MICHILD CHILDREN S SPECIAL HEALTH CARE SERVICES (CSHCS) FORMULARY Effective October 2015

Transcription

1 MICHILD CHILDREN S SPECIAL HEALTH CARE SERVICES (CSHCS) FORMULARY Effective October 2015 Provided by EnvisionRxOptions Introduction The Total Health Care (THC) MIChild Children s Special Health Care Services (CSHCS) Formulary was developed to serve as a guide for physicians, pharmacists, health care professionals and members in the selection of cost-effective drug therapy. Total Health Care recognizes that drug therapy is an integral part of effective health management. Total Health Care continually reviews new and existing medications to ensure the Formulary remains responsive to the needs of our members and health professionals. Criteria used to evaluate drug selection for the formulary includes, but is not limited to: safety, efficacy and cost-effectiveness data, as well as comparison of relevant benefits of similar prescription or over-the counter (OTC) agents while minimizing potential duplications. Notice The information contained in this formulary is provided by THC, solely for the convenience of medical providers and members. THC does not warrant or assure accuracy of this information, nor is it intended to be comprehensive in nature. This formulary is not intended to be a substitute for the knowledge, expertise, skill or judgment of the medical provider in their choice of prescription drugs. Total Health Care assumes no responsibility for the actions or omissions of any medical provider based upon reliance, in whole or in part, on the information contained herein. The medical provider should consult the drug manufacturer s product literature or standard references for more detailed information. How to Read the Formulary Drug Name All formulary drugs are listed either by their generic names (in lowercase) or by their brand names (in uppercase). Drugs are grouped together by their therapeutic drug category. Specific drug listings may be accessed by using the index, using the covered generic name or the covered brand name of the drug. The brand names listed are for reference use only, and do not denote coverage, unless specifically noted. Any drug not found in this Formulary listing shall be considered a non-formulary drug. i

2 Requirements/Limits This field includes potential limitations to the formulary drug. It also may contain additional information about the coverage of the drug such as applicable quantity limits (). For certain agents within the MIChild-CSHCS Formulary, a recommended prescribing guideline may apply. Prescribing Guidelines Prescribing guidelines may apply to select drugs on the THC formulary. Prescribing guidelines may vary by benefit design but may include: Prior Authorization Required () Over the Counter Drugs (OTC) Specialty Drugs (SP) Quantity Limit () Age Limit (AL) Drug requires prior authorization through a specific physician request process. Drug coverage is available for drugs that are available OTC with an authorized prescription from your provider. Drug requires processing through THC s contracted specialty pharmacy, Diplomat Specialty Pharmacy. Drug coverage may be limited to specific quantities per prescription and/or time period. Drug coverage may depend on patient age. Gender Restriction (GR) Drug coverage may depend on patient gender. Step Therapy Required (ST) Custom (C) Drug coverage requires that an alternative or trial of another drug be used before the medication is covered. Drug coverage has unique restrictions. Benefit Coverage and Limitations This formulary does not define benefit coverage and limitations. Members should contact Total Health Care at if they have questions regarding their coverage. Please note that the formulary process is evolutionary and changes can occur throughout the year. Prior Authorization () Drugs indicated with a require Prior Authorization for coverage. A prescriber may complete a Prior Authorization form that can be found on the Total Health Care website at You may also request a form by calling Total Health Care at Completed prior authorization forms should be faxed to Prior Authorization review of prescribing guidelines will be evaluated utilizing the established drug review criteria approved by Total Health Care. If the request does not meet the approved criteria, the request will not be approved and alternative therapy may be recommended along with the proper course of alternative action. The requesting provider will be provided written notification of Total Health ii

3 Care review decisions. THC s website has a contact link where members can contact THC s Pharmacy Department to ask for an exception request. Non-Formulary Agents Drugs not found on the Total Health Care MIChild - CSHCS Formulary, or any updates published by Total Health Care, shall be considered a non-formulary drug. Requests for coverage of non-formulary agents may be requested by the health professional depending on specific coverage parameters. Review for nonformulary drug requests will require a Prior Authorization request with documentation of medical necessity. Generally, the following basic medical necessity guidelines are used in conducting a review: The patient has failed an appropriate trial of formulary or preferred agents. The use of preferred or formulary agent is contraindicated in the patient. The formulary drug or preferred agents are not suited for the present patient care need, and the drug selected is required for patient safety. If the request does not meet the established guidelines request, it will not be approved and alternative therapy may be recommended along with the proper course of alternative action. Common Drug Exclusions The member s plan design may exclude certain drug classes. Prior authorization is generally not available for drugs that are specifically excluded by benefit design. Common excluded coverage may include, but are not limited to: Drug products used for cosmetic purposes. Drug products for erectile dysfunction. Drug products for infertility treatment. Experimental drug products or any drug product used in an experimental manner. Foreign drugs or drugs not approved by the United States Food & Drug Administration (FDA). MICHILD - CSHCS Fee-For-Service Carve Out List The State of Michigan has a carve-out list for the CSHCS formulary. The carve-out drugs include HIV/AIDS, Oncology, Hemophilia and other miscellaneous drugs that have been added to the State's 100% carve-out list. These drugs must be billed directly by the pharmacies at point-of-sale to the Michigan Department of Community Health's contracted Pharmacy Benefits Manager (PBM). A list of the carve-out drugs can be found at Mandated Generic Substitution Total Health Care advocates the use of cost-effective generic drugs where FDA- approved generic equivalent drugs are available. Generic products are listed in the Formulary and noted as generic wherever an FDAapproved generic drug product is available. The brand names listed in the formulary are for reference only. Total Health Care Pharmacy and Therapeutics (P&T) Committee Total Health Care s Pharmacy & Therapeutic Committee meets quarterly to review and recommend medications for formulary consideration. The Committee considers clinical information on drugs that are new to the market and drugs that are typically included in an outpatient pharmacy benefit. This assures that the formulary remains responsive to patient and physician needs. The Committee is composed of physicians, iii

4 pharmacists, and health care professionals. The Committee also uses reference materials from our Pharmacy Benefits Manager's Pharmacy and Therapeutics Advisory Panel. Product Selection Criteria The primary goal of the THC Pharmacy & Therapeutic Committee is to maintain and update the formulary based upon an objective analysis of the safety, efficacy, approved indications, adverse effects, contraindications, patient administration/compliance considerations and cost effectiveness of available drugs. When a drug is considered for formulary inclusion, it will be reviewed relative to similar drugs including those currently in the THC Formulary. Physicians may request a copy of THC s drug criteria by calling the Pharmacy Department at Diabetic Testing Supplies Total Health Care works with J&B Medical Supply to provide diabetic testing supplies to our members. Covered diabetic testing supplies include Glucocard Vital glucometer, Glucocard Expression glucometer, and SD Biosensor GlucoNavii glucometer, Glucocard Vital test strips, Glucocard Expression test strips, SD Biosensor GlucoNavii test strips, lancets, insulin syringes, alcohol swabs and ketone strips. These supplies are to be filled through J&B Medical Supply. If you have any questions about our diabetic supply program, please contact J&B Medical Supply at Specialty Bio-Pharmaceutical Pharmacy Program Total Health Care works with Diplomat Specialty Pharmacy to provide Specialty Bio-Pharmaceutical Pharmacy products to our members. These medications are to be filled exclusively through Diplomat Specialty Pharmacy. A Specialty Drug Prior Authorization Request form must be completed and faxed to EnvisionRxOptions at with supporting documentation and the prescription. A prescriber may obtain a Specialty Drug Prior Authorization Request form found on the Total Health Care website at Once the order is received, EnvisionRxOptions obtains authorization from Total Health Care. If the specialty prior authorization is approved, Total Health Care notifies Diplomat Specialty Pharmacy. Then, the Diplomat Specialty Pharmacy staff ships the medication directly to the physician's office or the patient s home. All packages are individually marked for each patient and refrigerated items are shipped in insulated containers. Where appropriate, each shipment includes needles, syringes and alcohol swabs. If you have any questions about our Specialty Bio-Pharmaceutical Pharmacy program, please contact EnvisionRxOptions at or Diplomat Specialty Pharmacy at Contact Information The Total Health Care MIChild-CSHCS formulary is designed to assist physicians, members and other health care professionals in the selection of cost-effective agents. Total Health Care encourages your input and feedback on how we can assist in improving this document and the formulary management process. You may contact THC at iv

5 Medication Limitations Quantity Limitations Quantity Limitations are on medications throughout the formulary and are indicated with a "" notation. These are medications that have a daily dose restriction, quantity/days supply limitation, and/or a limitation on the duration of therapy. Age Limitations Age Limitations are on medications throughout the formulary and are indicated with an "AL" notation. Coverage for a medication is indicated by the age limitation. This could be a minimum age, maximum age, and/or the combination of a minimum and maximum age edit. Gender Restrictions Gender restrictions are indicated with a GR on the formulary and require the member to be a specific gender for coverage. Step Therapy Criteria Step Therapy medications are indicated with a ST on the formulary and require that an alternative, first line medication be tried and failed before the requested medication can be covered. The online claims adjudication system will automatically allow for the requested medication to be filled based on electronic claims history indicating that the first line medication was filled. Step-Therapy Criteria Therapy Class First Line Second Line Step Therapy Criteria Antibiotics Amoxicillin, Ampicillin, Amoxicillin & Clavulanate, Cefpodoxime, Cefdinir, Cefuroxime, Cephalexin, Ciprofloxacin, Clindamycin, Dicloxacillin, Doxycycline, Erythromycin, Penicillin, Sulfamethoxazole- Trimethoprim, Tetracycline Cefadroxil, Cefaclor, Cefprozil Antidiabetic Agents Metformin Januvia, Janumet Attention Amphetamine Immediate- Deficit/Hyperactivity Release Amphetamine Extended-Release Antipsychotic Agents Risperidone Quetiapine Immediate-Release Benign Prostatic Doxazosin Immediate- Alfuzosin Hypertrophy agents Release, Prior use of Amoxicillin, Ampicillin, Amoxicillin & Clavulanate, Cefpodoxime, Cefdinir, Cefuroxime, Cephalexin, Ciprofloxacin, Clindamycin, Dicloxacillin, Doxycycline, Erythromycin, Penicillin, Sulfamethoxazole- Trimethoprim or Tetracycline in the last 30 days Prior use of Metformin in the last 90 days Prior use of Amphetamine Immediate-Release for 60 days within the last 90 days Prior use of Quetiapine within the last 90 days. Prior use of Doxazosin Immediate-Release, v

6 Finasteride, Tamsulosin, Terazosin Glucocorticoid Inhaler Dulera Breo Ellipta, Pediculicides Urinary Antispasmodics Lice-B-Gone Kit, Lice-B-Gone Shampoo, Pyrethrins-Piperonyl Butoxide Liquid, Permethrin Spray & Pyrethins-Piperonyl Butoxide Shampoo Kit Oxybutynin, Oxybutynin Syrup, Oxytrol OTC Symbicort Malathion Lotion Oxybutynin Extended-Release, Tolterodine, Tolterodine Extended-Release Finasteride, Tamsulosin or Terazosin in the last 90 days Prior use of Dulera within the last 90 days. Prior use of Lice-B-Gone Kit, Lice-B-Gone Shampoo, Pyrethrins-Piperonyl Butoxide Liquid, Permethrin Spray & Pyrethins- Piperonyl Butoxide Shampoo Kit in the last 30 days Prior use of Oxytrol OTC or Oxybutynin/Oxybutynin Syrup in the last 90 days. *Formulary Disclaimer: Coverage for some drugs may be limited to specific dosage forms and/or strengths. The benefit design determines what is covered. The medications listed on this formulary are subject to change pursuant to the formulary management activities of EnvisionRxOptions. The presence of a medication on this formulary list does not guarantee coverage. vi

7 ANALGESICS (IN, INFLAMMATION, MUSCLE, JOINT CONDITIONS DRUGS) Nonsteroidal Anti-inflammatory Drugs (IN, ANTI-INFLAMMATORY DRUGS) diclofenac potassium tab 50 mg diclofenac sodium tab delayed release 25 mg diclofenac sodium tab delayed release 50 mg diclofenac sodium tab delayed release 75 mg diclofenac sodium tab sr 24hr 100 mg diflunisal tab 500 mg etodolac cap 200 mg etodolac cap 300 mg etodolac tab 400 mg etodolac tab 500 mg etodolac tab sr 24hr 400 mg etodolac tab sr 24hr 500 mg etodolac tab sr 24hr 600 mg FENOPROFEN CALCIUM TAB 600 MG fenoprofen calcium flurbiprofen tab 100 mg flurbiprofen tab 50 mg ibuprofen susp 100 mg/5ml ibuprofen tab 200 mg ibuprofen tab 400 mg ibuprofen tab 600 mg ibuprofen tab 800 mg indomethacin cap 25 mg indomethacin cap 50 mg ketoprofen cap 50 mg ketoprofen cap 75 mg 120 / 30 days ketorolac tromethamine tab 10 mg 20 / 5 days GE 7 LAST UPDATED 09/2015

8 MECLOFENAMATE SODIUM CAP 50 MG meclofenamate sodium meloxicam tab 15 mg meloxicam tab 7.5 mg nabumetone tab 500 mg 120 / 30 days nabumetone tab 750 mg 60 / 30 days naproxen sodium tab 220 mg naproxen sodium tab 275 mg naproxen sodium tab 550 mg naproxen susp 125 mg/5ml NAPROXEN SUSPENSION 125 MG/5ML naproxen naproxen tab 250 mg naproxen tab 375 mg naproxen tab 500 mg naproxen tab ec 375 mg oxaprozin tab 600 mg piroxicam cap 10 mg piroxicam cap 20 mg sulindac tab 150 mg sulindac tab 200 mg Opioid Analgesics, Long-acting (NARCOTIC IN RELIEVERS) fentanyl td patch 72hr 100 mcg/hr fentanyl td patch 72hr 12 mcg/hr fentanyl td patch 72hr 25 mcg/hr fentanyl td patch 72hr 50 mcg/hr fentanyl td patch 72hr 75 mcg/hr 10 / 30 days 10 / 30 days 10 / 30 days 10 / 30 days 10 / 30 days GE 8 LAST UPDATED 09/2015

9 methadone hcl soln 10 mg/5ml methadone hcl soln 5 mg/5ml METHADONE HCL SOLUTION 10 MG/5ML methadone hcl METHADONE HCL SOLUTION 5 MG/5ML methadone hcl methadone hcl tab 10 mg 240 / 30 days methadone hcl tab 5 mg MORPHINE SULFATE TAB 15 MG morphine sulfate MORPHINE SULFATE TAB 30 MG morphine sulfate 180 / 30 days 180 / 30 days morphine sulfate tab cr 100 mg 90 / 30 days morphine sulfate tab cr 15 mg 90 / 30 days morphine sulfate tab cr 30 mg 90 / 30 days morphine sulfate tab cr 60 mg 90 / 30 days Opioid Analgesics, Short-Acting ( NARCOTIC IN RELIEVERS) acetaminophen w/ codeine soln mg/5ml acetaminophen w/ codeine tab mg 390 / 30 days acetaminophen w/ codeine tab mg 390 / 30 days acetaminophen w/ codeine tab mg 390 / 30 days butalbital-aspirin-caff w/ codeine cap mg codeine sulfate tab 30 mg CODEINE SULFATE TAB 30 MG codeine sulfate codeine sulfate tab 60 mg CODEINE SULFATE TAB 60 MG codeine sulfate hydrocodone-acetaminophen soln mg/15ml 900 / 90 days hydrocodone-acetaminophen soln mg/15ml 900 / 90 days HYDROCODONE-ACETAMINOPHEN SOLUTION MG/15ML hydrocodone-acetaminophen 900 / 90 days GE 9 LAST UPDATED 09/2015

10 hydrocodone-acetaminophen tab mg 180 / 30 days hydrocodone-acetaminophen tab mg hydrocodone-acetaminophen tab mg hydrocodone-acetaminophen tab mg hydrocodone-acetaminophen tab mg hydrocodone-acetaminophen tab mg 360 / 30 days hydrocodone-acetaminophen tab mg hydrocodone-acetaminophen tab mg 180 / 30 days hydrocodone-acetaminophen tab mg HYDROCODONE-ACETAMINOPHEN TAB MG hydrocodone-acetaminophen hydrocodone-acetaminophen tab mg HYDROCODONE-ACETAMINOPHEN TAB MG hydrocodone-acetaminophen hydrocodone-acetaminophen tab mg HYDROCODONE-ACETAMINOPHEN TAB MG hydrocodone-acetaminophen hydromorphone hcl tab 2 mg 240 / 30 days hydromorphone hcl tab 4 mg 240 / 30 days hydromorphone hcl tab 8 mg 240 / 30 days LORTAB ELIXIR MG/15ML hydrocodone-acetaminophen morphine sulfate (concentrate) oral soln 20 mg/ml morphine sulfate oral soln 10 mg/5ml morphine sulfate oral soln 20 mg/5ml oxycodone hcl soln 5 mg/5ml OXYCODONE HCL SOLUTION 5 MG/5ML oxycodone hcl 900 / 90 days oxycodone hcl tab 15 mg 180 / 30 days oxycodone hcl tab 30 mg 180 / 30 days oxycodone hcl tab 5 mg 180 / 30 days GE 10 LAST UPDATED 09/2015

11 oxycodone w/ acetaminophen tab mg 180 / 30 days oxycodone w/ acetaminophen tab mg oxycodone w/ acetaminophen tab mg 360 / 30 days oxycodone w/ acetaminophen tab mg 180 / 30 days oxycodone w/ acetaminophen tab mg oxycodone-aspirin tab mg tramadol hcl tab 50 mg 240 / 30 days ZAMICET SOLUTION MG/15ML hydrocodone-acetaminophen Anesthetics LOCAL ANESTHETICS (LOCAL NUMBING DRUGS) 900 / 90 days lidocaine hcl cream 3% 85 / 30 days lidocaine hcl gel 2% lidocaine hcl laryngotracheal soln 4% lidocaine hcl local inj 4% lidocaine hcl soln 4% lidocaine hcl viscous soln 2% lidocaine-prilocaine cream % 30 / 30 days Anti-Addiction/Substance Abuse Treatment Agents (NERVE CONDITIONS DRUGS) Opioid Reversal Agents (MISCELLANEOUS MENTAL HEALTH DRUGS) naloxone hcl inj 0.4 mg/ml 2 / 90 days naloxone hcl inj 1 mg/ml 2 / 90 days NALOXONE HCL SOLUTION 0.4 MG/ML naloxone hcl NALOXONE HCL SOLUTION 1 MG/ML naloxone hcl Smoking Cessation Agents (DEPRESSION DRUGS) 2 / 90 days 2 / 90 days bupropion hcl (smoking deterrent) tab sr 12hr 150 mg 180 / 365 days CHANTIX CONTINUING MONTH K TAB 1 MG varenicline tartrate C 60 / 30 days 90 days of coverage per year GE 11 LAST UPDATED 09/2015

12 CHANTIX STARTING MONTH K TAB 0.5 MG X 11 & 1 MG X 42 varenicline tartrate CHANTIX TAB 0.5 MG varenicline tartrate CHANTIX TAB 1 MG varenicline tartrate NICOTROL NS SOLUTION 10 MG/ML nicotine Antibacterials (INFECTION FIGHTING DRUGS) Aminoglycosides (BACTERIAL INFECTION DRUGS (ANTIBIOTICS)) GENTAMICIN SULFATE CREAM 0.1 % gentamicin sulfate (topical) gentamicin sulfate cream 0.1% gentamicin sulfate oint 0.1% GENTAMICIN SULFATE OINTMENT 0.1 % gentamicin sulfate (topical) gentamicin sulfate ophth oint 0.3% gentamicin sulfate ophth soln 0.3% neomycin sulfate tab 500 mg tobramycin ophth soln 0.3% Antibacterials, Other (MISCELLANEOUS INFECTION FIGHTING DRUGS) BACITRACIN OINTMENT 500 UNIT/GM bacitracin (ophthalmic) bacitracin-polymyxin b ophth oint bacitracin-polymyxin-neomycin-hc ophth oint 1% CLEOCIN SUPPOS 100 MG clindamycin phosphate vaginal clindamycin hcl cap 150 mg clindamycin hcl cap 300 mg C C C C 60 / 30 days 90 days of coverage per year 60 / 30 days 90 days of coverage per year 60 / 30 days 90 days of coverage per year 90 days of coverage per year GE 12 LAST UPDATED 09/2015

13 clindamycin hcl cap 75 mg clindamycin palmitate hcl for soln 75 mg/5ml (base equiv) clindamycin phosphate vaginal cream 2% CURITY ALCOHOL PREPS D 70 % alcohol swabs MACRODANTIN CAP 25 MG nitrofurantoin macrocrystal methenamine hippurate tab 1 gm METHENAMINE MANDELATE TAB 0.5 GM methenamine mandelate methenamine mandelate tab 1 gm metronidazole cream 0.75% metronidazole gel 0.75% metronidazole lotion 0.75% metronidazole tab 250 mg metronidazole tab 500 mg metronidazole vaginal gel 0.75% mupirocin calcium cream 2% mupirocin oint 2% neomycin-bacitrac zn-polymyx 5(3.5)mg-400unt-10000unt op oin neomycin-polymy-gramicid op sol mg-unt-mg/ml NEOMYCIN-POLYMYXIN-HC SUSPENSION neomycin-polymyxin-hc (ophth) nitrofurantoin macrocrystalline cap 100 mg 60 / 30 days nitrofurantoin macrocrystalline cap 50 mg 60 / 30 days nitrofurantoin monohydrate macrocrystalline cap 100 mg 60 / 30 days polymyxin b-trimethoprim ophth soln unit/ml-0.1% silver sulfadiazine cream 1% trimethoprim tab 100 mg 60 / 30 days vancomycin hcl for inj 10 gm vancomycin hcl for inj 1000 mg vancomycin hcl for inj 500 mg GE 13 LAST UPDATED 09/2015

14 vancomycin hcl for inj 5000 mg VANCOMYCIN HCL RECON SOLN 750 MG vancomycin hcl Beta-lactam, Cephalosporins (BACTERIAL INFECTION DRUGS (ANTIBIOTICS)) cefaclor cap 250 mg cefaclor cap 500 mg CEFACLOR RECON SUSP 125 MG/5ML cefaclor CEFACLOR RECON SUSP 250 MG/5ML cefaclor CEFACLOR RECON SUSP 375 MG/5ML cefaclor cefadroxil cap 500 mg cefadroxil for susp 250 mg/5ml cefadroxil for susp 500 mg/5ml cefadroxil tab 1 gm cefdinir cap 300 mg ST ST ST ST ST ST ST ST ST 40 / 10 days 20 / 10 days cefdinir for susp 125 mg/5ml AL1 Up to 11 yrs old cefdinir for susp 250 mg/5ml AL1 Up to 11 yrs old cefpodoxime proxetil for susp 100 mg/5ml cefpodoxime proxetil for susp 50 mg/5ml cefpodoxime proxetil tab 100 mg 60 / 30 days cefpodoxime proxetil tab 200 mg 60 / 30 days cefprozil for susp 125 mg/5ml cefprozil for susp 250 mg/5ml cefprozil tab 250 mg cefprozil tab 500 mg ST ST ST ST 60 / 30 days 60 / 30 days GE 14 LAST UPDATED 09/2015

15 ceftriaxone sodium for inj 1 gm 10 / 30 days ceftriaxone sodium for inj 250 mg 10 / 30 days ceftriaxone sodium for inj 500 mg 10 / 30 days ceftriaxone sodium for iv soln 1 gm 10 / 30 days cefuroxime axetil tab 250 mg cefuroxime axetil tab 500 mg cephalexin cap 250 mg cephalexin cap 500 mg cephalexin for susp 125 mg/5ml cephalexin for susp 250 mg/5ml Beta-lactam, Other (BACTERIAL INFECTION DRUGS (ANTIBIOTICS)) DORIBAX RECON SOLN 250 MG doripenem DORIBAX RECON SOLN 500 MG doripenem Beta-lactam, Penicillins (BACTERIAL INFECTION DRUGS (ANTIBIOTICS)) amoxicillin & k clavulanate chew tab mg amoxicillin & k clavulanate chew tab mg amoxicillin & k clavulanate for susp mg/5ml amoxicillin & k clavulanate for susp mg/5ml amoxicillin & k clavulanate for susp mg/5ml amoxicillin & k clavulanate tab mg 42 / 14 days amoxicillin & k clavulanate tab mg 28 / 14 days amoxicillin & k clavulanate tab mg 28 / 14 days amoxicillin (trihydrate) cap 250 mg amoxicillin (trihydrate) cap 500 mg amoxicillin (trihydrate) chew tab 250 mg amoxicillin (trihydrate) for susp 125 mg/5ml amoxicillin (trihydrate) for susp 200 mg/5ml amoxicillin (trihydrate) for susp 250 mg/5ml GE 15 LAST UPDATED 09/2015

16 amoxicillin (trihydrate) for susp 400 mg/5ml amoxicillin (trihydrate) tab 500 mg amoxicillin (trihydrate) tab 875 mg AMOXICILLIN CHEW TAB 125 MG amoxicillin AMOXICILLIN CHEW TAB 250 MG amoxicillin ampicillin cap 250 mg ampicillin cap 500 mg BICILLIN C-R 900/300 SUSPENSION UNIT/2ML penicillin g benzathine & procaine BICILLIN C-R SUSPENSION UNIT/2ML penicillin g benzathine & procaine dicloxacillin sodium cap 250 mg dicloxacillin sodium cap 500 mg penicillin v potassium for soln 125 mg/5ml penicillin v potassium for soln 250 mg/5ml penicillin v potassium tab 250 mg penicillin v potassium tab 500 mg Macrolides (BACTERIAL INFECTION DRUGS (ANTIBIOTICS)) azithromycin for susp 100 mg/5ml azithromycin for susp 200 mg/5ml 4 / 28 days 4 / 28 days azithromycin tab 250 mg 12 / 30 days azithromycin tab 500 mg 6 / 30 days azithromycin tab 600 mg 60 / 30 days clarithromycin for susp 125 mg/5ml clarithromycin for susp 250 mg/5ml clarithromycin tab 250 mg clarithromycin tab 500 mg clarithromycin tab sr 24hr 500 mg erythromycin gel 2% erythromycin ophth oint 5 mg/gm GE 16 LAST UPDATED 09/2015

17 erythromycin soln 2% erythromycin-sulfisoxazole for susp mg/5ml Quinolones (BACTERIAL INFECTION DRUGS (ANTIBIOTICS)) ciprofloxacin hcl ophth soln 0.3% ciprofloxacin hcl tab 250 mg (base equiv) ciprofloxacin hcl tab 500 mg (base equiv) ciprofloxacin hcl tab 750 mg (base equiv) levofloxacin tab 250 mg 14 / 14 days levofloxacin tab 500 mg 14 / 14 days levofloxacin tab 750 mg 14 / 14 days ofloxacin ophth soln 0.3% ofloxacin otic soln 0.3% ofloxacin tab 200 mg 60 / 30 days ofloxacin tab 300 mg 60 / 30 days ofloxacin tab 400 mg 60 / 30 days OFLOXACIN TAB 400 MG ofloxacin Sulfonamides (BACTERIAL INFECTION DRUGS (ANTIBIOTICS)) BLEPHAMIDE S.O.P. OINTMENT % sulfacetamide sod-prednisolone BLEPHAMIDE SUSPENSION % sulfacetamide sod-prednisolone sulfacetamide sodium-prednisolone ophth soln (0.25)% SULFADIAZINE TAB 500 MG sulfadiazine sulfamethoxazole-trimethoprim susp mg/5ml sulfamethoxazole-trimethoprim tab mg sulfamethoxazole-trimethoprim tab mg Tetracyclines (BACTERIAL INFECTION DRUGS (ANTIBIOTICS)) doxycycline hyclate cap 100 mg doxycycline hyclate cap 50 mg 60 / 30 days GE 17 LAST UPDATED 09/2015

18 doxycycline hyclate tab 100 mg doxycycline monohydrate for susp 25 mg/5ml minocycline hcl cap 100 mg minocycline hcl cap 50 mg minocycline hcl cap 75 mg Anticonvulsants (NERVE CONDITIONS DRUGS) Anticonvulsants, Other (SEIZURE CONTROL DRUGS) levetiracetam oral soln 100 mg/ml levetiracetam tab 1000 mg 90 / 30 days levetiracetam tab 250 mg levetiracetam tab 500 mg 180 / 30 days levetiracetam tab 750 mg 120 / 30 days phenobarbital elixir 20 mg/5ml PHENOBARBITAL TAB 100 MG phenobarbital PHENOBARBITAL TAB 15 MG phenobarbital phenobarbital tab 16.2 mg PHENOBARBITAL TAB 30 MG phenobarbital phenobarbital tab 32.4 mg PHENOBARBITAL TAB 60 MG phenobarbital phenobarbital tab 64.8 mg phenobarbital tab 97.2 mg Calcium Channel Modifying Agents (SEIZURES CONTROL DRUGS) ethosuximide cap 250 mg ethosuximide soln 250 mg/5ml zonisamide cap 100 mg 180 / 30 days zonisamide cap 25 mg 30 / 30 days zonisamide cap 50 mg 30 / 30 days GE 18 LAST UPDATED 09/2015

19 Gamma-aminobutyric Acid (GABA) Augmenting Agents (SEIZURES CONTROL DRUGS) clonazepam tab 0.5 mg clonazepam tab 1 mg clonazepam tab 2 mg DIAZEM GEL 2.5 MG diazepam (anticonvulsant) divalproex sodium cap sprinkle 125 mg divalproex sodium tab delayed release 125 mg divalproex sodium tab delayed release 250 mg divalproex sodium tab delayed release 500 mg divalproex sodium tab sr 24 hr 250 mg divalproex sodium tab sr 24 hr 500 mg gabapentin cap 100 mg gabapentin cap 300 mg gabapentin cap 400 mg gabapentin oral soln 250 mg/5ml gabapentin tab 600 mg gabapentin tab 800 mg primidone tab 250 mg primidone tab 50 mg valproate sodium syrup 250 mg/5ml (base equiv) Glutamate Reducing Agents (SEIZURES CONTROL DRUGS) lamotrigine tab 100 mg lamotrigine tab 150 mg lamotrigine tab 200 mg lamotrigine tab 25 mg lamotrigine tab chewable dispersible 25 mg lamotrigine tab chewable dispersible 5 mg topiramate sprinkle cap 15 mg topiramate sprinkle cap 25 mg topiramate tab 100 mg 2 / 30 days GE 19 LAST UPDATED 09/2015

20 topiramate tab 200 mg topiramate tab 25 mg topiramate tab 50 mg Sodium Channel Agents (SEIZURES CONTROL DRUGS) carbamazepine cap sr 12hr 300 mg carbamazepine chew tab 100 mg carbamazepine susp 100 mg/5ml carbamazepine tab 200 mg carbamazepine tab sr 12hr 200 mg carbamazepine tab sr 12hr 400 mg fosphenytoin sodium inj 100 mg/2ml (phenytoin equiv) fosphenytoin sodium inj 500 mg/10ml (phenytoin equiv) oxcarbazepine tab 150 mg oxcarbazepine tab 300 mg oxcarbazepine tab 600 mg phenytoin chew tab 50 mg phenytoin sodium extended cap 100 mg phenytoin susp 125 mg/5ml 750 / 30 days Antidepressants (NERVE CONDITIONS DRUGS) Antidepressants, Other (DEPRESSION DRUGS) bupropion hcl tab 100 mg bupropion hcl tab 75 mg bupropion hcl tab sr 12hr 100 mg bupropion hcl tab sr 12hr 150 mg bupropion hcl tab sr 12hr 200 mg bupropion hcl tab sr 24hr 150 mg bupropion hcl tab sr 24hr 300 mg mirtazapine tab 15 mg mirtazapine tab 30 mg mirtazapine tab 45 mg trazodone hcl tab 100 mg GE 20 LAST UPDATED 09/2015

21 trazodone hcl tab 150 mg trazodone hcl tab 300 mg trazodone hcl tab 50 mg Monoamine Oxidase Inhibitors (DEPRESSION DRUGS) phenelzine sulfate tab 15 mg tranylcypromine sulfate tab 10 mg SSRIs/SNRIs (Selective Serotonin Reuptake Inhibitors/Serotonin and Norepinephrine Reuptake Inhibitor (DEPRESSION) citalopram hydrobromide tab 10 mg (base equiv) 51 / 30 days citalopram hydrobromide tab 20 mg (base equiv) 51 / 30 days citalopram hydrobromide tab 40 mg (base equiv) duloxetine hcl enteric coated pellets cap 20 mg 30 / 30 days duloxetine hcl enteric coated pellets cap 30 mg 30 / 30 days duloxetine hcl enteric coated pellets cap 60 mg 30 / 30 days escitalopram oxalate tab 10 mg (base equiv) 45 / 30 days escitalopram oxalate tab 20 mg (base equiv) 30 / 30 days escitalopram oxalate tab 5 mg (base equiv) 45 / 30 days fluoxetine hcl cap 10 mg fluoxetine hcl cap 20 mg fluoxetine hcl cap 40 mg fluoxetine hcl solution 20 mg/5ml fluoxetine hcl tab 10 mg fluoxetine hcl tab 20 mg fluvoxamine maleate tab 100 mg fluvoxamine maleate tab 25 mg fluvoxamine maleate tab 50 mg paroxetine hcl tab 10 mg paroxetine hcl tab 20 mg paroxetine hcl tab 30 mg paroxetine hcl tab 40 mg GE 21 LAST UPDATED 09/2015

22 sertraline hcl tab 100 mg sertraline hcl tab 25 mg sertraline hcl tab 50 mg venlafaxine hcl cap sr 24hr 150 mg (base equivalent) venlafaxine hcl cap sr 24hr 37.5 mg (base equivalent) venlafaxine hcl cap sr 24hr 75 mg (base equivalent) venlafaxine hcl tab 100 mg venlafaxine hcl tab 25 mg venlafaxine hcl tab 37.5 mg venlafaxine hcl tab 50 mg venlafaxine hcl tab 75 mg Tricyclics (DEPRESSION DRUGS) amitriptyline hcl tab 10 mg amitriptyline hcl tab 100 mg amitriptyline hcl tab 150 mg amitriptyline hcl tab 25 mg amitriptyline hcl tab 50 mg amitriptyline hcl tab 75 mg AMOXAPINE TAB 100 MG amoxapine AMOXAPINE TAB 150 MG amoxapine AMOXAPINE TAB 25 MG amoxapine AMOXAPINE TAB 50 MG amoxapine clomipramine hcl cap 75 mg imipramine hcl tab 10 mg imipramine hcl tab 25 mg imipramine hcl tab 50 mg nortriptyline hcl cap 10 mg nortriptyline hcl cap 25 mg nortriptyline hcl cap 50 mg GE 22 LAST UPDATED 09/2015

23 nortriptyline hcl cap 75 mg nortriptyline hcl soln 10 mg/5ml NORTRIPTYLINE HCL SOLUTION 10 MG/5ML nortriptyline hcl trimipramine maleate cap 100 mg trimipramine maleate cap 25 mg trimipramine maleate cap 50 mg Antiemetics (BOWEL, INSTESTINE, AND STOMACH CONDITIONS DRUGS) ANTIEMETICS, Other (NAUSEA AND VOMITING DRUGS) meclizine hcl tab 12.5 mg meclizine hcl tab 25 mg promethazine hcl suppos 12.5 mg 28 / 14 days promethazine hcl suppos 25 mg 28 / 14 days promethazine hcl suppos 50 mg 28 / 14 days promethazine hcl syrup 6.25 mg/5ml promethazine hcl tab 12.5 mg promethazine hcl tab 25 mg promethazine hcl tab 50 mg trimethobenzamide hcl cap 300 mg Emetogenic Therapy Adjuncts (NAUSEA AND VOMITING DRUGS) dronabinol cap 10 mg dronabinol cap 2.5 mg dronabinol cap 5 mg ondansetron hcl oral soln 4 mg/5ml 50 / 30 days ondansetron hcl tab 4 mg ondansetron hcl tab 8 mg ondansetron orally disintegrating tab 4 mg ondansetron orally disintegrating tab 8 mg GE 23 LAST UPDATED 09/2015

24 ANTIFUNGALS (FUNGUS INFECTION DRUGS) *nystatin topical powder** ciclopirox solution 8% 6.6 / 30 days clotrimazole soln 1% clotrimazole troche 10 mg econazole nitrate cream 1% fluconazole for susp 10 mg/ml fluconazole for susp 40 mg/ml fluconazole tab 100 mg 30 / 30 days fluconazole tab 150 mg 4 / 30 days fluconazole tab 200 mg 30 / 30 days fluconazole tab 50 mg 30 / 30 days griseofulvin microsize susp 125 mg/5ml griseofulvin microsize tab 500 mg griseofulvin ultramicrosize tab 125 mg griseofulvin ultramicrosize tab 250 mg ketoconazole cream 2% ketoconazole shampoo 2% ketoconazole tab 200 mg MICONAZOLE 3 SUPPOS 200 MG miconazole nitrate vaginal miconazole nitrate vaginal suppos 100 mg nystatin cream unit/gm nystatin oint unit/gm NYSTATIN POWDER nystatin (topical) nystatin susp unit/ml nystatin tab unit nystatin-triamcinolone cream unit/gm-% nystatin-triamcinolone oint unit/gm-% terbinafine hcl tab 250 mg GE 24 LAST UPDATED 09/2015

25 terconazole vaginal cream 0.4% terconazole vaginal cream 0.8% terconazole vaginal suppos 80 mg Antigout Agents (GOUT DRUGS) allopurinol tab 100 mg allopurinol tab 300 mg COLCHICINE TAB 0.6 MG colchicine colchicine w/ probenecid tab mg probenecid tab 500 mg Antimigraine Agents (NERVE CONDITIONS DRUGS) Prophylactic (MIGRAINE DRUGS) TIMOLOL MALEATE TAB 10 MG timolol maleate TIMOLOL MALEATE TAB 20 MG timolol maleate TIMOLOL MALEATE TAB 5 MG timolol maleate valproic acid cap 250 mg Serotonin (5-HT) 1b/1d Receptor Agonists (MIGRAINE DRUGS) 20 / 30 days sumatriptan succinate tab 100 mg 9 / 30 days sumatriptan succinate tab 25 mg 9 / 30 days sumatriptan succinate tab 50 mg 9 / 30 days Antimycobacterials (INFECTION FIGHTING DRUGS) Antimycobacterials, Other (MISCELLANEOUS INFECTION FIGHTING DRUGS) DAPSONE TAB 100 MG dapsone DAPSONE TAB 25 MG dapsone Antituberculars ethambutol hcl tab 100 mg ethambutol hcl tab 400 mg GE 25 LAST UPDATED 09/2015

26 isoniazid tab 100 mg isoniazid tab 300 mg pyrazinamide tab 500 mg rifampin cap 150 mg rifampin cap 300 mg RIFATER TAB MG isoniazid-rifampin w/ pyrazinamide TRECATOR TAB 250 MG ethionamide ANTINEOPLASTICS (CANCER DRUGS) ALKYLATING AGENTS (CHEMOTHERAPY DRUGS) CYCLOPHOSPHAMIDE TAB 25 MG cyclophosphamide CYCLOPHOSPHAMIDE TAB 50 MG cyclophosphamide HEXALEN CAP 50 MG altretamine LEUKERAN TAB 2 MG chlorambucil LOMUSTINE CAP 10 MG lomustine LOMUSTINE CAP 100 MG lomustine LOMUSTINE CAP 40 MG lomustine MATULANE CAP 50 MG procarbazine hcl Antiandrogens (CANCER DRUGS) bicalutamide tab 50 mg flutamide cap 125 mg Antiestrogens/Modifiers (CANCER DRUGS) tamoxifen citrate tab 10 mg (base equivalent) GL AL1 Female At least 35 yrs old GE 26 LAST UPDATED 09/2015

27 tamoxifen citrate tab 20 mg (base equivalent) ANTIMETABOLITES (CHEMOTHERAPY DRUGS) hydroxyurea cap 500 mg mercaptopurine tab 50 mg TABLOID TAB 40 MG thioguanine Antineoplastics, Other (CANCER DRUGS) CYCLOPHOSPHAMIDE CAP 25 MG cyclophosphamide CYCLOPHOSPHAMIDE CAP 50 MG cyclophosphamide LEUCOVORIN CALCIUM TAB 15 MG leucovorin calcium leucovorin calcium tab 25 mg leucovorin calcium tab 5 mg MENEST TAB 0.3 MG esterified estrogens MENEST TAB MG esterified estrogens MENEST TAB 1.25 MG esterified estrogens MENEST TAB 2.5 MG esterified estrogens Aromatase Inhibitors, 3rd Generation (HORMONAL CHEMOTHERAPY DRUGS) GL AL1 GL GL GL GL Female At least 35 yrs old Female Female Female Female anastrozole tab 1 mg GL Female letrozole tab 2.5 mg Retinoids (CANCER DRUGS) tretinoin cap 10 mg AL1 30 / 30 days At least 18 yrs old GE 27 LAST UPDATED 09/2015

28 ANTIRASITICS (INFECTION FIGHTING DRUGS) Antiprotozoals (MALARIA DRUGS) atovaquone susp 750 mg/5ml 210 / 18 days chloroquine phosphate tab 250 mg DARAPRIM TAB 25 MG pyrimethamine hydroxychloroquine sulfate tab 200 mg 6 / 30 days mefloquine hcl tab 250 mg 5 / 30 days PRIMAQUINE PHOSPHATE TAB 26.3 MG primaquine phosphate quinine sulfate cap 324 mg Pediculicides/Scabicides (SCABIES DRUGS) EURAX CREAM 10 % crotamiton EURAX LOTION 10 % crotamiton lindane lotion 1% lindane shampoo 1% malathion lotion 0.5% OVIDE LOTION 0.5 % malathion ST ST 14 / 30 days 120 / 365 days 120 / 365 days permethrin cream 5% 120 / 30 days Antiparkinson Agents (NERVE CONDITIONS DRUGS) 'Dopamine Agonists (RKINSON'S DISEASE DRUGS)' pramipexole dihydrochloride tab mg Antipsychotics (NERVE CONDITIONS DRUGS) 1st Generation/Typical (MOOD DISORDER DRUGS) chlorpromazine hcl tab 10 mg chlorpromazine hcl tab 100 mg chlorpromazine hcl tab 200 mg chlorpromazine hcl tab 25 mg GE 28 LAST UPDATED 09/2015

29 chlorpromazine hcl tab 50 mg FLUPHENAZINE HCL CONC 5 MG/ML fluphenazine hcl FLUPHENAZINE HCL ELIXIR 2.5 MG/5ML fluphenazine hcl FLUPHENAZINE HCL SOLUTION 2.5 MG/ML fluphenazine hcl fluphenazine hcl tab 1 mg fluphenazine hcl tab 10 mg fluphenazine hcl tab 2.5 mg fluphenazine hcl tab 5 mg haloperidol decanoate im soln 100 mg/ml haloperidol tab 0.5 mg haloperidol tab 1 mg haloperidol tab 10 mg haloperidol tab 2 mg haloperidol tab 20 mg haloperidol tab 5 mg loxapine succinate cap 10 mg loxapine succinate cap 25 mg loxapine succinate cap 5 mg loxapine succinate cap 50 mg perphenazine tab 16 mg perphenazine tab 2 mg perphenazine tab 4 mg perphenazine tab 8 mg prochlorperazine maleate tab 10 mg (base equivalent) prochlorperazine maleate tab 5 mg (base equivalent) prochlorperazine suppos 25 mg 60 / 30 days thiothixene cap 1 mg thiothixene cap 10 mg thiothixene cap 2 mg GE 29 LAST UPDATED 09/2015

30 thiothixene cap 5 mg trifluoperazine hcl tab 1 mg trifluoperazine hcl tab 10 mg trifluoperazine hcl tab 2 mg trifluoperazine hcl tab 5 mg 2nd Generation/Atypical (MOOD DISORDER DRUGS) quetiapine fumarate tab 100 mg quetiapine fumarate tab 200 mg quetiapine fumarate tab 25 mg quetiapine fumarate tab 300 mg quetiapine fumarate tab 400 mg quetiapine fumarate tab 50 mg ST ST ST ST ST ST risperidone tab 0.25 mg risperidone tab 0.5 mg risperidone tab 1 mg risperidone tab 2 mg risperidone tab 3 mg risperidone tab 4 mg ziprasidone hcl cap 20 mg ziprasidone hcl cap 40 mg ziprasidone hcl cap 60 mg ziprasidone hcl cap 80 mg ST ST ST ST Treatment-Resistant (MOOD DISORDER DRUGS) clozapine tab 100 mg clozapine tab 200 mg clozapine tab 25 mg clozapine tab 50 mg GE 30 LAST UPDATED 09/2015

31 Antispasticity Agents (MUSCLE AND JOINT DRUGS) baclofen tab 10 mg baclofen tab 20 mg tizanidine hcl tab 2 mg 90 / 30 days tizanidine hcl tab 2 mg (base equivalent) 90 / 30 days tizanidine hcl tab 4 mg 90 / 30 days tizanidine hcl tab 4 mg (base equivalent) 90 / 30 days Antivirals (INFECTION FIGHTING DRUGS) Anti-hepatitis B (HBV) Agents (VIRUS INFECTION DRUGS) INTRON A RECON SOLN UNIT interferon alfa-2b INTRON A RECON SOLN UNIT interferon alfa-2b INTRON A RECON SOLN UNIT interferon alfa-2b INTRON A SOLUTION UNIT/ML interferon alfa-2b INTRON A SOLUTION UNIT/ML interferon alfa-2b Anti-hepatitis C (HCV) Agents (VIRUS INFECTION DRUGS) PEG-INTRON KIT 120 MCG/0.5ML peginterferon alfa-2b PEG-INTRON KIT 150 MCG/0.5ML peginterferon alfa-2b PEG-INTRON KIT 50 MCG/0.5ML peginterferon alfa-2b PEG-INTRON KIT 80 MCG/0.5ML peginterferon alfa-2b PEG-INTRON REDIPEN KIT 120 MCG/0.5ML peginterferon alfa-2b PEG-INTRON REDIPEN KIT 150 MCG/0.5ML peginterferon alfa-2b PEG-INTRON REDIPEN KIT 50 MCG/0.5ML peginterferon alfa-2b PEG-INTRON REDIPEN KIT 80 MCG/0.5ML peginterferon alfa-2b GE 31 LAST UPDATED 09/2015

32 PEG-INTRON REDIPEN K 4 KIT 120 MCG/0.5ML peginterferon alfa-2b PEG-INTRON REDIPEN K 4 KIT 150 MCG/0.5ML peginterferon alfa-2b PEG-INTRON REDIPEN K 4 KIT 50 MCG/0.5ML peginterferon alfa-2b PEG-INTRON REDIPEN K 4 KIT 80 MCG/0.5ML peginterferon alfa-2b PEGINTRON KIT 120 MCG/0.5ML peginterferon alfa-2b PEGINTRON KIT 150 MCG/0.5ML peginterferon alfa-2b PEGINTRON KIT 50 MCG/0.5ML peginterferon alfa-2b PEGINTRON KIT 80 MCG/0.5ML peginterferon alfa-2b ribavirin cap 200 mg Anti-HIV Agents, Nucleoside and Nucleotide Reverse Transcriptase Inhibitors (NRTI) (RETROVIRUS INFECTION DRUGS) EPIVIR HBV SOLUTION 5 MG/ML lamivudine (hbv) Anti-influenza Agents (VIRUS INFECTION DRUGS) amantadine hcl cap 100 mg amantadine hcl syrup 50 mg/5ml RELENZA DISKHALER AER POW BA 5 MG/BLISTER zanamivir rimantadine hydrochloride tab 100 mg TAMIFLU CAP 30 MG oseltamivir phosphate TAMIFLU CAP 45 MG oseltamivir phosphate TAMIFLU CAP 75 MG oseltamivir phosphate Antiherpetic Agents acyclovir cap 200 mg 1800 / 30 days 20 / 5 days 10 / 5 days 10 / 5 days 10 / 5 days acyclovir susp 200 mg/5ml AL1 Up to 12 yrs old GE 32 LAST UPDATED 09/2015

33 acyclovir tab 400 mg acyclovir tab 800 mg trifluridine ophth soln 1% Anxiolytics (NERVE CONDITIONS DRUGS) Anxiolytics, Other (ANXIETY DRUGS) buspirone hcl tab 10 mg buspirone hcl tab 15 mg buspirone hcl tab 30 mg buspirone hcl tab 5 mg buspirone hcl tab 7.5 mg doxepin hcl cap 10 mg doxepin hcl cap 100 mg doxepin hcl cap 150 mg doxepin hcl cap 25 mg doxepin hcl cap 50 mg DOXEPIN HCL CAP 75 MG doxepin hcl doxepin hcl conc 10 mg/ml Benzodiazepines (ANXIETY DRUGS) alprazolam tab 0.25 mg alprazolam tab 0.5 mg alprazolam tab 1 mg alprazolam tab 2 mg alprazolam tab sr 24hr 0.5 mg alprazolam tab sr 24hr 1 mg alprazolam tab sr 24hr 2 mg alprazolam tab sr 24hr 3 mg clorazepate dipotassium tab 15 mg clorazepate dipotassium tab 3.75 mg clorazepate dipotassium tab 7.5 mg GE 33 LAST UPDATED 09/2015

34 DIAZEM SOLUTION 1 MG/ML diazepam DIAZEM SOLUTION 5 MG/ML diazepam diazepam tab 10 mg diazepam tab 2 mg diazepam tab 5 mg lorazepam tab 0.5 mg lorazepam tab 1 mg lorazepam tab 2 mg oxazepam cap 10 mg oxazepam cap 15 mg oxazepam cap 30 mg temazepam cap 15 mg temazepam cap 30 mg Bipolar Agents (NERVE CONDITIONS DRUGS) Mood Stabilizers (MISCELLANEOUS NERVE CONDITIONS DRUGS) lithium carbonate cap 150 mg LITHIUM CARBONATE CAP 150 MG lithium carbonate lithium carbonate cap 300 mg lithium carbonate cap 600 mg LITHIUM CARBONATE CAP 600 MG lithium carbonate lithium carbonate tab 300 mg lithium carbonate tab cr 300 mg lithium carbonate tab cr 450 mg Blood Glucose Regulators (HORMONE AND DIABETIC DRUGS) ANTIDIABETIC AGENTS (BLOOD SUGAR PRODUCTS) acarbose tab 100 mg acarbose tab 25 mg acarbose tab 50 mg GE 34 LAST UPDATED 09/2015

35 glimepiride tab 1 mg glimepiride tab 2 mg glimepiride tab 4 mg glipizide tab 10 mg glipizide tab 5 mg glipizide tab sr 24hr 10 mg 60 / 30 days glipizide tab sr 24hr 2.5 mg 60 / 30 days glipizide tab sr 24hr 5 mg 60 / 30 days glyburide micronized tab 1.5 mg glyburide micronized tab 3 mg glyburide micronized tab 6 mg glyburide tab 1.25 mg GLYBURIDE TAB 1.25 MG glyburide glyburide tab 2.5 mg GLYBURIDE TAB 2.5 MG glyburide glyburide tab 5 mg GLYBURIDE TAB 5 MG glyburide glyburide-metformin tab mg glyburide-metformin tab mg glyburide-metformin tab mg JANUMET TAB MG sitagliptin-metformin hcl JANUMET TAB MG sitagliptin-metformin hcl JANUVIA TAB 100 MG sitagliptin phosphate JANUVIA TAB 25 MG sitagliptin phosphate ST ST ST ST 60 / 30 days 60 / 30 days 30 / 30 days 30 / 30 days GE 35 LAST UPDATED 09/2015

36 JANUVIA TAB 50 MG sitagliptin phosphate metformin hcl tab 1000 mg metformin hcl tab 500 mg metformin hcl tab 850 mg metformin hcl tab sr 24hr 500 mg metformin hcl tab sr 24hr 750 mg ST 30 / 30 days nateglinide tab 120 mg 90 / 30 days nateglinide tab 60 mg 90 / 30 days pioglitazone hcl tab 15 mg (base equiv) 30 / 30 days pioglitazone hcl tab 30 mg (base equiv) 30 / 30 days pioglitazone hcl tab 45 mg (base equiv) 30 / 30 days pioglitazone hcl-metformin hcl tab mg 60 / 30 days pioglitazone hcl-metformin hcl tab mg 60 / 30 days GLYCEMIC AGENTS (LOW BLOOD GLUCOSE DRUGS) GLUCAGON EMERGENCY KIT 1 MG glucagon (rdna) Insulins (INJECTABLE DIABETES, BLOOD SUGAR DRUGS) APIDRA SOLOSTAR SOLN PEN 100 UNIT/ML insulin glulisine APIDRA SOLUTION 100 UNIT/ML insulin glulisine LANTUS SOLOSTAR SOLN PEN 100 UNIT/ML insulin glargine LANTUS SOLUTION 100 UNIT/ML insulin glargine LEVEMIR SOLUTION 100 UNIT/ML insulin detemir NOVOLIN 70/30 RELION SUSPENSION (70-30) 100 UNIT/ML insulin isophane & reg (human) NOVOLIN 70/30 SUSPENSION (70-30) 100 UNIT/ML insulin isophane & reg (human) NOVOLIN N RELION SUSPENSION 100 UNIT/ML insulin isophane (human) GE 36 LAST UPDATED 09/2015

37 NOVOLIN N SUSPENSION 100 UNIT/ML insulin isophane (human) NOVOLIN R RELION SOLUTION 100 UNIT/ML insulin regular (human) NOVOLIN R SOLUTION 100 UNIT/ML insulin regular (human) NOVOLOG MIX 70/30 SUSPENSION (70-30) 100 UNIT/ML insulin aspart protamine & aspart (human) Blood Products/Modifiers/Volume Expanders (BLOOD DISORDER DRUGS) ANTICOAGULANTS (BLOOD THINNERS) enoxaparin sodium inj 100 mg/ml enoxaparin sodium inj 120 mg/0.8ml enoxaparin sodium inj 150 mg/ml enoxaparin sodium inj 30 mg/0.3ml enoxaparin sodium inj 300 mg/3ml enoxaparin sodium inj 40 mg/0.4ml enoxaparin sodium inj 60 mg/0.6ml enoxaparin sodium inj 80 mg/0.8ml heparin sodium (porcine) inj 1000 unit/ml heparin sodium (porcine) inj unit/ml heparin sodium (porcine) inj unit/ml heparin sodium (porcine) inj 5000 unit/ml heparin sodium (porcine) pf inj 5000 unit/0.5ml warfarin sodium tab 1 mg GL GL GL GL GL GL GL GL Female Female Female Female Female Female Female Female GE 37 LAST UPDATED 09/2015

38 warfarin sodium tab 10 mg warfarin sodium tab 2 mg warfarin sodium tab 2.5 mg warfarin sodium tab 3 mg warfarin sodium tab 4 mg warfarin sodium tab 5 mg warfarin sodium tab 6 mg warfarin sodium tab 7.5 mg XARELTO TAB 10 MG rivaroxaban Blood Formation Modifiers (BLOOD FORMATION DRUGS) anagrelide hcl cap 0.5 mg anagrelide hcl cap 1 mg EPOGEN SOLUTION UNIT/ML epoetin alfa EPOGEN SOLUTION 2000 UNIT/ML epoetin alfa EPOGEN SOLUTION 3000 UNIT/ML epoetin alfa EPOGEN SOLUTION 4000 UNIT/ML epoetin alfa NEUPOGEN SOLUTION 300 MCG/0.5ML filgrastim NEUPOGEN SOLUTION 300 MCG/ML filgrastim NEUPOGEN SOLUTION 480 MCG/0.8ML filgrastim NEUPOGEN SOLUTION 480 MCG/1.6ML filgrastim PROCRIT SOLUTION UNIT/ML epoetin alfa PROCRIT SOLUTION 2000 UNIT/ML epoetin alfa PROCRIT SOLUTION 3000 UNIT/ML epoetin alfa 35 / 35 days GE 38 LAST UPDATED 09/2015

39 PROCRIT SOLUTION 4000 UNIT/ML epoetin alfa PROCRIT SOLUTION UNIT/ML epoetin alfa DRUG DESCRIPTION (RX) Platelet Modifying Agents (BLOOD THINNERS) cilostazol tab 100 mg cilostazol tab 50 mg clopidogrel bisulfate tab 300 mg (base equiv) 5 / 90 days clopidogrel bisulfate tab 75 mg (base equiv) 30 / 30 days dipyridamole tab 25 mg dipyridamole tab 50 mg dipyridamole tab 75 mg EFFIENT TAB 10 MG prasugrel hcl EFFIENT TAB 5 MG prasugrel hcl ticlopidine hcl tab 250 mg TICLOPIDINE HCL TAB 250 MG ticlopidine hcl Cardiovascular Agents (HEART AND CIRCULATION CONDITIONS DRUGS) Alpha-adrenergic Agonists (HEART AND CIRCULATION CONDITIONS DRUGS) clonidine hcl tab 0.1 mg clonidine hcl tab 0.2 mg clonidine hcl tab 0.3 mg guanfacine hcl tab 1 mg guanfacine hcl tab 2 mg methyldopa tab 250 mg methyldopa tab 500 mg midodrine hcl tab 10 mg 120 / 30 days midodrine hcl tab 2.5 mg 30 / 30 days midodrine hcl tab 5 mg 240 / 30 days GE 39 LAST UPDATED 09/2015

40 Alpha-adrenergic Blocking Agents (BLOOD PRESSURE DRUGS) prazosin hcl cap 1 mg prazosin hcl cap 2 mg prazosin hcl cap 5 mg ANGIOTENSIN II RECEPTOR ANTAGONISTS (BLOOD PRESSURE DRUGS) irbesartan tab 150 mg 30 / 30 days irbesartan tab 300 mg 30 / 30 days irbesartan tab 75 mg 30 / 30 days irbesartan-hydrochlorothiazide tab mg 30 / 30 days irbesartan-hydrochlorothiazide tab mg 30 / 30 days losartan potassium & hydrochlorothiazide tab mg 30 / 30 days losartan potassium & hydrochlorothiazide tab mg 30 / 30 days losartan potassium & hydrochlorothiazide tab mg 30 / 30 days losartan potassium tab 100 mg 30 / 30 days losartan potassium tab 25 mg 30 / 30 days losartan potassium tab 50 mg 30 / 30 days Angiotensin-converting Enzyme (ACE) Inhibitors (BLOOD PRESSURE DRUGS) benazepril & hydrochlorothiazide tab mg 30 / 30 days benazepril & hydrochlorothiazide tab mg 30 / 30 days benazepril & hydrochlorothiazide tab mg 30 / 30 days benazepril & hydrochlorothiazide tab mg 30 / 30 days benazepril hcl tab 10 mg 30 / 30 days benazepril hcl tab 20 mg 30 / 30 days benazepril hcl tab 40 mg benazepril hcl tab 5 mg 30 / 30 days captopril & hydrochlorothiazide tab mg 30 / 30 days captopril & hydrochlorothiazide tab mg 30 / 30 days GE 40 LAST UPDATED 09/2015

41 captopril & hydrochlorothiazide tab mg 30 / 30 days captopril & hydrochlorothiazide tab mg 30 / 30 days captopril tab 100 mg captopril tab 12.5 mg 90 / 30 days captopril tab 25 mg 90 / 30 days captopril tab 50 mg 90 / 30 days CAPTOPRIL-HYDROCHLOROTHIAZIDE TAB MG captopril & hydrochlorothiazide CAPTOPRIL-HYDROCHLOROTHIAZIDE TAB MG captopril & hydrochlorothiazide CAPTOPRIL-HYDROCHLOROTHIAZIDE TAB MG captopril & hydrochlorothiazide CAPTOPRIL-HYDROCHLOROTHIAZIDE TAB MG captopril & hydrochlorothiazide 30 / 30 days 30 / 30 days 30 / 30 days 30 / 30 days enalapril maleate & hydrochlorothiazide tab mg 30 / 30 days enalapril maleate & hydrochlorothiazide tab mg 30 / 30 days enalapril maleate tab 10 mg 30 / 30 days enalapril maleate tab 2.5 mg 30 / 30 days enalapril maleate tab 20 mg enalapril maleate tab 5 mg 30 / 30 days fosinopril sodium tab 10 mg 30 / 30 days fosinopril sodium tab 20 mg 30 / 30 days fosinopril sodium tab 40 mg lisinopril & hydrochlorothiazide tab mg 30 / 30 days lisinopril & hydrochlorothiazide tab mg 30 / 30 days lisinopril & hydrochlorothiazide tab mg 30 / 30 days lisinopril tab 10 mg 30 / 30 days lisinopril tab 2.5 mg 30 / 30 days lisinopril tab 20 mg 30 / 30 days GE 41 LAST UPDATED 09/2015

42 lisinopril tab 30 mg 30 / 30 days lisinopril tab 40 mg lisinopril tab 5 mg 30 / 30 days moexipril hcl tab 15 mg moexipril hcl tab 7.5 mg 30 / 30 days quinapril hcl tab 10 mg 30 / 30 days quinapril hcl tab 20 mg 30 / 30 days quinapril hcl tab 40 mg quinapril hcl tab 5 mg 30 / 30 days quinapril-hydrochlorothiazide tab mg 30 / 30 days quinapril-hydrochlorothiazide tab mg 30 / 30 days quinapril-hydrochlorothiazide tab mg 30 / 30 days ramipril cap 1.25 mg 30 / 30 days ramipril cap 10 mg ramipril cap 2.5 mg 30 / 30 days ramipril cap 5 mg 30 / 30 days trandolapril tab 1 mg 30 / 30 days trandolapril tab 2 mg 30 / 30 days trandolapril tab 4 mg ANTIARRHYTHMICS (HEART REGULATION DRUGS) amiodarone hcl tab 200 mg disopyramide phosphate cap 100 mg disopyramide phosphate cap 150 mg flecainide acetate tab 100 mg flecainide acetate tab 150 mg flecainide acetate tab 50 mg NORCE CR CAP ER 12H 100 MG disopyramide phosphate NORCE CR CAP ER 12H 150 MG disopyramide phosphate 60 / 30 days 120 / 30 days GE 42 LAST UPDATED 09/2015

43 propafenone hcl tab 150 mg propafenone hcl tab 225 mg propafenone hcl tab 300 mg quinidine gluconate tab cr 324 mg quinidine sulfate tab 200 mg QUINIDINE SULFATE TAB 200 MG quinidine sulfate quinidine sulfate tab 300 mg sotalol hcl (afib/afl) tab 120 mg sotalol hcl (afib/afl) tab 160 mg sotalol hcl (afib/afl) tab 80 mg sotalol hcl tab 120 mg sotalol hcl tab 160 mg sotalol hcl tab 240 mg sotalol hcl tab 80 mg Beta-adrenergic Blocking Agents (BLOOD PRESSURE DRUGS) acebutolol hcl cap 200 mg acebutolol hcl cap 400 mg atenolol & chlorthalidone tab mg atenolol & chlorthalidone tab mg atenolol tab 100 mg atenolol tab 25 mg atenolol tab 50 mg bisoprolol & hydrochlorothiazide tab mg bisoprolol & hydrochlorothiazide tab mg bisoprolol & hydrochlorothiazide tab mg bisoprolol fumarate tab 10 mg bisoprolol fumarate tab 5 mg BYSTOLIC TAB 10 MG nebivolol hcl BYSTOLIC TAB 2.5 MG nebivolol hcl GE 43 LAST UPDATED 09/2015

44 BYSTOLIC TAB 20 MG nebivolol hcl BYSTOLIC TAB 5 MG nebivolol hcl carvedilol tab 12.5 mg carvedilol tab 25 mg carvedilol tab mg carvedilol tab 6.25 mg labetalol hcl tab 100 mg labetalol hcl tab 200 mg labetalol hcl tab 300 mg metoprolol & hydrochlorothiazide tab mg metoprolol & hydrochlorothiazide tab mg metoprolol & hydrochlorothiazide tab mg metoprolol succinate tab sr 24hr 100 mg 30 / 30 days metoprolol succinate tab sr 24hr 200 mg 30 / 30 days metoprolol succinate tab sr 24hr 25 mg 30 / 30 days metoprolol succinate tab sr 24hr 50 mg 30 / 30 days metoprolol tartrate tab 100 mg metoprolol tartrate tab 25 mg metoprolol tartrate tab 50 mg nadolol tab 20 mg nadolol tab 40 mg nadolol tab 80 mg pindolol tab 10 mg pindolol tab 5 mg propranolol hcl cap sr 24hr 120 mg propranolol hcl cap sr 24hr 160 mg propranolol hcl cap sr 24hr 60 mg propranolol hcl cap sr 24hr 80 mg propranolol hcl tab 10 mg GE 44 LAST UPDATED 09/2015

45 propranolol hcl tab 20 mg propranolol hcl tab 40 mg propranolol hcl tab 60 mg propranolol hcl tab 80 mg PROPRANOLOL-HCTZ TAB MG propranolol & hydrochlorothiazide PROPRANOLOL-HCTZ TAB MG propranolol & hydrochlorothiazide Calcium Channel Blocking Agents (BLOOD PRESSURE DRUGS) 30 / 30 days 30 / 30 days amlodipine besylate tab 10 mg 30 / 30 days amlodipine besylate tab 2.5 mg 30 / 30 days amlodipine besylate tab 5 mg 30 / 30 days amlodipine besylate-benazepril hcl cap mg 30 / 30 days amlodipine besylate-benazepril hcl cap mg 30 / 30 days amlodipine besylate-benazepril hcl cap mg 30 / 30 days amlodipine besylate-benazepril hcl cap 5-10 mg 30 / 30 days amlodipine besylate-benazepril hcl cap 5-20 mg 30 / 30 days amlodipine besylate-benazepril hcl cap 5-40 mg 30 / 30 days AZOR TAB MG amlodipine besylate-olmesartan medoxomil AZOR TAB MG amlodipine besylate-olmesartan medoxomil AZOR TAB 5-20 MG amlodipine besylate-olmesartan medoxomil AZOR TAB 5-40 MG amlodipine besylate-olmesartan medoxomil 30 / 30 days 30 / 30 days 30 / 30 days 30 / 30 days diltiazem hcl cap sr 12hr 120 mg 60 / 30 days diltiazem hcl cap sr 12hr 60 mg 60 / 30 days diltiazem hcl cap sr 12hr 90 mg 60 / 30 days GE 45 LAST UPDATED 09/2015

46 diltiazem hcl cap sr 24hr 120 mg 30 / 30 days diltiazem hcl cap sr 24hr 180 mg 30 / 30 days diltiazem hcl cap sr 24hr 240 mg 30 / 30 days diltiazem hcl coated beads cap sr 24hr 120 mg 30 / 30 days diltiazem hcl coated beads cap sr 24hr 180 mg 30 / 30 days diltiazem hcl coated beads cap sr 24hr 240 mg 30 / 30 days diltiazem hcl coated beads cap sr 24hr 300 mg 30 / 30 days diltiazem hcl extended release beads cap sr 24hr 120 mg 30 / 30 days diltiazem hcl extended release beads cap sr 24hr 180 mg 30 / 30 days diltiazem hcl extended release beads cap sr 24hr 240 mg 30 / 30 days diltiazem hcl extended release beads cap sr 24hr 300 mg 30 / 30 days diltiazem hcl extended release beads cap sr 24hr 360 mg 30 / 30 days diltiazem hcl extended release beads cap sr 24hr 420 mg 30 / 30 days diltiazem hcl tab 120 mg diltiazem hcl tab 30 mg diltiazem hcl tab 60 mg diltiazem hcl tab 90 mg felodipine tab sr 24hr 10 mg 30 / 30 days felodipine tab sr 24hr 2.5 mg 30 / 30 days felodipine tab sr 24hr 5 mg 30 / 30 days nicardipine hcl cap 20 mg nicardipine hcl cap 30 mg nifedipine cap 10 mg nifedipine cap 20 mg nifedipine tab sr 24hr 30 mg 30 / 30 days nifedipine tab sr 24hr 60 mg 30 / 30 days nifedipine tab sr 24hr 90 mg 30 / 30 days GE 46 LAST UPDATED 09/2015

47 nifedipine tab sr 24hr osmotic 30 mg 30 / 30 days nifedipine tab sr 24hr osmotic 60 mg 30 / 30 days nifedipine tab sr 24hr osmotic 90 mg 30 / 30 days nimodipine cap 30 mg verapamil hcl cap sr 24hr 100 mg 30 / 30 days verapamil hcl cap sr 24hr 120 mg 30 / 30 days verapamil hcl cap sr 24hr 180 mg 30 / 30 days verapamil hcl cap sr 24hr 200 mg 30 / 30 days verapamil hcl cap sr 24hr 240 mg 30 / 30 days verapamil hcl cap sr 24hr 300 mg 30 / 30 days verapamil hcl cap sr 24hr 360 mg 30 / 30 days verapamil hcl tab 120 mg VERAMIL HCL TAB 40 MG verapamil hcl verapamil hcl tab 80 mg verapamil hcl tab cr 120 mg 30 / 30 days verapamil hcl tab cr 180 mg 30 / 30 days verapamil hcl tab cr 240 mg 30 / 30 days Cardiovascular Agents, Other (MISCELLANEOUS HEART AND CIRCULATION DRUGS) digoxin tab 125 mcg (0.125 mg) digoxin tab 250 mcg (0.25 mg) pentoxifylline tab cr 400 mg 90 / 30 days Diuretics, Carbonic Anhydrase Inhibitors (BLOOD PRESSURE DRUGS (WATER PILLS)) ACETAZOLAMIDE TAB 125 MG acetazolamide acetazolamide tab 250 mg methazolamide tab 25 mg methazolamide tab 50 mg GE 47 LAST UPDATED 09/2015

48 DIURETICS, LOOP (BLOOD PRESSURE DRUGS (WATER PILLS)) bumetanide tab 0.5 mg bumetanide tab 1 mg bumetanide tab 2 mg furosemide inj 10 mg/ml furosemide oral soln 10 mg/ml furosemide tab 20 mg furosemide tab 40 mg furosemide tab 80 mg torsemide tab 10 mg torsemide tab 100 mg torsemide tab 20 mg torsemide tab 5 mg Diuretics, Potassium-sparing (BLOOD PRESSURE DRUGS (WATER PILLS)) amiloride & hydrochlorothiazide tab 5-50 mg amiloride hcl tab 5 mg spironolactone & hydrochlorothiazide tab mg spironolactone tab 100 mg spironolactone tab 25 mg spironolactone tab 50 mg triamterene & hydrochlorothiazide cap mg triamterene & hydrochlorothiazide tab mg triamterene & hydrochlorothiazide tab mg TRIAMTERENE-HCTZ CAP MG triamterene & hydrochlorothiazide DIURETICS, THIAZIDE (BLOOD PRESSURE DRUGS (WATER PILLS)) chlorothiazide tab 250 mg CHLOROTHIAZIDE TAB 250 MG chlorothiazide chlorothiazide tab 500 mg CHLORTHALIDONE TAB 25 MG chlorthalidone GE 48 LAST UPDATED 09/2015

49 CHLORTHALIDONE TAB 50 MG chlorthalidone hydrochlorothiazide cap 12.5 mg hydrochlorothiazide tab 25 mg hydrochlorothiazide tab 50 mg indapamide tab 1.25 mg indapamide tab 2.5 mg METHYCLOTHIAZIDE TAB 5 MG methyclothiazide metolazone tab 10 mg metolazone tab 2.5 mg metolazone tab 5 mg Dyslipidemics, Fibric Acid Derivatives (CHOLESTEROL DRUGS) fenofibrate micronized cap 134 mg fenofibrate micronized cap 200 mg fenofibrate micronized cap 67 mg fenofibrate tab 160 mg 30 / 30 days fenofibrate tab 54 mg 30 / 30 days gemfibrozil tab 600 mg Dyslipidemics, HMG CoA Reductase Inhibitors atorvastatin calcium tab 10 mg (base equivalent) 30 / 30 days atorvastatin calcium tab 20 mg (base equivalent) 30 / 30 days atorvastatin calcium tab 40 mg (base equivalent) 30 / 30 days atorvastatin calcium tab 80 mg (base equivalent) 30 / 30 days lovastatin tab 10 mg lovastatin tab 20 mg lovastatin tab 40 mg pravastatin sodium tab 10 mg pravastatin sodium tab 20 mg pravastatin sodium tab 40 mg GE 49 LAST UPDATED 09/2015

50 pravastatin sodium tab 80 mg simvastatin tab 10 mg 30 / 30 days simvastatin tab 20 mg 30 / 30 days simvastatin tab 40 mg 30 / 30 days simvastatin tab 5 mg 30 / 30 days Dyslipidemics, Other (CHOLESTEROL DRUGS) cholestyramine light powder 4 gm/dose cholestyramine powder 4 gm/dose colestipol hcl granules 5 gm colestipol hcl tab 1 gm NIACOR TAB 500 MG niacin (antihyperlipidemic) Vasodilators, Direct-acting Arterial (MISCELLANEOUS HEART AND CIRCULATION DRUGS) hydralazine hcl tab 10 mg hydralazine hcl tab 100 mg hydralazine hcl tab 25 mg hydralazine hcl tab 50 mg minoxidil tab 10 mg minoxidil tab 2.5 mg Vasodilators, Direct-acting Arterial/Venous (CHEST IN DRUGS) ISOSORBIDE DINITRATE ER TAB ER 40 MG isosorbide dinitrate isosorbide dinitrate tab 10 mg isosorbide dinitrate tab 20 mg isosorbide dinitrate tab 30 mg ISOSORBIDE DINITRATE TAB 30 MG isosorbide dinitrate isosorbide dinitrate tab 5 mg isosorbide dinitrate tab cr 40 mg isosorbide mononitrate tab 20 mg isosorbide mononitrate tab sr 24hr 120 mg GE 50 LAST UPDATED 09/2015

51 isosorbide mononitrate tab sr 24hr 30 mg isosorbide mononitrate tab sr 24hr 60 mg NITRO-BID OINTMENT 2 % nitroglycerin nitroglycerin td patch 24hr 0.1 mg/hr nitroglycerin td patch 24hr 0.2 mg/hr nitroglycerin td patch 24hr 0.4 mg/hr nitroglycerin td patch 24hr 0.6 mg/hr NITROSTAT SL TAB 0.3 MG nitroglycerin NITROSTAT SL TAB 0.4 MG nitroglycerin NITROSTAT SL TAB 0.6 MG nitroglycerin CENTRAL NERVOUS SYSTEM AGENTS (NERVE CONDITIONS DRUGS) Attention Deficit Hyperactivity Disorder Agents, Amphetamines (ADHD DRUGS) amphetamine-dextroamphetamine cap sr 24hr 10 mg amphetamine-dextroamphetamine cap sr 24hr 15 mg amphetamine-dextroamphetamine cap sr 24hr 20 mg amphetamine-dextroamphetamine cap sr 24hr 25 mg amphetamine-dextroamphetamine cap sr 24hr 30 mg amphetamine-dextroamphetamine cap sr 24hr 5 mg ST AL1 ST AL1 ST AL1 ST AL1 ST AL1 ST AL1 30 / 30 days 6 to 17 yrs old 30 / 30 days 6 to 17 yrs old 30 / 30 days 6 to 17 yrs old 30 / 30 days 6 to 17 yrs old 30 / 30 days 6 to 17 yrs old 30 / 30 days 6 to 17 yrs old GE 51 LAST UPDATED 09/2015

52 amphetamine-dextroamphetamine tab 10 mg AL1 6 to 17 yrs old amphetamine-dextroamphetamine tab 12.5 mg AL1 6 to 17 yrs old amphetamine-dextroamphetamine tab 15 mg AL1 6 to 17 yrs old amphetamine-dextroamphetamine tab 20 mg AL1 6 to 17 yrs old amphetamine-dextroamphetamine tab 30 mg AL1 6 to 17 yrs old amphetamine-dextroamphetamine tab 5 mg AL1 6 to 17 yrs old amphetamine-dextroamphetamine tab 7.5 mg AL1 6 to 17 yrs old dextroamphetamine sulfate cap sr 24hr 10 mg dextroamphetamine sulfate cap sr 24hr 15 mg dextroamphetamine sulfate cap sr 24hr 5 mg dextroamphetamine sulfate tab 10 mg ST AL1 ST AL1 ST AL1 ST AL1 6 to 17 yrs old 6 to 17 yrs old 6 to 17 yrs old 6 to 17 yrs old dextroamphetamine sulfate tab 5 mg AL1 6 to 17 yrs old Attention Deficit Hyperactivity Disorder Agents, Non-amphetamines (ADHD DRUGS) dexmethylphenidate hcl tab 10 mg AL1 6 to 17 yrs old dexmethylphenidate hcl tab 2.5 mg AL1 6 to 17 yrs old dexmethylphenidate hcl tab 5 mg AL1 6 to 17 yrs old methylphenidate hcl cap cr 10 mg methylphenidate hcl cap cr 20 mg methylphenidate hcl cap cr 30 mg methylphenidate hcl cap cr 40 mg AL1 AL1 AL1 AL1 30 / 30 days 6 to 17 yrs old 30 / 30 days 6 to 17 yrs old 30 / 30 days 6 to 17 yrs old 30 / 30 days 6 to 17 yrs old GE 52 LAST UPDATED 09/2015

53 methylphenidate hcl cap cr 50 mg methylphenidate hcl cap cr 60 mg methylphenidate hcl tab 10 mg methylphenidate hcl tab 20 mg methylphenidate hcl tab 5 mg methylphenidate hcl tab cr 10 mg methylphenidate hcl tab cr 20 mg AL1 AL1 AL1 AL1 AL1 AL1 AL1 30 / 30 days 6 to 17 yrs old 30 / 30 days 6 to 17 yrs old 180 / 30 days 6 to 17 yrs old 90 / 30 days 6 to 17 yrs old 90 / 30 days 6 to 17 yrs old 30 / 30 days 6 to 17 yrs old 90 / 30 days 6 to 17 yrs old Central Nervous System, Other (MISCELLANEOUS NERVE CONDITIONS DRUGS) butalbital-acetaminophen-caff w/ cod cap mg MULTIPLE SCLEROSIS AGENTS (MULTIPLE SCLEROSIS DRUGS) AVONEX KIT 30 MCG interferon beta-1a BETASERON KIT 0.3 MG interferon beta-1b EXTAVIA KIT 0.3 MG interferon beta-1b glatiramer acetate soln prefilled syringe 20 mg/ml Dental and Oral Agents (DRUGS FOR THE MOUTH) chlorhexidine gluconate soln 0.12% pilocarpine hcl tab 5 mg triamcinolone acetonide dental paste 0.1% Dermatological Agents alclometasone dipropionate cream 0.05% alclometasone dipropionate oint 0.05% GE 53 LAST UPDATED 09/2015

54 betamethasone dipropionate augmented cream 0.05% betamethasone dipropionate cream 0.05% 90 / 30 days betamethasone dipropionate lotion 0.05% 120 / 30 days betamethasone dipropionate oint 0.05% 90 / 30 days betamethasone valerate cream 0.1% 90 / 30 days betamethasone valerate lotion 0.1% 120 / 30 days betamethasone valerate oint 0.1% 90 / 30 days clindamycin phosphate lotion 1% clindamycin phosphate soln 1% clindamycin phosphate swab 1% clobetasol propionate soln 0.05% DERMA-SMOOTHE/FS BODY OIL 0.01 % fluocinolone acetonide DERMA-SMOOTHE/FS SCALP OIL 0.01 % fluocinolone acetonide 120 / 30 days 120 / 30 days desonide oint 0.05% 120 / 30 days fluocinolone acetonide cream 0.01% 120 / 30 days fluocinolone acetonide cream 0.025% 120 / 30 days fluocinolone acetonide oint 0.025% 120 / 30 days fluocinonide cream 0.05% 120 / 30 days fluocinonide emulsified base cream 0.05% 120 / 30 days fluocinonide gel 0.05% 120 / 30 days fluocinonide oint 0.05% 120 / 30 days fluocinonide soln 0.05% 120 / 30 days fluorouracil cream 5% fluorouracil soln 2% fluorouracil soln 5% fluticasone propionate cream 0.05% 120 / 30 days GE 54 LAST UPDATED 09/2015

55 fluticasone propionate oint 0.005% 120 / 30 days GAUZE SPONGE D 4"X4" gauze pads & dressings 60 / 30 days halobetasol propionate cream 0.05% halobetasol propionate oint 0.05% hydrocortisone cream 0.5% 60 / 30 days hydrocortisone cream 1% 120 / 30 days hydrocortisone cream 2.5% 90 / 30 days hydrocortisone lotion 1% 240 / 30 days hydrocortisone lotion 2.5% 120 / 30 days hydrocortisone oint 0.5% 60 / 30 days hydrocortisone oint 1% 60 / 30 days hydrocortisone oint 2.5% 90 / 30 days hydrocortisone rectal cream 2.5% hydrocortisone valerate cream 0.2% 120 / 30 days hydrocortisone valerate oint 0.2% 120 / 30 days lactic acid (ammonium lactate) cream 12% lactic acid (ammonium lactate) lotion 10% lactic acid (ammonium lactate) lotion 12% lactic acid (ammonium lactate) lotion 5% 226 / 30 days mometasone furoate cream 0.1% 60 / 30 days mometasone furoate oint 0.1% 60 / 30 days mometasone furoate solution 0.1% (lotion) 60 / 30 days podofilox soln 0.5% prednicarbate oint 0.1% 60 / 30 days SANTYL OINTMENT 250 UNIT/GM collagenase selenium sulfide lotion 2.5% 60 / 30 days GE 55 LAST UPDATED 09/2015

56 sulfacetamide sodium lotion 10% (acne) SURGICAL DRESSING D 5"X9" gauze pads & dressings tretinoin cream 0.025% tretinoin cream 0.05% tretinoin cream 0.1% tretinoin gel 0.01% tretinoin gel 0.025% AL1 AL1 AL1 AL1 AL1 60 / 30 days 45 / 30 days Up to 29 yrs old 45 / 30 days Up to 29 yrs old 45 / 30 days Up to 29 yrs old 45 / 30 days Up to 29 yrs old 45 / 30 days Up to 29 yrs old triamcinolone acetonide cream 0.025% 160 / 30 days triamcinolone acetonide cream 0.1% 160 / 30 days triamcinolone acetonide cream 0.5% 60 / 30 days triamcinolone acetonide lotion 0.025% 120 / 30 days triamcinolone acetonide lotion 0.1% 120 / 30 days triamcinolone acetonide oint 0.025% 160 / 30 days triamcinolone acetonide oint 0.1% 160 / 30 days TRIAMCINOLONE ACETONIDE OINTMENT 0.5 % triamcinolone acetonide (topical) Enzyme Replacement/Modifiers (ENZYME DEFICIENCY DRUGS) CREON CP DR RT UNIT pancrelipase (lipase-protease-amylase) CREON CP DR RT UNIT pancrelipase (lipase-protease-amylase) CREON CP DR RT UNIT pancrelipase (lipase-protease-amylase) CREON CP DR RT UNIT pancrelipase (lipase-protease-amylase) 60 / 30 days GE 56 LAST UPDATED 09/2015

57 CREON CP DR RT 6000 UNIT pancrelipase (lipase-protease-amylase) NCREAZE CP DR RT UNIT pancrelipase (lipase-protease-amylase) NCREAZE CP DR RT UNIT pancrelipase (lipase-protease-amylase) NCREAZE CP DR RT UNIT pancrelipase (lipase-protease-amylase) NCREAZE CP DR RT 4200 UNIT pancrelipase (lipase-protease-amylase) NCRELISE (LIP-PROT-AMYL) CP DR RT 5000 UNIT pancrelipase (lipase-protease-amylase) PERTZYE CP DR RT UNIT pancrelipase (lipase-protease-amylase) PERTZYE CP DR RT 8000 UNIT pancrelipase (lipase-protease-amylase) ULTRESA CP DR RT UNIT pancrelipase (lipase-protease-amylase) ULTRESA CP DR RT UNIT pancrelipase (lipase-protease-amylase) ULTRESA CP DR RT UNIT pancrelipase (lipase-protease-amylase) VIOKACE TAB UNIT pancrelipase (lipase-protease-amylase) VIOKACE TAB UNIT pancrelipase (lipase-protease-amylase) ZENPEP CP DR RT UNIT pancrelipase (lipase-protease-amylase) ZENPEP CP DR RT UNIT pancrelipase (lipase-protease-amylase) ZENPEP CP DR RT UNIT pancrelipase (lipase-protease-amylase) ZENPEP CP DR RT UNIT pancrelipase (lipase-protease-amylase) ZENPEP CP DR RT UNIT pancrelipase (lipase-protease-amylase) ZENPEP CP DR RT 5000 UNIT pancrelipase (lipase-protease-amylase) GE 57 LAST UPDATED 09/2015

58 GASTROINTESTINAL Agents (BOWEL, INSTESTINE, AND STOMACH CONDITIONS DRUGS) ANTISSMODICS, GASTROINTESTINAL (BOWEL TREATMENT DRUGS) dicyclomine hcl cap 10 mg dicyclomine hcl tab 20 mg glycopyrrolate tab 1 mg glycopyrrolate tab 2 mg Gastrointestinal Agents, Other (MISCELLANEOUS DIGESTIVE SYSTEM DRUGS) diphenoxylate w/ atropine tab mg DIPHENOXYLATE-ATROPINE LIQUID MG/5ML diphenoxylate w/ atropine loperamide hcl cap 2 mg loperamide hcl tab 2 mg metoclopramide hcl soln 5 mg/5ml (10 mg/10ml) metoclopramide hcl tab 10 mg metoclopramide hcl tab 5 mg ursodiol cap 300 mg Histamine2 (H2) Receptor Antagonists (ULCER AND STOMACH ACID DRUGS) cimetidine hcl soln 300 mg/5ml cimetidine tab 200 mg cimetidine tab 300 mg cimetidine tab 400 mg cimetidine tab 800 mg famotidine inj 20 mg/2ml famotidine inj 200 mg/20ml famotidine inj 40 mg/4ml FAMOTIDINE SOLUTION 500 MG/50ML famotidine famotidine tab 10 mg famotidine tab 20 mg famotidine tab 40 mg ranitidine hcl syrup 15 mg/ml (75 mg/5ml) GE 58 LAST UPDATED 09/2015

59 ranitidine hcl tab 150 mg ranitidine hcl tab 300 mg LAXATIVES (CONSTITION DRUGS) COLYTE WITH FLAVOR CKS 240 GM peg 3350-kcl-sod bicarb-sod chloride-sod sulfate COLYTE WITH FLAVOR CKS RECON SOLN 240 GM peg 3350-kcl-sod bicarb-sod chloride-sod sulfate GOLYTELY RECON SOLN 236 GM peg 3350-kcl-sod bicarb-sod chloride-sod sulfate lactulose solution 10 gm/15ml NULYTELY WITH FLAVOR CKS RECON SOLN 420 GM peg 3350-potassium chloride-sod bicarbonate-sod chloride peg 3350-kcl-na bicarb-nacl-na sulfate for soln 236 gm peg 3350-kcl-na bicarb-nacl-na sulfate for soln 240 gm peg 3350-kcl-sod bicarb-nacl for soln 420 gm polyethylene glycol 3350 oral packet polyethylene glycol 3350 oral powder PROTECTANTS (MISCELLANEOUS DIGESTIVE SYSTEM DRUGS) misoprostol tab 100 mcg misoprostol tab 200 mcg sucralfate tab 1 gm PROTON PUMP INHIBITORS (ULCER AND STOMACH ACID DRUGS) AL1 AL1 AL1 AL1 AL1 AL1 AL / 365 days 50 to 75 yrs old 4000 / 365 days 50 to 75 yrs old 4000 / 365 days 50 to 75 yrs old 4000 / 365 days 50 to 75 yrs old 4000 / 365 days 50 to 75 yrs old 4000 / 365 days 50 to 75 yrs old 4000 / 365 days 50 to 75 yrs old lansoprazole cap delayed release 15 mg 60 / 30 days lansoprazole cap delayed release 30 mg 30 / 30 days omeprazole cap delayed release 20 mg 60 / 30 days GE 59 LAST UPDATED 09/2015

60 omeprazole cap delayed release 40 mg 30 / 30 days pantoprazole sodium ec tab 20 mg (base equiv) 30 / 30 days pantoprazole sodium ec tab 40 mg (base equiv) 60 / 30 days Genitourinary Agents (BLADDER, GENITAL, AND KIDNEY CONDITIONS DRUGS) Antispasmodics, Urinary (BLADDER MUSCLE RELAXANTS) oxybutynin chloride syrup 5 mg/5ml oxybutynin chloride tab 5 mg oxybutynin chloride tab sr 24hr 10 mg oxybutynin chloride tab sr 24hr 15 mg oxybutynin chloride tab sr 24hr 5 mg OXYTROL FOR WOMEN TCH TW 3.9 MG/24HR oxybutynin OXYTROL TCH TW 3.9 MG/24HR oxybutynin tolterodine tartrate cap sr 24hr 2 mg tolterodine tartrate cap sr 24hr 4 mg tolterodine tartrate tab 1 mg tolterodine tartrate tab 2 mg ST ST ST ST BENIGN PROSTATIC HYPERTROPHY AGENTS (PROSTATE DRUGS) alfuzosin hcl tab sr 24hr 10 mg ST doxazosin mesylate tab 1 mg doxazosin mesylate tab 2 mg doxazosin mesylate tab 4 mg doxazosin mesylate tab 8 mg finasteride tab 5 mg terazosin hcl cap 1 mg terazosin hcl cap 10 mg terazosin hcl cap 2 mg terazosin hcl cap 5 mg GE 60 LAST UPDATED 09/2015

61 Genitourinary Agents, Other (MISCELLANEOUS BLADDER, GENITAL, AND KIDNEY CONDITIONS DRUGS) bethanechol chloride tab 10 mg bethanechol chloride tab 25 mg bethanechol chloride tab 5 mg bethanechol chloride tab 50 mg PHOSPHATE BINDERS (PHOSPHATE REMOVING DRUGS) calcium acetate (phosphate binder) cap 667 mg (169 mg ca) calcium acetate (phosphate binder) tab 667 mg ELIPHOS TAB 667 MG calcium acetate (phosphate binder) Hormonal Agents, Stimulant/Replacement/Modifying (Adrenal) clotrimazole w/ betamethasone cream % 90 / 24 days clotrimazole w/ betamethasone lotion % 60 / 24 days CORTISONE ACETATE TAB 25 MG cortisone acetate dexamethasone elixir 0.5 mg/5ml DEXAMETHASONE INTENSOL CONC 1 MG/ML dexamethasone dexamethasone tab 0.5 mg dexamethasone tab 0.75 mg dexamethasone tab 1.5 mg DEXAMETHASONE TAB 2 MG dexamethasone dexamethasone tab 4 mg dexamethasone tab 6 mg fludrocortisone acetate tab 0.1 mg hydrocortisone rectal cream 1% hydrocortisone rectal cream 2.5% hydrocortisone tab 10 mg hydrocortisone tab 20 mg hydrocortisone tab 5 mg methylprednisolone tab 4 mg GE 61 LAST UPDATED 09/2015

62 methylprednisolone tab 4 mg dose pack methylprednisolone tab 8 mg prednisolone sod phosphate oral soln 15 mg/5ml (base equiv) prednisolone syrup 15 mg/5ml (usp solution equivalent) PREDNISONE (K) TAB 10 MG prednisone PREDNISONE (K) TAB 5 MG prednisone PREDNISONE SOLUTION 5 MG/5ML prednisone prednisone tab 1 mg prednisone tab 10 mg prednisone tab 10 mg dose pack prednisone tab 2.5 mg prednisone tab 20 mg prednisone tab 5 mg prednisone tab 5 mg dose pack PREDNISONE TAB 50 MG prednisone Hormonal Agents, Stimulant/Replacement/Modifying (Pituitary) desmopressin acetate nasal spray soln 0.01% desmopressin acetate nasal spray soln 0.01% (refrigerated) desmopressin acetate tab 0.1 mg desmopressin acetate tab 0.2 mg Hormonal Agents, Stimulant/Replacement/Modifying (Sex Hormones/Modifiers) ANDROGENS (MALE HORMONE DRUGS) testosterone cypionate im inj in oil 100 mg/ml testosterone cypionate im inj in oil 200 mg/ml ESTROGENS (HORMONE REPLACEMENT/MODIFYING DRUGS) GL GL Male Male GE 62 LAST UPDATED 09/2015

63 desogest-ethin est tab / / mg-mg GL 37.5 / 28 days Female DRUG DESCRIPTION (RX) desogestrel & ethinyl estradiol tab 0.15 mg-30 mcg ESTRACE CREAM 0.1 MG/GM estradiol vaginal GL 37.5 / 28 days Female estradiol tab 0.5 mg GL Female estradiol tab 1 mg GL Female estradiol tab 2 mg GL Female estradiol td patch twice weekly mg/24hr estradiol td patch twice weekly mg/24hr estradiol td patch twice weekly 0.05 mg/24hr estradiol td patch twice weekly mg/24hr estradiol td patch twice weekly 0.1 mg/24hr estradiol td patch weekly mg/24hr estradiol td patch weekly mg/24hr (37.5 mcg/24hr) estradiol td patch weekly 0.05 mg/24hr estradiol td patch weekly 0.06 mg/24hr estradiol td patch weekly mg/24hr GL GL GL GL GL GL GL GL GL GL 8 / 28 days Female 8 / 28 days Female 8 / 28 days Female 8 / 28 days Female 8 / 28 days Female 4 / 21 days Female 4 / 21 days Female 4 / 21 days Female 4 / 21 days Female 4 / 21 days Female GE 63 LAST UPDATED 09/2015

64 estradiol td patch weekly 0.1 mg/24hr estropipate tab 0.75 mg estropipate tab 1.5 mg ESTROPITE TAB 3 MG estropipate ethynodiol diacetate & ethinyl estradiol tab 1 mg-35 mcg levonorgestrel & ethinyl estradiol (91-day) tab mg levonorgestrel & ethinyl estradiol tab 0.1 mg-20 mcg levonorgestrel & ethinyl estradiol tab 0.15 mg-30 mcg levonorgestrel-eth estra tab / / mg-mcg NECON 10/11 (28) TAB 35 MCG norethindrone-eth estradiol (biphasic) norethindrone & ethinyl estradiol tab 0.5 mg-35 mcg norethindrone & ethinyl estradiol tab 1 mg-35 mcg norethindrone ace & ethinyl estradiol tab 1 mg-20 mcg GL GL GL GL GL GL GL GL GL GL GL GL 4 / 21 days Female 21 / 28 days Female 21 / 28 days Female 21 / 28 days Female Female 91 / 91 days Female 37.5 / 28 days Female 37.5 / 28 days Female 37.5 / 28 days Female 37.5 / 28 days 37.5 / 28 days Female 37.5 / 28 days Female 28 / 28 days Female GE 64 LAST UPDATED 09/2015

65 norethindrone ace & ethinyl estradiol tab 1.5 mg-30 mcg norethindrone ace & ethinyl estradiol-fe tab 1 mg-20 mcg norethindrone ace & ethinyl estradiol-fe tab 1.5 mg-30 mcg norethindrone ace-ethinyl estradiol-fe tab 1 mg-20 mcg (24) norethindrone acetate-ethinyl estradiol tab 0.5 mg-2.5 mcg norethindrone acetate-ethinyl estradiol tab 1 mg-5 mcg norethindrone-eth estradiol tab / /1-35 mg-mcg norgestimate & ethinyl estradiol tab 0.25 mg-35 mcg norgestimate-eth estrad tab / / mg-mcg norgestrel & ethinyl estradiol tab 0.3 mg-30 mcg PREMARIN TAB 0.3 MG estrogens, conjugated PREMARIN TAB 0.45 MG estrogens, conjugated GL GL GL GL GL GL GL GL GL GL GL 28 / 28 days Female 37.5 / 28 days Female 37.5 / 28 days Female 37.5 / 28 days 28 / 28 days Female 21 / 28 days Female 37.5 / 28 days Female 37.5 / 28 days Female 37.5 / 28 days Female 37.5 / 28 days Female 30 / 30 days Female 30 / 30 days Female GE 65 LAST UPDATED 09/2015

66 PREMARIN TAB MG estrogens, conjugated PREMARIN TAB 0.9 MG estrogens, conjugated PREMARIN TAB 1.25 MG estrogens, conjugated PREMPHASE TAB MG conjugated estrogens-medroxyprogesterone acetate PREMPRO TAB MG conjugated estrogens-medroxyprogesterone acetate PREMPRO TAB MG conjugated estrogens-medroxyprogesterone acetate PREMPRO TAB MG conjugated estrogens-medroxyprogesterone acetate PREMPRO TAB MG conjugated estrogens-medroxyprogesterone acetate ZOVIA 1/50E (28) TAB 1-50 MG-MCG ethynodiol diacet & eth estrad PROGESTINS (HORMONE REPLACEMENT/MODIFYING DRUGS) DEPO-PROVERA SUSPENSION 150 MG/ML medroxyprogesterone acetate (contraceptive) furosemide inj 10 mg/ml magnesium sulfate inj 50% MAGNESIUM SULFATE SOLUTION 40 MG/ML magnesium sulfate MAGNESIUM SULFATE SOLUTION 80 MG/ML magnesium sulfate medroxyprogesterone acetate im susp 150 mg/ml medroxyprogesterone acetate tab 10 mg GL GL GL GL GL GL GL GL GL GL GL 30 / 30 days Female 30 / 30 days Female 30 / 30 days Female 30 / 30 days Female 30 / 30 days Female 30 / 30 days Female 30 / 30 days Female 30 / 30 days Female 37.5 / 28 days 1 / 90 days Female 1 / 90 days Female 30 / 30 days Female GE 66 LAST UPDATED 09/2015

67 medroxyprogesterone acetate tab 2.5 mg medroxyprogesterone acetate tab 5 mg megestrol acetate susp 40 mg/ml megestrol acetate tab 20 mg megestrol acetate tab 40 mg norethindrone acetate tab 5 mg norethindrone tab 0.35 mg Hormonal Agents, Stimulant/Replacement/Modifying (Thyroid) levothyroxine sodium tab 100 mcg levothyroxine sodium tab 112 mcg levothyroxine sodium tab 125 mcg levothyroxine sodium tab 137 mcg levothyroxine sodium tab 150 mcg levothyroxine sodium tab 175 mcg levothyroxine sodium tab 200 mcg levothyroxine sodium tab 25 mcg levothyroxine sodium tab 300 mcg levothyroxine sodium tab 50 mcg levothyroxine sodium tab 75 mcg levothyroxine sodium tab 88 mcg GL GL GL GL 28 / 28 days Female 120 / 30 days Female 60 / 30 days Female 37.5 / 28 days Female Hormonal Agents, Suppressant (Parathyroid) (DRUGS TO TREAT HIGH CALCIUM) SENSIR TAB 30 MG cinacalcet hcl SENSIR TAB 60 MG cinacalcet hcl GE 67 LAST UPDATED 09/2015

68 Hormonal Agents, Suppressant (Pituitary) (HORMONE AND DIABETIC DRUGS) ELIGARD KIT 22.5 MG leuprolide acetate (3 month) ELIGARD KIT 30 MG leuprolide acetate (4 month) ELIGARD KIT 45 MG leuprolide acetate (6 month) ELIGARD KIT 7.5 MG leuprolide acetate LUPRON DEPOT KIT MG leuprolide acetate (3 month) LUPRON DEPOT KIT 22.5 MG leuprolide acetate (3 month) LUPRON DEPOT KIT 3.75 MG leuprolide acetate LUPRON DEPOT KIT 30 MG leuprolide acetate (4 month) LUPRON DEPOT KIT 7.5 MG leuprolide acetate LUPRON DEPOT-PED KIT MG leuprolide acetate (cpp) LUPRON DEPOT-PED KIT 15 MG leuprolide acetate (cpp) LUPRON DEPOT-PED KIT 7.5 MG leuprolide acetate (cpp) Hormonal Agents, Suppressant (Thyroid) (HORMONE AND DIABETIC DRUGS) Antithyroid Agents (THYROID DRUGS) methimazole tab 10 mg methimazole tab 5 mg propylthiouracil tab 50 mg Immunological Agents (DRUGS AFFECTING THE IMMUNE SYSTEM) Immune Suppressants (IMMUNE SYSTEM DRUGS) azathioprine tab 50 mg CELLCEPT RECON SUSP 200 MG/ML mycophenolate mofetil cyclosporine cap 100 mg GE 68 LAST UPDATED 09/2015

69 cyclosporine cap 25 mg cyclosporine modified cap 100 mg cyclosporine modified cap 25 mg CYCLOSPORINE MODIFIED CAP 50 MG cyclosporine modified (for microemulsion) cyclosporine modified oral soln 100 mg/ml ENBREL KIT 25 MG etanercept ENBREL SOLN PRSYR 25 MG/0.5ML etanercept ENBREL SOLN PRSYR 50 MG/ML etanercept ENBREL SURECLICK SOLN A-INJ 50 MG/ML etanercept HUMIRA PEDIATRIC CROHNS START PREF SY KT 40 MG/0.8ML adalimumab HUMIRA PEN PEN KIT 40 MG/0.8ML adalimumab HUMIRA PEN-CROHNS STARTER PEN KIT 40 MG/0.8ML adalimumab HUMIRA PEN-PSORIASIS STARTER PEN KIT 40 MG/0.8ML adalimumab HUMIRA PREF SY KT 10 MG/0.2ML adalimumab HUMIRA PREF SY KT 20 MG/0.4ML adalimumab HUMIRA PREF SY KT 40 MG/0.8ML adalimumab methotrexate sodium tab 2.5 mg (base equiv) mycophenolate mofetil cap 250 mg mycophenolate mofetil for oral susp 200 mg/ml mycophenolate mofetil tab 500 mg tacrolimus cap 0.5 mg tacrolimus cap 1 mg tacrolimus cap 5 mg GE 69 LAST UPDATED 09/2015

70 Immunomodulators (IMMUNE SYSTEM DRUGS) leflunomide tab 10 mg leflunomide tab 20 mg SYNAGIS SOLUTION 100 MG/ML palivizumab SYNAGIS SOLUTION 50 MG/0.5ML palivizumab VACCINES (VACCINES) ZOSTAVAX RECON SOLN UNT/0.65ML zoster vaccine live AL1 At least 60 yrs old Inflammatory Bowel Disease Agents (BOWEL, INSTESTINE, AND STOMACH CONDITIONS DRUGS) Aminosalicylates (BOWEL TREATMENT DRUGS) APRISO CAP ER 24H GM mesalamine balsalazide disodium cap 750 mg 120 / 30 days mesalamine enema 4 gm 1800 / 30 days SFROWASA ENEMA 4 GM/60ML mesalamine Glucocorticoids (BOWEL TREATMENT DRUGS) hydrocortisone enema 100 mg/60ml Sulfonamides (BACTERIAL INFECTION DRUGS (ANTIBIOTICS)) sulfasalazine tab 500 mg sulfasalazine tab delayed release 500 mg Metabolic Bone Disease Agents (HORMONE AND BONE DRUGS) alendronate sodium tab 10 mg alendronate sodium tab 35 mg ALENDRONATE SODIUM TAB 40 MG alendronate sodium alendronate sodium tab 5 mg 1800 / 30 days alendronate sodium tab 70 mg 4 / 28 days calcitriol cap 0.25 mcg calcitriol cap 0.5 mcg GE 70 LAST UPDATED 09/2015

71 Miscellaneous Therapeutic Agents (Miscellaneous Drug Products) 1ST TIER UNIFINE PENTIPS MISC 29G X 12MM 1ST TIER UNIFINE PENTIPS MISC 31G X 5 MM 1ST TIER UNIFINE PENTIPS MISC 31G X 6 MM 1ST TIER UNIFINE PENTIPS MISC 31G X 8 MM 1ST TIER UNIFINE PENTIPS MISC 32G X 4 MM 1ST TIER UNIFINE PENTIPS PLUS MISC 29G X 12MM 1ST TIER UNIFINE PENTIPS PLUS MISC 31G X 5 MM 1ST TIER UNIFINE PENTIPS PLUS MISC 31G X 6 MM 1ST TIER UNIFINE PENTIPS PLUS MISC 31G X 8 MM 1ST TIER UNIFINE PENTIPS PLUS MISC 32G X 4 MM ADVOCATE INSULIN PEN NEEDLES MISC 31G X 5 MM ADVOCATE INSULIN PEN NEEDLES MISC 31G X 8 MM ADVOCATE INSULIN SYRINGE MISC 29G X 1/2" 0.3 ML ADVOCATE INSULIN SYRINGE MISC 29G X 1/2" 0.5 ML ADVOCATE INSULIN SYRINGE MISC 29G X 1/2" 1 ML ADVOCATE INSULIN SYRINGE MISC 30G X 5/16" 0.3 ML ADVOCATE INSULIN SYRINGE MISC 30G X 5/16" 0.5 ML ADVOCATE INSULIN SYRINGE MISC 30G X 5/16" 1 ML ADVOCATE INSULIN SYRINGE MISC 31G X 5/16" 0.3 ML GE 71 LAST UPDATED 09/2015

72 ADVOCATE INSULIN SYRINGE MISC 31G X 5/16" 0.5 ML ADVOCATE INSULIN SYRINGE MISC 31G X 5/16" 1 ML ANTI-STICK INSULIN SYRINGE MISC 29G X 1/2" 1 ML ASSURE ID INSULIN SAFETY SYR MISC 29G X 1/2" 0.5 ML ASSURE ID INSULIN SAFETY SYR MISC 29G X 1/2" 1 ML AURORA PEN NEEDLES MISC 29G X 12MM AURORA PEN NEEDLES MISC 31G X 6 MM AURORA PEN NEEDLES MISC 31G X 8 MM AURORA UNIFINE PENTIPS MISC 31G X 5 MM AURORA UNIFINE PENTIPS MISC 32G X 4 MM BD AUTOSHIELD DUO MISC 30G X 5 MM BD AUTOSHIELD MISC 29G X 12MM BD AUTOSHIELD MISC 29G X 5MM BD AUTOSHIELD MISC 29G X 8MM BD INSULIN SYR ULTRAFINE II MISC 31G X 5/16" 0.5 ML BD INSULIN SYR ULTRAFINE II MISC 31G X 5/16" 1 ML BD INSULIN SYRINGE HALF-UNIT MISC 31G X 5/16" 0.3 ML BD INSULIN SYRINGE MICROFINE MISC 27G X 5/8" 1 ML BD INSULIN SYRINGE MICROFINE MISC 28G X 1/2" 0.3 ML BD INSULIN SYRINGE MICROFINE MISC 28G X 1/2" 0.5 ML GE 72 LAST UPDATED 09/2015

73 BD INSULIN SYRINGE MICROFINE MISC 28G X 1/2" 1 ML BD INSULIN SYRINGE MISC 25G X 1" 1 ML BD INSULIN SYRINGE MISC 25G X 5/8" 1 ML BD INSULIN SYRINGE MISC 26G X 1/2" 1 ML BD INSULIN SYRINGE MISC 27G X 1/2" 1 ML BD INSULIN SYRINGE MISC 28G X 1/2" 1 ML BD INSULIN SYRINGE MISC 29G X 1/2" 0.5 ML BD INSULIN SYRINGE MISC 29G X 1/2" 1 ML BD INSULIN SYRINGE MISC 30G X 1/2" 0.5 ML BD INSULIN SYRINGE MISC 31G X 5/16" 0.3 ML BD INSULIN SYRINGE MISC U ML insulin syringes (disposable) BD INSULIN SYRINGE U-40 MISC 25G X 5/8" 1 ML insulin syringe/needle u-40 BD INSULIN SYRINGE ULTRAFINE MISC 29G X 1/2" 0.3 ML BD INSULIN SYRINGE ULTRAFINE MISC 29G X 1/2" 0.5 ML BD INSULIN SYRINGE ULTRAFINE MISC 29G X 1/2" 1 ML BD INSULIN SYRINGE ULTRAFINE MISC 30G X 1/2" 0.3 ML BD INSULIN SYRINGE ULTRAFINE MISC 30G X 1/2" 0.5 ML BD INSULIN SYRINGE ULTRAFINE MISC 31G X 15/64" 0.3 ML BD INSULIN SYRINGE ULTRAFINE MISC 31G X 15/64" 0.5 ML BD INSULIN SYRINGE ULTRAFINE MISC 31G X 15/64" 1 ML GE 73 LAST UPDATED 09/2015

74 BD INSULIN SYRINGE ULTRAFINE MISC 31G X 5/16" 0.3 ML BD INSULIN SYRINGE ULTRAFINE MISC 31G X 5/16" 0.5 ML BD INSULIN SYRINGE ULTRAFINE MISC 31G X 5/16" 1 ML BD INTEGRA INSULIN SYRINGE MISC 29G X 1/2" 1 ML BD INTEGRA SYRINGE MISC 25G X 1" 1 ML BD PEN NEEDLE MINI U/F MISC 31G X 5 MM BD PEN NEEDLE NANO U/F MISC 32G X 4 MM BD PEN NEEDLE SHORT U/F MISC 31G X 8 MM BD PEN NEEDLE ULTRAFINE MISC 29G X 12.7MM BD SAFETY-LOK INSULIN SYRINGE MISC 29G X 1/2" 1 ML BD SAFETYGLIDE INSULIN SYRINGE MISC 30G X 5/16" 0.5 ML CAREFINE PEN NEEDLES MISC 29G X 12MM CAREFINE PEN NEEDLES MISC 30G X 8 MM CAREFINE PEN NEEDLES MISC 31G X 6 MM CAREFINE PEN NEEDLES MISC 31G X 8 MM CAREFINE PEN NEEDLES MISC 32G X 4 MM CAREFINE PEN NEEDLES MISC 32G X 5 MM CAREFINE PEN NEEDLES MISC 32G X 6 MM CAREONE UNIFINE PENTIPS MISC 29G X 12MM CAREONE UNIFINE PENTIPS MISC 31G X 5 MM GE 74 LAST UPDATED 09/2015

75 CAREONE UNIFINE PENTIPS MISC 31G X 6 MM CAREONE UNIFINE PENTIPS MISC 31G X 8 MM CAREONE UNIFINE PENTIPS MISC 32G X 4 MM CAREONE UNIFINE PENTIPS PLUS MISC 29G X 12MM CAREONE UNIFINE PENTIPS PLUS MISC 31G X 5 MM CAREONE UNIFINE PENTIPS PLUS MISC 31G X 6 MM CAREONE UNIFINE PENTIPS PLUS MISC 31G X 8 MM CAREONE UNIFINE PENTIPS PLUS MISC 32G X 4 MM CLICKFINE PEN NEEDLES MISC 31G X 6 MM CLICKFINE PEN NEEDLES MISC 31G X 8 MM CLICKFINE PEN NEEDLES MISC 32G X 4 MM COMFORT EZ INSULIN SYRINGE MISC 28G X 1/2" 0.5 ML COMFORT EZ INSULIN SYRINGE MISC 28G X 1/2" 1 ML COMFORT EZ INSULIN SYRINGE MISC 29G X 1/2" 0.3 ML COMFORT EZ INSULIN SYRINGE MISC 29G X 1/2" 0.5 ML COMFORT EZ INSULIN SYRINGE MISC 29G X 1/2" 1 ML COMFORT EZ INSULIN SYRINGE MISC 30G X 1/2" 0.3 ML COMFORT EZ INSULIN SYRINGE MISC 30G X 1/2" 0.5 ML COMFORT EZ INSULIN SYRINGE MISC 30G X 5/16" 0.3 ML COMFORT EZ INSULIN SYRINGE MISC 30G X 5/16" 0.5 ML GE 75 LAST UPDATED 09/2015

76 COMFORT EZ INSULIN SYRINGE MISC 30G X 5/16" 1 ML COMFORT EZ INSULIN SYRINGE MISC 31G X 5/16" 0.3 ML COMFORT EZ INSULIN SYRINGE MISC 31G X 5/16" 0.5 ML COMFORT EZ INSULIN SYRINGE MISC 31G X 5/16" 1 ML COMFORT EZ PEN NEEDLES MISC 31G X 5 MM COMFORT EZ PEN NEEDLES MISC 31G X 6 MM COMFORT EZ PEN NEEDLES MISC 31G X 8 MM COMFORT EZ PEN NEEDLES MISC 32G X 4 MM CVS INSULIN SYRINGE MISC 29G X 1/2" 0.3 ML CVS INSULIN SYRINGE MISC 29G X 1/2" 0.5 ML CVS INSULIN SYRINGE MISC 30G X 1/2" 0.3 ML CVS INSULIN SYRINGE MISC 30G X 1/2" 0.5 ML DRUG MART ULTRA COMFORT SYR MISC 29G X 1/2" 0.3 ML DRUG MART ULTRA COMFORT SYR MISC 29G X 1/2" 1 ML DRUG MART ULTRA COMFORT SYR MISC 30G X 5/16" 0.3 ML DRUG MART ULTRA COMFORT SYR MISC 30G X 5/16" 0.5 ML DRUG MART ULTRA COMFORT SYR MISC 30G X 5/16" 1 ML DRUG MART ULTRA COMFORT SYR MISC 31G X 5/16" 0.3 ML DRUG MART ULTRA COMFORT SYR MISC 31G X 5/16" 0.5 ML DRUG MART UNIFINE PENTIPS MISC 29G X 12MM GE 76 LAST UPDATED 09/2015

77 DRUG MART UNIFINE PENTIPS MISC 31G X 5 MM DRUG MART UNIFINE PENTIPS MISC 31G X 6 MM DRUG MART UNIFINE PENTIPS MISC 31G X 8 MM DRUG MART UNIFINE PENTIPS MISC 32G X 4 MM DRUG MART UNIFINE PENTIPS PLUS MISC 32G X 4 MM DUANE READE UNIFINE PENTIPS MISC 29G X 12MM DUANE READE UNIFINE PENTIPS MISC 31G X 6 MM DUANE READE UNIFINE PENTIPS MISC 31G X 8 MM EASY COMFORT INSULIN SYRINGE MISC 30G X 1/2" 0.5 ML EASY COMFORT INSULIN SYRINGE MISC 30G X 5/16" 0.3 ML EASY COMFORT INSULIN SYRINGE MISC 30G X 5/16" 0.5 ML EASY COMFORT INSULIN SYRINGE MISC 30G X 5/16" 1 ML EASY COMFORT PEN NEEDLES MISC 31G X 5 MM EASY COMFORT PEN NEEDLES MISC 31G X 8 MM EASY COMFORT PEN NEEDLES MISC 32G X 4 MM EASY TOUCH INSULIN SAFETY SYR MISC 29G X 1/2" 0.5 ML EASY TOUCH INSULIN SAFETY SYR MISC 29G X 1/2" 1 ML EASY TOUCH INSULIN SAFETY SYR MISC 30G X 5/16" 0.5 ML EASY TOUCH INSULIN SYRINGE MISC 27G X 1/2" 0.5 ML EASY TOUCH INSULIN SYRINGE MISC 27G X 1/2" 1 ML GE 77 LAST UPDATED 09/2015

78 EASY TOUCH INSULIN SYRINGE MISC 28G X 1/2" 0.5 ML EASY TOUCH INSULIN SYRINGE MISC 28G X 1/2" 1 ML EASY TOUCH INSULIN SYRINGE MISC 29G X 1/2" 0.5 ML EASY TOUCH INSULIN SYRINGE MISC 29G X 1/2" 1 ML EASY TOUCH INSULIN SYRINGE MISC 30G X 1/2" 0.3 ML EASY TOUCH INSULIN SYRINGE MISC 30G X 1/2" 0.5 ML EASY TOUCH INSULIN SYRINGE MISC 30G X 5/16" 0.3 ML EASY TOUCH INSULIN SYRINGE MISC 30G X 5/16" 0.5 ML EASY TOUCH INSULIN SYRINGE MISC 30G X 5/16" 1 ML EASY TOUCH INSULIN SYRINGE MISC 31G X 5/16" 0.3 ML EASY TOUCH INSULIN SYRINGE MISC 31G X 5/16" 0.5 ML EASY TOUCH INSULIN SYRINGE MISC 31G X 5/16" 1 ML EASY TOUCH PEN NEEDLES MISC 29G X 12MM EASY TOUCH PEN NEEDLES MISC 31G X 5 MM EASY TOUCH PEN NEEDLES MISC 31G X 6 MM EASY TOUCH PEN NEEDLES MISC 31G X 8 MM EASY TOUCH PEN NEEDLES MISC 32G X 4 MM EASY TOUCH PEN NEEDLES MISC 32G X 5 MM EASY TOUCH PEN NEEDLES MISC 32G X 6 MM E INSULIN SYRINGE MISC 29G X 1/2" 0.3 ML GE 78 LAST UPDATED 09/2015

79 E INSULIN SYRINGE MISC 29G X 1/2" 0.5 ML E INSULIN SYRINGE MISC 29G X 1/2" 1 ML E INSULIN SYRINGE MISC 30G X 5/16" 0.3 ML E INSULIN SYRINGE MISC 30G X 5/16" 0.5 ML E INSULIN SYRINGE MISC 30G X 5/16" 1 ML E INSULIN SYRINGE MISC 31G X 5/16" 0.3 ML E INSULIN SYRINGE MISC 31G X 5/16" 0.5 ML E INSULIN SYRINGE MISC 31G X 5/16" 1 ML E SHORT PEN NEEDLE MISC 31G X 8 MM E ULTRA COMFORT INSULIN SYR MISC 30G X 5/16" 1 ML E ULTRA COMFORT INSULIN SYR MISC 31G X 5/16" 0.3 ML E ULTRA SHORT PEN NEEDLE MISC 31G X 6 MM EXCEL COMFORT POINT PEN NEEDLE MISC 29G X 12MM EXCEL COMFORT POINT PEN NEEDLE MISC 31G X 6 MM EXCEL COMFORT POINT PEN NEEDLE MISC 31G X 8 MM EXEL COMFORT POINT INSULIN SYR MISC 28G X 1/2" 0.5 ML EXEL COMFORT POINT INSULIN SYR MISC 28G X 1/2" 1 ML EXEL COMFORT POINT INSULIN SYR MISC 29G X 1/2" 0.3 ML EXEL COMFORT POINT INSULIN SYR MISC 29G X 1/2" 0.5 ML EXEL COMFORT POINT INSULIN SYR MISC 29G X 1/2" 1 ML GE 79 LAST UPDATED 09/2015

80 EXEL COMFORT POINT INSULIN SYR MISC 30G X 5/16" 0.3 ML EXEL COMFORT POINT INSULIN SYR MISC 30G X 5/16" 0.5 ML EXEL COMFORT POINT INSULIN SYR MISC 30G X 5/16" 1 ML FIFTY50 PEN NEEDLES MISC 31G X 5 MM FIFTY50 PEN NEEDLES MISC 31G X 8 MM FIFTY50 SUPERIOR COMFORT SYR MISC 31G X 5/16" 0.3 ML FIFTY50 SUPERIOR COMFORT SYR MISC 31G X 5/16" 0.5 ML FIFTY50 SUPERIOR COMFORT SYR MISC 31G X 5/16" 1 ML FREDS PHARMACY UNIFINE PENTIP+ MISC 31G X 5 MM FREDS PHARMACY UNIFINE PENTIP+ MISC 31G X 8 MM FREDS PHARMACY UNIFINE PENTIPS MISC 32G X 4 MM FREESTYLE PRECISION INS SYR MISC 30G X 5/16" 0.5 ML FREESTYLE PRECISION INS SYR MISC 30G X 5/16" 1 ML FREESTYLE PRECISION INS SYR MISC 31G X 5/16" 0.5 ML FREESTYLE PRECISION INS SYR MISC 31G X 5/16" 1 ML GLOBAL EASE INJECT PEN NEEDLES MISC 29G X 12MM GLOBAL EASE INJECT PEN NEEDLES MISC 31G X 5 MM GLOBAL EASE INJECT PEN NEEDLES MISC 31G X 8 MM GLOBAL EASE INJECT PEN NEEDLES MISC 32G X 4 MM GLOBAL INJECT EASE INSULIN SYR MISC 28G X 1/2" 0.5 ML GE 80 LAST UPDATED 09/2015

81 GLOBAL INJECT EASE INSULIN SYR MISC 28G X 1/2" 1 ML GLOBAL INJECT EASE INSULIN SYR MISC 29G X 1/2" 0.3 ML GLOBAL INJECT EASE INSULIN SYR MISC 29G X 1/2" 0.5 ML GLOBAL INJECT EASE INSULIN SYR MISC 29G X 1/2" 1 ML GLOBAL INJECT EASE INSULIN SYR MISC 30G X 1/2" 0.3 ML GLOBAL INJECT EASE INSULIN SYR MISC 30G X 1/2" 0.5 ML GLOBAL INJECT EASE INSULIN SYR MISC 30G X 5/16" 0.3 ML GLOBAL INJECT EASE INSULIN SYR MISC 30G X 5/16" 0.5 ML GLOBAL INJECT EASE INSULIN SYR MISC 30G X 5/16" 1 ML GLOBAL INJECT EASE INSULIN SYR MISC 31G X 5/16" 0.3 ML GLOBAL INJECT EASE INSULIN SYR MISC 31G X 5/16" 0.5 ML GLOBAL INJECT EASE INSULIN SYR MISC 31G X 5/16" 1 ML GLUCOPRO INSULIN SYRINGE MISC 30G X 1/2" 0.3 ML GLUCOPRO INSULIN SYRINGE MISC 30G X 1/2" 0.5 ML GLUCOPRO INSULIN SYRINGE MISC 30G X 5/16" 0.3 ML GLUCOPRO INSULIN SYRINGE MISC 30G X 5/16" 0.5 ML GLUCOPRO INSULIN SYRINGE MISC 30G X 5/16" 1 ML GLUCOPRO INSULIN SYRINGE MISC 31G X 5/16" 0.3 ML GLUCOPRO INSULIN SYRINGE MISC 31G X 5/16" 0.5 ML GLUCOPRO INSULIN SYRINGE MISC 31G X 5/16" 1 ML GE 81 LAST UPDATED 09/2015

82 GNP CLICKFINE PEN NEEDLES MISC 31G X 6 MM GNP CLICKFINE PEN NEEDLES MISC 31G X 8 MM GNP INSULIN SYRINGE MISC 28G X 1/2" 0.5 ML GNP INSULIN SYRINGE MISC 28G X 1/2" 1 ML GNP INSULIN SYRINGE MISC 29G X 1/2" 0.3 ML GNP INSULIN SYRINGE MISC 29G X 1/2" 0.5 ML GNP INSULIN SYRINGE MISC 29G X 1/2" 1 ML GNP INSULIN SYRINGE MISC 30G X 5/16" 0.3 ML GNP INSULIN SYRINGE MISC 30G X 5/16" 0.5 ML GNP INSULIN SYRINGE MISC 30G X 5/16" 1 ML GNP INSULIN SYRINGE MISC 31G X 5/16" 0.3 ML GNP INSULIN SYRINGE MISC 31G X 5/16" 0.5 ML GNP INSULIN SYRINGE MISC 31G X 5/16" 1 ML GNP ULTRA COM INSULIN SYRINGE MISC 28G X 1/2" 0.5 ML GNP ULTRA COM INSULIN SYRINGE MISC 28G X 1/2" 1 ML GNP ULTRA COM INSULIN SYRINGE MISC 29G X 1/2" 0.3 ML GNP ULTRA COM INSULIN SYRINGE MISC 29G X 1/2" 0.5 ML GNP ULTRA COM INSULIN SYRINGE MISC 29G X 1/2" 1 ML GNP ULTRA COM INSULIN SYRINGE MISC 30G X 5/16" 0.3 ML GNP ULTRA COM INSULIN SYRINGE MISC 30G X 5/16" 0.5 ML GE 82 LAST UPDATED 09/2015

83 GNP ULTRA COM INSULIN SYRINGE MISC 30G X 5/16" 1 ML GNP ULTRA COM INSULIN SYRINGE MISC 31G X 5/16" 0.3 ML GNP ULTRA COM INSULIN SYRINGE MISC 31G X 5/16" 0.5 ML GNP ULTRA COM INSULIN SYRINGE MISC 31G X 5/16" 1 ML H-E-B INCONTROL PEN NEEDLES MISC 29G X 12MM H-E-B INCONTROL PEN NEEDLES MISC 31G X 5 MM H-E-B INCONTROL PEN NEEDLES MISC 31G X 6 MM H-E-B INCONTROL PEN NEEDLES MISC 31G X 8 MM H-E-B INCONTROL PEN NEEDLES MISC 32G X 4 MM HEALTHWISE MINI PEN NEEDLES MISC 31G X 6 MM HEALTHWISE PEN NEEDLES MISC 29G X 12MM HEALTHWISE SHORT PEN NEEDLES MISC 31G X 8 MM HEALTHWISE UNIFINE PENTIPS MISC 32G X 4 MM HEALTHY ACCENTS UNIFINE PENTIP MISC 29G X 12MM HEALTHY ACCENTS UNIFINE PENTIP MISC 31G X 5 MM HEALTHY ACCENTS UNIFINE PENTIP MISC 31G X 6 MM HEALTHY ACCENTS UNIFINE PENTIP MISC 31G X 8 MM HEALTHY ACCENTS UNIFINE PENTIP MISC 32G X 4 MM INSULIN SYRINGE MISC 28G X 1/2" 0.5 ML INSULIN SYRINGE MISC 28G X 1/2" 1 ML GE 83 LAST UPDATED 09/2015

84 INSULIN SYRINGE MISC 29G X 1" 0.3 ML INSULIN SYRINGE MISC 29G X 1/2" 0.3 ML INSULIN SYRINGE MISC 29G X 1/2" 0.5 ML INSULIN SYRINGE MISC 29G X 1/2" 1 ML INSULIN SYRINGE MISC 30G X 1/2" 0.5 ML INSULIN SYRINGE MISC 30G X 5/16" 0.3 ML INSULIN SYRINGE MISC 30G X 5/16" 0.5 ML INSULIN SYRINGE MISC 30G X 5/16" 1 ML INSULIN SYRINGE MISC 31G X 5/16" 0.3 ML INSULIN SYRINGE MISC 31G X 5/16" 0.5 ML INSULIN SYRINGE MISC 31G X 5/16" 1 ML INSULIN SYRINGE/NEEDLE MISC 27G X 1/2" 0.5 ML INSULIN SYRINGE/NEEDLE MISC 28G X 1/2" 0.5 ML INSULIN SYRINGE/NEEDLE MISC 28G X 1/2" 1 ML INSUPEN PEN NEEDLES MISC 32G X 4 MM INSUPEN SENSITIVE MISC 32G X 6 MM INSUPEN SENSITIVE MISC 32G X 8 MM INSUPEN ULTRAFIN MISC 29G X 12MM INSUPEN ULTRAFIN MISC 30G X 8 MM INSUPEN ULTRAFIN MISC 31G X 6 MM GE 84 LAST UPDATED 09/2015

85 INSUPEN ULTRAFIN MISC 31G X 8 MM KINRAY INSULIN SYRINGE MISC 29G X 1/2" 0.5 ML KINRAY INSULIN SYRINGE MISC 31G X 5/16" 0.3 ML KINRAY INSULIN SYRINGE MISC 31G X 5/16" 0.5 ML KINRAY INSULIN SYRINGE MISC 31G X 5/16" 1 ML KMART VALU INSULIN SYRINGE 29G MISC U ML insulin syringes (disposable) KMART VALU INSULIN SYRINGE 29G MISC U ML insulin syringes (disposable) KMART VALU INSULIN SYRINGE 30G MISC U ML insulin syringes (disposable) KMART VALU INSULIN SYRINGE 30G MISC U ML insulin syringes (disposable) KMART VALU INSULIN SYRINGE 30G MISC U ML insulin syringes (disposable) KROGER INSULIN SYRINGE MISC 29G X 1/2" 0.3 ML KROGER INSULIN SYRINGE MISC 29G X 1/2" 0.5 ML KROGER INSULIN SYRINGE MISC 29G X 1/2" 1 ML KROGER INSULIN SYRINGE MISC 30G X 5/16" 0.3 ML KROGER INSULIN SYRINGE MISC 30G X 5/16" 0.5 ML KROGER INSULIN SYRINGE MISC 30G X 5/16" 1 ML KROGER INSULIN SYRINGE MISC 31G X 5/16" 0.3 ML KROGER INSULIN SYRINGE MISC 31G X 5/16" 0.5 ML KROGER INSULIN SYRINGE MISC 31G X 5/16" 1 ML KROGER PEN NEEDLES MISC 29G X 12MM GE 85 LAST UPDATED 09/2015

86 KROGER PEN NEEDLES MISC 31G X 6 MM KROGER PEN NEEDLES MISC 31G X 8 MM LEADER INSULIN SYRINGE MISC 28G X 1/2" 0.5 ML LEADER INSULIN SYRINGE MISC 28G X 1/2" 1 ML LEADER INSULIN SYRINGE MISC 29G X 1/2" 0.3 ML LEADER INSULIN SYRINGE MISC 29G X 1/2" 0.5 ML LEADER INSULIN SYRINGE MISC 29G X 1/2" 1 ML LEADER INSULIN SYRINGE MISC 30G X 5/16" 0.3 ML LEADER INSULIN SYRINGE MISC 30G X 5/16" 0.5 ML LEADER INSULIN SYRINGE MISC 30G X 5/16" 1 ML LEADER INSULIN SYRINGE MISC 31G X 5/16" 0.3 ML LEADER INSULIN SYRINGE MISC 31G X 5/16" 0.5 ML LEADER INSULIN SYRINGE MISC 31G X 5/16" 1 ML LEADER UNIFINE PENTIPS MISC 31G X 5 MM LEADER UNIFINE PENTIPS MISC 32G X 4 MM LEADER UNIFINE PENTIPS PLUS MISC 31G X 5 MM LEADER UNIFINE PENTIPS PLUS MISC 31G X 8 MM LEADER UNIFINE PENTIPS PLUS MISC 32G X 4 MM LITE TOUCH PEN NEEDLES MISC 31G X 5 MM LITETOUCH INSULIN SYRINGE MISC 28G X 1/2" 0.5 ML GE 86 LAST UPDATED 09/2015

87 LITETOUCH INSULIN SYRINGE MISC 28G X 1/2" 1 ML LITETOUCH INSULIN SYRINGE MISC 29G X 1/2" 0.3 ML LITETOUCH INSULIN SYRINGE MISC 29G X 1/2" 0.5 ML LITETOUCH INSULIN SYRINGE MISC 29G X 1/2" 1 ML LITETOUCH INSULIN SYRINGE MISC 30G X 5/16" 0.3 ML LITETOUCH INSULIN SYRINGE MISC 30G X 5/16" 0.5 ML LITETOUCH INSULIN SYRINGE MISC 30G X 5/16" 1 ML LITETOUCH INSULIN SYRINGE MISC 31G X 5/16" 0.3 ML LITETOUCH INSULIN SYRINGE MISC 31G X 5/16" 0.5 ML LITETOUCH INSULIN SYRINGE MISC 31G X 5/16" 1 ML LITETOUCH PEN NEEDLES MISC 29G X 12.7MM LITETOUCH PEN NEEDLES MISC 31G X 6 MM LITETOUCH PEN NEEDLES MISC 31G X 8 MM LIVE BETTER PEN NEEDLES MISC 29G X 12MM LIVE BETTER PEN NEEDLES MISC 31G X 6 MM LIVE BETTER PEN NEEDLES MISC 31G X 8 MM LONGS INSULIN SYRINGE MISC 31G X 5/16" 0.5 ML MAGELLAN INSULIN SAFETY SYR MISC 29G X 1/2" 0.3 ML MAGELLAN INSULIN SAFETY SYR MISC 29G X 1/2" 0.5 ML MAGELLAN INSULIN SAFETY SYR MISC 29G X 1/2" 1 ML GE 87 LAST UPDATED 09/2015

88 MAGELLAN INSULIN SAFETY SYR MISC 30G X 5/16" 0.3 ML MAGELLAN INSULIN SAFETY SYR MISC 30G X 5/16" 0.5 ML MAGELLAN INSULIN SAFETY SYR MISC 30G X 5/16" 1 ML MEDIC INSULIN SYRINGE MISC 30G X 5/16" 0.3 ML MEDIC INSULIN SYRINGE MISC 30G X 5/16" 0.5 ML MEDICINE SHOPPE PEN NEEDLES MISC 29G X 12MM MEDICINE SHOPPE PEN NEEDLES MISC 31G X 6 MM MEDICINE SHOPPE PEN NEEDLES MISC 31G X 8 MM MEIJER PEN NEEDLES MISC 29G X 12MM MEIJER PEN NEEDLES MISC 31G X 6 MM MEIJER PEN NEEDLES MISC 31G X 8 MM methylergonovine maleate tab 0.2 mg MONOJECT INSULIN SYRINGE MISC 25G X 5/8" 1 ML MONOJECT INSULIN SYRINGE MISC 27G X 1/2" 1 ML MONOJECT INSULIN SYRINGE MISC 28G X 1/2" 0.5 ML MONOJECT INSULIN SYRINGE MISC 28G X 1/2" 1 ML MONOJECT INSULIN SYRINGE MISC 29G X 1/2" 0.3 ML MONOJECT INSULIN SYRINGE MISC 29G X 1/2" 0.5 ML MONOJECT INSULIN SYRINGE MISC 29G X 1/2" 1 ML MONOJECT INSULIN SYRINGE MISC 30G X 5/16" 0.3 ML GE 88 LAST UPDATED 09/2015

89 MONOJECT INSULIN SYRINGE MISC 30G X 5/16" 0.5 ML MONOJECT INSULIN SYRINGE MISC 30G X 5/16" 1 ML MONOJECT INSULIN SYRINGE MISC 31G X 5/16" 1 ML MONOJECT INSULIN SYRINGE MISC U ML insulin syringes (disposable) MONOJECT ULTRA COMFORT SYRINGE MISC 28G X 1/2" 0.5 ML MONOJECT ULTRA COMFORT SYRINGE MISC 28G X 1/2" 1 ML MONOJECT ULTRA COMFORT SYRINGE MISC 29G X 1/2" 0.3 ML MONOJECT ULTRA COMFORT SYRINGE MISC 29G X 1/2" 0.5 ML MONOJECT ULTRA COMFORT SYRINGE MISC 29G X 1/2" 1 ML MONOJECT ULTRA COMFORT SYRINGE MISC 30G X 5/16" 0.3 ML MONOJECT ULTRA COMFORT SYRINGE MISC 30G X 5/16" 0.5 ML MONOJECT ULTRA COMFORT SYRINGE MISC 31G X 5/16" 0.3 ML MONOJECT ULTRA COMFORT SYRINGE MISC 31G X 5/16" 0.5 ML MOORE MONO INSULIN SYRINGE MISC 28G X 1/2" 0.5 ML MOORE MONO INSULIN SYRINGE MISC 28G X 1/2" 1 ML MOORE MONO INSULIN SYRINGE MISC 29G X 1/2" 0.5 ML MOORE MONO INSULIN SYRINGE MISC 29G X 1/2" 1 ML MS INSULIN SYRINGE MISC 29G X 1/2" 0.3 ML MS INSULIN SYRINGE MISC 29G X 1/2" 0.5 ML MS INSULIN SYRINGE MISC 29G X 1/2" 1 ML GE 89 LAST UPDATED 09/2015

90 MS INSULIN SYRINGE MISC 30G X 5/16" 0.3 ML MS INSULIN SYRINGE MISC 30G X 5/16" 0.5 ML MS INSULIN SYRINGE MISC 30G X 5/16" 1 ML MS INSULIN SYRINGE MISC 31G X 5/16" 0.3 ML MS INSULIN SYRINGE MISC 31G X 5/16" 0.5 ML MS INSULIN SYRINGE MISC 31G X 5/16" 1 ML NOVOFINE AUTOCOVER MISC 30G X 8 MM NOVOFINE MISC 30G X 8 MM NOVOFINE MISC 32G X 6 MM NOVOFINE PLUS MISC 32G X 4 MM NOVOTWIST MISC 30G X 8 MM NOVOTWIST MISC 32G X 5 MM PC UNIFINE PENTIPS MISC 29G X 12MM PC UNIFINE PENTIPS MISC 31G X 5 MM PC UNIFINE PENTIPS MISC 31G X 6 MM PC UNIFINE PENTIPS MISC 31G X 8 MM PEN NEEDLES 1/2" MISC 29G X 12MM PEN NEEDLES 3/16" MISC 31G X 5 MM PEN NEEDLES 5/16" MISC 30G X 8 MM PEN NEEDLES 5/16" MISC 31G X 8 MM GE 90 LAST UPDATED 09/2015

91 PEN NEEDLES MISC 29G X 12MM PEN NEEDLES MISC 31G X 6 MM PRECISION SURE-DOSE SYRINGE MISC 28G X 1/2" 0.5 ML PRECISION SURE-DOSE SYRINGE MISC 28G X 1/2" 1 ML PRECISION SURE-DOSE SYRINGE MISC 29G X 1/2" 0.5 ML PRECISION SURE-DOSE SYRINGE MISC 30G X 3/8" 0.5 ML PRECISION SUREDOSE PLUS SYR MISC 29G X 1/2" 0.3 ML PRECISION SUREDOSE PLUS SYR MISC 29G X 1/2" 1 ML PREFERRED PLUS INSULIN SYRINGE MISC 28G X 1/2" 0.5 ML PREFERRED PLUS INSULIN SYRINGE MISC 28G X 1/2" 1 ML PREFERRED PLUS INSULIN SYRINGE MISC 29G X 1/2" 0.3 ML PREFERRED PLUS INSULIN SYRINGE MISC 29G X 1/2" 0.5 ML PREFERRED PLUS INSULIN SYRINGE MISC 29G X 1/2" 1 ML PREFERRED PLUS INSULIN SYRINGE MISC 30G X 5/16" 0.3 ML PREFERRED PLUS INSULIN SYRINGE MISC 30G X 5/16" 0.5 ML PREFERRED PLUS INSULIN SYRINGE MISC 30G X 5/16" 1 ML PREFERRED PLUS UNIFINE PENTIPS MISC 29G X 12MM PREFERRED PLUS UNIFINE PENTIPS MISC 31G X 5 MM PREFERRED PLUS UNIFINE PENTIPS MISC 31G X 6 MM PREFERRED PLUS UNIFINE PENTIPS MISC 31G X 8 MM GE 91 LAST UPDATED 09/2015

92 PREFERRED PLUS UNIFINE PENTIPS MISC 32G X 4 MM PRODIGY INSULIN SYRINGE MISC 28G X 1/2" 1 ML PRODIGY INSULIN SYRINGE MISC 31G X 5/16" 0.3 ML PRODIGY INSULIN SYRINGE MISC 31G X 5/16" 0.5 ML PX EXTRA SHORT PEN NEEDLES MISC 31G X 6 MM PX INSULIN SYRINGE MISC 30G X 1/2" 0.3 ML PX INSULIN SYRINGE MISC 30G X 1/2" 0.5 ML PX INSULIN SYRINGE MISC 31G X 5/16" 0.3 ML PX INSULIN SYRINGE MISC 31G X 5/16" 0.5 ML PX INSULIN SYRINGE MISC 31G X 5/16" 1 ML PX MINI PEN NEEDLES MISC 31G X 5 MM PX PEN NEEDLE MISC 29G X 12MM PX PEN NEEDLE MISC 31G X 8 MM QC INSULIN SYRINGE MISC 29G 0.3 ML QC INSULIN SYRINGE MISC 29G 0.5 ML QC INSULIN SYRINGE MISC 29G 1 ML QC INSULIN SYRINGE MISC 30G 0.5 ML QC PEN NEEDLES MISC 29G X 12MM QC PEN NEEDLES MISC 31G X 6 MM QC PEN NEEDLES MISC 31G X 8 MM GE 92 LAST UPDATED 09/2015

93 QC UNIFINE PENTIPS MISC 32G X 4 MM RA INSULIN SYRINGE MISC 29G X 1/2" 0.5 ML RA INSULIN SYRINGE MISC 29G X 1/2" 1 ML RA INSULIN SYRINGE MISC 30G X 5/16" 0.5 ML RA INSULIN SYRINGE MISC 30G X 5/16" 1 ML RA PEN NEEDLES MISC 31G X 5 MM RA PEN NEEDLES MISC 31G X 8 MM RELI-ON INSULIN SYRINGE MISC 29G 0.3 ML RELI-ON INSULIN SYRINGE MISC 29G 0.5 ML RELI-ON INSULIN SYRINGE MISC 29G X 1/2" 1 ML RELION INSULIN SYRINGE MISC 29G X 1/2" 0.3 ML RELION INSULIN SYRINGE MISC 29G X 1/2" 0.5 ML RELION INSULIN SYRINGE MISC 29G X 1/2" 1 ML RELION INSULIN SYRINGE MISC 30G X 5/16" 0.3 ML RELION INSULIN SYRINGE MISC 30G X 5/16" 0.5 ML RELION INSULIN SYRINGE MISC 30G X 5/16" 1 ML RELION INSULIN SYRINGE MISC 31G X 5/16" 0.3 ML RELION INSULIN SYRINGE MISC 31G X 5/16" 0.5 ML RELION INSULIN SYRINGE MISC 31G X 5/16" 1 ML RELION MINI PEN NEEDLES MISC 31G X 6 MM GE 93 LAST UPDATED 09/2015

94 RELION PEN NEEDLES MISC 29G X 12MM RELION PEN NEEDLES MISC 31G X 8 MM RELION PEN NEEDLES MISC 32G X 4 MM RELION SHORT PEN NEEDLES MISC 31G X 8 MM SAFESNAP INSULIN SYRINGE MISC 28G X 1/2" 1 ML SAFESNAP INSULIN SYRINGE MISC 29G X 1/2" 0.5 ML SAFESNAP INSULIN SYRINGE MISC 29G X 1/2" 1 ML SAFESNAP INSULIN SYRINGE MISC 30G X 5/16" 0.3 ML SAFESNAP INSULIN SYRINGE MISC 30G X 5/16" 0.5 ML SAFETY-GLIDE SYRINGE MISC 29G X 1/2" 0.3 ML SB INSULIN SYRINGE MISC 29G X 1/2" 0.5 ML SB INSULIN SYRINGE MISC 29G X 1/2" 1 ML SB INSULIN SYRINGE MISC 30G X 5/16" 0.5 ML SB INSULIN SYRINGE MISC 30G X 5/16" 1 ML SB INSULIN SYRINGE MISC 31G X 5/16" 1 ML SCHNUCKS INSULIN SYRINGE MISC 29G X 1/2" 0.5 ML SCHNUCKS INSULIN SYRINGE MISC 30G X 5/16" 0.5 ML SHOPKO UNIFINE PENTIPS MISC 29G X 12MM SHOPKO UNIFINE PENTIPS MISC 31G X 5 MM SHOPKO UNIFINE PENTIPS MISC 31G X 8 MM GE 94 LAST UPDATED 09/2015

95 SHOPKO UNIFINE PENTIPS MISC 32G X 4 MM SM INSULIN SYRINGE MISC 28G X 1/2" 0.5 ML SM INSULIN SYRINGE MISC 28G X 1/2" 1 ML SM INSULIN SYRINGE MISC 29G X 1/2" 0.3 ML SM INSULIN SYRINGE MISC 29G X 1/2" 0.5 ML SM INSULIN SYRINGE MISC 29G X 1/2" 1 ML SM INSULIN SYRINGE MISC 30G X 5/16" 0.3 ML SM INSULIN SYRINGE MISC 30G X 5/16" 0.5 ML SM INSULIN SYRINGE MISC 30G X 5/16" 1 ML SM INSULIN SYRINGE MISC 31G X 5/16" 0.3 ML SM INSULIN SYRINGE MISC 31G X 5/16" 0.5 ML SM INSULIN SYRINGE MISC 31G X 5/16" 1 ML sodium chloride irrigation soln 0.9% SURE COMFORT INSULIN SYRINGE MISC 28G X 1/2" 0.5 ML SURE COMFORT INSULIN SYRINGE MISC 28G X 1/2" 1 ML SURE COMFORT INSULIN SYRINGE MISC 29G X 1/2" 0.3 ML SURE COMFORT INSULIN SYRINGE MISC 29G X 1/2" 0.5 ML SURE COMFORT INSULIN SYRINGE MISC 29G X 1/2" 1 ML SURE COMFORT INSULIN SYRINGE MISC 30G X 1/2" 0.3 ML SURE COMFORT INSULIN SYRINGE MISC 30G X 1/2" 0.5 ML GE 95 LAST UPDATED 09/2015

96 SURE COMFORT INSULIN SYRINGE MISC 30G X 5/16" 0.5 ML SURE COMFORT INSULIN SYRINGE MISC 30G X 5/16" 1 ML SURE COMFORT INSULIN SYRINGE MISC 31G X 5/16" 0.3 ML SURE COMFORT INSULIN SYRINGE MISC 31G X 5/16" 0.5 ML SURE COMFORT INSULIN SYRINGE MISC 31G X 5/16" 1 ML SURE COMFORT PEN NEEDLES MISC 29G X 12.7MM SURE COMFORT PEN NEEDLES MISC 30G X 8 MM SURE COMFORT PEN NEEDLES MISC 31G X 5 MM SURE COMFORT PEN NEEDLES MISC 31G X 8 MM SURE COMFORT PEN NEEDLES MISC 32G X 4 MM SURE-FINE PEN NEEDLES MISC 29G X 12.7MM SURE-FINE PEN NEEDLES MISC 31G X 5 MM SURE-FINE PEN NEEDLES MISC 31G X 8 MM SURE-JECT INSULIN SYRINGE MISC 28G X 1/2" 0.5 ML SURE-JECT INSULIN SYRINGE MISC 28G X 1/2" 1 ML SURE-JECT INSULIN SYRINGE MISC 29G X 1/2" 0.3 ML SURE-JECT INSULIN SYRINGE MISC 29G X 1/2" 0.5 ML SURE-JECT INSULIN SYRINGE MISC 29G X 1/2" 1 ML SURE-JECT INSULIN SYRINGE MISC 30G X 5/16" 0.3 ML SURE-JECT INSULIN SYRINGE MISC 30G X 5/16" 0.5 ML GE 96 LAST UPDATED 09/2015

97 SURE-JECT INSULIN SYRINGE MISC 30G X 5/16" 1 ML SURE-JECT INSULIN SYRINGE MISC 31G X 5/16" 0.3 ML SURE-JECT INSULIN SYRINGE MISC 31G X 5/16" 0.5 ML SURE-JECT INSULIN SYRINGE MISC 31G X 5/16" 1 ML TERUMO INSULIN SYRINGE MISC 27G X 1/2" 0.5 ML TERUMO INSULIN SYRINGE MISC 27G X 1/2" 1 ML TERUMO INSULIN SYRINGE MISC 28G X 1/2" 0.5 ML TERUMO INSULIN SYRINGE MISC 28G X 1/2" 1 ML TERUMO INSULIN SYRINGE MISC 29G X 1/2" 0.3 ML TERUMO INSULIN SYRINGE MISC 29G X 1/2" 0.5 ML TERUMO INSULIN SYRINGE MISC 29G X 1/2" 1 ML TERUMO INSULIN SYRINGE MISC 30G X 3/8" 0.5 ML TERUMO INSULIN SYRINGE MISC 30G X 3/8" 1 ML TERUMO SURGUARD INSULIN SYR MISC 28G X 1/2" 0.5 ML TERUMO SURGUARD INSULIN SYR MISC 28G X 1/2" 1 ML TERUMO SURGUARD INSULIN SYR MISC 29G X 1/2" 0.3 ML TERUMO SURGUARD INSULIN SYR MISC 29G X 1/2" 0.5 ML TERUMO SURGUARD INSULIN SYR MISC 29G X 1/2" 1 ML THINPRO INSULIN SYRINGE MISC 28G X 1/2" 0.5 ML THINPRO INSULIN SYRINGE MISC 28G X 1/2" 1 ML GE 97 LAST UPDATED 09/2015

98 THINPRO INSULIN SYRINGE MISC 29G X 1/2" 0.3 ML THINPRO INSULIN SYRINGE MISC 29G X 1/2" 0.5 ML THINPRO INSULIN SYRINGE MISC 29G X 1/2" 1 ML THINPRO INSULIN SYRINGE MISC 30G X 3/8" 0.5 ML THINPRO INSULIN SYRINGE MISC 30G X 3/8" 1 ML THINPRO INSULIN SYRINGE MISC 31G X 3/8" 0.3 ML THINPRO INSULIN SYRINGE MISC 31G X 3/8" 0.5 ML THINPRO INSULIN SYRINGE MISC 31G X 3/8" 1 ML TODAYS HEALTH MINI PEN NEEDLES MISC 31G X 6 MM TODAYS HEALTH PEN NEEDLES MISC 29G X 12MM TODAYS HEALTH SHORT PEN NEEDLE MISC 31G X 8 MM TOPCARE CLICKFINE PEN NEEDLES MISC 31G X 6 MM TOPCARE CLICKFINE PEN NEEDLES MISC 31G X 8 MM TOPCARE ULTRA COMFORT INS SYR MISC 29G X 1/2" 0.3 ML TOPCARE ULTRA COMFORT INS SYR MISC 29G X 1/2" 0.5 ML TOPCARE ULTRA COMFORT INS SYR MISC 29G X 1/2" 1 ML TOPCARE ULTRA COMFORT INS SYR MISC 30G X 5/16" 0.3 ML TOPCARE ULTRA COMFORT INS SYR MISC 30G X 5/16" 0.5 ML TOPCARE ULTRA COMFORT INS SYR MISC 30G X 5/16" 1 ML TOPCARE ULTRA COMFORT INS SYR MISC 31G X 5/16" 0.3 ML GE 98 LAST UPDATED 09/2015

99 TOPCARE ULTRA COMFORT INS SYR MISC 31G X 5/16" 0.5 ML TOPCARE ULTRA COMFORT INS SYR MISC 31G X 5/16" 1 ML TRUEPLUS INSULIN SYRINGE MISC 28G X 1/2" 0.5 ML TRUEPLUS INSULIN SYRINGE MISC 28G X 1/2" 1 ML TRUEPLUS INSULIN SYRINGE MISC 29G X 1/2" 0.3 ML TRUEPLUS INSULIN SYRINGE MISC 29G X 1/2" 0.5 ML TRUEPLUS INSULIN SYRINGE MISC 29G X 1/2" 1 ML TRUEPLUS INSULIN SYRINGE MISC 30G X 5/16" 0.3 ML TRUEPLUS INSULIN SYRINGE MISC 30G X 5/16" 0.5 ML TRUEPLUS INSULIN SYRINGE MISC 30G X 5/16" 1 ML TRUEPLUS INSULIN SYRINGE MISC 31G X 5/16" 0.3 ML TRUEPLUS INSULIN SYRINGE MISC 31G X 5/16" 0.5 ML TRUEPLUS INSULIN SYRINGE MISC 31G X 5/16" 1 ML ULTICARE INSULIN SAFETY SYR MISC 29G X 1/2" 0.5 ML ULTICARE INSULIN SAFETY SYR MISC 29G X 1/2" 1 ML ULTICARE INSULIN SYRINGE MISC 28G X 1/2" 0.5 ML ULTICARE INSULIN SYRINGE MISC 28G X 1/2" 1 ML ULTICARE INSULIN SYRINGE MISC 29G X 1/2" 0.3 ML ULTICARE INSULIN SYRINGE MISC 29G X 1/2" 0.5 ML ULTICARE INSULIN SYRINGE MISC 29G X 1/2" 1 ML GE 99 LAST UPDATED 09/2015

100 ULTICARE INSULIN SYRINGE MISC 30G X 1/2" 0.3 ML ULTICARE INSULIN SYRINGE MISC 30G X 1/2" 0.5 ML ULTICARE INSULIN SYRINGE MISC 30G X 1/2" 1 ML ULTICARE INSULIN SYRINGE MISC 30G X 5/16" 0.3 ML ULTICARE INSULIN SYRINGE MISC 30G X 5/16" 0.5 ML ULTICARE INSULIN SYRINGE MISC 30G X 5/16" 1 ML ULTICARE INSULIN SYRINGE MISC 31G X 5/16" 0.3 ML ULTICARE INSULIN SYRINGE MISC 31G X 5/16" 0.5 ML ULTICARE INSULIN SYRINGE MISC 31G X 5/16" 1 ML ULTICARE MICRO PEN NEEDLES MISC 32G X 4 MM ULTICARE MINI PEN NEEDLES MISC 31G X 6 MM ULTICARE PEN NEEDLES MISC 29G X 12.7MM ULTICARE PEN NEEDLES MISC 29G X 12MM ULTICARE SHORT PEN NEEDLES MISC 31G X 8 MM ULTILET INSULIN SYRINGE MISC 29G X 7/16" 0.3 ML ULTILET INSULIN SYRINGE MISC 29G X 7/16" 0.5 ML ULTILET INSULIN SYRINGE SHORT MISC 30G X 5/16" 0.3 ML ULTILET INSULIN SYRINGE SHORT MISC 30G X 5/16" 0.5 ML ULTILET INSULIN SYRINGE SHORT MISC 30G X 5/16" 1 ML ULTILET INSULIN SYRINGE SHORT MISC 31G X 5/16" 0.3 ML GE 100 LAST UPDATED 09/2015

101 ULTILET INSULIN SYRINGE SHORT MISC 31G X 5/16" 0.5 ML ULTILET INSULIN SYRINGE SHORT MISC 31G X 5/16" 1 ML ULTILET PEN NEEDLE MISC 31G X 8 MM ULTRA COMFORT INSULIN SYRINGE MISC 30G X 5/16" 0.3 ML ULTRA-COMFORT INSULIN SYRINGE MISC 28G X 1/2" 0.5 ML ULTRA-COMFORT INSULIN SYRINGE MISC 28G X 1/2" 1 ML ULTRA-COMFORT INSULIN SYRINGE MISC 29G X 1/2" 0.3 ML ULTRA-COMFORT INSULIN SYRINGE MISC 29G X 1/2" 0.5 ML ULTRA-COMFORT INSULIN SYRINGE MISC 29G X 1/2" 1 ML ULTRA-COMFORT INSULIN SYRINGE MISC 30G X 5/16" 0.3 ML ULTRA-COMFORT INSULIN SYRINGE MISC 30G X 5/16" 0.5 ML ULTRA-COMFORT INSULIN SYRINGE MISC 30G X 5/16" 1 ML ULTRA-COMFORT INSULIN SYRINGE MISC 31G X 5/16" 0.3 ML ULTRA-COMFORT INSULIN SYRINGE MISC 31G X 5/16" 0.5 ML ULTRA-COMFORT INSULIN SYRINGE MISC 31G X 5/16" 1 ML ULTRA-THIN II INS SYR SHORT MISC 31G X 5/16" 1 ML UNIFINE PENTIPS MISC 29G X 12MM UNIFINE PENTIPS MISC 31G X 5 MM UNIFINE PENTIPS MISC 31G X 6 MM UNIFINE PENTIPS MISC 31G X 8 MM GE 101 LAST UPDATED 09/2015

102 UNIFINE PENTIPS MISC 32G X 4 MM UNIFINE PENTIPS PLUS MISC 29G X 12MM UNIFINE PENTIPS PLUS MISC 31G X 5 MM UNIFINE PENTIPS PLUS MISC 31G X 6 MM UNIFINE PENTIPS PLUS MISC 31G X 8 MM UNIFINE PENTIPS PLUS MISC 32G X 4 MM V-R MONO INSULIN SYRINGE MISC 28G X 1/2" 0.5 ML V-R MONO INSULIN SYRINGE MISC 28G X 1/2" 1 ML V-R MONO INSULIN SYRINGE MISC 29G X 1/2" 0.3 ML V-R MONO INSULIN SYRINGE MISC 29G X 1/2" 0.5 ML V-R MONO INSULIN SYRINGE MISC 29G X 1/2" 1 ML VALUE HEALTH INSULIN SYRINGE MISC 29G X 1/2" 0.5 ML VALUE HEALTH INSULIN SYRINGE MISC 29G X 1/2" 1 ML VALUMARK PEN NEEDLES MISC 29G X 12MM VALUMARK PEN NEEDLES MISC 31G X 6 MM VALUMARK PEN NEEDLES MISC 31G X 8 MM VANISHPOINT INSULIN SYRINGE MISC 29G X 1/2" 1 ML VANISHPOINT INSULIN SYRINGE MISC 30G X 1/2" 0.5 ML VIDA MIA UNIFINE PENTIPS MISC 29G X 12MM VIDA MIA UNIFINE PENTIPS MISC 31G X 6 MM GE 102 LAST UPDATED 09/2015

103 VIDA MIA UNIFINE PENTIPS MISC 31G X 8 MM VIDA MIA UNIFINE PENTIPS MISC 32G X 4 MM VP INSULIN SYRINGE MISC 29G X 1/2" 0.3 ML water for irrigation, sterile irrigation soln WEGMANS UNIFINE PENTIPS PLUS MISC 31G X 5 MM WEGMANS UNIFINE PENTIPS PLUS MISC 31G X 6 MM WEGMANS UNIFINE PENTIPS PLUS MISC 31G X 8 MM WEGMANS UNIFINE PENTIPS PLUS MISC 32G X 4 MM OPHTHALMIC AGENTS (EYE MEDICATIONS) Ophthalmic Agents, Other (MISCELLANEOUS EYE MEDICATIONS) *artificial tear ophth ointment*** *artificial tear ophth solution*** neomycin-polymyxin-dexamethasone ophth oint 0.1% neomycin-polymyxin-dexamethasone ophth susp 0.1% proparacaine hcl ophth soln 0.5% Ophthalmic Anti-allergy Agents (ALLERGY EYE MEDICATIONS) azelastine hcl ophth soln 0.05% cromolyn sodium ophth soln 4% Ophthalmic Anti-inflammatories (INFLAMMATION EYE MEDICATIONS) dexamethasone sodium phosphate ophth soln 0.1% diclofenac sodium ophth soln 0.1% FLAREX SUSPENSION 0.1 % fluorometholone acetate flurbiprofen sodium ophth soln 0.03% FML FORTE SUSPENSION 0.25 % fluorometholone (ophth) FML OINTMENT 0.1 % fluorometholone (ophth) GE 103 LAST UPDATED 09/2015

104 ketorolac tromethamine ophth soln 0.4% ketorolac tromethamine ophth soln 0.5% prednisolone acetate ophth susp 1% tobramycin-dexamethasone ophth susp % 5 / 10 days Ophthalmic Antiglaucoma Agents (GLAUCOMA MEDICATIONS) acetazolamide cap sr 12hr 500 mg atropine sulfate ophth soln 1% betaxolol hcl ophth soln 0.5% brimonidine tartrate ophth soln 0.2% carteolol hcl ophth soln 1% dorzolamide hcl ophth soln 2% dorzolamide hcl-timolol maleate ophth soln mg/ml levobunolol hcl ophth soln 0.5% metipranolol ophth soln 0.3% METIPRANOLOL SOLUTION 0.3 % metipranolol timolol maleate ophth soln 0.25% timolol maleate ophth soln 0.5% Ophthalmic Prostaglandin and Prostamide Analogs (GLAUCOMA MEDICATIONS) latanoprost ophth soln 0.005% 5 / 30 days OTIC AGENTS (EAR DRUGS) acetic acid otic soln 2% hydrocortisone w/ acetic acid otic soln 1-2% neomycin-polymyxin-hc otic soln 1% neomycin-polymyxin-hc otic susp 3.5 mg/ml unit/ml-1% Respiratory Tract/Pulmonary Agents (ALLERGIES, COUGH, COLD AND LUNG CONDITION DRUGS) Anti-inflammatories, Inhaled Corticosteroids (ASTHMA/LUNG DRUGS) ADVAIR DISKUS AER POW BA MCG/DOSE fluticasone-salmeterol BREO ELLIPTA AER POW BA MCG/INH fluticasone furoate-vilanterol AL1 ST 60 / 30 days Up to 11 yrs old 60 / 30 days GE 104 LAST UPDATED 09/2015

105 BREO ELLIPTA AER POW BA MCG/INH fluticasone furoate-vilanterol ST 60 / 30 days budesonide inhalation susp 0.25 mg/2ml AL1 Up to 8 yrs old budesonide inhalation susp 0.5 mg/2ml AL1 Up to 8 yrs old DULERA AEROSOL MCG/ACT mometasone furoate-formoterol fumarate dihydrate DULERA AEROSOL MCG/ACT mometasone furoate-formoterol fumarate dihydrate FLOVENT DISKUS AER POW BA 100 MCG/BLIST fluticasone propionate (inhalation) FLOVENT DISKUS AER POW BA 50 MCG/BLIST fluticasone propionate (inhalation) FLOVENT HFA AEROSOL 44 MCG/ACT fluticasone propionate hfa AL1 AL1 AL1 13 / 30 days 13 / 30 days 60 / 30 days 4 to 11 yrs old 60 / 30 days 4 to 11 yrs old 10.6 / 30 days 4 to 11 yrs old flunisolide nasal soln 25 mcg/act (0.025%) 50 / 30 days FLUNISOLIDE SOLUTION 29 MCG/ACT (0.025%) flunisolide (nasal) 50 / 30 days fluticasone propionate nasal susp 50 mcg/act 16 / 30 days NASACORT ALLERGY 24HR AEROSOL 55 MCG/ACT triamcinolone acetonide (nasal) SYMBICORT AEROSOL MCG/ACT budesonide-formoterol fumarate dihydrate SYMBICORT AEROSOL MCG/ACT budesonide-formoterol fumarate dihydrate ANTIHISTAMINES (ALLERGY DRUGS) cetirizine hcl oral soln 1 mg/ml (5 mg/5ml) cyproheptadine hcl syrup 2 mg/5ml cyproheptadine hcl tab 4 mg hydroxyzine hcl syrup 10 mg/5ml hydroxyzine hcl tab 10 mg hydroxyzine hcl tab 25 mg ST ST 10.2 / 30 days 10.2 / 30 days GE 105 LAST UPDATED 09/2015

106 hydroxyzine hcl tab 50 mg HYDROXYZINE MOATE CAP 100 MG hydroxyzine pamoate hydroxyzine pamoate cap 25 mg hydroxyzine pamoate cap 50 mg Antileukotrienes (ASTHMA/LUNG DRUGS) montelukast sodium chew tab 4 mg (base equiv) montelukast sodium chew tab 5 mg (base equiv) montelukast sodium tab 10 mg (base equiv) Bronchodilators, Anticholinergic (ASTHMA/LUNG DRUGS) ATROVENT HFA AERO SOLN 17 MCG/ACT ipratropium bromide hfa ipratropium bromide inhal soln 0.02% 12.9 / 30 days ipratropium bromide nasal soln 0.03% (21 mcg/spray) 30 / 30 days ipratropium bromide nasal soln 0.06% (42 mcg/spray) 15 / 30 days TUDORZA PRESSAIR AER POW BA 400 MCG/ACT aclidinium bromide Bronchodilators, Sympathomimetic (ASTHMA/LUNG DRUGS) ADRENACLICK SOLN A-INJ 0.3 MG/0.3ML epinephrine albuterol sulfate soln nebu 0.083% (2.5 mg/3ml) albuterol sulfate soln nebu 0.5% (5 mg/ml) albuterol sulfate syrup 2 mg/5ml ANORO ELLIPTA AER POW BA MCG/INH umeclidinium-vilanterol AUVI-Q SOLN A-INJ 0.3 MG/0.3ML epinephrine EPINEPHRINE SOLN A-INJ 0.3 MG/0.3ML epinephrine EPIPEN 2-K SOLN A-INJ 0.3 MG/0.3ML epinephrine EPIPEN JR 2-K SOLN A-INJ 0.15 MG/0.3ML epinephrine 1 / 30 days 2 / 90 days 60 / 30 days 2 / 90 days 2 / 90 days GE 106 LAST UPDATED 09/2015

107 EPIPEN JR SOLN A-INJ 0.15 MG/0.3ML epinephrine EPIPEN SOLN A-INJ 0.3 MG/0.3ML epinephrine FORADIL AEROLIZER CAP 12 MCG formoterol fumarate metaproterenol sulfate syrup 10 mg/5ml METAPROTERENOL SULFATE SYRUP 10 MG/5ML metaproterenol sulfate SEREVENT DISKUS AER POW BA 50 MCG/DOSE salmeterol xinafoate terbutaline sulfate tab 2.5 mg terbutaline sulfate tab 5 mg TWINJECT SOLN A-INJ 0.3 MG/0.3ML epinephrine VENTOLIN HFA AERO SOLN 108 (90 BASE) MCG/ACT albuterol sulfate 60 / 30 days 120 / 30 days 18 / 25 days Cystic Fibrosis Agents (ALLERGIES, COUGH, COLD AND LUNG CONDITION DRUGS) PULMOZYME SOLUTION 1 MG/ML dornase alfa Phosphodiesterase Inhibitors, Airways Disease (ALLERGIES, COUGH, COLD AND LUNG CONDITION DRUGS) ELIXOPHYLLIN ELIXIR 80 MG/15ML theophylline LUFYLLIN TAB 200 MG dyphylline LUFYLLIN TAB 400 MG dyphylline theophylline tab sr 12hr 100 mg theophylline tab sr 12hr 200 mg theophylline tab sr 12hr 300 mg theophylline tab sr 12hr 450 mg Respiratory Tract Agents, Other (MISCELLANEOUS RESPIRATORY DRUGS) acetylcysteine inhal soln 10% acetylcysteine inhal soln 20% promethazine & phenylephrine syrup mg/5ml GE 107 LAST UPDATED 09/2015

108 Skeletal Muscle Relaxants (MUSCLE AND JOINT DRUGS) chlorzoxazone tab 500 mg cyclobenzaprine hcl tab 10 mg cyclobenzaprine hcl tab 5 mg methocarbamol tab 500 mg methocarbamol tab 750 mg Sleep Disorder Agents (SLEEP CONDITIONS DRUGS) GABA Receptor Modulators (SEDATION AND SLEEP DRUGS) zaleplon cap 10 mg zaleplon cap 5 mg zolpidem tartrate tab 10 mg 30 / 30 days zolpidem tartrate tab 5 mg 30 / 30 days Therapeutic Nutrients/Minerals/Electrolytes (MULTIVITAMINS AND REPLACEMENT SOLUTIONS) ELECTROLYTE/MINERAL MODIFIERS (ANTIDOTES/PROTECTANTS) *sodium polystyrene sulfonate powder** ELECTROLYTE/MINERAL REPLACEMENT (ELECTROLYTES REPLACEMENTS) KLOR-CON M15 TAB ER 15 MEQ potassium chloride microencapsulated crystals cr potassium chloride cap cr 10 meq potassium chloride cap cr 8 meq POTASSIUM CHLORIDE ER TAB ER 8 MEQ potassium chloride potassium chloride microencapsulated crys cr tab 10 meq potassium chloride microencapsulated crys cr tab 20 meq potassium chloride tab cr 10 meq potassium chloride tab cr 8 meq (600 mg) sodium chloride flush iv soln 0.9% sodium chloride inj 0.9% sodium chloride iv soln 0.9% GE 108 LAST UPDATED 09/2015

109 Uncategorized Unclassified *b-complex w/ c & calcium tab*** *b-complex w/ c & e + zn tab*** *b-complex w/ c & folic acid cap 1 mg*** *b-complex w/ c & folic acid tab*** *b-complex w/ c tab** *iron combination cap*** *lactobacillus acidophilus-pectin cap** *multiple vitamin tab** *multiple vitamins w/ iron tab** *multiple vitamins w/ minerals cap** *multiple vitamins w/ minerals chew tab** *multiple vitamins w/ minerals tab cr** *multiple vitamins w/ minerals tab** *neomycin-bacitracin-polymyxin oint*** *neomycin-bacitracin-polymyxin w/ lidocaine oint 4%*** *nit remover - gel*** *nystatin oral powder* *pe-apap cap & doxylamine-pe-apap cap therapy pack*** *pediatric multiple vitamin liq** AL1 Up to 9 yrs old *pediatric multiple vitamin w/ c & fa chew tab** AL1 Up to 9 yrs old *pediatric multiple vitamin w/ c soln 35 mg/ml** AL1 Up to 9 yrs old *pediatric multiple vitamin w/ extra c & fa chew tab** AL1 Up to 9 yrs old *pediatric multiple vitamin w/ minerals & c chew tab 30 mg** AL1 Up to 9 yrs old *pediatric multiple vitamin w/ minerals & c chew tab 60 mg** AL1 Up to 9 yrs old *pediatric multiple vitamin w/ minerals & c chew tab** AL1 Up to 9 yrs old *pediatric multiple vitamin w/ minerals & c drops 45 mg/ml** AL1 Up to 9 yrs old *pediatric multiple vitamins w/ iron chew tab 15 mg** AL1 Up to 9 yrs old GE 109 LAST UPDATED 09/2015

110 *pediatric multiple vitamins w/ iron drops 10 mg/ml** AL1 Up to 9 yrs old *pediatric vitamins acd w/ fluoride soln 0.25 mg/ml*** AL1 Up to 9 yrs old *pediatric vitamins acd w/ fluoride soln 0.5 mg/ml*** AL1 Up to 9 yrs old *soft contact lens products - solution*** *white petrolatum-mineral oil ophth ointment*** ABREVA CREAM 10 % docosanol ACCU-CHEK TENDER 1 INFUSION KIT iv sets/tubing ACEROLA C 500 WAFER 500 MG ascorbic acid acetaminophen cap 500 mg acetaminophen chew tab 80 mg acetaminophen elixir 160 mg/5ml acetaminophen liquid 160 mg/5ml acetaminophen soln 100 mg/ml acetaminophen suppos 120 mg acetaminophen suppos 325 mg acetaminophen susp 80 mg/0.8ml acetaminophen tab 325 mg acetaminophen tab 500 mg acetaminophen tab cr 650 mg acetaminophen w/ dm liq mg/30ml acetaminophen w/ dm liq mg/5ml acetaminophen-guaifenesin tab mg ACETIC ACID-ALUMINUM ACETATE SOLUTION 2 % acetic acid-aluminum acetate ACETONE SOLUTION acetone ACIDOPHILUS PLUS PECTIN TAB lactobacillus acidophilus-pectin ACIDOPHILUS/CITRUS PECTIN TAB lactobacillus acidophilus-pectin GE 110 LAST UPDATED 09/2015

111 ACNE MEDICATION LOTION 10 % benzoyl peroxide ACTIPHYTE OF LEMONGRASS LIQUID lemongrass (bulk) ADMINISTRATION SET MISC iv sets/tubing ADULT ACNOMEL CREAM 2-8 % resorcinol-sulfur ADULT ASPIRIN LOW STRENGTH TAB DISP 81 MG aspirin ADVIL ALLERGY & CONGESTION TAB MG chlorpheniramine-phenylephrine-ibuprofen ADVIL ALLERGY SINUS TAB MG chlorpheniramine-pseudoephedrine-ibuprofen ADVIL COLD & SINUS LIQUI-GELS CAP MG pseudoephedrine-ibuprofen AEROSN AERO SOLN 80 MCG/ACT flunisolide hfa AFLURIA PRESERVATIVE FREE SUSP PRSYR 0.5 ML influenza virus vaccine split preservative free AFLURIA SUSPENSION influenza virus vaccine split AGORAL MAXIMUM STRENGTH LIQUID 25 MG/15ML sennosides AIMSCO LUBRICATED MISC condoms latex lubricated - male AIR ELIMINATING TPN IV SET MISC iv sets/tubing ALA-HIST PE TAB 2-10 MG dexbrompheniramine-phenylephrine ALCOHOL (RUBBING) SOLUTION 70 % alcohol, rubbing ALCOHOL DENATURED SOLUTION 95 % alcohol, rubbing AL1 30 / 30 days 40 to 79 yrs old 8.9 / 30 days 0.5 / 365 days 0.5 / 365 days 12 / 30 days ALER-DRYL TAB 50 MG diphenhydramine hcl C Covered up to age 65, then required GE 111 LAST UPDATED 09/2015

112 ALKA-SELTZER HEARTBURN EFFER TAB MG sodium bicarbonate-citric acid ALKA-SELTZER PLUS COLD & COUGH CAP MG phenylephrine-chlorpheniramine-dm w/ apap ALKA-SELTZER PLUS COLD & COUGH EFFER TAB MG phenylephrine-chlorpheniramine-dm-aspirin ALKA-SELTZER PLUS COLD & FLU EFFER TAB MG phenylephrine-chlorpheniramine-dm w/ apap ALKA-SELTZER PLUS DAY/NIGHT MISC phenylephrine-doxylamine-dextromethorphan-aspirin ALKA-SELTZER PLUS NIGHT COLD EFFER TAB MG phenylephrine-doxylamine-dextromethorphan-aspirin ALKA-SELTZER PLUS SINUS EFFER TAB MG phenylephrine-aspirin alum & mag hydroxide-simethicone chew tab mg alum & mag hydroxide-simethicone susp mg/5ml alum & mag hydroxide-simethicone susp mg/5ml aluminum hydroxide-magnesium carbonate chew tab mg aluminum hydroxide-magnesium carbonate susp mg/15ml aluminum hydroxide-magnesium trisilicate chew tab mg AMMONIUM LACTATE SOLUTION 70 % ammonium lactate AMPICILLIN RECON SUSP 125 MG/5ML ampicillin AMPICILLIN RECON SUSP 250 MG/5ML ampicillin ANESTHESIA EXTENSION TUBING MISC iv sets/tubing ANTACID CHEW TAB 1177 MG calcium carbonate (antacid) ANTACID CHEW TAB MG calcium carbonate-mag hydrox antipyrine-benzocaine otic soln mg/ml ( %) ATATE FORTE LIQUID multiple vitamins w/ minerals ARGYLE EXTENSION TUBE 20" MISC iv sets/tubing GE 112 LAST UPDATED 09/2015

113 ARMOUR THYROID TAB 120 MG thyroid ARMOUR THYROID TAB 15 MG thyroid ARMOUR THYROID TAB 180 MG thyroid ARMOUR THYROID TAB 240 MG thyroid ARMOUR THYROID TAB 300 MG thyroid ascorbic acid cap cr 500 mg ascorbic acid chew tab 100 mg ascorbic acid chew tab 250 mg ascorbic acid chew tab 500 mg ascorbic acid inj 500 mg/ml ascorbic acid liquid 500 mg/5ml ascorbic acid lozenge 60 mg ascorbic acid syrup 500 mg/5ml ascorbic acid tab 100 mg ascorbic acid tab 1000 mg ascorbic acid tab 250 mg ascorbic acid tab 500 mg ascorbic acid tab cr 1000 mg ascorbic acid tab cr 1500 mg ascorbic acid tab cr 500 mg aspirin buffered (ca carb-mg carb-mg ox) tab 325 mg aspirin buffered tab 325 mg aspirin chew tab 81 mg AL1 AL1 AL1 30 / 30 days 40 to 79 yrs old 30 / 30 days 40 to 79 yrs old 60 / 30 days 40 to 79 yrs old GE 113 LAST UPDATED 09/2015

114 ASPIRIN LOW DOSE TAB 81 MG aspirin aspirin suppos 300 mg aspirin suppos 600 mg aspirin tab 325 mg aspirin tab 500 mg aspirin tab 81 mg aspirin tab delayed release 325 mg aspirin tab delayed release 81 mg aspirin-acetaminophen-caffeine tab mg ASSURE DOSE CONTROL SOLUTION NORMAL blood glucose calibration ATABEX CHEW TAB MG prenatal without a vit w/ iron carbonyl-folic acid ATABEX EC TAB DR 29-1 MG prenatal vit w/ docusate-iron carbonyl-folic acid ATROPINE SULFATE OINTMENT 1 % atropine sulfate (ophthalmic) AUTOJECT 2 MISC injection device AUTOPEN DEVICE injection device for insulin AZOLEN TINCTURE SOLUTION 2 % miconazole nitrate (topical) B-NATAL LOZ HANDLE 25 MG pyridoxine hcl B-NATAL LOZENGE 25 MG pyridoxine hcl AL1 AL1 AL1 AL1 AL1 60 / 30 days 40 to 79 yrs old 30 / 30 days 40 to 79 yrs old 60 / 30 days 40 to 79 yrs old 30 / 30 days 40 to 79 yrs old 60 / 30 days 40 to 79 yrs old GE 114 LAST UPDATED 09/2015

115 B1 NATURAL TAB 250 MG thiamine mononitrate bacitracin oint 500 unit/gm bacitracin zinc oint 500 unit/gm BD ANGIOCATH AUTOGUARD MISC iv catheter BD ECLIPSE SYRINGE MISC 25G X 5/8" 1 ML syringe/needle (disp) 1 ml BD FIRST MIDCATH 18G/4FRX20CM KIT iv catheter BD FIRST MIDCATH 18G/4FRX20CM MISC iv catheter BD FIRST MIDCATH 20G/3FRX20CM KIT iv catheter BD FIRST MIDCATH 20G/3FRX20CM MISC iv catheter BD FIRST PICC 16G/5FRX65CM KIT iv catheter BD FIRST PICC 16G/5FRX65CM MISC iv catheter BD FIRST PICC 18G/4FRX65CM KIT iv catheter BD FIRST PICC 18G/4FRX65CM MISC iv catheter BD FIRST PICC 20G/3FRX65CM KIT iv catheter BD FIRST PICC 20G/3FRX65CM MISC iv catheter BD FIRST PICC 22G/2.8FRX50CM MISC iv catheter BD FIRST PICC 26G/1.9FRX50CM KIT iv catheter BD FIRST PICC 26G/1.9FRX50CM MISC iv catheter BD INTEGRA SYRINGE MISC 25G X 5/8" 1 ML syringe/needle (disp) 1 ml BD L-CATH 16G/5FR KIT iv catheter GE 115 LAST UPDATED 09/2015

116 BD L-CATH 16G/5FRX60CM MISC iv catheter BD L-CATH 18G/3.5FR KIT iv catheter BD L-CATH 18G/3.5FRX60CM MISC iv catheter BD L-CATH 20G/2.6FR KIT iv catheter BD L-CATH 20G/2.6FRX60CM MISC iv catheter BD L-CATH 20G/3FR KIT iv catheter BD L-CATH 20G/3FRX60CM MISC iv catheter BD L-CATH 28G/1.2FRX25CM KIT iv catheter BD L-CATH MIDLINE 18G/3.5FRX20 KIT iv catheter BD L-CATH MIDLINE 18G/3.5FRX20 MISC iv catheter BD L-CATH MIDLINE 20G/3FRX20CM MISC iv catheter BD LUER-LOK SYRINGE MISC 20G X 1" 1 ML syringe/needle (disp) 1 ml BD LUER-LOK SYRINGE MISC 25G X 5/8" 1 ML syringe/needle (disp) 1 ml BD NEXIVA 18GX1.25" MISC iv catheter BD NEXIVA 18GX1.75" MISC iv catheter BD NEXIVA 20GX1" MISC iv catheter BD NEXIVA 20GX1.25" MISC iv catheter BD NEXIVA 20GX1.75" MISC iv catheter BD NEXIVA 22GX1" MISC iv catheter BD NEXIVA 24GX0.56" MISC iv catheter GE 116 LAST UPDATED 09/2015

117 BD NEXIVA 24GX0.75" MISC iv catheter BD SAF-T E-Z SET MISC iv sets/tubing BD SAF-T-INTIMA 18G X 1" KIT iv catheter BD SAF-T-INTIMA 20GX1" MISC iv catheter BD SAF-T-INTIMA 22G X 0.75" KIT iv catheter BD SAF-T-INTIMA 22GX3/4" MISC iv catheter BD SAF-T-INTIMA 24G X 0.75" KIT iv catheter BD SAF-T-INTIMA 24GX3/4" MISC iv catheter BD SAFETY-LOK SET MISC iv sets/tubing BD SAFETY-LOK VACUTAINER SET MISC iv sets/tubing BD SYRINGE/NEEDLE MISC 25G X 5/8" 1 ML syringe/needle (disp) 1 ml BD SYRINGE/NEEDLE SLIP TIP MISC 26G X 5/8" 1 ML syringe/needle (disp) 1 ml BD VACUTAINER SET MISC iv sets/tubing BENFOTIAMINE CAP 150 MG benfotiamine BENFOTIAMINE-V CAP 150 MG benfotiamine benzocaine dental gel 20% benzocaine dental gel 7.5% benzocaine dental liquid 20% benzocaine dental paste 20% benzocaine dental soln 20% benzocaine dental swab 20% benzocaine-docusate sodium rectal enema mg GE 117 LAST UPDATED 09/2015

118 benzonatate cap 100 mg benzonatate cap 200 mg benzoyl peroxide cleanser 3.5% benzoyl peroxide cream 10% benzoyl peroxide cream 2.5% benzoyl peroxide gel 10% BENZOYL PEROXIDE GEL 2.5 % benzoyl peroxide benzoyl peroxide gel 5% benzoyl peroxide liq 10% benzoyl peroxide liq 2.5% benzoyl peroxide liq 5% benzoyl peroxide lotion 6% BENZYL ALCOHOL LIQUID benzyl alcohol BENZYL BENZOATE LIQUID benzyl benzoate (bulk) BICARSIM FORTE TAB 125 MG simethicone BICARSIM TAB 80 MG simethicone BICLORA LIQUID MG/5ML chlophedianol-chlorcyclizine BICLORA TAB MG chlophedianol-chlorcyclizine BICLORA-D LIQUID MG/5ML pseudoephedrine-chlorcyclizine-chlophedianol BICLORA-D TAB MG pseudoephedrine-chlorcyclizine-chlophedianol BIOBRON SF SYRUP MG/5ML phenylephrine w/ dm-gg BIODESP DM SYRUP MG/5ML phenylephrine w/ dm-gg BIONATUSS DXP LIQUID MG/5ML phenylephrine-dexbrompheniramine-dextromethorphan BIONEL LIQUID MG/5ML pseudoephedrine w/ dm-gg GE 118 LAST UPDATED 09/2015

119 BIONEL PEDIATRIC LIQUID MG/5ML pseudoephedrine w/ dm-gg BIOSPEC DMX LIQUID MG/5ML dextromethorphan-guaifenesin BIOSUPP LIQUID multiple vitamins w/ minerals BIOTECT PLUS LIQUID multiple vitamins w/ minerals biotin cap 2.5 mg biotin cap 5 mg BIOTIN TAB 10 MG biotin biotin tab 1000 mcg biotin tab 2.5 mg biotin tab 300 mcg biotin tab 5 mg BIOTIN TAB 7500 MCG biotin biotin tab 800 mcg BIOTIN ULTRA STRENGTH CAP 10 MG biotin BIOVOL SYRUP multiple vitamins w/ minerals bisacodyl suppos 10 mg bisacodyl tab delayed release 5 mg bismuth subsalicylate chew tab 262 mg bismuth subsalicylate susp 262 mg/15ml bismuth subsalicylate susp 525 mg/15ml bismuth subsalicylate tab 262 mg BLACK DRAUGHT CHEW TAB 10 MG sennosides BLINK TEARS GEL 0.25 % polyethylene glycol 400 (ophth) BLINK TEARS SOLUTION 0.25 % polyethylene glycol 400 (ophth) GE 119 LAST UPDATED 09/2015

120 BP CLEANSING WASH EMULSION 10-4 % sulfacetamide sodium-sulfur in urea vehicle BPO GEL 4 % benzoyl peroxide BRAINSTRONG PRENATAL MISC & 350 MG prenatal mv & min w/fe carbonyl-fa-dha BRASIVOL STE aluminum oxide BROHIST D TAB 4-10 MG brompheniramine & phenyleph brompheniramine & phenylephrine elixir mg/5ml brompheniramine & phenylephrine liqd 4-10 mg/5ml brompheniramine & phenylephrine susp 6-10 mg/5ml brompheniramine & pseudoephedrine elixir 1-15 mg/5ml BRONCOTRON PED DROPS LIQUID MG/ML phenylephrine w/ dm-gg BRONCOTRON-S LIQUID MG/5ML dextromethorphan-guaifenesin BRONKAID TAB MG ephedrine-guaifenesin BRONKIDS LIQUID MG/ML phenylephrine-chlorphen-dm BRONKIDS LIQUID MG/5ML phenylephrine-chlorphen-dm BUFFERED VITAMIN C CAP 1000 MG ascorbic acid buffered BUFFERIN TAB 325 MG aspirin buffered (cal carb-mag carb-mag oxide) BURIED TREASURE ACTIVE 55 PLUS LIQUID multiple vitamins w/ minerals butalbital-acetaminophen tab mg butalbital-acetaminophen-caffeine tab mg butalbital-acetaminophen-caffeine tab mg butalbital-aspirin-caffeine cap mg cal carb & mag hydrox-simethicone chew tab mg CAL-MAG CHELA-MAX CAP MG calcium w/ magnesium AL1 30 / 30 days 40 to 79 yrs old GE 120 LAST UPDATED 09/2015

121 CAL-QUICK LIQUID MG-UNT/5ML calcium carbonate-cholecalciferol CAL/MAG TAB MG calcium w/ magnesium CALCET CREAMY BITES CHEW TAB MG-UNIT calcium citrate-vitamin d calcium carbonate (antacid) chew tab 1000 mg calcium carbonate (antacid) chew tab 400 mg calcium carbonate (antacid) chew tab 420 mg calcium carbonate (antacid) chew tab 500 mg calcium carbonate (antacid) chew tab 750 mg CALCIUM CARBONATE ANTACID TAB 648 MG calcium carbonate (antacid) calcium carbonate susp 1250 mg/5ml (500 mg/5ml elemental ca) calcium carbonate tab 1250 mg (500 mg elemental ca) calcium carbonate-cholecalciferol chew tab 500 mg-100 unit calcium carbonate-cholecalciferol tab 500 mg-125 unit calcium carbonate-cholecalciferol tab 500 mg-200 unit calcium carbonate-cholecalciferol tab 500 mg-400 unit calcium carbonate-cholecalciferol tab 500 mg-600 unit calcium carbonate-cholecalciferol tab 600 mg-200 unit calcium carbonate-cholecalciferol tab 600 mg-400 unit calcium carbonate-mag hydroxide chew tab mg calcium carbonate-mag hydroxide chew tab mg calcium carbonate-mag hydroxide chew tab mg calcium carbonate-mag hydroxide susp mg/5ml calcium carbonate-simethicone chew tab mg calcium carbonate-vitamin d cap 600 mg-200 unit calcium carbonate-vitamin d tab 250 mg-125 unit calcium carbonate-vitamin d tab 500 mg-125 unit calcium carbonate-vitamin d tab 500 mg-200 unit calcium carbonate-vitamin d tab 500 mg-400 unit calcium carbonate-vitamin d tab 600 mg-125 unit GE 121 LAST UPDATED 09/2015

122 calcium carbonate-vitamin d tab 600 mg-200 unit calcium carbonate-vitamin d tab 600 mg-400 unit CALCIUM CHEW TAB MG-UNIT calcium carbonate-cholecalciferol CALCIUM CITRATE GRANULES 760 MG/3.5GM calcium citrate CALCIUM CITRATE MALATE-VIT D TAB MG-UNIT calcium citrate malate-cholecalciferol calcium citrate tab 200 mg calcium citrate tab 950 mg (200 mg elemental ca) calcium citrate-vitamin d tab 250 mg-200 unit (elemental ca) CALCIUM CITRATE-VITAMIN D TAB MG-UNIT calcium citrate-vitamin d calcium citrate-vitamin d tab 315 mg-200 unit (elemental ca) CALCIUM CITRATE-VITAMIN D3 LIQUID calcium citrate-vitamin d CALCIUM NTOTHENATE TAB 100 MG calcium pantothenate CALCIUM PLUS VITAMIN D CAP MG-UNIT calcium carbonate-vitamin d calcium polycarbophil tab 625 mg calcium w/ magnesium tab mg calcium w/ vitamin d tab 500 mg-125 unit calcium w/ vitamin d tab 600 mg-200 unit CALCIUM-MAGNESIUM TAB MG calcium w/ magnesium CALCIUM-VITAMIN D3 CAP MG-UNIT calcium carbonate-cholecalciferol CALCIUM/VITAMIN D3 GUMMIES CHEW TAB MG-UNIT calcium phosphate-cholecalciferol camphor inhalant liquid 6.2% CAMPHOR SPIRIT SPIRIT camphor spirit CAPCOF SYRUP MG/5ML phenylephrine-chlorpheniramine w/ codeine capecitabine tab 150 mg GE 122 LAST UPDATED 09/2015

123 capecitabine tab 500 mg CAPMIST DM TAB MG pseudoephedrine w/ dm-gg CAPRON DM LIQUID MG/5ML dextromethorphan-pyrilamine capsaicin cream 0.025% capsaicin cream 0.075% capsaicin cream 0.1% CAPZASIN LIQUID 0.15 % capsaicin carbamide peroxide 6.5% otic soln CARBAPHEN CH SUSPENSION MG/5ML phenylephrine-chlorpheniramine-chlophedianol CARBAPHEN PED CH SUSPENSION MG/ML phenylephrine-chlorpheniramine-chlophedianol carboxymethylcellulose sodium ophth gel 1% carboxymethylcellulose sodium ophth soln 0.5% carboxymethylcellulose-glycerin ophth soln % CCP CAFFEINE FREE TAB MG phenylephrine-acetaminophen-guaifenesin CEFTIN RECON SUSP 250 MG/5ML cefuroxime axetil AL1 Up to 11 yrs old cefuroxime axetil for susp 125 mg/5ml AL1 Up to 11 yrs old CENTRUM SPECIALIST PRENATAL MISC & 200 MG prenatal mv & min w/fe fumarate-fa-dha CERALYTE 70 SOLUTION oral electrolytes CERASPORT SOLUTION oral electrolytes CERTUSS-D TAB MG pseudoephedrine-chlophedianol-guaifenesin cetirizine hcl tab 10 mg cetirizine hcl tab 5 mg cetirizine-pseudoephedrine tab sr 12hr mg CHERRY CONCENTRATE SYRUP cherry syrup GE 123 LAST UPDATED 09/2015

124 CHERRY SYRUP cherry syrup CHLO TUSS EX LIQUID MG/5ML chlophedianol-guaifenesin CHLO TUSS LIQUID MG/5ML pseudoephedrine-dexbrompheniramine-chophedianol CHLO TUSS LIQUID MG/5ML phenylephrine-dexbrompheniramine-chlophedianol CHLOPHED LIQUID MG/5ML phenylephrine-chlophedianol-guaifenesin chlordiazepoxide hcl cap 10 mg chlordiazepoxide hcl cap 25 mg chlordiazepoxide hcl cap 5 mg chlordiazepoxide hcl-clidinium bromide cap mg CHLORHEXIDINE GLUCONATE SOLUTION chlorhexidine gluconate (bulk) CHLOROFORM SOLUTION chloroform chlorphen-pe-apap tab mg & pe-apap tab mg pack chlorphen-phenylephrine w/ apap effer tab mg chlorphen-phenylephrine w/ apap susp mg/5ml chlorphen-phenylephrine w/ apap tab mg chlorphen-phenylephrine w/ apap tab mg chlorphen-pseudoephedrine w/ apap cap mg chlorphen-pseudoephedrine w/ apap liquid mg/5ml chlorpheniramine & phenylephrine liquid 1-2 mg/ml chlorpheniramine & phenylephrine liquid mg/ml chlorpheniramine & phenylephrine liquid 4-10 mg/5ml chlorpheniramine & phenylephrine tab 4-10 mg chlorpheniramine & pseudoephedrine syrup 1-15 mg/5ml chlorpheniramine & pseudoephedrine tab 4-60 mg CHLORPHENIRAMINE MALEATE POWDER chlorpheniramine maleate chlorpheniramine maleate syrup 2 mg/5ml GE 124 LAST UPDATED 09/2015

125 chlorpheniramine maleate tab 4 mg chlorpheniramine maleate tab cr 12 mg chlorpheniramine w/ codeine liquid 2-10 mg/5ml chlorpheniramine-acetaminophen tab mg chlorpheniramine-dm liquid 1-5 mg/5ml chlorpheniramine-dm liquid 2-15 mg/5ml chlorpheniramine-dm tab 4-30 mg chlorpheniramine-phenylephrine-asa effer tab mg CHLORPROMIDE TAB 100 MG chlorpropamide CHLORPROMIDE TAB 250 MG chlorpropamide cholecalciferol cap 400 unit AL1 At least 65 yrs old cholecalciferol tab 1000 unit cholecalciferol tab 400 unit cholecalciferol tab 5000 unit choline & magnesium salicylates liq 500 mg/5ml choline & magnesium salicylates tab 1000 mg CIPROFLOXACIN HCL SOLUTION 0.2 % ciprofloxacin hcl (otic) CITROCARBONATE GRAN EFFER GM/DOSE sodium bicarbonate-sodium citrate CITRUS SYRUP SYRUP oral vehicles CLARITIN REDITABS TAB DISP 5 MG loratadine CLASSIC PRENATAL TAB MG prenatal vit w/ ferrous fumarate-folic acid CLEARCANAL EAR WAX REMOVAL KIT 6.5 % carbamide peroxide & saline CLEMASTINE FUMARATE SYRUP 0.67 MG/5ML clemastine fumarate clemastine fumarate syrup 0.67 mg/5ml (0.5 mg/5ml base eq) AL1 60 / 30 days At least 65 yrs old GE 125 LAST UPDATED 09/2015

126 clemastine fumarate tab 1.34 mg (1 mg base equiv) clemastine fumarate tab 2.68 mg CLINICAL NUTRIENTS PRENATAL TAB MG prenatal vitamins w/ ferrous succinate-folic acid clotrimazole cream 1% clotrimazole vaginal cream 1% clotrimazole vaginal cream 2% CODAR AR LIQUID 2-8 MG/5ML chlorpheniramine w/ codeine CODAR D LIQUID 30-8 MG/5ML pseudoephedrine w/ codeine CODITUSS DM SYRUP MG/5ML phenylephrine-pyrilamine-dm COMPLETE FORMULATION PEDIATRIC SOLUTION 45 MG/0.5ML pediatric multiple vitamin w/ minerals & c COMPLETE NATAL DHA MISC & 250 MG prenatal mv & min w/fe bisglyc-fe prot succ-fa-ca-omega 3 COMPLETE NUTRITIONAL DRINK POWDER nutritional supplements COMPLETE PRENATAL/DHA MISC & 300 MG prenatal without a w/ fe bisglycinate-fa-dha COMPLETE SINUS RELIEF TAB MG dexbrompheniramine-phenylephrine-acetaminophen COMPLETENATE CHEW TAB 29-1 MG prenatal vit w/ ferrous fumarate-folic acid CONCEPTIONXR MOTILITY SUPPORT MISC multiple vitamins w/ minerals CONDOMS MISC condoms - male CONEX COLD/ALLERGY SOLUTION 1-30 MG/5ML dexbrompheniramine & pseudoephedrine CONEX COLD/ALLERGY TAB 2-60 MG dexbrompheniramine & pseudoephedrine CONTAC COLD+FLU MAX ST TAB MG chlorpheniramine-phenylephrine-acetaminophen CONTAC COLD/FLU DAY & NIGHT TAB MG chlorpheniramine-phenylephrine-acetaminophen AL1 Up to 9 yrs old 12 / 30 days GE 126 LAST UPDATED 09/2015

127 COOL MIST HUMIDIFIER MISC humidifiers CORICIDIN HBP DAY/NIGHT COLD MISC & MG dextromethorphan-guaifenesin-chlorpheniramine-acetaminophen CORICIDIN NIGHTTIME COLD-COUGH LIQUID MG/15ML diphenhydramine-acetaminophen CORNWALL METAL PIPETTING MISC injection device CORRECTOL HERBAL TEA MISC 30 MG senna COTTONSEED OIL OIL cottonseed oil (bulk) cromolyn sodium nasal aerosol soln 5.2 mg/act (4%) CRYOSERV SOLUTION dimethyl sulfoxide (bulk) CULTURELLE CAP lactobacillus rhamnosus (gg) CULTURELLE DIGESTIVE HEALTH CAP lactobacillus-inulin CULTURELLE DIGESTIVE HEALTH CHEW TAB lactobacillus-inulin CULTURELLE HEALTH & WELLNESS CAP lactobacillus-inulin CULTURELLE IMMUNITY SUPPORT CAP lactobacillus rhamnosus (gg) CVS DIABETES HEALTH SUPPORT MISC multiple vitamins w/ minerals CVS EAR WAX CLEANSING SYSTEM KIT 6.5 % carbamide peroxide & saline CVS ETHYL ALCOHOL SOLUTION 70 % alcohol, usp CVS ISOPROPYL ALCOHOL SOLUTION 70 % isopropyl alcohol CVS ISOPROPYL ALCOHOL SOLUTION 91 % isopropyl alcohol CVS ISOPROPYL RUBBING ALCOHOL SOLUTION 70 % isopropyl alcohol CVS NATURAL FIBER SUPPLEMENT CKET 58.6 % psyllium GE 127 LAST UPDATED 09/2015

128 CVS PRENATAL GUMMY CHEW TAB MG prenatal multivitamins & minerals w/ folic acid-fish oil CVS PRENATAL TAB MG prenatal vit w/ ferrous fumarate-folic acid CVS VITAMIN C CHEW TAB 1000 MG ascorbic acid CVS WOMENS PRENATAL+DHA MISC & 200 MG prenatal mv & min w/fe fumarate-fa-dha cyanocobalamin inj 1000 mcg/ml cyanocobalamin tab 1000 mcg cyclopentolate hcl ophth soln 1% CYTRA-3 SYRUP MG/5ML pot & sod citrates w/citric ac DAILY ENERGY ENFUSION POWDER multiple vitamins w/ minerals DAILY HEART HEALTH SUPPORT MISC multiple vitamins w/ minerals DAILY K MAXIMUM MULTIVITAMIN MISC multiple vitamins w/ minerals DALLERGY LIQUID MG/ML chlorpheniramine & phenylephrine DALLERGY TAB 1-5 MG dexbrompheniramine-phenylephrine DALLERGY TAB MG chlorcyclizine-phenylephrine DAYTIME COLD MEDICINE LIQUID MG/15ML acetaminophen w/ dm DELTUSS DP LIQUID 1-30 MG/5ML dexchlorpheniramine & pseudoephedrine DELZICOL CAP DR 400 MG mesalamine DENTURE ADHESIVE CREAM denture care products DESGEN DM SYRUP MG/5ML phenylephrine w/ dm-gg DESPEC DM SYRUP MG/5ML phenylephrine w/ dm-gg DESPEC-DM TAB MG pseudoephedrine w/ dm-gg 180 / 30 days 60 / 30 days GE 128 LAST UPDATED 09/2015

129 DEWEES CARMINATIVE LIQUID magnesium oxide-asafoetida DEXAMETHASONE SOLUTION 0.5 MG/5ML dexamethasone DEXCHLORPHENIRAMINE MALEATE SYRUP 2 MG/5ML dexchlorpheniramine maleate DEXK 10 DAY TAB 1.5 MG dexamethasone DEXK 13 DAY TAB 1.5 MG dexamethasone DEXK 6 DAY TAB 1.5 MG dexamethasone dextromethorphan hbr syrup 15 mg/5ml dextromethorphan-apap-chlorpheniramine susp mg/5ml dextromethorphan-apap-chlorpheniramine tab mg dextromethorphan-doxylamine-apap cap mg dextromethorphan-doxylamine-apap liquid mg/15ml dextromethorphan-doxylamine-apap liquid mg/30ml dextromethorphan-guaifenesin cap mg dextromethorphan-guaifenesin liquid mg/5ml dextromethorphan-guaifenesin liquid mg/15ml dextromethorphan-guaifenesin liquid mg/5ml dextromethorphan-guaifenesin liquid mg/5ml dextromethorphan-guaifenesin liquid mg/5ml dextromethorphan-guaifenesin liquid mg/5ml dextromethorphan-guaifenesin syrup mg/5ml dextromethorphan-guaifenesin tab mg dextromethorphan-guaifenesin tab sr 12hr mg dextromethorphan-guaifenesin tab sr 12hr mg dextromethorphan-phenylephrine-apap cap mg dextromethorphan-phenylephrine-apap liqd mg/15ml dextromethorphan-phenylephrine-apap powd pack mg dextromethorphan-phenylephrine-apap tab mg GE 129 LAST UPDATED 09/2015

130 DIABETES HEALTH MISC multiple vitamins w/ minerals DIABETES SUPPORT MISC multiple vitamins w/ minerals DIABETIC TUSSIN COLD & FLU LIQUID MG/5ML dextromethorphan-diphenhydramine-acetaminophen DIABETIC TUSSIN NIGHT COLD/FLU LIQUID MG/5ML dextromethorphan-diphenhydramine-acetaminophen DIALYVITE SUPREME D TAB 3 MG multiple vitamins w/ minerals & folic acid DIMENHYDRINATE SOLUTION 50 MG/ML dimenhydrinate dimenhydrinate tab 50 mg DIMETAPP LONG ACT COUGH/COLD SYRUP MG/5ML chlorpheniramine-dm DIMETHYL SULFOXIDE SOLUTION dimethyl sulfoxide (bulk) DIMETHYL SULFOXIDE SOLUTION 100 % dimethyl sulfoxide (bulk) DINO-LIFE W/IRON-ZINC CHEW TAB pediatric multiple vitamins w/ iron diphenhydramine hcl (sleep) cap 25 mg diphenhydramine hcl (sleep) cap 50 mg diphenhydramine hcl (sleep) liquid 50 mg/30ml diphenhydramine hcl (sleep) tab 25 mg diphenhydramine hcl (sleep) tab 50 mg diphenhydramine hcl (sleep) tab disp 25 mg AL1 Up to 9 yrs old diphenhydramine hcl cap 25 mg diphenhydramine hcl cap 50 mg diphenhydramine hcl chew tab 12.5 mg diphenhydramine hcl elixir 12.5 mg/5ml C Covered up to age 65, then required C Covered up to age 65, then required C Covered up to age 65, then required C Covered up to age 65, then required GE 130 LAST UPDATED 09/2015

131 diphenhydramine hcl liquid 12.5 mg/5ml diphenhydramine hcl syrup 12.5 mg/5ml diphenhydramine hcl tab 25 mg diphenhydramine hcl tab disp 12.5 mg diphenhydramine-acetaminophen tab mg C Covered up to age 65, then required C Covered up to age 65, then required C Covered up to age 65, then required C Covered up to age 65, then required diphenhydramine-acetaminophen tab mg diphenhydramine-acetaminophen tab mg diphenhydramine-acetaminophen tab mg (sleep) diphenhydramine-phenylephrine liq mg/5ml diphenhydramine-phenylephrine soln mg/5ml diphenhydramine-phenylephrine tab mg diphenhydramine-phenylephrine-apap liq mg/10ml diphenhydramine-phenylephrine-apap liq mg/15ml diphenhydramine-phenylephrine-apap liq mg/5ml diphenhydramine-phenylephrine-apap packet mg diphenhydramine-phenylephrine-apap susp mg/5ml diphenhydramine-phenylephrine-apap tab mg diphenhydramine-phenylephrine-apap tab mg diphenhydramine-phenylephrine-apap tab mg diphenhydramine-pse w/ apap tab mg DIURIL SUSPENSION 250 MG/5ML chlorothiazide docusate calcium cap 240 mg docusate sodium cap 100 mg docusate sodium cap 250 mg AL1 600 / 30 days Up to 12 yrs old GE 131 LAST UPDATED 09/2015

132 docusate sodium cap 50 mg docusate sodium enema 283 mg docusate sodium liquid 150 mg/15ml docusate sodium syrup 60 mg/15ml docusate sodium tab 100 mg DOCUSOL KIDS ENEMA 100 MG/5ML docusate sodium DOLOGEN TAB MG dexbrompheniramine-acetaminophen DOMETUSS-DA/CHILDREN LIQUID MG/5ML chlorpheniramine & phenylephrine doxylamine-dm mg/15ml & dm 15 mg/15ml liqd ther pack doxylamine-dm liquid mg/15ml doxylamine-phenylephrine-apap cap mg DRAMAMINE CHEW TAB 50 MG dimenhydrinate DURAVENT PE TAB MG phenylephrine-guaifenesin E-Z-GAS II CKET GM sodium bicarb-citric acid w/ simethicone EAR WAX CLEANSING KIT 6.5 % carbamide peroxide & saline EASIVENT MASK LARGE MISC spacer/aerosol-holding chambers EASIVENT MASK MEDIUM MISC spacer/aerosol-holding chambers EASIVENT MASK SMALL MISC spacer/aerosol-holding chambers EASIVENT MISC spacer/aerosol-holding chambers EASY TOUCH FLURINGE MISC 25G X 1" 1 ML syringe/needle (disp) 1 ml EASY TOUCH FLURINGE MISC 25G X 5/8" 1 ML syringe/needle (disp) 1 ml EASY TOUCH SAFETY SYRINGE MISC 25G X 1" 1 ML syringe/needle (disp) 1 ml EASY TOUCH SAFETY SYRINGE MISC 25G X 5/8" 1 ML syringe/needle (disp) 1 ml 2 / 365 days 2 / 365 days 2 / 365 days 2 / 365 days GE 132 LAST UPDATED 09/2015

133 ECOTRIN TAB DR 325 MG aspirin ED CHLORPED D LIQUID 2-5 MG/ML chlorpheniramine & phenylephrine ED CHLORPED LIQUID 2 MG/ML chlorpheniramine maleate EFFACLAR DUO SOLUTION 5.5 % benzoyl peroxide ELDERTONIC ELIXIR multiple vitamins w/ minerals ELEXA NATURAL FEEL MISC condoms latex lubricated - male ELEXA STIMULATING MISC condoms latex lubricated - male ELEXA ULTRA SENSITIVE MISC condoms latex lubricated - male ELITE IRON TAB 15 MG ferrous bisglycinate chelate ELLIS TONIC ELIXIR multiple vitamins w/ minerals ENDACON SYRUP MG/5ML phenylephrine w/ dm-gg ENERGY BOOSTER CKET multiple vitamins w/ minerals ENFALYTE SOLUTION oral electrolytes ENFAMIL ENFALYTE SOLUTION oral electrolytes ENFAMIL EXPECTA MISC & 200 MG prenatal mv & min w/fe fumarate-fa-dha ENTEX LQ LIQUID MG/5ML phenylephrine-guaifenesin ENTEX T TAB MG pseudoephedrine-guaifenesin ephedrine-guaifenesin tab mg E CALCIUM/VITAMIN D CAP MG-UNIT calcium carbonate-cholecalciferol E ETHYL ALCOHOL (RUBBING) SOLUTION 70 % alcohol, rubbing AL1 30 / 30 days 40 to 79 yrs old 12 / 30 days 12 / 30 days 12 / 30 days GE 133 LAST UPDATED 09/2015

134 E ISOPROPYL ALCOHOL SOLUTION 91 % isopropyl alcohol E PRENATAL FORMULA TAB MG prenatal vit w/ ferrous fumarate-folic acid E SUPER ENERGY BOOSTER CKET multiple vitamins w/ minerals E VITAMIN D-3 HIGH POTENCY TAB MG-UNIT calcium phosphate-cholecalciferol EQUALACTIN CHEW TAB 625 MG calcium polycarbophil ergocalciferol cap unit 4 / 28 days estazolam tab 1 mg estazolam tab 2 mg esterified estrogens & methyltestosterone tab mg esterified estrogens & methyltestosterone tab mg ETHER SOLUTION ether ETHYL ALCOHOL (RUBBING) SOLUTION 70 % alcohol, rubbing ETHYL ALCOHOL SOLUTION 95 % alcohol, rubbing ETHYL ALCOHOL SOLUTION 95 % alcohol, usp EUGENOL SOLUTION eugenol (bulk) EVAC-U-GEN CHEW TAB 10 MG sennosides EZFE FORTE CAP MG prenatal without vit a w/ iron polysaccharide complex-fa FAMOTIDINE PREMIXED SOLUTION MG/50ML-% famotidine in nacl FANTASY LUBRICATED MISC condoms latex lubricated - male FANTASY LUBRICATED/SPERMICIDE MISC condoms latex lubricated - male GL GL 21 / 28 days Female 21 / 28 days Female 12 / 30 days 12 / 30 days GE 134 LAST UPDATED 09/2015

135 fe fumarate w/ b12-vit c-fa-ifc cap mg fe fumarate-vit c-vit b12-fa cap 460 (151 fe) mg FENESIN DM IR TAB MG dextromethorphan-guaifenesin FER-IN-SOL SOLUTION 75 (15 FE) MG/ML ferrous sulfate FERATE TAB 256 (28 FE) MG ferrous gluconate FERRETTS IPS SOLUTION 40 MG/15ML iron succinyl-protein complex FERRIMIN 150 TAB 150 MG ferrous fumarate FERROUS FUMARATE TAB 29 MG ferrous fumarate ferrous fumarate tab 325 mg (106 mg elemental fe) FERROUS GLUCONATE TAB 225 (27 FE) MG ferrous gluconate ferrous gluconate tab 240 mg (27 mg elemental fe) ferrous gluconate tab 324 mg (37.5 mg elemental iron) ferrous gluconate tab 325 mg (36 mg elemental fe) ferrous sulfate dried tab 200 mg (65 mg elemental fe) ferrous sulfate dried tab cr 160 mg (50 mg fe equivalent) ferrous sulfate dried tab cr 45 mg (fe equivalent) ferrous sulfate elixir 220 mg/5ml (44 mg/5ml elemental fe) FERROUS SULFATE GRANULES ferrous sulfate ferrous sulfate soln 75 mg/ml (15 mg/ml elemental fe) FERROUS SULFATE SYRUP 300 (60 FE) MG/5ML ferrous sulfate ferrous sulfate tab 134 mg (27 mg elemental fe) ferrous sulfate tab 27 mg (elemental fe) ferrous sulfate tab 325 mg (65 mg elemental fe) AL1 AL1 AL1 AL1 Up to 12 yrs old Up to 12 yrs old Up to 12 yrs old Up to 12 yrs old GE 135 LAST UPDATED 09/2015

136 ferrous sulfate tab cr 142 mg (45 mg fe equivalent) ferrous sulfate tab cr 47.5 mg (elemental fe) ferrous sulfate tab ec 325 mg (65 mg fe equivalent) ferrous sulfate-vit c-folic acid tab cr mg fexofenadine hcl tab 180 mg FIRST-LANSOPRAZOLE SUSPENSION 3 MG/ML lansoprazole FIRST-OMEPRAZOLE SUSPENSION 2 MG/ML omeprazole FIRST-VANCOMYCIN 25 SOLUTION 25 MG/ML vancomycin hcl FIRST-VANCOMYCIN 50 SOLUTION 50 MG/ML vancomycin hcl FLAVOR BLEND SUSPENSION oral vehicles FLAVOR PLUS LIQUID oral vehicles FLAVOR SWEET SYRUP oral vehicles FLAVOR SWEET-SF LIQUID oral vehicles FLEET BISACODYL ENEMA 10 MG/30ML bisacodyl FLU & SORE THROAT CKET MG pheniramine-phenylephrine-acetaminophen FLUARIX QUADRIVALENT SUSP PRSYR 0.5 ML influenza virus vaccine split quadrivalent FLUARIX SUSP PRSYR 0.5 ML influenza virus vaccine split preservative free FLUCELVAX SUSP PRSYR 0.5 ML influenza virus vaccine tissue-cultured subunit FLUID ADMINISTRATION SET MISC iv sets/tubing FLULAVAL SUSPENSION influenza virus vaccine split flurazepam hcl cap 15 mg 150 / 30 days 150 / 30 days 300 / 15 days 150 / 15 days 0.5 / 365 days 0.5 / 365 days 0.5 / 365 days 0.5 / 365 days GE 136 LAST UPDATED 09/2015

137 FLURAZEM HCL CAP 15 MG flurazepam hcl flurazepam hcl cap 30 mg FLURAZEM HCL CAP 30 MG flurazepam hcl FLUVIRIN PRESERVATIVE FREE SUSP PRSYR 0.5 ML influenza virus vaccine types a & b preservative free FLUVIRIN SUSP PRSYR 0.5 ML influenza virus vaccine types a & b surface antigen FLUVIRIN SUSPENSION influenza virus vaccine types a & b surface antigen FLUZONE PEDIATRIC PF SUSP PRSYR 0.25 ML influenza virus vaccine split preservative free FLUZONE PRESERVATIVE FREE SUSP PRSYR 0.5 ML influenza virus vaccine split preservative free FLUZONE PRESERVATIVE FREE SUSPENSION influenza virus vaccine split preservative free FLUZONE QUADRIVALENT SUSP PRSYR 0.5 ML influenza virus vaccine split quadrivalent FLUZONE QUADRIVALENT SUSPENSION 0.5 ML influenza virus vaccine split quadrivalent FLUZONE SUSP PEN 9 MCG/STRAIN influenza virus vaccine split FLUZONE SUSPENSION influenza virus vaccine split FOLGARD OS TAB MG multiple vitamins w/ minerals & calcium-folic acid folic acid tab 1 mg folic acid tab 400 mcg AL1 GL AL1 0.5 / 365 days 0.5 / 365 days 0.5 / 365 days 0.5 / 365 days 0.5 / 365 days 0.5 / 365 days 0.5 / 365 days 0.5 / 365 days 0.1 / 365 days 0.5 / 365 days 30 / 30 days 14 to 50 yrs old 30 / 30 days Female 14 to 50 yrs old GE 137 LAST UPDATED 09/2015

138 folic acid tab 800 mcg FORTAVIT LIQUID multiple vitamins w/ minerals FREESTYLE CONTROL SOLUTION LIQUID blood glucose calibration FREESTYLE LITE TEST STRIP glucose blood FREESTYLE TEST STRIP glucose blood FUNGOID TINCTURE SOLUTION 2 % miconazole nitrate (topical) G-DOLOGEN TAB MG dexbrompheniramine-acetaminophen G-P-TUSS DXP LIQUID MG/5ML phenylephrine-dexbrompheniramine-dextromethorphan G-TRON PEDIATRIC DROPS LIQUID MG/ML phenylephrine w/ dm-gg G-TUSICOF LIQUID MG/5ML phenylephrine w/ dm-gg G-ZYNCOF SYRUP MG/5ML dextromethorphan-guaifenesin GAS-X EXTRA STRENGTH STRIP 62.5 MG simethicone GAVISCON CHEW TAB MG aluminum hydroxide-mag trisil GAVISCON EXTRA RELIEF FORMULA SUSPENSION MG/10ML aluminum hydroxide-mag carb GENTEAL GEL % carboxymethylcellulose-hypromellose GENTEAL SEVERE GEL 0.3 % hypromellose (ophth) GLUCOCARD EXPRESSION CONTROL SOLUTION blood glucose calibration GLUCOCARD EXPRESSION TEST STRIP glucose blood GL AL1 30 / 30 days Female 14 to 50 yrs old GE 138 LAST UPDATED 09/2015

139 GLUCOCARD VITAL TEST STRIP glucose blood glucose gel 40% GLYCERIN LIQUID glycerin (bulk) GLYCERIN SOLUTION glycerin (bulk) glycerin suppos 1 gm glycerin suppos 1.2 gm glycerin suppos 2 gm glycerin suppos 2.1 gm glycerin suppos 80.7% glycerin topical liquid glycerin-hypromellose-peg 400 ophth soln % GLYCERINE LIQUID glycerin (bulk) GLYCEROL FORMAL LIQUID glycerin (bulk) GLYCEROL LIQUID glycerin (bulk) GLYCINE SOYA EXTRACT SOLUTION soybean (bulk) GLYCINE SOYA PROTEIN SOLUTION soybean protein (bulk) GNP ALCOHOL DENATURED SOLUTION alcohol, rubbing GNP CAPSAICIN LIQUID 0.15 % capsaicin GNP DAILY PRENATAL MISC & 440 MG prenatal vit w/ ferrous fumarate-fa-omega 3 fatty acids GNP ETHYL ALCOHOL SOLUTION 70 % alcohol, usp GNP ETHYL RUBBING ALCOHOL SOLUTION 70 % alcohol, usp GNP ISOPROPYL ALCOHOL SOLUTION 70 % isopropyl alcohol GNP ISOPROPYL ALCOHOL SOLUTION 91 % isopropyl alcohol GE 139 LAST UPDATED 09/2015

140 GNP PEPPERMINT SPIRIT SPIRIT peppermint spirit GNP PRENATAL TAB MG prenatal vit w/ ferrous fumarate-folic acid GNP SODIUM SILICATE SOLUTION sodium silicate GOODSENSE PRENATAL VITAMINS TAB MG prenatal vit w/ ferrous fumarate-folic acid GRAPE SYRUP SYRUP oral vehicles GUAIACOL SOLUTION guaiacol guaifenesin liquid 100 mg/5ml guaifenesin liquid 200 mg/5ml GUAIFENESIN POWDER guaifenesin guaifenesin syrup 100 mg/5ml guaifenesin tab 200 mg guaifenesin tab 400 mg guaifenesin tab sr 12hr 600 mg guaifenesin-codeine liquid mg/5ml guaifenesin-codeine soln mg/5ml guaifenesin-codeine soln mg/5ml GYNAZOLE-1 CREAM 2 % butoconazole nitrate (one dose) H 468L TUBING MISC iv sets/tubing HC DERMAX LIQUID % hydrocortisone-diphenhydramine hcl HEALTHY MAMA BE WELL ROUNDED THER CK & 450 MG prenatal vit w/ fe bisglycinate-folic acid-omega 3 fatty acd HERBAL EXPEC LIQUID 150 MG/15ML guaifenesin HIGH POTENCY IRON CAP 86 (27 FE) MG ferrous fumarate HISTEX-DM SYRUP MG/5ML phenylephrine-triprolidine-dextromethorphan GE 140 LAST UPDATED 09/2015

141 HISTEX-PE SYRUP MG/5ML triprolidine-phenylephrine HM ETHYL RUBBING ALCOHOL SOLUTION 70 % alcohol, usp HM ISOPROPYL ALCOHOL SOLUTION 70 % isopropyl alcohol HM ISOPROPYL ALCOHOL SOLUTION 91 % isopropyl alcohol HM ONE DAILY PRENATAL MISC & 440 MG prenatal vit w/ ferrous fumarate-fa-omega 3 fatty acids HM PRENATAL TAB MG prenatal vit w/ ferrous fumarate-folic acid homatropine hbr ophth soln 5% HONEY BEARS W/IRON-ZINC CHEW TAB pediatric multiple vitamins w/ iron HUBER INFUSION SET MISC iv sets/tubing HUMAPEN LUXURA HD DEVICE injection device for insulin HUMATROPEN FOR 12MG DEVICE injection device HUMATROPEN FOR 24MG DEVICE injection device HUMATROPEN FOR 6MG DEVICE injection device HYDROCIL CKET 95 % psyllium hydrocod polst-chlorphen polst cr susp 10-8 mg/5ml hydrocodone w/ homatropine syrup mg/5ml hydrocodone w/ homatropine tab mg AL1 Up to 9 yrs old hydrocortisone acetate cream 1% 60 / 30 days hydrocortisone acetate oint 1% 60 / 30 days hydrocortisone acetate suppos 25 mg 28 / 14 days hydrocortisone acetate suppos 30 mg 28 / 14 days hydrocortisone gel 1% 60 / 30 days GE 141 LAST UPDATED 09/2015

142 hydrocortisone soln 1% 90 / 30 days hydrocortisone-aloe vera cream 0.5% 90 / 30 days hydrocortisone-aloe vera cream 1% 90 / 30 days HYDROXYPROGESTERONE CAPROATE POWDER hydroxyprogesterone caproate (bulk) hyoscyamine sulfate elixir mg/5ml hyoscyamine sulfate soln mg/ml hyoscyamine sulfate tab mg hyoscyamine sulfate tab disp mg hyoscyamine sulfate tab sl mg hyoscyamine sulfate tab sr 12hr mg HYPERRHO S/D SOLN PRSYR 1500 UNIT rho d immune globulin (human) hypromellose gonioscopic soln 2.5% hypromellose ophth soln 0.3% hypromellose ophth soln 0.4% ibuprofen cap 200 mg ibuprofen-diphenhydramine citrate tab mg IMMUNE SUPPORT VITAMIN C CKET multiple vitamins w/ minerals IMODIUM A-D CHEW TAB 2 MG loperamide hcl INATAL ADVANCE TAB prenatal vit w/ docusate-iron carbonyl-folic acid INATAL ULTRA TAB prenatal vit w/ docusate-iron carbonyl-folic acid INCRUSE ELLIPTA AER POW BA 62.5 MCG/INH umeclidinium bromide INFERGEN INJECTABLE 15 MCG/0.5ML interferon alfacon-1 INFERGEN INJECTABLE 9 MCG/0.3ML interferon alfacon-1 INFUSION SET 23" COMFORT MISC iv sets/tubing 30 / 30 days GE 142 LAST UPDATED 09/2015

143 INFUSION SET MISC iv sets/tubing INJECT-EASE AUTOMATIC INJECTOR MISC injection device INJECT-EASE MISC injection device INSUFLON MISC 25G X 0.71" subcutaneous soft cannula INSYTE AUTOGUARD 14GX1.75" MISC iv catheter INSYTE AUTOGUARD 18GX1.16" MISC iv catheter INSYTE AUTOGUARD 20GX1" MISC iv catheter INSYTE AUTOGUARD 20GX1.16" MISC iv catheter INSYTE AUTOGUARD 22GX1" MISC iv catheter INSYTE AUTOGUARD 24GX3/4" MISC iv catheter INTERLINK INJECT SITE/LUER LOC MISC iv sets/tubing INVOKANA TAB 100 MG canagliflozin INVOKANA TAB 300 MG canagliflozin IRON (FERROUS GLUCONATE) TAB 256 (28 FE) MG ferrous gluconate iron polysacch complex-vit b12-fa cap mg IRON UP LIQUID 15 MG/0.5ML polysaccharide iron complex ISONIAZID SYRUP 50 MG/5ML isoniazid ISOPRONOL SOLUTION 70 % isopropyl alcohol ISOPROPYL ALCOHOL SOLUTION isopropyl alcohol ISOPROPYL ALCOHOL SOLUTION 50 % isopropyl alcohol GE 143 LAST UPDATED 09/2015

144 ISOPROPYL ALCOHOL SOLUTION 70 % isopropyl alcohol ISOPROPYL ALCOHOL SOLUTION 91 % isopropyl alcohol ISOPROPYL ALCOHOL WIPES MISC 70 % isopropyl alcohol (skin cleanser) ISOPROPYL LMITATE LIQUID isopropyl palmitate ISOPTO TEARS SOLUTION 0.5 % hypromellose (ophth) ISOSORBIDE DINITRATE SL TAB 2.5 MG isosorbide dinitrate K-PHOS NO 2 TAB MG potassium & sodium acid phosphates K-PHOS TAB 500 MG potassium phosphate monobasic KALA TAB lactobacillus acidophilus-pectin KAMELEON LUBRICATED MISC condoms latex lubricated - male KANGAROO BURETTE SET MISC iv sets/tubing KETOSTIX STRIP acetone (urine) test 12 / 30 days ketotifen fumarate ophth soln 0.025% (base equiv) 5 / 30 days KIMONO MICRO THIN MISC condoms latex non-lubricated - male KIMONO MICRO THIN PLUS MISC condoms latex lubricated - male KIMONO MISC condoms latex lubricated - male KIMONO PLUS MISC condoms latex lubricated - male KIMONO PS MISC condoms latex lubricated - male KIMONO PS PLUS MISC condoms latex lubricated - male KIMONO SENSATION MISC condoms latex lubricated - male 12 / 30 days 12 / 30 days 12 / 30 days 12 / 30 days 12 / 30 days 12 / 30 days 12 / 30 days GE 144 LAST UPDATED 09/2015

145 KIMONO SENSATION PLUS MISC condoms latex lubricated - male KNEE STABILIZER/ELASTIC/SM/MED MISC elastic bandages & supports KONSYL CKET 100 % psyllium KONSYL CKET 28.3 % psyllium KONSYL CKET 60.3 % psyllium KONSYL POWDER 60.3 % psyllium KONSYL POWDER % psyllium KONSYL-D POWDER 52.3 % psyllium KP PRENATAL MULTIVITAMINS TAB MG prenatal vit w/ ferrous fumarate-folic acid KPN PRENATAL TAB 0.1 MG prenatal multivit-min w/fe-fa L606 TUBING MISC iv sets/tubing L609 TUBING MISC iv sets/tubing lactic acid w/ vitamin e cream 10%-3500 unit/30gm LEVONORGESTREL TAB 0.75 MG levonorgestrel (emergency oc) levonorgestrel tab 0.75 mg levonorgestrel tab 1.5 mg LICIDE TREATMENT KIT pyrethrins-piperonyl butoxide GL GL GL 12 / 30 days 2 / 30 days Female 2 / 30 days Female 2 / 30 days Female GE 145 LAST UPDATED 09/2015

146 LIFE CK MENS MISC multiple vitamins w/ minerals LIFESTYLES ASSORTED COLORS MISC condoms - male LIFESTYLES EXTRA STRENGTH MISC condoms - male LIFESTYLES FORM FITTING MISC condoms - male LIFESTYLES LUBRICATED MISC condoms - male LIFESTYLES RIBBED MISC condoms - male LIFESTYLES SKYN ORIGINAL MISC condoms - male LIFESTYLES SPERMICIDAL LUBE MISC condoms - male LIFESTYLES STUDDED MISC condoms - male LIFESTYLES ULTRA SENSITIVE MISC condoms - male LIFESTYLES VIBRA-RIBBED MISC condoms - male LIFESTYLES XTRA PLEASURE MISC condoms - male LIQUIMAT LOTION 5 % sulfur LITTLE REMEDIES FOR COLDS LIQUID MG/ML dextromethorphan-phenylephrine-acetaminophen LODRANE D CAP 4-60 MG brompheniramine & pseudoeph LOHIST-D LIQUID 2-30 MG/5ML chlorpheniramine & pseudoeph loperamide hcl liq 1 mg/5ml (0.2 mg/ml) loperamide hcl liq 1 mg/7.5ml loratadine & pseudoephedrine tab sr 12hr mg loratadine & pseudoephedrine tab sr 24hr mg loratadine rapidly-disintegrating tab 10 mg 12 / 30 days 12 / 30 days 12 / 30 days 12 / 30 days 12 / 30 days 12 / 30 days 12 / 30 days 12 / 30 days 12 / 30 days 12 / 30 days 12 / 30 days GE 146 LAST UPDATED 09/2015

147 loratadine syrup 5 mg/5ml loratadine tab 10 mg LORTUSS DM LIQUID MG/5ML pseudoephedrine-doxylamine-dextromethorphan LORTUSS EX LIQUID MG/5ML pseudoephedrine w/ codeine-gg LORTUSS LQ LIQUID MG/5ML doxylamine-pseudoephedrine LTXF PRIM CNV PIN MICRODRIP MISC iv sets/tubing LTXF PRIM IV SET/CNVT PIN MISC iv sets/tubing LTXF SECONDARY/CNV PIN/32INC MISC iv sets/tubing M-END DMX LIQUID MG/5ML pseudoephedrine-dexbrompheniramine-dextromethorphan M-END MAX D LIQUID MG/5ML pseudoephedrine-dexbrompheniramine-codeine M-END PE LIQUID MG/5ML phenylephrine-brompheniramine w/ codeine M-VIT TAB prenatal vit w/ ferrous fumarate-folic acid M2 POTASSIUM CAP 60 MG potassium aminobenzoate MAG-AL LIQUID MG/5ML aluminum & magnesium hydroxide MAG-TAB SR TAB ER 84 MG (7MEQ) magnesium lactate MAGINEX DS CKET 1230 MG magnesium aspartate hydrochloride MAGINEX TAB DR 615 MG magnesium aspartate hydrochloride MAGNESIUM CAP 300 MG magnesium MAGNESIUM CARBONATE HEAVY POWDER magnesium carbonate MAGNESIUM CARBONATE POWDER magnesium carbonate GE 147 LAST UPDATED 09/2015

148 MAGNESIUM CHLORIDE CRYSTALS magnesium chloride MAGNESIUM CHLORIDE POWDER magnesium chloride magnesium chloride tab cr 535 mg (64 mg elemental mg) magnesium citrate soln MAGNESIUM CITRATE TAB 100 MG magnesium citrate (mg supplement) MAGNESIUM GLUCONATE TAB 30 MG magnesium gluconate magnesium gluconate tab 500 mg (27 mg elemental mg) MAGNESIUM GLUCONATE TAB 550 MG magnesium gluconate MAGNESIUM OXIDE CAP 400 MG magnesium oxide MAGNESIUM OXIDE POWDER magnesium oxide MAGNESIUM OXIDE POWDER magnesium oxide (mg supplement) magnesium oxide tab 250 mg magnesium oxide tab 250 mg (mg supplement) magnesium oxide tab 400 mg magnesium oxide tab 400 mg (240 mg elemental mg) magnesium oxide tab 400 mg (241.3 mg elemental mg) magnesium oxide tab 420 mg magnesium tab 100 mg magnesium tab 200 mg magnesium tab 250 mg MAGNESIUM TAB 30 MG magnesium MAGNESIUM TAB 400 MG magnesium MAGONATE LIQUID 1000 (54 MG) MG/5ML magnesium gluconate MAR-COF BP LIQUID MG/5ML pseudoephedrine-brompheniramine-codeine GE 148 LAST UPDATED 09/2015

149 MAXIMIN CK CKET multiple vitamins w/ minerals MAXX MISC condoms latex lubricated - male MAXX PLUS MISC condoms latex lubricated - male meclizine hcl chew tab 25 mg MECLIZINE HCL POWDER meclizine hcl MEDI-JECTOR VISION ADAPTERS MISC injection device needle-free for insulin MEDI-JECTOR VISION MISC injection device needle-free for insulin MEDSAVER SYRINGE MISC 25G X 5/8" 1 ML syringe/needle (disp) 1 ml MEGA BIOTIN CAP 10 MG biotin MEGA MULTIVITAMIN POWDER multiple vitamins w/ minerals meperidine hcl tab 100 mg meperidine hcl tab 50 mg METAMUCIL MULTIHEALTH FIBER POWDER 63 % psyllium METAMUCIL SMOOTH TEXTURE CKET 28 % psyllium METAMUCIL WAFER psyllium METAPROTERENOL SULFATE TAB 10 MG metaproterenol sulfate METAPROTERENOL SULFATE TAB 20 MG metaproterenol sulfate methadone hcl conc 10 mg/ml methadone hcl tab for oral susp 40 mg METHADOSE CONC 10 MG/ML methadone hcl METHADOSE SUGAR-FREE CONC 10 MG/ML methadone hcl 12 / 30 days 12 / 30 days GE 149 LAST UPDATED 09/2015

150 METHANOL SOLUTION methyl alcohol METHANOL SOLUTION 99 % methyl alcohol METHYL ALCOHOL SOLUTION methyl alcohol methylcellulose powder laxative MH MACULAR HEALTH MISC multiple vitamins w/ minerals miconazole nitrate aerosol 2% miconazole nitrate aerosol pow 2% miconazole nitrate cream 2% miconazole nitrate ointment 2% miconazole nitrate powder 2% miconazole nitrate vaginal cream 2% miconazole nitrate vaginal supp 200 mg & 2% cream 9 gm kit MIRANEL AF SOLUTION 2 % miconazole nitrate (topical) MONOJECT LIFESHIELD SYRINGE MISC 18G X 1" 1 ML syringe/needle (disp) 1 ml MONOJECT MAGELLAN SYRINGE MISC 23G X 1" 1 ML syringe/needle (disp) 1 ml MONOJECT MAGELLAN SYRINGE MISC 25G X 1" 1 ML syringe/needle (disp) 1 ml MONOJECT MAGELLAN SYRINGE MISC 25G X 5/8" 1 ML syringe/needle (disp) 1 ml MUCINEX CHILD MS DAY-NIGHT CLD MISC phenylephrine-diphenhydramine-dm-guaifenesin-apap MUCINEX COUGH FOR KIDS CKET MG dextromethorphan-guaifenesin MUCINEX D TAB ER 12H MG pseudoephedrine-guaifenesin MUCINEX D TAB ER 12H MG pseudoephedrine-guaifenesin MUCINEX FAST-MAX CONGEST COUGH TAB MG phenylephrine w/ dm-gg MUCINEX FAST-MAX DAY/NIGHT MISC phenylephrine-diphenhydramine-dm-guaifenesin-apap GE 150 LAST UPDATED 09/2015

151 MUCINEX FOR KIDS CKET 100 MG guaifenesin MUCINEX MAXIMUM STRENGTH TAB ER 12H 1200 MG guaifenesin MUCINEX SINUS-MAX DAY/NIGHT MISC phenylephrine-diphenhydramine-gg w/ apap MULTI FOR HER CKET multiple vitamins w/ minerals MULTI PRENATAL TAB MG prenatal vit w/ ferrous fumarate-folic acid MYKIDZ IRON 10 SUSPENSION 15 MG/1.5ML iron MYLERAN TAB 2 MG busulfan MYNATAL ADVANCE TAB prenatal vit w/ docusate-iron carbonyl-folic acid MYNATAL CAP prenatal multivit-min w/fe-fa MYNATAL PLUS TAB prenatal vit w/ ferrous fumarate-folic acid MYNATAL TAB 90-1 MG prenatal vit w/ docusate-iron carbonyl-folic acid MYNATAL-Z TAB prenatal vit w/ ferrous fumarate-folic acid MYNATE 90 PLUS TAB ER prenatal vit w/ docusate-fe fumarate-folic acid NANOVM T/F LIQUID pediatric multiple vitamin w/ minerals NAPHAZOLINE HCL SOLUTION 0.1 % naphazoline hcl naphazoline w/ pheniramine ophth soln % naphazoline w/ pheniramine ophth soln % naphazoline-glycerin ophth soln % naphazoline-glycerin ophth soln % naphazoline-glycerin ophth soln % naphazoline-hypromellose ophth soln % naphazoline-polyethylene glycol 300 ophth soln % AL1 Up to 9 yrs old GE 151 LAST UPDATED 09/2015

152 NAPRELAN TAB ER 24H 375 MG naproxen sodium NAPRELAN TAB ER 24H 500 MG naproxen sodium NAPRELAN TAB ER 24H 750 MG naproxen sodium naproxen sodium cap 220 mg NAPROXEN SODIUM POWDER naproxen sodium NASAL DECONGESTANT LIQUID 30 MG/5ML pseudoephedrine hcl NASAL DECONGESTANT SYRUP 30 MG/5ML pseudoephedrine hcl NASOPEN LIQUID MG/5ML chlorcyclizine & pseudoephedrine NASOPEN PE LIQUID MG/15ML thonzylamine-phenylephrine NAT-RUL PRENATAL VITAMINS TAB MG prenatal vit w/ ferrous fumarate-folic acid NATAL-V RX TAB 29-1 MG prenatal vit w/ iron carbonyl-folic acid NATALVIT TAB prenatal vit w/ ferrous fumarate-folic acid NATRUL-100 TAB ER multiple vitamins w/ minerals NATURAL SENNA LAXATIVE TAB MG senna NATURE-THROID TAB 130 MG thyroid NATURE-THROID TAB 195 MG thyroid NATURE-THROID TAB 260 MG thyroid NATURE-THROID TAB 32.5 MG thyroid NATURE-THROID TAB 325 MG thyroid NATURE-THROID TAB MG thyroid GE 152 LAST UPDATED 09/2015

153 NATURE-THROID TAB 65 MG thyroid NATURE-THROID TAB 97.5 MG thyroid NECON 1/50 (28) TAB 1-50 MG-MCG norethindrone & mestranol NEEDLE-FREE INSULIN SYRINGE A MISC injection device needle-free for insulin NEEDLE-FREE INSULIN SYRINGE B MISC injection device needle-free for insulin NEEDLE-FREE INSULIN SYRINGE C MISC injection device needle-free for insulin NEEDLE-FREE SYRINGE KIT A KIT injection device needle-free for insulin NEEDLE-FREE SYRINGE KIT B KIT injection device needle-free for insulin NEEDLE-FREE SYRINGE KIT C KIT injection device needle-free for insulin NEOSPORIN ESSENTIALS TRIAL PK KIT 1 & 1 % hydrocortisone & colloidal oatmeal & body wash NEOTUSS PLUS LIQUID MG/5ML phenylephrine-chlorphen-dm NEOTUSS-D LIQUID MG/5ML phenylephrine w/ dm-gg NERIA 29G INFUSION SET 10MM MISC iv sets/tubing NERIA 29G INFUSION SET 6MM MISC iv sets/tubing NERIA 29G INFUSION SET 8MM MISC iv sets/tubing NERIA MULTI 27G 2X10MM MISC iv sets/tubing NERIA MULTI 27G 3X10MM MISC iv sets/tubing NERIA MULTI 27G 4X12MM MISC iv sets/tubing NERIA SOFT 25G INFUSION 13MM MISC iv sets/tubing GL 37.5 / 28 days Female GE 153 LAST UPDATED 09/2015

154 NERIA SOFT 25G INFUSION 17MM MISC iv sets/tubing NEUTROGENA CLEAR PORE LIQUID 3.5 % benzoyl peroxide NEXIUM 24HR CAP DR 20 MG esomeprazole magnesium niacin cap cr 250 mg niacin cap cr 500 mg NIACIN ER TAB ER 1000 MG niacin niacin tab 100 mg niacin tab 250 mg niacin tab 50 mg niacin tab 500 mg niacin tab cr 250 mg niacin tab cr 500 mg niacin tab cr 750 mg niacinamide tab 100 mg niacinamide tab 500 mg NIACINAMIDE TAB ER 500 MG niacinamide NICODERM CQ TCH 24HR 14 MG/24HR nicotine NICODERM CQ TCH 24HR 21 MG/24HR nicotine NICODERM CQ TCH 24HR 7 MG/24HR nicotine NICORETTE GUM 2 MG nicotine polacrilex NICORETTE GUM 4 MG nicotine polacrilex NICORETTE LOZENGE 2 MG nicotine polacrilex C C C C C C 60 / 30 days 90 days of coverage per year 90 days of coverage per year 90 days of coverage per year 270 / 30 days 90 days of coverage per year 270 / 30 days 90 days of coverage per year 270 / 30 days 90 days of coverage per year GE 154 LAST UPDATED 09/2015

155 NICORETTE LOZENGE 4 MG nicotine polacrilex NICORETTE MINI LOZENGE 2 MG nicotine polacrilex NICORETTE MINI LOZENGE 4 MG nicotine polacrilex NICORETTE REFILL GUM 2 MG nicotine polacrilex NICORETTE REFILL GUM 4 MG nicotine polacrilex NICORETTE STARTER KIT GUM 2 MG nicotine polacrilex NICORETTE STARTER KIT GUM 4 MG nicotine polacrilex NICOTINE KIT MG/24HR nicotine NICOTINE MINI LOZENGE 2 MG nicotine polacrilex nicotine polacrilex gum 2 mg nicotine polacrilex gum 4 mg nicotine polacrilex lozenge 2 mg C C C C C C C C C C C C 270 / 30 days 90 days of coverage per year 270 / 30 days 90 days of coverage per year 270 / 30 days 90 days of coverage per year 270 / 30 days 90 days of coverage per year 270 / 30 days 90 days of coverage per year 270 / 30 days 90 days of coverage per year 270 / 30 days 90 days of coverage per year 90 / 365 days 90 days of coverage per year 270 / 30 days 90 days of coverage per year 270 / 30 days 90 days of coverage per year 270 / 30 days 90 days of coverage per year 270 / 30 days 90 days of coverage per year GE 155 LAST UPDATED 09/2015

156 nicotine polacrilex lozenge 4 mg nicotine td patch 24hr 14 mg/24hr nicotine td patch 24hr 21 mg/24hr nicotine td patch 24hr 7 mg/24hr NICOTROL INHALER 10 MG nicotine NITE-TIME COLD/FLU RELIEF LIQUID MG/15ML phenylephrine-doxylamine-dextromethorphan-acetaminophen nitroglycerin cap cr 2.5 mg nitroglycerin cap cr 6.5 mg nitroglycerin cap cr 9 mg NORDIPEN 5 INJECTION DEVICE MISC injection device NORDIPEN DELIVERY SYSTEM MISC injection device NOREL AD TAB MG chlorpheniramine-phenylephrine-acetaminophen NOREL CS LIQUID MG/5ML phenylephrine-chlorphen-dm NOVAFERRUM PEDIATRIC DROPS LIQUID 15 MG/ML polysaccharide iron complex NOVOPEN 3 MISC injection device for insulin NOVOPEN 3 PENMATE MISC injection device for insulin C C C C C 270 / 30 days 90 days of coverage per year 90 / 365 days 90 days of coverage per year 90 / 365 days 90 days of coverage per year 90 / 365 days 90 days of coverage per year 90 days of coverage per year GE 156 LAST UPDATED 09/2015

157 NOVOPEN ECHO DEVICE injection device for insulin NOVOPEN JR (GREEN) MISC injection device for insulin NOVOPEN JR (YELLOW) MISC injection device for insulin O-CAL FA TAB 27-1 MG prenatal vit w/ ferrous fumarate-folic acid O-CAL PRENATAL TAB prenatal vit w/ ferrous fumarate-folic acid OBSTETRIX DHA MISC 29-1 & 387 MG prenatal w/fe carbonyl-fa-dss-omega 3 fatty acids OBSTETRIX EC TAB 29-1 MG prenatal vit w/ docusate-iron carbonyl-folic acid OBTREX DHA MISC 29-1 & 387 MG prenatal w/fe carbonyl-fa-dss-omega 3 fatty acids OBTREX TAB prenatal vit w/ docusate-iron carbonyl-folic acid OC8 GEL 7 % benzoyl peroxide OMEPRAZOLE+SYRSPEND SF ALKA SUSPENSION 2 MG/ML omeprazole 150 / 30 days omeprazole-sodium bicarbonate cap mg 60 / 30 days omeprazole-sodium bicarbonate cap mg 60 / 30 days OMNIFLEX DIAPHRAGM DIAPHRAGM diaphragms OMNITROPE PEN 10 INJ DEVICE MISC injection device OMNITROPE PEN 5 INJ DEVICE MISC injection device ONE-A-DAY WOMENS PRENATAL MISC & 223 MG prenatal vit w/ ferrous fumarate-fa-omega 3 fatty acids ONETOUCH ULTRA CONTROL SOLUTION blood glucose calibration OPIUM TINCTURE (REGORIC) TINCTURE 2 MG/5ML paregoric GL 1 / 365 days Female GE 157 LAST UPDATED 09/2015

158 OPTIONS GYNOL II CONTRACEPTIVE GEL 3 % nonoxynol-9 ORA-BLEND SF SUSPENSION oral vehicles ORA-BLEND SUSPENSION oral vehicles ORA-FILM STRIP 6 % benzocaine (dental) ORA-PLUS LIQUID oral vehicles ORA-SWEET SF SYRUP oral vehicles ORA-SWEET SYRUP oral vehicles ORACIT SOLUTION MG/5ML sodium citrate & citric acid ORAL MIX LIQUID oral vehicles ORAL MIX SF LIQUID oral vehicles ORAL SUSPEND LIQUID oral vehicles ORAL SYRUP LIQUID oral vehicles ORAL SYRUP SF LIQUID oral vehicles ORAZINC TAB 110 MG zinc sulfate ORTHO DIAPHRAGM ALL-FLEX DIAPHRAGM 65 MM diaphragm arc-spring ORTHO DIAPHRAGM ALL-FLEX DIAPHRAGM 70 MM diaphragm arc-spring ORTHO DIAPHRAGM ALL-FLEX DIAPHRAGM 75 MM diaphragm arc-spring GL GL GL 1 / 365 days Female 1 / 365 days Female 1 / 365 days Female GE 158 LAST UPDATED 09/2015

159 ORTHO DIAPHRAGM ALL-FLEX DIAPHRAGM 80 MM diaphragm arc-spring ORTHO DIAPHRAGM COIL KIT 100 MM diaphragm coil spring ORTHO DIAPHRAGM COIL KIT 105 MM diaphragm coil spring ORTHO DIAPHRAGM COIL KIT 50 MM diaphragm coil spring ORTHO DIAPHRAGM FLAT KIT 55 MM diaphragm flat spring ORTHO DIAPHRAGM FLAT KIT 60 MM diaphragm flat spring ORTHO DIAPHRAGM FLAT KIT 65 MM diaphragm flat spring ORTHO DIAPHRAGM FLAT KIT 70 MM diaphragm flat spring ORTHO DIAPHRAGM FLAT KIT 75 MM diaphragm flat spring ORTHO DIAPHRAGM FLAT KIT 80 MM diaphragm flat spring GL GL GL GL GL GL GL GL GL GL 1 / 365 days Female 1 / 365 days Female 1 / 365 days Female 1 / 365 days Female 1 / 365 days Female 1 / 365 days Female 1 / 365 days Female 1 / 365 days Female 1 / 365 days Female 1 / 365 days Female GE 159 LAST UPDATED 09/2015

160 ORTHO DIAPHRAGM FLAT KIT 90 MM diaphragm flat spring ORTHO DIAPHRAGM FLAT KIT 95 MM diaphragm flat spring OSTEO-PORETICAL TAB MG-UNIT calcium carbonate-cholecalciferol OXYCODONE HCL CONC 100 MG/5ML oxycodone hcl oxycodone hcl conc 100 mg/5ml (20 mg/ml) oxycodone w/ acetaminophen cap mg oxymetazoline hcl nasal soln 0.05% OYSTER SHELL CALCIUM/D TAB MG-UNIT calcium carbonate-cholecalciferol MENS VITAK MISC multiple vitamins w/ minerals PRENATAL FORMULA TAB MG prenatal vit w/ selenium-fe fumarate-folic acid WOMENS VITAK MISC multiple vitamins w/ minerals BA TAB 100 MG para-aminobenzoic acid (paba) RVA-CAL TAB MG-UNIT calcium-ergocalciferol RVA-CAL TAB MG-UNIT calcium-ergocalciferol PCCA SWEET-SF SYRUP oral vehicles PCCA SYRUP VEHICLE SYRUP oral vehicles PCCA-PLUS SUSPENSION oral vehicles pe-dm-apap & pe-cpm-dm-apap tab day/night therapy pack pe-dm-apap cap & doxylamine-dm-apap cap day/night ther pack pe-dm-apap liq & doxylamine-dm-apap liq day/night ther pack GL GL 1 / 365 days Female 1 / 365 days Female GE 160 LAST UPDATED 09/2015

161 pe-dm-gg-apap tab & pe-diphenhyd-apap tab therapy pack PECGEN DMX LIQUID MG/5ML dextromethorphan-guaifenesin PEDIA-LAX LIQUID 50 MG/15ML docusate sodium PEDIA-LAX SUPPOS 2.8 GM glycerin (laxative) PEPCID AC MAXIMUM STRENGTH CHEW TAB 20 MG famotidine PEPPERMINT SPIRIT SPIRIT peppermint spirit PERFECT IRON TAB 25 MG carbonyl iron permethrin aerosol 0.5% permethrin creme rinse 1% permethrin lotion 1% 120 / 30 days permethrin spray & pyrethins-piperonyl butoxide shamp kit PERRY PRENATAL CAP MG prenatal vit w/ ferrous fumarate-folic acid phenazopyridine hcl tab 100 mg phenazopyridine hcl tab 200 mg phenazopyridine hcl tab 95 mg phenyleph-chlorphen-dm w/apap susp mg/5ml phenyleph-chlorphen-dm w/apap tab mg phenylephrine w/ acetaminophen cap mg phenylephrine w/ acetaminophen powd pack mg phenylephrine w/ acetaminophen tab mg phenylephrine w/ acetaminophen tab mg phenylephrine w/ dm-gg liqd mg/5ml phenylephrine w/ dm-gg liqd mg/5ml phenylephrine w/ dm-gg liqd mg/5ml phenylephrine w/ dm-gg liqd mg/5ml phenylephrine w/ dm-gg liqd mg/ml phenylephrine w/ dm-gg liqd mg/5ml GE 161 LAST UPDATED 09/2015

162 phenylephrine w/ dm-gg liqd mg/ml phenylephrine w/ dm-gg liqd mg/5ml phenylephrine w/ dm-gg liqd mg/5ml phenylephrine w/ dm-gg liquid mg/5ml phenylephrine w/ dm-gg syrup mg/5ml phenylephrine w/ dm-gg tab mg phenylephrine w/ dm-gg tab mg phenylephrine-apap-gg liqd mg/20ml phenylephrine-apap-gg tab mg phenylephrine-apap-gg tab mg phenylephrine-brompheniramine-dm elixir mg/5ml phenylephrine-brompheniramine-dm liquid mg/5ml phenylephrine-brompheniramine-dm liquid mg/5ml phenylephrine-brompheniramine-dm liquid mg/5ml phenylephrine-brompheniramine-dm syrup mg/5ml phenylephrine-chlorphen-dm liquid mg/5ml phenylephrine-chlorphen-dm liquid mg/5ml phenylephrine-chlorphen-dm liquid mg/ml phenylephrine-dm soln mg/5ml phenylephrine-dm-gg w/ apap liq mg/10ml phenylephrine-dm-gg w/ apap liq mg/15ml phenylephrine-dm-gg w/ apap tab mg phenylephrine-dm-gg w/ apap tab mg phenylephrine-dm-gg w/ apap tab mg phenylephrine-doxyl-dm-acetaminophen cap mg phenylephrine-doxylamine-dm-apap liq mg/15ml phenylephrine-guaifenesin liqd mg/5ml phenylephrine-guaifenesin syrup mg/5ml phenylephrine-guaifenesin tab mg phenylephrine-guaifenesin tab mg phenylephrine-guaifenesin tab mg GE 162 LAST UPDATED 09/2015

163 phenylephrine-promethazine w/ codeine syrup mg/5ml PHENYLHISTINE DH LIQUID MG/5ML pseudoeph-chlorphen w/ cod PHLEXY-VITS POWDER multiple vitamins w/ minerals phytonadione tab 100 mcg PINE TAR LIQUID pine tar (bulk) PLAN B ONE-STEP TAB 1.5 MG levonorgestrel (emergency oc) PLAN B TAB 0.75 MG levonorgestrel (emergency oc) PLASTIC ADAPTER MISC injection device PLASTIC ADAPTER MISC 1 ML injection device PNV FE FUM/DOCUSATE/FOLIC ACID TAB 29-1 MG prenatal vit w/ docusate-fe fumarate-folic acid PNV FOLIC ACID + IRON TAB 27-1 MG prenatal vit w/ ferrous fumarate-folic acid PNV PRENATAL PLUS MULTIVITAMIN TAB 27-1 MG prenatal vit w/ ferrous fumarate-folic acid PNV TABS 29-1 TAB 29-1 MG prenatal vit w/ iron carbonyl-folic acid PNV-VP-U CAP MG prenatal without a vit w/ fe fumarate-folic acid POLY HIST FORTE TAB MG doxylamine-phenylephrine POLY-HIST DM LIQUID MG/5ML phenylephrine-thonzylamine-dextromethorphan POLY-HIST PD LIQUID MG/ML thonzylamine-chlophedianol POLY-TUSSIN AC LIQUID MG/5ML phenylephrine-brompheniramine w/ codeine POLY-TUSSIN D LIQUID MG/5ML codeine-pseudoephedrine-chlorcyclizine POLY-TUSSIN LIQUID MG/5ML codeine-chlorcyclizine GL GL 2 / 30 days Female 2 / 30 days Female GE 163 LAST UPDATED 09/2015

164 POLY-VENT DM TAB MG pseudoephedrine w/ dm-gg POLY-VENT IR TAB MG pseudoephedrine-guaifenesin POLYETHYLENE GLYCOL 3350 POWDER polyethylene glycol 3350 (bulk) polyethylene glycol-propylene glycol ophth soln % POLYSORBATE 20 SOLUTION polysorbate 20 POLYSORBATE 40 SOLUTION polysorbate 40 POLYSORBATE 60 LIQUID polysorbate 60 POLYSORBATE 80 LIQUID polysorbate 80 polyvinyl alcohol-povidone ophth soln 5-6 mg/ml ( %) pot bicarbonate & chloride effer tab 25 meq pot phos monobasic w/sod phos di & monobas tab mg POTABA CAP 500 MG potassium aminobenzoate potassium bicarbonate effer tab 25 meq potassium chloride oral liq 10% (20 meq/15ml) potassium chloride powder packet 20 meq potassium citrate & citric acid powder pack mg potassium citrate & citric acid soln mg/5ml povidone-iodine douche soln 10% POVIDONE-IODINE D 10 % povidone-iodine povidone-iodine soln 10% PR NATAL 400 MISC & 400 MG prenatal mv & min w/fe bisglyc-fe prot succ-fa-ca-omega 3 PR NATAL 430 MISC & 430 MG prenatal mv & min w/fe bisglyc-fe prot succ-fa-ca-omega 3 pramox-pe-glycerin-petrolatum rectal cream % pramoxine-calamine lotion 1-8% GE 164 LAST UPDATED 09/2015

165 PRE-NATAL FORMULA TAB prenatal multivit-min w/fe-fa PRECISION XTRA KETONE STRIP ketone blood test PREMIUM CONDOMS LUBRICATED MISC condoms latex lubricated - male PREMIUM CKETS MISC multiple vitamins w/ minerals PRENAPLUS TAB 27-1 MG prenatal vit w/ ferrous fumarate-folic acid PRENATA CHEW TAB 29-1 MG prenatal without a vit w/ fe fumarate-folic acid PRENATABS FA TAB prenatal vit w/ ferrous fumarate-folic acid PRENATABS RX TAB 29-1 MG prenatal vit w/ iron carbonyl-folic acid PRENATAL 19 CHEW TAB prenatal vit w/ ferrous fumarate-folic acid PRENATAL 19 CHEW TAB 29-1 MG prenatal vit w/ ferrous fumarate-folic acid PRENATAL 19 TAB prenatal vit w/ docusate-fe fumarate-folic acid PRENATAL 19 TAB 29-1 MG prenatal vit w/ docusate-fe fumarate-folic acid PRENATAL AD TAB prenatal vit w/ docusate-iron carbonyl-folic acid PRENATAL COMPLETE TAB MG prenatal vit w/ ferrous fumarate-folic acid PRENATAL FORMULA A-FREE TAB MG prenatal without a vit w/ fe fumarate-folic acid PRENATAL FORMULA CAP MG prenatal vit w/ ferrous fumarate-fa-omega 3 fatty acids PRENATAL FORMULA TAB MG prenatal vit w/ ferrous fumarate-folic acid PRENATAL LOW IRON TAB MG prenatal vit w/ ferrous fumarate-folic acid PRENATAL LOW IRON TAB 27-1 MG prenatal vit w/ ferrous fumarate-folic acid PRENATAL MULTI +DHA CAP MG prenatal vit w/ ferrous fumarate-fa-omega 3 fatty acids 12 / 30 days GE 165 LAST UPDATED 09/2015

166 PRENATAL MULTIVITAMIN + DHA MISC & 200 MG prenatal mv & min w/fe fumarate-fa-dha PRENATAL ONE DAILY TAB MG prenatal vit w/ ferrous fumarate-folic acid PRENATAL PLUS IRON TAB 29-1 MG prenatal vit w/ iron carbonyl-folic acid PRENATAL PLUS TAB 27-1 MG prenatal vit w/ ferrous fumarate-folic acid PRENATAL TAB MG prenatal vit w/ ferrous fumarate-folic acid PRENATAL TAB 27-1 MG prenatal vit w/ ferrous fumarate-folic acid PRENATAL TAB MG prenatal vit w/ ferrous fumarate-folic acid PRENATAL TAB MG prenatal vit w/ ferrous fumarate-folic acid PRENATAL VITAMINS PLUS TAB 27-1 MG prenatal vit w/ ferrous fumarate-folic acid PRENATAL VITAMINS TAB 0.8 MG prenatal multivit-min w/fe-fa PRENATAL VITAMINS TAB MG prenatal vit w/ ferrous fumarate-folic acid PRENATAL+DHA MISC & 200 MG prenatal mv & min w/fe fumarate-fa-dha PRENATAL-U CAP MG prenatal without a vit w/ fe fumarate-folic acid PRENATAL/IRON TAB prenatal multivit-min w/fe-fa PRENATAL/OMEGA-3/FA/IRON CAP MG prenatal vit w/ ferrous fumarate-fa-fish oil PREPLUS TAB 27-1 MG prenatal vit w/ ferrous fumarate-folic acid PRESCRIPTIVE FORMULAS MENS MISC multiple vitamins w/ minerals PRESCRIPTIVE FORMULAS WOMENS MISC multiple vitamins w/ minerals PRETAB TAB 29-1 MG prenatal vit w/ ferrous fumarate-folic acid PRETZ SOLUTION 10 % glycerin (bulk) GE 166 LAST UPDATED 09/2015

167 PRILOSEC OTC TAB DR 20 MG omeprazole magnesium PRIMSOL SOLUTION 50 MG/5ML trimethoprim hcl PRO-CHLO LIQUID MG/5ML phenylephrine-pyrilamine-chlophedianol PRO-CLEAR AC SYRUP MG/5ML codeine-pyrilamine PRO-RED AC SYRUP MG/5ML phenylephrine-dexchlorpheniramine-codeine PROFE FORTE CAP MG prenatal without vit a w/ iron polysaccharide complex-fa PROFERRIN ES TAB 12 MG iron heme polypeptide promethazine w/ codeine syrup mg/5ml promethazine-dm syrup mg/5ml PRONTHELINE BROMIDE TAB 15 MG propantheline bromide PROPRANOLOL HCL SOLUTION 20 MG/5ML propranolol hcl PROPRANOLOL HCL SOLUTION 40 MG/5ML propranolol hcl propylene glycol-glycerin ophth soln 1-0.3% PROTECT PLUS LIQUID multiple vitamins w/ minerals PROTECT PLUS NF LIQUID multiple vitamins w/ minerals pseudoeph-chlorphen-dm w/ apap cap mg pseudoeph-chlorphen-dm w/ apap pack mg pseudoeph-chlorphen-dm w/ apap tab mg pseudoeph-chlorphen-dm w/ apap tab mg pseudoeph-doxylamine-dm w/ apap cap mg pseudoeph-doxylamine-dm w/apap liq mg/30ml pseudoephed-bromphen-dm elixir mg/5ml pseudoephed-bromphen-dm syrup mg/5ml pseudoephed-chlorphen-dm liq mg/5ml 60 / 30 days 600 / 30 days GE 167 LAST UPDATED 09/2015

168 pseudoephed-chlorphen-dm liq mg/5ml pseudoephed-chlorphen-dm liq mg/5ml pseudoephed-dexchlorphen-chlophedianol liq mg/ml pseudoephed-dexchlorphen-chlophedianol liqd mg/5ml pseudoephed-dexchlorphen-chlophedianol liqd mg/5ml pseudoephedrine hcl liq 15 mg/5ml pseudoephedrine hcl tab 30 mg pseudoephedrine hcl tab 60 mg pseudoephedrine hcl tab abuse deter 30 mg pseudoephedrine hcl tab sr 12hr 120 mg pseudoephedrine w/ acetaminophen tab mg pseudoephedrine w/ apap-dm cap mg pseudoephedrine w/ apap-dm liq mg/15ml pseudoephedrine w/ apap-dm tab mg pseudoephedrine w/ cod-gg soln mg/5ml pseudoephedrine w/ cod-gg syrup mg/5ml pseudoephedrine w/ dm-gg cap mg pseudoephedrine w/ dm-gg liquid mg/5ml pseudoephedrine w/ dm-gg liquid mg/5ml pseudoephedrine-bromphen-codeine liq mg/5ml pseudoephedrine-chlophedianol-gg liqd mg/5ml pseudoephedrine-dexchlorpheniramine-dm liqd mg/5ml pseudoephedrine-dm-gg w/ apap tab mg pseudoephedrine-guaifenesin cap mg pseudoephedrine-guaifenesin tab mg pseudoephedrine-guaifenesin tab mg pseudoephedrine-ibuprofen susp mg/5ml pseudoephedrine-ibuprofen tab mg pseudoephedrine-naproxen sodium tab sr 12hr mg psyllium cap 0.52 gm psyllium powder 100% GE 168 LAST UPDATED 09/2015

169 psyllium powder 28.3% psyllium powder 30.9% psyllium powder 48.57% psyllium powder 58.6% psyllium powder 68% psyllium powder 95% PUREFE OB PLUS CAP MG prenatal without a vit w/ fe fum-iron polysacch complex -fa pyrantel pamoate susp 144 mg/ml (50 mg/ml base equiv) pyreth-piperonyl butox sham-permeth aero-nit remover gel kit pyrethrins-piperonyl butoxide liq % pyrethrins-piperonyl butoxide shampoo % pyridoxine hcl tab 100 mg pyridoxine hcl tab 200 mg pyridoxine hcl tab 25 mg pyridoxine hcl tab 250 mg pyridoxine hcl tab 50 mg pyridoxine hcl tab 500 mg pyridoxine hcl tab cr 200 mg pyrilamine mal-phenylephrine hcl tann susp 16-5 mg/5ml pyrilamine-phenylephrine tab mg QC ISOPROPYL RUBBING ALCOHOL SOLUTION 91 % isopropyl alcohol QC PRENATAL TAB MG prenatal vit w/ ferrous fumarate-folic acid RA ACNE MAXIMUM D 2 % salicylic acid in alcohol RA CALCIUM-BORON TAB MG calcium-boron RA EAR WAX CLEANSING SYSTEM KIT 6.5 % carbamide peroxide & saline RA ESSENCE-C CKET multiple vitamins w/ minerals RA ETHYL ALCOHOL SOLUTION 70 % alcohol, usp GE 169 LAST UPDATED 09/2015

170 RA ONE DAILY MISC & 440 MG prenatal vit w/ ferrous fumarate-fa-omega 3 fatty acids RA PRENATAL FORMULA TAB MG prenatal vit w/ ferrous fumarate-folic acid RA PRENATAL TAB MG prenatal vit w/ ferrous fumarate-folic acid RAPID-FILL TUBE SET MISC iv sets/tubing REALITY LATEX/ULTRA TEXTURED DEVICE condoms latex lubricated - male REALITY LATEX/ULTRA THIN DEVICE condoms latex lubricated - male REFRESH OPTIVE ADVANCED SOLUTION % carboxymethylcellulose-glycerin-polysorbate 80 RENAGEL TAB 400 MG sevelamer hcl RENAGEL TAB 800 MG sevelamer hcl RESCON DM SYRUP MG/5ML pseudoephedrine-chlorphen-dm RESIRE-30 CAP MG pseudoephedrine-guaifenesin RETAINE MGD EMULSION % light mineral oil-mineral oil REZAMID LOTION 2-5 % resorcinol-sulfur RHOGAM ULTRA-FILTERED PLUS SOLN PRSYR 1500 UNIT rho d immune globulin (human) RIBOFLAVIN CAP 100 MG riboflavin RIBOFLAVIN CAP 50 MG riboflavin riboflavin tab 25 mg RIBOFLAVIN TAB 400 MG riboflavin riboflavin tab 50 mg RID ESSENTIAL LICE ELIMINATION KIT % pyrethrins-piperonyl butoxide 12 / 30 days 12 / 30 days GE 170 LAST UPDATED 09/2015

171 RIGHT STEP PRENATAL TAB MG prenatal vit w/ ferrous fumarate-folic acid ROBITUSSIN CHILD COUGH/COLD CF LIQUID MG/5ML phenylephrine w/ dm-gg ROBITUSSIN CHILD COUGH/COLD LA LIQUID MG/5ML chlorpheniramine-dm ROBITUSSIN DAY/NIGHT VALUE K MISC phenylephrine-diphenhydramine-dm-gg ROBITUSSIN NIGHTTIME COUGH DM LIQUID MG/10ML doxylamine-dm ROBITUSSIN PK COLD DAY/NGHT DM MISC phenylephrine-diphenhydramine-dm-guaifenesin-apap ROBITUSSIN PK COLD DAY/NGHT MS MISC phenylephrine-diphenhydramine-dm-guaifenesin-apap RU-HIST D TAB 4-10 MG brompheniramine & phenyleph RU-HIST-D LIQUID MG/5ML pyrilamine-phenylephrine RU-HIST-D TAB MG pyrilamine-phenylephrine RYMED TAB 2-10 MG dexchlorpheniramine-phenylephrine SAFE TUSSIN PM LIQUID MG/5ML doxylamine-dm SAFELET IV CATHETER MISC iv sets/tubing salicylic acid & sulfur shampoo 2-2% salicylic acid pad 40% saline nasal spray 0.65% 90 / 30 days salsalate tab 500 mg salsalate tab 750 mg SCALP VEIN SET MISC iv sets/tubing SCHOOLTIME SHAMPOO SHAMPOO nit remover SCOT-TUSSIN SENIOR LIQUID MG/5ML dextromethorphan-guaifenesin GE 171 LAST UPDATED 09/2015

172 SE-NATAL 19 CHEW TAB 29-1 MG prenatal vit w/ ferrous fumarate-folic acid SE-NATAL 19 TAB 29-1 MG prenatal vit w/ docusate-fe fumarate-folic acid SENNA LEAVES LEAVES senna SENNA SYRUP 176 MG/5ML senna sennosides cap 8.6 mg sennosides chew tab 15 mg sennosides syrup 8.8 mg/5ml sennosides tab 15 mg sennosides tab 17.2 mg sennosides tab 25 mg sennosides tab 8.6 mg SETONET MISC & 430 MG prenatal mv & min w/fe bisglyc-fe prot succ-fa-ca-omega 3 SEVELAMER CARBONATE TAB 800 MG sevelamer carbonate simethicone cap 125 mg simethicone cap 180 mg simethicone chew tab 125 mg simethicone chew tab 80 mg simethicone liquid 40 mg/0.6ml simethicone susp 40 mg/0.6ml SIMILAC PRENATAL EARLY SHIELD MISC & 200 MG prenatal mv & min w/fe fumarate-fa-dha SINADRIN PE COMPLETE SINUS REL TAB MG dexbrompheniramine-phenylephrine-acetaminophen SKIN BEAUTY & WELLNESS CKET multiple vitamins w/ minerals SM CAMPHOR SPIRIT SPIRIT camphor spirit SM ETHYL ALCOHOL (RUBBING) SOLUTION 70 % alcohol, usp GE 172 LAST UPDATED 09/2015

173 SM ISOPROPYL ALCOHOL SOLUTION 50 % isopropyl alcohol SM ISOPROPYL ALCOHOL SOLUTION 70 % isopropyl alcohol SM ISOPROPYL ALCOHOL SOLUTION 91 % isopropyl alcohol SM ONE DAILY PRENATAL MISC & 440 MG prenatal vit w/ ferrous fumarate-fa-omega 3 fatty acids SM PRENATAL VITAMINS TAB MG prenatal vit w/ ferrous fumarate-folic acid SODIUM ASCORBATE GRANULES sodium ascorbate SODIUM BICARBONATE POWDER sodium bicarbonate (antacid) SODIUM BICARBONATE POWDER sodium bicarbonate (bulk) sodium bicarbonate tab 325 mg sodium bicarbonate tab 650 mg sodium chloride aero soln 0.9% sodium chloride hypertonic ophth oint 5% sodium chloride hypertonic ophth soln 5% sodium chloride soln nebu 0.9% sodium chloride tab 1 gm sodium citrate & citric acid soln mg/5ml sodium fluoride chew tab 0.5 mg f (from 1.1 mg naf) sodium fluoride chew tab 1 mg f (from 2.2 mg naf) sodium fluoride cream 1.1% sodium fluoride soln 0.5 mg/ml f (from 1.1 mg/ml naf) SODIUM SILICATE SOLUTION sodium silicate AL1 AL1 AL1 30 / 30 days Up to 10 yrs old 30 / 30 days Up to 10 yrs old 30 / 30 days Up to 10 yrs old GE 173 LAST UPDATED 09/2015

174 SODIUM SILICATE SOLUTION 40 % sodium silicate SOLUTION ADMINISTRATION SET MISC iv sets/tubing SOLUTION TRANSFER DEVICE MISC iv sets/tubing SOURCECF PEDIATRIC LIQUID pediatric multiple vitamin w/ minerals SN 20 SOLUTION polysorbate 20 STONE PUR-ABSORB IRON LIQUID 5 MG/20ML ferrous sulfate STAHIST AD LIQUID MG/5ML chlorcyclizine & pseudoephedrine STAHIST AD TAB MG chlorcyclizine & pseudoephedrine stannous fluoride conc 0.63% stannous fluoride gel 0.4% starch suppositories 51% STATUSS GREEN LIQUID MG/5ML codeine-pseudoephedrine-chlorcyclizine STEP 2 SOLUTION 8 % formic acid (nit removal) STERILE LUBRICANT LIQUID 0.7 % carboxymethylcellulose sodium (ophth) STUART ONE CAP MG prenatal mv & min w/fe carbonyl-fa-dha STUART PRENATAL TAB MG prenatal vit w/ ferrous fumarate-folic acid SUDAFED PE DAY & NIGHT MISC & 10 MG diphenhydramine-phenylephrine SUDAFED TRIPLE ACTION TAB MG pseudoephedrine-acetaminophen-guaifenesin sulfacetamide sodium w/ sulfur cleanser 10-2% sulfacetamide sodium w/ sulfur cleanser % sulfacetamide sodium w/ sulfur emulsion 10-5% sulfacetamide sodium w/ sulfur susp 8-4% AL1 AL1 Up to 9 yrs old Up to 12 yrs old GE 174 LAST UPDATED 09/2015

175 sulfacetamide sodium w/ sulfur wash 9-4% sulfacetamide sodium w/ sulfur wash 9-4.5% sulfacetamide sodium-sulfur in urea emulsion 10-4% sulfur bar 5% SUPERVITE EC TAB DR 1 MG multiple vitamins w/ minerals & folic acid SUPPORT LIQUID multiple vitamins w/ minerals SUPRESS A PEDIATRIC LIQUID MG/ML phenylephrine-dexbrompheniramine-dextromethorphan SUPRESS DM PEDIATRIC LIQUID 5-50 MG/ML dextromethorphan-guaifenesin SUPRESS-PE PEDIATRIC LIQUID MG/ML phenylephrine-guaifenesin SURE-T INFUSION SET 18" MISC subcutaneous infusion set SURE-T INFUSION SET 23" MISC subcutaneous infusion set SURE-T INFUSION SET 32" MISC subcutaneous infusion set SYNAGEX CAP 1.25 MG multiple vitamins w/ minerals & folic acid SYNATEK CAP 1.25 MG multiple vitamins w/ minerals & folic acid SYRINGE LUER SLIP MISC 25G X 5/8" 1 ML syringe/needle (disp) 1 ml SYRINGE LUER SLIP MISC 26G X 3/8" 1 ML syringe/needle (disp) 1 ml SYRLTA (RED) SYRUP oral vehicles SYRLTA SYRUP oral vehicles SYRSPEND SF LIQUID oral vehicles SYSTANE BALANCE SOLUTION 0.6 % propylene glycol (ophth) SYSTANE OVERNIGHT THERAPY GEL 0.3 % hypromellose (ophth) GE 175 LAST UPDATED 09/2015

176 TAMIFLU RECON SUSP 6 MG/ML oseltamivir phosphate TANZEUM PEN 30 MG albiglutide TANZEUM PEN 50 MG albiglutide TARON-BC MISC 20-1 & 25 (2) MG prenatal without vit a w/ iron carbonyl-folic acid & vit b6 terbinafine hcl cream 1% TERPIN HYDRATE MONOHYDRATE POWDER terpin hydrate TERPIN HYDRATE POWDER terpin hydrate TERUMO SURGUARD2 SYRINGE MISC 25G X 5/8" 1 ML syringe/needle (disp) 1 ml TERUMO SURGUARD2 SYRINGE MISC 26G X 3/8" 1 ML syringe/needle (disp) 1 ml tetrahydrozoline hcl ophth soln 0.05% tetrahydrozoline w/ polyethylene glycol ophth soln % tetrahydrozoline w/ zinc sulfate ophth soln % TGQ 15DM/5PEH/2CPM SYRUP MG/5ML phenylephrine-chlorphen-dm TGQ 30PSE/150GFN/15DM SYRUP MG/5ML pseudoephedrine w/ dm-gg TH PRENATAL VITAMINS TAB MG prenatal vit w/ ferrous fumarate-folic acid THEO-24 CAP ER 24H 100 MG theophylline THEO-24 CAP ER 24H 200 MG theophylline THEO-24 CAP ER 24H 300 MG theophylline THERAFLU COLD & SORE THROAT CKET MG pheniramine-phenylephrine-acetaminophen THERAFLU FLU & SORE THROAT CKET MG pheniramine-phenylephrine-acetaminophen THERAFLU MAX-D COLD & FLU CKET MG pseudoephedrine-dm-gg w/ apap AL1 120 / 10 days Up to 12 yrs old GE 176 LAST UPDATED 09/2015

177 THERAFLU SEVERE COLD & COUGH MISC CKET phenylephrine-diphenhydramine-dm w/ apap THERAFLU SEVERE COLD DAYTIME TAB MG dextromethorphan-phenylephrine-acetaminophen THERAFLU SINUS & COLD CKET MG pheniramine-phenylephrine-acetaminophen THERANATAL COMPLETE MISC 27-1 & 300 MG prenatal mv & min w/fe fumarate-fa-dha THERANATAL CORE NUTRITION TAB 27-1 MG prenatal vit w/ ferrous fumarate-folic acid THERANATAL LACTATION SUPPORT MISC multiple vitamins w/ minerals THERANATAL PLUS MISC 27-1 & 300 MG prenatal mv & min w/fe fumarate-fa-dha THERAPEUTIC LIQUID SOLUTION multiple vitamins w/ minerals thiamine hcl tab 100 mg thiamine hcl tab 50 mg TL G-FOL OS TAB MG multiple vitamins w/ minerals & calcium-folic acid TREXBROM LIQUID MG/5ML phenylephrine-brompheniramine-chlophedianol TRIACTIN CHEST CONGESTION SOLUTION 50 MG/5ML guaifenesin TRIADVANCE TAB 90-1 MG prenatal vit w/ docusate-iron carbonyl-folic acid TRIAMINIC CHEST/NASAL CONGEST SYRUP MG/5ML phenylephrine-guaifenesin TRIAMINIC COLD/ALLERGY CHILD SYRUP MG/5ML chlorpheniramine & phenylephrine TRIAMINIC COLD/COUGH DAY TIME SOLUTION MG/5ML phenylephrine-dm TRIAMINIC COLD/COUGH DAY TIME SYRUP MG/5ML phenylephrine-dm TRIAMINIC COLD/COUGH MISC & MG/5ML phenylephrine-diphenhydramine-dextromethorphan TRIAMINIC COUGH & SORE THROAT SYRUP MG/5ML acetaminophen w/ dm AL1 30 / 30 days 14 to 50 yrs old GE 177 LAST UPDATED 09/2015

178 TRIAMINIC COUGH/RUNNY NOSE STRIP 12.5 MG diphenhydramine hcl TRIAMINIC COUGH/SORE THROAT CHEW TAB MG acetaminophen w/ dm C Covered up to age 65, then required TRIAMINIC NIGHT TIME COLD/CGH SYRUP MG/5ML diphenhydramine-phenylephrine triazolam tab mg triazolam tab 0.25 mg TRICARE TAB prenatal vit w/ ferrous fumarate-folic acid TRICODE AR LIQUID MG/5ML pseudoeph-chlorphen w/ cod TRICODE GF LIQUID MG/5ML pseudoephedrine w/ codeine-gg TRIGOFEN DM LIQUID MG/ML phenylephrine-chlorphen-dm TRINATAL GT TAB 90-1 MG prenatal vit w/ docusate-iron carbonyl-folic acid TRINATAL RX 1 TAB 60-1 MG prenatal vit w/ ferrous fumarate-folic acid TRINATAL ULTRA TAB 90-1 MG prenatal vit w/ docusate-iron carbonyl-folic acid triprolidine & pseudoephedrine liquid mg/ml triprolidine & pseudoephedrine tab mg TRISPEC DMX LIQUID MG/5ML dextromethorphan-guaifenesin TRISPEC DMX LIQUID MG/5ML dextromethorphan-guaifenesin TRISPEC PSE LIQUID MG/5ML pseudoephedrine w/ dm-gg TRISPEC PSE PEDIATRIC LIQUID MG/5ML pseudoephedrine w/ dm-gg TRIVEEN-DUO DHA MISC & 400 MG prenatal mv & min w/fe bisglyc-fe prot succ-fa-ca-omega 3 TRIVEEN-U CAP MG prenatal without a vit w/ fe fumarate-folic acid TROJAN MAGNUM WARM SENSATIONS DEVICE condoms latex lubricated - male 12 / 30 days GE 178 LAST UPDATED 09/2015

179 TROJAN NATURALAMB/SPERMICIDE MISC condoms - male TROJAN SUPRAS SPERMICIDAL DEVICE condoms latex lubricated - male TROJAN TWISTED PLEASURE DEVICE condoms latex lubricated - male tropicamide ophth soln 0.5% tropicamide ophth soln 1% TRUSTEX COLOR CONDOMS + LUBE MISC condoms latex lubricated - male TRUSTEX LUB/RIBBED/STUDDED MISC condoms latex lubricated - male TRUSTEX LUB/SPERMICIDE EX ST MISC condoms latex lubricated - male TRUSTEX LUB/SPERMICIDE XL MISC condoms latex lubricated - male TRUSTEX LUBRICATED EX LARGE MISC condoms latex lubricated - male TRUSTEX LUBRICATED EXTRA ST MISC condoms latex lubricated - male TRUSTEX LUBRICATED MISC condoms latex lubricated - male TRUSTEX LUBRICATED/SPERMICIDE MISC condoms latex lubricated - male TRUSTEX NATURAL CONDOMS + LUBE MISC condoms latex lubricated - male TRUSTEX NON-LUBRICATED MISC condoms latex non-lubricated - male TRUSTEX RIA LUB/SPERMICIDE MISC condoms latex lubricated - male TRUSTEX RIA LUBRICATED MISC condoms latex lubricated - male TRUSTEX RIA NON-LUBRICATED MISC condoms latex non-lubricated - male TRUSTEX-NONOXYNOL-9/RIB/STUD MISC condoms latex lubricated - male 12 / 30 days 12 / 30 days 12 / 30 days 12 / 30 days 12 / 30 days 12 / 30 days 12 / 30 days 12 / 30 days 12 / 30 days 12 / 30 days 12 / 30 days 12 / 30 days 12 / 30 days 12 / 30 days 12 / 30 days 12 / 30 days 12 / 30 days trypsin w/ castor oil & peruvian balsam oint 60 / 30 days TURPENTINE LIQUID turpentine GE 179 LAST UPDATED 09/2015

180 TUSICOF LIQUID MG/5ML phenylephrine w/ dm-gg TUSNEL CAP MG brompheniramine w/ dm-gg TUSNEL LIQUID MG/5ML pseudoephedrine w/ dm-gg TUSNEL PEDIATRIC LIQUID MG/5ML pseudoephedrine w/ dm-gg TUSSAFEX-A LIQUID MG/5ML phenylephrine-chlorphen-dm TYLENOL CHILDRENS COLD/STUFFY SUSPENSION MG/5ML phenylephrine w/ acetaminophen TYLENOL CHILDRENS PLUS CLD/CGH SUSPENSION MG/5ML dextromethorphan-phenylephrine-acetaminophen ULTICARE SYRINGE MISC 22G X 1-1/2" 1 ML syringe/needle (disp) 1 ml ULTRA MENS CK MISC multiple vitamins w/ minerals ULTRA WOMENS CK MISC multiple vitamins w/ minerals UNDECYLENIC ACID LIQUID undecylenic acid (bulk) UPCAL D CKET MG-UNIT calcium citrate-vitamin d UPCAL D POWDER MG-UNT/5GM calcium citrate-vitamin d urea cream 40% URO-MAG CAP 140 MG magnesium oxide VACUTAINER TUBING MISC iv sets/tubing VANACOF APE LIQUID MG/15ML phenylephrine-thonzylamine-chlophedianol VANACOF CD LIQUID MG/5ML phenylephrine-dexchlorpheniramine-codeine VANACOF DM LIQUID MG/15ML phenylephrine w/ dm-gg VANACOF G LIQUID MG/5ML chlophedianol-guaifenesin GE 180 LAST UPDATED 09/2015

181 VANACOF GPE LIQUID MG/15ML phenylephrine-chlophedianol-guaifenesin VANACOF-8 LIQUID MG/15ML chlophedianol-pyrilamine VANATAB DX TAB MG pseudoephedrine-chlophedianol-guaifenesin VANISHPOINT 18GX1-1/4" FEP MISC iv catheter VANISHPOINT 18GX1-1/4" PUR MISC iv catheter VANISHPOINT 20GX1-1/4" FEP MISC iv catheter VANISHPOINT 20GX1-1/4" PUR MISC iv catheter VANISHPOINT 22GX1" FEP MISC iv catheter VANISHPOINT 22GX1" PUR MISC iv catheter VANISHPOINT 24GX3/4" FEP MISC iv catheter VANISHPOINT 24GX3/4" PUR MISC iv catheter VANISHPOINT SYRINGE MISC 25G X 1" 1 ML syringe/needle (disp) 1 ml VENATAL-FA TAB 29-1 MG prenatal vit w/ ferrous fumarate-folic acid VERSAFREE SYRUP oral vehicles VERSAPLUS SYRUP oral vehicles VIBRAMYCIN SYRUP 50 MG/5ML doxycycline calcium VICKS NATURE FUSION COLD & FLU LIQUID MG/30ML dextromethorphan-doxylamine-acetaminophen VICKS NATURE FUSION CONGEST LIQUID MG/30ML dextromethorphan-guaifenesin VICKS NYQUIL CHILDRENS CLD/CGH LIQUID 2-15 MG/15ML chlorpheniramine-dm VICKS NYQUIL COLD & FLU NIGHT LIQUID MG/30ML dextromethorphan-acetaminophen-chlorpheniramine GE 181 LAST UPDATED 09/2015

182 VINATE GT TAB 90-1 MG prenatal vit w/ docusate-iron carbonyl-folic acid VINATE II TAB 29-1 MG prenatal vit w/ fe bisglycinate chelate-folic acid VINATE M TAB 27-1 MG prenatal vit w/ selenium-fe fumarate-folic acid VINATE ONE TAB 60-1 MG prenatal vit w/ ferrous fumarate-folic acid VINATE ULTRA TAB prenatal vit w/ docusate-iron carbonyl-folic acid VIRT-ADVANCE TAB 90-1 MG prenatal vit w/ docusate-iron carbonyl-folic acid VIRT-VITE GT TAB 90-1 MG prenatal vit w/ docusate-iron carbonyl-folic acid VITAFOL-OB TAB prenatal vit w/ ferrous fumarate-folic acid VITAFOL-PN TAB prenatal vit w/ ferrous fumarate-folic acid VITALINE BUFFERED ZINC-220 TAB ER 220 (50 ZN) MG zinc sulfate VITAMENT CKET multiple vitamins w/ minerals VITAMIN C (CALCIUM ASCORBATE) RECON SOLN calcium ascorbate VITAMIN C-ELECTROLYTES CKET multiple vitamins w/ minerals vitamin e cap 400 unit VITAMINS TO GO MAXIMUM MISC multiple vitamins w/ minerals VITAMINS TO GO MEN MISC multiple vitamins w/ minerals VITAMINS TO GO WOMEN MISC multiple vitamins w/ minerals VOL-PLUS TAB 27-1 MG prenatal vit w/ ferrous fumarate-folic acid VOL-TAB RX TAB 29-1 MG prenatal vit w/ iron carbonyl-folic acid WAL-FLU SEVERE COLD NIGHT TIME CKET MG pheniramine-phenylephrine-acetaminophen GE 182 LAST UPDATED 09/2015

183 WARM MIST VAPORIZER MISC vaporizers WEGMANS COMPLETE PRENATAL+DHA MISC & 200 MG prenatal mv & min w/fe fumarate-fa-dha WESTHROID TAB 130 MG thyroid WESTHROID TAB 195 MG thyroid WESTHROID TAB 32.5 MG thyroid WESTHROID TAB MG thyroid WESTHROID TAB 65 MG thyroid WESTHROID TAB 97.5 MG thyroid WIDE-SEAL DIAPHRAGM 60 DIAPHRAGM 2 % diaphragm wide seal WIDE-SEAL DIAPHRAGM 65 DIAPHRAGM 2 % diaphragm wide seal WIDE-SEAL DIAPHRAGM 70 DIAPHRAGM 2 % diaphragm wide seal WIDE-SEAL DIAPHRAGM 75 DIAPHRAGM 2 % diaphragm wide seal WIDE-SEAL DIAPHRAGM 80 DIAPHRAGM 2 % diaphragm wide seal WIDE-SEAL DIAPHRAGM 85 DIAPHRAGM 2 % diaphragm wide seal GL GL GL GL GL GL 1 / 365 days Female 1 / 365 days Female 1 / 365 days Female 1 / 365 days Female 1 / 365 days Female 1 / 365 days Female GE 183 LAST UPDATED 09/2015

184 WIDE-SEAL DIAPHRAGM 90 DIAPHRAGM 2 % diaphragm wide seal WIDE-SEAL DIAPHRAGM 95 DIAPHRAGM 2 % diaphragm wide seal WP THYROID TAB 130 MG thyroid WP THYROID TAB 32.5 MG thyroid WP THYROID TAB MG thyroid WP THYROID TAB 65 MG thyroid WP THYROID TAB 97.5 MG thyroid YOUR LIFE MULTI PRENATAL CAP MG prenatal vit w/ ferrous fumarate-fa-fish oil Z-TUSS AC LIQUID 2-9 MG/5ML chlorpheniramine w/ codeine Z-TUSS E LIQUID MG/5ML pseudoephedrine w/ codeine-gg ZINC 15 TAB 66 MG zinc sulfate ZINC SULFATE GRANULES zinc sulfate ZINC SULFATE SOLUTION 1 MG/ML zinc sulfate ZINC SULFATE SOLUTION 5 MG/ML zinc sulfate ZODRYL AC 25 SUSPENSION MG/ML chlorpheniramine w/ codeine ZODRYL AC 30 SUSPENSION MG/ML chlorpheniramine w/ codeine ZODRYL AC 35 SUSPENSION MG/ML chlorpheniramine w/ codeine ZODRYL AC 40 SUSPENSION MG/ML chlorpheniramine w/ codeine ZODRYL DAC 25 SUSPENSION MG/ML pseudoeph-chlorphen w/ cod GL 1 / 365 days Female 1 / 365 days GE 184 LAST UPDATED 09/2015

185 ZODRYL DAC 30 SUSPENSION MG/ML pseudoeph-chlorphen w/ cod ZODRYL DAC 35 SUSPENSION MG/ML pseudoeph-chlorphen w/ cod ZODRYL DAC 40 SUSPENSION MG/ML pseudoeph-chlorphen w/ cod ZODRYL DEC 25 SUSPENSION MG/ML pseudoephedrine w/ codeine-gg ZODRYL DEC 30 SUSPENSION MG/ML pseudoephedrine w/ codeine-gg ZODRYL DEC 35 SUSPENSION MG/ML pseudoephedrine w/ codeine-gg ZODRYL DEC 40 SUSPENSION MG/ML pseudoephedrine w/ codeine-gg ZYNCOF SYRUP MG/5ML dextromethorphan-guaifenesin GE 185 LAST UPDATED 09/2015

186 Index of covered drugs 1 1st Tier Unifine Pentips 71 1st Tier Unifine Pentips Plus 71 A Abreva 110 Acarbose 34 Accu-Chek Tender 1 Infusion 110 Acebutolol HCl 43 Acerola C Acetaminophen 110 Acetaminophen w/ Codeine 9 Acetaminophen w/ DM 110,128,177,178 Acetaminophen-Guaifenesin 110 Acetazolamide 47,104 AcetaZOLAMIDE 47 Acetic Acid (Otic) 104 Acetic Acid-Aluminum Acetate 110 Acetone 110 Acetone (Urine) Test 144 Acetylcysteine 107 Acidophilus Plus Pectin 110 Acidophilus/Citrus Pectin 110 Aclidinium Bromide 106 Acne Medication 111 Actiphyte of Lemongrass 111 Acyclovir 32,33 Adalimumab 69 Administration Set 111 Adrenaclick 106 Adult Acnomel 111 Adult Aspirin Low Strength 111 Advair Diskus 104 Advil Allergy & Congestion 111 Advil Allergy Sinus 111 Advil Cold & Sinus Liqui-Gels 111 Advocate Insulin Pen Needles 71 Advocate Insulin Syringe 71,72 Aerospan 111 Afluria 111 Afluria Preservative Free 111 Agoral Maximum Strength 111 Aimsco Lubricated 111 Air Eliminating TPN IV Set 111 Ala-Hist PE 111 Albiglutide 176 Albuterol Sulfate 106,107 Alclometasone Dipropionate 53 Alcohol (Rubbing) 111 Alcohol Denatured 111 Alcohol Swabs 13 Alcohol, Rubbing 111,133,134,139 Alcohol, USP 127,134,139,141,169,172 Alendronate Sodium 70 Aler-Dryl 111 Alfuzosin HCl 60 Alka-Seltzer Heartburn 112 Alka-Seltzer Plus Cold & Cough 112 Alka-Seltzer Plus Cold & Flu 112 Alka-Seltzer Plus Day/Night 112 Alka-Seltzer Plus Night Cold 112 Alka-Seltzer Plus Sinus 112 Allopurinol 25 Alprazolam 33 Altretamine 26 Alum & Mag Hydrox-Simethicone 112 Aluminum & Magnesium Hydroxide 147 Aluminum Hydroxide-Mag Carb 112,138 Aluminum Hydroxide-Mag Trisil 112,138 Aluminum Oxide 120 Amantadine HCl 32 Amiloride & Hydrochlorothiazide 48 Amiloride HCl 48 Amiodarone HCl 42 Amitriptyline HCl 22 Amlodipine Besylate 45 Amlodipine Besylate-Benazepril HCl 45 Amlodipine Besylate-Olmesartan Medoxomil 45 Ammonium Lactate 112 Amoxapine 22 Amoxicillin 15,16 GE 186 LAST UPDATED 09/2015

187 Amoxicillin & Pot Clavulanate 15 Amphetamine-Dextroamphetamine 51,52 Ampicillin 16,112 Anagrelide HCl 38 Anastrozole 27 Anesthesia Extension Tubing 112 Anoro Ellipta 106 Antacid 112 Anti-Stick Insulin Syringe 72 Antipyrine-Benzocaine 112 Apatate Forte 112 Apidra 36 Apidra SoloStar 36 Apriso 70 Argyle Extension Tube 20" 112 Armour Thyroid 113 Artificial Tear Ointment 103 Artificial Tear Solution 103 Ascorbic Acid 110,113,128 Ascorbic Acid Buffered 120 Aspirin 111,113,114,133 Aspirin Buffered 113 Aspirin Buffered (Cal Carb-Mag Carb-Mag Oxide) 113,120 Aspirin Low Dose 114 Aspirin-Acetaminophen-Caffeine 114 Assure Dose Control 114 Assure ID Insulin Safety Syr 72 Atabex 114 Atabex EC 114 Atenolol 43 Atenolol & Chlorthalidone 43 Atorvastatin Calcium 49 Atovaquone 28 Atropine Sulfate 114 Atropine Sulfate (Ophthalmic) 104,114 Atrovent HFA 106 Aurora Pen Needles 72 Aurora Unifine Pentips 72 Autoject Autopen 114 Auvi-Q 106 Avonex 53 Azathioprine 68 Azelastine HCl (Ophth) 103 Azithromycin 16 Azolen Tincture 114 Azor 45 B B Complex w/ C 109 B-Complex w/ C & Calcium 109 B-Complex w/ C & E + Zn 109 B-Complex w/ C & Folic Acid 109 B-natal 114 B1 Natural 115 Bacitracin 12 Bacitracin (Ophthalmic) 12 Bacitracin (Topical) 115 Bacitracin Zinc 115 Bacitracin-Poly-Neomycin-HC 12 Bacitracin-Polymyxin B (Ophth) 12 Baclofen 31 Balsalazide Disodium 70 BD Angiocath Autoguard 115 BD AutoShield 72 BD AutoShield Duo 72 BD Eclipse Syringe 115 BD First Midcath 18G/4FRx20cm 115 BD First Midcath 20G/3FRx20cm 115 BD First PICC 16G/5FRx65cm 115 BD First PICC 18G/4FRx65cm 115 BD First PICC 20G/3FRx65cm 115 BD First PICC 22G/2.8FRx50cm 115 BD First PICC 26G/1.9FRx50cm 115 BD Insulin Syr Ultrafine II 72 BD Insulin Syringe 73 BD Insulin Syringe Half-Unit 72 BD Insulin Syringe MicroFine 72,73 BD Insulin Syringe U BD Insulin Syringe Ultrafine 73,74 BD Integra Insulin Syringe 74 GE 187 LAST UPDATED 09/2015

188 BD Integra Syringe 74,115 BD L-Cath 16G/5FR 115 BD L-Cath 16G/5FRx60cm 116 BD L-Cath 18G/3.5FR 116 BD L-Cath 18G/3.5FRx60cm 116 BD L-Cath 20G/2.6FR 116 BD L-Cath 20G/2.6FRx60cm 116 BD L-Cath 20G/3FR 116 BD L-Cath 20G/3FRx60cm 116 BD L-Cath 28G/1.2FRx25cm 116 BD L-Cath Midline 18G/3.5FRx BD L-Cath Midline 20G/3FRx20cm 116 BD Luer-Lok Syringe 116 BD Nexiva 18Gx1.25" 116 BD Nexiva 18Gx1.75" 116 BD Nexiva 20Gx1" 116 BD Nexiva 20Gx1.25" 116 BD Nexiva 20Gx1.75" 116 BD Nexiva 22Gx1" 116 BD Nexiva 24Gx0.56" 116 BD Nexiva 24Gx0.75" 117 BD Pen Needle Mini U/F 74 BD Pen Needle Nano U/F 74 BD Pen Needle Short U/F 74 BD Pen Needle Ultrafine 74 BD Saf-T E-Z Set 117 BD Saf-T-Intima 18G x 1" 117 BD Saf-T-Intima 20Gx1" 117 BD Saf-T-Intima 22G x 0.75" 117 BD Saf-T-Intima 22Gx3/4" 117 BD Saf-T-Intima 24G x 0.75" 117 BD Saf-T-Intima 24Gx3/4" 117 BD Safety-Lok Insulin Syringe 74 BD Safety-Lok Set 117 BD Safety-Lok Vacutainer Set 117 BD SafetyGlide Insulin Syringe 74 BD Syringe/Needle 117 BD Syringe/Needle Slip Tip 117 BD Vacutainer Set 117 Benazepril & Hydrochlorothiazide 40 Benazepril HCl 40 Benfotiamine 117 Benfotiamine-V 117 Benzocaine (Dental) 117,158 Benzocaine-Docusate Sodium 117 Benzonatate 118 Benzoyl Peroxide 111,118,120,133,154,157 Benzyl Alcohol 118 Benzyl Benzoate 118 Benzyl Benzoate (Bulk) 118 Betamethasone Dipropionate (Topical) 54 Betamethasone Dipropionate Augmented 54 Betamethasone Valerate 54 Betaseron 53 Betaxolol HCl (Ophth) 104 Bethanechol Chloride 61 Bicalutamide 26 Bicarsim 118 Bicarsim Forte 118 Bicillin C-R 16 Bicillin C-R 900/ Biclora 118 Biclora-D 118 Biobron SF 118 Biodesp DM 118 Bionatuss DXP 118 Bionel 118 Bionel Pediatric 119 Biospec DMX 119 Biosupp 119 Biotect Plus 119 Biotin 119,149 Biotin Ultra Strength 119 Biovol 119 Bisacodyl 119,136 Bismuth Subsalicylate 119 Bisoprolol & Hydrochlorothiazide 43 Bisoprolol Fumarate 43 Black Draught 119 Blephamide 17 Blephamide S.O.P. 17 Blink Tears 119 GE 188 LAST UPDATED 09/2015

189 Blood Glucose Calibration 114,138,157 BP Cleansing Wash 120 BPO 120 BrainStrong Prenatal 120 Brasivol 120 Breo Ellipta 104,105 Brimonidine Tartrate 104 Brohist D 120 Brompheniramine & Phenyleph 120,171 Brompheniramine & Pseudoeph 120,146 Brompheniramine w/ DM-GG 180 Broncotron PED Drops 120 Broncotron-S 120 Bronkaid 120 Bronkids 120 Budesonide (Inhalation) 105 Budesonide-Formoterol Fumarate Dihydrate 105 Buffered Vitamin C 120 Bufferin 120 Bumetanide 48 Bupropion HCl 20 Bupropion HCl (Smoking Deterrent) 11 Buried Treasure Active 55 Plus 120 Buspirone HCl 33 Busulfan 151 Butalbital-Acetaminophen 120 Butalbital-Acetaminophen-Caffeine 120 Butalbital-Acetaminophen-Caffeine w/ Codeine 53 Butalbital-Aspirin-Caffeine 120 Butalbital-Aspirin-Caffeine w/cod 9 Butoconazole Nitrate (One Dose) 140 Bystolic 43,44 C Cal Carb & Mag Hydrox-Simeth 120 Cal-Mag Chela-Max 120 Cal-Quick 121 Cal/Mag 121 Calcet Creamy Bites 121 Calcitriol 70 Calcium 122 Calcium Acetate (Phosphate Binder) 61 Calcium Ascorbate 182 Calcium Carbonate 121 Calcium Carbonate (Antacid) 112,121 Calcium Carbonate Antacid 121 Calcium Carbonate-Cholecalciferol 121,122,133,160 Calcium Carbonate-Mag Hydrox 112,121 Calcium Carbonate-Simethicone 121 Calcium Carbonate-Vitamin D 121,122 Calcium Citrate 122 Calcium Citrate Malate-Cholecalciferol 122 Calcium Citrate Malate-Vit D 122 Calcium Citrate-Vitamin D 121,122,180 Calcium Citrate-Vitamin D3 122 Calcium Pantothenate 122 Calcium Phosphate-Cholecalciferol 122,134 Calcium Plus Vitamin D 122 Calcium Polycarbophil 122,134 Calcium w/ Magnesium 120,121,122 Calcium w/ Vitamin D 122 Calcium-Boron 169 Calcium-Ergocalciferol 160 Calcium-Magnesium 122 Calcium-Vitamin D3 122 Calcium/Vitamin D3 Gummies 122 Camphor (Inhalant) 122 Camphor Spirit 122,172 Canagliflozin 143 CapCof 122 Capecitabine 122,123 Capmist DM 123 Capron DM 123 Capsaicin 123,139 Captopril 41 Captopril & Hydrochlorothiazide 40,41 Captopril-Hydrochlorothiazide 41 Capzasin 123 Carbamazepine 20 Carbamide Peroxide & Saline 125,127,132,169 Carbamide Peroxide (Otic) 123 Carbaphen CH 123 GE 189 LAST UPDATED 09/2015

190 Carbaphen Ped CH 123 Carbonyl Iron 161 Carboxymethylcellulose Sodium (Ophth) 123,174 Carboxymethylcellulose-Glycerin 123 Carboxymethylcellulose-Glycerin-Polysorbate Carboxymethylcellulose-Hypromellose 138 CareFine Pen Needles 74 CareOne Unifine Pentips 74,75 CareOne Unifine Pentips Plus 75 Carteolol HCl (Ophth) 104 Carvedilol 44 CCP Caffeine Free 123 Cefaclor 14 Cefadroxil 14 Cefdinir 14 Cefpodoxime Proxetil 14 Cefprozil 14 Ceftin 123 Ceftriaxone Sodium 15 Cefuroxime Axetil 15,123 CellCept 68 Centrum Specialist Prenatal 123 Cephalexin 15 CeraLyte CeraSport 123 Certuss-D 123 Cetirizine HCl 105,123 Cetirizine-Pseudoephedrine 123 Chantix 12 Chantix Continuing Month Pak 11 Chantix Starting Month Pak 12 Cherry 124 Cherry Concentrate 123 Cherry Syrup 123,124 Chlo Tuss 124 Chlo Tuss EX 124 Chlophed 124 Chlophedianol-Chlorcyclizine 118 Chlophedianol-Guaifenesin 124,180 Chlophedianol-Pyrilamine 181 Chlorambucil 26 Chlorcyclizine & Pseudoephedrine 152,174 Chlorcyclizine-Phenylephrine 128 Chlordiazepoxide HCl 124 Chlordiazepoxide HCl-Clidinium Bromide 124 Chlorhexidine Gluconate 124 Chlorhexidine Gluconate (Bulk) 124 Chlorhexidine Gluconate (Mouth-Throat) 53 Chloroform 124 Chloroquine Phosphate 28 Chlorothiazide 48,131 Chlorpheniramine & Phenylephrine 124,128,132,133,177 Chlorpheniramine & Pseudoeph 124,146 Chlorpheniramine Maleate 124,125,133 Chlorpheniramine w/ Codeine 125,126,184 Chlorpheniramine-Acetaminophen 125 Chlorpheniramine-DM 125,130,171,181 Chlorpheniramine-Phenylephrine- Acetaminophen 124,126,156 Chlorpheniramine-Phenylephrine-ASA 125 Chlorpheniramine-Phenylephrine-Ibuprofen 111 Chlorpheniramine-Pseudoephedrine- Acetaminophen 124 Chlorpheniramine-Pseudoephedrine-Ibuprofen 111 Chlorpromazine HCl 28,29 Chlorpropamide 125 ChlorproMIDE 125 Chlorthalidone 48,49 Chlorzoxazone 108 Cholecalciferol 125 Cholestyramine 50 Cholestyramine Light 50 Choline & Mag Salicylate 125 Ciclopirox 24 Cilostazol 39 Cimetidine 58 Cimetidine HCl 58 Cinacalcet HCl 67 Ciprofloxacin HCl 17,125 Ciprofloxacin HCl (Ophth) 17 Ciprofloxacin HCl (Otic) 125 GE 190 LAST UPDATED 09/2015

191 Citalopram Hydrobromide 21 Citrocarbonate 125 Citrus Syrup 125 Clarithromycin 16 Claritin Reditabs 125 Classic Prenatal 125 Clearcanal Ear Wax Removal 125 Clemastine Fumarate 125,126 Cleocin 12 Clickfine Pen Needles 75 Clindamycin HCl 12,13 Clindamycin Palmitate Hydrochloride 13 Clindamycin Phosphate (Topical) 54 Clindamycin Phosphate Vaginal 12,13 Clinical Nutrients Prenatal 126 Clobetasol Propionate 54 Clomipramine HCl 22 Clonazepam 19 Clonidine HCl 39 Clopidogrel Bisulfate 39 Clorazepate Dipotassium 33 Clotrimazole 24 Clotrimazole (Topical) 24,126 Clotrimazole Vaginal 126 Clotrimazole w/ Betamethasone 61 Clozapine 30 Codar AR 126 Codar D 126 Codeine Sulfate 9 Codeine-Chlorcyclizine 163 Codeine-Pseudoephedrine-Chlorcyclizine 163,174 Codeine-Pyrilamine 167 Codituss DM 126 Colchicine 25 Colchicine w/ Probenecid 25 Colestipol HCl 50 Collagenase 55 Colyte with Flavor Packs 59 Comfort EZ Insulin Syringe 75,76 Comfort EZ Pen Needles 76 Complete Formulation Pediatric 126 Complete Natal DHA 126 Complete Nutritional Drink 126 Complete Prenatal/DHA 126 Complete Sinus Relief 126 CompleteNate 126 ConceptionXR Motility Support 126 Condoms 126 Condoms - Male 126,146,179 Condoms Latex Lubricated - Male 111,133,134,144,145,149,165,170,178,179 Condoms Latex Non-Lubricated - Male 144,179 Conex Cold/Allergy 126 Conjugated Estrogens-Medroxyprogesterone Acetate 66 Contac Cold+Flu Max St 126 Contac Cold/Flu Day & Night 126 Cool Mist Humidifier 127 Coricidin HBP Day/Night Cold 127 Coricidin Nighttime Cold-Cough 127 Cornwall Metal Pipetting 127 Correctol Herbal Tea 127 Cortisone Acetate 61 Cottonseed Oil 127 Cottonseed Oil (Bulk) 127 Creon 56,57 Cromolyn Sodium (Nasal) 127 Cromolyn Sodium (Ophth) 103 Crotamiton 28 Cryoserv 127 Culturelle 127 Culturelle Digestive Health 127 Culturelle Health & Wellness 127 Culturelle Immunity Support 127 Curity Alcohol Preps 13 CVS Diabetes Health Support 127 CVS Ear Wax Cleansing System 127 CVS Ethyl Alcohol 127 CVS Insulin Syringe 76 CVS Isopropyl Alcohol 127 CVS Isopropyl Rubbing Alcohol 127 CVS Natural Fiber Supplement 127 GE 191 LAST UPDATED 09/2015

192 CVS Prenatal 128 CVS Prenatal Gummy 128 CVS Vitamin C 128 CVS Womens Prenatal+DHA 128 Cyanocobalamin 128 Cyclobenzaprine HCl 108 Cyclopentolate HCl 128 Cyclophosphamide 26,27 Cyclosporine 68,69 CycloSPORINE Modified 69 Cyclosporine Modified (For Microemulsion) 69 Cyproheptadine HCl 105 Cytra D Daily Energy Enfusion 128 Daily Heart Health Support 128 Daily Pak Maximum Multivitamin 128 Dallergy 128 Dapsone 25 Daraprim 28 Daytime Cold Medicine 128 Deltuss DP 128 Delzicol 128 Denture Adhesive 128 Denture Care Products 128 Depo-Provera 66 Derma-Smoothe/FS Body 54 Derma-Smoothe/FS Scalp 54 Desgen DM 128 Desmopressin Acetate 62 Desmopressin Acetate Spray 62 Desmopressin Acetate Spray Refrigerated 62 Desogestrel & Ethinyl Estradiol 63 Desogestrel-Ethinyl Estradiol (Triphasic) 62 Desonide 54 Despec DM 128 Despec-DM 128 Dewees Carminative 129 Dexamethasone 61,129 Dexamethasone Intensol 61 Dexamethasone Sodium Phosphate (Ophth) 103 Dexbrompheniramine & Pseudoephedrine 126 Dexbrompheniramine-Acetaminophen 132,138 Dexbrompheniramine-Phenylephrine 111,128 Dexbrompheniramine-Phenylephrine- Acetaminophen 126,172 Dexchlorpheniramine & Pseudoephedrine 128 Dexchlorpheniramine Maleate 129 Dexchlorpheniramine-Phenylephrine 171 Dexmethylphenidate HCl 52 DexPak 10 Day 129 DexPak 13 Day 129 DexPak 6 Day 129 Dextroamphetamine Sulfate 52 Dextromethorphan HBr 129 Dextromethorphan-Acetaminophen- Chlorpheniramine 129,181 Dextromethorphan-Diphenhydramine- Acetaminophen 130 Dextromethorphan-Doxylamine- Acetaminophen 129,181 Dextromethorphan- Guaifenesin 119,120,129,135,138,150,161,171,175,17 8,181,185 Dextromethorphan-Guaifenesin-Chlorpheniramine- Acetaminophen 127 Dextromethorphan-Phenylephrine- Acetaminophen 129,146,177,180 Dextromethorphan-Pyrilamine 123 Dextrose (Diabetic Use) 139 Diabetes Health 130 Diabetes Support 130 Diabetic Tussin Cold & Flu 130 Diabetic Tussin Night Cold/Flu 130 Dialyvite Supreme D 130 Diaphragm Arc-Spring 158,159 Diaphragm Coil Spring 159 Diaphragm Flat Spring 159,160 Diaphragm Wide Seal 183,184 Diaphragms 157 Diazepam 19,34 GE 192 LAST UPDATED 09/2015

193 Diazepam (Anticonvulsant) 19 Diclofenac Potassium 7 Diclofenac Sodium 7 Diclofenac Sodium (Ophth) 103 Dicloxacillin Sodium 16 Dicyclomine HCl 58 Diflunisal 7 Digoxin 47 Diltiazem HCl 45,46 Diltiazem HCl Coated Beads 46 Diltiazem HCl Extended Release Beads 46 Dimenhydrinate 130,132 DimenhyDRINATE 130 Dimetapp Long Act Cough/Cold 130 Dimethyl Sulfoxide 130 Dimethyl Sulfoxide (bulk) 127,130 Dino-Life w/iron-zinc 130 Diphenhydramine HCl 111,130,131,178 Diphenhydramine HCl (Sleep) 130 Diphenhydramine-Acetaminophen 127,131 Diphenhydramine-Acetaminophen (sleep) 131 Diphenhydramine-Phenylephrine 131,174,178 Diphenhydramine-Phenylephrine-Acetaminophen 131 Diphenhydramine-Pseudoephedrine- Acetaminophen 131 Diphenoxylate w/ Atropine 58 Diphenoxylate-Atropine 58 Dipyridamole 39 Disopyramide Phosphate 42 Diuril 131 Divalproex Sodium 19 Docosanol 110 Docusate Calcium 131 Docusate Sodium 131,132,161 DocuSol Kids 132 Dologen 132 Dometuss-DA/Children 132 Doribax 15 Doripenem 15 Dornase Alfa 107 Dorzolamide HCl 104 Dorzolamide HCl-Timolol Maleate 104 Doxazosin Mesylate 60 Doxepin HCl 33 Doxycycline (Monohydrate) 18 Doxycycline Calcium 181 Doxycycline Hyclate 17,18 Doxylamine-DM 132,171 Doxylamine-Phenylephrine 163 Doxylamine-Phenylephrine-Acetaminophen 109,132 Doxylamine-Pseudoephedrine 147 Dramamine 132 Dronabinol 23 Drug Mart Ultra Comfort Syr 76 Drug Mart Unifine Pentips 76,77 Drug Mart Unifine Pentips Plus 77 Duane Reade Unifine Pentips 77 Dulera 105 Duloxetine HCl 21 Duravent PE 132 Dyphylline 107 E E-Z-Gas II 132 Ear Wax Cleansing 132 EasiVent 132 EasiVent Mask Large 132 EasiVent Mask Medium 132 EasiVent Mask Small 132 Easy Comfort Insulin Syringe 77 Easy Comfort Pen Needles 77 Easy Touch Fluringe 132 Easy Touch Insulin Safety Syr 77 Easy Touch Insulin Syringe 77,78 Easy Touch Pen Needles 78 Easy Touch Safety Syringe 132 Econazole Nitrate 24 Ecotrin 133 Ed ChlorPed 133 Ed ChlorPed D 133 Effaclar Duo 133 Effient 39 GE 193 LAST UPDATED 09/2015

194 Elastic Bandages & Supports 145 Eldertonic 133 Elexa Natural Feel 133 Elexa Stimulating 133 Elexa Ultra Sensitive 133 Eligard 68 Eliphos 61 Elite Iron 133 Elixophyllin 107 Ellis Tonic 133 Enalapril Maleate 41 Enalapril Maleate & Hydrochlorothiazide 41 Enbrel 69 Enbrel SureClick 69 Endacon 133 Energy Booster 133 Enfalyte 133 Enfamil Enfalyte 133 Enfamil Expecta 133 Enoxaparin Sodium 37 Entex LQ 133 Entex T 133 Ephedrine-Guaifenesin 120,133 Epinephrine 106,107 EPINEPHrine 106 EpiPen 107 EpiPen 2-Pak 106 EpiPen Jr 107 EpiPen Jr 2-Pak 106 Epivir HBV 32 Epoetin Alfa 38,39 Epogen 38 E Calcium/Vitamin D 133 E Ethyl Alcohol (Rubbing) 133 E Insulin Syringe 78,79 E Isopropyl Alcohol 134 E Prenatal Formula 134 E Short Pen Needle 79 E Super Energy Booster 134 E Ultra Comfort Insulin Syr 79 E Ultra Short Pen Needle 79 E Vitamin D-3 High Potency 134 Equalactin 134 Ergocalciferol 134 Erythromycin (Acne Aid) 16,17 Erythromycin (Ophth) 16 Erythromycin-Sulfisoxazole 17 Escitalopram Oxalate 21 Esomeprazole Magnesium 154 Estazolam 134 Esterified Estrogens 27 Esterified Estrogens & Methyltestosterone 134 Estrace 63 Estradiol 63,64 Estradiol Vaginal 63 Estrogens, Conjugated 65,66 Estropipate 64 Etanercept 69 Ethambutol HCl 25 Ether 134 Ethionamide 26 Ethosuximide 18 Ethyl Alcohol 134 Ethyl Alcohol (Rubbing) 134 Ethynodiol Diacet & Eth Estrad 64,66 Etodolac 7 Eugenol 134 Eugenol (Bulk) 134 Eurax 28 Evac-U-Gen 134 Excel Comfort Point Pen Needle 79 Exel Comfort Point Insulin Syr 79,80 Extavia 53 EzFe Forte 134 F Famotidine 58,161 Famotidine in NaCl 134 Famotidine Premixed 134 Fantasy Lubricated 134 Fantasy Lubricated/Spermicide 134 Fe Fumarate-Vitamin C-Vitamin B12-Folic Acid 135 GE 194 LAST UPDATED 09/2015

195 Felodipine 46 Fenesin DM IR 135 Fenofibrate 49 Fenofibrate Micronized 49 Fenoprofen Calcium 7 Fentanyl 8 Fer-In-Sol 135 Ferate 135 Ferretts IPS 135 Ferrimin Ferrous Bisglycinate Chelate 133 Ferrous Fumarate 135,140 Ferrous Fumarate w/ B12-Vit C-FA-IFC 135 Ferrous Gluconate 135,143 Ferrous Sulfate 135,136,174 Ferrous Sulfate Dried 135 Ferrous Sulfate-Vitamin C-Folic Acid 136 Fexofenadine HCl 136 Fifty50 Pen Needles 80 Fifty50 Superior Comfort Syr 80 Filgrastim 38 Finasteride 60 First-Lansoprazole 136 First-Omeprazole 136 First-Vancomycin First-Vancomycin Flarex 103 Flavor Blend 136 Flavor Plus 136 Flavor Sweet 136 Flavor Sweet-SF 136 Flecainide Acetate 42 Fleet Bisacodyl 136 Flovent Diskus 105 Flovent HFA 105 Flu & Sore Throat 136 Fluarix 136 Fluarix Quadrivalent 136 Flucelvax 136 Fluconazole 24 Fludrocortisone Acetate 61 Fluid Administration Set 136 Flulaval 136 Flunisolide 105 Flunisolide (Nasal) 105 Flunisolide HFA 111 Fluocinolone Acetonide 54 Fluocinonide 54 Fluocinonide Emulsified Base 54 Fluorometholone (Ophth) 103 Fluorometholone Acetate 103 Fluorouracil (Topical) 54 Fluoxetine HCl 21 Fluphenazine HCl 29 FluPHENAZine HCl 29 Flurazepam HCl 136,137 Flurbiprofen 7 Flurbiprofen Sodium 103 Flutamide 26 Fluticasone Furoate-Vilanterol 104,105 Fluticasone Propionate 54,55 Fluticasone Propionate HFA 105 Fluticasone Propionate (Inhalation) 105 Fluticasone Propionate (Nasal) 105 Fluticasone-Salmeterol 104 Fluvirin 137 Fluvirin Preservative Free 137 Fluvoxamine Maleate 21 Fluzone 137 Fluzone Pediatric PF 137 Fluzone Preservative Free 137 Fluzone Quadrivalent 137 FML 103 FML Forte 103 Folgard OS 137 Folic Acid 137,138 Foradil Aerolizer 107 Formic Acid (Nit Removal) 174 Formoterol Fumarate 107 Fortavit 138 Fosinopril Sodium 41 Fosphenytoin Sodium 20 GE 195 LAST UPDATED 09/2015

196 Freds Pharmacy Unifine Pentip+ 80 Freds Pharmacy Unifine Pentips 80 FreeStyle Control Solution 138 FreeStyle Lite Test 138 FreeStyle Precision Ins Syr 80 FreeStyle Test 138 Fungoid Tincture 138 Furosemide 48,66 G G-Dologen 138 G-P-Tuss DXP 138 G-Tron Pediatric Drops 138 G-Tusicof 138 G-Zyncof 138 Gabapentin 19 Gas-X Extra Strength 138 Gauze Pads & Dressings 55,56 Gauze Sponge 55 Gaviscon 138 Gaviscon Extra Relief Formula 138 Gemfibrozil 49 Gentamicin Sulfate 12 Gentamicin Sulfate (Ophth) 12 Gentamicin Sulfate (Topical) 12 GenTeal 138 GenTeal Severe 138 Glatiramer Acetate 53 Glimepiride 35 Glipizide 35 Global Ease Inject Pen Needles 80 Global Inject Ease Insulin Syr 80,81 Glucagon (rdna) 36 Glucagon Emergency 36 Glucocard Expression Control 138 Glucocard Expression Test 138 Glucocard Vital Test 139 GlucoPro Insulin Syringe 81 Glucose Blood 138,139 Glyburide 35 GlyBURIDE 35 Glyburide Micronized 35 Glyburide-Metformin 35 Glycerin 139 Glycerin (Bulk) 139,166 Glycerin (Laxative) 139,161 Glycerin (Topical) 139 Glycerin-Hypromellose-Polyethylene Glycol Glycerine 139 Glycerol 139 Glycerol Formal 139 Glycine Soya Extract 139 Glycine Soya Protein 139 Glycopyrrolate 58 GNP Alcohol Denatured 139 GNP Capsaicin 139 GNP Clickfine Pen Needles 82 GNP Daily Prenatal 139 GNP Ethyl Alcohol 139 GNP Ethyl Rubbing Alcohol 139 GNP Insulin Syringe 82 GNP Isopropyl Alcohol 139 GNP Peppermint Spirit 140 GNP PreNatal 140 GNP Sodium Silicate 140 GNP Ultra Com Insulin Syringe 82,83 Golytely 59 GoodSense Prenatal Vitamins 140 Grape Syrup 140 Griseofulvin Microsize 24 Griseofulvin Ultramicrosize 24 Guaiacol 140 Guaifenesin 140,151,177 GuaiFENesin 140 Guaifenesin-Codeine 140 Guanfacine HCl 39 Gynazole H H 468L Tubing 140 H-E-B incontrol Pen Needles 83 Halobetasol Propionate 55 GE 196 LAST UPDATED 09/2015

197 Haloperidol 29 Haloperidol Decanoate 29 HC DermaPax 140 HealthWise Mini Pen Needles 83 HealthWise Pen Needles 83 HealthWise Short Pen Needles 83 HealthWise Unifine Pentips 83 Healthy Accents Unifine Pentip 83 Healthy Mama Be Well Rounded 140 Heparin Sodium (Porcine) 37 Herbal Expec 140 Hexalen 26 High Potency Iron 140 Histex-DM 140 Histex-PE 141 HM Ethyl Rubbing Alcohol 141 HM Isopropyl Alcohol 141 HM One Daily Prenatal 141 HM Prenatal 141 Homatropine HBr 141 Honey Bears w/iron-zinc 141 Huber Infusion Set 141 HumaPen LUXURA HD 141 HumatroPen for 12mg 141 HumatroPen for 24mg 141 HumatroPen for 6mg 141 Humidifiers 127 Humira 69 Humira Pediatric Crohns Start 69 Humira Pen 69 Humira Pen-Crohns Starter 69 Humira Pen-Psoriasis Starter 69 Hydralazine HCl 50 Hydrochlorothiazide 49 Hydrocil 141 Hydrocodone Polistirex-Chlorpheniramine Polistirex 141 Hydrocodone w/ Homatropine 141 Hydrocodone-Acetaminophen 9,10,11 Hydrocortisone 61 Hydrocortisone & Colloidal Oatmeal & Body Wash 153 Hydrocortisone (Intrarectal) 70 Hydrocortisone (Rectal) 55,61 Hydrocortisone (Topical) 55,141,142 Hydrocortisone Acetate (Rectal) 141 Hydrocortisone Acetate (Topical) 141 Hydrocortisone Valerate 55 Hydrocortisone w/acetic Acid 104 Hydrocortisone-Aloe Vera 142 Hydrocortisone-Diphenhydramine HCl 140 Hydromorphone HCl 10 Hydroxychloroquine Sulfate 28 Hydroxyprogesterone Caproate 142 Hydroxyprogesterone Caproate (Bulk) 142 Hydroxyurea 27 Hydroxyzine HCl 105,106 Hydroxyzine Pamoate 106 HydrOXYzine Pamoate 106 Hyoscyamine Sulfate 142 HyperRHO S/D 142 Hypromellose (Gonioscopic) 142 Hypromellose (Ophth) 138,142,144,175 I Ibuprofen 7,142 Ibuprofen-Diphenhydramine Citrate 142 Imipramine HCl 22 Immune Support Vitamin C 142 Imodium A-D 142 inatal Advance 142 inatal Ultra 142 Incruse Ellipta 142 Indapamide 49 Indomethacin 7 Infergen 142 Influenza Virus Vaccine Split 111,136,137 Influenza Virus Vaccine Split Preservative Free 111,136,137 Influenza Virus Vaccine Split Quadrivalent 136,137 Influenza Virus Vaccine Tissue-Cultured Subunit 136 Influenza Virus Vaccine Types A & B Preservative Free 137 GE 197 LAST UPDATED 09/2015

198 Influenza Virus Vaccine Types A & B Surface Antigen 137 Infusion Set 143 Infusion Set 23" Comfort 142 Inject-Ease 143 Inject-Ease Automatic Injector 143 Injection Device 114,127,141,143,156,157,163 Injection Device for Insulin 114,141,156,157 Injection Device Needle-Free for Insulin 149,153 Insuflon 143 Insulin Aspart Protamine & Aspart (Human) 37 Insulin Detemir 36 Insulin Glargine 36 Insulin Glulisine 36 Insulin Isophane & Reg (Human) 36 Insulin Isophane (Human) 36,37 Insulin Pen Needle 71,72,74,75,76,77,78,79,80,82,83,84,85,86,87, 88,90,91,92,93,94,95,96,98,100,101,102,103 Insulin Regular (Human) 37 Insulin Syringe 83,84 Insulin Syringe/Needle 84 Insulin Syringe/Needle U ,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,8 7,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,10 3 Insulin Syringe/Needle U Insulin Syringes (Disposable) 73,85,89 Insupen Pen Needles 84 Insupen Sensitive 84 Insupen Ultrafin 84,85 Insyte Autoguard 14Gx1.75" 143 Insyte Autoguard 18Gx1.16" 143 Insyte Autoguard 20Gx1" 143 Insyte Autoguard 20Gx1.16" 143 Insyte Autoguard 22Gx1" 143 Insyte Autoguard 24Gx3/4" 143 Interferon Alfa-2B 31 Interferon alfacon Interferon Beta-1a 53 Interferon Beta-1b 53 InterLink Inject Site/Luer Loc 143 Intron A 31 Invokana 143 Ipratropium Bromide 106 Ipratropium Bromide (Nasal) 106 Ipratropium Bromide HFA 106 Irbesartan 40 Irbesartan-Hydrochlorothiazide 40 Iron 151 Iron (Ferrous Gluconate) 143 Iron Combinations 109 Iron Heme Polypeptide 167 Iron Polysaccharide Complex-Vit B12-Folic Acid 143 Iron Succinyl-Protein Complex 135 Iron Up 143 Isoniazid 26,143 Isoniazid-Rifampin w/ Pyrazinamide 26 Isopropanol 143 Isopropyl Alcohol 127,134,139,141,143,144,169,173 Isopropyl Alcohol (Skin Cleanser) 144 Isopropyl Alcohol Wipes 144 Isopropyl Palmitate 144 Isopto Tears 144 Isosorbide Dinitrate 50,144 Isosorbide Dinitrate ER 50 Isosorbide Mononitrate 50,51 IV Catheter 115,116,117,143,181 IV Sets/Tubing 110,111,112,117,136,140,141,142,143,14 4,145,147,153,154,170,171,174,180 J Janumet 35 Januvia 35,36 K K-Phos 144 K-Phos No Kala 144 Kameleon Lubricated 144 Kangaroo Burette Set 144 GE 198 LAST UPDATED 09/2015

199 Ketoconazole 24 Ketoconazole (Topical) 24 Ketone Blood Test 165 Ketoprofen 7 Ketorolac Tromethamine 7 Ketorolac Tromethamine (Ophth) 104 Ketostix 144 Ketotifen Fumarate (Ophth) 144 Kimono 144 Kimono Micro Thin 144 Kimono Micro Thin Plus 144 Kimono Plus 144 Kimono PS 144 Kimono PS Plus 144 Kimono Sensation 144 Kimono Sensation Plus 145 Kinray Insulin Syringe 85 Klor-Con M Kmart Valu Insulin Syringe 29G 85 Kmart Valu Insulin Syringe 30G 85 Knee Stabilizer/Elastic/Sm/Med 145 Konsyl 145 Konsyl-D 145 KP Prenatal Multivitamins 145 KPN Prenatal 145 Kroger Insulin Syringe 85 Kroger Pen Needles 85,86 L L606 Tubing 145 L609 Tubing 145 Labetalol HCl 44 Lactic Acid (Ammonium Lactate) 55 Lactic Acid w/ Vitamin E 145 Lactobacillus Acidophilus-Pectin 109,110,144 Lactobacillus Rhamnosus (GG) 127 Lactobacillus-Inulin 127 Lactulose 59 Lamivudine (HBV) 32 Lamotrigine 19 Lansoprazole 59,136 Lantus 36 Lantus SoloStar 36 Latanoprost 104 Leader Insulin Syringe 86 Leader Unifine Pentips 86 Leader Unifine Pentips Plus 86 Leflunomide 70 Lemongrass (Bulk) 111 Letrozole 27 Leucovorin Calcium 27 Leukeran 26 Leuprolide Acetate 68 Leuprolide Acetate (3 Month) 68 Leuprolide Acetate (4 Month) 68 Leuprolide Acetate (6 Month) 68 Leuprolide Acetate (CPP) 68 Levemir 36 Levetiracetam 18 Levobunolol HCl 104 Levofloxacin 17 Levonorgestrel 145 Levonorgestrel & Eth Estradiol 64 Levonorgestrel (Emergency OC) 145,163 Levonorgestrel-Eth Estradiol (Triphasic) 64 Levonorgestrel-Ethinyl Estradiol (91-Day) 64 Levothyroxine Sodium 67 Licide Treatment 145 Lidocaine HCl 11 Lidocaine HCl (Local Anesth.) 11 Lidocaine HCl (Mouth-Throat) 11 Lidocaine-Prilocaine 11 Life Pack Mens 146 LifeStyles Assorted Colors 146 LifeStyles Extra Strength 146 LifeStyles Form Fitting 146 LifeStyles Lubricated 146 LifeStyles Ribbed 146 LifeStyles Skyn Original 146 LifeStyles Spermicidal Lube 146 LifeStyles Studded 146 LifeStyles Ultra Sensitive 146 GE 199 LAST UPDATED 09/2015

200 LifeStyles Vibra-Ribbed 146 LifeStyles Xtra Pleasure 146 Light Mineral Oil-Mineral Oil 170 Lindane 28 Liquimat 146 Lisinopril 41,42 Lisinopril & Hydrochlorothiazide 41 Lite Touch Pen Needles 86 Litetouch Insulin Syringe 86,87 Litetouch Pen Needles 87 Lithium Carbonate 34 Little Remedies for Colds 146 Live Better Pen Needles 87 Lodrane D 146 LoHist-D 146 Lomustine 26 Longs Insulin Syringe 87 Loperamide HCl 58,142,146 Loratadine 125,146,147 Loratadine & Pseudoephedrine 146 Lorazepam 34 Lortab 10 Lortuss DM 147 Lortuss EX 147 Lortuss LQ 147 Losartan Potassium 40 Losartan Potassium & Hydrochlorothiazide 40 Lovastatin 49 Loxapine Succinate 29 LTXF Prim CNV Pin Microdrip 147 LTXF Prim IV Set/CNVT Pin 147 LTXF Secondary/CNV Pin/32INC 147 Lufyllin 107 Lupron Depot 68 Lupron Depot-Ped 68 M M-End DMX 147 M-END MAX D 147 M-End PE 147 M-Vit 147 M2 Potassium 147 Macrodantin 13 Mag-Al 147 Mag-Tab SR 147 Magellan Insulin Safety Syr 87,88 Maginex 147 Maginex DS 147 Magnesium 147,148 Magnesium Aspartate Hydrochloride 147 Magnesium Carbonate 147 Magnesium Carbonate Heavy 147 Magnesium Chloride 148 Magnesium Citrate 148 Magnesium Citrate (Mg Supplement) 148 Magnesium Gluconate 148 Magnesium Lactate 147 Magnesium Oxide 148,180 Magnesium Oxide (Mg Supplement) 148 Magnesium Oxide-Asafoetida 129 Magnesium Sulfate 66 Magonate 148 Malathion 28 Mar-cof BP 148 Matulane 26 Maximin Pack 149 Maxx 149 Maxx Plus 149 Meclizine HCl 23,149 Meclofenamate Sodium 8 Medi-Jector Vision 149 Medi-Jector Vision Adapters 149 Medic Insulin Syringe 88 Medicine Shoppe Pen Needles 88 Medroxyprogesterone Acetate 66,67 Medroxyprogesterone Acetate (Contraceptive) 66 MedSaver Syringe 149 Mefloquine HCl 28 Mega Biotin 149 Mega MultiVitamin 149 Megestrol Acetate 67 Meijer Pen Needles 88 GE 200 LAST UPDATED 09/2015

201 Meloxicam 8 Menest 27 Meperidine HCl 149 Mercaptopurine 27 Mesalamine 70,128 Metamucil 149 Metamucil MultiHealth Fiber 149 Metamucil Smooth Texture 149 Metaproterenol Sulfate 107,149 Metformin HCl 36 Methadone HCl 9,149 Methadose 149 Methadose Sugar-Free 149 Methanol 150 Methazolamide 47 Methenamine Hippurate 13 Methenamine Mandelate 13 Methimazole 68 Methocarbamol 108 Methotrexate Sodium 69 Methyclothiazide 49 Methyl Alcohol 150 Methylcellulose (Laxative) 150 Methyldopa 39 Methylergonovine Maleate 88 Methylphenidate HCl 52,53 Methylprednisolone 61,62 Metipranolol 104 Metoclopramide HCl 58 Metolazone 49 Metoprolol & Hydrochlorothiazide 44 Metoprolol Succinate 44 Metoprolol Tartrate 44 Metronidazole 13 Metronidazole (Topical) 13 Metronidazole Vaginal 13 MH Macular Health 150 Miconazole 3 24 Miconazole Nitrate (Topical) 114,138,150 Miconazole Nitrate Vaginal 24,150 Midodrine HCl 39 Minocycline HCl 18 Minoxidil 50 Miranel AF 150 Mirtazapine 20 Misoprostol 59 Moexipril HCl 42 Mometasone Furoate 55 Mometasone Furoate-Formoterol Fumarate Dihydrate 105 Monoject Insulin Syringe 88,89 Monoject LifeShield Syringe 150 Monoject Magellan Syringe 150 Monoject Ultra Comfort Syringe 89 Montelukast Sodium 106 Moore Mono Insulin Syringe 89 Morphine Sulfate 9,10 MS Insulin Syringe 89,90 Mucinex Child MS Day-Night Cld 150 Mucinex Cough For Kids 150 Mucinex D 150 Mucinex Fast-Max Congest Cough 150 Mucinex Fast-Max Day/Night 150 Mucinex For Kids 151 Mucinex Maximum Strength 151 Mucinex Sinus-Max Day/Night 151 Multi For Her 151 Multi Prenatal 151 Multiple Vitamin 109 Multiple Vitamins w/ Iron 109 Multiple Vitamins w/ Minerals 109,112,119,120,126,127,128,130,133,134,13 8,142,146,149,150,151,152,160,163,165,166,167,169, 172,175,177,180,182 Multiple Vitamins w/ Minerals & Calcium-Folic Acid 137,177 Multiple Vitamins w/ Minerals & Folic Acid 130,175 Mupirocin 13 Mupirocin Calcium (Topical) 13 Mycophenolate Mofetil 68,69 MyKidz Iron Myleran 151 GE 201 LAST UPDATED 09/2015

202 Mynatal 151 Mynatal Advance 151 Mynatal Plus 151 Mynatal-Z 151 Mynate 90 Plus 151 N Nabumetone 8 Nadolol 44 Naloxone HCl 11 NanoVM t/f 151 Naphazoline HCl 151 Naphazoline w/ Pheniramine 151 Naphazoline-Glycerin 151 Naphazoline-Hypromellose 151 Naphazoline-Polyethylene Glycol Naprelan 152 Naproxen 8 Naproxen Sodium 8,152 Nasacort Allergy 24HR 105 Nasal Decongestant 152 NasOpen 152 NasOpen PE 152 Nat-Rul Prenatal Vitamins 152 Natal-V RX 152 Natalvit 152 Nateglinide 36 Natrul Natural Senna Laxative 152 Nature-Throid 152,153 Nebivolol HCl 43,44 Necon 1/50 (28) 153 Necon 10/11 (28) 64 Needle-Free Insulin Syringe A 153 Needle-Free Insulin Syringe B 153 Needle-Free Insulin Syringe C 153 Needle-Free Syringe Kit A 153 Needle-Free Syringe Kit B 153 Needle-Free Syringe Kit C 153 Neomycin Sulfate 12 Neomycin-Bacitracin Zn-Polymyxin 13 Neomycin-Bacitracin-Polymyxin 109 Neomycin-Bacitracin-Polymyxin w/ Lidocaine 109 Neomycin-Polymy-Dexameth 103 Neomycin-Polymyxin-Gramicidin 13 Neomycin-Polymyxin-HC 13 Neomycin-Polymyxin-HC (Ophth) 13 Neomycin-Polymyxin-HC (Otic) 104 Neosporin Essentials Trial Pk 153 NeoTuss Plus 153 NeoTuss-D 153 Neria 29G Infusion Set 10mm 153 Neria 29G Infusion Set 6mm 153 Neria 29G Infusion Set 8mm 153 Neria Multi 27G 2x10mm 153 Neria Multi 27G 3x10mm 153 Neria Multi 27G 4x12mm 153 Neria Soft 25G Infusion 13mm 153 Neria Soft 25G Infusion 17mm 154 Neupogen 38 Neutrogena Clear Pore 154 Nexium 24HR 154 Niacin 154 Niacin (Antihyperlipidemic) 50 Niacin ER 154 Niacinamide 154 Niacor 50 Nicardipine HCl 46 Nicoderm CQ 154 Nicorette 154,155 Nicorette Mini 155 Nicorette Refill 155 Nicorette Starter Kit 155 Nicotine 12,154,155,156 Nicotine Mini 155 Nicotine Polacrilex 154,155,156 Nicotrol 156 Nicotrol NS 12 Nifedipine 46,47 Nimodipine 47 Nit Remover 109,171 Nite-Time Cold/Flu Relief 156 GE 202 LAST UPDATED 09/2015

203 Nitro-Bid 51 Nitrofurantoin Macrocrystal 13 Nitrofurantoin Monohyd Macro 13 Nitroglycerin 51,156 Nitrostat 51 Nonoxynol Nordipen 5 Injection Device 156 Nordipen Delivery System 156 Norel AD 156 Norel CS 156 Norethin Acet & Estrad-Fe 65 Norethindrone & Eth Estradiol 64 Norethindrone & Mestranol 153 Norethindrone (Contraceptive) 67 Norethindrone Acet & Eth Estra 64,65 Norethindrone Acetate 67 Norethindrone Acetate-Ethinyl Estradiol 65 Norethindrone-Eth Estradiol (Biphasic) 64 Norethindrone-Eth Estradiol (Triphasic) 65 Norgestimate-Ethinyl Estradiol 65 Norgestimate-Ethinyl Estradiol (Triphasic) 65 Norgestrel & Ethinyl Estradiol 65 Norpace CR 42 Nortriptyline HCl 22,23 NovaFerrum Pediatric Drops 156 NovoFine 90 NovoFine Autocover 90 NovoFine Plus 90 NovoLIN 70/30 36 NovoLIN 70/30 ReliOn 36 NovoLIN N 37 NovoLIN N ReliOn 36 NovoLIN R 37 NovoLIN R ReliOn 37 NovoLOG Mix 70/30 37 Novopen Novopen 3 Penmate 156 NovoPen Echo 157 Novopen Jr (Green) 157 Novopen Jr (Yellow) 157 NovoTwist 90 Nulytely with Flavor Packs 59 Nutritional Supplements 126 Nystatin 24,109 Nystatin (Mouth-Throat) 24 Nystatin (Topical) 24 Nystatin-Triamcinolone 24 O O-Cal FA 157 O-Cal Prenatal 157 Obstetrix DHA 157 Obstetrix EC 157 Obtrex 157 Obtrex DHA 157 OC8 157 Ofloxacin 17 Ofloxacin (Ophth) 17 Ofloxacin (Otic) 17 Omeprazole 59,60,136,157 Omeprazole Magnesium 167 Omeprazole+Syrspend SF Alka 157 Omeprazole-Sodium Bicarbonate 157 Omniflex Diaphragm 157 Omnitrope Pen 10 Inj Device 157 Omnitrope Pen 5 Inj Device 157 Ondansetron 23 Ondansetron HCl 23 One-A-Day Womens Prenatal 157 OneTouch Ultra Control 157 Opium Tincture (Paregoric) 157 Options Gynol II Contraceptive 158 Ora-Blend 158 Ora-Blend SF 158 Ora-film 158 Ora-Plus 158 Ora-Sweet 158 Ora-Sweet SF 158 Oracit 158 Oral Electrolytes 123,133 Oral Mix 158 Oral Mix SF 158 GE 203 LAST UPDATED 09/2015

204 Oral Suspend 158 Oral Syrup 158 Oral Syrup SF 158 Oral Vehicles 125,136,140,158,160,175,181 Orazinc 158 Ortho Diaphragm All-Flex 158,159 Ortho Diaphragm Coil 159 Ortho Diaphragm Flat 159,160 Oseltamivir Phosphate 32,176 Osteo-Poretical 160 Ovide 28 Oxaprozin 8 Oxazepam 34 Oxcarbazepine 20 Oxybutynin 60 Oxybutynin Chloride 60 Oxycodone HCl 10,160 OxyCODONE HCl 10,160 Oxycodone w/ Acetaminophen 11,160 Oxycodone-Aspirin 11 Oxymetazoline HCl 160 Oxytrol 60 Oxytrol For Women 60 Oyster Shell Calcium/D 160 P Mens Vitapak 160 Prenatal Formula 160 Womens Vitapak 160 BA 160 Palivizumab 70 Pancreaze 57 Pancrelipase (Lip-Prot-Amyl) 57 Pancrelipase (Lipase-Protease-Amylase) 56,57 Pantoprazole Sodium 60 Para-Aminobenzoic Acid (BA) 160 Paregoric 157 Paroxetine HCl 21 Parva-Cal 160 PC Unifine Pentips 90 PCCA Sweet-SF 160 PCCA Syrup Vehicle 160 PCCA-Plus 160 Pecgen DMX 161 Pedia-Lax 161 Pediatric Multiple Vitamin w/ C 109 Pediatric Multiple Vitamin w/ C & FA 109 Pediatric Multiple Vitamin w/ Extra C & FA 109 Pediatric Multiple Vitamin w/ Minerals 151,174 Pediatric Multiple Vitamin w/ Minerals & C 109,126 Pediatric Multiple Vitamins 109 Pediatric Multiple Vitamins w/ Iron 109,110,130,141 Pediatric Vitamins ACD w/ Fluoride 110 PEG 3350-KCl-Sod Bicarb-Sod Chloride-Sod Sulfate 59 PEG 3350-Potassium Chloride-Sod Bicarbonate-Sod Chloride 59 Peg-Intron 31 Peg-Intron Redipen 31 Peg-Intron Redipen Pak 4 32 Peginterferon alfa-2b 31,32 PegIntron 32 Pen Needles 91 Pen Needles 1/2" 90 Pen Needles 3/16" 90 Pen Needles 5/16" 90 Penicillin G Benzathine & Procaine 16 Penicillin V Potassium 16 Pentoxifylline 47 Pepcid AC Maximum Strength 161 Peppermint Spirit 140,161 Perfect Iron 161 Permethrin 28,161 Permethrin & Pyrethrins-Piperonyl Butoxide 161 Perphenazine 29 Perry Prenatal 161 Pertzye 57 Phenazopyridine HCl 161 Phenelzine Sulfate 21 Pheniramine-Phenylephrine- Acetaminophen 136,176,177,182 Phenobarbital 18 GE 204 LAST UPDATED 09/2015

205 PHENobarbital 18 Phenyleph-Promethazine w/ Cod 163 Phenylephrine w/ Acetaminophen 161,180 Phenylephrine w/ DM- GG 118,120,128,133,138,150,153,161,162,171,180 Phenylephrine-Acetaminophen-Guaifenesin 123,162 Phenylephrine-Aspirin 112 Phenylephrine-Brompheniramine w/ Codeine 147,163 Phenylephrine-Brompheniramine-Chlophedianol 177 Phenylephrine-Brompheniramine-DM 162 Phenylephrine-Chlophedianol-Guaifenesin 124,181 Phenylephrine-Chlorphen- DM 120,153,156,162,176,178,180 Phenylephrine-Chlorpheniramine w/ Codeine 122 Phenylephrine-Chlorpheniramine-Chlophedianol 123 Phenylephrine-Chlorpheniramine-DM w/ AP 112,160,161 Phenylephrine-Chlorpheniramine-DM-Aspirin 112 Phenylephrine-Dexbrompheniramine- Chlophedianol 124 Phenylephrine-Dexbrompheniramine- Dextromethorphan 118,138,175 Phenylephrine-Dexchlorpheniramine-Codeine 167,180 Phenylephrine-Diphenhydramine- Dextromethorphan 177 Phenylephrine-Diphenhydramine-DM w/ AP 177 Phenylephrine-Diphenhydramine-DM-GG 171 Phenylephrine-Diphenhydramine-DM-Guaifenesin- AP 150,161,171 Phenylephrine-Diphenhydramine-GG w/ AP 151 Phenylephrine-DM 162,177 Phenylephrine-DM-GG w/ AP 162 Phenylephrine-Doxylamine-Dextromethorphan- Acetaminophen 156,160,162 Phenylephrine-Doxylamine-Dextromethorphan- Aspirin 112 Phenylephrine-Guaifenesin 132,133,162,175,177 Phenylephrine-Pyrilamine-Chlophedianol 167 Phenylephrine-Pyrilamine-DM 126 Phenylephrine-Thonzylamine-Chlophedianol 180 Phenylephrine-Thonzylamine-Dextromethorphan 163 Phenylephrine-Triprolidine-Dextromethorphan 140 Phenylhistine DH 163 Phenytoin 20 Phenytoin Sodium Extended 20 Phlexy-Vits 163 Phytonadione 163 Pilocarpine HCl (Oral) 53 Pindolol 44 Pine Tar 163 Pine Tar (Bulk) 163 Pioglitazone HCl 36 Pioglitazone HCl-Metformin HCl 36 Piroxicam 8 Plan B 163 Plan B One-Step 163 Plastic Adapter 163 PNV Fe Fum/Docusate/Folic Acid 163 PNV Folic Acid + Iron 163 PNV Prenatal Plus Multivitamin 163 PNV Tabs PNV-VP-U 163 Podofilox 55 Poly Hist Forte 163 Poly-Hist DM 163 Poly-Hist PD 163 Poly-Tussin 163 Poly-Tussin AC 163 Poly-Tussin D 163 Poly-Vent DM 164 Poly-Vent IR 164 Polyethylene Glycol ,164 Polyethylene Glycol 3350 (Bulk) 164 Polyethylene Glycol 400 (Ophth) 119 Polyethylene Glycol-Propylene Glycol (Ophth) 164 Polymyxin B-Trimethoprim 13 Polysaccharide Iron Complex 143,156 Polysorbate ,174 Polysorbate Polysorbate Polysorbate Polyvinyl Alcohol-Povidone (Ophth) 164 GE 205 LAST UPDATED 09/2015

206 Pot & Sod Citrates w/citric Ac 128 Pot Phosphate Monobasic w/ Sod Phosphate Dibasic & Monobasic 164 Potaba 164 Potassium & Sodium Acid Phosphates 144 Potassium Aminobenzoate 147,164 Potassium Bicarb & Chloride 164 Potassium Bicarbonate 164 Potassium Chloride 108,164 Potassium Chloride ER 108 Potassium Chloride Microencapsulated Crystals CR 108 Potassium Citrate-Citric Acid 164 Potassium Phosphate Monobasic 144 Povidone-Iodine 164 Povidone-Iodine Vaginal 164 PR Natal PR Natal Pramipexole Dihydrochloride 28 Pramoxine-Calamine 164 Pramoxine-Phenylephrine-Glycerin-Petrolatum 164 Prasugrel HCl 39 Pravastatin Sodium 49,50 Prazosin HCl 40 Pre-Natal Formula 165 Precision Sure-Dose Syringe 91 Precision SureDose Plus Syr 91 Precision Xtra Ketone 165 Prednicarbate 55 Prednisolone 62 Prednisolone Acetate (Ophth) 104 Prednisolone Sodium Phosphate 62 Prednisone 62 PredniSONE 62 PredniSONE (Pak) 62 Preferred Plus Insulin Syringe 91 Preferred Plus Unifine Pentips 91,92 Premarin 65,66 Premium Condoms Lubricated 165 Premium Packets 165 Premphase 66 Prempro 66 PrenaPlus 165 PreNata 165 Prenatabs FA 165 Prenatabs Rx 165 Prenatal 166 Prenatal Prenatal AD 165 Prenatal Complete 165 Prenatal Formula 165 PreNatal Formula 165 Prenatal Formula A-Free 165 Prenatal Low Iron 165 Prenatal Multi +DHA 165 Prenatal Multivit-Min w/fe-fa 145,151,165,166 Prenatal Multivitamin + DHA 166 Prenatal Multivitamins & Minerals w/ Folic Acid-Fish Oil 128 Prenatal MV & Min w/fe Bisglyc-Fe Prot Succ-FA-CA- Omega 3 126,164,172,178 Prenatal MV & Min w/fe Carbonyl-FA-DHA 120,174 Prenatal MV & Min w/fe Fumarate-FA- DHA 123,128,133,166,172,177,183 Prenatal One Daily 166 Prenatal Plus 166 Prenatal Plus Iron 166 Prenatal Vit w/ Docusate-Fe Fumarate-Folic Acid 151,163,165,172 Prenatal Vit w/ Docusate-Iron Carbonyl-Folic Acid 114,142,151,157,165,177,178,182 Prenatal Vit w/ Fe Bisglycinate Chelate-Folic Acid 182 Prenatal Vit w/ Fe Bisglycinate-Folic Acid-Omega 3 Fatty Acd 140 Prenatal Vit w/ Ferrous Fumarate-FA-Fish Oil 166,184 Prenatal Vit w/ Ferrous Fumarate-FA-Omega 3 Fatty Acids 139,141,157,165,170,173 Prenatal Vit w/ Ferrous Fumarate-Folic Acid125,126,128,134,140,141,145,147,151,152,157,16 1,163,165,166,169,170,171,172,173,174,176,177,178, 181,182 GE 206 LAST UPDATED 09/2015

207 Prenatal Vit w/ Iron Carbonyl-Folic Acid 152,163,165,166,182 Prenatal Vit w/ Selenium-Fe Fumarate-Folic Acid 160,182 Prenatal Vitamins 166 PreNatal Vitamins Plus 166 Prenatal Vitamins w/ Ferrous Succinate-Folic Acid 126 Prenatal w/fe Carbonyl-FA-DSS-Omega 3 Fatty Acids 157 Prenatal without A Vit w/ Fe Fum-Iron Polysacch Complex -FA 169 Prenatal without A Vit w/ Fe Fumarate-Folic Acid 163,165,166,178 Prenatal without A Vit w/ Iron Carbonyl-Folic Acid 114 Prenatal without A w/ Fe Bisglycinate-FA-DHA 126 Prenatal without Vit A w/ Iron Carbonyl-Folic Acid & Vit B6 176 Prenatal without Vit A w/ Iron Polysaccharide Complex- FA 134,167 Prenatal+DHA 166 Prenatal-U 166 Prenatal/Iron 166 Prenatal/Omega-3/FA/Iron 166 PrePLUS 166 Prescriptive Formulas Mens 166 Prescriptive Formulas Womens 166 PreTAB 166 Pretz 166 PriLOSEC OTC 167 Primaquine Phosphate 28 Primidone 19 Primsol 167 Pro-Chlo 167 Pro-Clear AC 167 Pro-Red AC 167 Probenecid 25 Procarbazine HCl 26 Prochlorperazine 29 Prochlorperazine Maleate 29 Procrit 38,39 Prodigy Insulin Syringe 92 ProFe Forte 167 Proferrin ES 167 Promethazine & Phenylephrine 107 Promethazine HCl 23 Promethazine w/codeine 167 Promethazine-DM 167 Propafenone HCl 43 Propantheline Bromide 167 Proparacaine HCl 103 Propranolol & Hydrochlorothiazide 45 Propranolol HCl 44,45,167 Propranolol-HCTZ 45 Propylene Glycol (Ophth) 175 Propylene Glycol-Glycerin 167 Propylthiouracil 68 Protect Plus 167 Protect Plus NF 167 Pseudoeph-Chlorphen w/ Cod 163,178,184,185 Pseudoeph-CPM-DM w/ap 167 Pseudoephed-Bromphen-DM 167 Pseudoephed-Doxyl-DM w/ap 167 Pseudoephedrine HCl 152,168 Pseudoephedrine w/ Codeine 126 Pseudoephedrine w/ Codeine-GG147,168,178,184,185 Pseudoephedrine w/ DM- GG 118,119,123,128,164,168,176,178,180 Pseudoephedrine-Acetaminophen 168 Pseudoephedrine-Acetaminophen- Dextromethorphan 168 Pseudoephedrine-Acetaminophen-Guaifenesin 174 Pseudoephedrine-Brompheniramine-Codeine 148,168 Pseudoephedrine-Chlophedianol- Guaifenesin 123,168,181 Pseudoephedrine-Chlorcyclizine-Chlophedianol 118 Pseudoephedrine-Chlorphen-DM 167,168,170 Pseudoephedrine-Dexbrompheniramine- Chophedianol 124 Pseudoephedrine-Dexbrompheniramine-Codeine 147 Pseudoephedrine-Dexbrompheniramine- Dextromethorphan 147 GE 207 LAST UPDATED 09/2015

208 Chlophedianol 168 Pseudoephedrine-Dexchlorpheniramine- Pseudoephedrine-Dexchlorpheniramine- Dextromethorphan 168 Pseudoephedrine-DM-GG w/ AP 168,176 Pseudoephedrine-Doxylamine-Dextromethorphan 147 Pseudoephedrine-Guaifenesin 133,150,164,168,170 Pseudoephedrine-Ibuprofen 111,168 Pseudoephedrine-Naproxen Sodium 168 Psyllium 127,141,145,149,168,169 Pulmozyme 107 PureFe OB Plus 169 PX Extra Short Pen Needles 92 PX Insulin Syringe 92 PX Mini Pen Needles 92 PX Pen Needle 92 Pyrantel Pamoate 169 Pyrazinamide 26 Pyrethrins-Piperonyl Butoxide 145,169,170 Pyrethrins-Piperonyl Butoxide-Permethrin-Nit Remover 169 Pyridoxine HCl 114,169 Pyrilamine Maleate-Phenylephrine HCl Tannate 169 Pyrilamine-Phenylephrine 169,171 Pyrimethamine 28 Q QC Insulin Syringe 92 QC Isopropyl Rubbing Alcohol 169 QC Pen Needles 92 QC Prenatal 169 QC Unifine Pentips 93 Quetiapine Fumarate 30 Quinapril HCl 42 Quinapril-Hydrochlorothiazide 42 Quinidine Gluconate 43 Quinidine Sulfate 43 QuiNIDine Sulfate 43 Quinine Sulfate 28 R RA Acne Maximum 169 RA Calcium-Boron 169 RA Ear Wax Cleansing System 169 RA Essence-C 169 RA Ethyl Alcohol 169 RA Insulin Syringe 93 RA One Daily 170 RA Pen Needles 93 RA Prenatal 170 RA Prenatal Formula 170 Ramipril 42 Ranitidine HCl 58,59 Rapid-Fill Tube Set 170 Reality Latex/Ultra Textured 170 Reality Latex/Ultra Thin 170 Refresh Optive Advanced 170 Relenza Diskhaler 32 Reli-On Insulin Syringe 93 ReliOn Insulin Syringe 93 ReliOn Mini Pen Needles 93 ReliOn Pen Needles 94 ReliOn Short Pen Needles 94 Renagel 170 Rescon DM 170 Resorcinol-Sulfur 111,170 Respaire Retaine MGD 170 Rezamid 170 Rho D Immune Globulin (Human) 142,170 RhoGAM Ultra-Filtered Plus 170 Ribavirin (Hepatitis C) 32 Riboflavin 170 RID Essential Lice Elimination 170 Rifampin 26 Rifater 26 Right Step Prenatal 171 Rimantadine Hydrochloride 32 Risperidone 30 Rivaroxaban 38 GE 208 LAST UPDATED 09/2015

209 Robitussin Child Cough/Cold CF 171 Robitussin Child Cough/Cold LA 171 Robitussin Day/Night Value Pak 171 Robitussin Nighttime Cough DM 171 Robitussin Pk Cold Day/Nght DM 171 Robitussin Pk Cold Day/Nght MS 171 Ru-Hist D 171 Ru-Hist-D 171 Rymed 171 S Safe Tussin PM 171 Safelet IV Catheter 171 SafeSnap Insulin Syringe 94 Safety-Glide Syringe 94 Salicylic Acid 171 Salicylic Acid & Sulfur 171 Salicylic Acid in Alcohol 169 Saline 171 Salmeterol Xinafoate 107 Salsalate 171 Santyl 55 SB Insulin Syringe 94 Scalp Vein Set 171 Schnucks Insulin Syringe 94 SchoolTime Shampoo 171 Scot-Tussin Senior 171 Se-Natal Selenium Sulfide 55 Senna 127,152,172 Senna Leaves 172 Sennosides 111,119,134,172 Sensipar 67 Serevent Diskus 107 Sertraline HCl 22 SetonET 172 Sevelamer Carbonate 172 Sevelamer HCl 170 SfRowasa 70 Shopko Unifine Pentips 94,95 Silver Sulfadiazine 13 Simethicone 118,138,172 Similac Prenatal Early Shield 172 Simvastatin 50 Sinadrin PE Complete Sinus Rel 172 Sitagliptin Phosphate 35,36 Sitagliptin-Metformin HCl 35 Skin Beauty & Wellness 172 SM Camphor Spirit 172 SM Ethyl Alcohol (Rubbing) 172 SM Insulin Syringe 95 SM Isopropyl Alcohol 173 SM One Daily Prenatal 173 SM Prenatal Vitamins 173 Sodium Ascorbate 173 Sodium Bicarb-Citric Acid w/ Simethicone 132 Sodium Bicarbonate 173 Sodium Bicarbonate (Antacid) 173 Sodium Bicarbonate (Bulk) 173 Sodium Bicarbonate-Citric Acid 112 Sodium Bicarbonate-Sodium Citrate 125 Sodium Chloride 108,173 Sodium Chloride (GU Irrigant) 95 Sodium Chloride (Inhalant) 173 Sodium Chloride Flush 108 Sodium Chloride Hypertonic 173 Sodium Citrate & Citric Acid 158,173 Sodium Fluoride 173 Sodium Fluoride (Dental) 173 Sodium Polystyrene Sulfonate 108 Sodium Silicate 140,173,174 Soft Lens Products 110 Solution Administration Set 174 Solution Transfer Device 174 Sotalol HCl 43 Sotalol HCl (AFIB/AFL) 43 SourceCF Pediatric 174 Soybean (Bulk) 139 Soybean Protein (Bulk) 139 Spacer/Aerosol-Holding Chambers 132 Span Spatone pur-absorb Iron 174 GE 209 LAST UPDATED 09/2015

210 Spironolactone 48 Spironolactone & Hydrochlorothiazide 48 Stahist AD 174 Stannous Fluoride 174 Starch (topical) 174 Statuss Green 174 Step Sterile Lubricant 174 Stuart One 174 Stuart Prenatal 174 Subcutaneous Infusion Set 175 Subcutaneous Soft Cannula 143 Sucralfate 59 Sudafed PE Day & Night 174 Sudafed Triple Action 174 Sulfacetamide Sod-Prednisolone 17 Sulfacetamide Sodium (Acne) 56 Sulfacetamide Sodium w/ Sulfur 174,175 Sulfacetamide Sodium-Sulfur in Urea Vehicle 120,175 Sulfadiazine 17 SulfADIAZINE 17 Sulfamethoxazole-Trimethoprim 17 Sulfasalazine 70 Sulfur 146,175 Sulindac 8 Sumatriptan Succinate 25 Supervite EC 175 Support 175 Supress A Pediatric 175 Supress DM Pediatric 175 Supress-PE Pediatric 175 Sure Comfort Insulin Syringe 95,96 Sure Comfort Pen Needles 96 Sure-Fine Pen Needles 96 Sure-Ject Insulin Syringe 96,97 Sure-T Infusion Set 18" 175 Sure-T Infusion Set 23" 175 Sure-T Infusion Set 32" 175 Surgical Dressing 56 Symbicort 105 Synagex 175 Synagis 70 SynaTek 175 Syringe Luer Slip 175 Syringe/Needle (Disp) 1 ML 115,116,117,132,149,150,175,176,180,181 Syrpalta 175 Syrpalta (Red) 175 SyrSpend SF 175 Systane Balance 175 Systane Overnight Therapy 175 T Tabloid 27 Tacrolimus 69 Tamiflu 32,176 Tamoxifen Citrate 26,27 Tanzeum 176 Taron-Bc 176 Temazepam 34 Terazosin HCl 60 Terbinafine HCl 24 Terbinafine HCl (Topical) 176 Terbutaline Sulfate 107 Terconazole Vaginal 25 Terpin Hydrate 176 Terpin Hydrate Monohydrate 176 Terumo Insulin Syringe 97 Terumo SurGuard Insulin Syr 97 Terumo SurGuard2 Syringe 176 Testosterone Cypionate 62 Tetrahydrozoline HCl (Ophth) 176 Tetrahydrozoline w/ Polyethylene Glycol 176 Tetrahydrozoline w/ Zinc Sulfate 176 TGQ 15DM/5PEH/2CPM 176 TGQ 30PSE/150GFN/15DM 176 TH Prenatal Vitamins 176 Theo Theophylline 107,176 Theraflu Cold & Sore Throat 176 Theraflu Flu & Sore Throat 176 Theraflu Max-D Cold & Flu 176 GE 210 LAST UPDATED 09/2015

211 Theraflu Severe Cold & Cough 177 Theraflu Severe Cold Daytime 177 Theraflu Sinus & Cold 177 TheraNatal Complete 177 TheraNatal Core Nutrition 177 TheraNatal Lactation Support 177 TheraNatal Plus 177 Therapeutic Liquid 177 Thiamine HCl 177 Thiamine Mononitrate 115 Thinpro Insulin Syringe 97,98 Thioguanine 27 Thiothixene 29,30 Thonzylamine-Chlophedianol 163 Thonzylamine-Phenylephrine 152 Thyroid 113,152,153,183,184 Ticlopidine HCl 39 Timolol Maleate 25 Timolol Maleate (Ophth) 104 Tizanidine HCl 31 TL G-Fol OS 177 Tobramycin (Ophth) 12 Tobramycin-Dexamethasone 104 Todays Health Mini Pen Needles 98 Todays Health Pen Needles 98 Todays Health Short Pen Needle 98 Tolterodine Tartrate 60 TopCare Clickfine Pen Needles 98 TopCare Ultra Comfort Ins Syr 98,99 Topiramate 19,20 Torsemide 48 Tramadol HCl 11 Trandolapril 42 Tranylcypromine Sulfate 21 Trazodone HCl 20,21 Trecator 26 Tretinoin 56 Tretinoin (Chemotherapy) 27 Trexbrom 177 Triactin Chest Congestion 177 TriAdvance 177 Triamcinolone Acetonide 56 Triamcinolone Acetonide (Mouth) 53 Triamcinolone Acetonide (Nasal) 105 Triamcinolone Acetonide (Topical) 56 Triaminic Chest/Nasal Congest 177 Triaminic Cold/Allergy Child 177 Triaminic Cold/Cough 177 Triaminic Cold/Cough Day Time 177 Triaminic Cough & Sore Throat 177 Triaminic Cough/Runny Nose 178 Triaminic Cough/Sore Throat 178 Triaminic Night Time Cold/Cgh 178 Triamterene & Hydrochlorothiazide 48 Triamterene-HCTZ 48 Triazolam 178 TriCare 178 Tricode AR 178 Tricode GF 178 Trifluoperazine HCl 30 Trifluridine 33 Trigofen DM 178 Trimethobenzamide HCl 23 Trimethoprim 13 Trimethoprim HCl 167 Trimipramine Maleate 23 Trinatal GT 178 Trinatal Rx Trinatal Ultra 178 Triprolidine & Pseudoephedrine 178 Triprolidine-Phenylephrine 141 Trispec DMX 178 Trispec PSE 178 Trispec PSE Pediatric 178 Triveen-Duo DHA 178 Triveen-U 178 Trojan Magnum Warm Sensations 178 Trojan Naturalamb/Spermicide 179 Trojan Supras Spermicidal 179 Trojan Twisted Pleasure 179 Tropicamide 179 TRUEplus Insulin Syringe 99 GE 211 LAST UPDATED 09/2015

212 Trustex Color Condoms + Lube 179 Trustex Lub/Ribbed/Studded 179 Trustex Lub/Spermicide Ex St 179 Trustex Lub/Spermicide XL 179 Trustex Lubricated 179 Trustex Lubricated Ex Large 179 Trustex Lubricated Extra St 179 Trustex Lubricated/Spermicide 179 Trustex Natural Condoms + Lube 179 Trustex Non-Lubricated 179 Trustex Ria Lub/Spermicide 179 Trustex Ria Lubricated 179 Trustex Ria Non-Lubricated 179 Trustex-Nonoxynol-9/Rib/Stud 179 Trypsin w/ Castor Oil & Peruvian Balsam 179 Tudorza Pressair 106 Turpentine 179 Tusicof 180 Tusnel 180 Tusnel Pediatric 180 Tussafex-A 180 Twinject 107 Tylenol Childrens Cold/Stuffy 180 Tylenol Childrens Plus Cld/Cgh 180 U UltiCare Insulin Safety Syr 99 UltiCare Insulin Syringe 99,100 UltiCare Micro Pen Needles 100 UltiCare Mini Pen Needles 100 UltiCare Pen Needles 100 UltiCare Short Pen Needles 100 UltiCare Syringe 180 Ultilet Insulin Syringe 100 Ultilet Insulin Syringe Short 100,101 Ultilet Pen Needle 101 Ultra Comfort Insulin Syringe 101 Ultra Mens Pack 180 Ultra Womens Pack 180 Ultra-Comfort Insulin Syringe 101 Ultra-Thin II Ins Syr Short 101 Ultresa 57 Umeclidinium Bromide 142 Umeclidinium-Vilanterol 106 Undecylenic Acid 180 Undecylenic Acid (Bulk) 180 Unifine Pentips 101,102 Unifine Pentips Plus 102 UPCal D 180 Urea 180 Uro-Mag 180 Ursodiol 58 V V-R Mono Insulin Syringe 102 Vacutainer Tubing 180 Valproate Sodium 19 Valproic Acid 25 Value Health Insulin Syringe 102 ValuMark Pen Needles 102 Vanacof APE 180 Vanacof CD 180 Vanacof DM 180 Vanacof G 180 Vanacof GPE 181 Vanacof Vanatab DX 181 Vancomycin HCl 13,14,136 VanishPoint 18Gx1-1/4" FEP 181 VanishPoint 18Gx1-1/4" PUR 181 VanishPoint 20Gx1-1/4" FEP 181 VanishPoint 20Gx1-1/4" PUR 181 VanishPoint 22Gx1" FEP 181 VanishPoint 22Gx1" PUR 181 VanishPoint 24Gx3/4" FEP 181 VanishPoint 24Gx3/4" PUR 181 VanishPoint Insulin Syringe 102 VanishPoint Syringe 181 Vaporizers 183 Varenicline Tartrate 11,12 Venatal-FA 181 Venlafaxine HCl 22 GE 212 LAST UPDATED 09/2015

213 Ventolin HFA 107 Verapamil HCl 47 VersaFree 181 VersaPlus 181 Vibramycin 181 Vicks Nature Fusion Cold & Flu 181 Vicks Nature Fusion Congest 181 Vicks NyQuil Childrens Cld/Cgh 181 Vicks NyQuil Cold & Flu Night 181 Vida Mia Unifine Pentips 102,103 Vinate GT 182 Vinate II 182 Vinate M 182 Vinate One 182 Vinate Ultra 182 Viokace 57 Virt-Advance 182 Virt-Vite GT 182 Vitafol-OB 182 Vitafol-PN 182 Vitaline Buffered Zinc VitaMent 182 Vitamin C (Calcium Ascorbate) 182 Vitamin C-Electrolytes 182 Vitamin E 182 Vitamins To Go Maximum 182 Vitamins To Go Men 182 Vitamins To Go Women 182 Vol-Plus 182 Vol-Tab Rx 182 VP Insulin Syringe 103 W Wal-Flu Severe Cold Night Time 182 Warfarin Sodium 37,38 Warm Mist Vaporizer 183 Water For Irrigation, Sterile 103 Wegmans Complete Prenatal+DHA 183 Wegmans Unifine Pentips Plus 103 Westhroid 183 White Petrolatum-Mineral Oil 110 Wide-Seal Diaphragm Wide-Seal Diaphragm Wide-Seal Diaphragm Wide-Seal Diaphragm Wide-Seal Diaphragm Wide-Seal Diaphragm Wide-Seal Diaphragm Wide-Seal Diaphragm WP Thyroid 184 X Xarelto 38 Y Your Life Multi Prenatal 184 Z Z-Tuss AC 184 Z-Tuss E 184 Zaleplon 108 Zamicet 11 Zanamivir 32 Zenpep 57 Zinc Zinc Sulfate 158,182,184 Ziprasidone HCl 30 Zodryl AC Zodryl AC Zodryl AC Zodryl AC Zodryl DAC Zodryl DAC Zodryl DAC Zodryl DAC Zodryl DEC Zodryl DEC Zodryl DEC Zodryl DEC Zolpidem Tartrate 108 Zonisamide 18 Zostavax 70 GE 213 LAST UPDATED 09/2015

214 Zoster Vaccine Live 70 Zovia 1/50E (28) 66 Zyncof 185 GE 214 LAST UPDATED 09/2015