0.5ml VIMOVO naproxen-esomeprazole magnesium tab dr VIMOVO naproxen-esomeprazole magnesium tab dr ZORVOLEX diclofenac cap 18 ZORVOLEX diclofenac cap 35 ANALGESICS - NARCOTIC acetaminophen w/ codeine soln /5ml acetaminophen w/ codeine tab (Tylenol/codeine) acetaminophen w/ codeine tab (Tylenol/codeine #3) acetaminophen w/ codeine tab (Tylenol/codeine #4) buprenorphine hcl sl tab 2 (base buprenorphine hcl sl tab 8 (base buprenorphine hcl-naloxone hcl sl tab (base buprenorphine hcl-naloxone hcl sl tab 8-2 (base butalbital-aspirin-caff w/ codeine cap (Fiorinal/codeine #3) codeine sulfate tab 15 (Codeine sulfate) codeine sulfate tab 30 codeine sulfate tab 60 fentanyl citrate lozenge on a handle 1200 mcg (Actiq) fentanyl citrate lozenge on a handle 1600 mcg (Actiq) fentanyl citrate lozenge on a handle 200 mcg (Actiq) fentanyl citrate lozenge on a handle 400 mcg (Actiq) fentanyl citrate lozenge on a handle 600 mcg (Actiq) fentanyl citrate lozenge on a handle 800 mcg (Actiq) fentanyl td patch 72hr 100 mcg/hr (Duragesic) fentanyl td patch 72hr 12 mcg/hr (Duragesic) fentanyl td patch 72hr 25 mcg/hr (Duragesic) fentanyl td patch 72hr 50 mcg/hr (Duragesic) fentanyl td patch 72hr 75 mcg/hr (Duragesic) hydrocodone-acetaminophen soln /15ml (Hycet) hydrocodone-acetaminophen tab (Norco) hydrocodone-acetaminophen tab (Norco) hydrocodone-acetaminophen tab (Norco) hydrocodone-ibuprofen tab (Ibudone) hydrocodone-ibuprofen tab (Reprexain) hydrocodone-ibuprofen tab (Vicoprofen) hydromorphone hcl liqd 1 /ml (Dilaudid) hydromorphone hcl tab 2 (Dilaudid) hydromorphone hcl tab 4 (Dilaudid) hydromorphone hcl tab 8 (Dilaudid) methadone hcl conc 10 /ml (Methadose) methadone hcl soln 10 /5ml (Methadone hcl) methadone hcl soln 5 /5ml (Methadone hcl) methadone hcl tab 10 (Dolophine) methadone hcl tab 5 (Dolophine hcl) methadone hcl tab for oral susp 40 morphine sulfate cap sr 24hr 10 (Kadian) morphine sulfate cap sr 24hr 100 (Kadian) morphine sulfate cap sr 24hr 20 (Kadian) morphine sulfate cap sr 24hr 30 (Kadian) morphine sulfate cap sr 24hr 50 (Kadian) morphine sulfate cap sr 24hr 60 (Kadian) morphine sulfate cap sr 24hr 80 (Kadian) morphine sulfate oral soln 10 /5ml morphine sulfate oral soln 100 /5ml (20 /ml) morphine sulfate oral soln 20 /5ml morphine sulfate tab cr 100 (Ms contin) morphine sulfate tab cr 15 (Ms contin) morphine sulfate tab cr 200 (Ms contin) morphine sulfate tab cr 30 (Ms contin) morphine sulfate tab cr 60 (Ms contin) oxycodone hcl cap 5 oxycodone hcl conc 100 /5ml (20 /ml) (Oxycodone hcl) oxycodone hcl soln 5 /5ml (Oxycodone hcl) oxycodone hcl tab 10 Page 1 of 23

2 oxycodone hcl tab 15 (Roxicodone) oxycodone hcl tab 20 oxycodone hcl tab 30 (Roxicodone) oxycodone hcl tab 5 (Roxicodone) oxycodone w/ acetaminophen tab (Percocet) oxycodone w/ acetaminophen tab (Percocet) oxycodone w/ acetaminophen tab (Percocet) oxycodone-aspirin tab (Percodan) tramadol hcl tab 50 (Ultram) tramadol hcl tab sr 24hr 100 (Ultram er) tramadol hcl tab sr 24hr 200 (Ultram er) tramadol hcl tab sr 24hr 300 (Ultram er) tramadol-acetaminophen tab (Ultracet) HYDROMORPHONE HCL hydromorphone hcl suppos 3 MORPHINE SULFATE morphine sulfate suppos 10 MORPHINE SULFATE morphine sulfate suppos 20 MORPHINE SULFATE morphine sulfate suppos 30 MORPHINE SULFATE morphine sulfate suppos 5 MORPHINE SULFATE morphine sulfate tab 15 MORPHINE SULFATE morphine sulfate tab 30 MORPHINE SULFATE ER morphine sulfate beads cap sr 24hr 120 MORPHINE SULFATE ER morphine sulfate beads cap sr 24hr 30 MORPHINE SULFATE ER morphine sulfate beads cap sr 24hr 45 MORPHINE SULFATE ER morphine sulfate beads cap sr 24hr 60 MORPHINE SULFATE ER morphine sulfate beads cap sr 24hr 75 MORPHINE SULFATE ER morphine sulfate beads cap sr 24hr 90 NUCYNTA ER tapentadol hcl tab sr 12hr 100 NUCYNTA ER tapentadol hcl tab sr 12hr 150 NUCYNTA ER tapentadol hcl tab sr 12hr 200 NUCYNTA ER tapentadol hcl tab sr 12hr 250 NUCYNTA ER tapentadol hcl tab sr 12hr 50 OXYCONTIN oxycodone hcl tab er 12hr deter 10 OXYCONTIN oxycodone hcl tab er 12hr deter 15 OXYCONTIN oxycodone hcl tab er 12hr deter 20 OXYCONTIN oxycodone hcl tab er 12hr deter 30 OXYCONTIN oxycodone hcl tab er 12hr deter 40 OXYCONTIN oxycodone hcl tab er 12hr deter 60 OXYCONTIN oxycodone hcl tab er 12hr deter 80 SUBOXONE buprenorphine hcl-naloxone hcl sl film 12-3 (base SUBOXONE buprenorphine hcl-naloxone hcl sl film (base SUBOXONE buprenorphine hcl-naloxone hcl sl film 4-1 (base SUBOXONE buprenorphine hcl-naloxone hcl sl film 8-2 (base ANALGESICS - NON-NARCOTIC butalbital-acetaminophen tab butalbital-acetaminophen-caffeine cap (Esgic) butalbital-acetaminophen-caffeine tab (Esgic) butalbital-aspirin-caffeine cap (Fiorinal) salsalate tab 500 salsalate tab 750 TENCON butalbital-acetaminophen tab GOUT AGENTS allopurinol tab 100 (Zyloprim) allopurinol tab 300 (Zyloprim) colchicine w/ probenecid tab probenecid tab 500 COLCRYS colchicine tab 0.6 MIGRAINE PRODUCTS isometheptene-dichloral-acetaminophen cap naratriptan hcl tab 1 (base (Amerge) naratriptan hcl tab 2.5 (base (Amerge) rizatriptan benzoate oral disintegrating tab 10 (base eq) (Maxalt-mlt) rizatriptan benzoate oral disintegrating tab 5 (base eq) (Maxalt-mlt) rizatriptan benzoate tab 10 (base (Maxalt) rizatriptan benzoate tab 5 (base (Maxalt) sumatriptan nasal spray 20 /act (Imitrex) sumatriptan nasal spray 5 /act (Imitrex) sumatriptan succinate inj 6 /0.5ml (Imitrex statdose ref) sumatriptan succinate solution auto-injector 4 /0.5ml (Imitrex statdose sys) sumatriptan succinate solution auto-injector 6 /0.5ml (Imitrex statdose sys) sumatriptan succinate solution cartridge 4 /0.5ml (Imitrex statdose ref) sumatriptan succinate solution cartridge 6 /0.5ml (Imitrex statdose ref) sumatriptan succinate tab 100 (Imitrex) sumatriptan succinate tab 25 (Imitrex) sumatriptan succinate tab 50 (Imitrex) MIGRANAL dihydroergotamine mesylate nasal spray 4 /ml RELPAX eletriptan hydrobromide tab 20 (base RELPAX eletriptan hydrobromide tab 40 (base SUMATRIPTAN SUCCINATE sumatriptan succinate solution prefilled syringe 6 /0.5ml ANTI-INFECTIVE AGENTS AMINOGLYCOSIDES neomycin sulfate tab 500 paromomycin sulfate cap 250 tobramycin nebu soln 300 /5ml (Tobi) ANTHELMINTICS ivermectin tab 3 (Stromectol) ALBENZA albendazole tab 200 BILTRICIDE praziquantel tab 600 ANTIFUNGALS fluconazole for susp 10 /ml (Diflucan) fluconazole for susp 40 /ml (Diflucan) fluconazole tab 100 (Diflucan) fluconazole tab 150 (Diflucan) fluconazole tab 200 (Diflucan) fluconazole tab 50 (Diflucan) flucytosine cap 250 (Ancobon) flucytosine cap 500 (Ancobon) griseofulvin microsize susp 125 /5ml griseofulvin microsize tab 500 (Grifulvin v) itraconazole cap 100 (Sporanox) nystatin tab unit terbinafine hcl tab 250 (Lamisil) voriconazole for susp 40 /ml (Vfend) voriconazole tab 200 (Vfend) voriconazole tab 50 (Vfend) NOXAFIL posaconazole susp 40 /ml NOXAFIL posaconazole tab delayed release 100 SPORANOX itraconazole oral soln 10 /ml ANTI-INFECTIVE AGENTS - MISC. clindamycin hcl cap 150 (Cleocin) clindamycin hcl cap 300 (Cleocin) Page 2 of 23

3 clindamycin hcl cap 75 (Cleocin) clindamycin palmitate hcl for soln 75 /5ml (base (Cleocin pediatric gr) dapsone tab 100 dapsone tab 25 linezolid for susp 100 /5ml (Zyvox) linezolid tab 600 (Zyvox) metronidazole tab 250 (Flagyl) metronidazole tab 500 (Flagyl) sulfamethoxazole-trimethoprim susp /5ml sulfamethoxazole-trimethoprim tab (Bactrim) sulfamethoxazole-trimethoprim tab (Bactrim ds) trimethoprim tab 100 vancomycin hcl cap 125 (Vancocin hcl) vancomycin hcl cap 250 (Vancocin hcl) IMPAVIDO miltefosine cap 50 NEBUPENT pentamidine isethionate for nebulization soln 300 SIVEXTRO tedizolid phosphate tab 200 XIFAXAN rifaximin tab 550 ANTIMALARIALS atovaquone-proguanil hcl tab (Malarone) atovaquone-proguanil hcl tab (Malarone) chloroquine phosphate tab 250 chloroquine phosphate tab 500 (Aralen) hydroxychloroquine sulfate tab 200 (Plaquenil) mefloquine hcl tab 250 COARTEM artemether-lumefantrine tab DARAPRIM pyrimethamine tab 25 PRIMAQUINE PHOSPHATE primaquine phosphate tab 26.3 (15 base) ANTIMYCOBACTERIAL AGENTS ethambutol hcl tab 100 (Myambutol) ethambutol hcl tab 400 (Myambutol) isoniazid tab 100 isoniazid tab 300 pyrazinamide tab 500 rifabutin cap 150 (Mycobutin) rifampin cap 150 (Rifadin) rifampin cap 300 (Rifadin) ISONIAZID isoniazid syrup 50 /5ml PRIFTIN rifapentine tab 150 ANTIVIRALS abacavir sulfate tab 300 (base (Ziagen) abacavir sulfate-lamivudine tab (Epzicom) abacavir sulfate-lamivudine-zidovudine tab (Trizivir) acyclovir cap 200 (Zovirax) acyclovir susp 200 /5ml (Zovirax) acyclovir tab 400 (Zovirax) acyclovir tab 800 (Zovirax) adefovir dipivoxil tab 10 (Hepsera) didanosine delayed release capsule 125 (Videx ec) didanosine delayed release capsule 200 (Videx ec) didanosine delayed release capsule 250 (Videx ec) didanosine delayed release capsule 400 (Videx ec) entecavir tab 0.5 (Baraclude) entecavir tab 1 (Baraclude) famciclovir tab 125 (Famvir) famciclovir tab 250 (Famvir) famciclovir tab 500 (Famvir) lamivudine oral soln 10 /ml (Epivir) lamivudine tab 100 (hbv) (Epivir hbv) lamivudine tab 150 (Epivir) lamivudine tab 300 (Epivir) lamivudine-zidovudine tab (Combivir) nevirapine tab 200 (Viramune) nevirapine tab sr 24hr 100 (Viramune xr) nevirapine tab sr 24hr 400 (Viramune xr) ribavirin cap 200 (Rebetol) ribavirin tab 200 (Copegus) stavudine cap 15 (Zerit) stavudine cap 20 (Zerit) stavudine cap 30 (Zerit) stavudine cap 40 (Zerit) stavudine for oral soln 1 /ml (Zerit) valacyclovir hcl tab 1 gm (Valtrex) valacyclovir hcl tab 500 (Valtrex) valganciclovir hcl for soln 50 /ml (base (Valcyte) valganciclovir hcl tab 450 (base (Valcyte) zidovudine cap 100 (Retrovir) zidovudine syrup 10 /ml (Retrovir) zidovudine tab 300 ATRIPLA efavirenz-emtricitabine-tenofovir df tab BARACLUDE entecavir oral soln 0.05 /ml COMPLERA emtricitabine-rilpivirine-tenofovir df tab DESCOVY emtricitabine-tenofovir alafenamide fumarate tab EPCLUSA sofosbuvir-velpatasvir tab EPIVIR HBV lamivudine oral soln 5 /ml (hbv) EPZICOM abacavir sulfate-lamivudine tab EVOTAZ atazanavir sulfate-cobicistat tab (base GENVOYA elvitegrav-cobic-emtricitab-tenofov af tab HARVONI ledipasvir-sofosbuvir tab INTELENCE etravirine tab 100 INTELENCE etravirine tab 200 INTELENCE etravirine tab 25 ISENTRESS raltegravir potassium chew tab 100 (base ISENTRESS raltegravir potassium chew tab 25 (base ISENTRESS raltegravir potassium packet for susp 100 (base ISENTRESS raltegravir potassium tab 400 (base KALETRA lopinavir-ritonavir soln /5ml (80-20 /ml) KALETRA lopinavir-ritonavir tab KALETRA lopinavir-ritonavir tab NORVIR ritonavir oral soln 80 /ml NORVIR ritonavir tab 100 ODEFSEY emtricitabine-rilpivirine-tenofovir af tab PEGASYS peginterferon alfa-2a inj 180 mcg/0.5ml PEGASYS peginterferon alfa-2a inj 180 mcg/ml PEGASYS PROCLICK peginterferon alfa-2a inj 135 mcg/0.5ml PEGASYS PROCLICK peginterferon alfa-2a inj 180 mcg/0.5ml PREZCOBIX darunavir-cobicistat tab PREZISTA darunavir ethanolate susp 100 /ml (base PREZISTA darunavir ethanolate tab 150 (base PREZISTA darunavir ethanolate tab 600 (base PREZISTA darunavir ethanolate tab 75 (base PREZISTA darunavir ethanolate tab 800 (base REYATAZ atazanavir sulfate cap 150 (base REYATAZ atazanavir sulfate cap 200 (base REYATAZ atazanavir sulfate cap 300 (base SOVALDI sofosbuvir tab 400 STRIBILD elvitegrav-cobic-emtricitab-tenofovdf tab SUSTIVA efavirenz cap 200 SUSTIVA efavirenz cap 50 SUSTIVA efavirenz tab 600 Page 3 of 23

4 TAMIFLU oseltamivir phosphate cap 30 (base TAMIFLU oseltamivir phosphate cap 45 (base TAMIFLU oseltamivir phosphate cap 75 (base TAMIFLU oseltamivir phosphate for susp 6 /ml (base TIVICAY dolutegravir sodium tab 10 (base TIVICAY dolutegravir sodium tab 25 (base TIVICAY dolutegravir sodium tab 50 (base TRIUMEQ abacavir-dolutegravir-lamivudine tab TRUVADA emtricitabine-tenofovir disoproxil fumarate tab TRUVADA emtricitabine-tenofovir disoproxil fumarate tab TRUVADA emtricitabine-tenofovir disoproxil fumarate tab TRUVADA emtricitabine-tenofovir disoproxil fumarate tab VIDEX didanosine for soln 2 gm VIDEX didanosine for soln 4 gm VIRAMUNE nevirapine susp 50 /5ml VIREAD tenofovir disoproxil fumarate oral powder 40 /gm VIREAD tenofovir disoproxil fumarate tab 150 VIREAD tenofovir disoproxil fumarate tab 200 VIREAD tenofovir disoproxil fumarate tab 250 VIREAD tenofovir disoproxil fumarate tab 300 ZIAGEN abacavir sulfate soln 20 /ml (base CEPHALOSPORINS cefaclor cap 250 cefaclor cap 500 cefadroxil cap 500 cefadroxil for susp 250 /5ml cefadroxil for susp 500 /5ml cefadroxil tab 1 gm cefdinir cap 300 cefdinir for susp 125 /5ml cefdinir for susp 250 /5ml cefixime for susp 100 /5ml (Suprax) cefixime for susp 200 /5ml (Suprax) cefpodoxime proxetil for susp 100 /5ml cefpodoxime proxetil for susp 50 /5ml cefpodoxime proxetil tab 100 cefpodoxime proxetil tab 200 cefprozil for susp 125 /5ml cefprozil for susp 250 /5ml cefprozil tab 250 cefprozil tab 500 ceftriaxone sodium for inj 1 gm (Rocephin) ceftriaxone sodium for inj 2 gm ceftriaxone sodium for inj 250 ceftriaxone sodium for inj 500 (Rocephin) cefuroxime axetil tab 250 (Ceftin) cefuroxime axetil tab 500 (Ceftin) cephalexin cap 250 (Keflex) cephalexin cap 500 (Keflex) cephalexin for susp 125 /5ml cephalexin for susp 250 /5ml CEFTIN cefuroxime axetil for susp 125 /5ml SUPRAX cefixime cap 400 SUPRAX cefixime chew tab 100 SUPRAX cefixime chew tab 200 SUPRAX cefixime for susp 500 /5ml FLUOROQUINOLONES ciprofloxacin for oral susp 250 /5ml (5%) (5 gm/100ml) (Cipro) ciprofloxacin for oral susp 500 /5ml (10%) (10 gm/100ml) (Cipro) ciprofloxacin hcl tab 250 (base (Cipro) ciprofloxacin hcl tab 500 (base (Cipro) ciprofloxacin hcl tab 750 (base ciprofloxacin-ciprofloxacin hcl tab sr 24hr 1000 (base eq) (Cipro xr) ciprofloxacin-ciprofloxacin hcl tab sr 24hr 500 (base eq) (Cipro xr) levofloxacin oral soln 25 /ml (Levaquin) levofloxacin tab 250 (Levaquin) levofloxacin tab 500 (Levaquin) levofloxacin tab 750 (Levaquin) moxifloxacin hcl tab 400 (base (Avelox) CIPROFLOXACIN HCL ciprofloxacin hcl tab 100 (base OFLOXACIN ofloxacin tab 400 MACROLIDES azithromycin for susp 100 /5ml (Zithromax) azithromycin for susp 200 /5ml (Zithromax) azithromycin tab 250 (Zithromax) azithromycin tab 500 (Zithromax) azithromycin tab 600 (Zithromax) clarithromycin for susp 125 /5ml clarithromycin for susp 250 /5ml (Biaxin) clarithromycin tab 250 (Biaxin) clarithromycin tab 500 (Biaxin) clarithromycin tab sr 24hr 500 (Biaxin xl pac) erythromycin w/ delayed release particles cap 250 AZITHROMYCIN azithromycin powd pack for susp 1 gm DIFICID fidaxomicin tab 200 E.E.S. 400 erythromycin ethylsuccinate tab 400 ERY-TAB erythromycin tab delayed release 250 ERY-TAB erythromycin tab delayed release 333 ERY-TAB erythromycin tab delayed release 500 ERYTHROCIN STEARATE erythromycin stearate tab 250 ERYTHROMYCIN BASE erythromycin tab 250 ERYTHROMYCIN BASE erythromycin tab 500 ERYTHROMYCIN ETHYLSUCCINA erythromycin ethylsuccinate tab 400 PENICILLINS amoxicillin & k clavulanate for susp /5ml amoxicillin & k clavulanate for susp /5ml (Augmentin) amoxicillin & k clavulanate for susp /5ml amoxicillin & k clavulanate for susp /5ml (Augmentin es-600) amoxicillin & k clavulanate tab amoxicillin & k clavulanate tab (Augmentin) amoxicillin & k clavulanate tab (Augmentin) amoxicillin & k clavulanate tab sr 12hr (Augmentin xr) amoxicillin (trihydrate) cap 250 amoxicillin (trihydrate) cap 500 amoxicillin (trihydrate) for susp 125 /5ml amoxicillin (trihydrate) for susp 200 /5ml amoxicillin (trihydrate) for susp 250 /5ml amoxicillin (trihydrate) for susp 400 /5ml amoxicillin (trihydrate) tab 500 amoxicillin (trihydrate) tab 875 ampicillin cap 250 ampicillin cap 500 dicloxacillin sodium cap 250 dicloxacillin sodium cap 500 penicillin v potassium for soln 125 /5ml penicillin v potassium for soln 250 /5ml penicillin v potassium tab 250 penicillin v potassium tab 500 AMOXICILLIN amoxicillin (trihydrate) chew tab 125 AMOXICILLIN amoxicillin (trihydrate) chew tab 250 Page 4 of 23

5 AMOXICILLIN/CLAVULANATE P amoxicillin & k clavulanate chew tab AMOXICILLIN/CLAVULANATE P amoxicillin & k clavulanate chew tab AMPICILLIN ampicillin for susp 125 /5ml AMPICILLIN ampicillin for susp 250 /5ml AUGMENTIN amoxicillin & k clavulanate for susp /5ml TETRACYCLINES demeclocycline hcl tab 150 demeclocycline hcl tab 300 doxycycline hyclate cap 100 (Vibramycin) doxycycline hyclate cap 50 doxycycline hyclate tab 100 doxycycline hyclate tab 20 doxycycline monohydrate cap 100 (Monodox) doxycycline monohydrate cap 150 (Adoxa) doxycycline monohydrate cap 50 doxycycline monohydrate cap 75 (Monodox) doxycycline monohydrate tab 100 (Adoxa pak 1/100) doxycycline monohydrate tab 150 (Adoxa pak 1/150) doxycycline monohydrate tab 50 (Adoxa) doxycycline monohydrate tab 75 (Adoxa) minocycline hcl cap 100 (Minocin) minocycline hcl cap 50 (Minocin) minocycline hcl cap 75 (Minocin) minocycline hcl tab 100 minocycline hcl tab 50 minocycline hcl tab 75 tetracycline hcl cap 250 (Tetracycline hcl) tetracycline hcl cap 500 (Tetracycline hcl) ANTINEOPLASTIC AGENTS ANTINEOPLASTICS anastrozole tab 1 (Arimidex) bexarotene cap 75 (Targretin) bicalutamide tab 50 (Casodex) capecitabine tab 150 (Xeloda) capecitabine tab 500 (Xeloda) exemestane tab 25 (Aromasin) flutamide cap 125 hydroxyurea cap 500 (Hydrea) imatinib mesylate tab 100 (base (Gleevec) imatinib mesylate tab 400 (base (Gleevec) letrozole tab 2.5 (Femara) leucovorin calcium tab 25 leucovorin calcium tab 5 megestrol acetate susp 40 /ml (Megace oral) megestrol acetate tab 20 megestrol acetate tab 40 mercaptopurine tab 50 (Purinethol) methotrexate sodium tab 2.5 (base nilutamide tab 150 (Nilandron) tamoxifen citrate tab 10 (base tamoxifen citrate tab 20 (base temozolomide cap 100 (Temodar) temozolomide cap 140 (Temodar) temozolomide cap 180 (Temodar) temozolomide cap 20 (Temodar) temozolomide cap 250 (Temodar) temozolomide cap 5 (Temodar) tretinoin cap 10 ACTIMMUNE interferon gamma-1b inj 100 mcg/0.5ml ( unit/0.5ml) AFINITOR everolimus tab 10 AFINITOR everolimus tab 2.5 AFINITOR everolimus tab 5 AFINITOR everolimus tab 7.5 AFINITOR DISPERZ everolimus tab for oral susp 2 AFINITOR DISPERZ everolimus tab for oral susp 3 AFINITOR DISPERZ everolimus tab for oral susp 5 ALECENSA alectinib hcl cap 150 (base ALKERAN melphalan tab 2 BOSULIF bosutinib tab 100 BOSULIF bosutinib tab 500 CAPRELSA vandetanib tab 100 CAPRELSA vandetanib tab 300 COMETRIQ cabozantinib s-mal cap 1 x 80 & 1 x 20 (100 dose) kit COMETRIQ cabozantinib s-mal cap 1 x 80 & 3 x 20 (140 dose) kit COMETRIQ cabozantinib s-malate cap 3 x 20 (60 dose) kit COTELLIC cobimetinib fumarate tab 20 (base CYCLOPHOSPHAMIDE cyclophosphamide cap 25 CYCLOPHOSPHAMIDE cyclophosphamide cap 50 EMCYT estramustine phosphate sodium cap 140 ERIVEDGE vismodegib cap 150 ETOPOSIDE etoposide cap 50 FARESTON toremifene citrate tab 60 (base FARYDAK panobinostat lactate cap 10 (base FARYDAK panobinostat lactate cap 15 (base FARYDAK panobinostat lactate cap 20 (base GILOTRIF afatinib dimaleate tab 20 (base GILOTRIF afatinib dimaleate tab 30 (base GILOTRIF afatinib dimaleate tab 40 (base GLEOSTINE lomustine cap 10 GLEOSTINE lomustine cap 100 GLEOSTINE lomustine cap 40 GLEOSTINE lomustine cap 5 HEXALEN altretamine cap 50 HYCAMTIN topotecan hcl cap 0.25 (base HYCAMTIN topotecan hcl cap 1 (base IBRANCE palbociclib cap 100 IBRANCE palbociclib cap 125 IBRANCE palbociclib cap 75 ICLUSIG ponatinib hcl tab 15 (base ICLUSIG ponatinib hcl tab 45 (base IMBRUVICA ibrutinib cap 140 INLYTA axitinib tab 1 INLYTA axitinib tab 5 IRESSA gefitinib tab 250 JAKAFI ruxolitinib phosphate tab 10 (base JAKAFI ruxolitinib phosphate tab 15 (base JAKAFI ruxolitinib phosphate tab 20 (base JAKAFI ruxolitinib phosphate tab 25 (base JAKAFI ruxolitinib phosphate tab 5 (base LENVIMA 10 MG DAILY DOSE lenvatinib cap therapy pack 10 (10 daily dose) LENVIMA 14 MG DAILY DOSE lenvatinib cap therapy pack 10 & 4 (14 daily dose) LENVIMA 18 MG DAILY DOSE lenvatinib cap therapy pack 10 & 4 (2) (18 daily dose) LENVIMA 20 MG DAILY DOSE lenvatinib cap therapy pack 10 (2) (20 daily dose) LENVIMA 24 MG DAILY DOSE lenvatinib cap therapy pack 10 (2) & 4 (24 daily dose) LENVIMA 8 MG DAILY DOSE lenvatinib cap therapy pack 4 (2) (8 daily dose) LEUCOVORIN CALCIUM leucovorin calcium tab 10 LEUCOVORIN CALCIUM leucovorin calcium tab 15 LEUKERAN chlorambucil tab 2 LONSURF trifluridine-tipiracil tab LONSURF trifluridine-tipiracil tab Page 5 of 23

6 LYNPARZA olaparib cap 50 LYSODREN mitotane tab 500 MATULANE procarbazine hcl cap 50 MEKINIST trametinib dimethyl sulfoxide tab 0.5 (base MEKINIST trametinib dimethyl sulfoxide tab 2 (base MESNEX mesna tab 400 MYLERAN busulfan tab 2 NEXAVAR sorafenib tosylate tab 200 (base NINLARO ixazomib citrate cap 2.3 (base NINLARO ixazomib citrate cap 3 (base NINLARO ixazomib citrate cap 4 (base ODOMZO sonidegib phosphate cap 200 (base POMALYST pomalidomide cap 1 POMALYST pomalidomide cap 2 POMALYST pomalidomide cap 3 POMALYST pomalidomide cap 4 PURIXAN mercaptopurine susp 2000 /100ml (20 /ml) SOLTAMOX tamoxifen citrate oral soln 10 /5ml (base SPRYCEL dasatinib tab 100 SPRYCEL dasatinib tab 140 SPRYCEL dasatinib tab 20 SPRYCEL dasatinib tab 50 SPRYCEL dasatinib tab 70 SPRYCEL dasatinib tab 80 STIVARGA regorafenib tab 40 SUTENT sunitinib malate cap 12.5 (base SUTENT sunitinib malate cap 25 (base SUTENT sunitinib malate cap 37.5 (base SUTENT sunitinib malate cap 50 (base SYLATRON peginterferon alfa-2b for inj kit 200 mcg SYLATRON peginterferon alfa-2b for inj kit 300 mcg SYLATRON peginterferon alfa-2b for inj kit 600 mcg TABLOID thioguanine tab 40 TAFINLAR dabrafenib mesylate cap 50 (base TAFINLAR dabrafenib mesylate cap 75 (base TAGRISSO osimertinib mesylate tab 40 (base TAGRISSO osimertinib mesylate tab 80 (base TARCEVA erlotinib hcl tab 100 (base TARCEVA erlotinib hcl tab 150 (base TARCEVA erlotinib hcl tab 25 (base TASIGNA nilotinib hcl cap 150 (base TASIGNA nilotinib hcl cap 200 (base TYKERB lapatinib ditosylate tab 250 (base VOTRIENT pazopanib hcl tab 200 (base XALKORI crizotinib cap 200 XALKORI crizotinib cap 250 XTANDI enzalutamide cap 40 ZELBORAF vemurafenib tab 240 ZOLINZA vorinostat cap 100 ZYDELIG idelalisib tab 100 ZYDELIG idelalisib tab 150 ZYKADIA ceritinib cap 150 ZYTIGA abiraterone acetate tab 250 BIOLOGICALS PASSIVE IMMUNIZING AGENTS SYNAGIS palivizumab im soln 100 /ml SYNAGIS palivizumab im soln 50 /0.5ml CARDIOVASCULAR AGENTS ANTIANGINAL AGENTS isosorbide dinitrate tab 10 isosorbide dinitrate tab 20 isosorbide dinitrate tab 30 isosorbide dinitrate tab 5 (Isordil titradose) isosorbide mononitrate tab 10 isosorbide mononitrate tab 20 isosorbide mononitrate tab sr 24hr 120 (Imdur) isosorbide mononitrate tab sr 24hr 30 (Imdur) isosorbide mononitrate tab sr 24hr 60 (Imdur) nitroglycerin sl tab 0.3 (Nitrostat) nitroglycerin sl tab 0.4 (Nitrostat) nitroglycerin sl tab 0.6 (Nitrostat) nitroglycerin td patch 24hr 0.1 /hr (Nitro-dur) nitroglycerin td patch 24hr 0.2 /hr (Nitro-dur) nitroglycerin td patch 24hr 0.4 /hr (Nitro-dur) nitroglycerin td patch 24hr 0.6 /hr (Nitro-dur) NITRO-BID nitroglycerin oint 2% RANEXA ranolazine tab sr 12hr 1000 RANEXA ranolazine tab sr 12hr 500 ANTIARRHYTHMICS amiodarone hcl tab 100 amiodarone hcl tab 200 (Cordarone) amiodarone hcl tab 400 disopyramide phosphate cap 100 (Norpace) disopyramide phosphate cap 150 (Norpace) flecainide acetate tab 100 flecainide acetate tab 150 flecainide acetate tab 50 mexiletine hcl cap 150 mexiletine hcl cap 200 mexiletine hcl cap 250 propafenone hcl cap sr 12hr 225 (Rythmol sr) propafenone hcl cap sr 12hr 325 (Rythmol sr) propafenone hcl cap sr 12hr 425 (Rythmol sr) propafenone hcl tab 150 (Rythmol) propafenone hcl tab 225 (Rythmol) propafenone hcl tab 300 quinidine gluconate tab cr 324 MULTAQ dronedarone hcl tab 400 (base NORPACE CR disopyramide phosphate cap sr 12hr 100 QUINIDINE SULFATE quinidine sulfate tab 200 QUINIDINE SULFATE quinidine sulfate tab 300 ANTIHYPERLIPIDEMICS atorvastatin calcium tab 10 (base (Lipitor) atorvastatin calcium tab 20 (base (Lipitor) atorvastatin calcium tab 40 (base (Lipitor) atorvastatin calcium tab 80 (base (Lipitor) cholestyramine light powder 4 gm/dose (Questran light) cholestyramine light powder packets 4 gm cholestyramine powder 4 gm/dose (Questran) cholestyramine powder packets 4 gm (Questran) choline fenofibrate cap dr 135 (fenofibric acid (Trilipix) choline fenofibrate cap dr 45 (fenofibric acid (Trilipix) colestipol hcl granule packets 5 gm (Colestid flavored) colestipol hcl granules 5 gm (Colestid flavored) colestipol hcl tab 1 gm (Colestid) fenofibrate micronized cap 134 (Lofibra) fenofibrate micronized cap 200 (Lofibra) fenofibrate micronized cap 67 (Lofibra) fenofibrate tab 145 (Tricor) Page 6 of 23

7 fenofibrate tab 160 (Lofibra) fenofibrate tab 48 (Tricor) fenofibrate tab 54 (Lofibra) gemfibrozil tab 600 (Lopid) lovastatin tab 10 lovastatin tab 20 (Mevacor) lovastatin tab 40 (Mevacor) niacin tab cr 1000 (antihyperlipidemic) (Niaspan) niacin tab cr 500 (antihyperlipidemic) (Niaspan) niacin tab cr 750 (antihyperlipidemic) (Niaspan) omega-3-acid ethyl esters cap 1 gm (Lovaza) pravastatin sodium tab 10 pravastatin sodium tab 20 (Pravachol) pravastatin sodium tab 40 (Pravachol) pravastatin sodium tab 80 (Pravachol) rosuvastatin calcium tab 10 (Crestor) rosuvastatin calcium tab 20 (Crestor) rosuvastatin calcium tab 40 (Crestor) rosuvastatin calcium tab 5 (Crestor) simvastatin tab 10 (Zocor) simvastatin tab 20 (Zocor) simvastatin tab 40 (Zocor) simvastatin tab 5 (Zocor) simvastatin tab 80 (Zocor) PRALUENT alirocumab subcutaneous soln peninjector 150 /ml PRALUENT alirocumab subcutaneous soln peninjector 75 /ml PRALUENT alirocumab subcutaneous soln prefilled syringe 150 /ml PRALUENT alirocumab subcutaneous soln prefilled syringe 75 /ml REPATHA evolocumab subcutaneous soln prefilled syringe 140 /ml REPATHA PUSHTRONEX SYSTEM evolocumab subcutaneous soln cartridge/infusor 420 /3.5ml REPATHA SURECLICK evolocumab subcutaneous soln auto-injector 140 /ml VASCEPA icosapent ethyl cap 0.5 gm VASCEPA icosapent ethyl cap 1 gm WELCHOL colesevelam hcl packet for susp 3.75 gm WELCHOL colesevelam hcl tab 625 ZETIA ezetimibe tab 10 ANTIHYPERTENSIVES amlodipine besylate-benazepril hcl cap (Lotrel) amlodipine besylate-benazepril hcl cap (Lotrel) amlodipine besylate-benazepril hcl cap (Lotrel) amlodipine besylate-benazepril hcl cap 5-10 (Lotrel) amlodipine besylate-benazepril hcl cap 5-20 (Lotrel) amlodipine besylate-benazepril hcl cap 5-40 (Lotrel) amlodipine besylate-valsartan tab (Exforge) amlodipine besylate-valsartan tab (Exforge) amlodipine besylate-valsartan tab (Exforge) amlodipine besylate-valsartan tab (Exforge) amlodipine-valsartan-hydrochlorothiazide tab (Exforge hct) amlodipine-valsartan-hydrochlorothiazide tab (Exforge hct) amlodipine-valsartan-hydrochlorothiazide tab (Exforge hct) amlodipine-valsartan-hydrochlorothiazide tab (Exforge hct) amlodipine-valsartan-hydrochlorothiazide tab (Exforge hct) atenolol & chlorthalidone tab (Tenoretic 100) atenolol & chlorthalidone tab (Tenoretic 50) benazepril & hydrochlorothiazide tab (Lotensin hct) benazepril & hydrochlorothiazide tab (Lotensin hct) benazepril & hydrochlorothiazide tab (Lotensin hct) benazepril & hydrochlorothiazide tab benazepril hcl tab 10 (Lotensin) benazepril hcl tab 20 (Lotensin) benazepril hcl tab 40 (Lotensin) benazepril hcl tab 5 bisoprolol & hydrochlorothiazide tab (Ziac) bisoprolol & hydrochlorothiazide tab (Ziac) bisoprolol & hydrochlorothiazide tab (Ziac) candesartan cilexetil tab 16 (Atacand) candesartan cilexetil tab 32 (Atacand) candesartan cilexetil tab 4 (Atacand) candesartan cilexetil tab 8 (Atacand) candesartan cilexetil-hydrochlorothiazide tab (Atacand hct) candesartan cilexetil-hydrochlorothiazide tab (Atacand hct) candesartan cilexetil-hydrochlorothiazide tab (Atacand hct) captopril tab 100 captopril tab 12.5 captopril tab 25 captopril tab 50 clonidine hcl tab 0.1 (Catapres) clonidine hcl tab 0.2 (Catapres) clonidine hcl tab 0.3 (Catapres) clonidine hcl td patch weekly 0.1 /24hr (Catapres-tts-1) clonidine hcl td patch weekly 0.2 /24hr (Catapres-tts-2) clonidine hcl td patch weekly 0.3 /24hr (Catapres-tts-3) doxazosin mesylate tab 1 (Cardura) doxazosin mesylate tab 2 (Cardura) doxazosin mesylate tab 4 (Cardura) doxazosin mesylate tab 8 (Cardura) enalapril maleate & hydrochlorothiazide tab (Vaseretic) enalapril maleate & hydrochlorothiazide tab enalapril maleate tab 10 (Vasotec) enalapril maleate tab 2.5 (Vasotec) enalapril maleate tab 20 (Vasotec) enalapril maleate tab 5 (Vasotec) eplerenone tab 25 (Inspra) eplerenone tab 50 (Inspra) fosinopril sodium & hydrochlorothiazide tab fosinopril sodium & hydrochlorothiazide tab fosinopril sodium tab 10 fosinopril sodium tab 20 fosinopril sodium tab 40 guanfacine hcl tab 1 (Tenex) guanfacine hcl tab 2 (Tenex) hydralazine hcl tab 10 hydralazine hcl tab 100 hydralazine hcl tab 25 hydralazine hcl tab 50 irbesartan tab 150 (Avapro) irbesartan tab 300 (Avapro) irbesartan tab 75 (Avapro) irbesartan-hydrochlorothiazide tab (Avalide) irbesartan-hydrochlorothiazide tab (Avalide) lisinopril & hydrochlorothiazide tab (Zestoretic) lisinopril & hydrochlorothiazide tab (Zestoretic) lisinopril & hydrochlorothiazide tab (Zestoretic) lisinopril tab 10 (Prinivil) lisinopril tab 2.5 (Zestril) lisinopril tab 20 (Prinivil) lisinopril tab 30 (Zestril) Page 7 of 23

8 lisinopril tab 40 (Zestril) lisinopril tab 5 (Prinivil) losartan potassium & hydrochlorothiazide tab (Hyzaar) losartan potassium & hydrochlorothiazide tab (Hyzaar) losartan potassium & hydrochlorothiazide tab (Hyzaar) losartan potassium tab 100 (Cozaar) losartan potassium tab 25 (Cozaar) losartan potassium tab 50 (Cozaar) methyldopa tab 250 methyldopa tab 500 metoprolol & hydrochlorothiazide tab (Lopressor hct) metoprolol & hydrochlorothiazide tab metoprolol & hydrochlorothiazide tab (Lopressor hct) minoxidil tab 10 minoxidil tab 2.5 moexipril hcl tab 15 (Univasc) moexipril hcl tab 7.5 (Univasc) moexipril-hydrochlorothiazide tab (Uniretic) moexipril-hydrochlorothiazide tab moexipril-hydrochlorothiazide tab (Uniretic) perindopril erbumine tab 2 perindopril erbumine tab 4 (Aceon) perindopril erbumine tab 8 (Aceon) phenoxybenzamine hcl cap 10 (Dibenzyline) prazosin hcl cap 1 (Minipress) prazosin hcl cap 2 (Minipress) prazosin hcl cap 5 (Minipress) quinapril hcl tab 10 (Accupril) quinapril hcl tab 20 (Accupril) quinapril hcl tab 40 (Accupril) quinapril hcl tab 5 (Accupril) quinapril-hydrochlorothiazide tab (Accuretic) quinapril-hydrochlorothiazide tab (Accuretic) quinapril-hydrochlorothiazide tab (Accuretic) ramipril cap 1.25 (Altace) ramipril cap 10 (Altace) ramipril cap 2.5 (Altace) ramipril cap 5 (Altace) telmisartan tab 20 (Micardis) telmisartan tab 40 (Micardis) telmisartan tab 80 (Micardis) telmisartan-hydrochlorothiazide tab (Micardis hct) telmisartan-hydrochlorothiazide tab (Micardis hct) telmisartan-hydrochlorothiazide tab (Micardis hct) terazosin hcl cap 1 terazosin hcl cap 10 terazosin hcl cap 2 terazosin hcl cap 5 trandolapril tab 1 (Mavik) trandolapril tab 2 (Mavik) trandolapril tab 4 (Mavik) valsartan tab 160 (Diovan) valsartan tab 320 (Diovan) valsartan tab 40 (Diovan) valsartan tab 80 (Diovan) valsartan-hydrochlorothiazide tab (Diovan hct) valsartan-hydrochlorothiazide tab (Diovan hct) valsartan-hydrochlorothiazide tab (Diovan hct) valsartan-hydrochlorothiazide tab (Diovan hct) valsartan-hydrochlorothiazide tab (Diovan hct) AZOR amlodipine besylate-olmesartan medoxomil tab AZOR amlodipine besylate-olmesartan medoxomil tab AZOR amlodipine besylate-olmesartan medoxomil tab 5-20 AZOR amlodipine besylate-olmesartan medoxomil tab 5-40 BENICAR olmesartan medoxomil tab 20 BENICAR olmesartan medoxomil tab 40 BENICAR olmesartan medoxomil tab 5 BENICAR HCT olmesartan medoxomilhydrochlorothiazide tab BENICAR HCT olmesartan medoxomilhydrochlorothiazide tab BENICAR HCT olmesartan medoxomilhydrochlorothiazide tab CAPTOPRIL/HYDROCHLOROTHIA captopril & hydrochlorothiazide tab CAPTOPRIL/HYDROCHLOROTHIA captopril & hydrochlorothiazide tab CAPTOPRIL/HYDROCHLOROTHIA captopril & hydrochlorothiazide tab CAPTOPRIL/HYDROCHLOROTHIA captopril & hydrochlorothiazide tab PROPRANOLOL/HYDROCHLOROTH propranolol & hydrochlorothiazide tab PROPRANOLOL/HYDROCHLOROTH propranolol & hydrochlorothiazide tab BETA BLOCKERS acebutolol hcl cap 200 (Sectral) acebutolol hcl cap 400 (Sectral) atenolol tab 100 (Tenormin) atenolol tab 25 (Tenormin) atenolol tab 50 (Tenormin) bisoprolol fumarate tab 10 (Zebeta) bisoprolol fumarate tab 5 (Zebeta) carvedilol tab 12.5 (Coreg) carvedilol tab 25 (Coreg) carvedilol tab (Coreg) carvedilol tab 6.25 (Coreg) labetalol hcl tab 100 (Trandate) labetalol hcl tab 200 (Trandate) labetalol hcl tab 300 (Trandate) metoprolol succinate tab sr 24hr 100 (tartrate (Toprol xl) metoprolol succinate tab sr 24hr 200 (tartrate (Toprol xl) metoprolol succinate tab sr 24hr 25 (tartrate (Toprol xl) metoprolol succinate tab sr 24hr 50 (tartrate (Toprol xl) metoprolol tartrate tab 100 (Lopressor) metoprolol tartrate tab 25 metoprolol tartrate tab 50 (Lopressor) nadolol tab 20 (Corgard) nadolol tab 40 (Corgard) nadolol tab 80 (Corgard) pindolol tab 10 pindolol tab 5 propranolol hcl cap sr 24hr 120 (Inderal la) propranolol hcl cap sr 24hr 160 (Inderal la) propranolol hcl cap sr 24hr 60 (Inderal la) propranolol hcl cap sr 24hr 80 (Inderal la) propranolol hcl tab 10 propranolol hcl tab 20 propranolol hcl tab 40 propranolol hcl tab 60 propranolol hcl tab 80 sotalol hcl (afib/afl) tab 120 (Betapace af) sotalol hcl (afib/afl) tab 160 (Betapace af) sotalol hcl (afib/afl) tab 80 (Betapace af) sotalol hcl tab 120 (Betapace) sotalol hcl tab 160 (Betapace) sotalol hcl tab 240 sotalol hcl tab 80 (Betapace) BYSTOLIC nebivolol hcl tab 10 (base BYSTOLIC nebivolol hcl tab 2.5 (base BYSTOLIC nebivolol hcl tab 20 (base BYSTOLIC nebivolol hcl tab 5 (base PROPRANOLOL HCL propranolol hcl oral soln 20 /5ml Page 8 of 23

9 PROPRANOLOL HCL propranolol hcl oral soln 40 /5ml TIMOLOL MALEATE timolol maleate tab 10 TIMOLOL MALEATE timolol maleate tab 20 TIMOLOL MALEATE timolol maleate tab 5 CALCIUM CHANNEL BLOCKERS amlodipine besylate tab 10 (Norvasc) amlodipine besylate tab 2.5 (Norvasc) amlodipine besylate tab 5 (Norvasc) diltiazem hcl cap sr 24hr 120 diltiazem hcl cap sr 24hr 180 diltiazem hcl cap sr 24hr 240 (Dilacor xr) diltiazem hcl coated beads cap sr 24hr 120 (Cardizem cd) diltiazem hcl coated beads cap sr 24hr 180 (Cardizem cd) diltiazem hcl coated beads cap sr 24hr 240 (Cardizem cd) diltiazem hcl coated beads cap sr 24hr 300 (Cardizem cd) diltiazem hcl coated beads cap sr 24hr 360 (Cardizem cd) diltiazem hcl extended release beads cap sr 24hr 120 (Tiazac) diltiazem hcl extended release beads cap sr 24hr 180 (Tiazac) diltiazem hcl extended release beads cap sr 24hr 240 (Tiazac) diltiazem hcl extended release beads cap sr 24hr 300 (Tiazac) diltiazem hcl extended release beads cap sr 24hr 360 (Tiazac) diltiazem hcl extended release beads cap sr 24hr 420 (Tiazac) diltiazem hcl tab 120 (Cardizem) diltiazem hcl tab 30 (Cardizem) diltiazem hcl tab 60 (Cardizem) diltiazem hcl tab 90 felodipine tab sr 24hr 10 felodipine tab sr 24hr 2.5 felodipine tab sr 24hr 5 nifedipine tab sr 24hr 30 (Adalat cc) nifedipine tab sr 24hr 60 (Adalat cc) nifedipine tab sr 24hr 90 (Adalat cc) nifedipine tab sr 24hr osmotic release 30 (Procardia xl) nifedipine tab sr 24hr osmotic release 60 (Procardia xl) nifedipine tab sr 24hr osmotic release 90 (Procardia xl) verapamil hcl cap sr 24hr 120 (Verelan) verapamil hcl cap sr 24hr 180 (Verelan) verapamil hcl cap sr 24hr 240 (Verelan) verapamil hcl cap sr 24hr 360 (Verelan) verapamil hcl tab 120 (Calan) verapamil hcl tab 40 verapamil hcl tab 80 (Calan) verapamil hcl tab cr 120 (Calan sr) verapamil hcl tab cr 180 (Calan sr) verapamil hcl tab cr 240 (Calan sr) CARDIOTONICS digoxin tab 125 mcg (0.125 ) (Lanoxin) digoxin tab 250 mcg (0.25 ) (Lanoxin) DIGOXIN digoxin oral soln 0.05 /ml CARDIOVASCULAR AGENTS - MISC. amlodipine besylate-atorvastatin calcium tab (Caduet) amlodipine besylate-atorvastatin calcium tab (Caduet) amlodipine besylate-atorvastatin calcium tab (Caduet) amlodipine besylate-atorvastatin calcium tab (Caduet) amlodipine besylate-atorvastatin calcium tab (Caduet) amlodipine besylate-atorvastatin calcium tab (Caduet) amlodipine besylate-atorvastatin calcium tab (Caduet) amlodipine besylate-atorvastatin calcium tab 5-10 (Caduet) amlodipine besylate-atorvastatin calcium tab 5-20 (Caduet) amlodipine besylate-atorvastatin calcium tab 5-40 (Caduet) amlodipine besylate-atorvastatin calcium tab 5-80 (Caduet) sildenafil citrate tab 20 (Revatio) ADCIRCA tadalafil tab 20 (pah) CIALIS tadalafil tab 10 CIALIS tadalafil tab 2.5 CIALIS tadalafil tab 20 CIALIS tadalafil tab 5 LETAIRIS ambrisentan tab 10 LETAIRIS ambrisentan tab 5 OPSUMIT macitentan tab 10 TRACLEER bosentan tab 125 TRACLEER bosentan tab 62.5 UPTRAVI selexipag tab 1000 mcg UPTRAVI selexipag tab 1200 mcg UPTRAVI selexipag tab 1400 mcg UPTRAVI selexipag tab 1600 mcg UPTRAVI selexipag tab 200 mcg UPTRAVI selexipag tab 400 mcg UPTRAVI selexipag tab 600 mcg UPTRAVI selexipag tab 800 mcg UPTRAVI selexipag tab therapy pack 200 mcg (140) & 800 mcg (60) DIURETICS acetazolamide cap sr 12hr 500 (Diamox) acetazolamide tab 250 amiloride & hydrochlorothiazide tab 5-50 amiloride hcl tab 5 bumetanide tab 0.5 bumetanide tab 1 bumetanide tab 2 chlorothiazide tab 500 chlorthalidone tab 25 furosemide oral soln 10 /ml furosemide tab 20 (Lasix) furosemide tab 40 (Lasix) furosemide tab 80 (Lasix) hydrochlorothiazide cap 12.5 (Microzide) hydrochlorothiazide tab 12.5 hydrochlorothiazide tab 25 hydrochlorothiazide tab 50 indapamide tab 1.25 indapamide tab 2.5 methazolamide tab 25 (Neptazane) methazolamide tab 50 (Neptazane) metolazone tab 10 metolazone tab 2.5 (Zaroxolyn) metolazone tab 5 (Zaroxolyn) spironolactone & hydrochlorothiazide tab (Aldactazide) spironolactone tab 100 (Aldactone) spironolactone tab 25 (Aldactone) spironolactone tab 50 (Aldactone) torsemide tab 10 (Demadex) torsemide tab 100 (Demadex) torsemide tab 20 (Demadex) torsemide tab 5 (Demadex) triamterene & hydrochlorothiazide cap (Dyazide) triamterene & hydrochlorothiazide tab (Maxzide-25) triamterene & hydrochlorothiazide tab (Maxzide) ACETAZOLAMIDE acetazolamide tab 125 CHLOROTHIAZIDE chlorothiazide tab 250 CHLORTHALIDONE chlorthalidone tab 50 TRIAMTERENE/HYDROCHLOROTH triamterene & hydrochlorothiazide cap VASOPRESSORS midodrine hcl tab 10 midodrine hcl tab 2.5 Page 9 of 23

10 midodrine hcl tab 5 EPIPEN 2-PAK epinephrine solution auto-injector 0.3 /0.3ml (1:1000) EPIPEN-JR 2-PAK epinephrine solution autoinjector 0.15 /0.3ml (1:2000) CENTRAL NERVOUS SYSTEM DRUGS ADHD/ANTI-NARCOLEPSY/ANTI- OBESITY/ANOREXIANTS amphetamine-dextroamphetamine cap sr 24hr 10 (Adderall xr) amphetamine-dextroamphetamine cap sr 24hr 15 (Adderall xr) amphetamine-dextroamphetamine cap sr 24hr 20 (Adderall xr) amphetamine-dextroamphetamine cap sr 24hr 25 (Adderall xr) amphetamine-dextroamphetamine cap sr 24hr 30 (Adderall xr) amphetamine-dextroamphetamine cap sr 24hr 5 (Adderall xr) amphetamine-dextroamphetamine tab 10 (Adderall) amphetamine-dextroamphetamine tab 12.5 (Adderall) amphetamine-dextroamphetamine tab 15 (Adderall) amphetamine-dextroamphetamine tab 20 (Adderall) amphetamine-dextroamphetamine tab 30 (Adderall) amphetamine-dextroamphetamine tab 5 (Adderall) amphetamine-dextroamphetamine tab 7.5 (Adderall) caffeine citrate oral soln 60 /3ml (10 /ml base (Cafcit) dexmethylphenidate hcl cap sr 24 hr 10 (Focalin xr) dexmethylphenidate hcl cap sr 24 hr 15 (Focalin xr) dexmethylphenidate hcl cap sr 24 hr 20 (Focalin xr) dexmethylphenidate hcl cap sr 24 hr 30 (Focalin xr) dexmethylphenidate hcl cap sr 24 hr 40 (Focalin xr) dexmethylphenidate hcl cap sr 24 hr 5 (Focalin xr) dextroamphetamine sulfate cap sr 24hr 10 (Dexedrine) dextroamphetamine sulfate cap sr 24hr 15 (Dexedrine) dextroamphetamine sulfate cap sr 24hr 5 (Dexedrine) dextroamphetamine sulfate tab 10 dextroamphetamine sulfate tab 5 guanfacine hcl tab sr 24hr 1 (base (Intuniv) guanfacine hcl tab sr 24hr 2 (base (Intuniv) guanfacine hcl tab sr 24hr 3 (base (Intuniv) guanfacine hcl tab sr 24hr 4 (base (Intuniv) methylphenidate hcl tab 10 (Ritalin) methylphenidate hcl tab 20 (Ritalin) methylphenidate hcl tab 5 (Ritalin) methylphenidate hcl tab cr 10 methylphenidate hcl tab cr 20 (Ritalin sr) modafinil tab 100 (Provigil) modafinil tab 200 (Provigil) ADDERALL XR amphetaminedextroamphetamine cap sr 24hr 10 ADDERALL XR amphetaminedextroamphetamine cap sr 24hr 15 ADDERALL XR amphetaminedextroamphetamine cap sr 24hr 20 ADDERALL XR amphetaminedextroamphetamine cap sr 24hr 25 ADDERALL XR amphetaminedextroamphetamine cap sr 24hr 30 ADDERALL XR amphetaminedextroamphetamine cap sr 24hr 5 CONCERTA methylphenidate hcl tab sa osm 18 CONCERTA methylphenidate hcl tab sa osm 27 CONCERTA methylphenidate hcl tab sa osm 36 CONCERTA methylphenidate hcl tab sa osm 54 STRATTERA atomoxetine hcl cap 10 (base STRATTERA atomoxetine hcl cap 100 (base STRATTERA atomoxetine hcl cap 18 (base STRATTERA atomoxetine hcl cap 25 (base STRATTERA atomoxetine hcl cap 40 (base STRATTERA atomoxetine hcl cap 60 (base STRATTERA atomoxetine hcl cap 80 (base VYVANSE lisdexamfetamine dimesylate cap 10 VYVANSE lisdexamfetamine dimesylate cap 20 VYVANSE lisdexamfetamine dimesylate cap 30 VYVANSE lisdexamfetamine dimesylate cap 40 VYVANSE lisdexamfetamine dimesylate cap 50 VYVANSE lisdexamfetamine dimesylate cap 60 VYVANSE lisdexamfetamine dimesylate cap 70 ANTIANXIETY AGENTS alprazolam tab 0.25 (Xanax) alprazolam tab 0.5 (Xanax) alprazolam tab 1 (Xanax) alprazolam tab 2 (Xanax) alprazolam tab sr 24hr 0.5 (Xanax xr) alprazolam tab sr 24hr 1 (Xanax xr) alprazolam tab sr 24hr 2 (Xanax xr) alprazolam tab sr 24hr 3 (Xanax xr) buspirone hcl tab 10 buspirone hcl tab 15 buspirone hcl tab 30 buspirone hcl tab 5 diazepam tab 10 (Valium) diazepam tab 2 (Valium) diazepam tab 5 (Valium) hydroxyzine hcl syrup 10 /5ml hydroxyzine hcl tab 10 hydroxyzine hcl tab 25 hydroxyzine hcl tab 50 hydroxyzine pamoate cap 25 (Vistaril) hydroxyzine pamoate cap 50 (Vistaril) lorazepam conc 2 /ml (Lorazepam intensol) lorazepam tab 0.5 (Ativan) lorazepam tab 1 (Ativan) lorazepam tab 2 (Ativan) DIAZEPAM diazepam oral soln 1 /ml HYDROXYZINE PAMOATE hydroxyzine pamoate cap 100 ANTIDEPRESSANTS amitriptyline hcl tab 10 amitriptyline hcl tab 100 amitriptyline hcl tab 150 amitriptyline hcl tab 25 amitriptyline hcl tab 50 amitriptyline hcl tab 75 bupropion hcl tab 100 (Wellbutrin) bupropion hcl tab 75 (Wellbutrin) bupropion hcl tab sr 12hr 100 (Wellbutrin sr) bupropion hcl tab sr 12hr 150 (Wellbutrin sr) bupropion hcl tab sr 12hr 200 (Wellbutrin sr) bupropion hcl tab sr 24hr 150 (Wellbutrin xl) bupropion hcl tab sr 24hr 300 (Wellbutrin xl) citalopram hydrobromide oral soln 10 /5ml Page 10 of 23

11 citalopram hydrobromide tab 10 (base (Celexa) citalopram hydrobromide tab 20 (base (Celexa) citalopram hydrobromide tab 40 (base (Celexa) clomipramine hcl cap 25 (Anafranil) clomipramine hcl cap 50 (Anafranil) clomipramine hcl cap 75 (Anafranil) desipramine hcl tab 10 (Norpramin) desipramine hcl tab 100 (Norpramin) desipramine hcl tab 150 (Norpramin) desipramine hcl tab 25 (Norpramin) desipramine hcl tab 50 (Norpramin) desipramine hcl tab 75 (Norpramin) doxepin hcl cap 10 doxepin hcl cap 100 doxepin hcl cap 25 doxepin hcl cap 50 doxepin hcl conc 10 /ml duloxetine hcl enteric coated pellets cap 20 (Cymbalta) duloxetine hcl enteric coated pellets cap 30 (Cymbalta) duloxetine hcl enteric coated pellets cap 60 (Cymbalta) escitalopram oxalate soln 5 /5ml (base (Lexapro) escitalopram oxalate tab 10 (base (Lexapro) escitalopram oxalate tab 20 (base (Lexapro) escitalopram oxalate tab 5 (base (Lexapro) fluoxetine hcl cap 10 (Prozac) fluoxetine hcl cap 20 (Prozac) fluoxetine hcl cap 40 (Prozac) fluoxetine hcl solution 20 /5ml fluoxetine hcl tab 10 fluoxetine hcl tab 20 fluvoxamine maleate tab 100 fluvoxamine maleate tab 25 fluvoxamine maleate tab 50 imipramine hcl tab 10 (Tofranil) imipramine hcl tab 25 (Tofranil) imipramine hcl tab 50 (Tofranil) mirtazapine tab 15 (Remeron) mirtazapine tab 30 (Remeron) mirtazapine tab 45 (Remeron) mirtazapine tab 7.5 nortriptyline hcl cap 10 (Pamelor) nortriptyline hcl cap 25 (Pamelor) nortriptyline hcl cap 50 (Pamelor) nortriptyline hcl cap 75 (Pamelor) paroxetine hcl tab 10 (Paxil) paroxetine hcl tab 20 (Paxil) paroxetine hcl tab 30 (Paxil) paroxetine hcl tab 40 (Paxil) paroxetine hcl tab sr 24hr 12.5 (Paxil cr) paroxetine hcl tab sr 24hr 25 (Paxil cr) paroxetine hcl tab sr 24hr 37.5 (Paxil cr) phenelzine sulfate tab 15 (Nardil) sertraline hcl oral conc 20 /ml (Zoloft) sertraline hcl tab 100 (Zoloft) sertraline hcl tab 25 (Zoloft) sertraline hcl tab 50 (Zoloft) tranylcypromine sulfate tab 10 (Parnate) trazodone hcl tab 100 trazodone hcl tab 150 trazodone hcl tab 300 trazodone hcl tab 50 venlafaxine hcl cap sr 24hr 150 (base (Effexor xr) venlafaxine hcl cap sr 24hr 37.5 (base (Effexor xr) venlafaxine hcl cap sr 24hr 75 (base (Effexor xr) venlafaxine hcl tab 100 venlafaxine hcl tab 25 venlafaxine hcl tab 37.5 venlafaxine hcl tab 50 venlafaxine hcl tab 75 venlafaxine hcl tab sr 24hr 150 (base (Venlafaxine hcl er) venlafaxine hcl tab sr 24hr 37.5 (base (Venlafaxine hcl er) venlafaxine hcl tab sr 24hr 75 (base (Venlafaxine hcl er) DOXEPIN HCL doxepin hcl cap 75 NORTRIPTYLINE HCL nortriptyline hcl soln 10 /5ml PRISTIQ desvenlafaxine succinate tab sr 24hr 100 (base PRISTIQ desvenlafaxine succinate tab sr 24hr 25 (base PRISTIQ desvenlafaxine succinate tab sr 24hr 50 (base ANTIPSYCHOTICS aripiprazole tab 10 (Abilify) aripiprazole tab 15 (Abilify) aripiprazole tab 2 (Abilify) aripiprazole tab 20 (Abilify) aripiprazole tab 30 (Abilify) aripiprazole tab 5 (Abilify) chlorpromazine hcl tab 10 chlorpromazine hcl tab 100 chlorpromazine hcl tab 200 chlorpromazine hcl tab 25 chlorpromazine hcl tab 50 clozapine tab 100 (Clozaril) clozapine tab 200 clozapine tab 25 (Clozaril) clozapine tab 50 fluphenazine decanoate inj 25 /ml fluphenazine hcl tab 1 fluphenazine hcl tab 10 fluphenazine hcl tab 2.5 fluphenazine hcl tab 5 haloperidol decanoate im soln 100 /ml (Haldol decanoate 100) haloperidol decanoate im soln 50 /ml (Haldol decanoate 50) haloperidol lactate oral conc 2 /ml haloperidol tab 0.5 haloperidol tab 1 haloperidol tab 10 haloperidol tab 2 haloperidol tab 20 haloperidol tab 5 lithium carbonate cap 150 (Lithium carbonate) lithium carbonate cap 300 lithium carbonate cap 600 (Lithium carbonate) lithium carbonate tab 300 lithium carbonate tab cr 300 (Lithobid) lithium carbonate tab cr 450 loxapine succinate cap 10 loxapine succinate cap 25 loxapine succinate cap 5 (Loxitane) loxapine succinate cap 50 olanzapine orally disintegrating tab 10 (Zyprexa zydis) olanzapine orally disintegrating tab 15 (Zyprexa zydis) olanzapine orally disintegrating tab 20 (Zyprexa zydis) olanzapine orally disintegrating tab 5 (Zyprexa zydis) olanzapine tab 10 (Zyprexa) olanzapine tab 15 (Zyprexa) olanzapine tab 2.5 (Zyprexa) olanzapine tab 20 (Zyprexa) olanzapine tab 5 (Zyprexa) olanzapine tab 7.5 (Zyprexa) perphenazine tab 16 perphenazine tab 2 perphenazine tab 4 perphenazine tab 8 prochlorperazine maleate tab 10 (base (Compazine) Page 11 of 23