Generic Pharmacy Discount

Transcription

1 Generic Pharmacy Discount 83 Park Place Blvd Suite 101 Clearwater, FL Fourth Quarter

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3 Pharmacies Generic Discount Program Information Enclosed information provided ONLY as educational by Brown & Brown of Florida, Inc. What is all the talk about cheap or free generic drugs? When you pick up your next prescription, you may be told a generic equivalent was substituted for the brand name drug. A generic is a medication that has the same active ingredient as the brand name drug, but costs less. With patents on brand name drugs expiring every year, the number of generics on the market will keep increasing. This means savings for you! Why do generics cost less? Brand name drug companies pay millions of dollars over many years researching a new drug product. Once the patent of the brand name drug has expired, other manufacturers are allowed to enter the market with their generic product. Because these manufacturers can skip the research step and move right into manufacturing, they realize significant savings that they pass on to the patient. Are there any differences between brand name and generic drugs? Generics may look different than brand name drugs, but they still contain the same active ingredient. There can be very small differences in the amount of active ingredient, but the FDA puts limits on the variations. How do I get generics prescribed to me? Your doctor can determine whether or not a generic can be substituted for the brand name drug. Be sure to ask your pharmacist if a generic product has been substituted for the brand name drug when they fill your prescription. I have seen some pharmacies advertise $4 generics. Are all generic drugs on this list? No. Although a brand name drug may have a generic, it does not guarantee that the generic will be $4. Check out your pharmacy s specific conditions for more information on what is on this list. 3nd Quarter 2014 West Central Florida Table of Contents Publix FREE Medications 1 CVS 2-4 Kmart Rx Savings Club 5-13 Target Walgreens Savings Club Walmart Winn Dixie DISCLAIMER Brown & Brown provides this discount guide as a service to the employees of our client employers. Our first recommendation is to go to each providers online website for the most current and up-to-date information. The websites are listed on the back. We do not officially sanction one provider over another nor do we deem these as the only acceptable providers in the pharmacy marketplace. We provide this information for illustrative purposes only. It is the employee s responsibility to ensure that the information is correct per the providers website and discussion with the pharmacy staff prior to filling the prescription.

4 Free medications now including amlodipine! At Publix, we're always looking for ways to make your life easier and that includes helping you manage healthcare costs. That's why we offer a variety of some of the most-often prescribed medications absolutely free for as long as your doctor prescribes. It doesn't matter who your prescription insurance provider is, or how many prescriptions you need filled. There's no limit to the number of refills; there are no forms to fill out. Just drop your qualifying prescription off at your neighborhood Publix Pharmacy and get the generic medication you need free. Bet you're feeling better already. Now! FREE amlodipine This calcium channel blocker is used to treat high blood pressure and chest pain (angina). Thirty-day supply at a time. (Up to mg or 5-mg tablets, or mg tablets. Amlodipine combination products excluded.) FREE lisinopril An ACE inhibitor, lisinopril is used to prevent, treat, or improve symptoms of high blood pressure, certain heart conditions, diabetes, and certain chronic kidney conditions. Thirty-day supply (up to 60 tablets) at a time. Lisinopril- HCTZ combination products excluded. FREE antibiotics Get up to a 14-day supply of the following generic oral antibiotics free: Amoxicillin Ampicillin Sulfamethoxazole/Trimethoprim (SMZ-TMP) Ciprofloxacin (excluding Ciprofloxacin XR) Penicillin VK FREE metformin As part of our Publix Pharmacy Diabetes Management System, you can get generic immediate-release metformin FREE. Thirty-day supply at a time (up to mg tablets, or mg or 1000-mg tablets). Certain restrictions may apply. Please see your pharmacist for details. Publix reserves the right to modify the terms of, and medications covered by, the Publix Pharmacy free medications program at any time, and such terms are subject to change without advance notice. 1

5 November 2013 $ $ for 90 days* hundreds of generic medications Health Savings Pass medication list Sign up now to save on prescriptions. Plus 10% off at MinuteClinic. ALLERGY QTY FEXOFENADINE HCL 30 MG TAB HYDROXYZINE HCL 10 MG/5 ML SYRUP HYDROXYZINE PAMOATE 25 MG CAP LORATADINE 10 MG TAB PROMETHAZINE HCL 12.5 MG TAB PROMETHAZINE HCL 25 MG TAB** PROMETHAZINE HCL 6.25MG/5ML SYRUP** ANTIBIOTICS & ANTI-INFECTIVES QTY ACYCLOVIR 200 MG CAP CLINDAMYCIN PHOSPHATE 1% SOLN ISONIAZID 300 MG TAB POLYMYXIN B SULF/TRIMETHOPRIM 10K/ML-0.1 DROPS** ARTHRITIS & PAIN QTY BACLOFEN 10 MG TAB CHLORZOXAZONE 500 MG TAB CYCLOBENZAPRINE HCL 5 MG TAB CYCLOBENZAPRINE HCL 10 MG TAB IBUPROFEN 100 MG/5ML SUSP** IBUPROFEN 400 MG TAB IBUPROFEN 600 MG TAB IBUPROFEN 800 MG TAB INDOMETHACIN 25 MG CAP** INDOMETHACIN 50 MG CAP KETOPROFEN 50 MG CAP KETOPROFEN 75 MG CAP MELOXICAM 7.5 MG TAB MELOXICAM 15 MG TAB METHOCARBAMOL 500 MG TAB NAPROXEN 250 MG TAB NAPROXEN 375 MG TAB** NAPROXEN 500 MG TAB** NAPROXEN SODIUM 275 MG TAB NAPROXEN SODIUM 550 MG TAB TIZANIDINE HCL 2 MG TAB TIZANIDINE HCL 4 MG TAB ASTHMA QTY ALBUTEROL SULFATE 2 MG/5 ML SYRUP ALBUTEROL SULFATE 5 MG/ML SOLN IPRATROPIUM BROMIDE 0.2 MG/ML SOLN** THEOPHYLLINE ANHYDROUS 100 MG TAB THEOPHYLLINE ANHYDROUS 200 MG TAB DIABETES QTY GLIMEPIRIDE 1 MG TAB GLIMEPIRIDE 2 MG TAB GLIMEPIRIDE 4 MG TAB GLIPIZIDE 5 MG TAB GLIPIZIDE 10 MG TAB** GLYBURIDE 1.25 MG TAB GLYBURIDE 2.5 MG TAB GLYBURIDE 5 MG TAB GLYBURIDE, MICRONIZED 1.5 MG TAB GLYBURIDE, MICRONIZED 3 MG TAB GLYBURIDE, MICRONIZED 6 MG TAB GLYBURIDE/METFORMIN HCL 5 MG-500MG TAB METFORMIN HCL 500 MG TAB** METFORMIN HCL 850 MG TAB METFORMIN HCL 1000 MG TAB** METFORMIN HCL ER 500 MG TAB FUNGAL INFECTIONS QTY FLUCONAZOLE 100 MG TAB FLUCONAZOLE 200 MG TAB TERBINAFINE HCL 250 MG TAB** GASTROINTESTINAL HEALTH QTY CIMETIDINE 300 MG TAB CIMETIDINE 400 MG TAB DICYCLOMINE HCL 10 MG CAP DICYCLOMINE HCL 20 MG TAB FAMOTIDINE 20 MG TAB FAMOTIDINE 40 MG TAB LACTULOSE 10 G/15 ML SOLN MECLIZINE HCL 12.5 MG TAB METOCLOPRAMIDE HCL 5 MG TAB METOCLOPRAMIDE HCL 10 MG TAB METOCLOPRAMIDE HCL 5 MG/5 ML SOLN PHENOBARB/HYOSCY/ATROPINE/SCOP 16.2 MG TAB PROCHLORPERAZINE MALEATE 5 MG TAB PROCHLORPERAZINE MALEATE 10 MG TAB RANITIDINE HCL 150 MG TAB RANITIDINE HCL 300 MG TAB GLAUCOMA & EYE CARE QTY ATROPINE SULFATE 1 % DROPS CYCLOPENTOLATE HCL 1 % DROPS FLURBIPROFEN SODIUM 0.03 % DROPS LEVOBUNOLOL HCL 0.5 % DROPS TIMOLOL MALEATE 0.25 % DROPS TIMOLOL MALEATE 0.5 % DROPS HEART HEALTH & BLOOD PRESSURE..... QTY AMILORIDE/HCTZ 5MG-50MG TAB AMIODARONE HCL 200 MG TAB ATENOLOL 25 MG TAB ATENOLOL 50 MG TAB ATENOLOL 100 MG TAB ATENOLOL/CHLORTHALIDONE 50 MG-25MG TAB ATENOLOL/CHLORTHALIDONE 100MG-25MG TAB BENAZEPRIL HCL 5 MG TAB BENAZEPRIL HCL 10 MG TAB BENAZEPRIL HCL 20 MG TAB BENAZEPRIL HCL 40 MG TAB BENAZEPRIL/HCTZ MG TAB BENAZEPRIL/HCTZ MG TAB BENAZEPRIL/HCTZ 20-25MG TAB BISOPROLOL FUMARATE/HCTZ MG TAB.. 90 BISOPROLOL FUMARATE/HCTZ MG TAB.. 90 BISOPROLOL FUMARATE/HCTZ MG TAB.. 90 BUMETANIDE 0.5 MG TAB BUMETANIDE 1 MG TAB BUMETANIDE 2 MG TAB CAPTOPRIL 12.5 MG TAB CAPTOPRIL 25 MG TAB CAPTOPRIL 50 MG TAB CAPTOPRIL 100 MG TAB CARVEDILOL MG TAB CARVEDILOL 6.25 MG TAB CARVEDILOL 12.5 MG TAB CARVEDILOL 25 MG TAB** CHLORTHALIDONE 25 MG TAB CHLORTHALIDONE 50 MG TAB CLONIDINE HCL 0.1 MG TAB CLONIDINE HCL 0.2 MG TAB CLONIDINE HCL 0.3 MG TAB DIGOXIN 125 MCG TAB DIGOXIN 250 MCG TAB DILTIAZEM HCL 120 MG CAP DILTIAZEM HCL 30 MG TAB It s easy to enroll: in store or online at 1 2

6 November 2013 HEART HEALTH & BLOOD PRESSURE (cont.).. QTY DILTIAZEM HCL 60 MG TAB DILTIAZEM HCL 90 MG TAB** DILTIAZEM HCL 120 MG TAB DOXAZOSIN MESYLATE 1 MG TAB DOXAZOSIN MESYLATE 2 MG TAB DOXAZOSIN MESYLATE 4 MG TAB DOXAZOSIN MESYLATE 8 MG TAB ENALAPRIL MALEATE 5 MG TAB ENALAPRIL MALEATE 2.5 MG TAB ENALAPRIL MALEATE 10 MG TAB ENALAPRIL MALEATE 20 MG TAB ENALAPRIL-HCTZ MG TAB ENALAPRIL-HCTZ MG TAB FOSINOPRIL SODIUM 10 MG TAB FOSINOPRIL SODIUM 20 MG TAB FOSINOPRIL SODIUM 40 MG TAB FUROSEMIDE 20 MG TAB FUROSEMIDE 40 MG TAB FUROSEMIDE 80 MG TAB GUANFACINE HCL 1 MG TAB GUANFACINE HCL 2 MG TAB HYDRALAZINE HCL 10 MG TAB HYDRALAZINE HCL 25 MG TAB HYDROCHLOROTHIAZIDE 12.5 MG CAP** HYDROCHLOROTHIAZIDE 25 MG TAB HYDROCHLOROTHIAZIDE 50 MG TAB INDAPAMIDE 1.25 MG TAB INDAPAMIDE 2.5 MG TAB ISOSORBIDE MONONITRATE 20 MG TAB ISOSORBIDE MONONITRATE 30 MG TAB ISOSORBIDE MONONITRATE 60 MG TAB LISINOPRIL 2.5 MG TAB LISINOPRIL 5 MG TAB LISINOPRIL 10 MG TAB LISINOPRIL 20 MG TAB LISINOPRIL 30 MG TAB LISINOPRIL 40 MG TAB LISINOPRIL-HCTZ MG TAB LISINOPRIL-HCTZ MG TAB** LISINOPRIL-HCTZ MG TAB** LOVASTATIN 10 MG TAB LOVASTATIN 20 MG TAB** LOVASTATIN 40 MG TAB METHYLDOPA 250 MG TAB** METHYLDOPA 500 MG TAB** METOLAZONE 2.5 MG TAB METOLAZONE 5 MG TAB METOPROLOL TARTRATE 25 MG TAB METOPROLOL TARTRATE 50 MG TAB METOPROLOL TARTRATE 100 MG TAB** NADOLOL 20 MG TAB NADOLOL 40 MG TAB PRAVASTATIN SODIUM 10 MG TAB PRAVASTATIN SODIUM 20 MG TAB PRAVASTATIN SODIUM 40 MG TAB** PRAZOSIN HCL 1 MG CAP PRAZOSIN HCL 2 MG CAP PROPRANOLOL HCL 10 MG TAB PROPRANOLOL HCL 20 MG TAB PROPRANOLOL HCL 40 MG TAB PROPRANOLOL HCL 80 MG TAB QUINAPRIL HCL 5 MG TAB QUINAPRIL HCL 10 MG TAB QUINAPRIL HCL 20 MG TAB QUINAPRIL HCL 40 MG TAB SOTALOL HCL 80 MG TAB** SPIRONOLACTONE 25 MG TAB** TERAZOSIN HCL 1 MG CAP TERAZOSIN HCL 2 MG CAP TERAZOSIN HCL 5 MG CAP TERAZOSIN HCL 10 MG CAP TORSEMIDE 10 MG TAB TORSEMIDE 20 MG TAB TRIAMTERENE/HCTZ MG CAP TRIAMTERENE/HCTZ 75/50 TAB TRIAMTERENE-HCTZ MG TAB VERAPAMIL HCL 80 MG TAB VERAPAMIL HCL 120 MG TAB VERAPAMIL HCL 180 MG TAB VERAPAMIL HCL 240 MG TAB WARFARIN SODIUM 1 MG TAB WARFARIN SODIUM 2 MG TAB WARFARIN SODIUM 2.5 MG TAB WARFARIN SODIUM 3 MG TAB WARFARIN SODIUM 4 MG TAB WARFARIN SODIUM 5 MG TAB** WARFARIN SODIUM 6 MG TAB WARFARIN SODIUM 7.5 MG TAB WARFARIN SODIUM 10 MG TAB MENTAL HEALTH QTY AMITRIPTYLINE HCL 10 MG TAB AMITRIPTYLINE HCL 25 MG TAB AMITRIPTYLINE HCL 50 MG TAB AMITRIPTYLINE HCL 75 MG TAB AMITRIPTYLINE HCL 100 MG TAB AMITRIPTYLINE HCL 150 MG TAB BENZTROPINE MESYLATE 0.5 MG TAB BENZTROPINE MESYLATE 1 MG TAB BENZTROPINE MESYLATE 2 MG TAB BUSPIRONE HCL 5 MG TAB BUSPIRONE HCL 10 MG TAB** BUSPIRONE HCL 15 MG TAB CARBAMAZEPINE 200 MG TAB** CITALOPRAM HBR 10 MG TAB CITALOPRAM HBR 20 MG TAB CITALOPRAM HBR 40 MG TAB DOXEPIN HCL 10 MG CAP DOXEPIN HCL 25 MG CAP DOXEPIN HCL 50 MG CAP DOXEPIN HCL 75 MG CAP DOXEPIN HCL 100 MG CAP FLUOXETINE HCL 10 MG CAP FLUOXETINE HCL 20 MG CAP FLUOXETINE HCL 40 MG CAP FLUOXETINE HCL 10 MG TAB** FLUPHENAZINE HCL 1 MG TAB FLUPHENAZINE HCL 5 MG TAB GABAPENTIN 100 MG CAP HALOPERIDOL 0.5 MG TAB HALOPERIDOL 1 MG TAB HALOPERIDOL 2 MG TAB HALOPERIDOL 5 MG TAB IMIPRAMINE HCL 10 MG TAB IMIPRAMINE HCL 25 MG TAB LITHIUM CARBONATE 300 MG CAP** MIRTAZAPINE 15 MG TAB NORTRIPTYLINE HCL 10 MG CAP NORTRIPTYLINE HCL 25 MG CAP NORTRIPTYLINE HCL 75 MG CAP PAROXETINE HCL 10 MG TAB** PAROXETINE HCL 20 MG TAB** PAROXETINE HCL 30 MG TAB PAROXETINE HCL 40 MG TAB SERTRALINE HCL 25 MG TAB THIORIDAZINE HCL 10 MG TAB THIORIDAZINE HCL 25 MG TAB THIORIDAZINE HCL 50 MG TAB THIOTHIXENE 2 MG CAP TRAZODONE HCL 50 MG TAB TRAZODONE HCL 100 MG TAB TRAZODONE HCL 150 MG TAB TRIHEXYPHENIDYL HCL 2 MG TAB ZONISAMIDE 25 MG CAP OTHER MEDICAL CONDITIONS QTY ALLOPURINOL 100 MG TAB ALLOPURINOL 300 MG TAB CHLORHEXIDINE GLUCONATE 0.12% MOUTHWASH DEXAMETHASONE 0.5 MG TAB DEXAMETHASONE 0.75 MG TAB DEXAMETHASONE 4 MG TAB LIDOCAINE HCL 20 MG/ML SOLN OXYBUTYNIN CHLORIDE 5 MG TAB PREDNISONE 1 MG TAB PREDNISONE 2.5 MG TAB PREDNISONE 5 MG TAB PREDNISONE 5 MG TAB** PREDNISONE 10 MG TAB PREDNISONE 10 MG TAB** SKIN CONDITIONS QTY FLUOCINOLONE ACETONIDE % CRM HYDROCORTISONE 1% CRM HYDROCORTISONE 2.5% CRM HYDROCORTISONE 2.5% OINT TRIAMCINOLONE ACETONIDE 0.5% CRM TRIAMCINOLONE ACETONIDE 0.1% OINT TRIAMCINOLONE ACETONIDE 0.5% OINT It s easy to enroll: in store or online at 2 3

7 November 2013 THYROID CONDITIONS QTY LEVOTHYROXINE 25 MCG TAB LEVOTHYROXINE 50 MCG TAB LEVOTHYROXINE 75 MCG TAB LEVOTHYROXINE 88 MCG TAB LEVOTHYROXINE 100 MCG TAB LEVOTHYROXINE 112 MCG TAB LEVOTHYROXINE 125 MCG TAB LEVOTHYROXINE 137 MCG TAB LEVOTHYROXINE 150 MCG TAB LEVOTHYROXINE 175 MCG TAB** LEVOTHYROXINE 200 MCG TAB** VITAMINS & NUTRITIONAL HEALTH QTY CITRIC ACID/SODIUM CITRATE MG SOLN FLUORIDE/IRON/VIT A,C&D 0.25 MG/ML DROPS FOLIC ACID 1 MG TAB MAGNESIUM CHLORIDE 64 MG TAB** MAGNESIUM OXIDE 400 MG TAB MULTIVITAMINS WITH MIN NO.7/FA 1 MG CAP MULTIVITS WITH IRON & FLUORIDE 0.25 MG/ML DROPS PHOSPHORUS #1 250 MG TAB POTASSIUM CHLORIDE 10 MEQ TAB POTASSIUM CHLORIDE 20MEQ/15ML LIQUID POTASSIUM CHLORIDE 40MEQ/15ML LIQUID POTASSIUM CITRATE/CITRIC ACID /5 SOLN PRENATABS RX TAB PRENATAL 1/1 TAB PRENATAL CARE TAB PRENATAL PLUS TAB PRENATAL RX 1 TAB PRENATAL RX TAB** SODIUM FLUORIDE 0.2 % SOLN SODIUM FLUORIDE 0.5 (1.1)MG TAB SODIUM FLUORIDE 1MG (2.2MG) TAB ULTRA NATALCARE TAB WOMEN S HEALTH QTY ESTRADIOL 0.5 MG TAB ESTRADIOL 1 MG TAB ESTRADIOL 2 MG TAB ESTROPIPATE 0.75 MG TAB ESTROPIPATE 1.5 MG TAB** MEDROXYPROGESTERONE 10 MG TAB MEDROXYPROGESTERONE 2.5 MG TAB MEDROXYPROGESTERONE 5 MG TAB MEGESTROL ACETATE 20 MG TAB** WOMEN S HEALTH ($25.99) QTY ALENDRONATE SODIUM 35 MG TAB ALENDRONATE SODIUM 70 MG TAB TAMOXIFEN CITRATE 10 MG TAB TAMOXIFEN CITRATE 20 MG TAB $10.99 for 30 days ANTIBIOTICS & ANTI-INFECTIVES ($10.99).. QTY AMOXICILLIN 250 MG CAP AMOXICILLIN 500 MG CAP AMOXICILLIN 125 MG/5ML SUSP AMOXICILLIN 200 MG/5ML SUSP AMOXICILLIN 250 MG/5ML SUSP AMOXICILLIN 400 MG/5ML SUSP CEPHALEXIN 250 MG CAP CEPHALEXIN 500 MG CAP CIPROFLOXACIN HCL 250 MG TAB CIPROFLOXACIN HCL 500 MG TAB METRONIDAZOLE 250 MG TAB METRONIDAZOLE 500 MG TAB PENICILLIN V POTASSIUM 125 MG/5ML SOLN PENICILLIN V POTASSIUM 250 MG TAB PENICILLIN V POTASSIUM 250 MG/5ML SOLN SMZ/TMP MG/5 SUSP SMZ/TMP 400MG-80MG TAB SMZ/TMP MG TAB SULFAMETHOXAZOLE/TRIMETHOPRIM /20 SUSP TETRACYCLINE HCL 250 MG CAP TETRACYCLINE HCL 500 MG CAP $29.99 for 30 days DIABETES ($29.99) QTY BLOOD SUGAR DIAGNOSTIC STRIP *The day supply is based upon the average dispensing patterns for the specifi c drug and strength. ** These drugs may be priced higher in HI, MN, MT, PA, TN, and WI. Disclosures: Except in the states of Washington and California, these are custom-branded programs, provided and administered by Medical Security Card Company, LLC (MSC), 4911 E. Broadway Boulevard, Tucson, AZ 85711, , These programs are not available in all states and the terms of each program may vary from state to state. Each program is governed by the applicable terms of the membership agreement provided upon activation and made available at MSC is not responsible for providing or guaranteeing pharmacy services or for the quality of such rendered services. Participating CVS pharmacies are subject to change without notice and are not available in all areas. The program contracts are not protected by any state guaranty fund. 1 These membership programs are NOT health insurance policies and are NOT intended as a substitute for insurance. The programs only provide for member discounts on certain pharmacy products and medical services at CVS/pharmacy and MinuteClinic locations a complete list of locations can be found at The programs do not make and are prohibited from making payments to CVS/pharmacy for products or services received by you under the programs. You are required and obligated to pay for all prescription drugs and medical services you receive under the programs, but will receive a member discount on certain identifi ed prescription drugs and medical services from CVS/pharmacy and MinuteClinic. The CVS/pharmacy Health Savings Pass does not provide you with any member discounts or benefi ts at any other pharmacy. This program is marketed by CVS/pharmacy. You can call CARE (2273) for more information or visit Prescriptions paid for in whole or in part by federal or state health care programs, such as Medicare and Medicaid, are ineligible. Membership discount prices cannot be combined with any insurance. For MA residents: Health Savings Pass does not meet the minimum creditable coverage requirements under M.G.L.c.111M and 956 CMR TN. A $15 per person enrollment fee is required annually. If you wish to cancel your membership, you must do so in writing or call CARE (2273). MinuteClinic discount up to $10 per person, per visit. Cannot be used in conjunction with any health insurance. Payment is due at time of visit. MinuteClinic discount not available in Florida. Void where prohibited by law. Prices may vary in certain states. $11.99 pricing based on commonly prescribed doses. List is subject to change without notice. For complete terms and conditions and other details, see program brochure available at the pharmacy or go to 1 Notwithstanding the above, the programs, as described above and available in the states of Washington and California, are custom-branded and operated directly by CVS/pharmacy. The applicable terms relating to any such CVS/pharmacy custom-branded and operated programs shall also be available at healthsavingspass. MSC may participate or assist in the administration of such programs. It s easy to enroll: in store or online at A0162_CVS_CLASS_DL_

8 PREFERRED GENERIC DRUG LIST your home for family health These discount programs are NOT health insurance policies and are not intended as a substitute for insurance. The programs do not qualify as a minimum creditable coverage under Massachusetts law or where prohibited by law. The programs only provide for discounts on health services from participating pharmacies, and the range of the discounts will vary depending on the health services received. The programs do not make payments to pharmacies of health care services. Members are required to pay for all health care services, but will receive a discount from the contracted pharmacies. Except in the states of California, Utah, and Washington, these are custom-branded programs, provided and administered by Medical Security Card Company, LLC, (MSC), 4911 E. Broadway Boulevard, Tucson, AZ 85711, , and marketed by Kmart. These programs are not available in all states and the terms of each program may vary from state to state. Each program is governed by the applicable terms of the membership agreement provided upon activation and made available at MSC is not responsible for providing or guaranteeing pharmacy services or for the quality of such rendered services. Participating pharmacies are subject to change without notice and are not available in all areas. The program contracts are not protected by any state guaranty fund. 2 An annual fee of $10 is payable at the time of initial enrollment and enrollment renewal. The program, as well as the prices and the list of covered drugs, can be modified at any time without notice. 2 Notwithstanding the above, the programs, as described above and available in the states of California, Utah, and Washington, are custom-branded and operated directly by Kmart. The applicable terms relating to any such Kmart custom-branded and operated program shall also be available at www. KmartPrescriptionSavingsClub.com. MSC may participate or assist in the administration of such programs. your home for family health For questions, please call , log on to or see the pharmacist for further details. REVISED JUNE 16, 2014 Preferred generic drugs 30-day supply* for $5 or $10 90-day supply* for $10, $15, $20 or $30 *The day supply is based upon the average dispensing patterns for the specific drug and strength. 30-day supply price starts at $5. 90-day supply price starts at $10. a Select drugs for a 30-Day Supply are priced at $10; b Select drugs for a 90-Day Supply are priced at $15; c Select drugs for a 90-Day Supply are priced at $20; d Select drugs for a 90-Day Supply are priced at $30. Select Women s and Men s Health prescription medications are available in up to a 30-day supply for $12.00 each or in up to a 90-day supply for $36.00 each (see last page). 1 DRUG CLASSIFICATION/DRUG NAME ALLERGIES & COLD AND FLU 30-day $5 or $10 a 90-day $10, $15 b, $20 c or $30 d BENZONATATE 100 MG CAP CETIRIZINE HCL 5 MG TAB CETIRIZINE HCL 10 MG TAB CHLORPHENIRAMINE MALEATE 4 MG TAB CLEMASTINE FUMARATE 1.34 MG TAB b CYPROHEPTADINE HCL 4 MG TAB 30 a 90 d DIPHENHYDRAMINE HCL 50 MG CAP b 5

9 PREFERRED GENERIC DRUG LIST DRUG CLASSIFICATION/DRUG NAME 30-day $5 or $10 a 90-day $10, $15 b, $20 c or $30 d DRUG CLASSIFICATION/DRUG NAME 30-day $5 or $10 a 90-day $10, $15 b, $20 c or $30 d D-METHORPHAN HB/PROMETH HCL /5 SYRUP FLUTICASONE PROP 50 MCG SPRAY 16 a 48 c GUAIFENESIN/DEXTROMETHORPHAN MG/5 LIQUID b LORATADINE 10 MG TAB PROMETHAZINE HCL 12.5 MG TAB PROMETHAZINE HCL 25 MG TAB PROMETHAZINE HCL 50 MG TAB b PROMETHAZINE HCL 6.25MG/5ML SYRUP b ANTIBIOTIC & ANTI-INFECTIVE TREATMENTS ACYCLOVIR 200 MG CAP b AMOXICILLIN 250 MG CAP b AMOXICILLIN 500 MG CAP AMOXICILLIN 125 MG/5ML SUSP b AMOXICILLIN 200 MG/5ML SUSP b AMOXICILLIN 250 MG/5ML SUSP b AMOXICILLIN 400 MG/5ML SUSP AMOXICILLIN 125 MG TAB b AMPICILLIN TRIHYDRATE 250 MG CAP b AMPICILLIN TRIHYDRATE 500 MG CAP b BACITRACIN ZINC 500 UNIT/G OINT b BACITRACIN ZINC 500 UNIT/G PACKET b CEPHALEXIN 250 MG CAP b CEPHALEXIN 500 MG CAP b CIPROFLOXACIN HCL 250 MG TAB CIPROFLOXACIN HCL 500 MG TAB b ECONAZOLE NITRATE 1 % CRM b ISONIAZID 300 MG TAB b PENICILLIN V POTASSIUM 250 MG TAB b PENICILLIN V POTASSIUM 250 MG/5ML SOLN b PENICILLIN V POTASSIUM 500 MG TAB SMZ/TMP 400MG-80MG TAB b SMZ/TMP MG TAB b ARTHRITIS & PAIN ASPIRIN 81 MG TAB b BACLOFEN 10 MG TAB BACLOFEN 20 MG TAB CYCLOBENZAPRINE HCL 5 MG TAB CYCLOBENZAPRINE HCL 10 MG TAB DIBUCAINE 1 % OINT b IBUPROFEN 400 MG TAB b IBUPROFEN 600 MG TAB b IBUPROFEN 800 MG TAB b your home for family health 2 6 2

10 PREFERRED GENERIC DRUG LIST DRUG CLASSIFICATION/DRUG NAME 30-day $5 or $10 a 90-day $10, $15 b, $20 c or $30 d DRUG CLASSIFICATION/DRUG NAME 30-day $5 or $10 a 90-day $10, $15 b, $20 c or $30 d MELOXICAM 7.5 MG TAB MELOXICAM 15 MG TAB NAPROXEN 250 MG TAB b NAPROXEN 375 MG TAB b NAPROXEN 500 MG TAB b NAPROXEN SODIUM 275 MG TAB b ASTHMA ALBUTEROL SULFATE 2 MG/5 ML SYRUP b ALBUTEROL SULFATE 2.5 MG/3ML VIAL-NEB b IPRATROPIUM BROMIDE 0.2 MG/ML SOLN b DIABETES GLIMEPIRIDE 1 MG TAB GLIMEPIRIDE 2 MG TAB GLIMEPIRIDE 4 MG TAB GLIPIZIDE 5 MG TAB GLIPIZIDE 10 MG TAB GLYBURIDE 1.25 MG TAB b GLYBURIDE 2.5 MG TAB 30 a 90 c GLYBURIDE 5 MG TAB 30 a 90 c GLYBURIDE, MICRONIZED 1.5 MG TAB GLYBURIDE, MICRONIZED 3 MG TAB GLYBURIDE,MICRONIZED 6 MG TAB GLYBURIDE/METFORMIN HCL MG TAB 60 a 180 d GLYBURIDE/METFORMIN HCL MG TAB 60 a 180 d GLYBURIDE/METFORMIN HCL 5 MG-500MG TAB b METFORMIN HCL 500 MG TAB b METFORMIN HCL 850 MG TAB METFORMIN HCL 1000 MG TAB METFORMIN HCL ER 500 MG TAB METFORMIN HCL ER 750 MG TAB 60 a 180 d FUNGAL INFECTIONS FLUCONAZOLE 150 MG TAB 1 3 b GASTROINTESTINAL HEALTH CIMETIDINE 300 MG TAB CIMETIDINE 400 MG TAB DICYCLOMINE HCL 10 MG CAP b DICYCLOMINE HCL 20 MG TAB b DOCUSATE CALCIUM 240 MG CAP DOCUSATE SODIUM 100 MG CAP b FAMOTIDINE 20 MG TAB FAMOTIDINE 40 MG TAB 30 a 90 c LACTULOSE 10 G/15 ML SOLN b your home for family health 3 7 3

11 PREFERRED GENERIC DRUG LIST DRUG CLASSIFICATION/DRUG NAME 30-day $5 or $10 a 90-day $10, $15 b, $20 c or $30 d DRUG CLASSIFICATION/DRUG NAME 30-day $5 or $10 a 90-day $10, $15 b, $20 c or $30 d LACTULOSE 20 G/30 ML SOLN b LACTULOSE 10 GM/15 ML SYRUP b METOCLOPRAMIDE HCL 5 MG/5 ML SOLN METOCLOPRAMIDE HCL 10 MG/10ML SOLN METOCLOPRAMIDE HCL 5 MG TAB b METOCLOPRAMIDE HCL 10 MG TAB OMEPRAZOLE 20 MG CAP b PANTOPRAZOLE SODIUM 40 MG TAB 30 a 90 d PROCHLORPERAZINE MALEATE 5 MG TAB b PROCHLORPERAZINE MALEATE 10 MG TAB RANITIDINE HCL 15 MG/ML SYRUP b RANITIDINE HCL 150 MG TAB RANITIDINE HCL 300 MG TAB GLAUCOMA & EYE CARE DICLOFENAC SODIUM 0.1 % DROPS 2 6 b FLURBIPROFEN SODIUM 0.03 % DROPS 2 6 b NAPHAZOLINE HCL 0.1 % DROPS b TIMOLOL MALEATE 0.25 % DROPS 5 15 TIMOLOL MALEATE 0.5 % DROPS 5 15 b HEART HEALTH & BLOOD PRESSURE AMLODIPINE BESYLATE 2.5 MG TAB AMLODIPINE BESYLATE 5 MG TAB AMLODIPINE BESYLATE 10 MG TAB ATENOLOL 25 MG TAB ATENOLOL 50 MG TAB ATENOLOL 100 MG TAB BENAZEPRIL HCL 5 MG TAB b BENAZEPRIL HCL 10 MG TAB b BENAZEPRIL HCL 20 MG TAB b BENAZEPRIL HCL 40 MG TAB b BISOPROLOL FUMARATE/HCTZ MG TAB b BISOPROLOL FUMARATE/HCTZ MG TAB b BISOPROLOL FUMARATE/HCTZ MG TAB b BUMETANIDE 0.5 MG TAB 30 a 90 d BUMETANIDE 1 MG TAB 30 a 90 d CARVEDILOL MG TAB CARVEDILOL 6.25 MG TAB CARVEDILOL 12.5 MG TAB CARVEDILOL 25 MG TAB b CLONIDINE HCL 0.1 MG TAB CLONIDINE HCL 0.2 MG TAB DILTIAZEM HCL 30 MG TAB your home for family health 4 8 4

12 PREFERRED GENERIC DRUG LIST DRUG CLASSIFICATION/DRUG NAME 30-day $5 or $10 a 90-day $10, $15 b, $20 c or $30 d DRUG CLASSIFICATION/DRUG NAME 30-day $5 or $10 a 90-day $10, $15 b, $20 c or $30 d DILTIAZEM HCL 60 MG TAB DILTIAZEM HCL 90 MG TAB b DILTIAZEM HCL 120 MG TAB ENALAPRIL MALEATE 2.5 MG TAB b ENALAPRIL MALEATE 5 MG TAB b ENALAPRIL MALEATE 10 MG TAB b ENALAPRIL MALEATE 20 MG TAB b ENALAPRIL-HCTZ MG TAB b FOSINOPRIL SODIUM 20 MG TAB 30 a 90 d FOSINOPRIL SODIUM 40 MG TAB 30 a 90 d FUROSEMIDE 20 MG TAB FUROSEMIDE 40 MG TAB FUROSEMIDE 80 MG TAB GEMFIBROZIL 600 MG TAB 60 a 180 d GUANFACINE HCL 1 MG TAB GUANFACINE HCL 2 MG TAB b HYDRALAZINE HCL 25 MG TAB b HYDROCHLOROTHIAZIDE 12.5 MG CAP HYDROCHLOROTHIAZIDE 25 MG TAB HYDROCHLOROTHIAZIDE 50 MG TAB INDAPAMIDE 1.25 MG TAB INDAPAMIDE 2.5 MG TAB LISINOPRIL 2.5 MG TAB LISINOPRIL 5 MG TAB LISINOPRIL 10 MG TAB LISINOPRIL 20 MG TAB LISINOPRIL 30 MG TAB LISINOPRIL 40 MG TAB LISINOPRIL-HCTZ MG TAB LISINOPRIL-HCTZ MG TAB LISINOPRIL-HCTZ MG TAB 30 a 90 c LOSARTAN POTASSIUM 50 MG TAB 30 a 90 d LOVASTATIN 10 MG TAB LOVASTATIN 20 MG TAB LOVASTATIN 40 MG TAB METOPROLOL TARTRATE 25 MG TAB METOPROLOL TARTRATE 50 MG TAB METOPROLOL TARTRATE 100 MG TAB b PRAZOSIN HCL 1 MG CAP b PROPRANOLOL HCL 10 MG TAB PROPRANOLOL HCL 20 MG TAB PROPRANOLOL HCL 40 MG TAB your home for family health 5 9 5

13 PREFERRED GENERIC DRUG LIST DRUG CLASSIFICATION/DRUG NAME 30-day $5 or $10 a 90-day $10, $15 b, $20 c or $30 d DRUG CLASSIFICATION/DRUG NAME 30-day $5 or $10 a 90-day $10, $15 b, $20 c or $30 d PROPRANOLOL HCL 80 MG TAB b QUINAPRIL HCL 5 MG TAB b SIMVASTATIN 10 MG TAB SIMVASTATIN 20 MG TAB SIMVASTATIN 40 MG TAB SIMVASTATIN 80 MG TAB SOTALOL 80 MG TAB 30 a 90 c SPIRONOLACTONE 25 MG TAB TERAZOSIN HCL 1 MG CAP TERAZOSIN HCL 2 MG CAP TERAZOSIN HCL 5 MG CAP TERAZOSIN HCL 10 MG CAP TORSEMIDE 10 MG TAB b TRIAMTERENE-HCTZ MG TB 30 a 90 c VERAPAMIL HCL 80 MG TAB VERAPAMIL HCL 120 MG TAB VERAPAMIL HCL 180 MG TAB 30 a 90 c WARFARIN SODIUM 1 MG TAB WARFARIN SODIUM 2 MG TAB WARFARIN SODIUM 2.5 MG TAB WARFARIN SODIUM 3 MG TAB WARFARIN SODIUM 4 MG TAB WARFARIN SODIUM 5 MG TAB WARFARIN SODIUM 6 MG TAB WARFARIN SODIUM 7.5 MG TAB WARFARIN SODIUM 10 MG TAB MENTAL & NEURO HEALTH AMITRIPTYLINE HCL 10 MG TAB AMITRIPTYLINE HCL 25 MG TAB AMITRIPTYLINE HCL 50 MG TAB AMITRIPTYLINE HCL 75 MG TAB 30 a 90 c AMITRIPTYLINE HCL 100 MG TAB 30 a 90 c AMITRIPTYLINE HCL 150 MG TAB 30 a 90 c BUSPIRONE HCL 5 MG TAB BUSPIRONE HCL 10 MG TAB b CARBAMAZEPINE 100 MG TAB CARBAMAZEPINE 200 MG TAB CITALOPRAM HBR 20 MG TAB CITALOPRAM HBR 40 MG TAB DOXEPIN HCL 10 MG CAP b FLUOXETINE HCL 10 MG CAP FLUOXETINE HCL 20 MG CAP your home for family health

14 PREFERRED GENERIC DRUG LIST DRUG CLASSIFICATION/DRUG NAME 30-day $5 or $10 a 90-day $10, $15 b, $20 c or $30 d DRUG CLASSIFICATION/DRUG NAME 30-day $5 or $10 a 90-day $10, $15 b, $20 c or $30 d FLUOXETINE HCL 40 MG CAP 30 a 90 c FLUOXETINE HCL 10 MG TAB FLUPHENAZINE HCL 1 MG TAB FLUPHENAZINE HCL 2.5 MG TAB GABAPENTIN 100 MG CAP 90 a 270 c GABAPENTIN 300 MG CAP 90 a 270 d GABAPENTIN 400 MG CAP 90 a 270 d HALOPERIDOL 0.5 MG TAB HALOPERIDOL 1 MG TAB HALOPERIDOL 2 MG TAB b LITHIUM CARBONATE 150 MG CAP b LITHIUM CARBONATE 300 MG CAP b MIRTAZAPINE 15 MG TAB NORTRIPTYLINE HCL 10 MG CAP NORTRIPTYLINE HCL 25 MG CAP b PAROXETINE HCL 10 MG TAB b PAROXETINE HCL 20 MG TAB b PRAMIPEXOLE DI-HCL 0.5 MG TAB 30 a 90 c SERTRALINE HCL 25 MG TAB b SERTRALINE HCL 50 MG TAB b SERTRALINE HCL 100 MG TAB b TRAZODONE HCL 50 MG TAB TRAZODONE HCL 100 MG TAB TRAZODONE HCL 150 MG TAB b ZONISAMIDE 25 MG CAP b ZONISAMIDE 50 MG CAP b OTHER MEDICAL CONDITIONS ALLOPURINOL 100 MG TAB ALLOPURINOL 300 MG TAB CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH DEXAMETHASONE 0.5 MG TAB b DEXAMETHASONE 0.75 MG TAB b DEXAMETHASONE 4 MG TAB 6 18 b LIDOCAINE HCL 20 MG/ML SOLN b PHENAZOPYRIDINE HCL 100 MG TAB 6 18 PREDNISOLONE 15 MG/5 ML SOLN b PREDNISONE 2.5 MG TAB PREDNISONE 5 MG TAB PREDNISONE 10 MG TAB PREDNISONE 20 MG TAB SKIN CONDITIONS HYDROCORTISONE 1 % CRM b your home for family health

15 PREFERRED GENERIC DRUG LIST DRUG CLASSIFICATION/DRUG NAME 30-day $5 or $10 a 90-day $10, $15 b, $20 c or $30 d DRUG CLASSIFICATION/DRUG NAME 30-day $5 or $10 a 90-day $10, $15 b, $20 c or $30 d HYDROCORTISONE 1 % PACKET b HYDROCORTISONE 2.5 % CRM b HYDROCORTISONE 2.5 % OINT b HYDROCORTISONE/ALOE VERA 1 % CRM b MOMETASONE FUROATE 0.1 % OINT b TERBINAFINE HCL 250 MG TABLET 30 a 90 c TRIAMCINOLONE ACETONIDE % OINT b THYROID CONDITIONS LEVOTHYROXINE 25 MCG TAB b LEVOTHYROXINE 50 MCG TAB b LEVOTHYROXINE 75 MCG TAB b LEVOTHYROXINE 88 MCG TAB b LEVOTHYROXINE 100 MCG TAB b LEVOTHYROXINE 112 MCG TAB b LEVOTHYROXINE 125 MCG TAB b LEVOTHYROXINE 150 MCG TAB b METHIMAZOLE 5 MG TAB VITAMINS & NUTRITIONAL HEALTH AMINO ACIDS/MULTIVITS-MIN CAP b BETA-CAROTENE(A) W-C & E/MIN CAP b BETA-CAROTENE(A) W-C & E/SE CAP b CALCIUM CARBONATE/VITAMIN D3 600 MG-200 TAB b CALCIUM CARBONATE/VITAMIN D3 600 MG-400 TAB b CITRIC ACID/SODIUM CITRATE MG SOLN CO-NATAL FA TAB b ERGOCALCIFEROL (VITAMIN D2) UNIT CAP 4 12 FOLIC ACID 1 MG TAB FOLIC ACID/VITAMIN B COMP W-C 1 MG-100MG TAB b MAGNESIUM CHLORIDE 64 MG TAB b MAGNESIUM OXIDE 400 MG TAB b MULTIVIT/FOLIC ACID/ZINC/VIT C CAP b MULTIVITAMIN WITH MINERALS CAP b MULTIVITAMINS WITH MIN NO.7/FA 1 MG CAP b MULTIVITAMINS,THER W-MINERALS CAP b MULTIVITS-MINERALS/FA/LYCOPENE 0.4MG-600 CAP b POTASSIUM CITRATE/CITRIC ACID /5 SOLN b PRENATABS RX TAB b PRENATAL LOW IRON TAB b PRENATAL PLUS TAB b SOD/POT/K CIT/SOD CIT/CIT ACID /5 SOLN b SODIUM FLUORIDE 0.25 (0.55) TAB b SODIUM FLUORIDE 0.5 (1.1)MG TAB b your home for family health

16 PREFERRED GENERIC DRUG LIST DRUG CLASSIFICATION/DRUG NAME 30-day $5 or $10 a 90-day $10, $15 b, $20 c or $30 d SODIUM FLUORIDE 1MG (2.2MG) TAB b VIT B CMPLX 3/FA/VIT C/BIOTIN 1MG-60MG TAB b VIT B COMPLEX & C NO.19/FA/D TAB b VIT C/VIT E AC/LUT/MINERAL CAP b VITAMIN A/VIT C/VIT E/SELENIUM CAP b WOMEN S HEALTH ALENDRONATE SODIUM 5 MG TAB b ALENDRONATE SODIUM 70 MG TAB 4 12 b ESTRADIOL 0.5 MG TAB ESTRADIOL 1 MG TAB ESTRADIOL 2 MG TAB MEDROXYPROGESTERONE 2.5 MG TAB MEDROXYPROGESTERONE 5 MG TAB MEDROXYPROGESTERONE 10 MG TAB MEGESTROL ACETATE 20 MG TAB b Select Women s and Men s Health prescription medications are available in up to a 30-day supply* for $12.00 each or up to a 90-day supply* for $36.00 each. WOMEN S HEALTH 30-day Supply 90-day Supply ALENDRONATE SODIUM 10 MG TAB ALENDRONATE SODIUM 35 MG TAB 4 12 TAMOXIFEN CITRATE 10 MG TAB TAMOXIFEN CITRATE 20 MG TAB TRI-PREVIFEM TAB MEN S HEALTH 30-day Supply 90-day Supply FINASTERIDE 5 MG TAB A0158_KMART_CLASS_DL_ your home for family health

17 $ 4 and $ 10 Generic Medication List Medication Name/ Strength/Dosage Form $4 QTY $10 QTY A Acyclovir 200 mg Capsule Albuterol 2 mg/5ml Syrup 120 ml 360mL Albuterol NEB 0.083% Solution* 75 ml 225 ml Allopurinol 100, 300 mg Tablet Amitriptyline 10, 25, 50, 75, 100 mg Tablet Amoxicillin 125 mg/5ml Suspension 80 ml 240 ml Amoxicillin 125 mg/5ml Suspension 100 ml 300 ml Amoxicillin 125 mg/5ml Suspension 150 ml 450 ml Amoxicillin 200 mg/5ml Suspension 50 ml 150 ml Amoxicillin 200 mg/5ml Suspension* 75 ml 225 ml Amoxicillin 200 mg/5ml Suspension* 100 ml 300 ml Amoxicillin 250 mg Capsule Amoxicillin 250 mg/5ml Suspension 80 ml 240 ml Amoxicillin 250 mg/5ml Suspension 100 ml 300 ml Amoxicillin 250 mg/5ml Suspension 150 ml 450 ml Amoxicillin 400 mg/5ml Suspension 50 ml 150 ml Amoxicillin 400 mg/5ml Suspension* 75 ml 225 ml Amoxicillin 400 mg/5ml Suspension* 100 ml 300 ml Amoxicillin 500 mg Capsule Antipyrine/Benzocaine Otic Solution 10 ml 30 ml Atenolol 25, 50, 100 mg Tablet B Baclofen 10 mg Tablet Benazepril 5, 10, 20, 40 mg Tablet Benzonatate 100 mg Capsule Benztropine 2 mg Tablet Bisoprolol/HCTZ 5/6.25 mg Tablet Bisoprolol/HCTZ 10/6.25 mg Tablet Bumetanide 0.5, 1 mg Tablet Buspirone 5, 10* mg Tablet C Carbamazepine 200 mg Tablet* Carvedilol 3.125, 6.25, 12.5, 25* mg Tablet Cephalexin 250 mg Capsule Cephalexin 500 mg Capsule Chlorhexidine Gluconate 0.12% Solution 473 ml 1419 ml Ciprofloxacin 250 mg Tablet Ciprofloxacin 500 mg Tablet Citalopram 20, 40 mg Tablet Clonidine 0.1, 0.2 mg Tablet Cyclobenzaprine 5, 10 mg Tablet Cytra-2 Solution 180 ml 540 ml Medication Name/ Strength/Dosage Form $4 QTY $10 QTY D Dexamethasone 0.75 mg Tablet Dexamethasone 0.5 mg Tablet Dexamethasone 4 mg Tablet 6 18 Dicyclomine 10 mg Capsule Dicyclomine 20 mg Capsule E Enalapril 2.5, 5, 10, 20 mg Tablet Enalapril/HCTZ 5/12.5 mg Tablet Estradiol.5, 2 mg Tablet F Famotidine 20 mg Tablet Fluconazole 150 mg Tablet 1 3 Fluoxetine 10 mg Tablet* Fluoxetine 10, 20, 40* mg Capsule Fluphenazine 1 mg Tablet Folic Acid 1 mg Tablet Furosemide 20, 40, 80 mg Tablet G Gentak 0.3% Opthalmic Solution 5 ml 15 ml Gentamicin 0.3% Opthalmic Solution 5 ml 15 ml Glimepiride 1, 2, 4 mg Tablet Glipizide 5 mg Tablet Glipizide 10 mg Tablet* Glyburide 2.5, 5 mg Tablet Guanfacine 1 mg Tablet H Haloperidol 0.5, 1, 2 mg Tablet Hydralazine 10, 25 mg Tablet Hydrochlorothiazide 12.5 mg Capsule* Hydrochlorothiazide 25, 50 mg Tablet Hydrocortisone 2.5% Cream 30 g 90 g I Ibuprofen 100 mg/5ml Suspension* 120 ml 360 ml Ibuprofen 400 mg Tablet Ibuprofen 600 mg Tablet Ibuprofen 800 mg Tablet Indapamide 1.25, 2.5 mg Tablet Indomethacin 25 mg Capsule* Ipratropium NEB 0.02% Solution* 75 ml 225 ml Isosorbide Mononitrate ER 30, 60 mg Tablet L 14 Medication Name/ Strength/Dosage Form $4 QTY $10 QTY Lactulose 10 GM/15 ml Syrup 237 ml 711 ml Lidocaine Viscous 2% Solution 100 ml 300 ml Lisinopril 2.5, 5, 10, 20 mg Tablet Lisinopril/HCTZ mg Tablet Lisinopril/HCTZ mg Tablet* Lisinopril/HCTZ mg Tablet* Lithium Carbonate 300 mg Capsule* Loratadine 10 mg Tablet Lovastatin 10, 20 mg Tablet* M Magnesium Oxide 400 mg Tablet Medroxyprogesterone 2.5, 5 mg Tablet Medroxyprogesterone 10 mg Tablet Megestrol 20 mg Tablet* Meloxicam 7.5, 15 mg Tablet Metformin 500, 850, 1000* mg Tablet Metformin ER 500 mg Tablet* Methyldopa 250 mg Tablet* Metoclopramide 10 mg Tablet Metoclopramide 5 mg/5ml Syrup 60 ml 180 ml Metoprolol Tartrate 25, 50, 100* mg Tablet N Naproxen 375, 500 mg Tablet * Nortriptyline 10, 25 mg Capsule P Paroxetine 10, 20 mg Tablet* Penicillin VK 125mg/5mL Solution 100 ml 300 ml Penicillin VK 125 mg/5ml Solution Penicillin VK 250 mg/5ml Solution Penicillin VK 250 mg Tablet Phenazopyridine 100 mg Tablet 6 18 Polymyxin Sulfate/TMP Opthalmic Solution* Prednisone 2.5, 5 mg Tablet Prenatal Plus Tablet* 30 N/A Prochlorperazine 10 mg Tablet Promethazine 25 mg Tablet* Promethazine 6.25 mg/5ml Syrup* 180 ml 540 ml Promethazine DM Syrup 120 ml 360 ml Propranolol 10, 20, 40, 80 mg Tablet R Ranitidine 150 mg Tablet

18 Medication Name/ Strength/Dosage Form $4 QTY $10 QTY Ranitidine 300 mg Tablet S SMZ/TMP 200/40/5mL Suspension* 120 ml 360 ml SMZ/TMP 400/80 mg Tablet SMZ/TMP DS 800/160 mg Tablet Sodium Fluoride 0.5 mg Tablet* 120 N/A Sotalol HCL 80 mg Tablet* Spironolactone 25 mg Tablet* Sulfacetamide Sodium 10% Opthalmic Solution 15 ml 45 ml T Terazosin 1, 2, 5, 10 mg Capsule Terbinafine 250 mg Tablet* Timolol Maleate 0.25%, 0.5% Opthalmic Solution 5 ml 15 ml Tobramycin 0.3% Opthalmic Solution 5 ml 15 ml Trazodone 50, 100, 150 mg Tablet Triamcinolone 0.025% Cream 15 g 45 g Triamcinolone 0.025% Cream 80 g 240 g Triamcinolone 0.1% Cream/Ointment 15 g 45 g Triamcinolone 0.1% Cream/Ointment 80 g 240 g Triamcinolone 0.5% Cream 15 g 45 g Triamterene/HCTZ 37.5/25 mg Tablet Triamterene/HCTZ 75/50 mg Tablet Trihexyphenidyl 2 mg Tablet V Verapamil 80, 120 mg Tablet W Warfarin 1, 2, 2.5, 3, 4, 5*, 6, 7.5, 10 mg Tablet $9 and $24 Generic Medication List Women s Health $9 QTY $24 QTY Alendronate Sodium 35, 70 mg Tablet 4 12 Clomiphene 50 mg Tablet 5 15 Sprintec 28-Day Tablet* 28 N/A Tri-Sprintec 28-Day Tablet* 28 N/A Men s Health $9 QTY $24 QTY Finasteride 5mg Tablet 30 N/A Disclaimer: $4 prescriptions include up to a 30-day supply of covered drugs at commonly prescribed dosages. $10 prescriptions include up to a 90-day supply of covered drugs at commonly prescribed dosages. Physician permission may be required to change a 30-day prescription to a 90-day prescription. This list is subject to change. *These drugs may be priced higher in CA, HI, MN, MT, PA, RI, TN, WI and WY. Please ask your Target pharmacist for specific pricing in these states. This list is also available at Target.com/Pharmacy 15 April 2014

19 Value-Priced Medication List In addition to the discounts on thousands of brand-name and most other generic medications that Walgreens Prescription Savings Club members enjoy, club members receive greater discounts on three-tiers of value priced generics.* The price for a generic drug is based on its tier and whether it is a 30-day or 90-day supply: 30-day-supply drugs cost $5 (tier 1), $10 (tier 2) or $15 (tier 3) 90-day-supply drugs cost $10 (tier 1), $20 (tier 2) or $30 (tier 3) VALUE GENERICS Antifungal FLUCONAZOLE 150MG TAB TERBINAFINE 250MG TAB Antiviral ACYCLOVIR 200MG TAB Arthritis or Pain BACLOFEN 10MG TAB BACLOFEN 20MG TAB CYCLOBENZAPRINE 5MG TAB CYCLOBENZAPRINE 10MG TAB DICLOFENAC POTASSIUM 50MG TAB DICLOFENAC SODIUM 25MG TAB DICLOFENAC SODIUM 50MG TAB DICLOFENAC SODIUM 75MG EC TAB DICLOFENAC SODIUM 100MG ER TAB FLURBIPROFEN 50MG TAB FLURBIPROFEN 100MG TAB IBUPROFEN 100MG/5ML ORAL SUSP IBUPROFEN 400MG TAB IBUPROFEN 600MG TAB IBUPROFEN 800MG TAB INDOMETHACIN 25MG CAP INDOMETHACIN 50MG CAP KETOPROFEN 50MG CAP KETOPROFEN 75MG CAP KETOROLAC 10MG TAB KETOROLAC 30MG/ML INJ, 2ML LEFLUNOMIDE 10MG TAB MELOXICAM 7.5MG TAB MELOXICAM 15MG TAB NABUMETONE 500MG TAB NAPROXEN 250MG TAB NAPROXEN 375MG TAB NAPROXEN 500MG TAB NAPROXEN 375MG DR TAB NAPROXEN DR 500MG TAB NAPROXEN SODIUM 275MG TAB NAPROXEN SODIUM 550MG TAB SULINDAC 150MG TAB TIZANIDINE 2MG TAB TRAMADOL 50MG TAB Asthma ALBUTEROL 0.083% INH SOLN 25X3ML ALBUTEROL 0.5% INH SOL 20ML ALBUTEROL SULF INH SOLN 1.25MG/3ML ALBUTEROL SULFATE SYRUP (2MG/5ML) AMINOPHYLLINE 100MG TAB AMINOPHYLLINE 200MG TAB DYPHYLLINE-GG ELIXIR DYPHYLLIN-GG TAB IPRATROPIUM INHAL SOLN 60 X 2.5ML THEOPHYLLINE 200MG CR TAB THEOPHYLLINE 300MG CR TAB THEOPHYLLINE 100MG ER TAB THEOPHYLLINE 200MG ER TAB Blood Pressure/Heart Health AMILORIDE 5MG / HCTZ 50MG TAB AMIODARONE 200MG TAB AMLODIPINE BESYLATE 2.5MG TAB AMLODIPINE BESYLATE 5MG TAB AMLODIPINE BESYLATE 10MG TAB AMLODIPINE-BENAZ 2.5/10MG CAP AMLODIPINE-BENAZ 5/10MG CAP AMLODIPINE-BENAZ 5/20MG CAP AMLODIPINE-BENAZ 10/20MG CAP ATENOLOL 100MG TAB ATENOLOL 100MG/CHLORTHAL 25MG TAB ATENOLOL 25MG TAB ATENOLOL 50MG TAB ATENOLOL/CHLORTHALIDONE 50/25 TAB BENAZEPRIL 5MG TAB BENAZEPRIL 10MG TAB BENAZEPRIL 20MG TAB BENAZEPRIL 40MG TAB BISOPROLOL FUMARATE 5MG TAB BISOPROLOL/HCTZ 2.5MG/6.25MG TAB BISOPROLOL/HCTZ 5MG/6.25MG TAB BISOPROLOL/HCTZ 10MG/6.25MG TAB BUMETANIDE 0.5MG TAB BUMETANIDE 1MG TAB BUMETANIDE 2MG TAB CAPTOPRIL/HCTZ 25/25 TAB CARTIA 120MG XT CAP CARVEDILOL 3.125MG TAB CARVEDILOL 6.25MG TAB CARVEDILOL 12.5MG TAB CARVEDILOL 25MG TAB CHLOROTHIAZIDE 250MG TAB CHLORTHALIDONE 25MG TAB CHLORTHALIDONE 50MG TAB CILOSTAZOL 50MG TAB CILOSTAZOL 100MG TAB CLONIDINE 0.1MG TAB CLONIDINE 0.2MG TAB CLONIDINE 0.3MG TAB Blood Pressure/Heart Health (cont.) DILTIAZEM 30MG TAB DILTIAZEM 60MG TAB DILTIAZEM 90MG TAB DILTIAZEM 120MG TAB DILTIAZEM ER 120MG CAP (XR-24HR) DIPYRIDAMOLE 25MG TAB DIPYRIDAMOLE 50MG TAB DIPYRIDAMOLE 75MG TAB DOXAZOSIN 1MG TAB DOXAZOSIN 2MG TAB DOXAZOSIN 4MG TAB ENALAPRIL 2.5MG TAB ENALAPRIL 5MG TAB ENALAPRIL 10MG TAB ENALAPRIL 20MG TAB ENALAPRIL-HCTZ MG TAB ENALAPRIL-HCTZ 10-25MG TAB FELODIPINE 2.5MG TAB FOSINOPRIL 10MG TAB FOSINOPRIL 20MG TAB FOSINOPRIL 40MG TAB FUROSEMIDE 8MG/ML SOLN FUROSEMIDE 10MG/ML ORAL SOLN 60ML FUROSEMIDE 20MG TAB FUROSEMIDE 40MG TAB FUROSEMIDE 80MG TAB GUANFACINE 1MG TAB GUANFACINE 2MG TAB HYDRALAZINE 10MG TAB HYDRALAZINE 25MG TAB HYDRALAZINE 50MG TAB HYDROCHLOROTHIAZIDE 12.5MG CAP HYDROCHLOROTHIAZIDE 12.5MG TAB HYDROCHLOROTHIAZIDE 25MG TAB HYDROCHLOROTHIAZIDE 50MG TAB INDAPAMIDE 1.25MG TAB INDAPAMIDE 2.5MG TAB ISOSORBIDE DINITRATE 2.5MG SL TAB ISOSORBIDE DINITRATE 5MG SUBL TAB ISOSORBIDE MONONITRATE 10MG TAB ISOSORBIDE MONONITRATE 20MG TAB ISOSORBIDE MONONITRATE 30MG ER TAB ISOSORBIDE MONONITRATE 60MG ER TAB LISINOPRIL 2.5MG TAB LISINOPRIL 5MG TAB LISINOPRIL 10MG TAB LISINOPRIL 20MG TAB LISINOPRIL 30MG TAB LISINOPRIL 40MG TAB LISINOPRIL-HCTZ 10/12.5MG TAB LISINOPRIL-HCTZ 20/12.5MG TAB LISINOPRIL-HCTZ 20/25MG TAB LOSARTAN/HCTZ 100/12.5MG TAB METHYLDOPA 250MG TAB METHYLDOPA 500MG TAB METOLAZONE 2.5MG TAB

20 Valued Priced Medication List (cont.) 2 Blood Pressure/Heart Health (cont.) METOLAZONE 5MG TAB METOLAZONE 10MG TAB METOPROLOL TARTRATE 25MG TAB METOPROLOL TARTRATE 50MG TAB METOPROLOL TARTRATE 100MG TAB PENTOXIFYLLINE 400MG ER TAB PRAZOSIN 1MG CAP PRAZOSIN 2MG CAP PROPAFENONE 150MG TAB PROPRANOLOL 10MG TAB PROPRANOLOL 20MG TAB PROPRANOLOL 40MG TAB PROPRANOLOL 60MG TAB PROPRANOLOL 80MG TAB QUINAPRIL 5MG TAB QUINAPRIL 10MG TAB QUINAPRIL 20MG TAB QUINAPRIL 40MG TAB QUINAPRIL/HCTZ MG TAB RAMIPRIL 1.25MG CAP SOTALOL 120MG TAB SOTALOL 160MG TAB SPIRONOLACTONE 25MG TAB SPIRONOLACTONE 50MG TAB SPIRONOLACTONE 25MG W/HCTZ 25MG TAB TERAZOSIN 1MG CAP TERAZOSIN 2MG CAP TERAZOSIN 5MG CAP TERAZOSIN 10MG CAP TICLOPIDINE 250MG TAB TORSEMIDE 5MG TAB TORSEMIDE 10MG TAB TORSEMIDE 20MG TAB TORSEMIDE 100MG** TAB TRANDOLAPRIL 1MG TAB TRANDOLAPRIL 2MG TAB TRANDOLAPRIL 4MG TAB TRIAMTERENE 37.5MG/ HCTZ 25MG CAP TRIAMTERENE 37.5MG/ HCTZ 25MG TAB TRIAMTERENE 75MG/ HCTZ 50MG TAB VERAPAMIL 40MG TAB VERAPAMIL 80MG TAB VERAPAMIL 120MG TAB VERAPAMIL ER 100MG CAP (24 HR) WARFARIN SOD 1MG TAB WARFARIN SOD 2.5MG TAB WARFARIN SOD 2MG TAB WARFARIN SOD 3MG TAB WARFARIN SOD 4MG TAB WARFARIN SOD 5MG TAB WARFARIN SOD 6MG TAB WARFARIN SOD 7.5MG TAB WARFARIN SOD 10MG** TAB Cholesterol FENOFIBRATE 54MG TAB GEMFIBROZIL 600MG TAB LOVASTATIN 10MG TAB LOVASTATIN 20MG TAB LOVASTATIN 40MG TAB PRAVASTATIN 10MG TAB PRAVASTATIN 20MG TAB PRAVASTATIN 40MG TAB PRAVASTATIN 80MG TAB SIMVASTATIN 5MG TAB SIMVASTATIN 10MG TAB SIMVASTATIN 20MG TAB SIMVASTATIN 40MG TAB SIMVASTATIN 80MG TAB Cough/Cold/Allergy ALLER-CHLOR 4MG TAB BENZONATATE 100MG CAP BENZONATATE 200MG CAP BROMDEX D SYRUP CETIRIZINE 1MG/ML SYRUP CETIRIZINE 10MG TAB CYPROHEPTADINE 2MG/5ML SYRUP DE-CHLOR DM LIQUID DE-CHLOR DR SYRUP DEHISTINE SYRUP DIPHENHYDRAMINE 50MG CAP FLUTICASONE NASAL SP (120INH) 16GM LORATADINE 10MG TAB NOHIST TAB ORGAN-I NR 200MG TAB PBM ALLERGY SYRUP PHENYLTOLOXAMINE PE CPM SYRUP PROMETHAZINE 12.5MG TAB PROMETHAZINE 25MG TAB PROMETHAZINE 50MG TAB PROMETHAZINE DM SYRUP QUARTUSS DM DROPS 30ML QV-ALLERGY SYRUP REME TUSSIN DM SYRUP SILDEC PE-DM SYRUP SILDEC-PE SYRUP SUPRESS-DX PED DROPS 30ML TRIPOHIST LIQUID Diabetes GLIMEPIRIDE 1MG TAB GLIMEPIRIDE 2MG TAB GLIMEPIRIDE 4MG TAB GLIPIZIDE 5MG TAB GLIPIZIDE 10MG TAB GLIPIZIDE ER 10MG TAB GLIPIZIDE XL 2.5MG TAB GLIPIZIDE XL 5MG TAB GLIPIZIDE-METFORMIN 2.5MG/500MG TAB GLIPIZIDE-METFORMIN 5MG/500MG TAB GLYBURIDE 1.25MG TAB GLYBURIDE 2.5MG TAB GLYBURIDE 5MG TAB GLYBURIDE MICRO 1.5MG TAB GLYBURIDE MICRO 3MG TAB GLYBURIDE MICRO 6MG TAB GLYBURIDE/METFORMIN 1.25/250MG TAB GLYBURIDE/METFORMIN 2.5/500MG TAB GLYBURIDE/METFORMIN 5/500MG TAB METFORMIN 500MG TAB METFORMIN 850MG TAB METFORMIN 1000MG TAB METFORMIN ER 500MG 24HR TAB METFORMIN ER 750MG 24HR TAB Ear Care ACETIC ACID 2% OTIC SOLN ANTIPYRINE BENZOCAINE OTIC SOL 15ML Eye Care BACITRACIN/POLYMYX OPHTHOINT 3.5GM CARTEOLOL HCL 1% OPH SOL 5ML CARTEOLOL HCL 1% OPH SOL 10ML CARTEOLOL HCL 1% OPH SOL 15ML CROMOLYN SODIUM 4% OPHTH SOLN 10ML CYCLOPENTOL 1% OPTH SOLN 15ML DEXAMETHASONE 0.1% OPHTH SOLN 5ML DORZOLAMIDE 2% OPHTH SOLN 10ML ERYTHROMYCIN OPHTH OINT 3.5GM Eye Care (cont.) GENTAMICIN 0.3% OPHTH SOLN 5ML KETOROLAC 0.4% OPTH SOLN 5ML KETOROLAC 0.5% OPHTH SOLN 5ML LEVOBUNOLOL 0.5% OPTH SOLN 5ML PILOCARPINE 0.5% OPHTH SOLN POLYMYXIN-B/TRIMETHOPRIMOPHTH SOLN SULFACETAMIDE NA 10% OPH SOL 15ML TIMOLOL MALEATE.25% OPHTH SOL 5ML TIMOLOL MALEATE 0.5% OPHTH SOLN 5ML TOBRAMYCIN 0.3% OPH SOL 5ML TROPICAMIDE 1% OP SOLN Gastrointestinal Health CIMETIDINE 200MG TAB CIMETIDINE 300MG TAB CIMETIDINE 400MG TAB CIMETIDINE ORAL LIQ 300MG/5ML DICYCLOMINE 10MG CAP DICYCLOMINE 20MG TAB DOC-Q-LACE 100MG CAP FAMOTIDINE 20MG TAB FAMOTIDINE 40MG TAB GENERLAC 10GM/15ML SOLN LACTULOSE 10GM/15ML SOLN ,419 METOCLOPRAMIDE 5MG TAB METOCLOPRAMIDE 10MG TAB METOCLOPRAMIDE HCL 5MG/5ML SOLN NIZATIDINE 150MG CAP NIZATIDINE 300MG CAP OMEPRAZOLE 20MG CAP RANITIDINE 150MG TAB RANITIDINE 300MG TAB RANITIDINE 15MG/ML (75MG/5ML) SYRUP Gout ALLOPURINOL 100MG TAB ALLOPURINOL 300MG TAB Infections AMOX-CLAV 400MG CHEW TAB AMOX-CLAV 200MG/5ML SUSP 100ML AMOX-CLAV 400MG/5ML SUSP 100ML AMOX-CLAV 500MG TAB AMOX-CLAV ES 600MG/5ML SUSP 125ML AMOXICILLIN 250MG CAP AMOXICILLIN 500MG CAP AMOXICILLIN 125MG CHEWABLE TAB AMOXICILLIN 250MG CHEW TAB AMOXICILLIN 125MG/5ML SUSP 80ML AMOXICILLIN 125MG/5ML SUSP 100ML AMOXICILLIN 125MG/5ML SUSP 150ML AMOXICILLIN 200MG/5ML SUSP 75ML AMOXICILLIN 200MG/5ML SUSP 100ML AMOXICILLIN 250MG/5ML SUSP 150ML AMOXICILLIN 250MG/5ML SUSP 100ML AMOXICILLIN 250MG/5ML SUSP 80ML AMOXICILLIN 400MG/5ML SUSP 50ML AMOXICILLIN 400MG/5ML SUSP 75ML AMOXICILLIN 400MG/5ML SUSP 100ML AMOXICILLIN 500MG TAB AMOXICILLIN 875MG TAB AMPICILLIN 250MG CAP AMPICILLIN 500MG CAP CEFACLOR 250MG CAP CEFADROXIL 500MG CAP CEFPROZIL 125MG/5ML SUSP 50ML

21 Valued Priced Medication List (cont.) 3 Infections (cont.) CEFPROZIL 125MG/5ML SUSP 75ML CEFPROZIL 125MG/5ML SUSP 100ML CEFUROXIME 250MG TAB CEPHALEXIN 125MG/5ML SUSP 100ML CEPHALEXIN 250MG/5ML SUSP 100ML CEPHALEXIN 125MG/5ML SUSP 200ML CEPHALEXIN 250MG/5ML SUSP 200ML CEPHALEXIN 250MG CAP CEPHALEXIN 500MG CAP CIPROFLOXACIN 250MG TAB CIPROFLOXACIN 500MG TAB CIPROFLOXACIN 750MG TAB CLINDAMYCIN 150MG CAP CLINDAMYCIN 300MG CAP DICLOXACILLIN 250MG CAP DOXYCYCLINE MONOHYDRATE 50MG TAB DOXYCYCLINE MONOHYDRATE 100MG TAB METRONIDAZOLE 250MG TAB METRONIDAZOLE 500MG TAB MINOCYCLINE 50MG CAP MINOCYCLINE 75MG CAP MINOCYCLINE 100MG CAP PENICILLIN VK 125MG/5ML SOLN 100ML PENICILLIN VK 125MG/5ML SOLN 200ML PENICILLIN VK 250MG/5ML SOLN 100ML PENICILLIN VK 250MG/5ML SOLN 200ML PENICILLIN VK 250MG TAB PENICILLIN VK 500MG TAB SMZ/TMP REGULAR STRENGTH TAB SULFAMETH/TRIMETHOPRIM 800/160 TAB SULFAMETH-TRIMETH SUSP TRIMETHOPRIM 100MG TAB Medical Devices PROCHAMBER AERO SPACER Mental Health AMITRIPTYLINE 10MG TAB AMITRIPTYLINE 25MG TAB AMITRIPTYLINE 50MG TAB AMITRIPTYLINE 75MG TAB AMITRIPTYLINE 100MG** TAB AMITRIPTYLINE 150MG TAB BENZTROPINE 0.5MG TAB BENZTROPINE 1MG TAB BENZTROPINE 2MG TAB BUSPIRONE 5MG TAB BUSPIRONE 10MG TAB BUSPIRONE 15MG TAB CARBAMAZEPINE 100MG CHEWABLE TAB CARBAMAZEPINE 200MG TAB CARBIDOPA/LEVODOPA MG CR TAB CITALOPRAM 10MG TAB CITALOPRAM 20MG TAB CITALOPRAM 40MG TAB CLOZAPINE 25MG TAB DIVALPROEX DR 125MG TAB DOXEPIN 10MG CAP DOXEPIN 25MG CAP DOXEPIN 50MG CAP DOXEPIN 75MG CAP DOXEPIN 100MG** CAP DOXEPIN HCL 10MG/ML CONC 118ML FLUOXETINE 10MG CAP FLUOXETINE 20MG CAP FLUOXETINE 40MG CAP FLUOXETINE 10MG TAB FLUOXETINE 20MG TAB FLUOXETINE 20MG/5ML LIQUID FLUPHENAZINE 2.5MG TAB FLUPHENAZINE 5MG TAB Mental Health (cont.) FLUVOXAMINE 25MG TAB FLUVOXAMINE 100MG TAB GABAPENTIN 100MG CAP GABAPENTIN 300MG CAP GABAPENTIN 400MG CAP GABAPENTIN 250MG/5ML SOLN HALOPERIDOL 0.5MG TAB HALOPERIDOL 1MG TAB HALOPERIDOL 2MG TAB HALOPERIDOL 2MG/ML CONCENTRATE HYDROXYZINE 10MG/5ML SYRUP HYDROXYZINE HCL 10MG TAB HYDROXYZINE HCL 25MG TAB HYDROXYZINE HCL 50MG TAB HYDROXYZINE PAMOATE 25MG CAP IMIPRAMINE 10MG TAB IMIPRAMINE 25MG TAB IMIPRAMINE 50MG TAB LAMOTRIGINE 5MG CHEWABLE TAB LAMOTRIGINE 25MG CHEWABLE TAB LITHIUM CARBONATE 150MG CAP LITHIUM CARBONATE 300MG CAP LITHIUM CARBONATE 300MG TAB LITHIUM CARBONATE 600MG CAP LITHIUM CARBONATE ER 450MG TAB METHOCARBAMOL 500MG TAB METHOCARBAMOL 750MG TAB MIRTAZAPINE 15MG TAB MIRTAZAPINE 30MG TAB NORTRIPTYLINE 10MG CAP NORTRIPTYLINE 25MG CAP NORTRIPTYLINE 50MG CAP NORTRIPTYLINE 75MG CAP OXCARBAZEPINE 150MG TAB PAROXETINE 10MG TAB PAROXETINE 20MG TAB PAROXETINE 30MG TAB PRAMIPEXOLE 0.125MG TAB PRAMIPEXOLE 0.25MG TAB PRAMIPEXOLE 0.5MG TAB PRAMIPEXOLE 1.5MG TAB PRIMIDONE 50MG TAB PROCHLORPERAZINE 5MG TAB PROCHLORPERAZINE 10MG TAB RISPERIDONE 0.25MG TAB RISPERIDONE ODT 0.5MG TAB RISPERIDONE ODT 1MG TAB RISPERIDONE ODT 2MG TAB ROPINIROLE 0.25MG TAB ROPINIROLE 3MG TAB SERTRALINE 25MG TAB SERTRALINE 50MG TAB SERTRALINE 100MG TAB THIORIDAZINE 10MG TAB THIORIDAZINE 25MG TAB THIORIDAZINE 50MG TAB THIOTHIXENE 1MG CAP THIOTHIXENE 2MG CAP TRAZODONE 50MG TAB TRAZODONE 100MG TAB TRAZODONE 150MG TAB TRIHEXYPHENIDYL 2MG TAB TRIHEXYPHENIDYL 5MG TAB VALPROIC ACID 250MG/5ML SYRUP VENLAFAXINE 25MG TAB VENLAFAXINE 37.5MG TAB VENLAFAXINE 50MG TAB VENLAFAXINE 75MG TAB VENLAFAXINE 100MG TAB Mouth/Throat/Dental CHLORHEXIDINE ORAL RINSE 473ML LIDOCAINE VISCOUS 2% ORAL SOL 100ML PILOCARPINE 5MG TAB SF 5000 PLUS 1.1% CREAM 51GM SOD FLUORIDE 0.2% MINT SOLUTION STANNOUS FLUORIDE 0.63% RINSE Skin Conditions BENZOYL PEROXIDE 2.5% AQ GEL 60GM BENZOYL PEROXIDE 5% AQ GEL 60GM BETAMETHASONE VAL 0.1% CRM 15GM CICLOPIROX TOPICAL SUSPENSION 30ML CICLOPIROX TOPICAL SUSPENSION 60ML CLOBETASOL PROP 0.05% GEL 15GM CLOTRIMAZOLE 1% SOLN 30ML FLUTICASONE 0.005% OINT 30GM HYDROCORTISONE 1% CREAM 28.35GM HYDROCORTISONE 1% OINT 28.35GM HYDROCORTISONE 2.5% CREAM 30GM HYDROCORTISONE 2.5% OINT 28.35GM HYPERCARE 20% SOL DAB-O-MATIC 60ML MELQUIN 3% SOLN 30ML MOMETASONE 0.1% OINT 15GM MOMETASONE 0.1% OINT 45GM MOMETASONE 0.1% TOPICAL SOLN 30ML MOMETASONE 0.1% TOPICAL SOLN 60ML NYSTATIN OINT 15GM SALICYLIC AC 6% SHAMPOO 177ML SELENIUM SULFIDE 2.5% SHAMPOO (LOTN) TRIAMCINOLONE 0.025% CREAM 15GM TRIAMCINOLONE 0.5% CREAM 15GM TRIAMCINOLONE 0.1% CREAM 80GM TRIAMCINOLONE 0.1% OINT 80GM UREA 40% LOTION 236.6ML UREA 50% NAIL GEL 18ML Thyroid Conditions LEVOTHROID 0.1MG TAB LEVOTHYROXINE 0.025MG (25MCG) TAB LEVOTHYROXINE 0.05MG (50MCG) TAB LEVOTHYROXINE 0.075MG (75MCG) TAB LEVOTHYROXINE 0.088MG (88MCG) TAB LEVOTHYROXINE 0.100MG (100MCG) TAB LEVOTHYROXINE 0.112MG (112MCG) TAB LEVOTHYROXINE 0.125MG (125MCG) TAB LEVOTHYROXINE 0.137MG (137MCG) TAB LEVOTHYROXINE 0.150MG (150MCG) TAB LEVOTHYROXINE 0.175MG (175MCG) TAB LEVOTHYROXINE 0.2MG (200MCG) TAB LEVOTHYROXINE 0.3MG (300MCG) TAB METHIMAZOLE 5MG TAB METHIMAZOLE 10MG TAB NATURE-THROID 0.5GR (32.5MG) TAB Urinary Health BETHANECHOL 5MG TAB BETHANECHOL 10MG TAB BETHANECHOL 25MG TAB OXYBUTYNIN 5MG/5ML SYRUP OXYBUTYNIN ER 5MG TAB OXYBUTYNIN ER 10MG TAB OXYBUTYNIN ER 15MG TAB

22 Valued Priced Medication List (cont.) 4 Vitamins and Nutritional Health CYANOCOBALAMIN 1000MCG/ML INJ, 1ML FABB TAB FE C PLUS TAB FEROTRIN CAP FERREX 150 FORTE CAP FLUORIDE 0.25MG F CHEWABLE TAB FLUORIDE 0.5MG F CHEWABLE TAB FLUORIDE 1.0MG F CHEWABLE TAB FOLBECAL TAB FOLBEE PLUS TAB FOLBEE TAB FOLIC ACID 1MG TAB HEMATINIC/ FA TAB HEMATINIC PLUS TAB 10 X KLOR-CON 10MEQ TAB MULTIGEN FOLIC TAB MULTIGEN TAB MULTIVIT/F 0.25MG CHEWABLE TAB MULTI-VIT/FL 0.25MG DROPS 50ML MULTI-VITA-F 0.5MG CHEW TAB MULTI-VIT/FLUORIDE 1MG CHEW TAB MULTIVITAMIN W/FL.5MG/ML ORAL DROP MULTIVITAMINS W/ FL 1.0MG CHEW TAB MULTIVITS W/FL 1MG & IRON CHEW TAB NATALCARE PLUS TAB (1MG FOLIC ACID) OB-NATAL ONE CAP POLY-IRON 150 CAP POLY-IRON 150 FORTE CAP POT CHLOR 10% LIQ SF (20MEQ/15ML) POTASSIUM CL 10MEQ ER TAB PRENAFIRST TAB PRENATAB FA TAB PRENATAL - U CAP Vitamins and Nutritional Health (cont.) PRENATAL 19 CHEWABLE TAB PRENATAL 19 TAB PRENATAL PLUS TAB RE DUALVIT F CAP RE PRENATAL MULTIVIT W/IRON CHEW TB RENA-VITE RX TAB RENAL SOFTGEL CAP THEROBEC PLUS TAB TRI-VIT/FE FL.25MG DROPS 50ML VINATE AZ TAB VINATE CARE CHEWABLE TAB VINATE C TAB VINATE GT TAB VINATE M TAB VINATE ONE TAB VITAMIN B MCG TAB VITAMIN D 50,000IU CAP Women s Health ALENDRONATE 5MG TAB ALENDRONATE 10MG TAB ALENDRONATE 35MG TAB ALENDRONATE 70MG TAB ANASTROZOLE 1MG TAB CLOMIPHENE CITRATE 50MG TAB ESTRADIOL 0.5MG TAB ESTRADIOL 1MG TAB ESTRADIOL 2MG TAB ESTROPIPATE 0.625MG (0.75MG) TAB ESTROPIPATE 1.5MG (1.25MG) TAB Women s Health (cont.) MEDROXYPROGESTERONE 2.5MG TAB MEDROXYPROGESTERONE 5MGTAB MEDROXYPROGESTERONE 10MGTAB MEGESTROL ACETATE 20MG TAB TAMOXIFEN 10MG TAB TAMOXIFEN 20MG TAB Other ANAGRELIDE 0.5MG CAP ANAGRELIDE 1MG CAP CYTRA-2 SOLN CYTRA-K ORAL SOLN DEXAMETHASONE 0.5MG TAB DEXAMETHASONE 0.75MG TAB DEXAMETHASONE 1MG TAB DEXAMETHASONE 1.5MG TAB DEXAMETHASONE 4MG TAB FINASTERIDE 5MG TAB HYDROCORTISONE 5MG TAB ISONIAZID 100MG TAB LIDOCAINE 4% TOP SOLN 50ML PHENAZOPYRIDINE 100MG TAB PREDNISOLONE 15MG/5ML SOLN PREDNISOLONE SOD PHOS 15MG/5ML SOL PREDNISONE 1MG TAB PREDNISONE 2.5MG TAB PREDNISONE 5MG TAB PREDNISONE 10MG** TAB PREDNISONE 20MG TAB PREDNISONE 5MG TAB PACK 21 S

23 Valued Priced Medication List (cont.) Insulins VALUE BRAND-NAME LEVEMIR FLEXPEN 1 BOX $ LEVEMIR 100 UNITS/ML VIAL 1 VIAL $ NOVOLIN N 100 UNITS/ML VIAL 1 VIAL $58.12 NOVOLIN R 100 UNITS/ML VIAL 1 VIAL $58.12 NOVOLIN 70/ UNIT/ML VIAL 1 VIAL $58.12 NOVOLOG MIX 70/30 VIAL 1 VIAL $ NOVOLOG MIX 70/30 FLEXPEN 1 BOX $ NOVOLOG FLEXPEN 1 BOX $ NOVOLOG PENFILL 3 ML 1 BOX $ NOVOLOG 100 UNIT/ML VIAL 1 VIAL $ Diabetic Supplies WALGREENS TRUE RESULT METER 1 METER FREE WALGREENS TRUE TEST STRIPS 25 S 1 BOX $17.99 WALGREENS TRUE TEST STRIPS 50 S 1 BOX $24.99 WALGREENS TRUE TEST STRIPS 100 S 1 BOX $41.99 Discounted Lifestyle Medications CIALIS 5MG TAB (QTY 6) $39.99 CIALIS 10MG TAB (QTY 6) $ CIALIS 20MG TAB (QTY 6) $ LATISSE 0.03% OPHTH SOLN $ VIAGRA 50MG TAB (QTY 6) $ VIAGRA 100MG TAB (QTY 6) $ AVERAGE SAVINGS- 90-day supply of a value-priced generic Commonly prescribed quantities of all other generics Tier 1 $33.12 Tier 2 $32.99 Tier 3 $ $25.60 Brand-name drugs $ BAYER CONTOUR NEXT METER 1 METER FREE BAYER CONTOUR NEXT STRIPS 25 S 1 BOX $23.99 BAYER CONTOUR NEXT STRIPS 50 S 1 BOX $39.99 BAYER CONTOUR NEXT STRIPS 100 S 1 BOX $78.99 BAYER CONTOUR METER 1 METER FREE BAYER CONTOUR USB METER 1 METER FREE BAYER CONTOUR TEST STRIPS 50 S 1 BOX $47.99 BAYER CONTOUR TEST STRIPS 100 S 1 BOX $93.99 BAYER BREEZE 2 METER KIT 1 METER FREE BAYER BREEZE 2 TEST DISCS 50'S 1 BOX $48.99 BAYER BREEZE 2 TEST DISCS 100'S 1 BOX $93.99 LIFESTYLE MEDICATIONS Birth Control Special Price at $12 for 1-month supply MONONESSA TAB 28 TRINESSA TAB 28 $21.99 for 1-month supply MICROGESTIN 1.5/30 FE TAB 28 MICROGESTIN 1/20 FE TAB 28 RECLIPSEN 0.15MG-30MCG TAB 28 $23.99 for 1-month supply LOW-OGESTREL TAB 28 NECON 1/35 TAB 28 $24.99 for 1-month supply JOLIVETTE 0.35MG TAB 28 $25.99 for 1-month supply LEVORA 0.15/30 TAB 28 LUTERA TAB 28 Membership fee required ($20 individual or $35 family per year). Persons receiving benefits from Medicare, Medicaid or other federal or state healthcare programs are ineligible. Some restrictions apply to 10% bonus. Pet medications are for human-equivalent medications only. Membership may be cancelled within 30 days of issue date for a full refund. If by the end of the 1-year membership, member has not achieved total savings on all eligible Pharmacy and Walgreens Bonus Program items and services purchased with the PSC card that is equal to or greater than membership fee, member is eligible for store credit equal to the difference between membership fee and the member's total savings. For complete terms and conditions, call or visit Walgreens.com/rxsavingsclub. WAGDCO, LLC, 104 Wilmot Road, Deerfield, IL THIS PROGRAM DOES NOT CONSTITUTE INSURANCE. *List of drugs is not all-inclusive. Ask your Walgreens pharmacist if your medication is a value-priced generic. Drug names are the property of their respective owners Walgreen Co. All rights reserved. 12SC Revised: 04/11/

24 Retail Prescription Program Drug List Revised 5/16/2014 $ 4, 30-day $ 10, 90-day $ 4, 30-day $ 10, 90-day Price Matters New Men s Health Category Convenience Free Home Delivery ** Our $4 prescriptions have saved our customers over $3 billion The program is available to everyone, no membership required More affordable options for men $9 Finasteride for 30 tablets Easy Pay saves you time at the checkout counter Ready Reminders send you a free text message when your prescription is ready Auto Refill your prescriptions and save time Mailed right to your home, no matter where you live Free shipping Find out more at Walmart.com/pharmacy Allergies & Cold and Flu Benzonatate 100mg cap Loratadine 10mg tab Promethazine DM syrup ml ml Antibiotic Treatments Amoxicillin 125mg/5ml susp (80ml bottle) Amoxicillin 125mg/5ml susp (100ml bottle) Amoxicillin 125mg/5ml susp (150ml bottle) Amoxicillin 200mg/5ml susp (50ml bottle) Amoxicillin 200mg/5ml susp* (75ml bottle) Amoxicillin 200mg/5ml susp* (100ml bottle) Amoxicillin 250mg/5ml susp (80ml bottle) Amoxicillin 250mg/5ml susp (100ml bottle) Amoxicillin 250mg/5ml susp (150ml bottle) Amoxicillin 400mg/5ml susp (50ml bottle) Amoxicillin 400mg/5ml susp* (75ml bottle) Amoxicillin 400mg/5ml susp* (100ml bottle) Amoxicillin 250mg cap Amoxicillin 500mg cap Cephalexin 250mg cap Cephalexin 500mg cap Ciprofloxacin 250mg tab Ciprofloxacin 500mg tab Penicillin VK 250mg tab Penicillin VK 125mg/5ml susp (100ml bottle) Penicillin VK 125mg/5ml susp (200ml bottle) Penicillin VK 250mg/5ml susp (100ml bottle) SMZ-TMP 200mg-40mg/5ml susp* ml ml SMZ-TMP 400mg-80mg tab SMZ-TMP DS 800mg-160mg tab $ 4, 30-day $ 10, 90-day $ 4, 30-day $ 10, 90-day Arthritis & Pain Prescription Program includes up to a 30-day supply for $4 and a 90-day supply for $10 of some covered generic drugs at commonly prescribed dosages. Higher dosages cost more. Prices for some drugs covered by the Prescription Program may be higher and may vary in some states. Restrictions apply. See Program Details or your Walmart Pharmacist for details. Free language assistance services available for prescription drug information at Walmart and Sam s Club pharmacies in New York. Contact your Walmart or Sam s Club pharmacy for details. * Prices may be higher in CA, HI, MN, MT, PA, TN and WI. ** Home Delivery Service is not available through SamsClub.com. Prepackaged drugs are covered only in unit sizes specified on Drug List. See Program Details or your Walmart Pharmacist for details. Allopurinol 100mg tab Allopurinol 300mg tab Baclofen 10mg tab* Cyclobenzaprine 5mg tab Cyclobenzaprine 10mg tab Dexamethasone 0.5mg tab Dexamethasone 0.75mg tab Dexamethasone 4mg tab Diclofenac DR 75mg tab* Ibuprofen 100mg/5ml susp* ml ml Ibuprofen 400mg tab Ibuprofen 600mg tab* Ibuprofen 800mg tab Indomethacin 25mg cap* Meloxicam 7.5mg tab Meloxicam 15mg tab Naproxen 375mg tab* Naproxen 500mg tab* Asthma Albuterol 2mg tab Albuterol 4mg tab Albuterol 2mg/5ml syrup ml ml Albuterol 0.083% nebulizer soln* (25x3ml vials) $ 9/30-day Albuterol 0.5% nebulizer soln* (20ml bottle) Ipratropium 0.02% nebulizer soln* (25x2.5ml vials) Revised 5/16/ Wal-Mart Stores, Inc. Page 1 of 5 21 Savings Made Simple

25 $ 4, 30-day $ 10, 90-day $ 4, 30-day $ 10, 90-day Cholesterol Lovastatin 10mg tab Lovastatin 20mg tab* Diabetes Glimepiride 1mg tab Glimepiride 2mg tab Glimepiride 4mg tab Glipizide 5mg tab Glipizide 10mg tab* Glyburide 2.5mg tab Glyburide 5mg tab (blue) Glyburide 5mg tab (green) Glyburide, micronized 3mg tab Glyburide, micronized 6mg tab Metformin 500mg tab Metformin 850mg tab Metformin 1000mg tab* Metformin 500mg ER tab* Ear Health Antipyrine/Benzocaine otic* (15ml bottle) Fungal Infections Fluconazole 150mg tab Nystatin cream* (15gm tube) Nystatin cream* (30gm tube) Terbinafine 250mg tab* Gastrointestinal Health Cimetidine 800mg tab* Cytra2 solution ml ml Dicyclomine 10mg cap Dicyclomine 20mg tab Famotidine 20mg tab Lactulose syrup* ml ml Metoclopramide 10mg tab Metoclopramide syrup ml ml Promethazine 25mg tab* Promethazine plain syrup* ml ml Ranitidine 150mg tab Ranitidine 300mg tab Glaucoma & Eye Care Atropine Sulfate 1% op. soln* (5ml bottle) Erythromycin op. ointment (3.5gm tube) * Gentak 0.3% op. soln Gentamicin 0.3% op. soln (5ml bottle) Levobunolol 0.5% op soln (5ml bottle) Neomycin/Polymyxin/Dexamethasone 0.1% op. ointment* (3.5gm tube) Neomycin/Polymyxin/Dexamethasone 0.1% op. susp* (5ml bottle) Pilocarpine 1% op. soln* (15ml bottle) Pilocarpine 2% op. soln* (15ml bottle) Polymyxin Sulfate/TMP op. soln* (10ml bottle) Sulfacet Sodium 10% op. soln* (15ml bottle) Timolol Maleate 0.25% op. soln (5ml bottle) Timolol Maleate 0.5% op soln (5ml bottle) Tobramycin 0.3% op. soln (5ml bottle) Heart Health & Blood Pressure Atenolol-Chlorthalidone 100mg Atenolol 25mg tab Atenolol 50mg tab Atenolol 100mg tab Benazepril 5mg tab Benazepril 10mg tab Benazepril 20mg tab Benazepril 40mg tab Bisoprolol-HCTZ 2.5mg-6.25mg tab Bisoprolol-HCTZ 5mg-6.25mg tab Bisoprolol-HCTZ 10mg-6.25mg tab Bumetanide 0.5mg tab Bumetanide 1mg tab Carvedilol 3.125mg tab Carvedilol 6.25mg tab Carvedilol 12.5mg tab Carvedilol 25mg tab Clonidine 0.1mg tab Clonidine 0.2mg tab Enalapril-HCTZ 5mg-12.5mg tab Prescription Program includes up to a 30-day supply for $4 and a 90-day supply for $10 of some covered generic drugs at commonly prescribed dosages. Higher dosages cost more. Prices for some drugs covered by the Prescription Program may be higher and may vary in some states. Restrictions apply. See Program Details or your Walmart Pharmacist for details. Free language assistance services available for prescription drug information at Walmart and Sam s Club pharmacies in New York. Contact your Walmart or Sam s Club pharmacy for details. * Prices may be higher in CA, HI, MN, MT, PA, TN and WI. ** Home Delivery Service is not available through SamsClub.com. Prepackaged drugs are covered only in unit sizes specified on Drug List. See Program Details or your Walmart Pharmacist for details. Revised 5/16/ Wal-Mart Stores, Inc. Page 2 of 5 22 Savings Made Simple

26 $ 4, 30-day $ 10, 90-day $ 4, 30-day $ 10, 90-day Enalapril 2.5mg tab Enalapril 5mg tab Enalapril 10mg tab* Enalapril 20mg tab* Furosemide 20mg tab Furosemide 40mg tab Furosemide 80mg tab Guanfacine 1mg tab Hydralazine 10mg tab Hydralazine 25mg tab Hydrochlorothiazide(HCTZ)12.5mg cap Hydrochlorothiazide (HCTZ) 25mg tab Hydrochlorothiazide (HCTZ) 50mg tab Indapamide 1.25mg tab Indapamide 2.5mg tab Isosorbide Mononitrate 30mg ER tab* Isosorbide Mononitrate 60mg ER tab* Lisinopril-HCTZ 10mg-12.5mg tab Lisinopril-HCTZ 20mg-12.5mg tab* Lisinopril-HCTZ 20mg-25mg tab* Lisinopril 2.5mg tab Lisinopril 5mg tab Lisinopril 10mg tab Lisinopril 20mg tab Methyldopa 250mg tab* Metoprolol Tartrate 25mg tab Metoprolol Tartrate 50mg tab Metoprolol Tartrate 100mg tab* Propranolol 10mg tab Propranolol 20mg tab Propranolol 40mg tab Propranolol 80mg tab Sotalol HCL 80mg tab* Spironolactone 25mg tab* Terazosin 1mg cap Terazosin 2mg cap Terazosin 5mg cap Terazosin 10mg cap Triamterene-HCTZ 75mg-50mg tab Triamterene-HCTZ 37.5mg-25mg tab Verapamil 80mg tab Verapamil 120mg tab Warfarin 1mg tab Warfarin 2mg tab Warfarin 2.5mg tab Warfarin 3mg tab Warfarin 4mg tab Warfarin 5mg tab* Warfarin 6mg tab Warfarin 7.5mg tab Warfarin 10mg tab Men s Health $ 9/30-day Finasteride 5mg Mental Health Amitriptyline 10mg tab Amitriptyline 25mg tab Amitriptyline 50mg tab Amitriptyline 75mg tab Amitriptyline 100mg tab Benztropine 2mg tab Buspirone 5mg tab Buspirone 10mg tab* Carbamazepine 200mg tab* Citalopram 20mg tab Citalopram 40mg tab Fluoxetine 10mg tab* Fluoxetine 10mg cap Fluoxetine 20mg cap Fluoxetine 40mg cap Fluphenazine 1mg tab Haloperidol 0.5mg tab Haloperidol 1mg tab Haloperidol 2mg tab Haloperidol 5mg tab Lithium Carbonate 300mg cap* Nortriptyline 10mg cap Nortriptyline 25mg cap Paroxetine 10mg tab* Paroxetine 20mg tab* Prescription Program includes up to a 30-day supply for $4 and a 90-day supply for $10 of some covered generic drugs at commonly prescribed dosages. Higher dosages cost more. Prices for some drugs covered by the Prescription Program may be higher and may vary in some states. Restrictions apply. See Program Details or your Walmart Pharmacist for details. Free language assistance services available for prescription drug information at Walmart and Sam s Club pharmacies in New York. Contact your Walmart or Sam s Club pharmacy for details. * Prices may be higher in CA, HI, MN, MT, PA, TN and WI. ** Home Delivery Service is not available through SamsClub.com. Prepackaged drugs are covered only in unit sizes specified on Drug List. See Program Details or your Walmart Pharmacist for details. Revised 5/16/ Wal-Mart Stores, Inc. Page 3 of 5 23 Savings Made Simple

27 $ 4, 30-day $ 10, 90-day $ 4, 30-day $ 10, 90-day Prochlorperazine 10mg tab Trazodone 50mg tab Trazodone 100mg tab Trazodone 150mg tab Trihexyphenidyl 2mg tab Skin Conditions Gentamicin 0.1% cream (15gm tube) Gentamicin 0.1% ointment (15gm tube) Hydrocortisone 1% cream ( g tube) Hydrocortisone 2.5% cream (30gm tube) Silver Sulfadiazine 1% cream* (50gm tube) Triamcinolone 0.025% cream (15gm tube) Triamcinolone 0.025% cream (80gm tube) Triamcinolone 0.1% cream (15gm tube) Triamcinolone 0.1% cream (80gm tube) Triamcinolone 0.1% ointment (15gm tube) Triamcinolone 0.1% ointment (80gm tube) Triamcinolone 0.5% cream (15gm tube) Thyroid Conditions Levothyroxine 25mcg tab Levothyroxine 50mcg tab Levothyroxine 75mcg tab Levothyroxine 88mcg tab Levothyroxine 100mcg tab Levothyroxine 112mcg tab Levothyroxine 125mcg tab Levothyroxine 137mcg tab Levothyroxine 150mcg tab Levothyroxine 175mcg tab* Levothyroxine 200mcg tab* Viruses Acyclovir 200mg cap Vitamins & Nutritional Health Folic Acid 1mg tab Mag 64 64mg tab* Magnesium Oxide 400mg tab Prenatal Plus qty 30* Sodium Fluoride.25mg chewable* (120ct bottle) N/A Women s Health Estradiol 0.5mg tab Estradiol 1mg tab Estradiol 2mg tab MedroxyprogesteroneAcetate 2.5mg tab Medroxyprogesterone Acetate 5mg tab Medroxyprogesterone Acetate 10mg tab Oral Contraceptives $ 9, 28-day Levonorgestrel/Ethinyl Estradiol Kurvelo Norethindrone USP Enskyce Jencycla Pirmella 1/ Pirmella 7/7/ Sprintec Tri-Sprintec $ 9, 30-day $ 24, 90-day Alendronate SOD 35mg tab Alendronate SOD 70mg tab Clomiphene 50mg tab Tamoxifen 10mg tab Tamoxifen 20mg tab Other Medical Conditions Chlorhexidine Gluconate 0.12% soln (473ml bottle) Isoniazid 300mg tab Lidocaine 2% viscous solution (100ml bottle) Megestrol 20mg tab* Phenazopyridine 100mg tab* Prednisone 2.5mg tab* Prednisone 5mg tab* Prescription Program includes up to a 30-day supply for $4 and a 90-day supply for $10 of some covered generic drugs at commonly prescribed dosages. Higher dosages cost more. Prices for some drugs covered by the Prescription Program may be higher and may vary in some states. Restrictions apply. See Program Details or your Walmart Pharmacist for details. Free language assistance services available for prescription drug information at Walmart and Sam s Club pharmacies in New York. Contact your Walmart or Sam s Club pharmacy for details. * Prices may be higher in CA, HI, MN, MT, PA, TN and WI. ** Home Delivery Service is not available through SamsClub.com. Prepackaged drugs are covered only in unit sizes specified on Drug List. See Program Details or your Walmart Pharmacist for details. Revised 5/16/ Wal-Mart Stores, Inc. Page 4 of 5 24 Savings Made Simple

28 Walmart s Prescription Program Details 1. Walmart s Prescription Program (the Program ) is available at all Walmart, Sam s Club and Neighborhood Market pharmacies in the United States ( Walmart Retail Pharmacies ), except in North Dakota, as set forth below in Sections 3 and 4. The Program is also available through Walmart Mail Service ( Walmart Mail Service ), as set forth below in Section The Program applies only to certain generic drugs at commonly prescribed dosages. Higher dosages cost more. You may obtain a list of generic drugs and dosages covered under the Program at Walmart Retail Pharmacies (the Retail Drug List ) and through Walmart Mail Service (the Mail Service Drug List ) on Walmart. com or at Walmart Retail Pharmacies. The Retail Drug List and Mail Service Drug List may change and also may vary by state. Not all formulations of a drug (for example, enteric-coated, extended or timed release formulations) are covered under the Program. Program pricing not available when a covered drug is dispensed as part of a compound. 3. Under the Program at Walmart Retail Pharmacies, $4 is the price for up to a 30-day supply of certain covered generic drugs at commonly prescribed dosages (the $4 Retail Program ). $10 is the price of a 90-day supply of certain covered generic drugs at commonly prescribed dosages (the $10 Retail Program ). Not all drugs covered by the $4 Retail Program are covered by the $10 Program. Prices for quantities between a 30-day supply and a 90-day supply of drugs covered by both the $4 Retail Program and $10 Retail Program are prorated based on the $4 Program price, but will not exceed $10. Prices for quantities greater than a 90-day supply of drugs covered by the $10 Retail Program are prorated based on the $10 Program price. Prorated pricing is not available under the Program for prepackaged drugs. For pricing policies relating to prepackaged drugs (such as tubes, vials or bottles), see Section Under the Program at Walmart Retail Pharmacies, $9 is the price for up to a 30-day supply of certain women s health and other covered generic drugs at commonly prescribed dosages (the $9 Retail Program ). $24 is the price for a 90-day supply of certain women s health and other covered generic drugs at commonly prescribed dosages (the $24 Retail Program ). Not all drugs covered by the $9 Retail Program are covered by the $24 Retail Program. Prices for quantities between a 30-day supply and a 90-day supply of drugs covered by both the $9 Program and $24 Retail Program are prorated based on the $9 Program price, but will not exceed $24. Prices for quantities greater than a 90-day supply of drugs covered by the $24 Retail Program are prorated based on the $24 Program price. Prorated pricing is not available under the Program for prepackaged drugs. For pricing policies relating to prepackaged drugs, see Section Under the Program through Walmart Mail Service, $10 is the price for mail delivery of a 90-day supply of certain generic drugs at commonly prescribed dosages ( $10 Mail Service Program ). $24 is the price for mail delivery of certain women s health and certain other covered drugs at commonly prescribed dosages ($24 Mail Service Program ). Not all drugs covered by the $10 Retail Program are covered by the $10 Mail Service Program; not all drugs covered by the $24 Retail Program are covered by the $24 Mail Service Program. See Mail Service Drug List for a list of drugs covered by the $10 Mail Service Program and $24 Mail Service Program. Walmart Mail Service covers both initial fills and refills. Delivery of covered drugs is available only through Walmart Mail Service and is not available at Walmart, Sam s Club, and Neighborhood Market retail pharmacies. Delivery under the Program through Walmart Mail Service is limited to U.S. addresses by First-Class Mail; expedited delivery is also available for an additional charge. Some health plans do not cover Walmart Mail Service or 90-day supplies. Prices for quantities greater than a 90-day supply of drugs covered by the $10 Mail Service Program and the $24 Mail Service Program are prorated based on the $10 and $24 Program price, respectively. Prices for quantities less than a 90-day supply are not prorated under either the $10 Mail Service Program or the $24 Mail Service Program. Prorated pricing is not available under the Program for prepackaged drugs. For pricing policies relating to prepackaged drugs, see Section Prepackaged drugs are covered under the Program only in the unit sizes specified on the Retail Drug List and Mail Service Drug List. Prepackaged drugs are dispensed based on the quantities prescribed and unit sizes in stock at the dispensing pharmacy. Unit sizes not specified on the Retail Drug List or Mail Service Drug List are not covered under the Program. Multi-unit purchases are charged at a per unit price, based on the price per unit size dispensed, unless otherwise specified. Prepackaged drugs dispensed in unit sizes not specified on the Retail Drug List and Mail Service Drug List may be priced higher, even if equivalent quantities of the drug are available in specified unit sizes. Prorated pricing is not available under the Program for prepackaged drugs. 7. Prices of certain drugs covered by the Program may be higher in some states, as noted on the Retail Drug List and Mail Service Drug List. 8. Program pricing may be limited to select manufacturers of a covered drug and is available as long as supplies from such manufacturers are in stock at the dispensing pharmacy. 9. You may pay less or more than the Program price, depending on the terms of your health plan. Prescriber permission may be required to change a 30-day prescription to a 90-day prescription. Certain plans, including government-funded programs, may not cover a 90-day supply. 10. For purchases made at Walmart Retail Pharmacies, prescriptions must initially be filled in person, and refills must be picked up in store. There are no substitutions. Purchases made through Walmart Mail Service may be ordered at Walmart Retail Pharmacies, by phone or through walmart.com. 11. These Program Details are subject to change without advance notice. Changes to these Program Details may be made only in writing. Prescription Program includes up to a 30-day supply for $4 and a 90-day supply for $10 of some covered generic drugs at commonly prescribed dosages. Higher dosages cost more. Prices for some drugs covered by the Prescription Program may be higher and may vary in some states. Restrictions apply. See Program Details or your Walmart Pharmacist for details. Free language assistance services available for prescription drug information at Walmart and Sam s Club pharmacies in New York. Contact your Walmart or Sam s Club pharmacy for details. * Prices may be higher in CA, HI, MN, MT, PA, TN and WI. ** Home Delivery Service is not available through SamsClub.com. Prepackaged drugs are covered only in unit sizes specified on Drug List. See Program Details or your Walmart Pharmacist for details. Revised 5/16/ Wal-Mart Stores, Inc. Page 5 of 5 25 Savings Made Simple

29 Winn-Dixie Prescription Plan $4 & $10 GENERICS A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Men's Health Women's Health Baby Club Benefits Antibiotics QTY DRUG NAME $0.00 Copay$4.00 $10.00 AMOXICILLIN 125 MG/5 ML (150 ML BOTTLE) 150 AMOXICILLIN 125 MG/5 ML (100 ML BOTTLE) 100 AMOXICILLIN 125 MG/5 ML (80 ML BOTTLE) 80 AMOXICILLIN 200 MG/5 ML (100 ML BOTTLE) 100 AMOXICILLIN 200 MG/5 ML (75 ML BOTTLE) 75 AMOXICILLIN 200 MG/5 ML (50 ML BOTTLE) 50 AMOXICILLIN 250 MG CAPSULES 30 AMOXICILLIN 250 MG/5 ML (150 ML BOTTLE) 150 AMOXICILLIN 250 MG/5 ML (100 ML BOTTLE) 100 AMOXICILLIN 250 MG/5 ML (80 ML BOTTLE) 80 AMOXICILLIN 400 MG/5 ML (100 ML BOTTLE) 100 AMOXICILLIN 400 MG/5 ML (75 ML BOTTLE) 75 AMOXICILLIN 400 MG/5 ML (50 ML BOTTLE) 50 AMOXICILLIN 500 MG CAPSULES 30 AMOXICILLIN 875 MG TABLETS 20 AMPICILLIN 250 MG CAPSULES 28 AMPICILLIN 500 MG CAPSULES 28 CEPHALEXIN 250 MG CAPSULES 30 CEPHALEXIN 500 MG CAPSULES 30 CIPROFLOXACIN 250 MG TABLETS 20 CIPROFLOXACIN 500 MG TABLETS 20 CIPROFLOXACIN 750 MG TABLETS 14 CLINDAMYCIN 150 MG CASULES ISONIAZID 300 MG TABLETS MINOCYCLINE 50 MG CAPSULES MINOCYCLINE 100 MG CAPSULES PENICILLIN V Pot 125/5 100 ML (100 ML BOTTLE) 100 PENICILLIN V Pot 125/5 200 ML (200 ML BOTTLE) 200 PENICILLIN VK 250 MG TABLETS 28 PENICILLIN VK 250/5 ML (100 ML BOTTLE) 100 PENICILLIN VK 250/5 ML (200 ML BOTTLE) 200 PENICILLIN VK 500 MG TABLETS 28 SULFAMETH/TRIMETH 200/40/5 ML 120 SULFAMETH/TRIMETH 400/80 MG TABLETS 28 SULFAMETH/TRIMETH 800/160 MG TABLETS 20 SULFASALAZINE 500 MG TABLETS $8.00 $24.00 AMOX/K CLAV 500 MG TABLETS 20 AMOX/K CLAV 875 MG TABLETS 20 METRONIDAZOLE 250 MG TABLETS

30 METRONIDAZOLE 500 MG TABLETS $15.00 AZITHROMYCIN 250 MG PAK (6 TABLETS) (NEW) 6 N/A Antifungal DRUG NAME $4.00 $10.00 FLUCONAZOLE 150 MG TABLETS 1 3 KETOCONAZOLE 2% CREAM NYSTATIN 100 MU/ML ORAL SUSP DROP NYSTATIN 100 MU/ML ORAL SUSP TERBINAFINE 250 MG TABLETS $8.00 $24.00 KETOCONAZOLE 2% CREAM $12.00 $36.00 KETOCONAZOLE 2% CREAM Antiviral DRUG NAME $4.00 $10.00 AMANTADINE 50 MG/5 ML SYRUP ACYCLOVIR 200 MG CAPSULES ACYCLOVIR 400 MG TABLETS ACYCLOVIR 800 MG TABLETS Arthritis/ Pain DRUG NAME $4.00 $10.00 ALLOPURINOL 100 MG TABLETS ALLOPURINOL 300 MG TABLETS BACLOFEN 10 MG TABLETS BACLOFEN 20 MG TABLETS DICLOFENAC POT 50 MG TABLETS IBUPROFEN 400 MG TABLETS IBUPROFEN 600 MG TABLETS IBUPROFEN 800 MG TABLETS INDOMETHACIN 25 MG CAPSULES INDOMETHACIN 50 MG CAPSULES MELOXICAM 15 MG TABLETS MELOXICAM 7.5 MG TABLETS NAPROXEN 250 MG TABLETS NAPROXEN 375 MG TABLETS NAPROXEN 500 MG TABLETS $8.00 $24.00 DICLOFENAC SOD DR 50 MG TABLETS DICLOFENAC SOD DR 75 MG TABLETS KETOPROFEN 50 MG CAPSULES KETOPROFEN 75 MG CAPSULES Asthma/ Resp/Allergies DRUG NAME $4.00 $10.00 ALBUTEROL 2 MG/5 ML SYRUP CETIRIZINE 10 MG TABLETS LORATADINE 10 MG TABLETS $4.00 $10.00 ALBUTEROL SULFATE % NEB SOLN IPRATROPIUM BROMIDE 0.02% AMPULE $

31 IPRATROPIUM BROM/ALBUTEROL SUL $15.00 $45.00 FLUTICASONE 50 MCG NASAL SPRAY Cholesterol DRUG NAME $4.00 $10.00 LOVASTATIN 10 MG TABLETS LOVASTATIN 20 MG TABLETS LOVASTATIN 40 MG TABLETS SIMVASTATIN 20 MG TABLETS SIMVASTATIN 40 MG TABLETS SIMVASTATIN 10 MG TABLETS SIMVASTATIN 5 MG TABLETS SIMVASTATIN 80 MG TABLETS $10.00 $30.00 GEMFIBROZIL 600 MG TABLETS $15.00 $45.00 PRAVASTATIN 10 MG TABLETS PRAVASTATIN 20 MG TABLETS PRAVASTATIN 40 MG TABLETS CNS DRUG NAME $4.00 $10.00 BENZTROPINE 0.5 MG TABLETS BENZTROPINE 1 MG TABLETS CARBAMAZEPINE 100 MG CHEWABLES CARBAMAZEPINE 200 MG TABLETS DIVALPROEX SODIUM DR 125 MG TABLETS DIVALPROEX SODIUM DR 250 MG TABLETS DIVALPROEX SODIUM DR 500 MG TABLETS GABAPENTIN 100 MG CAPSULES GABAPENTIN 300 MG CAPSULES GABAPENTIN 400 MG CAPSULES HYDROXYZINE HCL 10 MG TABLETS HYDROXYZINE HCL 25 MG TABLETS HYDROXYZINE HCL 50 MG TABLETS HYDROXYZINE PAM 25 MG CAPSULES LAMOTRIGINE 100 MG TABLETS LAMOTRIGINE 150 MG TABLETS LAMOTRIGINE 200 MG TABLETS LAMOTRIGINE 25 MG TABLETS LAMOTRIGINE 25 MG CHEW TABS MIRTAZAPINE 15 MG TABLETS MIRTAZAPINE 30 MG TABLETS PRIMIDONE 50 MG TABLETS PRIMIDONE 250 MG TABLETS ROPINIROLE 0.25 MG TABLETS ROPINIROLE 0.5 MG TABLETS ROPINIROLE 1 MG TABLETS ROPINIROLE 2 MG TABLETS ROPINIROLE 3 MG TABLETS ROPINIROLE 4 MG TABLETS ROPINIROLE 5 MG TABLETS TOPIRAMATE 25 MG TABLETS TOPIRAMATE 50 MG TABLETS TOPIRAMATE 100 MG TABLETS TOPIRAMATE 200 MG TABLETS ZONISAMIDE 25 MG CAPSULES

32 ZONISAMIDE 50 MG CAPSULES ZONISAMIDE 100 MG CAPSULES DRUG NAME $8.00 $22.00 BENZTROPINE 2 MG TABLETS HYDROXYZINE PAM 50 MG CAPSULES MIRTAZAPINE 45 MG TABLETS OXCARBAZEPINE 150 MG TABLETS OXCARBAZEPINE 300 MG TABLETS 60 OXCARBAZEPINE 600 MG TABLETS PHENYTOIN 100 MG CAPSULES $24.00 N/A SUMATRIPTAN 25 MG TABLETS 9 SUMATRIPTAN 50 MG TABLETS 9 SUMATRIPTAN 100 MG TABLETS 9 Cough DRUG NAME $4.00 $10.00 BENZONATATE 100 MG CAPSULES BENZONATATE 100 MG CAPSULES PROMETHAZINE/DM MG/5 ML SYRUP PROMETHAZINE 6.25/5 ML SYRUP* Diabetes DRUG NAME $4.00 $10.00 BLOOD GLUCOSE KIT BY TOPCARE 1 N/A BLOOD GLUCOSE TEST STRIPS 25 CT BY TOPCARE 25 N/A BLOOD GLUCOSE LANCETS BY TOPCARE (NEW) 100 N/A GLIMEPIRIDE 1 MG TABLETS GLIMEPIRIDE 2 MG TABLETS GLIMEPIRIDE 4 MG TABLETS GLIPIZIDE 10 MG TABLETS GLIPIZIDE 5 MG TABLETS GLYBURIDE 1.25 MG TABLETS GLYBURIDE 2.5 MG TABLETS GLYBURIDE 5 MG TABLETS Diabetes QTY DRUG NAME $0.00 Copay$4.00 $10.00 GLYBURIDE/METFORMIN 1.25/250 MG TABLETS GLYBURIDE/METFORMIN 2.5/500 MG TABLETS GLYBURIDE/METFORMIN 5/500 MG TABLETS METFORMIN 1000 MG TABLETS 90 METFORMIN 500 MG TABLETS 90 METFORMIN 850 MG TABLETS 90 METFORMIN ER 500 MG TABLETS METFORMIN ER 750 MG TABLETS $8.00 $20.00 BLOOD GLUCOSE TEST STRIPS 50 CT BY TOPCARE 50 n/a GLYBURIDE MCR 6 MG TABLETS Ear/Eye DRUG NAME $4.00 $10.00 ANTIPYRINE/BENZO OTIC SOL CIPROFLOXACIN 0.3% OPTHALMIC SOL 5 15 GENTAMICIN SUL 0.3% OPTHALMIC SOL 5 15 OFLOXACIN OPTH 0.3 % SOL 5 15 TIMOLOL MAL 0.25% OPTHALMIC SOL (5 ML) 5 N/A TIMOLOL MAL 0.5% OPTHALMIC SOL (5 ML or 15ML)

33 TOBRAMYCIN 0.3% OPHTHALMIC SOLUTION 5 15 TRIMETHOPRIM-POLY B OPTHALMIC SOL $8.00 $24.00 TIMOLOL MAL 0.5% OPTHALMIC SOL (10 ML) 10 N/A Gastrointestinal DRUG NAME $4.00 $10.00 FAMOTIDINE 20 MG TABLETS FAMOTIDINE 40 MG TABLETS METOCLOPRAMIDE 10 MG TABLETS METOCLOPRAMIDE 5 MG METOCLOPRAMIDE 5 MG/5 ML SYRUP 240 OMEPRAZOLE 20 MG CAPSULES ONDANSETRON ODT 4 MG TABLETS ONDANSETRON ODT 8 MG TABLETS 7 21 PROMETHAZINE 25 MG TABLETS RANITIDINE 150 MG TABLETS RANITIDINE 300 MG TABLETS RANITIDINE 15MG/ML SYRUP DRUG NAME $4.00 $12.00 LACTULOSE 10 MG/15 ML SOLUTION DRUG NAME $8.00 $24.00 DICYCLOMINE 10 MG CAPSULES DICYCLOMINE 20 MG TABLETS LOPERAMIDE 2 MG CAPSULES OMEPRAZOLE 40 MG CAPSULES Heart and Blood Pressure DRUG NAME $4.00 $10.00 AMLODIPINE BES 10 MG TABLETS AMLODIPINE BES 2.5 MG TABLETS AMLODIPINE BES 5 MG TABLETS AMLODIPINE/BENZ 2.5/10 MG CAPSULES AMLODIPINE/BENZ 5/10 MG CAPSULES AMLODIPINE/BENZ 5/20 MG CAPSULES AMLODIPINE/BENZ 10/20 MG CAPSULES ATENOLOL/CHLOR 50/25 MG TABLETS ATENOLOL/CHLOR 100/25 MG TABLETS ATENOLOL 100 MG TABLETS ATENOLOL 25 MG TABLETS ATENOLOL 50 MG TABLETS BENAZEPRIL 10 MG TABLETS BENAZEPRIL 20 MG TABLETS BENAZEPRIL 40 MG TABLETS BENAZEPRIL 5 MG TABLETS BETHANECHOL 10 MG TABLETS BETHANECHOL 25 MG TABLETS BETHANECHOL 50 MG TABLETS BISOPROLOL 5 MG TABLETS BISOPROLOL 10 MG TABLETS BISOPROLOL/HCTZ 10/6.25 TABLETS BISOPROLOL/HCTZ 5/6.25 TABLETS BISOPROLOL/HCTZ 2.5/6.25 TABLETS CARVEDILOL 12.5 MG TABLETS CARVEDILOL 25 MG TABLETS CARVEDILOL MG TABLETS

34 CARVEDILOL 6.25 MG TABLETS CLONIDINE 0.1 MG TABLETS CLONIDINE 0.2 MG TABLETS CLONIDINE 0.3 MG TABLETS DIPYRIDAMOLE 25 MG TABLETS DIPYRIDAMOLE 50 MG TABLETS DIPYRIDAMOLE 75 MG TABLETS ENALAPRIL 10 MG TABLETS ENALAPRIL 2.5 MG TABLETS ENALAPRIL 5 MG TABLETS ENALAPRIL/HCTZ MG ENALAPRIL/HCTZ 5 MG/12.5 MG TABLETS FUROSEMIDE 10 MG/ ML SOLUTION 60 FUROSEMIDE 20 MG TABLETS FUROSEMIDE 40 MG TABLETS FUROSEMIDE 80 MG TABLETS GUANFACINE 1 MG TABLETS GUANFACINE 2 MG TABLETS HYDRALAZINE 10 MG TABLETS HYDRALAZINE 25 MG TABLETS HYDRALAZINE 50 MG TABLETS HYDRALAZINE 100 MG TABLETS HYDROCHLOROTHIAZIDE 12.5 MG CAPSULES HYDROCHLOROTHIAZIDE 12.5 MG TABLETS HYDROCHLOROTHIAZIDE 25 MG TABLETS HYDROCHLOROTHIAZIDE 50 MG TABLETS ISOSORBIDE MONONITRATE 20 MG TABLETS LISINOPRIL 10 MG TABLETS 60 LISINOPRIL 2.5 MG TABLETS 60 LISINOPRIL 20 MG TABLETS 60 LISINOPRIL 30 MG TABLETS 60 LISINOPRIL 40 MG TABLETS 60 LISINOPRIL 5 MG TABLETS 60 LISINOPRIL-HCTZ MG TABLETS LISINOPRIL-HCTZ MG TABLETS LISINOPRIL-HCTZ MG TABLETS METHYLDOPA 250 MG TABLETS METHYLDOPA 500 MG TABLETS METOPROLOL 100 MG TABLETS METOPROLOL 25 MG TABLETS METOPROLOL 50 MG TABLETS PENTOXIFLYLINE 400 MG TABLETS PROPRANOLOL 10 MG TABLETS PROPRANOLOL 20 MG TABLETS PROPRANOLOL 40 MG TABLETS PROPRANOLOL 60 MG TABLETS PROPRANOLOL 80 MG TABLETS QUINAPRIL 10 MG TABLETS QUINAPRIL 20 MG TABLETS QUINAPRIL 40 MG TABLETS QUINAPRIL 5 MG TABLETS SOTALOL HCL 80 MG TABLETS SOTALOL HCL 120 MG TABLETS SOTALOL HCL 160 MG TABLETS SPIRONOLACTONE 25 MG TABLETS SPIRONOLACTONE 50 MG TABLETS SPIRONOLACTONE 100 MG TABLETS TERAZOSIN 10 MG CAPSULES TERAZOSIN 1 MG CAPSULES TERAZOSIN 2 MG CAPSULES TERAZOSIN 5 MG CAPSULES

35 TRIAMTERENE/HCTZ TABLETS VERAPAMIL 120 MG TABLETS VERAPAMIL 80 MG TABLETS WARFARIN 10 MG TABLETS WARFARIN 1 MG TABLETS WARFARIN 2.5 MG TABLETS WARFARIN 2 MG TABLETS WARFARIN 3 MG TABLETS WARFARIN 4 MG TABLETS WARFARIN 5 MG TABLETS WARFARIN 6 MG TABLETS WARFARIN 7.5 MG TABLETS DRUG NAME $8.00 $22.00 AMILORIDE/HCTZ 5 MG/50 MG TABLETS AMIODARONE 200 MG TABLETS AMLODIPINE/BENZ 5/40 MG CAPSULES AMLODIPINE/BENZ 10/40 MG CAPSULES CILOSTAZOL 50 MG TABLETS CILOSTAZOL 100 MG TABLETS DILTIAZEM 30 MG TABLETS DILTIAZEM 60 MG TABLETS DILTIAZEM 90 MG TABLETS DILTIAZEM 120 MG TABLETS ENALAPRIL 20 MG TABLETS FOSINOPRIL 10 MG TABLETS FOSINOPRIL 20 MG TABLETS FOSINOPRIL 40 MG TABLETS FOSINOPRIL/HCTZ MG TABLETS FOSINOPRIL/HCTZ MG TABLETS LABETALOL HCL 100 MG TABLETS LABETALOL HCL 200 MG TABLETS LABETALOL HCL 300 MG TABLETS TRIAMTERENE/HCTZ CAPSULES TRIAMTERENE/HCTZ MG TABLETS $10.00 $30.00 CLOPIDOGREL 75 MG TABLETS INDAPAMIDE 1.25 MG TABLETS INDAPAMIDE 2.5 MG TABLETS DRUG NAME $12.00 $36.00 CHLORTHALIDONE 50 MG TABLETS DILTIAZEM CD 120 MG CAPSULES DILTIAZEM CD 180 MG CAPSULES DILTIAZEM CD 240 MG CAPSULES LOSARTAN POT 25 MG LOSARTAN POT 50 MG LOSARTAN POT 100 MG LOSARTAN-HCTZ 50/12.5 MG TABLETS LOSARTAN-HCTZ 100/12.5 MG TABLETS LOSARTAN-HCTZ 100/25 MG TABLETS RAMIPRIL 1.25 MG CAPSULES RAMIPRIL 10 MG CAPSULES RAMIPRIL 2.5 MG CAPSULES RAMIPRIL 5 MG CAPSULES Mental Health DRUG NAME $4.00 $10.00 AMITRIPTYLINE 100 MG TABLETS

36 AMITRIPTYLINE 10 MG TABLETS AMITRIPTYLINE 25 MG TABLETS AMITRIPTYLINE 50 MG TABLETS AMITRIPTYLINE 75 MG TABLETS BUSPIRONE 5 MG TABLETS BUSPIRONE 10 MG TABLETS CITALOPRAM 10 MG TABLETS CITALOPRAM 20 MG TABLETS CITALOPRAM 40 MG TABLETS FLUOXETINE 10 MG CAPSULES FLUOXETINE 20 MG CAPSULES FLUOXETINE 40 MG CAPSULES FLUPHENAZINE 1 MG TABLETS FLUPHENAZINE 5 MG TABLETS FLUPHENAZINE 10 MG TABLETS HALOPERIDOL 2 MG/ ML 15 ML Concentrate LITHIUM CARBONATE 300 MG CAPSULES NORTRIPTYLINE 10 MG CAPSULES NORTRIPTYLINE 25 MG CAPSULES PAROXETINE 10 MG TABLETS PAROXETINE 20 MG TABLETS PAROXETINE 30 MG TABLETS PAROXETINE 40 MG TABLETS PROCHLORPERAZINE 10 MG TABLETS PROCHLORPERAZINE 5 MG TABLETS DRUG NAME $4.00 $10.00 RISPERIDONE 0.25 MG TABLETS RISPERIDONE 0.5 MG TABLETS RISPERIDONE 1 MG TABLETS RISPERIDONE 2 MG TABLETS RISPERIDONE 3 MG TABLETS SERTRALINE 100 MG TABLETS SERTRALINE 25 MG TABLETS SERTRALINE 50 MG TABLETS TRAZODONE 100 MG TABLETS TRAZODONE 150 MG TABLETS TRAZODONE 50 MG TABLETS DRUG NAME $8.00 $22.00 BUSPIRONE 15 MG TABLETS NORTRIPTYLINE 50 MG CAPSULES NORTRIPTYLINE 75 MG CAPSULES RISPERIDONE 4 MG TABLETS THIOTHIXENE 1 MG THIORIDAZINE 10 MG TABLETS THIORIDAZINE 25 MG TABLETS DRUG NAME $12.00 $36.00 THIORIDAZINE 50 MG TABLETS DRUG NAME $18.00 $50.00 VENLAFAXINE 25 MG TABLETS VENLAFAXINE 37.5 MG TABLETS VENLAFAXINE 50 MG TABLETS VENLAFAXINE 75 MG TABLETS VENLAFAXINE 100 MG TABLETS Muscle Relaxants DRUG NAME $4.00 $

37 CYCLOBENZAPRINE 10 MG TABLETS CYCLOBENZAPRINE 5 MG TABLETS METHOCARBAMOL 500 MG TABLETS METHOCARBAMOL 750 MG TABLETS Other DRUG NAME $4.00 $10.00 CHLORHEXADINE GLUCOSE 0.12% SOLN 480 DEXAMETHASONE.5 MG TABLETS DEXAMETHASONE 0.75 MG TABLETS DEXAMETHASONE 4 MG TABLETS 6 18 LIDOCAINE 2% VISCOUS SOLUTION OXYBUTYNIN 5 MG/5 ML SYRUP 150 N/A PHENAZOPYRIDINE 100 MG TABLETS 6 18 PHENAZOPYRIDINE 200 MG TABLETS 6 18 PREDNISOLONE DROPS 15 MG/5 ML SYRUP (PRELONE) PREDNISOLONE SOD PHOS 15 MG/5 ML SYRUP (ORAPRED) PREDNISONE 1 MG TABLETS PREDNISONE 2.5 MG TABLETS PREDNISONE 20 MG TABLETS PREDNISONE 5 MG TABLETS PREDNISONE 10 MG TABLETS PREDNISONE 5 MG DOSEPACK 21 N/A 21 PREDNISONE 10 MG DOSEPACK 21 N/A 21 S.F PLUS 1.1 % GM CREAM 51 N/A VITAMIN D 50,000 UNIT CAPSULES 8 24 $8.00 $12.00 S.F PLUS 1.1 % GM CREAM Skin DRUG NAME $4.00 $10.00 HYDROCORTISONE 1% CREAM 30 GM HYDROCORTISONE 2.5% CREAM 30 GM MICONAZOLE 2% (OTC) 28 GM CREAM SILVER SULFADIAZINE 1% (25 GM) CREAM TRIAMCINOLONE 0.025% 15 GM (tube) CREAM TRIAMCINOLONE 0.1% 15 GM (tube) CREAM DRUG NAME $8.00 $18.00 CLOBETASOL PROPIONATE 0.05% SOL SILVER SULFADIAZINE 1% (50 GM) CREAM 50 TRIAMCINOLONE 0.025% 15 GM (tube) CREAM TRIAMCINOLONE 0.025% 15 GM (tube) OINTMENT TRIAMCINOLONE 0.025% 80 GM (tube) CREAM TRIAMCINOLONE 0.025% 80 GM (tube) OINTMENT TRIAMCINOLONE 0.1% 15 GM (tube) CREAM TRIAMCINOLONE 0.1% 15 GM (tube) OINTMENT TRIAMCINOLONE 0.1% 80 GM (tube) CREAM TRIAMCINOLONE 0.1% 80 GM (tube) OINTMENT TRIAMCINOLONE 0.5% 15 GM (tube) CREAM TRIAMCINOLONE 0.5% 15 GM (tube) OINTMENT $24.00 MUPIROCIN 2% OINTMENT 22 Thyroid DRUG NAME $4.00 $10.00 METHIMAZOLE 5 MG TABLETS METHIMAZOLE 10 MG TABLETS $8.00 $

38 LEVOTHYROXINE 25 MCG TABLETS LEVOTHYROXINE 50 MCG TABLETS LEVOTHYROXINE 75 MCG TABLETS LEVOTHYROXINE 88 MCG TABLETS LEVOTHYROXINE 100 MCG TABLETS LEVOTHYROXINE 112 MCG TABLETS LEVOTHYROXINE 125 MCG TABLETS LEVOTHYROXINE 137 MCG TABLETS LEVOTHYROXINE 150 MCG TABLETS LEVOTHYROXINE 175 MCG TABLETS LEVOTHYROXINE 200 MCG TABLETS Vaccines DRUG NAME Price ADACEL $56.99 DECAVAC $56.99 ENERGIX-B $59.99 GARDASIL $ HAVRIX $79.99 MENACTRA $ MMR $54.99 PNEUMOVAX $88.99 SEASONAL INFLUENZA (INCLUDING INTRA-DERMAL) $24.99 SEASONAL INFLUENZA HIGH DOSE $44.99 SEASONAL INFLUENZA MIST $39.99 SEASONAL INFLUENZA QUADRAVALENT $34.99 TWINRIX $ TYPHIM $65.99 VARIVAX $ VIVOTIF $51.99 ZOSTAVAX $ Vitamins/ Nutritional DRUG NAME $4.00 $10.00 FOLIC ACID 1 MG TABLETS LUDENT CHEW FL 0.5 MG TABLETS LUDENT CHEW FL 1 MG TABLETS MAG 64 MG TABLETS MAG-OXIDE 400 MG TABLETS PRENATABS FA TABLETS PRENATAL 27 TABLETS PRENATAL PLUS 27 TABLETS Mens Health DRUG NAME $9.00 $27.00 FINASTERIDE 5 MG TABLETS $10.00 $30.00 TAMSULOSIN 0.4 MG CAPSULES

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