NDC HCPCS Medication & Name and Amount Inpatient Outpatient Price Price 00002512330 J8499 PRASUGREL 10 MG TABLET $ $ 660.83 660.83 00002751017 J1815 INSULIN LISPRO (U‐100) 100 UNIT/ML SUBCUTANEOUS SOLUTION $ $ 661.08 661.08 00002759701 J3490 OLANZAPINE 10 MG INTRAMUSCULAR SOLUTION $ $ 1,686.23 1,686.23 00002762301 J9305 PEMETREXED 500 MG INTRAVENOUS SOLUTION $ $ 18,696.57 18,696.57 00002764001 J9305 PEMETREXED 100 MG INTRAVENOUS SOLUTION $ $ 3,739.32 3,739.32 00002821517 J1815 INSULIN U‐100 REGULAR HUMAN 100 UNIT/ML INJECTION $ $ SOLUTION 209.94 209.94 00002831517 J1815 INSULIN NPH ISOPHANE U‐100 HUMAN 100 UNIT/ML $ $ SUBCUTANEOUS SUSPENSION 209.94 209.94 00002871501 J1815 INSULIN HUMAN U‐100 NPH‐REGULR 70‐30 MIX 100 UNIT/ML $ $ SUBCUTANEOUS SUSP 651.10 651.10 00003029305 J3301 TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR $ $ INJECTION 352.90 352.90 00003089321 J8499 APIXABAN 2.5 MG TABLET $ $ 100.58 100.58 00003089431 J8499 APIXABAN 5 MG TABLET $ $ 100.58 100.58 00003218713 J0129 ABATACEPT (WITH MALTOSE) 250 MG INTRAVENOUS SOLUTION $ $ 5,860.65 5,860.65 00003229111 J9176 ELOTUZUMAB 300 MG INTRAVENOUS SOLUTION $ $ 10,369.87 10,369.87 00003232711 J9228 IPILIMUMAB 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION $ $ 40,056.79 40,056.79 00003256016 J3490 AZTREONAM 1 GRAM SOLUTION FOR INJECTION $ $ 1,141.64 1,141.64 00003257016 J3490 AZTREONAM 2 GRAM SOLUTION FOR INJECTION $ $ 2,104.27 2,104.27

4/28/20 1

00003373413 J9299 NIVOLUMAB 240 MG/24 ML INTRAVENOUS SOLUTION $ $ 258,809.03 258,809.03 00003377211 J9299 NIVOLUMAB 40 MG/4 ML INTRAVENOUS SOLUTION $ $ 5,856.49 5,856.49 00003377412 J9299 NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION $ $ 14,641.21 14,641.21 00003452211 J9176 ELOTUZUMAB 400 MG INTRAVENOUS SOLUTION $ $ 13,826.42 13,826.42 00004003909 J8499 VALGANCICLOVIR 50 MG/ML ORAL SOLUTION $ $ 40,367.43 40,367.43 00004029830 J3490 MYCOPHENOLATE 500 MG INTRAVENOUS SOLUTION $ $ 4,072.96 4,072.96 00004080085 J8499 OSELTAMIVIR 75 MG CAPSULE $ $ 655.99 655.99 00004082205 J8499 OSELTAMIVIR 6 MG/ML ORAL SUSPENSION $ $ 6,560.30 6,560.30 00005197105 90670 PNEUMOCOCCAL 13‐VAL CONJ VACCINE‐DIP CRM (PF) 0.5 ML IM $ $ SYRINGE 7,354.07 7,354.07 00005434462 MULTIVIT AND MINERALS‐FERROUS GLUCONATE 9 MG IRON/15 $ $ ML ORAL LIQUID 366.78 366.78 00006011231 J8499 SITAGLIPTIN 50 MG TABLET $ $ 19.76 19.76 00006022761 J8499 RALTEGRAVIR 400 MG TABLET $ $ 1,169.45 1,169.45 00006046401 J8501 APREPITANT 40 MG CAPSULE $ $ 5,096.21 5,096.21 00006095231 J8499 LOSARTAN 50 MG TABLET $ $ 4.87 4.87 00006302601 J9271 PEMBROLIZUMAB 25 MG/ML INTRAVENOUS SOLUTION $ $ 25,962.89 25,962.89 00006382210 J0637 CASPOFUNGIN 50 MG INTRAVENOUS SOLUTION $ $ 12,915.48 12,915.48 00006382310 J0637 CASPOFUNGIN 70 MG INTRAVENOUS SOLUTION $ $ 13,412.48 13,412.48

4/28/20 2

00006384371 J1335 ERTAPENEM 1 GRAM SOLUTION FOR INJECTION $ $ 5,031.92 5,031.92 00006391668 J8499 CARBIDOPA 25 MG‐LEVODOPA 100 MG TABLET $ $ 1.54 1.54 00006394132 J1453 FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION $ $ 11,658.24 11,658.24 00006468101 90707 MEASLES,MUMPS,RUBELLA VACCINE LIVE(PF)1,000‐ $ $ 12,500TCID50/0.5 ML SUBCUT 2,828.58 2,828.58 00006482700 90716 VARICELLA VIRUS VACCINE LIVE (PF) 1,350 UNIT/0.5 ML $ $ SUBCUTANEOUS SUSP 5,148.73 5,148.73 00006483701 90732 PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML $ $ INJECTION SYRINGE 3,848.93 3,848.93 00006542302 C9399 SUGAMMADEX 100 MG/ML INTRAVENOUS SOLUTION $ $ 3,762.07 3,762.07 00006542312 C9399 SUGAMMADEX 100 MG/ML INTRAVENOUS SOLUTION $ $ 3,762.07 3,762.07 00006542402 J3490 ANTIVENIN LATRODECTUS MACTANS 6,000 UNIT SOLUTION FOR $ $ INJECTION 1,106.19 1,106.19 00007440701 J0883 ARGATROBAN 100 MG/ML INTRAVENOUS SOLUTION $ $ 49,683.00 49,683.00 00008084401 J8499 PANTOPRAZOLE DR 40 MG GRANULES DELAYED‐RELEASE FOR $ $ SUSP IN PACKET 650.69 650.69 00008084402 J8499 PANTOPRAZOLE DR 40 MG GRANULES DELAYED‐RELEASE FOR $ $ SUSP IN PACKET 650.69 650.69 00008092351 C9113 PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION $ $ 138.00 138.00 00008200101 C9113 PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION $ $ 138.00 138.00 00009000501 J1720 HYDROCORTISONE SOD SUCCINATE (PF) 1,000 MG/8 ML $ $ SOLUTION FOR INJECTION 3,738.91 3,738.91 00009001103 J1720 HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION $ $ FOR INJECTION 497.01 497.01 00009001305 J1720 HYDROCORTISONE SOD SUCCINATE (PF) 250 MG/2 ML SOLUTION $ $ FOR INJECTION 927.75 927.75

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00009001612 J1720 HYDROCORTISONE SOD SUCCINATE (PF) 500 MG/4 ML SOLUTION $ $ FOR INJECTION 1,865.07 1,865.07 00009003930 J2920 METHYLPREDNISOLONE SOD SUCC (PF) 40 MG/ML SOLUTION FOR $ $ INJECTION 183.72 183.72 00009004725 J2930 METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION $ $ FOR INJECTION 292.34 292.34 00009023301 J3490 BACITRACIN 50,000 UNIT INTRAMUSCULAR SOLUTION $ $ 371.82 371.82 00009023344 J3490 BACITRACIN 50,000 UNIT INTRAMUSCULAR SOLUTION $ $ 371.82 371.82 00009027101 J1000 ESTRADIOL CYPIONATE 5 MG/ML INTRAMUSCULAR OIL $ $ 3,962.06 3,962.06 00009041701 J1071 TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL $ $ 358.49 358.49 00009069801 J2930 METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG $ $ INTRAVENOUS SOLUTION 1,279.04 1,279.04 00009075801 J2930 METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG $ $ INTRAVENOUS SOLUTION 820.36 820.36 00009077520 J3490 CLINDAMYCIN 150 MG/ML INJECTION SOLUTION $ $ 302.00 302.00 00009085605 J3490 CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR $ $ SOLUTION 13,368.41 13,368.41 00009087021 J3490 CLINDAMYCIN 150 MG/ML INJECTION SOLUTION $ $ 302.00 302.00 00009090211 J3490 CLINDAMYCIN 150 MG/ML INJECTION SOLUTION $ $ 302.00 302.00 00009090218 J3490 CLINDAMYCIN 150 MG/ML INJECTION SOLUTION $ $ 302.00 302.00 00009307301 J1030 METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION FOR $ $ INJECTION 263.48 263.48 00009316901 J0270 ALPROSTADIL 500 MCG/ML INJECTION SOLUTION $ $ 4,334.44 4,334.44 00009316906 J0270 ALPROSTADIL 500 MCG/ML INJECTION SOLUTION $ $ 4,334.44 4,334.44

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00009337501 J3490 CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS $ $ PIGGYBACK 432.50 432.50 00009338201 J3490 CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS $ $ PIGGYBACK 488.38 488.38 00009347501 J1040 METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR $ $ INJECTION 539.72 539.72 00009379401 J1742 IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION $ $ 9,430.31 9,430.31 00009454402 J8499 TOLTERODINE 2 MG TABLET $ $ 359.17 359.17 00009513601 J8499 LINEZOLID 100 MG/5 ML ORAL SUSPENSION $ $ 50,359.08 50,359.08 00009514001 J2020 LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML $ $ INTRAVENOUS PIGGYBACK 1,005.35 1,005.35 00009519104 J8499 TOLTERODINE ER 4 MG CAPSULE,EXTENDED RELEASE 24 HR $ $ 16.15 16.15 00013111401 J3490 TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS $ $ SOLUTION 348.91 348.91 00013111420 J3490 TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS $ $ SOLUTION 205.19 205.19 00013111421 J3490 TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS $ $ SOLUTION 205.19 205.19 00013872789 J1190 DEXRAZOXANE HCL 500 MG INTRAVENOUS SOLUTION $ $ 1,311.59 1,311.59 00019318309 Q9960 IOTHALAMATE MEGLUMINE 43 % INTRAVENOUS SOLUTION $ $ 19,041.84 19,041.84 00019481604 Q9963 DIATRIZOATE MEGLUMINE‐DIATRIZOATE SODIUM 66 %‐10 % $ $ ORAL SOLUTION 943.46 943.46 00023079815 J3490 CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS $ $ 333.54 333.54 00023114501 J0585 ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION $ $ 3,257.42 3,257.42 00023391950 J0585 ONABOTULINUMTOXINA (COSMETIC) 50 UNIT INTRAMUSCULAR $ $ SOLUTION 13,213.52 13,213.52

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00023585318 J3490 MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS $ $ INSIDE) 227.44 227.44 00023608201 J1750 IRON DEXTRAN 50 MG/ML INJECTION SOLUTION $ $ 1,227.94 1,227.94 00023916330 J3490 CYCLOSPORINE 0.05 % EYE DROPS IN A DROPPERETTE $ $ 401.25 401.25 00024279210 J2916 SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 $ $ ML INTRAVENOUS 138.00 138.00 00024414260 J8499 DRONEDARONE 400 MG TABLET $ $ 464.51 464.51 00024582411 J9043 CABAZITAXEL 10 MG/ML (FIRST DILUTION) INTRAVENOUS $ $ SOLUTION 231,995.08 231,995.08 00024585130 J8499 IRBESARTAN 150 MG TABLET $ $ 8.26 8.26 00032121201 J8499 LIPASE‐PROTEASE‐AMYLASE 12,000‐38,000‐60,000 UNIT $ $ CAPSULE,DELAYED REL 4.09 4.09 00032122401 J8499 LIPASE‐PROTEASE‐AMYLASE 24,000‐76,000‐120,000 UNIT $ $ CAPSULE,DELAYED REL 8.10 8.10 00037663104 J3490 SULFANILAMIDE 15 % VAGINAL CREAM $ $ 8,526.92 8,526.92 00043001718 J3490 SIMETHICONE 125 MG CHEWABLE TABLET $ $ 59.00 59.00 00046074905 J1410 CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION $ $ 11,195.57 11,195.57 00046087221 J3490 CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM $ $ 14,090.97 14,090.97 00046110081 J8499 CONJUGATED ESTROGENS 0.3 MG TABLET $ $ 7.39 7.39 00049001481 J0295 AMPICILLIN‐SULBACTAM 3 GRAM SOLUTION FOR INJECTION $ $ 508.90 508.90 00049052084 J2540 PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR $ $ INJECTION 401.56 401.56 00049053028 J2540 PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR $ $ INJECTION 1,418.12 1,418.12

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00049396060 J8499 ZIPRASIDONE 20 MG CAPSULE $ $ 25.27 25.27 00052433001 J7307 ETONOGESTREL 68 MG SUBDERMAL IMPLANT $ $ 35,540.78 35,540.78 00054001720 J7512 PREDNISONE 10 MG TABLET $ $ 59.00 59.00 00054001820 J7512 PREDNISONE 20 MG TABLET $ $ 1.00 1.00 00054005746 J3490 DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLUTION $ $ 154.96 154.96 00054010625 J3490 RAMIPRIL 1.25 MG CAPSULE $ $ 1.00 1.00 00054010725 J8499 RAMIPRIL 2.5 MG CAPSULE $ $ 59.00 59.00 00054017613 J0571 BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET $ $ 59.00 59.00 00054017713 J8499 BUPRENORPHINE HCL 8 MG SUBLINGUAL TABLET $ $ 78.22 78.22 00054022025 J8499 QUETIAPINE 25 MG TABLET $ $ 59.00 59.00 00054022125 J8499 QUETIAPINE 100 MG TABLET $ $ 59.00 59.00 00054023749 J3490 MORPHINE 10 MG/5 ML ORAL SOLUTION $ $ 383.97 383.97 00054024425 J8499 CODEINE SULFATE 30 MG TABLET $ $ 59.00 59.00 00054252625 J8499 LITHIUM CARBONATE 150 MG CAPSULE $ $ 59.00 59.00 00054319446 J8499 DIPHENOXYLATE‐ATROPINE 2.5 MG‐0.025 MG/5 ML ORAL LIQUID $ $ 2,789.23 2,789.23 00054327099 J3490 FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL $ $ SPRAY,SUSPENSION 1,071.14 1,071.14 00054350547 J3490 LIDOCAINE HCL 4 % (40 MG/ML) MUCOSAL SOLUTION $ $ 1,287.42 1,287.42

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00054352763 J8499 LITHIUM CITRATE 8 MEQ/5 ML ORAL SOLUTION $ $ 129.27 129.27 00054355563 J8499 METHADONE 5 MG/5 ML ORAL SOLUTION $ $ 41.70 41.70 00054449613 J8499 LEUCOVORIN CALCIUM 5 MG TABLET $ $ 73.22 73.22 00054458111 J8499 MERCAPTOPURINE 50 MG TABLET $ $ 79.60 79.60 00054474125 J7512 PREDNISONE 1 MG TABLET $ $ 59.00 59.00 00054814622 J8499 CLOTRIMAZOLE 10 MG TROCHE $ $ 73.76 73.76 00054817525 J8540 DEXAMETHASONE 4 MG TABLET $ $ 74.30 74.30 00054817925 J8540 DEXAMETHASONE 0.5 MG TABLET $ $ 59.00 59.00 00054829725 J8499 FUROSEMIDE 20 MG TABLET $ $ 1.00 1.00 00054850016 J3490 LIDOCAINE HCL 2 % MUCOSAL SOLUTION $ $ 84.90 84.90 00054852725 J8499 LITHIUM CARBONATE 300 MG CAPSULE $ $ 1.00 1.00 00054855324 J8499 METHADONE 5 MG TABLET $ $ 1.00 1.00 00054855424 J8499 METHADONE 10 MG TABLET $ $ 1.00 1.00 00054872425 J7512 PREDNISONE 5 MG TABLET $ $ 59.00 59.00 00056016901 J8499 WARFARIN 1 MG TABLET $ $ 1.00 1.00 00056017001 J8499 WARFARIN 2 MG TABLET $ $ 1.00 1.00 00056017201 J8499 WARFARIN 5 MG TABLET $ $ 59.00 59.00

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00056017301 J8499 WARFARIN 7.5 MG TABLET $ $ 1.00 1.00 00056017370 J8499 WARFARIN 7.5 MG TABLET $ $ 4.00 4.00 00056017601 J8499 WARFARIN 2.5 MG TABLET $ $ 1.00 1.00 00056018801 J8499 WARFARIN 3 MG TABLET $ $ 1.00 1.00 00064501030 J3490 COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM $ $ TOPICAL OINTMENT 8,180.81 8,180.81 00065002315 J3490 CARBACHOL 0.01 % INTRAOCULAR SOLUTION $ $ 481.32 481.32 00065009265 J3490 FLUORESCEIN 500 MG/5 ML (10 %) INTRAVENOUS SOLUTION $ $ 1,757.08 1,757.08 00065024610 J3490 BETAXOLOL 0.25 % EYE DROPS,SUSPENSION $ $ 11,655.05 11,655.05 00065064435 J3490 TOBRAMYCIN 0.3 % EYE OINTMENT $ $ 8,045.50 8,045.50 00065079515 J3490 BALANCED SALT SOLUTION COMBINATION NO.2 INTRAOCULAR $ $ IRRIGATION 207.19 207.19 00065853302 J3490 CIPROFLOXACIN 0.3 %‐DEXAMETHASONE 0.1 % EAR $ $ DROPS,SUSPENSION 8,861.35 8,861.35 00067012918 J3490 SIMETHICONE 125 MG CHEWABLE TABLET $ $ 59.00 59.00 00068059701 J3490 RIFAMPIN 600 MG INTRAVENOUS SOLUTION $ $ 3,306.98 3,306.98 00069040001 J0456 AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION $ $ 302.00 302.00 00069046911 J8499 VARENICLINE 1 MG TABLET $ $ 14.61 14.61 00069080901 Q5103 INFLIXIMAB‐DYYB 100 MG INTRAVENOUS SOLUTION $ $ 2,964.64 2,964.64 00069315084 J0456 AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION $ $ 302.00 302.00

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00069580043 J8499 DOFETILIDE 125 MCG CAPSULE $ $ 475.07 475.07 00069582043 J8499 DOFETILIDE 500 MCG CAPSULE $ $ 475.07 475.07 00071036940 J8499 PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE $ $ 1.89 1.89 00071041813 J8499 NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET $ $ 1.64 1.64 00071101268 J8499 PREGABALIN 25 MG CAPSULE $ $ 10.25 10.25 00071101341 J8499 PREGABALIN 50 MG CAPSULE $ $ 11.28 11.28 00071101441 J8499 PREGABALIN 75 MG CAPSULE $ $ 11.28 11.28 00074334603 J9217 LEUPROLIDE 22.5 MG (3 MONTH) INTRAMUSCULAR SYRINGE KIT $ $ 23,808.06 23,808.06 00074364103 J1950 LEUPROLIDE 3.75 MG INTRAMUSCULAR SYRINGE KIT $ $ 6,659.67 6,659.67 00074364203 J9217 LEUPROLIDE 7.5 MG INTRAMUSCULAR SYRINGE KIT $ $ 7,936.08 7,936.08 00074368303 J9217 LEUPROLIDE 30 MG (4 MONTH) INTRAMUSCULAR SYRINGE KIT $ $ 31,744.13 31,744.13 00074434190 J8499 LEVOTHYROXINE 25 MCG TABLET $ $ 1.63 1.63 00074436510 C9399 MIVACURIUM CHLORIDE 2 MG/ML INJECTION SOLUTION $ $ 1,126.15 1,126.15 00074437805 J3490 CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION $ $ 770.42 770.42 00074455211 J8499 LEVOTHYROXINE 50 MCG TABLET $ $ 1.63 1.63 00074455290 J8499 LEVOTHYROXINE 50 MCG TABLET $ $ 1.63 1.63 00074463701 J2501 PARICALCITOL 2 MCG/ML INTRAVENOUS SOLUTION $ $ 228.59 228.59

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00074518211 J8499 LEVOTHYROXINE 75 MCG TABLET $ $ 1.63 1.63 00074518290 J8499 LEVOTHYROXINE 75 MCG TABLET $ $ 1.63 1.63 00074611411 J8499 DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE $ $ 113.79 113.79 00074611413 J8499 DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE $ $ 113.57 113.57 00074659490 J8499 LEVOTHYROXINE 88 MCG TABLET $ $ 1.63 1.63 00074662411 J8499 LEVOTHYROXINE 100 MCG TABLET $ $ 1.63 1.63 00074662490 J8499 LEVOTHYROXINE 100 MCG TABLET $ $ 1.63 1.63 00074706911 J8499 LEVOTHYROXINE 150 MCG TABLET $ $ 1.63 1.63 00074706990 J8499 LEVOTHYROXINE 150 MCG TABLET $ $ 1.63 1.63 00074929690 J8499 LEVOTHYROXINE 112 MCG TABLET $ $ 83.05 83.05 00075062603 J1650 ENOXAPARIN 300 MG/3 ML SUBCUTANEOUS SOLUTION $ $ 2,129.54 2,129.54 00078050115 J3490 RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH $ $ 29.74 29.74 00078050215 J8499 RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH $ $ 977.79 977.79 00078064781 J2353 OCTREOTIDE,MICROSPHERES ER 20 MG INTRAMUSCULAR SUSP, $ $ EXTENDED RELEASE 4,165.22 4,165.22 00078064881 J2353 OCTREOTIDE,MICROSPHERES ER 30 MG INTRAMUSCULAR SUSP, $ $ EXTENDED RELEASE 6,252.63 6,252.63 00078065920 J3490 SACUBITRIL 24 MG‐VALSARTAN 26 MG TABLET $ $ 362.85 362.85 00078069620 J3490 SACUBITRIL 97 MG‐VALSARTAN 103 MG TABLET $ $ 362.85 362.85

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00078077720 J3490 SACUBITRIL 49 MG‐VALSARTAN 51 MG TABLET $ $ 362.85 362.85 00078081881 J2353 OCTREOTIDE,MICROSPHERES ER 20 MG INTRAMUSCULAR SUSP, $ $ EXTENDED RELEASE 21,841.25 21,841.25 00078082581 J2353 OCTREOTIDE,MICROSPHERES ER 30 MG INTRAMUSCULAR SUSP, $ $ EXTENDED RELEASE 32,705.69 32,705.69 00085126001 J3490 CLOTRIMAZOLE 2 % VAGINAL CREAM $ $ 299.29 299.29 00085432001 J0702 BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML $ $ SUSPENSION FOR INJECTION 1,613.11 1,613.11 00087040501 J3490 PEDIATRIC MULTIVIT NO.80‐IRON 10 MG‐750 UNIT‐400 UNIT/ML $ $ ORAL DROPS 411.39 411.39 00088222033 J1815 INSULIN GLARGINE 100 UNIT/ML SUB‐Q VIAL $ $ 3,379.23 3,379.23 00093001806 J8499 TOLTERODINE 2 MG TABLET $ $ 63.70 63.70 00093022056 J8499 BICALUTAMIDE 50 MG TABLET $ $ 1.00 1.00 00093031401 J8499 KETOROLAC 10 MG TABLET $ $ 70.98 70.98 00093066116 J8499 ALBUTEROL SULFATE 2 MG/5 ML ORAL SYRUP $ $ 1,774.93 1,774.93 00093077198 J8499 PRAVASTATIN 10 MG TABLET $ $ 1.00 1.00 00093117201 J8499 PENICILLIN V POTASSIUM 250 MG TABLET $ $ 59.00 59.00 00093202631 Q0144 AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION $ $ 457.49 457.49 00093205056 J8499 TOLTERODINE ER 2 MG CAPSULE,EXTENDED RELEASE 24 HR $ $ 5.00 5.00 00093220305 J8499 METOCLOPRAMIDE 10 MG TABLET $ $ 59.00 59.00 00093227434 J8499 AMOXICILLIN 500 MG‐POTASSIUM CLAVULANATE 125 MG TABLET $ $ 59.00 59.00

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00093310953 J8499 AMOXICILLIN 500 MG CAPSULE $ $ 1.00 1.00 00093314501 J8499 CEPHALEXIN 250 MG CAPSULE $ $ 59.00 59.00 00093314701 J8499 CEPHALEXIN 500 MG CAPSULE $ $ 59.00 59.00 00093360321 J3490 BUPRENORPHINE 20 MCG/HOUR WEEKLY TRANSDERMAL PATCH $ $ 6,126.42 6,126.42 00093365522 J8499 METHYLERGONOVINE 0.2 MG TABLET $ $ 26.10 26.10 00093412773 J8499 PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLUTION $ $ 155.69 155.69 00093417773 J8499 CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION $ $ 491.02 491.02 00093423201 J8499 BUMETANIDE 0.5 MG TABLET $ $ 1.22 1.22 00093574019 J7515 CYCLOSPORINE MODIFIED 25 MG CAPSULE $ $ 59.00 59.00 00093576801 J8499 OLANZAPINE 5 MG TABLET $ $ 59.00 59.00 00093598619 J0171 EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO‐INJECTOR $ $ 6,382.02 6,382.02 00093681645 J3490 BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION $ $ 205.23 205.23 00093762056 J8499 LETROZOLE 2.5 MG TABLET $ $ 59.00 59.00 00093961413 J3490 SILVER NITRATE 0.5 % TOPICAL SOLUTION $ $ 843.12 843.12 00093965201 J8597 PROCHLORPERAZINE MALEATE 10 MG TABLET $ $ 59.00 59.00 00115146853 J3490 LIDOCAINE‐PRILOCAINE 2.5 %‐2.5 % TOPICAL CREAM $ $ 188.63 188.63 00115166001 J8499 PROPRANOLOL 20 MG TABLET $ $ 1.00 1.00

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00115169449 J0171 EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO‐INJECTOR $ $ 6,381.82 6,381.82 00115169701 J8499 HYDROCORTISONE 10 MG TABLET $ $ 59.00 59.00 00115351101 J8499 PYRIDOSTIGMINE BROMIDE 60 MG TABLET $ $ 1.31 1.31 00115592201 J8499 PILOCARPINE 5 MG TABLET $ $ 64.15 64.15 00115703301 J8499 FLUDROCORTISONE 0.1 MG TABLET $ $ 59.00 59.00 00116200116 J3490 CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH $ $ 134.30 134.30 00121043130 J8499 MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION $ $ 2.88 2.88 00121048905 J8499 DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR $ $ 117.83 117.83 00121050405 J8499 ACETAMINOPHEN 120 MG‐CODEINE 12 MG/5 ML (5 ML) ORAL $ $ SOLUTION 78.61 78.61 00121053005 J8499 FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID $ $ 3.24 3.24 00121054410 J8499 DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID $ $ 59.00 59.00 00121054705 J8499 PROMETHAZINE 6.25 MG‐CODEINE 10 MG/5 ML SYRUP $ $ 78.08 78.08 00121057616 J8499 METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION $ $ 648.63 648.63 00121059530 J8499 SODIUM CITRATE‐CITRIC ACID 500 MG‐334 MG/5 ML ORAL $ $ SOLUTION 1.34 1.34 00121063810 J3490 DEXTROMETHORPHAN‐GUAIFENESIN 10 MG‐100 MG/5 ML ORAL $ $ SYRUP 59.00 59.00 00121065711 J8499 ACETAMINOPHEN 325 MG/10.15 ML ORAL SOLUTION $ $ 59.00 59.00 00121072104 J8499 FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION $ $ 49.71 49.71

4/28/20 14

00121074710 J8499 SUCRALFATE 100 MG/ML ORAL SUSPENSION $ $ 330.14 330.14 00121127610 J3490 DEXTROMETHORPHAN‐GUAIFENESIN 10 MG‐100 MG/5 ML ORAL $ $ SYRUP 124.71 124.71 00121146515 J8499 POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID $ $ 216.17 216.17 00121148800 J8499 GUAIFENESIN 100 MG/5 ML ORAL LIQUID $ $ 59.00 59.00 00121148810 J8499 GUAIFENESIN 100 MG/5 ML ORAL LIQUID $ $ 59.00 59.00 00121157610 J8499 METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION $ $ 75.24 75.24 00121174410 J8499 GUAIFENESIN 100 MG/5 ML ORAL LIQUID $ $ 59.00 59.00 00121176130 J3490 ALUMINUM‐MAG HYDROXIDE‐SIMETHICONE 200 MG‐200 MG‐20 $ $ MG/5 ML ORAL SUSP 104.20 104.20 00121177505 J8499 CODEINE 10 MG‐GUAIFENESIN 100 MG/5 ML ORAL LIQUID $ $ 59.00 59.00 00121457730 J8499 LACTULOSE 20 GRAM/30 ML ORAL SOLUTION $ $ 59.00 59.00 00121467505 J3490 VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL $ $ SOLUTION 59.00 59.00 00121472105 J8499 FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION $ $ 5.96 5.96 00121479905 J8499 LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION $ $ 205.98 205.98 00131247760 J8499 LACOSAMIDE 50 MG TABLET $ $ 437.82 437.82 00131247935 J8499 LACOSAMIDE 150 MG TABLET $ $ 658.96 658.96 00131248035 J8499 LACOSAMIDE 200 MG TABLET $ $ 659.14 659.14 00132007912 J8499 GLYCERIN (ADULT) RECTAL SUPPOSITORY $ $ 59.00 59.00

4/28/20 15

00132008112 J8499 GLYCERIN (CHILD) RECTAL SUPPOSITORY $ $ 59.00 59.00 00132020220 J8499 SODIUM PHOSPHATES 9.5 GRAM‐3.5 GRAM/59 ML ENEMA $ $ 63.24 63.24 00132030140 J3490 MINERAL OIL ENEMA $ $ 132.03 132.03 00143124001 J8499 DIGOXIN 125 MCG (0.125 MG) TABLET $ $ 1.00 1.00 00143177101 J8499 ISOSORBIDE DINITRATE 10 MG TABLET $ $ 59.00 59.00 00143312601 J8499 DICYCLOMINE 10 MG CAPSULE $ $ 59.00 59.00 00143921001 J2400 CHLOROPROCAINE (PF) 30 MG/ML (3 %) INJECTION SOLUTION $ $ 835.93 835.93 00143921010 J2400 CHLOROPROCAINE (PF) 30 MG/ML (3 %) INJECTION SOLUTION $ $ 835.93 835.93 00143928401 C9113 PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION $ $ 242.72 242.72 00143928410 C9113 PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION $ $ 242.72 242.72 00143935501 J3370 VANCOMYCIN 750 MG INTRAVENOUS SOLUTION $ $ 427.87 427.87 00143950101 J1630 HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 00143950301 J1120 ACETAZOLAMIDE 500 MG SOLUTION FOR INJECTION $ $ 302.00 302.00 00143950601 J3490 ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION $ $ 175.65 175.65 00143967401 J0883 ARGATROBAN 100 MG/ML INTRAVENOUS SOLUTION $ $ 8,835.66 8,835.66 00143968101 J3490 GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION $ $ 190.42 190.42 00143968901 J3490 NICARDIPINE 25 MG/10 ML INTRAVENOUS SOLUTION $ $ 933.89 933.89

4/28/20 16

00143974601 J3105 TERBUTALINE 1 MG/ML SUBCUTANEOUS SOLUTION $ $ 138.00 138.00 00143978401 J3490 FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION $ $ 241.32 241.32 00143978701 J3490 ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION $ $ 140.48 140.48 00143987201 J1800 PROPRANOLOL 1 MG/ML INTRAVENOUS SOLUTION $ $ 399.17 399.17 00143987301 J3490 METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION $ $ 138.00 138.00 00143987501 J0282 AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION $ $ 302.00 302.00 00143992490 J0690 CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION $ $ 302.00 302.00 00143992701 J8499 CIPROFLOXACIN 250 MG TABLET $ $ 59.00 59.00 00143992950 J8499 CIPROFLOXACIN 750 MG TABLET $ $ 59.00 59.00 00143997790 J0697 CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION $ $ 194.50 194.50 00143997990 J0697 CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION $ $ 302.00 302.00 00168000315 J3490 TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM $ $ 82.04 82.04 00168000380 J3490 TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM $ $ 194.81 194.81 00168006231 J3490 ZINC OXIDE 20 % TOPICAL OINTMENT $ $ 84.88 84.88 00168011109 J3490 BACITRACIN ZINC 500 UNIT/GRAM TOPICAL PACKET $ $ 1.00 1.00 00168025815 J3490 CLOTRIMAZOLE‐BETAMETHASONE 1 %‐0.05 % TOPICAL CREAM $ $ 244.91 244.91 00168032346 J3490 METRONIDAZOLE 0.75 % TOPICAL CREAM $ $ 3,136.52 3,136.52

4/28/20 17

00168035705 J3490 LIDOCAINE‐PRILOCAINE 2.5 %‐2.5 % TOPICAL CREAM $ $ 269.46 269.46 00168035755 J3490 LIDOCAINE‐PRILOCAINE 2.5 %‐2.5 % TOPICAL CREAM $ $ 269.46 269.46 00169183311 J1815 INSULIN U‐100 REGULAR HUMAN 100 UNIT/ML INJECTION $ $ SOLUTION 1,354.89 1,354.89 00169183411 J1815 INSULIN NPH ISOPHANE U‐100 HUMAN 100 UNIT/ML $ $ SUBCUTANEOUS SUSPENSION 1,354.89 1,354.89 00169720101 J7189 COAGULATION FACTOR VIIA RECOMB 1 MG (1,000 MCG) $ $ INTRAVENOUS SOLUTION 76,885.92 76,885.92 00169720201 J7189 COAGULATION FACTOR VIIA RECOMB 2 MG (2,000 MCG) $ $ INTRAVENOUS SOLUTION 153,771.84 153,771.84 00169720501 J7189 COAGULATION FACTOR VIIA RECOMB 5 MG (5,000 MCG) $ $ INTRAVENOUS SOLUTION 384,429.60 384,429.60 00169720801 J7189 COAGULATION FACTOR VIIA RECOMB 8 MG (8,000 MCG) $ $ INTRAVENOUS SOLUTION 615,215.11 615,215.11 00172531160 J8499 CIPROFLOXACIN 250 MG TABLET $ $ 59.00 59.00 00172541146 J8499 FLUCONAZOLE 100 MG TABLET $ $ 125.00 125.00 00172572860 J8499 FAMOTIDINE 20 MG TABLET $ $ 1.00 1.00 00173068101 J3490 ZANAMIVIR 5 MG/ACTUATION BLISTER POWDER FOR $ $ INHALATION 400.20 400.20 00173068224 J3535 ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER $ $ 143.61 143.61 00173071204 J8499 DUTASTERIDE 0.5 MG CAPSULE $ $ 8.59 8.59 00173071920 J3535 FLUTICASONE 110 MCG/ACTUATION AEROSOL ORAL INHALER $ $ 1,595.85 1,595.85 00173072020 J3535 FLUTICASONE 220 MCG/ACTUATION AEROSOL ORAL INHALER $ $ 2,478.63 2,478.63 00178031430 J3490 POTASSIUM IODIDE 65 MG/ML ORAL DROPS $ $ 556.89 556.89

4/28/20 18

00185012901 J8499 BUMETANIDE 1 MG TABLET $ $ 1.00 1.00 00185022360 J8499 CILOSTAZOL 100 MG TABLET $ $ 1.23 1.23 00185041060 J8499 BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED‐RELEASE $ $ 1.39 1.39 00185505001 J8499 METOLAZONE 2.5 MG TABLET $ $ 1.00 1.00 00186000431 J8499 CANDESARTAN 4 MG TABLET $ $ 4.67 4.67 00186037028 J3535 BUDESONIDE‐FORMOTEROL HFA 160 MCG‐4.5 MCG/ACTUATION $ $ AEROSOL INHALER 404.21 404.21 00186037228 J3535 BUDESONIDE‐FORMOTEROL HFA 80 MCG‐4.5 MCG/ACTUATION $ $ AEROSOL INHALER 404.21 404.21 00186077660 J8499 TICAGRELOR 60 MG TABLET $ $ 303.25 303.25 00186077760 J8499 TICAGRELOR 90 MG TABLET $ $ 303.25 303.25 00187099445 J3490 ACYCLOVIR 5 % TOPICAL CREAM $ $ 31,846.98 31,846.98 00187430202 J3490 SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION $ $ 6,808.52 6,808.52 00187442010 J8499 FAMOTIDINE 20 MG TABLET $ $ 15.78 15.78 00206886101 J2543 PIPERACILLIN‐TAZOBACTAM 3.375 GRAM/50 ML DEXTROSE(ISO‐ $ $ OS) IV PIGGYBACK 634.09 634.09 00206886201 J2543 PIPERACILLIN‐TAZOBACTAM 4.5 GRAM/100 ML DEXTROSE(ISO‐ $ $ OSM) IV PIGGYBACK 749.86 749.86 00223172101 J8499 SODIUM BICARBONATE 650 MG TABLET $ $ 59.00 59.00 00223176001 J8499 SODIUM CHLORIDE 1 GRAM TABLET $ $ 1.00 1.00 00225052547 J3490 SODIUM CHLORIDE‐ALOE VERA NASAL GEL $ $ 129.47 129.47

4/28/20 19

00228212710 J8499 CLONIDINE HCL 0.1 MG TABLET $ $ 59.00 59.00 00228234810 J8499 PROPYLTHIOURACIL 50 MG TABLET $ $ 1.00 1.00 00234057504 J3490 CHLORHEXIDINE GLUCONATE 4 % TOPICAL LIQUID $ $ 117.77 117.77 00245001289 J8499 SOTALOL 80 MG TABLET $ $ 1.37 1.37 00245010811 J3490 FERROUS SULFATE 325 MG (65 MG IRON) TABLET,DELAYED $ $ RELEASE 1.00 1.00 00245010889 J3490 FERROUS SULFATE 325 MG (65 MG IRON) TABLET,DELAYED $ $ RELEASE 1.00 1.00 00245021111 J8499 MIDODRINE 2.5 MG TABLET $ $ 59.00 59.00 00245021211 J8499 MIDODRINE 5 MG TABLET $ $ 59.00 59.00 00245021289 J8499 MIDODRINE 5 MG TABLET $ $ 175.89 175.89 00245086070 J3490 METRONIDAZOLE 0.75 % VAGINAL GEL $ $ 2,632.33 2,632.33 00245531589 J3490 POTASSIUM CHLORIDE ER 8 MEQ TABLET,EXTENDED RELEASE $ $ 1.00 1.00 00245531989 J8499 POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED $ $ RELEASE(PART/CRYST) 1.00 1.00 00264230400 J3490 ACETIC ACID 0.25 % IRRIGATION SOLUTION $ $ 119.76 119.76 00264310511 J0690 CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO‐OSMOTIC) $ $ INTRAVENOUS PIGGYBACK 610.54 610.54 00264780010 J7040 DEPRECATED NACL 0.9% 500ML $ $ 313.50 313.50 00264958720 J1644 HEPARIN (PORCINE) 25,000 UNIT/250 ML (100 UNIT/ML) IN $ $ DEXTROSE 5 % IV 707.94 707.94 00270044540 Q9963 DIATRIZOATE MEGLUMINE‐DIATRIZOATE SODIUM 66 %‐10 % $ $ ORAL SOLUTION 581.44 581.44

4/28/20 20

00270052330 Q9963 IODIPAMIDE AND DIATRIZOATE MEGLUMINE 52.7 %‐26.8 % $ $ INJECTION SOLUTION 2,147.30 2,147.30 00270055615 J2805 SINCALIDE 5 MCG SOLUTION FOR INJECTION $ $ 4,007.01 4,007.01 00270111101 A9579 GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION ‐ 10 ML $ $ VIAL 838.72 838.72 00270111102 A9579 GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION $ $ 1,244.91 1,244.91 00270111103 A9579 GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION $ $ 1,659.88 1,659.88 00270111104 A9579 GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION $ $ 421.56 421.56 00270131525 Q9967 IOPAMIDOL 61 % INTRAVENOUS SOLUTION $ $ 233.54 233.54 00270131530 Q9967 IOPAMIDOL 61 % INTRAVENOUS SOLUTION $ $ 247.51 247.51 00270131535 Q9967 IOPAMIDOL 61 % INTRAVENOUS SOLUTION $ $ 483.04 483.04 00270131604 Q9967 IOPAMIDOL 76 % INTRAVENOUS SOLUTION $ $ 633.73 633.73 00270131630 Q9967 IOPAMIDOL 76 % INTRAVENOUS SOLUTION $ $ 269.46 269.46 00270131635 Q9967 IOPAMIDOL 76 % INTRAVENOUS SOLUTION $ $ 538.92 538.92 00270131637 Q9967 IOPAMIDOL 76 % INTRAVENOUS SOLUTION $ $ 742.52 742.52 00270131641 Q9967 IOPAMIDOL 76 % INTRAVENOUS SOLUTION $ $ 974.05 974.05 00270141111 Q9966 IOPAMIDOL 41 % INTRATHECAL SOLUTION $ $ 552.10 552.10 00270141125 Q9966 IOPAMIDOL 41 % INTRATHECAL SOLUTION $ $ 756.09 756.09 00281032608 J3490 NITROGLYCERIN 2 % TRANSDERMAL OINTMENT $ $ 126.63 126.63

4/28/20 21

00310072010 J9395 FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE $ $ 5,122.66 5,122.66 00310075590 J8499 ROSUVASTATIN 5 MG TABLET $ $ 11.42 11.42 00310460039 J3490 GLYCOPYRROLATE 9 MCG‐FORMOTEROL 4.8 MCG HFA AEROSOL $ $ INHALER 151.81 151.81 00310461150 J9173 DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION $ $ 144,323.74 144,323.74 00338000347 A4217 WATER FOR IRRIGATION, STERILE SOLUTION CARRIER BAG $ $ 323.00 323.00 00338000403 A4217 WATER FOR IRRIGATION, STERILE SOLUTION CARRIER POUR $ $ BOTTLE 314.50 314.50 00338000405 A4217 WATER FOR IRRIGATION, STERILE SOLUTION CARRIER POUR $ $ BOTTLE 317.00 317.00 00338001304 A4217 WATER FOR INJECTION, STERILE INTRAVENOUS SOLUTION $ $ 319.00 319.00 00338001703 J7060 DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION $ $ 314.50 314.50 00338001704 J7070 DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION $ $ 315.00 315.00 00338002303 J3490 DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION $ $ 317.00 317.00 00338002304 J3490 DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION $ $ 319.00 319.00 00338004304 J3490 SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION $ $ 316.00 316.00 00338004746 A4217 SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION CARRIER POUR $ $ BOTTLE 321.00 321.00 00338004747 A4217 SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION CARRIER BAG $ $ 314.00 314.00 00338004803 A4217 SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION CARRIER POUR $ $ BOTTLE 314.50 314.50 00338004804 A4217 SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION CARRIER POUR $ $ BOTTLE 314.00 314.00

4/28/20 22

00338004903 J7040 DEPRECATED NACL 0.9% 500ML $ $ 314.50 314.50 00338004904 J7030 SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION $ $ 315.00 315.00 00338005403 J7131 SODIUM CHLORIDE 3% IV BOLUS $ $ 316.50 316.50 00338007703 J3490 DEXTROSE 5 % AND 0.2 % SODIUM CHLORIDE INTRAVENOUS $ $ SOLUTION 315.50 315.50 00338007704 J3490 DEXTROSE 5 % AND 0.2 % SODIUM CHLORIDE INTRAVENOUS $ $ SOLUTION 317.00 317.00 00338008503 J3490 DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS $ $ SOLUTION 315.50 315.50 00338008504 J3490 DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS $ $ SOLUTION 316.00 316.00 00338008903 J7042 DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS $ $ SOLUTION 399.00 399.00 00338008904 J7042 DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS $ $ SOLUTION 316.00 316.00 00338011704 J7120 LACTATED RINGERS INTRAVENOUS SOLUTION $ $ 315.00 315.00 00338012504 J7121 DEXTROSE 5 % AND LACTATED RINGERS INTRAVENOUS SOLUTION $ $ 316.00 316.00 00338012612 J3490 INSULIN REGULAR 100 UNIT/100 ML (1 UNIT/ML) IN 0.9 % NACL $ $ IV SOLUTION 1,536.28 1,536.28 00338029547 J3490 SORBITOL 3 % IRRIGATION SOLUTION $ $ 332.00 332.00 00338032401 C9399 THROMBIN (RECOMBINANT) 5,000 UNIT TOPICAL SOLUTION $ $ 3,714.40 3,714.40 00338035703 J3490 MANNITOL 20 % INTRAVENOUS SOLUTION $ $ 363.00 363.00 00338040903 J2001 LIDOCAINE (PF) 4 MG/ML (0.4 %) IN 5 % DEXTROSE INTRAVENOUS $ $ SOLUTION 239.52 239.52 00338051909 B4185 LIPID INJECTABLE EMULSION 20 % INTRAVENOUS $ $ 1,925.50 1,925.50

4/28/20 23

00338064406 J3490 PARENTERAL AMINO ACID 10 % COMBINATION NO.6 $ $ INTRAVENOUS SOLUTION 1,996.00 1,996.00 00338100702 J1265 DOPAMINE 400 MG/250 ML (1,600 MCG/ML) IN 5 % DEXTROSE $ $ INTRAVENOUS SOLN 638.08 638.08 00338102541 J2540 PENICILLIN G POT 3 MILLION UNIT/50 ML‐DEXTROSE $ $ INTRAVENOUS PIGGYBACK 530.30 530.30 00338104902 J3490 NITROGLYCERIN 50 MG/250 ML (200 MCG/ML) IN 5 % DEXTROSE $ $ INTRAVENOUS 728.54 728.54 00338107502 J1250 DOBUTAMINE 500 MG/250 ML (2,000 MCG/ML) IN 5 % DEXTROSE $ $ IV 1,317.36 1,317.36 00338108904 J3490 AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION $ $ 2,893.56 2,893.56 00338109104 J3490 AMINO ACID 4.25 % IN 10 % DEXTROSE INTRAVENOUS SOLUTION $ $ 2,973.40 2,973.40 00338109904 J3490 AMINO ACID 5 % IN 15 % DEXTROSE INTRAVENOUS SOLUTION $ $ 3,133.08 3,133.08 00338110104 J3490 AMINO ACID 5 % IN 20 % DEXTROSE INTRAVENOUS SOLUTION $ $ 3,053.24 3,053.24 00338110904 J3490 AMINO ACID 2.75 % NO.2‐DEXTROSE 10 %‐ELECTROLYTES NO.29 $ $ IV SOLUTION 2,175.00 2,175.00 00338111304 J3490 AMINO ACIDS 4.25 % WITH LYTES AND CALCIUM IN D5W $ $ INTRAVENOUS SOLUTION 2,973.40 2,973.40 00338111504 J3490 AMINO ACIDS 4.25 % WITH LYTES AND CALCIUM IN D10W $ $ INTRAVENOUS SOLUTION 3,212.92 3,212.92 00338112304 J3490 AMINO ACIDS 5 %‐DEXTROSE 15 %‐ELECTROLYTES INTRAVENOUS $ $ SOLUTION 3,372.60 3,372.60 00338112504 J3490 AMINO ACIDS 5 % WITH LYTES AND CALCIUM IN D20W $ $ INTRAVENOUS SOLUTION 3,212.92 3,212.92 00338113403 J3490 AMINO ACID 4.25 % IN 10 % DEXTROSE INTRAVENOUS SOLUTION $ $ 1,456.44 1,456.44 00338113803 J3490 AMINO ACID 5 % IN 20 % DEXTROSE INTRAVENOUS SOLUTION $ $ 1,855.64 1,855.64 00338114403 J3490 AMINO ACIDS 4.25 % WITH LYTES AND CALCIUM IN D5W $ $ INTRAVENOUS SOLUTION 1,695.96 1,695.96

4/28/20 24

00338114503 J3490 AMINO ACIDS 4.25 % WITH LYTES AND CALCIUM IN D10W $ $ INTRAVENOUS SOLUTION 1,935.48 1,935.48 00338604648 J1450 FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) $ $ INTRAVENOUS PIGGYBACK 925.51 925.51 00378003210 J8499 METOPROLOL TARTRATE 50 MG TABLET $ $ 59.00 59.00 00378008001 J8499 INDAPAMIDE 2.5 MG TABLET $ $ 1.00 1.00 00378014491 J8499 TAMOXIFEN 10 MG TABLET $ $ 1.00 1.00 00378041501 J8499 DIPHENOXYLATE‐ATROPINE 2.5 MG‐0.025 MG TABLET $ $ 59.00 59.00 00378047201 J8499 DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR $ $ 1.90 1.90 00378087116 J3490 CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH $ $ 450.71 450.71 00378087316 J3490 CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH $ $ 790.10 790.10 00378087399 J3490 CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH $ $ 790.10 790.10 00378092393 J0571 BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET $ $ 59.00 59.00 00378092493 J8499 BUPRENORPHINE HCL 8 MG SUBLINGUAL TABLET $ $ 152.44 152.44 00378116001 J8499 GUANFACINE 1 MG TABLET $ $ 59.00 59.00 00378427593 J8499 VALACYCLOVIR 500 MG TABLET $ $ 85.18 85.18 00378427693 J8499 VALACYCLOVIR 1 GRAM TABLET $ $ 135.58 135.58 00378551093 J8499 OLANZAPINE 5 MG DISINTEGRATING TABLET $ $ 73.04 73.04 00378563159 J8499 SUMATRIPTAN 50 MG TABLET $ $ 79.42 79.42

4/28/20 25

00378580793 J8499 VALSARTAN 40 MG TABLET $ $ 1.00 1.00 00378607401 J8499 FLUPHENAZINE 5 MG TABLET $ $ 59.00 59.00 00378830501 J3490 CARBIDOPA 50 MG‐LEVODOPA 200 MG‐ENTACAPONE 200 MG $ $ TABLET 86.53 86.53 00378862877 J3490 FENOFIBRATE MICRONIZED 67 MG CAPSULE $ $ 59.00 59.00 00378910216 J3490 NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH $ $ 59.00 59.00 00378910293 J3490 NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH $ $ 59.00 59.00 00378911916 J3490 FENTANYL 12 MCG/HR TRANSDERMAL PATCH $ $ 362.76 362.76 00378912116 J3490 FENTANYL 25 MCG/HR TRANSDERMAL PATCH $ $ 313.70 313.70 00378912298 J3490 FENTANYL 50 MCG/HR TRANSDERMAL PATCH $ $ 492.39 492.39 00378912416 J3490 FENTANYL 100 MCG/HR TRANSDERMAL PATCH $ $ 1,071.26 1,071.26 00395024392 BENZOIN‐ALOE VERA‐STORAX‐TOLU BALSAM 10 %‐2 %‐8 %‐4 % $ $ TOPICAL TINCTURE 294.61 294.61 00395041396 J3490 CALAMINE 8 %‐ZINC OXIDE 8 % LOTION $ $ 155.45 155.45 00395051592 J3490 CASTOR OIL ORAL $ $ 136.61 136.61 00395266116 J3490 SIMPLE SYRUP $ $ 583.77 583.77 00395266216 J8499 CHERRY FLAVOR (BULK) ORAL SYRUP $ $ 490.94 490.94 00406012323 J8499 HYDROCODONE 5 MG‐ACETAMINOPHEN 325 MG TABLET $ $ 59.00 59.00 00406012423 J8499 HYDROCODONE 7.5 MG‐ACETAMINOPHEN 325 MG TABLET $ $ 1.00 1.00

4/28/20 26

00406012523 J8499 HYDROCODONE 10 MG‐ACETAMINOPHEN 325 MG TABLET $ $ 59.00 59.00 00406052323 J8499 OXYCODONE‐ACETAMINOPHEN 10 MG‐325 MG TABLET $ $ 76.95 76.95 00406055223 J8499 OXYCODONE 5 MG TABLET $ $ 59.00 59.00 00406114201 J8499 METHYLPHENIDATE 5 MG TABLET $ $ 59.00 59.00 00406800330 J8499 MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL $ $ SOLUTION 252.70 252.70 00406831523 J8499 MORPHINE ER 15 MG TABLET,EXTENDED RELEASE $ $ 59.00 59.00 00406833023 J8499 MORPHINE ER 30 MG TABLET,EXTENDED RELEASE $ $ 83.47 83.47 00406838023 J8499 MORPHINE ER 60 MG TABLET,EXTENDED RELEASE $ $ 131.72 131.72 00406839062 J8499 MORPHINE ER 100 MG TABLET,EXTENDED RELEASE $ $ 212.06 212.06 00407141310 Q9967 IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION $ $ 1,604.79 1,604.79 00409018101 J9201 GEMCITABINE 1 GRAM/26.3 ML (38 MG/ML) INTRAVENOUS $ $ SOLUTION 138.00 138.00 00409018301 J9201 GEMCITABINE 200 MG/5.26 ML (38 MG/ML) INTRAVENOUS $ $ SOLUTION 138.00 138.00 00409052813 J1956 LEVOFLOXACIN 250 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS $ $ PIGGYBACK 302.00 302.00 00409104130 J0670 MEPIVACAINE (PF) 15 MG/ML (1.5 %) INJECTION SOLUTION $ $ 200.00 200.00 00409114102 J7131 SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION $ $ 138.00 138.00 00409114405 J3490 VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION $ $ 924.47 924.47 00409115901 J3490 BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION $ $ 138.00 138.00

4/28/20 27

00409115902 J3490 BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION $ $ 138.00 138.00 00409115918 J3490 BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION $ $ 138.00 138.00 00409115919 J3490 BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION $ $ 138.00 138.00 00409116201 J3490 BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION $ $ 138.00 138.00 00409117630 J2175 MEPERIDINE (PF) 25 MG/ML INJECTION SYRINGE $ $ 213.90 213.90 00409117830 J2175 MEPERIDINE (PF) 50 MG/ML INJECTION SYRINGE $ $ 221.04 221.04 00409121501 J2310 NALOXONE 0.4 MG/ML INJECTION SOLUTION $ $ 303.76 303.76 00409121901 J2310 NALOXONE 0.4 MG/ML INJECTION SOLUTION $ $ 2,974.04 2,974.04 00409127332 J3360 DIAZEPAM 5 MG/ML INJECTION SYRINGE $ $ 737.01 737.01 00409128331 J1170 HYDROMORPHONE 1 MG/ML INJECTION SYRINGE $ $ 138.00 138.00 00409131230 J1170 HYDROMORPHONE 2 MG/ML INJECTION SYRINGE $ $ 138.00 138.00 00409131632 J1644 HEPARIN, PORCINE (PF) 5,000 UNIT/0.5 ML INJECTION SYRINGE $ $ 138.00 138.00 00409132305 J3490 LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE $ $ 138.00 138.00 00409141204 J3490 BUMETANIDE 0.25 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 00409146501 J2300 NALBUPHINE 20 MG/ML INJECTION SOLUTION $ $ 223.68 223.68 00409155918 J3490 BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION $ $ 138.00 138.00 00409156019 J3490 BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION $ $ 143.72 143.72

4/28/20 28

00409162601 J0595 BUTORPHANOL TARTRATE 2 MG/ML INJECTION SOLUTION $ $ 175.41 175.41 00409163010 J0461 ATROPINE 0.1 MG/ML INJECTION SYRINGE $ $ 180.84 180.84 00409163110 J3490 CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE $ $ 243.52 243.52 00409163802 J3490 DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION $ $ 922.08 922.08 00409166010 J3490 DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % $ $ SODIUM CHLORIDE IV 3,017.96 3,017.96 00409174910 J3490 BUPIVACAINE‐EPINEPHRINE (PF) 0.5 %‐1:200,000 INJECTION $ $ SOLUTION 140.12 140.12 00409177510 J3490 DEXTROSE 25 % IN WATER (D25W) INTRAVENOUS SYRINGE $ $ 300.60 300.60 00409177805 J3490 METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION $ $ 138.00 138.00 00409177815 J3490 METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION $ $ 138.00 138.00 00409178269 J2310 NALOXONE 0.4 MG/ML INJECTION SYRINGE $ $ 554.49 554.49 00409188602 J1953 LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION $ $ 302.00 302.00 00409188622 J1953 LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION $ $ 302.00 302.00 00409189001 J2270 MORPHINE 2 MG/ML INTRAVENOUS SYRINGE $ $ 138.00 138.00 00409189003 J2270 MORPHINE 2 MG/ML INTRAVENOUS SYRINGE $ $ 138.00 138.00 00409189011 J2270 MORPHINE 2 MG/ML INTRAVENOUS SYRINGE $ $ 138.00 138.00 00409189101 J2270 MORPHINE 4 MG/ML INTRAVENOUS SYRINGE $ $ 138.00 138.00 00409189111 J2270 MORPHINE 4 MG/ML INTRAVENOUS SYRINGE $ $ 138.00 138.00

4/28/20 29

00409189301 J2270 MORPHINE 10 MG/ML INTRAVENOUS SYRINGE $ $ 138.00 138.00 00409189311 J2270 MORPHINE 10 MG/ML INTRAVENOUS SYRINGE $ $ 138.00 138.00 00409190301 J2690 PROCAINAMIDE 500 MG/ML INJECTION SOLUTION $ $ 2,754.16 2,754.16 00409198530 J2060 LORAZEPAM 2 MG/ML INJECTION SYRINGE $ $ 138.00 138.00 00409205105 J3490 KETAMINE 100 MG/ML INJECTION SOLUTION $ $ 267.87 267.87 00409226720 J3490 LABETALOL 5 MG/ML INTRAVENOUS SOLUTION $ $ 138.00 138.00 00409230505 J2250 MIDAZOLAM (PF) 1 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 00409230517 J2250 MIDAZOLAM (PF) 1 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 00409230801 J2250 MIDAZOLAM (PF) 5 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 00409230802 J2250 MIDAZOLAM (PF) 5 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 00409233610 J0895 DEFEROXAMINE 500 MG SOLUTION FOR INJECTION $ $ 511.14 511.14 00409233934 J3490 LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE $ $ 242.88 242.88 00409272130 J1644 HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION $ $ 138.00 138.00 00409277623 J2260 MILRINONE 20 MG/100 ML(200 MCG/ML) IN 5 % DEXTROSE $ $ INTRAVENOUS PIGGYBK 327.35 327.35 00409317801 J3490 LIDOCAINE 1 %‐EPINEPHRINE 1:100,000 INJECTION SOLUTION $ $ 138.00 138.00 00409318201 J3490 LIDOCAINE 20 MG/ML (2 %)‐EPINEPHRINE 1:100,000 INJECTION $ $ SOLUTION 138.00 138.00 00409335601 J1170 HYDROMORPHONE 2 MG/ML INJECTION SOLUTION $ $ 138.00 138.00

4/28/20 30

00409337504 J3490 NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS $ $ SOLUTION 883.67 883.67 00409341401 J2765 METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 00409341418 J2765 METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 00409350511 J2185 MEROPENEM 500 MG INTRAVENOUS SOLUTION $ $ 368.51 368.51 00409350601 J2185 MEROPENEM 1 GRAM INTRAVENOUS SOLUTION $ $ 558.01 558.01 00409361301 J3490 BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE $ $ INJECTION 138.00 138.00 00409379519 J1885 KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION $ $ 138.00 138.00 00409379619 J1885 KETOROLAC 60 MG/2 ML INTRAMUSCULAR SOLUTION $ $ 138.00 138.00 00409397701 J3490 WATER FOR INJECTION, BACTERIOSTATIC INJECTION SOLUTION $ $ 138.00 138.00 00409403101 J2150 MANNITOL 25 % INTRAVENOUS SOLUTION $ $ 138.00 138.00 00409409201 J3490 CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION $ $ 959.04 959.04 00409422801 J3489 ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %‐WATER $ $ INTRAVENOUS PIGGYBCK 752.84 752.84 00409427501 J3490 LIDOCAINE HCL 5 MG/ML (0.5 %) INJECTION SOLUTION $ $ 149.70 149.70 00409427601 J3490 LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION $ $ 138.00 138.00 00409427616 J3490 LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION $ $ 138.00 138.00 00409427701 J3490 LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION $ $ 138.00 138.00 00409427716 J3490 LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION $ $ 138.00 138.00

4/28/20 31

00409427902 J3490 LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION $ $ 138.00 138.00 00409427916 J3490 LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION $ $ 138.00 138.00 00409428202 J3490 LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION $ $ 138.00 138.00 00409428212 J3490 LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION $ $ 138.00 138.00 00409433201 J3370 VANCOMYCIN 500 MG INTRAVENOUS SOLUTION $ $ 302.00 302.00 00409434673 J3490 AMINOCAPROIC ACID 250 MG/ML INTRAVENOUS SOLUTION $ $ 410.54 410.54 00409464601 J3490 PANCURONIUM 1 MG/ML INTRAVENOUS SOLUTION $ $ 169.66 169.66 00409468822 J1450 FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) $ $ INTRAVENOUS PIGGYBACK 346.67 346.67 00409469924 J2704 PROPOFOL 10 MG/ML INTRAVENOUS EMULSION $ $ 339.32 339.32 00409469933 J2704 PROPOFOL 10 MG/ML INTRAVENOUS EMULSION $ $ 169.66 169.66 00409469954 J2704 PROPOFOL 10 MG/ML INTRAVENOUS EMULSION $ $ 339.32 339.32 00409471375 J3490 LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION $ $ 138.00 138.00 00409475518 J2405 ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION $ $ 138.00 138.00 00409477702 J0744 CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS $ $ PIGGYBACK 302.00 302.00 00409488717 WATER FOR INJECTION, STERILE INJECTION SOLUTION $ $ 138.00 138.00 00409488723 WATER FOR INJECTION, STERILE INJECTION SOLUTION $ $ 138.00 138.00 00409488724 WATER FOR INJECTION, STERILE INJECTION SOLUTION $ $ 138.00 138.00

4/28/20 32

00409488803 A4216 SODIUM CHLORIDE 0.9 % INJECTION SOLUTION $ $ 138.00 138.00 00409488806 A4216 SODIUM CHLORIDE 0.9 % INJECTION SOLUTION $ $ 138.00 138.00 00409488810 A4216 SODIUM CHLORIDE 0.9 % INJECTION SOLUTION $ $ 138.00 138.00 00409490034 J3490 SODIUM BICARBONATE 10 MEQ/10 ML (8.4 %) INTRAVENOUS $ $ SYRINGE 417.17 417.17 00409490118 J0171 EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE $ $ 297.41 297.41 00409490234 J3490 DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE $ $ 321.36 321.36 00409491134 J0461 ATROPINE 0.1 MG/ML INJECTION SYRINGE $ $ 331.74 331.74 00409492120 J0171 EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE $ $ 178.45 178.45 00409492134 J0171 EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE $ $ 163.28 163.28 00409508211 J0713 CEFTAZIDIME 1 GRAM SOLUTION FOR INJECTION $ $ 302.00 302.00 00409508216 J0713 CEFTAZIDIME 1 GRAM SOLUTION FOR INJECTION $ $ 302.00 302.00 00409582001 J1265 DOPAMINE 200 MG/5 ML (40 MG/ML) INTRAVENOUS SOLUTION $ $ 302.00 302.00 00409592101 J0280 AMINOPHYLLINE 250 MG/10 ML INTRAVENOUS SOLUTION $ $ 587.39 587.39 00409592116 J0280 AMINOPHYLLINE 250 MG/10 ML INTRAVENOUS SOLUTION $ $ 625.71 625.71 00409610219 J1940 FUROSEMIDE 10 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 00409648201 J1364 ERYTHROMYCIN LACTOBIONATE 500 MG INTRAVENOUS $ $ SOLUTION 2,851.89 2,851.89 00409650901 J3370 VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION $ $ 839.28 839.28

4/28/20 33

00409653102 J3370 VANCOMYCIN 750 MG INTRAVENOUS SOLUTION $ $ 460.44 460.44 00409653301 J3370 VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION $ $ 302.00 302.00 00409660902 J3490 SODIUM BICARBONATE 4 % INTRAVENOUS SOLUTION $ $ 150.30 150.30 00409662502 J3490 SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS $ $ SOLUTION 329.34 329.34 00409662902 J0330 SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION $ $ 577.25 577.25 00409665119 J3480 POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION $ $ 138.00 138.00 00409669501 J3490 ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION $ $ 198.81 198.81 00409672723 J3475 MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % $ $ INTRAVENOUS PIGGYBACK 354.65 354.65 00409672909 J3475 MAGNESIUM SULFATE 40 GRAM/1,000 ML (4 %) IN WATER $ $ INTRAVENOUS SOLUTION 239.52 239.52 00409677802 J2060 LORAZEPAM 2 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 00409707514 J3480 POTASSIUM CHLORIDE 10 MEQ/50 ML IN STERILE WATER $ $ INTRAVENOUS PIGGYBACK 378.60 378.60 00409707526 J3480 POTASSIUM CHLORIDE 20 MEQ/100ML IN STERILE WATER $ $ INTRAVENOUS PIGGYBACK 378.60 378.60 00409710709 J3490 POTASSIUM CHLORIDE 20 MEQ/L IN D5‐0.9 % SODIUM CHLORIDE $ $ INTRAVENOUS 318.00 318.00 00409710909 J3490 POTASSIUM CHLORIDE 40 MEQ/L IN D5‐0.9 % SODIUM CHLORIDE $ $ INTRAVENOUS 319.00 319.00 00409711509 J3480 POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE $ $ INTRAVENOUS 318.00 318.00 00409711609 J3490 POTASSIUM CHLORIDE 40 MEQ/L IN 0.9 % SODIUM CHLORIDE $ $ INTRAVENOUS 320.00 320.00 00409712007 J3490 DEXTROSE 70 % IN WATER (D70W) INTRAVENOUS SOLUTION $ $ 658.04 658.04

4/28/20 34

00409724101 J0171 EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION $ $ 302.00 302.00 00409724813 J3490 HETASTARCH 6 % IN 0.9 % SODIUM CHLORIDE INTRAVENOUS $ $ SOLUTION 777.80 777.80 00409729501 J3490 POTASSIUM PHOSPHATES‐MBASIC AND DIBASIC 3 MMOL/ML $ $ INTRAVENOUS SOLUTION 760.44 760.44 00409729973 J3490 SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION $ $ 138.00 138.00 00409733201 J0696 CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION $ $ 302.00 302.00 00409733211 J0696 CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION $ $ 302.00 302.00 00409733410 J0696 CEFTRIAXONE 10 GRAM SOLUTION FOR INJECTION $ $ 761.44 761.44 00409733503 J0696 CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION $ $ 302.00 302.00 00409733513 J0696 CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION $ $ 302.00 302.00 00409733701 J0696 CEFTRIAXONE 250 MG SOLUTION FOR INJECTION $ $ 302.00 302.00 00409733711 J0696 CEFTRIAXONE 250 MG SOLUTION FOR INJECTION $ $ 302.00 302.00 00409733801 J0696 CEFTRIAXONE 500 MG SOLUTION FOR INJECTION $ $ 302.00 302.00 00409739172 J3490 SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION $ $ 581.44 581.44 00409741903 J7100 DEXTRAN 40 10 % IN 0.9 % SODIUM CHLORIDE INTRAVENOUS $ $ SOLUTION 1,037.92 1,037.92 00409751716 J3490 DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE $ $ 287.43 287.43 00409762013 J1644 HEPARIN (PORCINE) (PF) 1,000 UNIT/500 ML IN 0.9 % SODIUM $ $ CHLORIDE IV 318.72 318.72 00409781137 J3490 METRONIDAZOLE 500 MG/100 ML‐SODIUM CHLORIDE(ISO) $ $ INTRAVENOUS PIGGYBACK 302.00 302.00

4/28/20 35

00409790103 POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %‐0.2 % $ $ SODIUM CHLORIDE IV 313.50 313.50 00409790109 J3490 POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %‐0.2 % $ $ SODIUM CHLORIDE IV 318.00 318.00 00409790203 J3490 D5 / 0.45% NACL W KCL 20 MEQ/L IV SOLUTION $ $ 319.00 319.00 00409790209 J3490 D5 / 0.45% NACL W KCL 20 MEQ/L IV SOLUTION $ $ 318.00 318.00 00409790309 J3490 POTASSIUM CHLORIDE 30 MEQ/L IN DEXTROSE 5 %‐0.45 % $ $ SODIUM CHLORIDE IV 318.00 318.00 00409790409 J3490 POTASSIUM CHLORIDE 40 MEQ/L IN DEXTROSE 5 %‐0.45 % $ $ SODIUM CHLORIDE IV 318.00 318.00 00409790509 J3490 POTASSIUM CHLORIDE 20 MEQ/L IN 5 % DEXTROSE $ $ INTRAVENOUS SOLUTION 318.00 318.00 00409796509 J3490 ELECTROLYTE‐M IN 5 % DEXTROSE INTRAVENOUS SOLUTION $ $ 315.00 315.00 00409796809 J3490 ELECTROLYTE‐R IN DEXTROSE 5 % INTRAVENOUS SOLUTION $ $ 316.00 316.00 00409798303 J7040 SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION $ $ 316.50 316.50 00409799309 J3490 POTASSIUM CHLORIDE 10 MEQ/L IN DEXTROSE 5 %‐0.45 % $ $ SODIUM CHLORIDE IV 318.00 318.00 00409818301 J3490 POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION $ $ 138.00 138.00 00409904201 J3490 BUPIVACAINE‐EPINEPHRINE (PF) 0.25 %‐1:200,000 INJECTION $ $ SOLUTION 138.00 138.00 00409904517 J3490 BUPIVACAINE‐EPINEPHRINE (PF) 0.5 %‐1:200,000 INJECTION $ $ SOLUTION 138.00 138.00 00409909332 J3010 FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION $ $ 138.00 138.00 00409909335 J3010 FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION $ $ 138.00 138.00 00409909337 J3010 FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION $ $ 138.00 138.00

4/28/20 36

00409909345 J3010 FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION $ $ 138.00 138.00 00409909431 J3010 FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION $ $ 138.00 138.00 00409909441 J3010 FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION $ $ 339.32 339.32 00409909461 J3010 FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION $ $ 339.32 339.32 00409910420 J1265 DOPAMINE 400 MG/10 ML (40 MG/ML) INTRAVENOUS SOLUTION $ $ 302.00 302.00 00409915801 J3430 PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION $ $ 1,732.89 1,732.89 00409915831 J3430 PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION $ $ 1,732.53 1,732.53 00409925739 J3480 POTASSIUM CHLORIDE 20 MEQ/L IN 0.45 % SODIUM CHLORIDE $ $ INTRAVENOUS SOLN 318.00 318.00 00409930131 J2795 ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION $ $ 210.78 210.78 00436093616 J3490 SODIUM HYPOCHLORITE 0.25 % SOLUTION $ $ 566.47 566.47 00436094616 J3490 SODIUM HYPOCHLORITE 0.5 % SOLUTION $ $ 566.47 566.47 00456045901 J8499 THYROID (PORK) 60 MG TABLET $ $ 71.16 71.16 00456060001 J0712 CEFTAROLINE FOSAMIL 600 MG INTRAVENOUS SOLUTION $ $ 7,317.18 7,317.18 00456060010 J0712 CEFTAROLINE FOSAMIL 600 MG INTRAVENOUS SOLUTION $ $ 7,317.18 7,317.18 00456140230 J3490 NEBIVOLOL 2.5 MG TABLET $ $ 6.28 6.28 00456141030 J8499 NEBIVOLOL 10 MG TABLET $ $ 6.28 6.28 00456270001 J0714 CEFTAZIDIME‐AVIBACTAM 2.5 GRAM INTRAVENOUS SOLUTION $ $ 13,706.66 13,706.66

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00469260130 J8499 MIRABEGRON ER 25 MG TABLET,EXTENDED RELEASE 24 HR $ $ 553.28 553.28 00469260230 J3490 MIRABEGRON ER 50 MG TABLET,EXTENDED RELEASE 24 HR $ $ 553.28 553.28 00469325010 J2248 MICAFUNGIN 50 MG INTRAVENOUS SOLUTION $ $ 3,508.17 3,508.17 00469650189 J2785 REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE $ $ 8,522.92 8,522.92 00472024260 J3490 PERMETHRIN 5 % TOPICAL CREAM $ $ 1,053.89 1,053.89 00472173803 J3490 MICONAZOLE NITRATE 200 MG VAGINAL SUPPOSITORY $ $ 435.65 435.65 00486112501 J8499 SODIUM DI‐ AND MONOPHOSPHATE‐POTASSIUM PHOS $ $ MONOBASIC 250 MG TABLET 59.00 59.00 00487590199 J3490 RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION $ $ 115.77 115.77 00487900360 J3490 SODIUM CHLORIDE 3 % FOR NEBULIZATION $ $ 59.00 59.00 00487970101 J3490 BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION $ $ 212.80 212.80 00487990130 J7611 ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION $ $ FOR NEBULIZATION 59.00 59.00 00501379801 J3490 BACITRACIN‐POLYMYXIN B 500 UNIT‐10,000 UNIT/GRAM TOPICAL $ $ OINTMENT 316.33 316.33 00517003101 J3420 CYANOCOBALAMIN (VIT B‐12) 1,000 MCG/ML INJECTION $ $ SOLUTION 258.33 258.33 00517003125 J3420 CYANOCOBALAMIN (VIT B‐12) 1,000 MCG/ML INJECTION $ $ SOLUTION 258.33 258.33 00517037401 C9399 METHYLENE BLUE (ANTIDOTE) 5 MG/ML (0.5 %) INTRAVENOUS $ $ SOLUTION 7,542.89 7,542.89 00517037501 J3490 INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION $ $ SOLUTION 5,394.00 5,394.00 00517037510 J3490 INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION $ $ SOLUTION 293.42 293.42

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00517040125 J0461 ATROPINE 0.4 MG/ML INJECTION SOLUTION $ $ 181.28 181.28 00517065001 J1439 FERRIC CARBOXYMALTOSE 50 MG IRON/ML INTRAVENOUS $ $ SOLUTION 4,574.84 4,574.84 00517072001 J0702 BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML $ $ SUSPENSION FOR INJECTION 1,511.63 1,511.63 00517095501 J3490 OLANZAPINE 10 MG INTRAMUSCULAR SOLUTION $ $ 1,061.08 1,061.08 00517234010 J1756 IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION $ $ 204.85 204.85 00517390025 J0610 CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS $ $ SOLUTION 646.71 646.71 00517481025 J3490 NITROGLYCERIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS $ $ SOLUTION 409.98 409.98 00517560125 J3410 HYDROXYZINE HCL 50 MG/ML INTRAMUSCULAR SOLUTION $ $ 545.79 545.79 00517611025 J3490 ZINC SULFATE 1 MG/ML INTRAVENOUS SOLUTION $ $ 684.23 684.23 00517651025 J3490 SELENIUM 40 MCG/ML INTRAVENOUS SOLUTION $ $ 672.26 672.26 00517821025 J3490 TRACE ELEMENTS CR‐CU‐MN‐SE‐ZN 10 MCG‐1 MG‐0.5 MG‐60 $ $ MCG‐5MG/ML IV SOLN 888.22 888.22 00517890510 J0210 METHYLDOPATE 250 MG/5 ML INTRAVENOUS SOLUTION $ $ 1,629.94 1,629.94 00527130101 J8499 PRIMIDONE 50 MG TABLET $ $ 1.00 1.00 00527131301 J8499 PILOCARPINE 5 MG TABLET $ $ 118.75 118.75 00527172874 J3490 COCAINE 4 % TOPICAL SOLUTION $ $ 7,375.40 7,375.40 00536002583 J3490 ALUMINUM‐MAG HYDROXIDE‐SIMETHICONE 200 MG‐200 MG‐20 $ $ MG/5 ML ORAL SUSP 59.00 59.00 00536009185 J8499 ALUMINUM HYDROXIDE GEL 320 MG/5 ML ORAL SUSPENSION $ $ 220.22 220.22

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00536077097 J3490 DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID $ $ 59.00 59.00 00536100294 J3490 TETRAHYDROZOLINE 0.05 % EYE DROPS $ $ 65.27 65.27 00536101701 J8499 MECLIZINE 12.5 MG TABLET $ $ 59.00 59.00 00536101801 J8499 MECLIZINE 25 MG CHEWABLE TABLET $ $ 59.00 59.00 00536102008 J3490 SIMETHICONE 125 MG CHEWABLE TABLET $ $ 59.00 59.00 00536106505 J3490 DOCUSATE CALCIUM 240 MG CAPSULE $ $ 59.00 59.00 00536108691 J3490 WHITE PETROLATUM‐MINERAL OIL 83 %‐15 % EYE OINTMENT $ $ 101.86 101.86 00536114941 J3490 ASPIRIN 81 MG TABLET,DELAYED RELEASE $ $ 1.00 1.00 00536118583 J3490 ALUMINUM‐MAG HYDROXIDE‐SIMETHICONE 200 MG‐200 MG‐20 $ $ MG/5 ML ORAL SUSP 70.86 70.86 00536123441 J3490 ASPIRIN 81 MG TABLET,DELAYED RELEASE $ $ 1.00 1.00 00536222075 J8499 SIMETHICONE 40 MG/0.6 ML ORAL DROPS,SUSPENSION $ $ 69.47 69.47 00536302934 J8499 NICOTINE (POLACRILEX) 2 MG GUM $ $ 59.00 59.00 00536355101 J8499 CYANOCOBALAMIN (VIT B‐12) 500 MCG TABLET $ $ 1.00 1.00 00536440601 J8499 PYRIDOXINE (VITAMIN B6) 25 MG TABLET $ $ 1.00 1.00 00536570028 ZINC OXIDE 20 % TOPICAL OINTMENT $ $ 83.84 83.84 00536589488 J3490 NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH $ $ 126.28 126.28 00536589588 J3490 NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH $ $ 126.28 126.28

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00536589688 J3490 NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH $ $ 126.28 126.28 00536673101 J3490 LYSINE 500 MG TABLET $ $ 1.00 1.00 00536741551 J8499 SODIUM PHOSPHATES 19 GRAM‐7 GRAM/118 ML ENEMA $ $ 71.70 71.70 00536853080 J3490 PEDI MULTIVIT NO.46 1,500 UNIT‐400 UNIT‐IRON 10 MG/ML $ $ ORAL DROPS 176.82 176.82 00548560100 J1650 ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE $ $ 138.00 138.00 00548560200 J1650 ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE $ $ 138.00 138.00 00548560400 J1650 ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE $ $ 241.41 241.41 00548560500 J1650 ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE $ $ 480.76 480.76 00548560700 J1650 ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE $ $ 452.66 452.66 00548563100 J1650 ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE $ $ 138.00 138.00 00548563200 J1650 ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE $ $ 138.00 138.00 00548563300 J1650 ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE $ $ 172.03 172.03 00548563400 J1650 ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE $ $ 229.34 229.34 00548563500 J1650 ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE $ $ 465.67 465.67 00548563600 J1650 ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE $ $ 343.99 343.99 00548590000 J0834 COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION $ $ 799.28 799.28 00555003302 J8499 CHLORDIAZEPOXIDE 10 MG CAPSULE $ $ 59.00 59.00

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00555007101 J8499 ISONIAZID 300 MG TABLET $ $ 59.00 59.00 00555015902 J8499 CHLORDIAZEPOXIDE 25 MG CAPSULE $ $ 59.00 59.00 00555077902 J8499 MEDROXYPROGESTERONE 10 MG TABLET $ $ 1.00 1.00 00555087202 J8499 MEDROXYPROGESTERONE 2.5 MG TABLET $ $ 1.00 1.00 00555088602 J8499 ESTRADIOL 1 MG TABLET $ $ 1.00 1.00 00555089902 J8499 ESTRADIOL 0.5 MG TABLET $ $ 1.00 1.00 00555100916 J3490 CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH $ $ 258.14 258.14 00555101016 J3490 CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH $ $ 2,041.55 2,041.55 00573287110 J3490 PHENYLEPHRINE 0.25 %‐MINERAL OIL 14 %‐PETROLATM 74.9 % $ $ RECTAL OINTMENT 281.68 281.68 00573287193 J3490 PHENYLEPHRINE 0.25 %‐MINERAL OIL 14 %‐PETROLATM 74.9 % $ $ RECTAL OINTMENT 281.68 281.68 00574006915 J3490 DEXTROSE 40 % ORAL GEL $ $ 59.00 59.00 00574006930 J3490 DEXTROSE 40 % ORAL GEL $ $ 130.24 130.24 00574010603 J8499 BROMOCRIPTINE 2.5 MG TABLET $ $ 134.02 134.02 00574012074 J3490 ACTIVATED CHARCOAL‐SORBITOL 25 GRAM/120 ML ORAL $ $ SUSPENSION 536.53 536.53 00574012174 J3490 ACTIVATED CHARCOAL 25 GRAM/120 ML ORAL SUSPENSION $ $ 536.53 536.53 00574014560 J3490 TROSPIUM 20 MG TABLET $ $ 59.00 59.00 00574030216 J3490 COMPOUNDING VEHICLE SUGAR‐FREE NO.9 ORAL LIQUID $ $ 756.73 756.73

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00574030316 J3490 COMPOUNDING VEHICLE SUSPENSION SUGAR‐FREE NO.20 ORAL $ $ 1.00 1.00 00574050811 J8499 FERROUS GLUCONATE 324 MG (38 MG IRON) TABLET $ $ 1.00 1.00 00574061816 J3490 MINERAL OIL ORAL $ $ 269.16 269.16 00574080530 J0132 ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION $ $ 1,933.49 1,933.49 00574085005 J1110 DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION $ $ 3,030.65 3,030.65 00574402135 J3490 BACITRACIN‐POLYMYXIN B 500 UNIT‐10,000 UNIT/GRAM EYE $ $ OINTMENT 1,042.32 1,042.32 00574402235 J3490 BACITRACIN 500 UNIT/GRAM EYE OINTMENT $ $ 3,310.95 3,310.95 00574402411 J3490 ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT $ $ 232.98 232.98 00574402450 J3490 ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT $ $ 232.98 232.98 00574402535 J3490 WHITE PETROLATUM‐MINERAL OIL 85 %‐15 % EYE OINTMENT $ $ 295.79 295.79 00574416035 J3490 NEOMYCIN 3.5 MG/G‐POLYMYXIN B 10,000 UNIT/G‐DEXAMETH $ $ 0.1 % EYE OINT 191.98 191.98 00574703412 J8499 ASPIRIN 300 MG RECTAL SUPPOSITORY $ $ 59.00 59.00 00574704001 J3490 BELLADONNA ALKALOIDS‐OPIUM 16.2 MG‐60 MG RECTAL $ $ SUPPOSITORY 895.93 895.93 00574704012 J3490 BELLADONNA ALKALOIDS‐OPIUM 16.2 MG‐60 MG RECTAL $ $ SUPPOSITORY 895.93 895.93 00574704501 J3490 BELLADONNA ALKALOIDS‐OPIUM 16.2 MG‐30 MG RECTAL $ $ SUPPOSITORY 736.89 736.89 00574704512 J3490 BELLADONNA ALKALOIDS‐OPIUM 16.2 MG‐30 MG RECTAL $ $ SUPPOSITORY 736.89 736.89 00574705012 J8499 BISACODYL 10 MG RECTAL SUPPOSITORY $ $ 59.00 59.00

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00574985510 J8499 BUDESONIDE DR ‐ ER 3 MG CAPSULE,DELAYED,EXTENDED $ $ RELEASE 66.49 66.49 00591044401 J8499 GUANFACINE 1 MG TABLET $ $ 59.00 59.00 00591084401 J8499 GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR $ $ 1.00 1.00 00591090030 J8499 GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR $ $ 1.00 1.00 00591222315 J7502 CYCLOSPORINE MODIFIED 100 MG CAPSULE $ $ 227.41 227.41 00591247260 J8499 TAMOXIFEN 10 MG TABLET $ $ 1.00 1.00 00591301226 J3490 LIDOCAINE HCL 2 % MUCOSAL JELLY $ $ 93.42 93.42 00591329315 J8499 TELMISARTAN 40 MG TABLET $ $ 6.71 6.71 00591329415 J8499 TELMISARTAN 80 MG TABLET $ $ 6.71 6.71 00591387045 J8499 MEMANTINE 5 MG TABLET $ $ 1.00 1.00 00591551305 J8499 CARISOPRODOL 350 MG TABLET $ $ 59.00 59.00 00597000160 J8499 ASPIRIN 25 MG‐DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 $ $ HR MULTIPHASE 397.82 397.82 00597000601 J8499 CLONIDINE HCL 0.1 MG TABLET $ $ 158.83 158.83 00597003334 J3490 CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH $ $ 6,640.30 6,640.30 00597004137 J8499 TELMISARTAN 80 MG TABLET $ $ 9.44 9.44 00597005345 J1610 GLUCAGON (HUMAN RECOMBINANT) 1 MG/ML SOLUTION FOR $ $ INJECTION 3,998.35 3,998.35 00597008717 J3535 IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL $ $ INHALER 2,658.73 2,658.73

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00597010051 J3535 TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION MIST FOR $ $ INHALATION 256.89 256.89 00597013560 J8499 DABIGATRAN ETEXILATE 150 MG CAPSULE $ $ 293.47 293.47 00597014960 J8499 DABIGATRAN ETEXILATE 75 MG CAPSULE $ $ 293.47 293.47 00597019705 C9399 IDARUCIZUMAB 2.5 GRAM/50 ML INTRAVENOUS SOLUTION $ $ 74,051.60 74,051.60 00597035556 J8499 DABIGATRAN ETEXILATE 75 MG CAPSULE $ $ 274.90 274.90 00597036082 J8499 DABIGATRAN ETEXILATE 150 MG CAPSULE $ $ 274.90 274.90 00603082354 J3490 DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID $ $ 59.00 59.00 00603139364 J3490 LIDOCAINE HCL 2 % MUCOSAL SOLUTION $ $ 161.31 161.31 00603150858 J8499 PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR $ $ 2,270.19 2,270.19 00603158558 J8499 PROMETHAZINE 6.25 MG‐CODEINE 10 MG/5 ML SYRUP $ $ 269.16 269.16 00603188010 J3490 LIDOCAINE 5 % TOPICAL PATCH $ $ 360.10 360.10 00603254421 J8499 BUTALBITAL‐ACETAMINOPHEN‐CAFFEINE 50 MG‐325 MG‐40 MG $ $ TABLET 110.52 110.52 00603516821 J8499 PHENOBARBITAL 97.2 MG TABLET $ $ 1.26 1.26 00603548321 J8499 PROPRANOLOL 20 MG TABLET $ $ 1.00 1.00 00603548421 J8499 PROPRANOLOL 40 MG TABLET $ $ 1.00 1.00 00603780550 J3490 MICONAZOLE NITRATE 2 % TOPICAL CREAM $ $ 99.77 99.77 00603781874 J3490 NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM $ $ 698.21 698.21

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00603781878 J3490 NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM $ $ 1,047.90 1,047.90 00641012121 J1170 HYDROMORPHONE 2 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 00641036721 J1100 DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION $ $ SOLUTION 138.00 138.00 00641037621 J1200 DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 00641047721 J2560 PHENOBARBITAL SODIUM 130 MG/ML INJECTION SOLUTION $ $ 2,279.44 2,279.44 00641049321 J1165 PHENYTOIN SODIUM 50 MG/ML INTRAVENOUS SOLUTION $ $ 302.00 302.00 00641092821 J2550 PROMETHAZINE 25 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 00641092921 J2550 PROMETHAZINE 50 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 00641092925 J2550 PROMETHAZINE 50 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 00641139831 J3230 CHLORPROMAZINE 25 MG/ML INJECTION SOLUTION $ $ 1,212.38 1,212.38 00641141031 J1160 DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION $ $ 138.00 138.00 00641141035 J1160 DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION $ $ 138.00 138.00 00641149631 J2550 PROMETHAZINE 50 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 00641234139 J1170 HYDROMORPHONE 2 MG/ML INJECTION SOLUTION $ $ 649.10 649.10 00641234141 J1170 HYDROMORPHONE 2 MG/ML INJECTION SOLUTION $ $ 649.10 649.10 00641255541 J1165 PHENYTOIN SODIUM 50 MG/ML INTRAVENOUS SOLUTION $ $ 302.00 302.00 00641600601 J0461 ATROPINE 0.4 MG/ML INJECTION SOLUTION $ $ 1,124.95 1,124.95

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00641600801 J3490 BUMETANIDE 0.25 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 00641600810 J3490 BUMETANIDE 0.25 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 00641601301 J3490 DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION $ $ 302.00 302.00 00641601501 J3490 DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION $ $ 475.41 475.41 00641601901 J2274 MORPHINE (PF) 1 MG/ML INJECTION SOLUTION $ $ 678.64 678.64 00641602201 J3490 FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION $ $ 138.00 138.00 00641602225 J3490 FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION $ $ 138.00 138.00 00641602901 J3010 FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION $ $ 289.82 289.82 00641604201 J1885 KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION $ $ 138.00 138.00 00641604425 J2060 LORAZEPAM 2 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 00641605325 J2175 MEPERIDINE (PF) 50 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 00641605901 J2250 MIDAZOLAM 1 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 00641605910 J2250 MIDAZOLAM 1 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 00641607201 J2270 MORPHINE 15 MG/ML INJECTION SOLUTION $ $ 295.41 295.41 00641607801 J2405 ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION $ $ 138.00 138.00 00641610325 J2800 METHOCARBAMOL 100 MG/ML INJECTION SOLUTION $ $ 422.36 422.36 00641611601 J0295 AMPICILLIN‐SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION $ $ 346.63 346.63

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00641612525 J2270 MORPHINE 4 MG/ML INTRAVENOUS SOLUTION $ $ 138.00 138.00 00641612701 J2270 MORPHINE 10 MG/ML INTRAVENOUS SOLUTION $ $ 138.00 138.00 00641613201 J2310 NALOXONE 0.4 MG/ML INJECTION SOLUTION $ $ 208.23 208.23 00641613225 J2310 NALOXONE 0.4 MG/ML INJECTION SOLUTION $ $ 208.23 208.23 00641614201 J2370 PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION $ $ 302.00 302.00 00641614501 J1100 DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION $ $ SOLUTION 138.00 138.00 00641617701 J2354 OCTREOTIDE ACETATE 200 MCG/ML INJECTION SOLUTION $ $ 3,490.37 3,490.37 00703012501 J0878 DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION $ $ 4,370.60 4,370.60 00703205601 J3490 CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION $ $ 701.16 701.16 00703301812 J9190 FLUOROURACIL 2.5 GRAM/50 ML INTRAVENOUS SOLUTION $ $ 138.00 138.00 00703301911 J9190 FLUOROURACIL 5 GRAM/100 ML INTRAVENOUS SOLUTION $ $ 168.57 168.57 00703331101 J2354 OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION $ $ 302.00 302.00 00703333301 J2354 OCTREOTIDE ACETATE 200 MCG/ML INJECTION SOLUTION $ $ 1,127.50 1,127.50 00703367101 J9260 METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 00703398501 J9263 OXALIPLATIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION $ $ 170.63 170.63 00703398601 J9263 OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION $ $ 341.36 341.36 00703443211 J9206 IRINOTECAN 40 MG/2 ML INTRAVENOUS SOLUTION $ $ 138.00 138.00

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00703443411 J9206 IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION $ $ 138.00 138.00 00703450201 J2765 METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 00703476401 J9267 PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS $ $ 138.00 138.00 00703504001 J9000 DOXORUBICIN 2 MG/ML INTRAVENOUS SOLUTION $ $ 763.14 763.14 00703514001 J0640 LEUCOVORIN CALCIUM 100 MG SOLUTION FOR INJECTION $ $ 138.00 138.00 00703514501 J0640 LEUCOVORIN CALCIUM 350 MG SOLUTION FOR INJECTION $ $ 138.00 138.00 00703565301 J9181 ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION $ $ 138.00 138.00 00703565601 J9181 ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION $ $ 174.80 174.80 00703877701 J0153 ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION $ $ 5,095.79 5,095.79 00703951401 J3490 SULFAMETHOXAZOLE 400 MG‐TRIMETHOPRIM 80 MG/5 ML $ $ INTRAVENOUS SOLUTION 636.49 636.49 00703952601 J3490 SULFAMETHOXAZOLE 400 MG‐TRIMETHOPRIM 80 MG/5 ML $ $ INTRAVENOUS SOLUTION 1,523.91 1,523.91 00713010109 J8499 GLYCERIN (ADULT) RECTAL SUPPOSITORY $ $ 59.00 59.00 00713010209 J8499 GLYCERIN (CHILD) RECTAL SUPPOSITORY $ $ 59.00 59.00 00713010906 J8499 BISACODYL 10 MG RECTAL SUPPOSITORY $ $ 59.00 59.00 00713010950 J8499 BISACODYL 10 MG RECTAL SUPPOSITORY $ $ 59.00 59.00 00713011850 J8499 ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY $ $ 59.00 59.00 00713013512 J8499 PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY $ $ 225.47 225.47

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00713016450 J8499 ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY $ $ 59.00 59.00 00713016501 J8499 ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY $ $ 59.00 59.00 00713016506 J8499 ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY $ $ 59.00 59.00 00713025237 J3490 MICONAZOLE NITRATE 2 % VAGINAL CREAM $ $ 107.79 107.79 00713050306 J8499 HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY $ $ 103.32 103.32 00713050312 J8499 HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY $ $ 103.32 103.32 00713052606 J8499 PROMETHAZINE 25 MG RECTAL SUPPOSITORY $ $ 196.45 196.45 00713053606 J8499 PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY $ $ 188.07 188.07 00731040106 J8499 ZINC SULFATE 220 MG (50 MG) CAPSULE $ $ 1.00 1.00 00781103401 J8499 TRIFLUOPERAZINE 5 MG TABLET $ $ 80.64 80.64 00781105301 J8499 BUPROPION HCL 75 MG TABLET $ $ 1.01 1.01 00781118201 J8499 NADOLOL 40 MG TABLET $ $ 207.55 207.55 00781139213 J8499 HALOPERIDOL 1 MG TABLET $ $ 59.00 59.00 00781139613 J8499 HALOPERIDOL 5 MG TABLET $ $ 59.00 59.00 00781155601 J8499 ISOSORBIDE DINITRATE 10 MG TABLET $ $ 74.03 74.03 00781165501 J8499 PENICILLIN V POTASSIUM 500 MG TABLET $ $ 59.00 59.00 00781187431 J8499 AMOXICILLIN 250 MG‐POTASSIUM CLAVULANATE 125 MG TABLET $ $ 103.21 103.21

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00781196160 J8499 CLARITHROMYCIN 250 MG TABLET $ $ 59.00 59.00 00781202001 J8499 AMOXICILLIN 250 MG CAPSULE $ $ 59.00 59.00 00781205101 J8499 TERAZOSIN 1 MG CAPSULE $ $ 1.00 1.00 00781214501 J8499 AMPICILLIN 500 MG CAPSULE $ $ 59.00 59.00 00781232106 J8501 APREPITANT 40 MG CAPSULE $ $ 2,373.27 2,373.27 00781261301 J8499 AMOXICILLIN 500 MG CAPSULE $ $ 1.00 1.00 00781282210 J8499 FLUOXETINE 20 MG CAPSULE $ $ 1.00 1.00 00781300094 J2185 MEROPENEM 500 MG INTRAVENOUS SOLUTION $ $ 414.49 414.49 00781300970 J0330 SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION $ $ 1,203.99 1,203.99 00781309894 J2185 MEROPENEM 1 GRAM INTRAVENOUS SOLUTION $ $ 418.56 418.56 00781309896 J2185 MEROPENEM 1 GRAM INTRAVENOUS SOLUTION $ $ 418.33 418.33 00781313301 J1650 ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE $ $ 138.00 138.00 00781315972 J3490 OLANZAPINE 10 MG INTRAMUSCULAR SOLUTION $ $ 867.47 867.47 00781320990 J0696 CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION $ $ 302.00 302.00 00781320995 J0696 CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION $ $ 302.00 302.00 00781322075 J3490 ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION $ $ 1,000.40 1,000.40 00781323394 J9070 CYCLOPHOSPHAMIDE 500 MG INTRAVENOUS SOLUTION $ $ 1,331.54 1,331.54

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00781323946 J0744 CIPROFLOXACIN 200 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS $ $ PIGGYBACK 302.00 302.00 00781324048 J0744 CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS $ $ PIGGYBACK 426.51 426.51 00781324494 J9070 CYCLOPHOSPHAMIDE 1 GRAM INTRAVENOUS SOLUTION $ $ 2,663.12 2,663.12 00781325394 J9025 AZACITIDINE 100 MG SOLUTION FOR INJECTION $ $ 11,533.45 11,533.45 00781328991 J3490 CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS $ $ PIGGYBACK 502.36 502.36 00781329091 J3490 CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS $ $ PIGGYBACK 572.22 572.22 00781331275 J2469 PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION $ $ 4,402.38 4,402.38 00781334152 J1956 LEVOFLOXACIN 250 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS $ $ PIGGYBACK 302.00 302.00 00781334246 J1956 LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS $ $ PIGGYBACK 302.00 302.00 00781334355 J1956 LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS $ $ PIGGYBACK 316.73 316.73 00781340485 J0290 AMPICILLIN 1 GRAM SOLUTION FOR INJECTION $ $ 302.00 302.00 00781341694 J3465 VORICONAZOLE 200 MG INTRAVENOUS SOLUTION $ $ 1,459.24 1,459.24 00781342194 J0637 CASPOFUNGIN 50 MG INTRAVENOUS SOLUTION $ $ 2,735.48 2,735.48 00781342804 J1650 ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE $ $ 236.04 236.04 00781345070 J0690 CEFAZOLIN 500 MG SOLUTION FOR INJECTION $ $ 472.74 472.74 00781345170 J0690 CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION $ $ 303.04 303.04 00781361204 J1650 ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE $ $ 354.11 354.11

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00781523806 J8499 ONDANSETRON 4 MG DISINTEGRATING TABLET $ $ 59.00 59.00 00781569092 J8499 EZETIMIBE 10 MG TABLET $ $ 158.33 158.33 00781577631 J8499 AZITHROMYCIN 250 MG TABLET $ $ 59.00 59.00 00781593831 J8499 CANDESARTAN 16 MG TABLET $ $ 3.39 3.39 00781603955 J8499 AMOXICILLIN 125 MG/5 ML ORAL SUSPENSION $ $ 71.86 71.86 00781604155 J8499 AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION $ $ 95.81 95.81 00781613948 J8499 AMOXICILLIN 600 MG‐POTASSIUM CLAVULANATE 42.9 MG/5 ML $ $ ORAL SUSPENSION 2,275.44 2,275.44 00781707787 J3490 METRONIDAZOLE 0.75 % VAGINAL GEL $ $ 5,954.87 5,954.87 00810073088 J3490 NEOMYCIN‐BACITRACN ZN‐POLYMYX 3.5 MG‐400 UNIT‐5,000 $ $ UNIT/GRAM TOP OINT 164.40 164.40 00832003800 J8499 OXYBUTYNIN CHLORIDE 5 MG TABLET $ $ 1.00 1.00 00832030100 J8499 CHLORPROMAZINE 25 MG TABLET $ $ 3.55 3.55 00832046515 J3490 NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER $ $ 127.55 127.55 00832051000 J3490 BETHANECHOL CHLORIDE 5 MG TABLET $ $ 59.00 59.00 00832051289 J8499 BETHANECHOL CHLORIDE 25 MG TABLET $ $ 1.00 1.00 00832201200 J8499 AMANTADINE HCL 100 MG CAPSULE $ $ 1.00 1.00 00869069338 J8499 MAGNESIUM CITRATE ORAL SOLUTION $ $ 59.09 59.09 00904052060 J8499 PYRIDOXINE (VITAMIN B6) 50 MG TABLET $ $ 1.00 1.00

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00904052260 J8499 ASCORBIC ACID (VITAMIN C) 250 MG TABLET $ $ 1.00 1.00 00904052361 J8499 ASCORBIC ACID (VITAMIN C) 500 MG TABLET $ $ 1.00 1.00 00904110231 J3490 POVIDONE‐IODINE 10 % TOPICAL OINTMENT $ $ 63.38 63.38 00904122800 J3490 DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID $ $ 59.00 59.00 00904131309 J8499 BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION $ $ 84.80 84.80 00904188261 J8499 CALCIUM CARBONATE‐VITAMIN D3 250 MG‐125 UNIT TABLET $ $ 1.00 1.00 00904188361 J8499 CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) TABLET $ $ 1.00 1.00 00904198261 J3490 ACETAMINOPHEN 325 MG TABLET $ $ 1.00 1.00 00904201360 J8499 ASPIRIN 325 MG TABLET,DELAYED RELEASE $ $ 1.00 1.00 00904205661 J8499 DIPHENHYDRAMINE 50 MG CAPSULE $ $ 59.00 59.00 00904208560 J8499 VITAMIN A 10,000 UNIT CAPSULE $ $ 1.00 1.00 00904227260 J8499 NIACIN 500 MG TABLET $ $ 59.00 59.00 00904268760 J3490 LYSINE 500 MG TABLET $ $ 1.00 1.00 00904272561 J8499 SULFAMETHOXAZOLE 800 MG‐TRIMETHOPRIM 160 MG TABLET $ $ 59.00 59.00 00904292061 J8499 VERAPAMIL 80 MG TABLET $ $ 1.00 1.00 00904319760 J8499 FOLIC ACID 400 MCG TABLET $ $ 1.00 1.00 00904322035 J3490 CARBAMIDE PEROXIDE 6.5 % EAR DROPS $ $ 138.00 138.00

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00904386575 J3490 SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL $ $ 59.00 59.00 00904505359 J8499 PSEUDOEPHEDRINE 30 MG TABLET $ $ 1.00 1.00 00904513559 J3490 ASPIRIN‐ACETAMINOPHEN‐CAFFEINE 250 MG‐250 MG‐65 MG $ $ TABLET 0.06 0.06 00904515460 J3490 GUAIFENESIN 200 MG TABLET $ $ 59.00 59.00 00904530661 J3490 DIPHENHYDRAMINE 25 MG CAPSULE $ $ 1.00 1.00 00904539261 J8499 ATENOLOL 25 MG TABLET $ $ 1.00 1.00 00904549261 J3490 MULTIVITAMIN‐IRON 9 MG‐FOLIC ACID 400 MCG‐CALCIUM AND $ $ MINERALS TABLET 1.00 1.00 00904549546 J3490 NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH $ $ 59.00 59.00 00904550261 J8499 ENALAPRIL MALEATE 5 MG TABLET $ $ 1.00 1.00 00904552361 J8499 DOXAZOSIN 2 MG TABLET $ $ 59.00 59.00 00904563261 J8499 GABAPENTIN 300 MG CAPSULE $ $ 1.00 1.00 00904564361 J3490 SENNOSIDES 8.6 MG‐DOCUSATE SODIUM 50 MG TABLET $ $ 1.00 1.00 00904565661 J8499 CLONIDINE HCL 0.1 MG TABLET $ $ 59.00 59.00 00904565761 J8499 CLONIDINE HCL 0.2 MG TABLET $ $ 59.00 59.00 00904567661 J8499 PAROXETINE 10 MG TABLET $ $ 1.00 1.00 00904571135 J3490 OXYMETAZOLINE 0.05 % NASAL SPRAY $ $ 59.00 59.00 00904578561 J8499 FLUOXETINE 20 MG CAPSULE $ $ 1.00 1.00

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00904578961 J8499 ACYCLOVIR 200 MG CAPSULE $ $ 59.00 59.00 00904579146 J8499 ACETAMINOPHEN 80 MG CHEWABLE TABLET $ $ 1.00 1.00 00904579661 J8499 FUROSEMIDE 20 MG TABLET $ $ 1.00 1.00 00904579761 J8499 FUROSEMIDE 40 MG TABLET $ $ 59.00 59.00 00904579861 J8499 FUROSEMIDE 80 MG TABLET $ $ 1.00 1.00 00904580161 J8499 SIMVASTATIN 20 MG TABLET $ $ 1.00 1.00 00904581161 J8499 LISINOPRIL 5 MG TABLET $ $ 1.00 1.00 00904585261 J8499 CETIRIZINE 10 MG TABLET $ $ 59.00 59.00 00904585461 J8499 IBUPROFEN 600 MG TABLET $ $ 59.00 59.00 00904585561 J8499 IBUPROFEN 800 MG TABLET $ $ 59.00 59.00 00904585861 J8499 ALPRAZOLAM 0.25 MG TABLET $ $ 59.00 59.00 00904585961 J8499 ALPRAZOLAM 0.5 MG TABLET $ $ 59.00 59.00 00904588061 J8499 DIAZEPAM 5 MG TABLET $ $ 1.00 1.00 00904588246 J3490 COENZYME Q10 100 MG CAPSULE $ $ 59.00 59.00 00904588761 J8499 THEOPHYLLINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR $ $ 59.00 59.00 00904589261 J8499 PRAVASTATIN 20 MG TABLET $ $ 1.00 1.00 00904592861 J8499 LABETALOL 100 MG TABLET $ $ 1.00 1.00

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00904595161 J8499 SPIRONOLACTONE 25 MG TABLET $ $ 1.00 1.00 00904600761 J8499 LORAZEPAM 0.5 MG TABLET $ $ 59.00 59.00 00904605161 J8499 LEVETIRACETAM 250 MG TABLET $ $ 59.00 59.00 00904605261 J8499 LEVETIRACETAM 500 MG TABLET $ $ 1.00 1.00 00904608261 J8499 ZOLPIDEM 5 MG TABLET $ $ 59.00 59.00 00904608461 J8499 CITALOPRAM 10 MG TABLET $ $ 1.00 1.00 00904610161 J8499 CLONAZEPAM 0.5 MG TABLET $ $ 59.00 59.00 00904610261 J8499 CLONAZEPAM 1 MG TABLET $ $ 1.00 1.00 00904623761 J8499 CARBIDOPA 25 MG‐LEVODOPA 100 MG TABLET $ $ 1.00 1.00 00904625549 J3490 BENZOCAINE 15 MG‐MENTHOL 3.6 MG LOZENGES $ $ 1.00 1.00 00904628361 J8499 OLANZAPINE 2.5 MG TABLET $ $ 59.00 59.00 00904628889 J8499 ASPIRIN 81 MG CHEWABLE TABLET $ $ 59.00 59.00 00904629061 J8499 ATORVASTATIN 10 MG TABLET $ $ 1.00 1.00 00904629261 J8499 ATORVASTATIN 40 MG TABLET $ $ 59.00 59.00 00904629461 J8499 CLOPIDOGREL 75 MG TABLET $ $ 59.00 59.00 00904630061 J8499 CARVEDILOL 3.125 MG TABLET $ $ 1.00 1.00 00904630161 J8499 CARVEDILOL 6.25 MG TABLET $ $ 1.00 1.00

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00904630361 J8499 CARVEDILOL 25 MG TABLET $ $ 1.00 1.00 00904630477 J8499 MAGNESIUM CITRATE ORAL SOLUTION $ $ 59.09 59.09 00904632261 J8499 METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE $ $ 24 HR 1.00 1.00 00904632361 J8499 METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE $ $ 24 HR 1.00 1.00 00904632661 J8499 METFORMIN 500 MG TABLET $ $ 1.00 1.00 00904632761 J8499 METFORMIN 850 MG TABLET $ $ 1.00 1.00 00904634061 J8499 METOPROLOL TARTRATE 25 MG TABLET $ $ 1.00 1.00 00904635161 J8499 LEVOFLOXACIN 250 MG TABLET $ $ 59.00 59.00 00904635261 J8499 LEVOFLOXACIN 500 MG TABLET $ $ 59.00 59.00 00904635361 J8499 LEVOFLOXACIN 750 MG TABLET $ $ 59.00 59.00 00904635861 J8499 RISPERIDONE 0.5 MG TABLET $ $ 1.00 1.00 00904635961 J8499 RISPERIDONE 1 MG TABLET $ $ 1.00 1.00 00904636361 J8499 DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR $ $ 1.15 1.15 00904636561 J8499 TRAMADOL 50 MG TABLET $ $ 59.00 59.00 00904636961 J8499 AMLODIPINE 2.5 MG TABLET $ $ 59.00 59.00 00904637061 J8499 AMLODIPINE 5 MG TABLET $ $ 1.00 1.00 00904637761 J8499 OLANZAPINE 5 MG TABLET $ $ 59.00 59.00

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00904640161 J8499 TAMSULOSIN 0.4 MG CAPSULE $ $ 59.00 59.00 00904640506 J8499 AZITHROMYCIN 250 MG TABLET $ $ 72.87 72.87 00904640761 J8499 BISACODYL 5 MG TABLET,DELAYED RELEASE $ $ 59.00 59.00 00904642161 J8499 HYDROCODONE 10 MG‐ACETAMINOPHEN 325 MG TABLET $ $ 59.00 59.00 00904642661 J8499 ESCITALOPRAM 10 MG TABLET $ $ 1.00 1.00 00904643459 J8499 SENNOSIDES 8.6 MG TABLET $ $ 59.00 59.00 00904643761 J8499 OXYCODONE‐ACETAMINOPHEN 5 MG‐325 MG TABLET $ $ 59.00 59.00 00904643961 J8499 OXYCODONE‐ACETAMINOPHEN 10 MG‐325 MG TABLET $ $ 59.00 59.00 00904644161 J8499 HYDRALAZINE 25 MG TABLET $ $ 1.00 1.00 00904644461 J8499 OXYCODONE 5 MG TABLET $ $ 59.00 59.00 00904644561 J8499 OXYCODONE 15 MG TABLET $ $ 59.00 59.00 00904644961 J8499 ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED $ $ RELEASE 24 HR 59.00 59.00 00904645361 J8499 DULOXETINE 30 MG CAPSULE,DELAYED RELEASE $ $ 1.19 1.19 00904645561 J8499 DOCUSATE SODIUM 100 MG CAPSULE $ $ 59.00 59.00 00904646161 J8597 PROMETHAZINE 25 MG TABLET $ $ 59.00 59.00 00904646707 J8499 CLOPIDOGREL 300 MG TABLET $ $ 451.85 451.85 00904647104 J8499 VORICONAZOLE 200 MG TABLET $ $ 574.95 574.95

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00904647461 J8499 PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE $ $ 1.00 1.00 00904647561 J8499 BACLOFEN 10 MG TABLET $ $ 59.00 59.00 00904647761 J8499 DONEPEZIL 5 MG TABLET $ $ 1.00 1.00 00904648561 J8499 LISINOPRIL 10 MG TABLET $ $ 1.00 1.00 00904648838 J3490 WHITE PETROLATUM‐MINERAL OIL 83 %‐15 % EYE OINTMENT $ $ 121.42 121.42 00904649235 J3490 POLYVINYL ALCOHOL 1.4 % EYE DROPS $ $ 59.00 59.00 00904651761 J8499 MECLIZINE 25 MG TABLET $ $ 1.00 1.00 00904651961 J8499 MIRTAZAPINE 15 MG TABLET $ $ 59.00 59.00 00904652261 J8499 SENNOSIDES 8.6 MG TABLET $ $ 59.00 59.00 00904652961 J8499 MONTELUKAST 10 MG TABLET $ $ 59.00 59.00 00904655061 J8499 PROPRANOLOL 10 MG TABLET $ $ 1.00 1.00 00904655304 J8499 LINEZOLID 600 MG TABLET $ $ 136.62 136.62 00904655561 J8499 TRAZODONE 100 MG TABLET $ $ 59.00 59.00 00904655661 J8499 AMIODARONE 200 MG TABLET $ $ 59.00 59.00 00904656460 J8499 BENZONATATE 100 MG CAPSULE $ $ 1.00 1.00 00904656461 J8499 BENZONATATE 100 MG CAPSULE $ $ 1.00 1.00 00904656761 J8499 HYDROCODONE 5 MG‐ACETAMINOPHEN 325 MG TABLET $ $ 59.00 59.00

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00904656861 J8499 METRONIDAZOLE 500 MG TABLET $ $ 59.00 59.00 00904657161 J8499 ALLOPURINOL 100 MG TABLET $ $ 1.00 1.00 00904658261 J8499 FOLIC ACID 1 MG TABLET $ $ 1.00 1.00 00904658561 J8499 BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED‐RELEASE $ $ 1.00 1.00 00904660361 J8499 ROSUVASTATIN 10 MG TABLET $ $ 80.05 80.05 00904662735 J3490 CARBAMIDE PEROXIDE 6.5 % EAR DROPS $ $ 138.00 138.00 00904663861 J8499 QUETIAPINE 25 MG TABLET $ $ 59.00 59.00 00904666561 J8499 GABAPENTIN 100 MG CAPSULE $ $ 1.00 1.00 00904666661 J8499 GABAPENTIN 300 MG CAPSULE $ $ 1.00 1.00 00904668961 J8499 METFORMIN 500 MG TABLET $ $ 1.00 1.00 00904670806 J8499 AZITHROMYCIN 250 MG TABLET $ $ 77.90 77.90 00904671761 J8499 CETIRIZINE 10 MG TABLET $ $ 59.00 59.00 00904678744 J8499 MAGNESIUM CITRATE ORAL SOLUTION $ $ 59.09 59.09 00904679861 J8499 LISINOPRIL 10 MG TABLET $ $ 1.00 1.00 00904679961 J8499 LISINOPRIL 20 MG TABLET $ $ 1.00 1.00 00904680861 J8499 MONTELUKAST 10 MG TABLET $ $ 59.00 59.00 00904770418 J3490 ASPIRIN 81 MG TABLET,DELAYED RELEASE $ $ 1.00 1.00

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00904780961 J8499 CYCLOBENZAPRINE 10 MG TABLET $ $ 59.00 59.00 00904791461 J8499 IBUPROFEN 200 MG TABLET $ $ 1.00 1.00 00944049301 P9047 ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION $ $ 1,738.52 1,738.52 00944265603 J1566 IMMUNE GLOB,GAMMA(IGG) 5 GRAM‐GLY‐GLUC‐IGA 0 TO 50 $ $ MCG/ML IV SOLUTION 3,397.80 3,397.80 00944265804 J1566 IMMUNE GLOB,GAMMA(IGG) 10 GRAM‐GLY‐GLUC‐IGA 0 TO 50 $ $ MCG/ML IV SOLUTION 6,795.60 6,795.60 00944270005 J1569 IMMUNE GLOB,GAMMA (IGG) 10 %‐GLY‐IGA OVER 50 MCG/ML $ $ INJECTION SOLUTION 35,767.68 35,767.68 00944270006 J1569 IMMUNE GLOB,GAMMA (IGG) 10 %‐GLY‐IGA OVER 50 MCG/ML $ $ INJECTION SOLUTION 71,356.36 71,356.36 00944270011 J1569 IMMUNE GLOB,GAMMA (IGG) 10 %‐GLY‐IGA OVER 50 MCG/ML $ $ INJECTION SOLUTION 35,767.68 35,767.68 00944270013 J1569 IMMUNE GLOB,GAMMA (IGG) 10 %‐GLY‐IGA OVER 50 MCG/ML $ $ INJECTION SOLUTION 106,945.04 106,945.04 00944284310 J7192 ANTIHEMOPHILIC FACTOR VIII (RECOMB) 1 UNIT IV KIT $ $ 45,683.01 45,683.01 00944284510 J7192 ANTIHEMOPHILIC FACTOR VIII (RECOMB) 1 UNIT IV KIT $ $ 90,621.76 90,621.76 00955173530 J8499 LEFLUNOMIDE 10 MG TABLET $ $ 245.72 245.72 00998063006 J3490 NEOMYCIN‐POLYMYXIN‐DEXAMETH 3.5 MG/ML‐10,000 UNIT/ML‐ $ $ 0.1% EYE DROPS 4,241.90 4,241.90 5020124001 J8499 POTASSIUM BICARBONATE‐CITRIC ACID 25 MEQ EFFERVESCENT $ $ TABLET 59.00 59.00 05446141601 J7999 MITOMYCIN‐C 40 MG/40 ML BLADDER IRRIGATION *CHEMO* $ $ (CC) 12,155.00 12,155.00 05446150505 J9250 METHOTREXATE SODIUM 25 MG/ML INJECTION SOLUTION $ $ 10,159.00 10,159.00 08080431302 J3490 BISMUTH TRIBROM‐PETROLATUM,WH 1" X 8" BANDAGE $ $ 59.00 59.00

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08290306500 A4216 SODIUM CHLORIDE 0.9 % (FLUSH) INJECTION SYRINGE $ $ 138.00 138.00 08290306512 J1642 HEPARIN, PORCINE (PF) 10 UNIT/ML INTRAVENOUS SYRINGE $ $ 138.00 138.00 08290306521 J1642 HEPARIN, PORCINE (PF) 10 UNIT/ML INTRAVENOUS SYRINGE $ $ 138.00 138.00 08290306546 A4216 SODIUM CHLORIDE 0.9 % (FLUSH) INJECTION SYRINGE $ $ 138.00 138.00 08290306553 A4216 SODIUM CHLORIDE 0.9 % (FLUSH) INJECTION SYRINGE $ $ 138.00 138.00 08881570300 A4216 SODIUM CHLORIDE 0.9 % (FLUSH) INJECTION SYRINGE $ $ 138.00 138.00 09046071015 J3490 GLUCOSE 4 GRAM CHEWABLE TABLET $ $ 59.00 59.00 10006070028 J8499 MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET $ $ 59.00 59.00 10019005561 J3490 ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE $ $ (ISO‐OSMOTIC) IV 13,302.70 13,302.70 10019055303 J3490 SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH $ $ 777.44 777.44 10019055388 J3490 SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH $ $ 612.52 612.52 10019055390 J3490 SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH $ $ 777.44 777.44 10019064664 J7699 DESFLURANE 100 % INHALATION LIQUID $ $ 6,373.81 6,373.81 10019065164 J3490 SEVOFLURANE INHALATION LIQUID $ $ 5,828.03 5,828.03 10019065364 J3490 SEVOFLURANE INHALATION LIQUID $ $ 3,199.70 3,199.70 10119000252 J3490 SODIUM BORATE‐BORIC ACID‐SODIUM CHLORIDE‐WATER EYE $ $ WASH SOLN 150.74 150.74 10122032510 J3490 NICARDIPINE 40 MG/200 ML IN SODIUM CHLORIDE(ISO) $ $ INTRAVENOUS PIGGYBACK 7,691.95 7,691.95

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10122051001 J3490 PORACTANT ALFA 120 MG/1.5 ML INTRATRACHEAL SUSPENSION $ $ 18,422.94 18,422.94 10122051003 J3490 PORACTANT ALFA 240 MG/3 ML INTRATRACHEAL SUSPENSION $ $ 35,853.60 35,853.60 10122061101 C9248 CLEVIDIPINE 50 MG/100 ML INTRAVENOUS EMULSION $ $ 5,328.68 5,328.68 10122061110 C9248 CLEVIDIPINE 50 MG/100 ML INTRAVENOUS EMULSION $ $ 5,328.68 5,328.68 10147088106 J8499 GALANTAMINE 4 MG TABLET $ $ 4.32 4.32 10147170007 J8499 ITRACONAZOLE 100 MG CAPSULE $ $ 320.52 320.52 10223020103 J3490 BUTAMBEN‐TETRACAINE‐BENZOCAINE 2 %‐2 %‐14 % (200 $ $ MG/SEC) TOPICAL SPRAY 2,075.84 2,075.84 10223020104 J3490 BUTAMBEN‐TETRACAINE‐BENZOCAINE 2 %‐2 %‐14 % (200 $ $ MG/SEC) TOPICAL SPRAY 1,885.43 1,885.43 10702001101 J8499 HYDROXYZINE HCL 25 MG TABLET $ $ 59.00 59.00 10939097433 J3490 GLYCERIN TOPICAL LIQUID $ $ 219.05 219.05 11523723401 J8499 POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET $ $ 93.56 93.56 11523726808 J8499 POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET $ $ 85.32 85.32 11534016501 J8499 FOLIC ACID 1 MG TABLET $ $ 1.00 1.00 11701006723 J3490 MICONAZOLE NITRATE 2 % TOPICAL OINTMENT $ $ 304.91 304.91 11704037001 J3490 HYDROXOCOBALAMIN 5 GRAM INTRAVENOUS SOLUTION $ $ 32,219.84 32,219.84 11845014770 J8499 CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) CAPSULE $ $ 1.00 1.00 11994001101 Q9957 PERFLUTREN LIPID MICROSPHERES 1.1 MG/ML INTRAVENOUS $ $ SUSPENSION 5,324.14 5,324.14

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12496120403 J3490 BUPRENORPHINE 4 MG‐NALOXONE 1 MG SUBLINGUAL FILM $ $ 369.52 369.52 12496120803 J0574 BUPRENORPHINE 8 MG‐NALOXONE 2 MG SUBLINGUAL FILM $ $ 369.52 369.52 12870000101 J3490 SILVER NITRATE APPLICATORS 75 %‐25 % TOPICAL STICK $ $ 59.00 59.00 13533061811 90375 RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML INTRAMUSCULAR $ $ SOLUTION 18,442.91 18,442.91 13533061820 90375 RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML INTRAMUSCULAR $ $ SOLUTION 3,749.02 3,749.02 13533063120 J2790 RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG) $ $ INTRAMUSCULAR SYRINGE 1,953.29 1,953.29 13533063402 J1670 TETANUS IMMUNE GLOBULIN (PF) 250 UNIT INTRAMUSCULAR $ $ SYRINGE 18,403.12 18,403.12 13533063420 J1670 TETANUS IMMUNE GLOBULIN (PF) 250 UNIT INTRAMUSCULAR $ $ SYRINGE 18,403.12 18,403.12 13533069020 P9045 ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION $ $ 1,301.40 1,301.40 13533069021 P9045 ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION $ $ 1,301.40 1,301.40 13533080024 J1561 IMMUNE GLOB G 20 GRAM/200 ML(10%)‐GLY‐IGA AVE 46 $ $ MCG/ML INJECTION SOLN 10,486.62 10,486.62 13533080071 J1561 IMMUNE GLOB G 10 GRAM/100 ML(10%)‐GLY‐IGA AVE 46 $ $ MCG/ML INJECTION SOLN 5,243.31 5,243.31 13533080072 J1561 IMMUNE GLOB G 10 GRAM/100 ML(10%)‐GLY‐IGA AVE 46 $ $ MCG/ML INJECTION SOLN 5,243.31 5,243.31 13668002101 J3490 ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR $ $ 59.00 59.00 13668009290 J8499 PRAMIPEXOLE 0.25 MG TABLET $ $ 1.00 1.00 13668013201 J8499 FELODIPINE ER 2.5 MG TABLET,EXTENDED RELEASE 24 HR $ $ 1.00 1.00 13811000710 J8499 PRENATAL VIT,CALCIUM 27‐FERROUS FUM 60 MG IRON‐FOLIC $ $ ACID 1 MG TABLET 1.00 1.00

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14428000944 J3490 BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT $ $ 62.60 62.60 14789070002 J0780 PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) $ $ INJECTION SOLUTION 682.64 682.64 14789090002 J2690 PROCAINAMIDE 500 MG/ML INJECTION SOLUTION $ $ 2,569.73 2,569.73 14789090007 J2690 PROCAINAMIDE 500 MG/ML INJECTION SOLUTION $ $ 2,569.73 2,569.73 16500002324 J3490 CALCIUM ACETATE‐ALUMINUM 952 MG‐1,347 MG TOPICAL $ $ POWDER IN PACKET 59.00 59.00 16571016010 J8499 TRIHEXYPHENIDYL 2 MG TABLET $ $ 1.00 1.00 16571041305 J8499 CIPROFLOXACIN 750 MG TABLET $ $ 59.00 59.00 16729000101 J8499 GLIMEPIRIDE 1 MG TABLET $ $ 59.00 59.00 16729002010 J8499 PIOGLITAZONE 15 MG TABLET $ $ 1.00 1.00 16729003001 J8499 METHYLDOPA 250 MG TABLET $ $ 1.00 1.00 16729003510 J8499 ANASTROZOLE 1 MG TABLET $ $ 1.00 1.00 16729004201 J7507 TACROLIMUS 1 MG CAPSULE $ $ 59.00 59.00 16729009015 J8499 FINASTERIDE 5 MG TABLET $ $ 1.00 1.00 16729009401 J7517 MYCOPHENOLATE MOFETIL 250 MG CAPSULE $ $ 59.00 59.00 16729010811 J9280 MITOMYCIN 20 MG INTRAVENOUS SOLUTION $ $ 712.30 712.30 16729011638 J9280 MITOMYCIN 40 MG INTRAVENOUS SOLUTION $ $ 10,669.18 10,669.18 16729017101 J8499 AMITRIPTYLINE 10 MG TABLET $ $ 1.00 1.00

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16729018201 J8499 HYDROCHLOROTHIAZIDE 12.5 MG TABLET $ $ 1.00 1.00 16729020016 J8499 BUSPIRONE 5 MG TABLET $ $ 1.00 1.00 16729020201 J8499 BUSPIRONE 10 MG TABLET $ $ 1.00 1.00 16729026765 J9171 DOCETAXEL 160 MG/8 ML (20 MG/ML) INTRAVENOUS SOLUTION $ $ 555.84 555.84 16729027735 J9260 METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 16729028110 J8499 ARIPIPRAZOLE 15 MG TABLET $ $ 1.00 1.00 16729029512 J9045 CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION $ $ 174.31 174.31 16864068002 J3490 BENZOCAINE 20 %‐MENTHOL 0.5 % TOPICAL AEROSOL $ $ 183.32 183.32 17238042425 J3490 INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION $ $ 3,002.39 3,002.39 17478001402 J3490 SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION $ $ 14,549.41 14,549.41 17478003002 J3010 FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION $ $ 138.00 138.00 17478004001 J2060 LORAZEPAM 2 MG/ML INJECTION SOLUTION $ $ 162.16 162.16 17478004101 J2310 NALOXONE 0.4 MG/ML INJECTION SOLUTION $ $ 522.72 522.72 17478004532 J3490 TETRACAINE HCL (PF) 1 % (10 MG/ML) INJECTION SOLUTION $ $ 3,031.85 3,031.85 17478006012 J3490 POLYVINYL ALCOHOL 1.4 % EYE DROPS $ $ 228.75 228.75 17478006235 J3490 WHITE PETROLATUM‐MINERAL OIL 83 %‐15 % EYE OINTMENT $ $ 159.70 159.70 17478007035 J3490 ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT $ $ 744.15 744.15

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17478010002 J3490 CYCLOPENTOLATE 1 % EYE DROPS $ $ 255.89 255.89 17478011430 J3260 TOBRAMYCIN 40 MG/ML INJECTION SOLUTION ‐ DIALYSIS $ $ INGREDIENT 1,010.14 1,010.14 17478012050 J3490 CLINDAMYCIN 300 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS $ $ PIGGYBACK 354.65 354.65 17478017101 J3490 LEVALBUTEROL CONCENTRATE 1.25 MG/0.5 ML SOLUTION FOR $ $ NEBULIZATION 333.92 333.92 17478019005 J3490 LIDOCAINE‐PRILOCAINE 2.5 %‐2.5 % TOPICAL CREAM $ $ 282.64 282.64 17478020102 J3490 PHENYLEPHRINE 2.5 % EYE DROPS $ $ 1,140.12 1,140.12 17478020605 J3490 PHENYLEPHRINE 10 % EYE DROPS $ $ 1,367.66 1,367.66 17478020910 J3490 KETOROLAC 0.5 % EYE DROPS $ $ 1,841.91 1,841.91 17478020919 J3490 KETOROLAC 0.5 % EYE DROPS $ $ 879.40 879.40 17478021505 J3490 ATROPINE 1 % EYE DROPS $ $ 1,935.73 1,935.73 17478023835 J3490 BACITRACIN‐POLYMYXIN B 500 UNIT‐10,000 UNIT/GRAM EYE $ $ OINTMENT 527.31 527.31 17478029010 J3490 TOBRAMYCIN 0.3 % EYE DROPS $ $ 587.63 587.63 17478040303 J3490 FLUORESCEIN 0.6 MG EYE STRIPS $ $ 59.00 59.00 17478040401 J3490 FLUORESCEIN 1 MG EYE STRIPS $ $ 59.00 59.00 17478041940 J1205 CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS SOLUTION $ $ 1,764.63 1,764.63 17478042020 J3490 LABETALOL 5 MG/ML INTRAVENOUS SOLUTION $ $ 948.50 948.50 17478050305 J3490 ETHANOL (ETHYL ALCOHOL) 98 % INJECTION SOLUTION $ $ 4,884.82 4,884.82

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17478051002 J3490 PHYSOSTIGMINE 1 MG/ML INJECTION SOLUTION $ $ 3,125.50 3,125.50 17478051500 J3490 EPHEDRINE SULFATE 50 MG/ML INJECTION SOLUTION $ $ 1,234.21 1,234.21 17478052603 J0470 DIMERCAPROL 100 MG/ML INTRAMUSCULAR SOLUTION $ $ 6,385.01 6,385.01 17478054005 J1170 HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION $ $ 241.72 241.72 17478054202 J0153 ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION $ $ 138.00 138.00 17478054602 J1626 GRANISETRON HCL 1 MG/ML (1 ML) INTRAVENOUS SOLUTION $ $ 138.00 138.00 17478062312 J3490 SODIUM CHLORIDE 5 % EYE DROPS $ $ 357.49 357.49 17478071110 J3490 LIDOCAINE HCL 2 % MUCOSAL JELLY $ $ 245.91 245.91 17478071130 J3490 LIDOCAINE HCL 2 % MUCOSAL JELLY $ $ 2,682.63 2,682.63 17478071510 J3490 BRIMONIDINE 0.2 % EYE DROPS $ $ 534.13 534.13 17478071710 J8499 KETOTIFEN 0.025 % (0.035 %) EYE DROPS $ $ 319.36 319.36 17478093401 J0360 HYDRALAZINE 20 MG/ML INJECTION SOLUTION $ $ 449.10 449.10 17478093705 J3490 DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION $ $ 302.00 302.00 17478093710 J3490 DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION $ $ 302.00 302.00 17478093725 J3490 DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION $ $ 548.26 548.26 18657010201 J3473 HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML $ $ INJECTION SOLUTION 1,209.75 1,209.75 18657011701 J3473 HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML $ $ INJECTION SOLUTION 204.07 204.07

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18657011702 J3473 HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML $ $ INJECTION SOLUTION 204.07 204.07 23155001701 J8499 TETRACYCLINE 250 MG CAPSULE $ $ 210.18 210.18 23155001801 J8499 TETRACYCLINE 500 MG CAPSULE $ $ 366.37 366.37 23155005901 J8499 VERAPAMIL 40 MG TABLET $ $ 1.00 1.00 23155007001 J8499 METHIMAZOLE 5 MG TABLET $ $ 1.00 1.00 23155007101 J8499 METHIMAZOLE 10 MG TABLET $ $ 1.00 1.00 23155010201 J8499 METFORMIN 500 MG TABLET $ $ 1.00 1.00 23155010301 J8499 METFORMIN 850 MG TABLET $ $ 1.00 1.00 23155029041 J0278 AMIKACIN 500 MG/2 ML INJECTION SOLUTION $ $ 392.34 392.34 23155029431 J0780 PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) $ $ INJECTION SOLUTION 384.20 384.20 23155047332 J1940 FUROSEMIDE 10 MG/ML INJECTION SOLUTION $ $ 141.16 141.16 23155047333 J1940 FUROSEMIDE 10 MG/ML INJECTION SOLUTION $ $ 158.09 158.09 23155050101 J8499 HYDROXYZINE HCL 25 MG TABLET $ $ 59.00 59.00 23155066201 J8499 CALCITRIOL 0.25 MCG CAPSULE $ $ 1.00 1.00 23155066203 J8499 CALCITRIOL 0.25 MCG CAPSULE $ $ 1.00 1.00 24208029005 J3490 TOBRAMYCIN 0.3 % EYE DROPS $ $ 441.52 441.52 24208029525 J3490 TOBRAMYCIN 0.3 %‐DEXAMETHASONE 0.1 % EYE $ $ DROPS,SUSPENSION 1,604.79 1,604.79

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24208031425 J3490 FLURBIPROFEN 0.03 % EYE DROPS $ $ 126.55 126.55 24208031510 J3490 POLYMYXIN B SULFATE 10,000 UNIT‐TRIMETHOPRIM 1 MG/ML $ $ EYE DROPS 245.11 245.11 24208035805 J3490 TOBRAMYCIN 0.3 %‐LOTEPRED 0.5 % EYE DROPS,SUSPENSION $ $ 9,329.71 9,329.71 24208041105 J3490 BRIMONIDINE 0.2 % EYE DROPS $ $ 550.10 550.10 24208046325 J3490 LATANOPROST 0.005 % EYE DROPS $ $ 677.05 677.05 24208048610 J3490 DORZOLAMIDE 22.3 MG‐TIMOLOL 6.8 MG/ML EYE DROPS $ $ 702.60 702.60 24208050505 J3490 LEVOBUNOLOL 0.5 % EYE DROPS $ $ 71.06 71.06 24208061577 J3490 ACETIC ACID‐ALUMINUM ACETATE 2 % EAR DROPS $ $ 1,913.77 1,913.77 24208063562 J3490 NEOMYCIN‐POLYMYXIN‐HYDROCORT 3.5 MG‐10,000 UNIT/ML‐1 $ $ % EAR DROPS,SUSP 2,020.76 2,020.76 24208073006 J3490 PROPARACAINE 0.5 % EYE DROPS $ $ 1,321.56 1,321.56 24208073501 J3490 CYCLOPENTOLATE 1 % EYE DROPS $ $ 459.08 459.08 24208083060 J3490 NEOMYCIN‐POLYMYXIN‐DEXAMETH 3.5 MG/ML‐10,000 UNIT/ML‐ $ $ 0.1% EYE DROPS 557.29 557.29 24208091019 J3490 ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT $ $ 376.65 376.65 24208091055 J3490 ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT $ $ 322.90 322.90 24338010213 J8499 ERYTHROMYCIN 250 MG TABLET $ $ 350.83 350.83 24338013402 J8499 ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER $ $ FOR SUSPENSION 9,225.52 9,225.52 24979015514 J8499 CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION $ $ 874.25 874.25

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25021010110 J0690 CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION $ $ 302.00 302.00 25021010910 J0694 CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION $ $ 326.11 326.11 25021011020 J0694 CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION $ $ 473.22 473.22 25021012120 J0692 CEFEPIME 1 GRAM SOLUTION FOR INJECTION $ $ 343.75 343.75 25021012250 J0692 CEFEPIME 2 GRAM SOLUTION FOR INJECTION $ $ 474.49 474.49 25021012720 J0713 CEFTAZIDIME 1 GRAM SOLUTION FOR INJECTION $ $ 349.42 349.42 25021012850 J0713 CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION $ $ 518.48 518.48 25021013410 J0290 AMPICILLIN 250 MG SOLUTION FOR INJECTION $ $ 302.00 302.00 25021013610 J0290 AMPICILLIN 1 GRAM SOLUTION FOR INJECTION $ $ 302.00 302.00 25021013720 J0290 AMPICILLIN 2 GRAM SOLUTION FOR INJECTION $ $ 311.02 311.02 25021015630 J2185 MEROPENEM 1 GRAM INTRAVENOUS SOLUTION $ $ 405.15 405.15 25021016648 J2543 PIPERACILLIN‐TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION $ $ 586.39 586.39 25021018482 J1450 FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) $ $ INTRAVENOUS PIGGYBACK 366.63 366.63 25021020110 J9209 MESNA 100 MG/ML INTRAVENOUS SOLUTION $ $ 138.00 138.00 25021020401 J9390 VINORELBINE 10 MG/ML INTRAVENOUS SOLUTION $ $ 524.71 524.71 25021020405 J9390 VINORELBINE 50 MG/5 ML INTRAVENOUS SOLUTION $ $ 189.49 189.49 25021020751 J9000 DOXORUBICIN 2 MG/ML INTRAVENOUS SOLUTION $ $ 753.38 753.38

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25021030167 J0153 ADENOSINE 3 MG/ML INTRAVENOUS SYRINGE $ $ 356.49 356.49 25021030520 J1205 CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS SOLUTION $ $ 2,140.27 2,140.27 25021030730 J0153 ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION $ $ 9,544.88 9,544.88 25021040001 J1644 HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION $ $ 138.00 138.00 25021040010 J1644 HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION $ $ 138.00 138.00 25021040301 J1644 HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION $ $ 138.00 138.00 25021040304 J1644 HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION $ $ 212.06 212.06 25021040366 J1644 HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION $ $ 138.00 138.00 25021045201 J2354 OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION $ $ 490.34 490.34 25021045405 J2354 OCTREOTIDE ACETATE 200 MCG/ML INJECTION SOLUTION $ $ 3,436.08 3,436.08 25021060820 J2704 PROPOFOL 10 MG/ML INTRAVENOUS EMULSION $ $ 138.00 138.00 25021067376 J3490 LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR $ $ 141.08 141.08 25021070001 J1885 KETOROLAC 15 MG/ML INJECTION SOLUTION $ $ 164.60 164.60 25021070101 J1885 KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION $ $ 219.17 219.17 25021070102 J1885 KETOROLAC 60 MG/2 ML INTRAMUSCULAR SOLUTION $ $ 274.18 274.18 25021077702 J2405 ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION $ $ 138.00 138.00 25021080166 J3489 ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION $ $ 281.68 281.68

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25021080601 J1630 HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION $ $ 383.20 383.20 25021082273 J1740 IBANDRONATE 3 MG/3 ML INTRAVENOUS SYRINGE $ $ 665.80 665.80 25021082682 J3489 ZOLEDRONIC ACID 4 MG/100 ML‐MANNITOL‐0.9 % NACL $ $ INTRAVENOUS PIGGYBACK 225.48 225.48 25021082850 J0640 LEUCOVORIN CALCIUM 500 MG SOLUTION FOR INJECTION $ $ 661.19 661.19 25021083082 J3489 ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %‐WATER $ $ INTRAVENOUS PIGGYBCK 665.58 665.58 25682000101 J1300 ECULIZUMAB 300 MG/30 ML INTRAVENOUS SOLUTION $ $ 35,354.61 35,354.61 27241011804 J3490 FENOFIBRATE MICRONIZED 67 MG CAPSULE $ $ 59.00 59.00 27808003301 J3490 THEOPHYLLINE 80 MG/15 ML ORAL SOLUTION $ $ 1,132.93 1,132.93 29300011101 J8499 LAMOTRIGINE 25 MG TABLET $ $ 59.00 59.00 29300012701 J8499 BISOPROLOL FUMARATE 10 MG TABLET $ $ 1.63 1.63 29300012713 J8499 BISOPROLOL FUMARATE 10 MG TABLET $ $ 1.81 1.81 29300013101 J8499 ZALEPLON 5 MG CAPSULE $ $ 1.00 1.00 29300022601 J8499 METRONIDAZOLE 250 MG TABLET $ $ 59.00 59.00 31604001894 J3490 COENZYME Q10 100 MG CAPSULE $ $ 59.00 59.00 31604002741 J8499 MELATONIN 3 MG TABLET $ $ 59.00 59.00 31722013190 J8499 DUTASTERIDE 0.5 MG CAPSULE $ $ 1.00 1.00 31722020090 J8499 FOSINOPRIL 10 MG TABLET $ $ 1.00 1.00

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31722026890 J8499 QUINAPRIL 10 MG TABLET $ $ 1.00 1.00 31722053001 J8499 TORSEMIDE 10 MG TABLET $ $ 59.00 59.00 31722082030 J8499 ARIPIPRAZOLE 5 MG TABLET $ $ 9.23 9.23 31722088390 J8499 ROSUVASTATIN 10 MG TABLET $ $ 59.00 59.00 31722090301 J8499 FLUOXETINE 10 MG CAPSULE $ $ 1.00 1.00 32909016802 J8499 BARIUM SULFATE 105 % (W/V), 58 % (W/W) ORAL SUSPENSION $ $ 607.95 607.95 32909018601 J3490 BARIUM SULFATE 60 % (W/V) ORAL SUSPENSION $ $ 1,042.19 1,042.19 32909072301 J8499 BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSPENSION $ $ 232.79 232.79 32909076401 J8499 BARIUM SULFATE 98 % ORAL POWDER FOR SUSPENSION $ $ 167.51 167.51 32909094503 J8499 BARIUM SULFATE 0.1 % (W/V), 0.1 % (W/W) ORAL SUSPENSION $ $ 325.90 325.90 33342006310 J8499 VALSARTAN 80 MG TABLET $ $ 1.00 1.00 33342008307 J8499 OLANZAPINE 5 MG DISINTEGRATING TABLET $ $ 59.00 59.00 33342011407 J8499 CANDESARTAN 4 MG TABLET $ $ 2.56 2.56 33342011607 J8499 CANDESARTAN 16 MG TABLET $ $ 5.54 5.54 36000000210 J1450 FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) $ $ INTRAVENOUS PIGGYBACK 410.54 410.54 36000000306 J1450 FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) $ $ INTRAVENOUS PIGGYBACK 322.72 322.72 36000000824 J0744 CIPROFLOXACIN 200 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS $ $ PIGGYBACK 302.00 302.00

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36000001225 J2405 ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION $ $ 138.00 138.00 36000024201 J3260 TOBRAMYCIN 40 MG/ML INJECTION SOLUTION $ $ 744.27 744.27 36000028225 J1940 FUROSEMIDE 10 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 36000028325 J1940 FUROSEMIDE 10 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 36000028425 J1940 FUROSEMIDE 10 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 36652026769 J3490 FERROUS FUMARATE 200 MG (65 MG IRON)‐VIT C 25 MG $ $ TABLET,EXTEND RELEASE 59.00 59.00 37000002410 J3490 PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET $ $ 59.00 59.00 37205019573 J8499 CAFFEINE 200 MG TABLET $ $ 59.00 59.00 37205033816 J3490 DIPHENHYDRAMINE 2 % TOPICAL SPRAY $ $ 120.12 120.12 37205067164 J8499 DOXYLAMINE SUCCINATE 25 MG TABLET $ $ 59.00 59.00 37864000033 J8499 SENNOSIDES 8.6 MG TABLET $ $ 59.00 59.00 37864082799 J8499 CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) TABLET $ $ 1.00 1.00 37864090599 J8499 THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET $ $ 1.00 1.00 38341010677 J3490 BENZOCAINE 20 % MUCOSAL PASTE $ $ 59.00 59.00 38779247109 J3490 GLUTAMINE (BULK) POWDER $ $ 118.15 118.15 38779251008 J3490 COMPOUNDING VEHICLE SUSPENSION NO.7 ORAL $ $ 540.53 540.53 39822017001 J3490 POLYMYXIN B SULFATE 500,000 UNIT SOLUTION FOR INJECTION $ $ 547.87 547.87

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39822019001 J1120 ACETAZOLAMIDE 500 MG SOLUTION FOR INJECTION $ $ 1,846.06 1,846.06 39822027801 J3490 BACITRACIN 50,000 UNIT INTRAMUSCULAR SOLUTION $ $ 379.44 379.44 39822031007 J8499 NEOMYCIN 500 MG TABLET $ $ 64.06 64.06 39822041201 J3260 TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION $ $ 2,602.79 2,602.79 39822050001 J0360 HYDRALAZINE 20 MG/ML INJECTION SOLUTION $ $ 335.09 335.09 39822070602 J3000 STREPTOMYCIN 1 GRAM INTRAMUSCULAR SOLUTION $ $ 3,018.88 3,018.88 39822105505 J0285 AMPHOTERICIN B 50 MG SOLUTION FOR INJECTION $ $ 1,535.09 1,535.09 39822120101 J3490 NEOMYCIN 40 MG‐POLYMYXIN B 200,000 UNIT/ML GU $ $ IRRIGATION SOLUTION 424.19 424.19 39822200001 J0735 CLONIDINE (PF) 1,000 MCG/10 ML (100 MCG/ML) EPIDURAL $ $ SOLUTION 414.77 414.77 39822420001 J3490 ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION $ $ 141.32 141.32 39822555005 J2550 PROMETHAZINE 50 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 39822990001 J3490 AMMONIA AROMATIC 15 % (W/V) SOLUTION FOR INHALATION $ $ 59.00 59.00 41100081123 J3490 OXYMETAZOLINE 0.05 % NASAL SPRAY $ $ 238.33 238.33 42023011310 J3490 KETAMINE 10 MG/ML INJECTION SOLUTION $ $ 746.51 746.51 42023011601 J2590 OXYTOCIN 10 UNIT/ML INJECTION SOLUTION $ $ 486.79 486.79 42023011625 J2590 OXYTOCIN 10 UNIT/ML INJECTION SOLUTION $ $ 314.81 314.81 42023011925 J3250 TRIMETHOBENZAMIDE 100 MG/ML INTRAMUSCULAR SOLUTION $ $ 1,335.97 1,335.97

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42023012306 J3490 DANTROLENE 20 MG INTRAVENOUS SOLUTION $ $ 2,451.81 2,451.81 42023015901 J0171 EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION $ $ 706.75 706.75 42023015925 J0171 EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION $ $ 707.11 707.11 42023016401 C9399 VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION $ $ 6,527.44 6,527.44 42023016801 J0171 EPINEPHRINE 1 MG/ML INJECTION SOLUTION $ $ 7,845.48 7,845.48 42023020101 J3490 LEVOTHYROXINE 100 MCG INTRAVENOUS POWDER FOR $ $ SOLUTION 3,982.42 3,982.42 42037010375 J3490 ASPIRIN 81 MG TABLET,DELAYED RELEASE $ $ 1.00 1.00 42037010379 J8499 ASPIRIN 325 MG TABLET,DELAYED RELEASE $ $ 1.00 1.00 42037010478 J3490 CARBAMIDE PEROXIDE 6.5 % EAR DROPS $ $ 225.15 225.15 42192033901 J8499 HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET $ $ 59.00 59.00 42192060501 J3490 TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS $ $ SOLUTION 354.89 354.89 42192060510 J3490 TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS $ $ SOLUTION 354.89 354.89 42211010243 J3490 INDOMETHACIN 50 MG RECTAL SUPPOSITORY $ $ 6,388.72 6,388.72 42292000101 J8499 METRONIDAZOLE 500 MG TABLET $ $ 59.00 59.00 42571016201 J8499 AMOXICILLIN 875 MG‐POTASSIUM CLAVULANATE 125 MG TABLET $ $ 59.00 59.00 42571026575 J3490 SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION $ $ 744.67 744.67 42794001812 J8499 LIOTHYRONINE 5 MCG TABLET $ $ 74.48 74.48

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42794001902 J8499 LIOTHYRONINE 25 MCG TABLET $ $ 59.00 59.00 42799040401 J8499 ZIDOVUDINE 10 MG/ML ORAL SYRUP $ $ 1,877.84 1,877.84 42858030125 J8499 HYDROMORPHONE 2 MG TABLET $ $ 59.00 59.00 42858030301 J3490 HYDROMORPHONE 8 MG TABLET $ $ 59.00 59.00 42858049340 J3490 BUPRENORPHINE 10 MCG/HOUR WEEKLY TRANSDERMAL PATCH $ $ 4,491.15 4,491.15 42858070101 J3490 THEOPHYLLINE ER 400 MG TABLET,EXTENDED RELEASE 24 HR $ $ 61.90 61.90 42858086806 J8597 DRONABINOL 5 MG CAPSULE $ $ 207.28 207.28 43066015010 J0282 AMIODARONE 150 MG/100 ML (1.5 MG/ML) IN DEXTROSE, ISO‐ $ $ OSMOTIC IV 1,488.38 1,488.38 43066036020 J0282 AMIODARONE 360 MG/200 ML (1.8 MG/ML) IN DEXTROSE, ISO‐ $ $ OSMOTIC IV 1,919.52 1,919.52 43386014007 J8499 METHYLERGONOVINE 0.2 MG TABLET $ $ 29.54 29.54 43386016006 J8499 MISOPROSTOL 100 MCG TABLET $ $ 1.00 1.00 43386044024 J8499 NIFEDIPINE 10 MG CAPSULE $ $ 1.00 1.00 43386051087 J3490 MESALAMINE 4 GRAM/60 ML ENEMA $ $ 536.53 536.53 43386062230 J8499 LEVONORGESTREL 1.5 MG TABLET $ $ 12.39 12.39 43547026810 J8499 ROPINIROLE 0.25 MG TABLET $ $ 59.00 59.00 43547027010 J8499 ROPINIROLE 1 MG TABLET $ $ 1.00 1.00 43547027503 J8499 DONEPEZIL 5 MG TABLET $ $ 1.00 1.00

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43547027803 J8499 IRBESARTAN 150 MG TABLET $ $ 1.00 1.00 43547036703 J8499 VALSARTAN 40 MG TABLET $ $ 1.00 1.00 43547036809 J8499 VALSARTAN 80 MG TABLET $ $ 1.00 1.00 43547040010 J8499 CYCLOBENZAPRINE 10 MG TABLET $ $ 59.00 59.00 43547040610 J8499 CLONAZEPAM 0.5 MG TABLET $ $ 59.00 59.00 43547041109 J8499 QUINAPRIL 10 MG TABLET $ $ 1.00 1.00 43598020451 J8499 AMOXICILLIN 250 MG‐POTASSIUM CLAVULANATE 62.5 MG/5 ML $ $ ORAL SUSPENSION 1,317.36 1,317.36 43598021040 J3490 SILVER SULFADIAZINE 1 % TOPICAL CREAM $ $ 1,660.68 1,660.68 43598044671 J3490 NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH $ $ 137.11 137.11 43598044771 J3490 NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH $ $ 137.11 137.11 43598044871 J3490 NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH $ $ 137.11 137.11 43598063552 J1953 LEVETIRACETAM 500 MG/100 ML IN SODIUM CHLORIDE (ISO‐ $ $ OSM) IV PIGGYBACK 689.98 689.98 43598067811 J9025 AZACITIDINE 100 MG SOLUTION FOR INJECTION $ $ 4,748.65 4,748.65 43825010201 J0131 ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS $ $ SOLUTION 1,624.75 1,624.75 43825060641 C9399 THROMBIN (RECOMBINANT) 5,000 UNIT TOPICAL SOLUTION $ $ 3,714.40 3,714.40 44206025105 P9047 ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION $ $ 1,570.86 1,570.86 44206025190 P9047 ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION $ $ 1,570.86 1,570.86

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44206031050 P9045 ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION $ $ 3,153.68 3,153.68 44206031091 P9045 ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION $ $ 3,153.68 3,153.68 44206043940 J1459 IMMUNE GLOB,GAMM(IGG) 10 %‐PRO‐IGA 0 TO 50 MCG/ML $ $ INTRAVENOUS SOLUTION 142,533.72 142,533.72 44206043993 J1459 IMMUNE GLOB,GAMM(IGG) 10 %‐PRO‐IGA 0 TO 50 MCG/ML $ $ INTRAVENOUS SOLUTION 142,533.72 142,533.72 44567022110 J3490 NAFCILLIN 1 GRAM SOLUTION FOR INJECTION $ $ 321.60 321.60 44567022210 J3490 NAFCILLIN 2 GRAM SOLUTION FOR INJECTION $ $ 440.80 440.80 44567022301 J3490 NAFCILLIN 10 GRAM SOLUTION FOR INJECTION $ $ 2,026.10 2,026.10 44567023610 J0713 CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION $ $ 658.01 658.01 44567024110 J0692 CEFEPIME 2 GRAM SOLUTION FOR INJECTION $ $ 543.43 543.43 44567024625 J0694 CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION $ $ 555.85 555.85 44567031110 J2540 PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR $ $ INJECTION 1,518.32 1,518.32 44567043524 J1956 LEVOFLOXACIN 250 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS $ $ PIGGYBACK 302.00 302.00 44567051001 J9060 CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION $ $ 138.00 138.00 44567060324 C9399 DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN DEXTROSE $ $ 5 % IV SOLUTION 1,691.97 1,691.97 44567062001 J3490 CALCIUM GLUCONATE 1 GRAM/50 ML IN SODIUM CHLORIDE, ISO‐ $ $ OSM IV SOLUTION 973.41 973.41 44567070725 J0690 CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION $ $ 302.00 302.00 44567080401 J2543 PIPERACILLIN‐TAZOBACTAM 40.5 GRAM INTRAVENOUS SOLUTION $ $ 2,718.32 2,718.32

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45802005003 J3490 DIBUCAINE 1 % TOPICAL OINTMENT $ $ 138.61 138.61 45802005935 J3490 NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM $ $ 147.91 147.91 45802011222 J3490 MUPIROCIN 2 % TOPICAL OINTMENT $ $ 221.32 221.32 45802017944 J3490 ZINC OXIDE‐COD LIVER OIL 40 % TOPICAL OINTMENT $ $ 81.20 81.20 45802042578 J8499 FEXOFENADINE 60 MG TABLET $ $ 59.00 59.00 45802043803 J3490 HYDROCORTISONE 1 % TOPICAL CREAM $ $ 59.00 59.00 46017001816 J8499 CAFFEINE 200 MG TABLET $ $ 59.00 59.00 46287000601 J8499 SODIUM POLYSTYRENE SULFONATE 15 GRAM‐SORBITOL 20 $ $ GRAM/60 ML ORAL SUSP 5,003.78 5,003.78 46287000660 J8499 SODIUM POLYSTYRENE SULFONATE 15 GRAM‐SORBITOL 20 $ $ GRAM/60 ML ORAL SUSP 661.08 661.08 46287050030 J8499 SORBITOL 70 % SOLUTION $ $ 59.00 59.00 47335023583 J8610 METHOTREXATE SODIUM 2.5 MG TABLET $ $ 1.66 1.66 47335033040 J1205 CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS SOLUTION $ $ 1,522.71 1,522.71 47335053981 J8499 NIACIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR $ $ 59.00 59.00 47781020604 J3490 ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH $ $ 1,010.10 1,010.10 47781020904 J3490 ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH $ $ 1,010.10 1,010.10 47781020911 J3490 ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH $ $ 1,009.74 1,009.74 47781029803 J3490 NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH $ $ 80.35 80.35

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47781030701 J8499 NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE $ $ 1.00 1.00 47781033331 J8499 DAPSONE 25 MG TABLET $ $ 95.90 95.90 47781046570 J3490 CLINDAMYCIN 150 MG/ML INJECTION SOLUTION $ $ 1,165.83 1,165.83 47781046813 J8499 OSELTAMIVIR 30 MG CAPSULE $ $ 371.90 371.90 47781058368 J1885 KETOROLAC 15 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 47781058393 J1885 KETOROLAC 15 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 47781058493 J1885 KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION $ $ 138.00 138.00 47781058629 J3490 LABETALOL 5 MG/ML INTRAVENOUS SOLUTION $ $ 138.00 138.00 47781058846 J2250 MIDAZOLAM 1 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 47781059507 J9267 PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS $ $ 357.72 357.72 48433020510 J8499 DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID $ $ 86.60 86.60 48433023015 J8499 IODINE STRONG (LUGOLS) 5 % ORAL SOLUTION $ $ 1,399.44 1,399.44 48783011208 J3490 FERRIC SUBSULFATE 0.2 GRAM TO 0.22 GRAM/ML TOPICAL SOLN $ $ AND APPLICATOR 709.62 709.62 48818000101 J9307 PRALATREXATE 20 MG/ML (1 ML) INTRAVENOUS SOLUTION $ $ 30,968.42 30,968.42 48878062001 J3490 CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH $ $ 324.32 324.32 49100036374 J3490 LACTOBACILLUS RHAMNOSUS GG 15 BILLION CELL SPRINKLE $ $ CAPSULE 59.00 59.00 49281040015 90715 DIPHTH,PERTUS(AC)TETANUS(PF)2 LF‐(2.5‐5‐3‐5MCG)‐5 LF/0.5 ML $ $ IM SYRINGE 1,323.43 1,323.43

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49281040089 90715 DIPHTH,PERTUS(AC)TETANUS(PF)2 LF‐(2.5‐5‐3‐5MCG)‐5 LF/0.5 ML $ $ IM SYRINGE 1,360.48 1,360.48 49281040565 90662 FLU VACCINE TS2019‐20(65YR UP)(PF)180 MCG/0.5 ML $ $ INTRAMUSCULAR SYRINGE 1,859.32 1,859.32 49281075278 86580 TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION $ $ SOLUTION 2,127.74 2,127.74 49401010101 J0490 BELIMUMAB 120 MG INTRAVENOUS SOLUTION $ $ 21,176.13 21,176.13 49502010201 J0171 EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO‐INJECTOR $ $ 5,375.23 5,375.23 49502010202 J0171 EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO‐INJECTOR $ $ 5,375.23 5,375.23 49502050001 J0171 EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO‐INJECTOR $ $ 11,478.40 11,478.40 49502050102 J3490 EPINEPHRINE (JR) 0.15 MG/0.3 ML INJECTION,AUTO‐INJECTOR $ $ 11,478.40 11,478.40 49502060530 J7606 FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR $ $ NEBULIZATION 218.72 218.72 49580032901 J8499 MAGNESIUM CITRATE ORAL SOLUTION $ $ 82.72 82.72 49648008402 J3490 DIBUCAINE 1 % RECTAL OINTMENT $ $ 291.99 291.99 49730011330 J3490 NITROGLYCERIN 0.6 MG/HR TRANSDERMAL 24 HOUR PATCH $ $ 59.00 59.00 49781010339 J3490 NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE $ $ 59.00 59.00 49884001908 J3490 OMEGA‐3 ACID ETHYL ESTERS 1 GRAM CAPSULE $ $ 2.88 2.88 49884002001 J8499 ISOSORBIDE DINITRATE 5 MG TABLET $ $ 88.50 88.50 49884002201 J8499 ISOSORBIDE DINITRATE 20 MG TABLET $ $ 84.61 84.61 49884005401 J8499 IMIPRAMINE 10 MG TABLET $ $ 59.00 59.00

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49884005501 J8499 IMIPRAMINE 25 MG TABLET $ $ 1.00 1.00 49884016111 J3490 CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY $ $ 927.29 927.29 49884030402 J8499 ZAFIRLUKAST 20 MG TABLET $ $ 99.09 99.09 49884046564 J8499 CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN $ $ A PACKET 108.89 108.89 49884049401 J8499 DIGOXIN 250 MCG (0.25 MG) TABLET $ $ 2.23 2.23 49884050101 J8499 BUDESONIDE DR ‐ ER 3 MG CAPSULE,DELAYED,EXTENDED $ $ RELEASE 784.89 784.89 49884051401 J8499 DIGOXIN 125 MCG (0.125 MG) TABLET $ $ 2.40 2.40 49884067801 J8499 NIFEDIPINE ER 60 MG TABLET,EXTENDED RELEASE $ $ 1.00 1.00 49884072401 J8499 HYDROXYUREA 500 MG CAPSULE $ $ 1.00 1.00 49884072703 J3490 DOXYCYCLINE MONOHYDRATE 100 MG CAPSULE $ $ 69.45 69.45 49884076352 J3490 FENTANYL 75 MCG/HR TRANSDERMAL PATCH $ $ 869.41 869.41 49884086702 J8597 DRONABINOL 2.5 MG CAPSULE $ $ 3.89 3.89 49938010230 J8499 DAPSONE 25 MG TABLET $ $ 133.76 133.76 50111033401 J8499 METRONIDAZOLE 500 MG TABLET $ $ 59.00 59.00 50111043301 J8499 TRAZODONE 50 MG TABLET $ $ 1.00 1.00 50111043401 J8499 TRAZODONE 100 MG TABLET $ $ 59.00 59.00 50111046701 J8499 PROPRANOLOL 10 MG TABLET $ $ 1.00 1.00

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50111048301 J8499 THEOPHYLLINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR $ $ 59.00 59.00 50242004164 J2997 ALTEPLASE 2 MG INTRA‐CATHETER SOLUTION $ $ 5,773.63 5,773.63 50242005121 J9312 RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS $ $ 5,092.20 5,092.20 50242005306 J9312 RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS $ $ 25,461.00 25,461.00 50242006001 J9035 BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION $ $ 4,319.42 4,319.42 50242006101 J9035 BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION $ $ 17,277.66 17,277.66 50242007001 J9301 OBINUTUZUMAB 1,000 MG/40 ML INTRAVENOUS SOLUTION $ $ 35,506.42 35,506.42 50242008527 J2997 ALTEPLASE 100 MG INTRAVENOUS SOLUTION $ $ 45,069.80 45,069.80 50242008701 J9354 ADO‐TRASTUZUMAB EMTANSINE 160 MG INTRAVENOUS $ $ SOLUTION 26,558.98 26,558.98 50242010040 J3490 DORNASE ALFA 1 MG/ML SOLUTION FOR INHALATION $ $ 4,513.82 4,513.82 50242012001 J3101 TENECTEPLASE 50 MG INTRAVENOUS KIT $ $ 30,806.85 30,806.85 50242013201 J9355 TRASTUZUMAB 150 MG INTRAVENOUS SOLUTION $ $ 8,446.64 8,446.64 50242013468 J9355 TRASTUZUMAB 440 MG INTRAVENOUS SOLUTION $ $ 24,055.16 24,055.16 50242013501 J3262 TOCILIZUMAB 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION $ $ 2,426.71 2,426.71 50242014501 J9306 PERTUZUMAB 420 MG/14 ML (30 MG/ML) INTRAVENOUS $ $ SOLUTION 27,847.28 27,847.28 50242015001 J2350 OCRELIZUMAB 30 MG/ML INTRAVENOUS SOLUTION $ $ 648,879.00 648,879.00 50242091701 J9022 ATEZOLIZUMAB 1,200 MG/20 ML (60 MG/ML) INTRAVENOUS $ $ SOLUTION 48,854.58 48,854.58

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50268006111 J8499 ACYCLOVIR 400 MG TABLET $ $ 59.00 59.00 50268009811 J8499 AZITHROMYCIN 250 MG TABLET $ $ 81.22 81.22 50268011011 J8499 BENAZEPRIL 10 MG TABLET $ $ 1.00 1.00 50268015211 J8499 CEPHALEXIN 500 MG CAPSULE $ $ 59.00 59.00 50268030311 J8499 FAMOTIDINE 20 MG TABLET $ $ 1.00 1.00 50268032311 J8499 FINASTERIDE 5 MG TABLET $ $ 1.00 1.00 50268037411 J3490 GUANFACINE 2 MG TABLET $ $ 108.18 108.18 50268040211 J8499 HYDROCODONE 10 MG‐ACETAMINOPHEN 325 MG TABLET $ $ 59.00 59.00 50268047211 J8499 LEVETIRACETAM 250 MG TABLET $ $ 59.00 59.00 50268054011 J8499 METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE $ $ 24 HR 1.00 1.00 50268056411 J8499 MIDODRINE 2.5 MG TABLET $ $ 59.00 59.00 50268063011 J8499 QUETIAPINE 25 MG TABLET $ $ 59.00 59.00 50268063611 J8499 PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE $ $ 1.00 1.00 50268075511 J8499 TORSEMIDE 10 MG TABLET $ $ 59.00 59.00 50268079611 J8499 URSODIOL 300 MG CAPSULE $ $ 6.50 6.50 50268079811 J8499 VENLAFAXINE 25 MG TABLET $ $ 59.00 59.00 50268079911 J8499 VENLAFAXINE 37.5 MG TABLET $ $ 59.00 59.00

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50268085111 J8499 THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET $ $ 1.00 1.00 50323000603 J3490 PHENYLEPHRINE 0.5 % NASAL SPRAY $ $ 1,234.73 1,234.73 50323000604 J3490 PHENYLEPHRINE 1 % NASAL SPRAY $ $ 20,802.32 20,802.32 50383004004 J7510 PREDNISOLONE SODIUM PHOSPHATE 5 MG BASE/5 ML (6.7 MG/5 $ $ ML) ORAL SOLN 2,589.02 2,589.02 50383004224 J7510 PREDNISOLONE 15 MG/5 ML ORAL SOLUTION $ $ 405.91 405.91 50383018902 J3490 GATIFLOXACIN 0.5 % EYE DROPS $ $ 4,716.55 4,716.55 50383031105 J8499 GABAPENTIN 250 MG/5 ML (5 ML) ORAL SOLUTION $ $ 89.44 89.44 50383056510 J8499 NEOMYCIN 500 MG TABLET $ $ 96.82 96.82 50383061810 J8499 LOPERAMIDE 1 MG/5 ML ORAL LIQUID $ $ 110.73 110.73 50383074016 J8499 ALBUTEROL SULFATE 2 MG/5 ML ORAL SYRUP $ $ 2,416.92 2,416.92 50383077110 J8499 DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID $ $ 59.00 59.00 50383077504 J3490 LIDOCAINE HCL 2 % MUCOSAL SOLUTION $ $ 379.40 379.40 50383077515 J3490 LIDOCAINE HCL 2 % MUCOSAL SOLUTION $ $ 76.66 76.66 50383077930 J8499 LACTULOSE 20 GRAM/30 ML ORAL SOLUTION $ $ 59.00 59.00 50383077931 J8499 LACTULOSE 20 GRAM/30 ML ORAL SOLUTION $ $ 59.00 59.00 50383079516 J8499 LACTULOSE 10 GRAM/15 ML ORAL SOLUTION $ $ 12.50 12.50 50419042201 J7301 LEVONORGESTREL 14 MCG/24 HRS (3 YRS) 13.5 MG $ $ INTRAUTERINE DEVICE 31,694.89 31,694.89

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50419042301 J7298 LEVONORGESTREL 20 MCG/24 HOURS (5 YRS) 52 MG $ $ INTRAUTERINE DEVICE 38,064.12 38,064.12 50419042401 J7296 LEVONORGESTREL 17.5 MCG/24 HRS (5YRS) 19.5MG $ $ INTRAUTERINE DEVICE 38,064.12 38,064.12 50458057830 J8499 RIVAROXABAN 15 MG TABLET $ $ 14.72 14.72 50458057930 J8499 RIVAROXABAN 20 MG TABLET $ $ 14.72 14.72 50458058030 J8499 RIVAROXABAN 10 MG TABLET $ $ 14.72 14.72 50484001030 J3490 COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM $ $ TOPICAL OINTMENT 8,807.16 8,807.16 50580019101 J3490 ACETAMINOPHEN 160 MG/5 ML ORAL SUSPENSION $ $ 228.75 228.75 50580045110 J3490 ACETAMINOPHEN 500 MG TABLET $ $ 1.00 1.00 50580050110 J3490 ACETAMINOPHEN 325 MG TABLET $ $ 1.00 1.00 50580053404 J3490 DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID $ $ 226.11 226.11 50580060002 J3490 ACETAMINOPHEN 325 MG TABLET $ $ 1.00 1.00 50633011012 J0840 CROTALIDAE POLYVAL IMMUNE FAB SOLUTION FOR INJECTION $ $ 19,258.89 19,258.89 50633012011 J1162 DIGOXIN IMMUNE FAB 40 MG INTRAVENOUS SOLUTION $ $ 144,308.57 144,308.57 51079002301 J8499 METOLAZONE 2.5 MG TABLET $ $ 2.82 2.82 51079005120 J8499 PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE $ $ 1.00 1.00 51079005801 J8499 CHLORTHALIDONE 25 MG TABLET $ $ 2.25 2.25 51079007201 J8499 FUROSEMIDE 20 MG TABLET $ $ 1.00 1.00

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51079007301 J8499 FUROSEMIDE 40 MG TABLET $ $ 59.00 59.00 51079010301 J8499 SPIRONOLACTONE 25 MG TABLET $ $ 1.00 1.00 51079010501 J8499 FOLIC ACID 1 MG TABLET $ $ 1.00 1.00 51079010701 J8499 AMITRIPTYLINE 25 MG TABLET $ $ 1.00 1.00 51079011801 J8499 DICYCLOMINE 10 MG CAPSULE $ $ 59.00 59.00 51079012901 J8499 PHENYTOIN 50 MG CHEWABLE TABLET $ $ 59.00 59.00 51079013101 J8499 AMITRIPTYLINE 10 MG TABLET $ $ 1.00 1.00 51079013301 J8499 AMITRIPTYLINE 50 MG TABLET $ $ 1.00 1.00 51079014501 J8499 BENAZEPRIL 10 MG TABLET $ $ 1.00 1.00 51079016501 J8499 VORICONAZOLE 200 MG TABLET $ $ 1,076.70 1,076.70 51079017201 J8499 METFORMIN 500 MG TABLET $ $ 1.00 1.00 51079017220 J8499 METFORMIN 500 MG TABLET $ $ 1.00 1.00 51079018201 J8499 CIPROFLOXACIN 500 MG TABLET $ $ 59.00 59.00 51079019001 J8499 INDOMETHACIN 25 MG CAPSULE $ $ 59.00 59.00 51079020501 J8499 ALLOPURINOL 100 MG TABLET $ $ 1.00 1.00 51079020601 J8499 ALLOPURINOL 300 MG TABLET $ $ 1.00 1.00 51079020801 J8499 ATORVASTATIN 10 MG TABLET $ $ 1.00 1.00

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51079022301 J8499 MONTELUKAST 10 MG TABLET $ $ 59.00 59.00 51079027301 J8499 ENTACAPONE 200 MG TABLET $ $ 224.62 224.62 51079028401 J8499 DIAZEPAM 2 MG TABLET $ $ 1.00 1.00 51079029901 J8499 CLONIDINE HCL 0.1 MG TABLET $ $ 59.00 59.00 51079030001 J8499 CLONIDINE HCL 0.2 MG TABLET $ $ 59.00 59.00 51079034801 J8499 NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG $ $ CAPSULE 213.79 213.79 51079038501 J8499 CARBAMAZEPINE 200 MG TABLET $ $ 1.00 1.00 51079038601 J8499 LORAZEPAM 1 MG TABLET $ $ 1.00 1.00 51079039201 J8499 BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED‐RELEASE $ $ 1.00 1.00 51079041801 J8499 TEMAZEPAM 15 MG CAPSULE $ $ 1.00 1.00 51079043401 J8499 MEGESTROL 20 MG TABLET $ $ 1.00 1.00 51079043701 J8499 DOXEPIN 25 MG CAPSULE $ $ 1.00 1.00 51079045001 J8499 AMLODIPINE 2.5 MG TABLET $ $ 59.00 59.00 51079045301 J8499 MIDODRINE 5 MG TABLET $ $ 59.00 59.00 51079045401 J8499 SIMVASTATIN 10 MG TABLET $ $ 1.00 1.00 51079048001 J8499 VENLAFAXINE 37.5 MG TABLET $ $ 59.00 59.00 51079049801 J8499 LAMOTRIGINE 25 MG TABLET $ $ 59.00 59.00

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51079052401 J8597 ONDANSETRON HCL 4 MG TABLET $ $ 59.00 59.00 51079052701 J8499 FUROSEMIDE 80 MG TABLET $ $ 1.00 1.00 51079054101 J8597 PROCHLORPERAZINE MALEATE 5 MG TABLET $ $ 59.00 59.00 51079054120 J8597 PROCHLORPERAZINE MALEATE 5 MG TABLET $ $ 59.00 59.00 51079054701 J8499 FEXOFENADINE 60 MG TABLET $ $ 76.88 76.88 51079058401 J8499 NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE $ $ 2.88 2.88 51079059701 J8499 CETIRIZINE 10 MG TABLET $ $ 59.00 59.00 51079062001 J7500 AZATHIOPRINE 50 MG TABLET $ $ 1.00 1.00 51079063001 J8499 PRAZOSIN 1 MG CAPSULE $ $ 1.59 1.59 51079063101 J8499 PRAZOSIN 2 MG CAPSULE $ $ 2.22 2.22 51079064401 J8499 CYCLOBENZAPRINE 10 MG TABLET $ $ 59.00 59.00 51079067001 J8610 METHOTREXATE SODIUM 2.5 MG TABLET $ $ 2.82 2.82 51079068401 J8499 ATENOLOL 50 MG TABLET $ $ 59.00 59.00 51079069001 J8499 LOPERAMIDE 2 MG CAPSULE $ $ 59.00 59.00 51079074501 J8499 DILTIAZEM 30 MG TABLET $ $ 1.00 1.00 51079074601 J8499 DILTIAZEM 60 MG TABLET $ $ 1.00 1.00 51079074701 J8499 DILTIAZEM 90 MG TABLET $ $ 1.00 1.00

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51079075301 J8499 SUCRALFATE 1 GRAM TABLET $ $ 1.00 1.00 51079075901 J8499 ATENOLOL 25 MG TABLET $ $ 1.00 1.00 51079077401 J8499 PAROXETINE 20 MG TABLET $ $ 1.00 1.00 51079081001 J8499 GLIPIZIDE 5 MG TABLET $ $ 1.00 1.00 51079086301 J8499 CAPTOPRIL 12.5 MG TABLET $ $ 87.45 87.45 51079087301 J8499 GLYBURIDE 5 MG TABLET $ $ 1.00 1.00 51079088601 J8499 METOCLOPRAMIDE 5 MG TABLET $ $ 1.00 1.00 51079088901 J8499 PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE $ $ 1.00 1.00 51079089401 J8499 VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE $ $ 2.01 2.01 51079089501 J8597 PROMETHAZINE 25 MG TABLET $ $ 59.00 59.00 51079089901 J8499 VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE $ $ 2.16 2.16 51079093001 J8499 CARVEDILOL 6.25 MG TABLET $ $ 1.00 1.00 51079093601 J8499 TERAZOSIN 1 MG CAPSULE $ $ 1.00 1.00 51079093701 J8499 TERAZOSIN 2 MG CAPSULE $ $ 1.00 1.00 51079093801 J8499 TERAZOSIN 5 MG CAPSULE $ $ 1.00 1.00 51079095801 J8499 DOXAZOSIN 2 MG TABLET $ $ 174.40 174.40 51079096601 J8499 FAMOTIDINE 20 MG TABLET $ $ 1.00 1.00

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51079098501 J8499 BUSPIRONE 5 MG TABLET $ $ 1.00 1.00 51079098601 J8499 BUSPIRONE 10 MG TABLET $ $ 1.00 1.00 51079099101 J8499 TRAMADOL 50 MG TABLET $ $ 59.00 59.00 51079099120 J8499 TRAMADOL 50 MG TABLET $ $ 59.00 59.00 51144005001 J9042 BRENTUXIMAB VEDOTIN 50 MG INTRAVENOUS SOLUTION $ $ 43,143.20 43,143.20 51248015001 J8499 SOLIFENACIN 5 MG TABLET $ $ 16.88 16.88 51293081001 J8499 PHENAZOPYRIDINE 100 MG TABLET $ $ 124.57 124.57 51293081101 J8499 PHENAZOPYRIDINE 200 MG TABLET $ $ 161.31 161.31 51552032302 J3490 TETRACAINE (BULK) 100 % WAX $ $ 685.65 685.65 51645090599 J8499 THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET $ $ 1.00 1.00 51672125302 J3490 FLUOCINONIDE 0.05 % TOPICAL CREAM $ $ 1,052.70 1,052.70 51672126302 J3490 NYSTATIN‐TRIAMCINOLONE 100,000 UNIT/G‐0.1 % TOPICAL $ $ CREAM 3,629.93 3,629.93 51672128901 J3490 NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM $ $ 522.76 522.76 51672129802 J3490 KETOCONAZOLE 2 % TOPICAL CREAM $ $ 928.14 928.14 51672130406 J3490 TERCONAZOLE 0.4 % VAGINAL CREAM $ $ 1,165.87 1,165.87 51672130803 J3490 CLOTRIMAZOLE‐BETAMETHASONE 1 %‐0.05 % LOTION $ $ 2,724.54 2,724.54 51672131200 J3490 MUPIROCIN 2 % TOPICAL OINTMENT $ $ 171.26 171.26

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51672138602 J3490 FLUOCINONIDE 0.05 % TOPICAL CREAM $ $ 741.32 741.32 51672200102 J3490 MICONAZOLE NITRATE 2 % TOPICAL CREAM $ $ 182.04 182.04 51672200202 J3490 CLOTRIMAZOLE 1 % TOPICAL CREAM $ $ 124.56 124.56 51672200306 J3490 CLOTRIMAZOLE 1 % VAGINAL CREAM $ $ 161.68 161.68 51672206200 J3490 CLOTRIMAZOLE 2 % VAGINAL CREAM $ $ 301.80 301.80 51672211600 J8499 ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY $ $ 59.00 59.00 51672211602 J8499 ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY $ $ 59.00 59.00 51672400105 J8499 NORTRIPTYLINE 10 MG CAPSULE $ $ 1.00 1.00 51672400201 J8499 NORTRIPTYLINE 25 MG CAPSULE $ $ 1.00 1.00 51672400501 J8499 CARBAMAZEPINE 200 MG TABLET $ $ 1.75 1.75 51672402301 J8499 ACETAZOLAMIDE 250 MG TABLET $ $ 1.69 1.69 51672402504 J8499 AMIODARONE 200 MG TABLET $ $ 59.00 59.00 51672404709 J8499 CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION $ $ 2,118.66 2,118.66 51672413001 J8499 LAMOTRIGINE 25 MG TABLET $ $ 59.00 59.00 51754020301 J3490 VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION $ $ 867.55 867.55 51754020304 J3490 VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION $ $ 867.55 867.55 51862024030 J8499 AMIODARONE 100 MG TABLET $ $ 109.74 109.74

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51862032001 J8499 LIOTHYRONINE 5 MCG TABLET $ $ 59.00 59.00 51862045801 J7515 CYCLOSPORINE MODIFIED 25 MG CAPSULE $ $ 63.97 63.97 51991014499 J2210 METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION $ $ 633.54 633.54 51991029301 J3490 OXCARBAZEPINE 300 MG TABLET $ $ 1.00 1.00 51991031190 J8499 DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED $ $ RELEASE 24 HR 59.00 59.00 51991060401 J8499 ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) $ $ CAPSULE 59.00 59.00 51991079306 J8499 RIVASTIGMINE 1.5 MG CAPSULE $ $ 2.04 2.04 51991079406 J3490 RIVASTIGMINE 3 MG CAPSULE $ $ 2.04 2.04 51991081801 J8499 PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE $ $ 1.00 1.00 51991083801 J8499 CYPROHEPTADINE 4 MG TABLET $ $ 59.00 59.00 51991093498 J3490 LABETALOL 5 MG/ML INTRAVENOUS SOLUTION $ $ 138.00 138.00 52015008001 J8499 FIDAXOMICIN 200 MG TABLET $ $ 4,090.78 4,090.78 52244010010 J3490 THEOPHYLLINE ER 100 MG CAPSULE,EXTENDED RELEASE 24 HR $ $ 128.74 128.74 52268001201 J3490 SODIUM,POTASSIUM,MAG SULFATES 17.5 GRAM‐3.13 GRAM‐1.6 $ $ GRAM ORAL SOLN 2,826.34 2,826.34 52268040001 J8499 PEG‐ELECTROLYTE SOLUTION 420 GRAM ORAL SOLUTION $ $ 479.04 479.04 52544015130 J3490 SILODOSIN 4 MG CAPSULE $ $ 358.60 358.60 52544093107 J1750 IRON DEXTRAN 50 MG/ML INJECTION SOLUTION $ $ 1,223.39 1,223.39

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52817021010 J8499 CYPROHEPTADINE 4 MG TABLET $ $ 59.00 59.00 52817027010 J8499 BISOPROLOL FUMARATE 5 MG TABLET $ $ 1.00 1.00 52817027110 J8499 BISOPROLOL FUMARATE 10 MG TABLET $ $ 1.00 1.00 53270005201 J1571 HEPATITIS B IMMUNE GLOBULIN‐MALTOSE >312 UNIT/ML $ $ INJECTION SOLUTION 5,997.19 5,997.19 53489014501 J8499 SULFAMETHOXAZOLE 400 MG‐TRIMETHOPRIM 80 MG TABLET $ $ 59.00 59.00 53489014601 J8499 SULFAMETHOXAZOLE 800 MG‐TRIMETHOPRIM 160 MG TABLET $ $ 59.00 59.00 53489037601 J8499 TRIMETHOBENZAMIDE 300 MG CAPSULE $ $ 116.20 116.20 53489038601 J8499 MINOXIDIL 2.5 MG TABLET $ $ 1.00 1.00 53746017801 J8499 METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR $ $ 1.00 1.00 53746021901 J8499 METFORMIN 850 MG TABLET $ $ 1.00 1.00 53746025301 J8499 RANITIDINE 150 MG TABLET $ $ 59.00 59.00 53746027101 J8499 SULFAMETHOXAZOLE 400 MG‐TRIMETHOPRIM 80 MG TABLET $ $ 59.00 59.00 53746027201 J8499 SULFAMETHOXAZOLE 800 MG‐TRIMETHOPRIM 160 MG TABLET $ $ 59.00 59.00 53746051101 J8499 SPIRONOLACTONE 25 MG TABLET $ $ 1.00 1.00 53746051501 J8499 SPIRONOLACTONE 100 MG TABLET $ $ 1.02 1.02 53746064101 J8499 FLECAINIDE 50 MG TABLET $ $ 1.00 1.00 53746064201 J8499 FLECAINIDE 100 MG TABLET $ $ 1.00 1.00

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54092018981 J8499 MESALAMINE CR 250 MG CAPSULE,CONTROLLED RELEASE $ $ 178.00 178.00 54092025410 J8499 LANTHANUM 1,000 MG CHEWABLE TABLET $ $ 518.58 518.58 54092047612 J8499 MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE $ $ 404.31 404.31 54162001101 J3490 DIBUCAINE 1 % TOPICAL OINTMENT $ $ 248.15 248.15 54162010002 J3490 BENZOIN‐ALOE VERA‐STORAX‐TOLU BALSAM 10 %‐2 %‐8 %‐4 % $ $ TOPICAL TINCTURE 131.98 131.98 54162060002 J3490 WHITE PETROLATUM‐MINERAL OIL TOPICAL CREAM $ $ 157.89 157.89 54482014701 J1955 LEVOCARNITINE 200 MG/ML INTRAVENOUS SOLUTION $ $ 679.04 679.04 54505033105 J8499 HYDROCORTISONE 5 MG TABLET $ $ 59.00 59.00 54505033210 J8499 HYDROCORTISONE 10 MG TABLET $ $ 59.00 59.00 54643564901 J3490 MVI,ADULT NO.4 WITH VIT K 3300 UNIT‐150 MCG/10 ML $ $ INTRAVENOUS SOLUTION 381.64 381.64 54766014923 J0630 CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION $ $ 138.00 138.00 54838001070 J3490 MULTIVIT AND MINERALS‐FERROUS GLUCONATE 9 MG IRON/15 $ $ ML ORAL LIQUID 257.47 257.47 54838055550 J8499 ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION $ $ 932.49 932.49 55111026281 J8499 OLANZAPINE 5 MG DISINTEGRATING TABLET $ $ 138.97 138.97 55111026379 J8499 OLANZAPINE 10 MG DISINTEGRATING TABLET $ $ 14.21 14.21 55111028050 J8499 LEVOFLOXACIN 500 MG TABLET $ $ 59.00 59.00 55111035260 J8499 RIVASTIGMINE 1.5 MG CAPSULE $ $ 1.00 1.00

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55111035360 J3490 RIVASTIGMINE 3 MG CAPSULE $ $ 1.00 1.00 55111067911 J1652 FONDAPARINUX 5 MG/0.4 ML SUBCUTANEOUS SOLUTION $ $ SYRINGE 1,003.59 1,003.59 55111068852 J3489 ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %‐WATER $ $ INTRAVENOUS PIGGYBCK 896.47 896.47 55150011210 J0290 AMPICILLIN 500 MG SOLUTION FOR INJECTION $ $ 302.00 302.00 55150011310 J0290 AMPICILLIN 1 GRAM SOLUTION FOR INJECTION $ $ 302.00 302.00 55150011420 J0290 AMPICILLIN 2 GRAM SOLUTION FOR INJECTION $ $ 302.00 302.00 55150011620 J0295 AMPICILLIN‐SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION $ $ 302.00 302.00 55150011720 J0295 AMPICILLIN‐SULBACTAM 3 GRAM SOLUTION FOR INJECTION $ $ 302.00 302.00 55150011899 J0295 AMPICILLIN‐SULBACTAM 15 GRAM SOLUTION FOR INJECTION $ $ 650.46 650.46 55150011930 J2543 PIPERACILLIN‐TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION $ $ 302.00 302.00 55150012030 J2543 PIPERACILLIN‐TAZOBACTAM 3.375 GRAM INTRAVENOUS $ $ SOLUTION 305.35 305.35 55150012150 J2543 PIPERACILLIN‐TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION $ $ 371.78 371.78 55150012215 J3490 NAFCILLIN 1 GRAM SOLUTION FOR INJECTION $ $ 375.13 375.13 55150012315 J3490 NAFCILLIN 2 GRAM SOLUTION FOR INJECTION $ $ 499.64 499.64 55150012499 J3490 NAFCILLIN 10 GRAM SOLUTION FOR INJECTION $ $ 2,065.22 2,065.22 55150012502 J2405 ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION $ $ 138.00 138.00 55150015410 J0133 ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION $ $ 302.00 302.00

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55150015520 J0133 ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION $ $ 405.75 405.75 55150016205 J3490 LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION $ $ 138.00 138.00 55150016330 J3490 LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION $ $ 138.00 138.00 55150016710 J3490 BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION $ $ 138.00 138.00 55150016910 J3490 BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION $ $ 138.00 138.00 55150017230 J3490 BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJECTION SOLUTION $ $ 138.00 138.00 55150017301 J3030 SUMATRIPTAN 6 MG/0.5 ML SUBCUTANEOUS SOLUTION $ $ 277.61 277.61 55150017410 J0456 AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION $ $ 302.00 302.00 55150017705 J1953 LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION $ $ 302.00 302.00 55150019410 J3490 ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SOLUTION $ $ 302.00 302.00 55150020200 C9113 PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION $ $ 138.00 138.00 55150020210 C9113 PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION $ $ 138.00 138.00 55150020720 J2185 MEROPENEM 500 MG INTRAVENOUS SOLUTION $ $ 302.00 302.00 55150020830 J2185 MEROPENEM 1 GRAM INTRAVENOUS SOLUTION $ $ 417.21 417.21 55150022099 J1327 EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION $ $ 1,717.60 1,717.60 55150022310 J2800 METHOCARBAMOL 100 MG/ML INJECTION SOLUTION $ $ 224.75 224.75 55150025220 J3490 LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION $ $ 138.00 138.00

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55150028220 J1335 ERTAPENEM 1 GRAM SOLUTION FOR INJECTION $ $ 2,747.86 2,747.86 55150032401 J1940 FUROSEMIDE 10 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 55253080230 J8499 MODAFINIL 200 MG TABLET $ $ 387.31 387.31 55390030803 J0207 AMIFOSTINE CRYSTALLINE 500 MG INTRAVENOUS SOLUTION $ $ 3,387.50 3,387.50 55513002304 J0882 DARBEPOETIN ALFA 60 MCG/0.3 ML IN POLYSORBATE INJECTION $ $ SYRINGE 2,355.97 2,355.97 55513002504 J0882 DARBEPOETIN ALFA 100 MCG/0.5 ML IN POLYSORBATE INJECTION $ $ SYRINGE 3,926.61 3,926.61 55513002801 J0882 DARBEPOETIN ALFA 200 MCG/0.4 ML IN POLYSORBATE INJECTION $ $ SYRINGE 7,853.21 7,853.21 55513005704 J0882 DARBEPOETIN ALFA 25 MCG/0.42 ML IN POLYSORBATE INJECTION $ $ SYRINGE 981.65 981.65 55513007330 J8499 CINACALCET 30 MG TABLET $ $ 1,161.40 1,161.40 55513011101 J0882 DARBEPOETIN ALFA 300 MCG/0.6 ML IN POLYSORBATE INJECTION $ $ SYRINGE 11,779.78 11,779.78 55513014101 Q5117 TRASTUZUMAB‐ANNS 150 MG INTRAVENOUS SOLUTION $ $ 6,977.93 6,977.93 55513019001 J2505 PEGFILGRASTIM 6 MG/0.6 ML SUBCUTANEOUS SYRINGE $ $ 26,554.64 26,554.64 55513019201 J2505 PEGFILGRASTIM 6 MG/0.6 ML (DELIVERABLE) WEARABLE $ $ SUBCUTANEOUS INJECTOR 26,554.64 26,554.64 55513022101 J2796 ROMIPLOSTIM 250 MCG SUBCUTANEOUS SOLUTION $ $ 74,194.52 74,194.52 55513022201 J2796 ROMIPLOSTIM 500 MCG SUBCUTANEOUS SOLUTION $ $ 148,389.03 148,389.03 55513071001 J0897 DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE $ $ 8,351.21 8,351.21 55513073001 J0897 DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS $ $ SOLUTION 11,695.88 11,695.88

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55513095401 J9303 PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS $ $ SOLUTION 6,462.65 6,462.65 55513095601 J9303 PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS $ $ SOLUTION 190,575.85 190,575.85 55566220000 J2597 DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION $ $ 2,018.88 2,018.88 55566230000 J2597 DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION $ $ 18,806.87 18,806.87 55566280000 J3490 DINOPROSTONE ER 10 MG VAGINAL INSERT,CONTROLLED $ $ RELEASE 13,415.12 13,415.12 55566280001 J3490 DINOPROSTONE ER 10 MG VAGINAL INSERT,CONTROLLED $ $ RELEASE 13,415.12 13,415.12 55566830301 J9155 DEGARELIX 80 MG SUBCUTANEOUS SOLUTION $ $ 1,550.94 1,550.94 55566840301 J9155 DEGARELIX 120 MG SUBCUTANEOUS SOLUTION $ $ 2,419.82 2,419.82 57237001830 J8499 DULOXETINE 30 MG CAPSULE,DELAYED RELEASE $ $ 1.00 1.00 57565006310 J3490 GLUCOSE 4 GRAM CHEWABLE TABLET $ $ 85.18 85.18 57664018788 J8499 OXYCODONE 15 MG TABLET $ $ 59.00 59.00 57664022388 J8499 OXYCODONE 5 MG TABLET $ $ 59.00 59.00 57664034788 J8499 CLOZAPINE 100 MG TABLET $ $ 59.00 59.00 57664050389 J8499 TIZANIDINE 4 MG TABLET $ $ 59.00 59.00 57664060088 J8499 ISOSORBIDE DINITRATE ER 40 MG TABLET,EXTENDED RELEASE $ $ 81.67 81.67 57664068331 J2020 LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML $ $ INTRAVENOUS PIGGYBACK 837.68 837.68 57664076188 J8499 HYDROXYCHLOROQUINE 200 MG TABLET $ $ 1.00 1.00

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57665010141 J0287 AMPHOTERICIN B LIPID COMPLEX 5 MG/ML INTRAVENOUS $ $ SUSPENSION 3,545.86 3,545.86 57894003001 J1745 INFLIXIMAB 100 MG INTRAVENOUS SOLUTION $ $ 6,168.29 6,168.29 57894005427 J3358 USTEKINUMAB 130 MG/26 ML INTRAVENOUS SOLUTION $ $ 45,624.33 45,624.33 57894006103 J3357 USTEKINUMAB 90 MG/ML SUBCUTANEOUS SYRINGE $ $ 870,694.33 870,694.33 57894035001 J1602 GOLIMUMAB 12.5 MG/ML INTRAVENOUS SOLUTION $ $ 70,923.63 70,923.63 57894050205 J9145 DARATUMUMAB 20 MG/ML INTRAVENOUS SOLUTION $ $ 2,871.09 2,871.09 57894050220 J9145 DARATUMUMAB 20 MG/ML INTRAVENOUS SOLUTION $ $ 11,484.33 11,484.33 57896045208 SENNOSIDES 8.8 MG/5 ML ORAL SYRUP $ $ 574.17 574.17 57970010001 J0875 DALBAVANCIN 500 MG INTRAVENOUS SOLUTION $ $ 37,899.41 37,899.41 58160082043 90744 HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM $ $ SYRINGE 994.25 994.25 58160082052 90744 HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM $ $ SYRINGE 994.25 994.25 58160082311 90750 VARICELLA‐ZOSTER GLYCOE VACC‐AS01B ADJ(PF) 50 MCG/0.5 ML $ $ IM SUSP, KIT 5,434.00 5,434.00 58160089641 90686 FLU VACCINE QS 2019‐20(6 MOS UP)(PF)60 MCG(15 MCGX4)/0.5 $ $ ML IM SYRINGE 630.02 630.02 58160096412 90675 RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT $ $ IM SUSP 14,300.55 14,300.55 58281056201 J0476 BACLOFEN 50 MCG/ML INTRATHECAL SOLUTION $ $ 3,093.16 3,093.16 58468002101 J8499 SEVELAMER HCL 800 MG TABLET $ $ 9.27 9.27 58468004101 J0180 AGALSIDASE BETA 5 MG INTRAVENOUS SOLUTION $ $ 34,789.64 34,789.64

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58468013001 J8499 SEVELAMER CARBONATE 800 MG TABLET $ $ 275.88 275.88 59011041020 J8499 OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED $ $ RELEASE 12 HR 203.50 203.50 59011042020 J8499 OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED $ $ RELEASE 12 HR 316.08 316.08 59011044020 J8499 OXYCODONE ER 40 MG TABLET,CRUSH RESISTANT,EXTENDED $ $ RELEASE 12 HR 478.13 478.13 59148000613 J8499 ARIPIPRAZOLE 2 MG TABLET $ $ 1,284.18 1,284.18 59148000913 J8499 ARIPIPRAZOLE 15 MG TABLET $ $ 39.06 39.06 59148001013 J3490 ARIPIPRAZOLE 20 MG TABLET $ $ 55.23 55.23 59148002050 J8499 TOLVAPTAN 15 MG TABLET $ $ 626.61 626.61 59212042204 J8499 PHENOBARB‐HYOSCY‐ATROPINE‐SCOP 16.2 MG‐0.1037 MG‐ $ $ 0.0194 MG/5 ML ELIXIR 15,621.85 15,621.85 59310061031 J2786 RESLIZUMAB 10 MG/ML INTRAVENOUS SOLUTION $ $ 26,837.18 26,837.18 59338077501 Q0139 FERUMOXYTOL 510 MG/17 ML (30 MG/ML) INTRAVENOUS $ $ SOLUTION 4,912.26 4,912.26 59365503000 J3490 OXYQUINOLINE 0.025 %‐SODIUM LAURYL SULFATE 0.01 % $ $ VAGINAL GEL 869.18 869.18 59390019205 J3490 HOMATROPINE 5 % EYE DROPS $ $ 900.60 900.60 59572010201 J9025 AZACITIDINE 100 MG SOLUTION FOR INJECTION $ $ 23,541.79 23,541.79 59572098301 J9315 ROMIDEPSIN 10 MG/2 ML INTRAVENOUS SOLUTION $ $ 15,865.48 15,865.48 59676031000 Q4081 EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION $ $ 762.64 762.64 59676032000 Q4081 EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION $ $ 2,824.57 2,824.57

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59676034000 Q4081 EPOETIN ALFA 40,000 UNIT/ML INJECTION SOLUTION $ $ 5,649.14 5,649.14 59676096001 Q2050 DOXORUBICIN, PEGYLATED LIPOSOMAL 2 MG/ML INTRAVENOUS $ $ SUSPENSION 6,600.16 6,600.16 59676096002 Q2050 DOXORUBICIN, PEGYLATED LIPOSOMAL 2 MG/ML INTRAVENOUS $ $ SUSPENSION 16,500.38 16,500.38 59676096601 Q2050 DOXORUBICIN, PEGYLATED LIPOSOMAL 2 MG/ML INTRAVENOUS $ $ SUSPENSION 4,114.00 4,114.00 59730420201 90371 HEPATITIS B IMMUNE GLOBULIN GREATR THAN 312 UNIT/ML $ $ INTRAMUSCULAR SOLN 5,518.55 5,518.55 59741030106 J8499 HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY $ $ 96.49 96.49 59741030112 J8499 HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY $ $ 96.49 96.49 59746000106 J7509 METHYLPREDNISOLONE 4 MG TABLET $ $ 59.00 59.00 59746011306 J8597 PROCHLORPERAZINE MALEATE 5 MG TABLET $ $ 59.00 59.00 59746012106 J8499 MECLIZINE 25 MG TABLET $ $ 1.00 1.00 59746017506 J7512 PREDNISONE 20 MG TABLET $ $ 1.00 1.00 59746030712 J8499 OLANZAPINE 10 MG DISINTEGRATING TABLET $ $ 8.57 8.57 59746032430 J8499 VALACYCLOVIR 500 MG TABLET $ $ 59.00 59.00 59746036190 J8499 VALSARTAN 80 MG TABLET $ $ 1.00 1.00 59762054001 J8499 GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR $ $ 1.00 1.00 59762054101 J8499 GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR $ $ 1.00 1.00 59762080002 J8499 TOLTERODINE 2 MG TABLET $ $ 160.07 160.07

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59762081101 J8499 NADOLOL 40 MG TABLET $ $ 141.89 141.89 59762151601 J8499 CELECOXIB 100 MG CAPSULE $ $ 78.88 78.88 59762151701 J8499 CELECOXIB 200 MG CAPSULE $ $ 107.47 107.47 59762171002 J8499 EPLERENONE 25 MG TABLET $ $ 5.80 5.80 59762371803 J8499 TRIAZOLAM 0.25 MG TABLET $ $ 88.68 88.68 59762444003 J7509 METHYLPREDNISOLONE 4 MG TABLET $ $ 77.09 77.09 59762453802 J1050 MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR $ $ SYRINGE 1,900.20 1,900.20 59762490003 J8499 SERTRALINE 50 MG TABLET $ $ 1.00 1.00 59762500001 J8499 SULFASALAZINE 500 MG TABLET $ $ 1.00 1.00 59762503201 J8499 GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR $ $ 1.00 1.00 59762669008 J8499 NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR $ $ 1.69 1.69 59781066688 J3490 ARGININE 7 GRAM‐GLUTAM 7 GRAM‐CAHMB 1.5 GRAM‐COLLA‐ $ $ MV‐MIN ORAL PWD PKT 139.97 139.97 59923060110 J2430 PAMIDRONATE 30 MG INTRAVENOUS SOLUTION $ $ 900.36 900.36 60258000601 J8499 POTASSIUM, SODIUM PHOSPHATES 280 MG‐160 MG‐250 MG $ $ ORAL POWDER PACKET 59.00 59.00 60258000615 J8499 POTASSIUM, SODIUM PHOSPHATES 280 MG‐160 MG‐250 MG $ $ ORAL POWDER PACKET 59.00 59.00 60258095106 J3490 SENNOSIDES 8.6 MG‐DOCUSATE SODIUM 50 MG TABLET $ $ 1.00 1.00 60267070550 J3490 SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) $ $ INTRAVENOUS SOLUTION 482.38 482.38

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60429017705 J8499 BICALUTAMIDE 50 MG TABLET $ $ 1.00 1.00 60432015004 J8499 HYDROXYZINE HCL 10 MG/5 ML ORAL SOLUTION $ $ 405.11 405.11 60432053760 J3490 NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION $ $ 675.45 675.45 60505005501 J8499 SELEGILINE 5 MG CAPSULE $ $ 1.01 1.01 60505008000 J8499 SOTALOL 80 MG TABLET $ $ 1.00 1.00 60505013300 J7515 CYCLOSPORINE 25 MG CAPSULE $ $ 113.57 113.57 60505013400 J7502 CYCLOSPORINE 100 MG CAPSULE $ $ 312.61 312.61 60505040205 J3490 PAROXETINE 10 MG/5 ML ORAL SUSPENSION $ $ 12,704.54 12,704.54 60505070610 J3490 NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH $ $ 126.28 126.28 60505070620 J3490 NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH $ $ 102.36 102.36 60505076900 J0690 CEFAZOLIN 10 GRAM SOLUTION FOR INJECTION $ $ 660.00 660.00 60505079600 J1650 ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE $ $ 665.20 665.20 60505082901 J3490 FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL $ $ SPRAY,SUSPENSION 132.86 132.86 60505100301 J3490 KETOROLAC 0.5 % EYE DROPS $ $ 360.08 360.08 60505132101 J8499 MIDODRINE 5 MG TABLET $ $ 110.02 110.02 60505252201 J8499 CILOSTAZOL 100 MG TABLET $ $ 1.00 1.00 60505265601 J8499 TRIAMTERENE 37.5 MG‐HYDROCHLOROTHIAZIDE 25 MG TABLET $ $ 1.00 1.00

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60505267303 J8499 ARIPIPRAZOLE 5 MG TABLET $ $ 3.05 3.05 60505296607 J7518 MYCOPHENOLATE SODIUM 360 MG TABLET,DELAYED RELEASE $ $ 146.42 146.42 60505317007 J3490 OMEGA‐3 ACID ETHYL ESTERS 1 GRAM CAPSULE $ $ 1.00 1.00 60505612800 J9206 IRINOTECAN 40 MG/2 ML INTRAVENOUS SOLUTION $ $ 138.00 138.00 60505613000 J2405 ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION $ $ 138.00 138.00 60505614200 J0690 CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION $ $ 302.00 302.00 60505614600 J0692 CEFEPIME 1 GRAM SOLUTION FOR INJECTION $ $ 305.55 305.55 60505614604 J0692 CEFEPIME 1 GRAM SOLUTION FOR INJECTION $ $ 302.00 302.00 60505614700 J0692 CEFEPIME 2 GRAM SOLUTION FOR INJECTION $ $ 401.76 401.76 60505614800 J0696 CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION $ $ 302.00 302.00 60505614804 J0696 CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION $ $ 302.00 302.00 60505614900 J0696 CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION $ $ 302.00 302.00 60505614904 J0696 CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION $ $ 302.00 302.00 60687011511 J8499 BENZONATATE 100 MG CAPSULE $ $ 1.00 1.00 60687012811 J8499 VALSARTAN 80 MG TABLET $ $ 1.14 1.14 60687015695 J8499 PHENYTOIN 50 MG CHEWABLE TABLET $ $ 66.49 66.49 60687019511 J8499 DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR $ $ 1.00 1.00

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60687020611 J8499 DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR $ $ 59.00 59.00 60687021011 J8499 SIMVASTATIN 40 MG TABLET $ $ 1.00 1.00 60687021711 J8499 DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR $ $ 1.00 1.00 60687022911 J8499 LOPERAMIDE 2 MG CAPSULE $ $ 59.00 59.00 60687023111 J8499 SERTRALINE 25 MG TABLET $ $ 1.00 1.00 60687023411 J8499 ROSUVASTATIN 5 MG TABLET $ $ 1.43 1.43 60687024201 J8499 SERTRALINE 50 MG TABLET $ $ 1.00 1.00 60687024211 J8499 SERTRALINE 50 MG TABLET $ $ 1.00 1.00 60687024511 J8499 ROSUVASTATIN 10 MG TABLET $ $ 89.22 89.22 60687032511 J8499 LISINOPRIL 10 MG TABLET $ $ 1.00 1.00 60687032711 J8499 QUETIAPINE 25 MG TABLET $ $ 59.00 59.00 60687033011 J8499 TOLTERODINE ER 4 MG CAPSULE,EXTENDED RELEASE 24 HR $ $ 11.59 11.59 60687033311 J8499 LISINOPRIL 20 MG TABLET $ $ 1.00 1.00 60687034611 J8499 BENZONATATE 100 MG CAPSULE $ $ 1.00 1.00 60687036811 J8499 BENZTROPINE 1 MG TABLET $ $ 59.00 59.00 60687036911 J8499 DICYCLOMINE 10 MG CAPSULE $ $ 59.00 59.00 60687039811 J8499 MIDODRINE 5 MG TABLET $ $ 62.89 62.89

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60687042411 J8499 METRONIDAZOLE 500 MG TABLET $ $ 59.00 59.00 60687045411 J8499 TRAZODONE 100 MG TABLET $ $ 59.00 59.00 60758080105 J3490 TIMOLOL MALEATE 0.5 % EYE DROPS $ $ 199.60 199.60 60758080205 J3490 TIMOLOL MALEATE 0.25 % EYE DROPS $ $ 103.40 103.40 60758090810 J3490 POLYMYXIN B SULFATE 10,000 UNIT‐TRIMETHOPRIM 1 MG/ML $ $ EYE DROPS 324.16 324.16 60793060102 J0558 PENICILLIN G BENZATHINE AND PROCAINE 1,200,000 UNIT/2 ML $ $ IM SYRINGE 4,730.84 4,730.84 60793070001 J0561 PENICILLIN G BENZATHINE 600,000 UNIT/ML INTRAMUSCULAR $ $ SYRINGE 3,426.34 3,426.34 60793070102 J0561 PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML $ $ INTRAMUSCULAR SYRINGE 5,934.99 5,934.99 60977014127 J2730 PRALIDOXIME 1 GRAM SOLUTION FOR INJECTION $ $ 19,779.97 19,779.97 61314001601 J3490 PROPARACAINE 0.5 % EYE DROPS $ $ 1,118.56 1,118.56 61314004475 J3490 TRIFLURIDINE 1 % EYE DROPS $ $ 4,861.36 4,861.36 61314012605 J3490 KETOROLAC 0.5 % EYE DROPS $ $ 669.46 669.46 61314014305 J3490 BRIMONIDINE 0.2 % EYE DROPS $ $ 222.36 222.36 61314020315 J3490 PILOCARPINE 1 % EYE DROPS $ $ 2,955.68 2,955.68 61314022705 J3490 TIMOLOL MALEATE 0.5 % EYE DROPS $ $ 363.68 363.68 61314031201 Q5101 FILGRASTIM‐SNDZ 480 MCG/0.8 ML INJECTION SYRINGE $ $ 1,391.92 1,391.92 61314031805 Q5101 FILGRASTIM‐SNDZ 300 MCG/0.5 ML INJECTION SYRINGE $ $ 797.44 797.44

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61314031810 Q5101 FILGRASTIM‐SNDZ 300 MCG/0.5 ML INJECTION SYRINGE $ $ 797.44 797.44 61314032605 Q5101 FILGRASTIM‐SNDZ 480 MCG/0.8 ML INJECTION SYRINGE $ $ 1,275.89 1,275.89 61314035501 J3490 TROPICAMIDE 1 % EYE DROPS $ $ 384.43 384.43 61314054701 J3490 LATANOPROST 0.005 % EYE DROPS $ $ 247.91 247.91 61314063136 J3490 NEOMYCIN 3.5 MG/G‐POLYMYXIN B 10,000 UNIT/G‐DEXAMETH $ $ 0.1 % EYE OINT 658.23 658.23 61314063705 J3490 PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION $ $ 1,403.19 1,403.19 61314064175 J3490 NEOMYCIN 3.5 MG‐POLYMYXIN 10,000 UNIT‐HYDROCORT 10 $ $ MG/ML EYE DROP,SUSP 4,158.97 4,158.97 61314067225 J3490 GATIFLOXACIN 0.5 % EYE DROPS $ $ 968.86 968.86 61364018101 J2547 PERAMIVIR (PF) 200 MG/20 ML (10 MG/ML) INTRAVENOUS $ $ SOLUTION 12,123.87 12,123.87 61553008041 J7999 CALCIUM GLUCONATE 1 GRAM/50 ML IN DEXTROSE 5% IV $ $ 670.02 670.02 61553011148 J3010 FENTANYL (PF) 10 MCG/ML IN 0.9 % SODIUM CHLORIDE $ $ INTRAVENOUS 897.56 897.56 61553019648 J7999 MIDAZOLAM 1 MG/ML IN 0.9 % SODIUM CHLORIDE $ $ INTRAVENOUS 1,173.01 1,173.01 61553020437 J3490 FENTANYL (PF) 2 MCG/ML‐BUPIVACAINE 0.125 %‐NACL INJECTION $ $ SOLUTION 1,105.15 1,105.15 61553029111 J3490 POTASSIUM PHOSPHATE 15 MMOL/250 ML IN 0.9 % SODIUM $ $ CHLORIDE IV SOLN 501.56 501.56 61553061975 J7999 MORPHINE 50 MG/50 ML (1 MG/ML) IN 0.9 % SODIUM CHLORIDE $ $ IV PCA SYRINGE 691.98 691.98 61553066976 J7999 FENTANYL (PF) 1,100 MCG/55 ML (20 MCG/ML) IN 0.9 % NACL $ $ PCA SYRINGE 565.43 565.43 61553068176 J7999 HYDROMORPHONE 11 MG/55 ML IN 0.9 % SODIUM CHLORIDE $ $ PCA SYRINGE 523.71 523.71

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61553071648 J7999 SODIUM PHOSPHATE 7.5 MMOL/100 ML IN 0.9 % SODIUM $ $ CHLORIDE IV SOLUTION 657.65 657.65 61553071811 J7999 SODIUM PHOSPHATE 15 MMOL/250 ML IN 0.9 % SODIUM $ $ CHLORIDE IV SOLUTION 990.98 990.98 61553072111 J7999 AMIODARONE 450 MG/250 ML (1.8 MG/ML) IN DEXTROSE 5 % $ $ INTRAVENOUS SOLN 1,248.46 1,248.46 61553072548 J7999 AMIODARONE 150 MG/100 ML (1.5 MG/ML) IN DEXTROSE 5 % $ $ INTRAVENOUS SOLN 661.64 661.64 61553072648 J7999 FUROSEMIDE 100 MG/100 ML (1 MG/ML) IN 0.9 % SOD CHLORIDE $ $ IV PIGGYBACK 1,674.01 1,674.01 61553073503 J7999 OXYTOCIN 30 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE $ $ INTRAVENOUS 857.64 857.64 61553076904 J2590 OXYTOCIN IN LACTATED RINGERS 20 UNIT/1,000 ML $ $ INTRAVENOUS SOLUTION 777.80 777.80 61553089411 J3490 NICARDIPINE 40 MG/200 ML IN SODIUM CHLORIDE(ISO) $ $ INTRAVENOUS PIGGYBACK 7,392.95 7,392.95 61703030906 J9370 VINCRISTINE 1 MG/ML INTRAVENOUS SOLUTION $ $ 138.00 138.00 61703030916 J9370 VINCRISTINE 2 MG/2 ML INTRAVENOUS SOLUTION $ $ 561.84 561.84 61703032322 J9040 BLEOMYCIN 30 UNIT SOLUTION FOR INJECTION $ $ 3,553.44 3,553.44 61703033950 J9045 CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION $ $ 182.93 182.93 61703034250 J9267 PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS $ $ 318.97 318.97 61703035037 J9250 METHOTREXATE SODIUM 25 MG/ML INJECTION SOLUTION $ $ 367.43 367.43 61755000801 J9119 CEMIPLIMAB‐RWLC 50 MG/ML INTRAVENOUS SOLUTION $ $ 49,322.00 49,322.00 61787006204 J3490 DEXTROMETHORPHAN‐GUAIFENESIN 10 MG‐100 MG/5 ML ORAL $ $ LIQUID 7.39 7.39 61924017404 J3490 WHITE PETROLATUM‐MINERAL OIL TOPICAL CREAM $ $ 169.27 169.27

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61953000403 J1572 IMMUNE GLOB,GAMM(IGG) 5 %‐SORB‐IGA 0 TO 50 MCG/ML $ $ INTRAVENOUS SOLUTION 18,186.92 18,186.92 61953000404 J1572 IMMUNE GLOB,GAMM(IGG) 5 %‐SORB‐IGA 0 TO 50 MCG/ML $ $ INTRAVENOUS SOLUTION 36,194.83 36,194.83 61958070101 J8499 EMTRICITABINE 200 MG‐TENOFOVIR DISOPROXIL FUMARATE 300 $ $ MG TABLET 2,611.51 2,611.51 61958100301 J8499 RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR $ $ 8.20 8.20 62037083001 J8499 METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE $ $ 24 HR 1.00 1.00 62327033303 C9399 STERILE TALC 3 GRAM INTRAPLEURAL AEROSOL POWDER $ $ 4,990.00 4,990.00 62332000131 J8499 FAMOTIDINE 20 MG TABLET $ $ 1.00 1.00 62332038630 J8499 MODAFINIL 200 MG TABLET $ $ 59.00 59.00 62559013807 J8499 HYDROCORTISONE 100 MG/60 ML ENEMA $ $ 238.24 238.24 62559015304 J8499 OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL $ $ 13,203.98 13,203.98 62559021052 J8499 NIMODIPINE 30 MG CAPSULE $ $ 2.09 2.09 62559043130 J3490 HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL $ $ APPLICATOR 2,628.74 2,628.74 62584046711 J8499 ATENOLOL 50 MG TABLET $ $ 59.00 59.00 62584071311 J8499 ALLOPURINOL 300 MG TABLET $ $ 1.00 1.00 62584089711 J8499 FOLIC ACID 1 MG TABLET $ $ 1.00 1.00 62756018488 J3490 OXCARBAZEPINE 300 MG TABLET $ $ 1.11 1.11 62756045983 J0571 BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET $ $ 72.15 72.15

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62756051183 J8499 LETROZOLE 2.5 MG TABLET $ $ 59.00 59.00 62756051788 J8499 CARBIDOPA 10 MG‐LEVODOPA 100 MG TABLET $ $ 59.00 59.00 62756052069 J8499 SUMATRIPTAN 25 MG TABLET $ $ 59.00 59.00 62756052169 J8499 SUMATRIPTAN 50 MG TABLET $ $ 114.21 114.21 62756052940 J2597 DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION $ $ 13,673.16 13,673.16 62756079688 J8499 DIVALPROEX 125 MG TABLET,DELAYED RELEASE $ $ 1.00 1.00 62756079788 J8499 DIVALPROEX 250 MG TABLET,DELAYED RELEASE $ $ 59.00 59.00 62856038901 J9179 ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION $ $ 46,626.56 46,626.56 62856079701 J2469 PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION $ $ 7,511.35 7,511.35 63020004901 J9041 BORTEZOMIB 3.5 MG SOLUTION FOR INJECTION $ $ 8,688.26 8,688.26 63029850401 J3490 BENZOCAINE 20 %‐MENTHOL 0.5 % TOPICAL AEROSOL $ $ 221.32 221.32 63304009711 J8499 SUMATRIPTAN 25 MG TABLET $ $ 134.37 134.37 63304009811 J8499 SUMATRIPTAN 50 MG TABLET $ $ 59.00 59.00 63323001002 J1580 GENTAMICIN 40 MG/ML INJECTION SOLUTION $ $ 302.00 302.00 63323001020 J1580 GENTAMICIN 40 MG/ML INJECTION SOLUTION $ $ 941.48 941.48 63323001201 J2590 OXYTOCIN 10 UNIT/ML INJECTION SOLUTION $ $ 302.00 302.00 63323001302 J3411 THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION $ $ 496.53 496.53

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63323004401 J3420 CYANOCOBALAMIN (VIT B‐12) 1,000 MCG/ML INJECTION $ $ SOLUTION 336.53 336.53 63323006402 J3475 MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJECTION SOLUTION $ $ 138.00 138.00 63323006410 J3475 MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJECTION SOLUTION $ $ 138.00 138.00 63323008950 J3490 SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS $ $ SOLUTION 970.06 970.06 63323010605 J3475 MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER $ $ INTRAVENOUS PIGGYBACK 751.86 751.86 63323011720 J9190 FLUOROURACIL 1 GRAM/20 ML INTRAVENOUS SOLUTION $ $ 138.00 138.00 63323012020 J9100 CYTARABINE (PF) 2 GRAM/20 ML (100 MG/ML) INJECTION $ $ SOLUTION 138.00 138.00 63323013011 J3490 DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR $ $ SOLUTION 1,461.36 1,461.36 63323013610 J9040 BLEOMYCIN 15 UNIT SOLUTION FOR INJECTION $ $ 1,263.63 1,263.63 63323014010 J9065 CLADRIBINE 10 MG/10 ML INTRAVENOUS SOLUTION $ $ 985.25 985.25 63323014397 J3490 TRACE ELEMENTS #1 5.33 MCG‐0.34 MG‐0.54 MG/ML $ $ INTRAVENOUS SOLUTION 603.60 603.60 63323016501 J1100 DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION $ $ SOLUTION 138.00 138.00 63323016502 J1100 DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION $ $ SOLUTION 138.00 138.00 63323017005 J3490 SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION $ $ 546.71 546.71 63323017302 J1580 GENTAMICIN SULFATE (PEDIATRIC) (PF) 20 MG/2 ML INJECTION $ $ SOLUTION 326.47 326.47 63323018001 J3415 PYRIDOXINE (VITAMIN B6) 100 MG/ML INJECTION SOLUTION $ $ 606.79 606.79 63323018410 J3490 FOLIC ACID 5 MG/ML INJECTION SOLUTION $ $ 1,880.00 1,880.00

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63323018520 WATER FOR INJECTION, STERILE INJECTION SOLUTION $ $ 138.00 138.00 63323018730 J7131 SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION $ $ 189.23 189.23 63323020110 J3490 LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION $ $ 138.00 138.00 63323022133 J3370 VANCOMYCIN 500 MG INTRAVENOUS SOLUTION $ $ 302.00 302.00 63323022905 J2720 PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION $ $ 462.08 462.08 63323025410 J3490 MINERAL OIL (STERILE) $ $ 18.24 18.24 63323027810 J9360 VINBLASTINE 1 MG/ML INTRAVENOUS SOLUTION $ $ 220.44 220.44 63323028611 J2795 ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION $ $ 234.73 234.73 63323028620 J2795 ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION $ $ 204.40 204.40 63323028631 J2795 ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION $ $ 306.59 306.59 63323028720 J2795 ROPIVACAINE (PF) 7.5 MG/ML (0.75 %) INJECTION SOLUTION $ $ 290.62 290.62 63323030030 J2543 PIPERACILLIN‐TAZOBACTAM 3.375 GRAM INTRAVENOUS $ $ SOLUTION 732.74 732.74 63323030602 J3260 TOBRAMYCIN 40 MG/ML INJECTION SOLUTION $ $ 348.19 348.19 63323030630 J3260 TOBRAMYCIN 40 MG/ML INJECTION SOLUTION $ $ 1,277.20 1,277.20 63323031119 J0610 CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS $ $ SOLUTION 295.81 295.81 63323031801 J1626 GRANISETRON (PF) 1 MG/ML (1 ML) INTRAVENOUS SOLUTION $ $ 175.25 175.25 63323032510 J0133 ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION $ $ 887.98 887.98

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63323032520 J0133 ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION $ $ 1,498.76 1,498.76 63323032620 J0692 CEFEPIME 1 GRAM SOLUTION FOR INJECTION $ $ 397.41 397.41 63323032621 J0692 CEFEPIME 1 GRAM SOLUTION FOR INJECTION $ $ 397.41 397.41 63323034125 J0694 CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION $ $ 419.28 419.28 63323035120 J3490 RIFAMPIN 600 MG INTRAVENOUS SOLUTION $ $ 5,770.84 5,770.84 63323036019 J0610 CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS $ $ SOLUTION 387.23 387.23 63323037805 J2354 OCTREOTIDE ACETATE 200 MCG/ML INJECTION SOLUTION $ $ 1,366.62 1,366.62 63323041112 J2250 MIDAZOLAM 1 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 63323041118 J2250 MIDAZOLAM 1 MG/ML INJECTION SOLUTION $ $ 167.07 167.07 63323041125 J2250 MIDAZOLAM 1 MG/ML INJECTION SOLUTION $ $ 167.07 167.07 63323042405 J3490 FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION $ $ 255.29 255.29 63323045400 J2270 MORPHINE 4 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 63323046357 J3490 BUPIVACAINE‐EPINEPHRINE 0.5 %‐1:200,000 INJECTION $ $ SOLUTION 373.26 373.26 63323046837 J3490 BUPIVACAINE‐EPINEPHRINE (PF) 0.25 %‐1:200,000 INJECTION $ $ SOLUTION 217.97 217.97 63323047400 J1630 HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION $ $ 231.58 231.58 63323047401 J1630 HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION $ $ 231.58 231.58 63323047827 J2400 CHLOROPROCAINE (PF) 30 MG/ML (3 %) INJECTION SOLUTION $ $ 843.12 843.12

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63323048157 J3490 LIDOCAINE‐EPINEPHRINE 0.5 %‐1:200,000 INJECTION SOLUTION $ $ 171.66 171.66 63323048303 J3490 LIDOCAINE 20 MG/ML (2 %)‐EPINEPHRINE 1:100,000 INJECTION $ $ SOLUTION 138.00 138.00 63323048457 J3490 LIDOCAINE HCL 5 MG/ML (0.5 %) INJECTION SOLUTION $ $ 155.69 155.69 63323048617 J3490 LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION $ $ 138.00 138.00 63323048837 J3490 LIDOCAINE‐EPINEPHRINE (PF) 1.5 %‐1:200,000 INJECTION $ $ SOLUTION 384.43 384.43 63323048927 J3490 LIDOCAINE‐EPINEPHRINE (PF) 2 %‐1:200,000 INJECTION $ $ SOLUTION 444.71 444.71 63323049227 J3490 LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION $ $ 138.00 138.00 63323049237 J3490 LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION $ $ 289.82 289.82 63323049257 J3490 LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION $ $ 138.00 138.00 63323049401 J3490 VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS $ $ SOLUTION 138.00 138.00 63323049405 J3490 VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS $ $ SOLUTION 138.00 138.00 63323049507 J3490 LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION $ $ 138.00 138.00 63323049527 J3490 LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION $ $ 138.00 138.00 63323050601 J1100 DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML $ $ INJECTION SOLUTION 138.00 138.00 63323050830 J2185 MEROPENEM 1 GRAM INTRAVENOUS SOLUTION $ $ 1,153.05 1,153.05 63323051610 J1100 DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION $ $ SOLUTION 138.00 138.00 63323054001 J1644 HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION $ $ 192.10 192.10

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63323054201 J1644 HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION $ $ 371.62 371.62 63323054302 J1644 HEPARIN, PORCINE (PF) 5,000 UNIT/0.5 ML INJECTION SOLUTION $ $ 213.88 213.88 63323056990 J1650 ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE $ $ 1,161.55 1,161.55 63323059710 J0895 DEFEROXAMINE 500 MG SOLUTION FOR INJECTION $ $ 695.57 695.57 63323061400 J0360 HYDRALAZINE 20 MG/ML INJECTION SOLUTION $ $ 522.16 522.16 63323061401 J0360 HYDRALAZINE 20 MG/ML INJECTION SOLUTION $ $ 522.16 522.16 63323061416 J0360 HYDRALAZINE 20 MG/ML INJECTION SOLUTION $ $ 522.12 522.12 63323061455 J0360 HYDRALAZINE 20 MG/ML INJECTION SOLUTION $ $ 522.16 522.16 63323064907 J3490 LEVOTHYROXINE 100 MCG INTRAVENOUS POWDER FOR $ $ SOLUTION 3,981.23 3,981.23 63323064921 J3490 LEVOTHYROXINE 100 MCG INTRAVENOUS POWDER FOR $ $ SOLUTION 3,406.78 3,406.78 63323065104 J0153 ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION $ $ 304.83 304.83 63323065121 J0153 ADENOSINE 3 MG/ML INTRAVENOUS SYRINGE $ $ 774.29 774.29 63323066401 J1200 DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 63323069030 J3490 ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION $ $ 1,193.37 1,193.37 63323069310 J3490 ACETYLCYSTEINE 100 MG/ML (10 %) SOLUTION $ $ 636.89 636.89 63323069404 J3490 ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION $ $ 801.92 801.92 63323071050 J0640 LEUCOVORIN CALCIUM 200 MG SOLUTION FOR INJECTION $ $ 138.00 138.00

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63323073912 J3490 FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION $ $ 138.00 138.00 63323087715 J2545 PENTAMIDINE 300 MG SOLUTION FOR INHALATION $ $ 6,473.19 6,473.19 63323096505 J3480 POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION $ $ 154.50 154.50 63323096510 J3480 POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION $ $ 138.00 138.00 63323096520 J3480 POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION $ $ 164.48 164.48 63323096600 J3489 ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %‐WATER $ $ INTRAVENOUS PIGGYBCK 650.95 650.95 63323096730 J3480 POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION $ $ 146.11 146.11 63402030630 J8499 LURASIDONE 60 MG TABLET $ $ 1,726.11 1,726.11 63402051530 J3490 LEVALBUTEROL CONCENTRATE 1.25 MG/0.5 ML SOLUTION FOR $ $ NEBULIZATION 321.25 321.25 63459034804 J9034 BENDAMUSTINE 25 MG/ML INTRAVENOUS SOLUTION $ $ 13,040.16 13,040.16 63459091011 J1447 TBO‐FILGRASTIM 300 MCG/0.5 ML SUBCUTANEOUS SYRINGE $ $ 1,201.56 1,201.56 63459091012 J1447 TBO‐FILGRASTIM 300 MCG/0.5 ML SUBCUTANEOUS SYRINGE $ $ 1,201.56 1,201.56 63459091211 J1447 TBO‐FILGRASTIM 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE $ $ 1,923.02 1,923.02 63459091212 J1447 TBO‐FILGRASTIM 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE $ $ 1,923.02 1,923.02 63481068447 J3490 DICLOFENAC 1 % TOPICAL GEL $ $ 2,031.93 2,031.93 63736012002 J3490 PERMETHRIN 1 % TOPICAL LIQUID $ $ 421.60 421.60 63739001510 J8499 DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR $ $ 59.00 59.00

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63739002910 J8499 BENZONATATE 100 MG CAPSULE $ $ 1.00 1.00 63739004710 J8499 CARBIDOPA 25 MG‐LEVODOPA 100 MG TABLET $ $ 1.00 1.00 63739004810 J8499 CARBIDOPA 25 MG‐LEVODOPA 250 MG TABLET $ $ 59.00 59.00 63739004910 J8499 CARISOPRODOL 350 MG TABLET $ $ 59.00 59.00 63739005910 J8499 CLINDAMYCIN HCL 150 MG CAPSULE $ $ 59.00 59.00 63739006010 J8499 CLONIDINE HCL 0.1 MG TABLET $ $ 59.00 59.00 63739007910 J8499 DILTIAZEM 30 MG TABLET $ $ 1.00 1.00 63739008010 J8499 DILTIAZEM 60 MG TABLET $ $ 1.00 1.00 63739010310 J8499 METOCLOPRAMIDE 5 MG TABLET $ $ 1.00 1.00 63739012610 J8499 HYDRALAZINE 25 MG TABLET $ $ 1.00 1.00 63739012710 J8499 HYDRALAZINE 50 MG TABLET $ $ 1.00 1.00 63739012810 J8499 HYDROCHLOROTHIAZIDE 25 MG TABLET $ $ 1.00 1.00 63739016610 J8499 METHOCARBAMOL 500 MG TABLET $ $ 1.00 1.00 63739020110 J8499 PHENOBARBITAL 32.4 MG TABLET $ $ 1.00 1.00 63739022810 J8499 SULFAMETHOXAZOLE 800 MG‐TRIMETHOPRIM 160 MG TABLET $ $ 59.00 59.00 63739023610 J8499 GABAPENTIN 300 MG CAPSULE $ $ 1.00 1.00 63739026310 J8499 CLONAZEPAM 0.5 MG TABLET $ $ 59.00 59.00

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63739027510 J8499 HYDROMORPHONE 2 MG TABLET $ $ 59.00 59.00 63739029101 J8499 CALCIUM CARBONATE 500 MG (1,250 MG)‐VITAMIN D3 200 UNIT $ $ TABLET 1.00 1.00 63739034910 J8499 LISINOPRIL 10 MG TABLET $ $ 1.00 1.00 63739035010 J8499 LISINOPRIL 20 MG TABLET $ $ 1.00 1.00 63739035410 J8499 MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET $ $ 59.00 59.00 63739035510 J8499 MIRTAZAPINE 15 MG TABLET $ $ 59.00 59.00 63739044610 J8499 POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED $ $ RELEASE(PART/CRYST) 1.00 1.00 63739044710 J8499 POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED $ $ RELEASE(PART/CRYST) 1.00 1.00 63739047810 J8499 DOCUSATE SODIUM 100 MG CAPSULE $ $ 59.00 59.00 63739048610 J8499 HYDROXYZINE HCL 25 MG TABLET $ $ 59.00 59.00 63739049910 J8499 LORAZEPAM 0.5 MG TABLET $ $ 59.00 59.00 63739052210 J3490 ASPIRIN 81 MG TABLET,DELAYED RELEASE $ $ 1.00 1.00 63739053710 J8499 FOLIC ACID 1 MG TABLET $ $ 1.00 1.00 63739054410 J8499 SPIRONOLACTONE 25 MG TABLET $ $ 1.00 1.00 63739055910 J8499 CIPROFLOXACIN 500 MG TABLET $ $ 59.00 59.00 63739056710 J8499 TAMSULOSIN 0.4 MG CAPSULE $ $ 59.00 59.00 63739057210 J8499 SIMVASTATIN 20 MG TABLET $ $ 1.00 1.00

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63739064510 J8499 FAMOTIDINE 20 MG TABLET $ $ 1.00 1.00 63739067110 J8499 TRAMADOL 50 MG TABLET $ $ 59.00 59.00 63739067210 J8499 IBUPROFEN 400 MG TABLET $ $ 59.00 59.00 63739068410 J8499 IBUPROFEN 600 MG TABLET $ $ 59.00 59.00 63739069110 J8499 IBUPROFEN 800 MG TABLET $ $ 59.00 59.00 63739070410 J8499 HYDROCODONE 5 MG‐ACETAMINOPHEN 325 MG TABLET $ $ 60.65 60.65 63739094310 J8499 SUCRALFATE 1 GRAM TABLET $ $ 1.00 1.00 63807060051 J1642 HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE $ $ 138.00 138.00 63807060055 J1642 HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE $ $ 138.00 138.00 63824000815 J3490 GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR $ $ 59.00 59.00 63824005632 J3490 DEXTROMETHORPHAN‐GUAIFENESIN 30 MG‐600 MG TABLET $ $ EXTENDED RELEASE12 HR 59.00 59.00 63833038602 C9132 PROTHROMBIN COMPLEX CONCENTRATE (HUMAN) $ $ 35,887.44 35,887.44 63833038702 C9132 PROTHROMBIN COMPLEX CONCENTRATE (HUMAN) $ $ 70,238.60 70,238.60 63851050102 90675 RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT $ $ IM SUSP 13,719.31 13,719.31 64193042302 ANTI‐INHIBITOR COAGULANT CMPLX (HUMAN) 1 UNIT IV SOLR $ $ 48,983.60 48,983.60 64193042402 J7198 ANTI‐INHIBITOR COAGULANT CMPLX (HUMAN) 1 UNIT IV SOLR $ $ 66,722.45 66,722.45 64193042502 J7198 ANTI‐INHIBITOR COAGULANT CMPLX (HUMAN) 1 UNIT IV SOLR $ $ 178,971.10 178,971.10

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64281010000 J7674 METHACHOLINE CHLORIDE 100 MG SOLUTION FOR INHALATION $ $ 2,704.42 2,704.42 64376013699 J8499 LEVETIRACETAM 250 MG TABLET $ $ 59.00 59.00 64380072306 J8499 CALCITRIOL 0.25 MCG CAPSULE $ $ 1.00 1.00 64406000801 J2323 NATALIZUMAB 300 MG/15 ML INTRAVENOUS SOLUTION $ $ 35,881.35 35,881.35 64679005601 J2543 PIPERACILLIN‐TAZOBACTAM 3.375 GRAM INTRAVENOUS $ $ SOLUTION 302.00 302.00 64679005602 J2543 PIPERACILLIN‐TAZOBACTAM 3.375 GRAM INTRAVENOUS $ $ SOLUTION 302.00 302.00 64679072808 J3030 SUMATRIPTAN 6 MG/0.5 ML SUBCUTANEOUS SOLUTION $ $ 245.19 245.19 64679092402 J8499 ENALAPRIL MALEATE 5 MG TABLET $ $ 1.00 1.00 64679092602 J8499 ENALAPRIL MALEATE 20 MG TABLET $ $ 1.00 1.00 64764011907 J8499 COLCHICINE 0.6 MG TABLET $ $ 9.17 9.17 64764024060 J3490 LUBIPROSTONE 24 MCG CAPSULE $ $ 299.31 299.31 64764030020 J3380 VEDOLIZUMAB 300 MG INTRAVENOUS SOLUTION $ $ 152,079.00 152,079.00 64764091830 J8499 FEBUXOSTAT 40 MG TABLET $ $ 475.16 475.16 64896066401 J3490 CARBIDOPA ER 61.25 MG‐LEVODOPA 245 MG $ $ CAPSULE,EXTENDED RELEASE 236.13 236.13 64980025901 J3490 GLYCOPYRROLATE 2 MG TABLET $ $ 59.00 59.00 64980030130 J3490 HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL $ $ APPLICATOR 1,900.60 1,900.60 64980032430 J3490 HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL $ $ APPLICATOR 567.67 567.67

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64980033990 J8499 MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET $ $ 59.00 59.00 64980051401 J3490 TIMOLOL MALEATE 0.5 % EYE DROPS $ $ 495.01 495.01 64980051405 J3490 TIMOLOL MALEATE 0.5 % EYE DROPS $ $ 338.13 338.13 64980051505 J3490 OFLOXACIN 0.3 % EYE DROPS $ $ 409.18 409.18 65162018810 J8499 NAPROXEN 250 MG TABLET $ $ 59.00 59.00 65162018910 J8499 NAPROXEN 375 MG TABLET $ $ 59.00 59.00 65162064110 J8499 FLECAINIDE 50 MG TABLET $ $ 1.00 1.00 65162064210 J8499 FLECAINIDE 100 MG TABLET $ $ 1.00 1.00 65162067384 J8499 RISPERIDONE 1 MG/ML ORAL SOLUTION $ $ 371.63 371.63 65162074510 J8597 PROMETHAZINE 12.5 MG TABLET $ $ 59.00 59.00 65162077810 J8499 BUDESONIDE DR ‐ ER 3 MG CAPSULE,DELAYED,EXTENDED $ $ RELEASE 139.69 139.69 65162089703 J8499 ARIPIPRAZOLE 5 MG TABLET $ $ 1.00 1.00 65162089903 J8499 ARIPIPRAZOLE 15 MG TABLET $ $ 1.00 1.00 65162090103 J3490 ARIPIPRAZOLE 20 MG TABLET $ $ 1.00 1.00 65197000201 J8499 TRIAMTERENE 50 MG CAPSULE $ $ 416.93 416.93 65250026620 C9290 BUPIVACAINE LIPOSOME(PF) 1.3 %(13.3 MG/ML) SUSPENSION $ $ FOR INFILTRATION 12,951.65 12,951.65 65293000511 C9248 CLEVIDIPINE 50 MG/100 ML INTRAVENOUS EMULSION $ $ 5,129.08 5,129.08

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65597010330 J8499 OLMESARTAN 20 MG TABLET $ $ 9.63 9.63 65597020330 J8499 EDOXABAN 60 MG TABLET $ $ 363.45 363.45 65597070118 J8499 COLESEVELAM 625 MG TABLET $ $ 4.80 4.80 65628020605 J8499 VANCOMYCIN 50 MG/ML ORAL SOLUTION $ $ 5,416.64 5,416.64 65649030303 J8499 RIFAXIMIN 550 MG TABLET $ $ 1,704.99 1,704.99 65649055102 J2212 METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SOLUTION $ $ 4,357.66 4,357.66 65649055103 J2212 METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SYRINGE $ $ 4,358.07 4,358.07 65649055107 J2212 METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SYRINGE $ $ 4,357.66 4,357.66 65862002106 J8499 MIRTAZAPINE 15 MG DISINTEGRATING TABLET $ $ 1.00 1.00 65862004824 J8499 ZIDOVUDINE 10 MG/ML ORAL SYRUP $ $ 977.25 977.25 65862014736 J8499 SUMATRIPTAN 50 MG TABLET $ $ 59.00 59.00 65862017760 J8499 CEFDINIR 300 MG CAPSULE $ $ 59.00 59.00 65862020190 J8499 LOSARTAN 25 MG TABLET $ $ 1.00 1.00 65862020290 J8499 LOSARTAN 50 MG TABLET $ $ 1.00 1.00 65862047401 J3490 RAMIPRIL 1.25 MG CAPSULE $ $ 1.00 1.00 65862047501 J8499 RAMIPRIL 2.5 MG CAPSULE $ $ 59.00 59.00 65862047701 J8499 RAMIPRIL 10 MG CAPSULE $ $ 59.00 59.00

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65862049647 J8499 SULFAMETHOXAZOLE 200 MG‐TRIMETHOPRIM 40 MG/5 ML ORAL $ $ SUSPENSION 2,171.45 2,171.45 65862052730 J8499 VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR $ $ 59.00 59.00 65862052890 J8499 VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR $ $ 59.00 59.00 65862053502 J8499 AMOXICILLIN 600 MG‐POTASSIUM CLAVULANATE 42.9 MG/5 ML $ $ ORAL SUSPENSION 590.82 590.82 65862055260 J8499 LAMIVUDINE 150 MG TABLET $ $ 200.27 200.27 65862057030 J8499 VALSARTAN 40 MG TABLET $ $ 1.00 1.00 65862069960 J8499 CEFUROXIME AXETIL 250 MG TABLET $ $ 2.17 2.17 66553000101 J8499 ASPIRIN 325 MG TABLET $ $ 1.00 1.00 66553000201 J8499 ASPIRIN 81 MG CHEWABLE TABLET $ $ 59.00 59.00 66553000401 J8499 CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE $ $ TABLET 1.00 1.00 66582041431 J8499 EZETIMIBE 10 MG TABLET $ $ 496.64 496.64 66685100101 J8499 AMOXICILLIN 875 MG‐POTASSIUM CLAVULANATE 125 MG TABLET $ $ 76.82 76.82 66685100200 J8499 AMOXICILLIN 500 MG‐POTASSIUM CLAVULANATE 125 MG TABLET $ $ 76.55 76.55 66689002001 J8499 MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION $ $ 193.57 193.57 66689002301 J3490 HYDROCODONE 7.5 MG‐ACETAMINOPHEN 325 MG/15 ML ORAL $ $ SOLUTION 203.81 203.81 66689002530 J8499 OXYCODONE 20 MG/ML ORAL CONCENTRATE $ $ 4,751.56 4,751.56 66689003601 J3490 PHENYTOIN 100 MG/4 ML ORAL SUSPENSION $ $ 182.36 182.36

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66689003701 J8499 NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION $ $ 59.00 59.00 66689004701 J8499 POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID $ $ 391.02 391.02 66689069479 J8499 METHADONE 10 MG/ML ORAL CONCENTRATE $ $ 2,605.47 2,605.47 66733094823 J9055 CETUXIMAB 100 MG/50 ML INTRAVENOUS SOLUTION $ $ 3,368.81 3,368.81 66733095823 J9055 CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION $ $ 6,737.61 6,737.61 66758011006 J3490 POTASSIUM CHLORIDE ER 8 MEQ TABLET,EXTENDED RELEASE $ $ 1.00 1.00 66758014094 J8499 POTASSIUM BICARBONATE‐CITRIC ACID 25 MEQ EFFERVESCENT $ $ TABLET 79.22 79.22 66758017006 J8499 POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED $ $ RELEASE(PART/CRYST) 1.00 1.00 66758017013 J8499 POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED $ $ RELEASE(PART/CRYST) 1.00 1.00 66758019006 J8499 POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED $ $ RELEASE(PART/CRYST) 1.00 1.00 66794064902 J3490 LEVOTHYROXINE 100 MCG INTRAVENOUS POWDER FOR $ $ SOLUTION 2,904.58 2,904.58 66993005702 J8499 HYDROXYCHLOROQUINE 200 MG TABLET $ $ 1.59 1.59 66993066130 J8499 RALOXIFENE 60 MG TABLET $ $ 1.00 1.00 66993089845 J3490 CLOTRIMAZOLE‐BETAMETHASONE 1 %‐0.05 % TOPICAL CREAM $ $ 2,019.16 2,019.16 67066000501 J2850 SECRETIN (HUMAN) 16 MCG INTRAVENOUS SOLUTION $ $ 20,958.00 20,958.00 67253014847 J8499 AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION $ $ 281.44 281.44 67253018010 J8499 AMPICILLIN 250 MG CAPSULE $ $ 59.00 59.00

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67253018110 J8499 AMPICILLIN 500 MG CAPSULE $ $ 59.00 59.00 67253090010 J8499 ALPRAZOLAM 0.25 MG TABLET $ $ 59.00 59.00 67405060203 J8499 FLUCONAZOLE 100 MG TABLET $ $ 59.00 59.00 67457012410 J1200 DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION $ $ 298.21 298.21 67457015300 J0282 AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION $ $ 306.67 306.67 67457017750 J1212 DIMETHYL SULFOXIDE 50 % INTRAVESICAL SOLUTION $ $ 3,553.90 3,553.90 67457018200 J3490 ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SOLUTION $ $ 397.37 397.37 67457019015 J3490 EDROPHONIUM CHLORIDE 10 MG/ML INJECTION SOLUTION $ $ 2,328.74 2,328.74 67457019803 J3490 REMIFENTANIL 1 MG INTRAVENOUS SOLUTION $ $ 2,242.55 2,242.55 67457020850 J1190 DEXRAZOXANE HCL 500 MG INTRAVENOUS SOLUTION $ $ 2,262.64 2,262.64 67457021102 J1451 FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION $ $ 37,370.89 37,370.89 67457021202 J0883 ARGATROBAN 100 MG/ML INTRAVENOUS SOLUTION $ $ 7,176.58 7,176.58 67457022800 J3490 ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION $ $ 241.92 241.92 67457022805 J3490 ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION $ $ 241.92 241.92 67457025500 J1953 LEVETIRACETAM 500 MG/100 ML IN SODIUM CHLORIDE (ISO‐ $ $ OSM) IV PIGGYBACK 709.94 709.94 67457025510 J1953 LEVETIRACETAM 500 MG/100 ML IN SODIUM CHLORIDE (ISO‐ $ $ OSM) IV PIGGYBACK 709.94 709.94 67457026510 J1953 LEVETIRACETAM 1,000 MG/100 ML IN SODIUM CHLORIDE(ISO‐ $ $ OSM) IV PIGGYBACK 1,041.28 1,041.28

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67457029200 J2310 NALOXONE 0.4 MG/ML INJECTION SOLUTION $ $ 627.55 627.55 67457029202 J2310 NALOXONE 0.4 MG/ML INJECTION SOLUTION $ $ 627.55 627.55 67457034105 J3370 VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION $ $ 4,438.87 4,438.87 67457042600 J1630 HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 67457047300 J3260 TOBRAMYCIN 40 MG/ML INJECTION SOLUTION $ $ 302.00 302.00 67457047500 J3490 VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION $ $ 326.91 326.91 67457052237 J2543 PIPERACILLIN‐TAZOBACTAM 3.375 GRAM INTRAVENOUS $ $ SOLUTION 732.74 732.74 67457058200 J1652 FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION $ $ SYRINGE 438.93 438.93 67457060202 J1644 HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION $ $ 150.86 150.86 67457061910 J3489 ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %‐WATER $ $ INTRAVENOUS PIGGYBCK 469.92 469.92 67457064000 J0780 PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) $ $ INJECTION SOLUTION 236.33 236.33 67457067502 J0630 CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION $ $ 101,960.87 101,960.87 67457081350 J0878 DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION $ $ 3,824.50 3,824.50 67457086301 J1626 GRANISETRON (PF) 1 MG/ML (1 ML) INTRAVENOUS SOLUTION $ $ 798.01 798.01 67871479006 J1430 ETHANOLAMINE OLEATE 5 % INTRAVENOUS SOLUTION $ $ 16,125.93 16,125.93 67877012450 J3490 SILVER SULFADIAZINE 1 % TOPICAL CREAM $ $ 281.44 281.44 67877025001 J8499 QUETIAPINE 100 MG TABLET $ $ 59.00 59.00

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67877025115 J3490 TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM $ $ 59.00 59.00 67877025180 J3490 TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM $ $ 169.27 169.27 67877032101 J8499 IBUPROFEN 800 MG TABLET $ $ 59.00 59.00 67877044630 J8499 OLMESARTAN 20 MG TABLET $ $ 1.00 1.00 67877056860 J8597 DRONABINOL 2.5 MG CAPSULE $ $ 1.96 1.96 67877057301 J8499 BENZONATATE 100 MG CAPSULE $ $ 1.00 1.00 67919001101 J0878 DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION $ $ 16,982.93 16,982.93 67919002010 J8499 ALVIMOPAN 12 MG CAPSULE $ $ 7,546.27 7,546.27 68084003211 J8499 NORTRIPTYLINE 25 MG CAPSULE $ $ 1.00 1.00 68084004411 J8499 PAROXETINE 10 MG TABLET $ $ 1.00 1.00 68084005211 J8499 DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR $ $ 1.00 1.00 68084005411 J8499 DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR $ $ 1.00 1.00 68084005611 J8499 METHOCARBAMOL 500 MG TABLET $ $ 1.00 1.00 68084006911 J8499 CIPROFLOXACIN 250 MG TABLET $ $ 59.00 59.00 68084007011 J8499 CIPROFLOXACIN 500 MG TABLET $ $ 59.00 59.00 68084007211 J8499 METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR $ $ 1.00 1.00 68084009411 J8499 CARBIDOPA 25 MG‐LEVODOPA 250 MG TABLET $ $ 59.00 59.00

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68084009911 J8499 ATORVASTATIN 40 MG TABLET $ $ 59.00 59.00 68084010311 J8499 ZIPRASIDONE 20 MG CAPSULE $ $ 2.98 2.98 68084015411 J8597 PROMETHAZINE 12.5 MG TABLET $ $ 59.00 59.00 68084017511 J8597 DRONABINOL 5 MG CAPSULE $ $ 355.13 355.13 68084018011 J8499 SERTRALINE 25 MG TABLET $ $ 1.00 1.00 68084018911 J8499 ZOLPIDEM 5 MG TABLET $ $ 59.00 59.00 68084019611 J8499 LISINOPRIL 5 MG TABLET $ $ 1.00 1.00 68084020211 J8499 PRIMIDONE 50 MG TABLET $ $ 1.00 1.00 68084020611 J8499 SPIRONOLACTONE 25 MG TABLET $ $ 1.00 1.00 68084024801 J8499 LORATADINE 10 MG TABLET $ $ 59.00 59.00 68084024811 J8499 LORATADINE 10 MG TABLET $ $ 59.00 59.00 68084025311 J8499 HYDROXYZINE HCL 10 MG TABLET $ $ 1.00 1.00 68084026611 J8499 RAMIPRIL 2.5 MG CAPSULE $ $ 59.00 59.00 68084026911 J8499 HYDROXYCHLOROQUINE 200 MG TABLET $ $ 1.88 1.88 68084028211 J8499 CARBIDOPA ER 50 MG‐LEVODOPA 200 MG TABLET,EXTENDED $ $ RELEASE 1.00 1.00 68084029411 J3490 RAMIPRIL 1.25 MG CAPSULE $ $ 1.72 1.72 68084031901 J8499 LAMOTRIGINE 100 MG TABLET $ $ 59.00 59.00

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68084031911 J8499 LAMOTRIGINE 100 MG TABLET $ $ 59.00 59.00 68084032811 J8499 FENOFIBRATE 160 MG TABLET $ $ 141.08 141.08 68084034411 J8499 TOPIRAMATE 100 MG TABLET $ $ 1.00 1.00 68084035411 J8499 OXYCODONE 5 MG TABLET $ $ 59.00 59.00 68084035511 J8499 OXYCODONE‐ACETAMINOPHEN 5 MG‐325 MG TABLET $ $ 59.00 59.00 68084037211 J8499 ACETAMINOPHEN 300 MG‐CODEINE 30 MG TABLET $ $ 59.00 59.00 68084038011 J8499 CARISOPRODOL 350 MG TABLET $ $ 59.00 59.00 68084038811 J8499 BENZTROPINE 1 MG TABLET $ $ 59.00 59.00 68084043098 J8499 POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET $ $ 83.69 83.69 68084043099 J8499 POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET $ $ 83.69 83.69 68084044011 J8499 PRAMIPEXOLE 0.25 MG TABLET $ $ 1.00 1.00 68084044711 J8499 HYDRALAZINE 10 MG TABLET $ $ 1.00 1.00 68084044911 J7507 TACROLIMUS 0.5 MG CAPSULE $ $ 81.94 81.94 68084046111 J8499 ZIDOVUDINE 100 MG CAPSULE $ $ 150.45 150.45 68084046911 J8499 HYDROCORTISONE 10 MG TABLET $ $ 62.53 62.53 68084048301 J8499 LEVOFLOXACIN 750 MG TABLET $ $ 59.00 59.00 68084048711 J8499 BISOPROLOL FUMARATE 5 MG TABLET $ $ 1.29 1.29

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68084049411 J8499 PYRIDOSTIGMINE BROMIDE 60 MG TABLET $ $ 1.30 1.30 68084050011 J8499 PRAVASTATIN 10 MG TABLET $ $ 1.00 1.00 68084050311 J8499 PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE $ $ 2.78 2.78 68084051311 J8499 SIMVASTATIN 40 MG TABLET $ $ 1.00 1.00 68084054111 J8499 ACETAZOLAMIDE 250 MG TABLET $ $ 3.94 3.94 68084057211 J3490 GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR $ $ 79.51 79.51 68084063211 J8499 POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED $ $ RELEASE(PART/CRYST) 1.00 1.00 68084065911 J8499 METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE $ $ 24 HR 1.00 1.00 68084067511 J8499 DULOXETINE 20 MG CAPSULE,DELAYED RELEASE $ $ 1.19 1.19 68084068311 J8499 DULOXETINE 30 MG CAPSULE,DELAYED RELEASE $ $ 1.52 1.52 68084069711 J8499 BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED‐RELEASE $ $ 1.00 1.00 68084070311 J8499 IBUPROFEN 600 MG TABLET $ $ 59.00 59.00 68084076211 J8499 GABAPENTIN 300 MG CAPSULE $ $ 1.00 1.00 68084078311 J8499 GABAPENTIN 100 MG CAPSULE $ $ 1.00 1.00 68084079511 J7517 MYCOPHENOLATE MOFETIL 250 MG CAPSULE $ $ 59.00 59.00 68084086911 J8499 SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET $ $ 59.00 59.00 68084086921 J8499 SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET $ $ 59.00 59.00

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68084087511 J8499 MONTELUKAST 10 MG TABLET $ $ 59.00 59.00 68084089695 J8499 VENLAFAXINE 25 MG TABLET $ $ 59.00 59.00 68084091233 J8499 NIMODIPINE 30 MG CAPSULE $ $ 2.76 2.76 68084096601 J8499 METRONIDAZOLE 500 MG TABLET $ $ 59.00 59.00 68084096611 J8499 METRONIDAZOLE 500 MG TABLET $ $ 59.00 59.00 68084099611 J8499 PRAZOSIN 1 MG CAPSULE $ $ 1.47 1.47 68094001559 J3490 ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION $ $ 80.21 80.21 68094001562 J3490 ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION $ $ 84.83 84.83 68094002259 J3490 DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID $ $ 65.47 65.47 68094017159 J8499 SUCRALFATE 100 MG/ML ORAL SUSPENSION $ $ 353.30 353.30 68094019359 J3490 VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL $ $ SOLUTION 619.96 619.96 68094049459 J3490 IBUPROFEN 100 MG/5 ML ORAL SUSPENSION $ $ 59.00 59.00 68094058759 J3490 ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION $ $ 69.18 69.18 68094058762 J3490 ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION $ $ 76.82 76.82 68094059959 J8499 NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION $ $ 75.05 75.05 68094060059 J3490 IBUPROFEN 100 MG/5 ML ORAL SUSPENSION $ $ 59.00 59.00 68094075159 J3490 DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLUTION $ $ 4.24 4.24

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68094075401 J8499 MORPHINE CONCENTRATE 10 MG/0.5 ML ORAL SYRINGE (FOR $ $ ORAL USE ONLY) 119.32 119.32 68094075759 J8499 LITHIUM CITRATE 8 MEQ/5 ML (5 ML) ORAL SOLUTION $ $ 84.45 84.45 68094080101 J8499 OXYCODONE 10 MG/0.5 ML ORAL SYRINGE (FOR ORAL USE ONLY) $ $ 171.92 171.92 68094085362 J8499 NALTREXONE 50 MG TABLET $ $ 129.19 129.19 68180013415 J8499 CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE $ $ 1.00 1.00 68180018001 J8499 CEFADROXIL 500 MG CAPSULE $ $ 59.00 59.00 68180030260 J8499 CEFUROXIME AXETIL 250 MG TABLET $ $ 1.00 1.00 68180036309 J8499 FENOFIBRATE 160 MG TABLET $ $ 59.00 59.00 68180043501 J3490 GATIFLOXACIN 0.5 % EYE DROPS $ $ 3,773.64 3,773.64 68180051201 J8499 LISINOPRIL 2.5 MG TABLET $ $ 1.00 1.00 68180051301 J8499 LISINOPRIL 5 MG TABLET $ $ 1.00 1.00 68180051501 J8499 LISINOPRIL 20 MG TABLET $ $ 1.00 1.00 68180065208 J3490 DOXYCYCLINE MONOHYDRATE 100 MG CAPSULE $ $ 59.00 59.00 68180065701 J3490 DOXYCYCLINE MONOHYDRATE 25 MG/5 ML ORAL SUSPENSION $ $ 543.72 543.72 68180065806 J8499 RIFAMPIN 150 MG CAPSULE $ $ 59.00 59.00 68180067511 J8499 OSELTAMIVIR 30 MG CAPSULE $ $ 243.82 243.82 68180067711 J8499 OSELTAMIVIR 75 MG CAPSULE $ $ 219.87 219.87

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68180072009 J8499 AMLODIPINE 5 MG TABLET $ $ 1.00 1.00 68180072320 J8499 CEFDINIR 250 MG/5 ML ORAL SUSPENSION $ $ 447.91 447.91 68180098001 J8499 LISINOPRIL 10 MG TABLET $ $ 1.00 1.00 68382005001 J8499 MELOXICAM 7.5 MG TABLET $ $ 1.00 1.00 68382007216 J8499 PRAVASTATIN 40 MG TABLET $ $ 1.00 1.00 68382007901 J8499 HALOPERIDOL 5 MG TABLET $ $ 59.00 59.00 68382009716 J8499 PAROXETINE 10 MG TABLET $ $ 1.00 1.00 68382011414 J8499 RISPERIDONE 1 MG TABLET $ $ 1.00 1.00 68382013814 J8499 TOPIRAMATE 25 MG TABLET $ $ 1.00 1.00 68382018101 J8499 BUSPIRONE 10 MG TABLET $ $ 1.00 1.00 68382019916 J8499 PRAMIPEXOLE 1 MG TABLET $ $ 1.00 1.00 68382030901 J3490 NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH $ $ 59.00 59.00 68382042202 J2780 RANITIDINE 50 MG/2 ML (25 MG/ML) INJECTION SOLUTION $ $ 343.08 343.08 68382054507 J3490 ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION $ $ 310.18 310.18 68382065101 J8499 ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED $ $ RELEASE 24 HR 59.00 59.00 68382070101 J8499 POTASSIUM CHLORIDE ER 10 MEQ CAPSULE,EXTENDED RELEASE $ $ 1.05 1.05 68382086002 J0515 BENZTROPINE 2 MG/2 ML INJECTION SOLUTION $ $ 850.22 850.22

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68382091001 J3490 DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR $ $ SOLUTION 1,143.47 1,143.47 68382099710 J9017 ARSENIC TRIOXIDE 1 MG/ML INTRAVENOUS SOLUTION $ $ 4,068.81 4,068.81 68455010763 J3490 ZINC OXIDE 3" X 10 YARD BANDAGE $ $ 555.84 555.84 68462010230 J8499 FLUCONAZOLE 100 MG TABLET $ $ 59.00 59.00 68462012901 J8499 ZONISAMIDE 50 MG CAPSULE $ $ 59.00 59.00 68462015740 J8499 ONDANSETRON 4 MG DISINTEGRATING TABLET $ $ 59.00 59.00 68462018901 J8499 NAPROXEN 375 MG TABLET $ $ 59.00 59.00 68462019590 J8499 PRAVASTATIN 10 MG TABLET $ $ 1.00 1.00 68462019690 J8499 PRAVASTATIN 20 MG TABLET $ $ 1.00 1.00 68462019790 J8499 PRAVASTATIN 40 MG TABLET $ $ 1.41 1.41 68462020111 J8499 TELMISARTAN 80 MG TABLET $ $ 1.47 1.47 68462029201 J8499 VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE $ $ 1.00 1.00 68462029301 J8499 VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE $ $ 1.00 1.00 68462031435 J3490 NYSTATIN‐TRIAMCINOLONE 100,000 UNIT/G‐0.1 % TOPICAL $ $ CREAM 633.54 633.54 68462033190 J8499 PRAMIPEXOLE 0.25 MG TABLET $ $ 1.00 1.00 68462033390 J8499 PRAMIPEXOLE 1 MG TABLET $ $ 1.00 1.00 68462035701 J8499 POTASSIUM CHLORIDE ER 10 MEQ CAPSULE,EXTENDED RELEASE $ $ 1.00 1.00

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68516320202 J7194 FACTOR IX COMPLEX (HUMAN) 1 UNIT IV SOLR $ $ 61,304.51 61,304.51 68516521402 P9045 ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION $ $ 3,852.28 3,852.28 68516521404 P9045 ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION $ $ 3,852.28 3,852.28 68516521601 P9047 ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION $ $ 1,928.14 1,928.14 68516521603 P9047 ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION $ $ 1,928.14 1,928.14 68546022956 J8499 RASAGILINE 1 MG TABLET $ $ 1,126.57 1,126.57 68585000575 J3490 MAGNESIUM 64 MG (MAGNESIUM CHLORIDE) TABLET,DELAYED $ $ RELEASE 59.00 59.00 68585000698 J8499 MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET $ $ 59.00 59.00 68817013450 J9264 PACLITAXEL‐PROTEIN BOUND 100 MG INTRAVENOUS $ $ SUSPENSION 7,282.10 7,282.10 68850001201 J8499 ETHAMBUTOL 400 MG TABLET $ $ 59.00 59.00 68982084003 J1568 IMMUNE GLOB,GAMM(IGG) 5 %‐MALT‐IGA OVER 50 MCG/ML $ $ INTRAVENOUS SOLUTION 2,113.80 2,113.80 68982084004 J1568 IMMUNE GLOB,GAMM(IGG) 5 %‐MALT‐IGA OVER 50 MCG/ML $ $ INTRAVENOUS SOLUTION 3,972.86 3,972.86 68982085003 J1568 IMMUNE GLOB,GAMM(IGG)10 %‐MALT‐IGA OVER 50 MCG/ML $ $ INTRAVENOUS SOLUTION 4,092.10 4,092.10 68982085004 J1568 IMMUNE GLOB,GAMM(IGG)10 %‐MALT‐IGA OVER 50 MCG/ML $ $ INTRAVENOUS SOLUTION 29,136.84 29,136.84 69097015807 J8499 MELOXICAM 7.5 MG TABLET $ $ 1.00 1.00 69097042107 J8499 CELECOXIB 200 MG CAPSULE $ $ 59.00 59.00 69097042207 J8499 CELECOXIB 100 MG CAPSULE $ $ 59.00 59.00

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69097084607 J8499 CYCLOBENZAPRINE 10 MG TABLET $ $ 59.00 59.00 69097085605 J8499 FOSINOPRIL 10 MG TABLET $ $ 1.00 1.00 69097094605 J8499 ATORVASTATIN 40 MG TABLET $ $ 59.00 59.00 69238115409 J8499 EZETIMIBE 10 MG TABLET $ $ 59.00 59.00 69238148401 J8499 ERYTHROMYCIN 250 MG TABLET $ $ 321.53 321.53 69238149001 J8499 BUMETANIDE 1 MG TABLET $ $ 1.00 1.00 69315011601 J8499 FUROSEMIDE 20 MG TABLET $ $ 1.00 1.00 69315090401 J8499 LORAZEPAM 0.5 MG TABLET $ $ 59.00 59.00 69339013815 J3490 CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH $ $ 124.57 124.57 69536002515 J3490 PHENYLEPHRINE 0.25 % NASAL SPRAY $ $ 159.29 159.29 69536005015 J3490 PHENYLEPHRINE 0.5 % NASAL SPRAY $ $ 159.29 159.29 69536010015 J3490 PHENYLEPHRINE 1 % NASAL SPRAY $ $ 179.05 179.05 69547035302 J3490 NALOXONE 4 MG/ACTUATION NASAL SPRAY $ $ 2,357.48 2,357.48 69740032400 A6250 ZINC OXIDE 30.6 % TOPICAL CREAM $ $ 525.19 525.19 69918089901 J2597 DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION $ $ 1,682.79 1,682.79 69918090110 J2597 DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION $ $ 15,416.07 15,416.07 70003030065 J3490 NITROGLYCERIN 400 MCG/SPRAY TRANSLINGUAL $ $ 6,703.30 6,703.30

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70004008346 J2590 OXYTOCIN IN LACTATED RINGERS 20 UNIT/1,000 ML $ $ INTRAVENOUS SOLUTION 658.04 658.04 70004008446 J7999 OXYTOCIN 20 UNIT/1000 ML IN 0.9 % SODIUM CHLORIDE $ $ INTRAVENOUS 658.04 658.04 70004008544 J7999 OXYTOCIN 30 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE $ $ INTRAVENOUS 658.04 658.04 70004010022 J7999 MORPHINE 50 MG/50 ML (1 MG/ML) IN 0.9 % SODIUM CHLORIDE $ $ IV PCA SYRINGE 480.40 480.40 70004020232 J3010 FENTANYL (PF) 10 MCG/ML IN 0.9 % SODIUM CHLORIDE $ $ INTRAVENOUS 598.16 598.16 70004020240 J3010 FENTANYL (PF) 10 MCG/ML IN 250 ML 0.9 % SODIUM CHLORIDE $ $ 977.40 977.40 70004022932 J3010 FENTANYL (PF) 10 MCG/ML IN 0.9 % SODIUM CHLORIDE $ $ INTRAVENOUS 1,512.33 1,512.33 70004023140 J3490 FENTANYL (PF) 2 MCG/ML‐BUPIVACAINE 0.125 %‐NACL INJECTION $ $ SOLUTION 1,326.70 1,326.70 70004030022 J7999 HYDROMORPHONE (PF) 10 MG/50 ML (0.2 MG/ML) IN 0.9% NACL $ $ IV PCA SYRINGE 518.32 518.32 70004030023 J7999 HYDROMORPHONE 11 MG/55 ML IN 0.9 % SODIUM CHLORIDE $ $ PCA SYRINGE 526.31 526.31 70004041132 J7999 MIDAZOLAM 1 MG/ML IN 0.9 % SODIUM CHLORIDE $ $ INTRAVENOUS 1,133.09 1,133.09 70004041159 J7999 MIDAZOLAM 1 MG/ML IN 0.9 % SODIUM CHLORIDE $ $ INTRAVENOUS 1,101.16 1,101.16 70004043009 J7999 KETAMINE 50 MG/5 ML (10 MG/ML) IN 0.9 % SODIUM CHLORIDE $ $ IV SYRINGE 179.64 179.64 70004060009 J3490 EPHEDRINE (PF) 25 MG/5 ML (5 MG/ML) IN 0.9% SODIUM $ $ CHLORIDE IV SYRINGE 381.24 381.24 70004064009 J3490 GLYCOPYRROLATE 1 MG/5 ML (0.2 MG/ML) IN STERILE WATER IV $ $ SYRINGE 315.37 315.37 70004076129 J3490 NITROGLYCERIN 1000 MCG/10 ML (100 MCG/ML) IN 5 % $ $ DEXTROSE INTRAVENOUS ‐ TEMPORARY ENTRY 207.59 207.59 70004077140 J7999 NOREPINEPHRINE BITARTRATE 4 MG/250 ML (16 MCG/ML) IN 0.9 $ $ % NACL IV 1,127.10 1,127.10

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70004081011 J7999 PHENYLEPHRINE 0.5 MG/5 ML (100 MCG/ML)IN 0.9 % $ $ SOD.CHLORIDE IV SYRINGE 157.69 157.69 70004082359 J3370 VANCOMYCIN 1.25 GRAM/250 ML IN 0.9 % SODIUM CHLORIDE $ $ INTRAVENOUS 901.56 901.56 70004092059 J3370 VANCOMYCIN 1 GRAM/250 ML IN 0.9 % SODIUM CHLORIDE $ $ INTRAVENOUS 801.76 801.76 70004092359 J3370 VANCOMYCIN 1.25 GRAM/250 ML IN 0.9 % SODIUM CHLORIDE $ $ INTRAVENOUS 947.46 947.46 70004092444 J7999 VANCOMYCIN 1.5 GRAM/500 ML IN 0.9 % SODIUM CHLORIDE $ $ INTRAVENOUS SOLN 1,025.31 1,025.31 70004092644 J3370 VANCOMYCIN 1.75 GRAM/500 ML IN 0.9 % SODIUM CHLORIDE $ $ INTRAVENOUS 1,173.01 1,173.01 70004092844 J7999 VANCOMYCIN 2 GRAM/500 ML IN 0.9 % SODIUM CHLORIDE $ $ INTRAVENOUS (IVPB) 1,212.93 1,212.93 70004092940 J3370 VANCOMYCIN 750 MG/250 ML IN 0.9 % SODIUM CHLORIDE $ $ INTRAVENOUS SOLUTION 697.96 697.96 70004093132 J7999 VASOPRESSIN 40 UNIT/100 ML (0.4 UNIT/ML) IN 0.9 % SODIUM $ $ CHLORIDE IV 14,128.65 14,128.65 70010075401 J8499 METHOCARBAMOL 500 MG TABLET $ $ 1.00 1.00 70069002101 J1100 DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML $ $ INJECTION SOLUTION 208.79 208.79 70069013101 J3490 TOBRAMYCIN 0.3 % EYE DROPS $ $ 587.63 587.63 70092101550 J3490 SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS $ $ SYRINGE 618.76 618.76 70092105305 J3370 VANCOMYCIN 1 GRAM/250 ML IN 0.9 % SODIUM CHLORIDE $ $ INTRAVENOUS 687.98 687.98 70092105405 J3370 VANCOMYCIN 1.25 GRAM/250 ML IN 0.9 % SODIUM CHLORIDE $ $ INTRAVENOUS 658.04 658.04 70092105605 J7999 VANCOMYCIN 1.5 GRAM/250 ML IN 0.9 % SODIUM CHLORIDE $ $ INTRAVENOUS 807.74 807.74 70092106708 J7999 OXYTOCIN 20 UNIT/1000 ML IN 0.9 % SODIUM CHLORIDE $ $ INTRAVENOUS 658.04 658.04

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70092106807 J7999 OXYTOCIN 30 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE $ $ INTRAVENOUS 678.00 678.00 70092110537 J3490 FENTANYL (PF) 2 MCG/ML‐BUPIVACAINE 0.125 %‐NACL INJECTION $ $ SOLUTION 1,186.98 1,186.98 70092113544 J3490 LIDOCAINE 4 %‐RACEPINEPHRINE 0.05 %‐TETRACAINE 0.5 % $ $ TOPICAL GEL 546.74 546.74 70092118944 J7999 NEOSTIGMINE METHYLSULFATE 5 MG/5 ML (1 MG/ML) $ $ INTRAVENOUS SYRINGE 1,243.91 1,243.91 70092123847 J7999 CEFAZOLIN 2 GRAM/20 ML IN STERILE WATER INTRAVENOUS $ $ SYRINGE 511.14 511.14 70092143350 J7999 ROPIV 2.46‐EPI 0.005‐CLONID 0.0008‐KETOROL 0.3 MG/ML $ $ PERIARTICULR SYRG 1,560.24 1,560.24 70092145244 J3490 ROCURONIUM 50 MG/5 ML (10 MG/ML) INTRAVENOUS SYRINGE $ $ 443.12 443.12 70092147903 J7999 POTASS.CHLOR 10 MEQ‐LIDOCAINE 10 MG/100 ML IN 0.9 % $ $ SODCH IV PIGGYBACK 582.20 582.20 70092152350 J7999 MORPHINE (PF) 50 MG/50 ML(1 MG/ML) IN 0.9% SOD.CHLORIDE $ $ IV PCA SYRINGE 460.44 460.44 70092903305 J7999 NOREPINEPHRINE BITARTRATE 4 MG/250 ML (16 MCG/ML) IN 0.9 $ $ % NACL IV 1,137.08 1,137.08 70114010101 Q5111 PEGFILGRASTIM‐CBQV 6 MG/0.6 ML SUBCUTANEOUS SYRINGE $ $ 21,180.28 21,180.28 70121145401 J2185 MEROPENEM 500 MG INTRAVENOUS SOLUTION $ $ 418.49 418.49 70324005201 J7999 EPINEPHRINE HCL 5 MG/250 ML (20 MCG/ML) IN 0.9% SODIUM $ $ CHLORIDE (TEMPORARY ENTRY) 1,376.60 1,376.60 70324032603 J3490 SODIUM BICARBONATE 150 MEQ/1,000 ML IN DEXTROSE 5 % $ $ INTRAVENOUS 1,216.92 1,216.92 70324067601 J7999 NOREPINEPHRINE BITARTRATE 8 MG/250 ML (32 MCG/ML) IN 0.9 $ $ % NACL IV 334.00 334.00 70324070101 J7999 PHENYLEPHRINE 20 MG/250 ML (80 MCG/ML) IN 0.9 % SODIUM $ $ CHLORIDE IV 847.66 847.66 70324092601 J7999 NOREPINEPHRINE BITARTRATE 16 MG/250 ML (64 MCG/ML) IN $ $ 0.9 % NACL IV 1,935.48 1,935.48

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70436005106 J8499 CILOSTAZOL 100 MG TABLET $ $ 1.00 1.00 70594004301 J3370 VANCOMYCIN 1.5 GRAM/300 ML‐WATER FOR INJECTION $ $ (PEG,NADA) IV PIGGYBACK 1,113.13 1,113.13 70710147801 J1451 FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION $ $ 32,370.49 32,370.49 70720095036 J9202 GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT $ $ 24,852.20 24,852.20 70860010010 J0456 AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION $ $ 307.95 307.95 70860010041 J0456 AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION $ $ 307.95 307.95 70860010610 J0637 CASPOFUNGIN 50 MG INTRAVENOUS SOLUTION $ $ 2,975.00 2,975.00 70860010710 J0637 CASPOFUNGIN 70 MG INTRAVENOUS SOLUTION $ $ 8,365.40 8,365.40 70860011999 J3490 NAFCILLIN 10 GRAM SOLUTION FOR INJECTION $ $ 2,007.74 2,007.74 70860030005 J3490 METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION $ $ 138.00 138.00 70860030041 J3490 METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION $ $ 138.00 138.00 70860045110 J3490 LEVOTHYROXINE 100 MCG INTRAVENOUS POWDER FOR $ $ SOLUTION 3,513.36 3,513.36 70860070001 J1885 KETOROLAC 15 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 70860070041 J1885 KETOROLAC 15 MG/ML INJECTION SOLUTION $ $ 138.00 138.00 70860070101 J1885 KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION $ $ 138.00 138.00 70860077602 J2405 ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION $ $ 138.00 138.00 71019000601 J7999 AMIODARONE 150 MG/100 ML (1.5 MG/ML) IN DEXTROSE 5 % $ $ INTRAVENOUS SOLN 661.64 661.64

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71019000701 J7999 AMIODARONE 450 MG/250 ML (1.8 MG/ML) IN DEXTROSE 5 % $ $ INTRAVENOUS SOLN 1,248.46 1,248.46 71019005501 J7999 DILTIAZEM 125 MG/125 ML (1 MG/ML) IN DEXTROSE 5 % IV $ $ 1,000.56 1,000.56 71019009201 J7999 FUROSEMIDE 100 MG/100 ML (1 MG/ML) IN 0.9 % SOD CHLORIDE $ $ IV PIGGYBACK 1,674.01 1,674.01 71019009601 J7999 CALCIUM GLUCONATE 1 GRAM/50 ML IN DEXTROSE 5% IV $ $ 670.02 670.02 71019017316 J3490 LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE $ $ 177.65 177.65 71019020801 J3490 NICARDIPINE 40 MG/200 ML IN SODIUM CHLORIDE(ISO) $ $ INTRAVENOUS PIGGYBACK 7,392.95 7,392.95 71019030704 J3490 POTASSIUM PHOSPHATE 15 MMOL/250 ML IN 0.9 % SODIUM $ $ CHLORIDE IV SOLN 501.56 501.56 71019031001 J7999 POTASSIUM PHOSPHATE 22 MMOL/500 ML IN 0.9 % SODIUM $ $ CHLORIDE IV SOLN 458.44 458.44 71019031601 J7999 POTASSIUM PHOSPHATE 7.5 MMOL/100 ML IN 0.9 % SODIUM $ $ CHLORIDE IV SOLN 302.00 302.00 71019033201 J7999 SODIUM CITRATE 4 % (3 ML) INTRA‐CATHETER INJECTION $ $ SYRINGE 138.00 138.00 71019033402 J7999 SODIUM PHOSPHATE 15 MMOL/250 ML IN 0.9 % SODIUM $ $ CHLORIDE IV SOLUTION 990.98 990.98 71019033701 SODIUM PHOSPHATE 30 MMOL/250 ML IN 0.9 % SODIUM $ $ CHLORIDE IV SOLUTION 1,444.87 1,444.87 71019033901 J7999 SODIUM PHOSPHATE 7.5 MMOL/100 ML IN 0.9 % SODIUM $ $ CHLORIDE IV SOLUTION 657.65 657.65 71019034804 J3370 VANCOMYCIN 1 GRAM/250 ML IN 0.9 % SODIUM CHLORIDE $ $ INTRAVENOUS 700.36 700.36 71019034902 J7999 VANCOMYCIN 1 GRAM/250 ML IN DEXTROSE 5 % INTRAVENOUS $ $ 707.94 707.94 71019035005 J3370 VANCOMYCIN 1.25 GRAM/250 ML IN 0.9 % SODIUM CHLORIDE $ $ INTRAVENOUS 743.47 743.47 71019035102 J3370 VANCOMYCIN 1.25 GRAM/250 ML IN DEXTROSE 5 % $ $ INTRAVENOUS 747.86 747.86

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71019035208 J7999 VANCOMYCIN 1.5 GRAM/500 ML IN 0.9 % SODIUM CHLORIDE $ $ INTRAVENOUS SOLN 980.20 980.20 71019035404 J3370 VANCOMYCIN 1.75 GRAM/500 ML IN 0.9 % SODIUM CHLORIDE $ $ INTRAVENOUS 1,035.69 1,035.69 71019035603 J7999 VANCOMYCIN 2 GRAM/500 ML IN 0.9 % SODIUM CHLORIDE $ $ INTRAVENOUS (IVPB) 1,062.43 1,062.43 71019036003 J3370 VANCOMYCIN 750 MG/250 ML IN 0.9 % SODIUM CHLORIDE $ $ INTRAVENOUS SOLUTION 655.65 655.65 71019036401 J7999 VASOPRESSIN 40 UNIT/100 ML (0.4 UNIT/ML) IN 0.9 % SODIUM $ $ CHLORIDE IV 8,250.83 8,250.83 71225012603 J3490 DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % $ $ SODIUM CHLORIDE IV 2,395.20 2,395.20 71225012606 J3490 DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % $ $ SODIUM CHLORIDE IV 2,395.20 2,395.20 72266010201 J3490 LABETALOL 5 MG/ML INTRAVENOUS SOLUTION $ $ 297.01 297.01 74300008186 J3490 METHYL SALICYLATE 15 %‐MENTHOL 10 % TOPICAL CREAM $ $ 168.39 168.39 74312001140 J8499 CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET $ $ 1.00 1.00 75826011410 J8499 PHENAZOPYRIDINE 100 MG TABLET $ $ 59.00 59.00 75826011510 J8499 PHENAZOPYRIDINE 200 MG TABLET $ $ 59.00 59.00 76014000333 J2710 NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS $ $ SOLUTION 679.04 679.04 76014000425 J2370 PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION $ $ 314.81 314.81 76014000430 J2370 PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION $ $ 314.81 314.81 76014000525 C9399 EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION $ $ 414.93 414.93 76014000530 C9399 EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION $ $ 414.93 414.93

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76045010210 J1200 DIPHENHYDRAMINE 50 MG/ML INJECTION SYRINGE $ $ 138.00 138.00 76075010101 J9047 CARFILZOMIB 60 MG INTRAVENOUS SOLUTION $ $ 12,582.16 12,582.16 76075010201 J9047 CARFILZOMIB 30 MG INTRAVENOUS SOLUTION $ $ 6,291.05 6,291.05 76075010301 J9047 CARFILZOMIB 10 MG INTRAVENOUS SOLUTION $ $ 2,097.00 2,097.00 76125015002 90376 RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML INTRAMUSCULAR $ $ SOLUTION 2,601.60 2,601.60 76282025705 J8499 NABUMETONE 500 MG TABLET $ $ 59.00 59.00 76329124001 J3430 PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SYRINGE $ $ 963.95 963.95 76329301305 J3490 LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR $ $ 223.16 223.16 76329330401 J3490 CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE $ $ 322.56 322.56 76329333901 J0461 ATROPINE 0.1 MG/ML INJECTION SYRINGE $ $ 326.55 326.55 76329335201 J3490 SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS $ $ SYRINGE 441.12 441.12 76329339001 J3490 LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE $ $ 184.04 184.04 76329630005 J3490 LIDOCAINE HCL 4 % LARYNGOTRACHEAL SOLUTION $ $ 863.08 863.08 76329826101 J2060 LORAZEPAM 2 MG/ML INJECTION SOLUTION $ $ 487.03 487.03 76439013120 J8499 ALENDRONATE 70 MG TABLET $ $ 1.00 1.00 76439030910 J8499 HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET $ $ 59.00 59.00 76478061102 J0515 BENZTROPINE 2 MG/2 ML INJECTION SOLUTION $ $ 5,569.32 5,569.32

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77333093725 J8499 CYANOCOBALAMIN (VIT B‐12) 500 MCG TABLET $ $ 1.00 1.00 77333094010 J8499 PYRIDOXINE (VITAMIN B6) 50 MG TABLET $ $ 1.00 1.00 77333094025 J8499 PYRIDOXINE (VITAMIN B6) 50 MG TABLET $ $ 1.00 1.00 78112069480 J3490 PHENOL 1.4 % MUCOSAL AEROSOL SPRAY $ $ 88.63 88.63 84389012178 J3490 OCTYL 2‐CYANOACRYLATE TOPICAL TISSUE ADHESIVE $ $ 99.80 99.80 84521000686 J3490 WHITE PETROLATUM TOPICAL OINTMENT IN PACKET $ $ 1.00 1.00 84521076708 A4216 SODIUM CHLORIDE 0.9 % (FLUSH) INJECTION SYRINGE $ $ 138.00 138.00 92670001210 A4216 SODIUM CHLORIDE 0.9 % (FLUSH) INJECTION SYRINGE $ $ 138.00 138.00 92771060002 J3490 WHITE PETROLATUM‐MINERAL OIL TOPICAL CREAM $ $ 117.29 117.29 96295010818 J8499 DOXYLAMINE SUCCINATE 25 MG TABLET $ $ 59.00 59.00 96295011845 J8499 B‐COMPLEX WITH VITAMIN C TABLET $ $ 59.00 59.00 96295013129 J8499 DOXYLAMINE SUCCINATE 25 MG TABLET $ $ 59.00 59.00 96295038243 J8499 MAGNESIUM CITRATE ORAL SOLUTION $ $ 59.00 59.00 99999000334 J3370 VANCOMYCIN ORAL SOLUTION 50 MG/ML $ $ 678.64 678.64 99999000493 J8499 PHENOBARB‐HYOSCY‐ATROPINE‐SCOP 16.2 MG‐0.1037 MG‐ $ $ 0.0194 MG/5 ML ELIXIR 667.14 667.14 99999000515 J3490 CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH $ $ 59.00 59.00 99999000518 J8499 WARFARIN 0.5 MG SPLIT TABLET $ $ 1.00 1.00

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99999000522 J8499 SULFAMETHOXAZOLE 200 MG‐TRIMETHOPRIM 40 MG/5 ML ORAL $ $ SUSPENSION 59.00 59.00 99999000748 J7510 PREDNISOLONE 15 MG/5 ML ORAL SOLUTION $ $ 59.00 59.00 99999001438 J8499 CODEINE 10 MG‐GUAIFENESIN 100 MG/5 ML ORAL LIQUID $ $ 59.00 59.00 99999002815 J8499 PROMETHAZINE 6.25 MG‐CODEINE 10 MG/5 ML SYRUP $ $ 59.00 59.00 99999002817 J8499 DIPHENOXYLATE‐ATROPINE 2.5 MG‐0.025 MG/5 ML ORAL LIQUID $ $ 263.05 263.05 99999002964 J3490 MULTIVIT AND MINERALS‐FERROUS GLUCONATE 9 MG IRON/15 $ $ ML ORAL LIQUID 59.00 59.00 99999002967 PATIENT'S OWN MEDICATION WITH COMPOUNDING FEE $ $ 179.00 179.00 99999002968 J8499 HYDROCODONE 5 MG‐ACETAMINOPHEN 325 MG STARTER PACK $ $ (FOR ED USE) 59.00 59.00 99999002969 J8499 HYDROCODONE 10 MG‐ACETAMINOPHEN 325 MG STARTER PACK $ $ (FOR ED USE) 59.00 59.00 99999002970 J8499 ACETAMINOPHEN 300 MG‐CODEINE 30 MG STARTER PACK (FOR $ $ ED USE) 59.00 59.00 99999003179 J3490 ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION $ $ 302.00 302.00 99999003180 J8499 METHADONE 5 MG/5 ML ORAL SOLUTION $ $ 1.00 1.00 99999003181 J8499 OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL $ $ 151.88 151.88 99999003183 J8499 METHADONE 10 MG/ML ORAL CONCENTRATE $ $ 59.00 59.00 99999003184 ALUMINUM HYDROXIDE GEL 320 MG/5 ML ORAL SUSPENSION $ $ 59.00 59.00 99999003243 J8499 OSELTAMIVIR 6 MG/ML ORAL SUSPENSION $ $ 546.70 546.70 99999003262 J8499 ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION $ $ 126.57 126.57

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99999003271 J8499 CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION $ $ 59.00 59.00 99999003272 J8499 GABAPENTIN 250 MG/5 ML ORAL SOLUTION $ $ 59.00 59.00 99999003332 J8499 SENNOSIDES 8.8 MG/5 ML ORAL SYRUP $ $ 59.00 59.00 99999003417 J8499 RISPERIDONE 1 MG/ML ORAL SOLUTION $ $ 59.00 59.00 99999003531 J7510 PREDNISOLONE SODIUM PHOSPHATE 5 MG BASE/5 ML (6.7 MG/5 $ $ ML) ORAL SOLN 146.42 146.42 99999003731 J8499 HALOPERIDOL LACTATE 2 MG/ML ORAL CONCENTRATE $ $ 59.00 59.00 99999003855 DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLUTION $ $ 6.46 6.46 99999003875 J3490 NORFLURANE‐PENTAFLUOROPROPANE TOPICAL SPRAY (CC) $ $ 1,272.57 1,272.57 99999003876 J8499 VANCOMYCIN 50 MG/ML ORAL SOLUTION $ $ 140.19 140.19 99999003877 J8499 VANCOMYCIN 50 MG/ML ORAL SOLUTION $ $ 245.06 245.06 99999003880 J3490 TRICHLOROACETIC ACID 80 % TOPICAL SOLUTION $ $ 2,326.34 2,326.34

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