THP WV Medicaid Quantity Limit Coverage Rules

Transcription

1 THP WV Medicaid Quantity Limit Coverage Rules ABILIFY SOLUTION LIMITED TO A DAILY DOSE OF 30ML PER DAY ABILIFY VIAL LIMITED TO A DAILY DOSE OF 1.3ML PER DAY ABILIFY/DISCMELT TABLET LIMITED TO A DAILY DOSE OF 1 TAB PER DAY ACCOLATE LIMITED TO A DAILY DOSE OF 2 TABLETS PER DAY ACCUNEB 0.63MG/3ML, 1.25MG/3ML NEBULES TO BE DISP AT A MAX QTY OF 375ML IN 30 DAYS ACCUPRIL 40MG LIMITED TO A DAILY DOSE OF 2 TABS PER DAY ACCUPRIL 5MG, 10MG, 20MG, ACCURETIC LIMITED TO A DAILY DOSE OF 1 TAB PER DAY ACEON 2MG,4MG LIMITED TO A DAILY DOSE OF 1 TAB PER DAY ACEON 8MG LIMITED TO A DAILY DOSE OF 2 TABS PER DAY ACIPHEX/SPRINKLE LIMITED TO A DAILY DOSE OF 1 TAB/CAP PER DAY ACLOVATE TO BE DISPENSED AT A MAX OF 1 PRESCRIPTION IN ANY 23 DAY PERIOD ACTONEL 150MG TO BE DISPENSED AT A MAX QUANTITY OF 1 TABLET IN 30 DAYS ACTONEL 5MG & 30MG LIMITED TO A DAILY DOSE OF 1 TAB PER DAY ACTONEL PLUS CALCIUM TO BE DISPENSED AT A MAX QUANTITY OF 28 TABLETS (1 PACK) IN 30 DAYS ACTONEL, ATELVIA 35MG TO BE DISPENSED AT A MAX QUANTITY OF 4 TABLETS IN 30 DAYS ACTOPLUS MET XR LIMITED TO A DAILY DOSE OF 1 TABLET PER DAY ACTOPLUSMET LIMITED TO A DAILY DOSE OF 2 TAB PER DAY ACTOS LIMITED TO A DAILY DOSE OF 1 TAB PER DAY ACUVAIL OPHTHALMIC SOLUTION TO BE DISP AT A MAXIMUM QTY OF 30 VIALS IN 30 DAYS ADALAT CC 30MG, 90MG LIMITED TO A DAILY DOSE OF 1 TAB PER DAY ADALAT CC/PROCARDIA XL 30MG, 90MG LIMITED TO A DAILY DOSE OF 1 TAB PER DAY ADCIRCA LIMITED TO A DAILY DOSE OF 2 TABS PER DAY ADDERALL 10 MG TABLET LIMITED TO A DAILY DOSE OF 3 TABLETS PER DAY ADDERALL 12.5 MG TABLET LIMITED TO A DAILY DOSE OF 3 TABLETS PER DAY ADDERALL 15 MG TABLET LIMITED TO A DAILY DOSE OF 3 TABLETS PER DAY ADDERALL 20 MG TABLET TO BE DISP AT A MAX QTY OF 90 TABLETS IN 30 DAYS ADDERALL 30 MG TABLET TO BE DISP AT A MAX QTY OF 60 TABLETS IN 30 DAYS ADDERALL 5 MG TABLET LIMITED TO A DAILY DOSE OF 3 TABLETS PER DAY ADDERALL 7.5 MG TABLET LIMITED TO A DAILY DOSE OF 3 TABLETS PER DAY ADDERALL XR, ZENZEDI 2.5MG, 7.5MG LIMITED TO A DAILY DOSE OF 1 CAPSULE/TABLET PER DAY ADRENACLICK,ADRENALIN CL,AUVI-Q,EPIPEN,EPIPEN JR,TWINJECT TO BE DISP AT MAX QTY OF 2 UNITS IN 30 D ADVAIR DISKUS LIMITED TO A DAILY DOSE OF 2 UNITS PER DAY ADVAIR HFA TO BE DISPENSED AT A MAXIMUM OF 12 GRAMS (1 INHALER) IN 30 DAYS ADVICOR MG LIMITED TO A DAILY DOSE OF 2 TABS PER DAY ADVICOR MG, MG MG LIMITED TO A DAILY DOSE OF 1 TAB PER DAY AGGRENOX 25 MG-200 MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 60 CAPS IN 30 DAYS ALAMAST 0.1% TO BE DISPENSED AT A MAXIMUM QUANTITY OF 10 ML IN 30 DAYS ALBUTEROL 2.5MG/0.5ML TO BE DISPENSED AT A MAXIMUM QUANTITY OF 120 VIALS IN 30 DAYS ALDARA 5% CREAM TO BE DISP AT A MAX QTY OF 12 PACKETS IN 30 DAYS ALINIA SUSPENSION TO BE DISP AT A MAXIMUM QTY OF 180 ML (3 BOTTLES) IN 30 DAYS ALINIA TABLETS TO BE DISP AT A MAXIMUM QTY OF 6 TABS IN 30 DAYS ALLEGRA 180MG LIMITED TO A DAILY DOSE OF 1 TAB PER DAY ALLEGRA 30 MG/5 ML SUSPENSION TO BE DISPENSED AT A MAXIMUM QUANTITY OF 900ML IN 30 DAYS ALLEGRA/ODT 30MG, 60MG LIMITED TO A DAILY DOSE OF 2 TABS/DAY ALLEGRA-D 12HR LIMITED TO A DAILY DOSE OF 2 TABS PER DAY ALLEGRA-D 24HR LIMITED TO A DAILY DOSE OF 1 TAB PER DAY ALOCRIL 2% TO BE DISPENSED AT A MAXIMUM QUANTITY OF 5ML (1 BOTTLE) IN 30 DAYS ALOMIDE 0.1% EYE DROPS TO BE DISPENSED AT A MAXIMUM QUANTITY OF 10 ML IN 30 DAYS ALTACE 1.25MG,2.5MG,5MG LIMITED TO A DAILY DOSE OF 1 TAB/CAP PER DAY ALTACE 10MG LIMITED TO A DAILY DOSE OF 2 TABS/CAPS PER DAY ALVESCO TO BE DISPENSED AT A MAXIMUM OF 7 GRAMS (1 INHALER) IN 30 DAYS AMBIEN, AMBIEN CR, EDLUAR, INTERMEZZO LIMITED TO A DAILY DOSE OF 1 TAB PER DAY AMERGE TO BE DISP AT A MAX QTY OF 9 TABS IN 30 DAYS

2 AMETHIA LO, CAMRESE LO, LOSEASONIQUE TO BE DISPENSED AT A MAX QTY OF 182 TABLETS IN 30 DAYS AMETHIA, CAMRESE, SEASONIQUE TO BE DISPENSED AT A MAX QTY OF 91 TABLETS IN 30 DAYS AMOX TR/POTASSIUM CLAVULANATE MG TO BE DISP AT A MAX QTY OF 120 TABLETS IN 90 DAYS AMOX TR/POTASSIUM CLAVULANATE MG TO BE DISP AT A MAX QTY OF 120 TABLETS IN 90 DAYS AMPYRA ER LIMITED TO A DAILY DOSE OF 2 TABLETS PER DAY AMRIX ER 15MG LIMITED TO A DAILY DOSE OF 2 CAPS PER DAY AMRIX ER 30MG LIMITED TO A DAILY DOSE OF 1 CAP PER DAY AMTURNIDE LIMITED TO A DAILY DOSE OF 1 TABLET PER DAY ANDRODERM (2MG, 4MG, 5MG)/24HR, DAYTRANA LIMITED TO A DAILY DOSE OF 1 PATCH PER DAY ANDRODERM PATCH 2.5MG/24HR,STRIANT 30 MG MUCOADHESIVE LIMIT TO A DAILY DOSE OF 2 UNITS PER DAY ANDROGEL 1% (2.5GM) GEL PACKET LIMITED TO A DAILY DOSE OF 2.5 GM (1 PACKET) PER DAY ANDROGEL 1% GEL PUMP, VOGELXO GEL, TESTOSTERONE GEL TO BE DISPENSED AT MAX QTY OF 150 GM IN 30 D ANDROGEL 1% GEL PUMP, VOGELXO LTD TO MAX QTY OF 150GM(2 PUMPS) PER DISP AT RTL ANDROGEL 1%(5GM) GEL PACKET,TESTIM 1%(50MG) GEL, VOGELXO GEL LTD TO A DAILY DOSE OF 5 GM PER DAY ANDROGEL 1.62% (1.25G) TO BE DISPENSED AT A MAX QUANTITY OF 38 GM (30 PKTS) IN 30 DAYS ANDROGEL 1.62% (2.5G) TO BE DISPENSED AT A MAX QUANTITY OF 75 GM (30 PKTS) IN 30 DAYS ANDROGEL 1.62% GEL PUMP LIMIT TO A MAX QTY OF 88GM (1 PUMP) AT RETAIL ANZEMET TABLET TO BE DISPENSED AT A MAXIMUM QUANTITY OF 5 TABLETS IN 30 DAYS APLENZIN LIMITED TO A DAILY DOSE OF 1 TAB PER DAY ARCAPTA NEOHALER TO BE DISPENSED AT A MAXIMUM QUANTITY OF 30 CAPS IN 30 DAYS ARICEPT/ODT LIMITED TO A DAILY DOSE OF 1 TAB PER DAY ARIXTRA TO BE DISP AT A MAX QTY OF A 21 DAYS SUPPLY IN 90 DAYS ASACOL HD 800MG LIMITED TO A DAILY DOSE OF 6 TABS PER DAY ASACOL/DELZICOL 400MG LIMITED TO A DAILY DOSE OF 6 TABS/CAPS PER DAY ASMANEX TWISTHALER TO BE DISPENSED AT A MAXIMUM OF 1 INHALER IN 30 DAYS ASTELIN, ASTEPRO NASAL SPRAY TO BE DISP AT A MAX QTY OF 30 ML (1 BOTTLE) IN 30 DAYS ATACAND HCT LIMITED TO A DAILY DOSE OF 1 TAB PER DAY ATACAND LIMITED TO A DAILY DOSE OF 1 TAB PER DAY ATROVENT HFA TO BE DISP AT MAXIMUM QTY OF 26 GM (2 INHALERS) IN 30 DAYS ATROVENT NASAL SPRAY 0.03% TO BE DISP AT A MAXIMUM QTY OF 30ML (1 BOTTLE) IN 30 DAYS ATROVENT NASAL SPRAY 0.06% TO BE DISP AT A MAXIMUM QTY OF 15ML (1 BOTTLE) IN 30 DAYS AUBAGIO 7 MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 30 TABS IN 30 DAYS AUGMENTIN MG TO BE DISP AT A MAX QTY OF 120 TABLETS IN 90 DAYS AUGMENTIN XR TO BE DISPENSED AT A MAX QUANTITY OF 40 TABS IN 30 DAYS AVALIDE LIMITED TO A DAILY DOSE OF 1 TAB PER DAY AVANDAMET LIMITED TO A DAILY DOSE OF 2 TAB PER DAY AVANDARYL LIMITED TO A DAILY DOSE OF 1 TAB PER DAY AVANDIA LIMITED TO A DAILY DOSE OF 1 TAB PER DAY AVAPRO LIMITED TO A DAILY DOSE OF 1 TAB PER DAY AVELOX ABC PACK TO BE DISPENSED AT A MAX QUANTITY OF 5 TABS IN 30 DAYS AVELOX TO BE DISPENSED AT A MAX QUANTITY OF 14 TABS IN 30 DAYS AVINZA CAPSULES LIMITED TO A DAILY DOSE OF 1 CAP PER DAY AVODART LIMITED TO A DAILY DOSE OF 1 CAP PER DAY AVONEX PEN TO BE DISP AT A MAXIMUM QTY OF 1 KIT (4 PENS) IN 30 DAYS AXERT TO BE DISP AT A MAX QTY OF 6 TABS IN 30 DAYS AXIRON 30MG LIMIT TO MAX QTY OF 90ML (1 PUMP) PER DISP AT RETAIL;; AZILECT LIMITED TO A DAILY DOSE OF 1 TAB PER DAY AZOR LIMITED TO A DAILY DOSE OF 1 TAB PER DAY BACLOFEN LIMITED TO A DAILY DOSE OF 4 TABLETS PER DAY BACTROBAN NASAL OINTMENT TO BE DISPENSED AT A MAXIMUM QUANTITY OF 10 GM IN 30 DAYS BARACLUDE LIMITED TO A DAILY DOSE OF 1 TAB PER DAY BECONASE AQ TO BE DISPENSED AT A MAXIMUM QUANTITY OF 50 GRAMS (2 BOTTLES) IN 30 DAYS BENICAR HCT LIMITED TO A DAILY DOSE OF 1 TAB PER DAY BENICAR LIMITED TO A DAILY DOSE OF 1 TAB PER DAY BENZACLIN GEL/PUMP TO BE DISPENSED AT A MAX QUANTITY OF 50GM IN 30 DAYS

3 BEPREVE TO BE DISPENSED AT A MAXIMUM QUANTITY OF 10ML IN 30 DAYS BETASERON, EXTAVIA KIT LIMITED TO A MAX QTY OF 15 VIALS PER DISPENSING AT RETAIL BETASERON/EXTAVIA TO BE DISP AT A MAXIMUM QTY OF 15 VIALS IN 30 DAYS BIAXIN SUSPENSION LIMITED TO MAX QTY OF 150 ML PER DISPENSING AT RETAIL BIAXIN XL LIMITED TO MAX QTY OF 28 TABS PER DISPENSING AT RETAIL BLOOD GLUCOSE TEST STRIPS TO BE DISPENSED AT A MAX QUANTITY OF 102 IN 23 DAYS OR 306 IN 68 DAYS BONIVA 150MG TO BE DISPENSED AT A MAX QUANTITY OF 1 TABLET IN 30 DAYS BONIVA 3MG/3ML, IBANDRONATE 3MG/3ML TO BE DISP AT A MAX QTY OF 3ML (1 SYRINGE/VIAL) IN 30 DAYS BP WASH 7%,DUAL ACTION 3.5%,PACNEX WASH 7%,PACNEX MX WASH 4.25% TO BE DISP AT MAX QTY OF 480ML IN BRILINTA LIMITED TO A DAILY DOSE OF 2 TABLETS PER DAY BROVANA TO BE DISP AT A MAX QTY OF 120ML (60 VIALS) IN 30 DAYS BUPHENYL POWDER TO BE DISPENSED AT A MAX QTY OF 750GM IN 30 DAYS BUTRANS TO BE DISPENSED AT A MAXIMUM QUANTITY OF 4 PATCHES (1 BOX) IN 28 DAYS BYDUREON TO BE DISPENSED AT A MAXIMUM QUANTITY OF 4 VIALS IN 30 DAYS BYETTA 10MCG TO BE DISPENSED AT A MAX OF 3ML (1 PEN) IN 30 DAYS BYETTA 5MCG TO BE DISPENSED AT A MAX OF 2ML(1 PEN) IN 30 DAYS BYSTOLIC 10MG LIMITED TO A DAILY DOSE OF 1 TAB PER DAY BYSTOLIC 2.5MG, 5MG LIMITED TO A DAILY DOSE OF 1 TAB PER DAY BYSTOLIC 20MG LIMITED TO A DAILY DOSE OF 2 TABS PER DAY CADUET LIMITED TO A DAILY DOSE OF 1 TAB PER DAY CAMBIA TO BE DISPENSED AT A MAXIMUM QUANTITY OF 9 POWDER PACKETS IN 30 DAYS CAPITAL WITH CODEINE SUSPENSION TO BE DISPENSED AT A MAXIMUM QUANTITY OF 1200 ML IN 30 DAYS CAPTOPRIL 100MG LIMITED TO A DAILY DOSE OF 3 TABLETS PER DAY CAPTOPRIL 12.5MG,25MG,50MG,CAPTOPRIL-HCTZ LTD TO A DAILY DOSE OF 1 TAB PER DAY CARDURA 8 MG LIMITED TO A DAILY DOSE OF 2 TABS PER DAY CARDURA XL LIMITED TO A DAILY DOSE OF 1 TAB PER DAY CARISOPRODOL COMPOUND, CARISOPRODOL COMPOUND-CODEINE LIMITED TO A DAILY DOSE OF 4 TABS PER DA CATAPRES 0.1 MG LIMITED TO A DAILY DOSE OF 10 TABLETS PER DAY CATAPRES 0.2 MG LIMITED TO A DAILY DOSE OF 10 TABLETS PER DAY CATAPRES 0.3 MG LIMITED TO A DAILY DOSE OF 8 TABLETS PER DAY CATAPRES TTS TO BE DISPENSED AT MAX QTY OF 4 PATCHES IN 30 DAYS OR 12 PATCHES IN 90 DAYS CAYSTON LIMITED TO A DAILY DOSE OF 3ML PER DAY CEFACLOR/ER 500MG LIMITED TO MAX QTY OF 14 TABS/CAPS PER DISPENSING AT RETAIL CEFTIN 500 MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 120 TABS IN 90 DAYS CELEBREX LIMITED TO A DAILY DOSE OF 1 CAPSULE PER DAY CELEXA 10MG, 20MG LIMITED TO A DAILY DOSE OF 1.5 TABS/DAY CELEXA 40MG LIMITED TO A DAILY DOSE OF 1 TAB/DAY CESAMET LIMITED TO A DAILY DOSE OF 2 CAPS PER DAY CHANTIX TO BE DISPENSED AT A MAXIMUM OF 180 DAYS SUPPLY IN ANY 365 DAY PERIOD CHLORAL HYDRATE 500 MG/5 ML LIMITED TO A DAILY DOSE OF 10 ML PER DAY CICLODAN KIT TO BE DISPENSED AT A MAXIMUM QUANTITY OF 35 ML (1 KIT) IN 30 DAYS CIMZIA SYRINGE KIT OR CIMZIA VIAL KIT TO BE DISP AT MAX QTY OF 1 KIT IN 30 DAYS CIPRO 250 MG LIMITED TO MAX QTY OF 56 TABLETS PER DISPENSING AT RETAIL CIPRO 500 MG TABLET LIMITED TO MAX QTY OF 56 TABS PER DISPENSING AT RETAIL CIPRO XR 1000MG TO BE DISPENSED AT A MAX QUANTITY OF 14 TABS IN 30 DAYS CIPRO XR 500MG TO BE DISPENSED AT A MAX QUANTITY OF 3 TABS IN 30 DAYS CIPRODEX OTIC SUSPENSION TO BE DISP AT A MAX QTY OF 1 BOTTLE (8 ML) IN 30 DAYS CIPROFLOXACIN 100 MG LIMITED TO MAX QTY OF 56 TABLETS PER DISP AT RETAIL CIPROFLOXACIN 750 MG LIMITED TO MAX QTY OF 56 TABLETS PER DISP AT RETAIL CITALOPRAM 10 MG/5 ML LIMITED TO A DAILY DOSE OF 20 ML PER DAY CITRANATAL DHA/ASSURE PACK,FOLTABS PRENATAL PLUS DHA TO BE DISP AT MAX QTY OF 60 TABS/CAPS IN 30D CLARINEX 2.5MG/5ML LIMITED TO A DAILY DOSE OF 10ML PER DAY CLARINEX, CLARINEX REDITABS LIMITED TO A DAILY DOSE OF 1 TAB PER DAY CLARINEX-D 12 HR LIMITED TO A DAILY DOSE OF 2 TABS PER DAY CLARINEX-D 24HR LIMITED TO A DAILY DOSE OF 1 TAB PER DAY

4 CLARITIN/CLARITIN REDITABS/CLARITIN LIQUI-GEL 10MG LIMITED TO A DAILY DOSE OF 1 TAB/CAP PER DAY CLARITIN-D 12 HR LIMITED TO A DAILY DOSE OF 2 TABS PER DAY CLARITIN-D 24 HR LIMITED TO A DAILY DOSE OF 1 TAB PER DAY COLCRYS LIMITED TO MAX QTY OF 9 TABS PER DISPENSING AT RETAIL COLYTE TO BE DISPENSED AT A MAXIMUM QUANTITY OF 4,000 ML IN 30 DAYS COMBIVENT INHALER TO BE DISP AT A MAX QTY OF 30GM (2 INHALERS) IN 30 DAYS COMBIVENT RESPIMAT TO BE DISP AT A MAX QTY OF 2 INHALERS IN 30 DAYS CONCERTA 18MG, 27MG, 54MG LIMITED TO A DAILY DOSE OF 1 TABLET PER DAY CONCERTA 36MG LIMITED TO A DAILY DOSE OF 2 TABLETS PER DAY CONZIP, TRAMADOL ER 150MG LIMITED TO A DAILY DOSE OF 1 CAPSULE PER DAY COPAXONE 20MG/ML TO BE DISPENSED AT A MAXIMUM QUANTITY OF 30ML (30 SYR) IN 30 DAYS CORDRAN CREAM, LOTION TO BE DISPENSED AT A MAX QTY OF 1 UNIT IN 30 DAYS CORDRAN TAPE TO BE DISPENSED AT A MAX OF 1 UNIT IN 30 DAYS COREG CR LIMITED TO A DAILY DOSE OF 1 CAP PER DAY COZAAR 100 MG LIMITED TO A DAILY DOSE OF 1 TAB PER DAY COZAAR 25 MG LIMITED TO A DAILY DOSE OF 2 TABS PER DAY COZAAR 50 MG LIMITED TO A DAILY DOSE OF 2 TABS PER DAY CRESTOR LIMITED TO A DAILY DOSE OF 1 TAB PER DAY CROMOLYN 4% TO BE DISPENSED AT A MAXIMUM QUANTITY OF 10 ML IN 30 DAYS CUTIVATE TO BE DISPENSED AT A MAX OF 1 PRESCRIPTION IN ANY 23 DAY PERIOD CYMBALTA 20MG LIMITED TO A DAILY DOSE OF 2 CAPS PER DAY CYMBALTA 30MG, 60MG LIMITED TO A DAILY DOSE OF 1 CAP PER DAY DALIRESP LIMITED TO A DAILY DOSE OF 1 TABLET PER DAY DANTRIUM LIMITED TO A DAILY DOSE OF 4 CAPSULES PER DAY DAYPRO LIMITED TO A DAILY DOSE OF 3 TABS PER DAY DEMEROL 50 MG/5 ML TO BE DISP AT A MAXIMUM QTY OF 3,600 ML IN 30 DAYS DESOXYN LIMITED TO A DAILY DOSE OF 5 TABLETS PER DAY DESVENLAFAXINE/FUMARATE ER, KHEDEZLA OR PRISTIQ ER LIMITED TO A DAILY DOSE OF 1 TAB PER DAY DETROL LA LIMITED TO A DAILY DOSE OF 1 CAP PER DAY DETROL TABLETS LIMITED TO A DAILY DOSE OF 2 TABS PER DAY DEXEDRINE SPANSULE 10MG TO BE DISPENSED AT A MAX QUANTITY OF 60 CAPS IN 30 DAYS DEXEDRINE SPANSULE 15MG TO BE DISPENSED AT A MAX QUANTITY OF 60 CAPS IN 30 DAYS DEXEDRINE SPANSULE 5MG LIMITED TO A DAILY DOSE OF 2 CAPS/DAY DEXILANT (WAS KAPIDEX) LIMITED TO A DAILY DOSE OF 1 CAP PER DAY DEXPAK, ZEMA-PAK 6 DAY 1.5MG TO BE DISPENSED AT A MAX QTY OF 21 TABS (1 PACK) IN 30 DAYS DEXTROSTAT LIMITED TO A DAILY DOSE OF 4 TABLETS PER DAY DIDRONEL 200MG LIMITED TO A DAILY DOSE OF 3 TABLETS PER DAY DIDRONEL 400MG LIMITED TO A DAILY DOSE OF 5 TABLETS PER DAY DIFFERIN 0.1% CREAM TO BE DISPENSED AT A MAXIMUM QUANTITY OF 90 GRAMS (2 TUBES) IN 30 DAYS DIFFERIN 0.1% GEL TO BE DISPENSED AT A MAXIMUM QUANTITY OF 90 GRAMS (2 TUBES) IN 30 DAYS DIFFERIN 0.1% LOTION TO BE DISPENSED AT A MAXIMUM QUANTITY OF 118 ML (2 BOTTLES) IN 30 DAYS DIFFERIN 0.3% GEL PUMP TO BE DISPENSED AT A MAXIMUM QUANTITY OF 90GM (2 BOTTLES) IN 30 DAYS DIFFERIN 0.3% GEL TO BE DISPENSED AT A MAXIMUM QUANTITY OF 90 GM IN 30 DAYS DIFICID TO BE DISPENSED AT A MAXIMUM QUANTITY OF 20 TABLETS IN 30 DAYS DIFLUCAN TABLET LIMITED TO A DAILY DOSE OF 2 TABS PER DAY DILACOR XR 120,180/TIAZAC,CARDIZEM LA 120,180,300,360,420/CARDIZEM CD 120,180,300,360 1/DAY DILACOR XR/TIAZAC/CARDIZEM CD/ CARDIZEM LA 240MG LIMITED TO A DAILY DOSE OF 2 CAPS/TABS PER DAY DILAUDID 1MG/ML LIQUID TO BE DISPENSED AT A MAX QUANTITY OF 1,920ML IN 30 DAYS DIOVAN HCT LIMITED TO A DAILY DOSE OF 1 TAB PER DAY DIOVAN LIMITED TO A DAILY DOSE OF 1 TAB PER DAY DITROPAN XL 10MG, 15MG LIMITED TO A DAILY DOSE OF 1 TABLET PER DAY DITROPAN XL 5MG LIMITED TO A DAILY DOSE OF 1 TAB PER DAY DOLOPHINE 5MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 720 TABS IN 30 DAYS DOLOPHINE HCL 10MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 360 TABLETS IN 30 DAYS DORAL LIMITED TO A DAILY DOSE OF 1 TABLET PER DAY

5 DOXYCYCLINE MONOHYDRATE 150MG LIMITED TO A DAILY DOSE OF 1 TABLET/CAPSULE PER DAY DUAC CS CONVENIENCE KIT TO BE DISPENSED AT A MAXIMUM QUANTITY OF 1 KIT IN 30 DAYS DUETACT 30-2 MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 30 TABS IN 30 DAYS DUETACT 30-4 MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 30 TABS IN 30 DAYS DUEXIS TO BE DISPENSED AT A MAXIMUM QUANTITY OF 90 TABS IN 30 DAYS DULERA 100-5MCG, 200MCG-5MCG INHALER LIMIT TO MAX OF 13GM PER DISP AT RETAIL OR 39GM AT MAIL DUONEB TO BE DISPENSED AT A MAX QTY OF 540ML (180 NEB.) IN 30 DAYS DURAGESIC 100MCG/HR TO BE DISPENSED AT A MAX QUANTITY OF 10 PATCHES IN 30 DAYS DURAGESIC 12MCG/HR TO BE DISPENSED AT A MAX QUANTITY OF 10 PATCHES IN 30 DAYS DURAGESIC 25MCG/HR TO BE DISPENSED AT A MAX QUANTITY OF 10 PATCHES IN 30 DAYS DURAGESIC 50MCG/HR TO BE DISPENSED AT A MAX QUANTITY OF 10 PATCHES IN 30 DAYS DURAGESIC 75MCG/HR TO BE DISPENSED AT A MAX QUANTITY OF 10 PATCHES IN 30 DAYS DUREZOL TO BE DISPENSED AT A MAXIMUM QUANTITY OF 10 ML IN 30 DAYS DYMISTA TO BE DISPENSED AT A MAXIMUM QUANTITY OF 23GM (1 BOTTLE) IN 30 DAYS DYNACIRC CR 10MG LIMITED TO A DAILY DOSE OF 2 TABS PER DAY DYNACIRC CR 5MG LIMITED TO A DAILY DOSE OF 1 TAB PER DAY EDARBI, EXFORGE LIMITED TO A DAILY DOSE OF 1 TAB PER DAY EDARBYCLOR MG LIMITED TO A DAILY DOSE OF 1 TAB PER DAY EDARBYCLOR 40-25MG LIMITED TO A DAILY DOSE OF 1 TAB PER DAY EFFEXOR XR LIMITED TO A DAILY DOSE OF 1 CAPSULE PER DAY EFFIENT LIMITED TO A DAILY DOSE OF 1 TAB PER DAY ELESTAT 0.05% EYE DROPS TO BE DISPENSED AT MAX QUANTITY OF 5 ML (1 BOTTLE) IN 30 DAYS ELIDEL 1% TO BE DISPENSED AT A MAX OF 60GM IN 30 DAYS ELLA TO BE DISPENSED AT A MAXIMUM QUANTITY OF 1 TAB IN 30 DAYS EMADINE EYE DROPS TO BE DISPENSED AT A MAXIMUM QUANTITY OF 5 ML (1 PACKAGE) IN 30 DAYS EMEND TO BE DISP AT A MAX QTY OF 3 CAPSULES IN 30 DAYS EMEND TRIFOLD PACK TO BE DISP AT A MAX QTY OF 3 CAPS (1 PACK) IN 30 DAYS EMSAM PATCHES LIMITED TO A DAILY DOSE OF 1 PATCH PER DAY ENABLEX LIMITED TO A DAILY DOSE OF 1 TAB PER DAY ENBREL TO BE DISP AT MAX QTY OF 204MG IN 28 DAYS EPIDUO TO BE DISPENSED AT A MAX QUANTITY OF 45GM (1 TUBE/PUMP) IN 30 DAYS ESTAZOLAM LIMITED TO A DAILY DOSE OF 1 TAB PER DAY EVAMIST SPRAY TO BE DISPENSED AT A MAXIMUM QUANTITY OF 9ML (1 BOTTLE) IN 28 DAYS EVISTA LIMITED TO A DAILY DOSE OF 1 TABLET PER DAY EXALGO ER LIMITED TO A DAILY DOSE OF 1 TABLET PER DAY EXELON (3MG, 4.5MG, 6MG) CAPSULES LIMITED TO A DAILY DOSE OF 2 CAPS PER DAY EXELON 1.5MG LIMITED TO A DAILY DOSE OF 1 CAPSULE PER DAY EXELON ORAL SOLUTION TO BE DISPENSED AT A MAX QUANTITY OF 120ML (1 BOTTLE) IN 30 DAYS EXELON PATCH LIMITED TO A DAILY DOSE OF 1 PATCH PER DAY EXFORGE HCT LIMITED TO A DAILY DOSE OF 1 TAB PER DAY FACTIVE TO BE DISPENSED AT A MAXIMUM QUANTITY OF 7 TABLETS IN 30 DAYS FAMVIR 125MG LIMITED TO A DAILY DOSE OF 2 TABLETS PER DAY FAMVIR 250MG, 500MG LIMITED TO A DAILY DOSE OF 3 TABS PER DAY FAMVIR LIMITED TO MAX QTY OF 21 TABS PER DISP AT RETAIL FANAPT LIMITED TO A DAILY DOSE OF 2 TABLETS PER DAY FAZACLO 12.5MG, 25MG, CLOZAPINE 25MG, 50MG LIMITED TO A DAILY DOSE OF 3 TABLETS PER DAY FAZACLO 150MG LIMITED TO A DAILY DOSE OF 6 TABLETS PER DAY FAZACLO ODT/CLOZAPINE 200MG LIMITED TO A DAILY DOSE OF 4 TABLETS PER DAY FAZACLO, CLOZARIL 100 MG LIMITED TO A DAILY DOSE OF 9 TABLETS PER DAY FENTORA, ACTIQ, ONSOLIS LIMITED TO A DAILY DOSE OF 4 UNITS PER DAY FIBRICOR 105MG, TRILIPIX LIMITED TO A DAILY DOSE OF 1 TAB/CAP PER DAY FIBRICOR LIMITED TO A DAILY DOSE OF 1 TAB PER DAY FINACEA PLUS TO BE DISPENSED AT A MAXIMUM QUANTITY OF 1 KIT IN 30 DAYS FIORICET WITH CODEINE TO BE DISP AT A MAX QTY OF 120 CAPS IN 30 DAYS FLAVOXATE LIMITED TO A DAILY DOSE OF 8 TABS PER DAY

6 FLECTOR LIMITED TO A DAILY DOSE OF 2 PATCHES PER DAY FLECTOR PATCH TO BE DISP AT A MAXIMUM OF 15 DAY SUPPLY IN 365 DAYS FLEXERIL, FEXMID LIMITED TO A DAILY DOSE OF 3 TABS PER DAY FLOMAX LIMITED TO A DAILY DOSE OF 2 CAPS PER DAY FLONASE NASAL SPRAY TO BE DISPENSED AT A MAXIMUM QUANTITY OF 16GM (1 BOTTLE) IN 30 DAYS FLOVENT DISKUS LIMITED TO A DAILY DOSE OF 2 UNITS PER DAY FLOVENT HFA 220MCG TO BE DISPENSED AT A MAXIMUM OF 24 GRAMS (2 INHALERS) IN 30 DAYS FLOVENT HFA 44MCG, 110MCG TO BE DISPENSED AT A MAXIMUM OF 12 GRAMS (1 INHALER) IN 30 DAYS FLOXIN TABLETS TO BE DISPENSED AT A MAX QUANTITY OF 28 TABS IN 30 DAYS FLUOXETINE 20MG/5ML LIMITED TO A DAILY DOSE OF 20 ML PER DAY FLUOXETINE 60 MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 30 TABS IN 30 DAYS FLURAZEPAM LIMITED TO A DAILY DOSE OF 1 CAPSULE PER DAY FOCALIN LIMITED TO A DAILY DOSE OF 2 TABLETS PER DAY FOCALIN XR LIMITED TO A DAILY DOSE OF 1 CAPSULE PER DAY FORADIL CAP FOR INHALATION LIMITED TO A DAILY DOSE OF 2 CAPS PER DAY FORFIVO XL 450 MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 30 TABS IN 30 DAYS FORTEO 600 MCG/2.4 ML TO BE DISP AT A MAXIMUM QTY OF 3ML (1 PKG) IN 28 DAYS FORTESTA 10MG GEL PUMP LIMIT TO MAX QTY OF 60GM (1 PUMP) PER DISP AT RETAIL; FOSAMAX 35MG, 70MG, FOSAMAX+D,BINOSTO 70MG TO BE DISPENSED AT A MAX QUANTITY OF 4 TABLETS IN 30 D FOSAMAX 5MG, 10MG, 40MG LIMITED TO A DAILY DOSE OF 1 TAB PER DAY FOSAMAX SOLUTION TO BE DISPENSED AT A MAX QUANTITY OF 300ML (4 BOTTLES) IN 30 DAYS FRAGMIN/DALTEPARIN LIMITED TO A MAX OF 21 DAY SUPPLY IN 90 DAYS FROVA TO BE DISP AT A MAX QTY OF 9 TABS IN 30 DAYS GABAPENTIN 300 MG/6 ML CUP TO BE DISPENSED AT A MAXIMUM QUANTITY OF 1,050 ML IN 30 DAYS GELNIQUE 10% GEL SACHET LIMITED TO A DAILY DOSE OF 1 GM (1 SACHET) PER DAY GELNIQUE 3% GEL TO BE DISP AT MAX QTY OF 92GM (1 BOTTLE) PER 30 DAYS GENOTROPIN 12 MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 28 CARTRIDGES IN 28 DAYS GENOTROPIN 5 MG CARTRIDGE TO BE DISP AT A MAX QTY OF 28 UNITS IN 28 DAYS GENOTROPIN MINIQUICK 0.2 MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 28 UNITS IN 28 DAYS GENOTROPIN MINIQUICK 0.4 MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 28 UNITS IN 28 DAYS GENOTROPIN MINIQUICK 0.6 MG TO BE DISP AT A MAX QTY OF 28 SYRINGES IN 28 DAYS GENOTROPIN MINIQUICK 0.8 MG TO BE DISP AT A MAX QTY OF 28 SYRINGES IN 28 DAYS GENOTROPIN MINIQUICK 1 MG TO BE DISP AT A MAX QTY OF 28 SYRINGES IN 28 DAYS GENOTROPIN MINIQUICK 1.2 MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 28 SYRINGES IN 28 DAYS GENOTROPIN MINIQUICK 1.4 MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 28 SYRINGES IN 28 DAYS GENOTROPIN MINIQUICK 1.6 MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 28 SYRINGES IN 28 DAYS GENOTROPIN MINIQUICK 1.8 MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 28 SYRINGES IN 28 DAYS GENOTROPIN MINIQUICK 2 MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 28 SYRINGES IN 28 DAYS GEODON LIMITED TO A DAILY DOSE OF 2 CAPS PER DAY GEODON VIAL LIMITED TO A MAX QUANTITY OF 1 VIAL PER DISPENSING AT RETAIL OR MAIL GILENYA LIMITED TO A DAILY DOSE OF 1 CAPSULE PER DAY GLUCAGEN, GLUCAGON TO BE DISPENSED AT A MAX QTY OF 2 UNITS IN 30 DAYS GRALISE 30-DAY STARTER PACK TO BE DISPENSED AT A MAXIMUM QUANTITY OF 78 TABLETS (1 PACK) IN 30 DAYS GRALISE ER 300MG LIMITED TO A DAILY DOSE OF 1 TABLET PER DAY GRALISE ER 600MG LIMITED TO A DAILY DOSE OF 3 TABLETS PER DAY GRANISETRON HCL 1MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 10 TABLETS IN 30 DAYS GRANISOL 2MG/10ML TO BE DISP AT A MAX QTY OF 60 ML IN 30 DAYS HALCION LIMITED TO A DAILY DOSE OF 1 TAB PER DAY HALFLYTELY,GOLYTELY,MOVIPREP TO BE DISPENSED AT A MAX QUANTITY OF 1 UNIT IN 30 DAYS HELIDAC TO BE DISPENSED AT A MAXIMUM QUANTITY OF 224 UNITS (1 KIT) IN 30 DAYS HEPSERA LIMITED TO A DAILY DOSE OF 1 TAB PER DAY HUMATROPE 12 MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 28 CARTRIDGES IN 28 DAYS HUMATROPE 24MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 28 CARTRIDGES IN 28 DAYS HUMATROPE 5MG VIAL TO BE DISP AT A MAX QTY OF 28 VIALS IN 28 DAYS HUMATROPE 6MG CARTRIDGE TO BE DISP AT A MAX QTY OF 28 UNITS IN 28 DAYS

7 HUMIRA 10MG, 20MG TO BE DISP AT MAX QTY OF 2 SYRINGES (1 KIT) IN 28 DAYS HUMIRA 40MG TO BE DISP AT A MAX QTY OF 2 SYRINGES (1 KIT) IN 28 DAYS HUMIRA CROHN'S STARTER PACK TO BE DISPENSED AT A MAX QUANTITY OF 6 SYR (1 KIT) IN 365 DAYS HUMIRA PSORIASIS STARTER PACK TO BE DISPENSED AT A MAX QUANTITY OF 4 SYR (1 KIT) IN 365 DAYS HUMULIN R, NOVOLIN R VIAL TO BE DISPENSED AT A MAXIMUM QUANTITY OF 180ML IN 30 DAYS HYCET MG/15ML SOLUTION TO BE DISPENSED AT A MAX QUANTITY OF 1,800ML IN 30 DAYS HYDROCODONE W/ APAP MG/15ML TO BE DISPENSED AT A MAXIMUM QUANTITY OF 1,800ML IN 30 DAYS HYDROCODONE W/ APAP 5-163MG/7.5ML TO BE DISPENSED AT A MAXIMUM QUANTITY OF 1,800ML IN 30 DAYS HYDROCODONE-ACETAMINOPHEN MG/5 ML TO BE DISPENSED AT A MAXIMUM QUANTITY OF 600 ML IN 30 D HYDROCODONE-ACETAMINOPHEN MG/10 ML TO BE DISPENSED AT A MAXIMUM QTY OF 1,200 ML IN 30 DAYS HYTRIN 1MG, 5MG LIMITED TO A DAILY DOSE OF 1 CAP PER DAY HYTRIN 2MG, 10MG LIMITED TO A DAILY DOSE OF 2 CAPS PER DAY HYZAAR LIMITED TO A DAILY DOSE OF 1 TAB PER DAY IMITREX 20MG NS TO BE DISP AT A MAX QTY OF 6 UNITS IN 30 DAYS IMITREX 5MG NS TO BE DISP AT A MAX QTY OF 12 UNITS IN 30 DAYS IMITREX INJECTION, ALSUMA TO BE DISP AT A MAX QTY OF 2 KITS (4 SYR) IN 30 DAYS IMITREX TABLETS TO BE DISP AT A MAX QTY OF 9 TABS IN 30 DAYS IMITREX VIALS TO BE DISP AT A MAX QTY OF 5 VIALS IN 30 DAYS INCIVEK LIMITED TO A DAILY DOSE OF 6 TABLETS PER DAY INDERAL LA 120MG, 160MG LIMITED TO A DAILY DOSE OF 1 CAP PER DAY INDERAL LA 60MG, INNOPRAN XL 120MG LIMITED TO A DAILY DOSE OF 1 CAP PER DAY INFLUENZA VACCINES ( ) TO BE DISPENSED AT MAXIMUM QUANTITY OF 1 UNIT IN 30 DAYS INNOPRAN XL 80MG, INDERAL LA 80MG LIMITED TO A DAILY DOSE OF 2 CAPS PER DAY INSULIN PENS/CARTRIDGES TO BE DISPENSED AT A MAXIMUM QUANTITY OF 90ML IN 30 DAYS INSULIN VIALS TO BE DISPENSED AT A MAXIMUM QUANTITY OF 90ML IN 30 DAYS INTROVALE, JOLESSA, QUASENSE, SEASONALE TO BE DISPENSED AT A MAX QTY OF 91 TABS (1 PACK) IN 30 DAYS INTUNIV ER LIMITED TO A DAILY DOSE OF 1 TABLET PER DAY INVEGA ER 1.5MG, 3MG, 9MG LIMITED TO A DAILY DOSE OF 1 TAB/DAY INVEGA ER 6MG LIMITED TO A DAILY DOSE OF 2 TABS/DAY INVEGA SUSTENNA PREFILLED SYRINGE LIMITED TO A MAX QUANTITY OF 1 SYRINGE IN 28 DAYS IPRATROPIUM BR 0.02% SOLN TO BE DISPENSED AT A MAX QUANTITY OF 380ML IN 30 DAYS JALYN LIMITED TO A DAILY DOSE OF 1 CAPSULE PER DAY JANUMET MG LIMITED TO A DAILY DOSE OF 2 TABLETS PER DAY JANUMET MG LIMITED TO A DAILY DOSE OF 1 TABLET PER DAY JANUMET XR MG, KAZANO LIMITED TO A DAILY DOSE OF 2 TABLETS PER DAY JANUMET XR MG, MG, JANUVIA, OSENI, NESINA LIMITED TO A DAILY DOSE OF 1 TAB PER DAY JENTADUETO 2.5 MG-1000 MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 60 TABS IN 30 DAYS JENTADUETO 2.5 MG-500 MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 60 TABS IN 30 DAYS JENTADUETO 2.5 MG-850 MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 60 TABS IN 30 DAYS JUVISYNC 100MG/10MG, 100MG/20MG, 100MG/40MG LIMITED TO A DAILY DOSE OF 1 TABLET PER DAY JUVISYNC 50-10MG, 50-20MG, 50-40MG LIMITED TO A DAILY DOSE OF 1 TABLET PER DAY KADIAN LIMITED TO A DAILY DOSE OF 2 CAPS PER DAY KAPVAY DOSEPACK TO BE DISP AT MAX QTY OF 1 PRESCRIPTION IN A 180 DAY PERIOD KAPVAY ER 0.1MG LIMITED TO A DAILY DOSE OF 3 TABLETS PER DAY KEROL 50% EMULSION TO BE DISPENSED AT A MAXIMUM QUANTITY OF 300 GM IN 30 DAYS KINERET 100MG/0.67ML LIMITED TO A DAILY DOSE OF 0.67ML (1 SYRINGE) PER DAY KOMBIGLYZE XR MG LIMITED TO A DAILY DOSE OF 2 TABS PER DAY KOMBIGLYZE XR 5-500MG, MG LIMITED TO A DAILY DOSE OF 1 TAB PER DAY LAMISIL 125MG GRANULES LIMITED TO A DAILY DOSE OF 2 PACKETS PER DAY LAMISIL 187.5MG GRANULES LIMITED TO A DAILY DOSE OF 1 PACKET PER DAY LAMISIL TABLET TO BE DISPENSED AT A MAX OF 4 PRESCRIPTIONS IN 365 DAY PERIOD LAMISIL TABLETS LIMITED TO A DAILY DOSE OF 1 TAB PER DAY LANCETS TO BE DISPENSED AT A MAX QUANTITY OF 102 UNITS IN 23 DAYS OR 306 UNITS IN 68 DAYS LASTACAFT TO BE DISPENSED AT A MAXIMUM QUANTITY OF 3ML (1 BOTTLE) IN 30 DAYS LATUDA 120 MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 30 TABS IN 30 DAYS

8 LATUDA 20MG LIMITED TO A DAILY DOSE OF 1 TAB PER DAY LATUDA 40MG, 80MG LIMITED TO A DAILY DOSE OF 1 TAB PER DAY LAZANDA TO BE DISPENSED AT A MAXIMUM QUANTITY OF 1 BOTTLE IN 30 DAYS LESCOL/LESCOL XL LIMITED TO A DAILY DOSE OF 1 TAB/CAP PER DAY LEVAQUIN LIMITED TO MAX QTY OF 14 TABLETS PER DISPENSING AT RETAIL LEVAQUIN,LEVOFLOXACIN SOLUTION LIMITED TO MAX QTY OF 280ML PER DISPENSING AT RETAIL LEVAQUIN/LEVAQUIN LEVAPAK 750MG LIMITED TO MAX QTY OF 5 TABLETS PER DISPENSING AT RETAIL LEVORPHANOL TO BE DISPENSED AT A MAXIMUM QUANTITY OF 240 TABLETS IN 30 DAYS LEXAPRO 10MG LIMITED TO A DAILY DOSE OF 1 TABLET PER DAY LEXAPRO 5MG, 20MG TABLET LIMITED TO A DAILY DOSE OF 1 TAB PER DAY LEXAPRO 5MG/5ML SOLUTION LIMITED TO A DAILY DOSE OF 20 ML PER DAY LIALDA 1.2 GM LIMITED TO A DAILY DOSE OF 4 TABLETS PER DAY LIDODERM PATCHES LIMITED TO A DAILY DOSE OF 3 PATCHES PER DAY LINDANE TO BE DISPENSED AT A MAX QUANTITY OF 60ML IN 30 DAYS LINZESS LIMITED TO A DAILY DOSE OF 1 CAPSULE PER DAY LIPITOR LIMITED TO A DAILY DOSE OF 1 TAB PER DAY LIVALO LIMITED TO A DAILY DOSE OF 1 TAB PER DAY LORTAB ELIXIR MG/15ML TO BE DISPENSED AT A MAXIMUM QUANTITY OF 1,800 ML IN 30 DAYS LOTENSIN 40MG LIMITED TO A DAILY DOSE OF 2 TABLETS PER DAY LOTENSIN HCT, LOTENSIN 5MG, 10MG, 20MG LIMITED TO A DAILY DOSE OF 1 TABLET PER DAY LOTREL LIMITED TO A DAILY DOSE OF 1 CAP PER DAY LOVAZA/OMACOR LIMITED TO A DAILY DOSE OF 4 CAPS PER DAY LOVENOX/ENOXAPARIN, FRAGMIN/DALTEPARIN LIMITED TO A MAX OF 21 DAY SUPPLY IN 90 DAYS LUMIGAN EYE DROPS TO BE DISPENSED AT A MAX OF 3ML IN 30 DAYS LUNESTA LIMITED TO A DAILY DOSE OF 1 TAB PER DAY LUVOX CR LIMITED TO A DAILY DOSE OF 2 CAPS PER DAY LUVOX TABLET LIMITED TO A DAILY DOSE OF 1 TAB PER DAY LYRICA 225MG, 300MG LIMITED TO A DAILY DOSE OF 2 CAPS PER DAY LYRICA 25,50,75,100,150,200MG LIMITED TO A DAILY DOSE OF 3 CAPS PER DAY LYRICA ORAL SOLUTION LIMITED TO A DAILY DOSE OF 30ML PER DAY MARINOL LIMITED TO A DAILY DOSE OF 2 CAPS PER DAY MARPLAN 10MG LIMITED TO A DAILY DOSE OF 3 TABLETS PER DAY MAVIK 1MG, 2MG LIMITED TO A DAILY DOSE OF 1 TAB PER DAY MAVIK 4MG LIMITED TO A DAILY DOSE OF 2 TABS PER DAY MAXAIR AUTOHALER TO BE DISPENSED AT A MAXIMUM QUANTITY OF 14GM (1 INHALER) IN 30 DAYS MAXALT/MAXALT MLT TO BE DISP AT A MAX QTY OF 9 TABS IN 30 DAYS METADATE CD LIMITED TO A DAILY DOSE OF 1 CAPSULE PER DAY METADATE ER, RITALIN SR LIMITED TO A DAILY DOSE OF 3 TABLETS PER DAY METHADONE HCL 10 MG/5 ML TO BE DISPENSED AT A MAXIMUM QUANTITY OF 1,800ML IN 30 DAYS METHADONE HCL 5 MG/5 ML TO BE DISPENSED AT A MAXIMUM QUANTITY OF 3,600ML IN 30 DAYS METHADONE INTENSOL, METHADOSE 10 MG/ML ORAL CONCENTRATE TO BE DISP AT A MAX QTY OF 360ML IN 30 D METHYLIN 10MG CHEWABLE TABLET TO BE DISPENSED AT A MAXIMUM QUANTITY OF 180 TABLETS IN 30 DAYS METHYLIN 10MG/5ML SOLUTION TO BE DISPENSED AT A MAXIMUM QUANTITY OF 900ML IN 30 DAYS METHYLIN 2.5MG CHEWABLE TABLET LIMITED TO A DAILY DOSE OF 3 TABLETS PER DAY METHYLIN 5MG CHEWABLE TABLET LIMITED TO A DAILY DOSE OF 3 TABLETS PER DAY METHYLIN 5MG/5ML SOLUTION TO BE DISPENSED AT A MAXIMUM QUANTITY OF 1800ML IN 30 DAYS MEVACOR 10MG,20MG & ALTOPREV LIMITED TO A DAILY DOSE OF 1 TAB PER DAY MEVACOR 40MG LIMITED TO A DAILY DOSE OF 2 TABS PER DAY MIACALCIN NASAL SPRAY TO BE DISP AT A MAXIMUM QTY OF 4ML (1 BOTTLE) IN 30 DAYS MICARDIS HCT LIMITED TO A DAILY DOSE OF 1 TAB PER DAY MICARDIS LIMITED TO A DAILY DOSE OF 1 TAB PER DAY MIGRANAL NASAL SPRAY TO BE DISPENSED AT A MAXIMUM QUANTITY OF 8 ML (8 VIALS) IN 30 DAYS MINOCIN KIT TO BE DISPENSED AT A MAX QTY OF 1 KIT IN 30 DAYS MOBIC LIMITED TO A DAILY DOSE OF 1 TAB PER DAY MONISTAT 3 200MG TO BE DISPENSED AT MAX QTY OF 1 UNIT IN 30 DAYS

9 MONOPRIL 10MG, 20MG LIMITED TO A DAILY DOSE OF 1 TAB PER DAY MONOPRIL 40MG LIMITED TO A DAILY DOSE OF 2 TABS PER DAY MORPHINE SULF 10 MG/5 ML TO BE DISP AT A MAXIMUM QTY OF 3,600 ML IN 30 DAYS MORPHINE SULF 20 MG/5 ML TO BE DISP AT A MAXIMUM QTY OF 1,800 ML IN 30 DAYS MORPHINE SULFATE 100MG/5ML SOLN TO BE DISPENSED AT A MAXIMUM QUANTITY OF 360ML IN 30 DAYS MOXATAG TO BE DISP AT A MAXIMUM QTY OF 10 TABLETS IN 30 DAYS MS CONTIN 100MG, ORAMORPH SR 100MG LIMITED TO A DAILY DOSE OF 6 TABS PER DAY MS CONTIN 15MG, ORAMORPH SR 15MG LIMITED TO A DAILY DOSE OF 4 TABS PER DAY MS CONTIN 200MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 120 TABLETS IN 30 DAYS MS CONTIN CR, ORAMORPH SR 30MG LIMITED TO A DAILY DOSE OF 4 TABS PER DAY MULTAQ LIMITED TO A DAILY DOSE OF 2 TABS PER DAY MYRBETRIQ LIMITED TO A DAILY DOSE OF 1 TABLET PER DAY NAMENDA 10MG/5ML LIMITED TO A DAILY DOSE OF 10ML PER DAY NAMENDA TABLETS LIMITED TO A DAILY DOSE OF 2 TABS PER DAY NAMENDA TITRATION PACK TO BE DISP AT MAX QTY OF 1 PACK (49 TABS) IN 30 DAYS NARDIL 15MG LIMITED TO A DAILY DOSE OF 6 TABLETS PER DAY NASACORT/AQ TO BE DISP AT A MAXIMUM QTY OF 1 BOTTLE IN 30 DAYS AT RETAIL NASAREL/NASALIDE TO BE DISP AT A MAXIMUM QTY OF 50ML (2 BOTTLES) IN 30 DAYS NASONEX TO BE DISP AT A MAXIMUM QTY OF 17 GM (1 BOTTLE) IN 30 DAYS NEFAZODONE HCL 100MG LIMITED TO A DAILY DOSE OF 2 TABLETS PER DAY NEFAZODONE HCL 150MG LIMITED TO A DAILY DOSE OF 2 TABLETS PER DAY NEFAZODONE HCL 200MG LIMITED TO A DAILY DOSE OF 2 TABLETS PER DAY NEFAZODONE HCL 250MG LIMITED TO A DAILY DOSE OF 2 TABLETS PER DAY NEFAZODONE HCL 50MG LIMITED TO A DAILY DOSE OF 2 TABLETS PER DAY NEOSPORIN G.U. IRRIGANT TO BE DISPENSED AT A MAX QUANTITY OF 60ML IN 30 DAYS NEOTIC TO BE DISPENSED AT A MAXIMUM QUANTITY OF 20 ML (2 BOTTLES) IN 30 DAYS NEULASTA 6 MG/0.6 ML TO BE DISP AT A MAXIMUM QTY OF 1.2 ML (2 PKGS) IN 28 DAYS NEUPRO LIMITED TO A DAILY DOSE OF 1 PATCH PER DAY NEURONTIN 100 MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 180 CAPSULES IN 30 DAYS NEURONTIN 250 MG/5 ML TO BE DISPENSED AT A MAXIMUM QUANTITY OF 1,050 ML IN 30 DAYS NEURONTIN 300 MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 180 CAPSULES IN 30 DAYS NEURONTIN 400 MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 270 CAPSULES IN 30 DAYS NEURONTIN 600 MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 180 TABS IN 30 DAYS NEURONTIN 800 MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 180 TABS IN 30 DAYS NEXIUM LIMITED TO A DAILY DOSE OF 1 UNIT PER DAY NICOTINE OR NICOTINE POLACRILEX TO BE DISP AT A MAX OF 180 DAYS SUPPLY IN ANY 365 DAY PERIOD NIMODIPINE 30 MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 360 CAPSULES IN 30 DAYS NITROLINGUAL (16.9GM, 13.8GM, 12GM) TO BE DISP AT A MAX QTY OF 12GM IN 30 DAYS NITROLINGUAL (4.9GM) TO BE DISP AT A MAX QTY OF 5GM IN 30 DAYS NORDITROPIN FLEXPRO/NORDIFLEX 10MG/1.5 ML TO BE DISP AT A MAX QTY OF 42ML(28 PENS) IN 28 DAYS NORDITROPIN FLEXPRO/NORDIFLEX 15MG/1.5 ML TO BE DISP AT A MAX QTY OF 42ML(28 PENS) IN 28 DAYS NORDITROPIN FLEXPRO/NORDIFLEX 5MG/1.5 ML TO BE DISP AT A MAX QUANTITY OF 42ML(28 PENS) IN 28 DAYS NORDITROPIN NORDIFLEX 30MG/3 ML TO BE DISPENSED AT A MAXIMUM QUANTITY OF 84ML(28 PENS) IN 28 DAYS NOROXIN LIMITED TO A DAILY DOSE OF 2 TABLETS PER DAY NORVASC LIMITED TO A DAILY DOSE OF 1 TAB PER DAY NOXAFIL SUSPENSION TO BE DISP AT A MAXIMUM QTY OF 105 ML (1 BOTTLE) IN 30 DAYS NUCORT LOTION TO BE DISPENSED AT A MAX QTY 60 GRAMS (1 BOTTLE) IN 30 DAYS NUCYNTA LIMITED TO A DAILY DOSE OF 6 TABS PER DAY NULYTELY, OCL TO BE DISPENSED AT A MAXIMUM QUANTITY OF 4,050 ML IN 30 DAYS NUTROPIN 10MG VIAL TO BE DISP AT A MAX QTY OF 28 VIALS IN 28 DAYS NUTROPIN AQ 5MG/ML VIAL TO BE DISPENSED AT A MAXIMUM QUANTITY OF 56ML (28 VIALS) IN 28 DAYS NUTROPIN AQ NUSPIN 5MG/2ML TO BE DISPENSED AT A MAXIMUM QUANTITY OF 28 ML IN 28 DAYS NUTROPIN AQ/ NUSPIN 20 MG/2 ML TO BE DISPENSED AT A MAXIMUM QUANTITY OF 28 ML IN 28 DAYS NUTROPIN AQ\ NUSPIN 10MG/2ML CARTRIDGE TO BE DISPENSED AT A MAXIMUM QUANTITY OF 28 ML IN 28 DAYS NUVIGIL LIMITED TO A DAILY DOSE OF 1 TAB PER DAY

10 NYSTATIN 50,000,000 UNIT POWDER TO BE DISPENSED AT A MAXIMUM QUANTITY OF 1 UNIT IN 30 DAYS OLEPTRO LIMITED TO A DAILY DOSE OF 1 TAB PER DAY OMECLAMOX-PAK TO BE DISP AT MAX QTY OF 80 UNITS (1 PACK) PER 30 DAYS OMNARIS 50MCG TO BE DISPENSED AT A MAX QUANTITY OF 13GM (1 NASAL SPRAY DEVICE) IN 30 DAYS OMNITROPE 10 MG/1.5 ML CRTG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 42 ML (28 CRTGS) IN 28 DAYS OMNITROPE 5 MG/1.5 ML CRTG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 42 ML (28 CRTGS) IN 28 DAYS OMNITROPE 5.8 MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 28 VIALS IN 28 DAYS ONDANSETRON 24MG TO BE DISPENSED AT A MAX QUANTITY OF 6 TABLETS IN 30 DAYS ONGLYZA LIMITED TO A DAILY DOSE OF 1 TAB PER DAY ONMEL LIMITED TO A DAILY DOSE OF 1 TABLET PER DAY ONSOLIS LIMITED TO A DAILY DOSE OF 4 UNITS PER DAY OPANA ER, NUCYNTA ER LIMITED TO A DAILY DOSE OF 2 TABS PER DAY OPTIVAR 0.05% DROPS TO BE DISPENSED AT A MAXIMUM QUANTITY OF 6 ML (1 PACKAGE) IN 30 DAYS ORACEA LIMITED TO A DAILY DOSE OF 1 CAP PER DAY ORAMORPH SR 60MG LIMITED TO A DAILY DOSE OF 2 TABLETS PER DAY ORAVIG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 14 TABLETS IN 30 DAYS ORENCIA SYRINGE TO BE DISP AT A MAX QTY OF 4ML (4 SYR) IN 30 DAYS ORENCIA TO BE DISPENSED AT A MAXIMUM QUANTITY OF 4 VIALS IN 30 DAYS ORPHENADRINE ER 100MG LIMITED TO A DAILY DOSE OF 2 TABLETS PER DAY ORTHO EVRA PATCH TO BE DISPENSED AT A MAXIMUM QUANTITY OF 3 PATCHES IN 30 DAYS OTC ZYRTEC SYRUP TO BE DISPENSED AT A MAXIMUM QUANTITY OF 150ML IN 30 DAYS OVIDE TO BE DISPENSED AT A MAX OF 59ML IN 30 DAYS OXYBUTYNIN 5MG TABLETS LIMITED TO A DAILY DOSE OF 3 TABS PER DAY OXYBUTYNIN SYRUP LIMITED TO A DAILY DOSE OF 15 ML PER DAY OXYCODONE CONCENTRATE 20MG/ML TO BE DISP AT A MAX QTY OF 405 ML IN 30 DAYS OXYCONTIN LIMITED TO A DAILY DOSE OF 2 TABS PER DAY OXYTROL TO BE DISPENSED AT A MAX QUANTITY OF 8 PATCHES (1 BOX) IN 28 DAYS PARAFON FORTE 500MG LIMITED TO A DAILY DOSE OF 4 TABS PER DAY PARNATE 10MG LIMITED TO A DAILY DOSE OF 6 TABLETS PER DAY PATADAY 0.2% TO BE DISPENSED AT A MAXIMUM QUANTITY OF 3 ML (1 PACKAGE) IN 30 DAYS PATANASE 0.6% NASAL SPRAY TO BE DISPENSED AT A MAXIMUM QUANTITY OF 31 GM (1 PACKAGE) IN 30 DAYS PATANOL 0.1% TO BE DISPENSED AT A MAXIMUM QUANTITY OF 5 ML IN 30 DAYS PAXIL 10MG,20MG, PAXIL CR 12.5MG,37.5MG TABLETS LIMITED TO A DAILY DOSE OF 1 TAB PER DAY PAXIL 10MG/5 ML LIMITED TO A DAILY DOSE OF 20 ML PER DAY PAXIL 30MG, PAXIL CR 25MG TABLETS LIMITED TO A DAILY DOSE OF 2 TABS PER DAY PAXIL 40MG LIMITED TO A DAILY DOSE OF 1.5 TABS PER DAY PEGASYS/PROCLICK, PEGINTRON/REDIPEN TO BE DISPENSED AT A MAX QUANTITY OF 4 UNITS IN 28 DAYS PENLAC, CICLODAN TO BE DISPENSED AT A MAX OF 2 PRESCRIPTIONS IN 365 DAY PERIOD PENNSAID 1.5% TO BE DISPENSED AT A MAXIMUM QUANTITY OF 150 ML (1 BOTTLE) IN 30 DAYS PERFOROMIST TO BE DISPENSED AT A MAX QTY OF 120ML (60 VIALS) IN 30 DAYS PEXEVA 10MG, 20MG, 40MG LIMITED TO A DAILY DOSE OF 1 TAB/DAY PEXEVA 30MG LIMITED TO A DAILY DOSE OF 2 TABS PER DAY PLAVIX 300 MG TO BE DISP AT A MAXIMUM QTY OF 1 TABLET IN 30 DAYS PLAVIX 75 MG LIMITED TO A DAILY DOSE OF 1 TAB PER DAY PLENDIL LIMITED TO A DAILY DOSE OF 1 TAB PER DAY POLYETHYLENE GLYCOL 3350 PACKET TO BE DISPENSED AT A MAX QUANTITY OF 30 UNITS IN 30 DAYS POLYETHYLENE GLYCOL 3350 POWDER TO BE DISPENSED AT A MAX QUANTITY OF 540 GRAMS IN 30 DAYS PRADAXA LIMITED TO A DAILY DOSE OF 2 CAPS PER DAY PRANDIMET LIMITED TO A DAILY DOSE OF 2 TABS PER DAY PRANDIN 0.5MG, 1MG LIMITED TO A DAILY DOSE OF 4 TABS PER DAY PRANDIN 2MG LIMITED TO A DAILY DOSE OF 8 TABS PER DAY PRAVACHOL 10MG,20MG & 80MG LIMITED TO A DAILY DOSE OF 1 TAB PER DAY PRAVACHOL 40MG LIMITED TO A DAILY DOSE OF 1 TABLET PER DAY PREVACID LIMITED TO A DAILY DOSE OF 1 UNIT PER DAY PRILOSEC 10MG, 20MG & 40MG LIMITED TO A DAILY DOSE OF 1 CAP PER DAY

11 PRILOSEC/PREVACID OTC LIMITED TO A DAILY DOSE OF 2 TABS/CAPS PER DAY PRINIVIL/ZESTRIL 2.5MG, 5MG, 10MG, 20MG, 30MG LIMITED TO A DAILY DOSE OF 1 TAB PER DAY PRINIVIL/ZESTRIL 40MG LIMITED TO A DAILY DOSE OF 2 TABS PER DAY PRINZIDE/ZESTORETIC MG, MG LIMITED TO A DAILY DOSE OF 1 TAB PER DAY PROAIR HFA TO BE DISPENSED AT A MAX QUANTITY OF 17 GM (2 INHALERS) IN 30 DAYS PROCARDIA XL 60MG / ADALAT CC 60MG LIMITED TO A DAILY DOSE OF 2 TAB PER DAY PROCENTRA ORAL SOLUTION LIMITED TO A DAILY DOSE OF 60 ML PER DAY PROGLYCEM 50MG/ML TO BE DISPENSED AT A MAXIMUM QUANTITY OF 600ML IN 30 DAYS PROMETHAZINE W/ CODEINE, PROMETHAZINE W/ CODEINE VC TO BE DISP AT MAX 120ML PER DISPENSING PROSCAR LIMITED TO A DAILY DOSE OF 1 TAB PER DAY PROTONIX 40MG TABLET/SUSPENSION LIMITED TO A DAILY DOSE OF 1 UNIT PER DAY PROTONIX DR 20MG LIMITED TO A DAILY DOSE OF 1 TAB PER DAY PROTOPIC (30,60) TO BE DISPENSED AT A MAX OF 1 PRESCRIPTION IN ANY 23 DAY PERIOD PROVENTIL HFA, VENTOLIN TO BE DISP AT MAX QTY OF 14GM (2 INHALERS) IN 30 DAYS PROVIGIL LIMITED TO A DAILY DOSE OF 1 TAB PER DAY PROZAC 40MG LIMITED TO A DAILY DOSE OF 2 CAPSULES PER DAY PROZAC WEEKLY TO BE DISP AT A MAX QTY OF 4 CAPSULES IN 30 DAYS PULMICORT FLEXHALER TO BE DISPENSED AT A MAX QTY OF 1 INHALER IN 30 DAYS PULMICORT RESPULES TO BE DISPENSED AT A MAX QTY OF 120ML (60 AMPS) IN 30 DAYS PYLERA LIMITED TO A DAILY DOSE OF 12 CAPS PER DAY QNASL 80MCG NASAL SPRAY TO BE DISPENSED AT A MAXIMUM QUANTITY OF 9GM (1 CANISTER) IN 30 DAYS RANEXA 500MG, 1000MG LIMITED TO A DAILY DOSE OF 2 TABS/DAY RAPAFLO LIMITED TO A DAILY DOSE OF 1 CAP PER DAY RAZADYNE 4 MG/ML LIMITED TO A DAILY DOSE OF 6 ML PER DAY RAZADYNE ER LIMITED TO A DAILY DOSE OF 1 CAP PER DAY RAZADYNE TABLETS LIMITED TO A DAILY DOSE OF 2 TABS PER DAY REBETOL SOLUTION TO BE DISPENSED AT A MAX OF 500ML (5 BOTTLES) IN 30 DAYS REBIF REBIDOSE TO BE DISP AT A MAXIMUM QTY OF 6ML (12 INJECTORS) IN 30 DAYS RELENZA TO BE DISPENSED AT A MAX OF 2 PRESCRIPTIONS IN ANY 365 DAY PERIOD RELENZA TO BE DISPENSED AT A MAXIMUM QUANTITY OF 20 INHALATIONS (1 DISKHALER) IN 180 DAYS RELPAX TO BE DISP AT A MAX QTY OF 6 TABS IN 30 DAYS REMERON/SOLTAB LIMITED TO A DAILY DOSE OF 1 TAB PER DAY REQUIP XL 12MG LIMITED TO A DAILY DOSE OF 2 TAB PER DAY REQUIP XL 2MG,4MG,6MG,8MG LIMITED TO A DAILY DOSE OF 1 TAB PER DAY RESCULA TO BE DISP AT A MAXIMUM QTY OF 5ML (1 BOTTLE) IN 30 DAYS RESTORIL LIMITED TO A DAILY DOSE OF 1 CAP PER DAY RETIN-A/MICRO,ATRALIN,AVITA,TAZORAC GEL/CREAM,TRETIN-X CREAM DISP AT MAX OF 1 RX IN ANY 23DAY PERIO REVATIO TABLET LIMITED TO A DAILY DOSE OF 3 TABS PER DAY REYATAZ 100, 150, 300 MG LIMITED TO A DAILY DOSE OF 1 CAPSULE PER DAY RHINOCORT NASAL SPRAY TO BE DISPENSED AT A MAXIMUM QUANTITY OF 18 GRAMS (2 BOTTLES) IN 30 DAYS RISPERDAL CONSTA TO BE DISPENSED AT A MAXIMUM QUANTITY OF 2 SYRINGES IN 28 DAYS RISPERDAL ORAL SOLUTION LIMITED TO A DAILY DOSE OF 8 ML PER DAY RISPERDAL/M-TAB 0.25MG,0.5MG,1MG,2MG LIMITED TO A DAILY DOSE OF 2 TABS PER DAY RISPERDAL/M-TAB 3MG LIMITED TO A DAILY DOSE OF 3 TABS PER DAY RISPERDAL/M-TAB 4MG LIMITED TO A DAILY DOSE OF 4 TABS PER DAY RITALIN LA 10MG, 20MG, 40MG LIMITED TO A DAILY DOSE OF 1 CAPSULE PER DAY RITALIN LA 30MG LIMITED TO A DAILY DOSE OF 2 CAPSULES PER DAY RITALIN LIMITED TO A DAILY DOSE OF 3 TABLETS PER DAY ROBAXIN 500MG LIMITED TO A DAILY DOSE OF 9 TABLETS PER DAY ROBAXIN 750MG LIMITED TO A DAILY DOSE OF 6 TABLETS PER DAY ROWASA KIT TO BE DISPENSED AT MAX QTY OF 4 UNITS (28 BOTTLES) IN 30 DAYS ROXICET ORAL SOLUTION TO BE DISPENSED AT A MAXIMUM QUANTITY OF 1,800 ML IN 30 DAYS ROZEREM LIMITED TO A DAILY DOSE OF 1 TAB PER DAY RYZOLT ER LIMITED TO A DAILY DOSE OF 1 TAB PER DAY SAIZEN 8.8MG CLICK EASY CARTRIDGE TO BE DISPENSED AT A MAXIMUM QUANTITY OF 28 CARTRIDGES IN 28 DAY

12 SAIZEN/SEROSTIM/TEV-TROPIN/NUTROPIN 5MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 28 VIALS IN 28 DA SANCTURA LIMITED TO A DAILY DOSE OF 2 TABS PER DAY SANCTURA XR LIMITED TO A DAILY DOSE OF 1 CAP PER DAY SANCUSO TO BE DISPENSED AT A MAX QTY OF 1 PATCH IN 30 DAYS SAPHRIS LIMITED TO A DAILY DOSE OF 2 TABS PER DAY SAPHRIS TO BE DISP AT A MAXIMUM QTY OF 20 TABS IN 365 DAYS SARAFEM, RAPIFLUX LIMITED TO A DAILY DOSE OF 1 TAB/CAP PER DAY SAVELLA LIMITED TO A DAILY DOSE OF 2 TABS PER DAY SENSIPAR 30MG LIMITED TO A DAILY DOSE OF 3 TABS PER DAY SENSIPAR 60MG, 90MG LIMITED TO A DAILY DOSE OF 2 TABS PER DAY SEREVENT DISKUS TO BE DISP AT A MAXIMUM QTY OF 60 UNITS IN 30 DAYS SEROQUEL 25MG, 50MG, 100MG, 200MG LIMITED TO A DAILY DOSE OF 3 TABLETS PER DAY SEROQUEL 300MG LIMITED TO A DAILY DOSE OF 2 TABLETS PER DAY SEROQUEL 400MG, SEROQUEL XR 50MG, 300MG, 400MG LIMITED TO A DAILY DOSE OF 2 TABS/DAY SEROQUEL XR 200MG LIMITED TO A DAILY DOSE OF 1 TAB PER DAY SEROSTIM 4 MG TO BE DISP AT A MAX QTY OF 28 VIALS IN 28 DAYS SEROSTIM 6MG VIAL TO BE DISP AT A MAX QTY OF 28 VIALS IN 28 DAYS SHORT-ACTING NARCOTIC ANALGESICS TO BE DISP AT A MAX QTY OF 120 UNITS IN 30 DAYS SILENOR LIMITED TO A DAILY DOSE OF 1 TABLET PER DAY SIMCOR 1,000-40MG, MG LIMITED TO A DAILY DOSE OF 1 TAB PER DAY SIMCOR MG, MG, MG LIMITED TO A DAILY DOSE OF 2 TABS PER DAY SIMPONI TO BE DISP AT A MAX QTY OF 1 UNIT IN 30 DAYS SINGULAIR LIMITED TO A DAILY DOSE OF 1 UNIT PER DAY SKELAXIN LIMIT TO MAX QTY OF 56 TABS AT RETAIL OR MAIL; SKELAXIN TO BE DISPENSED AT A MAXIMUM QUANTITY OF 56 TABLETS IN 30 DAYS SOMA LIMITED TO A DAILY DOSE OF 3 TABS PER DAY SOMNOTE TO BE DISPENSED AT A MAXIMUM QUANTITY OF 25 CAPSULES IN 30 DAYS SONATA LIMITED TO A DAILY DOSE OF 1 CAP PER DAY SPIRIVA LIMITED TO A DAILY DOSE OF 1 CAP FOR INHALATION PER DAY SPORANOX 100MG LIMITED TO A DAILY DOSE OF 4 CAPS PER DAY SPRIX NASAL SPRAY TO BE DISPENSED AT A MAXIMUM QUANTITY OF 5 UNITS (5 BOTTLES) IN 30 DAYS STADOL NS TO BE DISP AT A MAXIMUM QTY OF 5ML (2 BOTTLE) IN 30 DAYS STARLIX LIMITED TO A DAILY DOSE OF 3 TABS PER DAY STELARA SYRINGE TO BE DISP AT A MAX QTY OF 1 SYRINGE IN 84 DAYS STRATTERA LIMITED TO A DAILY DOSE OF 1 CAPSULE PER DAY SUBOXONE 12MG-3MG LIMITED TO A DAILY DOSE OF 1 UNIT PER DAY SUBOXONE 12MG-3MG LIMITED TO A DAILY DOSE OF 2 UNITS PER DAY SUBOXONE 2MG-0.5MG, 4MG-1MG, 8MG-2MG OR SUBUTEX LIMITED TO A DAILY DOSE OF 3 UNITS PER DAY SUBOXONE 2MG-0.5MG, 4MG-1MG, 8MG-2MG,SUBUTEX OR ZUBSOLV LTD TO A DAILY DOSE OF 2 UNITS PER DAY SUBSYS 1,200 MCG SPRAY TO BE DISPENSED AT A MAXIMUM QUANTITY OF 360 UNITS IN 30 DAYS SUBSYS 1,600 MCG SPRAY TO BE DISPENSED AT A MAXIMUM QUANTITY OF 360 UNITS IN 30 DAYS SUBSYS 100 MCG SPRAY TO BE DISPENSED AT A MAXIMUM QUANTITY OF 360 UNITS IN 30 DAYS SUBSYS 200 MCG SPRAY TO BE DISPENSED AT A MAXIMUM QUANTITY OF 360 UNITS IN 30 DAYS SUBSYS 400 MCG SPRAY TO BE DISPENSED AT A MAXIMUM QUANTITY OF 360 UNITS IN 30 DAYS SUBSYS 600 MCG SPRAY TO BE DISPENSED AT A MAXIMUM QUANTITY OF 360 UNITS IN 30 DAYS SUBSYS 800 MCG SPRAY TO BE DISPENSED AT A MAXIMUM QUANTITY OF 360 UNITS IN 30 DAYS SULAR 10MG, 20MG, 40MG, 8.5MG, 17MG, 25.5MG, 34MG LIMITED TO A DAILY DOSE OF 1 TAB PER DAY SULAR 30MG LIMITED TO A DAILY DOSE OF 2 TAB PER DAY SUMAVEL DOSEPRO TO BE DISPENSED AT A MAXIMUM QUANTITY OF 3 ML (6 UNITS) IN 30 DAYS SUMAXIN CLEANSING PADS LIMITED TO A DAILY DOSE OF 2 UNITS PER DAY SUMAXIN WASH TO BE DISPENSED AT A MAXIMUM QUANTITY OF 480 ML (1 BOTTLE) IN 30 DAYS SYMBICORT TO BE DISP AT A MAX QTY OF 1 INHALER IN 30 DAYS SYMBICORT TO BE DISPENSED AT A MAX QUANTITY OF 11GM (1 INHALER) IN 30 DAYS SYMBYAX LIMITED TO A DAILY DOSE OF 1 CAP/DAY SYMLIN PEN 120 TO BE DISPENSED AT A MAX OF 11ML (4 PENS) IN 30 DAYS

13 SYMLIN PEN 60 TO BE DISPENSED AT A MAX OF 6ML (4PENS) IN 30 DAYS SYMLIN VIAL TO BE DISPENSED AT A MAX OF 20ML (4VIALS) IN 30 DAYS SYNAGIS TO BE DISPENSED AT A MAX QUANTITY OF 1 VIAL IN 26 DAYS SYNALAR CREAM/OINTMENT KIT TO BE DISP AT A MAX QTY OF 375GM (1 KIT) IN 30 DAYS TAMIFLU CAPSULES TO BE DISPENSED AT A MAX OF 2 PRESCRIPTIONS IN ANY 365 DAY PERIOD TAMIFLU CAPSULES TO BE DISPENSED AT A MAX QUANTITY OF 20 CAPS IN 30 DAYS TAMIFLU SUSPENSION TO BE DISP AT A MAX QTY OF 180ML IN 30 DAYS TAMIFLU SUSPENSION TO BE DISPENSED AT A MAX OF 2 PRESCRIPTIONS IN ANY 365 DAY PERIOD TARKA ER LIMITED TO A DAILY DOSE OF 1 TAB PER DAY TEKAMLO LIMITED TO A DAILY DOSE OF 1 TAB PER DAY TEKTURNA/TEKTURNA HCT LIMITED TO A DAILY DOSE OF 1 TAB PER DAY TENEX 1 MG LIMITED TO A DAILY DOSE OF 2 TABLETS PER DAY TENEX 2 MG LIMITED TO A DAILY DOSE OF 2 TABLETS PER DAY TESTIM 1% (50MG), TESTOSTERONE, VOGELXO GEL LIMIT TO A MAX QTY OF 150GM AT RETAIL TEVETEN 400MG LIMITED TO A DAILY DOSE OF 2 TABS PER DAY TEVETEN 600 MG, TEVETEN HCT LIMITED TO A DAILY DOSE OF 1 TAB PER DAY THALOMID 100MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 112 CAPSULES IN 28 DAYS THALOMID 150MG, 200MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 56 CAPSULES IN 28 DAYS THALOMID 50MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 224 CAPSULES IN 28 DAYS TINDAMAX 250 MG TO BE DISP AT A MAXIMUM QTY OF 24 TABS IN 30 DAYS TINDAMAX 500 MG TO BE DISP AT A MAXIMUM QTY OF 12 TABS IN 30 DAYS TOBI LIMITED TO MAX QTY OF 280ML PER DISPENSING AT RETAIL TOFRANIL 10MG LIMITED TO A DAILY DOSE OF 2 TABS PER DAY TOFRANIL 25MG LIMITED TO A DAILY DOSE OF 1 TAB PER DAY TOFRANIL 50MG LIMITED TO A DAILY DOSE OF 6 TABS PER DAY TOFRANIL-PM 100MG LIMITED TO A DAILY DOSE OF 3 CAPS PER DAY TOFRANIL-PM 125MG LIMITED TO A DAILY DOSE OF 2 CAPS PER DAY TOFRANIL-PM 150MG LIMITED TO A DAILY DOSE OF 2 CAPS PER DAY TOFRANIL-PM 75MG LIMITED TO A DAILY DOSE OF 1 CAP PER DAY TOPROL XL 200MG LIMITED TO A DAILY DOSE OF 2 TABS PER DAY TOPROL XL 25MG LIMITED TO A DAILY DOSE OF 1 TAB PER DAY TOPROL XL 50MG,100MG LIMITED TO A DAILY DOSE OF 1.5 TABS PER DAY TORADOL TO BE DISPENSED AT A MAX QUANTITY OF 20 TABLETS IN 30 DAYS TOVIAZ LIMITED TO A DAILY DOSE OF 1 TAB/DAY TRADJENTA LIMITED TO A DAILY DOSE OF 1 TABLET PER DAY TRAVATAN, TRAVATAN Z TO BE DISPENSED AT A MAX OF 3ML IN 30 DAYS TRAZODONE 100MG LIMITED TO A DAILY DOSE OF 3 TABLETS PER DAY TRAZODONE 150MG TABLET LIMITED TO A DAILY DOSE OF 3 TABLETS PER DAY TRAZODONE 300MG TABLET LIMITED TO A DAILY DOSE OF 2 TABLETS PER DAY TRAZODONE 50 MG LIMITED TO A DAILY DOSE OF 2 TABS PER DAY TREXIMET TO BE DISP AT A MAX QTY OF 9 TABS IN 30 DAYS TRIBENZOR LIMITED TO A DAILY DOSE OF 1 TABLET PER DAY TRICOR 48MG, 145MG LIMITED TO A DAILY DOSE OF 1 TABLET PER DAY TRIGLIDE, FENOGLIDE TABLETS LIMITED TO A DAILY DOSE OF 1 TAB PER DAY TUDORZA PRESSAIR LIMITED TO MAX QTY OF 1 INHALER AT RETAIL TWYNSTA LIMITED TO A DAILY DOSE OF 1 TAB PER DAY TYVASO LIMITED TO A DAILY DOSE OF 2.9 ML (1 AMPULE) PER DAY TYZEKA LIMITED TO A DAILY DOSE OF 1 TAB PER DAY ULESFIA LOTION TO BE DISPENSED AT A MAXIMUM QUANTITY OF 681 GRAMS (3 BOTTLES) IN 30 DAYS ULORIC LIMITED TO A DAILY DOSE OF 1 TAB PER DAY ULTRACET LIMITED TO A DAILY DOSE OF 8 TABS PER DAY ULTRAM 50 MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 240 TABLETS IN 30 DAYS ULTRAM ER LIMITED TO A DAILY DOSE OF 1 TAB PER DAY UNIRETIC LIMITED TO A DAILY DOSE OF 1 TAB PER DAY UNIVASC 15MG LIMITED TO A DAILY DOSE OF 2 TABS PER DAY

14 UNIVASC 7.5MG LIMITED TO A DAILY DOSE OF 1 TAB PER DAY URAMAXIN 45% UREA CREAM TO BE DISPENSED AT A MAXIMUM QUANTITY OF 255 GM (1 TUBE) IN 30 DAYS UROXATRAL LIMITED TO A DAILY DOSE OF 1 TAB PER DAY VALTREX 1GM TO BE DISP AT A MAXIMUM QTY OF 21 TABLETS IN 30 DAYS VALTREX 500 MG TO BE DISP AT A MAXIMUM QTY OF 42 CAPLETS IN 30 DAYS VALTURNA LIMITED TO A DAILY DOSE OF 1 TABLET PER DAY VANCOCIN 125MG TO BE DISP AT A MAX QUANTITY OF 56 CAPSULES IN 30 DAYS VANCOCIN 250MG TO BE DISP AT A MAX QUANTITY OF 40 CAPSULES IN 30 DAYS VASOTEC 2.5MG, 5MG, 10MG, ENALAPRIL-HCTZ MG LIMITED TO A DAILY DOSE OF 1 TAB PER DAY VASOTEC 20MG, VASERETIC 10-25MG LIMITED TO A DAILY DOSE OF 2 TABS PER DAY VECTICAL OINTMENT TO BE DISPENSED AT A MAX QUANTITY OF 100 GRAMS IN 30 DAYS VENLAFAXINE 100 MG LIMITED TO A DAILY DOSE OF 3 TABLETS PER DAY VENLAFAXINE 25MG LIMITED TO A DAILY DOSE OF 3 TABS PER DAY VENLAFAXINE 37.5MG LIMITED TO A DAILY DOSE OF 3 TABS PER DAY VENLAFAXINE 50MG LIMITED TO A DAILY DOSE OF 3 TABS PER DAY VENLAFAXINE 75MG LIMITED TO A DAILY DOSE OF 3 TABS PER DAY VENLAFAXINE ER 150 MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 30 TABLETS IN 30 DAYS VENLAFAXINE ER 37.5 MG LIMITED TO A DAILY DOSE OF 1 TAB PER DAY VENLAFAXINE ER 75 MG TAB LIMITED TO A DAILY DOSE OF 1 TAB PER DAY VENLAFAXINE HCL ER 225 MG TO BE DISP AT A MAXIMUM QTY OF 30 TABS IN 30 DAYS VENTOLIN HFA TO BE DISP AT MAXIMUM QTY OF 36 GM (2 INHALERS) IN 30 DAYS VERAMYST TO BE DISPENSED AT A MAXIMUM QUANTITY OF 10GM (1 BOTTLE) IN 30 DAYS VERELAN PM 100MG, 300, VERELAN 120, 180, 360 CALAN/ISOPTIN SR 120MG, COVERA HS LIMIT 1 TAB/DAY VERELAN PM 200MG, VERELAN 240MG CALAN/ISOPTIN SR 180MG, 240MG LIMITED TO DAILY DOSE OF 2 PER DAY VESICARE LIMITED TO A DAILY DOSE OF 1 TAB/DAY VFEND 50MG LIMITED TO A DAILY DOSE OF 4 TABS PER DAY VFEND TO BE DISP AT A MAX OF 14 DAYS SUPPLY IN 30 DAYS VICTOZA 18MG/3ML (9ML) LTD TO MAX OF 9 ML (3 PENS) PER DISP AT RETAIL OR 27 ML (9 PENS) AT MAIL VICTOZA TO BE DISPENSED AT A MAXIMUM QUANTITY OF 6ML (2 PENS) IN 30 DAYS VICTRELIS LIMITED TO A DAILY DOSE OF 12 CAPSULES PER DAY VIIBRYD 10 MG TABLET LIMITED TO A DAILY DOSE OF 1 TABLET PER DAY VIIBRYD 20 MG TABLET LIMITED TO A DAILY DOSE OF 1 TABLET PER DAY VIIBRYD 40 MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 30 TABS IN 30 DAYS VIIBRYD TITRATION PACK TO BE DISPENSED AT A MAXIMUM QUANTITY OF 30 TABS (1 PACKAGE) PER 365 DAYS VIMOVO LIMITED TO A DAILY DOSE OF 2 TABLETS PER DAY VOLTAREN GEL TO BE DISP AT A MAXIMUM QTY OF 200GM (2 TUBES) IN 30 DAYS VUSION OINTMENT TO BE DISPENSED AT MAX QTY OF 50 GRAMS IN 30 DAYS VYTORIN LIMITED TO A DAILY DOSE OF 1 TAB PER DAY VYVANSE LIMITED TO A DAILY DOSE OF 1 CAPSULE PER DAY WELLBUTRIN 100 MG LIMITED TO A DAILY DOSE OF 4 TABS PER DAY WELLBUTRIN 75 MG LIMITED TO A DAILY DOSE OF 4 TABS PER DAY WELLBUTRIN SR 100 MG LIMITED TO A DAILY DOSE OF 2 TABS PER DAY WELLBUTRIN SR 200MG LIMITED TO A DAILY DOSE OF 2 TABS PER DAY WELLBUTRIN XL TABLET LIMITED TO A DAILY DOSE OF 1 TAB PER DAY XALATAN TO BE DISPENSED AT A MAX OF 3ML IN 30 DAYS XARELTO 10 MG TO BE DISP AT A MAXIMUM QTY OF 30 TABS IN 30 DAYS XARELTO 15MG LIMITED TO A DAILY DOSE OF 2 TABLETS PER DAY XARELTO 15MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 42 TABS IN 30 DAYS XARELTO 20 MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 30 TABS IN 30 DAYS XELJANZ LIMITED TO A DAILY DOSE OF 2 TABLETS PER DAY XIFAXAN 200MG TO BE DISP AT A MAXIMUM QTY OF 9 TABLETS IN 30 DAYS XIFAXAN 550MG LIMITED TO A DAILY DOSE OF 2 TABLETS PER DAY XOPENEX (.31MG,.63MG,OR 1.25MG/3ML) TO BE DISP AT A MAX QTY OF 216ML (72 VIALS) IN 30 DAYS XOPENEX 1.25MG/0.5ML VIALS TO BE DISP AT A MAX QTY OF 90 VIALS IN 30 DAYS XOPENEX HFA TO BE DISP AT A MAXIMUM QTY OF 30GM (2 INHALERS) IN 30 DAYS

15 XYLOCAINE 2% JELLY TO BE DISPENSED AT A MAX QTY OF 20ML IN 30 DAYS XYZAL 2.5 MG/5 ML TO BE DISPENSED AT A MAXIMUM QUANTITY OF 300 ML IN 30 DAYS XYZAL LIMITED TO A DAILY DOSE OF 1 TAB PER DAY ZADITOR 0.025% EYE DROPS TO BE DISPENSED AT A MAXIMUM QUANTITY OF 1 PACKAGE IN 30 DAYS ZAMICET MG/15 ML TO BE DISPENSED AT A MAXIMUM QUANTITY OF 2700 ML IN 30 DAYS ZANAFLEX 2MG, 4MG LIMITED TO A DAILY DOSE OF 9 TABS/CAPS PER DAY ZANAFLEX 6MG LIMITED TO A DAILY DOSE OF 6 CAPS PER DAY ZEBETA 10MG LIMITED TO A DAILY DOSE OF 4 TABS PER DAY ZEBETA 5MG LIMITED TO A DAILY DOSE OF 1 TAB PER DAY ZEGERID LIMITED TO A DAILY DOSE OF 1 UNIT PER DAY ZELAPAR LIMITED TO A DAILY DOSE OF 2 TABS PER DAY ZEMPLAR CAPSULES LIMITED TO A DAILY DOSE OF 1 CAP PER DAY ZESTORETIC 20-25MG LIMITED TO A DAILY DOSE OF 2 TABS PER DAY ZETIA LIMITED TO A DAILY DOSE OF 1 TAB PER DAY ZETONNA TO BE DISPENSED AT A MAX QTY OF 7GM IN 30 DAYS ZIOPTAN LIMITED TO A DAILY DOSE OF 1 UNIT PER DAY ZITHROMAX 1 GM LIMITED TO MAX QTY OF 2 PACKETS PER DISPENSING AT RETAIL ZITHROMAX 500MG TABLETS LIMITED TO MAX QTY OF 4 TABLETS PER DISPENSING AT RETAIL ZITHROMAX 600MG LIMITED TO MAX QTY OF 8 TABLETS PER DISPENSING AT RETAIL ZITHROMAX SUSPENSION (15) LIMITED TO MAX QTY OF 30ML PER DISPENSING AT RETAIL ZITHROMAX SUSPENSION (22.5ML) LIMITED TO MAX QTY OF 45ML PER DISPENSING AT RETAIL ZITHROMAX SUSPENSION (30ML) LIMITED TO MAX QTY OF 60ML PER DISPENSING AT RETAIL ZITHROMAX TRI-PAK LIMITED TO MAX QTY OF 3 TABLETS PER DISPENSING AT RETAIL ZITHROMAX/Z-PAK 250MG LIMITED TO A MAX QUANTITY OF 8 TABLETS PER DISPENSING AT RETAIL ZMAX SUSPENSION TO BE DISP AT A MAX QTY OF 2 BOTTLES PER DISPENSING AT RETAIL ZOCOR LIMITED TO A DAILY DOSE OF 1 TAB PER DAY ZOFRAN SOLUTION TO BE DISP AT A MAX QTY OF 50ML (1 BOTTLE) IN 30 DAYS ZOFRAN/ODT 4MG, 8MG TO BE DISP AT A MAX QTY OF 30 TABS IN 30 DAYS ZOLOFT 100MG LIMITED TO A DAILY DOSE OF 2 TABS PER DAY ZOLOFT 20MG/ML ORAL CONCENTRATE LIMITED TO A DAILY DOSE OF 10 ML PER DAY ZOLOFT 25MG, 50MG LIMITED TO A DAILY DOSE OF 1.5 TABS PER DAY ZOLPIMIST ORAL SPRAY TO BE DISPENSED AT A MAX QUANTITY OF 8ML (1 CANISTER) IN 30 DAYS ZOLVIT 10MG-300MG/15ML SOLN TO BE DISPENSED AT A MAXIMUM QUANTITY OF 200 ML IN 30 DAYS ZOMIG NASAL SPRAY TO BE DISP AT A MAX QTY OF 6 UNITS IN 30 DAYS ZOMIG/ZOMIG ZMT 2.5MG TO BE DISP AT A MAX QTY OF 6 TABS IN 30 DAYS ZOMIG/ZOMIG ZMT 5MG TO BE DISP AT A MAX QTY OF 3 TABS IN 30 DAYS ZONEGRAN 25MG, 50MG LIMITED TO A DAILY DOSE OF 1 CAP/DAY ZORBTIVE, SAIZEN 8.8 MG TO BE DISPENSED AT A MAXIMUM QUANTITY OF 28 VIALS IN 30 DAYS ZOVIRAX 5% CREAM TO BE DISPENSED AT A MAXIMUM QUANTITY OF 5 GRAMS (1 TUBE) IN 30 DAYS ZOVIRAX 5% OINTMENT TO BE DISPENSED AT A MAXIMUM QUANTITY OF 30 GRAMS (1 TUBE) IN 30 DAYS ZOVIRAX TO BE DISPENSED AT A MAXIMUM QUANTITY OF 50 CAPS/TABS IN 10 DAYS ZUPLENZ SOLUBLE FILM TO BE DISPENSED AT A MAXIMUM QUANTITY OF 30 UNITS (3 BOXES) IN 30 DAYS ZYBAN TO BE DISP AT A MAX OF 180 DAYS SUPPLY IN ANY 365 DAY PERIOD ;; ZYCLARA 2.5% CREAM PUMP TO BE DISPENSED AT A MAXIMUM QUANTITY OF 8GM (1 BOTTLE) IN 28 DAYS ZYCLARA 3.75% CREAM PUMP TO BE DISPENSED AT A MAXIMUM QUANTITY OF 8GM (1 BOTTLE) IN 28 DAYS ZYCLARA 3.75% CREAM TO BE DISPENSED AT A MAXIMUM QUANTITY OF 28 PACKETS (1 PACKAGE) IN 28 DAYS ZYFLO LIMITED TO A DAILY DOSE OF 4 TABS PER DAY ZYPREXA RELPREVV (210MG & 300MG) TO BE DISPENSED AT A MAX QUANTITY OF 2 VIALS IN 28 DAYS ZYPREXA RELPREVV 405MG TO BE DISPENSED AT A MAX QUANTITY OF 1 VIAL IN 28 DAYS ZYPREXA VIAL LIMITED TO A MAX QUANTITY OF 1 VIAL PER DISPENSING AT RETAIL OR MAIL ZYPREXA, ZYPREXA ZYDIS LIMITED TO A DAILY DOSE OF 1 TAB PER DAY ZYRTEC 5MG, 10MG LIMITED TO A DAILY DOSE OF 1 TAB/CAP PER DAY ZYRTEC ORAL SOLN, CLARITIN ORAL SOLN TO BE DISPENSED AT A MAXIMUM QUANTITY OF 300ML IN 30 DAYS ZYRTEC-D LIMITED TO A DAILY DOSE OF 2 TABS PER DAY

16 F 2 UNITS IN 30 D

17 IN 30 DAYS IN 90 DAYS 2 UNITS PER DAY Y OF 150 GM IN 30 DAYS E OF 5 GM PER DAY

18 306 IN 68 DAYS ) IN 30 DAYS AX QTY OF 480ML IN 30 L IN 30 DAYS E OF 4 TABS PER DAY 0 TABS/CAPS IN 30DAYS

19 AP PER DAY AB PER DAY 30 DAYS IN 30 DAYS /TABS PER DAY

20 9GM AT MAIL