Price List & Product Catalog 2011

Transcription

1 Price List & Product Catalog 2011 AL05121W

2 CONTENTS Terms and Conditions of Sale Baxter s Renal Business Unit develops, manufactures and markets a comprehensive selection of PRODUCTS and services used in the treatment of kidney disease. Directory of Services... 2 General Terms and Conditions of Sale... 3 Definitions... 4 Warranties Order/Delivery Billing/Payment Returned Goods APD EQUIPMENT Rental Program PERITONEAL DIALYSIS Dianeal PD Solution, UltraBag System... PD1 Dianeal PD Solution, Single Bag... PD2 Extraneal (icodextrin) PD Solution... PD4 HomeChoice PRO Automated Peritoneal Dialysis System... PD5 PD6 HomeChoice Automated Peritoneal Dialysis System PD5 PD6 APD Drain Supplies... PD6 APD Miscellaneous Supplies.... PD6 Disconnect Y-Sets... PD7 Miscellaneous CAPD Supplies.... PD7 Assist Devices... PD7 Transfer Sets, Catheter Supplies, Disconnect Caps, and Clamps... PD8 Trademarks... PDTM ACUTE DIALYSIS Dialysis Solutions for CRRT... AC1 Acute PD... AC1 Trademarks... ACTM HEMODIALYSIS Hemavision Disposable Blood Chamber... HD1 Dialyzers... HD2 HD3 Blood Tubing Sets... HD4 Fistula Needles... HD5 HD6 Disposable Supplies... HD7 Concentrates... HD8 Trademarks... HDTM SOFTWARE... SO1 Trademarks... SOTM ANCILLARIES Sponges... Dressings... Tape... AN2 Antiseptics/Chemicals... Gloves... Blood Pressure Units... AN4 Scales... AN4 Permanent Equipment... AN4 Miscellaneous Ancillary Supplies.... AN5 Trademarks... ANTM PRESCRIPTION FORMS... PF1 PF3 Trademarks... PFTM Numerical Index... IN1 IN3 Prices stated here are applicable to the U.S. only. Baxter may, at its sole discretion, revise or amend this price list and product catalog without prior notice to the customer. Effective July 1, 2011

3 Terms & Conditions of Sale Directory of Services HomeCare Services / Order Entry (HOME PATIENTS) Hours: 7:00 am - 6:00 pm CST Fax: Customer Service / Order Entry (Hospitals & Centers) Hours: 7:00 am - 6:00 pm CST Fax: NOTE: Hospital and Center orders are required to be placed electronically. Electronic Commerce Sales Inquiries PARTS and EQUIPMENT Service Hemodialysis On-site Service Hours: 8:00 am - 5:00 pm local time Emergency On-site Service (7 days a week) Hours: 8:00 am -10:00 pm EST Global Technical Services Peritoneal Dialysis Operational Support (24/7/365 days a year) Hemodialysis Technical Support Hours: 8:30 am - 5:00 pm EST Clinical Support PRODUCT Surveillance Hardware Billing Credit and Collections Hours: 7:00 am - 5:00 pm CST DIRECTACCESS Pharmacy Services Effective Date 7/1/11 2

4 I. General Terms and Conditions of Sale Terms & Conditions of Sale ALL SALES ARE SUBJECT TO AND EXPRESSLY CONDITIONED UPON THE TERMS AND CONDITIONS CONTAINED HEREIN, WHICH ARE ACCEPTED BY THE CUSTOMER UPON PLACING OF AN ORDER FOR PRODUCT WITH BAXTER WHICH ORDER IS CONFIRMED BY BAXTER. NO VARIATION OF THESE TERMS AND CONDITIONS WILL BE BINDING UPON BAXTER UNLESS AGREED TO IN WRITING AND SIGNED BY AN AUTHORIZED EMPLOYEE OF BAXTER, OR UNLESS A SEPARATE DIALYSIS PRODUCT PURCHASE AGREEMENT OR OTHER APPLICABLE SALES DOCUMENT HAS BEEN SIGNED, IN WHICH CASE, SUCH SALES DOCUMENT SHALL GOVERN IN THE EVENT OF AN EXPRESS CONFLICT WITH THESE TERMS AND CONDITIONS. THESE TERMS AND CONDITIONS CAN ALSO BE FOUND AT: Baxter reserves the right at any time to amend these Terms and Conditions. It is CUSTOMER S responsibility to review these Terms and Conditions prior to submitting each order. Baxter has no responsibility to notify CUSTOMER of any changes prior to the effective date of the changes. CUSTOMER shall be deemed to accept such amended Terms and Conditions by ordering PRODUCT after the date of such amendment. No Reselling, Transfer or Export CUSTOMER agrees that PRODUCT purchased from Baxter is not for: a) resale, transfer, barter or trade to any entity or person, b) use in the further processing, packaging or filling of other drugs, therapies or devices, or c) export. Neither CUSTOMER nor HOME PATIENT shall transfer any PRODUCT to any other person or entity except to the person for whom the prescription is written. Any unused PRODUCT, once dispensed or delivered to HOME PATIENT or CUSTOMER, cannot be transferred to any other patients and must be destroyed in accordance with applicable state or local regulations or returned to Baxter per the guidelines outlined in the Returned Goods section of these Terms and Conditions. Drug and Service State Licensing Requirements CUSTOMER agrees to maintain all state-mandated licenses and/or permits required to purchase, use, and dispense Baxter PRODUCT. CUSTOMER shall provide all applicable license and permit information to Baxter promptly upon request. Tax, Tax-Exempt Status and Other Fees CUSTOMER agrees to pay all applicable federal, state, and local taxes (including property taxes); license and registration fees; and all other fees and costs based on CUSTOMER S lease, rental, purchase, possession or use of PRODUCT. A CUSTOMER that is exempt from taxation is required to provide valid certification of its exempt status to Master Data Center of Excellence ( ; Fax ). No Prohibited Use of PRODUCT CUSTOMER will not knowingly use, resell, transfer or distribute any PRODUCT directly or indirectly for the development, production or proliferation of weapons of mass destruction, or missile delivery systems and/or for any terrorist activities. Effective Date 7/1/11 3

5 II. Definitions Terms & Conditions of Sale The following definitions apply to these Terms and Conditions: CUSTOMER shall mean the legal entity purchasing PRODUCT, for the provision of Automated Peritoneal Dialysis ( APD ), Continuous Ambulatory Peritoneal Dialysis ( CAPD ), or Hemodialysis ( HD ) therapy. Such entities include, but are not limited to: hospitals and their affiliated outpatient dialysis clinics ( Hospitals ) and other licensed, outpatient dialysis centers ( Centers ). DIRECTACCESS is an on-line tool to allow Hospitals and Centers to manage HOME PATIENT transactions. Key functions include: new patient set-up, status change, and prescription management. This is the preferred vehicle for CUSTOMER to manage HOME PATIENT transactions with Baxter. DISPOSABLE shall mean any PRODUCT manufactured or sold by Baxter, other than EQUIPMENT or PARTS. EQUIPMENT shall mean durable medical devices, hardware, instruments and instrumentation used primarily for dialysis which is manufactured or sold by Baxter for its intended use. EXPEDITED ORDER shall mean any order placed for delivery with less lead time than outlined in the Lead Time section of these Terms and Conditions. FORCE MAJEURE shall mean supply shortage of raw materials, manufacturing problems, delivery or labor problems, discontinuation of PRODUCT line, acts of regulatory or other governmental or quasi-governmental entities, terrorist activities, acts of hostility by foreign or domestic parties, acts of nature (including fire, flood, earthquake, storm, hurricane or other natural disaster), or unforeseen events or causes beyond Baxter s control. HOME PATIENT shall mean an individual for which CUSTOMER holds an active prescription and is providing CAPD, APD or HD therapy in the patient s home. PART shall mean a component manufactured or sold by Baxter for EQUIPMENT. PRODUCT shall mean DISPOSABLE, EQUIPMENT, PART or any combination thereof. RE-DELIVERY shall mean a situation in which previous delivery arrangements have been made and agreed to by HOME PATIENT and a second delivery is made after an unsuccessful first attempt to deliver has been made. SCHEDULED DELIVERY shall mean an order placed for delivery to an established address on an established date per the established delivery schedule. OFF-SCHEDULE DELIVERY shall mean an order placed for delivery to an established address on a date that varies from the established delivery date. 4 Effective Date 7/1/11

6 III. Warranties Terms & Conditions of Sale General Warranty Baxter warrants that PRODUCT manufactured by Baxter, when used in accordance with the directions on the labeling, is fit for the purposes and indications described on the labeling. The applicable manufacturer under the manufacturer s warranty will cover PRODUCT not manufactured by Baxter, and Baxter provides no warranty for PRODUCT not manufactured by Baxter. The warranty does not apply to any PRODUCT that is misused, abused, neglected, tampered with or damaged intentionally, by accident, flood, water, fire or other hazard. If PRODUCT is not used in accordance with manufacturer s instructions, PRODUCT warranties are void and of no effect. There are no other express or implied warranties, including any warranty of merchantability or fitness for a particular purpose. Baxter shall not be liable for proximate, incidental, or special damages. All warranties in these Terms and Conditions shall be construed to comply with the warranty Safe Harbor found at 42 C.F.R (g). THE WARRANTY IN THIS SECTION SHALL BE IN LIEU OF ANY OTHER WARRANTY EXPRESSED, OR IMPLIED OR STATUTORY, RESPECTING PRODUCT, AND BAXTER MAKES NO IMPLIED WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. CUSTOMER S SOLE AND EXCLUSIVE REMEDY IN CONTRACT, TORT OR UNDER ANY OTHER THEORY AGAINST BAXTER WITH RESPECT TO PRODUCT AND ITS USE SHALL BE THE REPLACEMENT OR REPAIR OF THE PRODUCT AND NO OTHER REMEDY (INCLUDING, WITHOUT LIMITATION, CONSEQUENTIAL DAMAGES) SHALL BE AVAILABLE TO CUSTOMER. BAXTER SHALL HAVE NO FURTHER OBLIGATION OR LIABILITY WITH RESPECT TO PRODUCT, OR ITS SALE, OPERATION AND USE, AND BAXTER NEITHER ASSUMES, NOR AUTHORIZES THE ASSUMPTION OF, ANY OBLIGATION OR LIABILITY IN CONNECTION WITH SUCH PRODUCT. EQUIPMENT Warranty Baxter warrants to CUSTOMER that EQUIPMENT delivered is free from defects in material or workmanship for the periods specified in the appropriate Operator s and Technician s manual (which outlines the complete warranty), provided EQUIPMENT is used and maintained in accordance with the manufacturer s operating instructions. PARTS installed which have been purchased from vendors other than Baxter shall void all applicable warranties. Warranty for EQUIPMENT Service Repair Service is subject to a thirty (30) day conditional warranty. Effective Date 7/1/11 5

7 Limitation to Warranty for EQUIPMENT and Service The warranty does not apply to any EQUIPMENT or PART that is subjected to abnormal or unusual electrical or fluid stress, improperly installed or operated, serviced by anyone other than a Baxter authorized representative or not maintained in accordance with the routine maintenance schedule set forth in the Operator s and Technician s manual for EQUIPMENT. Periodic preventative maintenance required to maintain proper EQUIPMENT operation is not covered under the warranty. These services can be purchased by calling and selecting the prompt for PARTS or on-site Service. Requests for service or replacement outside of Baxter s normal working hours will be subject to additional charges. Warranty does not provide replacement DISPOSABLE or any other compensation during the period that CUSTOMER S EQUIPMENT is inoperative. Baxter s sole obligation and CUSTOMER S exclusive remedy shall be limited to repair or replacement, at Baxter s option and expense of the defective PART or EQUIPMENT, using new or reconditioned PARTS and/or subassemblies for a period of one hundred eighty (180) days, except for the HomeChoice or the HomeChoice Pro system which shall be for a period of ninety (90) days, following the date of initial delivery. Such repair or replacement shall be made without cost to CUSTOMER and Baxter reserves the right to determine the location at which the repair or replacement will be accomplished. Terms & Conditions of Sale Indemnification CUSTOMER agrees to indemnify, defend and hold harmless Baxter, its affiliates and subsidiaries, and the officers, directors, employees, agents and insurers of each of them, from and against any and all third party claims, demands, actions, damages, expenses, costs, claims, judgments and liabilities (including, without limitation, interest, penalties and reasonable attorneys fees and investigative costs) incurred by Baxter, arising from, in connection with or as a consequence of a) any negligent, or wrongful act or omission by CUSTOMER; and/or b) CUSTOMER S transfer, use or sale of PRODUCT, except to the extent that such suit or demand arises out of the failure of PRODUCT to meet Baxter s express warranty(ies); and/or c) CUSTOMER S possession, operation, maintenance, delivery or return of PRODUCT. Such protection shall include, without limitation, claims for personal injury or death or property damage arising out of any act or omission of CUSTOMER or its patients. 6 Effective Date 7/1/11

8 IV. Order/Delivery Terms & Conditions of Sale Orders All orders shall be subject to these Terms and Conditions and shall not be subject to the terms, conditions, or provisions of any order confirmation, except to the extent that such confirmation specifies quantities. Baxter will use commercially reasonable efforts to fill orders, but Baxter shall not be liable for non-performance or delays caused by a FORCE MAJEURE event. CUSTOMER agrees that in any and all such events, Baxter may allocate PRODUCT among CUSTOMERS without liability or other negative outcome with CUSTOMER. All orders, with the exception of warranty orders or EQUIPMENT service orders covered under a service agreement, require a purchase order, supply contract or credit card authorization. When using a purchase order form, any modification by CUSTOMER regarding pricing, terms of sale or any other terms or conditions shall not be effective unless accepted in advance and in writing by an authorized representative of Baxter. Only the list and quantity of PRODUCT and any specific shipping instructions shall be applicable to said sale. Selling Unit of Measure Order quantities must be in the selling unit of measure indicated. Pack factors are noted for ease of ordering. Prescription Requirement BAXTER WILL NOT ACCEPT ANY ORDER FOR HOME PATIENT WITHOUT A PRESCRIPTION SIGNED AND DATED BY A PHYSICIAN, which lists PRODUCT codes, quantities and the allowable refill period, not to exceed one (1) year. All new APD HOME PATIENT prescriptions must also include either a HomeChoice or HomeChoice Pro rental. Prescriptions should be managed and e-signed through DIRECTACCESS. CUSTOMER may obtain copies of prescriptions at no charge through DIRECTACCESS. All other manner of requests shall be subject to a forty dollar ($40.00) processing fee. Lead Time Peritoneal dialysis PRODUCT and HD DISPOSABLE orders require a five (5) business day lead time. HD EQUIPMENT orders require a sixty (60) business day lead time. EQUIPMENT and PART orders requiring expedited delivery at CUSTOMER S request are subject to an expedited processing and delivery charge quoted at the time of the order placement. Orders must be placed no later than 12:00 pm local time in the time zone of CUSTOMER S local Baxter distribution center to be deemed placed on that business day. Orders placed after 12:00 pm local time will be deemed placed on the following business day. Freight and Distribution Published prices for DISPOSABLES include regular processing and distribution charges provided the order is placed five (5) business days prior to the SCHEDULED DELIVERY date. Inside delivery is standard for HOME PATIENT. Delivery to a Hospital or Center receiving or loading dock is standard while inside delivery is an additional service and may result in additional charges. Effective Date 7/1/11 7

9 Published prices for EQUIPMENT and PARTS do not include delivery, handling and installation. These charges will be arranged and billed separately, if applicable. Terms & Conditions of Sale CUSTOMER is responsible for all freight and distribution charges for all PRODUCT when expedited order processing and delivery is required, unless specifically provided in these Terms and Conditions. All shipments are considered contiguous USA only unless otherwise mutually agreed to in writing by CUSTOMER and Baxter. EQUIPMENT shall be sold FOB Origin. All other PRODUCT shall be sold FOB Destination; provided that PRODUCT is delivered in accordance with these Terms and Conditions. Minimum Order Charge All orders that are less than two hundred fifty dollars ($250.00) will be subject to a charge of forty dollars ($40.00). Exemptions will be permitted only for: deliveries required to correct Baxter error new HOME PATIENT orders SCHEDULED DELIVERY Hospitals and Centers: Recognizing that Hospitals and Centers have unique delivery and service requirements, Baxter and CUSTOMER may negotiate a mutually agreeable delivery, which in no event shall be more frequent than once weekly. HOME PATIENT: Upon initiation of a new HOME PATIENT account, Baxter will establish a delivery schedule. HOME PATIENT delivery days shall be set according to this schedule. SCHEDULED DELIVERY will occur approximately once every four (4) weeks or thirteen (13) times per year. Delivery frequency and scheduling will be maintained in Baxter s transaction management system and will be used to determine if an order represents a SCHEDULED DELIVERY or OFF-SCHEDULE DELIVERY. HOME PATIENT S will receive a calendar indicating their ordering days and SCHEDULED DELIVERY days. Effective July 1, 2011, clinicians requiring a copy of HOME PATIENT S order and delivery schedule must utilize DIRECTACCESS to obtain a copy. Please contact HomeCare Services at for details or to setup a DIRECTACCESS account. HOME PATIENT orders must be placed no later than 12:00 pm local time, five (5) business days prior to the SCHEDULED DELIVERY date established on the routing calendar. Orders may be placed by telephone or by fax. Any order received less than five (5) business days prior to the SCHEDULED DELIVERY date will be considered an EXPEDITED ORDER and will be subject to expediting fees. Should Baxter initiate a modification in delivery schedules due to route realignment, holiday shipping schedules, or pre-negotiated accelerated orders or special orders, CUSTOMER shall not incur freight charges for the shipment of these items. 8 Effective Date 7/1/11

10 OFF-SCHEDULE DELIVERY All OFF-SCHEDULE DELIVERY will be assessed a one hundred fifty dollar ($150.00) service fee. Exemptions will be permitted only for: a) prescription changes authorized and documented by the physician; b) usage changes called in by the clinician; c) deliveries required to correct Baxter error; d) domestic travel orders subject to the Vacation Supply Deliveries section; and e) New HOME PATIENT Orders. Terms & Conditions of Sale HOME PATIENT RE-DELIVERY Orders requiring RE-DELIVERY are subject to a charge of seventy-five dollar ($75.00). EXPEDITED ORDERS EXPEDITED ORDERS at CUSTOMER S request are subject to an expedited processing charge. The expedited processing charge for Hospitals or Center orders is one hundred fifty dollars ($150.00) if placed during normal business hours and two hundred fifty dollars ($250.00) if placed outside of normal business hours plus actual freight charges. If an extra delivery is required that can ship ground a fifty dollar ($50.00) extra delivery fee is applied. If order placed after cut-off but can meet CUSTOMER S SCHEDULED DELIVERY a fifty dollar ($50.00) late fee is applied. All Will Call (customer pickup) orders will be assessed a one hundred fifty dollar ($150.00) EXPEDITED ORDER charge regardless of time of request. Expedited processing charges for HOME PATIENTS are: Same Business Day* Next Business Day* Second Business Day* Third Business Day* $95.00 $65.00 $45.00 $35.00 $25.00 Fourth Business Day* *When and where available EXPEDITED ORDERS to Alaska and Hawaii residents are subject to the expedited processing charge PLUS an additional charge to be quoted at the time of the order Orders placed after normal business hours or on weekends are subject to the expedited processing charge PLUS an additional charge of one hundred twenty-five dollars ($125.00), PLUS any applicable OFF- SCHEDULE DELIVERY and Minimum Order Charges Effective Date 7/1/11 9

11 Vacation Supply Deliveries Travel orders for destinations within the continental U.S. (excluding all cruises regardless of departure port) require a lead time of fourteen (14) business days. Less lead time will result in EXPEDITED ORDER charges of one hundred dollars ($100.00) as outlined in the previous section. Terms & Conditions of Sale Through the Global Destinations Program, peritoneal dialysis HOME PATIENTS can successfully continue their therapy while travelling outside of the continental U.S., including Alaska and Hawaii and cruises from any port, domestic or international. Customer is responsible for the shipping and handling costs associated with the order delivery. The handling cost for a standard order (>30 days notice) is one hundred dollars ($100.00) while an EXPEDITED ORDER (<30 days) is two hundred dollars ($200.00). Shipping fees vary and are calculated based on travel destination. To place an order through the Global Destinations Program, call APD EQUIPMENT A one-time cycler delivery charge of two hundred dollars ($200.00) will apply for new orders. CUSTOMER assumes the entire risk of loss, damage or failure to return the cycler. In such cases, CUSTOMER will be invoiced a fee of four thousand dollars ($4,000.00) to cover the costs of such a loss. In the event the cycler is not returned according to the Returned Goods section of these Terms and Conditions within thirty (30) days, the fee will be invoiced and be payable to Baxter immediately. Receipt and Verification CUSTOMER or HOME PATIENT should verify deliveries to ensure that all items ordered and shipped are received. All deliveries must be verified within two (2) business days from receipt in order to be eligible for credit for shortages or to have PRODUCT replaced without incurring delivery charges. Proof of Delivery The Baxter invoice and packing list must be retained as proof of delivery. Subject to availability and within thirty (30) days following the date of shipment, requests for additional documentation of delivery (e.g., carrier delivery logs) will be subject to a service charge of forty dollars ($40.00). HD EQUIPMENT Services and Charges Global Technical Services provides the scheduling and actual on-site service of HD EQUIPMENT by qualified service engineers. HD EQUIPMENT field service will be performed during Baxter s normal business hours at Baxter s then current standard labor rate. Field service performed after Baxter s normal business hours and on weekends and holidays will be charged at a premium labor rate. 10 Effective Date 7/1/11

12 V. Billing/Payment Terms & Conditions of Sale Terms of Sale All orders are subject to credit approval and acceptance at Baxter s home office. Standard payment terms are net thirty (30) from the date of invoice. Payment terms are in effect as of the date of the order. Payment is made to the remit to address indicated on the invoice. Credit card payments are subject to approval by Credit and Collections. Invoices that are not paid according to the payment terms of each sale shall bear interest at the lesser of 18% per annum or the highest rate allowed by applicable law. Additionally, Baxter reserves the right to require payment in advance of shipment. Prices PRODUCT is priced at the amount indicated for the selling unit of measure ordered. Prices and specifications are subject to change without notice. All shipments are billed at the price in effect on the date of the order. PRODUCT is billed upon shipment. Published PRODUCT prices are exclusive of all taxes. EQUIPMENT service and separately billable PRODUCT processing and delivery charges are priced as described in these Terms and Conditions. Discount Disclosure Statement CUSTOMER and Baxter intend that all purchases of PRODUCT and services made by CUSTOMER shall be administered in accordance with the provisions of the federal Anti-Kickback Statute (42, U.S.C. 1320a-7b(b)). Any discounts and rebates received by CUSTOMER with respect to PRODUCT may be considered discounts or other reductions in price under the Anti-Kickback Statute, Section 1128B(b)(3)(A) of the Social Security Act [42 U.S.C. 1320a-7b(b)(3)(A)]. To the extent required by the Anti-Kickback Statute or the Discount Safe Harbor regulations, 42 C.F.R (h) et seq., CUSTOMER shall fully and accurately disclose such discounts and other reductions in price in accordance with the applicable state or federal cost reporting requirements, including, without limitation, disclosing and accurately reflecting where appropriate, and as appropriate, to the applicable reimbursement methodology. Baxter will provide CUSTOMER with sales and discount information to allow CUSTOMER to comply with this Section and the Discount Safe Harbor regulation, including sufficient rebate and pricing information to enable CUSTOMER to accurately report its actual costs for all purchases of PRODUCT and services. The total charges for PRODUCT and services purchased by CUSTOMER shall be the contract price less any such discounts, including rebates. Credit and Disputes Only amounts which are disputed in good faith may be withheld from payment pending resolution. Any portion of an invoice not in dispute must be remitted within the payment terms of each sale. All disputes must be submitted in writing to Credit and Collections within thirty (30) days from the date of invoice. All disputes or rights are waived unless the CUSTOMER S complaint has been received by Baxter within such thirty (30) day period. Effective Date 7/1/11 11

13 VI. Returned Goods Terms & Conditions of Sale DISPOSABLES and PARTS DISPOSABLES and PARTS that have not been stored in a sanitary manner and in accordance with the package insert cannot be returned or credited. Verification of proper storage may be required for credit. DISPOSABLES and PARTS must be returned in the original, unopened and undamaged carton or package to be eligible for credit. CUSTOMER must notify Baxter and obtain a return goods authorization ( RGA ) number prior to returning DISPOSABLES and PARTS. DISPOSABLES and PARTS will not be eligible for credit without prior approval of the return and unless returned in accordance with this Returned Goods section. Approval to return DISPOSABLES and PARTS does not guarantee credit. Baxter does not assume liability for DISPOSABLES and PARTS returned without prior approval. Credit will be issued to the original purchaser only. DISPOSABLE and PARTS provided at no charge are not eligible for credit but remain subject to the terms of this Returned Goods section. A ninety-five dollar ($95.00) pick-up charge will be applied against any credit due on DISPOSABLE returns, excluding Baxter order/delivery errors. Any portion of the charge that exceeds the credit will be invoiced separately. Baxter order/delivery errors must be reported within two (2) business days of receipt and, when applicable, returned within thirty (30) days of receipt to be eligible for one hundred percent (100%) credit. Examples include shortages, damages, order entry errors and delivery errors. DISPOSABLES and PARTS returned after thirty (30) days but within ninety (90) days of receipt may be eligible for credit as excess stock. CUSTOMER or HOME PATIENT order errors must be reported within two (2) business days of receipt and returned within thirty (30) days of receipt to be eligible for fifty percent (50%) credit. Peritoneal dialysis solutions returned from HOME PATIENT are not eligible for credit. DISPOSABLES with a 5K or 5Q prefix are not returnable. DISPOSABLES and PARTS returned after thirty (30) days but within ninety (90) days of receipt may be eligible for credit as excess stock. Excess stock must be returned within ninety (90) days of receipt to be eligible for fifty percent (50%) credit. Excess stock shall not be eligible for credit under the following circumstances: returned after ninety (90) days from receipt returned with less than three (3) months remaining to expiration returned from HOME PATIENT returns with a 5K or 5Q prefix returns sold on a no return basis EQUIPMENT Purchased EQUIPMENT is not returnable unless shipped in error by Baxter. Leased, rental, trade-in, and/or evaluation EQUIPMENT may be returned as governed by the terms of this section. EQUIPMENT returns are at CUSTOMER S expense, and EQUIPMENT must be in the same condition as when delivered to CUSTOMER, normal wear and tear expected. CUSTOMER shall deliver the EQUIPMENT to such place or on board such carrier, packed for shipping, as Baxter may specify. CUSTOMER is responsible for return of EQUIPMENT including all associated charges with the exception of return due to EQUIPMENT shipped in error by Baxter. CUSTOMER shall give Baxter prior written notice that it is returning EQUIPMENT. 12 Effective Date 7/1/11

14 VII. APD EQUIPMENT Rental Program Terms & Conditions of Sale Commencement and Monthly Fee The rental program shall begin on the date that is five (5) days after the date of shipment ( EQUIPMENT Effective Date ) and shall continue until EQUIPMENT is returned to Baxter. CUSTOMER may terminate the rental program at any time by giving notice to Baxter and returning EQUIPMENT to Baxter. Rental fees will be billed monthly. If EQUIPMENT Effective Date is any day other than the first of the month, the first monthly rental fee shall be prorated. Thereafter, full monthly rental fees shall be due for each month through the month in which the rental program terminates. CUSTOMER is responsible for all rental fees until such time as the EQUIPMENT is returned to Baxter. The rental program for EQUIPMENT delivered to CUSTOMER for evaluation purposes only ( Evaluator EQUIPMENT ) is governed by these Terms and Conditions except that the rental program shall begin on the forty-fifth (45th) day after Baxter provides the first in-service for the Evaluator EQUIPMENT ( Evaluator Rental Commencement Date ). Warranties All applicable warranties in the Warranties section extend to EQUIPMENT. Customer Obligation CUSTOMER shall use EQUIPMENT only for the purposes and according to the instructions indicated in the labeling as well as those included with EQUIPMENT. CUSTOMER shall not make modifications, alterations, or additions to EQUIPMENT without prior written consent of Baxter. EQUIPMENT shall remain personal property at all times regardless of how it is attached or installed. Baxter shall have the right, during normal business hours, to enter CUSTOMER S premises or any EQUIPMENT site to inspect EQUIPMENT. Title to EQUIPMENT remains with Baxter. CUSTOMER assumes the risk of loss of, and has responsibility for, damage to EQUIPMENT from any cause. 13 Effective Date 7/1/11

15 Default The following shall constitute events of default: Terms & Conditions of Sale CUSTOMER fails to pay monthly rental fee according to the terms stated on the invoice CUSTOMER fails to perform any of its other obligations under the rental program and such failure continues for thirty (30) calendar days after Baxter gives CUSTOMER written notice of such failure A petition in bankruptcy is filed by CUSTOMER or CUSTOMER makes an assignment for the benefit of creditors, or consents to the appointment of a trustee or receiver, or a trustee or receiver is appointed by CUSTOMER for any parts of EQUIPMENT or for a substantial part of CUSTOMER S assets without its consent and is not dismissed within a period of thirty (30) calendar days, or bankruptcy, reorganization, or insolvency proceedings are instituted against CUSTOMER and are not dismissed within thirty (30) calendar days thereafter Upon the happening of any event of CUSTOMER default, Baxter may, at its sole option: a) take immediate possession of any or all of EQUIPMENT, and, for such purposes, enter upon CUSTOMER S premises or site where EQUIPMENT is located and remove it, without liability for so doing, or b) require CUSTOMER, at its expense, to return EQUIPMENT to Baxter as provided in the Returned Goods section. EQUIPMENT Services and Charges Global Technical Services provides the scheduling and replacement of APD EQUIPMENT. Replacement of APD EQUIPMENT will be performed on a next day basis, subject to availability. Expedited replacements are those requiring same day delivery. Expedited replacements are subject to an additional processing and delivery charge quoted at the time service is requested. 14 Effective Date 7/1/11

16 Peritoneal Dialysis Dianeal PD Solution, UltraBag System Na Ca Mg Cl Lactate Dianeal Low Calcium PD Solution (meq/l) Dianeal PD-2 PD Solution (meq/l) DIANEAL PD-2 and Low Calcium peritoneal dialysis solutions in Ultrabag containers are indicated for use in chronic renal failure patients being maintained on continuous ambulatory peritoneal dialysis when nondialytic medical therapy is judged to be inadequate. Important Risk Information for DIANEAL Solutions Not for Intravenous Injection. Use aseptic technique. Contamination of connector may result in peritonitis. Adverse reactions to peritoneal dialysis include mechanical and solution related problems as well as the results of contamination of equipment. Solution-related adverse reactions may include peritonitis, electrolyte and fluid imbalances, hypovolemia, hypervolemia, hypotension, hypertension, disequilibrium syndrome, allergic symptoms, and muscle cramping. Please see full prescribing information. DIANEAL Low Calcium PD Solution in Ultrabag Product Insert DIANEAL PD-2 PD Solution in Ultrabag Product Insert Peritoneal Dialysis Dianeal Low Calcium PD Solution Product Dextrose Fill Volume (ml) Container Size (ml) Pack Factor Price/Case 5B9765P 1.5% /case $ B9775P 2.5% /case $ B9795P 4.25% /case $ B % /case $ B % /case $ B % /case $ B9768P 1.5% /case $ B9778P 2.5% /case $ B9798P 4.25% /case $ B % /case $ B % /case $ B % /case $ Dianeal PD-2 PD Solution 5B % /case $ B % /case $ B % /case $ B9868P 1.5% /case $ B9878P 2.5% /case $ B9898P 4.25% /case $ B % /case $ B % /case $ B % /case $ Effective Date 7/1/11 PD1

17 Peritoneal Dialysis Dianeal PD Solution, Single Bag (AMBU-FLEX Container) Na Ca Mg Cl Lactate Dianeal Low Calcium PD Solution (meq/l) Dianeal PD-2 PD Solution (meq/l) Please see important safety information on page PD1. Please see full prescribing information. DIANEAL Low Calcium Peritoneal Dialysis Solution Product Insert Peritoneal Dialysis Dianeal Low Calcium PD Solution, Spike (AMBU-FLEX III Container) Product Dextrose Fill Volume (ml) Container Size (ml) Pack Factor Price/Case 5B % /case $ B % /case $ B % /case $ B % /case $ B % /case $ B % /case $ B % /case $ B % /case $ B % /case $ B % /case $ B % /case $ B % /case $86.85 Dianeal Low Calcium PD Solution, Luer (AMBU-FLEX II Container)* Product Dextrose Fill Volume (ml) Container Size (ml) Pack Factor Price/Case L5B % /case $ L5B % /case $ L5B % /case $ L5B % /case $ L5B % /case $ L5B % /case $ L5B % /case $71.99 L5B % /case $73.67 L5B % /case $75.46 L5B % /case $86.03 L5B % /case $87.90 L5B % /case $90.33 *Baxter is pleased to introduce Luer connection for all Dianeal solution in AMBU-FLEX containers. The conversion will be introduced in a phased roll out. Your Baxter Account Executive will provide specific information regarding timing in your area. PD2 Effective Date 7/1/11

18 Peritoneal Dialysis Dianeal PD Solution, Single Bag (AMBU-FLEX Container) (Cont.) Na Ca Mg Cl Lactate Dianeal Low Calcium PD Solution (meq/l) Dianeal PD-2 PD Solution (meq/l) Please see important safety information on page PD1. Please see full prescribing information. DIANEAL PD-2 Peritoneal Dialysis Solution Product Insert Dianeal PD-2 PD Solution, Spike (AMBU-FLEX III Container) Peritoneal Dialysis Product Dextrose Fill Volume (ml) Container Size (ml) Pack Factor Price/Case 5B % /case $ B % /case $ B % /case $ B % /case $ B % /case $ B % /case $ B % /case $ B % /case $ B % /case $ B % /case $ B % /case $ B % /case $ B % /case $ B % /case $ B % /case $86.85 Dianeal PD-2 PD Solution, Luer (AMBU-FLEX II Container)* Product Dextrose Fill Volume (ml) Container Size (ml) Pack Factor Price/Case L5B % /case $ L5B % /case $ L5B % /case $ L5B % /case $ L5B % /case $ L5B % /case $ L5B % /case $ L5B % /case $ L5B % /case $ L5B % /case $71.99 L5B % /case $73.66 L5B % /case $75.28 L5B % /case $85.37 L5B % /case $87.61 L5B % /case $89.86 *Baxter is pleased to introduce Luer connection for all Dianeal solution in AMBU-FLEX containers. The conversion will be introduced in a phased roll out. Your Baxter Account Executive will provide specific information regarding timing in your area. Effective Date 7/1/11

19 Peritoneal Dialysis EXTRAneal (icodextrin) PD Solution Na Ca Mg Cl Lactate Extraneal (icodextrin) PD Solution (meq/l) Extraneal (icodextrin) Peritoneal Dialysis (PD) solution is indicated for a single daily exchange for the long (8 to16 hour) dwell during Continuous Ambulatory Peritoneal Dialysis (CAPD) or Automated Peritoneal Dialysis (APD) for the management of End-Stage Renal Disease (ESRD). Extraneal is also indicated to improve (compared to 4.25% dextrose) long-dwell ultrafiltration and clearance of creatinine and urea nitrogen in patients with high-average or greater transport characteristics, as defined using the Peritoneal Equilibration Test (PET). Important Risk Information Dangerous Drug-Device Interaction Only use glucose-specific monitors and test strips to measure blood glucose levels in patients using Extraneal (icodextrin) Peritoneal Dialysis Solution. Blood glucose monitoring devices using glucose dehydrogenase pyrroloquinolinequinone (GDH-PQQ) or glucose-dye-oxidoreductase (GDO)-based methods must not be used. In addition, some blood glucose monitoring systems using glucose dehydrogenase flavin-adenine dinucleotide (GDH-FAD)-based methods must not be used. Use of GDH-PQQ, GDO, and GDH-FAD-based glucose monitors and test strips has resulted in falsely elevated glucose readings (due to the presence of maltose, see PRECAUTIONS/Drug/Laboratory Test Interactions). Falsely elevated glucose readings have led patients or health care providers to withhold treatment of hypoglycemia or to administer insulin inappropriately. Both of these situations have resulted in unrecognized hypoglycemia, which has led to loss of consciousness, coma, permanent neurological damage, and death. Plasma levels of Extraneal (icodextrin) and its metabolites return to baseline within approximately 14 days following cessation of Extraneal (icodextrin) administration. Therefore falsely elevated glucose levels may be measured up to two weeks following cessation of Extraneal (icodextrin) therapy when GDH-PQQ, GDO, and GDH-FAD-based blood glucose monitors and test strips are used. Because GDH-PQQ, GDO, and GDH-FAD-based blood glucose monitors may be used in hospital settings, it is important that the health care providers of peritoneal dialysis patients using Extraneal (icodextrin) carefully review the product information of the blood glucose testing system, including that of test strips, to determine if the system is appropriate for use with Extraneal (icodextrin). To avoid improper insulin administration, educate patients to alert health care providers of this interaction whenever they are admitted to the hospital. The manufacturer(s) of the monitor and test strips should be contacted to determine if icodextrin or maltose causes interference or falsely elevated glucose readings. For a list of toll free numbers for glucose monitor and test strip manufacturers, please contact the Baxter Renal Clinical Help Line RENAL-HELP or visit Extraneal is contraindicated in patients with a known allergy to cornstarch or icodextrin, in patients with maltose or isomaltose intolerance, in patients with glycogen storage disease, and in patients with pre-existing severe lactic acidosis Extraneal PD solution is intended for intraperitoneal administration only. Not for intravenous injection Rarely, serious hypersensitivity reactions to Extraneal have been reported, such as toxic epidermal necrolysis, angioedema, serum sickness, erythema multiforme and leukocytoclastic vasculitis. If a serious reaction is suspected, discontinue Extraneal and institute appropriate treatment as clinically indicated Patients with insulin-dependent diabetes may require modification of insulin dosage following initiation of treatment A patient s volume status should be carefully monitored to avoid hyper- or hypovolemia and potentially severe consequences including congestive heart failure, volume depletion and hypovolemic shock. An accurate fluid balance record must be kept and the patient s body weight monitored In clinical trials, the most frequently reported adverse events occurring in 10% of patients, and more common in Extraneal PD solution patients than in control patients, were peritonitis, upper respiratory infection, hypertension, and rash. The most common treatment-related adverse event for Extraneal PD solution patients was skin rash. Additional adverse reactions have been reported in the post-marketing setting and are detailed in the full prescribing information General Peritoneal Dialysis-Related Encapsulating peritoneal sclerosis (EPS) is a known, rare complication of peritoneal dialysis therapy. EPS has been reported in patients using peritoneal dialysis solutions including Extraneal PD solution. Infrequent but fatal outcomes have been reported Aseptic technique should be used throughout the peritoneal dialysis procedure to reduce the possibility of infection, such as peritonitis Fluid status, hematologic indices, blood chemistry, and electrolyte concentrations, including calcium, potassium, sodium, magnesium and bicarbonate, should be monitored periodically. Abnormalities in any of these parameters should be treated promptly under the care of a physician Overinfusion of peritoneal dialysis solution volume into the peritoneal cavity may be characterized by abdominal distention, feeling of fullness and/or shortness of breath. Treatment of overinfusion is to drain the peritoneal dialysis solution from the peritoneal cavity Treatment should be initiated and monitored under the supervision of a physician knowledgeable in the management of patients with renal failure Please see full prescribing information. Extraneal Product Insert and Extraneal Medication Guide. Peritoneal Dialysis EXTRANEAL PD Solution, ULTRABAG System Product Icodextrin Fill Volume (ml) Container Size (ml) Pack Factor Price/Case 5B % /case per contract 5B % /case per contract EXTRANEAL PD Solution, Single Bag, Spike (AMBU-FLEX III) Container Product Icodextrin Fill Volume (ml) Container Size (ml) Pack Factor Price/Case 5B % /case per contract 5B4976P 7.5% /case per contract EXTRANEAL PD Solution, Single Bag, Luer (AMBU-FLEX II) Container* Product Icodextrin Fill Volume (ml) Container Size (ml) Pack Factor Price/Case L5B % /case per contract L5B % /case per contract *Baxter is pleased to introduce Luer connection for all EXTRANEAL solution in AMBU-FLEX containers. The conversion will be introduced in a phased roll out. Your Baxter Account Executive will provide specific information regarding timing in your area. PD4 Effective Date 7/1/11

20 Peritoneal Dialysis Systems Automated Peritoneal Dialysis HomeChoice PRO and HomeChoice Automated Peritoneal Systems Peritoneal Dialysis HomeChoice PRO System HomeChoice System Product Description Pack Factor Price Devices 5C4471 HomeChoice Automated PD System 1/each $17, C8310 HomeChoice Pro Automated PD System 1/each $19, Spike Disposable Sets 5C4469C Automated PD Set with Cassette - 4 Prong 30/case $ C4531C Integrated APD Set 30/case $1, C8302C Low Recirculation Volume APD Set with cassette 30/case $2, Luer Disposable Sets* R5C4479C Automated PD Set with Cassette - 4 Prong 30/case $ L5C4531 Integrated APD Set 30/case $1, N5C8305C Low Recirculation Volume APD Set with cassette 30/case $2, Integrated APD Set has 3 supply lines, and 22 patient and drain lines. Low Recirculation Volume APD Set has in-line medication port, a shrouded patient connector, and a smaller internal diameter and shorter patient line length. Recirculation volume 17mL. *Baxter is pleased to introduce Luer connection for all APD Disposable Sets. The conversion will be introduced in a phased roll out. Your Baxter Account Executive will provide specific information regarding timing in your area. Effective Date 7/1/11 PD5

21 Peritoneal Dialysis Systems Automated Peritoneal Dialysis HomeChoice PRO and HomeChoice Automated Peritoneal Systems (Cont.) Product Description Pack Factor Price Data Cards R5C4522 HomeChoice PRO Card 6/case $ R5C4526 Homechoice PRO Patient Data Card Adapter 1/each $ Carrying Cases Peritoneal Dialysis 5C4406 Carrying Case 1/each $ C8346 Hard Carrying Case with Wheels 1/each $ Extension Lines 5C4480C 12 Foot Patient Extension Line with Easy-Lock Connector 30/case $ APD Drain Supplies 5C4145P 15 Liter Drainage Bag 30/case $ C4464P Sterile Drain Extension Line, 12 feet 30/case $ C4476 Effluent Sample Bag, 150mL 6/case $ C4512 APD Drain Manifold (Connects two 15 liter drain bags) 30/case $ APD Miscellaneous Supplies 5C4462 Empty Sterile Bag, 3 Liter 48/case $ C Prong Manifold Set with Connector Tube 30/case $ C Prong Manifold Set (Spike) 15/case $ L5C Prong Manifold Set (Luer) 15/case $ C4971 QuietCoil Device 1/each $46.78 PD6 Effective Date 7/1/11

22 Peritoneal Dialysis Systems CAPD Product Description Pack Factor Price Disconnect Y-Sets 5C4366P UltraSet Disposable Disconnect Y-Set (Spike) 60/case $ L5C4366 UltraSet Disposable Disconnect Y-Set (Luer) 30/case $ Miscellaneous CAPD Supplies Peritoneal Dialysis 5C4530 Spike Protector II (protective cover for aseptic transfer set spikes) 48/case $ C4190 CAPD Drainage Bracket 1/each $ Assist Devices CXD II Compact Exchange Device for APD Patients Product Description Pack Factor Price/Each Device 5C4275 Compact Exchange Device (CXD II) 1/each $ Carrying Case 5C4942 Compact Exchange Device Carrying Case 1/each $83.59 Product Description Pack Factor Price/Each 5C4505 EZ-Aide Assist Device 1/each $ Effective Date 7/1/11 PD7

23 Peritoneal Dialysis Patient ConnectologY Product Description Pack Factor Price/Case Transfer Sets 5C4442 Extended Life Easy-Lock Transfer Set (6 ) 6/case $ C4449 MiniCap Extended Life PD Transfer Set (6 ) with Roller Clamp 6/case $ C4482 MiniCap Extended Life PD Transfer Set (6 ) with Twist Clamp 6/case $ C4483 MiniCap Extended Life PD Transfer Set Extra Short (4 ) 6/case $ with Twist Clamp 5C4160 Transfer Set with Spike Connector (48 ) 12/case $ Convenient kit includes everything necessary for a transfer set change except povidone iodine. 2 Masks, 10 Gauze pads, 1 Towel, 1 Catheter Clamp, 3 Pair Gloves, 1 Tray, 1 Drape, 1 Wrap. 5C4150A Transfer Set Change Kit for PD 20/case $ Peritoneal Dialysis Locking Titanium Adapter FlexiCap Disconnect Cap MiniCap Disconnect Cap Transfer Set Adapters 5C4136 Easy-Lock-to-Spike Adapter Set 12/case $ C4137 PD Spike-to-Easy-Lock Adapter Set 12/case $ C4413 Spike/Syringe Adapter (connects spike on patient transfer set to luer-type syringe) 10/case $51.57 Transfer Sets For Straight Line CAPD 5C4213P Connection Shield II-K with Povidone-Iodine Solution 60/case $ C4215P Locking Connection Shield 60/case $ Catheter Supplies 5C4129 Locking Titanium Adapter (2 piece) 5/case $1, C4169 Locking cap for Baxter PD Catheter Adapter 25/case $ C4319 Immobile catheter and transfer set stabilizing device 30/case $ C4381 Immobilizer catheter stabilizing device 30/case $ Disconnect Caps 5C4212P Disconnect Cap (Walnut Cap) 60/case $ C4456 FlexiCap Disconnect Cap for High Dose Therapy 30/case $ C4466P MiniCap Disconnect Cap 60/case $ Outlet Port Clamp Clamps 5C4527 Outlet Port Clamp with Short Nose 12/case $ C4957 UltraClamp Clamp (not for use as outlet port clamp) 12/case $76.58 UltraClamp Clamp PD8 Effective Date 7/1/11

24 TRADEMARKS For peritoneal dialysis products listed on pages PD1-PD8 The following is a listing of trademarks of Baxter International Inc: Ambu-Flex Baxter Dianeal Easy-Lock Extraneal Peritoneal Dialysis FlexiCap HomeChoice HomeChoice PRO Immobilizer MiniCap QuietCoil UltraBag UltraClamp UltraSet Effective Date 7/1/11 PDTM

25 Acute Dialysis CRRT - Continuous Renal Replacement Therapy - Critical Care Nephrology Product Description Pack Factor Price Renaflo II Hemofilters 5M3121 HF400 Hemofilter 0.30m 2 12/case $1, M3122 HF700 Hemofilter 0.71m 2 12/case $1, M3123 HF1200 Hemofilter 1.25m 2 12/case $1, M3074 HF2000 Hemofilter 1.98m 2 12/case $1, M3134 Minifilter Plus Hemofilter 700cm 2 4/case $ Acute Dialysis Dialysis Solutions for CRRT Bicarbonate Buffer Solution Product Description Pack Factor Price/Case 5B9248 ACCUSOL Dialysis Solution 2.5L 35 Bicarbonate K4 4/case $ B9249 ACCUSOL Dialysis Solution 2.5L 35 Bicarbonate K2 4/case $ B9250 ACCUSOL Dialysis Solution 2.5L 35 Bicarbonate K0 0 Dextrose 4/case $ B9251 ACCUSOL Dialysis Solution 2.5L 30 Bicarbonate K2 4/case $ B9252 ACCUSOL Dialysis Solution 2.5L 30 Bicarbonate K2 0 Calcium 4/case $ Lactate Buffer Solution 5B7860 Premixed Dialysate for Hemodiafiltration-5 liter bag 2/case $80.12 Acute PD Catheter Supplies Product Description Pack Factor Price/Case 2C7565 InterLink System with Add-On Buretrol 48/case $ Disposable Sets 5C Prong Manifold Set (Spike) 15/case $ Effective Date 7/1/11 AC1

26 TRADEMARKS For acute dialysis products listed on page AC1 The following is a listing of trademarks of Baxter International Inc: Accusol Baxter Buretrol InterLink The following is a listing of trademarks of Minntech Corporation: Minifilter Renaflo Acute Dialysis Effective Date 7/1/11 ACTM

27 HemoDialysis Hemavision Disposable Blood Chamber Product Description Pack Factor Price HCT1000B Hemavision Disposable Blood Chamber 288/case $1, Hemodialysis Effective Date 7/1/11 HD1

28 HemoDialysis Dialyzers Single-Use Xenium XPH Dialyzers, High Flux, Synthetic Xenium Dialyzers, High Flux, Synthetic Product Description Pack Factor Price/Case H25601A XENIUM XPH 110 dialyzer (for single-use only) 24/case $ H25602A XENIUM XPH 130 dialyzer (for single-use only) 24/case $ H25603A XENIUM XPH 150 dialyzer (for single-use only) 24/case $ H25604A XENIUM XPH 170 dialyzer (for single-use only) 24/case $ H25605A XENIUM XPH 190 dialyzer (for single-use only) 24/case $1, H25606A XENIUM XPH 210 dialyzer (for single-use only) 24/case $1, Product Description Pack Factor Price/Case 5M6400 XENIUM 110 dialyzer (for single-use only) 24/case $ M6401 XENIUM 130 dialyzer (for single-use only) 24/case $ M6402 XENIUM 150 dialyzer (for single-use only) 24/case $ M6403 XENIUM 170 dialyzer (for single-use only) 24/case $ M6404 XENIUM 190 dialyzer (for single-use only) 24/case $1, M6405 XENIUM 210 dialyzer (for single-use only) 24/case $1, Hemodialysis EXELTRA High Flux Dialyzers, Cellulose Triacetate Product Description Pack Factor Price/Case 5M2119 EXELTRA 150 dialyzer (for single-use only) 24/case $1, M2120 EXELTRA 170 dialyzer (for single-use only) 24/case $1, M2121 EXELTRA 190 dialyzer (for single-use only) 24/case $1, M2132 EXELTRA Plus 210 dialyzer (for single-use only) 24/case $1, DICEA High Performance Dialyzers, Cellulose Diacetate, High Efficiency Product Description Pack Factor Price/Case 5M2591 Dicea 90 dialyzer (for single-use only) 24/case $1, M2592 Dicea 110 dialyzer (for single-use only) 24/case $1, M2593 Dicea 130 dialyzer (for single-use only) 24/case $1, M2594 Dicea 150 dialyzer (for single-use only) 24/case $1, M2595 Dicea 170 dialyzer (for single-use only) 24/case $1, M2596 Dicea 210 dialyzer (for single-use only) 24/case $1, HD2 Effective Date 7/1/11

29 HemoDialysis Dialyzers Single-Use CA Cellulose Acetate Hollow Fiber Dialyzers, Conventional Product Description Pack Factor Price/Case 5M1729 CA 50 dialyzer (for single-use only) 24/case $ M1730 CA 70 dialyzer (for single-use only) 24/case $ REUSE CT Cellulose Triacetate Hollow Fiber Dialyzers, High Flux Product Description Pack Factor Price/Case 5M1542 CT 110G dialyzer 24/case $1, M1546 CT 190G dialyzer 24/case $1, Hemodialysis CA-HP High Performance Cellulose Diacetate Hollow Fiber Dialyzers, High Efficiency Product Description Pack Factor Price/Case 5M2731 CA-HP 90 dialyzer 24/case $1, M2732 CA-HP 110 dialyzer 24/case $1, M2733 CA-HP 130 dialyzer 24/case $1, M2734 CA-HP 150 dialyzer 24/case $1, M2735 CA-HP 170 dialyzer 24/case $1, M2736 CA-HP 210 dialyzer 24/case $1, Effective Date 7/1/11 HD3

30 HemoDialysis Blood Tubing SETS NIPRO SET Blood Tubing Sets by Nipro Corporation Blood tubing with pre-attached transducer protectors and priming set with needleless access port Product Description Pack Factor Price/Case *5M mm pump segment, pre-pump pillow, post-pump arterial chamber 24/case $ *A201V801 1/4 pump segment, pre-pump arterial chamber 24/case $ *A203V801 8 mm pump segment, pre-pump arterial chamber 24/case $ *A204V801 8 mm pump segment, post-pump arterial chamber 24/case $ A209YV803 8 mm pump segment, pre-pump arterial chamber, Y-port saline set 24/case $ A210V803 8 mm pump segment, post-pump arterial chamber 24/case $ A217YV806 8 mm pump segment, post-pump arterial chamber, Y-port saline set 24/case $ *These tubing sets are compatible with selected Baxter Hemodialysis Instruments. Hemodialysis Please refer to the Recommended Blood Tubing Set Matrix for Baxter Hemodialysis Instruments. Baxter cannot recommend using sets outside the sets listed in the matrix. Please also refer to the Blood Tubing Set-up Guide for proper set-up for each recommended blood tubing set. For a copy of either the Blood Tubing Set Matrix or the Blood Tubing Set-up Guide please contact Renal Technical Support at , Select 1 for English, Prompt 4, Option 1. HD4 Effective Date 7/1/11

31 HemoDialysis Fistula Needles Nipro s SafeTouch II Safety Fistula Needle, Single Needle Set with Back-Eye Product Description Pack Factor Price/Case FS1425BC Safety Fistula 14G x 1, fixed hub 500/case $ FS1525BC Safety Fistula 15G x 1, fixed hub 500/case $ FS1525BCR Safety Fistula 15G x 1, rotating hub 500/case $ FS1532BC Safety Fistula 15G x 1 1 4, fixed hub 500/case $ FS1625BC Safety Fistula 16G x 1, fixed hub 500/case $ FS1625BCR Safety Fistula 16G x 1, rotating hub 500/case $ FS163230BC Safety Fistula 16G x 1 1 4, fixed hub 500/case $ FS1725BC Safety Fistula 17G x 1, fixed hub 500/case $ FS173230BC Safety Fistula 17G x 1 1 4, fixed hub 500/case $ Nipro s SafeTouch II Safety Fistula Needle, Twin Pack Needle Set, Arterial Needle with Back-Eye, Venous Needle without Back-Eye Product Description Pack Factor Price/Case FS142530TP Safety Fistula 14G x 1, fixed hub 250 pair/case $ FS142530TPR Safety Fistula 14G x 1, rotating hub 250 pair/case $ FS152530TP Safety Fistula 15G x 1, fixed hub 250 pair/case $ FS152530TPR Safety Fistula 15G x 1, rotating hub 250 pair/case $ FS162530TP Safety Fistula 16G x 1, fixed hub 250 pair/case $ FS162530TPR Safety Fistula 16G x 1, rotating hub 250 pair/case $ FS172530TP Safety Fistula 17G x 1, fixed hub 250 pair/case $ FS172530TPR Safety Fistula 17G x 1, rotating hub 250 pair/case $ Hemodialysis Nipro s BioHole Dull Needles Product Description Pack Factor Price/Case FD152530BC 15G x 1 Fixed Hub w/backeye 50/case $93.06 Nipro s Tulip Safety Fistula Needle, Single Needle Set with Back-Eye Product Description Pack Factor Price/Case FT152530BC Tulip 15G x 1 Fixed Hub w/backeye 300/case $ FT153230BC Tulip 15G x 1 1 /4 Fixed Hub w/backeye 300/case $ FT162530BC Tulip 16G x 1 Fixed Hub w/backeye 300/case $ FT152530BCR Tulip 15G x 1 Rotating Hub w/backeye 300/case $ FT162530BCR Tulip 16G x 1 Rotating Hub w/backeye 300/case $ Effective Date 7/1/11 HD5

32 HemoDialysis Fistula Needles Nipro s Tulip Safety Fistula Needle, Twin Pack Needle Set, Arterial Needle with Back-Eye, Venous Needle without Back-Eye Product Description Pack Factor Price/Case FT142530TP Tulip 14G x 1 Fixed Hub Twin Pack 120 pair + 10 singles/case $ FT152530TP Tulip 15G x 1 Fixed Hub Twin Pack 120 pair + 10 singles/case $ FT162530TP Tulip 16G x 1 Fixed Hub Twin Pack 120 pair + 10 singles/case $ FT172530TP Tulip 17G x 1 Fixed Hub Twin Pack 120 pair + 10 singles/case $ Hemodialysis HD6 Effective Date 7/1/11

33 HemoDialysis Disposable Supplies Nipro s Disposable Dose-saver Syringes Product Description Pack Factor Price/Case JD01D2238 Disposable Dose-saver Syringe 1cc 22G x 1 1/2 1000/case $ JD01D2516 Disposable Dose-saver Syringe 1cc 25G x 5/8 1000/case $ JD03D2238 Disposable Dose-saver Syringe 3cc 22G x 1 1/2 1000/case $ Miscellaneous Nipro Supplies Product Description Pack Factor Price/Case TPSURE1 Transducer Protector 1000/case $1, PS01 Priming Set 200/case $ Intravenous Injections In Viaflex Plastic Containers (Saline) Sodium Chloride Injections Product Description Container Size (ml) Pack Factor Price/Case 2B % Sodium Chloride Injection, USP /case $ B1322Q 0.9% Sodium Chloride Injection, USP /case $ B1323Q 0.9% Sodium Chloride Injection, USP /case $ B1324X 0.9% Sodium Chloride Injection, USP /case $81.34 Hemodialysis Irrigation Solutions in Plastic Containers Product Description Container Size (ml) Pack Factor Price/Case 2F7112 Sterile Water For Irrigation, USP /case $ F7115 Sterile Water For Irrigation, USP /case $ F % Sodium Chloride Irrigation, USP /case $ F % Sodium Chloride Irrigation, USP /case $ F % Sodium Chloride Irrigation, USP /case $91.80 Effective Date 7/1/11 HD7

34 HemoDialysis Concentrates Acid Concentrate (A-Side) by Minntech Renal Systems Three Stream (Conventional) Proportioning Systems (36.83x dilution) Final dialysate composition approximates meq/l when diluted with purified water and any B-side Bicarbonate product listed below Product Na K Ca Mg Cl Acetate Dextrose Bicarbonate Pack Price/Case Factor 5M /case $ M /case $ M /case $ M /case $ M /case $ M /case $ M /case $ M /case $ M /case $45.45 COBE Proportioning Systems (45x dilution) Product Na K Ca Mg Cl Acetate Dextrose Bicarbonate Pack Price/Case Factor 5M /case $ M /case $ M /case $ M /case $ M /case $ M /case $49.78 Hemodialysis Bicarbonate Concentrate (B-Side) by Minntech Renal Systems Three Stream Product Description Pack Factor Price/Case 5M7828 Bicarbonate Concentrate Powder for Conventional Proportioning Systems gal 20 packets/case $ M7829 Liquid Bicarbonate Concentrate for use with Conventional Proportioning Systems 4/case $58.43 (1 gal; 3.78 liters) COBE (B-Side) Product Description Pack Factor Price/Case 5M7905 Bicarbonate Concentrate Powder for COBE Proportioning Systems (2.1 gal: 8 liters) 20 packets/case $ M7906 Liquid Bicarbonate Concentrate for use with COBE (45x) Proportioning Systems 4/case $58.43 (1 gal; 3.78 liters) HD8 Effective Date 7/1/11

35 TRADEMARKS For hemodialysis products listed on pages HD1-HD8 The following is a listing of trademarks of Baxter International Inc: Baxter CA CA-HP CT Dicea Exeltra Hemavision Viaflex Xenium The following is a listing of trademarks of VascA, Inc: LifeSite The following is a listing of trademarks of Cardian NBCT, Inc: COBE The following is a listing of trademarks of Nipro Corporation: Hemodialysis Dose-Saver SafeTouch II Tulip Effective Date 7/1/11 HDTM

36 Software Renal Software Suite (for use with HOMECHOICE PRO Automated PD System) Product Description Pack Factor 5M5730 Renal Software Suite, Single User License 1/each 5M5730U Renal Software Suite, User License Upgrade 1/each RENALSOFT Clinical Software - Medical Record, CKD, PD, HD modules RENLSFT RENALSOFT Clinical Software 1/each Contact your Baxter representative for more information Renal Software Interface 5M5720 Renal Software Interface CD 1/each Contact your Baxter representative for more information Software Effective Date 7/1/11 SO1

37 TRADEMARKS For software products listed on page SO1 The following is a listing of trademarks of Baxter International Inc: Baxter HomeChoice PRO RenalSoft Software SOTM Effective Date 7/1/11

38 Ancillaries Sponges Gauze Sponge IV Sponge Product Description Pack Factor Price/Box 5K7458P SORB-IT IV Sponge (split) 2 x 2 6-ply Sterile 35/box $ K7407P EXCILON Drain Sponge (split) 4 x 4 6-ply Sterile 25/box $ K7424P CURITY Gauze Sponge 2 x 2 8-ply Sterile 50/box $8.96 5K7505P CURITY Gauze Sponge 4 x 4 8-ply Sterile 25/box $ K7416P CURITY Gauze Sponge 4 x 4 12-ply Sterile 25/box $ K7426P CURITY Gauze Sponge 2 x 2 12-ply Non-Sterile 200/box $ K7425P CURITY Gauze Pad 2 x 2 12-ply Sterile 100/box $ K7567P VERSALON All Purpose Sponge 2 x 2 4-ply Sterile 25/box $4.31 5K7559P VERSALON All Purpose Sponge 3 x 3 4-ply Sterile 25/box $7.98 5K7589P VERSALON All Purpose Sponge 4 x 4 4-ply Sterile 25/box $ K7428P CURITY Cover Sponge 4 x 3 Sterile 25/box $ K7543P CURITY Cover Sponge 4 x 4 Sterile 25/box $ K7427P CURITY Cover Sponge 3 x 3 Non-Sterile 100/box $ K7525P CURITY Cover Sponge 4 x 3 Non-Sterile 100/box $ K7430P CURITY Cover Sponge 4 x 4 Non-Sterile 100/box $19.21 Dressings Product Description Pack Factor Price/Box 5K7401P COVERLET Adhesive Bandage, Flexible 1 x 3 100/box $ K7479P BioPatch Antimicrobial Dressing - 1 disk w/7.0 mm center hole 10/box $ K7538P PRIMAPORE Adhesive Dressing 4 x 3 1 /8 Sterile 20/box $ K7548P PRIMAPORE Adhesive Dressing 6 x 3 1 /8 Sterile 20/box $ K7568P PRIMAPORE Adhesive Dressing 8 x 4 Sterile 20/box $ K7532P TELFA Adhesive Island Dressing 2 x 3 1 /2 Sterile 50/box $ K7588P TELFA Adhesive Island Dressing 4 x 5 Sterile 25/box $ K7522P Viasorb Wound Dressing 2 x 3 Sterile 20/box $ K7523P Viasorb Wound Dressing 4 x 6 Sterile 20/box $ K7459P OPSITE Post Op Dressing 6 1 /8 x 3 3 /8 Sterile 20/box $ K7580P TEGADERM Transparent Dressing 2 3 /8 x 2 3 /4 Sterile 100/box $ K7579P TEGADERM Transparent Dressing 4 x 4 3 /4 Sterile 50/box $ K7578P TEGADERM Transparent Dressing 6 x 8 Sterile 10/box $86.39 Ancillaries Effective Date 7/1/11

39 Ancillaries Tape Cloth Tape Product Description Pack Factor Price/Box 5K7624 Cloth Tape 1 x 10 yds 1/ea $2.17 5K7630 Cloth Tape 2 x 10 yds 1/ea $4.79 5K7639 Soft Cloth Tape 2 x 10 yds 1/ea $ K7615 Paper Tape 1 x 10 yds 1/ea $1.84 5K7617 Paper Tape 2 x 10 yds 1/ea $3.52 5K7660 Paper Tape 1 x 10 yds w/dispenser 1/ea $1.82 5K7667 Paper Tape 2 x 10 yds w/dispenser 1/ea $3.66 5K7619 Plastic Tape 1 x 10 yds 1/ea $2.98 5K7627 Plastic Tape 2 x 10 yds 1/ea $6.77 Paper Tape Plastic Tape Ancillaries AN2 Effective Date 7/1/11

40 Ancillaries Antiseptics/Chemicals Product Description Pack Factor Price Surgical Scrub 5K4075 Manugel 85 Antiseptic Hydroalcoholic Gel, 500 ml with Pump 1 ea $ K4227 CAL STAT PLUS Hand Rub No Rinse - 4 oz. 1 ea $ K4070 Liquid Soap Antimicrobial - 16 oz. w/pump 1 ea $9.09 5K4066 Exsept PLUS Skin Antiseptic 500 ml 1 ea $ K4054P SHUR-CLENS Skin Wound Cleanser - 20 ml 25/box $ K4005 Alcavis ml 1 ea $ K4027 BetaSept Surgical Scrub 4% - 32oz. with Pump 1 ea $ K4001 Alcohol Isopropyl 70% - 16oz. 1 ea $3.58 5K4172P Alcohol Prep Medium 2 1 /4 x 1 1 /4 2-ply 200/box $7.74 5K4012P Povidone-Iodine Swab-aid 1 3 /4 x 1 1 /4 100/box $ K4013P Povidone-Iodine Swabstick 3/pk 25/box $ K8148P Skin-Prep Protective Dressing 50/box $ K8058P Adhesive Remover Pad 100/box $ K4033P Hemastix Reagent Strips 50/box $ K4265P SERIM Cholorine Residual Test Kit 1 ea $ K4291P Bleach Wipes 50/box $ K4226 Actril Cold Sterilant for Machine and Surface Disinfectant - Gallon 1 ea $ K4225P Actril Residual Test Strips 100/bottle $ K4285 MINNCARE Cold Sterilant for use on RO Membranes - Quart 1 ea $ K4286P MINNCARE Residual Test Strip 100/box $ K4077 Conductivity Standard Solution 14.0 M/HHOS - 32oz. 1 ea $52.06 Gloves Product Description Pack Factor Price/Box 5K7742P Latex Exam Glove. Non-sterile. Powder Free. Small 100/box $ K7743P Latex Exam Glove. Non-sterile. Powder Free. Medium 100/box $ K7744P Latex Exam Glove. Non-sterile. Powder Free. Large 100/box $ K7797P Latex Free Exam Glove. Non-sterile. Powder Free. Small 100/box $ K7798P Latex Free Exam Glove. Non-sterile. Powder Free. Medium 100/box $ K7799P Latex Free Exam Glove. Non-sterile. Powder Free. Large 100/box $26.01 Ancillaries Effective Date 7/1/11

41 Ancillaries Blood Pressure Units Product Description Pack Factor Price/Each 5K3966 Digital Auto Inflate Blood Pressure Unit w/medium cuff (arm girth ) 1/each $ K3967 Digital Auto Inflate Blood Pressure Unit w/small cuff (arm girth ) 1/each $ K3968 Digital Auto Inflate Blood Pressure Unit w/large cuff (arm girth ) 1/each $ Scales Product Description Pack Factor Price/Each 5K3517 Scale Pediatric Digital (Capacity: 44 lbs x 1/2 oz / 20 kg x 0.01 kg) 1/each $ K3545 Scale Digital w/detachable display (Capacity: 400 lbs x 0.2 lbs / 180 kg x 0.1 kg) 1/each $ K3575 Scale Digital 1-1/2 Display (Capacity: 400 lbs x 0.1 lbs / 180 kg x 0.05 kg) 1/each $ K3582 Scale Spring (5000 gm x 100 gm) 1/each $ K3585 Scale Spring Pediatric (250 gm x 10 gm) 1/each $20.05 Permanent Equipment Product Description Pack Factor Price/Each 5K3961 Heating Pad - King Size 3 Heat Setting 1/each $ Q3810 I.V. Pole Double-Hook Free Standing 47 x 84 1/each $ K3572 Thermometer, Digital 1/each $ K3826 Dialysis Bath Conductivity Meter 1/each $ K8100 PD Simulator and Case Dummy Tummy 1/each $1, Ancillaries AN4 Effective Date 7/1/11

42 Ancillaries Miscellaneous Ancillary Supplies Product Description Pack Factor Price/Each 5K7444P Underpad Plastic Lined 17 x /box $ K7402P Sterile Field 18 x 26 50/box $ K4500 Beta-Cap Clamp 1 ea $5.38 5K3739 Forcep Blue Plastic Dravon A-Clamp Smooth Jaw 1 ea $5.86 5K7406P Cotton-Tipped Applicator Sterile 6 Long - 2/pkg 100/box $ K8123P Face Mask White Paper Pleated 50/box $7.80 5K8070P Face Mask - Yellow Pleated 50/box $ K8032P Face Mask - Blue Molded Fluid Resistant 50/box $ K8065P Can Liner, 33 Gal, Black 250/box $76.21 Face Mask Ancillaries Effective Date 7/1/11 AN5

43 TRADEMARKS For ancillary products listed on pages -AN5 The following is a listing of trademarks of Alcavis HDC, LLC: Alcavis Exsept Plus Manugel The following is a listing of trademarks of Bayer Healthcare LLC: Hemastix The following is a listing of trademarks of BSN Medical gmbh Corporation: Coverlet The following is a trademark of Covidien AG: Beta-Cap Viasorb The following is a listing of trademarks of E-Med Corporation: IV Strip The following is a trademark of E.R. Squibb & Sons, LLC: Shur-Clens The following is a listing of trademarks of Johnson & Johnson Corporation: BioPatch The following is a listing of trademarks of Minntech Corporation: Actril Minncare The following is a trademark of Nitto Denko Corp.: Xtrata The following is a listing of trademarks of Purdue Frederick Company: Betasept The following is a listing of trademarks of Serim Research Corporation: Serim The following is a listing of trademarks of Smith & Nephew Medical Limited: Opsite Primapore Skin-Prep The following is a trademark of Steris Inc.: Cal-Stat The following is a listing of trademarks of Tyco Healthcare Group LP Curity Excilon Sorb-It Telfa Versalon The following is a trademark of 3M Company: Tegaderm Ancillaries ANTM Effective Date 7/1/11

44 Renal Division Baxter Healthcare Corporation, 1620 Waukegan Road, MPGR-A1S, McGaw Park, IL FAX: HomeCare Services APD Prescription Form Patient Name Phone DOB Address City State Zip Alternate Contact Phone ESRD Patient Selection: Bill supplies to: (billing company name) Date Selection Signed / / Applied for Medicare: Yes Date Applied / / No Medicare # / / Effective Date / / If Baxter will hold the Assignment of Benefits, the following forms are required: HCFA-1500 Form Selection (HCFA-382) Form Health Insurance Form Clinic/Hospital Phone Address City State Zip Contact PO# If Diabetic choose type: Type 1 Insulin Dependent Type 2 Insulin Dependent Type 2 Non Insulin Dependent Days reserve: Maximum Solution Case Quantity per 28 Day cycle Exchanges/Day Liters/Day ONE YEAR REFILL unless otherwise noted This ESRD or ESRD and Diabetic patient has been trained in Home Peritoneal Dialysis and will require the supplies listed below. Product % Dextrose Fill Cont. Pack Ord Max Code Vol Size Factor Qty Qty Dianeal: LowCal PDII 5B 1.5% L L 5B L L 5B 2.5% L L 5B L L 5B 4.25% L L 5B L L 5B Extraneal PDII L L 5B Extraneal PDII L L HomeChoice: 5C8310 HomeChoice Pro Cycler 1 5C4471 HomeChoice Cycler 1 5C4406 HomeChoice Case 1 5C4469C 4-Prong Cycler Set 30 5C4531C Integrated Cycler Set 30 5C4466P MiniCap 60 5C4527 Outlet Port Clamp 12 5C4480C 12 Patient Extension Line 30 Drain Option: 5C4464P 12 Drain Extension Line 30 5C4145P 15 Liter Drainage Bag 30 Product Pack Ord Max Code Description Factor Qty Qty Dressings: 5K7416P Gauze Sponge 4 x 4 12-ply 25 5K7458P IV Sponge 2 x 2 6-ply 35 Underpad: 5K7444P Underpad Plastic Lined 17 x Face Masks: 5K8123P Face Masks, White, Pleated Paper 50 Tape: 5K7615 Paper Tape 1 1 5K7619 Plastic Tape 1 1 5K7624 Cloth Tape 1 1 Product Pack Ord Max Code Description Factor Qty Qty Antiseptics/Cleansers: 5K4027 Surgical Scrub 32 oz. with Pump 1 Wipes: 5K4075 Manugel 85 Antiseptic 1 Permanent Equip (as needed): 5K3961 Heating Pad, King Size 1 5Q3810 Rams Horn IV Pole 1 5K3582 Spring Scale 1 5K3966 Blood Pressure Unit 1 5K3572 Thermometer-Digital 1 5K3575 Scale, Digital, 1 1 / 2 Display 1 5C4275 Compact Exchange Device (CXD II) 1 other (If Needed): USE AS DIRECTED For New York State Prescriptions Only: PRESCRIPITONS WILL BE FILLED GENERICALLY UNLESS PRESCRIBER WRITES daw IN THE BOX BELOW Physician: Signature (Substitution Permitted) Date (Dispense as Written) Physician Name Printed Dispense As Written PF1 Prescription Forms

45 Renal Division Baxter Healthcare Corporation, 1620 Waukegan Road, MPGR-A1S, McGaw Park, IL FAX: HomeCare Services CAPD Prescription Form Patient Name Phone DOB Address City State Zip Alternate Contact Phone ESRD Patient Selection: Bill supplies to: (billing company name) Date Selection Signed / / Applied for Medicare: Yes Date Applied / / No Medicare # / / Effective Date / / If Baxter will hold the Assignment of Benefits, the following forms are required: HCFA-1500 Form Selection (HCFA-382) Form Health Insurance Form Clinic/Hospital Phone Address City State Zip Contact PO# If Diabetic choose type: Type 1 Insulin Dependent Type 2 Insulin Dependent Type 2 Non Insulin Dependent Days reserve: Maximum Solution Case Quantity per 28 Day cycle Exchanges/Day Liters/Day ONE YEAR REFILL unless otherwise noted This ESRD or ESRD and Diabetic patient has been trained in Home Peritoneal Dialysis and will require the supplies listed below. Product % Dextrose Fill Cont. Pack Ord Max Code Vol Size Factor Qty Qty Dianeal UltraBag: LowCal PDII 5B 1.5% L L 5B L L 5B 2.5% L L 5B L L 5B 4.25% L L 5B L L 5B Extraneal PDII L L 5B Extraneal PDII L L Devices: 5C4466P MiniCap 60 5C4212P Disconnect Cap 60 5C4527 Outlet Port Clamp 12 5C4957 UltraClamp 12 Product Pack Ord Max Code Description Factor Qty Qty Dressings: 5K7416P Gauze Sponge 4 x 4 12-ply 25 5K7458P IV Sponge 2 x 2 6-ply 35 Underpad: 5K7444P Underpad Plastic Lined 17 x Face Masks: 5K8123P Face Masks, White, Pleated Paper 50 Tape: 5K7615 Paper Tape 1 1 5K7619 Plastic Tape 1 1 5K7624 Cloth Tape 1 1 Product Pack Ord Max Code Description Factor Qty Qty Antiseptics/Cleansers: 5K4027 Surgical Scrub 32 oz. with Pump 1 Wipes: 5K4075 Manugel 85 Antiseptic 1 Permanent Equip (as needed): 5K3961 Heating Pad, King Size 1 5Q3810 Rams Horn IV Pole 1 5K3582 Spring Scale 1 5K3966 Blood Pressure Unit 1 5K3572 Thermometer-Digital 1 5K3575 Scale, Digital, 1 1 / 2 Display 1 other (If Needed): USE AS DIRECTED For New York State Prescriptions Only: PRESCRIPITONS WILL BE FILLED GENERICALLY UNLESS PRESCRIBER WRITES daw IN THE BOX BELOW Physician: Signature (Substitution Permitted) Date (Dispense as Written) Physician Name Printed Dispense As Written PF2 Prescription Forms

46 Renal Division Baxter Healthcare Corporation, 1620 Waukegan Road, MPGR-A1S, McGaw Park, IL FAX: HomeCare Services HEMO Prescription Form Patient Name Phone DOB Address City State Zip Alternate Contact Phone ESRD Patient Selection: Bill supplies to: (billing company name) Date Selection Signed / / Applied for Medicare: Yes Date Applied / / No Medicare # / / Effective Date / / If Baxter will hold the Assignment of Benefits, the following forms are required: HCFA-1500 Form Selection (HCFA-382) Form Health Insurance Form Clinic/Hospital Phone Address City State Zip Contact PO# If Diabetic choose type: Type 1 Insulin Dependent Type 2 Insulin Dependent Type 2 Non Insulin Dependent ONE YEAR REFILL unless otherwise noted # Treatments per week: Product Pack Ord Max Code Description Factor Qty Qty 2B Saline 5M Acid Conc 5M Bicarb Conc 5M Bicarb Pwdr 5M Dialyzer Fistula Gx Blood Tubing Set Transducer Protector 5M4110 Priming Set 5K4077 Conductivity STD Sol K4226 Actril Mach Disinfect Gal 1 5K4001 Alcohol 70% 16oz. 1 Product Pack Ord Max Code Description Factor Qty Qty Guaze/Sponge: 5K7416P Gauze Sponge 4 x4 12-ply 25 5K7458P IV Sponge 2 x2 6-ply 35 Tape: 5K7615 Paper Tape 1 1 5K7619 Plastic Tape 1 1 5K7624 Cloth Tape 1 1 Underpads: 5K7444P Underpad Plastic Lined 17 x Gloves: 5K77 Gloves 100 Face Masks: 5K8123P Face Masks, White, Pleated Paper 50 Product Pack Ord Max Code Description Factor Qty Qty 5K4033P Hemastix Strips 50 5K4225P Actril Test Strip 100 5K4027 Surgical Scrub 32 oz. with Pump 1 5K4075 Manugel 85 Antiseptic 1 5K4 Alcohol Prep Pad 100 5k4012P PVP Prep Pad 100 5K4013P PVP Swabsticks 3/pkg 25 Permanent Equipment (as needed): 5K3826 Conductivity Meter 1 5K3575 Scale, Digital, 1 1 /2 Display 1 5K3966 Blood Pressure Unit 1 5K3739 Forceps 4 1 /4 1 USE AS DIRECTED For New York State Prescriptions Only: PRESCRIPITONS WILL BE FILLED GENERICALLY UNLESS PRESCRIBER WRITES daw IN THE BOX BELOW Physician: Signature (Substitution Permitted) Date (Dispense as Written) Physician Name Printed Dispense As Written Prescription Forms PF3

47 TRADEMARKS For prescription forms listed on pages PF1-PF3 The following is a listing of trademarks of Baxter International Inc.: Baxter Dianeal Extraneal HomeChoice HomeChoice PRO MiniCap UltraBag UltraClamp The following is a listing of trademarks of Minntech Corporation: Actril The following is a listing of trademarks of Bayer Healthcare LLC: Hemastix The following is a listing of trademarks of Alcavis HDC,LLC: Manugel Prescription Forms Effective Date 7/1/11 PFTM

48 NumericAL Index 2B1321 HD7 2B1322Q HD7 2B1323Q HD7 2B1324X HD7 2C7565 AC1 2F7112 HD7 2F7115 HD7 2F7122 HD7 2F7124 HD7 2F7125 HD7 5B4825 PD2 5B4826 PD2 5B4974 PD4 5B4976P PD4 5B4984 PD4 5B4986 PD4 5B5163 5B5166 5B5169 5B5173 5B5177 5B5179 5B5183 5B5187 5B5189 5B5193 5B5194 5B5195 5B5202 PD2 5B5203 PD2 5B7860 AC1 5B9248 AC1 5B9249 AC1 5B9250 AC1 5B9251 AC1 5B9252 AC1 5B9710 5B9711 5B9712 5B9727 PD2 5B9747 PD2 5B9757 PD1 5B9758 PD1 5B9759 PD1 5B9765P PD1 5B9766 PD1 5B9768P PD1 5B9770 PD2 5B9771 PD2 5B9772 PD2 5B9775P PD1 5B9776 PD1 5B9778P PD1 5B9795P PD1 5B9796 PD1 5B9798P PD1 5B9857 PD1 5B9858 PD1 5B9859 PD1 5B9866 PD1 5B9868P PD1 5B9876 PD1 5B9878P PD1 5B9896 PD1 5B9898P PD1 5B9901 PD2 5B9902 PD2 5B9903 PD2 5C4129 PD8 5C4136 PD8 5C4137 PD8 5C4145P PD6 5C4150A PD8 5C4160 PD8 5C4169 PD8 5C4190 PD7 5C4212P PD8 5C4213P PD8 5C4215P PD8 5C4275 PD7 5C4319 PD8 5C4366P PD7 5C4381 PD8 5C4406 PD6 5C4413 PD8 5C4426 PD6 5C4442 PD8 5C4446 PD6, AC1 5C4449 PD8 5C4456 PD8 5C4462 PD6 5C4464P PD6 5C4466P PD8 5C4469C PD5 5C4471 PD5 5C4476 PD6 5C4480C PD6 5C4482 PD8 5C4483 PD8 5C4505 PD7 5C4512 PD6 5C4527 PD8 5C4530 PD7 5C4531C PD5 5C4942 PD7 5C4957 PD8 5C4971 PD6 5C8302C PD5 5C8310 PD5 5C8346 PD6 5K3517 AN4 5K3545 AN4 5K3572 AN4 5K3575 AN4 5K3582 AN4 5K3585 AN4 5K3739 AN5 5K3826 AN4 5K3961 AN4 5K3966 AN4 5K3967 AN4 5K3968 AN4 5K4001 5K4005 5K4012P 5K4013P 5K4027 5K4033P 5K4054P 5K4066 5K4070 5K4075 5K4077 5K4172P 5K4225P 5K4226 5K4227 5K4265P 5K4285 5K4286P 5K4291P 5K4500 5K7401P 5K7402P AN5 5K7406P AN5 5K7407P 5K7416P 5K7424P 5K7425P 5K7426P 5K7427P 5K7428P 5K7430P 5K7444P AN5 5K7458P 5K7459P 5K7479P 5K7505P 5K7522P 5K7523P 5K7525P 5K7532P 5K7538P 5K7543P 5K7548P 5K7559P 5K7567P 5K7568P 5K7578P 5K7579P 5K7580P 5K7588P 5K7589P 5K7615 AN2 5K7617 AN2 5K7619 AN2 Code Page Code Page Code Page Code Page Effective Date 7/1/11 IN1 Numerical Index

49 IN2 Effective Date 7/1/11 5K7624 AN2 5K7627 AN2 5K7630 AN2 5K7639 AN2 5K7660 AN2 5K7667 AN2 5K7742P 5K7743P 5K7744P 5K7797P 5K7798P 5K7799P 5K8032P AN5 5K8058P 5K8065P AN5 5K8070P AN5 5K8100 AN4 5K8123P AN5 5K8148P 5M1542 HD3 5M1546 HD3 5M1729 HD3 5M1730 HD3 5M2119 HD2 5M2120 HD2 5M2121 HD2 5M2132 HD2 5M2591 HD2 5M2592 HD2 5M2593 HD2 5M2594 HD2 5M2595 HD2 5M2596 HD2 5M2731 HD3 5M2732 HD3 5M2733 HD3 5M2734 HD3 5M2735 HD3 5M2736 HD3 5M3074 AC1 5M3121 AC1 5M3122 AC1 5M3123 AC1 5M3134 AC1 5M5720 SO1 5M5730 SO1 5M5730U SO1 5M6400 HD2 5M6401 HD2 5M6402 HD2 5M6403 HD2 5M6404 HD2 5M6405 HD2 5M7818 HD8 5M7820 HD8 5M7821 HD8 5M7822 HD8 5M7823 HD8 5M7824 HD8 5M7825 HD8 5M7828 HD8 5M7829 HD8 5M7856 HD8 5M7857 HD8 5M7901 HD8 5M7902 HD8 5M7903 HD8 5M7904 HD8 5M7905 HD8 5M7906 HD8 5M7909 HD8 5M7911 HD8 5M9634 HD4 5Q3810 AN4 A201V801 HD4 A203V801 HD4 A204V801 HD4 A209YV803 HD4 A210V803 HD4 A217YV806 HD4 FD152530BC HD5 FS1425BC HD5 FS142530TP HD5 FS142530TPR HD5 FS1525BC HD5 FS1525BCR HD5 FS1532BC HD5 FS152530TP HD5 FS152530TPR HD5 FS1625BC HD5 FS1625BCR HD5 FS162530TP HD5 FS162530TPR HD5 FS163230BC HD5 FS1725BC HD5 FS172530TP HD5 FS172530TPR HD5 FS173230BC HD5 FT152530BC HD5 FT153230BC HD5 FT162530BC HD5 FT152530BCR HD5 FT162530BCR HD5 FT142530TP HD6 FT152530TP HD6 FT162530TP HD6 FT172530TP HD6 H25601A HD2 H25602A HD2 H25603A HD2 H25604A HD2 H25605A HD2 H25606A HD2 HCT1000B HD1 JD01D2238 HD7 JD01D2516 HD7 JD03D2238 HD7 L5B4825 PD2 L5B4826 PD2 L5B4974 PD4 L5B4976 PD4 L5B5163 L5B5166 L5B5169 L5B5173 L5B5177 L5B5179 L5B5183 L5B5187 L5B5189 L5B5193 L5B5194 L5B5195 L5B5202 PD2 L5B5203 PD2 L5B9710 L5B9711 L5B9712 L5B9727 PD2 L5B9747 PD2 L5B9770 PD2 L5B9771 PD2 L5B9772 PD2 L5B9901 PD2 L5B9902 PD2 L5B9903 PD2 L5C4366 PD7 L5C4446 PD6 L5C4531 PD5 N5C8305C PD5 R5C4479C PD5 PS01 HD7 R5C4522 PD6 R5C4526 PD6 RENLSFT SO1 TPSURE1 HD7 NumericAL Index Code Page Code Page Code Page Code Page Numerical Index

50 Baxter Healthcare Corporation Renal Business Unit 1620 Waukegan Road McGaw Park, IL AL05121W 7/11